Myalgia may not be associated with severity of coronavirus disease 2019 (COVID-19) / 世界急诊医学杂志（英文）

@#A recent study based on the use of experimental artificial intelligence (AI) tool showed 70%–80% accuracy in predicting development of severe disease in coronavirus disease 2019 (COVID-19) based on predictive parameters alanine aminotransferase (ALT), myalgia and hemoglobin, whilst only 5 of 53 patients developed acute respiratory distress syndrome (ARDS), 2 of whom reporting myalgia.[1] It is commonly advocated that myalgia may reflect generalized inflammation and cytokine response.[1] Multiple studies showed that myalgia is a common symptom at onset of COVID-19, seen in up to 36% of such patients.[2] Therefore, in this short article we aim to further assess whether myalgia may be a reliable predictor of severe COVID-19 disease.

Multicenter observational study on the reliability of the HEART score

OBJECTIVE: To rapidly and safely identify the risk of developing acute coronary syndrome in patients with chest pain who present to the emergency department, the clinical use of the History, Electrocardiogram, Age, Risk Factors, and Troponin (HEART) scoring has recently been proposed. This study aimed to assess the inter-rater reliability of the HEART score calculated by a large number of Italian emergency physicians.METHODS: The study was conducted in three academic emergency departments using clinical scenarios obtained from medical records of patients with chest pain. Twenty physicians, who took the HEART score course, independently assigned a score to different clinical scenarios, which were randomly administered to the participants, and data were collected and recorded in a spreadsheet by an independent investigator who was blinded to the study’s aim.RESULTS: After applying the exclusion criteria, 53 scenarios were finally included in the analysis. The general inter-rater reliability was good (kappa statistics [κ], 0.63; 95% confidence interval, 0.57 to 0.70), and a good inter-rater agreement for the high- and low-risk classes (HEART score, 7 to 10 and 0 to 3, respectively; κ, 0.60 to 0.73) was observed, whereas a moderate agreement was found for the intermediate-risk class (HEART score, 4 to 6; κ, 0.51). Among the different items of the HEART score, history and electrocardiogram had the worse agreement (κ, 0.37 and 0.42, respectively).CONCLUSION: The HEART score had good inter-rater reliability, particularly among the high- and low-risk classes. The modest agreement for history suggests that major improvements are needed for objectively assessing this component.

Role of emergency department observation units in the management of patients with unexplained syncope: a critical review and meta-analysis

This meta-analysis aimed to establish the role of standardized emergency department (ED) observation protocols in the management of syncopal patients as an alternative to ordinary admission. A systematic electronic literature search was performed to identify randomized controlled trials or observational studies evaluating syncopal patients managed in ED observation units. Data regarding mean length of stay, rate of etiological diagnosis, admission rate, and incidence of short-term serious outcomes were extracted. Six mostly single-center, small sized studies characterized by high heterogeneity, were included. A total of 458 patients were included with a balanced sex distribution (male 50.2%), a mean age of 60.1 years, and a considerable prevalence of heart disease (32.4%). Pooled analysis of the outcomes showed a mean stay of 28.2 hours, an etiological diagnosis rate of 67.3%, an admission rate of 18.5%, and a very low incidence of short-term serious outcomes (2.8%). Due to elevated diagnostic yield and low incidence of short-term adverse events, ED observation units-based management strategy seems ideal for patients with syncope. Nevertheless, further research is needed to identify criteria for selecting patients to be managed with this approach, define evaluation protocols, and confirm the safety of this strategy.

Is Google Trends a reliable tool for digital epidemiology? Insights from different clinical settings

Internet-derived information has been recently recognized as a valuable tool for epidemiological inves-tigation. Google Trends, a Google Inc. portal, generates data on geographical and temporal patterns according to specified keywords. The aim of this study was to compare the reliability of Google Trends in different clinical settings, for both common diseases with lower media coverage, and for less common diseases attracting major media coverage. We carried out a search in Google Trends using the keywords [renal colic], [epistaxis], and [mushroom poisoning], selected on the basis of available and reliable epi-demiological data. Besides this search, we carried out a second search for three clinical conditions [i.e., [meningitis], [Legionella Pneumophila pneumonia], and [Ebola fever]], which recently received major focus by the Italian media. In our analysis, no correlation was found between data captured from Google Trends and epidemiology of renal colics, epistaxis and mushroom poisoning. Only when searching for the term [mushroom] alone the Google Trends search generated a seasonal pattern which almost overlaps with the epidemiological profile, but this was probably mostly due to searches for harvesting and cooking rather than to for poisoning. The Google Trends data also failed to reflect the geographical and temporary patterns of disease for meningitis, Legionella Pneumophila pneumonia and Ebola fever. The results of our study confirm that Google Trends has modest reliability for defining the epidemiology of relatively common diseases with minor media coverage, or relatively rare diseases with higher audience. Overall, Google Trends seems to be more influenced by the media clamor than by true epidemiological burden

Incidence of acute-onset atrial fibrillation correlates with air temperature. Results of a nine-year survey

Some diseases, such as renal colic, stroke, and myocardial infarction, correlate with seasonality and microclimatic variations. Although evidence is limited and controversial, a correlation between acute-onset atrial fibrillation [AAF] and seasonality has been previously reported. In order to elucidate the possible correlations between weather and incidence of AAF in a country with a temperate climate, the influence of day-by-day climate changes was analyzed based on the number of visits for AAF [defined as onset of symptoms within 48 h] in a large urban Emergency Department [ED] of northern Italy. All the episodes of AAF were retrieved from the hospital's electronic database during a period of 3287 days [January 2002 to December 2010]. Only the cases whose onset occurred within 48 h from the ED visit were selected. The total number of ED visits was 725, 812 throughout the observational period. Among these, 3633 AAF cases were observed, 52% of which were males. A slight but significant negative linear correlation was found between the number of AAFs and the daily temperature [R = -0.60; p = 0.001]. No correlation was found between the number of AAFs and the daily humidity [R = -0.07; p = 0.2]

Blood phosphorus and magnesium levels in 130 elite track and field athletes

This study tested the clinical utility and relevance of serum phosphorus and magnesium as markers possibly useful to monitor training in athletes. Phosphorus and magnesium serum concentrations of 130 elite track and field athletes [65 males and 65 females, age range 20-30 years] from the National Athletics Sports Medicine Center database in Thessaloniki, Greece were measured. Abnormal results were found in 61 [47%] athletes [32 men and 29 women]. In male athletes, serum phosphate was higher than normal in 18% and decreased in 1.5%, whereas serum magnesium concentration was higher in 26%, and lower in 3%. Regarding female athletes, higher serum phosphate and magnesium levels were detected in 26% and 17% respectively, whereas decreased serum magnesium was found in 3%. The most common alterations were higher serum phosphate [29/61, 47%] and magnesium concentrations [28/61, 46%]. Abnormalities of serum phosphorus and magnesium concentrations were detected in almost half of the athletes. Hyperphosphataemia and hypermagnesaemia were the most common abnormalities. The reference intervals used for general population cannot be used for athletes. Given the lack of pathological manifestations, the physiopathological significance of these findings is uncertain. Further studies on the interpretation of reported ion concentrations in athletes should take in account the type of sport practiced and also the possible variations during the training and competition season

Influence of a Regular, Standardized Meal on Clinical Chemistry Analytes

BACKGROUND: Preanalytical variability, including biological variability and patient preparation, is an important source of variability in laboratory testing. In this study, we assessed whether a regular light meal might bias the results of routine clinical chemistry testing. METHODS: We studied 17 healthy volunteers who consumed light meals containing a standardized amount of carbohydrates, proteins, and lipids. We collected blood for routine clinical chemistry tests before the meal and 1, 2, and 4 hr thereafter. RESULTS: One hour after the meal, triglycerides (TG), albumin (ALB), uric acid (UA), phosphatase (ALP), Ca, Fe, and Na levels significantly increased, whereas blood urea nitrogen (BUN) and P levels decreased. TG, ALB, Ca, Na, P, and total protein (TP) levels varied significantly. Two hours after the meal, TG, ALB, Ca, Fe, and Na levels remained significantly high, whereas BUN, P, UA, and total bilirubin (BT) levels decreased. Clinically significant variations were recorded for TG, ALB, ALT, Ca, Fe, Na, P, BT, and direct bilirubin (BD) levels. Four hours after the meal, TG, ALB, Ca, Fe, Na, lactate dehydrogenase (LDH), P, Mg, and K levels significantly increased, whereas UA and BT levels decreased. Clinically significant variations were observed for TG, ALB, ALT, Ca, Na, Mg, K, C-reactive protein (CRP), AST, UA, and BT levels. CONCLUSIONS: A significant variation in the clinical chemistry parameters after a regular meal shows that fasting time needs to be carefully considered when performing tests to prevent spurious results and reduce laboratory errors, especially in an emergency setting.