Distinguishing Characteristics between Pandemic 2009–2010 Influenza A (H1N1) and Other Viruses in Patients Hospitalized with Respiratory Illness

BACKGROUND: Differences in clinical presentation and outcomes among patients infected with pandemic 2009 influenza A H1N1 (pH1N1) compared to other respiratory viruses have not been fully elucidated. METHODOLOGY/PRINCIPAL FINDINGS: A retrospective study was performed of all hospitalized patients at the peak of the pH1N1 season in whom a single respiratory virus was detected by a molecular assay targeting 18 viruses/subtypes (RVP, Luminex xTAG). Fifty-two percent (615/1192) of patients from October, 2009 to December, 2009 had a single respiratory virus (291 pH1N1; 207 rhinovirus; 45 RSV A/B; 37 parainfluenza; 27 adenovirus; 6 coronavirus; and 2 metapneumovirus). No seasonal influenza A or B was detected. Individuals with pH1N1, compared to other viruses, were more likely to present with fever (92% & 70%), cough (92% & 86%), sore throat (32% & 16%), nausea (31% & 8%), vomiting (39% & 30%), abdominal pain (14% & 7%), and a lower white blood count (8,500/L & 13,600/L, all p-values<0.05). In patients with cough and gastrointestinal complaints, the presence of subjective fever/chills independently raised the likelihood of pH1N1 (OR 10). Fifty-five percent (336/615) of our cohort received antibacterial agents, 63% (385/615) received oseltamivir, and 41% (252/615) received steroids. The mortality rate of our cohort was 1% (7/615) and was higher in individuals with pH1N1 compared to other viruses (2.1% & 0.3%, respectively; p = 0.04). CONCLUSIONS/SIGNIFICANCE: During the peak pandemic 2009-2010 influenza season in Rhode Island, nearly half of patients admitted with influenza-like symptoms had respiratory viruses other than influenza A. A high proportion of patients were treated with antibiotics and pH1N1 infection had higher mortality compared to other respiratory viruses

Financial Impact of Incentive Spirometry

Despite largely unproven clinical effectiveness, incentive spirometry (IS) is widely used in an effort to reduce postoperative pulmonary complications. The objective of the study is to evaluate the financial impact of implementing IS. The amount of time nurses and RTs spend each day doing IS-related activities was assessed utilizing an online survey distributed to the relevant national nursing and respiratory therapists (RT) societies along with questionnaire that was prospectively collected every day for 4 weeks at a single 10-bed cardiothoracic surgery step-down unit. Cost of RT time to teach IS use to patients and cost of nurse time spent reeducating and reminding patients to use IS were used to calculate IS implementation cost estimates per patient. Per-patient cost of IS implementation ranged from $65.30 to$240.96 for a mean 9-day step-down stay. For the 566 patients who stayed in the 10-bed step-down in 2016, the total estimated cost of implementing IS ranged from $36 959.80 to$136 383.36. Using national survey workload data, per-patient cost of IS implementation costed $107.36 (95$97.88-$116.98) for a hospital stay of 4.5 days. For the 9.7 million inpatient surgeries performed annually in the United States, the total annual cost of implementing postoperative IS is estimated to be$1.04 billion (95% CI, $949.4 million-$1.13 billion). The cost of implementing IS is substantial. Further efficacy studies are necessary to determine whether the cost is justifiable

Association of clinical and imaging characteristics with pulmonary function testing in patients with Long-COVID

Purpose: The purpose of this study is to identify clinical and imaging characteristics associated with post-COVID pulmonary function decline. Methods: This study included 22 patients recovering from COVID-19 who underwent serial spirometry pulmonary function testing (PFT) before and after diagnosis. Patients were divided into two cohorts by difference between baseline and post-COVID follow-up PFT: Decline group (>10 % decrease in FEV1), and Stable group (≤10 % decrease or improvement in FEV1). Demographic, clinical, and laboratory data were collected, as well as PFT and chest computed tomography (CT) at the time of COVID diagnosis and follow-up. CTs were semi-quantitatively scored on a five-point severity scale for disease extent in each lobe by two radiologists. Mann-Whitney U-tests, T-tests, and Chi-Squared tests were used for comparison. P-values <0.05 were considered statistically significant. Results: The Decline group had a higher proportion of neutrophils (79.47 ± 4.83 % vs. 65.45 ± 10.22 %; p = 0.003), a higher absolute neutrophil count (5.73 ± 2.68 × 109/L vs. 3.43 ± 1.74 × 109/L; p = 0.031), and a lower proportion of lymphocytes (9.90 ± 4.20 % vs. 21.21 ± 10.97 %; p = 0.018) compared to the Stable group. The Decline group also had significantly higher involvement of ground-glass opacities (GGO) on follow-up chest CT [8.50 (4.50, 14.50) vs. 3.0 (1.50, 9.50); p = 0.032] and significantly higher extent of reticulations on chest CT at time of COVID diagnosis [6.50 (4.00, 9.00) vs. 2.00 (0.00, 6.00); p = 0.039] and follow-up [5.00 (3.00, 13.00) vs. 2.00 (0.00, 5.00); p = 0.041]. ICU admission was higher in the Decline group than in the Stable group (71.4 % vs. 13.3 %; p = 0.014). Conclusions: This study provides novel insight into factors influencing post-COVID lung function, irrespective of pre-existing pulmonary conditions. Our findings underscore the significance of neutrophil counts, reduced lymphocyte counts, pulmonary reticulation on chest CT at diagnosis, and extent of GGOs on follow-up chest CT as potential indicators of decreased post-COVID lung function. This knowledge may guide prediction and further understanding of long-term sequelae of COVID-19 infection

Characteristics and demographics of patients presenting with pandemic influenza A (pH1N1) compared to other respiratory viruses.

a<p>Odds ratios for age categories are compared to individuals <5 years-old, otherwise odds ratios are comparing individuals with pandemic influenza A (H1N1) to those with another respiratory virus;</p>b<p>Congenital malformations, asthma, chronic obstructive pulmonary disease (COPD), chronic lung disease, previous serious or multiple lung infection/disease/intubation, cystic fibrosis, history of reactive airway disease or wheezing;</p>c<p>Cirrhosis, end-stage liver disease, hepatitis, congenital abnormalities;</p>d<p>Chronic kidney disease, end-stage renal disease, congenital disease, nephrotic syndrome, transplant recipient; <b>Malignancy</b> = leukemia, bladder, breast, head and neck, lung, lymphoma, medulloblastoma, prostate, multiple myeloma, neuroblastoma, ovarian, sarcoma;</p>e<p>Seizure disorder, dementia, developmental delay, cerebral palsy, stroke, congenital, neuromuscular, trauma/surgery; <b>Cardiac disease</b> = arrhythmia, coronary artery disease, heart failure, congenital, valvular disease, cardiomyopathy, myocardial infarction;</p>f<p>Human Immunodeficiency Virus;</p>g<p>Systemic steroid use, transplant recipient, chemotherapy, human immunodeficiency virus (HIV).</p

Chest radiograph characteristics of patients with pandemic influenza A (pH1N1) compared to other respiratory viruses.

a<p>No acute disease;</p>b<p>Interstitial Opacity consistent with viral disease;</p>c<p>focal air-space disease;</p>d<p>multi-focal air-space disease.</p><p>Other categories included edema (N = 16), collapse (N = 1), pneumomedistinum (N = 3). Patients could have multiple findings on chest radiograph (i.e. MFASD and effusion). OR = odds ratio.</p

Likelihood of patients with clinical characteristics having pandemic 2009 influenza A (pH1N1) using multiple logistic regressions.

<p>OR = odds ratio; CI = confidence intervals.</p

Study inclusion algorithm.

<p>Study inclusion algorithm.</p