A study in Nature Microbiology suggests trace-level cytokines, a marker of cardiac inflammation, may play a key role in long-COVID cardiac symptoms, including chest pains and shortness of breath.

The findings were based on blood samples collected from 50 COVID-19 patients in Australia collected up to 18 months after infections. People reporting long-COVID symptoms had elevated levels of cytokines, which are proteins the body makes to fight inflammation.

Lab studies showed these trace-level cytokines had a direct effect on the functionality of cardiomyocytes, the cells of the heart responsible for its pump function.

“Lab studies showed these trace-level cytokines had a direct effect on the functionality of cardiomyocytes, the cells of the heart responsible for its pump function,” said study author Kirsty Short, PhD, of the University of Queensland in a press release from that university. 

Analysis showed participants' cardiovascular-specific long COVID symptoms had a more pronounced upregulation of inflammation-related pathways/terms, including neutrophil degranulation, antimicrobial peptides, and response to bacterium pathways, the authors said. 

"We’re now curious to know whether our findings could be applied to other symptoms of long COVID such as neurological disease or respiratory disease, as this study actively recruited sufferers with chest pain and/or heart palpitations," said Short, who added that  these initial findings need validation in larger studies. 

China has reported seven more H9N2 avian flu infections in humans, mostly involving children and all in people whose symptoms began in September and October, Hong Kong's Centre for Health Protection (CHP) said today in its weekly avian flu update.

Four of the patients are from Hunan province, including a 10-month-old boy, a 1-year-old girl, and two boys ages 3 and 5 years old. One person is a 6-year-old boy from Hubei province, and another is a 7-year-old boy from Jiangxi province.

The only adult patient is a 67-year-old woman from Sichuan province.

Exposures unknown

Exposure sources weren't noted in the report. H9N2 is known to circulate in poultry, especially in Asia, where sporadic infections are reported, mainly in children and mostly mild after exposure to poultry. No sustained transmission has been reported.

China reported its last H9N2 case in September and has now reported 13 cases this year.

An intervention to reduce antibiotic treatment of asymptomatic bacteriuria (ASB) at critical-access hospitals (CAHs) was associated with small but clinically significant improvement, researchers reported yesterday in Infection Control & Hospital Epidemiology.

Misdiagnosis and treatment of ASB—the presence of bacteria in the urine without other signs of infection—is a common practice and major driver of inappropriate antibiotic use in hospitals, particularly CAHs, which are primarily rural and have limited infrastructure for quality-improvement and antibiotic stewardship programs. 

To address the problem, researchers at the University of Washington Center for Stewardship in Medicine created a stewardship collaborative centered on an inappropriate diagnosis of urinary tract infection (ID-UTI) measure that has been shown to reduce ASB treatment in other types of hospitals. 

Reduction in ASB treatment not statistically significant

From October 2022 through July 2023, 1o CAHs participated in the quality-intervention program, which included learning labs, mentoring, and performance reports using the ID-UTI measure, which allowed hospitals to compare rates of ASB treatment. During the study period, ASB treatment at the CAHs fell from 28.4% during the first month to 18.6% during the final month, for an absolute reduction of 9.8%.

After adjusting for hospital clustering, the odds that a case treated for UTI was ASB non-significantly decreased by 6.5% with each additional month (adjusted odds ratio [aOR], 0.935; 95% confidence interval [CI], 0.873 to 1.001). There was no change in antibiotic duration or unjustified fluoroquinolone use.

"Although the reduction in ASB treatment was not statistically significant, the estimated effect size was fairly substantial and thus potentially clinically significant," the study authors wrote, adding that the findings indicate the ID-UTI measure can be implemented in resource-limited settings. 

"Future work over a longer period should be done to ensure that the decrease in overtreatment in ASB can be sustained," they concluded.