Since the beginning of the devastating COVID-19 pandemic, there has been a great debate about various public health relevant parameters such as the number of people infected with SARS-CoV-2, the ...number of deaths from COVID-19, and the resulting infection fatality rate (IFR), calculated as a ratio of the number of deaths from COVID-19 and the number of people infected with SARS-CoV-2. Among people dying from COVID-19, the largest burden is carried by the elderly, and locations with an older population will have a higher average IFR. Drawing from a project on the estimation of age-stratified IFR at an international level, in this methodological presentation, I will review the considered sources of bias for COVID-19 IFR calculation and interpretation. Both numerator and denominator can be overestimated or underestimated leading to biased estimates, while different locations can present sources of true variability. The estimation of the number of people infected with SARS-CoV-2 (the denominator of the IFR) presents several challenges. Relying on testing is inadequate due to a substantial undiagnosed proportion, and seroprevalence studies have been used to estimate the number of people infected with COVID-19, but selection bias can arise when the examined population might have a lower or higher risk than the target population. This can be the case when factors such as ethnicity, working status, and comorbidity are not considered in the recruitment. Information bias can result from suboptimal test performance and seroreversion. The number of deaths can be underestimated in situations where testing is not widely available and overestimated by the attribution of COVID-19 deaths to patients that have died with COVID-19 but not from it. Sources of true variability between locations are the population age distribution, protection of the vulnerable populations, as well as the presence of a prepared and efficient healthcare system.
Background
Thyroid nodules are a common clinical problem, and differentiated thyroid cancer is becoming increasingly prevalent.
Methods
Six scientific Italian societies entitled to cure thyroid ...cancer patients (the Italian Thyroid Association, the Medical Endocrinology Association, the Italian Society of Endocrinology, the Italian Association of Nuclear Medicine and Molecular Imaging, the Italian Society of Unified Endocrine Surgery and the Italian Society of Anatomic Pathology and Diagnostic Cytology) felt the need to develop a consensus report based on significant scientific advances occurred in the field.
Objective
The document includes recommendations regarding initial evaluation of thyroid nodules, clinical and ultrasound criteria for fine-needle aspiration biopsy, initial management of thyroid cancer including staging and risk assessment, surgical management, radioiodine remnant ablation, and levothyroxine therapy, short-term and long-term follow-up strategies, and management of recurrent and metastatic disease. The objective of this consensus is to inform clinicians, patients, researchers, and health policy makers about the best strategies (and their limitations) relating to the diagnosis and treatment of differentiated thyroid cancer.
Infection with yellow fever virus (YFV), the prototypic mosquito-borne flavivirus, causes severe febrile disease with haemorrhage, multi-organ failure and a high mortality. Moreover, in recent years ...the Flavivirus genus has gained further attention due to re-emergence and increasing incidence of West Nile, dengue and Japanese encephalitis viruses. Potent and safe antivirals are urgently needed.
Starting from the crystal structure of the NS3 helicase from Kunjin virus (an Australian variant of West Nile virus), we identified a novel, unexploited protein site that might be involved in the helicase catalytic cycle and could thus in principle be targeted for enzyme inhibition. In silico docking of a library of small molecules allowed us to identify a few selected compounds with high predicted affinity for the new site. Their activity against helicases from several flaviviruses was confirmed in in vitro helicase/enzymatic assays. The effect on the in vitro replication of flaviviruses was then evaluated.
Ivermectin, a broadly used anti-helminthic drug, proved to be a highly potent inhibitor of YFV replication (EC₅₀ values in the sub-nanomolar range). Moreover, ivermectin inhibited, although less efficiently, the replication of several other flaviviruses, i.e. dengue fever, Japanese encephalitis and tick-borne encephalitis viruses. Ivermectin exerts its effect at a timepoint that coincides with the onset of intracellular viral RNA synthesis, as expected for a molecule that specifically targets the viral helicase.
The well-tolerated drug ivermectin may hold great potential for treatment of YFV infections. Furthermore, structure-based optimization may result in analogues exerting potent activity against flaviviruses other than YFV.
Duodenal adenocarcinoma is a rare digestive cancer, often diagnosed at a late stage and harbours a poor prognosis. The arrival of immunotherapy has changed the prognosis of many neoplasia, including ...digestive adenocarcinomas with MSI-H status. Hereby, we describe three cases of MSI-H locally advanced duodenal adenocarcinoma who received neoadjuvant treatment with a PD1 inhibitor, pembrolizumab. A partial metabolic and endoscopic response was observed in all patients after 2 cycles. Duodenopancreatectomy was performed at the end of treatment (4–6 cycles), and anatomopathological analysis demonstrated pathological complete response in all patients. Our case series paves the way for prospectively exploring neoadjuvant immunotherapy in duodenal MSI-H adenocarcinoma and raises the question of organ sparing surgery in case of complete clinical response as observed in gastric and colo-rectal adenocarcinomas.
•Duodenal adenocarcinoma is rare cancer with poorly defined standard therapies.•Immune checkpoint inhibitors have changed management of MSI-H tumours.•Neoadjuvant immunotherapy may lead to pathological complete response.•Our observation paves the way to further explore organ sparing surgery.
Background
In 2017, the Lancet group launched The Lancet Planetary Health to promote the dissemination of research conducted in this field. Planetary health was also extensively discussed during the ...World Congress on Public Health 2020, which underlines the strategic importance recognized to this topic by experts and researchers active in public health at an international level. The aim was to investigate the role of public health university departments in the field of planetary health.
Methods
The Lancet Planetary Health database was queried from the inception to February 2021, to retrieve original articles or reviews whose first and/or last author was affiliated to a University Department of Public Health worldwide. We used the twenty-six EUPHA operational sections to define the research areas of the identified articles. The following data were extracted: study design, EUPHA area, research question, topic, identified gaps in the literature, and key concepts.
Results
Out of 543 entries, 44 original articles and reviews were included. Thirty-two percent studies were conducted in Asia, 20% in America, 13% in Europe, 8% in Oceania, 4% in Africa while 23% in a multicentric global context. The area investigated was mainly environmental and health (68%) followed by infectious disease control (14%). Collaboration across different disciplines is highly present in the authorships. Regarding the study design, 30% of the included articles were cohort studies.
Conclusions
From 2017 till February 2021, the number of studies performed by public health researchers published on The Lancet Planetary Health is gradually increasing.
Since published articles take advantage of the typical research methods and topics of public health and environmental health research, public health university departments can contribute to planetary health science if they seek transdisciplinary collaboration and adopt a planetary health vision.
Background
Influenza is a major public health issue for its epidemiological, clinical and economic impact. Children are a relevant age group for the diffusion of the infection in the community as ...they shed the virus in greater amounts and for longer periods of time than adults of any age. Vaccination is the best strategy to fight the disease. In Italy, until last year, influenza vaccination for the pediatric population was offered free only to children in specific risk categories, while in the last season its was extended also to all subjects from 6 months to 6 years old. The purpose of this work is to analyze the trend of vaccination coverage among children in the last decade in Italy.
Methods
We retrieved vaccination coverage data by the Italian Ministry of Health relating to influenza vaccination in the age groups 0-2, 2-4, 5-8 and 9-14 in the years 2010-2020 and analysed trends in and between regions.
Results
A preliminary analysis shows that vaccination coverage in the age groups considered ranged from a minimum of 1.1% to a maximum of 4.5%. The highest average percentage reached was recorded in the season 2010-11 (3.8%), while the lowest in the 2015-16 (1.5%). The highest average values (12,9%; 10,5%) were found in Puglia and Toscana, while the lowest (0.3%) in Friuli Venezia Giulia. From 2010 to 2015 there was a progressive decline in vaccination coverage, while in the following years there was a slight increase, up to the year 2019-2020, in which the average percentage value was 3%. Further results are expected for next summer, when 2020-21 data will be available.
Conclusions
Our analysis shows that in the Italian regions influenza vaccination coverage in children is variable but still extremely low. Childhood vaccination could provide an opportunity to decrease the burden of disease in this age group but may also help to protect the population at risk of serious complications, such as the elderly, due to the social role children play in the spread of this virus.
Key messages
Influenza vaccination in children is a major public health issue.
Additional efforts are needed to make vaccination available for children and improve the stakeholders’ awareness on this topic.
Optimum imaging of chronic pancreatitis Zamboni, G. A.; Ambrosetti, M. C.; Pezzullo, M. ...
Abdominal imaging,
05/2020, Letnik:
45, Številka:
5
Journal Article
Recenzirano
Chronic pancreatitis is an inflammatory process of the pancreas characterized by progressive parenchyma destruction, resulting in pain and exocrine and endocrine insufficiency. In the advanced stages ...the diagnosis by imaging is usually straightforward, while in the early phases of the disease there can be a paucity of findings at imaging, thus making an early diagnosis challenging. Different imaging modalities can have a role in the initial diagnosis and in the longitudinal follow-up of patients affected by chronic pancreatitis, also enabling to assess the complications of the disease. Radiography, Ultrasonography, CT and MRI can all provide morphological information, and MRI with the administration of secretin can also provide functional information. The use of an appropriate technique is fundamental for optimizing the examination to the clinical question.
Hepatocellular carcinoma accounts for 90% of primary liver cancers and represents a growing health problem worldwide. We report the complex case of a 71 year-old patient diagnosed with a large ...hepatocellular carcinoma and presenting an extensive vascular invasion of the middle hepatic vein and the inferior caval vein ascending to the right atrium with no extrahepatic spread. Due to several comorbidities, a systemic treatment by tyrosine kinase inhibitors was contraindicated. After discussion at the multidisciplinary hepatology tumor board, he was referred for selective internal radiation therapy. Unfortunately, the work-up showed an important lung shunt not allowing radioembolization. No clear recommendations are available in this situation. The decision was made to propose a combination treatment by transarterial chemoembolization, that was performed using a new generation of radio-opaque microspheres loaded with doxorubicin, followed by immunotherapy. This allowed a complete response with a very good quality of life.
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