Reduction In Mortality Research Articles

Evaluation of the Effectiveness of Tuberculosis Intervention in the US

This study evaluates the effectiveness of tuberculosis (TB) interventions implemented in the United States by comparing actual TB incidence and mortality data with predicted data that assumes no interventions. The analysis focuses on two key intervention periods: the introduction of strict infection control measures and enhanced environmental controls in 2005, and the update to TB screening guidelines for healthcare personnel in 2019. This study trained the Auto-regressive Integrated Moving Average (ARIMA) model on pre-2005 data in order to forecast the number of tuberculosis cases and the proportion of cases overall that did not get these interventions. The predicted data was then compared with actual post-intervention data to assess the impact of these public health measures. Results show that without these interventions, TB cases and mortality rates would have remained significantly higher. The actual data, in contrast, demonstrated a marked decline in both metrics following the implementation of these measures. The findings underscore the critical role of comprehensive public health interventions in reducing the burden of TB. The long-term impact of these measures is evident in the sustained reduction in TB incidence and mortality, highlighting the importance of continuous monitoring and adaptation of TB control strategies to maintain effective disease management.

Atherothrombotic Outcomes After Sodium-Glucose Cotransporter 2 Inhibitors Versus Dipeptidyl Peptidase-4 Inhibitors in Patients With Type 2 Diabetes: A Territory-Wide Retrospective Cohort Study.

This study compared the risks of atherothrombotic major adverse cardiovascular events in patients with type 2 diabetes taking SGLT2 (sodium-glucose cotransporter 2) inhibitors to those taking DPP-4 (dipeptidyl peptidase-4) inhibitors. All adult patients (≥18 years of age) with type 2 diabetes and newly prescribed with SGLT2 inhibitors or DPP-4 inhibitors across all public hospitals in Hong Kong between January 2015 and December 2019 were included. Patients were propensity matched in a 1:1 ratio using a caliper distance of 0.2 without replacement. The primary outcome was atherothrombotic major adverse cardiovascular events as a composite outcome of cardiovascular mortality, nonfatal stroke, and nonfatal myocardial infarction. Time-to-first event analysis was conducted using a univariable Cox proportional hazards model. Primary and secondary analyses were repeated using stabilized inverse probability weighting and propensity score adjustment in the complete case cohort. A total of 20 642 patients (10 321 SGLT2 inhibitors versus 10 321 DPP-4 inhibitors) were included in the final analysis. The mean age was 59±11 years, and 13 142 (63.7%) were men. The median follow-up period was 2.9 years. The use of SGLT2 inhibitors was associated with a significant reduction in atherothrombotic major adverse cardiovascular events (453 [4.4%] versus 719 [7.0%]; hazard ratio, 0.64 [95% CI, 0.57-0.72]; P<0.001) compared with DPP-4 inhibitors. SGLT2 inhibitors were independently associated with reduced all-cause mortality, cardiovascular mortality, stroke, myocardial infarction, and incident dialysis (all P values <0.001). SGLT2 inhibitors in patients with diabetes were independently associated with reduction in atherothrombotic major adverse cardiovascular events, all-cause mortality, cardiovascular mortality, myocardial infarction, stroke, and incident dialysis, compared with DPP-4 inhibitors.

Passive Immunisation in the Treatment of Infectious Diseases Related to Highly Potent Bacterial Toxins.

The discovery of microbial toxins as the primary factors responsible for disease manifestations and the discovery that these toxins could be neutralised by antitoxins are linked to the birth of immunology. In the late 19th century, the serum or plasma of animals or patients who had recovered from infectious diseases or who had been immunised with a relevant antigen began to be used to treat or prevent infections. Before the advent of widespread vaccination campaigns, antitoxins played a key role in the treatment and prevention of diseases such as diphtheria and tetanus. A significant reduction in mortality following the introduction of antitoxins confirmed their efficacy. Serum therapy remains an important measure for post-exposure prophylaxis and for the treatment of unvaccinated or incompletely vaccinated patients. For the botulinum toxin, antitoxin therapy continues to be the sole available treatment. The manuscript contains a summary of the most important information on the passive immunoprophylaxis used in the treatment of diphtheria, tetanus, and botulism, all representing diseases in which symptoms are driven by the activity of highly potent bacterial toxins.

‘I am a father but not pregnant’: a qualitative analysis of the perspectives of pregnant couples on male partner role during pregnancy care in Bamenda, Cameroon

Abstract Background The reduction of maternal mortality has stagnated globally. Estimates project a rise to 140.9 deaths per 100,000 live births by 2030, which is double the Sustainable Development Goal target. Male involvement in pregnancy care has been proposed as an intervention to improve maternal and child health outcomes. However, there is limited understanding of how communities view the role of men beyond the instrumentalist approach that only targets men as accompanying partners without altering the underlying gender and socio-cultural determinants that shape their involvement in pregnancy care. This study broadens existing research by exploring and and contextualising the role of male partners during pregnancy in Bamenda, Cameroon. Methods This study employed a qualitative design underpinned by symbolic interactionism. We conducted 68 semi-structured interviews (SSIs) and three focus group discussions (FGDs) with purposively selected pregnant women (n = 38 SSIs; n = 2, FGD) and male partners (n = 30 SSIs; n = 1, FGD) in an urban hospital in the North West Regional capital—Bamenda. Nvivo was used for data management and subsequently, we performed thematic analysis using a critical discourse lens to generate manifest and latent interpretations of study findings. Results The role of male partners reflected hegemonic masculinity and was broadly conceptualised in three categories: breadwinner, protector/comforter, and ‘sender’ for antenatal care. Perceptions of men’s role differed between male and female participants. While women sought male involvement for pragmatic reasons like joint attendance of antenatal care, psychosocial support (affirmation) and assistance with domestic chores, men limited their involvement to roles that matched gendered preconceptions of masculinity like financial support for antenatal fees, maternal nutrition and birth supplies. Nonetheless, the perceived benefits for antenatal attendance was expressed by some men in terms of the direct access it gives them to pregnancy-related education from experts, paternal bonding and the appeal of fast-track services for couples. Conclusion Male involvement in maternal and child health in Bamenda Health District is an extension and reflection of how patriarchal norms on masculinity are constructed and adapted in this setting. To address gaps in male involvement, intervention designers and implementers will need to take into account prevailing culture-specific norms while deconstructing and leveraging masculine ideals to situate male involvement in the prenatal context.

Long-term impact of atrial fibrillation catheter ablation on heart failure with preserved ejection fraction.

The efficacy of catheter ablation as a treatment approach for patients with concurrent atrial fibrillation (AF) and heart failure with preserved ejection fraction (HFpEF) has been inadequately investigated. This study's objective was to assess the effectiveness of atrial fibrillation ablation (AFA) in patients with heart failure with preserved ejection fraction. Utilizing the TriNetX research network, we identified individuals aged 18 and older with atrial fibrillation (AF) and concurrent heart failure with preserved ejection fraction (HFpEF) from January 1, 2010, to June 1, 2021. Patients were further classified based on their catheter ablation procedure, using Current Procedural Terminology codes. Following propensity-score matching, each cohort consisted of 9440 patients. The primary endpoint was all-cause mortality at two years and secondary outcomes during the 2-year follow-up encompassing readmissions for heart failure, AF, and stroke. In propensity-matched cohort, patients with AF and HFpEF who underwent AFA plus medical therapy had significantly lower all-cause mortality at two years than those who did not undergo AFA (hazard ratio (HR): 0.37, 95% CI: 0.34-0.40; P < 0.001) even after matching antiarrhythmic medications. At two years, secondary outcomes including HF readmissions (HR: 0.86 95% CI: 0.84-0.89; P < 0.001) and stroke readmissions (HR: 0.66 95% CI: 0.59-0.73; P < 0.001) were lower in the AFA group. AFA amongst AF patients with concomitant HFpEF showed a significant reduction in all-cause mortality. It also leads to significant reductions in readmissions due to HF and ischemic stroke at two years.

Simultaneous tumors: ovarian cancer in a patient with multiple myeloma

Multiple myeloma is the second most common hematological malignancy, accounting for approximately 1% and 10–15% of malignant tumors of the hematopoietic and lymphoid systems, respectively. Until recently, the diagnosis of multiple myeloma was inherently associated with unfavorable prognosis of overall survival. On the one hand, advanced diagnosis techniques and the development of new treatment approaches have led to the improved life expectancy and significant reduction of mortality of patients with multiple myeloma. On the other hand, the medical and research communities have encountered a previously unknown issue: the combination of multiple myeloma with other types of cancer. This combination sets a task of multidisciplinary approach in the diagnosis and requires development of patient management strategy and prognostic parameters of the outcome. Some researchers adhere to the theory of independent tumor appearance in patients suffering from multiple myeloma, while other authors suppose that multiple myeloma and secondary cancer virtually represent multiple primary malignant neoplasms. This article presents a clinical case of postmortem verification of ovarian cancer in a patient with recurrent multiple myeloma.

Association between oral microbiome diversity and all-cause mortality: a longitudinal study of NHANES, 2009–2012

ObjectiveThe study investigates the association between oral microbiome diversity and all-cause mortality.DesignPopulation-based cohort study.SettingUS National Health and Nutrition Examination Survey (2009–2010 and 2011–2012).ParticipantsA total of 8224 participants who had valid...

Longer Duration of Cord Clamping Improves Nicu Survival Without Major Morbidities in Very Preterm Infants.

Longer duration of deferred cord clamping (DCC), at least 120 s, is associated with the highest reduction in mortality compared to shorter durations of DCC or immediate cord clamping in preterm infants. We compared the neonatal outcomes of very preterm infants who received at least 60 s to those who received at least 120 s of DCC. This is a retrospective single-center study including preterm infants born <33 weeks of gestational age (GA) between 2014 and 2019. The intended duration of DCC was 60 s in Period 1 (January 2014 to June 2016, n = 139) and 120 to 180 s in Period 2 (July 2016 to December 2019, n = 155). We compared the demographics, delivery room measures, and neonatal outcomes between the two periods as intent-to-treat analysis and per protocol analysis. The intended duration of DCC was completed in 75% of infants in Period 1 (n = 106) and 76% of infants in Period 2 (n = 114). There was an increase in survival without major morbidities in the infants that received at least 120 s of DCC, which remained significant after adjusting for GA and erythropoietin use (Odds ratio 8.6, 95% CI 1.6 to 45.7). Longer duration of DCC is associated with improved survival without major morbidities in preterm infants <33 weeks GA.

Epidemiology, Clinical, Radiological and Biological Characteristics, and Outcomes of Mucormycosis: A Retrospective Study at a French University Hospital.

Mucormycosis is a rare but emerging and life-threatening infection caused by environmental mold, with a mortality rate of 30-70% despite progress in management. A better understanding could improve its management. We conducted a single-center retrospective study of all cases of mucormycosis observed over a decade at the University Hospital of Caen. Between 2014 and 2024, 18 cases of mucormycosis were identified, predominantly in males (n = 11, 65%). Most patients had hematological malignancies (n = 16, 89%). Seven cases were proven, and eleven were classified as probable. The main locations of infection were pulmonary (n = 12, 67%). Since 2021, we have observed an increase in the number of cases, rising from three between 2014 and 2021 to fifteen between 2021 and 2024. Among the 12 patients with pulmonary mucormycosis, all presented with fever except 1, and 67% required oxygen therapy. Chest computed tomography scans revealed an inverse halo sign in one-third of the patients. The first-line treatment consisted of amphotericin B in seventeen patients, posaconazole in one patient, and isavuconazole in one patient. Surgery was performed on seven patients. In cases of cutaneous mucormycosis, all patients underwent surgery, and none died within three months after the diagnosis. Overall, the three-month mortality rate was 39%. Surgical management was associated with a reduction in mortality (0% vs. 64%, p = 0.013). This study highlights the role of PCR for early diagnosis and the key role of surgery in improving clinical outcomes while underscoring the need for better-adapted therapeutic protocols for these rare infections.

Would provision of Take Home Naloxone Kits by Emergency Medical Services be perceived as acceptable to people at risk of opioid overdose? A qualitative study

ABSTRACT OBJECTIVES Take home naloxone kits can reduce mortality, but we know little about how they are perceived by people with lived experience of opioid use. Provision of naloxone in the community has been shown to significantly reduce mortality from opioid overdose. Currently, this is predominantly through drug treatment support services but expanding provision through other services might be effective in increasing kit take-up and mortality reduction. This study aimed to examine participants' experiences of opiate overdose and acceptability of provision of naloxone kits through ambulance/paramedic emergency services (EMS) and hospital Emergency Departments (ED). METHODS Qualitative interviews were conducted with 26 people who had direct experience of opioid use. Participants were recruited at two substance-use treatment centres and a third sector support organisation in three large cities in the United Kingdom. Interviews examined respondents’ experiences of opioid use and opioid overdose, access and personal use of naloxone kits, and opinions about kit provision from EMS and hospital ED staff. Interview data were thematically analysed using a constant comparative method. RESULTS Four key themes were identified during analysis: 1) High levels of overdose experience and knowledge of naloxone and naloxone kits; 2) naloxone kits were perceived as effective and easy to use 3) There were some concerns around the risks of administering naloxone, such as peer aggression during withdrawal. 4) Participants supported much wider personal, family and peer provision of naloxone kits from community support organisations as well as from EMS. CONCLUSIONS Participants felt naloxone kits were an important resource and they wanted increased provision across a range of services including EMS and hospital ED staff as well as community pharmacies and needle exchange centres. Participants wanted naloxone kit provision to be extended to peers, family and friends.

A refined, minimally invasive, reproducible ovine ischaemia-reperfusion-infarction model using implantable defibrillators: Methodology and validation.

Ischaemic heart disease remains a leading cause of premature mortality and morbidity. Understanding the associated pathophysiological mechanisms of cardiac dysfunction arising from ischaemic heart disease and the identification of sites for new therapeutic interventions requires a preclinical model that reproduces the key clinical characteristics of myocardial ischaemia, reperfusion and infarction. Here, we describe and validate a refined and minimally invasive translationally relevant approach to induce ischaemia, reperfusion and infarction in the sheep. The novelty and refinement in the procedure stems from utilization of implantable cardiac defibrillators prior to coronary engagement, balloon angioplasty to induce infarction, and intra-operative anti-arrhythmic drug protocols to reduce adverse arrhythmic events. The protocol is readily adoptable by researchers with access to standard fluoroscopic instrumentation, and it requires minimally invasive surgery. These refinements lead to a substantial reduction of intra-operative mortality to 6.7% from previously published values ranging between 13% and 43%. The model produces key characteristics associated with the fourth universal definition of myocardial infarction, including ECG changes, elevated cardiac biomarkers and cardiac wall motility defects. In conclusion, the model closely replicates the clinical paradigm of myocardial ischaemia, reperfusion and infarction in a translationally relevant large animal setting, and the applied refinements reduce the incidence of intra-operative mortality typically associated with preclinical myocardial infarction models.

Effect of Statins on the Prognosis After Thoracic Endovascular Aortic Repair for Patients With Acute Type B Aortic Dissection.

To analyze the clinical efficacy of long-term statin therapy following thoracic endovascular aortic repair (TEVAR) in patients with acute type B aortic dissection (ATBAD). We retrospectively analyzed data from 645 patients treated between January 2005 and June 2022, dividing them into Statin Group (n=330) and Non-statin Group (n=315) based on whether they received long-term postoperative statin therapy. Patients were further categorized based on median admission low-density lipoprotein cholesterol (LDL-C) levels into High and Low LDL-C Groups to assess the effect of statins on the prognosis of ATBAD patients after TEVAR. The cohort had an average age of 53.44±11.42 years old, and 81.71% were male. Statin therapy significantly reduced occurrences of all-cause death (3.03% vs 8.57%, p=0.002) and aorta-related death (0.91% vs 3.81%, p=0.015), particularly in patients with high admission LDL-C levels. In addition, patients with statin therapy had a lower incidence of aorta-related adverse events (ARAE) (4.24% vs 11.11%, p=0.001). Kaplan-Meier analysis indicated statins reduced 5-year cumulative incidence rates of all-cause death and ARAE (all Log-rank p<0.05). These trends were sustained after adjustment. Multivariate Cox analysis confirmed that statin therapy was associated with reduced risks of all-cause and aorta-related deaths, as well as ARAE. Long-term statin therapy appears to decrease the risk of all-cause and aorta-related death in ATBAD patients after TEVAR, particularly patients with high admission LDL-C levels. Patients with lower LDL-C levels at admission have a reduction of aorta-related death in the follow-up period. Statin therapy also was associated with a lower incidence of ARAE in follow-up. These findings suggest that statins might be crucial in improving long-term outcomes in this patient population. Long-term statin therapy administered to patients with acute type B aortic dissection (ATBAD) following thoracic endovascular aortic repair (TEVAR) demonstrates a substantial reduction in both all-cause and aorta-related mortality. Notably, this therapeutic benefit is most evident in patients presenting with elevated low-density lipoprotein cholesterol (LDL-C) levels at admission. Furthermore, statin therapy is associated with a decreased incidence of aorta-related adverse events during follow-up. These findings underscore the pivotal role of statin therapy in enhancing long-term clinical outcomes for ATBAD patients undergoing TEVAR, thereby contributing to improved patient care and prognosis.

Central vs. Brachial Blood Pressure and Pulse Pressure Amplification for Mortality Risk Prediction in Patients Undergoing Coronary Angiography.

Arterial hypertension is a significant risk factor for cardiovascular (CV) morbidity and mortality. Although central blood pressure (BP) evaluation is considered the gold standard, the reliability of non-invasive measurements remains unclear. Therefore, we compared the predictive value of invasively measured central BP with non-invasively measured brachial BP and analyzed pulse pressure (PP) amplification (delta-PP; difference between central and peripheral PP) as an independent predictor of mortality. We analyzed systolic (SBP), diastolic (DBP), mean arterial BP (MAP), PP and delta-PP as predictors of CV and all-cause mortality in the Ludwigshafen Risk and Cardiovascular Health (LURIC) study, involving 3316 patients referred for coronary angiography. All brachial BP parameters, except DBP, were significantly linked to all-cause and CV mortality in a univariate analysis. A 10 mmHg increase in SBP, MAP, and PP corresponded to increased risks of all-cause (11%, 10%, and 19%) and CV mortality (11%, 11%, and 18%). Central SBP and PP showed similar, but numerically weaker, associations with increased risks of all-cause (5% and 10%) and CV mortality (4% and 8%).After adjusting for age, sex, BMI, diabetes mellitus, and eGFR, only delta-PP independently predicted mortality with a 10 mmHg increase linked to a 4% reduction in all-cause and 6% reduction in CV mortality. Neither brachial nor centrally measured BP parameters were independent mortality predictors in contrast to PP amplification, which remained an independent predictor of mortality in multivariate analysis, in a cohort with a medium to high CV risk profile. As PP amplification decreased, mortality increased.

Comparison between the effect of angiotensin-converting enzyme inhibitors and angiotensin receptor blockers and their combination on mortality in maintenance dialysis patients: a systematic review and meta-analysis.

Patients undergoing maintenance dialysis have a higher mortality rate compared to the general population. It is known that angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) have protective effects on the kidney; however, few studies have directly compared their impact on mortality in patients undergoing dialysis. This study aims to evaluate the effectiveness of ACEIs, ARBs, or their combination in reducing all-cause and cardiovascular mortality in maintenance dialysis patients. We systematically searched PubMed, Cochrane Central, Web of Science (WOS), and Scopus databases from inception until August 23rd, 2024. We included all observational studies and clinical trials that assessed the effectiveness of ACEIs versus ARBs or their combination on mortality outcomes, in patients with CKD on maintenance dialysis. We used Review Manager 5.4 for all statistical analyses. Five observational studies, including 126,612 patients, met the eligibility criteria and were included in the final analysis. Among all patients, no statistically significant difference was found between ACEIs and ARBs in reducing all-cause mortality (RR: 1.12, 95% CI [0.98, 1.27], P = 0.10) or cardiovascular mortality (RR: 1.10, 95% CI [0.92, 1.33], P = 0.30). In patients on hemodialysis, ARBs were associated with a statistically significant reduction in cardiovascular mortality (P < 0.0001). Our results suggest no differences between ACEIs and ARBs in reducing all-cause or cardiovascular mortality in maintenance dialysis patients. However, ARBs may reduce cardiovascular mortality more effectively in hemodialysis patients. Conducting randomized controlled clinical trials to validate our results is warranted.

Evaluation of the effect of DRG payment policy based on interrupted time series modeling: evidence from a tertiary hospital in Anhui Province

BackgroundThe payment methodology for diagnosis-related groups (DRG) has implications for both society and medical institutions. Our study aims to analyse the impact of the reform of the payment policy according to the DRG on the operation of a tertiary hospital in Anhui Province.MethodsMonthly data were collected from April 2020 to September 2023 during the reform period for a tertiary hospital on nine types of operational indicators, including average length of stay (ALOS), number of discharges, number of outpatient visits, percentage of discharged patients undergoing level III or IV surgery, bed turnover rate, inpatient essential drug utilization rate, low-risk group mortality, outpatient subaverage cost and inpatient subaverage cost. The data were divided into two phases according to the time of DRG implementation: pre-reform (April 2020–December 2021) and post-reform (January 2022–September 2023), and the segmented regression model with interrupted time series data was used to analyse the changes in the trend of each type of indicator before and after the reform. Statistical analysis was performed using R software (4.3.1).ResultsAfter the implementation of the DRG, the number of discharges increased by 112 800 patients (95% confidence interval [CI] 31.125–194.484, P = 0.008), the bed turnover rate rose by 1.403% (95% CI 1.028–1.778, P = 0.022) and the percentage of discharged patients undergoing level III or IV surgery decreased by 0.098% (95% CI −0.181 to −0.015, P = 0.022). The low-risk group mortality decreased by 0.016% (95% CI −0.027 to −0.005, P = 0.007), and the inpatient subaverage cost decreased by 81.514 CNY (95% CI −121.782 to −41.245, P < 0.001). However, there were no significant differences in the trends of average length of stay, outpatient visits, inpatient essential drug utilization rate and outpatient subaverage cost after the DRG implementation.ConclusionsThe findings show that the DRG reform has positively impacted hospital functioning, including quality, safety, efficiency and costs. Although the average length of stay remained unchanged, there was an increase in discharged patients and outpatient visits, indicating hospitals adapted to the new payment model. The reduction in low-risk group mortality suggests improvements in patient safety and care quality. However, challenges remain, as evidenced by decreased surgical complexity and initial drops in bed turnover rates. While the DRG reform holds promise for enhancing healthcare efficiency and controlling costs, potential negative effects such as patient selection bias and coding changes need to be monitored. Future research should focus on the long-term effects of the DRG policy across different healthcare institutions.

Future of Acute Severe Ulcerative Colitis-A Narrative Review.

While corticosteroids have led to significant reduction in ASUC mortality over the last few decades, they are associated with significant side effects and up to 30% of patients have steroid refractory ASUC, which means we require safer and better therapies for patients with ASUC. Several salvage therapies have been proposed in guidelines; however, we lack high quality head-to-head randomised controlled trials to assess effectiveness and safety of these agents. Furthermore, the role of newer novel agents in ASUC management is unclear. We aim to present an up to date review and envisage future treatment of ASUC without steroids based on current trials and data. In summary, we conclude that ASUC treatment still heavily relies on corticosteroids despite the side effect profile. While infliximab and cyclosporine have extensive data, there are no prospective studies comparing them with corticosteroids as initial therapy. Novel therapies open up the possibility of oral options but require prospective data before any conclusion can be made.

Sensitivity of difficult‐to‐control Palmer amaranth accessions to fluridone and diflufenican

AbstractPalmer amaranth (Amaranthus palmeri S. Watson) has evolved resistance to herbicides targeting nine sites of action. Phytoene desaturase‐inhibiting herbicides remain among the few sites of action that are still effective in controlling Palmer amaranth. Greenhouse experiments were conducted to evaluate the effectiveness of fluridone and diflufenican in controlling difficult‐to‐control Palmer amaranth accessions collected in Arkansas from 2016 to 2022, to quantify the response of three accessions that exhibited low sensitivity to both herbicides, and to evaluate the effectiveness of photosystem II inhibitors alone and with fluridone or diflufenican on three accessions. At 14 days after a preemergence application, Palmer amaranth control with fluridone and diflufenican ranged from 42% to 100% and 33% to 99% across 23 accessions, respectively. Three accessions required 10.2 to 26.7 times more fluridone than the susceptible Palmer amaranth standard based on LD50 values (where LD50 is the lethal dose to kill 50% of the population), with less than 50% mortality achieved with a 1x herbicide rate for two of the three accessions. For diflufenican, the LD50 values for the three accessions were 3.9–18.5 times greater than the susceptible standard. An additive response for mortality and biomass reduction resulted from adding fluometuron to fluridone at all rates tested. An additive or sometimes a synergistic response occurred with the combinations of metribuzin plus diflufenican. Overall, fluridone exhibited higher efficacy than diflufenican for most accessions tested. While phytoene desaturase‐inhibiting herbicides remain an effective control option for most Palmer amaranth accessions, herbicide mixtures targeting multiple sites of action remain essential for delaying resistance and obtaining effective control of this problematic weed.

Efficacy of Hemoadsorption combined with Continuous Renal Replacement Therapy in Patients with Rhabdomyolysis and Acute Kidney Injury: A Retrospective Study

Abstract Background Clearance of circulating myoglobin is crucial to prevent further damage in patients with rhabdomyolysis (RM) and acute kidney injury (AKI). The objective of the present study is to evaluate the efficacy and safety of hemoadsorption (HA) combined with continuous renal replacement therapy (CRRT) in critically ill patients with RM and AKI. Methods RM with AKI patients who received CRRT+HA or CRRT with concomitant creatine kinase (CK) greater than 10 000 IU/L in our intensive care unit between May 2021 and December 2023 were retrospectively included. The primary outcome was 90-day mortality; secondary outcomes were kidney function recovery and CK decline rate. Adverse events were also evaluated including hypotension, circuit clotting, albumin leakage, and blood loss. Propensity score matching (PSM) and Cox retrospective analysis were performed. Results A total of 111 RM patients with AKI were ultimately included. The ICU and in-hospital mortality were significantly lower in the CRRT+HA group compared with the CRRT group (ICU mortality: 18% vs. 42%, P = .025; in-hospital mortality: 21% vs. 42%, P = .048). However, the CRRT+HA group only showed a non-significant reduction in 90-day mortality compared with the CRRT group (47% vs. 68%, P = .063). After treatment for 90 days, the number of patients with kidney function recovery was not significantly different between CRRT+HA and CRRT groups (95% vs. 84%, P = .639). Moreover, the incidence of hypotension and circuit clotting events did not increase during CRRT+HA treatment. In addition, the CRRT+HA group also appeared to have a higher rate of CK reduction and reduction of CK than the CRRT group at 24 and 48 hours after the initiation of CRRT. Multivariate Cox regression model demonstrated that CRRT+HA (HR 0.477, 95% confidence interval (CI) 0.234-0.972; P = .042), mean arterial blood pressure (MAP) (per 1 mmHg, HR 0.967,95% CI 0.943-0.992; P=.009) and CRRT treatment duration (per 1 h, HR 0.995,95% CI 0.992-0.998; P = .002) played a favorably important role in the survival prognosis of RM and AKI patients. In contrast, serum phosphate before RRT (per 1mmol/L, HR 1.531, 95% CI 1.113-2.106; P = .009) and McMahon score (per 1 score, HR 1.15, 95% CI 1.006-1.313, P = .04) were independent risk factors for 90-day mortality. Conclusions CRRT combined with HA therapy reduced ICU and in-hospital mortality in patients with RM and AKI and also had a cleansing effect on creatine kinase without significant adverse events.

Maternal and perinatal mortality: Geospatial analysis of inequality in pregnancy and perinatal mortality in Ethiopia.

While there is ample evidence of the overall reduction in perinatal and pregnancy-related mortality in Ethiopia, it remains uncertain if geographic disparities have diminished. This study aimed to investigate perinatal and pregnancy-related mortality spatial distributions, trends over time, and factors associated with the distribution in Ethiopia. We used data from Ethiopian Demographic and Health Surveys conducted in Ethiopia in 2000, 2005, 2011, and 2016. In each survey, around 15,500 women aged 15-49 were interviewed from about 550 neighborhoods randomly sampled from across the country. Perinatal and pregnancy-related mortality were used as outcome variables. We carried out Optimized Hotspot Analysis using the Getis-Ord Gi* statistic in ArcGIS Pro to identify the time trend of geographical clusters with high (hot spot) and low (cold spot) perinatal and pregnancy-related mortality. In addition, we conducted a Geographically Weighted Poisson Regression in R to examine the factors associated with the spatial distribution of perinatal and pregnancy-related mortality. Perinatal and pregnancy-related mortality exhibited a clustering pattern indicating the presence of geographic inequality, with a decreasing pattern from 2000 to 2016. We detected hotspot areas in developed administrative regions of Amhara, Oromia, and Southern Nations, indicating inequality within large regions. Inequality in perinatal mortality was associated with rural residence, younger age of women, and high birth rate, whereas pregnancy-related mortality was associated with low autonomy, younger age, and anemia. We found that anemia (p-value = 0.01) has a geographically varying relationship with perinatal mortality, while education (p-value = 0.03) and wealth (p-value = 0.01) with pregnancy-related mortality. While there has been a reduction during the study period, geographical disparities in perinatal and pregnancy-related mortality still persist. Therefore, targeting intervention programs in areas where spatial inequalities still persist is essential for effectively utilizing scarce resources.

Metformin lowers risk of hearing loss and mortality in type 2 diabetes.

To assess the association between metformin use and the risk of sudden sensorineural hearing loss (SSNHL) in patients with Type 2 diabetes (T2D), a population at elevated risk for SSNHL. This cohort study utilized data from Taiwan's National Health Insurance Research Database, following T2D patients from 2008 to 202 database's baseline. Metformin use was defined as achieving ≥80% of the medication possession ratio (MPR) and ≥28 cumulative defined daily doses (cDDD) within three months. The control group included patients with ≥80% MPR from other antidiabetic agents, ensuring active treatment comparability. Propensity score matching was applied to balance covariates, while competing risk models accounted for mortality. Hazard ratios (HRs), incidence rates (IRs), and incidence rate ratios (IRRs) were calculated. Metformin users demonstrated a lower SSNHL incidence (IR: 11.48 per 10,000 person-years) compared to non-users (IR: 15.66 per 10,000 person-years), with an IRR of 0.73 (95% CI: 0.66-0.82; p < 0.0001). Adjusted HRs indicated a 27% reduction in SSNHL risk (HR: 0.73; 95% CI: 0.66-0.82). Higher cumulative doses (Q4: HR 0.36; 95% CI: 0.29-0.46) and daily doses ≥1 DDD (HR: 0.78; 95% CI: 0.69-0.87) were linked to further risk reductions. Metformin use was also associated with lower overall mortality. Metformin use is associated with a dose-dependent reduction in SSNHL risk and lower mortality in T2D patients. The rigorous definitions of metformin exposure and an actively treated comparator group emphasize these findings, suggesting metformin's potential role in SSNHL prevention and improved survival.