Short-Term Joint Effects of PM10, NO2 and SO2 on Cardio-Respiratory Disease Hospital Admissions in Cape Town, South Africa

Background/Aim: In sub-Sahara Africa, few studies have investigated the short-term association between hospital admissions and ambient air pollution. Therefore, this study explored the association between multiple air pollutants and hospital admissions in Cape Town, South Africa. Methods: Generalized additive quasi-Poisson models were used within a distributed lag linear modelling framework to estimate the cumulative effects of PM10, NO2, and SO2 up to a lag of 21 days. We further conducted multi-pollutant models and stratified our analysis by age group, sex, and season. Results: The overall relative risk (95% confidence interval (CI)) for PM10, NO2, and SO2 at lag 0–1 for hospital admissions due to respiratory disease (RD) were 1.9% (0.5–3.2%), 2.3% (0.6–4%), and 1.1% (−0.2–2.4%), respectively. For cardiovascular disease (CVD), these values were 2.1% (0.6–3.5%), 1% (−0.8–2.8%), and −0.3% (−1.6–1.1%), respectively, per inter-quartile range increase of 12 µg/m3 for PM10, 7.3 µg/m3 for NO2, and 3.6 µg/m3 for SO2. The overall cumulative risks for RD per IQR increase in PM10 and NO2 for children were 2% (0.2–3.9%) and 3.1% (0.7–5.6%), respectively. Conclusion: We found robust associations of daily respiratory disease hospital admissions with daily PM10 and NO2 concentrations. Associations were strongest among children and warm season for RD.

The Use of Convalescent Plasma (CP) Transfusion Therapy in Moderate to Severe COVID-19 Patients: a Single Center Experience in Indonesia

Background: Coronavirus disease 2019 (COVID-19) was declared as a world pandemic since early 2020. There was no specific antiviral agent that appeared to be active against the virus, and antiviral agent such as remdesivir, favipiravir were in limited supply. We evaluated the use of convalescent plasma (CP) administered as adjuctive treatment to standard of care in moderate to severe COVID-19 patients. Methods: We conducted a series of 9 moderate to severe patients of COVID-19 older than 18 years received CP transfusion from 9 recovered donors at a single institution (Sulianti Saroso Infectious Disease Hospital, Jakarta, Indonesia) from January 2021 to June 2021. Results: Out of 9 patients (age range 30-81 years, 6 males and 3 female), and all patients received at least 1 or 2 unit of 200 mL of CP from 9 recovered donors. There were 4 patients (age range 30-71 years, 4 male) that were not treated with antiviral therapy. Of the 9 patients, 2 severe cases were died, while all of moderate cases survived and they were discharged from the hospital (length of stay: 8-22 days). Conclusion: Our experience showed that CP transfusion in moderate COVID-19 patients might provide clinical benefit and it was well-tolerated. However, further development clinical trials with better designs and greater power is needed to evaluate the efficacy and safety of this treatment.

Experiences of COVID-19 patients admitted in a government infectious disease hospital in Nepal and its implications for health system strengthening: A qualitative study

Introduction The COVID-19 pandemic has affected the health systems in many ways. It has put unprecedented strain on health systems worldwide and exposed gaps in public health infrastructure. A health system comprises all institutions and resources working towards improving and maintaining health. Among the different aspects of health system strengthening, a patient’s experiences and expectations play a crucial role in determining how well the health facilities function. This study aims to explore health system strengthening’s implications based on experiences and feedback provided by COVID-19 patients admitted to a government tropical and infectious disease hospital in Nepal. Methods In this qualitative study, we collected the voluntary handwritten feedback by the admitted COVID-19 patients to document the feedback and experiences from a book, maintained by the hospital. We performed thematic content analysis using the World Health Organization’s six building blocks of health system as a theoretical framework which included service delivery, health workforce, information, leadership and governance, financing, and access to medicines. Results Most patients in this study had positive experiences on service delivery and health workforce. Some also highlighted the gaps in infrastructure, cleanliness, and hygiene. Many suggested positive experiences on other dimensions of the health system such as financing, governance and leadership, and access to medicines reflected upon by the patients’ thankfulness to the hospital and the government for the treatment they received. The responses also reflected the inter-connectedness between the different building blocks of health system. Conclusion This study approached a unique way to strengthen the health system by exploring patients’ feedback, which suggested an overall positive impression on most building blocks of health system. However, it also highlighted certain gaps in infrastructure, cleanliness, and hygiene. It reinforces the hospital management and government’s role to continue its efforts to strengthen the health system.

Epidemiology and factors of tuberculosis treatment outcome, Bangladesh, 2012-13

Tuberculosis (TB) treatment outcome is an important indicator to improve TB control efforts. We assessed factors associated with unfavorable treatment outcomes among smear-positive pulmonary TB patients reported to the national TB program from January 2012 to December 2013 in Bangladesh. Favorable outcomes were cured and treatment completed with unfavorable outcomes as failed, defaulted, died and lost to follow-up. We retrieved 98,932 patients with outcome data; 65,458 (66%) were male and 7,956 (8%) had unfavorable outcomes (3,737 (47%) died, 1,641 (21%) defaulted, and 1,599 (20%) lost to follow-up). In multivariable analysis, male gender (adjusted odds ratio [aOR] 1.41; 95% confidence interval [CI] 1.34-1.49) and treatment at a chest disease hospital (CDH) (aOR 1.44; 95% CI 1.25-1.66) were risk factors. The association between male gender and unfavorable outcomes may result from the high smoking rates among males in Bangladesh. The association of treatment at a CDH with unfavorable outcomes may occur because complicated cases (e.g., TB with co-infections) are usually treated in a chest hospital in Bangladesh. A case-control study could further confirm and explain these findings.

Economic Impact of SARS-COV2 Infection in the Department of Diagnostic Imaging

The COVID-19 pandemic caused an unprecedented effect on national radiological investigations. Since the World Health Organization officially declared the COVID-19 as a global pandemic, health policies have been rapidly organized to limit the spread of the virus and decrease the risk of exposure. These restrictions, in combination with home-stay arrangements and the onset of economic recession. As a result of public policies, financial difficulties and patient fear, many radiology departments have suffered a significant reduction in diagnostic examinations with important implications for their economic stability. The aim of this work is to evaluate the economic impact of the COVID-19 pandemic in the Radiology Department of an infectious disease hospital.

Does apparent temperature modify the effects of air pollution on respiratory disease hospital admissions in an industrial area of South Africa?

Background: Temperature and air pollution are often treated as separate risk factors and very few studies have investigated effect modification by temperature on air pollution, and the impact of this interaction on human health in Africa. This study therefore investigated the modifying effects of temperature on the association between air pollution and Respiratory disease (RD) hospital admission in South Africa. Methods: RD admission data (ICD10 J00-J99) were obtained from two hospitals located in Secunda, South Africa beween 1 January 2011 to 31 October 2016. NO2, SO2, PM10, PM2.5, temperature and relative humidity data were obtained from the South African Weather Services. A case-crossover epidemiological study design was applied and lag0-1 was used. Models were adjusted for public holidays and Apparent Temperature (Tapp). Tapp was classified as warm (Tapp>75th percentile), cold (Tapp<25th percentile) and normal (Tapp 25th-75th percentile). Results: Of the 14 568 RD admissions, approximately equal number of females and males were admitted. The average daily NO2, SO2, PM2.5 and PM10 levels were 12.4 μm/m3, 8.5 μm/m3, 32.3 μm/m3 and 68.6 μm/m3, respectively. Overall, a 10 μm/m3 increase in SO2 on warm days was associated with an increase in RD hospital admissions among the patients by 8.5% (95% Conf. Int: 0.4%, 17.2%) and 8.4% (95% Conf. Int: 0.3%, 17.1%) after adjustment for PM2.5 and PM10 respectively. However, increasing PM2.5 or PM10 by 10 μm/m3 was associated with an increase in RD hospital admissions when the temperature was normal after adjusting for SO2. On cold days there were significant associations between the SO2 and RD admissions among the 0-14 year age group after adjusting for either PM2.5 (6.5%; 95% Conf.Int: 0.9%, 12.4%) or PM10 (5.5%; 95% Conf.Int: 0.3%, 11.1%). Conclusions: SO2 was affected by extremes of temperature while the particulate matters had effect on RD admission during normal temperature in Secunda.

The course of labor in term patients with concomitant acute intestinal infections

BACKGROUND: Literature data on the course of labor in women with concomitant acute intestinal infections are very scarce. Individual works and articles are devoted to the coverage of this most important final stage of pregnancy. There are no developed specific tactics of labor management in patients with acute intestinal infections, therefore obstetricians and gynecologists have to use generally accepted standards of labor management in this group of patients, without having a clear idea of the frequency and nature of clinically relevant complications in childbirth. AIM: The aim of this study was to evaluate the course of labor in women with concomitant AIIs at full-term pregnancy. MATERIALS AND METHODS: We examined 120 patients aged 19 to 39 years, delivered in Clinical Infectious Disease Hospital named after S.P. Botkin, St. Petersburg in 2017-2019. The main group consisted of 60 women with concomitant acute intestinal infections who gave birth, and the comparison group comprised 60 conditionally healthy women. The spectrum of acute intestinal infection pathogens in pregnant women, the course of labor, complications during labor and the condition of newborns were evaluated. RESULTS: Women of the both study groups did not differ in the duration of labor and the anhydrous interval, the frequency of birth abnormalities, the volume of blood loss, and the frequency of maternal injury and complications in the postpartum period. The frequency of premature rupture of membranes, acute and chronic fetal hypoxia, and episiotomy was higher in patients of the main group. Asphyxia in the first minute after birth was also more common in newborns from women with concomitant acute intestinal infections. CONCLUSIONS: Acute intestinal infections may complicate the course of labor. Labor management in women with concomitant acute intestinal infections requires continuous monitoring of the condition of the fetus during labor and the provision of timely medical care to the newborn.