Predominant Cause Of Death Research Articles

Potential Benefits of Coffee Consumption on Improving Biomarkers of Oxidative Stress and Inflammation in Healthy Individuals and Those at Increased Risk of Cardiovascular Disease.

Cardiovascular diseases (CVDs) are considered the predominant cause of death globally. An abnormal increase in biomarkers of oxidative stress and inflammation are consistently linked with the development and even progression of metabolic diseases, including enhanced CVD risk. Coffee is considered one of the most consumed beverages in the world, while reviewed evidence regarding its capacity to modulate biomarkers of oxidative stress and inflammation remains limited. The current study made use of prominent electronic databases, including PubMed, Google Scholar, and Scopus to retrieve information from randomized controlled trials reporting on any association between coffee consumption and modulation of biomarkers of oxidative stress and inflammation in healthy individuals or those at increased risk of developing CVD. In fact, summarized evidence indicates that coffee consumption, mainly due to its abundant antioxidant properties, can reduce biomarkers of oxidative stress and inflammation, which can be essential in alleviating the CVD risk in healthy individuals. However, more evidence suggests that regular/prolonged use or long term (>4 weeks) consumption of coffee appeared to be more beneficial in comparison with short-term intake (<4 weeks). These positive effects are also observed in individuals already presenting with increased CVD risk, although such evidence is very limited. The current analysis of data highlights the importance of understanding how coffee consumption can be beneficial in strengthening intracellular antioxidants to alleviate pathological features of oxidative stress and inflammation to reduce CVD risk within the general population. Also covered within the review is essential information on the metabolism and bioavailability profile of coffee, especially caffeine as one of its major bioactive compounds.

Https://jhds.vn/bai-bao/cause-specific-mortality-in-a6-death-registration-system-results-from-a-population-based-study-in-hanoi-2017-vietnam-514.html

Objectives: Mortality data is vital information on the health status of a population, especially data from developing countries such as Vietnam. This paper describes the mortality status by specific cause in Hanoi city in 2017 from A6 document. Methods: A cross-sectional study recorded death records of Hanoi residents who died between 1 January 2017 to 31 December 2017 from the death registration system (the A6 document) in 22 over 30 districts in Hanoi. Causes of death were classified based on the International Classification of Diseases, tenth revision (ICD-10). Descriptive statistics were used to show the mortality status of Hanoi citizens in 2017. Results: There were 20,256 death records in 2017 in Hanoi obtained in this study. The predominant cause of death was non-communicable diseases, particularly cardiovascular diseases, malignant neoplasms, and respiratory diseases. The mortality rate of males was higher than that of females. Conclusions: This study reported the death incidents by cause in Hanoi, Vietnam with a high percentage of missing. This raised the utter need for updating the death registration system. Keywords: Mortality rate, non-communicable diseases, Hanoi.

Clinical Outcomes in Patients With COVID-19 and Hematologic Disease.

Patients with hematologic diseases are at higher risk of the SARS-CoV-2 infection and more severe clinical outcomes of the coronavirus disease. CHRONOS19 is an observational prospective cohort study with the aim to determine the short and longer-term clinical outcomes, risk factors for disease severity and mortality, and rates of postinfectious immunity in patients with malignant and nonmalignant hematologic diseases and COVID-19. Overall, 666 patients were enrolled in the study, of which 626 were included in the final data analysis. The primary endpoint was 30-days all-cause mortality. Secondary endpoints included COVID-19 complications, rates of ICU admission and mechanical ventilation, outcomes of a hematologic disease in SARS-CoV-2 infected patients, overall survival, and risk factors for disease severity and mortality. Data from 15 centers were collected at 30, 90, and 180 days after COVID-19 was diagnosed and were managed using a web-based e-data capture platform. All evaluations were performed in the pre-omicron period of COVID-19 pandemic. Thirty-days all-cause mortality was 18.9%. The predominant cause of death (in 80% of cases) were COVID-19 complications. At 180 days, the majority (70%) of additional deaths were due to hematologic disease progression. At a median follow-up of 5.7 [0.03-19.04] months, 6-months overall survival was 72% [95% CI: 0.69-0.76]. One-third of patients had severe SARS-CoV-2 disease. The rate of ICU admission was 22% with 77% of these patients requiring mechanical ventilation, with poor survival rate. A univariate analysis revealed that older age (≥ 60 years), male sex, malignant hematologic disease, myelotoxic agranulocytosis, transfusion dependence, refractory disease or relapse, diabetes among comorbidities, any complications, especially ARDS alone or in combination with CRS, admission to an ICU, and mechanical ventilation were associated with higher risks of mortality. Treatment of the hematologic disease was changed, postponed, or canceled in 63% of patients. At a longer follow-up (90 and 180 days), the status of the hematologic disease changed in 7.5% of patients. Patients with hematologic disease and COVID-19 have high mortality rates, predominantly due to COVID-19 complications. At a longer-term follow-up, no significant impact of COVID-19 on the course of a hematologic disease was revealed.

Survivorship and the second epidemiological transition in industrial-era London.

The second epidemiological transition describes a shift in predominant causes of death from infectious to degenerative (non-communicable) diseases associated with the demographic transition from high to low levels of mortality and fertility. In England, the epidemiological transition followed the Industrial Revolution, but there is little reliable historical data on cause of death beforehand. Because of the association between the demographic and epidemiological transitions, skeletal data can potentially be used to examine demographic trends as a proxy for the latter. This study uses skeletal data to examine differences in survivorship in London, England in the decades preceding and following initial industrialization and the second epidemiological transition. We use data (from n = 924 adults) from London cemeteries (New Churchyard, New Bunhill Fields, St. Bride's Lower Churchyard, and St. Bride's Church Fleet Street) in use prior to and during industrialization (c. 1569-1853 CE). We assess associations between estimated adult age at death and time period (pre-industrial vs. industrial) using Kaplan-Meier survival analysis. We find evidence of significantly lower adult survivorship prior to industrialization (c. 1569-1669 and 1670-1739 CE) compared to the industrial period (c. 1740-1853 CE) (p < 0.001). Our results are consistent with historical evidence that, in London, survivorship was improving in the later 18th century, prior to the recognized beginning of the second epidemiological transition. These findings support the use of skeletal demographic data to examine the context of the second epidemiological transition in past populations.

Plasma Homocysteine Levels and Cardiovascular Events in Patients With End-Stage Renal Disease: A Systematic Review.

Patients with chronic renal disease or failure are at a heightened risk of mortality due to cardiovascular disease (CVD), which is a predominant cause of death in this population. Hyperhomocysteinemia is prevalent in patients with end-stage renal disease (ESRD), which may increase their susceptibility to CVD. We conducted a comprehensive search of PubMed, Science Direct, and Google Scholar for articles published between 2003 and February 2023, using a combination of keywords such as "plasma homocysteine levels," "hyperhomocysteinemia," "end-stage renal disease," "renal failure," "kidney failure," "cardiovascular events," "cardiovascular disease," "myocardial infarction," "coronary artery disease," and "stroke." Our inclusion criteria were studies that investigated the association between total homocysteine (Hcy) level and CVD or total mortality, as well as the impact of vitamin supplementation on cardiovascular or mortality risk. We restricted our search to English-language studies that included ESRD patients and provided data on plasma Hcylevels and associated CVD events. This systematic review includes 11 articles published between 2003 and 2023 that enrolled a total of 3,953 subjects, of whom 79.15% were male patients. All studies included in the review were either quantitative randomized trials or non-randomized studies, such as cross-sectional, cohort, or case-control studies. Of the total studies included, 10 reported either cardiovascular mortality or CVD events, including cardiovascular death, myocardial infarction (MI), angina, and stroke. One study reported the CVD risk score of the patients, and most of them had higher total homocysteine (tHcy) levels. Overall, a total of 817 CVD events were reported across the studies. In conclusion, the relationship between Hcy and cardiovascular events in ESRD patients is not straightforward and requires further research. However, our review suggests that Hcy could be a predictor of cardiovascular events in this population, and its nutritional characteristics as well as other associated comorbidities may contribute to its inverse association with outcomes.

Global Burden of Digestive Diseases: A Systematic Analysis of the Global Burden of Diseases Study, 1990 to 2019

This study assessed the worldwide burden of digestive diseases between 1990 and2019. We analyzed data from the Global Burden of Diseases study, covering 18 digestive diseases across 204 countries and territories. Key disease burden indicators, including incidence, prevalence, mortality, and disability-adjusted life years (DALYs), were studied. Linear regression analysis was applied to the natural logarithm of age-standardized outcomes to determine the annual percent change. In 2019, there were 7.32 billion incidents and 2.86 billion prevalent cases of digestive diseases, resulting in 8 million deaths and 277 million DALYs lost. Little to no decrease in global age-standardized incidence and prevalence of digestive diseases was observed between 1990 and 2019, with 95,582 and 35,106 cases per 100,000 individuals in 2019, respectively. The age-standardized death rate was 102 per 100,000 individuals. Digestive diseases accounted for a significant portion of the overall disease burden, with more than one-third of prevalent cases having a digestive etiology. Enteric infections were the primary contributor to incidence, death, and DALYs lost, whereas cirrhosis and other chronic liver diseases had the highest prevalence rate. The burden of digestive diseases was inversely related to the sociodemographic index, with enteric infections being the predominant cause of death in low and low-middle quintiles and colorectal cancer in the high quintile. Despite significant reductions in deaths and DALYs due to digestive diseases from 1990 to 2019, they remain prevalent. A significant disparity in the burden of digestive diseases exists among countries with different development levels.

Feasibility of switching from alteplase to tenecteplase for stroke thrombolysis - A retrospective cohort analysis.

Tenecteplase (TNK-tPA) has several benefits over alteplase (tPA) in treatment of acute ischaemic stroke. Randomised controlled trials have shown promising results. In June 2017, the Stroke Unit at Sundsvall County Hospital switched from tPA to TNK-tPA in standard clinical practice. This study examines the effects of that shift. All thrombolysis treatments performed during the first twenty-four months with TNK-tPA (168) were compared to the last twenty-four months with tPA (191). Data were collected from patient records. Follow-up time was 30 days. Co-primary outcomes were death and symptomatic intracranial haemorrhage (SICH). Secondary outcomes were types of intracerebral bleeding and cause of death. Tertiary outcome was door-to-needle time (DNT). Treatment groups were of comparable age (75.7±0.2 years). tPA-treated patients had an NIHSS (National Institutes of Health Stroke Scale) score of 9.2 versus 7.5 for TNK-tPA. Patients older than 80 had more severe strokes (median NIHSS 9 versus 5). SICH occurred in 6 (3.6%) patients in the TNK-tPA group and in 2 (1.0%) treated with tPA, odds ratio (OR) 3.41 (0.70-16.7). Numbers for death were 21 (12.5%) and 31 (15.2%), OR 0.77 (0.46-1.29), meaning no statistically significant differences in primary outcomes. There were no significant differences in secondary outcomes. Predominant cause of death was cerebral infarction. DNT with tenecteplase was shorter: mean 44 versus 26, and median 35 versus 19min. Switching from alteplase to tenecteplase was associated with shorter time to treatment. To draw certain conclusions regarding safety or efficacy would require a larger material.

Immediate and contributory causes of death in patients hospitalized with COVID-19

ObjectivesAccurate determination of the immediate causes of death in patients with COVID-19 is important for optimal care and mitigation strategies. MethodsAll deaths in Qatar between March 01, 2020, and August 31, 2022, flagged for likely relationship to COVID-19 were reviewed by two independent, trained reviewers using a standardized methodology to determine the immediate and contributory causes of death. ResultsAmong 749 flagged deaths, the most common admitting diagnoses were respiratory tract infection (91%) and major adverse cardiac event (MACE, 2.3%). The most common immediate causes of death were COVID-19 pneumonia (66.2%), MACE (7.1%), hospital-associated pneumonia (HAP, 6.8%), bacteremia (6.3%), disseminated fungal infection (DFI, 5.2%), and thromboembolism (4.5%). After COVID-19 pneumonia, MACE was the predominant cause of death in the first 2 weeks but declined thereafter. No death occurred due to bacteremia, HAP, or DFI in the first week after hospitalization, but became increasingly common with increased length of stay in the hospital accounting for 9%, 12%, and 10% of all deaths after 4 weeks in the hospital, respectively. ConclusionNearly one-third of patients with COVID-19 infection die of non-COVID-19 causes, some of which are preventable. Mitigation strategies should be instituted to reduce the risk of such deaths.

Long-COVID, neurological and cardiovascular disorders

Introduction. After the disease COVID-19 caused by the SARS-CoV-2 virus, many people recover completely, but others have symptoms that persist for weeks, months or even years after the illness, with the number of patients who are worried about the signs of Long-COVID constantly growing.&#x0D; The aim. Study of the features of the epidemiological and clinical course, pathophysiological mechanisms of long-COVID development, based on the study and analysis of modern scientific data and the establishment of causal relationships of damage to the nervous and cardiovascular systems. &#x0D; Materials and methods. The electronic databases Scopus, PubMed, Web of Science, using modern technologies (Obsidian), key terms and words related to Long COVID, distant neurological and cardio-vascular complications have been studied and analyzed.&#x0D; Conclusions. "Long COVID" is conceptualized as a multiorgan disorder with a wide range of clinical signs that may indicate primarily damage to the nervous and cardiovascular systems. Central or peripheral nervous system lesions occur in more than one-third of patients. Cardiovascular complications, including stroke, are the predominant causes of death of people with "long COVID" (40 %). The most frequent neurological signs of "Long COVID" (&gt;70 %) are fatigue, headache, sleep disorders, emotional disorders and sensorimotor disorders. The processes of neuroinflammatory and oxidative stress predominate in the spread of neurological consequences of "Long COVID".

Synthesis and characterization of Sr2+ and Gd3+ doped magnetite nanoparticles for magnetic hyperthermia and drug delivery application

Commendable efforts have been gingered towards the fight against cancer. Nevertheless, it remains a major public health concern due to its predominant cause of death globally. Given this, we synthesized two different nanoparticles, Sr2+ and Gd3+ doped magnetite for magnetic hyperthermia and drug delivery application. Based on the characterization, the diffractogram shows that only one phase related to magnetite with a crystallite size of 10 nm was formed. TEM images revealed nanoparticles of spherical shapes of approximately 12 nm. There is no difference in magnetic saturation of the as-received synthesized samples (Fe3O4@Sr and Fe3O4@Gd), while the BET-specific surface area of Fe3O4@Gd is 8 m2 g−1 higher than Fe3O4@Sr. The heat generation in alternating magnetic field (the magnetic hyperthermia) of Fe3O4@Sr functionalized with citric acid and loaded with 5- fluorouracil (Fe3O4@Sr@CA@5-flu) is slower than Fe3O4@Gd@CA@5-flu. The specific absorption rate (SAR) of Fe3O4@Gd@CA@5-flu, 112.0 ± 10.4 W g−1 was found to be higher than that of Fe3O4@Sr@CA@5-flu. The thermogram shows that 11% of the drug was successfully loaded on Fe3O4@Gd@CA@5-flu. The release of the antitumor drug by the synthesized nanoparticle drug carriers for ovarian cancer (SKOV-3 cells) therapy showed that more than 50% of the cancer cell’s viability was reduced after 72 h of incubation. The synthesized nanoparticles demonstrated a promising drug carrier for the treatment of SKOV-3 cells.

Characterization of NDM-5-Producing Escherichia coli Strains Isolated from Pediatric Patients with Bloodstream Infections in a Chinese Hospital.

Escherichia coli (E. coli) bloodstream infections (BSIs) are among the most predominant causes of death in infants and children worldwide. NDM-5 (New Delhi Metallo-lactamase-5) is responsible for one of the main mechanisms of carbapenem resistance in E. coli. To analyze the phenotypic and genomic characteristics of NDM-5-producing E. coli from bloodstream infections (BSIs), a total of 114 E. coli strains was collected from a children's hospital in Jiangsu province, China. Eight blaNDM-5-carrying E. coli strains were identified which were all carbapenem-resistant and carried diverse antimicrobial resistance genes apart from blaNDM-5. They belonged to six distinct sequence types (STs) and serotypes including one each for ST38/O7:H8, ST58/O?:H37, ST131/O25:H4, ST156/O11:H25 and ST361/O9:H30 and three strains are originating from a single clone belonging to ST410/O?:H9. Apart from blaNDM-5, the E. coli strains isolated from BSIs also carried other β-lactamase genes, including blaCMY-2 (n = 4), blaCTX-M-14 (n = 2), blaCTX-M-15 (n = 3), blaCTX-M-65 (n = 1), blaOXA-1 (n = 4) and blaTEM-1B (n = 5). The blaNDM-5 genes were located on three different types of plasmids, which were IncFII/I1 (n = 1), IncX3 (n = 4) and IncFIA/FIB/FII/Q1 (n = 3). The former two types were conjugatively transferable at frequencies of 10-3 and 10-6, respectively. The dissemination of NDM-producing strains, which exhibit resistance to the last-line antibiotics, carbapenems, may increase the muti-antimicrobial resistance burden among E. coli BSIs and further threaten public health.

The association of BTLA gene polymorphisms with non-small lung cancer risk in smokers and never-smokers.

Lung cancer is the predominant cause of death among cancer patients and non-small cell lung cancer (NSCLC) is the most common type. Cigarette smoking is the prevailing risk factor for NSCLC, nevertheless, this cancer is also diagnosed in never-smokers. B and T lymphocyte attenuator (BTLA) belongs to immunological checkpoints which are key regulatory molecules of the immune response. A growing body of evidence highlights the important role of BTLA in cancer. In our previous studies, we showed a significant association between BTLA gene variants and susceptibility to chronic lymphoblastic leukemia and renal cell carcinoma in the Polish population. The present study aimed to analyze the impact of BTLA polymorphic variants on the susceptibility to NSCLC and NSCLC patients' overall survival (OS). Using TaqMan probes we genotyped seven BTLA single-nucleotide polymorphisms (SNPs): rs2705511, rs1982809, rs9288952, rs9288953, rs1844089, rs11921669 and rs2633582 with the use of ViiA 7 Real-Time PCR System. We found that rs1982809 within BTLA is associated with NSCLC risk, where carriers of rs1982809G allele (AG+GG genotypes) were more frequent in patients compared to controls. In subgroup analyses, we also noticed that rs1982809G carriers are significantly overrepresented in never-smokers, but not in smokers compared to controls. Additionally, the global distribution of the haplotypes differed between the never-smokers and smokers, where haplotypes A G G C A, C G A C G, and C G A T G were more frequent in never-smoking patients. Furthermore, the presence rs1982809G (AG+GG genotypes) allele as well as the presence of rs9288953T allele (CT+TT genotypes) increased NSCLC risk in females' patients. After stratification by histological type, we noticed that rs1982809G and rs2705511C carriers were more frequent among adenocarcinoma patients. Moreover, rs1982809G and rs2705511C correlated with the more advanced stages of NSCLC (stage II and III), but not with stage IV. Furthermore, we showed that rs2705511 and rs1982809 significantly modified OS, while rs9288952 tend to be associated with patients' survival. Our results indicate that BTLA polymorphic variants may be considered low penetrating risk factors for NSCLC especially in never-smokers, and in females, and are associated with OS of NSCLC patients.

Delay in seeking healthcare for pneumonia and associated factors among mothers/caregivers of children aged 2–59 months in public health facilities in Nekemte town, Ethiopia

BackgroundPneumonia is the most significant infectious disease and the predominant cause of death among under-five children (U5C) in low- and middle-income countries. It is the second leading cause of death in Ethiopia. Delay in seeking healthcare is one of the contributing factors to pneumonia-associated mortality. There is a limitation to the study aimed at identifying health-seeking behavior and risk factors in the western part of Ethiopia. The study aimed to determine the level of delay in seeking healthcare for pneumonia and associated factors among caregivers of U5C in public health facilities in Nekemte town, Ethiopia.MethodsA health facility-based cross-sectional study was conducted from 1st March to 5thApril, 2022 using a structured interviewer-administered questionnaire to collect data from 410 caregivers of children aged 2–59 months. We used a systematic sampling technique for collecting the data. For analysis, data were entered into Epi Data version 4.6 and exported to SPSS version 25. Binary logistic regression was used to identify the associated factors of delay in seeking healthcare for pneumonia at a p-value < 0.05 using a 95% confidence interval (CI) in multivariable logistic regression.ResultsA proportion of delays in seeking healthcare for pneumonia among children aged 2-59 months is 62.2%. Rural residence (AOR = 2.77, CI:2.48-5.17), child aged ≥12 months (AOR = 5.4,95%CI:4.17-7.20), monthly income < 1000 Ethiopian birr (AOR = 6.11,95%CI:2.16-17.26,), not using health insurance (AOR = 8.93,95%CI:5.43-14.68), use of self-medication (AOR = 10.97,95%CI:1.85-65.3), poor knowledge (AOR = 4.63,95%CI: 1.35-15.9), perceiving illness due to pneumonia as mild (AOR = 14.97,95%CI:9.76-22.9) and no previous admission history (AOR = 2.85,95%CI:1.77-4.56) were significant factors for delay in seeking healthcare for pneumonia among children aged 2-59 months.ConclusionThe study emphasizes that caregivers’ delay in seeking healthcare for pneumonia is high. Creating caregivers’ awareness or providing adequate health education to develop early healthcare-seeking behavior and encouraging caregivers to use health insurance is essential.

EFFECTS OF AIR POLUTION ON HEALTH: A STUDY OF NIGERIA ENVIRONMENT

The quality of air individual inhale can affect their well-being as air pollution is detrimental to health and causing respiratory challenges. Air pollution is no doubt an issue of significant public interest in many developing countries and the international community at large. Therefore, air pollution health related risks are major concern in Nigeria and with various environmental challenges ranging from water pollution, air pollution, oil spillage, deforestation, desertification, erosion and flooding (resulted from bad or no drainage systems) caused mostly by human activities. Air pollution is a wide-reaching problem and it influence human population a great deal. Respiratory infection associated with air pollution is also on the increase and other predominant cause of death associated with air pollution include chronic respiratory diseases, cardiovascular diseases, enteric infections, diarrheal diseases, communicable, maternal, neonatal, and nutritional disease and has caused about 900 thousand deaths and 32 million people living with health related disability per annum in Nigeria. Healthy environmental sustainability is critical to improving the quality and life expectancy. Therefore, sustainable development policies and practices is essential to the policymakers to enhance a healthy life. This paper presents a review of the air pollution challenges in Nigeria and proffer some recommendation to forestall continuous air pollution health related problem. Study shows that air pollutions are not only affecting the human by time but also affecting animals and plants.

A Multi-Centre, Randomised, Double-Blind, Placebo-Controlled Phase III Clinical Trial Evaluating the Impact of BCG Re-Vaccination on the Incidence and Severity of SARS-CoV-2 Infections among Symptomatic Healthcare Professionals during the COVID-19 Pandemic in Poland-Evaluation of Antibody Concentrations.

Tuberculosis (TB) was the predominant cause of death from a single infectious agent worldwide before the severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) pandemic. Although TB vaccines have been successfully used for about 100 years, their full effect is still unknown. In previous studies, a reduced incidence and mortality from a coronavirus disease in TB-vaccinated populations were reported. In this article, we present the secondary analysis of a randomised controlled trial, reporting the results of a serological assessment evaluating the effect of the Bacillus Calmette-Guérin (BCG) vaccine on SARS-CoV-2. Participants-healthcare workers-were assessed 1-2 and 8 months after the second dose of the coronavirus disease 2019 (COVID-19) vaccine. We found no associations between antibody concentration, BCG revaccination, and additional characteristics, such as age, gender, or Body Mass Index. The effect of BCG vaccination on the immunological response against SARS-CoV-2 requires further research.

Causes of Death in the Lithuanian Armed Forces, 1919–1940

Between the First World War and the Second World War, approximately 280 thousand men served in the Lithuanian armed forces. This is a significant figure for a country that only had a population of two to 2.5 million. Even though the Lithuanian armed forces were only involved in active military operations and low-intensity fighting from 1919 to 1923, servicemen died during the entire period up to 1940. The numbers of deaths during the Wars of Independence are well known; however, the causes of death in the Lithuanian armed forces, both from 1919 to 1920 and in later years, have not been investigated in great depth. We understand that one cause of death in an active army is active combat. In the study of war, deaths in action are further classified into deaths caused by artillery fire, machine gun and rifle fire, bayonets, etc. This allows scholars to determine the effectiveness of weapons systems and tactical elements used on the battlefield. However, the focus of this article is the causes of soldiers’ deaths that are not directly combat related. In the first section, I discuss causes of death in the Lithuanian armed forces during periods of war and peace, and provide a host of examples, which include deaths caused by disease, accidents, homicide and suicide. In the last section, I present the results of quantitative analysis. The quantitative analysis is a case study of a single regiment that demonstrates the predominant causes of death from 1919 to 1940, with a separate analysis of causes of death for the period 1919 to 1920.

Clinical features and outcomes of epidermolysis bullosa in thai children: A 20-Year review from a Tertiary Care Center

Background: Epidermolysis Bullosa (EB) is a heterogeneous genetic disorder with skin fragility. Only a few cases have been reported in Thailand. This study aims to determine the clinical characteristics, complications, and outcomes of EB stratified by subtype. Methods: A retrospective single-center study of EB patients at the Dermatology Unit, Queen Sirikit National Institute of Child Health, was reviewed from January 1, 2002, to December 31, 2021. Diagnosis is based on clinical manifestations and some skin biopsies. Results: There were 38 enrolled patients, age range from 0 to 25 years with a male-to-female ratio of 1.1:1. Family history of EB and consanguineous marriage were found in 6 cases and 2 cases, respectively. The most common type of EB was dystrophic EB (DEB) (26 cases) (68.4%), including recessive DEB in 15 cases (39.5%) and dominant DEB in 11 cases (28.9%). Other types were EB simplex in 10 cases (26.3%) and junctional EB in 2 cases (5.3%). Common complications were cutaneous bacterial infection (39.5%), anemia (31.6%), failure to thrive (18.4%), and protein energy malnutrition (15.8%). Musculoskeletal (21.1%), gastrointestinal (13.2%), and eye complications (7.9%) were exclusively found in DEB. Nineteen patients (50%) received regular follow-ups with a median duration of 9 months (range = 0.5 to 248 months). The mortality rate was 31.6% (6/19). Five cases died from bacterial sepsis, while one case died from metastatic squamous cell carcinoma. Conclusion: DEB is the most common type of EB in Thai children, and bacterial sepsis is the predominant cause of death. Further multicenter and molecular genetic studies are recommended for a definite diagnosis.

Causes of death and predictors of long-term mortality after pulmonary embolism

Abstract Background While a large number of studies has investigated short-term outcome after pulmonary embolism (PE), the effects of PE on long-term mortality are insufficiently studied. Purpose To investigate long-term outcomes in an unselected real-world cohort of patients with acute PE. Methods Consecutive patients with acute PE enrolled in a prospective single-centre registry between 05/2005 and 12/2017 were followed for up to 14 years. The primary study outcome was all-cause mortality during follow-up. Kaplan-Meier analyses were used to evaluate the probability of long-term survival. The prognostic relevance of baseline characteristics was assessed using Cox proportional hazards models. Standardised mortality rates (SMR) were calculated to estimate relative rates of mortality in the study cohort compared to the expected mortality in the general population adjusted for sex, age and year of birth. Results We analysed data from 882 patients (age 69 [interquartile range (IQR) 56–77] years), followed for a total of 3,904 patient years (median follow-up 3.2 [IQR 1.3–7.2] years). Overall, 40.9% of patients died during follow-up. One- and five-year mortality rates were 19.8% and 33.7%, respectively. While most early deaths could be attributed to PE or associated complications, cancer was the predominant cause of death between 30 days and 3 years after PE, whereas cardiovascular events and infections were the most frequent causes of death after more than 3 years (Figure 1). In patients who survived the first 30 days after PE, the observed number of deaths was higher than the expected mortality in the general population throughout the follow-up period (Figure 2; 5-year SMR 2.77 [95% CI 2.42–3.15]). The strongest predictor of late mortality was active cancer at the time of PE, that was associated with a Hazard Ratio [HR] of 4.03 [95% CI 3.07–5.28]) for death after &amp;gt;30 days. Of note, active cancer was only associated with an increased mortality risk during the first three years of follow-up, but did not predict death after more than three years. In non-cancer patients, mortality was also elevated compared to the general population (5-year SMR 1.80 [95% CI 1.51–2.14]) and late mortality was predicted by chronic pulmonary disease (HR 2.22 [95% CI 1.51–3.27]), chronic heart failure (HR 1.90 [95% CI 1.36–2.66]), age per decade (HR 1.79 [95% CI 1.54–2.09]) and anaemia (HR 1.59 [95% CI 1.16–2.17]). Conclusion Even after survival of the acute phase, the mortality risk of PE patients remained elevated compared to the general population throughout the 14 year follow-up period. The main driver of late mortality is cancer. However, elevated mortality was also observed in in PE patients without cancer, in whom late mortality was predicted by chronic cardiopulmonary comorbidities, age and anaemia. Funding Acknowledgement Type of funding sources: Public grant(s) – National budget only. Main funding source(s): This study was supported by the German Federal Ministry of Education and Research (BMBF 01EO1503).

Obesity in young sudden cardiac death: rates, clinical features, and insights into people with body mass index &amp;gt;50kg/m2

Abstract Background Obesity is common in young sudden cardiac death (SCD) victims but it is unclear whether it is more common than in the general population. This study aimed to contextualize young SCD obesity rates, identifying clinical and pathologic features in WHO class II and III obesity. Methods A prospective state-wide out-of-hospital cardiac arrest registry included all SCDs in Victoria, Australia from 2019–2021. Body mass indices (BMIs) of patients 18–50 years were compared to age-referenced general population. Characteristics of SCD patients with WHO Class II obesity (BMI ≥30kg/m2) and non-obesity (BMI &amp;lt;30kg/m2) were compared. Clinical characteristics of people with BMI &amp;gt;50kg/m2 were assessed. Results 504 patients were included. Obesity was strongly over-represented in young SCD compared to the age-matched general population (55.0% vs 28.7%, p&amp;lt;0.0001). Obese SCD patients more frequently had hypertension, diabetes and obstructive sleep apnoea (p&amp;lt;0.0001, p=0.009 and p=0.001 respectively), ventricular fibrillation as their arrest rhythm (p=0.008) and left ventricular hypertrophy (LVH) (p&amp;lt;0.0001). Obese patients were less likely to have toxicology positive for illicit substances (22.0% vs 32.6%, p=0.008) or significant alcohol history (18.8% vs 26.9%, p=0.030). Patients with BMI &amp;gt;50 kg/m2 represented 8.5% of young SCD. LVH (n=26, 60.5%) was their predominant cause of death and only 10 (9.3%) patients died from coronary disease. Conclusion Over half of young Australian SCD patients are obese, with all obesity classes over-represented compared to the general population. Obese patients had more cardiac risk factors. Almost two thirds of patients with BMI&amp;gt;50 kg/m2 died with LVH, with fewer than 10% dying from coronary disease. Funding Acknowledgement Type of funding sources: None.

Predation strongly limits demography of a keystone migratory herbivore in a recovering transfrontier ecosystem.

Large herbivore migrations are imperiled globally; however the factors limiting a population across its migratory range are typically poorly understood. Zambia's Greater Liuwa Ecosystem (GLE) contains one of the largest remaining blue wildebeest (Connochaetes taurinus taurinus) migrations, yet the population structure, vital rates, and limiting factors are virtually unknown. We conducted a long‐term demographic study of GLE wildebeest from 2012 to 2019 of 107 collared adult females and their calves, 7352 herd observations, 12 aerial population surveys, and concurrent carnivore studies. We applied methods of vital rate estimation and survival analysis within a Bayesian estimation framework. From herd composition observations, we estimated rates of fecundity, first‐year survival, and recruitment as 68%, 56%, and 38% respectively, with pronounced interannual variation. Similar rates were estimated from calf‐detections with collared cows. Adult survival rates declined steadily from 91% at age 2 years to 61% at age 10 years thereafter dropping more sharply to 2% at age 16 years. Predation, particularly by spotted hyena, was the predominant cause of death for all wildebeest ages and focused on older animals. Starvation only accounted for 0.8% of all unbiased known natural causes of death. Mortality risk differed substantially between wet and dry season ranges, reflecting strong spatio‐temporal differences in habitat and predator densities. There was substantial evidence that mortality risk to adults was 27% higher in the wet season, and strong evidence that it was 45% higher in the migratory range where predator density was highest. The estimated vital rates were internally consistent, predicting a stable population trajectory consistent with aerial estimates. From essentially zero knowledge of GLE wildebeest dynamics, this work provides vital rates, age structure, limiting factors, and a plausible mechanism for the migratory tendency, and a robust model‐based foundation to evaluate the effects of potential restrictions in migratory range, climate change, predator–prey dynamics, and poaching.