Mortality Factors Research Articles

Native Valve Infective Endocarditis with Severe Regurgitation: What Matters Is Heart Failure.

Background/Objectives: Heart failure worsens the prognosis of patients with infective endocarditis (IE) and is mainly caused by severe valvular regurgitation. The aim of our investigation is to describe the clinical, epidemiological, microbiological, and echocardiographic characteristics of patients with native left-sided infective endocarditis (NLSIE) with severe valvular regurgitation; to describe the prognosis according to the therapeutic approach; and to determine the prognostic factors of in-hospital mortality. Methods: We prospectively recruited all episodes of possible or definite NLSIE diagnosed at three tertiary hospitals between 2005 and 2022. Patients were divided into two groups: patients with severe valvular regurgitation at the time of admission or during hospitalization and patients without severe valvular regurgitation. We analyzed up to 85 variables concerning epidemiological, clinical, analytical, microbiological, and echocardiographic data. Results: We recovered 874 patients with NLSIE, 564 (65%) of them with severe valvular regurgitation. There were no differences in mortality among patients with and without severe regurgitation (30.2% vs. 26.5%, p = 0.223). However, mortality increased when patients with severe regurgitation developed heart failure (33% vs. 11.4%, p < 0.001). Independent factors related to heart failure were age (OR 1.02 [1.01-1.034], p = 0.001), anemia (OR 1.2 [1.18-3.31], p = 0.01), atrial fibrillation (OR 2.3 [1.08-4.89], p = 0.03), S. viridans-related IE (OR 0.47 [0.3-0.73], p = 0.001), and mitroaortic severe regurgitation (OR 2.4 [1.15-5.02], p = 0.019). Conclusions: Severe valvular regurgitation is very frequent among patients with NLSIE, but it does not worsen the prognosis of patients unless complicated with heart failure.

Effectiveness of Diachasmimorpha longicaudata in Killing Ceratitis capitata Larvae Infesting Commercial Fruits in Dryland Agroecosystems of Western Argentina

Ceratitis capitata (Wiedemann) (medfly) strongly affects Argentinean fruit production and export. Augmentative biological control using the exotic parasitoid Diachasmimorpha longicaudata (Ashmead) is currently applied to this problem. The ability to find and parasitize medfly larvae on a wide diversity of fruit host species is a key issue that needs to be analyzed. This research assessed the effect of the physical features of fruit on the preference of foraging D. longicaudata females and the influence of varying release density on parasitoid performance as a pest mortality factor in three fruit species. Trials were performed inside field cages under semi-arid environmental conditions in Argentina’s central-western fruit-growing region. Sweet orange, peach, and fig were tested. The fruits were inoculated with third-instar larvae of the Vienna-8 temperature-sensitive lethal medfly strain. Naïve, 5 d-old mated D. longicaudata females were released in cages at 20, 40, 80, and 160 parasitoid densities. The highest levels of medfly mortality and parasitoid emergence were recorded in fig and peach, although D. longicaudata also induced mortality in orange, a fruit with few physical features favorable to parasitism. The medfly mortality in all fruit host species significantly increased with an increased number of parasitoid females released into the field cages. Diachsmimorpha longicaudata has high potential as a medfly biocontrol agent.

Predictive Indicators and Outcomes of Pregnancies Affected by Stage I Twin-Twin Transfusion Syndrome Treated With Fetoscopic Laser Photocoagulation.

The significance of fetoscopic laser photocoagulation (FLP) in stage I twin-twin transfusion syndrome (TTTS) remains controversial. This study aimed to clarify the outcomes and prognostic factors of stage I TTTS after FLP. We conducted a retrospective cohort study on patients with stage I TTTS who underwent FLP in Japan. The primary outcome was neonatal survival at 28days. The adjusted odds ratios (aOR) of pre- and intraoperative factors for mortality in recipient and donor twins were calculated. This study included 272 twin pairs. The survival rate of at least one twin and both twins was 98% (267 pairs) and 85% (232 pairs), respectively. Survival of the recipient twin was observed in 253 cases (93%). No factor was associated with the mortality of the recipients. Among the donor twins, 246 (90%) survived. Preoperative twin anemia-polycythemia sequence (aOR, 17.45; 95% CI, 3.16-96.31) and arterio-arterial vascular anastomosis (AAA) identified at FLP (aOR, 2.78; 95% CI, 1.10-7.06) were independently associated with mortality of the donors. The neonatal survival rate for both recipient and donor twins was >90% among patients with stage I TTTS who underwent FLP. AAA is a risk factor for mortality in donors following FLP, though the pathophysiology of AAA remains to be clarified.

Analysis of early and treatment related deaths among children and adolescents with acute myeloid leukemia in Poland: 2005–2023

BackgroundA personalised approach to the treatment of acute myeloid leukemia (AML) in children and adolescents, as well as the development of supportive therapies, has significantly improved survival. Despite this, some patients still die before starting treatment or in an early phase of therapy before achieving remission. The study analysed the frequency, clinical features and risk factors for early deaths (ED) and treatment related deaths (TRD) of children and adolescents with AML.MethodsFrom January 2005 to November 2023, 646 children with AML treated in the centers of the Polish Pediatric Leukemia and Lymphoma Study Group according to three subsequent therapeutic protocols were evaluated: AML-BFM 2004 Interim (385 children), AML-BFM 2012 Registry (131 children) and AML-BFM 2019 (130 children).ResultsOut of 646 children, early death occurred in 30 children, including 15 girls. The median age was 10.7 years (1 day to 18 years). More than half of the patients (53%) were diagnosed with acute myelomonocytic leukemia (M5) and 13% with acute promyelocytic leukemia (M3). The ED rate for the three consecutive AML-BFM protocols was 4.9% vs. 5.3% vs. 3.1%, respectively. In 19 patients, death occurred before the 15th day of treatment, in 11 between the 15th and 42nd day. The most common cause of death before the 15th day (ED15) was leukostasis and bleeding, whereas between the 15th and 42nd day (ED15-42), infections, mainly bacterial sepsis. A significant association was found between ED15 and high leukocyte count (&amp;gt;10 × 109/L), M3 leukemia (p &amp;lt; 0.001), and ED15-42 and age &amp;lt;1 year (p = 0.029). In the univariate analysis only initial high leukocyte count &amp;gt;100 × 109/L, was a significant predictor of early death. The overall TRD for the entire study period was 3.4%. The main cause of death were infections, mainly bacterial sepsis (10 children out of 22, 45.4%).ConclusionsHyperleukocytosis remains significant factor of early mortality in patients with AML, despite the introduction of various cytoreductive methods. Infections are still the main cause of treatment related deaths. A more individualized approach by using new targeted drugs may be the therapeutic option of choice in the future.

The role of preoperative immunonutrition on morbidity and immune response after cystectomy: protocol of a multicenter randomized controlled trial (INCyst Trial)

IntroductionCancer, malnutrition, and surgery negatively impact patient’s immune system. Despite standardized surgical technique and the development of new perioperative care protocols, morbidity after cystectomy remains a serious challenge for urologists. Most common postoperative complications, such as infections and ileus, often lead to longer length of stay and worse survival. The immune system and its interaction with the gut microbiota play a pivotal role in cancer immunosurveillance and in patient’s response to surgical stress. Malnutrition has been identified as an independent and modifiable risk factor for both mortality and morbidity. Immunonutrition (IN) may improve the nutritional status, immunological function, and clinical outcome of surgical patients. Aims of the study are (1) to evaluate the impact of IN on morbidity and mortality at 30 and 90 days after cystectomy and (2) to determine immune and microbiota signature that would predict IN effect.MethodsThis is a randomized, multicentric, controlled, pragmatic, parallel-group comparative study, supported by the Swiss National Science Foundation. A total of 232 patients is planned to be enrolled between April 2023 and June 2026. Three participating centers (Lausanne, Bern, and Riviera-Chablais) have been selected. All patients undergoing elective radical and simple cystectomy will be randomly assigned to receive 7 days of preoperative IN (Oral Impact®, Nestlé, Switzerland) versus standard of care (control group) and followed for 90 days after surgery. For the exploratory outcomes, blood, serum, urine, and stool samples will be collected in patients treated at Lausanne. In order to determine the impact of IN on immune fitness, patients enrolled at Lausanne will be vaccinated against influenza and the establishment of the vaccine-specific immune response will be followed. Analysis of the microbiota and expression of argininosuccinate synthetase 1 as potential biomarker will also be performed.Discussion and conclusionStrengths of the INCyst study include the randomized, multicenter, prospective design, the large number of patients studied, and the translational investigation. This study will challenge the added value of preoperative IN in patients undergoing cystectomy, assessing the clinical effect of IN on the onset of postoperative morbidity and mortality after cystectomy. Furthermore, it will provide invaluable data on the host immune response and microbiota composition.Trial registrationClinicalTrials.gov NCT05726786. Registered on March 9, 2023.

Physical Inactivity and its Sociodemographic Determinants among Adults: A Community-Based Study

Introduction: Physical inactivity (PI) is the fourth leading risk factor for global mortality and is potentially modifiable. Understanding its sociodemographic correlates can contribute in planning preventive measures to reduce the same. Aims and Objectives: 1) To estimate the prevalence of PI among adults aged 20–60 years and 2) to identify the sociodemographic determinants of PI among adults. Material and Methods: A community-based cross-sectional study was done in district Aligarh, Uttar Pradesh. 304 adults aged 20–60 years, giving informed consent were selected by simple random sampling. Pregnant women and those with febrile disease and physical defect were excluded. Predesigned structured proforma and Global Physical Activity Questionnaire were used. Chi-square test and logistic regression analysis were applied using IBM SPSS 23.0. Results: Prevalence of PI was 47.7% (95% CI: 42.0–52.6). It was significantly higher in urban (55.3% vs 41.1%) than in rural area and among females than in males (68.7% vs 34.9%). PI during work was 74.3%, during travel 78.9%, and during recreation 88.5%. Being female increased odds of PI by almost ten times (adjusted odds atio (AOR) =9.7, 95% CI: 1.6–58.5). Unskilled workers/laborers and farmers (those involved in active occupational work) were found to have lesser odds of PI (AOR = 0.2, 95% CI: 0.1–0.5 and AOR = 0.2, 95% CI: 0.01–0.6, respectively). Conclusion: PI is highly prevalent among adults. Targeted interventions to increase physical activity in recreational domain are recommended, specially in urban areas and among women. Further studies to explore barriers to physical activity are needed to address this problem.

Mortality and Associated Factors in Patients with Systemic Sclerosis Associated Pulmonary Hypertension with and without Interstitial Lung Disease: A Long-Term Follow-up Study.

We aimed to analyze the prevalence, mortality, and prognostic factors in systemic sclerosis (SSc) patients with pulmonary hypertension (PH) with or without interstitial lung disease (ILD). The associations between mortality and demographics, transthoracic echocardiography, right heart catheterization (RHC), pulmonary functional parameters at baseline, and treatment modalities in two groups; patients with pulmonary arterial hypertension (PAH, PH without significant ILD) and PH + ILD were evaluated. The mean age of the patients was 56.6±13.5 (range: 34-82, 44 women/ 2 men), and 23 (52.3%) were deceased during a median follow-up of 45 months. The survival rates of PH-SSc patients were 91% for the first year, 75% for 2 years, 68% for 3 years, and 43.1% for 5 years. The majority of deceased patients were in the PH + ILD group (p=0.007). The PH + ILD group had more diffuse skin involvement, anti-Scl-70 positivity, high C-reactive protein, low FVC, and lower DLCO values. The deceased patients had higher ePASP, low CO, and FVC values compared to surviving patients. Median survival time was significantly better in patients on combined therapy (44 vs. 61 months, p=0.01). The mortality-related factors in the PH + ILD group were decreased initial FVC, high ePASP on echocardiography, low cardiac output on RHC, deteriorated functional class, and monotherapy. This is the first reported SSc-PH cohort from Turkey by a multidisciplinary team after the implementation of PAH-specific drugs. SSc-PH is a severe complication of SSc with high mortality especially in patients with accompanying severe ILD.

Determinants of under-five mortality in informal settlements in Nairobi, Kenya from 2002 to 2018

BackgroundChildhood mortality persists as a significant public health challenge in low and middle-income countries and is uneven within countries, with poor communities such as urban informal settlements bearing the highest burden. There is limited literature from urban informal settlements on the risk factors of mortality. We assessed under-five mortality and associated risk factors from the period 2002 to 2018 in Nairobi urban informal settlements.MethodsWe used secondary data from the Nairobi Urban Health and Demographic Surveillance System (NUHDSS), a longitudinal surveillance platform that routinely collects individual and household-level data in two informal settlements (Viwandani and Korogocho) in Nairobi, Kenya. We used Kaplan-Meier curves to estimate overall survival and the Cox proportional hazard model with a frailty term to evaluate the impact of risk factors on survival time.ResultsOverall under-five survival rate was 96.8% and this improved from 82.6% (2002-2006) to 95% (2007-2012) and 98.4% (2012-2018). There was a reduced risk of mortality among children who had BCG vaccination, those born to a married mother or a mother not engaging in any income-generating activity (both from 2007 to 2011), children from singleton pregnancy, children born in Viwandani slum and ethnicity of the child.ConclusionUnder-five mortality is still high in urban informal settlements. Targeted public health interventions such as vaccinations and interventions empowering women such as single mothers, those with multiple pregnancies, and more impoverished slums are needed to further reduce under-five mortality in urban informal settlements.

Serum sodium concentration predicting mortality in patients with aneurysmal subarachnoid hemorrhage

BackgroundTo date, inconsistent evidence exists on the role of hypernatremia in patients with aneurysmal subarachnoid hemorrhage (aSAH) who underwent surgical clipping. We aimed to investigate the association between serum sodium and mortality in these patients. MethodsA cohort study was performed to include adult patients with aSAH who underwent surgical clipping in a university hospital. The primary outcome was follow-up mortality. Propensity score matching (PSM) was used for matching patients’ baseline characteristics. Net reclassification improvement (NRI), and integrated discrimination improvement (IDI) were calculated to assess and compare the reclassification and discrimination capacity of different models. Trends in serum sodium over time were detected by the ordinary least squares model. ResultsOf 618 aSAH patients with surgical clipping during the study period, normal serum sodium was observed in 467 patients (75.6 %), and admission hypernatremia was noted in 151 patients (24.4 %). After adjustment with multivariate regression analysis, patients with hypernatremia had significantly higher odds for follow-up mortality (aOR: 2.86, 95 % CI: 1.54 to 5.30; P = 0.001). PSM analysis observed similar results (aOR: 2.38, 95 % CI: 1.29 to 4.55; P = 0.009). The incorporation of serum sodium during hospitalization markedly enhanced the IDI (P < 0.001) and NRI (P < 0.001) for the prediction of mortality. ConclusionsIn conclusion, the findings from this cohort study of aSAH patients with surgical clipping indicated that serum sodium can be an independent predictive factor of all-cause mortality, and inferior sequelae in aSAH patients. These findings endorsed the importance of managing hypernatremia and monitoring serum sodium in patients with aSAH.

Risks factors of adverse clinical outcomes in asymptomatic mitral regurgitation patients with preserved ejection fraction: a systematic review and meta-analysis.

Indication for mitral valve (MV) surgery in asymptomatic mitral regurgitation (MR) patients with preserved ejection fraction (EF) remains unclear. This study aims to identify risk factors of adverse clinical outcomes in asymptomatic MR patients with preserved EF for early indication of MV surgery. 3 databases were systematically searched to include studies with asymptomatic MR patients with preserved EF. Risk factors of adverse clinical outcomes (composite outcome of MACE and MV surgery indication), mortality, and left ventricular dysfunction (LVD) are pooled with a meta-analysis of random effect model. A total of 39 observational studies with 9135 asymptomatic moderate to severe MR patients are included. We identified 21 statistically significant risk factors for adverse outcomes. Increased natriuretic peptide, presence of atrial fibrillation, LV GLS > 20%, LVEDD > 35mm, LVESD > 22mm, and LAVI > 55ml/mm2, ERO > 55mm2, and regurgitation volume > 60ml (HR 2.21, 2.07, 4.23, 2.98, 4.05, 1.84, 4.02, 3.30, respectively; p-value < 0.05; I2 0-87%) are associated with greater risk of adverse clinical outcome. Risk factors associated with postoperative LVD are the increase of LVEDD, LVESD, and RVSP. Risk factors associated with mortality are increasing STS score and LV GLS. Several clinical parameters and risk factors can be used to stratify asymptomatic MR patients with preserved ejection fraction who could benefit from early indication for MV surgery.

Gender-specific correlates for suicide mortality in people with schizophrenia: a 9-year population-based study

BackgroundSchizophrenia is associated with a high mortality rate due to the high risk of suicide. However, there is still a lack of evidence on the gender-specific risk factors for suicide among people with schizophrenia. In this study, we aimed to measure the sociodemographic and clinical correlates of suicide deaths in different genders among people with schizophrenia.MethodsData on patients with schizophrenia from 2013 to 2021 in Guangzhou, China were obtained from the National Information System for Psychosis (NISP), involving a total of 33,080 patients. Cox regression and Fine-Gray models were used to explore the sociodemographic and clinical risk factors for suicide mortality in different genders.ResultsThe overall age-standardized mortality rates due to suicide were 133.89 (95% CI: 124.31-143.47) per 100,000 person-years for females and 163.25 (95% CI: 152.92-173.59) per 100,000 person-years for males. To be specific, lack of medical insurance, history of non-treatment, and history of suicidal behavior was associated with a higher risk for suicide mortality for females, while an age of 35–54, being hospitalized once, and the age of onset being > 28 years were linked to lower risk for suicide mortality for males. For both genders, a lower risk for suicide mortality was observed in patients at an older age (≥ 55 years) and with a history of hospitalization more than once, and a higher suicide mortality risk was found in married patients and those residing in rural areas.ConclusionThe present study found that gender differences should be taken into account in the development of suicide prevention programs for people with schizophrenia, and future research is still required to verify our preliminary results.

Evaluating predictors of mortality in octogenarians undergoing urgent or emergent trauma laparotomy.

This study aimed to identify associated risk factors for mortality in octogenarian trauma patients undergoing urgent or emergent laparotomy (UEL). Trauma patients ages 80-89 years-old undergoing UEL within 6-hours of arrival were included. A multivariable logistic regression analysis was performed to determine associated risk of mortality. From 701 octogenarians undergoing UEL, 324 (46.2%) died. Compared to survivors, UEL octogenarians who died had higher rates of cirrhosis (3.5% vs. 1.1%, p = 0.028), injuries to the brain (17.3% vs. 5.6%, p < 0.001), heart (8.6% vs. 1.6%, p < 0.001), and lung (57.4% vs. 23.9%, p < 0.001) and lower rates of functional independence (6.4% vs. 12.6%, p = 0.007). The strongest independent associated patient-related risk factor for death was cirrhosis (OR 8.28, CI 2.25-30.46, p = 0.001). However, undergoing concurrent thoracotomy increased risk of death significantly (OR 16.59, CI 2.07-132.76, p = 0.008). Functional independence was not associated with mortality (p > 0.05). This national analysis emphasizes the need to identify and manage pre-existing conditions like cirrhosis and not determine futility based on pre-trauma functional status alone. Concurrent thoracotomy for hemorrhage control increases risk of death over 16-fold.

Body Weight's Role in Infective Endocarditis Surgery.

Objective: to investigate how body mass index (BMI) affects the outcome in patients treated surgically for infective endocarditis (IE). Methods: This is a single-center observational analysis of consecutive patients treated surgically for IE. We divided the cohort into six groups, according to the WHO classification of BMI, and performed subsequent outcome analysis. Results: The patient population consisted of 17 (2.6%) underweight, 249 (38.3%) normal weight, 252 (38.8%) overweight, 83 (12.8%) class I obese, 28 (4.3%) class II obese, and 21 (3.8%) class III, or morbidly obese, patients. The median age of the entire cohort was 64.5 [52.5-73.6] years. While only 168 (25.9%) patients were female, women significantly more often exhibited extremes in regards to BMI, including underweight (47.1%) and morbid obesity (52.4%), p = 0.026. Class II and III obese patients displayed more postoperative acute kidney injury (47.9%), p = 0.003, more sternal wound infection (12.9%), p < 0.001, worse 30-day survival (20.4%), p = 0.031, and worse long-term survival, p = 0.026, compared to the results for the other groups. However, the multivariable analysis did not identify obesity as an independent risk factor for 30-day mortality, with an odds ratio of 1.257 [0.613-2.579], p = 0.533. Rather, age > 60, reduced LVEF < 30%, staphylococcal infection, and prosthetic valve endocarditis correlated with mortality. While BMI showed poor discrimination in predicting 30-day mortality on the ROC curve (AUC = 0.609), it showed a fair degree of discrimination in predicting sternal wound infection (AUC = 0.723). Conclusions: Obesity was associated with increased comorbidities, complications, and higher postoperative mortality in IE patients, but it is not an independent mortality risk factor. While BMI is a poor predictor of death, it is a good predictor of sternal wound infections.

Early Period Survival and Neurologic Prognosis in Newborns with Perinatal Asphyxia: A Tertiary Center Experience and a Mortality Chart

Background: Clinicians require more data regarding mortality and brain damage risk factors in perinatal asphyxia. Objectives: To assess early term outcomes and identify mortality risk factors in perinatal asphyxia. Methods: This study was conducted in a referral-center tertiary intensive care unit in Istanbul, Turkey, between 2016 and 2023. We included all patients who underwent therapeutic hypothermia treatment due to perinatal asphyxia. We recorded laboratory follow-up data, magnetic resonance imaging (MRI) findings, amplitude-integrated electroencephalograms (aEEG) results, mortality, and clinical outcomes. Both conventional frequentist statistical methods and Bayesian methods were used for analysis. Results: A total of 164 patients were included in the study, with an overall mortality rate of 9.8%. Risk factors for mortality included LDH, troponin I, INR, lactate, 2nd day creatinine, voltage anomalies, seizures, and male gender, as well as APGAR scores. A basic chart for mortality prediction was developed. The Sarnat score showed strong evidence, and APGAR 1 showed anecdotal evidence for association with brain damage, although brain damage was independent of laboratory results and other clinical findings, based on moderate and anecdotal evidence from Bayesian calculations. Cranial MRI findings revealed profound damage in 14.8% of Sarnat 1, 21.8% of Sarnat 2, and 50% of Sarnat 3 patients. Conclusions: This study presents prognostic factors for survival and brain damage in perinatal asphyxia. We recommend obtaining cranial MRI for all patients diagnosed with asphyxia, as most laboratory tests were independent of brain damage. Given that profound brain damage can occur even in Sarnat stage I patients, we emphasize the importance of therapeutic hypothermia for these patients.

CHARACTERISTICS OF THE HOSPITALIZATION PERIOD IN PATIENTS WHO DIED AS A RESULT OF COVID-19 WITH ACUTE CARDIOVASCULAR COMPLICATIONS

The aim. To identify adverse risk factors in hospitalized patients with fatal consequences of the coronavirus disease-2019 and its acute cardiovascular complications. Materials and methods. A retrospective study was conducted of 66 people in the study group with acute respiratory failure and cardiovascular complications due to COVID-19. The comparison group was 48 people who died of acute cardiovascular events without SARS-CoV-2 infection or other bacterial or viral diseases. The criteria for inclusion in the study group were the presence of confirmed SARS-CoV-2 infection by the polymerase chain reaction method, the presence of acute cardiovascular complications during COVID-19, and patients hospitalized during its treatment. Inclusion criteria for the comparison group were hospitalized patients with acute cardiovascular diseases that led to death without SARS-CoV-2 infection. The exclusion criteria for both groups were: age before 18 years old; absence of informed consent of the authorized person of dead person or the decision of the authorized person to withdraw from the study at any of the stages; the presence of other co-infections that could have a cumulative negative effect on the state of the respiratory and cardiovascular systems (flu virus, hepatitis virus, human immunodeficiency virus, pathogens that led to symptoms of acute intestinal infections). Age and gender distribution, comorbidities, length of hospitalization, and laboratory markers were evaluated in both cohorts. Cardiovascular complications were confirmed by the results of ultrasound examinations, computed tomography angiography and comparison with postmortem morphological findings in autopsy reports for the analysis of the current study,. The results. There were 48 men (72.7%) and 18 women (27.3%) in the study group of 66 patients who developed cardiovascular complications at the background of COVID-19, and in the comparison group – 39 men (81.3%) and 9 women (18.7%), which indicates acceptable comparability of the groups among themselves due to sex (p=0.374) and age (p=0.338). In particular, the age median for men in the study group was 65 years (IQR - 21 years), with minimum and maximum age values ​​– 36 and 83 years, respectively; the median age for women in the study group was also 65 years (IQR – 12.5 years), with the lower and upper age limits in the group being 41 and 78 years. The age median for men in the comparison group was 62 years (IQR 15 years), with a lower and upper age range of 54 and 81 years. The age median for women in the comparison group was 68 years (IQR – 16.5 years), with the lower and upper age values ​​in the group being 55 and 79 years. Men and women of the comparison group did not statistically differ from each other in terms of age (р=0.412). A significant difference was found between the length of hospitalization in both cohorts (р˂0.00001) – the median length of stay in hospital for the study group was 15 days, and for the comparison group – 10 days. It was established that malignant diseases were an additional concomitant factor of mortality in the group of patients with COVID-19 (р=0.043). The percentage ratio of neutrophils (p=0.048) and lymphocytes (p=0.031) in patients of the study group significantly differed. Conclusions. Unfavorable risk factors in patients with fatal consequences of Coronavirus disease-2019 and acute cardiovascular complications were concomitant oncological pathology, a long period of hospitalization, and changes in the percentage ratio of neutrophils and lymphocytes.

Former jean sandblasters die younger.

Silicosis remains a critical public and occupational health issue, exacerbated by its expansion into non-traditional industries and resulting in significant global morbidity and mortality. This study aims to investigate the death rates associated with silicosis from jean sandblasting by comparing the results of diagnosed individuals to those of the general population. Conducted from 2008 to 2023 in Taşlıçay and Toklular villages, Bingöl City, Turkey, this retrospective cohort study analysed mortality among 220 diagnosed males versus 2851 undiagnosed residents. Data were derived from the Cohort database and validated with the Bingöl Provincial Health Directorate and the Turkish Statistical Institute. Statistical analysis involved univariate comparisons and survival analysis, utilizing the Mann-Whitney U-test, Kruskal-Wallis test and Cox proportional hazards model, with significance set at P < 0.05. The analysis revealed a silicosis mortality rate of 10% in diagnosed individuals over 15 years, notably higher than the 4% in the general population. Higher radiological profusions and younger ages at diagnosis were significant mortality factors. A radiological profusion above five notably increased the mortality risk by 1.37 times, with age and radiological density proving critical in survival rates. This research highlights the increased mortality risk in silicosis patients, particularly among former jean sandblasters, underscoring the significant effects of radiological density and early age exposure on mortality, thereby addressing a crucial gap in understanding the impact of silicosis on life expectancy and community health.

Evaluation of mid-term outcomes of partial and intermediate atrioventricular canal defect surgery.

The risk factors for reoperation and mortality after partial and intermediate atrioventricular canal defect repair are unclear. This study assessed the mid-term outcomes and risk factors for reoperation and mortality after partial and intermediate atrioventricular canal defect surgery. Ninety-seven patients who underwent primary repair of intermediate (n = 45) or partial (n = 52) atrioventricular canal defect between 2005 and 2019 were included in this single-centre study. The median age was 5 years (2.7-8.9 years). The median follow-up time was 32 months (1.6-90.8 months). The estimated freedom from reoperation at 1, 5, and 10 years was 97%, 91%, and 73%, respectively.In multivariable analyses, post-operative left atrioventricular valve regurgitation of grade II or higher (odds ratio [OR]: 5.3, 95% confidence interval [CI]: 1.8-15.5, p = 0.01) and post-operative residual intracardiac shunt (OR: 11.6, 95% CI: 1.6-85.8, p = 0.02) were risk factors for reoperation.In multivariable analyses, perioperative reoperation (OR: 93.4, 95% CI: 3.9-218.7, p = 0.01) and the need for right atrioventricular valve repair (OR: 11.2, 95% CI: 1.0 - 123.3, p = 0.04) were risk factors for mortality. Mortality was higher in patients under 2.6 years of age. For patients undergoing repair of partial or intermediate atrioventricular canal defect, those with post-operative left atrioventricular valve regurgitation of grade II or higher and post-operative residual intracardiac shunt have an increased reoperation risk. Higher mortality can be expected after a perioperative reoperation, and in patients requiring right atrioventricular valve repair during the index procedure.

Clinical features and risk factors for outcome in hemodialysis patients with COVID-19 after complete liberalization of epidemic control in China.

Patients undergoing hemodialysis (HD) are highly vulnerable during the COVID-19 pandemic. We aimed to investigate the risk factors associated with the severity of COVID-19 and death after the complete liberalization of epidemic control in China. We followed the outcomes of the HD patients of Central Hospital of Dalian University of Technology, from December 6, 2022 to January 8, 2023. The non-contrast enhanced chest computed tomography (CT) was performed on all COVID-19-infected hospitalized patients. We recorded the patient's clinical characteristics, demographic features, vaccination history, treatments, and lung lesions. Odds ratios and 95% confidence intervals were calculated using logistic regression models to identify independent risk factors for COVID-19-related severity and mortality. This study included a total of 858 hemodialysis patients, of which 660 were infected with COVID-19. The mean age was (55.61±14.61) years, with a median (interquartile range) dialysis duration of 44.5 (69.5) months. Over half (60%) of the study participants were male, and the majority had hypertension as a comorbidity. Multivariable analysis revealed that age, pre-dialysis diastolic pressure, fever, white blood cell (WBC) count, potassium, β2-microglobulin level and calcium were independent risk factors for disease severity, while platelets, urea nitrogen and creatinine were identified as independent protective factors. Furthermore, total iron- binding capacity and vaccination were found to be independent protective factors against mortality, and WBC count was an independent risk factor for in-hospital mortality (p &lt; 0.05). The most frequent CT finding among hospitalized patients with chest symptoms was patchy shadow or pleural effusion, observed in 64.8% of cases. More than half of the patients exhibited bilateral lung lesions, and over 60% involved two or more lobes. The majority of HD patients are susceptible to COVID-19. Demographic, clinical features and laboratory indicators can be used to predict the severity and mortality associated with COVID-19. Our findings will assist clinicians in identifying markers for the early detection of high mortality risk in HD patients with COVID-19.

Financial impact of pandemics on pension sustainability: an application for Spain

AbstractEpidemiologists are warning that the next pandemic is almost around the corner. As we have seen during the COVID-19 pandemic, the death toll was at the highest for over 60th, transforming the population pyramids. In times of pandemics, two effects on sustainability of the pay-as-you-go (PAYG) pension scheme go in different directions: the increase in old-age mortality (leading to a decrease in pension spending) and the increase in unemployment (leading to a decline in income from contributions). In this paper, we investigate the long-term effects of pandemics on the financial sustainability of PAYG pension schemes, taking into account changes in both mortality and unemployment factors. Using functional data analysis we develop projections of population pyramids and allow for anticipated mortality jumps as a result of future pandemics. An application is carried out using mortality and fertility data from Spain. Given some plausible assumptions, our findings indicate, firstly, that the financial sustainability of the Spanish pension system is compromised. Secondly, in the event of a pandemic, we observe that financial sustainability is primarily driven by the mortality effect—resulting in a decrease in pension expenditure—while the impact of unemployment is almost negligible.

Risk Factors and Outcomes of Patients with Pseudomonas aeruginosa Bloodstream Infection in the Intensive Care Unit

Background: Bloodstream infections (BSIs) caused by Pseudomonas aeruginosa have high mortality rates and pose a significant threat to healthcare settings. Objectives: We aimed to investigate the clinical risk factors related to mortality and the development of P. aeruginosa with difficult-to-treat resistance (DTR-PA) BSI in the intensive care unit. Methods: This was a retrospective, single-center study that included patients with P. aeruginosa BSI who were hospitalized between 2020 and 2022. The risk factors affecting 30-day mortality and the development of DTR-PA were investigated using both univariate and multivariate analyses. Results: A total of 140 patients were analyzed. The mean age was (66 ± 17.5) years, and 48% of the patients were male. Previous meropenem use was an independent risk factor for DTR-PA BSI (odds ratio, 2.68; 95% CI, 1.24 to 5.80; P = 0.012). Multivariate analysis demonstrated that the requirement for inotropic support was an independent risk factor for 30-day mortality [hazard ratio, 2.50; 95% confidence interval (CI), 1.33 to 4.68; P = 0.004]. Conclusions: Prior meropenem use was an independent risk factor for DTR-PA development. Strict policies for Carbapenem use and infection control procedures are essential to combat infections caused by DTR-PA.