ABSTRACT
Currently, Bacille Calmette-Guerin(BCG) is still the only admitted vaccine to prevent tuberculosis around the world. The target population is infants and children, but its protective efficacy is limited. As more and more studies have shown that re-vaccination with BCG protects against tuberculosis in adults, BCG can also induce non-specific immunity against other respiratory diseases and some chronic diseases by training immunity, especially the immune effects against COVID-19. At present, the epidemic of COVID-19 has not been effectively contained, and it is worth considering whether BCG vaccine can be used as an intervention to prevent COVID-19. The WHO and China do not have a policy to support BCG revaccination, and as more and more BCG vaccines are discovered, whether selective revaccination can be carried out in some high-risk populations and whether the vaccine can be used more widely have led to intense discussions. This article reviewed the effects of specific immunity and non-specific immunity of BCG on tuberculosis and non-tuberculous diseases.
Subject(s)
COVID-19 , Tuberculosis , Infant , Child , Adult , Humans , BCG Vaccine , Tuberculosis/prevention & control , Risk Factors , ChinaABSTRACT
Background and Objective: With the onset of the Coronavirus Disease 2019 (COVID-19) pandemic, various aspects of health care have been affected;however, there has been an unknown effect on hospital admissions for gastrointestinal (GI) diseases and the potential consequences on specific illnesses. Our study aims to characterize the rates of GI disease hospitalizations during the pandemic as compared to prior and any differences between specific gastrointestinal diseases throughout this period. This will be important in highlighting any gaps of care as related to gastroenterology during COVID-19.Methods: We conducted a retrospective, cross-sectional study between the months of January to May from the years 2016-2020 in a regional integrated health care system. January –May 2020 was delineated as the COVID-19 period. ICD-10 codes were used to identify principal diagnoses related to the most common GI hospitalizations in the United States (upper GI hemorrhage, pancreatitis, liver disease, diverticular disease, cholelithiasis). Rates of hospitalization were then calculated per 100,000 members for each calendar month and each respective year. Rates for the 5 most identified GI diseases were then calculated using a similar method from 2019 as compared to 2020. The rate of percent change for each month for these diseases were then analyzed during the pandemic year of 2020 versus the preceding year of 2019.Results: A total of 4589 (rate of 19.57 per 100,000) hospitalizations for GI related diseases occurred between January – May 2020 as opposed to 5328 (rate of 23.10 per 100,000) hospitalizations from January – May 2019 (p=0.03). The median age in 2020 was 59.1 (p= 0.27 compared to 2019) with a 51% female to male ratio. 38% of patients were White, 42% Hispanic, 10% Black, 8% Asian (p=0.58 compared to 2019 for all ethnicities). There was a decrease in the rate of hospitalization in each month from January – April 2020 compared to 2019 with a subsequent rise in May. There was a 2.86 increase in rate of hospitalization (p<0.01) from April to May 2020. There were only significant differences (p<0.05) in hospitalization rates between the months of March – May from 2020 versus 2019. Of the 5 most common GI diseases, upper gastrointestinal hemorrhage showed the highest average rate change of -20% from 2020 to 2019. Cholelithiasis had a change of -15%, pancreatitis with a change of -14%, diverticular disease with a change of -11%, and liver disease with a change of -9%.Conclusion: GI related hospitalizations decreased during the COVID-19 pandemic as com-pared to the previous year. Upper gastrointestinal hemorrhage showed the most average rate change of the GI diseases. Further studies highlighting the implications of these findings, such as mortality and severity of illness during the pandemic, need to be completed to assess the impact COVID-19 on GI disease.(Figure presented)(Table Presented)
ABSTRACT
Background: New-onset hyperglycemia may suggest presence of occult pancreatic cancer. The aim of this pilot study was to assess feasibility of pancreatic imaging in patients enrolled in the prospective NOD cohort study. Methods:We conducted a prospective pilot study November 2018-April 2020 within Kaiser Permanente Southern California. Patients 50-85 years enrolled in the NOD study (newly elevated glycemic parameter, no history of diabetes) were invited to complete a three-phase contrast-enhanced computed tomography pancreas-protocol scan. Time to imaging, abnormal pancreatic findings, incidental extra-pancreatic findings, including those prompting additional clinical evaluation were identified. Variability in clinical reporting (descriptors of pancreatic duct and parenchyma) between medical centers was assessed. Results: The majority (88.4%, N = 130) of 147 patients invited consented to undergo imaging;91 scans were completed (prior to COVID-19 stay-at-home orders). Median time from radiology order to imaging was 19.7 days (IQR, 15.4-27.6). Median age was 60.8 years (IQR, 56.3-68.8), 37.8% female;race/ethnicity was Hispanic (41.1%), followed by non-Hispanic white (27.8%), blacks (13.3%), and Asians (13.3%). One (1.1%) case of pancreatic cancer was detected between enrollment and study imaging;12/91 (13.1%) of patients had other pancreatic findings: 2 atrophy, 5 fatty infiltration, 1 divisum, 3 cysts, 1 calcification. Among those with findings, 2 (16.7%) underwent further diagnostic evaluation. Therewere 57 extra-pancreatic findings among 52 (57.1%) unique patients, of which 21.1% (12/57) prompted clinical evaluation. Reports from one of the 8 participating medical centers more frequently described both normal pancreatic parenchyma and normal ducts (39/42 (92.9%) compared to 9/49 (18.4%), P < 0.0001). Conclusions: Among participants in this pilot NOD study, pancreatic imaging was found to be acceptable and feasible to be completed in a timely fashion. There was a high rate of incidental findings as well as significant variability in clinical reports. These challenges will need to be addressed in future studies evaluating early detection of pancreatic cancer.