Illness tracking in SARS-CoV-2 tested persons using a smartphone app: a non-interventional, prospective, cohort study.

There are few data on the range and severity of symptoms of SARS-CoV-2 infection or the impact on life quality in infected, previously healthy, young adults such as Swiss Armed Forces personnel. It is also unclear if an app can be used to remotely monitor symptoms in persons who test positive. Using a smartphone app called ITITP (Illness Tracking in Tested Persons) and weekly pop-up questionnaires, we aimed to evaluate the spectrum, duration, and impact of symptoms reported after a positive SARS-CoV-2 test according to sex, age, location, and comorbidities, and to compare these to responses from persons who tested negative. We followed up 502 participants (57% active participation), including 68 (13.5%) positive tested persons. Hospitalisation was reported by 6% of the positive tested participants. We found that positives reported significantly more symptoms that are typical of COVID-19 compared to negatives. These symptoms with odds ratio (OR > 1) were having difficulty breathing (OR 3.35; 95% CI: 1.16, 9.65; p = 0.03), having a reduced sense of taste (OR 5.45; 95% CI: 1.22, 24.34; p = 0.03) and a reduced sense of smell (OR 18.24; 95% CI: 4.23, 78.69; p < 0.001). Using a random forest model, we showed that tiredness was the single symptom that was rated as having a significant impact on daily activities, whereas the other symptoms, although frequent, had less impact. The study showed that the use of an app was feasible to remotely monitor symptoms in persons infected with SARS-CoV-2 and could be adapted for other settings and new pandemic phases such as the current Omicron wave.

Assessment of novel biomarkers: sTREM-1, pentraxin-3 and pro-adrenomedullin in the early diagnosis of neonatal early onset sepsis.

BACKGROUND: Early onset bacterial sepsis in neonates (EOS) is recognized as an important health condition. Early diagnosis is crucial. However, blood culture results are released in 48-72 hours. Many biomarkers have been investigated but none have been accepted as the gold standard. This study aimed to investigate the diagnostic value of the molecules: soluble form of triggering receptor expressed on myeloid cells-1 (sTREM-1), pentraxin-3 (PTX-3) and pro adrenomedullin (pro-ADM) in EOS and compare with currently used biomarkers. METHODS: In this multicenter prospective study, patients were enrolled from different NICUs around the Turkey. Patient data were collected via web-based registry system from attending centers. Neonates, hospitalized with a suspicion of EOS were enrolled. Blood culture and routine blood tests were collected and a serum sample was obtained and kept in - 80°C for studying the molecules. According to laboratory results, patients were divided into three groups as; proven sepsis, clinical sepsis and control group. Groups were compared in terms of demographic, clinical and laboratory findings. The primary outcome of the study was to assess any difference between groups in terms of the diagnostic value of the markers aforementioned. RESULTS: A total of 130 patients were enrolled; proven sepsis (n = 36), clinical sepsis (n = 53) and control (n = 41) groups. Groups were similar in terms of demographic findings; mean WBC (P = 0.445), procalcitonin (PCT) (P = 0.083) and IL-6 (P = 0.814) levels. Mean C-reactive protein (CRP) level was significantly higher in clinical sepsis and proven sepsis groups compared to control group (P < 0.001). Mean PTX-3 (P = 0.547), pro-ADM (P = 0.766) and sTREM-1 (P = 0.838) levels were similar between groups. CONCLUSION: These promising molecules failed to help in early diagnosis of EOS. Their relation to correlation with disease progression may make more sense as they seem to be expressed in higher amounts with the progression of the disease in previous studies. CRP was the most frequently used biomarker for detecting the sepsis in our study population.

Coexistence of Kasabach-Merritt Syndrome and placental chorioangioma in a premature infant.

Kasabach-Merritt syndrome is a rare life-threatening clinical presentation in neonatal period. it is characterized by giant hemangioma and serious thrombocytopenia. The diagnostic criteria include: 1) hemangiomas on skin, 2) thrombocytopenia or coagulopathy, 3) hemangioma on internal organs diagnosed by ultrasonography, computed tomography or magnetic resonance imaging, and 4) excluding reasons, such as idiopathic thrombocytopenic purpura or hypersplenism.Placental chorioangiomas are the most widespread non-trophoblastic benign tumor-like lesions of placenta. The clinical signs are associated with tumor size. Chorioangiomas larger than 4-5 cm may lead to various maternal and fetal complications.Here, a female premature infant was diagnosed with placental chorioangioma and liver hemangioma during antenatal period. She developed heart failure secondary to non-immune hydrops fetalis in the neonatal period. The atypical giant hemangioma and coagulopathy suggested the diagnosis of Kasabach-Merritt syndrome. The macroscopic and histopathological examination of the placenta confirmed the diagnosis of chorioangioma. The patient died due to purpura fulminans despite the treatment with prednisolone and propranolol that was started on the second day of life. We are presenting this rare case where placental chorioangioma leading to non-immune hydrops fetalis co-existed with Kasabach-Merritt syndrome.

Giant thrombus on apical wall of left ventricle due to HIT syndrome after anterior MI.

Heparin-induced thrombocytopenia (HIT) is the most important and the most frequent drug-induced, immune-mediated type of thrombocytopenia. It is associated with significant mortality and morbidity if unrecognized. We describe a patient with a giant thrombus on the apical wall of the left ventricle that occurred due to HIT syndrome after anterior myocardial infarction.

[Pay for performance (P4P). Long-term effects and perspectives]. / Pay for Performance (P4P). Langfristige Effekte und Anreizwirkungen.

After 10 years of experience and research, a wide array of results on evaluation and long-term effects of pay for performance (P4P) programs have been published. These data do not only give insight into most of the problems of implementation, but also into aspects which, in part, may attenuate the high expectations at the beginning of the discussion. P4P programs exhibit a ceiling effect, some improvements are reversed after incentives are cancelled, and improvements show opportunity costs as absent improvements for indicators, which are not object to financial incentives (in some cases for the same disease). These observations can be explained by the hypothesis that P4P programs have characteristics of fee-for-service reimbursement, if symmetric information is available for insurance and provider. P4P programs are local instruments. While integration of healthcare is considered as an important issue, they should be combined with programs and incentives which foster further vertical and horizontal integration. For Germany, further research in the implementation and effects of P4P programs is necessary.

Acute and sustained antianginal effects of nitroglycerin patches: objective evaluation with training-effect-eliminated exercise performance index.

A randomized within-patient double-blind acute and sustained study was performed to compare transdermal nitroglycerin (NTG) patches (5 and 10 mg) and matching placebo in 10 patients with chronic stable angina pectoris confirmed on exercise thallium scintigraphy or coronary angiography, or both. Patients performed treadmill tests 2 and 24 hours after application of patches on the first and last days of each of the 3 treatment periods. Effects caused by sequence of treatments and training with serial testing were prominent so the changes in the well-known parameters did not favor either of the active doses over placebo. Quantification of training effects and its subtraction from performance index disclosed that 10 mg of transdermal NTG caused significant increase in performance in both the acute and sustained stages of therapy in comparison to pretreatment performance. This was not observed with 5 mg and placebo treatments. To our knowledge, this is the first trial to study the efficacy of transdermal NTG with a more objective parameter that permitted elimination of training effects of serial exercise testing.

Acute systolic hypertension after acute myocardial infarction: prognostic and therapeutic significance.

In this study, the incidence of acute systolic hypertension (ASH) after acute myocardial infarction and the effects of this complication on the clinical course and prognosis of the disease were studied retrospectively in 950 cases. ASH was characterized as an elevation of systolic blood pressure over 170 mmHg for at least 30 minutes in a previously normotensive subject. There were 50 cases with ASH (5.3%) and 370 (38.9%) with normal blood pressures among the studied 950. The incidences of acute left ventricular failure and of arrhythmias such as sinus tachycardia, atrial and ventricular premature beats and ventricular tachycardia were significantly higher in the group with ASH in comparison with those with normal blood pressures. The group with ASH had also a greater average number of recurrent ventricular fibrillation attacks. The peak SGOT levels were found to be significantly increased in cases in whom the ASH sustained for more than 12 hours. The results suggested that the ASH which occurred predominantly in the early period of acute myocardial infarction was associated with more extensive myocardial damage resulting in a poor clinical course complicated by frequent ventricular arrhythmias and left ventricular failure. It is our conclusion that ASH after myocardial infraction is associated with relatively poor prognosis.