Abstract Background：Recurrent respiratory papillomatosis (RRP) is recurring benign papillomatous lesions which still relies on repeated surgical treatment. However, there is no guidelines of surgical technique nowadays. Objectives: This retrospective cohort study aims to obtain a better understanding of RRP, and select the best surgical modality for RRP among microdebrider, CO2 laser and KTP laser. Study design: Retrospective cohort study. Methods: Medical records of 112 RRP patients treated at EYE&ENT Hospital of Fudan University from 2018 to 2021 were reviewed, with at least 6-month follow-up. Three treatment subgroups(microdebrider, CO2 laser and KTP laser) were analyzed within AO-RRP and JO-RRP populations respectively. Results: 112 patients (39 JO-RRP and 72 AO-RRP) and a total of 353 surgical procedures were included. Jo-RRP group had higher Derkay anatomical score(p<0.05), lower percentage of dysplasia and an earlier trend in recurrence(p<0.05) than Ao-RRP group. There were no significant differences among three surgical modalities on median treatment intervals(MTI) or survival curves(p>0.05), with the Jo-RRP MTI of the microdebrider(92.5[47.3~200]), CO2 laser(140[70~255]), KTP laser(90[62.3~221.3]), and Ao-RRP microdebrider(267.50[152.5,449.5]), CO2 laser(247.5[145.5,474.7]), KTP laser(107.5[68.3,330.5]). Conclusion and Significance: The Jo-RRP patients have more concomitant invasiveness, but less dysplasia than AO-RRP patients. Three surgical modalities appeare to be equally effective in management of Jo-RRP or AO-RRP. Key Words: Papillomatosis, surgery, treatment, recurrence, efficacy.

Background. Population-level estimates of hospitalisations for physical disease in recently treated populations of childhood cancer survivors are limited. In the Australian context, the long-term effects of childhood cancer on survivors and the health system are unclear. We examined the trends in primary hospitalisations for physical disease in a whole-population cohort of 5-year childhood cancer survivors (CCS) diagnosed in Western Australia (WA) from 1982-2014. Methods. We examined hospitalisation records for 2938 CCS and 24 792 matched ‘non-CCS’ controls, discharged from 1987-2019. Andersen-Gill Cox regression models for recurrent events were used to examine hospitalisation risk. Mean cumulative counts were used to examine hospitalisation burden by time since diagnosis and attained age. Negative binomial regression models were used to examine the annual percentage change (APC) in hospitalisations. Results. We identified a higher risk of hospitalisation for all-cause (HR=1.8, 95%CI 1.6-2.0) physical disease in CCS than controls. Compared to controls, hospitalisation risk was highest for second malignant neoplasms (HR=13.2, 95%CI 9.9-17.6) and blood diseases (HR=5.6, 95%CI 1.8-17.1) in CCS. Characteristics associated with higher hospitalisation rates included female gender, diagnosis with malignant bone tumours, cancer diagnosis age between 5-9 years, multiple childhood cancer diagnoses, higher comorbidity, high socio-economic deprivation, and geographic remoteness. The APC in hospitalisations differed between groups (CCS APC=-3.8%; controls APC=2.4%, p<0.05). Conclusions. A higher risk of hospitalisation for physical disease was observed in CCS compared with children not diagnosed with cancer, with the risk continuing to increase up to 30 years post-diagnosis. These findings emphasise the need for continued specialised care and additional research to understand the unmet needs in this population.

A document by Peter Socha. Click on the document to view its contents.

Objective: To evaluate caesarean section (CS) rates in women with and without HIV and frequency of mother-to-child HIV transmission. Design: Retrospective cohort study. Setting: Tertiary hospital in south Brazil, epicenter of the country’s HIV epidemic. Population or Sample: Women-infant pairs delivering at one institution between 1/1/2008 to 12/31/2018 Methods: Data was extracted from hospital records CS frequencies were compared using Pearson’s chi-squared test. CS predictors were evaluated by multivariate log-linear Poisson regression using a generalized estimating equations approach. HIV viral suppression (VS) was defined as virus load (VL) of <1000 copies/ml at delivery. HIV MTCT was determined according to national guidelines. Main Outcome Measures: C-section, HIV mother-to-child transmission (MTCT). Results: Over 11 years, 48,688 pregnancies occurred in 40,375 women; HIV seroprevalence was 2.7%; 18,886 (38.8%) CS were performed; 47.7% of WLH and 38.6% of women without HIV (WWOH) had CS, p<0.001. Although HIV was a risk factor for CS (aRR: 1.17 [1.05-1.29]), WLH with VS achieved similar CS rates (36.7%) as WWOH (39.8%) by 2018. CS in WLH with unknown VL at delivery (42.6%) did not increase over time. HIV MTCT rate was 2.2%, highest in WLH with unknown VL (8.4%) versus WLH without VS (4.1%) and WLH with VS (0.5%; p<0.001). Conclusion: In the HIV epicenter of Brazil, WLH with VS had less surgical deliveries, likely due to potent combination antiretroviral use. Nearly half of WLH with unknown VL, did not undergo CS, a potential missed opportunity for HIV PMTCT.

Objective: To investigate whether the Antenatal Late Preterm Steroids (ALPS) trial, has been translated into clinical practice in Canada and the United States. Temporal trends in optimal and suboptimal antenatal corticosteroid (ACS) use among late preterm deliveries were also assessed. Design: A retrospective cohort study. Setting: USA and Canada, 2007 to 2020. Population: All live births in the US (n= 32,476,039) and Nova Scotia, Canada (n= 116,575). Methods and Main outcome measured: Using data from the Natality database and the Nova Scotia Atlee Perinatal Database, ACS administration within specific categories of gestational age was assessed by calculating rates per 100 live births. Temporal trends in optimal, and suboptimal ACS use were also assessed. Results: In Nova Scotia, the rate of any ACS administration increased significantly among women delivering at 35-36 weeks, from 15.2% in 2007-2016 to 19.6% in 2017-2020 (OR 1.36, 95%CI 1.14, 1.62). In the U.S., among live births at 35-36 weeks’ gestation, any ACS use increased from 4.1% in 2007–2016 to 18.5% in 2017–2020 (OR 5.33, 95% CI 5.28–5.38). Among infants between 24 and 34 weeks’ gestation in Nova Scotia, 32% received optimally timed ACS, while 47% received ACS with suboptimal timing. Of the women who received ACS in 2020, 34% in Canada and 20% in the United States delivered at ≥37 weeks. Conclusion: Publication of the ALPS trial resulted in increased ACS administration at late preterm gestation in Nova Scotia, Canada and the U.S.. However, a significant fraction of women receiving ACS prophylaxis delivered at term gestation.

Hyperbaric oxygen should not be used routinely for carbon monoxide poisoning: CONDavid N. Juurlink, MD, PhDDepartments of Medicine, Pediatrics, and Health Policy, Management and Evaluation, University of Toronto, the Ontario Poison Centre, and Sunnybrook Research InstituteWord count: 2036

Objective：Discussing the influence of Diastasis Recti Abdominis (DRA) on patients’ social, psychological, and biological experiences, It tries to direct the patients’ attention to DRA. Meanwhile, how patients deal with DRA is summarised to provide effective measures to help them, provide reference for medical staff in managing DRA. Design: An observational and descriptive study design Setting: Zhejiang Province, China Sample：Female diagnosed with DRA. Methods: A purposive sampling method was adopted when selecting female DRA participants for semi-structured interviews based on their disease perception with the Colaizzi seven-step analysis method being used for analysis. Main outcome measure: DRA people’s perception and response to disease Results: In the interviews, three themes, and 10 sub-themes, were extracted 1) Inadequate disease perception (including a lack of aetiology cognition, incomplete prevention knowledge, and insufficient treatment knowledge), 2) The disease as a daily inconvenience (including body image disorder, abdominal muscle weakness, poor pelvic floor strength, backache, and a psychological burden), and 3) Varying attitudes and management responses to DRA (including positive and negative responses). Conclusion: Patients awareness of their DRA should be improved to consider whether any of their physical or mental discomfort experienced in daily life is related to this condition. DRA’s management should be holistic and comprehensive— including a simple symptomatic treatment— along with emotional, psychological, and behavioural coping strategies. Tweetable Abstract: DRA is common among women and has adverse effects on patients. The exploration of DRA helps to promote disease perception of DRA and promote women’s health.

Background. Cystic fibrosis (CF) is an autosomal recessive disorder associated with an increased susceptibility to respiratory infections that cause progressive decline in lung function and lead to lung damage and chronic respiratory failure. To analyze the CF-related mortality trends in the Mexican population during a 22-year period.  We conducted a mortality trend analysis using death certificates data. Trends in CF-specific and in age-specific mortality rates were evaluated using Joinpoint regression analysis. Among subjects ≤40 years, 1184 CF-related deaths were identified. In 1999–2009 median age at death was 7 years compared to 10 years in 2010–2020. Overall mortality rate increased from 0.03 per 100,000 in 1999 to 0.06 per 100,000 in 2020. A decline in mortality rate for patients ≤28 days and an increase in mortality rate in older age groups was observed. Conclusion. The increasing trend in overall mortality, associated with a downward trend in neonatal mortality and an increase in median age at death is conceivably due to enhanced diagnosis, as well as major advances in treatment modalities, leading to higher survival rates. Key words: age at death, cystic fibrosis, epidemiology, low- and middle-income countries, mortality, survival rate.

JOURNAL: BJOGDATE 08_25_2022TITLE: Mini commentary on “Familial aggregation of stillbirth: a pedigree analysis of a matched case control study” BJOG_22-0217Author: Matthew A. Shear, MDa,bAuthor Affiliations:a Department of Obstetrics, Gynecology, & Reproductive Sciences, University of California, San Franciscob Division of Medical Genetics, Department of Pediatrics, University of California, San FranciscoDespite advances in genomics, the underlying cause of many stillbirths remains elusive. The emotional toll that a stillbirth takes on families, as well as the providers caring for them, is hard to overstate. Karyotype may identify a causative aneuploidy or large unbalanced translocation, but only in about 6% of stillbirths. Chromosomal microarray is higher yield, but still only identifies pathogenic copy number variants in about 10% of stillbirth cases (Reddy et al. N Engl J Med. 2012). The addition of exome sequencing to microarray only yielded a plausible genetic explanation in 15 out of 246 cases, or about 6% (Stanley et al. N Engl J Med. 2020). This suggested that non-mendelian mechanisms may play a significant role in stillbirth (Wojcik et al N. Engl J Med. 2020), although single gene pathogenic variants are poorly understood at the fetal level relative to the postnatal setting. The non-genetic mechanisms underlying stillbirth are also poorly understood at present, including viral infections, environmental toxins, and comorbid conditions.Workalemahu and their colleagues present a unique analysis suggesting genomic heritability of stillbirth in some families. Using a robust matched case-control study of over 9000 stillbirths and 390 high-risk pedigrees from the Utah Population Database, they calculated the familial standardized incidence ratio and risk of stillbirth among first, second, and third-degree relatives of the pregnant individuals who had experienced stillbirth. In their adjusted model, among all relatives of an individual who experienced stillbirth, there was a relative risk of stillbirth of 1.1 (95% CI 1.00-1.22). This study adds further evidence there are heritable genetic etiologies of stillbirth not yet fully described.Many non-genetic contributors to stillbirth risk may also cluster in families. In the present study, when adjusting for maternal race/ethnicity, socioeconomic status, and education, the elevations in stillbirth risk became attenuated, although this may be due to collinearity among variables used in the model. Health behaviors are informed through regional and family culture, leading to patterns in diet, nutrition, and exercise. These patterns contribute to modifiable health conditions known to impact stillbirth risk, including hypertension, obesity, diabetes, and smoking status. We also know the incidence of stillbirth is higher in lower income versus higher income countries, higher among individuals of lower educational attainment versus higher education, and higher among African American and Black individuals compared to White, likely complicated by the impacts of systemic racism. This is to say nothing of the additional social determinants of health that may impact families across generations.As Workalemahu and colleagues note, there is still much unknown about complex outcomes such as stillbirth. Their findings support that for a patient with a high-risk pedigree, genomic testing may prove informative. Future epigenetic and functional studies may help understand variants at the tissue level, and the impact of comorbidities on gene expression. Together with fetal genome sequencing, previously unexplained cases of stillbirth might be solved, improving patient counseling, and possibly changing clinical management. While genomic testing offers promise to explain a subset of stillbirths, we should not neglect the “non-mendelian” and non-genetic factors that continue to play a significant role in stillbirth risk.

BJOG-22-0382.R1: Implementing Effective Investigations for Cause of StillbirthElizabeth M McClure, PhDRobert L Goldenberg, MDRTI International, Durham, NCColumbia University, New York, NYStillbirth is one of the most common adverse pregnancy outcomes in low and middle-income countries (LMICs), with rates in the range of 40 to 50 per thousand births in some regions [1]. International goals aim for no country to have a rate of >10 per thousand births by 2035 [Hug L, et al. Lancet. 2021;398(10302):772-85]. To achieve this, a better understanding of stillbirth causes often requiring additional investigations is critical. For several reasons, including low prioritization, inadequate resources, and hesitancy by families and providers, investigations on stillbirth causes in LMICs have been limited to date.Bedwell et al used a grounded theory approach to explore the views of women, partners, families, health workers and community leaders in Malawi, Tanzania, and Zambia regarding investigations to determine the cause(s) of stillbirth [Bedwell et al, BJOG (in press)]. While most would like more information regarding the stillbirth, the authors noted cultural and religious obstacles to performing the investigations, including preferences for quick burial, reluctance to disfigure the deceased fetus, concerns about blame, as well as costs.One test to inform cause of stillbirths is minimally invasive tissue sampling (MITS), using needle biopsies to obtain internal organ tissue for histological evaluation and microbial analyses. For a study on causes of stillbirth in Pakistan and India, we explored the acceptability of MITS among parents, relatives, religious leaders, and government officials [Feroz A, et al. Reprod Health.2019;16(1):53]. The perceived benefits included knowing the cause of death, and both personal and societal benefits in preventing subsequent stillbirths. Concerns regarded rapid burial and reluctance to disfigure the stillborn. In Pakistan, with some caveats, religious leaders approved, and, when MITS was undertaken, in both Pakistan and India, approximately 50% of the parents consented for the MITS procedure.Because obstacles to testing in general and to MITS specifically relate to time, cost, and disfigurement, we have considered which examinations feasible in LMICs provide the most information at minimal cost. Page et al., in a similar exercise in a US study, noted that the most useful test was placental histology (65%) followed by full autopsy (42%) [Page JM, Obstet Gynecol 2017;129(4):699-706.]. No other tests were useful for >12% of cases. Similar studies have rarely been performed in LMICs. The prevalence of the causes relates to the frequency of tests’ usefulness. In high-income countries where birth asphyxia and infection have been reduced, congenital and genetic anomalies have assumed a larger proportion of stillbirths, and testing for those conditions using karyotyping and other genetic tests become proportionately more important. However, in many LMICs, birth asphyxia remains the major cause of stillbirth and genetic issues play a smaller proportional role.To develop the most effective methodology to determine cause of stillbirth, the prevalent conditions, and the tests’ usefulness to diagnose those conditions should be considered together. Importantly, the community and other stakeholder’s perceived benefits and obstacles to various tests as described in the Bedwell, et al must be considered to ultimately be successful in implementing the necessary investigations.For LMICs, given that asphyxia and infection appear to be major causes of stillbirth, tests to diagnose these conditions will likely be important to implement, including the obstetric history and histological placental evaluation for diagnosing asphyxia and infection. Of potential information gained from MITS, histology of the fetal lung, and bacteriological assessment of the fetal blood and brain/CSF may be the most useful. Thus, by considering the prevalence of the causes of stillbirth, the usefulness of tests to diagnose the prevalent conditions, and importantly addressing the community’s sense of benefit and obstacles, an effective approach to stillbirth cause of death investigation can be developed.Declaration of Interest: The authors declare no conflicts of interest.

Background The role of cancer rehabilitation is key in maintaining functional abilities and improving quality of life. Rehabilitation is a component of the CureALL program, which aims to achieve at least 60% survival for children with cancer globally while ensuring that suffering is reduced for every child with cancer. The demand for pediatric cancer rehabilitation will increase as the life expectancy of these children improves, but not all countries in Latin America are prepared. With the support of Sociedad Latinoamericana de Oncologia Pediatrica (SLAOP), the aims were (1) identify the availability of rehabilitation services for children and adolescent with cancer in Latin America; (1.1) identify the rehabilitation services and the comprehensive approach they have (physical, psychological, cognitive, social); (1.2) identify the rehabilitation healthcare professional that work with pediatric oncology; and (2) explore the barriers of access and opportunity that exists in Latin-America regarding rehabilitation of children and adolescents with cancer. Methods A survey was sent to all members of the 21 countries of SLAOP. The survey had questions regarding different aspects of rehabilitation, access, and barriers. Results Out of the 21 countries who are members of SLAOP, we had responses from 19 with a total of n=123 responses. Most healthcare providers (98.4%) know the importance of rehabilitation in pediatric oncology, and 86.2% had rehabilitation teams. Only 19 respondents said they had pediatric oncology rehabilitation educational programs. Barriers to access rehabilitation were reported by 83% providers: Approachability (n=25), Acceptability (n=4), Availability (n=76), Affordability (n=35), Appropriateness (n=24) The main barriers associated with availability were distance (n=31) and lack of health care professionals (n=39). Conclusions While the importance of pediatric oncology rehabilitation is known in Latin America, there are many factors that act as barriers to access to care for children and adolescents with cancer. It is key to address these barriers to improve the quality of life of Latin American pediatric oncology patients.

Background: Influenza is a persistent public health problem associated with severe morbidity and mortality. Drug use is related to myriad health complications, but the relationship between drug use and severe influenza outcomes is not well understood. The study objective was to evaluate the relationship between drug use and severe influenza-associated outcomes. Methods: Data were collected by the Influenza Hospitalization Surveillance Network (FluSurv-NET) from the 2016-2017 through 2018-2019 influenza seasons. Among persons hospitalized with influenza, descriptive statistics and logistic regression models were used to analyze differences in demographic characteristics, risk and behavioral factors, and severe outcomes (intensive care unit [ICU] admission, mechanical ventilation, or death) between people who used drugs (PWUD), defined as having documented drug use within the past year, and non-PWUD. Results: Among 48,430 eligible hospitalized influenza cases, 2,019 were PWUD and 46,411 were non-PWUD. PWUD were younger than non-PWUD and more likely to be male, non-Hispanic Black or Hispanic/Latino, smoke tobacco, abuse alcohol, and have chronic conditions including asthma, chronic liver disease, chronic lung disease, or immunosuppressive conditions. PWUD had greater odds of ICU admission and mechanical ventilation, but not death compared with non-PWUD. Opioid use specifically was associated with increased risk of ICU admission and mechanical ventilation. Conclusion: PWUD had greater odds of ICU admission and mechanical ventilation than non-PWUD hospitalized with influenza. These results support targeted initiatives to prevent influenza and associated severe outcomes among this population.

Objective To assess the effectiveness, safety, and acceptability of post-placental insertion of GyneFix postpartum intrauterine device (PPIUD) in women undergoing cesarean section (C-section). Design Prospective cohort study. Setting Fourteen hospitals in four provinces of China. Population and sample Women who underwent C-section and consented to the post-placental insertion of GyneFix PPIUD. We enrolled 470 participants, and 400 completed the 12-month follow-up. Methods Participants were interviewed in the wards after delivery and followed up at 42 days, and months 3, 6, and 12 after delivery. Main outcome measures Pregnancy, PPIUD expulsion, serious adverse events, and continuation of PPIUD. Results Nine pregnancies were detected during the first year after GytneFix PPIUD insertion, 7 were due to device expulsion and 2 occurred with PPIUD in situ. The Pearl Indices (PI; pregnancy per 100 women-years) for overall 1-year pregnancy rate and pregnancies with IUD in situ were 2.32 (95% CI: 1.06–4.40) and 0.51 (95% CI: 0.06–1.86), respectively. The 1-year expulsion PI was 8.25 (95% CI: 5.63–11.63). The expulsion PI was significantly higher in the first 6 months (12.78, 95% CI: 8.42–18.60) than the second 6 months (2.82, 95% CI: 0.92–6.58). The cumulative 1-year continuation rate was 86.56% (95% CI: 83.32–89.79). We did not identify any patient with insertion failure, uterine perforation, pelvic infection, or excess bleeding due to GyneFix PPIUD insertion. Conclusions Post-placental insertion of GyneFix PPIUD is effective, safe, and acceptable for women undergoing C-section. An ultrasound scan during the first 6 months after PPIUD insertion is recommended to identify any unrecognized expulsions.

Mini Commentary on manuscript ID BJOG-22-0531.R1

Objective: the exact link between COVID-19 pandemic and different adverse outcomes of pregnancy remains unclear. Plus, large-scale research is lacking. In the present study, we aimed to compare the maternal and fetal health outcomes during the COVID-19 pandemic with the same last year duration in Iran. Design: Two retrospective cohorts (pre-COVID-19 and during COVID-19) were studied. The pre-COVID-19 cohort include pregnant women who had given birth between 1 January 2019 and 31 December 2019. The COVID-19 cohort, who had given birth between 1 January 2020 and 31 December 2020. The characteristics of pregnant women before COVID-19 and during COVID-19 pandemic were compared with Fisher’s exact test. Uni-variate and multivariate log-binomial regression models were used to determine the risk ratios of the impacts of the COVID-19 pandemic on adverse pregnancy outcomes. Results: among 128968 women showed that women who had given birth during the pandemic were more likely to be of young age, lower rates of alcohol consumption and smoking, lower weight gain, and higher rates of using synthetic milk for feeding neonates (P<0.05). Also, the risks of preterm labor were high (cOR 95% CI, 1.13 to 1.31; p<0.01) and the risk of caesarian were low (cOR 95% CI, 0.95 0.92 to 0.98; p<0.01) among pregnant women who gave birth during the COVID-19 pandemic compared with those who gave birth before the pandemic. Conclusions: In summary, we found that during the COVID-19 pandemic there were the higher risks of preterm labor and lower risk of caesarean among pregnant women.

Objective Anaemia during pregnancy is higher in developing countries like India and associated with an increased risk to maternal health and outcomes. The present study estimates the prevalence and determinant risk factors of anaemia among pregnant women in India. Design Cross-sectional Setting Data from a nationally representative household survey of National Family Health Survey-5 conducted during 2019-21. Population A total of 27,317 currently pregnant women with anaemia status. Methods Estimating the prevalence differences and risk factors using descriptive statistics and multinomial logistic regression. Main outcome measures Anaemia Results About 52.2% of pregnant women in India were anaemic and prevalence was higher among women with no education (59.2%), belonging to poorest wealth quintile (61.9%), and scheduled tribes (59.3%) compared to their counterparts. The socio-economic determinant factors for severe anaemia were no education (aOR 4.07, 95% CI 3.40-4.86), poorest wealth quintile (aOR 2.05, 95% CI 1.73-2.43), and no exposure to media (aOR 2.11, 95% CI 1.70-2.60) than their counterparts. Women who were vegetarian (aOR 1.78, 95% CI 1.64-1.93), had previous abortion (aOR 1.97, 95% CI 1.58-2.47) and stillbirth (aOR 2.09, 95% CI 1.66-2.64) are more likely to have severe anaemia than non-vegetarian, and those in first pregnancy. Among women with gestation of ≤20 weeks, underweight were more likely to have severe anaemia (aOR 1.60, 95% CI 1.44-1.79). Conclusion Different geographical, socio-economic and clinical factors influence high prevalence and severity of anaemia among pregnant Indian women. Social norms-based interventions and strengthening the community health facilitators may help to combat high burden of anaemia.

Background There is evidence gastrointestinal (GI) motility may play a role in the development of GI cancers. Weak opioids (codeine and dihydrocodeine) decrease GI motility, but their effect on GI cancer risk has not been assessed. Aim To assess the association between weak opioids and cancers of the GI tract. Methods A series of nested case-control studies was conducted using Scottish general practice records from the Primary Care Clinical Informatics Unit Research database. Oesophageal (n=2,432), gastric (n=1,443), and colorectal cancer (n=8,750) cases, diagnosed between 1999 and 2011, were identified and matched with up to five controls. Weak opioid use was identified from prescribing records. Odds ratios (OR) and 95% confidence intervals (CI) were calculated using conditional logistic regression, adjusting for relevant comorbidities and medication use. Results There was no association between weak opioids and colorectal cancer (adjusted OR=0.96, CI 0.90, 1.02, p=0.15). There was an increased risk of oesophageal (adjusted OR=1.16, CI 1.04, 1.29, p=0.01) and gastric cancer (adjusted OR=1.26, CI 1.10, 1.45, p=0.001). The associations for oesophageal cancer, but not gastric cancer, were attenuated when weak opioid users were compared with users of another analgesic (adjusted OR=1.03 CI 0.86, 1.22, p=0.76 and adjusted OR=1.29 CI 1.02, 1.64, p=0.04 respectively). Conclusion In this large population-based study, there was no consistent evidence of an association between weak opioids and oesophageal or colorectal cancer risk, but a small increased risk of gastric cancer. Further investigation is required to determine whether this association is causal or reflects residual confounding or confounding by indication.

Objective: To investigate the features of the superficial mucosa and microvascular network of the vocal cords in patients with suspected laryngeal cancer using contact endoscopy (CE). Design: A retrospective review of patients with leukoplakia and cancer of vocal cords. Main outcome measure: Fourty-two patients (mean age = 57.2 ±7.6 years), were prospectively evaluated. Eighteen had malignant lesions and 24 had leukoplakia, proven on histologic exam. Eight cancer patients and 8 patients with leukoplakia had bilateral lesions. Therefore, a total of 58 lesions (26 malignant and 32 non-malignant) was found. Contact-endoscopic imaging findings were classified into five types (I to V) based on the features of the mucosal intraepithelial capillary loops. Results: The CE-based intraepithelial papillary capillary loop classification was strongly correlated with the histological findings. Smoking habits didn’t significantly differ between patients with unilateral and bilateral lesions. Conclusions: CE imaging of the vocal cord mucosal capillaries may be useful in the early detection of laryngeal cancer and precancerous lesions.

Background and Aims: Worldwide, the incidence of COVID-19 is lower in children than in adults and symptoms are less severe. So far, few studies from Latin America have been published on the behavior of COVID-19 in children with cancer. Purpose: To characterize the epidemiology, clinical course, morbidity, and mortality in children with cancer and COVID-19. Methods: All patients registered in the Argentine National Pediatric Cancer Registry (ROHA) with diagnosis of SARS-CoV-2 between December 4, 2020, and May 3, 2022 were included. Variables analyzed were: sex, age at COVID-19 diagnosis, clinical presentation at diagnosis, symptom severity, tumor type, intensive care requirement, specific treatment for COVID-19, vital status, and cause of death. Mortality was analyzed comparing the three main waves. Results: Overall, 888 children with cancer and COVID-19 infection were registered (484 females); 437 (49.2%) had leukemia, followed by central nervous system tumors (CNS-T) 120 (13.5%). Of the children, 57.2% (n=508) were symptomatic; 75% were febrile, and 37% (n=210) had neutropenia; 17.1% (n=152) were diagnosed within one month of cancer diagnosis. A total of 154 children had severe or critical symptoms (17%). In this study, 112 deaths were reported, 105 (94%) due to disease progression, sepsis, comorbidities, or treatment complications. Seven patients (0.8%) died from COVID-19, all diagnosed with leukemia/lymphoma. No association of deaths was found between the three waves analyzed. Conclusions: Based on the ROHA data, we may conclude that in pediatric cancer patients, contrary to what was initially expected, morbidity and mortality due to COVID-19 were not increased.

African swine fever (ASF) is a high-consequence transboundary disease of domestic and wild swine often characterized by high case mortality rates. On July 29, 2021, the Dominican Republic announced the African swine fever virus (ASFV) had been detected in samples collected in early- to mid-July 2021. Retrospective testing of samples collected as part of a collaborative surveillance project between the United States and the Dominican Republic identified ASFV in samples collected as early as May 13, 2021. These detections represent a new outbreak of ASF in the Dominican Republic, which had been declared free of the disease since 1981. Overall, 73 whole genomes of ASFV were sequenced from clinical samples received during the outbreak across 18 provinces. The genomic sequence data have been deposited in public databases to support and expand global data sharing on this impactful disease. While the sequences show a high degree of nucleotide identity to publicly available ASFV genomes from Europe and Asia, they are genetically distant from genomes in the public repositories by at least 8 previously undescribed single nucleotide polymorphisms.

The need for economic evaluation of new health care technologies, especially in the modern world era, is undisputable. Economic evidence alongside clinical evidence are the two main pillars of the Health Technology Assessment (HTA), a process which is followed for reimbursement medical technologies and budget allocation decisions. The role of epidemiological research is essential in obtaining the necessary data for the development of the economic evaluations. In this review paper, we adopt a stepwise approach, based on current guidelines for conducting economic evaluation (both budget impact and cost effectiveness analyses) for highlighting the need for modern epidemiological methods and tools in such a process. Epidemiological studies provide the data for the eligible patient population, the prevalence and incidence of disease, treatment effectiveness and health care resource utilization; these, in turn, are synthesized in an appropriate framework, together with real world data, for assisting in the budget allocation decisions.

Perinatal Mortality Rate is an important epidemiological indicator of Maternal and Child Health care because of its sensitivity for both maternal and new-born care. To analyse trends of perinatal morbidity and mortality, 4177 deliveries were studied across 18 months in a tertiary care hospital in Karnataka. Fetal growth restriction accounted to more than 50% of the perinatal deaths. Maternal morbidities were associated with up to 40.6% of causes for still birth. Preterm births account to 45.3% of neonatal deaths, sepsis accounting to 20.31%. Early recognition and intervention for these conditions seemed to be the mainstay in improving perinatal outcome.

Purpose. To assess the effect of exposure to fluvoxamine around the COVID-19 diagnosis on subsequent hospitalizations and mortality in COVID-19 outpatients in a real-life setting. Methods. Using nationwide administrative data, we identified adult COVID-19 outpatients diagnosed up to August 15, 2021 and conducted two cohort studies. Study 1 included subjects prescribed fluvoxamine around the index COVID-19 diagnosis (Cohort A), their peers suffering similar psychiatric difficulties but not prescribed fluvoxamine (Cohort B) and those free of psychiatric difficulties/treatments (Cohort C). Study 2 included subjects prescribed fluvoxamine (Cohort Fluvoxamine) and their peers prescribed paroxetine (Cohort Paroxetine). Cohorts were mutually exactly matched and incidence of COVID-19-related hospitalization, 30-day all-cause hospitalization and of COVID-19-related mortality was estimated. Results. Of the 416030 first-episode outpatients, Study 1 included 1016 Cohort A, 95984 Cohort B and 275804 Cohort C patients. Matched Cohort A (n=749) vs. Cohort B (n=31336) relative risks (95%CI/CrI), frequentist and Bayes with skeptical, otpimistic and pesimistic priors, were: COVID-related hospitalization 1.37 (0.56-3.33), 1.15 (0.55-2.11), 1.03 (0.56.1.96) and 1.43 (0.63-2.94), respectively; 30-day all-cause hospitalization 1.88 (0.76-4.67), 1.76 (1.39-2.25), 1.76 (1.39-2.24) and 1.86 (1.43-2.38), respectively; COVID-19 related mortality 0.73 (0.35-1.55), 0.93 (0.53-1.76), 0.79 (0.40-1.54) and 0.88 (0.37-2.11), respectively. Matched Cohort A vs. C (866 vs. 222792) comparison yielded similar estimates, as did the matched Cohort Fluvoxamine vs. Paroxetine comparison in Study 2 (344 of 994 matched to 535 of 1796 patients). Conslusion. Outpatients prescribed fluvoxamine around the time of COVID-19 diagnosis were not at a reduced risk of hospitalizations and mortality compared to their non-prescribed peers.

We develop a mathematical model to study the effects of non-pharmaceutical interventions (NPIs) on the dynamics of an epidemic. The level of intervention is assessed as a fraction of the population being isolated and depends on the level of incidence of the epidemic in the population. We perform the mathematical analysis of the model and show that, depending on the choice of the prevalence-dependent isolation function, it is possible to create new endemic equilibria and to change the stability of the disease-free equilibrium for which the epidemic vanishes. The model is then applied to the case of the covid-19 pandemic. Several NPI management strategies are considered. In the case of a NPI intensity increasing with the level of infection, it is possible to avoid the initial epidemic peak of great amplitude that would have occurred without intervention and to stabilize the epidemic at a chosen and sufficiently low endemic level. In the case of a NPI intensity decreasing with the level of infection, the epidemic can be driven to extinction by generating an “Allee” effect: when the incidence is below a given level, the epidemic goes extinct while above it, the epidemic will still be able take hold at a lower endemic level. Simulations illustrate that appropriate NPIs could make the Covid-19 vanish relatively fast. We show that in the context of the covid-19 pandemic, most countries have not chosen to use the most efficient strategies.