Τρίτη 29 Νοεμβρίου 2022

Trends and disparities in 44 national notifiable infectious diseases in China: an analysis of national surveillance data from 2010 to 2019

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Abstract

Background

Research assessing the changing epidemiology of infectious diseases in China after the implementation of new health-care reform in 2009 was scarce. We aimed to get the latest trends and disparities of national notifiable infectious diseases by age, sex, province and seasons in China from 2010 to 2019.

Methods

The number of incident cases and deaths, incidence rate and mortality of 44 national notifiable infectious diseases by sex, age groups, and provincial regions from 2010 to 2019 was extracted from the China Information System for Disease Control and Prevention and official reports, and divided into six kinds of infectious diseases by transmission routes and three classes (A, B and C) in this descriptive study. Estimated annual percentage changes (EAPCs) were calculated to quantify the temporal trends of incidence and mortality rate. We calculated concentration index to measure economic-related inequality. Segmented interrupted time-series analy sis was used to estimate the impact of the COVID-19 pandemic on the epidemic of notifiable infectious disease.

Results

The trend of incidence rate on six kinds of infectious diseases by transmission routes was stable, while only mortality of sexual, blood-borne, and mother-to-child-borne infectious diseases increased from 0.6466 per 100 000 population in 2010 to 1.5499 per 100 000 population in 2019 by 8.76% per year (95%CI: 6.88-10.68). There was a decreasing trend of incidence rate on Class-A infectious diseases (EAPC=-16.30%; 95%CI: -27.93 - -2.79) and Class-B infectious diseases (EAPC=-1.05%; 95%CI: -1.56 - -0.54), while an increasing trend on Class-C infectious diseases (EAPC=6.22%; 95%CI: 2.13~10.48). For mortality, there was a decreasing trend on Class-C infectious diseases (EAPC=-14.76%; 95%CI: -23.46 - -5.07), and an increasing trend on Class-B infectious diseases (EAPC=4.56%; 95%CI: 2.44-6.72). In 2019, the infectious diseases with highest incidence rate and mortality were respiratory diseases (340.95 per 100 000 population), and sexual, blood-borne, and mother-to-child-borne infectious diseases (1.5459 per 100 000 population), respectively. The greatest increasing trend of incidence rate was observed in seasonal influenza, from 4.83 per 100 000 population in 2010 to 253.36 per 100 000 population in 2019 by 45.16% per year (95%CI: 29.81-62.33), especially among female and children aged 0 – 4 years old. The top disease with highest mortality was still AIDs which had the highest average yearly mortality in 24 provinces from 2010 to 2019, and its incidence rate (EAPC=14.99%; 95%CI: 8.75-21.59) and mortality (EAPC=9.65; 95%CI: 7.71-11.63) both increased from 2010 to 2019, especially among people aged 44 – 59 years old and 60 or older. Male incidence rate and mortality were higher than females each year from 2010 to 2018 on 29 and 10 infectious diseases, respectively. Additionally, sex differences of incidence and mortality of AIDS were becoming larger. The curve lay above the equality line, with the negative value of the concentration index, which indicated that economic-related health disparities exist in the distribution of incidence rate and mortality of respiratory diseases (incidence rate: the concentration index = -0.063, P<0.0001; mortality: the concentration index = -0.131, P<0.001), sexual, blood-borne, and mother-to-child-borne infectious diseases (incidence rate: the concentration index = -0.039, P=0.0192; mortality: the concentration index = -0.207, P<0.0001), and the inequality disadvantageous to the poor (pro-rich). Respiratory diseases (Dec, Jan), intestinal diseases (May, Jun, July), zoonotic infectious diseases (Mar-Jul) and vector-borne infectious diseases (Sep-Oct) had distinct seasonal epidemic patterns. In addition, segmented interrupted time-series analyses showed that, after adjusted for potential seasonality, autocorrelation, GDP per capita, number of primary medical institutions a nd other factors, there was no significant impact of COVID-19 epidemic on the monthly incidence rate of six kinds of infectious diseases by transmission routes from 2018 to 2020 (all P>0.05).

Conclusions

The incidence rates of six kinds of infectious diseases were stable in the past decade, and incidence rates of Class-A and Class-B infectious diseases were deceasing, because of comprehensive prevention and control measures and strengthened health system after the implementation of the new health-care reform in China since 2009. However, age, gender, regional and economic disparities were still observed. Concerted efforts are needed to reduce the impact of seasonal influenza (especially among children aged 0 – 4 years old) and the mortality of AIDs (especially among people aged 44 – 59 years old and 60 or older). More attention should be paid to the disparities on the burden of infectious diseases.

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Haplotypic variants of COVID‐19 related genes are associated with blood pressure and metabolites levels

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Abstract

The genetic association of COVID-19 with its complications has not been fully understood. This study aimed to identify variants and haplotypes of candidate genes implicated in COVID-19 related traits by combining the literature review and pathway analysis. In order to explore such genes, the protein-protein interactions and relevant pathways of COVID-19-associated genes were assessed. A number of variants on candidate genes were identified from genome-wide association studies (GWASs) which were associated with COVID-19 related traits (p˂10-6). Haplotypic blocks were assessed using haplotypic structures among the 1000 Genomes Project (r2≥0.8, D'≥0.8). Further functional analyses were performed on the selected variants. The results demonstrated that a group of variants in ACE and AGT genes were significantly correlated with COVID-19 related traits. Three haplotypes were identified to be involved in the blood metabolites levels and the development of blood pressure. Functional analyses revealed that most GWAS index variants were expression quantitative trait loci (eQTL) and had transcription factor binding sites, exonic splicing enhancers, or silencer activities. Furthermore, the proxy haplotype variants, rs4316, rs4353, rs4359, and three variants, namely rs2493133, rs2478543, and rs5051, were associated with blood metabolite and systolic blood pressure, respectively. These variants exerted more regulatory effects compared with other GWAS variants. The present study indicates that the genetic variants and candidate haplotypes of COVID-19 related genes are associated with blood pressure and blood metabolites. However, further observational studies are warranted to confirm these results.

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Use of Statistical Process Control Methods for Early Detection of Healthcare Facility-Associated Nontuberculous Mycobacterial Outbreaks: A Single Center Pilot Study

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Abstract
Background
Nontuberculous mycobacteria (NTM) are emerging pathogens increasingly implicated in healthcare facility-associated (HCFA) infections and outbreaks. We analyzed the performance of statistical process control (SPC) methods in detecting HCFA NTM outbreaks.
Methods
We retrospectively analyzed 3 NTM outbreaks that occurred from 2013-2016 at a tertiary care hospital. The outbreaks consisted of pulmonary Mycobacterium abscessus complex (MABC) acquisition, cardiac surgery-associated extrapulmonary MABC infection, and a bronchoscopy-associated pseudo-outbreak of Mycobacterium avium complex (MAC). We analyzed monthly case rates of unique patients who had positive respiratory cultures for MABC, non-respiratory cultures for MABC, and bronchoalveolar lavage cultures for MAC, respectively. For each outbreak, we used these rates to construct a pilot mov ing average (MA) SPC chart with a rolling baseline window. We also explored the performance of numerous alternative control charts, including exponentially weighted moving average, Shewhart, and cumulative sum charts.
Results
The pilot MA chart detected each outbreak within 2 months of outbreak onset, preceding actual outbreak detection by an average of 6 months. Over a combined 117 months of pre- and post-outbreak surveillance, no false positive SPC signals occurred (specificity = 100%). Prospective use of this chart for NTM surveillance could have prevented an estimated 108 cases of NTM. Six high-performing alternative charts detected all outbreaks during the month of onset with specificities ranging from 85.7% to 94.9%.
Conclusions
SPC methods have potential to substantially improve HCFA NTM surveillance, promoting early outbreak detection and prevention of NTM infections. Additional study is needed to determine the best application of SPC for prospective HC FA NTM surveillance in other settings.
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Determining Invasion Depth in Superficial Pharyngeal Carcinoma by Transoral Ultrasonography

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Determining Invasion Depth in Superficial Pharyngeal Carcinoma by Transoral Ultrasonography

Classification for transoral US findings. (A) US-EP. (B) US-SEP slight. (C) US-SEP deep. White arrow: Tumor. EP, epithelium; SEP, subepithelial propria; US, ultrasonography.


Objectives

To examine the clinical usefulness of transoral ultrasonography (US) in determining the invasion depth of superficial pharyngeal carcinoma (SPC). Determining the invasion depth of SPC is crucial for transoral surgery including determining treatment strategy. This study aimed to examine the usefulness of transoral US in determining the invasion depth of SPC.

Methods

Forty-six patients with 51 lesions who underwent both magnifying endoscopy with narrow-band imaging (ME-NBI) and transoral US were included. The primary outcomes were the sensitivity, specificity, positive (PPV), and negative predictive values (NPV) of ME-NBI and transoral US findings for pathological tumor depth in SPCs.

Results

The accuracy (82.4%), sensitivity (85.2%), PPV (82.1%), and NPV (82.6%) rates of US for subepithelial propria (SEP) were higher than those of ME-NBI and macroscopic classification, indicating that transoral US is superior to ME-NBI in determining the invasion depth. All cases where the SEP was clearly invaded (SEP deep) could be diagnosed as SEP by transoral US.

Conclusions

Transoral US may be useful in determining the invasion depth of SPCs.

Level of Evidence

3 Laryngoscope, 2022
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The efficacy of oral corticosteroids for treatment of Tietze syndrome: A pragmatic randomized controlled trial

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The efficacy of oral corticosteroids for treatment of Tietze syndrome: A pragmatic randomized controlled trial

The addition of short-term oral corticosteroids showed a clear benefit for use at 1, 2 and 3 weeks in improvement of pain and quality of life in patients with Tietze syndrome. The difference found by adding corticosteroids was maintained at mid-term follow up of patients with Tietze syndrome after treatment cessation. Joint swelling reported by patients with Tietze syndrome does not correlate with improvement in pain symptoms.


Abstract

What is known and objective

Tietze syndrome is a rare form of chest wall costochondritis with joint swelling which can cause significant chest pain and decline in ability of daily activities. There is no standardized treatment protocol. The aim of this study was to assess the efficacy of adding oral steroids in addition to other non- steroidal treatment in improvement of pain and quality of life (QOL) in patients with Tietze syndrome.

Methods

Forty patients with Tietze syndrome were randomly divided into two treatment groups: (1) One week of prednisolone 40 mg daily followed by 1 week of prednisolone 20 mg daily followed by 1 week of 10 mg with 3 weeks of non-steroidal anti-inflammatory drug (NSAID) treatment (n = 20); (2) three weeks of NSAID treatment only (n = 20). A symptom questionnaire was used to rate the major symptoms of Tietze syndrome and costochondritis: Numeric rating scale (NRS) for pain on a scale of 0 (no pain) to 10 (severest pain); the resulting global symptom score was used to evaluate the efficacy of treatment with assessment of joint swelling resolution. The EQ-5D-5L instrument for measurement of QOL was used. Assessments were made on intention to treat basis at baseline and at 1, 2 and 3 weeks followed by a medium term follow period after treatment cessation. The trial was registered at www.isrctn.com ISRCTN11877533.

Results and discussion

There was a significant drop in mean NRS pain scores between the groups at 1, 2 and 3 weeks in favour of the steroid group (46.8% vs. 17.7%; p < 0.001, 56.3% vs. 35.8% p < 0.001 and 65.4% vs. 46.7% p < 0.001 respectively). There was a 25.8% (95% CI 13.2–38.8) difference in mean NRS score drop at a median of 6.5 months after treatment cessation in favour of the steroid group over the NSAID only group. Only three cases of mild GIT upset in the steroid group and two cases of mild nausea were reported in the NSAID group. There was an improvement in QOL using the median EQ-5D-5L scoring at 3 weeks in favour of the steroid group 7 (7, 8) versus 10 (8.5–11), (p < 0.001). The improvement in pain scoring and QOL did not correlate with improvement in joint swelling at 3 weeks after treatment with 2/20 (10%) in the steroid arm versus 1/20 (5%) in NSAID arm having an obvious improvement (p = 0.393).

What is new and conclusion

In this study, addition of short-term oral corticosteroids showed a clear benefit for use at 1, 2 and 3 weeks in improvement of pain and QOL in patients with Tietze syndrome. This difference was maintained at mid-term follow up after treatment cessation. This facilitates the advantage of using steroids as well as excluding their side effects for an accepted timeframe.
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Concomitant administration of warfarin and toremifene: A case report

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Concomitant administration of warfarin and toremifene: A case report

We reported a 50-year-old woman who was treated with warfarin after prosthetic valve replacement and had a fluctuating international normalized ratio (INR) following the concomitant administration of toremifene. The results suggested when concomitant administration of warfarin and to remifene, the interaction between them is not serious, but the dose of warfarin needs to be reduced.


Abstract

What Is Known and Objective

Antiestrogen agents have been reported to enhance the anticoagulant activity of warfarin. The use of tamoxifen with warfarin has been contraindicated. However, warfarin in combination with toremifene has not been reported. We report a case in which warfarin was combined with toremifene and applied warfarin dose prediction models to predict the dose of warfarin.

Case Summary

We report the case of a 50-year-old woman with a history of breast cancer, who underwent long-term toremifene therapy after mastectomy. The patient was treated with warfarin after prosthetic valve replacement and had a fluctuating international normalized ratio (INR) following the concomitant administration of toremifene. We applied the warfarin dose prediction model to adjust the warfarin dose during treatment. Finally, her INR stabilized with a lower dose of warfarin, and there was no serious bleeding during the 1-year follow-up.

What Is New and Conclusion

Warfarin does not have a serious interaction with toremifene in this case, but it needed about 37.5% dose reduction which was comparable to the interaction of some common antibiotics with warfarin.
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Impact of magnetic resonance angiography parameters on stroke prevention therapy in pediatric patients with sickle cell anemia

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Abstract

Background

Degree of cerebrovascular stenosis in pediatric patients with sickle cell anemia (SCA) informs need for chronic transfusion therapy, which has significant risks. Flow artifact, intrinsic to magnetic resonance angiography (MRA), is dependent on technical parameters and can lead to overinterpretation of stenosis. The primary objective of this study was to document any change in stroke prevention therapy that could be attributed to the implementation of a standardized MRA scanning protocol for patients with SCA.

Methods

A standardized MRA scanning protocol with an echo time of less than 5 ms was implemented at Montefiore Medical Center (MMC), NY in May 2016. Retrospective chart review identified 21 pediatric patients with SCA, with an MRA head both pre- and post-May 2016. Arterial stenosis on MRA, machine parameters, and treatment plans were compared pre- and post-implementation.

Results

Ten of the 21 patients met inclusion criteria. Previously seen stenosis was re-classified to a lower degree in six of the 10 patients, leading to discontinuation of transfusions in five patients. No patients required escalation of therapy to chronic transfusions.

Conclusion

Optimizing flow artifact by decreasing echo time to less than 5 ms can improve accurate interpretation of cerebrovascular disease, and ensure appropriate treatment plans are in place for stroke prevention. This is especially important for implementing "TCD With Transfusions Changing to Hydroxyurea (TWiTCH)" clinical trial results in the real-world setting.
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Differential Associations of Rheumatoid Arthritis and Periodontitis or Tooth Loss: A Cross‐Sectional Study

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Abstract

Aims

To study the association between periodontitis, tooth loss, and rheumatoid arthritis by using a large national dataset.

Materials and Methods

An observational cross-sectional study was performed using the National Health and Nutrition Examination Survey (NHANES) cycles (2009-2014). Rheumatoid arthritis status was detected by a questionnaire. Periodontal status was assigned based on clinical attachment level and periodontal pocket depth. Dentition status was assessed by the number of permanent teeth observed. We examined the association between rheumatoid arthritis as exposure and moderate/severe periodontitis and non-functional dentition as outcomes. We progressively adjusted our models for different sets of potential confounders.

Results

Moderate/severe periodontitis was more prevalent in participants reporting rheumatoid arthritis (53% vs. 41.5%, p= 0.0003). Non-functional dentition was more prevalent in participants with rheumatoid arthritis (41% vs. 15.5%, p= 0.0001). The fully adjusted model showed participants with rheumatoid arthritis had higher odds of having a non-functional dentition (Odds Ratio 1.8, 95% CI 1.3-2.3, p= 0.0001), but no association with moderate/severe periodontitis (Prevalence Ratio 1.01, 95% CI 0.9-1.1, p= 0.9).

Conclusion

Rheumatoid arthritis was associated with a higher likelihood of having non-functional dentition but did not show an association with periodontitis after adjustments of the risk factors to control their confounding effect.
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Mechanical properties of platelet-rich fibrin from patients on warfarin

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Platelet-rich fibrin (PRF) has been used increasingly in oral and maxillofacial surgery in recent years. The aim of this experimental study was to perform a mechanical evaluation of PRF from patients on warfarin. PRF samples were obtained from 21 patients on warfarin (mean INR 2.30  ± 0.89) and 21 non-anticoagulated patients (control; mean INR 1.08 ± 0.07). For the patients on warfarin, two experimental groups were formed based on the PRF centrifugation time: group A, 10 min (21 samples); group B, 18 min (20 samples). (Source: International Journal of Oral and Maxillofacial Surgery)
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