Analyzing Features and Social Determinants of the Incidence of Class A and B Notifiable Infectious Diseases in China From 2004 to 2018

Background: The social order of the whole world has been disrupted since the COVID-19 outbreak. In China, we added novel coronavirus pneumonia to the list of Class B notifiable infectious diseases, and we placed Class A notifiable infectious diseases under strict monitoring. Therefore, it is significant that we study the features and social determinants of the incidence of both Class A and B infectious diseases.Methods: We analyzed the annual percentage change in the incidence of overall infectious diseases and the four main diseases by descriptive statistics analysis, estimated the differences in the incidence of infections in seven regions over 15 years by using a generalized estimation equation (GEE), and then determined social determinants affecting these infectious diseases by using a panel data model.Results: The incidence of overall Class A and B infectious diseases has been declining since January 2004. The infectious diseases with the highest yearly incidence were hepatitis, tuberculosis, syphilis, and bacterial and amoebic dysentery, with an incidence rate that has remained stable over the past 15 years. The locations of disease incidence in ascending order from low to high was East China, Northeast China, North China, Southwest China, Central China, South China, and Northwest China (c2=68.60 p<0.001). The changes in the characteristics of yearly incidence varied (c2=44.84 p<0.001). We found that two determinants, namely, percentage of people with illiteracy in the total population aged 15 years and older (p=0.01) and number of family health service people per capita (p<0.001), were positive for infectious diseases. Three determinants, including public green areas per capita (p<0.001), number of public transportation vehicles per 10 000 people (p=0.02) and area of paved roads per capita (p<0.001), were negative for infectious diseases.Conclusions: We successfully prevented and controlled Class A and B infectious diseases after the outbreak of severe acute respiratory syndrome (SARS) in 2003. Over the years, hepatitis and tuberculosis have had the highest incidence among infectious diseases and thus more attention needs to be given to these diseases. Social determinants had a significant influence on infectious diseases. Some strategies related to social determinants are needed to prevent infectious diseases.

Nationwide incidence of sarcomas and connective tissue tumors of intermediate malignancy over four years using an expert pathology review network

Background Since 2010, nationwide networks of reference centers for sarcomas (RREPS/NETSARC/RESOS) collected and prospectively reviewed all cases of sarcomas and connective tumors of intermediate malignancy (TIM) in France. Methods The nationwide incidence of sarcoma or TIM (2013–2016) was measured using the 2013 WHO classification and confirmed by a second independent review by expert pathologists. Simple clinical characteristics, yearly variations and correlation of incidence with published clinical trials are presented and analyzed. Results Over 150 different histological subtypes are reported from the 25172 patients with sarcomas (n = 18712, 74,3%) or TIM (n = 6460, 25.7%), with n = 5838, n = 6153, n = 6654, and n = 6527 yearly cases from 2013 to 2016. Over these 4 years, the yearly incidence of sarcomas and TIM was therefore 70.7 and 24.4 respectively, with a combined incidence of 95.1/106/year, higher than previously reported. GIST, liposarcoma, leiomyosarcomas, undifferentiated sarcomas represented 13%, 13%, 11% and 11% of tumors. Only GIST, as a single entity had a yearly incidence above 10/106/year. There were respectively 30, 64 and 66 different histological subtypes of sarcomas or TIM with an incidence ranging from 10 to 1/106, 1–0.1/106, or < 0.1/106/year respectively. The 2 latter incidence groups represented 21% of the patients with 130 histotypes. Published phase III and phase II clinical trials (p<10−6) are significantly higher with sarcomas subtypes with an incidence above 1/106 per. Conclusions This nationwide registry of sarcoma patients, with exhaustive histology review by sarcoma experts, shows that the incidence of sarcoma and TIM is higher than reported, and that tumors with a very low incidence (1<106/year) are less likely to be included in clinical trials.

Cardiotoxicity during long-term trastuzumab use in patients with HER2-positive metastatic breast cancer: who needs cardiac monitoring?

Purpose Patients with HER2-positive metastatic breast cancer (MBC) usually receive many years of trastuzumab treatment. It is unknown whether these patients require continuous left ventricular ejection fraction (LVEF) monitoring. We studied a real-world cohort to identify risk factors for cardiotoxicity to select patients in whom LVEF monitoring could be omitted. Methods We included patients with HER2-positive MBC who received > 1 cycle of trastuzumab-based therapy in eight Dutch hospitals between 2000 and 2014. Cardiotoxicity was defined as LVEF < 50% that declined > 10%-points and was categorized into non-severe cardiotoxicity (LVEF 40–50%) and severe cardiotoxicity (LVEF < 40%). Multivariable Cox and mixed model analyses were performed to identify risk factors associated with cardiotoxicity. Additionally, we explored the reversibility of cardiotoxicity in patients who continued trastuzumab. Results In total, 429 patients were included. Median follow-up for cardiotoxicity was 15 months (interquartile range 8–31 months). The yearly incidence of non-severe + severe cardiotoxicity in the first and second year was 11.7% and 9.1%, respectively, which decreased thereafter. The yearly incidence of severe cardiotoxicity was low (2.8%) and stable over time. In non-smoking patients with baseline LVEF > 60% and no cardiotoxicity during prior neoadjuvant/adjuvant treatment, the cumulative incidence of severe cardiotoxicity was 3.1% after 4 years of trastuzumab. Despite continuing trastuzumab, LVEF decline was reversible in 56% of patients with non-severe cardiotoxicity and in 33% with severe cardiotoxicity. Conclusions Serial cardiac monitoring can be safely omitted in non-smoking patients with baseline LVEF > 60% and without cardiotoxicity during prior neoadjuvant/adjuvant treatment.

Profile of intraoperative complications in cataract surgery SEHEDS: Sitapur eye hospital eye disease study

Background: Over the past several decades there have been many advances in the equipment, instrumentation and techniques of performing cataract surgery. This article will address the profile of intraoperative complications in cataract surgery.Methods: In this retrospective study all cataract procedures performed (n=18775) during the two years period (i.e. 2017 and 2018) were analysed and total 1401 (7.46%) valid cases (those having complications) were seen with 686 (49.0%) and 715 (51.0%) cases in the year 2017 and 2018 respectively. The age, gender, and side of the eye operated on were noted. The yearly incidence of the profile of complications was analysed. Results: Out of the total 1401 cases of eventful cataract surgery majority of the cases were of the age range of 51-70 years 1140 (6.07%) males were slightly higher in number i.e. 710 (3.78%) whereas females were 691 (3.68%), right eye was majorly operated for cataract i.e. 760 (4.05%). Manual small incision cataract surgery (MSICS) was done in the majority of the patients followed by phaco. The patients faced the complications due to cataract surgery in which posterior capsular rent- vitreous disturbance was the major complication occurred in majority of the patients 965 (5.15%). Conclusions: Patients who underwent eventful cataract surgery the most common intra-operative complications which were mainly posterior capsular rent- with vitreous disturbance and iridodialysis. Patients with higher risk factor should be identified and appropriate measures must be taken to minimize intraoperative complications to get better visual outcomes.

Tuberculosis Burden in the Tea Gardens of Assam: A Discussion on the Risk Factors and Social Determinants

ABSTRACT Tuberculosis (TB) is one of the deadliest diseases identified as the ‘disease of the poor’. India has the highest yearly incidence of TB in the world. Besides bio-medical determinants and risk factors, social determinants increase the risk factors of exposure to TB germs and after-exposure effects on a population. Growing experiences in TB control advocate more focus on intervention in social determinants as a complementary measure to the curative TB control regimen, as the curative TB control programme alone has been unable to control TB effectively. There is a high TB burden in the tea gardens of Assam despite the presence of a TB monitoring mechanism in place. This paper explores the extent of risk factors and social determinants prevalent among the tea garden worker population, which might help policy planning for controlling TB in Assam’s tea gardens.

Revisiting the epidemiology of pertussis in Canada, 1924–2015: a literature review, evidence synthesis, and modeling study

Background Disease surveillance is central to the public health understanding of pertussis epidemiology. In Canada, public reporting practices have significantly changed over time, creating challenges in accurately characterizing pertussis epidemiology. Debate has emerged over whether pertussis resurged after the introduction of adsorbed pertussis vaccines (1981–1985), and if the incidence fell to its pre-1985 after the introduction of acellular pertussis vaccines (1997–1998). Here, we aim to assemble a unified picture of pertussis disease incidence in Canada. Methods Using publicly available pertussis surveillance reports, we collected, analyzed and presented Canadian pertussis data for the period (1924–2015), encompassing the pre-vaccine era, introduction of vaccine, changes to vaccine technology, and the introduction of booster doses. Information on age began to be reported since 1952, but age reporting practices (full, partial or no ages) have evolved over time, and varied across provinces/territories. For those cases reported without age each year, we impute an age distribution by assuming it follows that of the age-reported cases. Results Below the age of 20 years, the adjusted age-specific incidence from 1969 to 1988 is substantially higher than existing estimates. In children < 1 year, the incidence in some years was comparable to that during the 1988–1999 resurgence. Conclusions The results presented here suggest that the surge in the average yearly incidence of pertussis that began in 1988 was weaker than previously inferred, and in contrary to the past findings, below age 5, the average yearly incidence of pertussis from 1999 to 2015 (when the incidence dropped again) has been lower than it was from 1969 to 1988.

Atrial fibrillation with or without structural abnormalities. Analysis from a nationwide database

Background Atrial Fibrillation (AF) is often associated with underlying heart failure, valvular disease, ischemic heart disease, as well as other structural heart diseases, but can also occur as an independent entity which may be named pure AF or lone AF. Small cohort studies have suggested that lone AF patients may have a favorable prognosis in terms of mortality and ischemic stroke rates. We aimed to assess, at a nationwide scale, the prognosis of patients hospitalized with lone AF and AF associated with cardiac disease. Methods From the French administrative hospital-discharge PMSI database (Programme de Médicalisation des Systèmes d'Information) covering hospital care and representative of the whole French population, all consecutive patients with AF diagnosis hospitalized between 2010 and 2018 were included. From this huge database, 2,793,234 patients were included: group lone FA: 665,431, group AF and cardiac disease: 2,727,803. Incidence rates (%/year) for the outcomes (all-cause death, cardiovascular [CV] death, or ischemic stroke) during follow-up were compared between groups using incidence rate ratios (RR) for the whole cohort and also for a subgroup of 539,654 propensity score matched patients for non-cardiovascular conditions (269,827 with AF alone and 269,827 with AF and CD). Results The majority of this population had AF associated with a cardiac disease (n=2,127,803; 76.2%). At follow-up (median [IQR] 1.1 [0.1–3.4] years), patients with AF and CD were at higher risk of all-cause mortality (yearly incidence 13.6% vs 9.0%, RR [95% CI] 1.51 [1.50–1.52], p&lt;0.00001) and CV death (4.4% vs 1.9%, RR 2.33 [2.30–2.36], p&lt;0.00001) than those with lone AF. In the propensity score matched population (median follow-up [IQR] 1.9 [0.3–4.4] years), patients with AF and CD also had worse outcomes than patients with lone AF (yearly incidence rates for all-cause mortality: 10.6% vs 7.4%, RR 1.43 [1.42–1.45], p&lt;0.00001; and for CV death: 3.3% vs 2.0%, RR 1.64 [1.61–1.68], p&lt;0.00001). However, lone AF patients were at higher risk of ischemic stroke: yearly incidence rates 2.75% in those with lone AF vs 1.69% in patients with AF and CD (RR 0.62 [0.60–0.63], p&lt;0.00001). Conclusion In our large study from a nationwide database about patients hospitalized with AF, two distinct clinical entities were identified, that could explain the results highlighted: 1) the consistently higher mortality in the group associating AF and underlying heart disease (AF may bea marker for poor outcome when there is a structural heart disease; 2) Lone AF group which prognosis may be related to a higher incidence of thromboembolic events. These results could have important implications in terms of thromboembolic prevention but further studies are still needed to investigate the underlying mechanisms of embolic pathophysiology and its specific management. Funding Acknowledgement Type of funding source: None

Exploring the temporal relationship between atrial fibrillation and heart failure development. Analysis from a nationwide database

Background Atrial Fibrillation (AF) and Heart Failure (HF) often coexist and are closely intertwined, each condition worsening the other. Small cohorts studies have suggested a worse prognosis in patients who had developed HF first. However, the temporal relationships between these two pathologies have not been fully explored yet. We aimed to assess, at a nationwide scale, the prognosis of patients hospitalized with HF and AF, based on the timing of AF and HF development. Methods From the French administrative hospital-discharge PMSI database (Programme de Médicalisation des Systèmes d'Information), covering hospital care and representative of the whole french population. All consecutive patients with both diagnoses of AF and HF hospitalized between 2010 and 2018, whatever the order of occurrence for HF or AF, were included. From the database, 1,412,730 patients had inclusion criteria, of whom 403,934 developed AF First and 1,008,796 who developed HF First. Incidence rates (%/year) for the outcomes (all-cause death, cardiovascular (CV) death, or ischemic stroke) during follow-up were compared for each group using incidence rate ratios (RR) in the whole cohort and in a subgroup of 502,456 propensity-score matched patients (251,228 with AF first and 251,228 with HF first). Results In the whole population, most patients had developed HF before AF (n=1,008,796; 71.40%). At follow-up (median [IQR] 1.4 [0.1–3.7] years) patients with HF First had increased risk of all-cause death (yearly incidence: 18.9% vs 9.4%; [RR ([95% CI)]: [2.01 (2.00–2.02)]; p&lt;0.00001), and CV death (7.0% vs 3.0%; [RR 2.31 (2.29–2.34)]; p&lt;0.00001). In propensity score matched population, (follow-up median [IQR] 2.2 [0.5–4.4] years), patients with HF first had also worse outcomes than patients with AF first (all-cause death rates yearly incidence; 15.2% vs 9.4% [RR 1.63 (1.61–1.64)], p&lt;0.00001; CV death rates: 5.6% vs 3.0% [RR 1.87 (1.84–1.90)], p&lt;0,00001); ischemic stroke rate: 2.2% vs 1.3% [RR 1.71 (1.67–1.76)], p&lt;0.00001). Conclusion In our large study from a nationwide database in patients hospitalized with both AF and HF, two distinct clinical entities were identified, based on the chronological sequence of AF and HF developments. Our results confirming that HF preceding AF is much worse than the opposite, and this might have therapeutics implications. However, further studies are needed to investigate the underlying mechanisms of the interplay of these dual conditions. Funding Acknowledgement Type of funding source: None

Multiple system atrophy in a man misdiagnosed with parkinsonism

Multiple system atrophy (MSA) is a rare sporadic, progressive, neurodegenerative disorder with autonomic deficits, with a yearly incidence of 0.000006%. MSA is often misdiagnosed as idiopathic Parkinson’s Disease (PD). It may present with a combination of parkinsonian, autonomic, and cerebellar signs. From a prognostic point of view, accurate diagnosis is essential. Our patient was misdiagnosed as having PD, but after thorough workup was diagnosed as having MSA type Parkinson’s. Because of this, the patient was put on supportive treatment for MSA. The authors strive to differentiate between the types of multiple system atrophy and its diagnostic criteria as well as differences between MSA and Parkinson’s.

Inhaled corticosteroids and the risk of type 2 diabetes among Swedish COPD patients

This study reports the association of ICS use and the risk of type 2 diabetes mellitus (T2DM) in Swedish patients with COPD using data from real-world, primary care settings. A total of 7078 patients with COPD were included in this analysis and the 5-year cumulative incidence rate per 100,000 person years was 1506.9. The yearly incidence rate per 100,000 person years ranged from 850 to 1919. Use of ICS especially at a high dose in patients with COPD was related to an increased risk of T2DM.