UNASSIGNED: Anxiety has been increasingly recognized as part of the psychosocial health issues in COVID-19 patients. However, the impact of this topic may be underestimated in low- and middle-income countries. This study aimed to estimate the prevalence of and risk factors of anxiety in COVID-19 patients compared to controls in a local tertiary teaching hospital in Malaysia.
UNASSIGNED: In this case-control study, we analyzed data on adult patients aged 18 years and above hospitalized for COVID-19 infection with matched hospitalized controls. The demographic, clinical data and anxiety measures using the Generalized Anxiety Disorder-7 questionnaire were analyzed using univariate and multivariate analysis.
UNASSIGNED: 86.6% in the COVID-19 group had anxiety, significantly higher than 13.4% in the control group (p = 0.001). The COVID-19 group was significantly associated with the GAD-7 severity (p = 0.001). The number of COVID-19 patients in the mild, moderate, and severe anxiety groups was 48 (84.2%), 37 (86%), and 18 (94.7%), respectively. Multiple logistic regression showed significant predictors for anxiety, including COVID-19 diagnosis and neurological symptoms. Anxiety was found 36.92 times higher in the patients with COVID-19 compared to those without COVID-19 (OR 36.92;95% CI 17.09, 79.78, p = 0.001). Patients with neurological symptoms were at risk of having anxiety (OR 2.94; 95% CI 1.03, 8.41, p = 0.044).
UNASSIGNED: COVID-19 patients experience a significant disruption in psychosocial functioning due to hospitalization. The burden of anxiety is notably high, compounded by a diagnosis of COVID-19 itself and neurological symptomatology. Early psychiatric referrals are warranted for patients at risk of developing anxiety symptoms.

UNASSIGNED: Multisystem inflammatory syndrome in children (MIS-C) is believed to be one of the most important life-threatening complications of COVID-19 infection among children. In any setting, early recognition, investigations, and management of MIS-C is crucial, but it is particularly difficult in resource-limited settings (RLS). This is the first case report of MIS-C in Lao People\'s Democratic Republic (Lao PDR) that was promptly recognized, treated, and resulted in full recovery with no known complications despite the resource limitations.
UNASSIGNED: A healthy 9-year-old boy presented to a central teaching hospital fulfilling the World Health\'s Organization\'s MIS-C criteria. The patient had never received a COVID-19 vaccine and had a history of COVID-19 contact. The diagnosis was based upon the history, changes in the patient\'s clinical status, and response to treatment and negative testing and response to treatment for alternative diagnoses. Despite management challenges relating to limited access to an intensive care bed and the high cost of IVIG; the patient received a full course of treatment and appropriate follow-up cares post discharge. There were several aspects to this case that may not hold true for other children in Lao PDR. First, the family lived in the capital city, close to the central hospitals. Second, the family was able to afford repeated visits to private clinics, and the cost of IVIG, and other treatments. Third, the physicians involved in his care promptly recognized a new diagnosis.
UNASSIGNED: MIS-C is a rare but life-threatening complication of COVID-19 infection among children. The management of MIS-C requires early recognition, investigations, and interventions which may be difficult to access, cost-prohibitive, and further increase demand on healthcare services that are already limited in RLS. Nevertheless, clinicians must consider means for improving access, determine which tests and interventions are worth the cost, and establishing local clinical guidelines for working within resource constraints while awaiting additional assistance from local and international public health systems. Additionally, using COVID-19 vaccination to prevent MIS-C and its complication for children may be cost-effective.

UNASSIGNED: Although elderly people are at a huge risk of mortality due to COVID-19, the Case Fatality Rate (CFR) in hospitalized elderly patients is poorly investigated. This meta-analysis and meta-regression aimed to generate pooled CFR due to COVID-19 in hospitalized elderly patients by sex, Gross Domestic Product (GDP), year, and continent and also to explain the potential source of the heterogeneity and variations in the pooled estimation of COVID-19 CFR.
UNASSIGNED: We systematically searched PubMed, Scopus, Web of Science, CINAHL, and Embase up to 31 July 2022. Eligibility assessment of records was performed independently in a blinded, standardized way by two reviewers. Meta-analysis and Meta-regression analysis were carried out to estimate pooled CFR and the potential sources of the heterogeneity.
UNASSIGNED: The study included 5683 confirmed hospitalized elderly COVID-19 patients, 1809 deaths, and 19 original articles from 10 countries. The pooled estimate of the overall CFR, and by male and female sexes were 29%, 34%, and 24%, respectively. We found CFR was decreased by increasing female sex proportion, GDP, and year of publication. Multivariate meta-regression analysis indicated that the age and sex of patients, continent, GDP, and year of the publication together explained the majority of the heterogeneity and variations in the pooled estimate of the hospitalized elderly COVID-19 CFR.
UNASSIGNED: This review provided reliable pooled CFR measures for hospitalized elderly patients with COVID-19. Although COVID-19 fatality has decreased in hospitalized elderly patients over time, it is still high in hospitalized elderly patients and needs advanced treatment support.

Background: Persistent fever after SARS-CoV-2 infection in rituximab-treated patients has been reported. Due to reduced sensitivity in conventional sampling methods and unspecific symptoms in these patients, distinguishing between low-grade viral replication or hyperinflammation is challenging. Antiviral treatment is recommended as prophylactic or early treatment in the at-risk population; however, no defined treatment approaches for protracted SARS-CoV-2 infection exist. Results: We present a case of 96 days of persistent fever and SARS-CoV-2 infection in a patient receiving B cell depletion therapy for multiple sclerosis. Migratory lung infiltrates and positive PCR tests from serum (day-58 post infection) and lower airways (day-90 post infection) confirmed continuous viral replication. The dominant symptoms were continuous high fever, dyspnea and mild to moderate hypoxemia, which never developed into severe respiratory failure. The patient was hospitalized three times, with transient improvement after late antiviral treatment and full recovery 6 months post-rituximab infusion. Conclusions: A strategy for securing samples from lower airways and serum should be a prioritization to strengthen diagnostic certainty in immunocompromised patients. B-cell-deprived patients could benefit from late treatment with SARS-CoV-2-specific monoclonal antibodies and antivirals. Importantly, increased intervals between immunosuppressive therapy should be considered where feasible.

UNASSIGNED: Fungal infections are common in pediatric intensive care units (PICUs), but the monitoring methods are limited. This study analyzed the differences in clinical features, diagnosis, and treatment between PICU patients with and without fungal infection.
UNASSIGNED: This retrospective study analyzed PICU patients at the Maternal and Child Health Hospital of Hubei Province diagnosed with severe pneumonia between January 2015 and January 2020. The patients were divided into the fungal (F) and non-fungal (NF) infection groups. Levels of 1,3-beta-D-glucan (BDG) and galactomannan (GM) in serum and bronchoalveolar lavage fluid (BALF) were analyzed. Chest computed tomography (CT) images were reviewed.
UNASSIGNED: A total of 357 patients were included. In the F group, fever, moist rales, coarse rales, shortness of breath, and sepsis were more common (all P < 0.05); PICU time, hospitalization duration, and BDG- and GM-positive rates in serum and BALF were all significantly higher than in the NF group (all P < 0.05). The BDG- and GM-positive rates in serum and BALF were higher in the F than in the NF group (all P < 0.05). The abnormal lymphocyte ratios in serum were higher in the F group (all P < 0.05). Wedge-shaped, patchy, streaky shadows and subpleural reticulation were higher in CT images of the F group (all P < 0.05). Tracheobronchial stenosis was more common in pulmonary fibroscopy results of the F group (P = 0.04).
UNASSIGNED: PICU pneumonia patients with fungal infection have specific clinical and laboratory features compared with those without fungal infection, including higher rates of BALF, serum BDG, GM positivity and tracheobronchial stenosis.

Treatment options for acute severe ulcerative colitis (ASUC) are limited. Tofacitinib, an approved treatment for moderate to severe ulcerative colitis, could be a potential rescue therapy for ASUC given its rapid onset of action.
To evaluate the effectiveness of tofacitinib in hospitalized patients with ASUC refractory to standard therapy in a real-world setting.
Retrospective observational study of hospitalized adult patients with ASUC treated with tofacitinib between January 2019 and September 2020 at five Canadian centers. We extracted patient demographics, clinical status, biomarkers (C-reactive protein and fecal calprotectin), endoscopic findings, and colectomy-free rate at admission, 30 days, 90 days, and 6 months after tofacitinib initiation.
Eight patients with symptoms refractory to standard rescue therapy (corticosteroids ± infliximab if infliximab-naïve prior to admission) were treated with tofacitinib. During index hospitalization, clinical response was observed in 5/8 patients. The median time to discharge post-tofacitinib initiation was 5 days (IQR 5.0-6). At 30 and 90 days, all five responders were in clinical remission. At 6 months, only 3/5 responders remained in clinical remission. The colectomy-free rate was 37.5% during the follow-up period (two colectomies occurred within 30 days; one occurred within 90 days). No drug-related adverse reaction occurred.
In this small case-series, tofacitinib was an effective rescue therapy in patients with refractory ASUC. These findings need to be evaluated in a randomized controlled trial.

Background: Opioids are commonly prescribed to hospitalized adults to promote adequate pain relief, yet they can cause potentially fatal respiratory depression. Aim: The aim of this study was to examine the risk factors for the development of severe opioid-induced respiratory depression (OIRD) in hospitalized adults to ensure adequate monitoring of high-risk patients. Methods: A retrospective case-control study was conducted using data from the medical records of a university-affiliated hospital in Canada. Cases were eligible if they were adults (≥18 years old) and received opioid analgesia within 24 h of naloxone administration for respiratory depression. Controls had the same eligibility criteria, except for respiratory depression and naloxone administration. The case-control ratio was 1:1, and they were matched based on sex, type of unit, opioid molecule and the presence/absence of medication errors. Results: A total of 133 cases and 133 controls were included. Following cumulative risk factor analysis, renal failure (odds ratio [OR] = 2.176, 95% confidence interval [CI], 1.021-4.640, P = 0.044), the first 24 h of opioid administration (OR = 1.899, 95% CI, 1.090-3.309, P = 0.024), concomitant central nervous system (CNS) depressants (OR = 1.785, 95% CI, 1.023-3.113, P = 0.041), and increasing age (OR = 1.019, 95% CI, 1.002-1.035, P = 0.028) were positively associated with severe OIRD. Conclusions: Some adult hospitalized patients were at higher risk of experiencing severe OIRD, such as those with renal failure, those in their first 24 h of opioid administration, those receiving CNS depressants in addition to opioids, and those with an advanced age. These results will assist with the screening of patients at higher risk for severe OIRD, which is key to implementing appropriate monitoring and enhancing the safety of opioid use in hospital settings.
Contexte: Les opioïdes sont couramment prescrits aux adultes hospitalisés pour favoriser un soulagement adéquat de la douleur, mais ils peuvent provoquer une dépression respiratoire potentiellement mortelle.Objectif: Examiner les facteurs de risque du développement d\'une dépression respiratoire sévère induite par un opioïde chez les adultes hospitalisés afin d\'assurer un suivi adéquat des patients à haut risque.Méthodes: Une étude rétrospective cas - témoins a été menée en utilisant les données des dossiers médicaux d\'un hôpital universitaire au Canada. Les cas étaient admissibles s\'ils étaient adultes (≥ 18 ans) et avaient reçu une analgésie opioïde dans les 24 heures suivant l\'administration de naloxone pour une dépression respiratoire. Les critères d\'admissibilité étaient les mêmes pour les témoins, à l’exception de la dépression respiratoire et de l\'administration de naloxone. Le rapport cas/témoins était de 1:1 et ceux-ci étaient appariés en fonction du sexe, du type d\'unité, de la molécule opioïde et de la présence ou absence d\'erreurs de médication.Résultats: Un total de 133 cas et 133 témoins ont été inclus. Après analyse des facteurs de risque cumulés, l\'insuffisance rénale (RC = 2,176, IC à 95 % : 1,021 - 4,640, p = 0,044), les premières 24 heures d\'administration d\'opioïdes (RC = 1,899, IC à 95 % : 1,090 -3, 309, p = .024), les dépresseurs du SNC concomitants (RC = 1,785, IC à 95 % : 1,023-3,113, p = 0,041) et l\'augmentation de l’âge par âge avancé (RC = 1,019, IC à 95 % : 1,002 - 1,035, p = 0,028) ont été positivement associés à des dépressions respiratoires sévères induites par un opioïde.Conclusions: Certains patients adultes hospitalisés présentaient un risque plus élevé de souffrir d\'une dépression respiratoire sévère induite par un opioïde, notamment les personnes souffrant d\'insuffisance rénale, celles à qui un opoïde a été administré dans les dernières 24 heures, celles qui ont reçu ds dépresseurs du SNC en plus d\'un opioïde et celles qui étaient plus âgées. Ces résultats permettront d\'identifier les patients à haut risque de souffrir d\'une dépression respiratoire sévère induite par un opioïde, ce qui est essentiel pour mettre en place un suivi approprié et améliorer la sécurité de l\'utilisation des opioïdes en milieu hospitalier.

BACKGROUND: Successful human milk supply in neonatal intensive care units (NICUs) requires the development of family-centered services.
OBJECTIVE: This study aimed to assess parent perceptions of factors that help or hinder providing human milk to very preterm infants (VPI) in the NICU according to sociodemographic, reproductive, and obstetric characteristics.
METHODS: This cross-sectional quantitative study included 120 mothers and 91 fathers of VPI hospitalized in a level 3 NICU located in the Northern Health Region of Portugal (July 2013-June 2014). Interviewers administered structured questionnaires regarding parent characteristics and the provision and perception of factors that help or hinder human milk supply in the NICU, 15 to 22 days after birth.
RESULTS: The main facilitators of human milk supply were its contribution to infant growth and well-being (51.4%) and parents\' knowledge of breastfeeding benefits (27.6%). The main barriers were worries related to inadequate milk supply (35.7%), difficulties with expressing breast milk (24.8%), and physical separation from infants (24.3%). Fathers referred less frequently to the contribution of human milk to infant growth and well-being (odds ratio [OR] = 0.57; 95% confidence interval [CI], 0.32-1.00) but more frequently to knowledge of breastfeeding benefits as facilitators (OR = 2.31; 95% CI, 1.23-4.32). Participants with > 12 years of education (OR = 1.91; 95% CI, 1.05-3.47) and those with an extremely low birth weight infant (OR = 1.90; 95% CI, 1.02-3.54) highlighted worries related to inadequate milk supply. Fathers (OR = 2.16; 95% CI, 1.11-4.19) and participants with ≤ 12 years of education (OR = 0.25; 95% CI, 0.11-0.57) more frequently reported difficulties with expressing as the main barrier.
CONCLUSIONS: The parent\'s gender and education and the infant\'s birth weight are crucial considerations for establishing optimal practices for supporting breastfeeding.