Epidemiology History Research Articles

Maladies of Empire: How Colonialism, Slavery, and War Transformed Medicine by Jim Downs

Reviewed by: Maladies of Empire: How Colonialism, Slavery, and War Transformed Medicine by Jim Downs Zachary Dorner (bio) Medicine, Medical history, Slavery, Colonialism, Migration, War, Epidemiology Maladies of Empire: How Colonialism, Slavery, and War Transformed Medicine. By Jim Downs. (Cambridge, MA: The Belknap Press of Harvard University Press, 2021. Pp. 262. Cloth, $29.95.) Quick, what comes to mind when you read the word epidemiology? For some it may be the Broad Street pump from the London cholera outbreak of 1854; others might picture Dr. Anthony Fauci. With Maladies of Empire: How Colonialism, Slavery, and War Transformed Medicine, Jim Downs prompts readers to form different associations—the slave ship, prison, military hospital, lazaretto—by rooting the development of preventive medicine and knowledge about infectious disease in "imbalances of power such as those created by slavery, colonialism, and war" (148). To do so, he recovers the experiences of people "whose health, suffering, and even death contributed to the development of medical knowledge," most of whom were people [End Page 320] of color, from the reports, journals, treatises, and lectures of the time (8). The book thus provides a corrective to heroic narratives of the declines in mortality witnessed across the Atlantic world during the nineteenth century but can, at times, ignore a longer history of understanding disease via contexts of slavery, colonialism, war, and migration in its ambition to relocate the origins of modern epidemiological practice. In Downs's telling, the century from approximately 1756 to 1866 holds the key to an overlooked history of epidemiology. The narrative operates on a global scale, often removed from the typical metropolitan centers of knowledge production, encompassing Russian prisoners, laundresses in Malta, British sailors, freed people in Jamaica, Black Union soldiers, enslaved infants, and Muslim pilgrims as examples of vulnerable populations instrumentalized for purposes of public health by military and colonial bureaucracies. Empire (whether European or U.S.), in other words, is a unifying thread through these examples, so the terms "colonialism" and "imperialism" tend to do a lot of work in the narrative, which would have benefitted from more specific definitions of both. Early chapters establish that infrastructures, power differentials, and recordkeeping routines of the British Empire enabled the extraction of epidemiological data from certain people but also created the very health crises to which those efforts were responding with such urgency. Dr. Thomas Trotter, for example, gathered information aboard the slave ship Brookes in 1783 for his theories about fresh air that stood alongside laboratory experiments and observations from Europe's overcrowded prisons on the importance of oxygen. Empire's "crowded places" provided practical sites for collecting practical observations (9). Chapters in the latter half of Maladies of Empire turn to the Civil War-era United States, the author's specialty, for a closer look at the racialization of understandings of infectious disease and their afterlives through examples of the U.S. Sanitary Commission, smallpox vaccinations, and cholera-mapping in what are some of the book's most effective chapters. Maladies of Empire is also a book about the human body. People, both individually and in groups, became sources of data for the "founding generation" of epidemiologists Downs identifies (194). Though often remaining nameless and faceless in contemporaneous texts, these men, women, and children contributed to knowledge production as literal bodies of evidence and as sources of verbal or visual information akin, in some ways, to the Indigenous informants described in other histories of imperial [End Page 321] science and medicine.1 That many of these anonymous people remain so in Maladies of Empire is not a criticism of the book, but rather an acknowledgement of the challenges posed by reading against the grain in sources that are abstracting by design. Even the most crucial sources for the study of slavery have been subject to such attention in recent years.2 Throughout the book, understandings of infectious disease act dialectically whereby they reshape perceptions of the persons who provide the initial bodily data. A prominent example for the United States is the racialization of disease susceptibility and immunity described in Chapters 6 and 7 that "solidif[ied] racial identity as a central component in epidemiology and public health" (114). To some readers...

Proceedings of the VI National Meeting of the Italian Group of Paleopathology (GIPaleo)

The presence of numerous scientific contributions in the program is certainly demonstrative of the fact that research in the field of paleopathology and anthropology has not stopped since the beginning of Covid-19. Furthermore, the same emergency that we are still partially feeling, has pushed our community scientific research to question itself more intensely in connection to the epidemic relationship and measures that repeatedly led to profound transformations in the societies of the past from different points of view: demographic, economic, social and the history buried under the bioarchaeological strata is today more capable than ever to show this connection.It can do this by bringing to light the paleodemographic data that is obtained from the study of human remains.Today we will listen to many paleopathological stories and among these I am very happy to also present ours.Twenty years ago, the University of Insubria started a collaboration with the Archaeological Superintendence of Lombardy for the study of osteological remains found mostly during emergency archaeology recoveries. These experiences led us to reach those bioarchaeological sites again with the aim of extracting all those cemetery layers that remained there because they were not subjected at that time by building reclamation interventions.Returning to those sites that in the past brought to light fragmentary anthropological data means allowing oneself the possibility of obtaining new palaeodemographic and palaeopathological data which are decisive for reconstructing the demographic and epidemiological history of the populations of the past.These new interventions led us to create an operational model that immediately intended to underline the importance of an evident continuity between the archaeological recovery and the anthropological study of the finds through the setting up of physical anthropology and paleopathology laboratories directly on the sites of the finds. All this in harmony with the final design of the projects or the museumization of bioarchaeological sites in their complexity aimed at enhancing cultural tourist routes in the area. In this regard, I would like to thank the community foundation of Varese and the Cariplo foundation for supporting our current initiatives.These include the project financed by the emblematic provincial tender and which has as its final objective the enhancement of three bioarchaeological sites in Valcuvia: the medieval sites of San Biagio in Cittiglio, Sant’Agostino in Caravate, and the modern crypt of the church of the Convent of Azzio.Today, our Research Centre works in Piedmont in different sites in the province of Vercelli and Alessandria.Aware of the importance of a physical anthropological approach in the field, our young Centre goes beyond the continental borders to reach Eritrea, the ancient city of Adulis, because it is in dissecting the taphonomic events and the funeral actions that will make it possible to identify the funerary ritual adopted by the ancient populations.The operational model of paleopathological research, which gradually enriches itself thanks to the multidisciplinary nature of the interventions and thanks to the individual experiences in the field, is thus continuously transferred and adapted to other anthropological contexts that retain potential both in terms of investigative and enhancement of the bioarchaeological heritage. Through the musealization of the sites it is also possible to acquire an attractive force towards all those potentially bioarchaeological areas but which today are in conditions of neglect because they are marginal with respect to the conventionally understood cultural tourist good. And we all know how important it is to transfer the study data even outside the academic context because making this aspect of archaeology, the truly human one, usable too, cannot fail to arouse a strong awareness of our past. We also know how much more we will have to work, following in the footsteps of the professors who started this path, to ensure that the disciplines of paleopathology and physical anthropology arrive within all those degree courses still discovered today by these teachings to heal an important lack: knowing the human past from a physical and pathological point of view allows us to understand the evolutionary path of some pathologies, especially those of infectious nature.If my title of the speech “Paleopathology and osteoarchaeology in the province of Varese” does not respond to what is being said today, it is because my feeling about paleopathology and osteoarchaeology in the province of Varese is understood as that of carrying out research, what I could feel everywhere, through the operational model, the enthusiasm for paleopathological research and of course the people I am lucky enough to work with.

Pleural tuberculosis: experiences from two centers in Brazil

ObjectiveThis study aimed to describe the clinical and laboratory findings of patients diagnosed with pleural tuberculosis at two hospitals in southern Brazil. MethodsPatients aged < 18 years were evaluated retrospectively. The patients’ medical and epidemiological history, tuberculin skin test results, radiological and pathological findings, and pleural fluid analysis results were retrieved. ResultsNinety-two patients with pleural tuberculosis were identified. The mean age was 10.9 years old. Twenty-one percent were children aged six years or less. The most common symptoms were fever (88%), cough (72%), and chest pain (70%). Unilateral pleural effusion was observed in 96% of the cases. Lymphocyte predominance was found in 90% of the pleural fluid samples. The adenosine deaminase activity of the pleural fluid was greater than 40 U/L in 85% of patients. A diagnosis of community-acquired pneumonia with antibiotic prescriptions was observed in 76% of the study population. ConclusionsTuberculosis etiology must be considered in unilateral pleural effusion in a child with contact with a case of tuberculosis. Pleural fluid biomarkers contribute to the diagnosis of pleural tuberculosis in children and adolescents.

Edible Mushrooms as a Potential Component of Dietary Interventions for Major Depressive Disorder.

Dietary interventions for people suffering from major depressive disorder (MDD) are an ongoing field of research. In this article, we present a comprehensive background for understanding the possibility of using edible medicinal mushrooms as an adjunctive treatment for MDD. We start with a brief history of MDD, its diagnosis, epidemiology and treatment, and the effects of diet on depression symptoms, followed by a review of neurobiological, behavioral, and clinical studies of medicinal mushrooms. We specifically highlight the results of preclinical and clinical studies on dietary supplementation with three selected mushroom species: Lion’s mane (Hericium erinaceus), Caterpillar mushroom (Cordyceps militaris), and Lingzhi/Reishi (Ganoderma lucidum). Preliminary small-sample clinical studies suggest that Lion’s mane can influence well-being of humans. In the case of Reishi, the results of clinical studies are equivocal, while in the case of Caterpillar Mushroom, such studies are underway. Edible mushrooms contain 5-hydroxy-L-tryptophan (5-HTP), which is a direct precursor of serotonin—a neurotransmitter targeted in pharmacotherapy of MDD. Therefore, in light of the well-recognized role of stress as a pathogenic factor of MDD, we also describe the neurobiological mechanisms of the interaction between stress and serotonergic neurotransmission; and summarize the current state of knowledge on dietary supplementation with 5-HTP in MDD.

Can we prevent the occurrence of stroke in patients admitted with non-ST-segment elevation myocardial infarction?

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Cardio-cerebral vascular diseases are a leading cause of deaths worldwide. Stroke is a potential complication in high-risk patients who had non-ST-segment elevation myocardial infarction (NSTEMI). Purpose Identify high-risk patients with stroke and their prognosis in the setting of NSTEMI. Methods Based on a multicenter retrospective study, data collected from admissions between January 2013 and January 2020. Patients without data on previous cardiovascular history or uncompleted clinical data were excluded. Patients were divided in 2 groups (G): G1 – patients who suffered stroke; G2 - patients without stroke. Logistic regression and survival analysis were performed. Results 7180 patients were admitted with NSTEMI, stroke occurred in 35 patients (0.49%). Regarding epidemiological and past history G1 was older (72±9 vs 66±12, p= 0.004), had more females (54.3% vs 45.75, p&amp;lt;0.001), had higher rates of type 2 diabetes mellitus (51.3% vs 35.2%, p=0.05), previous strokes / transient ischemic attack (24.2% vs 7.0%, p=0.007) and dementia (3.3% vs 0.8%, p&amp;lt;0.001). Arterial hypertension (77.1 vs 72.8%, p=0.56), dyslipidaemia (61.8% vs 63.0%, p=0.88) and smoking (17.6% vs 26.0%, p=0.27) were similar between groups. Patients who presented with chest pain (72.7% vs 92.0%, p&amp;lt;0.001) and patients who were not revascularized were more likely to suffer a stroke (43.3% vs 17.5%, p&amp;lt;0.001). Logist regression only confirmed that females were more likely to have a stroke (p&amp;lt;0.001, OR 4.13, CI 1.87-9.15) and patients who presented with chest pain (p=0.001, OR 0.23, CI 0.10-0.54). One year event-free survival was higher in patients who did not have stroke (95.3% vs 80.0%, p=0.005, OR 4.50, CI 1.43-14.15) Conclusion Since sex gender and form of presentation of NSTEMI are not modifiable factors we cannot prevent strokes from happening in the context of NSTEMI.

Short-term outcomes in patients with non-ST-segment elevation myocardial infarction

Abstract Funding Acknowledgements Type of funding sources: None. Introduction The proportion of non-ST-segment elevation myocardial infarction (NSTEMI) is increasing among the acute coronary syndromes (ACS). Reinfarction (RI) is a potential complication in high-risk patients with NSTEMI and it will cause an impact on these patients’ prognosis. Purpose Identify high-risk patients with RI and their prognosis in the setting of NSTEMI. Methods Based on a multicenter retrospective study, data collected from admissions between January 2013 and January 2020. Patients without data on previous cardiovascular history or uncompleted clinical data were excluded. Patients were divided in 2 groups (G): G1 – patients without RI; G2 - patients with RI during hospitalization. Logistic regression and survival analysis were performed. Results 7180 patients were admitted with NSTEMI, RI occurred in 71 pts (0.99%). Regarding epidemiological and past history G2 was older (71±12 vs 66±12, p=0.001), had higher rates of previous stroke (15.9% vs 7.0%, p 0.003) and peripheric arterial disease (6.3% vs 6.1%, p=0.004). The groups were similar regarding arterial hypertension (p=0.74), diabetes type 2 (p=0.11) and dyslipidaemia (p=0.48). G2 had higher levels of brain natriuretic peptide (45.5% vs 24.5%, p&amp;lt;0.001) and lower levels of haemoglobin (20.3% vs 7.9%, p&amp;lt;0.001). Patients taking prasugrel (2% vs 0.3%, p=0.002) or ticagrelor (6.1% vs 2.2%, p&amp;lt;0.001) previously to the admission were more susceptible to have RI. Patients with severe left ventricular systolic dysfunction (3.4% vs 2.6%, p&amp;lt;0.001), need of invasive (2.8% vs 0.8%, p&amp;lt;0.001) or non-invasive (4.2% vs 1.3%, p&amp;lt;0.001) ventilation and percutaneous coronary intervention (PCI) (80.3% vs 64.7%, p0.006) had higher rates of RI. Logist regression confirmed that PCI (p=0.03, OR 2.22, CI 1.08-4.53), previous stroke (p=0.02, OR 0.58, CI 0.37-0.92) and pts previously taking prasugrel (p=0.02, OR 1.85, CI 1.11-3.10) were predictors of RI in the setting of NSTEMI. Conclusion RI in the setting of NSTEMI was associated with PCI, previous stroke and pts previously taking prasugrel. One year prognosis was poorer for patients who suffered RI.

Characterization of yam mosaic viruses from Brazil reveals a new phylogenetic group and possible incursion from the African continent.

Yam (Dioscorea spp.) is an important crop for smallholder farmers in the Northeast region of Brazil. Wherever yam is grown, diseases caused by yam mosaic virus (YMV) are prevalent. In the present study, the diversity of YMV infecting Dioscorea cayennensis-rotundata was analyzed. In addition, five species of Dioscorea (D. alata, D. altissima, D. bulbifera, D. subhastata, and D. trifida) commonly found in Brazil were analyzed using ELISA and high-throughput sequencing (HTS). YMV was detected only in D. cayennensis-rotundata, of which 66.7% of the samples tested positive in ELISA. Three YMV genome sequences were assembled from HTS and one by Sanger sequencing to group the sequences in a clade phylogenetically distinct from YMV from other origins. Temporal phylogenetic analyses estimated the mean evolutionary rate for the CP gene of YMV as 1.76 × 10-3 substitutions per site per year, and the time to the most recent common ancestor as 168.68years (95% Highest Posterior Density, HPD: 48.56-363.28years), with a most likely geographic origin in the African continent. The data presented in this study contribute to reveal key aspects of the probable epidemiological history of YMV in Brazil.

A total infectome approach to understand the etiology of infectious disease in pigs

BackgroundThe global pork industry is continuously affected by infectious diseases that can result in large-scale mortality, trade restrictions, and major reductions in production. Nevertheless, the cause of many infectious diseases in pigs remains unclear, largely because commonly used diagnostic tools fail to capture the full diversity of potential pathogens and because pathogen co-infection is common.ResultsWe used a meta-transcriptomic approach to systematically characterize the pathogens in 136 clinical cases representing different disease syndromes in pigs, as well as in 12 non-diseased controls. This enabled us to simultaneously determine the diversity, abundance, genomic information, and detailed epidemiological history of a wide range of potential pathogens. We identified 34 species of RNA viruses, nine species of DNA viruses, seven species of bacteria, and three species of fungi, including two novel divergent members of the genus Pneumocystis. While most of these pathogens were only apparent in diseased animals or were at higher abundance in diseased animals than in healthy animals, others were present in healthy controls, suggesting opportunistic infections. Importantly, most of the cases examined here were characterized by co-infection with more than two species of viral, bacterial, or fungal pathogens, some with highly correlated occurrence and abundance levels. Examination of clinical signs and necropsy results in the context of relevant pathogens revealed that a multiple-pathogen model was better associated with the data than a single-pathogen model was.ConclusionsOur data demonstrate that most of the pig diseases examined were better explained by the presence of multiple rather than single pathogens and that infection with one pathogen can facilitate infection or increase the prevalence/abundance of another. Consequently, it is generally preferable to consider the cause of a disease based on a panel of co-infecting pathogens rather than on individual infectious agents.-CFtrnVrpn8o8P42pZ9u6vVideo abstract

Short-term outcomes in patients with non-ST-segment elevation myocardial infarction

Abstract Funding Acknowledgements Type of funding sources: None. Introduction The proportion of non-ST-segment elevation myocardial infarction (NSTEMI) is increasing among the acute coronary syndromes (ACS). Reinfarction (RI) is a potential complication in high-risk patients with NSTEMI and it will cause an impact on these patients’ prognosis. Purpose Identify high-risk patients with RI and their prognosis in the setting of NSTEMI. Methods Based on a multicenter retrospective study, data collected from admissions between January 2013 and January 2020. Patients without data on previous cardiovascular history or uncompleted clinical data were excluded. Patients were divided in 2 groups (G): G1 – patients without RI; G2 - patients with RI during hospitalization. Logistic regression and survival analysis were performed. Results 7180 patients were admitted with NSTEMI, RI occurred in 71 pts (0.99%). Regarding epidemiological and past history G2 was older (71±12 vs 66±12, p=0.001), had higher rates of previous stroke (15.9% vs 7.0%, p 0.003) and peripheric arterial disease (6.3% vs 6.1%, p=0.004). The groups were similar regarding arterial hypertension (p=0.74), diabetes type 2 (p=0.11) and dyslipidaemia (p=0.48). G2 had higher levels of brain natriuretic peptide (45.5% vs 24.5%, p&amp;lt;0.001) and lower levels of haemoglobin (20.3% vs 7.9%, p&amp;lt;0.001). Patients taking prasugrel (2% vs 0.3%, p=0.002) or ticagrelor (6.1% vs 2.2%, p&amp;lt;0.001) previously to the admission were more susceptible to have RI. Patients with severe left ventricular systolic dysfunction (3.4% vs 2.6%, p&amp;lt;0.001), need of invasive (2.8% vs 0.8%, p&amp;lt;0.001) or non-invasive (4.2% vs 1.3%, p&amp;lt;0.001) ventilation and percutaneous coronary intervention (PCI) (80.3% vs 64.7%, p0.006) had higher rates of RI. Logist regression confirmed that PCI (p=0.03, OR 2.22, CI 1.08-4.53), previous stroke (p=0.02, OR 0.58, CI 0.37-0.92) and pts previously taking prasugrel (p=0.02, OR 1.85, CI 1.11-3.10) were predictors of RI in the setting of NSTEMI. Conclusion RI in the setting of NSTEMI was associated with PCI, previous stroke and pts previously taking prasugrel. One year prognosis was poorer for patients who suffered RI.

In-hospital mortality predictors in patients with non-ST-segment elevation myocardial infarction

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Ischemic heart disease is a leading cause of cardiovascular mortality. Non-ST-segment elevation myocardial infarction (NSTEMI) makes up for the majority of admissions to a cardiac unit. Purpose identify the predictors leading to in-hospital mortality in patients presenting with NSTEMI. Methods Based on a multicenter retrospective study, data collected from admissions between January 2013 and January 2020. Patients without data on previous cardiovascular history or uncompleted clinical data were excluded. Patients were divided in 2 groups (G): G1 – in-hospital death due to NSTEMI; G2 – patients with NSTEMI that survived. Logistic regression was performed. Results 7453 patients were admitted with NSTEMI, 90 patients (1.2%) died during the in-hospital stay. Regarding epidemiological and past history, G1 was older (74±11 vs 66±12, p&amp;lt;0.001), had higher rates of arterial hypertension (83.9% vs 72.7%, p=0.02), renal insufficiency (19.3% vs 6.1%, p&amp;lt;0.001) and dementia (5.3% vs 0.7%, p&amp;lt;0.001). G1 had more patients taking diuretics (54.9% vs 25.7%, p&amp;lt;0.001) previously to the hospital admission, presented more frequently with fatigue (6.0% vs 0.6%, p=0.01) and Killip-Kimball class (KKC) &amp;gt; 1 (51.8% vs 11.5%, p&amp;lt;0.001), had higher rates of elevated brain natriuretic peptide (BNP) (61.8% vs 23.8%, p&amp;lt;0.001), multivessel disease (74.2% vs 50.5%, p&amp;lt;0.001) and had worse left ventricular systolic function &amp;lt;30% (27.0% vs 2.4%, p&amp;lt;0.001). Logist regression confirmed that patients previously taking diuretics (p=0.01, OR 1.99, CI 1.16-3.42), presenting with fatigue (p=0.01, OR 5.75, CI 1.45-22.96) and KKC &amp;gt; 1 (p=0.001, OR 2.66, CI 1.51-4.66) and with severe left ventricular systolic dysfunction &amp;lt;30% (p=0.01, OR 2.57, CI 1.21-5.46) were predictors of in-hospital death in patients presenting with NSTEMI. Conclusion In-hospital mortality in the setting of NSTEMI was associated with patients taking diuretics previously to the admission, fatigue and Killip-Kimball class &amp;gt; 1 at admission and with poorer left ventricular systolic function.

Neumonías bacterianas no neumocócicas (I). Infecciones por Legionella, fiebre Q y otras

Community-acquired pneumonia is a very common disease. In this thematic unit, we will dedicate 2 updates to reviewing pneumonias caused by bacteria that are less common in our setting, but which have distinctive characteristics, such as those which cause so-called «atypical» pneumonias. These are produced by microorganisms which cause very nonspecific clinical, analytical, and radiological changes. Therefore, the diagnosis is based on the epidemiological history and clinical suspicion in order to provide appropriate treatment, follow-up, and prevention. The most important microorganisms that cause atypical pneumonia are Legionella spp. and Coxiella burnetii. Their microbiological documentation is necessary, given that it has repercussions on public health and follow-up due to risk of chronicity. Other less common bacteria in which pneumonia is not the most habitual clinical presentation are those related to murine typhus, tularemia, pneumonic plague, and leptospirosis.

Genotypes Variation and Molecular Epidemiology Of The Hbv Chronic Liver Infection In The Local Population Of Pakistan: An Overview Of The Recent Literature

Hepatitis is defined as an enlargement of the liver. Viral hepatitis is the word used for the group of liver ailments generated by viral infections. There are approximately 350 million people worldwide who have chronic hepatitis B virus (HBV) infection. HBV is estimated to kill 563,000 people each year and cause a high rate of infection. The Hepatitis B DNA virus comprises of a 3.2 kb relaxed-spherical DNA molecule. Of the total eight genotypes of HBV, genotype D is the most common, with an actual incidence rate of 63.71%, followed by genotype A at 10%, according to ten distinct studies conducted in diverse parts of Pakistan. Symptoms may take up to six months to emerge after exposure. Early signs and symptoms of HBV infection are lethargy, nausea, poor appetite, vomiting, pyrexia, headache, muscle pain, joint pain, gastrointestinal disturbances, dark urine, and jaundice. Pakistan is one of the worst affected countries, with over 40 million Pakistanis infected with HBV. This article provides an overview of the epidemiology and natural history of HBV infection and its diagnosis and treatment.

COVID-19: Healthcare Workers May Be at Greater Risk Outside Their Work Environment—A Retrospective Observational Study

BackgroundWith the availability of coronavirus disease 2019 (COVID-19) vaccine, concerns have been raised regarding pre-vaccination seroprevalence in healthcare workers (HCW). This study examines the seroprevalence of HCW at an Israeli tertiary medical center before first BNT162b2 vaccination.MethodsThis was a retrospective observational study. Before vaccination, HCW at our center were offered serological testing. Data on their epidemiological, workplace, and quarantine history were collected. The SARS-CoV-2 IgG assay was performed pre-vaccination.ResultsA total of 4,519 (82.5%) of the HCW were tested. Of these, 210 were seropositive; 101 had no known history of COVID-19. Of the 101 asymptomatic HCW, only 3 (3%) had worked at COVID-19 departments, and 70 (69.3%) had not been previously quarantined. Positive serology was similarly distributed across age groups, and about 40% had no children. Nearly half of the HCW tested were administrative and service staff. Overall, seropositive tests were associated with having no children (OR 1.42, 95% CI 1.06–1.89; P=0.0218), history of having been quarantined without proof of disease (OR 6.04, 95% CI 4.55–8.01; P<0.001), and Arab ethnicity (OR 3.36, 95% CI 2.54–4.43; P<0.001). Seropositivity was also more prevalent in members of the administration compared to other sectors, medical and paramedical, who are exposed to patients in their daily work (OR 1.365, 95% CI 1.02–1.82; P=0.04).ConclusionsThe low percentage of asymptomatic COVID-19 among our HCW may reflect the high compliance to personal protective equipment use despite treating hundreds of COVID-19 patients. The relatively high number of childless seropositive HCW could reflect misconceptions regarding children as a main source of infection, leading to carelessness regarding the need for appropriate out-of-hospital protection.

Anemia and thrombocytopenia in HIV-positive pregnant women

BACKGROUND: During pregnancy and childbirth, anemia and thrombocytopenia are twice as common among HIV-positive women as in the general population. It has not been yet clear to what extent HIV affects the incidence of cytopenias, therefore, the correlation between the incidence and the HIV RNA level and CD4 count in HIV-positive pregnant women, as well as the role of antiretroviral therapy, requires further study.&#x0D; AIM: The aim of this study was to assess the effect of the HIV RNA level and CD4 count on the frequency of anemia and thrombocytopenia in HIV-positive pregnant women.&#x0D; MATERIALS AND METHODS: In this study, we analyzed social and demographic features, epidemiological personal history data, the frequency of pregnancy and delivery complications, and the timing of the initiation of antiretroviral therapy in 303 HIV-positive pregnant women, as well as the data of screening for HIV infection of their children. The study included 27 mother-child pairs with perinatal HIV transmission and 276 mother-child pairs without mother-to-child transmission of HIV. All pregnant women were divided into groups depending on the CD4 count and HIV RNA level. A comparative analysis of anemia and thrombocytopenia frequencies was carried out in the study groups.&#x0D; RESULTS: A direct correlation was revealed between the frequency of anemia and thrombocytopenia in HIV-positive pregnant women and markers of HIV infection: severe immunodeficiency (CD4 200 cells/l, p 0.01) and high HIV RNA levels (more than 100,000 copies / ml, p 0.01) in peripheral blood.&#x0D; CONCLUSIONS: We confirmed the high frequency of cytopenias in HIV-positive pregnant women, which exceeds the general population level. In addition, we demonstrated the effectiveness of prescribing antiretroviral therapy among women of reproductive age who planned to become pregnant or did not exclude the possibility of pregnancy (who did not use the effective methods of contraception), as a means of anemia and thrombocytopenia prevention during pregnancy.

Surgical treatment of a patient with live intracranial sparganosis for 17\xa0years

BackgroundThe incidence of sparganosis, especially intracranial live sparganosis is very low in China. Due to the lack of typical clinical manifestations, it is difficult to make a clear preoperative diagnosis of the disease, which often leads to delays the disease and serious consequences.Case presentationA 23-year-old man presented with a 17-year history of intermittent seizures and right extremity numbness and weakness. Magnetic resonance imaging (MRI) showed patchy, nodular and line-like enhancement. Enzyme-linked immunosorbent assay (ELISA) detected positive antibodies to Spirometra mansoni in peripheral blood and cerebrospinal fluid (CSF). In addition, during the operation, an ivory-colored live sparganosis was removed under the precise positioning of neuronavigation, and the patient was diagnosed with cerebral sparganosis. The patient began praziquantel and sodium valproate treatment after the operation, and was followed up for 3 months. There was no recurrence of epilepsy, and the weakness and numbness of the right limb improved.ConclusionNonspecific clinical manifestations often make the diagnosis of cerebral sparganosis difficult, and a comprehensive diagnosis should be made based on epidemiological history, clinical manifestations, ELISA results and imaging findings. Surgery is the preferred method for the treatment of cerebral sparganosis, and more satisfactory results can be achieved under the precise positioning of neuronavigation.

Clinical and epidemiological aspects of enterobiosis in preschoolers

The aim of the study is to analyze the clinical and epidemiological aspects of enterobiosis in preschool children. Materials and methods. The material for the study was the data of outpatient records of 164 patients with laboratory-confirmed enterobiosis aged 9 months to 17 years. Results. Of the 164 children who sought medical help, more than half — 54.9 % — were children of preschool age. The majority of children — 86.7 % were from organized collectives (nurseries, kindergartens). The reasons for the examination of children were diverse. More than half of cases of enetrobiosis (55.4 %) were detected in children according to the results of preventive examinations in children's institutions. Another part of the children — 43.4 % — sought medical help due to the presence of clinical symptoms and complaints. And only in a single case — 1.2 % — the child was examined as a contact with a sick family member. When collecting an epidemiological history, it was found that 58 % had geophagia (eating the earth), 30.1 % had onychophagia (the habit of biting nails). 7.2 % of the surveyed children and their parents indicated non-compliance with the rules of personal hygiene (the habit of not washing their hands before eating). 12 % of children had contact with pets (cats and dogs), including 4.8 % with dogs and 1.2 % with cats. Clinical manifestations of the disease, as a rule, occurred in children who sought medical help (50.1 %), and were not detected as a result of a preventive examination. All patients with enetrobiosis received therapy with albendazole and pyrantel in accordance with the instructions for these drugs. Conclusion. According to the results of the study, a wide prevalence of enetrobiosis was revealed among preschool children attending organized collectives. The main risk factors are bad habits, such as geo- and onychophagy, as well as lack of hand washing skills before eating. The most effective measures for the prevention of this parasitosis are timely periodic preventive examinations and hygienic training of preschool children.

Nationwide comprehensive epidemiological study of rare diseases in Japan using a health insurance claims database

BackgroundThere are more than 7000 rare diseases, most of which have no specific treatment. Disease profiles, such as prevalence and natural history, among the population of a specific country are essential in determining for which disease to research and develop drugs. In Japan, disease profiles of fewer than 2000 rare diseases, called Nanbyo, have been investigated. However, non-Nanbyo rare diseases remain largely uninvestigated. Accordingly, we revealed the prevalence and natural history of rare diseases among the Japanese population. This cross-disease study is the first to analyze rare-disease epidemiology in Japan with high accuracy, disease coverage, and granularity.MethodWe applied for permission to use the National Database of Health Insurance Claims and Specific Health Checkups of Japan (NDB), which covered 99.9% of public health insurance claims from hospitals and 97.9% from clinics as of May 2015. Then, we obtained 10 years of data on the number of patients of approx. 4500 rare diseases, by sex and age. We translated disease names and established correspondences between rare diseases in NDB and those in Orphanet. Accordingly, we compared the prevalence and natural history between them.ResultsAbout 3000 diseases in NDB are included in Orphanet and other medical databases. The data indicates that even if the Nanbyo systems do not cover a rare disease, its patients survive in many cases. Regarding natural history, genetic diseases tend to be diagnosed later in Japan than in the West. The data shown in this research are available in the Additional file 1 and the website of NanbyoData.ConclusionsOur research revealed the basic epidemiology and natural history of Japanese patients with some rare diseases using a health insurance claims database. The results imply that the coverage of the present Nanbyo systems is inadequate for rare diseases. Therefore, fundamental reform might be needed to reduce unfairness between rare diseases. Most diseases in Japan follow a tendency of natural history similar to those reported in Orphanet. However, some are detected later, partly because fewer clinical genetic tests are available in Japan than in the West. Finally, we hope that our data and analysis accelerate drug discovery for rare diseases in Japan.

The experience of specialized medical care by vascular surgeons in the COVID-19 pandemic

Introduction. The aim of the study was to analyze the provision of specialized medical care by vascular surgeons during the COVID-19 pandemic on the example of the Sverdlovsk Regional Clinical Hospital No. 1.Materials and methods. A retrospective analysis of the activities of vascular surgeons of Sverdlovsk Regional Clinical Hospital No. 1 in 2020 was conducted. In addition, an assessment was given of the organization of measures aimed at reducing nosocomial infection and the spread of a new coronavirus infection.Results. The number of outpatient visits to a vascular surgeon in 2020 decreased by about 10%, and the number of hospitalizations to the vascular surgery department decreased by more than a third compared to previous years. But in 2020, the number of consultations of a vascular surgeon with the use of telemedicine technologies increased almost 2 times. In the vast majority of cases, patients with abdominal aortic aneurysm underwent endovascular prosthetics, which significantly reduced the time spent in the hospital and minimized the risks of nosocomial infection with COVID-19. The preoperative preparation included: computed tomography of the lungs and determination of coronavirus RNA (SARS-CoV-2) by PCR. In addition, on the day of hospitalization, it was mandatory to conduct: thorough collection of an epidemiological history and characteristic complaints, thermometry. Also, in order to prevent the spread of a new coronavirus infection, isolators for temporary stay of patients with suspected COVID-19 were organized in the emergency room and hospital departments.Conclusions. All organizational measures at the Sverdlovsk Regional Clinical Hospital No. 1 have made it possible to minimize the risk of nosocomial infection and the spread of COVID-19, thereby ensuring continuous work on the provision of planned and emergency specialized medical care.

Clinical Features and Principles of Differential Diagnosis of Erysipelas

Purpose. The purpose is to find out the common and different features of the clinical course of erysipelas from other diseases that can imitate it. Materials and methods. 114 case histories of patients who were hospitalized in the center of purulent-septic surgery in the Non-profit municipal enterprise “City Hospital № 3” in Zaporizhzhia for the period 2019-2020 were analyzed. 123 patients, who underwent hospital treatment in the center during this period of time, were with post-injection abscesses of soft tissue, 184 - with soft tissue abscesses, 203 - with phlegmons of various localizations, 49 - with complicated panaritium, 3 of which - subcutaneous. Over the past 5 years, 127 patients were consulted in the clinic and other therapeutic, infectious, neurological and other departments of the city. A number of criteria and signs have been identified to differentiate erysipelas from diseases that may have similar clinical symptoms and a number of circumstances that need to be clarified. Results. It is established that the diagnosis of erysipelas does not require special laboratory examination and is made on the basis of examination of the patient, epidemiological history and medical history. Provoking factors in the development of erysipelas are: violation of the integrity of the skin (abrasions, scratches, abrasions, cracks, bruises, injuries); mycoses; a sharp change in temperature (supercooling, overheating); emotional stress; increased insolation. Erysipelas has a characteristic summer-autumn seasonality. In people engaged in physical labor, the disease is registered more often than in other types of work. Hereditary predisposition to the disease is observed in 10-15% of cases. In this regard, the presence of such factors as congenital and acquired venous insufficiency of the lower extremities, fungal infection of the lower extremities, the presence of postoperative and post-traumatic scars, lymphostasis, diabetes, cardiovascular disease and diseases accompanied by the development of edema, intake of corticosteroids or cytostatics are of essential significance in the development of the disease.&#x0D; Conclusions. Mathematical modeling between erysipelas and other diseases that have similar syndromes in their clinical picture may be useful in making a differential diagnosis between them.

Foodborne botulism: A brief review of cases transmitted by cheese products (Review).

Food safety constitutes a basic priority for public health. Foodborne botulism occurs worldwide; it is an acute paralytic disease caused by the consumption of food containing the botulinum toxin. Growing consumer demand for cheese products could result in increased exposure of the population to this toxin, and thus the risk of foodborne botulism. The majority of cases of botulism caused by dairy products are related to cheese products specifically. Epidemic outbreaks and isolated cases have been reported over time. Domestically canned foods are still among the primary causes of the disease. Cheese products are not regularly involved in botulism incidents; it is however, necessary to take control measures for manufacturing and domestic preparation due to the high risk of occurrence of this particular disease. The aim of this review is to discuss foodborne botulism caused by cheese products, providing a brief epidemiological history, and to examine certain control measures that should be taken throughout the production process to better protect public health.