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.

Aim. To assess the relationship between a fact of being prescribed fluvoxamine around the time of COVID-19 diagnosis and subsequent hospitalizations and mortality in COVID-19 outpatients. Methods. Using administrative data, we identified adult COVID-19 outpatients diagnosed up to August 15, 2021 in Croatia. Subjects prescribed fluvoxamine around the time of COVID-19 diagnosis (Group A), their peers suffering similar psychiatric difficulties but not prescribed with fluvoxamine (Group B) and those free of psychiatric difficulties/treatments (Group C) were mutually exactly matched on a range of pre-COVID covariates. We determined relative risks of COVID-19-related hospitalization, 30-day all-cause hospitaliziation and of COVID-19-related mortality. Results. Out of 416030 outpatients, 1016 were Group A subjects, 749 of whom were matched to 31336/95984 Group B subjects, while 866 were matched to 22792/275804 Group C subjects. Group B and C patients were matched 82323 to 268778. Matched A vs. B relative risks (95%CI/CrI), frequentist and Bayes with skeptical, otpimistic and pesimistic priors, were: COVID-related hospitalization 1.73 (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. Conslusion. COVID-19 outpatients prescribed fluvoxamine around the time of COVID-19 diagnosis were not at a reduced risk of subsequent hospitalizations and mortality compared to COVID-19 outpatients suffering similar psychiatric difficulties but not prescribed with fluvoxamine, or compared to COVID-19 outpatients free of psychiatric difficulties and related treatments

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.

Reality has failed to agree with the expectation that vaccines will solve the COVID-19 problem by preventing onward transmission of the coronavirus known as SARS-CoV-2, which followed logical deductions from inflammatory phenomena in which Mechnikov and his contemporaries described immunity as originating from the elimination of pathogens by a system of cells and substances that has since been named the immune system. But upon illustrating the reality in which we are protected from the pathological manifestations that occur in response to the pathogen in immunological phenomena, it was found to be that in which the pathogen does not cause such pathological manifestations through effects that are due to its mere presence but rather through effects that are due to its influence on pathological mechanisms so that immune mechanisms do not protect us from such pathological manifestations by eliminating the pathogen but rather by making asymptomatic hosting of the pathogen possible. And such protection, which occurs in spite of the presence of the pathogen when the conditions from which it originates are present, is obtained by means of infection with the same pathogen through the attenuation of its

Background The role of cancer rehabilitation is key in maintaining functional role and improving quality of life. Rehabilitation is in 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 for it. With the support of Sociedad Latinoamericana de Oncologia Pediatrica (SLAOP), the aim is to describe the existing resources that provide rehabilitation to these children with cancer. Methods A survey was sent to all members of the 21 countries of SLAOP. The survey had 10 questions regarding different aspects of rehabilitation, access, and barriers. Results Out of the 22 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 adolescent with cancer. It is key to address these barriers to improve the quality of life of Latin American pediatric oncology patients.

Objective: To compare labour outcomes in a midwifery continuity of care (MCoC) model to standard midwifery care. Design: Matched cohort study. Setting: Public healthcare during pregnancy and childbirth, Stockholm, Sweden. Population: Women giving birth at Karolinska University Hospital site Huddinge in Stockholm between January 1st, 2019 to August 31st, 2021. Methods: Propensity score matching was applied to obtain a matched set from the standard care group for every woman in the MCoC model. Based on the matched cohort, we estimated risk ratios (RR) for binary outcomes with 95% confidence intervals (CI). Main Outcome Measures: Interventions during labor, mode of birth, and preterm birth (<37 gestational weeks). Results: Compared with standard care, women in the MCoC model were more likely to give birth spontaneously (RR 1.06 95% CI 1.02-1.10), and less likely to have an elective caesarean section on maternal request (RR 0.24 95% CI 0.11-0.51). The risk of preterm birth was reduced in the MCoC group (RR 0.51 95% CI 0.32-0.82). Conclusions: The MCoC model was associated with fewer medical interventions and improved maternal and neonatal outcomes.

Aim: To evaluate the treatments used in patients diagnosed with SARS-CoV-2 infection hospitalized in critical care service, through a prescription indication study. Methods: A longitudinal observational study of medication use, of the indication-prescription type with elements of the therapeutic scheme and practical consequences, was carried out. The sample was characterized from the sociodemographic, clinical, and pharmacotherapeutic points of view. The prescription was evaluated through the indicators: indication, therapeutic scheme, treatment individualization, and drug combinations. The detected adverse reactions were classified according to their causality by the Naranjo Algorithm, their severity, their clinical significance, and according to their mechanism by Rawlins and Thompson. Results: In the sample (N=77), the male gender predominated (79%) between 27-59 years old (64%), alcohol consumer (62%), hypertensive (33%) with long hospital stay (51%). 417 medications were analyzed, being antibiotics (50.6%) being the most prescribed. 73.4% of the therapeutic schemes were correct, however, 26.6% had problems with the therapeutic schemes due to the use of incorrect doses, intervals, and duration of treatment, as well as risky interactions. Two probable adverse reactions were detected, mild, non-serious, and type A and B according to Rawlins and Thompson. Conclusions: The results obtained will allow the pharmaceutical professional to create risk matrices that guarantee a timely intervention in the health team to contribute to the rational and safe use of medicines in patients infected with SARS-CoV-2.

Background: Elaeis guineensis (oil palm) pollen is one of the most predominant species of inhalant allergens in the tropical Southeast Asia region; however, its association with the manifestation of allergic diseases remains largely unexplored. We aimed to determine the sensitization pattern of oil palm pollen and associate this with the risk and severity of allergic diseases. Methods: Participants were recruited as a part of the Singapore and Malaysia cross-sectional genetic and epidemiological study (SMCSGES). Two independent cohorts were recruited: n=564 serum samples were collected and serological assessment was performed against a panel of 16 crude inhalant allergens including house dust mite, pet, insect, pollen, and fungal allergens; n=13,652 Singapore/Malaysia Chinese young adults were recruited and skin prick test was used to assess oil palm sensitization, which was tested for its association with the risk and severity of asthma, allergic rhinitis (AR), and atopic dermatitis (AD). Results: The sensitization rate of oil palm pollen is 9.6% in the n=564 Singapore/Malaysia cohort. In the n=13,652 Singapore/Malaysia Chinese cohort, oil palm sensitization significantly associates with increased risks of asthma ( p=1.34x10 -4), AR ( p=2.91x10 -13), and AD ( p=6.95x10 -7). Asthmatic patients with oil palm sensitization have increased risks of wheezing ( p=0.00995), nocturnal cough ( p=0.0122), and exacerbations ( p=0.00139) in the past 12 months. AR patients with oil palm sensitization also have an increased risk of developing moderate-to-severe symptoms ( p=0.00113). Conclusions: We have identified significant associations of oil palm sensitization with increased risks, exacerbations, and the severity of symptoms of allergic diseases in the tropical Southeast Asian region (Singapore/Malaysia).

Objectives: The purpose of this study was to compare the incidences of common upper airway infections and their complications, and of antibiotic prescription rates during 2020, when the COVID-19 pandemic struck, and the previous year. Study design: Retrospective national register study Setting/source population: The Swedish population in 2019 and 2020. Methods: The Swedish Board of Health and Welfare statistics data base, which includes all out- and inpatient diagnoses in specialised care was used to retrieve the number of otitis media, rhinosinusitis, pharyngotonsillitis, acute mastoiditis and peritonsillar abscess diagnoses in various age groups during 2019 and 2020. The number of prescriptions of oral antibiotics used to treat upper airway infections was collected from the Swedish E-Health Authority, which covers all prescriptions in Sweden. Population data were retrieved from Statistics Sweden. Results: There was strong evidence of a substantial decrease (approximately 40%) in otitis media, rhinosinusitis and pharyngotonsillitis cases in the population as a whole in 2020 compared to 2019. For otitis media, the decrease was most pronounced among children, whereas rhinosinusitis and pharyngotonsillitis incidence decreased to a similar extent in adults, as well. Furthermore, there was equally strong evidence that acute mastoiditis decreased by 40% in children and adolescents and that peritonsillitis in adults decreased by 24%. The decrease in infections was accompanied by a corresponding decrease in antibiotic prescriptions. Conclusion: The social distancing measures introduced during 2020 were followed by a significant decrease in upper airway infections and antibiotic prescriptions.

Objective: Lifestyle factors including education, coffee intake, tea consumption, dietary fat intake, obesity, physical activities, smoking and alcohol drinking, sleep duration, and insomnia, have been linked to Ovarian Cancer (OC) in observational studies. We assessed whether the concerning factors are causally associated with the risk of OC by histological subtypes. Design: Mendelian Randomization (MR) study. Setting: Independent genetic instruments associated with thirteen lifestyle behaviors were selected from ten genome-wide association studies. Summary-level data for OC subtypes were obtained from the Ovarian Cancer Association Consortium. Population: Exposures population were including 375,833 to 1,232,091 European individuals, outcomes population were including up to 25,509 cases and 40,941 controls. Methods: Two-sample and multivariable MR study, and multiple complementary sensitivity analyses were conducted. Main Outcome Measures: Histological subtypes of OC. Results: We provided unconfounded genetic evidence of inverse associations of genetically predicted years of education and fat intake with specific OC subtypes, which are independent of BMI. Whereas consumption of coffee or tea was positively associated with endometroid OC, which may be partly mediated by BMI. Although physical activity and sleep characteristics have been reported to be the risk factors for OC, no causal associations were observed in our study. Conclusions: Our study clarified the protective and independent role of high level education and relative fat intake in particularly OC subtypes. We also showed detrimental effects of higher coffee or tea consumption on OC histotypes. Our results may provide insight into the corresponding interventions as lifestyle factors can easily be modified.

Aim: To explore the validity and strength of evidence on the association between environmental factors and risk of developing childhood (0-14 years) cancer. Methods: An umbrella review was conducted including systematic reviews and meta-analyses of observational epidemiological studies that examined the association of any environmental exposure of either parent or child with any type of childhood cancer. PubMed and Scopus databases were searched until April 2020. Based on predefined criteria, the evidence was graded into strong, highly suggestive, suggestive or weak. Results: 509 meta-analyses explored environmental exposures and risk of developing 10 different types of childhood cancer. Only 2.4% of the associations were considered to have highly suggestive evidence inferred by strongly statistically significant results. These associations were confined to increased risk of overall leukemia, especially acute lymphoblastic leukemia (ALL), in relation to high birthweight, paternal smoking and exposure to pesticides, particularly insecticides. By contrast, maternal multivitamin supplementation during pregnancy (summary odds ratio [OR]: 0.64, 95% confidence intervals [CI]: 0.52, 0.80) and breastfeeding for more than 6 months (summary OR: 0.76, 95%CI: 0.68, 0.84) were supported by highly suggestive evidence for decreased risk of ALL. There was also highly suggestive evidence for increased risk of central nervous system (CNS) tumors, especially astrocytoma, in relation to high birthweight, as well as increased risk of testicular cancer in relation to testicular microlithiasis and isolated cryptorchidism. Conclusions: The present findings provide evidence that exposure to seven maternal/neonatal factors significantly affects the risk of childhood leukemia, CNS tumors and testicular cancer. Further evidence from sufficiently powered studies and large consortia with uniform reporting of analyses is needed to allow firmer conclusions to be drawn.

Objective: To investigate the associations of seminal plasma selenium (Se) concentrations with semen quality and to explore the mediating role of sperm mitochondrial DNA copy number (mtDNAcn). Design: Cross-sectional study with repeated measurements. Setting: Hubei Province Human Sperm Bank of China. Population: A total of 1159 healthy men who repeatedly provided 5617 semen samples were included. Main Outcome Measures: Seminal plasma Se concentration and sperm mtDNAcn of healthy men screened as potential sperm donors were determined using inductively coupled plasma mass spectrometry (ICP-MS) and real-time fluorescent quantitative PCR (RT-qPCR), respectively. Methods: Linear mixed-effects models and mediation analyses were performed. Result(s): After adjusting for potential confounders, we observed positive associations of seminal plasma Se concentrations with sperm concentration and total count (both p-Values for trend < 0.001). Volunteers in the highest vs. lowest quartiles of seminal plasma Se concentrations had 70.1% (95% CI: 53.3%, 88.9%) and 59.1% (95% CI: 40.5%, 80.2%) higher sperm concentration and total count, respectively. We also found inverse associations between within-subject pooled seminal plasma Se concentrations and sperm mtDNAcn, and between sperm mtDNAcn and sperm concentration, total count, total motility, and progressive motility (all p-Values for trend < 0.05). Mediation analyses showed that sperm mtDNAcn mediated 19.7% (95% CI: 15.9%, 25.3%) and 23.1% (95% CI: 17.4%, 33.4%) of the associations between within-subject average seminal plasma Se concentrations and sperm concentration and total count, respectively. Conclusions: Seminal plasma Se concentrations were positively associated with sperm concentration and total count, which was partly mediated by sperm mtDNAcn.

“Pharmacovigilance is the science and activities relating to the detection, assessment, understanding and prevention of adverse effects or any other medication-related problem”, according to the WHO. With the increasing volume of legislation, pharmacovigilance systems have shifted from reactive (responding to emerging risks), to planned, active, risk-proportionate approaches operating throughout the lifecycle of medicines. Whilst medicines are beneficial to society, adverse reactions represent a significant cause of concern. They are a major cause of failed regulatory authorizations, and withdrawal from the marketplace post-approval. Evaluation of real-world data plays an increasingly important role in pharmacovigilance. There is great interest on the part of the regulators, MAHs, academia and patients in optimizing the use of safety data. Innovative approaches, including pharmacogenetics and passive measures (sensors), will lead to increased complexity in data collation and evaluation, and inevitably to an increase in the volume of case reports. There is a multiplicity of regulations and guidelines on how to manage these data, with an inherent lack of harmonization. We summarize the current characterization of safety data types, sources, and the classification of these data. Using this benchmark, we discuss the future requirements of an effective pharmacovigilance ecosystem, keeping the principle of parsimony in mind.

Aim. To describe the trends in anti-infective use during pregnancy between 2010 and 2019 and determine whether they were prescribed according to drug fetal safety international classification systems. Methods. We conducted a population-based, nationwide study using the French national health data system including all pregnancies ended between 2010 and 2019. Anti-infective were considered according to their pharmacological group and potential harmful risk using the Australian and Swedish classification systems. Prevalence rate was estimated annually and by trimester. Average annual percent change (AAPC) and 95% confidence intervals (CI) were calculated using Joinpoint regression. Results. Among 7,571,035 pregnancies, 3,027,031 (40.0%) received ≥ 1 antibacterial. This proportion decreased significantly from 41.5% in 2010 to 36.1% in 2019 (AAPC=-1.7%, [95%CI, -2.5% to -1.0%]). Conversely, use of antiviral agents increased during the 10 years’ study period for anti-HSV agents (AAPC=4.4%, [3.7%-5.2%]), influenza agents (AAPC=25.4%, [6.2%-48.1%]), and for HIV-antiretroviral agents (HIV-ART) (AAPC=1.3%, [0.6%-2.0%]). Use of influenza vaccine increased from 0.2% in 2010 to 4.2% in 2019 (AAPC=49.7%, [95%CI, 39.3% to 60.9%]). Among all pregnancies, 0.9% had been exposed to a potentially harmful anti-infective agent increasing from 0.7% in 2010 to 1.2% in 2019 (AAPC=6.4%, [4.4%-8.5 %]). Conclusion. Based on more than 7 million pregnancies identified from French nationwide data, this study showed that antibacterials are frequently prescribed during pregnancy although their use has decreased over the past ten years. Our results suggest that anti-infective are generally prescribed in accordance with recommendations, with however a potential for improvement in influenza vaccination.

Logical deductions from experimental data have been unable to explain the origin of the current monkeypox outbreaks in multiple countries. But upon illustrating the reality in which these outbreaks occur, it was found to be that in which different diseases of the same immunological nature, the nature that permits them to be rendered asymptomatic simultaneously without the elimination of their different causes, appear simultaneously when conditions that permitted immune mechanisms to bring about such protection disappear. An outbreak of such immunologically equivalent diseases therefore does not require the spread of those that are pathogens among the causes of such diseases to occur. And the manifestations of such diseases will become widespread in a population when factors that cause the disappearance of conditions that permitted them to be rendered asymptomatic by immune mechanisms become widespread in the population. If we will escape the threat that the catastrophically widespread appearance of manifestations such as Ebola and malignancies will pose to our species, our topmost research priority ought to be the immunological nature of the pathological effects of the pathogens that are linked with them.

Objectives: To evaluate risks of preterm birth and severe maternal morbidity (SMM) in female adolescent and young adult cancer survivors; assess maternal comorbidity as a potential mechanism; determine whether associations differ by use of assisted reproductive technology (ART). Design: Retrospective cohort Setting: Privately insured females in the U.S. Sample: Female with live births from 2000 to 2019 within OptumLabs®, a U.S. administrative health claims dataset Methods: Log-binomial regression models estimated relative risks of preterm birth and SMM by cancer status and tested for effect modification. Causal mediation analysis based on a counterfactual approach evaluated the proportions explained by maternal comorbidity. Main Outcome Measures: SMM, preterm birth Results: Among 46,064 cancer survivors, 2,440 singleton births, 214 multiple births, and 2,590 linked newborns occurred after cancer. In singleton births, preterm birth incidence was 14.8% in cancer survivors versus 12.4% in females without cancer (aRR 1.19, 95%CI 1.06-1.34); SMM incidence was 3.9% in cancer survivors versus 2.4% in females without cancer (aRR 1.44, 95%CI 1.13-1.83). Cancer survivors had more maternal comorbidities before and during pregnancy; 26% of the association between cancer and preterm birth and 30% of the association between cancer and SMM was mediated by maternal comorbidities. Associations between cancer and outcomes did not differ between ART and non-ART births. Conclusion: Preterm birth and SMM risks were modestly increased after cancer. Significant proportions of elevated risks may be due to increased comorbidities. Prevention and treatment of comorbidities provides an opportunity to improve perinatal outcomes among cancer survivors.

BACKGROUND: Recent pharmacoepidemiology data show an increase in the proportion of patients receiving second-generation antipsychotic (SGA) monotherapy, but no studies have analyzed the same patients over a long period of time. Therefore, in this study, we decided to evaluate retrospectively schizophrenia patients with available data for 20 years to see whether the drug treatments in the same patients have changed in the past 20 years. METHODS: The study began in April 2021 and was conducted in 15 psychiatric hospitals in Japan. Schizophrenia patients treated in the same hospital for 20 years were retrospectively examined for all prescriptions in 2016, 2011, 2006, and 2001 (i.e., every 5 years). RESULTS: The mean age of the 716 patients surveyed in 2021 was 61.7 years, with 49.0% being female. The rate of antipsychotic monotherapy use showed a slight increasing trend over the past 20 years; the rate of SGA use showed a marked increasing trend from 28.9% to 70.3% over the past 20 years, while the rate of SGA monotherapy use showed a gradual increasing trend over the past 20 years. The rates of concomitant use of anticholinergics, antidepressants, anxiolytics/sleep medications, and mood stabilizers showed decreasing, flat, decreasing, and flat trends over the past 20 years, respectively. CONCLUSION: The results of this study showed a slow but steady substitution of SGAs for first-generation antipsychotics (FGAs) over time, even in the same patients.

Objective To characterize pregnant women with or without pre-existing chronic kidney disease (CKD) and to describe changes in renal filtration during and after pregnancy. Design Descriptive study. Setting UK-based Clinical Practice Research Datalink GOLD linked to hospital data (2000-2019). Population Pregnancies of women with or without pre-existing CKD, categorized by median baseline eGFR [ml/min/1.73m2] based on serum creatinine (SCr [mg/dl]) measurements (proteinuria under-recorded). Methods Description of median SCr levels within two-week periods during and within one year after pregnancy. Results Of 14’401 pregnancies, 84% had a normal baseline eGFR≥90. In 1’932 women (13%) with a low-normal eGFR=75-89, SCr patterns during and after pregnancy followed the pattern of women with normal eGFR, although at higher starting levels (median baseline SCr=0.92, IQR=0.88-0.96). SCr levels returned to baseline by week 3/4 postpartum. In 388 women (3%) with a moderately low baseline eGFR=60-74, median baseline SCr levels were 1.05 (IQR=1.01-1.10) and patterns also followed those of women with normal eGFR. However, SCr levels increased slower in trimester 3 and reached baseline levels at week 9/10 postpartum. 53 women (<1%) with a low baseline eGFR=15-59 (median baseline SCr levels=1.43, IQR=1.26-1.72) showed renal adaptation in trimester 1/2, but increased SCr levels of 1.71 (IQR=1.32-2.36) in trimester 3 (small sample size, 10-week periods). Conclusion The observed prolonged hyperfiltration in women with baseline eGFR<75 may warrant closer medical surveillance. Future studies should evaluate individual risk factors with focus on subgroups of women with eGFR=60-74 and eGFR<60. Funding Non. Key words Disease progression, pregnancy, nephrology, renal filtration

Objective To gain insight into perinatal outcomes in women with chronic conditions, in order to contribute to the optimization of personalized perinatal care. Design Population-based study using data of the Dutch national perinatal registry between 2010-2019. Setting Nationwide. Population Pregnancies of women who were diagnosed with chronic medical conditions by a medical specialist before pregnancy (n=36,835), divided over seven subgroups and a reference group of pregnancies of women without known chronic medical conditions (n=1,084,623). Methods Descriptive and testing statistics. Main outcome measures The primary outcome was mode of birth. Secondary outcomes were onset of labor, preterm birth, asphyxia, NICU admission, and perinatal mortality. Results Spontaneous birth ranged from 45.0% (orthopedic conditions) to 71.3% (neurological conditions) to 82.6% in the reference group. Instrumental vaginal birth (p<0.001), planned Cesarean birth (p<0.001) and emergency Cesarean birth (p<0.001) differed significantly in all groups if compared to the reference group. Preterm birth was significantly more present in the studied groups (p<0.001) as well as perinatal asphyxia (p<0.001) and NICU admission (p<0.001). Adjusting for mode of birth, parity, age and ethnicity did not change the outcomes for the total group of women with chronic medical conditions. Perinatal mortality was seen in all groups but in none of the separate groups significantly more than in the reference group. Conclusions Women with chronic conditions more often are confronted with preterm birth, Cesarean deliveries, NICU admission of the newborn, and perinatal mortality

Evaluation of Industry Payments to Allergists and Clinical Immunologists in the United States during the COVID-19 pandemic: A Seven-year analysis of the Open Payments Database from 2014 to 2020Anju Murayama1,2,*, Sae Kamamoto1,3; Hanano Mamada1,4; Hiroaki Saito1,5; Erika Yamashita1; Tetsuya Tanimoto1,6; Akihiko Ozaki1,7

Objective: Tonsillectomy is one of the most common surgeries worldwide, mostly indicated for recurrent throat infections and sleep-disordered breathing. The most significant complication is post-tonsillectomy bleeding. Although several risk factors for post-tonsillectomy bleeding in adults have been described, the role of post-operative pain as a risk factor for hemorrhage has not been described in this patient population. Design: Retrospective cohort study of adult patients (18 years and older) who underwent tonsillectomy in a tertiary referral center. Multi-variable logistic regression model was used to test correlation between the independent variables and post-tonsillectomy bleeding. Results: 305 patients (male to female ratio 1:1) with a mean age of 30.5 years old (18-82, ± 12). Mean body mass index was 26.6 (16-42, ±5) and 13% of patients were current smokers. Post-tonsillectomy pain on post-operative day 1 and 2 was associated with increased risk of bleeding (adjusted odds ratio 2.18, 95% confidence interval 1.73-2.44). Other factors that were associated with increased risk of post-tonsillectomy bleeding were male sex, young age (18-30 years old), smoking, recurrent throat infections as an indication for surgery and the usage of hot technique (p < 0.05). Conclusions: Increased post-operative pain following tonsillectomy is associated with increased risk of bleeding in adults. Other factors such as younger age group, males, smoking, previous throat infections and using hot dissection technique are also associated with risk of post-tonsillectomy bleeding. Further studies should explore the effect of strict pain control regimens on post-tonsillectomy bleeding in adults.