Dynamics of age characteristics and prevalence of concomitant cardiovascular and non-sardiovascular diseases in patients hospitalized with COVID-19 during epidemic wave: data from TARGET-VIP registry

Aim. According to hospital-based registry, to evaluate the age characteristics and prevalence of concomitant cardiovascular and non-сardiovascular diseases in patients hospitalized with COVID-19 during epidemic wave.Material and methods. The TARGET-VIP register included 1130 patients aged 57,5+12,8 years (men, 51,2%) hospitalized at the Pirogov National Medical and Surgical Center from April 6, 2020 to June 22, 2020 with COVID-19. Cardiovascular diseases (CVDs) were diagnosed in 51,6% of patients, non-сardiovascular chronic diseases — in 48,6%, while CVDs and/or non-сardiovascular chronic diseases — in 65,8% of patients.Results. The average age of patients significantly increased by an average of 0,77 years per week (p<0,001), while the difference between the 1st week (52,8 years) and 11th week (62,2 years) was 9,4 years; the proportion of men did not change significantly. The proportion of patients with CVDs increased significantly — from 34,2% to 66,7%, on average by 3,7% per week (p<0,001; Incidence Risk Ratio (IRR)=1,037; 95% confidence interval (CI), 1,017-1,058), with chronic non-cardiovascular diseases — from 32,5% to 43,2%, on average by 2,5% per week (p<0,001; IRR=1,025; 95% CI, 1,002-1,049), as well as those with CVDs and/or chronic non-cardiovascular diseases — from 47,5% to 75,3%, on average by 3,2% per week (p<0,001; IRR=1,032; 95% CI, 1,017-1,048). Over the entire period, the proportion of people with hypertension (HTN) was 47,0%, with coronary artery disease (CAD) — 15,4%, with heart failure (HF) — 4,0%, and with atrial fibrillation (AF) — 10,1%. The proportion of patients with HTN increased by 9,5% (p<0,001; OR=1,095; 95% CI, 1,047-1,144), with СAD — by 9,4% (p=0,01; OR=1,094; 95% CI, 1,022-1,172) and with AF — by 9,4% (p<0,001; OR=1,094; 95% CI, 1,023-1,170) per week. The proportion of patients with diabetes was 16,5%, with respiratory diseases — 11,4%, with chronic kidney disease (CKD) — 12,6%, with digestive diseases — 22,5%, with obesity — 6,1%. During the epidemic wave, the most pronounced increase in the proportion of patients with CKD was by 6,2% (p=0,036; OR=1,062; 95% CI, 1,004-1,124) and with digestive diseases — by 6,0% (p=0,01; OR=1,060; 95% CI, 1,014-1,109) per week.Conclusion. According to the 11-week TARGET-VIP registry, the age of patients increased by 9,4 years, CVD cases — by 1,9 times (mainly HTN, CAD, AF), and chronic non­сardiovascular pathology — by 1,3 times (mainly CKD and digestive diseases). These trends in hospital practice corresponded to a weekly increase in the proportion of patients with a higher risk of fatal and non-fatal complications, which is the basis for further research in order to develop a system for a comprehensive prognostic assessment of the degree and rate of increase in the load on hospitals during COVID-19 epidemic wave.

Digestive Disease Mortality Dynamics During New Coronavirus Infection Pandemic in Different Subjects of Russian Federation

Aim. An analysis of digestive disease mortality dynamics in different subjects of the Russian Federation in course of the new coronavirus infection pandemic.Key points. In most subjects of the Russian Federation, the first half of 2021 enduring the COVID-19 pandemic has witnessed a higher overall mortality from digestive diseases and from peptic ulcer, liver and pancreatic illnesses compared to the same period in 2020. This situation may have roots in both the adverse impact of coronavirus infection on pre-existing digestive diseases and shortages in providing specialty medical aid to gastroenterological patients during the pandemic. Improved outpatient care and remote counselling, as well as successful educational measures, may reduce gastroenterological disease-associated mortality.Conclusion. Most regions of Russia have registered a growing mortality from digestive diseases at the new coronavirus infection pandemic due to the SARS-CoV-2 adverse impact on illness progression, as well as imposed difficulties in providing specialty medical aid.

Pediatric Endoscopy During COVID-19 Times

The global COVID-19 pandemic has led to healthcare resources being diverted or stretched, especially during periods of lock-down in affected countries. Disruptions to normal services have resulted in reduced or delayed provision of endoscopy in many countries, with consequent impacts on diagnosis or management of digestive diseases and upon endoscopy training. This review article aims to highlight key aspects of the impact of the pandemic upon endoscopy services, with a focus upon endoscopy in children.

Monitoring of the bovine digestive diseases on the Transbaikal territory

The dynamics of digestive diseases of bacterial etiology among cattle are presented. Statistical, laboratory and annual average data on registered animals with this pathology, mortality and forced slaughter of livestock were analysed for the period 2016-2020. It has been found that digestive diseases of bacterial etiology are prevalent both in young cattle (53.7% to 61.4%) and in adult cattle (43.1% of the total number of diseased animals). The following pathogens were identified on the basis of bacterial tests on biological material: enteropathogenic E. coli (37.8% of the total number of diseased animals) and group D streptococci, E. Faecalis (15.1%). The rest of the herd had associated infections (19.2%) and non-contagious digestive diseases (27.9%). As a result of this monitoring, a high incidence of digestive diseases among cattle in livestock farms in the following districts of the Trans-Baikal Territory was recorded: Akshinsky, Krasnochikoysky, Kyrinsky, Nerchinsky, Olovyaninsky, Priargunsky, Khiloksky, Shelopuginsky, Aginsky. The lowest prevalence of cattle diseases in organizations of various forms of ownership has been recorded in peasant farms in the region (6.8-10.9%). The average number of registered animals with this pathology is recorded in agricultural organizations (26.9-37.6%). A high percentage of these diseases were recorded in households (62.8%). When farms follow the organization of therapeutic and prophylactic measures, housing and feeding hygiene rules, it is possible to ensure the safety and productivity of livestock, high quality and safety of livestock products and to prevent bacterial diseases of the digestive organs.

Robotics in Gastrointestinal Endoscopy

Recent advances in endoscopic technology allow clinicians to not only detect digestive diseases early, but also provide appropriate treatment. The development of various therapeutic endoscopic technologies has changed the paradigm in the treatment of gastrointestinal diseases, contributing greatly to improving the quality of life of patients. The application of robotics for gastrointestinal endoscopy improves the maneuverability and therapeutic ability of gastrointestinal endoscopists, but there are still technical limitations. With the development of minimally invasive endoscopic treatment, clinicians need more sophisticated and precise endoscopic instruments. Novel robotic systems are being developed for application in various clinical fields, to ultimately develop into minimally invasive robotic surgery to lower the risk to patients. Robots for endoscopic submucosal dissection, autonomous locomotive robotic colonoscopes, and robotic capsule endoscopes are currently being developed. In this review, the most recently developed innovative endoscopic robots were evaluated according to their operating mechanisms and purpose of use. Robotic endoscopy is an innovative treatment platform for future digestive endoscopy.

Impact of diagnostic errors on adverse outcomes: learning from emergency department revisits with repeat CT or MRI

Background To investigate diagnostic errors and their association with adverse outcomes (AOs) during patient revisits with repeat imaging (RVRIs) in the emergency department (ED). Results Diagnostic errors stemming from index imaging studies and AOs within 30 days in 1054 RVRIs (≤ 7 days) from 2005 to 2015 were retrospectively analyzed according to revisit timing (early [≤ 72 h] or late [> 72 h to 7 days] RVRIs). Risk factors for AOs were assessed using multivariable logistic analysis. The AO rate in the diagnostic error group was significantly higher than that in the non-error group (33.3% [77 of 231] vs. 14.8% [122 of 823], p < .001). The AO rate was the highest in early revisits within 72 h if diagnostic errors occurred (36.2%, 54 of 149). The most common diseases associated with diagnostic errors were digestive diseases in the radiologic misdiagnosis category (47.5%, 28 of 59) and neurologic diseases in the delayed radiology reporting time (46.8%, 29 of 62) and clinician error (27.3%, 30 of 110) categories. In the matched set of the AO and non-AO groups, multivariable logistic regression analysis revealed that the following diagnostic errors contributed to AO occurrence: radiologic error (odds ratio [OR] 3.56; p < .001) in total RVRIs, radiologic error (OR 3.70; p = .001) and clinician error (OR 4.82; p = .03) in early RVRIs, and radiologic error (OR 3.36; p = .02) in late RVRIs. Conclusion Diagnostic errors in index imaging studies are strongly associated with high AO rates in RVRIs in the ED.

Accreditation program for gastrointestinal endoscopes reprocessing in Italy: An on-site survey

Background and study aims Endoscope reprocessing has been associated with a variable failure rate. Our aim was to present an overview on current practices for reprocessing in Italian facilities and discuss the principle critical points. Methods In 2014 the Italian Society for Digestive Diseases implemented an accreditation program in collaboration with an independent organization for certification and with the Italian Association for Endoscopy Technical Operators. During a 1-day site visit of the endoscopy center, two endoscopists, one nurse, and the representative of the certification body evaluated the endoscope reprocessing. Results As of July 1, 2020, 28 endoscopy centers had been accredited. Ten centers are completing the measures to correct deficiencies found at the visit. Three centers withdrew from the program. The accreditation program has found variations between the various centers, confirming the poor compliance with guidelines. Major deviations from the standards, established by the model before the site visit according to national and international guidelines, concerned instrument cleaning (44.7 % of the centers), instrument storage (23.7 %), and microbiological tests (31.6 %). Conclusions Our overview demonstrated the lack of many reprocessing phases, which are important to prevent endoscopy-associated infections. Accreditation can achieve a transformation in quality and safety of reprocessing with the Italian centrally-led approach.

The development of the incidence of non-neoplastic diseases of the digestive system in adults evacuated from the 30-kilometer zone of the Chornobyl nuclear power plant during the post-accident observation period (1992–2016)

Objective: We analyzed the absolute risk of the development of the incidence of non-neoplastic diseases of the digestive system in adults evacuated from the 30-kilometer zone of the Chornobyl NPP over 1992–2016 epidemiological surveillance. Materials and methods: For the epidemiological study of the incidence of non-neoplastic diseases of the digestive system in the evacuated from the 30-kilometer Chornobyl zone after the Chornobyl accident in 1992–2016 we formed a cohort of 7,143 people aged 18 years and older (2,198 men and 4,945 women). To study the features of the incidence of diseases of the digestive system over the years of observation, we calculated the epidemiological indicator - the absolute risk of development (AR). Results: During 1992–2016, 13,532 cases of the diseases of the digestive system: 3,298 (24.37%) – in men; 10,234 (75.63%) - in women) were revealed for the first time. The absolute risk of the development of digestive diseases makes up 467.64 ± 2.93 cases per 103 man-years of observation (further cases/103 man-years). It was found that 91.05% (12,321 cases) with an absolute risk of 425.32 ± 5.89 93 cas./103 man-years ( 423.22 ± 5.89- in men, 426.19 ± 3, 34 - in women) belonged to the class of the diseases of digestive system (C00-C93). Mostly diseases of oral cavity, salivary glands and jaws (C00 – C14) (200.63 ± 4.77 cases/103 man-years), esophageal diseases, stomach and duodenum (C20 – C31) (146.26 ± 4.21 93) were manifested. Significant loss of health was also caused by the diseases of the gallbladder, biliary tract and pancreas (C83–C87) (50.23 ± 2.60 93), liver disease (C70-C77) – (22.44 ± 1.76 93), non-infectious enteritis and colitis (C50–C52) – (3.93 ± 8.75), other intestinal diseases (C55–C63) – (1.83 ± 0.51) respectively. Irrespective of gender, the development of the incidence of non-neoplastic diseases of the digestive system is characterized by the identity of the diseases and the ratio of their values to the total cohort. However, women suffered more from the diseases of the gallbladder, biliary tract and pancreas, diseases of the oral cavity, men – from the diseases of esophagus, stomach and duodenum. Conclusions: 1. The revealed features of the development of digestive diseases in the evacuated from the 30-kilometer zone of the Chornobyl NPP (high absolute risks of diseases of oral cavity, salivary glands and jaws (C00–C14), diseases of esophagus, stomach and duodenum (C20–C31), biliary diseases bladder, biliary tract and pancreas (C80–C87)) need the improvement of medico-social measures to provide qualitative treatment-and-preventive, rehabilitative care from the primary level of medical care. 2. It is necessary to conduct medico-educational work on radiation hygiene, regimen, food intake and dietary nutrition for the minimization of the development of established prior nosological forms in the evacuees from the 30-kilometer zone of the ChNPP.