Low-incidence Regions Research Articles

514VP Latent tuberculosis infection in myasthenia gravis patients in a low-incidence region

514VP Latent tuberculosis infection in myasthenia gravis patients in a low-incidence region

Comprehensive computational and pharmacokinetic investigation of an amide derivative (C34H34N8O4S2) as a potential drug candidate for tuberculosis: Unraveling structural analysis and reactivity descriptors

Despite the early success of tuberculosis combination therapies, which have high cure rates and low relapse rates, drug-resistant strains of Mycobacterium tuberculosis have continued to emerge in both high- and low-incidence regions. This has made the exploration of antitubercular compounds highly important; thus, the present study explored the antitubercular activities of amide derivatives (BTPs). This research utilized computational techniques, particularly DFT at the ωB97XD/6–311++g(2d,2p) level of theory, to explore various aspects of a chemical compound, including the nature of chemical bonds and intra/intermolecular bonding analysis. The antitubercular activities of the investigated compounds were assessed through pharmacokinetics and molecular docking studies. This study reported substantial findings, beginning with high energy gaps of 8.072 eV, 8.074 eV, 7.954 eV, and 8.0736 eV for ACE, DMSO, gas, and water, respectively, defining the stability of the investigated compound. Pharmacokinetic studies revealed that carcinogenicity, hepatotoxicity, cytotoxicity, mutagenicity, and immunogenicity were all predicted to be inactive, with probabilities of P = 0.57, P = 0.97, P = 0.78, P = 0.85, and P = 0.99, respectively. Furthermore, molecular docking studies revealed that the interaction of the compound with the EmbC receptor (PDB ID: 3PTY) resulted in a good binding affinity of −7.0 kcal/mol with six (6) hydrogen bonds, suggesting that it is a potential candidate antitubercular compound. Therefore, the amide derivatives studied herein are recommended for exploration, particularly in in vitro and in vivo analyses.

Prostate cancer severity prediction in advanced age groups in low incidence region

Prostate cancer severity prediction in advanced age groups in low incidence region

Determination of Prostate Specific Antigen Level among Male Patients with Bacterial Urinary Tract Infections Attending Kuje General Hospital Abuja, Nigeria

Recent hospital and cancer registry data shows increasing prostate cancer incidence in Nigeria, which was previously regarded as a low incidence region. Prostate cancer is the leading cause of cancer death among men in Nigeria and second most common cancers of men worldwide and sexual history has been a consistent risk factor. Prostate specific antigen (PSA) test is still the single most important test for early detection of prostate cancer worldwide. However, not much is reported about prostate cancer in relation to urinary tract infections in Africa. This study investigates the prevalence of prostate cancer risk in and bacterial urinary tract infections among men in Abuja, Nigeria. One Hundred (100) samples each of blood and urine were collected, from fifty (50) male patients suffering from urinary tract infections and fifty (50) apparently healthy males attending Kuje General Hospital Abuja, Nigeria. All the blood samples were subjected to PSA analysis using Enzyme-linked Immunosorbent Assay procedure (Diagnostic Automation/ Cortez Diagnostics, Inc, USA) while urine analysis (microscopy, culture and biochemical identification) was performed on the urine to isolate and identify the common bacteria associated with urinary tract infections among the study population.

Serologic Testing for Rocky Mountain Spotted Fever in a Low-Incidence Region.

Tick-borne diseases have grown in incidence over recent decades. As a result, diagnostic testing has become more common, often performed as broad antibody-based panels for multiple tick-transmitted pathogens. Rocky Mountain spotted fever (RMSF) is rare in our region yet may cause severe morbidity, leading to diagnostic screening in low-risk patients. We sought to describe trends in RMSF diagnostic testing, rate of IgG seropositivity, and clinical features of those tested. We performed a retrospective chart review of patients ≤21 years old undergoing testing for RMSF and/or with an ICD-9/10 code for RMSF. Patients were categorized by infection likelihood based on clinical and laboratory criteria adapted from Centers for Disease Control and Prevention's (CDC) case definition of spotted fever rickettsioses. Clinical data were collected and analyzed with descriptive statistics. One hundred and seventy patients were included. 5.8% met CDC criteria for rickettsial infection, 6.5% had an elevated IgG titer but lacked suggestive symptoms, and 87.6% had a negative IgG titer. Many patients tested were unlikely to have RMSF, including 50% lacking fever, 20% lacking any RMSF "classic triad" symptoms, 13% without acute illness, and 22% tested during months with low tick activity. Convalescent serology was performed in 7.6% of patients and none underwent Rickettsia rickettsii polymerase chain reaction (PCR) testing. Diagnostic testing was frequently performed in patients unlikely to have RMSF. We identified many opportunities for improving test utilization. Reserving testing for those with higher pretest probability, performing convalescent serology, and utilizing PCR may improve the accuracy of RMSF diagnosis and reduce clinical challenges stemming from inappropriate testing.

Risk Factors in HIV-1 Positive Patients on the Intensive Care Unit: A Single Center Experience from a Tertiary Care Hospital.

HIV-positive patients with acquired immunodeficiency syndrome (AIDS) often require treatment on intensive care units (ICUs). We aimed to present data from a German, low-incidence region cohort, and subsequently evaluate factors measured during the first 24 h of ICU stay to predict short- and long-term survival, and compare with data from high-incidence regions. We documented 62 patient courses between 2009 and 2019, treated on a non-operative ICU of a tertiary care hospital, mostly due to respiratory deterioration and co-infections. Of these, 54 patients required ventilatory support within the first 24 h with either nasal cannula/mask (n = 12), non-invasive ventilation (n = 16), or invasive ventilation (n = 26). Overall survival at day 30 was 77.4%. While ventilatory parameters (all p < 0.05), pH level (c/o 7.31, p = 0.001), and platelet count (c/o 164,000/µL, p = 0.002) were significant univariate predictors of 30-day and 60-day survival, different ICU scoring systems, such as SOFA score, APACHE II, and SAPS 2 predicted overall survival (all p < 0.001). Next to the presence or history of solid neoplasia (p = 0.026), platelet count (HR 6.7 for <164,000/µL, p = 0.020) and pH level (HR 5.8 for <7.31, p = 0.009) remained independently associated with 30-day and 60-day survival in multivariable Cox regression. However, ventilation parameters did not predict survival multivariably.

Different mutation rates in the basal core promoter and precore regions between hepatitis B virus subgenotype F1b clusters.

Hepatitis B virus (HBV) is the main etiological agent of hepatocellular carcinoma (HCC) worldwide. It has been classified into nine genotypes and several subgenotypes, with uneven global distribution. There is growing evidence that the viral genotype influences the course and outcome of chronic hepatitis B infection. Two evolutionarily different clusters of the subgenotype F1b, called basal and cosmopolitan, have been described. The two clusters have constrained geographical distribution, with the particular feature that the basal cluster is present in regions of high HCC incidence, while the Cosmopolitan cluster is found in regions of low HCC incidence. The BCP/pC region was sequenced in 68 cases chronically infected with the F1b subgenotype to determine if there was a differential pattern of pathogenic-associated mutations between both clusters. Twenty-two of the 68 cases belonged to the subgenotype F1b basal cluster and 46 to the cosmopolitan cluster. Among the HBeAg-negative patients the A1762T/G1764A and G1896A mutations were more frequently found in the basal samples (85.7 and 92.9%) compared to the cosmopolitan ones (50 and 18.2%). Interestingly, no HBeAg loss-associated mutations were observed in 7.1 and 36.4% of the basal and cosmopolitan cases, respectively. The different rate of mutations associated with a more severe course of chronic hepatitis in the basal cluster would support the difference in the HCC incidence rate in the geographical regions where the basal cluster is restricted.

1313. Clinical significance of Rickettsia rickettsii antibody testing among children in Eastern Long Island, New York

Abstract Background Rocky Mountain spotted fever (RMSF) is a tickborne illness caused by Rickettsia rickettsii (Rr). Diagnosis is challenging due to non-specific symptoms and reliance on convalescent antibodies (Ab) for definitive diagnosis. Early doxycycline administration reduces poor outcomes but is sometimes prescribed without clear exposure or suggestive symptoms. Confusion also arises from positive Ab testing in patients lacking RMSF symptoms. Our study aims to describe Rr Ab results and clinical impact in a low incidence region. Specific objectives were to describe signs and symptoms of children tested for RMSF, false-positive Ab rates, and unnecessary antibiotic administration. Methods Retrospective chart review of patients ≤ 21 years old tested for Rr Ab within the Stony Brook Medicine system from 2010-2020. Patients were identified by ICD-9/-10 RMSF diagnosis code and/or Ab test results. Charts without clinical notes were excluded. Data collected included demographics, symptoms, laboratory results, treatments, and outcomes. Patients were classified as RMSF confirmed, probable, suspected, unlikely, or negative based on symptoms and Ab results, per CDC definitions (Table). Results recorded in Qualtrics. Descriptive statistics were calculated. ‘Unlikely RMSF’ cases were considered false positive Ab and ‘proven’ or ‘probable’ cases were considered true positive Ab. Case definitions based on CDC Rocky Mountain spotted fever (RMSF) case surveillance definition Abbreviation: Rr - Rickettsia rickettsii Results 172 charts were included. Average age was 14 years. 56% were male. Of RMSF classic triad symptoms, 52% had fever, 41% rash, and 44% headache. Of RMSF case categories, 2 (1.2%) were confirmed, 3 (1.7%) probable, 10 (5.8%) suspected, 14 (8.1%) unlikely, and 143 (83%) negative. Both confirmed cases had fever, rash and headache. False positive and true positive Rr Ab rates were 8.9% (n=5) and 2.9% (n=5), respectively. 5 patients with false positive Ab received doxycycline within 14 days of Ab collection date. Conclusion Among children in a low-incidence region, Rr Ab were frequently obtained without signs of infection, including half without fever. The cause of false positive Rr Ab in patients lacking RMSF symptoms is unknown, but may be due to non-severe infection or cross-reactivity with other Rickettsia. Focused testing on those with suggestive symptoms may avoid unnecessary treatment and anxiety. Disclosures All Authors: No reported disclosures.

Heightened Risk for Gastric Cancer Among Immigrant Populations in New York State From High-Incidence Countries

Emerging global evidence points to country of origin as an important risk factor for developing gastric cancer (GC). Immigrants from high-incidence countries for GC may retain an increased risk despite living in low-incidence regions, and precursor lesions such as intestinal metaplasia may be more common in foreign-born individuals than in individuals born in the United States, particularly within high-risk racial/ethnic groups.1,2 Although the United States had 51 million immigrants in 2020—the highest number of foreign-born residents globally—data on the association between immigrant status and GC risk within the United States remain limited.

An international report on bacterial communities in esophageal squamous cell carcinoma.

The incidence of esophageal squamous cell carcinoma (ESCC) is disproportionately high in the eastern corridor of Africa and parts of Asia. Emerging research has identified a potential association between poor oral health and ESCC. One possible link between poor oral health and ESCC involves the alteration of the microbiome. We performed an integrated analysis of four independent sequencing efforts of ESCC tumors from patients from high- and low-incidence regions of the world. Using whole genome sequencing (WGS) and RNA sequencing (RNAseq) of ESCC tumors from 61 patients in Tanzania, we identified a community of bacteria, including members of the genera Fusobacterium, Selenomonas, Prevotella, Streptococcus, Porphyromonas, Veillonella and Campylobacter, present at high abundance in ESCC tumors. We then characterized the microbiome of 238 ESCC tumor specimens collected in two additional independent sequencing efforts consisting of patients from other high-ESCC incidence regions (Tanzania, Malawi, Kenya, Iran, China). This analysis revealed similar ESCC-associated bacterial communities in these cancers. Because these genera are traditionally considered members of the oral microbiota, we next explored whether there was a relationship between the synchronous saliva and tumor microbiomes of ESCC patients in Tanzania. Comparative analyses revealed that paired saliva and tumor microbiomes were significantly similar with a specific enrichment of Fusobacterium and Prevotella in the tumor microbiome. Together, these data indicate that cancer-associated oral bacteria are associated with ESCC tumors at the time of diagnosis and support a model in which oral bacteria are present in high abundance in both saliva and tumors of some ESCC patients.

Early experience with total robotic D2 gastrectomy in a low incidence region: surgical perspectives

BackgroundFew European centers have reported on robotic gastrectomy for malignancy. We report our early experience with curative-intent total robotic gastrectomy.Materials and methodsThe Intuitive Surgery Da Vinci Surgical System Xi 4 armed robot was used. Routine D2 lymphadenectomy was applied.ResultsSome 27 patients with adenocarcinoma (n = 18), hereditary cancer susceptibility (n = 8) and premalignancy (n = 1) were allocated to robotic gastrectomy, three were excluded due to inoperability during surgery. Median (range) age was 66 (18–87) years, 14 (58.3%) were females and body mass index was 25.5 (22.1–33.5) kg/m2. Total gastrectomy was performed in 19 (79.2%) and subtotal in five (20.8%) patients. One (4.2%) procedure was converted to laparotomy. Procedural time was 273 (195–427) minutes. Three (12.5%) patients were reoperated within 30 days, one (4.2%) died. Serious complications (Clavien Dindo IIIb or more) occurred in three (12.5%) patients. Postoperative hospital stay was 10 (6–43) days. Fourteen of 16 (87.5%) patients with adenocarcinoma/premalignancy received radical resections. The median number of harvested lymph nodes was 20 (11–34). Eleven (73.3%) patients with adenocarcinoma had T3/T4 tumors and 6 (40%) had TNM stage III or more.ConclusionTotal robotic D2 gastrectomy appears feasible and safe during early introduction in a low incidence region.

Effectiveness of nationwide programmatic testing and treatment for latent tuberculosis infection in migrants in England: a retrospective, population-based cohort study

SummaryBackgroundIn low-incidence countries, tuberculosis mainly affects migrants, mostly resulting from reactivation of latent tuberculosis infection (LTBI) acquired in high-incidence countries before migration. A nationwide primary care-based LTBI testing and treatment programme for migrants from high-incidence countries was therefore established in high tuberculosis incidence areas in England. We aimed to assess the effectiveness of this programme.MethodsWe did a retrospective, population-based cohort study of migrants who registered in primary care between Jan 1, 2011, and Dec 31, 2018, in 55 high-burden areas with programmatic LTBI testing and treatment. Eligible individuals were aged 16–35 years, born in a high-incidence country, and had entered England in the past 5 years. Individuals who tested interferon-γ release assay (IGRA)-negative were advised about symptoms of tuberculosis, whereas those who tested IGRA-positive were clinically assessed to rule out active tuberculosis and offered preventive therapy. The primary outcome was incident tuberculosis notified to the national Enhanced Tuberculosis Surveillance system.FindingsOur cohort comprised 368 097 eligible individuals who had registered in primary care, of whom 37 268 (10·1%) were tested by the programme. 1446 incident cases of tuberculosis were identified: 166 cases in individuals who had IGRA testing (incidence 204 cases [95% CI 176–238] per 100 000 person-years) and 1280 in individuals without IGRA testing (82 cases [77–86] per 100 000 person-years). Overall, in our primary analysis including all diagnosed tuberculosis cases, a time-varying association was identified between LTBI testing and treatment and lower risk of incident tuberculosis (hazard ratio [HR] 0·76 [95% CI 0·63–0·91]) when compared with no testing. In stratified analysis by follow-up period, the intervention was associated with higher risk of tuberculosis diagnosis during the first 6 months of follow-up (9·93 [7·63–12·9) and a lower risk after 6 months (0·57 [0·41–0·79]). IGRA-positive individuals had higher risk of tuberculosis diagnosis than IGRA-negative individuals (31·9 [20·4–49·8]). Of 37 268 migrants who were tested, 6640 (17·8%) were IGRA-positive, of whom 1740 (26·2%) started preventive treatment. LTBI treatment lowered the risk of tuberculosis: of 135 incident cases in the IGRA-positive cohort, seven cases were diagnosed in the treated group (1·87 cases [95% CI 0·89–3·93] per 1000 person-years) and 128 cases were diagnosed in the untreated group (10·9 cases [9·16–12·9] per 1000 person-years; HR 0·14 [95% CI 0·06–0·32]).InterpretationA low proportion of eligible migrants were tested by the programme and a small proportion of those testing positive started treatment. Despite this, programmatic LTBI testing and treatment of individuals migrating to a low-incidence region is effective at diagnosing active tuberculosis earlier and lowers the long-term risk of progression to tuberculosis. Increasing programme participation and treatment rates for those testing positive could substantially impact national tuberculosis incidence.FundingNational Institute for Health Research Health Protection Research Unit in Respiratory Infections.

Nasopharyngeal carcinoma patients from Norway show elevated Epstein-Barr virus IgA and IgG antibodies prior to diagnosis

BackgroundIgA antibodies against few Epstein-Barr virus (EBV) proteins are established serological markers for nasopharyngeal carcinoma (NPC). We recently validated a novel, comprehensive EBV marker panel and showed that IgA, but also IgG antibodies against multiple EBV proteins are highly sensitive and specific for EBV-positive NPC at diagnosis. However, data about these novel biomarkers as prospective markers for NPC are sparse. MethodsThis study included 30 incident NPC cases and 60 matched controls from the Norwegian Janus Serum Bank. For 21 NPCs, molecular EBV and human papillomavirus (HPV) status were assessed by EBER-ISH and HPV DNA/RNA testing by PCR, respectively. IgA and IgG serum antibodies against 17 EBV antigens were analyzed in prediagnostic sera of cases (median lead time 14 years) and controls using multiplex serology. Sensitivities were calculated using receiver operating characteristic analysis pre-specified to yield 90% specificity in the control group. From 10 cases, serial samples were available. ResultsQuantitative EBV antibody levels were significantly elevated among all cases (p < 0.05) for three IgA and six IgG antibodies. The highest sensitivities for defining 12 EBER-ISH-positive NPCs were observed for BGLF2 IgA (67%) and BGLF2 IgG (83%). Increased IgA and IgG antibody levels between the first and last draw before diagnosis were observed for EBER-ISH positive, but not for EBER-ISH negative NPCs. Among 21 molecularly analyzed NPCs, 4 EBER-ISH negative NPCs showed concomitant positivity to HPV type-specific DNA and RNA; 3 NPCs were HPV16 and 1 NPC was HPV18 positive. ConclusionBoth, EBV IgA and IgG antibody levels are significantly elevated many years before diagnosis of EBV-positive NPCs in Norway, an NPC low-incidence region. This study provides insights into one of the largest available prospective sample collections of NPCs in a non-endemic country.

Screening for SARS-CoV-2 in non-symptomatic students and staff shows safe school openings under varying incidence with sufficient mandatory measures.

Screening for SARS-CoV-2 in non-symptomatic students and staff shows safe school openings under varying incidence with sufficient mandatory measures.

SARS-CoV-2 seroprevalence in health care workers from 10 hospitals in Quebec, Canada: a cross-sectional study.

Background:The COVID-19 pandemic has disproportionately affected health care workers. We sought to estimate SARS-CoV-2 seroprevalence among hospital health care workers in Quebec, Canada, after the first wave of the pandemic and to explore factors associated with SARS-CoV-2 seropositivity.Methods:Between July 6 and Sept. 24, 2020, we enrolled health care workers from 10 hospitals, including 8 from a region with a high incidence of COVID-19 (the Montréal area) and 2 from low-incidence regions of Quebec. Eligible health care workers were physicians, nurses, orderlies and cleaning staff working in 4 types of care units (emergency department, intensive care unit, COVID-19 inpatient unit and non-COVID-19 inpatient unit). Participants completed a questionnaire and underwent SARS-CoV-2 serology testing. We identified factors independently associated with higher seroprevalence.Results:Among 2056 enrolled health care workers, 241 (11.7%) had positive SARS-CoV-2 serology. Of these, 171 (71.0%) had been previously diagnosed with COVID-19. Seroprevalence varied among hospitals, from 2.4% to 3.7% in low-incidence regions to 17.9% to 32.0% in hospitals with outbreaks involving 5 or more health care workers. Higher seroprevalence was associated with working in a hospital where outbreaks occurred (adjusted prevalence ratio 4.16, 95% confidence interval [CI] 2.63–6.57), being a nurse or nursing assistant (adjusted prevalence ratio 1.34, 95% CI 1.03–1.74) or an orderly (adjusted prevalence ratio 1.49, 95% CI 1.12–1.97), and Black or Hispanic ethnicity (adjusted prevalence ratio 1.41, 95% CI 1.13–1.76). Lower seroprevalence was associated with working in the intensive care unit (adjusted prevalence ratio 0.47, 95% CI 0.30–0.71) or the emergency department (adjusted prevalence ratio 0.61, 95% CI 0.39–0.98).Interpretation:Health care workers in Quebec hospitals were at high risk of SARS-CoV-2 infection, particularly in outbreak settings. More work is needed to better understand SARS-CoV-2 transmission dynamics in health care settings.

Psychological distress of mental health workers during the COVID-19 pandemic: A comparison with the general population in high- and low-incidence regions.

ObjectiveDespite their essential role during this health crisis, little is known about the psychological distress of mental health workers (MHW).MethodA total of 616 MHW and 658 workers from the general population (GP) completed an online survey including depressive, anxiety, irritability, loneliness, and resilience measures.ResultsOverall, MHW had fewer cases with above cut‐off clinically significant depression (19% MHW vs. 27%) or anxiety (16% MHW vs. 29%) than the GP. MHW in high‐incidence regions of COVID‐19 cases displayed the same levels of depressive and anxiety symptoms than the GP and higher levels compared to MHW from low‐incidence regions. MHW in high‐incidence regions presented higher levels of irritability and lower levels of resilience than the MHW in low‐incidence regions. Moreover, MHW in high‐incidence regions reported more feelings of loneliness than all other groups.ConclusionImplications for social and organizational preventive strategies to minimize the distress of MHW in times of crisis are discussed.

A genome epidemiological study of mycobacterium tuberculosis in subpopulations with high and low incidence rate in Guangxi, South China

BackgroundTuberculosis (TB) is caused by a bacterium called Mycobacterium tuberculosis (Mtb). China is the third in top 8 high TB burden countries and Guangxi is one of the high incidence areas in South China. Determine bacterial factors that affected TB incidence rate is a step toward Ending the TB epidemic.ResultsGenomes of M. tuberculosis cultures from a relatively high and low incidence region in Guangxi have been sequenced. 347 of 358(96.9%) were identified as M. tuberculosis. All the strains belong to Lineage 2 and Lineage 4, except for one in Lineage 1. We found that the genetic structure of the M. tuberculosis population in each county varies enormously. Low incidence rate regions have a lower prevalence of Beijing genotypes than other regions. Four isolates which harbored mutT4-48 also had mutT2-58 mutations. It is suggested that strains from the ancestors of modern Beijing lineage is circulating in Guangxi. Strains of modern Beijing lineage (OR=2.04) were more likely to acquire drug resistances than Lineage 4. Most of the lineage differentiation SNPs are related to cell wall biosynthetic pathways.ConclusionsThese results provided a higher resolution to better understand the history of transmission of M. tuberculosis from/to South China. And the incidence rate of tuberculosis might be affected by bacterial population structure shaped by demographic history. Our findings also support the hypothesis that Modern Beijing lineage originated in South China.

Sars-Cov2 Not Detected in a Pediatric Population With Acute Respiratory Infection in Primary Care in Central and Southern Italy From November 2019 to Early March 2020.

Background: In December 2019, a novel coronavirus named SARS-CoV-2 started circulating in China and this led to a major epidemic in Northern Italy between February and May 2020. Young children (aged <5 years) seem to be less affected by this coronavirus disease (COVID-19) compared to adults, although there is very little information on the circulation of this new virus among children in Italy. We retrospectively tested nasopharyngeal swabs for SARS-CoV-2 in samples collected in young children between November, 2019 and March, 2020 in the context of the RSV ComNet study.Methods: Two networks of primary care pediatricians in Lazio (Central Italy) and Puglia (Southern Italy) collected nasopharyngeal swabs from children, aged <5 years, presenting with symptoms for an acute respiratory infection (ARI). The RSV ComNet study is a multicenter study implemented to estimate the burden of RSV in young children (aged <5 years) in the community. Swabs were sent to a central reference laboratory and tested for 14 respiratory viruses through RT-PCR. All collected samples were retrospectively tested for SARS-CoV-2 using RT-PCR (Istituto Superiore di Sanità protocol).Results: A total of 293 children with ARI were identified in the two participating networks. The highest number of cases were recruited in weeks 51/2019 and 3/2020. The majority of patients (57%) came from the Lazio region. All of the 293 samples tested negative for SARS-Cov2. Rhinovirus was the most frequently detected virus (44%), followed by RSV (41%) and influenza viruses (14%).Conclusions: Our study shows that in Lazio (a region of intermediate SARS-COV-2 incidence) and Puglia (a region of low incidence), the SARS-Cov2 virus did not circulate in a sample of ARI pediatric cases consulting primary care pediatricians between November 2019 and March 2020.

Changing trends in robot-assisted radical prostatectomy: Inverse stage migration-A retrospective analysis.

BackgroundWith increasing availability of data on outcomes of surgery for prostate cancer, the profile of patients undergoing robot-assisted radical prostatectomy (RARP) has changed over the past decade. This impacts the decision-making process for surgeons and patients, particularly in low-incidence regions of Asia. Our institution was among the first in Asia to acquire a da Vinci surgical robot in 2005. We evaluated the changes in the clinical and pathology profile of patients undergoing RARP at our institution over the past 15 years (2005-2019).MethodsA retrospective analysis of patients undergoing RARP between April 2005 and December 2019 was conducted from the hospital database. The patients were divided into two groups; patients undergoing RARP from April 2005 to December 2012 (Group I, first 8 years) and January 2013 to December 2019 (Group II, next 7 years). The perioperative characteristics were compared between these two groups to assess changes in their profile and outcome.ResultsFour hundred forty-seven patients were included in this study; 244 (54.6%) in Group I and 203 (45.4%) in Group II. The median prostate specific antigen in Group II was significantly higher than that in Group I (14.5 vs. 11.7 ng/ml, P = 0.016). Unfavorable pathological characteristics, i.e., Gleason Grade ≥3, perineural invasion, and the margin positivity rate increased substantially from 18.5% to 37.5%, 20.5% to 36.9%, and 15.2% to 26.6%, respectively, in Group II compared with Group I. More patients in Group II received adjuvant therapy than in Group I (P < 0.001).ConclusionThere has been a change in profile of patients undergoing RARP and patients with more unfavorable disease characteristics such as higher prostate specific antigen and tumor grade are undergoing surgery. In line with international trends, the number of patients with low-grade disease undergoing surgery has substantially decreased. Multimodal treatment with adjuvant therapy is increasingly used, particularly in high-risk disease.

Efficacy of chest CT scan for COVID-19 diagnosis in a low prevalence and incidence region.

ObjectivesValue of chest CT was mainly studied in area of high COVID-19 incidence. The aim of this study was therefore to evaluate chest CT performances to diagnose COVID-19 pneumonia with regard to RT-PCR as reference standard in a low incidence area.MethodsA survey was sent to radiology department in 4 hospitals in an administrative French region of weak disease prevalence (3.4%). Study design was approved by the local institutional review board and recorded on the clinicaltrial.gov website (NCT04339686). Written informed consent was waived due to retrospective anonymized data collection. Patients who underwent a RT-PCR and a chest CT scan within 48 h for COVID-19 pneumonia suspicion were consecutively included. Diagnostic accuracy including the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of chest CT regarding RT-PCR as reference standard were calculated.ResultsOne hundred twenty-nine patients had abnormal chest CT findings compatible with a COVID-19 pneumonia (26%, 129/487). Among the 358 negative chest CT findings, 3% (10/358) were RT-PCR positive. Chest CT sensitivity, specificity, positive, and negative predictive value were respectively 87% (IC95: 85, 89; 69/79), 85% (IC95: 83, 87; 348/408), 53% (IC95: 50, 56; 69/129), and 97% (IC95: 95, 99; 348/358).ConclusionsIn a low prevalence area, chest CT scan is a good diagnostic tool to rule out COVID-19 infection among symptomatic suspected patients.Key Points • In a low prevalence area (3.4% in the administrative area and 5.8% at mean in the study) chest CT sensitivity and specificity for diagnosing COVID-19 pneumonia were 87% and 85% respectively. • In patients with negative chest CT for COVID-19 pneumonia, the negative predictive value of COVID-19 infection was 97% (348/358 subjects). • Performance of CT was equivalent between the 4 centers participating to this study. Supplementary InformationThe online version contains supplementary material available at 10.1007/s00330-021-07863-4.