Real-world corticosteroid use in severe pneumonia: a propensity-score-matched study

Background Community-acquired pneumonia (CAP) is a leading cause of morbidity and mortality worldwide despite correct antibiotic use. Corticosteroids have long been evaluated as a treatment option, but heterogeneous effects on survival have precluded their widespread implementation. We aimed to evaluate whether corticosteroids might improve clinical outcomes in patients with severe CAP and high inflammatory responses. Study design and methods We analyzed two prospective observational cohorts of patients with CAP in Barcelona and Rome who were admitted to intensive care with a high inflammatory response. Propensity score (PS) matching was used to obtain balance among the baseline variables in both groups, and we excluded patients with viral pneumonia or who received hydrocortisone. Results Of the 610 patients admitted with severe CAP, 198 (32%) received corticosteroids and 387 had major criteria for severe CAP. All patients had a baseline serum C-reactive protein above 15 mg/dL. Patients who received corticosteroids were more commonly male, had more comorbidities (e.g., cancer or chronic obstructive pulmonary disease), and presented with significantly higher sequential organ failure assessment scores. Eighty-nine patients met major severity criteria (invasive mechanical ventilation and/or septic shock) and were matched per group. Twenty-eight-day mortality was lower among patients receiving corticosteroids (16 patients, 18%) than among those not receiving them (28 patients, 31%; p = 0.037). After PS matching, corticosteroid therapy reduced the 28-day mortality risk in patients who met major severity criteria (hazard ratio (HR) 0.53, 95% confidence interval (CI) 0.29–0.98) (p = 0.043). In patients who did not meet major severity criteria, no benefits were observed with corticosteroid use (HR 0.88 (95%CI 0.32–2.36). Conclusions Corticosteroid treatment may be of benefit for patients with CAP who have septic shock and/or a high inflammatory response and requirement for invasive mechanical ventilation. Corticosteroids appear to have no impact on mortality when these features are not present.

Severe Testing and Characterization of Change Points in Climate Time Series

This paper applies misspecification (M-S) testing to the detection of abrupt changes in climate regimes as part of undertaking severe testing of climate shifts versus trends. Severe testing, proposed by Mayo and Spanos, provides severity criteria for evaluating statistical inference using probative criteria, requiring tests that would find any flaws present. Applying M-S testing increases the severity of hypothesis testing. We utilize a systematic approach, based on well-founded principles that combines the development of probative criteria with error statistical testing. Given the widespread acceptance of trend-like change in climate, especially temperature, tests that produce counter-examples need proper specification. Reasoning about abrupt shifts embedded within a complex times series requires detection methods sensitive to level changes, accurate in timing, and tolerant of simultaneous changes of trend, variance, autocorrelation, and red-drift, given that many of these measures may shift together. Our preference is to analyse the raw data to avoid pre-emptive assumptions and test the results for robustness. We use a simple detection method, based on the Maronna-Yohai (MY) test, then re-assess nominated shift-points using tests with varied null hypotheses guided by M-S testing. Doing so sharpens conclusions while avoiding an over-reliance on data manipulation, which carries its own assumptions.

CLINICAL PROFILE OF PLASMODIUM VIVAX MALARIA IN CHILDREN

Background: To study clinical presentations and complications of P. vivax malaria Methods: A prospective hospital-based clinical observational study was conducted on 100 patients under age of 14 years were enrolled in the study. Result: The most common presentation was fever followed by pallor. Among the total of 100 cases studied 2 cases died with a case fatality rate of 2%. Among the total of 100 cases studied 5 cases (10%) required ICU admission. Conclusion: P. vivax monoinfection tends to have severe complications in children. There is a need to review severity criteria for P. vivax malaria. Keywords: Vivax, Fever, ICU

Verification of the severity of damage to health with damage to the organ of vision

The eye-damage is one of the most significant causes of disability and blindness. In this study the possibilities of practical use of harm to health severity criteria in cases of eye-damages are considered and the illustration of their application is presented.

Evaluation of Severity Levels of the Athens Insomnia Scale Based on the Criterion of Insomnia Severity Index

The Athens Insomnia Scale (AIS) can be regarded as a highly useful instrument in both clinical and research settings, except for when assessing the severity level. This study aims to determine the severity criteria for AIS by using the Insomnia Severity Index (ISI). A total of 1666 government employees aged 20 years or older were evaluated using the AIS and ISI, the Patient Health Questionnaire for depressive symptoms, the Epworth Sleepiness Scale for daytime sleepiness, and the Short Form Health Survey of the Medical Outcomes Study for health-related quality of life (QoL). A significant positive correlation (r) was found between the AIS and the ISI (r = 0.80, p < 0.001). As a result of describing receiver–operator curves, the severity criteria of the AIS are capable of categorizing insomnia severity as follows: absence of insomnia (0–5), mild insomnia (6–9), moderate insomnia (10–15), and severe insomnia (16–24). In addition, compared to all scales across groups categorized by AIS or ISI, it was revealed that similar results could be obtained (all p < 0.05). Therefore, the identification of the severity of AIS in this study is important in linking the findings of epidemiological studies with those of clinical studies.

Hemodynamic Profiles of Cardiogenic Shock Depending on Their Etiology

The pathophysiology of cardiogenic shock (CS) varies depending on its etiology, which may lead to different hemodynamic profiles (HP) and may help tailor therapy. We aimed to assess the HP of CS patients according to their etiologies of acute myocardial infarction (AMI) and acute decompensated chronic heart failure (ADCHF). We included patients admitted for CS secondary to ADCHF and AMI. HP were measured before the administration of any inotrope or vasopressor. Systemic Vascular Resistances index (SVRi), Cardiac Index (CI), and Cardiac Power Index (CPI) were measured by trans-thoracic Doppler echocardiography on admission. Among 37 CS patients, 28 had CS secondary to ADCHF or AMI and were prospectively included. The two groups were similar in terms of demographic data and shock severity criteria. AMI CS was associated with lower SVRi compared to CS related to ADCHF: 2010 (interquartile range (IQR): 1895–2277) vs. 2622 (2264–2993) dynes-s·cm−5·m−2 (p = 0.002). A trend toward a higher CI was observed: respectively 2.13 (1.88–2.18) vs. 1.78 (1.65–1.96) L·min−1·m−2 (p = 0.067) in AMICS compared to ADCHF. CS patients had different HP according to their etiologies. AMICS had lower SVR and tended to have a higher CI compared to ADHF CS. These differences should be taken into account for patient selection in future research.

Predictive Methodology for the Quantification of Environmental Aspects in Urban Infrastructures

The interest in sustainability in the construction industry arose in the 1990s, and current studies have created models to predict environmental aspects. Previous quantitative research to investigate environmental aspects was based on the perception of specialists. The present article proposes a methodology applicable to urban infrastructure activities in order to quantify environmental aspects by applying duration and severity criteria, using calculations founded in the scientific literature. The quantitative methodology to assess environmental aspects calculated ten aspects for six construction activities based on duration and severity criteria, eliminating the judgement of the latter criterion of earlier methodologies. The results revealed five significant environmental aspects: greenhouse gas emissions, energy use, noise pollution, water pollution, and soil pollution, due to the type of construction, which required a large amount of equipment that impacted the atmosphere, soil, and water. Possibly for the first time, urban projects can be objectively assessed based on a methodology that quantifies environmental aspects in the pre-construction phase.