The Silent Suffering of Jane Doe: Negligence of Mental Health Problems in Daily Practice

N

Resurgence of common respiratory viruses in patients with community-acquired pneumonia (CAP) - a prospective multicenter study

Background Community-acquired pneumonia (CAP) is a major global cause of death and hospitalization. Bacteria or community-acquired viruses (CARVs) cause CAP. COVID-19 associated restrictions effectively reduced the circulation of CARVs. Objectives The aim of this study was to analyze the proportion of CARVs in adult patients with CAP from mid-2020 to mid-2023. Specifically, we aimed to compare the rate of influenza virus, SARS-CoV-2, and RSV detections in patients aged 18–59 years and ≥60 years. Study design We analyze the proportion of 21 community-acquired respiratory viruses (CARVs) and three atypical bacteria (Bordetella pertussis, Legionella pneumophila, and Mycoplasma pneumoniae) in nasopharyngeal swab samples using molecular multiplex methods within the prospective, multicentre, multinational study of the German study Group CAPNETZ. We used stringent inclusion criteria throughout the study. Results We identified CARVs in 364/1,388 (26.2 %) patients. In detail, we detected SARS-CoV-2 in 210/1,388 (15.1 %), rhino-/enterovirus in 64/1,388 (4.6 %), influenza virus in 23/1,388 (1.6 %) and RSV in 17/1,388 (1.2 %) of all patients. We detected RSV and influenza more frequently in patients ≥60 years, especially in 22/23 compared to the previous season. None of the atypical bacteria were detected. Conclusions Beginning in 2023, we demonstrate a re-emergence of CARVs in CAP patients. Effective vaccines or specific antiviral therapies for more than two thirds of the detected viral infections are currently available. High detection rates of vaccine-preventable viruses in older age groups support targeted vaccination campaigns

Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570

: On the production of researched knowledge in literature. Comparativestudy of literary research in francophone Africa.

Cette présente étude répond aux trois questions de recherche suivantes : Y-a-t-il une épistémologie africaine (francophone) ? Comment la méthodologie de la recherche littéraire se définit-elle ? Quelles sont les méthodes exactes employées par la recherche littéraire dans un contexte africain ? En nous appuyant sur l’oeuvre philosophique de Paulin J. Hountondji nous avons développé un concept de savoir africain. En l’absence des théories africaines sur la recherche littéraire nous recourrons aux théories formulées dans un contexte européen, par des chercheurs tels que Kathrin Busch, Ivan Jablonka et Corina Caduff. Ensuite, quatre oeuvres littéraires africaines, Wala Bok. Une histoire orale du hip hop au Sénégal de Fatou Kandé Senghor, Bribes d’une vie nigériane de Françoise Ugochukwu, La Gloire des imposteurs, lettres sur le Mali et l’Afrique d’Aminata Dramane Traoré et de Boubacar Boris Diop et Bogo. Notes de travail chez des potières à Bamako d’Emmanuelle Samson ont été analysées pour identifier les méthodes exactes employées par la recherche littéraire en Afrique.This study answers the following three research questions : Does an African (francophone) epistemology exist ? How is the methodology of literary research defined ? What are the exact methods used by literary research in Africa ? Building on the philosophical work of Paulin J. Hountondji we develop a concept of African knowledge. In the absence of African theories of literary research we call upon European theories proposed by researchers such as Kathrin Busch, Ivan Jablonka and Corina Caduff. Next, four literary works, Wala Bok. Une histoire orale du hip hop au Sénégal by Fatou Kandé Senghor, Bribes d’une vie nigériane by Françoise Ugochukwu, La Gloire des imposteurs, lettres sur le Mali et l’Afrique by Aminata Dramane Traoré and Boubacar Boris Diop and Bogo. Notes de travail chez des potières à Bamako by Emmanuelle Samson are analyzed to identify the exact literary research methods used in Africa

: On the production of researched knowledge in literature. Comparativestudy of literary research in francophone Africa.

Cette présente étude répond aux trois questions de recherche suivantes : Y-a-t-il une épistémologie africaine (francophone) ? Comment la méthodologie de la recherche littéraire se définit-elle ? Quelles sont les méthodes exactes employées par la recherche littéraire dans un contexte africain ? En nous appuyant sur l’oeuvre philosophique de Paulin J. Hountondji nous avons développé un concept de savoir africain. En l’absence des théories africaines sur la recherche littéraire nous recourrons aux théories formulées dans un contexte européen, par des chercheurs tels que Kathrin Busch, Ivan Jablonka et Corina Caduff. Ensuite, quatre oeuvres littéraires africaines, Wala Bok. Une histoire orale du hip hop au Sénégal de Fatou Kandé Senghor, Bribes d’une vie nigériane de Françoise Ugochukwu, La Gloire des imposteurs, lettres sur le Mali et l’Afrique d’Aminata Dramane Traoré et de Boubacar Boris Diop et Bogo. Notes de travail chez des potières à Bamako d’Emmanuelle Samson ont été analysées pour identifier les méthodes exactes employées par la recherche littéraire en Afrique.This study answers the following three research questions : Does an African (francophone) epistemology exist ? How is the methodology of literary research defined ? What are the exact methods used by literary research in Africa ? Building on the philosophical work of Paulin J. Hountondji we develop a concept of African knowledge. In the absence of African theories of literary research we call upon European theories proposed by researchers such as Kathrin Busch, Ivan Jablonka and Corina Caduff. Next, four literary works, Wala Bok. Une histoire orale du hip hop au Sénégal by Fatou Kandé Senghor, Bribes d’une vie nigériane by Françoise Ugochukwu, La Gloire des imposteurs, lettres sur le Mali et l’Afrique by Aminata Dramane Traoré and Boubacar Boris Diop and Bogo. Notes de travail chez des potières à Bamako by Emmanuelle Samson are analyzed to identify the exact literary research methods used in Africa

The Silent Suffering of Jane Doe: Negligence of Mental Health Problems in Daily Practice

NA</jats:p

Comparison of clinical outcomes in hospitalized patients with COVID-19 or non-COVID-19 community-acquired pneumonia in a prospective observational cohort study

&lt;jats:title&gt;Abstract&lt;/jats:title&gt;&lt;jats:sec&gt; &lt;jats:title&gt;Purpose&lt;/jats:title&gt; &lt;jats:p&gt;Coronavirus disease 2019 (COVID-19) and non-COVID-19 community-acquired pneumonia (NC-CAP) often result in hospitalization with considerable risks of mortality, ICU treatment, and long-term morbidity. A comparative analysis of clinical outcomes in COVID-19 CAP (C-CAP) and NC-CAP may improve clinical management.&lt;/jats:p&gt; &lt;/jats:sec&gt;&lt;jats:sec&gt; &lt;jats:title&gt;Methods&lt;/jats:title&gt; &lt;jats:p&gt;Using prospectively collected CAPNETZ study data (January 2017 to June 2021, 35 study centers), we conducted a comprehensive analysis of clinical outcomes including in-hospital death, ICU treatment, length of hospital stay (LOHS), 180-day survival, and post-discharge re-hospitalization rate. Logistic regression models were used to examine group differences between C-CAP and NC-CAP patients and associations with patient demography, recruitment period, comorbidity, and treatment.&lt;/jats:p&gt; &lt;/jats:sec&gt;&lt;jats:sec&gt; &lt;jats:title&gt;Results&lt;/jats:title&gt; &lt;jats:p&gt;Among 1368 patients (C-CAP: n = 344; NC-CAP: n = 1024), C-CAP showed elevated adjusted probabilities for in-hospital death (aOR 4.48 [95% CI 2.38–8.53]) and ICU treatment (aOR 8.08 [95% CI 5.31–12.52]) compared to NC-CAP. C-CAP patients were at increased risk of LOHS over seven days (aOR 1.88 [95% CI 1.47–2.42]). Although ICU patients had similar in-hospital mortality risk, C-CAP was associated with length of ICU stay over seven days (aOR 3.59 [95% CI 1.65–8.38]). Recruitment period influenced outcomes in C-CAP but not in NC-CAP. During follow-up, C-CAP was linked to a reduced risk of re-hospitalization and mortality post-discharge (aOR 0.43 [95% CI 0.27–0.70]).&lt;/jats:p&gt; &lt;/jats:sec&gt;&lt;jats:sec&gt; &lt;jats:title&gt;Conclusion&lt;/jats:title&gt; &lt;jats:p&gt;Distinct clinical trajectories of C-CAP and NC-CAP underscore the need for adapted management to avoid acute and long-term morbidity and mortality amid the evolving landscape of CAP pathogens.&lt;/jats:p&gt; &lt;/jats:sec&gt

Effect of Antiplatelet Therapy on Survival and Organ Support–Free Days in Critically Ill Patients With COVID-19

International audienc