Decrease In Mortality Rate Research Articles

Intraoperative Goal-Directed Perfusion in Cardiac Surgery with Cardiopulmonary Bypass: The Roles of Delivery Oxygen Index and Cardiac Index.

Goal-directed perfusion (GDP) refers to individualized goal-directed therapy using comprehensive monitoring and optimizing the delivery of oxygen during cardiopulmonary bypass (CPB). This study aims to determine whether the intraoperative GDP protocol method has better outcomes compared to conventional methods. We searched the PubMed, Central, and Scopus databases up to October 12, 2023. We primarily examined the GDP protocol in adult cardiac surgery, using CPB with oxygen delivery index (DO2I) and cardiac index (CI) as the main parameters. In all, 1128 participants from seven studies were included in our analysis. The results showed significant differences in the duration of intensive care unit (ICU) stays (p = 0.01), with a mean difference of -0.33 (-0.59 to 0.07), and hospital length of stay (LOS) (p = 0.0002), with a mean difference of -0.84 (-1.29 to -0.39). There was also a notable reduction in postoperative complications (p <0.00001), odds ratio (OR) of 0.43 (0.32-0.60). However, there was no significant decrease in mortality rate (p = 0.54), OR of 0.77 (0.34-1.77). Postoperative acute kidney injury and ICU and hospital LOS are significantly reduced when GDP protocols with indicators of flow management, oxygen delivery index, and CI are used in intraoperative cardiac surgery using CPB.

Clinical implementation of partial splenic artery embolization for the prevention of recurrent bleeding from esophageal varices in portal hypertension.

Aim: To evaluate the effectiveness of PSAE for secondary prevention of VB episodes in patients with chronic liver disease (CLD) and CSPH. Materials and Methods: One hundred twenty patients (from 2008 to 2020) were submitted of PSAE as secondary prevention treatment. The results of the treatment of 27 patients between 2008 and 2012 (first period) were compared with those of 93 patients treated with PSAE since 2013 (second period), as procedure and management protocol were modificated. VB recurrence rate and mortality (related and non-related to bleeding episodes) were defined as study end-points in both groups at 12-months follow-up. Results: At 12-months follow-up, 11 (40,7 %) and 54 (58,1 %) patients in groups 1 and 2, respectively, were free from VBs (p=0,129). Overall mortality rate was significantly higher in group 1, as compared to group 2: 10 (37,0 %) versus 6 (6,4 %) patients, respectively (p<0,001), - due to higher frequency of fatal VB events (7 (26,0 %) vs. 3 (3,2 %) patients, respectively; p=0,001). Conclusions: PSAE is an effective treatment for secondary prevention of VB in patients with CLD and CSPS. The management protocol modification resulted in the decrease in overall mortality rate and mortality related to recurrent VB episodes.

Identifying and quantifying initial post-discharge needs for clinical review of sick, newborns in Kenya based on a large multi-site, retrospective cohort study.

Progress in neonatal care has resulted in a 51% decrease in global neonatal mortality rates from 1990 to 2017. Enhanced survival will put pressure on health care systems to provide appropriate post-discharge, follow-up care but the scale of need for such care is poorly defined. We conducted a retrospective cohort study of newborns discharged from 23 public hospital neonatal units (NBUs) in Kenya between January 2018 and June 2023 to identify initial follow-up needs. We first determined pragmatic follow-up categories based on survivors' clinical conditions and morbidities. We then used individual phenotypes of individual babies to assign them to needing one or more forms of specialized clinical follow-up. We use descriptive statistics to estimate proportions of those with specific needs and patterns of need. Among 136,249/159,792 (85.3%) neonates discharged, around one-third (33%) were low birth weight (<2,500 g), and a similar 33.4% were preterm (<37 weeks). We estimated 131,351 initial episodes of follow-up would be needed across nine distinct follow-up categories: general pediatrics, nutrition, growth & development (40.4%), auditory screening (38.8%), ophthalmology for retinopathy of prematurity (9.6%), neurology (8.0%), occupational therapy (1.3%), specialized nutrition (0.9%), surgery (0.8%), cardiology (0.2%), and pulmonary (<0.1%). Most neonates met the criteria for two (52.3%, 28,733), followed by three (39.6%, 21,738) and one follow-up episodes (5.6%, 3,098). In addition to prematurity and very low birth weight (≤1,500 g), severe infections with extended gentamicin treatment, severe jaundice managed with phototherapy, and hypoxic-ischemic encephalopathy (HIE) contributed substantially to the pattern of need for post-discharge follow-up. Almost half of surviving NBU infants have multiple specialty post-discharge follow-up needs. More urgent attention needs to be focused on healthcare planning now to guide strategies to address the varied medical and developmental needs that we outline in resource-constrained contexts like Kenya.

Trends and insights in liver cancer from a single institution study from Main Medical Directorate of the Russian Presidential Administration over 35 years (1981-2015) Trends and insights in liver cancer from a single institution study from X over 35 years (1981-2015)

Background: This study aims to analyze liver and bile duct tumors over 35 years in the population of the Main Medical Directorate of the Russian Presidential Administration with a view to identifying epidemiological trends and their possible causes. Objective: to assess incidence and mortality rates, examine gender-specific patterns, describe histological picture, and evaluate the effectiveness of routine screenings on patient outcomes. Methods: Retrospective data from the cancer registry of the Main Medical Directorate of the Russian Presidential Administration for 1981-2015 were analyzed. Incidence and mortality rates were assessed with regard to gender distribution, histological confirmation, and survival rates. Standardized indicators were compared with national and international benchmarks. Results: For a period of 35 years, 227 cases of primary liver and bile duct tumors (ICD-C22) were identified. Of these, males made up 66% (149 cases), whereas for females it was 34% (78 cases). The average age of patients was 71.6 ± 11.4 years. The study reveals a consistent decrease in morbidity and mortality rates for both men and women within the studied population, contrasting with national trends. Study showed 20% increase in the 3-year survival rate for patients diagnosed during routine screenings compared to those presenting with symptoms (p=0.0001). Hepatocellular carcinoma was the most common type of liver cancer in the population. Surgical intervention was utilized in 16% of cases, while chemotherapy was used in 25%. Symptomatic treatment constituted a significant proportion of the treatment modalities. Conclusion: Our study provides insights into promising epidemiological trends in liver and bile duct tumors. Factors contributing to favorable outcomes include immunization, antiviral treatments, and lower alcohol consumption. Gender-specific patterns highlight the necessity for tailored screening. This study supports the adoption of regular screening efforts to boost early detection rates and enhance patient outcomes. These findings provide significant clinical implications and pave the way for future research.

Anthracycline-Induced Cardiomyopathy in Cancer Survivors: Management and Long-Term Implications.

Recent advancements in personalized treatments, such as anthracycline chemotherapy, coupled with timely diagnoses, have contributed to a decrease in cancer-specific mortality rates and an improvement in cancer prognosis. Anthracyclines, a potent class of antibiotics, are extensively used as anticancer medications to treat a broad spectrum of tumors. Despite these advancements, a considerable number of cancer survivors face increased risks of treatment complications, particularly the cardiotoxic effects of chemotherapeutic drugs like anthracyclines. These effects can range from subclinical manifestations to severe consequences such as irreversible heart failure and death, highlighting the need for effective management of chemotherapy side effects for improved cancer care outcomes. Given the lack of specific treatments, early detection of subclinical cardiac events post-anthracycline therapy and the implementation of preventive strategies are vital. An interdisciplinary approach involving cardiovascular teams is crucial for the prevention and efficient management of anthracycline-induced cardiotoxicity. Various factors, such as age, gender, duration of treatment, and comorbidities, should be considered significant risk factors for developing chemotherapy-related cardiotoxicity. Tools such as electrocardiography, echocardiography, nuclear imaging, magnetic resonance imaging, histopathologic evaluations, and serum biomarkers should be appropriately used for the early detection of anthracycline-related cardiotoxicity. Furthermore, understanding the underlying biological mechanisms is key to developing preventive measures and personalized treatment strategies to mitigate anthracycline-induced cardiotoxicity. Exploring specific cardiotoxic mechanisms and identifying genetic variations can offer fresh perspectives on innovative, personalized treatments. This chapter aims to discuss cardiomyopathy following anthracycline therapy, with a focus on molecular mechanisms, preventive strategies, and emerging treatments.

Trends in COPD mortality from 1983 to 2018: protocol for a population-based cohort study in Denmark

IntroductionChronic obstructive pulmonary disease (COPD) is one of the leading causes of death worldwide, which is partly contributed to the increasing prevalence of COPD owning to a demographic shift towards...

Tobacco- and alcohol-attributable burden of early-onset lip, oral cavity, and pharyngeal cancer in 204 countries and territories from 1990 to 2019, with projections to 2040.

Rising trends in early-onset Lip and oral cavity cancer (LOC) and Other pharyngeal cancer (OPC) burden had been observed. This study aimed to evaluate the burdens of LOC and OPC attributable to tobacco and alcohol in young adults aged 15-49 years from 1990 to 2040. Tobacco- and alcohol-attributable death and disability-adjusted life years (DALYs) for LOC and OPC and the corresponding population-attributable fraction were obtained from Global Burden of Disease Study 2019 for individuals aged 15-49 years. Estimated annual percent change was calculated to quantify the temporal trend of disease burden between 1990 and 2019. The Bayesian age-period-cohort model was used to predict the age-standardized mortality rate from 2020 to 2040. In 2019, an estimated 16,887 deaths and 799,495 DALYs for tobacco- and alcohol-attributable early-onset LOC, and 8,402 deaths and 386,418 DALYs for early-onset OPC attributable to tobacco and alcohol were reported globally. Despite the global decrease in age-standardized mortality and DALYs rates of tobacco- and alcohol-attributable LOC and OPC in young adults aged 15-49 years between 1990 and 2019, certain regions experienced increases, such as regions of Asia, Eastern Europe, and Western Sub-Saharan Africa. Moreover, a growing age-standardized mortality in individuals aged <34 years was found. The socio-demographic index level was positively associated with a faster reduction of early-onset LOC and OPC DALYs attributable to alcohol use and smoking, except for that due to chewing tobacco. Furthermore, projections have also indicated an expected increase in the age-standardized mortality for tobacco- and alcohol-attributable early-onset LOC and OPC. Significant regional and demographic disparities in tobacco and alcohol-related early-onset LOC and OPC burden and their attributable proportion highlight a need for tailored age- and region-appropriate interventions to reduce the future LOC and OPC burden among young adults.

Silicosis mortality in Spain (1999-2020): A temporal and geographical approach.

Silicosis is an occupational respiratory disease linked to silica dust inhalation. The main driver was traditional coal mining, but in recent decades, new sources of exposure have emerged. Our aim in this study was to assess the temporal and spatial distribution of mortality due to this disease over a 22-year period in Spain. Silicosis records, as an Underlying Cause of Death, were extracted from the National Institute of Statistics from 1999 to 2020 using the International Classification of Diseases 10th revision (code J62.8). Age- and sex-adjusted mortality rates per 1,000,000 inhabitants were calculated for the territory and by province. A geographic analysis was performed, and clusters of deaths were identified at the municipal level, and then the outcomes were compared in two periods of 11 years. There were 2618 deaths due to silicosis in Spain. The mean age of death increased significantly by 0.66% annually from 1999 to 2013. The age-adjusted mortality rate decreased by 7.30% per year, falling from 3.00 to 0.65 per 1,000,000 inhabitants. The temporal pattern showed a significant decrease of mortality rate in 31% of the provinces (16 out of 52), while it increased in Pontevedra. Regarding the spatial analysis, 11 clusters were found in both periods, but some variations were observed in terms of their distribution in the Spanish territory, as well as in the affected municipalities. The decrease in mortality due to Silicosis could be related to less exposure to silica dust over the years and an improvement in the survival of those affected. It is thus essential to analyze the role of preventive measures for this occupational disease.

Overview of the Prevalence of Patients with Sexually Transmitted Infections at Dr RM Djoelham Binjai Hospital in the Period of January 2019-July 2023

Sexually Transmitted Infections (STIs) are infections transmitted through vaginal, anal/anal, and oral/oral intercourse. In Indonesia, this disease continues to grow in the community and can cause death. Types of STIs include gonorrhea, non-specific urethritis, syphilis, mole ulcer, inguinal granuloma, lymphogranuloma venereum, bacterial vaginosis, genital herpes, condyloma acuminata, HIV (Human Immunodeficiency Virus), trichomoniasis and candidiasis vulvovaginitis. The retrospective :descriptive method with a cross sectional design and data collection means is secondary data of new patients diagnosed with STIs and recorded in the Medical Record Sciences of Dr RM Djoelham General Hospital for the period January 2019-July 2023. Results : the prevalence of STI patients, from the diagnosis of the most gonorrhea 27 patients (42.9%), age group 17-25 years 27 patients (42.9%), male sex 39 patients (61.9%) and employment is not ASN (State Civil Apparatus) as many as 20 patients (31.7%) and education is high school graduation / equivalent 29 patients (21.4%). Conclusion: counseling and education are routinely provided to all levels of society. so that this STI is controlled so that morbidity and mortality rates decrease.

CHARACTERIZATION OF CUTANEOUS MELANOMA: CARCINOGENESIS BEYOND ULTRAVIOLET LIGHT

Melanoma is the most aggressive type of skin cancer due to its metastatic potential, and its incidence has increased considerably in recent decades. Sun exposure to ultraviolet A and B irradiation remains the main risk factor for the development of this type of cancer, however, other factors involved are family history, artificial tanning, melanocytic nevi, and low phototype and feomelanin photosensitization by visible light (VL). Through early diagnostic detection of the malignant lesion, it is possible to initiate therapy in an early and curative way, increasing survival with a subsequent decrease in the overall mortality rate. Advances in immunotherapy and targeted therapy have changed treatment paradigms and improved the prognosis of late-stage disease. Due to the high prevalence of the disease worldwide, the purpose of this review was to characterize the cutaneous melanoma (epidemiology, etiology, pathophysiology, clinic, diagnosis, treatment, prognosis, prevention and psychosocial aspects) such as prevention of the melanocytes against Visible Light (VL).

Evaluation of survival time in people hospitalized for COVID-19 in Brazil

This study aimed to evaluate the time between hospitalization and death of patients affected by COVID-19, and to investigate which factors are associated with this survival time. The data were obtained from the Influenza Epidemiological Surveillance Information System, which contains all cases of hospitalization for Severe Acute Respiratory Syndrome in Brazil. Initially, survival time was evaluated descriptively using the Kaplan-Meier estimator, which allows you to calculate the median survival time and the probability that a patient will survive certain periods of hospitalization. Next, a parametric regression model was constructed to investigate the relationship between the survival time and several factors jointly and the results were interpreted in terms of median survival time. Among the possible associated factors, the registration variables (gender, age, region, race and education), comorbidities and symptoms presented were considered. The results showed that the probability of a patient surviving the first day of hospitalization is 97.9%, dropping to 87.5% on the seventh day and reaching 33.5% on the thirtieth day. Half of the deaths occurred within 21 days of hospitalization and only 25% of the patients survived for more than 38 days, showing that, over time, the mortality rate decreases. Evaluating the associated factors, the results showed that elderly patients with low education have a shorter survival time and, consequently, a higher risk of death. With regard to comorbidities, neurological and liver diseases are the main risk factors. On the other hand, we do not have enough evidence to state that survival time is influenced by puerperal variables, down syndrome and abdominal pain.

Maternity Behavior and Infant Care of Coastal Communities on the Prevention of Neonatal Mortality

Background: Infant mortality is one of the targets of health problems in sustainable development. The vast majority of infant deaths are preventable, with high-quality, evidence-based interventions in the form of data. Based on the results of the Indonesian Demographic and Health Survey (SDKI) infant mortality in 2017 was 24/1,000 KH with neonatal mortality of 15/1,000. There was a decrease in the infant mortality rate (IMR) in 2017, compared to the IMR in 2012 which amounted to 32/1,000 KH and 19/1,000 KH neonatal. This study aims to analyze the behavior of childbirth and infant care through the behavior of local wisdom so as to prevent neonatal death. Methods: This study uses a quantitative observational method through a Case Control Study Design approach. The population in this study were all mothers in the coastal area of the Konawe Islands Regency. Results: Birth behavior and baby care at risk provide opportunities for neonatal events. Health agencies need to increase education to the public about risk factors, causes of neonatal death and efforts to prevent neonatal death to mothers and expectant mothers and their families to pay attention to pregnant and postpartum women. Conclusion: For the community, it is necessary to regulate the age of marriage with efforts to control it from the local government

Molecular Evolution of Protein Sequences and Codon Usage in Monkeypox Viruses.

The monkeypox virus (mpox virus, MPXV) epidemic in 2022 has posed a significant public health risk. Yet, the evolutionary principles of MPXV remain largely unknown. Here, we examined the evolutionary patterns of protein sequences and codon usage in MPXV. We first demonstrated the signal of positive selection in OPG027, specifically in the Clade I lineage of MPXV. Subsequently, we discovered accelerated protein sequence evolution over time in the variants responsible for the 2022 outbreak. Furthermore, we showed strong epistasis between amino acid substitutions located in different genes. The codon adaptation index (CAI) analysis revealed that MPXV genes tended to use more non-preferred codons compared to human genes, and the CAI decreased over time and diverged between clades, with Clade I > IIa and IIb-A > IIb-B. While the decrease in fatality rate among the three groups aligned with the CAI pattern, it remains unclear whether this correlation was coincidental or if the deoptimization of codon usage in MPXV led to a reduction in fatality rates. This study sheds new light on the mechanisms that govern the evolution of MPXV in human populations.

Artificial Intelligence in the Early Prediction of Cardiogenic Shock in Acute Heart Failure or Myocardial Infarction Patients: A Systematic Review and Meta-Analysis.

Cardiogenic shock (CS) may have a negative impact on mortality in patients with heart failure (HF) or acute myocardial infarction (AMI). Early prediction of CS can result in improved survival. Artificial intelligence (AI) through machine learning (ML) models haveshown promise in predictive medicine. Here, we conduct a systematic review and meta-analysis to assess the effectiveness of these models in the early prediction of CS. A thorough search of the PubMed, Web of Science, Cochrane, and Scopus databases was conducted from the time of inception until November 2, 2023, to find relevant studies. Our outcomes were area under the curve (AUC), the sensitivity and specificity of the ML model, the accuracy of the ML model, and the predictor variables that had the most impact in predicting CS. Comprehensive Meta-Analysis (CMA) Version 3.0 was used to conduct the meta-analysis. Six studies were considered in our study. The pooled mean AUC was 0.808 (95% confidence interval: 0.727, 0.890). The AUC in the included studies ranged from 0.77 to 0.91. ML models performed well, with accuracy ranging from 0.88 to 0.93 and sensitivity and specificity of 58%-78% and 88%-93%, respectively. Age, blood pressure, heart rate, oxygen saturation, and blood glucose were the most significant variables required by ML models to acquire their outputs. In conclusion, AI has the potential for early prediction of CS, which may lead to a decrease in the high mortality rate associated with it. Future studies are needed to confirm the results.

Late-life shift in caloric intake affects fly metabolism and longevity

The prevalence of obesity is increasing in older adults and contributes to age-related decline. Caloric restriction (CR) alleviates obesity phenotypes and delays the onset of age-related changes. However, how late in life organisms benefit from switching from a high-(H) to a low-calorie (L) diet is unclear. We transferred male flies from a H to a L (HL) diet or vice versa (LH) at different times during life. Both shifts immediately change fly rate of aging even when applied late in life. HL shift rapidly reduces fly mortality rate to briefly lower rate than in flies on a constant L diet, and extends lifespan. Transcriptomic analysis uncovers that flies aged on H diet have acquired increased stress response, which may have temporal advantage over flies aged on L diet and leads to rapid decrease in mortality rate after HL switch. Conversely, a LH shift increases mortality rate, which is temporarily higher than in flies aged on a H diet, and shortens lifespan. Unexpectedly, more abundant transcriptomic changes accompanied LH shift, including increase in ribosome biogenesis, stress response and growth. These changes reflect protection from sudden release of ROS, energy storage, and use of energy to growth, which all likely contribute to higher mortality rate. As the beneficial effects of CR on physiology and lifespan are conserved across many organisms, our study provides framework to study underlying mechanisms of CR interventions that counteract the detrimental effects of H diets and reduce rate of aging even when initiated later in life.

Use of health services and medication use, new comorbidities, and mortality in patients with chronic diseases who did not contract COVID-19 during the first year of the pandemic: a retrospective study and comparison by sex

BackgroundThe restrictions introduced to stop the spread of the COVID-19 virus have also had a direct impact on people with chronic diseases and especially on diseases to which lifestyles are relevant in their control and management, such as diabetes, hypertension, chronic obstructive pulmonary disease (COPD), etc. The purpose of this paper is to conduct a longitudinal analysis of new comorbidities, mortality, medication use, and the use of health resources in patients with chronic diseases who did not contract COVID-19, comparing the six months before the strict lockdown to the 12 months following the end of the strict lockdown.MethodAn observational real world data pre-post study of 668,974 people was undertaken. The patients studied were over 16 years of age, had been receiving care from the Aragon Health Service (Northeastern Spain), were diagnosed with one or more chronic diseases, and had not contracted COVID-19. Sociodemographic, comorbidity, pharmacological and health resource use variables were collected during the six months before the onset of the lockdown and during the six and 12 months following the end of the lockdown. The comparisons by sex were carried out using a Student T-test or chi-squared test to analyse differences.ResultsDyslipidaemia (42.1%) followed by hypertension (35.1%) and anxiety and depression (34.6%) were the most prevalent chronic diseases among the study population. 78.% of patients had between one and four chronic illnesses. There was a decrease in new diagnoses of other chronic comorbidities in this population and a decrease in medications prescribed and the use of health services. Although women received more diagnoses of chronic diseases, the number of medications dispensed was lower, but the use of health services was higher. These figures were maintained throughout the pandemic.ConclusionOur results suggest an underdiagnosis of new chronic comorbidities and a decrease in mortality rates from causes unrelated to COVID-19 due to the closure of health centres in Aragón (Spain) during the lockdown. This trend was exacerbated in women. The underdiagnosis of new chronic comorbidities during confinement can cause the disease to worsen, with the consequent increase in symptoms and the worsening of chronic pathologies in patients with a severe evolution.

1870. Changes of Tuberculosis Incidence and Mortality after COVID-19 Pandemic: A Interrupted Time-series Analysis

Abstract Background The objective of this study is to investigate how the incidence and mortality levels and trends of tuberculosis changed before and after the COVID-19 pandemic in Korea. Methods To estimate the incidence rate of tuberculosis in Korea, we calculated the number of reported cases per year from 2015 to 2021 and divided it by the corresponding mid-year population. Data on reported cases were obtained from the Korea Centers for Disease Control and Prevention, which mandates the reporting of tuberculosis. Descriptive epidemiology was used to analyze monthly incidence and mortality rates, and the Durbin-Watson test was employed to assess seasonality and time-series autocorrelation. Interrupted time series analysis (ITS) using ARIMA models was performed on both the incidence and mortality rates, with the starting point of the COVID-19 pandemic set at February 2020, when the first cases emerged in the community. The tuberculosis mortality was analyzed separately for two age groups: those aged 65 and above, and those under 65. Results During the study period, a total of 204,190 tuberculosis cases were reported, with 12,407 deaths identified. The ITS results showed that the incidence had a significant decreasing trend before the COVID-19 pandemic (b=-0.024, p&amp;lt; 0.01) and a significant decrease in the level of incidence after the pandemic (b=-0.72, p&amp;lt; 0.01). The decreasing trend of incidence was not statistically significant after the pandemic. The mortality had a continuous decreasing trend before the pandemic (b=-0.002, p&amp;lt; 0.01), and the level of mortality significantly decreased after the pandemic (b=-0.029, p&amp;lt; 0.01). However, the trend of mortality increased significantly after the pandemic (b=0.003, p&amp;lt; 0.01). When analyzed by age group, the increase in mortality rate was significantly evident in those aged 65 and above (b=0.016, p&amp;lt; 0.01), while it was not significant in those under 65 (b=0.002, p=7.08). Conclusion After the COVID-19 pandemic, there was a decrease in the incidence of tuberculosis, which resulted in a decrease in the tuberculosis mortality rate. However, in contrast to the pre-pandemic period, the tuberculosis mortality rate has shown a significant increasing trend since the pandemic, indicating collateral damage to tuberculosis patients due to the COVID-19 pandemic. Disclosures All Authors: No reported disclosures

Trends in gastric cancer mortality 2005–2020 in Peru and its geographical areas: A joinpoint regression analysis

BackgroundGastric cancer (GC) is the leading cause of cancer death in Peru. However, information regarding trends in mortality rates in Peru and its geographical areas in the last few decades is lacking. Our objective was to describe GC mortality rates in Peru between 2005 and 2020. MethodsAge standardized mortality rates (ASMR) were calculated per 100,000 person-years using the world SEGI standard population. Joinpoint regression analysis was performed to examine mortality trends. The analysis of the last 5 years was performed for Peru and its geographical areas. ResultsGC mortality rates in 2005 and in 2020 were 13.81 and 10.52, respectively, for men and 11.81 and 8.06, respectively, for women. Between 2016 and 2020, Huanuco and Huancavelica reported the highest mortality rates (≥20 deaths per 100,000). In men, Peru and the highlands region reported significant decreases in GC mortality rates in both sexes for some periods. Coastal region significant decreased by 2.6 % in all periods for women. In both sexes, six provinces reported significant decreases in GC mortality rates. ConclusionAlthough GC mortality rates in Peru have declined over the past 16 years. They are still one of the highest in the Latin American and Caribbean region. It is important that the Peruvian State seek to reduce the mortality of this disease through prevention efforts, timely detection and treatment in all patients.

The prevalence of malignant neoplasms of the kidney in Saint Petersburg and various regions of Russia in 2016-2021

Background. Currently, kidney cancer remains one of the most common oncourological diseases with relatively high mortality rate.Aim. To study the main epidemiological indicators of malignant neoplasms of the kidney in various regions of Russia and Saint Petersburg.Materials and methods. Based on the data from the Department of Medical Statistics of Tumor Diseases of the Medical Information and Analytical Center, the epidemiological indicators of malignant neoplasms of the kidney for the period between 2016 and 2021 in Russia, individual Federal Districts of the country and Saint Petersburg were analyzed.Results. Despite the increase in the prevalence of malignant neoplasms of the kidney, medical oncological care for the population is at an appropriate level. Most cases of the disease are diagnosed at early stages, there is a decrease in patient mortality rates and an increase in 5-year survival, which indicates the effectiveness of ongoing anticancer measures. In a number of Federal Districts, a number of indicators showed a negative trend compared to the all-Russia data, which requires close attention.Conclusion. The analysis of statistical data of patients with malignant neoplasms of the kidney can be used to optimize the algorithms for diagnosing and treating this category of patients, as well as to improve oncological care for the population.

Influence of antibiotic therapy with hemodynamic optimization on 30-day mortality among septic shock patients cared for in the prehospital setting

BackgroundIn order to reduce septic shock mortality, international guidelines recommend early treatment implementation, antibiotic therapy (ABT) and hemodynamic optimisation, within 1-h.This retrospective multicentric study aims to investigate the relationship between prehospital ABT delivered within 1st hour and mean blood pressure (MAP) ≥ 65 mmHg at the end of the prehospital stage, and 30-day mortality among patients with septic shock. MethodsFrom May 2016 to December 2021, patients with septic shock requiring pre-hospital Mobile Intensive Care Unit intervention (MICU) were retrospectively analysed. To assess the relationship between 30-day mortality and prehospital ABT delivered within 1st hour and/or MAP ≥ 65 mmHg at the end of the prehospital stage, Inverse Probability Treatment Weighting (IPTW) propensity score method was performed. ResultsAmong the 530 patients included, 341 were male gender (64%) with a mean age of 69 ± 15 years. One-hundred and thirty-two patients (25%) patients received prehospital ABT, among which 98 patients (74%) were treated with 3rd generation cephalosporin.Suspected pulmonary, urinary and digestive infections were the cause of sepsis in respectively 43%, 25% and 17%. The 30-day overall mortality was 31%.A significant association was observed between 30-day mortality rate and (i) ABT administration within the first hour: RRa = 0.14 [0.04–0.55], (ii) ABT administration within the first hour associated with a MAP ≥ 65 mmHg: RRa = 0.08 [0.02–0.37] and (iii) ABT administration within the first hour in the prehospital setting associated with a MAP < 65 mmHg at the end of the prehospital stage: RRa = 0.75 [0.45–0.85]. Patients who received prehospital ABT after the first hour have also a 30-day mortality rate decrease: RRa = 0.87 [0.57–0.99], whereas patients who did not received ABT had an increased 30-day mortality rate: RRa = 2.36 [1.89–2.95]. ConclusionIn this study, we showed that pre-hospital ABT within the first hour and MAP≥65 mmHg at the end of prehospital stage are both associated with 30-day mortality decrease among patients suffering from septic shock cared for by a MICU. Further prospective studies are needed to confirm these preliminary results.