Decrease Mortality Research Articles

Prevalence and determinants of late-stage presentation among cervical cancer patients, a systematic review and meta-analysis.

An estimated 570,000 women were diagnosed with cervical cancer worldwide, and about 311,000 women died from the disease. Cervical cancer is possibly the most curable human cancer; if detected at the precancerous stage. Additionally, early diagnosis and management other factors are essential to decrease mortality rate among those patients. So this review was aimed to identify the prevalence and determinants of late-stage presentation among cervical cancer patients. A systematic search had carried out on PubMed, EMBASE, MEDLINE, Cochrane, Scopus, Web of Science CINAHL, and manually on Google Scholar. This meta-analysis follows the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The modified Newcastle-Ottawa Scale (NOS) was used to assess the quality of each study. A meta-analysis was done using a random-effects method using the STATA™ Version 14 software. Twenty-five studies from 3 world regions with 53,233 participants were enrolled in this meta-analysis. The overall estimated global pooled prevalence of late-stage presentation among cervical cancer patients with a random-effects model was 60.66% (95% CI: 56.27, 65.06). The subgroup analysis revealed that the prevalence of late-stage presentation was 62.60% in Africa, 69.30% in Asia, 46.51% in Europe, and 50.16% in North America. Educational status (p = 0.031) and place of residence (p = 0.004) are determinants of late-stage presentation. The results of this meta-analysis indicated that the prevalence of late-stage presentation of cervical cancer is substantially high. Place of residence and educational status were significantly associated with late-stage presentation. Health care organizations should work on early screening, management, and on increasing community awareness to minimize late stage at presentation among those patients.

Weakly supervised attention model for RV strain classification from volumetric CTPA scans

Background and objective: Evaluation of the right ventricle (RV) is a key component of the clinical assessment of many cardiovascular and pulmonary disorders. In this work, we focus on RV strain classification from patients who were diagnosed with pulmonary embolism (PE) in computed tomography pulmonary angiography (CTPA) scans. PE is a life-threatening condition, often without warning signs or symptoms. Early diagnosis and accurate risk stratification are critical for decreasing mortality rates. High-risk PE relies on the presence of RV dysfunction resulting from acute pressure overload. PE severity classification and specifically, high-risk PE diagnosis are crucial for appropriate therapy. CTPA is the golden standard in the diagnostic workup of suspected PE. Therefore, it can link between diagnosis and risk stratification strategies. Methods: We retrieved data of consecutive patients who underwent CTPA and were diagnosed with PE and extracted a single binary label of “RV strain biomarker” from the CTPA scan report. This label was used as a weak label for classification. Our solution applies a 3D DenseNet network architecture, further improved by integrating residual attention blocks into the network’s layers. Results: This model achieved an area under the receiver operating characteristic curve (AUC) of 0.88 for classifying RV strain. For Youden’s index, the model showed a sensitivity of 87% and specificity of 83.7%. Our solution outperforms state-of-the-art 3D CNN networks. The proposed design allows for a fully automated network that can be trained easily in an end-to-end manner without requiring computationally intensive and time-consuming preprocessing or strenuous labeling of the data. Conclusions: This current solution demonstrates that a small dataset of readily available unmarked CTPAs can be used for effective RV strain classification. To our knowledge, this is the first work that attempts to solve the problem of RV strain classification from CTPA scans and this is the first work where medical images are used in such an architecture. Our generalized self-attention blocks can be incorporated into various existing classification architectures making this a general methodology that can be applied to 3D medical datasets.

Mortality Rate of Ischemic Stroke Patients Undergoing Decompressive Hemicraniectomy With Obesity.

BackgroundObesity has been shown to have a positive mortality benefit in patients undergoing percutaneous coronary intervention and dialysis and those with rheumatoid arthritis, chronic obstructive pulmonary disease, and various wasting diseases. Studies for this mortality benefit in ischemic stroke patients are conflicting and have not been well studied in hemicraniectomy patients. We sought to determine the impact of obesity on outcomes of hemicraniectomy patients.MethodsWe performed a retrospective case-control database analysis using a multi-institutional database (TriNetX) looking at obese versus non-obese patients with ischemic stroke undergoing hemicraniectomy. Our primary endpoint was mortality. Secondary endpoints included seizure, pulmonary embolism, myocardial infarction (MI), cerebral infarction, deep vein thrombosis, tracheostomy, and percutaneous endoscopic gastrostomy. Cohorts were propensity-score matched for confounders.ResultsAfter propensity score matching for basic demographics and common comorbidities, as well as indicators of stroke severity, 646 patients were identified that were obese and had an ischemic stroke with subsequent hemicraniectomy (cohort 1), and 646 patients were identified who were non-obese with ischemic stroke and hemicraniectomy (cohort 2). Thirty-day survival rate was 98.142% in the obese vs. 87.771% in the non-obese cohorts, 90-day survival was 85.15% vs. 79.35%, 180-day survival was 96.44% vs. 84.52%, 365-day survival was 94.272% vs. 81.734%, and five-year survival was 81.889% vs. 75.077%, respectively. At five years, risk difference was −7.276% (95% CI: −11.757, −2.794) and odds ratio was 0.666 (95% CI: 0.510, 0.871) (p = 0.0029). Despite a higher mortality rate, obese patients had a statistically significant increase in pulmonary embolism (11.61% vs. 5.108, p < 0.0001), deep venous thrombosis (16.873% vs. 9.133%, p < 0.0001), and MI (8.824% vs. 5.882%, p = 0.0428). There was no significant difference in intensive care unit length of stay, ventilator dependence, tracheostomy placement, percutaneous endoscopic gastrostomy placement, or intracerebral hemorrhage.ConclusionsDespite the increased risk of ischemic stroke, obese patients who undergo hemicraniectomy have decreased mortality rates compared to their non-obese counterparts.

Effects of Prone Position on Lung Recruitment and Ventilation-Perfusion Matching in Patients With COVID-19 Acute Respiratory Distress Syndrome: A Combined CT Scan/Electrical Impedance Tomography Study.

OBJECTIVES:Prone positioning allows to improve oxygenation and decrease mortality rate in COVID-19–associated acute respiratory distress syndrome (C-ARDS). However, the mechanisms leading to these effects are not fully understood. The aim of this study is to assess the physiologic effects of pronation by the means of CT scan and electrical impedance tomography (EIT).DESIGN:Experimental, physiologic study.SETTING:Patients were enrolled from October 2020 to March 2021 in an Italian dedicated COVID-19 ICU.PATIENTS:Twenty-one intubated patients with moderate or severe C-ARDS.INTERVENTIONS:First, patients were transported to the CT scan facility, and image acquisition was performed in prone, then supine position. Back to the ICU, gas exchange, respiratory mechanics, and ventilation and perfusion EIT-based analysis were provided toward the end of two 30 minutes steps (e.g., in supine, then prone position).MEASUREMENTS AND MAIN RESULTS:Prone position induced recruitment in the dorsal part of the lungs (12.5% ± 8.0%; p < 0.001 from baseline) and derecruitment in the ventral regions (–6.9% ± 5.2%; p < 0.001). These changes led to a global increase in recruitment (6.0% ± 6.7%; p < 0.001). Respiratory system compliance did not change with prone position (45 ± 15 vs 45 ± 18 mL/cm H2O in supine and prone position, respectively; p = 0.957) suggesting a decrease in atelectrauma. This hypothesis was supported by the decrease of a time-impedance curve concavity index designed as a surrogate for atelectrauma (1.41 ± 0.16 vs 1.30 ± 0.16; p = 0.001). Dead space measured by EIT was reduced in the ventral regions of the lungs, and the dead-space/shunt ratio decreased significantly (5.1 [2.3–23.4] vs 4.3 [0.7–6.8]; p = 0.035), showing an improvement in ventilation-perfusion matching.CONCLUSIONS:Several changes are associated with prone position in C-ARDS: increased lung recruitment, decreased atelectrauma, and improved ventilation-perfusion matching. These physiologic effects may be associated with more protective ventilation.

Epidemiology of traumatic spinal cord injury: a large population-based study.

Study designA retrospective population-based study.ObjectivesDescribe the incidence of traumatic spinal cord injury (TSCI) and mortality risks, based on the characteristics of the patient, anatomical level of the lesion, setting/cause of the injury, and type of healthcare support received within the regional trauma network (highly specialized trauma center or spoke hospital).SettingBetween 2011 and 2020, 1303 patients with incident TSCI were identified in a population of 4.9 million inhabitants.MethodsHospital discharge records and mortality records were used to identify patients and outcomes. Cox regression models were fitted to estimate mortality risks across several subgroups.ResultsOver the past decade, age-sex-standardized TSCI incidence rates remained stable with 26.5 cases (95% CI, 25.0–27.9) per 1,000,000 inhabitants (mean age 59.2 years) and most cases were males (68.3%). Incidence was directly associated with age while the male to female ratio was inversely related. Most TSCIs were cervical lesions (52.1%), and the most common cause of injury were traffic crashes (29.9%) followed by occupational accidents (29.8%). Sex, cause of the trauma, or inpatient hospital management were not associated with an increased risk of death. Mortality rates were greater for cervical lesions, and increased with age, remaining stably high among older individuals even 12 months after the accident. One-month mortality risk was significantly higher at ≥75 years compared to <55 years (adjusted HR 9.14 (95% CI, 4.17–20.03)).ConclusionPublic health policies should aim at reducing preventable TSCIs, and special attention should be drawn to long-term management of elderly patients in the attempt to decrease mortality rates.

PROSPECTIVE EVALUATION OF PANC 3 SCORE IN PREDICTING SEVERITY OF ACUTE PANCREATITIS

Background: About 15-20% of cases of acute pancreatitis progress to a severe form, leading to high mortality rates. Thus early prediction of severity is utmost important so as to provide better management and decrease mortality. Objective: To explore the efficiency of PANC 3 SCORE in predicting the severity in patients with acute pancreatitis on admission and its relation to clinical outcome. Methods: Patients with Acute pancreatitis were assessed to sex, age, body mass index (BMI), etiology of pancreatitis, Hematocrit and presence or absence of pleural effusion at the time of admission intensive care need, length of hospital stay, length of stay in intensive care unit and mortality. The PANC 3 score was determined on admission and compared to acute pancreatitis grade of the Revised Atlanta classification. Results: Out of 46 patients diagnosed with acute pancreatitis, 46 patients met the inclusion criteria. The PANC 3 score was positive in 4 cases (8.69%), pancreatitis progressed to a severe form in 7 cases (15.2%) and 3 patients (6.5%) died. Patients with a positive score and severe pancreatitis required intensive care more often, and stayed for a longer period in intensive care units. The PANC 3 score showed sensitivity of 42.85%, specificity of 97.45%, accuracy of 90.17%, positive predictive value of 75% and negative predictive value of 89.13% in prediction of severe acute pancreatitis. Conclusion: The PANC 3 score has high specificity, high accuracy and high predictive value in prediction of severe acute pancreatitis. It has only 3 parameters which can be easily done in any healthcare system. It does not need much expertise to analyze PANC3 at the time of admission which adds the advantage of this score over other scoring systems.

IMPACTS OF BARRIER INSECTICIDE MIXTURES ON MOSQUITO, AEDES AEGYPTI AND NON-TARGET HONEY BEE, APIS MELLIFERA

Four novel commercial insecticide mixtures, composed of pyrethroid and nicotinoid active ingredients, were evaluated in a series of experiments in the laboratory, semi-field and field to determine acute toxicity (LC50) against pyrethroid-susceptible (ORL1952) and resistant (Puerto Rico) strains of Aedes aegypti L., and non-target adult European honey bees, Apis mellifera L. The four products were Tandem, Temprid FX, Transport Mikron, and Crossfire. The acute toxicity data showed that pyrethroid-resistant Ae. aegypti PR exhibited decreased sensitivity to all 4 insecticide mixtures, compared to pyrethroid-susceptible Ae. aegypti ORL1952. Tandem, Temprid FX, and Transport Mikron were more toxic to Ae. aegypti ORL1952 than to A. mellifera, but Crossfire was the least toxic. Transport Mikron was also more toxic to Ae. aegypti PR than to A. mellifera. The Honey bee Tolerance Indexes, determined with LC50 data of pyrethroid-susceptible mosquitoes, demonstrated that while Transport Mikron, Tandem, and Temprid FX were more toxic to Ae. aegypti ORL1952 than to A. mellifera, Crossfire was less toxic. The honey bee Tolerance Indexes decreased substantially when calculated with LC50 data from pyrethroid- resistant mosquitoes, but honey bees remained tolerant of Transport Mikron. Notably, while the insecticide mixtures did not control the PR resistant Ae. aegypti strain when applied as residual sprays to perimeter vegetation at label rates, susceptible Ae. aegypti ORL1951 were controlled, but applications affected honeybees (A. mellifera) for up to 28 days after treatment. Temprid FX resulted in 74% and 99% mortality, in adult Ae. aegypti ORL1952 and A. mellifera, respectively, for 28 days post-treatment. Transport Mikron and Tandem residues killed Ae. aegypti ORL1952 for up to 21 days post-treatment, while the effect of Crossfire lasted only 14 days. All three insecticides killed A. mellifera for up to 28 days post-treatment but at decreased mortality rates. For operational mosquito control, these data indicate that Transport Mikron has a reasonable safety margin (~25%) when targeting susceptible mosquitoes, compared to Tandem, Temprid FX, and Crossfire. The tested insecticide formulations need to be applied in higher doses to control resistant strains of mosquitoes that may be detrimental to honey bees. The ULV data indicated that pyrethroid resistance can be overcome with the insecticide mixtures.

The Peritoneal Membrane—A Potential Mediator of Fibrosis and Inflammation among Heart Failure Patients on Peritoneal Dialysis

Peritoneal dialysis is a feasible, cost-effective, home-based treatment of renal replacement therapy, based on the dialytic properties of the peritoneal membrane. As compared with hemodialysis, peritoneal dialysis is cheaper, survival rate is similar, residual kidney function is better preserved, fluid and solutes are removed more gradually and continuously leading to minimal impact on hemodynamics, and risks related to a vascular access are avoided. Those features of peritoneal dialysis are useful to treat refractory congestive heart failure patients with fluid overload. It was shown that in such patients, peritoneal dialysis improves functional status and quality of life, reduces hospitalization rate, and may decrease mortality rate. High levels of serum proinflammatory cytokines and fibrosis markers, among other factors, play an important part in congestive heart failure pathogenesis and progression. We demonstrated that those levels decreased following peritoneal dialysis treatment in refractory congestive heart failure patients. The exact mechanism of beneficial effect of peritoneal dialysis in refractory congestive heart failure is currently unknown. Maintenance of fluid balance, leading to resetting of neurohumoral activation towards a more physiological condition, reduced remodeling due to the decrease in mechanical pressure on the heart, decreased inflammatory cytokine levels and oxidative stress, and a potential impact on uremic toxins could play a role in this regard. In this paper, we describe the unique characteristics of the peritoneal membrane, principals of peritoneal dialysis and its role in heart failure patients.

Recuperación funcional al alta y a tres meses tras una intervención multicomponente de ejercicio físico en ancianos hospitalizados en una unidad de agudos de geriatría

IntroductionHospitalization in the elderly, even in short stays, is associated with functional impairment. Once the acute illness is reversed, the evolution of this hospital-generated impairment can be variable, and a year after hospitalization more than half of the elderly patients remain impaired. This impairment is associated with a higher risk of institutionalization, of mortality at discharge and of 30-day mortality. Previous studies have shown how interdisciplinary physical exercise programs can improve functionality at discharge and decrease mortality rate, hospital stay and institutionalization. Study design and objectivesIn the Acute Geriatric Unit of the Gregorio Marañon University hospital a randomized controlled trial was carried out to assess the effectiveness of an exercise and health education program to prevent functional decline during hospitalization and at three months after discharge in elderly subjects aged 74 years or older. Patients were excluded if at least one of the following exclusion criteria was met: baseline Barthel Index (15-days prior hospitalization) below 20, severe cognitive impairment or inability to walk. The intervention consisted on a physical exercise program (that included squats, balance, gait stimulation, elastic bands, and inspiratory muscle training) and health education program. The control group received usual care.

Sodium Glucose Cotransporter-2 Inhibitors: Spotlight on Favorable Effects on Clinical Outcomes beyond Diabetes.

Sodium glucose transporter type 2 (SGLT2) molecules are found in proximal tubules of the kidney, and perhaps in the brain or intestine, but rarely in any other tissue. However, their inhibitors, intended to improve diabetes compensation, have many more beneficial effects. They improve kidney and cardiovascular outcomes and decrease mortality. These benefits are not limited to diabetics but were also found in non-diabetic individuals. The pathophysiological pathways underlying the treatment success have been investigated in both clinical and experimental studies. There have been numerous excellent reviews, but these were mostly restricted to limited aspects of the knowledge. The aim of this review is to summarize the known experimental and clinical evidence of SGLT2 inhibitors’ effects on individual organs (kidney, heart, liver, etc.), as well as the systemic changes that lead to an improvement in clinical outcomes.

Effects of Vitamin D Serum Level on Morbidity and Mortality in Patients with COVID-19: A Systematic Review and Meta-Analysis.

It has been shown that low Vitamin D serum concentration is associated with increased pneumonia and viral respiratory infections. Vitamin D is readily available, inexpensive, and easy to administer to subjects infected with COVID-19. If effective in reducing the severity of COVID-19, it could be an important and feasible therapeutic intervention. We performed a systematic review and meta-analysis of the literature to determine the effects of Vitamin D serum concentration on mortality and morbidity in COVID-19 patients. The primary objectives were to determine if Vitamin D serum concentration decrease mortality, ICU admissions, ventilator support, and length of hospital stay in COVID-19 patients. A total of 3572 publications were identified. Ultimately, 20 studies are included. A total of 12,806 patients aged between 42 to 81 years old were analyzed. The pooled estimated RR for mortality, ICU admission, ventilator support and length of hospital stay were 1.49 (95% CI: 1.34, 1.65), 0.87 (95% CI: 0.67, 1.14), 1.29 (95% CI: 0.79, 1.84), and 0.84 (95% CI -0.45, 2.13). There is no statistical difference in mortality, ICU admission rate, ventilator support requirement, and length of hospital stay in COVID-19 patients with low and high Vitamin D serum concentration.

Achieving the hip fracture Best Practise Tariff during the COVID-19 pandemic.

Objectives:Achieving the hip fracture best practice tariff is associated with decreased mortality rates. The aim of this study is to evaluate the impact of Covid-19 pandemic on achieving Best Practice Tariff.Methods:We retrospectively reviewed all adult hip fractures admitted to our unit between March and June 2020. Patient’s characteristics, place of residence, delirium assessment, and mobility status were recorded. All the Best practice Tariff criteria have been analysed. Covid-19 was diagnosed using reverse transcriptase polymerase chain reaction.Results:178 patients with a mean age of 82.8 years presented with hip fractures during the study period. 18 patients (10.1%) tested positive for COVID-19. 44.4% failed to achieve the BPT from the COVID-19 positive group and 22.5% from the negative group.Conclusion:Based on this study, hip fractures associated with Covid-19 infection are more likely to fail the BPT and have higher 30-day mortality rates compare to the COVID-19 negative patients.

Concomitant trans-sternal repair of Morgagni hernia and ventricular septal defect in a patient with Down syndrome: A case report

IntroductionMorgagni hernia is a rare type of hernia occurring secondary to potential anterior-medial defects in the diaphragm. The association of the defect with congenital cardiac pathologies and Down syndrome are well known. The defect is repaired usually by trans-abdominal or transthoracic approaches. Trans-sternal repair of the hernia is preferred in patients undergoing concomitant open heart surgery.Case presentationA 2-year-old child with Down syndrome underwent concomitant repair of Morgagni hernia and closure of his ventricular septal defect under cardiopulmonary bypass. The hernia was corrected by the sternotomy approach, without opening the hernia content, before the correction of the cardiac pathology. The patient made an uneventful recovery and was discharged on the 4th postoperative day.DiscussionPreoperative diagnosis of diaphragmatic hernia in congenital heart disease is important to decrease mortality rate. However, trans-sternal exposure of the defect is also possible, as in this case, in patients undergoing open heart surgery for congenital cardiac defects. The defect can be repaired by this approach, concomitantly with the cardiac anomaly, no need for an additional incision and without opening the hernia sac.ConclusionOur experience, although very limited, in patients who are suffering from Morgagni hernia and concomitant congenital heart defects shows that simultaneous repair of Morgagni hernia through midline sternotomy prior to cardiac procedure is effective. As Morgagni hernia can be accompanied with many congenital cardiac anomalies, cardiac surgeons should be familiar with the trans-sternal approach to the defect.

Evaluation of cefquinome's efficacy in controlling avian colibacillosis and detection of its residues using high performance liquid chromatography (HPLC)

This study aimed to evaluate the efficacy of cefquinome in treatment and controlling of Escherichia coli experimentally infected broiler chickens, in addition of detection of its residues using High performance liquid chromatography (HPLC). In this study, 150 one-day old Cobb broiler chicks were used. On the 14th day chicks experimentally infected and divided into 3 equal groups (50 each); control group (G1) non-infected, non-treated, (G2) infected with E. coli O78 non treated, (G3) infected with E. coli O78, cefquinome treated. Cefquinome was administrated 5th day post infection, intramuscularly by a dose of (2 mg/ kg b w.t) for 3 consecutive days. Experimental E. coli infection in broilers induced weakness, loss of appetite, depression, cough and watery diarrhea in addition to a recorded mortality (30%) with reduction in growth performance, erythrogram, total proteins, albumin, antioxidants and haemagglutination inhibition(HI) titers. In addition, a significant increase in feed conversion rate (FCR), leukocytic count, liver enzymes, kidney functions, total globulins, malondialdehyde, nitric oxide and lysozyme activity. Treatment with cefquinome led to decreased mortality rate, improvement in clinical signs, growth performance and modulated most of these altered parameters. Cefquinome's residues was not detected in breast muscles 3rd day and liver and kidneys 7th days post treatment. Therefore, it's recommended that cefquinome is a good choice for controlling of colibacillosis in broilers and its withdrawal time 3 days in breast muscles and 7 days in liver and kidney post treatment.

Anesthesia management of patients posted for resection of rhino-orbital mucormycosis developed as a postCovid sequale: Sharing our experiences

Background: Although Mucormycosis is a rare life-threatening fungal infection mainly seen in immunocompromised patients, there has been increasing number of mucormycosis cases presenting as a post COVID sequale mainly from India. Uncontrolled diabetes and overzealous use of steroid seems to be two main aggravating factors. Aggressive medical and surgical management of mucormycosis decreases mortality rate from 88% to 21%.&#x0D; Aim: This study is aimed to evaluate anaesthetic challenges in the post COVID patients coming for surgical clearance of mucormycosis.&#x0D; Demographic characteristics, associated comorbidities, procedural data, surgical details, hospital stay and mortality rates were reviewed in 32 patients. The mean age of our patients was 52.66 yrs. and 96.9% had associated comorbidities. Two (6.3%) patients had mallampati classification (MPC) IV and 12 had III (40.6%). Average anaesthesia duration was 282.5 min with mean blood loss 792 ml. Twenty-one (65.6%) patients were shifted to ICU (intensive care unit) out of which 15 (46.87%) were electively ventilated. Mortality was seen in 2 patients with mortality rate of 6.25%.&#x0D; Conclusion: Surgical resection of mucormycosis in post covid patients presents unique challenges – associated comorbidities, difficult airway, prolonged surgical duration, intraoperative hemodynamic instability massive blood loss, Amphotericin B related side effects mainly nephrotoxicity and hypokalemia, need for postoperative ventilation and prolonged hospital stay. Preoperative optimization, careful intraoperative monitoring and postoperative management are necessary for better outcome.

Promotion of early and exclusive breastfeeding in neonatal care units in rural Rwanda: a pre- and post-intervention study

BackgroundEarly initiation of breastfeeding after birth and exclusive breastfeeding for the first six months improves child survival, nutrition and health outcomes. However, only 42% of newborns worldwide are breastfed within the first hour of life. Small and sick newborns are at greater risk of not receiving breastmilk and often require additional support for feeding. This study compares breastfeeding practices in Rwandan neonatal care units (NCUs) before and after the implementation of a package of interventions aimed to improve breastfeeding.MethodsThis pre-post intervention study was conducted at two district hospital NCUs in rural Rwanda from October–December 2017 (pre-intervention) and September 2018–March 2019 (post-intervention). Only newborns admitted before their second day of life (DOL) were included. Data were extracted from patient charts for clinical and demographic characteristics, feeding, and patient outcomes. Exclusive breastfeeding at discharge was based on last recorded infant feeding on the day of discharge. Logistic regression analysis was used to evaluate factors associated with exclusive breastfeeding at discharge.ResultsPre-intervention, 255 newborns were admitted in the NCUs and 793 were admitted in post-intervention. Exclusive breastfeeding on the day of birth (DOL0) increased from 5.4% (12/255) to 35.9% (249/793). At discharge, exclusive breastfeeding increased from 69.6% (149/214) to 87.0% (618/710). The mortality rate decreased from 16.1% (41/255) to 10.5% (83/793). Factors associated with greater odds of exclusive breastfeeding at discharge included admission during the post-intervention period (aOR 4.91; 95% CI 1.99, 12.11), and admission for infection (aOR 2.99; 95% CI 1.13, 7.93). Home deliveries (aOR 0.15; 95% CI 0.05, 0.47), preterm delivery (aOR 0.36; 95% CI 0.15, 0.87) and delayed first breastmilk feed (aOR 0.04 for DOL3 vs. DOL0; 95% CI 0.01, 0.35) reduced odds of exclusive breastfeeding at discharge.ConclusionsExpansion and adoption of evidenced-based guidelines, using innovative approaches, aimed at the unique needs of small and sick newborns may help to improve earlier initiation of breastfeeding, decrease mortality, and improve exclusive breastfeeding on discharge from hospital among small and sick newborns. These interventions should be replicated in similar settings to determine their effectiveness.

Whole body CT for trauma reduces emergency department time for patients with lower extremity fractures.

Whole body CT in the setting of trauma has been shown to improve patient outcomes and decrease mortality in the emergency department (ED). Our institutional WBCT protocol allows for easy inclusion of the lower extremities, circumventing the need for diagnostic radiographs of the lower extremities. We hypothesized that this WBCT protocol would decrease time in the ED, reduce time to ED discharge, and decrease the number of lower extremity radiographs obtained in this patient population. To assess patient throughput in the ED by determining total time in the ED, number of lower extremity radiographs, cost of radiographs, and total cost of imaging before and after the implementation of a WBCT protocol for trauma. The trauma registry from an urban level 1 trauma center was searched for blunt trauma patients 6months before and 6months after the implementation of a WBCT protocol for trauma. Time between admission and discharge from the ED, total number of radiographs, total radiographs cost, total cost of ED imaging, and radiation dose estimations before and after WBCT implementation were calculated. There was a statistically significant decrease in time in the ED (76min, p = 0.033) and number of lower extremity radiographs (decreased by 2 per patient, p < 0.01) following the implementation of the WBCT for trauma protocol. The cost of radiographs was decreased by 28.5% (p = 0.013) but the total cost of ED imaging was increased by approximately 4 × (p < 0.0001). Calculated effective radiation dose to the lower extremities increased by a factor of 1.9 × after implementation of WBCT for trauma. Implementation of a WBCT protocol for trauma resulted in statistically significant decreased time in the ED and decreased the number of radiographs at the expense of increased imaging costs and radiation exposure.

Evaluation of the Pink Luminous Breast LED-Based Technology Device as a Screening Tool for the Early Detection of Breast Abnormalities.

Breast cancer is the leading cause of sex-specific female cancer deaths in the United States. Detection at earlier stages contributes to decreasing the mortality rate. The mammogram is the “Gold Standard” for breast cancer screening with an estimated sensitivity of 86.9% and a specificity of 88.9%. However, these values are negatively affected by the breast density considered a risk factor for developing breast cancer. Herein, we validate the novel LED-based medical device Pink Luminous Breast (PLB) by comparison with the mammogram using a double blinded approach. The PLB works by emitting a LED red light with a harmless spectrum of 640–800 nanometers. This allows the observation of abnormalities represented by dark or shadow areas. In this study, we evaluated the sensitivity and specificity of the PLB device as a screening tool for the early detection of breast abnormalities. Our results show that the PLB device has a high sensitivity (89.6%) and specificity (96.4%) for detecting breast abnormalities comparable to the adjusted mammogram values: 86.3 and 68.9%, respectively. The percentage of presence of breast density was 78.2% using PLB vs. 72.9% with the mammogram. Even with higher findings of breast density, the PLB is still capable of detecting 9.4% of calcifications compared to 6.2% in mammogram results and the reported findings for cysts, masses, or tumor-like abnormalities was higher using the PLB (6.5%) than the mammogram (5.6%). A 100% of the participants felt comfortable using the device without feeling pain or discomfort during the examination with 100% acceptability. The PLB positive validation shows its potential for routine breast screening at non-clinical settings. The PLB provides a rapid, non-invasive, portable, and easy-to-use tool for breast screening that can complement the home-based breast self-examination technique or the clinical breast examination. In addition, the PLB can be conveniently used for screening breasts with surgical implants. PLB provides an accessible and painless breast cancer screening tool. The PLB use is not intended to replace the mammogram for breast screening but rather to use it as an adjunct or complemental tool as part of more efficient earlier detection strategies contributing to decrease mortality rates.

Secondary prevention and treatment of cervical cancer - update from Poland

Introduction. Cervical cancer is the 4th most common cancer in terms of incidence and mortality in women worldwide. The aim of the study was to investigate and analyze the effects of Poland’s publicly funded cervical cancer screening and treatment programs. Material and methods. The study analyzed the financial and epidemiological data provided by the Polish National Health Fund and the Polish National Cancer Registry on the prevention and treatment of cervical cancer in Poland in 2011–2017. Results. Our study identified a systematic reduction in the number of patients undergoing cervical cytology. Despite high levels of financial expenditure, no correlation was found between the total cost of benefits in PLN million (W = 0.911; p = 0.404) and mortality expressed by the standardized coefficient (W = 0.884; p = 0.243). Conclusions. Despite decreasing mortality rates in cases of cervical cancer in Poland, the organization and delivery of prevention and treatment programs should be considered insufficient.

Endotherapy in Pancreatic Diseases

AbstractInterventional endoscopy is now considered an effective minimally invasive treatment modality for the management of pancreatic diseases. It is important for the clinician to know the indications and contraindications as well as the timing of various endoscopic interventions. This will help in its safe and effective use and consequently decrease morbidity and mortality from various pancreatic diseases. This review will provide a broad overview of the indications, techniques, and outcomes of pancreatic endotherapy.