Epidemiology of respiratory distress and the illness severity in late preterm or term infants： a prospective multi-center study

Background The severity of respiratory distress was associated with neonatal prognosis. This study aimed to explore the clinical characteristics, therapeutic interventions and short-term outcomes of late preterm or term infants who required respiratory support, and compare the usage of different illness severity assessment tools.Methods Seven neonatal intensive care units in tertiary hospitals were recruited. From November 2008 to October 2009, neonates born at ≥34 weeks＇ gestational age, admitted at 〈72 hours of age, requiring continuous positive airway pressure （CPAP） or mechanical ventilation for respiratory support were enrolled. Clinical data including demographic variables, underlying disease, complications, therapeutic interventions and short-term outcomes were collected. All infants were divided into three groups by Acute care of at-risk newborns （ACoRN） Respiratory Score 〈5, 5-8, and 〉8.Results During the study period, 503 newborn late preterm or term infants required respiratory support. The mean gestational age was （36.8±2.2） weeks, mean birth weight was （2734.5±603.5） g. The majority of the neonates were male （69.4%）, late preterm （63.3%）, delivered by cesarean section （74.8%）, admitted in the first day of life （89.3%） and outborn （born at other hospitals, 76.9%）. Of the cesarean section, 51.1% were performed electively. Infants in the severe group were more mature, had the highest rate of elective cesarean section, Apgar score 〈7 at 5 minutes and resuscitated with intubation, the in-hospital mortality increased significantly. In total, 58.1% of the patients were supported with mechanical ventilation and 17.3% received high frequency oscillation. Adjunctive therapies were commonly needed.Higher rate of infants in severe group needed mechanical ventilation or high frequency oscillation, volume expansion,bicarbonate infusion or vasopressors therapy （P 〈0.05）. The incidence of complications was also increased significantly in severe group （P 〈0.05）. The in-hospital mortality in the severe group was significantly higher than other two groups （P〈0.05）. ACoRN Respiratory Score was correlated with Score for Neonatal Acute Physiology-Version Ⅱ （SNAP-Ⅱ） （P〈0.01）. High gestational age, high SNAP-Ⅱ score and oxygenation index （OI）, and Apgar score at 5 minutes 〈5 were independent risks for death.Conclusions Neonatal respiratory distress is still a common cause of hospitalization in China. Illness severity assessment is important for the management. ACoRN Respiratory Score which correlated with SNAP-Ⅱ score is easy to use and may be helpful in facilitating the caregivers in local hospital to identify the early signs and make the transfer decision promptly.

High Severity of Illness Patients in a Small Metropolitan Area

This study evaluated the impact of high severity of illness patients on hospital utilization in the metropolitan area of Syracuse, New York between 2012 and 2015. It employed the All Patients Refined Severity of Illness system developed by 3M&#8482 Health Information Systems. These patients are important for the management and practice of nursing in acute hospitals. The study demonstrated that patients at extreme and major severity of illness generated 60 - 70 percent of the inpatient days for adult medicine and adult surgery in the combined Syracuse hospitals. Mean lengths of stay for patients at extreme severity of illness were two to four times the stays for these services. Inpatient readmission rates for extreme severity of illness patients were more than double the rates for these services. The study data also indicated that the impact of patients at high severity of illness was increasing over time. The study also demonstrated that recent efforts of the Syracuse hospitals have produced reductions in the numbers of excess patient days for adult medicine and surgery, but limited reductions in the mean lengths of stay for these patients. The data suggested that meeting the needs of these patients is especially challenging in a small metropolitan area without an additional level of care within the continuum.

Effect of Bifidobacterium longum 35624 on disease severity and quality of life in patients with irritable bowel syndrome

BACKGROUND Bifidobacterium longum 35624 has shown efficacy in improving irritable bowel syndrome(IBS)symptoms compared with placebo in double-blind randomized studies.However,few data are available from real-life clinical practice or from studies that used Rome IV criteria to diagnose IBS.AIM To assess the effect of B.longum 35624 on IBS severity and quality of life in a reallife setting.METHODS From November 2018 to January 2020,278 patients with IBS(according to Rome IV criteria)were enrolled in a prospective,open-label,multicenter observational study by private practice gastroenterologists to received one capsule of B.longum 35624(10^(9) colony-forming units)per day for 30 d.Participation in the study was independently proposed to patients during spontaneous consultations.Disease severity(assessed by the IBS severity scoring system)and patient quality of life(assessed by the IBS quality of life questionnaire)were compared between the inclusion visit(baseline)and the visit at the end of 30 d of treatment.The characteristics of patients were described at baseline.Continuous variables comparisons between inclusion and end-of-treatment visits were performed using the t-test and Kruskal-Wallis test.Categorical variables comparisons were performed using theχ^(2) test.RESULTSA total of 233 patients,with a mean age of 51.4 years and composed of 71.2%women,were included in the study.Of these patients,48.1%had moderate IBS and 46.4%had severe IBS.After a 30-d treatment period with one B.longum 35624 capsule per day,a significant decrease in IBS severity was observed compared to baseline(mean±SD,IBS severity scoring system scores:208±104 vs 303±81,P<0.001)and 57%of patients moved to lower severity categories or achieved remission.The quality of life of patients was also improved by the treatment(IBS Quality of Life questionnaire score:68.8±20.9 vs 60.2±20.5;P<0.001)and 63.8%of patients were satisfied with the treatment.CONCLUSION Thirty days of treatment with B.longum 35624 reduces disease severity and improves the quality of life of patients with IBS,particularly those with the most severe forms of IBS.

Factors Defining the Development of Severe Illness in Patients with COVID-19:A Retrospective Study

Objective Early triage of patients with coronavirus disease 2019(COVID-19) is pivotal in managing the disease. However, studies on the clinical risk score system of the risk factors for the development of severe disease are limited. Hence, we conducted a clinical risk score system for severe illness, which might optimize appropriate treatment strategies.Methods We conducted a retrospective, single-center study at the JinYinTan Hospital from January 24,2020 to March 31, 2020. We evaluated the demographic, clinical, and laboratory data and performed a10-fold cross-validation to split the data into a training set and validation set. We then screened the prognostic factors for severe illness using the least absolute shrinkage and selection operator(LASSO)and logistic regression, and finally conducted a risk score to estimate the probability of severe illness in the training set. Data from the validation set were used to validate the score.Results A total of 295 patients were included. From 49 potential risk factors, 3 variables were measured as the risk score: neutrophil to lymphocyte ratio(OR, 1.27;95% CI, 1.15–1.39), albumin(OR,0.76;95% CI, 0.70–0.83), and chest computed tomography abnormalities(OR, 2.01;95% CI, 1.41–2.86)and the AUC of the validation cohort was 0.822(95% CI, 0.7667–0.8776).Conclusion This report may help define the potential of developing severe illness in patients with COVID-19 at an early stage, which might be related to the neutrophil to lymphocyte ratio, albumin, and chest computed tomography abnormalities.

Prevalence and Factors Associated with Risky Sexual Behaviors among Patients with Severe Mental Illness in Uganda: A Descriptive Cross Sectional Study

Background: Persons living with severe mental illness (SMI) which includes schizophrenia, bipolar affective disorder and recurrent major depressive disorder are predisposed to risky sexual behavior (RSB). There is a paucity of data on this problem in sub-Saharan Africa and where research has been undertaken, only a limited range of risk factors have been considered and most of it was undertaken before antiretroviral therapy was universally available, hence the need for this study. The objective of this study was to determine the prevalence and factors associated with risky sexual behavior among individuals with SMI attending care in central and south western Uganda. Methods: A cross sectional study was conducted among 393 persons with SMI attending two psychiatric out-patient facilities in Uganda. Psychiatric disorder was confirmed using MINI International Neuropsychiatric Interview version 7.2. RSB was defined as engaging in at least one of four risky sexual behaviours that have been associated with HIV infection in the Ugandan psychosocial environment in the last three months using an 8 item RSB questionnaire used for assessment of RSB. Prevalence of RSB and associated correlates were determined using multiple logistic regression. Results: The Prevalence of RSB in last 3 months’ periods was 24.2% (95% CI: 20.2% - 28.7%). The factors that were independently significantly associated with RSB were: trauma related (history of childhood trauma, past and current sexual abuse, past and current physical abuse) current psychosocial challenges (mental health stigma) and psychiatric illness factors (history of a past manic episode, current psychotic episode, severity of depressive symptoms and severity of manic symptoms). Conclusions: One quarter of clinic attending respondents with severe mental illness in Uganda practice risky sexual behaviour. Factors associated with risky sexual behaviour fall under the domains of past and present trauma, current psychosocial challenges and psychiatric illness factors. This calls for a multi-sectoral approach that includes community awareness about the nature of SMI and the rights of persons with SMI and measures to improve Psychiatric symptom management.

Understanding Anger and Effective Anger Management Techniques(A Short Review)

This article explores the complex topic of rage and its important concomitant,anger management.Anger is a natural emotion that is experienced in many ways.Its triggers,body reactions,and mental components are all examined.Developing techniques for efficient anger management begins with an understanding of the nature of rage.This short review emphasizes the significance of anger management,stressing its critical role in preserving mental and physical health,stimulating personal development,and preserving relationships.Anger that is out of control can have serious ramifications,such as long-term stress,poor decision-making,damaged relationships,and legal issues.In order to provide readers with practical knowledge,an extensive range of effective strategies for managing anger is provided.These techniques include deep breathing,cognitive restructuring,self-awareness,and physical practices including progressive muscle relaxation and exercise.Other essential elements of anger control are stress reduction,obtaining professional help,and developing effective communication skills.The conclusion highlights the transformative potential of anger management,highlighting that the key to effectively managing and utilizing this powerful emotion is not about repressing anger.By putting these strategies into practice and seeing anger as a chance for development and transformation,people can start down the path to greater wellbeing,more wholesome relationships,and a more peaceful life.

Scoring systems in critically ill: Which one to use in cancer patients?

BACKGROUND Scoring systems have not been evaluated in oncology patients.We aimed to assess the performance of Acute Physiology and Chronic Health Evaluation(APACHE)II,APACHE III,APACHE IV,Simplified Acute Physiology Score(SAPS)II,SAPS III,Mortality Probability Model(MPM)II0 and Sequential Organ Failure Assessment(SOFA)score in critically ill oncology patients.AIM To compare the efficacy of seven commonly employed scoring systems to predict outcomes of critically ill cancer patients.METHODS We conducted a retrospective analysis of 400 consecutive cancer patients admitted in the medical intensive care unit over a two-year period.Primary outcome was hospital mortality and the secondary outcome measure was comparison of various scoring systems in predicting hospital mortality.RESULTS In our study,the overall intensive care unit and hospital mortality was 43.5%and 57.8%,respectively.All of the seven tested scores underestimated mortality.The mortality as predicted by MPM II0 predicted death rate(PDR)was nearest to the actual mortality followed by that predicted by APACHE II,with a standardized mortality rate(SMR)of 1.305 and 1.547,respectively.The best calibration was shown by the APACHE III score(χ^(2)=4.704,P=0.788).On the other hand,SOFA score(χ^(2)=15.966,P=0.025)had the worst calibration,although the difference was not statistically significant.All of the seven scores had acceptable discrimination with good efficacy however,SAPS III PDR and MPM II0 PDR(AUROC=0.762),had a better performance as compared to others.The correlation between the different scoring systems was significant(P<0.001).CONCLUSION All the severity scores were tested under-predicted mortality in the present study.As the difference in efficacy and performance was not statistically significant,the choice of scoring system used may depend on the ease of use and local preferences.

Gynaecological Cancers in HIV Positive and Negative Women—A Single-Center Retrospective Study (2008-2017)

Background/Objective: The association between Human Immunodeficiency Virus (HIV) and invasive cervical carcinoma is fully recognized. However, the effect of HIV and antiretroviral therapy on the morbidity and mortality of other gynaecological cancers have not been conclusively determined. Our study objective was to examine the effects of HIV on patient age at presentation, prevalence, and severity of the illness of various gynaecological cancers diagnosed in University of Nigeria Teaching Hospital (UNTH), Enugu over the period 2008-2017. Methods: This was a retrospective cross-sectional study of 224 patients who were managed in UNTH for different gynaecological malignancies. Ethical clearance was obtained from the Research Ethics Committee of the UNTH, Enugu. Data analysis was done with SPSS software with results expressed in descriptive statistics of simple frequency and percentage, and p-value set at Results: A total of 224 patients were studied. Twenty-five percent of HIV positive patients were aged 31 - 40 years at presentation compared to 12% of HIV negative patients. The commonest gynaecological cancer was cervical cancer with a higher proportion among the HIV-positive patients. While 32% of HIV negative patients presented at FIGO stages 1 - 2 Versus 8.3% of HIV positive patients, 58.3% and 33.3% of HIV positive patients presented at stages 3 and 4 respectively. Only 8.3% of HIV positive patients presented with ovarian cancer compared with 31% of HIV negative patients. A higher proportion of HIV positive patients presented with vulvar cancer (16.7%), but no endometrial or choriocarcinoma/GTD, compared with HIV negative patients. Conclusion: HIV positive clients present at an earlier age with more advanced disease, mostly cervical cancer of the squamous cell variety, with minimal non-AIDS defining cancers over the study period in UNTH, Enugu.

Performance of the PRISM I,PIM2,PELOD-2 and PRISM IV scoring systems in western China:a multicenter prospective study

Background The aim of this study was to evaluate the performance of the four scoring tools in predicting mortality in pediatric intensive care units(PICUs)in western China.Methods This was a multicenter,prospective,cohort study conducted in six PICUs in western China.The performances of the scoring systems were evaluated based on both discrimination and calibration.Discrimination was assessed by calculating the area under the receiver operating characteristic curve(AUC)for each model.Calibration was measured across defined groups based on mortality risk using the Hosmer-Lemeshow goodness-of-fit test.Results A total of 2034 patients were included in this study,of whom 127(6.2%)died.For the entire cohort,AUCs for Pediatric Risk of Mortality Score(PRISM)I,Pediatric Index of Mortality 2(PIM2),Pediatric Logistic Organ Dysfunction Score-2(PELOD-2)and PRISM IV were 0.88[95%confidence interval(CI)0.85–0.92],0.84(95%CI 0.80–0.88),0.80(95%CI 0.75–0.85),and 0.91(95%CI 0.88–0.94),respectively.The Hosmer-Lemeshow goodness-of-fit Chi-square value was 12.71(P=0.12)for PRISM I,4.70(P=0.79)for PIM2,205.98(P<0.001)for PELOD-2,and 7.50(P=0.48)for PRISM IV[degree of freedom(df)=8].The standardized mortality ratios obtained with the PRISM I,PIM2,PELOD-2,and PRISM IV models were 0.87(95%CI,0.75–1.01),0.97(95%CI,0.85–1.12),1.74(95%CI,1.58–1.92),and 1.05(95%CI,0.92–1.21),respectively.Conclusions PRISM IV performed best and can be used as a prediction tool in PICUs in Western China.However,PRISM IV needs to be further validated in NICUs.

Analysis of severe human adenovirus infection outbreak in Guangdong Province,southern China in 2019

During 2018–2019,a severe human adenovirus(HAdV)infection outbreak occurred in southern China.Here,we screened 18 respiratory pathogens in 1704 children(≤14 years old)hospitalized with acute respiratory illness in Guangzhou,China,in 2019.In total,151 patients had positive HAdV test results;34.4%(52/151)of them exhibited severe illness.HAdV infection occurred throughout the year,with a peak in summer.The median patient age was 3.0(interquartile range:1.1–5.0)years.Patients with severe HAdV infection exhibited increases in12 clinical indexes(P≤0.019)and decreases in four indexes(P≤0.007),compared with patients exhibiting nonsevere infection.No significant differences were found in age or sex distribution according to HAdV infection severity(P>0.05);however,the distributions of comorbid disease and HAdV co-infection differed according to HAdV infection severity(P<0.05).The main epidemic types were HAdV-3(47.0%,71/151)and HAdV-7(46.4%,70/151).However,the severe illness rate was significantly higher in patients with HAdV-7(51.4%)than in patients with HAdV-3(19.7%)and other types of HAdV(20%)(P<0.001).Sequencing analysis of genomes/capsid genes of 13 HAdV-7 isolates revealed high similarity to previous Chinese isolates.A representative HAdV-7isolate exhibited a similar proliferation curve to the curve described for the epidemic HAdV-3 strain Guangzhou01(accession no.DQ099432)(P>0.05);the HAdV-7 isolate exhibited stronger virulence and infectivity,compared with HAdV-3(P<0.001).Overall,comorbid disease,HAdV co-infection,and high virulence and infectivity of HAdV-7 were critical risk factors for severe HAdV infection;these data can facilitate treatment,control,and prevention of HAdV infection.

The WHO near miss criteria are appropriate for admission of critically ill pregnant women to intensive care units in China

Background Evaluation of the severity of the pregnant women with suitable admission to the Intensive Care Unit （ICU） is very important for obstetricians. By now there are no criteria for critically ill obstetric patients admitted to the ICU. In this article, we investigated the admission criteria of critically ill patients admitted to the ICU in order to provide a referral basis of reasonable use of the ICU. Methods A retrospective analysis of critically ill pregnant women admitted to the ICU in Perking University Third Hospital in China in the last 6 years （from January 2006 to December 2011） was performed, using acute physiology and chronic health evaluation II （APACHE-II）, Marshall and WHO near miss criteria to assess the severity of illness of patients. Results There were 101 critically ill pregnant patients admitted to the ICU. Among them, 25.7% women were complicated with internal or surgical diseases, and 23.8% women were patients of postpartum hemorrhage and 23.8% women were patients of pregnancy-induced hypertension. Sixty-nine cases （68.3%） were administrated with adjunct respiration with a respirator. Sixteen cases （15.8%） required 1-2 types of vasoactive drugs. Fifty-five cases （54.5%） required a hemodynamic monitoring. Seventy-three cases （72.3%） had multiple organ dysfunctions （MODS）. The average duration in ICU was （7.5＋3.0） days. A total of 12.9%, 23.8% and 74.3% of women were diagnosed as critically ill according to the APACHE-II, Marshall and WHO near miss criteria, respectively. The rate was significantly different according to the three criteria （P〈0.01）. Conclusions The WHO near miss criteria can correctly reflect the severity of illness of pregnant women, and the WHO near miss criteria are appropriate for admission of critically ill pregnant women to ICU in China.