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Patients on maintenance hemodialysis (MHD) are highly susceptible to SARS-CoV-2 and with high mortality rates due to Coronavirus disease 2019, mainly because of the older age in this group of patients, comorbidities, compromised immune status due to uremia, as well as inability to keep social isolation because of the necessity for regular physical presence in dialysis facility. Several retrospective studies of patients on MHD in Europe, America and Asia, show high susceptibility to SARS-CoV-2 in this group of patients with very high rates of critical course of the disease and high mortality rates, reaching more than 40% The aim of this retrospective observational study was to identify risk factors among patients on intermittent hemodialysis for infection with SARS-CoV-2 as well as predictors of severe COVID-19 and fatal outcome. Materials and methods. We analyzed 69 patients receiving intermittent dialysis in Aleksandrovska University Hospital - Hemodialysis Unit. 34 of them have been tested positive for SARS-CoV-2 in the period from September 2020 (when the first case of the disease was registered for our dialysis center) up to March 2022, and are compared with a control group of 35 dialysis-dependent patients without COVID-19. Data about comorbidities, main laboratory and radiologic findings, need of hospitalization and treatment in ICU, as well as data for conducted treatment, are collected from electronic medical records. To identify predictors of severe COVID and poor outcome we compared the group of survivors with the one of non-survivors. Results. There are no significant differences between patients on MHD with and without COVID-19 except higher frequency of COPD and hypoproteinemia in the positive group. Older age, female gender, history of smoking, lymphopenia with neutrophilia, treatment in ICU and need of mechanical ventilation, signs of malnutrition - hypoproteinemia and lower levels of serum creatinine, are risk factors for severe disease and fatal outcomes. Conclusions. The course of COVID infection in dialysis-dependent patients is severe and with high mortality rate, in line with other studies worldwide. Malnutrition is the main risk factor for COVID and also main predictor for poor outcomes.
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Objective: Coronaviruses are a large family of viruses that cause different types of diseases. This study aims to evaluate the risk factors for mortality based on comorbidity and sociodemographic characteristics among COVID-19 patients. Methods: This cross-sectional study conducted in Herat, Afghanistan, from February 24 to July 5, 2020, used data provided by the public health department, including sociodemographics, symptoms, comorbidities, hospitalization, contact history, and COVID-19 test type. The Chi-square test was used to observe differences between categorical variables. In bivariate analysis, all independent variables with a significant p-value were put into the model. Odds ratios and 95% confidence intervals were calculated, and a p-value less than 0.05 was considered statistically significant. Results: The study analyzed 11,183 COVID-19 cases, with a 53.5% positivity rate. Recovery rates in the city and Herat province districts were 96.2% and 94.7%, respectively. Case-fatality rates varied with age, with 0.4% for those aged 1-29 and 33% for those aged 80-105. Mortality rates were highest for those with COPD and cancer, at 12.5% and 18.2%, respectively. In the logistic regression results, age, gender, and COPD were significant variables for COVID-19 mortality. Conclusion: By providing more health service facilities to people in risk groups, especially in rural areas, the mortality rate of COVID-19 and other diseases can be decreased.
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Introduction: COVID-19 infection can be complicated by coagulation derangement and a high risk of thromboembolic episodes. Our study aimedto investigate coagulation parameters in COVID-19 patients and their correlation with clinical severity. Methods: We analyzed coagulation parameters PT, APTT, D-Dimer, and Fibrinogen in 98 RT-PCR-confirmed COVID-19 patients admitted to the Government Institute of Medical Sciences, Gautam Buddha Nagar, Uttar Pradesh, India. Results: This study involved 69 males (70.50%), and 29 (29.5%) were females. The mortality rate was 6.12% (n= 06). Forty-six patients (46.94%) had comorbidities. Thirty-four patients had elevated PT, and 7 had high APTT, whereas D-dimer and fibrinogen levels were raised in 68 and 61 patients, respectively. Among all four parameters, D-Dimer levels were significantly associated with disease severity. Conclusion: Derangement of D-dimer levels is significantly associated with disease severity in COVID-19 infection.
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In recent times, numerous reports of systemic fungal infections have been a major concern. The angioinvasive fungal infection, mucormycosis has surged in patients with COVID-19 due to various factors, mainly uncontrolled diabetes and inappropriate corticosteroid use. The prevalence of this acute and fatal fungal infection caused by Mucorales-related fungal species has been highest in the Indian population. COVID-associated mucormycosis (CAM) has a propensity for contiguous spread, and exhibits high morbidity as well as mortality. Unless promptly detected and treated, it is associated with a poor prognosis. A high index of suspicion, aggressive surgical debridement and use of systemic antifungal agents continue to be the standard of care for CAM. Moreover, there is an imperative need to address this public health issue by increasing public awareness and education. This article provides a comprehensive overview on the emergence of CAM during the pandemic, the current burden, pathophysiology, diagnostic interventions and management of CAM in Indian clinical practice.
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Background: D-dimer and LDH are crucial biomarkers, particularly in view of the fact that they have been strongly linked to COVID-19 infection and have been linked to worse consequences in people who have severe viral infections. Objectives: To determine how D-dimer and LDH correlated with clinical effects in COVID-19 patients who were hospitalised and how they forecasted the severity of COVID-19 patients. Material and Methods: This was cross-sectional research conducted relatively early in the second wave of the pandemic. A total of 110 patients diagnosed with COVID-19 and admitted to the ICU from January 2021 to June 2021, were included in the study. The clinical outcome was evaluated in terms of discharge and death among patients requiring various forms of assisted ventilation. Results: The average age of patients was 53.16 years (+or- 18.47 years). 35.5% of the patients were with comorbidities of which diabetes, hypertension, and COPD were around 80%. D-dimer was deranged in 2.7% of the subjects and LDH was deranged in 60% of the study subjects at the time of admission. Coming on to the outcome, all patients were put on assisted ventilation with 71.8% on NIV, 20% on HFNO, 1% on CPAP, and 7.2% on MV. During their hospital stays, 6 (5.45%) patients died and the remaining patients were discharged. A higher D-dimer value (> 1.5 g/ml) during the hospital stay was found to be statistically significant with assisted ventilation and deaths of the admitted study subjects. Conclusion: In our investigation, the biomarker D-dimer value was more associated than LDH with mortality in patients with COVID-19 infection.
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Objective: Covid-19 is a highly infectious viral disease, and our understanding of the impact of this virus on the nervous system is limited. Therefore, we aimed to do a systematic analysis of the neurological manifestations. Methods: We retrospectively studied the clinical, laboratory, and radiological findings of patients with major neurological syndromes (MNS) in Covid-19 over 6 months. Results: We had 39 patients with major neurological syndromes (MNS). The most common MNS was cerebrovascular disease (CVD) (61.53%), in which ischemic stroke (83.33%), cortical sinus thrombosis (12.50%), and haemorrhagic stroke (4.16%) were seen. Among ischemic stroke patients, 50% had a large vessel occlusion, and 66.66% of patients with CVD had a significant residual disability. Cranial neuropathy (15.38%), GBS (10.26%), encephalitis (7.26%), and myelitis (5.12%) were the other MNS. Among the three encephalitis cases, two had CSF-Covid-19 PCR positivity and had severe manifestations and a poor outcome. Associated comorbidities included hypertension (30.76%), diabetes mellitus (12.82%), chronic kidney diseases (7.69%), and polycythaemia vera (2.56%). Lung involvement was seen in 64.1% of patients. Mortality was 17.94% in MNS with Covid-19. Conclusions: The most common major neurological syndrome associated with Covid-19 is CVD with increased frequency of large vessel occlusion causing significant morbidity and mortality. Simultaneous lung and other systemic involvement in MNS results in a deleterious outcome.
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Hospitals were overburdened during peak periods of Coronavirus disease 2019 (COVID-19) pandemic, and bed occupancy was full. The ability to predict and plan patients' hospital length of stay allows predictability in terms of the free capacity of hospital facilities. The purpose of this article is to evaluate the factors that influence the hospital length of stay among discharged (recovered) from COVID-19 patients. This will allow the prediction of the likely number of bed days in the conditions of intensive workload of medical facilities for hospital care. A total of 441 discharged after hospital treatment for COVID-19 patients are followed up. Factors for prolonged hospital length of stay are searched among the indicators recorded at admission. Median hospital length of stay of the patients discharged from COVID-19 ward is 9 days (IQR 6-12) and in the COVID-19 intensive care unit 12 days (IQR 9.75-18.75). The median length of stay assessed by a survival analysis is 35 days in the COVID-19 unit and only 8 days in intensive care, due to the high mortality in the intensive care unit. The longer hospital length of stay of patients discharged from the COVID-19 wards is associated with the presence of hypertension (median 10 vs. 8 days for patients without the disease, p=0.006), ischemic heart disease (10 vs. 8 days, p<0.001), cerebrovascular disease (10 vs. 8 days, p=0.061 - did not reach significance), peripheral arterial disease (12 vs. 8 days, p=0.024), chronic renal failure or chroniodialysis (14 vs. 8 days, p<0.001), oncological illness (11 vs. 8 days, p=0.024), presence of at least one comorbidity (9 vs. 8 days, p=0.006), arrival at the hospital by ambulance vs. the patient's own transport (11 vs. 8 days, p=0.003), severe lung involvement shown on X-ray (10 vs. 8 days, p=0.030) or CT (18 vs. 10 days, p=0.045). Prolonged hospital length of stay is associated with older age (Spearman's rho=0.185, p<0.001), greater number of comorbidities (Spearman's rho=0.200, p<0.001), lower oxygen saturation on admission (Spearman's rho=- 0.294, p<0.001) and lower lymphocytes count (Spearman's rho=-0.209, p<0.001), as well as higher CRP (Spearman's rho=0.168, p<0.001), LDH (Spearman's rho=0.140, p=0.004), ferritin (Spearman's rho=0.143, p=0.004) and d-dimer (Spearman's rho=0.207, p<0.001). The multiple linear regression model found that the increase in the number of bed days of discharged from COVID-19 unit patients depends on the way the patient arrived at the Emergency Department (by ambulance instead of on their own transportation) and the presence of an accompanying oncological disease (R2=0.628, p<0.001). The hospital length of stay of patients discharged from COVID-19 intensive care unit is associated with the presence of hypertension (median 14 vs. 9 days for patients without the disease, p=0.067 - significance not reached) and at least one comorbidity (14 vs. 9 days, p=0.067 - significance not reached). The number of bed days is higher when recorded more comorbidities (Spearman's rho=0.818, p=0.004), lower oxygen saturation (Spearman's rho=-0.605, p=0.067 - significance not reached) and higher leukocytes count (Spearman's rho=0.546, p=0.102 - significance not reached). A multiple linear regression model demonstrated the hospital length of stay of patients in the COVID-19 intensive care unit as an outcome of the number of comorbidities only (R2=0.826, p=0.003). The ability to estimate and forecast quickly the number of bed-days based on a small number of variables would help reduce the burden on the healthcare system during a pandemic.
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In recent years, a number of complications have been observed as a result of uncontrolled antibiotic treatment. One of them is gastrointestinal dysbiosis. Not infrequently it is the cause of pseudomembranous colitis, a disease with a remarkably high associated mortality. It can be severe and requires serious medical care. This report presents a clinical case of a patient who developed the disease pseudomembranous colitis after antibiotic treatment for a Covid infection. The aim of the report is to define and present in a systematized manner the nursing care provided in the specific case. The daily analysis of the patient's condition allows to offer complex, adequate and individual nursing care, which, in addition to meeting her needs, also aims to alleviate her condition.
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Non-invasive ventilation (NIV) might be successful if carefully selected in adult patients with cardiac dysfunction presenting with community-acquired pneumonia. The main objective of this study was to identify the early predictors of NIV failure. Adult patients with left ventricle ejection fraction (LV EF) <50% admitted to the intensive care unit (ICU) with community-acquired pneumonia and acute respiratory failure were enrolled in this multicenter prospective study after obtaining informed consents (study registrationID: ISRCTN14641518). Non-invasive ventilation failure was defined as the requirement of intubation after initiation of NIV. All patients were assessed using the Acute Physiology and Chronic Health Evaluation II (APACHE II) and sequential organ failure assessment (SOFA) scores at admission, while their Heart rate Acidosis Consciousness Oxygenation and Respiratory rate (HACOR) and lung ultrasound (LUS) scores in addition to blood lactate were assessed at NIV initiation and 12 and 24 hours later. A total of 177 patients were prospectively enrolled from February 2019 to July 2020. Of them, 53 (29.9%) had failed NIV. The mean age of the study cohort was 64.1+or- 12.6 years, with a male predominance (73.4%) and a mean LV EF of 36.4 +or- 7.8%. Almost 55.9% of the studied patients had diabetes mellitus, 45.8% had chronic systemic hypertension, 73.4% had ischemic heart disease, 20.3% had chronic kidney disease, and 9.6% had liver cirrhosis. No significant differences were observed between the NIV success and NIV failure groups regarding underlying morbidities or inflammatory markers. Patients who failed NIV were significantly older and had higher mean SOFA and APACHE II scores than those with successful NIV. We also found that NIV failure was associated with longer ICU stay (p < 0.001), higher SOFA scores at 48 hours (p < 0.001) and higher mortality (p < 0.001) compared with the NIV success group. In addition, SOFA (Odds Ratio (OR): 4.52, 95% Confidence Interval (CI): 2.59-7.88, p < 0.001), HACOR (OR: 2.01, 95% CI: 0.97-4.18, p = 0.036) and LUS (OR: 1.33, 95% CI: 1.014-1.106, p = 0.027) scores and blood lactate levels (OR: 9.35, 95% CI: 5.32-43.26, p < 0.001) were independent factors for NIV failure. High initial HACOR and SOFA scores, persistent hyperlactatemia and non-decrementing LUS score were associated with early NIV failure in patients with cardiac dysfunction presenting with community-acquired pneumonia, and could be used as clinical and paraclinical variables for early decision making regarding invasive ventilation.
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Asthma and COPD comorbidities are expected to exacerbate the clinical manifestations of COVID-19. However, many reported studies show that asthmatic patients infected with COVID-19 do not show severe clinical manifestations, and some are asymptomatic. This literature review aimed to describe COVID-19 in asthmatic patients along with the hypothesis that asthma is a protective factor against COVID-19 infection. Systemic corticosteroids have been shown to reduce the death/mortality rate in patients who are hospitalized due to COVID-19 infection. This is possibly due to the suppression of the immune system against a hyperinflammatory state which can result in further damage from SARS-CoV-2 infection. Mucus hypersecretion, which is one of the hallmarks of asthma, can prevent the SARS-CoV-2 virus from reaching the distal lung and can protect the lungs from pathological processes. The secreted mucus is rich in glycoproteins, such as MUC5AC, which act as the first line of defense against infection. Mucus hypersecretion in asthmatic patients may prevent SARS-CoV-2 from penetrating far enough to gain access to type-2 alveolar cells, which are the cells that predominantly express ACE2 in the lungs. In conclusion, comorbid asthma in patients infected with COVID-19 does not cause adverse clinical manifestations to appear, but on the contrary, it will have a protective effect on patients.
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Background: The COVID-19 pandemic has had a significant impact on the mental health of older people. One concern is the exposure to a lot of pandemic-related information without any evidence-based background through the media and social networks. This study aimed to examine the effect of exposure to such information on the mental health of older people. Methods: The study is a cross-sectional correlational study. Sampling was focused on selecting older people through a systematic sample according to a random starting point and with a fixed, periodic interval, between late 2020 and early 2021, with a total of 200 participants age above 60 considered as older people. Results: We found that a significant percentage of older people had a high level of clinical symptoms/distress, according to the General Health Questionnaire (GHQ) scales. These results show that being exposed COVID-19 information from the media during the pandemic is a risk predictor for mental health/distress, GHQ-28 scores, (OR ExpB = 2.11, p =0.001). Similar results were found for Media Info (OR ExpB = 1.37, p =0.008). For each point increase in media information, the risk for general mental health problems increases 1.37 times. Conclusion: Through the results it was clear that older people are at risk of mental health problems, and being exposed to the infodemic increased this risk significantly, as well as being exposed to media where elevated risk of death from SARS-CoV-2 for older people was reported.
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The recent Human Coronavirus 2019 (hCoV-19) pandemic has devastated the whole world and impacted all aspects of human life. One of the most comprehensively recorded data for this outbreak is the daily morbidities and mortalities record. The analysis of this dataset would provide insight into the pattern and progression of this disease. The present study focused on the quantitative investigation and descriptive statistical examination of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) as part of a series of evaluations for this epidemic in the primarily affected geopolitical regions. The year 2021 is worse than 2020 in terms of the recorded daily newly emerging cases and deaths, and there are no signs that there would be an improvement in 2022, as could be estimated from early warning signs, even if there could be an apparent decline in the outbreak waves. India is one of the major countries that have been adversely affected by this global pandemic. The present study addressed this nation as a detailed record of COVID-19 cases and deaths extracted from a chronologically arranged dataset for the newly emerged cases and deaths on a daily basis. Cumulative counts were calculated and logarithmically transformed. Two significant peaks - embracing multiple waves - were observed with tailing for morbidity and mortality, which were highly correlated. There were no signs of a recession in the outbreak census. However, relative calm periods between waves might be detected. There were rising trends in morbidities and mortalities with a clustering tendency upon examination of the run charts. The Morgan-Mercer-Flodin (MMF) model was found to demonstrate the best-fitting non-linear curve for the transformed cumulative database. Derivatization of the model equation demonstrated a factor that could be used in the assessment of the outbreak effect numerically to show influence on the impacted population.
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Background and Objective: At the beginning of the pandemic, Hydroxychloroquine (HCQ) was one of the most widely used drugs prescribed to patients admitted to hospitals with coronavirus disease 2019 (COVID-19). We try to find the effect of HCQ on the severity and mortality of patients who did not receive corticosteroids. Methods: In this retrospective study, patients with COVID-19 disease were collected from February 20, 2020, to July 21, 2020, at Rouhani Hospital in Babol. Patients were followed up until December 6, 2021. In this study, 170 patients in case and control groups were studied. We used logistic and COX regression models to explore the effects of drugs. Data were analyzed by SPSS version 22. Findings: The use of HCQ did not affect mortality (p=0.46, 95%CI= 0.63 to 2.71, OR= 1.31) and final severity (p= 0.75, 95%CI= 0.59 to 2.06, OR= 1.10) at admission time. However, azithromycin remained in the final model but did not have a significant effect (P= 0.08, HR= 0.28, 95%CI= 0.06 to 0.18). Heparin use was not associated with severity improvement (p= 0.06, 95%CI= 0.97 to 2.81, HR= 1.65), while ceftriaxone remained a factor affecting severity in the model (p = 0.03, 95% CI= 0.29 to 0.95, HR = 0.52). Conclusion: In this study, HCQ harmed mortality admission time and was ineffective in the long term. The use of ceftriaxone compared to other drugs showed protective effects against the mortality hospitalization time. Heparin is not recommended without considering the risk of bleeding in COVID-19 patients.
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Introduction: SARS-CoV-2 infection has affected more than 683 million people worldwide with 6.8 million deaths. Unfortunately, Bulgaria is one of the most severely affected European Union (EU) member-states with one of the highest mortality rates. Aim: The study aims to provide a description of the demographic characteristics, discharge rate, and fatality rate of COVID-19-diagnosed patients in one region of Central South Bulgaria in 2021. Materials and methods: A retrospective nested case series study was conducted among patients hospitalized with a confirmed diagnosis of SARS-CoV-2 infection between January 1st and December 31st, 2021. Anonymized patient data on age, sex, admission and discharge dates, treatment, and the outcome was collected from hospital electronic patient records and analyzed using descriptive statistics. Results: Data from 1630 (51% male) patients were identified. The mean age was 63.64 years (+or-15.23). 1342 (82%) of the patients were discharged. The mean age of the diseased was 70.88 years (+or-10.05). 1455 (89%) patients received only symptomatic therapy, 155 (10%) patients were treated with remdesivir (VekluryR), 11 (1%) patients were treated with casirivimab/imdevimab (RonapreveR) and 9 (1%) patients were administered regdanvimab (RegkironaR). Conclusions: The study results demonstrate that Bulgarian patients with COVID-19 were treated according to the best global and national evidencebased guidelines. Lethality and discharge rates are in concordance with global trends and outcomes.
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Deaths from COVID-19 are increasing in patients with comorbidities. One of the most common comorbidities is diabetes mellitus. The researchers wanted to see how having diabetes affected the mortality rate of COVID-19 participants. This investigation is a case control observational analytical study. Different types of people, called "cases", and "controls", complete the research sample. Each group had 68 responders, for a grand total of 136. Medical records from COVID-19 patients treated at Airlangga University Hospital, Surabaya, between March 2020 and September 2021 serve as the study's secondary data source. The purpose of this study's data analysis is to calculate an odds ratio. Patients with COVID-19 with concomitant diabetes mellitus had an increased risk of death, and this risk increased with age, gender, and COVID-19 symptoms. In contrast, education, occupation, and laboratory results were not significantly related to mortality among COVID-19 individuals with concomitant diabetes mellitus (GDA status). The results of this study show that COVID-19 patients with concomitant diabetes mellitus are at a higher risk of death if they are over the age of 65, if they are male, and if they have severe symptoms.
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The COVID-19 pandemic situation demands the discovery of newer drugs and/ or repurposing of the existing drugs. The anti-viral drugs approved for COVID-19 are remdesivir and favipiravir. Two more directly acting oral anti-viral drugs have been granted Emergency Use Authorization by US-FDA, molnupiravir on December 23, 2021, and nirmatrelvir and ritonavir (PaxlovidTM) on December 22, 2021. Molnupiravir, an RNA-dependent RNA polymerase (RdRp) inhibitor, has also been approved in the UK and is under review with other regulatory agencies. PaxlovidTM (a combination of the new anti-viral drugs nirmatrelvir and ritonavir) has been developed and approved by US-FDA and CDSCO, India. Nirmatrelvir acts by inhibiting 3CL (chymotrypsin-like) protease enzyme and it is combined with ritonavir to slow down its breakdown by cytochrome P450 enzymes and to increase the bioavailability. Both molnupiravir and PaxlovidTM have been approved for mild and moderate COVID-19 and in patients who have a higher risk of disease progression to severe disease including hospitalisation and death. This article systematically reviews the clinical trials of molnupiravir and PaxlovidTM that evaluated their efficacy and safety against COVID-19 in both published and unpublished literature.
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Background: Perforating ocular injuries in particular carry a high risk of visual morbidity in all age groups. Risk factors associated with ocular trauma include gender, age, occupation, and lower socioeconomic status. Eye injuries are causing a major concern to the general ophthalmologists both in the developed and developing countries. Background: The objective of this article is to study the profile of penetrating ocular injuries before and during the period of lockdown. Materials and Methods: A study was done to make a comparative analysis of the penetrating ocular injuries occurring during the period of lockdown of 3 months (April 1, 2020-June 30, 2020) and 3 months (January 1, 2020-March 31, 2020) before lockdown. Results: The study included 33 patients hospitalized before lockdown and 45 hospitalizations during the lockdown in all age groups. Injuries were more common in males. The injuries reported in the age group of 0-15 years before lockdown were 36.36% while during lockdown 60% injuries were observed. Modes of injuries reported before lockdown were indoor injuries (36.36%) and road traffic accidents (36.36%) while during lockdown, the major mode of injuries were indoor injuries (76.6%) whereas the road traffic accidents (10.0%) declined. Conclusion: During the lockdown, indoor injuries were more common in comparison to the outdoor injuries such as road traffic accidents, the latter being more prevalent before lockdown. During lockdown, increase in the indoor leisure activities of children led to a rise in the cases of eye injuries and an increase of almost double the number was observed. In addition to this, immobilization led to a decrease in the injuries due to road traffic accidents. The coronavirus disease-19 lockdown did have an impact on the profile of penetrating ocular injuries.
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This special issue contains 8 articles that explore various latest research on COVID-19, including the clinical presentation of the disease, the role of inflammation, the development of new treatments, and the long-term effects of the infection. The topics covered include the evaluation of white blood cell parameters and their significance in COVID-19 patients in Western Maharashtra, India;the association between acute phase reactants and COVID-19 severity and mortality in a tertiary care hospital in India;the clinico-hematological profile of COVID-19 patients from an Indian perspective;the correlation between C-reactive protein test results and clinical characteristics in COVID-19 patients;the effective binding affinity of an inhibitor against the SARS-CoV-2 NSP13 helicase;the assessment of absolute neutrophil count in COVID-19 patients in a tertiary care hospital;the analysis of the anti-SARS-CoV-2 IgG response following the first and second dose of a COVID-19 vaccine;and a case report discussing the diagnostic dilemma of hypoplastic acute myeloid leukemia in a COVID-19 patient.
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Negative demographic trends in Croatia (natural decrease, negative net migration and population aging) are increasingly influencing socio-economic development of the country. Already in early 21st century, the long term decrease of live births and the increase of deaths were recognized as destabilizing factors of population development in Croatia. After the Croatian accession to the EU, the concerns regarding future demographic development of the country raised even more due to intensive emigration to other EU countries, which coincided with the historically low birth rates and high death rates. The focus of this paper is on mortality trends in Croatia in the first two decades of the 21st century. In this period, mortality in Croatia was influenced by different socio-economic, demographic, and epidemiological factors. Given the lack of recent papers dealing with mortality in Croatia, the main aim of this paper is to provide an overview of the changes in selected mortality indicators and contribute to the discussion on recent mortality trends in Croatia. The results of this research indicate that Croatia experienced some positive changes regarding mortality (increase of life expectancy at birth and decrease of infant mortality rates in the first period, in particular), but, some of the trends are not favourable, particularly the changes in the causes of death. Although improvements were observed regarding the share of deaths caused by the diseases of the circulatory system, there was a notable increase in deaths caused by the endocrine, nutritional and metabolic diseases which can be attributed to the unhealthy lifestyle and various behavioural factors.
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Introduction. According to International Agency for Research on Cancer in 2040, about 3 million new cases of breast cancer (BC) are predicted and about 1 million women are expected to die from this pathology. The aim of the study to assess the impact of COVID-19 on the indicators of the oncological service for breast cancer in Kazakhstan. Material and research methods. The main method was a retrospective study using descriptive, analytical methods of biomedical statistics and data of the Ministry of Health of the Republic of Kazakhstan - form No.7 and 35 regarding BC (ICD 10 - C50) for 2011-2020. Results. For 2011-2020 42,376 new cases of BC and 12,914 deaths from this pathology were registered. The average annual crude incidence rate was 46.4+or-1.10/0000 (95%CI=44.3-48.5), and increased from 40.8+or-0.70/0000 (2011) to 51 .3+or-0.70/0000 in 2019 and then decrease to 44.2+or-0.70/0000 in 2020 (p<0.001). In dynamics, mortality rates tended to (p<0.001) decrease from 16.1+or-0.40/0000 (2009) to 11.9+or-0.40/0000 in 2019 and 11.5+or- 0.40/0000 in 2020, and the average annual crude mortality rate was 14.2+or-0.60/0000 (95%CI=13.1-15.3). Indicators of early diagnosis (stage I-II) improved from 73.4% (2011) to 86.9% in 2019, and decreased to 84.2% in 2020. Proportion of patients with stage III decreased (from 20.9% in 2011 to 8.4% in 2019 and to 10.0% in 2020) and stage IV (from 5.6% to 4.2% and 5.0%, respectively), i.e. neglect rates are declining. The indicators of morphological verification improved from 95.7% to 99.4% over the years. Conclusions. As a result of the analysis, an improvement in the indicators of morphological verification, early diagnosis, a decrease in the neglect and mortality rates were established. The trends in 2011-2019 differed significantly from the period from 2011-2020, which is due to the COVID-19 pandemic on the registration of BC.