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Relevance. In 2020, there was a unique situation caused by the COVID-19 pandemic and the anti-epidemic measures introduced in this regard. To date, the question of how these methods affect the spread of other infectious diseases, including salmonellosis, has not been studied. Target. To assess the impact of anti-epidemic measures during the COVID-19 pandemic on the epidemic process of salmonella infection in St. Petersburg. Materials and methods. Reporting form No. 2 of Rospotrebnadzor «Information on infectious and parasitic diseases» for 2018–2020 and data from the State report «On the state of sanitary and epidemiological well-being of the population in St. Petersburg in 2019», «On the state of sanitary and epidemiological well-being of the population in St. Petersburg in 2020». Data processing was carried out using Microsoft Excel (Microsoft®, USA), Statistica for Windows (StatSoft®, USA) with the determination of the level of significance (p), the calculation of confidence intervals (95% CI) was carried out in the EpiTools application. Results. The incidence of salmonellosis in 2020 was significantly lower than in the previous 2 years 28.86 (95% CI 27.45–30.34) per 100 ths population, and in 2019 and 2018 – 49.8 (95% CI 47.9–51.7) and 39.21 (95% CI 37.6– 40.9) per 100 ths of the population respectively. When analyzing the incidence of salmonellosis in 1995 to 2020, it was revealed that in 2020 the incidence rate was the lowest over the past 25 years and below the multi-year average (37 per 100 ths population) in St. Petersburg by 22%. A decrease in the incidence of salmonellosis was observed in 2020 and in the Russian Federation as a whole compared to 2019, the indicator increased 1.6 times and amounted to 14.71 per 100 ths rubles. population (multi-year average – 29.1). In 2020, there was a change in the intra-annual incidence of salmonellosis. While the peak incidence of salmonellosis persisted in the autumn period (September–October), in 2020 there was no characteristic rise in the spring period, as was observed in 2018 and 2019, which may be due to the spring lockdown (p = 0.03). The decrease in the incidence of salmonellosis was due to a significant decrease in the incidence among adults, while this was not observed in other age groups. In 2018–2020, diseases in the population were caused by 61 serotypes of Salmonella: in 2018 – 33, in 2019 – 32, and in 2020 – 39 serotypes. During the pandemic, the decrease in the incidence of salmonellosis was due to the decrease in the incidence caused by S. Enteritis, which in 2020 amounted to 19.91 (95% CI 18.73-21.14) per 100 thousand population, while in 2019 – 39, 01 (95% CI 37.4–40.7) and in 2018 – 31.24 (95% CI 29.8–32.8) per 100 ths population. At the same time, the decrease in the incidence rate was a decrease in the incidence rate among adults, while in other age groups no changes in the incidence rate were observed. The incidence due to other salmonella serotypes did not change. There were no significant differences in the incidence of salmonellosis by sex and age. Conclusion. The measures introduced during the pandemic in 2020 led to a decrease in the incidence of salmonellosis in St. Petersburg by reducing the incidence of salmonellosis caused by S. Enteritidis among adults. © Lubimova AV, et al.
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Relevance. At present, three infections – HIV infection, tuberculosis, and COVID-19-are spreading simultaneously in the world. Of great practical importance is the assessment of clinical and epidemiological features of COVID-19 in HIV-infected patients with tuberculosis, COVID-19. Aim. To study the risk of COVID-19 disease and identify clinical and epidemiological features in and population of patients with HIV infection complicated by tuberculosis in comparison with patients with HIV infection and the population without these diseases. Materials and methods. Since 13.03.2020 by 31.12.2021 in the Kemerovo Region-Kuzbass, a continuous prospective analytical epidemiological study of the case-control type was performed. Of those with COVID-19, two observation groups were formed: group I (HIV +), group II (HIV/TB) and comparison group III (persons without either HIV or tuberculosis). All patients underwent: determination of SARS-CoV-2 RNA, standard examination methods in accordance with the temporary methodological recommendations «Prevention, diagnosis and treatment of a new coronavirus infection (COVID-19)», relevant at the time of treatment. Results. The incidence of COVID-19 among patients with HIV infection complicated by tuberculosis exceeded the incidence of COVID-19 among HIV-infected by 14%. There were no gender differences between patients I (HIV +) and II (HIV/TB) groups. In the comparison group, the incidence of COVID-19 was 1.26 times higher in women compared to men. COVID-19 disease in patients with co-infection (HIV/TB) was predominantly mild. Viral pneumonia developed 1.86 times less often, oxygenotherapy was required only in 18.75% of cases, which is 2.5 times lower than in group I (HIV +) and 2.47 times less than in the comparison group (III). In labeled pairs, clinical symptoms of COVID-19 in all groups occurred with the same frequency. Metabolic disorders were evident in all groups. Co-infected patients (HIV/TB) had higher levels of D-dimer, ESR, total bilirubin. Conclusion. Active tuberculosis in HIV-infected people is a factor that increases the risk of COVID-19 disease without affecting the severity of the infectious process. © 2023, Numikom. All rights reserved.
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Relevance. Elderly people have become the fastest growing segment of the global population over the past few decades. The number of people over the working age in Russia, and with them citizens living in closed long-term care facilities (CLTFS), is growing. Residents of these organizations belong to the risk group, and CLTFS have a number of characteristics that turn these institutions into a unique environment for the spread of infectious diseases. Aims. To analyze the CLTFS residents infectious morbidity in the "pre-covid stage" (according to literature sources). A scientific review of research in Russian and English using information portals and platforms has been carried out eLIBRARY.ru, Web of Science, PubMed, Google Academy and Scopus for the period 1981-2022. The search was carried out by keywords. Information about the most frequent infectious diseases affecting residents of closed long-term care institutions was the criterion for inclusion in the sample of publications. Out of 16171 initially identified articles, 61 publications were selected after initial analysis. Conclusions. According to various estimates, the leading infectious diseases in CLTFS were: acute respiratory infections, pneumonia, urinary tract infections, skin and mucous infections, acute intestinal infections. The article describes pathogens and their prevalence in CLTFS including pathogens with multiple drug resistance (MDR), describes the resistance of bacteria to antimicrobial drugs formation problem in these organizations, as well as development of certain diseases risk factors. Studies conducted in various CLTFS in Europe, Russia, the USA, and Asia indicate a high prevalence of infectious diseases among their residents, high colonization of residents with antimicrobial-resistant pathogens, as well as the infection transmission probability from the CLTFS and its spread to other long-term care institutions and medical and preventive organizations. © 2023, Numikom. All rights reserved.
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Background: The COVID-19 pandemic posed special challenges for the existing structures for vaccination prevention in Germany with respect to 1) understanding the role and aims of those involved and the interests of the children and 2) the definition of adequate criteria and assessment of the risk of severe diseases in children. Objectives: Do the priorities of different groups of interest differ in the recommendations for COVID-19 vaccination? Which data on the pathogenicity of different variants of severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) are necessary and how did they change during the pandemic? Methods: The tasks, objectives and perception of politics and the German national vaccination advisory committee regarding vaccination of children are discussed in the face of summarized recent data on clinical manifestations of pediatric SARS-CoV2 infections among children and adolescents in Germany, which could be estimated by combining different German data sources. Results: The perspectives of politics and children differ but are legitimate when they are clearly stated. The decisive risk for a severe course or the pediatric inflammatory multisystem syndrome temporally associated with SARS-CoV2 (PIMS-TS) per 10,000 SARS-CoV2 infections for the decision on vaccination from the perspective of children, decreased during the course of the pandemic with dominance of the omicron variant. Severe courses of COVID-19 still predominantly affect children with underlying diseases. The age-stratified analysis of vaccinated and nonvaccinated children showed that the alterations in the pathogenicity of the virus in the course of the pandemic is particularly reflected in the reduction in the risk of PIMS-TS. The general reduction of severe courses of COVID-19 again can be explained by the characteristics of variants of concern (VOC) as well as increasing vaccination rates and immunity following a SARS-CoV2 infection. Conclusion: The primary goal of COVID-19 vaccination in children and adolescents is the prevention of severe courses of the disease. In pediatric risk groups the best possible immunity or immune protection by vaccination should be strived for. It is currently unclear whether catch-up vaccination in already infected or vaccinated children or whether forthcoming healthy children will need vaccination, aiming for hybrid immunity.
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BACKGROUND: Persons with Coronavirus Disease 2019 (COVID-19) infection have an increased risk of pregnancy-related complications. However, data on acute cardiovascular complications during delivery admissions remain limited. OBJECTIVE(S): To determine whether birthing individuals with COVID-19 have an increased risk of acute peripartum cardiovascular complications during their delivery admission. METHOD(S): This population-based retrospective cohort study used the National Inpatient Sample (2020) by utilizing ICD-10 codes to identify delivery admissions with a diagnosis of COVID-19. A multivariable logistic regression model was developed to report an adjusted odds ratio for the association between COVID-19 and acute peripartum cardiovascular complications. RESULT(S): A total of 3,458,691 weighted delivery admissions were identified, of which 1.3% were among persons with COVID-19 (n=46,375). Persons with COVID-19 were younger (median 28 vs. 29 years, p<0.01) and had a higher prevalence of gestational diabetes mellitus (GDM), preterm births and Cesarean delivery (p<0.01). After adjustment for age, race/ethnicity, comorbidities, insurance, and income, COVID-19 remained an independent predictor of peripartum cardiovascular complications including preeclampsia (aOR 1.33 [1.29-1.37]), peripartum cardiomyopathy (aOR 2.09 [1.54-2,84]), acute coronary syndrome (ACS) (aOR 12.94 [8.85-18.90]), and cardiac arrhythmias (aOR 1.55 [1.45-1.67]) compared with no COVID-19. Likewise, the risk of in-hospital mortality, AKI, stroke, pulmonary edema, and VTE was higher with COVID-19. For resource utilization, cost of hospitalization ($5,374 vs. $4,837, p<0.01) was higher for deliveries among persons with COVID-19. CONCLUSION(S): Persons with COVID-19 had a higher risk of preeclampsia, peripartum cardiomyopathy, ACS, arrhythmias, in-hospital mortality, pulmonary edema, AKI, stroke, and VTE during delivery hospitalizations. This was associated with an increased cost of hospitalization. Keywords: COVID-19, Pregnancy, GDM, PCOS, Preeclampsia, CVD, Cardiovascular Disease Abbreviations: COVID-19: Coronavirus disease-2019, GDM: Gestational Diabetes Mellitus, PCOS: Polycystic Ovary Syndrome, National Inpatient Sample: NIS, AHRQ: Agency for Healthcare Research and Quality, HCUP: the Healthcare Cost and Utilization Project Funding and Conflicts of Interest Dr. Michos reports Advisory Board participation for Amgen, AstraZeneca, Amarin, Bayer, Boehringer Ingelheim, Esperion, Novartis, Novo Nordisk, and Pfizer. The remaining authors have nothing to disclose.Copyright © 2023
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Background: The management of patients with T2DM is often complicated by psychological disorders including distress, depression, and anxiety, which might negatively impact diabetic patients' life quality and coping mechanisms with their disease. Patients with T2DM are more likely to experience severe or fatal COVID-19 infection. A cross-sectional study on patients with diabetes mellitus during the COVID-19 pandemic found that more than 90% of the participants had features of ongoing mental suffering. Objective(s): To compare lifestyle, positive & negative affective emotions in patients with T2DM, with or without COVID-19 history. Method(s): Using a cross-sectional design, we conducted a study in a primary care facility in Campeche, Mexico. Sixty participants with T2DM were included, thirty per group (COVID-19 history or not). IMEVID questionnaire designed to measure lifestyle in subjects with T2DM was applied. PANAS, a 20-item questionnaire assessed positive affects (10 items) and negative affects (10 items) experienced by the participants in the previous month. Result(s): The most frequent lifestyle was unhealthy with 68%. About both positive and negative affects, were classified as low with 68.3 and 66.7% respectively. Conclusion(s): In this study, no significant relation was observed between the lifestyle and the positive and negative affects of T2DM patients with and without a history of COVID-19. Although several risk factors identified for COVID-19 related mortality in people with T2DM cannot readily be modified, been able to identify unhealthy lifestyle in this cohort allow to intervene early to avoid worst outcomes in subjects infected with COVID-19 and they have uncontrolled T2DM. Keywords: Diabetes mellitus, lifestyle, positive affects, negative affects, and COVID-19 Abbreviations: T2DM: Type 2 Diabetes Mellitus, IMEVID: Instrumento para medir el estilo de vida en diabeticos (Instrument to measure lifestyle in diabetics), PANAS: Positive and Negative Affect Schedule Funding and Conflicts of Interest This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.Copyright © 2023
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Introduction/Aim: Acute hypoxaemic respiratory failure occurs often in people with COVID-19 pneumonia, with high need for respiratory support therapies (RST). We aimed to examine the clinical management of COVID-19 pneumonia including use of ward-based RST. Method(s): A ambispective electronic medical record review was conducted at an Australian tertiary hospital for COVID-19 patients requiring ward-based RST between 28/02/2020 and 18/03/2022. Result(s): Of 964 patient records identified, 670 were included, with 61% male and mean age 62 years (SD=19). 344 (51.4%) were unvaccinated, with 120 (17.9%) having >=1respiratory comorbidities. Prone positional therapy was achieved in 63 (9.4%) and recommended in 221 (33%) patients. High flow nasal oxygen (HFNO;n = 243, 36.2%), continuous positive airway pressure (CPAP;n = 131, 19.5%) and non-invasive ventilation (NIV;n = 4, 0.6%) were frequently administered to patients. 120 (49.4%) patients received both HFNO and CPAP. Arterial blood gases were infrequently measured prior to initiation of HFNO (n = 23, 9.5%) or CPAP (n = 25,19.1%). Target saturation aims were documented in 547 (81.6%) patients with a medical prescription for RST in 486 (72.5%). Patients using HFNO/CPAP/NIV had a daily respiratory nurse consultant review 236 (97.1%) with documented RST prescriptions and aims. Medical verification occurred at least once per admission from a consultant or advanced trainee for 213 (87.6%) HFNO patients and 117 (89.3%) CPAP patients. Median usage of HFNO was 2 days (IQR 1-4) and for CPAP 1 days (IQR 0.5-3). The median length of stay was 5 days (IQR 3-8). Clinical escalation with transfer to ICU occurred in 90 (13.4%) patients, with 24 (26.6%) intubated. 44 (6.6%) patients died. Most (n = 424, 63.2%) were discharged directly home without requiring domiciliary respiratory supports. Conclusion(s): Multidisciplinary, ward-based RST was successfully provided to most patients with COVID-19 pneumonia with clear documentation of processes of care. Support for and expansion of ward-based RST models of care should be considered longer term. Conflict of Interest: Nil.
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Background: In India, less than 5% of women get routine screening for breast cancer due to lack of awareness and the absence of a coordinated national breast cancer screening programme. A community health initiative was launched by Niramai in collaboration with City Health officials in Bangalore as a pilot to increase awareness and make breast health screening available to all. Free breast cancer screening using AI powered Thermalytix test is being offered to all the underprivileged women walking into Bruhat Bengaluru Mahanagara Palike (BBMP) government hospitals from November 14, 2017 till today (after a break for 15 months during COVID). Material(s) and Method(s): This observational study was conducted in 22 BBMP-affiliated primary health centers where outpatient women over the age of 18 years and not pregnant were enrolled. The procedure included a briefing on camp procedures, taking patient consent, identification of eligible candidates, general health education, and conducting the Thermalytix test by a healthcare worker who was trained to use the Thermalytix software tool. Women were triaged using the output generated by Thermalytix 180. Those triaged as red were referred for further detailed imaging investigation in a district hospital using mammography, ultrasound and FNAC/biopsy. Result(s): A total of 6935 women underwent Thermalytix screening in 22 BBMP hospitals during Nov 2017 to July 2022. A total of 1687 participants were excluded from the analysis as they did not meet the eligibility criteria. The median age of the 5248 eligible participants was 42 years (range 18-86). Among them, 90 women (1.71%) had previously noticed a lump in their breast, 431 women (8.12%) had breast pain, 16 women had complained of nipple discharge, and 5 women had noticed skin discoloration. When screened, 62 (1.2%) women were detected with abnormalities and triaged positive by Thermalytix. Among them 11 women have so far gone through diagnostic investigations, of which 8 were radiologically positive and were recommended for histopathology correlation. The overall test positivity rate of Thermalytix in this cohort was 1.2% and positive predictive value with radiological positivity as reference was found to be 9/11 = 81.81%. Furhter histological analysis reported 1 DCIS and 8 benign fibroadenoma. The tests were conducted in screening camps and the average cost of conducting the test in the field came to around 6.5 USD per person. Conclusion(s): Thermalytix could be a potential automated screening tool for population-level screening in resource constrained settings. The portable equipment enabled easy movement across different PHCs. Since it is a privacy-aware test, there was less refusal to participate in the test. Community mobilization with the help of the local government health officials was crucial to ensure walk-ins. Conflict of interest: Ownership: yes Board of Directors: yes Corporate-sponsored Research: yesCopyright © 2022 Elsevier Ltd. All rights reserved
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Background: Breast cancer screening helps in early intervention and treatment. Post COVID, there is a huge backlog of women who missed their regular screening resulting in increased workload for radiologists, delayed reporting and intervention for malignant women. Thermalytix is an AI-based tool over thermal images that generates a 5 point score called B-Score where 5 is highest suspected risk for breast cancer and 1 is the lowest risk. In this study, we propose and evaluate a multimodal imaging modality called MaThAI that combines mammography and Thermalytix for prioritization of Mammography scans using B-Score. Material(s) and Method(s): Data from two clinical studies were pooled together and a total of 583 women who took both mammography and thermal scans were included in the study. Among them, 72 women were diagnosed to be malignant using mammography, ultrasound, and/or biopsy. Sensitivity and specificity of (i) Mammography alone (as reported by experienced radiologists), (ii) Thermalytix alone (using B-Score >=3 as positive) and (iii) MaThAI (considering a scan as positive if either Mammogram interpretation or Thermalytix interpretation or both were positive) were computed. As a second experiment, we assessed the benefit of MathAI prioritized mammography scans by estimating the reporting times for detecting 95% malignant patients. Result(s): The sensitivity and specificity of mammography were 81.9% and 98.8%, respectively, assuming BIRAD 0 as negative. Assuming BIRAD 0 as positive the sensitivity and specificity were 90.3% and 86.9%, respectively. Six malignancies were found in the 67 women with inconclusive reports (BIRADS 0). When Thermalytix B-Score was considered, the sensitivity and specificity were 94.4% and 81.0%, respectively. MaThAI showed an overall sensitivity and specificity of 98.6% (CI: 95.9%-100%) and 80.6% (CI: 77.2%-84.1%), respectively. The combo modality increased sensitivity over mammography alone by 16.7%, and Thermalytix alone by 4.2%, while decreasing the specificity of mammography by 6.3%. In the second experiment, we evaluated the benefit of MaThAI in prioritizing mammography scans using Thermalytix B-Score. Assuming mammography interpretation time is 20 minutes per exam and considering the order of the interpretation to be scan date + time, a single radiologist would have released the reports of 95% of the women with malignancy in 6720 minutes. Whereas using B-Score to reorder the scans for interpreting, the same radiologist would release the reports of 95% of the women with malignancy in 3080 minutes. Conclusion(s): MaThAI is a promising multimodal tool for breast screening that enables effective and efficient adjunct usage of thermal image along with mammography. It was effective in increasing the sensitivity of mammography by 16.7% and is estimated to reduce the reporting time for malignant patients by 54%. Conflict of interest: Ownership: Yes Board of Directors: Yes Corporate-sponsored Research: YesCopyright © 2022 Elsevier Ltd. All rights reserved
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Introduction: A dialysis unit is compatible with a long-range airborne transmission environment resulting in a higher risk of Coronavirus disease 2019 (COVID-19) infection in hemodialysis patients. Reduction of hemodialysis frequency is a common practice to prevent COVID-19 from spreading in the dialysis unit. However, the predictors to determine which patient is likely to fail from reducing frequency of dialysis is still lacking. This study determined the predictors for a failure reduction in hemodialysis frequency at 4 weeks. Method(s): This retrospective observational study enrolled adult patients receiving long-term thrice-weekly hemodialysis at Thammasat University Hospital in 2021 who decreased dialysis frequency to twice-weekly during COVID-19 outbreak in Thailand. The outcomes were prevalence of failure reduction in dialysis frequency at 4 and 8 weeks and predictors of failure reduction at 4 weeks. Multivariable logistic regression analysis was performed to determine the predictors and create a predicting model for failure reduction of dialysis frequency. Result(s): Of 161 patients receiving hemodialysis in 2021, 83 patients with dialysis frequency reduction had a median age of 69.6 years and a median dialysis vintage of 4.5 years. 27 (33%) and 68 (82%) patients failed to reduce dialysis frequency at 4 and 8 weeks. At 4 weeks, 22 (81.5%) patients failed to reduce dialysis frequency from hypervolemia-related causes. From multivariate logistic regression analysis showed that the predictors for failure reduction at 4 weeks were pre-existing diabetes, congestive heart failure, pre-dialysis weight gain, dry weight from body composition measurement, mean pre- and post-dialysis weight gain during one week before dialysis reduction (Table 1). The model including these predictors (Table 2) demonstrated an Area Under the Receiver Operating Characteristic (AUROC) of 0.78 (95% CI 0.69-0.88) for predicting a failure reduction. At 4 weeks, 0 (0%), 7 (28.0%), and 20 (54.1%) of patients with low risk (score of <0 point), intermediate risk (score of 0-1 point) and high risk (score of >1 point) failed to reduce dialysis frequency, respectively. Conclusion(s): During the COVID-19 pandemic, 33% and 88% of hemodialysis patients failed to reduce their dialysis frequency at 4 and 8 weeks. The predicting model for a failure dialysis reduction demonstrated a good performance. Conflict of interest Potential conflict of interest: - Speaker fee from Fresenius Medical Care and Boehringer Ingelheim (Thai) - Registration fee from Novo Nordisk and Sanofi Aventis ThailandCopyright © 2023
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Introduction: The SARS-CoV-2 pandemic accelerated health disparities in chronic kidney disease (CKD). Here, we describe risk factors and access to care surrogates (area deprivation index-ADI) for clinical outcomes among SARS-CoV-2-tested patients in the Center for Kidney Disease Research, Education, and Hope (CURE-CKD) Registry. Method(s): We formed a COVID-19 Sub-Registry within CURE-CKD (1/1-6/30/2021;N=171,988) of patients with CKD, diabetes (DM)/pre-DM, or hypertension (HTN) with SARS-CoV-2 testing at UCLA Health (UCLA;N=17,884) and Providence St. Joseph Health (PSJH;N=154,104). Statistical analyses and fitted multivariable logistic regression models were adjusted for age and sex. The UCLA cohort included analyses for acute kidney injury (AKI), area deprivation index (ADI, for poor housing, education, income), Charlson Comorbidity Index (CCI), and severe COVID-19 disease. Result(s): We determined the odds ratios and 95% confidence interval (OR[95%CI[) of COVID-19 positivity for the combined UCLA + PSJH population, as well as OR of having severe COVID-19 disease in the UCLA cohort (Table 1) only. OR[95%CI] for AKI was higher for ages >=80 years (1.77[1.14-2.46]), ADI by state (1.12[1.06-1.18]), CKD (12.20[8.46-17.58]) and pre-existing DM (3.65[2.62-5.08]), p<0.001. In the UCLA CURE-CKD population, AKI was associated with severe COVID-19 (r=0.26) and ICU admissions (r=0.29). Mortality was associated with severe COVID-19 disease (r=0.5). [Formula presented] Conclusion(s): Non-White and/or LatinX race/ethnicity, ADI, CKD, DM, and older age were associated with higher risks of COVID-19 positivity, disease severity, and mortality in CURE-CKD. Efforts on viral screening, timely COVID-19 diagnosis, and optimal care delivery for patients with or at-risk of CKD are needed. Conflict of interest Potential conflict of interest: SBN is supported by NIH research grants R01MD014712, RF00250-2022-0038, U2CDK129496 and P50MD017366, and CDC project number 75D301-21-P-12254 receives research support from Bayer AG for the submitted work, Goldfinch Bio, Travere and Terasaki Institute of Biomedical Innovation, and personal fees and other support from AstraZeneca, Bayer AG, Gilead, NovoNordisk and Boehringer Ingelheim/Lilly. KBD is supported by an NIH research grant R01MD014712 and CDC project number 75D301-21-P-12254 and reports other support from Bayer AG for the submitted work, and Goldfinch Bio and Travere outside the submitted work. CRJ is supported by an NIH research grant R01MD014712 and CDC project number 75D301-21-P-12254 and reports other support from Bayer AG for the submitted work, and Goldfinch Bio and Travere outside the submitted work. KCN is supported in part by NIH research grants UL1TR001881, P30AG021684, U2CDK129496 and P50MD017366. KRT is supported by NIH research grants R01MD014712, U2CDK114886, UL1TR002319, U54DK083912, U01DK100846, OT2HL161847, UM1AI109568 and CDC project number 75D301-21-P-12254 and reports other support from Eli Lilly personal fees and other support from Boehringer Ingelheim personal fees and other support from AstraZeneca grants, personal fees and other support from Bayer AG grants, personal fees and other support from Novo Nordisk grants and other support from Goldfinch Bio other support from Gilead and grants from Travere outside the submitted work.Copyright © 2023
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Introduction: Acute kidney injury (AKI) is associated with a very high mortality and an increased risk for progression to chronic kidney disease (CKD). Preclinical studies have identified that NAD+ augmentation as a potential strategy for the prevention and treatment of AKI. NAD+ is the final metabolized form of vitamin B3. A recent clinical study found that COVID-19 related AKI was associated with NAD+ biosynthetic impairment arising in the context of ischemic, inflammatory, or toxic kidney injury. Since there is no availability of vitamin B3 in the country, we tested if I.V. vitamin B complex (vitamin B1, B6 and B12) could improve renal recovery in patients with AKI. By oxidation, vitamin B6 through the pathway of pentose phosphate leads to the formation of NADPH (nicotamide adenine phosphate dinucleotide) an analog of NAD+. Method(s): We conducted randomized, blind, placebo-controlled study in hospitalized patients with AKI (NCT04893733). During the study I.V. vitamin B complex or placebo was given twice a day for 5 consecutive days. In each patient, a protocol-based treatment approach for AKI was used (STOP AKI protocol from the ISN 0by25 trial https://doi.org/10.1371/journal.pmed.1003408). Serum creatinine (sCr) was measured using a point of care device (NOVA Biomedical Xpress CREA) at enrollment and every 24 hours for 7 days, and then at day 30, and day 90. We evaluated if vitamin B complex could improve renal recovery in patients with AKI, reduce the risk of De Novo CKD or CKD progression, and improve survival. Result(s): From September 2020 to September 2021, 260 patients were enrolled. Baseline characteristics are shown on table 1. The drop in sCr values by day 7 was higher in the vitamin B complex group (1.04 vs. 0.33 mg/dl;p < 0.001). Complete recovery was higher in patients randomized to vitamin B complex (59.2% vs. 34.6%;p=0.001), no difference was found in terms of partial recovery (26.2% vs. 27.7%;p=0.888). Non-recovery was lower in patients who received vitamin B complex as compared to placebo (16.6% vs. 37.7%;p < 0.001). At 3 months, the incidence of de novo CKD was lower in patients who received vitamin B complex (19.2% vs. 26.9%;p=0.043) in patients with CKD the progression of the disease was lower in patients who received vitamin B complex (13.1% vs. 20.8%;p=0.023). No differences were found in terms of 90-day mortality (Vitamin B complex 74.3% vs. Placebo 80.1%;0.554). The relative risk of Vitamin B complex for renal recovery was 0.37 (95% CI 0.242 - 0.593;p<0,0001) with a NNT of 3.1 patients with a relative risk for CKD progression or De Novo CKD of 0.47 (95% CI 0.28 - 0.79;p = 0.005) with a NNT of 4.8 patients. Conclusion(s): Vitamin B complex could accelerate renal recovery in patients with AKI;reduce the incidence of De Novo CKD and CKD progression. Our results support ongoing studies investigating the therapeutic potential of NAD+ augmentation as a means to mitigate kidney injury. Conflict of interest Potential conflict of interest: Nova Biomedical MedtronicCopyright © 2023
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Background: The recent serious outbreak of Covid-19 has required urgent medical treat-ments for numerous patients. No clinically active vaccines or antiviral agents are available for Covid-19. According to several studies, Chloroquine (CQ) and Hydroxychloroquine (HCQ) have shown potential as Covid-19 antivirals, especially when administered with Azithromycin (AZM). Objective(s): Here, we review the rationale behind this use. CQ/HCQ is effective against Covid-19 in--vitro and in-vivo laboratory studies. Therapy in Covid-19 infected patients with CQ/HCQ is supported by evidence of trials and field experiences from multiple sources. Method(s): The relevant works are reviewed. The presence or absence of conflict of interest is weighed against the conclusions. Result(s): CQ/HCQ has been used with success in mild cases or medium severity cases. No randomized controlled trial has, however, been conducted to support the safety and efficacy of CQ/HCQ and AZM for Covid-19. Prophylaxis with CQ/HCQ is more controversial but generally not having side effects and supported by pre-clinical studies. The mechanism of action against Covid-19 is unclear. More research is needed to understand the mechanisms of actions CQ/HCQ has against Covid-19 infection, and this requires investigations with nanoscale imaging of viral infection of host cells. Conclusion(s): Most of the published works indicate CQ/HCQ is likely effective against Covid-19 in-fection, almost 100% in prophylaxis and mild to medium severity cases, and 60% in late infection cases. The percentage of positive works is larger if works conducted under a probable conflict of interest are excluded from the list.Copyright © 2021 Bentham Science Publishers.
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Introduction: Access to safe, effective, quality, and affordable essential medicines (EM) for all is one of the World Health Organization's Sustainable Development Goals for health. However, access to EM for the treatment of non-communicable diseases (NCDs) is lacking in many low-income (LICs) and lower-middle income countries (LMICs). Chronic kidney disease (CKD) is often a downstream consequence of other NCDs, such as diabetes (DM) and cardiovascular disease (CVD), further exacerbating the economic burden on healthcare systems and societies. In nephrology, access to EM is especially important to reduce the risk of CKD progression because kidney replacement therapy is unavailable or cost-prohibitive in many regions of the world. As members of the International Society of Nephrology (ISN) Emerging Leaders Program 2021 cohort, we conducted a scoping review to assess the breadth of evidence regarding EMs for management of CKD and related NCDs, with identification of barriers to EM access as one of our main aims. Method(s): We included English-language articles of any study design that addressed barriers to accessing essential medicines in populations with CKD (all stages, causes, and ages), CVD, hypertension, and/or DM. All ISN geographical regions and World Bank income categories were considered. We searched MEDLINE, EMBASE, Web of Science and Cochrane Central Register of Controlled Trials to May 2021. Titles and abstracts were screened, and full texts were retrieved for potentially relevant publications. Each full-text article was assessed for inclusion. For included articles, data extraction was performed with a standardized form using Covidence software. Each step was performed by one reviewer and checked by a 2nd reviewer. Applying an ecological model, barriers were categorized as occurring at the national/health policy level, regional level, organization level, provider level, or patient level. Result(s): Ninety-six publications addressed barriers to access to essential medicines, including LICs (16 articles), LMICs (43 articles), upper-middle income countries (25 articles), high-income countries (10 articles), plus 21 articles which did not specify countries. Most publications assessed barriers at the health policy-level, which included high EM prices in the setting of current patent laws;lack of effective systems for public procurement of EM, resulting in large out-of-pocket household expenditure for medicines in LIC/LMIC;inefficient distribution systems with multiple price mark-ups;and lack of regulatory systems, giving rise to counterfeit medications. Regional-level barriers included lack of governance of supply chain logistics, lack of regional coordination, and poor transportation infrastructure, especially in rural settings. Organization-level barriers included medication stock-outs at facilities, and health care worker shortages. Provider-level barriers included irrational prescribing, lack of CKD identification, and poor communication with patients. Patient-level barriers included poverty, informational barriers/health literacy, and negative perception of generic medicines (Figure). [Formula presented] Conclusion(s): Barriers to accessing EM exist at several levels, particularly the health system-level, and affect LICs and LMICs disproportionately. This scoping review serves as an initial step towards designing implementation studies to address barriers to improve EM access. Conflict of interest Potential conflict of interest: MMMY has a consultancy agreement with George Clinical and served on a CKD advisory board sponsored by AstraZenecaCopyright © 2023
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The article presents general information about etiology, epidemiology, pathogenesis and clinical manifestations infections COVID-19. The features and factors affecting the prevalence of COVID-19 in European countries and in the Russian Federation are given. Mechanisms consideredinvasions of SARS-CoV-2 and specific clinical manifestations of COVID-19 encountered in dental practice. Provides supporting facts about three different ways of spreading COVID-19 in dental practice, as well as data that allow making a conclusion and the possibility of infection through other routes. The features of the diagnosis of COVID-19 in dental practice, namely the factors that allow diagnostics in the early stages of the disease, are considered. Conclusions are drawn on the preventionand prospects of studying the spread of COVID-19 in dental practice. Conflict of interest: The authors have declared no conflicts of interest.Copyright © 2020 Ubiquity Press. All rights reserved.
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Matching epidemiology's aspirations to actual delivery of goods valuable for population health depends both on the scientific and operational capabilities of epidemiology and on the degree to which the goods meet its contract with society. Epidemiology's capabilities have advanced remarkably in recent decades, although research gaps have appeared during the current coronavirus disease 2019 (COVID-19) pandemic. Epidemiology's social contract reflecting a dual commitment to science and health could arguably be entirely met by producing research results under conditions variously described as objective, impartial, neutral, or independent and handing such results to decision makers and the public at large. However, a closer examination shows that those four terms address sharply distinct issues, with distinct practical implications, and that the epidemiologist responsibility is de facto involved beyond providing research results. Hence the epidemiologist's engagement should encompass arguing from a science-for-health viewpoint and proactively driving the results into decision processes on public health issues.
Subject(s)
COVID-19 , Humans , Public Health , SARS-CoV-2ABSTRACT
Introduction: COVID-19 is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). This emerging disease has become a public health emergency worldwide. Acute Kidney Injury (AKI) secondary to COVID-19 has been described in different studies, but information characterising patients with subsequent AKI is limited. The cause of kidney involvement in COVID-19 is thought to be multifactorial. Cardiovascular comorbidity and predisposing factors (e.g. sepsis and nephrotoxins) are considered as important contributors. The tubular damage has been linked to the cytopathic effects of kidney-resident cells and cytokine storm syndrome. To gain better understanding of the effect of COVID-19 on renal function, large clinical and register based studies have been requested. The objective of this study was to quantify the risk of acute kidney injury during and after covid-19. Method(s): This was a Swedish prospective cohort study where Generalised Estimating Equation methods (GEE) was used to map the kinetics of kidney injury markers such as serum-creatinine (s-creatinine), cystatin and eGFR for the hospitalised patients in the cohort, comparing patients with moderate and severe COVID-19 during and after the acute infection. Furthermore, we will investigate if patients with kidney dysfunction during COVID-19 have more severe disease outcome compared with the whole cohort, adjusting for age, sex, and comorbidities. We will also compare start values of kidney injury markers with the latest values and count the percentage worsening among all disease severity groups. Cohort: Approximately 550 COVID-19 patients were recruited to the study following informed and signed consent at 2 Swedish University Hospitals. A case report form was filled in at pre-specified time points, and samples collected consecutively. A database was then created containing dates and information regarding symptoms, laboratory samples, complications, and disease severity (e.g., need of oxygen, intensive care, mechanical ventilation, death). Result(s): There was a significant increase in s-creatinine among hospitalised and intensive care unit patients (n=126) during the acute phase of COVID-19 (day 0-6 post disease onset) when compared to the follow up samples after 90 days from disease onset. There was also a decrease in s-creatinine in day 11-21 and 31-70 among hospitalised and intensive care unit COVID-19 patients when compared to the same follow up samples. This analysis was adjusted for age and sex. See figure 1. [Formula presented] Conclusion(s): Our preliminary results show that s-creatinine was increased during the first days of COVID-19 followed by decreased levels compared to baseline. The higher levels of s-creatinine day 0-6 of COVID-19 could be an effect of the acute infection, but it could also be caused by other factors such as dehydration or medication. The lower levels of s-creatinine might be caused by dietary changes or loss of muscle mass due to immobilisation during hospitalisation. Knowledge about fluctuations in s-creatinine in COVID-19 patients may be of use for treating physicians. Conflict of interest Potential conflict of interest: Funding from: Swedish Kidney Foundation Central and local ALF funding Vasterbotten County Council, Sweden Arnerska Research Fund, Umea University, SwedenCopyright © 2023
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Relevance. Due to the COVID-19 pandemic a infectious diseases hospitals nationwide network has been deployed to treat patients infected with SARS-CoV-2. The principles of their formation with a strict division into «infectious» and «clean» zones, despite the epidemiological justification, lead to the formation of a dynamic artificially created closed ecosystem. In such an ecosystem, on the one hand, patients who undergo a wide range of invasive and aggressive therapeutic and diagnostic manipulations, and medical personnel stay for a long time, on the other hand, pathogens of a viral and bacterial nature that can adapt to hospital conditions and form resistant strains circulate. As a result, high risks of contamination of environmental objects of hospitals and patients themselves are created, which can lead to the development of exogenous nosocomial infection. Aims. To study the features of viral and bacterial contamination of objects in the hospital environment of the infectious diseases hospital for the treatment of patients infected with SARS-CoV-2 during the COVID-19 pandemic. Materials and methods. A study was conducted on 343 samples from the external environment of the infectious diseases hospital for COVID-19 patients' treatment during its planned work. Sample collection was performed during three days (Tuesday, Thursday, Sunday) at 20 unified sampling points: in the area where patients general hospital area as well as from the outer surface of personal protective equipment for medical personnel (overalls, gloves). The study used epidemiological (descriptive-evaluative and analytical), molecular genetic (SARS-CoV-2 PCR-RT, sequencing), bacteriological (isolation, cultivation and MALDI-TOF identification of bacterial cultures) methods. Statistical significance of differences was assessed by Fisher's point test (φ). Differences were considered significant at p≤0.05. Statistical data processing was carried out using the Microsoft Office 2010 application package, the online resource https://medstatistic. ru/, ST Statistica 10. Results. The study demonstrated a high level of viral and bacterial contamination of environmental objects in the intensive care unit of the infectious diseases hospital for COVID-19 patients treatment – 11.1%, incl. objects of the general hospital environment – 9.3% (doctor's workplace – 16.7%);patient location area – 13.9% (electric pump – 27.8%, mechanical ventilation, manipulation table – 16.7% each);the outer surface of personnel gloves – 21.1–38.9%;the outer surface of protective overalls for personnel – 44.4–50.0%. SARS-CoV-2 isolated from the objects of the external environment of the hospital belonged to the genetic variant B.1.617.1 DELTA, which corresponded to the epidemiological situation at sampling collection period. The opportunistic microflora structure was dominated by Enterococcus faecalis (38.1%), Klebsiella pneumoniaе (21.4%) and Escherichia coli (16.7%), which demonstrated a high level of resistance (to 3 or more groups of antibiotics). Conclusion. Initially, the main sources of the infectious diseases hospital environmental objects contamination with SARS-CoV-2 are most likely patients. Further contamination of the infectious diseases hospital environmental objects with viruses and opportunistic microflora occurs with the medical personnel direct participation. The current situation requires a review of approaches to the rules for disinfection, the PPE use and employees hands antiseptic treatment in infectious diseases hospital during the COVID-19 pandemic, as well as the length of staff work period length. © 2022, Numikom. All rights reserved.
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Background Although the sudden coronavirus disease 2019 (COVID-19) pandemic would have significantly influenced financial relationships between the healthcare industry and gastroenterologists and hepatologists, little is known about the trend in financial relations in the United States. This study, thus, aimed to examine the trends in industry payments made to gastroenterologists and hepatologists during the COVID-19 pandemic. Materials and methods Using the Open Payments Database between 2013 and 2021, we evaluated trends in financial relationships between the healthcare industry and gastroenterologists and hepatologists in the United States. Trends in general payments during the COVID-19 pandemic were evaluated by interrupted time series analysis with monthly and yearly payments at the physician level. Results A total of 16,808 or 89.4% of all active gastroenterologists received general payments totaling $393,823,094 from the pharmaceutical and medical device companies between 2013 and 2021. The payment per gastroenterologist and the number of gastroenterologists receiving payments decreased by 70.9% (95% CI: -73.4% - -68.1%, p<0.001) and by 51.5% (95%CI: -52.2% - -50.7%, p<0.001) due to the onset of the COVID-19 pandemic, respectively. However, both payments and the number of physicians with payments have recovered monthly since the COVID-19 pandemic, with relative monthly change rates of 4.1% (95% CI: 3.5% â 4.7%, p<0.001) and 3.2% (95%CI: 3.1% â 3.2%, p<0.001). Additionally, the general payments per gastroenterologist significantly decreased by 2.5% (95%CI: -3.9% - -1.1%, p<0.001) each year before the COVID-19 pandemic, while there was a very small change in the number of gastroenterologists with payments. Conclusions The industry payments to gastroenterologists and hepatologists significantly decreased due to the COVID-19 pandemic, but the payments have recovered right after the pandemic in the United States.