True Prevalence Research Articles

Patient characteristics and incidence of cardiac amyloidosis: an observational study in the UK clinical setting using electronic health records

Abstract Background Cardiac amyloidosis (CA) is associated with a high mortality rate due to sudden or progressive heart failure. It is often misdiagnosed due to non-specific symptoms, and its true incidence and prevalence in the United Kingdom (UK) remain uncertain. Purpose To describe patient characteristics and incidence of CA in the UK clinical setting using electronic health records. Methods In this retrospective observational study, anonymised, linked primary and secondary care data (Clinical Practice Research Datalink, CPRD and Hospital Episode Statistics, HES) were used to describe individuals diagnosed with CA. The CPRD database contains de-identified patient data sourced from a sample of general practitioner (GP) practices in the UK. Patients aged 18 years and older with a recorded Read or SNOMED-CT diagnosis code for CA or record of treatment with tafamidis (a licensed but not reimbursed treatment for transthyretin amyloid cardiomyopathy, ATTR-CM in the UK) in the period between January 2004 to December 2021 were included. The index date was defined as the earliest recorded date of CA diagnosis or tafamidis treatment. Demographic and clinical data were summarised using descriptive statistics. Incidence rates were reported per 100,000 person-years (PY). Results There were a total of 3,788 patients with CA (mean age: 67 years; 61% males) of which only 277 were coded as having wild-type transthyretin (ATTRwt) CA in mostly older patients (mean age: 79 years). The low patient counts of ATTRwt amyloidosis could be attributed to the lack of specificity in CA types and the low utilisation of ATTR amyloidosis codes. Heart Failure, essential hypertension and dyspnoea were the most common clinical presentations recorded in the 12 months to first diagnosis code or tafamidis prescription for CA (Table). The incidence of CA varied from 0.75 in 2004 to a peak of 1.96 in 2021, per 100,000 PY; a 2.9-fold increase in newly coded diagnoses in CA. There was a slight decline in the rates in 2020 and 2021 (Figure). Incidence rates in males and females increased over the 17-year period, with males consistently having higher rates than females. The incidence rate in females started from a lower base at 0.62/100,000 PY in 2004, increased by a factor of 1.9 to 1.1/100,000 PY, whereas in males it started at 0.88/100,000 PY and rose by a factor of 2.9 to 2.5 /100,000 PY. Incidence rates in subgroup populations have also been analysed. Conclusions In the UK clinical setting, the incidence rate of newly coded CA increased overall between 2004 and 2021, as well as in both male and female subgroups. The data suggest CA is becoming more common, or that awareness has improved, and there is now an urgent need for enhanced methods of detection, characterisation, and the need for thorough data capture to shape future pathway advancements.

High prevalence of porcine cysticercosis in slaughtered pigs in Rwanda: An abattoir survey.

Porcine cysticercosis (PC) is an important public health problem, especially in sub-Saharan Africa, but limited information is available on the prevalence of infection in pigs entering the food chain. Existing diagnostic methods vary in accuracy and efficiency; whole carcass dissection is the most reliable method but is labour-intensive and destroys the carcass so can only be used in a research setting. Serological tests offer lower specificity, while meat inspection and lingual examination lack sensitivity, hampering accurate estimates and the removal of infected pigs from the food chain. Here, we provide the first estimates of PC prevalence in abattoirs in Rwanda. We use whole carcass dissection to determine the diagnostic accuracy of a commercial antigen-ELISA to estimate the true prevalence of infection across Rwanda and identify Taenia species affecting local pigs. We carried out a cross-sectional survey in 6 abattoirs across Rwanda (n = 744 pigs), with whole carcass dissection of a subset of 67 pigs. Cysts were detected in 20/67 (30%) of carcasses, with >1000 cysts in 9/20 (45%) of infected pigs. All cysts were identified as Taenia solium by PCR-RFLP, with no cysts of Taenia hydatigena found. The antigen-ELISA showed a sensitivity of 90% (95% CI: 68-99) and specificity of 85% (95% CI: 72-94), when compared to dissection. Using these estimates, the true prevalence was calculated as 25-43% in two abattoirs in south-west Rwanda, and 2-3% in the rest of the country. Fewer than half of infected pigs were detected by tongue palpation and post-mortem veterinary inspection. Our data indicate a high prevalence of PC in Rwandan abattoirs. Tongue palpation and veterinary inspections, as currently carried out, have little impact in removing cyst-infested pigs from the food chain. Additional interventions are needed, such as proper pig husbandry, treatment and vaccination against cysticercosis, health education, improved sanitation and hygiene, and improved processing and cooking of meat.

Autism Spectrum Disorder and Associated Factors in Children in Spain, 2017: Population-Based Cross-Sectional Study.

Autism spectrum disorder (ASD) is a neurodevelopmental disorder with biological, multicausal and polygenic origins. The true prevalence of ASD has not been clearly established. The aim of this study was to estimate the prevalence of ASD in children aged 3 to 14 years in Spain and to analyze the factors associated with it. A cross-sectional observational study using data from the 2017 National Survey of Health in Minors in Spain. Primary outcome was the diagnosis of ASD, and sociodemographic, behavioral, health-related, the use of health services, household and medication use variables was analyzed. Multivariable logistic regression model with a correction for modelling rare events was fitted. Complex sampling was undertaken, using the survey elevation factor in the analysis. A total of 4409 children were included, and there were 26 children with ASD, for a prevalence of 0.59%, representing 29,143 children with ASD. Factors significantly associated were male sex, having visited a psychologist, and/or a speech therapist in the past year, presenting probable problems with peers, antisocial behavior, taking antibiotics and taking other medications. The findings of this study may be useful to inform health policies and develop strategic plans to identify and address the needs of children with ASD.

Effect of Fluorescence Lymph Node Mapping on Improving Diagnostic Values of CT D3 Lymph Node Staging for Right-Sided Colon Cancer

Background/Objectives: This study evaluated the impact of fluorescence lymph node mapping (FLNM) using indocyanine green (ICG) on the diagnostic accuracy of preoperative computed tomography (CT) in right-sided colon cancer. Methods: A total of 218 patients who underwent laparoscopic right hemicolectomy with D3 lymph node dissection (LND) were analyzed: 86 patients in the FLNM group and 132 in the conventional surgery group. The FLNM technique allowed for enhanced intraoperative visualization of lymph node (LN) and more precise dissection, improving the identification of metastatic LNs. The diagnostic value of preoperative CT staging was assessed in both the FLNM and control groups by calculating the apparent prevalence, true prevalence, sensitivity, specificity, positive predictive value (PPV), negative predictive value, positive likelihood ratio (PLR), negative likelihood ratio, false positive and false negative proportions, and accuracy. Results: FLNM increased the accuracy of CT staging for detecting D3 LN metastasis in advanced cancer cases, with a higher PPV, PLR, and accuracy. In the FLNM group, the false-positive rate was significantly reduced, and the specificity was higher compared to the control group. Multivariate analysis identified FLNM as an independent factor associated with improved D3 LN metastasis detection. These findings suggest that incorporating FLNM into surgical procedures enhances the diagnostic value of preoperative CT by improving the precision of LND, particularly in patients with advanced colon cancer. Conclusions: The use of FLNM for D3 LND enhances the diagnostic accuracy of cN staging in right-sided colon cancer by improving surgical precision.

Serpentoviruses in Free-Ranging Shingleback Skinks (Tiliqua rugosa) in Western Australia and South Australia, Australia.

Serpentoviruses are strongly associated with upper respiratory tract disease in captive and free-ranging bluetongued skinks (Tiliqua spp.). In Australia, bluetongue serpentoviruses were first reported in shingleback skinks (Tiliqua rugosa) with upper respiratory tract disease that presented to wildlife rehabilitation facilities in Perth, Western Australia. Since then, serpentoviruses have been detected commonly in captive bluetongued skinks from most areas of Australia, yet knowledge about the prevalence and distribution of these viruses in free-ranging bluetongued skinks, and other skink species, remains limited. Oral swabs were collected from 162 shingleback skinks from four areas in Western Australia and neighboring South Australia to screen for bluetongue serpentoviruses by PCR. The proportions of PCR positives were 0% (0/4) for Rottnest Island (a small island west of Perth, Western Australia), 3% (1/32) for the Shire of Kent (∼5,600 km2 in the southwest of Western Australia), 1% (1/91) from an approximately 250,000 km2 area across South Australia and Western Australia, and 0% (0/35) from Mount Mary (∼150 km2 in the mid north of South Australia). Neither of the two PCR-positive shingleback skinks had overt signs of upper respiratory tract disease. These results are consistent with serpentoviruses occurring at a relatively low crude prevalence of 1.4% (95% confidence interval, 0.2-4.9%) across these areas, although the potential bias from sampling active and apparently healthy individuals may mean that this estimate is lower than the true prevalence. This contrasts with the high proportion of PCR positives reported in captive individuals. In the absence of experimental or observational data on viral clearance and recovery, Tiliqua spp. skinks that are intended for release into the wild should be housed with strict biosecurity to prevent interactions with captive individuals and screened to ensure that they are not PCR positive before release.

A machine learning algorithm for the detection of paroxysmal nocturnal haemoglobinuria (PNH) in UK primary care electronic health records

BackgroundParoxysmal Nocturnal Haemoglobinuria (PNH) is an ultra-rare, acquired disorder that is challenging to diagnose due to varied symptoms, heterogeneous patient presentations, and lack of awareness among healthcare professionals. This leads to frequent misdiagnosis and delays in diagnosis. This study evaluated the feasibility of a machine learning model to identify undiagnosed PNH patients using structured electronic health records.MethodsThe study used data from the Optimum Patient Care Research Database, which contains electronic health records from general practitioner (GP) practices across the United Kingdom. PNH patients were identified by the presence, and control patients by the absence of a PNH diagnosis code in their records. Clinical features (symptoms, diagnoses, healthcare utilisation) from 131 patients in the PNH group and 593,838 patients in the control group, were inputted to a tree-based XGBoost machine learning model to classify patients as either “positive” or “negative” for PNH suspicion. The algorithm was finalised after additional exclusions and inclusions applied. Performance was assessed using positive predictive value (PPV), recall and specificity. As the sample used to develop the algorithm was not representative of the true population prevalence, PPV was additionally adjusted to reflect performance in the wider population.ResultsOf all the patients in the PNH group, 27% were classified as positive (recall). 99.99% of the control group were classified as negative (specificity). Of all the patients classified as positive, 60.4% had a diagnosis of PNH in their record (PPV). The PPV adjusted for the population prevalence of PNH was 19.59 suggesting nearly 1 in 5 patients flagged may warrant further PNH investigation. The key clinical features in the model were aplastic anaemia, pancytopenia, haemolytic anaemia, myelodysplastic syndrome, and Budd-Chiari syndrome.ConclusionThis is the first study to combine clinical understanding of PNH with machine learning, demonstrating the ability to discriminate between PNH and control patients in retrospective electronic health records. With further investigation and validation, this algorithm could be deployed on live health data, potentially leading to earlier diagnosis for patients who currently experience long diagnostic delays or remain undiagnosed.

COVID-19 Deaths in Transnational Settings: Disrupted Bereavement and Pandemic-Related Prolonged Grief Disorder in the Latinx Immigrant Population.

The Latinx immigrant population experienced one of the highest COVID-19 death rates. Those left behind have exhibited rising rates of mental illness, particularly, pandemic-related prolonged grief disorder. The Latinx immigrant population is uniquely vulnerable to this disorder as a result of disrupted culturally appropriate bereavement practices, constrained social support, and concurrent COVID-19 stressors and immigration-related trauma. Despite a rising call for research on pandemic-related prolonged grief disorder, little is known about the true prevalence, cause, and appropriate treatment protocol behind this disorder in the Latinx immigrant population. Four areas of research critical to the identification and understanding of pandemic-related prolonged grief disorder in this population are recommended: 1) death and bereavement in transnational settings, 2) immigrant social networks and disrupted bereavement, 3) COVID-19 stressors and grieving, and 4) prolonged grief disorder and mental illness comorbidities. An understanding of these four contributing areas to Latinx immigrants' vulnerability to prolonged grief disorder is imperative to providers' development of assessments and treatment protocols needed to identify and treat prolonged grief disorder in this population.

Underlying cerebrovascular pathology causing secondary psychosis

Case Background Psychosis can be classified as primary if it is caused by a psychiatric disorder or secondary if it is due to a specific medical condition. Despite there being multiple identified causes of secondary psychosis, making such a diagnosis can prove challenging. Case Details This case report presents a 57-year-old male who was brought by ambulance to the emergency department following an intentional jump from a first story window due to visual and auditory hallucinations and persecutory paranoid delusions. MRI findings on admission were consistent with cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL). The patient’s background included an ischaemic stroke with haemorrhagic transformation five years previously. He experienced psychotic symptoms during the immediate recovery period. Prior to this he had no psychiatric history. Discussion Post-stroke psychosis and the condition of CADASIL are both entities that are relatively rarely described in the literature. However, this may be due to missed diagnosis and therefore not reflective of true prevalence. Conclusion Identifying a cause-effect relationship and establishing a diagnosis of secondary psychosis can be confounded by many factors. Nevertheless, this patient’s case demonstrates the importance of considering an underlying cause, particularly when the presentation is atypical and there is a temporal relationship between the proposed medical condition and the symptoms of psychosis. Patient Consent Obtained: Yes

Long COVID at 3 and 6 months after covid-19 infection in Thailand.

"Long COVID", which describes a diverse set of symptoms or conditions that persist or develop after four weeks from the onset of initial SARS-CoV-2 infection has been introduced. However, the true prevalence varies worldwide. This study aimed to determine the point prevalence and clinical characteristics of long COVID at three and six months after acute COVID-19 infection in Thailand. Methods All adult patients who were diagnosed with COVID-19 by positive nasopharyngeal RT-PCR for SARS-CoV-2 at Thammasat University Hospital between October and December 2021 were recruited and followed for long COVID symptoms by telephone interviews at 3 and 6 months after an acute infection. Among 1,400 eligible COVID-19 cases, interviews were complete for 1,129 and 932 individuals at 3 and 6 months, respectively. Of those, 431 and 314 reported at least one symptom consistent with long COVID. The point prevalence was 38.2% (95% confidence interval: 35.3-41.1%) and 33.7% (95% confidence interval: 30.7-36.7%) respectively. Female gender, disease severity, and symptomatic acute infection were identified as independent risk factors. Conclusion Based on the reported symptoms, long COVID is commonly observed either at 3 or 6 months in our study.

8373 High suspicion for thyroid cancer in patient with thyroid Hemiagenesis

Abstract Disclosure: L. Aoun: None. S. Almardini: None. M. Anise: None. F. Haddadin: None. F. Saliba: None. J. Zaidan: None. Background: Thyroid Hemiagenesis (THA) is a rare condition characterized by congenital absence of one lobe of the thyroid gland. Notably, THA is more prevalent in females and the left lobe is more likely to be absent with or without the isthmus. Most patients are euthyroid, and diagnosis is usually incidental, so the true prevalence of THA is uncertain as there are certainly undiagnosed cases. Studies have shown a link between THA, thyroid cancer, and hyperparathyroidism. We present a case of THA and high suspicion for thyroid cancer. Case Presentation: 54-year-old female with history of Rheumatoid arthritis who presented for evaluation of incidental thyroid nodules, occasional palpitations, tremors, and mild change in her voice. She denied abnormal weight loss or diarrhea. No history of radiation to the neck and no family history of thyroid disease or thyroid cancer. The thyroid exam showed an enlarged left palpable nodule. Labs significant for TSH 1.6 mIU/L (normal: 0.4-4 mIU/L), FT4 0.8 ng/dl (normal 0.7-1.9 ng/dL) and T3 77ng/dL (normal: 60-180 ng/dL). Thyroid U/S showed left hemiagenesis and right sided nodules biggest is 1.1 cm solid, hypoechoic with coarse calcifications, FNA was recommended and showed follicular lesion of undetermined significance, molecular testing was done and Thyroseq came back intermediate to high risk RAS and EIF1AX positive reflecting a 70 % probability of cancer. Based on these results, surgery was recommended, and the patient underwent right thyroidectomy. Surgery was uncomplicated and despite reported higher risk of hyperparathyroidism patient’s calcium and PTH were normal, and no parathyroid adenomas were identified intraoperatively. The pathology from the thyroidectomy showed follicular adenoma of 1 cm and no malignancy. She was started on Synthroid 100mcg daily post op. Discussion: This case demonstrates a case of a benign thyroid nodule and preserved parathyroid levels in the setting of thyroid hemiagenesis. Usually in THA, the contralateral lobe is at an increased risk for pathology of compensatory hypertrophy or hyperplasia. According to available studies, cancer association with THA was more common in left hemiagenesis and parathyroid adenomas more common ipsilateral to hemiagenesis . Despite Our patient’s FNA revealed atypical findings, molecular testing revealed RAS and EIF1AX positive, marking intermediate to high cancer risk. However, the thyroidectomy pathology report unveiled no evidence of malignancy, contraindicating the anticipated high cancer risk in those with left THA. This case highlights the rarity of THA and different possible presentations and cancer risks. Presentation: 6/2/2024

The herd-level prevalence of caprine arthritis-encephalitis and genetic characteristics of small ruminant lentivirus in the Lithuanian goat population

Caprine arthritis-encephalitis (CAE) is a progressive disease of goats caused by small ruminant lentivirus (SRLV) and is considered as one of the most important threats for goat farming in developed countries. The disease prevalence has never been investigated in the Lithuanian goat population. Therefore, a descriptive cross-sectional study was carried out in 2021-2022 to determine if SRLV infection was present in the Lithuanian goat population and, in the case of a positive result, to estimate the true herd-level prevalence of SRLV infection and specify genotypes and subtypes of SRLV responsible for the infection. Thirty goat herds counting >5 adult goats were randomly selected and, in each herd, a representative sample of adult goats was blood-sampled and tested serologically for SRLV infection using a commercial ELISA. The herd was considered infected if at least one goat tested positive and the true herd-level prevalence of SRLV infection was estimated using the Bayesian approach. Seropositive animals were found in 17 / 30 herds (57%; 95% confidence interval: 39%, 73%). The true herd-level prevalence was 56% (95% credible interval: 36%, 76%). In 10 / 17 seropositive herds whose owners consented for resampling of seropositive goats, 1 to 5 seropositive goats were tested using the nested real-time PCR (nRT-PCR). Goats from 9 seropositive herds tested positive in the nRT-PCR: in 4 herds for genotype A, in 4 herds for genotype B, and in 1 herd – 2 goats for genotype B and 1 goat for genotype A. From each of 9 nRT-PCR-positive herds, 1 PCR product of each genotype was sequenced using Sanger method and the phylogenic tree was constructed using the neighbor-joining method in the Molecular Evolutionary Genetics Analysis software. Four herds turned out to be infected with B1 subtype (91% identity with the prototypic strain), 3 herds with A2 subtype (90%-92% identity), and a herd with mixed infection was infected with B1 (91% identity) and A2 subtype (90% identity). In one herd, the only seropositive goat was found to be infected with the strain most closely related to the A1 subtype (80% identity). This study shows for the first time that SRLV infection is present and widespread in the Lithuanian goat population and both classical SRLV genotypes, represented by quite typical subtypes A2 and B1, appear to be responsible for the infection.

Italian report on RARE epilepsies (i-RARE): A consensus on multidisciplinarity.

Rare and complex epilepsies encompass a diverse range of disorders characterized by seizures. We aimed to establish a consensus on key issues related to these conditions through collaboration among experienced neurologists, neuropediatricians, and patient advocacy representatives. Employing a modified Delphi method, a scientific board comprising 20 physicians and 4 patient advocacy representatives synthesized existing literature with their expertise to formulate statements on contentious topics. A final 32-member expert panel, representing diverse regions of Italy, validated these statements through a two-round voting process, with consensus defined as an average score ≥7. Sixteen statements reached a consensus, emphasizing the necessity for epidemiological studies to ascertain the true prevalence of rare epilepsies. Etiology emerged as a crucial factor influencing therapeutic strategies and outcome prediction, with particular concern regarding prolonged and tonic-clonic seizures. The importance of early implementation of specific drugs and non-pharmacological interventions in the treatment algorithm for developmental and epileptic encephalopathies (DEEs) was underscored. Multidisciplinary care involving experts with diverse skills was deemed essential, emphasizing non-seizure outcomes in adolescence and adulthood. This national consensus underscores the imperative for personalized, comprehensive, and multidisciplinary management of rare epilepsies/DEEs. It advocates for increased research, particularly in epidemiology and therapeutic approaches, to inform clinical decision-making and healthcare policies, ultimately enhancing patients' outcomes. The modified Delphi method is broadly used to evaluate debated topics. In this work, we sought the consensus on integrated and social care in epilepsy management. Both representatives of high-level epilepsy centers and patients' caregivers were directly involved.

Diagnosis and management of spontaneous coronary artery dissection: Two cases and a review of the literature

Introduction and importance: Spontaneous coronary artery dissection (SCAD) is a rare but potentially fatal condition, often underdiagnosed despite its significance in acute coronary syndrome (ACS). The true prevalence remains uncertain due to diagnostic challenges. Identifying SCAD cases is crucial for reducing mortality and morbidity, especially considering the recurrence risk. The authors present two cases highlighting the importance of multimodality imaging in diagnosing and managing SCAD. Case presentation: Case 1: A 53-year-old man with a history of brain aneurysm presented with chest pain and shortness of breath. Despite negative EKGs and stress tests, coronary computed tomography angiography (CCTA) revealed non-obstructive dissection flaps. Medical management improved his condition. Case 2: A 55-year-old woman with no significant medical history experienced recurrent chest pain. Initial tests were negative, but CCTA revealed SCAD. Further screening uncovered undiagnosed fibromuscular dysplasia. Clinical discussion: SCAD poses diagnostic challenges, often mimicking other cardiac conditions. Traditional tests may yield negative results, necessitating advanced imaging techniques like CCTA. Recognizing SCAD’s association with connective tissue disorders (CTD) is vital for comprehensive patient care. The authors’ cases emphasize the importance of a systematic approach to diagnosing chest pain, including noninvasive modalities and considering underlying etiologies. Conclusion: SCAD diagnosis requires a high index of suspicion, especially when traditional cardiac tests are inconclusive. Beyond treatment, patients should undergo further evaluation for CTDs, particularly in those with minimal risk factors for atherosclerosis. Increased awareness and a multimodal diagnostic approach are crucial for timely intervention and improved outcomes in SCAD patients. Learning objectives: The authors aim to increase awareness regarding different clinical presentations of SCAD to decrease the risk of missed or late diagnosis. The authors’ case series also signifies the multimodal imaging approach’s role in evaluating chest pain. Upon diagnosis of SCAD, it is imperative to go beyond treatment and implement a reverse algorithmic strategy to discover any underlying causes and risk factors for SCAD predisposition.

Management of protective lung ventilation in children with a critical course of acute respiratory distress syndrome caused by SARS-CoV-2 coronavirus infection

the pandemic of coronavirus disease COVID-19 has created a serious threat to the public health system worldwide. With the beginning of the pandemic, it became clear that children infected by SARS-CoV-2, for unknown reasons, have a milder course compared to adults. In some cases, children are asymptomatic carriers of the infection. In light of today's scientific discoveries, contrary to initial reports, recent studies have shown that children are just as likely to contract the virus as adults, while vague symptoms and a milder course more often characterize the disease itself. However, it is worth noting that the true prevalence of asymptomatic SARS-CoV-2 infection is most likely underestimated since children are not tested for COVID-19 without obvious clinical symptoms. This fact has been confirmed by multiple blood tests indicating high titers of IgG to SARS-CoV-2. Compared to adults, the typical clinical manifestations of COVID-19 in children are fever, runny nose, cough, and general weakness. The laboratory test results indicate a normal level of leukocytes, lymphopenia, and an increased level of aspartate aminotransferase, alanine aminotransferase, D-dimer, and MB creatine kinase. Currently, there is no sufficient evidence that the etiotropic therapy is 100% successful. Yet a course of action such as respiratory system protection, control of fluids and electrolyte homeostasis, anti-cytokine therapy, preventative measures for thrombosis, and treatment for bacterial superinfection proved to be efficient at preventing the development of possible complications caused by SARS-CoV-2. Therefore, it is important to collect and accumulate new experiences\cases of respiratory system protection management of an acute respiratory syndrome with a critical course of acute respiratory distress syndrome caused by COVID-19 and implement practical treatment plans for healthcare facilities. The results were analyzed using clinical epidemiology methods. Children were admitted to the intensive care unit on an average of 6,6±0,62 days of illness and were more associated with systemic disorders and water-electrolyte imbalance, which required prosthetic respiratory function, correction of hemodynamics and water-electrolyte disorders, which was carried out in the infectious diseases department of anesthesiology and intensive care for an average of 5,2±0,7 days. In children in the clinical group, SARS-CoV-2 was verified by reverse transcription polymerase chain reaction of a nasopharyngeal swab and/or exhaled air condensate based on its positive results. Comprehensive treatment of patients with severe and extremely severe respiratory distress syndrome in coronavirus disease included respiratory and hemodynamic support, antiviral and antibacterial therapy, parenteral glucocorticosteroids and anticoagulants, which was in line with current national regulatory guidelines and local protocols. According to the criteria for choosing a method of respiratory function prosthetics, in more than half of the patients (62,2%) with hemoglobin oxygen saturation of less than 92%, while maintaining active respiratory capacity, respiratory support was provided by supplementing humidified oxygen through a face mask or nasal cannulas. In another 29,7% of patients, non-invasive ventilation was performed by constant positive airway pressure, with an oxygenation index of 0,4-0,5 and a positive end-expiratory pressure of 4-5 cm of water column. Children who had a critical course of acute respiratory syndrome caused by coronavirus infection COVID-19 (8,1%) and in whom non-invasive methods of respiratory support did not bring the desired therapeutic result were on invasive ventilation in the mode of auxiliary controlled ventilation or in the mode of synchronized intermittent forced ventilation. It should be noted that children who received respiratory support in the form of non-invasive ventilation by means of constant positive airway pressure required a lower concentration of oxygen in the inhalation mixture compared to patients on free-flow oxygen supplementation. The need for admission to the intensive care unit of children with COVID-19 is primarily associated with respiratory disorders caused by interstitial pneumonia. Oxygen supplementation was of paramount importance in patient management, primarily through noninvasive ventilation with constant positive airway pressure or free flow. The use of a pulmonary protective strategy in the treatment of acute respiratory distress syndrome caused by coronavirus disease COVID-19 in children requiring invasive ventilation was accompanied by a pronounced positive result, as it was not accompanied by side effects and resulted in a rapid recovery of patients.

Prevalence of cardiomyopathy and cardiac mortality in a colony of non-purebred cats in New Zealand

ABSTRACT Aims To evaluate the prevalence of subclinical cardiomyopathy and cardiac mortality in a research colony of non-purebred cats, established as a model of the wider cat population in New Zealand. Methods All apparently healthy, compliant, non-pregnant, non-neonatal cats in the colony at the Centre for Feline Nutrition (Massey University, Palmerston North, NZ) underwent physical examination and echocardiography using a 4.4–6.2-MHz probe by a board-certified veterinary cardiologist. Cardiac phenotype was classified following current guidelines. Hypertrophic cardiomyopathy (HCM) phenotype was defined as an end-diastolic left ventricular wall thickness ≥ 6 mm. Colony mortality data from February 2012 to February 2022 was reviewed to determine cardiac mortality. Results Cats (n = 132; 65 females and 67 males) included in the study had a median age of 4.1 (IQR 3.0–8.0) years. Thirty-two (24%) cats had a heart murmur, and three (2%) cats had an arrhythmia. Echocardiography revealed heart disease in 24 (18.2%) cats, including 23 with an HCM phenotype and one with a restrictive cardiomyopathy phenotype. Of the cats with the HCM phenotype, 3/23 had systemic hypertension or hyperthyroidism or both, and these cats were excluded from the final diagnosis of HCM (20/132; 15.2 (95% CI = 9.5–22.4)%). Between 2012 and 2022, 168 colony cats died, with 132 undergoing post-mortem examination. Heart disease was considered the cause of death in 7/132 (5.3%; 95% CI = 2.2–10.6%) cats; five had HCM, one a congenital heart defect, and one myocarditis. The overall prevalence of death related to HCM in the colony during this period was 3.8% (95% CI = 1.2–8.6%). Three cats with HCM and the cat with a congenital heart defect died unexpectedly without prior clinical signs, while congestive heart failure was observed prior to death in two cats with HCM and the cat with myocarditis. Additionally, 30/132 (22.7%) cats had cardiac abnormalities but died for non-cardiac reasons. Conclusions Subclinical cardiomyopathy, specifically HCM, was common in cats in the colony. Given that the colony originated as a convenience selection of non-purebred cats in New Zealand, the true prevalence of HCM in the wider New Zealand population is likely to fall within the 95% CI (9.5–22%). The proportion of deaths of colony cats due to HCM was lower (3.8%) supporting the conclusion that subclinical cardiomyopathy may not progress to clinical disease causing death. Clinical relevance Veterinarians should be aware of the high prevalence of subclinical HCM when treating cats. Abbreviations CAM: Systolic anterior motion of the chordae tendineae; CFN: Centre for Feline Nutrition; HCM: Hypertrophic cardiomyopathy; LA/Ao: Left atrial to aortic ratio; LV FS: Left ventricular fractional shortening; LVIDd: Left ventricular internal diameters in end-diastole; LVIDs: Left ventricular internal diameter in end-systole; LVWT: Max Maximum left ventricular wall thickness; SAM: Systolic anterior motion of the mitral valve; 2D: Two-dimensional

Performance of post-mortem diagnostic tests for tuberculosis in wild ungulates at low and high prevalence assessed using Bayesian latent class models.

Animal tuberculosis (TB) is often maintained by multi-host communities, including livestock and wildlife. Quantitative studies of such communities require estimating the true prevalence of TB, correcting the apparent prevalence by the diagnostic sensitivity (Se) and specificity (Sp) of the test. The goal of this study was to lay the foundations for estimating the true prevalence of TB in wild ungulate populations (wild boar and two cervids: red deer and fallow deer). We used Bayesian latent class models to assess the Se and Sp of gross pathology, IS6110 real-time PCR in tissues, bacteriological culture, and P22 indirect ELISA. We analyzed 308 harvested wild ungulates (211 wild boar and 97 cervids: 92 red deer and 5 fallow deer). The Se of bacteriological culture (80.4%, CI95 61.0-96.3%) and gross pathology (87.9%, CI95 69.5-99.9%) was reasonably good in wild boar. These tests showed lower Se in cervids: 60.2% (CI95 38.3-82.3%) for bacteriological culture and 81.5% (CI95 63.6-96.2%) for gross pathology. The Se of the real-time PCR was low (50.7% in wild boar and 53.0% in cervids). These tests showed Sp between 95.2 and 99.1% in both taxa. The P22 ELISA performed reasonably well in wild boar (Se = 71.9%, CI95 59.2-83.4%; Sp = 98.8%, CI95 96.9-99.9%) but lacked Sp in cervids (Se = 77.1%, CI95 62.9-89.7%; Sp = 74.5%, CI95 65.7-83.3%). The real-time PCR in wild boar and cervids and bacteriological culture in cervids tended to show higher Se in low-prevalence populations, possibly due to a higher proportion of early-stage TB lesions. In cervids, the parallel interpretation of gross pathology and bacteriological culture significantly improved the diagnostic performance (Se = 93.1%, CI95 84.7-98.9%; Sp = 92.9%, CI95 86.0-98.3%). Our results allow the estimation of true prevalence from the results of a single diagnostic test applied to harvested wild boar, red deer, and fallow deer, paving the way for more precise quantitative ecological studies of the multi-host TB maintenance community.

PREVALENCE OF HEPATITIS B VIRUS INFECTION AMONG HIV PATIENTS INBENUE SOUTH SENATORIAL DISTRICT, NIGERIA

Hepatitis B infection seriously threatens global public health, especially in developing nations. Despite severalefforts on ascertaining the true prevalence of HBV, it tenaciously varies across different locations and subpopulations, particularly among those at risk of infection such as the HIV-infected population. This study aimed atdetermining the sero-prevalence of HIV-HBV co-infection in Benue South Senatorial District, Nigeria. This crosssectional study was conducted in four anti-retroviral therapy (ART) specialized clinics between May 1, andSeptember 2023 using pretested questionnaires, after obtained ethical approval and informed consent.Bloodsamples of participants were screened using HBsAg testing kitsand the results were interpreted according to themanufacturer’s instructions. The screening for HIV-HBV co-infection showed a sero-prevalence of 25/457 (5.47%).The distribution based on clinic location was 12(48%) GH Otukpo, 8(32%) GH Oju, 2(8%) GH Ugbokpo and3(12%) SMH Okpoga. The distribution also revealed that most cases were in the age group 40-49 and the femalegender.The prevalence showed that only 3/25 (12.0%) reported a history of sexually transmitted diseases other thanHIV while 2/25 (8.0%) had a history of multiple sex partners. Most co-infected cases 23/25(92.0%) had no historyof same-sex relationships and 23/25(92.0%) had recent history of unprotected sex. In Nigeria, hepatitis B infectionremains a significant public health problem. Notable preventive strategies include abstinence from sex, avoidanceof multiple sex partners, strict adherence to safe sex, and avoiding contact with infected body fluids. Otherstrategies such as averting mother-to-infant hepatitis B transmission, scale-up of screening programs and extensivevaccination programs are eminently recommended in the course of HBV control.

Estimating the prevalence of Breast Implant Associated Anaplastic Large Cell Lymphoma (BIA-ALCL) - a systematic review.

Assessment of BIA-ALCL prevalence is challenged by a lack of population-level data for the prevalence of breast implants in the wider population. Absence of such data obscures the true prevalence of BIA-ALCL and hinders informed consent consultations. We performed a systematic review to synthesise data from published studies reporting BIA-ALCL cases in defined patient populations to better inform the evidence base. PubMed and Embase were searched to obtain studies reporting the prevalence of BIA-ALCL in defined patient cohorts with breast implants where case prevalence was calculable. Study characteristics, the number of BIA-ALCL cases and total sample size were extracted and used to calculate the prevalence of BIA-ALCL per 100,000 implanted patients. Of 1,477 publications identified by the search, 38 studies incorporating 28 cohort and 6 registry studies satisfied the inclusion criteria encompassing a total population sample of 17,038,371 patients and 1,170 BIA-ALCL patients. The prevalence of BIA-ALCL was found to be 30.54 per 100,000 implanted patients with textured implants (1 case per 3,274 implanted patients) and 6.70 per 100,000 implanted patients with implants of any-type (1 case per 14,925 implanted patients). By synthesising the published literature, this work provides a determination of BIA-ALCL prevalence using study- and population-level data where the prevalence of breast implants is known. The accurate determination of BIA-ALCL prevalence is of fundamental importance for patients undergoing implant-related surgery to enable the provision of valid informed consent.

Incident reporting and data monitoring of sexual violence and harassment on public transport

IntroductionSexual violence and harassment occur in different settings, including public transport, and cause significant harm to victim-survivors' mental and physical health. While sexual violence and harassment on public transport is a documented problem, the public transport sector uptake has been slow and the true prevalence of sexual violence and harassment on public transport is yet to be determined. We aimed to investigate existing public transport and key stakeholder data systems, and explore the views of service providers, to ultimately improve sexual violence and harassment incident reporting and data monitoring. MethodsUsing a mixed methods design, researchers worked with public transport providers and other interested stakeholders in one Australian state. Twelve organizations were involved in the project and six provided current data on public transport safety for analysis. An audit of public transport and stakeholder websites was also undertaken to assess sexual violence and harassment incident reporting pathways. In addition, seven managers from five public transport organizations were interviewed to capture views on gender sensitive data collection and monitoring, and the challenges and enabling factors facing the sector. ResultsThe results uncovered varied sexual violence and harassment reporting formats and subsequent limited reporting of sexual violence and harassment incidents on public transport. In addition, poor-quality data sets lacked gender sensitivity, comprehensiveness, comparability, reliability and accessibility. Three key themes from public transport providers, on sexual violence and harassment data collection included increasing incident reporting, barriers and enablers of collecting and analysing quality data and governance frameworks. A minimum data set collection tool has been developed and could be tested in future. ConclusionTo improve women's safety on public transport, enhanced gender-sensitive data collection and monitoring is required. Long term government investment in sexual violence and harassment primary prevention strategies on public transport are urgently needed.

Long-Term Disability After Traumatic Spinal Injuries: A Military Retrospective Study.

Traumatic spinal injuries (TSI) pose a significant life-long burden, impacting both military and civilian populations. Assessing long-term outcomes is crucial for comprehending the enduring consequences of the initial insult and informing effective prevention and management strategies. Most existing studies have narrowly focused on subsets of traumatic cord injuries, leaving a gap in understanding the broader impact of severe spinal trauma. This study aims to examine severe TSIs in military personnel, who may face unique risk factors and injury patterns, and its association with long-term disability. A retrospective cohort study was conducted on all military personnel who suffered traumatic injuries (Injury Severity Score ≥ 9) from 1997 to 2020. Severe spinal injuries were defined using the spinal Abbreviated Injury Scale ≥ 3 (n = 95), and compared to all other injuries as a reference group (n = 1,394). Data were extracted and cross-referenced from three distinct nationwide registries-pre-hospital, admission, and rehabilitation. Logistic regression analysis was used to evaluate the impact of spinal injuries on long-term disabilities (defined as the highest possible disability tier). The study received approval from the institutional review board of the Israel Defense Forces Medical Corps. Motor vehicle accidents and falls were the primary causes of spinal injuries (50.5% and 15.8%, respectively). The median age at injury was 20 years (interquartile range 19-22). Personnel with spinal trauma had a significantly higher prevalence of Injury Severity Score ≥ 25 (46.3% vs. 19.9%, P < .001), longer median hospital stays (11 vs. 8 days, P = .036), and increased intensive care unit admissions (55% vs. 40%, P = .05). The median follow-up duration was 10.9 years (interquartile range 6.7-14.3). Spinal injuries were associated with a more than 10-fold increase in the adjusted odds ratio for severe permanent disability (11.92, 95% CI, 5.95-23.72). Upon long-term follow-up, military personnel with severe TSI exhibit a significantly higher prevalence of debilitating disability compared to those with significant non-spinal traumatic injuries. These findings highlight the critical need for targeted prevention strategies and improved management of spinal injuries to reduce long-term disability. Strengths of this study include its extensive follow-up period and the use of multiple nationwide registries. However, the study may be limited by potential discrepancies in identity matching across databases and the reliance on disability claims, which may underrepresent the true prevalence of long-term disability. Future research should explore the efficacy of early interventions and rehabilitation strategies in mitigating long-term disability following spinal injuries. This study underscores the importance of developing evidence-based policies to enhance care for individuals with TSIs.