Background Hospitalized COVID-19 patients tend to be older and frequently have hypertension, diabetes or coronary heart disease (CHD), but whether these co-morbidities are true risk factors (i.e. more common than in the general older population) is unclear. We estimated associations between pre-existing diagnoses and hospitalized COVID-19 alone or with mortality, in a large community cohort. Methods UK Biobank (England) participants with baseline assessment 2006 to 2010, followed in hospital discharge records to 2017 and death records to 2020. Demographic and pre-existing common diagnoses association tested with hospitalized laboratory confirmed COVID-19 (16th March to 26th April 2020), alone or with mortality, in logistic models. Results Of 269,070 participants aged 65+, 507 (0.2%) became COVID-19 hospital inpatients, of which 141 (27.8%) died. Common co-morbidities in hospitalized inpatients were hypertension (59.6%), history of fall or fragility fractures (29.4%), coronary heart disease (CHD, 21.5%), type 2 diabetes (type 2, 19. 9%) and asthma (17.6%). However, in models adjusted for comorbidities, age-group, sex, ethnicity and education, pre-existing diagnoses of dementia, type 2 diabetes, COPD, pneumonia, depression, atrial fibrillation and hypertension emerged as independent risk factors for COVID-19 hospitalization, the first five remaining statistically significant for related mortality. Chronic Kidney Disease and asthma were risk factors for COVID-19 hospitalization in women but not men. Conclusion There are specific high risk pre-existing co-morbidities for COVID-19 hospitalization and related deaths in community based older men and women. These results do not support simple age-based targeting of the older population to prevent severe COVID-19 infections.

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Objective: To characterize the presentation of burns in children and risk factors associated with their occurrence in a developing country as a basis for future prevention programs. Design: Case-control study. Setting: Burn unit of the National Institute of Child Health (Instituto Nacional de Salud del Niño) in Lima, Peru. Methods: A questionnaire was administered to all consenting guardians of children admitted to the burns (cases) and general medicine (controls) units during a period of 14 months. Guardians of patients were questioned regarding etiology of the injury, demographic and socioeconomic data. Results: 740 cases and controls were enrolled. Altogether 77.5% of the cases burns occurred in the patient's home, with 67.8% in the kitchen; 74% were due to scalding. Most involved children younger than 5 years. Lack of water supply (odds ratio (OR) 5.2, 95% confidence interval (CI) 2.1 to 12.3), low income (OR 2.8, 95% CI 2.0 to 3.9), and crowding (OR 2.5, 95%CI 1.7 to 3.6) were associated with an increased risk. The presence of a living room (OR 0.6, 95% CI 0.4 to 0.8) and better maternal education (OR 0.6, 95% CI 0.5 to 0.9) were protective factors. Conclusions: To prevent burns interventions should be directed to low socioeconomic status groups; these interventions should be designed accordingly to local risk factors.

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The emergence of multidrug-resistant tuberculosis underscores the need for low-cost, rapid methods to determine the susceptibility of Mycobacterium tuberculosis to antibiotics. A new, rapid, easily read, and inexpensive colorimetric method with a tetrazolium indicator performs this determination as quickly and accurately as the more expensive Alamar Blue technique.In recent years, tuberculosis (TB) has acquired a growing importance in developed and developing countries. The great toll of the disease, the emergence of multidrug-resistant (MDR) strains around the globe, and the close relationship between TB and human immunodeficiency virus infection underscore the need for simple, rapid, and affordable methods of detection and antibiotic susceptibility determination (2, 3, 5). Such methods could reduce the spread of resistant strains by determining more appropriate treatment regimens.A rapid and low-cost method for the culture of Mycobacterium tuberculosis in clinical samples and determination of the susceptibilities of the strains to antibiotics was developed previously (1). This method, the microplate Alamar Blue assay (MABA), is based on the detection of colorimetric changes caused by the oxidation and reduction capabilities of Alamar Blue dye. With a pure culture, this method can determine antibiotic susceptibility in 6 to 7 days. We have recently tested a tetrazolium microplate assay (TEMA) that uses tetrazolium bromide [3-(4,5-dimethylthiazol-2-yl)-2,5diphenyl-tetrazolium bromide] as an alternative, less expensive, and easier-to-read method for antibiotic susceptibility determination. This paper compares the results of this alternative method with those of the previously described MABA (1).Briefly, the MABA involves the addition of Alamar Blue solution to microplates containing antibiotics in increasing concentrations and pure cultures of M. tuberculosis obtained from clinical samples. After an incubation period of 5 days, the growth of M. tuberculosis can be observed as a change in the coloration of the Alamar Blue solution due to reduction of the dye. MICs of each antibiotic tested can be determined by this change of color in the wells.To perform the TEMA, suspensions of M. tuberculosis were prepared by emulsifying growth from slants with 100 l of Tween 80 into 0.2% bovine serum albumin (Sigma Chemical Co., St. Louis, Mo. were added to the wells in columns 2 and 3. One hundred microliters of solution was transferred from column 3 to column 4 with a multichannel pipette. The antibiotics were serially diluted 1:2 in consecutive columns, except for column 10, where 100 l of excess medium was discarded. The final drug concentration ranges were as follows: 0.125 to 32 g/ml for INH, 0.062 to 16 g/ml for RIF, 0.125 to 32 g/ml for STR, and 0.5 to 128 g/ml for ETB.One hundred microliters of a log-phase M. tuberculosis bacterial suspension (20 to 30 days old) was added to wells in rows B to G in columns 2 to 11 with an Eppendorf repeating pipette. The wells in column 11 served as inoculum-only controls.The plates we...

The novel respiratory disease COVID-19 produces varying symptoms, with fever, cough, and shortness of breath being common. In older adults, we found that pre-existing dementia is a major risk factor (OR = 3.07, 95% CI: 1.71 to 5.50) for COVID-19 severity in the UK Biobank (UKB). In another UK study of 16,749 patients hospitalized for COVID-19, dementia was among the common comorbidities and was associated with higher mortality. Additionally, impaired consciousness, including delirium, is common in severe cases. The ApoE e4 genotype is associated with both dementia and delirium, with the e4e4 (homozygous) genotype associated with a 14-fold increase in risk of Alzheimer's disease compared to the common e3e3 genotype, in populations with European ancestries. We therefore aimed to test associations between ApoE e4 alleles and COVID-19 severity, using the UKB data.

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Objectives Opioid pain reliever (OPR) prescribing at Emergency Department (ED) discharge has increased in the past decade but specific prescription details are lacking. Prior ED OPR prescribing estimates relied on national survey extrapolation or prescription databases. The main goal of this study was to utilize a research consortium to analyze the characteristics of patients and opioid prescriptions using a national sample of ED patients. We also aimed to examine the indications for OPR prescribing, characteristics of opioids prescribed both in the ED and at the time of discharge, and characteristics of patients who received OPRs compared with those who did not. Methods This observational, multi-centered, retrospective cohort study assessed OPR prescribing to consecutive patients presenting to the consortium EDs during 1 week in October 2012. The consortium study sites consisted of 19 EDs representing 1.4 million annual visits, varied geographically, and were predominantly academic centers. Medical records of all patients aged 18-90 years discharged with an OPR (excluding tramadol) were individually abstracted via standardized chart review by investigators for detailed analysis. Descriptive statistics were generated. Results During the study week, 27,516 patient visits were evaluated in the consortium EDs. 19,321 (70.2%) were discharged and 3,284 patients (11.9% of all patients and 17.0% of discharged patients) received an OPR prescription. For those prescribed an OPR, mean age was 41.1 (SD 14.7) years and 1,694 (51.6%) were female. Mean initial pain score was 7.7 (SD 2.4). The most common diagnoses associated with OPR prescribing were back pain (10.2%), abdominal pain (10.1%), and extremity fracture (7.1%) or sprain (6.5%). The most common OPRs prescribed were oxycodone (52.3%), hydrocodone (40.9%) and codeine (4.8%). >99% were immediate release, 90.0% were combination preparations, and the mean and median number of pills was 16.6 (SD 7.6) and 15 (IQR=12-20) respectively. Conclusion In a study of ED patients treated over a single week across the country, 17% of discharged patients were prescribed OPRs. The majority of the prescriptions had small pill counts and almost exclusively immediate release formulations.