Cystic fibrosis improves COVID-19 survival and provides clues for treatment of SARS-CoV-2.

Systemic pools of ATP are elevated in individuals homozygous for cystic fibrosis (CF) as evidenced by elevated blood and plasma ATP levels. This elevated ATP level seems to provide benefit in the presence of advanced solid tumors (Abraham et al., Nature Medicine 2(5):593-596, 1996). We published in this journal a paper showing that IV ATP can elevate the depleted ATP pools of advanced cancer patients up to levels found in CF patients with subsequent clinical, biochemical, and quality of life (QOL) improvements (Rapaport et al., Purinergic Signalling 11(2): 251-262, 2015). We hypothesize that the elevated ATP levels seen in CF patients may be benefiting CF patients in another way: by improving their survival after contracting COVID-19. We discuss here the reasoning behind this hypothesis and suggest how these findings might be applied clinically in the general population.

Non-medical prescription opioid use and violent behaviour among adolescents.

OBJECTIVE: A pharmacological explanation for the observed positive association between opioid abuse and violence does not appear to exist. Several explanations have therefore been posited. This study attempted to shed additional light on the latent factors linking opioid abuse and adolescent violence. To the best of our knowledge, this is the first investigation to examine this relationship while distinguishing between adolescents who misused their own versus a diverted prescription. A secondary objective was to compare the estimated effects of opioid abuse to those of other substances. METHOD: The 2008 Washington State Healthy Youth Survey data were analysed. A full information maximum likelihood multiple regression was used to account for missing data. RESULTS: Diverted- and own-prescription opioid abuse among adolescents were evidenced to be relatively strong predictors of violent thoughts and subsequent violent behaviour. CONCLUSIONS: These findings, in conjunction with our unique operationalisation of violence, help us draw inferences about the true source of the relationship between opioid abuse and violence. The results also indicate that opioid abuse is a potentially modifiable risk factor for violence. The fact that this negative outcome was observed for youths abusing their own prescription is further cause for concern given the recent surge in opioid prescriptions.

Multicultural emergency medicine epidemiology: A health economic analysis of patient visits.

OBJECTIVE: There is growing evidence to suggest that culturally and linguistically diverse (CALD) patients cost the health system more than non-CALD patients because of a higher burden of disease and increased resource consumption. The present study aimed to compare the ED resource utilisation of CALD and non-CALD patients at a tertiary hospital in Sydney, Australia. METHODS: The total ED resource utilisation was calculated by separating each visit into diagnostic test cost and time spent in ED components. The time component was calculated using the product of the total length of stay and a resource cost per unit time measure. Diagnostic tests were costed using the Australian Medicare Benefit Schedule. A generalised additive model was developed to estimate the isolated effect of CALD status on the resource utilisation during an ED visit. RESULTS: CALD patients had a higher median resource utilisation than non-CALD patients ($736.93 vs $701.36, P < 0.0001); however, the generalised additive model demonstrated that CALD status was not independently associated with increased resource utilisation. CONCLUSION: CALD status is not an independent influence on ED resource utilisation but other explanatory variables such as increased age and altered case-mix appear to have a much greater influence. There may, however, be other reasons to consider CALD loading such as equity in healthcare and to address poorer overall health outcomes for CALD patients.

Does the removal of contact precautions for MRSA and VRE infected patients change health care-associated infection rate?: A systematic review and meta-analysis.

OBJECTIVE: Update existing meta-analysis to analyze if discontinuation of contact precautions (CPs) for Methicillin-resistant Staphylococcus aureus (MRSA) and Vancomycin resistant Enterococcus (VRE) colonization or infection affects hospital-associated MRSA or VRE infection rates. METHODS: We conducted a systematic review of 17 studies evaluating discontinuation of CPs for MRSA and VRE. Random-effects and fixed-effects models were used to determine the pooled risk ratios (RR) of preincidence hospital-associated infection rate to postincidence rate. Subgroup analysis was used to assess sources of heterogeneity. RESULTS: No significant difference between rates of hospital-associated MRSA infection before and after stopping the CPs was observed (RR, 0.84; 95% confidence internal [CI], 0.71-1.01; P = .06). An inverse association was observed between discontinuation of CPs and rates of hospital-associated VRE infection (RR, 0.82; 95% CI, 0.72-0.94; P = .005). A subgroup analysis of 6 studies that used chlorhexidine, showed no difference between rates of hospital-associated MRSA infection with discontinuation of CPs (RR, 0.83; 95% CI, 0.69-1.00; P = .05). In 5 studies that did not use chlorhexidine, there was no difference between rates of hospital-associated MRSA infection with discontinuation of CPs (RR, 1.02; 95% CI, 0.55-1.88; P= .95). CONCLUSIONS: There was no significant difference in rates of hospital-associated MRSA infection before and after removing CPs. Additionally, there were decreased rates of hospital-associated VRE infection following stoppage of CPs.

Emerging trends in genetic-based medical diagnostics.

Prior to the publication of the sequencing of the human genome in April 2003, approximately 1,000 genetic tests were available for monogenetic diseases, i.e., those diseases that emanate from a single gene. The Human Genome Project (HGP) offers the data needed to elucidate the more difficult polygenetic diseases and genetic predisposition to diseases, and help explain variability in drug response. Microarray technology utilizing HGP data has made it possible to survey a person's genome. The applications of this technology include minimizing drug reactions and deriving cancer prognoses. This article will address the role of genetic testing in diagnosing and predicting disease now and in the near future.

Compliance with stress testing in patients discharged from the emergency department following a diagnosis of low-risk chest pain.

OBJECTIVE: To determine rates of compliance with outpatient stress testing in patients with a diagnosis of low-risk chest pain, reasons for non-compliance and incidence of adverse cardiac events (ACE). METHODS: This was a prospective study of 79 patients who were discharged from the emergency department with low-risk chest pain. Patients were followed-up by phone interview. RESULTS: 36.7% of patients completed EST within 30 days, 2.5% of patients completed their EST within the recommended 72 h. A lack of time was the most common reason for non-compliance and was seen in 32.0% of patients. 20% of ESTs were cancelled by the primary care physician (PCP). 12% of patients were non-compliant, as they believed the pain to be non-cardiac. There were no documented ACEs in the study. CONCLUSIONS: Compliance with EST is poor in patients with low-risk chest pain. Non-compliance is related to a number of factors including work commitments, cancellation of studies by the PCP and patients beliefs about the nature of their chest pain.

Early emergency department representations.

OBJECTIVE: The present study aims to describe early ED representation rates and identify the causes for this commonly seen problem. METHODS: This was a retrospective chart review of all patients that represented within 72 h of discharge from a tertiary level ED in Sydney, Australia, over a 2 month period between 1 May 2010 and 30 June 2010. Presentations were categorised according to their diagnosis and cause for representation. Each representation was then classified as being avoidable or unavoidable. RESULTS: There were 10 141 presentations to the ED during the study period, with 497 patients (4.9%, 95% confidence interval [CI] 4.5-5.3) representing within 72 h of discharge. Disease-related causes of representation were seen in 55.1% (95% CI 50.7-59.5), with 39% (95% CI 34.8-43.4) of these caused by disease progression and 12.3% (95% CI 9.6-15.5) for scheduled review. Patient-related causes were seen in 32.2% (95% CI 28.2-36.4) of representations with 20.9% (95% CI 17.6-24.7) of these for patients who did not wait or left against medical advice. Physician-related causes were seen in 3.2% (95% CI 2.0-5.2) of representations. Furthermore, 23.7% (95% CI 20.2-27.7) of patients who represented to the ED required hospital admission. A total of 37.0% (95% CI 32.9-41.4) of representations were assessed as being preventable. CONCLUSION: Early ED representations are a common problem. The majority of preventable representations are patient related, and interventions to target these areas might be of benefit in reducing this problem.

Terson's syndrome: subarachnoid haemorrhage presenting as sudden visual loss.

Subarachnoid haemorrhage is a condition that usually presents with headache and altered mental state. We report the case of a 50-year-old man with subarachnoid haemorrhage who presented with Terson's syndrome. This is a condition where there is retinal or vitreous haemorrhage secondary to subarachnoid or subdural haemorrhage.