Current Cancer Epidemiology

In this brief report, we offer a concise overview on current cancer epidemiology garnered from the official databases of World Health Organization and American Cancer Society and provide recent information on frequency, mortality, and survival expectancy of the 15 leading types of cancers worldwide. Overall, cancer poses the highest clinical, social, and economic burden in terms of cause-specific Disability-Adjusted Life Years (DALYs) among all human diseases. The overall 0\u201374 years risk of developing cancer is 20.2% (22.4% in men and 18.2% in women, respectively). A total number of 18 million new cases have been diagnosed in 2018, the most frequent of which are lung (2.09 million cases), breast (2.09 million cases), and prostate (1.28 million cases) cancers. Beside sex-specific malignancies, the ratio of frequency between men and women is >1 for all cancers, except thyroid (i.e., 0.30). As concerns mortality, cancer is the second worldwide cause of death (8.97 million deaths) after ischemic heart disease, but will likely become the first in 2060 (~18.63 million deaths). Lung, liver, and stomach are the three most deadly cancers in the general population, while lung and breast cancers are the leading causes of cancer related-mortality in men and women, respectively. Prostate and thyroid cancers have the best prognosis, with 5-year survival ~100%, while esophagus, liver, and especially pancreas cancers have the worst prognosis, typically <20% at 5 years. We hope that this report will provide fertile ground for addressing health-care interventions aimed at preventing, diagnosing, and managing cancer around the world

Interference of medical contrast media on laboratory testing

The use of contrast media such as organic iodine molecules and gadolinium contrast agents is commonplace in diagnostic imaging. Although there is widespread perception that side effects and drug interactions may be the leading problems caused by these compounds, various degrees of interference with some laboratory tests have been clearly demonstrated. Overall, the described interference for iodinate contrast media include inappropriate gel barrier formation in blood tubes, the appearance of abnormal peaks in capillary zone electrophoresis of serum proteins, and a positive bias in assessment of cardiac troponin I with one immunoassay. The interference for gadolinium contrast agents include negative bias in calcium assessment with ortho-cresolphthalein colorimetric assays and occasional positive bias using some Arsenazo reagents, negative bias in measurement of angiotensin converting enzyme (ACE) and zinc (colorimetric assay), as well as positive bias in creatinine (Jaffe reaction), total iron binding capacity (TIBC, ferrozine method), magnesium (calmagite reagent) and selenium (mass spectrometry) measurement. Interference has also been reported in assessment of serum indices, pulse oximetry and methaemoglobin in samples of patients receiving Patent Blue V. Under several circumstances the interference was absent from manufacturer-supplied information and limited to certain type of reagents and/or analytes, so that local verification may be advisable to establish whether or not the test in use may be biased. Since the elimination half-life of these compounds is typically lower than 2 h, blood collection after this period may be a safer alternative in patients who have received contrast media for diagnostic purposes

Is digital epidemiology the future of clinical epidemiology?

[no abstract available

Seasonal variation in the frequency of myocardial infarction diagnosed in a large emergency department of a European country with a temperate climate

Previous studies at different latitudes showed that acute myocardial infarction (AMI) exhibits a seasonal variation, with higher frequency in spring and winter. We conducted a retrospective analysis to verify whether the frequency of AMI cases diagnosed in the emergency department (ED) may follow a seasonal pattern in a European country with a temperate climate. A retrospective analysis was performed in the hospital database of the University Hospital of Parma (northwestern Italy), to retrieve the total number of AMI cases diagnosed in the ED during the entire year 2010. The search for AMI cases was conducted using both ICD-9 codes and related diagnostic terms. The seasonality was defined according to the typical equinoxes and solstices at the latitude of the study. A total of 83,919 patients visited the ED of the University Hospital of Parma during the year 2010, 502 (0.6%) of whom with a final diagnosis of AMI (mean age, 73±14 years; 188 women and 314 men). The largest frequency of AMIs was observed in autumn (n=148; 29%), followed by winter (n=136, 27%), whereas the lowest frequencies were recorded in spring (n=110; 22%) and summer (n=108; 22%). The difference in frequency distribution of AMI cases across the four seasons of the year was found to be statistically significant (P<0.001), and this trend was independent from sex and age. Compared to the summer period (i.e., the season with the lowest frequency of AMI cases), the relative risk (RR) for AMI was significantly higher in autumn (1.37; 95% CI, 1.15-1.63; P<0.001) and winter (1.26; 95% CI, 1.05-1.51; P=0.013), but not in spring (1.02; 95% CI, 0.83-1.24; P=0.857). Compared to the spring period, the RR for AMI was found also to be significantly higher in autumn (1.34; 95% CI, 1.13-1.60; P<0.001) and winter (1.24; 95% CI, 1.03-1.48; P=0.021)

Overview on patient safety in healthcare and laboratory diagnostics

The healthcare context is characterized by a high degree of complexity. Despite eager efforts of the healthcare personnel, sometimes things go wrong and produce unintentional harm to the patients. As such, patient safety must be considered as one of leading healthcare challenges. Some foremost studies have highlighted that serious medical errors might occur rather frequently, jeopardizing patient\u27s health and costing a huge amount of money to the healthcare system. A medical error is traditionally defined as an unintended act, the failure of a planned action to be completed as intended, the use of a wrong plan to achieve an aim when the failure can not be attributed to chance. Medical errors can be classified according to several models, such as the clinical pathway (i.e., diagnostic, treatment, prevention and others), or the resulting harm to the patient (i.e., near misses, no harm or harmful incident). Medical errors can also be classified in skill-based slips and lapses (i.e., errors of action), or rule and knowledge-based mistakes (i.e., errors of intention). According to the source, most errors result from the combination of active failures and latent conditions. It is noteworthy, however, that diagnostic errors have been frequently underestimated in the clinical practice. A laboratory error is any defect occurring at any part of the laboratory cycle, from ordering tests to reporting, interpreting, and reacting to results. Although they have been traditionally identified with analytical problems and uncertainty of measurements, an extensive scientific literature now attests that the vast majority of these arise from the extra-analytical activities of the total testing process. Data from representative studies also show that preanalytical errors are the first cause of variability in laboratory testing. The aim of this article is to provide an overview on the current knowledge about patient safety in healthcare and laboratory diagnostics

Epidemiology of cycling road injuries-related deaths

Dear Editor,   There are now several lines of evidence that millions of people around the world use bicycles as a routine means of transportation. In the US alone, for example, the website Statista estimates that 55 million people use bicycles as a primary or complementary mode of transportation, with a trend that has been steadily increasing over the past decade. In addition to the positive environmental impact of cycling as an alternative means of transportation for reducing pollution, cycling also offers numerous health and wellness benefits. Nevertheless, cycling injuries on the road are still a primary health concern, as collisions with motor vehicles or accidental falls can cause serious harm to cyclists. [...

Critical review and meta-analysis of spurious hemolysis in blood samples collected from intravenous catheters

Background: A number of preanalytical activities strongly influence sample quality, especially those related to sample collection. Since blood drawing through intravenous catheters is reported as a po-tential source of erythrocyte injury, we performed a critical review and meta-analysis about the risk of catheter-related hemolysis. Materials and methods: We performed a systematic search on PubMed, Web of Science and Sco-pus to estimate the risk of spurious hemolysis in blood samples collected from intravenous catheters. A meta-analysis with calculation of Odds ratio (OR) and Relative risk (RR) along with 95% Confidence interval (95% CI) was carried out using random effect mode. Results: Fifteen articles including 17 studies were finally selected. The total number of patients was 14,796 in 13 studies assessing catheter and evacuated tubes versus straight needle and evacuated tubes, and 1251 in 4 studies assessing catheter and evacuated tubes versus catheter and manual aspiration. A significant risk of hemolysis was found in studies assessing catheter and evacuated tu-bes versus straight needle and evacuated tubes (random effect OR 3.4; 95% CI = 2.9-3.9 and ran-dom effect RR 1.07; 95% CI = 1.06-1.08), as well as in studies assessing catheter and evacuated tubes versus catheter and manual aspiration of blood (OR 3.7; 95% CI = 2.7-5.1 and RR 1.32; 95% CI = 1.24-1.40). Conclusions: Sample collection through intravenous catheters is associated with significant higher risk of spurious hemolysis as compared with standard blood drawn by straight needle, and this risk is further amplified when intravenous catheter are associated with primary evacuated blood tubes as compared with manual aspiration

Trends of popularity of cardiac biomarkers: Insights from Google Trends

This study was aimed at assessing the trend of worldwide popularity, thus likely reflecting usage, of conventional cardiac biomarkers, including cardiac troponins, myoglobin and creatine kinase MB (CK-MB). Google Trends was interrogated using a combination of the three search terms "troponin" AND "myoglobin" AND "CK-MB", with a time limit set between January 1, 2014 (i.e., the oldest searchable year) and present time (i.e., August 13, 2018). The raw data were entered into an Excel worksheet and reported as cumulative Google Trends scores per week for each cardiac biomarker. The popularity score of myoglobin and CK-MB has displayed a significantly decreasing trend since the 2004, whilst that of troponin has exhibited an apparently paradoxical Ushape behavior, with a more pronounced increase during the past 10 years. The correlation between time and cumulative Google searches was significant for all biomarkers, being r= 0.40 (P<0.001) for troponin, r= -0.45 (P<0.001) for myoglobin and r= - 0.79 (P<0.001) for CK-MB. The score of overall Google searches for troponin was approximately 2.5-fold and 8.5-fold higher than for myoglobin and CK-MB, respectively. When the analysis was limited to the past ten years, the correlation between time and cumulative Google searches became even stronger for troponin (r= 0.85; P<0.001), remained virtually identical for CK-MB (r= -0.80; P<0.001), whilst it was no longer significant for myoglobin (r= - 0.13; P=0.150). The graphical analysis of Google search frequency also showed that CK-MB appears to be popular in Mexico, Brazil, Chile, Japan, Poland and Romania, myoglobin seems popular in Uruguay, Bolivia, Denmark, Kazakhstan and in some African Nations, whilst troponin is mostly predominant in the remaining parts of the world. The results of this study suggest that, despite all available guidelines share the principle that cardiac troponin should be considered the one and only reference biomarker for diagnosing myocardial ischemia, CK-MB and especially myoglobin are still popular worldwide, especially in certain geographic areas