Delay-Adjusted Age-Specific COVID-19 Case Fatality Rates in a High Testing Setting: South Korea, February 2020 to February 2021

In South Korea, a country with a high coronavirus disease 19 (COVID-19) testing rate, a total of 87,324 COVID-19 cases, including 1562 deaths, have been recorded as of 23 February 2021. This study assessed the delay-adjusted COVID-19 case fatality risk (CFR), including data from the second and third waves. A statistical method was applied to the data from 20 February 2021 through 23 February 2021 to minimize bias in the crude CFR, accounting for the survival interval as the lag time between disease onset and death. The resulting overall delay-adjusted CFR was 1.97% (95% credible interval: 1.94–2.00%). The delay-adjusted CFR was highest among adults aged ≥80 years and 70–79 years (22.88% and 7.09%, respectively). The cumulative incidence rate was highest among individuals aged ≥80 years and 60–69 years. The cumulative mortality rate was highest among individuals aged ≥80 years and 70–79 years (47 and 12 per million, respectively). In South Korea, older adults are being disproportionately affected by COVID-19 with a high death rate, although the incidence rate among younger individuals is relatively high. Interventions to prevent COVID-19 should target older adults to minimize the number of deaths.

Prognostic Value of TNFR2 and STAT3 among High-Grade Serous Ovarian Cancer Survivors According to Platinum Sensitivity

This study’s goal was to determine the protein expression level of tumour necrosis factor receptor 2 (TNFR2) and signal transducer and activator of transcription 3 (STAT3) in high-grade serous ovarian cancer (HGSC) tissues in relation to the platinum-based chemotherapy response and the prognosis outcome. A total of 25 HGSC patients underwent primary surgical debulking followed by first-line adjuvant platinum-based chemotherapy. Tissue microarray (TMA) slides were constructed utilising archived formalin fixed paraffin embedded (FFPE). The protein expression of TNFR2 and STAT3 were analysed using immunohistochemistry (IHC) staining and subsequently were correlated to the clinicopathological characteristics, platinum sensitivity as well as the duration of progression-free survival. About 14 out of 25 patients (56.0%) were platinum-sensitive. The progression free survival was significantly longer in the platinum-sensitive (PS) group when compared to those with the platinum-resistant group (PR), p = 0.0001. Among patients with TNFR2 strong expression on ovarian tissue, there was a significantly longer progression-free survival interval of 540 days in the PS group compared to PR, p = 0.0001. Patients with STAT3 expression also showed significantly better progression-free survival of 660 days in the PS group when compared to the PR group, p = 0.0001. In conclusion, patients with strong TNFR2 and STAT3 expression in the ovarian tissue had significantly longer progression-free survival interval in the PS group. Nevertheless, further research with a larger number of tissues may be required to demonstrate further significant differences.

The Disaster Taxon Lystrosaurus: A Paleontological Myth

The term “disaster species” was a term originally conceived to describe marine microfossils that exhibited profound abundances in the wake of a biological crisis. The term was expanded in the 1990s to describe (as “disaster taxa”) opportunistic taxa that dominated their biota numerically (“bloomed”) during the survival interval of a mass extinction event. The Permo-Triassic tetrapod genus Lystrosaurus has been cited regularly as a “disaster taxon” of the end-Permian mass extinction. A review of the definitions that have been developed for disaster taxa, and data from recent biostratigraphic and phylogenetic studies that include species of Lystrosaurus, leads to the conclusion that the genus is not a “disaster taxon”. Further, the known biostratigraphy and tree topologies of species of Lystrosaurus do not satisfy more recent definitions that attribute diversification to disaster species. At most, species of Lystrosaurus that form the informal “Lystrosaurus abundant zone” in the lower Katberg Formation, Lower Triassic of South Africa, could be described as opportunistic species.

Finding the real COVID-19 case-fatality rates for SAARC countries

Crude case fatality rate (CFR) is the most accurate when the pandemic is over. Adjustments to the crude CFR measure can better explain the pandemic situation by improving the CFR estimation. However, no study has thoroughly investigated COVID-19 adjusted CFR of the South Asian Association for Regional Cooperation (SAARC) countries. In this study, we estimated both survival interval and underreporting adjusted CFR of COVID-19 for the SAARC countries and observed the CFR changes due to the imposition of fees on COVID-19 tests in Bangladesh. Using the daily records up to 9th October, we implemented a statistical method to remove both the bias in crude CFR, i.e., the delay between disease onset and outcome bias and due to asymptomatic or mild symptomatic cases, reporting rates lower than 50% (95% CI: 10%-50%) bias. According to our findings, Afghanistan had the highest CFR, followed by Pakistan, India, Bangladesh, Nepal, Maldives, and Sri Lanka. Our estimated crude CFR varied from 3.71% to 0.29%, survival interval adjusted CFR varied from 3.77% to 0.3% and further underreporting adjusted CFR varied from 1.1% to 0.08%. We have also found that crude CFR increased from 1.261% to 1.572% after imposing the COVID-19 test fees in Bangladesh. Therefore, the authorities of countries with higher CFR should be looking for strategic counsel from the countries with lower CFR to equip themselves with the necessary knowledge to combat the pandemic. Moreover, caution is needed to report the CFR.

Gastric stump cancer. Etiology and treatment. A general review of the last 5 years

Introduction: Gastric stump cancer (GSC) is an entity described in the literature as early as the 1920s. Along the years the clinicopathological characteristic had changed. At the moment, there are no well-established guidelines regarding the optimal treatment. Material and method: We conducted a literature review of the studies published from 2014 to 2019 using the PubMed database. Results: After searching the PubMed database for the keywords: “gastric remnant cancer” AND “stump” AND “neoplasm” we identified 167 articles. Of these, 25 studies were considered relevant. Discussions: GSC develops after 2 years from the primary intervention for malignancy and after 20 years for benign lesions. The development mechanisms vary depending on the type of primary gastric lesions. GSC is considered a unique clinicopathological entity. The pattern of lymphatic drainage is different in comparison to primary gastric neoplasm. Thus an important negative prognostic factor is considered to be the N group of TNM staging. Conclusion: More studies are required to improve the understanding of development mechanisms and evolution of this pathology. Survival after gastric cancer has increased and it is possible to observe an increased percentage of patients who achieve the 5-year survival interval after surgery. Currently, there are no guidelines to select the optimal treatment with regards to surgery or chemotherapy as pathology is rare and studies which investigate the evolution and prognosis lack a significant cohort of patients. Therefore, the existent data is not substantial enough to elaborate guidelines that would define a standard surgical treatment.

Observed Survival Interval: A Supplement to TCGA Pan-Cancer Clinical Data Resource

To drive high-quality omics translational research using The Cancer Genome Atlas (TCGA) data, a TCGA Pan-Cancer Clinical Data Resource was proposed. However, there is an out-of-step issue between clinical outcomes and the omics data of TCGA for skin cutaneous melanoma (SKCM), due to the majority of metastatic samples. In clinical cases, the survival time started from the initial SKCM diagnosis, while the omics data were characterized at TCGA sampling. This study aimed to address this issue by proposing an observed survival interval (OBS), which was defined as the time interval from TCGA sampling to patient death or last follow-up. We compared the OBS with the usual recommended overall survival (OS) by associating them with both clinical data and microRNA sequencing data of TCGA-SKCM. We found that the OS of primary SKCM was significantly shorter than that of metastatic SKCM, while the opposite happened if OBS was compared. OS was associated with the pathological stage of both primary and metastatic SKCM, while OBS was associated with the pathological stage of primary SKCM but not that of metastatic SKCM. Five previously cross-validated survival-associated microRNAs were found to be associated with the OBS rather than OS in metastatic SKCM. Thus, the OBS was more appropriate for associating microRNA-omics data of TCGA-SKCM than OS, and it is a timely supplement to TCGA Pan-Cancer Clinical Data Resource.

Postmortem Diagnosis of Hypertonic Dehydration by Chemical Analysis of Vitreous Humor

The aim of forensic autopsy is to accurately reconstitute, as much as possible, the circumstances of death (the cause of death and the mechanism of death, the post-mortem interval, the related pathology and its role, the survival interval). Post-mortem biochemical analyses can help to various extents in establishing these issues. In order to elucidate the issue of post-mortem biochemical investigations, we conducted an analysis of forensic casuistry within a delimited territory, for a period of 3 years in order to identify the elements necessary for the diagnosis of hypertonic dehydration. By grouping the cases depending on the immediate cause of death, the diagnosis criteria for hypertonic dehydration showed the possibility of performing the differential diagnosis by biochemical analyses performed in vitreous humor (sodium, chlorine, urea, creatinine), the criteria being not met in any of the other groups.

Survival Outcomes of Double and Triple-Only Combination Anti-Myeloma Chemotherapeutic Regimens on 26 Multiple Myeloma Patients Seen in a Sub-Saharan African Country

Backgound: Multiple myeloma (MM) is one of the commonest haematological malignancies of public health importance in low-income countries of sub-Saharan Africa. Though primarily a disease of the bone marrow, it often poses a diagnostic dilemma for the orthopaedic surgeons because of the frequent skeletal manifestations. Consequently, misdiagnosis and late presentation are often common contributory factors to the poor prognosis and survival of victims in this environment. This retrospective study aimed at finding out the therapeutic challenges of MM in developing countries such as Nigeria. Methodology: A-10-year multi-centered retrospective analysis of 26 patients diagnosed and managed in three major centers between 2003 and 2013. Informations on the clinical, laboratory, radiological datas and therapeutic interventions were obtained at presentation until patients were lost to follow-up. Result: The median age of diagnosis was 60.6 years with M:F ratio of 2.3:1.(p<0.05). 61.5%, 30.8% and 7.7% presented in Durie Salmon (DS) stages III, II and I diseases respectively. The mean survival interval was 39.2 months (95% CI, 32.0-47.2 months). 84.5% and 8% were on Melphalan plus Prednisolone (MP) and Cyclophosphamide plus prednisolone (CP) combination chemotherapies respectively. The longest survival interval of 80 months was recorded by MP plus Bortezomib (V) triple regimen.There was no significant difference between the outcome of MP and VMP (p=0.33). Conclusion: Triple combination regimens (i.e,VMP, MPT) are superior to standard MP in terms of overall survival (OS),and quality of life of MM patients in developing countries, although this is not statistically significant. Disclosures No relevant conflicts of interest to declare.