Clinical characteristics and population‐based attack rates of respiratory syncytial virus versus influenza hospitalizations among adults—An observational study

BackgroundThe clinical significance of respiratory syncytial virus (RSV) among adults remains underinvestigated. We compared the characteristics and population‐based attack rates of RSV and influenza hospitalizations.MethodsDuring 2018–2020, we recruited hospitalized adults with respiratory infection to our prospective substudy at a tertiary care hospital in Finland and compared the characteristics of RSV and influenza patients. In our retrospective substudy, we calculated the attack rates of all RSV and influenza hospitalizations among adults in the same geographic area during 2016–2020.ResultsOf the 537 prospective substudy patients, 31 (6%) had RSV, and 106 (20%) had influenza. Duration of hospitalization, need for intensive care or outcome did not differ significantly between RSV and influenza patients. RSV was more often missed or its diagnosis omitted from medical record (13% vs 1% p = 0.016 and 48% vs 15%, p > 0.001). In the retrospective substudy, the mean attack rates of RSV, influenza A, and influenza B hospitalizations rose with age from 4.1 (range by season 1.9–5.9), 15.4 (12.3–23.3), and 4.7 (0.5–16.2) per 100,000 persons among 18‐ to 64‐year‐olds to 58.3 (19.3–117.6), 204.1 (31.0–345.0), and 60.4 (0.0–231.0) per 100,000 persons among 65+‐year‐olds and varied considerably between seasons.DiscussionWhile the attack rates of influenza hospitalizations were higher compared with RSV, RSV and influenza hospitalizations were similar in severity. Missing or underreporting of RSV infections may lead to underestimating its disease burden. Both RSV and influenza caused a substantial amount of hospitalizations among the elderly, stressing the need for more effective interventions.     

Severe COVID‐19 pneumonia in an intensive care setting and comparisons with historic severe viral pneumonia due to other viruses

PurposeSevere viral pneumonia is associated with significant morbidity and mortality. Recent COVID‐19 pandemic continues to impose significant health burden worldwide, and individual pandemic waves often lead to a large surge in the intensive care unit (ICU) admissions for respiratory support. Comparisons of severe SARS‐CoV‐2 pneumonia with other seasonal and nonseasonal severe viral infections are rarely studied in an intensive care setting.MethodsA retrospective cohort study comparing patients admitted to ICU with COVID‐19 between March and June 2020 and those with viral pneumonias between January and December 2019. We compared patient specific demographic variables, duration of illness, ICU organ supportive measures and outcomes between both groups.ResultsAnalysis of 93 COVID‐19 (Group 1) and 52 other viral pneumonia patients (Group 2) showed an increased proportion of obesity (42% vs. 23%, p = 0.02), non‐White ethnicities (41% vs. 6%, p < 0.001) and diabetes mellitus (30% vs. 13%, p = 0.03) in Group 1, with lower prevalence of chronic obstructive pulmonary disease (COPD)/asthma (16% vs. 34%, p = 0.02). In Group 1, the neutrophil to lymphocyte ratio was much lower (6.7 vs. 10, p = 0.006), and invasive mechanical ventilation (58% vs. 26%, p < 0.001) was more common. Length of ICU (8 vs. 4, p < 0.001) and hospital stay (22 vs. 11, p < 0.001) was prolonged in Group 1, with no significant difference in mortality. Influenza A and rhinovirus were the most common pathogens in Group 2 (26% each).ConclusionsKey differences were identified within demographics (obesity, ethnicity, age, ICU scores, comorbidities) and organ support. Despite these variations, there were no significant differences in mortality between both groups. Further studies with larger sample sizes would allow for further assessment of clinical parameters in these patients.     

Construction and validation of prognostic nomograms for elderly patients with metastatic non‐small cell lung cancer

BackgroundMetastatic non‐small cell lung cancer (NSCLC) is mostly seen in older patients and is associated with poor prognosis. There is no reliable method to predict the prognosis of elderly patients (≥60 years old) with metastatic NSCLC. The aim of our study was to develop and validate nomograms which accurately predict survival in this group of patients.MethodsNSCLC patients diagnosed between 2010 and 2015 were all identified from the Surveillance, Epidemiology, and End Results (SEER) database. Nomograms were constructed by significant clinicopathological variables (p < 0.05) selected in multivariate Cox analysis regression.ResultsA total of 9584 patients met the inclusion criteria and were randomly allocated in the training (n = 6712) and validation (n = 2872) cohorts. In training cohort, independent prognostic factors included age, gender, race, grade, tumor site, pathology, T stage, N stage, radiotherapy, surgery, chemotherapy, and metastatic site (p < 0.05) for lung cancer‐specific survival (LCSS) and overall survival (OS) were identified by the Cox regression. Nomograms for predicting 1‐, 2‐, and 3‐years LCSS and OS were established and showed excellent predictive performance with a higher C‐index than that of the 7th TNM staging system (LCSS: training cohort: 0.712 vs. 0.534; p < 0.001; validation cohort: 0.707 vs. 0.528; p < 0.001; OS: training cohort: 0.713 vs. 0.531; p < 0.001; validation cohort: 0.710 vs. 0.528; p < 0.001). The calibration plots showed good consistency from the predicted to actual survival probabilities both in training cohort and validation cohort. Moreover, the decision curve analysis (DCA) achieved better net clinical benefit compared with TNM staging models.ConclusionsWe established and validated novel nomograms for predicting LCSS and OS in elderly patients with metastatic NSCLC with desirable discrimination and calibration ability. These nomograms could provide personalized risk assessment for these patients and assist in clinical decision.     

Genotyping of respiratory syncytial virus among influenza‐like illness and severe acute respiratory infection cases of children in the Philippines from 2006 to 2016

ObjectiveRespiratory syncytial virus (RSV) is a leading cause of severe lower respiratory infection, and therefore, a major threat to global health. This study determined the epidemiological and molecular characteristics of RSV among cases of influenza‐like illness (ILI) and severe acute respiratory infection (SARI) among children in the Philippines.MethodThe study included archived nasopharyngeal swab and oropharyngeal swab samples collected from patients under the age of five who are presented with ILI or SARI for the period of 2006–2016. Swabs were examined for RSV subgroup by multiplex real‐time qRT‐PCR. Partial genome sequencing and phylogenetic analyses of the second hypervariable region (HVR) of the G gene were used to determine the genotype of RSV isolates.ResultsA total of 1036 representative samples from all sites were selected and tested. Of these samples, 122 were RSV‐positive at 11.8% prevalence rate, and 58.2% (71/122) were classified as RSV‐A. Six genotypes were identified, which include NA1 (27/122, 22.1%), ON1 (5/122, 4.1%), GA2 (1/122, 0.8%), and GA5 (1/122, 0.8%) for RSV‐A; and BA2 (13/122, 10.7%) and BA9 (1/122, 0.8%) for RSV‐B. Most RSV‐related cases were significantly associated with clinical characteristics such as runny nose (88.1% RSV vs. 11.9% non‐RSV: p value = 0.021), pneumonia (80.6% RSV vs. 19.4% non‐RSV; p value = 0.015), and bronchitis (71.7% RSV vs. 28.3% non‐RSV; p value < 0.001). Increased RSV‐related cases were observed among children below 24 months old.ConclusionThe RSV trend and genetic variability in the Philippines resembles a similar pattern of transmission globally.     

Short Research Communication Anti-Spike Antibody Response to COVISHIELD™ (SII-ChAdOx1 nCoV-19) Vaccine in Patients with B-Cell and Plasma Cell Malignancies and Hematopoietic Cell Transplantation Recipients

IntroductionThere is limited data on the serologic antibody responses after the ChAdOx1 vaccine in patients with hematological malignancies and hematopoietic cell transplantation recipients. There is no data on the safety and efficacy of the Indian COVISHIELD™ vaccine in this population.MethodsThis study reports the anti-S antibody response to the COVISHIELD™ vaccine in a prospective cohort of patients with B-cell and plasma cell malignancies and HCT recipients at a single center. The quantitative antibodies to the SARS-CoV-2 S protein receptor-binding domain in human plasma were determined by the validated Roche Elecsys Anti-SARS-CoV-2 S kit.ResultsA total of 118 patients were included over the study period from April 2021 to August 2021. The seropositivity rate at baseline and after the first and second dose of the vaccine was 39%, 66%, and 79%, respectively (p < 0.0001). The seronegative cohort had a higher median age (65 vs. 60 years, p = 0.03), were more likely to be males (81% vs. 42%, p = 0.009), had a diagnosis of B-CLPD (100% vs. 42%, p < 0.001) and were more likely to be on ibrutinib therapy (56% vs. 15%, p = 0.001).ConclusionsThis study confirms the safety and efficacy of the COVISHIELD™ vaccine in patients with hematological malignancies.     

Impact of coinfection status and comorbidity on disease severity in adult emergency department patients with influenza B

BackgroundInfluenza B accounts for approximately one fourth of the seasonal influenza burden. However, research on the importance of influenza B has received less attention compared to influenza A. We sought to describe the association of both coinfections and comorbidities with disease severity among adults presenting to emergency departments (ED) with influenza B.MethodsNasopharyngeal samples from patients found to be influenza B positive in four US and three Taiwanese ED over four consecutive influenza seasons (2014–2018) were tested for coinfections with the ePlex RP RUO panel. Multivariable logistic regressions were fitted to model adjusted odds ratios (aOR) for two severity outcomes separately: hospitalization and pneumonia diagnosis. Adjusting for demographic factors, underlying health conditions, and the National Early Warning Score (NEWS), we estimated the association of upper respiratory coinfections and comorbidity with disease severity (including hospitalization or pneumonia).ResultsAmongst all influenza B positive individuals (n = 446), presence of another upper respiratory pathogen was associated with an increased likelihood of hospitalization (aOR = 2.99 [95% confidence interval (95% CI): 1.14–7.85, p = 0.026]) and pneumonia (aOR = 2.27 [95% CI: 1.25–4.09, p = 0.007]). Chronic lung diseases (CLD) were the strongest predictor for hospitalization (aOR = 3.43 [95% CI: 2.98–3.95, p < 0.001]), but not for pneumonia (aOR = 1.73 [95% CI: 0.80–3.78, p = 0.166]).ConclusionAmongst ED patients infected with influenza B, the presence of other upper respiratory pathogens was independently associated with both hospitalization and pneumonia; presence of CLD was also associated with hospitalization. These findings may be informative for ED clinician''s in managing patients infected with influenza B.     

Vaccine‐preventable disease hospitalized patients with heart failure with reduced ejection fraction

BackgroundOver five million Americans suffer from heart failure (HF), and this is associated with multiple chronic comorbidities and recurrent decompensation. Currently, there is an increased incidence in vaccine‐preventable diseases (VPDs). We aim to investigate the impact of HF with reduced ejection fraction (HFrEF) in patients hospitalized with VPDs.HypothesisPatient with HFrEF are at higher risk for VPDs and they carry a higher risk for in‐hospital complications.MethodsRetrospective analysis from all hospital admissions from the 2016‐2018 National Inpatient Sample (NIS) using the ICD‐10CM codes for patients admitted with a primary diagnosis of VPDs with HFrEF and those without reduced ejection fraction. Outcomes evaluated were in‐hospital mortality, length of stay (LOS), healthcare utilization, frequency of admissions, and in‐hospital complications. Multivariate regression analysis was conducted to adjust for confounders.ResultsOut of 317 670 VPDs discharges, we identified 12 130 (3.8%) patients with HFrEF as a comorbidity. The most common admission diagnosis for VPDs was influenza virus (IV) infection (75.0% vs. 64.1%; p < .01), followed by pneumococcal pneumonia (PNA) (13% vs. 9.4%; p < .01). After adjusting for confounders, patients with HFrEF had higher odds of having diagnosis of IV (adjusted [aOR], 1.42; p < .01) and PNA (aOR, 1.27; p < .01). Patients with VPDs and HFrEF had significantly higher odds of mortality (aOR, 1.76; p < .01), LOS, respiratory failure requiring mechanical ventilation, and mechanical ventilation for less than 96 h.ConclusionInfluenza and PNA were the most common VPDs admitted to the hospital in patients with a concomitant diagnosis of HFrEF. They were associated with increased mortality and in‐hospital complications.     

Global prevalence of prediabetes in children and adolescents: A systematic review and meta‐analysis

BackgroundPrediabetes is a pivotal risk factor for developing diabetes. This meta‐analysis was performed to assess the global prevalence of childhood prediabetes.MethodsA systematic search was conducted for studies of prediabetes prevalence in the general pediatric population from inception until December 2021. Random‐effects meta‐analysis was used to combine the data. Variations in the prevalence estimates in different subgroups (age group, sex, setting, investigation period, body mass index [BMI] group, family history of diabetes, diagnosis criteria, World Health Organization [WHO] and World Bank [WB] regions) were examined by subgroup meta‐analysis.ResultsA total of 48 studies were included in the meta‐analysis. The pooled prevalence was 8.84% (95% CI, 6.74%‐10.95%) for prediabetes in childhood. Subgroup meta‐analyses showed that the prevalence was higher in males than females (8.98% vs 8.74%, P < .01), in older compared to younger children (7.56% vs. 2.51%, p < 0.01), in urban compared to rural areas (6.78% vs. 2.47, p < 0.01), and higher in children with a family history of diabetes than in those without such a history (7.59% vs. 6.80%, p < 0.01). We observed an upward trend in prediabetes prevalence from 0.93% to 10.66% over past decades (p < 0.01). The pooled prevalence increased from 7.64% to 14.27% with increased BMI (p < 0.01). Pooled prevalence was the lowest for criterion A among different diagnosis criteria (p < 0.01). For WHO and WB regions, the European Region and high‐income countries yielded the lowest pooled prevalence (p < 0.01).ConclusionsElevated prediabetes prevalence in childhood reaches an alarming level. Intensive lifestyle modification is needed to improve the prediabetes epidemic.     

Discrepancies in glycemic metrics derived from different continuous glucose monitoring systems in adult patients with type 1 diabetes mellitus

BackgroundContinuous glucose monitoring systems have been widely used but discrepancies among various brands of devices are rarely discussed. This study aimed to explore differences in glycemic metrics between FreeStyle Libre (FSL) and iPro2 among adults with type 1 diabetes mellitus (T1DM).MethodsParticipants with T1DM and glycosylated hemoglobin of 7%–10% were included and wore FSL and iPro2 for 2 weeks simultaneously. Datasets collected on the insertion and detachment day, and those with insufficient quantity (<90%) were excluded. Agreements of measurement accuracy and glycemic metrics were evaluated.ResultsA total of 40 498 paired data were included. Compared with the values from FSL, significantly higher median value was observed in iPro2 (147.6 [106.2, 192.6] vs. 144.0 [100.8, 192.6] mg/dl, p < 0.001) and the largest discordance was observed in hypoglycemic range (median absolute relative difference with iPro2 as reference value: 25.8% [10.8%, 42.1%]). Furthermore, significant differences in glycemic metrics between iPro2 and FSL were also observed in time in range (TIR) 70–180 mg/dl (TIR, 62.8 ± 12.4% vs. 58.8 ± 12.3%, p = 0.004), time spent below 70 mg/dl (4.4 [1.8, 10.9]% vs. 7.2 [5.4, 13.3]%, p < 0.001), time spent below 54 mg/dl (0.9 [0.3, 4.0]% vs. 2.6 [1.3, 5.6]%, p = 0.011), and coefficient of variation (CV, 38.7 ± 8.5% vs. 40.9 ± 9.3%, p = 0.017).ConclusionsDuring 14 days of use, FSL and iPro2 provided different estimations on TIR, CV, and hypoglycemia‐related parameters, which needs to be considered when making clinical decisions and clinical trial designs.     

What are the factors affecting the recovery rate of bronchoalveolar lavage fluid?

BackgroundBronchoalveolar lavage (BAL) is a useful examination for the evaluation of interstitial lung disease. A high BAL fluid (BALF) recovery rate is desirable because low recovery rates lead to inaccurate diagnoses and increased adverse events. Few studies have explored whether BALF recovery rates are influenced by clinical factors.ObjectivesThis study aimed to identify the clinical parameters affecting the recovery rates of BALF and the extent of their effects.MethodData from patients who underwent BAL at the Chiba University Hospital between 2013 and 2019 were retrospectively reviewed. BAL was performed with three aliquots of 50‐ml physiological saline. The potential association of the BALF recovery rate with clinical parameters such as age, sex, smoking status, underlying disease, bronchus used for the procedure and pulmonary function, was analysed.ResultsEight hundred twenty‐six patients had undergone BAL. The average recovery rate was 52.4%. Factors affecting BALF recovery rates included male sex (odds ratio [OR]: 0.32, 95% confidence interval [CI]: 0.20–0.53, p < 0.001); age ≥ 65 years (OR: 0.50, 95% CI: 0.33–0.76, p < 0.001); use of the left bronchus (OR: 0.46, 95% CI: 0.30–0.71, p = 0.001) and bronchi other than the middle lobe bronchus or lingula (OR: 0.41, 95% CI: 0.25–0.65, p < 0.001); and forced expiratory volume in 1 s divided by forced vital capacity <80% (OR: 0.42, 95% CI: 0.40–1.00, p < 0.001).ConclusionSex, age, bronchus used for the procedure and pulmonary function may be useful as pre‐procedural predictors of BALF recovery rates.     

Effect of Aging on Human Circulatory System in Normotensive Healthy Subjects

Aging is associated with degenerative changes in cardiac and endothelial function (EF). This study was done to assess whether age-related changes take place on EF, carotid intima-media thickness (IMT), blood pressure (BP), and echocardiographic measurements. All volunteers were healthy normotensive healthy subjects. They were divided into three groups. Group 1, young adults: < 40 years old; Group 2, middle age: between 40 and 60 years old; Group 3, elderly: > 60 years old. High-frequency vascular ultrasound was used to assess the baseline brachial artery dimension and flow velocity after reactive hyperemia. The carotid IMT and echocardiographic measurements including Doppler variables were recorded in all subjects. Systolic BP, left ventricular mass, and left ventricular end-diastolic volume increased progressively with age (p < 0.001). Left ventricular ejection fraction decreased progressively with age (male, p = 0.034; female, p = 0.001); E/A ratio of the left ventricular flow spectrum declined with age (p < 0.001). The ultrasonic EF variables of flow increased during reactive hyperemia and IMT increased with age (p < 0.001). Our study demonstrates that BP, body weight, and ultrasonic variables changed significantly with age. The aging-associated changes provide insight into progression to atherosclerosis.     

Association between insurance status and in‐hospital outcomes in patients with out‐of‐hospital ventricular fibrillation arrest

BackgroundLack of health insurance is associated with adverse clinical outcomes; however, the association between health insurance status and in‐hospital outcomes after out‐of‐hospital ventricular fibrillation (OHVFA) arrest is unclear.HypothesisLack of health insurance is associated with worse in‐hospital outcomes after out‐of‐hospital ventricular fibrillation arrest.MethodsFrom January 2003 to December 2014, hospitalizations with a primary diagnosis of OHVFA in patients ≥18 years of age were extracted from the Nationwide Inpatient Sample. Patients were categorized into insured and uninsured groups based on their documented health insurance status. Study outcome measures were in‐hospital mortality, utilization of implantable cardioverter defibrillator (ICD), and cost of hospitalization. Inverse probability weighting adjusted binary logistic regression was performed to identify independent predictors of in‐hospital mortality and ICD utilization and linear regression was performed to identify independent predictors of cost of hospitalization.ResultsOf 188 946 patients included in the final analyses, 178 005 (94.2%) patients were insured and 10 941 (5.8%) patients were uninsured. Unadjusted in‐hospital mortality was higher (61.7% vs. 54.7%, p < .001) and ICD utilization was lower (15.3% vs. 18.3%, p < .001) in the uninsured patients. Lack of health insurance was independently associated with higher in‐hospital mortality (O.R = 1.53, 95% C.I. [1.46–1.61]; p < .001) and lower utilization of ICD (O.R = 0.84, 95% C.I [0.79–0.90], p < .001). Cost of hospitalization was significantly higher in uninsured patients (median [interquartile range], p‐value) ($) (39 650 [18 034‐93 399] vs. 35 965 [14 568.50‐96 163], p < .001).ConclusionLack of health insurance is associated with higher in‐hospital mortality, lower utilization of ICD and higher cost of hospitalization after OHVFA.     

Asthma,from mild to severe,is an independent prognostic factor for mild to severe Coronavirus disease 2019 (COVID‐19)

BackgroundChronic illnesses were reported to be poor prognostic factors associated with severe illness and mortality in Coronavirus disease 2019 (COVID‐19) infection. The association with asthma, however, is limited and controversial, especially for mild asthma.MethodsA territory wide retrospective study was conducted to investigate the association between asthma and the prognosis of COVID‐19. All patients with laboratory confirmed in Hong Kong for COVID‐19 from the 23 January to 30 September 2020 were included in the study. Severe diseases were defined as those who develop respiratory complications, systemic complications, and death.ResultsAmong the 4498 patients included in the analysis, 165 had asthma, with 141 having mild asthma. Patients with asthma were significantly more likely to require invasive mechanical ventilation (incidence = 17.0% odds ratio [OR] = 4.765, p < 0.001), oxygen therapy (incidence = 39.4%, OR = 3.291, p < 0.001), intensive care unit admission (incidence = 21.2%, OR = 3.625, p < 0.001), and systemic steroid treatment (incidence = 34.5%, OR = 4.178, p < 0.001) and develop shock (incidence = 16.4%, OR = 4.061, p < 0.001), acute kidney injury (incidence = 6.1%, OR = 3.281, p = 0.033), and secondary bacterial infection (incidence = 56.4%, OR = 2.256, p < 0.001). They also had significantly longer length of stay. Similar findings were also found in patients with asthma of the Global Initiative for Asthma (GINA) steps 1 and 2 upon subgroup analysis.ConclusionsAsthma, regardless of severity, is an independent prognostic factor for COVID‐19 and is associated with more severe disease with respiratory and systemic complications.     

Diabetes mellitus and its impact on mortality rate and outcome in pulmonary embolism

Aims/IntroductionIn patients with pulmonary embolism (PE), the impact of diabetes mellitus on patient profile and outcome is not well investigated.Material and MethodsThe German nationwide inpatient sample of the years 2005–2018 was analyzed. Hospitalized PE patients were stratified for diabetes, and the impact of diabetes on in‐hospital events was investigated.ResultsOverall, 1,174,196 PE patients (53.8% aged ≥70 years, 53.5% women) and, among these, 219,550 (18.7%) diabetes patients were included. In‐hospital mortality rate amounted to 15.8%, and was higher in diabetes patients than in non‐diabetes patients (19.8% vs 14.8%, P < 0.001). PE patients with diabetes had a higher prevalence of cardiovascular risk factors, comorbidities, right ventricular dysfunction (31.8% vs 27.7%, P < 0.001), prolonged in‐hospital stay (11.0 vs 9.0 days, P < 0.001) and higher rates of adverse in‐hospital events. Remarkably, diabetes was independently associated with increased in‐hospital mortality (odds ratio [OR] 1.21, 95% confidence interval [CI] 1.20–1.23, P < 0.001) when adjusted for age, sex and comorbidities. Within the observation period of 2005–2018, a relevant decrease of in‐hospital mortality in PE patients with diabetes was observed (25.5% to 16.8%). Systemic thrombolysis was more often administered to diabetes patients (OR 1.18, 95% CI 1.01–3.49, P < 0.001), and diabetes was associated with intracerebral (OR 1.19, 95% CI 1.12–1.26, P < 0.001), as well as gastrointestinal bleeding (OR 1.11, 95% CI 1.07–1.15, P < 0.001). Type 1 diabetes mellitus was shown to be a strong risk factor in PE patients for shock, right ventricular dysfunction, cardiopulmonary resuscitation and in‐hospital death (OR 1.75, 95% CI 1.61–1.90, P < 0.001).ConclusionsDespite the progress in diabetes treatments, diabetes is still associated with an unfavorable clinical patient profile and higher risk for adverse events, including substantially increased in‐hospital mortality in acute PE.     

Clinical significance of coronavirus disease 2019 in hospitalized patients with myocardial injury

BackgroundThe clinical significance of Coronavirus disease 2019 (COVID‐19) as an associate of myocardial injury is controversial.HypothesisType 2 MI/Myocardial Injury are associated with worse outcomes if complicated by COVID‐19.MethodsThis longitudinal cohort study involved consecutive patients admitted to a large urban hospital. Myocardial injury was determined using laboratory records as ≥1 hs‐TnI result >99th percentile (male: >34 ng/L; female: >16 ng/L). Endotypes were defined according to the Fourth Universal Definition of Myocardial Infarction (MI) and COVID‐19 determined using PCR. Outcomes of patients with myocardial injury with and without COVID‐19 were assessed.ResultsOf 346 hospitalized patients with elevated hs‐TnI, 35 (10.1%) had laboratory‐confirmed COVID‐19 (median age [IQR]; 65 [59–74]; 64.8% male vs. COVID‐19 negative: 74 [63–83] years; 43.7% male). Cardiac endotypes by COVID‐19 status (yes vs. no) were: Type 1 MI (0 [0%] vs. 115 [100%]; p < .0005), Type 2 MI (13 [16.5%] vs. 66 [83.5%]; p = .045), and non‐ischemic myocardial injury (cardiac: 4 [5.8%] vs. 65 [94.2%]; p = .191, non‐cardiac:19 [22.9%] vs. 64 [77.%]; p < .0005). COVID‐19 patients had less comorbidity (median [IQR] Charlson Comorbidity Index: 3.0 [3.0] vs. 5.0 [4.0]; p = .001), similar hs‐TnI concentrations (median [IQR] initial: 46 [113] vs. 62 [138]; p = .199, peak: 122 [474] vs. 79 [220] ng/L; p = .564), longer admission (days) (median [IQR]: 14[19] vs. 6[12]; p = .001) and higher in‐hospital mortality (63.9% vs. 11.3%; OR = 13.2; 95%CI: 5.90, 29.7).ConclusionsCardiac sequelae of COVID‐19 typically manifest as Non‐cardiac myocardial injury/Type 2MI in younger patients with less co‐morbidity. Paradoxically, the admission duration and in‐hospital mortality are increased.     

The burden of influenza among Kenyan pregnant and postpartum women and their infants, 2015–2020

BackgroundIn tropical Africa, data about influenza‐associated illness burden are needed to assess potential benefits of influenza vaccination among pregnant women. We estimated the incidence of influenza among pregnant women and their infants in Siaya County, Kenya.MethodsWe enrolled women at <31 weeks of gestation and conducted weekly follow‐up until 6‐month postpartum to identify acute respiratory illnesses (ARIs). We defined ARI among mothers as reported cough, rhinorrhoea or sore throat and among infants as maternal‐reported cough, difficulty breathing, rhinorrhoea or clinician diagnosis of respiratory illness. We collected nasal/nasopharyngeal and oropharyngeal swabs from mothers/infants with ARI and tested for influenza A and B using molecular assays. We calculated antenatal incidence of laboratory‐confirmed influenza among mothers and postnatal incidence among mothers and infants.ResultsDuring June 2015 to May 2020, we analysed data from 3,026 pregnant women at a median gestational age of 16 weeks (interquartile range [IQR], 13, 18) and followed 2,550 infants. Incidence of laboratory‐confirmed influenza during pregnancy (10.3 episodes per 1,000 person‐months [95% confidence interval {CI} 8.6–11.8]) was twofold higher than in the postpartum period (4.0 [95% CI 2.6–5.5]; p < 0.01). Incidence was significantly higher among human immunodeficiency virus (HIV)‐infected pregnant women (15.6 [95% CI 11.0–20.6] vs. 9.1 [95% CI 7.5–10.8]; p < 0.01). Incidence among young infants was 4.4 (95% CI 3.0–5.9) and similar among HIV‐exposed and HIV‐unexposed infants.ConclusionOur findings suggest a substantial burden of influenza illnesses during pregnancy, with a higher burden among HIV‐infected mothers. Kenyan authorities should consider the value of vaccinating pregnant women, especially if HIV infected.     

Hospital outcomes of community-acquired COVID-19 versus influenza: Insights from the Swiss hospital-based surveillance of influenza and COVID-19

BackgroundSince the onset of the COVID-19 pandemic, the disease has frequently been compared with seasonal influenza, but this comparison is based on little empirical data.AimThis study compares in-hospital outcomes for patients with community-acquired COVID-19 and patients with community-acquired influenza in Switzerland.MethodsThis retrospective multi-centre cohort study includes patients > 18 years admitted for COVID-19 or influenza A/B infection determined by RT-PCR. Primary and secondary outcomes were in-hospital mortality and intensive care unit (ICU) admission for patients with COVID-19 or influenza. We used Cox regression (cause-specific and Fine-Gray subdistribution hazard models) to account for time-dependency and competing events with inverse probability weighting to adjust for confounders.ResultsIn 2020, 2,843 patients with COVID-19 from 14 centres were included. Between 2018 and 2020, 1,381 patients with influenza from seven centres were included; 1,722 (61%) of the patients with COVID-19 and 666 (48%) of the patients with influenza were male (p < 0.001). The patients with COVID-19 were younger (median 67 years; interquartile range (IQR): 54–78) than the patients with influenza (median 74 years; IQR: 61–84) (p < 0.001). A larger percentage of patients with COVID-19 (12.8%) than patients with influenza (4.4%) died in hospital (p < 0.001). The final adjusted subdistribution hazard ratio for mortality was 3.01 (95% CI: 2.22–4.09; p < 0.001) for COVID-19 compared with influenza and 2.44 (95% CI: 2.00–3.00, p < 0.001) for ICU admission.ConclusionCommunity-acquired COVID-19 was associated with worse outcomes compared with community-acquired influenza, as the hazards of ICU admission and in-hospital death were about two-fold to three-fold higher.