Italy has been badly affected by the COVID-19 pandemic and has one of the highest death tolls. We analyzed the severity of COVID-19 across all 20 Italian regions.
We manually retrieved the daily ...cumulative numbers of laboratory-confirmed cases and deaths attributed to COVID-19 in each region, and estimated the crude case fatality ratio and time delay-adjusted case fatality ratio (aCFR). We then assessed the association between aCFR and sociodemographic, health care and transmission factors using multivariate regression analysis.
The overall aCFR in Italy was estimated at 17.4%. Lombardia exhibited the highest aCFR (24.7%), followed by Marche (19.3%), Emilia Romagna (17.7%) and Liguria (17.6%). Our aCFR estimate was greater than 10% for 12 regions. Our aCFR estimates were statistically associated with population density and cumulative morbidity rate in a multivariate analysis.
Our aCFR estimates for Italy as a whole and for seven out of the 20 regions exceeded those reported for the most badly affected region in China. These findings highlight the importance of social distancing to suppress transmission to avoid overwhelming the health care system and reduce the risk of death.
Predicting the impact of natural disasters such as hurricanes on the transmission dynamics of infectious diseases poses significant challenges. In this paper, we put forward a simple modelling ...framework to investigate the impact of heavy rainfall events (HREs) on mosquito-borne disease transmission in temperate areas of the world such as the southern coastal areas of the USA. In particular, we explore the impact of the timing of HREs relative to the transmission season via analyses that test the sensitivity of HRE-induced epidemics to variation in the effects of rainfall on the dynamics of mosquito breeding capacity, and the intensity and temporal profile of human population displacement patterns. The recent Hurricane Harvey in Texas motivates the simulations reported. Overall, we find that the impact of vector-borne disease transmission is likely to be greater the earlier the HREs occur in the transmission season. Simulations based on data for Hurricane Harvey suggest that the limited impact it had on vector-borne disease transmission was in part because of when it occurred (late August) relative to the local transmission season, and in part because of the mitigating effect of the displacement of people. We also highlight key data gaps related to models of vector-borne disease transmission in the context of natural disasters. This article is part of the theme issue 'Modelling infectious disease outbreaks in humans, animals and plants: approaches and important themes'. This issue is linked with the subsequent theme issue 'Modelling infectious disease outbreaks in humans, animals and plants: epidemic forecasting and control'.
•The epidemic appears to be approaching a steady state with ∼35 cases per week during last 8 weeks.•The average reporting delay exhibited 81.1% decline from May 2018 to September 2018.•The average ...reporting delay for the last 4 epidemic weeks is at 1.7 weeks (95% CI: 1.6,1.9).•Most recent estimate of R is at 0.9 (95% CI: 0.4, 1.1) during the last generation interval.
On August 1, 2018, the Democratic Republic of Congo declared its 10th and largest outbreak of Ebola inflicting North Khivu and Ituri provinces. The spread of Ebola to Congolese urban centers along with deliberate attacks on the health care workers has hindered epidemiological surveillance activities, leading to substantial reporting delays. Reporting delays distort the epidemic incidence pattern misrepresenting estimates of epidemic potential and the outbreak trajectory. To assess the impact of reporting delays, we conducted a real-time analysis of the dynamics of the ongoing Ebola outbreak in the DRC using epidemiological data retrieved from the World Health Organization Situation Reports and Disease Outbreak News. We analyzed temporal trends in reporting delays, epidemic curves of crude and reporting-delay adjusted incidences and changes in the effective reproduction number, Rt. As of January 15, 2019, 663 Ebola cases have been reported in the Democratic Republic of Congo. The average reporting delay exhibited 81.1% decline from a mean of 17.4 weeks (95% CI 13–24.1) in May, 2018 to 3.3 weeks (95% CI 2.7–4.2) in September, 2018 (F-test statistic = 44.9, p = 0.0067). The Ebola epidemic has shown a two-wave pattern with the first surge in cases occurring between July 30 and August 13, 2018 and the second on September 24, 2018. During the last 4 generation intervals, the trend in the mean Rt has exhibited a slight decline (rho = −0.37, p < 0.001), fluctuating around 0.9 (range: 0–1.8). Our most recent estimate of R is at 0.9 (95% CI: 0.4, 1.1) during the last generation interval. Our most recent analysis of the Ebola outbreak in DRC indicates that the Ebola virus still active although transmission is characterized by a low fluctuating reproduction number. Yet, this pattern does not imply that the epidemic can be easily controlled particularly in the context of unstable epidemiological surveillance efforts hindered by unpredictable local violence.
Background
Total pancreatectomy is required to completely clear tumours that are locally advanced or located in the centre of the pancreas. However, reports describing clinical outcomes after total ...pancreatectomy are rare. The aim of this retrospective observational study was to assess clinical outcomes following total pancreatectomy using a nationwide registry and to create a risk model for severe postoperative complications.
Methods
Patients who underwent total pancreatectomy from 2013 to 2017, and who were recorded in the Japan Society of Gastroenterological Surgery and Japanese Society of Hepato‐Biliary‐Pancreatic Surgery database, were included. Severe complications at 30 days were defined as those with a Clavien–Dindo grade III needing reoperation, or grade IV–V. Occurrence of severe complications was modelled using data from patients treated from 2013 to 2016, and the accuracy of the model tested among patients from 2017 using c‐statistics and a calibration plot.
Results
A total of 2167 patients undergoing total pancreatectomy were included. Postoperative 30‐day and in‐hospital mortality rates were 1·0 per cent (22 of 2167 patients) and 2·7 per cent (58 of 167) respectively, and severe complications developed in 6·0 per cent (131 of 2167). Factors showing a strong positive association with outcome in this risk model were the ASA performance status grade and combined arterial resection. In the test cohort, the c‐statistic of the model was 0·70 (95 per cent c.i. 0·59 to 0·81).
Conclusion
The risk model may be used to predict severe complications after total pancreatectomy.
Antecedentes
La pancreatectomía total está indicada cuando se requiere la resección completa de tumores localmente avanzados o ubicados en el centro del páncreas. Sin embargo, existen pocos artículos que describan los resultados clínicos después de una pancreatectomía total. El objetivo de este estudio observacional retrospectivo fue evaluar los resultados clínicos después de una pancreatectomía total utilizando un registro nacional y crear un modelo de riesgo de complicaciones postoperatorias graves.
Métodos
Se incluyeron aquellos pacientes que se sometieron a una pancreatectomía total entre 2013 y 2017 y que fueron registrados en la base de datos de la Sociedad Japonesa de Cirugía Gastrointestinal y de la Sociedad Japonesa de Cirugía Hepato‐Bilio‐Pancreática. Las complicaciones graves a los 30 días se definieron como Clavien‐Dindo grado III con reintervención o grado IV/V. Se analizó la aparición de complicaciones graves de los pacientes desde 2013 a 2016 y se evaluó la precisión del modelo entre los pacientes operados desde 2017 usando estadísticos c y un gráfico de calibración.
Resultados
Se incluyeron 2.167 pacientes sometidos a una pancreatectomía total. La mortalidad postoperatoria a los 30 días y la mortalidad hospitalaria fueron del 1,0% (22/2167) y del 2,7% (58/2167), respectivamente, y las complicaciones graves ocurrieron en el 6,0% (131/2167) de los pacientes. Los factores que mostraron una fuerte asociación positiva con los resultados en este modelo de riesgo fueron el estado funcional según la Sociedad Americana de Anestesiología y la resección arterial combinada. En la cohorte de prueba, el estadístico c del modelo fue de 0,70 (i.c. del 95% 0,59‐0,81).
Conclusión
El modelo de riesgo puede usarse para predecir las complicaciones graves después de una pancreatectomía total.
This study assessed the clinical outcomes of total pancreatectomy using a nationwide registry in Japan, and proposed a risk model for severe postoperative complications. Rates of mortality and severe complication after total pancreatectomy were lower in this study than in previous reports. The risk model showed good calibration.
Tool for preoperative risk estimation
Purpose
The GEST study showed non-inferiority of S-1 but not superiority of gemcitabine plus S-1 (GS) to gemcitabine alone for overall survival with the data by the cut-off date of 31st July in 2010 ...for chemo-naïve patients with advanced pancreatic cancer. We considered it important to determine whether S-1 maintains non-inferiority after a long-term follow-up in the GEST study and to obtain a firm positive conclusion. In addition, it may be an interesting challenge to explore the efficacious profile of GS in the long-term follow-up study. Using the data from the follow-up period, background and efficacy in patients from Taiwan and Japan, as well as the rates of tumor shrinkage in locally advanced and metastatic patients (Waterfall plot) were also analyzed.
Methods
The results of the primary analysis were reconfirmed, and subset analysis of overall survival and progression-free survival was performed based on the overall survival data updated by the cut-off date of 31st July in 2011.
Results
The median follow-up period was 29.8 months, and 795 deaths occurred (95.6%). The median overall survival was 8.8 months for gemcitabine, 9.7 months for S-1 (hazard ratio HR, 0.96; 97.5% confidence interval CI, 0.79–1.17), and 9.9 months for GS (HR 0.91; 97.5% CI 0.75–1.11). In patients with performance status (PS) 0, the median overall survival was 9.8 months for gemcitabine, 10.9 months for S-1, and 10.5 months for GS. In patients with PS 1, the median overall survival was 6.2 months for gemcitabine, 6.3 months for S-1, and 9.6 months for GS.
Conclusion
Our survey reconfirmed the non-inferiority of S-1 to gemcitabine and showed S-1 can be used as one of the standard treatment options for advanced pancreatic cancer.
Trial registration
ClinicalTrials.gov: NCT00498225.
Non-specific symptoms of acute respiratory viral infections make it difficult for many countries without ongoing transmission of a novel coronavirus to rule out other possibilities including ...influenza before isolating imported febrile individuals with a possible exposure history. The incubation period helps differential diagnosis, and up to two days is suggestive of influenza. It is worth including the incubation period in the case definition of novel coronavirus infection.
Although minimally invasive surgery has achieved worldwide acceptance in various fields, laparoscopic surgery for pancreatic diseases has been reported only rarely. The purpose of this study was to ...evaluate the outcomes and feasibility of laparoscopic pancreatic surgery.
Fifteen patients, comprising eight men and seven women with an average age of 54 years, underwent laparoscopic pancreatic surgery. Distal pancreatectomy was indicated for solid tumors ( n = 4), cystic lesions ( n = 3), and chronic pancreatitis ( n = 2). Cystogastrostomy was performed for pseudocysts ( n = 4) and enucleation for insulinomas ( n = 2). The lesions varied in size from 1 to 9 cm (2.9 +/- 2.4 cm) and were located in the pancreatic head ( n = 2), body ( n = 3), or tail ( n = 10). For distal pancreatectomy, the splenic artery was divided and the parenchyma was transected with a linear stapler. Laparoscopic ultrasonography was used to determine the distance between the tumor and the main pancreatic duct for enucleation as well as to localize the lesion for distal pancreatectomy. Cystogastrostomy, 4.5 cm in length, was also performed with the linear stapler through the window of the lesser omentum.
Mean operation time was 249 +/- 70 min (293 +/- 58 min in distal pancreatectomy, 185 +/- 14 min in enucleation, 204 +/- 50 min in cystogastrostomy), and mean blood loss was 138 +/- 184 g (213 +/- 227 g, 75 +/- 35 g, 38 +/- 48 g, respectively). Two distal pancreatectomies (13%) were converted to open surgery due to severe peripancreatic inflammation. There was no related mortality, but there were two cases (15%) of pancreatic fistula, one in a distal pancreatectomy case and the other in an enucleation case, and both were treated conservatively.
Laparoscopic pancreatic surgery is safe and feasible for patients with benign tumors and cystic lesions.
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