Accuracy of the Veterans Health Administration COVID-19 (VACO) Index for predicting short-term mortality among 1307 US academic medical centre inpatients and 427 224 US Medicare patients.

BACKGROUND: The Veterans Health Administration COVID-19 (VACO) Index predicts 30-day all-cause mortality in patients with COVID-19 using age, sex and pre-existing comorbidity diagnoses. The VACO Index was initially developed and validated in a nationwide cohort of US veterans-we now assess its accuracy in an academic medical centre and a nationwide US Medicare cohort. METHODS: With measures and weights previously derived and validated in US national Veterans Health Administration (VA) inpatients and outpatients (n=13 323), we evaluated the accuracy of the VACO Index for estimating 30-day all-cause mortality using area under the receiver operating characteristic curve (AUC) and calibration plots of predicted versus observed mortality in inpatients at a single US academic medical centre (n=1307) and in Medicare inpatients and outpatients aged 65+ (n=427 224). RESULTS: 30-day mortality varied by data source: VA 8.5%, academic medical centre 17.5%, Medicare 16.0%. The VACO Index demonstrated similar discrimination in VA (AUC=0.82) and academic medical centre inpatient population (AUC=0.80), and when restricted to patients aged 65+ in VA (AUC=0.69) and Medicare inpatient and outpatient data (AUC=0.67). The Index modestly overestimated risk in VA and Medicare data and underestimated risk in Yale New Haven Hospital data. CONCLUSIONS: The VACO Index estimates risk of short-term mortality across a wide variety of patients with COVID-19 using data available prior to or at the time of diagnosis. The VACO Index could help inform primary and booster vaccination prioritisation, and indicate who among outpatients testing positive for SARS-CoV-2 should receive greater clinical attention or scarce treatments.

Accuracy of the Veterans Health Administration COVID-19 (VACO) Index for predicting short-term mortality among 1,307 Yale New Haven Hospital inpatients and 427,224 Medicare patients

BackgroundThe Veterans Health Administration COVID-19 (VACO) Index incorporates age, sex, and pre-existing comorbidity diagnoses readily available in the electronic health record (EHR) to predict 30-day all-cause mortality in both inpatients and outpatients infected with SARS-CoV-2. We examined the performance of the Index using data from Yale New Haven Hospital (YNHH) and national Medicare data overall, over time, and within important patient subgroups. Methods and findingsWith measures and weights previously derived and validated in a national Veterans Healthcare Administration (VA) sample, we evaluated the accuracy of the VACO Index for estimating inpatient (YNHH) and both inpatient and outpatient mortality (Medicare) using area under the receiver operating characteristic curve (AUC) and comparisons of predicted versus observed mortality by decile (calibration plots). The VACO Index demonstrated similar discrimination and calibration in both settings, over time, and among important patient subgroups including women, Blacks, Hispanics, Asians, and Native Americans. In sensitivity analyses, we allowed component variables to be re-weighted in the validation datasets and found that weights were largely consistent with those determined in VA data. Supplementing the VACO Index with body mass index and race/ethnicity had no effect on discrimination. ConclusionAmong COVID-19 positive individuals, the VACO Index accurately estimates risk of short-term mortality among a wide variety of patients. While it modestly over-estimates risk in recent intervals, the Index consistently identifies those at greatest relative risk. The VACO Index could identify individuals who should continue practicing social distancing, help determine who should be prioritized for vaccination, and among outpatients who test positive for SARS-CoV-2, indicate who should receive greater clinical attention or monoclonal antibodies.

Acute respiratory failure and the kinetics of neutrophil recovery in pediatric hematopoietic cell transplantation: a multicenter study.

In this multicenter study, we investigated the kinetics of neutrophil recovery in relation to acuity and survival among 125 children undergoing allogeneic hematopoietic cell transplantation (allo-HCT) who required invasive mechanical ventilation (IMV). Recovery of neutrophils, whether prior to or after initiation of IMV, was associated with a significantly decreased risk of death relative to never achieving neutrophil recovery. A transient increase in acuity (by oxygenation index and vasopressor requirements) occurred among a subset of the patients who achieved neutrophil recovery after initiation of IMV; 61.5% of these patients survived to discharge from the intensive care unit (ICU). Improved survival among patients who subsequently achieved neutrophil recovery on IMV was not limited to those with peri-engraftment respiratory distress syndrome. The presence of a respiratory pathogen did not affect the risk of death while on IMV but was associated with an increased length of IMV (p < 0.01). Among patients undergoing HCT who develop respiratory failure and require advanced therapeutic support, neutrophil recovery at time of IMV and/or presence of a respiratory pathogen should not be used as determining factors when counseling families about survival.

Correction to: Acute respiratory failure and the kinetics of neutrophil recovery in pediatric hematopoietic cell transplantation: a multicenter study.

An amendment to this paper has been published and can be accessed via a link at the top of the paper.

Tuberculosis remains a public health problem in Romania.

BACKGROUND: Tuberculosis (TB) remains a major public health problem in Romania, which has the highest TB incidence in the European Union. METHODS: We undertook a retrospective study to describe changing trends in the main epidemiological indicators of TB in Romania from 1995 to 2016. Data were obtained from the Marius Nasta Institute of Pneumology, Bucharest, official data published by the National Center for Public Health Statistics and Informatics in Health Statistics Yearbooks, the European Health For All database and the World Health Organization 2017 global TB report. RESULTS: Overall TB notifications in Romania declined after 2002, from 142.2 to 74/100 000 in 2016. For new TB cases, the incidence declined after 2002, from 118.9 to 54.5/100 000 in 2016. After peaking in 2002, at 23.3/100 000, the notification rate of relapses declined to 11.8/100 000 in 2014, but almost doubled the following year. The number of multidrug-resistant TB cases decreased from 624 in 2009 to 530 in 2012, but then increased to 670 in 2015. The number of extensively drug-resistant TB cases tripled between 2012 and 2015, from 22 to 68 cases. CONCLUSION: Although the decline in TB nationwide after 2002 confirms the effectiveness of control measures, the current TB burden in Romania remains very high by European standards.

Practice Variation in the Immediate Postoperative Care of Pediatric Kidney Transplantation: A National Survey.

INTRODUCTION: Advances in organ allocation, surgical technique, immunosuppression, and long-term follow-up have led to a significant improvement in kidney transplant outcomes. Although there are clear recommendations for several aspects of kidney transplant management, there are no pediatric-specific guidelines for immediate postoperative care. The aim of this survey is to examine practice variations in the immediate postoperative care of pediatric kidney transplant patients. METHODS: We surveyed medical directors of Pediatric Acute Lung Injury and Sepsis Investigators (PALISI)-affiliated pediatric intensive care units regarding center-specific immediate postoperative management of pediatric kidney transplantation. RESULTS: The majority of PALISI centers admit patients to the pediatric intensive care unit postoperatively, and 97% of the centers involve a pediatric nephrologist in immediate postoperative care. Most patients undergo invasive hemodynamic monitoring; 97% of centers monitor invasive arterial blood pressure and 88% monitor central venous pressure. Most centers monitor serum electrolytes every 4 to 6 hours. Wide variation exists regarding blood pressure goal, fluid replacement type, frequency of obtaining kidney ultrasound, and use of prophylactic anticoagulation. CONCLUSION: There is consistent practice across PALISI centers in regards to many aspects of immediate postoperative management of pediatric kidney transplantation. However, variation still exists in some management aspects that warrant further discussions to reach a national consensus.

Left Pleuropericardial Cyst.

INTRODUCTION: Cysts of the mediastinum, which are benign masses, are usually detected by chance, and constitute a small but important diagnose group, representing 7 to 18% of all primary mediastinal tumors. Pleuropericardial cysts, located most frequently in the left anterior and inferior mediastinum, are identified in the fourth or fifth decade of life affecting females more than males with a sex ratio of 8:4. MATERIAL AND METHOD: We present the case of a 52 year old woman diagnosed with pericardial cyst located in the left cardiophrenic angle. CPP was rather big and was initially diagnosed as encysted pleurisy. Ultrasound guided exploratory thoracentesis was performed evacuating 300 ml "water spring" like fluid very scarce in cells. We further investigated our patient for differential diagnosis but the patient refused surgery and she is now managed conservatively with a close follow-up. CONCLUSIONS: A pericardial cyst should always be suspected when a cystic lesion is detected in the mediastinum. Pleuropericardial cysts are usually suspected after an abnormal chest X-ray is obtained. If the patient is asymptomatic and the information provided by CT indicates a benign tumoral process suggestive for a pleuropericardial cyst, conservative management with careful follow-up is justified.

Histopathological Aspects Described in Patients with Hepatic Hydatidosis.

INTRODUCTION: Hydatidosis is a parasitic disease with tumour-like development of a cystic mass. This has specific endemic areas, Romania being amongst them. Our hospital has national addressability and the collaboration between the Departments of Parasitology, General Surgery and Pathology ensures optimal multidisciplinary approach to cases of therapeutic and diagnostic standpoint. The study aims to test the hypothesis that the gallbladder is a hydatid reservoir, to identify signs of biliary fistulas in the pericyst and liver parenchyma; to identify inflammation elements in the pericyst and the gallbladder. MATERIAL AND METHODS: The study is a retrospective observational one, carried out between 2011-2014, on a total of 35 patients operated for hepatic hydatidosis in the General Surgery Department of "Colentina" Clinical Hospital. All the selected patients had sent to the Pathology Department: gallbladder, cyst and pericyst. Statistical analysis of the data was performed using SPSS package Statistics 19. RESULTS: The main results of the study revealed no evidence to confirm the hypothesis that the gallbladder is a hydatid reservoir. Out of the 35 cases, in 16 we observed the tendency to include hepatic biliary ducts in the pericyst or the formation of new canals which lead to the formation of biliary fistulas. Using immunohistochemical techniques with mark of CK19 (cytokeratin 19), have been observed the pattern of fistulization and modification of local architecture through the formation of the pericyst, in 16/35 (45.7%) of cases. CONCLUSION: Although it is a benign pathology, the evolution of hepatic hydatidosis can lead to severe complications and a low quality of life for the patient, both before and after surgery. Better knowledge of the pathology behind the local evolution of the disease can influence the therapeutic approach.

Rare Case of Pulmonary Tuberculosis with Hematogenous Spread to Larynx and Skin.

INTRODUCTION: Tuberculosis is an infectious disease with various clinical and radiological symptoms which are determined primarily by the immune system of the host towards the infection with Mycobacterium tuberculosis. The infection with M. tuberculosis can be limited to an organ or it can spread through hematogenous or lymphatic route to other organs (especially cases of younger or older people). Tuberculosis always needs bacteriological or histopathological confirmation. Matherial and method: We present the case of a 62 year old woman investigated and treated in our Hospital in 2009-2010 for Pulmonary tuberculosis complicated with Laryngeal Tuberculosis and Skin Tuberculosis (confirmed by histopathological exams). We intend to focus our case report on the cutaneous form of tuberculosis because of its rareness and clinical interest. CONCLUSIONS: Cutaneous tuberculosis is a very rare form of extrapulmonary tuberculosis and can be highly variable in its clinical appearance, significance and prognosis. Lesions of the skin are a real challenge for dermatologists. The treatment of cutaneous tuberculosis in most cases is the same as for pulmonary tuberculosis leading to regression and healing of the skin lesions.

PGMD: a comprehensive manually curated pharmacogenomic database.

The PharmacoGenomic Mutation Database (PGMD) is a comprehensive manually curated pharmacogenomics database. Two major sources of PGMD data are peer-reviewed literature and Food and Drug Administration (FDA) and European Medicines Agency (EMA) drug labels. PGMD curators capture information on exact genomic location and sequence changes, on resulting phenotype, drugs administered, patient population, study design, disease context, statistical significance and other properties of reported pharmacogenomic variants. Variants are annotated into functional categories on the basis of their influence on pharmacokinetics, pharmacodynamics, efficacy or clinical outcome. The current release of PGMD includes over 117 000 unique pharmacogenomic observations, covering all 24 disease superclasses and nearly 1400 drugs. Over 2800 genes have associated pharmacogenomic variants, including genes in proximity to intergenic variants. PGMD is optimized for use in annotating next-generation sequencing data by providing genomic coordinates for all covered variants, including Single Nucleotide Polymorphisms (SNPs), insertions, deletions, haplotypes, diplotypes, Variable Number Tandem Repeats (VNTR), copy number variations and structural variations.

[Evolution of tuberculosis in the District of Dolj]. / [Evolutia tuberculozei în judetul Dolj.]

The 742,500 inhabitants of Dolj District face a high risk of TB since over 10 years. In 1992 the TB incidence was 93.7@100,000 and 155.7@100,000 in 2000 (66% increase). A number of 1156 TB patients were registered in year 2000, 84% new cases and 16% relapses. 82% of the patients had lung lesions, 11.9% had pleurisy and 6.1% had various extra-thoracic lesions. Bacteriologic confirmation was 67.7%. The periodic prevalence of smear positive patients, with a high level of 139@100,000 in 1999, determined a high risk for disease among children, also, the TB incidence in this category being 46.8@100,000. The evaluation of treatment results in a cohort of smear positive patients registered in 1999 showed a success rate of only 75.5%. The decrease of the TB endemy level in Dolj district depends on improvement of life status in the district, complete use of DOTS and a good financement of all parts of the National TB Control Program in 2001-2005.

[The importance of the tuberculin test in adults with bacteriologically confirmed pulmonary tuberculosis]. / Semnificatia testului tuberculinic la adultii cu tuberculoza pulmonara confirmata bacteriologic.

The tuberculin skin test is used worldwide to assess the tuberculosis infection in humans and animals. It is conventionally admitted that a reaction larger than 10 mm expresses a consumptive infection. It is possible to find a reaction smaller than 10 mm in patients with active disease, like bacteriological confirmed pulmonary tuberculosis, that is a negative reaction. 1719 patients with recently discovered bacteriological confirmed pulmonary tuberculosis were tested with PPD-IC65 solution 2 U/0.1 ml; 497 of them (28.9%) reacted less than 10 mm; 151 of these were retested with PPD solution 10 U/0.1 ml, in 11.5% of them the test was negative.