Retrospective Epidemiological Study Research Articles

A retrospective observational study of epidemiology, clinical characteristics and outcomes of melioidosis in a tertiary care hospital in Hyderabad

Abstract Background: Melioidosis, caused by Burkholderia pseudomallei, is becoming a disease of public health importance. Despite appropriate treatment, the disease is associated with a high mortality due to the non-availability of diagnostic modalities at primary care and due to delayed presentation to the tertiary care hospital. Methods: This is a retrospective observational study of 12 cases of culture-proven melioidosis diagnosed at a tertiary care hospital in Hyderabad in South India over a period of 15 months. This study presents the epidemiology, risk factors, clinical and radiological manifestations and outcomes of patients with culture-proven melioidosis. Results: The study included 12 participants, out of which 11 were male, with a mean age of 39 years. Diabetes mellitus was the most common comorbidity in our series. The most common organs involved were lung (n = 5) and bone (n = 4). The other organs involved were prostate, liver, skin and soft tissue, spleen, aorta, brain, kidney and bone marrow. B. pseudomallei was isolated from pus culture in eight patients, blood cultures in seven patients and bone marrow culture in one patient. Eleven out of 12 patients were treated with meropenem. In our series, 7 out of 12 patients died; thus, a mortality of 58.3% was noted. Conclusions: Melioidosis is an emerging disease in India but remains under-recognised. This study showed that young males with diabetes, working in agricultural fields, are susceptible. Although the clinical manifestations are diverse, melioidosis should be suspected when patients with diabetes present with pneumonia and abscesses.

A retrospective epidemiological cohort study of ankle fractures in children and teenagers.

Ankle fracture is one of the most frequent pediatric lower-limb fractures and may result in serious complications. This study aimed to determine the epidemiology of ankle fractures, defining fracture types, treatments, and complications in a pediatric population below 16 years old. Medical records of all the ankle fracture patients treated in our hospital during 2004-2020 were retrospectively reviewed. Data regarding age, sex, mechanism of injury, fracture type, treatment modalities, and complications were collected. We examined records involving 328 children with 331 ankle fractures, with a ratio of 1:2 male per female. Mean annual prevalence was 24.3 per 100,000 children. Mean patient age was 11.2 ± 4.2 years, with 75.3% of them aged over 10 years. Sports activities accounted for the largest percentage of fractures (162 cases; 49.4%), followed by falls (67; 20.4%) and road traffic accidents (37; 11.3%). Physeal fractures were the most frequent type of lesion (223 cases). Most ankle fractures (60%) were managed using closed reduction and casting; for the remaining 40% of cases, fracture fixation was performed after closed or open reduction to correct the articular step-off and ensure the anatomical restoration of the physis. The main ankle fracture complication was premature growth arrest (12.1% of all physeal fractures). Pediatric ankle fractures primarily affect children older than 10 years. Most of these fractures were caused by sports injuries or low-energy trauma. The majority of these fractures are physeal, and the distal tibial physis is affected 10 times more frequently than the distal fibular physis. Level III.

Mental Health of Children and Adolescents before and during the COVID-19 Pandemic: How Did the Lockdown Modify Psychiatric Emergencies in Tuscany, Italy?

The COVID-19 pandemic has deeply impacted several aspects of the lives of children and adolescents. We analyzed the trends of psychiatric disorders in the emergency room. The analysis comprised the pre-pandemic (2018-2019) and the pandemic years (2020-2021). We conducted a retrospective observational epidemiological study that compared admissions during the two periods on a sample of 1311 patients aged between 4 and 18, focusing on new admissions vs. relapse, demographic variables, lockdown severity, presentation of psychiatric symptoms, diagnosis, severity, and outcome. Over the two-year pandemic period, we observed a 33% decrease in admissions to the emergency room for non-psychiatric disorders and a 200% increase in admissions for psychiatric emergencies. This increase is concentrated in periods with fewer restrictions and in the second year of the pandemic. We also observed a greater impact of psychiatric disorders on female patients, a greater severity of psychiatric disorders, a change in diagnoses associated with the presentation of symptoms, and an increase in hospitalizations. The children's psychiatric emergency service faced an "emergency within the emergency". In the future, it will be necessary to continue the follow-up of these patients, strengthen the field of study of gender psychiatry, and intensify our efforts towards prevention.

#5167 RENAL PROGNOSIS IN PATIENTS WITH ACUTE KIDNEY INJURY AND COMPARISON OF THE RIFLE AND KDIGO CLASIFICATION SYSTEMS: WHAT IS THE ROLE OF DIABETUS MELLITUS?

Abstract Background and Aims Acute Kidney Injury (AKI) is a frequent clinical entity. There are three AKI definition clasifications: RIFLE, AKIN and KDIGO. The endpoint of this study is to compare KDIGO and RIFLE regarding the prediction of AKI stage and adverse outcomes and to evaluate the renal prognosis of patients with a history of chronic kidney disease (CKD), who develop AKI during hospitalization. It is a well-known fact that Diabetes mellitus (DM) is the most common cause of end-stage chronic kidney disease (CKD). The epidemiology and outcome of diabetic patients with AKI during hospitalization, needs further study and comparison with the data of non-diabetic patients. As a secondary end point of this study we observed the progression of kidney function and severity of treatment in diabetic patients with stage III AKI (KDIGO) in comparison with the non-diabetic patients. Method This is a retrospective epidemiological study where data of 1083 adult patients were examined with AKI, who were hospitalized in various clinics at General Hospital of Athens Hippokratio between January 2021-September 2022. Results A total of 1083 patients were registered (63% male, mean age 74.5 ±12.6 years). 42% suffered from diabetes mellitus, 39% from arterial hypertension and 41% from CKD. RIFLE identified fewer patients with AKI than KDIGO (69.7% vs. 100%, p<0.001). Of all patients, 45.1% corresponded to AKI stage 1 (AKI-1), 7.3% to AKI stage 2 (AKI-2) and 47.6% to AKI stage 3 (AKI-3) according to KDIGO. 41.9% of AKI-3 patients underwent hemodialysis. Of the 214 patients on dialysis, 31.8% were not identified as AKI by RIFLE. In addition, patients with a history of CKD showed a higher percentage of AKI-3 (47.1% vs. 39.3% AKI-1, p=0.003 and 13.6% AKI-2, p=0.001) and underwent hemodialysis in a higher percentage (56.6% vs. 43.4%, p= 0.002). On the secondary end point 1083 patients, 458 (42.3%) diabetic and 625 (57.7%) non-diabetic were recognized. Hemodialysis was required in 83(18%) diabetic patients and in 132(21.1%) non-diabetic patients. Patients who ended up on end stage CKD requiring chronic hemodialysis or with GFR<15ml/min/1.73 m2 one month after hospital discharge were 37.7% and 51, 1% respectively. More specifically patients with the worst prognosis, who developed end stage CKD or ended up with GFR<15ml/min/1.73 m2 one month after hospital discharge, were categorized in three groups according to CKD Stage at hospital admission : in group A) CKD STAGE II out of 29, 8 (27.3%) non-diabetics and out of 19, 4 (21%) diabetic, in group B) STAGE IIIa out of 30 patients 5 (16.6%) non-diabetic and out of 15 3 (20%) diabetic and in group C) STAGE IIIb out of 17 patients 8 (47%) non-diabetic and out of 20 6 (30%) diabetics. It should be mentioned that the worst prognosis was observed in patients who were hospitalized for infection out of 30, 16(63%), with prerenal AKI out of 19 patients, 10(53%) and with a cardiovascular event out of 18 patients, 6(33%). Conclusion RIFLE criteria identified a lower proportion of patients with AKI compared to KDIGO, while not classifying a proportion of patients undergoing hemodialysis as AKI. Additionally, CKD was associated with worse renal prognosis in hospitalized patients with AKI. Patients with AKI on CKD who required hemodialysis during their hospitalization did not appear to have a worse prognosis at one month after discharge,compering diabetic with non-diabetic in group A and B. On the contrary there was a significant difference between patients in group C.

#3859 THE TREND OF RENAL REPLACEMENT THERAPY IN N. MACEDONIA FROM 2015 TO 2020: DATA FROM THE ERA-EDTA ANNUAL REGISTRY

Abstract Background and Aims Kidney Failure (KF) is treated with three modalities of renal replacement therapy (RRT): kidney transplantation (Tx), hemodialysis (HD), and peritoneal dialysis (PD). Our study aimed to present the trend of RRT in N. Macedonia from 2015 to 2020. Method The epidemiological retrospective study analyzed the patients with kidney failure by gender, age, etiology of kidney disease, and modality of RRT. The data were processed from the annual reports of the European Renal Association-European Dialysis and Transplant Association (ERA-EDTA). The study patients were divided into group 1 (prevalent) with patients on the RRT at the current year, group 2 (incidence at Day 1) with patients on the RRT with a duration of at least 1 day, and group 3 (incidence at Day 91) with patients on the RRT with a duration beyond 91 days. Results A total of 10395 patients were analyzed with a mean age of 59.2 ± 9.5 years (median 60.4 years), of which 60.2% were male. From 2015 to 2019, there was an increasing trend in all groups, and most patients were reported in 2019. In group 1, 1598 patients were registered in 2015, and 1762 patients were registered in 2020, which is an increasing trend of 10.3%. The number of patients in group 2 was increasing every following year, with the highest growth in 2019 up to 12.1%, compared to 2018. The number of patients in group 3 also showed significant growth from 253 patients in 2015 to 324 patients in 2019, but there was a decrease of 16.4% in 2020 (271 patients). Deviations are observed in 2020, with a decrease in the number of patients in group 1 and group 3, as well as a slowdown in the growth dynamics of patients in group 2, which might be associated with the start of the SARS-CoV-2 pandemic. According to the modality, most of the patients (84.7%) were on HD in 2015 and 85.9% in 2020. The most frequent age group of patients was from 45 to 64 years, from 36.3% to 49.4%. There was an increasing trend of patients from older age groups (over 64 years) and male patients. The increasing number of patients from the age group 75+ years was also noted in all groups. Etiology of kidney disease: hypertension (25.8%) and diabetes mellitus (17.4%) were the leading causes of KF in patients requiring RRT. Conclusion The study showed a constantly increasing trend of patients with KF requiring RRT. The largest number of patients were men, aged from 45 to 64 years. Hypertension and diabetes mellitus were the leading causes of KF, and most of the patients were treated with HD.

Population-Based Study of Coronary Artery Calcification Using the Automated Analysis of Radiology Reports in Moscow

Introduction: Problems of prevention, diagnosis and treatment of diseases of the circulatory system remain highly relevant. One of the effective preventive measures is early identification of risk factors, including coronary calcium. Recent achievements in the field of computer vision have made it possible to conduct opportunistic coronary calcium screening. Objective: To study the prevalence of coronary artery calcification as a risk factor for cardiovascular diseases in the population of Moscow based on the results of an automated analysis of radiology findings. Materials and methods: In July 2021 – December 2022, we conducted a retrospective descriptive epidemiological study, within which we analyzed chest CT images of 165,234 patients (71,635 males and 93,599 females) for coronary artery calcification and calcium scoring using AI services in an automated mode. Results: Coronary calcium was detected in 61.4 % of the examined. The proportion of men was 68.9 %, women – 55.7 % (р < 0.001). The calcium score ranged from 1 to 60,306 units (mean = 558.2). The average growth rate of the calcium score for the whole population was 170.75, the average growth rate was 168.13, and the average increase rate was 68.13 units during study period. In 47.6 % of men and 36.5 % of women with coronary calcium, the calcium score was clinically significant, i.e. ≥ 300 (p < 0.001). Most people with coronary calcium at a clinically significant level belonged to elderly and senile age groups (42.0 % each). Conclusions: The prevalence of coronary calcium in the population of Moscow was 8.03 per 1,000 people. In men, coronary calcium (including that at a clinically significant level) was statistically more frequent while the average calcium score in them was significantly higher than in women of most age groups. The mean calcium score demonstrated a constant increase with age.

Exclusion of Horizontal and Vertical Transmission as Major Sources of Trypanosoma Cruzi Infections in a Breeding Colony of Rhesus Macaques (Macaca Mulatta).

The vector-borne protozoal parasite Trypanosoma cruzi causes Chagas disease in humans and animals. This parasite is endemic to the southern United States where outdoor-housed NHP at biomedical facilities are at risk of infection. In addi- tion to the direct morbidity caused by T. cruzi, infected animals are of limited biomedical research use because infections can produce confounding pathophysiologic changes even in animals with no clinical disease. In part due to concerns for direct T. cruzi transmission between animals, infected NHP at some institutions have been culled, removed, or otherwise isolated from uninfected animal populations. However, data that document horizontal or vertical transmission in captive NHP in the United States are not available. To evaluate the potential for inter-animal transmission and to identify environmental factors that affect the distribution of new infections in NHPs, we conducted a retrospective epidemiologic study of a rhesus macaque ( Macaca mulatta ) breeding colony in south Texas. We used archived biologic samples and husbandry records to identify the time and location of macaque seroconversion. These data were used to perform a spatial analysis of how geographic location and animal associations affected the spread of disease and to infer the importance of horizontal or vertical routes of transmission. The majority of T. cruzi infections were spatially clustered, suggesting that environmental factors promoted vector exposure in various areas of the facility. Although we cannot not rule out horizontal transmission, our data suggest that horizontal transmission was not a critical route for spread for the disease. Vertical transmission was not a contributing factor in this colony. In conclusion, our findings suggest that local triatome vectors were the major source of T. cruzi infections in captive macaques in our colony. Therefore, limiting contact with vectors, rather than segregation of infected macaques, is a key strategy for disease prevention at institutions that house macaques outdoors in the southern United States.

Pediatric foreign body ingestion in Makkah, Saudi Arabia: A retrospective epidemiological study.

To improve the local data and demographics of foreign body (FB) ingestion in the Makkah, Saudi Arabia and to provide basic statistics for future studies in the local community. We carried out a record-based retrospective epidemiological study of 153 pediatric patients with FB ingestion who presented to our center in Makkah, Saudi Arabia, between December 2014 and December 2019. Adult age, impacted FB at other sites, and chemical ingestion were excluded. Descriptive statistical analyses were performed. There has been an alarming increase in the number of children admitted to hospitals following FB ingestion. Approximately 41.8% of these patients were under the age of 4 years, with boys (63.4%) accounting for the majority. Most of the ingested FB were coins (60.8%), and 96.7% of the patients remained under 24 hours of observation at the hospital. The results showed a highly statistically significant relationship between the FB type, age, length of hospital stay, and esophagoscopic findings. A large number of children presented with ingested FB, especially those younger than 4 years of age, whose clinical presentation varied from asymptomatic to severe complications, and urgent endoscopic intervention might have decreased serious complications. Further preventive measures are necessary within homes in addition to increasing caregivers' awareness of the different circumstances of FB ingestion and the time required for urgent admission.

Transmission and resistome of extremely drug-resistant tuberculosis in Beijing, China: A retrospective population-based epidemiological study

BackgroundIn this study, we utilized whole genome sequencing (WGS) of clinical extremely drug-resistant tuberculosis (EDR-TB) strains collected during 2014–2020 in Beijing to detect clustered strains. MethodsA retrospective cohort study was conducted by inclusion of EDR-TB patients with positive cultures in Beijing between 2014 and 2020. ResultsA total of 95 EDR-TB patients were included in our analysis. Up on the WGS based genotyping, 94 (94/95, 98.9%) out of 95 were identified as lineage 2 (East Asia). The pairwise genomic distance analysis identified 7 clusters, ranging in size from 2 to 5 isolates. The clustering rate of EDR-TB was 21.1%; while no patients had significantly higher odds of clustering. All isolates harbor rpoB RRDR mutations that confer RIF resistance and katG or inhA promoter mutations that confer INH resistance. Of 95 EDR-TB isolates, a total of 15 mutation types were recorded in the transcriptional regulator mmpR5. In vitro susceptibility testing results revealed that 14 (14/15, 93.3%) out of 15 mutation types were resistant to CFZ; whereas only 3 (3/15, 20.0%) showed resistance to BDQ. Interestingly, 12 isolates harbored mutations within rrl locus, whereas only mutations at positions 2294 and 2296 conferred CLA resistance. Favorable outcomes of EDR-TB patients were positively associated with more effective drugs in the regimes. ConclusionWGS data demonstrate limited transmission of EDR-TB in this metropolis city. WGS-based drug susceptibility predictions will bring benefits to EDR-TB patients to formulate optimal therapeutic regimens.

Factors affecting hospital discharge outcomes in patients with community-acquired pneumonia: A retrospective epidemiological study (2014-2021)

BackgroundIn patients with community-acquired pneumonia (CAP), the risk and protective factors influencing discharge outcomes have not been fully elucidated. Therefore, we aimed to investigate the factors affecting discharge outcomes and provide a theoretical basis for improving the cure rate of patients with CAP. MethodsWe describe a retrospective epidemiological study of patients with CAP conducted from 2014 to 2021. We used age, sex, co-morbidities, multilobar involvement, severe pneumonia, the main abnormal symptoms present on admission, and pathogen-targeted therapy as variables that may affect discharge outcomes. These variables were included in subsequent logistic regression analyses. Discharge outcomes were divided into remission and cure. ResultsOf a total of 1008 patients with CAP, 247 patients were discharged as remission. The results of multivariate logistic regression analyses showed that age >65 years, smoking history, co-morbidity of chronic obstructive pulmonary disease, co-morbidity of chronic heart disease, co-morbidity of diabetes, co-morbidity of malignancy, co-morbidity of cerebrovascular disease, pleural effusion, hypoxemia, respiratory failure, electrolyte disturbances, and severe pneumonia were independently associated with poor discharge outcomes (all P < 0.05), while pathogen-targeted therapy (odds ratio: 0.32, 95% confidence interval: 0.16–0.62) was found as a protective factor. ConclusionsAge > 65 years, the presence of co-morbidities, the presence of admission symptoms such as electrolyte disturbances, and severe pneumonia are associated with a poor discharge outcome, while pathogen-targeted therapy is associated with a good discharge outcome. Patients with CAP with a defined pathogen are more likely to be cured. Our results suggest that accurate and efficient pathogen testing is essential for CAP inpatients.

Celiac Disease on the Rise in the US Military Population: A 22 Year Retrospective Epidemiologic Study.

We describe celiac disease epidemiology in the US military population. This is a population-based study from data collected between 2000 and 2021. Incidence and prevalence rates and descriptive statistics for demographics are presented. Overall, 2248 incident cases of celiac disease were identified. The incidence rate increased from 1.2 to 14.0 per 100,000 person-years and the overall lifetime prevalence increased from 3.1 to 57.4 per 100,000 service members. In gastroenterology clinics, the incidence rate increased from 1.4 to 8.2 per 100,000 person-years, while prevalence increased from 3.3 to 33.4 per 100,000 service members. In this study, celiac disease incidence and prevalence increased significantly.

Association of socio-economic deprivation with COVID-19 incidence and fatality during the first wave of the pandemic in Italy: lessons learned from a local register-based study

BackgroundCOVID-19 has been characterised by its global and rapid spread, with high infection, hospitalisation, and mortality rates worldwide. However, the course of the pandemic showed differences in chronology and intensity in different geographical areas and countries, probably due to a multitude of factors. Among these, socio-economic deprivation has been supposed to play a substantial role, although available evidence is not fully in agreement. Our study aimed to assess incidence and fatality rates of COVID-19 across the levels of socio-economic deprivation during the first epidemic wave (March–May 2020) in the Italian Province of Foggia, Apulia Region.MethodsBased on the data of the regional active surveillance platform, we performed a retrospective epidemiological study among all COVID-19 confirmed cases that occurred in the Apulian District of Foggia, Italy, from March 1st to May 5th, 2020. Geocoded addresses were linked to the individual Census Tract (CT) of residence. Effects of socio-economic condition were calculated by means of the Socio-Economic and Health-related Deprivation Index (SEHDI) on COVID-19 incidence and fatality.ResultsOf the 1054 confirmed COVID-19 cases, 537 (50.9%) were men, 682 (64.7%) were 0–64 years old, and 338 (32.1%) had pre-existing comorbidities. COVID-19 incidence was higher in the less deprived areas (p < 0.05), independently on age. The level of socio-economic deprivation did not show a significant impact on the vital status, while a higher fatality was observed in male cases (p < 0.001), cases > 65 years (p < 0.001), cases having a connection with a nursing home (p < 0.05) or having at least 1 comorbidity (p < 0.001). On the other hand, a significant protection for healthcare workers was apparent (p < 0.001).ConclusionsOur findings show that deprivation alone does not affect COVID-19 incidence and fatality burden, suggesting that the burden of disease is driven by a complexity of factors not yet fully understood. Better knowledge is needed to identify subgroups at higher risk and implement effective preventive strategies.

Adults in Northwest China experienced the largest outbreak of Japanese encephalitis in history 10 years after the Japanese encephalitis vaccine was included in the national immunization program: A retrospective epidemiological study.

Mainland China included Japanese encephalitis (JE) vaccine in the national immunization program in 2008 to control the JE epidemic. However, Gansu province in Western China experienced the largest JE outbreak since 1958 in 2018. We conducted a retrospective epidemiological study to explore the causes of this outbreak. We found that adults aged ≥20 years (especially those in rural areas) were the main JE cases in Gansu Province, with a significant increase in the JE incidence in older adults aged ≥60 years in 2017 and 2018. In addition, JE outbreaks in Gansu Province were mainly located in the southeastern region, while the temperature and precipitation in Gansu Province were gradually increasing in recent years, which made the JE epidemic areas in Gansu Province gradually spread to the western of Gansu Province. We also found that adults aged ≥20 years in Gansu Province had lower JE antibody positivity than children and infants, and the antibody positivity rate decreased with age. In the summer of 2017 and 2018, the density of mosquitoes (mainly the Culex tritaeniorhynchus) in Gansu Province was significantly higher than in other years, and the genotype of JEV was mainly Genotype-G1. Therefore, in the future JE control in Gansu Province, we need to strengthen JE vaccination for adults. Moreover, strengthening mosquito surveillance can provide early warning of JE outbreaks and the spread of epidemic areas in Gansu Province. At the same time, strengthening JE antibody surveillance is also necessary for JE control.

Association of Early Sports Participation With Sedentary Behavior in Community-Dwelling Adults—The Role of Sociodemographic Factors in a Retrospective Epidemiological Study

The role of sociodemographic factors in the association between early sports participation (ESP) and sedentary behavior is unclear. We analyzed the association of ESP with sedentary behavior and identified the influence of sociodemographic factors in adulthood. A sample of 264 community-dwelling adults was randomly assessed (42.6 [17.0]y old, 57.6% women). Sociodemographic factors (age, gender, and socioeconomic status) and ESP (retrospectively) were assessed by questionnaire. Sedentary behavior was measured by accelerometer and self-reported for domains identification. The association between ESP and sedentary behavior domains and sociodemographic factors was analyzed by Poisson regression and presented in prevalence ratio (PR). Sociodemographic factors were separately included as covariates to identify their role in the main association analysis. The ESP prevalence was 56.4% (n = 149). ESP participants included a higher proportion of men (59.7% vs 20.0%), had a lower age (36.8 [15.3] vs 50.8 [15.9]), and included a smaller proportion of individuals with low socioeconomic status (24.8% vs 43.5%) compared with those without ESP. The ESP was inversely associated with older age (PR = 0.58, P < .001 for middle aged; PR = 0.34, P < .001 for older participants), female gender (PR = 0.79, P < .001), low socioeconomic status (PR = 0.63, P = .036), and TV watching (PR = 0.67, P = .011). ESP was associated with driving (PR = 1.50, P = .028), office/paper work (PR = 1.63, P = .012), and using a cellphone (PR = 1.60, P = .009). The age was the main confounding factor of association between ESP and sedentary behavior, followed by socioeconomic status. No mediation role was identified. The ESP was associated with mentally active behavior domains and inversely associated with mentally passive sedentary behavior domains, but this association was majorly affected by sociodemographic factors, mainly by age.

Epidemiological characteristics of pulmonary tuberculosis among students in Guizhou, China: a retrospective study from 2010 to 2020

ObjectiveWe described epidemiological characteristics of pulmonary tuberculosis (PTB) among students and evaluated susceptible populations and areas in Guizhou province and also to provide scientific suggestions for prevention and control.SettingGuizhou, China.DesignThis...

Long-term tendency and risk factors for stroke in Bishkek

Objective: This retrospective study was designed to describe the morbidity, mortality rates and risk factors in adult urban population Bishkek, Kyrgyz Republic for the period 2004–2019 using data from the Stroke Registry. Methods: The data were derived from Stroke Registry between 2004 and 2019 in Bishkek through examination of records of patients admitted to hospitals and those receiving treatment at home prescribed by doctors of Registry. A retrospective epidemiological study of the long-term dynamics of the morbidity and mortality rates between 2004 and 2019 was performed. The growth (drawdown) rate was calculated using the least-squares method to align the time series. A comparative analysis of the rates was carried out by calculating the long-term average annual level of incidence by gender and age. Ethical approval was not necessary for the preparation of this article. Results: The most common type of stroke registered for the population of Bishkek was ischemic stroke (IS) (68.5%), followed by hemorrhagic stroke (HS) (21.4%) and cryptogenic stroke (10.1%). During the analyzed period of time there has been a moderate decrease in the incidence of IS (4,0%) and a notable decrease of HS (9,0%) and cryptogenic (26,9%) strokes. As for stroke mortality in long-term dynamics, we could observe an essential decrease in this indicator in all strokes (IS-13.0%, HS 13.6%, cryptogenic ones-37.7%). The most remarkable risk factor for stroke was arterial hypertension (86.5%). Cardiovascular pathology of another origin was detected in 32.7% of patients. Conclusion: Our results further help to understand what changes have been in the long-term dynamics of the incidence and mortality of stroke in Kyrgyzstan, in relation to which risk factors for stroke should be taken more action. There is a need to continue to strengthen prevention at the population level, to assess and manage the risk of cardiovascular disease in primary healthcare. Such measures will help prevent complications and support efforts to prevent relapse and disability.

Secondary Infections in Patients with Extremely Severe COVID-19 During ECMO Therapy

Up to 70% of patients hospitalized for COVID-19 need respiratory support, up to 10% need high-flow oxygen therapy, non-invasive and invasive ventilation. However, standard methods of respiratory support are ineffective in 0.4-0.5% of patients. In case of potentially reversible critical refractory respiratory failure that patients may require ECMO. Management of patients with extremely severe COVID-19 associates with numerous clinical challenges, including critical illness, multiple organ dysfunction, blood coagulation disorders, requiring prolonged ICU stay and care, use of multiple pharmacotherapies including immunosuppressive drugs. Pharmacological suppression of immunity is associated with a significant increase in the risk of secondary bacterial and fungal infections. Currently, data on epidemiology of secondary infections in patients with COVID-19 undergoing ECMO is limited.Aim. To study the prevalence and etiology of secondary infections associated with positive blood cultures in patients with extremely severe COVID-19 requiring ECMO.Materials and methods. A single-center retrospective non-interventional epidemiological study including 125 patients with extremely severe COVID-19 treated with ECMO in April 2020 to December 2021.Results. Out of 700 blood culture tests performed in 125 patients during the study, 250 tests were positive confirming bacteremia/fungemia. Isolated pathogens varied depending on the duration of ECMO: gram-positive bacteria (primarily coagulase-negative staphylococci) dominated from the initiation of ECMO support; increased duration of ECMO associated with an increasing the proportion of pathogens common in ICU (Klebsiella pneumoniae and/or Acinetobacter baumannii with extensively drug resistant and pan-drug resistant phenotypes, and vancomycin-resistant Enterococcus faecium). When ECMO lasted more than 7-14 days, opportunistic pathogens (Candida species, Stenotrophomonas maltophilia, Providencia stuartii, non-diphtheria corynebacteria, Burkholderia species and others) prevailed as etiological agents.Conclusion. Longer duration of ECMO resulted in increasing the rates of infectious complications. In patients undergoing ECMO for more than 14 days, the microbiological landscape becomes extremely diverse, which hampers choosing an empirical antimicrobial therapy. Since potential pathogens causing secondary infections in patients during ECMO are difficult to predict, rapid identification of rare opportunistic pathogens and their sensitivity profile, followed by targeted administration of antimicrobials, seems most beneficial.

Epidemiological study of paediatric traumatic brain injury in Brazil

BackgroundTraumatic brain injury (TBI) has a high economic and social impact on the family dynamics, particularly among children. High-quality and comprehensive epidemiological studies about TBI in this population are limited worldwide, specifically in Latin America. Therefore, this study aimed to elucidate the epidemiology of TBI among children in Brazil and its effects on the public health system. MethodsThis epidemiological (cohort) retrospective study collected data from the Brazilian healthcare database between 1992 and 2021. ResultsThe mean annual volume of hospital admission (HA) due to TBI in Brazil was 29,017. Moreover, the incidence of TBI in the paediatric population was 45.35 admissions per 100,000 inhabitants/year. Furthermore, approximately 941 paediatric hospital deaths per year were caused by TBI, with an in-hospital lethality rate of 3.21%. The average annual financial transfer for TBI was 12,376,628 USD, and the mean cost per admission was 417 USD. In addition, the mean length of hospital stay was 4.2 days. Notably, the length of stay in the hospital was longer among males, Afro-Brazilians patients and individuals aged 15–19 years. ConclusionPaediatric TBI is an important public health issue worldwide with high social and economic costs. The incidence of paediatric TBI in Brazil is similar to that in developing countries. Moreover, male predominance (2.3:1) was observed in relation paediatric TBI. Notably, during the pandemic, the incidence of paediatric HA has decreased. To the best of our knowledge, this is the first epidemiological study that specifically evaluates paediatric TBI in Latin America.

Síndrome de Wiskott-Aldrich en España: incidencia, mortalidad y sesgo de género durante 21 años

BackgroundWiskott-Aldrich syndrome (WAS) is a rare X-linked disorder considered to predominantly affect males. ObjectiveThis study aims to investigate the incidence and intrahospital death associated with WAS in Spain as well as the gender bias. MethodsA population-based retrospective epidemiological study of 97 WAS patients that were diagnosed in Spanish hospitals between 1997 and 2017 was conducted by using data from the National Surveillance System for Hospital Data. ResultsOur results revealed that the mean annual incidence of WAS in Spain was 1.1 per 10,000,000 inhabitants (CI95% 0,45-2,33). The relative risk was higher in male than female (2.42). WAS diagnosis occurs at later ages in women (median age of 47 years) compared to men (median age of 5.5 years). Only male were admitted to the hospital at least in 10 different occasions and all deaths were detected in men. The intra-hospital death rate was of 9.28% inWAS, being most of the deaths associated with brain hemorrhage or infection. ConclusionsWAS, a rare disease, is diagnoses at later ages in women and the mortality wasfound in males mostly associated with brain hemorrhage and infection.

Changes in the pathogen spectrum of hospitalized adults with community-acquired pneumonia in Fujian Province: A multicenter, retrospective study from 2012 to 2018.

Changes in the pathogen spectrum of hospitalized adults with community-acquired pneumonia in Fujian Province: A multicenter, retrospective study from 2012 to 2018.