ABSTRACT
Aim To investigate the reasons for disparity regarding the country-specific COVID-19-related case fatality rate (CFR) within the 30 countries of the European Economic Area (EEA). Materials and methods Data regarding population, area, COVID-19-associated infections/deaths, vaccination, life expectancy, elderly population, infant mortality, gender disparity, urbanization, gross domestic product (GDP), income per capita, health spending per capita, physicians, nursing personnel, hospital beds, ICU beds, hypertension, diabetes, obesity, and smoking from all EEA countries were collected from official sources on January 16, 2022. Correlation coefficients were computed, and optimal scaling using ridge regression was used to reach the most parsimonious multivariate model assessing any potential independent correlation of public health parameters with COVID-19 CFR. Results COVID-19 CFR ranges from 0.1% (Iceland) to 4.0% (Bulgaria). All parameters but population density, GDP, total health spending (% of GDP), ICU beds, diabetes, and obesity were correlated with COVID-19 CFR. In the most parsimonious multivariate model, elderly population rate (P = 0.018), males/total ratio (P = 0.013), nurses/hospital beds (P = 0.001), physicians/hospital beds (P = 0.026), public health spending (P = 0.013), smoking rate (P = 0.013), and unvaccinated population rate (P = 0.00005) were demonstrated to present independent correlation with COVID-19 CFR. In detail, the COVID-19 CFR is estimated to increase by 1.24 times in countries with vaccination rate of <0.34, 1.11 times in countries with an elderly population rate of ≥0.20, 1.14 times in countries with male ratio values ≥0.493, 1.12 times in countries spending <2,000$ annually per capita for public health, 1.14 and 1.10 times in countries with <2.30 nurses and <0.88 physicians per hospital bed, respectively, and 1.12 in countries with smoking ratio ≥0.22, while holding all other independent variables of the model constant. Conclusion COVID-19 CFR varies substantially among EEA countries and is independently linked with low vaccination rates, increased elderly population rate, diminished public health spending per capita, insufficient physicians and nursing personnel per hospital bed, and prevalent smoking habits. Therefore, public health authorities are awaited to consider these parameters in prioritizing actions to manage the SARS-CoV-2 pandemic.
ABSTRACT
Acute esophageal necrosis (AEN) implicates poor tissue perfusion, functionally defective mucosal barrier, and corrosive injury of the esophageal mucosa, typically characterized by diffuse, circumferential greyish or black discoloration of the esophagus in esophagogastroduodenoscopy. Low-volume states, as diabetic ketoacidosis (DKA), predispose to AEN. Cola drinks diminish the esophageal pH by decreasing the lower esophageal sphincter pressure. We report a 47-year-old male shepherd with chest pain, nausea, odynophagia and gradual decline in level of consciousness, who reported consumption of 6-7 L of cola beverages per day, and was diagnosed with DKA. The patient had a record of type 2 diabetes mellitus and coronary heart disease, and he was administered empagliflozin 25 mg q24 hours, vildagliptin 50 mg bid, metformin 1000 mg bid, and insulin glargine 24 IU q 24. Esophagogastroduodenoscopy was indicative of a diffuse, edematous, and eroded mucosa of grey colour from the upper to the lower esophageal sphincter. CT scan supported the diagnosis, revealing diffuse thickening and edematous imaging of the esophageal wall with an abnormal edge of the mucosa in the lower half of the esophagus. Seven days after rigorous treatment with fluid resuscitation, insulin restoration, esomeprazole, fluconazole, cefoxitine, and metronidazole, the patient was ameliorated. A second endoscopy revealed obvious improvement. Pathophysiology, diagnosis, and treatment of DKA/AEN intertwining are thoroughly discussed. In conclusion, clinicians should not disregard AEN in the differential diagnosis of patients with DKA and clinical symptoms of esophagitis. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s13340-021-00537-y.
