There is a paucity of information on extrahepatic autoimmune (EHA) conditions associated with primary biliary cirrhosis (PBC) and on the impact of EHA conditions on PBC patients' survival. Our goal was to assess the association between PBC and other autoimmune diseases and the impact of EHA conditions on the natural history of PBC. We took advantage of 361 consecutive PBC patients enrolled between 1975 and 2012 (22 males, 339 females; mean follow-up 8 ± 6.9 years). Any associated EHA conditions, PBC histological stage at diagnosis, biochemical data, physiological history, and extrahepatic malignancies developing during the follow-up were recorded. Survival was analyzed by means of Kaplan-Meier curves. Importantly, 221 patients (61.2 %) had at least one EHA conditions: 45 patients (20.4 %) had Hashimoto thyroiditis; 7 (3.2 %) had Graves' thyroiditis; 65 (29.4 %) had Raynaud's phenomenon; 124 (56.1 %) had Sjogren's syndrome; 8 (3.6 %) had systemic lupus erythematosus; 22 (9.9 %) had scleroderma; 22 (9.9 %) had rheumatoid arthritis; 18 (8.1 %) had cutaneous autoimmune diseases; 8 (3.6 %) had vasculitis; 5 (1.4 %) had celiac disease; and 25 (13.1 %) had other EHA conditions. The proportion of patients with associated EHA conditions enrolled during representative periods (1975-1980, 1981-1990, 1991-2000, 2001-2010, 2011-2012) remained stable. No differences emerged between patients with versus without EHA conditions in terms of mean age at PBC diagnosis, antimitochondrial antibody (AMA), or antinuclear antibody (ANA) positivity, histological stage at diagnosis, smoking habits, alcohol consumption, or BMI >25. Multiple logistic regression analysis showed that only female gender was significantly associated with positivity for EHA conditions (OR 4.8; 95 % CI 1.6-13.7, p = 0.004). The mean survival after the diagnosis of PBC was much the same in patients with and without EHA conditions. In conclusion, EHA conditions are often associated with PBC, especially in female patients, but they do not reduce patient survival.

The genus Hantavirus of the family Bunyaviridae comprises to the retroperitoneal space, and the kidneys are usually not affected [7]. at least 15 viruses, including those that cause hemorrhagic fever with renal syndrome (HFRS) and hantavirus pulmonary Slovenia is situated in the northern part of the Balkan Peninsula. Evidence of the circulation of PUU and DOB viruses syndrome. Each hantavirus is carried primarily by a specific throughout the Balkans has been collected recently [5, 8]. The rodent or insectivore host and is transmitted by inhalation of presence of HFRS in Slovenia was first reported in 1954 [9]. virus-contaminated aerosols of rodent excreta [1, 2]. Because Since then, 110 cases occurring sporadically or in small epiof the virus-rodent association, each hantavirus has a characterdemics have been documented [authors' unpublished data]. istic geographic distribution. HFRS, which is caused by HanBoth severe and mild clinical courses of the disease are seen, taan (HTN), Seoul (SEO), Dobrava (DOB), and Puumala with an overall mortality rate of 4.5% [10]. The presence of (PUU) viruses, occurs endemically on the Eurasian continent, two different hantaviruses responsible for human infections in whereas hantavirus pulmonary syndrome caused by Sin NomSlovenia has already been reported [11]. Broad epidemiological bre and related viruses occurs in the Americas [3 -5]. Both studies have shown that 10% to 35% of the rodents captured syndromes involve a sudden onset of high fever, headache, and in areas in Slovenia where HFRS is endemic have antibodies myalgia. HFRS may appear as a mild, moderate, or severe to hantavirus [12]. disease with renal impairment as the predominant organ maniIn 1988, DOB virus was isolated from the lungs of a yellowfestation. The mortality rate varies from õ0.5% for HFRS necked field mouse (Apodemus flavicollis) captured in the vilcaused by PUU virus to Ç5% to 10% for HFRS caused by HTN lage of Dobrava (Dolenjska region, Slovenia) where a number virus [6]. Hantavirus pulmonary syndrome is characterized by of cases of severe HFRS had occurred. Complete genetic and acute noncardiac pulmonary edema and is associated with a antigenic characterization identified DOB virus as a unique mortality rate of Ç50%; capillary leakage in hantavirus pulmohantavirus [13]. Recent reports have shown that DOB virus is nary syndrome is localized exclusively to the lungs, rather than the etiologic agent of the severe form of HFRS that occurs in the Balkans [5, 8,14]. In this report, we describe the clinical presentation of patients with HFRS who were hospitalized from 1985 to 1995 at the

BackgroundPneumonia is an important cause of illness and death, particularly in elderly adults. This retrospective study was conducted to estimate the trend of hospitalization for pneumonia in the Veneto from the records of all hospitals in the region (serving a population of 4.81 million) during the years 2004 through 2012.MethodsThe cases of pneumonia identified in the hospital discharge records were all cases in which the first-listed diagnosis was pneumonia, or meningitis, septicemia or empyema associated with pneumonia. The annual total and age-specific hospitalization rates and trends were calculated and correlated with vaccine coverage. Total related costs were also calculated.ResultsThere were 110,927 hospitalizations for pneumonia, meaning an annual rate of 256.3/100,000 population, with peaks in children and elderly people. The overall pneumonia-related hospitalization rate did not change significantly during the study period (AAPC: 1.3% [95% CI: −0.5, 3.1]). The rate dropped significantly among the 0- to 4-year-olds, however, from 617.3/100,000 in 2004 to 451.8/100,000 in 2012 (AAPC: −2.5% [95% CI: −4.5; −0.5]), while it increased slightly in adults aged 80+ (AAPC: 1.2% [95% CI: −0.9; 3.4]). The overall pneumonia-related mortality rate was 10.7%. The estimated cost per hospitalized patient was €3,090.ConclusionThis study shows that hospitalization for pneumonia has a considerable impact on the health services, especially for children and the elderly. No decline in hospitalization rates was seen for the very elderly after the introduction of pneumococcal conjugate vaccination for children.Electronic supplementary materialThe online version of this article (doi:10.1186/1471-2334-14-485) contains supplementary material, which is available to authorized users.

The potentially inappropriate use of A and E for non-urgent conditions was common among all the patient groups considered and barriers to primary care may enhance this behavior among migrants. This situation could also explain the higher odds ratio for migrants' hospitalization and discharge to ambulatory services after A and E visits.

BackgroundCommunity-acquired pneumonia (CAP) is an important cause of illness and death worldwide, particularly among the elderly. Previous studies on the factors associated with mortality in patients hospitalized for CAP revealed a direct association between the type of microorganism involved, the characteristics of the patient and mortality. Vaccination status against pneumococcal disease was not considered. We conducted a retrospective analysis on the mortality rates after a first hospitalization for CAP in north-east Italy with a view to examining especially the role of anti-pneumococcal vaccination as a factor associated with pneumonia-related mortality at one year.MethodBetween 2012–2013, patients aged 65+ hospitalized with a primary diagnosis of CAP, identified based on International Classification of Diseases, Ninth Revision, Clinical Modification codes 481–486, were enrolled in the study only once. Patients were divided into three groups by pneumococcal vaccination status: 1) 13-valent pneumococcal conjugate vaccine (PCV13) prior to their hospitalization; 2) 23-valent pneumococcal polysaccharide vaccine (PPV23) within 5 years before hospitalization and 3) unvaccinated or PPV23 more than 5 years prior to admission. Gender, age, length of hospital stay and influenza vaccination were considered. Comorbidities were ascertained by means of a properly coded diagnosis. Every patient was followed up for 1 year and the outcome investigated was mortality for any cause and for pneumonia.ResultsA total of 4,030 patient were included in the study; mean age at the time of admission to hospital was 84.3±7.7; 50.9% were female. 74.2% of subjects had at least one comorbidity; 73.7% has been vaccinated against influenza. Regard to pneumococcal vaccine, 80.4% of patients were not vaccinated, 14.5% vaccinated with PPV23 and 5.1% with PCV13. The 1-year survival rates after hospitalization for pneumonia were 83.6%, 85.9% and 89.3% in the unvaccinated, PPV23 and PCV13 groups, respectively. Regression analysis indicated that the risk of death due to pneumonia increased significantly with age (adjusted OR: 1.073; 1.061–1.085), shorter hospital stay (adjusted OR: 0.981; 0.971–0.990), and male gender (adjusted OR: 1.372; 1.165–1.616). The model also confirmed the pneumococcal 13-valent conjugated vaccine as an independent protective factor for mortality-related pneumonia (adjusted OR: 0.599; 0.390–0.921).ConclusionThe main finding of our observational cohort study is a high mortality rate among elderly patients admitted to hospital for pneumonia. The present study suggests a protective role for PCV13 vaccination.