ABSTRACT
Recent global trade disruptions, due to blockage of the Suez Canal and cascading effects of COVID-19, have altered the movement patterns of commercial ships and may increase worldwide invasions of marine non-indigenous species. Organisms settle on the hulls and underwater surfaces of vessels and can accumulate rapidly, especially when vessels remain stationary during lay-ups and delays. Once present, organisms can persist on vessels for long-periods (months to years), with the potential to release propagules and seed invasions as ships visit ports across the global transportation network. Shipborne propagules also may be released in increasing numbers during extended vessel residence times at port or anchor. Thus, the large scale of shipping disruptions, impacting thousands of vessels and geographic locations and still on-going for over two years, may elevate invasion rates in coastal ecosystems in the absence of policy and management efforts to prevent this outcome. Concerted international and national biosecurity actions, mobilizing existing frameworks and tools with due diligence, are urgently needed to address a critical gap and abate the associated invasion risks.
ABSTRACT
Introduction: Since the start of COVID-19 pandemic almost six million people succumbed to the illness, with more that 430 million people infected [1],[2]. To mitigate the spread of the virus, various public health measures were deployed, affecting all spheres of the society, including healthcare in every level, without sparing cancer patients worldwide. The 'lockdown' period initiated during the first wave of pandemic limited the access to diagnostics and treatment of colorectal cancer, exposing the vulnerable population of colorectal cancer patients to additional risk[3]. Previous publications report the decrease in number of patients diagnosed with colorectal cancer, in diagnostic procedures, and treatment initiation. Given the fact the incidence of colorectal cancer is in constant rise, these factors hurt not only patients but healthcare system in general [4]. It is estimated that the decrease in diagnostic will be in the range absolute of 5,4-26% [5]. Official records for the period of 2020-2022. published by Croatian Cancer registry are expected between 2024-2026. The goal of this collaboration was to define the effect of epidemiologic measures deployed to contain the virus spread on the number of newly registered colorectal patients in three general hospitals in Dalmatia and the university hospital center in Split. Methods: This retrospective observational study was conducted at the Department of oncology and nuclear medicine at the General hospital in Zadar, Department of internal medicine at General hospital Šibenik and Department of oncology at General hospital Dubrovnik as well as the Department of oncology and radiotherapy at the University hospital in Split. Analysis included patient history files of patients being registered at the Departments between January 1st, 2018. to December 31st, 2020. Results:Analysis included a three-years period and consisted of evaluating 1864 patients. The numbers of patients diagnosed with colorectal cancer was 648 (2018), 605 (2019) and 611 (2020). The most significant drop in 2020 compared to the average of the two preceeding years was observed in the area gravitating the University hospital center (-7,7%), and the General hospital Šibenik (-3%). On the area of Dubrovnik-Neretva County and Zadar County an increase of number of patients was observed (+18% and + 33%, respectively). Conclusion: Number of newly reported colorectal cancer patients was in slight decline in 2020, compared to the average in the pre-pandemic years. The decline in Dalmatia was -2,5% in absolute, which contrasts with projected incidence of colorectal in Croatia and the world. It is also discordant to the previously published papers. This unique and thus far the biggest collaboration of oncology institutions in Dalmatia offered a comprised data on incidence of colorectal cancer in real time, while the nationwide (Croatian Cancer registry) data are expected within 2.4 years (based on previous publishing practice). True impact of the public health measures on patients characteristics, tumor characteristics and disease stage at diagnosis will be reported in the upcoming period.
ABSTRACT
Introduction: Breast cancer is the most diagnosed carcinoma in the world[1]. The incidence of breast cancer is on the rise. In breast cancer, early detection and initiation of treatment showed significant benefits in survival[2]. At the time of the pandemic and lockdown breast cancer patients had limited access to the diagnosis and treatment. Several observational studies reported a temporary shutdown of the early detection program, and in countries where there was no shutdown of the program, there were almost twice as many patients who did not respond to the calls for the preventive examinations [3],[4]. Official data for the Republic of Croatia for the period 2020-2022. are expected from 2024 to 2026. (data based on the current practice of publishing a newsletter). The collaborative study aims to show the effect of pandemic and epidemiological measures on the number of newly registered patients with invasive breast cancer in three Dalmatian general hospitals and the Clinical Hospital Center Split. Methods: A retrospective observational study was conducted at the Clinic for Oncology and Radiotherapy, Clinical Hospital Center Split, Department of Oncology General hospital (GH) Dubrovnik, Department of Oncology GH Šibenik, and Department of Oncology and nuclear medicine GH Zadar. The analysis includes medical histories of newly reported patients with breast cancer in the period from 1 January 2018 to 31 December 2020 Results: The analysis covered three years. A total of 2297 medical histories were reviewed. The number of patients with newly diagnosed breast cancer was 754 (2018), 818 (2019) and 707 (2020). The most significant decrease in the number of patients was observed in the Clinical Hospital Center Split, while the number of patients with breast cancer maintained the trend in the areas gravitating to general/county hospitals. The largest decline in the number of patients was recorded in the 'lockdown' months, without the 'rebound' phenomenon in later months. Conglusion:The number of newly diagnosed patients with breast cancer was declining in 2020. in relation to 2019. This decrease is 14% of the absolute number, which is in significant contrast to the expected increase in the incidence of breast cancer in Croatia and the world. The COVID 19 pandemic and consequent lockdown limited patients 'access to health care at the Clinical Hospital Center. Epidemiological measures, as well as the reluctance of patients described in other studies to go for examinations, reduced the number of newly diagnosed patients with breast cancer. The number of patients did not change significantly in the area of general hospitals in Dalmatia. The strength of the research is in the coverage of the geographical region, general hospitals in Dalmatia, and the Clinical Hospital Center Split, and it represents a unique collaboration of oncological institutions and a collection of oncological and epidemiological data on breast cancer incidence, while nationallevel data are still expected. More precise data on the stages of the disease, the condition of patients at diagnosis are currently being collected and will be published in later publications.
ABSTRACT
Introduction: Prostate cancer is the most common cancer in men[1]. The incidence of prostate cancer in Croatia is in steady increase[2]. One of the possible reasons in the early screening via PSA screening, but also, global aging of the population. Pandemic has greatly affected all levels of healthcare, including, unfortunately, cancer patients. The 'lockdown' period during the first wave of pandemic limited patients' access to diagnostics and subsequently, timely treatment [3]. Several observational studies reported temporary suspensions of early detection programs, and, in the countries where such suspensions did not occur, a lesser number of patients underwent screening programs [4],[5]. The number of patients increased afterwards, to the pre-pandemic level[6]. Based on the current publishing practice, Croatian Cancer registry bulletin for Croatia in the period 2022-2022 are expected in 2024 at soonest. The goal of this collaboration was to test the impact of epidemiologic measures on the number of newly registered prostate cancer patients within three dalmatian general hospitals and the University hospital center in Split. Methods: Retrospective observational study was conducted at the Department of internal medicine at the General hospital of Šibenik- Knin County, Department of oncology at the General hospital Zadar, Department of oncology at the General hospital Dubrovnik, and the Department of oncology and radiotherapy at the University hospital in Split. Analysis involved newly diagnosed prostate cancer patients' medical charts in the period of January 1st, 2018, till December 31st, 2020. Results: Analysis encompassed a three-year period, and 1644 patients' medicals files were examined. The number of newly diagnosed prostate cancer patients in 2018 was 634, 524 in 2019 and 486 in 2020. Most patients were from the area surrounding University hospital Split (865), followed by the Zadar County (506). General hospitals in Šibenik and Dubrovnik had fewer patients (136 and 137, respectively). The most significant decrease in number of newly diagnosed patients in 2020 compared to the average of the two pre-pandemic years was in the area belonging to General hospital Dubrovnik (-36%), followed by General hospital Zadar (-31%), University Hospital of Split (-7%), while the number of newly diagnosed patients in General hospital Šibenik-Knin County was increased (+7%). Conclusion: The number of newly diagnosed prostate cancer patients in Dalmatia decreased during the first wave of pandemics compared to the average of the previous years. The decrease was 23% in absolute, contradicting the increase of incidence expected both in Croatia and worldwide. Public health measures, and previously reported patients' unwillingness to participate in the screening programs during the pandemics decreased the number of newly diagnosed prostate cancer patients. True consequences of these measures, described through patients' and tumors' characteristics, disease stage at diagnosis and the treatment initiation are to be analyzed.
ABSTRACT
Background-aim: SARS coronavirus 2 (SARS-CoV-2) is responsible for high morbidity and mortality worldwide, mostly due to the exacerbated inflammatory response observed in critically ill patients. However, little is known about the kinetics of the systemic immune response and its association with survival in Covid-19 patients admitted in ICU Methods: We performed a retrospective multicenter study including all patients with SARS-Cov-2 infection admitted in 3 ICUs between March 1st and April 15th 2020, with at least 2 measurements of Interleukin 6 (IL6) in 4 days (baseline and day 3-4). Patients who received immunomodulatory treatment were excluded. IL6 was measured on serum by ELISA (Quantikine R&D Systems) and results were expressed at median [25th – 75th percentile]. The relationship between IL6 and CRP, organ failure severity (SOFA score) or in-ICU mortality was analyzed. Results: From the 140 patients admitted in the 3 ICU for SARS-Cov2 infection (PCR diagnosis), 101 patients were included, the mean age was 59 ± 11 years with a high proportion of men (82%). Patients had severe respiratory disease with media SOFA score of 4 [3-7] and 83 required endotracheal intubation/mechanical ventilation at baseline. An increase of SOFA score between baseline and day3-4 was observed in 32 patients (worsening group). Baseline measurements were done 14 days [11-20] after onset of symptoms. At the end of the study, on April 15th 2020, 47 patients had been discharged from ICU, 35 were still in ICU, and 19 had died in ICU. Baseline IL6 concentrations were positively associated with SOFA score. Moreover, baseline IL-6 and CRP concentrations were significantly higher in the worsening group vs the non-worsening: 278 [70-622] vs 71 [29-153] pg/mL (P<0.01) for IL6 and 178 [100-295] vs 100 [37-213] mg/L (P<0.05) for CRP. However, IL6 concentrations were not correlated with CRP. Il6 and CRP concentrations were higher in non-survivors at baseline and at day 3-4. CRP significantly decreased in survivors (190 [80-248] to 108 [45-185], P<0.05) whereas IL6 decreased in both groups. Conclusions: In this multicenter cohort of ICU patients with SARS-CoV-2 infection, we found that Il6 was associated with organ failure severity, worsening and poor outcome.