Objectives: (1) Analyze the clinical characteristics of upper respiratory infections (URIs) complicated by acute bacterial sinusitis (ABS) in young children.(2) Describe the bacteria and viruses isolated in nasopharyngeal specimens in children with ABS.Methods: We identified ABS episodes in a prospective, longitudinal cohort study of 294 children (aged 6-35 months at enrollment), who were followed up for one year to capture all URI episodes and complications. At the initial URI visit (median day = 4), nasopharyngeal samples were obtained for bacterial cultures and viral studies. The study was conducted at the University of Texas Medical Branch, Galveston, during 2003Galveston, during -2007.Results: Of 1295 documented URI episodes, 103 (8%) episodes (in 73 children) were complicated by ABS, 32 of which were concurrent with acute otitis media. The majority (72%) of ABS episodes were diagnosed based on persistent symptoms or a biphasic course. The average age was 18.8 ± 7.2 months; white children were more likely to have ABS episodes than blacks (P = .01). Viruses were detected in 63% during the initial URI visit; rhinovirus detection was positively correlated with ABS (P = .01). Bacterial cultures were positive in 82/83 (99%) available samples; polymicrobial (56%), Moraxella catarrhalis (20%) and Streptococcus pneumoniae (10%) were the most common cultures. Presence of pathogenic bacteria overall and presence of M. catarrhalis during URI were positively correlated with ABS risk (P = .04 for both).Conclusions: ABS complicates 8% of URIs in children. Girls have more frequent ABS episodes than boys. Presence of rhinovirus and M catarrhalis during URI are positively correlated with ABS risk.

Background This study aimed to determine the impact of pulmonary complications on death after surgery both before and during the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic. Methods This was a patient-level, comparative analysis of two, international prospective cohort studies: one before the pandemic (January–October 2019) and the second during the SARS-CoV-2 pandemic (local emergence of COVID-19 up to 19 April 2020). Both included patients undergoing elective resection of an intra-abdominal cancer with curative intent across five surgical oncology disciplines. Patient selection and rates of 30-day postoperative pulmonary complications were compared. The primary outcome was 30-day postoperative mortality. Mediation analysis using a natural-effects model was used to estimate the proportion of deaths during the pandemic attributable to SARS-CoV-2 infection. Results This study included 7402 patients from 50 countries; 3031 (40.9 per cent) underwent surgery before and 4371 (59.1 per cent) during the pandemic. Overall, 4.3 per cent (187 of 4371) developed postoperative SARS-CoV-2 in the pandemic cohort. The pulmonary complication rate was similar (7.1 per cent (216 of 3031) versus 6.3 per cent (274 of 4371); P = 0.158) but the mortality rate was significantly higher (0.7 per cent (20 of 3031) versus 2.0 per cent (87 of 4371); P < 0.001) among patients who had surgery during the pandemic. The adjusted odds of death were higher during than before the pandemic (odds ratio (OR) 2.72, 95 per cent c.i. 1.58 to 4.67; P < 0.001). In mediation analysis, 54.8 per cent of excess postoperative deaths during the pandemic were estimated to be attributable to SARS-CoV-2 (OR 1.73, 1.40 to 2.13; P < 0.001). Conclusion Although providers may have selected patients with a lower risk profile for surgery during the pandemic, this did not mitigate the likelihood of death through SARS-CoV-2 infection. Care providers must act urgently to protect surgical patients from SARS-CoV-2 infection.

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Background Immune checkpoint inhibitors (ICI), combined with hypomethylating agents, can be used to treat acute myeloid leukemia (AML), but this strategy results in a high rate of pneumonitis. The authors sought to determine risk factors for pneumonitis development and whether pneumonitis increased mortality. Methods The authors conducted a retrospective review of 258 AML patients who received ICI‐containing regimens from 2016 to 2018. A multidisciplinary adjudication committee diagnosed pneumonia and pneumonitis by reviewing symptoms, imaging, microbiology, and response to therapies. To measure risk factors for pneumonitis and mortality, multivariate Cox proportional hazards models were constructed. Pneumonia, pneumonitis, and disease progression were modeled as a time‐dependent variable and incorporated a standard risk set modifying variables into the models. Results Thirty patients developed pneumonitis (12%). Of these, 17 had partial or complete resolution, whereas 13 patients died from pneumonitis. Increasing age (hazard ratio [HR], 1.04 per year; 95% confidence interval [CI], 1.00‐1.08), and baseline shortness of breath increased pneumonitis risk (HR, 2.51; 95% CI, 1.13‐5.55). Female sex (HR, 0.33; 95% CI, 0.15‐0.70) and increasing platelet count (HR, 0.52 per log‐unit increase; 95% CI, 0.30‐0.92) decreased pneumonitis risk. In adjusted models, ICI‐related pneumonitis significantly increased mortality (HR, 2.84; 95% CI, 1.84‐4.37). Conclusions ICI‐related pneumonitis occurs at a high rate in AML patients and increases mortality. Lay Summary Immune checkpoint inhibitors (ICIs) remove inhibitory signals that reduce T‐cell function and allow T‐cells to better attack cancer cells. In acute myeloid leukemia (AML), the effectiveness of ICIs is limited in part by inflammation of the lung, called pneumonitis. This study reviewed 258 patients with AML who received ICIs and identified 30 patients who developed pneumonitis, nearly half of whom died. Older age and baseline shortness of breath increased pneumonitis risk, whereas female sex and higher baseline platelet counts decreased pneumonitis risk. Pneumonitis increased mortality by nearly 3‐fold. This work highlights the significant harm imposed by pneumonitis after ICI therapies.

The SARS‐CoV‐2 pandemic may negatively impact mood and emotion. Physical activity may protect against mood disturbance and promote positive affect. This study asked if physical activity before, during, or the change in physical activity with the pandemic, impacted affect and mood during the pandemic. US adult residents (18–74 years; N = 338) were surveyed from 29 April to 3 June 2020. Physical activity before and during the pandemic was assessed with the Physical Activity Rating survey. The Positive and Negative Affect Schedule measured affect and the Profile of Moods Questionnaire assessed mood. Comparisons between physically inactive and active participants by Analysis of Covariance found greater vigour in participants classed as physically active before the pandemic. Positive affect, vigour and esteem‐related affect were greater in participants physically active during the pandemic. Multiple linear regression revealed relationships between the change in physical activity and mood. Change in physical activity positively associated with positive affect ( b = 1.06), esteem‐related affect ( b = 0.33) and vigour ( b = 0.53), and negatively associated with negative affect ( b = −0.47), total mood disturbance ( b = −2.60), tension ( b = −0.31), anger ( b = −0.24), fatigue ( b = −0.54), depression ( b = −0.50) and confusion ( b = −0.23). These data demonstrate that physical activity during the pandemic, and increased physical activity relative to before the pandemic, related to better mood.