Thirty-Day Post-Discharge Outcomes Following COVID-19 Infection

BackgroundThe clinical course of COVID-19 includes multiple disease phases. Data describing post-hospital discharge outcomes may provide insight into disease course. Studies describing post-hospitalization outcomes of adults following COVID-19 infection are limited to electronic medical record review, which may underestimate the incidence of outcomes.ObjectiveTo determine 30-day post-hospitalization outcomes following COVID-19 infection.DesignRetrospective cohort studySettingQuaternary referral hospital and community hospital in New York City.ParticipantsCOVID-19 infected patients discharged alive from the emergency department (ED) or hospital between March 3 and May 15, 2020.MeasurementOutcomes included return to an ED, re-hospitalization, and mortality within 30 days of hospital discharge.ResultsThirty-day follow-up data were successfully collected on 94.6% of eligible patients. Among 1344 patients, 16.5% returned to an ED, 9.8% were re-hospitalized, and 2.4% died. Among patients who returned to the ED, 50.0% (108/216) went to a different hospital from the hospital of the index presentation, and 61.1% (132/216) of those who returned were re-hospitalized. In Cox models adjusted for variables selected using the lasso method, age (HR 1.01 per year [95% CI 1.00–1.02]), diabetes (1.54 [1.06–2.23]), and the need for inpatient dialysis (3.78 [2.23–6.43]) during the index presentation were independently associated with a higher re-hospitalization rate. Older age (HR 1.08 [1.05–1.11]) and Asian race (2.89 [1.27–6.61]) were significantly associated with mortality.ConclusionsAmong patients discharged alive following their index presentation for COVID-19, risk for returning to a hospital within 30 days of discharge was substantial. These patients merit close post-discharge follow-up to optimize outcomes.Supplementary InformationThe online version contains supplementary material available at 10.1007/s11606-021-06924-0.KEY WORDS: COVID-19, mortality, re-admission, discharge     

Reverse LISS plating for intertrochanteric Hip Fractures in elderly patients

Background  

Fractures of the intertrochanteric hip are common and the treatment of unstable fractures generally requires an operative approach. In elderly patients, osteoporosis makes internal fixation problematic and frequently contributes to failed fixation and poor clinical results. We have attempted to apply the Less Invasive Stabilization System (LISS) in reverse position for the repair of intertrochanteric hip fractures in elderly patients with osteoporotic bones. A retrospective review is presented of the cases of 28 elderly patients with stable and unstable fractures of the intertrochanteric hip treated using the reverse LISS.     

Skeletal maturation during thyroxine treatment in children with congenital hypothyroidism

Heyerdahl S, Kase BF, Stake G. Skeletal maturation during thyroxine treatment in children with congenital hypothyroidism. Acta Prediatr 1994;83:618–22. Stockholm. ISSN 0803–5253
The aim of this investigation was to study if bone age development (assessed by the Greulich & Pyle atlas) was related to L-thyroxine treatment in 47 children with congenital hypothyroidism, treated early and according to general recommendations. In spite of frequent delay in skeletal maturation at diagnosis, the delay in mean bone age at a mean chronological age of 1.5 years was slight (0.5 months), and 30% of the variation in bone age SD score (SDS) at 1.5 years was accounted for by the dose of L-thyroxine and serum thyroxine during the first year. The children with a bone age within ± 1 SDS had a prescribed mean dose of L-thyroxine per kg body weight from 3 to 12 months of age of 5.4 ± 1.7 pg/kg/day, and their mean serum thyroxine concentration during the first year was 175 ± 29 nmol/l. We conclude that bone age at 1.5 years of age was positively correlated with the dose of L-thyroxine and the serum thyroxine concentration during the first year. This supports the general use of bone age assessments as a complement to other treatment variables in the follow-up of children with congenital hypothyroidism.     

A culture-based study of personal and social influences of adolescent smoking

BACKGROUND: A range of factors have been found to influence the onset and maintenance of smoking among adolescents. The aim was to explore interrelationships among adolescent smoking and certain personal influences (academic achievement, life satisfaction and future-orientedness) and social influences (hostility, social comparison and perceived friends' smoking) using a cultural perspective. METHODS: The study surveyed high school students aged 13-20, a total sample of 2387 adolescents from randomly selected classes in urban and metropolitan areas from Szeged (Hungary), Lublin and Warsaw (Poland), Izmir (Turkey) and Ames, Iowa (USA). The self-administered questionnaire contained items on smoking, sociodemographics, life satisfaction, future-orientedness, academic achievement, hostility, social comparison and perceived friends' smoking. RESULTS: The frequency of smoking proved to be the highest among Hungarian (58.7%) and Polish (57.6%) adolescents, while the occurrence was 22.1% among US and 23.6% among Turkish adolescents. Across the countries, high life satisfaction, academic achievement, future orientedness and social comparison were related to lower rates of smoking. Perceived friends' smoking was a strong influence of adolescent smoking in all samples. Only paths from academic achievement and perceived peers' smoking differed across the countries. CONCLUSION: Findings suggest that interrelationships between adolescents' smoking and its social and personal influences are similar across all countries as a part of the developmental processes of adolescence. These findings point to the importance of both personal and social influences of adolescent smoking, which interact in a complex model, regardless culture or smoking rates.     

Depressive symptomatology, exposure to violence, and the role of social capital among African American adolescents

Focusing on the role of capital as both personal and social resources for adolescents, the authors examined depressive symptomatology among a sample of 10- to 18-year-old African American youths (N=1,538). In addition to gender and age differences, adolescents exposed to threatening environments (school, neighborhood, home) reported more depressive symptoms. Social capital had a significant inverse relationship with adolescent depression; self-esteem and a social capital index were negatively related to depressive symptomatology. Furthermore, the interaction effects of gender with social capital, age with self-esteem, and age with grades were significant, indicating the presence of a buffering effect. These findings suggest the importance of interrelationships among violence exposure, capital, and well-being for adolescents.     

Substance use, religiosity, and other protective factors among Hungarian adolescents

A number of risk factors have emerged as important correlates of adolescent substance use. In addition, research continues to focus on which factors act as mediators protecting adolescents from negative outcomes. One of these protective factors is religiosity, and the focus of this paper is to examine its role in the life of adolescents in postsocialist Hungary, where active religious participation was highly discouraged until a decade ago. The sample of adolescents (N=1240) consists of middle and high school students living in Szeged, Hungary. The calculated odds ratios for the relationship between religiosity, and other protective factors, and substance use revealed that smoking, drinking, and marijuana use among boys and marijuana use only among girls were related to religiosity. Group membership, for example, participation in school clubs, sports clubs, or religious groups, seems to be more important for boys compared with girls. A more careful examination of the protective role of religion in postsocialist Hungary could be extremely important in a country where both adult and adolescent smoking and alcohol use is among the highest in Europe.     

Does class matter? SES and psychosocial health among Hungarian adolescents

Previous research finds a significant relationship between socioeconomic inequalities and health status: individuals with lower income, education, and occupational prestige have and report more health problems. Interestingly, this relationship is not consistent across the life cycle: health differences among adolescents across socioeconomic groups are not as clearly defined. Using data (n = 1,039) on adolescents from southern Hungary, we examine the role of socioeconomic differences in predicting psychosocial health. We argue that this investigation is of particular importance in a post-communist system where the general perception of SES is undergoing significant transformation. Findings show that classical' SES (socioeconomic status) indicators (manual/nonmanual occupational status) were not significant predictors of psychosocial health in this sample of Hungarian adolescents. While parents' employment status as a 'objective' SES indicator had limited effect, SES self-assessment, as a subjective SES variable, proved to be a strong predictor of adolescents' psychosocial health. We discuss the implications of these findings for the broader SES-health literature with specific attention paid to the impact these relationships may have for adolescent and young adult development in a post-communist country like Hungary.     

Interleukin-6 alters the cellular responsiveness to clopidogrel, irinotecan, and Oseltamivir by suppressing the expression of Carboxylesterases HCE1 and HCE2

Carboxylesterases constitute a class of enzymes that play important roles in the hydrolytic metabolism of drugs and other xenobiotics, patients with liver conditions such as cirrhosis show increased secretion of proinflammatory cytokines [e. g., interleukin-6 （IL- 6）] and decreased capacity of hydrolysis. In this sfudy, we provide a molecular explanation linking cytokine secretion directly to the decreased capacity of hydrolytic biotransformation. In both primary hepatocytes and HepG2 cells, treatment with IL-6 decreased the expression of human carboxylesterases HCE1 and HCE2 by as much as 60%. The decreased expression occurred at both mRNA and protein levels, and it was confirmed .by enzymatic assay. In cotransfection experiments, both HCE1 and HCE2 promoters were significantly repressed, and the repression was comparable with the decrease in HCE1 and HCE2 mRNA, suggesting that transrepression is responsible for the suppressed expression. In addition, pretreatment with IL-6 altered the cellular responsiveness in an opposite manner of overexpression of HCE1 and HCE2 toward various ester therapeutic agents （ e. g., clopidogrel）. Transfection of HCE1, for example, decreased the cytotoxicity induced by antithrombogenic agent clopidogrel, whereas pretreatment with IL-6 increased the cytotoxicity. Such a reversal was observed with other ester drugs, including anticancer agent irinotecan and anti-influenza agent oseltamivir. The altered cellular responsiveness was observed when drugs were assayed at sub-and low-micromolar concentrations, suggesting that suppressed expression of carboxylesterases by IL-6 has profound pharmacological consequences, particularly with those that are hvdrolvzed in an isoform-specific manner.     

7-溴乙氧苯四氢巴马汀对离体豚鼠工作心脏的作用

用Tris-丙酮酸钠液灌流离体豚鼠工作心脏,记录左室压的导管从左房灌流管插入,可使心脏有效工作时间达70min。用Tris-丙酮酸钠液加0.5%的氟碳液能使有效工作时间延长至90min。7-溴乙氧苯四氢巴马汀(7-bromoethyoxybenzene tetrahydropalmatine,EBP)及哌唑嗪0.1μmol/L对工作心脏各项指标均无显著影响。甲氧胺1μmol/L,多巴胺1μmol/L对LVP,ABF,T-CO等指标均有明显的药理作用。EBP 10μmol/L能对抗甲氧胺、多巴胺对上述指标的影响。