An Analysis of The Trend of Incidences and Fatality of Pulmonary Tuberculosis in East Java from 2015-2020: A Lesson From COVID-19

Background: Pulmonary tuberculosis is still a public health problem, and surveillance data analysis has not been done much. Recently a global pandemic of COVID-19 has the potential in disturbing TB elimination pro-grams and treatment. This study aims to comprehensively analyse the incidence rate (IR) and Case Fatality Rate (CFR) of pulmonary tuberculosis in East Java from 2015–2020 and during COVID-19 and the strategies for optimizing tuberculosis disease control. Methodology: The study analyzed annual surveillance data using an analytical descriptive design. The Varia-bles were analyzed with Spearman correlation with a level of evidence of 95% (p<0.05). Results: The prevalence of pulmonary tuberculosis in East Java fluctuated from 2015–2020. In 2020 and dur-ing the COVID-19 pandemic, the number of cases and morbidity rates increased. Statistic results confirm the presence of a significant correlation between the values of Incidence rate (IR) and Case Fatality rate (CFR) (p = 0.032), IR and Treatment Success Rate (TSR) (p = 0.020), and CFR and TSR (p = 0.002). Population density is not correlated with the number of new cases (p = 0.667). Treatment rates have increased to 51%; cure and treatment rates have decreased to 76% and 89%, respectively, and there was a 4% increase in mortality dur-ing COVID-19. Conclusions: COVID-19 has tremendously affected the treatment of pulmonary TB cases in East Java, Indone-sia by increasing the incidence rate and decreasing the fatality rate. The pandemic promotes fear in the com-munity to check their medical status and improve the quality of their health in East Java.

Características y factores de riesgo de mortalidad por COVID-19 en Tamaulipas, a un año de pandemia / Characteristics and risk factors of COVID-19 mortality in Tamaulipas, one year after the pandemic

Resumen Coronavirus 19 (COVID-19), es una enfermedad viral prevalente y diseminada a nivel mundial, considerada una pandemia con alta tasa de mortalidad. A la fecha no existen estudios que describan la influencia de las variables asociadas a la enfermedad en el estado fronterizo de Tamaulipas, México. El objetivo del presente estudio fue evaluar y analizar las características, complicaciones, tasas de letalidad y factores de riesgo asociados a mortalidad en paciente positivos a COVID-19 en el estado de Tamaulipas, a un año de la emergencia local. Se utilizó la frecuencia de casos observados en relación a características, complicaciones y comorbilidades para estimar prevalencias y tasas de letalidad. Se ajustó un modelo de regresión logística multivariada para estimar los factores de riesgo significativos y se utilizaron curvas de supervivencia de Kaplan-Meier para describir las comorbilidades más importantes. Los análisis indicaron una mayor infección en pacientes en edad productiva, con una probabilidad significativa de muerte a partir de los 40 años, más evidente en pacientes masculinos. Los riesgos asociados a la hospitalización, como intubación endotraqueal y neumonía, son factores muy importantes. Las comorbilidades con alta prevalencia (diabetes, hipertensión y obesidad) y enfermedad renal crónica (ERC) están asociados significativamente (P < 0.01) a mayor mortalidad por COVID-19 en pacientes positivos. El presente estudio demostró algunos patrones generales de prevalencia y tasas de letalidad por COVID-19, por lo que se sugieren particularidades en los factores asociados a mortalidad en la población de Tamaulipas que requieren atención en sus grupos vulnerables, sobre todo en posibles casos de rebrotes de la enfermedad.

Abstract Coronavirus 19 (COVID-19) is a prevalent and globally disseminated viral disease that has become a pandemic associated with a high case fatality rate. To date, there are no published studies that describe the influence of the variables associated with the disease, specifically in the border state of Tamaulipas, Mexico. The objective of the present study was to assess the characteristics, complications, fatality rates and risk factors associated to mortality in patients positive to COVID-19 in Tamaulipas, one year after the local emergency. Descriptive frequency of characteristics, complications for prevalence and case fatality rates were used. A multivariate logistic regression model was adjusted to estimate the meaningful risk factors, and Kaplan-Meier survival curves were used to describe the most important comorbidities. The analysis indicated higher infection rates in patients of productive age, with a significant death probability in male patients from the age of 40. The risks associated with hospitalization, such as endotracheal intubation and the presence of pneumonia are important risk factors. Comorbidities with high prevalence; diabetes, hypertension, obesity, and chronic kidney disease (CKD) were significantly associated (P < 0.01) with higher COVID-19 mortality risk in the assessed population. The present study demonstrated some COVID-19 general patterns on frequency and mortality rates. It also suggested particularities in factors associated to mortality in the Tamaulipas population, which require proper attention in vulnerable groups, especially in future outbreaks of the disease.

Impacto indirecto de COVID-19 en las tasas de incidencia de enfermedades transmitidas por vector en México / Indirect impact of COVID-19 on the incidence rates of vector-borne diseases in Mexico

Resumen Introducción: La distribución espacial y temporal de la infección por SARS-CoV-2 sobrepasa las áreas endémicas de enfermedades transmitidas por vector (ETV), cuya vigilancia en México ha cambiado sustancialmente a partir del primer caso confirmado de COVID-19. Objetivos: Estimar y comparar las tasas de incidencia de las ETV antes y después de la introducción del SARS-CoV-2 en México. Métodos: Estudio retrospectivo de casos de ETV de 2014 a 2021. Las tasas de incidencia de cada ETV en el periodo previo (2014-2019) y posterior (2020-2021) a la introducción del SARS-CoV-2 en México fueron calculadas y comparadas. Resultados: Antes de la introducción del SARS-CoV-2, las tasas de incidencia de las ETV fueron altas y posterior a la introducción del coronavirus hubo un descenso en los índices epidemiológicos; sin embargo, solo se identificó diferencia estadística significativa en la tasa de incidencia de la malaria (p ≤ 0.05) y otras rickettsias (p ≤ 0.05). Conclusiones: Algunas medidas para reducir los casos de COVID-19, como el distanciamiento social, el confinamiento domiciliario, la reducción en el aforo en el transporte público y el trabajo en casa, probablemente contribuyeron a disminuir temporalmente el número de casos de las ETV; sin embargo, puede haber rebrote de las ETV en el futuro cercano.

Abstract Introduction: SARS-CoV-2 infection spatial and temporal distribution overlaps with endemic areas of vector-borne diseases (VBD), whose surveillance in Mexico has substantially changed since the first COVID-19 confirmed case. Objectives: To estimate and compare the incidence rates of VBDs before and after the introduction of SARS-CoV-2 in Mexico. Methods: Retrospective study of VBD cases from 2014 to 2021. The incidence rates of each VBD in the period before (2014-2019) and after (2020-2021) the introduction of SARS-CoV-2 in Mexico were calculated and compared. Results: Before the introduction of SARS-CoV-2, the incidence rates of VBDs were high and after the introduction of coronavirus there was a decrease in epidemiological indices; however, there was only statistically significant difference in the incidence rate of malaria (p ≤ 0.05) and other rickettsiae (p ≤ 0.05). Conclusions: Some measures to reduce COVID-19 cases, such as social distancing, home confinement, reductions in public transport and working at home (home office), probably temporarily decreased the number of VBD cases; however, there may be a resurgence of VBDs in the near future.

Mortality in post-discharge COVID-19 patients from a tertiary care center - A follow-up study

Background: Among many responsibilities, the doctors from the COVID war room of our institute were assigned to take telephonic follow-up of discharged COVID patients to provide any medical assistance if needed. During this process, few relatives of the patient’s informed back that the patients had died after discharge from the COVID wards. Aim and Objective: Such data of death in the COVID patients after discharged are limited in India; hence, we conducted this study so that more information is generated. Materials and Methods: Relatives of these COVID patients were asked about date and place of death. Other data including gender, age, date of admission, date of discharge, and requirement of oxygen were available with the COVID war room and were used for evaluation. Results: Out of the 892 COVID discharged patients (between August and October 2020) who could be contacted, 19 (2.13%) patients (6 females and 13 males) had died after discharge from the COVID ward. Characteristics of these 19 patients included higher age (n = 11 were 61–80 years old and n = 3 were >80 years old), hospital stay of 11–20 days (n = 12), and required oxygen support (n = 12). Most deaths occurred within 20 days (n = 16) after discharge from the COVID ward. Conclusions: The current study reports deaths occurring COVID patients after discharge. Most of these deaths occurred within 4 weeks of cure and in elderly patients. More research with long-term follow-up is needed in “cured” COVID-19 patients so that appropriate preventive measures can be undertaken in the future.

Effect of emergency heart failure units on readmission and mortality within 6 months after discharge in patients with acute heart failure / 中华急诊医学杂志

Objective:At present, emergency acute heart failure unit has been gradually carried out in China. This study is to analyze the impact of acute heart failure unit on the mortality and readmission rate of acute heart failure (AHF) within 6 months after discharge.Methods:Patients with AHF admitted to Emergency Department and Department of Cardiology, Peking University People's Hospital between December 2019 and December 2020, were prospectively collected. Patients with complicated malignant tumor, stage 4-5 chronic kidney disease, automatic discharge, and incomplete medical history were excluded. The baseline data, past medical history, admission condition, and auxiliary examination were collected. After discharge, the information of oral drugs, hospital readmission and death were collected through outpatient medical records in clinical data center or telephone consultation. Patients were divided into the emergency acute heart failure unit treatment group (emergency AHFU group), emergency routine treatment group (outside AHFU group) and cardiology treatment group according to the different treatment locations. SPSS 25.0 software was used for comparison between groups, and a P<0.05 was considered as statistically significant. ResuIts:A total of 238 patients with AHF were enrolled, 28 patients died in hospital, and 210 patients were followed up. Four cases were excluded from malignant tumor during follow-up, and 6 cases were lost to follow-up. There were 40 cases in the emergency AHFU group, 67 cases in the outside AHFU group, and 93 cases in the cardiology treatment group. According to the prognosis, the patients were divided into the poor prognosis group ( n=83) and good prognosis group ( n=145). The age, sex, vital signs and cardiac function of patients in the emergency AHFU group were basically the same as those in the outside AHFU group at admission, and the proportion of patients in the emergency AHFU group using non-invasive positive pressure ventilation was higher (52.5% vs. 32.8%, P<0.05). The utilization rate of angiotensin converting enzyme inhibitors/angiotensin receptor blockers/angiotensin receptor enkephalinase inhibitors, β-blockers, diuretics and other oral drugs was higher in the emergency AHFU group after discharge, and patients also had more regular follow-up (95% vs. 79.1%, P<0.05). The 6-month readmission rate (15.0% vs. 40.3%, P<0.05) and the 6-month readmission and mortality composite results of patients in the emergency AHFU group (17.5% vs. 43.3%, P<0.05) were significantly lower than those in the outside AHFU group. COX regression analysis showed that the readmission rate of patients in the emergency AHFU group was lower than that in the outside AHFU group ( OR=2.882, 95% CI:1.267~6.611, P=0.12). Compared with the cardiology treatment group, the AHFU group had higher systolic blood pressure, faster heart rate, NT-probNP level, higher proportion of NYHA grade Ⅳ and Killip grade Ⅲ cardiac function (all P<0.05). The proportion of non-invasive mechanical ventilation in the AHFU group was significantly higher than that in the cardiology treatment group (52.5% vs. 30.1%, P<0.05). After discharge, there were no significant differences between angiotensin converting enzyme inhibitor/angiotensin receptor blocker/angiotensin receptor enkephalinase inhibitors and β-blockers. There were also no significant differences in readmission and mortality rate 6 months after discharge. Binary logistics regression analysis found that the independent risk factors of AHF were routine emergency treatment, age, female sex, coronary heart disease, and BUN peak. Conclusions:The emergency acute heart failure unit is an independent protective factor for acute heart failure and reduced readmission rates within 6 months and readmission and mortality composite outcomes. Older age, female sex, coronary heart disease and elevated BUN peak are independent risk factors affecting the prognosis of AHF, which should be identified and preventive measures should be taken early.

Analysis of relevant factors of death cases in pediatric intensive care units in Guiyang City in 2017 / 中国小儿急救医学

Objective:The epidemiological characteristics of PICU deaths in 2017 in the Affiliated Hospital of Guizhou Medical University, Guizhou Provincial People′s Hospital, and Guiyang Children′s Hospital were summarized and analyzed to provide a basis for formulating intervention measures to effectively reduce the mortality rate of children.Methods:The clinical datas of PICU deaths in three tertiary hospitals in 2017 were collected retrospectively.The cases were divided according to different ages and lengths of hospitalization.And gender, age, length of death, length of hospitalization, and death diseases were summarized and analyzed.Results:In 2017, the PICU of the three tertiary hospitals admitted 2 092 children, of which 139 (6.64%) died, including 84 males and 55 females.The months with the highest case fatality rates were January, February, July and August.The fatality rates were 9.14% (18/197), 9.04% (15/166), 13.25% (20/151), 7.93% (13/164), respectively.There was statistically significant difference in the mortality of children admitted in each month ( P=0.038). Among the death cases, the infant group (29 days to 1 year old) accounted for the largest proportion with 58 cases (41.73%), followed by the preschool group (3 to 7 years old) with 37 cases (26.62%), the infant group (1 to 3 years old) with 24 cases(17.27%), and the school-age group (7 to 14 years old) with 20 cases(14.38%). The top three death diseases were: 39 cases (28.06%) of bronchial pneumonia (severe), 28 cases (20.14%) of hematological tumors and solid tumors, and 23 cases (16.55%) of trauma.The difference of its distribution in different age groups was statistically significant( P<0.05). The patients were divided into four groups according to the length of hospital stay.The time ≤1 d group had the highest mortality of 54 cases (38.85%), -3 d group and -7 d group both had 32 cases (23.02%), the >7 d group had the lowest mortality of 21 cases (15.11%). Conclusion:In 2017, January, February and July, August are the peak months of deaths in PICUs in Guizhou, with the highest number of infant deaths.Bronchial pneumonia(severe), hematological tumors and solid tumors, and trauma are the top three death diseases.

Análisis temporal del covid-19 en Colombia: indicadores asociados y modelización / Temporal analysis of covid-19 in Colombia: associated indicators and modeling

AbstractIntroduction. This study shows statistical information regarding COVID-19 in Colombia up to this date (March 1-2022). Specifically, the daily, monthly and cumulative evolution of infections and deaths, correlated with the distribution of the population according to age and gender. Objective. Show statistical information about COVID-19 that allows help to plan and design, in future Pandemics, public health policy strategies in Colombia. Methods. Daily information since the official declaration of Pandemic in Colombia (March 16 ­ 2020) was obtained by the National Health Institute (INS) and was organized in a database in order to conduct respective analysis. This information was compared to similar studies obtained based on the bibliographical review. Results and Conclusions. Results and conclusions are similar to those found in the reference literature: most part of those dead by COVID-19 are of senior age and male gender. Regarding Case Fatality Rate (CFR), it notoriously increases with age. The most vulnerable population displays an average age of ≥ 52.8 years. The less vulnerable population are young persons under 30 years of age, but specifically, those within the age range of 10 and 20 years. Gompertz and Logistic models can mathematically simulate the evolution of deaths and the evolution of CFR according to age

ResumenIntroducción. Este estudio muestra información estadística sobre el COVID-19 en Colombia a la fecha (1 de marzo de 2022). Específicamente, la evolución diaria, mensual y acumulada de contagios y defunciones, correlacionada con la distribución de la población según edad y sexo. Objetivo. Mostrar información estadística sobre COVID-19 que permita ayudar a planificar y diseñar, en futuras Pandemias, estrategias de política de salud pública en Colombia. Metodología. La información diaria desde la declaratoria oficial de Pandemia en Colombia (16 de marzo de 2020) fue obtenida del Instituto Nacional de Salud (INS) y fue organizada en una base de datos para realizar los análisis respectivos. Esta información se comparó con estudios similares obtenidos a partir de revisión bibliográfica. Resultados y conclusiones. Los resultados y conclusiones son similares a los encontrados en la literatura de referencia: la mayor parte de los fallecidos por COVID-19 son de edad avanzada y sexo masculino. En cuanto a la tasa de letalidad (CFR), ésta aumenta notoriamente con la edad. La población más vulnerable presenta una edad promedio ≥ 52.8 años. La población menos vulnerable son los jóvenes menores de 30 años, pero específicamente, los que se encuentran en el rango de edad de 10 y 20 años. Los modelos Gompertz y Logistic pueden simular matemáticamente la evolución de las muertes y la evolución de la CFR según la edad.

Mortality and case fatality rates of COVID-19 in the State of Goiás, Brazil / Taxas de mortalidade e fatalidade de casos da COVID-19 no Estado de Goiás, Brasil

INTRODUCTION: the initial spread of the pandemic in Brazil was mainly affected by patterns of socioeconomic vulnerability. It should be noted that the Central-West region of Brazil is one of the regions with the lowest number of cases, but the states of this region together have the highest mortality rate of COVID-19 in the country. Goiás was the most affected state of this region, with the highest number of deaths in the area. OBJECTIVE: to assess the incidence of mortality and lethality caused by COVID-19 from March 2020 to June 2021 in the State of Goiás, Brazil. METHODS: an ecological study, using a series of time series of public and official data of the Department of Health of the State of Goiás, Brazil. Information was collected on cases and deaths from COVID-19 from March 2020 to June 2021. Mortality, case fatality, and incidence rates were calculated. The Prais-Wisten regression model was used to build time series. The daily percent change (DPC) and the effective reproductive number (Rt) were estimated. RESULTS: Goiás had a predominance of a greater viral spread during the first and the beginning of the second wave, with Rt higher than 1. The second wave from December 2020 to June 2021 was more lethal and had higher mortality rates than the first wave. It was observed, higher scores of case fatality and mortality belonged to males and the elderly. CONCLUSION: an analysis of mortality and case fatality rates helps understand the COVID-19 pandemic behavior in Goiás. It is essential to monitor epidemiological indicators and strengthen intervention strategies to contain the pandemic in this state.

INTRODUÇÃO: a propagação inicial da pandemia no Brasil foi afetada principalmente por padrões de vulnerabilidade socioeconômica. Ressalta-se que a região Centro-Oeste do Brasil é uma das regiões com menor número de casos, mas os estados dessa região juntos apresentaram a maior taxa de mortalidade por COVID-19 do país. Goiás foi o estado mais afetado da região, com o maior número de óbitos. OBJETIVO: avaliar a incidência, mortalidade e letalidade por COVID-19 no Estado de Goiás, Brasil, no período de março de 2020 a junho de 2021. MÉTODO: estudo ecológico, utilizando séries temporais de dados públicos e oficiais da Secretaria de Saúde do Estado de Goiás, Brasil. As informações foram coletadas sobre casos e óbitos de COVID-19 de março de 2020 a junho de 2021. Mortalidade, letalidade e taxas de incidência foram calculadas. O modelo de regressão Prais-Wisten foi usado para construir séries temporais. A mudança percentual diária (DPC) e o número reprodutivo efetivo (Rt) foram estimados. RESULTADOS: Goiás teve predomínio de maior disseminação viral durante a primeira onda e o início da segunda onda, com Rt maior que 1. A segunda onda, dezembro de 2020 a junho de 2021, foi mais letal e apresentou taxas de mortalidade maiores que a primeira onda. Observou-se que os maiores escores de letalidade e mortalidade pertenciam ao sexo masculino e aos idosos CONCLUSÃO: uma análise das taxas de mortalidade e letalidade ajuda a entender o comportamento da pandemia do COVID-19 em Goiás. É fundamental monitorar indicadores epidemiológicos e fortalecer estratégias de intervenção para conter a pandemia neste estado.

Factores asociados a letalidad por COVID-19 en un hospital de la región Cajamarca en Perú / Factors associated with COVID-19 lethality in a hospital in the Cajamarca region in Peru

RESUMEN Objetivo. Identificar las características clínicas y epidemiológicas relacionadas a la letalidad en pacientes hospitalizados por COVID-19 en el Hospital Simón Bolívar de Cajamarca, durante junio-agosto de 2020. Materiales y métodos. Cohorte retrospectiva, con información recolectada de historias clínicas y sistemas oficiales de vigilancia epidemiológica (NOTIWEB, SISCOVID y SINADEF), sobre pacientes hospitalizados con diagnóstico confirmado de COVID-19. Se recolectó información sobre factores sociodemográficos y clínicos, considerando como desenlace el egreso (fallece/sobrevive) y los días de hospitalización. Resultados. La tasa de letalidad intrahospitalaria fue 39,6%, encontrándose diferencias significativas entre el tiempo de hospitalización y la condición de egreso en las personas mayores de 60 años (p<0,001). La edad mayor de 60 años (HR: 2,87; IC95%: 1,76-4,68),) solicitud de cama UCI no atendida (HR: 3,49; IC95%: 2,02-6,05), saturación de oxígeno menor a 80% al ingreso (HR: 2,73; IC95%: 1,35-5,53) y el uso de ivermectina (HR: 1,68; IC95% 1,06-2,68) fueron factores asociados a letalidad. El modelo de Machine Learning (ML) elegido consideró que las variables con mayor importancia fueron la saturación de oxígeno, la edad mayor de 60 años, tiempo de hospitalización y tiempo de síntomas. Conclusión. Los factores que podrían incrementar la letalidad en pacientes hospitalizados por COVID-19 fueron la edad, saturación de oxígeno menor a 80%, uso de ivermectina en la terapéutica hospitalaria y la solicitud no atendida de camas UCI. Futuros estudios con una mejor representatividad podrían confirmar estas posibles relaciones a nivel regional o nacional.

ABSTRACT Objective. To identify the clinical and epidemiological characteristics related to lethality in patients hospitalized for COVID-19 at the Simón Bolívar Hospital in Cajamarca, during June-August 2020. Materials and Methods. This was a retrospective cohort, that used information collected from clinical records and official epidemiological surveillance systems (NOTIWEB, SISCOVID and SINADEF), on hospitalized patients with confirmed COVID-19 diagnosis. Information was collected on sociodemographic and clinical factors, considering discharge (death/survival) and days of hospitalization as outcomes. Results. The in-hospital fatality rate was 39.6%, and significant differences were found between hospitalization time and status at discharge in people over 60 years of age (p<0.001). Age older than 60 years (HR: 2.87; 95% CI: 1.76-4.68),) unattended ICU bed request (HR: 3.49; 95% CI: 2.02-6.05), oxygen saturation less than 80% at admission (HR: 2.73; 95% CI: 1.35-5.53) and the use of ivermectin (HR: 1.68; 95%CI 1.06-2.68) were factors associated with lethality. The chosen ML model considered that the most important variables were oxygen saturation, age over 60 years, time of hospitalization and time of the onset of symptoms. Conclusion. The factors that could increase lethality in patients hospitalized for COVID-19 were age, oxygen saturation less than 80%, use of ivermectin as part of hospital treatment and unattended request for ICU beds. Future studies with better representativeness could confirm these possible relationships at the regional or national level.

Current situation of emergency medical service system for patients with acute myocardial infarction in Hebei Province and its influence on treatment and prognosis / 中华急诊医学杂志

Objective:To investigate the current situation of emergency medical service (EMS) system and its effect on treatment of the acute stage and short- and long-term prognosis in patients with acute myocardial infarction in Hebei province.Methods:Totally 2 961 patients with acute myocardial infarction who were admitted to major tertiary and some representative secondary hospitals in Hebei province from January 2016 to December 2016 were collected. According to the pattern of arriving hospital, all the patients were divided into the EMS group and self-transport group. The general conditions, time from onset to treatment, treatment methods, in-hospital mortality rate and 3-year mortality rate were compared between the two groups.Results:Of the included 2 961 patients, 33.13% of them were transported through EMS and 66.87% of them by private transport. Patients with a history of hypertension and ST-segment elevation myocardial infarction were more likely to choose EMS, and the difference was statistically significant ( P<0.05). Moreover, patients in the EMS group were more likely to go to tertiary hospitals for treatment (88.58% vs 85.76%, P=0.033). The time from onset to treatment of the EMS group was significantly shorter than that of the self-transport group (160 min vs 185 min, P<0.01), and the proportion of patients in the EMS group from onset-to-door time in <3 h and 3-6 h was higher than that of the self-transport group (55.76% vs 49.14%, 21.41% vs 19.09%, P<0.01). Compared with the self-transport group, the EMS group has a higher rate of reperfusion therapy (67.48% vs 61.67%, P=0.002). Patients in the EMS group had a higher in-hospital mortality rate in the acute stage (7.03% vs 4.44%, P=0.003), but its 3-year mortality rate was lower than that of the self-transport group (17.31% vs 20.77%, P<0.05). Conclusions:EMS can shorten symptom-onset-to-arrival time, increase the rate of reperfusion therapy and improve long-term prognosis of patients with acute myocardial infarction.

Predicting COVID-19 fatality rate based on age group using LSTM

Objective: To predict the daily incidence and fatality rates based on long short-term memory (LSTM) in 4 age groups of COVID-19 patients in Mazandaran Province, Iran. Methods: To predict the daily incidence and fatality rates by age groups, this epidemiological study was conducted based on the LSTM model. All data of COVID-19 disease were collected daily for training the LSTM model from February 22, 2020 to April 10, 2021 in the Mazandaran University of Medical Sciences. We defined 4 age groups, i.e., patients under 29, between 30 and 49, between 50 and 59, and over 60 years old. Then, LSTM models were applied to predict the trend of daily incidence and fatality rates from 14 to 40 days in different age groups. The results of different methods were compared with each other. Results: This study evaluated 5 0826 patients and 5 109 deaths with COVID-19 daily in 20 cities of Mazandaran Province. Among the patients, 25 240 were females (49.7%), and 25 586 were males (50.3%). The predicted daily incidence rates on April 11, 2021 were 91.76, 155.84, 150.03, and 325.99 per 100 000 people, respectively; for the fourteenth day April 24, 2021, the predicted daily incidence rates were 35.91, 92.90, 83.74, and 225.68 in each group per 100 000 people. Furthermore, the predicted average daily incidence rates in 40 days for the 4 age groups were 34.25, 95.68, 76.43, and 210.80 per 100 000 people, and the daily fatality rates were 8.38, 4.18, 3.40, 22.53 per 100 000 people according to the established LSTM model. The findings demonstrated the daily incidence and fatality rates of 417.16 and 38.49 per 100 000 people for all age groups over the next 40 days. Conclusions: The results highlighted the proper performance of the LSTM model for predicting the daily incidence and fatality rates. It can clarify the path of spread or decline of the COVID-19 outbreak and the priority of vaccination in age groups.

No Effects of Meteorological Factors on the SARS-CoV-2 Infection Fatality Rate / 生物医学与环境科学（英文）

Objective@#Previous studies have shown that meteorological factors may increase COVID-19 mortality, likely due to the increased transmission of the virus. However, this could also be related to an increased infection fatality rate (IFR). We investigated the association between meteorological factors (temperature, humidity, solar irradiance, pressure, wind, precipitation, cloud coverage) and IFR across Spanish provinces ( @*Methods@#We estimated IFR as excess deaths (the gap between observed and expected deaths, considering COVID-19-unrelated deaths prevented by lockdown measures) divided by the number of infections (SARS-CoV-2 seropositive individuals plus excess deaths) and conducted Spearman correlations between meteorological factors and IFR across the provinces.@*Results@#We estimated 2,418,250 infections and 43,237 deaths. The IFR was 0.03% in < 50-year-old, 0.22% in 50-59-year-old, 0.9% in 60-69-year-old, 3.3% in 70-79-year-old, 12.6% in 80-89-year-old, and 26.5% in ≥ 90-year-old. We did not find statistically significant relationships between meteorological factors and adjusted IFR. However, we found strong relationships between low temperature and unadjusted IFR, likely due to Spain's colder provinces' aging population.@*Conclusion@#The association between meteorological factors and adjusted COVID-19 IFR is unclear. Neglecting age differences or ignoring COVID-19-unrelated deaths may severely bias COVID-19 epidemiological analyses.

Desigualdades sociais associadas com a letalidade por COVID-19 na cidade de Fortaleza, Ceará, 2020 / Desigualdades sociales asociadas con la letalidad por COVID-19 en la ciudad de Fortaleza, estado de Ceará, Brasil, 2020 / Social inequalities associated with COVID-19 case fatality rate in Fortaleza, Ceará state, Brazil, 2020

Resumo Objetivo Analisar a associação entre as desigualdades sociais e sanitárias, condições socioeconômicas, segregação espacial e letalidade por COVID-19 em Fortaleza, Ceará, Brasil. Métodos Estudo ecológico de casos confirmados e óbitos por COVID-19, tendo como unidades de análise os 119 bairros de Fortaleza. Calcularam-se os indicadores de incidência, mortalidade e letalidade aparente por COVID-19, entre 1º de janeiro e 8 de junho de 2020. Indicadores socioeconômicos foram extraídos do Censo Demográfico do Brasil de 2010. Foi realizada análise espacial e calculados índice global e local de Moran. Resultados Foram encontrados 22.830 casos confirmados, 2.333 óbitos e uma letalidade aparente de 12,7% (IC95% 11,6;13,9). Observaram--se autocorrelações espaciais significativas para letalidade aparente (I=0,35) e extrema pobreza (I=0,51), sobrepostas em diversos bairros da cidade. Conclusão A letalidade aparente por COVID-19 está associada a piores condições socioeconômicas e de saúde, demonstrando a relação entre desigualdades sociais e desfechos de saúde em tempos de pandemia.

Resumen Objetivo Analizar la asociación entre las desigualdades sociales y sanitarias, condiciones socioeconómicas, segregación espacial y letalidad por COVID-19 en Fortaleza, Ceará, Brasil. Métodos Estudio ecológico de casos y defunciones confirmadas por COVID-19, se utilizaron, como unidades de análisis, 119 barrios de Fortaleza. Se calcularon los indicadores de incidencia, mortalidad y letalidad aparente por COVID-19, entre el 1 de enero y el 8 de junio de 2020. Los indicadores socioeconómicos se extrajeron del Censo Demográfico de Brasil 2010. Se realizó un análisis espacial y calculados los índices Global y Local de Moran. Resultados Se encontraron 22.830 casos confirmados, 2.333 muertes y una letalidad aparente de 12,7 (IC95% 11,6;13,9). Se observaron autocorrelaciones espaciales significativas para letalidad aparente (I=0,35) y extrema pobreza (I=0,51) que se sobreponen en diversos barrios de la ciudad. Conclusión La letalidad por COVID-19 está asociada con peores condiciones socioeconómicas y sanitárias, demostrando la relación entre desigualdades sociales y los resultados de salud en tiempos de pandemia.

Abstract Objective To analyze the association among social and health inequalities, socioeconomic status, spatial segregation and Case Fatality Rate (CFR) due to COVID-19 in Fortaleza, the state capital of Ceará, Brazil. Methods This was an ecological study of confirmed cases and deaths due to COVID-19. The 119 neighborhoods of Fortaleza were used as units of analysis. Incidence, mortality and apparent CFR indicators due to COVID-19 were calculated between January 1 and June 8, 2020. Socioeconomic indicators were obtained from the 2010 Brazilian Demographic Census. Spatial analysis was performed and local and global Moran's indexes were calculated. Results There were 22,830 confirmed cases, 2,333 deaths and the apparent CFR was 12.7% (95% CI 11.6;13.9). Significant spatial autocorrelations between apparent CFR (I=0.35) and extreme poverty (I=0.51), overlapping in several neighborhoods of the city, were found. Conclusion The apparent CFR due to COVID-19 is associated with the worst socioeconomic and health status, which shows the relationship between social inequalities and health outcomes in times of pandemic.

Analysis of influencing factors of death in patients with COVID-19 / 中草药

Objective: To analyze the influencing factors of death in patients with coronavirus disease 2019 (COVID-19) and provide a reference for clinically reducing the mortality of patients with COVID-19. Methods: Based on the retrospective analysis of the case data of all patients with COVID-19 admitted in our hospital from January 17th to February 25th, 2020, and the sex, age, whether or not to take Chinese medicine preparations during hospitalization, clinical classification, comorbidities, nucleic acid test results, admission time, discharge and other relevant indicators were collected for statistical analysis. Results: During the period of COVID-19, the number of patients of COVID-19 in our hospital gradually increased. At the epidemic peak period, 904 patients with COVID-19 were treated simultaneously. From January 17th to February 25th, 2020, a total of 1 305 patients with COVID-19 were treated in our hospital, including 632 males and 673 females, and the male to female ratio was 1:1.06. The age distribution ranged from 7 to 111 years, with a median of 63 (51, 70) years old. There was no significant difference in the age distribution of patients between different genders (Z = 1.217, P = 0.224). The results of univariate analysis showed that the patient's gender, age, whether to take Chinese medicine preparations during treatment, clinical classification, whether combined with underlying diseases (hypertension, coronary heart disease, diabetes, tumors and uremia) and nucleic acid test results all could affect patients fatality rate. Logistics multivariate regression analysis found that taking traditional Chinese medicine preparations, clinical classification, and whether combined with underlying diseases were independent risk factors for death in patients with COVID-19. Conclusion: The death of patients with COVID-19 is related to various factors. Reducing the occurrence of critical illness, controlling underlying diseases, stabilizing blood pressure and blood sugar, actively improving cardio-cerebral vascular conditions, and stabilizing renal function are main measures to improve the therapeutic effect, and early application of traditional Chinese medicine treatment also plays a very important role in reducing the mortality of patients with COVID-19.

Effect of low postoperative platelet count on early fatality rate of adult liver transplantation without platelet transfusion during operation / 器官移植

Objective To investigate the effect of low platelet (PLT) count on the early fatality rate of liver transplant recipients without intraoperative PLT transfusion. Methods Clinical data of 180 recipients undergoing orthotopic liver transplantation were retrospectively analyzed. The critical value of PLT count on postoperative 7 d to predict the early postoperative fatality rate was evaluated by the receiver operating characteristic(ROC) curve. All recipients were divided into the low PLT count group and control group according to the critical value. Relevant clinical data including perioperative PLT count, preoperative general conditions and intraoperative conditions of the recipients were included. The independent risk factors of the early fatality rate of liver transplant recipients were analyzed by Logistic regression analysis. The early prognosis of the recipients between two groups was observed and compared by the postoperative length of intensive care unit (ICU) stay, postoperative length of hospital stay, early allograft dysfunction and fatality rate on postoperative 30 d. Results The PLT count < 32×109/L on 7 d after liver transplantation was an independent risk factor of the fatality rate on postoperative 30 d (P < 0.05). The postoperative length of ICU stay of the recipients in the low PLT count group was 9 (5, 14) d, significantly longer than 5 (3, 6) d in the control group (P < 0.05). In the low PLT count group, the early allograft dysfunction rate was 55.0%, significantly higher than 20.6% in the control group (P < 0.05). In the low PLT count group, the fatality rate on postoperative 30 d was 40.0%, significantly higher than 2.5% in the control group (P < 0.05). The length of hospital stay did not significantly differ between two groups (P > 0.05). Conclusions The PLT count < 32×109/L on postoperative 7 d is an independent risk factor for the fatality rate on postoperative 30 d of liver transplant recipients. It can prompt the early allograft dysfunction and contribute to predict the early clinical prognosis of liver transplant recipients.

Comparison of the accuracy of RIFLE, AKIN and KDIGO criteria in predicting early death after liver transplantation / 器官移植

Objective To compare the accuracy of three acute kidney injury (AKI) criteria of RIFLE, Acute Kidney Injury Network (AKIN) and Kidney Disease: Improving Global Outcomes (KDIGO) in predicting the early (30 d) postoperative death of liver transplant recipients. Methods Clinical data of 173 liver transplant recipients were retrospectively analyzed. The incidence of postoperative AKI was calculated according to the three criteria of RIFLE, AKIN and KDIGO. The all-cause fatality rate and cause of death at postoperative 30 d were analyzed. The risk factors of death within 30 d after operation were analyzed by binary Logistic regression. The prediction accuracy of three criteria for death within 30 d after operation was compared by the receiver operating characteristic (ROC) curve. Results According to the RIFLE, AKIN and KDIGO criteria, the incidences of postoperative AKI were 48.0%, 51.4% and 53.8%, respectively. Thirteen patients died within 30 d after operation and the fatality rate was 7.5%. RIFLE, AKIN and KDIGO stages were the independent risk factors for death within 30 d after operation (all P < 0.05). The area under the curve (AUC) of RIFLE, AKIN and KDIGO stages to predict death within 30 d after liver transplantation were 0.828, 0.766 and 0.844, respectively. There was a statistically significant difference between AKIN and KDIGO (P < 0.05). Conclusions KDIGO criterion is better for predicting early death after liver transplantation. However, as a tool, the comparative selection among these three criteria still needs the evidence support from a large multicenter sample.

The cholera epidemic of 2004 in Douala, Cameroon: A lesson learned

Objective: To describe the outbreak of 2004 with a view of retrospectively identifying factors that might explain the low case fatality rate. Methods: Outbreak data from 4 915 Cholera patients from registers of the Regional Health Delegation in Douala were analyzed using SPSS. Chi-square test, univariate and multivariate analysis were applied. Results: The outbreak started January 2004, peaking at 187 cases per week in February. After a decrease in April, case numbers rose to 688 cases per week in June. The outbreak was over in September 2004 ( <10 cases per week). The case fatality rate was higher in treatment centers with fewer than one nurse per two patients, than in those with more nursing staff. A temporary staff reduction after the first wave of the epidemic was associated with the increase of the case fatality rate during the second wave. This increase was reversed after re-instating full staff capacity. Conclusions: Providing sufficient nursing staff helps to lower the case fatality rate of cholera. Besides a lack of staff, age above 40 years is a risk factor for death in this disease.

The cholera epidemic of 2004 in Douala, Cameroon: A lesson learned

Objective: To describe the outbreak of 2004 with a view of retrospectively identifying factors that might explain the low case fatality rate. Methods: Outbreak data from 4 915 Cholera patients from registers of the Regional Health Delegation in Douala were analyzed using SPSS. Chi-square test, univariate and multivariate analysis were applied. Results: The outbreak started January 2004, peaking at 187 cases per week in February. After a decrease in April, case numbers rose to 688 cases per week in June. The outbreak was over in September 2004 ( <10 cases per week). The case fatality rate was higher in treatment centers with fewer than one nurse per two patients, than in those with more nursing staff. A temporary staff reduction after the first wave of the epidemic was associated with the increase of the case fatality rate during the second wave. This increase was reversed after re-instating full staff capacity. Conclusions: Providing sufficient nursing staff helps to lower the case fatality rate of cholera. Besides a lack of staff, age above 40 years is a risk factor for death in this disease.

Tuberculosis fatality rates in the city of Campinas - São Paulo, Brazil, from 2001 to 2009 / Taxas de letalidade por tuberculose na cidade de Campinas, São Paulo, Brasil, de 2001 a 2009

ABSTRACT: Introduction: The mortality rate among tuberculosis patients (TB fatality) has been attributed to irregular chemotherapy, delay in diagnosis, multidrug resistance, and HIV coinfection. Objective: To analyze TB fatality rates by sex, clinical presentation and HIV coinfection in Campinas, São Paulo, Brazil. Methods: Cohorts of residents in the city of Campinas who either died during treatment for tuberculosis or had the disease confirmed after death were divided into three intervals: 2001-2003, 2004-2006, and 2007-2009. Data were obtained from the database of the Tuberculosis Surveillance System of the University of Campinas, and notifications were gathered through TB-WEB Health São Paulo Secretary. Statistical significance was determined using a chi-square test, considering p < 0.05. Results: Between 2001 and 2009, 3,416 TB patients were diagnosed: 2,827 (82.8%) were new TB cases and 589 (17.2%) were retreatments. Between the first and second triennium, the number of new patients decreased by 18%, and 23% among retreatments. Between the second and third intervals, the reduction was 5% and 21%, respectively. General case fatality rate declined from 11.4% to 9.9% across intervals, and was most significant among patients that had previously abandoned treatment (17.3% to 5.1%). Fatality rates among patients coinfected with TB-AIDS were 2-3 times that of patients not infected with TB-AIDS throughout the intervals. Fatality between the first and third triennium among TB-AIDS co-infected patients declined (24.8% to 19.5%), while increasing slightly among non-AIDS TB patients (7.3% to 8%) during this period. Conclusion: Though mortality among TB-AIDS patients declined from 2001-2009, rates among non-AIDS TB remained stagnant. Improved TB diagnosis and treatment is needed to further decrease TB mortality in Campinas.

RESUMO: Introdução: A letalidade por tuberculose tem sido atribuída à quimioterapia irregular, à demora no diagnóstico, à multidrogarresistência, à coinfecção com o vírus da imunodeficiência humana (HIV). Objetivo: Analisar letalidade por tuberculose segundo sexo, apresentação clínica, presença da coinfecção pelo HIV, em Campinas, São Paulo, Brasil. Metodologia: Foram verificadas coortes de residentes em Campinas que morreram durante tratamento para tuberculose e aqueles notificados após óbito, agrupados em três intervalos: 2001-2003, 2004-2006 e 2007-2009. As informações foram obtidas no Banco de Dados para Vigilância da Tuberculose da Universidade Estadual de Campinas (UNICAMP), com captação das notificações no Sistema de Notificação e Acompanhamento de Casos de Tuberculose da Secretaria Estadual de Saúde de São Paulo. A significância estatística foi verificada pelo teste χ2 considerando p < 0,05. Resultados: Entre 2001 e 2009, foram diagnosticados 3.416 pacientes com tuberculose: 2.827 (82,8%) sem tratamento anterior e 589 (17,2%) com retratamentos. Entre o primeiro e o segundo triênio, o número de pacientes novos diminuiu 18% sem tratamento anterior e 23% entre retratamentos. Entre o segundo e o terceiro intervalo, a redução foi de 5 e 21%, respectivamente. A letalidade geral declinou de 11,4 para 9,9%, diferença mais significante entre os que haviam abandonado tratamento anteriormente (17,3 para 5,1%). A letalidade entre pacientes com coinfecção tuberculose-síndrome da imunodeficiência adquirida (Aids) foi 2-3 vezes maior que entre tuberculose sem aids durante todo o período estudado. A letalidade entre o primeiro e o terceiro triênio declinou no grupo com tuberculose-aids (24,8 para 19,5%), enquanto teve ligeiro aumento entre tuberculose sem aids (7,3 para 8%). Conclusão: Embora a mortalidade entre pacientes com tuberculose-aids tenha diminuído de 2001-2009, as taxas no grupo tuberculose sem aids permaneceram estagnadas. Melhorias no diagnóstico e no tratamento são necessárias para a redução da mortalidade entre pacientes com tuberculose em Campinas.

Victim-oriented digital disaster emergency medical system

The fatality rate of a disaster is associated with the impact of the disaster and the case fatality rate. The severity of the disaster can be reduced by an efficient disaster management system, and the capacity of the trained disaster response system can lower the case mortality rate. The severity of a disaster is determined by the interaction of risk factors and vulnerabilities in a particular area, and the case-fatality rate is determined by a correlation between the capacity of the disaster response team and the survivability of the victims. The disaster management system and the disaster response system are complementary and interconnected, and the efficiency of cooperation and linkage can be improved by developing well organized digitalization. Efforts to increase the survival rate of victims through digitalization has been a continued process and new alternatives are being developed in accordance with the advances in information and communication technology to manage disaster risk factors and to improve disaster response capabilities. However, in case of mass casualty incidents, it is still difficult to reduce the case mortality rate by securing the survival time limit of the victims. Often, sharing the disaster scene information and communicating with the victim is not feasible. A lack of ability to provide real time escape route to exit or safe zone proves fatal. The communication revolution of the next generation wireless wide area network called 5G can overcome the disruption of communication network during the disaster incidents. It can enable real time tracking of the position of victim and linking the victims with its rescuers. Hence, it is possible to increase the survival rate of victims during mass casualty incidents by associating information and communication technologies with appropriate disaster management and response strategies, real-time information exchange and education and training of rescuers and citizens.