Large Proportion Of Fatalities Research Articles

COVID-19 Comes 40 Years After AIDS - Any Lesson?

The pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has hit health-care systems and societies in an unprecedented manner. In 1981, the first cases of AIDS were reported and wide diagnostic testing helped to characterize high-risk groups and the global burden of the epidemic. With Coronavirus Disease (COVID)-19, everything has happened too fast and both cases and fatalities are huge but still uncertain in most places. Diagnostic testing of active and past SARS-CoV-2 infections needs to expand rapidly, ideally using rapid tests. COVID-19 deaths are highly concentrated in the elderly population, with a large proportion of fatalities being "with" rather than "by" SARS-CoV-2 infection. They are often the result of inadequate health care due to overwhelming demands. To date, there is no specific therapy for SARS-CoV-2 infection. Several antivirals are being tested clinically, including remdesivir, at this time the most promising. For others such as lopinavir/ritonavir, neither significant virological nor clinical benefit has been shown. Given the characteristic pulmonary cytokine storm underlying the pathogenic mechanism of severe COVID-19 pneumonia and acute respiratory distress, antiinflammatory agents are being investigated. The benefit of orticosteroids, hydroxychloroquine, etc., is limited. Monoclonal antibodies targeting different pro-inflammatory cytokines, such as tocilizumab, an anti-interleukin 6 agent, are being tried with encouraging results. Ultimately a protective vaccine will be the best response for controlling the COVID-19 pandemic.

Retrospective overview of a COVID-19 outbreak in Mauritania.

A coronavirus disease 2019 (COVID-19) outbreak is currently ongoing in Mauritania. Until 1 July 2020, Mauritania health authorities reported 41 862 serologic and real-time reverse transcriptase PCR tests performed, of which 4472 (10.7%) were positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Male subjects were significantly more affected (57.1%) than female subjects (42.9%). Individuals of the age groups 15–34 years (35.8%) and 35–54 years (36.6%) were the most affected. There were 129 deaths (2.9%), 1677 recoveries (37.5%) and 2666 active cases (59.6%) of which 2261 (84.8%) were asymptomatic, 394 (14.7%) had mild symptoms and 11 (0.4%) had severe symptoms. A large proportion of fatalities (72%, 85/118) occurred among adults aged ≥55 years. Of 4472 positive cases, 4241 (94.8%) were infected through contact with a confirmed COVID-19 case, 133 (3.0%) had no contact with a confirmed COVID-19 case and 98 (2.2%) were imported. As a response to COVID-19, the Mauritanian authorities announced a set of preventive measures, including closure of land and air borders, night curfew, closure of markets, schools and universities and restriction of movement between cities. Control measures included the systematic testing of symptomatic patients, isolation and management of active cases, contact tracing and quarantine of people who have been in contact with a COVID-19–positive individual. We discuss the efforts of the Mauritanian government to combat this potentially life-threatening pneumonia.

Analysis of Run-Off-Road Accidents by Association Rule Mining and Geographic Information System Techniques on Imbalanced Datasets

Run-off-road (ROR) accidents cause a large proportion of fatalities on roads. Exploring key factors is an effective method to reduce fatalities and improve safety sustainability. However, some limitations exist in current studies: (1) Datasets of ROR accidents have imbalance problems, in which the samples of fatal accidents (FA) are much less than non-fatal accidents (NFA). Data mining methods on such imbalanced datasets make the results biased. (2) Few studies conducted spatial analysis of ROR accidents in visualization. Therefore, this study proposes an association rule mining (ARM)-based framework to analyze ROR accidents on imbalanced datasets. A novel method is proposed to address the imbalance problem and ARM is applied to analyze accident severity. Geographic information system (GIS) is adopted for spatial analysis of ROR accidents. The proposed framework is applied to ROR accidents in Victoria, Australia. Six FA factors and seven NFA factors are identified from two-item rules. The results of three-item rules indicate factors acting interactively increase the likelihood of FA or NFA. Hot spots of ROR accidents are presented by GIS maps. Effective measures are accordingly proposed to improve road safety. Compared with traditional data-balancing methods, the proposed framework has been validated to provide more robust and reliable results on imbalanced datasets.

Agricultural Work-Related Fatalities to Non-Working Youth: Implications for Intervention Development.

This article presents data for agricultural work-related fatal injuries to non-working youth (> 18 years old) in Pennsylvania. Cases were identified from the Pennsylvania Farm Fatality (PA-FF) database for the period 2000-2018. The circumstances of the death in each incident were reviewed from news clippings, death certificates, and other reports available to determine the victim's status as a bystander, passenger, or other non-working child. The study identified 69 agricultural work-related fatalities to non-working youth in Pennsylvania. Incidents were coded as non-working accomplice (26), non-working accomplice extra rider (14), non-working attendant (25), and ambiguous (4). Fatalities to children > 5 years old accounted for 74% of the non-working youth fatalities, and most (75%) of the victims were male. Plain Sect community members (Anabaptists) comprised 78% of the cases. Children contribute significantly to the overall burden of agricultural work-related fatal injuries in Pennsylvania, especially as bystanders. From the review of the data, we conclude that fatal injuries to non-working children on farms are preventable. The process of identifying different injury patterns associated with non-work-related child activity has increased our understanding of how safety professionals and community members may help prevent these fatalities. Many researchers have noted a variety of intervention efforts that show potential for providing safer farm and home environments but will need long-term commitments in various capacities.

The major element of 1-year prognosis in acute coronary syndromes is severity of initial clinical presentation: Results from the French MONICA registries

While the death rate from acute coronary syndromes (ACS) has been in decline for more than 50 years, out-of-hospital mortality remains high despite improvements in care. To evaluate the importance of out-of-hospital mortality and identify the main predictors of in-hospital and 1-year mortality in France. Analyses were based on data from the French MONICA population-based registry, which included all cases of ACS occurring in people aged 35-74 years during 2006 in three geographic areas in France. We first evaluated out-of-hospital mortality; then, using data from patients with incident ACS who reached hospital alive, Cox models were performed to determine the main predictors of 1-year mortality. The number of attributable deaths was assessed for variables of interest. After 1-year follow-up, case-fatality was 29.3% for incident events (n=2547); the proportion of out-of-hospital deaths was 70.3%, and 91.5% of deaths occurred in the 28 days following the ACS. On multivariable analysis, the number of attributable deaths associated with three scenarios (out-of-hospital life-and-death emergency, hospitalization before ACS occurrence, and lack of coronary angiography) was 130 (accounting for 59% of deaths occurring after reaching the hospital) during 1-year follow-up. These scenarios corresponded to patients with an initial severe clinical presentation in whom rates of use of specific treatments and invasive procedures were very low. A large proportion of fatalities after an ACS occurs in the out-of-hospital phase. Moreover, the major component of 1-year mortality is associated with a poor prognosis at initial presentation. This finding highlights the importance of cardiovascular prevention, population education and better out-of-hospital emergency management in improving prognosis after an ACS.

Pharmacology, Pathophysiology and Management of Calcium Channel Blocker and ??-Blocker Toxicity

Calcium channel blockers (CCB) and beta-blockers (BB) account for approximately 40% of cardiovascular drug exposures reported to the American Association of Poison Centers. However, these drugs represent >65% of deaths from cardiovascular medications. Yet, caring for patients poisoned with these medications can be extremely difficult. Severely poisoned patients may have profound bradycardia and hypotension that is refractory to standard medications used for circulatory support.Calcium plays a pivotal role in cardiovascular function. The flow of calcium across cell membranes is necessary for cardiac automaticity, conduction and contraction, as well as maintenance of vascular tone. Through differing mechanisms, CCB and BB interfere with calcium fluxes across cell membranes. CCB directly block calcium flow through L-type calcium channels found in the heart, vasculature and pancreas, whereas BB decrease calcium flow by modifying the channels via second messenger systems. Interruption of calcium fluxes leads to decreased intracellular calcium producing cardiovascular dysfunction that, in the most severe situations, results in cardiovascular collapse.Although, CCB and BB have different mechanisms of action, their physiological and toxic effects are similar. However, differences exist between these drug classes and between drugs in each class. Diltiazem and especially verapamil tend to produce the most hypotension, bradycardia, conduction disturbances and deaths of the CCB. Nifedipine and other dihydropyridines are generally less lethal and tend to produce sinus tachycardia instead of bradycardia with fewer conduction disturbances.BB have a wider array of properties influencing their toxicity compared with CCB. BB possessing membrane stabilising activity are associated with the largest proportion of fatalities from BB overdose. Sotalol overdoses, in addition to bradycardia and hypotension, can cause torsade de pointes. Although BB and CCB poisoning can present in a similar fashion with hypotension and bradycardia, CCB toxicity is often associated with significant hyperglycaemia and acidosis because of complex metabolic derangements related to these medications. Despite differences, treatment of poisoning is nearly identical for BB and CCB, with some additional considerations given to specific BB. Initial management of critically ill patients consists of supporting airway, breathing and circulation. However, maintenance of adequate circulation in poisoned patients often requires a multitude of simultaneous therapies including intravenous fluids, vasopressors, calcium, glucagon, phosphodiesterase inhibitors, high-dose insulin, a relatively new therapy, and mechanical devices. This article provides a detailed review of the pharmacology, pathophysiology, clinical presentation and treatment strategies for CCB and BB overdoses.

New dummy head prototype : development, validation and injury criteria

Head injuries cause a large proportion of fatalities to road users particularly motorcyclists. Currently, helmets are assessed using rigid headforms and criteria related to acceleration measured at the centre of the headform. This system is not representative of the human head, which comprises a brain that moves relative to the skull in an impact. Finite element techniques were used in the design, development and validation of a new dummy head prototype named Bi-mass 150. It has been constructed using a Hybrid III headform and comprises two masses: a skull and a mass to represent the brain attached to the skull with a damped spring system. The novel feature of this device is that it can simulate the brain - skull relative displacement at a frequency close to 150 Hz. This is the frequency recorded in tests in vivo. The prototype was made by removing mass from a Hybrid III dummy head and fixing to the centre a metallic mass, which simulates the brain. The two components were connected by means of a plastic element such that the natural frequency corresponded to the 150 Hz measured in-vivo. The outputs from thirteen accident reconstructions, using an instrumented helmeted headform, were used as inputs to the FE model. The results are the first part of the process to establish bi-mass related injury criteria, and, in turn, to provide a much more human-like headform for evaluating and optimising head protection systems.

Intestinal Putrefaction (Auto-Infection).

It seems remarkable that with all the teliologic acumen of our profession, one of the principal causes of disease has been hitherto almost entirely overlooked—that of intestinal putrefaction, so palpable that it could not have been concealed; and it is more than probable that the largest proportion of fatalities have heretofore resulted, directly or indirectly, from that single cause. The idea is a simple cognition apart from any technical qualification; in other words, we have only to see and believe; for if we observe the natural process of digestion, assimilation and elimination we can not fail to perceive the inevitable morbid influence that must necessarily follow in the wake of delayed defecation. As soon as the mass of chyme emerges from the stomach, the elements of which it is composed begin to change their relations, and as it gradually passes down through the alimentary canal the nutritive combinations are absorbed