Psoriasis and the Risk of Pneumonia: A Population-Based Study

Background

Psoriasis is a prevalent autoimmune disorder. Various studies have reported on the relationship between psoriasis and chronic diseases but very few have explored the association between psoriasis and subsequent acute infection. This retrospective cohort study aimed to compare the risk of pneumonia between subjects with and those without psoriasis.

Methods

The medical records of 14,022 patients with psoriasis and 14,022 without psoriasis were obtained from the Taiwan Longitudinal Health Insurance Database 2000. Each patient was followed-up for a three-year period. Cox proportional hazard regressions were performed to compare difference of subsequent pneumonia incidence between subjects with and those without psoriasis.

Results

There were 206 (1.47%) subjects with psoriasis and 138 (0.98%) without psoriasis hospitalized for pneumonia. By Cox proportional hazard regressions analysis, the HR (hazard ratio) of pneumonia requiring hospitalization for patients with psoriasis was 1.50 (95% confidence interval [CI]: 1.21–1.86) compared to patients without psoriasis. The adjusted HR was 1.40 (95% CI: 1.12–1.73). The adjusted HR of pneumonia hospitalization for subjects with mild and severe psoriasis was 1.36 (95% CI: 1.09–1.70) and 1.68 (95% CI: 1.12–2.52), respectively, compared to those without psoriasis.

Conclusions

Patients with psoriasis have significantly higher incidence of pneumonia compared to those without psoriasis.     

Predictors and Outcomes of Infection-Related Hospital Admissions of Heart Failure Patients

Background

Infections are one of the most common causes for hospitalization of patients with heart failure (HF). Yet, little is known regarding the prevalence and predictors of different types of acute infections as well as their impact on outcome among this growing population.

Methods and Results

We identified all patients aged 50 or older with a major diagnosis of HF and at least one echocardiography examination who had been hospitalized over a 10-year period (January 2000 and December 2009). Infection-associated admissions were identified according to discharge diagnoses. Among 9,335 HF patients, 3530 (38%) were hospitalized at least once due to infections. The most frequent diagnoses were respiratory infection (52.6%) and sepsis/bacteremia (23.6%) followed by urinary (15.7%) and skin and soft tissue infections (7.8%). Hospitalizations due to infections compared to other indications were associated with increased 30-day mortality (13% vs. 8%, p<0.0001). These higher mortality rates were predominately related to respiratory infections (OR 1.28 [95% CI 1.09, 1.5]) and sepsis\bacteremia (OR 3.13 [95% CI 2.6, 3.7]). Important predictors for these serious infections included female gender, chronic obstructive pulmonary disease, past myocardial infarction and echocardiography-defined significant right (RV) but not left ventricular dysfunction.

Conclusions

Major infection-related hospitalizations are frequent among patients with HF and are associated with increased mortality rates. Elderly female patients with multiple comorbidities and those with severe RV dysfunction are at higher risk for these infections.     

Implementation of first Croatian Law on Protection of Persons with Mental Disorders

The aim of this article was to examine Croatian psychiatric practice regarding involuntary hospitalization, after the Law on Protection of Persons with Mental Disorders became effective, on January 1, 1998. Data on the practice of involuntary hospitalizations of patients with mental disorders in Vrapce Psychiatric Hospital were collected from the medical records, for the years 1998 and 1999. Data regarding involuntary hospitalizations from other Croatian hospitals and departments were obtained from heads of psychiatric hospitals and departments for the first five months of 1998. The rate of involuntarily hospitalized patients in Vrapce Psychiatric Hospital rose significantly from 1998 to 1999 (p < 0.01). The rate of patients involuntarily hospitalized under section 21, subsection 3 rose significantly from 1998 to 1999 (p < 0.01), while rate of patients involuntarily hospitalized under section 22, subsection 1 decreased significantly in the same period (p < 0.01) in Vrapce Psychiatric Hospital. The implementation of the Law on protection of persons with mental disorders was not applied uniformly in all Croatian psychiatric institutions during first five months of 1998. Further analyses on this subject are necessary in order to investigate the influence of changes and supplements to the Law on the protection of persons with mental disorders on the practice of involuntary hospitalizations.     

Readmissions after Hospitalization for Heart Failure,Acute Myocardial Infarction,or Pneumonia among Young and Middle-Aged Adults: A Retrospective Observational Cohort Study

Background

Patients aged ≥65 years are vulnerable to readmissions due to a transient period of generalized risk after hospitalization. However, whether young and middle-aged adults share a similar risk pattern is uncertain. We compared the rate, timing, and readmission diagnoses following hospitalization for heart failure (HF), acute myocardial infarction (AMI), and pneumonia among patients aged 18–64 years with patients aged ≥65 years.

Methods and Findings

We used an all-payer administrative dataset from California consisting of all hospitalizations for HF (n = 206,141), AMI (n = 107,256), and pneumonia (n = 199,620) from 2007–2009. The primary outcomes were unplanned 30-day readmission rate, timing of readmission, and readmission diagnoses. Our findings show that the readmission rate among patients aged 18–64 years exceeded the readmission rate in patients aged ≥65 years in the HF cohort (23.4% vs. 22.0%, p<0.001), but was lower in the AMI (11.2% vs. 17.5%, p<0.001) and pneumonia (14.4% vs. 17.3%, p<0.001) cohorts. When adjusted for sex, race, comorbidities, and payer status, the 30-day readmission risk in patients aged 18–64 years was similar to patients ≥65 years in the HF (HR 0.99; 95%CI 0.97–1.02) and pneumonia (HR 0.97; 95%CI 0.94–1.01) cohorts and was marginally lower in the AMI cohort (HR 0.92; 95%CI 0.87–0.96). For all cohorts, the timing of readmission was similar; readmission risks were highest between days 2 and 5 and declined thereafter across all age groups. Diagnoses other than the index admission diagnosis accounted for a substantial proportion of readmissions among age groups <65 years; a non-cardiac diagnosis represented 39–44% of readmissions in the HF cohort and 37–45% of readmissions in the AMI cohort, while a non-pulmonary diagnosis represented 61–64% of patients in the pneumonia cohort.

Conclusion

When adjusted for differences in patient characteristics, young and middle-aged adults have 30-day readmission rates that are similar to elderly patients for HF, AMI, and pneumonia. A generalized risk after hospitalization is present regardless of age. Please see later in the article for the Editors'' Summary     

Prevalence of Mycoplasma pneumoniae and Chlamydia pneumoniae in pneumonia patients in four major hospitals in Trinidad

The prevalence of current Mycoplasma pneumoniae and Chlamydia pneumoniae infections in patients with pneumonia in Trinidad, and the relationship between pneumonia and risk factors were investigated. Blood samples were collected from 132 patients diagnosed by attending physicians, as suffering from pneumonia at four hospitals in Trinidad. Serum samples were tested for M. pneumoniae IgM and IgG and C. pneumoniae IgM by the enzyme immunoassay (EIA). In addition, C. pneumoniae IgM and IgG were detected using microimmunofluorescence (MIF). A comprehensive questionnaire which addressed demographic information as well as risk factors for pneumonia was administered to patients. All analyses were done using the Statistical Package for Social Sciences (SPSS), version 9. Seroprevalences of 46.0% (58 of 126) were found for C. pneumoniae Ig M/G, and 66.7% (88 of 132) for M. pneumoniae Ig M/G. The difference was statistically significant (p < 0.01; chi2). Thirty-four percent (43 of 125) for C. pneumoniae Ig M/acute Ig G and 28.8% (36 of 125) of M. pneumoniae IgM were not statistically significant (p > 0.05; chi2). Hospital, gender and ethnicity of patients did not significantly (p > 0.05; chi2) affect the seroprevalence of the bacteria assayed for. However, the prevalence of C. pneumoniae (23.3%) in patients under 21 years old compared to other age groups was statistically significant (p = 0.043; chi2). Overall, the seroprevalence to both pathogens was not significantly (p > 0.05; chi2) affected by comorbidities and signs/symptoms. It was concluded that new infections by C. pneumoniae in pneumonia patients may be an important aetiological agent for the condition in Trinidad.     

A comparison of olanzapine and risperidone on the risk of psychiatric hospitalization in the naturalistic treatment of patients with schizophrenia

BACKGROUND: Decreasing hospital admissions is important for improving outcomes for people with schizophrenia and for reducing cost of hospitalization, the largest expenditure in treating this persistent and severe mental illness. This prospective observational study compared olanzapine and risperidone on one-year psychiatric hospitalization rate, duration, and time to hospitalization in the treatment of patients with schizophrenia in usual care. METHODS: We examined data of patients newly initiated on olanzapine (N = 159) or risperidone (N = 112) who continued on the index antipsychotic for at least one year following initiation. Patients were participants in a 3-year prospective, observational study of schizophrenia patients in the US. Outcome measures were percent of hospitalized patients, total days hospitalized per patient, and time to first hospitalization during the one-year post initiation. Analyses employed a generalized linear model with adjustments for demographic and clinical variables. A two-part model was used to confirm the findings. Time to hospitalization was measured by the Kaplan-Meier survival formula. RESULTS: Compared to risperidone, olanzapine-treated patients had significantly lower hospitalization rates, (24.1% vs. 14.4%, respectively, p = 0.040) and significantly fewer hospitalization days (14.5 days vs. 9.9 days, respectively, p = 0.035). The mean difference of 4.6 days translated to $2,502 in annual psychiatric hospitalization cost savings per olanzapine-treated patient, on average. CONCLUSIONS: Consistent with prior clinical trial research, treatment-adherent schizophrenia patients who were treated in usual care with olanzapine had a lower risk of psychiatric hospitalization than risperidone-treated patients. Lower hospitalization costs appear to more than offset the higher medication acquisition cost of olanzapine.     

An administrative claims model for profiling hospital 30-day mortality rates for pneumonia patients

Background

Outcome measures for patients hospitalized with pneumonia may complement process measures in characterizing quality of care. We sought to develop and validate a hierarchical regression model using Medicare claims data that produces hospital-level, risk-standardized 30-day mortality rates useful for public reporting for patients hospitalized with pneumonia.

Methodology/Principal Findings

Retrospective study of fee-for-service Medicare beneficiaries age 66 years and older with a principal discharge diagnosis of pneumonia. Candidate risk-adjustment variables included patient demographics, administrative diagnosis codes from the index hospitalization, and all inpatient and outpatient encounters from the year before admission. The model derivation cohort included 224,608 pneumonia cases admitted to 4,664 hospitals in 2000, and validation cohorts included cases from each of years 1998–2003. We compared model-derived state-level standardized mortality estimates with medical record-derived state-level standardized mortality estimates using data from the Medicare National Pneumonia Project on 50,858 patients hospitalized from 1998–2001. The final model included 31 variables and had an area under the Receiver Operating Characteristic curve of 0.72. In each administrative claims validation cohort, model fit was similar to the derivation cohort. The distribution of standardized mortality rates among hospitals ranged from 13.0% to 23.7%, with 25^th, 50^th, and 75^th percentiles of 16.5%, 17.4%, and 18.3%, respectively. Comparing model-derived risk-standardized state mortality rates with medical record-derived estimates, the correlation coefficient was 0.86 (Standard Error = 0.032).

Conclusions/Significance

An administrative claims-based model for profiling hospitals for pneumonia mortality performs consistently over several years and produces hospital estimates close to those using a medical record model.     

Incidence and Predictors of Hospitalization for Bacterial Infection in Community-Based Patients with Type 2 Diabetes: The Fremantle Diabetes Study

Background

The few studies that have examined the relationship between diabetes and bacterial infections have utilized administrative databases and/or have had limited/incomplete data including recognized infection risk factors. The aim of this study was to determine the incidence and associates of bacterial infection severe enough to require hospitalization in well-characterized community-based patients with type 2 diabetes.

Methods and Findings

We studied a cohort of 1,294 patients (mean±SD age 64.1±11.3 years) from the longitudinal observational Fremantle Diabetes Study Phase I (FDS1) and 5,156 age-, gender- and zip-code-matched non-diabetic controls. The main outcome measure was incident hospitalization for bacterial infection as principal diagnosis between 1993 and 2010. We also examined differences in statin use in 52 FDS1 pairs hospitalized with pneumonia (cases) or a contemporaneous non-infection-related cause (controls). During 12.0±5.4 years of follow-up, 251 (19.4%) patients were hospitalized on 368 occasions for infection (23.7/1,000 patient-years). This was more than double the rate in matched controls (incident rate ratio (IRR) (95% CI), 2.13 (1.88–2.42), P<0.001). IRRs for pneumonia, cellulitis, and septicemia/bacteremia were 1.86 (1.55–2.21), 2.45 (1.92–3.12), and 2.08 (1.41–3.04), respectively (P<0.001). Among the diabetic patients, older age, male sex, prior recent infection-related hospitalization, obesity, albuminuria, retinopathy and Aboriginal ethnicity were baseline variables independently associated with risk of first hospitalization with any infection (P≤0.005). After adjustment for these variables, baseline statin treatment was not significant (hazard ratio (95% CI), 0.70 (0.39–1.25), P = 0.22). Statin use at hospitalization for pneumonia among the case-control pairs was similar (23.1% vs. 13.5%, P = 0.27).

Conclusions

The risk of severe infection is increased among type 2 diabetic patients and is not reduced by statin therapy. There are a number of other easily-accessible sociodemographic and clinical variables that could be used to optimize infection-related education, prevention and management in type 2 diabetes.     

Valor pronóstico del diagnóstico principal en ancianos ingresados en una unidad geriátrica de agudos al alta y al año

ObjectiveTo analyse the relationship between the primary diagnosis on admission to an Acute Geriatric Unit (AGU) and the risk of hospital mortality and one year after dischargeMaterial and methodsA longitudinal study was conducted on patients admitted to the Central Hospital AGU Red Cross in Madrid in 2009. The admission diagnosis was grouped by Diagnosis Related Groups (DRGs). The date of death was collected from the medical charts and the National Death Index Ministry of Health report. The main outcome of study was the association between diagnoses on admission and functional impairment at discharge (measured as a loss of 10 or more points between the Barthel Index at discharge and that on admission), mortality during hospitalization, at 3 months and one year after discharge. The multivariate analysis was adjusted for age, sex, comorbidity, functional and cognitive status, and serum albumin.ResultsThe study included1147 patients, with a mean age of 86.7 years (SD ± 6.7), and 66% were women. During admission, 10.1% of patients died and 36.6% had functional impairment at discharge. After discharge, 25.5% died at 3 months, and 42.2% at one year. The distribution of the primary diagnoses at admission (between parentheses hospital mortality and at year) were heart failure, 21.4% (8.1% and 37.4%), pneumonia,13.3% (12.3% and 46.4%), and aspiration pneumonia, 4.7% (27.5%, y 71%), respiratory diseases,13.3% (6.6% and 38.2%), urinary infection,10.2% (5.1% and 42.7%), and stroke (excluding AIT), 9.9% (13.3% and 46.9%). In the multivariate analysis, only admissions due to aspiration pneumonia were independently associated with increased risk of hospital mortality (odds ratio, 2.23; 95% CI = 1.13 to 44.42), and stroke with increased risk of functional impairment at discharge (odds ratio, 6.01; 95% CI = 3.42-10.57). No diagnosis was independently associated with increased risk of death at 3 months and at yearConclusionsAdmission from aspiration pneumonia carries an increased risk of death in elderly patients hospitalised for acute medical conditions. After discharge, the risk of death must be attributed to factors other than the admission diagnosis     

Cardiac Complications Associated with Short-Term Mortality in Schizophrenia Patients Hospitalized for Pneumonia: A Nationwide Case-Control Study

Background

Pneumonia is one of most prevalent infectious diseases worldwide and is associated with considerable mortality. In comparison to general population, schizophrenia patients hospitalized for pneumonia have poorer outcomes. We explored the risk factors of short-term mortality in this population because the information is lacking in the literature.

Methods

In a nationwide schizophrenia cohort, derived from the National Health Insurance Research Database in Taiwan, that was hospitalized for pneumonia between 2000 and 2008 (n = 1,741), we identified 141 subjects who died during their hospitalizations or shortly after their discharges. Based on risk-set sampling in a 1∶4 ratio, 468 matched controls were selected from the study cohort (i.e., schizophrenia cohort with pneumonia). Physical illnesses were categorized as pre-existing and incident illnesses that developed after pneumonia respectively. Exposures to medications were categorized by type, duration, and defined daily dose. We used stepwise conditional logistic regression to explore the risk factors for short-term mortality.

Results

Pre-existing arrhythmia was associated with short-term mortality (adjusted risk ratio [RR] = 4.99, p<0.01). Several variables during hospitalization were associated with increased mortality risk, including incident arrhythmia (RR = 7.44, p<0.01), incident heart failure (RR = 5.49, p = 0.0183) and the use of hypoglycemic drugs (RR = 2.32, p<0.01). Furthermore, individual antipsychotic drugs (such as clozapine) known to induce pneumonia were not significantly associated with the risk.

Conclusions

Incident cardiac complications following pneumonia are associated with increased short-term mortality. These findings have broad implications for clinical intervention and future studies are needed to clarify the mechanisms of the risk factors.     

Efficacy of intravenous immunoglobulin on the prevention of pneumonia in patients with agammaglobulinemia

Agammaglobulinemia is characterized by failure of B-cell differentiation (hypogammaglobulinemia) and increased susceptibility to bacterial infections. The present study was set up in order to evaluate the effectiveness of intravenous immunoglobulin (IVIG) treatment on the incidence of pneumonia in patients with agammaglobulinemia. We carried out chart reviews of 23 patients with agammaglobulinemia (mean age 11.5+/-5.4 years), who had been observed in a 22-year period (July 1981-January 2003) in Iran's referral center for primary immunodeficiency disorders. Nineteen of these 23 (82.5%) had been infected with pneumonia at least once before receiving the immunoglobulin treatment and 11 of them had experienced multiple episodes. During treatment with gamma-globulin - over a mean period of 6.8+/-4.1 years (range: 0.8-15.3 years) - the incidence of pneumonia requiring treatment or hospitalization decreased from 0.82 to 0.12 per patient per year (P=0.006). During IVIG replacement, hospitalization due to pneumonia decreased from 0.58 to 0.05 per patient per year (P=0.08) and the immunoglobulin G level (mean+/-S.D.) changed from 66.2+/-63.9 (range: 0-210 mg dl(-1)) to 552.4+/-199.1 (range: 136-942 mg dl(-1)) (P<0.001). Treatment of agammaglobulinemia with IVIG significantly reduced the incidence of pneumonia and hospital admission. Intensive management and regular monitoring is required in order to fully prevent severe respiratory complications.     

Sociodemographic factors and clinical conditions associated to hospitalization in influenza A (H1N1) 2009 virus infected patients in Spain, 2009-2010

The emergence and pandemic spread of a new strain of influenza A (H1N1) virus in 2009 resulted in a serious alarm in clinical and public health services all over the world. One distinguishing feature of this new influenza pandemic was the different profile of hospitalized patients compared to those from traditional seasonal influenza infections. Our goal was to analyze sociodemographic and clinical factors associated to hospitalization following infection by influenza A(H1N1) virus. We report the results of a Spanish nationwide study with laboratory confirmed infection by the new pandemic virus in a case-control design based on hospitalized patients. The main risk factors for hospitalization of influenza A (H1N1) 2009 were determined to be obesity (BMI≥40, with an odds-ratio [OR] 14.27), hematological neoplasia (OR 10.71), chronic heart disease, COPD (OR 5.16) and neurological disease, among the clinical conditions, whereas low education level and some ethnic backgrounds (Gypsies and Amerinds) were the sociodemographic variables found associated to hospitalization. The presence of any clinical condition of moderate risk almost triples the risk of hospitalization (OR 2.88) and high risk conditions raise this value markedly (OR 6.43). The risk of hospitalization increased proportionally when for two (OR 2.08) or for three or more (OR 4.86) risk factors were simultaneously present in the same patient. These findings should be considered when a new influenza virus appears in the human population.     

Recurrent psychiatric hospitalization.

Undue emphasis has been placed on rising rates of readmission to psychiatric facilities. After a decade of preoccupation with discharge rates, readmission statistics have been singled out in the last 15 years as the key factor for assessing hospital effectiveness. A study of a group of patients at high risk for recurrent hospitalization revealed that these patients were characterized more by features relating to environmental supports than by diagnosis. The operational definition for recurrent hospitalization (five or more admissions during the 2-year period preceding the latest admission) was effective in identifying this group; this is the first reported instance in which the definition has specified a certain number of admissions within a time-limited period. The findings of this study, as well as of an analysis of case histories and consumer opinion, led to the design of a pilot program for persons undergoing recurrent hospitalization. Readmission statistics are useless or misleading as measures of hospital effectiveness and efficiency; what matters is the way the former patients function in the community after discharge. Rather than simply trying to reduce the readmission rate psychiatric facilities should be examining the types of persons who are hospitalized recurrently to develop programs aimed at improving the functioning of these people in the community.     

Epidemiological characteristics and disease burden of infectious mononucleosis in hospitalized children in China: A nationwide retrospective study

Epstein-Barr virus (EBV) is very common, with the infection rate in adults over 90% worldwide. Infectious mononucleosis (IM) is caused by primary infection with EBV. Most IM patients are generally considered to have a favorable prognosis, but a few patients will also develop complications. Children with severe symptoms will require hospitalization. However, the disease burden of children hospitalized with IM in China has been rarely described. In this study, we included the Face sheets of discharge medical records from 27 member children's hospitals of Futang Research Center of Pediatric Development from Jan 1st, 2016 to Dec 31st, 2020, and medical information such as gender, age, region, time of admission, length of stay and expenditure were extracted. There were 24,120 IM cases, which accounted for 0.42% (24,120/5,693,262) of all hospitalized cases during this period. The ratio of male to female was 1.48:1. Hospitalization for IM in the 4–6 years age group was the highest among inpatients of all age groups. Case numbers increased year by year between 2016 and 2020, and the monthly hospitalization was generally high from Jul to Sep but reduced from Jan to Feb per year. Bronchitis/pneumonia and hepatic dysfunction were two common complications in hospitalized IM patients. The median length of stay was 8 days, and the median cost of hospitalization was 970.59 US dollars. This study will help understand the epidemiological characteristics and disease burden of hospitalized children with IM in China.     

北京地区住院患儿WU多瘤病毒感染的流行病学研究

自2007年Gaynor A M等人通过高通量测序在肺炎患儿呼吸道样本中发现了WU多瘤病毒(Washington University polyomavirus,WUPyV)以来,WUPyV在世界各地被广泛检出。为了解北京地区急性呼吸道感染住院儿童中WUPyV感染情况及其临床特征,收集北京地区2017年4月至2018年3月共1 276份呼吸道感染住院患儿的鼻咽抽吸物样本,使用real time PCR方法对样本进行WUPyV检测,同时对WUPyV阳性样本进行17种常见呼吸道病毒筛查。共检出WUPyV阳性样本76份(5.96%,76/1 276),4岁以下儿童居多(92.11%,70/76);WUPyV感染全年可见,无显著季节性;多伴随其他呼吸道病毒混合感染(60.53%,46/76),最常见混合感染为鼻病毒和A型流感病毒;WUPyV单一感染者与混合感染者病毒载量无显著性差异,临床诊断和表现基本一致;WUPyV感染患儿的常见诊断为支气管炎(68.42%,52/76)和肺炎(30.26%,23/76);临床症状主要表现为高热、咳嗽、咳痰。研究结果提示WUPyV是北京地区急性呼吸道感染住院患儿呼吸道样本中常见病毒之一,多见于4岁以下儿童。     

Gestational exposure to cigarette smoke imperils the long-term physical and mental health of offspring

BACKGROUND: In this study, we sought to understand whether prenatal exposure to cigarette smoke would be associated with increased offspring hospitalization through age 22 years for various physical and mental health diagnoses. METHODS: We used multivariate logistic regression to investigate the relationship between gestational exposure to cigarette smoke and offspring hospitalization for physical and mental health conditions based on International Classification of Diseases (ICD; World Health Organization) diagnoses. RESULTS: When controlling for parental psychiatric status, maternal somatic health, socioeconomic status, parity, and maternal age, youth born to mothers who smoked six or more cigarettes per day were more likely to have experienced hospitalization for neuroses (OR, 1.97), diseases of the nervous system (i.e., neurological disorders) (OR, 1.47), respiratory infections (OR, 1.28), accidents (OR, 1.44), infections (OR, 1.54), undiagnosed symptoms (OR, 1.65), and total admissions (OR, 1.48). Female offspring prenatally exposed were more likely to have experienced hospitalization for obstetric complications (OR, 2.94). No association was found for the remaining categories analyzed: blood disorders, skin diseases, psychoses, metabolic/endocrine disease, circulatory disease, digestive disease, disease of the skeletal/muscular system, physical anomalies, neoplasms, and genital/urinary disease. CONCLUSIONS: This is the first study to investigate the impact of gestational exposure to cigarette smoke on global measures of somatic and physical health in offspring. This study adds to the literature by demonstrating that smoking during pregnancy increases offspring risk for additional health outcomes not previously recognized in the literature, and that the effect of smoking during pregnancy persists throughout the developmental period. The possibility that these findings are related to lifestyle markers or smoke exposure during childhood should also be considered.     

Fungal Infections in COVID-19 Intensive Care Patients

Opportunistic fungal infections increase morbidity and mortality in COVID-19 patients monitored in intensive care units (ICU). As patients’ hospitalization days in the ICU and intubation period increase, opportunistic infections also increase, which prolongs hospital stay days and elevates costs. The study aimed to describe the profile of fungal infections and identify the risk factors associated with mortality in COVID-19 intensive care patients. The records of 627 patients hospitalized in ICU with the diagnosis of COVID-19 were investigated from electronic health records and hospitalization files. The demographic characteristics (age, gender), the number of ICU hospitalization days and mortality rates, APACHE II scores, accompanying diseases, antibiotic-steroid treatments taken during hospitalization, and microbiological results (blood, urine, tracheal aspirate samples) of the patients were recorded. Opportunistic fungal infection was detected in 32 patients (5.10%) of 627 patients monitored in ICU with a COVID-19 diagnosis. The average APACHE II score of the patients was 28 ± 6. While 25 of the patients (78.12%) died, seven (21.87%) were discharged from the ICU. Candida parapsilosis (43.7%) was the opportunistic fungal agent isolated from most blood samples taken from COVID-19 positive patients. The mortality rate of COVID-19 positive patients with candidemia was 80%. While two out of the three patients (66.6%) for whom fungi were grown from their tracheal aspirate died, one patient (33.3%) was transferred to the ward. Opportunistic fungal infections increase the mortality rate of COVID-19-positive patients. In addition to the risk factors that we cannot change, invasive procedures should be avoided, constant blood sugar regulation should be applied, and unnecessary antibiotics use should be avoided.     

Congenital Cataract: Prevalence and Surgery Age at Zhongshan Ophthalmic Center (ZOC)

Congenital cataract (CC) is the primary cause of treatable childhood blindness. Population-based assessments of prevalence and surgery age of CC, which are critical for improving management strategies, have been unavailable in China until now. We conducted a hospital-based, cross-sectional study of the hospital charts of CC patients younger than 18 years old from January 2005 to December 2010 at Zhongshan Ophthalmic Center (ZOC) in Guangzhou, China. Residence, gender, age at surgery, hospitalization time, and the presence of other ocular abnormalities were extracted and statistically analyzed in different subgroups. The search identified 1314 patients diagnosed with CC from a total of 136154 hospitalizations, which accounted for 2.39% of all the cataract in-patients and 1.06% of the total in-patients over the six-year study period. Of the identified CC patients, 9.2% had ≥2 hospitalizations due to the necessity of additional surgeries, with a total ratio of boys to girls of 1.75∶1. Based on a subgroup analysis according to age, patients 2–6 years old constituted the highest proportion (29.22%) of all hospitalized CC patients, and those 13–18 years old constituted the lowest proportion (13.47%) of the total number. The average age at surgery was 27.62±23.36 months, but CC patients ≤6 years old (especially ≤6 months old) became increasingly prevalent throughout the 6-year study period. A total of 276 cases (20.93%) of CC were associated with one or more other ocular abnormalities, the highest incidence rates were observed for exotropia (6.24%), nystagmus (6.16%), and refractive error (3.65%). In conclusion, CC patients accounted for 2.39% of all cataract in-patients in a review of 6 years of hospitalization charts from ZOC. The age at the time of surgery decreased over the 6-year study period, which probably reflects the continuing improvement of public awareness of children’s eye care in China.