Epidemiology and direct healthcare costs of Influenza-associated hospitalizations – nationwide inpatient data (Germany 2010-2019)

Introduction Detailed and up-to-date data on the epidemiology and healthcare costs of Influenza are fundamental for public health decision-making. We analyzed inpatient data on Influenza-associated hospitalizations (IAH), selected complications and risk factors, and their related direct costs for Germany during ten consecutive years. Methods We conducted a retrospective cost-of-illness study on patients with laboratory-confirmed IAH (ICD-10-GM code J09/J10 as primary diagnosis) by ICD-10-GM-based remote data query using the Hospital Statistics database of the German Federal Statistical Office. Clinical data and associated direct costs of hospital treatment are presented stratified by demographic and clinical variables. Results Between January 2010 to December 2019, 156,097 persons were hospitalized due to laboratory-confirmed Influenza (J09/J10 primary diagnosis). The annual cumulative incidence was low in 2010, 2012 and 2014 (1.3 to 3.1 hospitalizations per 100,000 persons) and high in 2013 and 2015-2019 (12.6 to 60.3). Overall direct per patient hospitalization costs were mean (SD) 3521 EUR (± 8896) and median (IQR) 1805 EUR (1502; 2694), with the highest mean costs in 2010 (mean 8965 EUR ± 26,538) and the lowest costs in 2012 (mean 2588 EUR ± 6153). Mean costs were highest in 60-69 year olds, and in 50-59, 70-79 and 40-49 year olds; they were lowest in 10-19 year olds. Increased costs were associated with conditions such as diabetes (frequency 15.0%; 3.45-fold increase compared to those without diabetes), adiposity (3.3%; 2.09-fold increase) or immune disorders (5.6%; 1.88-fold increase) and with Influenza-associated complications such as Influenza pneumonia (24.3%; 1.95-fold), bacterial pneumonia (6.3%; 3.86-fold), ARDS (1.2%; 10.90-fold increase) or sepsis (2.3%; 8.30-fold). Estimated overall costs reported for the 10-year period were 549.6 Million euros (95% CI 542.7-556.4 million euros). Conclusion We found that the economic burden of IAH in Germany is substantial, even when considering solely laboratory-confirmed IAH reported as primary diagnosis. The highest costs were found in the elderly, patients with certain underlying risk factors and patients who required advanced life support treatment, and median and mean costs showed considerable variations between single years. Furthermore, there was a relevant burden of disease in middle-aged adults, who are not covered by the current vaccination recommendations in Germany.

Case Report: A Rare Syncope Case Caused by Abernethy II and a Review of the Literature

Background: Abernethy malformation is an extremely rare anomaly of the splanchnic venous system, and only 2 cases that manifested as syncope had been reported previously.Case Presentation: A 24-year-old male had a 15-year history of jaundice and was in long-term use of hepatoprotective drugs. He was admitted for complaint of syncope. He underwent a series of examinations and cardiac ultrasound showed that his pulmonary artery pressure was elevated. Further imaging revealed the absence of intrahepatic portal veins. His blood ammonia was significantly increased. All signs and symptoms pointed to an Abernethy diagnosis. He was finally diagnosed as having Abernethy type II. He was discharged after 17 days of in-hospital treatment with sildenafil (50 mg/day) and ornithine aspartate (20 g/day).Conclusion: We now report this rare case of syncope that is caused by Abernethy malformation. As a typically pediatric disease, it was not identified in this patient until adulthood due to long-term treatment for jaundice and liver cirrhosis. Furthermore, we present a review of portosystemic shunts previously reported in the literature.

Healthwise, Part 5. Prevention and treatment of type 2 diabetes

The coronavirus (COVID-19) pandemic has highlighted the importance of public health in the UK and globally. The UK's death rates and obesity rates are related and many people in the UK experience poor health because they are overweight or obese ( Lobstein, 2021 ; Mohammad et al, 2021 ). Obesity increases the risks of developing type 2 diabetes. People with both type 1 and type 2 diabetes are at greater risk of developing severe COVID symptoms, of requiring hospital treatment and of poor outcomes and death ( Barron et al, 2020 ). This article, the fifth in a series, examines risk factors for type 2 diabetes and explains how readers can reduce their risk of developing type 2 diabetes.

Mental and Psycho-social Health and Quality-of-Life Before and After Cardiac Rehabilitation: A Prospective Cohort Study With Comparison to Specific Population Norms

Background. Data on mental health improvement after cardiac rehabilitation (CR) are contradicting. The aim was to examine the mental and psycho-social health of patients admitted to our rehabilitation center following hospital treatment for acute coronary syndrome, before and after multidisciplinary CR.Methods. Outcome was measured at admission and discharge by the 36-Item Short Form Survey (SF-36), the Symptom Checklist-90 Revised (SCL-90R), the Coping Strategy Questionnaire (CSQ) and the 6-minute-walking distance test. The patients’ health status was compared with norms of sex-, age- and comorbidity-matched data from the German general population. Score differences from norms were measured by standardized mean differences (SMDs); health changes were quantified by standardized effect sizes (ESs). Their importance for comprehensive assessment was quantified by explorative factor analysis.Results. Of n=70 patients followed-up (male: 79%; mean age: 66.6 years), 79% had ≥3 comorbidities. At baseline, SF-36 Physical functioning (SMD=–0.75), Role physical (–0.90), Social functioning (SMD=–0.44), and Role emotional (SMD=–0.45) were significantly worse than the norm. After CR, almost all scores significantly improved by ES=0.23 (SCL-90R Interpersonal sensitivity) to 1.04 (SF-36 Physical functioning). The strongest factor (up to 41.1% explained variance) for health state and change was the mental health domain, followed by function&pain (up to 26.3%).Conclusions. Normative deficits in physical and psycho-social health were reported at baseline. After CR, at follow-up, all scores, except phobia, showed significant improvement. The comprehensive measurement of bio-psycho-social health should not be limited to depression and anxiety but include, especially, the somatization and social participation dimensions.

Challenge Test as Special Tool to Estimate the Dynamic of Listeria monocytogenes and Other Foodborne Pathogens

Over 23 million cases of foodborne disease (FBD) occur in Europe each year, with over 4700 deaths. Outbreaks of FBD have a significant impact on our society due to the high economic losses they cause (hospital treatment of affected patients and destruction of contaminated food). Among its health objectives, the European Union has set itself the goal of reducing the incidence of the main FBDs, approving various regulations that codify requirements in order to produce food that is “safe” for human consumption. Among these rules, Regulation 2005/2073 establishes precise food safety criteria for foods that are judged to be most at risk of causing episodes of FBD. The food business operator (FBO) must know their food better and know how to estimate whether a food can support the growth of food pathogens or if they are able to hinder it during the food’s shelf life. It is becoming crucial for each FBO to schedule specific laboratory tests (challenge tests) to establish the growth potential of individual pathogens and their maximum growth rate. In 2008 the European Union published the guidelines for programming the challenge tests for Listeria monocytogenes in RTE foods. These guidelines were further implemented in 2014 and again in 2019. In June 2019 the UNI EN ISO 20976-1 was published, which contains indications for setting up and carrying out challenge tests for all foodborne pathogens in all foods. In this article, we compare the three official documents to highlight their common aspects and differences, highlighting the advantages and disadvantages that each of them offers for those who have to set up a challenge test for the various foodborne pathogens. Our conclusion is that the challenge test is today the most effective tool to estimate the dynamics and growth potential of pathogenic microorganisms in food, if it is designed and implemented in a scrupulous way. It is important to develop a rational experimental design for each challenge test, and for each food, and this requires professionals who are experts in this specific field of study and who must be properly trained.

Peculiarities of complete blood count indicators in patients with community-acquired pneumonia during the COVID-19 pandemic

The article presents the literature review data on the community-acquired pneumonia and the survey of patients with community-acquired pneumonia during the pandemic of the new coronavirus infection COVID-19. There are no changes in the rate of leukocytosis detection in patients with mild course of the di­sease within 10 days of hospital stay. There is a tendency to increase the proportion of people with a normal number of leukocytes and lymphocytes from day 4–6 of hospital treatment. Significantly, leukopenia was detected in 9.3 % of patients 1–3 days after hospitalization and was not observed in the future. Lymphopenia was registered in the first 1–6 days of hospital stay and was not observed from day 7–9. Granulocytosis was detected in 27.6 % of patients on day 1–3 in the hospital and in the following days their percentage decreased significantly; at the same time, the number of people with normal range of granulocytes increased significantly. Normal platelet counts were observed in most patients (93.8 %) on day 1–3 of hospital stay, and thrombocytopenia was recorded only in 6.3 % of individuals on day 1–3 after hospitalization. In moderate-to-severe form, 24.7 % of patients had leukocytosis on day 1–3 of hospital stay, and on day 7–9 of treatment, it was detected already in 28.8 % (p > 0.05). The majority of patients (66.7 %) had normocytosis in the first three days, and leukopenia was observed in 8.7 % of people on day 1–3. Significantly, the share of detected lymphocytosis increased, and lymphopenia — decreased from 4–6 days of hospital stay. Granulocytosis was registered in 23.2 % of patients on day 1–3 of hospital stay, followed by a significant decrease in the percentage of granulocytes from days 4–6. Band neutrophils were elevated in the first three days among 51.6 % of patients, and their percen­tage significantly decreased after the fourth day. Most individuals (77.3 %) had a normal platelet count on day 1–3 in the hospital, and thrombocytopenia at this time was found in 16.7 %. The majority of patients aged 20–30 years had a normal number of leukocytes (65.5 %), and 25.5 % had leukocytosis 1–3 days after hospitalization. Lymphocytosis in the first 3 days was registered among 9 % of people and then increased significantly, lymphopenia was observed in 31 % of patients on day 1–3 and subsequently decreased, granulocytosis — in 25 % of cases, elevated levels of band neutrophils — in 43.8 %, thrombocytosis — in 7.3 %, thrombocytopenia — in 10.9 %. Among patients aged 31–40 years in the first 3 days after hospitalization, leukocytosis was registered in 28 % of cases, leukocyte count was normal in 72 %, leukopenia was not detected, 48 % of patients had lymphopenia, 15.8 % — granulocytosis, levels of band neutrophils were elevated in 65.2 %, thrombocytosis was observed in 8 % of cases, thrombocytopenia — in 8 %. Most patients (66.7 %) aged 41–50 years on day 1–3 after hospitalization had normocytosis, 19 % — leukocytosis, 14.3 % — leukopenia, 14.3 % — lymphocytosis, 38.1 % — lymphopenia, 3 (25 %) people had granulocytosis, levels of band neutrophils were elevated in 65 % of cases, thrombocytosis was detected in 4.8 %, thrombocytopenia — in 28.5 %. Among patients aged 51–60 years in the first 3 days after hospitalization, the following indicators of complete blood count were found: 16.1 % of individuals had leukocytosis, number of leukocytes was normal in 83.9 % of cases, leukopenia was not detected, lymphocytosis was found in 16.1 % of people, lymphopenia — in 22.6 %, granulocytosis — in 20 %, elevated levels of band neutrophils — in 39.3 %, thrombocytosis — in 3.2 %, thrombocytopenia — in 16.2 %. Patients older than 60 years on days 1–3 after hospitalization had the following changes: 38.8 % — leukocytosis, white blood cell count was normal in 49 % of cases, 12.2 % of people had leukopenia, 12.2 % — lymphocytosis, 51.1 % — lymphopenia, granulocytosis was not observed, 25 % had granulocytopenia, 60 % — elevated levels of band neutrophils, 8.2 % — thrombocytosis, and 18.3 % — thrombocytopenia.

THE EFFECT OF SPIRITUAL BASED REIKI THERAPY (PRAYER) ON POSTTRAUMATIC GROWTH (PTG) AMONG CHRONIC RENAL FAILURE PATIENTS THROUGH HEMODIALYSIS

Background: Disease Chronic kidney failure can result in positive and negative implications as Posttraumatic Growth (PTG) and problems mental - psychological include self-concept, and the quality of life of patients. Objectives: The research objective was to analyze the effect of spiritual based reiki therapy (prayer) on posttraumatic growth. Methods: The study design was Quasy-Experimental with pre-post test control group design and research conducted by a research assistant. The population was all chronic renal failure patients undergoing hemodialysis. Sample size 40, divided into 20 interventions and 20 controls. The sampling technique is purposive sampling. In the intervention group-based therapy reiki spiritual (prayer) for 45 - 75 minutes of 8-12 meetings (se whenever there are 3 sessions) performed 2 weeks. The control group was given action according to hospital standards. Test analysis Wilcoxon Signed Ranks Test and analysis uji depending Mann Whitney. Results: Results of analysis of test Wilcoxon Signed Ranks Test P no intervention group therapy reiki spiritually based (Prayer) no effect on posttraumatic growth p = 0.000. If the control group was given therapy according to hospital SOP, there was an effect on posttraumatic growth p = 0.025. And the results of the analysis using Mann Whitney found that Results Posttraumatic Growth in the intervention group of the therapy reiki spiritually based (Prayer) - In the group controls are enforcedi according to SOP hospital treatment, the results are no different, p = 0.000. Conclusion: Reiki therapy based spiritual (prayer) is very effective to decrease the Posttraumatic Growth, can improve quality of life and positive attitude in which respondents were willing to change his priorities and biases appreciate herself.

Economic impact of Enterosgel® in the hospital treatment of diarrhoeal syndromes associated with different disease conditions

Background: Enterosorbents are orally administered materials which pass through the gut where they bind various substances. In a randomized clinical trial, the efficacy and safety of enterosorbent Enterosgel® in the treatment of non-infectious diseases with diarrhoea have been proved. Objective: To assess the cost impact of Enterosgel® in the treatment of hospitalized patients with non-infectious diseases with diarrhoea adopting a cost/minimization approach. Methods: A cost analysis was conducted considering the hospital’s perspective. The analysis compared the treatment costs (drugs and hospital stays) of Enterosgel® in addition to the standard of care (SoC) to SoC alone. The main analysis focused on the comparison between the two therapeutic strategies regarding the economic valorization of hospital stays, while the secondary analysis estimated the hospital organizational efficiency with regard to the annual bed turnover. Results: Reducing the duration of inpatient admission, compared to SoC alone, Enterosgel® in addition to SoC let the hospital obtain a greater valorization of the hospital stays (range: € 68.54-€ 558.60). The shorter duration of inpatient admission results in an increased number of hospital admissions per year. For example, assuming a 10-bed ward, the total hospital annual gain would be € 82,616. Conclusions: Enterosgel® in addition to SoC is cost saving, allowing the hospital to achieve greater efficiency in managing patients with non-infectious diseases with diarrhoea.

RETROSPECTIVE ANALYSIS OF ACUTE LYMPHADENITIS OF THE MAXILLOFACIAL REGION AND NECK IN CHILDREN

Дети с острыми формами лимфаденитов челюстно-лицевой области составляют большую часть пациентов поликлиник и профильных стационаров. Зачастую они имеют недооцененную клиническую картину, общее состояние, распространенность и динамику острого воспалительного процесса, требуя хирургического вмешательства. Допущенные ошибки приводят к удлинению сроков лечения и иногда угрозе для жизни. Для раннего выявления показаний для госпитализации и помощи практикующим врачам в алгоритме действий проведен анализ случаев острых лимфаденитов лица и шеи в детском возрасте. На основе ретроспективных данных осуществлена систематизация лимфаденитов челюстно-лицевой области по клиническим формам и распределении частоты встречаемости, возрасту, анатомической принадлежности, выделены основные изменения гематологических показателей. Определена корреляция температурной кривой, этиологические причины возникновения лимфаденитов и основные микробиологические возбудители гнойных форм лимфаденитов лица и шеи у детей. На основании полученных данных нами разработаны и предложены критерии дифференциальной диагностики разных клинических форм лимфаденита, что поможет врачу с постановкой предварительного диагноза, или дифференциальной диагностике, на этапе поликлиники или на догоспитальном приёме. Данные критерии помогут сократить сроки лечения детей в стационаре и не допустить развития тяжелых осложнений Children with acute forms of lymphadenitis of the maxillofacial region make up the majority of patients in polyclinics and specialized hospitals. They often have an underestimated clinical picture, general condition, prevalence and dynamics of an acute inflammatory process, requiring surgical intervention. Mistakes lead to lengthening of treatment and sometimes life-threatening. For early detection of indications for hospitalization and assistance to practitioners in the algorithm of actions, an analysis of cases of acute lymphadenitis of the face and neck in childhood was carried out. On the basis of retrospective data, the systematization of lymphadenitis of the maxillofacial region by clinical forms and distribution of frequency of occurrence, age, anatomical affiliation was carried out, the main changes in hematological parameters were highlighted. The correlation of the temperature curve, the etiological causes of the occurrence of lymphadenitis and the main microbiological pathogens of purulent forms of lymphadenitis of the face and neck in children were determined. Based on the data obtained, we have developed and proposed criteria for the differential diagnosis of various clinical forms of lymphadenitis, which will help the doctor with a preliminary diagnosis, or differential diagnosis, at the stage of the polyclinic or at the pre-hospital admission. These criteria will help to shorten the period of hospital treatment for children and prevent the development of severe complications

THE POSSIBILITIES OF COMPLEX VISUAL DIAGNOSTICS OF LIVER PATHOLOGY IN PATIENTS WITH DIFFUSE LIVER DISEASES ASSOCIATED WITH COVID-19.

The research shows the possibilities of visual diagnostics of liver pathology in patients with various diffuse liver diseases and COVID-19. The analysis is based on the results of examination of patients, who got hospital treatment in Clinical Hospital №1 of Smolensk from September to November 2021. The research shows the efficiency of ultrasound diagnosis as the first step of examination. Using Magnetic Resonance Imaging (MRI) allowed to study the symptoms of liver pathology more deeply. In order to improve the exact specific diagnosis of liver pathology in patients with diffuse liver diseases and COVID-19, arterial spin labeling technique is recommended to use. The research shows the efficiency of complex using of diagnostic methods in patients with diffuse liver diseases and SARS-CoV-2 infection