Retrospective Epidemiological Study Research Articles

Pneumococcal Vaccination Coverage Among Adults at Risk in the Russian Federation

Relevance. Pneumococcal infection remains one of the most significant health problems worldwide. Vaccination of adults against it has been carried out in the Russian Federation for over 10 years. During this time, more than 9 million people have been vaccinated. However, data on the level of coverage among adults of certain risk categories are not routinely collected. Our study in 2019 showed that it was low in most groups. Given the significant increase in the volume of vaccination over the past five years, it seems appropriate to conduct a study to assess changes in the level of coverage.Aim. To study the level of vaccination coverage against pneumococcal infection in adult risk groups in the Russian Federation.Materials and methods. An observational descriptive retrospective epidemiological study was conducted. Information on the number and contingents of people vaccinated against pneumococcal infection was collected by sending a request to the executive authorities of the constituent entities of the Russian Federation in the field of healthcare. The depth of data collection was 8 years (from 2015 to 2023 inclusive), information was received from 74 out of 89 regions. In addition, federal statistical observation forms were used: No. 5 «Information on preventive vaccinations» and No. 6 «Information on the contingents of children and adults vaccinated against infectious diseases», data from the Unified Interdepartmental Information and Statistical System. The results obtained were compared with the indicators obtained in the 2019 study, which was conducted according to a similar design. The analysis was carried out using descriptive statistics methods.Results. The coverage rate of vaccination against pneumococcal infection among the adult population in the Russian Federation increased from 1.5% in 2018 to 7.7% in 2023. The most significant coverage rates were achieved among persons subject to conscription for military service (78.5%) and persons over 60 years old, living in residential care facilities (87.7%). By 2023, vaccination coverage has increased among the following risk categories: individuals with chronic bronchopulmonary diseases (from 15.1% in 2018 to 47.9% in 2023), chronic heart diseases (from 3.8% to 17.0%), patients with endocrine diseases (from 1.1% to 17.6%), liver diseases (from 4.0% to 12.0%), healthcare workers (from 4.9% to 19.7%), school and preschool employees (from 3.1% to 12.9%), employees of residential care facilities (homes for elderly, nursing homes, ect.) (from 0.1% to 26.9%), the elderly population as a whole (from 1.4% to 12.7%), and working-age men (from 1.4% to 7.0%). There was virtually no increase in coverage among all groups of immunocompromised patients (1.0% in 2018, 6.2% in 2023), the working population with risk factors harmful to the respiratory system (0.9% in 2018, 5.0% in 2023), workers in the oil and gas and chemical industries (1.3% in 2018, 1.8% in 2023).Conclusion. The obtained results indicate the need to develop a strategy of measures to promote increased vaccination coverage in risk groups that are insufficiently covered by vaccination against pneumococcal infection.

“Retrospective epidemiological study on musculoskeletal injuries in amateur football athletes in Greece”

ABSTRACT Injuries in football affect team performance, players’ quality of life, and careers. While research mainly targets professionals, limited data exists for amateur players, especially in Greece. Methodological differences and variations in preparation and technique make applying professional injury data to amateurs uncertain. This study aimed to investigate the injury profile, sports history, and training routines of amateur male football players in Greece over one competitive season. It was conducted as a retrospective cross-sectional study using an electronic questionnaire to survey 222 amateur players aged 18–44 years. Among them, 70.7% reported at least one injury. A total of 220 injuries were recorded, with an incidence rate of 5.3 injuries per 1000 hours of play. Most injuries occurred during matches, predominantly affecting the lower limbs, with the posterior and inner thighs being the most common injury sites. Players were found to be 6.6 times more likely to sustain injuries in matches (12.1 injuries/1000 hours) than in training sessions (1.8 injuries/1000 hours). Strains were identified as the most common type of injury, often resulting from running/sprinting. These findings underscore the importance of implementing specific injury prevention measures in amateur football leagues in Greece to minimise the risks and severity of injuries among players.

The spread of molecular markers of artemisinin partial resistance and diagnostic evasion in Eritrea: a retrospective molecular epidemiology study

Eritrea was the first African country to discontinue the use of histidine rich protein 2 (HRP2)-detecting rapid diagnostic tests (RDTs) for malaria diagnosis following reports of a high prevalence of pfhrp2/3-deleted Plasmodium falciparum parasites causing false-negative results in the country. Eritrea was also the first African country to report partial artemisinin resistance due to the Pfalciparum kelch13 (pfk13) Arg622Ile mutation. We aimed tocharacterise the spatial distribution of pfk13 mutants and their interactions with pfhrp2/3 deletions in Eritrea andto assess the role of the use of HRP2-detecting RDTs and antimalarial (artesunate-amodiaquine) therapy in the spread of the two variants. We conducted a retrospective molecular epidemiological analysis of pfk13 mutations and pfhrp2/3 deletions in existing Pfalciparum-infected blood samples collected as part of previous pfhrp2/3 deletion and severe malaria studies. Samples were collected in March, 2016and between September, 2018, and January, 2020, from symptomatic patients seeking care at 15health centres in four administration zones (Semenawi Keyih Bahri, Gash Barka, Anseba, and Debub) in Eritrea. Afragment spanning the propeller region of pfk13 was amplified from samples and sequenced using Sanger sequencing or targeted amplicon sequencing to identify genetic mutations. Deletions of pfhrp2/3 genes in samples were determined using multiplex quantitative PCR. Parasite haplotypes and genetic relatedness of parasite haplotypes were determined previously using microsatellite marker typing. The primary objective was to determine the prevalence of pfk13 mutations at health centres and administrative zones. The secondary objective was to investigate whether pfk13 mutants and pfhrp2/3 deleted parasites converge. We sequenced 50samples collected in March, 2016from the Semenawi Keyih Bahri zone and identified no pfk13 mutations. By contrast, in 587samples included in this study that were collected from health centres in GashBarka, Anseba, and Debub in 2018-20, we detected five different single non-synonymous mutations: Glu605Lys, Arg622Ile, Asn657Lys, Lys658Glu, and Ser679Leu. The most prevalent mutation was pfk13 Arg622Ile, which was detected in samples collected from all nine health centres where more than five samples were available across all three administration zones, with an overall prevalence of 11·9% (70 of 587samples; range 5·9-28·0%). Weidentified 22unique pfk13 Arg622Ile mutant haplotypes among 26samples tested, of which 13 (59·1%) were genetically related, whereas the remaining nine (40·9%) were not. The prevalence of pfk13 Arg622Ile was significantly higher in parasites with a single pfhrp3 deletion (46 [18·0%] of 255samples) than in parasites withoutpfhrp2/3 deletions (ten [6·2%] of 161samples; odds ratio 3·89 [95% CI 1·59-7·61]; p=0·0006) and with dual pfhrp2/3-deleted parasites (13 [9·0%] of 145; 2·23 [1·13-4·68]; p=0·018). The geographical spread of the pfk13 Arg622Ile mutation might have initially resulted from the clonal expansion and spread of pfhrp2/3 deletions under the test-and-treat policy using HRP2-detecting RDTs. Subsequently, selective pressure from artemisinin combination therapy could have further facilitated the spread of both pfk13 Arg622Ile and pfhrp2/3 deletions. Continuous monitoring of trends in pfk13 and pfhrp2/3 variants is needed to inform effective malaria control and elimination strategies in Eritrea and other African countries. US Department of Defense Armed Forces Health Surveillance Division, Global Emerging Infections Surveillance Branch (AFHSD/GEIS), and Wellcome Trust.

Epidemiological, Clinical and Therapeutic Profile of Rectal Adenocarcinomas Treated in the Radiotherapy Department of EHSO Emir Abdelkader

Rectal cancer is classified among the most common cancers in the world, the second most common digestive cancer in Algeria; however its incidence in our country remains lower than that of western countries. The interest of this article is the retrospective analysis of the epidemiological, clinical and therapeutic aspects of malignant tumors of the rectum managed in the department of the EHS oncology Emir Abdelkader in Oran, Algeria. Concomitant preoperative radio chemotherapy is the standard treatment for locally advanced rectal adenocarcinomas; however it can be carried out postoperatively if the initial stage of the disease is underestimated. We conducted a retrospective epidemiological, clinical, anatomopathological, therapeutic and prognosis study at the radiotherapy department of the EHS oncology Emir Abdelkader in Oran over a period of 6 years from January 2017 to December 2019 involving 70 patients taken in charge during this period. This hypo fractionated irradiation regimen at a dose of 39 Gray could be a therapeutic alternative in the preoperative situation for locally advanced rectal tumors with promising results in terms of effectiveness and an acceptable toxicity profile.

ANÁLISE DO PERFIL CLÍNICO-EPIDEMIOLÓGICO DE PACIENTES COM SÍNDROME RESPIRATÓRIA AGUDA GRAVE POR COVID-19 NO NORTE DE MINAS

Objective: to describe the epidemiological profile of cases of SARS (severe acute respiratory syndrome) caused by Covid-19 in northern Minas Gerais. Materials and methods: this is a descriptive, documentary and retrospective epidemiological study, carried out through the analysis of notification forms released in the Information System for the Epidemiological Surveillance of Influenza (SIVEP-GRIPE), in the north of Minas Gerais. The target population of the analysis were patients with severe acute respiratory syndrome who tested positive for Covid-19. The collected data were statistically analyzed using the Statistical Package for Social Science (SPSS) version 22.0 program. Results: after analyzing the 5,719 notified cases, it was observed that 56.1% were male, mostly aged between 60 and 79 years, with the majority living in urban areas. The most common symptoms among patients were fever, cough and dyspnea. It was also observed that patients with heart disease and diabetes were the most affected. As for the evolution, it was observed that from the total of 5,719 records, 34.1% evolved to death. Conclusion: It is believed that studies of this nature are extremely important to contribute to the planning of actions aimed at promoting and preventing health.

Signatures of transmission in within-host Mycobacterium tuberculosis complex variation: a retrospective genomic epidemiology study

Mycobacterium tuberculosis complex (MTBC) species evolve slowly, so isolates from individuals linked in transmission often have identical or nearly identical genomes, making it difficult to reconstruct transmission chains. Finding additional sources of shared MTBC variation could help overcome this problem. Previous studies have reported MTBC diversity within infected individuals; however, whether within-host variation improves transmission inferences remains unclear. Here, we aimed to quantify within-host MTBC variation and assess whether such information improves transmission inferences. We conducted a retrospective genomic epidemiology study in which we reanalysed publicly available sequence data from household transmission studies published in PubMed from database inception until Jan 31, 2024, for which both genomic and epidemiological contact data were available, using household membership as a proxy for transmission linkage. Wequantified minority variants (ie, positions with two or more alleles each supported by at least five-fold coverage and with a minor allele frequency of 1% or more) outside of PE and PPE genes, within individual samples and shared across samples. We used receiver operator characteristic (ROC) curves to compare the performance of a general linear model for household membership that included shared minority variants and one that included only fixed genetic differences. We identified three MTBC household transmission studies with publicly available whole-genome sequencing data and epidemiological linkages: a household transmission study in Vitória, Brazil (Colangeli etal), a retrospective population-based study of paediatric tuberculosis in British Columbia, Canada (Guthrie etal), and a retrospective population-based study in Oxfordshire, England (Walker etal). We found moderate levels of minority variation present in MTBC sequence data from cultured isolates that varied significantly across studies: mean 168·6minority variants (95% CI 151·4-185·9) for the Colangeli etal dataset, 5·8 (1·5-10·2) for Guthrie etal (p<0·0001, Wilcoxon rank sum test, vsColangeli etal), and 7·1 (2·4-11·9) for Walker etal (p<0·0001, Wilcoxon rank sum test, vs Colangeli etal). Isolates from household pairs shared more minority variants than did randomly selected pairs of isolates: mean 97·7shared minority variants (79·1-116·3) versus 9·8 (8·6-11·0) in Colangeli etal, 0·8 (0·1-1·5) versus 0·2(0·1-0·2) in Guthrie etal, and 0·7 (0·1-1·3) versus 0·2 (0·2-0·2) in Walker etal (allp<0·0001, Wilcoxon rank sumtest). Shared within-host variation was significantly associated with household membership (odds ratio 1·51 [95% CI 1·30-1·71], p<0·0001), for one standard deviation increase in shared minority variants. Models that included shared within-host variation versus models without within-host variation improved the accuracy of predicting household membership in all three studies: area under the ROC curve 0·95versus 0·92for the Colangeli etal study, 0·99versus 0·95for the Guthrie etal study, and 0·93versus 0·91for the Walker etal study. Within-host MTBC variation persists through culture of sputum and could enhance the resolution of transmission inferences. The substantial differences in minority variation recovered across studies highlight the need to optimise approaches to recover and incorporate within-host variation into automated phylogenetic and transmission inference. National Institutes of Health.

Current epidemiological characteristics of cervical cancer in the Russian Federation

Background. The prevalence of cervical cancer (Cca) in Russian women makes it crucial to study modern epidemiological characteristics and adjust control measures accordingly.The aim. To analyze trends in the incidence of cervical cancer in the Russian Federation.Materials and methods. A retrospective epidemiological study was conducted on cervical cancer incidence in Russian Federation from 2008 to 2021. The materials of annual statistical data “Malignant neoplasms in Russia (morbidity and mortality)” and “Status of oncological assistance to the population of Russia” (2008–2022), data of the federal statistical reporting form No. 5 “Information about preventive vaccinations” (2021), data on the number of studies conducted (cytological study and HPV-test based on RT-PCR) in the clinical diagnostic laboratory of Central Research Institute of Epidemiology of Rospotrebnadzor (2013–2021) were used.Results and discussion. The trends of Cca incidence varied depending on the women’s age. Starting in 2016, there was a stabilization of the level of morbidity in women aged 30–49 with the subsequent decrease from 2019 due to the strengthening of secondary prevention measures, including the active introduction of HPV-test into the diagnostic schemes conducted in the Russian Federation. Increased control of cervical cancer caused a rise in the proportion of cases diagnosed at an early stage (carcinomas in situ and I–II stages Cca), the increase of detection rate of in situ carcinomas per 100 cases of Cca, the growth of the proportion of carcinomas in situ to I–II stages Cca, rise of the percentage of the cases detected actively, decrease of the number of Cca cases detected at later stages and one-year mortality index.Conclusion. The epidemiological analysis of cervical cancer incidence shows that preventive measures are effective and that there is a need to intensify and increase their coverage.

High Diversity in Genotypes of Human Rhinovirus Contributes to High Prevalence in Beijing, 2018-2022: A Retrospective Multiple-Center Epidemiological Study.

To comprehensively examine the molecular epidemiological characteristics of human rhinovirus (HRV) in Beijing. A total of 7,151 children and adults with acute respiratory tract infections (ARTIs) were recruited from 35 sentinel hospitals in Beijing between 2018 and 2022. Their respiratory samples were obtained, and epidemiological and clinical data were collected. Nucleic acid testing for 11 respiratory pathogens, including HRV, was performed on the specimens. We sequenced VP4/VP2 or 5'UTR of HRV isolates to identify their genotypes using phylogenetic analyses. HRV was detected in 462 (6.5%) cases. A total of 105 HRV genotypes were successfully identified in 359 (77.7%) specimens, comprising 247 (68.8%) with HRV-A, 42 (11.7%) with HRV-B, and 70 (19.5%) with HRV-C. No predominant genotype was observed. HRV was prevalent year-round with two weak peaks in spring and autumn. HRV detection declined gradually between 2018 and 2022, with seven genotypes disappearing and five genotypes emerging. HRV detection rate decreased by age without resurge among old people. HRV-C was more common among children aged less than 5 years with severe community-acquired pneumonia compared to HRV-A and HRV-B. Adults infected with HRV-B had higher rates of hospitalization, intensive care unit admission, and complications than those infected with HRV-A and HRV-C. HRV epidemics in Beijing were highly dispersed in genotypes, which probably resulted in a high prevalence of HRV infection, attenuated its seasonality, and made it more difficult to establish effective population immunity.

Pancreatic ductal adenocarcinoma, β-blockers and antihistamines: A clinical trial is needed.

Survival in pancreatic cancer (pancreatic ductal adenocarcinoma, PDAC) at just 5 months is the worst of all cancers. It is predicted to become the second highest cause of cancer deaths worldwide this decade and unlike most cancers, there has been little progress in improving survival in PDAC. Numerous studies including molecular and mechanistic studies, cancer biology studies and retrospective human epidemiological studies suggest that two well-known, approved drug classes - β-blockers and H1-antihistamines - may be beneficial and thus may potentially prolong life in patients with PDAC. In our opinion, the body of evidence has reached a point where the potential gains outweigh the very low risks involved in a clinical study in PDAC. We thus believe that it is now time for a clinical trial involving these two agents in PDAC patients. As a repurposing of generic drugs, this is not likely to be appealing to pharmaceutical companies and therefore is likely to require governmental, philanthropic and /or charitable organisational input. In this article, we opine and propose that an urgent clinical trial is needed to determine if repurposing these two orally administered, inexpensive, largely safe drug classes, either alone or in combination, could prolong survival in PDAC and thus improve the outcome for the 10,000 people worldwide who die from PDAC each week.

A retrospective clinico epidemiological study of pattern of dermatosis involving trigeminal distribution in a tertiary care center

Trigeminal nerve is the principal sensory nerve of face. Many dermatological conditions known occur in relation to trigeminal nerve distribution clinically presenting as unilateral facial lesions with strict midline demarcation. To study the clinical pattern and epidemiological determinants of dermatoses along trigeminal nerve among the patients of both the sexes, involving all the age groups. Thirty two patients presenting with skin lesions along trigeminal nerve presenting to Dermatology department of a tertiary care center, Bangalore, Karnataka, are selected for the study. Study design is retrospective hospital record based study conducted from January 2023 to January 2024. In this study, out of 32 patients most common dermatoses along trigeminal nerve were infection of which herpes zoster was seen thirteen (40.62%) patients, followed by nevi (n=6, 18.75%), pigmentary disorders (n=5, 15.62%), vascular disorder (n=4, 12.5%) and auto inflammatory disorder (n=4, 12.5%) was seen. Most common branch affected was ophthalmic followed maxillary branch .Females were more common and mean age was 24 years. Small sample size and rare clinical cases are included Studies focusing on the pattern of dermatoses involving the trigeminal nerve contribute to the advancement of medical knowledge and facilitate the development of novel diagnostic techniques and therapeutic modalities. By elucidating the underlying pathophysiological mechanisms and identifying potential risk factors, research in this field can lead to the development of more effective treatment strategies tailored to the specific needs of patients.

SURGICAL SITE INFECTION IN HIV-POSITIVE PATIENTS WITH CHRONIC SPONDYLITIS

Introduction. The epidemic process of medical care-related infections complies to the general laws for development of epidemic process, although it has specific features. The probability for development of surgical site infection becomes precipitated by risk factors, which contribute to emergence of surgical site infection based on traits of pathology, patient populations and the specifics of hospital facility. The aim of the study was to evaluate HIV-related effect on developing surgical site infection in patients with chronic spondylitis. Materials and methods. A retrospective cohort epidemiological study was conducted. The inclusion criteria were met by 809 examined patients including 119 HIV-positive patients who underwent 192 surgical interventions. At admission, a patient provided a discharge summary describing the disease profile as well as HIV-positive status verified by infectious disease specialist through a comprehensive data assessment, no more than a month prior to admission. HIV-infected and HIV-free patients comprised exposed and unexposed cohort, respectively. Results. Tuberculous spinal lesions prevailed in HIV patients (p≤0.001; RR=4.864; 95% CI [3.070- 7.707]). Almost all patients were at stage 4 HIV, and one patient – stage 3. The incidence of surgical site infection in patients with chronic infectious spondylitis was 5.01 per 100 operations (49 cases per 978 operations), in HIV patients it developed only in 2 cases of tuberculous spondylitis (the incidence was 1.04 per 100 operations). HIV-infection did not increase the risk of surgical site infection (p=0.009; RR=0.174; 95% CI [0.043 - 0.711]. surprisingly, it turned out to observe higher risk of revision interventions in HIV-free patients (p=0.007; RR = 1.783; 95% CI [1.149 - 2.768]). Conclusions. HIV-positive patients had higher risk of developing a tuberculous than a nonspecific lesion. The HIV status of patients with chronic infectious spondylitis did not significantly affect development of surgical site infection and increased incidence of revision operations. A potential reason for the final result is the long-term use of anti-tuberculosis drugs acting, in this case, as a preventive measure against developing surgical site infection.

Genomic reconstruction of an azole-resistant Candida parapsilosis outbreak and the creation of a multi-locus sequence typing scheme: a retrospective observational and genomic epidemiology study

Fluconazole-resistant Candida parapsilosis has emerged as a significant health-care-associated pathogen with a propensity to spread patient to patient and cause nosocomial outbreaks, similar to Candida auris. This studyinvestigates a long-lasting outbreak of fluconazole-resistant Cparapsilosis that was initially detected in December, 2018, and January, 2019, and officially declared in November, 2019; lasted multiple years; and involved several health-care centres in Berlin, Germany. In this retrospective, observational, and genomic epidemiology study, we used whole-genome sequencing (WGS) of isolates sent by German health-care facilities and laboratories to the National Reference Center for Invasive Fungal Infections (Jena, Germany) for antifungal susceptibility testing between Jan 1, 2016, and Dec 31, 2022. Weincluded all potential outbreak samples (ie, isolates originating from Berlin that were resistant to fluconazole and voriconazole but susceptible to posaconazole) and all non-outbreak isolates that originated from outside of Berlin and were resistant to at least one azole. We also included a number of non-outbreak isolates from outside Berlin that were susceptible or resistant to azoles so that the total study dataset included a matching amount of outbreak and non-outbreak samples from Germany. We used admission and discharge records for patients involved in the outbreak and constructed a network of patient transfers in time and space. We used WGS data for included samples, complemented with WGS data for global samples obtained from the National Center for Biotechnology Information Sequence Read Archive, to construct single-nucleotide variant (SNV)-based phylogeny and perform SNV distance-based analyses. Additionally, we used the whole genomic dataset to identify loci with high discriminatory power to establish a multi-locus sequence typing (MLST) strategy for Cparapsilosis. We identified 38clonal, azole-resistant isolates of Cparapsilosis causing 33cases of invasive infection during a 2018-22outbreak in multiple hospitals in Berlin. We also sequenced the genomes of 37 non-outbreak isolates. WGSrevealed that outbreak strains were separated by a mean of 36SNVs (SD 20), whereas outbreak strains differed from outgroup samples from Berlin and other regions of Germany by a mean of 2112SNVs (828). Temporal and genomic reconstruction of the outbreak cases indicated that transfer of patients between health-care facilities was probably responsible for the persistent reimportation of the drug-resistant clone and subsequent person-to-person transmission. German outbreak strains were closely related to strains responsible for an outbreak in Canada and to isolates from Kuwait, Türkiye, and South Korea. Including the outbreak clone, we identified three distinct azole-resistant lineages carrying ERG11 Y132F in Germany. We identified four 750bp loci in CPAR2_101400, CPAR2_101470, CPAR2_108720, and CPAR2_808110 for inclusion in our MLST strategy. Application of the MLST method to a global collection of 386isolates identified 62sequence types, with the outbreak strains all belonging to the same sequence type. This study underscores the emergence of drug-resistant Cparapsilosis that can spread patient to patient within a health-care system, but also, possibly, internationally. Our findings highlight the importance of monitoring Cparapsilosis epidemiology globally and of continuous surveillance and rigorous infection control measures at the local scale. We also developed a novel MLST scheme for genetic epidemiology and outbreak investigations, which could represent a faster and less expensive alternative to WGS. German Federal Ministry for Education and Research, German Research Foundation, and German Ministry of Health.

Clinical and epidemiological characteristics of dengue fever in Primorsky Krai

Aim. To characterize imported cases of dengue fever in Primorsky Krai and to establish the clinical and epidemiological features of the disease. Materials and methods. A retrospective clinical and epidemiological descriptive study was conducted. The material was 71 maps of an epidemiological survey of people sick with dengue fever for the period from 2012 to 2023, as well as 66 case histories. Results. The peak incidence occurred in 2018, with the intensity of 0.78 per 100 thousand population. Since 2012, the cases of dengue fever had been reported every year, except for 2021–22. The import was carried out from the region of Southeast Asia, often from Thailand, mainly in the winter–spring period. The disease was characterized by an acute onset, a persistent fever for 7.1 ± 0.2 days, symptoms of general intoxication, and the appearance of maculopapular exanthema (97.0%). Dengue hemorrhagic fever in the structure of identified cases was 3.0%. Cytolysis (83.3%), leukopenia (72.7%), thrombocytopenia (60.6%), and lymphocytosis (72.2%) were observed in the blood test. Conclusions. Considering the significant excess of the average incidence rate in the Russian Federation, the epidemiological situation regarding the import of dengue fever into the Primorsky Krai can be considered unfavorable. Diagnosis should take into account the clinical characteristics and morbidity risks of the disease.

Povezanost med vročinskimi valovi in obiski na Internistični prvi pomoči Univerzitetnega kliničnega centra Ljubljana v obdobju 2013–2017

Background: Heatwaves have a severe impact on the number of deaths and emergency department visits, making them the most hazardous natural disaster due to climate change in many regions of the world. Our aim was to assess the short-term association between emergency department visits and heat waves from 2013 to 2017 to see whether any difference in the number of visits occurred at the Emergency Department in Ljubljana University Medical Centre during that period. Methods: The design of our study is a retrospective cross-sectional epidemiologic study. We estimated relative risks (RR) for a number of ED visits during heatwave days and reference period days for the observed diagnoses (all causes, diseases of the circulatory system, respiratory system, endocrine diseases, diseases of the digestive system and genitourinary diseases) sex, and age (from 19 to 74 years old, 75 years old and older), as well as 99.6% confidence intervals (CI) and excess ED visits in percent (%) associated with heatwaves occurring in the years from 2014 to 2017. Data were analyzed for the patients arriving at the Emergency Department of the Ljubljana University Medical Centre during summer time, from May to September. The region covers around 550,000 people and is considered an urban and rural area. Results: The results of our study showed that there was no statistically significant increase in number of ED visits during heatwaves for all causes in all observed years. We noticed even statistically significant protective phenomena between heatwaves and the number of ED visits. These happened in the years 2015 and 2017 for both sexes and circulatory system diseases, in 2016 for men, circulatory system diseases, and in 2015 for respiratory system diseases. We showed a statistically significant association between heatwaves and the number of visits in the ED for endocrine diseases in 2013. Conclusion: Despite the increased heat load in the last observed years, the number of ED visits in Ljubljana has remained stable or even decreased. Further studies on how each intervention affects the behavior of the observed population are needed to clarify whether public health measures and inter-sectoral cooperation impact the number of ED visits.

Cardiovascular mortality rate between 2018 and 2022 in Kyrgyz Republic

Abstract Background Cardiovascular diseases (CVD) are the number one cause of death in low- and middle-income countries (LMICs), including Kyrgyz Republic. According to official statistics, CVD ranks first in the structure of overall mortality, accounting for more than half (52.1% according to 2022 data) of all deaths. Purpose to analyze the cardiovascular mortality rate in the Kyrgyz Republic, from 2018 to 2022. Methods Medical and statistical information on mortality from CVD in the population was obtained from the Centre for Electronic Health (CEH) of the Ministry of Health. To conduct a comparative analysis, relative indicators per 100 thousand population were calculated. A retrospective epidemiological study of mortality from CVD including different nosological forms over period for 2018–2022 was conducted, calculating the rate of increase (decrease). An analysis of the epidemiological situation of the disease in nine administrative-territorial units of the Kyrgyz Republic was also carried out with the calculation of the average 5-year mortality ratefor the period from 2018 to 2022. Results Despite the decrease in morbidity, a high proportion of mortality from CVD remains in all years, more than 50%. In terms of the percentage indicator for recent years, all this time it has maintained the highest position, in contrast to diseases of other organs and systems. In the last decade, from 2012 until 2020, there was a gradual decrease in the mortality rate. Since 2020, we have seen a sharp increase in the CVD mortality rate per 100 thousand population by 19.6% compared to 2018, by 19.4% since 2019, which is associated with the influence of Covid-19 pandemic, in 2021 this indicator amounted to 297.6 cases, in 2022 - 234.5. The main contribution to population death from CVD is made by coronary heart disease (65.90%), including acute myocardial infarction, cerebrovascular diseases (21.4%), arterial hypertension (5.9%). If we analyze the mortality rate from CVD by nine administrative-territorial units, the highest rates in 2022 are observed in the Chui and Talas regions, 291.9 and 266.3 per 100 thousand population respectively; the lowest in the Osh region (207.3), Osh city (196.1) and Bishkek (208.6), which is explained by the better organization of health services in these areas. Conclusion CVD remains the main cause of mortality in the population of the Kyrgyz Republic. Although over the past year there has been a good decline in this indicator, in almost all regions, particularly the greatest successes have been achieved in Naryn and Issyk-Kul regions. In connection with the above, there is requirement for a clear identification of priorities when determining the strategy of treatment and preventive interventions. It is necessary to create an effective National system of care for patients with CVD with a focus on emergency cardiac care and prevention issues.

Characteristics of the Cohort of Personnel of the Sublimate Production of the Siberian Chemical Plant Involved in Working with Plutonium-239

239Pu has the property of initiating radiogenic diseases in workers who come into contact with it during their professional activities. To study adverse medical and biological effects and to study in detail the potential consequences of plutonium exposure on the body of personnel at nuclear energy facilities, it is necessary to form a cohort of people involved in working with this isotope. The purpose of the study is to form and characterize a cohort of Siberian Chemical Plant sublimation production employees involved in working with 239Pu in the period 1953–2000. The source of information for forming the cohort was the database of the regional medical and dosimetric register of the population of closed administrative-territorial formation Seversk and the personnel of the Siberian Chemical Plant, containing personal, dosimetric, medical and biological information regarding all current and former employees of the Siberian Chemical Plant (about 65,000 people) since the founding of the enterprise till now. As part of this work, a cohort of sublimation production employees involved in working with 239Pu 9 in 1953–2000 was formed (1,052 people, 577 men and 475 women). The dosimetric, medical and biological characteristics of workers included in the sublimation production cohort are given. The created sublimation production cohort will make it possible to conduct comprehensive retrospective and prospective epidemiological studies to assess the morbidity and mortality of nuclear energy facilities employees, as well as to draw scientifically based conclusions regarding the role of 239Pu in the initiation of the most important socially significant non-infectious diseases (for example, malignant neoplasms, diseases of the circulatory system etc.) and mortality from these diseases. The scientific data obtained as a result of this study will make it possible to determine the main directions for organizing a system for assessing risks to the health of personnel at sites for the decommissioning of nuclear facilities and the formation of a set of measures aimed at improving the health-saving system of nuclear facilities employees and extending their working longevity.

Short-Term Outcomes and Complications of Premature Infants with a Birth Weight ≤ 1500g

prognosis of a premature infant is correlated with the conditions of medical care, both during and after birth, as well as the quality of the environment they are welcomed into. Objective: The aim of our study is to highlight the complications and outcomes of premature infants with a birth weight ≤ 1500g, by identifying the factors of morbidity and mortality, and then comparing our results with other studies. Materials and Methods: This is a retrospective descriptive, epidemiological, clinical, therapeutic, and developmental study conducted over a two-year period, from June 1, 2019, to June 30, 2021, in the neonatology and neonatal resuscitation unit at CHU HASSAN II of Fès. Results: We reported a mortality rate of 54% among the newborns, with the main causes of death being alveolar hemorrhage (43.41%), septic shock (29.45%), and severe respiratory distress (20.93%). The main complications and conditions observed during the hospital stay were: hyaline membrane disease (35.26%), alveolar hemorrhage (26.14%), patent ductus arteriosus (14.93%), hemodynamic instability (56.01%), electrolyte imbalances (44.81%), neonatal jaundice (54.77%), anemia (46.05%), thrombocytopenia (54.77%), apnea of prematurity (51.81%), intraventricular hemorrhage (12.86%), and neonatal infection (85.89%). Conclusion: The results of our study serve as a wake-up call for the necessity of implementing a management and prevention plan to improve the prognosis of premature infants with a birth weight ≤ 1500g.

Increased resistance rates of extended-spectrum β-lactamase-producing Enterobacterales isolated from blood cultures in Brazil

This study aimed to identify and evaluate the antimicrobial susceptibility profile of extended-spectrum β-lactamase (ESBL)-producing Enterobacterales isolated from blood cultures of patients with suspected sepsis. This retrospective cross-sectional epidemiological study was performed for four years (2015 to 2018) by accessing the medical records of patients diagnosed with bloodstream infections in two tertiary public hospitals in Brazil. Culture results and susceptibility tests of bacterial strains isolated from blood samples were analyzed. During four years, 2,263 blood culture exams were performed, and Enterobacterales were isolated in 694 (30.7%) samples. The disk approximation test detected ESBL production in 171 (24.6%) of the 694 isolated Enterobacterales (p&lt;0.05), with 125 (73.1%) corresponding to Klebsiella spp., 28 (16.2%) to Escherichia coli, eight (4.6%) to Enterobacter spp., five (2.9%) to Serratia spp., three (1.7%) to Proteus spp., and two (1.2%) to Citrobacter spp. All tested antibiotics demonstrated low susceptibility (2.9% to 26.9%). The classes of monobactams, cephalosporins, and penicillin showed high resistance indices. The evaluated Enterobacterales isolates exhibited expressive antimicrobial resistance to drugs commonly used as empirical treatment in bloodstream infections. The findings reinforce the relevance of assessing the bacterial antimicrobial susceptibility profile, as it drives antibiotic therapy, potentially detecting multiresistance cases.

Retrospective epidemiological study of the width of maxillary diastema in patients from northeastern Bulgaria.

A maxillary diastema (MD) is identified when the gap between the central incisors exceeds 0.5 mm. It poses an a and phonetic concern, often seen in mixed dentition and occasionally continuing into permanent dentition.

Risk assessment and transmission of fluoroquinolone resistance in drug-resistant pulmonary tuberculosis: a retrospective genomic epidemiology study

Fluoroquinolone resistance is a major challenge in treating Multidrug-Resistant Tuberculosis globally. The GenoType MTBDRsl Ver 2.0, endorsed by the WHO, was used to characterize fluoroquinolone resistance. The fluoroquinolone resistance rates in the MDR-TB, Rifampicin-Resistant TB, and non-MDR-TB were 33%, 16.5%, and 5.4%, respectively. The most common mutation found in fluoroquinolone-resistant isolates was D94G (49.5%) in the gyrA gene. Of the 150 MDR-TB isolates, the prevalence of Extensively Drug-Resistant Tuberculosis and pre-XDR-TB was 1.33% and 30%, respectively. Among the 139 RR-TB isolates, pre-XDR-TB prevalence was 15.8%. The fluoroquinolone resistance rates were 5.12% among the 1230 isoniazid-monoresistant isolates. The study found that MDR-TB and RR-TB have higher risk of fluoroquinolone resistance than non-MDR tuberculosis. Rifampicin-resistant isolates with a mutation at codon S450L have a higher risk (RR = 12.96; 95%CI: 8.34–20.13) of developing fluoroquinolone resistance than isolates with mutations at other codons in the rpoB gene. Isoniazid-resistant isolates with a mutation at codon S315T have a higher risk (RR = 2.09; 95%CI: 1.25–3.50) of developing fluoroquinolone resistance. The study concludes that rapid diagnosis of fluoroquinolone resistance before starting treatment is urgently needed to prevent the spread and increase of resistance and to achieve better treatment outcomes in areas where it is higher.