Global socioeconomic inequality in the burden of communicable and non-communicable diseases and injuries: an analysis on global burden of disease study 2019

BACKGROUND

Examining the distribution of the burden of different communicable and non-communicable diseases and injuries worldwide can present proper evidence to global policymakers to deal with health inequality. The present study aimed to determine socioeconomic inequality in the burden of 25 groups of diseases between countries around the world in 2019.

METHODS

In the current study data according to 204 countries in the world was gathered from the Human Development Report and the Global Burden of Diseases study. Variables referring to incidence, prevalence, years of life lost (YLL), years lived with disability (YLD) and disability adjusted life years (DALY) resulting by 25 groups of diseases and injuries also human development index was applied for the analysis. For measurement of socioeconomic inequality, concentration index (CI) and curve was applied. CI is considered as one of the popular measures for inequality measurement. It ranges from - 1 to + 1. A positive value implies that a variable is concentrated among the higher socioeconomic status population and vice versa.

RESULTS

The findings showed that CI of the incidence, prevalence, YLL, YLD and DALY for all causes were - 0.0255, - 0.0035, - 0.1773, 0.0718 and - 0.0973, respectively. CI for total Communicable, Maternal, Neonatal, and Nutritional Diseases (CMNNDs) incidence, prevalence, YLL, YLD and DALY were estimated as - 0.0495, - 0.1355, - 0.5585, - 0.2801 and - 0.5203, respectively. Moreover, estimates indicated that CIs of incidence, prevalence, YLL, YLD and DALY for Non-Communicable Diseases (NCDs) were 0.1488, 0.1218, 0.1552, 0.1847 and 0.1669, respectively. Regarding injuries, the CIs of incidence, prevalence, YLL, YLD and DALY were determined as 0.0212, 0.1364, - 0.1605, 0.1146 and 0.3316, respectively. In the CMNNDs group, highest and lowest CI of DALY were related to the respiratory infections and tuberculosis (- 0.4291) and neglected tropical diseases and malaria (- 0.6872). Regarding NCDs, the highest and lowest CI for DALY is determined for neoplasms (0.3192) and other NCDs (- 0.0784). Moreover, the maximum and minimum of CI of DALY for injuries group were related to the transport injuries (0.0421) and unintentional injuries (- 0.0297).

CONCLUSIONS

The distribution of all-causes and CMNNDs burden were more concentrated in low-HDI countries and there are pro-poor inequality. However, there is a pro-rich inequality for NCDs' burden i.e. it was concentrated in high-HDI countries. On the other hand, the concentration of DALY, YLD, prevalence, and incidence in injuries was observed in the countries with higher HDI, while YLL was concentrated in low-HDI countries.

Aerosol-generating dental procedures: a reappraisal of analysis methods and infection control measures

BACKGROUND

Dental aerosol-generating procedures (AGPs) have been associated with risk for transmitting infectious agents. However, existing infection control monitoring studies potentially underestimate the extent of contamination, due to methodological inadequacies. These studies employed settle plate methodology which only captures droplets that land on agar plates, but not those suspended in air. Furthermore, bacterial culture was used to determine the extent of contamination, without accounting for non-bacterial sources of contamination.

AIMS

This study sought to bridge these gaps by establishing a monitoring protocol involving active aerosol sampling and analysis of two dental AGPs, root canal treatment (RCT) and scaling.

METHODS

RCT and scaling were performed with standard aerosol mitigation precautions. Aerosols generated throughout each procedure were sampled using the air sampler device, while contamination of operatory fomites and personal protective equipment was sampled using surface swabs, before and post-treatment. The amount of contamination was quantified using bacterial culture and adenosine triphosphate (ATP) assay.

FINDINGS

RCT generated insignificant aerosol and splatter, supporting the infection control procedures' effectiveness. Conversely, scaling significantly increased the amount of aerosol and splatter. When comparing bacterial culture and ATP assay, the magnitude of contamination obtained with ATP assay was greater, suggesting that ATP assay may have detected additional contamination of human origin and bacteria that was not recovered by the culture conditions employed.

CONCLUSIONS

This monitoring protocol is feasible in the dental setting and determines the extent of contamination generated during AGPs. This could be adopted in future studies to overcome the limitations of the existing literature.

Surgeons' user experience of telemedicine in surgical consultations during the COVID-19 pandemic, with an emphasis on general surgical consultations

BACKGROUND

The COVID-19 pandemic and the eventual national lockdown in the UK brought a halt to the face-to-face outpatient appointments at most NHS hospitals. Owing to this, clinicians have had to switch to other means of consultation, to maintain continuity of care. This survey was done to see how surgeons perceive telemedicine as part of their surgical consultations.

METHODS

A questionnaire was piloted and re-designed following which an improved questionnaire was circulated among all users of telemedicine in surgical specialties through social media platforms. The results were analysed using smart survey software.

RESULTS

Seventy per cent of the respondents had never used telemedicine before the COVID-19 pandemic. Three-quarters of the respondents found difficulty in assessing patients preoperatively. A significant proportion were worried about confidentiality and data security. The other concerns expressed were difficulty in building a rapport and the absence of a legal framework to support the surgeons in the transition. Despite some concerns, most of them were in favour of using telemedicine in the future with some improvements.

CONCLUSION

As the pandemic prevented people from attending face-to-face appointments, remote consultations were stepped up to help overcome the difficulties. Screening services were suspended and treatment accumulated. Telemedicine will be a corner-stone service as healthcare systems attempt to tackle this backlog. The already existing software need to be further explored. Future studies must address the use of telemedicine in preoperative consultations. Regulatory bodies must ensure that there is adequate legal framework in place so that clinicians continue to embrace telemedicine.

Molecular Communications in Viral Infections Research: Modeling, Experimental Data, and Future Directions

Hundreds of millions of people worldwide are affected by viral infections each year, and yet, several of them neither have vaccines nor effective treatment during and post-infection. This challenge has been highlighted by the COVID-19 pandemic, showing how viruses can quickly spread and impact society as a whole. Novel interdisciplinary techniques must emerge to provide forward-looking strategies to combat viral infections, as well as possible future pandemics. In the past decade, an interdisciplinary area involving bioengineering, nanotechnology and information and communication technology (ICT) has been developed, known as Molecular Communications. This new emerging area uses elements of classical communication systems to molecular signalling and communication found inside and outside biological systems, characterizing the signalling processes between cells and viruses. In this paper, we provide an extensive and detailed discussion on how molecular communications can be integrated into the viral infectious diseases research, and how possible treatment and vaccines can be developed considering molecules as information carriers. We provide a literature review on molecular communications models for viral infection (intra-body and extra-body), a deep analysis on their effects on immune response, how experimental can be used by the molecular communications community, as well as open issues and future directions.

Histoid leprosy - a rare clinical presentation

Histoid leprosy is considered a rare form of lepromatous leprosy. Its peculiar clinical picture makes its diagnosis a challenging one, which can delay starting treatment and perpetuate the disease as endemic. In addition to representing a reservoir of bacilli, and being an important means of contamination, these patients have greater resistance to standard treatment. This is a report of a typical case of this rare presentation, aiming to share the knowledge and favor earlier diagnosis of the disease.

The economic value of changing mortality risk in low- and middle-income countries: a systematic breakdown by cause of death

BACKGROUND

We develop a framework for quantifying monetary values associated with changes in disease-specific mortality risk in low- and middle-income countries to help quantify trade-offs involved in investing in mortality reduction due to one disease versus another.

METHODS

We monetized the changes in mortality risk for communicable and non-communicable diseases (CD and NCD, respectively) between 2017 and 2030 for low-income, lower-middle-income, and upper-middle-income countries (LICs, LMICs, and UMICs, respectively). We modeled three mortality trajectories ("base-case", "high-performance", and "low-performance") using Global Burden of Disease study forecasts and estimated disease-specific mortality risk changes relative to the base-case. We assigned monetary values to changes in mortality risk using value of a statistical life (VSL) methods and conducted multiple sensitivity analyses.

RESULTS

In terms of NCDs, the absolute monetary value associated with changing mortality risk was highest for cardiovascular diseases in older age groups. For example, being on the low-performance trajectory relative to the base-case in 2030 was valued at $9100 (95% uncertainty range $6800; $11,400), $28,300 ($24,200; $32,400), and $30,300 ($27,200; $33,300) for females aged 70-74 years in LICs, LMICs, and UMICs, respectively. Changing the mortality rate from the base-case to the high-performance trajectory was associated with high monetary value for CDs as well, especially among younger age groups. Estimates were sensitive to assumptions made in calculating VSL.

CONCLUSIONS

Our framework provides a priority setting paradigm to best allocate investments toward the health sector and enables intersectoral comparisons of returns on investments from health interventions.

Hypertension is associated with increased mortality in patients with tuberculosis in Guinea-Bissau

OBJECTIVES

Tuberculosis (TB) is associated with a number of non-communicable co-morbidities, which can complicate treatment and impair outcome. The aim of this study was to assess the impact of hypertension on disease severity, treatment outcome and survival in a cohort of patients with TB.

METHODS

A retrospective cohort study was conducted in Guinea-Bissau. Patients newly diagnosed with TB between November 2003 and June 2016 were included. Hypertension was defined as blood pressure ≥140/90 mmHg. Disease severity was assessed using the Bandim TBscore. Survival was assessed at the end of treatment and 2 years after treatment initiation.

RESULTS

In total, 1544 patients were included in this study. Hypertension was present in 12.8% of patients at inclusion. Patients with hypertension had slightly less severe TB, but were less likely to have a successful treatment outcome and had 64% higher mortality at 2-year follow-up (adjusted hazard ratio 1.64, 95% confidence interval 1.15-2.34). Mortality rates were highest in hypertensive female patients and patients aged ≥ 45 years.

CONCLUSION

Patients with high blood pressure at the start of TB treatment had a higher mortality rate at 2-year follow-up. Mortality rates were highest in hypertensive females and patients aged ≥ 45 years.

[Case fatality rate of COVID-19: absence of epidemiological pattern]

Objective

Analyze a set of indicators to understand the variability of the evolution and impact of the COVID-19 epidemic in a set of selected countries.

Method

Ecological study of a group of countries with more than 200 reported cases. Demographic variables, health expenditure variables, and variables about characteristics of health services were included as explanatory variables. and incidence, mortality and fatality rates have been analyzed as response variables. In addition, a relative fatality index has been created. Data are from international organizations. Spearman's correlation coefficient was used to estimate the magnitude of the associations.

Results

Number of tests and of medical professionals are associated with a higher incidence rate. Mortality and case fatality rate are not associated with demographic, health expenditure, or health services variables.

Conclusion

Differences suggest a general underestimation of the magnitude of the epidemic. Improvement of case identification and effectiveness of epidemiological surveillance systems is necessary.

An analysis of COVID-19 vaccine sentiments and opinions on Twitter

OBJECTIVE

We identified public sentiments and opinions toward the COVID-19 vaccines based on the content of Twitter.

MATERIALS AND METHODS

We retrieved 4,552,652 publicly available tweets posted within the timeline of January 2020 to January 2021. Following extraction, we identified vaccine sentiments and opinions of tweets and compared their progression by time, geographical distribution, main themes, keywords, posts engagement metrics and accounts characteristics.

RESULTS

We found a slight difference in the prevalence of positive and negative sentiments, with positive being the dominant polarity and having higher engagements. The amount of discussion on vaccine rejection and hesitancy was more than interest in vaccines during the course of the study, but the pattern was different in various countries. We found the accounts producing vaccine opposition content were partly Twitter bots or political activists while well-known individuals and organizations generated the content in favour of vaccination.

CONCLUSION

Understanding sentiments and opinions toward vaccination using Twitter may help public health agencies to increase positive messaging and eliminate opposing messages in order to enhance vaccine uptake.

Lessons for and from the COVID-19 pandemic response - An appraisal of guidance for the public health management of Invasive Meningococcal Disease

BACKGROUND

COVID-19 has focussed public attention on the management of communicable disease like never before. Surveillance, contact tracing, and case management are recognised as key components of outbreak prevention. Development of guidance for COVID-19 has drawn from existing management of other communicable diseases, including Invasive Meningococcal Disease (IMD). IMD is a rare but severe outcome of Neisseria meningitidis infection that can be prevented through vaccination. Cases still occur sporadically, requiring ongoing surveillance and consistent management. To this end, national and international public health agencies have developed and published guidance for identification and management of IMD cases.

AIM

To assess national and international guidelines for the public health management of IMD, with a focus on the recommendations for identification and management of "close contacts" to IMD cases.

METHODS

Guidelines from six national and international public health agencies were assessed using a modified version of the Appraisal of Guidelines, Research and Evaluation (AGREE II) Instrument in four key domains: stakeholder involvement, developmental rigour, clarity, and applicability. A direct comparison of terminology and recommendations for identification and management of close contacts to IMD cases was also conducted.

RESULTS

Guidelines from Europe and the United Kingdom rated most highly using the AGREE II Instrument, both presenting a clear, critical assessment of the strength of the available evidence, and the risks, costs, and benefits behind recommendations for management of close contacts. Direct comparison of guidelines identified inconsistencies in the language defining close contacts to IMD cases.

CONCLUSION

Discrepancies between guidelines could be due to limited evidence concerning mechanisms behind disease transmission, along with the lack of a consistent process for development and review of guideline recommendations. COVID-19 management has demonstrated that international collaboration for development of public health guidance is possible, a practice that should be extended to management of other communicable diseases.

[Epidemiological characteristics of infectious diseases of group A, B and C among Chinese students' population]

OBJECTIVE

To analyze the secular trend, ranking change, age- and regional- characteristics of leading infectious diseases among Chinese students population aged 6 to 22 years from 2008 to 2017.

METHODS

Data were drawn from the national surveillance from 2008 to 2017, and the participants were students aged from 6 to 22 years who were diagnosed with notifiable infectious diseases. A total of 40 infectious diseases were classified into three groups based on national notifiable infectious diseases classification of A, B and C. The morbidity and mortality rates from infectious diseases were calculated using the numbers of students published by the ministry of education as the denominator. The age- and province-specific infectious diseases with the highest incidence were selected as the leading infectious diseases for analysis.

RESULTS

From 2008 to 2017, the incidence rate, the number of cases and the number of deaths of infectious diseases among the boys aged 6-22 years in China were higher than that of the girls, and the overall trend was downward during the study period. The incidence rates in the boys and girls decreased from 2008 to 2015 with decrease of 43.4% and 40.1%, respectively. However, by 2017, the increase rate rebounded with the increases of 47.1% and 53.8%. The rebound trend was mainly caused by the increase of group C of infectious diseases. During the past decade, the top leading three diseases of groups A and B of infectious diseases were viral hepatitis, tuberculosis and dysentery in 2018, respectively, which changed to tuberculosis, scarlet fever and viral hepatitis in 2017. The top leading three infectious diseases in terms of mortality were rabies, tuberculosis, and human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS) in 2008, which were transformed into HIV/AIDS, rabies, and tuberculosis in 2017. There was no significantly obvious change in the incidence and mortality order of group C of infectious diseases during the decade. In the analysis of age groups and regions, the leading infectious diseases in groups A and B transferred from viral hepatitis to scarlet fever and tuberculosis, while in group C, mumps and infectious diarrhoea almost always dominated the leading infectious diseases. But in recent years, influenza and hand-foot-and-mouth disease increased significantly in the eastern region.

CONCLUSION

During the past decade, China has got remarkable achievements in the prevention and control of children infectious disease. However, the change patterns and characteristics of notifiable infectious diseases among children and adolescents show the urgent need for prevention and control of respiratory tract infectious diseases, HIV/AIDS and other sexually transmitted diseases as well as new emerging infectious diseases in China in the future. This study provides important basis for policy making of Chinese national school-based infectious disease prevention and control mechanism.

[Epidemiological characteristics of infectious diseases of group A, B and C among Chinese students' population]

OBJECTIVE

To analyze the secular trend, ranking change, age- and regional- characteristics of leading infectious diseases among Chinese students population aged 6 to 22 years from 2008 to 2017.

METHODS

Data were drawn from the national surveillance from 2008 to 2017, and the participants were students aged from 6 to 22 years who were diagnosed with notifiable infectious diseases. A total of 40 infectious diseases were classified into three groups based on national notifiable infectious diseases classification of A, B and C. The morbidity and mortality rates from infectious diseases were calculated using the numbers of students published by the ministry of education as the denominator. The age- and province-specific infectious diseases with the highest incidence were selected as the leading infectious diseases for analysis.

RESULTS

From 2008 to 2017, the incidence rate, the number of cases and the number of deaths of infectious diseases among the boys aged 6-22 years in China were higher than that of the girls, and the overall trend was downward during the study period. The incidence rates in the boys and girls decreased from 2008 to 2015 with decrease of 43.4% and 40.1%, respectively. However, by 2017, the increase rate rebounded with the increases of 47.1% and 53.8%. The rebound trend was mainly caused by the increase of group C of infectious diseases. During the past decade, the top leading three diseases of groups A and B of infectious diseases were viral hepatitis, tuberculosis and dysentery in 2018, respectively, which changed to tuberculosis, scarlet fever and viral hepatitis in 2017. The top leading three infectious diseases in terms of mortality were rabies, tuberculosis, and human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS) in 2008, which were transformed into HIV/AIDS, rabies, and tuberculosis in 2017. There was no significantly obvious change in the incidence and mortality order of group C of infectious diseases during the decade. In the analysis of age groups and regions, the leading infectious diseases in groups A and B transferred from viral hepatitis to scarlet fever and tuberculosis, while in group C, mumps and infectious diarrhoea almost always dominated the leading infectious diseases. But in recent years, influenza and hand-foot-and-mouth disease increased significantly in the eastern region.

CONCLUSION

During the past decade, China has got remarkable achievements in the prevention and control of children infectious disease. However, the change patterns and characteristics of notifiable infectious diseases among children and adolescents show the urgent need for prevention and control of respiratory tract infectious diseases, HIV/AIDS and other sexually transmitted diseases as well as new emerging infectious diseases in China in the future. This study provides important basis for policy making of Chinese national school-based infectious disease prevention and control mechanism.

Seasonal and socio-demographic patterns of self-reporting major disease groups in north-west Burkina Faso: an analysis of the Nouna Health and Demographic Surveillance System (HDSS) data

Background

Sub-Saharan Africa (SSA) is facing a rapid growth of non-communicable diseases (NCDs), while communicable diseases still prevail. For rural SSA, evidence for this development is scarce. We aimed at quantifying self-reported major disease groups according to season, and determining the associations with socio-economic factors in rural Burkina Faso.

Methods

This study used data of 4192 adults (age range: 18–101 years; male: 49.0%) from the Nouna Health and Demographic Surveillance System (HDSS) in north-west Burkina Faso, rainy season of 2010 and dry season of 2011. We assessed the proportions and their 95% confidence intervals (CIs) of self-reported major disease groups as defined by the World Health Organization. For their associations with socio-economic factors, odds ratios (OR), 95% CIs and p-values were calculated by logistic regression.

Results

The surveys were completed by 3949 adults in 2010 (mean age: 37.5 ± 14.9 years, male: 48.8%) and by 4039 adults in 2011 (mean age: 37.3 ± 16.2 years, male: 49.1%). The proportions of self-reported communicable diseases were 20.7% (95% CI: 19.4–21.9%) in the rainy season and 11.0% (10.0–11.9%; McNemar’s p < 0.0001) in the dry season. Self-reported NCDs amounted to 5.3% (4.6–6.0%) and 4.5% (3.8–5.1%; p = 0.08), respectively. In each year, less than 1% reported injuries (p = 0.57). Few individuals reported an overlap of communicable diseases and NCDs: 1.4% in 2010 and 0.6% in 2011. In the multiple-adjusted models, formal education (vs. lack of education) showed the strongest association with self-reporting of communicable diseases in both seasons. For NCD-reporting, non-manual occupation (vs. manual) was positively associated, only in the rainy season.

Conclusions

Self-reporting of communicable diseases is subject to seasonal variation in this population in north-west Burkina Faso. The exact reasons for the low overall self-reporting of NCDs and injuries, apart from a low socio-demographic position, require further investigation.

Increasing incidence of invasive group A streptococcal disease in Western Australia, particularly among Indigenous people

OBJECTIVE

To quantify the burden of invasive group A Streptococcus (GAS) disease in Western Australia during 2000-2018.

DESIGN, SETTING

Population-based data linkage study: Hospital Morbidity Data Collection (HMDC; all WA public and private hospital records), PathWest pathology data (government-owned pathology services provider), and death registrations.

PARTICIPANTS

People with invasive GAS disease, defined by an isolate from a normally sterile site (PathWest) or a hospital-based principal ICD-10-AM diagnosis code (HMDC).

MAIN OUTCOME MEASURES

Incidence of invasive GAS disease; median length of hospital stay; all-cause mortality.

RESULTS

We identified 2237 cases of GAS disease during 2000-2018; 1283 were in male patients (57%). 1950 cases had been confirmed by GAS isolates from normally sterile tissues (87%; including 1089 from blood [56% of cases] and 750 from tissue [38%]). The age-standardised incidence increased from 2.0 (95% CI, 1.4-2.7) cases per 100 000 population in 2000 to 9.1 (95% CI, 7.9-10.2) cases per 100 000 in 2017 (by year, adjusted for age group and sex: incidence rate ratio [IRR], 1.09; 95% CI, 1.08-1.10). Incidence was consistently higher among Indigenous than non-Indigenous Australians (year-adjusted IRR, 13.1; 95% CI, 11.3-15.1). All-cause 30-day mortality was 5% (116 deaths), and 90-day mortality 7% (156 deaths); 30-day mortality, adjusted for age group and sex, was not statistically significantly different for cases involving Indigenous or non-Indigenous patients (adjusted odds ratio, 0.8; 95% CI, 0.6-1.1).

CONCLUSIONS

The incidence of invasive GAS disease in WA increased between 2000 and 2018, particularly among Indigenous Australians. Mandatory notification of invasive GAS disease would therefore be appropriate. The social determinants of differences in incidence should be addressed, and other relevant host, pathogen, and health system factors investigated.

Why and how to open intensive care units to family visits during the pandemic

Since the lockdown because of the pandemic, family members have been prohibited from visiting their loved ones in hospital. While it is clearly complicated to implement protocols for the admission of family members, we believe precise strategic goals are essential and operational guidance is needed on how to achieve them. Even during the pandemic, we consider it a priority to share strategies adapted to every local setting to allow family members to enter intensive care units and all the other hospital wards.

[Basic hygiene measures in the delivery room-also during a pandemic]

BACKGROUND

The German Infection Protection Act calls for effective measures to be implemented in clinics to avoid nosocomial infections. The corona pandemic once again demonstrates the importance of adequate hygiene measures in avoiding infections.

OBJECTIVES

Compilation of common basic hygiene measures for clinical obstetrics.

METHODS

Discussion of relevant German guidelines relating to the work in the delivery room. Development of recommendations for hygienically correct childbirth care.

RESULTS

Recommendations for surface disinfection refer to predefined risk-categories in the delivery unit. In cooperation with hospital hygiene, the frequency of cleaning and disinfection must be specified in the facility's internal hygiene plans. To avoid a selection of disinfectant-tolerant germs, it is essential to observe the spectrum of activity and exposure time of each disinfectant. Hand disinfection is the single most effective measure to prevent nosocomial infections. The challenge here is the consistent implementation of the generally known indications for hand disinfection in everyday life. For the hygienically correct management of water birth and maintenance of the bathtub, standards should be developed in every delivery room, the effectiveness of which must be regularly monitored. In a pandemic, there are additional hygiene rules, tailored to the particular pathogen.

CONCLUSIONS

Although there is no lack of knowledge in the form of guidelines and recommendations, the implementation of basic hygiene measures in everyday life in the delivery room requires perseverance and commitment.

[Hygiene measures in antenatal care]

BACKGROUND

The prevention of infections in the obstetric care of pregnant women is paramount, on the one hand with regard to pathogens of congenital infections and on the other hand due to the association of maternal infections with premature delivery.

OBJECTIVES

Which measures are recommended for effective prevention of bacterial and viral diseases relevant to obstetrics?

MATERIALS AND METHODS

Literature search on hygiene measures in terms of preventing transmission of infection.

RESULTS

The physiological vaginal flora of the pregnant woman is a fundamental factor in natural defence against infection. Its disruption-also through antimicrobial therapies-has a proven influence on the course of pregnancy (premature rupture of membranes, premature birth). It also leads to a disturbed intestinal microbiome in newborns, which has long-term consequences for their neurological, respiratory, metabolic and immunological development and increases mortality. The focus should therefore be on prevention-rather than therapy-of infectious diseases during pregnancy. This requires a detailed anamnesis, monitoring and updating of the vaccination status and, if necessary, clarification of the infection status by means of targeted serological tests. Then the gynecologist can give individual advice on preventive measures. This article provides specific recommendations on selected obstetrically relevant infections.

CONCLUSIONS

Focusing on hygiene measures to prevent infection in obstetrics can improve the health of both mother and child.

Clinical diagnosis of severe COVID-19: A derivation and validation of a prediction rule

BACKGROUND

The widespread coronavirus disease 2019 (COVID-19) has led to high morbidity and mortality. Therefore, early risk identification of critically ill patients remains crucial.

AIM

To develop predictive rules at the time of admission to identify COVID-19 patients who might require intensive care unit (ICU) care.

METHODS

This retrospective study included a total of 361 patients with confirmed COVID-19 by reverse transcription-polymerase chain reaction between January 19, 2020, and March 14, 2020 in Shenzhen Third People’s Hospital. Multivariate logistic regression was applied to develop the predictive model. The performance of the predictive model was externally validated and evaluated based on a dataset involving 126 patients from the Wuhan Asia General Hospital between December 2019 and March 2020, by area under the receiver operating curve (AUROC), goodness-of-fit and the performance matrix including the sensitivity, specificity, and precision. A nomogram was also used to visualize the model.

RESULTS

Among the patients in the derivation and validation datasets, 38 and 9 participants (10.5% and 2.54%, respectively) developed severe COVID-19, respectively. In univariate analysis, 21 parameters such as age, sex (male), smoker, body mass index (BMI), time from onset to admission (> 5 d), asthenia, dry cough, expectoration, shortness of breath, asthenia, and Rox index < 18 (pulse oxygen saturation, SpO₂)/(FiO₂ × respiratory rate, RR) showed positive correlations with severe COVID-19. In multivariate logistic regression analysis, only six parameters including BMI [odds ratio (OR) 3.939; 95% confidence interval (CI): 1.409-11.015; P = 0.009], time from onset to admission (≥ 5 d) (OR 7.107; 95%CI: 1.449-34.849; P = 0.016), fever (OR 6.794; 95%CI: 1.401-32.951; P = 0.017), Charlson index (OR 2.917; 95%CI: 1.279-6.654; P = 0.011), PaO₂/FiO₂ ratio (OR 17.570; 95%CI: 1.117-276.383; P = 0.041), and neutrophil/lymphocyte ratio (OR 3.574; 95%CI: 1.048-12.191; P = 0.042) were found to be independent predictors of COVID-19. These factors were found to be significant risk factors for severe patients confirmed with COVID-19. The AUROC was 0.941 (95%CI: 0.901-0.981) and 0.936 (95%CI: 0.886-0.987) in both datasets. The calibration properties were good.

CONCLUSION

The proposed predictive model had great potential in severity prediction of COVID-19 in the ICU. It assisted the ICU clinicians in making timely decisions for the target population.

Seroprevalence of antibodies to SARS-CoV-2 and predictors of seropositivity among employees of a teaching hospital in New Delhi, India

Objectives

Healthcare workers (HCWs) are at a high risk of contracting severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) due to the increased likelihood of clinical exposure during patient management. The study objective was to determine the seroprevalence of antibodies to SARS-CoV-2 and its predictors among hospital employees.

Methods

The cross-sectional study was conducted at a teaching hospital from August 2020 to September 2020 among 1,401 employees, including 1,217 HCWs, in New Delhi, India. The serum samples were examined for immunoglobulin G (IgG) antibodies to SARS-CoV-2 using the COVID Kavach-Anti-SARS-CoV-2 IgG Antibody Detection enzyme-linked immunosorbent assay kit. Data were collected electronically using the EpiCollect mobile platform. A p < 0.05 was considered to indicate statistical significance.

Results

A total of 169 participants (12.1%) had detectable IgG antibodies to SARS-CoV-2. The highest seropositivity rate was observed in the administrative staff (20.1%), while it was lowest among medical doctors (5.5%, p < 0.001). Male sex and ever having lived in a containment zone were independently associated with past infection with SARS-CoV-2.

Conclusion

The seroprevalence of SARS-CoV-2 infection in health workers may be lower than in the general population in New Delhi. However, nonpharmaceutical interventions were not associated with a reduction in the risk of acquisition of SARS-CoV-2.

Burden of infections on older patients presenting to general practice: a registry-based study

BACKGROUND

Estimates on the incidence rates of infections are needed to assess the burden of disease in the community.

OBJECTIVE

To assess incidence rates of potentially serious infections in patients aged 65 years and over presenting to Flemish general practice from 2000 to 2015, and to describe patient characteristics.

METHODS

We performed a retrospective study, based on data provided by the Intego morbidity registry of the KU Leuven, which includes the electronic medical records of 111 general practitioners. Incidence rates were calculated taking person-time at risk into account, and longitudinal trends from 2000 to 2015 were analysed using autoregressive time-series analyses.

RESULTS

On average, a person aged 65 years or older has an 8.0% risk of getting a potentially serious infection each year. Acute cystitis was the most often occurring potentially serious infection [39.8/1000 person-years; 95% confidence interval (CI): 39.4-40.2], followed by influenza like illness (ILI, 24.3/1000 person-years; 95% CI: 24.0-24.6) and pneumonia (9.7/1000 person-years; 95% CI: 9.5-9.9). The incidence rates of pneumonia were higher in older age groups and in men, whereas they were markedly lower for ILI at older ages, in both genders. From 2000 to 2015, overall incidence rates decreased significantly for ILI, while they increased in women for pneumonia, acute cystitis and pyelonephritis. Common chronic comorbidities were non-insulin dependent diabetes, chronic obstructive pulmonary disease, asthma, heart failure and chronic renal insufficiency.

CONCLUSIONS

Potentially serious infections are quite common in an older patient population presenting to primary care. They are accompanied by several chronic comorbidities, which may differ by infection type.

Effects of COVID-19 on mortality: A 5-year population-based study in Oman

BACKGROUND

Mortality surveillance provides a crucial method for monitoring disease activity. Coronavirus disease 2019 (COVID-19) can cause excess mortality both directly and indirectly by increasing deaths from other diseases. The aim of this study was to investigate the effects of COVID-19 on mortality in Oman.

METHODS

A cross-sectional retrospective analysis of mortality data from 1 January 2015 to 16 August 2020 was undertaken. Baseline mortality estimated using the Farrington flexible model and excess mortality were calculated for the pandemic period (16 March-16 August 2020) according to cause of death, place of death and age group.

RESULTS

During the pandemic period, there was a 15% [95% confidence interval (CI) 14-17] increase in all-cause mortality from baseline. When classifying by cause, there was a 9% (95% CI 5-12) increase in deaths due to respiratory diseases, a 2% (95% CI 1-4) increase in deaths due to infectious diseases and a 9% (95% CI 8-11) increase in unclassified deaths. In terms of place of death, 12% (95% CI 11-14) of excess mortality occurred in hospitals and 7% (95% CI 5-8) occurred in homes during the pandemic period. Patients aged >60 years recorded a 15% (95% CI 13-16) increase in all-cause mortality during this period.

CONCLUSION

The COVID-19 pandemic has resulted in a 15% increase in all-cause mortality in Oman, mainly as a result of deaths from COVID-19. However, unclassified deaths, deaths due to respiratory diseases and deaths due to infectious diseases have also increased, enforcing the need for a holistic approach and appropriate coordination of health services during such health crises.

Antibiotic stewardship in direct-to-consumer telemedicine consultations leads to high adherence to best practice guidelines and a low prescription rate

OBJECTIVE

To analyze the antibiotic prescription rate in low-risk patients evaluated at a telemedicine program that adopts antibiotic stewardship protocols.

METHODS

Adult patients who accessed a single direct-to-consumer telemedicine center (Jan/2019-Feb/2020) were retrospectively enrolled. Diseases amenable to antimicrobial treatment were classified under five diagnostic groups: upper respiratory tract infection (URI), acute pharyngotonsillitis (PT), acute sinusitis (AS), urinary tract infection (UTI), and acute diarrhea (AD). Physicians were trained on and advised to strictly follow the current guideline recommendations supported by institutional antibiotic stewardship protocols, readily available online during consultations. We analyzed the antibiotic prescription rate among patients, referral rate, and antibiotic class through descriptive statistics.

RESULTS

A total of 2328 patients were included in the study. A total of 2085 (89·6%) patients were discharged with usual recommendations, medication (if needed), and instructions about red flags, while 243 (10·4%) were referred to a face-to-face consultation. Among the discharged patients, the antibiotic prescription rates by the diagnostic group were URI - 2·5%, PT - 35·0%, AS - 51·8%, UTI - 91.6%, and AD - 1·6%. In most cases, prescribed antibiotics were in line with institutional stewardship protocols.

CONCLUSIONS

Low prescription rate of antibiotics can be achieved using antibiotic stewardship protocols at direct-to-consumer telemedicine consultations, showing high adherence to international guidelines. These results reinforce telemedicine as a cost-effective and safe strategy for the initial assessment of acute non-urgent symptoms.

Molecular detection of cosaviruses in a patient with acute flaccid paralysis and in sewage samples in Germany

Cosaviruses (CoSV) were first identified in stool samples collected from non-polio acute flaccid paralysis (AFP) cases and their healthy contacts in Pakistan in 2003. The clinical importance of CoSV remains unclear as data on epidemiology are scarce and no routine diagnostic testing is done. In this study, we characterized human CoSV (HCoSV) in a child with non-polio AFP and in sewage samples collected in Berlin, Germany. Using unbiased high-throughput sequencing and specific PCR, we characterized a HCoSV-D in stool samples of a three-year-old child hospitalized in Germany with non-polio AFP and travel history to Pakistan. The shedding pattern and absence of other relevant pathogens suggests that HCoSV-D may have been involved in the genesis of AFP. The HCoSV-RNA concentration was high, with 2.57 × 10⁶ copies per mL fecal/suspension, decreasing in follow-up samples. To investigate the possibility of local circulation of HCoSV, we screened Berlin sewage samples collected between 2013 and 2018. Molecular testing of sewage samples has shown the presence of CoSV in several parts of the world, but until now not in Germany. Of our sewage samples, 54.3 % were positive for CoSV, with up to three viral species identified in samples. Phylogenetically, the German sequences clustered intermixed with sequences obtained globally. Together, these findings emphasize the need for further clinical, epidemiological, environmental, pathogenicity and phylogenetic studies of HCoSV.