Search Results (79)

Introduction: Respiratory Syncytial Virus (RSV) infection causes seasonal respiratory illness in both children and adults, with increasing recognition of its impact in older adults with chronic comorbidities. This study aimed to characterize adult patients hospitalized with RSV infection in Switzerland and identify comorbidities linked to poor outcomes. Methods: Adults hospitalized with RSV infection between May 2022 and April 2024 at a Swiss public teaching hospital were included in this retrospective observational study. To assess the association between comorbidities and patient outcomes, separate multivariable regression analyses for each comorbidity, adjusted for age and sex, were performed. The primary composite endpoint was ’severe course’ (in-hospital death or intensive care unit (ICU) admission), secondary endpoints included in-hospital death, ICU admission, and length of stay. Results: Among 136 included patients (mean age 78, 38% male), 98% had comorbidities, most commonly cardiovascular (75.7%), respiratory (51%), and chronic kidney disease (CKD) (36.7%). Further, 18.4% experienced a severe course. The ICU admission rate was 14.0%, in-hospital mortality 6.6%, and the median hospital stay of survivors was 6 days (IQR 4–10). CKD was significantly associated with severe course (OR 2.64, p = 0.045) and in-hospital mortality (OR 11.6, p = 0.025), while immunosuppression predicted ICU admission (OR 5.7, p = 0.018). Length of stay was not linked to any comorbidities. Conclusions: In this cohort of hospitalized adults, mainly elderly individuals with chronic comorbidities were tested positive for RSV. CKD and immunosuppression were associated with severe course. Prevention strategies, including RSV vaccination, should prioritize these high-risk populations. Full article

This study investigates the health impacts of air pollution in the Greater Athens Area (GAA), Greece, by estimating the Relative Risk (RR) of hospital admissions (HA) for cardiovascular (CVD) and respiratory diseases (RD) from 2018 to 2020. The analysis focuses on daily exceedances of key air pollutants—PM₁₀, O₃, and NO₂—based on the “Fair” threshold and above, as defined by the European Union Air Quality Index (EU AQI). Data from ten monitoring stations operated by the Ministry of Environment and Energy were spatially matched with six hospitals across the GAA. A Distributed Lag Non-linear Model (DLNM) was employed to capture both the delayed and non-linear exposure–response (ER) relationships between pollutant exceedances and daily HA. Additionally, the synergistic effects of pollutant interactions were assessed to provide a more comprehensive understanding of cumulative health risks. The combined exposure term showed a peak RR of 1.49 (95% CI: 0.79–2.78), indicating a notable amplification of risk when multiple pollutants exceed thresholds simultaneously. The study utilizes R for data processing and statistical modeling. Findings aim to inform public health strategies by identifying critical exposure thresholds and time-lagged effects, ultimately supporting targeted interventions in urban environments experiencing air quality challenges. Full article

Air pollution is one of the most serious environmental threats, with particulate matter PM₁₀ and PM_2.5 representing its most harmful components, significantly affecting public health. These particles are primarily generated by transport, industry, residential heating, and agriculture, and are associated with increased incidence of respiratory and cardiovascular diseases, asthma attacks, and heart attacks, as well as chronic illnesses and premature mortality. The most vulnerable groups include children, the elderly, and individuals with pre-existing health conditions. This study focuses on the analysis of health risks associated with PM₁₀ and PM_2.5 air pollution in the city of Zvolen, which serves as a representative case due to its urban structure, traffic load, and industrial activity. The aim is to assess the current state of air quality, identify the main sources of pollution, and evaluate the health impacts of particulate matter on the local population. The results will be compared with selected Slovak cities—Banská Bystrica and Ružomberok—to understand regional differences in exposure and its health consequences. The results revealed consistently elevated concentrations of particulate matter (PM) across all analyzed cities, frequently exceeding the guideline values recommended by the World Health Organization (WHO), although remaining below the thresholds set by current national legislation. The lowest average concentrations were recorded in the city of Zvolen (PM₁₀: 20 μg/m³; PM_2.5: 15 μg/m³). These lower values may be attributed to the location of the reference monitoring station operated by the Slovak Hydrometeorological Institute (SHMÚ), situated on J. Alexy Street in the southern part of the city—south of Zvolen’s primary industrial emitter, Kronospan. Due to predominantly southerly wind patterns, PM particles are transported northward, potentially leading to higher pollution loads in the northern areas of the city, which are currently not being monitored. We analyzed trends in PM₁₀ and PM_2.5 concentrations and their relationship with hospitalization data for respiratory diseases. The results indicate a clear correlation between the concentration of suspended particulate matter and the number of hospital admissions due to respiratory illnesses. Our findings thus confirm the significant adverse effects of particulate air pollution on population health and highlight the urgent need for systematic monitoring and effective measures to reduce emissions, particularly in urban areas. Full article

The aim of this study is to examine the impact of poor air quality and adverse meteorological conditions on health risks in the Greater Athens Area (GAA), Greece, during the period from 2018 to 2022. Specifically, the aim is to assess the Relative Risk (RR) of hospital admissions (HAs) for cardiovascular diseases (CVDs) and respiratory diseases (RDs), due to air pollution in combination with thermal discomfort, as well as to identify the time lag effect on admissions. For this purpose, data from six (6) different hospitals within the GAA were collected and used. Statistical analysis of hourly measurements of key pollutants (NO₂, O₃, PM_2.5, and PM₁₀) obtained from the Directorate of Climate Change and Air Quality (DCCAQ), which falls under the auspices of the Ministry of Environment and Energy (MEE), and meteorological parameters (T, RH, and wind velocity), is performed to calculate the daily air quality and human thermal comfort–discomfort levels, respectively. These conditions were examined using appropriate indexes for both air quality and human thermal comfort–discomfort, as independent variables in a Negative Binomial regression model developed in R, with daily HAs (not including scheduled cases or pre-existing health conditions) as the response variable. Moreover, a spatiotemporal analysis of air quality and meteorological parameters is conducted to identify associated variations in health risks. This analysis highlights key risk patterns linked to environmental conditions and the relevant measures to both manage and mitigate the risk. Findings indicate that extreme environmental conditions significantly elevate health risks, with cumulative RR over a one-week period peaking at 1.540 (95% CI: 1.158–2.050) during the warm season, while prolonged increases in the RR are also observed during the cold season, reaching 1.214 (95% CI: 0.937–1.572) under extreme cold exposures. Full article

Background: Kyphoscoliosis is a restrictive thoracic disorder frequently associated with chronic respiratory failure. While home non-invasive ventilation (NIV) improves short-term outcomes, long-term mortality predictors remain underexplored in this context. Methods: This retrospective cohort study evaluated 88 kyphoscoliosis patients with chronic respiratory failure who were initiated on home-based NIV between 2008 and 2018 at a tertiary ICU outpatient clinic. The demographic, clinical, and laboratory data were analyzed. Survival was assessed using Kaplan–Meier analysis, and independent predictors of mortality were identified via Cox regression. Results: Among the 88 patients (52% male), 28 (32%) died during long-term follow-up. Age, BMI, pulmonary function, and arterial blood gas values were similar between survivors and non-survivors. Non-survivors had significantly higher mMRC dyspnea scores, were more likely to be active smokers, and had a higher prevalence of coronary artery disease (CAD) (p = 0.015). The Kaplan–Meier survival analysis revealed significantly lower survival in patients with CAD (p = 0.021) and active smokers (p = 0.034). Cox regression analysis indicated that the presence of CAD (HR: 5.69, 95% CI: 1.34–24.08, p = 0.018) and hospital admission after the initiation of home-based NIV therapy (HR: 1.97, 95% CI: 1.01–3.85, p = 0.040) increased the risk of mortality. Conversely, a higher pH at the last outpatient visit was associated with improved survival (HR: 0.50, 95% CI: 0.00–0.692, p = 0.003). Conclusions: CAD, pH value, and increased ICU admissions after the initiation of home-based NIV are predictors of mortality in kyphoscoliosis patients. The study results highlight reduced survival associated with the presence of coronary artery disease and smoking, emphasizing the importance of routine cardiovascular assessment and close clinical follow-up in this high-risk population. Full article

It is crucial to assess health impacts of PM_2.5, especially from wildfire smoke, to ensure proper planning for healthcare services. Studies often focus on respiratory conditions; fewer estimate the additional burden of cardiovascular complications. This study aims to extend previous work on the impacts of wildfire smoke and associated PM_2.5 on health in Southern Oregon by expanding study areas and timeframes, including cardiovascular conditions, and applying improved and novel air quality measurement data. This study adopts a case-crossover approach using conditional Poisson regression to analyze time stratified patient counts while controlling for mean temperature. Every 10 μg/m³ increase in PM_2.5 is associated with a 1.6% increase in same-day hospital or emergency room admission rates for respiratory conditions (OR = 1.0157; 95% CI: 1.0024–1.0287) and no significant increase in admission rates for cardiovascular conditions. A 10 μg/m³ increase in PM_2.5 lasting fifteen days is associated with a 6.5% increase in hospital or emergency room admission rates for respiratory conditions (OR = 1.0645; 95% CI: 1.0400–1.0894) and a 4.9% increase in hospital or emergency room admission rates for cardiovascular conditions (OR = 1.0493; 95% CI: 1.0265–1.0723). As the duration of poor air quality increases, the risk of negative respiratory and cardiovascular health outcomes increases. Full article

Background: Chronic ischemic cardiovascular disease (CICD) is a common cardiovascular disease and a frequent cause of hospitalization, with significant differences between men and women. It is also an important comorbidity, affecting hospitalization length and mortality. The purpose of this paper is to investigate the clinical and economic impact of CICD on hospital admissions of non-surgical patients. Methods: To conduct the study, hospital discharge data (SDO) from each public and private hospital facility regularly sent by the regions to the Ministry of Health were analyzed, focusing on internal medicine, cardiology, and geriatrics departments’ 2019 discharged data coming from all Italian hospitals. Data were stratified according to age, gender, hospital charge ward, and costs. Results: The typical CICD patient is elderly (average age 80 years) and stays longer (+10.5 days) compared to the average one. They are also typically chronic patients with many comorbidities (respiratory and renal failure, as well as atrial fibrillation) in geriatrics and internal medicine departments, while in the cardiology departments, atrial fibrillation and outcomes of acute cardiovascular events predominate. Conclusions: CICD is a condition that leads to more hospitalizations in internal medicine departments than in cardiology and geriatrics departments and generates an average hospitalization value in line with the average one in internal medicine and geriatrics departments. In cardiology, the average value level is higher than the department average. Gender differences were found in cardiology departments; this data could suggest that the existing guidelines are affected by studies carried out mainly on males which lead to fewer recommendations for interventional procedures on females. Full article

Background: Asthma, a chronic respiratory disease characterized by airway inflammation and hyperresponsiveness, exhibits significant heterogeneity in its presentation. This study aimed to investigate age-related comorbidity patterns, seasonal variations, and demographic trends among a cohort of asthma patients within a defined geographical region. Methods: A retrospective analysis of 13,695 asthma patients admitted to a Romanian hospital from 2013 to 2023 was conducted. Comorbidity patterns were analyzed using network analysis across age groups, and seasonal trends were investigated through spectral analysis. Results: Asthma admissions exhibited non-linear trends with female predominance (57.72%). The pandemic significantly impacted admission rates, with males experiencing greater COVID-19-related effects. Female admissions showed distinct seasonal patterns potentially linked to domestic responsibilities. Comorbidity patterns evolved with age, shifting from lifestyle factors in younger patients to complex cardiovascular and neurological disorders in older groups. The 60–69 age group showed the highest integration of comorbidity communities. Conclusions: The study revealed that asthma management focus should shift with patient age from the disease itself to addressing underlying comorbidities. Understanding these complex patterns may help personalize treatment strategies and improve long-term prognosis for asthma patients. Full article

Respiratory syncytial virus (RSV) is a significant cause of respiratory infections in adults, particularly among older adults and individuals with chronic diseases. While traditionally linked to pediatric populations, RSV’s impact on adults, especially the elderly, is increasingly recognized but remains understudied in many regions. This retrospective study, conducted at the University Hospital Center Zagreb from October 2022 to April 2024, is the first to analyze RSV-positive adults in Croatia. Using RT-PCR testing, we evaluated clinical and epidemiological characteristics in both hospitalized and outpatient populations, focusing on those aged > 65 years. Among 2631 tested individuals, the RSV prevalence was 5.25%, with older adults experiencing the most severe outcomes, including pneumonia, COPD exacerbation, and intensive care admissions. Seasonal analysis confirmed a winter peak in RSV cases, while chronic conditions such as cardiovascular and respiratory diseases were strongly associated with higher complication rates. These findings demonstrate that older adults with comorbidities bear the greatest burden of RSV infection, highlighting the need for the early identification of high-risk patients. By providing detailed insights into RSV-related outcomes in this population, this study supports the development of targeted prevention and management strategies to reduce the burden of RSV in vulnerable groups. Full article

Background/Objectives: Heart failure is the leading cause of hospital admission and mortality. Racial disparities have been demonstrated in various cardiovascular disorders; however, the data for in-hospital outcomes, complications, and procedural rates are limited. Methods: Utilizing the National Inpatient Sample (NIS) database, this retrospective cohort study included adult patients admitted with a principal diagnosis of heart failure. Coding for race and ethnicity in the NIS combines self-reported race and ethnicity provided by the data source into 1 data element (“RACE”). We compared the outcomes between various racial groups, focusing on mortality, the length of stay (LOS), hospital charges, and complications. Differences in the utilization of advanced therapies, including implantable cardiac defibrillators, cardiac resynchronization therapy (CRT), ventricular assist devices (VADs), and heart transplant, were also analyzed. Results: Out of 1,107,860 patients hospitalized with heart failure, 715,345 (64.57%) patients were White, 244,394 (22.06%) patients were Black, and 97,063 (8.31%) patients were Hispanic. Compared to White people, the odds of in-hospital mortality were lower among Black (aOR 0.74; 95% CI 0.68–0.81; p < 0.001) and Hispanic (aOR 0.78; 95% CI 0.69–0.88; p < 0.001) people. Complication rates including cardiogenic shock were found to be significantly lower in Black people (aOR 0.86; 95% CI 0.77–0.96; p < 0.001) and in Hispanic (aOR 0.72; 95% CI 0.63–0.81; p < 0.001) people. The rates of acute respiratory failure were also lower in Black (aOR 0.72; 95% CI 0.69–0.74; p < 0.001) and Hispanic (aOR 0.77; 95% CI 0.73–0.81; p < 0.001) people as opposed to White people. However, Black people were found to have higher rates of acute kidney injury (aOR 1.11; 95% CI 1.07–1.14; p < 0.001) and cardiac arrest (aOR 1.17; 95% CI 1.03–1.34; p = 0.02) compared to White people. Black people were less likely to receive advanced interventions, including cardiac resynchronization therapy (aOR 0.71; 95% CI 0.60–0.83; p < 0001), a ventricular assist device (aOR 0.45; 95% CI 0.34–0.59; p < 0.001), and heart transplants (aOR 0.57; 95% CI 0.42–0.77; p < 0.001), than White people. Hispanic people were found to have lower rates of ventricular assist device (aOR 0.49; 95% CI 0.33–0.72; p < 0.001) use than White people. Conclusions: These findings highlight significant racial disparities in mortality, secondary outcomes, and advanced therapy utilization in heart failure admissions. Further research is needed to identify the root factors for these disparities in order to guide targeted interventions to reduce this racial gap. Full article

Backgrounds: Despite the significant global health impact of cardiometabolic multimorbidity (CMM), our understanding of potential predictors associated with its development in smokers, remains limited. Objective: This study aimed to investigate whether a new COPD diagnosis and the rate of lung function decline serve as predictors for incident CMM (defined as having at least two of the following comorbidities: cerebro-cardiovascular diseases, hypertension, dyslipidemia, and diabetes mellitus) in smokers. Methods: An observational longitudinal analysis of prospectively collected data was conducted, including smokers without a previous COPD diagnosis and any cardiometabolic conditions. Sociodemographic and clinical data (body mass index, smoking history, respiratory symptoms, and hospital admissions) were collected at baseline. Lung function tests were performed at baseline and at the end of the follow-up period. The incidence of CMM, a new positive diagnosis of COPD, and the forced expiratory volume in 1 s (FEV₁) annual rate of decline were prospectively registered. Adjusted Cox proportional hazard models were adopted to explore risk factors associated with the incidence of CMM. Results: From the 391 smokers included in the study, 207 (53%) were newly diagnosed with COPD, and 184 had a preserved spirometry at baseline (non-COPD group). After nearly a decade of follow-up, 34% (n = 133) of smokers developed CMM. This group was characterized by male predominance, older age, higher BMI and pack-years of smoking, lower post-FEV₁, baseline COPD diagnosis, and a history of hospital admission. A positive diagnosis of COPD at baseline and a greater rate of lung function decline (ΔFEV₁ ≥ 40 mL/year) were independent predictors for developing CMM. Conclusions: A new COPD diagnosis and an accelerated decline in lung function are significantly associated with the development of CMM in smokers. Full article

Background and Objectives: Due to its link with the SARS-CoV-2, Multisystem Inflammatory Syndrome in Children (MIS-C) gained global attention as a serious condition that requires hospital care. Our study aimed to present the clinical and laboratory characteristics of MIS-C patients by age group and intensive care unit (ICU) admission status and assess early echocardiographic changes. Materials and Methods: A single-center partly retrospective, partly prospective observational cohort study was performed from December 2020 to June 2024. The study included 42 patients aged between 1 month and 18 years who were diagnosed with MIS-C and gave informed consent. Results: The median age was 6.5 years (IQR 2.0–9.3). The predominant symptoms were cardiovascular (88.1%), mucocutaneous (85.7%) and gastrointestinal (76.2%). Five children (11.9%) developed shock. About two-thirds of patients (66.7%) were admitted to the ICU. Adolescents (≥12 years) were less likely to exhibit mucocutaneous or cardiovascular symptoms and thus less frequently having Kawasaki—like disease symptoms compared with other age groups (<5 years or 5–11 years). Lymphopenia was more common among patients aged 5 years and older. Adolescents had higher procalcitonin (PCT) and a lower estimated glomerular filtration rate. Troponin I and B-type natriuretic peptide (BNP) levels were higher in children aged 5–11 years, while ferritin levels were lower among the youngest (<5 years). Patients treated at the ICU were more likely to have cardiovascular and respiratory symptoms, as well as a history of symptomatic COVID-19, higher C-reactive protein (CRP), PCT, BNP and lower albumin levels. Echocardiographic abnormalities were found in 71.4% of cases. During hospitalization, left ventricular ejection fraction values increased significantly (p < 0.001) over 12 (IQR 9.0–14.0) days. Conclusions: Symptoms and laboratory markers of MIS-C vary according to age. Higher CRP, PCT, BNP and hypoalbuminemia are predictors of MIS-C severity. Cardiovascular involvement is common and might be severe, but rapid resolution is encouraging. Full article

Background and Objectives: Hypertensive disorders, particularly pre-eclampsia, pose significant risks during pregnancy, affecting both maternal and neonatal health. The study aims to analyze short- and long-term health implications for mothers and their children, comparing those with pre-eclampsia to those without, to improve understanding of risk factors, diagnostic markers, and outcomes. Materials and Methods: This retrospective observational study involved 235 patients, 98 with pre-eclampsia and 137 without, monitored from 2015 to 2018 at the Obstetrics and Gynecology Department of the “Pius Brînzeu” Emergency County Clinical Hospital in Timișoara, Romania. Results: Women with pre-eclampsia were older, had higher BMIs, and more frequently had a family history of pre-eclampsia, hypertension, and diabetes. They also had lower educational and socioeconomic levels and fewer prenatal visits. Biochemical markers such as higher proteinuria, elevated sFlt-1, and lower PlGF were significant in diagnosing pre-eclampsia. Short-term maternal complications like eclampsia, HELLP syndrome, and acute kidney injury were more prevalent in the pre-eclampsia group. Neonatal outcomes included higher rates of preterm birth, low birth weight, and NICU admissions. Long-term mothers with a history of pre-eclampsia had higher incidences of chronic hypertension, cardiovascular disease, kidney problems, diabetes, and mental health disorders. Their children faced increased risks of neuropsychological delays, chronic respiratory issues, behavioral disorders, learning difficulties, and frequent infections. Conclusions: The study highlights the significant short- and long-term health impacts of pre-eclampsia on both mothers and their children. Early monitoring, intervention, and comprehensive management are crucial in mitigating these risks. These findings underscore the need for personalized care strategies to improve health outcomes for affected individuals. Full article

Background: Respiratory syncytial virus (RSV) is a significant cause of illness in adults, especially older adults and those with underlying conditions. This study aimed to assess the incidence of RSV hospitalizations in adults and identify risk factors for hospitalization and poor outcomes. Methods: A retrospective cohort study was conducted using data from two hospitals in southern Israel from 2016–2022. We calculated incidence rates of RSV and influenza hospitalizations. Risk factors for hospitalization were analyzed using Poisson regression. We evaluated poor outcomes (death, ICU admission, or mechanical ventilation) among RSV-hospitalized patients. Results: The median annual incidence of RSV hospitalization was 28.2/100,000 population, increasing with age to 199/100,000 in those ≥75 years. Significant risk factors for RSV hospitalization included pulmonary diseases (RR 4.2, 95% CI 3.4–5.2), cardiovascular diseases (RR 3.3, 95% CI 2.6–4.2), and chronic renal failure (RR 2.9, 95% CI 2.3–3.7). Among hospitalized RSV patients, 13.9% had poor outcomes. Renal failure (RR 1.81, 95% CI 1.23–2.66), neutropenia (RR 2.53, 95% CI 1.19–5.35), neutrophilia (RR 1.66, 95% CI 1.81–2.34), and lymphopenia (RR 2.03, 95% CI 1.37–3.0) were associated with poor outcomes. Conclusions: RSV causes a substantial burden of hospitalizations in adults, particularly among older adults and those with comorbidities. Identifying high-risk groups can help target prevention and treatment strategies, including vaccination. Full article

Background: The COVID-19 pandemic has caused severe health issues worldwide and contributed to huge financial losses. Key comorbidities linked to an increased risk of severe COVID-19 and higher mortality rates include cardio-metabolic disorders such as type 1 and type 2 diabetes mellitus (T1DM and T2DM), atherosclerotic cardiovascular disease, chronic kidney disease, hypertension, heart failure, and obesity. The persistence of symptoms even after the acute phase is over is termed long COVID-19 syndrome. This study aimed to evaluate the relationship between long COVID-19 syndrome and the development of insulin resistance in previously non-diabetic patients. Methods: A prospective observational study was performed on 143 non-diabetic patients who had tested positive for SARS-CoV-2 infection by a PCR test and were hospitalized in our hospital between January 2020 and December 2022. The clinical and para-clinical data at 0, 4, and 12 months of hospital admission for post-COVID-19 infection follow-up was collected and labeled as t0, t4, and t12. Blood glucose, insulin, and C-peptide levels were measured at the beginning and further at 2, 5, 10, and 30 min after the intravenous arginine stimulation test. Similarly, BMI was calculated, and hs-CRP and ESR levels were noted. The results obtained were statistically analyzed. Results: More than one-third (30.7%) of the included patients developed long COVID-19 syndrome. It was found that 75% of patients with long COVID-19 hospitalized in our clinic developed diabetes within a year of acute infection with COVID-19; therefore, it can be said that the presence of long COVID-19 is a major risk for an altered metabolic status, which can cause diabetes. When comparing the glycemia levels (106 mg/dL) with the BMI at t0, t4, and t12 time intervals, the p-values were found to be 0.214, 0.042, and 0.058, respectively. Almost 62% of the patients having BMI > 30 kg/m² were found to have an increase in blood glucose levels at 1 year. Similarly, insulin resistance was noted during this interval. A negative correlation of 0.40 for hsCRP and 0.38 for ESR was noted when compared with acute infection with COVID-19. Conclusions: The association between long COVID-19 and insulin resistance highlights the varied and widespread impacts of SARS-CoV-2 infection. Addressing the complexities of long COVID-19 requires a holistic strategy that encompasses both respiratory and metabolic considerations, which is crucial for enhancing the well-being of those enduring this persistent condition. Full article