Epidemiological Variables Research Articles

Diagnostic Usefulness of Flexible Fibroscopy Biopsy in Suspected Lesions of the Otolaryngological Area.

The efficiency in the management of patients with suspected malignant lesions represents the main objective of the oncology of head and neck. Flexible nasopahyngolaryngoscopy with working channel allows to quickly and safely assess and obtain histological samples of this type of lesion. Our objective is to describe the usefulness of this technique in lesions suggestive of malignancy in terms of efficiency, sensitivity and specificity. A retrospective study was carried out over a period of time from December 2014 to December 2019, including patients biopsied with flexible fibroscopy of lesions of debut suspected of malignancy. Here we assess the location of the lesion, the histological results, the diagnostic time and the epidemiological variables. 104 patients were included in the study. More than half of the lesions, 55.2% (57), were located in the larynx; 57.7% (60) resulted positive for malignancy in the flexible fiberscope biopsy; 19.2% (20) were taken to the operating room to get biopsied under general anesthesia resulting in 7.4% (14) positive for malignancy, which shows a sensitivity of the test of 81%. In our sample, a diagnostic time of 15days was obtained. Considering our results, the few complications and the revised literature, flexible fiberscope biopsy with working channel is an efficient procedure for the management of oncological patients of head and neck.

Fear of COVID-19 and COVID-19 Stress and Association with Sociodemographic and Psychological Process Factors in Cases under Surveillance in a Frontline Worker Population in Borneo.

COVID-19 stress and fear of COVID-19 is an increasingly researched construct in the general population. However, its prevalence and association with sociodemographic factors and psychological process variables has not been explored in frontline workers under surveillance in a Bornean population. This study was a cross-sectional study using a sociodemographic questionnaire incorporating two specific epidemiological risk variables, namely specific questions about COVID-19 surveillance status (persons under investigation (PUI), persons under surveillance (PUS), and positive cases) and the nature of frontline worker status. Furthermore, five other instruments were used, with three measuring psychopathology (namely depression, anxiety and stress, fear of COVID-19, and stress due to COVID-19) and two psychological process variables (namely psychological flexibility and mindfulness). Kruskal–Wallis and Mann–Whitney tests were performed to assess if there were significant differences in psychopathology and psychological process variables between sociodemographic and epidemiological risk variables. Hierarchical multiple regression was further performed, with depression, anxiety, and stress as dependent variables. There were significant differences in the fear of COVID-19 between positive cases, PUI, and PUS. The fear of COVID-19 scores were higher in positive cases compared to in PUS and PUI groups. Upon hierarchical multiple regression, mindfulness and psychological flexibility were significant predictors of depression, anxiety, and stress after controlling for sociodemographic and epidemiological risk factors. This study demonstrates that exposure to COVID-19 as persons under investigation or surveillance significantly increases the fear of COVID-19, and brief psychological interventions that can positively influence mindfulness and psychological flexibility should be prioritized for these at-risk groups to prevent undue psychological morbidity in the long run.

Abstract 2737: Clinical and epidemiologic predictors of clonal immune responses in colorectal cancer

Abstract The quantity and quality of immune responses in colorectal cancers (CRC) are widely variable and have important clinical, therapeutic, and prognostic implications. We studied clinical and epidemiologic factors that might influence T-cell quantity and clonality within colorectal adenocarcinomas to better understand the drivers of diverse immune responses. Incident cases of CRC from the Molecular Epidemiology of Colorectal Cancer Study (MECC) were interviewed, and 6,006 cases had complete epidemiologic data. Archived tumor blocks were retrieved from 3,865 (64.4%) cases, and all were reviewed by a single expert pathologist who quantified TILS/hpf. Sufficient tissue for macrodissection and measurement of TCR abundance and clonality using the immunoSEQ assay (Adaptive Biotechnologies) was available and completed for 2,750 cases. Logistic regression, negative binomial regression and linear regression models were used to evaluate potential associations between clinical and epidemiologic variables for: TILS/hpf, TCR abundance, and T-cell clonality. The stage distribution was representative of cancer incidence in the population, and the MSI-H phenotype was observed in 14.2% of cases. Clinical, pathologic, and epidemiologic variables including aspirin, alcohol, diet, hormone use, physical activity, smoking, and statins were assessed in relation to immune measures. Among other findings, >5 years of statins (p<0.001) and daily aspirin (p=0.037) were each strongly associated with T-cell clonality. Our study suggests that important parameters of the adaptive immune response may be mediated by modifiable factors. Mechanisms regulating immune responses in CRC may have implications for chemoprevention as well as immunotherapy. Citation Format: Stephen B. Gruber, Joseph D. Bonner, Sidney S. Lindsey, Ya-Yu Tsai, Rebeca Sanz-Pamplona, M. Henar Alonso, Marilena Melas, Hedy S. Rennert, Kevin J. McDonnell, Gregory E. Idos, Christopher P. Walker, W. Martin Kast, Diane Da Silva, Harlan S. Robins, Joel K. Greenson, Victor Moreno, Stephanie L. Schmit, Gad Rennert. Clinical and epidemiologic predictors of clonal immune responses in colorectal cancer [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2021; 2021 Apr 10-15 and May 17-21. Philadelphia (PA): AACR; Cancer Res 2021;81(13_Suppl):Abstract nr 2737.

An Assessment of the Macroeconomic Implications of COVID-19 in Nepal: Evidence from SIR –Macro Model Analysis

This paper assesses the macroeconomic implications of COVID-19 in the context of Nepal. The study uses a susceptible, infected, and recovered macro model (SIR-Macro model) where epidemiological variables are interacted with macroeconomic variables namely consumption and working hours to simulate the implication. The model estimates show that the containment measures of the government reduced the spread of the disease by 17 percent. However, the COVID-19 pandemic had a significant negative impact on macroeconomic outputs. On average, both consumption and working hours declined by 20 percent which otherwise would be more serious if no containment measures were adopted. In addition, the study also finds that the impact has been heterogeneous across susceptible, infected, and recovered population. Interestingly, the study also indicates that the individual utility lowered while societal utility improved with containment policies.

Improved esophageal squamous cell carcinoma screening effectiveness by risk-stratified endoscopic screening: evidence from high-risk areas in China.

BackgroundRisk‐stratified endoscopic screening (RSES), which offers endoscopy to those with a high risk of esophageal cancer, has the potential to increase effectiveness and reduce endoscopic demands compared with the universal screening strategy (i.e., endoscopic screening for all targets without risk prediction). Evidence of RSES in high‐risk areas of China is limited. This study aimed to estimate whether RSES based on a 22‐score esophageal squamous cell carcinoma (ESCC) risk prediction model could optimize the universal endoscopic screening strategy for ESCC screening in high‐risk areas of China.MethodsEight epidemiological variables in the ESCC risk prediction model were collected retrospectively from 26,618 individuals aged 40‐69 from three high‐risk areas of China who underwent endoscopic screening between May 2015 and July 2017. The model's performance was estimated using the area under the curve (AUC). Participants were categorized into a high‐risk group and a low‐risk group with a cutoff score having sensitivities of both ESCC and severe dysplasia and above (SDA) at more than 90.0%.ResultsThe ESCC risk prediction model had an AUC of 0.80 (95% confidence interval: 0.75–0.84) in this external population. We found that a score of 8 (ranging from 0 to 22) had a sensitivity of 94.2% for ESCC and 92.5% for SDA. The RSES strategy using this threshold score would allow 50.6% of endoscopies to be avoided and save approximately US$ 0.59 million compared to universal endoscopic screening among 26,618 participants. In addition, a higher prevalence of SDA (1.7% vs. 0.9%), a lower number need to screen (60 vs. 111), and a lower average cost per detected SDA (US$ 3.22 thousand vs. US$ 5.45 thousand) could have been obtained by the RSES strategy.ConclusionsThe RSES strategy based on individual risk has the potential to optimize the universal endoscopic screening strategy in ESCC high‐risk areas of China.

Prognosis of in hospital nonagenarians with acute kidney injury

There has been little in the way of study of nonagenarians with acute kidney injury (AKI, defined in lines with KDIGO guidelines), but the rise in their life expectancy makes further study of this population necessary. The aim of this study is to assess mortality in nonagenarians with AKI during hospitalization. In this retrospective study, patients with AKI during hospitalization between 2013-2014 were included. At baseline, epidemiological variables, comorbidities and treatments were collected. Analytics and mortality were studied during hospitalisation. Univariate analysis was carried out to evaluate mortality-associated variables. A logistic regres-sion analysis was carried out to demonstrate independent predictors for mortality. Two hundred and sixty-four nonagenarian patients were included. Mean age was 93±3 years, 73 (27.7?%) of whom were men. During hospitalization, 79 patients (29.9?%) died. Comorbidities related to mortality were history of heart failure (p?=?0.018), diastolic dysfunction (p?<?0.042) and higher dependence according to the modified Barthel index (p?=?0.003). The clinical variables related to mortality at hospital admission were lower systolic (p?=?0.016) and diastolic blood pressure (p?=?0.013), higher white blood cell count (p?=?0.003), greater severity of AKI (p?=?0.003) and L-?lactic (p?=?0.005). In an adjusted multivariate analysis, history of heart failure (OR?=?2.31, 95%CI: 1.07-5.00, p?=?0.036), depend-ence according to the Barthel index (OR?=?0.80, 95%CI: 0.67-0.97, p?=?0.016) and L-?lactic acid (OR?=?1.31, 95%IC: 1.06-1.61, p?=?0.005) were independent predictors of mortality. Heart failure, dependence according to the Barthel index and L-?lactic acid at admission are independent predictors of mortality in nonagenarians hospitalized with AKI.

¿Qué características epidemiológicas tienen los pacientes con fibromialgia e incapacidad laboral que se reincorporan a un puesto de trabajo?

ObjectiveTo ascertain what epidemiological variables determine whether a patient with work incapacity as a result of fibromyalgia returns to work. Material and methodsA retrospective cohort study was carried out that included 412 patients with fibromyalgia under 54 years of age and classified as having a total permanent disability by the National Institute of Social Security in Madrid in 2005. Follow-up from 2005 to 2019. We studied the variables of age, sex, marital status, CFS/MCS, psychiatric diagnosis, type of social security affiliation, occupation (CNO-11) and economic amount of the disability benefit in euros/month (4 tranches are established of <500, 500-750, 750-1000 and> 1000). We analyse the impact of these variables on return to work using a binary logistic regression model. ResultThe mean age was 45+/-7. A total of 44% did not return to another job. The variables that were significant in the multivariate study were age (OR 0.93, CI 0.90 - 0.97), association with CFS and/or MCS (OR 0.07, CI 0.02 - 0.24), occupation (OR 0, 82; IC 0.73 - 0.92) and the amount of the disability benefit (OR 0.26; IC 0.19 - 0.35). ConclusionThe probability of returning to another job decreases with age (1.07 times for each year), as the amount of the disability benefit increases (3.85 times for each successive tranche), as the level of qualification required for the occupation decreases (1.21 times for each successive CON-11 code) or if there is CFS and/or MCS (12.9 times).

Data Sharing in Southeast Asia During the First Wave of the COVID-19 Pandemic.

Background: When a new pathogen emerges, consistent case reporting is critical for public health surveillance. Tracking cases geographically and over time is key for understanding the spread of an infectious disease and effectively designing interventions to contain and mitigate an epidemic. In this paper we describe the reporting systems on COVID-19 in Southeast Asia during the first wave in 2020, and highlight the impact of specific reporting methods.Methods: We reviewed key epidemiological variables from various sources including a regionally comprehensive dataset, national trackers, dashboards, and case bulletins for 11 countries during the first wave of the epidemic in Southeast Asia. We recorded timelines of shifts in epidemiological reporting systems and described the differences in how epidemiological data are reported across countries and timepoints.Results: Our findings suggest that countries in Southeast Asia generally reported precise and detailed epidemiological data during the first wave of the pandemic. Changes in reporting rarely occurred for demographic data, while reporting shifts for geographic and temporal data were frequent. Most countries provided COVID-19 individual-level data daily using HTML and PDF, necessitating scraping and extraction before data could be used in analyses.Conclusion: Our study highlights the importance of more nuanced analyses of COVID-19 epidemiological data within and across countries because of the frequent shifts in reporting. As governments continue to respond to impacts on health and the economy, data sharing also needs to be prioritised given its foundational role in policymaking, and in the implementation and evaluation of interventions.

Epidemiology, haematology and molecular characterization of haemoprotozoon and rickettsial organisms causing infections in cattle of Jammu region, North India

BackgroundThe present study was aimed at establishing the prevalence, epidemiology and molecular characterization of major haemoprotozoons (Babesia and Theileria) and rickettsia (Anaplasma) of cattle in Jammu region (North India) using microscopy and Polymerase Chain Reaction (PCR). Hematology, microscopy and PCR based prevalence studies were undertaken with 278 whole blood samples from cattle. Molecular prevalence studies were followed by genetic characterization of the isolates of Babesia, Anaplasma and Theileria spp. based on 18S rRNA, 16S rRNA and Tams1 gene, respectively. The data related to metrology and epidemiological variables like temperature, rainfall, season, age and type of livestock rearing was analyzed and correlated with occurrence of disease by statistical methods.ResultsThe prevalence based on microscopy was 12.9% (36/278) whereas PCR recorded 30.22% (84/278) animals positive for haemoparasitic infections. All the samples found positive by microscopy were also recorded positive by PCR. Thus the study revealed prevalence of Babesia bigemina, Anaplasma marginale and Theileria annulata to be 9.7, 16.5 and 0.7% respectively. The metrological and epidemiological variables made inroads for the propagation of vector ticks and occurrence of infection. Haematological alterations predominantly related to decrease in haemoglobin, red blood cell count and packed cell volume were evident in diseased animals and collaterally affected the productivity. Further the genetic characterization of Babesia bigemina. (MN566925.1, MN567603, MN566924.1), Anaplasma marginale. (MH733242.1, MN567602.1) and Theileria annulata (MT113479) provided a representative data of the isolates circulating in the region and their proximity with available sequences across the world.ConclusionsDespite holding much significance to the animal sector, comprehensive disease mapping has yet not been undertaken in several parts of India. The present study provides a blue print of disease mapping, epidemiological correlations and genomic diversity of Babesia bigemina, Anaplasma marginale and Theileria annulata circulating in the region.

Mental Health Status, Life Satisfaction, and Mood State of Elite Athletes During the COVID-19 Pandemic: A Follow-Up Study in the Phases of Home Confinement, Reopening, and Semi-Lockdown Condition.

Scientific reports notified that the pandemic caused by the Coronavirus disease 2019 (COVID-19) has raised an unprecedented mental health emergency worldwide. Abrupt changes in daily routine, environmental constraints, adopted home confinement measures, and uncertainty about a date for returning to usual activities can potentially affect mental health and sports activities in athletes. Hence, we designed a cross-sectional study with a within-subjects design to investigate the impact of the pandemic on mental health, mood states, and life satisfaction of elite athletes. During the three phases of home confinement (April 14–24, n = 525), reopening (May 9–19, n = 464), and current semi-lockdown (July 20–31, n = 428), elite athletes voluntarily responded to an online survey. The self-report questionnaire was prepared to collect demographic and epidemiological variables of interest and the COVID-19-related information. All participants also completed the Profile of Mood State (POMS), General Health Questionnaire-28 (GHQ-28), and Satisfaction with Life Scale (SWLS). The main result is that the training rate, mental health, life satisfaction, and positive mood have decreased during the home confinement period as compared with the reopening and semi-lockdown phases. However, the need for psychosocial services has increased during the pandemic period. The present study provides the first preliminary evidence that home confinement conditions during the COVID-19 pandemic might have negatively influenced elite athlete’s mood state, mental health, and life satisfaction, as well as training rates. Monitoring the psychological parameters of elite athletes and developing strategies to improve their mental health during the COVID-19 pandemic should be on the agenda. Next studies, therefore, seem reasonable to focus on active interventions for athletes during the ongoing COVID-19 pandemic.

Clinical, biological, therapeutic and evolving profile of malignant hemopathies in adults at the central hospital of Yaounde

Malignant hemopathies designate neoplasias of hematopoietic tissues, characterized by a disorder of the multiplication and differentiation of cells from one or more blood lines; Very few related studies are carried out in Africa due to diagnostic difficulties. We have carried out the present study to enrich the data on these pathologies. An analytical retrospective study was carried out in the hematology and medical oncology department of the Central Hospital of Yaoundé in Cameroon over 10 years, from January 1, 2008 to December 31, 2017. A technical sheet in which the epidemiological variables were noted, clinical, biological, therapeutic and evolutionary has been developed. Of the 167 files selected, the average age of the patients was 52 years +/- 16, with extremes of 21 and 87 years. Acute myeloid leukemias (AML) was more common in patients aged 45 to 54 (8 cases) and the disease affected more women than men at this age group (1H / 7F). Lymphoproliferative syndromes were the most common group of malignant hemopathies, accounting for 52.7% (88 patients). Non hodgkin lymphomas (NHL) were represented at all age groups with a male predominance. Patients with multiple myeloma clinically presented osteoarticular pain in 66.7% of cases. The chemotherapy protocols were varied according to the pathologies and their evolutionary stages. Toxic events were rare. Survival after one year was 9% for AML cases, 30% for CML cases. Few data being available on malignant hemopathies, this work allowed us to measure the importance of this group of pathologies in our context and to identify the clinical-biological profiles and the survival of the patients

Prevalence and Epidemiological Study of hepatitis B and C patients admitted to BEN AMOR DJILANI hospital in El Oued, Algeria

The Goal of the present study is to evaluate the epidemiological variations of hepatitis B and C in El Oued population. Our epidemiological study was carried out on 1798 hepatitis patients admitted to hospital BEN AMOR DJILANI the period (January 2013 to December 2020) in El Oued region. In Results, 5.45% of patients were aged less than 20 years 72.14% of the patients are aged between 20-40 years, 15.85% patients are ages between 40-60 years and 6.56 % patient are aged more than 60 years. In the other hand, 57.29% of hepatitis patients are men versus 42.71% are women. In this study, 95% of the patients had a hepatitis B whereas 5% of the people were affected by hepatitis C. Concerning regions of hepatitis patients, the eastern region include the highest number with 37%, followed by - with a small difference - the central region with 33%, then come the southern region with 18%, the northern region contain 11% and at least the western region which include the lowest number of hepatitis patients with 1%, of total cases of hepatitis patients in the state of El Oued. Hence epidemiological studies are needed to understand and improve facilities and implement effective treatment measures to control the disease and thus help to reduce mortality in the society associated with this disease.

Waiting list eradication in serious mental illness (SMI) “secondary care” psychology: addressing an NHS blind spot

AimsThe poster focuses on the reduction, and eventual eradication, of waiting times within a community-based NHS psychology service in the North East of England. The poster aims to demonstrate the effectiveness of strategies implemented within a secondary care psychology service whilst examining patterns of help-seeking behaviour and treatment compliance in those waiting for therapy, and also the care needs of this cohort following a wait for services.BackgroundSecondary care waiting lists for psychological therapy, as highlighted by a recent British Medical Association audit, remain a so-called ‘blind-spot’ in mental health care provision and a national problem. Tackling waiting lists within this sector has been stated as a priority within the Five Year Forward View, however “core ingredients” of waiting list eradication methodologies and the components leading to such, have yet to be disseminated.MethodA historical audit and follow-up of clinical data were utilised to gather and analyse data of 208 individuals who were seen by the psychology service between October 2014 and March 2016.ResultNo significant differences were found between individuals who successfully completed therapy compared to those who disengaged in regard to demographic or epidemiological variables, or mental health service input. Despite lengthy waiting times of up to 3.69 years, waiting time did not significantly impact whether someone engaged with psychological services. Any form of input from psychological services led to a significant reduction in distress, as measured by the CORE-OM. No individuals who completed therapy were re-referred for psychological input at 12-month follow-up.ConclusionIf imposed appropriately over a suitable time-frame evidence-based, effective and efficient needs-led psychological input can be provided whilst eradicating a waiting list and still remaining flexible, formulation-based and person-centred.

Epidemiology of COVID-19 in Indonesia: common source and propagated source as a cause for outbreaks.

The COVID-19 outbreak first occurred in China and has developed throughout the world, including Indonesia. The Indonesian government reports that up to May 22, 2020 there have been 21,430 confirmed cases. The purpose of this study is to describe the epidemiology, clinical symptoms and comorbidities of COVID-19 as well as the various government interventions to reduce the rate of incidence. A retrospective cohort study was designed. The population in this study is based data from the official Indonesian government website run by the Task Force for the Acceleration of Handling COVID-19. The sample was observed b March 2 to April 24, 2020. The total sample included 8,211 cases of patients diagnosed with COVID-19, among these 1,002 recovered and 689 died. Data analysis used percentages from various recorded epidemiological variables. The results showed that COVID-19 epidemiological features were mostly observed in men (56.5%) and patients of productive age (31-59 of age) by 57.5%; most deaths were recorded in patients aged > 60 years (43.6%). The most recurrent clinical symptom was cough (77.8%), the most recurrent comorbidity was hypertension (52.4%), and the province with the highest COVID-19 incidence was DKI Jakarta (34.3%). The combination of common sources and propagated source was observed during the COVID-19 outbreak in Indonesia. Special attention should be given to protecting vulnerable populations such as children, health care providers, and the elderly. The community is expected to participate in preventing the transmission of COVID-19 by complying with health protocols.

Oral contraceptives and hypertension in women: results of the enrolment phase of Tabari Cohort Study

BackgroundThe association between oral contraceptives (OCP) and hypertension has been reported in the literature with controversial results. According to the growing use of OCPs among women in Iran, this study aims to investigate the association between the duration of the OCP consumption and risk of hypertension among Iranian women.MethodsIn the current study, the data collected during the enrolment phase of the Tabari cohort were analyzed. Of 6106 women recruited in the cohort, 133 pregnant women were excluded. Epidemiological variables were collected using pre-designed questionnaires as well as the health insurance evidences. In addition, blood pressure and anthropometric factors were measured based on the standard guidelines. Chi square and partial correlation tests as well as logistic regression models were applied for data analysis.ResultsFrequency of oral contraceptive use among 35–70 year-old women in Tabari cohort study (TCS) was 42.2% (2520/5973). Hypertension was observed among 25% (1793/5973) of them. The adjusted odds ratio for OCP use was 1.23 (95% confidence interval: 1.08, 1.40, p = 0.002). The corresponding odds ratios for 61–120 months and more than 120 months OCP use were 1.39 (1.12,1.73) and 1.47 (1.16,1.87) respectively.ConclusionsOral contraceptives especially in long term use can be associated with hypertension.

Simple and complex febrile seizures: is there such a difference? Management and complications in an emergency department

ObjectiveWe aimed to analyse the prevalence, characteristics, and management of simple and complex febrile seizures. The secondary objective was to compare the risk of underlying organic lesion and epilepsy in both types of seizures, with a particular focus on the different subtypes defining a complex febrile seizure. Material and methodsWe performed a retrospective cohort study including patients aged 0-−16 years who were treated for febrile seizures in the paediatric emergency department of a tertiary hospital over a period of 5 years. Epidemiological and clinical variables were collected. Patients were followed up for at least 2 years to confirm the final diagnosis. ResultsWe identified 654 patients with febrile seizures, with a prevalence of 0.20% (95% CI, 0.18-0.22); 537 (82%) had simple febrile seizures and 117 (18%) had complex febrile seizures. The clinical and epidemiological characteristics of both types were similar. Significantly more complementary tests were requested for complex febrile seizures: blood tests (71.8% vs 24.2% for simple febrile seizures), urine analysis (10.3% vs 2.4%), lumbar puncture (14.5% vs 1.5%), and CT (7.7% vs 0%). Similarly, admission was indicated more frequently (41.0% vs 6.1%). Underlying organic lesions (central nervous system infection, metabolic disease, tumour/intracranial space-occupying lesion, intoxication) were diagnosed in only 11 patients, 5 of whom had complex forms (4.3%; 95% CI, 0.6-7.9). Risk factors for developing epilepsy, identified in the multivariate analysis, were complex forms with recurrent seizures in a single attack (odds ratio [OR]: 4.94; 95% CI, 1.29-18.95), history of seizures (OR: 17.97; 95% CI, 2.26-−143.10), and seizures presenting at atypical ages (OR: 11.69; 95% CI, 1.99-68.61). ConclusionsThe systematic indication of complementary tests or hospital admission of patients with complex febrile seizures is unnecessary. The risk of epilepsy in patients with complex forms gives rise to the need for follow-up in paediatric neurology departments.

Quantitative and qualitative analysis of the influence of confinement by COVID-19 in fracture patients entered in a traumatology service at a third level hospital

IntroductionThe COVID-19 pandemic has led to the confinement of approximately one third of the world population, causing a drastic change in the activities of daily life with many repercussions at the health, economic and social levels. ObjectivesThe objective of the present work is to present the epidemiological variations in the production of fractures in the period of mandatory confinement in our reference population. MethodsAnalytical retrospective comparative study of two groups of patients: Group A: patients admitted before the state of alarm that forced confinement in the period from January 13 to March 13 compared to Group B: patients admitted in the two months of confinement, until the de-escalation period began, March 13-May 13. Epidemiological variables including age, personal history, type of fracture, mechanism of injury, outpatient rate, and hospital stay were recorded. ResultsA total of 190 patients were included. 112 in the pre-confinement period and 78 in the confinement (30% decrease). The mean age (p = 0.007) and falls at home (p < 0.001) were higher in the confinement group. The postoperative (p = 0.006) and overall (p < 0.001) hospital stay were significantly less in the confinement group. No differences were found in the anatomical location of the lesion, sex, comorbidities, mechanism of injury, outpatient rate, or death. ConclusionsBased on the results of our study, the period of forced confinement due to the COVID-19 pandemic has produced a drastic decrease in the total number of fractures admitted to the traumatology service of a third level hospital. On the other hand, osteoporotic hip fractures have not varied in their incidence and a decrease in the average postoperative and overall stay has been observed.

بررسی آمادگی اورژانس بیمارستان خاتم الانبیا (ص) زاهدان برای مقابله با کووید ۱۹ در سال 1399: یک مطالعه توصیفی-تحلیلی

Introduction: Hospitals play an important role in crisis management in the society. Since the outbreak of Coronavirus Disease 2019 (COVID-19) in the world, hospital's readiness to continue providing medical care during the COVID-19 crisis has received much attention. The aim of the current study was to assess the readiness of the Emergency Department (ED) of Khatam Al-Anbia Hospital in Zahedan, Iran for facing COVID-19 crisis in 2020. Methods: The present study was performed on all emergency personnel of Khatam Al-Anbia Hospital in Zahedan, 100 in number. The sampling method was random and to collect information, two questionnaires of psychological readiness to deal with COVID-19, and the questionnaire of epidemiological and clinical variables (COVID-19 coping rate) were used. Data were collected and analyzed using SPSS software version 26. Pearson test was used to find correlations between study variables. P-values <0.05 were considered significant. Results: There was a significant positive correlation between all three psychological components of the Cognitive Readiness Questionnaire against Corona (behavioral, cognitive, and emotional dimensions) as well as its total score with the total score of the Epidemiological and Clinical Variables Questionnaire (COVID-19 coping rate). Conclusion: Based on the results of the present study, psychological components have a significant correlation with the rate of coping with COVID-19 among hospital emergency personnel. It was also found that psychological readiness of the emergency treatment staff of Khatam Al-Anbia Hospital in Zahedan, in the face of COVID-19, was at an acceptable level. Considering the newness of COVID-19, the importance of recognizing the effective factors in combating this disease among the medical staff, and scarcity of studies in this regard, it is recommended to conduct further studies in other medical centers in the country.

Epidemiología, clínica y distribución temporal de los casos confirmados y sospechosos de enfermedad por coronavirus (COVID-19) atendidos por un centro de salud urbano (Cáceres)

ObjectiveTo describe the experience about healthcare provided to suspected COVID-19 patients in a typical primary healthcare center during the alarm period. DesignRetrospective observational study. SettingPrimary healthcare centre Zona Centro in Cáceres. ParticipantsConsecutive suspected COVID-19 patients attended from March 2 to June 21, 2020. Main measurementsAge, sex, most frequent symptoms attributed to the infection, duration of symptoms, days to epidemiological discharge, comorbidities, treatments, diagnostic methods, referrals to hospital emergencies, hospitalized patients, patients suffering from pneumonia, deaths, diagnostic setting and alarm period phase. Results464 patients were included; 53 were confirmed by PCR and 90 by serology. A 81.1% of PCR diagnoses were made during the first 4 weeks of the confinement period. Twenty-nine patients were referred to hospital (6.2%). Seven died (rate 0.52/1,000). Cough, fever, asthenia and digestive symptomswerepredominant in suspected cases; cough, dyspnea and feverin those confirmed ones. Cardiovascular diseaseand chronic renal disease were more frequent in the latter group (P<.001). ConclusionsThe mortality rate was similar to the Spanish one. Epidemiological and clinical variables correspond to those described in other areas. Those diagnosed by PCR were concentrated in the first half of the confinement period.

AB0153 REAL LIFE SEVERE INFECTIONS IN PATIENTS WITH RHEUMATOID ARTHRITIS ON TREATMENT WITH BIOLOGICAL THERAPY AND JAKI

Background:Infections are one of the main complications among patients with rheumatoid arthritis (RA) with immunosuppressive treatment. The differences between treatments and the influence of other factors is unclear.Objectives:To evaluate the frequency and factors associated with serious infections in patients with RA treated with biological therapy (BT) and JAKi and the differences between treatments.Methods:Descriptive and retrospective study (January 2015-December 2020) of patients with RA treated with BT (TNFi, non-TNFi) and JAKi (tofacitinib, bariticinib, upadacitinib) in a single center. Severe infection was considered a life-threatening infection or one that required hospitalization and intravenous treatment. Epidemiological variables, clinical characteristics, Charlson comorbidity index, type of BT or JAKi and concomitant treatment were collected.For the analysis frequencies and percentages are used in qualitative variables and mean ± SD in the quantitative ones. Statistical analysis was performed with IBM SPSS v 23.Results:We registered 257 patients (84.4% women) mean aged 56.1±13.4 years. RF was positive in 86.8%, anti-CCP in 75.9% and 16.5 % presented extra-articular manifestations (nodulosis 9.7%, intersticial lung disease 4.3%, other 1.5%). At the start of the study, 157 (61.1%) patients were with TNFi, 80 (31.1%) with non-TNFi and 20 (7.8%) with JAKi. Conventional synthetic DMARDs (csDMARDs) were used in 86% of cases (methotrexate 71.1%, leflunomide 21.2%, other 7.7%).During the study, 162 (63%) patients continued with the same treatment and in 95 (37%) it was changed at least once. 3 patients discontinued the treatment. At the end of the study, 126 (49%) patients were with TNFi, 81 (31.5%) with non-TNFi and 47 (18.3%) with JAKi.Severe infection was developed in 28 (10.9%) patients (13 respiratory, 5 urinary, 5 cellulitis, 4 sepsis, 1 osteomyelitis) among them 2 patients had severe infection and herpes zoster at the same time and 3 developed a second infection. 14 (50%) patients were with TNFi, 8 (28.6%) with non-TNFi and 6 (21.4%) with JAKi. Table 1The inflammatory activity of RA was mild at the time of infection (DAS28: 2.6±1.1). The median time until infection was: TNFi 45.25 [4.9-202.3] months, non- TNFi 19.14 [4.9-72.5] months and JAKi 17.63 [1.1-29.2] months.The Charlson index, concomitant use of glucocorticoids (GCC) at lower doses than 10mg/d, chronic obstructive pulmonary disease (COPD), diabetes (DM), moderate-severe renal insufficiency, congestive heart failure (CHF) and peripheral vascular disease were statistically significantly associated with infection. Table 1.TABLE 1.CHARACTERISTICS OF PATIENTS WITH INFECTION VS. WITHOUT INFECTIONINFECTIONYES n:28NO n:229pFEMALE, n (%)22 (78.6)195 (85.2)0.406AGE years, (mean±SD)57.7 ± 13.955.9 ± 13.40.507AGE ≥ 65 n (%)10 (35.7)68 (29.7)0.513RF +, n (%)25 (89.3)198 (86.5)0.677ANTI-CCP +, n (%)21 (75)174 (75.1)1.00ILD, n (%)1 (3.5)10 (4.3)0.809ALCOHOL, n (%)3 (10.7)17 (7.4)0.465SMOKER, n (%)10 (35.7)60 (26.2)0.244COPD, n (%)7 (25)24 (10.5)0.026*DM, n (%)7 (25)19 (8.3)0.013*CHF, n (%)4 (14.3)1 (0.4)0.001*RENAL INSUFFICIENCY, n (%)3 (10.7)2 (0.9)0.010*PERIPHERAL VASCULAR DISEASE, n (%)9 (32.1)22 (9.6)0.002*CHARLSON INDEX (mean±SD)1.64 ± 2.10.63 ± 1.20.001*TNFi, n (%) NON-TNFi n (%) JAKi, n (%)14 (50)112 (48.9)8 (28.6)73 (31.9)6 (21.4)41 (17.9)csDMARDs, n (%)22 (78.6)159 (69.4)0.317GCC dose &lt;10mg/d, n (%)17 (60.8)111 (48.5)0.007*Conclusion:In our study, 10.9% of patients with RA treated with BT or JAKi developed severe infection during 5 years of follow-up. Concomitant GCC therapy and comorbidity increased the risk of presenting this complication.Disclosure of Interests:None declared