Predictors of non-invasive ventilation failure in adult patients with cardiac dysfunction presenting with community-acquired pneumonia: an Egyptian multicenter prospective study

Non-invasive ventilation (NIV) might be successful if carefully selected in adult patients with cardiac dysfunction presenting with community-acquired pneumonia. The main objective of this study was to identify the early predictors of NIV failure. Adult patients with left ventricle ejection fraction (LV EF) <50% admitted to the intensive care unit (ICU) with community-acquired pneumonia and acute respiratory failure were enrolled in this multicenter prospective study after obtaining informed consents (study registrationID: ISRCTN14641518). Non-invasive ventilation failure was defined as the requirement of intubation after initiation of NIV. All patients were assessed using the Acute Physiology and Chronic Health Evaluation II (APACHE II) and sequential organ failure assessment (SOFA) scores at admission, while their Heart rate Acidosis Consciousness Oxygenation and Respiratory rate (HACOR) and lung ultrasound (LUS) scores in addition to blood lactate were assessed at NIV initiation and 12 and 24 hours later. A total of 177 patients were prospectively enrolled from February 2019 to July 2020. Of them, 53 (29.9%) had failed NIV. The mean age of the study cohort was 64.1+or- 12.6 years, with a male predominance (73.4%) and a mean LV EF of 36.4 +or- 7.8%. Almost 55.9% of the studied patients had diabetes mellitus, 45.8% had chronic systemic hypertension, 73.4% had ischemic heart disease, 20.3% had chronic kidney disease, and 9.6% had liver cirrhosis. No significant differences were observed between the NIV success and NIV failure groups regarding underlying morbidities or inflammatory markers. Patients who failed NIV were significantly older and had higher mean SOFA and APACHE II scores than those with successful NIV. We also found that NIV failure was associated with longer ICU stay (p < 0.001), higher SOFA scores at 48 hours (p < 0.001) and higher mortality (p < 0.001) compared with the NIV success group. In addition, SOFA (Odds Ratio (OR): 4.52, 95% Confidence Interval (CI): 2.59-7.88, p < 0.001), HACOR (OR: 2.01, 95% CI: 0.97-4.18, p = 0.036) and LUS (OR: 1.33, 95% CI: 1.014-1.106, p = 0.027) scores and blood lactate levels (OR: 9.35, 95% CI: 5.32-43.26, p < 0.001) were independent factors for NIV failure. High initial HACOR and SOFA scores, persistent hyperlactatemia and non-decrementing LUS score were associated with early NIV failure in patients with cardiac dysfunction presenting with community-acquired pneumonia, and could be used as clinical and paraclinical variables for early decision making regarding invasive ventilation.

Molecular investigation of Campylobacter spp. and Salmonella infection in children with community acquired diarrhea

Introduction : Acute gastroenteritis is a typical disorder that accounts for 8-12% of pediatric outpatient visits. Campylobacter and Salmonella infections account for about 8.4% and 11% of global diarrhea cases. Due to the importance of these bacteria in pediatric diseases, the aim of this study was to determine the infectious rate of Salmonella and Campylobacter species and also the frequency of the gene encoding Cytholethal distending toxin in children with community-acquired diarrhea. Materials and Methods: Stool samples of children under 5 years of age with diarrhea were collected. The samples were related to children referred to hospitals in Hamadan, Ardabil, Bandar Abbas and two hospitals in Tehran. DNA was extracted from the samples using a DNA extraction kit from stool. The presence of Campylobacter in the studied samples was detected by polymerase chain reaction using specific primers. A control stool sample was spiked with 10-fold dilution of C. jejuni suspension for LOD (detection limit determination) measurement. Results: In this study, PCR results showed a LOD of 100 CFU per gram in the spiked feces sample. Accordingly, out of 144 fecal samples of children with acute diarrhea, one case was positive for Campylobacter jejuni;this sample was also positive for the presence of cdtB gene. Presence of Salmonella was confirmed in two samples of the patients (1.4%). Conclusion: Low prevalence of Campylobacter and Salmonella was detected in symptomatic children under 5 years of age during the Covid-19 pandemic. Examination of these samples for viruses and other microbial agents can clarify the etiology of diarrhea in children referred to the hospitals.

Advances in molecular diagnostic tests for community-acquired pneumonia

The use of a timely and appropriate antibiotic therapy, which requires early and accurate microorganisms' detection in pneumonia. Currently, the identification of microorganisms in pneumonia is limited by the low sensitivity and long response time of standard culture-based diagnostic tools. For this reason, treatment in pneumonia is empirical. An inadequate empirical treatment is related to poor outcomes in patients with pneumonia. The microbiological diagnosis is key to improve the outcomes in patient with pneumonia. Over the past years there was a significant advance in the molecular diagnosis of infectious diseases including pneumonia. Also the impact of the COVID-19 pandemic has impacted the development and application of these new molecular techniques. This review summarizes the advances in molecular diagnosis of community-acquired pneumonia.Copyright © 2022 EDIZIONI MINERVA MEDICA.

Infection Diseases Following Natural Disaster in Children: Health Prevention and Assessment

[17] Diseases with a long incubation period (leishmaniasis and leptospirosis) and vector-borne diseases such as malaria and dengue should be considered as possible infections during the recovery phase (> 4 weeks) of natural disasters. [20] Outbreaks of group A streptococcus infection in camps could have devastating consequences, not just as a cause of respiratory infection, but also of wound infections. [10] In the post-earthquake period, the first wave of infectious diseases is caused by food-borne and/or water-borne infections, and/or by infections transmitted by respiratory droplets. [Extracted from the article] Copyright of Journal of Pediatric Infectious Diseases is the property of Thieme Medical Publishing Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

Timeline: Key Stories and Topics in HIC This Century

The article presents the discussion on news related to various topics. Topics include Infection preventionists (IPs) urging to take a leadership role in the burgeoning national patient safety movement after the 1999 Institute of Medicine report;and MRSA killing more people annually than human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) in the US.

Descriptive analysis of treatment regimens used in the management of COVID -19 in an urban area during the first six months of 2021

Covid 19 is an acute viral infection affecting the main respiratory system. Treatment practices were based on technical guidance from national health authorities, WHO, and CDC Atlanta. The study was aimed at enhancing the understanding of treatment practices for Covid 19. The study was based on a descriptive analysis of records of hundred patients in an urban health facility. 54% were females. 13% received vaccination of the first dose. 24% had known exposure;39 had a history of co-morbidities. Disease severity was classified as 'mild (59), moderate (28) and severe (12)' 76 were managed at home through video-consultation. 42 (55%) were women. 91% treated at home recovered completely. 24 were hospitalized, and 8 of them were admitted in the Covid-19 Intensive care unit (ICU). 33% recovered completely among hospitalized. Covid 19 has affected all age groups, and the median age was 43.5. Elderly and high-risk patients were prone to severe disease. 76% had no history of exposure suggesting community transmission. The diagnosis was based on the clinical status of 6 patients and the rest through RT PCR. All severe patients needed hospitalization. 77% of hospitalized recovered completely. 6% died, indicating close monitoring. Clinical outcome was dependent on disease severity. Complete recovery is possible in the majority of patients (78%). Treatment practices varied from using simple supplements to use of steroids and to anti-viral. Colchicine was prescribed to two patients because of complications Isolation and diligent contact tracing, and timely management helped in containing the spread and effective management of Covid-19.

Community transmission of COVID-19 outbreaks caused by SARS-CoV-2 Delta variant in 3 areas of Zhejiang, December 2021

Objective: To analyze epidemiological characteristics of COVID-19 outbreaks caused by SARS-CoV-2 Delta variant in 3 areas of Zhejiang province in December 2021.

Research on transmission pattern of SARS-CoV-2

Objective: Taking the three outbreaks caused by Delta variant (B.1.617.2) in Guangzhou, Guangdong Province, Nanjing, Jiangsu Province and Zhengzhou, Henan Province as examples, to explore different transmission pattern of SARS-CoV-2 epidemic and to provide basis for scientific prevention and control.

Explaining the limited impact of COVID-19 in African countries

It is not possible to attribute the low rate of COVID-19 in African nations to insufficient data, hence it is important to investigate the causes of this. This article examines a few of the hypothesised explanations for the low incidence and mortality rates in African nations. African nations' success may have been influenced by cultural traits including collectivism, short-termism, and aversion to ambiguity. Having a younger population also appears to have had a significant role in the disease's reduced spread and mortality. Further research is required to determine how much the high illness burden from infectious diseases may have contributed to reducing the symptoms, dissemination, and mortality. For instance, it's likely that Africans have been exposed to a coronavirus strain that confers some level of protection against the COVID-19 virus. Early in the pandemic, lockdowns and competent leadership were important in averting broad community transmission. However, despite increased vaccination, observation and monitoring must continue.

Diagnostic Accuracy of Procalcitonin upon Emergency Department Admission during SARS-CoV-2 Pandemic.

INTRODUCTION: Procalcitonin is a marker for bacterial diseases and has been used to guide antibiotic prescription. Procalcitonin accuracy, measured at admission, in patients with community-acquired pneumonia (CAP), is unknown in the current severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic. OBJECTIVES: To evaluate the diagnostic accuracy of procalcitonin to assess the need for antibiotic treatment in patients with CAP presenting to the emergency department during the SARS-CoV-2 pandemic. METHODS: We performed a real-world diagnostic retrospective accuracy study of procalcitonin in patients admitted to the emergency department. Measures of diagnostic accuracy were calculated based on procalcitonin results compared to the reference standard of combined microbiological and radiological analysis. Sensitivity, specificity, positive and negative predictive values, and area under (AUC) the receiver-operating characteristic (ROC) curve were calculated in two analyses: first assessing procalcitonin ability to differentiate microbiologically proven bacteria from viral CAP and then clinically diagnosed bacterial CAP from viral CAP. RESULTS: When using a procalcitonin threshold of 0.5 ng/mL to identify bacterial etiology within patients with CAP, we observed sensitivity and specificity of 50% and 64.1%, and 43% and 82.6%, respectively, in the two analyses. The positive and negative predictive values of a procalcitonin threshold of 0.5 ng/mL to identify patients for whom antibiotics should be advised were 46.4% and 79.7%, and 48.9% and 79% in the two analyses, respectively. The AUC for the two analyses was 0.60 (95% confidence interval [CI] 0.52-0.68) and 0.62 (95% CI, 0.55-0.69). CONCLUSIONS: Procalcitonin measured upon admission during the SARS-CoV-2 pandemic should not guide antibiotic treatment in patients with CAP.

Special Issue: COVID 19 pandemic: challenges and opportunities. (Special Issue: COVID 19 pandemic: challenges and opportunities.)

This special issue consists of 10 original articles providing evidence-based findings on each of the following themes: (1) natural infectious process resulting from the spread and transmission of SARS-CoV-2 and the disease progression after onset of symptoms;(2) containment measures on NPIs, vaccine, and antiviral therapy for the alteration of natural course from infection to disease;(3) evidence-based evaluation of all these interventions;and (4) economic evaluation of interventions and of global burden of COVID-19. This special issue provides a new insight into the new patterns of household infection, cluster infection, and new patterns of community-acquired outbreaks in parallel with the evolution of viral on the spread of SARS-CoV-2, which had heralded from the original outbreak in China until evolved into three surges of pandemic contained by effective NPIs implemented in 2020, and vaccine uptake from 2021 onwards.

COVID-19 in health care workers, Australia 2020

Background: Health care workers are at increased risk of SARS-CoV-2 infection due to potential exposure to patients or staff in health care settings. Australian health care services and health care workers experienced intense pressure to prepare for and respond to SARS-CoV-2 infections. We summarise national data on health care worker infections and associated outbreaks during 2020.

Community-acquired pneumonia: updated recommendations from the ATS and IDSA

This paper outlines the recently updated recommendations on the diagnosis and treatment of community-acquired pneumonia (CAP). This guideline focuses on immunocompetent U.S. adults who have not recently traveled internationally, particularly to regions with emerging respiratory pathogens. It predates the coronavirus disease 2019 (COVID-19) pandemic. The updated recommendations are based on validated illness severity criteria (major or minor). Severe CAP is defined as the presence of one major criterion or at least three minor criteria.

Coronavirus disease 2019 (COVID-19) outbreak in pediatrics and the role of pediatricians: a systematic review

The coronavirus disease 2019 (COVID-19) outbreak initiated in Wuhan, China and has spread rapidly all around the world and labeled as a pandemic with almost 168,000 infected cases and 6,500 deaths globally up to March 16, 2020. It is believed that children are less likely than adults to be infected with COVID-19. In this review, we discuss different aspects of COVID-19 infection in pediatrics. COVID-19 in pediatrics occurs in the early stages of its outbreak at a high rate with a family cluster pattern mainly. Children infected with COVID-19 are mostly asymptomatic carriers and the main potential causes of the spread and transmission of the disease in communities. Asymptomatic children with no underlying disease or red flags should follow home isolation protocols. Children with red flags, comorbidities and risk factors or those with severe pneumonia must be admitted to the hospitals. Children's hospitals should be equipped with the acute respiratory diseases ward, quarantine rooms, and intensive care unit to protect other patients and health care staff during the COVID-19 outbreak.

Artificial intelligence-empowered mobilization of assessments in COVID-19-like pandemics: A case study for early flattening of the curve

The global outbreak of the Coronavirus Disease 2019 (COVID-19) pandemic has uncovered the fragility of healthcare and public health preparedness and planning against epidemics/pandemics. In addition to the medical practice for treatment and immunization, it is vital to have a thorough understanding of community spread phenomena as related research reports 17.9-30.8% confirmed cases to remain asymptomatic. Therefore, an effective assessment strategy is vital to maximize tested population in a short amount of time. This article proposes an Artificial Intelligence (AI)-driven mobilization strategy for mobile assessment agents for epidemics/pandemics. To this end, a self-organizing feature map (SOFM) is trained by using data acquired from past mobile crowdsensing (MCS) campaigns to model mobility patterns of individuals in multiple districts of a city so to maximize the assessed population with minimum agents in the shortest possible time. Through simulation results for a real street map on a mobile crowdsensing simulator and considering the worst case analysis, it is shown that on the 15th day following the first confirmed case in the city under the risk of community spread, AI-enabled mobilization of assessment centers can reduce the unassessed population size down to one fourth of the unassessed population under the case when assessment agents are randomly deployed over the entire city.

SARS-CoV-2 infection in patients with hematological malignancies and transplants

SARS-CoV-2 infection in patients with hematological malignancies and hematopoietic stem cell transplants (HSCT) can be severe and with significant mortality. We carried out a prospective and observational study to describe the clinical and epidemiological characteristics and outcome of SARS-CoV-2 infection in patients with hematological malignancies and HSCT. Twenty adult patients were included with a median age of 58 years and a median Charlson score of 3. Infections were community-acquired and nosocomial in 60% and 40%, respectively, and 30% of the patients had a history of contact with a SARS-CoV-2 infected person. Sixty-five percent had pulmonary infiltrates, mostly with a ground-glass pattern on CT scan. Almost half of the patients had a severe and critical illness, and a high proportion received convalescent plasma as treatment. Twenty percent and 15% had complications and hospital infections, respectively, and had prolonged hospitalization expressed as median days of it. The 30-day mortality was 10%. SARS-CoV-2 infection in our population had a considerable clinical and epidemiological impact.

Societal activities associated with SARS-CoV-2 infection: a case-control study in Denmark, November 2020.

Identification of societal activities associated with SARS-CoV-2 infection may provide an evidence base for implementing preventive measures. Here, we investigated potential determinants for infection in Denmark in a situation where society was only partially open. We conducted a national matched case-control study. Cases were recent RT-PCR test-positives, while controls, individually matched on age, sex and residence, had not previously tested positive for SARS-CoV-2. Questions concerned person contact and community exposures. Telephone interviews were performed over a 7-day period in December 2020. We included 300 cases and 317 controls and determined odds ratios (ORs) and 95% confidence intervals (95% CI) by conditional logistical regression with adjustment for household size and country of origin. Contact (OR 4.9, 95% CI 2.4-10) and close contact (OR 13, 95% CI 6.7-25) with a person with a known SARS-CoV-2 infection were main determinants. Contact most often took place in the household or work place. Community determinants included events with singing (OR 2.1, 95% CI 1.1-4.1), attending fitness centres (OR 1.8, 95% CI 1.1-2.8) and consumption of alcohol in a bar (OR 10, 95% CI 1.5-65). Other community exposures appeared not to be associated with infection, these included shopping at supermarkets, travel by public transport, dining at restaurants and private social events with few participants. Overall, the restrictions in place at the time of the study appeared to be sufficient to reduce transmission of disease in the public space, which instead largely took place following direct exposures to people with known SARS-CoV-2 infections.

Incidence and epidemiological characteristics of COVID-19 among health care workers in Saudi Arabia: A retrospective cohort study.

INTRODUCTION: Novel coronavirus (SARS-CoV-2) is a highly infectious serious acute respiratory syndrome that has emerged in Wuhan, China, and has spread rapidly throughout the world including Saudi Arabia. An important source of infection of 2019 novel coronavirus (2019-nCoV) is healthcare-associated infection (HAI). Healthcare workers (HCWs) have a greater risk of acquiring COVID-19 infection than the general population. Globally, thousands of HCWs have lost their lives due to COVID-19 infection. AIM: Identify Incidence Rate and epidemiological characteristics of COVID-19 infection among health workers in Saudi Arabia. METHODOLOGY: A retrospective cohort study carried from March to November 2020. HCWs selected by a Complete Enumeration Survey method. Data analyzed in frequencies and percentage tables. To test the differences, post hoc after chi-square-(χ2) tests were used. RESULTS: As of November 30, 2020, a total of 57,159 HCWs tested positive with COVID-19. Their median age was 34 years, and 53% were male. Nurses were the most infected HCWs category (36%). The most common source of infection was from the community (78%). The majority of HCWs who acquired the infection from healthcare facilities got the infection from another HCW (63%). There was a significant difference between community and healthcare-acquired COVID-19 in relation to gender (P < 0.001) nationality (P < 0.001) job categories (P < 0.001) three age groups (<26: P = 0.012, 26-35 and 36-45: P < 0.001), and among HCWs who worked in MOH and private healthcare facilities (P < 0.001). The total number of reported deaths among HCWs during the study period was 198, with a case fatality rate of (0.35%). CONCLUSION: This study findings show that infected HCWs characteristics were similar to the previous studies and indicate incidence rates of 10% among COVID-19 infected HCWs in Saudi Arabia. Analysis of the infection status of HCWs is critical, to understand their needs and challenges, improve protective measures, and provide effective recommendations for policymakers.

Paediatric primary care in Germany during the early COVID-19 pandemic: the calm before the storm.

OBJECTIVES: Globally, the COVID-19 pandemic has a major impact on healthcare provision. The effects in primary care are understudied. This study aimed to explore changes in consultation numbers and patient management during the COVID-19 pandemic, and to identify challenges for patient care. DESIGN: Survey of paediatric primary care practices on consultation numbers and patient management changes, and semistructured interviews to identify challenges for patient care. Surveys and interviews were partially linked in an explanatory sequential design to identify patient groups perceived to be at higher risk for worse care during the pandemic. SETTING: In and around Düsseldorf, a densely populated area in Western Germany. The primary care facilities are spread over an area with approximately 2 million inhabitants. PARTICIPANTS: Primary care in Germany is provided through practices run by self-employed specialist physicians that are contracted to offer services to patients under public health insurance which is compulsory to the majority of the population. The sample contained 44 paediatric primary care practices in the area, the response rate was 50%. RESULTS: Numbers of consultations for scheduled developmental examinations remained unchanged compared with the previous year while emergency visits were strongly reduced (mean 87.3 less/week in March-May 2020 compared with 2019, median reduction 55.0%). Children dependent on developmental therapy and with chronic health conditions were identified as patient groups receiving deteriorated care. High patient numbers, including of mildly symptomatic children presenting for health certificates, in combination with increased organisational demands and expected staff outages are priority concerns for the winter. CONCLUSIONS: Primary care paediatricians offered stable service through the early pandemic but expected strained resources for the upcoming winter. Unambiguous guidance on which children should present to primary care and who should be tested would help to allocate resources appropriately, and this guidance needs to consider age group specific issues including high prevalence of respiratory symptoms, dependency on carers and high contact rates.

Infectious events in patients with severe COVID-19: results of a cohort of patients with high prevalence of underlying immune defect.

BACKGROUND: Empirical antibiotic has been considered in severe COVID-19 although little data are available regarding concomitant infections. This study aims to assess the frequency of infections, community and hospital-acquired infections, and risk factors for infections and mortality during severe COVID-19. METHODS: Retrospective single-center study including consecutive patients admitted to the intensive care unit (ICU) for severe COVID-19. Competing-risk analyses were used to assess cumulative risk of infections. Time-dependent Cox and fine and gray models were used to assess risk factors for infections and mortality. Propensity score matching was performed to estimate the effect of dexamethasone. RESULTS: We included 100 patients including 34 patients with underlying malignancies or organ transplantation. First infectious event was bacterial for 35 patients, and fungal for one. Cumulative incidence of infectious events was 27% [18-35] at 10 ICU-days. Prevalence of community-acquired infections was 7% [2.8-13.9]. Incidence density of hospital-acquired infections was 125 [91-200] events per 1000 ICU-days. Risk factors independently associated with hospital-acquired infections included MV. Patient's severity and underlying malignancy were associated with mortality. Dexamethasone was associated with increased infections (36% [20-53] vs. 12% [4-20] cumulative incidence at day-10; p = 0.01). After matching, dexamethasone was associated with hospital-acquired infections (35% [18-52] vs. 13% [1-25] at 10 days, respectively, p = 0.03), except in the subset of patients requiring MV, and had no influence on mortality. CONCLUSIONS: In this population of COVID-19 patients with high prevalence of underlying immune defect, a high risk of infections was noted. MV and use of steroids were independently associated with infection rate.