Variation In Incidence Rates Research Articles

Mutational signatures in esophageal squamous cell carcinoma from eight countries with varying incidence.

Esophageal squamous cell carcinoma (ESCC) shows remarkable variation in incidence that is not fully explained by known lifestyle and environmental risk factors. It has been speculated that an unknown exogenous exposure(s) could be responsible. Here we combine the fields of mutational signature analysis with cancer epidemiology to study 552 ESCC genomes from eight countries with varying incidence rates. Mutational profiles were similar across all countries studied. Associations between specific mutational signatures and ESCC risk factors were identified for tobacco, alcohol, opium and germline variants, with modest impacts on mutation burden. We find no evidence of a mutational signature indicative of an exogenous exposure capable of explaining differences in ESCC incidence. Apolipoprotein B mRNA-editing enzyme, catalytic polypeptide-like (APOBEC)-associated mutational signatures single-base substitution (SBS)2 and SBS13 were present in 88% and 91% of cases, respectively, and accounted for 25% of the mutation burden on average, indicating that APOBEC activation is a crucial step in ESCC tumor development.

Demographic, clinical, and laboratory characteristics of children with confirmed Coronavirus disease 2019 (COVID-19) in Bali

Introduction: The Coronavirus disease 2019 (COVID-19) has become a global issue since the disease was first reported in Wuhan, China, in December 2019. The proportion of COVID-19 cases in children is less than in adults, with highly variable incidence rates. Milder clinical manifestations occur in children than adults. Children with comorbidities are more likely to develop more severe symptoms and require hospitalization. Monitoring of laboratory results in confirmed cases of COVID-19 is crucial. Methods: This study was a retrospective study on data collected from the Bali Branch of Indonesia Pediatric Society COVID-19 Team and the Bali Provincial Government Health Department, Indonesia, from March 2020 until February 2021. The study population included children aged 0-18 years with laboratory-confirmed COVID-19. Subjects were selected using the total sampling method. Results: During the study period, 3,674 children were confirmed to have COVID-19. In this study, the majority of age was 12-18 years. Nineteen (0.5%) were neonates with a vertical transmission source. The most prevalent source of transmission was living in the same house, which was found in 1,811 cases (49.3%). Out of 181 confirmed cases of COVID-19 treated at Sanglah Hospital, Denpasar, 49 (27.1%) had comorbidities. In 2,701 (73.5%) cases, the subjects were found to be asymptomatic. 652 (17.7%) subjects had fever, 771 (21%) had cough, and only 17 (0.5%) had anosmia. A total of 139 (3.8%) subjects had symptoms of shortness of breath, and only 4 subjects required treatment with a ventilator. Regarding the infection markers, lactate dehydrogenase (LDH), C-reactive protein (CRP), D-dimer, and procalcitonin showed higher levels in the critical group compared to other groups. Conclusion: The highest incidence of COVID-19 occurs in children aged 12-18 years, and the most frequent sources of close contact come from household contacts. Most children who have confirmed COVID-19 have asymptomatic clinical manifestation. The most common clinical manifestation was cough (21%). Increased infection markers such as LDH, CRP, procalcitonin and D-dimer occur in critically ill COVID-19 patients.

810Geographical disparities in diagnosis of myeloproliferative neoplasms in Australia

Abstract Background Myeloproliferative neoplasms (MPNs) are a relatively new group of blood cancers arising from genetic mutations in haematopoietic stem cells. Diagnostic delay is associated with thromboses, strokes and heart attacks. We investigated geographic variation in diagnosis and survival for classic MPNs. Methods Data for classic MPNs were obtained from the Australian Cancer Database. Leroux spatial models for incidence and survival were fitted using CARBayes, WinBUGS via R and tests for spatial clustering were conducted. Results The age-standardised incidence rate was 4.9 (95% CI: 4.8-5.0) per 100,000 person-years during 2007-2016 with relative survival of 78% (77%, 79%) at 5 years after diagnosis. Strong evidence of spatial variation in incidence was observed (p < 0.001), with incidence rates low in Tasmania (4.2 per 100,000 person-years, 95% CI: 3.5-5.0) and Western Australia (6.1, 5.6-6.6) and high in Victoria (9.5, 9.2-9.9) and Queensland (10.6, 10.2-11.1). Differences between states and territories could not be explained by population rates of genetic testing or the proportion of registered cases with histological evidence. Conclusions Stark spatial differences in incidence rates of classic MPNs suggest that varying diagnosis and registration patterns between states results in under-recognition, and potentially undertreatment. It is imperative that reporting is consistent so that sound evidence is available for efforts to reduce disparities in diagnosis and management. Key messages Early identification of MPNs is crucial, however, strong spatial geographical variation in incidence rates suggest diagnostic and notification practices may not be consistent across the country.

Management and Outcome of Post-Infectious Multiloculated Hydrocephalus: A Case Series.

Background and importance: Infection following ventriculoperitoneal shunt (VPS) placement is a recognized complication, with variable incidence rates worldwide. Development of post-infectious multiloculated hydrocephalus (MLH) is likely if VPS infection is improperly managed, in turn affecting the prognosis. There is a lack of studies from Saudi Arabia regarding patients' functional outcome in relation to different variables.Objectives: To study the causative organisms, related variables and patient outcomes in MLH after VPS infection.Methods: This case series is a retrospective chart review of pediatric patients diagnosed with hydrocephalus from 2011 to 2019. Patients were included if they were aged <18 years, had confirmed cerebrospinal fluid/blood infection with radiological evidence of MLH, and were regularly followed-up. Functional status score was used to evaluate the outcomes.Results: A total of 150 patients underwent VPS insertion during the study period, of which 12 (8%) had postinfection MLH. The mean age at diagnosis and follow-up was 9 and 19 months, respectively. Ten patients developed MLH after their first VPS infection and one each developed MLH following the second and third VPS infections. Cerebrospinal fluid cultures mostly grew only single organisms (6/12), with Staphylococcus species being the most common. All patients underwent navigated endoscopic fenestration; nine patients required VPS placement and three required redo endoscopic fenestration surgery. All patients were developmentally delayed, with the majority (75%) having a functional status score of 6–10.Conclusion: Development of MLH after VPS infection is debilitating and requires prompt treatment. Although the overall functional outcome is poor, evolving neuroendoscopic techniques with tailored preoperative planning may play a role in reducing the adverse effect of shunt multiplicity, shunt infections and the higher failure rate among patients with complex hydrocephalus.

64 Progression of COVID-19 from Urban to Rural Areas in the Southwest: A Spatiotemporal Analysis of Prevalence Rates

COVID-19 emerged in the United States on January 20, 2020 and has rapidly proliferated across the nation affecting more than 15 million individuals. Case incidence rates vary at the local, county, and state levels and it is unclear if a difference exists in the incidence of new COVID-19 cases among urban or rural counties. Due to county population density and geographic progression of the virus over time, COVID-19 may demonstrate variable incidence rates among urban and rural population centers.

A new model to assist decision-making of optimal antibiotics duration for treating asymptomatic bacteriuria or pyuria prior to retrograde intrarenal surgery.

The aim of this study was to establish a model that predicts postoperative fever and enables decision-making regarding optimal antibiotic therapy duration for asymptomatic bacteriuria or pyuria prior to retrograde intrarenal surgery (RIRS). We retrospectively investigated 667 consecutive patients with asymptomatic bacteriuria or pyuria who underwent RIRS between September 2016 and December 2019. We constructed a predictive nomogram for risk quantification of postoperative infection. A preoperative score model was used for risk stratification. The effect of antibiotic therapy duration (short-course [2-3 days] vs. long-course [≥4 days]) was evaluated. Infections occurred in 113 (16.9%) patients. The incidence of fever was marginally lower in long-course group than in short-course group (15% vs. 19%, P=0.173). Hydronephrosis, stone size, multi-drug resistant bacteriuria, and degree of pyuria were used to construct a preoperative score model (the H-SMP score). Using the H-SMP score, the patients were stratified into low- and high-risk groups based on varying incidence rates of postoperative fever (11.0% vs. 29.9%, P<0.001). Significant reduction in fever occurred only among high-risk patients in the long-course group (23.5% vs. 38.0%, P=0.022), and no such reduction in postoperative fever rates occurred in low-risk patients (10.4% vs. 11.5%, P=0.712). Even after propensity score matching, the low-risk group showed no improvement in postoperative fever incidence with long-course antibiotic therapy (7.5% vs. 10.0%, P=0.419). Based on the newly developed H-SMP score, we concluded that long-course antibiotics (≥4 days) recommended in high-risk patients may not bring in more benefit in low-risk patients for treating asymptomatic bacteriuria or pyuria prior to RIRS.

Spinal block and delirium in oncologic patients after laparoscopic surgery in the Trendelenburg position: A randomized controlled trial.

Delirium is the most common postsurgical neurological complication and has a variable incidence rate. Laparoscopic surgery, when associated with the Trendelenburg position, can cause innumerable physiological changes and increase the risk of neurocognitive changes. The association of general anesthesia with a spinal block allows the use of lower doses of anesthetic agents for anesthesia maintenance and facilitates better control over postoperative pain. Our primary outcome was to assess whether a spinal block influences the incidence of delirium in oncologic patients following laparoscopic surgery in the Trendelenburg position. Our secondary outcome was to analyze whether there were other associated factors. A total of 150 oncologic patients who underwent elective laparoscopic surgeries in the Trendelenburg position were included in this randomized controlled trial. The patients were randomized into 2 groups: the general anesthesia group and the general anesthesia plus spinal block group. Patients were immediately evaluated during the postoperative period and monitored until they were discharged, to rule out the presence of delirium. Delirium occurred in 29 patients in total (22.3%) (general anesthesia group: 30.8%; general anesthesia plus spinal block: 13.8% p = 0.035). Patients who received general anesthesia had a higher risk of delirium than patients who received general anesthesia associated with a spinal block (odds ratio = 3.4; 95% confidence interval: 1.2–9.6; p = 0.020). Spinal block was associated with reduced delirium incidence in oncologic patients who underwent elective laparoscopic surgeries in the Trendelenburg position.

A systematic review and meta-analysis of the incidence rate of Takayasu arteritis.

ObjectivesTakayasu arteritis (TAK) is a rare autoimmune rheumatic disease causing large-vessel vasculitis. Onset is typically between the ages of 20 and 30 years. It is associated with substantial morbidity and mortality, notably due to its effects on the cardiovascular system. It has a poorly understood global epidemiology. Our objective was to systematically review the available evidence in order to calculate the incidence rate of TAK.MethodsThree databases (MEDLINE, PubMed and Embase) were searched in November 2019 and the results were screened by two reviewers. A random effects meta-analysis was then conducted in R to calculate the overall incidence rate. Heterogeneity was assessed using I2. The quality of the studies was assessed using an adapted Newcastle–Ottawa scale. Further subgroup analyses were performed by quality, sex, research setting and geographical location. Publication bias was assessed using a Begg’s funnel plot.ResultsThe incidence rate for TAK was 1.11 per million person-years (95% CI 0.70–1.76). The heterogeneity in the data was extremely high in all analyses, which suggests that there was considerable variation in incidence rates across the different populations studied. TAK was found to be more common in women (incidence rate 2.01 per million person-years, 95% CI 1.39–2.90).ConclusionsTAK is an extremely rare disease. It affects women more commonly than men. There is considerable variation in the incidence rate between populations. We suggest that future research should focus on discrete populations in order to better identify genetic and environmental risk factors.

Inherited or Acquired in Hipertension and Cronic Kidney Disease in Diabetes Mellitus Patients?

Abstract Diabetic kidney disease (DKD) is a common and serious microvascular complication of diabetes mellitus (DM), which is characterized by an elevated urinary albumin excretion rate, elevated blood pressure, and declined renal function. Approximately 30-40% of DM patients will develop DKD, which is the leading cause of end-stage renal disease (ESRD) and renal failure. Genetic factors appear critical in DKD pathogenesis based upon the evidence including aggregation in families, variable incidence rates of DKD between different races, and the highly heritable nature of diabetic renal clinic and histologic changes. Each 10 mmHg increase in mean systolic blood pressure (BP) was associated with a 15% increase in the hazard ratio for development of both micro- and macroalbuminuria and impaired kidney function defined as eGFR &lt;60 ml/min per 1.73 m2 or doubling of the blood creatinine level. Broadly, a baseline systolic BP &gt;140 mmHg in patients with DM2 has been associated with higher risk of ESRD and death. The ACE genes may predict diabetic nephropathy in some groups, the rate of progression and the antiproteinuric response to ACE inhibitors.

A retrospective epidemiological study of type 1 diabetes mellitus in wales, UK between 2008 and 2018.

IntroductionStudies of prevalence and the demographic profile of type 1 diabetes are challenging because of the relative rarity of the condition, however, these outcomes can be determined using routine healthcare data repositories. Understanding the epidemiology of type 1 diabetes allows for targeted interventions and care of this life-affecting condition.ObjectivesTo describe the prevalence, incidence and demographics of persons with type 1 diabetes diagnosed in Wales, UK, using the Secure Anonymised Information Linkage (SAIL) Databank.MethodsData derived from primary and secondary care throughout Wales available in the SAIL Databank were used to identify people with type 1 diabetes to determine the prevalence and incidence of type 1 diabetes over a 10 year period (2008–18) and describe the demographic and clinical characteristics of this population by age, socioeconomic deprivation and settlement type. The seasonal variation in incidence rates was also examined.ResultsThe prevalence of type 1 diabetes in 2018 was 0.32% in the whole population, being greater in men compared to women (0.35% vs 0.28% respectively); highest in those aged 15-29 years (0.52%) and living in the most socioeconomically deprived areas (0.38%). The incidence of type 1 diabetes over 10 years was 14.0 cases/100,000 people/year for the whole population of Wales. It was highest in children aged 0-14 years (33.6 cases/100,000 people/year) and areas of high socioeconomic deprivation (16.8 cases/100,000 people/year) and least in those aged 45-60 years (6.5 cases/100,000 people/year) and in areas of low socioeconomic deprivation (11.63 cases/100,000 people/year). A seasonal trend in the diagnoses of type 1 diabetes was observed with higher incidence in winter months.ConclusionThis nation-wide retrospective epidemiological study using routine data revealed that the incidence of type 1 diabetes in Wales was greatest in those aged 0-14 years with a higher incidence and prevalence in the most deprived areas. These findings illustrate the need for health-related policies targeted at high deprivation areas to include type 1 diabetes in their remit.

Risk of post-operative venous thromboembolism after surgery for colorectal malignancy: A systematic review and meta-analysis

Background: Colorectal cancer (CRC) is common and has the second highest mortality of any malignancy. Venous thromboembolism (VTE) is a major post-operative complication and may be associated with an increased risk of mortality. This study aimed to determine the variation in incidence rate of VTE following CRC surgical resection.

Esophageal cancer: Epidemiology, risk factors and screening.

More than 600,000 people are diagnosed with esophageal cancer (EC) every year globally, and the five-year survival rate of EC is less than 20%. Two common histological subtypes of EC, esophageal squamous cell carcinoma (ESCC) and esophageal adenocarcinoma (EAC), have great geographical variations in incidence rates. About half of the world’s EC was diagnosed in China and a majority of which belong to ESCC. Globally, the overall incidence rate of EC is decreasing. In some high-risk Asian regions, such as China, the incidence rate of ESCC has generally declined, potentially due to economic growth and improvement of diet habits. In some European high-income countries and the United States, the decline is mainly attributed to the decrease in smoking and drinking. The risk factors of EC are not well understood, and the importance of environmental and genetic factors in the pathogenesis is also unclear. The incidence and mortality of advanced EC can be reduced through early diagnosis and screening. White light endoscopy is still the gold standard in the current screening technology. This article reviews the epidemiology, risk factors, and screening strategies of EC in recent years to help researchers determine the most effective management strategies to reduce the risk of EC.

Complications in spondylolisthesis surgery: Common, uncommon, and rare

Spondylolisthesis is a common pathological condition caused due to numerous etiologies in young and old alike. The forward slippage of one vertebra over the other alters the biomechanics to an extent that can result in various postoperative complications. The most common complications reported are pseudoarthrosis, neurological deficits, and transitional syndrome. The rate of pseudoarthrosis varies based on etiology as well as various intraoperative factors. The authors reviewed the literature for the varying incidence rates and suggest principles of reduction and fusion based on evidence and experience. Similarly, neurological complications are a common occurrence postoperatively particularly in the treatment of high-grade slips. Percentage of reduction of slips, slip angle, and traction injury to nerve roots tend to have a complex interaction leading to neurological injuries. The authors try to decipher this co-relation based on literature. Though most neurological issues have been found reversible, recent innovations like intraoperative neuromonitoring tend to decrease its incidence even further. The development of transition syndrome is an enigma in itself. Whether increased stresses at adjacent levels are due to fusion or a part of an ongoing degenerative process is yet to be understood. On the basis of case examples, the authors suggest recommendations to avoid them. Finally, minimally invasive spine surgeries (MISS) are now being used to treat spondylolisthesis. The authors reviewed comparative studies between open and MISS and found similar complication rates between them with regards to low-grade slips with a word of caution to treat high-grade listhesis with minimally invasive surgery techniques. Last but not the least, a few unusual and rare complications have been enlisted with case examples and learning points. This manuscript aims at reviewing the common, uncommon, and rare complications of treating cases of spondylolisthesis along with enlisting the principles to avoid and treat them in day to day practice.

STUDY OF PRESCRIPTION PROFILE OF PATIENTS WITH BRONCHIAL ASTHMA AT PARSOBURAN COMMUNITY HEALTH CITY PEMATANGSIANTAR PERIOD JANUARY-MARCH 2017

Bronchial asthma has varying incidence rates in different countries, but there is a tendency for this disease to increase in number, even though asthma medications have been developed. This study aims to determine the pattern of treatment of bronchial asthma in patients at the Parsoburan Health Center, Pematangsiantar City for the period January-March 2017. This research was a non-experimental (observational) descriptive study conducted using a retrospective method. The data used are medical records of bronchial asthma patients. The results of the study showed that in the January-March 2017 period there were 18 cases of bronchial asthma. The gender distribution of bronchial asthma patients was 66.7% male and 33.3% female, while the age distribution of bronchial asthma patients was divided into 4 groups, namely, Toddlers (0≤5 years) by 33.3%, children (5&lt;n&lt;12 years) by 5.6%, adults (12&lt;n&lt;65 years) by 38.9%, and elderly (&gt; 65 years) of 22.2% The general description of prescribing the highest number of drugs given to bronchial asthma patients in one prescription are 5 and 6 drugs each of 38.9%, the distribution of drug classes used for therapy includes, bronchodilators 25, 7%, mucolytic 18.5%, corticosteroid 15.5%, anti-microbial 15.5%, anti-hypoxemia 4.1%, analgesic 6.2%, anti-histamine 3.1% and accompanying drugs (anti- diabetic, anti-epileptic, anti-hypertensive, anti-angina, and vitamins) given at 1% each. Distribution of discrepancies in drug administration based on the Indonesian National Drug Informatorium standard of 17.5%, based on the Physicians Drug Handbook standard of 0%,

Open Transforaminal Lumbar Interbody Fusion (TLIF) for post-discectomy spondylodiscitis: Our experience

Introduction: Post operative lumbar Spondylodiscitis after lumbar discectomy surgery is well known complication with has a variable incidence rate, usually less than 1%.1 Post op spondylodiscitis is an infection of nucleus pulposus , annulus fibrosis with sometimes secondary involvement of cartilaginous end plates and vertebral bodies following lumbar disc surgeries.2 Early diagnosis of discitis based on clinical, laboratory, radiological findings and appropriate management is essential to reduce morbidity. Aim: Retrospective review of patients undergoing transforaminal lumbar interbody fusion (TLIF) for post-op discitis to evaluate clinical outcome and complications. Material and Methods:All patients undergone TLIF for post-lumbar discectomy spondylodiscitis at our institute from sept'13 to sept'17 were included in our study. All patients had moderate to severe lumbar backage. Initialy a course of conservative treatment with broad spectrum I .V antibiotics was given followed by surgery. On follow up patients were assessed with physical examination and radiographs. Outcome were measured in terms of operative time, blood loss, and surgical complications. Parameters like Visual analogue scale(VAS) for pain,modified Rankin scale (mRS) were evaluate before and after surgery and on subsequent follow up visits. Results: Modified Rankin scale (mRS) and VAS enhanced in all patients. Conclusion: Postoperative spondylodiscitis can be successfully managed with transforaminal lumbar interbody fusion (TLIF) and posterior spinal instrumentation. There is significant pain relief and good functional outcome after surgery. Keywords: Spondylodiscitis, Post discectomy infection, Transforaminal Lumbar Interbody Fusion (TLIF), Lumbar disc infection.

RpoB mutations conferring rifampicin-resistance affect growth, stress response and motility in Vibrio vulnificus.

Rifampicin is a broad-spectrum antibiotic that binds to the bacterial RNA polymerase (RNAP), compromising DNA transcription. Rifampicin resistance is common in several microorganisms and it is typically caused by point mutations in the gene encoding the β subunit of RNA polymerase, rpoB. Different rpoB mutations are responsible for various levels of rifampicin resistance and for a range of secondary effects. rpoB mutations conferring rifampicin resistance have been shown to be responsible for severe effects on transcription, cell fitness, bacterial stress response and virulence. Such effects have never been investigated in the marine pathogen Vibrio vulnificus , even though rifampicin-resistant strains of V. vulnificus have been isolated previously. Moreover, spontaneous rifampicin-resistant strains of V. vulnificus have an important role in conjugation and mutagenesis protocols, with poor consideration of the effects of rpoB mutations. In this work, effects on growth, stress response and virulence of V. vulnificus were investigated using a set of nine spontaneous rifampicin-resistant derivatives of V. vulnificus CMCP6. Three different mutations (Q513K, S522L and H526Y) were identified with varying incidence rates. These three mutant types each showed high resistance to rifampicin [minimal inhibitory concentration (MIC) >800 µg ml−1], but different secondary effects. The strains carrying the mutation H526Y had a growth advantage in rich medium but had severely reduced salt stress tolerance in the presence of high NaCl concentrations as well as a significant reduction in ethanol stress resistance. Strains possessing the S522L mutation had reduced growth rate and overall biomass accumulation in rich medium. Furthermore, investigation of virulence characteristics demonstrated that all the rifampicin-resistant strains showed compromised motility when compared with the wild-type, but no major effects on exoenzyme production were observed. These findings reveal a wide range of secondary effects of rpoB mutations and indicate that rifampicin resistance is not an appropriate selectable marker for studies that aim to investigate phenotypic behaviour in this organism.

Geography of suicide in Japan: spatial patterning and rural\u2013urban differences

PurposeThere are notable geographic variations in incidence rates of suicide both in Japan and globally. Previous studies have found that rurality/urbanity shapes intra-regional differences in suicide mortality, and suicide risk associated with rurality can vary significantly by gender and age. This study aimed to examine spatial patterning of and rural–urban differences in suicide mortality by gender and age group across 1887 municipalities in Japan between 2009 and 2017.MethodsSuicide data were obtained from suicide statistics of the Ministry of Health, Labour and Welfare in Japan. We estimated smoothed standardized mortality ratios for suicide for each of the municipalities and investigated associations with level of rurality/urbanity using Bayesian hierarchical models before and after adjusting for socioeconomic characteristics.ResultsThe results of the multivariate analyses showed that, for males aged 0–39 and 40–59 years, rural residents tended to have a higher suicide risk compared to urban ones. For males aged 60+ years, a distinct rural–urban gradient in suicide risk was not observed. For females aged 0–39 years, a significant association between suicide risk and rurality was not observed, while for females aged 40–59 years and females aged 60 years or above, the association was a U-shaped curve.ConclusionOur results showed that geographical distribution of and rural–urban differences in suicide mortality in Japan differed substantially by gender and age. These findings suggest that it is important to take demographic factors into consideration when municipalities allocate resources for suicide prevention.

A paradoxical phenomenon: Intense pulsed light‐induced hypertrichosis, a brief review

AbstractThe advancement of laser and light therapies have allowed patients of all races and ethnicities access to different methods for removing unwanted hairs that can cause emotional distress and impact one's quality of life. Despite their effectiveness, these technologies are not without their risks, such as the well‐known side effects of blister formation, erythema, crusting, and postinflammatory hypo‐ and hyperpigmentation. However, one adverse effect that seems to remain a clinical mystery is paradoxical hypertrichosis. Paradoxical hypertrichosis is the growth of fine, dark hair in treated areas or untreated areas close to the area treated on the face and neck, more frequently affecting those with darker skin (Fitzpatrick III‐VI) and darker hair color, and most associated with those having undergone the intense pulsed laser and long‐pulse alexandrite laser, although, this adverse reaction is likely common to all current and laser and light hair removal devices, despite the unknown prevalence and varying incidence rates. This phenomenon is not well understood, although explanations include the activation of dormant hair follicles by the intense pulse light flashlamp's suboptimal fluences and the synchronization of hair growth cycles caused by direct light stimulation.

A retrospective review of the contribution of rare diseases to paediatric mortality in Ireland

AimsTo ascertain the number of paediatric deaths (0–14 years) with an underlying rare disease in the Republic of Ireland between the years 2006–2016, and to analyse bed usage by a paediatric cohort of rare disease inpatients prior to in-hospital death.BackgroundRare diseases are often chronically debilitating and sometimes life-threatening diseases, with the majority (69.9%) of rare diseases being of paediatric onset. The Orphanet database contains information on 6172 unique rare diseases. Under-representation of rare diseases in hospital healthcare coding systems leads to a paucity of rare disease epidemiological data required for healthcare planning. Studies have cited variable incidence rates for rare disease, however the burden of rare diseases to healthcare services still remains unclear. This study represents a thorough effort to identify the percentage of child mortality and paediatric bed usage attributable to rare diseases in the Republic of Ireland, thus addressing a major gap in the rare disease field.MethodsRetrospective analysis of paediatric death registration details for the Republic of Ireland in the 11-year period 2006–2016 from the National Paediatric Mortality Register. Data was subcategorised as Neonatal (0–28 days), Post Neonatal (29 days < 1 year) and older (1–14 years). Bed usage data (ICD-10 code, narrative and usage) of paediatric inpatients who died during hospitalisation from January 2015 to December 2016 was extracted from the National Quality Assurance Improvement System of in-patient data. Orphacodes were assigned to rare disease cases from ICD-10 codes or diagnostic narrative of both datasets.ResultsThere were 4044 deaths registered from 2006–2016, aged < 15 years, of these 2368 (58.6%) had an underlying rare disease. Stratifying by age group; 55.6% (1140/2050) of neonatal deaths had a rare disease, 57.8% (450/778) post-neonatal, and 64% (778/1216) of children aged 1–14 years. Mortality coding using ICD-10 codes identified 42% of rare disease cases with the remainder identified using death certificate narrative records. Rare disease patients occupied 87% of bed days used by children < 15 years who died during hospitalisation from January 2015 to December 2016.ConclusionAdditional routine rare disease coding is necessary to identify rare diseases within Irish healthcare systems to enable better healthcare planning. Rare disease patients are overrepresented in paediatric mortality statistics and in-patient length of stay during hospital admission prior to death.

Assessing correlations between short-term exposure to atmospheric pollutants and COVID-19 spread in all Italian territorial areas.

The spread of SARS-CoV-2, the beta coronavirus responsible for the current pneumonia pandemic outbreak, has been speculated to be linked to short-term and long-term atmospheric pollutants exposure. The present work has been aimed at analyzing the atmospheric pollutants concentrations (PM10, PM2.5, NO2) and spatio-temporal distribution of cases and deaths (specifically incidence, mortality and lethality rates) across the whole Italian national territory, down to the level of each individual territorial area, with the goal of checking any potential short-term correlation between these two phenomena. The data analysis has been limited to the first quarter of 2020 to reduce the lockdown-dependent biased effects on the atmospheric pollutant levels as much as possible. The analysis looked at non-linear, monotonic correlations using the Spearman non-parametric correlation index. The statistical significance of the Spearman correlations has also been evaluated. The results of the statistical analysis suggest the hypothesis of a moderate-to-strong correlation between the number of days exceeding the annual regulatory limits of PM10, PM2.5 and NO2 atmospheric pollutants and COVID-19 incidence, mortality and lethality rates for all the 107 territorial areas in Italy. A weak-to-moderate correlation seems to exist when considering the 36 territorial areas in four of the most affected regions (Lombardy, Piedmont, Emilia-Romagna and Veneto). Overall, PM10 and PM2.5 showed a higher non-linear correlation than NO2 with incidence, mortality and lethality rates. As to particulate matters, PM10 profile has been compared with the incidence rate variation that occurred in three of the most affected territorial areas in Northern Italy (i.e., Milan, Brescia, and Bergamo). All areas showed a similar PM10 time trend but a different incidence rate variation, that was less severe in Milan compared with Brescia and Bergamo.