Retrospective Epidemiological Study Research Articles

Trends in asthma hospitalizations among adults in Spain: Analysis of hospital discharge data from 2011 to 2020

AimsTo analyze trends in asthma hospitalizations in patients over 15 years of age in Spain. To identify possible changes in incidence, demographic characteristics, clinical conditions, and outcomes. MethodsWe conducted an observational retrospective epidemiological study using the Spanish National Hospital Discharge Database and included all patients hospitalized with a diagnosis of asthma from 2011 to 2020. ResultsA total of 1,102,923 patients were hospitalized with a code for asthma in any diagnostic position; of these, 153,749 (13.94%) had asthma coded as the primary diagnosis (asthma exacerbation). The number of patients with an asthma exacerbation decreased over time, from 15,356 in 2011 to 8804 in 2020. In-hospital mortality (IHM) remained low (around 1.5%) and stable in this subgroup of patients. When the diagnosis of asthma appeared in any diagnostic position, hospitalizations increased for all ages and sexes. In this case, a significant change was observed for IHM, which increased from 3.27% in 2011–12 to 4.36% in 2019–20 (p < 0.001). The main risk factors for IHM in both cases were age over 65 years, need for mechanical ventilation, and associated diagnoses of pneumonia, heart disease, or atrial fibrillation. In contrast, obesity was a predictor of lower mortality. ConclusionOur results suggest a decline in the incidence of hospitalizations for asthma exacerbations from 2011 to 2020. In contrast, the number of patients with asthma in any diagnostic position increased progressively, as did mortality, probably owing to an increase in comorbidities in a gradually ageing population.

Mortality related to pulmonary embolism in the United States before and during the COVID-19 pandemic: an analysis of the CDC Multiple Cause of Death database

Abstract Background The COVID-19 pandemic caused a large number of excess deaths. COVID-19 emerged as a prothrombotic disease often complicated by pulmonary embolism (PE). In light of this, we hypothesized that PE-related mortality rates (stable before the pandemic) would be characterized by an increasing trend following the COVID-19 outbreak. Purpose To investigate the mortality rates associated with PE among deaths with or without COVID-19 during the 2020 pandemic in the United States (US). Methods For this retrospective epidemiological study, we analyzed public medically certified vital registration data (death certificates encompassing underlying and multiple causes of death) from the Mortality Multiple Cause-of-Death database provided by the Division of Vital Statistics of the US Centers for Disease Control and Prevention (CDC; US, 2018–20). We investigated the time trends in monthly PE-related crude mortality rates for 2018–2019 and for 2020 (the latter associated vs. not associated with COVID-19), utilizing annual national population totals from the US Census Bureau. Second, we calculated the PE-related proportionate mortality among COVID-19 deaths (overall and limited to autopsy-based diagnosis). We performed subgroup analyses based on age groups, sex and race. Results During 2020, 49,423 deaths in association with PE were reported, vs. 39,450 in 2019 and 38,215 in 2018. The crude PE-related mortality rate without COVID-19 was 13.3 per 100,000 population in 2020 compared to 11.7 in 2018 and 12.0 in 2019 (Figure 1A). The PE-related mortality rate with COVID-19 was 1.6 per 100,000 population in 2020. Among non-COVID-19-related deaths, the crude PE-related mortality rate was higher in women; among COVID-19-related deaths, it was higher in men. PE-related mortality rates were approximately two-fold higher among black (vs. white) general population irrespective of COVID-19 status (Figures 1B and 1C). Among COVID-19 deaths, PE-related deaths corresponded to 1.4% of total; the value rose to 6.0% when an autopsy was performed. This figure was higher in men and its time evolution is depicted in Figure 2A. The proportionate mortality of PE in COVID-19 deaths was higher for younger age groups (15–44 years) compared to non-COVID-19-related deaths (Figure 2B). Conclusion In 2020, an overall 20%-increase in PE-related mortality was reported, not being limited to patients with COVID-19. Our findings could be interpreted in the context of undiagnosed COVID-19 cases, uncounted late sequelae, and possibly sedentary lifestyle and avoidance of healthcare facilities during the pandemic that may have prevented timely diagnosis and treatment of other diseases. Whether vaccination programs had an impact on PE-associated mortality in the year 2021, remains to be determined. Funding Acknowledgement Type of funding sources: None.

TCL-307 Epidemiological Data on T-Cell Lymphoma in the Republic of Kosovo During the Period of 2016-2021.

T-cell lymphomas consist of a wide variety of uncommon diseases that can be indolent or aggressive and consists of 12% of all NHL. T-cell lymphoma is an uncommon hematological malignancy in Kosovo compared to the other lymphoid malignancies. There are a variety of subtypes of the disease present with anaplastic large T-cell lymphoma being the most common. The diagnosis of this disease has increased in the last few years and the treatment with chemotherapy and other supportive care has many challenges. With this study, we want to better understand the disease so we can improve the quality of care for the patients. Cross-sectional retrospective epidemiological study. The data was collected during the period of February 2016 to January 2021. The data was collected from the chemotherapy treatment protocol books and patient files in the Hematology Clinic of the University Clinical Center of Kosovo. Adults, age 18 and older, of both genders, diagnosed the treated with T-cell lymphoma in the Hematology clinic of Kosovo. The diagnosis was made based on histopathological and immunohistochemical analysis of lymphoid tissue mostly in the Republic of Kosovo. During the period specified above, 47 patients were diagnosed and treated with T-cell lymphoma, the most common was anaplastic large T-cell lymphoma with 11(23.40%) then enteropathy associated T-cell lymphoma with 8(17.02%), NK/T-cell lymphoma with 5(10.63%). One rare example of T-cell lymphoma was a patient diagnosed with gamma/delta T-cell lymphoma, which was the only such case in our clinic. Of the patients diagnosed with T-cell lymphoma during this period, 33 were treated with the CHOP protocol as first-line chemotherapy. The majority of patients were treated with the CHOP chemotherapy protocol as the first-line therapy. The results of the treatments were successful in achieving remissions in a small number of patients. The patients that did not achieve remission received a second treatment protocol with mixed results.

Перебіг COVID-19 у госпіталізованих дітей

Purpose - to study the features of COVID-19 in hospitalized children. Materials and methods. Retrospective multicenter clinical and epidemiological study which includes 328 hospitalized children with laboratory-confirmed COVID-19 for the period from January to August 2021. Results. the highest specific weight among all hospitalized children falls on children of the first year (75/328; 22.8%), in general, early childhood (up to 3 years) accounted for 43% (141/328) of all hospitalizations of children with COVID-19. Common symptoms of the disease included fever, upper respiratory symptoms, intoxication, diarrhea. In 99/328 (30.1%) hospitalized children pneumonia has developed, 50/99 (50.5%) of which needed oxygen support, 10/99 (10.1%) - mechanical ventilation. Pneumonia was most common in children under 1 year, children of the first 5 years of life accounted for more than a half of all pneumonia cases (53/99; 53,5%). 13/328 (3.9%) children were hospitalized to the intensive care unit. Comorbidities including endocrine, oncological, neurological diseases, congenital malformations and others, were noted in 24.6% of hospitalized children. In children with comorbid conditions, pneumonia occurred 2 times more often (relative risk factor RR=1.98, CI 95%), the relative risk of getting into resuscitation RR in the presence of comorbidity is 10.86 (CI 95%). In addition to children with pneumonia, oxygen support or mechanical ventilation required children with obstructive syndrome, pancytopenia, convulsions. The largest proportion of comorbidities in patients hospitalized to the intensive care unit were diseases of the nervous system (congenital malformations of the CNS, cerebral palsy, epilepsy, astrocytoma). Lymphopenia and thrombocytopenia were most commonly associated with severe COVID-19. Conclusions. Children of all ages are susceptible to COVID-19. The main risk factors for severe disease are early age and the presence of comorbid conditions, among which the most relevant are diabetes, obesity, neurological diseases and cancer. The presence of comorbidities in children determines the priority groups for the prevention of coronavirus infection through vaccination. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of the Shupyk National Healthcare University of Ukraine. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the authors.

Is it Good to be Born as a Late Preterm Infant?

Background: This study conducted at the Clinic for Children’s Diseases of the University Clinical Hospital Mostar, aims to highlight the characteristics, frequency, course, most common complications and treatment outcomes of pregnant women and their late preterm infants according to gestational age. Methods: This study is a retrospective epidemiologic study for the period from 1/1/2018 to 31/12/2021. The study included all the preterm infants who were born at a gestational age from 34+0/7 to 36+6/7 weeks and their mothers. Results: In the period under study, a total of 7178 infants were born, of which 253 (3.52%) were late preterm infants. The results show that most mothers were between 30 and 39 years of age, pregnant for the first time with a single pregnancy, delivered by caesarean section, with complications in 53.1% of the pregnancies. All the analyzed pathological conditions were more common in the pregnancies which ended at 34 weeks. Our results indicate that the late preterm babies had a good birth weight (53.8%) and high vitality scores (93%) at birth, but these scores were not confirmed on the first day of life. A significant number of late preterm infants had some pathological condition which was treated in the intensive care units (ICU) (p &lt; 0.001). Conclusions: The study concludes that half of the pregnant women had risk factors which were the basis for the preterm births and the development of complications in the late preterm infants. Furthermore, despite good birth weight and vitality scores at birth, only one fifth of the late preterm infants were not treated with medications or developed pathological conditions, whereas only one third required no intensive care treatment. It is, therefore, necessary to improve the monitoring and understanding of such pregnancies, implement antenatal corticosteroid therapy, and increase parental awareness to ensure long-term and frequent monitoring of late preterm infants by pediatricians.

Oral Cancer Disparities in the Outer US-affiliated Pacific Islands.

Oral cancers in the US-affiliated Pacific Islands are poorly described despite disproportionately higher incidences in certain jurisdictions. This study attempts to better characterize the incidence, staging, and management of oral cancers in this region. Retrospective Epidemiological Study. A retrospective review was conducted across the US-affiliated Pacific Islands between 2007 and 2019. Patient data were obtained for individuals with primary head and neck cancers from the Pacific Regional Central Cancer Registry database. All cohorts were age-adjusted to the 2000 US Standard Population. Further analysis was performed on oral cavity cancers due to their clear predominance within the sample. A total of 585 patients with primary head and neck cancers were included. The average age was 54.5 ± 12.9 years, and most patients were male (76.8%). Oral cancer subsite analysis revealed the proportional incidence of buccal mucosa was higher in 5 of 9 jurisdictions when compared with the United States (p < 0.001). Tongue and lip cancers were not found to have significantly higher incidence proportions. Patients in the Pacific Islander group were less likely to be detected at earlier stages for cancers of the cheek and other mouth (p < 0.001), tongue (p < 0.001), and lips (p < 0.001) compared with the United States. Many Pacific Island populations are burdened with higher incidences of oral cancer with later staging. Further investigation is recommended to evaluate oral cancer-related outcomes and mortality in this region. 3 Laryngoscope, 133:1899-1905, 2023.

Landscape of Zoonoses Clusters in Bangladesh from 2001 to 2016: Impact to National Health

It remains unclear how human diseases are distributed spatially and temporally in Bangladesh. A retrospective epidemiological study was conducted using Bangladesh National Health Surveillance Data from 2000 to 2016, examining the risk factors, transmission mode, and treatment of viral dengue fever (DF), Nipah virus encephalitis (NiVE), rabies, zika, protozoan malaria, and bacterial anthrax in Bangladesh. Morbidity and mortality rates for dengue were 375 to 6132 cases and 0 to 2.5%, respectively, with the major hotspots in urban areas of Dhaka, Khulna, and Chittagong. It was reported that all four causative virus serotypes were present. It was estimated that Nipah morbidity/mortality ranged from 4 to 44 cases and 25 to 92%. The highestburden was to be found in the Northwestern and Central districts, with 31 geographical clusters. Despite being an emerging disease, Zika remains an underreported problem. Dhaka and its surrounding regions saw an increase in rabies cases caused by dog bites. Rabies was associated with a morbidity/mortality rate of 0 to 100,000 cases and 0 to 3.61%, respectively. Mortality and morbidity from anthrax were 0 to 607 cases and 0 to 0.0164%, respectively. The disease was prevalent in Sirajganj and its surrounding areas. Most cases were attributed to butchershandling infected cattle-meat. There were 3864 to 84690 malaria cases, with a mortality rate of 0.03 to 0.54%. 28.6 to 95.2% of the cases were caused by the protozoa P. falcifarum. Malaria is hyper-endemic in the Khagrachari, Bandarban and Rangamati districts. Since the beginning of the 2000s, advanced diagnostic, preventive, and treatment methods have been introduced to combat malaria. In order to control the spread of zoonotic diseases in the future, public health officials must take intensive interactive preventive measures.

Orthopaedic and trauma surgery in France: Do patterns differ across healthcare institution types (public community, public university, private not-for-profit, and private for-profit)?

BackgroundNo studies have evaluated, to our knowledge, potential differences in practices in France according to type of healthcare institution, i.e., university public hospital, community public hospital, or private hospital with or without participation in the public healthcare system. The objectives of this study of the exhaustive information collected in the French hospital-admission database were to: (1) describe the numbers of the main procedures performed in France by orthopaedic and trauma surgeons in each type of institution and each subspecialty; and (2) to determine whether the pattern of procedures differed according to the type of healthcare institution. HypothesisDifferences in surgical practice patterns exist across healthcare institution types and according to the nature of the procedures. Patients and methodsA retrospective observational nationwide study was performed using the exhaustive French hospital database. All surgical procedures done in 2019 for orthopaedic and trauma indications were collected. We then classified the procedures according to the most common diagnoses by distinguishing procedures on the hip, knee, shoulder, hand, spine, ankle, and foot, as well as paediatric and traumatology procedures. ResultsProcedures performed more often in private institutions included those on the hip (93,225 [64.3%] of 144,919), knee (223,542 [75.5%] of 296,255), shoulder (103,923 [76.6%] of 300,577), hand (408,035 [77.6%] of 525,534), spine (for degenerative disease, 27,001 [71.2%] of 37,915), and ankle and foot (75,392 [77.1%] of 105,720). In contrast, of the 19,157 (80.3%) of the 23,848 paediatric procedures and 203,090 (67.7%) of the 300,065 traumatology procedures were done in public institutions. For all eight comparisons, the difference between public and private institutions was statistically significant. The overall trend was towards public university hospitals performing more paediatric and trauma procedures and more complex surgeries such as those required by multiple traumatic injuries. DiscussionOur study provides accurate numbers of surgical procedures done in public and private healthcare institutions in France in 2019. We found major differences not only across categories and specialties but also within specialties depending on the type of procedure. Orthopaedic surgical activity shows a marked imbalance in France between public and private institutions. Further research would be needed to identify the causes. Level of evidenceIV, retrospective observational epidemiological study.

Epidemiological and faunistic characterization of scorpionism in the Beni Mellal-Khenifra region, Central Morocco

Scorpionism is a serious public health problem in several parts of the world including Morocco, where is considered as the first cause of intoxication. The Beni Mellal-Khenifra region is one of the most affected regions by this health problem. The aim of this study is to describe the epidemiological and faunistic characteristics of scorpionism in this area. A retrospective epidemiological study was conducted based on the data of 16,388 cases of scorpion stings recorded between 2016 and 2020. In the laboratory, the collected scorpions were determined morphologically based on the valid taxonomic keys. Statistical and descriptive analyses were performed using Excel 2016. Statistical significance was determined by P-value < 0.05. The study comprised 16,388 stung patients. The scorpion stings incidence was 123.58 cases/100,000 population/year and was significantly higher at Azilal province (217.69 cases/100,000 population/year). We found a positive correlation between the scorpion stings incidence and the percentage of the rural population (r = 0.72) and between the scorpion stings incidence and the number of harmful species found in each province (r = 0.69). The general lethality rate was on average of 0.30% with a higher rate in Fquih Ben Salah province (0.63%) followed by Azilal province (0.32%). Children have the highest lethality than adults (p < 0.05). In the study area, eight species were identified, belonging to the families Buthidae and Scorpionidae, including dangerous species. Scorpionism is a real health problem in the Beni Mellal-Khenifra region, which is a rich and diverse area of scorpion fauna. Our findings can be useful for better understanding the problem of scorpionism in this region in order to better control it.

Teleconsultation at Sea and Acute Wound Management Onboard.

Introduction: The French Tele-Medical Assistance Service (TMAS) provides medical teleconsultation for any ship at sea. At the end of the consultation, the doctor decides whether the problem can be taken care of onboard or not. In this study, we determined the factors associated with the decision for disembarkation or evacuation in case of wounds. Methods: We conducted a retrospective epidemiological study between 2011 and 2019 from consultations with the French TMAS. The inclusion criterion was the presence of an acute wound. Results: One thousand six patients (n = 1,006) were analyzed and 586 (58%) patients were disembarked or evacuated. Factors associated with disembarkation or evacuation are wound characteristics (severity and location), the onboard staff's medical training, the availability of photography, and the ship's location. Wound severity is a risk factor for disembarkation or evacuation. The availability of photography, staff with advanced training, and being at >1 day of navigation from a harbor are protective factors against being disembarked or evacuated. Conclusion: The added value of photography and an update of medium medical training could increase the number of wounds taken care of onboard.

Contribution of Patch Tests with Occupational Handled Products in the Diagnosis of Occupational Contact Dermatitis: A 10-year Review.

Introduction Allergic contact dermatitis (ACD) is a common occupational disease. Its diagnosis is essentially based on interrogation and patch tests. However, commercially available batteries are sometimes not appropriate for the working conditions and the handled products, which must then be tested. In Tunisia, no previous study has focused on the contribution of patch tests with handled products in the workplace. The objective of this study is to establish the sociodemographic and occupational profile of the patients benefiting from patch tests with handled products in the workplace to identify the characteristics of these products as well as to evaluate the relevance of their positivity and their contributions in terms of aetiological diagnosis of occupational ACD. Methods This is a retrospective descriptive epidemiological study conducted for a period of 10 years from January 1st, 2006, to December 31, 2015, among patients exercising a professional activity and consulting the Dermato-Allergology Unit of the Occupational Medicine ward of the University Hospital Farhat Hached of Sousse for the exploration of ACD. Results During the study period, 113 patients received patch tests of handled products in the workplace with a prevalence of 7.3% of patch-tested patients during the same period. The mean age was 35.79 ± 9.45 years with a male predominance (sex ratio = 1.35). The most represented activity sectors were the health sector in 30.1% and the textile sector in 21.2%. The majority of patients were professionally active (61.9% of the study population) with an average professional seniority of 10.28 ± 8.49 months. In total, 138 patch tests with handled products were carried out of which 46 tests were positive (33.3%). After the analytical study, variables independently significantly associated with the positivity of patch tests with handled products in the workplace were the male gender and the working in the plastics industry. An occupational disease was declared to the National Health Insurance Fund for 8 patients, i.e., 7.1% of cases. Conclusion Patch tests with handled products in the workplace can provide strong arguments for the professional origin of the ACD.

Epidemiology of shoulder instability procedures: A comprehensive analysis of complications and costs.

Recurrent shoulder instability is a debilitating condition that can lead to chronic pain, decreased function, and inability to return to activities or sport. This retrospective epidemiology study was performed to report 90-day postoperative complications and costs of Latarjet, anterior bone block reconstruction, arthroscopic, and open Bankart repair for shoulder instability. Patients 18 years and older who underwent four primary shoulder surgeries from 2010 to 2019 were identified using national claims data. Patient demographics, comorbidities, and 90-day postoperative complications were analyzed using univariate analysis and multivariable logistic regression. Total and itemized 90-day reimbursements were determined for each procedure. The 90-day medical and surgery-specific complication rates were highest for anterior bone block reconstruction, followed by Latarjet. Arthroscopic Bankart repair had the highest 90-day costs and primary procedure costs compared to other procedures. Anterior bone block reconstruction and Latarjet procedures were associated with the highest rates of 90-day medical and surgery-specific complications, while arthroscopic Bankart repair was associated with the highest costs.

Visceral Leishmaniasis in Ardabil Province, Northwest of Iran: A Retrospective Epidemiological, Clinical and Paraclinical Study (1985-2018).

Background:We aimed to investigate the epidemiological, clinical and paraclinical aspects of Visceral Leishmaniasis in Ardabil Province, from 1986 to 2018.Methods:The disease has been diagnosed by a serological validate test as Direct Agglutination Test, parasitological methods, and clinical manifestations. The data were collected and then analyzed.Results:Overall, 2824 out of 69007cases (4.1%) had anti-Leishmania antibodies at titers≥1:3200. The majority of VL cases belonged to Meshkin-Shahr, and then Germi County. The percentages of both male and female cases were 52.8 % and 46.6%, respectively. Approximately 78.1% of cases were less than 5 yr old. The high incidence rate of the disease was recorded in the years 1987 and 2003. 48.6%, 3.2%, and 1.9% of the patients had low titer (1:3200), high titer (1:102400), and suspicious titer (1:1600), respectively. Out of 1200 bone marrow aspiration, 23% were positive, and 77% were negative. Fever, paleness, and hepatosplenomegaly were the main symptoms in patients. Moreover, abdominal swelling, edema, weight loss, lymphadenopathy and jaundice were some other symptoms in the patients. Among biochemistry factors, the levels of aspartate aminotransferase, alanine aminotransferase, lactate dehydrogenase, triglyceride and cholesterol have been increased. The death rate was estimated to be 2.8%, mainly related to the Ardabil and Germi cases.Conclusion:Kala-Azar is still one of the most important infectious diseases in Ardabil Province, and is responsible for considerable death rate in infants. More attention should be done to parasite control and early diagnosis.

Repercussões para o trabalho, a saúde e as relações familiares dos policiais feridos por arma de fogo em face

Abstract This article aims to identify the profile of police officers who underwent surgery due to gunshot wounds to the face, to survey the anatomical distribution of injuries and the repercussions on their health, work and family relationships. We conducted a retrospective epidemiological study based on secondary data of police officers who underwent surgery at the Central Military Police Hospital of the state of Rio de Janeiro due to gunshot wounds to the face from June 2003 to December 2020 (N=87). We also adopted a qualitative approach by applying a questionnaire with open and closed questions (N=37) to survey repercussions of the violent event on police officers’ work, families and health. The profile of police officers who underwent surgery showed that they were exclusively males, aged 34.9 years on average, privates, and injured in the line of duty. Fractures of the mandibular region were the most frequent injuries. After the accident, physical health conditions of police officers deteriorated, including an increase in cases of hypertension, a high frequency of insomnia (59.4%), and headache (51.3%). Damaged family relationship included an increasing trend of self-isolation and a feeling of fear experienced by police officers’ family members.

Repercussions on work, health and family relationships of police officers wounded by gunshot to the face.

This article aims to identify the profile of police officers who underwent surgery due to gunshot wounds to the face, to survey the anatomical distribution of injuries and the repercussions on their health, work and family relationships. We conducted a retrospective epidemiological study based on secondary data of police officers who underwent surgery at the Central Military Police Hospital of the state of Rio de Janeiro due to gunshot wounds to the face from June 2003 to December 2020 (N=87). We also adopted a qualitative approach by applying a questionnaire with open and closed questions (N=37) to survey repercussions of the violent event on police officers' work, families and health. The profile of police officers who underwent surgery showed that they were exclusively males, aged 34.9 years on average, privates, and injured in the line of duty. Fractures of the mandibular region were the most frequent injuries. After the accident, physical health conditions of police officers deteriorated, including an increase in cases of hypertension, a high frequency of insomnia (59.4%), and headache (51.3%). Damaged family relationship included an increasing trend of self-isolation and a feeling of fear experienced by police officers' family members.

Clinical and epidemiological characteristics of hospitalized patients with COVID-19 during different pandemic periods in Moscow

Background. The incidence of COVID-19 novel coronavirus infection has a wave-like pattern with surges in new cases followed by declines. Viral mutations, changes in viral properties, and new strains continue to emerge and are regularly reported.The aim of the study is to present a comparative analysis of clinical and epidemiological characteristics of hospitalized patients with COVID-19 during different periods of the coronavirus infection pandemic in Moscow.Materials and methods. A two-center, retrospective observational epidemiological study was performed using medical records of patients hospitalized with the confirmed diagnosis of COVID-19 in Moscow from March 2020 to March 2022 (34,354 patients).Results. Within 2 years of the pandemic, there were significant differences in the age structure of hospitalized patients. During the early months (March–June 2020) of the pandemic, age groups of 18–45 and 46–65 yearolds accounted for higher percentages of hospitalizations. Later on (July 2020 – February 2021), the proportion of older age groups demonstrated an upward trend. From spring 2021 (the emergence of the SARS-CoV-2 delta strain) to March 2022 (dominance of the omicron strain), the proportion of hospitalized working-age adults increased once again.The proportion of severe and critically severe cases among the patients hospitalized during different periods remained at steady levels: 7.7% (6.6–8.8%) and 5.5% (4.4–6.6%), respectively. The highest death rates were observed during the delta strain surge, while the lowest death rates were reported for the omicron strain. Throughout the pandemic, the older age and chronic diseases remained risk factors contributing to the severity of the disease and adverse outcomes.Conclusion. The emergence of new variants of SARS-CoV-2 causing a shift of the need for hospitalization towards younger age groups, the persistent high rates of severe cases and death rates among people of retirement age are pressing for the unfailing readiness for implementing preventive and epidemic control measures focusing on the above groups of population.

Epidemic characteristics and transmission risk prediction of brucellosis in Xi'an city, Northwest China.

Human brucellosis (HB) has re-emerged in China since the mid-1990s, and exhibited an apparent geographic expansion shifted from the traditional livestock regions to the inland areas of China. It is often neglected in non-traditional epidemic areas, posing a serious threat to public health in big cities. We carried out a retrospective epidemiological study in Xi'an, the largest city in northwestern China. It utilizes long-term surveillance data on HB during 2008–2021 and investigation data during 2014–2021. A total of 1989 HB cases were reported in Xi'an, consisting of 505 local cases, i.e., those located in Xi'an and 1,484 non-local cases, i.e., those located in other cities. Significantly epidemiological heterogeneity was observed between them, mainly owing to differences in the gender, occupation, diagnostic delays, and reporting institutions. Serological investigations suggested that 59 people and 1,822 animals (sheep, cattle, and cows) tested positive for brucellosis from 2014 to 2021, with the annual average seroprevalence rates were 1.38 and 1.54%, respectively. The annual animal seroprevalence rate was positively correlated with the annual incidence of non-local HB cases. Multivariate boosted regression tree models revealed that gross domestic product, population density, length of township roads, number of farms, and nighttime lights substantially contributed to the spatial distribution of local HB. Approximately 7.84 million people inhabited the potential infection risk zones in Xi'an. Our study highlights the reemergence of HB in non-epidemic areas and provides a baseline for large and medium-sized cities to identify regions, where prevention and control efforts should be prioritized in the future.

National incidence of joint dislocation in China: a retrospective survey of 512,187 individuals.

Background:Joint dislocations significantly impact public health. However, a comprehensive study on the incidence, distribution, and risk factors for joint dislocations in China is lacking. We conducted the China National Joint Dislocation Study, which is a part of the China National Fracture Study conducted to obtain the national incidence and risk factors for traumatic fractures, and to investigate the incidence and risk factors for joint dislocations.Methods:For this national retrospective epidemiological study, 512,187 participants were recruited using stratified random sampling and probability-proportional-to-size method from January 19 to May 16, 2015. Participants who sustained joint dislocations of the trunk, arms, or legs (skull, sternum, and ribs being excluded) in 2014 were personally interviewed to obtain data on age, educational background, ethnic origin, occupation, geographic region, and urbanization degree. The joint-dislocation incidence was calculated based on age, sex, body site, and demographic factors. The risk factors for different groups were examined using multiple logistic regression.Results:One hundred and nineteen participants sustained 121 joint dislocations in 2014. The population-weighted incidence rate of joint dislocations of the trunk, arms, or legs was 0.22 (95% confidence interval [CI]: 0.16, 0.27) per 1000 population in 2014 (men, 0.27 [0.20, 0.34]; women, 0.16 [0.10, 0.23]). For all ages, previous dislocation history (male: OR 42.33, 95% confidence interval [CI]: 12.03–148.90; female: OR 54.43, 95% CI: 17.37–170.50) and alcohol consumption (male: OR 3.50, 95% CI: 1.49–8.22; female: OR 2.65, 95% CI: 1.08–6.50) were risk factors for joint dislocation. Sleeping less than 7 h/day was a risk factor for men. Compared with children, women aged ≥15 years (female 15–64 years: OR 0.16, 95% CI: 0.04–0.61; female ≥65 years: OR 0.06, 95% CI: 0.01–0.41) were less likely to sustain joint dislocations. Women with more than three children were at higher dislocation risk than women without children (OR 6.92, 95% CI: 1.18–40.78).Conclusions:The up-to-date data on joint dislocation incidence, distribution, and risk factors can be used as a reference for national healthcare, prevention, and management in China. Specific strategies for decreasing alcohol consumption and encouraging adequate sleeping hours should be developed to prevent or reduce dislocation incidents.Trial Registration:Chinese Clinical Trial Registry, ChiCTR-EPR-15005878.

A Unique Trinucleotide-Bloc Mutation-Based Two SARS-CoV-2 Genotypes with Potential Pathogenic Impacts.

SARS-CoV-2, the novel coronavirus behind the COVID-19 pandemic, is acquiring new mutations in its genome. Although some mutations provide benefits to the virus against human immune response, others may result in their reduced pathogenicity and virulence. By analyzing more than 3000 high-coverage, complete sequences deposited in the GISAID database up to April 2020, here I report the uniqueness of the 28881–28883: GGG > AAC trinucleotide-bloc mutation in the SARS-CoV-2 genome that results in two substrains, described here as SARS-CoV-2g (28881–28883: GGG genotype) and SARS-CoV-2a (28881–28883: AAC genotype). Computational analysis and literature review suggest that this bloc mutation would bring 203–204: RG (arginine-glycine)>KR (lysine-arginine) amino acid changes in the nucleocapsid (N) protein affecting the SR (serine-arginine)-rich motif of the protein, a critical region for the transcription of viral RNA and replication of the virus. Thus, 28881–28883: GGG > AAC bloc mutation is expected to modulate the pathogenicity of SARS-CoV-2. These analyses suggest that SARS-CoV-2 has evolved into SARS-CoV-2a affecting COVID-19 infectivity and severity. To confirm these assumptions, retrospective and prospective epidemiological studies should be conducted in different countries to understand the course of pathogenicity of SARS-CoV-2a and SARS-CoV-2g. Laboratory research should focus on the bloc mutation to understand its true impacts on the course of the pandemic. Potential drug and vaccine development should also keep the 28881–28883 region of the N protein under consideration.

Reconstruction of transmission chains of SARS-CoV-2 amidst multiple outbreaks in a geriatric acute-care hospital: a combined retrospective epidemiological and genomic study.

There is ongoing uncertainty regarding transmission chains and the respective roles of healthcare workers (HCWs) and elderly patients in nosocomial outbreaks of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in geriatric settings. We performed a retrospective cohort study including patients with nosocomial coronavirus disease 2019 (COVID-19) in four outbreak-affected wards, and all SARS-CoV-2 RT-PCR positive HCWs from a Swiss university-affiliated geriatric acute-care hospital that admitted both Covid-19 and non-Covid-19 patients during the first pandemic wave in Spring 2020. We combined epidemiological and genetic sequencing data using a Bayesian modelling framework, and reconstructed transmission dynamics of SARS-CoV-2 involving patients and HCWs, to determine who infected whom. We evaluated general transmission patterns according to case type (HCWs working in dedicated Covid-19 cohorting wards: HCWcovid; HCWs working in non-Covid-19 wards where outbreaks occurred: HCWoutbreak; patients with nosocomial Covid-19: patientnoso) by deriving the proportion of infections attributed to each case type across all posterior trees and comparing them to random expectations. During the study period (1 March to 7 May 2020), we included 180 SARS-CoV-2 positive cases: 127 HCWs (91 HCWcovid, 36 HCWoutbreak) and 53 patients. The attack rates ranged from 10% to 19% for patients, and 21% for HCWs. We estimated that 16 importation events occurred with high confidence (4 patients, 12 HCWs) that jointly led to up to 41 secondary cases; in six additional cases (5 HCWs, 1 patient), importation was possible with a posterior probability between 10% and 50%. Most patient-to-patient transmission events involved patients having shared a ward (95.2%, 95% credible interval [CrI] 84.2%-100%), in contrast to those having shared a room (19.7%, 95% CrI 6.7%-33.3%). Transmission events tended to cluster by case type: patientnoso were almost twice as likely to be infected by other patientnoso than expected (observed:expected ratio 2.16, 95% CrI 1.17-4.20, p=0.006); similarly, HCWoutbreak were more than twice as likely to be infected by other HCWoutbreak than expected (2.72, 95% CrI 0.87-9.00, p=0.06). The proportion of infectors being HCWcovid was as expected as random. We found a trend towards a greater proportion of high transmitters (≥2 secondary cases) among HCWoutbreak than patientnoso in the late phases (28.6% vs. 11.8%) of the outbreak, although this was not statistically significant. Most importation events were linked to HCW. Unexpectedly, transmission between HCWcovid was more limited than transmission between patients and HCWoutbreak. This finding highlights gaps in infection control and suggests the possible areas of improvements to limit the extent of nosocomial transmission. This study was supported by a grant from the Swiss National Science Foundation under the NRP78 funding scheme (Grant no. 4078P0_198363).