Epidemiology of fatal cases associated with pandemic influenza reported in Yemen

Objectives: This study describes the incidence of all fatal cases associated with Pandemic Influenza A (H1N1) in Yemen. It sets out to highlight the factors associated with poor prognosis *The authors declare that they have no competing interests. to enhance the implementation of prevention and control programs. Methods: The study is based on retrospective analysis of available data until 14 March 2010, as compiled by the disease control and surveillance team in Yemen. Results: Between 16 June 2009 and 14 March 2010, a total of 33 laboratory-confirmed death cases associated with pandemic influenza A (H1N1) were reported to the Diseases Control and Surveillance in the Ministry of Public Health and Population. During this period, a total of 6049 suspected influenza A (H1N1) cases were recorded. With this denominator, the case fatality rate (CFR) was 0.54%. During June through August, H1N1 confirmed cases were infrequently detected, including only 30;however, from September through December, over 200 confirmed cases were reported each month. Of the 33 cases recorded, 25 were male (76%) and 8 were female (24%), male to female ratio being 3:1. Overall median age of the death cases was 30.8 years (range 1 - 55). The most common diagnosis upon admission was pneumonia. Out of the deaths, twenty five (75.8%) had no documented underlying diseases. Chronic cardiovascular disease (9.1%) was the most commonly reported disease and 2 deaths (6.1%) were recorded as pregnant women. Conclusions: The most common diagnosis upon admission was pneumonia. Chronic cardiovascular diseases were the most commonly reported underlying conditions, while the most identified risk factor was pregnancy. These findings should be taken into consideration, when vaccination strategies are employed.

Country-based modelling of COVID-19 case fatality rate:A multiple regression analysis

BACKGROUND The spread of the severe acute respiratory syndrome coronavirus 2 outbreak worldwide has caused concern regarding the mortality rate caused by the infection.The determinants of mortality on a global scale cannot be fully understood due to lack of information.AIM To identify key factors that may explain the variability in case lethality across countries.METHODS We identified 21 Potential risk factors for coronavirus disease 2019(COVID-19)case fatality rate for all the countries with available data.We examined univariate relationships of each variable with case fatality rate(CFR),and all independent variables to identify candidate variables for our final multiple model.Multiple regression analysis technique was used to assess the strength of relationship.RESULTS The mean of COVID-19 mortality was 1.52±1.72%.There was a statistically significant inverse correlation between health expenditure,and number of computed tomography scanners per 1 million with CFR,and significant direct correlation was found between literacy,and air pollution with CFR.This final model can predict approximately 97%of the changes in CFR.CONCLUSION The current study recommends some new predictors explaining affect mortality rate.Thus,it could help decision-makers develop health policies to fight COVID-19.

Clinical features of 162 fatal cases of COVID-19:a multi-center retrospective study

Background:The coronavirus disease 2019(COVID-19)has affected approximately 2 million individuals worldwide;however,data regarding fatal cases have been limited.Objective:To report the clinical features of 162 fatal cases of COVID-19 from 5 hospitals in Wuhan between December 30,2019 and March 12,2020.Methods:The demographic data,signs and symptoms,clinical course,comorbidities,laboratory findings,computed tomographic(CT)scans,treatments,and complications of the patients with fatal cases were retrieved from electronic medical records.Results:The median patient age was 69.5(interquartile range:63.0–77.25)years,and 80%of the patients were over 61 years.A total of 112(69.1%)patients were men.Hypertension(45.1%)was the most common comorbidity,while 59(36.4%)patients had no comorbidity.At admission,131(81.9%)patients had severe or critical COVID-19,whereas 39(18.1%)patients with hypertension or chronic lung disease had moderate COVID-19.In total,126(77.8%)patients received antiviral treatment,while 132(81.5%)patients received glucocorticoid treatment.A total of 116(71.6%)patients were admitted to the intensive care unit(ICU),and 137(85.1%)patients received mechanical ventilation.Most patients received mechanical ventilation before ICU admission.Approximately 93.2%of the patients developed respiratory failure or acute respiratory distress syndrome.There were no significant differences in the inhospital survival time among the hospitals(P=0.14).Conclusion:Young patients with moderate COVID-19 without comorbidity at admission could also develop fatal outcomes.The in-hospital survival time of the fatal cases was similar among the hospitals of different levels in Wuhan.

SEIHCRD Model for COVID-19 Spread Scenarios,Disease Predictions and Estimates the Basic Reproduction Number,Case Fatality Rate,Hospital,and ICU Beds Requirement

We have proposed a new mathematical method,the SEIHCRD model,which has an excellent potential to predict the incidence of COVID-19 diseases.Our proposed SEIHCRD model is an extension of the SEIR model.Three-compartments have added death,hospitalized,and critical,which improves the basic understanding of disease spread and results.We have studiedCOVID-19 cases of six countries,where the impact of this disease in the highest are Brazil,India,Italy,Spain,the United Kingdom,and the United States.After estimating model parameters based on available clinical data,the modelwill propagate and forecast dynamic evolution.Themodel calculates the Basic reproduction number over time using logistic regression and the Case fatality rate based on the selected countries’age-category scenario.Themodel calculates two types of Case fatality rate one is CFR daily,and the other is total CFR.The proposed model estimates the approximate time when the disease is at its peak and the approximate time when death cases rarely occur and calculate how much hospital beds and ICU beds will be needed in the peak days of infection.The SEIHCRD model outperforms the classic ARXmodel and the ARIMA model.RMSE,MAPE,andRsquaredmatrices are used to evaluate results and are graphically represented using Taylor and Target diagrams.The result shows RMSE has improved by 56%–74%,and MAPE has a 53%–89%improvement in prediction accuracy.

Case Fatality Rate of Severe Acute Respiratory Syndromes in Beijing

To describe the case fatality rate of SARS in Beijing. Methods Data of SARS cases notified from Beijing Center for Disease Control and Prevention （BCDC） and supplemented by other channels were collected. The data were analyzed by rate calculation. Results The case fatality rate of SARS in Beijing was 7.66%, and had an ascending trend while the age of cases was getting older, and a descending trend while the epidemic developmem. The case fatality rate in Beijing was lower than that in other main epidemic countries or regions. Conclusions The risk of death increases with the increment of age of SARS patients. Beijing is successful in controlling and treating SARS.

A Study on the Global Scenario of COVID-19 Related Case Fatality Rate, Recovery Rate and Prevalence Rate and Its Implications for India—A Record Based Retrospective Cohort Study

Importance: Corona virus disease 2019 (COVID-19) caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the pandemic claiming millions of lives since the first outbreak was reported in Wuhan, China during December 2019. It is thus important to make cross-country comparison of the relevant rates and understand the socio-demographic risk factors. Methods: This is a record based retrospective cohort study. Table 1 was extracted from https://www.worldometers.info/coronavirus/ and from the Corona virus resource center (Table 2, Figures 1-3), Johns Hopkins University. Data for Table 1 includes all countries which reported >1000 cases and Table 2 includes 20 countries reporting the largest number of deaths. The estimation of CFR, RR and PR of the infection, and disease pattern across geographical clusters in the world is presented. Results: From Table 1, we could infer that as on 4th May 2020, COVID-19 has rapidly spread world-wide with total infections of 3,566,423 and mortality of 248,291. The maximum morbidity is in USA with 1,188,122 cases and 68,598 deaths (CFR 5.77%, RR 15% and PR 16.51%), while Spain is at the second position with 247,122 cases and 25,264 deaths (CFR 13.71%, RR 38.75%, PR 9.78%). Table 2 depicts the scenario as on 8th October 2020, where-in the highest number of confirmed cases occurred in US followed by India and Brazil (cases per million population: 23,080, 5007 & 23,872 respectively). For deaths per million population: US recorded 647, while India and Brazil recorded 77 and 708 respectively. Conclusion: Studying the distribution of relevant rates across different geographical clusters plays a major role for measuring the disease burden, which in-turn enables implementation of appropriate public healthcare measures.

Crizotinib-induced acute fatal liver failure in an Asian ALK-positive lung adenocarcinoma patient with liver metastasis: A case report

BACKGROUND Crizotinib-induce hepatotoxicity is rare and non-specific, and severe hepatotoxicity can develop into fatal liver failure. Herein, we report a case of fatal crizotinib-induced liver failure in a 37-year-old Asian patient.CASE SUMMARY The patient complained of dyspnea and upper abdominal pain for a week in August 2017. He was diagnosed with anaplastic lymphoma kinase-rearranged lung adenocarcinoma combined with multiple distant metastases. Crizotinib was initiated as a first-line treatment at a dosage of 250 mg twice daily. No adverse effects were seen until day 46. On day 55, he was admitted to the hospital with elevated liver enzymes aspartate aminotransferase(AST)(402 IU/L), alanine aminotransferase(ALT)(215 IU/L) and total bilirubin(145 μmol/L) and was diagnosed with crizotinib-induced fulminant liver failure. Despite crizotinib discontinuation and intensive supportive therapy, the level of AST(1075 IU/L),ALT(240 IU/L) and total bilirubin(233 μmol/L) continued to rapidly increase,and he died on day 60.CONCLUSION Physicians should be aware of the potential fatal adverse effects of crizotinib.

Subgroup comparison of COVID-19 case and mortality with associated factors in Mississippi: findings from analysis of the first four months of public data

We compared subgroup differences in COVID-19 case and mortality and investigated factors associated with case and mortality rate(MR)measured at the county level in Mississippi.Findings were based on data published by the Mississippi State Department of Health between March 11 and July 16,2020.The COVID-19 case rate and case fatality rate(CFR)differed by gender and race,while MR only differed by race.Residents aged 80 years or older and those who live in a non-metro area had a higher case rate,CFR,and MR.After controlling for selected factors,researchers found that the percent of residents who are obese,low income,or with certain chronic conditions were associated with the county COVID-19 case rate,CFR,and/or MR,though some were negatively related.The findings may help the state to identify counties with higher COVID-19 case rate,CFR,and MR based on county demographics and the degree of its chronic conditions.

Tuberculosis septic shock, an elusive pathophysiology and hurdles in management: A case report and review of literature

BACKGROUND Tuberculosis (TB) is a rare etiology of the septic shock. Timely administration of the anti-microbial agents has shown mortality benefit. Prompt diagnosis and a high index of suspicion are crucial to the management. We present three cases of TBSS with poor outcome in the majority despite timely and susceptible antibiotic administration. CASE SUMMARY Sixty-seven-year-old woman with latent TB presented with fever, cough, and shortness of breath. She was promptly diagnosed with active TB and started on the appropriate anti-microbial regimen;she had a worsening clinical course with septic shock and multi-organ failure after initiation of antibiotics. Thirty-threeyear- old man immunocompromised with acquired immune deficiency syndrome presented with fever, anorexia and weight loss. He had no respiratory symptoms, and first chest X-ray was normal. He had enlarged liver, spleen and lymph nodes suspicious for lymphoma. Despite broad-spectrum antibiotics, he succumbed to refractory septic shock and multi-organ failure. It was shortly before his death that anti-TB antimicrobials were initiated based on pathology reports of bone marrow and lymph node biopsies. Forty-nine-year-old woman with asthma and latent TB admitted with cough and shortness of breath. Although Initial sputum analysis was negative, a subsequent broncho-alveolar lavage turned out to be positive for acid fast bacilli followed by initiation of susceptible ant-TB regimen. She had a downward spiral clinical course with shock, multi-organ failure and finally death. CONCLUSION Worse outcome despite timely initiation of appropriate antibiotics raises suspicion of TB immune reconstitution as a possible pathogenesis for TB septic shock.

儿童急性坏死性脑病26例临床特征及预后分析

目的总结儿童急性坏死性脑病(ANEC)的临床特征、治疗过程和预后。方法回顾性分析2016年6月至2022年12月确诊ANEC患儿的临床资料。对存活患儿进行电话随访,应用儿童整体表现分类量表(POPC)评估患儿生存质量。结果共纳入26例ANEC患儿,男女比例为1.6∶1,中位年龄36.0(23.0~69.0)个月。发病季节以夏季常见(42.3%),其次为冬季(34.6%);前驱感染以流感病毒感染多见(34.6%),其次为人类疱疹病毒6B型及新型冠状病毒。所有患儿均有发热伴不同程度意识障碍,24例出现惊厥。神经影像学以对称性丘脑受累(100%)为典型改变,多伴有基底节区(50.0%)、脑干(61.5%)、小脑(26.9%)等部位受累。23例患儿接受甲基泼尼松龙激素冲击治疗,住院病死率为23.1%(6/26),出院6个月后累积病死率为30.7%(8/26)。6个月后随访到14例存活患儿,11例接受康复治疗,其中POPC评估2分1例,3分4例,4分6例,5分1例,6分2例。3例新型冠状病毒感染后ANEC患儿3个月随访POPC评估结果为2分2例,6分1例。结论华南地区ANEC于夏季和冬季高发,新型冠状病毒感染可诱发ANEC;临床表现为发热、抽搐、意识障碍三联征,典型影像学改变为双侧丘脑受累。早期免疫治疗及综合康复训练有助于减少神经系统后遗症的严重程度。

全球COVID-19疫情主要预测模型比较分析

目的新冠感染病死率预测对于深入理解新冠病毒严重性、合理配置医疗资源及开展针对性防疫策略有重大意义。方法本研究依据新冠病毒变异优势株,将疫情发展划分四个时期,选取美国、印度、巴西、墨西哥、秘鲁、中国六个国家以及全球平均水平的病死率为研究对象。运用灰色模型、指数平滑模型、ARIMA模型、支持向量机、Prophet和LSTM模型六个模型进行拟合预测,探讨各模型的优缺点和适用性,选取效果最优的模型对全球和重点国家的病死率进行预测。结果模型比较显示多种模型各有优缺点,经预测,多数国家的累计确诊人数和累计死亡人数增长速度减缓,发展趋势逐渐平稳。结论传统时间序列模型适于发展趋势平稳、有限样本的预测;而机器学习模型更适用于波动型变化数据,可进行大样本预测,进一步外推,运用到其他卫生领域的研究。

1990年至2049年全球脑卒中疾病负担分析及预测

目的:通过分析1990年至2019年全球脑卒中疾病负担现状,预测2020年至2049年30年脑卒中疾病负担发展趋势,为制订国家脑卒中疾病卫生政策提供依据。方法:检索全球疾病负担2019(GBD2019)数据库,提取1990年至2019年全球脑卒中发病率、患病率、病死率和残疾调整生命年(DALYs)疾病负担指标数据,使用线性回归、泊松回归和指数回归分析对其随时间趋势变化进行建模,基于人均国内生产总值(GDP)预测并研究脑卒中与社会人口指数(SDI)之间的关系。结果:1990年至2019年,全球脑卒中疾病负担显著增长,预计未来30年(2020年至2049年)持续上升,2049年全球脑卒中发病、患病、病死人数和DALYs相较于2019年分别增加853万例、11 983万例、779万例和11 892万人年,老年人群脑卒中负担显著加重。未来30年男性与女性脑卒中发病率的年龄标准化率相似,而女性患病率的年龄标准化率相对较高,男性病死率和DALYs的年龄标准化率相对较高。脑卒中疾病负担与SDI具有负相关性,SDI低的地区脑卒中疾病负担明显高于SDI高的地区。结论:未来30年全球脑卒中疾病负担增加,这可能与人口老龄化有关,且与经济发展状况密切联系,必须加大对脑卒中的预防力度,并根据不同SDI地区制定针对性策略。

2018—2022年某综合性三甲医院住院死亡病例分析

目的 分析2018—2022年某综合性三甲医院住院患者死亡病例特征,为科学合理配置医疗资源,加强医疗质量管理提供参考。方法 从该院病案信息系统中提取2018年1月1日至2022年12月31日的所有出院患者信息,对出院患者和死亡病例总数、年龄、性别分布以及疾病诊断等,采用Excel 2007和SPSS 18.0软件进行数据整理和统计分析。结果 675例死亡病例中,男性病例443例(65.63%),女性232例(34.37%),住院患者病死率0.64%;死亡原因居前3位的疾病为循环系统疾病、呼吸系统疾病、肿瘤,分别占总死亡病例数的28.44%、28.30%和27.56%;死亡病例男女性别比1.91∶1,病死率男性高于女性,差异有统计学意义(χ2=46.068,P<0.001)。年龄越大,病死率越高,50岁以上病死率迅速上升。结论 医院住院患者病死率总体较低,老年人是该院的死亡高危人群,循环系统疾病、恶性肿瘤和呼吸系统疾病是最主要的死亡原因。在医疗工作中,应根据患者年龄、性别、死亡高发病种等特点,科学合理配置医疗资源,降低住院患者病死率。

影响热射病患者90 d预后的危险因素分析

目的探讨热射病患者90 d预后的危险因素。方法回顾性分析2018年6月至2022年8月该院重症医学科收治的热射病患者89例,根据90 d死亡情况分为存活组(62例)和死亡组(27例),比较2组患者年龄、入院时体温及心率、降温时间、炎症及器官功能障碍的实验室数据、急性生理和慢性健康状况Ⅱ评分、序贯器官衰竭估计(SOFA)评分、格拉斯哥昏迷评分法评分等。结果89例患者中90 d内死亡27例(30.3%)。降温时间、入院时心率、SOFA评分是影响患者生存的独立危险因素(风险比=6.230、1.738、1.042,95%可信区间:2.561~14.521、1.026~2.114、1.011~1.427,P=0.004、0.002、0.023)。降温时间、入院时心率、SOFA评分联合预测热射病患者90 d病死率的受试者工作特征曲线下面积为0.993(95%可信区间:0.976~1.000,P<0.001),灵敏度为1.000,特异度为0.933。结论降温时间、入院时心率、SOFA评分是影响热射病患者90 d生存的因素,3个指标可联合使用预测患者90 d病死率和不良预后。

清醒俯卧位通气联合高流量氧疗在轻中度ARDS患者中的临床效果

目的:探究清醒俯卧位通气联合高流量氧疗在轻中度急性呼吸窘迫综合征(ARDS)患者中的临床效果。方法:选取2023年7月—2024年5月上饶市人民医院收治的80例轻中度ARDS患者作为研究对象,按照治疗方法分为对照组及观察组,各40例。对照组给予高流量氧疗治疗。观察组给予清醒俯卧位联合高流量氧疗治疗。比较两组患者吸入气氧浓度(FiO_(2))、氧合指数(PaO_(2)/FiO_(2))、治疗依从性及气管插管率、重症监护室(ICU)住院时间和28 d病死率。结果:治疗第3天和治疗第7天观察组FiO_(2)均低于对照组,而PaO_(2)/FiO_(2)均高于对照组,差异均有统计学意义(P<0.05);治疗后观察组总依从性高于对照组,差异有统计学意义(P<0.05);治疗后两组28 d病死率比较差异无统计学意义(P>0.05);而观察组的气管插管率低于对照组,ICU住院时间短于对照组,差异均有统计学意义(P<0.05)。结论:清醒俯卧位通气联合高流量氧疗在轻中度ARDS患者中临床效果较好,可改善机体PaO_(2)/FiO_(2)和FiO_(2),同时还可以降低气管插管率和缩短ICU住院时间。

发热伴血小板减少综合征死亡病例的流行病学和临床特征分析(英文)

目的探讨发热伴血小板减少综合征(SFTS)死亡病例的流行病学和临床特征。方法应用病例-对照研究方法,分别对16例SFTS死亡病例(病例组)和16例一般病例(对照组)的临床与流行病学信息进行统计分析,本研究所有病例均为发热伴血小板减少综合征实验室确诊病例。结果病例组和对照组有蜱叮咬史的比例分别为25.00%和18.75%,有田间劳作史的比例分别为75.00%和81.25%,差异均无统计学意义(P值均>0.05)。死亡病例发病至死亡平均时间为10天,发病至确诊平均时间为4天。病例组从发病到首诊的时间间隔和住院治疗天数均显著小于对照组,差异有统计学意义(P值均<0.05)。62.50%的死亡病例伴有基础疾病,显著高于对照组25%的比例,差异有统计学意义(P=0.035)。病例组具有神经系统症状的比例(87.50%)显著高于对照组(37.50%),差异有统计学意义(P<0.05)。病例组ALT、AST、LDH、CK和BUN均高于对照组,但两组比较差异均无统计学意义。结论既往有基础疾病史和有神经系统症状的患者,死亡风险较高。

北京部分地区15年脑卒中事件变化趋势——WHO-SINO-MONICA研究

目的探讨脑卒中在北京地区变化趋势。方法采用北京地区心血管病人群监测 (WHO MONICA方案 )诊断标准 ,通过三级监测网对人群脑卒中发病进行登记监测。结果 1北京人群 15年间 (1984～ 1998年 )脑卒中标化发病率呈显著上升的趋势 (+9.0 % /年 ,P=0 .0 39)。男性为 (+11.4% /年 ,P=0 .0 2 7) ,女性为 (+8.2 % /年 ) ,但无显著性差异 ;人群脑卒中首次发作标化发病率也呈上升的趋势 (+9.1% /年 ,P=0 .0 2 3) ,男性较女性上升更明显。 2人群脑卒中标化死亡率呈显著下降的趋势 (- 6 .6 % /年 ,P=0 .0 42 )。城市人群较农村人群下降明显。 3人群脑卒中病死率下降趋势明显 (- 16 .7% /年 ,P=0 .0 14) ,女性较男性更明显。结论人群脑卒中发病率 15年来呈显著上升的趋势 ,主要是首次发生率的增加 ,并且与高血压患病率相平行 。

2007年至2009年北京市居民急性心肌梗死住院病死率及其分布特征的研究

目的:分析2007年至2009年北京市户籍人口25岁以上人群急性心肌梗死(AMI)患者住院病死率及其分布特征。方法:研究资料来源于北京市公共卫生信息中心的北京市出院病人信息系统。AMI住院病死率指住院期间因AMI死亡的患者占所有AMI住院患者的比例。结果:2007年至2009年北京市户籍人口25岁以上人群因AMI住院者共35 335例,其中男性占68.2%。3年中AMI患者平均住院病死率为10.0%,女性为14.3%,高于男性的7.9%(P<0.001)。在二级医院住院的AMI患者的住院病死率高于三级医院者(11.4%比9.0%,P<0.001),中医医院高于西医医院者(17.5%比9.5%,P<0.001)。ST段抬高AMI患者住院病死率高于非ST段抬高患者(9.4%比8.4%,P<0.001)。住院期间未接受经皮冠状动脉介入治疗者的住院病死率,明显高于接受该治疗者(14.4%比1.9%,P<0.001)。2007年、2008年和2009年北京市AMI年龄标化住院病死率分别为10.7%、9.8%和9.4%,3年间下降了12.1%,男女两性分别下降了11.1%和10.7%。结论:目前北京市AMI住院病死率仍然较高,但近3年来逐年下降,提示北京市AMI住院期间救治水平总体提高。不同特征AMI患者的住院病死率存在差异。研究结果为进一步改善北京市AMI的住院治疗水平提供了依据。

1984～1993年北京市70万人群脑卒中流行趋势的研究

本研究结果显示：北京地区人群脑卒中发病率仍持续在一较高发病水平，10年总的发病趋势略有上升，男性上升更显著（P＜0．035）；农村男性发病率上升趋势较城市明显。北京地区人群死亡率趋势下降明显（P＜0．05），城市较农村更明显。病死率女性明显高于男性，城乡男女两性脑卒中病死率均呈明显下降趋势（P＜0．001），且城市较农村更明显。故我们的医疗、预防工作的重点仍应放在农村。