Epidemiological Variables Research Articles

The direct correlation between oxidative stress and LDL-C levels in adults is maintained by the Friedewald and Martin equations, but the methylation levels in the MTHFR and ADRB3 genes differ

Low-density lipoprotein (LDL-C) concentrations are a standard of care in the prevention of cardiovascular disease and are influenced by different factors. This study compared the LDL-C concentrations estimated by two different equations and determined their associations with inflammatory status, oxidative stress, anthropometric variables, food intake and DNA methylation levels in the LPL, ADRB3 and MTHFR genes. A cross-sectional population-based study was conducted with 236 adults (median age 37.5 years) of both sexes from the municipality of João Pessoa, Paraíba, Brazil. The LDL-C concentrations were estimated according to the Friedewald and Martin equations. LPL, ADRB3 and MTHFR gene methylation levels; malondialdehyde levels; total antioxidant capacity; ultra-sensitive C-reactive protein, alpha-1-acid glycoprotein, homocysteine, cobalamin, and folic acid levels; usual dietary intake; and epidemiological variables were also determined. For each unit increase in malondialdehyde concentration there was an increase in the LDL-C concentration from 6.25 to 10.29 mg/dL (p <0.000). Based on the Martin equation (≥70 mg/dL), there was a decrease in the DNA methylation levels in the ADRB3 gene and an increase in the DNA methylation levels in the MTHFR gene (p <0.05). There was a positive relation of homocysteine and cholesterol intake on LDL-C concentrations estimated according to the Friedewald equation and of waist circumference and age based on the two estimates. It is concluded the LDL-C concentrations estimated by the Friedewald and Martin equations were different, and the Friedewald equation values were significantly lower than those obtained by the Martin equation. MDA was the variable that was most positively associated with the estimated LDL-C levels in all multivariate models. Significant relationships were observed based on the two estimates and occurred for most variables. The methylation levels of the ADRB3 and MTHFR genes were different according to the Martin equation at low LDL-C concentrations (70 mg/dL).

Characteristics of patients with invasive pneumococcal disease requiring admission to intensive care units

IntroductionPatients with invasive pneumococcal disease (IPD) may require admission into paediatric intensive care units (PICU). The aim of this study is to analyse the epidemiological, clinical, and microbiological characteristics associated with IPD that may require admission to the PICU. Material and methodsA prospective study was conducted on cases of IPD diagnosed in three Paediatric Hospitals in Barcelona between January 2012 and June 2016. An analysis was made of the associations between the admission to PICU and the epidemiological, clinical, and microbiological variables. ResultsA total of 263 cases with IPD were included, of which 19% (n=50) required admission to PICU. Patients with septic shock (7; 100%), meningitis (16; 84.2%), and those with complicated pneumonia (23; 15.2%) were admitted to the PICU. The most frequent complications were pulmonary (35.2%) and neurological (39.5%). The ratio between admission and non-admission to PICU was 4.7 times higher in subjects with an underlying disease. The serotypes associated with PICU admission were 19A (23% of the total of this serotype), serotype 14 (20%), serotype 3 (17%), and serotype 1 (12.5%). ConclusionsIPD required PICU admission in cases of septic shock and meningitis, and less so with complicated pneumonia. The percentage of admissions is greater in children with an underlying disease. Admission into the PICU involves a longer stay, complications during the acute phase, as well as sequelae, particularly neurological ones. The serotypes of the patients that were admitted to PICU were predominantly vaccine serotypes.

Análisis cuantitativo y cualitativo de la influencia del confinamiento por COVID-19 en los pacientes con fractura ingresados en un servicio de traumatología en un hospital de tercer nivel

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.

Air quality and COVID-19 adverse outcomes: Divergent views and experimental findings

BackgroundThe questioned link between air pollution and coronavirus disease 2019 (COVID-19) spreading or related mortality represents a hot topic that has immediately been regarded in the light of divergent views. A first “school of thought” advocates that what matters are only standard epidemiological variables (i.e. frequency of interactions in proportion of the viral charge). A second school of thought argues that co-factors such as quality of air play an important role too. MethodsWe analyzed available literature concerning the link between air quality, as measured by different pollutants and a number of COVID-19 outcomes, such as number of positive cases, deaths, and excess mortality rates. We reviewed several studies conducted worldwide and discussing many different methodological approaches aimed at investigating causality associations. ResultsOur paper reviewed the most recent empirical researches documenting the existence of a huge evidence produced worldwide concerning the role played by air pollution on health in general and on COVID-19 outcomes in particular. These results support both research hypotheses, i.e. long-term exposure effects and short-term consequences (including the hypothesis of particulate matter acting as viral “carrier”) according to the two schools of thought, respectively. ConclusionsThe link between air pollution and COVID-19 outcomes is strong and robust as resulting from many different research methodologies. Policy implications should be drawn from a “rational” assessment of these findings as “not taking any action” represents an action itself.

Identification of co-circulating pathogens that are clinically indistinguishable from Lassa fever during the 2018 Lassa outbreak in Nigeria

Background: The burden of undiagnosed febrile illness in low and middle-income countries is high and infectious diseases remain the leading cause of morbidity and mortality. The aetiology of systemic febrile illness and sepsis are particularly badly described partly because many pathogens cause a similar initial clinical presentation. In early 2018, Nigeria experienced its largest recorded outbreak of Lassa fever (LF). During this period of heightened transmission, there were 1,968 persons who met the clinical case definition for LF. However, only 431 could be laboratory confirmed, while for 1,537 no causative pathogen could be identified. The unprecedented scale of this outbreak prompted the Nigeria Centre for Disease Control (NCDC) and the WHO to reconsider their diagnostic strategy and re-prioritise LF diagnostics. A joint research collaboration between the NCDC and the United Kingdom Public Health Rapid Support Team (UK-PHRST) has worked to address this question. Methods and materials: Archived clinical diagnostic samples collected under the auspices of the Nigerian National Lassa Virus Testing Algorithm taken from patients who met NCDCs case definition for LF during the 2018 LF outbreak in Nigeria were sought and a non-probability sampling technique on consecutive cases who meet the selection criteria (lassa-negative by PCR and malaria-negative by RDT) was employed. RNA extracts were screened TaqMan array card system for 50 pathogens known to occur in West Africa and a subset of TAC+/- samples underwent unbiased metagenomic sequencing to determine which pathogen(s) are co-circulating and potentially mimicking the presentation of LF. Associations between pathogens and selected epidemiological and clinical variables were tested by Chi-square with significance level set at p < 0.05. Results: Results from this study indicate that there was no one specific pathogen responsible for patients developing clinical presentations indistinguishable from LF. Rather, a variety of pathogens (both viral and bacterial) were found to be co-circulating at the time of heightened LF transmission resulting in both single and co-infections (particularly in the immunocompromised). Conclusion: We anticipate that this study will help ensure proper and expedited diagnosis of diseases in the differential diagnosis for LF, helping to target treatment of patients with both LF and non-LF acute febrile illnesses in Nigeria.

Clinical and epidemiological characterization of patients with psoriasis and the prescription of biological therapy in Venezuela: a cross-sectional study.

Psoriasis is a chronic disease that affects the skin. One hundred twenty-five million people around the world suffer from this condition. In specific groups of patients, the joints may also be involved. To control and follow-up patients with psoriasis, psoriasis area severity and dermatological quality of life measurements were established. Both parameters are necessary for the initiation of biological therapy, as specified in the psoriasis management guide (2015) of the national committee of rheumatological, immunological, and bone metabolism diseases of the Venezuelan Institute of Social Security. To characterize the clinical and epidemiological variables and the prescription of biological therapy in patients with psoriasis who access the high-cost dispensing program of the Venezuelan Institute Social Security (IVSS) pharmacy. This is a descriptive, cross-sectional study. A total of 374 patient records were assessed. The male gender was more frequent, with 56.1% (p <0.001), mostly from Caracas city. In comparing age groups with sex, a difference among these was observed (p <0.05). 57.5% previously used methotrexate, 6.68% biological, 3.2% topical steroids, and 31% did not report which type of previous therapy they had received. Amongst the clinical presentations, 70% corresponded to plaque psoriasis. 79% of the patients presented moderate activity according to the Psoriasis Area and Severity Index (PASI): Eleven percent were assessed with the Dermatology Life Quality Index (DLQI); 39% of them reported an extremely important effect. The anergic range of the Mantoux test represented 70.9% of the cases, and 0.3% took the booster evaluation. Chest X-ray was reported normal in 95% of the cases. The most demanded biological medicine was etanercept, in 52% of the cases. Male gender and its association with psoriasis was an important finding. The need to improve the administrative components in completing the medication request formats and strengthen clinical measurements and good medical practice was also found.

15043 Topical 15% resorcinol in hidradenitis suppurativa: Patient satisfaction

Background and Objective: Topical 15% resorcinol is frequently used for the treatment of hidradenitis suppurativa (HS). It has been shown to be effective in two small open studies. Nevertheless, studies on satisfaction perceived by patients are lacking. The Treatment Satisfaction Questionnaire for Medication (TSQM) is a validated measure of patient satisfaction. The objective of this study is to obtain data from HS patients regarding resorcinol treatment satisfaction and its relationship with clinical and epidemiologic variables.

Nasogastric tube utilization after esophagectomy: An unnecessary gesture?

IntroductionNasogastric decompressive tube utilization has been accepted as one of the basic perioperative care measures after esophageal resection surgery. However, with the development of multimodal rehabilitation programs and without clear evidence to support their use, the systematic indication of this measure may be controversial. Material and methodsRetrospective, descriptive and comparative study of patients who had undergone Ivor-Lewis esophagectomy in our center – from January 2015 to December 2018 – with placement (Group S), or without placement (Group N) of a decompressive tube in gastroplasty during postoperative period. Epidemiological variables and differences between groups in post-surgical morbidity and mortality, hospital stay, onset of oral tolerance and the need for nasogastric tube placement were evaluated. ResultsA total of 43 patients were included in this study, with a median age of 61 years, being 86% male. 46.5% were hypertensive, 25.5% had lung disease and 16.3% had diabetes mellitus. The median length of hospital stay was 9 days in group S versus 11.5 days in group N, with no differences in the onset of oral tolerance. Anastomotic dehiscence rate was 5% and 0% respectively. The overall mortality was 2.3% in the first 90 days, without differences between the groups. Placement of nasogastric tube during postoperative period was required only in 1 patient (4.3%) of the group N. ConclusionsNon-use of nasogastric tube during postoperative period of an Ivor-Lewis esophagectomy is a safe measure, as it is not associated with a higher rate of complications or hospital stay. This fact may be able to improve patients’ comfort and postoperative recovery.

Epidemiological situation of leprosy in a province in China: a long time to diagnosis and a high rate of deformity

BackgroundThis epidemiological study aimed to analyse both the distribution and characteristics of leprosy in an endemic province in Northwest China.MethodsThe medical records of leprosy patients in the province of Shaanxi, China, from 1998 to 2018 were collected from the Chinese Leprosy Management Information System (LEPMIS). Epidemiological variables were analysed in this study.ResultsA total of 477 new cases were diagnosed between 1998 and 2018 in this region. The average annual detection rate was 0.070/100,000 population, and the average annual prevalence was 0.305/100,000 population. The mean age of the newly diagnosed patients was 46.7 years, and the ratio of males to females was 2.5:1. There were 399 cases (83.6%) of multibacillary (MB) leprosy. One hundred forty-eight patients (31.0%) had grade 2 disability. The mean diagnosis time for new cases was 62.0 months.ConclusionThis epidemiological study showed that the characteristics of newly diagnosed leprosy cases in our province were a long time to diagnosis and a high rate of deformity, indicating the need for actions focusing on early diagnosis and treatment and strengthening the detection of leprosy in low-prevalence areas.

Human intestinal spirochetosis, a sexually transmissible infection? Review of six cases from two sexually transmitted infection centres in Barcelona.

Human intestinal spirochetosis (HIS) is a possible cause of chronic diarrhoea and affects mainly men who have sex with men (MSM) and people living with HIV. Diagnosis is based on colon biopsy, where spirochetes can be observed on the luminal surface, especially with the Warthin-Starry stain or similar silver stains. We conducted a retrospective descriptive study of all HIS cases diagnosed in two sexually transmitted infections (STI) centres in Barcelona from 2009 until 2018. The medical histories were reviewed to gather epidemiological, clinical, and diagnostic variables. Six patients were diagnosed with HIS. All the individuals were MSM, with a median age of 31.5 years (interquartile range [IQR] 29.5;49.25) and half of them were living with HIV. Five patients reported condomless anal intercourse and 4 patients had practised oro-anal sex previously. Concomitantly, two of them had rectal gonorrhoea, one had rectal Chlamydia trachomatis and none of them had syphilis. The predominant clinical symptom was diarrhoea (5 patients). All cases were diagnosed by a Warthin-Starry stain on a colon biopsy specimen, and mild inflammatory changes were found in 5 cases. Five patients were treated with metronidazole and one with benzathine penicillin G. Treatment was successful in all the patients. HIS should be considered in patients with chronic diarrhoea who report risky sexual practices and/or concomitant STI. HIS may also be sexually transmitted according to the context.

Eficacia y seguridad de oxihidróxido sucroférrico en el tratamiento de la hiperfosforemia en la enfermedad renal crónica. Estudio FOSFASTUR

IntroductionAlterations in bone and mineral metabolism are very common in chronic kidney disease (CKD). The increase in phosphate levels leads to bone disease, risk of calcification and greater mortality, so any strategy aimed at reducing them should be welcomed. The latest drug incorporated into the therapeutic arsenal to treat hyperphosphataemia in CKD is sucroferric oxyhydroxide (SFO). ObjectiveTo analyse the efficacy and safety of SFO in 3 cohorts of patients, one with advanced CKD not on dialysis, another on peritoneal dialysis and the last on haemodialysis, followed for 6 months. MethodsA prospective, observational, multicentre study in clinical practice. Clinical and epidemiological variables were analysed. The evolution of parameters relating to alterations in bone and mineral metabolism and anaemia was analysed. ResultsEighty-five patients were included in the study (62±12 years, 64% male, 34% diabetic), 25 with advanced CKD not on dialysis, 25 on peritoneal dialysis and lastly, 35 on haemodialysis. In 66 patients (78%), SFO was the first phosphate binder; in the other 19, SFO replaced a previous phosphate binder due to poor tolerance or efficacy. The initial dose of SFO was 964±323mg/day. Overall, serum phosphate levels saw a significant reduction at 3 months of treatment (19.6%; P<.001). There were no differences in the efficacy of the drug when the different populations analysed were compared. Over the course of the study, there were no changes to levels of calcium, PTHi, ferritin, transferrin saturation index or haemoglobin, although there was a tendency for the last 2 to increase. Twelve patients (14%) withdrew from follow-up, 10 due to gastrointestinal adverse effects (primarily diarrhoea) and 2 were lost to follow-up (kidney transplant). The mean dose of the drug that the patients received increased over time, up to 1,147±371mg/day. ConclusionsSFO is an effective option for the treatment of hyperphosphataemia in patients with CKD both in the advanced phases of the disease and on dialysis. We found similar efficacy across the 3 groups analysed. The higher their baseline phosphate level, the greater the reduction in the serum levels. A notable reduction in phosphate levels can be achieved with doses of around 1,000mg/day. Diarrhoea was the most common side effect, although it generally was not significant.

NIMG-22. INTEGRATION OF A RADIOMIC SIGNATURE, CLINICAL VARIABLES AND PLASMA CELL-FREE DNA IN ADULT PATIENTS WITH NEWLY DIAGNOSED GLIOBLASTOMA PREDICTS PATIENT SURVIVAL AND IMPROVES DISEASE STRATIFICATION

Abstract PURPOSE We have previously demonstrated the potential role of liquid biopsy, specifically plasma cell-free DNA (cfDNA), as a non-invasive biomarker for prognostication in patients with glioblastoma. In separate prior studies, we have also developed MRI-based radiomic signatures to predict survival outcomes in glioblastoma. In this study, for the first time, we evaluated the potential of combining radiomic signatures, epidemiological and clinical variables, and plasma cfDNA quantification for upfront prediction of overall survival (OS) in patients with newly diagnosed glioblastoma. METHODS Quantitative radiomic features were extracted from multiparametric MRI (T1, T1Gd, T2, T2-FLAIR) scans of a discovery cohort of 505 and an independent replication cohort of 50 IDH-wildtype glioblastoma patients. For the independent replication cohort, pre-surgical plasma cfDNA was extracted and quantified. In the first stage, a radiomic signature was created for stratification of patients into categories of short (OS ≤ 6 months) and long (OS ≥ 18 months) survivors using a cross-validated XGBoost method based on the discovery cohort, which was tested independently on the replication cohort. In the second stage, the radiomic signature and clinical variables were integrated to build a second-stage signature using a cross-validated support vector machine (SVM) classifier to stratify the patients into short and long survivor categories. In the third stage, the value of the second-stage signature integrated with cfDNA concentration was assessed through a cross-validated SVM regression method. RESULTS The combination of radiomic, clinical, and cfDNA variables resulted in the best overall predictive accuracy, with Pearson’s correlation coefficient of 0.59 (p&amp;lt; 0.0001) between actual and predicted OS. CONCLUSION In this study, we evaluated the value of combining plasma cfDNA, radiomic, and clinical variables for predicting OS, and showed that it could act as an effective non-invasive prognostic and patient stratification tool in patients with newly diagnosed glioblastoma.

Predictors of postoperative atrial fibrillation after coronary artery bypass grafting: a prospective observational cohort study

BackgroundThis study was conducted to determine the effect of certain predictors on the incidence of postoperative atrial fibrillation (POAF) during ICU stay after coronary artery bypass graft (CABG) surgery.ResultsWe enrolled 123 patients in this study. The mean age was 57.4 ± 8.7 years, and the mean left atrial diameter was 4.1 ± 0.52 cm with male preponderance (76.4%). The incidence of POAF following CABG was 33.3%. There was no statistically significant association between POAF and smoking (P = 0.123). However, POAF was significantly associated with higher CHA2DS2-VASc score (P = 0.002), valve replacement (P < 0.001), and inotropic support (P = 0.005). Moreover, patients with POAF had significantly higher mean age (P = 0.031) and left atrial (LA) diameter (P < 0.001). Logistic regression showed that LA diameter (P < 0.001), potassium level at 36 h (P = 0.016), and female gender (P = 0.001) were independent predictors of POAF.ConclusionsWe had several significant epidemiological, clinical, and operative variables that were significantly associated with post-CABG AF, including older age, female gender, large LA diameter, valve replacement, higher CHA2DS2-VASc score, and postoperative inotropic support. However, only LA diameter, female gender, and potassium level at 36 h were independent predictors of POAF. Nevertheless, further large-scale studies are needed to confirm our findings.

Surgically treated calcaneal joint fractures: What does postoperative computed tomography give us?

IntroductionThere is currently great controversy about the ideal treatment of intraarticular calcaneal fractures. The objective of this study is to determine the usefulness of postoperative computed tomography (CT). Material and MethodsWe conducted a retrospective descriptive study of patients operated on in the period 2007–2015 in our center. Epidemiological variables, specific fracture data, surgical intervention as well as results and complications were collected. The radiological evaluation was performed using simple radiology (Böhler angle) and coronal CT (congruence of posterior subtalar joint). For the functional results we use the AOFAS hindfoot scale and the EVA scale for the level of pain. ResultsWe included 46 fractures in 43 patients (3 bilateral). 35 were male and 8 female, with an average age of 42 years (18−79) and an average follow-up of 57.39 months (33–129). Preoperative CT was performed in all cases, of which 11 were Sanders II, 23 type III and 12 type IV. Postoperative CT was only performed in 17 cases. The subsequent subtalar reduction measured by CT was satisfactory (articular step <2 mm) in 12 cases. The average presurgical Böhler angle was 6.45 ± 10.21 (-22−25) and the post-surgical angle of 20.46 ± 7.09 (4−38). Subtalar osteoarthritis developed in 19 cases (symptomatic in 12) and calcaneo-cuboid osteoarthritis in 6 cases (only 1 symptomatic). The AOFAS was 74.28 ± 18.98 (27−100) and the EVA was 4.14 ± 2.98 (2–9). A CT scan with a step of less than 2 mm was statistically significant, with a higher result on the AOFAS scale (77.17 average points) as well as lower EVA on average (2.83) (p = 0.002). Regarding the Böhler, it was statistically significant the relationship of an angle> 20° post-surgical with higher AOFAS (80.82) and lower VAS (3.18) (p = 0.001). The literature search obtained a total of 117 articles that met the search criteria, of which only 29 requested postoperative CT. ConclusionsThe indication of postoperative CT in patients operated by intraarticular calcaneal fracture is the best technique to corroborate the correct reduction of the subtalar joint surface, although it is not universally accepted, according to the literature.

Negative Correlation between Altitude and COVID-19 Pandemic in Colombia: A Preliminary Report.

.It has been suggested that high altitude can reduce the infectivity and case fatality rate of COVID-19. We investigated the relationship between altitude and the COVID-19 pandemic in Colombia. Epidemiological data included the number of positive cases, deaths, and the case fatality rate of COVID-19. In particular, we analyzed data from 70 cities with altitudes between 1 and 3,180 m. Correlations and linear regression models adjusted to population density were performed to examine the relationship and contribution of altitude to epidemiological variables. The case fatality rate was negatively correlated with the altitude of the cities. The incidence of cases and deaths from COVID-19 had an apparent correlation with altitude; however, these variables were better explained by population density. In general, these findings suggest that living at high altitude can reduce the impact of COVID-19, especially the case fatality rate.

Vigilancia epidemiológica intensificada de arbovirosis: primer caso de dengue autóctono en Cataluña (España), zona Metropolitana Norte de Barcelona, 2018-2019

ObjectiveTo evaluate the results obtained by a surveillance network on arbovirosis composed by doctors and nurses located at hospitals and Primary Care trained in their identification, diagnostic confirmation and clinical management. LocationNorth Metropolitan Area of Barcelona (1,400,000 inhabitants; Catalonia; Spain) during a calendar year. ParticipantsSeven Primary Care and 10 hospital physicians plus 4 Primary Care nurses. Type of studyA prospective observational study. Main measurementsDemographic, epidemiological (autochthonous/imported, suspect/probable/confirmed case) and healthcare variables (symptoms, serological profile, viral period) were defined. ResultsOf the 34 patients identified, 26 (76.5%) met study criteria. Among them, any arbovirosis was confirmed in 14 (53.8%): 13 dengue plus 1chikungunya fever. There were no cases of Zika fever. There was a history of travel to endemic areas 23 (88.4%), but not in 3cases (11.6%) in which the possibility of an indigenous transmission was considered; of them, a case of dengue was confirmed. The estimated incidence of arbovirosis was 0.4 (95%CI: 0.33-0.51) cases ×10,000hab/year which, when compared to the estimated incidence in the same geographical area during the period 2009-2013 (0.19cases ×10,000hab/year; 95%CI: 0.07-0.31), a significant increase was found (P=.044). Patients within viremia period at the time of their first medical visit were 11 (42.3%). ConclusionsAn intensified epidemiological surveillance program defined at Primary Care and hospital levels is able to detect significantly more cases of imported and autochthonous arbovirosis. Possibly we are witnessing an increase in the incidence of imported arbovirosis and, thus, measures aimed at their identification and confirmation should be reinforced.

Current challenges of suicide and future directions of management in Bangladesh: a systematic review

Objectives Bangladesh is a densely populated country in south-east Asia with paucity of research in suicide. This systematic review was aimed at critical appraising various aspects of suicide in Bangladesh based on available literature and systematic search. Methods Extensive literature search was conducted in Scopus, PubMed, PubMed Central, Google, Google Scholar and BanglaJOL with searching key words without any date boundary and without any basis of types of studies, that is, all types of studies were scrutinised. The author focused on sources of suicide data along with epidemiological variables of suicides in Bangladesh such as suicide rate, gender of victims, methods of suicides, risk factors and prevention activities and role of media in suicide. Results After exclusion of repetitions, screening was performed, and finally, 35 articles were selected for review. Amongst the 35 articles, 16 articles were original contributions, 2 systematic reviews, 6 narrative reviews, 2 scoping reviews, 3 editorials, 3 case reports and rest correspondence article. The review revealed that the actual rate of suicide in Bangladesh is yet to come out and quality data is a real challenge. Women are dying more than the men, and early adulthood is the most vulnerable time of life. Discussion Suicide is a under attended problem in Bangladesh, as the country yet to reveal the actual rate of suicide along with the challenge of quality data. Prevention activities have been started but yet to be visualised. Decriminalisation of suicide in the legal criteria and establishment of suicide surveillance can be the top priorities in the country.

Is the result of breast Tc-99m mibi scintigraphy a prognostic factor for survival in invasive breast cancer?

BackgroundBreast scintigraphy with Tc-99m MIBI showed utility in diagnosing and monitoring response to neoadjuvant treatment. This work studies if there are differences in long-term survival in breast carcinomas depending on the result of Tc-99 MIBI scintigraphy and to analyze their relationship with other variables of prognostic value. Material and methodsA prospective observational study on a series of cases of breast cancer in which scintigraphy with Tc-99m MIBI was carried out prior to its treatment, and which had a minimum follow-up of ten years. Clinical–epidemiological, histopathological and immunohistochemical variables were recorded. Bivariate and multivariate analysis were performed studying the result of Tc99m-MIBI scintigraphy. Differences in OS and DFS were studied using Kaplan Meier curves with the log-rank test between factors. ResultsThe significant relationship was found between Tc-99m-MIBI positive result and palpable tumors (p=0.0001), poorly differentiated (p=0.003), with lymph node involvement (p=0.038) and high cell proliferation (p=0.007), although only the palpability and tumor size are related after multivariate analysis.Patients with Tc-99m MIBI positive tumors showed a worse OS (p=0.043) and DFS (p=0.026), independently of size and palpability of the lesión. ConclusionTc-99m MIBI scintigraphy showed prognostic importance in invasive breast cancer, relating its positivity to reduced long-term survival.

Knowledge, attitudes and practices concerning visceral leishmaniasis among residents of a sporadic transmission area in southeast Brazil.

In the last four decades, visceral leishmaniasis (VL) has undergone an urbanization process in Brazil. This research aimed to assess the knowledge, attitudes and practices concerning VL among residents of a sporadic transmission urban area in southeast Brazil. A community-based, cross-sectional quantitative study was conducted. Scores for knowledge, attitudes and practices concerning VL were evaluated and the bivariate analysis was performed. The analysis indicated that 29.9% had good knowledge, 5.2% had appropriate attitudes and 62.1% had appropriate practices. Notwithstanding that, pivotal practices for controlling VL had unsatisfactory individual frequencies. Good knowledge on VL was related to women, a higher level of education, a higher income, the place of residence and having pets. Appropriate attitudes were related to the place of residence. The practices had no significant associations with the sociodemographic and epidemiological variables. This study demonstrated that even in the area of disease transmission, knowledge on VL is very limited, including at the most basic level. In order to achieve effectiveness in actions against VL in Brazil, the participation of the affected communities is imperative, therefore popular health education interventions are necessary to improve the population's understanding of the disease and to avoid inappropriate attitudes and practices.

Diversity of rotavirus genotypes circulating in children

BackgroundFrom 2016, the Government of India introduced the oral rotavirus vaccine into the national immunization schedule. Currently, two indigenously developed vaccines (ROTAVAC, Bharat Biotech; ROTASIIL, Serum Institute of India) are included in the Indian immunization program. We report the rotavirus disease burden and the diversity of rotavirus genotypes from 2005 to 2016 in a multi-centric surveillance study before the introduction of vaccines.MethodsA total of 29,561 stool samples collected from 2005 to 2016 (7 sites during 2005–2009, 3 sites from 2009 to 2012, and 28 sites during 2012–2016) were included in the analysis. Stools were tested for rotavirus antigen using enzyme immunoassay (EIA). Genotyping was performed on 65.8% of the EIA positive samples using reverse transcription- polymerase chain reaction (RT-PCR) to identify the G (VP7) and P (VP4) types. Multinomial logistic regression was used to quantify the odds of detecting genotypes across the surveillance period and in particular age groups.ResultsOf the 29,561 samples tested, 10,959 (37.1%) were positive for rotavirus. There was a peak in rotavirus positivity during December to February across all sites. Of the 7215 genotyped samples, G1P[8] (38.7%) was the most common, followed by G2P[4] (12.3%), G9P[4] (5.8%), G12P[6] (4.2%), G9P[8] (4%), and G12P[8] (2.4%). Globally, G9P[4] and G12P[6] are less common genotypes, although these genotypes have been reported from India and few other countries. There was a variation in the geographic and temporal distribution of genotypes, and the emergence or re-emergence of new genotypes such as G3P[8] was seen. Over the surveillance period, there was a decline in the proportion of G2P[4], and an increase in the proportion of G9P[4]. A higher proportion of mixed and partially typed/untyped samples was also seen more in the age group 0–11 months.ConclusionsThis 11 years surveillance highlights the high burden of severe rotavirus gastroenteritis in Indian children < 5 years of age before inclusion of rotavirus vaccines in the national programme. Regional variations in rotavirus epidemiology were seen, including the emergence of G3P[8] in the latter part of the surveillance. Having pre-introduction data is important to track changing epidemiology of rotaviruses, particularly following vaccine introduction.