It is unclear whether the changes in critical care throughout the pandemic have improved the outcomes in coronavirus disease 2019 (COVID-19) patients admitted to the intensive care units (ICUs).
We ...conducted a retrospective cohort study in adults with COVID-19 pneumonia admitted to 73 ICUs from Spain, Andorra and Ireland between February 2020 and March 2021. The first wave corresponded with the period from February 2020 to June 2020, whereas the second/third waves occurred from July 2020 to March 2021. The primary outcome was ICU mortality between study periods. Mortality predictors and differences in mortality between COVID-19 waves were identified using logistic regression.
As of March 2021, the participating ICUs had included 3795 COVID-19 pneumonia patients, 2479 (65·3%) and 1316 (34·7%) belonging to the first and second/third waves, respectively. Illness severity scores predicting mortality were lower in the second/third waves compared with the first wave according with the Acute Physiology and Chronic Health Evaluation system (median APACHE II score 12 IQR 9–16 vs 14 IQR 10–19) and the organ failure assessment score (median SOFA 4 3–6 vs 5 3–7, p<0·001). The need of invasive mechanical ventilation was high (76·1%) during the whole study period. However, a significant increase in the use of high flow nasal cannula (48·7% vs 18·2%, p<0·001) was found in the second/third waves compared with the first surge. Significant changes on treatments prescribed were also observed, highlighting the remarkable increase on the use of corticosteroids to up to 95.9% in the second/third waves. A significant reduction on the use of tocilizumab was found during the study (first wave 28·9% vs second/third waves 6·2%, p<0·001), and a negligible administration of lopinavir/ritonavir, hydroxychloroquine, and interferon during the second/third waves compared with the first wave. Overall ICU mortality was 30·7% (n = 1166), without significant differences between study periods (first wave 31·7% vs second/third waves 28·8%, p = 0·06). No significant differences were found in ICU mortality between waves according to age subsets except for the subgroup of 61–75 years of age, in whom a reduced unadjusted ICU mortality was observed in the second/third waves (first 38·7% vs second/third 34·0%, p = 0·048). Non-survivors were older, with higher severity of the disease, had more comorbidities, and developed more complications. After adjusting for confounding factors through a multivariable analysis, no significant association was found between the COVID-19 waves and mortality (OR 0·81, 95% CI 0·64–1·03; p = 0·09). Ventilator-associated pneumonia rate increased significantly during the second/third waves and it was independently associated with ICU mortality (OR 1·48, 95% CI 1·19–1·85, p<0·001). Nevertheless, a significant reduction both in the ICU and hospital length of stay in survivors was observed during the second/third waves.
Despite substantial changes on supportive care and management, we did not find significant improvement on case-fatality rates among critical COVID-19 pneumonia patients.
Ricardo Barri Casanovas Foundation (RBCF2020) and SEMICYUC.
BACKGROUND:It is unclear how characteristics, risk factors, and incidence of coronavirus disease 2019 (COVID-19) in people living with HIV (PLWH) differ from the general population.
...METHODS:Prospective observational single-center cohort study of adult PLWH reporting symptoms of COVID-19. We assessed clinical characteristics, risk factors for COVID-19 diagnosis and severity, and standardized incidence rate ratio for COVID-19 cases in PLWH cohort and in Barcelona.
RESULTS:From 1 March 2020 to 10 May 2020, 53 out of 5683 (0.9% confidence interval 0.7–1.2%) PLWH were diagnosed with COVID-19. Median age was 44 years, CD4 T cells were 618/μl and CD4/CD8 was 0.90. All but two individuals were virologically suppressed. Cough (87%) and fever (82%) were the most common symptoms. Twenty-six (49%) were admitted, six (14%) had severe disease, four (8%) required ICU admission, and two (4%) died. Several laboratory markers (lower O2 saturation and platelets, and higher leukocytes, creatinine, lactate dehydrogenase, C reactive protein, procalcitonin, and ferritin) were associated with COVID-19 severity. No HIV or antiretroviral-related factors were associated with COVID-19 diagnosis or severity. Standardized incidence rate ratios of confirmed or confirmed/probable COVID-19 in PLWH were 38% (95% confidence interval 27–52%, P < 0.0001) and 33% (95% confidence interval 21–50%, P < 0.0001), respectively relative to the general population.
CONCLUSION:PLWH with COVID-19 did not differ from the rest of the HIV cohort. Clinical presentation, severity rate, and mortality were not dependent on any HIV-related or antiretroviral-related factor. COVID-19 standardized incidence rate was lower in PLWH than in the general population. These findings should be confirmed in larger multicenter cohort studies.
Mental disorders in chronic obstructive pulmonary diseases Montserrat‐Capdevila, Josep; Godoy, Pere; Marsal, Josep Ramon ...
Perspectives in psychiatric care,
July 2018, 2018-Jul, 2018-07-00, 20180701, Letnik:
54, Številka:
3
Journal Article
Recenzirano
Odprti dostop
Purpose
Anxiety and depression are underdiagnosed in chronic obstructive pulmonary disease (COPD) patients. Few studies have tried to identify their association with hospitalization (severe ...exacerbation). The objective of this study was to determine whether the anxiety/depression was associated with severe exacerbation.
Design and Methods
A prospective cohort study, based on a sample of 512 patients diagnosed with COPD originating from primary care in a rural area in Lleida (Spain) and monitored between November 1, 2012 and October 31, 2014. For each patient, variables of interest were recorded; they were administered the HADS (Hospital Anxiety and Depression Scale) test to determine the possible presence of anxiety/depression, and its association with severe exacerbation was analyzed using a logistic regression model.
Findings
Initially, the prevalence of anxiety/depression was 15.6%. The incidence of global hospitalization in the first year was 8.2% and 11.3% in the second year. In patients with anxiety/depression, it increased to 17.5% in the first year and 18.8% in the second year. In the multivariate regression model, the diagnosis of anxiety/depression almost doubled the risk of hospitalization (OR = 1.94) (p < .041).
Practice Implications
Anxiety and depression are associated with an increased risk of hospitalization. Intervention studies are needed to evaluate the effects of anxiety/depression in the hospitalization.
Actinomycosis is quite an infrequent bacterial infection nowadays. However it can be considered in cases with a persistent cervicofacial disease. Although it is a bacterial infection, microbiologic ...cultures are frequently not diagnoses, therefore histopathologic studies and image studies are essential. Our interest is to explain our experience with cervicofacial actinomycosis; the clinical behaviour, evolution and treatment, always assisted by their elected diagnostic technique: the FNAC.
In the last 16 years, 15 patients have been diagnosed with cervicofacial actinomycosis by FNAC, treated by Maxillofacial, Internal Medicine and Paediatrics units. Clinical course, evolution, anatomical space situation, antibiotic treatment, and surgical treatment have been studied.
The fine-needle aspiration cytology (FNAC) is an easy, safe and rapid method, with a high effect, that has made the final diagnosis in 15 cases in our Hospital. All the patients have had a good clinical evolution, only in one case did we need a new treatment for recidive. In all the cases treatment has been definitive. Our interest is to explain our experience in the treatment of cervicofacial actinomycosis, its clinical presentation and evolution, together with its elected method of diagnosis, FNAC.
BACKGROUND--There is some controversy concerning the efficacy of low dose alpha interferon therapy in chronic hepatitis C. AIMS--To evaluate the effectiveness of treatment with low doses of alpha ...interferon in chronic hepatitis C. PATIENTS--One hundred and forty one patients with anti-HCV positive chronic active hepatitis C from six hospitals were enrolled in the study. METHODS--Patients were randomised to treatment with 5 MU (group A) or 1.5 MU (group B) injections. The dose was reduced in responders from group A or increased in non-responders from group B to maintain treatment with the minimal effective dose. Patients were treated for 48 weeks and followed up for 24 additional weeks with no treatment. Normalisation of alanine aminotransferase (ALT) was used to evaluate response. RESULTS--A sustained response was seen in eight patients from group A (12%) and in 15 (21%) from group B. This difference was not statistically significant. Increasing the dose of interferon led to sustained response in only five of 58 patients (9%) from group B who did not respond to 1.5 MU injections. In contrast, 15 of 21 patients (71%) in whom ALT remained normal with 1.5 MU injections developed a sustained response. By multivariate analysis sustained response seemed associated with young age and was more frequent in patients with genotype 3 HCV infection. Sustained response was preceded by a rapid normalisation of ALT and was inversely related to the amount of alpha interferon necessary to maintain ALT at low values during treatment. CONCLUSIONS--Some patients with chronic hepatitis C are very sensitive to alpha interferon and can be successfully treated with low doses. Treatment with higher doses may be effective in a minority of patients who do not respond to low doses.
This paper reviews advanced gate dielectric processes for SiC MOSFETs. The poor quality of the SiO2/SiC interface severely limits the value of the channel field-effect mobility, especially in 4H-SiC ...MOSFETs. Several strategies have been addressed to overcome this issue. Nitridation methods are effective in increasing the channel mobility and have been adopted by manufacturers for the first generations of commercial power devices. Gate oxide doping techniques have also been successfully implemented to further increase the channel mobility, although device stability is compromised. The use of high-k dielectrics is also analyzed, together with the impact of different crystal orientations on the channel mobility. Finally, the performance of SiC MOSFETs in harsh environments is also reviewed with special emphasis on high temperature operation.
In all fields of medicine, major efforts are currently dedicated to improve the clinical, physiological and therapeutic understanding of disease, and obstructive sleep apnoea (OSA) is no exception. ...The personalised medicine approach is relevant for OSA, given its complex pathophysiology and variable clinical presentation, the interactions with comorbid conditions and its possible contribution to poor outcomes. Treatment with continuous positive airway pressure (CPAP) is effective, but CPAP is poorly tolerated or not accepted in a considerable proportion of OSA patients. This review summarises the available studies on the physiological phenotypes of upper airway response to obstruction during sleep, and the clinical presentations of OSA (phenotypes and clusters) with a special focus on our changing attitudes towards approaches to treatment. Such major efforts are likely to change and expand treatment options for OSA beyond the most common current choices (
CPAP, mandibular advancement devices, positional treatment, lifestyle changes or upper airway surgery). More importantly, treatment for OSA may become more effective, being tailored to each patient's need.
Abstract
Study Objectives:
Intermittent hypoxia (IH) mimicking obstructive sleep apnea (OSA) significantly modifies gut microbiota in mice. However, whether these IH-induced gut microbiome changes ...are reversible after restoring normal oxygenation (the equivalent of effective OSA therapy) is unknown. The aim of this study was to investigate gut microbiota composition and circulating endotoxemia after a post-IH normoxic period in a mouse model of OSA.
Methods:
Ten mice were subjected to IH (40 sec 21% O2-20 sec 5% O2) for 6 h/day for 6 w and 10 mice breathing normoxic air (NM) were used as controls. After exposures, both groups were subjected to 6 w in normoxia. Microbiome composition of fecal samples was determined by 16S ribosomal RNA (rRNA) pyrosequencing. Bioinformatic analysis was performed by Quantitative Insights into Microbial Ecology. Plasma lipopolysaccharide (LPS) levels were measured by endotoxin assay.
Results:
After normoxic recovery, the Chao and Shannon indices of each group suggested similar bacterial richness and diversity. 16S rRNA pyrosequencing analysis showed that IH-exposed mice had a significant decrease in the abundance of Bacteroidetes and a significant increase of Firmicutes and Deferribacteres compared to the NM group. After normoxic recovery, circulating LPS concentrations were higher in the IH group (P < 0.009). Moreover, the IH group showed a negative and significant correlation between the abundance of Lactobacillus and Ruminococcus and significant positive correlations between the abundance of Mucispirillum and Desulfovibrio and plasma LPS levels, respectively.
Conclusions:
Even after prolonged normoxic recovery after IH exposures, gut microbiota and circulating endotoxemia remain negatively altered, suggesting that potential benefits of OSA treatment for reversing OSA-induced changes in gut microbiota may either require a longer period or alternative interventions.
Background Narrow-band imaging (NBI) is a novel technique that may represent an alternative method to chromoendoscopy (CE) for the detection of colitis-associated intraepithelial neoplasia (IN) in ...patients with long-standing inflammatory bowel disease (IBD). Objective To compare NBI with CE for the detection of IN. Design Prospective, randomized, crossover study. Setting Academic hospital. Patients Patients with clinically inactive colonic IBD (≥8 years). Intervention Patients underwent both CE and NBI in randomized order. Targeted biopsy specimens from abnormal areas were obtained. Pathological examination was regarded as the reference standard. Main Outcome Measurements Number of false-positive and true-positive lesions in patients undergoing CE and NBI were compared as well as the proportion of patients with missed IN lesions. Results Eighty patients were screened, of whom 20 were excluded. Mean ± standard deviation withdrawal time for CE was significantly longer than that for NBI (26.87 ± 9.89 minutes vs 15.74 ± 5.62 minutes, P < .01). Thirteen patients had at least 1 IN lesion on 1 of the examinations. In the per-lesion analysis, NBI resulted in a significantly inferior false-positive biopsy rate ( P = .001) and a similar true-positive rate. The percentage of missed IN lesions and patients was superior with NBI, albeit without reaching statistical significance. Limitations Lesions were sampled immediately after detection, which precluded the possibility of paired analysis. Conclusions NBI appears to be a less time-consuming and equally effective alternative to CE for the detection of IN. However, given the NBI lesion and patient miss rates, it cannot be recommended as the standard technique.
Objectives:
Actinomycosis is quite an infrequent bacterial infection nowadays.
However it can be considered in cases with a persistent cervicofacial
disease.
Although it is a bacterial infection, ...microbiologic cultures are
frequently not diagnoses, therefore histopathologic studies and
image studies are essential.
Our interest is to explain our experience with cervicofacial actinomycosis;
the clinical behaviour, evolution and treatment, always
assisted by their elected diagnostic technique: the FNAC.
Study design:
In the last 16 years, 15 patients have been diagnosed with cervicofacial
actinomycosis by FNAC, treated by Maxillofacial, Internal Medicine and Paediatrics units.
Clinical course, evolution, anatomical space situation, antibiotic
treatment, and surgical treatment have been studied.
Results and conclusions:
The fine-needle aspiration cytology (FNAC) is an easy, safe
and rapid method, with a high effect, that has made the final
diagnosis in 15 cases in our Hospital.
All the patients have had a good clinical evolution, only in one
case did we need a new treatment for recidive.
In all the cases treatment has been definitive.
Our interest is to explain our experience in the treatment of cervicofacial
actinomycosis, its clinical presentation and evolution,
together with its elected method of diagnosis, FNAC. Objetivos:
La actinomicosis es una enfermedad infecciosa muy poco frecuente
en nuestros días, a pesar de lo cual, su diagnóstico debe
ser tenido en cuenta por el clínico que se enfrenta a una lesión
persistente a nivel cervicofacial.
Aún tratándose de una enfermedad infecciosa, los cultivos microbiológicos
son pocas veces diagnósticos, por lo que el estudio
histopatológico y las pruebas de imagen son esenciales.
Nuestro interés es exponer nuestra experiencia en el manejo de
la actinomicosis de localización cervicofacial, su presentación
clínica, evolución y tratamiento, siempre apoyados en la que
creemos que es su técnica diagnóstica de elección, la PAAF.
Diseño del estudio:
A lo largo de 16 años se han diagnosticado 15 pacientes de
actinomicosis cervicofacial mediante PAAF, siendo estudiados
y tratados por los Servicios de Cirugía Maxilofacial, Medicina
Interna y Pediatría del Hospital Universitari de Girona Doctor
Josep Trueta.
La clínica, la evolución, la localización de las lesiones, cultivo
y el tratamiento con antibioticoterapia de duración prolongada,
asociado en algunos casos a intervención quirúrgica, son datos
valorados en nuestro estudio.
Resultados y conclusiones:
El estudio anatomopatológico mediante la punción aspiración con
aguja fina (PAAF), es un método sencillo, rápido y seguro, de una
alta sensibilidad diagnóstica, puesto que nos ha permitido el diagnóstico
definitivo de los 15 casos seguidos en nuestro Hospital.
La evolución clínica fue favorable en todos los pacientes, con
un único caso de recidiva clínica, solucionado con un segundo
tratamiento.
El tratamiento instaurado fue curativo en todos los casos.
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