ABSTRACT
Introduction: The COVID-19 pandemic has a significant impact on the primary, secondary and tertiary levels of the health system. In a low-middle income countries such as Bosnia and Herzegovina, ensuring optimal oncology care was challenging even before the COVID-19 pandemic. Since the beginning of the COVID-19 pandemic, there was a warning of the possible impact of worsening mortality and/ or morbidity due to delayed diagnosis and suboptimal treatment.1 The COVID 19 pandemic has impact on reducing the number of patients treated with radiotherapy.2 The aim of our study was to analyze the impact of the COVID-19 pandemic on radiotherapy in a patient with head and neck cancer who were treated with radiotherapy in a tertiary health care facility. Methods: We analyzed data from the institutional databases for radiotherapy of the Oncology Department at University Clinical Hospital Mostar, Bosnia and Herzegovina. We performed data extraction for patients with head and neck cancer who were treated with primary or adjuvant radiotherapy with or without chemotherapy from January 2018 to December 2021. Results: A total of 114 patients were treated with radiotherapy for head and neck cancer in the pre- COVID-19 period (2018-2019) and COVID-19 period (2020-2021). There were more patients treated with radiotherapy in the preCOVID19 period, 64 (56%) compared to the COVID19 period, 50 (44%). In the COVID 19 period, the number of patients treated with radiotherapy was reduced by 22% compared to the preCOVID19 period. Conclusion: A decline innumber of patients treated with radiotherapy in the COVID 19 period was detected. Health system optimization and education of the general population about the negative indirect impact of COVID 19 on the health system, diagnosis and treatment of cancer is needed.
ABSTRACT
OBJECTIVES: In March 2020, the World Health Organization declared that an infectious respiratory disease caused by a new severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2, causing coronavirus disease 2019 (COVID-19)] became a pandemic. In our study, we have analyzed a large publicly available dataset, the Genome Aggregation Database (gnomAD), as well as a cohort of 37 Russian patients with COVID-19 to assess the influence of different classes of genetic variants in the angiotensin-converting enzyme-2 (ACE2) gene on the susceptibility to COVID-19 and the severity of disease outcome. RESULTS: We demonstrate that the European populations slightly differ in alternative allele frequencies at the 2,754 variant sites in ACE2 identified in the gnomAD database. We find that the Southern European population has a lower frequency of missense variants and slightly higher frequency of regulatory variants. However, we found no statistical support for the significance of these differences. We also show that the Russian population is similar to other European populations when comparing the frequencies of the ACE2 variants. Evaluation of the effect of various classes of ACE2 variants on COVID-19 outcome in a cohort of Russian patients showed that common missense and regulatory variants do not explain the differences in disease severity. At the same time, we find several rare ACE2 variants (including rs146598386, rs73195521, rs755766792, and others) that are likely to affect the outcome of COVID-19. Our results demonstrate that the spectrum of genetic variants in ACE2 may partially explain the differences in severity of the COVID-19 outcome.