Detection rate and distribution pattern of HIV infected patients in the emergency room of a hospital

HIV positive patients needing urgent treatment have become reality in the clinical practice of the multiprofile hospital of the Sklifosovsky Research Institute of Emergency Aid. 243,030 patients and 55,163 donors were examined at the Laboratory of Clinical Immunology and AIDS Diagnostics during the period of 1989-2001, and among the examinees 814 patients and 13 donors were found to be HIV-infected. The highest detection rate of HIV-infected patients was registered in the poisoning center, the somatic-psychiatric and endotoxicosis departments. After the period of a sharp rise in the number of HIV-positive patients (1997-2000) a decrease in their proportion among hospitalized patients was registered in 2001.     

Frequency of emergency room visits for childhood asthma in Ottawa, Canada: the role of weather

The aim of this study was to evaluate associations between meteorological conditions and the number of emergency department visits for asthma in a childrens hospital in Ottawa, Canada. A case-crossover study design was used. Hospital emergency department visits for asthma between 1992 and 2000 were identified based on patients presenting complaints. We obtained hourly measures for the following meteorological variables: wind speed, temperature, atmospheric pressure, relative humidity, and visibility. Particular emphasis was placed on exploring the association between asthma visits and fog, thunderstorms, snow, and liquid and freezing forms of precipitation. In total, there were 18,970 asthma visits among children between 2 and 15 years of age. The number of visits and weather characteristics were grouped into 6 h case and control intervals. The occurrence of fog or liquid precipitation was associated with an increased number of asthma visits, while snow was associated with a reduced number (P<0.05). Stratified analyses by season found no association in any of the four calendar intervals between the number of asthma visits and visibility, change in relative humidity and change in temperature. In contrast, summertime thunderstorm activity was associated with an odds ratio of 1.35 (95% CI=1.02–1.77) relative to summer periods with no activity. Models that incorporate calendar and meteorological data may help emergency departments to more efficiently allocate resources needed to treat children presenting with respiratory distress.     

Bringing the hospital to the patient: first treatment of stroke patients at the emergency site

Background

Early treatment with rt-PA is critical for favorable outcome of acute stroke. However, only a very small proportion of stroke patients receive this treatment, as most arrive at hospital too late to be eligible for rt-PA therapy.

Methods and Findings

We developed a “Mobile Stroke Unit”, consisting of an ambulance equipped with computed tomography, a point-of-care laboratory system for complete stroke laboratory work-up, and telemedicine capabilities for contact with hospital experts, to achieve delivery of etiology-specific and guideline-adherent stroke treatment at the site of the emergency, well before arrival at the hospital. In a departure from current practice, stroke patients could be differentially treated according to their ischemic or hemorrhagic etiology even in the prehospital phase of stroke management. Immediate diagnosis of cerebral ischemia and exclusion of thrombolysis contraindications enabled us to perform prehospital rt-PA thrombolysis as bridging to later intra-arterial recanalization in one patient. In a complementary patient with cerebral hemorrhage, prehospital diagnosis allowed immediate initiation of hemorrhage-specific blood pressure management and telemedicine consultation regarding surgery. Call-to-therapy-decision times were 35 minutes.

Conclusion

This preliminary study proves the feasibility of guideline-adherent, etiology-specific and causal treatment of acute stroke directly at the emergency site.     

Association between the APOE*4 allele and atherosclerosis is age dependent among Argentine males

Several studies have shown evidence of an association between the *4 allele of apolipoprotein E (APOE) and coronary heart disease (CHD) in different populations. We determined the APOE genotype and total cholesterol (TC), triglycerides (TG), and high-density lipoprotein cholesterol (HDLC) values in 189 patients with angiographically evaluated atherosclerosis. The APOE*4 allele was found to be statistically significantly more frequent (odds ratio, 1.93; 95% confidence interval, 1.12-3.32) among male patients than in a randomly chosen population-based sample. No significant difference was found when female patients were compared to the general population. The APOE*4 allele was found primarily among young (30-45-year-old) male patients (p < 0.04). Despite the ascending linear tendency of the mean TC values for genotypes APOE*2/*3, APOE*3/*3, and APOE*3/ *4 reported in our case population, no differences were observed among our patients. We conclude that the APOE*4 allele is associated with an increased risk for atherosclerotic vascular disease, that this association has an age-dependent effect, and that it acts as a genetic factor that increases susceptibility to developing the disease in young to middle-aged male adults in our population.     

Association between minihaplotypes and mutations at the PAH locus in Polish hyperphenylalaninemic patients

Hereditary hyperphenylalaninemia (HPA) is a disorder of amino acid metabolism and results from an insufficiency of hepatic phenylalanine hydroxylase (PAH). HPA phenotypes form a spectrum ranging from classical phenylketonuria (PKU) to mild hyperphenylalaninemia (MHP). The phenotypic diversity reflects heterogeneity at the molecular level, and more than 320 different mutations in the PAH gene are known to date. The association of 3 mutations (R408W, IVS10 and A403V) common in different European populations with a variable number tandem repeat (VNTR) and short tandem repeat sites (minihaplotype) in the PAH gene was examined in a group of Polish PKU and MHP patients. Additionally, minihaplotypes were established for another 16 mutations. The presented data support the hypothesis that the R408W/VNTR3/STR238 allele originated among pre-Indo-Europeans on the territory in present-day Lithuania and Belarus. Mutation IVS10nt-11g-->a (IVS10) is strongly associated with VNTR7/STR250 minihaplotype and is possibly of Mediterranean origin.     

Mapping perceptions related to acceptance of smallpox vaccination by hospital emergency room personnel

Emergency department personnel would be first responders in the event of a bioterror smallpox outbreak, yet few were willing to be vaccinated during the 2002 federal campaign. To better understand vaccination concerns, perceptual mapping methods were used to create multidimensional models of how emergency department personnel (N= 73) in the Philadelphia area perceive the risks and benefits of smallpox vaccination under 4 levels of threat: (1) today; (2) if another terrorist attack happened anywhere in the U.S.; (3) if a smallpox attack happened somewhere in the U.S.; (4) if a smallpox attack happened locally. The perceptual maps show significant shifts in factors that are important for motivating respondents to accept vaccination under increasingly higher levels of threat. In the today scenario, endorsement of vaccination from a credible source, such as a major hospital in the area, was a very important factor (mean =7.10 on a 0-10 scale).However, endorsement was not as important under the 2 higher levels of threat. Under these conditions, respondents'sense of wanting to help in a disaster emerged as an important element the closer the hypothetical attack was to the respondent,ranging in importance from 3.87 under the least threat to 7.35 under the greatest threat scenario. The perceptual maps yield information that would assist planners in designing more effective risk communication strategies tailored to particular audiences and levels of threat. Such communications are important to prepare for a smallpox event or other uncertain outbreak, where it is essential to rapidly vaccinate a critical mass of healthcare workers.     

Biopsychosocial health care needs at the emergency room: challenge of complexity

Background

In an emergency room of internal medicine, triage and treatment of patients deserve first priority. However, biopsychosocial case complexity may also affect patient health outcome but has not yet been explored in this setting. Therefore, the aims of the study are (1) to estimate prevalence rates of complex patients in the emergency room (ER), (2) to describe biopsychosocial complexity in this population and (3) to evaluate possible correlations between patient profiles regarding case complexity and further clinical treatment.

Methods

During a study period of one week, all patients of an emergency room of internal medicine who were triaged to Manchester levels three to five were invited to participate in the study. Biopsychosocial case complexity was assessed by the INTERMED method. Psychosocial interventions were evaluated based on all documented interventions and recommendations given at the emergency room and during inpatient treatment.

Results

Study participants consisted of 167 patients with a subgroup of 19% (n = 32) receiving subsequent inpatient-treatment at the department. High biopsychosocial case complexity was found in 12% (n = 20) of the total sample (INTERMED score >20). This finding was paralleled by a cluster analysis suggesting three clusters with one highly complex patient group of 14%. These highly complex patients differed significantly from the other clusters as they had visited the emergency room more often within the last year and lived alone more frequently. In addition, admission rates were highest in this group. During ER treatment and subsequent inpatient treatment, 21% of highly complex patients received interventions addressing psychosocial factors as compared to 6% and 7%, respectively, in the other clusters.

Conclusions

A standardized screening of biopsychosocial case complexity among ‘frequent utilizers’ of the ER would be helpful to detect specific multidisciplinary health care needs among this particularly burdened patient group.     

Interrelationships of fish and channel environmental conditions with aquatic macrophytes in an Argentine irrigation system

This study examines the relationships between fish, environmental variables and submerged macrophytes within the irrigation system of the lower valley of the Río Colorado in southern Argentina. Using Canonical Correspondence Analysis (CCA), the strongest environmental gradients detected were conductivity and carp ( Cyprinus carpi) biomass per unit area of channel cross-section. These variables were positively associated with each other and also with water turbidity. Sites scoring high on these gradients were mainly drainage channels; those scoring lowest were irrigation channels. The main fish species associated with high carp biomass, high turbidity and high conductivity were carpa ( C. carpio), pejerrey ( Odontesthes bonariensis), madrecita ( Jenynsia lineata lineata) and lisa ( Mugil liza). Dientudo ( Oligosarcus jenynsi) and mojarra ( Astianax eigenmanniorum) were more strongly associated with clearer water, with low carp biomass. In all CCA analyses macrophytes were arranged in similar order along the main conductivity-turbidity-carp biomass gradient. Lowest on this main environmental gradient, and scoring very close to each other, were Potamogeton pectinatus and Chara contraria. Salinity-tolerant species such as Ruppia maritima, Zannichellia palustris and Enteromorpha flexuosa tended to score highest, followed by the surface floating Azolla filiculoides and the filamentous alga Cladophora surera. Within the constraints imposed by conductivity, turbidity was a key predictor of both abundance and distribution of the two dominant plants of the irrigation scheme ( P. pectinatus and C. contraria). Turbidity was strongly predicted by biomass of carp per unit channel cross sectional area, when fine sediment particle content was taken into account. The positive association between carp biomass and water turbidity was both substantial and predictable, and was in turn associated with reduction in submerged plant growth. The biomass of the most widespread nuisance-causing plant species in the channels, Potamogeton pectinatus, could best be predicted ( R = 0.592, P < 0.05) using a multiple regression model utilising four predictor variables: conductivity, nitrate, phosphate and carp biomass. This revised version was published online in July 2006 with corrections to the Cover Date.     

Association of meteorological and day-of-the-week factors with emergency hospital admissions in Fukuoka, Japan

We carried out a statistical study of the influence of meteorological and day-of-the-week factors on the intrinsic emergency patients transported to hospitals by ambulance. Multiple piecewise linear regression analysis was performed on data from 6,081 emergency admissions for 1 year between April 1997 and March 1998 in Fukuoka, Japan. The response variable was the daily number of emergency patients admitted with three types of disease: cerebrovascular, respiratory and digestive diseases. The results showed that the number of emergency patients admitted daily with cerebrovascular disease was significantly associated with temperature on the day of admission and whether the day was Sunday. As it became colder than 12 degrees C, emergency admissions of patients with cerebrovascular disease increased drastically, reaching a plateau at 4 degrees C. On the 3rd and 7th days after the temperature fell below 10 degrees C, the daily admission of patients with respiratory disease significantly increased. We also observed a weak association between emergency admissions of patients suffering from digestive disease and rising barometric pressure on the day of admission.     

Blood ethanol levels in sober alcohol users seen in an emergency room

During the course of two years, 76 representative subjects seen in a community hospital emergency room who admitted to having recently used alcohol while still appearing sober had their blood alcohol levels measured to determine the levels of blood alcohol present in ambulatory sober alcohol users. As a group the mean blood alcohol level obtained in those who had measurable levels was 268 ± 10 mg/dl mean ± SEM). More men (47) than women (18) admitted to having used ethanol and had measurable blood ethanol levels and therefore were studied. Moreover, the mean blood alcohol level in the men studied was arithmetically greater (272 ± 13 mg/d1) than that present in the women (260 ± 13mg/d1). The range of alcohol levels seen in the two sexes, however, were quite similar. Using a blood alcohol level > 200 mg/dl in a clinically “non-intoxicated” individual as the cut-off level for defining one as a suspect chronic alcohol user, our data would suggest that such individuals not uncommonly have blood alcohol levels as high as 290 ± 9 mg/dl.     

Antibiotic susceptibility of the bacterial strains isolated at the emergency hospital]

Comparative evaluation of the incidence of the drug resistant pathogens at the patients with sepsis was performed. High ratio of the resistnt strain was shown and the most potent drugs were estimated. The investigation results demonstrates the necessity to improve diagnostic quality control. The data on drug susceptibility of the pathogens may be used for their taxonomic clarification.     

Diagnosis and differential diagnosis of poliomyelitis; the management of patients in the hospital admitting room

Because of the great variety of early symptoms of poliomyelitis and their similarity to the symptoms of a number of other diseases, in times of epidemic many patients are admitted to hospital on suspicion of poliomyelitis. At such times the prime purpose of the hospital admitting room staff is to distinguish between patients with poliomyelitis (or other diseases requiring immediate treatment) and those who may be referred into other channels. This presentation (1) points out the superficial similarities of the clinically observable signs and symptoms and of laboratory data in poliomyelitis and in other diseases, and (2) discusses the more occult dissimilarities which aid in differentiation.     

Association between depression and hospital outcomes among older men

Background:

Studies that have investigated the relation between depression and the type, nature, extent and outcome of general hospital admissions have been limited by their retrospective designs and focus on specific clinical populations. We explored this relation prospectively in a large, community-based sample of older men.

Methods:

A cohort of 5411 men aged 69 years and older enrolled in the Health in Men Study was assessed at baseline for depressive symptoms, defined as a score of 7 or higher on the 15-item Geriatric Depression Scale. Participants were followed for 2 years for occurrence and number of hospital admissions, type of hospital admission, length of hospital stay and inpatient death as recorded in the Western Australian Data Linkage System.

Results:

Of 339 men with depressive symptoms, 152 (44.8%) had at least 1 emergency hospital admission, compared with 1164 of 5072 (22.9%) nondepressed men (p < 0.001). In multivariate analyses, the presence of depressive symptoms was a significant independent predictor of hospital admission (hazard ratio 1.67, 95% confidence interval [CI] 1.38–2.01), number of hospital admissions (incidence rate ratio [IRR] 1.22, 95% CI 1.07–1.39) and total length of hospital stay (IRR 1.65, 95% CI 1.36–2.01).

Interpretation:

Participants with depressive symptoms were at higher risk of hospital admission for nonpsychiatric conditions and were more likely to have longer hospital stays and worse hospital outcomes, compared with nondepressed participants. These results highlight the potential to target this high-risk group to reduce the burden of health care costs in an aging population.Older people are the most frequent users of health services, and the progressive aging of the world’s population may lead to a saturation of available services. Therefore, we must find ways to reduce preventable admissions to hospital and uncover the factors associated with potentially preventable use of health services. An association between depression and hospital admission for nonpsychiatric conditions has been postulated, although the data have been limited to specific clinical populations and the interpretation of the results hampered by the retrospective study design and the use of self-reported outcomes.^1–8 Consequently, these findings cannot be easily generalized or used to develop data-driven interventions.We addressed this gap in the literature by using a community-based population survey with prospective data linkage to measure important health-related outcomes. Our main objective was to investigate whether community-dwelling older men with depressive symptoms were more likely than nondepressed men to be admitted to general hospitals. Our other aims were to determine whether the long-term clinical outcomes of these 2 groups differed in relation to the number of future hospital admissions, length of hospital stay and inpatient deaths.     

Common Buzzards wintering strategies as an effect of weather conditions and geographic barriers

AimMigration is a constantly changing adaptation due to the climate condition evolution. The struggle for surviving during harsh winter season is different across Europe, being more complex toward the inner parts of the continent. The current approach explores the Common Buzzard number variation during the cold season and the climatic predictors of birds of prey wintering movements in relation to the possible influences of the Carpathian Mountains, which may act as a geographical barrier providing shelter from cold air outbreak from north and northeast of the continent.LocationRomania (45°N25°E).TaxonBirds of Prey.MethodsWe applied a GLMM to investigate the relation between continental and local climatic factors with the number of Common Buzzard observations in two regions. The first region is located inside the Carpathian Arch and the other one outside, east of this large mountains chain.ResultsThe Common Buzzard numbers wintering Eastern from the Carpathian Mountains are highly influenced by AO (Z = 2.87, p < .05%), while those wintering western are influenced by NAO (Z = 2.17, p < .05%). This is the first proof of separating influences for biodiversity of AO and NAO at continental scale, outlining the influence limit placed over the Eastern Carpathian Mountains.Main conclusionsThe Carpathian Mountains act like a geographic barrier, separating the wintering Common Buzzard populations from both sides of the mountain range. While the high number of individuals in Moldova is related to their eastern and northeastern Europe origins, in Transylvania the large number of individuals observed is related to the more sheltered characteristics of the region attracting individuals from central Europe. Also, since Transylvania region is well sheltered during cold air outbreak, it represents a more favorable region for wintering. From this point of view, we can consider that the Carpathian Mountains are a geographic barrier for wintering birds of prey.     

Decisional procalcitonin thresholds are not adapted toelderly patients admitted to the emergency room

Context: Diagnosis of sepsis in elderly is challenging.

Objectives: We investigated whether procalcitonin concentrations in elderly differed from values for the general population.

Methods: Procalcitonin measurement was assessed prospectively in 307 apyretic patients ≥75 years visiting the emergency department.

Results: Median age was 86 years [IQR81–90] and 222 (72%) were female. Procalcitonin concentration was 0.057 µg/L [0.040–0.092]; 99th percentile was 0.661 µg/L. Patients with procalcitonin concentrations above decisional thresholds had lower glomerular filtration rate and higher C-reactive protein concentrations. Conclusions: Baseline procalcitonin levels are increased in elderly. Elevated values are common and associated to low-grade inflammation and lower eGFR.