Clinical and molecular epidemiological features of coronavirus HKU1-associated community-acquired pneumonia

Background. Recently, we described the discovery of a novel group 2 coronavirus, coronavirus HKU1 (CoV-HKU1), from a patient with pneumonia. However, the clinical and molecular epidemiological features of CoV-HKU1-associated pneumonia are unknown. Methods. Prospectively collected (during a 12-month period) nasopharyngeal aspirates (NPAs) from patients with community-acquired pneumonia from 4 hospitals were subjected to reverse-transcription polymerase chain reaction, for detection of CoV-HKU1. The epidemiological, clinical, and laboratory characteristics of patients with CoV-HKU1-associated pneumonia were analyzed. The pol, spike (S), and nucleocapsid (N) genes were also sequenced. Results. NPAs from 10 (2.4%) of 418 patients with community-acquired pneumonia were found to be positive for CoV-HKU1. All 10 cases occurred in spring and winter. Nine of these patients were adults, and 4 had underlying diseases of the respiratory tract. In the 6 patients from whom serum samples were available, all had a 4-fold change in immunoglobulin (Ig) G titer and/or presence of IgM against CoV-HKU1. The 2 patients who died had significantly lower hemoglobin levels, monocyte counts, albumin levels, and oxygen saturation levels on admission and had more-extensive involvement visible on chest radiographs. Sequence analysis of the pol, S, and N genes revealed 2 genotypes of CoV-HKU1. Conclusions. CoV-HKU1 accounts for 2.4% of community-acquired pneumonia, with 2 genotypes in the study population. Without performance of diagnostic tests, the illness was clinically indistinguishable from other community-acquired pneumonia illnesses. © 2005 by the Infectious Diseases Society of America. All rights reserved.published_or_final_versio

Towards sustainable urban development: the social acceptability of high-rise buildings in a Ghanaian city

Over the years, many city managers, policy makers and academics alike have turned to high-rise buildings as pathway to sustainable urban development. However, the sustainability of such types of development in various geographical contexts, especially in sub-Saharan Africa, is a subject less explored. Amidst the promotion of high-rise development in a rapidly urbanizing metropolis in Ghana, Kumasi, the research empirically examined the social acceptability of high-rise residential facilities and the institutional capacity for their effective management. By conducting face-to-face interviews with sampled households, and critical public service providers in the metropolis, the study uncovered that, contrary to the evidence from many Asian cities, there is generally low social acceptability of high-rise developments, and a weak institutional capacity for effective service delivery. The research concludes that, whilst it is tempting to embrace high-rise buildings as sustainable development pathway, it is crucial they are pursued with much circumspection. In addition to their design being tailored to the local needs of the people for whom they are built, the promotion of high-rise development should recognize the importance of effective service delivery, and general social acceptability

Susceptibility patterns of clinical and fish isolates of Laribacter hongkongensis: Comparison of the Etest, disc diffusion and broth microdilution methods

Objectives: To determine the antibiotic susceptibility patterns of 60 strains of Laribacter hongkongensis isolated from humans and fish to eight antibiotics and compare the results obtained from broth microdilution, Etest and disc diffusion susceptibility testing. Patients and methods: The susceptibilities of 60 isolates of L. hongkongensis from humans with gastroenteritis and fish to eight antibiotics were tested by three methods [broth microdilution (reference method), Etest and disc diffusion] and their results were compared. Results: All isolates were susceptible to imipenem and ciprofloxacin by all three methods, except for one strain which was resistant to ciprofloxacin by broth microdilution. All were susceptible to ampicillin/ sulbactam by Etest and disc diffusion, but eight were resistant by broth microdilution. By broth microdilution, 90%, 100%, 46.7%, 100% and 8.3% of isolates were resistant to ampicillin, ceftriaxone, cefuroxime, erythromycin and tetracycline, respectively. Although broth microdilution generally yielded higher MICs of β-lactams, MICs obtained with Etest were in good correlation with broth microdilution for all drugs except ampicillin/sulbactam, with >90% agreement within 2 log2 dilutions for imipenem, ciprofloxacin, erythromycin and tetracycline. Comparison of susceptibilities between broth microdilution and the other two methods showed the highest (>95%) percentage agreement for imipenem, ciprofloxacin and tetracycline. The highest discrepancies were observed with erythromycin (58.3% agreement), with an apparent increase in susceptibility by disc diffusion. A higher proportion of human isolates than fish isolates were tetracycline-resistant by all three tests (P = 0.022). Conclusions: Etest and disc diffusion appear to be reliable for evaluation of susceptibilities of L. hongkongensis to imipenem, ciprofloxacin and tetracycline. However, these methods may underestimate resistance to other β-lactams. © The Author 2009. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved.link_to_subscribed_fulltex

The contribution of comorbidities to mortality in hospitalized patients with heart failure

BACKGROUND: Heart failure (HF) with reduced ejection fraction (HFrEF) has a worse prognosis than HF with preserved EF (HFpEF). The study aimed to evaluate whether different comorbidity profiles of HFrEF- and HFpEF-patients or HF-specific mechanisms contribute to a greater extent to this difference. METHODS: We linked data from two health insurances to data from a cardiology clinic hospital information system. Patients with a hospitalization with HF in 2005–2011, categorized as HFrEF (EF < 45%) or HFpEF (EF ≥ 45%), were propensity score (PS) matched to controls without HF on comorbidites and medication to assure similar comorbidity profiles of patients and their respective controls. The balance of the covariates in patients and controls was compared via the standardized difference (SDiff). Age-standardized 1-year mortality rates (MR) with 95% confidence intervals (CI) were calculated. RESULTS: 777 HFrEF-patients (1135 HFpEF-patients) were PS-matched to 3446 (4832) controls. Balance between patients and controls was largely achieved with a SDiff < 0.1 on most variables considered. The age-standardized 1-year MRs per 1000 persons in HFrEF-patients and controls were 267.8 (95% CI 175.9–359.8) and 86.1 (95% CI 70.0–102.3). MRs in HFpEF-patients and controls were 166.2 (95% CI 101.5–230.9) and 61.5 (95% CI 52.9–70.1). Thus, differences in MRs between patients and their controls were higher for HFrEF (181.7) than for HFpEF (104.7). CONCLUSIONS: Given the similar comorbidity profiles between HF-patients and controls, the higher difference in mortality rates between HFrEF-patients and controls points more to HF-specific mechanisms for these patients, whereas for HFpEF-patients a higher contribution of comorbidity is suggested by our results