ABSTRACT
A "Public Health Emergency of International Concern (PHEIC)" monkeypox outbreak was declared by the World Health Organization on 23 June 2022. More than 16,000 monkeypox cases were reported in more than 75 countries across six regions as of July 25. The Bayesian SIR (Susceptible-Infected-Recovered) model with the directed acyclic graphic method was used to estimate the basic/effective reproductive number (R0/Re) and to assess the epidemic spread of monkeypox across the globe. The maximum estimated R0/Re was 1.16 (1.15-1.17), 1.20 (1.20-1.20), 1.34 (1.34-1.35), 1.33 (1.33-1.33) and 2.52 (2.41-2.66) in the United States, Spain, Brazil, the United Kingdom and the Democratic Republic of the Congo, respectively. The values of R0/Re were below 1 after August 2022. The estimated infectious time before isolation ranged from 2.05 to 2.74 days. The PHEIC of the global spreading of human monkeypox has been contained so as to avoid a pandemic in the light of the reasoning-based epidemic model assessment.
ABSTRACT
Evaluating the magnitude of overdiagnosis associated with stool-based service screening for colorectal cancer (CRC) beyond a randomized controlled trial is often intractable and understudied. We aim to estimate the proportion of overdiagnosis in population-based service screening programs for CRC with the fecal immunochemical test (FIT). The natural process of overdiagnosis-embedded disease was first built up to learn transition parameters that quantify the pathway of non-progressive and progressive screen-detected cases calibrated with sensitivity, while also taking competing mortality into account. The Markov algorithms were then developed for estimating these transition parameters based on Taiwan FIT service CRC screening data on 5,417,699 residents aged 50-69 years from 2004 to 2014. Following the digital twin design with the parallel universe structure for emulating the randomized controlled trial, the screened twin, mirroring the control group without screening, was virtually recreated by the application of the above-mentioned trained parameters to predict CRC cases containing overdiagnosis. The ratio of the predicted CRCs derived from the screened twin to the observed CRCs of the control group minus 1 was imputed to measure the extent of overdiagnosis. The extent of overdiagnosis for invasive CRCs resulting from FIT screening is 4.16% (95% CI: 2.61-5.78%). The corresponding figure is increased to 9.90% (95% CI: 8.41-11.42%) for including high grade dysplasia (HGD) and further inflated to 15.83% (95% CI: 15.23-16.46%) when the removal adenoma is considered. The modest proportion of overdiagnosis modelled by the digital twin method, dispensing with the randomized controlled trial design, suggests the harm done to population-based FIT service screening is negligible.
ABSTRACT
Imatinib is a crucial therapeutic strategy against chronic myeloid leukemia. Though superficial edema is a common adverse effect of imatinib, massive fluid retention is rarely reported. Here, we report the case of an adolescent who had tolerated imatinib for a long time, and then presented with massive pleural/pericardial effusion during an episode of Campylobacter jejuni bacteremia. A stepwise and comprehensive survey excluded all other plausible causes of disease. The Naranjo scale was used to assess the probability of an adverse effect of medication, and the score turned out to be 9, indicating severe fluid retention to be a definite reaction to imatinib. Drug discontinuation, antibiotic administration, and invasive procedures improved this condition. After this episode, the patient could tolerate imatinib again, illustrating the transient and reversible nature of this reaction. Since prolonged imatinib usage is crucial for chronic myeloid leukemia control, alertness to drug-related adverse effects is recommended, even if the subject has previously shown a good tolerance to the drug due to various physical conditions, especially physiological stressors, like infection or inflammation.
