COVID-19's impact on hospital stays, mortality, and readmissions for poverty-related diseases, noncommunicable diseases, and injury groups in Thailand.

AIMS: This study aims to compare the trends in the quality of hospital care for WHO's three disease groups pre-, during, and post-COVID-19 pandemic peak in Thailand. METHODS: The study utilized existing hospital admission data from the Thai Health Information Portal (THIP) database, covering the period from 2017 to 2022. We categorized WHO's three disease groups: poverty-related, noncommunicable, and injury groups using the International Classification of Diseases (ICD)-10 of initial admission of patients, and we analyzed three major outcomes: prolonged (≥ 90th percentile) length of stay (LOS), hospital mortality, and readmission pre-, during, and post-COVID-19 pandemic peak. Relative weight (RW) of hospital reimbursements was used as a surrogate measure of the severity of the diseases. RESULTS: The average prolonged LOS of patients with poverty disease pre-, during, and post-COVID-19 pandemic peak were 7.1%, 10.8%, 9.05%, respectively. Respective hospital mortality rates were 5.02%, 6.22%, 6.05% and readmission were 6.98/1,000, 6.16/1,000, 5.43/1,000, respectively. For non-communicable diseases, the respective proportions in the prolonged LOS were 9.0%, 9.12%, and 7.58%, with respective hospital mortality being 10.65%, 8.86%, 6.62%, and readmissions were 17.79/1,000, 13.94/1,000, 13.19/1,000, respectively. The respective prolonged LOS for injuries were 8.75%, 8.55%, 8.25%. Meanwhile, respective hospital mortality were 4.95%, 4.05%, 3.20%, and readmissions were 1.99/1,000, 1.60/1,000, 1.48/1,000, respectively. The RW analysis reveals diverse impacts on resource utilization and costs. Most poverty-related and noncommunicable diseases indicate increased resource requirements and associated costs, except for HIV/AIDS and diabetes mellitus, showing mixed trends. In injuries, road traffic accidents consistently decrease resource needs and costs, but suicide cases show mixed trends. CONCLUSIONS: COVID-19 had a more serious impact, especially prolonged LOS and hospital mortality for poverty-related diseases more than noncommunicable diseases and injuries.

Chronology of emergence of the genus Leptospira and over-representation of gene families enriched by vitamin B2, B12 biosynthesis, cell adhesion and external encapsulating structure in L. interrogans isolates from asymptomatic dogs.

The spirochete species Leptospira interrogans is the most common cause of leptospirosis, producing acute to chronic infections in most mammalian species. This pathogenic bacterium has an ability to evolve in many ways to occupy various environments and hosts. In this study, we performed chronology analysis to look for insight into the emergence of Leptospira species, focusing on L. interrogans, and investigated gene gain and loss related to their adaptation in strains isolated from asymptomatic dogs. Chronology analysis revealed that the emergence of L. interrogans was around 53.7 million years ago (MYA), corresponding to the Paleogene period that coincided with an optimal climatic temperature and the evolution of suitable mammalian hosts. Gene families encoding for vitamin B2, B12 biosynthesis, cell adhesion and external encapsulating structure were found to be enriched in L. interrogans isolated from the urine of asymptomatic dogs. The activity of these gene families may have favored adaptations resulting in chronic infections.

Genomic analysis of Leptospira interrogans serovar Paidjan and Dadas isolates from carrier dogs and comparative genomic analysis to detect genes under positive selection.

BACKGROUND: Leptospirosis is an emerging infectious disease worldwide that can cause high morbidity and mortality rates in humans and animals. The causative spirochetes have reservoirs in mammalian hosts, but there has been limited analysis of the genomes of isolates recovered from animals. The aims of this study were to characterize genomic features of two Leptospira interrogans strains recently isolated from asymptomatic dogs in Thailand (strains CUDO5 and CDUO8), and to perform comparative genome analyses with other strains. Molecular adaptive evolution in L. interrogans as signaled by positive selection also was analyzed. RESULTS: Whole genome sequence analysis revealed that strains CUDO5 and CUDO8 had genome sizes of approximately 4.9 Mbp with 35.1% GC contents. Using monoclonal antibodies, strains CUDO5 and CUDO8 were identified as serovars Paidjan and Dadas, respectively. These strains harbored genes known to be associated with acute and chronic infections. Using Single Nucleotide Polymorphisms phylogeny (SNPs) with 97 L. interrogans strains, CUDO5 and CUDO8 had closest genetic relatedness with each other. Nevertheless, the serovar determinant region (rfb locus) showed variations in the genes encoding sugar biosynthesis. Amongst 13 representative L. interrogans strains examined for molecular adaptive evolution through positive selection under the site-model of Phylogenetic Analysis of Maximum Likelihood, genes responsible for iron acquisition (tlyA and hbpA), motility (fliN2, flgK, and flhB) and thermal adaptation (lpxD1) were under increased selective pressure. CONCLUSIONS: L. interrogans serovar Paidjan strain CUDO5 and serovar Dadas strain CUDO8 had close genetic relatedness as analyzed by SNPs phylogeny. They contained genes with established roles in acute and chronic leptospirosis. The rfb locus in both serovars showed gene variation associated with sugar biosynthesis. Positive selection analysis indicated that genes encoding factors involved in motility, temperature adaptation, and iron acquisition were under strong positive selection in L. interrogans. These may be associated with adaptation in the early stages of infection.

Correction to: Genomic analysis of Leptospira interrogans serovar Paidjan and Dadas isolates from carrier dogs and comparative genomic analysis to detect genes under positive selection.

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Draft Genome Sequence of a Leptospira interrogans Strain Isolated from the Urine of an Asymptomatic Dog in Thailand.

In 2014, Leptospira interrogans strain CUDO8 was isolated from the urine of an asymptomatic dog in Thailand. Here we report the draft genome sequence of this pathogenic bacterium.