Clinical features, treatment, and outcomes of mpox in solid organ transplant recipients: A multicenter case series and literature review.

In 2022, the largest global outbreak of mpox to date emerged. In the immunocompetent host, mpox generally presents as a self-limiting illness. However, immunosuppression, such as that seen with advanced HIV, has been associated with significant morbidity and mortality related to mpox infection. To evaluate the impact of immunosuppression related to solid organ transplantation on clinical features and outcomes of mpox we established a multicenter case registry. Eleven cases from 7 participating centers in the USA were submitted. All cases occurred in males. The majority were kidney transplant recipients (91%, n = 10). Median duration of symptoms at presentation was 6 days (range, 3-14 days). Rates of hospitalization were high (73%, n = 8) with a median length of stay of 4.5 days (range, 1-10 days). Mpox in solid organ transplant recipients was associated with a high burden of skin lesions and systemic symptoms. Fever, fatigue, pharyngitis, and proctitis were commonly reported. Other clinical features included headache, myalgia, epididymo-orchitis, urinary retention, hematemesis, pneumonitis, and circulatory shock. All patients received treatment with tecovirimat. There was 1 mpox-related death in the cohort. Infection was reported to have resolved at 30-day follow-up in all other cases.

Correlation Between Serum and Arterial Blood Gas Bicarbonate in Patients Admitted to the Intensive Care Unit.

Objective Clinicians use two modalities to determine acid-base disturbances: calculated bicarbonate on arterial blood gas (ABG) and measured bicarbonate on basic metabolic panels (BMP). The primary objective was to investigate the discrepancy between the two values for diagnosing acidemia in the intensive care unit (ICU). Our secondary objective was to discern the threshold to treat acidemia within various clinical settings.  Materials and methods We performed a multi-center study using a retrospective patient chart review consisting of ABG and BMP bicarbonate levels at various pH ranges; 584 adult patients were included in this study. SAS software (SAS Institute Inc., Cary, NC) was used for analysis. Results Strong positive correlations were found between calculated ABG and measured BMP bicarbonate, with the group of pH 6.9-7.0 being the strongest. Based on odds ratio analysis, patients were more likely to not receive bicarbonate treatment if pH was greater than 7.1 based on calculated ABG bicarbonate. Patients also did not receive bicarbonate treatment when pH was greater than 7.2 based on BMP bicarbonate levels. Our study found that patients with higher pH (pH > 7.1) were less likely to receive bicarbonate treatment. Patients with pH 6.9-7.0 were more likely to receive bicarbonate treatment. Based on receiver operator curve (ROC) model curves, neither ABG nor BMP bicarbonate values have strong accuracy for diagnosing acidemia. Conclusion We found no significant difference in CO2 levels and ICU types regardless of if ABG or BMP was used.

The Effect of Adding Procalcitonin to the Systemic Inflammatory Response Syndrome (Sirs) and Quick Sepsis-Related Organ Failure Assessment (qSOFA) Scoring System in Predicting Sepsis Mortality.

OBJECTIVE:  The primary objective of this study was to determine if the addition of procalcitonin to the existing systemic inflammatory response syndrome (SIRS) and quick Sepsis-related Organ Failure Assessment (qSOFA) scoring systems could improve the predictability of in-hospital sepsis-related mortality. Secondarily, we sought to determine if the addition of procalcitonin could predict the likelihood of ICU admission and discharge home. DESIGN: This is a retrospective, single-center, observational study that looked at data from January 1, 2017 to January 1, 2019. Patients were stratified into four groups: SIRS-positive + procalcitonin >2 ng/mL (pSIRS+), SIRS-positive + procalcitonin ≤2 ng/mL (pSIRS-), qSOFA-positive + procalcitonin >2 ng/mL (pqSOFA+), and qSOFA-positive + procalcitonin ≤2 ng/mL (pqSOFA-). SETTING: The study was conducted at a community hospital in Las Vegas, Nevada. PATIENTS: Patients were included in the study if they were >18 years of age and had hospital admission diagnosis of sepsis with at least one value of procalcitonin level. INTERVENTIONS: After patients which met the inclusion criteria, patients were divided into subgroups of SIRS, SIRS + procalcitonin > 2 ng/mL, qSOFA, qSOFA + procalcitonin >2 ng/mL. Primary outcomes were in-hospital mortality and secondary outcomes were ICU admission, length of stay, and discharge to home. RESULTS:  933 patients were included in the study with an overall mortality rate of 21.22%, an overall ICU admission rate of 56.15%, and an overall discharge home rate of 29.58%. In those identified with a sepsis-related diagnosis code, pSIRS+ predicted an in-hospital mortality rate of 31.89% compared to pSIRS- 16.15% (P < 0.0001). In regards to qSOFA, the addition of procalcitonin added no statistically significant difference in predicting in-hospital mortality. pSIRS+ patients were found to have an ICU admission rate of 76.16% and a discharge home rate of 19.20% compared to pSIRS- who had 47.40% and 34.90%, respectively (P < 0.0001). Like in our primary outcome, our data for qSOFA was not statistically significant. CONCLUSIONS:  Procalcitonin added utility to the SIRS scoring system in predicting sepsis-related in-hospital mortality, ICU admission, and discharge home. Procalcitonin did not add statistically significant benefit to the qSOFA scoring system in predicting sepsis-related in-hospital mortality, ICU admission, and discharge home.

The Coronaviruses: Past, Present, Future.

Description The current coronavirus pandemic is unparalleled in recent memory and fundamentally unique. It has been more than a century since humanity fought the Spanish flu pandemic. That widespread disease devastated a World War I-ravaged population when there was a relative paucity of medical knowledge. Coronavirus, on the other hand, is now befalling upon a developed world with advanced infrastructure and health systems; wherein access to medical information and technology is abundant. Yet, it has proven to be a destroyer of economies and populations without geographical partiality. This article is meant to be a broad analysis of the virus, which is causing global disruption from both a historical and clinical perspective. We are receiving new facts and figures daily. Thus, this review is up-to-date as much as it can be and meant to serve as a general knowledge base for all involved in the fight.