Incidence of Primary Aldosteronism in Patients with Hypokalemia (IPAHK+): Study Design and Baseline Characteristics

Hypokalemia plays a central role for case finding, course, treatment decision, and prognosis of patients with primary aldosteronism. However, to date there is a lack of high-level evidence about the incidence of primary aldosteronism in hypokalemic patients. The IPAHK+study is an epidemiological, cross-sectional, monocentric study to provide evidence on the incidence of PA in a hypokalemic population. The aim of the current analysis was to describe the baseline characteristics of the first 100 patients eligible for study inclusion. The recruitment of patients with hypokalemia (≤3 mmol/l) is carried out continuously on a referral-basis by the central laboratory of the University Hospital Zurich through an automated suitability testing and data delivery system. The careful evaluation of the first 100 reported patients was based on the available reporting system. Out of 28 140 screened patients, 222 (0.79%) were identified with a serum potassium value of≤3 mmol/l (mean 2.89±0.02 mmol/l). Mean potassium levels were slightly lower in non-hypertensive subjects compared to hypertensive subjects (mean difference 0.07 mmol/l, p=0.033), while no significant difference was found between the sexes and patients with and without the diagnosis of primary aldosteronism, atrial fibrillation, or the use of diuretics. The incidence of PA was 4% in the total population studied and 7.5% in the subgroup of hypertensive patients. In conclusion, the continuous enrollment of patients from the IPHAK+hypokalemia registry into the IPAHK+trial will provide evidence about the actual incidence of primary aldosteronism in a hypokalemic outpatient population.

Actual incidence of cerebral infarction after thoracic endovascular aortic repair: a magnetic resonance imaging study

OBJECTIVES The actual incidence of cerebral infarction (CI), including asymptomatic infarction, owing to thoracic endovascular aortic repair (TEVAR) has not been reported in detail. This study was performed to investigate the incidence of post-TEVAR CI by using diffusion-weighted magnetic resonance imaging (DW-MRI) and to determine the risk factors for both symptomatic and asymptomatic CI. METHODS We examined 64 patients undergoing TEVAR at our institute between April 2017 and November 2020. Aortic atheroma was graded from 1 to 5 by preoperative computed tomography. Cerebral DW-MRIs were conducted 2 days after the procedure to diagnose postoperative CI. RESULTS A total of 44 new foci were detected by post-interventional cerebral DW-MRI in 22 patients (34.4%). Only one patient developed a symptomatic stroke (1.6%), and TEVAR was successfully completed in all cases. Debranching of the aortic arch and left subclavian artery occlusion with a vascular plug was performed in 19 (29.7%) and 12 (18.8%) patients, respectively. The number of patients with proximal landing zones 0–2 was significantly higher in the CI group than in the non-CI group (68.2% vs 11.9%; P < 0.001). The following risk factors were identified for asymptomatic CI: aortic arch debranching (P < 0.001), left subclavian artery occlusion (P = 0.001) and grade 4/5 aortic arch atheroma (P = 0.048). CONCLUSIONS Over one-third of the patients examined by cerebral DW-MRI after TEVAR were diagnosed with CI. High-grade atheroma and TEVAR landing in zone 0–2 were found to be positively associated with asymptomatic CI. Clinical trial registration 02-014.

Endocrine dysfunctions may be sequelae of snake bite

Background: At present snakebite has become a serious health problem in India. The actual incidence of mortality and morbidity related to the snakebite are not reported properly. Further, the most neglected part is the long term endocrine dysfunctions in survivors of snake bite. Aims and Objectives: To evaluate serum fT4, TSH, cortisol, prolactin, and testosterone levels in snake bite survivors after 3 and 6 months of snakebite. Materials and Methods: Forty-five survivors of russels viper bite patients were selected for the study according to inclusion and exclusion criteria. Admitted patients were treated accordingly and discharged in stable condition. The hormonal status were analysed and they have been followed up after 3 and 6 months. Results: Significant decrease in serum cortisol and prolactin were observed in survivors of russels viper bite patients particularly in them whose mean serum creatinine was more than 1.2 mg/dl and systolic blood pressure was <110 mm of Hg and diastolic Blood pressure was < 70 mm of Hg. Conclusion: Measurement of long term hormonal status like serum cortisol and prolactin can be beneficial in survivors of hematotoxic snake bite patients.

ON ESTIMATING THE ADDITIONAL INCIDENCE OF COVID-19 AMONG POPULATIONS EXPOSED TO POLLUTED AMBIENT AIR: METHODICAL APPROACHES AND SOME PRACTICAL RESULTS

This research is vital due to the considerable global medical and demographic losses during the COVID-19 pandemic and the latest research works providing evidence of a correlation between air pollution and spread of the disease, its sever- ity, clinical course and outcomes. Our research goal was to quantitatively estimate the influence of ambient air pollution on SARS-CoV-2 spread among populations in six cities in the Russian Federation. These cities were among priority ones as per air pollution and were in- cluded in the “Clean air” Federal project (Bratsk, Krasnoyarsk, Norilsk, Omsk, Cherepovets, and Lipetsk). Our hypothesis was that dynamic features of the infection spread would be different from an expected model of its epi- demiologic process under exposure to environmental pollution. Regression and correlation analysis was performed for rela- tionships between a daily deviation in actual incidence from a basic epidemiologic scenario and the average daily concen- trations of chemicals in ambient air. The initial data were results obtained from instrument measurements of ambient air quality in the examined cities (approximately 10.8 thousand measurements covering 29 chemicals) and the daily incidence of COVID-19 from April 18, 2020 to July 31, 2021 (77,337 cases). An authentic correlation between COVID-19 incidence and chemical concentrations in ambient air was detected in all six examined cities. The contribution of air pollution to COVID-19 prevalence amounted to 5.0 ± 2.6 % in five cities (Kras- noyarsk, Norilsk, Omsk, Cherepovets, and Lipetsk) over the examined period. In Bratsk, this value was about 33% and it requires additional research for either confirmation or correction. Growth in COVID-19 incidence in the examined territo- ries is associated with particulate matter (PM10, PM2.5) and some other chemicals that can irritate the airway directly or indirectly (sulfuric acid vapors, hydrogen chloride, formaldehyde, hydrogen sulphide, etc.). Target levels were substantiated for several priority chemicals; should these levels be achieved, one would predict a decrease in COVID-19 prevalence by more than 1-3% in the examined cities. We propose that population morbidity and mortality caused by COVID-19 require further studies, including those combined with medical and biological examination regarding efficiency of vaccination and post-vaccination immunity per- sistence on territories with elevated environmental pollution.

ON ESTIMATING THE ADDITIONAL INCIDENCE OF COVID-19 AMONG POPULATIONS EXPOSED TO POLLUTED AMBIENT AIR: METHODICAL APPROACHES AND SOME PRACTICAL RESULTS

This research is vital due to the considerable global medical and demographic losses during the COVID-19 pandemic and the latest research works providing evidence of a correlation between air pollution and spread of the disease, its sever- ity, clinical course and outcomes. Our research goal was to quantitatively estimate the influence of ambient air pollution on SARS-CoV-2 spread among populations in six cities in the Russian Federation. These cities were among priority ones as per air pollution and were in- cluded in the “Clean air” Federal project (Bratsk, Krasnoyarsk, Norilsk, Omsk, Cherepovets, and Lipetsk). Our hypothesis was that dynamic features of the infection spread would be different from an expected model of its epi- demiologic process under exposure to environmental pollution. Regression and correlation analysis was performed for rela- tionships between a daily deviation in actual incidence from a basic epidemiologic scenario and the average daily concen- trations of chemicals in ambient air. The initial data were results obtained from instrument measurements of ambient air quality in the examined cities (approximately 10.8 thousand measurements covering 29 chemicals) and the daily incidence of COVID-19 from April 18, 2020 to July 31, 2021 (77,337 cases). An authentic correlation between COVID-19 incidence and chemical concentrations in ambient air was detected in all six examined cities. The contribution of air pollution to COVID-19 prevalence amounted to 5.0 ± 2.6 % in five cities (Kras- noyarsk, Norilsk, Omsk, Cherepovets, and Lipetsk) over the examined period. In Bratsk, this value was about 33% and it requires additional research for either confirmation or correction. Growth in COVID-19 incidence in the examined territo- ries is associated with particulate matter (PM10, PM2.5) and some other chemicals that can irritate the airway directly or indirectly (sulfuric acid vapors, hydrogen chloride, formaldehyde, hydrogen sulphide, etc.). Target levels were substantiated for several priority chemicals; should these levels be achieved, one would predict a decrease in COVID-19 prevalence by more than 1-3% in the examined cities. We propose that population morbidity and mortality caused by COVID-19 require further studies, including those combined with medical and biological examination regarding efficiency of vaccination and post-vaccination immunity per- sistence on territories with elevated environmental pollution.

Dying by Suicide in Nursing Homes: A Preventable End of Life Outcome for Older Residents

Suicide research and suicide prevention have given comparatively little attention to the older adult residents of nursing homes. This population is characterized by advanced age, significant infirmity, limited autonomy and social connections, and other factors associated with high suicide risk such as self-neglect. However, little is known of the actual incidence and prevalence of suicide in older adults in such residential care settings, partly because of how such deaths are reported. Suicide risk screenings are nominal, facility staff lack training to identify signs of suicidality, and suicide prevention programs are not common in the nursing home industry. These deficits can be remedied by increasing awareness among family members, facility caregivers, contracted providers, community aging services, accrediting and regulatory agencies, and residents.

A retrospective cohort study using a national surveillance questionnaire to investigate the characteristics of maternal venous thromboembolism in Japan in 2018

Background In Japan, the numbers of deliveries by women of older maternal age and women with overweight or obesity have recently increased. Since 2008, the guidelines and practices to prevent the maternal venous thromboembolism (VTE) have been recommended antepartum and postpartum thromboprophylaxis for each risk level of VTE. This study aimed to clarify the incidence and characteristics (type of VTE and thromboprophylaxis) of VTE in pregnant women in Japan to reduce the rate of mortality from VTE Methods Of 2299 institutions sent the surveillance questionnaire, 666 (29.0%) responded, and data from 295,961 women who gave birth in those institutions in 2018 were analyzed. We calculated the incidence and characteristics of VTE before and after the deliveries. Results At the responding institutions, 243 women (0.082%) had VTE in 2018. In 2018, deep vein thrombosis was significantly more common (0.0053%) than pulmonary thromboembolism (0.0019%; p < 0.0001). The incidence of antepartum VTE (0.0055%) was significantly higher than that of postpartum VTE (0.0026%; p < 0.0001). The incidence of VTE after cesarean Sect. (0.0074%) was significantly higher than that after vaginal delivery (0.0012%; p < 0.0001). Of the women with VTE, 4 (1.6%) died. Conclusions Among the women thought to have a low risk of VTE during the antepartum period, and especially women who had a vaginal delivery, the actual incidence of VTE might have increased in Japan.

COMPARISON OF THE SIDE EFFECTS OF THE VARIOUS COVID-19 VACCINES

Purpose: In this paper, we will analyze the side effects of the 4 popular Covid-19 vaccines (Moderna, Pzer, Johnson & Johnson, AstraZeneca) and compare the population groups involved in each vaccine trial. With the availability of these 4 different vaccines, people are trying to understand the differences in the side effect prole of each vaccine. We have attempted to collect data from the different publicly reported sites which include information about the various trials for each vaccine and pull all the numbers in one place to help the readers compare for themselves. Method: We collected data relating to the side effects of each vaccine from the Fact Sheet for Health Care Providers EUA published by the FDA for each vaccine as well as data from the Phase 1-2a trial of the AstraZeneca vaccine published by the Lancet. https://www.fda.gov/media/144637/download https://www.fda.gov/media/144413/download https://www.fda.gov/media/146304/download https://www.thelancet.com/action/showPdf?pii=S0140-6736%2820%2932661-1 Results: The common side effects after the vaccines such as headache, fatigue, nausea, pain, swelling at vaccine site, fever was compared between different vaccine groups as well as between various age subgroups in each vaccine group. Then we focused on the rare side effects associated with each vaccine such as Bell's Palsy with Pzer and Moderna vaccines and thromboembolic events with J&J vaccine and transverse myelitis in the Astra Zeneca vaccine. The side effect rate in each vaccine and placebo group is included in the data. Conclusion:In effect all vaccines are found safe with incidence of the rare and serious adverse events being extremely low and, in some cases, extremely difcult to say whether the adverse event could actually be attributed to the vaccine or to chance given the actual incidence of the disease in the general population.

Estimation of the Actual Incidence of Coronavirus Disease (COVID-19) in Emergent Hotspots: The Example of Hokkaido, Japan during February–March 2020

Following the first report of the coronavirus disease 2019 (COVID-19) in Sapporo city, Hokkaido Prefecture, Japan, on 14 February 2020, a surge of cases was observed in Hokkaido during February and March. As of 6 March, 90 cases were diagnosed in Hokkaido. Unfortunately, many infected persons may not have been recognized due to having mild or no symptoms during the initial months of the outbreak. We therefore aimed to predict the actual number of COVID-19 cases in (i) Hokkaido Prefecture and (ii) Sapporo city using data on cases diagnosed outside these areas. Two statistical frameworks involving a balance equation and an extrapolated linear regression model with a negative binomial link were used for deriving both estimates, respectively. The estimated cumulative incidence in Hokkaido as of 27 February was 2,297 cases (95% confidence interval (CI): 382–7091) based on data on travelers outbound from Hokkaido. The cumulative incidence in Sapporo city as of 28 February was estimated at 2233 cases (95% CI: 0–4893) based on the count of confirmed cases within Hokkaido. Both approaches resulted in similar estimates, indicating a higher incidence of infections in Hokkaido than were detected by the surveillance system. This quantification of the gap between detected and estimated cases helped to inform the public health response at the beginning of the pandemic and provided insight into the possible scope of undetected transmission for future assessments.

Re-Evaluation of the Prevalence of Permanent Congenital Hypothyroidism in Niigata, Japan: A Retrospective Study

Although newborn screening (NBS) for congenital hypothyroidism (CH) in Japan started more than 40 years ago, the prevalence of CH remains unclear. Prevalence estimations among NBS-positive CH individuals include those with transient hypothyroidism and transient hyperthyrotropinemia, and re-evaluation with increasing age is necessary to clarify the actual incidence. Thus, we re-evaluated the incidence of permanent CH. Of the 106,114 patients who underwent NBS in the Niigata Prefecture, Japan, between April 2002 and March 2006, 116 were examined further due to high thyroid-stimulating hormone levels (>8 mIU/L) and were included in the study. We retrospectively evaluated their levothyroxine sodium (LT4) replacement therapy status from the first visit to 15 years of age. Of the 116 NBS-positive patients, 105 (91%) were initially examined in our department. Of these, 72 (69%) started LT4 replacement therapy on the first visit. Subsequently, 27 patients continued LT4 replacement until 15 years of age after multiple re-evaluations. The prevalence of permanent CH in the Niigata Prefecture during this period was 1 in 2500–3500 children. Ultimately, 62.5% of patients on LT4 replacement discontinued treatment by 15 years of age. This is the first study to clarify the true prevalence of permanent CH in Japan.