Comparison Of Mortality Research Articles

Mortality in a cohort of WTC-exposed law-enforcement officers compared to non-WTC law-enforcement officers.

World Trade Center (WTC) rescue/recovery workers were exposed to materials hazardous to health. Previous studies found lower than expected mortality among WTC rescue/recovery workers when compared to general populations, possibly due to healthy worker effects, better healthcare access and/or incomparability of the groups. We compared mortality rates in WTC-exposed law enforcement officers (LEOs) with rates in LEOs employed by the Buffalo, NY, Police Department. We also compared both cohorts to the general population. Follow-up began at the later of one year after enrollment date or 1/1/2005 and ended at the earlier of death date or 12/31/2018. Analyses were restricted to ages 40-79 years (N = 11,476 WTC LEOs, N = 1668 non-WTC LEOs). We estimated standardized mortality ratios (SMRs) in each cohort using stratum-specific US mortality rates. Relative rates (RRs) and 95% CIs were estimated for the WTC vs. the Buffalo cohort using Poisson regression models adjusted for sex, race, age-group, and calendar-period. 185 deaths were observed in the WTC cohort and 186 in the Buffalo cohort. All-cause and cause-specific SMRs were significantly lower in the WTC cohort. Similarly, the adjusted all-cause mortality RR for the WTC vs. Buffalo cohorts was 0.30 (95% CI = 0.23-0.40). The cause-specific mortality RRs were all significantly < 1. We found lower overall and cause-specific mortality rates in WTC LEOs compared with both the general population and Buffalo LEOs. These results suggest that factors other than healthy worker effects, such as access to healthcare via the WTC Health Program, contribute to lower mortality rates in WTC rescue/recovery workers.

Abstract TMP99: Characterization of Large Vessel Occlusion Stroke in Head and Neck Cancer Survivors treated with Endovascular Therapy

Background: Head and neck cancer (HNC) survivors have more than double the risk of ischemic stroke relative to the general population, attributed to radiation-induced carotid vasculopathy. Yet the characteristics of large vessel occlusion (LVO) stroke in HNC survivors is undefined. This study aimed to characterize LVO strokes among HNC survivors who received endovascular therapy (EVT). Methods: Retrospective analysis of a single-center prospective stroke registry of EVT patients from January 2021 to January 2024. Patients were divided into three groups: HNC, other cancer (other-CA) and no cancer (non-CA). Demographic data, clinical characteristics, and procedural variables were compared between groups. Primary outcomes were functional independence (modified Rankin Scale [mRS] 0-2) and mortality at 90 days. Multivariable binary and multinominal logistic analyses were performed to adjust for baseline imbalances. Results: Among 1004 patients undergoing EVT in this cohort, 884 (88.0%) were non-CA, 110 (11.0%) had other-CA, and 10 (1.0%) had HNC status post neck radiation therapy. The median [IQR] age of HNC patients were significantly younger (63.5 years [IQR: 61.3–69]), compared to both non-CA and other-CA groups (72 years [IQR: 61–80] and 73.5 years [IQR: 65–82], respectively), p = 0.02. The prevalence of tandem carotid occlusion requiring angioplasty or stenting was 90% in the HNC group, whereas it was 15.3% in non-CA and 10.8% in other-CA groups (adjusted odd ratio (aOR) 48.7, 95% CI [8.1 – 830], p=&lt;0.001). HNC patients were less likely to achieve complete reperfusion compared to the other 2 groups (40.0 % vs 48.5 % vs 61.8 %; aOR 1.6, 95% CI [1.09 – 2.4], p=0.01). The rate of mRS 0-2 at 90 days was 55.5% in the HNC group, compared to the 33.4% in non-CA or 32.2% in other-CA, which did not reach statistical significance (p = 0.4). There was no statistically significant difference in the age-adjusted mortality rate at 90 days among the 3 groups. Conclusion: HNC survivors with LVO stroke referred for EVT were younger but had extremely high prevalence of tandem carotid occlusion requiring angioplasty and stenting. They experienced comparable rates of functional outcomes and mortality, despite lower rates of complete reperfusion relative to non-HNC groups. The findings support the need for early monitoring and prevention for accelerated carotid vasculopathy in this population.

Survival of Patients at a Neurology Clinic: No Improvement Over 12 Years.

We previously followed Emory patients with neurodegenerative disease from 1993 to 2006. Here, we follow survivor and new patients for 2007 to 2018. We studied mortality from 10 different diagnostic groups among 4322 research volunteers, and compared mortality rates to controls with normal cognition, using Cox regression. We assessed mortality through the National Death Index, controlling for sex, education, race, comorbidities, and age. Supplemental analyses considered APOE and cognitive test scores. Fifty-nine percent of patients died during follow-up. Mortality rate ratios, compared with controls (n=641) in descending order were 12.54, 6.61, 4.77, 4.92, 3.36, 2.25, 2.21 1.71, 1.39, and 1.17 for diagnostic groups ALS, (n=571), FTD (n=197), LBD (n=134), PD (n=584), AD (n=1118), MCI/dementia (n=82), dementia not specified (n=165), PD symptoms (n=256), vascular dementia (n=234), and MCI (n=340), respectively. Women, non-whites, those with higher education, with no comorbidities, and lower ages had lower mortality rates for most diagnostic groups. Mortality rates were higher in the presence of APOE4 variants for several diagnostic groups. Lower MMSEs predicted worse survival for most diseases. Overall, 41% of patients survived during 12 years of follow-up, compared with an expected 75% in the US population. Survival times for different diagnostic groups have changed little over several decades.

312. Impact of Patient Subgroups on the Efficacy of Ceftazidime-Avibactam (CZA) versus Ceftolozane-Tazobactam (C/T) for Multidrug-resistant (MDR) Pseudomonas aeruginosa infections in the United States (CACTUS)

Abstract Background CACTUS is a retrospective, matched, multicenter study comparing the efficacy of C/T and CZA for treatment of bacteremia or pneumonia due to MDR P. aeruginosa. We found that treatment with C/T resulted in higher rates of clinical success compared to CZA after controlling for baseline differences between cohorts. The objective of this study is to determine the impact of patient subgroups on the overall findings. Methods C/T and CZA patients were matched 1:1 within each study site based on severity of illness, infection type, and time to treatment initiation. The primary outcome was clinical success at day 30, defined as survival, resolution of signs/symptoms of infection with the intended treatment course, and absence of recurrent infection. For subgroups of interest, the proportion with clinical success in each group was compared using an unadjusted odds ratio (OR) and 95% confidence interval. Results Among 420 cases from 28 sites, 60.95% (128/210) of C/T- and 51.9% (109/210) of CZA-treated patients experienced clinical success. Groups were overall well-balanced by matching; however, CT-treated patients were older, more likely to have immunocompromising conditions, and to receive suboptimal dosing (Table 1). After conditional logistic regression, the adjusted OR for clinical success with C/T treatment was 1.97 (95% CI: 1.11 – 3.49; P=0.02). Unadjusted OR for patient subgroups are listed in Table 2. Overall, the effect size was consistent across all subgroups. Key factors are highlighted in Figure 1. Significantly higher rates of clinical success were found for treatment with C/T compared to CZA for patients with pneumonia, SOFA ≤7, mechanical ventilation, and optimal dosing. Table 3 displays comparative 30-day mortality rates. Higher mortality rates were identified in both C/T- and CZA-treated patients who were critically-ill, received suboptimal dosing, and were treated within 72 hours of index culture (Table 3); rates did not vary by treatment. Conclusion The consistency of the results in this subgroup analysis of CACTUS reinforces the primary finding of higher rates of clinical success for patients with MDR P. aeruginosa pneumonia or bacteremia treated with C/T compared to CZA. Disclosures jason M. Pogue, PharmD, Entasis: Advisor/Consultant|GSK: Advisor/Consultant|Melinta: Advisor/Consultant|Melinta: Grant/Research Support|Merck: Advisor/Consultant|Merck: Grant/Research Support|Shionogi: Advisor/Consultant|Shionogi: Grant/Research Support|Venatorx: Advisor/Consultant Samuel L. Aitken, PharmD, MPH, Basilea: Advisor/Consultant|bioMerieux: Advisor/Consultant|Melinta: Advisor/Consultant|Shionogi: Advisor/Consultant Ahmed Babiker, MBBS, Beckman Coulter Inc.: Advisor/Consultant Kimberly C. Claeys, PharmD, PhD, bioMérieux: Advisor/Consultant|bioMérieux: Honoraria Kate DeSear, PharmD, BCIDP, AAHIVP, FIDSA, AbbVie Inc: Advisor/Consultant|Basilea Pharmaceutica: Advisor/Consultant|GSK: Advisor/Consultant|La Jolla (Entasis): Advisor/Consultant|Melinta Therapuetics: Advisor/Consultant Alan E. Gross, PharmD, Becton Dickinson Co: Advisor/Consultant Keith S. Kaye, MD, MPH, Allecra: Advisor/Consultant|CARB-X: Advisor/Consultant|GSK: Advisor/Consultant|Merck: Advisor/Consultant|Shionogi: Advisor/Consultant|Spero: Advisor/Consultant Wesley D. Kufel, Pharm.D., BCPS, BCIDP, Merck &amp; Co.: Grant/Research Support|Shionogi, Inc: Grant/Research Support Conan MacDougall, PharmD, MAS, Merck: Grant/Research Support Erin K. McCreary, PharmD, Abbvie: Advisor/Consultant|Basilea: Advisor/Consultant|Ciadara: Advisor/Consultant|Entasis: Advisor/Consultant|Ferring: Advisor/Consultant|GSK: Advisor/Consultant|GSK: Honoraria|Melinta: Advisor/Consultant|Merck: Advisor/Consultant|Pfizer: Honoraria|Shionogi: Advisor/Consultant|Shionogi: Honoraria William R. Miller, M.D., Merck: Grant/Research Support|UptoDate: Royalties Jeffrey C. Pearson, PharmD, inflarx: Advisor/Consultant Michael J. Satlin, MD, AbbVie: DSMB participant|bioMerieux: Grant/Research Support|Merck: Grant/Research Support|Selux Diagnostics: Grant/Research Support|SNIPRBiome: Grant/Research Support David van Duin, MD, PhD, Merck: Advisor/Consultant|Merck: Grant/Research Support|Pfizer: Advisor/Consultant|Qpex: Advisor/Consultant|Roche: Advisor/Consultant|Shionogi: Advisor/Consultant|Shionogi: Grant/Research Support Ryan K. Shields, PharmD, MS, Allergan: Advisor/Consultant|Cidara: Advisor/Consultant|Entasis: Advisor/Consultant|GSK: Advisor/Consultant|Melinta: Advisor/Consultant|Melinta: Grant/Research Support|Menarini: Advisor/Consultant|Merck: Advisor/Consultant|Merck: Grant/Research Support|Pfizer: Advisor/Consultant|Roche: Grant/Research Support|Shionogi: Advisor/Consultant|Shionogi: Grant/Research Support|Utility: Advisor/Consultant|Venatorx: Advisor/Consultant|Venatorx: Grant/Research Support

Effect of census-based correction of population figures on mortality rates in Germany

BackgroundThe population figures in Germany are obtained by updating the results of the latest census with information from the statistics on birth, deaths and migration statistics. The Census 2011 in Germany corrected population figures, which have only been updated over a long period of time. The aim of this work is to show the effect of the census-based correction of the population figures on the magnitude of mortality rates in Germany 2011–2013.MethodsWe compared mortality rates (total, cancer, and cardiovascular disease) for the period 2011–2013 based on the uncorrected and Census 2011 corrected population figures. We also compared the effect of the choice of different standard populations in the age standardization of rates on the difference in uncorrected and corrected mortality rates.ResultsThere is a clear decline in age-specific cancer mortality among men aged 90 and over when using the uncorrected population figures, which is reversed as soon as the corrected population figures are used. Among women, there is hardly any difference between the uncorrected and corrected mortality rates. The correction of the population figures does not lead to a qualitatively different pattern in the mortality rates for cardiovascular diseases and myocardial infarction, but it increases the magnitude of the rates, particularly for elderly men. Standard populations with higher weights at older ages produced larger corrections in mortality rates.ConclusionsEven though the Census 2011 corrected nationwide mortality rates without age stratification differed only slightly from the uncorrected rates, there were noticeable increases in mortality, particularly in the city states of Hamburg and Berlin and in old age. Due to the particularly large error in the population figures in the older age range, an age standard that assigns lower weights at older ages should be used for age standardization of rates wherever possible.

Propensity-score matched outcomes of minimally invasive and open pelvic exenteration in locally advanced rectal cancer.

Pelvic exenteration (PE) entails anen bloc resection of locally advanced primary or recurrent rectal cancer. This study aimed to assessthe short-term and survival outcomes of minimally invasive (MI)- and open PE. Aretrospective cohort analysis of patients with stage III rectal adenocarcinoma treated with PE from the National Cancer Database (2010-2019)was conducted. Open and MI-PE were matched for baseline and treatment characteristics using 2:1 propensity score matching. Primary outcomes were 30- and 90-day mortality; secondary outcomes included 30-day readmission, hospital stay, surgical margins, lymph node yield, and overall survival (OS). PE was performed in 1010 (1.9%) of 52,242 patients; 705 (69.8%) were open and 304 were (30.2%) MI procedures. After matching, 169 patients in the MI-PE group were matched to 338 patients in the open PE group. The matched cohort included 507 patients (54.2% female). Hospital stay was shorter after MI compared to open PE (median: 6 vs. 8 days, p < 0.001). MI and open PE had similar odds of 30- (OR: 0.33, p = 0.306) and 90-day mortality (OR: 0.29, p = 0.113), and comparable rates of positive surgical margins (12.7% vs. 15%, p = 0.586) and suboptimal lymph node yield (19% vs. 26%, p = 0.096). MI-PE had a similar OS to open surgery (82.5 vs. 77.5 months, p = 0.281). Robotic-assisted PE was associated with significantly lower odds of conversion to open surgery (OR: 0.15, p = 0.003) and shorter hospital stay (median: 5 vs. 7 days, p = 0.026) than laparoscopic PE. MI-PE provided similar pathologic and survival outcomes to open PE with comparable short-term mortality rates and significantly shorter hospital stays.

Impact of Sex-Related Differences in Infrarenal Aortic Neck Morphology on Outcomes of Endovascular Aneurysm Repair for Similar-Sized Aortic Aneurysm.

Objectives: This study aimed to evaluate whether gender-related anatomical differences in proximal aortic neck morphology affect the feasibility and outcomes of endovascular aortic aneurysm repair (EVAR) in women with abdominal aortic aneurysms (AAA). Methods: This study performed a retrospective analysis of patients electively treated by EVAR for infrarenal AAA between January 2019 and December 2023. Demographics, anatomical characteristics, and stent graft details were analyzed. The primary endpoint was technical success. Secondary endpoints included freedom from aortic and neck-related reinterventions, endoleak rate, and freedom from aneurysm-related mortality during follow-up. Technical aspects, including adherence to the instructions for use (IFUs), were retrospectively analyzed. Results: One-hundred-seventeen patients (fifty-six females; mean age 76.2 ± 5.3 years) underwent elective EVAR for AAA. Demographics and comorbidities were homogeneous across genders. Female patients (Group A) demonstrated a higher prevalence of hostile proximal aortic neck features, including neck length < 10 mm and angulation > 60° (p = 0.009, p = 0.029, respectively) and a higher frequency of off-label EVAR procedures (28.6% vs. 11.5%; p = 0.034). The overall technical success rate was 98.3%, with no significant differences between genders in terms of stent graft selection, use of suprarenal fixation, or incidence of type 1-3 endoleaks. The median follow-up period was 35.2 ± 12.7 months, showing comparable rates of neck-related reinterventions, open conversions, and aneurysm-related mortality between genders. Notably, off-label EVAR was identified as an independent risk factor for type 1A endoleaks, reinterventions, and aneurysm-related mortality (p < 0.00001, p < 0.0001, and p = 0.001, respectively). Conclusions: Female patients undergoing EVAR often present with hostile proximal aortic neck features and are treated at an older age than males. Despite these differences, technical success rates and mid- to long-term outcomes were comparable between genders, with no variation in stent graft selection or suprarenal fixation use. Effective procedural planning, device selection, and surgical expertise appear to mitigate historical gender-related anatomical challenges. Further large-scale studies are needed to confirm whether anatomical factors alone drive outcomes, irrespective of gender.

Effect of del Nido cardioplegia in patients with reduced left ventricular ejection fraction: A meta-analysis.

Research on the safety and efficacy of del Nido cardioplegia in adult patients with reduced left ventricular ejection fraction (LVEF) is limited. We evaluated the effect of del Nido cardioplegia on early outcomes of cardiac surgery in this cohort. PubMed, Scopus, and the Cochrane Central Register of Controlled Trials were searched through August 2024 to conduct a meta-analysis comparing del Nido to other cardioplegia in adult patients with reduced LVEF (≤50%). Primary endpoint was early mortality, and secondary endpoints included morbidities, aortic cross-clamp time and postoperative LVEF before discharge. A random-effect model was used to estimate the pooled effect size. Seven studies met our eligibility criteria, including three propensity score-matched studies with a total of 1160 patients. Conventional blood cardioplegia was used exclusively as a control solution in the included studies. The incidence of early mortality was similar between the del Nido and control groups, with a pooled odds ratio of 0.94 [95% confidence interval: 0.52; 1.71] (p = .822). Postoperative stroke (p = .680), renal failure (p = .832), atrial fibrillation (p = .412), and aortic cross-clamp time (p = .153) were also comparable between the two groups. Postoperative LVEF was significantly higher in the del Nido group compared to the control group, with a standardized mean difference of 0.52 [95% confidence interval: 0.07; 0.96] (p = .034). In adult patients with reduced LVEF undergoing cardiac surgery, del Nido cardioplegia provides comparable mortality and morbidity rates compared to conventional blood cardioplegic solutions, with the potential to offer protective effects on myocardial function.

Causes of Death Following Coronary Revascularization in Patients with Diabetes.

In patients with diabetes and multivessel coronary artery disease, percutaneous coronary intervention (PCI) has been associated with higher long-term cardiovascular mortality compared to coronary artery bypass grafting (CABG), but the specific causes of death are not well known. We aimed to determine the causes of death among patients with diabetes and multivessel disease undergoing coronary revascularization with PCI versus CABG. We analyzed the centrally adjudicated causes of death of 1,900 participants in the FREEDOM trial. Cause-specific hazard ratios (csHR) were used to compare mortality rates. There were 197 deaths during the five years of follow-up, 63.5% were classified as cardiovascular deaths and the remaining (36.5%), non-cardiovascular deaths. Sudden cardiac death was the most common cause of cardiovascular mortality (40% of all cardiovascular deaths), followed by myocardial infarction deaths (16% of all cardiovascular deaths). Compared to CABG, PCI was associated with increased ischemic-related mortality, namely sudden cardiac death (csHR: 2.04;95%CI: 1.13 to 3.70; p=0.02) and the composite of sudden cardiac death and myocardial infarction death (csHR: 2.10, 95%CI: 1.27 to 3.48, p=0.004). PCI was associated with a non-significant increase in overall cardiovascular mortality compared to CABG (csHR: 1.35;95%CI: 0.95 to 1.93; p=0.09). Sudden cardiac death was the most common cause of long-term mortality among patients with diabetes and multivessel coronary artery disease undergoing a revascularization procedure. Compared to CABG, PCI was associated with increased long-term rates of ischemic-related mortality. Operative techniques and secondary prevention should target reducing post-revascularization spontaneous myocardial infarction in patients treated with PCI.

Mortality after high-risk myocardial infarction over the last 20 years: Insights from the VALIANT and PARADISE-MI trials.

The temporal changes in clinical profiles and outcomes of high-risk myocardial infarction survivors enrolled in clinical trials are poorly described. This study compares mortality rates, baseline characteristics, and the prognostic impact of therapies among participants of the VALIANT and PARADISE-MI trials. Exclusively VALIANT participants who matched the inclusion criteria of the PARADISE-MI trial were included in the analysis. Risk of death was compared between trials using Cox regression models. The impact of baseline characteristics and therapies on mortality was estimated by the magnitude reduction of β coefficients using Cox proportional hazards regression models. A total of 9617 VALIANT participants matched the inclusion criteria of the PARADISE-MI trial (n = 5661). All-cause mortality in PARADISE-MI was less than half that in VALIANT (4.2 vs 9.9 per 100 patient-years; hazard ratio [HR] 0.41, 95% confidence interval [CI] 0.37-0.46). This difference was reduced after adjustment for clinical variables but remained substantial (adjusted HR 0.68, 95% CI 0.58-0.80). The most important mediator of this reduction related to covariate adjustment was the use of percutaneous coronary intervention (PCI), accounting for almost half of the attenuation observed. Similar results were found for cardiovascular (CV) death, while no between-trial significant differences were found in the non-CV mortality risk. Cardiovascular mortality following high-risk myocardial infarction has significantly declined over time, while the risk for non-CV death has remained unchanged. This improvement is partially attributable to advancements in CV care, particularly the use of PCI. Continued efforts to implement guidelines and standardize the quality of care are needed to sustain this positive trend.

Trends in the growing impact of group A Streptococcus infection on public health after COVID-19 pandemic: a multicentral observational study in Okayama, Japan

PurposeFollowing the COVID-19 pandemic, group A Streptococcus (GAS) infection has been surging worldwide. We aimed to compare the disease burden between notified cases of streptococcal toxic shock syndrome (STSS) and unreported GAS infections.MethodsThis is a multicentral observational study, retrospectively performed at seven hospitals in Okayama prefecture in Japan from January 2022, to June 2024. Clinical and microbiological data of patients with positive cultures of GAS were collected from the medical records. Primary outcomes were defined as rates of surgical procedures, intensive care unit (ICU) admission, and in-hospital mortality, which were compared among patients with locally-defined STSS, invasive GAS (iGAS), and non-iGAS infection.ResultsGAS was detected in 181 patients, with 154 active cases of GAS infection. The number of patients with GAS infection surged in late 2023. The most common source of infection was skin and soft tissue infections, accounting for 83 cases, including 15 cases of necrotizing fasciitis, and 12 cases (7.8%) were notified to public health authorities as STSS. Among the 25 unreported iGAS cases, 9 (36.0%) underwent surgical intervention, and 4 patients (16.0%) required ICU admission. The mortality rates in the unreported iGAS cases were comparable to those observed in the notified STSS.ConclusionsWe highlighted that the number of iGAS infections was twofold higher than that of notified STSS, with comparable mortality rate between these groups, indicating substantial underestimation of the true burden of iGAS. This epidemiological investigation has significant implications for enhancing infectious disease surveillance frameworks and public health policy development.

Nationwide Cross-Sectional Analysis of Mortality Trends in Patients with Sarcoidosis and Non-Ischemic Cardiovascular Disease-The Impact of Gender, Ethnicity, Geographical Location, and COVID-19 Pandemic.

Background and Objectives: The epidemiological data regarding mortality rates of adults with sarcoidosis and non-ischemic cardiovascular disease (CVD) are limited. A retrospective observational analysis was conducted to identify trends and disparities related to sarcoidosis and non-ischemic cardiovascular disease mortality among the adult US population from 1999 to 2022. Methods: We used the Centers for Disease Control and Prevention (CDC) WONDER database to extract death certificate data for the adult US population (≥25 years). The age-adjusted mortality rates (AAMRs) per 100,000 persons were calculated, and annual percent changes (APCs) were determined using Joinpoint. Results: Between 1999 and 2022, 23,642 deaths were identified related to non-ischemic CVD + sarcoidosis. The overall AAMR increased from 0.2 (95% CI, 0.2 to 0.3) in 1999 to 0.5 (95% CI, 0.5 to 0.6) in 2022. Females had a higher AAMR than males (0.6 vs. 0.5). Non-Hispanic (NH) blacks had the highest AAMR, followed by NH whites and Hispanic or Latinos. The southern region had the highest AAMR (0.7: 95% CI, 0.6-0.7), followed by the Midwest (0.6, 95% CI, 0.54-0.669), the Northeast (0.5, 95% CI, 0.5 to 0.6), and the West (0.4; 95% CI, 0.3-0.4). Urban and rural areas had comparable mortality rates (0.5 vs. 0.6). People aged 65+ had the highest AAMRs. Conclusions: The overall mortality rates for non-ischemic CVD and sarcoidosis have increased in the US from 1999 to 2022. Females and NH blacks had higher AAMRs, while a minimal variation was observed based on geographical regions. Early diagnosis and prompt management are the keys to reducing the mortality burden of non-ischemic CVD plus sarcoidosis.

The victims of the last great Bubonic plague epidemic in Ottoman Anatolia: dynamics of mortality by age and gender during the plague epidemic of Kastamonu (1836–1839)

ABSTRACT This study examines the bubonic plague epidemic that struck Kastamonu, a province in Northern Anatolia, between 1836 and 1839, offering a distinctive and thorough contribution to historical research on the plague within the framework of Ottoman studies. By employing rare daily death records, known as jurnal defteri, this research undertakes a quantitative analysis of mortality patterns during the epidemic—an approach rarely applied in Ottoman historical studies. The study investigates demographic details, analyzing the victims’ age and gender to uncover significant patterns, such as the particularly severe impact on younger age groups. Additionally, it compares mortality rates during the epidemic to those from non-plague-related deaths, providing a broader perspective on mortality dynamics and the overall demographic toll. This research bridges a critical gap in Ottoman plague studies by integrating statistical methodologies with demographic analysis. This approach helps to understand how such epidemics affected populations at a granular level. By focusing on an understudied region and time period, this study contributes novel insights into the social and demographic results of the plague in the Ottoman Empire. The findings underscore the epidemic’s profound impact on local communities, contributing to broader discussions on public health and mortality in historical contexts of Ottoman Empire..

Comparing unilateral and bilateral cerebral perfusion during total arch replacement for acute type A aortic dissection.

To assess the effects of unilateral versus bilateral antegrade cerebral perfusion (u-ACP vs b-ACP) on postoperative complications and mid-term follow-up results in Asian patients with acute type A aortic dissection (ATAAD) undergoing total arch replacement (TAR) + the frozen elephant trunk (FET). Clinical baseline data and postoperative complications of 702 ATAAD patients undergoing TAR+ FET at China Cardiovascular Centre Fuwai Hospital between January 2019 and December 2022 were collected. Patients were categorized into two groups based on antegrade cerebral perfusion: unilateral (n = 402) and bilateral (n = 300). Propensity scores were matched for 217 pairs of patients. Mid-term and perioperative surgical complications were analyzed, and baseline characteristics between the two groups were assessed. The matched cohort revealed comparable 30-day mortality rates between u-ACP and b-ACP: 4.15% and 3.23%, respectively (p = 0.61). Rates of postoperative permanent neurologic dysfunction (PND) were similar across groups (2.76% for u-ACP and 3.23% for b-ACP, p = 0.76). However, u-ACP exhibited a higher incidence of postoperative transient neurologic deficit (TND) at 14.29% compared to 6.91% with b-ACP (p = 0.01). Logistic regression models identified u-ACP and cardiopulmonary bypass (CPB) time as independent risk factors for TND. Mid-term survival rates were comparable between the two groups (5-year survival: 90.29% vs 93.67%, p = 0.133). Both u-ACP and b-ACP are effective brain protection techniques for ATAAD patients undergoing total arch replacement. The use of b-ACP significantly reduces the incidence of TND.

Effect of empiric antibiotics against Pseudomonas aeruginosa on mortality in hospitalized patients: a systematic review and meta-analysis.

Empiric antibiotics active against Pseudomonas aeruginosa are recommended by professional societies for certain infections and are commonly prescribed for hospitalized patients. The effect of this practice on mortality is uncertain. A systematic literature search was conducted using Embase, Medline, PubMed, Web of Science, Cochrane, Scopus and Google Scholar from earliest entry through 9 October 2023. We included studies of patients hospitalized with P. aeruginosa infections that compared mortality rates depending on whether patients received active empiric antibiotics. We found 27 studies of 12 522 patients that reported adjusted OR of active empiric antibiotics on mortality. The pooled adjusted OR was 0.40 (95% CI, 0.32-0.50), favouring active empiric antibiotics. In practice, the mortality effect of empiric antibiotics against P. aeruginosa depends on the prevalence of P. aeruginosa and baseline mortality. The estimated absolute mortality benefit was 0.02% (95% CI, 0.02-0.02) for soft tissue infections, 0.12% (95% CI, 0.10-0.13) for urinary tract infections and community-acquired pneumonia, 0.3% (0.25-0.34) for sepsis without shock, 1.1% (95% CI, 0.9-1.4) for septic shock and 2.4% (95% CI, 1.9-2.8) for nosocomial pneumonia. The mortality effect for empiric antibiotics against P. aeruginosa depends crucially on the prevalence of P. aeruginosa and baseline mortality by type of infection. For soft tissue infections, urinary tract infections and community-acquired pneumonia, the mortality benefit is low. Meaningful benefit of empiric antibiotics against P. aeruginosa is limited to patients with approximately 30% mortality and 5% prevalence of P. aeruginosa, which is largely limited to patients in intensive care settings.

Timing dilemma: a systematic review and meta-analysis of short-term mortality in patients with COVID-19 undergoing tracheostomy with varied timing, including 7, 10 and 14 days

ObjectiveTo analyse the effects of tracheostomy timing on COVID-19 outcomes by comparing mortality rates at different time points (7, 10 and 14 days).DesignSystematic review and meta-analysis.Data sourcesPubMed, Embase, Cochrane Library,...

Meta-analysis of longitudinal comparison of transcatheter versus surgical aortic valve replacement in patients at low to intermediate surgical risk.

Surgical aortic valve replacement (SAVR) is the commonly used approach for aortic valve replacement (AVR) in patients with aortic stenosis at low or intermediate surgical risk. However, transcatheter aortic valve replacement (TAVR) has emerged as an alternative to SAVR for AVR. This meta-analysis aims to assess the comparative efficacy and safety of TAVR versus SAVR in low-to-intermediate surgical risk patients by analyzing temporal trends in the outcomes of TAVR and SAVR at various follow-up intervals, providing a more detailed understanding. A thorough literature search was performed across PubMed/MEDLINE, Embase, and the Cochrane Library from their inception up to May 2024 to identify eligible randomized controlled trials (RCTs). Clinical outcomes were evaluated using a random-effects model to pool risk ratios (RRs) with 95% CIs. A total of 17 studies reporting data at different follow-ups for nine trials were included (n=9092). No statistically significant difference was observed between TAVR and SAVR for reducing all-cause death at 30 days, 1 year, and 2 years but significantly increased risk with TAVR at 5 years or longer follow-up (RR=1.13, 95% CI: 1.03-1.23). However, TAVR was associated with a significantly decreased risk for cardiac death at 1-year follow-up (RR=0.79, 95% CI: 0.64-0.96) and comparable risk for cardiac death at 30 days, 2 years, and 5 years or longer follow-up when compared with SAVR. No statistically significant difference was observed between TAVR and SAVR for reducing the risk of myocardial infarction (MI) at 30 days, 1 year, 2 years, and 5 years or longer follow-up.TAVR was associated with a significantly lower risk of major bleeding events at 30 days (RR=0.38, 95% CI: 0.21-0.67); lower risk of acute kidney injury (AKI) at 30 days (RR=0.38, 95% CI: 0.26-0.54) and 1 year (RR=0.58, 95% CI: 0.41-0.82) and lower risk of new onset or worsening atrial fibrillation (AF) at 30 days (RR=0.25, 95% CI: 0.18-0.34), 1 year (RR=0.26, 95% CI: 0.16-0.41) and 2 years (RR=0.32, 95% CI: 0.20-0.49) when compared with SAVR. However, TAVR was associated with a significantly increased risk of permanent pacemaker implantation (PPI) at 30 days (RR: 2.62, 95% CI: 1.40-4.91), at 1 year (RR: 2.19, 95% CI: 1.24-3.87), at 2 years (RR: 2.74, 95% CI: 1.31-5.71), and beyond 5 years (RR: 1.95, 95% CI: 1.20-3.15). TAVR was also associated with a significantly increased risk of prosthetic valve thrombosis at 2 years (RR=2.70, 95% CI: 1.08-6.71), though no significant association was observed at 30 days, 1 year, or 5 years. Similarly, no significant differences were observed in aortic-valve reintervention rates at 30 days, 2 years, or 5 years, but TAVR showed a significantly increased risk at 1 year (RR=1.98, 95% CI: 1.21-3.24). TAVR was associated with a significantly increased risk of major vascular complications at 30 days (RR=2.37, 95% CI: 1.38-4.04) and a significantly increased risk of TIA at 2 years (RR: 1.43, 95% CI: 1.02-2.00, I2=0%). The risk of hospitalizations was comparable between the groups. TAVR and SAVR demonstrated comparable rates of all-cause death up to 2 years of follow-up. However, at 5 years or longer follow-up, TAVR was associated with a higher risk of all-cause death. While TAVR showed certain procedural advantages, such as a lower risk of major bleeding, AKI, and new-onset or worsening AF, the choice between TAVR and SAVR in patients with low or intermediate surgical risk should consider long-term outcomes, with SAVR potentially being more favorable due to better survival observed on longer follow-up durations.

A Retrospective Analysis of Mortality Due to Pneumonia and Renal Disease in a Midwestern Patient Population.

The impact of pneumonia (PNA) with concomitant renal disease (RD) has not been fully investigated in a United States Midwestern patient population, despite the morbidity and mortality associated with such diseases. A retrospective cohort study was performed on International Classification of Diseases, 10thRevision (ICD-10) data from a hospital system located in Southwest Missouri. Data was acquired from patients admitted between January 2019 and December 2021. Patients were separated into five groups (disease categories): acute kidney injury (AKI), chronic kidney disease (CKD), PNA, AKI with PNA, and CKD with PNA. The data were analyzed, and subset analysis was performed utilizing two-sample proportion tests (Wald test) to compare mortality rates. Informed consent was not needed due to the retrospective nature of the study. The mortality rate of patients with PNA with AKI and PNA with CKD was 36.08% (32.87% to 39.28%, 95% CI) and 24.97% (21.93% to 28.00%, 95% CI), respectively, revealing a significant increase in mortality for thosediagnosed with PNA and AKI-higher than any other disease category. For reference, PNA without (w/o) RD, CKD w/o PNA, and AKI w/o PNA had much lower mortality rates at 9.45%, 7.87% and 12.19%, respectively, with AKI w/o PNAhaving a 2.63% to 6.00% higher (p<0.0001) and 0.99% to 4.49% higher (p=0.0020), mortality alone than CKD w/o PNA or PNA w/o RD, respectively. Mortality associated with RD and PNA was examined in apredominantly rural, relatively poor, Midwestern patient population presenting to a tertiary center with the key finding that the presence of AKI correlates with a much greater mortality rate in both patients with and without PNA. Looking forward, future studies may include a broader population base(including urban, suburban, and rural areas), allowing not only for more statistical power but also a broader assessment of the population.Such knowledge is invaluable as we continue to prioritize healthcare resources for critically ill patients suffering from RD and PNA in different settings.

THE HEALTH STATUS OF THE POPULATION BEYOND WORKING AGE IN THE TRANSBAIKAL TERRITORY

The aim of the research. To analyze morbidity rates by turnover, mortality of the population over the working age in the Trans-Baikal Territory.Materials and methods. The work analyzed morbidity rates by turnover, mortality among the population older than working age. The sources of information were collections of the Ministry of Health of the region and the Russian Federation, as well as data from official sources of Rosstat. The work calculates the indicators of the dynamic range. Graphical forecasting was performed for the indicators in the Microsoft Excel program with the construction of a trend line.Results. In 2022, the share of the population over the working age in the region was 20%. Thus, over a 10year period, the number of people in this age group increased by 11,4%. The primary morbidity rate in 2022 amounted to more than 57 thousand cases per 100 thousand population. The primary morbidity rate of the population over the working age in the region remained lower than similar indicators for the Far Eastern Federal District and the Russian Federation. The total incidence of the older generation in the region in 2022 amounted to about 220 thousand cases per 100 thousand population. The level of general morbidity in the region is lower than the same indicator in the Russian Federation. The mortality rate of the population over the working age in 2022 amounted to 43,7 cases per 100 thousand population. When comparing mortality rates in the region and the Russian Federation, higher rates were observed in the region throughout the analyzed period, on average by 8%.Conclusions. Morbidity rates in terms of turnover among the older generation in the Trans-Baikal Territory tend to increase over the analyzed period. At the same time, these indicators remain lower than those in the Far Eastern Federal District and the Russian Federation. The mortality rate of the population of this age group remains higher than in the Russian Federation. The analysis of the health status of the older generation in the region indicates the need for managerial decisions in the regional health system.

Nosemosis negatively affects honeybee survival: experimental and meta-analytic evidence.

Nosemosis, caused by microsporidian parasites of the genus Nosema, is considered a significant health concern for insect pollinators, including the economically important honeybee (Apis mellifera). Despite its acknowledged importance, the impact of this disease on honeybee survivorship remains unclear. Here, a standard laboratory cage trial was used to compare mortality rates between healthy and Nosema-infected honeybees. Additionally, a systematic review and meta-analysis of existing literature were conducted to explore how nosemosis contributes to increased mortality in honeybees tested under standard conditions. The review and meta-analysis included 50 studies that reported relevant experiments involving healthy and Nosema-infected individuals. Studies lacking survivorship curves or information on potential moderators, such as spore inoculation dose, age of inoculated bees, or factors that may impact energy expenditure, were excluded. Both the experimental results and meta-analysis revealed a consistent, robust effect of infection, indicating a threefold increase in mortality among the infected group of honeybee workers (hazard ratio for infected individuals = 3.16 [1.97–5.07] and 2.99 [2.36–3.79] in the experiment and meta-analysis, respectively). However, the meta-analysis also indicated high heterogeneity in the effect magnitude, which was not explained by our moderators. Furthermore, there was a serious risk of bias within studies and potential publication bias across studies. The findings underscore knowledge gaps in the literature. It is stressed that laboratory cage trials should be viewed as an initial step in evaluating the impact of Nosema on mortality and that complementary field and apiary studies are essential for identifying effective treatments to preserve honeybee populations.