Abstract
Background
Washington State served as the initial epicenter of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic in the United States. An understanding of the risk ...factors and clinical outcomes of hospitalized patients with coronavirus disease 2019 (COVID-19) may provide guidance for management.
Methods
All laboratory-confirmed COVID-19 cases in adults admitted to an academic medical center in Seattle, Washington, between 2 March and 26 March 2020 were included. We evaluated individuals with and without severe disease, defined as admission to the intensive care unit or death.
Results
One hundred five COVID-19 patients were hospitalized. Thirty-five percent were admitted from a senior home or skilled nursing facility. The median age was 69 years, and half were women. Three or more comorbidities were present in 55% of patients, with hypertension (59%), obesity (47%), cardiovascular disease (38%), and diabetes (33%) being the most prevalent. Most (63%) had symptoms for ≥5 days prior to admission. Only 39% had fever in the first 24 hours, whereas 41% had hypoxia at admission. Seventy-three percent of patients had lymphopenia. Of 50 samples available for additional testing, no viral coinfections were identified. Severe disease occurred in 49%. Eighteen percent of patients were placed on mechanical ventilation, and the overall mortality rate was 33%.
Conclusions
During the early days of the COVID-19 epidemic in Washington State, the disease had its greatest impact on elderly patients with medical comorbidities. We observed high rates of severe disease and mortality in our hospitalized patients.
In this case series of 105 consecutively hospitalized COVID-19 patients, the median age was 69 years, and 55% had 3 or more comorbidities. Severe disease occurred in 49% of patients, and overall mortality was 33%.
Little is known about contraceptive use among women with bacterial sexually transmitted infections (STIs), despite their high risk for unplanned pregnancy. This analysis describes contraceptive use ...and interest in long-acting reversible contraception (LARC) among women with bacterial STIs. This cross-sectional study included 1,623 women ages 13 to 45 with bacterial STIs who completed a public health Partner Services interview between January 2017 and December 2019 in King County, WA. For women not using LARC and not planning pregnancy, public health disease intervention specialists (DIS) delivered a brief educational message on LARC and assessed interest in switching to LARC. Contraceptive method type was divided into two groups consisting of highly or moderately effective methods and least effective, other, or no method. We conducted univariate analyses between individual level factors and contraceptive method followed by a multivariate logistic regression analysis adjusting for factors found to be statistically significant in the univariate analyses. Just over half of the women (52.8%) interviewed reported using highly or moderately effective contraception. Black women were less likely to use a highly or moderately effective method compared to White women (aRR 0.58, 95%CI 0.43-0.80) and women with private insurance were more likely to use a highly or moderately effective method compared to those with public insurance (aRR 1.67, 95% CI 1.28-2.19). After brief counseling, fewer than one in five women were interested in switching to LARC. These data suggest there is an opportunity for public health partner services to fill an unmet need for contraception access and reproductive health programming more intensive than brief educational counseling is likely needed to increase LARC use among women with bacterial STIs.
During the early months of the coronavirus disease 2019 pandemic, risks associated with severe acute respiratory syndrome coronavirus 2 in pregnancy were uncertain. Pregnant patients can serve as a ...model for the success of clinical and public health responses during public health emergencies as they are typically in frequent contact with the medical system. Population-based estimates of severe acute respiratory syndrome coronavirus 2 infections in pregnancy are unknown because of incomplete ascertainment of pregnancy status or inclusion of only single centers or hospitalized cases. Whether pregnant women were protected by the public health response or through their interactions with obstetrical providers in the early months of pandemic is not clearly understood.
This study aimed to estimate the severe acute respiratory syndrome coronavirus 2 infection rate in pregnancy and to examine the disparities by race and ethnicity and English language proficiency in Washington State.
Pregnant patients with a polymerase chain reaction–confirmed severe acute respiratory syndrome coronavirus 2 infection diagnosed between March 1, 2020, and June 30, 2020 were identified within 35 hospitals and clinics, capturing 61% of annual deliveries in Washington State. Infection rates in pregnancy were estimated overall and by Washington State Accountable Community of Health region and cross-sectionally compared with severe acute respiratory syndrome coronavirus 2 infection rates in similarly aged adults in Washington State. Race and ethnicity and language used for medical care of pregnant patients were compared with recent data from Washington State.
A total of 240 pregnant patients with severe acute respiratory syndrome coronavirus 2 infections were identified during the study period with 70.7% from minority racial and ethnic groups. The principal findings in our study were as follows: (1) the severe acute respiratory syndrome coronavirus 2 infection rate was 13.9 per 1000 deliveries in pregnant patients (95% confidence interval, 8.3–23.2) compared with 7.3 per 1000 (95% confidence interval, 7.2–7.4) in adults aged 20 to 39 years in Washington State (rate ratio, 1.7; 95% confidence interval, 1.3–2.3); (2) the severe acute respiratory syndrome coronavirus 2 infection rate reduced to 11.3 per 1000 deliveries (95% confidence interval, 6.3–20.3) when excluding 45 cases of severe acute respiratory syndrome coronavirus disease 2 detected through asymptomatic screening (rate ratio, 1.3; 95% confidence interval, 0.96–1.9); (3) the proportion of pregnant patients in non-White racial and ethnic groups with severe acute respiratory syndrome coronavirus disease 2 infection was 2- to 4-fold higher than the race and ethnicity distribution of women in Washington State who delivered live births in 2018; and (4) the proportion of pregnant patients with severe acute respiratory syndrome coronavirus 2 infection receiving medical care in a non-English language was higher than estimates of pregnant patients receiving care with limited English proficiency in Washington State (30.4% vs 7.6%).
The severe acute respiratory syndrome coronavirus 2 infection rate in pregnant people was 70% higher than similarly aged adults in Washington State, which could not be completely explained by universal screening at delivery. Pregnant patients from nearly all racial and ethnic minority groups and patients receiving medical care in a non-English language were overrepresented. Pregnant women were not protected from severe acute respiratory syndrome coronavirus 2 infection in the early months of the pandemic. Moreover, the greatest burden of infections occurred in nearly all racial and ethnic minority groups. These data coupled with a broader recognition that pregnancy is a risk factor for severe illness and maternal mortality strongly suggested that pregnant people should be broadly prioritized for coronavirus disease 2019 vaccine allocation in the United States similar to some states.
New skin lesions in a liver transplant recipient Blain, Michela; Walter, Kara; Sibulesky, Lena ...
American journal of transplantation,
October 2019, 2019-Oct, 2019-10-00, 20191001, Letnik:
19, Številka:
10
Journal Article
Abstract
We found low prevalence of SARS-CoV-2 (2.7% 5/188) among pregnant and postpartum patients with universal testing. Prevalence among symptomatic patients was similar under initial targeted ...screening (22.2% 4/18) and universal approaches (19.1% 8/42). Among 170 asymptomatic patients, 2 were positive or inconclusive, respectively; repeat testing at 24 hours was negative.
We found a low prevalence of severe acute respiratory syndrome coronavirus 2 among pregnant and postpartum patients after initiation of universal testing at University of Washington–affiliated hospitals using a combination of on-site rapid testing, high-throughput centralized testing, and outpatient drive-through screening prior to admission.
Introduction
Monensin is a veterinary antibiotic with a narrow therapeutic window that has led to lethal intoxication in many animal species. Only two prior cases of human toxicity have been ...reported, both fatal. We present the first case of survival from severe toxicity following monensin ingestion.
Case
A 58-year-old man presented with 8 days of vomiting and abdominal pain. Due to delusions of central nervous system toxoplasmosis, he ingested 300 mg of monensin. His laboratory studies revealed severe rhabdomyolysis without renal dysfunction. Total creatine kinase (CK) peaked above 100,000 U/L. His CK decreased to 5192 U/L after 15 days of aggressive hydration and sodium bicarbonate therapy. His ejection fraction on echocardiogram decreased from 69 to 56%.
Discussion
Reports on acute clinical effects after human exposure to monensin are limited. Ingestion is known to cause skeletal and cardiac muscle rhabdomyolysis and necrosis. Animal studies demonstrate that monensin’s toxicity is due to increases in intracellular sodium concentrations and Ca
2+
release. To date, no effective antidotal treatment has been described.
Conclusions
Monensin is a veterinary medication not approved for human use by the US Food and Drug Administration. Though poorly studied in humans, this case demonstrates the severe harm that may occur following ingestion.
Abstract
Patients with chronic granulomatous disease are at increased risk for invasive aspergillosis. Cryptic Aspergillus species are being increasingly recognized as distinct causes of infection in ...this population. In this study, we describe the first case of Aspergillus udagawae vertebral osteomyelitis in a patient with X-linked chronic granulomatous disease.
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