ABSTRACT
Candidemia is the most common recorded invasive fungal infection worldwide. During the last couple of years, the world has been struggling with the COVID-19 pandemic caused by the Severe Acute Respiratory Syndrome Corona Virus (SARS-CoV-2), during which an increase in the incidence of candidemia and Candida auris cases were reported by several researchers. This study aimed to address how the entire landscape evolved during the downslide of the COVID-19 pandemic over the study period that spanned five years, including the pre-pandemic, peak, and waning of the COVID-19 pandemic. This retrospective observational study was conducted on a cohort of 1450 tertiary care cases in a University hospital in Jaipur, India, from July, 2017 to November, 2021. During the study period, all blood cultures of the suspected sepsis cases were screened for candidemia. Identification and antifungal susceptibility testing of Candida isolates were carried out using the standard assays. A consistent increase in the prevalence of candidemia has been observed during the current study period. Despite this, the prevalence of Non albicans Candida has remained almost steady. A sharp increase in C. auris candidemia during the COVID-19 pandemic was observed. The waning of the COVID-19 pandemic has brought the epidemiology of candidemia back to the pre-pandemic times, and C. tropicalis has become the predominant clinical isolate again. There is a slight fall in resistance to fluconazole. Echinocandins, which is considered as a remedy till few years back, has also showed first signs of emerging resistance in patients attending to Mahatma Gandhi University of Medical Sciences & Technology (MGUMST), Jaipur, Rajasthan, India. Due to the extreme overlapping of the associated disease/ risk factors observed between COVID-19 and candidemia, these two disease entities have definitely influenced the epidemiology of each other's. However, how the landscape will evolve in the aftermath of the COVID-19 pandemic is yet to be detected. © 2022, Egyptian Association for Medical Mycologists (EAMM). All rights reserved.
ABSTRACT
Background: With many resources redirected to care for the those affected by the COVID-19 pandemic, the NHS faced unprecedented pressure to maintain oesophagogastric (OG) cancer resectional services. Our institution along with many tertiary units across the country were faced with limited access to essential critical care beds. The implementation of emergency contracts between the NHS and the independent sector (IS) allowed our unit to maintain a high volume resectional service by utilising the resources of a local private hospital with HDU/ ITU provision. We began operating within the IS shortly after the first UK lockdown in March 2020, and continued through till February 2022. During this period, we continued operating at our tertiary unit (TU) albeit at a reduced capacity. This study aimed to evaluate the surgical outcomes of patients undergoing major OG resectional surgery between the two sites. Method(s): This retrospective study included all patients who underwent major OG resectional surgery (including GIST) from March 2020-February 2022. Operation type and site were identified using OPCS-4 clinical codes and combined with National OG Cancer Audit (NOGCA) data to compare basic patient demographics, length of stay, complication rates, COVID infection rates and 90-day mortality. Descriptive and statistical analysis between the two operating sites was performed. Result(s): A total of 204 major OG resections were undertaken, 44% (89) at our TU;57 oesophagectomies and 32 gastrectomies, with 56% (115) at a local IS hospital;86 oesophagectomies and 29 gastrectomies. Additionally, 13 (6.4%) open and close procedures were performed across both sites. Median patient age was similar, 69 (45-86) years at our TU v. 68 (38-85) years at the IS site. A higher proportion of ASA 3 patients (46%) were operated on at our TU. No difference in median length of stay was observed;TU= 8 (1-93) days v. IS =9 (3-69) days, this included all patients who were repatriated to the TU. Higher complication rates seemed to occur in patients operated at the IS site v. the TU though these did not reach statistical significance;18 (15.7%) patients suffered an anastomotic leak v. 9 (10.1%) respectively (p= 0.246). 21 (18.3%) v. 13 (14.6%) patients suffered a major respiratory (p=0.487) and 4 (3.5%) v. 1 (1.1%) a major cardiac (p=0.281) complication. There were no cases of COVID infection within 30 days of primary procedure at the IS site, with 2 cases within the TU cohort. Our 90-day mortality rates were similar (IS= 4.54% v. TU=5.32%), p=0.661. Conclusion(s): Our study demonstrates that resection of patients with OG cancer is feasible in an independent sector hospital if supported by critical care. It allowed a high-volume tertiary unit to continue offering potentially curative surgery to patients whose treatment options would have otherwise been limited to oncological therapy only. Long term survival data compared to non-resecting trusts is required to determine whether this approach was superior. When considering future pandemic planning, we have demonstrated the value of this model in maintaining major OG resectional services.
ABSTRACT
The fear of contracting a serious illness caused by a contagious disease limits economic activity even after reopening. Widespread testing alone will not alleviate this problem. We argue that targeted testing in concert with targeted transfers is essential. We propose a model with these features to determine where agents should be tested and how they should be incentivized. Agents with a low wage, a high risk of infection, and who bear a large cost of falling ill should be tested at work. When testing is very costly, agents with high wages and low expected costs associated with falling ill should be tested at home. © 2022, The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.