Impact of lockdown on cardiovascular disease hospitalizations in a Zero-COVID-19 country.

OBJECTIVES: There are concerns about the potential effect of social distancing used to control COVID-19 on the incidence of cardiovascular diseases (CVD). STUDY DESIGN: Retrospective cohort study. METHODS: We examined the association between lockdown and CVD incidence in a Zero-COVID country, New Caledonia. Inclusion criteria were defined by a positive troponin sample during hospitalization. The study period lasted for 2 months, starting March 20, 2020 (strict lockdown: first month; loose lockdown: second month) compared with the same period of the three previous years to calculate incidence ratio (IR). Demographic characteristics and main CVD diagnoses were collected. The primary endpoint was the change in incidence of hospital admission with CVD during lockdown compared with the historical counterpart. The secondary endpoint included influence of strict lockdown, change in incidence of the primary endpoint by disease, and outcome incidences (intubation or death) analyzed with inverse probability weighting method. RESULTS: A total of 1215 patients were included: 264 in 2020 vs 317 (average of the historical period). CVD hospitalizations were reduced during strict lockdown (IR 0.71 [0.58-0.88]), but not during loose lockdown (IR 0.94 [0.78-1.12]). The incidence of acute coronary syndromes was similar in both periods. The incidence of acute decompensated heart failure was reduced during strict lockdown (IR 0.42 [0.24-0.73]), followed by a rebound (IR 1.42 [1-1.98]). There was no association between lockdown and short-term outcomes. CONCLUSIONS: Our study showed that lockdown was associated with a striking reduction in CVD hospitalizations, independently from viral spread, and a rebound of acute decompensated heart failure hospitalizations during looser lockdown.

Mucoviscous characteristics of Klebsiella pneumoniae strains: A factor of clinical severity?

INTRODUCTION: Hypermucoviscous Klebsiella pneumoniae (KP) strains are responsible for complicated bacteremia with multiple septic sites (liver, central nervous system, muscles). We aimed to compare the clinical severity of patients presenting with KP bacteremia based on the hypermucoviscous or non-hypermucoviscous characteristic of the strains. METHODS: Observational retrospective study successively including all patients with KP bacteremia from May 2013 to March 2015 at the tertiary medical center of New Caledonia. The hypermucoviscous characteristic was defined by the string test results and molecular analysis to determine the capsular serotype. RESULTS: A total of 55 bacteremic patients were included in the study; 27% of isolated strains were hypermucoviscous. Hypermucoviscous strains accounted for two-thirds of community-acquired infections (72.5% vs. 33.4%, p=0.01). The rate of intensive care hospitalization was high (hypermucoviscous 46.7%; standard 52.5%) without any difference between the two groups. No significant difference was observed in case fatality (hypermucoviscous 46.7% vs. standard 15%, p=0.07) but patients with hypermucoviscous strains had longer hospital stays (73.5 days versus 50.7 days, p=0.04) and longer persistence of positive blood cultures despite an appropriate treatment (OR 1.41, 95% CI: 1.0-1.96, p=0.045). CONCLUSION: Hypermucoviscous KP bacteremia account for most community-acquired Klebsiella infections in New Caledonia and are associated with longer hospital stay and persistence of positive blood cultures despite the implementation of an appropriate treatment.

Amplified Fragment Length Polymorphism Diversity in Cephalosporium maydis from Egypt.

ABSTRACT Cephalosporium maydis, the causal agent of late wilt of maize, was first described in Egypt in the 1960s, where it can cause yield losses of up to 40% in susceptible plantings. We characterized 866 isolates of C. maydis collected from 14 governates in Egypt, 7 in the Nile River Delta and 7 in southern (Middle and Upper) Egypt, with amplified fragment length polymorphism (AFLP) markers. The four AFLP primer-pair combinations generated 68 bands, 25 of which were polymorphic, resulting in 52 clonal haplotypes that clustered the 866 isolates into four phylogenetic lineages. Three lineages were found in both the Nile River Delta and southern Egypt. Lineage IV, the most diverse group (20 haplotypes), was recovered only from governates in the Nile River Delta. In some locations, one lineage dominated (up to 98% of the isolates recovered) and, from some fields, only a single haplotype was recovered. Under field conditions in Egypt, there is no evidence that C. maydis reproduces sexually. The nonuniform geographic distribution of the pathogen lineages within the country could be due to differences in climate or in the farming system, because host material differs in susceptibility and C. maydis lineages differ in pathogenicity.

Relative Competitiveness and Virulence of Four Clonal Lineages of Cephalosporium maydis from Egypt Toward Greenhouse-Grown Maize.

Four clonal lineages of Cephalosporium maydis, a soilborne vascular wilt pathogen that causes late wilt of maize, were differentiated previously with molecular markers. In Egypt, this fungus can cause significant losses in infected susceptible plants. In greenhouse tests of individual isolates we found that these lineages differ in their virulence toward a series of maize accessions commonly used in Egyptian maize breeding programs. We also determined the relative competitiveness of representatives of the four lineages when incorporated into the soil as a mixed inoculum. The lineage (IV) with greatest mean disease incidence (virulence), when tested alone, was the least competitive on susceptible maize accessions when coinoculated as a component of mixed inocula of all four lineages. In these coinoculation experiments, one of the less-virulent lineages (II) dominated (70% of infections) and appeared to be the most competitive. These results suggest that virulence and competitive ability are not the same in this host-pathogen system. These results also suggest that standard protocols that rely on mixed inocula for resistance screening need to be altered, and that the relative proportion of the different lineages of the pathogen recovered in a field may be influenced by the maize variety/hybrid planted.