Trends in diabetic ketoacidosis in Victoria, Australia 2002-2016.

BACKGROUND: International longitudinal studies have indicated an increasing incidence of diabetic ketoacidosis (DKA). We aim to examine the incident trends, demographic differences, length of stay and mortality for DKA in adults with type 1 diabetes (T1D) and type 2 diabetes (T2D) in Victoria, Australia from 2002 to 2016. METHODS: Age and sex adjusted incident trends, length of stay and mortality for DKA was retrospectively obtained using the Victorian Admitted Episode Dataset between 2002 and 2016. Data for adults with T1D and T2D was obtained from the National Diabetes Services Scheme (NDSS). Joinpoint regression analysis was used to identify changes in linear trends that were described as average annual percentage change (AAPC). RESULTS: There were 23,628 DKA presentations in Victoria between 2002 and 2016. For T1D there was an increase in DKA presentations (AAPC + 6.8%) from 2003 to 2016 and for T2D there was a decline from 2003 to 2011 (APC - 3.5%), increase from 2011 to 2014 (APC + 38.5%), and a decrease from 2014 to 2016 (APC - 20.9%). Length of stay was longer for people with T2D than T1D (P < 0.001) and the mortality rate was 0.51% for the study period. CONCLUSIONS: DKA rates increased for T2D from 2011 to 2014 which correlates with the introduction of sodium glucose-linked transport protein 2 inhibitors. However, the aetiology for the observed increase in T1D from 2002 to 2016 remains unknown.

Epidemiology, clinical presentations and outcome of patients presenting to the emergency department after a COVID-19 vaccination: An observational study.

OBJECTIVE: The World Health Organization declared the COVID-19 pandemic on 11 March 2020. In 2021, several vaccines were provisionally approved to reduce the risk of transmission and hospitalisation of COVID-19 infection. A surge in COVID-19 vaccination was seen between August and October 2021 in Victoria, Australia. We hypothesised this led to an increase in ED presentations. METHODS: Patients in the present study were adults who presented to the ED within 21 days of receiving a dose of a COVID-19 vaccine between 11 August 2021 and 14 November 2021. All cases underwent chart reviews to extract epidemiological features, clinical presentations, ED assessments, investigations and disposition. RESULTS: Notably, 968 patients were included in the study, comprising 6.1% of all ED presentations during the study period. The median age was 31 years. 82.9% of patients were younger than 45 years. 20.1% of patients arrived by ambulance. Chest pain was the most common presenting complaint (43.6%), followed by headache (10.3%) and palpitations (8.2%). The most common investigations were a full blood examination (73.5%), an ECG (63.8%) and serum troponin (49.1%). 64.8% of patients were directly discharged home and 22.1% were sent home after a short stay admission. Only 2.2% of patients were admitted to the hospital. CONCLUSION: A majority of patients who presented to the ED after their COVID vaccinations were young and discharged home after the initial assessment. These presentations have significantly increased the workload in prehospital settings and EDs, contributing to increased investigation usage, ED treatment space occupancy, and increased costs to the health system.

Biophysical Characterization of Viral and Lipid-Based Vectors for Vaccines and Therapeutics with Light Scattering and Calorimetric Techniques.

Novel vaccine platforms for delivery of nucleic acids based on viral and non-viral vectors, such as recombinant adeno associated viruses (rAAV) and lipid-based nanoparticles (LNPs), hold great promise. However, they pose significant manufacturing and analytical challenges due to their intrinsic structural complexity. During product development and process control, their design, characterization, and quality control require the combination of fit-for-purpose complementary analytical tools. Moreover, an in-depth methodological expertise and holistic approach to data analysis are required for robust measurements and to enable an adequate interpretation of experimental findings. Here the combination of complementary label-free biophysical techniques, including dynamic light scattering (DLS), multiangle-DLS (MADLS), Electrophoretic Light Scattering (ELS), nanoparticle tracking analysis (NTA), multiple detection SEC and differential scanning calorimetry (DSC), have been successfully used for the characterization of physical and chemical attributes of rAAV and LNPs encapsulating mRNA. Methods' performance, applicability, dynamic range of detection and method optimization are discussed for the measurements of multiple critical physical-chemical quality attributes, including particle size distribution, aggregation propensity, polydispersity, particle concentration, particle structural properties and nucleic acid payload.