Incidence Of Overall Mortality Research Articles

Influence of Body Composition Assessed by Computed Tomography on Mortality Risk in Young Women with Breast Cancer.

Background/Objectives: Increasing evidence indicates that body composition can significantly influence prognosis in women with breast cancer. However, alterations in body composition, particularly among young women (<40 years), remain largely unknown and underexplored. This study aimed to investigate the relationship of computed tomography (CT)-derived body composition with mortality rates among young women recently diagnosed with breast cancer, identifying the best-correlated cutoff value. Methods: This is a bi-set cohort study with retrospective data collection. Women newly diagnosed with ductal invasive breast cancer, aged 20 to 40 years, treated in reference oncology units were included. Body composition was assessed using CT scans at the third lumbar vertebra (L3) level, including muscle and adipose compartments. The outcome of interest was the incidence of overall mortality. A maximally selected log-rank Cox-derived analysis was employed to assess the cutoffs associated with mortality. Results: A total of 192 women were included before any form of treatment (median age of 35 years, IQ range: 31-37). Overall mortality occurred in 12% of the females. Stages III-IV were the most frequent (69.5%). Patients who died had a significantly lower muscle area index. CT-derived muscle area was inversely associated with mortality. Each 1 cm2/m2 decrease in skeletal muscle index increased the mortality hazard by 9%. Higher values of adiposity compartments were independently associated with higher mortality. Conclusions: Our study highlights the predictive significance of skeletal muscle area and adipose tissue in predicting survival among young women recently diagnosed with breast cancer.

Association of Atrial Fibrillation Burden and Mortality Among Patients With Cardiac Implantable Electronic Devices.

Current estimates of atrial fibrillation (AF)-associated mortality rely on claims- or clinical-derived diagnoses of AF, limit AF to a binary entity, or are confounded by comorbidities. The objective of the present study is to assess the association between device-recognized AF and mortality among patients with cardiac implantable electronic devices capable of sensitive and continuous atrial arrhythmia detection. Secondary outcomes include relative mortality among cohorts with no AF, paroxysmal AF, persistent AF, and permanent AF. Using the deidentified Optum Clinformatics US claims database (2015 to 2020) linked to the Medtronic CareLink database, we identified individuals with a cardiac implantable electronic device who transmitted data ≥6 months after implantation. AF burden was assessed during the first 6 months after implantation (baseline period). Subsequent mortality, assessed from claims data, was compared between patients with and without AF, with adjustment for age, geographic region, insurance type, Charlson Comorbidity Index, and implantation year. Of 21 391 patients (age, 72.9±10.9 years; 56.3% male) analyzed, 7798 (36.5%) had device-recognized AF. During a mean of 22.4±12.9 months (median, 20.1 [12.8-29.7] months) of follow-up, the overall incidence of mortality was 13.5%. Patients with AF had higher adjusted all-cause mortality than patients without AF (hazard ratio, 1.29 [95% CI, 1.20-1.39]; P<0.001). Among those with AF, patients with nonparoxysmal AF had the greatest risk of mortality (persistent AF versus paroxysmal AF: hazard ratio, 1.36 [95% CI, 1.18-1.58]; P<.001; permanent AF versus paroxysmal AF: hazard ratio, 1.23 [95% CI, 1.14-1.34]; P<.001). After adjustment for potential confounding factors, the presence of AF was associated with higher mortality in our cohort of patients with cardiac implantable electronic devices. Among those with AF, nonparoxysmal AF was associated with the greatest risk of mortality.

Malnutrition as a potential predictor of mortality in chronic kidney disease patients on dialysis: A systematic review and meta-analysis

Background & AimsMalnutrition, a significant problem in patients with chronic kidney disease (CKD), is linked to lower health-related quality of life, longer and more frequent hospital admissions, worse functional capacity, and higher levels of morbidity. However, the extent of its impact on mortality is poorly elucidated. This systematic review and meta-analysis aimed to investigate the impact of malnutrition on mortality among CKD patients on dialysis. MethodsThis meta-analysis was designed and performed in accordance with the PRISMA guidelines (CRD42023394584). A systematic electronic literature search was conducted in PubMed, ScienceDirect, and Embase to identify relevant cohort studies. The studies that reported nutritional status and its impact on mortality in patients were considered for analysis. The generic inverse variance method was used to pool the hazard ratio effect estimates by employing a random effects model. The Newcastle-Ottawa scale was used for the quality assessment. The statistical analysis was performed by utilizing RevMan and CMA 2.0. ResultsA total of 29 studies that comprised 11063 patients on dialysis whose nutritional status was evaluated were eligible for quantitative analysis. Based on a comparison between the "malnutrition" category and the reference "normal nutrition status" category, the results showed that the overall pooled hazard risk (HR) for mortality was (HR 1.49, 95% CI: 1.36–1.64, p<0.0001). According to the subgroup analysis, the hemodialysis subgroup had greater mortality hazards (HR 1.53; 95% CI 1.38–1.70, p<0.0001), compared to the peritoneal dialysis subgroup (HR 1.26; 95% CI 1.15–1.37, p<0.00001). Additionally, the overall incidence of mortality was explored but the authors were unable to combine the results due to limitations with the data. ConclusionThe findings conclude that malnutrition is a strong predictor of mortality among patients on dialysis, with the hemodialysis subgroup having a higher mortality hazard compared to the peritoneal dialysis subgroup. The results of this study will advocate for early nutritional evaluation and timely dietary interventions to halt the progression of CKD and death.

Survival status and its predictors among undernourished children on antiretroviral therapy in Bahir Dar city, Northwest Ethiopia, 2010 – 2020, a multicenter retrospective cohort study

BackgroundIn environments with limited resources, undernutrition is a serious public health risk. Its dual relationship to human immunodeficiency virus infection (HIV) leads to crises in a child's physical, emotional, social, and economic spheres of life. Nevertheless, little research has been done on the survival rate and risk factors that lead to poor survival outcomes in undernourished children receiving antiretroviral therapy. This study sought to evaluate survival status and its predictors among undernourished children on antiretroviral therapy (ART) in public health facilities, Bahir Dar city, September 1, 2010 – December 31, 2020.MethodsAn institution-based retrospective cohort study design was used among 414 study participants from September 1, 2010 – December 31, 2020. A simple random sampling method was applied to select study participants. All collected data were entered into epi data version 4.6 and exported to STATA version 14.0 for analysis. Each independent predictor variable with a p-value < 0.05 in the multivariable Cox proportional hazard regression was considered statistically significant.ResultsThe overall incidence of mortality was 11.6 deaths per 1000 child year observation (95%CI: 7.7- 17.5). Baseline weight for age < -3 Z score (adjusted hazard ratio (AHR) = 4.9, 95% CI: 1.30–18.98), height for age < -3 Z score (AHR = 4.34, 95%CI 1.13–16.6), cotrimoxazole prophylaxis given (AHR = 0.27, 95%CI 0.08–0.87), hemoglobin level < 10 g/dl (AHR = 3.7, 95%CI 1.1–12.7), CD4 cells < threshold (AHR = 4.86, 95%CI 1.9–12.7), and WHO clinical disease stage III and IV (AHR = 8.1, 95%CI 1.97–33) were found independent predictors of mortality.Conclusion and recommendationThe incidence of mortality was determined in the study to be 11.6 per 1000 child years. Mortality was predicted by severe stunting, severe underweight, a low hemoglobin level, a low CD4 count, and WHO clinical stages III and IV. But the risk of death is reduced by starting cotrimoxazole preventative therapy early. The risk factors that result in a low survival status should be the primary focus of all concerned bodies, and early cotrimoxazole preventive treatment initiation is strongly recommended.

Prediction of 30-day, 90-day, and 1-year mortality after colorectal cancer surgery using a data-driven approach

PurposeTo develop prediction models for short-term mortality risk assessment following colorectal cancer surgery.MethodsData was harmonized from four Danish observational health databases into the Observational Medical Outcomes Partnership Common Data Model. With a data-driven approach using the Least Absolute Shrinkage and Selection Operator logistic regression on preoperative data, we developed 30-day, 90-day, and 1-year mortality prediction models. We assessed discriminative performance using the area under the receiver operating characteristic and precision-recall curve and calibration using calibration slope, intercept, and calibration-in-the-large. We additionally assessed model performance in subgroups of curative, palliative, elective, and emergency surgery.ResultsA total of 57,521 patients were included in the study population, 51.1% male and with a median age of 72 years. The model showed good discrimination with an area under the receiver operating characteristic curve of 0.88, 0.878, and 0.861 for 30-day, 90-day, and 1-year mortality, respectively, and a calibration-in-the-large of 1.01, 0.99, and 0.99. The overall incidence of mortality were 4.48% for 30-day mortality, 6.64% for 90-day mortality, and 12.8% for 1-year mortality, respectively. Subgroup analysis showed no improvement of discrimination or calibration when separating the cohort into cohorts of elective surgery, emergency surgery, curative surgery, and palliative surgery.ConclusionWe were able to train prediction models for the risk of short-term mortality on a data set of four combined national health databases with good discrimination and calibration. We found that one cohort including all operated patients resulted in better performing models than cohorts based on several subgroups.

Medium-term follow up of active surveillance for early prostate cancer at a non-academic institution.

To report oncological outcomes of active surveillance (AS) at a single non-academic institution adopting the standardised Prostate Cancer Research International Active Surveillance (PRIAS) protocol. Competing risk analyses estimated the incidence of overall mortality, metastases, conversion to treatment, and grade reclassification. The incidence of reclassification and adverse pathological findings at radical prostatectomy were compared between patients fulfilling all PRIAS inclusion criteria vs those not fulfilling at least one. We analysed 341 men with Grade Group 1 prostate cancer (PCa) followed on AS between 2010 and 2022. There were no PCa deaths, two patients developed distant metastases and were alive at the end of the study period. The 10-year cumulative incidence of metastases was 1.9% (95% confidence interval [CI] 0.33-6.4%). A total of 111 men were reclassified, and 127 underwent definitive treatment. Men not fulfilling at least one PRIAS inclusion criteria (n = 43) had a higher incidence of reclassification (subdistribution hazards ratio 1.73, 95% CI 1.07-2.81; P = 0.03), but similar rates of adverse pathological findings at radical prostatectomy. Metastases in men on AS at a non-academic institution are as rare as those reported in established international cohorts. Men followed without stringent inclusion criteria should be counselled about the higher incidence of reclassification and reassured they can expect rates of adverse pathological findings comparable to those fulfilling all criteria. Therefore, AS should be proposed to all men with low-grade PCa regardless of whether they are followed at academic institutions or smaller community hospitals.

Long-term outcomes after heart transplantation in adult patients with univentricular versus biventricular congenital heart disease.

Heart transplantation (HT) is the only life-extending therapy in adults with congenital heart disease (CHD) and end-stage heart failure. HT is considered at high risk in complex CHD given the anatomical complexity and past medical history. Little is known about long-term outcomes after HT in these patients. We aimed to evaluate early and long-term outcomes after HT in adult patients with univentricular versus biventricular CHD. This multicentre retrospective cohort study included all adult CHD patients who underwent HT between 1988 and 2021 in 3 tertiary centres. Factors associated with early (<30 days) and conditional long-term survival were assessed in the entire cohort. Over a mean follow-up of 10.1 ± 7.8 years, 149 patients were included, of whom 55 (36.9%) had univentricular CHD. Sixty-four patients died during follow-up including 47 deaths before discharge from hospital. In multivariable analysis, univentricular physiology and female recipient gender were independently associated with a higher risk of early mortality (odds ratio 2.99; 95% confidence interval [1.33-6.74] and odds ratio 2.76; 95% confidence interval [1.23-6.20], respectively). For patients who survived the early period, conditional long-term survival was excellent for both groups and was not different between 2 groups (P = 0.764). Adult CHD patients have a high incidence of overall mortality due to a high rate of early mortality. Univentricular physiology was associated with a significant increased risk of early death compared to biventricular physiology. However, late mortality was excellent and no longer different between the 2 physiologies.

Incidence and predictors of mortality among neonates admitted with perinatal asphyxia at west Oromia tertiary hospitals, Ethiopia, 2022

BackgroundPerinatal asphyxia is one of the preventable and treatable causes of neonatal mortality. However, it is the fifth-largest cause of under-five mortality. Even with management advancements, it remains one of the key public health issues in underdeveloped countries, including Ethiopia. Comorbidities are also understated; therefore, adequate information regarding the incidence of death and its predictors is required.MethodsA four-year retrospective follow-up study was conducted from October 3 to November 2, 2022. From a total sample size, of 655, 616 data were collected by nurse through follow-up reviews charts using Kobo Toolbox software. The data was exported to STATA Version 14 for analysis. The Cox proportional hazard assumption was checked, and the model for the data was selected using Akaike Information Criteria. Finally, an adjusted hazard ratio with 95% CI was computed, and variables with a P-value < 0.05 in the multivariable analysis were taken as significant predictors of death.ResultThe overall incidence of mortality was 38.86/1000 (95% CI: 33.85–44.60). The median time of follow-up was 15 days (95% CI: 14–20). The proportion of deaths was 202 (32.79%, 95% CI: 29.18–36.61) among neonates with perinatal asphyxia. While the distance from health facility > 10 km is (AHR: 2.25; 95% CI: 1.60–3.17), direct oxygen (AHR: 1.83; 95% CI: 1.35–2.48), APGAR score (Appearance, Pulse, Grimace, Activity, and Respiration) < 3 at the fifth minute (AHR: 2.63; 95% CI: 1.03–6.73), prolonged rupture of membrane (AHR: 1.41; 95% CI: 1.02–1.94), and stage III hypoxic ischemic encephalopathy (AHR: 2.02; 95% CI: 1.18–3.47) were predictors of mortality among neonates with perinatal asphyxia.ConclusionAccording to this study’s findings, high neonatal mortality due to perinatal asphyxia requires proper intervention regarding membrane rupture, APGAR score (Appearance, Pulse, Grimace, Activity, and Respiration), oxygen use, stage III hypoxic-ischemic encephalopathy, and residence distance.

Rates and determinants of fast chronic kidney disease progression distinguished by nutritional status, and the impact of malnutrition on mortality - evidence from a clinical population

Malnutrition is a serious problem that influences morbidity, mortality, functional activity, and quality of life in patients with chronic kidney disease (CKD). However, there has not been much research done on how nutritional status appears to affect mortality in non-dialysis CKD patients. This study aimed to recognize the rates and predictors of fast CKD progression distinguished by nutritional status, and also sought to determine the impact of malnutrition on mortality in non-dialysis CKD patients. This prospective cohort study (n=360) involved non-dialysis CKD patients with index estimated glomerular filtration rate (eGFR) between the range of 15-89ml/min/1.73m2. Nutritional status was evaluated by using the "Pt-Global web tool/PG-SGA". A loss of eGFR >4ml/min/1.73m2 per year was considered to be a sign of fast CKD progression. Kaplan-Meier plots were used to evaluate the cumulative survival, and Cox-proportional hazard models were used to analyze the renal outcomes. Around 244 (67.8%) of patients have experienced a fast decline in kidney function. In the malnourished group, systolic blood pressure and hyperphosphatemia were observed to have increased hazards for fast CKD progression. The overall incidence of mortality and composite endpoints were found to be 13.9% & 37.6%, respectively. Death rates (11.6%) and composite endpoints (29.8%) were higher in the malnourished (severe & moderate) group. Cox regression hazard model reported 4 times increased hazards for death [HR 4.41 (1.99-9.77) 95% CI; P≤0.005] and 3 times increased hazards for composite endpoints [HR 3.29 (2.10-5.16) 95% CI; P≤0.005] for 'severely malnourished' category in reference to 'normal nutrition' category. Fast CKD progression was observed to be more common in malnourished patients. Systolic blood pressure and hyperphosphatemia were recognized as potential predictors of fast CKD progression. Moreover, malnutrition was found to be a significant predictor of mortality among non-dialysis CKD patients. The findings of this study advocate for early nutritional evaluation and timely dietary interventions to halt the progression of CKD.

Incidence and predictors of mortality among traumatic brain injury patients admitted to Amhara region Comprehensive Specialized Hospitals, northwest Ethiopia, 2022

IntroductionTraumatic brain injury is a substantial cause of mortality and morbidity with a higher burden in low and middle-income countries due to healthcare systems that are unable to deliver effectively the acute and long-term care the patients require. Besides its burden, there is little information on traumatic brain injury-related mortality in Ethiopia, especially in the region. Therefore, this study aimed to assess the incidence and predictors of mortality among traumatic brain injury patients admitted to comprehensive specialized hospitals in the Amhara region, northwest Ethiopia, 2022.MethodsAn institution-based retrospective follow-up study was conducted among 544 traumatic brain injury patients admitted from January 1, 2021, to December 31, 2021. A simple random sampling method was used. Data were extracted using a pre-tested and structured data abstraction sheet. Data were entered, coded, and cleaned into EPi-info version 7.2.0.1 software and exported to STATA version 14.1 for analysis. The Weibull regression model was fitted to determine the association between time to death and covariates. Variables with a P-value < 0.05 were declared statistically significant.ResultsThe overall incidence of mortality among traumatic brain injury patients was 1.23 per 100 person-day observation [95% (CI: 1.0, 1.5)] with a median survival time of 106 (95% CI: 60, 121) days. Age [AHR: 1.08 (95% CI; 1.06, 1.1)], severe traumatic brain injury [AHR: 10 (95% CI; 3.55, 28.2)], moderate traumatic brain injury [AHR: 9.2 (95% CI 2.97, 29)], hypotension [AHR: 6.9 (95% CI; 2.8, 17.1)], coagulopathy [AHR: 2.55 (95% CI: 1.27, 5.1)], hyperthermia [AHR: 2.79 (95% CI; 1.4, 5.5)], and hyperglycemia [AHR: 2.28 (95% CI; 1.13, 4.6)] were positively associated with mortality while undergoing neurosurgery were negatively associated with mortality [AHR: 0.47 (95% CI; 0.27-0 0.82)].ConclusionThe overall incidence of mortality was found to be high. Age, severe and moderate traumatic brain injury, hypotension at admission, coagulopathy, presence of associated aspiration pneumonia, undergoing a neurosurgical procedure, episode of hyperthermia, and hyperglycemia during hospitalization were the independent predictors of time to death. Therefore, interventions to reduce mortality should focus on the prevention of primary injury and secondary brain injury.

Role of Antiplatelet Therapy in Patients with Severe Coronary Artery Disease Undergoing Coronary Artery Endarterectomy within Coronary Artery Bypass Surgery

Background-Coronary endarterectomy (CEA) has been introduced to allow revascularization in end-stage coronary artery disease (CAD). After CEA, the injured remnants of the vessel's media could result in fast neo intimal tissue ingrowth, which require an anti-proliferation agent (antiplatelet therapy (APT). We aimed to review outcomes of patients undergoing CEA within bypass surgery who received either single-APT (SAPT) or dual-APT (DAPT). Methods-We retrospectively evaluated 353 consecutive patients undergoing CEA within isolated coronary artery bypass grafting (CABG) in the period 01/2000-07/2019. After surgery, patients received either SAPT (n = 153), or DAPT (n = 200) for six months then lifelong SAPT. Endpoints included early, late survival, and freedom from major-adverse-cardiac and cerebrovascular events (MACCE), which were defined as incidence of stroke, myocardial infarction, need for coronary intervention (PCI or CABG) or death for any cause. Results-Patients' mean age was 67 ± 9.3 years; they were predominantly male 88.1%. Both DAPT- and SAPT-groups had the same extent of CAD (mean SYNTAX-Score-II: 34.1 ± 11.6 vs. 34.4 ± 17.2, p = 0.91). Postoperatively, no difference between DAPT- and SAPT-groups was reported in the incidence of low-cardiac-output syndrome (5% vs. 9.8%, p = 0.16), revision for bleeding (5% vs. 6.5% p = 0.64), 30-day mortality (4.5% vs. 5.2%, p = 0.8) or MACCE (7.5% vs. 11.8%, p = 0.19). Imaging follow-up reported significantly higher CEA and total grafts patency (90% vs. 81.5% and 95% vs. 81%, p = 0.017) in DAPT patients. Late outcomes within 97.4 ± 67.4 months show lower incidence of overall mortality (19 vs. 51%, p < 0.001) and MACCE (24.5 vs. 58.2%, p < 0.001) in the DAPT patients when compared with SAPT patients. Conclusions-Coronary endarterectomy allows revascularization in end-stage CAD when the myocardium is still viable. The use of dual APT after CEA for at least six months seems to improve mid-to-long-term patency rates and survival, and reduced the incidence of major adverse cardiac and cerebrovascular events.

Effect of phosphodiesterase type 5 inhibitors on major adverse cardiovascular events and overall mortality in a large nationwide cohort of men with erectile dysfunction and cardiovascular risk factors: A retrospective, observational study based on healthcare claims and national death index data.

Treatment with phosphodiesterase type 5 inhibitors (PDE-5is) is effective in treating erectile dysfunction (ED). The objective of this study was to determine the effect of PDE-5is on the incidence of major adverse cardiovascular (CV) events (MACE; composite outcome of CV death, hospitalization for myocardial infarction, coronary revascularization, stroke, heart failure, and unstable angina pectoris) and overall mortality. A retrospective observational cohort study was conducted in a large US claims database in men with ≥1 diagnosis of ED without prior MACE within 1year, from January 1, 2006, to October 31, 2020. The exposed group had ≥1 claim for PDE-5i and the unexposed group had no claims for PDE-5i, and the groups were matched up to 1:4 on baseline risk variables. The primary outcome was MACE and the secondary outcomes were overall mortality and individual components of MACE, determined by multivariable Cox proportional hazard modeling. Matched plus multivariable analyses showed that MACE was lower by 13% in men exposed (n = 23 816) to PDE-5is (hazard ratio [HR] 0.87; 95% CI 0.79-0.95; P = .001) vs nonexposure (n = 48 682) over mean follow-up periods of 37 and 29months, respectively, with lower incidence of coronary revascularization (HR 0.85; 95% CI 0.73-0.98; P = .029), heart failure (HR 0.83; 95% CI 0.72-0.97; P = .016), unstable angina (HR 0.78; 95% CI 0.64-0.96; P = .021), and CV death (HR 0.61; 95% CI 0.41-0.90; P = .014) with PDE-5i exposure. Phosphodiesterase type 5 inhibitor-exposed men had a 25% lower incidence of overall mortality (HR 0.75; 95% CI 0.65-0.87; P < .001). Men without coronary artery disease (CAD) but with CV risk factors at baseline showed a similar pattern. In the main study cohort, men in the highest quartile of PDE-5i exposure had the lowest incidence of MACE (HR 0.45; 95% CI 0.37-0.54; P < .001) and overall mortality (HR 0.51; 95% CI 0.37-0.71; P < .001) vs the lowest exposure quartile. In a subgroup with baseline type 2 diabetes (n = 6503), PDE-5i exposure was associated with a lower MACE risk (HR 0.79; 95% CI 0.64-0.97; P = .022). PDE-5is may have cardioprotective effects. Strengths are the large numbers of participants and consistency of the data; limitations include the retrospective nature of the study and unknown confounders. In a large population of US men with ED, PDE-5i exposure was associated with lower incidence of MACE, CV death, and overall mortality risk compared to non-exposure. Risk reduction correlated with PDE-5i exposure level.

Trend over six years of incidence of mortality related to road traffic accidents in six cities of the Democratic Republic of the Congo: A retrospective survey in population based

Background and objective: Despite the reduction in the risks incurred, obtained thanks to the constant improvement of the road networks, the mortality rate by road accidents had doubled in 20 years in the world. The objective of this study is to evaluate the evolutionary trend of mortality due to road traffic accidents in 6 cities of the Democratic Republic of Congo. Methods: This was an analytical cross-sectional study of road traffic accident data in 6 cities in the DRC over a period from 2011 to 2016, based on data from the police stations of these 6 cities. It took into account all the accidents on the public highway having been the subject of a report by the police officers. Mortality and injuries due to road accidents were the dependent variables while socio-demographic characteristics, behavioral and environmental determinants were the independent variables. Results: A total of 4635 road traffic accidents were recorded during 6 years in six cities of the Democratic Republic of Congo. Road traffic accidents evolved linearly over the years with a high frequency in 2016 (1415 cases). The overall incidence of mortality in the six cities was 3.4/100P-Y. This incidence of mortality increased more and more over the wyears, going from 1.6/100PA in 2011 to 5.1/100P-Y in 2016. The incidence of mortality per year and per city, it is noted that mortality increased over the years in each city, with very high and significant mortality in Kinshasa and Lubumbashi. Conclusion: these data have shown that road traffic accidents increased over the years and the incidence of mortality varied from one city to another.

Survival status and predictor of mortality among adult stroke patients in Saint Paul's hospital millennium medical college, Addis Ababa, Ethiopia.

Objective:In Africa, there is up to 316 per 100,000 annual incidence rate of stroke, a prevalence of up to 1460 per 100,000, and a 3-year mortality rate higher than 80%. The incidence of stroke mortality in Ethiopia is 19.2%. Stroke is a major cause of disability and death worldwide. Early mortality in-hospital and deprived functional outcomes are common in acute stroke. This study aims to assess survival status and predictors of mortality among adult stroke patients.Methods:Institution-based retrospective cohort was conducted on patients who were admitted to Saint Paul’s Hospital Millennium Medical College. A simple random sampling technique was used. Bivariate and multivariable cox regression analysis were used to identify predictors of stroke mortality. For multivariable cox regression analysis statistically, significance was declared at p-value <0.05 and 95% CI.Results:A total of 251 adult stroke patient charts were included in the study. The overall Kaplan–Meier estimate showed that the probability of in-hospital stroke patients’ survival on the 41st day was nearly 50%. In this study, 77 (30.7%) of the study participants died. Decreased Glasgow Coma Scale (GCS) with adjusted hazard ratio (AHR) 4.26 (95% CI: 2.25–8.07) and p-value ⩽ 0.01 and presence of pneumonia with AHR 3.05 (95% CI: 1.29–7.21) and p-value ⩽ 0.01 are the predictor of mortality.Conclusion:The probability of survival relatively falls as follow-up time increases. The overall incidence of mortality among adult stroke patients was high. The decreased GCS and the presence of pneumonia are predictors of mortality among adult stroke patients.

Hepatitis C-associated late-onset schizophrenia: a nationwide, population-based cohort study.

Background:Whether infection with the hepatitis C virus (HCV) causes schizophrenia — and whether the associated risk reverses after anti-HCV therapy — is unknown; we aimed to investigate these topics.Methods:We conducted a nationwide, population-based cohort study using the Taiwan National Health Insurance Research Database (TNHIRD). A diagnosis of schizophrenia was based on criteria from the International Classification of Diseases, 9th revision (295.xx).Results:From 2003 to 2012, from a total population of 19 298 735, we enrolled 3 propensity-score-matched cohorts (1:2:2): HCV-treated (8931 HCV-infected patients who had received interferon-based therapy for ≥ 6 months); HCV-untreated (17 862); and HCV-uninfected (17 862) from the TNHIRD. Of the total sample (44 655), 82.81% (36 980) were 40 years of age or older. Of the 3 cohorts, the HCV-untreated group had the highest 9-year cumulative incidence of schizophrenia (0.870%, 95% confidence interval [CI] 0.556%–1.311%; p < 0.001); the HCV-treated (0.251%, 95% CI 0.091%–0.599%) and HCV-uninfected (0.118%, 95% CI 0.062%–0.213%) cohorts showed similar cumulative incidence of schizophrenia (p = 0.33). Multivariate Cox analyses showed that HCV positivity (hazard ratio [HR] 3.469, 95% CI 2.168–5.551) was independently associated with the development of schizophrenia. The HCV-untreated cohort also had the highest cumulative incidence of overall mortality (20.799%, 95% CI 18.739%–22.936%; p < 0.001); the HCV-treated (12.518%, 95% CI 8.707%–17.052%) and HCV uninfected (6.707%, 95% CI 5.533%–8.026%) cohorts showed similar cumulative incidence of mortality (p = 0.12).Limitations:We were unable to determine the precise mechanism of the increased risk of schizophrenia in patients with HCV infection.Conclusion:In a population-based cohort (most aged ≥ 40 years), HCV positivity was a potential risk factor for the development of schizophrenia; the HCV-associated risk of schizophrenia might be reversed by interferon-based antiviral therapy.

Association between Hepatitis C Virus Infection and Esophageal Cancer: An Asian Nationwide Population-Based Cohort Study.

Background: Hepatitis C virus (HCV) infection causes many extrahepatic cancers, and whether HCV infection is associated with esophageal cancer development remains inconclusive. Methods: A nationwide population-based cohort study of the Taiwan National Health Insurance Research Database (TNHIRD) was conducted. Results: From 2003 to 2012, of 11,895,993 patients, three 1:1:1 propensity score-matched cohorts, including HCV-treated (interferon-based therapy ≧6 months, n = 9047), HCV-untreated (n = 9047), and HCV-uninfected cohorts (n = 9047), were enrolled. The HCV-untreated cohort had the highest 9-year cumulative incidence of esophageal cancer among the three cohorts (0.174%; 95% confidence interval (CI): 0.068–0.395) (p = 0.0292). However, no difference in cumulative incidences was identified between the HCV-treated (0.019%; 0.002–0.109%) and HCV-uninfected cohorts (0.035%; 0.007–0.133%) (p = 0.5964). The multivariate analysis showed that HCV positivity (hazard ratio (HR): 5.1, 95% CI HR: 1.39–18.51) and male sex (HR: 8.897; 95% CI HR: 1.194–66.323) were independently associated with the development of esophageal cancer. Of the three cohorts, the HCV-untreated cohort had the highest cumulative incidence of overall mortality at 9 years (21.459%, 95% CI: 18.599–24.460) (p < 0.0001), and the HCV-treated (12.422%, 95% CI: 8.653–16.905%) and HCV-uninfected cohorts (5.545%, 95% CI: 4.225–7.108%) yielded indifferent cumulative mortality incidences (p = 0.1234). Conclusions: Although HCV positivity and male sex were independent factors associated with esophageal cancer development, whether HCV infection is the true culprit or a bystander for developing esophageal cancer remains to be further investigated. Interferon-based anti-HCV therapy might attenuate esophageal risk and decrease overall mortality in HCV-infected patients.

Solid Organs Injuries in Blunt Abdominal Trauma Patients

Background: Trauma is a major public health problem worldwide, morbidity and mortality in solid organ injuries (SOIs) following blunt abdominal trauma are often related to the severity of associated injuries. The management of SOIs depends upon the hemodynamic status of the patients. Hemodynamically unstable patients often require surgical management. Nonoperative management (NOM) is preferred in hemodynamically stable patients. Objective: This study was conducted to detect both incidence of solid organs injuries in blunt abdominal trauma patients and pattern of injuries as well as outcome in operative management comparing to non-operative management patients. Patients and methods: During the study period, total number of 6908 polytrauma patients presented to Mansoura University Emergency Hospital. Among them 685 (9.9%) presented by abdominal trauma. There were 173 cases with penetrating abdominal trauma and 512 cases with blunt abdominal trauma (BTA). Among the cases with BAT, 268 cases were excluded and the remaining 244 were included in the current study. Results: The most common cause of trauma was road traffic accidents (RTA) (64.3%) of the cases. Solid organs were affected in (70.1%) of the cases, bowels and other abdominal organs were affected in (24.2%), combined solid organs and other abdominal injuries were detected in (5.7%) of the cases. Spleen was the most affected organ in 55.1% of the cases. Total operative management (OM) was required in 70 cases (37.8%) and total NOM was required in 115 cases (62.2%). The overall incidence of mortality was 5.4%. There was no statistically significant difference in the length of hospital stay between the cases according to management (operative or non-operative). Conclusion: Hemodynamically stable blunt abdominal trauma with solid organ injury may be managed safely using a NOM approach.

Impact of Interferon-Based Therapy on Hepatitis C-Associated Rheumatic Diseases: A Nationwide Population-Based Cohort Study

Whether hepatitis C virus (HCV) infection-associated risk of rheumatic diseases is reversed by anti-HCV therapy remain elusive. A nationwide population-based cohort study of the Taiwan National Health Insurance Research Database was conducted. Of 19,298,735 subjects, 3 cohorts (1:4:4, propensity score-matched), including HCV-treated (6919 HCV-infected subjects with interferon and ribavirin therapy ≥ 6 months), HCV-untreated (n = 27,676) and HCV-uninfected (n = 27,676) cohorts, were enrolled and followed (2003–2015). The HCV-uninfected cohort had the lowest cumulative incidence of rheumatic diseases (95% confidence interval (CI): 8.416–10.734%), while HCV-treated (12.417–17.704%) and HCV-untreated (13.585–16.479%) cohorts showed no difference in the cumulative incidences. Multivariate analyses showed that HCV infection (95% CI hazard ratio (HR): 1.54–1.765), female sex (1.57–1.789), age ≥ 49 years (1.091–1.257), Charlson comorbidity index ≥ 1 (1.075–1.245), liver cirrhosis (0.655–0.916), chronic obstruction pulmonary disease (1.130–1.360), end-stage renal disease (0.553–0.98), diabetes mellitus (0.834–0.991) and dyslipidemia (1.102–1.304) were associated with incident rheumatic diseases. Among the 3 cohorts, the untreated cohort had the highest cumulative incidence of overall mortality, while the treated and un-infected cohorts had indifferent mortalities. Conclusions: HCV infection, baseline demographics and comorbidities were associated with rheumatic diseases. Although HCV-associated risk of rheumatic diseases might not be reversed by interferon-based therapy, which reduced the overall mortality in HCV-infected patients.

Clinical outcomes of allogeneic hematopoietic stem cell transplant recipients developing Cytomegalovirus DNAemia prior to engraftment.

There is limited information on the impact of CMV DNAemia episodes developing prior to engraftment (pre-CMV DNAemia) on clinical outcomes following allogeneic hematopoietic stem cell transplantation (allo-HSCT). This issue was addressed in the current retrospective multicenter study including 878 patients. All participant centers used preemptive antiviral therapy strategies for prevention of CMV disease. CMV DNA load in blood was monitored by real-time PCR assays. A total of 144 patients (cumulative incidence 16.5%, 95% CI, 14%-19%) had an episode of pre-CMV DNAemia at a median of 10 days after allo-HSCT. Patients who developed pre-CMV DNAemia had a significantly higher (P = < 0.001) probability of recurrent episodes (50%) than those who experienced post-CMV DNAemia (32.9%); Nevertheless, the incidence of CMV disease was comparable (P = 0.52). Cumulative incidences of overall mortality (OM) and non-relapse mortality (NRM) at 1-year after allo-HSCT were 32% (95% CI, 29-35%) and 23% (95% CI 20-26%), respectively. The risk of OM and NRM in adjusted models appeared comparable in patients developing a single episode of CMV DNAemia, regardless of whether it occurred before or after engraftment, in patients with pre- and post-engraftment CMV DNAemia episodes or in those without CMV DNAemia.

Economic implications of osteoporotic fractures in postmenopausal women.

Osteoporosis is a condition affecting millions of Americans, the majority of which are women secondary to low estrogen in the postmenopausal state. In many instances, the diagnosis is not recognized until after a fracture has occurred due to the "silent" nature of this disease. As a result, this leads to millions of fractures each year, placing a substantial economic burden of billions of dollars from Medicare alone. Prevention, early diagnosis, and treatment remain paramount in reducing this economic impact as well as improving overall incidence of mortality and morbidity. Goals of care include preventing the progression of disease and minimizing bone fractures, particularly in the hips, spine, and wrists. This article will examine the risks of osteoporosis and osteoporotic fractures in postmenopausal women, the current and emerging pharmacologic treatment options, and the role of managed care pharmacists in decreasing economic burden and improving patient care.