Abstract 13: Elevated Atmospheric Levels of Environmental Allergens Might be Associated with Decreased Risk of an Immunologic Reaction to an Etiologic Trigger in Kawasaki Disease

Circulation ◽  
2015 ◽  
Vol 131 (suppl_2) ◽  
Author(s):  
Cedric Manlhiot ◽  
Sunita O’Shea ◽  
Bailey Bernknopf ◽  
Nita Chahal ◽  
Brian W McCrindle
Keyword(s):  
Kawasaki Disease ◽  
Hospital Admissions ◽  
Fungal Species ◽  
Linear Regression Models ◽  
Greater Toronto Area ◽  
Etiologic Agents ◽  
Total Pollen ◽  
Specific Species ◽  
Fungi Imperfecti ◽  
Discharge Database

Introduction: There is considerable interest in identifying potential etiologic and/or triggering agents for the severe immune response associated with Kawasaki disease (KD). The presence of environmental allergens might modulate the odds of triggering such a response despite those allergens not being direct etiologic agents. Methods: We queried the Canadian hospital discharge database (Canadian Institute for Health Information) for hospital admissions associated with a discharge diagnosis of KD in 2011 in the Greater Toronto Area. Atmospheric levels of pollens (35 species), spores (24 species) and fungi (27 species) were measured by Aerobiology Research Laboratories (Nepean, Ontario). A number of separate models were tested using theoretical incubation periods of 0, 7, 14 or 21 days. Correlation between KD cases and atmospheric levels of environmental allergens were assessed in linear regression models. Results: n=145 patients with KD were included. The highest levels of environmental allergens were in summer months. Overall atmospheric pollens levels were not associated with the KD cases (total pollen count r=0.04, p=0.54); there was no consistent pattern of association with specific pollens. . However, higher levels of spores were associated with a decreased prevalence of KD for all spore species (r=-0.23, p<0.001). Associations were observed for 6 of 19 specific species detected (p<0.001), including leptosphaeria, ascospores, oospore, coprinus/coprinellus, basidiospores, and uredinales . The same pattern was observed for all fungi species (r=-0.17, p=0.009). Associations were observed for 5 of 26 specific fungal species (p=0.002), including alternaria, cladosporium, epicoccum, fusarium, and fungi imperfecti . There were no discernable patterns regarding a potential incubation period. Conclusions: High levels of environmental allergens, particularly fungus and spores, were associated with lower incidence of KD. These results suggest that environmental allergens, even if they are not etiologic agents for KD, might modulate the threshold necessary for the actual etiologic/triggering agent. Atmospheric levels of environmental allergens might be partly responsible for the KD seasonality patterns observed in Canada.

Abstract O.02: Validation of Kawasaki Disease Incidence Assessment as Derived from Health System Administrative Databases vs. Active Retrospective Surveillance in Ontario, Canada

Circulation ◽  
2015 ◽  
Vol 131 (suppl_2) ◽  
Author(s):  
Cedric Manlhiot ◽  
Sunita O’Shea ◽  
Bailey Bernknopf ◽  
Michael Labelle ◽  
Mathew Mathew ◽  
...  
Keyword(s):  
Kawasaki Disease ◽  
Hospital Discharge ◽  
Hospital Admissions ◽  
Disease Incidence ◽  
Administrative Databases ◽  
Canadian Hospital ◽  
Hospital Discharge Database ◽  
Incident Cases ◽  
Discharge Database

Introduction: Historically, 2 methods have been used to determine the incidence of Kawasaki disease (KD): active or passive surveillance, or the use of administrative databases. Given the increasing regulatory requirements, mainly around patient privacy, periodic retrospective surveillances have become increasingly challenging. Administrative databases are not curated datasets and doubts have been cast on their accuracy. Methods: The Hospital for Sick Children has been conducting retrospective triennial surveillances of KD since 1995 by contacting all hospitals in Ontario and manually reviewing all cases through chart review, reconciling inter-hospital transfers and multiple readmissions. We queried the Canadian hospital discharge database (Canadian Institute for Health Information) for hospitalizations associated with a diagnosis of KD between 2004-9. The administrative dataset was manually reviewed; patient national health number, institution and dates of admission/discharge were used to identify inter-hospital transfers, readmission and follow-up episodes. Results: The Canadian hospital discharge database reported 1,685 admissions during the study period (281±44 per year) for Ontario. Manual review of the dataset identified 219 (13%) as inter-hospital transfers (56, 26%), readmissions (122, 56%), admissions for follow-up of coronary artery aneurysms (14, 6%) or hospital admissions not related to KD (27, 12%). When these admissions were removed, the total number of incident cases for the study period was 1,466 (244±45 per year). The retrospective triennial surveillance identified 1,373 KD cases during the same period (229±33 per year). The Canadian hospital discharge database overestimated the number of cases in all 6 years by an average of 6.7±5.9%. The overestimation likely comes from patients who were originally diagnosed with KD but in whom the diagnosis of KD was subsequently excluded (historically ~5-6%). Conclusions: Reliance on administrative data to determine incidence of KD is possible and accurate; data should be manually reviewed to remove non-incident cases and estimates should be adjusted to reflect the expected proportion of patients in whom the diagnosis of KD will be subsequently excluded.

scholarly journals Hospitalisation for COPD in Puglia: the role of hospital discharge database to estimate prevalence and incidence

2016 ◽  
Vol 70 (3) ◽  
Author(s):  
P. Trerotoli ◽  
N. Bartolomeo ◽  
A.M. Moretti
Keyword(s):  
Disease Management ◽  
Hospital Discharge ◽  
Respiratory Diseases ◽  
Hospital Admissions ◽  
Diagnostic Procedures ◽  
Chronic Respiratory Disease ◽  
Chronic Obstructive ◽  
Chronic Respiratory Diseases ◽  
Hospital Discharge Database ◽  
Discharge Database

Background and aim. Chronic Obstructive Pulmonary Disease (COPD), although largely preventable, is a great health burden in all the countries worldwide. Statistics of morbidity and mortality of COPD show the need for correct management of the disease. Chronic Obstructive Respiratory Diseases (DRG 88) are in 9th place for discharge in in-patient hospital admission. It is necessary to establish specific indicators which are efficacious and relevant for the patient, the doctor and the health manager. This study will analyse the information in respect of hospital admissions (Hospital discharge database) in Puglia for the period 2000-2005. Methods. The analysis was carried out utilising the Puglia Region hospital patient discharge database, selecting those patients with admission for chronic respiratory disease as principal or secondary diagnosis. Results. Chronic respiratory diseases are more frequent in males and in people over 45 years old with frequency increasing with age. Geographical distribution shows that there are greater rates of hospitalisation in big cities and in the neighbourhood of industrial areas. Although the trend over time is slight. A higher percentage of re-admission has been found for patients with COPD, and the interval between the two admissions occurs within one or two months; the diagnosis at the second admission is the same as for the first. 10.6% of discharge forms report one diagnosis, especially in patients older than 65 years of age. Little could be said about diagnostic procedures because these are not reported on the discharge form. Conclusion. Hospitalisation data confirms expectations regarding age and sex of patients. The high hospitalisation rates indicate that in-patients care still remains the only viable treatment for COPD and other chronic respiratory diseases. The high number of exacerbations reflect the absence of out-patients service or community care, and the same diagnosis in more than one episode shows the lack of efficiency of health services and disease management. This data is necessary to understand disease distribution and the modification of disease management in order to reduce health care costs, to increase efficacy in disease control and to limit repeated exacerbation and so to obtain the maximum benefit for the patients.

scholarly journals COVID-19 Incidence and Hospitalization Rates are Inversely Related to Vaccination Coverage Among the 112 Most Populous Counties in the United States

2021 ◽  
Author(s):  
Jeffrey E. Harris
Keyword(s):  
United States ◽  
Vaccination Coverage ◽  
Hospital Admissions ◽  
The United States ◽  
Lower Half ◽  
Linear Regression Models ◽  
Percentage Point Increase ◽  
Hospitalization Rates ◽  
Point Increase ◽  
Log Linear

AbstractWe tested whether COVID-19 incidence and hospitalization rates were inversely related to vaccination coverage among the 112 most populous counties in the United States, each with a population exceeding 600,000. We measured vaccination coverage as the percent of the total population fully vaccinated as of July 15, 2021, with the exception of 11 Texas counties, where the cutoff date was July 14, 2021. We measured COVID-19 incidence as the number of confirmed cases per 100,000 population during the 14-day period ending August 12, 2021. We measured hospitalization rates as the number of confirmed COVID-19 admissions per 100,000 population during the same 14-day period. COVID-19 incidence was significantly higher among counties in the lower half of the distribution of vaccination coverage (incidence 543.8 per 100,000 among 56 counties with mean coverage 42.61%) than among counties in the lower half of the distribution of coverage (incidence 280.7 per 100,000 among 56 counties with mean coverage 57.37%, p < 0.0001). Hospital admissions were also significantly higher among counties in the lower half of the distribution (55.37 per 100,000) than in the upper half of the distribution (20.48 per 100,000, p < 0.0001). In log-linear regression models, a 10-percentage-point increase in vaccination coverage was associated with a 28.3% decrease in COVID-19 incidence (95% confidence interval, 16.8 – 39.7%), a 44.9 percent increase in the rate of COVID-19 hospitalization (95% CI, 28.8 – 61.0%), and a 16.6% decrease in COVID-19 hospitalizations per 100 cases (95% CI, 8.4 – 24.8%). Higher vaccination coverage is associated not only with significantly lower COVID-19 incidence, but also significantly less severe cases of the disease.

Prevalence and predictors of coronary artery disease in adults with Kawasaki disease

2014 ◽  
Vol 25 (6) ◽  
pp. 1124-1129 ◽  
Author(s):  
Jalaj Garg ◽  
Parasuram Krishnamoorthy ◽  
Chandrasekar Palaniswamy ◽  
Rajiv Paudel ◽  
Saurav Chatterjee ◽  
...  
Keyword(s):  
Risk Factors ◽  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Kawasaki Disease ◽  
Hospital Admissions ◽  
Artery Aneurysm ◽  
Adult Patients ◽  
Significant Difference ◽  
Traditional Risk Factors ◽  
Artery Disease

AbstractBackground: Accelerated coronary atherosclerosis in patients with Kawasaki disease, in conjunction with coronary artery aneurysm and stenosis that characterise this disease, are potential risk factors for developing coronary artery disease in young adults. We aimed to determine the prevalence and predictors of coronary artery disease in adult patients with Kawasaki disease. Methods: All patients aged 18−55 years of age diagnosed with Kawasaki disease were sampled from Nationwide Inpatient Sample database using International Classification of Diseases 9th revision (ICD 9 code 446.1) from 2009 to 2010. Demographics, prevalence of coronary artery disease, and other traditional risk factors in adult patients with Kawasaki disease were analysed using ICD 9 codes. Results: The prevalence of Kawasaki disease among adults was 0.0005% (n=215) of all in-hospital admissions in United States. The mean age was 27.3 years with women (27.6 years) older than men (27.1 years). Traditional risk factors were hypertension (21%), hyperlipidaemia (15.6%), diabetes (11.5%), tobacco use (8.8%), and obesity (8.8%), with no significant difference between men and women. Coronary artery disease (32.4%), however, was more prevalent in men (44.7%) than in women (12.1%; p=0.03). In multivariate regression analysis, after adjusting for demographics and traditional risk factors, hypertension (OR=13.2, p=0.03) was an independent risk factor of coronary artery disease. Conclusion: There was increased preponderance of coronary artery disease in men with Kawasaki disease. On multivariate analysis, hypertension was found to be the only independent predictor of coronary artery disease in this population after adjusting for other risk factors.

scholarly journals Influence of particulate matter and meteorological conditions on multiple sclerosis relapse: a preliminary study in São Paulo, Brazil

2017 ◽  
Vol 6 (8) ◽  
Author(s):  
Fernanda Rodrigues Diniz ◽  
Ana Lúcia Frony-Macedo ◽  
Marina Piacenti-Silva
Keyword(s):  
Multiple Sclerosis ◽  
Particulate Matter ◽  
Relative Humidity ◽  
Linear Models ◽  
Hospital Admissions ◽  
Demyelinating Disease ◽  
Inflammatory Responses ◽  
Sao Paulo ◽  
São Paulo ◽  
Linear Regression Models

Introduction: Multiple sclerosis (MS) is a chronic, inflammatory, and demyelinating disease of the central nervous system, which in some cases may be characterized by recurrent relapses of inflammation that cause mild to severe neurological disability. Some studies around the world have associated the increase of systemic inflammatory responses and neuro-inflammation of patients with exposure to high levels of particulate matter (PM10) and certain conditions of temperature and humidity. Materials and methods: The objective of this study was to verify the influence of the concentration of PM10 and meteorological variables (air temperature and relative humidity) on the number of hospitalizations forMS in the city of São Paulo. Data from 2008 to 2016, which passed through descriptive statistics and inferences, were used as multiple linear regression models. Results: The models obtained indicated a positive relation (p < 0.01) in the number of hospitalizations with the increase of PM10and relative humidity, showing that 31.23% of hospital admissions can be explained by these variables. Conclusion: These results are important, since there are no other studies from Brazil that correlate meteorological and air quality variables with MS.Descriptors: Air Pollution; Multiple Sclerosis; Linear Models.

scholarly journals Sex-differences in the effect of obstructive sleep apnea on patients hospitalized with pulmonary embolism and on in-hospital mortality

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Javier de-Miguel-Diez ◽  
Marta Lopez-Herranz ◽  
Valentín Hernandez-Barrera ◽  
David Jimenez ◽  
Manuel Monreal ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Obstructive Sleep Apnea ◽  
Sex Differences ◽  
Sleep Apnea ◽  
Hospital Mortality ◽  
Hospital Admissions ◽  
Non Invasive ◽  
Non Invasive Ventilation ◽  
Obstructive Sleep ◽  
Discharge Database

AbstractWe determined sex differences in the prevalence of obstructive sleep apnea (OSA) among patients hospitalized with pulmonary embolism (PE) in Spain (2016–2018). We also compared outcomes according to the presence of OSA, and identified variables associated with in-hospital-mortality (IHM) after PE using the Spanish National Hospital Discharge Database. We identified 46,794 hospital admissions for PE; of these, 5.47% had OSA. OSA was more prevalent among men than women (7.57% vs. 3.65%, p < 0.001), as in the general population. Propensity score matching did not reveal differences in concomitant conditions or procedures between patients with and without OSA, except for the use of non-invasive ventilation, which was more frequent in patients with OSA. IHM was similar in patients with and without OSA (3.58% vs. 4.31% for men and 4.39% vs. 4.93% for women; p > 0.05). Older age, cancer, atrial fibrillation, non-septic shock, and need for mechanical ventilation increased IHM in men and women with OSA hospitalized with PE. The logistic regression model showed no sex differences in IHM among patients with OSA.

scholarly journals Starch Degradation by Microbial Communities in Soils from Oldupai Gorge (Tanzania)

2019 ◽  
Author(s):  
Tolutope Akeju ◽  
Peter Dunfield ◽  
Julio Mercader
Keyword(s):  
Microbial Communities ◽  
High Throughput Sequencing ◽  
Fungal Species ◽  
Soil Samples ◽  
Model Organisms ◽  
Starch Degradation ◽  
Soil Conditions ◽  
Soil Microbial ◽  
Specific Species ◽  
Microbial Dna

The taphonomy behind ancient starch preservation is very poorly understood in archaeological contexts. This understanding could be aided by biogeochemical experimentation in controlled laboratory environments to isolate degradation pathways in soils, and how this degradation is affected by biotic and abiotic variables. The aims of this project were to:1) Identify and characterize bacterial and fungal species responsible for the degradation of starch in Tanzanian soils2) Determine how factors such as the starch source, soil water, and soil aeration affect the activity of these microbes3) Observe the alterations of starch granules inflicted by degradation by different microbial communities. Field and laboratory studies were designed to achieve these objectives:In the field, bulk soil samples (not adjacent to plant roots/tubers) and tubersphere soil samples (attached to starchy plant tubers) were collected for analysis of microbial communities via high-throughput sequencing of soil microbial DNA. Laboratory analysis of these samples is ongoing, but initial results suggest that particular starch-degrading microbes associate with particular starchy tubers. Secondly, controlled laboratory microcosms of soils amended with various starch types were incubated under different conditions. The microbial communities degrading the starch were followed over time via DNA sequencing and the starch taphonomy observed microscopically. These studies have shown that hardy, spore-forming bacteria of the phylum Firmicutes dominate starch-degrading microbial communities in the Tanzanian soils, but that the specific species change depending on experimental variables. The soil conditions and the source of the starch dramatically affected both the degradation rate and the specific microbial species involved. These findings suggest that starch degradation and taphonomy may be site-specific, that certain starches may be more prone to preservation than others may, and that starch-degradation studies using model organisms may not always be representative of the field conditions.

scholarly journals Epidemiological Pattern of Traumatic Brain Injury in Brazil between 2008 and 2019

2021 ◽  
Author(s):  
André Akira Ramos Takahashi ◽  
Saulo Barros Teixeira ◽  
Giovanna Zambo Galafassi ◽  
Maria Beatriz Almeida Silva ◽  
Victoria Fernandez Comprido ◽  
...  
Keyword(s):  
Brain Injuries ◽  
Hospital Admissions ◽  
Descriptive Analysis ◽  
Public Health Problem ◽  
Secondary Data ◽  
Main Concern ◽  
Linear Regression Models ◽  
Mato Grosso ◽  
Unified Health System ◽  
And Gender

Abstract Introduction Traumatic brain injuries (TBIs) are a public health problem with high economic impact, as well as an important cause of death and sequela in polytrauma patients, affecting mainly young adults. Objective To analyze the temporal trend of TBI incidence in Brazil between 2008 and 2019, according to age group and gender. Methods An ecological study, based on secondary data from hospital admissions for TBI in all Brazilian states between 2008 and 2019. The numbers were collected using the hospital information system of the Unified Health System in Brazil. We performed a descriptive analysis using the data obtained. Linear regression models were used to measure the incidence trend of TBI in the period adopted. Results The state of Piauí had the highest increase in the incidence of TBI in the country in the last 10 years (coefficient β = 63.43 e p = 0.002). The main concern, though, is the increase in the incidence of TBI amongst children (0–4 years old) in the states of Ceará (β = 31.22 and p < 0.001 for boys; β = 42.20 and p < 0.001 for girls), Paraná (β = 37.26 and p = 0.011 for boys; β = 25.90 and p = 0.015 for girls), Pernambuco (β = 20.08 and p = 0.016 for girls), Mato Grosso (β = 18.76 and p = 0.005 for boys; β = 16.11 and p = 0.035 for girls), and Distrito Federal (β = 48.87 and p = 0.004 for girls; β = 48.28 and p = 0.006 for boys). Conclusion The analysis of the results is able to point out improvements that can be made. Besides that, it is remarkably important to redirect public polices to preventive medicine since many of the TBI causes are avoidable through awareness and education of the population.

Incidence of Thrombosis in Children with Tunneled Central Venous Access Devices Versus Peripherally Inserted Central Catheters (PICC lines)

Blood ◽  
2012 ◽  
Vol 120 (21) ◽  
pp. 1146-1146
Author(s):  
Maralee Kanin ◽  
Guy Young
Keyword(s):  
Hospital Discharge ◽  
Pediatric Patients ◽  
Hospital Admissions ◽  
Conflicts Of Interest ◽  
Central Venous ◽  
Peripherally Inserted Central Catheters ◽  
Hospital Discharge Database ◽  
The Mean ◽  
Discharge Database ◽  
Central Catheters

Abstract Abstract 1146 Background: The recent proliferation in deep vein thrombosis (DVT) in pediatric patients has been attributed to the improved care of children with serious and life-threatening disorders as well as the prolonged survival of children with chronic disease. Often such treatment involves the insertion of central venous catheters. Yet the incidence of DVT associated with peripherally-inserted central catheters (PICC) and tunneled Lines (TL) has not been investigated in depth. Thus we report a retrospective database study to determine the incidence of DVT in pediatric patients with PICC and TL lines. Methods: Children <18 years of age who were admitted to Children's Hospital Los Angeles from January 1, 2003- December 31, 2009 were eligible for inclusion. Data were extracted from the CHLA hospital discharge database which includes data on all procedures and up to 20 diagnoses per admission. Diagnoses and procedures were identified by International Classification of Disease, Ninth Revision (ICD-9) coding in the hospital discharge database. PICC codes used were: 365.69 and TL codes used were: 365.57, 365.58, 365.60, 365.61, 365.63, 365.65, 365.66. DVT codes were: 415.11, 415.12, 415.19, 452, 453.0, 453.1, 453.3, 453.41, 453.42, 453.8, 453.9. Patient diagnoses other than DVT were grouped according to ICD. 9 coding into categories termed Complex Chronic Conditions (CCC) as previously described. To ensure that the DVT event was related to the individual line insertion, patients were excluded if their lines were placed after three days of hospital admissions and if they received more than one line or more than one type of line. A limitation of the data is the lack of information regarding the length of time the catheters remained in place. Results: Over the 6 year period of this study, 1449 eligible subjects were identified of whom 29 had DVTs (2%). There were 947 PICC insertions and 502 TL insertions. The mean age of PICC patients was 12±4 years and 56% were male. The mean age of TL patients was 8±6 years and 54% were male. There were 9 (0.95%) DVTs in PICC patients, and 20 (3.9%) DVTs in TL patients. The odds ratio for developing a DVT with a TL was 3.6 (p-value.002; confidence interval 1.6–8.1) which remained significant at 3.8 (p=.001; confidence value 1.7–8.55) when controlling for the presence of CCCs. Conclusions: Despite the proliferation in the utilization of PICC in recent years, it appears that they are not associated with a higher risk for DVT than TL, and in fact, the data from this study suggests that TL were associated with more DVT than PICC. Although it is possible that the results could be explained by the fact that TL in general remain in place for a longer period of time than PICC, this study nonetheless provides important reassurance that PICC appear to have relatively low thrombotic potential when compared to TL. Disclosures: No relevant conflicts of interest to declare.

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