Christus Health

In 2024, Chile experienced an outbreak of invasive group A Streptococcus (iGAS) infections. Although increasing reports of GAS outbreaks have been described worldwide, it remains unclear whether these events are driven by increased virulence of circulating lineages or by lineage replacement. In parallel, the burden of hospitalized noninvasive GAS infections (h-niGAS), which may present with severe disease, remains poorly characterized. This study aimed to compare epidemiological, clinical, antimicrobial resistance, and genomic features of iGAS and h-niGAS infections in Chile over a six-year period. We analyzed 2,307 GAS isolates collected between 2018 and 2024, including 2,249 noninvasive isolates and 58 iGAS isolates. Noninvasive cases were classified as outpatient niGAS or hospitalized niGAS (h-niGAS). Antimicrobial susceptibility testing was performed for all isolates. emm typing was performed on isolates from hospitalized patients (28 iGAS and 94 h-niGAS). Whole-genome sequencing was performed on outbreak-related isolates, followed by virulence gene profiling and phylogenetic analysis. Clinical characteristics were compared between iGAS and non-iGAS cases and across time periods. Among niGAS isolates, 2,119 were obtained from outpatients and 130 from hospitalized patients. h-niGAS isolates showed the highest proportion of clindamycin resistance (42%), whereas iGAS isolates showed the lowest (16%). Notably, clindamycin resistance among iGAS increased from 0% during 2020-2023 to nearly 20% in 2024. The most frequent emm types were emm1, emm12, and emm4. The frequency of emm1 increased from 0% in 2020-2023 to 10% in 2024, while overall emm diversity declined markedly (Simpson's reciprocal index from 17.3 to 6.63). Clinically, iGAS infections were associated with immunosuppression, chronic liver disease, viral coinfection, and trauma. During the 2024 outbreak, iGAS cases did not differ clinically from those reported in 2018-2023; however, h-niGAS cases required more surgical procedures (p = 0.005) and medical evaluations (p = 0.025). Whole-genome sequencing revealed predominance of emm1, including three M1UK strains harboring all 27 defining single-nucleotide polymorphisms. emm1 isolates carried a higher number of virulence-associated genes compared with non-emm1 isolates (p < 0.05). Phylogenetic analysis showed close relatedness to strains from the United Kingdom, Argentina, and the United States. These findings suggest that the Chilean outbreak was driven by the expansion of the emm1 lineage rather than an increase in strain virulence. The identification of M1UK strains and the reduced emm diversity support a model of lineage introduction and clonal expansion. The significant clinical burden observed among h-niGAS cases underscores the importance of including hospitalized noninvasive infections in surveillance efforts. Ongoing integrated clinical and genomic surveillance of both iGAS and h-niGAS is essential to monitor emerging lineages and antimicrobial resistance trends.

O artigo analisa o impacto do uso de crowdlaw, construção coletiva de proposições legislativas por meio digital, na promoção da participação cidadã e na redução do déficit democrático. O objetivo é avaliar a eficácia dessa iniciativa, sobretudo por meio da ferramenta brasileira Wikilegis. A metodologia adota uma abordagem qualitativa, incluindo análise de literatura nacional e internacional e revisão documental. Os resultados indicam que, embora o Wikilegis seja inovador ao propor um canal digital para interação entre cidadãos e legisladores, sua utilização tem sido limitada. Apenas uma pequena fração dos projetos legislativos foi disponibilizada, e a adesão tanto de parlamentares quanto da população permanece baixa. Além disso, a atual configuração do Wikilegis restringe a interação direta entre usuários e deputados, comprometendo sua capacidade de gerar deliberações racionais e legitimidade legislativa. O estudo conclui que o Wikilegis não cumpriu plenamente seu papel como ferramenta de crowdlaw, carecendo de maior regulamentação, integração com outras instâncias legislativas e incentivo à participação popular. Recomenda-se a adoção de medidas como tramitação prioritária para projetos com elevado engajamento público e a promoção de uma interação mais direta e discursiva entre parlamentares e cidadãos, de modo a aproximar a produção legislativa das demandas sociais.

Abstract Background While current evidence suggests that the clinical outcomes of ST-elevation myocardial infarction (STEMI) are worse among patients with cancer, it is unknown what role the quality of care received during admission plays. We aimed to evaluate the association between care quality and patient survival after discharge. Methods A nationally-linked cohort of STEMI patients (January 2005-March 2019) were obtained from the UK Myocardial Infarction National Audit Project (MINAP) and UK national Hospital Episode Statistics Admitted Patient Care (HES APC) registries. We used the composite opportunity-based quality indicator (OBQI) to measure overall care quality. Survival outcomes were assessed using Cox proportional hazard models and Kaplan-Meier and cumulative survival curves. Results In total, 6,787 STEMI indexed admissions with cancer were identified. Of those, 4,340 (63.9%) patients received optimum care, 1,320 (19.5%) intermediate care, and 1,127(25.2%) low care quality. Patients with low care quality were older (optimum quality median (IQR)=72.8 (65.1, 79.6), intermediate quality 75.5 (67.9, 82.1), low quality 78.2 (69.2, 84.7)) and more frequently women (optimum quality 21.6%, intermediate quality 27.3%, low quality 35.5%). Compared to patients with optimum care, patients with low care quality had a higher risk of death at 30 days (HR 7.0, 95% CI 5.7-8.7), 1 year (HR 4.0, 95% CI 3.6-4.4), and 5 years (HR 2.6, 95% CI 2.4-2.8). Relative survival analysis revealed that the number of patients who would survive nationally if they received optimal care is 84 (95% CI 67-102), 508 (95% CI 468-548), and 1096 (95% CI 1034-1158) at 30 days, one year, and five years respectively. The association between care quality and survival was more profound in the Northwest and Northeast regions. Conclusion Quality of care is closely associated with short- and long-term survival among STEMI patients with cancer. Improving quality of care may save hundreds to thousands of lives in the shorter and longer term.

Introduction Pembrolizumab is a monoclonal antibody used to treat various cancers via monotherapy or in conjunction with other chemotherapeutic regimens. Randomized-control trials report adrenal insufficiency in approximately 0.7% of patients on pembr

The QIAstat-Dx Gastrointestinal Panel 2 (GI2 Panel) is a sample-to-answer multiplex PCR instrument that can detect 17 targets in a run time of about 80 minutes. The performance of the QIAstat-Dx GI2 Panel was evaluated by testing 1,939 prospective, 119 prospectively collected and then archived positive clinical samples and 750 retrospective clinical specimens across 13 sites in Europe and the United States. Specimens tested included bulk stool samples preserved in modified Cary-Blair transport medium. For most targets, results were compared to those of the FilmArray GI panel (13/17), and discordant results were adjudicated with a third assay. For the remaining targets (4/17), a composite comparator method was used, which included three comparator assays for each target. Before discordant resolution, the QIAstat-Dx GI2 Panel positive percent agreement (PPA) was 95% or greater for 5/17 targets (Campylobacter, E. coli O157, Cryptosporidium, Cyclospora cayetanensis, and Giardia lamblia) and 90% or greater for 11/17 targets: adenovirus F40/F41, astrovirus, norovirus GI/GII, rotavirus A, Plesiomonas shigelloides, enteropathogenic Escherichia coli, enterotoxigenic E. coli, Salmonella, Yersinia enterocolitica, Shiga-like toxin E. coli (STEC) stx1/stx2, and Shigella/enteroinvasive E. coli. No cases of Entamoeba histolytica were encountered during the clinical study. The negative percent agreement (NPA) was >98.9% for all QIAstat-Dx GI2 Panel targets. The three most common pathogens identified in single and co-infections were enteropathogenic E. coli (9.9%), Campylobacter (5.2%), and norovirus GI/GII (3.1%). In summary, this clinical study examined more than 2,800 samples from Europe and the U.S. using the QIAstat-Dx GI2 Panel and identified 90%-100% PPA and 99% NPA for its 17 targets.IMPORTANCEThe manuscript highlights the significance and impact of the QIAstat-Dx GI2 Panel, a sample-to-answer multiplex PCR instrument capable of detecting 17 targets in approximately 80 minutes. This comprehensive clinical study, conducted across 13 sites in Europe and the United States, evaluated the performance of the panel using over 2,800 clinical samples. The results demonstrate a high accuracy of the QIAstat-Dx GI2 panel, with a PPA equal to or higher than 90% for all targets and an NPA greater than 98.9% for all targets. These findings underscore the reliability and effectiveness of the GI2 panel in the rapid and precise detection of gastrointestinal pathogens, which is crucial for timely diagnosis and treatment of infections.

BackgroundWhile current evidence suggests that the clinical outcomes of ST-elevation myocardial infarction (STEMI) are worse among patients with cancer, it is unknown what role the quality of care received during admission plays. We aimed to evaluate the association between care quality and patient survival after discharge.Methods and resultsA nationally-linked cohort of STEMI patients (January 2005–March 2019) were obtained from the UK Myocardial Infarction National Audit Project and UK national Hospital Episode Statistics Admitted Patient Care registries. We used the composite opportunity-based quality indicator to measure overall care quality. Survival outcomes were assessed using Cox proportional hazard models and Kaplan–Meier and cumulative survival curves. In total, 6787 STEMI indexed admissions with cancer were identified. Of those, 4340 (63.9%) patients received optimum care, 1320 (19.5%) intermediate care, and 1127(25.2%) low care quality. Patients with low care quality were older [optimum quality median (IQR) = 72.8 (65.1, 79.6), intermediate quality 75.5 (67.9, 82.1), low quality 78.2 (69.2, 84.7)] and more frequently women (optimum quality 21.6%, intermediate quality 27.3%, low quality 35.5%). Compared to patients with optimum care, patients with low care quality had a higher risk of death at 30 days [hazard ratio (HR) 7.0, 95% confidence interval (CI) 5.7–8.7], 1 year (HR 4.0, 95% CI 3.6–4.4), and 5 years (HR 2.6, 95% CI 2.4–2.8). Relative survival analysis revealed that the number of patients who would survive nationally if they received optimal care is 84 (95% CI 67–102), 508 (95% CI 468–548), and 1096 (95% CI 1034–1158) at 30 days, 1 year, and 5 years, respectively. The association between care quality and survival was more profound in the Northwest and Northeast regions.ConclusionQuality of care is closely associated with short- and long-term survival among STEMI patients with cancer. Improving quality of care may save hundreds to thousands of lives in the shorter and longer term.

Abstract BackgroundMild cognitive impairment (MCI), is characterized by cognitive dysfunction not severe enough to affect one’s activities of daily living (ADLs)1. Annually, approximately 15‐20% adults 65 and older will present with MCI 1. MCI is considered a significant risk factor and a robust predictor for developing dementia. The time course for progression to dementia can vary substantially between individuals and is impacted by the specific pathology underlying the MCI, and the cognitive deficits associated with cognitive impairment (CI) subtypes 2,3. Despite the conversion risk of MCI to dementia and the effectiveness of early lifestyle interventions to mitigate the conversion risk, many investigations do not account for MCI in their CI prediction models. This research investigates binary and 3‐class ML‐enabled modeling to classify CI status leveraging multiple modalities of cognition extracted from the Digital Clock and Recall (DCR), a brief digital cognitive assessment.MethodData from 983 participants in the Bio‐Hermes‐001 multi‐site study (age mean±SD=72±6.7; 56% female; years of education mean±SD=15±2.7; primary language English), a priori classified as cognitively unimpaired (CU; n=417), mild cognitively impaired (n=309), or probable Alzheimer’s dementia (n=257) based on expert consensus clinical diagnosis and neuropsychological evaluation were analyzed. A random forest model was trained on DCTclock and word recall data to classify cognitive impairment using a binary (CI and CU) and 3‐tier (CI, Indeterminate, and CU) prediction thresholding schemes.ResultThe 3‐tier model predictions performed well (AUC=0.887; accuracy=0.834; NPV=0.801; PPV=0.859) outperforming the binary predictions (AUC=0.865; accuracy=0.79; NPV=0.737; PPV=0.837) when measured on Biohermes’ cohort diagnosis. The sensitivity and specificity of the 3‐tier predictions were 0.858 and 0.8, respectively.ConclusionThe DCR, a 3‐minute digital cognitive assessment can be used to classify MCI and probable Alzheimer’s dementia with high accuracy, NPV, and PPV.