No abstract

Adults with sickle cell disease(SCD) are a growing population. Recent national estimates of outcomes in acute chest syndrome(ACS) among adults with SCD are lacking. We describe the incidence, outcomes and predictors of mortality in ACS in adults. We hypothesize that any need for mechanical ventilation is an independent predictor of mortality.MethodsWe performed a retrospective analysis of the Nationwide Inpatient Sample(2004–2010),the largest all payer inpatient database in United States, to estimate the incidence and outcomes of ACS needing mechanical ventilation(MV) and exchange transfusion(ET) in patients >21 years. The effects of MV and ET on outcomes including length of stay(LOS) and in-hospital mortality(IHM) were examined using multivariable linear and logistic regression models respectively. The effects of age, sex, race, type of sickle cell crisis, race, co-morbid burden, insurance status, type of admission, and hospital characteristics were adjusted in the regression models.ResultsOf the 24,699 hospitalizations, 4.6% needed MV(2.7% for <96 hours, 1.9% for ≥96 hours), 6% had ET, with a mean length of stay(LOS) of 7.8 days and an in-hospital mortality rate(IHM) of 1.6%. There was a gradual yearly increase in ACS hospitalizations that needed MV(2.6% in 2004 to 5.8% in 2010). Hb-SS disease was the phenotype in 84.3% of all hospitalizations. After adjusting for a multitude of patient and hospital related factors, patients who had MV for <96 hours(OR = 67.53,p<0.01) or those who had MV for ≥96 hours(OR = 8.73,p<0.01) were associated with a significantly higher odds for IHM when compared to their counterparts. Patients who had MV for ≥96 hours and those who had ET had a significantly longer LOS in-hospitals(p<0.001).ConclusionIn this large cohort of hospitalized adults with SCD patients with ACS, the need for mechanical ventilation predicted higher mortality rates and increased hospital resource utilization. Identification of risk factors may enable optimization of outcomes.

SCT indications and procedures are increasing worldwide. We sought to estimate the prevalence of acute respiratory failure (ARF) of any cause in hospitalized SCT patients, and assess the impact of invasive mechanical ventilation (IMV) on outcomes. We hypothesize that duration of IMV in such patients is an independent predictor of higher mortality. We performed a retrospective analysis of the largest all-payer hospitalization data set in the United States, Nationwide In-patient Sample for years [2004][2005][2006][2007][2008][2009][2010]. Of the 101 462 SCT hospitalizations, 6074 (6%) developed ARF and were the final cohort. Type of SCT with ARF included autologous 1987 (32.7%), allogeneic 3467 (57.1%) and cord blood 655 (10.8%). Duration of IMV included o96 h (17.1%) and ⩾ 96 h (41.1%). Overall in-hospital mortality (IHM) was 50.6% (3075). Predictors of IHM were IMV o96 h (odds ratio = 3.42 (2.44-4.79), P o0.0001) or IMV ⩾ 96 h (OR = 4.61 (3.17-6.70), P o 0.0001). Type of SCT, comorbid burden, gender, hospital-teaching status/bed size or insurance did not influence IHM. IMV ⩾ 96 h was associated with higher hospital charges (mean $762 515, 95% estimate 0.3991 (0.3123-0.4859), increase of $304 474, P o 0.0001) and higher length of stay (mean 61.5 days, 95% estimate 0.2198 (0.1531-0.2866), increase of 13 days, P o 0.0001). In conclusion, ARF in hospitalized SCT patients is not an uncommon occurrence and is associated with 50% mortality. Duration of IMV (⩾96 h) was an independent predictor of higher mortality rates. Hospital resource utilization was significant.

Objectives: Population-based analysis of incidence, comorbid conditions, microbiological characteristics, and outcomes of pyogenic liver abscess (PLA) in children. Methodology: Retrospective analysis of National Inpatient Sample (NIS) and Kids Inpatient database (KID) database from 2003 to 2014 and included patients between 1 and 20 years of age. Using ICD-9 codes, we identified all hospitalizations with PLA and compared them with 1 : 10 age- and gender-matched controls. Amebic liver abscess and Candida infections were excluded. Results: Total number of PLA admissions is 4075. The overall incidence of PLA is 13.5 per 100,000 hospitalizations, which increased by 60% between 2003 and 2014. The mean age of patients was 13.03 ± 6.1 years and were predominantly boys—61%. Of the comorbid conditions, hepatobiliary malignancy had the highest odds ratio (OR 71.8) followed by liver transplant (OR 38.4), biliary disease (OR 29.9), inflammatory bowel disease (IBD) (OR 5.35), other GI malignancies (OR 4.74), primary immune deficiency disorder (OR 4.13). Patients with PLA had 12 times increased odds of having associated severe sepsis. Infective endocarditis (IE) (OR 4.5), appendicitis (OR 1.8), and diverticulitis (OR 8.1) were significantly associated with PLA. Almost 39% (1575) of the PLA patients had positive culture, whereas Streptococcus (10.8%) and Staphylococcus spp (9.2%) were the most common pathogens. About 45% of PLA patients underwent percutaneous liver abscess aspiration whereas 4.1% had hepatic resection for PLA. The mortality rate of PLA was 0.8% (n = 32). Conclusions: The incidence of PLA is steadily increasing over the last decade among pediatric population in the United States. Hepatobiliary malignancy and liver transplant are the most common comorbid conditions associated with PLA.

SummaryObjectiveMorbid obesity is proinflammatory has been associated with adverse clinical outcomes in acute pancreatitis (AP) among adults. Obesity is increasingly prevalent in children and hence, we sought to evaluate the impact of morbid obesity on the clinical outcomes of AP using a large paediatric population‐based cohort.MethodsWe analysed the US Kids' Inpatient Database between years 2003 and 2016 to include all patients (age ≤ 21 years) with a primary diagnosis of AP using specific ICD‐9‐CM and ICD‐10‐CM codes. We compared clinical outcomes between children without obesity (controls) and those with morbid obesity (cases). The primary outcome was severe AP (2012 revised Atlanta classification) and secondary outcomes included healthcare resource utilization (length of stay and hospital costs).ResultsAmong 36 698 paediatric AP hospitalizations, 1275 (3.5%) were found to have morbid obesity. From 2003 to 2016, the proportion of children with morbid obesity among AP patients increased from 1.3% to 5.5% (P < .001). More than half (54%) of the children with morbid obesity were presented with cholelithiasis as contributive aetiology. The prevalence of severe AP was significantly higher in morbid obesity (7.3% vs 3.8%, P < .001). Multivariate analysis revealed that morbid obesity was increasingly associated with severe AP (OR 1.79, 95% CI 1.4, 2.26), prolonged hospitalization (by 0.41 days, P = .03), and higher hospital costs (by $1596, P < .001).ConclusionUnlike adult population, there is a lack of other confounding comorbidities in children and this national‐level analysis shows that morbid obesity independently prognosticates adverse clinical outcomes in paediatric AP.

The COVID-19 pandemic has created unprecedented human health crisis in recent global history with rippling social and economic effects. The outbreak in India has resulted in emergency lockdown in the country for more than 2 months, and that caused decline in the catch, demand, and supply of fish. It has severely altered the life and livelihoods of the floodplain wetland fishers. These floodplain wetlands play a key role in socio-economic development of stakeholders, by generating employment and livelihood in the studied regions. In the present study, a systematic assessment was conducted to identify the impact of lockdown on floodplain wetland fisheries in India with the aim to evaluate the impact of the COVID-19 lockdown on wetland fishing, fisheries production, income, and food access. We conducted a rapid telephonic survey covering176 wetland fishers in 3 states to document the early impacts of the pandemic and policy responses on floodplain wetland fisher households. The majority of fishers report negative impacts on production, sales, and incomes. Fishers of three Indian states Bihar, West Bengal, and Assam lost 20, 25, and 9 fishing days, respectively. About 70, 60, and 55 % fishers of floodplain wetlands of the three states admitted that lockdown made them partially jobless. Fish harvest during March to May was 32, 44, and 20 % lower than the previous years in Bihar, West Bengal, and Assam. The fishers of Bihar, West Bengal, and Assam lost income of INR 10000/-, 12500/-, and 4500/- due to lockdown. The analysis also showed that 25% of fishers each responded moderate to severe psychological impact and anxiety symptoms due to COVID-19. Demand supply gap during the lockdown led to the in 20–40 % increase in farm gate price of fishes at the wetland level. The present study is the first of its kind in India to systematically assess the impact and discusses several magnitudes on floodplain wetland fisher livelihood, income, and food access and suggests strategies and decision support.

No abstract

Follicle-stimulating hormone (FSH) is a pituitary glycoprotein hormone that is comprised of two dissimilar subunits, alpha and beta, encoded by separate genes. We have isolated the gene encoding the beta-subunit of rat FSH by screening a rat genomic DNA-library by filter hybridization with bovine FSH-beta cDNA. Southern blot analysis of rat genomic DNA suggests that there is a single copy of the FSH-beta gene per haploid genome in the rat. The nucleotide sequence of the rat FSH-beta gene was determined and the amino acid sequence of the subunit was deduced. The gene is composed of three exons and two introns. The predicted amino acid sequence reveals that there is a 20-amino-acid signal peptide followed by a mature protein of 110 amino acid residues. Exons I, II, and III are 36, 187, and 1221 bp, respectively. Intron 1 (640 bp) interrupts the 5'-untranslated (UT) region (61 bp) and intron 2 (approximately 1 kb) interrupts the coding region between amino acid residues +34 and +35. Comparison of the amino acid sequence to those of the human and bovine FSH-beta subunits reveals 80% similarity to both species. The "CAGY" sequence, or the Cys-Ala-Gly-Tyr quartet of amino acids encoded by exon II is present in every other glycoprotein beta-subunit sequenced thus far, is altered in rat FSH-beta, with the Ala residue replaced by Glu. Primer extension analysis demonstrated that there is a single transcriptional start site. The nucleotide sequence of the 5'-flanking region (1 kb) was determined and compared to the nucleotide sequences of corresponding regions in the bovine and human genes. This analysis revealed that there are three regions in the 5'-flanking region of the rat FSH-beta gene that display greater than 80% sequence similarity to regions in the bovine and human genes. The second of these regions also shares similarity to segments within the 5'-flanking regions of the rat alpha- and LH beta-subunit genes. The characterization of the rat FSH-beta gene will enable further study of the regulation of rat FSH using in vitro systems.