scholarly journals Adenoviral Infections in Singapore: Should New Antiviral Therapies and Vaccines Be Adopted?

2019 ◽  
Author(s):  
Kristen K Coleman ◽  
Chui Ching Wong ◽  
Jayanthi Jayakumar ◽  
Tham T Nguyen ◽  
Abigail W L Wong ◽  
...  
Keyword(s):  
Odds Ratio ◽  
Pediatric Patients ◽  
Phylogenetic Analyses ◽  
Severe Disease ◽  
Human Adenovirus ◽  
Clinical Samples ◽  
Antiviral Therapies ◽  
Increased Risk ◽  
Patients At Risk ◽  
Over Time

Abstract Background A number of serious human adenovirus (HAdV) outbreaks have been recently reported: HAdV-B7 (Israel, Singapore, and USA), HAdV-B7d (USA and China), HAdV-D8, -D54, and -C2 (Japan), HAdV-B14p1 (USA, Europe, and China), and HAdV-B55 (China, Singapore, and France). Methods To understand the epidemiology of HAdV infections in Singapore, we studied 533 HAdV-positive clinical samples collected from 396 pediatric and 137 adult patients in Singapore from 2012 to 2018. Genome sequencing and phylogenetic analyses were performed to identify HAdV genotypes, clonal clusters, and recombinant or novel HAdVs. Results The most prevalent genotypes identified were HAdV-B3 (35.6%), HAdV-B7 (15.4%), and HAdV-E4 (15.2%). We detected 4 new HAdV-C strains and detected incursions with HAdV-B7 (odds ratio [OR], 14.6; 95% confidence interval [CI], 4.1–52.0) and HAdV-E4 (OR, 13.6; 95% CI, 3.9–46.7) among pediatric patients over time. In addition, immunocompromised patients (adjusted OR [aOR], 11.4; 95% CI, 3.8–34.8) and patients infected with HAdV-C2 (aOR, 8.5; 95% CI, 1.5–48.0), HAdV-B7 (aOR, 3.7; 95% CI, 1.2–10.9), or HAdV-E4 (aOR, 3.2; 95% CI, 1.1–8.9) were at increased risk for severe disease. Conclusions Singapore would benefit from more frequent studies of clinical HAdV genotypes to identify patients at risk for severe disease and help guide the use of new antiviral therapies, such as brincidofovir, and potential administration of HAdV 4 and 7 vaccine.

Increased fasting total homocysteine plasma levels as a risk factor for thromboembolism in children

2004 ◽  
Vol 91 (02) ◽  
pp. 308-314 ◽  
Author(s):  
Achim Heinecke ◽  
Karin Kurnik ◽  
Christine Heller ◽  
Ulrike Nowak-Göttl ◽  
Andrea Kosch ◽  
...  
Keyword(s):  
Risk Factor ◽  
Odds Ratio ◽  
Thromboembolic Event ◽  
Pediatric Patients ◽  
Thromboembolic Disease ◽  
Thromboembolic Events ◽  
Thcy Level ◽  
Increased Risk ◽  
Total Homocysteine ◽  
Mild Hyperhomocysteinemia

SummaryElevated total homocysteine (tHcy) concentrations are an inde- pendent risk factor for thromboembolic events in adults. In children with moderate hyperhomocysteinemia data are sparse. Therefore, between 1995 and 2002 we consecutively recruited 163 white pediatric patients with a first symptomatic thromboembolic event and 255 healthy controls (mean age: 6.4 years in patients vs. 6.6 years in controls, range: 3 months to 18 years) and measured fasting tHcy levels. Median tHcy levels in patients were significantly higher (6.6 µmol/l, range 2.9-20.4 µmol/l) than in controls (5.7 µmol/l, 2.0-14.0 µmol/l, p<0.0001). 48 of the 163 patients with thromboembolism (29.5%) versus 26 of the 255 controls (10.2%) had tHcy levels above the age- specific normal 90th percentile (OR 2.9, 95%CI: 1.7-4.8). The odds ratio for children in the highest quintile compared to chil- dren with levels in the lowest quintile was 4.3 (1.6-8.1; highest quintile: median tHcy level 9.6 µmol, range 8.0-20.4), showing a significantly increased risk for thromboembolic disease with even mild hyperhomocysteinemia. We conclude that hyperho- mocysteinemia above the age-specific cut-off values is a risk fac- tor for thromboembolic events in children. Therefore, screen- ing for elevated fasting tHcy levels of patients with thromboem- bolism is recommended to stratify the risk of thromboembo- lism.

scholarly journals Diagnostic potential of nested PCR, galactomannan EIA, and Beta-D-glucan for invasive aspergillosis in pediatric patients

2012 ◽  
Vol 6 (04) ◽  
pp. 352-357 ◽  
Author(s):  
Parisa Badiee ◽  
Abdolvahab Alborzi ◽  
Mahammad Karimi ◽  
Bahman Pourabbas ◽  
Pedram Haddadi ◽  
...  
Keyword(s):  
Invasive Aspergillosis ◽  
Nested Pcr ◽  
Pediatric Patients ◽  
Clinical Samples ◽  
Predictive Values ◽  
Blood Samples ◽  
Diagnostic Potential ◽  
Increased Risk ◽  
Galactomannan Antigen ◽  
Noninvasive Tests

Introduction: Limited specific data and investigations are available for invasive aspergillosis (IA) in pediatric patients. We evaluated the diagnostic potential of three noninvasive tests including the Platelia Aspergillus EIA kit for using galactomannan antigen, (1,3)-β-D-glucan Detection Reagent Kit, and nested-PCR for Aspergillus DNA in sera. We evaluated the diagnostic potential of three noninvasive tests including EIA for galactomannan antigen  (Platelia Aspergillus), nested  PCR assay for Aspergillus DNA and test for  (1→3)-β-D-glucan (Glucatell assay Kit). Methodology: All pediatric patients treated at the hematology/oncology unit who were at increased risk of developing invasive aspergillosis were enrolled. Clinical samples were examined for Aspergillus infections by mycological methods. Serial blood samples were collected twice weekly and evaluated by noninvasive tests. Results: We analyzed 230 consecutive blood samples from 62 pediatric patients. The incidence rate of invasive aspergillosis in the patients was found to be 27.4%, and the etiologic agents were Aspergillus flavus, Aspergillus fumigatus, and Aspergillus spp.  The sensitivity, specificity, positive and negative predictive values, and likelihood ratios for positive and negative results of galactomannan in patients with proven and probable IA were 90%, 92%, 81.8%, 96%, 11.25, and 0.1; for beta-D-glucan they were 50%, 46%, 26%, 70.6%, 0.9, 0.9; and for nested-PCR they were 80%, 96.2%, 88.9%, 92.6%, 21, and 0.2, respectively. Conclusions: The conventional methods are not able to detect IA, due to the lack of valid and proper sampling. Galactomannan and nested-PCR tests in serum, with enough accuracy and reliability, can serve as noninvasive methods for the detection of IA in pediatric patients. However, the beta-D-glucan test cannot serve as an efficient diagnostic tool in those with hematologic disorders. 

Central Venous Lines in Children With Lesser Risk Acute Lymphoblastic Leukemia: Optimal Type and Timing of Placement

2005 ◽  
Vol 23 (13) ◽  
pp. 3024-3029 ◽  
Author(s):  
Thomas W. McLean ◽  
Christen J. Fisher ◽  
Beverly M. Snively ◽  
Allen R. Chauvenet
Keyword(s):  
Acute Lymphoblastic Leukemia ◽  
Blood Culture ◽  
Positive Blood Culture ◽  
Odds Ratio ◽  
Pediatric Patients ◽  
Lymphoblastic Leukemia ◽  
Complication Rates ◽  
Central Venous ◽  
Increased Risk ◽  
Optimal Type

Purpose In pediatric patients with acute lymphoblastic leukemia (ALL), the optimal time for central venous line (CVL) insertion and the optimal type of CVL (internal v external) is unclear. This study was undertaken to compare complication rates between early versus late line insertion, and between internal versus external lines in children with lesser risk ALL. Patients and Methods We performed a retrospective analysis of patients enrolled onto Pediatric Oncology Group (POG) protocol 9201. Data regarding demographics, CVL types and insertion dates, blood counts, and complications were reviewed through week 25 of therapy. Results Of 697 patients enrolled onto POG protocol 9201, 362 patients had sufficient data for analysis. When compared to late line placement (> day 15 of induction), early CVL placement (≤ day 15 of induction) was associated with an increased risk of having a positive blood culture (odds ratio, 2.2; 95% CI, 1.0 to 5.0; P = .05). When compared with internal CVLs (“ports”), external CVLs were associated with a positive blood culture (odds ratio, 3.1; 95% CI, 1.3 to 7.5; P = .01), thrombosis (odds ratio, 3.9; 95% CI, 1.5 to 10.3; P = .006), and CVL removal (odds ratio, 5.6; 95% CI, 2.7 to 11.6; P < .001). Conclusion In pediatric patients with lesser risk ALL, internal lines (ports) should be the preferred CVL type due to a lower risk of infectious and thrombotic complications. In addition, CVLs placed early in induction are associated with a higher risk of positive blood culture than those placed later in induction.

Tracking novel adenovirus in environmental and human clinical samples: no evidence of endemic human adenovirus type 58 circulation in Córdoba city, Argentina

2014 ◽  
Vol 143 (7) ◽  
pp. 1427-1431 ◽  
Author(s):  
L. J. FERREYRA ◽  
M. O. GIORDANO ◽  
L. C. MARTÍNEZ ◽  
P. A. BARRIL ◽  
G. MASACHESSI ◽  
...  
Keyword(s):  
Treatment Plant ◽  
Human Adenovirus ◽  
Adenovirus Type ◽  
Local Area ◽  
Clinical Samples ◽  
Hiv Positive ◽  
Biologically Relevant ◽  
Stool Samples ◽  
Human Stool ◽  
Over Time

SUMMARYIn recent years, several types of human adenovirus (HAdV) have arisen from the recombination between two or more previously known HAdV types, but their epidemiology is poorly understood. In this study, we investigated the circulation of HAdV-58, a recently described HAdV isolated from an HIV-positive patient in Córdoba city, Argentina. For this purpose, a 30-month survey was conducted to study the presence of this type of adenovirus in sewage samples collected at the inlet from a wastewater treatment plant in Córdoba city, Argentina.Complementarily, the virus was sought in stools of HIV-positive patients.Although HAdVs were detected in human stool samples and in a high percentage of sewage samples, no evidence of HAdV-58 circulation was detected. We suggest that there is no endemic circulation of HAdV-58 in the geographical local area. The trend is that the number of identified HAdVs increases over time. In this context, understanding the current circulating HAdVs may be biologically relevant.

scholarly journals Longitudinal characterization of Plasmodium inter-species interactions during a period of increasing prevalence of Plasmodium ovale

2020 ◽  
Author(s):  
Hoseah M. Akala ◽  
Oliver Watson ◽  
Kenneth K. Mitei ◽  
Dennis W. Juma ◽  
Robert Verity ◽  
...  
Keyword(s):  
Falciparum Malaria ◽  
Species Interactions ◽  
Regression Models ◽  
Temporal Trends ◽  
Single Species ◽  
Clinical Samples ◽  
Mixed Infections ◽  
Mixed Effect ◽  
Increased Risk ◽  
Over Time

AbstractBackgroundThe epidemiology and severity of non-falciparum malaria in endemic settings has garnered limited attention. We aimed to characterize the prevalence, interaction, clinical risk factors and temporal trends of non-falciparum malaria in endemic settings of Kenya.MethodsWe diagnosed and analyzed infecting malaria species via PCR in 2027 clinical samples collected between 2008 and 2016. Descriptive statistics were used to describe the prevalence and distribution of Plasmodium species. A statistical model was designed and used for estimating the frequency of Plasmodium species and assessing inter-species interactions. Mixed effect linear regression models with random intercepts for each location was used to test for change in prevalence over time.Findings72•5% of the samples were P. falciparum single species infections, 25·8% were mixed infections and only 1•7% occurred as single non-falciparum species infections. 23•1% were mixed infections containing P. ovale. A likelihood-based model calculation of the population frequency of each species estimated a significant within-host interference between P. falciparum and P. ovale curtisi. Mixed-effect logistic regression models identified a significant increase of P. ovale wallikeri and P. ovale curtisi species over time with reciprocal decrease in P. falciparum single species and P. malariae. The risk of P. falciparum infections presenting with fever was 0•43 times less likely if co-infected with P. malariae.InterpretationFindings show higher prevalence of non-falciparum malaria than expected. The proportion of infections that were positive for infection by P. ovale wallikeri and P. ovale curtisi was observed to significantly increase over the period of study which could be due to attenuated responsiveness to malaria drug treatment on these species. The increase in frequency of P. ovale spp in Kenya could threaten malaria control effort in Kenya and pose increased risk of malaria to travelers.FundingAFHSB and its GEIS Section

scholarly journals Development of additional pituitary hormone deficiencies in pediatric patients originally diagnosed with idiopathic isolated GH deficiency

2014 ◽  
Vol 170 (1) ◽  
pp. 13-21 ◽  
Author(s):  
Werner F Blum ◽  
Cheri Deal ◽  
Alan G Zimmermann ◽  
Elena P Shavrikova ◽  
Christopher J Child ◽  
...  
Keyword(s):  
Adverse Events ◽  
Odds Ratio ◽  
Pediatric Patients ◽  
Gh Deficiency ◽  
International Study ◽  
Pituitary Hormone ◽  
Lower Baseline ◽  
Increased Risk ◽  
Concomitant Medications

ObjectiveWe assessed the characteristics of children initially diagnosed with idiopathic isolated GH deficiency (IGHD) who later developed additional (multiple) pituitary hormone deficiencies (MPHD).DesignData were analyzed for 5805 pediatric patients with idiopathic IGHD, who were GH-naïve at baseline and GH-treated in the multinational, observational Genetics and Neuroendocrinology of Short Stature International Study.MethodsDevelopment of MPHD was assessed from investigator diagnoses, adverse events, and concomitant medications. Analyses were performed for all patients and for those who developed MPHD within 4.5 years or had ≥3.5 years, follow-up and continued to have IGHD (4-year cohort).ResultsMPHD developed in 118/5805 (2.0%) children overall, and in 96/1757 (5.5%) in the 4-year cohort. Patients who developed MPHD had more profound GHD, with decreased height SDS, IGF1 SDS and peak stimulated GH, and greater height decrement vs target, compared with children who continued to have IGHD (P<0.001 for each variable). Delivery complications, congenital anomalies, and perinatal/neonatal adverse events occurred more frequently in patients who developed MPHD. The most frequent additional deficiency was TSH (82 patients overall); four patients developed two pituitary hormone deficiencies and one developed three deficiencies. Multivariable logistic regression indicated that years of follow-up (odds ratio 1.55), baseline age (1.17), baseline height SDS (0.69), and peak stimulated GH (0.64) were associated with the development of MPHD.ConclusionsMPHD is more likely to develop in patients with more severe idiopathic IGHD. Older baseline age, lower baseline height SDS, and longer follow-up duration are associated with increased risk of development of MPHD.

Examining heterotypic continuity of psychopathology: a prospective national study

2017 ◽  
Vol 47 (12) ◽  
pp. 2097-2106 ◽  
Author(s):  
C. Blanco ◽  
M. M. Wall ◽  
S. Wang ◽  
M. Olfson
Keyword(s):  
Substance Use ◽  
Anxiety Disorder ◽  
Odds Ratio ◽  
The Other ◽  
National Study ◽  
Lower Odds ◽  
Epidemiologic Survey ◽  
Increased Risk ◽  
Heterotypic Continuity ◽  
Over Time

BackgroundIndividuals with one psychiatric disorder are at increased risk for incidence and recurrence of other disorders. We characterize whether the magnitude of such heterotypic continuity varies based on whether the first disorder remits or persists over time.MethodCohorts were selected from participants in the National Epidemiologic Survey on Alcohol and Related Conditions wave 1 (2001–2002) and wave 2 (2004–2005) surveys with ⩾1 mood, anxiety, or substance use disorder at wave 1. Among respondents remitting (n = 6719) or not remitting (n = 3435) from ⩾1 of disorder at wave 2, the analyses compared the odds of developing new disorders.ResultsAs compared with adults whose disorders persisted from wave 1 to wave 2, those with ⩾1 remission had lower odds of incidence or recurrence of another disorder. Remission from alcohol dependence [odds ratio (OR) 0.4, 95% confidence interval (CI) 0.3–0.5] and drug dependence (OR 0.4, 95% CI 0.3–0.6) were associated with the lowest odds of incidence of another disorder. Social anxiety disorder was associated with the lowest adjusted odds of recurrence (adjusted OR = 0.2, 95% CI 0.1–0.6). Remission of disorders within one class (mood, anxiety, substance use) was consistently associated with lower odds of incidence or recurrence of disorders from the same class than with developing disorders from the other classes.ConclusionsRemission from common psychiatric disorders tends to decrease the risk for incidence or recurrence of disorders and this effect is stronger within than across disorder classes. These results do not support the concept of heterotypic continuity as a substitution of one disorder for another.

scholarly journals Mental Disorders and Subsequent Suicide in A Representative Community Population

2020 ◽  
Vol 5 (5) ◽  
Author(s):  
Kamala Adhikari ◽  
Amy Metcalfe ◽  
Andrew GM Bulloch ◽  
Jeanne VA Williams ◽  
Scott B Patten
Keyword(s):  
Mental Disorders ◽  
Mental Disorder ◽  
Clinical Samples ◽  
Time To Event ◽  
Sampling Weights ◽  
Early Management ◽  
Increased Risk ◽  
Major Depressive Episodes ◽  
Depressive Episodes ◽  
Over Time

BackgroundExisting association between mental disorders and suicidality is mostly based on cross- sectional studies, using clinical samples. Objective and methodsWe examined the patterns of association between mental disorders and subsequent suicide in a representative sample of the Canadian household population. This is a retrospective cohort study that used data from the Canadian Community Health Survey 2002 linked to the Death Database 2000-2011 and the Hospitalization Database 1999/2000-2012/2013) (N=27,000). Mental disorders (past-year major depressive episodes (MDE), bipolar disorders (BPD), anxiety disorders (AD), and substance-dependent (SD)) were diagnosed in the survey data using the Composite International Diagnostic Interview. Subsequent suicide events (deaths/hospitalizations for suicide attempts) were identified using ICD-10-CA codes. Time-to-event data were analyzed using competing-risk regression models, adjusting for age, sex, marital status, and educational attainment. Due to the violation of the proportional hazard assumption, the models were stratified into two strata. Sampling weights were used to ensure representation of the target population. ResultsOf 27,000 respondents, mental disorders were diagnosed in 15.0% respondents and 0.4% had suicide events. Each mental disorder was significantly associated with an increased risk of suicide. The strength of association between mental disorder and suicide weakened over-time for MDE, SD, but not for BPD and AD. For example, using the time-to-event cut-off 4-year, the hazard ratio (HR) for MDE was 6.02 (95% CI=2.65,13.68) in the first 4-year, whereas, it was 2.03 (95% CI=0.91,4.53) after 4-year. The HRs of suicide for BPD were 16.95 (95% CI=6.88,41.75) and 15.81 (95% CI=5.89,42.45) before and after 4-year. Conclusions/ImplicationsFindings reflect improvement of suicide-risk over-time for people with MDE and SA and the persisting risk for people with BPD and AD. Our findings underscore the importance of early management of mental disorders for effective suicide prevention, and requirement of longer-term follow-up for people with BPD and AD.

scholarly journals Systemic Inflammatory Mediators Are Effective Biomarkers for Predicting Adverse Outcomes in Clostridioides difficile Infection

mBio ◽  
2020 ◽  
Vol 11 (3) ◽  
Author(s):  
Michael G. Dieterle ◽  
Rosemary Putler ◽  
D. Alexander Perry ◽  
Anitha Menon ◽  
Lisa Abernathy-Close ◽  
...  
Keyword(s):  
Severe Disease ◽  
The United States ◽  
Human Infection ◽  
Serum Biomarkers ◽  
Adverse Outcomes ◽  
Gastrointestinal Infections ◽  
Content Type ◽  
Clostridioides Difficile ◽  
Increased Risk ◽  
Patients At Risk

ABSTRACT Clostridioides difficile infection (CDI) can result in severe disease and death, with no accurate models that allow for early prediction of adverse outcomes. To address this need, we sought to develop serum-based biomarker models to predict CDI outcomes. We prospectively collected sera ≤48 h after diagnosis of CDI in two cohorts. Biomarkers were measured with a custom multiplex bead array assay. Patients were classified using IDSA severity criteria and the development of disease-related complications (DRCs), which were defined as ICU admission, colectomy, and/or death attributed to CDI. Unadjusted and adjusted models were built using logistic and elastic net modeling. The best model for severity included procalcitonin (PCT) and hepatocyte growth factor (HGF) with an area (AUC) under the receiver operating characteristic (ROC) curve of 0.74 (95% confidence interval, 0.67 to 0.81). The best model for 30-day mortality included interleukin-8 (IL-8), PCT, CXCL-5, IP-10, and IL-2Rα with an AUC of 0.89 (0.84 to 0.95). The best model for DRCs included IL-8, procalcitonin, HGF, and IL-2Rα with an AUC of 0.84 (0.73 to 0.94). To validate our models, we employed experimental infection of mice with C. difficile. Antibiotic-treated mice were challenged with C. difficile and a similar panel of serum biomarkers was measured. Applying each model to the mouse cohort of severe and nonsevere CDI revealed AUCs of 0.59 (0.44 to 0.74), 0.96 (0.90 to 1.0), and 0.89 (0.81 to 0.97). In both human and murine CDI, models based on serum biomarkers predicted adverse CDI outcomes. Our results support the use of serum-based biomarker panels to inform Clostridioides difficile infection treatment. IMPORTANCE Each year in the United States, Clostridioides difficile causes nearly 500,000 gastrointestinal infections that range from mild diarrhea to severe colitis and death. The ability to identify patients at increased risk for severe disease or mortality at the time of diagnosis of C. difficile infection (CDI) would allow clinicians to effectively allocate disease modifying therapies. In this study, we developed models consisting of only a small number of serum biomarkers that are capable of predicting both 30-day all-cause mortality and adverse outcomes of patients at time of CDI diagnosis. We were able to validate these models through experimental mouse infection. This provides evidence that the biomarkers reflect the underlying pathophysiology and that our mouse model of CDI reflects the pathogenesis of human infection. Predictive models can not only assist clinicians in identifying patients at risk for severe CDI but also be utilized for targeted enrollment in clinical trials aimed at reduction of adverse outcomes from severe CDI.

Abstract 044: Association Of Cardiovascular Comorbidities With Sars-cov-2 Seropositivity In A Population-based Cohort.

Circulation ◽  
2021 ◽  
Vol 143 (Suppl_1) ◽  
Author(s):  
Alexander Ivanov ◽  
Rahul V Annabathula ◽  
Aziz Hammoud ◽  
David X Zhao ◽  
Adolfo Correa ◽  
...  
Keyword(s):  
Heart Failure ◽  
Odds Ratio ◽  
Serological Test ◽  
Severe Disease ◽  
Case Series ◽  
Arterial Disease ◽  
Population Based ◽  
Community Research ◽  
Increased Risk ◽  
History Of

Background: Following the outbreak of SARS-COV2 > 7,750,000 Americans were diagnosed with COVID-19. Many comorbidities were found to be associated with increased risk of severe disease. Due to limited testing and high percent of asymptomatic cases the exact prevalence is unclear. Moreover, whether the presence of comorbidities is associated with an increased rate of COVID-19 remains unknown. Methods: COVID-19 Community Research Partnership (CCRP) is a prospective cohort designed to collect information about the community's coronavirus exposures, symptoms, and prevalence (NCT04342884). Serological substudy is a prospective case series evaluating development of IgM or IgG in randomly selected 5000 participants from the CCRP cohort. Serological test kits are shipped to the volunteers monthly. Prevalence of comorbidities was estimated using electronic health records. Results: There were 4902 patients included in the analysis (Figure). Of those, 2,832 (57.8%) were female, mean age±SD was 49.6±14.4. There were 3,871 (79%) Caucasians, 422 (8.6%) - African Americans and 242 (4.9%) - Hispanics (Table). From May 2020 to August 2020, 424 patients (8.7%) seroconverted (IgM or IgG positive): 327 (6.7%) were found to be IgM positive/ IgG negative, 38 (0.8%)- IgM negative/IgG positive and 59 (1.2%) - IgM positive/ IgG positive. Prevalence of comorbidities was low: 1,318 (26.9%) patients have hypertension, 1,379 (28.1%)- hyperlipidemia, 413 (8.4%)- diabetes, 217 (4.4%)- coronary artery disease, 156 (3.2%)- peripheral arterial disease, 132 (2.7%)- atrial fibrillation, 95 (1.9%)- history of deep venous thrombosis and pulmonary embolism, and 54 (1.1%)- history of heart failure (HF). Only the presence of HF was associated with an increased odds ratio of seroconversion OR 2.4, (1.21- 4.87), p<0.012. This association remained robust after controlling for age, sex and race. Conclusion: Prevalence of seroconversion was near 9%. Presence of heart failure was independently associated with an increased odds ratio of seroconversion.

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