Hospital Lethality Research Articles

Opportunistic Infections among People Living with HIV in the Infectious Disease Department, the University Hospital of Fann in Dakar, Senegal

Aim: The aim of this study was to identify the main infections and opportunistic infections in hospitalized patients living with HIV and to determine the hospital lethality rate. Patients and Methods: This was a retrospective, descriptive study of patients hospitalized in the infectious diseases department of the University Hospital of Fann over a 02-year period from 1 January 2021 to 31 December 2022. Results: We recorded 308 cases, 296 of which were patients living with HIV, out of a total of 1208 patients admitted to the department, a hospital prevalence rate of 24.5%. The average age of the patients was 43.3 ± 13.3 years, with a sex ratio of 0.7. One hundred and thirty-one patients (44.26%) were married. 22.97% had no occupation and 35.5% of patients came from home. The average diagnostic period was 3.9 days ± 4.78 days. Two hundred and five patients (69.26%) were at WHO stage 4. Tuberculosis was the most common bacterial infection, with 114 cases (38.5%), followed by common bacterial pneumonia (7.77%) and septicemia (4.72%). With regard to viral infections, the prevalence of viral hepatitis B was 6.76%, followed by herpes (1.68%). Among parasitic infections, toxoplasmosis was noted in 6.41% and cryptosporidiosis in 2.02%. Candidiasis was the most common fungal opportunistic infection, affecting forty-three patients (14.52%), followed by pneumocystis (7.09%) and cryptococcosis (2.36%). More than a third of our patients (37.84%) had severe anaemia, with haemoglobin levels below 8g/dl. Nearly a quarter of patients (21.28%) had impaired kidney function. Conclusion: HIV infection occurs in young adults at a late stage. Mortality remains high due to opportunistic infection. It is essential to carry out early screening, but above all to make available diagnostic tools and certain molecules for treatment of opportunistic infections.

Impact of Consistent and Inconsistent Creatine Kinase-MB and Troponin Levels on Hospital lethality in Acute Coronary Disorder

Background: Serum CK-MB and cardiac troponin are important diagnostic predictors used to determine the prognosis of patients with acute coronary disorders (ACD). However, the effects of these biomarkers on hospital lethality remain underexplored. Objective: This research aimed to determine the effects of consistent and inconsistent CK-MB and troponin levels on hospital mortality in ACD patients. Methodology: This comparative study was conducted on patients with confirmed ACD admitted to a tertiary care hospital from January 2023 till June 2024. Patients were categorized into two groups based on the consistency of their CK-MB and troponin levels during hospitalization: consistently elevated or normal biomarkers versus those with variable levels. Hospital lethality was defined as mortality occurring during the hospital stay. SPSS version 26 was used for statistical analysis. The study utilized multivariate logistic regression to ascertain independent factors that are associated with hospital death. For continuous variables, t-tests or Mann-Whitney U tests were employed, and for categorical data, chi-square tests. Results: There were 500 patients in the trial; 250 were in the inconsistent group and 250 were in the consistent group. In the inconsistent group, the hospital fatality rate was 18%, while in the consistent group it was 10% (p < 0.05). Variability in biomarker levels was an independent predictor of higher hospital mortality, according to multivariate analysis (OR 2.5, 95% CI 1.5–4.2). Conclusion: Inconsistent CK-MB and troponin levels were associated with higher hospital mortality in ACD patients. Monitoring and stabilizing these biomarkers may be essential for improving patient outcomes and guiding therapeutic interventions in acute care settings.

Effectiveness of Surgical Treatment of Patients with Destructive Pulmonary Tuberculosis (Meta-Analysis)

The objective: to study effectiveness of surgical methods for treatment of various forms of destructive pulmonary tuberculosis (meta-analysis).Subjects and Methods. A systematic search was performed in electronic bibliographic databases, including PubMed and Google Scholar. Cohort studies published from January 1, 2019 to June 20, 2023 were selected, those studies were aimed to assess effectiveness of surgical treatment in patients with destructive tuberculosis using resections of various volume. For meta-analysis, 9 studies published in 2019 - 2023 were selected.Results. The effectiveness of comprehensive treatment with resections of various volume in destructive pulmonary tuberculosis patients made 85.3%. The success of surgical treatment in patients with fibrous cavernous pulmonary tuberculosis was somewhat less – 80.3%. At the same time, the incidence of postoperative complications in patients with fibrous cavernous pulmonary tuberculosis was higher and could reach 42.5%, while in the group patients with destructive tuberculosis, it was 27.3%. Some postoperative complications required repeated operations. The ratio of surgeries to patients was the following: 3263 surgical interventions per 1564 patients (average 2.08 surgeries per patient). Hospital lethality among patients with fibrous cavernous pulmonary tuberculosis after surgical treatment was 2.6%, and tuberculosis mortality within 5 years after surgery was 4.8%. The relapse rate among patients with fibrous cavernous pulmonary tuberculosis after surgical treatment was 7.1%.

Individual and contextual factors associated with the survival of patients with severe acute respiratory syndrome by COVID-19 in Brazil.

To analyze the influence of individual and contextual factors of the hospital and the municipality of care on the survival of patients with Severe Acute Respiratory Syndrome due to COVID-19. Hospital cohort study with data from 159,948 adults and elderly with Severe Acute Respiratory Syndrome due to COVID-19 hospitalized from January 1 to December 31, 2022 and reported in the Influenza Epidemiological Surveillance Information System. The contextual variables were related to the structure, professionals and equipment of the hospital establishments and socioeconomic and health indicators of the municipalities. The outcome was hospital survival up to 90 days. Survival tree and Kaplan-Meier curves were used for survival analysis. Hospital lethality was 30.4%. Elderly patients who underwent invasive mechanical ventilation and were hospitalized in cities with low tax collection rates had lower survival rates compared to other groups identified in the survival tree (p<0.001). The study indicated the interaction of contextual factors with the individual ones, and it shows that hospital and municipal characteristics increase the risk of death, highlighting the attention to the organization, operation, and performance of the hospital network.

Characteristics and Management of Pyogenic Liver Abscess: A Rural Senegalese Experience

Background: The incidence of pyogenic liver abscess (PLA) has increased in recent years with the development of digestive surgery, particularly hepatobiliary surgery. In recent decades, progress in diagnostic techniques have improved patient prognosis. In Senegal, there are few studies of PLA. This study was carried out within this context.&#x0D; Objective: The main objective was to describe the profile and the management of pyogenic liver abscesses cases in rural Senegal.&#x0D; Results: We collected 17 cases of PLA among 47.553 patients, during the study period, representing a hospital frequency of 0.035%. The mean age of patients was 48.6 ± 18.9. The sex ratio (M/F) was 2:4. Most of the patients (58.82%) had at least one risk factor, the main ones being smoking, a history of abdominal surgery and alcoholism. Right upper abdominal pain was the main reason for consultation (94.11%). Right basithoracic pain and cough were the most frequent respiratory symptoms. Escherichia coli remained the most frequently isolated bacteria. The mean time to diagnosis was 17.8 days ± 14.4. All patients received antibiotic therapy, which was combined with echo-guided liver aspiration in 58.82% cases. Mean hospital stay was 17.5 days ± 7.65. The hospital lethality rate was 29.41%.&#x0D; Conclusion: Liver abscesses are most often of amoebic origin in our context, but in recent years there has been an increase in cases of pyogenic liver abscesses, with the progress made in diagnosis.

Multivisceral resection of advanced colon and rectal cancer: a prospective multicenter observational study with propensity score analysis of the morbidity, mortality, and survival.

In the surgical treatment of colorectal carcinoma (CRC), 1 in 10 patients has a peritumorous adhesion or tumor infiltration in the adjacent tissue or organs. Accordingly, multivisceral resection (MVR) must be performed in these patients. This prospective multicenter observational study aimed to analyze the possible differences between non-multivisceral resection (nMVR) and MVR in terms of early postoperative and long-term oncological treatment outcomes. We also aimed to determine the factors influencing overall survival. The data of 25,321 patients from 364 hospitals who had undergone surgery for CRC (the Union for International Cancer Control stages I-III) during a defined period were evaluated. MVR was defined as (partial) resection of the tumor-bearing organ along with resection of the adherent and adjacent organs or tissues. In addition to the patients' personal, diagnosis (tumor findings), and therapy data, demographic data were also recorded and the early postoperative outcome was determined. Furthermore, the long-term survival of each patient was investigated, and a "matched-pair" analysis was performed. From 2008 to 2015, the MVR rates were 9.9 % (n=1,551) for colon cancer (colon CA) and 10.6 % (n=1,027) for rectal cancer (rectal CA). CRC was more common in men (colon CA: 53.4 %; rectal CA: 62.0 %) than in women; all MVR groups had high proportions of women (53.6 % vs. 55.2 %; pairs of values in previously mentioned order). Resection of another organ frequently occurred (75.6 % vs. 63.7 %). The MVR group had a high prevalence of intraoperative (5.8 %; 12.1 %) and postoperative surgical complications (30.8 % vs. 36.4 %; each p<0.001). Wound infections (colon CA: 7.1 %) and anastomotic insufficiencies (rectal CA: 8.3 %) frequently occurred after MVR. The morbidity rates of the MVR groups were also determined (43.7 % vs. 47.2 %). The hospital mortality rates were 4.9 % in the colon CA-related MVR group and 3.8 % in the rectal CA-related MVR group and were significantly increased compared with those of the nMVR group (both p<0.001). Results of the matched-pair analysis showed that the morbidity rates in both MVR groups (colon CA: 42.9 % vs. 34.3 %; rectal CA: 46.3 % vs. 37.2 %; each p<0.001) were significantly increased. The hospital lethality rate tended to increase in the colon CA-related MVR group (4.8 % vs. 3.7 %; p=0.084), while it significantly increased in the rectal CA-related MVR group (3.4 % vs. 3.0 %; p=0.005). Moreover, the 5-year (yr) overall survival rates were 53.9 % (nMVR: 69.5 %; p<0.001) in the colon CA group and 56.8 % (nMVR: 69.4 %; p<0.001) in the rectal CA group. Comparison of individual T stages (MVR vs. nMVR) showed no significant differences in the survival outcomes (p<0.05); however, according to the matched-pair analysis, a significant difference was observed in the survival outcomes of those with pT4 colon CA (40.6 % vs. 50.2 %; p=0.017). By contrast, the local recurrence rates after MVR were not significantly different (7.0 % vs. 5.8 %; both p>0.05). The risk factors common to both tumor types were advanced age (>79 yr), pT stage, sex, and morbidity (each hazard ratio: >1; p<0.05). MVR allows curation by R0 resection with adequate long-term survival. For colon or rectal CA, MVR tended to be associated with reduced 5-year overall survival rates (significant only for pT4 colon CA based on the MPA results), as well as, with a significant increase in morbidity rates in both tumor entities. In the overall data, MVR was associated with significant increases in hospital lethality rates, as indicated by the matched-pair analysis (significant only for rectal CA).

Sociodemographic Factors, Comorbidities, In-Hospital Complications, and Outcomes of Ischaemic Stroke Patients in the Context of the COVID-19 Pandemic in Lithuania: A Retrospective, Record-Based, Single-Centre Study.

The role of COVID-19 regarding in-hospital complications and poor outcomes for patients with ischaemic stroke (IS) is still important to explore. The aim of this study was to evaluate the risk of in-hospital lethality for IS patientsrespectivelyto their comorbidities and in-hospital complications in the context of the COVID-19 pandemic. We identified 1898 acute IS patients (749 men and 1149 women)admitted to the Lithuanian University of Health Sciences Kaunas Hospital, Lithuania, from December 2020 to February 2022. The sociodemographic, clinical, and outcome features of the patients were evaluated deploying appropriate statistical tests. Hazard ratios and 95% confidence intervals were estimated by the Cox proportional hazards regression for hospital lethality. The risk of in-hospital lethality was 2.22 times higherin mensuffering from IS and chronic ischaemic heart disease (cIHD) compared to thosewith IS and isolated arterial hypertension (iAH) (p < 0.05). COVID-19 elevated the risk of in-hospital lethality in men by3.16 times (p < 0.05). In comorbid womenwith type two diabetes mellitus (DM) or cIHD, the risk of in-hospital lethality was two times higher compared to thosewith iAH (p < 0.05). The risk of in-hospital lethality increased significantly in both men and women, with the total number of in-hospital complications increasing per one unit. Of the comorbidities studied, DM and cIHD together with COVID-19elevated the risk of in-hospital lethality significantly. Within the acute in-hospital complications, pneumonia with respiratory failure and acute renal failure showed the most significant prognostic value anticipating lethal outcomes for IS patients.

Outcome of 42 thousands cases of SARS-CoV-2 in a municipality: Role of symptoms in outcome.

INTRODUCTION: The coronavirus disease 2019 (COVID-19) pandemic is a major public health problem worldwide with high rates of morbidity and mortality. Elderly patients or patients with comorbidities are more likely to develop more severe conditions and consequently have a high rate of hospital lethality. The presence of some symptoms in SARS-CoV-2 infection can be associated with lower rates of mortality and admission to the ICU in patients. The aim of this study was to determine the associations between the clinical and epidemiological characteristics and clinical outcomes of SARS-CoV-2 infection patients.&#x0D; METHODS: This was a retrospective cohort study of patients with COVID-19 in 2020–2021 in a municipality in the Midwest region of Brazil. The variables analyzed were age, sex, clinical characteristics, clinical results and presence of comorbidities in patients. Associations between the clinical or epidemiological characteristics were analyzed using appropriate tests for categorical variables and continuous normal or parametric distributions. An alpha value of 5% was used as the maximum error limit allowed to reject the null hypothesis in all analysis.&#x0D; RESULTS: In total, 42,469 patients were analyzed, with lethality rates of 4.4% and 2.9% in 2020 and 2021, respectively. There was a higher prevalence among women (53.8%) and a higher mortality in men (p = 0.000), the elderly (p = 0.000), patients with dyspnea (p = 0.000), and patients with comorbidities (p = 0.000). The presence of headache, sore throat, anosmia, dysgeusia or diarrhea were related with a lower mortality (p = 0.000).&#x0D; MAIN CONCLUSIONS: This study demonstrated higher lethality, revealing a higher mortality rate in patients who were male, aged over 65 years, with dyspnea, and with comorbidities. However, headache, sore throat, anosmia, dysgeusia, and diarrhea were associated with an improved prognosis. Further studies to elucidate these findings are warranted.

Association between exposure to air pollutants and hospitalization for SARS-Cov-2: an ecological time-series study.

Exposure to air pollutants and illness by severe acute respiratory syndrome coronavirus 2 (SARS-Cov-2) infection can cause serious pulmonary impairment. To identify a possible association between exposure to air pollutants and hospitalizations due to SARS-Cov-2. Ecological time-series study carried out in Taubaté, Tremembé, and Pindamonhangaba in 2020 and 2021. Study with Sars-Cov-2 hospitalizations with information on hospitalization date, sex and age of the subjects, duration of hospitalization, type of discharge, and costs of these hospitalizations. Statistical analysis was performed through a negative binomial regression, with data on pollutant concentrations, temperature, air relative humidity, and hospitalization date. Coefficients obtained by the analysis were transformed into relative risk for hospitalization, which estimated hospitalizations excess according to an increase in pollutant concentrations. There were 1,300 hospitalizations and 368 deaths, with a predominance of men (61.7%). These data represent an incidence rate of 250.4 per 100,000 inhabitants and 28.4% hospital lethality. Significant exposure (P value < 0.05) occurred seven days before hospital admission (lag 7) for nitrogen dioxide (NO2) (relative risk, RR = 1.0124) and two days before hospital admission for PM2.5 (RR = 1.0216). A 10 μg/m3 in NO2 concentration would decrease by 320 hospitalizations and » US $ 240,000 in costs; a 5 μg/m3 in PM2.5 concentration would decrease by 278 hospitalizations and » US $ 190,000 in costs. An association between exposure to air pollutants and hospital admission due to Sars-Cov-2 was observed with excess hospitalization and costs for the Brazilian public health system.

The «labyrinth» operative procedure with the left atrium plasty in correction of isolated failure of a mitral valve

Objective. To study the possibilities of the «labyrinth» procedure in combination with the left atrium reduction.&#x0D; Materials and methods. Into the investigation 261 patients, suffering isolated failure of a mitral valve Stage IV, operated in the National Institute of Cardio-Vascular Surgery n. a. M. M. Amosov, were included. The left atrium plasty with objective to reduce and prevent the waves spread re-entry was performed in 139 (53.2%) patients. Fragmentation in the left atrium was made in regime of low radiofrequencies (25 - 35 Вт) in accordance to schemes of Maze ІІІ, ІV.&#x0D; Results. In the hospital period 5 patients died (the hospital lethality have constituted 1.9%). While discharge from the hospital the sinus rhythm was noted in majority of the patients after the left atrium plasty, than in the alternative group - in 119 (85.6%) of 139 and in 79 (64.8%) of 122 patients, accordingly.&#x0D; Conclusion. The «labyrinth» procedure in combination with the left atrium plasty owes significant clinical advantages, including restoration and persistence of the sinus rhythm in patients, suffering pathology of a mitral valve.

Surgical treatment of mitral stenosis, complicated by massive thrombosis of the left atrium: stationary stage

Objective. Elaboration of the correction methodology of mitral stenosis, complicated by massive thrombosis of left atrium, for improvement of immediate and late results of surgical treatment of this pathology.&#x0D; Materials and methods. Into the group analyzed 344 patients with mitral stenosis, complicated by massive thrombosis of left atrium, operated in Amosov National Institute of Cardiovascular Surgery in a period from 1 January 1984 yr to 1 January 2019 yr, were incorporated. In all the patients surgical correction of mitral stenosis and thrombectomy from left atrium was performed. In 161 (46.8%) patients a radical removal of thrombotic mass together with their base–lining was performed, while in 183 (53.2%) – without it. In 256 (74.4%) patients the left atrium auricle was ligated or resected, while in 88 (25.6%) – left intact.&#x0D; Results. The hospital lethality index have had directly proportionally raised with enhancement of degree of the left ventricle auricle: I – 0%, II – 3.9%, III – 5.1% (p&lt;0.05). In a general group during all period of the investigation a directly proportional dependence of index of hospital lethality due to lethal thromboembolic complications on degree of massive thrombosis of the left atrium auricle was observed: I – 0.0%, II – 3.5%, III – 5.2% (p&lt;0.05). Best indices of hospital lethality were achieved in radical removal of thrombi together with their base–lining with ligature or resection of the left atrium auricle as a possible origin of thrombi creation.&#x0D; Conclusion. While doing surgical correction in patients with massive thrombosis of left atrium it is important to remove the thrombotic base–lining and to ligate or resect the left atrium auricle, what significantly lowers the risk of hospital lethality, thromboembolic complications on stationary stage of treatment.

Pharmaco–cold cardioplegia during isolated prosthesis of the aortal valve

Objective. To study the possibilities of pharmaco–cold cardioplegia, while doing isolated prosthesis of the aortal valve.&#x0D; Materials and methods. Into the investigation were included 279 patients with aortal failures, operated in Department of Surgical Treatment of the Acquired Failures of the Heart of National Institute of Cardio–Vascular Surgery named after М. М. Аmosov in 2015–2021 yrs. The average age of the patients have constituted (62,5 ± 6,4) yrs old. In all the patients the isolated аоrtal valve correction for aortal failures was performed, using mechanical and biological prostheses. Infusion of “Kustodiol” solution for defense of the myocardium was applied.&#x0D; Results. On the hospital stage 9 patients died (hospital lethality have constituted 3,2%). Іnotropic support (dobutamin) in early postoperative period was applied in dosage of 3 – 4 mcg/kg/min during first 48 h. The levels of cardiac creatine phosphokinase enzyme on the second postoperative day, while exploiting antegrade, аnteretrograde, retroantegrade and retrograde methods of the cardioplegic solution delivery, have hade differences.&#x0D; Conclusion. Retrograde pathway of injection of cardioplegic solution permits to defense the myocardium effectively while correcting of aortal failure.

The impact of systemic changes on quality of care providing in acute myocardial infarction in Ukraine

For the past 5 years, the system of providing medical care to patients with acute myocardial infarction (AMI) has radically changed in Ukraine. The accession of our country to the European initiative "Stent for Life" contributed to the creation of the national reperfusion network. It ensured the wide availability of medical care for patients with AMI due to the fastest delivery of patients to clinics that provide a 24-hour emergency coronary artery stenting. Nowadays in Ukraine, 42 reperfusion centers are successfully operating 24/7/365 care delivery and more than 50% of patients with AMI undergo primary percutaneous coronary intervention (PCI). Almost 70% of patients are delivered to clinics within the first 6 hours after the onset of AMI symptoms, which corresponds to the obligatory “therapeutic window” for emergency PCI. The average number of primary PCI performed in AMI increased by 4 times in 2018 compared to 2012, reaching 286 procedures per 1 million population. The structure of reperfusion therapy has qualitatively changed in 2016. The total number of reperfusion procedures increased due to a decrease of thrombolytic therapy cases and an increase in the frequency of using the most effective method – primary coronary stenting in patients with STEMI. Systemic changes in the structure of medical care providing to patients with AMI contributed to a decrease in hospital lethality in patients with AMI - from 14,1% in 2012 to 13,81% in 2019.

Prognostic Factors of the Lethality of Stroke at the Sourô Sanou University Teaching Hospital of Burkina Faso

Introduction: Stroke is a major public health concern. It is a frequent pathology, 80% of which is of ischemic origin. Approximately 86% of all stroke deaths worldwide occur in low- and middle-income countries. The objective of this study was to investigate prognostic factors for in hospital lethality of stroke cases admitted in a public university hospital in Burkina Faso. Methods: This was a retrospective cohort study with a descriptive and analytical aim on adults admitted for a stroke confirmed by a brain scan at the Sourô Sanou University Teaching Hospital (CHUSS) of Bobo-Dioulasso over the period from January 1, 2009, to December 31, 2013. Results: The proportion of cases confirmed by the brain CT scan was 32% of all patients admitted for stroke in the CHUSS. The overall case fatality was 27.6%. This lethality was more pronounced in patients with hemorrhagic stroke (35.8%) compared to patients with ischemic stroke (22.4%). Median survival was higher in patients with ischemic stroke than those with hemorrhagic one (36 and 25 days, respectively) with a statistically significant difference (p value = 0.001). In multivariate analysis and hemorrhagic stroke (hazard ratio [HR]: 2.25; CI 95%: 1.41–3.61), an altered state of consciousness (HR: 1.90; CI 95%: 1.20–2.99) and the presence of central facial paralysis (HR: 1.67; CI 95%: 1.04–2.67) are factors that increased significantly the lethality. Conclusion: The study has identified three prognostic factors of lethality that are the hemorrhagic stroke type, the altered state of consciousness, and the central facial paralysis. Given the high case fatality, it is important to develop and implement effective prevention and management strategies adapted to the resources for the optimal control of stroke in Africa.

Management of COVID-19 Infection in a Context of Countries with Limited Resources: Case of the University Hospital Center of Renaissance (UHCR) in N’Djamena, Chad

Introduction: The aim of this study was to describe the clinical characteristics of patients admitted for Covid-19 in the department of Covid-19 of the University Hospital Center of Renaissance (UHCR) of N’Djamena in Chad. The pandemic of the sickness of Covid-19 constitutes a real public health problem in the world since its appearance in December 2019.&#x0D; Materials and Methods: This was an observational, transversal and descriptive study carried out from 19 March 2020 to 19 November 2021. All patients diagnosed with Covid-19, confirmed at least either by RT-PCR or chest computed tomography (CT) were included. The healing was defined through the disappearance of clinical signs and two negative RT-PCRs at 72 hours intervals.&#x0D; Results: Our study included 825 patients of which 613 (74.34%) men (sex ratio 2.9). Age Medium for patients was 50 ± 4 years with extreme ranging from 19 to 84 years old. Six hundred and thirty-three (76.70%) patients came directly from their residences. Respectively 82 and 71 were transferred from the provincial hospital of Farcha (9.9%) and from a private health structure (8.7%). Three hundred and thirteen patients had at least a comorbidity especially arterial hypertension (n = 173; 21%); the diabetes (n = 156; 19.7%); chronic renal failure (n = 28; 3.5%); heart disease (n =27; 3.3%) and obesity (n= 14; 1.6%), HIV infection (n = 9; 1.09%). five hundred and seventy-two (61.12%) patients performed the CT and all the RT-PCR. Four hundred and ninety-two patients (59.60%) presented severe forms of the disease, 160 (19.40%) were critical and 124 (15.10%) were moderates. The hospital lethality was 16.24% (n = 134). The treatment consisted in the administration of Hydroxychloroquine-Azythromycin in 99.4% of cases (n = 813) and by covid-organics in 0.6% of cases (n = 5).&#x0D; Conclusion: The infected patients with Covid-19 were admitted with the advance stage of the disease. Lethality was associate with the presence of comorbidities. The sensitization of the population on the importance of vaccination, barrier measures and recourse to care are necessary.

Comparative assessment of mortality and lethality rates of newborns at the regional level

In order to assess the mortality and lethality rates of newborns in obstetric organizations of the North-Western Federal District in 2013–2019, a comparative analysis of official statistics data was carried out. It was found that in the North-Western Federal District in the period from 2013 to 2019, there was an almost annual decrease in newborn mortality rates. The overall decrease in mortality in maternity care organizations of the Federal District (from 2,5% to 1,9%) was mainly due to a decrease in mortality in obstetric hospitals of the first and second levels (respectively from 3,2% to 1,2% and from 1,7% to 0,7%), while most children died in perinatal centers, where the mortality rate has not changed in recent years (2013 – 4,1%; 2019 – 4,0%). The study showed a decrease in mortality rates in the subjects of the Russian Federation that are part of the federal district, except for the city of St. Petersburg. The average hospital lethality rate of newborns in maternity care organizations of the North-Western Federal District during 2013–2019 was in the range of 1,9%–2,0%, did not change significantly and corresponded to the national average. However, the level of hospital lethality significantly differed in individual subjects of the district – in more than half of them, the level of hospital lethality exceeded the average, while in others it was significantly lower. Thus, the decrease in the mortality and lethality rates of newborns in maternity care organizations indicates an increase in the quality of medical care for children in the North-Western Federal District. dicates an increase in the quality of medical care for children in the North-Western Federal District.

Social vulnerability, survival, and hospital lethality by COVID-19 in patients aged 50 years and over: retrospective cohort of cases in Brazil in 2020 and 2021

The outcome of SARS-CoV-2 infection is not only associated with age and comorbidities but is also aggravated by social vulnerability. This study aims to analyze - according to social vulnerability - survival and hospital lethality by COVID-19 in the first 100 days from symptoms to death in individuals aged 50 years or older hospitalized in Brazil. This is a retrospective cohort from Epidemiological Week 11 of 2020 to week 33 of 2021. The Influenza Epidemiological Surveillance Information System (SIVEP-Gripe) provided clinical and epidemiological data. The Geographic Index of the Socioeconomic Context for Health and Social Studies (GeoSES) measured social vulnerability. The Kaplan-Meier curve and the adjusted proportional risk model by Cox were used for survival, with hazard ratio (HR) and 95% confidence intervals (95%CI). Among the 410,504 cases, overall lethality was of 42.2% in general and 51.4% in the most vulnerable. We found a higher lethality according to worse socioeconomic status in all categories by age group; the double is registered for 50-59 years. The adjusted Cox model showed a 32% increase in risk of death (HR = 1.32; 95%CI: 1.24-1.42). Moreover, men, older adults, black or indigenous adults, with multiple comorbidities, and subjected to invasive ventilation, have a higher risk of death after hospitalization. Intersectoral policy measures need to be targeted to alleviate the effects of the COVID-19 pandemic aggravated by social vulnerability.

Analysis of Hospital Lethality of COVID-19 in Mexico

Background. COVID-19 has caused 244,830 deaths in Mexico. Evaluating the severity of this contingency is possible if the hospital fatality rate of COVID-19 is described because hospitalized patients present more severe conditions. Objective. To analyze the fatality of COVID-19 in hospitalized patients. Methods. A quantitative, descriptive, analytical, cross-sectional, and retrospective study was conducted using open database from Ministry of Health in Mexico. Results. The analysis included 71,189 discharges from patients diagnosed with COVID-19 in the Mexican Ministry of Health Hospitals during 2020. Of them, 27,403 were due to death, predominantly in men and age groups from 50 to 69 years. The general hospital fatality due to COVID-19 was 38.49%, a hospital fatality of 40.75% in men and 35.03% in women. The 55-to-99-year-old age groups, Baja California, Puebla, and Coahuila had a higher hospital fatality than the general fatality. Conclusion. Besides the deaths caused directly by COVID-19 (those that occurred due to respiratory failures), many deaths were indirect in persons with comorbidities exacerbated by this disease. Access to health services, social changes derived from job loss, home protection, and changes in social dynamics, facts expressed in the general mortality excess, cannot be quantified in our study. There are similar patterns with other persons infected worldwide: this disease is more severe for males and older age subjects.

Trends in Morbidity and Hospital Lethality from Neoplasms before and during the New Coronavirus Infection COVID-19

Background. Taking into account the special medical and social significance of oncological diseases, as well as taking into account that patients suffering from neoplasms are a special risk group for developing complications of coronavirus infection, it seems relevant to study the impact of the COVID-19 pandemic on the level of morbidity and hospital lethality of patients with neoplasms.&#x0D; Aims to study the trends of morbidity and hospital lethality due to neoplasms in the Russian Federation before and during the pandemic of the new coronavirus infection COVID-19.&#x0D; Methods. The indicators of primary and general morbidity, hospital lethality from neoplasms of the adult population were calculated on the basis of federal statistical observation data contained in reporting forms No. 12 and No. 14 of all subjects of the Russian Federation for 20152020.&#x0D; Results. During the period from 2015 to 2019, an increase in the general (by 14.8%) and primary (by 4.8%) incidence of neoplasms was noted in the Russian Federation. In 2020, compared with 2019, on the contrary, the indicators of general (by 5.0%) and primary (by 17.4%) incidence of neoplasms decreased. Hospital lethality due to neoplasms also increased during 20152019, in total it increased by 19.2%, in one year (2020) hospital lethality increased by 6.6%. A similar situation has developed in all federal districts and most regions of the country.&#x0D; Conclusions. The decline in the incidence of neoplasms in 2020, with their previous continuous growth, reflects the difficult situation that has developed during the pandemic of a new coronavirus infection in the healthcare of the Russian Federation. The increase in hospital lethality from neoplasms indicates a more severe course of coronavirus infection in adult patients with malignant neoplasms and a more frequent development of fatal complications in them.

Non-communicable diseases in Southern Tunisia: morbidity, mortality profile and chronological trends

Abstract Introduction Non-communicable diseases (NCDs) represent a major public health problem worldwide. Giving their impact on the morbidity and mortality burden, understanding their chronological trends over time is a priority for epidemiological surveillance. We aimed to determine the epidemiological specificities of NCDs and to study their chronological trends over the period 2010-2015. Methods We retrospectively collected data of hospitalized patients from the regional registry of morbidity and mortality in the Southern University Hospital of Tunisia during the period 2010-2015. Results We included 18081 patients with NCDs aged ≥ 25 years, with an annual number of 3013 cases/year. The median age of patients was 60 years(Interquartile range IQR = [43-80 years)]). There were 10288 males(57%), with a sex ratio (male/female)of 1.3. The distribution of NCDs was characterized by the predominance of cardiovascular disease(CVD)(10346 cases, 57.2%), then cancers(3034 cases; 16.8%),diabetes(2489 cases; 13.8%) and chronic respiratory tract diseases(2212 cases; 12.2%). Chronological trends analysis of NCDs showed that they remained globally stable between 2010 and 2015. The same result was applied to the group of cancers, chronic respiratory diseases and diabetes mellitus. However, there was a sharp rise for CVD between 2010 and 2015(ρ = 0.84; p = 0.036). The proportion of CVD increased significantly among men(ρ = 0.87; p = 0.019) and elderly(ρ = 0.88; p = 0.019). During the study period, 234 deaths were due to NCDs, with hospital mortality and lethality rates of 5.2/1000 hospitalizations and 1.29%, respectively. CVD were the main cause of deaths(60%). The hospital mortality rate of NCDs increased significantly from 2010 to 2015(ρ = 0.85; p = 0.031), notably for CVDs(ρ = 0.94; p = 0.005). Conclusions Chronological trends analysis revealed a significant rise in the morbidity and mortality burden ofCVDs during the period 2010-2015. It is imperative, therefore, to strengthen health care for these patients. Key messages Non-communicable diseases. Morbidity and mortality.