Humoral Immune Response to SARS-CoV-2 in Iceland Gudbjartsson, Daniel F; Norddahl, Gudmundur L; Melsted, Pall ...
The New England journal of medicine,
10/2020, Letnik:
383, Številka:
18
Journal Article
Recenzirano
Odprti dostop
This large comparative study of the Icelandic population showed that the humoral response did not decline within 4 months after infection, that 44% of persons who had been infected had not been ...diagnosed with qPCR, and that the infection fatality risk was 0.3%.
Background Global death rate in children has been declining during the last decades worldwide, especially in high income countries. This has been attributed to several factors, including improved ...prenatal and perinatal care, immunisations, infection management as well as progress in diagnosis and treatment of most diseases. However, there is certainly room for further progress. The aim of the current study was to describe the changes in death rates and causes of death in Iceland, a high-income country during almost half a century. Methods The Causes of Death Register at The Directorate of Health was used to identify all children under the age of 18 years in Iceland that died during the study period from January 1.sup.st, 1971 until December 31.sup.st, 2018. Using Icelandic national identification numbers, individuals could be identified for further information. Hospital records, laboratory results and post-mortem diagnosis could be accessed if cause of death was unclear. Findings Results showed a distinct decrease in death rates in children during the study period that was continuous over the whole period. This was established for almost all causes of death and in all age groups. This reduction was primarily attributed to a decrease in fatal accidents and fewer deaths due to infections, perinatal or congenital disease as well as malignancies, the reduction in death rates from other causes was less distinct. Childhood suicide rates remained constant. Interpretation Our results are encouraging for further prevention of childhood deaths. In addition, our results emphasise the need to improve measures to detect and treat mental and behavioural disorders leading to childhood suicide.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Purpose
To describe the prevalence of, risk factors for, and prognostic importance of gastrointestinal (GI) bleeding and use of acid suppressants in acutely ill adult intensive care patients.
Methods
...We included adults without GI bleeding who were acutely admitted to the intensive care unit (ICU) during a 7-day period. The primary outcome was clinically important GI bleeding in ICU, and the analyses included estimations of baseline risk factors and potential associations with 90-day mortality.
Results
A total of 1,034 patients in 97 ICUs in 11 countries were included. Clinically important GI bleeding occurred in 2.6 % (95 % confidence interval 1.6–3.6 %) of patients. The following variables at ICU admission were independently associated with clinically important GI bleeding: three or more co-existing diseases (odds ratio 8.9, 2.7–28.8), co-existing liver disease (7.6, 3.3–17.6), use of renal replacement therapy (6.9, 2.7–17.5), co-existing coagulopathy (5.2, 2.3–11.8), acute coagulopathy (4.2, 1.7–10.2), use of acid suppressants (3.6, 1.3–10.2) and higher organ failure score (1.4, 1.2–1.5). In ICU, 73 % (71–76 %) of patients received acid suppressants; most received proton pump inhibitors. In patients with clinically important GI bleeding, crude and adjusted odds for mortality were 3.7 (1.7–8.0) and 1.7 (0.7–4.3), respectively.
Conclusions
In ICU patients clinically important GI bleeding is rare, and acid suppressants are frequently used. Co-existing diseases, liver failure, coagulopathy and organ failures are the main risk factors for GI bleeding. Clinically important GI bleeding was not associated with increased adjusted 90-day mortality, which largely can be explained by severity of comorbidity, other organ failures and age.
Spread of SARS-CoV-2 in the Icelandic Population Gudbjartsson, Daniel F; Helgason, Agnar; Jonsson, Hakon ...
The New England journal of medicine,
06/2020, Letnik:
382, Številka:
24
Journal Article
Recenzirano
Odprti dostop
Despite timely implementation of testing for SARS-CoV-2 virus, a contact-tracing scheme, and social-distancing measures, infection has spread in Iceland. However, there was no detected increase in ...the proportion of infected persons between March 13 and April 4, 2020.
Background
Elucidating factors that influence physical recovery of survivors after an intensive care unit (ICU) stay is paramount in maximizing long‐term functional outcomes. We examined potential ...predictors for poor long‐term physical recovery in ICU survivors.
Methods
Based on secondary analysis of a trial of 50 ICU patients who underwent mobilization in the ICU and were followed for one year, linear regression analysis examined the associations of exposure variables (baseline characteristics, severity of illness variables, ICU‐related variables, and lengths of ICU and hospital stay), with physical recovery variables (muscle strength, exercise capacity, and self‐reported physical function), measured one year after ICU discharge.
Results
When the data were adjusted for age, female gender was associated with reduced muscle strength (P = .003), exercise capacity (P < .0001), and self‐reported physical function (P = .01). Older age, when adjusted for gender, was associated with reduced exercise capacity (P < .001). After adjusting for gender and age, an association was observed between a lower score on one or two physical recovery variables and exposure variables, specifically, high body mass index, low functional independence, comorbidity and low self‐reported physical function at baseline, muscle weakness at ICU discharge, and longer hospital stay. No adjustment was made for cumulative type I error rate due to small number of participants.
Conclusion
Elucidating risk factors for poor long‐term physical recovery after ICU stay, including gender, may be critical if mobilization and exercise are to be prescribed expediently during and after ICU stay, to ensure maximal long‐term recovery.
Background: Early identification of prodromal signs of acute deterioration of patients is essential in high quality care. Rigorous monitoring of patients is facilitated by risk assessment tools, e.g. ...the Modified Early Warning Score (MEWS).
Aims and objectives: The purpose of the study was to estimate the accuracy of nursing documentation according to parameters that comprise MEWS in patients prior to emergency admission to the intensive care unit (ICU).
Methods: The research design was retrospective and descriptive. Data was collected from medical records of in‐patients who presented as emergency admission to two ICUs at a university hospital between 1 October and 31 December 2006.
Results: Data was collected from 65 patients' records over the 3‐month period. Most admissions occurred between the hours of 8 a.m. and 4 p.m. Respiratory failure was the primary reason for admission, followed by septic shock. Respiratory rate was documented for 14% of patients (n = 9) prior to ICU admission, which was the least documented observation. Urine output and fluid balance were documented for 40% of the patients, level of consciousness in 48% of patients (n = 31), temperature for 69% (n = 45) and oxygen saturation for 80% of the patients (n = 53).
Discussion: Respiratory failure was the primary cause of emergency admission of in‐patients to the ICUs with respiratory rate the least documented vital sign. Nursing documentation according to the MEWS was insufficient.
Conclusions/Relevance to clinical practice: Nurses need to be alerted to the necessity of documenting early signs of deterioration of patients, particularly the respiratory rate. With better monitoring and documentation of physiological parameters, emergency admission to the ICU might be avoided.
OBJECTIVETo analyze and compare the capillary permeability-reducing effects of prostacyclin, terbutaline, and aminophylline.
DESIGNA prospective, experimental study.
SETTINGA university laboratory.
...SUBJECTSFourteen adult, anesthetized cats.
INTERVENTIONSThe study was performed on an autoperfused calf muscle preparation enclosed in a plethysmograph, with continuous recordings of tissue volume, arterial and venous blood pressures, and blood flow. The capillary filtration coefficient was used as a measure of capillary hydraulic permeability, and measured at different doses of intravenous infusions of prostacyclin, terbutaline, and aminophylline. These analyses were made from normal and from raised permeability levels, the latter by prior and simultaneous infusion of tumor necrosis factor-alpha (TNF-alpha) or histamine. All three of the drugs analyzed were given at low doses, without vasodilator effect, and at doses with a clear vasodilator effect.
MAIN RESULTSProstacyclin infusion reduced capillary permeability to a value of about 25% below the initial control value, and this level was reached both from normal and increased permeability levels. The maximal reduction level was obtained at a low nonvasodilator dose of 2 ng/kg/min. Terbutaline and aminophylline had no significant effect on capillary filtration coefficient when tested from the initial control permeability level. From a TNF-alpha-raised permeability level (about 50% above control) and from a histamine-raised permeability level (about 60% above control), both drugs induced small reductions in the capillary filtration coefficient.
CONCLUSIONLow-dose prostacyclin effectively reduces hydraulic capillary permeability in cat skeletal muscle and is superior to terbutaline and aminophylline. (Crit Care Med 1999; 27:130-136)
Abstract
A pressing concern in the SARS-CoV-2 epidemic and other viral outbreaks, is the extent to which the containment measures are halting the viral spread. A straightforward way to assess this is ...to tally the active cases and the recovered ones throughout the epidemic. Here, we show how epidemic control can be assessed with molecular information during a well characterized epidemic in Iceland. We demonstrate how the viral concentration decreased in those newly diagnosed as the epidemic transitioned from exponential growth phase to containment phase. The viral concentration in the cases identified in population screening decreased faster than in those symptomatic and considered at high risk and that were targeted by the healthcare system. The viral concentration persists in recovering individuals as we found that half of the cases are still positive after two weeks. We demonstrate that accumulation of mutations in SARS-CoV-2 genome can be exploited to track the rate of new viral generations throughout the different phases of the epidemic, where the accumulation of mutations decreases as the transmission rate decreases in the containment phase. Overall, the molecular signatures of SARS-CoV-2 infections contain valuable epidemiological information that can be used to assess the effectiveness of containment measures.
A. D. Moller and P. O. Grande
Department of Physiology and Neuroscience, University of Lund, Sweden.
The dose-response effects of intravenous infusion of prostacyclin on
capillary permeability (the ...capillary filtration coefficient technique),
hydrostatic capillary pressure, transcapillary filtration, and vascular
tone were analyzed in vivo on cat skeletal muscle from a normal and an
increased permeability level. Increased permeability was accomplished by
intra-arterial infusion of tumor necrosis factor-alpha or histamine.
Permeability effects of bradykinin were also analyzed. Prostacyclin
decreased capillary permeability by 8% at a dose of 0.1 ng.kg-1.min-1 and
at most by 30% below control attained at 2 ng.kg-1.min-1, also with no
effect on vascular tone and hydrostatic capillary pressure. The
permeability increase by tumor necrosis factor-alpha and histamine (by 54
and 73%) was more than counteracted by the simultaneous infusion of
prostacyclin at 2 ng.kg-1.min-1. The vasodilator effect of tumor necrosis
factor-alpha was also restituted. Indomethacin (prostacyclin
inhibitor)-induced increase in capillary permeability (25%) was more than
restituted by prostacyclin at 2 ng.kg-1.min-1. Surprisingly, bradykinin
decreased capillary permeability. We conclude that endogenous prostacyclin
may be a physiological regulator of capillary permeability and that
low-dose prostacyclin infusion may have clinical relevance in states of
increased permeability.
PDF
