Background Coronavirus disease 2019 (COVID‐19) is a global pandemic and information on risk factors for worse prognosis is needed to accurately identify patients at risk and potentially provide insight into therapeutic options. Methods In this retrospective cohort study, including 3703 patients with laboratory confirmed COVID‐19, we identified risk factors associated with all‐cause mortality, need for hospitalization and mechanical ventilation. Results Male gender was independently associated with increased risk of hospitalization (Adjusted Odds Ratio (OR adj : 1.62 (95% Confidence Interval (95% CI): 1.38‐ 1.91)), mechanical ventilation (OR adj : 1.35 (95% CI: 1.08‐ 1.69)) and death (OR adj : 1.46 (95% CI: 1.17‐ 1.82)). Patients > 60 years had higher risk of hospitalization (OR adj : 5.47 (95% CI: 4.29‐ 6.96)), mechanical ventilation (OR adj : 3.26 (95% CI: 2.08‐ 5.11)) and death (OR adj : 13.04 (95% CI: 6.25‐ 27.24)). Congestive heart failure (OR adj : 1.47 (95% CI: 1.06‐ 2.02)) and dementia (OR adj : 2.03 (95% CI: 1.46‐ 2.83)) were associated with increased odds of death, as well as the presence of more than two comorbidities (OR adj : 1.90 (95% CI: 1.35‐ 2.68)). Conclusion COVID‐19 patients of older age, male gender or having more than two comorbidities are at higher risk of hospitalization, mechanical ventilation and death, and should therefore be closely monitored. This article is protected by copyright. All rights reserved.

Coronavirus diseases (COVID-19) is associated with high rates of morbidity and mortality and worse outcomes have been reported for various morbidities. The impact of pre-existing hypothyroidism on COVID-19 outcomes remains unknown. The aim of the present study was to identify a possible association between hypothyroidism and outcomes related to COVID-19 including hospitalization, need for mechanical ventilation, and all-cause mortality. All patients with a laboratory confirmed COVID-19 diagnosis in March 2020 in a large New York City health system were reviewed. Of the 3703 COVID-19 positive patients included in present study, 251 patients (6.8%) had pre-existing hypothyroidism and received thyroid hormone therapy. Hypothyroidism was not associated with increased risk of hospitalization [Adjusted Odds Ratio (OR adj): 1.23 (95% Confidence Interval (CI): 0.88-1.70)], mechanical ventilation [OR adj : 1.17 (95% CI: 0.81-1.69)] nor death [OR adj : 1.07 (95% CI: 0.75-1.54)]. This study provides insight into the role of hypothyroidism on the outcomes of COVID-19 positive patients, indicating that no additional precautions or consultations are needed. However, future research into the potential complications of COVID-19 on the thyroid gland and function is warranted.

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ImportanceThere is growing interest in the use of circulating plasma tumor human papillomavirus (HPV) DNA for diagnosis and surveillance of patients with HPV-associated oropharyngeal squamous cell carcinoma (OPSCC). Recent advances in the assays, combining the identification of circulating HPV tumor DNA and tumor DNA fragment analysis (tumor tissue–modified viral [TTMV]-HPV DNA), have been shown to be highly accurate. However, use of these newer techniques has been limited to small cohort studies and clinical trials.ObjectiveTo establish the clinical efficacy of plasma TTMV-HPV DNA testing in the diagnosis and surveillance of HPV-associated OPSCC in a contemporary clinical setting.Design, Setting, and ParticipantsThis retrospective observational cohort study included patients with OPSCC who underwent TTMV-HPV DNA testing between April 2020 and September 2022 during the course of routine clinical care. For the diagnosis cohort, patients with at least 1 TTMV-HPV DNA measurement prior to initiation of primary therapy were included. Patients were included in the surveillance cohort if they had at least 1 TTMV-HPV DNA test performed after completion of definitive or salvage therapy.Main Outcomes and MeasuresPer-test performance metrics, including sensitivity, specificity, positive predictive value, and negative predictive value, for TTMV-HPV DNA testing.ResultsOf 399 patients included in the analysis, 163 were in the diagnostic cohort (median [IQR] age, 63 [56-68.5] years; 142 [87.1%] male), and 290 were in the surveillance cohort (median [IQR] age, 63 [57-70] years; 237 [81.7%] male). Of the 163 patients in the diagnostic cohort, 152 (93.3%) had HPV-associated OPSCC while 11 (6.7%) had HPV-negative OPSCC. The TTMV-HPV DNA sensitivity in pretreatment diagnosis was 91.5% (95% CI, 85.8%-95.4% [139 of 152 tests]), and the specificity was 100% (95% CI, 71.5%-100% [11 of 11 tests]). In the surveillance cohort, 591 tests conducted in 290 patients were evaluated. A total of 23 patients had molecularly confirmed pathologic recurrences. The TTMV-HPV DNA test demonstrated sensitivity of 88.4% (95% CI, 74.9%-96.1% [38 of 43 tests]) and specificity of 100% (95% CI, 99.3%-100% [548 of 548 tests]) in detecting the recurrences. Positive predictive value was 100% (95% CI, 90.7%-100% [38 of 38 tests]), and negative predictive value was 99.1% (95% CI, 97.9%-99.7% [548 of 553 tests]). The median (range) lead time from positive TTMV-HPV DNA test to pathologic confirmation was 47 (0-507) days.Conclusions and RelevanceThis cohort study demonstrated that when evaluated in a clinical setting, the TTMV-HPV DNA assay demonstrated 100% specificity in both diagnosis and surveillance. However, the sensitivity was 91.5% for the diagnosis cohort and 88.4% for the surveillance cohort, signifying that nearly 1 in 10 negative tests among patients with HPV-associated OPSCC was a false negative. Additional research is required to validate the assay’s performance and, if validated, then further research into the implementation of this assay into standard clinical practice guidelines will be required.

Summary OBJECTIVEOBJ ECTIVE Neonatal tetanus (NNT) is an important cause of mortality in resource poor countries, particularly sub-Saharan Africa. There are no reports of the long-term outcome of children who survive NNT in African hospitals. D ESIGNDESIG N In a retrospective study of children discharged from Kili® District Hospital (KDH), Kenya with NNT, each child was linked with a comparative child (CC) in the community matched for age, sex and locality.PARTICIPANTS PARTICIPANTS A total of 123 patients were admitted with NNT between 1992 and 1996, of whom 68% died. Twenty-three (59%) of the 39 survivors were traced in the community, 10 had moved away, six had died. OUTCOME OUT COME MEASURES MEASURES NNT survivors underwent a neurological and developmental examination and a questionnaire was administered to the parents about the behaviour of the child. A verbal autopsy was used to determine the cause of death in children who had died after discharge. RESULTSRES ULTS The head circumference of NNT survivors was signi®cantly smaller than that of CC (P 0.037); eight children had microcephaly compared with one CC (P 0.011). NNT survivors had more problems with hand±eye co-ordination tasks (P 0.035), a lower summated developmental score (P 0.023) and more mild neurological abnormalities (P 0.008) than CC. Parents of NNT survivors reported more behavioural problems (P 0.02) than parents of CC. CONCLUSIONS CONCLUSIONS Children who survive NNT have evidence of brain damage that manifests as microcephaly, mild neurological abnormalities, developmental impairment ± particularly ®ne motor dif®culties ± and behaviour problems.