Algorithm for Individual Prediction of COVID-19-Related Hospitalization Based on Symptoms: Development and Implementation Study.

BACKGROUND: The COVID-19 pandemic has placed a huge strain on the health care system globally. The metropolitan area of Milan, Italy, was one of the regions most impacted by the COVID-19 pandemic worldwide. Risk prediction models developed by combining administrative databases and basic clinical data are needed to stratify individual patient risk for public health purposes. OBJECTIVE: This study aims to develop a stratification tool aimed at improving COVID-19 patient management and health care organization. METHODS: A predictive algorithm was developed and applied to 36,834 patients with COVID-19 in Italy between March 8 and the October 9, 2020, in order to foresee their risk of hospitalization. Exposures considered were age, sex, comorbidities, and symptoms associated with COVID-19 (eg, vomiting, cough, fever, diarrhea, myalgia, asthenia, headache, anosmia, ageusia, and dyspnea). The outcome was hospitalizations and emergency department admissions for COVID-19. Discrimination and calibration of the model were also assessed. RESULTS: The predictive model showed a good fit for predicting COVID-19 hospitalization (C-index 0.79) and a good overall prediction accuracy (Brier score 0.14). The model was well calibrated (intercept -0.0028, slope 0.9970). Based on these results, 118,804 patients diagnosed with COVID-19 from October 25 to December 11, 2020, were stratified into low, medium, and high risk for COVID-19 severity. Among the overall study population, 67,030 (56.42%) were classified as low-risk patients; 43,886 (36.94%), as medium-risk patients; and 7888 (6.64%), as high-risk patients. In all, 89.37% (106,179/118,804) of the overall study population was being assisted at home, 9% (10,695/118,804) was hospitalized, and 1.62% (1930/118,804) died. Among those assisted at home, most people (63,983/106,179, 60.26%) were classified as low risk, whereas only 3.63% (3858/106,179) were classified at high risk. According to ordinal logistic regression, the odds ratio (OR) of being hospitalized or dead was 5.0 (95% CI 4.6-5.4) among high-risk patients and 2.7 (95% CI 2.6-2.9) among medium-risk patients, as compared to low-risk patients. CONCLUSIONS: A simple monitoring system, based on primary care data sets linked to COVID-19 testing results, hospital admissions data, and death records may assist in the proper planning and allocation of patients and resources during the ongoing COVID-19 pandemic.

Spatial Distribution and Sampling Plans for Grapevine Plant Canopy-Inhabiting Scaphoideus titanus (Hemiptera: Cicadellidae) Nymphs.

The paper deals with the study of the spatial distribution and the design of sampling plans for estimating nymph densities of the grape leafhopper Scaphoideus titanus Ball in vine plant canopies. In a reference vineyard sampled for model parameterization, leaf samples were repeatedly taken according to a multistage, stratified, random sampling procedure, and data were subjected to an ANOVA. There were no significant differences in density neither among the strata within the vineyard nor between the two strata with basal and apical leaves. The significant differences between densities on trunk and productive shoots led to the adoption of two-stage (leaves and plants) and three-stage (leaves, shoots, and plants) sampling plans for trunk shoots- and productive shoots-inhabiting individuals, respectively. The mean crowding to mean relationship used to analyze the nymphs spatial distribution revealed aggregated distributions. In both the enumerative and the sequential enumerative sampling plans, the number of leaves of trunk shoots, and of leaves and shoots of productive shoots, was kept constant while the number of plants varied. In additional vineyards data were collected and used to test the applicability of the distribution model and the sampling plans. The tests confirmed the applicability 1) of the mean crowding to mean regression model on the plant and leaf stages for representing trunk shoot-inhabiting distributions, and on the plant, shoot, and leaf stages for productive shoot-inhabiting nymphs, 2) of the enumerative sampling plan, and 3) of the sequential enumerative sampling plan. In general, sequential enumerative sampling was more cost efficient than enumerative sampling.

Insight and subjective measures of quality of life in chronic schizophrenia.

Lack of insight is a well-established phenomenon in schizophrenia, and has been associated with reduced rater-assessed functional performance but increased self-reported well-being in previous studies. The objective of this study was to examine factors that might influence insight (as assessed by the Insight and Treatment Attitudes Questionnaire [ITAQ] or PANSS item G12) and subjective quality-of-life (as assessed by Lehman QoL Interview [LQOLI]), using the large National Institute of Mental Health Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) dataset. Uncooperativeness was assessed by PANSS item G8 ("Uncooperativeness"). In the analysis, we found significant moderating effects for insight on the relationships of subjective life satisfaction assessment to symptom severity (as assessed by CGI-S score), objective everyday functioning (as assessed by rater-administered Heinrichs-Carpenter Quality of Life scale), clinically rated uncooperativeness (as assessed by PANSS G8), and discontinuation of treatment for all causes (all P > 0.05 for statistical interaction between insight and subject QoL). Patients with chronic schizophrenia who reported being "pleased" or "delighted" on LQOLI were found to have significantly lower neurocognitive reasoning performance and poorer insight (ITAQ total score). Our findings underscore the importance of reducing cognitive and insight impairments for both treatment compliance and improved functional outcomes.

Cirurgia plástica periodontal para correção de sorriso gengivoso / Periodontal plastic surgery for treatment of gummy smile. Reports of clinical

A necessidade de um sorriso perfeito e de tratamentos estéticos tem aumentado nos últimos anos. O sorriso é determinado por posição, forma, tamanho do dente, textura, cor e linha da gengiva e dos lábios e a forma da maxila. O objetivo do presente trabalho foi relatar dois casos clínicos de sorriso gengivoso e descrever os diferentes fatores etiológicos e as formas de tratamento.

Aspirin resistance determined with PFA-100 does not predict new thrombotic events in patients with stable ischemic cerebrovascular disease.

OBJECTIVE: Evidence is growing that some patients are not responsive to the antithrombotic action of aspirin. We prospectively evaluated the ability of aspirin resistance status, determined by PFA-100, to predict new thrombotic events in patients with stable ischemic cerebrovascular disease. METHODS: We studied 129 consecutive patients with stroke, transient ischemic attack (TIA) or vascular cognitive impairment. We assessed relationships between aspirin resistance, risk factors for ischemic cerebrovascular disease, and occurrence of new thrombotic events (composite of stroke, TIA, myocardial infarction, and cardiovascular death). RESULTS: Aspirin resistance, found in 26 (20.1%) cases, was unrelated to any of the examined vascular risk factors. During mean follow-up of 56 months, new thrombotic events occurred in 19 patients (14.7%), four with aspirin resistance (15.4%) and 15 (14.6%) without aspirin resistance (p=1.00). CONCLUSION: Aspirin resistance determined by PFA-100 does not predict new thrombotic events in patients with stable ischemic cerebrovascular disease.

Avaliação clínica da eficiência do uso do sistema LED-laser, LED e luz halógena na ativação do agente clareador em dentes vitalizados / Clinical evaluation of the LED/diode laser, LED and halogen units efficiency in the activation of the vital tooth bleaching agent

O objetivo deste estudo foi avaliar, comparativamente, a efetividade de diferentes fontes de luz (halógena, LED e LED-laser) na ativação do peróxido de hidrogênio a 35%, usado na clareação de dentes vitalizados. Para isso, 24 voluntários foram divididos em 2 grupos independentes. Após a tomada da cor dos dentes com uma escala padronizada e realização de fotografias do terço inferior a face, os voluntários foram submetidos à técnica de clareação de consultório com peróxido de hidrogênio a 35%. No grupo 1, o hemi-arco superior direito foi fotoativado com um aparelho LED, enquanto o hemi-arco superior esquerdo foi fotoativado com um aparelho de luz halógena. No grupo 2, o gel clareador no hemi-arco superior direito foi fotoativado utilizando um aparelho LED-laser de diodo, e no hemi-arco superior esquerdo não foi realizada a ativação física do gel clareador. Após 2 sessões de tratamento, num controle pós-operatório, foi realizada a observação do branqueamento obtido, comparando-se os dentes superiores com os do arco inferior ainda não-clareado. Foram também observadas a sensibilidade trans e pós-operatória, a regressão - após 1 ano - do branqueamento obtido, bem como a satisfação dos pacientes quanto ao tratamento recebido. A análise comparativa dos resultados permitiu concluir que no grupo 1, as duas fontes testadas foram efetivas em proporcionar a clareação dentária na técnica de consultório, porém o sistema de luz LED proporcionou uma menor sensibilidade pós-operatóri. No grupo 2, observou-se não haver diferença clínica de tonalidade de cor entre o hemi-arco ativado e o não-ativadocom sistema LED-lase, demonstrando que o gel clareador foi efetivado independente da ativação com uma fonte de luz.

An effect of the PAI-1 4G/5G polymorphism on cholesterol levels may explain conflicting associations with myocardial infarction and stroke.

BACKGROUND AND PURPOSE: The gene-encoding plasminogen activator inhibitor type 1 (PAI-1) has a common 4G/5G 'functional' polymorphism, and people homozygous for the 4G allele have higher PAI-1 plasma concentrations. The 4G/4G genotype is associated with increased risk of myocardial infarction but paradoxically protects against stroke. We hypothesized that this paradox may be explained via an effect of the PAI-1 polymorphism on plasma lipids. METHODS: We studied 71 consecutive Italian patients referred to our Institute for first stroke or vascular cognitive impairment. PAI-1 gene 4G/5G polymorphism, total plasma cholesterol, plasma triglycerides, sex, age, smoking, oral contraceptive use, statin therapy, hypertension, diabetes, and history of myocardial infarction were examined. RESULTS: The 4G/4G genotype was significantly associated with high cholesterol (p = 0.003) but not with triglycerides (p = 0.39). Adjusted odds ratios were: 5.8 for 4G/4G vs. 4G/5G (95% CI, 3.1-23.0), and 15.9 for 4G/4G vs. 5G/5G (95% CI, 2.4-105.0). CONCLUSIONS: This finding may explain the involvement of the PAI-1 polymorphism in the clustering of atherothrombotic risk factors, and why people with the 4G/4G genotype are at increased risk for myocardial infarction. Stroke is not so clearly related to hypercholesterolemia and other effects of the 4G/4G genotype (perhaps increased PAI-1 expression) may protect against stroke.