Survival and predictive factors in dialysis patients with COVID-19 in Japan: a nationwide cohort study

BACKGROUND: The Japanese Association of Dialysis Physicians, the Japanese Society for Dialysis Therapy, and the Japanese Society of Nephrology jointly established COVID-19 Task Force Committee and began surveying the number of newly infected patients. METHODS: This registry of the COVID-19 Task Force Committee was used to collect data of dialysis patients; a total of 1010 dialysis patients with COVID-19 were included in the analysis. Overall survival of patients was investigated with stratification by age group, complication status, and treatment. In addition, predictive factors for mortality were also investigated. The overall survival was estimated by Kaplan–Meier methods and compared by using log-rank test. Multivariate analysis was performed to identify the risk factor of mortality. For all statistical analyses, p < 0.05 was considered to be statistically significant. RESULTS: The mortality risk was increased with age (p < 0.001). The mortality risk was significantly higher in patients with peripheral arterial disease (HR: 1.49, 95% CI 1.05–2.10) and significantly lower in patients who were treated with remdesivir (HR: 0.60, 95% CI 0.37–0.98). Multivariate analysis showed increased risk of mortality with increment in BMI, and increment in CRP, and decreased risk with increment in albumin. CONCLUSION: Dialysis patients have a high severity of illness and a high risk of mortality in cases of COVID-19. Treatment with remdesivir might be effective in shortening the duration of hospitalization and reducing the risk of mortality

Dibothriocephalus nihonkaiensis infection identified by pathological and genetic analyses -a case report and a recent literature review of human diphyllobothriasis

We report a 20-year-old male with a past history of diarrhea and discharge of a strobila of a broad tapeworm from his anus 3 months ago. He again noticed passing a tapeworm strobila and he visited our hospital with the tapeworm sample. The macroscopic appearance and the pathological features strongly suggested Diphyllobothriasis. Soon after the first visit to our hospital, a capsule endoscopy was performed with the result of no evidence of strobilae or scoleces. Praziquantel at 20 mg/kg was orally administered once. Before drug administration, egg-like structures were present in the stool. They disappeared soon after drug administration. In human Diphyllobothriasis, Dibothriocephalus nihonkaiensis (D. nihonkaiensis) infection and Dibothriocephalus latus (D. latus) infection are common. These two species are morphologically similar but genetically distinct. Accordingly, polymerase chain reaction (PCR) using genomic DNA of the tapeworm infecting our case was performed for amplifying mitochondrial cytochrome c oxidase subunit 1 (cox1) gene. The amplified DNA fragment by PCR of our case was phylogenetically compared with other mitochondrial cox1 gene sequences of D. nihonkaiensis, D. latus, D. dendriticus, Taenia saginata, Taenia solium and Spirometra erinaceieuropaei. As a result, the tapeworm of our case was most likely within the spectrum of D. nihonkaiensis. Although human diphyllobothriasis is not a life-threatening disease for human beings, it has become a re-emerging problem even in the most developed countries with the increasing popularity of eating raw fish. The knowledge of how to cook or freeze raw fish before eating can reduce the risk of infection. However, without general awareness of human parasite infection, food-borne infections will continue to be a public health problem. Keywords: Tapeworm, Dibothriocephalus nihonkaiensis, Dibothriocephalus latus, Mitochondrial cytochrome c oxidase subunit 1 gene, Praziquante

National trends in the outcomes of subarachnoid haemorrhage and the prognostic influence of stroke centre capability in Japan: retrospective cohort study

Objectives To examine the national, 6-year trends in in-hospital clinical outcomes of patients with subarachnoid haemorrhage (SAH) who underwent clipping or coiling and the prognostic influence of temporal trends in the Comprehensive Stroke Center (CSC) capabilities on patient outcomes in Japan.Design Retrospective study.Setting Six hundred and thirty-one primary care institutions in Japan.Participants Forty-five thousand and eleven patients with SAH who were urgently hospitalised, identified using the J-ASPECT Diagnosis Procedure Combination database.Primary and secondary outcome measures Annual number of patients with SAH who remained untreated, or who received clipping or coiling, in-hospital mortality and poor functional outcomes (modified Rankin Scale: 3–6) at discharge. Each CSC was assessed using a validated scoring system (CSC score: 1–25 points).Results In the overall cohort, in-hospital mortality decreased (year for trend, OR (95% CI): 0.97 (0.96 to 0.99)), while the proportion of poor functional outcomes remained unchanged (1.00 (0.98 to 1.02)). The proportion of patients who underwent clipping gradually decreased from 46.6% to 38.5%, while that of those who received coiling and those left untreated gradually increased from 16.9% to 22.6% and 35.4% to 38%, respectively. In-hospital mortality of coiled (0.94 (0.89 to 0.98)) and untreated (0.93 (0.90 to 0.96)) patients decreased, whereas that of clipped patients remained stable. CSC score improvement was associated with increased use of coiling (per 1-point increase, 1.14 (1.08 to 1.20)) but not with short-term patient outcomes regardless of treatment modality.Conclusions The 6-year trends indicated lower in-hospital mortality for patients with SAH (attributable to better outcomes), increased use of coiling and multidisciplinary care for untreated patients. Further increasing CSC capabilities may improve overall outcomes, mainly by increasing the use of coiling. Additional studies are necessary to determine the effect of confounders such as aneurysm complexity on outcomes of clipped patients in the modern endovascular era