Higher Case Rates Research Articles

Gastrointestinal basidiobolomycosis in pediatric age group: A single-center experience [Case Series

Basidiobolomycosis is a rare tropical fungal infection that affects mainly the skin. Gastrointestinal basidiobolomycosis (GIB) is extremely rare, especially in the pediatric age group with no history of immune deficiency diseases. Our patients have been diagnosed and managed between 2016 and 2019; diagnoses have been confirmed by histopathology. Six children were analyzed: 1 female and 5 males. Their age range was 15 months to 6 years of age. All patients came from Jazan governance, southwestern Saudi Arabia. None of the patients had a history of immune deficiency diseases. They all had a high level of eosinophil, erythrocyte sedimentation rate (ESR), and C-reactive protein. Three of them were diagnosed initially with GIT mass, 2 with acute appendicitis, and one with intussusception. Most of them were subjected to surgical procedures before definitive diagnosis: 2 had mass resection and 4 had a stoma. Only one case was diagnosed by simple biopsy, with no laparotomy, which reflects the difficulty of direct diagnosis of disease. All patients were managed properly post definitive diagnoses with antifungal and recovered completely. GIB is generally a lethal fungal infection, which can affect even immunocompetent individuals. Patients with GIB can present with variant complaints: constipation, vomiting, abdominal distention, or simply a palpable mass. Proper investigation, including complete blood count, ESR, and radiological examination, can prevent unnecessary surgery and catastrophic surgical management. Pediatric patients can recover completely after receiving antifungals if diagnosed early. • Voriconazole has a quick and good effect on disease. Early diagnosis helps avoid unnecessary operative management. • Before resecting intestinal mass in pediatric age group, a biopsy is mandatory to roll out other causes such as fungal mass. • Restoration of complete health in Gastrointestinal basidiobolomycosis can be achieved if treatment is initiated early. • Tihama plains has the highest rate of cases all over the world, needs more awareness of the disease among health professionals.

Pengaruh Ketimpangan Pendapatan Suami Istri Terhadap Tingginya Kasus Cerai Gugat Di Pengadilan Agama Kelas 1B Kabupaten Ponorogo

Ponorogo is a city that has a high rate of divorce cases. From the divorce cases, the majority of submissions come from female workers who work as migrant workers, the implication is that the wife has a far greater income than her husband giving rise to a shift in the role of husband and wife which also results in a shift in rights and obligations. Although Islam allows a wife to work (in the context of helping her husband), it is expected that the husband and wife have considered together the good and bad consequences that may arise from the decision. Income gap or income inequality between husband and wife if not interpreted wisely can have an impact on the disharmony of the relationship between the two can even reach the stage of divorce. This research will explain an analyze the effect of income inequality between husbnad and wife on the high cases of divorce in Ponorogo. For that, researcher will examine this income inequality in the view of the sociology of Islamic law in the Ponorogo community in particular and driving factors the rise of female workers in Ponorogo and things that arise when the wife’s income is greater than her husband. The paradigm of this research is used a qualitative paradigm with emphasis on case studies in teh field. The result of the research stated that income inequality where the wife has a greater income than the husband is not a main problem in divorce cases, but there are other factors as a trigger such as the inability of the husband in managing finances, the wife’s takings is only for consumptive activities and even tends to spree, the interference from the husband’s family, especially in financial matters, lack of understanding of religion, and infidelity. This hiigh financial ability of the wife ultimately makes the wife dare to sue for divorce of her husband.

Relevance of Spatial and Temporal Trends in Nymphal Tick Density and Infection Prevalence for Public Health and Surveillance Practice in Long-Term Endemic Areas: A Case Study in Monmouth County, NJ.

Tick-borne diseases are a growing public health problem in the United States, and the US northeast has reported consistently high case rates for decades. Monmouth County, New Jersey, was one of the earliest jurisdictions to report Lyme disease cases in 1979 and reports several hundred cases per year nearly 40 yr later. In the time since, however, tick-borne health risks have expanded far beyond Lyme disease to include a variety of other bacterial pathogens and viruses, and additional vectors, necessitating a continually evolving approach to tick surveillance. In 2017, Monmouth County initiated an active surveillance program targeting sites across three ecological regions for collection of Ixodes scapularis Say (Acari: Ixodidae) and Amblyomma americanum L. (Acari: Ixodidae) as well as testing via qPCR for associated bacterial pathogens. During the first five years of this program (2017-2021), we report high levels of spatiotemporal variability in nymphal density and infection prevalence in both species, limiting the granularity with which human risk can be predicted from acarological data. Nonetheless, broader patterns emerged, including an ongoing trend of A. americanum dominance, risks posed by Borrelia miyamotoi, and the frequency of coinfected ticks. We present some of the first county-level, systematic surveillance of nymphal A. americanum density and infection prevalence in the northeastern US. We also documented a temporary decline in Borrelia burgdorferi that could relate to unmeasured trends in reservoir host populations. We discuss the implications of our findings for tick-borne disease ecology, public health communication, and tick surveillance strategies in endemic areas.

A single center experience in 90 cases with nonimmune hydrops fetalis: diagnostic categories ‒ mostly aneuploidy and still often idiopathic

The prognosis of nonimmune hydrops fetalis (NIHF) is still poor with a high mortality and morbidity rate despite progress in perinatal care. This study was designed to investigate etiology and outcome of NIHF. A retrospective review of 90 NIHF cases from 2007 to 2019 was conducted at University Medical Center of the Johannes Gutenberg University, Mainz, Germany. Demographics, genetic results, prenatal and postnatal outcomes including one year survival as well as autopsy data were extracted. Etiology of hydrops was classified using 13 previously established categories. In 4 patients observed between 2016 and 2019, we used a next-generation-sequencing (NGS) panel for genetic evaluation. Ninety NIHF cases were identified, with a median gestational age (GA) at diagnosis of 14weeks. There were 25 live-born infants with a median GA of 34weeks at birth, 15 patients survived to one year. There was aneuploidy in more than one third of the cases. All 90 cases were subclassified into etiologic categories with chromosomal 35, idiopathic 15, syndromic 11, cardiovascular 9, inborn errors of metabolism 6, lymphatic dysplasia 3, thoracic 3, infections 3, gastrointestinal 3 and hematologic 2. The NGS panel was used in 4 cases and 4 diagnoses were made. In 90 cases with NIHF we identified an aneuploidy in more than one third of the cases. Improved techniques, such as possibly specific genetic analysis, could reduce the high rate of unexplained cases of NIHF.

Barriers and Facilitators to Prevention and Care of COVID-19 Infection in Cincinnati Latinx Families: a Community-Based Convergent Mixed Methods Study.

BackgroundLatinx populations have experienced disproportionately high case rates of COVID-19 across the USA. Latinx communities in non-traditional migration areas may experience greater baseline day-to-day challenges such as a lack of resources for immigrants and insufficient language services. These challenges may be exacerbated by the COVID-19 pandemic.ObjectiveThis article describes the results of an initial community health needs assessment to better understand the prevention and care of COVID-19 infection in the Cincinnati Latinx community.MethodsWe used convergent mixed methods to examine barriers and facilitators to COVID-19 prevention and care for those with infection.ResultsLatinx adults ≥ 18 years old completed 255 quantitative surveys and 17 qualitative interviews. Overarching mixed methods domains included knowledge, prevention, work, challenges, and treatment. Quantitative results largely reinforced qualitative results (confirmation). Certain quantitative and qualitative results, however, diverged and expanded insights related to caring for COVID-19 infection among Latinx adults (expansion). There were infrequent contradictions between quantitative and qualitative findings (discordance). Primary barriers for the Latinx community during the COVID-19 pandemic included insecurities in food, jobs, housing, and immigration. Key facilitators included having trusted messengers of health-related information.ConclusionPublic health interventions should be centered on community partnerships and the use of trusted messengers. Wraparound services (including resources for immigrants) are essential public health services. Close partnership with employers is essential as lack of sick leave and mask supplies were more frequent barriers than knowledge. These findings emerged from experiences during the COVID-19 pandemic but likely generalize to future public health crises.Supplementary InformationThe online version contains supplementary material available at 10.1007/s40615-022-01294-7.

Certified Nursing Aides' Training Hours and COVID Case and Mortality Rates Across States in the U.S.: Implications for Infection Prevention and Control and Relationships With Nursing Home Residents.

Disproportionately high COVID case and mortality rates in skilled nursing facilities (SNFs) have heightened interest in the role of Certified Nursing Aides (CNAs) in the care of residents living in SNFs. This policy brief will make recommendations for CNA training based on an examination of two sources of secondary data using descriptive statistics. From the first source of secondary data, 34% of CNAs report feeling inadequately trained. The second source, U.S. government data, revealed statistically significant negative correlations between the amount of CNA training required across states and COVID mortality rates (Kendall's τb = −0.32; p = 0.002) but not case rates (Kendall's τb = −0.18; p = 0.09). More training for CNAs may not only reduce health risks from infectious diseases but also improve how they relate to SNF residents during care.

Study of climatology parameters on COVID-19 outbreak in Jordan.

To control the spread of COVID-19 disease and reduce its mortality, an early and precise diagnose of this disease is of significant importance. Emerging research data show that the current COVID-19 pandemic may be affected by environmental conditions. Therefore, the impact of weather parameters on COVID-19 distribution should be explored to predict its development in the next few months. This research aims to study the association between the daily confirmed COVID-19 cases in the three major cities of Jordan; Amman, Zarqa, and Irbid and climate indicators to include the average daily temperature (°C), wind speed (m/s), relative humidity (%), pressure (kPa), and the concentration of four pollutants (CO, NO2, PM10, and SO2). The data were obtained from the World Air Quality Project website and the Jordanian Ministry of Environment. A total of 305 samples for each city was used to conduct the data analysis using multiple linear regression and a feedforward artificial neural network. It was concluded that the multiple linear regression and feedforward artificial neural network could forecast the COVID-19 confirmed cases in the case studies; Amman, Irbid, and Zarqa. Finally, global sensitivity analysis using Sobol analysis indicated that pressure in Amman and Zarqa and the concentration of NO2 in Irbid has a high rate of positive cases that supports the virus's spread.

Gastric metastases of breast cancer: Histopathological and molecular characterization of a single Institution case series

The metastatic spread of breast carcinoma to the stomach is a rare event and often represents a diagnostic challenge. In the present study, 23 cases of gastric metastases from breast cancer were retrospectively identified dating back until 2007. Primitive histotype, localization, gross appearance, microscopic architecture were analyzed. Cytokeratins 7 and 20, sex hormones, HER2 and Ki67 expression was evaluated. According to the results, the series was characterized by an enrichment of lobular primitive histotype (43.7%). In most cases gastric metastases were described as parietal nodules, polypoid masses or ulcerated lesions, mainly involving the antro-angular region. In a relatively high rate (10.5%) of cases, endoscopic examinations resulted negative for macroscopic lesions. More than half of the cases (52.2%) microscopically resembled primitive poorly cohesive gastric cancer. Because gross and histological findings can be deceiving, immunohistochemistry may be essential for the diagnosis of gastric metastases from breast cancer. Accordingly with the results of our analysis and literature review, an immunohistochemical panel composed of cytokeratins 7 and 20, Estrogen and Progesteron Receptors would drastically improve diagnostic accuracy. Interaction among the clinician, endoscopist and the pathologist is also essential to provide the patient the best therapeutic option.

Mapping local hot spots with routine tuberculosis data: A pragmatic approach to identify spatial variability.

ObjectiveTo use routinely collected data, with the addition of geographic information and census data, to identify local hot spots of rates of reported tuberculosis cases.DesignResidential locations of tuberculosis cases identified from eight public health facilities in Lima, Peru (2013–2018) were linked to census data to calculate neighborhood-level annual case rates. Heat maps of tuberculosis case rates by neighborhood were created. Local indicators of spatial autocorrelation, Moran’s I, were used to identify where in the study area spatial clusters and outliers of tuberculosis case rates were occurring. Age- and sex-stratified case rates were also assessed.ResultsWe identified reports of 1,295 TB cases across 74 neighborhoods during the five-year study period, for an average annual rate of 124.2 reported TB cases per 100,000 population. In evaluating case rates by individual neighborhood, we identified a median rate of reported cases of 123.6 and a range from 0 to 800 cases per 100,000 population. Individuals aged 15–44 years old and men had higher case rates than other age groups and women. Locations of both hot and cold spots overlapped across age- and gender-specific maps.ConclusionsThere is significant geographic heterogeneity in rates of reported TB cases and evident hot and cold spots within the study area. Characterization of the spatial distribution of these rates and local hot spots may be one practical tool to inform the work of local coalitions to target TB interventions in their zones.

Analysis of Healthy Housing and TB Prevalence in Yogyakarta City

Environmental health is one of the determinants factors toward the public health status. Transmission of tuberculosis (TB) is influenced by environmental factors. Based on previous TB data in local study, it shows that urban areas (urban) have a high case rate. Therefore, this study aims to reveal the disparity of urban TB sufferers, especially in the city of Yogyakarta based on indicators of the physical environment of the house from the coverage of healthy households. The method of study used is quantitative descriptive analysis of secondary data. The data used were the physical environment of the house which is obtained from healthy housing data and TB prevalence data in Yogyakarta City. The secondary data spread over 18 Public Health Centers in Yogyakarta City. The data collected include healthy housing data and BTA (+) cases data in the study scope using total sampling technique. Based on the trend analysis, it was found that there was a significant trend in data. The higher percentage of non-healthy housing coverage wasassociated in line with the higher the TB prevalence rate. It can be concluded that the physical environment factor of the house as an indicator of a healthy housing is closely related to the incidence of TB in Yogyakarta City. Environmental quality studies need to be carried out for comprehensive TB disease control towards elimination (End TB 2030) which is in line with national programs and SDGs goals.

A Resampling Method to Improve the Prognostic Model of End-Stage Kidney Disease: A Better Strategy for Imbalanced Data.

BackgroundPrognostic models can help to identify patients at risk for end-stage kidney disease (ESKD) at an earlier stage to provide preventive medical interventions. Previous studies mostly applied the Cox proportional hazards model. The aim of this study is to present a resampling method, which can deal with imbalanced data structure for the prognostic model and help to improve predictive performance.MethodsThe electronic health records of patients with chronic kidney disease (CKD) older than 50 years during 2005–2015 collected from primary care in Belgium were used (n = 11,645). Both the Cox proportional hazards model and the logistic regression analysis were applied as reference model. Then, the resampling method, the Synthetic Minority Over-Sampling Technique-Edited Nearest Neighbor (SMOTE-ENN), was applied as a preprocessing procedure followed by the logistic regression analysis. The performance was evaluated by accuracy, the area under the curve (AUC), confusion matrix, and F3 score.ResultsThe C statistics for the Cox proportional hazards model was 0.807, while the AUC for the logistic regression analysis was 0.700, both on a comparable level to previous studies. With the model trained on the resampled set, 86.3% of patients with ESKD were correctly identified, although it was at the cost of the high misclassification rate of negative cases. The F3 score was 0.245, much higher than 0.043 for the logistic regression analysis and 0.022 for the Cox proportional hazards model.ConclusionThis study pointed out the imbalanced data structure and its effects on prediction accuracy, which were not thoroughly discussed in previous studies. We were able to identify patients with high risk for ESKD better from a clinical perspective by using the resampling method. But, it has the limitation of the high misclassification of negative cases. The technique can be widely used in other clinical topics when imbalanced data structure should be considered.

The impact of broadening COVID-19 testing eligibility on communities of color – A lesson for overcoming structural barriers to health care

CDC guidelines for COVID-19 testing in March 2020 did not prioritize underserved communities. We present the effect that expanding COVID-19 testing had for residents of the predominantly Hispanic city of Chelsea, MA, which had the highest case rate in the state. Results were compared to another city with similar demographics, Lynn, MA, where testing eligibility remained unchanged. Institutional data were used to identify outpatient visits for influenza-like illness or COVID-19 exposure, COVID-19 tests, and hospitalizations for confirmed COVID-19 between 3/30/2020–4/28/2020. Multivariable logistic regressions were used to compare outcomes before and after the change in testing eligibility occurred on 4/13/2020. A total of 3,060 patients were included, 1,374 Chelsea residents and 1,686 Lynn residents. After guidelines changed, Chelsea residents were more likely to present as outpatients (adjusted odds ratio [AOR] 4.2, p < 0.001) and less likely to be hospitalized (AOR 0.2, p < 0.001). They were more likely to be tested (AOR 8.8, p < 0.001), but less likely to test positive (AOR 0.6, p = 0.05). Lynn residents were also more likely to be tested after 4/13/2020 (AOR 1.9, p < 0.001), but no significant differences in visit acuity or test positivity were observed. This study demonstrates how broadening testing eligibility for one highly affected, predominantly Hispanic community was associated with an increase in outpatient presentations and a concomitant decrease in test positivity and hospitalizations. These results highlight the impact of improved access to care on utilization of services among underserved communities, a lesson that is especially crucial as we continue to grapple with the COVID pandemic.

Investing to Both Prevent and Prepare for COVID-XX.

One cause of the high rate of COVID-19 cases in the USA is thought to be insufficient prior capital investment in national health programs to preemptively reduce the likelihood of an outbreak and in national capacity to reduce the severity of any outbreak that does occur. We analyze the choice of capital investments (e.g. testing capacity, stockpiles of PPE, and information sharing capacity) and find the economically efficient capital stock associated with mitigating pandemic risk should be dramatically expanded. Policymakers who fail to invest in public health forgo significant expected cost savings from being prepared.Supplementary InformationThe online version contains supplementary material available at 10.1007/s10393-022-01576-w.

EFFECT OF MOMORDICA CHARANTIA FRUIT ETHANOLIC EXTRACT ON MALONDIALDEHYDE (MDA) LEVEL IN BLOOD OF SPRAGUE-DAWLEY RATS INDUCED BY 7,12-DIMETHYLBENZ[A]ANTHRACENE

Background: Cancer is a type of disease with a high rate of diagnostic cases. The real cause of cancer remains unknown. Free radicals can cause cancer by DNA’s gen mutation. 7, 12- Dimethylbenz[a]anthracene (DMBA) is often used for researching carcinogenesis. Many types of research have used natural substances as supportive cancer therapies including Momordica charantia (bitter melon). Malondialdehyde (MDA) is one of the oxidative damage biomarkers which can significantly increase, especially on breast cancer patients. The success of therapy on a breast cancer patient is shown by decreasing MDA levels in the blood. Aim: To investigate the effect of Momordica charantia fruit ethanolic extract on malondialdehyde levels in the blood of Sprague Dawley rats induced by 7,12- Dimethylbenz [a] anthracene. Methods: This study was a true experimental randomized post-test only with control group design on rats that divided into two groups: X1 given DMBA induction only and X2 given DMBA induction with Momordica charantia fruit ethanolic extract by feeding tube with 200mg/kgbw/day for 14 days. Results: The mean of MDA level in group X1 = 0,83±0,32 and in group X2 = 0,30±0,19. The result of the normality test of data using the Shapiro-Wilk test obtained abnormal distribution data for one of the groups. The result of independent-samples T-Test showed a significant difference with P = 0,001. Conclusion: There was an effect of Momordica charantia fruit ethanolic extract on MDA level in the blood of Sprague-Dawley induced by 7,12- Dimethylbenz[a]anthracene.

Epidemiology of coinfection with tuberculosis and HIV in Japan, 2012-2020.

This report examines the characteristics and treatment outcomes of patients with tuberculosis (TB) who are coinfected with HIV in Japan. Active TB cases newly notified to the Japan Tuberculosis Surveillance system during 2012–2020 were analysed retrospectively, during which 379 HIV-positive TB cases were reported. The proportion of HIV-positive cases among those with known HIV status increased, from 1.9% (62/3328) in 2012 to 3.5% (31/877) in 2020. The proportion of those with unknown HIV testing status was consistently high, at approximately 60%, and the proportion of those who did not undergo HIV testing increased significantly, from 21.6% (4601/21 283) in 2012 to 33.7% (4292/12 739) in 2020. The proportion of foreign-born cases more than tripled, from 14.5% (9/62) in 2012 to 45.2% (14/31) in 2020. The TB treatment success rate was higher among HIV-negative than HIV-positive cases (72.7% [3796/5222] versus 60.3% [88/146]), and among Japan-born than foreign-born HIV-positive patients (65.6% [61/93] versus 50.9% [27/53]), owing largely to the high rate of foreign-born cases transferring to care outside Japan. The increasing proportion of HIV positivity among TB cases tested for HIV in this study requires ongoing monitoring, especially among foreign-born persons. However, because the number of reported cases was small, and there was low completeness of reporting of HIV testing data in the TB surveillance system, these results should be interpreted with caution. Encouraging more complete data collection by training public health nurses who complete TB case interviews and ensuring ongoing monitoring of patients with TB/HIV coinfection are recommended.

Assessing the role of imported cases on the establishment of SARS-CoV-2 Delta variant of concern in Bolton, UK

This paper presents a method used to rapidly assess the incursion and the establishment of community transmission of suspected SARS-CoV-2 variant of concern Delta (lineage B.1.617.2) into the UK in April and May 2021. The method described is independent of any genetically sequenced data, and so avoids the inherent lag times involved in sequencing of cases. We show that, between 1 April and 12 May 2021, there was a strong correlation between local authorities with high numbers of imported positive cases from India and high COVID-19 case rates, and that this relationship holds as we look at finer geographic detail. Further, we also show that Bolton was an outlier in the relationship, having the highest COVID-19 case rates despite relatively few importations. We use an artificial neural network trained on demographic data, to show that observed importations in Bolton were consistent with similar areas. Finally, using an SEIR transmission model, we show that imported positive cases were a contributing factor to persistent transmission in a number of local authorities, however they could not account for increased case rates observed in Bolton. As such, the outbreak of Delta variant in Bolton was likely not a result of direct importation from overseas, but rather secondary transmission from other regions within the UK.

БУЛІНГ ЯК ОДНА З ФОРМ ДИСКРИМІНАЦІЇ ДИТИНИ

The article is devoted to the research of the current state of manifestations of bullying as one of the most widespread forms of discrimination against children. Relevance of the investigated topic is caused primarily by the realities of today, which are related to the ways to combat discrimination in any of its manifestations. Nowadays gender nervousness, bullying, harassment, hacking and other phenomena that infringe on the honor, dignity, health, lack of freedom and life of people are actively condemned by the world community, which actualizes this research. The purpose of this article is to define the essence of the concept of bullying. To outline the current state of manifestations of bullying as one of the most widespread forms of discrimination against children and ways to improve the mechanics of combating and preventing bullying. As a result of the study of anti-bullying laws and different points of view of scientists, the main features of bullying, which consist in the presence of the parties (the bully, the victim of violence and the witnesses) the intention in the buller's actions, which consists in dominating the victim and humiliation of the victim; the systemic nature of brutal behavior, and its consequences. The article analyzes the current state of manifestations of bullying, as a result of which a high rate of cases of bullying in recent years in the period from the adoption of new anti-bullying legislation to the present day, indicating that the mechanism of combating and opposing bullying is not fully developed. It is suggested, taking into account the experience of anti-bullying legislation of foreign countries, to consider introducing into the national legislation a norm that provides for liability for participation in bullying of witnesses, which can contribute to a significant reduction in the occurrence of aggression among young people. The position on the improvement of the mechanism of prevention and prevention of bullying, which consists in the implementation of anonymous testing in educational institutions, which is systematic in nature, by students and their parents, is substantiated, as well as testing to identify an uncomfortable atmosphere in the team, with the involvement of staff psychologists, which will contribute to the timely response of the authorities to violations of the rights and legitimate interests of the child. It is argued the feasibility of creating online resources for anonymous appeal, both for people who were physically or psychologically abused and for witnesses, The victims were not able to report the fact of bullying in another way to the relevant persons as a result of the attacks.

Serum amyloid A, ferritin and carcinoembryonic antigen as biomarkers of severity in patients with COVID‑19

In view of the rapid spread of COVID-19 and the high mortality rate of severe cases, reliable risk stratifying indicators of prognosis are necessary to decrease morbidity and mortality. The aim of the present study was to evaluate the value of serum amyloid A (SAA) and carcinoembryonic antigen (CEA) as prognostic biomarkers in comparison to other predictors, including C-reactive protein (CRP) and ferritin levels. This study included 124 patients diagnosed with COVID-19, and they were assigned to one of two groups: Mild and severe, based on the severity of the infection. Radiological and laboratory investigations were performed, including evaluation of CRP, ferritin, D-Dimer, SAA and CEA levels. Significantly higher levels of CRP, ferritin, D-Dimer, SAA and CEA were observed in severe cases. SAA was significantly correlated with CRP (r=0.422, P<0.001), ferritin (r=0.574, P<0.001), CEA (r=0.514, P<0.001) and computed tomography severity score (CT-SS; r=0.691, P<0.001). CEA was correlated with CRP (r=0.441, P<0.001), ferritin (r=0.349, P<0.001) and CT-SS (r=0.374, P<0.001). Receiver operator characteristic (ROC) curves for performance of SAA, CEA, ferritin, CRP and SAA showed the highest AUC value of 0.928, with a specificity of 93.1%, and a sensitivity of 98.5% at a cut-off of 16 mg/l. The multi-ROC curve for SAA and ferritin showed 100% specificity, 100% sensitivity and 100% efficiency, with an AUC of 1.000. Thus, combining SAA and ferritin may have guiding significance for predicting COVID-19 severity. SAA alone showed the highest prognostic significance. Both SAA and CEA were positively correlated with the CT-SS. Early monitoring of these laboratory markers may thus provide significant input for halting disease progression and reducing mortality rates.

Fetal central nervous system anomalies according to RT-PCR and trimester of maternal infection with Zika virus: A prospective cohort study.

In October 2015, an epidemic of Zika began in Colombia's geographic areas with a high population of mosquitoes of the genusAedes. We aimed to describe the fetal brain ultrasound findings in pregnant women with active symptoms or a history of symptoms suggestive of Zika virus (ZIKV) infection. Eligible pregnant women were tested with reverse transcriptase-polymerase chain reaction (RT-PCR) for ZIKV and followed prospectively using detailed anatomic ultrasound and transvaginal neurosonography to detect structural anomalies of the fetal central nervous system (CNS). A total of 115 symptomatic women with a positive ZIKV RT-PCR and 55 with a negative ZIKV RT-PCR were enrolled in the study; CNS compromise of the fetus occurred in 22% and 17%, respectively (p=0.255). Callosal dysgenesis (14.5%) was the most frequent anomaly of the CNS, followed by microcephaly (13.6%) and neuronal migration disorders (8.3%). When symptomatic ZIKV RT-PCR-positive women were categorized by trimester of infection, CNS anomalies were present in 40% of first-trimester infections, compared with 21% and 7% in second- and third-trimester infections (p=0.002). CNS anomalies were also more severe in first-trimester-infected fetuses than in second- and third-trimester-infected fetuses. The high prevalence of CNS anomalies in fetuses of symptomatic ZIKV RT-PCR negative women suggests a high rate of false-negative cases and an even higher prevalence of CNS anomalies than observed in this study. The prevalence of fetal CNS anomalies was higher than previously reported in the literature for both symptomatic RT-PCR-positive and -negative pregnant women. Corpus callosum anomalies, microcephaly, neuronal migration disorders, and brain parenchymal hyperechogenicities were the most frequent CNS anomalies detected. In addition, CNS anomalies were more frequent and severe in infected fetuses during the first trimester of pregnancy than during the second or third trimester.

Analysis to the failure rate and causes of noninvasive prenatal testing based on high-throughput sequencing

To analyze the cause and pregnancy outcome for non-reportable cell-free DNA (cfDNA) results during non-invasive prenatal testing (NIPT). cfDNA was extracted from maternal plasma from 5898 singleton pregnancies at 12 to 22 gestational weeks and underwent NIPT with strict quality control standards. For those with sub-standard results, redraw or invasive prenatal procedures were recommended. Among the 5898 cases, 32 have failed for the initial NIPT, including 17 cases with substandard cffDNA%, 10 cases with data fluctuation after twice library constructing and sequencing, and 5 cases with unidentifiable sex chromosome abnormalities. For these 32 cases, 2 directly underwent amniocentesis, and karyotyping analysis showed both were normal. Six of the 30 redrawn cases finally turned out to be nonreportable. The final nonreportable rate was therefore 0.1% (8/5898). Of the redrawn cases, 1 trisomy 21, 1 trisomy 18 and 1 trisomy 13 high risk-cases were identified, which were all confirmed to be false positive. Among the 6 nonreportable cases, 2 women underwent invasive prenatal testing, and 1 was found to have a normal fetal karyotype, while another was found to have an abnormal karyotype of mos45,X[32]/46,XY[18]. The other 4 nonreportable cases who did not accept invasive prenatal testing have all reported normal child development at follow-up. The main reason for nonreportable NIPT results was low cffDNA%. The high success rate of the redrawn cases has effectively increased the overall NIPT success rate and reduced the number of the cases necessitating invasive prenatal diagnosis. The initially nonreportable women may consider retesting after careful counseling with informed consent.