Context The neurologic manifestations, laboratory findings, and outcome of patients with West Nile virus (WNV) infection have not been prospectively characterized. Objective To describe prospectively the clinical and laboratory features and longterm outcome of patients with neurologic manifestations of WNV infection. Design, Setting, and Participants From August 1 to September 2, 2002, a community-based, prospective case series was conducted in St Tammany Parish, La. Standardized clinical data were collected on patients with suspected WNV infection. Confirmed WNV-seropositive patients were reassessed at 8 months. Main Outcome Measures Clinical, neurologic, and laboratory features at initial presentation, and long-term neurologic outcome. Results Sixteen (37%) of 39 suspected cases had antibodies against WNV; 5 had meningitis, 8 had encephalitis, and 3 had poliomyelitis-like acute flaccid paralysis. Movement disorders, including tremor (15 [94%]), myoclonus (5 [31%]), and parkinsonism (11 [69%]), were common among WNV-seropositive patients. One patient died. At 8-month followup, fatigue, headache, and myalgias were persistent symptoms; gait and movement disorders persisted in 6 patients. Patients with WNV meningitis or encephalitis had favorable outcomes, although patients with acute flaccid paralysis did not recover limb strength. Conclusions Movement disorders, including tremor, myoclonus, and parkinsonism, may be present during acute illness with WNV infection. Some patients with WNV infection and meningitis or encephalitis ultimately may have good long-term outcome, although an irreversible poliomyelitis-like syndrome may result.

and Utah. Portions of the population in Colorado (49%), Minnesota (55%), New Mexico (61%), and Utah (35%) and the whole population of Maryland are included as part of the COVID-19-Associated Hospitalization Surveillance Network (COVID-NET). https://www.cdc.gov/coronavirus/2019-ncov/covid-data/ covid-net/purpose-methods.html † A COVID-19 case (confirmed or probable) was defined as the detection of SARS-CoV-2 RNA or antigen in a respiratory specimen collected from a person aged ≥18 years per the Council of State and Territorial Epidemiologists' update to the standardized surveillance case definition and national notification for 2019 novel coronavirus disease (COVID-19) (21-ID-01

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Background: Drug use-associated infective endocarditis (DUA-IE) is rising during the opioid epidemic. Infective endocarditis (IE) can require valve surgery, but surgical treatment of DUA-IE has invoked controversy and the extent of its use is unknown. Objective: To examine hospitalization trends for DUA-IE, the proportion with surgery, patient characteristics, length of stay and charges. Design: Ten-year analysis of a statewide hospital discharge database. Setting: North Carolina hospitals, 2007–2017. Patients: All patients hospitalized for IE aged ≥ 18 years. Measurements: Annual trends in all IE hospitalizations and those with valve surgery, stratified by patients’ drug use. Characteristics of DUA-IE surgical hospitalizations including demographics, length of stay, disposition and charges. Results: Of 22,825 IE hospitalizations, 2,602 (11%) were for DUA-IE. Valve surgery was performed in 1,655 (7%) IE hospitalizations, including 285 (17%) for DUA-IE. Annual DUA-IE hospitalizations increased from 0.92 to 10.95 per 100,000, and DUA-IE hospitalizations with surgery rose from 0.10 per 100,000 to 1.38 per 100,000. In the final year, surgeries for DUA-IE comprised 42% of IE valve surgeries. Compared to other IE surgical patients, DUA-IE patients were younger (median age 33 vs. 56), more commonly female (47% vs. 33%) and White (89% vs. 63%), and primarily insured by Medicaid (38%) or uninsured (35%). Hospital stays for DUA-IE were longer (median 27 vs. 17 days) with higher median charges ($250,994 vs. $198,764). Charges for 282 DUA-IE hospitalizations exceeded $78,000,000. Limitations: Reliance on administrative data and billing codes. Conclusions: DUA-IE hospitalizations and valve surgeries increased over twelve-fold and DUA-IE approached half of all IE valve surgeries. The swell of DUA-IE patients is reshaping the scope, type, and financing of healthcare resources needed for effective IE treatment.

Animal and in vitro studies provide evidence of an anticarcinogenic effect of active ingredients in garlic. This review of the epidemiologic literature on garlic consumption addresses cancers of the stomach, colon, head and neck, lung, breast and prostate. Nineteen studies reported relative risk estimates for garlic consumption and cancer incidence. Site-specific case-control studies of stomach and colorectal cancer, in which multiple reports were available, suggest a protective effect of high intake of raw and/or cooked garlic. Cohort studies confirm this inverse association for colorectal cancer. Few cohort and case-control studies for other sites of cancer exist. Garlic supplements, as analyzed in four cohort studies and one case-control report, from two distinct populations, do not appear to be related to risk. Low study power, lack of variability in garlic consumption categorization within studies and poor adjustment for potential cofounders may limit the reliability of any conclusions regarding garlic supplements. However, an indication of publication bias was also found by visual inspection of a funnel plot and in a log-rank test (P = 0.004). Evidence from available studies nevertheless suggests a preventive effect of garlic consumption in stomach and colorectal cancers. The study limitations indicate the need for more definitive research and improved nutritional epidemiologic analyses of dietary data.