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Tracheostomy is a standard surgical procedure that is used in critically ill patients who require sustained mechanical ventilation. In this article, we review the outcomes of coronavirus disease 2019 (COVID-19) patients who underwent tracheostomy. We searched for relevant articles on PubMed, Scopus, and Google Scholar, up to April 20, 2021. This meta- analysis examines ventilation liberation, decannulation, and hospital mortality rates in COVID-19 patients who have undergone tracheostomy. Two investigators evaluated the articles, and the differences of opinion were settled by consensus with a third author. A total of 4366 patients were included in 47 related articles for this meta-analysis. After data pooling, the proportions of ventilation liberation, decannulation and mortality were found to be 48% (95% CI: 31-64), 42% (95% CI: 17-69) and 18% (95% CI: 9-28) respectively. The Luis Furuya-Kanamori (LFK) index values for ventilation liberation, decannulation and mortality were 4.28, 1.32 and 0.69. No transmission of the disease attributable to participating in tracheostomy procedures was reported in most of the included articles.
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COVID-19 , Critical Illness , Humans , Respiration, Artificial , SARS-CoV-2 , TracheostomyABSTRACT
INTRODUCTION: We aimed to investigate the clinical features and mortality of critically ill patients treated with convalescent plasma for COVID-19 in the intensive care unit (ICU). MATERIAL AND METHODS: We retrospectively collected clinical and laboratory data of COVID-19 patients treated in the ICU. The patients were divided into two groups: those who received convalescent plasma and those who did not. We evaluated changes in the laboratory parameters and PaO2/FiO2 of the patients in the convalescent plasma group on days 0, 7, and 14. RESULTS: A total of 188 patients were included, 89 of whom received convalescent plasma. There were no significant differences in length of hospitalization [median: 17 vs. 16 days, P = 0.13] or 28-day mortality between the two groups (59% vs. 65%, P = 0.38). The ICU stay of patients who received convalescent plasma was longer (P = 0.001). The dynamics of the laboratory parameters of 44 patients in the convalescent plasma group, who were still in intensive care on the 14th day, were analysed. There was no differences in CRP or PaO2/FiO2 on day 0, 7 or 14 (P = 0.12; P = 0.10, respectively). CONCLUSIONS: Convalescent plasma treatment was not associated with shorter hospitalisation or lower mortality in patients diagnosed with COVID-19. However, the ICU stay was longer in patients who received convalescent plasma.
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COVID-19 , COVID-19/therapy , Humans , Immunization, Passive , Intensive Care Units , Length of Stay , Retrospective Studies , SARS-CoV-2 , COVID-19 SerotherapyABSTRACT
To predict the mortality of patients with coronavirus disease 2019 (COVID-19). We collected clinical data of COVID-19 patients between January 18 and March 29 2020 in Wuhan, China . Gradient boosting decision tree (GBDT), logistic regression (LR) model, and simplified LR were built to predict the mortality of COVID-19. We also evaluated different models by computing area under curve (AUC), accuracy, positive predictive value (PPV), and negative predictive value (NPV) under fivefold cross-validation. A total of 2924 patients were included in our evaluation, with 257 (8.8%) died and 2667 (91.2%) survived during hospitalization. Upon admission, there were 21 (0.7%) mild cases, 2051 (70.1%) moderate case, 779 (26.6%) severe cases, and 73 (2.5%) critically severe cases. The GBDT model exhibited the highest fivefold AUC, which was 0.941, followed by LR (0.928) and LR-5 (0.913). The diagnostic accuracies of GBDT, LR, and LR-5 were 0.889, 0.868, and 0.887, respectively. In particular, the GBDT model demonstrated the highest sensitivity (0.899) and specificity (0.889). The NPV of all three models exceeded 97%, while their PPV values were relatively low, resulting in 0.381 for LR, 0.402 for LR-5, and 0.432 for GBDT. Regarding severe and critically severe cases, the GBDT model also performed the best with a fivefold AUC of 0.918. In the external validation test of the LR-5 model using 72 cases of COVID-19 from Brunei, leukomonocyte (%) turned to show the highest fivefold AUC (0.917), followed by urea (0.867), age (0.826), and SPO2 (0.704). The findings confirm that the mortality prediction performance of the GBDT is better than the LR models in confirmed cases of COVID-19. The performance comparison seems independent of disease severity. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at(10.1007/s00521-020-05592-1).
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This chapter is devoted to the spread of the SARS-CoV-2 virus in time and space in Czechia and in a brief context of its neighboring countries. It is (except for the theoretical background and data description) thematically divided into three parts and uses different approaches in the analysis. The first part descriptively outlines the trajectories of the virus in the Czech population. The second part, based on the demographic approach, examines the potential impact of COVID-19 on mortality. The third part presents a time-space analysis of the spread of COVID-19 at the regional level. Among the fundamental risk factors for Czechia, there is the inexperience of the Czech health and hygiene systems in dealing with more serious infectious epidemics in the past, the absence of a scientific and independent public health institution, and non-conceptual political decisions in the management of pandemics. In the analysis, the interdisciplinary scientific approach is used (medical geography, demography, and spatial analysis) to analyze such a complex phenomenon. It was shown that during the first year of pandemics (March 2020-March 2021) there were four pandemic waves in Czechia. Except for the preventive and anti-pandemic measures, the effect on the mortality level and socioeconomic status in particular regions could be expected. The estimated effect of COVID-19 on the life expectancy at birth was estimated around a 1 year decrease, the same as in other Central European countries. This impact is expected to be much lower in the case of Germany. © The Author(s), under exclusive license to Springer Nature Switzerland AG 2022.
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Objectives: We aimed at examining whether patients with rheumatological conditions receiving chronic hydroxychloroquine therapy are at a lower risk of developing SARS-CoV-2 infection than those not receiving hydroxychloroquine. Method(s): This historical cohort study included information of all patients aged 18 years or older with rheumatoid arthritis, systemic lupus erythematosus, or associated rheumatological conditions (based on International Classification of Diseases, 10th edition, diagnostic codes). A propensity score was calculated for each patient, and each patientwho was receiving hydroxychloroquine was matched to two patients who were not receiving hydroxychloroquine (controls). The primary endpoint was the proportion of patients with PCR-confirmed SARS-CoV-2 infection among those receiving chronic hydroxychloroquine versus the propensity-matched patients not receiving chronic hydroxychloroquine in 2021. Result(s): 322 patients receiving hydroxychloroquine and 645 patients not receiving hydroxychloroquine were included in the primary analysis. The incidence of active SARS-CoV-2 infections during the study period did not differ between patients receiving hydroxychloroquine and patients not receiving hydroxychloroquine ( [0 3%] vs 78 [0 4%] of 21406;odds ratio 0 79, 95% CI 0 52-1 20, p = 0 27). There were no significant differences in secondary outcomes between the two groups of patients who developed active SARS-CoV-2 infection. For all patients in the study, overall mortality was lower in the hydroxychloroquine group than in the group of patients who did not receive hydroxychloroquine (odds ratio hydroxychloroquine was not associated with the development of active SARS-CoV-2 infection (odds ratio 0 79, 95% CI 0 51-1 42) Conclusion(s): Hydroxychloroquine was not associated with a protective effect against SARS-CoV-2 infection in a large group of patients with rheumatological conditions.
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The focus of the present study is on the psychological and social dimensions of collective trauma resulting from the intense impact of strong emotional and stress factors connected with the COVID-19 pandemic and the crisis in Ukraine in parents of children with oncological diseases. The process of overcoming collective trauma in its diversity is a long one and requires specific care. The challenge of recovery is to regain the sense of control over the mental, economic and social parameters of the individuals affected. For the group of parents studied this includes discovery of a way for the caregivers to be calm and focused on the accompanying care for the child with an oncological disease, even in a pandemic situation and war. The effective overcoming collective trauma of the sense of imminent danger in society is based on public support and personal responsibility. Fear, anger, depression, isolation and lack of resources that are a direct psychological and economic result of pandemic and war, aggravates the quality of life of patients. As socially determined parameters, they carry a high risk of the recurrence and mortality of children with malignant diseases.
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Objective: Acute-phase proteins are a family of proteins synthesized by the liver. With this study, we aimed to investigate the effects of COVID-19 infection on acute phase reactants (AFR) and determine the usability of AFRs as prognostic factors in COVID-19 disease. Material(s) and Method(s): Serum samples taken for routine analysis of the patients admitted to the Emergency Department and diagnosed with COVID-19, were used. AFR levels of 30 patients who resulted in mortality and 30 recovered patients were evaluated. C-reactive protein (CRP), ferritin (FER), ceruloplasmin (Cp), albumin (Alb), prealbumin (Prealb), transferrin (Trf), lactate, Acute Physiology and Chronic Health Evaluation (APACHE), and Sequential Organ Failure Assessment (SOFA) assessment was performed. Result(s): The hazard ratio and 95% confidence interval for FER, CRP, lactate, Alb, Cp, Prealb, Trf, Age, SOFA, and APACHE were 1.001 (1.000-1.001), 1.005 (1.001- 1.008), 1.141 (1.016-1.243), 1.016 (0.740-1.399), 1.016 (0.740-1.399), 1.056 (1.017-1.100), 0.978 (0.917-1.035), 1.000 (0.995-1.006), 1.032 (1.004- 1.064), 1.104 (0.971-1.247), and 1.012 (0.974-1.051), respectively, in univariable model. Only CRP, lactate, and FER found significant in multivariable model. In addition, patients in the nonsurvivors group had significantly higher FER, CRP, lactate, APACHE, age, and SOFA. Nonsurvivors also had lower Alb, Prealb, and serum Trf level compared to survivors. Conclusion(s): CRP, lactate, and FER, which we have shown to be significantly higher in severe COVID-19 patients, will be valuable parameters that will contribute to clinical improvement if they are used in the follow-up of patients due to their easy measurement and predictive values.Copyright © 2023, Nobelmedicus. All rights reserved.
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Introduction Prognostic nutritional index (PNI) is a novel inflammation marker that useful in predicting prognosis of certain conditions. We aimed to study PNI of the outpatient and inpatient subjects with established Covid-19 and also aimed to compare PNI of deceased and survived Covid-19 patients. Methods The patients with Covid-19 whom presented to outpatient or inpatient clinics of Abant Izzet Baysal University Hospital were enrolled to the study. PNI levels of the inpatients and outpatients, deceased and survived were compared. PNI values of deceased and survived in inpatients were also compared. Results Study population was consisted of 4419 subjects (2907 outpatients and 1512 inpatients). PNI of the inpatient (41.55 (36.42-47.1)) group was significantly lower than the PNI of the outpatient (51.95 (47.95-55.75)) subjects (p<0.001). The sensitivity and specificity of PNI (≤46.2 level) in determination of requirement inpatient treatment were 71.2% and 83.5%, respectively. PNI of the deceased patients (37(33.39-40.86)) was lower than the PNI of the survivors (50.45(45.6-54.65)), (p<0.001). The sensitivity and specificity of PNI at ≤44.55 level in determining mortality were 89.22% and 78.87%, respectively. Conclusion We suggest that PNI could serve as a reliable prognostic index in covid-19 patients. Reduced level of PNI should alert physicians since it is associated with need for hospitalization and mortality in this population. © 2023 Kamuzu University of Health Sciences.
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Objective: Multiple factors have been studied in association with disease severity in COVID-19. The cycle threshold (Ct) value of polymerase chain reaction (PCR) can reflect viral load in the specimens. In this study, we aimed to evaluate the effect of the Ct value on clinical course and mortality in COVID-19 patients. Methods: Adult patients who tested positive for SARS-CoV-2 with PCR test and who were hospitalized with COVID-19-related symptoms between August 1, 2020, and November 30, 2020, were included in the study. In addition, Ct value, demographic and clinical data (length of hospital stay, need for admission to intensive care unit (ICU), need for mechanical ventilation (MV), and mortality) were reviewed retrospectively. Results: 117 patients were included in the study. The mean Ct value was 22.37 +/- 4.72 (11.07-34.06). There was no significant difference in the mean Ct values between the patients who needed ICU admission and those who did not. When the patients were evaluated by dividing them into three groups according to their Ct values, as < 20, between 20-24 and >24;there was no significant difference between these three groups in terms of severity of pneumonia, laboratory parameters (D-dimer, Neutrophil/Lymphocyte ratio, C-reactive protein, lymphocyte count), length of hospital stay, need for ICU admission, need for MV and mortality. When the patients were divided into two groups with Ct values as <23.3 and >= 23.3, no significant difference was found between the groups regarding ICU need, MV need, and 28-day mortality rates. Conclusion: Most of the studies in the literature about Ct value and its effect on clinical course indicate that lower Ct values are potentially associated with worse outcomes in COVID-19. However, there are also studies reporting that the Ct value does not reflect the severity of the disease. We did not find a correlation between Ct value and laboratory markers, length of hospital stay, the severity of pneumonia, need for ICU admission or MV, and mortality in COVID-19 patients in this presented study.
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The chapter explores the impact of the Coronavirus Disease 2019 (COVID-19) pandemic on language endangerment in Italy. Despite their misleading name, Italian Dialects (IDs) are sister languages of Italian and independently developed from Latin. Since the introduction of compulsory education in the 1960s and concurrent Italy's sharp industrialisation, IDs are in decline, and a clear language shift is detectable towards the dominant national language: Italian. IDs are hence only discretely vital among the aging population with the younger generations having broken their intergenerational transmission. Given the higher mortality rates among the elderly and the strict intermittent national and regional lockdowns enforced by the Italian Government, the COVID-19 pandemic has accelerated the process of language death across Italy. This is particularly noticeable in Bergamo, one of the Italian provinces most affected by COVID-19, where the disease caused a five-fold increase in excess mortality in March 2020. In the same period, COVID-19 was the attributable cause of death in half of those older than 50 and the mean age of those dying for COVID-19 was 80. The death toll of COVID-19 on the elderly population has left Bergamasco, the ancestral language of Bergamo, a step closer to extinction. By taking Bergamasco as a case study, the chapter denounces the vulnerability of IDs and the negative impact of the COVID-19 pandemic on their level of vitality. To this aim, the chapter presents a quantitative sociolinguistic study of the vitality of Bergamasco in relation to COVID-19 incidence and lethality rates in the province of Bergamo. © The Author(s), under exclusive license to Springer Nature Switzerland AG 2022.
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The new coronavirus infection (COVID-19) caused by the SARS-CoV-2 virus continues to spread rapidly worldwide, despite the increased prevention and treatment measures being taken. Vaccination is one of the most cost-effective and effective methods of preventing infectious diseases in the modern world, including one of the most effective methods of combating COVID-19. Over several centuries of history, vaccination has proven its effectiveness in saving people's lives, reducing the spread of infectious diseases among the population, as well as reducing mortality. The effectiveness of immunization against COVID-19 is an urgent problem at the moment, especially when it comes to vaccination. The aim of the work is to study the effect of vaccination on the incidence of a new coronavirus infection among residents of the Saratov Region. Material and methods. Methods of retrospective epidemiological analysis of trends in the epidemic process COVID-19 were used. The obtained materials were processed using methods of variational statistics (Excel program). The analysis was based on data from daily monitoring of laboratory diagnostic results (more than 1780 thousand PCR diagnostic studies were conducted during the epidemic), COVID-19 cases and deaths, taking into account the coverage of the population with preventive vaccinations. The statistical significance of the differences was assessed according to the Student's criterion. The differences were considered significant at t<=2. Results and discussion. As of June 30, 2021, more than 267 thousand people or 11% of the population of the Saratov region were fully vaccinated against COVID-19. There were no complications after the introduction of vaccines. In the structure of all medical immunobiological preparations that were immunized, the proportion of the vaccine "Gam-COVID-Vac" was 97.88%, "Epivaccorona" - 1.69% and "Covivac" - 0.43%. According to preliminary data, 361 of the vaccinated people were infected with SARS-CoV-2, of which: 255 (70.6%) had a mild course of the disease with manifestations of catarrhal syndrome, 84 (23.3%) had community-acquired pneumonia, 22 (6%) had no symptoms of the disease. No deaths have been registered among the vaccinated. The overall incidence of COVID-19 among vaccinated was 0.06%. The incidence rate of COVID-19 among the vaccinated population is 6.025+/-0.15 per 10 thousand people, which is significantly lower (t>2) than among the unvaccinated (103.8+/-0.63 per 10 thousand people), efficiency index - 17.23, epidemiological efficiency coefficient - 94.20% Conclusion. Insufficient coverage of the population of the Saratov Region with vaccination (as of June 30, 2021, 11% were fully vaccinated) does not allow to influence the reduction of the incidence of COVID-19. The high epidemiological effectiveness of COVID-19 vaccination of the adult population with domestic vaccines, including people over 65 years of age, has been revealed.Copyright © 2022 Geotar Media Publishing Group
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Background: COVID-19 infection is a disease caused by severe acute respiratory syndrome coronavirus 2. The manifestations, effects, and severity of the infection are varied in different waves, especially during pregnancy. Material(s) and Method(s): The study was conducted in two equal time periods during the first and second waves. During the first wave, the period of study was between June and August 2020 corresponding to the peak of the first wave, and in the second wave, the study period was between May and July 2021 corresponding to the peak of the second wave. Result(s): A total of 3,791 pregnant women was screened for COVID-19 infection during the first wave and second wave, the pregnant mothers with COVID-19 positive were 4.2 (n = 163) and 5.1% (n = 191), respectively. Around 60% were antenatal mothers and 37% were postnatal mothers who were COVID-19-positive. The predominant age group affected was between 20 and 25 years of age. Gestational diabetes mellitus (GDM), gestational hypertension, anemia, previous lower segment cesarean section (LSCS), postdated pregnancy, and past history of infertility were the high-risk factors observed during the study. Hypoxia was observed in 15% of patients in the second wave. About 49.7% (n = 95) of the COVID-19-positive mothers in the second wave required steroids, anticoagulants, and antiviral drugs. Conclusion(s): The incidence of COVID-19 infection was mild and asymptomatic during the first wave and symptomatic as well as with complications during the second wave. The disease severity, intensive care unit (ICU) admissions, duration of stay, LSCS delivery, and need for antivirals, anticoagulants, and steroids were more during the second wave of COVID-19.Copyright © The Author(s). 2023.
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Background: The B.1.1.7 SARS-CoV-2 variant results in spike gene target failure (SGTF) in reverse transcription-quantitative polymerase chain reaction (RT-PCR) assays. Few studies have been published on the clinical impact of B.1.1.7/SGTF. Aim(s): To assess the incidence of B.1.1.7/SGTF and its associated clinical characteristics among hospitalized COVID-19 patients. Method(s): This observational, single-centre, cohort study was conducted between December 2020 and February 2021 and included 387 hospitalized COVID-19 patients. The Kaplan-Meier method was used for survival analysis, and logistic regression to identify risk factors associated with B.1.1.7/SGTF. Result(s): By February 2021, B.1.1.7/SGTF (88%) dominated the SARS-CoV-2 PCR results in a Lebanese hospital. Of the 387 eligible COVID-19 patients confirmed by SARS-CoV-2 RT-PCR, 154 (40%) were non-SGTF and 233 (60%) were B.1.1.1.7/SGTF;this was associated with a higher mortality rate among female patients [22/51 (43%) vs 7/37 (19%);P = 0.0170]. Among patients in the B.1.1.7/SGTF group, most were aged >= 65 years [162/233 (70%) vs 74/154 (48%);P < 0.0001]. Independent predictors of B.1.1.7/SGTF infection were hypertension (OR = 0.415;CI: 0.242-0.711;P = 0.0010), age >= 65 years (OR = 0.379;CI: 0.231-0.622;P < 0.0001), smoking (OR = 1.698;CI: 1.023-2.819;P = 0.0410), and cardiovascular disease (OR = 3.812;CI: 2.215-6.389;P < 0.0001). Only non-SGTF patients experienced multi-organ failure [5/154 (4%) vs 0/233 (0%);P = 0.0096]. Conclusion(s): There was a clear difference between the clinical features associated with B.1.1.7/SGTF and non-SGTF lineages. Tracking viral evolution and its clinical impact is crucial for proper understanding and management of the COVID-19 pandemic.Copyright © Authors 2023.
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Intro: The ongoing pandemic caused by the SARS-CoV-2 virus has brought many new insights into medicine. During the first months of the pandemic, when there were no comprehensive guidelines for precise antimicrobial therapy, empirical overuse of broad-spectrum antibiotics was observed. Which resulted in the development of clostidium infection in certain cases. In our report, we address 83 cases of clostridial colitis in post-covid patients from 3/2020 to 3/2021 and their specific therapy. Method(s): Retrospective analysis of risk factors for clostridial infection and therapy of clostridial colitis. Finding(s): In the period 3/2020-3/2021, 9617 patients were diagnosed with SARS-CoV-2 virus infection in our hospital, of which 1247 were hospitalized. In 83 cases, clostridial colitis occurred during or after the covid infection had resolved. Mortality in this group was 17%, which corresponds to 14 patients. Previous empirical administered antiobiotics in COVID-19 infection contributed to the development of clostridial colitis in case of 22 patients (27%) by clarithromycin, in 14 pacients (17%) by penicillins and by 3rd generation cephalosporins in 9 patients (11%). The average duration of therapy with broad-spectrum antibiotics was 15.63 days (+-8.99). Other risk factors we observed are: PPI use (25%), active malignant disease (10%), previous glucocorticoid therapy (22%). Vancomycin was used in clostridial infection therapy in 47% (39), metronidazole in 31% (25) and fidaxonicin in 7% (6). In the group, we observed recurrence of clostridium difficile infection in 14% of patients and FMT was performed in 6 patients. Conclusion(s): This study shows a higher percentage of clostridial infection in cases of long-term therapy with broad-spectrum antibiotics. It also points to the effect of specific antimicrobial therapy for infection caused by the bacterium Clostridium difficile and the possibility of using fecal bacteriotherapy.Copyright © 2023
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Background The effect of and optimal timing for initiating oral nutritional supplement (ONS) on hospitalized older patients with the Omicron variant infection remain unclear. Methods We collected data from confirmed COVID-19 patients between April 2022 to June 2022 at Shanghai Fourth People's Hospital, one of the designated medical centers for COVID-19 in Shanghai, China. Patients were identified as ONS users or non-ONS users, and the former was further defined as early ONS (ONS initiated within 48h from hospital admission), and late ONS (ONS initiated after 48 h) users. We conducted a retrospective cohort design as primary analysis and a case-control design as sensitivity analysis to explore the associations between ONS and clinical outcomes. Results A total of 1181 hospitalized patients ≥60 years old were included in our study. The mean age of the entire cohort was 78.0, and most patients were female (57.7%). The mortalities after PSM were 1.2% and 4.3% in the ONS group and non-ONS groups, respectively (P = 0.032). Subgroup analysis results showed that patients with early-ONS had significantly shorter hospital length of stay and length from symptom onset to viral clearance when compared to patients with late-ONS (9.0 [6.0-13.0] vs 14.0 [11.0-18.0] and 11.0 [8.0, 17.0] vs 17.0 [13.0-21.8], respectively). The findings from case-control analysis supported those from the primary analysis. Conclusions Early ONS could significantly lower risk of in-hospital death, as well as reduce hospital length of stay and days of viral clearance in COVID-19 older patients during the omicron wave.
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In 1990, the seroprevalence of antibody against hepatitis C virus (anti- HCV) in Taiwan was first documented to be 0.95% in volunteer blood donors, 90% in hemophiliacs, and 81% in parenteral drug abusers. The risk factors for HCV infection in Taiwan include iatrogenic transmission (medical injection, hemodialysis, acupuncture, and blood transfusion), tattooing, and sexual transmission. The long-term risk of hepatic and non-hepatic diseases has been well-documented by REVEL-HCV study. A national program of antiviral therapy for chronic viral hepatitis was launched in Taiwan in 2003. Mortality rates of end-stage liver diseases decreased continuously from 2000-2003 to 2008-2011 in all age and gender groups. When the World Health Assembly adopted the Global Health Sector Strategy on Viral Hepatitis in 2016, National program to eliminate hepatitis C was very carefully evaluated. It became a consensus to reach the WHO's 2030 goals in 2025. Taiwan Hepatitis C Policy Guideline 2018-2025 was approved and published at the beginning of 2019. There are triple focuses of hepatitis C elimination in Taiwan including (1) therapy spearheads prevention, (2) screening supports therapy, and (3) prevention secures outcome. A total of US$1.7 billion will be allocated from 2017 to 2025 for the elimination of HCV. The coverage of HCV screening and treatment has been increasing significantly since 2017. The HCV screening coverage was almost 100% for dialytic patients, 96% for HIV-infected patients, 65% for patients under opioid substitution treatment, 63% for patients in the pre-end-stage renal disease care program, 57% for patients in the early chronic kidney disease care program, 52% for patients in diabetes care program, 39% for prisoners, and 38% for adults aged 45-79 years old in the general population by April 30, 2020. The budget to cover the cost of DAA increased from US$101 million in 2017 to US$219 million in 2019. The number of chronic hepatitis C patients receiving DAA therapy increased from 9,538 in 2017, 19,549 in 2018, to 45,806 in 2019. However, the number of DAA-treated CHC patients reduced to 36,159 in 2020 and 20,559 in 2021 due to the COVID-19 pandemic. The cure rate based on SVR12 was 96.8% in 2017, 97.4% in 2018, over 98.6% after 2019. It is expected that Taiwan will achieve WHO's HCV elimination goal by 2025.
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Introduction: Hepatocellular carcinoma (HCC) comprises the majority of primary liver cancer and has a poor prognosis. Clivus metastasis is rare with only a few reported cases in the medical literature. We report a case of a patient who presented with clival mass found to have metastatic HCC. Case Description/Methods: A 63-year-old woman presented for neurosurgical evaluation after she was found to have a skull base mass on computerized tomography (CT) of the head at an outside hospital. She endorsed dysphagia for three months, however denied headaches or visual disturbances. A magnetic resonance imaging (MRI) revealed a 5.4 cm by 2.9 cm by 3.6 cm mass in the clivus, which was deemed as the cause of dysphagia (Figure 1a). The patient subsequently underwent an endoscopic transsphenoidal resection of the clival mass. Histopathology from the tissue revealed a hepatoid carcinoma, concerning for metastatic HCC (Figure 1b and 2c). Immunohistochemical strains were positive for hepatocytic marker arginase-1 (Figure 1d). Laboratory studies revealed alpha fetoprotein (AFP) of 56,344 ng/mL, CA-125 of 376 ng/mL, normal B-HCG and carcinoembryonic antigen (CEA). Thereafter, a triple phase CT of the liver revealed two LI-RADS 5 lesions suggestive of HCC as the primary malignancy. Patient's case was discussed at multidisciplinary tumor board with recommendations for systemic immunotherapy with atezolimumab plus bevacizumab and radiation therapy to the clivus. Discussion(s): The incidence of HCC has almost tripled since the 1980s making it the fastest rising cause of cancer related deaths. Metastasis to the brain comprises 0.26% to 2.2% of cases and the skull base is the most rarely affected anatomical site. Although CNS presentation is rare, we may see more neurological manifestations of metastatic HCC with the persistence of chronic hepatitis infections, the rise of metabolic diseases such as NASH, and an increase in alcohol-related liver disease during the COVID-19 pandemic. Although exceedingly rare, metastasis to the clivus should be considered in the differential diagnosis of skull base masses. Despite detection and treatment, prognosis remains poor and emphasis should be placed on consistent HCC surveillance. This case emphasizes that skull masses must be evaluated diligently as they can be the first sign of underlying liver malignancy. Given the morbidity and mortality associated with HCC, recognition of atypical manifestations of HCC can lead to a prompt diagnosis and initiation of life-saving treatment. (Figure Presented).
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Intro: To ensure adequate coverage against numerous waves of different variants of concern, Thailand has proactively adopted heterologous primary and booster vaccination schedules. While studies have assessed homologous schedules in detail, the effectiveness of heterologous booster vaccine schedules against severity and mortality of COVID-19 patients, particularly with newer variants, remains to be explored fully. Method(s): Utilising an active Hospital Information System for COVID-19 (CMC-19 HIS) network established in Chiang Mai, Thailand, we conducted a cohort study by linking patient-level data on laboratory-confirmed hospitalised COVID-19 cases to the national immunization records, during delta-predominant (1st October - 31st December 2021) and omicron predominant (1st February - 30th April 2022) periods. Demographic and baseline clinical characteristics associated with severe COVID-19 outcomes, mortality were examined for each period. Finding(s): Patients hospitalised during delta predominance were ten times more likely to have severe COVID-19 outcomes, in-hospital deaths, and a longer median hospital stay as compared to omicron predominance. During omicron predominance, a third vaccine dose was associated with 89% reduced risk of both severe COVID-19 and deaths, as compared to the unvaccinated group. Those who received the third dose 14-90 days prior to the date of positive SARS- CoV-2 test had the highest protection against severe COVID-19 outcomes (93%) followed by a drop to 87% among those who received their last dose >90 days prior. Severe outcomes were not observed among third dose recipients during delta predominance and fourth dose recipients during omicron predominance. All the vaccine types used for boosting in Thailand offered similar protection against severe COVID-19. Conclusion(s): The risk of severe outcomes were significantly lower for COVID-19 patients hospitalised with omicron as compared to delta. Booster doses provided very high level of protection against severe COVID-19 outcomes and deaths. Ongoing booster campaigns should focus on improving coverage utilising all available vaccines to ensure optimal protection.Copyright © 2023
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Introduction: While elevated lipase is typically used to diagnose acute pancreatitis, it has also been associated with other critical disease states including sepsis, COVID-19, bowel obstruction, and trauma. In this study we compared outcomes of patients with elevated lipase who had pancreatitis and NPHL. Method(s): Retrospective analysis was performed on all patients who presented to the Emergency Department between February 2016 and August 2020 with lipase >= 3x the upper limit of normal. Patient demographics and past medical history, including active cancer, were noted. Patient outcomes were followed through November 2021. If applicable, dates of death were also documented. Result(s): 414 total patients were included in this study. Upon initial evaluation, 305/414 (74%) were diagnosed with acute pancreatitis (AP) and 109/414 had NPHL. The age (54 617 vs. 58 618, p=0.0220), Sex (male 164/305 vs. 49/109, p=0.1194), and BMI (28.9 67.4 vs. 25.8 64.6, p=0.0066) were compared between the AP and NPHL groups. The serum lipase in the AP and NPHL group were respectively 1471 61070 vs. 605 6555 (p< 0.0001). The most common causes of NPHL were sepsis (10/109;9%) renal failure (7/109;6%), GI bleed (5/109;4%), and bowel obstruction (5/109;4%). The NPHL group had higher rate of malignancy (29/105;28%) compared to those with AP (35/305;11%, p< 0.0001). NPHL patients without malignancy had a higher mortality rate (63/80;80%) compared to those without malignancy in the AP group (17/270;6.3%, p< 0.0001). The most common malignancy in patients with AP was breast (6/35;17%, vs. 3/29;10%, p=0.4943). In NPHL, the most common malignancies were pancreatic (4/29;14%, vs. 3/35;9%, p=0.6920) and bowel malignancies (4/29;14%, vs. 4/35, 11% p51.0000). Conclusion(s): Patients with NPHL without malignancy have higher mortality than those with pancreatitis despite lower serum lipase levels. A limitation of our study is the difference between age and BMI of AP versus NPHL patients. Whether this impacts the prognostic relevance of NPHL on survival need to be explored in future studies.
ABSTRACT
While historically some have viewed the work of medical examiners/coroners (ME/C) and death investigators as predominantly serving the criminal justice system, in fact, the act of certifying a death is—in and of itself—a public health endeavor. The purpose of the death certificate is to track how and why individuals die as a means of helping others survive. Death certificates do save lives. In addition to generating these vital statistics, which guide public health policy, ME/C also perform a public health service in a variety of other ways. For instance, autopsy pathologists report unsafe consumer products, warn of recreational hazards (e.g., the dangers of snowmobile or all-terrain vehicle use), publicize and report occupational hazards (e.g., falls and electrocution risks), identify toxic exposures (e.g., carbon monoxide from defective heating units), and evaluate the safety of medical therapies. At autopsy, ME/C perform infectious disease surveillance, diagnosing and reporting communicable diseases such as bacterial meningitis, tuberculosis, and Legionella, thereby helping to mitigate disease spread in the community. They identify and characterize emerging infectious threats, such as COVID-19. They track violent deaths, including homicides, suicides, accidents, child and domestic abuse deaths, maternal mortality, and overdose deaths—to name a few—and participate as members of death review teams that attempt to identify systemic issues and prevent further such deaths. © 2023 Elsevier Inc. All rights reserved.