Association of Surge Conditions with Mortality Among Critically Ill Patients with COVID-19

Objective To determine whether surge conditions were associated with increased mortality. Design Multicenter cohort study. Setting U.S. ICUs participating in STOP-COVID. Patients Consecutive adults with COVID-19 admitted to participating ICUs between March 4 and July 1, 2020. Interventions None Measurements and Main Results The main outcome was 28-day in-hospital mortality. To assess the association between admission to an ICU during a surge period and mortality, we used two different strategies: (1) an inverse probability weighted difference-in-differences model limited to appropriately matched surge and non-surge patients and (2) a meta-regression of 50 multivariable difference-in-differences models (each based on sets of randomly matched surge- and non-surge hospitals). In the first analysis, we considered a single surge period for the cohort (March 23 – May 6). In the second, each surge hospital had its own surge period (which was compared to the same time periods in matched non-surge hospitals). Our cohort consisted of 4342 ICU patients (average age 60.8 [sd 14.8], 63.5% men) in 53 U.S. hospitals. Of these, 13 hospitals encountered surge conditions. In analysis 1, the increase in mortality seen during surge was not statistically significant (odds ratio [95% CI]: 1.30 [0.47-3.58], p = .6). In analysis 2, surge was associated with an increased odds of death (odds ratio 1.39 [95% CI, 1.34-1.43], p < .001). Conclusions Admission to an ICU with COVID-19 in a hospital that is experiencing surge conditions may be associated with an increased odds of death. Given the high incidence of COVID-19, such increases would translate into substantial excess mortality.

Regression model for predicting low work ability among sedentary agng workers

BACKGROUND: Work ability is the physical and psychological capacity of workers to meet the demands of a job; it declines with age, and the effect is multiplied in a sedentary job. Early detection of workers at risk would help to improve their functional capacity and work efficiency. OBJECTIVE: To identify factors and develop a prediction model for low work ability among sedentary aging office workers. METHODS: In this case-control study, work ability among sedentary aging workers was evaluated using a Work Ability Questionnaire (WAQ). The worker’s age, gender, BMI, marital status, years at work, diabetes, hypertension, diagnosed medical condition, musculoskeletal problems, medicine intake, menopause, physical activity, sedentary work behaviour and six job-related tasks were recorded. Multiple logistic regression was performed, and the odds ratio was calculated for the variables assessed. RESULTS: 157 sedentary aging workers were assessed for 19 independent factors. BMI and years at work in the demographic domain, diagnosed medical condition and intake of medicine in the health-related domain and handgrip strength in the task domain were found to have a statistically significant odds ratio for poor work ability. CONCLUSIONS: The study identified factors influencing work ability among sedentary aging workers and a prediction model was developed.

PERINATAL OUTCOME OF VAGINAL BREECH DELIVERY VERSUS CAESAREAN BREECH DELIVERY

Background: The aim to find out any differences in outcome between vaginal breech delivery and cesarean breech delivery in our setup Methods: Data were collected from record book of Department of Gynecology and obstetrics. Data of 100 patients were analysed among which 36 underwent vaginal delivery for breech and 64 underwent cesarean breech delivery Results: Binary logistic regression was used to compare outcome among different groups. In our study only 5.56% of newborn delivered by vaginal route were admitted to NCU vs. 12.50% in cesarean group which was significant (odds ratio=0.07, P=0.01) Conclusion: Keywords: LSCS, Breech, NICU

Evaluation of Antimicrobial Usage in Dogs and Cats at a Veterinary Teaching Hospital in Germany in 2017 and 2018

In contrast to food-producing animals, where the documentation of the usage of antimicrobials is regulated by law, antimicrobial usage (AMU) in dogs and cats is only sparsely monitored. We collected data generated by an electronic practice management software (EPMS) between January 1, 2017 and December 31, 2018 to investigate AMU. All information was obtained from clinical routine data from the Department of Small Animal Medicine and Surgery (DSAM), University of Veterinary Medicine Hannover (TiHo). In 2017, 78,076 drug administrations were documented for 5,471 dogs and cats, of which 14,020 (17.96%) were antimicrobial drugs (AMs) specifically documented in 2,910 (51.31%) dogs and cats. In 2018, 104,481 drug administrations were documented for 5,939 dogs and cats. Of these drug administrations, 18,170 (17.39%) AM administrations were documented for 3,176 (53.48%) dogs and cats. Despite the increasing documentation of AM administrations, differences between 2017 and 2018 were not statistically significant [odds ratio (OR), 1.01; 95% confidence interval (CI), 0.98–1.03]. Prescription diversity (PD) in 2017 for dogs was 0.92 and for cats 0.89. In 2018, PD for dogs was 0.93 and for cats 0.88. As well as the documented number of AM administrations, the documented amount of active ingredients administered in 2018 (total: 17.06 kg; dogs: 16.11 kg, cats: 0.96 kg) increased compared with 2017 (total: 15.60 kg; dogs: 14.80 kg, cats: 0.80 kg). In 2017 and 2018, the most commonly administered antimicrobial groups were penicillins, nitroimidazoles, and quinolones for dogs and cats, respectively. While the in-house point-of-care administration accounts for the largest share of the documented amount of AMs administered, the highest number of documented AM administrations was assigned to inpatient care in 2017 and 2018, respectively. However, AM administration in outpatient care remained the lowest in both years. Since no statistically significant difference in AM administrations was observed between 2017 and 2018 and the most commonly used AMs at the DSAM were ranked, data can be used as a baseline to evaluate how changes in in-house guidelines and future legal requirements affect the prescribing culture. Data generated within the DSAM should be evaluated annually.

Risk for mental illness and family composition after migration to Sweden

Objectives The aim of the present study is to determine how marital status and certain post-migration family structures are associated with the risk of mental illness among recently arrived Arabic- speaking refugees in Sweden. Methods A cross-sectional study was conducted during 2015 and 2016. The study population was recruited by inviting all adult refugees who participated in the mandatory public integration support programme. All refugees that participated had received refugee status. A total of 681 of the invited participants returned the GHQ-12 questionnaires, through which the risk for mental illness was measured and only Arabic- speaking refugees (N = 638) were included in the analyses. Results Marital status per se was not associated with a risk for mental illness. However, for the whole study sample there was a statistical significant odds ratio of 1.72 (95% CI 1.03–2.86). For male Arabic-speaking refugees with a spouse or child left behind in the home country there was a borderline significant increased risk for mental illness, odds ratio = 1. 87 (95% CI 0.99–3.56). The risk for female Arabic-speaking refugees was non-significant, odds ratio = 1.35 (95% CI 0.55–3.33). Conclusions Arabic- speaking refugees who were separated from family members reported an increased risk for mental illness after arriving in the host country. Actions to facilitate family reunion after arriving as a refugee (in Sweden) seems to be an important factor to promote mental health among refugees.

Does Higher Self-Reported Cardiorespiratory Fitness Reduce the Odds of Hospitalization From COVID-19?

Background: Regular physical activity and higher cardiorespiratory (CR) fitness enhance immune function, possibly reducing coronavirus disease 2019 (COVID-19) infection severity. The aim was to assess the association between physical activity and self-reported CR fitness on COVID-19 infection characteristics. Methods: Participants formerly testing positive for COVID-19 completed an online questionnaire measuring COVID-19 infection characteristics and complications, self-reported CR fitness level, physical activity, and sociodemographic and health-related characteristics. Self-reported CR fitness was determined as the pace to cover 4.8 km without becoming overly fatigued (with slow walking, brisk walking, jogging, and running corresponding to low, moderate, good, and excellent levels of fitness, respectively). Results: A total of 263 individuals completed the survey. Compared with the lowest level of self-reported CR fitness, the odds of hospitalization significantly decreased by 64% (odds ratio = 0.36; 95% confidence interval, 0.13–0.98; P = .04) in individuals reporting the ability to maintain a brisk walk. In individuals reporting the ability to maintain a jogging pace, the further reduction in hospitalization was not significant (odds ratio = 0.22; 95% confidence interval, 0.05–1.04; P = .05). For COVID-19 symptom severity and number, there were no significant associations with self-reported CR fitness or physical activity levels. Conclusions: For individuals with low self-reported CR fitness, improving CR fitness represents a strategy to reduce the risk of hospitalization from COVID-19.

Clinicopathological Study of Cholecystectomy Specimens

In this study, there are possible causes of two years from June 2015 to May of 2017. During study includes 130 cases of cholecystectomy specimens from January 2013 to June 2017. The objective/purpose of the study is to correlate histopathological findings with various biochemical parameters viz. fasting blood sugar level, lipid profile, etc. Amongst the four cases of adenocarcinoma, 3 (75 %) cases showed serosal infiltration and liver infiltration. Out of a total of 130 cases, 69 (53%) were female, and 61 (47%) were male. Out of 4 patients of adenocarcinoma 2 (50%) patients expired during the postoperative period, while 2 (50%) patients improved. Diabetic patients constitute 13.84% of total cholecystectomy patients, so diabetes proved to be a risk factor for the development of gallbladder diseases with statistically significant Odds Ratio (2.66). Results from this study show that a variety of gallbladder lesions are observed in cholecystectomy specimens. The most common lesion observed was chronic cholecystitis with cholelithiasis 99 cases (76.1%), followed by acute cholecystitis 12 cases (9.2%). The present study was undertaken to emphasize the role of histopathological examination in cholecystectomy specimens and its correlation with clinical presentation. Histopathological examination many time reveals an unusual diagnosis bearing significant implications on the treatment, prognosis and outcome of the patient. Hence, the study was undertaken to emphasize the role of histopathological examination in cholecystectomy specimens and its correlation with clinical presentation.

Findings and prognostic value of lung ultrasound in COVID-19 pneumonia

ABSTRACTObjectivesThe aim is to systematically describe the findings of lung ultrasound in patients with COVID-19 pneumonia and to analyze its prognostic value.MethodsLung ultrasound was performed to 63 patients with COVID-19 pneumonia admitted to a University Hospital. Lung involvement was evaluated using a 4-point scale with a 12-area pulmonary division (lung score -LS-). Ultrasound findings, along with clinical characteristics, were recorded.ResultsAll patients showed ultrasound involvement in at least 1 area (mean 8 ± 3.5). Total LS was 15.3 ± 8.1, without differences between left and right lung. Most affected regions were the lower one (95.2%) and the posterior one (73.8%). Total LS showed a strong correlation (r = -0.765) with PaO2/FiO2; by lung regions, those with a higher correlation were the LS of the anterior one (r = -0.823) and the LS of the upper one (r = -0.731). 22.2% of patients required non-invasive respiratory support (NIRS). Multivariate analysis shows that anterior region LS, adjusted for age and sex, is significant (odds ratio 2.159, 95% confidence interval 1.309 to 3.561) for the risk of requiring NIRS. Anterior region LS ≥ 4 and total LS ≥19 have similar characteristics to predict the need for NIRS.ConclusionsUltrasound involvement in COVID-19 pneumonia is bilateral and heterogeneous. Most affected regions are the posterior and the lower ones. The anterior region has prognostic value, because its involvement strongly correlates with the risk of requiring NIRS, and an anterior region LS ≥ 4 has high sensitivity and specificity for predicting the need for NIRS.

Peripheral arterial diseases and the risk of thrombotic outcomes in patients after scheduled percutaneous coronary interventions (according to results of prospective study)

Введение. Атеросклеротическое поражение периферических артерий (АПА) рассматривается в качестве возможного фактора риска разви1 тия тромботических осложнений. Частота встречаемости периферического атеросклероза и его влияние на прогноз больных ИБС, в том числе подвергаемых чрескожным коронарным вмешательствам (ЧКВ), изучены мало. Цель. Изучить частоту встречаемости АПА и значимость данной патологии в отношении развития тромботических осложнений после пла1 новых чрескожных коронарных вмешательств. Материал и методы. Представлены результаты Проспективного регистра длительной антитромботической терапии — РЕГАТА, организо1 ванного на базе Национального медицинского исследовательского центра кардиологии Министерства здравоохранения Российской Феде1 рации. Настоящий фрагмент посвящен анализу исходов больных, подвергнутых плановым ЧКВ (n=687, средний возраст — 59,8±10,0 лет). Медиана наблюдения составила 1,83 года. Конечная точка определялась как сумма тромботических осложнений (ТО): сердечно1сосудистой смерти, острого коронарного синдрома, ишемического инсульта / транзиторной ишемической атаки, тромбоэмболии легочной артерии, тромбоза периферических артерий. Результаты. Из 687 включенных больных только 394 (57%) были обследованы на предмет АПА. В этой когорте значимое атеросклеротиче1 ское поражение выявлено у 114 человек (29%). Наличие АПА ассоциировалось с двукратным увеличением вероятности ТО: ОШ=2,07 (95% ДИ 1,1 – 3,9, р=0,03). Увеличение частоты ТО у больных с АПА начиналось к концу первого года от момента ЧКВ и совпадало с отменой двойной антитромбоцитарной терапии. Вывод. Скрининг на наличие периферического атеросклероза должен быть включен в алгоритм стандартного обследования пациентов с ИБС. При выявлении АПА у больных после ЧКВ возможно проведение более активной антитромботической терапии (продление двойной антитромбоцитарной терапии или назначение комбинации аспирина с «сосудистой» дозой ривароксабана, после плановой отмены блока1 тора P2Y121рецептора тромбоцитов). The aim of the trial was to study the incidence of peripheral arterial diseases and its correlation with thrombotic outcomes in patients with CAD after scheduled PCI. Materials and methods. It was included 687 patients (average age 59.8±10.0 years) on double antiplatelet therapy (DAPT) up to 1 year after PCI. The follow7up was continued until the first thrombotic outcome (cardiovascular death, ACS, ischemic stroke/TIA, other locations thrombosis), or until the end of the planned observation period. A standard cardiac examination and the analysis of medical records for concomitants PAD was performed for all patients. Peripheral arterial diseases was diagnosed in the presence of at least a one criterion in according with international guidelines of the PAD diagnosis and treatment. Results. 57% of all patients were examined for PAD. Significant peripheral arterial stenosis was detected in 114 people. The median duration of follow7up was 1.83 years. During this period, thrombotic outcomes were registered in 86 patients (7.3 cases per 100 people / year). According to one7way regression analysis the relationship between PAD and thrombotic outcomes (TO) was highly significant [odds ratio 2.19 (95% CI 1.15–4.14, p=0.015)]. The frequency of TO increase by the first year7end after PCI in patients with PAD. According to multivariate analysis, PAD was a predictor of thrombotic complications [OR 2.07 (95% CI 1.1–3.9, p=0.03)]. Also we found that another independent thrombotic outcomes predictor was a previous myocardial infarction: OR 2.49 (95% CI 1.2–5.0, p=0.01). Conclusion. Additional checkup for peripheral arterial diseases should be included in the standard examination algorithm of the patients with coronary heart disease. It is possible to prescribe more active antithrombotic therapy (extension of DAPT or use the combination with low7dose rivaroxaban plus aspirin, after planned P2Y12 blocker of the platelet receptor withdrawal) if peripheral arterial diseases was diagnosed in patients after PCI.

Perinatal Outcome of Vaginal Breech Delivery versus Caesarean Breech Delivery in a Tertiary Care Center

Introduction: Breech delivery has always been matter of interest in obstetrics. Cesarean breech delivery has been preferred method of delivery. We aim to find out any differences in outcome between vaginal breech delivery and cesarean breech delivery in our setup. Methods: Data were collected from record book of Department of Gynaecology and obstetrics, Pokhara Academy of Health Sciences, Kaski, Nepal. Pregnant with breech presentation who had delivery in the centre from 2074 Baishak to 2074 chaitra were enrolled in the study. Data of 174 patients were analysed among which 74 underwent vaginal delivery for breech and 110 underwent cesarean breech delivery. Results: Only 1 (1.6%) of newborn delivered by vaginal route were admitted to NCU vs 17 (15.5% )in cesarean group which was significant (odds ratio= 0.071, 95% C.I 0.009-0.574; p= 0.004). There was only one death of newborn which was delivered by vaginal route. Mean APGAR score at 1 and 5 minute in vaginal breech delivery was 6 and 7 and in cesarean breech delivery was 6 and 8. Conclusions: Though perinatal morbidity was more with cesarean breech delivery but further study with more sample size is needed before reaching conclusion.