Mean Incidence Research Articles

#260 Epidemiology of immunoglobulin A nephropathy (IgAN) in Germany

Abstract Background and Aims Immunoglobulin A nephropathy (IgAN) is a rare kidney disease characterized by proteinuria, persistent micro- or macrohematuria, and arterial hypertension. It can take a variety of courses from long-term minor symptoms to rapid progressive loss of kidney function with terminal renal failure. Epidemiological measures often refer to the proportion of IgAN among patients with glomerulonephritis instead of the entire population. Therefore, we estimated the prevalence and incidence of IgAN in Germany. Method Statutory health insurance (SHI) claims data from a large German database (InGef research database) with approximately four million insurees was retrospectively analyzed. The database represents about 5% of the German population and is representative of the German demographic and clinical structure in terms of age, gender, region, morbidity, mortality, and medication usage. As there is no specific IgAN code in ICD-10-GM and coding practices vary between physicians, two algorithms with different sets of codes were developed to estimate a lower and upper bound of the 1-year prevalence and incidence from 2017-2022. The lower bound considered specific diagnosis codes which usually rely on biopsies (N00.3, N02.3, N06.3). The upper bound included a broader field of specific and unspecific codes (N00.3, N02.3, N02.5, N02.7, N02.8, N02.9, N06.3, N06.8) that are potentially used by physicians to diagnose IgAN. Identified patients were described in terms of age and gender. Results were extrapolated to the German overall population, and a trend for the upcoming five years was estimated by applying the mean prevalence and incidence from the years 2017 to 2022 to the forecasted German population for the years 2023 to 2027. Results In 2022, the 1-year prevalence of IgAN ranged from 5 (lower bound) to 38 (upper bound) per 100 000 individuals in Germany. This corresponds to approximately 4 000 and 32 200 affected patients in Germany, respectively. There was no significant change from 2017 to 2022 with mean rates ranging from 4 (lower bound) to 38 (upper bound) per 100 000 individuals in Germany. The number of prevalent patients in Germany is expected to slowly increase in the coming years due to a forecasted increasing German overall population. About 57% of the prevalent IgAN patients in 2022 were male and the mean age was 59 years for the upper bound. For the lower bound about 73% of the prevalent IgAN patients in 2022 were male and the mean age was 53. The 1-year incidence of IgAN in 2022 ranged from 0.2 (lower bound) to 0.6 (upper bound) per 100 000 individuals in Germany. Extrapolation to the German population resulted in 164 to 538 newly diagnosed IgAN patients, respectively. Both the lower and the upper bound remained stable from 2017 to 2022 with slight fluctuations and a mean incidence rate of 0.2 (lower bound) and 0.6 (upper bound) per 100 000. The trend estimation showed steady numbers of incident patients in Germany until 2027 with a minor tendency towards an increase. About 86% (lower bound) and 83% (upper bound) of the incident IgAN patients in 2022 were male and the mean age was 36 years (lower bound) and 44 years (upper bound). Conclusion Estimating the epidemiology of IgAN is challenging as physicians use different ICD codes for diagnosis. To capture the uncertainty, an upper and lower bound of the prevalence and incidence were assessed as a minimum and maximum of patient numbers. Overall, IgAN was shown to be a rare disease with a prevalence of less than 50 per 100 000 in Germany. The upper bound of the incidence rate dropped in 2020 which may be associated with the onset of the global COVID-19 pandemic in March 2020, but the rate picked up in 2021 and the lower bound did not indicate an effect caused by the pandemic. Due to the forecasted rising population in Germany until 2027, the total number of prevalent and incident IgAN patient is expected to increase slowly.

Incidence and Severity of Bacterial Wilt Disease on Three Eggplant (Solanum melongena L.) Varieties in Central Uganda.

This study was aimed at evaluating three eggplant varieties for response to bacterial wilt disease, to guide recommendations to farmers in central Uganda. Experiments were conducted at four sites under field conditions in 2016 and 2017 in central Uganda during three planting seasons. Two commercial eggplant varieties, namely, “Black beauty” and “Long purple”, were tested alongside one newly introduced variety, the “Thai long green”. Data was collected on disease incidence, severity and fruit yield. Analysis of variance revealed statistically significant differences in disease incidence, severity, and fruit yield across seasons, varieties and sites. The “Thai long green” variety proved to be a superior in terms of bacterial wilt resistance, showing the lowest levels of mean disease severity (1.5) and incidence (14%). The long purple variety was the most susceptible. “Thai long green” also attained highest average yields (14.86 t/ha), fruit weight per plant (1.2 kg) and fruit number per plant (9), across all locations for the three seasons. Therefore, we recommend promotion of the “Thai long green” variety in the region.

Underreporting or Failed Notification? Global Botulism Reporting, 2000-2022.

Botulism is a rare, potentially fatal illness caused by botulinum toxins produced by Clostridium bacteria. There are no coordinated worldwide reporting mechanisms for botulism cases and therefore few reliable case frequency estimates. This study aimed to establish an international benchmark for case frequency to determine estimated global rates of underreporting of botulism cases. To this end, a comprehensive, multilingual search of major global and national databases, including gray data and government sources, was performed. Data from case series were pooled, standardized against United Nations midyear population estimates, and analyzed using Kolmogorov-Smirnov tests to identify normally distributed data series. National incidence rates of normally distributed series were compared with that of the United States, which was considered the gold standard due to its extensive data reported for 2004-2018. A total of 6,932 botulism cases from 59 nations were identified in the literature, with a global case fatality rate of 1.37%. The national mean incidence rate ranged from 0.00 to 8.04 cases per million people, with an international mean incidence rate of 0.62 cases per million people. At the continent level, incidence rates tended toward normal distributions, although few countries outside of North America and Europe exhibited normal distributions. Based on comparisons with the US standard, an estimated 88.71% of botulism cases worldwide were unreported in 2016. Better awareness of botulism among healthcare professionals, coordinated global reporting mechanisms, and research on additional contributing factors to underreporting would enable better understanding of global case frequency, thereby potentially reducing the global incidence of botulism and improving outcomes.

Incidence of hand and wrist disorders in primary care.

The incidence of different types of hand and wrist disorders in primary care is unknown since there are no specific encodings for it. To determine the overall incidence and the incidence of specific types of hand and wrist disorders in primary care. A healthcare registration database from Dutch general practice, which contains medical records of over 200 000 patients and included approximately 25% of the population of the area of Rotterdam. Patients aged ≥18 years with a new diagnosis of hand or wrist disorder from 1 January 2015 to 31 December 2019 were extracted using a search algorithm based on ICPC coding and search terms in free text. The mean incidence over the study period of a hand disorder was 5.9 per 1,000 persons-years and of a wrist disorder 0.3 per 1,000 persons-years. The incidence of trigger finger/thumb, fracture hand/finger, tendon/ligament tendinopathy, mallet finger and ligament injury hand/finger were 3 (2.69-3.15), 1 (1.03-1.33), 1 (0.98-1.28), 0.6 (0.48-0.69) and 0.1 (0.06-0.14) per 1,000 persons-years, respectively. The incidence of a wrist fracture and ligament injury were 0.2 (0.13-0.25) and 0.1 (0.04-0.12) per 1,000 persons-years, respectively. There is a large difference between the number of patients presenting to the GP with hand and wrist complaints and the number of hand and wrist diagnosis reported in the medical files. Introducing specific ICPC codes for different types of hand and wrist disorders could (potentially) lead to a more accurate registration of a diagnosis and determination of the incidence figures.

Correlation between Stenotrophomonas maltophilia incidence and systemic antibiotic use: A 10-year retrospective, observational study in Hungary.

Extensive use of carbapenems may lead to selection pressure for Stenotrophomonas maltophilia (SM) in hospital environments. The aim of our study was to assess the possible association between systemic antibiotic use and the incidence of SM. A retrospective, observational study was carried out in a tertiary-care hospital in Hungary, between January 1st 2010 and December 31st 2019. Incidence-density for SM and SM resistant to trimethoprim-sulfamethoxazole (SXT) was standardized for 1000 patient-days, while systemic antibiotic use was expressed as defined daily doses (DDDs) per 100 patient-days. Mean incidence density for SM infections was 0.42/1000 patient-days; 11.08% were were resistant to SXT, the mean incidence density for SXT-resistant SM was 0.047/1000 patient-days. Consumption rate for colistin, glycopeptides and carbapenems increased by 258.82, 278.94 and 372.72% from 2010 to 2019, respectively. Strong and significant positive correlations were observed with the consumption of carbapenems (r: 0.8759; P < 0.001 and r: 0.8968; P < 0.001), SXT (r: 0.7552; P = 0.011 and r: 0.7004; P=0.024), and glycopeptides (r: 0.7542; P = 0.012 and r: 0.8138; P < 0.001) with SM and SXT-resistant SM incidence-density/1000 patient-days, respectively. Implementation of institutional carbapenem-sparing strategies are critical in preserving these life-saving drugs, and may affect the microbial spectrum of infections in clinical settings.

Progressive overload in cardiorespiratory exercise training for young and old: Is increasing duration or intensity of exercise more important?

People undertake endurance training to improve their health and cardio-respiratory fitness. Subsequent cardio-respiratory and skeletal muscle aerobic metabolic adaptations are gauged by improvements in maximum or peak oxygen uptake (V̇O2peak) and the blood lactate inflection point or threshold during incremental exercise – (LIP). To further improve physiological capability, subsequent homoeostatic disturbances from exercise should be progressively greater in succeeding exercise sessions. Therefore, exercise duration, frequency or intensity should be progressively increased during a training regimen to ensure adaptation potential is realized. A progressive increase in training workload is termed “progressive overload”. Despite the universal acknowledgment of the importance of progressive overload, it is unclear if systematically progressing altering either exercise intensity or duration (or distance covered) affect cardio-respiratory gains differently in young and older populations. As running faster results in higher heart rates and greater skeletal muscle metabolic stress than running the same distance at a lower speed, in this hypothesis we postulate that progressively increasing exercise run intensity will result in greater mean and higher incidence of V̇O2peak and LIP gains in young adults (<50 years). However, the mechanisms that initiate improvements in cardio-respiratory fitness and skeletal muscle aerobic function may be different in older adults due to the inevitable aging decline in cardio-vascular function and mechanical and morphological properties of muscle–tendon units. In older adults (>60 years) we hypothesize progressively increasing run distance while maintaining the same speed will just be as effective as to progressively increasing speed to improve V̇O2peak and LIP. To test these hypotheses, we propose a study that compares progressively increasing run intensity to a treatment of progressive matched run distance where speed remains constant in young and old adults.

Comparison of IOL power formulas in eyes with a flat cornea

PurposeTo assess and compare accuracy of intraocular lens (IOL) power calculation performed with old generation, new generation and artificial intelligence (AI)-based formulas in eyes with flat corneas. DesignPatients with a tomography-derived mean keratometry <42 D were retrospectively recruited among those who underwent uncomplicated phacoemulsification with intracapsular IOL implantation in two different tertiary care centers. Mean prediction error (ME), mean absolute prediction error (MAE) and incidence of MAE>0.25D were calculated for Barrett Universal II (BUII),EVO 2.0, Hoffer QST, Kane, Olsen-C, Pearl-DGS and SRK/T formulas. Linear correlation between MAE and axial length was also calculated for each formula. ResultsEighty (80) eyes with a mean keratometry of 41.4 ± 0.6 D (range 40.6–41.9 D) were recruited. The SRK/T significantly differed from both the Olsen-C (p = 0.022) and the BUII (p = 0.048) in ME. The EVO 2.0, the Hoffer QST, the Kane and the PEARL-DGS showed a significantly lower MAE compared to all other formulas (p < 0.001) and a significant lower incidence of MAE>0.25D (p < 0.001), MAE>0.50 D (p < 0.001) and MAE>1.0 D (0.002). ConclusionFormulas based on AI and on the theory of vergence show superior accuracy in IOL power calculation in corneas with low mean keratometry; their MAE is not correlated to axial length.

TEMPORAL TRENDS AND REGIONAL VARIATION OF HIP ARTHROSCOPY AND PELVIC OSTEOTOMY IN ENGLAND FROM 2010 TO 2023

Hip arthroscopy (HA) and pelvic osteotomy (PO) are surgical procedures used to treat a variety of hip pathology affecting young adults, including femoroacetabular impingement and hip dysplasia respectively. This study aimed to investigate the trends and regional variation in the provision of HA and PO across England from 2010 to 2023 to inform healthcare resource allocation.We analysed the National Hospital Episode Statistics database for all HA and PO procedures in NHS England using specific OPCS-4 codes: HA: ‘W83+Z843’ or ‘W84+Z843’; PO: ‘X222+Z75’. We collected patient demographics, age, sex, and region of treatment. We performed descriptive and regression analyses to evaluate temporal trends in PO volume, age, sex and regional variation.22,401 HAs and 1,348 POs were recorded between 2010 and 2023. The annual number of HAs declined by 28.4%, whilst the number of POs increased by 64% (p&lt;0.001). Significantly more females underwent PO vs HA (90% vs 61.3%) and were older than males undergoing the same procedure (PO: 29.0±8.7 vs 25.8±9.2 years; HA: 36.8±12.0 years vs 35.8±11.2 years, p&lt;0.001). For HA, the mean age of both sexes decreased by 3.3 and 2.9 years respectively (p&lt;0.001), whereas the age of PO patients did not change significantly over the study period. There were significant regional variations with a mean incidence of 1.60/100,00 for HA (ranging from 0.70–2.66 per 100,000) and 0.43/100,000 for PO (ranging from 0.08–2.07 per 100,000).We have observed a decline in HA volume in England, likely due to improved patient selection and the impact of COVID-19, whilst PO volume has significantly increased, with regional variation persisting for both procedures. These trends highlight the need for equitable HA and PO access to improve patient outcomes and call for strategic healthcare planning and resource allocation to reduce disparities and improve training opportunities.

The Epidemiology of Needlestick and Sharp Injuries Among Healthcare Workers in a Secondary Care Hospital in Saudi Arabia: A Retrospective Study.

Introduction Needlestick and sharp injuries (NSI) continue to pose a significant risk for healthcare workers (HCWs) at their workplace. The incidence rate of NSI in hospitals depends on multiple risk factors. This study aimed to analyze the epidemiological characteristics of NSI among HCWs and the risk factors influencing NSI rates and to provide further direction for NSI prevention in secondary care hospitals. Methods This study included all the NSI cases reported by HCWs in King Abdul Aziz Hospital, Makkah from 2005 to 2017. All the cases were recorded in the Exposure Prevention Information Network (EPINet™)database (International Healthcare Worker Safety Center, University of Virginia, Charlottesville, USA). The study was executed by using data loaded in the EPINet™Program, the hospital electronic recording system Medica Plus, and analyzed by the StatisticalPackage for the Social Sciences program (SPSS Inc. Released 2007. SPSS for Windows, Version 15.0. Chicago, SPSS Inc.). Results During the period of study, 524 NSI cases were reported. The mean incidence rate per 100 occupied beds with 95% CI was 25.43 (22.05-28.81) and a statistically insignificant decline in NSI incidence rate was observed from 2005 to 2017. The maximal annual incidence rate (35.63 per 100 occupied beds) was registered in 2010 and the minimal value (14.84 per 100 occupied beds) in 2013. Injuries were mainly reported in patient rooms/wards (30.2%) and most frequently by nurses (56.1%). The mean of incident reporting within 24 hours was 74.0, 95% CI (67.19-80.73). This rate showed a statistically significant (p=0.01) increasing trend of 5.0% per annum. The mean of identified source patients - 83.5, 95% CI (79.13- 87.23) - possessed an annual 2.1% rise during 2005-2017 which was statistically insignificant (p=0.7). Cases occurred after the use/before disposal of items in 45.0% of cases and during the use of items in 44.7%. Hollow-bore needles caused injuries in 46.5% of incidents. Blood sample taking - 23.2% and IV or arterial line insertion/removal/manipulation (19.1%) - presented exposure-prone procedures posing the highest risk. Conclusions The results of this study revealed a high rate of NSI in the hospital. NSI rate in hospitals was impacted by a group of related risk factors, particularly, the location of risk (patient room/ward, intensive care unit (ICU), and emergency room (ER) depending on job intensity, the kind and frequency of exposure-prone procedures (blood sample taking, IV or arterial line insertion/removal/manipulation) and handling of hollow-bore and solid needle connected to the main healthcare professional group at risk (nurses). Future direction in NSI prevention requires a complex approach of continuous staff education along with the usage of devices with safety features.

Increased begomovirus disease incidence and severity in cucurbits associated with the emergence of CuLCrV in mixed infection with SLCuV in Baja California Sur, Mexico

Begomoviral diseases in cucurbits have been observed in Baja California Sur (BCS), Mexico recurrently since the 2017 detection of the Squash leaf curl virus (SLCuV) in squash. Two years later, samples of symptomatic plants were collected in three arid agricultural regions, where the most frequently observed symptoms were chlorosis, reduced leaf size, stunting and severe leaf deformation, observed mainly on squash and cantaloupe. The mean incidence of begomovirus-like symptoms differed among cucurbits, with 20% in cucumber, 28% in cantaloupe, 30% in watermelon and 50% in squash. Samples were tested by polymerase chain reaction for begomovirus infection with degenerate primers, and later the virus identities were confirmed by specific primer pairs. All symptomatic cucurbit samples tested positive for SLCuV, and in a second analysis of these previously tested samples, squash, and cantaloupe samples tested positive for Cucurbit leaf crumple virus (CuLCrV). Thus, these samples showed a mixed CuLCrV/SLCuV infection. Pairwise identity analysis of the DNA-A component of the viruses indicated the presence of CuLCrV at 99%, and SLCuV at 99.1%. Recombination analyses between these viruses were negative, indicating that they belong to well-defined phylogenetic groups. Additionally, the 5´-TGGTGTCC-3´ iteron was consistently observed in all SLCuV and CuLCrV variants, including in other close species of the SLCuV clade. However, an additional iteron was observed in CuLCrV-BCS that is not in the Arizona and California variants, indicating that more studies are needed to elucidate the role of the additional iteron and the importance of CuLCrV/SLCuVSLCV mixed infection in emerging viruses in Mexico and other parts of the world.

Incidence of amyotrophic lateral sclerosis before and during the COVID-19 pandemic: evidence from an 8-year population-based study in Central Italy based on healthcare utilization databases

Background Amyotrophic Lateral Sclerosis (ALS) is a fatal neurodegenerative disorder with a high multidimensional burden, with an obscure etiopathogenesis. Methods We designed a longitudinal, population-based study of people residing in Central Italy (Marche Region) who were beneficiaries of the National Health System. People with an unprecedented ALS hospitalization (335.20 ICD-9 CM) or tagged with an ALS exemption between 2014 and 2021 were considered incident cases. ALS cases residing in the region for <3 years or with an active ALS exemption or hospitalized for ALS before 2014 were excluded. We used secondary sources to identify new ALS diagnoses. The regional referral center for ALS’s database was used to test the accuracy of secondary sources in detecting cases. ALS mean incidence was compared to that reported in similar studies conducted in Italy. The incidence rate trend adjusted by sex and age was evaluated using the Poisson regression model. Results We detected 425 new ALS cases (median age: 70y) in the 2014–2021 period, with a mean incidence of 3.5:100,000 py (95%CI: 3.2–3.8; M:F = 1.2), similar to that reported in similar studies conducted in Italy. No trend was observed during 2014–2019. After including 2020–2021 in the model, we observed a mean decrease in incidence of 5.8% (95% CI 2.0%; 9.5%, p = 0.003). Conclusion We show a decrease in the incidence rate of ALS in Marche, during the 2014–2021 period, as a possible outcome of a delayed neurological assessment and diagnosis during the pandemic. An ad hoc developed identification algorithm, based on healthcare utilization databases, is a valuable tool to assess the health impact of global contingencies.

Thirteen-year surveillance results of acute flaccid paralysis cases in Southeast Turkey and the effect of refugee movements on surveillance results.

Acute flaccid paralysis (AFP) is a major neurological problem. Turkey has accepted over 4 million refugees since 2011 due to the wars in neighbouring countries. In the long term, refugees can have adverse effects on the limited resources of health, sanitation, water supply, foodstuff, and shelter services of host countries, precipitating the transmission and spread of enteroviruses causing AFP. This study examines the 13-year surveillance and incidence of AFP cases in southeast Turkey, and questions possible impact of refugee movements on these parameters, comparing the periods before (2007-2010) and after (2011-2019) 2011, when the refugee movements emerged. The records of cases reported from southeast part of Turkey with suspected AFP between January 2007 and December 2019 were reviewed retrospectively. Of the patients, 121 (58.5%) were male. Mean age was 80.36 ± 46.67 months. Eighty-five (41.1%) were aged 60 months or younger. The number of patients under 60 months increased significantly after 2011. Mean incidence was calculated as 0.88 cases/100,000 person years versus 1.58 cases/100,000 person years in the period before and after 2011, respectively. Guillain-Barré syndrome (GBS) was the most common cause of AFP in both periods. As of 2011, however, the incidence of acute transverse myelitis increased approximately 4 times and GBS decreased proportionally. Non-polio enteroviruses were the most frequent isolates, detected from 9.1% of stool samples. Although refugee movements appear to may have adverse effects on AFP incidence and surveillance outcomes, larger studies involving the whole country, particularly at places where no refugees settled, are needed to achieve more conclusive evidence.

Tuberculosis in elderly Australians: a 10-year retrospective review.

This report describes the epidemiology of active tuberculosis (TB) in elderly Australians (≥65 years) with analysis of the factors associated with TB disease and successful treatment outcomes. A retrospective study of TB cases reported to the National Notifiable Diseases Surveillance System over a 10-year period from 2011 to 2020 was conducted. Cases were stratified by sex, age, risk factors, drug resistance, treatment type and outcome. Notification rates and incidence rate ratios with 95% confidence intervals were calculated and factors associated with treatment success analysed using multivariable logistic regression. A total of 2231 TB cases among elderly people were reported over the study period, with a 10-year mean incidence rate of 6.2 per 100 000 population. The median age of cases was 75 years (range 65-100 years); most were male (65%) and born overseas (85%). Multivariable analysis found that successful treatment outcome was strongly associated with younger age, while unsuccessful treatment outcome was associated with being diagnosed within the first 2years of arrival in Australia, ever having resided in an aged-care facility and resistance to fluoroquinolones. Compared to other low-incidence settings in the Western Pacific Region, TB incidence in elderly people is low and stable in Australia, with most cases occurring among recent migrants from TB-endemic settings. Continued efforts to reduce TB importation and address migrant health, especially among elderly people, are important.

Horizontal pharyngeal closure during total laryngectomy reduces rates of pharyngocutaneous fistula.

Pharyngocutaneous fistula (PCF) is a possible complication following total laryngectomy (TL), with a mean incidence of 17%. We intended to investigate the effect of pharyngeal closure type during TL on the prevention of PCF. We retrospectively reviewed patients that underwent TL with a horizontal pharyngeal closure over a 10-year period. The frequency of PCF clinically, dysphagia, total oral diet, postoperative dilatation of the neopharynx and voice problems were tabulated. Seventy-seven subjects underwent TL due to laryngeal tumor without pharyngeal extension. Of them, 45 underwent a salvage TL. PCF occurred in 1/77 subjects. The rest of the subjects (76/77) did not develop a PCF, neither in the early nor in the late postoperative phase. All subjects (15/77) that underwent implantation of a voice prosthesis were satisfied with their voice. No subject complained about dysphagia. Every subject achieved total oral diet. The horizontal pharyngeal closure is a safe pharyngeal closure technique during TL, reduces PCF rates (< 2%), results in excellent voice rehabilitation and swallowing function, and can also be used during salvage TL instead of a major pectoral flap. This type of closure should be used only in selected patients with laryngeal disease without pharyngeal extension.

Burden of disease and treatment patterns in patients with vitiligo: findings from a national longitudinal retrospective study in the UK.

UK studies examining vitiligo burden and vitiligo-related healthcare resource utilization (HCRU) are lacking. To describe the incidence and prevalence of vitiligo, the demographic and clinical characteristics of patients with vitiligo, vitiligo burden, HCRU, incidence of mental health comorbidities and management strategies, including treatment patterns. This retrospective study used UK Clinical Practice Research Datalink and Hospital Episode Statistics databases to analyse patients with vitiligo from 1 January 2010 to 31 December 2021. Among 17 239 incident patients, mean incidence of vitiligo was 0.16 (2010-2021) per 1000 person-years [PY; range 0.10 (2020-COVID-19) to 0.19 (2010/2013/2018)]; among 66 217 prevalent patients, prevalence increased from 0.21% (2010) to 0.38% (2021). The most common comorbidities recorded after vitiligo diagnosis were diabetes (19.4%), eczema (8.9%), thyroid disease (7.5%) and rheumatoid arthritis (6.9%). Mental health diagnoses recorded at any time included depression and/or anxiety (24.6%), depression (18.5%), anxiety (16.0%) and sleep disturbance (12.7%), and recorded after vitiligo diagnosis in 6.4%, 4.4%, 5.5% and 3.9%, respectively. Mental health comorbidities were more common in White (e.g. depression and/or anxiety 29.0%) than in Black (18.8%) and Asian (16.1%) patients. In adolescents, depression and/or anxiety was most commonly diagnosed after a vitiligo diagnosis than before (7.4% vs. 1.8%). Healthcare resources were used most frequently in the first year after vitiligo diagnosis (incident cohort), typically dermatology-related outpatient appointments (101.9/100PY) and general practitioner consultations (97.9/100 PY). In the year after diagnosis, 60.8% of incident patients did not receive vitiligo-related treatment (i.e. topical corticosteroids, topical calcineurin inhibitors, oral corticosteroids or phototherapy), increasing to 82.0% the next year; median time from diagnosis to first treatment was 34.0 months (95% confidence interval 31.6-36.4). Antidepressants and/or anxiolytics were recorded for 16.7% of incident patients in the year after diagnosis. In 2019, 85.0% of prevalent patients did not receive vitiligo-related treatments. Most patients were not on vitiligo-related treatments within a year of diagnosis, with the time to first treatment exceeding 2 years, suggesting that vitiligo may be dismissed as unimportant. New effective treatments, early initiation and psychological intervention and support are needed to reduce the vitiligo burden on patients.

Incidence rates of retinal vascular occlusive diseases from 2011 to 2020 in South Korea: a nationwide cohort study

BackgroundRetinal vascular occlusions, including retinal vein occlusion and retinal artery occlusion, are common causes of visual impairment. In order to evaluate the national medical burden and help improve ophthalmic health care policy planning, we investigated the incidence of retinal vascular occlusive diseases from 2011 to 2020 in Korea.MethodsThis study is a nationwide population-based retrospective study using data from the Korea national health claim database of the Health Insurance Review and Assessment (HIRA) service. We identified retinal vascular occlusive diseases registered from January 1, 2009, to December 31, 2020, according to the retinal vascular occlusion code (H34) and its sub-codes from international classification of disease, tenth revision diagnosis code. We used data from the entire Korean population based on the 2015 census of the population in Korea to calculate standardized incidence rates.ResultsWe identified 348,775 individuals (male, 161,673 [46.4%]; female, 187,102 [53.6%]) with incident retinal vascular occlusion (H34), 10,451 individuals (males, 6,329 [60.6%]; females, 4,122 [39.4%]) with incident central retinal artery occlusion (H34.1), and 252,810 individuals (males, 114,717 [45.4%]; females, 138,093 [54.6%]) with incident retinal vein occlusion (H34.8) during the 10-year study period. The weighted mean incidence rate of retinal vascular occlusion was 70.41 (95% CI, 70.18–70.65) cases/100,000 person-years. The weighted mean incidence rate of central retinal artery occlusion was 2.10 (95% CI, 2.06–2.14) cases/100,000 person-years. The weighted mean incidence rate of retinal vein occlusion was 50.99 (95% CI, 50.79–51.19) cases/100,000 person-years.ConclusionThe total retinal vascular occlusion and retinal vein occlusion showed a decreasing trend until 2020. However, the central retinal artery occlusion decreased until 2014 and remained stable without a significant further decline until 2020. The incidence of total retinal vascular occlusion and retinal vein occlusion was higher in females than in males, while the incidence of central retinal artery occlusion was higher in males. All retinal vascular occlusive diseases showed an increasing incidence with older age; the peak age incidence was 75–79 years for total retinal vascular occlusion and retinal vein occlusion, and 80–85 years for central retinal artery occlusion.

Incidence Rate and Risk Factors of Intraocular Lens Dislocation in South Korea

Purpose: To analyze the incidence rate and risk factors of intraocular lens dislocation in South Korea from 2002 to 2020 using Health Insurance Review and Assessment Service data.Methods: This study included 15% of patients aged &gt; 40 years had pseudophakia or intraocular lens primary implantation codes during 2002-2020 (737,606 patients). The annual incidence rate and risk factors of intraocular lens dislocation during 2002-2020 were analyzed.Results: The mean annual incidence rate of intraocular lens dislocation during 2002-2020 was 0.20 ± 0.7%. The annual incidence rate increased significantly from 0.17% in 2002 to 0.34% in 2020 (&lt;i&gt;p&lt;/i&gt; &lt; 0.001). The annual mean incidence rate for women was 0.1 ± 0.05%, and there was no increasing trend (&lt;i&gt;p&lt;/i&gt; &gt; 0.05). The annual mean incidence rate for men was 0.35 ± 0.13% and an increasing trend was found (&lt;i&gt;p&lt;/i&gt; &lt; 0.001). High myopia, uveitis, retinitis pigmentosa, glaucoma, pseudoexfoliative glaucoma and previous vitreoretinal surgery significantly increased the risk of intraocular lens dislocation (p &lt; 0.001). Hemodialysis and hypertension were not significant risk factors (&lt;i&gt;p&lt;/i&gt; &gt; 0.05).Conclusions: The mean annual incidence rate of intraocular lens dislocation in South Korea was 0.2 ± 0.7%, and it showed an increasing trend, among men. High myopia, uveitis, retinitis pigmentosa, glaucoma, pseudoexfoliative glaucoma and previous vitreoretinal surgery significantly increased the risk of intraocular lens dislocation.

Current and future advances in practice: aromatase inhibitor-induced arthralgia.

Aromatase inhibitors (AIs) have shown great success as adjuvant therapy for post-menopausal women with hormone receptor-positive breast cancers. AI-induced arthralgia (AIA) is a frequent AI toxicity contributing to non-adherence and discontinuation. This review aims to understand current knowledge of AIA. The mean incidence of AIA was 39.1% and the mean discontinuation of AI therapy due to AIA was 9.3%. Most of the AIAs were non-inflammatory. A shorter time since the last menstrual period and pre-existing joint pain were risk factors. Vitamin D3 supplementation may be a preventative measure and treatment with duloxetine, acupuncture and/or exercise is supported by large randomized controlled trials. There was consistent improvement in AIAs with switching to an alternate AI, and this could additionally allow continuation of cancer treatment with AI. Further research is needed to identify predictive biomarkers, better characterize AIA subcategories and study more reliable therapeutic options.

Is Robotic Surgery the Future for Resectable Esophageal Cancer?: A Systematic Literature Review of Oncological and Clinical Outcomes

BackgroundRadical esophagectomy for resectable esophageal cancer is a major surgical intervention, associated with considerable postoperative morbidity. The introduction of robotic surgical platforms in esophagectomy may enhance advantages of minimally invasive surgery enabled by laparoscopy and thoracoscopy, including reduced postoperative pain and pulmonary complications. This systematic review aims to assess the clinical and oncological benefits of robot-assisted esophagectomy.MethodsA systematic literature search of the MEDLINE (PubMed), Embase and Cochrane databases was performed for studies published up to 1 August 2023. This review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) protocols and was registered in the PROSPERO database (CRD42022370983). Clinical and oncological outcomes data were extracted following full-text review of eligible studies.ResultsA total of 113 studies (n = 14,701 patients, n = 2455 female) were included. The majority of the studies were retrospective in nature (n = 89, 79%), and cohort studies were the most common type of study design (n = 88, 79%). The median number of patients per study was 54. Sixty-three studies reported using a robotic surgical platform for both the abdominal and thoracic phases of the procedure. The weighted mean incidence of postoperative pneumonia was 11%, anastomotic leak 10%, total length of hospitalisation 15.2 days, and a resection margin clear of the tumour was achieved in 95% of cases.ConclusionsThere are numerous reported advantages of robot-assisted surgery for resectable esophageal cancer. A correlation between procedural volume and improvements in outcomes with robotic esophagectomy has also been identified. Multicentre comparative clinical studies are essential to identify the true objective benefit on outcomes compared with conventional surgical approaches before robotic surgery is accepted as standard of practice.

Geographical Distribution and Molecular Characterization of Begomovirus Infecting Soybean [Glycine max (L.) Merr.] in Northern Hills and North Western Plains of India

Background: Yellow mosaic disease (YMD) is one of the most severe and widespread constraint for the cultivation of soybean. Given that no comprehensive data on the status of soybean yellow mosaic disease in Northern Hills and North Western Plains of India is present, a detailed investigation was undertaken for three years to study the prevalence of the disease in the region and to characterize the pathogen. Methods: Towards Kharif end, a three year (2018-2020) farmer field survey (76 villages) was carried out to assess the YMD distribution in the major soybean growing areas Northern Hills and North Western Plains of India. The variability of yellow mosaic virus associated with YMD of soybean was studied based on molecular characterization of partial DNA-A coat protein gene and DNA-B movement protein with subsequent nucleotide sequencing and phylogenetic tree construction. Result: The results revealed that YMD is prevalent in the plains, whereas the disease was undetectable in the Hills. In the plains, the mean disease incidence ranged from 25.40% in 2019 to 16.78% in 2020. Moreover, disease incidence (r = -0.748) had negative and significant (p less than 0.0001) correlation with altitude. The phylogenetic studies revealed that the virus inciting the yellow mosaic in soybean in Tarai region had closest relationship with Mungbean yellow mosaic India virus (MYMIV). It shared more than 96 per cent sequence identity with other MYMIV isolates reported earlier within the country and abroad and hence, was designated as an isolate of MYMIV.