Suicide mortality in Spain in 2020: The impact of the COVID-19 pandemic

INTRODUCTION

Suicide constitutes a major concern with evident contribution to global mortality worldwide. Evidence on suicide trends is mixed in the COVID-19 pandemic era. Spain may be an at-risk country for increased suicide risk in the time of COVID-19 pandemic due to prolonged restrictions and lockdown, elevated COVID-19 wave recurrence and related mental health impact. This brief report aims to provide some insight into the suicide mortality trends in the first COVID-19 pandemic year in Spain, using national data.

MATERIAL AND METHODS

Data from the National Death Index were used. Annual mortality rate was calculated at a province level under random-effects models for the 2019 and 2020 years. Poisson timeseries regression was used to study the relationship between monthly suicide mortality and COVID-19 pandemic outbreak and lockdown, and second COVID-19 wave peak covariates.

RESULTS

3671 people died by suicide in 2019 in Spain and 3941 people died by suicide in 2020. The random-effects mortality rate in 2019 was 8.3 (CI95=7.6, 9.0) per 100,000 inhabitants, and mortality rate in 2020 was 8.9 (CI95=8.3, 9.6). No significant differences between mortality rates were found (p=.18). The Poisson regression showed a significant relationship between the COVID-19 outbreak and suicide mortality trend, with OR=1.07 (CI95=1.02, 1.12).

CONCLUSIONS

Although annual mortality rates were not significantly different, an increased suicide risk was found from May, 2020 onwards. Our results claim for action to tackle suicide in the post-pandemic era taking into account the discouraging upcoming scenario.

Syphilis in Poland in 2020

PURPOSE

The aim of the study was to assess the epidemiological situation of syphilis cases in Poland in 2020 in comparison to previous years.

MATERIAL AND METHODS

Analysis of the epidemiological situation was based on case-based data from reports of newly detected syphilis cases received from doctors and laboratories in 2020. Additionally aggregated data from MZ-56 reports on infectious diseases, infections and poisoning from 2014 to 2018 sent from Sanitary Inspections to NIPH NIH -NRI was used. Also, data about treatment patients in dermatology/venerology clinics in 2020 reported on MZ-14 forms and published in statistics bulletin on Ministry of Health on e-health system website (actually: https://e-zdrowie.gov.pl; https://cez.gov.pl) and NIPH NIH - NRI website were used.

RESULTS

In 2020 in Poland 686 newly diagnosed syphilis cases were reported (diagnosis rate was 1.79 per 100,000), including 18 cases among non-Polish citizens. The frequency of newly detected syphilis cases decreased by 54.6% compared to the previous year and similar decreased 52.5% compared to the median in 2014-2018 years. The syphilis cases were most often detected in the age group between 20 and 39 years (68.9%) and among men (86.2%). On the other hand, places where syphilis cases are treated, reported 1,529 cases - less by 4% than in 2019 year, including 979 cases on early stage of syphilis.

CONCLUSION

In 2020, the number of reported a newly detected syphilis cases decreased more than by half compared to the previous year, what is probably related to the COVID-19 pandemic and action taken to reduce it. A huge difference in some regions in Poland for diagnosis rates and not visible a significant decrease in the number of treated person, indicate on problem with reporting a newly diagnosed infections, as a main explanation about increasing observed in 2020.

Characterizing the volume of surgery and post-operative complications during the COVID-19 pandemic

PURPOSE

The COVID-19 pandemic led to unprecedented changes in volume and quality of surgery. Utilizing the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database, the current study assesses the impact of COVID-19 on surgical volume during each quarter of 2020 in comparison to 2019. Quality of surgical care during 2020 was also investigated by assessing postoperative complications, readmissions, and reoperations during 2020 in comparison to the previous 5 years.

MATERIALS AND METHODS

The NSQIP database was queried from 2015 to 2020. Descriptive statistics and a chi-squared test were utilized to compare demographic variables. A seasonal autoregressive integrated moving average time-series model was fit to assess the trend and seasonality of complications from 2015 to 2019 and was used to forecast the proportion of complications in the year 2020 and compared the forecast with the actual proportions graphically.

RESULTS

There were fewer patients operated on in 2020 compared to 2019, with the most dramatic drop in Q2 with a nearly 27% decrease. Patients with ASA class 3 or greater were operated on at a greater proportion in every quarter of 2020. Q2 of 2020 represented the highest proportion of any operative complications since 2015 at ~13%. Q4 of 2020 demonstrated a return to 2020 Q1 complication proportions.

CONCLUSION

Surgical volume was heavily affected in 2020, particularly in Q2. Patients during Q2 of 2020 were generally of a higher ASA class and had increased operative complications. Operative volume and overall surgical complication rate normalized over the next two quarters.

The COVID-19 pandemic and associated rise in pediatric firearm injuries: A multi-institutional study

BACKGROUND

Firearm sales in the United States (U.S.) markedly increased during the COVID-19 pandemic. Our objective was to determine if firearm injuries in children were associated with stay-at-home orders (SHO) during the COVID-19 pandemic. We hypothesized there would be an increase in pediatric firearm injuries during SHO.

METHODS

This was a multi institutional, retrospective study of institutional trauma registries. Patients <18 years with traumatic injuries meeting National Trauma Data Bank (NTDB) criteria were included. A "COVID" cohort, defined as time from initiation of state SHO through September 30, 2020 was compared to "Historical" controls from an averaged period of corresponding dates in 2016-2019. An interrupted time series analysis (ITSA) was utilized to evaluate the association of the U.S. declaration of a national state of emergency with pediatric firearm injuries.

RESULTS

Nine Level I pediatric trauma centers were included, contributing 48,111 pediatric trauma patients, of which 1,090 patients (2.3%) suffered firearm injuries. There was a significant increase in the proportion of firearm injuries in the COVID cohort (COVID 3.04% vs. Historical 1.83%; p < 0.001). There was an increased cumulative burden of firearm injuries in 2020 compared to a historical average. ITSA showed an 87% increase in the observed rate of firearm injuries above expected after the declaration of a nationwide emergency (p < 0.001).

CONCLUSION

The proportion of firearm injuries affecting children increased during the COVID-19 pandemic. The pandemic was associated with an increase in pediatric firearm injuries above expected rates based on historical patterns.

Tourette syndrome research highlights from 2020

We present here research from 2020 relevant to Tourette syndrome (TS). The authors briefly summarize a few reports they consider most important or interesting.

European Federation of Periodontology Survey of Postgraduate and Specialist Training in Europe in 2020

AIMS

The survey's aim was to establish which universities and other educational organisations deliver postgraduate and specialist training in Periodontology in the 31 countries who are members of the European Federation of Periodontology (EFP) and to obtain details of how these programmes are organised, funded, regulated and evaluated.

METHODS

A questionnaire and covering letter were emailed to all national periodontal societies. The questions were on the name of country, official recognition, training programmes, entry to specialist training, specialist training assessment and recognition after completion of training.

RESULTS

Twenty-nine (93%) of national periodontal societies responded. Key findings included the following: Periodontology was reported as being recognised at a national level in 17 countries, there was a three-year full-time programme in 12 countries, no fees were charged for specialist training in 10 countries, in 14 countries trainees received annual salaries, end of training (summative) assessments varied from country to country, 12 countries reported that they had a requirement for specialists in Periodontology to complete continuing education to maintain registration as specialists.

CONCLUSIONS

This survey has established which universities and other educational organisations deliver postgraduate and specialist training in Periodontology and how these programmes are organised, funded, regulated and evaluated. To provide uniformly high-quality periodontal care for patients in all European countries, further harmonisation of postgraduate and specialty training in Periodontology would be advantageous.

Circulating vaccine derived polio virus type 1 outbreak, Saadah governorate, Yemen, 2020

Background

Yemen has faced one of the worst humanitarian crises in the world since the start of the war in 2015. In 2020; 30 Vaccine Derived Polio Virus type 1 (VDPV1) isolates were detected in Saadah governorate. The aims are to characterize the outbreak and address the gaps predisposing the emergence and circulation of VDPV1 in Saadah governorate, Yemen.

Method

A retrospective descriptive study of confirmed cases of VDPV1 between January and December 2020 was performed. Surveillance staff collected data from patient cases, contacts, as well as stool specimens that shipped to WHO accredited polio labs. Data of population immunity was also reviewed. The difference in days between the date of sample collection, shipment, and receiving lab result was used to calculate the average of delayed days for lab confirmation.

Results

From January to December 2020, a total of 114 cases of acute flaccid paralysis (AFP) were reported from 87% (13/15) districts, and cVDPV1 was confirmed among 26% (30) AFP cases. 75% (21) were < 5 years, 73% (20) had zero doses of Oral Polio Vaccine (OPV). The first confirmed case (3%) was from Saadah city, with paralysis onset at the end of January 2020 followed by 5 cases (17%) in March from another four districts, 8 cases (27%) in April, and 13 (43%) up to December 2020 were from the same five districts in addition to 3 (10%) form three new districts. The lab confirmation was received after an average of 126 days (71–196) from sample collection. The isolates differ from the Sabin 1 type by 17- 30 VP1 nucleotides (nt) and were linked to VDPV1 with 13 (nt) divergence that isolated in July 2020 from stool specimens collected before one year from contacts of an inadequate AFP case reported from Sahar district.

Conclusion

The new emerging VDPV1 was retrospectively confirmed after one year of sample collection from Sahar district. Delayed lab confirmation, as well as the response and low immunization profile of children against polio, were the main predisposing factors for cVDPV1 outbreak. This outbreak highlights the need to maintain regular biweekly shipments to referral polio labs in the short-term, and the exploration of other options in the longer-term to enable the Yemen National Lab to fully process national samples itself.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12879-022-07397-0.

Detection of African Swine Fever at an Abattoir in South Korea, 2020

In October 2020, a suspect case of African swine fever (ASF) was detected at an abattoir located in the north-central border region of South Korea. The farm of origin was traced and confirmed positive for ASF. This recurrence was following a period of absence of outbreaks in domestic pigs after the first incursion in 2019, during which a total of 14 domestic pig farms were confirmed between September and October 2019. In 2020, a total of two farms were confirmed, and the molecular characterization of key regions of the genome showed that the two isolates from 2020 were identical with the previous isolates from South Korea in 2019. The continued spread and circulation of ASF in the wild boar population represents an increased risk of spill-over outbreaks in domestic pigs, and, therefore, additional control measures should be implemented for farms in these regions, including a heightened level of surveillance. This was the case for the index farm, which was required to send pigs only to the designated abattoir at which the suspect case was quickly detected. The improvement of biosecurity in pig farms, particularly at the wild boar-domestic pig interface, will be key to the successful control of ASF in the region.

The effect of COVID-19 on the distribution of PM10 pollution classes of vehicles: Comparison between 2020 and 2018

A recent study by Pini et al. (2021), focusing on year 2018, demonstrated that different strategies should be considered in different Italian cities to mitigate the effects of PM10 pollution produced by circulating cars and commercial vehicles. The current study focuses on year 2020, considering the same ten Italian cities. This new study relies on the estimation of specific indices used to assess the size of the different circulating vehicle fleets (vehicle yearly mileage, diesel-fuel car and LCV fleet dimension, etc.) and their impact on PM10 pollution (Strength of Pollution). Results for 2020, severely affected by vehicular restrictions associated with COVID-19, indicate the need to adopt PM10 pollution reduction strategies for the various cities partially different from those identified earlier. For example, Euro 4 cars is the fleet having the highest impact on PM10 pollution in Rome (emitting 3,3 times more than Euro 6 vehicles), while in Milan the most polluting vehicles are Euro 0 cars (emitting 2 times more than Euro 6 vehicles). In Naples, Euro 0 cars emit 12,5 times more than Euro 6 vehicles. A careful look into the results also reveals that, for all considered cities, the three top fleets in terms of PM10 pollution always include Euro 4 or a higher Euro category fleet and a lower Euro category fleet (Euro 0 or Euro 3). These values were validated based on the use of pollution data from ground monitoring stations, which also allowed estimating the atmospheric mixing layer height. Results from the paper suggest that different incentivization policies have to be considered for the different considered cities. For example, in Naples the allocation of incentives should be ~60% towards new vehicles and ~40% towards recent used (i.e. second-hand) non-diesel vehicles, while in Florence it should be ~90% towards ECVs and ~10% towards recent used non-diesel vehicles.

Near-real-time global gridded daily CO2 emissions

Precise and high-resolution carbon dioxide (CO₂) emission data is of great importance in achieving carbon neutrality around the world. Here we present for the first time the near-real-time Global Gridded Daily CO₂ Emissions Dataset (GRACED) from fossil fuel and cement production with a global spatial resolution of 0.1° by 0.1° and a temporal resolution of 1 day. Gridded fossil emissions are computed for different sectors based on the daily national CO₂ emissions from near-real-time dataset (Carbon Monitor), the spatial patterns of point source emission dataset Global Energy Infrastructure Emissions Database (GID), Emission Database for Global Atmospheric Research (EDGAR), and spatiotemporal patters of satellite nitrogen dioxide (NO₂) retrievals. Our study on the global CO₂ emissions responds to the growing and urgent need for high-quality, fine-grained, near-real-time CO₂ emissions estimates to support global emissions monitoring across various spatial scales. We show the spatial patterns of emission changes for power, industry, residential consumption, ground transportation, domestic and international aviation, and international shipping sectors from January 1, 2019, to December 31, 2020. This gives thorough insights into the relative contributions from each sector. Furthermore, it provides the most up-to-date and fine-grained overview of where and when fossil CO₂ emissions have decreased and rebounded in response to emergencies (e.g., coronavirus disease 2019 [COVID-19]) and other disturbances of human activities of any previously published dataset. As the world recovers from the pandemic and decarbonizes its energy systems, regular updates of this dataset will enable policymakers to more closely monitor the effectiveness of climate and energy policies and quickly adapt.

Hepatitis B in Poland in 2020

OBJECTIVE

Aim of the study was the assessment of hepatitis B epidemiological situation in Poland in 2019 compared to previous years, taking into consideration the impact of the COVID-19 pandemic during that time.

MATERIAL AND METHODS

Data for 2020 included in individual reports on hepatitis B and HBV infections recorded by sanitary and epidemiological stations at EpiBaza, i.e. in the electronic epidemiological surveillance system on infectious diseases, were analyzed. In the assessment of the epidemiological situation, data published in the annual bulletins: "Infectious diseases and poisonings in Poland in 2020" and "Vaccinations in Poland in 2020" were also used. Data on deaths were obtained from the Statistics Poland (GUS).

RESULTS

In 2020, 2,854 cases of hepatitis B were reported, which corresponds to the incidence of 2.59 per 100,000 population, lower by 65.1% than in 2019. 14 cases of acute hepatitis B were reported, constituting 1.4% of all registered cases. The incidence of acute hepatitis B was 0.04 per 100,000 population and was lower by 67% compared to 2019 and lower by 71% compared to the median for the years 2014-2018. There were no cases of acute disease in the age group 0-29 years. A total of 978 chronic and unknown hepatitis B cases (UNK) were registered and the diagnosis rate was 2.56 per 100,000 population, lower by 64.2% than in 2019. Compared to the median diagnosis rate of chronic hepatitis B in 2014-2018, a decrease of 70.4% was observed. In the age group 0-19 years, there was no case reported. In 2020, 24 people died due to hepatitis B, including 22 from chronic hepatitis B.

CONCLUSIONS

The COVID-19 pandemic resulted in a significant reduction in the number of HBV tests performed and, consequently, a reduction in the number of diagnosed infections. A decrease in the number of detected infections was observed from the second quarter of 2020, i.e. from the beginning of the COVID-19 pandemic, although already in the first quarter of 2020 the number of registered hepatitis B cases was lower than in the same period in 2019. No acute cases were reported among people who were vaccinated against hepatitis B during childhood. Vaccination with three doses of hepatitis B vaccine in children in the second year of life was only slightly lower than in 2019, which proves the stability of the implementation of the preventive vaccination program, despite the limited access to primary health care during the pandemic.

Pertussis in Poland in 2020

INTRODUCTION

The epidemiological situation of infectious diseases in Poland in 2020, including pertussis cases, was significantly influenced by the limitation of interpersonal contacts introduced to reduce the transmission of SARS-CoV-2 virus. There was a reduction by more than half in the number of recorded pertussis cases, from 1,629 in 2019 to 753 in 2020. Pertussis is most dangerous for young children, however, it can get sick at any age, and the disease does not leave permanent immunity. Severe pertussis can also develop in the elderly, which may increase the risk of mortality. Adults usually have pertussis is mildly symptomatic and constitute an important reservoir of B. pertussis. The most effective strategy for the prevention of pertussis is still immunization of children in accordance with the Protective Vaccination Program, and in the case of adults, vaccination with the pertussis component in acellular form, repeated regularly every 10 years.

OBJECTIVES

The aim of the study was to assess the epidemiological situation of pertussis in Poland in 2020 compared to the situation in previous years, with particular emphasis on the assessment of the vaccination status of children against pertussis.

MATERIAL AND METHODS

The assessment of the epidemiological situation of pertussis in Poland was performed on the basis of the results of the analysis of unit reports of pertussis registered in the NIPH NIH - NRI in the EpiBaza system and data from the annual bulletin "Infectious diseases and poisonings in Poland in 2020" and the bulletin "Vaccinations in Poland in 2020".

RESULTS

In 2020, 753 cases of pertussis were registered. The incidence was 1.96 per 100,000 population and was lower compared to the incidence in 2019 (4.24). The highest incidence of pertussis occurred in the age group 0-4 years (9.9), and high in children and adolescents aged 5-9 years (5.1) and 10-14 years (6.0 per 100,000 population). About half of the cases concerned people over 15 years of age. In general, a higher incidence of women was observed than that of men, as well as a greater number of cases in cities than in rural areas. In 2020, among people suffering from pertussis, 206 people (i.e. 27%) required hospitalization. In 2020, one fatal case of the disease was reported to the epidemiological surveillance system.

SUMMARY AND CONCLUSIONS

In Poland, in 2020, there was a decrease in the number of pertussis cases by more than a half compared to the previous year. Despite the decline in disease rates, pertussis remains a public health problem as immunization-induced immunity is not sustained throughout life. Increasing the number of people susceptible to pertussis may lead to compensatory epidemics in the future, therefore the highest possible level of vaccination of the population, >92-94%, should be maintained to prevent new cases of pertussis.

Lyme disease in Poland in 2020

INTRODUCTION

Lyme borreliosis, also known as Lyme disease, is a zoonotic disease transmitted by ticks. The infection occurs through a bite by a common tick (Ixodes ricinus). Due to the annual cycle of tick activity, mainly dependent on temperature, Lyme disease is seasonal. In certain cases, post-exposure prophylaxis may be indicated, while the vaccine is in phase III clinical trials.

AIM OF THE STUDY

The aim of the study is to assess the epidemiological situation of Lyme disease in Poland in 2020 compared to the situation in previous years.

MATERIAL AND METHODS

The epidemiological situation of Lyme disease in Poland was assessed on the basis of the data sent to NIPH NIH - NRI by voivodeship sanitary-epidemiological stations and published in the bulletin "Infectious diseases and poisoning in Poland in 2020".

RESULTS

In 2020, 12,934 Lyme borreliosis cases and 459 hospitalizations were registered which, compared to 2019, means a 37.3% decrease in morbidity and a 73% decrease in hospitalization. It may be related to the outbreak of the SARS-CoV-2 virus at the end of 2019, which reached Poland at the beginning of March 2020. It can be seen that in Q2, due to the lower activity of people due to the epidemic, the number of cases of Lyme disease was less than in Q1 (2,064 in Q2 compared to 2,253 in Q1). The decrease compared to 2019 also continued in the third and fourth quarter, by 28% and 49%, respectively.

SUMMARY AND CONCLUSION

The impact of the SARS-CoV-2 outbreak on the distribution of Lyme disease incidence is noticeable, in particular on the decrease in the overall number of cases during the year, as well as on hospitalization due to Lyme disease with the previously observed stabilization of the incidence. The pandemic could have influenced this state of affairs on various levels. The main reason was, of course, the introduction of the epidemic and the related restrictions (including reduced mobility), but it cannot be ruled out that the cause was not an excessive burden on the health care system and sanitary inspection (delay in registration of reports).

Infectious diseases in Poland in 2020

OBJECTIVE OF THE WORK

The article reviews the main problems of the epidemiology of infectious diseases in Poland in 2020. It summarizes relevant findings from the national infectious disease surveillance system.

MATERIAL AND METHODS

The data contained in this article come from the reports collected by the State Sanitary Inspection on cases of notifiable infectious diseases notified by clinicians and/or laboratories. These are supplemented by mortality data published by the Statistics Poland.

RESULTS AND THEIR DISCUSSION

The epidemiology of infectious diseases was highly impacted by the COVID-19 pandemic. There were 1,306,983 cases notified in 2020 and 41,451 deaths attributed to COVID-19 (according to Statistics Poland). The reported incidence of other infections decreased by 10-98%. We noted especially high decreases in the incidence of viral gastrointestinal infections (by over 70%). The incidence of influenza and influenza-like infections decreased by 34% and tuberculosis by 36% as compared to 2019. However, important decreases were also noted for other diseases under surveillance, which could point to disruption of diagnosis services and reporting due to lockdowns and high workload on the public health services.

Rubella in Poland in 2020

INTRODUCTION

Since 2005, rubella has been included in the eradication program coordinated by the World Health Organization (WHO). The elimination of rubella in the country is possible provided that it is achieved by min. 95% immunization status and monitoring of the epidemiological situation, including the recording all suspicions of rubella and conducting laboratory diagnostics in the WHO Reference Laboratory.

AIM OF THE STUDY

The aim of the study is to assess the epidemiological situation of rubella in Poland in 2020, taking into account the assessment of rubella vaccination status and the degree of implementation of the WHO rubella elimination program in Poland.

MATERIAL AND METHODS

Assessment of the epidemiological situation of rubella in Poland based on aggregated reports of suspected rubella cases sent to the National Institute of Public Health NIH - National Research Institute by the Voivodeship Sanitary and Epidemiological Stations, data from the bulletin "Infectious diseases and poisoning in Poland in 2020" and data from the Epibaza system and the bulletin "Preventive vaccination in Poland in 2020".

RESULTS

In 2020, 98 cases of rubella were registered, 187 cases less than in 2019 (285 cases). There was also a decrease in the incidence to 0.26 per 100,000, compared to 0.74 per 100,000 in 2019. The highest incidence, iregardless of gender and place of residence, was recorded in the 0-4 age group (2.98 per 100,000). In 2020, no cases of congenital rubella syndrome were reported. In 2020, only one case (1.02%) was classified as a case confirmed in a laboratory test. The remaining 98.98% (97 cases) were diagnosed on the basis of clinical symptoms.

SUMMARY AND CONCLUSIONS

In 2020, in Poland, a decrease in the number of rubella was observed. Rubella was registered in 99% on the basis of a general diagnosis, without the required laboratory confirmation, which means that other rash diseases can be registered as rubella.

Measles in Poland in 2020

INTRODUCTION

Measles is a disease under the elimination program coordinated by the World Health Organization (WHO). The elimination of measles in the country is possible provided that 95% of the population is vaccinated with two doses of the vaccine, the epidemiological situation is monitored, all suspected cases of measles are recorded, and laboratory diagnostics are conducted by the WHO Reference Laboratory. Polish Reference Laboratory is located at the Department of Virology NIPH NIH - NRI.

OBJECTIVE

The aim of the article is to analyze the epidemiological situation of measles in Poland in 2020 with presenting the measles vaccination coverage and the progress of the measles elimination programme in Poland.

MATERIAL AND METHODS

The epidemiological situation of measles in Poland was analyzed on the basis of the case-based questionnaires of cases suspected of measles sent to NIPH NIH - NRI by the Sanitary and Epidemiological Stations, data from the publications: "Infectious diseases and poisonings in Poland in 2020" and "Vaccinations in Poland in 2020".

RESULTS

In 2020, 29 cases of measles were notified to the surveillance system in Poland (incidence 0.08 per 100,000 population). The highest incidence was observed in the aged 0-4 was estimated at 0.42 per 100,000 population. Out of all cases, 9 (31%) were hospitalized. No fatal cases due to the measles were reported.

CONCLUSIONS

The epidemiological situation of measles in 2020 in comparison with the situation in 2019, has improvement. This was a trend in throughout Europe.

Hepatitis C in Poland in 2020

BACKGROUND

The year 2020 in the extent of HCV infection was set for the first milestones on the road to the eradication of HCV infection in 2030. In addition, in 2020 there was a global public health crisis - the COVID-19 pandemic. The aim of this paper was to assess the epidemiological situation of HCV infection based on epidemiological surveillance data in Poland in 2020.

MATERIAL AND METHODS

Analysis of: 1) individual data from surveillance in 2020 conducted by EpiBaza system; 2) diagnosis rate from bulletins "Infectious diseases and poisonings in Poland" for the years 2014-2020; and 3) data about deaths due to hepatitis C from the Demographic Surveys and Labour Market Department of Statistics Poland.

RESULTS

In 2020, there was a significant decrease in the number of reported cases and thus in the diagnosis rate of HCV infection in Poland - 955 HCV infections were reported (2.49/100,000 - in comparison with 2019, 3.5 times less). The decrease occurred in all voivodeships (ranging from 0.50 to 6.37/100,000), we observe more districts in which HCV infections were not detected (in 2020 - 35.3%; in 2019 - 16.8%). The diagnosis rate of HCV infection in women and men was at a similar level. However, large disproportions are visible if age groups are considered in addition to gender. For years, we have observed a variation of the diagnosis rate of HCV infection depending on the environment of residence - also in 2020, higher values were reported overall in residents of urban than in rural areas (2.90 vs. 1.88/100,000). In 2.9% of newly diagnosed HCV infections, at the same time cirrhosis was already present, 0.4% had liver failure, and 0.1% had hepatocellular carcinoma. Among exposures of HCV infection, those related to nosocomial transmission still dominate (59%), also in acute hepatitis C (60%). One-third of reported infections were diagnosed in primary health care, and one in four were diagnosed during hospitalization.

CONCLUSIONS

The data presented in this paper show that the COVID-19 pandemic deepened the inequalities observed for years in HCV areas. Establishing a diverse system of testing and linking to care in Poland, reaching those in the greatest risk of ongoing transmission of HCV infection, and providing methodologically correct studies to assess progress in the eradication of HCV infection is becoming increasingly urgent to achieve the planned 2030 WHO targets.

Gonorrhoea in Poland in 2019-2020

PURPOSE

The aim was the assessment of the epidemiological situation of gonorrhoea in Poland in 2019 and 2020.

MATERIAL AND METHODS

Case-based data on gonorrhoea from surveillance were used (to calculate the rate, data from the Statistics Poland on the number of population was used), which were compared with data from previous years. Data on patients treated in dermatology-venereology clinics in 2019-2020 were taken from the Statistical Bulletins of the Ministry of Health. The surveillance definition is: a confirmed case (means meeting the laboratory criteria), probable case (clinical criteria and an epidemiological link - contact with a confirmed case of gonorrhoea) and a possible case (the doctor diagnosed gonorrhoea).

RESULTS

Year 2019 was the one with the highest number of reported gonorrhoea cases over the 2014-2020 period - 522 cases and 1.37/100,000 population. In 2020, there was a decrease in cases by 47.13% (246 cases and 0.64/100,000 inhabitants). Delays in reporting were identified - between the diagnosis and the first notification for 2019 and 2020, on average, intervened 36 and 52 days, respectively. On the other hand, in dermatologyvenereology clinics, the number of people treated for gonorrhoea did not change - 448 in 2019 and 442 in 2020.

CONCLUSION

1) The COVID-19 pandemic has deepened the problems of reporting good quality gonorrhoea data in epidemiological surveillance - the planning of appropriate preventive measures in central/local health policies is not possible. Improving surveillance and reporting of complete data on gonorrhoea cases is essential for reliable evaluation of the epidemiological situation. 2) Extensive prophylactic measures should be implemented (including for those under 18 years of age), targeting the source of and to cross routes of infection, including the promotion of safer sexual behaviors and informing the sexual partner.

Chickenpox in Poland in 2020

INTRODUCTION

Chickenpox is an infectious disease caused by the varicella zoster virus. The characteristic feature of this virus is very high visibility of 90-95%. The most common connection is direct contact with the disease or via droplets. The United States was the first country to introduce a universal, population-based childhood varicella vaccination program in 1995. In its 25 years of implementation, this program has significantly reduced the burden of chickenpox. There was a more than 97% reduction in varicella incidence and a 90% reduction in varicella-related hospitalizations and deaths, the highest (99%) in those under the age of 20 (born after starting the vaccination programme). Chickenpox is very common in Poland. In recent years, starting from 2002, there has been an upward trend in the incidence of chickenpox, except for 2020. In 2020, a decrease in the number of cases was recorded.

OBJECTIVES

The aim of the study was to assess the epidemiological situation of chickenpox in Poland in 2020 and to compare it with the situation in previous years.

MATERIAL AND METHODS

Evaluation of the epidemiological situation of chickenpox in Poland in 2020 was based on the results of the analysis of aggregate data published in the annual bulletins: "Infectious diseases and poisonings in Poland in 2020." and "Vaccinations in Poland in 2020". In addition, recommendations from the Protective Vaccination Program for 2020 were used.

RESULTS

In 2020, 71,567 cases of chickenpox were registered in Poland, i.e. 39.6% less than in the previous year. The incidence of chickenpox in 2020 was 186.6 per 100,000 and was lower than in 2019. The lowest incidence was recorded in the Świętokrzyskie Voivodship - 118.5/100,000, while the highest in the Kujawsko-Pomorskie Voivodeship - 263.5/100,000. Most cases concerned children aged 0-4 years (36,661). The incidence of chickenpox in men was higher than in women, and in rural areas higher than in urban dwellers. Hospitalization due to chickenpox in 2020 covered 1,368 people, which accounted for 0.51% of the total number of registered cases.

CONCLUSIONS

In 2020, there was a decrease in the number of cases of chickenpox compared to the previous year. The lower incidence may have been the result of reduced transmission of the varicella virus due to changes in the health behavior of the population during the COVID-19 pandemic (isolation measures and the introduction of a lock down throughout Poland limiting the activity of the population).

Mumps in Poland in 2020

INTRODUCTION

Mumps is an acute, generalized viral disease whose source of infection is the infected person. In 2003, vaccination against mumps became compulsory in Poland, performed according to a twodose scheme. The combined MMR vaccine (against measles, mumps and rubella) was introduced as part of the Protective Vaccination Program (PVP), which influenced the number of cases in Poland.

AIM

The aim of the study was to evaluate the epidemiological indicators of mumps in Poland in 2020 compared to previous years.

METHODS

The analysis of the epidemiological situation of mumps in Poland in 2020 was based on the interpretation of data from the bulletin "Infectious diseases and poisonings in Poland in 2020" and "Vaccinations in Poland in 2020".

RESULTS

In 2020, 582 cases of mumps were registered in Poland. The total incidence was 1.5 per 100,000 inhabitants and was lower compared to 2019. The highest incidence was 2.0 per 100,000 inhabitants were registered in the Świętokrzyskie Voivodeship and the lowest - 0.7 in the Dolnośląskie Voivodeship. The highest incidence (24.6/100,000) was recorded in children aged 5-9 years. The incidence of men (1.8/100,000) was higher than that of women (1.2/100,000). In 2020, 6 patients were hospitalized in Poland due to mumps, which was less than in 2019 (22 patients). The level of vaccination against mumps in children aged 3 was lower by 0.7 percentage points compared to 2019 and amounted to 91.9% across Poland.

CONCLUSIONS

In 2020, there was a decrease in the number of mumps cases compared to the previous year. The lower incidence may have been the result of a reduction in mumps virus transmission due to a change in population health behavior during the COVID-19 pandemic. Due to the epidemiological threat, the functioning of nurseries, kindergartens and schools was also temporarily suspended, which resulted in a reduction in the incidence of mumps in younger age groups, which are the main group of patients.

Salmonellosis in Poland in 2020

AIM

The aim of the study is to assess the epidemiological situation of salmonellosis in Poland in 2020 compared with previous years.

MATERIAL AND METHODS

The epidemiological situation was assessed on the basis of data provided to the Department of Epidemiology of Infectious Diseases and Surveillance of the NIPH NIH-NRI by sanitary-epidemiological stations through the EpiBaza System and the Registry of Epidemic Outbreaks System (ROE), as well as on the basis of data published in the annual bulletin "Infectious Diseases and Poisoning in Poland in 2020" (NIPH NIH-NRI, GIS, Warsaw, 2021) and from information received from laboratories of sanitary-epidemiological stations and data from the Demographic Research Department of the Statistics Poland.

RESULTS

In Poland in 2020, in the sanitary-epidemiological surveillance registered a total of 5,470 cases of salmonellosis, 5,302 cases of intestinal salmonellosis, and the remaining 168 cases of extra-intestinal salmonellosis. The incidence per 100,000 population was 14.3 for total salmonellosis, 13.8 for intestinal salmonellosis and 0.44 for extra-intestinal salmonellosis. Sanitary-epidemiological stations registered 5,349 confirmed cases and 121 probable cases of salmonellosis. Due to intestinal salmonellosis, 63.9% of all patients were hospitalized, while for extra-intestinal salmonellosis 153 patients or 91.1% of cases, were hospitalized. The increase in the number of salmonellosis cases in 2020 started in June, while the peak of the incidence was in August. Among the voivodeships, the highest incidence of salmonellosis was registered in the Podkarpackie voivodeship 33.3/100,000 population, the lowest in Zachodniopomorskie 6.1/100,000 population. Cases in the 0-4 age group accounted for 45.2% of all salmonellosis cases in 2020. Among extra-intestinal salmonellosis, 63.1% were people aged 60+. Sanitary-epidemiological stations registered 131 food poisoning outbreaks caused by Salmonella bacilli in the ROE system, 108 of these outbreaks were caused by the Enteritidis serotype. In 2020, the most common serotypes were S. Enteritidis 70% of all recorded salmonellosis, S. Typhimurium 1.9%, and S. Infantis 0.54%. There were 9 deaths due to Salmonella infection.

CONCLUSIONS

The COVID-19 pandemic and the associated restrictions introduced in the country, as well as increased hygiene through more frequent washing and disinfection of hands, could have contributed to a reduction of almost 69% in the number of salmonellosis cases registered in 2020, in Poland, compared to 2019. This is a 82% decrease in relation to 2018. There was also a decrease in the number of food poisoning outbreaks caused by Salmonella bacilli, while at the same time their percentage in the total number of outbreaks increased. On the one hand, the implemented restrictions could have had an impact on the decrease in the number of cases and outbreaks, on the other hand, worse access to medical care and diagnostics, most likely deepened the underestimation of these cases in the country observed for years, and distorted the real picture of the situation.

Advances in urologic oncology "OncoUrology Forum Special Edition": The best of 2020

OBJECTIVE

To provide latest findings of Urologic Oncology on prostate, kidney, and bladder cancer, and analyze its impact on clinical practice as well as future schemes in the medium- and long-term.

METHODS

This document reviews the abstracts on Uro-Oncology presented at the 2020 Congresses (EUA, AUA, ASCO, ESMO and ASTRO), the publications with the highest impact and especially the new lines of development and progress in Uro-Oncology evaluated by the OncoForum committee.

RESULTS

The use of prostate-specific membrane antigen (PSMA) radioligands in the diagnosis of prostate cancer may have great potential and utility in the coming years due to their improved sensitivity and specificity. The genetic characterization of the tumor is important at both, germline and somatic levels, due to the significant role of BRCA2 mutations regarding risk. The cohort multiple randomised controlled trial is the most suitable study design at the genitourinary cancer level. The application of big data will lead to process improvements, savings in healthcare costs, and an empowerment of real-life studies through ease of data comparison, management, and storage.

CONCLUSIONS

The use of new diagnostic techniques with PSMA ligands will provide a more comprehensive diagnostic modality, increase the number of studies about tumor genetic profiling, and enhance their quality. The practical application of artificial intelligence will improve the treatment genitourinary cancer.

The Running Track of Government Responsibility During the Pandemic, Characteristic Analysis of Policy Documents Relevant to the COVID-19 Pandemic Released by Beijing Municipal Government in 2020

Objective: Provide a reference point for the division of labor during the collaboration of multiple departments and the planning for the prevention and control of the Covid-19 epidemic of departments of the Beijing Municipal Government, from the perspective of policy documents. Methods: Policy documents and daily updates on COVID-19 cases published in 2020 are taken from the official website of Beijing Municipal Government and Beijing Municipal Health Commission. The characteristics of the pandemic situation and the content of relevant documents issued by different departments are described in five stages. Results: There were 988 confirmed cases of COVID-19 in Beijing in 2020, and policy analysis covered 444 documents (257 policy documents and 187 explanations of policy). A total of 153 policy documents were directly issued by the Beijing Municipal Government and its 45 subordinate commissions and bureaus, while others were policy forwarding from the central government and its relevant departments, county-level governments of Beijing and other organizations. Most cases and documents emerged during the initial stage of the pandemic (Level-I of the Emergency Response, which is the most serious). It was found that as many as 109 documents published by Beijing Municipal Government during the Level I emergency response period were relevant to economic and social development, 83 documents were related to disease control and medical services, and the rest were in close relation to the production and daily life of the people. Overall, major policy measures taken were relevant to 7 fields: finance, transportation, economic activities, employment people's lives, epidemic prevention and control and medical insurance. Policy implementation objectives were centered on promoting epidemic prevention and control and maintaining the stability of social production and residents' life. However, there are different emphases in different stages of the epidemic. Conclusion: Beijing municipality realized an effective mode of collaboration among multiple departments and organizations in the prevention and control of the COVID-19 epidemic, which was an example of the practice of "Health in All Policies."

Impact of COVID-19 pandemic on vaccination coverage among children aged 15 to 23 months at Dessie town, Northeast Ethiopia, 2020

Background: Disturbances are occurring in healthcare, trade, and travel, with countries closing off their borders due to the pandemic of coronavirus disease 2019(COVID-19) in the world. The pandemic has its impact on the delivery of important health services, including vaccinations. This study aimed to assess the impact of COVID-19 on vaccination coverage among children aged 15-23 months.Methods: A community-based cross-sectional study was conducted from July 22 to August 7, 2020, in Dessie town, Ethiopia. 633 children with their mother/caregiver were interviewed. Interviewer administered pre-tested structured questioner was used. Data was entered into EPI data and analyzed by using SPSS (Statistical Package for Social Sciences). Both binary and multivariate logistic regression analyses were tested. In multivariate analysis, a significant association was declared at a p-value of < 0.05.Result: Response rate was 96.4%. Based on the vaccination card plus recall, 350 (57.4%) of children finished all recommended vaccines. Age-eligible vaccination coverage during the COVID-19 outbreak was 12.5% lower than before the outbreak. Being a father main caregiver, mother/caregiver who can write and read, and mother/caregiver who educated from grade 1 to 8 mother/caregiver who is divorced, mother/caregiver who spend more than 30 minutes to reach health institution, and mother/caregiver who aware about the benefit of vaccination, about the campaign, and knowledge of COVID-19 each shows statistically significant association with full vaccination status of children.Conclusion: Full vaccination coverage among children aged 15-23 months remains low in Dessie town, which further decreases after the COVID-19 pandemic. Hence, measures should be taken to increase consciousness about vaccination and the COVID-19 pandemic.

[Annual review of capillary electrophoresis technology in 2020]

该文为2020年毛细管电泳(capillary electrophoresis, CE)技术年度回顾。归纳总结了以“capillary electrophoresis-mass spectrometry”或“capillary isoelectric focusing”或“micellar electrokinetic chromatography”或“capillary electrophoresis”为关键词在ISI Web of Science数据库中进行主题检索得到的2020年CE技术相关研究论文222篇,以及中文期刊《分析化学》和《色谱》中CE技术相关的研究论文37篇。对2020年影响因子(IF)≥5.0的Analytical Chemistry, Food Chemistry, Analytica Chimica Acta和Talanta等13本期刊的38篇文章报道的科研工作作了逐一介绍;对IF<5.0的期刊中CE技术报道较为集中的Journal of Chromatography A和Electrophoresis两本分析化学类期刊发表40篇文章中的代表性内容作了综合介绍;对重要的中文期刊《分析化学》出版的“核酸适配体专刊”和《色谱》出版的2期CE技术专刊所收录的37篇文章中的工作作了总体介绍。总体来说,2020年CE技术发展趋势仍以毛细管电泳-质谱(CE-MS)的新方法和新应用最为突出,主要集中在CE-MS与电化学检测、固相萃取以及多种毛细管电泳模式的联用方面,CE-MS接口相关的报道较前几年有所减少;常规CE技术则以胶束电动毛细管色谱(MEKC)在复杂样本分析、浓缩富集应用为主,尤其在食品和药品等复杂基质样本分析方面的报道较为集中;此外,我国CE相关领域专家学者的科研成果涵盖了CE在生命科学、临床医学、医药研发、环境科学、天然产物、食品分析等领域的应用,代表了国内CE科研应用水平和现状。

Psychological Distress Among Health Care Workers in Health Facilities of Mettu Town During COVID-19 Outbreak, South West Ethiopia, 2020

Background: During any of the infectious disease outbreak, health care workers were at increased risk of being infected, and psychological distress was a common phenomenon. Therefore, the study aimed to assess the psychological distress related to COVID-19 among healthcare workers in Mettu town. Methods: A cross sectional study was conducted from May 1-15, 2020 using convenient sampling techniques among 127 health care providers during COVID-19 pandemic in the Mettu town. Self-administered questionnaire was used to collect information. Depression and anxiety were evaluated as subscales from the Depression Anxiety Stress Scale (DASS-21). Psychological distress related to COVID-19 was measured using the Impact of Event Scale Revised (IES-R). Data analysis were done using SPSS version 24. Chi-square test was used to find the association between the outcome and demographic variables. Multivariable logistic regression analyses were used to evaluate the significance of the association at P-value < 0.05. Result: Using IES-R scale, 40.2% of the participants reported to have the symptoms of psychological distress. The majority of the participants reported mild psychological distress (37%) followed by moderate psychological distress (29%). The multivariate logistic regression analysis revealed that the odds of psychological distress were found to be higher among health care providers who reported to have depressive symptoms, and those who used alcohol, khat and tobacco in the past 3 months shows a significant association with psychological distress. Conclusion: Our findings revealed that the COVID-19 pandemic had exerted major psychological distress on health care providers. So the findings, seek attention for early psychological intervention needed to manage psychological distress in health care providers regarding identified factors.

Characterizing all-cause excess mortality patterns during COVID-19 pandemic in Mexico

BACKGROUND

Low testing rates and delays in reporting hinder the estimation of the mortality burden associated with the COVID-19 pandemic. During a public health emergency, estimating all cause excess deaths above an expected level of death can provide a more reliable picture of the mortality burden. Here, we aim to estimate the absolute and relative mortality impact of COVID-19 pandemic in Mexico.

METHODS

We obtained weekly mortality time series due to all causes for Mexico, and by gender, and geographic region from 2015 to 2020. We also compiled surveillance data on COVID-19 cases and deaths to assess the timing and intensity of the pandemic and assembled weekly series of the proportion of tweets about 'death' from Mexico to assess the correlation between people's media interaction about 'death' and the rise in pandemic deaths. We estimated all-cause excess mortality rates and mortality rate ratio increase over baseline by fitting Serfling regression models and forecasted the total excess deaths for Mexico for the first 4 weeks of 2021 using the generalized logistic growth model.

RESULTS

We estimated the all-cause excess mortality rate associated with the COVID-19 pandemic in Mexico in 2020 at 26.10 per 10,000 population, which corresponds to 333,538 excess deaths. Males had about 2-fold higher excess mortality rate (33.99) compared to females (18.53). Mexico City reported the highest excess death rate (63.54) and RR (2.09) compared to rest of the country (excess rate = 23.25, RR = 1.62). While COVID-19 deaths accounted for only 38.64% of total excess deaths in Mexico, our forecast estimate that Mexico has accumulated a total of ~ 61,610 [95% PI: 60,003, 63,216] excess deaths in the first 4 weeks of 2021. Proportion of tweets was significantly correlated with the excess mortality (ρ = 0.508 [95% CI: 0.245, 0.701], p-value = 0.0004).

CONCLUSION

The COVID-19 pandemic has heavily affected Mexico. The lab-confirmed COVID-19 deaths accounted for only 38.64% of total all cause excess deaths (333,538) in Mexico in 2020. This reflects either the effect of low testing rates in Mexico, or the surge in number of deaths due to other causes during the pandemic. A model-based forecast indicates that an average of 61,610 excess deaths have occurred in January 2021.

Environmental Earth Sciences Progress Report 2020 and Outlook 2021

The present editorial 2020 continues the series of status reports in Environmental Earth Sciences (EES) in previous years 2017 and 2019 (Kolditz et al. in Environ Earth Sci 77: 8, 2018, Kolditz et al. in Environ Earth Sci 79: 11, 2020). The year 2020 coming to an end was heavily influenced by the COVID-19 pandemic affecting all areas of life including research work and, therefore, scientific publishing as well ("Introduction"). One bright spot which shows longevity of journals that produce a quality product is that Environmental Earth Sciences (EES) is celebrating its 45th anniversary of publication. To this extent EES continues the tradition to honor the most cited papers contributing to the 2020 Impact Factor (IF) ("Highly and most cited topics") and provide information on the current status of EES as well as an outlook to 2021 ("Progress report").

First Outbreak of an H5N8 Highly Pathogenic Avian Influenza Virus on a Chicken Farm in Japan in 2020

On 5 November 2020, a confirmed outbreak due to an H5N8 highly pathogenic avian influenza virus (HPAIV) occurred at an egg-hen farm in Kagawa prefecture (western Japan). This virus, A/chicken/Kagawa/11C/2020 (Kagawa11C2020), was the first HPAI poultry isolate in Japan in 2020 and had multiple basic amino acids—a motif conferring high pathogenicity to chickens—at the hemagglutinin cleavage site. Mortality of chickens was 100% through intravenous inoculation tests performed according to World Organization for Animal Health criteria. Phylogenetic analysis showed that the hemagglutinin of Kagawa11C2020 belongs to clade 2.3.4.4B of the H5 Goose/Guangdong lineage and clusters with H5N8 HPAIVs isolated from wild bird feces collected in Hokkaido (Japan) and Korea in October 2020. These H5N8 HPAIVs are closely related to H5N8 HPAIVs isolated in European countries during the winter of 2019–2020. Intranasal inoculation of chickens with 10⁶ fifty-percent egg infectious doses of Kagawa11C2020 revealed that the 50% chicken lethal dose was 10^4.63 and the mean time to death was 134.4 h. All infected chickens demonstrated viral shedding beginning on 2 dpi—before clinical signs were observed. These results suggest that affected chickens could transmit Kagawa11C2020 to surrounding chickens in the absence of clinical signs for several days before they died.

COVID-19 Preventive Measure Practices and Knowledge of Pregnant Women in Guraghe Zone Hospitals

BACKGROUND

The COVID-19 pandemic is caused by a severe acute respiratory syndrome coronavirus which emerged in Wuhan. Recently this virus has rapidly spread throughout Ethiopia. The current preventive measure practices and knowledge have gaps. Therefore this study aimed to assess COVID-19 preventive measure practices and knowledge of pregnant women in Guraghe Zone hospitals.

METHODS AND MATERIALS

This cross-sectional study was conducted from July 27-August 27, 2020 among pregnant women in Guraghe zone hospitals. Systematic random sampling technique were employed to select 403 participants. Data were checked manually for completeness, cleaned, and stored in Epi Data and exported to SPSS for further analysis. Variables which have a P-value less than 0.25 on bivariate analysis were taken to multivariate analysis. A P-value of less than 0.05 and 95% confidence level was used as a cut-off point for presence of association in multivariate analysis.

RESULTS

COVID-19 preventive measure practice and knowledge of pregnant women visiting Guraghe Zone hospitals was 76.2% and 54.84%, respectively. Those aged 20-24 (AOR=1.22, 95% CI=1.15-22.24), 25-29 (AOR=1.32, 95% CI=1.20-20.25), and 30-34 (AOR=2.57, 95% CI-2.32-43.38) were more likely to practice COVID-19 preventive measures. Those residing in urban area (AOR=2.16, 95% CI=1.24-3.77) and perceiving that COVID-19 is worst for people with chronic disease (AOR=5.12, 95% CI=1.73-15.17) were more likely to practice COVID-19 preventive measures.

CONCLUSION

COVID-19 preventive measure practices and knowledge were low. Age, residence, and perception of COVID-19 on chronic disease were independent factors associated with preventive measure practices. Pregnant women aged ≥35 need to be counseled on practices of preventing COVID-19 by their healthcare providers.

A SOX5 gene variant as a possible contributor to short stature

SUMMARY

SOX5 plays an important role in chondrogenesis and chondrocyte differentiation. SOX5 defects in humans (often deletions) result in a Lamb-Shaffer syndrome (LSS), presenting with speech delay, behavioral problems and minor dysmorphic features. We present a patient with idiopathic short stature (ISS) who carried a heterozygous novel variant in SOX5. The patient had no dysmorphic features, but a skeletal survey revealed minor skeletal abnormalities. Laboratory and endocrine evaluation for known causes of growth disorders was negative. The missense variant in SOX5 gene (c.1783A>G, p.K595E) was de novo and was predicted to be deleterious by in silico programs. In summary, we present a patient whose presentation may provide evidence that gene defects in SOX5 may contribute to the etiology of short stature and/or mild skeletal defects beyond LSS.

LEARNING POINTS

We report a girl with idiopathic short stature and mild skeletal defects presenting with a de novo variant in SOX5 gene, predicted in silico to be deleterious. Although SOX5 has not been previously specifically associated with short stature, several evidences support its contributing effect on dyschondrogenesis. Missense variants in SOX5 gene may lead to mild phenotypes, differing from typical presentation of patients with Lamb-Shaffer syndrome.

Thyrotoxic dilated cardiomyopathy: personal experience and case collection from the literature

SUMMARY

The authors examine several reports of the literature concerning thyrotoxic dilated cardiomyopathy. In particular, it is pointed out that this clinical manifestation of hyperthyroidism is rare in readily diagnosed and properly treated hyperthyroidism. Case reports are analyzed comparatively. A case deriving from the direct experience of the authors is also presented.

LEARNING POINTS

Dilated cardiomyopathy has been reported as the initial presentation of hyperthyroidism in only 6% of patients although <1% developed severe LV dysfunction. Clinical picture of thyrotoxic dilated cardiomyopathy can degenerate into an overt cardiogenic shock sometimes requiring the use of devices for mechanical assistance to the circulation, or extracorporeal membrane oxygenation. For thyrotoxic dilated cardiomyopathy, evidence-based pharmacologic measures valid for heart failure should always be supplemented by the administration of specific thyroid therapies such as thionamides (methimazole, carbimazole or propylthiouracil), whose relatively long latency of action should be supported by the i.v. administration of small doses of beta-blocker. In cases of cardiogenic shock, the administration of beta-blocker should be carried out only after the restoration of satisfactory blood pressure levels- with the prudent use of synthetic catecholamines, if necessary.

Hypoparathyroidism as the single major component for decades of autoimmune polyglandular syndrome type 1

SUMMARY

Autoimmune polyglandular syndrome type 1 (APS-1) is a very rare autoimmune entity, accounting for about 400 cases reported worldwide. It is characterized by the presence of at least two of three cardinal components: chronic mucocutaneous candidiasis (CMC), hypoparathyroidism and Addison's disease. It typically manifests in childhood with CMC and years later with hypoparathyroidism. A 50-year-old man was referred to the Endocrinology outpatient clinic due to irregular follow-up of primary hypoparathyroidism diagnosed at age 7. Previous analysis reported frequent fluctuations of calcium and phosphate levels and persistent hypercalciuria. He presented several comorbidities, including bilateral cataracts, other ocular disorders, transient alopecia and chronic gastritis. Due to weight loss, fatigue, gastrointestinal complaints and the findings at objective examination, Addison's disease and CMC were investigated and confirmed. Antifungal therapy and hormonal replacement were started with evident clinical improvement. Regarding hypoparathyroidism, calcium-phosphate product decreased and other extraskeletal calcifications were diagnosed, such as nephrolithiasis and in basal ganglia. Further evaluation by genetic analysis revealed homozygosity for a frameshift mutation considered to be a pathogenic variant. It was reported only in two Asian siblings in compound heterozygosity. This case highlights the broad phenotypic spectrum of APS-1 and the significative intra-familial phenotype variability. A complete clinical history taking and high index of suspicion allowed the diagnosis of this rare entity. This case clarifies the need for regular long-term follow-up. In the specific case of hypoparathyroidism and Addison's disease in combination, the management of APS-1 can be complex.

LEARNING POINTS

Autoimmune polyglandular syndrome type 1 (APS-1) is a deeply heterogeneous genetic entity with a broad spectrum of clinical manifestations and a significant intra-family phenotypic variability. Early diagnosis of APS-1 is challenging but clinically relevant, as endocrine and non-endocrine manifestations may occur during its natural history. APS-1 should be considered in cases of acquired hypoparathyroidism, and even more so with manifestations with early onset, family history and consanguinity. APS-1 diagnosis needs a high index of suspicion. Key information such as all the comorbidities and family aspects would never be valued in the absence of a complete clinical history taking. Especially in hypoparathyroidism and Addison's disease in combination, the management of APS-1 can be complex and is not a matter of simply approaching individually each condition. Regular long-term monitoring of APS-1 is essential. Intercalary contact by phone calls benefits the control of the disease and the management of complications.

Multifocal insulinoma secondary to insulinomatosis: persistent hypoglycaemia despite total pancreatectomy

SUMMARY

Insulinomatosis is a rare cause of hyperinsulinaemic hypoglycaemia. The ideal management approach is not known. A 40-year-old woman with recurrent symptomatic hyperinsulinaemic hypoglycaemia was diagnosed with an insulinoma. A benign 12 mm pancreatic head insulinoma was resected but hypoglycaemia recurred 7 years later. A benign 10 mm pancreatic head insulinoma was then resected but hypoglycaemia recurred within 2 months. Octreotide injections were trialled but exacerbated hypoglycaemia. After a 2-year interval, she underwent total pancreatectomy. A benign 28 mm pancreatic head insulinoma was found alongside insulin-expressing monohormonal endocrine cell clusters (IMECCs) and islet cell hyperplasia, consistent with a diagnosis of insulinomatosis. Hypoglycaemia recurred within 6 weeks. There was no identifiable lesion on MRI pancreas, Ga-68 PET or FDG PET. Diazoxide and everolimus were not tolerated. MEN-1 testing was negative. Insulinomatosis should be suspected in insulinomas with early recurrence or multifocality. De novo lesions can arise throughout the pancreas. Extensive surgery will assist diagnosis but may not provide cure.

LEARNING POINTS

Insulinomas are usually benign and managed surgically. Insulinomatosis is characterised by multifocal benign insulinomas with a tendency to recur early. It is rare. Multifocal or recurrent insulinomas should raise suspicion of MEN-1 syndrome, or insulinomatosis. Insulinomatosis is distinguished histologically by insulin-expressing monohormonal endocrine cell clusters (IMECCs) and tumour staining only for insulin, whereas MEN-1 associated insulinomas stain for multiple hormones. The ideal treatment strategy is unknown. Total pancreatectomy may not offer cure.

The Aichi Biodiversity Targets: achievements for marine conservation and priorities beyond 2020

In 2010 the Conference of the Parties (COP) for the Convention on Biological Diversity revised and updated a Strategic Plan for Biodiversity 2011–2020, which included the Aichi Biodiversity Targets. Here a group of early career researchers mentored by senior scientists, convened as part of the 4th World Conference on Marine Biodiversity, reflects on the accomplishments and shortfalls under four of the Aichi Targets considered highly relevant to marine conservation: target 6 (sustainable fisheries), 11 (protection measures), 15 (ecosystem restoration and resilience) and 19 (knowledge, science and technology). We conclude that although progress has been made towards the targets, these have not been fully achieved for the marine environment by the 2020 deadline. The progress made, however, lays the foundations for further work beyond 2020 to work towards the 2050 Vision for Biodiversity. We identify key priorities that must be addressed to better enable marine biodiversity conservation efforts moving forward.

BSR 2020 Annual Meeting: Program

Different times call for different measures. The COVID-19 pandemic has forced us to search for alternative methods to provide an annual meeting which is equally interesting and has quality. For the Belgian Society of Radiology (BSR) 2020 Annual Meeting, the sections on Abdominal Imaging, Thoracic Imaging and the Young Radiologist Section (YRS) joined forces to organize a meeting which is quite different from the ones we have organised in the past. We have chosen to create a compact - approximately 5 hour - and entirely virtual meeting with the possibility of live interaction with the speakers during the question and answer sessions. The meeting kicks off with a message from the BSR president about radiology in 2020, followed by three abdominal talks. The second session combines an abdominal talk with COVID-related talks. We have chosen to include not only thoracic findings in COVID-19, but to take it further and discuss neurological patterns, long-term clinical findings and the progress in artificial intelligence in COVID-19. Lastly, the annual meeting closes off with a short movie about the (re)discovery of Röntgens X-ray, presented to us by the Belgian Museum for Radiology, Military Hospital, Brussels.

Spinal epidural lipomatosis: a rare association of Cushing's disease

SUMMARY

Excess cortisol is associated with hypertrophy and redistribution of adipose tissue leading to central obesity which is classically seen in Cushing's syndrome. Abnormal accumulation of fatty tissue in the spinal canal is most commonly associated with chronic steroid therapy and rarely reported with endogenous Cushing's syndrome. Herein, we describe a case of spinal epidural lipomatosis (SEL) associated with Cushing's disease. A 17-year-old man was referred with lower limb weakness, weight gain, multiple stretch marks, back pain and loss of height. He had clinical and biochemical features of Cushing's syndrome. MRI and Inferior Petrosal Sinus Sampling (IPSS) confirmed a pituitary adenoma as the source. On day 1 post trans-sphenoidal adenectomy he developed spastic paraparesis with a sensory deficit to the level of T5. MRI spine showed increased fat deposition in the spinal canal from T2 to T9 consistent with a diagnosis of SEL. He was managed conservatively and made a good recovery following restoration of eucortisolism and a period of rehabilitation.

LEARNING POINTS

SEL is a serious complication of glucocorticoid excess and should be considered in any patient presenting with new lower limb neurological symptoms associated with hypercortisolism. It is important to distinguish symptomatic SEL from cortisol-induced proximal myopathy by good history and clinical examination. MRI of the spine is the gold standard investigation for making a diagnosis of SEL. Restoration of eucortisolism can lead to resolution of fat accumulation and good neurological outcome.

Cannabis alleviates neuropathic pain and reverses weight loss in diabetic neuropathic cachexia in a previous heroin abuser

SUMMARY

Ten years after the successful withdrawal from heroin abuse, a person with diabetes suffered intractable pain and severe muscular emaciation consistent with the syndrome of diabetic neuropathic cachexia. Anti-neuropathic medications failed neither to alleviate suffering and reverse weight loss, nor to stop muscular emaciation. Vigilant evaluation for weight loss aetiologies revealed no responsible aetiology. Prescribing medical cannabis became mandatory, with the intention to alleviate neuropathic pain, regain muscular mass and strengthen legs, enable standing upright and walking normally. Medical cannabis for pain-relief, and the orexigenic properties of tetrahydrocannabinol (THC) ingredient successfully achieved these goals.

LEARNING POINTS

Medical cannabis can serve to promptly alleviate severe diabetic neuropathic pain. Past history of heroin abuse was not an absolute contraindication to medical cannabis use. Medical cannabis increased appetite and reversed muscular emaciation. Medical cannabis decreased chronic pain and hence, its catabolic consequences.

Successful remission of type B insulin resistance syndrome without rituximab in an elderly male

SUMMARY

Type B insulin resistance syndrome (TBIR) is a rare autoimmune disease caused by antibodies against the insulin receptor. It should be considered in patients with dysglycaemia and severe insulin resistance when other more common causes have been ruled out. We report a case of a 72-year-old male with a 4-year history of type 2 diabetes who presented with hypercatabolism, vitiligo, acanthosis nigricans, and hyperglycaemia resistant to massive doses of insulin (up to 1000 U/day). Detection of anti-insulin receptor antibodies confirmed TBIR. The patient received six pulses of methylprednisolone and daily treatment with cyclophosphamide for 6 months. Response to treatment was evident after the fourth pulse of methylprednisolone, as indicated by weight gain, decreased glycosylated haemoglobin and decreased requirement of exogenous insulin that was later discontinued due to episodes of hypoglycaemia. Remission was eventually achieved and the patient is currently asymptomatic, does not require insulin therapy, has normal glycaemia and is awaiting initiation of maintenance therapy with azathioprine. Thus, TBIR remitted without the use of rituximab. This case highlights the importance of diagnosis and treatment in a timely fashion, as well as the significance of clinical features, available laboratory findings and medication. Large controlled studies are required to standardise a therapeutic protocol, particularly in resource-constrained settings where access to rituximab is limited.

LEARNING POINTS

Type B insulin resistance syndrome is a rare autoimmune disorder that should be considered in patients with dysglycaemia, severe insulin resistance and a concomitant autoimmune disease. Serological confirmation of antibodies against the insulin receptor is not necessary in all cases due to the high associated mortality without timely treatment. Although there is no standardised immunosuppressive treatment, a protocol containing rituximab, cyclophosphamide and steroids has shown a significant reduction in previously reported mortality rates. The present case, reports successful remission in an atypical patient using cyclophosphamide and methylprednisolone, which is an effective therapy in countries in which rituximab is not covered by health insurance. When there is improvement in the hypercatabolic phase, the insulin dose should be reduced and/or discontinued to prevent hypoglycaemia; a mild postprandial hyperglycaemic state should be acceptable.

The challenges of post-bariatric surgery hypocalcaemia in pre-existing hypoparathyroidism

SUMMARY

Conventional treatment of hypoparathyroidism relies on oral calcium and calcitriol. Challenges in managing post-parathyroid- and post-thyroidectomy hypocalcaemia in patients with a history of bariatric surgery and malabsorption have been described, but postoperative management of bariatric surgery in patients with established hypoparathyroidism has not. We report the case of a 46-year-old woman who underwent elective sleeve gastrectomy on a background of post-surgical hypoparathyroidism and hypothyroidism. Multiple gastric perforations necessitated an emergency Roux-en-Y gastric bypass. She was transferred to a tertiary ICU and remained nil orally for 4 days, whereupon her ionised calcium level was 0.78 mmol/L (1.11-1.28 mmol/L). Continuous intravenous calcium infusion was required. She remained nil orally for 6 months due to abdominal sepsis and the need for multiple debridements. Intravenous calcium gluconate 4.4 mmol 8 hourly was continued and intravenous calcitriol twice weekly was added. Euthyroidism was achieved with intravenous levothyroxine. Maintaining normocalcaemia was fraught with difficulties in a patient with pre-existing surgical hypoparathyroidism, where oral replacement was impossible. The challenges in managing hypoparathyroidism in the setting of impaired enteral absorption are discussed with analysis of the cost and availability of parenteral treatments.

LEARNING POINTS

Management of hypoparathyroidism is complicated when gastrointestinal absorption is impaired. Careful consideration should be given before bariatric surgery in patients with pre-existing hypoparathyroidism, due to potential difficulty in managing hypocalcaemia, which is exacerbated when complications occur. While oral treatment of hypoparathyroidism is cheap and relatively simple, available parenteral options can carry significant cost and necessitate a more complicated dosing schedule. International guidelines for the management of hypoparathyroidism recommend the use of PTH analogues where large doses of calcium and calcitriol are required, including in gastrointestinal disorders with malabsorption. Approval of subcutaneous recombinant PTH for hypoparathyroidism in Australia will alter future management.

Severe early onset obesity and hypopituitarism in a child with a novel SIM1 gene mutation

SUMMARY

Single-minded homolog 1 (SIM1) is a transcription factor that plays a role in the development of both the hypothalamus and pituitary. SIM1 gene mutations are known to cause obesity in humans, and chromosomal deletions encompassing SIM1 and other genes necessary for pituitary development can cause a Prader-Willi-like syndrome with obesity and hypopituitarism. There have been no reported cases of hypopituitarism linked to a single SIM1 mutation. A 21-month-old male presented to endocrinology clinic with excessive weight gain and severe obesity. History was also notable for excessive drinking and urination. Endocrine workup revealed central hypothyroidism, partial diabetes insipidus, and central adrenal insufficiency. Genetic evaluation revealed a novel mutation in the SIM1 gene. No other genetic abnormalities to account for his obesity and hypopituitarism were identified. While we cannot definitively state this mutation is pathogenic, it is notable that SIM1 plays a role in the development of all three of the patient's affected hormone axes. He is now 6 years old and remains on treatment for his pituitary hormone deficiencies and continues to exhibit excessive weight gain despite lifestyle interventions.

LEARNING POINTS

Mutations in SIM1 are a well-recognized cause of monogenic human obesity, and there have been case reports of Prader-Willi-like syndrome and hypopituitarism in patients with chromosomal deletions that contain the SIM1 gene. SIM1 is expressed during the development of the hypothalamus, specifically in neuroendocrine lineages that give rise to the hormones oxytocin, arginine vasopressin, thyrotropin-releasing hormone, corticotropin-releasing hormone, and somatostatin. Pituitary testing should be considered in patients with severe obesity and a known genetic abnormality affecting the SIM1 gene, particularly in the pediatric population.

Successful medical management of insulinoma with diazoxide for 27 years

SUMMARY

Despite improvements in localisation techniques and surgical advances, some patients with insulinoma will not be cured by surgery or may not be suitable for surgery. Medical management with diazoxide is an option for such cases. This case report details 27 years of successful management of insulinoma using diazoxide. It has been effective and safe, with only minor adverse effects.

LEARNING POINTS

Long term diazoxide use can be a safe, effective option for insulinoma when it cannot be localised or removed surgically. Common adverse effects include peripheral oedema, hyperuricaemia, and hirsutism. 68Ga-NOTA-exendin-4 PET/CT scan should be considered for insulinoma localisation when other modalities have been unhelpful.

Pheochromocytoma crisis with cyclic fluctuation in blood pressure mimics acute coronary syndrome

SUMMARY

Pheochromocytoma crisis results from the sudden release of large quantities of catecholamines and leads to progressive multiple organ dysfunction. Here we report a case of pheochromocytoma crisis with symptoms associated with acute coronary syndrome (ACS) and severe fluctuations in blood pressure (BP). A 43-year-old Japanese man with hypertension (240/120 mmHg) visited a general hospital for chest pain. Echocardiogram showed ST segment depression and blood test demonstrated elevated troponin T. However, emergent coronary angiography revealed normal findings. CT showed a large adrenal mass on the left side, which was suspected as the cause of chest pain and BP elevation. After the patient was transported to our hospital, his BP was found to oscillate between 70 and 240 mmHg, and level of consciousness was decreased. After hospitalization, he had a further decrease in consciousness, a rise in body temperature, and a gradual increase in the interval between the upper and lower systolic BP. His systolic BP varied between 30 mmHg and 300 mmHg at the intervals of 20-30 min. After a multimodality therapy, including α-blocker and high dose fluid replacement, the fluctuation in his BP was gradually decreased and got stabilized after approximately 24 h. Approximately 3 weeks later, he underwent left adrenalectomy. This case showed that pheochromocytoma with internal necrosis might be misdiagnosed as ACS. Furthermore, in cases with a large adrenal tumor and severe elevation or fluctuations of BP, pheochromocytoma should be suspected and treated with α-blockers and fluid replacements as soon as possible prior to surgery.

LEARNING POINTS

High catecholamine levels due to pheochromocytoma crisis might cause symptoms associated with acute coronary syndrome. Adrenal tumor with internal necrosis and the elevation or fluctuations of blood pressure should be suspected to be pheochromocytoma. If pheochromocytoma crisis is suspected, the specialist, such as an endocrinologist or a urologist, should intervene, and an α-blocker treatment with adequate fluid replacement therapy should be initiated as soon as possible. Pheochromocytoma multisystem crisis (PMC) is a fatal condition characterized by multiple organ failure, severe blood pressure variability, high fever, and encephalopathy. This is an extremely rare subtype of a very rare disease such as pheochromocytoma. However, because the fatality rate of PMC is high, clinicians should be aware of the symptoms that mark its onset.

Metastatic insulinoma presenting 14 years after benign tumour resection: a rare case and management dilemma

SUMMARY

We present a 60-year-old woman who underwent successful surgical resection (partial pancreatectomy) for a low grade non-functioning pancreatic neuroendocrine tumour (pNET), with no biochemical or radiological features of recurrence on follow-up visits for 5 years. Fourteen years after the initial surgery, she developed spontaneous severe hypoglycaemic episodes which required hospitalisation, with subsequent investigations confirming the diagnosis of a metastatic insulin-secreting pNET (insulinoma). Medical management of her severe spontaneous hypoglycaemic episodes remained challenging, despite optimum use of diazoxide and somatostatin analogue therapy. Based on a discussion at the regional neuroendocrine tumour multidisciplinary team meeting, she underwent an elective hepatic trans-arterial embolization which was unfortunately unsuccessful. She ended up requiring an emergency right hemihepatectomy and left retroperitoneal mass resection which finally stabilised her clinical condition.

LEARNING POINTS

Ours is only the seventh case report of a previously benign pNET presenting as a functional insulin secreting metastatic tumour. However, it is the first case report, in which the metastatic functional pNET presented after such a long hiatus (14 years). There is currently no clear consensus regarding the length of follow-up of non-functional pNET which are deemed cured post-surgical resection, with most guidelines advocating a median follow up of 5 years (1). The delayed presentation in our case suggests additional considerations should be made regarding optimal post-operative surveillance duration based on the age of the patient, location of the tumour, lymph node spread and Ki-67 index. Hepatic artery embolization and/or partial hepatectomy remains a treatment option for pNET patients with significant hepatic metastasis.

A case of Williams syndrome with suspected coexisting ectopic aldosterone-producing tumor in the liver

SUMMARY

A 31-year-old man with Williams syndrome (WS) was referred to our hospital because of a 9-year history of hypertension, hypokalemia, and high plasma aldosterone concentration to renin activity ratio. A diagnosis of primary aldosteronism (PA) was clinically confirmed but an abdominal CT scan showed no abnormal findings in his adrenal glands. However, a 13-mm hypervascular tumor in the posterosuperior segment of the right hepatic lobe was detected. Adrenal venous sampling (AVS) subsequently revealed the presence of an extended tributary of the right adrenal vein to the liver surrounding the tumor. Segmental AVS further demonstrated a high plasma aldosterone concentration (PAC) in the right superior tributary vein draining the tumor. Laparoscopic partial hepatectomy was performed. The resected tumor histologically separated from the liver was composed of clear cells, immunohistochemically positive for aldesterone synthase (CYP11B2), and subsequently diagnosed as aldosterone-producing adrenal adenoma. After surgery, his blood pressure, serum potassium level, plasma renin activity and PAC were normalized. To the best of our knowledge, this is the first report of WS associated with PA. WS harbors a high prevalence of hypertension and therefore PA should be considered when managing the patients with WS and hypertension. In this case, the CT findings alone could not differentiate the adrenal rest tumor. Our case, therefore, highlights the usefulness of segmental AVS to distinguish adrenal tumors from hepatic adrenal rest tumors.

LEARNING POINTS

Williams syndrome (WS) is a rare genetic disorder, characterized by a constellation of medical and cognitive findings, with a hallmark feature of generalized arteriopathy presenting as stenoses of elastic arteries and hypertension. WS is a disease with a high frequency of hypertension but the renin-aldosterone system in WS cases has not been studied at all. If a patient with WS had hypertension and severe hypokalemia, low PRA and high ARR, the coexistence of primary aldosteronism (PA) should be considered. Adrenal rest tumors are thought to arise from aberrant adrenal tissues and are a rare cause of PA. Hepatic adrenal rest tumor (HART) should be considered in the differential diagnosis when detecting a mass in the right hepatic lobe. Segmental adrenal venous sampling could contribute to distinguish adrenal tumors from HART.

Identification of a TMEM127 variant in a patient with paraganglioma and acromegaly

SUMMARY

The coincidence of a pheochromocytoma or paraganglioma and a pituitary adenoma in the same patient is a rare condition. In the last few years SDHx and MAX mutations have been identified and discussed as a potential causal connection in cases of coincidence. We describe a case of a middle-aged female patient which presented with acromegaly, a growth hormone-secreting pituitary adenoma and a symptomatic neck paraganglioma. The patient was cured by surgery from both the pituitary tumour and the paraganglioma and is well after ten years follow-up. Due to the unusual coexistence of two neuroendocrine tumours, further molecular genetic testing was performed which revealed a variant in the TMEM127 gene (c245-10C>G).

LEARNING POINTS

Pheochromocytoma/paraganglioma and coexisting functioning pituitary adenoma are a very rare condition. An appropriate treatment of each tumour entity with a multi-disciplinary approach and regular follow-up is needed. The possibility of a hereditary disease should be considered and genetic workup is recommended. Genetic testing should focus primarily on the genes with mutations related to pheochromocytomas and paragangliomas. Next-generation sequencing with multi-gene panel testing is the currently suggested strategy. Genes associated with paragangliomas and pituitary adenomas are SDHA, SDHB, SDHC, SDHD, SDHAF2, MAX and MEN1, while case reports with VHL, RET and NF1 may represent coincidences. Variants of uncertain significance may need ongoing vigilance, in case novel data become available of these variants.

Late infantile form of multiple sulfatase deficiency

SUMMARY

Multiple sulfatase deficiency (MSD) is a lysosomal storage disorder (LSD) that results in the accumulation of sulfate esters which go on to cause neurological deterioration and mental delay, skin changes, and dysmorphism. The disease can be categorized into three subtypes based on the age of onset: neonatal, late infantile, or juvenile. Our patient is a 2.5-year-old girl, the only child of a healthy couple. Prior to the presentation of the disease, she had not been noted to have any previous health complications. The condition began at the age of 6 months with developmental regression and global hypotonia. Following thorough evaluation and testing, the patient was diagnosed with severe late infantile MSD, although some features, such as minimal mental deterioration, minimal dysmorphic facial features, and minimal organ enlargement, did not fully correlate with the diagnosis, since in cases of severe forms of the condition these features are almost always quite marked. The unexpected minimalism of some of the patient's MSD signs in spite of the severity of her MSD condition made her case worth further studying.

LEARNING POINTS

Treating dermatologic signs and symptoms greatly eased our patient's discomfort. We would suggest the use of appropriate supportive treatment for symptom management regardless of the life expectancy of the patient. As regards the diagnosis of MLD, given that in some cases the patient may present with irregular features of the condition, a genetic evaluation may be useful for accurate diagnosis. If motor function impairment is followed by dermatologic involvement, as seen in our patient and in many cases in the literature, MSD must be considered, and additional tests should be done to rule it out.

A case of testicular atrophy associated with cystic fibrosis

SUMMARY

An 8-year-old boy with cystic fibrosis came to our attention for an empty scrotum. General physical examination showed a normal penis and hypoplastic scrotum with non-palpable testes bilaterally. Routine blood investigations showed low levels of LH, testosterone, inhibin B and antiMullerian hormone and elevated levels of FSH. Karyotype was normal. An abdominal ultrasound confirmed the absence of the testes into the scrotum, in the inguinal region and abdomen. At laparoscopy were noted bilaterally hypotrophic spermatic vessels, absence of the vas deferens and a closed inner ring. Inguinal exploration found out a small residual testis and histological examination showed fibrotic tissue. This is the first case of testicular atrophy associated to CFTR mutation described. The process that led to bilateral testicular and vas deferens atrophy remains unexplained, a possible influence of CFTR dysfunction cannot be ruled out, although it is possible that these conditions are independently associated.

LEARNING POINTS

Cystic fibrosis produces a multisystemic disease which can affect also the reproductive tract. Nearly 97-98% of male patients are infertile because of congenital bilateral absence of vas deferens. A correlation between cystic fibrosis and bilateral testicular atrophy could be possible.