Cause Of Death Research Articles

Estimated health effect, cost, and cost-effectiveness of mandating sodium benchmarks in Australia's packaged foods: a modelling study.

Excess dietary sodium is a leading cause of death and disability globally. Because packaged foods are a major source of sodium in many countries, including Australia, mandatory limits for sodium might improve population health. We aimed to estimate the long-term health and economic effect of mandating such thresholds in Australia. We used a multiple cohort, proportional, multistate, life table model to simulate the effect of mandating either the WHO global sodium benchmarks or the currently non-mandatory Australian Healthy Food Partnership (HFP) sodium targets. We compared maintaining the current sodium intake status quo with intervention scenarios, using nationally representative data on dietary intake, sodium in packaged foods, and food sales volume. Blood pressure and disease burden data were obtained from the Global Burden of Diseases, Injuries, and Risk Factors Study. The effect of sodium reduction on blood pressure and disease risk was modelled on the basis of meta-analyses of randomised trials and cohort studies. Intervention and health-care costs were used to calculate the incremental cost per health-adjusted life-year (HALY) gained. Costs and HALYs were discounted annually at 3%. Compared with the status quo intervention, mandating the WHO benchmarks could be cost saving over the first 10 years (AUD$223 [95% uncertainty interval 82-433] million saved), with 2743 (1677-3976) cardiovascular disease deaths and 43 971 (26 892-63 748) incident cardiovascular disease events averted, and 11 174 (6800-16 205) HALYs gained. Over the population's lifetime, the intervention was cost effective (100·0% probability). Mandating the HFP sodium targets was also estimated to be cost effective (100·0% probability), but with 29% of the health benefits compared with the WHO benchmarks. Our modelling study supports mandating sodium thresholds for packaged foods as a cost-effective strategy to prevent death and disease in Australia. Although making Australia's voluntary reformulation targets mandatory might save thousands of lives, mandating the WHO global benchmarks could yield substantially greater health gains. None.

Collaborative Forensic Autopsy Documentation and Supervised Report Generation Using a Hybrid Mixed-Reality Environment and Generative AI.

Forensic investigation is a complex procedure involving experts working together to establish cause of death and report findings to legal authorities. While new technologies are being developed to provide better post-mortem imaging capabilities-including mixed-reality (MR) tools to support 3D visualisation of such data-these tools do not integrate seamlessly into their existing collaborative workflow and report authoring process, requiring extra steps, e.g. to extract imagery from the MR tool and combine with physical autopsy findings for inclusion in the report. Therefore, in this work we design and evaluate a new forensic autopsy report generation workflow and present a novel documentation system using hybrid mixed-reality approaches to integrate visualisation, voice and hand interaction, as well as collaboration and procedure recording. Our preliminary findings indicate that this approach has the potential to improve data management, aid reviewability, and thus, achieve more robust standards. Further, it potentially streamlines report generation and minimise dependency on external tools and assistance, reducing autopsy time and related costs. This system also offers significant potential for education. A free copy of this paper and all supplemental materials are available at https://osf.io/ygfzx.

Ten-Year Outcome After Supracricoid Partial Laryngectomy in cT3M0 Laryngeal Squamous Cell Carcinoma-A STROBE Analysis.

The aim of this study was to document 10-year outcomes after supracricoid partial laryngectomy (SCPL) in selected cT3M0 laryngeal squamous cell carcinoma (SCC) patients. This real-life retrospective observational study analyzed an inception cohort of 168 patients with isolated, untreated, selected cT3M0 laryngeal SCC, that were consecutively managed by SCPL during the period 1973-2013, and followed up until death or for a minimum of 10 years in 92% of cases at a single French academic and tertiary referral care center. Prior induction chemotherapy, arytenoid cartilage removal, level II-IV neck dissection, and postoperative radiation therapy were performed on 148, 77, 136, and 27 patients, respectively. The main objective was to determine 10-year actuarial local control and laryngeal preservation estimates. Secondary objectives included 10-year actuarial survival and cause-of-death analysis, and assessment of correlations between endpoints and clinical variables. The significance threshold was set at p < 0.005. Ten-year actuarial local control, laryngeal preservation, and survival estimates were 90%, 85%, and 52%, respectively. Salvage treatment resulted in an overall 99% local control rate. Metachronous second primary cancer, intercurrent disease without evidence of SCC, SCPL-related death, and uncontrolled local recurrence accounted for 31%, 26%, 7%, and 2% of causes of death. On univariate analysis, overall local recurrence and laryngeal preservation rates varied significantly, from 5% to 54% and 90% to 46% when resection margins were R0 and R1, respectively. The present study highlighted successful 10-year outcomes after SCPL, providing further evidence in favor of its integration into the conservative armamentarium for endolaryngeal cT3 SCC. 4 Laryngoscope, 134:4557-4563, 2024.

Alcohol and mortality in Mexico: prospective study of 150 000 adults.

Alcohol consumption is a leading cause of premature death globally, but there is no large-scale prospective evidence from Mexico. The Mexico City Prospective Study recruited 150 000 adults aged 35 years or older between 1998 and 2004. Participants were followed up until Oct 1, 2022 for cause-specific mortality. Cox regression in those with no self-reported chronic disease at entry (adjusted for age, sex, district, education, physical activity, smoking, and diabetes) was used to relate baseline-reported alcohol consumption (never, former, occasional [less than monthly], and regular [at least monthly, split into <70, ≥70 to <140, ≥140 to <210, and ≥210 g/week]) to mortality at ages 35-74 from all causes, and from a pre-specified alcohol-related set of underlying causes. Heavy episodic drinking (normally consuming >5 [men] or >4 [women] drinks on a single occasion) and type of preferred drink were also examined. Among 138 413 participants aged 35-74 years at recruitment, 21 136 (15%) were regular alcohol drinkers (14 863 [33%] men, 6273 [7%] women), of whom 13 383 (63%) favoured spirits and 6580 (31%) favoured beer. During follow-up, there were 13 889 deaths at ages 35-74 years, including 3067 deaths from the pre-specified alcohol-related causes. Overall, J-shaped associations with mortality were observed. Compared with occasional drinkers, those with baseline-reported consumption ≥210 g/week had 43% higher all-cause mortality (rate ratio [RR] 1·43 [95% CI 1·30-1·56]) and nearly three times the mortality from the pre-specified alcohol-related causes (2·77 [2·39-3·20]). Death from liver disease was strongly related to alcohol consumption; the RR comparing regular drinkers of ≥140 g/week with occasional drinkers was 4·03 (3·36-4·83). Compared with occasional light drinking, occasional heavy episodic drinking was associated with 20% higher alcohol-related mortality (1·20 [1·06-1·35]), and regular heavy episodic drinking was associated with 89% higher alcohol-related mortality (1·89 [1·67-2·15]). Drinks with alcohol percentages higher than spirits were associated with the greatest increased mortality risk, even after accounting for the total alcohol consumed. In this Mexican population, higher alcohol consumption, episodic drinking, and very high percentage alcoholic products were all associated with increased mortality. Wellcome Trust, the Mexican Health Ministry, the National Council of Science and Technology for Mexico, Cancer Research UK, British Heart Foundation, and the UK Medical Research Council. For the Spanish translation of the abstract see Supplementary Materials section.

Pediatric Trauma - A Silent Epidemic.

Trauma is the leading cause of preventable deaths in children all over the world. In the majority of cases, children are innocent victims of road traffic accidents. They suffer from both short-term and long-term impacts of trauma. Deaths from road traffic accidents can be prevented by adopting simple road safety measures and the use of protective equipment. Worldwide programs have been initiated to curb this ever-rising menace; however, the success of these programs depends on their outreach and acceptance among the population in general. Golden hours in trauma management is the initial hour post-trauma, the success of resuscitation depends on the appropriate management of pediatric trauma victims in hospitals dedicated to the management of pediatric trauma victims. The current review highlights the epidemiology, pattern of injury, road safety measures, and global health initiatives for the prevention of accident-related injury in children. The shortcomings of this review are as follows- Firstly pediatric trauma is an exhaustive topic, it is impossible to cover all aspects of pediatric trauma. Thus, the review might have missed some important aspects of pediatric trauma. Secondly, the concept of a pediatric trauma registry is nonexistent in almost all developing countries; hence a true picture of pediatric trauma epidemiology and injury patterns is missing. Thirdly not much work has been done on pediatric trauma in developing countries leading to insufficient data from these countries.

The heterogeneity of breast cancer metastasis: a bioinformatics analysis utilizing single-cell RNA sequencing data.

Breast cancer is a common malignancy in women, and its metastasis is a leading cause of cancer-related deaths. Single-cell RNA sequencing (scRNA-seq) can distinguish the molecular characteristics of metastasis and identify predictor genes for patient prognosis. This article explores gene expression in primary breast cancer tumor tissue against metastatic cells in the lymph node and liver using scRNA-seq. Breast cancer scRNA-seq data from the Gene Expression Omnibus were used. The data were processed using R and the Seurat package. The cells were clustered and identified using Metascape. InferCNV is used to analyze the variation in copy number. Differential expression analysis was conducted for the cancer cells using Seurat and was enriched using Metascape. We identified 18 distinct cell clusters, 6 of which were epithelial. CNV analysis identified significant alterations with duplication of chromosomes 1, 8, and 19. Differential gene analysis resulted in 17 upregulated and 171 downregulated genes for the primary tumor in the primary tumor vs. liver metastasis comparison and 43 upregulated and 4 downregulated genes in the primary tumor in the primary tumor vs lymph node metastasis comparison. Several enriched terms include Ribosome biogenesis, NTP synthesis, Epithelial dedifferentiation, Autophagy, and genes associated with epithelial-to-mesenchymal transitions. No single gene or pathway can clearly explain the mechanisms behind tumor metastasis. Several mechanisms contribute to lymph node and liver metastasis, such as the loss of differentiation, epithelial-to-mesenchymal transition, and autophagy. These findings necessitate further study of metastatic tissue for effective drug development.

Combined treatment with Aronia berry extract and oligomeric proanthocyanidins exhibit a synergistic anticancer efficacy through LMNB1-AKT signaling pathways in colorectal cancer.

Colorectal cancer (CRC) is one of the most prevalent and highly recurrent malignancies worldwide and currently ranks as the second leading cause of cancer-related deaths. The high degree of morbidity and mortality associated with CRC is primarily attributed to the limited effectiveness of current therapeutic approaches and the emergence of chemoresistance to standard treatment modalities. Recent research indicates that several natural products, including Aronia berry extracts (ABE) and oligomeric proanthocyanidins (OPCs), might offer a safe, cost-effective, and multitargeted adjunctive role to cancer treatment. Herein, we hypothesized a combined treatment with ABE and OPCs could synergistically modulate multiple oncogenic pathways in CRC, thereby enhancing their anticancer activity. We initially conducted a series of in vitro experiments to assess the synergistic anticancer effects of ABE and OPCs on CRC cell lines. We demonstrate that these two compounds exhibited a superior synergistic anticancer potential versus individual treatments in enhancing the ability to inhibit cell viability, suppress colony formation, and induce apoptosis (p < 0.05). Consistent with our in vitro findings, we validated this combinatorial anticancer effect in tumor-derived 3D organoids (PDOs; p < 0.01). Using genome-wide transcriptomic profiling, we identified that a specific gene, LMNB1, associated with the cell apoptosis pathway, was found to play a crucial role in exhibiting anticancer effects with these two products. Furthermore, the combined treatment of ABE and OPCs significantly impacted the expression of key proteins involved in apoptosis, including suppressed expression levels of LMNB1 in CRC cell lines (p < 0.05), which resulted in inhibiting downstream AKT phosphorylation. In conclusion, our study provides novel evidence of the synergistic anticancer effects of ABE and OPCs in CRC cells, partially mediated through the regulation of apoptosis and the oncogene LMNB1 within the AKT signaling pathway. These findings have the potential to better appreciate the anticancer potential of natural products in CRC and help improve treatment outcomes in this malignancy.

Concealed cardiomyopathy as an emerging cause of sudden cardiac arrest and sudden cardiac death.

The inherited cardiomyopathies exhibit a broad spectrum of disease, with some patients remaining asymptomatic throughout life, while, for others, the first symptom of disease is sudden cardiac death at a young age. The risk of malignant ventricular arrhythmia in these conditions has traditionally been linked to the degree of structural myocardial abnormalities and functional impairment. However, recent advances in genetic testing and knowledge of the genetic basis of the diseases have led to the identification of concealed cardiomyopathy, in which sudden cardiac arrest or sudden cardiac death occurs in the absence of observable clinical features of cardiomyopathy, with a diagnosis being made only after the identification of a causative genetic variant. Increased awareness of concealed cardiomyopathy, a better understanding of mechanisms of arrhythmia and identification of risk modulators will be vital to improve care for families with concealed cardiomyopathy.

Liposomes and Their Therapeutic Applications in Enhancing Psoriasis and Breast Cancer Treatments

Psoriasis and breast cancer are two examples of diseases where associated inflammatory pathways within the body’s immune system are implicated. Psoriasis is a complex, chronic and incurable inflammatory skin disorder that is primarily recognized by thick, scaly plaques on the skin. The most noticeable pathophysiological effect of psoriasis is the abnormal proliferation of keratinocytes. Breast cancer is currently the most diagnosed cancer and the leading cause of cancer-related death among women globally. While treatments targeting the primary tumor have significantly improved, preventing metastasis with systemic treatments is less effective. Nanocarriers such as liposomes and lipid nanoparticles have emerged as promising drug delivery systems for drug targeting and specificity. Advances in technologies and drug combinations have emerged to develop more efficient lipid nanocarriers to include more than one drug in combinational therapy to enhance treatment outcomes and/or relief symptoms for better patients’ quality of life. Although there are FDA-approved liposomes with anti-cancer drugs for breast cancer, there are still unmet clinical needs to reduce the side effects associated with those nanomedicines. Hence, combinational nano-therapy may eliminate some of the issues and challenges. Furthermore, there are no nanomedicines yet clinically available for psoriasis. Hence, this review will focus on liposomes encapsulated single and/or combinational therapy to augment treatment outcomes with an emphasis on the effectiveness of combinational therapy within liposomal-based nanoparticulate drug delivery systems to tackle psoriasis and breast cancer. This review will also include an overview of both diseases, challenges in delivering drug therapy and the roles of nanomedicines as well as psoriasis and breast cancer models used for testing therapeutic interventions to pave the way for effective in vivo testing prior to the clinical trials.

The effect of the keto diet on lipid profile with type two diabetic patients

Introduction. In the developed world, among the main causes of disease and death is type 2 diabetes. It is a significant public health issue with rising prevalence, with more than 380 million patients estimated to be affected by 2025.Aim. To evaluate the effect of ketogenic diets on glycemic control in patients with type II DM in Kirkuk and Mosul provinces.Materials and methods. Patients with T2DM in both Mosul and Kirkuk cities were enrolled in this study to evaluate the effect of keto diet on HbA1c level and Lipid profile variations between 1/9/2022 to 1/4/2023.Results and discussion. This study shows that the distributions of patients according to age and gender there was about 43.3 % female and 56.7 % male and the age variations, female with age above 56 years old was 30 % while male 60.7 %. A significant p value was shown in HbA1C variations before and after keto diet (0.0001), also in lipid profile of a significant p value before and after keto diet (0.001) regarding total Glyceride a significant p value highly was (0.002). Due to the large particle size of LDL-C, it has been hypothesized that this elevation in LDL-C would not likely cause cardiovascular problems. For individuals with type 2 diabetes, the low-calorie-ketogenic VLCK diet (&lt;50 g of carbohydrates per day) is a safe, well-tolerated, and recognized medical nutritional therapy option when used in conjunction with an interventional weight loss program that offers support for lifestyle and behavioral modification over a 4-month period.Conclusion. Diabetic and ketogenic diet there is a good clear relationship regarding the HbA1c and lipid profile. Further studies are required for larger numbers of patients and longer duration follow up.

Trauma Program Value Assessment at an Academic Health Network System Over 12 Years.

Trauma is a leading cause of global death, with 200000 deaths and over 3 million non-fatal injuries/year in the United States. We aim to assess trauma care value for patients who underwent urgent laparotomies (LAP) and thoracotomies (THO) in our Health Network System. Clinical variables (v = 84) from trauma patients (>18 yo) were retrieved retrospectively (Jan-2010 to July-2016) and prospectively (Aug-2016 to Sept-2021) from a Health System warehouse under IRB-approved protocols. Patients were divided according to their Injury Severity Score (ISS) into mild/moderate cases (ISS <15) and severe cases (ISS >15). Value was assessed using quality and cost domains. Quality surrogates included graded postoperative complications (PCs), length of stay (LOS), 30-day readmission (RA), patient satisfaction (PS), and textbook (TB) cases. Total charges (TCs) and reimbursement index (RI) were included as surrogates for cost. Value domains were displayed in scorecards comparing Observed (O) with Expected (E) (using the ACS risk calculator) outcomes. Uni-/multivariate analyses were performed using SPSS. 41,927 trauma evaluations were performed, leading to 16044 admissions, with 528 (3.2%) patients requiring urgent surgical procedures (LAP = 413 and THO = 115). Although the M:F ratio (7:3) was similar in LAP vs THO groups, age and BMI were significantly different (41.8 ± 19.1 vs 51.8 ± 19.9 years, 28.6 ± 9.9 vs 27.4 ± 7Kg/m2, respectively, P < .05). Blunt trauma was involved in 68.8/77.3% of the LAP/THO procedures, respectively (P < .05). Multivariate analyses showed ISS, age, ASA class, and medical center as factors significantly predicting PC (P < .05). Postoperative complication grades from the LAP/THO groups showed above-average outcomes; nonetheless, LOS was higher than the national averages. The Trauma Program holds high value in our Health Network System. Protocols for decreasing LOS are being implemented.

Investigation of the Efficacy of Nowarta110 in the Treatment of HPV-16 and HPV-18 Oncogenically-transformed Human Cells and Cancer-implanted Animal Models.

Cervical cancer is the third leading cause of cancer-related death in women worldwide. Nearly all cases of cervical cancer are due to infection with human papillomavirus (HPV). Nowata110 has shown breakthrough therapeutic efficacy in phase II clinical study against plantar warts, with no reported side effects. This study evaluated the effectiveness of Nowarta110 in killing cultured HPV-transformed cancer cells and its anti-cancer effects in mice, using both vaginally engrafted and subcutaneously implanted animal cancer models. Nowata110 is a novel compound composed of colloidal silver and fig extract. The cytotoxic properties of Nowarta110 were evaluated on HPV-16 and HPV-18-transformed human cancer cells (ARPE-19/HPV-16 and HeLa cells, respectively). The therapeutic potential of Nowarta110 in vivo was evaluated following the engraftment of ME-180 epidermoid carcinoma cells in the mouse vagina or their subcutaneous implantation. Nowarta110 treatment was initiated when the tumor reached an approximate volume of 65 mm3 Results: Our data showed that HPV16-expressing human retinal pigmented epithelial cells are susceptible to Nowarta110-induced cell death, with a reduction in cell viability observed at 1% Nowarta110 and a complete absence of viable cells at 5% Nowarta110. In HPV18-expressing HeLa cells, Nowarta110 caused significant and rapid cell death at a dose of 5%, whereas lower doses of 1% did not produce the same effects. The results from animal studies indicated that Nowarta110 effectively induced tumor regression in both the intravaginal and subcutaneous tumor models. Nowarta110 effectively induced cell death in HPV-16 and HPV-18-transformed human cancer cells. It also effectively induced tumor regression in mouse models with intravaginally engrafted or subcutaneously implanted cancer cells. Considering the high prevalence of HPV-induced cervical dysplasia and cancer and the lack of treatment, clinical studies to promote the implementation of Nowarta110 are warranted.

Review on Alzheimers Disease

Abstract: Loss of Abstract Thinking Someone with Alzheimer’s disease may lose the ability to draw conclusions and solve problems. It may become difficult to balance a checkbook, for example, because the patient has forgotten what to do with the numbers. About 29.8 million people worldwide had been diagnosed with Alzheimer’s disease (AD) in 2015, And the number is projected to triple by 2050. In 2018, AD was the fifth leading cause of death in Americans with 65 years of age or older, but the progress of AD drug research is very limited. It is Helpful to identify the key factors and research trends of AD for guiding further more effective Studies. Alzheimer’s disease is a degenerative disease of the brain, the most common cause of dementia in the geriatric population, and a major cause of death. Alzheimer’s disease is one of the fastest growing risk factors in middle age, which Increases the risk of Alzheimer’s disease in coronary weddings and higher levels of Homocysteine, which can lead to withdrawal due to lifestyle changes. Cigarettes prevent Alzheimer’s disease by recalling memories. Also, despite the fact that there is no Definitive cure for Alzheimer’s, the ability to increase acetylcholine levels and reduce Ameloid beta deposition and your medications such as Donepezil has proven to be very Effective when treating Alzheimer’s disease (AD) is a progressive neurodegenerative disease. It Is characterized by progressive cognitive deterioration together with Declining activities of daily living and behavioral changes. It is the Most common type of pre-senile and senile dementia. Alzheimer disease (AD) is a heterogeneous disease with a complex pathobiology. The presence Extracellular b-amyloid deposition as neuritic plaques and intracellular accumulation of hyperphos . Phorylated tau as neurofibrillary tangles remains the primary neuropathologic criteria for AD diagnosis. However, a number of recent fundamental discoveries highlight important pathological roles For other critical cellular and molecular processes. Despite this, no disease-modifying treatment Currently exists, and numerous phase 3 clinical trials have failed to demonstrate benefits. Here ,We review recent advances in our understanding of AD pathobiology and discuss current treatment Strategies, highlighting recent clinical trials and opportunities for developing future disease modifying therapies.

Cardiovascular Disease and Diabetes Are Among the Main Underlying Causes of Death in Twenty Healthcare Facilities Across Two Cities in the Democratic Republic of Congo

Introduction: The mortality rates associated with cardiovascular disease (CVD) and diabetes exhibit disparities by region, with Central Africa ranking fourth globally in terms of mortality rate. The Democratic Republic of Congo (DRC) does not possess mortality data pertaining to these specific underlying causes of death. This study aimed to determine the death rate attributable to CVD and diabetes in two cities in the DRC. Methodology: The data on CVD and diabetes utilized in this study were obtained from a pilot project and were registered in the National Health Information System (NHIS). Data quality was initially evaluated using an automated Digital Open Rule Integrated Selection (DORIS), followed by an assessment conducted manually by three assessors. Descriptive and comparative analyses were carried out to determine the proportion of mortality related to CVD and diabetes. Results: CVD accounted for 20.4% (95%CI: 17.7–23.4%) of deaths in the two cities (Kinshasa and Matadi), whereas diabetes accounted for 5.4% (95%CI: 3.9–7.2%). After adjusting for age and city, the proportional mortality from CVD and diabetes was higher for women than men and increased with age. This study recorded 4.4% of deaths among men and 7.0% among women as the proportional mortality from diabetes. Conclusions: Non-communicable diseases (NCDs) continue to be a major cause of death, and CVD and diabetes are among the leading causes of early mortality in adults in urban areas. The proportional mortality related to CVD and diabetes appears to be higher in women than in men. Special emphasis should be placed on women, particularly during adulthood, to ensure the prompt detection of diabetes and cardiovascular conditions.

Congenital Epidermolysis Bullosa Epidemiology among Children of Russian Federation

Background. The prevalence of all types of congenital epidermolysis bullosa (СEB) worldwide is approximately 11 cases per 1 million according to the latest data from the American Epidermolysis Bullosa Registry. Data on the prevalence of СEB in Russian Federation is scattered, while data on life expectancy and mortality for this this disease is absent. This article presents medical and epidemiological data on children with СEB in Russian Federation. Objective. The aim of the study is to analyze clinical and epidemiological features of children with СEB in Russian Federation. Methods. We have performed analysis of the clinical and epidemiological features among pediatric population of Russian Federation with СEB using the “Registers of Genetic and Other Rare Diseases” of the “Butterfly Children” charitable foundation. Results. There are 491 children with СEB in Russian Federation as of 2024 according to the national registry data from “Registers of Genetic and Other Rare Diseases” of the “Butterfly Children” charitable foundation. The ratio of boys and girls was 1.08:1, that is relevant to the global data. The prevalence of CEB in children aged from 0 to 17 years in Russian Federation is 15.48 cases per 1,000,000 children as of January 1, 2024. The highest number of children with CEB were revealed in the Republic of Dagestan — 54 (11%) children, which is apparently due to the high rate of consanguineous marriages (50%). Other regions with high prevalence are Moscow Region (n = 28, 5.7%), Moscow (n = 25, 5.1%), Saint Petersburg (n = 26, 5.2%) and Krasnodar Territory (n = 23, 4.6%). Largest age group of children (from 12 to 18 years) includes 146 patients with mean age of 14.32 ± 1.72 years. The most common form of CEB is dystrophic one — 261 patients, the next one is simplex — 191 patients, then junctional form — 31 patient, and Kindler syndrome — 8 patients. The birth rate of children with CEB by year during the period from 2019 to 2023 (per 100,000 children born): 2019 — 1.42, 2020 — 2.09, 2021 — 2.65, 2022 — 2.76 and 2023 — 1.74. The arithmetic mean birth rate of children with CEB over a five-year period was 2.13 cases per 100,000 children born. The registry contains information on 22 deceased patients, average age was 3.06 ± 4.66 (from 0 to 15 years, median 0.54 years). The highest number of fatal outcomes was observed in the Republic of Dagestan (n = 3). Junctional CBE dominates in fatal outcomes among all the CEB types — 59.1% (n = 13 cases, 0.40 ± 0.22 years). The highest mortality was observed in I age group (from 0 to 1 year), which is 65.2% (15 fatal outcomes). Multisystem organ failure resulting from sepsis was the most common cause of death in both types of CEB (junctional and dystrophic). The mortality trend in the junctional form of CEB shows a decline in mortality, while the dystrophic type shows a stable situation during 2021–2023 years — 2 fatal outcomes per year. Junctional CEB has higher mortality rate at early age: survival curve shows sharp decline in the first months of life indicating high mortality in early life. The probability of survival drops to almost 0% in the first 100 days. Higher survival rate is more specific for the dystrophic type of CEB. Conclusion. This study demonstrates the significance and necessity to create and maintain registers for rare (orphan) diseases. Registry maintenance is an effective model for real understanding of the number of patients and value of needed assistance from the government to this category of patients.

ADVANCES IN CARE FOR PATIENTS WITH STROKE

Stroke is a medical emergency characterized by the sudden onset of neurological deficits, classified as either ischemic, caused by obstruction of blood flow, or hemorrhagic, due to the rupture of a cerebral vessel. It remains one of the leading causes of death and disability worldwide, with early diagnosis being crucial for improving patient outcomes. This study presents an integrative review of advancements in stroke care, emphasizing the importance of prompt treatment to reduce complications and enhance functional independence. The review analyzed 14 relevant studies from the last five years, sourced from databases like PubMed and Google Scholar. Key findings highlight the significance of rapid hospital arrival, early use of MRI to predict cognitive impairments, and clear communication regarding prognosis. The study also identified barriers in patient care flow, indicating a need for Continuing Education and improved coordination within the Emergency Care Network. Effective integration among healthcare professionals is essential to optimize care quality and rehabilitation outcomes for stroke patients.

First records of Procellaria cinerea Gmelin, 1789 and Pachyptila vittata (Forster, 1977) from the state of S&amp;atilde;o Paulo, southeastern Brazil (Aves, Procellariiformes)

Procellaria cinerea Gmelin, 1789 and Pachyptila vittata (Forster, 1977) are considered vagrants in Brazil, with very few documented records in the country. Here, we present the &amp;#64257;rst documented records of these species from the state of S&amp;atilde;o Paulo, southeastern Brazil. Morphometrics, post-mortem examinations, and a genetic analysis allowed us to identify the species, reproductive status, cause of death, and sex of the specimens.

Hemangiossarcoma hepático em cadela da raça Dobermann

In this work, a case is reported of a young Doberman dog, with a history of ingesting cica palm (Cycas revoluta), in the first months of life, she presented changes in liver enzymes. The patient was diagnosed with primary hepatic hemangiosarcoma, which is a malignant neoplasm of epithelial cells, and is highly metastatic in its visceral form. The diagnosis was made through exploratory laparotomy and histopathological results. In addition, complementary hematological and imaging tests were performed for follow-up. Eight chemotherapy sessions with doxorubicin were performed. Due to the aggressiveness of this neoplasm, the prognosis is reserved to unfavorable. During treatment, the patient developed dilated cardiomyopathy, progressing to heart failure, which was the cause of death. The objective of this report is to present a case of primary hepatic hemangiosarcoma, raising the possible cause related to the carcinogenic agent responsible for its development.

Correlation between lithium concentrations in drinking water and suicide attempt in the southeast of Iran.

Suicide, as an avoidable cause of death in public health systems, currently lacks effective global strategies to prevent it. However, several epidemiological studies found a correlation between the concentration of lithium (Li) in drinking water and lower suicide rates in the general population. Our ecologicalstudy investigated this hypothesis in the Rafsanjan districtof Iran. Samples from the public water supply in 16 areas in the district were analyzed using the graphite furnace atomic absorption. The resulting data were examined in relation to the suicide attempt from March 2019 to March 2020 obtained from Iran's Ministry of Health's registration system. During that period, 239 suicide attempts were recorded, resulting in an average of 69 individuals (85 women and 54 men) per 100,000 residents of the area. The average Li concentration in the drinking water was 47.30 µg/L (ranging from 9.4 to 141 µg/L). A negative significantcorrelation (r = -0.551, p = 0.027) between Li concentration in water and the rate of suicide attempt were observed in the studied population. Notably, these findings indicate an inverse significantrelationship between Li levels and suicide attempt rate in women (r = -0.725, p = 0.001). This is the first study in Iran that examines the relationship between Li levels in drinking water and suicide attempt rate. The findings of this study support an inverse relationship between the level of Li in public drinking water and the rate of womensuicide attempt.

End-of-life management of multiple myeloma patients in the era of CD38 and immunotherapy

BackgroundIn spite of spectacular advances in the treatment of multiple myeloma, a majority of patients will die from this disease or related complications. While a great amount of focus has been dedicated to the development of novel therapies, little attention has been paid to latter stages of patient follow-up.Patients and methodsIn order to describe patient management during this critical period as well as the immediate causes and circumstances of death, we have analyzed a single center series of 100 patients diagnosed with myeloma who died between 2016 and 2021.ResultsPatients received a median of 3 lines of treatment, including 2 during their last year of life. Sixty per cent of patients had received daratumumab. Fifty patients had obtained complete remission or very good partial response at some time during the course of disease but 75 were refractory to the last treatment line. Eighteen patients died while their disease was stable or in remission while 77 had confirmed progressive disease at time of death. Thirty six patients had uncontrolled sepsis, 49 were in renal failure and 24 had hypercalcemia at the time of death. Seventy three patients presented with lymphopenia. Disease progression was documented in a majority of MM patients at the time of death and was associated with disease-related complications in a significant number of patients.ConclusionDisease progression remains the main cause of death in patients with multiple myeloma.