The EVALI and Youth Vaping Epidemics — Implications for Public Health
17-01-2020 – Brian A. King,Christopher M. Jones,Grant T. Baldwin,Peter A. Briss
A Novel Coronavirus Emerging in China — Key Questions for Impact Assessment
24-01-2020 – Vincent J. Munster,Marion Koopmans,Neeltje van Doremalen,Debby van Riel,Emmie de Wit
When Sensitivity Is a Liability
19-02-2020 – Jay Baruch
Vitamin E Acetate in Bronchoalveolar-Lavage Fluid Associated with EVALI
20-12-2019 – Benjamin C. Blount,Mateusz P. Karwowski,Peter G. Shields,Maria Morel-Espinosa,Liza Valentin-Blasini,Michael Gardner,Martha Braselton,Christina R. Brosius,Kevin T. Caron,David Chambers,Joseph Corstvet,Elizabeth Cowan,Víctor R. De Jesús,Paul Espinosa,Carolina Fernandez,Cory Holder,Zsuzsanna Kuklenyik,Jennifer D. Kusovschi,Cody Newman,Gregory B. Reis,Jon Rees,Chris Reese,Lalith Silva,Tiffany Seyler,Min-Ae Song,Connie Sosnoff,Carleen R. Spitzer,Denise Tevis,Lanqing Wang,Cliff Watson,Mark D. Wewers,Baoyun Xia,Douglas T. Heitkemper,Isaac Ghinai,Jennifer Layden,Peter Briss,Brian A. King,Lisa J. Delaney,Christopher M. Jones,Grant T. Baldwin,Anita Patel,Dana Meaney-Delman,Dale Rose,Vikram Krishnasamy,John R. Barr,Jerry Thomas,James L. Pirkle
The causative agents for the current national outbreak of electronic-cigarette, or vaping, product use-associated lung injury (EVALI) have not been established. Detection of toxicants in bronchoalveolar-lavage (BAL) fluid from patients with EVALI can provide direct information on exposure within the lung. BAL fluids were collected from 51 patients with EVALI in 16 states and from 99 healthy participants who were part of an ongoing study of smoking involving nonsmokers, exclusive users of e-cigarettes or vaping products, and exclusive cigarette smokers that was initiated in 2015. Using the BAL fluid, we performed isotope dilution mass spectrometry to measure several priority toxicants: vitamin E acetate, plant oils, medium-chain triglyceride oil, coconut oil, petroleum distillates, and diluent terpenes. State and local health departments assigned EVALI case status as confirmed for 25 patients and as probable for 26 patients. Vitamin E acetate was identified in BAL fluid obtained from 48 of 51 case patients (94%) in 16 states but not in such fluid obtained from the healthy comparator group. No other priority toxicants were found in BAL fluid from the case patients or the comparator group, except for coconut oil and limonene, which were found in 1 patient each. Among the case patients for whom laboratory or epidemiologic data were available, 47 of 50 (94%) had detectable tetrahydrocannabinol (THC) or its metabolites in BAL fluid or had reported vaping THC products in the 90 days before the onset of illness. Nicotine or its metabolites were detected in 30 of 47 of the case patients (64%). Vitamin E acetate was associated with EVALI in a convenience sample of 51 patients in 16 states across the United States. (Funded by the National Cancer Institute and others.).
Trial of Nemolizumab in Moderate-to-Severe Prurigo Nodularis
19-02-2020 – Sonja Ständer,Gil Yosipovitch,Franz J. Legat,Jean-Philippe Lacour,Carle Paul,Joanna Narbutt,Thomas Bieber,Laurent Misery,Andreas Wollenberg,Adam Reich,Faiz Ahmad,Christophe Piketty
Prurigo nodularis is a chronic pruritic skin disease with multiple nodular skin lesions. Nemolizumab is a monoclonal antibody targeting the interleukin-31 receptor, which is involved in the pathogenesis of prurigo nodularis.
We conducted a 12-week, randomized, double-blind, phase 2 trial of nemolizumab (at a dose of 0.5 mg per kilogram of body weight) administered subcutaneously at baseline, week 4, and week 8, as compared with placebo, in patients with moderate-to-severe prurigo nodularis and severe pruritus. Moderate-to-severe prurigo nodularis was defined as 20 or more nodules, and severe pruritus was defined as a mean score of at least 7 for the worst daily intensity of pruritus on the numerical rating scale (scores range from 0 [no itch] to 10 [worst itch imaginable]). The primary outcome was the percent change from baseline in the mean peak score for pruritus on the numerical rating scale at week 4. Secondary outcomes included additional measures of itching and disease severity. Safety assessments were performed through week 18.
A total of 70 patients were randomly assigned in a 1:1 ratio to receive nemolizumab (34 patients) or placebo (36). The initial pruritus score on the numerical rating scale was 8.4 in each group. At week 4, the peak pruritus score on the numerical rating scale was reduced from baseline by 4.5 points (change, -53.0%) in the nemolizumab group, as compared with a reduction of 1.7 points (change, -20.2%) in the placebo group (difference, -32.8 percentage points; 95% confidence interval, -46.8 to -18.8; P<0.001). Results for secondary outcomes were in the same direction as for the primary outcome. Nemolizumab was associated with gastrointestinal symptoms (abdominal pain and diarrhea) and musculoskeletal symptoms.
Nemolizumab resulted in a greater reduction in pruritus and severity of skin lesions than placebo in patients with prurigo nodularis but was associated with adverse events. Larger and longer trials are needed to determine the durability and safety of nemolizumab for the treatment of prurigo nodularis. (Funded by Galderma; Clinical
Trials.gov number, NCT03181503.).
A Community-Based Intervention for Managing Hypertension in Rural South Asia
19-02-2020 – Tazeen H. Jafar,Mihir Gandhi,H. Asita de Silva,Imtiaz Jehan,Aliya Naheed,Eric A. Finkelstein,Elizabeth L. Turner,Donald Morisky,Anuradhani Kasturiratne,Aamir H. Khan,John D. Clemens,Shah Ebrahim,Pryseley N. Assam,Liang Feng
The burden of hypertension is escalating, and control rates are poor in low- and middle-income countries. Cardiovascular mortality is high in rural areas.
We conducted a cluster-randomized, controlled trial in rural districts in Bangladesh, Pakistan, and Sri Lanka. A total of 30 communities were randomly assigned to either a multicomponent intervention (intervention group) or usual care (control group). The intervention involved home visits by trained government community health workers for blood-pressure monitoring and counseling, training of physicians, and care coordination in the public sector. A total of 2645 adults with hypertension were enrolled. The primary outcome was reduction in systolic blood pressure at 24 months. Follow-up at 24 months was completed for more than 90% of the participants.
At baseline, the mean systolic blood pressure was 146.7 mm Hg in the intervention group and 144.7 mm Hg in the control group. At 24 months, the mean systolic blood pressure fell by 9.0 mm Hg in the intervention group and by 3.9 mm Hg in the control group; the mean reduction was 5.2 mm Hg greater with the intervention (95% confidence interval [CI], 3.2 to 7.1; P<0.001). The mean reduction in diastolic blood pressure was 2.8 mm Hg greater in the intervention group than in the control group (95% CI, 1.7 to 3.9). Blood-pressure control (<140/90 mm Hg) was achieved in 53.2% of the participants in the intervention group, as compared with 43.7% of those in the control group (relative risk, 1.22; 95% CI, 1.10 to 1.35). All-cause mortality was 2.9% in the intervention group and 4.3% in the control group.
In rural communities in Bangladesh, Pakistan, and Sri Lanka, a multicomponent intervention that was centered on proactive home visits by trained government community health workers who were linked with existing public health care infrastructure led to a greater reduction in blood pressure than usual care among adults with hypertension. (Funded by the Joint Global Health Trials scheme; COBRA-BPS Clinical
Trials.gov number, NCT02657746.).
A Novel Coronavirus from Patients with Pneumonia in China, 2019
24-01-2020 – Na Zhu,Dingyu Zhang,Wenling Wang,Xingwang Li,Bo Yang,Jingdong Song,Xiang Zhao,Baoying Huang,Weifeng Shi,Roujian Lu,Peihua Niu,Faxian Zhan,Xuejun Ma,Dayan Wang,Wenbo Xu,Guizhen Wu,George F. Gao,Wenjie Tan
In December 2019, a cluster of patients with pneumonia of unknown cause was linked to a seafood wholesale market in Wuhan, China. A previously unknown betacoronavirus was discovered through the use of unbiased sequencing in samples from patients with pneumonia. Human airway epithelial cells were used to isolate a novel coronavirus, named 2019-n
CoV, which formed a clade within the subgenus sarbecovirus, Orthocoronavirinae subfamily. Different from both MERS-CoV and SARS-CoV, 2019-n
CoV is the seventh member of the family of coronaviruses that infect humans. Enhanced surveillance and further investigation are ongoing. (Funded by the National Key Research and Development Program of China and the National Major Project for Control and Prevention of Infectious Disease in China.).
Prevention of Falls in Community-Dwelling Older Adults
19-02-2020 – David A. Ganz,Nancy K. Latham
Journal Article, Review
Sarcoidal Reaction in a Tattoo
19-02-2020 – Darosa Lim,Mélissa Nantel-Battista
Case Reports, Journal Article
19-02-2020 – Muhammad Sohail Mansoor,Asra Batool
Case Reports, Journal Article
Case 6-2020: A 34-Year-Old Woman with Hyperglycemia
19-02-2020 – Miriam S. Udler,Camille E. Powe,Christina A. Austin-Tse
Case Reports, Journal Article
Cornering the Suspects in Vaping-Associated EVALI
19-02-2020 – Terry Gordon,Jonathan Fine
Breaking the Itch–Scratch Cycle in Prurigo Nodularis
19-02-2020 – Shawn G. Kwatra
Lower Blood Pressure in South Asia? Trial Evidence
19-02-2020 – Neil Poulter
Another Decade, Another Coronavirus
24-01-2020 – Stanley Perlman
Disclosure of Genetic Risk Revealed in a Research Study
19-02-2020 – Angela Castellanos,Elizabeth G. Phimister,Kári Stefánsson,Ellen W. Clayton
Case Reports, Journal Article
Syndromic Surveillance for E-Cigarette, or Vaping, Product Use–Associated Lung Injury
20-12-2019 – Kathleen P. Hartnett,Aaron Kite-Powell,Megan T. Patel,Brittani L. Haag,Michael J. Sheppard,Taylor P. Dias,Brian A. King,Paul C. Melstrom,Matthew D. Ritchey,Zachary Stein,Nimi Idaikkadar,Alana M. Vivolo-Kantor,Dale A. Rose,Peter A. Briss,Jennifer E. Layden,Loren Rodgers,Jennifer Adjemian
Responding to Unprofessional Behavior by Trainees — A “Just Culture” Framework
19-02-2020 – Jason A. Wasserman,Michael Redinger,Tyler Gibb
Behavioral Heuristics in Coronary-Artery Bypass Graft Surgery
19-02-2020 – Andrew R. Olenski,André Zimerman,Stephen Coussens,Anupam B. Jena
Nintedanib in Progressive Fibrosing Interstitial Lung Diseases
19-02-2020 – KR Flaherty,AU Wells,KK Brown
Acute Upper Airway Obstruction
19-02-2020 – A Eskander,JR de Almeida,JC Irish
Emicizumab in Hemophilia A
19-02-2020 – LM Aledort
Retraction: Banegas JR et al. Relationship between Clinic and Ambulatory Blood-Pressure Measurements and Mortality. N Engl J Med 2018;378:1509-20.
29-01-2020 – José R. Banegas,Luis M. Ruilope,Alejandro de la Sierra,Ernest Vinyoles,Manuel Gorostidi,Juan J. de la Cruz,Gema Ruiz-Hurtado,Julián Segura,Fernando Rodríguez-Artalejo,Bryan Williams
Letter, Retraction of Publication
SARS-CoV-2 Viral Load in Upper Respiratory Specimens of Infected Patients
19-02-2020 – Lirong Zou,Feng Ruan,Mingxing Huang,Lijun Liang,Huitao Huang,Zhongsi Hong,Jianxiang Yu,Min Kang,Yingchao Song,Jinyu Xia,Qianfang Guo,Tie Song,Jianfeng He,Hui-Ling Yen,Malik Peiris,Jie Wu
Stalled Federal Efforts to End Surprise Billing — The Role of Private Equity
19-02-2020 – Erin C. Fuse Brown
Defining the Epidemiology of Covid-19 — Studies Needed
19-02-2020 – Marc Lipsitch,David L. Swerdlow,Lyn Finelli
Evidence of SARS-CoV-2 Infection in Returning Travelers from Wuhan, China
18-02-2020 – Sebastian Hoehl,Annemarie Berger,Marhild Kortenbusch,Jindrich Cinatl,Denisa Bojkova,Holger Rabenau,Pia Behrens,Boris Böddinghaus,Udo Götsch,Frank Naujoks,Peter Neumann,Joscha Schork,Petra Tiarks-Jungk,Antoni Walczok,Markus Eickmann,Maria J.G.T. Vehreschild,Gerrit Kann,Timo Wolf,René Gottschalk,Sandra Ciesek
Calming Down about Sedation in Critically Ill Patients
16-02-2020 – Claude Guérin
Nonsedation or Light Sedation in Critically Ill, Mechanically Ventilated Patients
16-02-2020 – Hanne T. Olsen,Helene K. Nedergaard,Thomas Strøm,Jakob Oxlund,Karl-Andre Wian,Lars M. Ytrebø,Bjørn A. Kroken,Michelle Chew,Serkan Korkmaz,Jørgen T. Lauridsen,Palle Toft
In critically ill, mechanically ventilated patients, daily interruption of sedation has been shown to reduce the time on ventilation and the length of stay in the intensive care unit (ICU). Data on whether a plan of no sedation, as compared with a plan of light sedation, has an effect on mortality are lacking.
In a multicenter, randomized, controlled trial, we assigned, in a 1:1 ratio, mechanically ventilated ICU patients to a plan of no sedation (nonsedation group) or to a plan of light sedation (i.e., to a level at which the patient was arousable, defined as a score of -2 to -3 on the Richmond Agitation and Sedation Scale [RASS], on which scores range from -5 [unresponsive] to +4 [combative]) (sedation group) with daily interruption. The primary outcome was mortality at 90 days. Secondary outcomes were the number of major thromboembolic events, the number of days free from coma or delirium, acute kidney injury according to severity, the number of ICU-free days, and the number of ventilator-free days. Between-group differences were calculated as the value in the nonsedation group minus the value in the sedation group.
A total of 710 patients underwent randomization, and 700 were included in the modified intention-to-treat analysis. The characteristics of the patients at baseline were similar in the two trial groups, except for the score on the Acute Physiology and Chronic Health Evaluation (APACHE) II, which was 1 point higher in the nonsedation group than in the sedation group, indicating a greater chance of in-hospital death. The mean RASS score in the nonsedation group increased from -1.3 on day 1 to -0.8 on day 7 and, in the sedation group, from -2.3 on day 1 to -1.8 on day 7. Mortality at 90 days was 42.4% in the nonsedation group and 37.0% in the sedated group (difference, 5.4 percentage points; 95% confidence interval [CI], -2.2 to 12.2; P = 0.65). The number of ICU-free days and of ventilator-free days did not differ significantly between the trial groups. The patients in the nonsedation group had a median of 27 days free from coma or delirium, and those in the sedation group had a median of 26 days free from coma or delirium. A major thromboembolic event occurred in 1 patient (0.3%) in the nonsedation group and in 10 patients (2.8%) in the sedation group (difference, -2.5 percentage points; 95% CI, -4.8 to -0.7 [unadjusted for multiple comparisons]).
Among mechanically ventilated ICU patients, mortality at 90 days did not differ significantly between those assigned to a plan of no sedation and those assigned to a plan of light sedation with daily interruption. (Funded by the Danish Medical Research Council and others; NONSEDA Clinical
Trials.gov number, NCT01967680.).
A Locally Transmitted Case of SARS-CoV-2 Infection in Taiwan
12-02-2020 – Ying-Chu Liu,Ching-Hui Liao,Chin-Fu Chang,Chu-Chung Chou,Yan-Ren Lin
Journey of a Thai Taxi Driver and Novel Coronavirus
12-02-2020 – Wannarat A. Pongpirul,Krit Pongpirul,Anuttra C. Ratnarathon,Wisit Prasithsirikul
Polymer-based or Polymer-free Stents in Patients at High Bleeding Risk
12-02-2020 – Stephan Windecker,Azeem Latib,Elvin Kedhi,Ajay J. Kirtane,David E. Kandzari,Roxana Mehran,Matthew J. Price,Alexandre Abizaid,Daniel I. Simon,Stephen G. Worthley,Azfar Zaman,Martin Hudec,Petra Poliacikova,A. Kahar bin Abdul Ghapar,Kamaraj Selvaraj,Ivo Petrov,Darren Mylotte,Eduardo Pinar,Raul Moreno,Franco Fabbiocchi,Sanjeevan Pasupati,Hyo-Soo Kim,Adel Aminian,Charles Tie,Adrian Wlodarczak,Seung-Ho Hur,Steven O. Marx,Ivana Jankovic,Sandeep Brar,Lisa Bousquette,Minglei Liu,Gregg W. Stone
Polymer-free drug-coated stents provide superior clinical outcomes to bare-metal stents in patients at high bleeding risk who undergo percutaneous coronary intervention (PCI) and are treated with 1 month of dual antiplatelet therapy. Data on the use of polymer-based drug-eluting stents, as compared with polymer-free drug-coated stents, in such patients are limited.
In an international, randomized, single-blind trial, we compared polymer-based zotarolimus-eluting stents with polymer-free umirolimus-coated stents in patients at high bleeding risk. After PCI, patients were treated with 1 month of dual antiplatelet therapy, followed by single antiplatelet therapy. The primary outcome was a safety composite of death from cardiac causes, myocardial infarction, or stent thrombosis at 1 year. The principal secondary outcome was target-lesion failure, an effectiveness composite of death from cardiac causes, target-vessel myocardial infarction, or clinically indicated target-lesion revascularization. Both outcomes were powered for noninferiority.
A total of 1996 patients at high bleeding risk were randomly assigned in a 1:1 ratio to receive zotarolimus-eluting stents (1003 patients) or polymer-free drug-coated stents (993 patients). At 1 year, the primary outcome was observed in 169 of 988 patients (17.1%) in the zotarolimus-eluting stent group and in 164 of 969 (16.9%) in the polymer-free drug-coated stent group (risk difference, 0.2 percentage points; upper boundary of the one-sided 97.5% confidence interval [CI], 3.5; noninferiority margin, 4.1; P = 0.01 for noninferiority). The principal secondary outcome was observed in 174 patients (17.6%) in the zotarolimus-eluting stent group and in 169 (17.4%) in the polymer-free drug-coated stent group (risk difference, 0.2 percentage points; upper boundary of the one-sided 97.5% CI, 3.5; noninferiority margin, 4.4; P = 0.007 for noninferiority).
Among patients at high bleeding risk who received 1 month of dual antiplatelet therapy after PCI, use of polymer-based zotarolimus-eluting stents was noninferior to use of polymer-free drug-coated stents with regard to safety and effectiveness composite outcomes. (Funded by Medtronic; ONYX ONE Clinical
Trials.gov number, NCT03344653.).
Patent Foramen Ovale Closure or Antiplatelet Therapy for Cryptogenic Stroke
Organ Donation after Medical Assistance in Dying — Canada’s First Cases
First Case of 2019 Novel Coronavirus in the United States
31-01-2020 – Michelle L. Holshue,Chas DeBolt,Scott Lindquist,Kathy H. Lofy,John Wiesman,Hollianne Bruce,Christopher Spitters,Keith Ericson,Sara Wilkerson,Ahmet Tural,George Diaz,Amanda Cohn,LeAnne Fox,Anita Patel,Susan I. Gerber,Lindsay Kim,Suxiang Tong,Xiaoyan Lu,Steve Lindstrom,Mark A. Pallansch,William C. Weldon,Holly M. Biggs,Timothy M. Uyeki,Satish K. Pillai
An outbreak of novel coronavirus (2019-n
CoV) that began in Wuhan, China, has spread rapidly, with cases now confirmed in multiple countries. We report the first case of 2019-n
CoV infection confirmed in the United States and describe the identification, diagnosis, clinical course, and management of the case, including the patient’s initial mild symptoms at presentation with progression to pneumonia on day 9 of illness. This case highlights the importance of close coordination between clinicians and public health authorities at the local, state, and federal levels, as well as the need for rapid dissemination of clinical information related to the care of patients with this emerging infection.
Transmission of 2019-nCoV Infection from an Asymptomatic Contact in Germany
31-01-2020 – Camilla Rothe,Mirjam Schunk,Peter Sothmann,Gisela Bretzel,Guenter Froeschl,Claudia Wallrauch,Thorbjörn Zimmer,Verena Thiel,Christian Janke,Wolfgang Guggemos,Michael Seilmaier,Christian Drosten,Patrick Vollmar,Katrin Zwirglmaier,Sabine Zange,Roman Wölfel,Michael Hoelscher
Five-Year Outcomes of Transcatheter or Surgical Aortic-Valve Replacement
29-01-2020 – Raj R. Makkar,Vinod H. Thourani,Michael J. Mack,Susheel K. Kodali,Samir Kapadia,John G. Webb,Sung-Han Yoon,Alfredo Trento,Lars G. Svensson,Howard C. Herrmann,Wilson Y. Szeto,D. Craig Miller,Lowell Satler,David J. Cohen,Todd M. Dewey,Vasilis Babaliaros,Mathew R. Williams,Dean J. Kereiakes,Alan Zajarias,Kevin L. Greason,Brian K. Whisenant,Robert W. Hodson,David L. Brown,William F. Fearon,Mark J. Russo,Philippe Pibarot,Rebecca T. Hahn,Wael A. Jaber,Erin Rogers,Ke Xu,Jaime Wheeler,Maria C. Alu,Craig R. Smith,Martin B. Leon
Comparative Study, Journal Article, Multicenter Study, Randomized Controlled Trial, Research Support, Non-U.S. Gov’t
There are scant data on long-term clinical outcomes and bioprosthetic-valve function after transcatheter aortic-valve replacement (TAVR) as compared with surgical aortic-valve replacement in patients with severe aortic stenosis and intermediate surgical risk.
We enrolled 2032 intermediate-risk patients with severe, symptomatic aortic stenosis at 57 centers. Patients were stratified according to intended transfemoral or transthoracic access (76.3% and 23.7%, respectively) and were randomly assigned to undergo either TAVR or surgical replacement. Clinical, echocardiographic, and health-status outcomes were followed for 5 years. The primary end point was death from any cause or disabling stroke.
At 5 years, there was no significant difference in the incidence of death from any cause or disabling stroke between the TAVR group and the surgery group (47.9% and 43.4%, respectively; hazard ratio, 1.09; 95% confidence interval [CI], 0.95 to 1.25; P = 0.21). Results were similar for the transfemoral-access cohort (44.5% and 42.0%, respectively; hazard ratio, 1.02; 95% CI, 0.87 to 1.20), but the incidence of death or disabling stroke was higher after TAVR than after surgery in the transthoracic-access cohort (59.3% vs. 48.3%; hazard ratio, 1.32; 95% CI, 1.02 to 1.71). At 5 years, more patients in the TAVR group than in the surgery group had at least mild paravalvular aortic regurgitation (33.3% vs. 6.3%). Repeat hospitalizations were more frequent after TAVR than after surgery (33.3% vs. 25.2%), as were aortic-valve reinterventions (3.2% vs. 0.8%). Improvement in health status at 5 years was similar for TAVR and surgery.
Among patients with aortic stenosis who were at intermediate surgical risk, there was no significant difference in the incidence of death or disabling stroke at 5 years after TAVR as compared with surgical aortic-valve replacement. (Funded by Edwards Lifesciences; PARTNER 2 Clinical
Trials.gov number, NCT01314313.).
Early Transmission Dynamics in Wuhan, China, of Novel Coronavirus–Infected Pneumonia
29-01-2020 – Qun Li,Xuhua Guan,Peng Wu,Xiaoye Wang,Lei Zhou,Yeqing Tong,Ruiqi Ren,Kathy S.M. Leung,Eric H.Y. Lau,Jessica Y. Wong,Xuesen Xing,Nijuan Xiang,Yang Wu,Chao Li,Qi Chen,Dan Li,Tian Liu,Jing Zhao,Man Liu,Wenxiao Tu,Chuding Chen,Lianmei Jin,Rui Yang,Qi Wang,Suhua Zhou,Rui Wang,Hui Liu,Yinbo Luo,Yuan Liu,Ge Shao,Huan Li,Zhongfa Tao,Yang Yang,Zhiqiang Deng,Boxi Liu,Zhitao Ma,Yanping Zhang,Guoqing Shi,Tommy T.Y. Lam,Joseph T. Wu,George F. Gao,Benjamin J. Cowling,Bo Yang,Gabriel M. Leung,Zijian Feng
The initial cases of novel coronavirus (2019-n
CoV)-infected pneumonia (NCIP) occurred in Wuhan, Hubei Province, China, in December 2019 and January 2020. We analyzed data on the first 425 confirmed cases in Wuhan to determine the epidemiologic characteristics of NCIP. We collected information on demographic characteristics, exposure history, and illness timelines of laboratory-confirmed cases of NCIP that had been reported by January 22, 2020. We described characteristics of the cases and estimated the key epidemiologic time-delay distributions. In the early period of exponential growth, we estimated the epidemic doubling time and the basic reproductive number. Among the first 425 patients with confirmed NCIP, the median age was 59 years and 56% were male. The majority of cases (55%) with onset before January 1, 2020, were linked to the Huanan Seafood Wholesale Market, as compared with 8.6% of the subsequent cases. The mean incubation period was 5.2 days (95% confidence interval [CI], 4.1 to 7.0), with the 95th percentile of the distribution at 12.5 days. In its early stages, the epidemic doubled in size every 7.4 days. With a mean serial interval of 7.5 days (95% CI, 5.3 to 19), the basic reproductive number was estimated to be 2.2 (95% CI, 1.4 to 3.9). On the basis of this information, there is evidence that human-to-human transmission has occurred among close contacts since the middle of December 2019. Considerable efforts to reduce transmission will be required to control outbreaks if similar dynamics apply elsewhere. Measures to prevent or reduce transmission should be implemented in populations at risk. (Funded by the Ministry of Science and Technology of China and others.).
Influenza in U.S. Detention Centers — The Desperate Need for Immunization
29-01-2020 – Carlo Foppiano Palacios,John J. Openshaw,Mark A. Travassos
Importation and Human-to-Human Transmission of a Novel Coronavirus in Vietnam
28-01-2020 – Lan T. Phan,Thuong V. Nguyen,Quang C. Luong,Thinh V. Nguyen,Hieu T. Nguyen,Hung Q. Le,Thuc T. Nguyen,Thang M. Cao,Quang D. Pham
Medical Journals and the 2019-nCoV Outbreak
27-01-2020 – Eric J. Rubin,Lindsey R. Baden,Stephen Morrissey,Edward W. Campion
Unethical International Nurse-Staffing Agencies — The Need for Legislative Action
22-01-2020 – Patricia Pittman,Adam R. Pulver
Conservative Oxygen Therapy during Mechanical Ventilation in the ICU
14-10-2019 – Geen auteurs bekend
Patients who are undergoing mechanical ventilation in the intensive care unit (ICU) often receive a high fraction of inspired oxygen (Fio We randomly assigned 1000 adult patients who were anticipated to require mechanical ventilation beyond the day after recruitment in the ICU to receive conservative or usual oxygen therapy. In the two groups, the default lower limit for oxygen saturation as measured by pulse oximetry (Spo The number of ventilator-free days did not differ significantly between the conservative-oxygen group and the usual-oxygen group, with a median duration of 21.3 days (interquartile range, 0 to 26.3) and 22.1 days (interquartile range, 0 to 26.2), respectively, for an absolute difference of -0.3 days (95% confidence interval [CI], -2.1 to 1.6; P = 0.80). The conservative-oxygen group spent more time in the ICU with an Fio In adults undergoing mechanical ventilation in the ICU, the use of conservative oxygen therapy, as compared with usual oxygen therapy, did not significantly affect the number of ventilator-free days. (Funded by the New Zealand Health Research Council; ICU-ROX Australian and New Zealand Clinical Trials Registry number, ACTRN12615000957594.).
Vaping-Induced Lung Injury
06-09-2019 – David C. Christiani
Pulmonary Illness Related to E-Cigarette Use in Illinois and Wisconsin — Preliminary Report
06-09-2019 – Jennifer E. Layden,Isaac Ghinai,Ian Pray,Anne Kimball,Mark Layer,Mark Tenforde,Livia Navon,Brooke Hoots,Phillip P. Salvatore,Megan Elderbrook,Thomas Haupt,Jeffrey Kanne,Megan T. Patel,Lori Saathoff-Huber,Brian A. King,Josh G. Schier,Christina A. Mikosz,Jonathan Meiman
E-cigarettes are battery-operated devices that heat a liquid and deliver an aerosolized product to the user. Pulmonary illnesses related to e-cigarette use have been reported, but no large series has been described. In July 2019, the Wisconsin Department of Health Services and the Illinois Department of Public Health received reports of pulmonary disease associated with the use of e-cigarettes (also called vaping) and launched a coordinated public health investigation. We defined case patients as persons who reported use of e-cigarette devices and related products in the 90 days before symptom onset and had pulmonary infiltrates on imaging and whose illnesses were not attributed to other causes. Medical record abstraction and case patient interviews were conducted with the use of standardized tools. There were 53 case patients, 83% of whom were male; the median age of the patients was 19 years. The majority of patients presented with respiratory symptoms (98%), gastrointestinal symptoms (81%), and constitutional symptoms (100%). All case patients had bilateral infiltrates on chest imaging (which was part of the case definition). A total of 94% of the patients were hospitalized, 32% underwent intubation and mechanical ventilation, and one death was reported. A total of 84% of the patients reported having used tetrahydrocannabinol products in e-cigarette devices, although a wide variety of products and devices was reported. Syndromic surveillance data from Illinois showed that the mean monthly rate of visits related to severe respiratory illness in June through August of 2019 was twice the rate that was observed in the same months in 2018. Case patients presented with similar clinical characteristics. Although the features of e-cigarette use that were responsible for injury have not been identified, this cluster of illnesses represents an emerging clinical syndrome or syndromes. Additional work is needed to characterize the pathophysiology and to identify the definitive causes.