Notes

[COPD: dealing with treatable traits].
Clostridioides difficile infection (CDi) is one of the foremost hospital-acquired infections. We present an observational study aimed to describe the incidence, epidemiology, and clinical outcome of CDi in a tertiary university hospital in Buenos Aires. The episodes, diagnosed in 117 consecutive adult patients in the period 01/01/2017 to 01/04/2020, were distributed in three groups 63 (53.9%) were classified as hospital-acquired infections (HA), 25 (21.4%) as community onset-health care-associated infections (CO-HCA) and 29 (24.8%) as community-associated infections (CA). The incidence of HA CDi infections was 3.1, 5. 2 and 2.8 every 10 000 patient days in 2017, 2018 and 2019, respectively. XL092 mouse The microbiological diagnosis was made by immunochromatography with antigen GDH and C. difficile toxin positive in 51 episodes (43.6%) and by GDH positive, toxin negative and PCR positive in 66 episodes (56.4%). Older age (p = 0.018), chronic kidney disease (p = 0.013), immunosuppression (p = 0.021), and higher comorbidity Charlson score (p = 0.001) were observed in patients with IH and CA-HCA infections. No significant differences in clinical features were found among groups. During the hospital st ay, 13 patients (11.1%) required admission to the intensive care unit. Ten recurrences occurred, representing 8.5% of CDI episodes. The 90-day mortality was 19.8%, being significantly higher in HA and CO-HCA infections (p = 0.014). Our findings highlight both the local burden of CDi morbidity and mortality and the need for the implementation of preventive strategies.The incidence of acute kidney injury (AKI) in hospitalized patients with COVID-19 is variable, being associated with worse outcomes. The objectives of the study were to evaluate the incidence, risk factors (considering demographic characteristics, comorbidities, initial clinical presentation and associated complications) and impact of AKI in subjects hospitalized for COVID-19 in two third-level hospitals in Córdoba, Argentina. A retrospective cohort study was conducted. We included 448 adults who were consecutively hospitalized for COVID-19 between March 3 and October 31, 2020 and were followed throughout the hospitalization. The incidence of AKI was 19% (n = 85; stage I = 43, stage II = 17, and stage III = 25, 18 required renal replacement therapy). In the multivariate analysis, the variables that were independently associated with AKI were age (for every 10 years, adjusted odd ratio [95%CI] = 1.30 [1.04-1.63], p = 0.022), history of chronic kidney disease -CKD- (9.92 [4.52-21.77], p less then 0.001), blood neutrophil count at admission -BNCA- (for every increase of 1000 BNCA, 1.09 [1.01-1.18], p = 0.037) and requirement for mechanical ventilation -MV- (6.69 [2.24-19.90], p = 0.001). AKI was associated with longer hospitalization, higher admission (63.5 vs. 29.7%; p less then 0.001) and longer stay in the intensive care unit, a positive association with respiratory bacterial superinfection, sepsis, respiratory distress syndrome, MV requirement and mortality (mortality without AK I = 12.4% vs with AKI = 47.1%; stage I = 26%, stage II = 41% and stage III = 88%; p less then 0.001). AKI was independently associated with higher mortality (3.32 [1.6-6.9], p = 0.001). In conclusion, the incidence of AKI in adults hospitalized for COVID-19 was 19% and had a clear impact on morbidity and mortality. The independent risk factors for AKI were Age, CKD, BNCA and MV.The report of the preliminary data of the Argentine Registry of COVID in chronic dialysis is presented, from April 10, 2020 to April 9, 2021 and includes all dialysis centers in the country. In the study period, 36 918 prevalent patients on chronic dialysis were registered. COVID-19 infection was confirmed in 3709 patients (10% of prevalent patients), of which 1675 patients (45.2%) required hospitalization, and of these, 39% (550 patients) required ICU admission. 62% of those admitted to the ICU (339 patients) required mechanical ventilation (MV). 1307 patients died (35.24%). Multivariate analysis showed as factors associated with mortality from COVID in dialysis patients, age greater than 60 years (OR 2.6; 95% CI 2.2-3.1); diabetes (OR 1.5; 95% CI 1.3-1.8); time on dialysis greater than 55 months (OR 1.5; 95% CI 1.2-1.7); cerebrovascular disease (OR 1.6; 95% CI 1.1-2.3); neoplasia (OR 1.7; 95% CI 1.1-2.6); hospitalization requirement (OR 3.4; 95% CI 2.8-3.9); ICU admission (OR 1.8; 95% CI 1.3-2.5); need of MV (OR 11.8; 95% CI 6.9-20.2). The population on chronic dialysis in Argentina, as shown in the rest of the world, is highly vulnerable to COVID infection, showing a lethality 12 times higher than the general population. The measures implemented in dialysis units, patient care and their family environment, and above all priority vaccination are essential in this vulnerable population of patients.COVID-19 pneumonia represents a challenge for health systems. The objective of this study is to describe the clinical presentation and evolution of hospitalized patients with COVID-19 pneumonia. This is a prospective and descriptive study. Patients older than 16 years with a PCR confirmed diagnosis of COVID-19 were included in 94.0% (n = 395) of the cases. Biochemical and imaging determinations were made. 421 patients were included, 57.0% male (n = 240), with a mean age of 56.1 ± 15.1 years. 41.0% (n = 172) were older than 60 years. 79.7% (n = 333) had comorbidities. They had seven days 7 days (IQR 5) from symptom onset to hospitalization. The most frequent symptoms were dyspnea (78.1%, n = 307), cough (76.5%, n = 297) and fever (73.6%, n = 289). 50.2% (n = 204) presented respiratory failure upon admission. 63.4% (n = 173) presented pathological infiltrates on radiography and 96.0% (n = 312) on chest tomography. The 4C score was 8 (IQR 6). 31.6% (n = 133) had a poor clinical evolution. In-hospital mortality was 18.9% (n = 80) and 23.7% (n = 100) received mechanical ventilation. 21.9% (n = 92) presented in-hospital complications. 39.6% (n = 67) of those over 60 years of age were admitted to the Intensive Care Unit and 31.4% (n = 54) died. 76.9% (n = 319) of the patients received corticosteroids, 69.3% (n = 289) antibiotics, and convalescent plasma 10.5% (n = 43). This series stands out for the high rate of comorbidities and the severity of the patients included. Mortality was similar to other international series.Controversies still exist regarding the humoral response to the virus SARS-CoV-2 in convalescent patients and seroconversion in patients with autoimmune diseases. There are few reports on the clinical and evolution of COVID-19 in the latter group. The objective was to examine the clinical and evolutionary characteristics associated with COVID-19 and the percentage of seroconversion in people with rheumatic diseases. Fifty-three patients were included, mainly with rheumatoid arthritis and lupus. The majority were female and average age 48 ± 14 years. Symptoms fever (56%), anosmia (35.8%), dyspnea (34%), headache (30.2%) and cough (30.2%). Duration of infection 12 ± 7 days. Almost half of the patients were hospitalized (23, 43.4%), 5 in critical care units (9.4%) and 3 died (5.6%). The prevalence of steroid use was 56.6% (30), with an average dose of 8 mg/d, and 17 (32%) used immunosuppressive biopharmaceuticals. There was a correlation between age and the need for hospitalization with a risk of 9.4% per year. There were no differences with other variables. The presence in serum of IgG immunoglobulin against SARS-CoV-2 protein S was determined in 23/53 patients (43.4%), with detectable levels in 15 (62.2%), and in the 23 without autoimmune connective tissue diseases who suffered from COVID-19, 12 had detectable antibodies. Death in this group of rheumatic diseases was low, similar to the general population. More than half had specific antibodies against the virus regardless of the medication used.The humoral immune response associated with both SARSCoV-2 infection and vaccination with Sputnik V in health workers, was analyzed.. A study was carried out in 660 health workers vaccinated with 2 doses of Sputnik V at the Vélez Sarsfield hospital, in the city of Buenos Aires, from December 2020 to April 2021. The objectives were to quantify anti-S1 SARS-CoV-2 IgG antibodies in vaccinated individuals and to determine clinical and pathological factors associated with that response. Samples were taken at least 21 days after the second vaccine dose. The mean age was 45 years (ES 0.44), 71.1% were women and 20.7% (n = 137) reported previous COVID-19 infection. IgG anti-spike (S) 1 SARS-CoV-2 antibodies were detected in 99.7% (n = 658) of the participants. The mean titer was 4197 ± 263.87 AU / ml (95 CI 3679.1, 4715.3). The antibody response was higher in the group with prior COVID-19 disease vs. the group with no previous infection (10 693 ± 846.22 AU / ml vs. 2495.8 ± 187.98 AU / ml, p less then 0.0001 in t-test). In a subgroup of 21 participants with high titers of anti-S1 IgG antibodies and with no apparent previous COVID-19, 11 individuals were positive for antibodies against the SARS-CoV-2 nucleocapsid. It is concluded that most of the vaccinated health workers developed antibodies and that those who had the disease prior to vaccination had higher antibody titers than those who did not have the disease.Pneumonia is the leading infectious cause of death in children, with especially high mortality in low- and middle-income countries. Interleukin-18 binding protein (IL-18BP) is a natural antagonist of the pro-inflammatory cytokine interleukin-18 and is elevated in numerous autoimmune conditions and infectious diseases. We conducted a prospective cohort study to determine the association between admission IL-18BP levels and clinical severity among children admitted to two hospitals in Uganda for hypoxemic pneumonia. A total of 42 children (median age of 1.2 years) were included. IL-18BP levels were higher in patients with respiratory distress, including chest indrawing (median 15 ng/mL (IQR 9.8-18) versus 4.5 ng/mL (IQR 3.8-11) without chest indrawing, P = 0.0064) and nasal flaring (median 15 ng/mL (IQR 9.7-19) versus 11 ng/mL (IQR 5.4-14) without nasal flaring, P = 0.034). IL-18BP levels were positively correlated with the composite clinical severity score, Pediatric Early Death Index for Africa (PEDIA-e, ρ = 0.46, P = 0.0020). Patients with IL-18BP > 14 ng/mL also had slower recovery times, including time to sit (median 0.69 days (IQR 0.25-1) versus 0.15 days (IQR 0.076-0.36) with IL-18BP less then 14 ng/mL, P = 0.036) and time to fever resolution (median 0.63 days (IQR 0.16-2) versus 0.13 days (IQR 0-0.42), P = 0.016). In summary, higher IL-18BP levels were associated with increased disease severity and prolonged recovery times in Ugandan children with pneumonia.COVID-19 in the UK has been characterised by periods of exponential growth and decline, as different non-pharmaceutical interventions (NPIs) are brought into play. During the early uncontrolled phase of the outbreak (March 2020) there was a period of prolonged exponential growth with epidemiological observations such as hospitalisation doubling every 3-4 days. The enforcement of strict lockdown measures led to a noticeable decline in all epidemic quantities that slowed during the summer as control measures were relaxed. From August 2020, infections, hospitalisations and deaths began rising once more and various NPIs were applied locally throughout the UK in response. Controlling any rise in infection is a compromise between public health and societal costs, with more stringent NPIs reducing cases but damaging the economy and restricting freedoms. Typically, NPI imposition is made in response to the epidemiological state, are of indefinite length and are often imposed at short notice, greatly increasing the negative impact.
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