Health Sufficiency Indicators for Pandemic Monitoring.

The outbreak of the COVID-19 disease, spreading all around the world and causing a worldwide pandemic, has lead to the collapse of the health systems of the most affected countries. Due to the ease of transmission, early prevention measures are proved to be fundamental to control the pandemic and, hence, the saturation of the health systems. Given the difficulty of obtaining characteristics of these systems of different countries and regions, it is necessary to define indicators based on basic information that enable the assessment of the evolution of the impact of a disease in a health system along with fair comparisons among different ones. This present paper introduces the Health Sufficiency Indicator (HSI), in its accumulated and daily versions. This indicator measures the additional pressure that a health care system has to deal with due to a pandemic. Hence, it allows to evaluate the capacity of a health system to give response to the corresponding needs arising from a pandemic and to compare the evolution of the disease among different regions. In addition, the Potential Occupancy Ratio (POR) in both its hospital ward bed and ICU bed versions is here introduced to asses the impact of the pandemic in the capacity of hospitals. These indicators and other well-known ones are applied to track the evolution of the impact of the disease on the Spanish health system during the first wave of the pandemic, both on national and regional levels. An international comparison among the most affected countries is also performed.

Econometric ARIMA methodology to elucidate the evolution of trends in nosocomial antimicrobial resistance rates in the European Union.

BACKGROUND: Infections with bacteria harbouring resistance to cephalosporins or fluoroquinolones (FQ) constitute a serious hazard to human health. OBJECTIVES: To establish a methodology based on econometric analysis and the largest European Union (EU) resistance database (EARS-Net), to model nosocomial antimicrobial resistance (AMR) in the EU and to detect tendency changes, steps or peaks. The contribution of legislation based on third-generation cephalosporin (3GC) and FQ class referrals to resistance rate patterns is evaluated. METHODS: Resistance to 3GC and FQ was examined in nosocomial Escherichia coli, Klebsiella pneumoniae and Pseudomonas aeruginosa in at least 25 out of 30 EU countries (> 94% population coverage), weighted by their mean annual population, between 2006 and 2016. Autoregressive integrated moving average (ARIMA) model analysis, inspired by Box-Jenkins methodology, was prepared to adjust series to a mathematical model to detect hypothetical changes in the general behaviour. To the best of the authors' knowledge, this is the first study to use ARIMA with interventions to model overall nosocomial AMR data compiled in EARS-Net. RESULTS AND CONCLUSIONS: Econometric ARIMA models statistically prove the occurence of slowdowns and reversions in the increasing trend of AMR prevalence in nosocomial E. coli and K. pneumoniae to 3GC and FQ, as well as resistance of P. aeruginosa to 3GC. The resistance of P. aeruginosa to FQ exhibited a descending slope. The presented decreasing trends constitute noteworthy milestones in tackling AMR in Europe.

Seminal Vesiculitis in Three Pet Rabbits ( Oryctolagus cuniculus ).

To date, descriptions of pathologic conditions of the seminal vesicle in rabbits are scarce and limited to the laboratory animals in experimental conditions. The present article describes three cases of strangury, abdominal pain, and anorexia associated with seminal vesiculitis in pet rabbits. Three non-neutered male pet rabbits aged 3.6, 1.5, and 2.1 yrs were presented with strangury, abdominal pain, and anorexia. Seminal vesiculitis was diagnosed based on clinical signs and ultrasonography findings. Vesiculectomy was performed in two cases that presented strangury refractory to medical treatment, and diagnosis was confirmed by histopathology. In the third case, the patient received medical treatment, and a sequela in the form of lithiasis of the seminal vesicle was detected 3 yrs later. Plain radiographs were nearly unremarkable, and results from complete blood analysis and urinalysis were not specific in all three cases. Contrast radiography was performed in one case, showing a dilated seminal vesicle. Ultrasound and surgical biopsy seem to be the most sensitive techniques in the diagnosis of this pathology. Seminal vesiculitis must be included in the differential diagnosis of acute or chronic strangury in male pet rabbits.

Plasmatic L-lactate in pet rabbits: association with morbidity and mortality at 14 days.

BACKGROUND: The clinical relevance of plasmatic L-lactate concentration (PLLC) is unknown in rabbits. Due to an entirely different metabolism of lactic acid, PLLC in rabbits can reach much higher concentrations than in other species. OBJECTIVES: The aim of this study was to establish a reference interval (95% RI) for venous PLLC in pet rabbits and to assess its diagnostic and prognostic significance in ill pet rabbits. METHODS: Plasmatic L-lactate concentration was determined by an enzymatic colorimetric method. In the first study, healthy rabbits (n = 140) were the control group. The ill rabbits group (n = 405) included the deceased (n = 108) and the survivors (n = 266), depending on the outcome at day 14. In a second study, variation in the PLLC was determined in 25 boarding (control-serial), 99 hospitalized (deceased-serial [n = 27], and survivors-serial [n = 72]) rabbits sampled at 0, 12, 24 and 48 hours. RESULTS: The 95% RI for PLLC in controls was 2.1-15.2 mmol/L. On-arrival PLLC in ill rabbits was not statistically different from those in the control group, but was significantly lower in deceased compared to survivors or controls. The range of PLLC variation differed significantly between control-serial, deceased-serial, and survivors-serial groups. A better prognosis was associated with an increase of 3.3 mmol/L PLLC within 48 hours after arrival. CONCLUSIONS: Contrary to the available information in other species, morbidity and mortality is associated with sustained low PLLC in pet rabbits, while a good prognosis is associated with an increase in PLLC. Monitoring PLLC in hospitalized rabbits is advisable.