ABSTRACT
The research carried out on socioeconomic implication models of (re)emerging infectious diseases triggering pandemics has shown us that these largely depended on infection transmission, conditioned by the type of pathogen and the human host. Also, these depended on certain external factors, such as the phenomenon of globalization, pollution, fragile health systems, modification of human behaviors, expansion of human habitat near the outbreaks, favorable vectors involved in the transmission and development of new pandemics and last but not least of wars or civil revolts. The present research attempts to provide some responses to the following questions: 1. What have been the most recent and important emerging infectious disease pandemics and what were the risk factors? 2. What was the socioeconomic impact generated by these pandemics and what important lessons did we learn/identify? 3. What measures and/or directions must be implemented/addressed to prevent/possibly stop a future wave of infections or a new pandemic? The answers to these questions are substantiated by different indicators (transmission potential and pathogen severity) through which we focused to offer some suggestions/directions regarding the way in which these pandemics could be anticipated or prevent, indicators that otherwise are already used by public authorities in the development and exploration of intervention strategies. However, through the elaboration and staged presentation of how these pandemics acted as well as the socioeconomic implications and human reactions, this research could be useful in leading to the development of new, effective ways to prevent the transmission of (re)emerging infectious diseases.
ABSTRACT
High grade serous ovarian cancer typically presents at advanced stage with a median survival of 44 months. Small precursors to this cancer are found in the fallopian tube and likely seed the ovary and peritoneum simultaneously. Early detection is urgently needed and ideally would detect precursor lesions. This award will determine if DNA methylation patterns exhibited in circulating cell-free DNA could be used to detect precursor lesions. During the first year of the award, application for province-wide (Ontario) research ethics approval was submitted to umbrella all 4 participating hospitals. This umbrella approval was obtained;however, we are awaiting final approval from 2 hospitals, which was delayed by the covid-19 shutdown. All research activities were halted (Covid-19 research being the exception) and department staff were redeployed to other hospital activities, causing a back-up of research-related activity. All centres are currently reopening (in stage 2) and study approval should be forthcoming. The Material Transfer Agreements have been started by Sinai Health System and once final REB/IRB approval has been obtained, these will be finalized across the all institutions. Patient samples for use in this study as identified have been secured and we are poised to complete the study once approvals are finalized.
ABSTRACT
Background : Massive bleeding(MB) is associated with coagulopathy and high mortality. Currently, there are diverse approaches to the management of MB. The main difference is the number of blood products in the transfusion packages, which include red blood cells(RBC), fresh frozen plasma(FFP) and platelet concentrates(PC). The use of hemostatic agents like fibrinogen concentrate(FC), tranexamic acid and prothrombin complex concentrate (PCC) has been shown to reduce mortality.Our MB protocol utilizes a ratio of 4RBC:4FFP:1PC in the initial transfusion package. Our hospital administrates approx. 12000 blood products/year. The anesthetics team is experienced with the use of Rotational thrombelastometry (ROTEM) in the management of MB. Aims : This study aimed to determine the use of blood components and hemostatic agents during MB in our hospital. Methods : We performed a retrospective review of MB cases from January 2018 to December 2020. Patient demographics, indications and laboratory records were analyzed. ROTEM guided transfusion was performed by the team of anesthesiologists managing the patient. Results : During this period, a total of 108 MB were detected, with an average of 36/year. The medium age for these events was 57.18 y (range of 18-88 y) and included 49 females and 59 males. MB were associated with surgery(57), cirrhotic complications(27), trauma(20), obstetric bleeding(4).The blood products used were 850 RBC(average 7.87/patient) and 169 PC(average 1.56/patient). Of the 510 FFP units(average 4.72/patient) that were thawed, 411(average 3.84/patient) were used. The remaining units were discarded. Tranexamic acid was used in 70 patients and CCP in 13.There was a favorable outcome in 83 cases and 25 patients died from the major bleeding event.A decrease in MB events was recorded during the COVID pandemic. Conclusions : The optimal way to resuscitate patients with MB remains unclear, and clinical trials are difficult to perform in this setting. We believe that uniform approach for the management of MB is deleterious to the best use of blood products.