Association between serological evidence of past Coxiella burnetii infection and atherosclerotic cardiovascular disease in elderly patients

Q fever, caused by Coxiella burnetii, may cause vascular complications, but the role that this infection may play in the development of atherosclerotic cardiovascular disease remains unknown. This study examined the association between Q fever serology and cardiovascular disease in a region where Q fever is endemic. A case-control study was conducted in the Hospital Universitario de Burgos (Spain) between February 2011 and June 2012. A total of 513 samples were tested, from 454 hospitalized patients ≥65 years old, of whom 164 were cases (patients with prevalent or incident coronary heart, cerebrovascular or peripheral artery, disease) and 290 controls (patients without cardiovascular disease). Serum IgG antibody phase II titres against Q fever were determined by immunofluorescence assay. Seropositivity (titres ≥1:256) was detected in 84/164 (51.2%) cases and in 109/290 (37.6%) controls (p = 0.005; OR, 1.7; 95% CI, 1.1–2.5). This ratio increases when adjusted for sex, hypertension, dyslipidaemia, smoking, diabetes and atrial fibrillation (OR, 2.6; 95% CI, 1.5–4.7). The geometric mean titre (GMT) for C. burnetii phase II assay was higher in cases than in controls (p = 0.004). We found no significant relationship between cardiovascular disease and C. pneumoniae, and Cytomegalovirus seropositivity (both determined by the IgG ELISA method). In conclusion, serological evidence of past Q fever is associated with atherosclerotic cardiovascular disease in elderly patients in an endemic region.     

The prognostic value of serological titres for clinical outcomes during treatment and follow-up of patients with chronic Q fever

ObjectivesWe assessed the prognostic value of phase I IgG titres during treatment and follow-up of chronic Q fever.MethodsWe performed a retrospective cohort study to analyse the course of phase I IgG titres in chronic Q fever. We used a multivariable time-varying Cox regression to assess our primary (first disease-related event) and secondary (therapy failure) outcomes. In a second analysis, we evaluated serological characteristics after 1 year of therapy (fourfold decrease in phase I IgG titre, absence of phase II IgM and reaching phase I IgG titre of ≤1:1024) with multivariable Cox regression.ResultsIn total, 337 patients that were treated for proven (n = 284, 84.3%) or probable (n = 53, 15.7%) chronic Q fever were included. Complications occurred in 190 (56.4%), disease-related mortality in 71 (21.1%) and therapy failure in 142 (42.1%) patients. The course of phase I IgG titres was not associated with first disease-related event (HR 1.00, 95% CI 0.86–1.15) or therapy failure (HR 1.02, 95% CI 0.91–1.15). Similar results were found for the serological characteristics for the primary (HR 0.97, 95% CI 0.62–1.51; HR 1.12, 95% CI 0.66–1.90; HR 0.99, 95% CI 0.57–1.69, respectively) and secondary outcomes (HR 0.86, 95% CI 0.57–1.29; HR 1.37, 95% CI 0.86–2.18; HR 0.80, 95% CI 0.48–1.34, respectively).DiscussionCoxiella burnetii serology does not reliably predict disease-related events or therapy failure during treatment and follow-up of chronic Q fever. Alternative markers for disease management are needed, but, for now, management should be based on clinical factors, PCR results, and imaging results.     

Toxoplasma prevalence among pregnant women in Norway: a cross‐sectional study

Infection by Toxoplasma gondii may lead to complications in the foetus if the mother suffers from primary infection during pregnancy . Previously infected women have produced toxoplasma‐specific IgG antibodies. The most recent study on prevalence of toxoplasma IgG in the Norwegian pregnant population was conducted 20 years ago. The present study is part of a research programme initiated by the Norwegian Institute of Public Health. We aimed to update the knowledge regarding the prevalence of toxoplasma IgG among pregnant women in Norway. In this cross‐sectional study, sera from 1922 pregnant women in Buskerud (992) and Sør‐Trøndelag counties (930) in Norway were collected consecutively. The presence of toxoplasma IgG was identified by values ≥8 IU/mL using an ELISA test. The overall prevalence of toxoplasma IgG seropositivity was 9.3% (95% CI 8.1–10.7); Sør‐Trøndelag 10.4% (95% CI 8.6–12.6) and Buskerud 8.3% (95% CI 6.7–10.2). There was no difference between the counties (p = 0.13), and the result did not differ from prevalences found in 1974 (12.1%) and 1994 (10.7%). We found a higher prevalence among women ≥40 years (OR 2.65, 95% CI 1.30–5.42). The prevalence of toxoplasma IgG among pregnant women in Norway is low and has been stable during the last decades.     

Severe immunosuppression is related to poorer immunogenicity to SARS-CoV-2 vaccines among people living with HIV

ObjectivesThe aim of this study was to assess the immunogenicity of SARS-CoV-2 available vaccines among people living with HIV (PLWH) after a complete vaccination scheme, and determine predictors of seroconversion.MethodsThis multicentre prospective cohort study included 420 PLWH who had received a standard immunization, either with mRNA or adenoviral-vectored COVID-19 vaccines. Antibody response was evaluated within 1 to 2 months after the last dose of the vaccine with a quantitative determination of antitrimeric spike protein-specific IgG antibodies and IgG neutralizing antibodies.ResultsOverall, 384 of 420 PLWH (91%) showed antibody response to vaccination. Seroconversion was observed in 308 of 326 individuals with cluster of differentiation 4 (CD4) counts ≥350 cells/mm³ (95%), 55 of 61 PLWH with 200 to 349 cells/mm³ (90%), and 21 of 33 PLWH with CD4 counts <200 cells/mm³ (64%; p < 0.001). The median log₁₀ IgG neutralization levels were 2.4 IU/mL (Q1–Q3, 1.0–3.1) among PLWH with CD4 counts <200 cells/mm³, 3.1 IU/mL (Q1–Q3, 2.8–3.4) for the 200 to 349 cells/mm³ group, and 3.1 IU/mL (Q1–Q3, 2.7–3.4) for PLWH with CD4 counts ≥350 cells/mm³ (p = 0.016). In the multivariate analysis, CD4 counts ≥350 cells/mm³ (OR: 7.10; 95% CI, 1.91–26.46; p = 0.004) and receiving mRNA-vectored COVID-19 vaccines (OR: 8.19; 95% CI, 3.24–20.70; p ≤ 0.001) were independently associated with a higher probability of response to vaccination.DiscussionHIV-related immunosuppression impairs the antibody response to SARS-CoV-2 vaccines. Specific vaccination schemes should be urgently tailored in this setting, particularly in patients with CD4 cell counts <200 cells/μL. Adenoviral-vectored vaccines should be avoided in PLWH whenever possible.     

The temporal dynamics of humoral immunity to Rickettsia typhi infection in murine typhus patients

ObjectivesThis study examined individuals with Rickettsia typhi infection in the Lao People's Democratic Republic (Lao PDR) to (a) investigate humoral immune dynamics; (b) determine the differences in reference diagnostic results and recommend appropriate cut-offs; (c) determine differences in immune response after different antibiotic treatments; and (d) determine appropriate diagnostic cut-off parameters for indirect immunofluorescence assay (IFA).MethodsSequential serum samples from 90 non-pregnant, adults were collected at seven time-points (days 0, 7, 14, 28, 90, 180 and 365) as part of a clinical antibiotic treatment trial. Samples were tested using IFA to determine IgM and IgG antibody reciprocal end-point titres against R. typhi and PCR.ResultsFor all 90 individuals, reciprocal R. typhi IgM and IgG antibody titres ranged from <400 to ≥3200. The median half-life of R. typhi IgM was 126 days (interquartile range 36–204 days) and IgG was 177 days (interquartile range 134–355 days). Overall median patient titres for R. typhi IgM and IgG were significantly different (p < 0.0001) and at each temporal sample collection point (range p < 0.0001 to p 0.0411). Using Bayesian latent class model analysis, the optimal diagnostic cut-off reciprocal IFA titer on patient admission for IgM was 800 (78.6%, 95% CI 71.6%–85.2% sensitivity; 89.9%, 95% CI 62.5%–100% specificity), and for IFA IgG 1600 (77.3%; 95% CI 68.2%–87.6% sensitivity; 99%, 95% CI 95%–100% specificity).ConclusionsThis study suggests suitable diagnostic cut-offs for local diagnostic laboratories and other endemic settings and highlights antibody persistence following acute infection. Further studies are required to validate and define cut-offs in other geographically diverse locations.     

Prevalence of Toscana virus antibodies in residents of Croatia

To assess the prevalence of Toscana virus (TOSV) infection among healthy residents of Croatia we tested sera from 2016 persons, for IgG antibodies to TOSV, by an enzyme immunoassay. A total of 755 (37.5%) persons had IgG antibodies to TOSV: 53.9%, 33.6% and 6.1% among residents of the islands, coastal area and mainland of Croatia, respectively. Risk factors significantly associated with seropositivity to TOSV were: living on islands (OR, 11.10; 95% CI, 6.02–20.50; p <0.001) or in coastal areas (OR, 6.96; 95% CI, 3.81–12.71; p <0.001) and increase of age (OR, 1.03; 95% CI, 1.02–1.03; p <0.001).     

Galectin-3 may serve as a marker for poor prognosis in colorectal cancer: A meta-analysis

Galectin-3 has an important function in the development of tumors. The purpose of this meta-analysis was to explore the relationships between the expression of galectin-3 on clinicopathological features and prognosis of colorectal cancer (CRC). A comprehensive literature search was used to identify eligible studies, and Stata software was conducted using in this meta-analysis. A total of 15 studies, including 1661 cases, were matched in the inclusion criteria. The pooled analysis indicated that galectin-3 expression was related to the poor overall survival (OS) in CRC patients (HR: 1.77, 95% CI: 1.36–2.31, P < 0.0001). Our meta-analysis also showed that cancerous tissues have higher levels of galectin-3 expression than normal tissues. Besides, positive galectin-3 expression was also related to advanced TNM stages(III/IV vs. I/II: OR 5.30, 95% CI: 2.42–11.61, P < 0.0001), higher Duke’s stages (C/D vs. A/B: OR 4.00, 95% CI: 2.22–7.22, P < 0.0001), venous invasion (venous invasion vs. not: OR 3.02, 95%CI: 1.75–5.22, P < 0.0001) and higher CEA level (CEA≥5 ng/ml vs. ≤ 5 ng/ml: OR 2.09, 95% CI: 1.09–4.03, P = 0.03). In summary, our results indicated that overexpression of galectin-3 is significantly related to the tumor progression and could be a efficient in predicting the prognosis of patients with CRC.     

The signification of antiphospholipid antibodies in pregnancy-associated pathologies and venous thromboembolism

Women with antiphospholipid antibodies are at high risk of pregnancy complications. Three hundred and two women with pregnancy complications matched with 100 women having a past history of uncomplicated pregnancy outcome were screened for the presence of antiphospholipid antibodies such as lupus anticoagulant and immunoglobulin G (IgG)/M antibodies for cardiolipin. Among the overall positivity for any one of the antiphospholipid antibodies studied, significant associations were found with recurrent pregnancy loss (OR 16.87; 95% CI, 5.5–51.63, p?<?10^?3), intrauterine growth retardation (OR 3.9; 95% CI, 1.08–14.05, p?=?0.04) and preeclampsia (OR 4.54; 95% CI, 1.25–16.42, p?=?0.035). IgG was considered a risk factor for recurrent pregnancy loss (OR 15.31; 95% CI, 3.37–69.7, p?<?10^?3) and intrauterine growth retardation (OR 6.7; 95% CI, 1.3–34.4, p?=?0.017). The lupus anticoagulant was associated only with recurrent pregnancy loss (OR 12.4; 95% CI, 1.48–103.1, p?=?0.006).     

Risk factors for asthma in young adults: a co-twin control study

Background: The liability to asthma is influenced both by genetic and environmental factors. The objective of this study was to identify risk factors for asthma in young adult twin pairs during an 8‐year period. Methods: From the birth cohorts 1953–1982 of the Danish Twin Registry, 6090 twin pairs who were initially unaffected with respect to asthma at a nationwide questionnaire‐based study in 1994 participated in a similar follow‐up study in 2002. Subjects were regarded incident asthma cases when responding affirmatively to the question ‘Do you have, or have you ever had asthma'? in 2002. Pairs in which only one twin developed asthma – discordant pairs – were identified and conditional logistic regression was applied to detect effects of risk factors. Results: A total of 126 monozygotic (MZ) and 273 dizygotic (DZ) discordant twin pairs were identified. In MZ twins hay fever (OR = 3.16, 95% CI: 1.29–7.73, P = 0.007) and exercise (OR for inactivity = 0.35, 95% CI: 0.13–0.91, P = 0.023) were significantly associated with asthma, whereas in DZ twins, hay fever (OR = 2.44, 95% CI: 1.44–4.13, P = 0.001), eczema (OR = 1.96, 95% CI: 1.02–3.78, P = 0.040), female sex (OR between males and females = 0.54, 95% CI: 0.36–0.80, P = 0.002), and increasing levels of body mass index (BMI; OR per unit = 1.11, 95% CI: 1.02–1.20, P = 0.009) were significant predictors of asthma. Conclusions: Hay fever, eczema, female sex, exercise and increasing levels of BMI were risk factors for asthma in young adults. The different risk profile observed in MZ twins compared with DZ twins may reflect an underlying genetic vulnerability shared between those risk factors and asthma.     

Pregnancy Outcomes in HIV-Infected Women of Advanced Maternal Age

Abstract

Background: There is limited information on pregnancy outcomes in women with HIV who are of a more advanced maternal age.Methods: Data from a national observational study in Italy were used to evaluate the risk of nonelective cesarean section, preterm delivery, low birthweight, major birth defects, and small gestational age-adjusted birthweight according to maternal age (<35 and ≥35 years, respectively).Results: Among 1,375 pregnancies with live births, 82.4% of deliveries were elective cesarean sections, 15.8% were nonelective cesarean sections, and 1.8% were vaginal deliveries. Rates of nonelective cesarean section were similar among mothers ≥35 and <35 years (odds ratio [OR], 1.22; 95% CI, 0.90–1.65;P = .19). Preterm delivery and low birthweight were significantly more common among women ≥35 years in univariate but not in multivariate analyses. Newborns from women ≥35 and <35 years showed no differences inZ scores of birthweight, with a similar occurrence of birthweight <10th percentile (12.1% vs 12.0%; OR, 1.02; 95% CI, 0.71–1.46;P = .93). The overall rate of birth defects was 3.4% (95% CI, 2.4–4.4), with no differences by maternal age (≥35 years, 3.5%; <35 years, 3.3%; OR, 1.05; 95% CI, 0.56–1.98;P = .88).Discussion: In this study of pregnant women with HIV, older women were at higher risk of some adverse pregnancy outcomes, such as preterm delivery and low birthweight. The association, however, did not persist in multivariable analyses, suggesting a role of some predisposing factors associated with older age.     

Healthcare-associated,community-acquired and hospital-acquired bacteraemic urinary tract infections in hospitalized patients: a prospective multicentre cohort study in the era of antimicrobial resistance

The clinical and microbiological characteristics of community-onset healthcare-associated (HCA) bacteraemia of urinary source are not well defined. We conducted a prospective cohort study at eight tertiary-care hospitals in Spain, from October 2010 to June 2011. All consecutive adult patients hospitalized with bacteraemic urinary tract infection (BUTI) were included. HCA-BUTI episodes were compared with community-acquired (CA) and hospital-acquired (HA) BUTI. A logistic regression analysis was performed to identify 30-day mortality risk factors. We included 667 episodes of BUTI (246 HCA, 279 CA and 142 HA). Differences between HCA-BUTI and CA-BUTI were female gender (40% vs 69%, p <0.001), McCabe score II–III (48% vs 14%, p <0.001), Pitt score ≥2 (40% vs 31%, p 0.03), isolation of extended spectrum β-lactamase-producing Enterobacteriaciae (13% vs 5%, p <0.001), median hospital stay (9 vs 7 days, p 0.03), inappropriate empirical antimicrobial therapy (21% vs 13%, p 0.02) and mortality (11.4% vs 3.9%, p 0.001). Pseudomonas aeruginosa was more frequently isolated in HA-BUTI (16%) than in HCA-BUTI (4%, p <0.001). Independent factors for mortality were age (OR 1.04; 95% CI 1.01–1.07), McCabe score II–III (OR 3.2; 95% CI 1.8–5.5), Pitt score ≥ 2 (OR 3.2 (1.8–5.5) and HA-BUTI OR 3.4 (1.2–9.0)). Patients with HCA-BUTI are a specific group with significant clinical and microbiological differences from patients with CA-BUTI, and some similarities with patients with HA-BUTI. Mortality was associated with patient condition, the severity of infection and hospital acquisition.     

The relationship of initial embryo crown-rump length to pregnancy outcome and abortus karyotype based on new growth curves for the 2-31 mm embryo

The objective of this study was to determine if measurementof initial crown-rump length (CRL) is helpful in predictinglow birth weight, newborn length, spontaneous abortions, orabortus karyotype. We measured CRL prospectively in 837 consecutivesingleton pregnancies at the time a heart rate was first detectablewith transvaginal ultrasonography and compared these measurementsto normal values for the 10th through 90th centiles determinedfrom 227 transvaginal ultrasound measurements in in-vitro fertilizationand gamete intra-Fallopian transfer pregnancies with known ovulationdates. The relationship of initial CRL to birth weight and lengthand to abortion and abortus karyotype was analysed after allpregnancies had delivered. Initial CRL measured after the 28thpost-ovulation day was predictive of subsequent abortion, butnot of low birth weight or length. The abortion rate was 3.3%[95% confidence interval (CI) 1.5%, 5.1%] when initial CRL50thcentile, compared to 19.4% (95% CI 15.4%, 23.4%) when <50thcentile. Initial CRL was <50th centile in 13 out of 14 trisomicand in eight out of 10 other karyotypically abnormal aborti.These results indicate that initial CRL measured after the 28thpost-ovulation day may help to identify pregnancies at increasedrisk of abortion due to abnormal karyotypes.     

Measles seroprevalence in pregnant women in Soweto,South Africa: a nested cohort study

ObjectivesMeasles infection causes particularly severe disease in young children who, prior to vaccination, are dependent on maternal antibodies for protection against infection. Measles vaccination was introduced into the South African public immunization programme in 1983 and became widely available in 1992. The aim of this study was to determine measles-specific immunoglobulin G (IgG) levels in pregnant women living with and without HIV born before and after measles vaccine introduction in South Africa.MethodsMeasles IgG antibody level from blood obtained at the time of delivery was compared between women who were born before 1983 (n = 349) and since 1992 (n = 349). Serum samples were tested for measles IgG antibody using an enzyme-linked immunosorbent assay. Geometric mean titres (GMTs) and the proportion with seronegative (<200 mIU/mL) or seropositive titres (≥275 mIU/mL) were compared.ResultsWomen born since 1992 had lower GMTs [379.7 mIU/mL (95% CI 352.7–448.6)] and fewer were seropositive (55.9%, 195/349) than women born before 1983 [905.8 mIU/mL (95% CI 784.7–1045.5); 76.8%, 268/349], for both comparisons p < 0.001.ConclusionsWe found an association between measles vaccine implementation into the public immunization program in South Africa and peri-partum maternal measles immunity, where women born before vaccine introduction had higher measles IgG antibody titres and were more likely to be seropositive. These findings suggest a need to reconsider the infant measles immunization schedule in settings where women have derived immunity mainly from measles vaccine rather than wild-type virus exposure.     

Factors associated with virological success with raltegravir-containing regimens and prevalence of raltegravir-resistance-associated mutations at failure in the ARCA database

Raltegravir (RAL) is the only licensed human immunodeficiency virus (HIV) integrase inhibitor. The factors associated with the virological response to RAL-containing regimens and the prevalence of integrase mutations associated with RAL failure deserve further investigation. From the Antiretroviral Resistance Cohort Analysis database, we selected triple-class-experienced subjects failing their current treatment with complete treatment history available. Selection criteria included HIV-RNA, CD4 count and HIV genotype within 3 months of RAL initiation. Factors associated with 24-week response were analysed; genotypic sensitivity scores (GSS) and weighted-GSS were evaluated. Virological response was achieved in 74.3% of 105 subjects. Mutations associated with RAL failure were detected in 12/24 subjects with an integrase genotype, with the prevalence of Q148H + G140S. Each extra unit of GSS (p 0.05, OR 2.62; 95% CI 1.00–6.87). was found to be a associated with response. Weighted-GSS had borderline statistical significance (p 0.063, OR 2.04; 95% CI 0.96–4.33) When stratifying for different cut-offs (< 1 as reference, 1–1.49, ≥ 1.5), a borderline significant increase in the probability of response appeared for GSS ≥ 1.5 (p 0.053, OR 4.00; 95% CI 0.98–16.25). GSS ≥ 1 showed the highest sensitivity, 82.6%. Receiver operating characteristic curves depicted the widest area under the curve (0.663, p 0.054) of GSS ≥ 1. Unresponsiveness to RAL-containing regimens among triple-class-experienced subjects was low. The activity of the background regimen was strongly associated with response. Although few integrase genotypes were available at failure, half of these were without integrase resistance mutations. The substantial rate of RAL failure in the absence of known RAL-resistance mutations may be associated with adherence issues and this issue warrants further analysis in longer observations.     

Usefulness of EQUAL Candida Score for predicting outcomes in patients with candidaemia: a retrospective cohort study

BackgroundThe European Confederation of Medical Mycology (ECMM) Quality of Clinical Candidaemia Management (EQUAL) score is a tool designed by the ECMM to measure guideline adherence. The current study investigated the association between EQUAL scores and clinical outcomes.MethodsThis retrospective study was conducted in three hospitals in Taiwan. Patients with candidaemia between January 2014 and July 2018 were enrolled. Guideline adherence was evaluated using EQUAL score indicators. Clinical outcomes and predictors of 30-day mortality were investigated.ResultsA total of 384 patients were enrolled. The overall mean EQUAL score was 8.91 ± 3.42 (9.42 ± 3.60 in survivors vs. 8.10 ± 2.94 in non-survivors, p < 0.001). Higher scores were positively correlated with survival (p < 0.001). Scores of 16–22 indicated the highest survival rates (p for trend <0.001). The Kaplan–Meier plot revealed that patients with EQUAL scores ≥10 exhibited significantly higher survival rates (p < 0.001) than those with scores <10. Multivariable analysis revealed that EQUAL scores ≥10 (odds ratio (OR) 0.37, 95% confidence interval (CI) 0.19–0.74), advanced age (OR 1.02, 95% CI 1.00–1.04), septic shock (OR 4.42, 95% CI 2.09–9.36), high sequential organ failure assessment scores (OR 4.28, 95% CI 2.15–8.52), intravascular catheter-related source (OR 0.42, 95% CI 0.19–0.94) and central venous catheter retention (OR 5.41, 95% CI 2.06–14.24) were independent predictors of 30-day mortality.DiscussionGreater guideline adherence with a higher EQUAL score was significantly associated with survival. An EQUAL score cutoff point <10 predicted 30-day mortality.     

Association between IgG antibody levels and adverse events after first and second Bnt162b2 mRNA vaccine doses

ObjectivesThis study sought to correlate the SARS-CoV-2 IgG antibody response level to the BNT162b2 (Pfizer BioNTech) mRNA vaccine after the first and second doses with the reported adverse events.MethodsThis cohort study examined the adverse events profiles of people vaccinated with BNT162b2 in our institute between late 2020 and May 2021. Adverse events, age, and sex were reported using an electronic questionnaire, and their SARS-CoV-2 IgG antibody levels were retrieved from the hospital database.ResultsBetween 20 December 2020 and 31 May 2021, the adverse events questionnaire was completed by 9700 individuals who received the first vaccine dose and 8321 who received the second dose. After the first and second doses, the average antibody levels were 62.34 AU/mL (mean 4–373) and 188.19 AU/mL (mean 20–392), respectively. All of the adverse events, except local pain, were more common after the second vaccine dose. Multivariate analysis showed that after the first vaccine dose, female sex and younger age (but not IgG titres) were associated with a higher probability of adverse events (OR 2.377, 95% CI, 1.607–3.515, p = 0.000; OR 0.959, 95% CI, 0.944–0.977, p £0.000; OR 1.002, 95% CI, 0.995–1.008, p £0.601; respectively); however, all three parameters were associated with the incidence of adverse events after the second dose (OR 2.332, 95% CI, 1.636–3.322, p = 0.000; OR 0.984, 95% CI, 0.970–0.999, p £0.039; OR 1.004, 95% CI, 1.001–1.007, p £0.022; respectively).DiscussionAdverse events are significantly more common after the second BNT162b2 vaccine dose than after the first dose. We found an association between sex, age, and SARS-CoV-2 IgG antibody titre with the incidence of adverse events.     

Predictors of survival in elderly patients with coronavirus disease 2019 admitted to the hospital: derivation and validation of the FLAMINCOV score

ObjectiveTo identify predictors of 30-day survival in elderly patients with coronavirus disease 2019 (COVID-19).MethodsRetrospective cohort study including patients with COVID-19 aged ≥65 years hospitalized in six European sites (January 2020 to May 2021). Data on demographics, comorbidities, clinical characteristics, and outcomes were collected. A predictive score (FLAMINCOV) was developed using logistic regression. Regression coefficients were used to calculate the score. External validation was performed in a cohort including elderly patients from a major COVID-19 centre in Israel. Discrimination was evaluated using the area under the receiver operating characteristic curve (AUC) in the derivation and validation cohorts. Survival risk groups based on the score were derived and applied to the validation cohort.ResultsAmong 3010 patients included in the derivation cohort, 30-day survival was 74.5% (2242/3010). The intensive care unit admission rate was 7.6% (228/3010). The model predicting survival included independent functional status (OR, 4.87; 95% CI, 3.93–6.03), a oxygen saturation to fraction of inspired oxygen (SpO₂/FiO₂₎ ratio of >235 (OR, 3.75; 95% CI, 3.04–4.63), a C-reactive protein level of <14 mg/dL (OR, 2.41; 95% CI, 1.91–3.04), a creatinine level of <1.3 (OR, 2.02; 95% CI, 1.62–2.52) mg/dL, and absence of fever (OR, 1.34; 95% CI, 1.09–1.66). The score was validated in 1174 patients. The FLAMINCOV score ranges from 0 to 15 and showed good discrimination in the derivation (AUC, 0.79; 95% CI, 0.77–0.81; p < 0.001) and validation cohorts (AUC, 0.79; 95% CI, 0.76–0.81; p < 0.001). Thirty-day survival ranged from 39.4% (203/515) to 95.3% (634/665) across four risk groups according to score quartiles in the derivation cohort. Similar proportions were observed in the validation set.DiscussionThe FLAMINCOV score identifying elderly with higher or lower chances of survival may allow better triage and management, including intensive care unit admission/exclusion.     

Serological follow-up in patients with aorto-iliac disease and evidence of Q fever infection

The aim of this study was to provide data on the risk of developing chronic Q fever in patients with aorto-iliac disease and evidence of previous Q fever infection. Patients with an aortic and/or iliac aneurysm or aorto-iliac reconstruction (aorto-iliac disease) and evidence of previous Q fever infection were included. The presence of phase I and II Coxiella burnetii IgG antibodies was assessed periodically using immunofluorescence assay. A total of 111 patients with aorto-iliac disease were divided into three groups, based upon the serological profile [mean follow-up: 16?±?9 months (mean?±?standard deviation)]. Group 1 consisted of 30 patients with a serological trace of C. burnetii infection (negative IgG phase I, IgG phase II titer of 1:32). Of these, 36.7 % converted to serological profile matching past resolved Q fever. Group 2 included 49 patients with negative IgG phase I titer and IgG phase II titer ≥1:64. No patients developed chronic Q fever, but 14.3 % converted to a positive IgG phase I titer. Group 3 consisted of 32 patients with positive IgG phase I and positive IgG phase II titers, of which 9.4 % developed chronic Q fever (significantly different from group 2, p?=?0.039). The IgG phase I titer increased in 28.1 % of patients (from 1:64 to 1:4,096). The risk of developing chronic Q fever in patients with aorto-iliac disease and previous Q fever infection with a positive IgG phase I titer was 9.4 %. The IgG phase I titer increases or becomes positive in a substantial number of patients. A standardized serological follow-up is proposed.     

Relationship of initial chorionic sac diameter to abortion and abortus karyotype based on new growth curves for the 16th to 49th post-ovulation day

In order to determine whether initial chorionic sac diameteris related to subsequent abortion, abortus karyotype, or birthweight and length, chorionic sac diameter was prospectivelymeasured by transvaginal ultrasound in 700 singleton pregnanciesbefore post-ovulation day 31, the latest day cardiac activitybecomes detectable in normal pregnancy. Results were comparedto values for the 10th to the 90th centiles, determined from227 measurements of in-vitro fertilization and gamete intra-Fallopiantransfer pregnancies. The abortion rate was 23.9% [95% confidenceinterval (CI) 19.2%, 28.6%] when initial chorionic sac diameterwas below the 50th centile, compared to 6.9% (95% CI 4.9%, 9.4%)when equal to or above the 50th centile. Chorionic sac diameterwas below the 50th centile in all anembryonic abortions andin 62% of embryonic abortions. Triploidy, trisomy 47 + 16, ortrisomy 16 and the presence of satellite bodies on chromosome22 were the only abortus karyotypes significantly associatedwith small chorionic sac diameter. Initial chorionic sac diameterwas not associated with birth weight or length. We concludethat chorionic sac diameter is decreased in anembryonic andembryonic abortion and that normal pregnancy outcome may beexpected in 90–95% of pregnancies in which initial chorionicsac diameter is equal to or above average