PedCAPNETZ – prospective observational study on community acquired pneumonia in children and adolescents

Abstract Background Pediatric community acquired pneumonia (pedCAP) is one of the leading causes for childhood morbidity accounting for up to 20% of pediatric hospital admissions in high income countries. In spite of its high morbidity, updated epidemiological and pathogen data after introduction of preventive vaccination and novel pathogen screening strategies are limited. Moreover, there is a need for validated recommendations on diagnostic and treatment regimens in pedCAP. Through collection of patient data and analysis of pathogen and host factors in a large sample of unselected pedCAP patients in Germany, we aim to address and substantially improve this situation. Methods pedCAPNETZ is an observational, multi-center study on pedCAP. Thus far, nine study centers in hospitals, outpatient clinics and practices have been initiated and more than 400 patients with radiologically confirmed pneumonia have been enrolled, aiming at a total of 1000 study participants. Employing an online data base, information on disease course, treatment as well as demographical and socioeconomical data is recorded. Patients are followed up until day 90 after enrollment; Comprehensive biosample collection and a central pedCAPNETZ biobank allow for in-depth analyses of pathogen and host factors. Standardized workflows to assure sample logistics and data management in more than fifteen future study centers have been established. Discussion Through comprehensive epidemiological, clinical and biological analyses, pedCAPNETZ fills an important gap in pediatric and infection research. To secure dissemination of the registry, we will raise clinical and scientific awareness at all levels. We aim at participating in decision making processes for guidelines and prevention strategies. Ultimately, we hope the results of the pedCAPNETZ registry will help to improve care and quality of life in pedCAP patients in the future.

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Cost of illness of community-acquired pneumonia. Review of the literature and possible strategies in the Serbian health care setting

Farmeconomia Health economics and therapeutic pathways ◽

10.7175/fe.v13i3.275 ◽

2012 ◽

Vol 13 (3) ◽

pp. 133-139 ◽

Cited By ~ 1

Author(s):

Mihajlo Jakovljevic ◽

Vojislav Cupurdija ◽

Zorica Lazic

Keyword(s):

Health Care ◽

Length Of Stay ◽

Cost Of Illness ◽

Care Setting ◽

Hospital Admissions ◽

Pneumonia Severity Index ◽

Community Acquired Pneumonia ◽

Health Care Setting ◽

Severe Illness ◽

High Morbidity

Community-acquired pneumonia (CAP) represents a potentially severe illness with high incidence and significant economic impact. The estimated incidence varies from 1.6 to 13.4 cases/1000 inhabitants per year. Its burden of disease is attributed to high morbidity, mortality and serious health care utilization and expenditure throughout the world. The identification of determinants of high treatment costs could help in defining strategies for their reduction and more efficient use of the existing resources. In this article, a review of the existing literature about CAP cost-of-illness is provided, together with some considerations about possible strategies to decrease CAP costs in the Serbian health care setting. Available reports from cost-of-illness trials of CAP are relatively scarce. Most of them highlight the high costs generated by treatment protocols, with important differences between inpatients and outpatients. The inpatient cases of CAP varies from 18 to 60%. The therapy represents 10 to 15% of the overall costs of CAP. The costs of CAP treatment among inpatients are 7.9 times higher than those in outpatients. In case of complications and prolonged length of stay, this difference could even be 17 to 51 times higher. Frequent hospital admissions could be avoided, which would reduce the costs of CAP treatment. An important precondition for successful cost containment would be higher adherence to clinical guidelines, particularly reflected through Pneumonia Severity Index-a (PSI) application. Thus, it would be possible to significantly reduce the length of stay in hospital, in majority of patients, without jeopardizing their health or influencing the clinical course of illness.

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1683. Hospital Admission Patterns in Adult Patients with Complicated Urinary Tract Infections (cUTIs): Identification of Potentially Avoidable Hospital Admissions Across United States (US) Hospitals

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.1861 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S825-S826

Author(s):

Thomas Lodise ◽

Teena Chopra ◽

Brian Nathanson ◽

Katherine Sulham

Keyword(s):

Hospital Admission ◽

Hospital Admissions ◽

Panel Member ◽

Inclusion Criteria ◽

Independent Contractor ◽

Healthcare Database ◽

Admission Rates ◽

Comorbidity Index ◽

Multi Center Study ◽

Tract Infections

Abstract Background There is an increase in hospital admissions for cUTI in the US despite apparent reductions in the severity of admissions. However, there are scant data on cUTI hospital admission rates from the emergency department (ED) stratified by age, infection severity, and presence of comorbidities. This study described US hospitalization patterns among adults who present to the ED with a cUTI. We sought to quantify the proportion of admissions that were potentially avoidable based on presence of sepsis and associated symtpoms as well as Charlston Comorbidity Index (CCI) scores. Methods A retrospective multi-center study using data from the Premier Healthcare Database (2013-18) was performed. Inclusion criteria: (1) age ≥ 18 years, (2) primary cUTI ED/inpatient discharge diagnosis, (3) positive blood or urine culture between index ED service days -5 to +2. Transfers from acute care facilities were excluded. Based on ICD-9/10 diagnosis codes present on admission, incidence of hospital admissions were stratified by age (≥ 65 years vs. < 65 years), presence of sepsis (S), sepsis symptoms but no sepsis codes (SS) (e.g., fever, tachycardia, tachypnea, leukocytosis, etc.), and CCI. Results 187,789 patients met inclusion criteria. The mean (SD) age was 59.7 (21.9), 40.4% were male, 29.4% had sepsis, 16.7% had at least 1 SS symptom (but no S), and 53.9% had no evidence of S or SS. The median [IQR] CCI was 1 [0, 3]. 119,668 out of 187,789 (63.7%) were admitted to hospital. Among inpatients, median [IQR] length of stay (LOS) and total costs were 5 [3, 7] days and $7,956 [$4,834, $13,960] USD. Incidence of hospital admissions by age, presence of S/SS, and CCI score are shown in the Table. 18.9% of admissions (22,644/119,668) occurred in patients with no S/SS and a CCI ≤ 2. Their median [IQR] LOS and total costs were 3 [2, 5] days and $5,575 [$3,607, $9,133]. Incidence of Hospital Admission by Age, Charlson comorbidity index (CCI), Presence of Sepsis (S), and Presence of Sepsis Symptoms (SS) Conclusion Nearly 1 in 5 cUTI hospital admissions may be avoidable. Given the resources associated with the management of inpatients with cUTIs, these findings highlight the critical need for healthcare systems to develop well-defined criteria for hospital admission based on presence of comorbid conditions and infection severity. Preventing avoidable hospital admissions has the potential to save the healthcare system substantial costs. Disclosures Thomas Lodise, PharmD, PhD, Paratek Pharmaceuticals, Inc. (Consultant) Teena Chopra, MD, MPH, Spero Therapeutics (Consultant, Advisor or Review Panel member) Brian Nathanson, PhD, Spero Therapeutics (Independent Contractor) Katherine Sulham, MPH, Spero Therapeutics (Independent Contractor)

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Lymphocyte Count and Serum PCT L ev els Improve the Sensitivity of CURB-65 in Prediction of 30-day Mortality of Patients with Community-acquired Pneumonia

10.21203/rs.2.13741/v1 ◽

2019 ◽

Author(s):

Jin Zhang ◽

Rui Tao ◽

Pengcheng Liu ◽

Dahai Zhao ◽

Jiegou Xu

Keyword(s):

Logistic Regression ◽

Lymphocyte Count ◽

Scoring System ◽

Community Acquired Pneumonia ◽

Hospitalized Patients ◽

Diagnostic Model ◽

High Morbidity ◽

Operating Characteristics ◽

Blood Biomarkers ◽

Combined Models

Abstract Background Community-acquired pneumonia (CAP) is an infectious disease with high morbidity and mortality worldwide. The CURB-65 score and other blood biomarkers were used to evaluate prognosis of hospitalized patients with CAP. The aim of our study is t o evaluate the prognostic values of other blood biomarkers and the CURB-65 score in hospitalized patients with community-acquired pneumonia (CAP). Methods A retrospective study of clinical data of in-hospitalized adult CAP patients who fulfilled the CAP criteria and were admitted to the Second Affiliated Hospital of Anhui medical university between January 2015 and December 2018 was conducted. The CURB-65 score was calculated, and other biomarkers including blood lymphocyte countat and serum PCT (a propeptide of calcitonin) level were collected at enrolment. Logistic regression analysis was performed to develop combined models to predict 30-day mortality in overall hospitalized and/or the ICU admission of CAP patients. Then, receiver operating characteristics curve (ROC) analysis was conducted to measure and compare the prognostic values of the CURB-65 score and biomarkers in the combined models.Results The ROC curve analysis using logistic regression of the new combined models showed that the CURB-65 score combined with lymphocyte count and serum PCT level (designated as CURB-65L P) improved the predictive value and was sensitive diagnostic model in predicting the 30-day mortality of CAP patients.Conclusion Serum level of lymphocytes or PCT alone is a strong prognostic factor for evaluation of 30-day mortality of CAP patients. Incorporation of both factors improves the sensitivity of the CURB-65 scoring system in the prediction of the 30-day mortality. This new CURB-65LP scoring system is simple, but more accurate for evaluating the severity of CAP with higher sensitivity and specificity than the current CURB-65 scoring system.

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IDENTIFIED PLANTS WHICH ARE BELONGS IN INDIGOFERA GENERA IN THOOTHUKUDI DISTRICT, TAMIL NADU, INDIA

International Journal of Research -GRANTHAALAYAH ◽

10.29121/granthaalayah.v8.i11.2020.2455 ◽

2020 ◽

Vol 8 (11) ◽

pp. 287-295

Author(s):

A. Rajesh

Keyword(s):

Data Base ◽

Tamil Nadu ◽

Soil Types ◽

Online Data ◽

Size And Shape ◽

Herbaceous Perennials ◽

Botanical Description ◽

Indigofera Hirsuta ◽

Online Data Base ◽

Indigofera Tinctoria

The Indigofera are frequently shrubs, and some are small trees or herbaceous perennials or annuals. These have pinnate leaves. Racemes of flowers grow in the leaf axils, in hues of red, but there are a few white- and yellow-flowered species. The fruit is a legume pod of varying size and shape. Botanical description schedule as; Kingdom: Plantae, (unranked): Angiosperms, (unranked): Eudicots, (unranked): Rosids, Order: Fabales, Family: Fabaceae, Subfamily: Faboideae, Tribe: Indigofereae, Genus: Indigofera. 1620 plant name records match your search criteria Indigofera. The names found have these generic epithets: as accepted in the plant list online data base. That plants were; Indigofera argentea / I. articulate, Indigofera aspalathoides Vahl. Indigofera enneaphylla Linn. Indigofera glabra Linn. Indigofera glandulosa Willd. Indigofera linifolia Retz. Indigofera pulchella Roxb. Indigofera tinctoria Linn. Indigofera trifoliata Linn. Indigofera trita Linn. Books mentioned 04 species were not latest updated Plant List Online data base which were; Indigofera caerulea Roxb. Indigofera cordifolia. Indigofera frutescens. Indigofera hirsuta. According to the Results and Discussion this research revealed that, 20 species of Indigofera genera by the evidence of books and 04 species synonyms like updated latest in online data base. However, 16 species available in the Thoothukudi District 16 species available commonly and 04 species were rarely showed in Thoothukudi District by randomly field to all soil types of areas.

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Systemic Monotherapy Treatments for Generalized Pustular Psoriasis: A Systematic Review

Journal of Cutaneous Medicine and Surgery ◽

10.1177/1203475418773358 ◽

2018 ◽

Vol 22 (6) ◽

pp. 591-601 ◽

Cited By ~ 1

Author(s):

Linghong Linda Zhou ◽

Jorge R. Georgakopoulos ◽

Arvin Ighani ◽

Jensen Yeung

Keyword(s):

Treatment Options ◽

Treatment Algorithm ◽

Pustular Psoriasis ◽

Treatment Modalities ◽

High Morbidity ◽

Eligibility Criteria ◽

Level Of Evidence ◽

Treatment Regimens ◽

Generalized Pustular Psoriasis ◽

Pubmed Search

Generalized pustular psoriasis (GPP) is a rare but serious and difficult to treat cutaneous disease, with high morbidity and mortality rates. Despite the numerous treatment regimens available, the overall quality of evidence-based research is limited with a lack of an algorithmic approach available. In this review, we aim to evaluate the current level of evidence regarding the efficacy and safety/tolerability of systemic monotherapies available in the treatment of GPP. A comprehensive MEDLINE, EMBASE, and PubMed search of clinical studies examining systemic monotherapy treatment options for GPP was conducted. In total, 31 studies met eligibility criteria. Described treatment modalities included retinoids, cyclosporine, biologics, and dapsone. Despite the lack of high-quality evidence or a well-accepted treatment algorithm for GPP, systemic retinoids, cyclosporine, biologics, and dapsone are all possible first-line agents, with retinoids being one of the best-supported treatment options and biologics as an emerging therapeutic field with great potential requiring additional data. However, the final choice of treatment should be considered within the unique context of each patient.

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INTERNET SELF-EFFICACY DAN PSYCHOLOGICAL WELL-BEING: STUDI META-ANALISIS

Jurnal Psikologi ◽

10.35760/psi.2020.v13i2.3130 ◽

2020 ◽

Vol 13 (2) ◽

pp. 133-145

Author(s):

Endah Nawangsih

Keyword(s):

Data Base ◽

Self Efficacy ◽

Well Being ◽

Online Data ◽

Psychological Well Being ◽

Online Data Base

Tujuan dari studi meta-analisis ini adalah untuk mengetahui pengaruh penggunaan internet pada efikasi diri penggunaan internet (internet self-efficacy) dan kesejahteraan psikologis (psychological well-being). Publikasi dalam literatur dikumpulkan dengan menyelidiki artikel yang berkaitan dengan topik tersebut. Berdasarkan kriteria yang ditentukan oleh peneliti, 10 studi dimasukkan dalam analisis, yang merupakan hasil penelitian dari tahun 2005 hingga 2019 dan diperoleh dari online data base. Penelitian ini terdiri dari kelompok sampel 5769 individu. Analisis dilakukan dengan menggunakan dua artifak, yaitu koreksi kesalahan sampling serta koreksi kesalahan pengukuran. Hasil perhitungan memperlihatkan true r sebesar r = 0.626. Hasil dari metaanalisis menunjukkan internet self-efficacy memiliki korelasi positif yang signifikan dengan psychological well-being.

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Radiographically Confirmed Community-Acquired Pneumonia in Pediatric Patients Prior to Pneumococcal Vaccination in Nepal

Journal of Pediatric Infectious Diseases ◽

10.1055/s-0037-1607266 ◽

2017 ◽

Vol 13 (01) ◽

pp. 057-062

Author(s):

Dhruba Shrestha ◽

Ganendra Raya ◽

Amar Prajapati ◽

Suruchi Dhaubhadel ◽

Sushmita Puri ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Pleural Effusion ◽

Intensive Care Unit Admission ◽

Pneumococcal Vaccination ◽

Community Acquired Pneumonia ◽

Blood Cultures ◽

Hospital Treatment ◽

High Morbidity ◽

Rural Nepal

Background The massive burden of pediatric pneumonia is associated with high morbidity and mortality, particularly in developing countries where immunization programs are absent or recently been implemented. The objective of this study was to describe the number of hospitalizations and outcomes of children aged 1 month to 10 years with community-acquired pneumonia (CAP) between January 1, 2014, and June 30, 2015, in semi-rural Nepal. Methods This retrospective study was undertaken prior to the implementation of the pneumococcal conjugate vaccination (PCV) program in Bhaktapur district of Nepal. Chart review of children with CAP, defined as the presence of symptoms, physical examination findings compatible with bacterial pneumonia together with lobar consolidation on chest X-ray (CXR), was performed. Data extracted included laboratory parameters and blood cultures on admission, antibiotic treatment, and length of hospital stay, as well as complications, such as death, intensive care unit admission, pleural effusion, and empyema. Outcomes assessed were clinical improvement accompanied by radiological improvement of consolidation. Results During the study period, 367 patients were admitted with pneumonia, of which, 74 (20%) had definite CXR evidence of lobar pneumonia. A total of 86.5% of the cases were children < 5 years of age. Admission blood cultures from all patients were negative. More than 80% of patients had white blood cell (WBC) counts >11,000/mm3 and ≥ 75% neutrophils. The highest number of cases presented between February and July. Forty-three of 45 patients responded to crystalline penicillin (CP), and 25/27 patients treated with cefotaxime also responded; the mean duration of treatment was 10 ± 2.3 days. There were no deaths. None of the patients developed empyema, sepsis, or pleural effusion or required intensive care unit admission. Conclusions CAP in pre-PCV semi-rural Nepal mostly affects male children < 5 years old and peaks between March and May. In-hospital treatment with CP or cefotaxime is effective.

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Promising Anti-Hepatitis C Virus Compounds from Natural Resources

Natural Product Communications ◽

10.1177/1934578x1601100840 ◽

2016 ◽

Vol 11 (8) ◽

pp. 1934578X1601100 ◽

Cited By ~ 1

Author(s):

Tutik Sri Wahyuni ◽

Chie Aoki Utsubo ◽

Hak Hotta

Keyword(s):

Hepatocellular Carcinoma ◽

Hepatitis C Virus ◽

Hepatitis C ◽

Natural Resources ◽

Antiviral Agents ◽

High Morbidity ◽

Current Standard ◽

Treatment Regimens ◽

Medicinal Plant Extracts ◽

Ns3 Protease

Hepatitis C virus (HCV) infection is a major worldwide problem, which involves approximately 170 million people. High morbidity of patients is caused by chronic infection, which leads to liver cirrhosis, hepatocellular carcinoma and other HCV-related diseases. The sustained virological response (SVR) has been markedly improved to be >90% by the current standard interferon (IFN)-free treatment regimens with a combination of direct-acting antiviral agents (DAAs) targeting the viral NS3 protease, NS5A multi-function protein and NS5B RNA-dependent RNA polymerase, compared with 50–70% of SVR rates achieved by the previous standard IFN-based treatment regimens with or without an NS3 protease inhibitor. However, the emergence of DAA-resistant HCV strains and the limited access to the DAAs due to their high cost could be major concerns. Also, the long-term prognosis of patients treated with DAAs, such as the possible development of hepatocellular carcinoma, still needs to be further evaluated. Natural resources are considered to be good candidates to develop anti-HCV agents. Here, we summarize anti-HCV compounds obtained from natural resources, including medicinal plant extracts, their isolated compounds and some of their derivatives that possess high antiviral potency against HCV.

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Shining the light on eating disorders, incidence, prognosis and profiling of patients in primary and secondary care: national data linkage study

The British Journal of Psychiatry ◽

10.1192/bjp.2019.153 ◽

2019 ◽

Vol 216 (2) ◽

pp. 105-112 ◽

Cited By ~ 8

Author(s):

Joanne C. Demmler ◽

Sinead T. Brophy ◽

Amanda Marchant ◽

Ann John ◽

Jacinta O. A. Tan

Keyword(s):

Eating Disorders ◽

Odds Ratio ◽

Hospital Admissions ◽

Linkage Study ◽

Morbidity And Mortality ◽

High Morbidity ◽

National Data ◽

Specialist Services ◽

External Causes ◽

The Individual

BackgroundDiagnosing eating disorders can be difficult and few people with the disorder receive specialist services despite the associated high morbidity and mortality.AimsTo examine the burden of eating disorders in the population in terms of incidence, comorbidities and survival.MethodWe used linked electronic health records from general practitioner and hospital admissions in Wales, UK within the Secure Anonymised Information Linkage (SAIL) databank to investigate the incidence of new eating disorder diagnoses. We examined the frequency of comorbid diagnoses and prescribed medications in cases and controls in the 2 years before and 3 years after diagnosis, and performed a survival analysis.ResultsA total of 15 558 people were diagnosed with eating disorders between 1990 and 2017. The incidence peaked at 24 per 100 000 people in 2003/04. People with eating disorders showed higher levels of other mental disorders (odds ratio 4.32, 95% CI 4.01–4.66) and external causes of morbidity and mortality (odds ratio 2.92, 95% CI 2.44–3.50). They had greater prescription of central nervous system drugs (odds ratio 3.15, 95% CI 2.97–3.33), gastrointestinal drugs (odds ratio 2.61, 95% CI 2.45–2.79) and dietetic drugs (odds ratio 2.42, 95% CI 2.24–2.62) before diagnosis. These excess diagnoses and prescriptions remained 3 years after diagnosis. Mortality was raised compared with controls for some eating disorders, particularly in females with anorexia nervosa.ConclusionsIncidence of diagnosed eating disorders is relatively low in the population but there is a major longer term burden in morbidity and mortality to the individual.

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Association between malignancy and non-alcoholic Wernicke's encephalopathy: a case report and literature review

Neuro-Oncology Practice ◽

10.1093/nop/npv036 ◽

2015 ◽

Vol 3 (3) ◽

pp. 196-207 ◽

Cited By ~ 1

Author(s):

Evan Y. Choi ◽

William A. Gomes ◽

Missak Haigentz ◽

Jerome J. Graber

Keyword(s):

Literature Review ◽

Hospital Admissions ◽

Short Term Memory ◽

Medical Condition ◽

Case Reports ◽

Hematologic Malignancies ◽

Wernicke’S Encephalopathy ◽

Wernicke's Encephalopathy ◽

High Morbidity ◽

Fluid Attenuated Inversion Recovery

Abstract Background Wernicke's encephalopathy is a serious medical condition associated with high morbidity and mortality caused by deficiency of thiamine. This disease is classically associated with alcoholism, but is underappreciated in the nonalcoholic population. There is growing acknowledgement of the development of Wernicke's encephalopathy in patients with malignancies. Methods We conducted a literature review in PubMed for cases of Wernicke's encephalopathy occurring in patients with malignancy. We also present the case of a 47-year-old woman with recurrent laryngeal cancer and multiple hospital admissions for malnutrition. Neurological examination was notable for pendular nystagmus, severe gait ataxia, confusion, and poor memory consolidation. MRI of the brain was significant for T2-weighted fluid-attenuated inversion recovery hyperintensities in periaqueductal regions, medial thalami, and the tectal plate, typical for Wernicke's encephalopathy. She was treated with thiamine repletion, and had marked improvement in her mental status and some improvement in her vision problems and ataxia, although some nystagmus and significant short-term memory impairment persisted. Results The literature review yielded dozens of case reports of Wernicke's encephalopathy in patients with malignancy, dominated by cases of patients with malignancies of the gastrointestinal system, followed by those with hematologic malignancies. Conclusions Malignancy is an important risk factor for the development of Wernicke's encephalopathy. This diagnosis is underappreciated and difficult for the clinician to discern from multifactorial delirium. Clinicians should be aware to treat at-risk patients with thiamine immediately, especially if multiple risk factors are present.

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