Number Of Reported Cases Research Articles

Clinical and Epidemiological Information Required for Lyme Disease Surveillance in a Low-Incidence State, California 2011-2017.

Background: Between January 1, 2011, and December 31, 2017, over 12,000 case reports of Lyme disease (LD) were submitted to the California Reportable Disease Information Exchange for further investigation. The number of case reports has tripled compared to previous years, emphasizing the need for efficient estimation and classification methods. We evaluated whether estimation procedures can be implemented in a low-incidence state such as California to correctly classify a case of LD, similar to those procedures used in high-incidence states. Objective: The purpose of this study was to identify whether a minimum number of variables was sufficient to reliably classify cases in California and potentially reduce workload while maintaining the ability to track LD trends in California. Methods: To determine the relative value of diagnostic information, we compared five candidate logistic regression models that were used to classify cases based on information that varied in its degree of difficulty for collection. Results: Our results using California's surveillance data showed that automatically reported data were not sufficient, additional information such as, a patient's clinical presentation and travel history were necessary in a low-incidence state to improve the overall sensitivity of the models. Conclusion: This study may help inform public health surveillance efforts by demonstrating that both clinical and travel information are required to accurately classify a case of LD in a low-incidence state.

SARS-CoV-2 seroprevalence and associated factors among outpatient attendees at health facilities in different provinces in Chad

BackgroundChad with 7,698 confirmed cases of infection and 194 deaths since the beginning of the COVID-19 pandemic, is one of the African countries with the lowest reported case numbers. However, this figure likely underestimates the true spread of the virus due to the low rate of diagnosis. The high rate of asymptomatic infections reflects the reality of SARS-CoV-2 transmission in Chad. In this study, we estimated the seroprevalence and identified factors associated with SARS-CoV-2 infection.MethodsA cross-sectional study was conducted between September 2022 and February 2023. A total of 1,290 plasma samples were collected from outpatient attendees at Health Facilities located in 11 provinces of Chad and tested by ELISA method, for the presence of IgG antibodies to SARS-CoV2 nucleocapsid (N) protein. KoboToolbox was used to gather data from the participants and data were analyzed using STATA 16.ResultsThe overall seroprevalence was 83.0% [95% CI = 81.6%—85.5%], with variations between provinces, ranging from 99.2% [95% CI = 94.0%—100%] in Moundou (Southern Chad) to 46.8% [95% CI = 36.0% -57.1%] in Biltine (Eastern Chad). Factors associated with the seroprevalence included military occupation (OR = 0.37 CI [0.80–1.77] p = 0.025) and age group between 55–64 years (OR = 0.33 CI [0.15–0.72] p = 0.005). While, other factors, such as gender and age were not significantly associated with seroprevalence.ConclusionOur results indicated that, the seroprevalence of COVID-19 in Chad is among the highest in Sub-Saharan Africa. These estimates could guide the response and public health policy decisions, enhancing the management of future outbreaks involving respiratory pathogens.

The epidemiology of lung cancer in Hungary based on the characteristics of patients diagnosed in 2018

Among malignant diseases, lung cancer has one of the highest mortality and incidence. Most epidemiological studies conclude that Hungary faces the most severe burden in association with this disease. However, for various reasons estimates and population-based studies show discrepancies. In this study, an intense data cleansing was performed on lung cancer cases that were reported to the Hungarian National Cancer Registry in 2018, and the major clinico-pathological parameters as well as survival characteristics were described. Our population-based figures were compared to the European estimates. As a result of our thorough revision, the corrected incidence of lung cancer has fallen below the number of cases that were reported to the Registry from 11,746 to 9,519. We also demonstrate that Hungary did not show the highest incidence and mortality in Europe, but it is still among the ones with the worst raking countries, with 92.9 and 50.6 age standardized rate per 100 thousand capita among males and females, respectively. Analysis of the annually reported case numbers revealed a gender-specific difference in incidence trends: while from 2001 to 2019 it slightly decreased among males, it increased among females. The most dominant subtype was adenocarcinoma, which was more frequent among female patients. Unfortunately, most of the newly diagnosed cases were in advanced stage; thus, 5 year overall survival was 14.8%. We anticipate that in the longer term, a decrease in incidence and improvement in survival rates may be expected as a result of the development of primary and secondary prevention programs in the country.

Effect of indoor residual spraying on sandfly abundance and incidence of visceral leishmaniasis in India, 2016–22: an interrupted time-series analysis and modelling study

Efforts to eliminate visceral leishmaniasis in India mainly consist of early detection and treatment of cases and indoor residual spraying with insecticides to kill the phlebotomine sandfly Phlebotomus argentipes that transmits the causative Leishmania protozoa. In this modelling study, we aimed to estimate the effect of indoor residual spraying (IRS) on vector abundance and transmission of visceral leishmaniasis in India. In this time-series analysis and modelling study, we assessed the effect of IRS on vector abundance by using indoor vector-abundance data (from 2016 to 2022) and IRS quality-assurance data (from 2017-20) from 50 villages in eight endemic blocks in India where IRS was implemented programmatically. To assess a potential dose-response relation between insecticide concentrations and changes in sandfly abundance, we examined the correlation between site-level insecticide concentrations and the site-level data for monthly sandfly abundances. We used mathematical modelling to link vector data to visceral leishmaniasis case numbers from the national Kala-Azar Management Information System registry (2013-21), and to predict the effect of IRS on numbers of averted cases and deaths. IRS was estimated to reduce indoor sandfly abundance by 27% (95% CI 20-34). Concentrations of insecticides on walls were significantly-but weakly-associated with the degree of reduction in vector abundance, with a reduction of -0·0023 (95% CI -0·0040 to -0·0007) sandflies per mg/m2 insecticide (p=0·0057). Reported case numbers of visceral leishmaniasis were well explained by trends in vector abundance. Village-wide IRS in response to a newly detected case of visceral leishmaniasis was predicted to reduce disease incidence by 6-40% depending on the presumed reduction in vector abundance modelled. Indoor residual spraying has substantially reduced sandfly abundance in India, which has contributed to reductions in visceral leishmaniasis and related deaths. To prevent the re-emergence of visceral leishmaniasis as a public health problem, surveillance of transmission and sandfly abundance is warranted. Bill & Melinda Gates Foundation. For the Hindi translation of the abstract see Supplementary Materials section.

Inferring enterovirus D68 transmission dynamics from the genomic data of two 2022 North American outbreaks

Enterovirus D68 (EV-D68) has emerged as a significant cause of acute respiratory illness in children globally, notably following its extensive outbreak in North America in 2014. A recent outbreak of EV-D68 was observed in Ontario, Canada, from August to October 2022. Our phylogenetic analysis revealed a notable genetic similarity between the Ontario outbreak and a concurrent outbreak in Maryland, USA. Utilizing Bayesian phylodynamic modeling on whole genome sequences (WGS) from both outbreaks, we determined the median peak time-varying reproduction number (Rt) to be 2.70, 95% HPD (1.76, 4.08) in Ontario and 2.10, 95% HPD (1.41, 3.17) in Maryland. The Rt trends in Ontario closely matched those derived via EpiEstim using reported case numbers. Our study also provides new insights into the median infection duration of EV-D68, estimated at 7.94 days, 95% HPD (4.55, 12.8) in Ontario and 10.8 days, 95% HPD (5.85, 18.6) in Maryland, addressing the gap in the existing literature surrounding EV-D68’s infection period. We observed that the estimated Time since the Most Recent Common Ancestor (TMRCA) and the epidemic’s origin coincided with the easing of COVID-19 related social contact restrictions in both areas. This suggests that the relaxation of non-pharmaceutical interventions, initially implemented to control COVID-19, may have inadvertently facilitated the spread of EV-D68. These findings underscore the effectiveness of phylodynamic methods in public health, demonstrating their broad application from local to global scales and underscoring the critical role of pathogen genomic data in enhancing public health surveillance and outbreak characterization.

Piloting wastewater-based surveillance of norovirus in England

Wastewater-based epidemiology (WBE) gained widespread use as a tool for supporting clinical disease surveillance during the COVID-19 pandemic. There is now significant interest in the continued development of WBE for other pathogens of clinical significance. In this study, approximately 3,200 samples of wastewater from across England, previously collected for quantification of SARS-CoV-2, were re-analysed for the quantification of norovirus genogroup I (GI) and II (GII). Overall, GI and GII were detected in 93% and 98% of samples respectively, and at least one of the genogroups was detected in 99% of samples. GI was found at significantly lower concentrations than GII, but the proportion of each genogroup varied over time, with GI becoming more prevalent than GII in some areas towards the end of the study period (May 2021 – March 2022). Using relative strength indices (RSI), it was possible to study the trends of each genogroup, and total norovirus over time. Increases in norovirus levels appeared to coincide with the removal of COVID-19 related lockdown restrictions within England. Local Moran's I analyses indicated several localised outbreaks of both GI and GII across England, notably the possible GI outbreak in the north of England in early 2022. Comparisons of national average norovirus concentrations in wastewater against concomitant norovirus reported case numbers showed a significant linear relationship. This highlights the potential for wastewater-based monitoring of norovirus as a valuable approach to support surveillance of norovirus in communities.

A Rare Syndrome in Adolescents: Capgras Syndrome and Its Psychopharmacological Treatment

In this letter to editor, while explaining the process leading to Capgras syndrome (CS), it will be tried to evaluate the psychodynamic, cognitive, neurological, and systemic factors as a result of the anamnesis and detailed examinations. Clinical aspects of the syndrome, psychopharmacologic agents to be used in the treatment process, and these agents' mechanisms of acts will be discussed. Y.B., a 16-year-old female patient, was admitted to our clinic by her family with complaints of restlessness, introversion, and voices in her ears. A psychiatric examination revealed that the patient had persecutory, referential, and somatic delusions and that her family was replaced with other families in her thought content. In the initial treatment of the patient, risperidone was preferred, and sertraline was added to her treatment after the regression in her symptoms was not at the desired level. CS is the most common type of misidentification syndrome. The patient believes that their parents, friends, or themselves have been replaced by people similar to them and may show strong hostility and distrust toward their environment. Although there is no single cause, biological and psychological factors are thought to play a role in its etiopathogenesis. When the literature is examined, it is seen that there are reports of CS in adults, and the number of case reports in adolescence is lower. It should be kept in mind that although rare, CS can be seen in the pediatric and young population and the addition of selective serotonin reuptake inhibitors may be beneficial in cases that do not respond to antipsychotic treatment.

Oligohydramnios and Intrauterine Premature Closure of Ductus Arteriosus Associated with the Use of NSAIDs During Pregnancy – An Overview of Clinical Evidence

Background: Pregnant women may experience low back pain and other pain symptoms, fever, and inflammatory conditions that may harm the fetus and mother if left untreated. The most common uses of non-steroidal anti-inflammatory drugs (NSAIDs) are the treatment of inflammation, pain and pyrexia. However, after 20-30 weeks of gestation, using NSAIDs during pregnancy may cause oligohydramnios and premature ductus arteriosus closure, which could harm the developing fetus. Objective: The purpose of this review article is to critically examine the clinical evidence that is currently available for oligohydramnios and premature ductus arteriosus closure linked to NSAIDs. Methods: Online databases such as Medline/Pubmed/PMC, EBSCOhost, Scopus, Web of science, Embase, Science Direct, Google Scholar, and reference lists were searched to identify articles which dealt with NSAIDs-associated oligohydramnios and premature closure of ductus arteriosus. Results: Numerous regulatory agencies released warnings about oligohydramnios and premature closure of ductus arteriosus linked to NSAIDs. Furthermore, a number of case reports, case series, and some observational studies have also been published about the possibility of oligohydramnios and premature closure of ductus arteriosus linked to NSAIDs use. Conclusion: Women who are pregnant for 20 weeks or more should refrain from self-medicating with NSAIDs without consulting a pharmacist or a physician. The use of NSAIDs during pregnancy should carefully be considered due to potential risks to the mother and developing fetus, especially after 20-30 weeks of gestation. To guarantee the best possible health for the expectant mother and the unborn child, healthcare professionals should weigh the benefits and risks and look into alternate options. Pregnant women may opt for acetaminophen (paracetamol) to relieve pain and fever during pregnancy. Pregnant women should seek medical attention if there is persisting pain for more than three days.

Variables Associated With Hyperkalemic Renal Tubular Acidosis in Solid Organ Transplant Recipients.

The occurrence of hyperkalemic renal tubular acidosis (RTA) in the post-transplantation period is likely underestimated, and its identification remains important to offer adequate medical management. Transplant recipients frequently present with clinical and biological characteristics that may be associated with the occurrence of this complication. This was a single-center retrospective study that compared transplanted patients with hyperkalemic RTA and a control group to identify variables associated with the occurrence of this complication. Fisher's exact test and the Mann-Whitney test, followed by multivariate logistic regression, were applied to test whether there was a significant association between hyperkalemic RTA and different variables. Kidney and heart transplant recipients were at greater risk of developing RTA than lung transplant recipients (p = 0.016). There was also a significant association between the development of RTA and kalemia (p < 0.01), chloremia (p < 0.01), and bicarbonatemia (p < 0.01). The significant impact of these last three variables was confirmed by the results of the multivariate logistic regression. Residual serum tacrolimus levels (p = 0.13) and creatinine levels (p = 0.17) of renal transplant patients were not significantly associated with hyperkalemic RTA. The type of transplanted organ, kalemia, chloremia, and bicarbonatemia were significantly associated with the occurrence of hyperkalemic RTA. This study calls into question certain approaches to managing this complication proposed in a number of case reports, such as reducing the target serum residual of tacrolimus or discontinuing trimethoprim-sulfamethoxazole(TMP-SMX) in favor of another antibiotic prophylactic agent, potentially exposing patients to graft rejection and opportunistic infections.

Contrast-Enhanced Ultrasound Features of Primary Hepatic Lymphoepithelioma-Like Carcinoma: Comparison with Hepatocellular Carcinoma

Abstract Background: Primary hepatic lymphoepithelioma-like carcinoma (LELC) is a malignant tumor with a low incidence, but the number of case reports has increased in recent years. The prognosis of hepatic LELC is better than hepatocellular carcinoma (HCC). The differentiation between hepatic LELC and HCC has clinical value during follow-up treatment. The purpose of our study was to compare contrast-enhanced ultrasound (CEUS) imaging features in patients with hepatic LELC and HCC. Methods: Twelve patients with an average age of 60.1±9.5 years and histopathologically confirmed hepatic LELC were included in the study. Forty-three patients with an average age of 57.4±9.0 years and a histopathological diagnosis of HCC were designated as the control group by means of propensity score matching (1:4). The clinical data, B-mode ultrasound (BMUS), and CEUS features were retrospectively analyzed between patients with hepatic LELC and HCC. Results: The serum a-fetoprotein (58.1% [25/43] vs.16.7% [2/12]; p=0.017) and des-gamma-carboxy prothrombin levels (74.4% [32/43] vs.16.7% [2/12]; p=0.001) were not significantly elevated in patients with hepatic LELCs compared to HCCs. LELCs were mainly hypoechoic based on BMUS, while the echogenicity of HCCs varied (p=0.016). A halo sign was less common in patients with hepatic LELCs than HCCs (16.7% [2/12] vs. 58.1% [25/43]; p=0.011). Of hepatic LELCs, 75% (9/12) had homogeneous hyperenhancement based on CEUS, whereas 58.1% (25/43) of HCCs had heterogeneous hyperenhancement (p=0.004). Early washout was noted in 91.7% (11/12) of hepatic LELCs compared to 46.5% (20/43) of HCCs (p=0.005). Furthermore, hepatic LELCs were more likely to exhibit peripheral rim-like hyperenhancement (83.3% [10/12] vs. 11.6% [5/43]; p &lt; 0.001). Conclusion: BMUS and CEUS are helpful in discriminating between hepatic LELC and HCC. A hypoechoic mass, the rare halo sign, homogeneous hyperenhancement in the arterial phase, higher frequencies of early washout, and peripheral rim-like hyperenhancement are useful ultrasound features that can help differentiate hepatic LELCs from HCCs.

A Bibliographic Analysis of Indian Contribution in Application of Presurgical Naso-Alveolar Molding in Cleft Lip/Palate Infants

Background: Pre-surgical nasoalveolar molding is a novel treatment modality applied in cleft lip/palate infants prior to surgery. Numerous articles have been published in the literature. Using Bibliographic analysis tt is essential to know the nation wise contribution of total research output towards PSNAM. Aim: To evaluate Indian contribution globally on the domain ‘application of presurgical naso-alveolar molding in cleft lip/palate infants’ by analysing all the studies published till date. Materials and Methods: A detailed bibliographic database search was carried out using PUBMED for a period of two months from September to October 2023. Different Mesh keywords in several combinations were used to obtain the articles. All types of published articles from inception till October 2023 and were published in English language were considered for this bibliographic analysis. The selected published articles pertaining to Indian Institutions, researchers or authors and specialties were tabulated and evaluated to obtain the overall bibliographic details. Results: India’s global contribution was 6.65% (total 31 articles). More number of case reports (n=15) were published followed by case control studies (n=5). Highest publication credit was conquered by author Thakur S (n=5) and Journal of Indian Prosthodontic Society and Contemporary clinical dentistry journals shared maximum articles published (n=5 each) having impact factor of 0.265 and 1.2 respectively. South zone contribution was highest (n=12) in that Karnataka state bagged with highest contribution. H.P. Government Dental College and Hospital and regarding specialty, Pediatric and Preventive Dentistry contributed more research work towards PSNAM. Conclusion: From the present bibliographic review, it was concluded that there is a growing demand and increasing trend in the application of PSNAM in cleft lip/palate infants. The current review provides insight into the current literature on PSNAM and paves for further research and its application in clinical practice

Unraveling the role of adapting risk perception during the COVID-19 pandemic in Europe

During the COVID-19 pandemic, the behavioral response to reported case numbers changed drastically over time. While a few dozen cases were enough to trigger government-induced and voluntary contact reduction in early 2020, less than a year later much higher case numbers were required to induce behavioral change. Little attention has been paid to understand and mathematically model this effect of decreasing risk perception over longer time-scales. Here, first we show that weighing the number of cases with a time-varying factor of the form ta,a<0 explains real-world mobility patterns from several European countries during 2020 when introduced into a very simple behavior model. Subsequently, we couple our behavior model with an SIR epidemic model. Remarkably, decreasing risk perception can produce complex dynamics, including multiple waves of infection. We find two regimes for the total number of infected individuals that are explained by the interplay of initial attention and the rate of attention decrease. Our results show that including adaption into non-equilibrium models is necessary to understand behavior change over long time scales and the emergence of non-trivial infection dynamics.

Digital Public Health in Ireland

Abstract Before COVID-19 Ireland had a very limited digital health infrastructure. There are no unique health identifiers, and it is common for patients to be on the books of multiple providers, be that general practitioners, or hospital waiting lists, so capacity analysis beyond actual hospital admissions, is very limited. There are separate systems used to manage child development and vaccine delivery. Infectious disease reporting is done, feeding into a 25-year-old central system. General practice (GP) is the only sector that uses electronic records widely, which support a messaging system, to return hospital test results to the GP. Prescriptions were commonly handwritten on paper or typed, specifically on three-layer fan-fold paper, using obsolete printers for fully state-funded prescriptions. The patient transferred these to the pharmacist. COVID-19 shook this system to the foundation. It became necessary to set up contact tracing systems and vaccination systems for the entire population. These were built very quickly as free-standing systems. In addition, hospital activity data, which had been typically available a month after the date of discharge, was needed daily to manage bed capacity. Pharmacists had to receive prescriptions online, and e-prescribing was brought in. All of this worked and often worked well. More embarrassingly, as COVID-19 case numbers rose, the recording system did not scale, and reported case numbers were substantially too low for a time. Now that the acute pandemic response is over, very little has changed. Hospital prescriptions are still paper-based, although GP prescriptions use the new system. Contact tracing is shut down, and the vaccination system is scaled back. There is still no health identifier in use. Few of the lessons of the pandemic response have been learned, and the opportunity to make more significant changes in public health systems has been missed. A ‘good’ crisis was wasted.

Analisis Putusan Tindak Pidana Asusila Terhadap Anak di Kabupaten Sidoarjo (Studi Kasus pada Pengadilan Negeri Sidoarjo)

Lately, immoral acts involving children often occur, One of them is the number of case reports regarding rape, harassment, and so on. The immoral act of rape is one of the forms of violence against children. The purpose of this study was to determine the analysis of decisions on immoral crimes against children in Sidoarjo Regency. The research method used is normative juridical with a statutory approach. The results of this study show that there is a disparity between the decisions of one another in the 2019-2021 timeframe, both from the judge's considerations, decisions and other things. The benefit of this research is that the author hopes that this writing can be useful by providing knowledge and information to the public as a reference to find out how to analyze the decision on immoral actions against children in Sidoarjo Regency (Case Study at the Sidoarjo District Court). The analysis of the legal material used is deductive reasoning, what is meant by deductive reasoning analysis here is reasoning based on a mindset that has a general nature to draw conclusions on a specific nature.

Australian Paediatric Surveillance Unit (APSU) Annual Surveillance Report 2022.

For 30 years the Australian Paediatric Surveillance Unit (APSU) has conducted national surveillance of rare communicable diseases and rare complications of communicable diseases. In this report, we describe the results of thirteen such studies surveyed by the APSU in 2022, including reported case numbers and incidence estimates, demographics, clinical features, management and short-term outcomes. Conditions described are: acute flaccid paralysis (AFP); congenital cytomegalovirus (cCMV); neonatal and infant herpes simplex virus (HSV) infection; perinatal exposure to human immunodeficiency virus (HIV) and paediatric HIV infection; severe complications of influenza; juvenile-onset recurrent respiratory papillomatosis (JoRRP); congenital rubella infection/syndrome; congenital varicella syndrome (CVS) and neonatal varicella infection (NVI); and the new conditions dengue; Q fever; and severe acute hepatitis. In 2022, cases of severe complications of influenza were reported to the APSU for the first time since 2019. This likely reflects the easing of government-mandated restrictions imposed in 2020-2021 to curb the transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and the re-emergence of a range of infectious diseases. As previously, AFP surveillance by the APSU contributed to Australia achieving a minimum target incidence of one AFP case per 105 children aged less than 15 years. Cases of JoRRP and NVI were reported in 2022. This indicates potential gaps in human papillomavirus (HPV) and varicella vaccination coverage respectively, especially in high-risk groups such as young migrant and refugee women of childbearing age from countries without universal vaccination programs. Paediatric HIV case numbers resulting from mother-to-child-transmission (MTCT) of HIV remain low in Australia due to use of effective intervention strategies. However, there has been an increase in the number of imported cases of HIV in children (mainly perinatally-acquired) from countries with a high HIV prevalence. Without effective vaccines, there has been no decline in the incidence of congenital CMV and neonatal HSV, indicating the importance of early identification and management to reduce morbidity and mortality. The first cases of dengue, Q fever and severe acute hepatitis were received by APSU in 2022, including two cases of acute hepatitis in which aetiology has not been confirmed to date. The APSU has an important ongoing role in monitoring rare childhood infections.

The Carotid-Hyoid Topography Is Variable.

Background and Objectives: The carotid bifurcation (CB) is presented in most anatomy textbooks as having a unique location at the upper margin of the thyroid cartilage. Although a number of case reports have provided evidence of the possibility of carotid artery location either lateral or medial to the greater hyoid horn, these reports have not established specific anatomic possibilities and prevalences. Materials and Methods: We retrospectively analysed a batch of 147 CT angiograms for 12 types of carotid-hyoid relationships and classified the bilateral combination possibilities of these types. Results: In 168/294 sides there were no carotid-hyoid relationships. Type I, external carotid artery (ECA) medial to the greater horn of the hyoid bone (GHHB), was observed in 0.34%; type II, internal carotid artery (ICA) medial to GHHB, in 0.34%; type III, ICA and ECA medial to GHHB, in 1.02%; type IV, common carotid artery (CCA) medial to GHHB, in 1.02%; type V, CB medial to GHHB, in 0.34%; type VI, ECA lateral to GHHB, in 20.41%; type VII, ICA lateral to GHHB, was not recorded; type VIII, ECA and ICA lateral to GHHB, in 3.74%; type IX, CCA lateral to GHHB, in 8.5%; type X, CB lateral to GHHB, in 6.46%; type XI, ECA lateral and ICA medial to GHHB, in 0.34%; and type XII, ICA lateral and ECA medial to GHHB, in 0.34%. Bilateral symmetry was found in 70.74% of cases, including the null types without carotid-hyoid relationships as well as types IV, VI, VIII, IX, and X. There was a highly significant association between the left and right variants of the carotid-hyoid relationship. Conclusions: Mechanical compression of the hyoid bone on the carotid arteries has various undesirable effects on the ICA and cerebral circulation. Underlying these are several variational anatomical patterns of carotid-hyoid relationships, which can be accurately documented on CT angiograms. A case-by-case anatomical study is better than assuming the carotid anatomy learned from textbooks.

Transcatheter vacuum aspiration of valvular and lead related infective endocarditis

BackgroundTranscatheter aspiration is utilized for removal of thrombi and vegetations in inoperable patients and high-risk surgical candidates where medical therapy alone is unlikely to achieve desired outcome. A number of case reports and series have been published since the introduction of AngioVac system (AngioDynamics Inc., Latham, NY) in 2012 where this technology was used in the treatment of endocarditis. However, there is a lack of consolidated data reporting on patient selection, safety and outcomes. MethodsPubMed and Google Scholar databases were queried for publications reporting cases where transcatheter aspiration was used for endocarditis vegetation debulking or removal. Data on patient characteristics, outcomes and complications from select reports were extracted and systematically reviewed. ResultsData from 11 publications with 232 patients were included in the final analyses. Of these, 124 had lead vegetation aspiration, 105 had valvular vegetation aspiration, and 3 had both lead as well as valvular vegetation aspiration. Among the 105 valvular endocarditis cases, 102 (97 %) patients had right sided vegetation removal. Patients with valvular endocarditis were younger (mean age 35 years) vs. patients with lead vegetations (mean age 66 years). Among the valvular endocarditis cases, there was a 50–85 % reduction in vegetation size, 14 % had worsening valvular regurgitation, 8 % had persistent bacteremia and 37 % required blood transfusion. Surgical valve repair or replacement was subsequently performed in 3 % and in-hospital mortality was 11 %. Among patients with lead infection, procedural success rate was reported at 86 %, 2 % had vascular complications and in-hospital mortality was 6 %. Persistent bacteremia, renal failure requiring hemodialysis, and clinically significant pulmonary embolism occurred in about 1 % each. ConclusionsTranscatheter aspiration of vegetations in infective endocarditis has acceptable success rates in vegetation debulking as well as rates of morbidity or mortality. Large prospective multi-center studies are warranted to determine predictors of complications, thus helping identify suitable patients.

Assessing the heterogeneity in the transmission of infectious diseases from time series of epidemiological data.

Structural features and the heterogeneity of disease transmissions play an essential role in the dynamics of epidemic spread. But these aspects can not completely be assessed from aggregate data or macroscopic indicators such as the effective reproduction number. We propose in this paper an index of effective aggregate dispersion (EffDI) that indicates the significance of infection clusters and superspreading events in the progression of outbreaks by carefully measuring the level of relative stochasticity in time series of reported case numbers using a specially crafted statistical model for reproduction. This allows to detect potential transitions from predominantly clustered spreading to a diffusive regime with diminishing significance of singular clusters, which can be a decisive turning point in the progression of outbreaks and relevant in the planning of containment measures. We evaluate EffDI for SARS-CoV-2 case data in different countries and compare the results with a quantifier for the socio-demographic heterogeneity in disease transmissions in a case study to substantiate that EffDI qualifies as a measure for the heterogeneity in transmission dynamics.

Wastewater monitoring of SARS-CoV-2 in on-grid, partially and fully off-grid Bedouin communities in Southern Israel

BackgroundWastewater based epidemiology (WBE) has become an important tool in SARS-CoV-2 surveillance and epidemiology. While WBE measurements generally correlate with observed case numbers in large municipal areas on sewer grids, there are few studies on its utility in communities that are off-grid (non-sewered).Methods and materialsTo explore the applicability of wastewater surveillance in our region, five Bedouin communities along the Hebron Stream in Southern Israel (Negev desert) were sampled. One point (El-Sayed) represents a community with partial connection to the sewer grid system and another point (Um Batin) represents a community with no access to the sewer grid system. The towns of Hura, Lakia, and Tel Al-Sabi/Tel Sheva were on-grid. A total of 87 samples were collected between August 2020 to January 2021 using both grab and composite sampling. RNA was extracted from the raw sewage and concentrated sewage. RT-qPCR was carried out with N1, N2, and N3 gene targets, and findings were compared to human case data from the Israeli Ministry of Health.ResultsSARS-CoV-2 was detected consistently over time in on-grid Bedouin towns (Lakia, Tel Sheva/Tel as-Sabi, and Hura) and inconsistently in smaller, off-grid communities (El-Sayed and Um Batin). The trend in maximum copy number/L appears to be driven by population size. When comparing case numbers normalized to population size, the amount of gene copies/L was inconsistently related to reported case numbers. SARS-CoV-2 was also detected from sewage-impacted environmental waters representing communities with no access to the wastewater grid. When grab sampling and composite sampling data were compared, results were generally comparable however composite sampling produced superior results.ConclusionsThe mismatch observed between detected virus and reported cases could indicate asymptomatic or “silent” community transmission, under-testing within these communities (due to factors like mistrust in government, stigma, misinformation) or a combination therein. While the exact reason for the mismatch between environmental SARS-CoV-2 signals and case numbers remains unresolved, these findings suggest that sewage surveillance, including grab sampling methodologies, can be a critical aspect of outbreak surveillance and control in areas with insufficient human testing and off-grid communities.

Asymptomatic Metastatic Osteosarcoma to The Right Atrium: Case Report and Review of The Literature

The heart may rarely be affected by primary or secondary tumors. Cardiac osteosarcoma metastasis is extremely rare and has been documented in young adults as shown in a number of case reports. IT may occur by local extension or haematogenous spread [1-2]. Only 5% of cases affect the endocardium or chamber cavities. We report a rare case of a 17-year-old children with asymptomatic cardiac osteosarcoma metastasis suspected by trans-thoracic echocardiography for pre-chemotherapy assessment and then confirmed by MRI.