Higher Risk Of Fatal Outcome Research Articles

Is there evidence for negative effects of antidepressants on suicidality in depressive patients?

The role of antidepressants in suicide prevention is a major public health question given the high prevalence of both depression and depression-related suicidality. Therefore all available means should be utilised to clarify the influence of antidepressants on suicidality, especially in view of the ongoing intensive debate about possible suicidality-inducing effects of antidepressants that may outweigh their traditionally hypothesised beneficial effects. This paper gives a systematic and comprehensive review of the empirical data which might indicate that antidepressants have negative effects on suicidality. First, principal methodological issues related to this research question are discussed. Thereafter, the results of controlled trials and epidemiological and cohort studies are presented. Altogether, there seems to be only a small amount of evidence from different research approaches that antidepressants, not only serotonin reuptake inhibitors (SSRIs), might induce, aggravate or increase the risk of suicidal ideation and suicide attempts. As to suicide, there are no hints in this direction. TCAs have a higher risk of fatal outcome in overdose compared to SSRIs, which, in case of mono-intoxication, carry almost no risk of lethal consequences. The ongoing discussion about suicidality-inducing effects should not prevent physicians from prescribing SSRIs and other antidepressants to their patients if they are clinically indicated. However, they should take into account potential risks and manage them by good clinical practice.

Fatalities in Swedish skydiving

Exact risk patterns in skydiving fatalities are not well known, but incomplete world injury data indicate that many are preventable. A comprehensive national material for Sweden of 37 skydiving fatalities 1964–2003 were reviewed to identify risk factors. In relation to jump volume, the period 1994–2003 had a fatality rate 11 times lower than 1964–1973. Student skydivers had the highest risk of fatal outcome, often caused by instability in freefall leading to unstable parachute activation with subsequent line entanglement, or parachute activation failure. Unintentional water landings also contributed to student fatality, with life jacket malfunctions, neglect to use life jackets, and automatic reserve parachute activation devices activated by water as aggravating factors. One-third of all fatalities had an inflated and operational parachute at some point prior to injury. A drastic worldwide increase in fatal landing incidents with fast wing parachutes during the 1990s did not occur in Sweden. Every fourth fatality caused by rapid deceleration against ground or water survived impact and died during transports or in hospitals. Rescue units and health care providers can improve management of skydiving incidents from knowledge about the incident and injury mechanisms we have described, and the skydiving community can target risk factors in preventive safety work.

Identification of long-term prognostic markers in heart failure patients with restrictive filling pattern using doppler echocardiography

Background: Restrictive left ventricular filling pattern (RFP) is a well-known poor prognostic marker tn patients with congestive head failure (CHF). However, the information regardtng the prognostic marker in CHF patients with RFP is scarce. The aim of the present study was to look for long-term prognostic markers in CHF with RFP using echocardiography. Methods and results: 40 CHF patients (26 men, age = 5404 yrs) with RFP were followed for 35*19 months. Using Doppler echocardiography. early(E) and late(A) filling velocities, deceleration time(DT) of E wave, and early and late(A) mitral annulus velocities were measured. The reversibility of RFP was defined as a reversal of E/A ratio with Valsalva maneuver. Mean ejection fraction was 30.0-l 2.7%. During the follow-up period, 16 patients died of cardiac causes. Nonsurvivors showed lower A (0.29 vs 0.37 m/s, p = 0.04) and lower A’ (4.3 vs 5.3 cmls, p = 0.02). Also, mortality was higher in patients with irreversible RFP (52 vs 13 %, p = 0.01). However, left ventricular ejection fraction, DT of early filling and left atria size did not show significant difference. Multivariate analysis revealed A’ (p=O.O2), followed by A (p=O.O4), as the only independent predictor of subsequent cardiac death. Patients at high risk for fatal outcome could be identified by A’ < 4 cm/s (p = 0.030, C.I. = 0.000-0.000) and A < 0.32 m/s (p = 0.023, C.I. = 0.000 0.046) in Cox regression analysis. Conclusion: A’ and A were independent prognostic markers in CHF patients RFP.

Prognostic value of nocturnal Cheyne-Stokes respiration in chronic heart failure.

Nocturnal Cheyne-Stokes respiration (CSR) occurs frequently in patients with chronic heart failure (CHF), and it may be associated with sympathetic activation. The aim of the present study was to evaluate whether CSR could affect prognosis in patients with CHF. Sixty-two CHF patients with left ventricular ejection fraction </=35%, in NYHA class II to III, underwent clinical evaluation, Doppler echocardiography, ergospirometry, phenylephrine test, Holter recording, and a sleep study to evaluate the occurrence of CSR, expressed as percentage of periodic breathing, and apnea/hypopnea index (AHI) (ie, the number of apneas and hypopneas per hour of recording). During a mean follow-up of 28+/-13 months, 15 patients died of cardiac causes. Nonsurvivors were in a higher NYHA functional class than survivors (P<0.001) and had a more depressed left ventricular ejection fraction (P<0.03), a shorter deceleration time of early filling (P<0. 05), larger left and right atria (P<0.05 and P<0.02, respectively) and a lower peak V(O2) (P<0.05). Nonsurvivors also spent a greater percentage of the night in periodic breathing (P<0.01) with a greater AHI (P<0.03) and showed lower values of diurnal baroreflex sensitivity (P<0.05) and of heart rate variability (sdNN: P<0.01). Multivariate analysis revealed the AHI (chi2, 10.4; P<0.01), followed by left atrial area (chi2, 5.7; P<0.01), as the only independent and additional predictors of subsequent cardiac death. Patients at very high risk for fatal outcome could be identified by an AHI >/=30/h and left atria >/=25 cm2. The AHI is a powerful independent predictor of poor prognosis in clinically stable patients with CHF. The presence of an AHI >/=30/h adds prognostic information compared with other clinical, echocardiographic, and autonomic data and identifies patients at very high risk for subsequent cardiac death.

Correlates of Outcome Following Acute Glutethimide Overdosage

Potential predictors of outcome following acute glutethimide overdosage were assessed in 63 patients hospitalized with this diagnosis at a large urban medical center between 1962 and 1975. Their mean age was 34 years (range, 15 to 84 years) and 62% were female. Assisted ventilation was required in 59% of cases, and 32% developed hypotension. Six patients died, including all three aged 60 years or older. Multiple regression analysis confirmed that age was the major identifiable determinant of survival, regardless of other factors. Among identifiable determinants of coma grade, glutethimide dose, glutethimide plasma concentration, and coingestion of barbiturates were the most important. An ingested dose of 10 g or more, or a plasma concentration exceeding 30 microgram/ml, was almost always associated with deep coma. However, a relatively small ingested dose or a low plasma level by no means ruled out development of serious intoxication, particularly in those patients who also ingested barbiturates. Thus elderly individuals are at high risk for fatal outcome following glutethimide overdosage and should receive priority for intensive care and monitoring. Glutethimide dose, plasma concentration, and history of coingestion of barbiturates are of value in predicting development of deep coma. These items of information should be obtained on admission whenever possible.