Median Incidence Research Articles

A bibliometric analysis of inflammatory bowel disease research in the Arab world.

The prevalence of inflammatory bowel disease (IBD) continues to increase worldwide, including in the Arab world. This study investigates IBD research output in Arab countries from 2009 to 2023, alongside prevalence and incidence trends. We utilized bibliometric analysis with data from Clarivate Analytics, the Institute for Health Metrics and Evaluation, and the World Bank. We compared the research output, citation impact, and funding across 22 Arab countries with global averages. Spearman's correlation examined relationships between IBD publications and prevalence, incidence rates, gross domestic product (GDP), and population size. Between 2009 and 2023, Arab countries produced 1004 IBD-related publications (2.9% of global output), with Saudi Arabia (37.7%) and Egypt (27.5%) being the leading countries. The median IBD incidence rose from 2.42 to 3.06 per 100,000, with the prevalence increasing from 28.93 to 33.95 per 100,000 from 2009 to 2019. Arab IBD research had a citation impact of 14.49 compared to the global average of 23.98. Funded research constituted 18.7% of Arab publications, lower than the global rate of 32.4%. We found positive correlations between IBD publication counts and prevalence (r s = 0.753), incidence rates (r s = 0.734), and GDP (r s = 0.782), all with P < 0.001. Population size showed a nonsignificant correlation (r s = 0.371, P = 0.090) with IBD publication counts. Arab nations contribute 2.9% of global IBD research, with lower citation impact and funding than the global average. Enhanced local support is crucial to improving research impact and addressing the rising prevalence of IBD in the Arab world.

Antiresorptive medication-related osteonecrosis of the jaw: Incidence and preventive measures utilization in cancer patients

IntroductionAntiresorptive drugs are commonly used to treat cancer and bone metastases. These drugs can impose the risk of osteonecrosis of the jaw (ONJ). ONJ is a serious complication that can lead to significant morbidity and mortality. This study aimed to investigate the incidence and preventive measures utilization of ONJ among cancer patients treated with antiresorptive agent. Materials and MethodsThis retrospective cohort study investigated 210 adult patients with cancer on either zoledronic acid (ZA) or denosumab at a tertiary cancer center. The primary endpoint was to determine the incidence rate of Osteonecrosis of the Jaw. Secondary endpoints were to determine the utilization rate of antiresorptive agent related ONJ preventive measures and the exposure duration of antiresorptive agents to the ONJ incidence. ResultsOf 210 patients, 68 were on zoledronic acid (group 1) and 142 were maintained on denosumab (group 2). The median incidence rate of medication related ONJ (MRONJ) was 3.8 % (8 out of 210), with 4.4 % (3 out of 68) in the first group and 3.5 % (5 out of 142) in the second group. All ONJ cases were females with metastatic breast cancer to bone. The utilization rate of ONJ preventive measures was 5.2 %, including regular dental check-ups (3.3 %) and oral hygiene education (1.9 %). The median duration of exposure before ONJ was 1 year for zoledronic acid and 2 years for denosumab. Risk factors included female sex, diabetes mellitus, and hypertension. Duration of Denosumab exposure, but not ZA, was associated with incidence of ONJ. ConclusionHigher incidence rate of ONJ among denosumab-treated group. The findings emphasize the importance of female sex, diabetes, and hypertension as significant risk factors. The use of preventive measures was found to be low, indicating a need for better education and awareness.

Prevention of infectious complications after radical cystectomy: a systematic review and meta-analysis

The aim of this study was to conduct a systematic review and meta-analysis of the literature to evaluate the impact of different antibiotic prophylaxis (АР) strategies on the incidence of infectious complications within 30 days after radical cystectomy (RC).Material and Methods. The meta-analysis protocol was registered in the International Prospective Register of Systematic Reviews (PROSPERO): ID-CRD42023480525. A systematic search for studies published in the last 10 years (November 2013 – November 2023) was conducted in the PubMed and Cochrane Library databases by two independent researchers. A total of 7 full-text articles were included in the final statistical analysis (data from 90,935 patients). The analysis focused on three aspects: comparison of the effectiveness of different durations of antibiotic prophylaxis (24 hours or more), the impact of the type of antibacterial agent used, and the application of Enhanced Recovery after Surgery (ERAS) protocols on the overall incidence of infectious complications, the development of soft tissue infections, and upper urinary tract infections (UTIs). Meta-analysis was performed using R 4.3.2 (R Foundation for Statistical Computing, Vienna, Austria) and the metafor 4.2-0 package.Results. The median overall incidence of infectious complications was 31.78 % (23.8–58.8 %), surgical site infections – 16.46 % (6.25–35.41 %), and UTIs – 25.11 % (3.86–35.7 %), including cases leading to urosepsis. The meta-analysis did not reveal a statistically signifшcant effect of the duration of AP (24 hours or more) on the risk of infectious complications: for overall infectious complications, the risk was OR 1.11 (95 % CI 0.92–1.33; p=0.27), for surgical site infection OR 1.00 (95 % CI 0.87–1.15; p=0.97), and for UTIs OR 0.96 (95 % CI 0.84–1.10; p=0.59). However, the overall incidence of infectious complications was significantly higher in the standard perioperative management group, without ERAS protocols (OR=3.02 [95 % CI 2.07; 4.39], p&lt;0.001, I 2 =93.1 %). Conclusion. The results of this study indicate that existing AP strategies may be ineffective in reducing postoperative infectious complications in patients undergoing cystectomy with urinary diversion. Extending AP beyond 24 hours, as well as the standard regimen, did not demonstrate a reduction in infection risk, highlighting the need for a revision of clinical guidelines in this area. The principles of the ERAS program may play a crucial role in reducing infectious complications, showing promising results and requiring further research and implementation in clinical practice. Key words: radical cystectomy, antibiotic prophylaxis, complications, surgical site infection, upper urinary tract infections, ERAS&gt; ˂ 0.001, I2 =93.1 %).Conclusion. The results of this study indicate that existing AP strategies may be ineffective in reducing postoperative infectious complications in patients undergoing cystectomy with urinary diversion. Extending AP beyond 24 hours, as well as the standard regimen, did not demonstrate a reduction in infection risk, highlighting the need for a revision of clinical guidelines in this area. The principles of the ERAS program may play a crucial role in reducing infectious complications, showing promising results and requiring further research and implementation in clinical practice.

Abstract Su702: Association Between In-hospital Cardiac Arrest Incidence and Survival in Older Patients

Background: Survival after an in-hospital cardiac arrest (IHCA) varies markedly across hospitals in the U.S. Whether hospitals with IHCA survival also excel in ‘preventing’ IHCA remains unclear. Methods: Using 2013-2019 data from the Get-With-The-Guidelines–Resuscitation (GWTG-R) registry linked with Medicare and American Hospital Association data, we identified all patients &gt; 65 years with IHCA at participating hospitals. Using two-level hierarchical multivariable regression models, we calculated hospital rates of IHCA incidence, adjusted for case-mix index, and risk-standardized survival to discharge (RSSR) for IHCA, adjusted for patient and cardiac arrest variables. We also examined the association of IHCA incidence and RSSR with hospital variables. Results: Among &gt;10 million admissions at 335 hospitals during 2013-2019, 77676 patients experienced an IHCA. The median hospital rate of IHCA incidence was 6.9 per 1000 admissions, and the median case-survival rate among those with IHCA was 21.9%. After case-mix adjustment, the median IHCA incidence was 7.9 per 1000 admissions with considerable variation across hospitals: IQR: 5.8-10.3 per 1000 admissions, range 1.2 to 25.4 per 1000 admissions. The median RSSR for IHCA was 22.3%, which varied from 11.5% to 35.7% across hospitals (IQR: 19.5%-24.9%). There was a weak negative correlation between risk-adjusted hospital IHCA incidence and its RSSR (rho = -0.11; p = 0.037) (Figure 1). Adjustment for hospital variables attenuated the negative association between IHCA incidence and RSSR (rho = -0.08; p = 0.13). The nurse-patient ratio was the only modifiable factor significantly associated with lower IHCA incidence (OR = 0.97; p = 0.004) and higher RSSR (OR = 1.05; p &lt;.0001). Conclusion: Even after case-mix adjustment, hospital IHCA incidence and survival rates varied markedly. Notably, hospitals with higher survival rates for IHCA did not have a higher incidence. Since case-survival rates for IHCA have plateaued in recent years, our findings highlight that efforts focused on reducing IHCA incidence may yield additional gains in reducing resuscitation deaths in hospitals.

Cutaneous leishmaniasis in British troops following jungle training in Belize: Cumulative incidence and potential risk practices

BackgroundBritish soldiers undergoing jungle training in Belize typically experience a relatively low risk of developing cutaneous leishmaniasis. However, an uncharacteristically large outbreak of cutaneous leishmaniasis occurred in 2022. This study aimed to determine the cumulative incidence of the disease and highlight potential shortcomings in personal protective measures to mitigate exposure to sand fly vector bites. MethodsA retrospective analysis was conducted on medical records of cutaneous leishmaniasis cases between 2005 and 2022, as well as on questionnaire responses regarding personal protective measures administered to cutaneous leishmaniasis cases in 2022. Data were sourced from Defence Public Health Unit, Military Environmental Health Department and British Army Training Support Unit Belize. ResultsEighty-one confirmed clinical cutaneous leishmaniasis cases were recorded between 2005 and 2022, with a substantial peak (38 cases) in 2022. Most cases occurred during the wet season. Pre-2022, the median cumulative incidence per 8-week deployment was 0.90 % (Q1–Q3: 0.34 %–1.34 %), with an annual variation of 0.2 % to 2.0 %. In 2022, the cumulative incidence spiked to 4.22 %, associated with a risk ratio of 5.3 (95 % C.I.s, 3.41, 8.16), and rising to a cumulative incidence of 7.3 % in a single unit of 450 men (33 cases) in late 2022. These values are significantly higher than the median cumulative incidence of all previous years, and to published reports for other cutaneous leishmaniasis -endemic regions. Troop responses identified limitations in the supply of optimal equipment, and in sand fly bite and leishmaniasis risk avoidance information provided by the pre-deployment health education programme. Compliance with health education advise was also suboptimal, with irregular use of insect repellents, protective clothing / head netting, and insecticide-treated hammocks. ConclusionsThe reasons behind the unusually high numbers of cutaneous leishmaniasis cases and cumulative incidence in 2022 remain unclear, emphasising the need to improve personal protective measures provision and implement a comprehensive health education programme for troops undergoing jungle training in Belize.

Higher Morbidity and Mortality in Females With Fournier Gangrene Compared With Males: Insights From National Inpatient Sample Data.

We compare Fournier gangrene in female and male patients and identify mortality-associated characteristics in both. We used National Inpatient Sample data (2016-2020) to identify Fournier gangrene cases and extracted demographic, comorbidity, and procedural variables. Multivariable regression models were used to identify mortality risk factors for both cohorts. We identified 2875 female (31%) and 6451 male patients (69%) with Fournier gangrene corresponding to an estimated 14,375 (95% CI, 13,784-14,966) and 32,255 (95% CI, 31,390-33,120) cases, respectively. Female patients were more likely to die than male patients (7.1% vs 5.7%, P < .0001, respectively). The median incidence rates were 1.7 (interquartile range, 1.5-1.8) and 4 (interquartile range, 3.6-4.3) cases per 100,000 person-years for female and male patients, respectively. Female patients had higher median age, longer hospital stays, more charges, procedures, and fecal diversion rates, but lower routine discharges than male patients (P < .05). Non-White female patients had increased mortality odds compared with White female patients (odds ratio [OR], 1.49; 95% CI, 1.07-2.07; P = .019). Prolonged interval until initial perineal debridement correlated with higher mortality odds in both female and male patients (OR, 1.02; 95% CI, 1-1.04; P = .034 vs OR, 1.03; 95% CI, 1.01-1.05; P < .0001). Diabetes lowered mortality odds in female and male patients (OR, 0.68; 95% CI, 0.47-0.99; P = .046 vs OR, 0.54; 95% CI, 0.41-0.7; P < .0001). In female patients, Fournier gangrene incidence surpasses previous reports, with slightly worse outcomes compared with male patients, emphasizing the need for precise clinical assessment and early intensive interventions.

An Evaluation of the Postvoid Residual Urine Volume in Acute Stroke Patients.

We analyzed the time course of postvoid residual urine volume for patients with cerebrovascular diseases in the acute phase. A multidisciplinary specialized team measured postvoid residual urine volume of 65 patients (31 patients with cerebral infarction and 34 patients with cerebral hemorrhage) from September 2021 to August 2023. If a patient's postvoid residual urine volume was 100 mL or more, an indwelling urinary catheter was reinserted with or without medication, or clean intermittent catheterization was performed with or without medication. The multidisciplinary specialized team took repeated measurements of postvoid residual urine volume for a patient at every week's round until the postvoid residual urine volume was <100 mL. The cumulative incidence of the time interval between the onset of the cerebrovascular accident and the day of postvoid residual urine volume <100 mL was calculated as 1 + the Kaplan-Meier estimator. In the Kaplan-Meier estimator, the median cumulative incidence of the period between the onset of a cerebrovascular accident and the day in which postvoid residual urine volume was <100 mL was 16.5 days and 15.5 days for patients with cerebral infarction and cerebral hemorrhage, respectively. No significant difference existed between the two groups in the time interval from the onset of a cerebrovascular accident to the day in which postvoid residual urine volume was <100 mL (The P value from the Log-rank test was 0.845). The time interval between the onset of a cerebrovascular accident and the day in which postvoid residual urine volume was <100 mL was 75 days after the onset of both types of cerebrovascular accidents. Postvoid residual urine volume of patients with cerebrovascular disease was expected to become <100 mL within 75 days after the onset of the cerebrovascular accident.

Early and Late Microvascular Inflammation Have Differing Etiological Causes and Clinical Expression.

Microvascular inflammation (MVI) is an important pathological feature of antibody-mediated rejection (AMR). How posttransplant time affects its clinicopathological expression is little understood. This retrospective, single-center study screened 3398 kidney transplant biopsies and dichotomized 202 MVI ≥ 2 (Banff glomerulitis + peritubular capillaritis ≥ 2) samples by 9-mo median incidence time for comparison. The prevalence of MVI ≥ 2 was 12.4% in transplant kidneys, which failed more frequently than propensity-matched normal controls (n = 202; P < 0.001). Epidemiological risk factors for early MVI ≥ 2 were delayed graft function, prior AMR, and circulating donor-specific antibodies (DSAs+). Prior recipient sensitization occurred in 72.3%. Early MVI ≥ 2 was classified AMR in 65.3% and cellular rejection in 34.7%, and demonstrated excellent functional recovery and graft survival comparable to normal control kidneys. Late MVI ≥ 2 was predicted by younger (18 = 29 y) age, female recipient, living-donation, prior methylprednisolone, cyclosporine (versus tacrolimus, levels <5 ng/mL), absent antiproliferative therapy, and DSA+ using multivariable epidemiological modeling. Nonadherence caused 49.5%, with iatrogenic minimization responsible for 47.5%, usually for recipient infection. Late MVI ≥ 2 was because of AMR in 93.1%, and characterized by greater interstitial fibrosis, tubular atrophy, complement degradation split-product 4d (C4d) staining of peritubular capillaries+, endothelial C4d staining of glomerular capillaries+, transplant glomerulopathy and vasculopathy scores, DSA strength, and graft failure than early MVI ≥ 2 or normal transplant kidneys. Death-censored graft survival in 149 unique MVI ≥ 2 kidneys was independently determined by nonadherence, serum creatinine, proteinuria, DSA+, Banff C4d staining of peritubular capillaries+, and chronic interstitial fibrosis scores. MVI score and time lost significance using multivariable Cox regression. The changing expression of MVI ≥ 2 over time is best explained by differences in underimmunosuppression and microvascular injury from AMR impacting allograft function and survival.

Management of Refractory/Resistant Herpes Simplex Virus Infections in Haematopoietic Stem Cell Transplantation Recipients: A Literature Review.

Herpes simplex virus (HSV) infections in allogeneic haematopoietic stem cell transplantation (HSCT) recipients pose significant challenges, with higher incidence, severity, and risk of emergence of resistance to antivirals due to impaired T-cell mediated immunity. This literature review focuses on acyclovir-refractory/resistant HSV infections in HSCT recipients. The review addresses the efficacy of antiviral prophylaxis, the incidence of acyclovir-refractory/resistant HSV infections, and the identification of risk factors and potential prognostic impact associated with those infections. Additionally, alternative therapeutic options are discussed. While acyclovir prophylaxis demonstrates a significant benefit in reducing HSV infections in HSCT recipients and, in some cases, overall mortality, concerns arise about the emergence of drug-resistant HSV strains. Our systematic review reports a median incidence of acyclovir-resistant HSV infections of 16.1%, with an increasing trend in recent years. Despite limitations in available studies, potential risk factors of emergence of HSV resistance to acyclovir include human leucocyte antigen (HLA) mismatches, myeloid neoplasms and acute leukaemias, and graft-versus-host disease (GVHD). Limited evidences suggest a potentially poorer prognosis for allogeneic HSCT recipients with acyclovir-refractory/resistant HSV infection. Alternative therapeutic approaches, such as foscarnet, cidofovir, topical cidofovir, optimised acyclovir dosing, and helicase-primase inhibitors offer promising options but require further investigations. Overall, larger studies are needed to refine preventive and therapeutic strategies for acyclovir-refractory/resistant HSV infections in allogeneic HSCT recipients and to identify those at higher risk.

Adult Respiratory Syncytial Virus Infection: Defining Incidence, Risk Factors for Hospitalization, and Poor Outcomes, a Regional Cohort Study, 2016-2022.

Respiratory syncytial virus (RSV) is a significant cause of illness in adults, especially older adults and those with underlying conditions. This study aimed to assess the incidence of RSV hospitalizations in adults and identify risk factors for hospitalization and poor outcomes. A retrospective cohort study was conducted using data from two hospitals in southern Israel from 2016-2022. We calculated incidence rates of RSV and influenza hospitalizations. Risk factors for hospitalization were analyzed using Poisson regression. We evaluated poor outcomes (death, ICU admission, or mechanical ventilation) among RSV-hospitalized patients. The median annual incidence of RSV hospitalization was 28.2/100,000 population, increasing with age to 199/100,000 in those ≥75 years. Significant risk factors for RSV hospitalization included pulmonary diseases (RR 4.2, 95% CI 3.4-5.2), cardiovascular diseases (RR 3.3, 95% CI 2.6-4.2), and chronic renal failure (RR 2.9, 95% CI 2.3-3.7). Among hospitalized RSV patients, 13.9% had poor outcomes. Renal failure (RR 1.81, 95% CI 1.23-2.66), neutropenia (RR 2.53, 95% CI 1.19-5.35), neutrophilia (RR 1.66, 95% CI 1.81-2.34), and lymphopenia (RR 2.03, 95% CI 1.37-3.0) were associated with poor outcomes. RSV causes a substantial burden of hospitalizations in adults, particularly among older adults and those with comorbidities. Identifying high-risk groups can help target prevention and treatment strategies, including vaccination.

Self-Reported PrEP Use and Risk of Bacterial STIs Among Ontarian Men Who Are Gay or Bisexual or Have Sex With Men.

HIV pre-exposure prophylaxis (PrEP) may increase rates of bacterial sexually transmitted infections (STIs) among gay, bisexual, and other men who have sex with men (GBM) through risk compensation (eg, an increase in condomless sex or number of partners); however, longitudinal studies exploring the time-dependent nature of PrEP uptake and bacterial STIs are limited. We used marginal structural models to estimate the effect of PrEP uptake on STI incidence. We analyzed data from the iCruise study, an online longitudinal study of 535 Ontarian GBM from July 2017 to April 2018, to estimate the effects of PrEP uptake on incidence of self-reported bacterial STIs (chlamydia, gonorrhea, and syphilis) collected with 12 weekly diaries. The incidence rate was calculated as the number of infections per 100 person-months, with evaluation of the STIs overall and individually. We used marginal structural models to account for time-varying confounding and quantitative bias analysis to evaluate the sensitivity of estimates to nondifferential outcome misclassification. Participating GBM were followed up for a total of 1,623.5 person-months. Overall, 70 participants (13.1%) took PrEP during the study period. Relative to no uptake, PrEP uptake was associated with an increased incidence rate of gonorrhea (incidence rate ratio = 4.00; 95% CI, 1.67-9.58), but not of chlamydia or syphilis, and not of any bacterial STI overall. Accounting for misclassification, the median incidence rate ratio for gonorrhea was 2.36 (95% simulation interval, 1.08-5.06). We observed an increased incidence rate of gonorrhea associated with PrEP uptake among Ontarian GBM that was robust to misclassification. Although our findings support current guidelines for integrating gonorrhea screening with PrEP services, additional research should consider the long-term impact of PrEP among this population.Annals Early Access article.

Rapid metastatic recurrence after pancreatic cancer resection: a multi-center, regional analysis of trends in surgical failure over two decades

BackgroundPancreatic ductal adenocarcinoma (PDAc) is a lethal malignancy, attributed in part to high rates of rapid recurrence (rrPDAc) following resection. We sought to characterize recurrence rates over time and investigate factors predictive of rrPDAc. MethodsA regional multi-institutional cancer registry, augmented with data from the National Surgical Quality Improvement Program database, was queried for patients with PDAc from 1996 to 2020. rrPDAc was defined as recurrence within 6 months following curative-intent resection. ResultsWe identified 924 patients who underwent resection for PDAc; rrPDAc occurred in 236 (26%) patients. Median incidence of rrPDAc was 25.3% (IQR 22–30.2%) per year. Median survival in rrPDAc, non-rapid recurrence, and no recurrence was 10.3, 25.2, and 56.1 months respectively (p < 0.001). Variables independently associated with greater odds of rrPDAc included surgical site infection (SSI) (OR 2.06) and nodal positivity (OR 2.05); adjuvant therapy was associated with lower odds (OR 0.38). Neoadjuvant chemotherapy did not alter risk of rrPDAc. Three-year post-recurrence survival was no different in rrPDAc versus those without. ConclusionDespite therapeutic advances, incidence of rrPDAc remains unchanged. SSIs and nodal positivity are independently associated with increased risk of rrPDAc, while adjuvant chemotherapy is associated with lower risk. Strategies focused on preventing rapid recurrence may improve survival.

Multiple sclerosis in Denmark (1950-2023): mean age, sex distribution, incidence and prevalence.

With rising life expectancy and advancements in disease management, we expect the multiple sclerosis population is getting older. However, evidence supporting this hypothesis remains sparse. Our study aimed to determine whether the mean age of the Danish multiple sclerosis population has increased and to analyse the developments in sex distribution, incidence, and prevalence, all of which affect age composition. We conducted a cohort study by linking nationwide data from the Danish Multiple Sclerosis Registry to the Population Statistics Registry, the Danish Cause of Death Registry, and the Historical Migration Registry. We included all living patients with a confirmed multiple sclerosis diagnosis who lived in Denmark on the 1st of January each year from 1950 to 2023. We calculated the mean and median age, age distribution, sex distribution, incidence, and prevalence of the Danish MS population annually from 1950 to 2023. We included 28,145 individuals with multiple sclerosis. The mean age of the Danish multiple sclerosis population increased until the late 1970s to around 52.5 years, where it stabilised until 1990. The mean age experienced a slight decline to 51.2 years in 2005, followed by a subsequent rise to its peak of 54.2 years in 2023. In 1975, females comprised 58.7% of the multiple sclerosis population, increasing to 65.7% by 2000 and 68.5% in 2023. The incidence of multiple sclerosis remained stable at around 3.5 per 100,000 until 1975 and steadily increased by more than 2.5 times in 2000 to 11.4 per 100,000. Despite fluctuations, it remained relatively stable from 2000 until 2022, showing a slight decrease in 2022 compared to the previous two decades. Both overall and sex-specific prevalence exhibited an upward trend, particularly among females. Our study demonstrates that the mean age of the Danish multiple sclerosis population has increased, although not as decisively as expected. The female proportion has grown in tandem with prevalence, while incidence appears to have stabilised in recent decades after years of increase. Denmark's robust registry data and universal healthcare system offer a unique opportunity for reliable epidemiological analysis. Our results establish a benchmark for future demographic studies in the field of multiple sclerosis.

SARS-CoV-2 Transmission during High-Altitude Field Studies.

Grimm, Mirjam, Lucie Ziegler, Annina Seglias, Maamed Mademilov, Kamila Magdieva, Gulzada Mirzalieva, Aijan Taalaibekova, Simone Suter, Simon R. Schneider, Fiona Zoller, Vera Bissig, Lukas Reinhard, Meret Bauer, Julian Müller, Tanja L. Ulrich, Arcangelo F. Carta, Patrick R. Bader, Konstantinos Bitos, Aurelia E. Reiser, Benoit Champigneulle, Damira Ashyralieva, Philipp M. Scheiwiller, Silvia Ulrich, Talant M. Sooronbaev, Michael Furian, and Konrad E. Bloch. SARS-CoV-2 Transmission during High-Altitude Field Studies. High Alt Med Biol. 25:197-204, 2024. Background: Throughout the severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) pandemic, virus transmission during clinical research was of concern. Therefore, during high-altitude field studies performed in 2021, we took specific COVID-19 precautions and investigated the occurrence of SARS-CoV-2 infection. Methods: From May to September 2021, we performed studies in patients with chronic obstructive pulmonary disease (COPD) and in healthy school-age children in Kyrgyzstan in high-altitude facilities at 3,100 m and 3,250 m and at 760 m. The various implemented COVID-19 safety measures included systematic SARS-CoV-2 rapid antigen testing (RAT). Main outcomes were SARS-CoV-2-RAT-positive rate among participants and staff at initial presentation (prevalence) and SARS-CoV-2-RAT-positive conversion during and within 10 days after studies (incidence). Results: Among 338 participants and staff, SARS-CoV-2-RAT-positive prevalence was 15 (4.4%). During mean ± SD duration of individual study participation of 3.1 ± 1.0 day and within 10 days, RAT-positive conversion occurred in 1/237(0.4%) participants. Among staff working in studies for 31.5 ± 29.3 days, SARS-CoV-2-RAT-positive conversion was 11/101(10.9%). In all 338 individuals involved in the studies over the course of 15.6 weeks, the median SARS-CoV-2-RAT-positive incidence was 0.00%/week (quartiles 0.00; 0.64). Over the same period, the median background incidence among the total Kyrgyz population of 6,636 million was 0.06%/week (0.03; 0.11), p = 0.013 (Wilcoxon rank sum test). Conclusions: Taking precautions by implementing specific safety measures, SARS-CoV-2 transmission during clinical studies was very rare, and the SARS-CoV-2 incidence among participants and staff was lower than that in the general population during the same period. The results are reassuring and may help in decision-making on the conduct of clinical research in similar settings.

Association of Global Ultraviolet Radiation With the Incidence of Aneurysmal Subarachnoid Hemorrhage

BACKGROUND AND OBJECTIVES: Inflammation is a key pathomechanism for growth and rupture of intracranial aneurysms. Anti-inflammatory mechanisms may reduce rupture of intracranial aneurysms and the incidence of aneurysmal subarachnoid hemorrhage (SAH). Ultraviolet (UV) radiation from sunlight exposure induces systemic anti-inflammatory responses through immunosuppressive mechanisms. We studied whether SAH incidence is associated with UV radiation. METHODS: Global SAH incidence, time trends, and regional differences from 32 countries were linked to UV radiation data from the Tropospheric Emission Monitoring Internet Service. Odds between low vs high UV exposure and SAH incidence were calculated. Correlation analysis was performed using R (R 4.1.2). RESULTS: SAH incidences ranged from 1.3 to 27 per 100 000 patient-years (p-y) and UV index from 1.76 to 11.27. The correlation coefficient (rho) between SAH incidence and UV index was −0.48 (P = .012). SAH incidence was highest in Japan (13.7-27.9 p-y) with an UV index 6.28. UV index was highest in Chile 11.27 with a lower SAH incidence (3.8-4.8 p-y). The lowest UV index 1.76 was seen in Iceland with higher SAH incidence (9.8 p-y).Within Europe, regions with higher UV indices reported lower SAH incidences (Northwest Europe: SAH incidence p-y 8.61/UV index 2.85; Southeast Europe: SAH incidence p-y 7.37/UV index 4.65) with a significant inverse correlation (rho = −0.68, P = .004) and not a significant correlation between non-European countries (rho = −0.43, P = .19). Low exposure of UV radiation in global regions predicted higher than median incidences of SAH with an odds ratio 5.13 (95% CIs 1.02-31.5). CONCLUSION: The incidence of SAH is inversely associated with UV radiation. Further studies should assess the actual UV exposure in relation to SAH incidence and potential biological explanations for the relation we found.

Sport-related concussion in Brazilian professional soccer: A four-year prospective epidemiological analysis

This study aimed to investigate the incidence and other significant features of craniomaxillofacial trauma (CMFT), particularly Sport-Related Concussion (SRC), among professional soccer players from two major leagues in Brazil. This is a prospective epidemiological study which assessed two divisions of the national championship and large regional one over four seasons. Data were gathered from soccer clubs and their medical staff using two online forms. Data related to players (age and position) and injuries (diagnosis, type, body location, laterality, field location, tests performed, need for surgery, time lost in sports, and recurrence) were collected. Between 2016 and 2019, a total of 15 seasons, comprising 3 828 matches and 126 ​324 hours (h) of gameplay, were analyzed. A total of 299 CMFT cases were reported, with a median incidence of 2.37 per 1 000 ​h of play. Among them, there were 178 head and 121 face traumas, which led to 87 SRC (representing 29.10% of all CMFT), with an incidence of 0.69. Defensive midfielders (14.43%) and goalkeepers (14.00%) had the highest prevalence rates of CMFT. Only 3.68% of the injuries, mostly lacerations and fractures, required surgical treatment. This study identified that the average time lost in sports due to SRC was 5.12 days, with a recurrence rate of 12.71%. SRC are a frequent consequence of CMFT in Brazilian professional soccer. Although most cases are mild, there is a high recurrence rate, which may have long-term implications.

Acquired haemophilia A in Finland: A nationwide study of incidence, treatment and outcomes.

Acquired haemophilia A (AHA) is a bleeding disorder caused by autoantibody development against factor VIII (FVIII). Studies on AHA have mainly focused on patients treated at specialist centres. To determine the incidence, clinical characteristics and outcomes of AHA in an unselected population-based patient cohort from Finland. This retrospective observational cohort comprised all cases diagnosed with AHA in Finland between 2006 and 2019. Patients were identified by the two central laboratories performing FVIII antibody testing in Finland, the Finnish Red Cross Blood Service and HUSLAB. Clinical details were collected from all hospitals and healthcare units where patients were treated. This study was performed in conjunction with the AHA in the Nordics study. The median incidence of AHA was 0.65 per million per year (range 0.19-1.27). Fifty-five patients were identified, with a median age of 76 years and an even sex ratio (51% women). When diagnosed, all had bleeding symptoms with severe bleeds in 92%. First-line immunosuppressive treatment regimens included steroid monotherapy in 31% of cases, steroids and a cytotoxic agent in 51% and a rituximab-based regimen in 16%. Clinical remission was achieved in 71% of cases, and 15% had relapses. Mortality was 13% for bleeds and 9% for treatment-related infections. Overall survival was 64% for 1 year and 56% for 2 years after diagnosis. In a nationwide population-based cohort study, we discovered a lower incidence of AHA than previously reported. Mortality among patients with AHA was high, calling for the consideration of updated treatment strategies.

Prevalence, number of fractures, and hospital characteristics among the pediatric population with osteogenesis imperfecta: results from the nationwide registry of Türkiye.

Osteogenesis imperfecta is a rare connective tissue disorder with an estimated number of 4-20 cases per 100 000 inhabitants. Although the prevalence differs among regions, there are only a few number of national registry studies published previously. The aim of this study was to determine the prevalence of osteogenesis imperfecta among the pediatric age group in Türkiye, together with the patient and hospital characteristics. Via the e-health database of the Turkish Ministry of Health, we collected and retrospectively evaluated the medical records of the patients who were under 18 years of age with the diagnosis of osteogenesis imperfecta between 2016 and 2022. Total number of fractures, treatment modalities, and the hospital characteristics were also recorded. Two thousand seven hundred forty patients were extracted with a mean age of 9.77 ± 4.81 years. The prevalence of osteogenesis imperfecta in Türkiye among the pediatric population was calculated as 11.6 per 100 000 individuals. The median annual incidence was 31.5 per 100 000 live births between 2016 and 2022. There were 17.4 hospital admissions per patient per year. The mean age at the time of in-hospital mortality was 4.08 ± 5.03 years. The fracture rate per patient per year was 0.56 and conservative treatment was the most commonly preferred modality for all ages. This is the first registry-based nationwide study of osteogenesis imperfecta patients in Türkiye, providing important characteristics of the disease. Together with the help of the ongoing development of national health database systems, precision in patient identification would yield substantial benefits in terms of management of osteogenesis imperfecta.

Prognosis of Reflux Symptom Resolution After Bariatric Surgery: How Can Preoperative Esophageal Testing Help?

The incidence of unresolved postoperative reflux after bariatric surgery varies considerably. Consistent perioperative patient characteristics predictive of unresolved reflux remain unknown. We leverage our institution's comprehensive preoperative esophageal testing to identify predictors of postoperative reflux. We performed a single-center retrospective review of adult patients with preoperative reflux symptoms who underwent either vertical sleeve gastrectomy (VSG) or Roux-en-Y gastric bypass (RYGB) from 2015 to 2021. All patients had pH and high-resolution manometry preoperatively. Predictors of postoperative unresolved reflux at 1year were explored via Fisher's exact test, Kruskal Wallis test, and univariate logistic regression. Unresolved reflux was higher in patients undergoing VSG (n = 60/129,46.5%) vs. RYGB (n = 19/98, 19.4%). Median DeMeester scores were higher (22 vs. 13, p = .07) along with rates of ineffective esophageal motility (IEM) (31.6 vs. 8.9%, p = .01) in the 19 (19.3%) patients with unresolved postoperative reflux after RYGB compared to the resolved RYGB reflux cohort. Sixty (46.5%) of VSG patients had unresolved postoperative reflux. The VSG unresolved reflux cohort had similar median DeMeester and IEM incidence to the resolved VSG group but more preoperative dysphagia (13.3% vs. 2.9%, p = .04) and higher preoperative PPI use (56.7 vs. 39.1%, p = .05). In univariate analysis, only IEM was predictive of unresolved reflux after RYGB (OR 4.74, 95% CI 1.37, 16.4). Unresolved reflux was higher after VSG. Preoperative IEM predicted unresolved reflux symptoms after RYGB. In VSG patients, preoperative dysphagia symptoms and PPI use predicted unresolved reflux though lack of correlation to objective testing highlights the subjective nature of symptoms and the challenges in predicting postoperative symptomatology.

Time, cause of early neonatal death, and its predictors among neonates admitted to neonatal intensive care units at Bahir Dar City public hospitals, northwest Ethiopia: a prospective follow-up study.

Globally, 75% of neonatal deaths occur during the first weeks of life and more than 43% of deaths are covered by sub-Saharan Africa. Health-related policymakers and decision-makers need to use evidence-based treatments to reduce the time to early neonatal death and associated predictors. However, there are limited studies on median survival time, cause, incidence, and predictors in the study area as well as the country. Therefore, the aim of the present study was to assess time, the cause of early neonatal death, and its predictors among neonates admitted to neonatal intensive care units at Bahir Dar City public hospitals in northwest Ethiopia. An institution-based prospective follow-up study design was conducted among 387 early neonates selected by systematic sampling between 22 February and 22 April 2023. Statistical software, Epi Data version 4.6 and Stata version 14, was used for entry and analysis, respectively. Proportional hazard assumption and model fitness were checked by the Schoenfeld residual test and the Cox-Snell residual test, respectively. Descriptive statistics, the Kaplan-Meier curve, and the life table were used to describe variables. The Cox regression analysis model was fitted to identify the predictors of early neonatal death. During the follow-up time, 59 (15.25%) early neonates died, with an incidence of 31.79 per 1,000 early neonate days [95% confidence interval (CI): 0.024-0.041]. The leading causes of early neonatal death were prematurity complications, asphyxia, sepsis, meconium aspiration syndrome, and necrotizing enterocolitis. The mean survival time was 2.72 days. Being born from a multigravida mother [adjusted hazard ratio (AHR) 4.34; 95% CI: 1.63-11.55], a grand multigravida mother (AHR 3.50; 95% CI: 1.12-10.95), respiratory distress syndrome (AHR 2.60; 95% CI: 1.03-6.58), birth asphyxia (AHR 7.51; 95% CI: 2.30-24.51), a small gestational age (AHR 2.05; 95% CI: 1.08-4.92), and being unable to exclusively breastfeed (AHR 3.46; 95% CI: 1.52-7.88) were significantly associated predictors for time to early neonatal death. The incidence of early neonatal death was high, and the mean survival time was 2.72 days. Gravidity, respiratory distress syndrome, birth asphyxia, and being unable to exclusively breastfeed were identified as predictors of early neonatal death. Therefore, future research will consist of long-term prospective follow-up studies at a multicenter, nationwide level.