Serum neopterin levels in relation to mild and severe COVID-19

Background: The COVID-19 pandemic, caused by the coronavirus SARS-CoV-2, is rapidly spreading worldwide. There is limited information about prognostic markers that could help clinicians to identify COVID-19 patients with a poor prognosis. Serum levels of the immune activation marker neopterin has shown to be of prognostic value in patients with SARS. The aim of this study was to investigate whether serum neopterin is associated with the severity of COVID-19. Methods: We included 34 patients with confirmed COVID-19 between March 3 and March 30, 2020. Fifteen patients had mild disease and did not require hospitalization, whereas 19 patients developed severe COVID-19 requiring intensive care. Concentrations of serum neopterin, tryptophan, and kynurenine were measured at and repeatedly after inclusion. Results: We found a more than two-fold higher mean concentration of neopterin in severely ill patients (mean value 42.0 nmol/L (SD 18.2)) compared to patients with mild symptoms (16.9 nmol/L (SD 11.0)). All of the severe cases had elevated neopterin concentrations (> 9.1 nmol/L) at the initial sampling with values ranging from 17.2 to 86.7 nmol/L. In comparison, 10 of 15 patients with mild disease had neopterin levels above 9.1 nmol/L, with concentrations in the range from 4.9 to 31.6 nmol/L. Neopterin levels gradually decreased during the course of COVID-19, but severe cases maintained elevated levels for a longer period. Moreover, lower levels of tryptophan and higher levels of kynurenine, indicating an increased tryptophan catabolism, were seen in the group with severe cases. Conclusions: In conclusion, we found that serum neopterin levels are associated with the severity of COVID-19. Our findings suggest that neopterin could be used as a prognostic marker, but further studies are needed to elucidate how it can be used in the clinic

Body Mass Index in young women and risk of cardiomyopathy: a long-term follow-up study in Sweden

Incidence rates of cardiomyopathies, which are a common cause of heart failure in young people, have increased during the last decades. An association between body weight in adolescence and future cardiomyopathy among men was recently identified. Whether or not this holds true also for women is unknown. The aim was therefore to determine whether for young women being overweight or obese is associated with a higher risk of developing cardiomyopathy. This was a registry-based national prospective cohort study with data collected from the Swedish Medical Birth Register, 1982 to 2014, with up to 33 years of follow-up. Included women were of childbearing age (18-45 years) during the initial antenatal visit in their first or second pregnancy (n=1 393 346). We obtained baseline data on body mass index (BMI), smoking, education, and previous disorders. After exclusions, mainly because of previous disorders, the final sample was composed of 1 388 571 women. Cardiomyopathy cases were identified by linking the Medical Birth Register to the National Patient and Cause of Death registers. In total, we identified 1699 cases of cardiomyopathy (mean age at diagnosis, 46.2 [SD 9.1] years) during the follow-up with an incidence rate of 5.9 per 100 000 observation years. Of these, 481 were diagnosed with dilated cardiomyopathy, 246 had hypertrophic cardiomyopathy, 61 had alcohol/drug-induced cardiomyopathy, and 509 had other forms. The lowest risk for being diagnosed with a cardiomyopathy was detected at a BMI of 21 kg/m , with a gradual increase in risk with higher BMI, particularly for dilated cardiomyopathy, where a hazard ratio of 4.71 (95% CI, 2.81-7.89) was found for severely obese subjects (BMI ≥35 kg/m ), as compared with BMI 20 to <22.5. Elevated BMI among young women was associated with an increased risk of being diagnosed with a subsequent cardiomyopathy, especially dilated cardiomyopathy, starting already at mildly elevated body weight, whereas severe obesity entailed an almost 5-fold increase in risk. With the increasing numbers of persons who are overweight or obese, higher rates of cardiomyopathy can be expected in the future, along with an altered disease burden related to adiposity

No effect of remdesivir or betamethasone on upper respiratory tract SARS-CoV-2 RNA kinetics in hospitalised COVID-19 patients: a retrospective observational study

Background The viral kinetics of SARS-CoV-2 has been considered clinically important. While remdesivir and corticosteroids are recommended for COVID-19 patients requiring oxygen support, there is a limited number of published reports on viral kinetics in hospitalised patients with COVID-19 treated with remdesivir or corticosteroids. Methods We conducted a retrospective study by collecting longitudinal samples from the nasopharynx/throat of 123 hospitalised patients (median age 55 years, 74% male) with COVID-19, to evaluate the effects of remdesivir and corticosteroid treatment on viral RNA levels. The subjects were divided into four groups: those receiving remdesivir (n = 25), betamethasone (n = 41), both (n = 15), or neither (n = 42). Time to viral RNA clearance was analysed using Kaplan-Meier plots, categorical data were analysed using Fisher\u27s exact test, and Kruskal-Wallis for continuous data. Viral RNA decline rate was analysed using a mixed effect model. Results We found no significant difference in SARS-CoV-2 RNA decline rate or time to SARS-CoV-2 RNA clearance between the groups. Moreover, clinical status at baseline was not correlated with time to viral clearance. Conclusions Since SARS-CoV-2 RNA kinetics was not affected by treatment, repeated sampling from the upper respiratory tract cannot be used to evaluate treatment response

COVID-19 in people aged 18-64 in Sweden in the first year of the pandemic: Key factors for severe disease and death

Background: Studies on risk factors for severe COVID-19 in people of working age have generally not included non-working persons or established population attributable fractions (PAFs) for occupational and other factors. Objectives: We describe the effect of job-related, sociodemographic, and other exposures on the incidence, relative risks and PAFs of severe COVID-19 in individuals aged 18–64. Methods: We conducted a registry-based study in Swedish citizens aged 18–64 from 1 January 2020 to 1 February 2021 with respect to COVID-19-related hospitalizations and death. Results: Of 6,205,459 persons, 272,043 (7.5%) were registered as infected, 3399 (0.05%) needed intensive care, and 620 (0.01%) died, with an estimated case fatality rate of 0.06% over the last 4-month period when testing was adequate. Non-Nordic origin was associated with a RR for need of intensive care of 3·13, 95%CI 2·91–3·36, and a PAF of 32·2% after adjustment for age, sex, work, region and comorbidities. In a second model with occupation as main exposure, and adjusted for age, sex, region, comorbidities and origin, essential workers had an RR of 1·51, 95%CI, 1·35–1·6, blue-collar workers 1·18, 95%CI 1·06–1·31, school staff 1·21, 95%CI 1·01–1·46, and health and social care workers 1·89, 95%CI 1·67–2·135) compared with people able to work from home, with altogether about 13% of the PAF associated with these occupations. Essential workers and blue-collar workers, but no other job categories had higher risk of death, adjusted RRs of 1·79, 95%CI 1·34–2·38 and 1·37, 95%CI 1·04–1·81, with adjusted PAFs of altogether 9%. Conclusion: Among people of working age in Sweden, overall mortality and case fatality were low. Occupations that require physical presence at work were associated with elevated risk of needing intensive care for COVID-19, with 14% cases attributable to this factor, and 9% of deaths

A search for resonances decaying into a Higgs boson and a new particle X in the XH→qqbb final state with the ATLAS detector

A search for heavy resonances decaying into a Higgs boson ($H$) and a new particle ($X$) is reported, utilizing 36.1 fb$^{-1}$ of proton-proton collision data at $\sqrt{s} =$ 13 TeV collected during 2015 and 2016 with the ATLAS detector at the CERN Large Hadron Collider. The particle $X$ is assumed to decay to a pair of light quarks, and the fully hadronic final state $XH \rightarrow q\bar q'b\bar b$ is analysed. The search considers the regime of high $XH$ resonance masses, where the $X$ and $H$ bosons are both highly Lorentz-boosted and are each reconstructed using a single jet with large radius parameter. A two-dimensional phase space of $XH$ mass versus $X$ mass is scanned for evidence of a signal, over a range of $XH$ resonance mass values between 1 TeV and 4 TeV, and for $X$ particles with masses from 50 GeV to 1000 GeV. All search results are consistent with the expectations for the background due to Standard Model processes, and 95% CL upper limits are set, as a function of $XH$ and $X$ masses, on the production cross-section of the $XH\rightarrow q\bar q'b\bar b$ resonance

Body mass index and mental health in young people - predictors of early heart failure and cardiomyopathy

Heart failure among young people is rare, but in contrast to decreasing incidence rates overall, recent studies have found increasing rates among the young over the last decades. Concomitantly, cardiomyopathies, which is a common underlying condition to heart failure at a young age, have more than doubled in Sweden for unknown reasons. Two phenomena that coincide with these trends are rising rates of overweight and mental illness in young people. The overall aim of this thesis was therefore to investigate if body mass index (BMI), nonpsychotic mental disorders, and stress resilience (susceptibility to stressful events) at a young age, are associated with early heart failure and cardiomyopathy. We obtained information on BMI and mental disorders from the Swedish Military Service Conscription Register, and the Medical Birth Register. By linking data to the National Patient and Cause of Death registers, which is a unique possibility in Sweden thanks to our personal identification numbers, we identified cases of early heart failure and cardiomyopathy in large population cohorts of 1.7 million men and 1.4 million women during a follow-up of up to 46 years. We found that elevated BMI in young people is associated with an increased risk of early heart failure and cardiomyopathy (Papers I, III, IV). The increased risk was detectable already at BMI-levels considered mid- to high-normal for adolescent men (BMI 20–25), whereas, for cardiomyopathy, women of childbearing age had an elevated risk from BMI 25. There was a gradual increase in risk with increasing BMI, regardless of gender, such that severe obesity (BMI ≥35) entailed a nine-fold increase in risk for early heart failure and cardiomyopathy among men, and a five-fold higher risk for cardiomyopathy among women. Furthermore, we found that nonpsychotic mental disorders in adolescent males, as well as low stress resilience, are associated with an elevated risk of early heart failure (Paper II). Given the current increase in body weight and mental illness among young people, physicians need to be aware of a potential future increase in heart failure and cardiomyopathy cases. The present findings emphasize the already marked importance of weight control in youth, which is essential to curb the obesity epidemic and to prevent the consequences related to it. This should go hand in hand with intensified efforts to prevent mental illness among young people

Waiting Time at the Emergency Department from a Gender Equality Perspective

Master thesis, Programme in Medicine. TITLE: Waiting Time at the Emergency Department from a Gender Equality Perspective. Introduction Increasing patient load and longer waiting times at the emergency departments are well-known phenomena. A central function is the so-called triage system for prioritization of the patients. Only a few studies address the question if there is a gender bias in triaging and waiting time. Aim To quantify gender effects in a large mixed population of patients seeking health care at a large emergency department and, on the basis of the magnitude of the gender difference in subpopulations draw conclusions regarding possible causes of observed gender effects. Methods The patient material consisted of all cases seeking medical care at the emergency ward of the Östra Hospital during 2009-2012. They were divided into subgroups on the basis of gender, chief complaint, age and socioeconomic status. A standardized formula (RETTSTM) was used in the triaging process and the patients were prioritized with one of five colors. Three time registrations were recorded; time to triage (TTT), time to doctor (TTD) and total lead time (TLT). Results 135 417 patients were included in the study with a mean age of 54,2 years. They came from all parts of Gothenburg. Men were more often triaged red/orange and women more often green/yellow. There was no gender difference in TTT. The mean TTD and TLT were significantly longer for females than for males in the entire material, with an approximate magnitude of 15 minutes. The gender signal was seen independently of the chief complaint, in both medical and surgical cases. The signal disappeared among old seriously ill patients and among patients from residence areas with high socioeconomic status. Conclusion We observed differences in waiting times and triage priority levels that are hard to explain on the basis of presenting symptoms. The magnitude of the gender dependent signal was affected by age and socioeconomic status. Key words Waiting Time at the Emergency Department from a Gender Equality Perspective,, waiting times, gender, age, socioeconom

Los problemas fundamentales del personal de tropa de Carabineros de Chile (Temuco)

Tesis colección histórica Escuela de Trabajo Social: Cap. 1. Reseña histórica de "Carabineros de Chile"; Cap. 2. El alcoholismo considerado bajo los aspectos médico, social y moral; Cap. 3. Problemas médico-sociales; Cap. 4. Problemas de orden moral; Cap. 5. Problemas de orden jurídico Cap. 6. Problemas de orden económico; Cap. 7. Instrucción y cultura; Cap. 8. El servicio social en Carabineros de Temuco; Cap. 9. Conclusiones; Sugerencias para auspiciar un mejoramiento del personal de tropa de Carabineros; Bibliografía e Indice general.Ubicación: Trab.Social C198 1945 (Biblioteca Padre Felipe Gómez de Vidaurre #1550, Santiago

Body Weight in Adolescent Men in Sweden and Risk of an Early Acute Coronary Event: A Prospective Population‐Based Study

Background Coronary heart disease remains the dominant cause of death worldwide. To improve cardiovascular disease prevention, knowledge of early key risk factors, especially those that are modifiable, is essential. The ongoing global obesity epidemic is of particular concern. We aimed to determine whether body mass index at conscription predicts early acute coronary events among men in Sweden. Methods and Results This was a population‐based Swedish cohort study of conscripts (n=1 668 921; mean age, 18.3 years; 1968–2005), with follow‐up through linkage to the nationwide Swedish patient and death registries. Risk of a first acute coronary event (hospitalization for acute myocardial infarction or coronary death) during follow‐up (1–48 years) was calculated with generalized additive models. Objective baseline measures of fitness and cognition were included in the models in secondary analyses. During follow‐up, there were 51 779 acute coronary events, of which 6457 (12.5%) were fatal within 30 days. Compared with men at the lowest end of the normal body mass index spectrum (body mass index, 18.5 kg/m2), an increasing risk for a first acute coronary event was observed, with hazard ratios (HRs) peaking at 40 years of age. After multivariable adjustments, men with a body mass index of 35 kg/m2 had an HR of 4.84 (95% CI, 4.29–5.46) for an event before the age of 40 years. Conclusions An increased risk of an early acute coronary event was detectable within normal levels of body weight at the age of 18 years, increasing to almost 5‐fold in the highest weight category at 40 years of age. Given increasing levels of body weight and prevalence of overweight and obesity in young adults, the current decrease in coronary heart disease incidence in Sweden may flatten or even reverse in the near future

Higher body mass index in adolescence predicts cardiomyopathy risk in midlife: Long-term follow-up among Swedish men

Background: Modifiable lifestyle factors in relation to risk for cardiomyopathy, a common and increasing cause of heart failure in the young, have not been widely studied. We sought to investigate a potential link between obesity, a recognized predictor of early heart failure, in adolescence and being diagnosed with cardiomyopathy in adulthood. Methods: This was a nationwide register-based prospective cohort study of 1 668 893 adolescent men (mean age, 18.3 years; SD, 0.7 years) who enlisted for compulsory military service from 1969 to 2005. At baseline, body mass index (BMI), blood pressure, and medical disorders were registered, along with test results for fitness and muscle strength. Cardiomyopathy diagnoses were identified from the National Hospital Register and Cause of Death Register during an up to 46-year follow-up and divided into categories: dilated, hypertrophic, alcohol/drug-induced, and other. Hazard ratios were calculated with Cox proportional hazards models. Results: During follow-up (median, 27 years; Q1–Q3, 19–35 years), 4477 cases of cardiomyopathy were identified, of which 2631 (59%) were dilated, 673 (15%) were hypertrophic, and 480 (11%) were alcohol/drug-induced. Increasing BMI was strongly associated with elevated risk of cardiomyopathy, especially dilated, starting at levels considered normal (BMI, 22.5–8-fold increased risk at BMI ≥35 kg/m2 compared with BMI of 18.5 to <20 kg/m2. For each 1-unit increase in BMI, similarly adjusted hazard ratios were 1.15 (95% CI, 1.14–1.17) for dilated cardiomyopathy, 1.09 (95% CI, 1.06–1.12) for hypertrophic cardiomyopathy, and 1.10 (1.06–1.13) for alcohol/drug-induced cardiomyopathy. Conclusions: Even mildly elevated body weight in late adolescence may contribute to being diagnosed with cardiomyopathy in adulthood. The already marked importance of weight control in youth is further strengthened by these findings, as well as greater evidence for obesity as a potential important cause of adverse cardiac remodeling that is independent of clinically evident ischemic heart disease