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2021 ◽  
Vol 12 ◽  
Author(s):  
Giulia Maria Giordano ◽  
Paola Bucci ◽  
Armida Mucci ◽  
Pasquale Pezzella ◽  
Silvana Galderisi

An extensive literature regarding gender differences relevant to several aspects of schizophrenia is nowadays available. It includes some robust findings as well as some inconsistencies. In the present review, we summarize the literature on gender differences in schizophrenia relevant to clinical and social outcome as well as their determinants, focusing on clinical variables, while gender differences on biological factors which may have an impact on the outcome of the disorder were not included herewith. Consistent findings include, in male with respect to female patients, an earlier age of illness onset limited to early- and middle-onset schizophrenia, a worse premorbid functioning, a greater severity of negative symptoms, a lower severity of affective symptoms and a higher rate of comorbid alcohol/substance abuse. Discrepant findings have been reported on gender differences in positive symptoms and in social and non-social cognition, as well as in functional outcome and rates of recovery. In fact, despite the overall finding of a more severe clinical picture in males, this does not seem to translate into a worse outcome. From the recent literature emerges that, although some findings on gender differences in schizophrenia are consistent, there are still aspects of clinical and functional outcome which need clarification by means of further studies taking into account several methodological issues.


2021 ◽  
Author(s):  
Wei Li ◽  
Jieguo Wang ◽  
Kai Zhou ◽  
Ye Tian ◽  
Feiran Wei ◽  
...  

Abstract Background Hand foot and mouth disease (HFMD) is a public health concern. Studies on air pollution and the lengths of hospital stay (LOS) of HFMD are scarce. Methods We characterized the clinic demographic features of 5135 hospitalized HFMD in Nanjing, China from 2012 to 2017, and analyzed the association between short-term exposure to PM2.5 as well as its components (OM, BC, SO42−, NH4+, NIT, SOIL and SS) and the LOS of HFMD. Results Among them 98.62% were aged 0–6 years old, and 3772 (73.46%) were hospitalized for seven days or less. The LOS of HFMD children was different in different ages, illness onset years and illness onset seasons (P<0.01). For per IQR increase in PM2.5 concentrations, LOS of HFMD increased by 0.52(0.33, 0.71), 0.50 (95% CI, 0.31–0.69) and 0.46 (95% CI, 0.28–0.65) day in adjusted models at lag 3 days, lag 7days and lag 14 days, respectively. In addition, per IQR increase of BC, SO42−, NH4+, NIT and SOIL were also significantly associated with the LOS of HFMD. Conclusions Our findings corroborated the hypothesis that short-term PM2.5 exposure was associated with increased the LOS of HFMD, and its components (BC, SO42−, NH4+, NIT and SOIL) of PM2.5 might play a key role in the prolonged LOS of HFMD.


PLoS ONE ◽  
2021 ◽  
Vol 16 (12) ◽  
pp. e0261411
Author(s):  
Narongdet Kositpantawong ◽  
Smonrapat Surasombatpattana ◽  
Pisud Siripaitoon ◽  
Siripen Kanchanasuwan ◽  
Thanaporn Hortiwakul ◽  
...  

Early initiation of oseltamivir within 48 h to 5 days from illness onset has been associated with improved survival among patients with community-acquired influenza pneumonia. Delay of hospitalization limits early treatment and the survival of patients. To date, the effects of early oseltamivir initiation within 24 hours from admission on patient mortality has remained unknown. This retrospective study reviewed and analyzed the clinical and non-clinical outcomes of 143 patients, with community-acquired influenza pneumonia, who received oseltamivir within 24 h (group A) and after 24 h (group B) from admission. Among the patients, 82 (57.3%) received oseltamivir within 24 h while 61 (42.7%) received oseltamivir after 24 h. The median time from symptom onset to admission for group A and group B was not statistically significant (P < 0.001). The 14-day mortality rate was 9% and 23% for group A and B, respectively (P = 0.03), while the 30-day mortality were 15% and 30% for group A and B, respectively (P = 0.05). Administration of oseltamivir within 24 h significantly affected 30-day mortality rates (adjust OR: 0.14, 95% CI: 0.47–0.04, P < 0.01), particularly among patients with respiratory failure at admission (adjust OR: 0.08, 95% CI: 0+.30–0.06, P < 0.01). Survival analysis of patient with influenza pneumonia and respiratory failure at admission demonstrated significant difference between those who received oseltamivir within and after 24 h (P = 0.002). The results indicated that early oseltamivir initiation within 24 h improved the survival outcome mainly among those with respiratory failure at admission.


2021 ◽  
Vol 10 (1) ◽  
Author(s):  
Ze-yu Zhao ◽  
Yan Niu ◽  
Li Luo ◽  
Qing-qing Hu ◽  
Tian-long Yang ◽  
...  

Abstract Background Reaching optimal vaccination rates is an essential public health strategy to control the coronavirus disease 2019 (COVID-19) pandemic. This study aimed to simulate the optimal vaccination strategy to control the disease by developing an age-specific model based on the current transmission patterns of COVID-19 in Wuhan City, China. Methods We collected two indicators of COVID-19, including illness onset data and age of confirmed case in Wuhan City, from December 2, 2019, to March 16, 2020. The reported cases were divided into four age groups: group 1, ≤ 14 years old; group 2, 15 to 44 years old; group 3, 44 to 64 years old; and group 4, ≥ 65 years old. An age-specific susceptible-exposed-symptomatic-asymptomatic-recovered/removed model was developed to estimate the transmissibility and simulate the optimal vaccination strategy. The effective reproduction number (Reff) was used to estimate the transmission interaction in different age groups. Results A total of 47 722 new cases were reported in Wuhan City from December 2, 2019, to March 16, 2020. Before the travel ban of Wuhan City, the highest transmissibility was observed among age group 2 (Reff = 4.28), followed by group 2 to 3 (Reff = 2.61), and group 2 to 4 (Reff = 1.69). China should vaccinate at least 85% of the total population to interrupt transmission. The priority for controlling transmission should be to vaccinate 5% to 8% of individuals in age group 2 per day (ultimately vaccinated 90% of age group 2), followed by 10% of age group 3 per day (ultimately vaccinated 90% age group 3). However, the optimal vaccination strategy for reducing the disease severity identified individuals ≥ 65 years old as a priority group, followed by those 45–64 years old. Conclusions Approximately 85% of the total population (nearly 1.2 billion people) should be vaccinated to build an immune barrier in China to safely consider removing border restrictions. Based on these results, we concluded that 90% of adults aged 15–64 years should first be vaccinated to prevent transmission in China. Graphical Abstract


PeerJ ◽  
2021 ◽  
Vol 9 ◽  
pp. e12535
Author(s):  
Weitao Zhuang ◽  
Shujie Huang ◽  
Dongya Wang ◽  
Lulu Zha ◽  
Wei Xu ◽  
...  

Background This study aimed to characterize a cohort of patients with a refractory course of COVID-19, and to investigate factors associated with the duration of viral clearance (DoVC). Materials & Methods A total of 65 patients with refractory COVID-19 were retrospectively enrolled from Huoshenshan Hospital. Univariate analysis and multivariate analysis were performed to examine the potential association between clinicopathologic characteristics and the DoVC. Results The median DoVC in the overall study cohort was 48 days (ranged from 21 to 104 days). Multivariate analysis indicated that fever at illness onset (Hazard ratio (HR) = 4.897, 95% CI [1.809–13.260], p = 0.002), serum level of aspartate aminotransferase (AST) > 21.8 IU/L (HR = 3.010, 95% CI [1.195–7.578], p = 0.019), and titer of SARS-CoV-2 IgG > 142.09 AU/ml (HR = 3.061, 95% CI [1.263–7.415], p = 0.013) were the three independent risk factors associated with delayed viral clearance. Conclusion The current study suggested that clinical characteristics such as fever at illness onset, a high serum level of AST or SARS-CoV-2 IgG were associated with delayed viral clearance. Patients with these characteristics might need a more individualized treatment strategy to accelerate their recovery from the refractory COVID-19.


2021 ◽  
Vol 15 (1) ◽  
Author(s):  
Theresia Monica Rahardjo ◽  
Elizabeth Yogipranata ◽  
Ardian Hediyanto Naswan ◽  
Fitri Rahayu Sari ◽  
Fajar Budiono ◽  
...  

Abstract Background Severe acute respiratory syndrome coronavirus 2, the cause of coronavirus disease 2019, has become a global pandemic. Currently, there is no definitive treatment for coronavirus disease 2019. Convalescent plasma therapy has become a potential specific curative method, while vaccines as protection modalities require further work. Case presentation Eight non-intubated Indonesian patients, ages ranging from 40 to 74 years old, with coronavirus disease 2019 confirmed by viral Ribonucleid Acid (RNA) real-time polymerase chain reaction tests were included. Four patients were administered two doses of 200 mL convalescent plasma, and the other four patients were administered one dose of convalescent plasma with an antibody titer of 1:320, within the first 14 days since symptoms occurred. The median times from illness onset to convalescent plasma therapy and from the first day of hospital admission to convalescent plasma therapy were 13 and 6.5 days, respectively. All patients showed improvements in clinical symptoms, laboratory parameters, thorax imaging, negative conversion of polymerase chain reaction results, and decreased oxygen supplementation within 1 week after convalescent plasma therapy. Patients with two convalescent plasma doses tended to have faster recovery than those with one convalescent plasma dose. No severe adverse effects were observed in any patient. Conclusion This is the first case series in Indonesia showing that convalescent plasma therapy is safe and well tolerated and that early convalescent plasma therapy before the patient is intubated could potentially prevent disease progression, increase the recovery rate, and shorten the inpatient time of stay.


2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S252-S253
Author(s):  
Harrison L Howe ◽  
Danielle A Rankin ◽  
Sean M Bloos ◽  
Kailee N Fernandez ◽  
Seifein Salib ◽  
...  

Abstract Background Regardless of severity of acute SARS-CoV-2 illness, adults infected with SARS-CoV-2 are at risk for post-acute sequelae of COVID-19. Long COVID is typically classified as symptoms lasting greater than four weeks post-infection. We aimed to evaluate the frequency of resolved and unresolved long COVID symptoms in adults residing in greater Nashville, TN. Methods We conducted a longitudinal cohort study of SARS-CoV-2-positive and exposed individuals from March 20 to May 15, 2020. Participants for this analysis were included if: 1) ≥18 years; 2) SARS-CoV-2 positive by molecular or antibody testing; and 3) completed a one-year visit. Demographic and illness information were collected at enrollment, and long COVID symptoms were systematically collected at the one-year survey. Long COVID symptoms are defined as an adult experiencing at least one of the following symptoms four weeks post-infection: fatigue, confusion, loss of smell or taste, shortness of breath, chest pain, cough, muscle aches, inability to exercise, or heart palpitations. Unresolved symptoms are defined as an individual with long COVID still experiencing symptoms at the one-year visit. Results A total of 115 adults enrolled and completed the one-year survey, of which 63 (54.8%) were SARS-CoV-2-positive, with one asymptomatic individual. Of SARS-CoV-2-positive symptomatic adults, 32 (51%) were female, 5 (88%) were of Hispanic ethnicity, and 58 (92%) were white. At the one-year visit, 33 (52%) reported having long COVID, of which 17 (52%) reported having unresolved symptoms. Fatigue (89%), headache (89%), muscle aches (79%), and cough (77%) were the most common symptoms reported at illness onset (Figure 1). Among 33 adults with long COVID, fatigue (42%), loss of smell (39%), and loss of taste (33%) were most common (Figure 2A). In the 17 individuals with unresolved symptoms, loss of smell (29%) and loss of taste (24%) were commonly reported (Figure 2B). Figure 1. COVID-19 symptoms reported at enrollment (n=62) Figure 2. Long COVID (symptoms lasting ≥ 4 weeks) (n=33) (A) and unresolved long COVID symptoms one-year post-infection (n=17) (B) reported on the one-year survey Conclusion Half of the adults in our cohort reported long COVID symptoms, with more than quarter of symptoms persisting one-year post-illness. Our findings support that prolonged symptoms up to year after SARS-CoV-2 exposure occur, and future studies should investigate the residual impacts of long COVID symptoms and conditions. Disclosures Natasha B. Halasa, MD, MPH, Genentech (Other Financial or Material Support, I receive an honorarium for lectures - it’s a education grant, supported by genetech)Quidel (Grant/Research Support, Other Financial or Material Support, Donation of supplies/kits)Sanofi (Grant/Research Support, Other Financial or Material Support, HAI/NAI testing) Natasha B. Halasa, MD, MPH, Genentech (Individual(s) Involved: Self): I receive an honorarium for lectures - it’s a education grant, supported by genetech, Other Financial or Material Support, Other Financial or Material Support; Sanofi (Individual(s) Involved: Self): Grant/Research Support, Research Grant or Support


2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S288-S289
Author(s):  
Raymond Soto ◽  
Christoper Hsu ◽  
Meagan Chuey ◽  
Marisa Donnelly ◽  
Victoria T Chu ◽  
...  

Abstract Background In December 2020, B.1.1.7 lineage of SARS-CoV-2 was first detected in the United States and has since become the dominant lineage. Previous investigations involving B.1.1.7 suggested higher rates of transmission relative to non-B.1.1.7 lineages. We conducted a household transmission investigation to determine the secondary infection rates (SIR) of B.1.1.7 and non-B.1.1.7 SARS-CoV-2 lineages. Methods From January–April 2021, we enrolled members of households in San Diego County, CA, and Denver, CO metropolitan area (Tri-County), with a confirmed SARS-CoV-2 infection in a household member with illness onset date in the previous 10 days. CDC investigators visited households at enrollment and 14 days later at closeout to obtain demographic and clinical data and nasopharyngeal (NP) samples on all consenting household members. Interim visits, with collection of NP swabs, occurred if a participant became symptomatic during follow-up. NP samples were tested for SARS-CoV-2 using TaqPath™ RT-PCR test, where failure to amplify the spike protein results in S-Gene target failure (SGTF) may indicate B.1.1.7 lineage. Demographic characteristics and SIR were compared among SGTF and non-SGTF households using two-sided p-values with chi-square tests; 95% confidence intervals (CI) were calculated with Wilson score intervals. Results 552 persons from 151 households were enrolled. 91 (60%) households were classified as SGTF, 57 (38%) non-SGTF, and 3 (2%) indeterminant. SGTF and non-SGTF households had similar sex distribution (49% female and 52% female, respectively; P=0.54) and age (median 30 years, interquartile range (IQR 14–47) and 31 years (IQR 15–45), respectively). Hispanic people accounted for 24% and 32% of enrolled members of SGTF and non-SGTF households, respectively (p=0.04). At least one secondary case occurred in 61% of SGTF and 58% of non-SGTF households (P=0.66). SIR was 52% (95%[CI] 46%-59%) for SGTF and 45% (95% CI 37%-53%) for non-SGTF households (P=0.18). Conclusion SIRs were high in both SGTF and non-SGTF households; our findings did not support an increase in SIR for SGTF relative to non-SGTF households in this setting. Sequence confirmed SARS-CoV-2 samples will provide further information on lineage specific SIRs. Disclosures All Authors: No reported disclosures


2021 ◽  
pp. 184-186
Author(s):  
Andrew McKeon ◽  
Nicholas L. Zalewski

A 61-year-old woman with no pertinent medical history had progressive decline in multiple neurologic domains over the course of 2 months. She had development of progressive sensory loss in her left foot that subsequently spread up the left lower extremity and into the left upper extremity; accompanied by a sense of unsteadiness. Later, jerky movements of the left leg occurred while she was lying supine and sometimes when walking. At times, her left hand would wander involuntarily. Later in the course of her symptoms, mild short-term memory loss was also noted. On examination, she was unable to recall her home address, but findings were otherwise normal. She had mild gaze-evoked nystagmus and significant saccadic intrusion of smooth pursuits. A mild upper motor pattern of weakness, action myoclonus, hyperreflexia, and moderate loss of vibration was present on the left. Gait was markedly ataxic. Repeated magnetic resonance imaging of the brain 2 months after illness onset showed right parietal cortical hyperintense signal on diffusion-weighted imaging consistent with cortical ribboning, a common diagnostic finding early in the course of prion disease. Although characteristic of prion disease, similar imaging findings have been reported in autoimmune encephalitis and in the postictal setting. However, the putamen and caudate nucleus also demonstrated subtle asymmetric diffusion-weighted imaging hyperintense signal, which in the clinicoradiologic context is highly specific for prion disease. Electroencephalography showed frequent sharp wave discharges over right posterior temporal and left occipital head regions, along with frontal intermittent rhythmic delta slowing, consistent with encephalopathy (not otherwise specified). Real-time quaking-induced conversion testing of cerebrospinal fluid was positive for misfolded prion proteins. The positive real-time quaking-induced conversion result confirmed a diagnosis of sporadic Creutzfeldt-Jakob disease. The patient’s treatment was palliative. Hospice services implemented a home palliation program. Clonazepam was prescribed to reduce myoclonus. The patient died 18 weeks after onset of her neurologic symptoms. The differential diagnosis of a rapidly progressive multifocal neurologic syndrome includes many considerations but can be focused in complex situations by first confirming lesion localization and characterization with neuroimaging or other objective studies (eg, electromyography).


Antioxidants ◽  
2021 ◽  
Vol 10 (11) ◽  
pp. 1703
Author(s):  
Lena Palaniyappan ◽  
Min Tae M. Park ◽  
Peter Jeon ◽  
Roberto Limongi ◽  
Kun Yang ◽  
...  

Schizophrenia continues to be an illness with poor outcome. Most mechanistic changes occur many years before the first episode of schizophrenia; these are not reversible after the illness onset. A developmental mechanism that is still modifiable in adult life may center on intracortical glutathione (GSH). A large body of pre-clinical data has suggested the possibility of notable GSH-deficit in a subgroup of patients with schizophrenia. Nevertheless, studies of intracortical GSH are not conclusive in this regard. In this review, we highlight the recent ultra-high field magnetic resonance spectroscopic studies linking GSH to critical outcome measures across various stages of schizophrenia. We discuss the methodological steps required to conclusively establish or refute the persistence of GSH-deficit subtype and clarify the role of the central antioxidant system in disrupting the brain structure and connectivity in the early stages of schizophrenia. We propose in-vivo GSH quantification for patient selection in forthcoming antioxidant trials in psychosis. This review offers directions for a promising non-dopaminergic early intervention approach in schizophrenia.


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