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AIM: To assess whether there were differences in resuscitation efforts and outcomes for medical intensive care unit (MICU) in-hospital cardiac arrest (IHCA) during the COVID-19 pandemic when compared to pre-pandemic. METHODS: Comparing COVID-19 MICU-IHCA patients (03/2020 to 10/2020) to non-COVID-19 MICU IHCA (01/2014 to 12/2018) at Clevleand Clinic Health System (CCHS) of NE Ohio. Propensity score matching analysis (PSMA) was used to create comparable groups. RESULTS: There were a total of 516 patients, 51 in COVID-19 MICU IHCA cohort and 465 in the non-COVID-19 MICU IHCA cohort. The mean (SD) age of the study population was 60.9 (16) years and 56% were males. In 92.1% (n = 475) patients, initial arrest rhythm was non-shockable. At the time of ICU admission, compared to the non-COVID-19 MICU-IHCA cohort, the COVID-19 MICU IHCA cohort had a lower mean APACHE III score (70 [32.9] vs 101.3 [39.6], P =

Background: The methicillin-resistant Staphylococcus aureus (MRSA) accounts for 20% to 40% of all hospital-acquired pneumonia (HAP) cases with mortality rates up to 55%. Prompt and accurate diagnosis is essential, especially in intensive care unit (ICU) patients. Nasal MRSA polymerase chain reaction (PCR) diagnostic utility evidence is conflicting in the literature for HAP due to a low number of HAP patients included in prior studies or due to the lack of high-yield gold standard cultures defined for comparisons. Methods: This was a retrospective cohort study conducted in a 65-bed medical ICU, and encompassing all adult patients admitted from January 2015 to March 2023 for HAP. Respiratory cultures included were those obtained by bronchoalveolar lavage or endotracheal suction within 7 days of nasal MRSA PCR testing. Results: The study included 412 patients; 56.8% were males and 65% were Whites. The mean age was 60.5 years. Most patients (82.5%) underwent MRSA-PCR before intubation, and the average time between MRSA-PCR and lower respiratory cultures was 2.15 days. The diagnostic performance of nasal MRSA PCR in diagnosing HAP in the ICU yielded a sensitivity (Sen) of 47.83%, specificity (Sp) of 92.29%, positive predictive value (PPV) of 26.83%, and negative predictive value (NPV) of 96.77%. For nonventilator HAP (nv-HAP) cases sensitivity was at 50%, specificity 92.83%, PPV 28.57%, and NPV at 97.00%. In ventilator-acquired pneumonia (VAP-HAP), the corresponding values were 42.86%, 90.91%, 23.08%, and 96.15%, respectively. Conclusion: The nasal MRSA PCR shows a high NPV and low false negative rate, suggesting it is a reliable tool for ruling out MRSA HAP in ICU patients. Care should be taken into account for disease prevalence and clinical context, as these factors may influence test performance. Further validation through prospective large-sample studies utilizing high-yield lower respiratory tract cultures is necessary to confirm our findings. [ABSTRACT FROM AUTHOR]

Objectives: Examining the cumulative evidence from randomized controlled trials (RCTs), evaluating the use of pharmacological agents for the treatment of COVID‐19 infections in patients with critical illness. Data Sources: Databases Medline, Embase, Web of Science, Scopus, CINAHL, and Cochrane. Study Selection: Inclusion criteria were RCTs that enrolled patients with confirmed or suspected COVID‐19 infection who are critically ill. Only RCTs that examined therapeutic agents against one another or no intervention, placebo, or standard of care, were included. Data Extraction: Pairs of reviewers extracted data independently. Outcomes of interest included the overall reported mortality defined as either the ICU mortality, hospital mortality, mortality within 28 days or mortality within 90 days. Data Synthesis: A total of 40 studies (11,613 patients) evaluated 50 therapeutic intervention arms divided into five main therapy categories; steroids, antiviral medications, immunomodulators, plasma therapies [intravenous immunoglobulins (IVIG), convalescent plasma and/or, therapeutic plasma exchange], and therapeutic anticoagulation. Immunomodulators was the only group with possible mortality benefit, risk ratio (RR) 0.83 (95% CI 0.73; 0.95), with nonsignificant heterogeneity (I2 = 8%, p = 0.36). In contrast, the other therapy groups showed no significant impact on mortality, as indicated by their respective pooled RRs: steroids [RR 0.91 (95% CI 0.82; 1.01), I2 = 31%], antiviral medications [RR 1.11 (95% CI 0.82; 1.49), I2 = 57%], plasma therapies [RR 0.77 (95% CI 0.58; 1.01), I2 = 36%], and anticoagulation [RR 1.06 (95% CI 0.95; 1.18), I2 = 0%]. Conclusions: This meta‐analysis highlights both the heterogeneity and a lack of benefit from therapies evaluated during the COVID‐19 pandemic. Many of the RCTs were developed based on limited observational data. Future RCTs investigating pharmaceutical interventions in critically ill patients during pandemics need to be designed based on better evidence. [ABSTRACT FROM AUTHOR]

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Background Persons with diabetes mellitus (DM) have a 3-fold increased risk of tuberculosis (TB). Atypical radiographic findings and differences in bacteriologic response during anti-TB treatment have been reported in earlier studies; however, the findings have varied. We evaluated the effect of DM on manifestations and response to treatment in adults with pulmonary TB in Qatar. Methods The impact of DM on the clinical and radiographic presentations of pulmonary TB and bacteriologic response during anti-TB treatment was evaluated between January 2007 and December 2011, comparing patients with and without DM. This is a retrospective unmatched case-control study conducted at a large national hospital. Cases and controls were randomly selected from patients diagnosed with pulmonary TB over a 5-year period. Sputum culture conversion was assessed after 2 months of anti-TB treatment. Results Clinical symptoms were similar between patients with and without DM. Patients with DM had a higher initial sputum acid-fast bacillus (AFB) smear grade and were less likely to have cavitary lesions on initial chest radiographs than patients without DM. Of 134 adults with DM and TB, 71 (53%) remained sputum culture positive after 2 months of anti-TB treatment, compared with 36 (27%) patients without DM. Conclusions DM was associated with atypical radiographic findings and delayed sputum culture conversion at 2 months in adults with pulmonary TB in Qatar. Increased health education of patients with DM about symptoms of TB, low thresholds for evaluation for active TB, and close monitoring of bacteriologic response to treatment among patients with TB and DM are warranted. [ABSTRACT FROM AUTHOR]

Background: Although hypothesized to be the root cause of the pulse oximetry disparities, skin tone and its use for improving medical therapies have yet to be extensively studied. Studies previously used self-reported race as a proxy variable for skin tone. However, this approach cannot account for skin tone variability within race groups and also risks the potential to be confounded by other non-biological factors when modeling data. Therefore, to better evaluate health disparities associated with pulse oximetry, this study aimed to create a unique baseline dataset that included skin tone and electronic health record (EHR) data., Methods: Patients admitted to Duke University Hospital were eligible if they had at least one pulse oximetry value recorded within 5 minutes before an arterial blood gas (ABG) value. We collected skin tone data at 16 different body locations using multiple devices, including administered visual scales, colorimetric, spectrophotometric, and photography via mobile phone cameras. All patients' data were linked in Duke's Protected Analytics Computational Environment (PACE), converted into a common data model, and then de-identified before publication in PhysioNet., Results: Skin tone data were collected from 128 patients. We assessed 167 features per skin location on each patient. We also collected over 2000 images from mobile phones measured in the same controlled environment. Skin tone data are linked with patients' EHR data, such as laboratory data, vital sign recordings, and demographic information., Conclusions: Measuring different aspects of skin tone for each of the sixteen body locations and linking them with patients' EHR data could assist in the development of a more equitable AI model to combat disparities in healthcare associated with skin tone. A common data model format enables easy data federation with similar data from other sources, facilitating multicenter research on skin tone in healthcare., Description: A prospectively collected EHR-linked skin tone measurements database in a common data model with emphasis on pulse oximetry disparities.