Epidemiology History Research Articles

Epidemiological characteristics of tick-borne infectious diseases in Hubei Province, 2016-2021

Objective: To understand the epidemiological characteristics of tick-borne infectious diseases (TBID) and the risk factors of severe illness and death in Hubei Province from 2016 to 2021. Methods: Based on the incidence data of fever with thrombocytopenia syndrome (SFTS), tsutsugamushi disease, typhus and other TBID reported during 2016-2021, the epidemiological analysis was conducted. Field investigation results of TBID in areas with high incidence in 2021, logistic regression analysis of population characteristics, epidemiological history and other factors were used to explore the risk factors of severe and fatal cases. In the field vector investigation, free ticks and surface ticks of the host animals in the cases' home and surrounding grassland were monitored and detected. Results: A total of 3 826 TBID cases were reported in Hubei from 2016 to 2021, of which 71.30% (2 728/3 826) were SFTS, 13.04% (499/3 826) were tsutsugamushi disease and 15.66% (599/3 826) were typhus. A total of 44 cases died in 6 years; the fatality rate was 1.15% (44/3 826). In the peak seasons of incidence from May to July, the cases in people engaged in agriculture related work accounted for 84.61% (3 237/3 826). The incidence rate in women was higher than that in men, and the cases aged ≥50 years accounted for 81.02% of the total (3 100/3 826), and the incidence rate increased with age (P<0.001). The TBID cases were distributed in 86 counties and districts in 16 prefectures (municipality). The incidence rates of different areas had significant differences (P<0.05), and there was a certain spatial-temporal clustering and expasion. Bovis microplus and Haemaphysalis longicornis were captured in the field, and the positive rates in host animals and grassland ticks were 10.94% (7/64) and 40.00% (2/5), respectively. Univariate logistic regression analysis results showed that age ≥50 years and leukocyte <2.0×109/L were risk factors for severe illness and death. Conclusions: The TBID reported in Hubei were mainly SFTS, tsutsugamushi disease and typhus. In order to reduce the incidence of TBID, it is necessary to strengthen the prevention and control in women aged ≥50 years and reduce field exposure and tick bites during the epidemic period.

Covid-19 omicron variant infection in neonates of Guangdong province-a report of 52 cases.

To analyze the clinical characteristics of neonatal infection during the outbreak of COVID-19 omicron variant in Guangdong province of China. The clinical data of neonates infected with COVID-19 omicron variant were collected from three hospitals of Guangdong province, their epidemiological history, clinical manifestation and prognosis were summarized. From December 12, 2022 to January 15, 2023, a total of 52 neonates with COVID-19 infection were identified across three hospitals in Guangdong Province, including 34 males and 18 females. The age of diagnosis was 18.42 ± 6.32 days. 24 cases had clear contact history with adults who were suspected to be infected with COVID-19. The most common clinical manifestation was fever (43/52, 82.7%), the duration of fever was 1-8 days. The other clinical manifestations were cough (27/52, 51.9%), rales (21/52, 40.4%), nasal congestion (10/52, 19.2%), shortness of breath (2/52, 3.8%), and vomiting (4/52, 7.7%). C-reactive protein was only increased in 3 cases. Chest radiological examination was performed in 42 neonates, twenty-three cases showed abnormal chest radiographic findings, including ground-glass opacity and consolidation. Fifty cases were admitted with COVID-19 presentation, two cases were admitted for jaundice. The hospital stay was 6.59 ± 2.77 days. The clinical classification included 3 cases of severe COVID-19 and one critical case. Fifty-one cases were cured and discharged after general treatment, and one critical case with respiratory failure was intubated and transferred to another hospital. The COVID-19 omicron variant infection in neonates is usually mild. The clinical manifestation and laboratory results are not specific, and the short-term prognosis is good.

Unusual serological profile in hepatitis B virus (HBV) infection associated with a probable clinical case of acute exacerbation of pre-existing chronic HBV infection.

Acute or chronic HBV infection in an individual can be laboratory characterized according to the serological profile of the viral markers in the bloodstream, and the dynamics monitoring of these markers is necessary to assess the disorder course and the infection outcome. However, under certain circumstances unusual or atypical serological profiles may be observed in both acute and chronic HBV infection. They are considered as such because they do not properly characterize the form or infection clinical phase or because they seem inconsistent, considering the viral markers dynamics in both clinical contexts. This manuscript comprises the analysis of an unusual serological profile in HBV infection. This clinical-laboratory study, had as reference a patient who presented clinical profile suggestive of acute HBV infection after recent exposure, whose laboratory data were initially compatible with this clinical presentation. However, the serological profile analysis and its monitoring demonstrated unusual pattern of viral markers expression, which has been observed in several clinical contexts, and is often associated a number of agent- or host-related factors. The serological profile analyzed here, associated with the biochemical markers serum levels found, is indicative of active chronic infection, consequence of viral reactivation. This finding suggests that in the event of unusual serological profiles in HBV infection, if the influence of agent- or host-related factors is not properly considered and neither the viral markers dynamics properly analyzed, there may be mistake in the infection clinical diagnosis, especially when the patient's clinical and epidemiological history is unknown.

Growth history of hepatitis C virus among HIV/HCV co-infected patients in Guizhou Province.

Background: The evolutionary and epidemiological history and the regional differences of various hepatitis C virus (HCV) genotypes are complex. Our aim was to better understand the molecular epidemiology and evolutionary dynamics of HCV among HIV/HCV co-infected individuals in Guizhou Province. This information could contribute to improve HCV prevention and control strategies in Guizhou and surrounding provinces. Methods: The HCV RNA was extracted from the serum of HIV/HCV co-infected patients, and reverse transcription/nested PCR was performed to amplify nucleotide sequences of the C-E1 region. Then, the successfully amplified sequences were selected for phylogenetic analysis. The available C-E1 region reference sequences from the surrounding provinces of Guizhou (Guangxi, Yunnan, Hunan, and Sichuan) were retrieved in GenBank, and the evolutionary analysis by Bayesian Markov chain Monte Carlo (MCMC) algorithm was performed using BEAST software to reconstruct a phylogeographic tree in order to explore their migration patterns. Finally, the epidemiological history of HCV in the Guizhou region was retraced by reconstructing Bayesian skyline plots (BSPs) after excluding sequences from surrounding provinces. Results: Among 186 HIV/HCV co-infected patients, the C-E1 region sequence was successfully amplified in 177 cases. Phylogenetic analysis classified these sequences into six subtypes: 1a, 1b, 3a, 3b, 6a, and 6n. Among them, subtype 6a was the most dominant strain (n = 70), followed by 3b (n = 55), 1b (n = 31), 3a (n = 11), 1a (n = 8), and 6n (n = 2). By reconstructing the phylogeographic tree, we estimated that the 6a strain in Guizhou mainly originated from Yunnan and Guangxi, while the 3b strain emerged due to transmission from the IDU network in Yunnan. Subtypes 1b, 3a, 3b, and 6a, as the major subtypes of HCV in HIV/HCV co-infected individuals in Guizhou, emerged and later grew more rapidly than the national average. Notably, BSPs of the currently prevalent HCV predominant strain subtype 6a in Guizhou have shown a rapid population growth since 2004. Although the growth rate slowed down around 2010, this growth has continued to date. Conclusion: Overall, despite the improvement and implementation of a series of HCV prevention and control policies and measures, a delayed growth pattern may indicate a unique history of the spread of 6a in Guizhou. Its trend as the dominant strain in Guizhou in recent years may continue to increase slowly over subsequent years.

The History of Psychiatric Epidemiology in Finland: From National Needs to International Arenas, 1900s-1990s.

Psychiatric epidemiology has significantly influenced public health policies all around the world. This article discusses how Finnish epidemiologists reacted to local needs, which were born in specific circumstances and were controlled by science policy and funding opportunities. The development between the 1900s and 1990s is divided into three stages. The first Finnish studies in the field focused on the prevalence of mental illnesses in the country. The focus was to gain information for service planning, most of all to estimate the need for new hospitals and to set up the national social insurance system. After the Second World War, structural changes and social engineering fueled epidemiological interest. From the 1960s until the late 1980s, psychiatric epidemiology was interconnected with social psychiatry, which held a strong position in Finland. Since the 1990s, Finnish psychiatric epidemiology has been integrated with international epidemiology by using shared methodologies and through participation in transnational studies.

Poc (Pox), a term for various infectious diseases in the history of public health and epidemiology: the dreaded Smallpox, the almost unknown Alastrim and the Mpox.

In 2022, the appearance of cases of Mpox outside the countries where the disease is endemic, and of some cases of human-to-human transmission, alerted the scientific community to a virus that is closely related to the smallpox virus. Mpox is a zoonosis and can be transmitted to humans. Following the eradication of smallpox in 1980 and the subsequent cessation of smallpox vaccination, it is emerging as the most important Orthopoxvirus in terms of public health impact. In outlining the current situation of Mpox in the world, the authors frame the virus responsible within a broader reflection on the Orthopoxvirus family, focusing particular attention on the Variola virus, which formerly caused millions of deaths. Since Edward Jenner initiated the practice of vaccination, a progressive and careful vaccination campaign has led to the eradication not only of human smallpox but also of a minor form, called Alastrim, which was caused by the same virus. The mode of transmission of Mpox has been debated. At first, it seemed that the disease mainly, though not exclusively, affected men who had sex with other men. This conviction has been partially revised and the WHO recently changed the name of the disease from Monkeypox to Mpox, thereby alleviating the stigma involved. The recent human cases of Mpox have prompted greater surveillance and research into the biology of MPXV and other closely related poxviruses. Studies have focused on the natural history of the virus, its transmission, pathogenesis, host interactions and evolution, and on the development of drugs and vaccines to prevent its spread.

Multidrug-resistant Acinetobacter outbreak in spinal cord unit identified and stemmed through infection prevention epidemiologic efforts

Background: Drug-resistant pathogens are a significant source of increased cost and patient complications in long-term and/or congregate care settings. Once introduced, depending on the environmental niche in which they establish and the mechanisms they employ for survival, they can be difficult to eradicate. We report the details of an epidemiologic investigation of a multidrug-resistant Acinetobacter baumannii (MDR-A) outbreak in a spinal cord intervention (SCI) unit within a Veterans Affairs facility in San Antonio, Texas, that was identified after back tracing a positive wound culture from a long-term resident. Methods: All MDR-A isolates were matched to the patients harboring them. Their clinical, epidemiologic, and geographic histories within our facility were traced. All potentially shared characteristics between cases were evaluated closely. Results: In total, 5 cases were determined to be likely connected over a period of ~18 months starting December 2020. The extant isolates underwent molecular evaluation and were genetically related. Patient activity was traced by the infection prevention team to identify potential sources of transmission. Environmental sampling after standard cleaning found a common strain on a shower trolley shared by these patients. Following focused cleaning of this and other shared locations, no new related isolates have been identified from patient or environmental samples. Conclusions: In this case, investigation by the infection prevention team of a single multidrug-resistant organism led to identification and eradication of a potential pathogen. Despite standard cleaning processes, a likely shared fomite was identified and decontaminated, thereby preventing future infections. This case exemplifies the value of thorough epidemiologic study paired with modern molecular methods of identification.Disclosures: None

Long-term disease course, cost and prognosis of inflammatory bowel disease: epidemiological studies of a European and a Danish inception cohort.

Long-term disease course, cost and prognosis of inflammatory bowel disease: epidemiological studies of a European and a Danish inception cohort.

Computed tomography findings of pulmonary histoplasmosis: pictorial essay.

Endemic systemic mycoses are prevalent in specific geographic areas of the world and are responsible for high rates of morbidity and mortality in the populations of such areas, as well as in immigrants and travelers returning from endemic regions. Pulmonary histoplasmosis is an infection caused by Histoplasma capsulatum, a dimorphic fungus. This infection has a worldwide distribution, being endemic in Brazil. Histoplasmosis can affect the lungs, and its diagnosis and management remain challenging, especially in non-endemic areas. Therefore, recognition of the various radiological manifestations of pulmonary histoplasmosis, together with the clinical and epidemiological history of the patient, is essential to narrowing the differential diagnosis. This essay discusses the main computed tomography findings of pulmonary histoplasmosis.

Subacute brucellosis: A case report

Brucellosis is one of the most common zoonotic diseases worldwide. The epidemiological situation of brucellosis in the Russian Federation is characterized as unfavorable. Brucellosis remains a problem in regions with developed animal husbandry. The variety of clinical manifestations and the absence of specific symptoms of brucellosis make its diagnosis challenging. The clinical case presented in this paper illustrates the delayed diagnosis of brucellosis in a 10-year-old patient presenting with fever and enlarged lymph nodes, liver, and spleen. The failure in the provision of medical care was attributed to the lack of the alertness of doctors regarding brucellosis, insufficient interpretation of epidemiological history data, and incorrect assessment of the totality of the clinical syndrome of the disease and laboratory parameters. As a result, brucellosis was diagnosed only 6 months after disease onset. Subsequent etiotropic therapy led to the stabilization of the patients condition, who was discharged from the hospital with recommendations under the supervision of an infectious disease specialist.

Rheumatology and Long COVID: lessons from the study of fibromyalgia

Rheumatology, such as other subspecialties, has both a unique perspective to offer as well as an evolving role to play in the global COVID-19 pandemic. Our field has already contributed...

Rapid Diagnosis of Disseminated Tuberculosis Using Cell-free DNA Sequencing in a Kidney Transplant Recipient.

Here, we report a case of smear-negative disseminated tuberculosis (TB) in a kidney transplant recipient diagnosed using plasma cell-free DNA (cfDNA). A 68-y-old woman presented with 2 mo of fevers and a 15-pound weight loss. Six years earlier, she received a living donor kidney transplant from her husband for adult polycystic kidney disease. She received standard induction with antithymocyte globulin and maintenance immunosuppression with tacrolimus, mycophenolate mofetil, and low-dose prednisone. Her posttransplant course was uncomplicated. She was born and lived in Massachusetts and had not traveled internationally in many years. She worked in finance until she retired a few years prior. She had no history of incarceration or homelessness. Her hobbies included volunteering at a local food bank. On presentation, she was febrile to 38.8 °C and diaphoretic but otherwise appeared well. Her laboratory values were notable for a leukocytosis of 16 000 K/µL and a urinalysis with >100 white blood cells per high power field. There was no growth in the urine or blood cultures. Her nasopharyngeal multiplex polymerase chain reaction (PCR) was negative for common respiratory viruses. She had negative test results for Epstein-Barr virus DNA, cytomegalovirus DNA, HIV 1/2 antigen/antibody, cryptococcal and Histoplasma antigens. Chest computed tomography showed innumerable 1- to 3-mm bilateral nodules (Figure 1A) and lytic lesions of the T6 and T7 vertebral bodies. Spine magnetic resonance imaging demonstrated enhancing lesions involving the entire T6 and T7 bodies (Figure 1B).FIGURE 1.: Abnormal imaging findings. A, Chest CT scan with diffuse bilateral pulmonary nodules in a miliary pattern. B, MRI of the thoracic spine with enhancing lesions of the T6 and T7 vertebral bodies. CT, computed tomography.Further workup included bronchoalveolar lavage with multiple negative studies: bacterial cultures, Pneumocystis direct fluorescent antibody, galactomannan antigen, acid-fast bacilli (AFB) and modified AFB smear, and Mycobacterium tuberculosis PCR. Transbronchial biopsy was nondiagnostic, with negative AFB and fungal stains. Mycobacterial blood and urine cultures were also obtained. A biopsy of her T7 vertebral body noted chronic inflammation and 1 nonnecrotizing granuloma. On hospital day (HD) 13, while she remained febrile and without a definitive diagnosis, we sent a quantitative cfDNA test (Karius, Inc, Redwood City, CA). On HD 15, the Karius cfDNA test returned positive for M tuberculosis. Subsequently, the mycobacterial blood, urine, and bronchoalveolar lavage cultures grew M tuberculosis on HD 17, 17, and 21, respectively. Bone cultures grew M tuberculosis at 34 d after biopsy after the patient had been discharged from the hospital. Cell-free DNA tests have become increasingly prevalent in recent years, including donor-derived cfDNA, which is routinely used to detect allograft rejection. The Karius cfDNA test uses metagenomic next-generation sequencing to specifically detect microbial nucleic acid from over a thousand clinically relevant species in plasma.1 This was the first case of TB diagnosed by plasma cfDNA sequencing in our institution. The turnaround time of 48 h is a promising characteristic of this test, especially when slow-growing pathogens are suspected. Had it been obtained earlier in the course, this test would have not only expedited diagnosis and treatment initiation but also eliminated the need for invasive diagnostics. Nevertheless, like other molecular tests, cfDNA sequencing does not provide antimicrobial susceptibilities to guide antimicrobial therapy and thus does not eliminate the need for cultures. In a recent meta-analysis, cfDNA sequencing showed excellent specificity but poor pooled sensitivity for the diagnosis of TB.2 The very low-risk epidemiologic history for TB and disease onset in the late posttransplant period were other interesting features of this case. Her pretransplant T spot TB was negative. We considered donor-derived TB, but this was deemed unlikely because her donor was her husband, who was healthy and had a negative TB screening. She had no known exposures to TB, and her exposure to higher-risk populations via volunteerism was her only epidemiologic risk factor.

Towards a philosophy of psychiatric epidemiology

Two diametrically opposed approaches to the history of medicine in general, or to a specific area such as the history of psychiatric epidemiology, seem possible. A hagiographic account of a particular health specialization might emphasize how empirical observations have accumulated, how research methods have improved, how causal understanding has expanded and how such developments have contributed to rising levels of health. A critical account of, say, psychiatry epidemiology might on the other hand emphasize how empirical observations are theory-laden and therefore biased, how research methods have been intrusive or inappropriate, how causal understanding is poor and how such developments have contributed to, say, a powerful and profitable medical–industrial complex. Lovell and Oppenheimer argue that theirs is the first volume of historical scholarship addressing psychiatric epidemiology, tracing its historical development and the use of its methods to further social ends. In their introduction they discuss a well-known review by Dohrenwend and Dohrenwend of how psychiatric epidemiology has developed from first-generation investigations of hospital and agency records and informants through to third-generation population studies using structured diagnostic interviews.1 Some may see this as indicative of gradual progress in the field but Lovell and Oppenheimer emphasize instead that over time different constellations of research methods, professional bodies and sociopolitical contexts are apparent.

Challenges in Local Allergic Rhinitis Diagnosis, Management, and Research: Current Concepts and Future Perspectives.

Local allergic rhinitis (LAR) is diagnosed based on the presence of clinical symptoms such as rhinorrhea, sneezing, and nasal itching using negative skin prick testing and serum IgE assessment. Several novel studies have shown that it is possible to use the assessment of nasal sIgE (specific immunoglobulin E) secretion as an additional diagnostic criterion for local allergic rhinitis. Additionally, allergen immunotherapy is a promising-albeit still not fully assessed and evaluated-future method of managing patients with LAR. In this review, the historical background, epidemiology, and main pathophysiological mechanisms of LAR shall be presented. Additionally, we address the current state of knowledge based on selected articles regarding the assessment of the local mucosal IgE presence in response to exposure to such allergens as mites, pollen, molds, and others. The impact of LAR on quality of life as well as the possible options of management (including allergen immunotherapy (AIT), which showed promising results) will then be presented.

Characteristics of the epidemic process of Lyme borreliosis in the Sverdlovsk district over a 20-year period

Relevance. The Sverdlovsk district is a tense natural focus for Lyme borreliosis (LB) with a constantly recorded incidence that exceeds these indicators in the Russian Federation and the Ural Federal region several times. LB is registered on 56 of 59 administrative territories of the district. Currently, the count of LB in the Russian Federation includes both infections caused by Borrelia burgdorferi sensu lato group Borrelia and infections caused by Borrelia miyamotoi sensu lato group Borrelia.Aim. To characterize the epidemic process of LB in the territory of the Sverdlovsk district over a 20-year period (2002–2021).Materials and methods. The paper uses data from federal and regional statistical observations, reporting materials of the Department of Rospotrebnadzor in the Sverdlovsk district for 2002–2021, methods of statistical analysis.Results and discussion. During the follow–up period (2002–2021), the incidence rate of BL in the Sverdlovsk district exceeded the average long-term level in the Russian Federation by almost 3 times, and in the Ural Federal region – by 1.8 times. Among the mechanisms and ways of transmission of LB pathogens, the vector-borne mechanism dominated (84.5%), the share of the unidentified pathway was 15.4%, alimentary (when using raw goat's milk) – 0.1%. The duration of the epidemic season for LB in the district was 10 months (from March to December) with a peak incidence in June. Cases of LB were registered among people of different ages, with a predominance in the group of 60 years and older (39.1%). An analysis of the distribution of people with LB by social composition showed that pensioners prevailed among them – 36.3%, officials made up 27.8%, unemployed – 14.1%. Among the cases, a high proportion of schoolchildren and children under 7 years old were noted. It was found that erythematous and non-erythematous forms of LB are registered in the district, with a predominance of erythematous (64.5%). The main etiological agent of the erythematous form is Borrelia garinii, while the non-erythematous form is Borrelia miyamotoi and B. garinii. In the general structure of morbidity, the number of cases of LB is largely determined by the city inhabitants (92.9%). There were no fatal outcomes in LB in the territory of the district during the studied period.Conclusions. Due to the lack of vaccination of LB worldwide, the only strategy to reduce the incidence of LB is non-specific prevention and timely diagnosis of the disease, including data from epidemiological history, clinical and laboratory diagnostics. The long-term clinical and epidemiological and laboratory studies conducted by us in the Sverdlovsk district allowed us to characterize the main manifestations of the epidemic process of LB and to improve the diagnosis of the disease.

Viewing Psychiatric Epidemiology Within a Global Historical Framework to Shape Future Practice

This Viewpoint discusses the benefits of rethinking the history of psychiatric epidemiology from a global perspective.

Hemoptysis: differential diagnosis in the practice of a family doctor

Hemoptysis is the expectoration of sputum with blood from the larynx, bronchi, or lungs. Hemoptysis is most often caused by diseases of the respiratory tract and lungs: bronchitis, pneumonia, lung cancer, aspergilloma, tuberculosis, bronchiectasis, pulmonary embolism, etc. In the diagnostic search for the cause of hemoptysis, it is important to take a detailed history (in the case of an epidemiological history — a laboratory analysis of sputum to detect the causative agent of an infectious disease), interpret patient complaints correctly, and assess the nature of sputum (differential diagnosis with bleeding from the upper gastrointestinal tract). An X-ray of the chest organs is performed, and then, computed tomography, bronchoscopy, and other studies are carried out according to indications. The article presents an algorithm for differential diagnostic search in a patient with hemoptysis.

Epidemiology and Post-Discharge Resource Utilization of Isolated Traumatic Brain Injury in Geriatric Patients.

Benchmark data on traumatic brain injury (TBI) are potentially confounded by morbidity and rehabilitation needs associated with coincident extracranial injuries. Using data on isolated head injuries from 13 trauma centers in Georgia over 3years, we studied the epidemiology and natural history of isolated TBI in geriatric vs non-geriatric patients in order to identify potential areas for quality improvement. We identified 8 512 patients, 3 895 of whom were geriatric. Geriatric patients had higher baseline comorbidity burden, mostly presented after ground level falls, had higher mortality despite equivalent ICU admission rates, and had higher rates of post-discharge resource utilization than non-geriatric counterparts. Geriatric patients are more likely to require post-discharge services and/or facility placement, regardless of pre-injury functional status. These data highlight the importance of streamlined protocols that place an early focus on post-discharge needs and goals of care, informed by cohort-specific prognosis data.

Disorders of the hemostatic system in patients with COVID-19 infection of varying severity

Aim to evaluate the individual characteristics of the hemostatic system and lungs CT-scan data in patients with a new coronavirus infection caused by the COVID-19, depending on the severity of the disease.&#x0D; Material and methods.A comparative analysis included the results of clinical, epidemiological and laboratory examination of 209 COVID-19 patients divided in two groups: in-patients of the Samara State Medical University Clinics with moderate (n=106) and severe (n=103) course of the disease. The diagnosis was verified by enzyme immunoassay (ELISA) and polymerase chain reaction (PCR). The following indicators were analyzed: gender, age, body mass index (BMI), epidemiological history, clinical signs of the disease, severity, degree of lung damage according to the results of computed tomography (CT).&#x0D; Results.There were no significant differences between the groups in terms of gender and age characteristics, as well as epidemiological data of COVID-19 patients. In 91% of patients with severe COVID-19, the clinical manifestations of hemorrhagic syndrome were recorded in the form of ecchymoses at injection sites, and in 75% - in the form of bleeding of various localization. The changes in the hemostatic system in patients with severe COVID-19 were characterized by high levels of platelets, INR, APTT, fibrinogen and a decrease in PI. In patients with severe COVID-19, a positive correlation was established between the level of fibrinogen, INR, APTT, PI and consolidation of lung tissue, as well as between the level of INR, APTT, PI and the presence of lung lesions in the form of "ground-glass" opacities on the CT images.

Interpretation on Consensus on drug-induced liver injury by CIOMS Working Group:liver injury attributed to herbal and dietary supplements

With the increase in the medical level, the improvement of adverse drug reaction(ADR) monitoring systems, and the enhancement of public awareness of safe medication, drug safety incidents have been frequently reported. Drug-induced liver injury(DILI), especially liver injury attributed to herbal and dietary supplements(HDS), has globally attracted high attention, bringing great threats and severe challenges to the people for drug safety management such as clinical medication and medical supervision. Consensus on drug-induced liver injury had been published by the Council for International Organizations of Medical Sciences(CIOMS) in 2020. In this consensus, liver injury attributed to HDS was included in a special chapter for the first time. The hot topics, including the definition of HDS-induced liver injury, epidemiological history, potential risk factors, collection of related risk signals, causality assessment, risk prevention, control and management were discussed from a global perspective. Based on the previous works, some experts from China were invited by CIOMS to undertake the compilation of this chapter. Meanwhile, a new causality assessment in DILI based on the integrated evidence chain(iEC) method was widely recognized by experts in China and abroad, and was recommended by this consensus. This paper briefly introduced the main contents, background, and characteristics of the Consensus on drug-induced liver injury. Significantly, a brief interpretation was illustrated to analyze the special highlights of Chapter 8, &quot;Liver injury attributed to HDS&quot;, so as to provide practical references for the medical staff and the researchers who worked on either Chinese or Western medicine in China.