IntroductionHemodialysis is renal replacement therapy. However, it is associated with various complications. Sexual dysfunction is one of them. It is estimated that 25%-64% of female patients on hemodialysis have sexual dysfunction worldwide. This impaired quality of life further leads to anxiety and depression. Around 22.8%-39.3% of patients on hemodialysis are depressed while 27% have a major anxiety disorder. In Pakistan, the incidence of end-stage renal disease (ESRD) is 100 per million people. As far as we know, this is the first study conducted in Multan to assess sexual dysfunction in female patients undergoing hemodialysis. The objective of this study was to find out the prevalence of sexual dysfunction in female patients on hemodialysis and its relationship with anxiety and depression.Material and methodsA cross-sectional study was conducted in Nishtar Medical University Hospital, Multan, Pakistan, from February 2021 to May 2021. Data were collected from 55 female patients in the form of an interview after having met inclusion and exclusion criteria. The questionnaire had some sociodemographic questions. The female sexual function index (FSFI) was used to evaluate sexual dysfunction in hemodialysis patients while anxiety and depression were assessed using the hospital anxiety and depression (HADS) scale. SPSS version 25.0  was used for data analysis. Pearson's correlation was used to find the association of sexual dysfunction with anxiety and depression. A p-value of <0.05 was considered statistically significant.ResultsHypertension (56.4%) was the leading cause of chronic kidney disease (CKD). The most serious problem of the patients was sexual arousal suggested by the low mean score (1.77 ± 2.27) as compared to other sexual domains. Anxiety and depression were found in 20% and 30.9% of patients, respectively. There was a significant negative correlation between age , , , and ) and depression , ) with sexual function. While anxiety was not significantly associated with sexual function , , , ,  and ).ConclusionSexual dysfunction is not uncommon in female hemodialysis patients. There was a significant negative correlation of different sexual domains with age and depression, respectively. The correlation of anxiety with sexual dysfunction was found to be statistically insignificant. Hemodialysis is a form of renal replacement therapy for end-stage renal failure patients. Although life-saving, it is associated with multiple complications such as dialysis disequilibrium syndrome, hemolysis, allergic reactions, and intradialytic hypotension . FurtherRegular dialysis is extremely distressing. Besides impairing quality of life, it could lead to depression and anxiety among dialysis patients. Among patients with end-stage renal disease (ESRD), depression is the most common psychiatric illness. The reported prevalence of depression in the dialysis population varied from 22.8% (interview-based diagnosis) to 39.3%  [Depression is characterized by a persistent depressed (low) mood, feelings of worthlessness, a lack of positive affect, and a loss of interest in things one once enjoyed (anhedonia). It is a significant prognostic factor for mortality among dialysis patients (associated with a 50% increase in risk) . In addiIn Pakistan, the estimated incidence of ESRD is 100 per million of the population . HoweverA cross-sectional study was carried out in the dialysis unit of the Nephrology Department, Nishtar Medical University Hospital, Multan, Pakistan, from February 2021 to May 2021. Ethical approval was given by the ethical review committee of Nishtar Hospital Multan. Data were collected after obtaining proper informed consent, by distributing the questionnaire among study participants using the random sampling technique. We divided the questionnaire into three sections. Section A comprised eight questions regarding various sociodemographic characteristics  and a few clinical questions .We included only those female patients aged 19 to 60 years who were married and living with their husbands for the past four weeks. In contrast, the study did not include female patients who were unmarried, widows, living away from their husbands, or suffering from some major psychiatric illnesses.There were 19 questions in section B related to sexual functioning in female patients-FSFI . Six sexSection C was related to questions that assess the severity of anxiety and depression among participants using the Hospital Anxiety and Depression Scale (HADS) . It has SPSS version 25.0  was used to analyze the data. Frequencies, means, and standard deviations were calculated for various sociodemographic and clinical variables. Pearson's correlation was used to find the relationship between various categorical variables. A p-value of <0.05 was considered statistically significant.In the study, 55 female patients receiving hemodialysis were included. Among these patients, the minimum age was 19 years, and the maximum age was 60 years. The mean duration of hemodialysis was 31.52 ± 30.2 months, and their average BMI was 22.01 ± 5.28. Among these, 22 (40%) were illiterates, 18 (32.7%) got education up to primary level, 9 (16.4%) up to secondary level, and 6 (10.9%) went to university. While 53 (96.4%) were housewives. The leading cause of renal failure was hypertension (56.4%) followed by diabetes mellitus (12.7%) and postpartum hemorrhage (12.7%). About 30 (54.5%) patients had associated hepatitis C and two (3.6%) had associated cardiovascular disease. The average hemoglobin was 9.25 ± 1.85  were normal, 11 (20%) were borderline abnormal, and 11 (20%) were abnormal. Concerning depression, 20 (36.4%) were normal, 18 (32.7%) were borderline abnormal, and 17 (30.9%) were abnormal  in chronic kidney disease (CKD) patients. Hypertension was also the most common risk factor as found by Strippoli et al. 67%) [6.4% in c% 6.4% i, and ZeiWe found that the most serious problem of the patients was sexual arousal suggested by the low mean score 1.77 ± 2.27) as compared to other sexual domains while, at the same time, most were sexually satisfied, suggesting that sexual satisfaction does not rely merely upon sexual desire and arousal. It is multidimensional and affected by various physical, psychological, and social factors. This finding is supported by other studies as well 7 ± 2.27 . MoreoveMany studies reported a negative correlation between age and sexual function with a slight difference in various domains -7. We alA chronic illness not only affects the body physically but also affects its psychological, social, and financial aspects, further deteriorating one's mental health. Using HADS, 20% of patients on hemodialysis had anxiety, and 30% of patients were found depressed in this study. A similar study conducted in Karachi reported a slightly higher percentage of anxiety 45.8%) and depression (31.3%) . In Iran.8% and dThere were, however, certain limitations to our study. First, we had a small sample size. Second, it was a single-center study. Third, a pre-dialysis psychological evaluation was not done. Fourth, many other risk factors of sexual dysfunction were not excluded.Sexual dysfunction was a common problem in female hemodialysis patients. Most of them had problems with arousal. There was a significant negative correlation between different sexual domains with age and depression. The correlation of anxiety with sexual dysfunction was found to be statistically insignificant. Our study underscores the importance of psychological interventions besides pharmacological therapy in hemodialysis patients.


Fusarium and Aspergillus equally accounting for 33.3% (21 of 63), Alternaria 9.5% (6 of 63), Curvularia 6.3% (4 of 63), Scedosporium apiospermum 6.3% (4 of 63), Paecilomyces lilacinus 3.2% (2 of 63), Exserohilum 3.2% (2 of 63), and Candida 4.8% (3 of 63), respectively. In positive culture cases, IVCM was found to be positive for hyphae or spores in 61 of 63 patients (96.8%). Different fungal species had a variety of cultural characteristics and IVCM manifestations. Conclusions: In a tertiary referral hospital in central China, Fusarium species, Aspergillus species, and Alternaria species were the 3 most common isolated fungal pathogens, and the proportion of Aspergillus species was significantly higher than that in other regions of China. Careful lesion depth examination by IVCM and OCT should be taken before lamellar keratoplasty to avoid postoperative recurrence. Identifying the IVCM image and culture characteristics will facilitate rapid diagnosis and proper treatment, but IVCM cannot yet replace fungal cultures to distinguish between different fungal species.Purpose: To investigate the characteristics of in vitro culture and in vivo confocal microscopy (IVCM) in patients with fungal keratitis (FK) presented in a tertiary referral hospital in central China. Methods: In this noncomparative retrospective study, patients with the diagnosis of FK between October 2021 and November 2022 were reviewed. An IVCM and fungal culture  were performed, and the characteristics were analyzed. Results: During October 2021 and November 2022, 85 patients were diagnosed with FK. From 63 culture-positive cases, 8 species of fungus were identified. The proportions of isolated fungal species were  Fungal keratitis (FK) is a severe corneal infection that often results in blindness and eye loss in developing countries ,2. AnnuaThough time-consuming, microbiological culture of corneal scrapings is still the gold standard for identifying the causative organism in FK . In vivoIn order to improve the prognosis of FK, ophthalmologists are required to gain a better understanding of the characteristics of the isolation and identification of fungi, as well as those of IVCM ,7,14. HoThe medical history data of patients with the diagnosis of FK at Union Hospital, Tongji Medical College, Huazhong University of Science and Technology between October 2021 and November 2022 were retrospectively reviewed. The Ethics Committee of Union Hospital approved this study  according to the tenets of the Declaration of Helsinki.All patients underwent anterior segment photography, IVCM, corneal scraping, anterior segment optical coherence tomography (AS-OCT), and bacterial and fungal culture examinations. The inclusion criteria were: (1) hyphae or spores observed on IVCM; (2) hyphae or spores detected by corneal scraping; or (3) a positive fungal culture result. The exclusion criteria were the following: (1) other types of keratitis; or (2) fungal endophthalmitis without keratitis. The culture-positive cases  were collected for further analysis.The following clinical data were collected: (1) demographic data ; (2) ocular examination data ; (3) treatment processes; (4) visual changes on follow-up.An IVCM was performed to detect fungal hyphae and spores as previously described , using tFollowing a standard microbiological procedure , a corneTopical eyedrops were administered to patients diagnosed with FK, including 0.15% amphotericin B  and 1% Voriconazole  hourly for 2 weeks, every 2 hours for 4–8 weeks. Oral Voriconazole was administered at 200 mg twice daily for 4 weeks. The response to therapy was noted on slit lamp examination. To avoid posterior synechiae of the iris and reduce inflammation, 1% atropine and 0.1% bromfenac sodium eye drops were used. If there were no changes or worsening of corneal lesions after 7 days of medical treatment, the operation would be performed.All patients in this study were examined and followed with hepatic and renal function regularly monitored. All complications were documented and described. The FK healing was defined as the re-epithelialization, disappearance of infiltrate and hypopyon, absence of hyphae through IVCM. Failure was defined as corneal perforation or recurrence of FK or eyeball removal. The outcome measures included visual acuity, healing of the ulcers, recurrence of FK, and relevant complications. All patients were followed up daily for 1 week, biweekly for 1 month, monthly for 3 months, and then at different intervals after treatment.All aggregated data were expressed as mean ± standard deviation (SD). This was an observation descriptive analysis. No statistical analysis was performed.During October 2021 and November 2022, 85 patients were diagnosed with FK. The average age of the patients was 60.1 ± 7.8 (30–79) years. The number of female patients  was lower than that of male patients . All the patients had unilateral infections . Patients from rural areas accounted for 88.2% of the total (75 of 85). In 56.5% (48 of 85) of the cases, plant-related trauma was the leading risk factor, and corn leaves were the primary source of trauma in 21.1% (18 of 85) patients. In 2 patients (2.4%), it was due to long-term use of topical steroids. No significant predisposing factors were recorded in 17 patients (20%) .Fusarium . Among 63 culture-positive cases, 8 species of fungus were identified. Fusarium A and Aspergillus B were thAlternaria, 9.5% (6 of 63)       C, Curvul4 of 63) D, Scedos4 of 63) A, Paecil2 of 63) B, Exsero2 of 63) C, and Ca3 of 63) D, respecFusarium species were typically flat, spreading, wooly colony growths, initially appearing white or grey-white in color, then producing a variety of colors when grown in culture . Different fungal species had a variety of IVCM manifestations. Some reports have postulated that fungi’s hyphae length, width, and branching, as seen in IVCM images, might be used to differentiate fungal species .Fusarium keratitis revealed a large number of highly reflective lines that were 374.3 ± 49.2  μm in length, and 9.4 ± 2.3  μm in width, branching at 45.4 ± 7.8  degrees  μm in length, and 11.7 ± 2.7  μm in width, with branch angle at 52.1 ± 5.5  degrees  μm in width, and 130.7 ± 45.7  μm in length with branch angle of 39.5 ± 3.7  degrees  μm in width, and 37.3 ± 8.6  μm in length without apparent fungal branching  μm in width, and 217.3 ± 56.5  μm in length with a branch angle of 48.2 ± 6.0  degrees  μm in width and 71.2 ± 22.9  μm in length with a branch angle of 63.7 ± 17.2  degrees  in width and 320.2 ± 50.6  μm in length with a branch angle of 82.1 ± 7.2  degrees  of the patients improved after topical drug therapy. The rest, 79.4% of patients (50 of 63), with deep or wide lesions responded poorly to medical treatment, and surgical intervention was performed .Pseudallescheria boydii . Among these patients, 2 underwent eyeball removal, and both had positive fungal culture results for a boydii .Visual acuity change is an essential indicator of improvement in patients with FK after treatment. A total of 35 of 63 (55.6%) patients had improved visual acuity after treatment, 26 of 63 (41.2%) patients had no change in visual acuity, and 2 of 63 (3.2%) patients had decreased visual acuity after treatment. The lack of improvement was often due to pupillary lesions or other serious complications .The most common cause of FK is an exogenous source in origin, usually due to fungal fragments or spores implanted into the cornea’s surface layer. Patients with FK are generally healthy, young male agricultural or outdoor workers who accidentally suffer from plant-related trauma during harvesting . The proAspergillus, Fusarium, Candida, Curvularia, and Penicillium, with Fusarium (37–62%) and Aspergillus (24–30%) being the most common ones [Aspergillus, Fusarium, and Curvularia species are found mainly in tropical regions, while yeast is common in temperate areas of the world [Aspergillus species were the most common etiologies in northern and eastern India, while the Fusarium species were the most ordinary pathogens in western and southern India [Fusarium and Aspergillus species were 2 of the most common isolated pathogens in our study, followed by Alternaria species, consistent with a previous report from central China [The common pathogenic species included mon ones ,28,29. Aillus 24–% being the world . Prajna rn India . FusariuAspergillus species than other regions of China. The proportion of Aspergillus species ranges from 7.3% [Aspergillus species increases with regional latitude.Fungal species are influenced by differences in geography, climate, age, sex, socioeconomic status, agricultural activity, and degree of urbanization, so there are significant regional variations. In our research, Hubei, a major agricultural province in central China, has a subtropical climate and an extraordinarily higher positive rate of rom 7.3%  to 21.7%rom 7.3%  in northrom 7.3% ) to 30.7rom 7.3%  in southIn all cases of clinically suspected fungal infection, we found clear evidence of fungal hyphae and spores on IVCM in 61 patients, which significantly compensates for the shortcomings of fungal culture. The positivity rate of IVCM was 96.8% in this study. The IVCM is a promising complementary diagnostic approach of increasing importance that allows non-invasive real-time direct visualization of potential fungal pathogens and shows deeper layers directly in the cornea. Comparing culture plates in vitro and IVCM images in vivo may be a method to determine the morphological features of different species, but to date, such information is lacking in the published literature .Aspergillus species was higher. Our results were similar to other reports that suggested corneal debridement combined with intrastromal voriconazole is a safe and effective treatment for FK [Fusarium species are the most common isolated pathogens in northern China, and that Fusarium hyphae grow in the horizontal direction and Aspergillus hyphae show vertical growth [After topical drug treatment, 20.6% of patients showed improvement, and the most frequent initial therapy was 0.15% amphotericin B and 1% Voriconazole eye drops. Natamycin is the only drug approved by the FDA for the treatment of corneal infection caused by fungi. However, it has difficulty penetrating the corneal stroma and is not available in some areas. Thus, other antifungal drugs, such as amphotericin B and fluconazole, are recommended as complementary treatments . In our t for FK ,35. Moret for FK ,37 and lt for FK ,38,39 arl growth ,41. CareThe variety of fungal species in our study was not abundant. Fungal species in our region may exhibit characteristics that differ from other parts of the world. Finally, the small number of each fungus in this study makes it difficult to draw conclusions about the best treatment for the infections.Fusarium, Aspergillus, and Alternaria species were the 3 most common cultured fungal pathogens, and the proportion of Aspergillus species was significantly higher than that in other regions of China. Careful lesion depth examination by IVCM and OCT should be taken before lamellar keratoplasty to avoid postoperative recurrence. Identifying the IVCM and fungal culture characteristics will facilitate rapid diagnosis and proper treatment, but IVCM cannot yet replace fungal culture to distinguish different fungal species.In a tertiary referral hospital in central China,


Women and girls are more disadvantaged in times of crisis, and their chances of surviving and fleeing are limited. As the Syrian crisis enters its eleventh year, Turkey alone hosts the largest population (over 3.7 million). It aimed to evaluate essential reproductive health services in the shadow of the pandemic that deepens the crisis. The research was conducted in April 2021 with 637 married Syrian refugee women aged 15-49 living in Ankara (mean age: 29.6). The median age at first marriage was 17, and consanguinity with her spouse was 29.8%. 8.6% were illiterate. 36.3% did not/could not benefit from public hospitals free of charge, and 89.8% did not have health insurance. 96.7% had a previous pregnancy (median:4). Since the pandemic's beginning, 35.6% have been pregnant (n = 219), and 14% are still pregnant (n = 86). Of 133 women whose pregnancies ended during this period, 78.2% gave birth (n = 104) and 21.8% miscarried. 12.8% of pregnancy was terminated at home . 41.1% of those who became pregnant during the pandemic were not followed up in pregnancy; 45.1% of those whose pregnancies ended were not followed up in the puerperium. 29.5% of all the participants stated that they had not used any birth control method. The most common reason for not using family planning is fear of harm to health and their spouse's disapproval. Only 3.3% of those currently using birth control methods stated difficulty accessing birth control methods. The most used information resources about pregnancy, childbirth and contraception methods were hospitals and Migrant Health Centres.This study is funded through the UK Research and Innovation GCRF Research for Health In Conflict (R4HC-MENA), developing capability, partnerships and research in the Middle and Near East (MENA) [ES/P010962/1].• In refugee crises, women's health should be structured as a separate heading in the health system and unmet sexual health needs should be met, especially in culture-oriented primary care services.• Women should be empowered with a health system where women can determine their own needs and make decisions about their bodies.


BackgroundThis study aimed to determine the mean improvement in the quality of life (QoL) after laparoscopic cholecystectomy (LC) in patients with symptomatic cholelithiasis.MethodologyAfter obtaining approval from the hospital’s ethical committee, the Gastrointestinal Quality of Life Index (GIQLI) proforma was filled on admission (T0) and at week six (T1) postoperatively. All data were collected, and GIQLI scores were calculated for individual patients.ResultsIn our study, among the 70 patients undergoing LC, 20% (n = 14) were aged 18-30 years and 80% (n = 56) were aged 31-60 years, with the mean ± standard deviation calculated as 41.56 ± 10.13 years. Overall, 44.29% (n = 31) of patients were men and 55.71% (n = 39) were women. GIQLI scores were 94.64 ± 2.24 for pre-treatment and 106.09 ± 2.40 for post-treatment, with a mean change of 11.44 ± 3.29, and a p-value of 0.001, showing a significant difference.ConclusionsThe mean improvement in QoL after LC in patients with symptomatic cholelithiasis is significantly higher when compared with pretreatment. Gallstone disease (cholelithiasis) is a wide spectrum of conditions, ranging from asymptomatic cholelithiasis, biliary colic, empyema gallbladder, and gangrene to perforation and peritonitis . In otheCholecystectomy is one of the most common surgical procedures performed worldwide, with >750,000 cases in the United States reported annually . Since tHealth-related quality of life (HRQoL), a rather unknown aspect two decades ago, is now a vital component of medical research . DespiteFor as commonly performed surgery as LC, little evidence has been reported on postoperative changes in QoL ,12. AlthThis study aimed at evaluating changes in QoL post-LC using GIQLI to justify its use as the standard procedure for the treatment of symptomatic gallstone disease. Preoperative GIQLI scores were compared with postoperative scores to determine whether LC improves the QoL. Moreover, this study also aimed to determine the mean improvement in QoL post-LC in patients with symptomatic cholelithiasis.This study was conducted in the General Surgical Unit  of a tertiary care center in Pakistan from July 17, 2015, to January 16, 2016.Using the Epi Info calculator and significance of 0.05, power of 80%, a confidence level of 95%, preoperative mean of 96 ± 20.2, and postoperative mean of 108.6 ± 16.8 (reference statistics) , the minInclusion and exclusion criteriaPatients of both genders aged 18-60 years were included in the study. All included patients had sonological evidence of cholelithiasis (ultrasonography showing echoes) with symptoms . Patients undergoing uncomplicated LC and who consented to participate in the study were included.The following patients were excluded from the study: those with complicated cholelithiasis/acute diseases ; those who converted to open cholecystectomy or complicated LC ; those with choledocholithiasis (intraoperative cholangiogram or common bile duct exploration); those with major comorbidity and/or American Society of Anesthesiologists grade of >3 ; those who underwent emergency LC; those with gallstones of >3 cm in size on ultrasound scan; those with contraindications to laparoscopy; those with previous upper abdominal surgery; pregnant patients; and those with psychiatric disorders. All these criteria could act as confounding variables and introduce bias.After obtaining approval from the hospital’s ethical committee , the study and its objectives were explained to consecutive patients admitted to the ward for LC who met the inclusion criteria. Then, patients were interviewed after obtaining consent for study participation. GIQLI proforma along with patient profile and contact number was filled on admission (T0). After a detailed history and physical examination, a baseline preoperative workup was performed, including an electrocardiogram and a chest X-ray in selected patients. Anesthesia fitness was obtained preoperatively, and patients were listed for surgery. Preoperatively, patients underwent a standard four-port LC. Another proforma was filled out at week six (T1) postoperatively by the doctor in charge during the patient’s follow-up visit. All data were collected, and GIQLI scores were calculated for each patient.Statistical analysisThe Statistical Package for the Social Sciences version 17  was used for data analysis. The frequency and percentages for qualitative variables  and the mean and standard deviation (SD) for quantitative variables  at baseline and six weeks and changes were calculated pre and postoperatively. A paired sample t-test was applied between pre and post-mean GIQLI changes. Effect modifiers such as age and gender were controlled through stratification. Post-stratification paired sample test was applied. P-values of <0.05 were considered statistically significant.A total of 70 patients fulfilling the inclusion/exclusion criteria were enrolled to determine the mean improvement in QoL post-LC in patients with symptomatic cholelithiasis. Overall, 20% n = 14) of patients were aged between 18 and 30 years, whereas 80% (n = 56) were aged between 31 and 60 years, with the mean ± SD calculated as 41.56 + 10.13 years  were males and 55.71% (n = 39) were females , showing a significant difference  for determining the success of any medical or surgical intervention for any disease. The number of studies performed to measure HRQoL in gastrointestinal medicine and surgery to establish the appropriateness of any intervention is increasing.This study aimed to evaluate QoL changes post-LC using GIQLI to justify its use as the standard procedure for the treatment of symptomatic gallstone diseases. Preoperative GIQLI scores were compared with postoperative scores to determine whether LC improves the QoL.In our study, among the 70 patients undergoing LC, 20% (n = 14) were aged between 18 and 30 years, whereas 80% (n = 56) were aged between 31 and 60 years, with a mean ± SD of 41.56 ± 10.13 years. Overall, 44.29% (n = 31) of the patients were males and 55.71% (n = 39) were females. GIQLI scores were 94.64 ± 2.24 for pretreatment and 106.09 ± 2.40 for post-treatment, and the mean change was calculated as 11.44 ± 3.29 (p = 0.001), showing a significant difference.The study findings are in agreement with a previous study reporting that the QoL score was 96 ± 20.2 pretreatment and 108 ± 16.8 post-LC in one study .Mosimann  examinedAlternatively, Cuschieri examined acute cholecystitis versus symptomatic uncomplicated gallstone disease . The stuAnother study from Taiwan reported that symptomatic patients scored lower on SF-36 preoperatively; LC significantly improved the GIQLI scores .However, some studies suggest that certain digestive issues persisted even postoperatively. Indeed, only a few studies showed a drop in SF-36 at 12 months postoperatively; thus, they found different QoL evaluators postoperatively. Two such markers are preoperative direct bilirubin level and drain in Morison’s pouch. This finding supports the fact that poorer preoperative conditions result in maximum GIQLI and QoL gains; moreover, variables that may act as confounding events should be identified . PostopeHowever, findings based on other studies reveal that QoL post-LC using GIQLI justifies its use as the standard procedure for the treatment of symptomatic gallstone disease. Further studies are required to validate our findings.Our study had a few limitations. First, the sample size was not enough to generalize the findings. Second, the confounding factors were not adequately identified and controlled. Moreover, other conditions causing similar symptoms were not taken into account.The mean improvement in QoL after LC in patients with symptomatic cholelithiasis is significantly higher when compared with pretreatment. Further large-scale studies need to be conducted to better objectify the usefulness of LC as a treatment strategy for cholelithiasis.


Influenza is associated with a decline in functional abilities among Canadian older adults, although specific impacts on daily life have not been fully explored.In August 2019 and May 2020, we conducted surveys of Canadian adults 50-64 years and 65 years and older through an online market research platform. The survey included questions about the impact of diagnosed influenza or self-reported influenza-like-illness (ILI) on working, volunteering and caregiving.We surveyed 1006 adults in the 50-64 year age group about the 2018/19 season and 1001 about the 2019/20 season. In the 65 years and older age group, we surveyed 3548 and 3500 individuals about the 2018/19 and 2019/20 influenza seasons, respectively. In each season, nearly two-thirds of individuals 50-64 years with influenza/ILI were employed; 51.7% reported absenteeism in 2018/19 and 53.6% in 2019/20. Of the 20% of individuals 65 years and older who were employed, 47.0% of those with influenza/ILI were absent while ill in 2018/19 (39.8% in 2019/20). In 2018/2019, 29.6% of respondents 50-64 years old with influenza/ILI identified as volunteers (29.3% in 2019/2020). In both seasons, nearly half were unable to do so while ill. Of the 164 (32.7%) individuals 65 years and older who volunteered during the 2018/19 season, 80 (48.8%) did not while ill; 224 (37.3%) respondents volunteered in the 2019/20 season, and half were absent while ill. Of those 50-64 years with influenza/ILI, 97 (42.2%) and 57 (22.2%) were caregivers in 2018/19 and 2019/20, respectively. In 2018/19 and 2019/20, 40 (41.2%) and 28 (49.1%) caregivers were unable to provide care when ill, respectively. Of those with influenza/ILI in the 65 years and older age group, 123 (24.6%) and 162 (27.0%) were caregivers in 2018/19 and 2019/20, respectively. In 2018/19, 18 (14.6%) caregivers with influenza/ILI did not provide care while ill (42 [25.9%] in 2019/20).In Canadian older adults, influenza and ILI had notable impacts on ability to volunteer and provide care across two recent seasons. Optimization of influenza prevention in this population may yield important societal benefits. Influenza is a major cause of illness , with thWhile those 50-64 years have not demonstrated the same influenza-related risks as older adults, they comprise a subgroup that typically has a higher rate of chronic conditions and other risk factors than younger populations . AdditioEXamining the Knowledge,Attitudes and Experiences ofCanadian SeniorsTowards Influenza (EXACT). This survey, available in English and French, became the first in a series of annual surveys to understand experiences with and impact of influenza  in 2018/19 and 53.6% [mean = 4.4 days] in 2019/20), though a significantly higher rate worked at lower capacity while ill in 2018/19 than 2019/20 . Nearly half of those (47.0%) with influenza/ILI who work were absent while ill during the 2018/19 season (39.8% during the 2019/20 season) Table p = 0.009 in 2019/20) or present at work but working at low capacity than older adults (p = 0.02 in 2018/19). However, those 65 years and older who were absent from work, were home from work for a longer period of time in 2019/20, and worked at sub-optimal capacity for a slightly longer period of time than the younger age group. These differences were not statistically significant.Of working individuals with influenza/ILI, those who were 50-64 years were more likely to be both absent from work . In both seasons, nearly half were unable to do so while ill with influenza/ILI, with approximately a full day of volunteering lost  individuals who volunteered at least occasionally during the 2018/19 season, 80 (48.8%) did not while ill; 224 (37.3%) respondents volunteered in the 2019/20 season, and 111 (49.6%) were absent while ill  and 57 (22.2%) were caregivers in 2018/19 and 2019/20, respectively. Those who provided care most commonly did so for spouse/partner, child, or parent. In 2018/19, 40 (41.2%) were unable to provide care when ill mean = 5.3 days) while in 2019/20, 28 (49.1%) caregivers who had influenza/ILI could not provide care during illness (mean = 6.9 days)  while fewer provided care at lower capacity than usual   and 162 (27.0%) were caregivers in 2018/19 and 2019/20, respectively, mainly for spouse/partner, grandchildren and parents. Compared to 2018/19, a higher rate of caregivers did not provide care while ill with influenza/ILI in 2019/20  and able to provide care but at less-than-usual capacity than older adults in 2019/20 (p = 0.009).Of individuals with influenza/ILI who also act as caregivers, those who were 50-64 years were more likely to be both unable to provide care , for infection control and spread of viral illnesses. We found a statistically significant decrease in these behaviours and an increase in absenteeism in the 2019/20 season versus the 2018/19 season, which may be indicative of a more severe influenza season, given that we also noted increased healthcare utilization in the 2019/20 season. Additionally, it may also be reflective of the awareness of public health messaging to stay home while ill that was growing in the later part of the 2019/20 season due to the onset of the COVID-19 pandemic.In comparing older vs. younger respondents, we found that the impact on life responsibilities and activities was fairly similar. However, having influenza/ILI was more likely to result in absenteeism from work and caregiving for the 50-64 year adults than the older age group. This highlights the importance of targeted messaging about influenza prevention, including through vaccination, to adults 50 years and older who may not see themselves at risk of the daily impact from influenza.This study has several strengths including the large number of respondents, inclusion of all 10 Canadian provinces, and samples similar to the country’s senior population in terms of chronic illness prevalence . AdditioOur study has some limitations, several previously described . Our onlOur findings provide important insight on the notable impacts of influenza on both healthcare resource utilization and ability to conduct daily life including reduced ability to work, volunteer and provide care to dependents, for those 50 years and older. Such data can inform discussions of the risks and benefits of influenza vaccination and contribute to more comprehensive economic and social evaluations of immunization programs.


Both Response Evaluation Criteria in Solid Tumors (RECIST) and tumor regression grade (TRG) play key roles in evaluating tumor response. We analyzed the consistency of TRG and RECIST 1.1 for gastric cancer (GC) patients and compared their prognostic values.Patients with GC who received preoperative chemotherapy or chemoimmunotherapy and had records of TRG from December 2013 to October 2021 were enrolled retrospectively. TRG 0–1 and 2–3 are considered as corresponding to complete response (CR)/partial response (PR) and stable disease (SD)/progress disease (PD) in RECIST 1.1, respectively. The primary endpoints were disease-free survival (DFS) and overall survival (OS). The consistency of RECIST and TRG was examined by kappa statistics. Survival analysis was performed using the Kaplan Meier method.P = 0.02 and 0.03, respectively) while response according to RECIST1.1 was not . The median DFS had not reached in the TRG 0–1 group and was 16.13 months in TRG 2–3 group. TRG 2–3 was associated with young age and peritoneal or liver metastasis. Besides, preoperative chemoimmunotherapy had a significantly higher pCR rate than chemotherapy alone .One hundred fifty seven GC patients were enrolled, including 125 with preoperative chemotherapy and 32 with chemoimmunotherapy. Among them, 56 patients had measurable lesions. Only 19.6% (11/56) of the patients had consistent results between RECIST 1.1 and TRG. TRG was correlated with both OS and DFS (TRG was in poor agreement with RECIST 1.1. TRG was better than RECIST 1.1 in predicting DFS and OS for GC patients who received preoperative therapy.The online version contains supplementary material available at 10.1186/s12885-022-10125-1. Perioperative chemotherapy (PC) with radical surgery represents the gold standard of treatment for resectable locally advanced gastric cancer (GC). GC causes a large number of health and economic burdens worldwide and it is the second most common diagnosed cancer and leading cause of cancer-related death in China . About 6In this study, the data of gastric cancer patients who received preoperative therapy between December 2013 and October 2021 at Sun Yat-sen University Cancer Center were retrospectively collected. The inclusion criteria were: 1. had received chemotherapy or chemotherapy combined with immunotherapy before surgery; 2. underwent gastrectomy surgery. The exclusion criteria were as follows: 1. underwent preoperative radiotherapy; 2. History of another malignancy within the last 5 years except cured basal cell carcinoma of skin and cured carcinoma in situ of the uterine cervix. Our study was performed in accordance with the Declaration of Helsinki protocols and was approved by the local Ethics Committee of SYSUCC and waived patient-specific consent.The overall survival (OS) was calculated from the date of diagnosis to death or the final follow-up date. The disease-free survival (DFS) was calculated from gastrectomy surgery to death or the final follow-up date or the date of recurrence/metastasis. The failure events of the survival analysis were death for OS and tumor recurrence or death for DFS. The censoring data was defined as not having observed a failure event and not knowing the exact survival time.This study applied the National Comprehensive Cancer Network (NCCN) classification system to assess the tumor regression grade (TRG). TRG was defined by the percentage of viable cancer cells in the resected primary tumor: TRG 0 = complete response, no viable tumor cells including lymph nodes; TRG 1 = near complete response, single cancer cells or rare small groups of cells; TRG 2 = partial response, residual tumor cells with obvious tumor regression but the amount of cancer cells is more than that in TRG 1; TRG 3 = poor or no response, extensive residual cancer with no evident tumor regression , 14. AccRECIST version 1.1 were applied in the present study: CR (complete response) means disappearance of all target lesions, PR  means the sum of the diameters of all targets lesions deceases ≥30%, PD (progressive disease) means the sum of the diameters of all targets lesions increases ≥20%, SD (stable disease) means insufficient shrinkage to qualify for PR or insufficient increase to qualify for PD) . PatientP values less than 0.05 were considered significant statistically.SPSS ver. 22.0 software  was used to perform statistical analysis in this study. Consistency of TRG and RECIST were analyzed using kappa statistics  . OS and We finally collected a total of 157 patients with preoperative treatment and gastrectomy in the present study. 125 (79.6%) patients were administered preoperative chemotherapy, and 32 (20.4%) patients received preoperative chemotherapy combined with immunotherapy. Most patients were male (65.6%), and their median age was 64 years old (ranging from 24 to 78). Most primary tumors (72.0%) were gastric cancers, and 28.0% were in the esophageal-gastric junction. Five patients (3.2%) were mismatch repair deficient (dMMR), and 10 (6.4%) were human epidermal growth factor receptor-2 (HER-2) positive. Fifty patients (31.8%) were classified as diffuse type and 60 (38.2%) were classified as intestinal type.n = 24, 15.3%); TRG 1 ; TRG 2 (n = 60 38.2%); TRG 3 . Only 56 patients had measurable lesions, including PD , SD  and PR . The patient characteristics are listed in Supplementary Table The TRG scores were as follows: TRG 0 n = 24, 5.3%; TRGIn all 157 patients, 44 (28.0%) showed progression, including local recurrence and distant metastasis. According to RECIST 1.1, 7 of them achieved PR after preoperative therapy and 13 got SD. The rest could not be evaluated since they had no targeted lesion. Of the 44 patients with progression after surgery, no one got pCR after preoperative therapy, 7 got TRG 1, 19 got TRG 2, and 18 got TRG 3.P < 0.05, Table P < 0.05, Table Patients who got SD or PD after preoperative chemotherapy tended to have peritoneal metastasis . Ninteen patients got effective in RECIST 1.1 and ineffective in TRG, and another 6 patients got effective in TRG and ineffective in RECIST 1.1. The kappa value was 0.132, which showed poor consistency. Considering the patients were with different TNM stages, we classified them as neoadjuvant therapy group and conversion therapy group. There were 123 patients (78.3%) in neoadjuvant therapy group and 34 patients (21.7%) in conversion therapy group and we analyzed the agreement between TRG and RECIST separately. The kappa values were 0.089 and 0.048 in the preoperative chemotherapy group and conversion therapy group respectively, which showed poor consistency.P = 0.02).Considering that TRG scores focus on regression of primary lesions, which could not be considered as target lesions in the RECIST system, we retrospectively calculated the change of thickness of primary lesions after preoperative therapy and compared the changes with their TRG scores in 80 patients. When using 30% shrinkage of thickness as the cut-off point, the change of thickness on CT can predict the TRG score better . The median DFS was not reached vs. 16.13 months in TRG effective and ineffective group, respectively (P = 0.03). The median OS of both TRG 0–1 group and TRG 2–3 group were not reached (P = 0.02). The DFS and OS were significantly better in the TRG effective group  of 53 patients in the TRG effective group had disease progression, compared with 31 (29.8%) of 104 patients in the TRG ineffective group  of 30 patients in the RECIST 1.1 effective group had disease progression, compared to eight (30.8%) of 26 patients in the ineffective group, 3.3% of 3P = 0.52;not reached vs. not reached for OS, P = 0.75) . The median DFS was 19.53 months and not reached for patients who received chemotherapy or chemoimmunotherapy, respectively. But the difference of DFS and OS between these two groups were not statistically significant (P = 0.91 for both OS and DFS) .Patients in the chemoimmunotherapy group had a higher pathological complete response (pCR) rate than those in the chemotherapy group  got pCR (The follow-up time ranging from 3.13 months to 34.17 months). Among them, 5 (23.8%) got PR according to RECIST 1.1, and the rest had no target lesions. Five patients did not receive any treatment after surgery, and none of them suffered from recurrence or metastasis with. Seven patients (33.3%) had received chemotherapy combined with immunotherapy after surgery, and one of them had peritoneum metastasis 4 months after surgery. One patient (4.8%) had received immunotherapy alone. Eight patients (38.1%) had received postoperative chemotherapy , which excluded primary gastric lesion. Hence, we tried to compare TRG with the degree of shrinkage of primary lesions on computed tomography (CT), which showed better consistency with TRG. Secondly, unlike other malignancies, gastric cancer is a tumor with high heterogeneity, which may lead to different responses to therapy between the primary site and lymph nodes or distant metastatic lesions. Thirdly, due to fibrosis, necrosis, or edema after preoperative therapy, the size of lesions may not change on imaging . FinallyFurthermore, we found that TRG was a better prognostic factor than RECIST 1.1 for GC patients who received preoperative therapy. The TRG score for 84.1% of patients who developed disease progression was 2 or 3. Some previous studies demonstrated that TRG was a reliable prognostic factor for OS and DFS , 20. AltNowadays, perioperative chemotherapy has become the standard treatment for locally advanced GC patients, however, we found that only 35.7% (56/157) of the patients from our study had measurable lesions. About two-thirds of the patients could not be effectively evaluated by RECIST 1.1. Given the low consistency between RECIST 1.1 and TRG, the poor prognostic value and the limited application of RECIST1.1, novel parameters for imaging evaluation were warranted to better predict the response of preoperative therapy. A previous study found that Tumor Volume Reduction Rate (TVRR) was significantly associated with TRG in locally advanced rectal cancer patients . CT perfThe rate of pCR was 12.8% in our study, but none of them was considered as CR by RECIST 1.1 before operation. A study demonstrated that FDG-PET/CT may be more accurate for the prediction of pCR . pCR ratTill now, there is no consensus on postoperative treatment for pCR patients. A recent cohort study revealed that gastric patients who were sensitive to preoperative chemotherapy tended to have a better prognosis if they would receive postoperative chemotherapy . In our There were some inherent limitations in our study. Firstly, the sample size was small and only 56 patients had measurable lesions. Secondly, the regimens for preoperative treatment were different, including chemotherapy and chemoimmunotherapy. Finally, selection bias existed due to the specialty of the retrospective study. Despite the limitations above, we innovatively analyzed the postoperative treatment of pCR patients. Last but not least, we revealed the relationship between TRG and RECIST 1.1 directly, which was rare in previous studies.In conclusion, our results suggested that pathological assessment (TRG) was in poor agreement with imaging assessment (RECIST 1.1), and TRG is more useful in predicting the effect of preoperative therapy and prognosis. Patients who achieved TRG 0 or 1 after surgery tended to have better OS and DFS compared to those who got TRG 2 or 3. We demonstrated that the addition of immunotherapy may increase the pCR rate than using chemotherapy alone. In addition, patients with pCR should also highly value postoperative therapy. Further studies with a larger sample size are needed to confirm our findings.Additional file 1.Additional file 2.Additional file 3.Additional file 4.Additional file 5.Additional file 6.


The aim of our study was to show our short-term experience in managing large renal masses (cT1b/T2) through partial nephrectomy (PN) over the last 3 years. Retrospective data collection for all patients managed by PN for renal masses larger than 4 cm over the last 3 years. Epidemiological data were collected. Surgical data including surgical and ischemic times as well as intra and postoperative complications were collected. Pre- and postoperative estimated glomerular filtration rate (eGFR) data were collected and correlated as well as postoperative complications and recurrence. We could identify 47 patients managed by PN for radiologically confirmed >4 cm renal masses. The mean age of the patients was 55.7 ± 13.4, including 29 males and 18 females. Masses were T1b and T2 in 40 and 7 patients, respectively. The mean tumor size was 6.2 ± 1.5 cm. Using renal nephrometry score; 8, 28, and 11 had low, moderate, and high complexity, respectively. Renal cell carcinoma (RCC) was identified in 42 patients. Five patients out of 42 cancerous cases (12%) had pathological T3 RCC. The mean preoperative and postoperative eGFR were 89.09 ± 12.41 and 88.50 ± 10.50, respectively (P 0.2). The median follow-up was 14 months and within that short time, no patient had evidence for cancer recurrence. PN for large renal masses is safe in experienced hands and should be attempted in a higher percentage of patients, regardless of the tumor complexity. No cancer recurrence or deterioration of renal function was observed within our short-term follow-up. Renal cell carcinoma (RCC) is becoming more common as imaging technology improves and the population ages . Both paRetrospective data collection of all patients treated by PN for renal masses larger than 4 cm over the last 3 years. Demographic, pathologic, operative, and postoperative data were obtained from the medical records. Postoperative complications were evaluated and classified using the Clavien–Dindo grading system for surgical complications .Patient age, tumor size, estimated glomerular filtration rate (eGFR), and ischemia time are all presented as mean ± standard deviations. Other information, such as sex, complexity score, type of tumor, pathological results, and complications are expressed as numbers and percentages.Patients’ consent for data collection and publishing was obtained. Institutional ethical approval was obtained.We were able to identify 47 patients who were being treated by two surgeons by PN for radiologically confirmed >4 cm renal masses. The patients’ mean age was 55.7 + 13.4, with 29 males and 18 females. In 30 and 17 patients, the tumor was found on the right and left sides, respectively. There were 44 patients (93.6%) with solid enhancing mass and three patients with Bosniak 3/4 renal cysts. T1b and T2 masses were found on radiographs in 40 and 7 patients, respectively. The mean tumor size was 6.2 + 1.5 cm (Range: 4.5–10.5 cm). Renal nephrometry scores of 8 (17%), 28 (60%), and 11 (23%) indicated low, moderate, and high complexity, respectively. All cases were managed through open surgery, with 45 and 2 being treated via retroperitoneal and transperitoneal approaches, respectively.Warm and cold ischemia were used to treat 40 and 7 cases, respectively. The median warm and cold ischemic times were 10 and 25 min, respectively. There was no need for a blood transfusion in any of the cases. The drain was removed on the first postoperative day, and all patients were discharged 48–72 h later. One patient (2%) developed a Grade 3 complication as he returned to the emergency department 1 week after surgery with hypotension and low hemoglobin. A CT angiogram revealed a bleeding pseudoaneurysm that was successfully managed by the interventional radiology team.RCC was found in 42 patients, while oncocytoma and low-fat angiomyolipoma were found in five others. Negative surgical margins were found in 45 patients (96%), while positive surgical margins were found in two patients (4%). Five patients (12%) out of 42 cancerous cases had pathological T3 RCC, and none had a positive margin. The preoperative and postoperative eGFR were 89.09 ± 12.41 and 88.50 ± 10.50, respectively (P = 0.2). The median follow-up was 14 months, and no patient had evidence of cancer recurrence during that time. We retrospectively summarized the medical records of 47 patients with large renal masses managed by PN. According to our findings, the size of the renal masses ranged from 4.5 to 10.5 cm, with 60% having moderate complexity and 23% having high complexity. Based on radiographic evaluation, 85.1% were T1b, and 4.9% were T2. Pathological findings revealed that 89.4% of patients had RCC, with the remainder having oncocytoma or low-fat angiomyolipoma. Regarding the recurrence rate, no patient had evidence of cancer recurrence during the follow-up period.Our experience with open PN has yielded promising results for treating large renal masses, with only 2% of grade 3 complications necessitating further management reported during postoperative evaluation and patient follow-up. In terms of complications, some studies did show that PN was associated with a higher complications rate compared to RN , 10, 11.Despite the fact that PN has more complications than RN, PN has a higher overall survival rate. PN, as opposed to RN, preserves renal parenchyma and protects against renal function deterioration caused by noncancer causes . Some poPN has been shown to benefit patients with T2 renal tumors in terms of survival and renal function protection . OverallThere were no differences in eGFR between the preoperative and postoperative periods, according to our findings. This is consistent with previous findings that the decrease in eGFR after PN is significantly lower than that after RN , 11. A mAlthough several studies have demonstrated that PN, whether performed as open surgery or as a laparoscopic procedure, has a satisfactory outcome , 8, 15, A major limitation of the study is that it is a retrospective study looking at patients managed with PN. This actually is expected to miss patients that were managed with RN following a failed attempt with PN. While our study confirms the safety and applicability of PN in the case of large renal masses, it does not point to the actual success rate to fulfill that target.PN for large renal masses is safe in experienced hands and should be attempted in a higher percentage of patients, regardless of the tumor complexity. No cancer recurrence or significant deterioration of renal function was observed within short-term follow-up. In consequence, PN should be attempted whenever technically feasible.


The hepatitis C virus (HCV) causes both acute and chronic infection of the liver that can lead to liver cirrhosis, cancer, and liver failure. HCV is characterized by high genetic diversity and substantial variations in the prevalence of specific HCV genotypes throughout the world. Many effective regimens of direct-acting antivirals (DAAs), including pan-genotypic, can successfully treat HCV infection. Additionally, genotype-specific treatments for HCV are being actively employed in national plans for eliminating HCV infection around the world. The evaluation of HCV genotype prevalence in a given country is necessary for the successful implementation of the HCV elimination plans and for allocating financial resources to the DAAs which are the most effective against those specific HCV genotypes prevalent in a given country. Here, we analyzed HCV genotypes, subgenotypes, and recombinants in 10,107 serum samples collected in 2015–2017 from patients with chronic HCV infection living in all federal districts of Russia. This is the first and largest evaluation of HCV genotypes performed on samples from all territories of Russia, from its Central federal district to the Far East. Moreover, we have updated retrospective epidemiological analysis of chronic and acute HCV infection in Russia from 2001 to 2021. We demonstrate that the incidence of acute HCV (AHC) infection in Russia decreased from 16.7 cases per 100,000 people in 2001 to 0.6/100,000 in 2021. The number of cases of chronic HCV (CHC) infection also decreased from 29.5 to 16.4 per 100,000 people during this period. The HCV genotype analysis indicated that HCV genotype 1 dominates in Russia (53.6%), while genotypes 3 and 2 were detected in 35.4% and 7.8% of patients, respectively. These proportions are virtually identical in all regions of Russia except for the Far East, where HCV genotype 2 was detected in only 1% of the samples. HCV genotypes 1 and 2 are more widespread in women, and HCV genotype 3 in men. Genotype 3 was the most prevalent in 31–40-year-olds (44.9%), and genotype 1 was most prevalent in those over 70 years of age (72.2%). HCV genotype 2 was predominant among HCV-infected persons older than 40 years. Discriminating between HCV genotype 2 and recombinant RF1_2k/1b, which are frequently misclassified, is important for successful antiviral treatment. For the first time, we demonstrate, here, countrywide prevalence of HCV RF1_2k/1b in different regions of Russia. HCV RF1_2k/1b makes up 3.2% of HCV genotypes, reaching 30% among samples classified as genotype 2 by some commercial genotyping tests. The highest proportion of HCV RF1_2k/1b was detected in the North-West (60%), Southern (41.6%), and Central (31.6%) federal districts; its frequency in the Far Eastern and North Caucasus districts was ~14.3%. HCV RF1_2k/1b, and it was not detected in the Volga, Ural, or Siberian districts. To conclude, this is the first and most complete evaluation of HCV epidemiology and genotype/subgenotype distribution in Russia. Flaviviridae family. HCV infection can lead to severe liver diseases, including liver cirrhosis (LC) and cancer . It is a global health problem and, along with hepatitis B virus (HBV) infection, is the leading cause of cirrhosis and liver cancer in the world [Acute and chronic hepatitis C infections are caused by the hepatitis C virus (HCV), which infects the liver and induces liver inflammation. HCV is an enveloped, plus-strand RNA virus of a he world . In 2015he world , abnormahe world , pathogehe world ,7,8,9.To eliminate hepatitis as a threat to public health, the 69th World Health Assembly adopted the first global health sector strategy, aiming to reduce new HBV and HCV infections by 90% and deaths by 65% by 2030, compared to 2015 ,11. The HCV displays a high genetic diversity, and is currently classified into eight genotypes (GTs), with varying geographic prevalence in different regions of the world . GloballFor many years, various direct-acting antiviral drugs (DAA) have been successfully used to treat HCV infection. Pangenotypic and genotype-specific treatment regimens for HCV infection have been developed . AlthougHCV infection has been registered in all regions of the world; however, about 80% of infected persons live in just 30 countries . A largeUntil now, HCV genotype distribution in all Russian regions has never been studied. Only several reports on HCV genotypes in small sample groups and with specific groups of patients have been published previously ,20,21,22The aim of our study was to evaluate the current epidemiology of HCV infection in Russia and determine the distribution of HCV genotypes and clinically relevant HCV subgenotypes , as well as recombinant RF1_2k/1b. Understanding HCV genotype distribution is extremely important for the rational use of DAAs and strategic planning of medical healthcare to ensure successful implementation of the HCV elimination program in a given country. Along with genotyping, we analyzed the distribution of HCV recombinant RF1_2k/1b, which is frequently misclassified as genotype 2 by some commercially available test kits, affecting the choice of DAAs and treatment outcomes. RF1_2k/1b is the most actively circulating in the world; however, other recombinants  were described as well . Highly The RF1_2k/1b recombinant or «chimera» was first discovered in St. Peterburg by O. Kalinina et al. . AlthougTo estimate the incidence of AHC and CHC in Russia, we analyzed the official statistical data from 2001 to 2021 . The ana10,107 HCV positive serum samples were collected during routine epidemiological monitoring from 2015 to 2017. HCV isolates were obtained from patients from all 8 federal districts  of Russia, and stored at −80 °C before use. All patients gave voluntary informed consent before participating in the study.RNA was isolated from patient samples using commercial kits “RIBOSORB,” “MAGNO-sorb,” and “RIBOSOL E”  according to manufacturer’s instructions. Reverse transcription was performed using “REVERTA-L” variant 100 kit , designed to obtain cDNA on an RNA matrix according to the manufacturer’s instructions.HCV cDNA was amplified by PCR using proprietary primers and reagents for amplification. HCV genotype was determined using the commercially available test kit “AmpliSens HCV-Genotype-FL” . In brief, genotyping procedure is based on simultaneous identification of genotypes 1a, 1b, 2, 3, 4, 5, and 6 with specific sets of primers in several tubes using two fluorescent probes (FAM and JOE) together with an internal control using real-time PCR. All samples classified as genotype 2 were subsequently sequenced for confirmation purposes. “Rotor Gene Q”  machine was used for real-time PCR analysis.The RF_2k/1b HCV recombinant was determined by sequencing of core and NS5B regions of viral isolates classified as genotype 2 by commercially-available genotyping test. Sequence results were analyzed using Geneious software version 7.1.7  and NCBI information resources .The study group included 5780 (57.2%) men and 4327 (42.8%) women aged 0 to 83 years (median age 41 years). All patients were divided into 8 age groups: under 15 years old, 16–20 years old, 21–30 years old, 31–40 years old, 41–50 years old, 51–60 years old, 61–70 years old, and over 70 years old.p values < 0.05 were considered statistically significant.Data analysis was performed in SPSS software (SPSS 21.0.0.0). Chi-square tests were used to determine statistically significant differences between variables. Since the early 2000s, AHC incidence in Russia has shown a pronounced downward trend. In 2001, AHC incidence in Russia was 16.7 per 100,000 persons; by 2019, that rate dropped to 1/100,000 . On the The incidence of hepatitis varied among Russia’s federal districts. In 2019, the highest number of CHC cases was registered in the Northwestern federal district , and the lowest was registered in the North Caucasian district . The highest CHC incidence rates were registered among persons aged 30–39 years  (results are not shown).p > 0.05), and the proportions of HCV genotypes remained virtually the same across Russia except for the Far East district, where genotype 2 was the lowest (1%) (This study showed that genotype 1 is predominant in Russia (53.6%) A. Subtypest (1%) C. A mixtest (1%) .p < 0.05; The prevalence of HCV genotypes 1, 2, and 3 differed among gender and age groups  and increased in each subsequent age group, reaching its maximum value in 61–70-year-olds (13.5%).p < 0.05) .RF1_2k/1b, the most prevalent HCV recombinant, was found in 312 infected patients, which amounted to 3.2% of the total genotypes and 30% of isolates classified as genotype 2 by commercial genotype testing (putative genotype 2) A. The pr < 0.05) D, with t < 0.05) D. In thep < 0.05) among men (3.9%) and women (2.4%).The highest prevalence of the recombinant was identified among persons under 15 years of age (5.4%); however, it was generally similar in all age groups, descending from 3.6% in 41–50-year-olds to 0.9% in >70-year-olds . The freThe high incidence of AHC in Russia in the early 2000s was related to the large number of intravenous drug users, most of which were young men ,37. MoreHCV phylogenetic analyses identified similarities between Russian HCV isolates and those from Europe and Asia. RF1_2k/1b was found to be related to European strains . The relAccording to WHO Guidelines, pangenotypic treatment regimens are prioritized for people with CHC. Genotype-specific treatments are recommended in countries where certain viral genotypes are more prevalent . SeveralThe Russian national CHC guidelines include both pangenotypic regimens  and various regimens for treating patients with subtypes 1a and 1b, and genotypes 3 and 4 . The useAccording to our study, HCV genotype 1 dominates in Russia (53.6%). Genotypes 3 and 2 were detected in 35.4% and 7.8% of patients, respectively . Over 92Genotypes 1 and 2 HCV were more often detected in women, and genotype 3 in men. Genotype 3 was found most frequently in the age group 31–40-year-olds (44.9%), and genotype 1 in those over 70 (72.2%). The proportion of genotype 2 was higher among those over 40. HCV RF1_2k/1b prevalence was 3.2%, which is higher than in previous estimates (1.5–2%) ,29.The Russian Ministry of Health has prepared a national plan for HCV elimination, a comprehensive program that covers all aspects, ranging from HCV prevention to the treatment and control of HCV infection, with the final goal being to substantially reduce the incidence and mortality of HCV infection by 2030. Thus, the data obtained during the study on the distribution of HCV genotypes in the country has become the basis for meeting the needs of genotype-specific therapeutic regimens.To achieve the WHO’s goals of HCV elimination by 2030, further work is needed to expand testing and treatment. All patients with CHC should be given DAAs to significantly reduce CHC prevalence and mortality from liver cirrhosis and primary liver cancer. A comprehensive treatment program will reduce the socio-economic burden of hepatitis C and achieve the targets of the WHO strategy for eliminating HCV infection in Russia by 2030.Although the incidence of AHC and CHC in Russia has been declining in recent years, a large number of patients with CHC require antiviral treatment in accordance with modern national guidance. In Russia, a comprehensive national hepatitis C plan has been prepared, which includes all aspects from prevention to the treatment and control of diseases to reduce incidence and mortality from HCV infection by 2030.To conclude, HCV infection remains a global health problem Achieving the WHO Plans for eliminating HCV as a public health threat by 2030 requires extensive characterization of HCV prevalence and genotype characteristics . Here, we demonstrate a very uniform pattern of HCV genotype distribution across the country, with the highest prevalence of HCV genotype 1 (53.6%) followed by genotypes 3 and 2. HCV genotypes 4 and 6, and mixed genotypes, were extremely rare (~0.1–0.2%), while genotype 5 was absent. The prevalence of RF1_2k/1b recombinant was higher compared to previous estimations. Significant differences in HCV genotypes were found between gender and age groups. Overall, these data provide the basis for implementing national plans for eliminating HCV in Russia.


Caffeine intake affects bone metabolism through inhibition of osteoblast proliferation. This study aims to assess the effect of caffeine consumption on implant stability in the healing period of patients. A prospective cohort study is designed to assess implant stability in the posterior of the maxilla. Patients were divided into two groups based ondaily caffeine intake as group 1 with consumption of 400 mg/daily caffeine or more, and group 2 with consumption of 100 mg/daily caffeine or less.The implant stability was measured by resonance frequency analysis (RFA). The mean implant stability quotients (ISQs) were calculated. RFA measurementswere made at 4, 6 and 8 weeks after implant placement.p= 0.13, p= 0.36 and p= 0.08 respectively)The repeated measure test indicated a similar increase in ISQ in various study times in the two studied groups . A total of 102 patients were studied (51 in each group). The mean of ISQ was 43.49± 2.32 in the group 1 and 42.78±2.34 in the group 2 at four weeksafter insertion. The mean of ISQ was 50.86±3.06 in group 1 and 51.37±2.44 in the group at six weeks after implant placement. At eight weeks after implant surgery,the mean of ISQ was 56.78±3.77 in the group 1 and 57.84±1.82 in the group 2. The mean of ISQ between the two groups at 4, 6 and 8 weeks after implant placement wasnot statistically different. ( Acquired data suggest that caffeine intake may not have a negative effect on implant stability in the healing period at the posterior of the maxilla. Up to 80% of people consume caffeine around the world  . It is sterase  . In an sterase  . It wassterase  . Implant stability is defined as the absence of clinical mobility, which is crucial for osseointegration. Resonance frequency analysis (RFA)stability measurement applies a bending load, which is similar to the clinical load and indicates the stiffness of the implant-bone connection  . To theThe purpose of this study is to address the following question: Do patients consuming caffeine have lower implant stability during the healing period?We hypothesized that caffeine affects the bone healing process and decreases implant stability. Therefore, the aim of this study was tocompare implant stability in patients with and without caffeine consumption.The authors designed a prospective cohort study. The sample was derived from patients who attended the Oral and Maxillofacial Department of Shahid Beheshti Universityof Medical Sciences and a private clinic between September 1, 2018, and December 31, 2019. The Medical Ethics Committee of Shahid Beheshti Universityof Medical Sciences has approved the study (IR.SBMU. DRC.REC.1397.60). Patients eligible for study inclusion had a partially edentulous area at theposterior of the maxilla and received a dental implant for restoration there. The exclusion criteria were defined as any systemic disease affecting bone metabolism,smoking habit, need for augmentation and or sinus lift and those who refused participation or failed to return for follow up.Patients were divided up into two groups as group 1, in which patients took 400 mg/daily or more of caffeine, and group 2, in which theparticipants took caffeine for 100 mg/ daily or less. The estimated amount of caffeine intake is shown in All implants were placed in healed bone at least 12 weeks after tooth removal. A crestal incision was made on the alveolar ridge with two short releasing withpreserving gingival tissue in the proximal and distal aspects adjacent to neighbor teeth. Instrumentation was performed based on the company guidelines.A dental implant  with 4.5mm x 10mm size was placed at the first or second molar area in the posterior of the maxilla. A smart peg was connected to the fixture.Two examiners who were blinded to the groups evaluated the implant stability. The stability of the implants was measured by RFA. An Osstell device  was used. The buccolingual and mesiodistal directions were measured. Next, the mean implant stability quotients (ISQs) were calculated. RFA measurements were made at 4, 6 and 8 weeks after implant placement.The statistical analysis was performed using statistical package for the social sciences (SPSS) version 21 software .The repeated measurement test was used to compare ISQ values between the two groups at each measurement time point. An Independent T-test wasused to compare the mean of age between the studied groups. A p value of <0.05 was considered statistically significant. An inter-examiner reliabilityanalysis (Kappa test) was applied to determine the agreement between the two examiners.p= 0.50). The mean age was 38.27±10.07 years in group 1 and 40.24± 7.67 years in the group 2.There was no difference in the mean of age between the two groups (p= 0.27) .Group 1 consisted of 30 males and 21 females, and group 2 included 29 males and 22 females. The gender distribution between the two groups wasnot statistically different (p= 0.27) .p= 0.13, p= 0.36 and p= 0.08, respectively) (p< .0.001),95% CI, which shows almost a perfect agreement between the examiners.The mean of ISQ was 43.49±2.32 in the group 1 and 42.78±2.34 in the group 2 at four weeks after insertion. The mean of ISQ was 50.86±3.06 in the group 1 and 51.37±2.44 in thegroup at six weeks after implant placement. Eight weeks after surgery, the mean of ISQ was measured to be 56.78±3.77 in the group 1 and 57.84±1.82 in thegroup 2. Analysis of the data did not demonstrate any difference for the mean of ISQ between the two groups at 4, 6 and 8 weeksafter implant placement (ctively) .The rep F=0.52). The intCaffeine  is the most commonly consumed psychoactive agent around the world. The possible effect of caffeine onbone metabolism was evaluated in a series of animal and clinical studies  - 8. ItThe dose of caffeine was estimated according to patients’ self-reports. Various beverages with caffeine content were consumed which were documented.ISQ measurements at 4, 6, 8 weeks after implant placement indicated no significant difference in the mean of ISQ in patients who consumed more than 400 mg/dailyand less than 100 mg/daily. It was suggested that the dose of caffeine more than 400 mg is toxic for human kind and less than 100 mg does not have a clinical effect on bone  . It couet al. [ in vivo [ Duarte et al.   studiedet al.  . A hypoet al.  . Caffeiet al.  - 14. Tin vivo  , 19 . et al. [ et al. [ et al. [ et al. [ et al. [ Tasuang et al.   studiedet al.  . Rapuri et al.   reporte et al.   studied et al.   indicat et al.   studiedet al. [ In dental research, caffeine was studied in orthodontic tooth movements. The study showed that drinking coffee might accelerate tooth movement in orthodontic treatment   Shiraziet al.  , studieet al.  . Moreovet al.   .Concerning the limitation of the present study, the estimation of the amount of caffeine intake by patients was performed based on self-reports, which may not be very precise. Our findings indicate that caffeine intake may not have a negative effect on implant stability in the healing period at the posterior of the maxilla.The authors declare that there is no conflict of interest.


We set out to address the limited validation of TNM8 (stages I-IV) in large population-based datasets.The 8This retrospective cohort-study included 6,414 patients from the population-based Ontario Cancer Registry diagnosed with cutaneous melanoma between January 1, 2007 and December 31, 2012. Kaplan–Meier curves estimated the melanoma-specific survival (MSS) and overall survival (OS). Cox proportional hazard models were used to estimate adjusted hazard ratios for MSS and OS across stage groups. The Schemper-Henderson measure was used to assess the variance explained in the Cox regression.n = 4,556), II , III (n = 598), and IV (n = 54) had an estimated 5-year MSS of 98.4%, 82.5%, 66.4%, and 14.4%, respectively. Within stage III, IIIA 5-year MSS was 91.7% while stage IIID was 23.5%. HRs indicated that TNM8 more evenly separates subgroups once adjusted for patient- and disease-characteristics. The variance in MSS explained by TNM7 and TNM8 is 18.9% and 19.7%, respectively.In our sample, 21.3% of patients were reclassified with TNM8 from TNM7; reclassifications in stage II were uncommon, and 44.1% of patients in stage III were reclassified to a higher subgroup. Minimal changes in MSS curves were observed between editions, but the stage IIB curve decreased and the stage IIIC curve increased. For TNM8, Stage I (TNM8 performed well in our sample, with more even separation of stage subgroups and a modest improvement in predictive ability compared to TNM7.The online version contains supplementary material available at 10.1186/s12885-022-09781-0. Melanoma is the eighth most common cancer among Canadians with an estimated 7,800 new cases in 2019 .thedition (AJCC8 and UICC8) of the Melanoma Staging Manual in 2017 ). The HR increased sequentially with each stage from IA-IIC and IIIA-IIID as the MSS declined  staging system for cutaneous melanoma using a Canadian population-based sample. We believe our study is the largest population-based validation study to date, with 6,414 eligible participants from stage I-IV. Our study used detailed demographic and disease data from the provincial cancer registry and other administrative sources to estimate overall survival, melanoma-specific survival, and cox regression hazard ratios.Our study set out to investigate the performance of the 8The changes made between TNM7 and TNM8 resulted in the reclassification of many patient’s stage subgroups. Stage IIIC was the largest TNM8 stage III subgroup, representing 54.3% of our sample, 48% of the IMDDP, and 41–65% in the literature . It is iVery few patients shifted between the broad stage groups  with 8 moving from stage II to stage I. This highlights that differences in stage subgroup survival relates overwhelmingly to shifts within a given stage’s subgroups (e.g. shifts between TNM7 IIIB and TNM8 IIIC). Our findings also suggest that historic data staged with TNM7 can be expected to have very similar underlying major disease factors  to TNM8 staged patients for broad stage groups. The small improvement in the percent of variance in survival explained by stage is of a similar magnitude to typical observations for other cancer sites. In general, the percent of variance explained is low –23.Survival for melanoma decreases with increasing age, ulceration rate, and male sex. Our median age of 61 IQR 49–73) aligns with that found in several studies , 13. The3 aligns While the OCR has an excellent tumour-capture rate, some limitations are present. Ulceration, an important prognostic factor, could not be determined in 6.8% of cases. Moreover, risks of misclassification of cause of death from secondary cancers (not counted in MSS) being related to melanoma metastases, and heterogeneous pathology reporting, all introduce potential sources of error.Gershenwald et al. using the IMDDP [We demonstrated lower survival for nearly all stages in comparison to the largely institution-based IMDDP that first established the AJCC8 staging system. Our TNM8 5-year MSS for stage I 98.4%), stage II (82.5%) and stage III (66.4%) was comparable or lower than the 5-year MSS for stage I (98%), stage II (90%), and stage III (77%) reported by %, stage Our 5-year MSS estimates were lower than the IMDDP for all stage subgroups except IA, IIIA, and IIID, which contained the IMDDP value in their 95% CI. Our 5-year MSS was lower than the IMDDP for stage IB 95.6% vs 97%), IIA 90.4% vs 94%), IIB (80.8% vs 87%), IIC (69.0% vs 82%), IIIB (74.8% vs 83%), and IIIC (59.0% vs 69%) [% vs 94%,% vs 97%,It is not immediately clear why the IMDDP cohort reported higher survival for most stages. The IMDDP analysis used institutional data of 46,000 patients from ten institutions globally. None of these institutions were Canadian, and 15,746 patients (33.5%) were from three institutions in the U.S. . As suchBRAF status) [Our findings also emphasize the importance of considering subgroup-specific treatment recommendations, and evaluating novel adjuvant therapies for high-risk stage II patients. We highlight this given that survival for stage III and IV patients is improving with immunotherapies  and targeted therapies  . Current status) , 27. TheShifts in stage III subgroups are also notable. The MSS for stage IIIC improved between TNM7 and TNM8, and the MSS for stage IIID approximated stage IV metastatic disease. The need for expanded treatment recommendations is clear, and several ongoing phase 3 trials will provide valuable insight . In the future, patients will surely benefit from increased access to innovative therapies and further-refined treatment guidelines.th edition UICC/AJCC TNM melanoma staging system in the largest population-based sample published to date. We found that the staging system performed well, with good separation of stage subgroups and a small improvement in the percent of variance explained compared to TNM7. We note that our MSS was similar to other validation studies, though inferior to the original institution-based sample that drove the development of the TNM8. This difference is important for clinicians to consider when advising their patients on expected stage-based outcomes.We investigated the performance of the 8Additional file 1: Table S1. Stage III subgroup reclassification from TNM7 to TNM8. N (row percent).Additional file 2: Appendix 1. Overall survival (OS) for the TNM (A) 7th edition and (B) 8th edition.Additional file 3: Table S2. 2-year and 5-year overall survival and 95% confidence interval (CI) for each stage of the 7th and 8th edition TNM melanoma staging system.Additional file 4: Table S3. Adjusted cox regression hazard ratios for overall survival of each stage of the 7th and 8th edition TNM melanoma staging system.


Wilms tumor (WT) is the second most common solid tumor in Africa with both low overall survival (OS) and event-free survival (EFS) rates. However, no known factors are predicting this poor overall survival.The study was to determine the one-year overall survival of WT cases and its predictors among children diagnosed in the pediatric oncology and surgical units of Mbarara regional referral hospital (MRRH), western Uganda.Children’s treatment charts and files diagnosed and managed for WT were retrospectively followed up for the period between January 2017 to January 2021. Charts of children with histologically confirmed diagnoses were reviewed for demographics, clinical and histological characteristics, as well as treatment modalities.One-year overall survival was found to be 59.3% (95% CI: 40.7–73.3), with tumor size greater than 15 cm (p 0.021) and unfavorable WT type (p 0.012) being the predominant predictors. Overall survival (OS) of WT at MRRH was found to be 59.3%, and predictive factors noted were unfavorable histology and tumor size greater than 115 cm. Worldwide, WT affects about 8.1 per million children with a hiIn Nigeria, the stage of WT at diagnosis, age at diagnosis, histology type, frequent treatment interruptions, and size of the tumor were factors predicting OS of children diagnosed with WT . In GermWT treatment involves multi-modal therapy with chemotherapy, radiation, and surgery . HoweverThe target of this study was to assess predictors of one-year OS in children diagnosed with WT.st January 2021.This was a retrospective cohort study of 41 children diagnosed with WT between 1st January 2017 to 31The study was conducted in the surgical and pediatric departments, pediatric surgery, and pediatric oncology units of MRRH.Children with a histologically confirmed diagnosis of WT.Children with missing data on clinical and pathological characteristics and children involved in the pilot study.Permission to access the records was sought from the research ethics committee. The data extraction tool was designed following the variables to be studied. Electronic in-patient numbers of children diagnosed with WT between January 2017 to January 2021 at MRRH were accessed from the open medical record system (MRS). These electronically retrieved in-patient numbers were used to trace paper charts from the records office of the pediatric surgery and oncology unit. Unique patient codes were assigned to each patient’s file, to maintain patient confidentiality. The data extraction tool was then used to capture clinical, imaging, histology, and treatment records from the paper charts. Any missing information from the paper charts was obtained by cross-checking with the electronic database. A sub-database was created from the data extracted for analysis.A complete dataset was exported into STATA software version 15.0 for analysis. Continuous data were summarized into means, standard deviations, median, and interquartile ranges. Proportions for ordered categorical data were done and results were presented as percentages. Clinical and histology characteristics were described as frequencies and percentages. One-year overall survival was estimated using the Kaplan–Meier curve and expressed as a percentage with its corresponding 95% confidence interval. To identify predictors of OS, data was declared as survival time data, and time of survival was used as the time variable. In bivariate analysis, cox proportional hazard model regression was used to establish the covariates of time of survival. The unadjusted hazard ratios with their corresponding 95% Confidence intervals were reported for each covariate. A significance level of 5% was considered.Out of 41 records of children studied, 27(65.9%) were below 5 years of age, and 14(34.1%) were above 5 years of age. Females being the majority diagnosed with WT, were 23(56.1%). All 41 (100%) children presented with symptoms of abdominal swelling and pain. Sixteen (39%) children had severe weight loss, 15 (36.6%) had hypertension and 19 (46.3%) children had developed temperature on admission. In our study, the average duration of presentation with WT was 2 months. The cardinal presenting symptoms of WT were; abdominal swelling, hypertension, and hematuria observed in only 3(7.3%) children. No associated predisposition syndromes were noted. Nineteen children were diagnosed with stage III (46%) and IV (46%) of WT. Only 2 (5%) children presented with stage II WT and one (3%) with stage V. There was no child diagnosed with stage I WT at admission (Table Sites of metastasis: Lung metastasis accounted for 7 (17%) cases, liver 5 (12.2%), and spleen 1 (2.4%) cases. Four (9.7%) of children had metastasis to both the liver and lungs.Side of tumor origin: WT originated from the right kidney in 27 (65.8%) of children, and the left in 14 (34.1%) of children diagnosed with WT.Of the children diagnosed with WT, 41 (100%) had chemotherapy, 36 (87.8%) had surgery, and 5 (12.2%) did not get surgery. Of the 36 children who received chemotherapy, 20 (48.8%) complied and received all cycles on schedule, 8 (19.5%) received chemotherapy but not on schedule, and 13 (31.7%) missed some cycles of chemotherapy. Those who had nephrectomy had 13 (31.7%) with residual tumor cells and 14 (34.1%) without residual tumor cells in the perinephric fat. Samples that did not have their resection margins assessed were 14 (34.1%). There was however an imbalance in the multimodal treatment, where 36 (87.8%) of children who received surgery and chemotherapy did not receive radiotherapy, as only 5 (12.2%) received them from Mulago national referral hospital (MNRH). Following chemotherapy and surgery alone, 8(19.5%) relapsed  of children diagnosed with WT had favorable histology, while 10 24%) had unfavorable histology. Out of the 10 children who had anaplasia, 7 (70%) had diffuse and 3 (30%) had focal anaplasia. Five (12.1%) children had blastemal predominant, 26 (63.4%) had triphasic, and 10 (24.4%) had stromal predominant subtypes of WT4% had unAt the beginning of the follow-up, one child died within the first month, making the survival probability initially 97.6% (95% CI: 83.9–99.7). The survival rate decreased subsequently over the next eleven months, being 75.7% (95% CI: 0.5843- 0.86606) at 6 months, with 9 deaths and 8 losses to follow up Fig. . At the . However, by the end of one year, 15 children with favorable and only 2 unfavorable WT histology were still at risk of death.The one-year OS in children with the favorable histology WT type was 72%, which was threefold the survival rate of those with the unfavorable histology WT type at 22% Fig. . HoweverChildren with WT size < 15 cm had OS of 68%, while WT > 15 cm decreased OS to 58% Fig. . Nine chChildren diagnosed with stage 3 WT had OS at 78%, only second to those diagnosed with stage 5 WT at 100%. However, only 1 child had WT stage 5 and remained at risk throughout the follow-up period. OS in WT stage 4 was the lowest at 48%. The majority, 92.6% of newly diagnosed children had stage 3 and 4 WT , or Actinomycin and doxorubicin (AD) combinations. Vincristine and dactinomycin are administered for WT stages above 3.WT stages 2–4 with UH are treated with cyclophosphamide, ifosfamide, carboplatin, and etoposide, in addition to radiotherapy. However, stage 5 UH is treated with vincristine, dactinomycin and doxorubicin for 6–12 weeks, after which nephron-sparing surgery is performed , 17.Post nephrectomy, all children receive adjuvant chemotherapy except for those with FH stage 1.Children with stages 2 and above with FH receive vincristine, actinomycin, and doxorubicin.In addition to radiotherapy, those with UH are treated with cyclophosphamide, doxorubicin, etoposide, and carboplatin for 27 weeks, with each cycle of chemotherapy being administered at a 21-day interval , 18.In this study, the majority (65.9%) of children diagnosed with WT were below 5 years of age. The age most affected correlates with other studies , 20. ChiThere were more female children diagnosed with WT in this study than males, with a Male: Female ratio of 1:1.2, which correlates with a study done in Rwanda by , which sIn this study, the most common symptoms at presentation in all children were abdominal pain and swelling. All children presented with abdominal swelling probably because any small increase in the tumor size would have decreased the already small intrabdominal cavity volume in children. The pressure effect from this swelling would subsequently cause abdominal pain. The above symptoms were also found in studies done in America , and NigHypertension was one of the common presenting symptoms in children with WT, due to hypersecretion of renin by the tumor  though tMany children (87.8%) did not receive chemotherapy, probably because they could not foot the costs of transport to Mulago national referral hospital (MNRH), the only hospital in the country with a radiotherapy machine.The majority (75.6%) of children diagnosed with WT had a favorable (non-anaplastic) histological type, similar to a finding in Nigeria . ComparaThis was found to be 59.3%, which is a better survival rate compared to those reported in MNRH. We attribute the better 1-year OS to the fact that the majority of children had favorable histology. The better 1-year OS could also be because all children in the study had unilateral WT, which has been shown not to affect OS greatly even in stage IV . In our Children with unfavorable WT histology had poor OS compared to those with favorable type, similar to previous studies done in Iran  and in mWilms tumor size > 15 cm decreased OS to 58%, probably because of metastasis and tumor rupture, which are risks in huge tumors. In literature, WT size > 10 cm greatly decreases OS [Similar to findings in Nigeria  and KenyTumor size greater than 15 cm and unfavorable histology were two factors that predicted overall survival. Tumor size greater than 15 cm was found to contribute to poor OS, probably due to tumor destruction to the affected kidney, causing renal failure. A study in Germany , showed Overall survival of WT at MRRH was found to be 59.3%, and predictive significant factors noted were unfavorable histology and tumor size greater than 115 cm. Unfavorable WT histology and late stages of WT correlated with poor OS.


Context: In view of the growing incidence of pathogenic yeast infection all over the world, this study was undertaken to understand its etiology and epidemiology in Assam.Aims: To characterize and study the antifungal susceptibility pattern of the pathogenic yeasts from the clinical samples.Settings and Design: The study was a hospital-based cross-sectional study.TM. Antifungal susceptibility test was done by disk diffusion method as per Clinical and Laboratory Standards Institute (CLSI), M44-A2.Methods and Material: 150 patients were enrolled in the study and from which clinical samples were collected. A total of 83 samples showing the growth of yeast in culture were included in the study. The yeasts were identified by conventional and BioMerieux ID 32C and VITEK 2p less than 0.05 was considered statistically significant.Statistical analysis used: Data was analyzed using statistical software Epi-Info 7.1.2.0 . For comparison of categorical data, the Chi-square test or Fisher exact test was used. A value of Candida albicans (43.4%) followed by Candida tropicalis (19.3%). Emerging yeasts like Kodaemea ohmeri (4.8%), Pichia anomala (2.4%), and Candida auris (1.2%) were also isolated. Amphotericin B was effective against all yeast isolates. All the isolates of Candida krusei were resistant to all the azoles.Results: The most affected population was the age group of ≤10 years (32.5%) with male preponderance (67.5%). Yeasts were mostly isolated bloodstream infections (49.3%). The major risk factor was prolonged antibiotic intake. Predominant yeast isolates were Conclusions: The study reflects that there is a growing incidence of emerging yeast infections and efforts are to be made for their identification and antifungal susceptibility testing for the initiation of appropriate therapy. Candida species, various fungi like Trichosporon, Cryptococcus neoformans, and some emerging yeasts have been widely reported [Candida) or obtained from host surroundings (Cryptococcus) [Candida species accounted for 95-97% of all clinical isolates in each study year from 1997 to 2005 [Candida albicans was the most frequent , followed by Candida glabrata (11.2%), Candida tropicalis (7.0%), and Candida parapsilosis (5.8%). Among the non-candidial yeast, C. neoformans (31.2%) was most frequent, followed by Saccharomyces species (9.6%), Trichosporon species (6.7%), and Pichia anomala (2.5%) [ Candida infection was reported to be 6% in a 5-year study (2001-2005) [Candida (NAC) [C. neoformans is a saprophytic encapsulated haploid yeast that is distributed worldwide in association with avian excreta, mostly pigeons [Cryptococcal infection was seen in the range of 2.09-53.1% [Candida auris has caused increased clinical attention due to its multidrug resistance [Infections have dramatically increased over the last few decades due to pathogenic yeasts. The increasing risk of opportunistic fungal infections is due to growing numbers of immunocompromised hosts, including AIDS patients, the abuse of broad-spectrum antibiotics, immunosuppressive agents after organ transplantation, and cancer chemotherapy ,2. Apartreported ,4. Theseococcus) . The ARTococcus) . On the  to 2005 . Candidailosis 5.%. Among ilosis 5.%. Among  pigeons . There i09-53.1% -12. Fluc09-53.1% ,11. Candsistance -15. To msistance . Althougsistance . Also, tCandida species was done by Germ tube test, Corn Meal Agar morphology , HiChrom Candida Agar, sugar assimilation and fermentation tests and using Biomerieux ID 32C, and VITEK 2TM with YST card for yeast identification system. For confirmation of Cryptococcus species, urease hydrolysis tests and phenol oxidase tests were done. Antifungal disk diffusion susceptibility test was done as per the Clinical and Laboratory Standards Institute (CLSI) protocol  to find the susceptibility pattern of the fungal growths  was obtained before the commencement of the study. The clinical specimens  were collected under aseptic conditions. The samples were processed as per standard protocol [Interpretative criteria Eighty-three samples showing the growth of yeast in culture were further processed for their identification and antifungal susceptibility testing. Maximum number of the patients (32.5%) were of ≤10 years of age followed by 24.1% in the >60 years age group. This shows that higher incidence of infection with pathogenic yeast was common in the extremes of age. Majority (49.3%) of the patients presented with bloodstream infection (BSI). The second common clinical presentation was bronchopneumonia and pleural effusion (36.1%) followed by meningitis (12%) and tuberculosis (2.4%).With regard to the risk factors, 88% of the patients in this study had a history of prolonged antibiotic intake (≥7 days) within the last 1 month and it was the leading risk factor in this study. The antibiotics that were used were cephalosporins, carbapenems, and aminoglycosides mostly. Another leading risk factor in this study was ≥7 days stay in the hospital (88%). The second commonest risk factor was indwelling devices like central line, intravenous cannula, and urinary catheter. 92.8% of the patients had history of indwelling devices.C. albicans . Among the NAC, C. tropicalis (19.3%) was the most common isolate. C. neoformans was the third commonest yeast isolated from all the CSF samples. Kodaemia ohmeri was found in 4.8% of cases and all the isolates were from BSI in neonates. In the present study, the third most common Candida species was C. parapsilosis (10.8%). In this study, 2.4% of the cases yielded P. anomala and all were isolated from blood in neonates.In this study, the maximum number of isolates Table  was C. aC. krusei and Candida auris were resistant to all the azoles. 91.7% and 83.3% of the C. albicans were sensitive to fluconazole and voriconazole, respectively. In this study, 56.3%, 81.3%, and 68.8% of C. tropicalis were sensitive to fluconazole, voriconazole, and itraconazole, respectively  were susceptible to amphotericin B. All the isolates of This study was done to determine the occurrence of pathogenic yeast infections and their antifungal susceptibility pattern in Assam. Most of the studies showed the growing incidence of pathogenic yeasts in immunocompromised patients. The present study showed a higher incidence of infection with pathogenic yeast was common in the pediatric age group as well as in the geriatric age group as the immunity is low in the extremes of age, which is in concordance with the study by Kim et al. 2016) who reported that 75.8% of the patients were in the age group of >60 years of age 16 who re. In the C. albicans and this finding is in concordance with Kim et al., 2016 (48.6%) [C. tropicalis was the most common isolate. Chakrabarti et al. (2015) also found C. tropicalis as the most common isolate with an isolation rate of 31.2% and 41.6% [In the present study maximum preponderance of isolates was nd 41.6% .K. ohmeri in neonatal candidemia [Candida species was C. parapsilosis (10.8%). This finding corresponds with the finding of Chakrabarti et al. (2015) who also reported C. parapsilosis to be the third most common Candida species (10.9%) [The study of Taj-Aldeen et al. (2006) reported ndidemia . In the  (10.9%) .P. anomala isolates were isolated from blood in neonates. This shows a higher incidence of infection in neonates which also corresponds with the findings of the study by Pasqualotto et al. (2005) [C. krusei (4.7%) [The study showed that . (2005) . Shaik ei (4.7%) .C. albicans were sensitive to fluconazole and voriconazole, respectively, which is in concordance with the present study [The antifungal susceptibility pattern showed that all the yeast isolates were sensitive to amphotericin B, which correlates with the report of Shaik et al (2016) . Shaik ent study . As flucnt study .K. ohmeri, C. auris, P. anomala by conventional methods, and they were identified by automated culture methods only. Therefore, conventional and automated methods are required for the identification of pathogenic yeast. Variation of species distribution is also dependent on variation in methods adopted in different studies.In the present study, it was not possible to identify The limitations of the study were that the characterization and antimicrobial susceptibility of the organisms are done using conventional methods and automated blood culture system but molecular characterization could not be done. The sample size is also less as the study was done for only a year.To conclude, the incidence of pathogenic yeast infections is increasing with a gradual increase in infection with some emerging yeasts, many of them showing resistance to commonly used antifungals, making it necessary for their speciation. Hence, identification of the yeasts up to their species level is of utmost importance for the commencement of appropriate antifungal therapy.