Prognosis In Terms Of Mortality Research Articles

DAMAGE CONTROL IN ORTHOPEDICS

Introduction: DAMAGE CONTROL - in orthopedic surgery and traumatology, it is indicated for fresh fractures, especially for trauma with open bone fractures. In all these fresh fractures, hemodynamic instability of the body occurs. In these cases, a minimally invasive procedure is recommended, which initially aims to temporarily stabilize the fractures and control bleeding Material and methods: In our work, we will present the official literature that deals with the issue of damage control in orthopedics. Discussion: One of the leading causes of death in people under 40 is polytrauma. Fractures of the diaphysis of the tibia, femur, and pelvis are the most common fractures that are stabilized using external fixation. Bilateral fractures of the femoral diaphysis are associated with a poor prognosis in terms of mortality and fat embolism syndrome.Hemodynamically stable patients should always undergo definitive fracture fixation. Any prolonged intervention in hemodynamically unstable patients worsens the favorable outcome. Then the immune response can be triggered and increased, which is identified with the clinical condition “Second trauma”. Therefore, these patients should be immediately subjected to DAMAGE CONTROL with temporary stabilization and then delayed definitive fixation for a period of 5-10 days from damage control, i.e. in the second act. Orthopedic surgeons should be very careful and recognize the triangle of death - acidosis, hypothermia and coagulopathy, which are interconnected and eventually become irreversible and lead to death as the final outcome. Damage control surgery in orthopedics includes three stages: the first stage of treatment involves controlling bleeding, reducing contamination, and achieving temporary fracture fixation. The time in which all this is done should be as short as 1-2 hours. The second phase involves the stabilization of vital parameters in the ICU as well as the reanimation of the child with the prescription of the necessary therapy as well as blood replacement The aim: The aim of our work is to demonstrate the outcome and feasibility of damage control in orthopedic surgery for both adults and children with multiple limb injuries and polytraumatized patients Conclusion: Polytrauma is a condition of the body that requires immediate action and a special approach because the patient’s life is at risk in a high percentage. The principles used to manage patients with multiple injuries including head, lower leg. Early fracture fixation led to earlier mobilization of patients and thus And reduced the percentage of complications, wound infections as well as reducing treatment costs. DAMAGE CONTROL is not only used in traumatized adult patients. It is also necessary to do it in children’s patients.

Trombosis venosa cerebral en adultos: cohorte de 35 casos de un hospital terciario

ObjectiveTo describe the baseline characteristics, clinical presentation, imaging tests and outcomes, and identify potential prognostic factors in a cohort of patients diagnosed with cerebral venous thrombosis (CVT). Patients and methodsThis retrospective, single-center, observational study included adult patients diagnosed with CVT from January 2016 to December 2020. The variables were reviewed using electronic medical records. ResultsA total of 35 patients were included, with a median age at diagnosis of 50.3 (± 17.8) years, and the majority being women (74.4%). Nearly 95% of the patients presented at least one risk factor for the development of CVT. Heparins were used for the acute phase in 97.1% of cases, with 75% of those being low molecular weight heparins. During the first two weeks, a compound event (death, intensive care unit admission, National Institute of Health Stroke Scale at discharge >3, CVT recurrence, major bleeding, or the presence of complications) occurred in 28.6% of patients (10 patients). Over the mean follow-up period of 3.3 years, 14.3% of the patients died (with only one death attributed to CVT), one patient experienced major bleeding, and no patients had a recurrence of CVT. ConclusionsIn our cohort, CVT predominantly affected young women with at least one risk factor for its development. The presence of edema on CT and corticosteroid treatment were associated with a poor short-term prognosis. However, we observed a favorable long-term prognosis in terms of mortality, recurrence, and bleeding.

Cerebral venous thrombosis in adults: a case series of 35 patients from a tertiary hospital

ObjectiveTo describe the baseline characteristics, clinical presentation, imaging tests and outcomes, and identify potential prognostic factors in a cohort of patients diagnosed with cerebral venous thrombosis (CVT). Patients and methodsThis retrospective, single-center, observational study included adult patients diagnosed with CVT from January 2016 to December 2020. The variables were reviewed using electronic medical records. ResultsA total of 35 patients were included, with a median age at diagnosis of 50.3 (+/- 17.8) years, and the majority being women (74.4%). Nearly 95% of the patients presented at least one risk factor for the development of CVT. Heparins were used for the acute phase in 97.1% of cases, with 75% of those being low molecular weight heparins.During the first two weeks, a compound event (death, intensive care unit admission, National Institute of Health Stroke Scale at discharge >3, CVT recurrence, major bleeding, or the presence of complications) occurred in 28.6% of patients (10 patients).Over the mean follow-up period of 3.3 years, 14.3% of the patients died (with only one death attributed to CVT), one patient experienced major bleeding, and no patients had a recurrence of CVT. ConclusionsIn our cohort, CVT predominantly affected young women with at least one risk factor for its development. The presence of edema on CT and corticosteroid treatment were associated with a poor short-term prognosis. However, we observed a favorable long-term prognosis in terms of mortality, recurrence, and bleeding.

Pneumothorax in hospitalized COVID-19 patients with severe respiratory failure: Risk factors and outcome

PNX was described as an uncommon complication in COVID-19 patients but clinical risk predictors and the potential role in patient's outcome are still unclear. We assessed prevalence, risk predictors and mortality of PNX in hospitalized COVID- 19 with severe respiratory failure performing a retrospective observational analysis of 184 patients admitted to our COVID-19 Respiratory Unit in Vercelli from October 2020 to March 2021. We compared patients with and without PNX reporting prevalence, clinical and radiological features, comorbidities, and outcomes. Prevalence of PNX was 8.1% and mortality was >86% (13/15) significantly higher than in patients without PNX (56/169) (P < 0.001). PNX was more likely to occur in patients with a history of cognitive decline (HR: 31.18) who received non-invasive ventilation (NIV) (p < 0.0071) and with low P/F ratio (HR: 0.99, p = 0.004). Blood chemistry in the PNX subgroup compared to patients without PNX showed a significant increase in LDH (420 U/L vs 345 U/L, respectively p = 0.003), ferritin (1111 mg/dl vs 660 mg/dl, respectively p = 0.006) and decreased lymphocytes (HR: 4.440, p = 0.004). PNX may be associated with a worse prognosis in terms of mortality in COVID patients. Possible mechanisms may include the hyperinflammatory status associated with critical illness, the use of NIV, the severity of respiratory failure and cognitive impairment. We suggest, in selected patients showing low P/F ratio, cognitive impairment and metabolic cytokine storm, an early treatment of systemic inflammation in association with high-flow oxygen therapy as a safer alternative to NIV in order to avoid fatalities connected with PNX.

Assessment of foetal ventriculomegaly from prenatal to early postnatal period: a single-centre retrospective cohort study

The aim of this study was to evaluate the early neonatal outcomes of cases with foetal ventriculomegaly (VM) and to investigate the aetiological and prognostic factors according to the degree of VM in a single tertiary referring centre. The medical records of 87 foetuses diagnosed with VM (≥10 mm) within 6 years were evaluated. Postnatal evaluation and early neonatal prognosis were determined in 39 cases divided into two groups as mild (10–15 mm, 30 cases) and severe (>15 mm, 9 cases) according to the ventricular size. The mean gestational age at which foetal VM was detected was 22 + 3 weeks. In terms of severity, severe cases of VM were more frequent in terminated pregnancies. There was no difference in gestational age, birth weight, fifth minute Apgar scores, or cord blood gases between mild and severe cases at delivery. Isolated VM was detected in 63% of mild and 22% of severe cases. In severe cases, the need for intensive care and surgery was higher than in mild cases. Antenatal VM regressed in 50% of mild cases and 22% of severe cases. Increasing knowledge about neonatal prognosis, the factors involved in aetiology, and the degree of VM will guide the management of foetal VM. IMPACT STATEMENT What is already known in this subject? Some cases of foetal VM resolve spontaneously, and postnatal ultrasonography can detect normal ventricle sizes. While 74.6% of isolated VM cases show spontaneous regression, this rate is 52.1% in nonisolated cases. The gestational week at the time of diagnosis, the degree and cause of VM, intrauterine progression and the presence of any genetic, infectious, cerebral, or extracerebral disorders all influence the prognosis. What do the results of this study add? Antenatal VM regressed in 50% of mild cases and 22% of severe cases. In severe cases, the need for intensive care and surgery was higher than in mild cases. The higher frequency of accompanying cerebral findings in severe cases was striking. What are the implications of these findings for clinical practice and/or further research? The current study revealed that isolated VM with ventricular diameter less than 15 mm, after excluding out chromosomal abnormalities and prenatal infections, and no prior history of VM, has a favourable neonatal prognosis in terms of mortality and morbidity. In cases of foetal VM, increased knowledge of neonatal prognosis will guide pregnancy care and postnatal follow-up planning. Prospective multicentre studies on the neonatal period are required to bridge the gap between foetal VM and long-term consequences

The protective effects of SGLT-2 inhibitors, GLP-1 receptor agonists, and RAAS blockers against renal injury in patients with type 2 diabetes.

Diabetic kidney disease is one of the most severe complications of type 2 diabetes mellitus. Patients with diabetic kidney disease have a worse prognosis in terms of mortality and morbidity, compared with patients who have diabetes alone. Strict control of blood pressure and blood glucose is the primary method for prevention of initial kidney damage and delaying further progression of existing damage. Other management approaches include the use of exogenous drugs that can effectively protect the kidneys from diabetes, such as sodium-glucose transporter 2 inhibitors, glucagon-like peptide-1 receptor agonists, and renin-angiotensin-aldosterone system blockers. These drugs may protect against kidney injury through various molecular mechanisms. This review focuses on renal impairment in patients with type 2 diabetes; it discusses the direct and indirect effects of sodium-glucose transporter 2 inhibitors, glucagon-like peptide-1 receptor agonists, and renin-angiotensin-aldosterone system blockers on diabetic kidney disease. Finally, it discusses the effects of combination treatment with two or three types of drugs in patients with chronic kidney disease.

Clinical, Biological, Scannographic and Prognosis Characteristics of Severe Covid-19 According To the Extent of Lung Lesions on Chest CT Scan

Introduction: COVID-19 caused by SARSCov-2 could be serious and fatal. The objective was to determine the correlation of clinical, biological, CT and prognosis of severe COVID-19 according to the extent of lung lesions on the chest CT scan. Patients and method: This is a retrospective analytical study carried out in the department of pneumology University Hospital of the Joseph Raseta Befelatanana, Antananarivo, Madagascar for a three-month period from March to May 2021. Results: 78 severe COVID-19 cases met the inclusion criteria, for an incidence of 66.7%. The mean age of our patients was 52.81 ± 16.64 years. Age did not differ for the three CT extension groups (p = 0.60). Male gender, dyspnea, C-Reactive protein elevation correlated with the extent of lung damage (p &lt;0.05). On CT scan, the ground glass image and bilateral involvement were also associated with CT extension of lung lesions (p = 0.03, p = 0.04). The prognosis in terms of mortality was worse in severe COVID-19 patients with disease greater than 26%. The overall death was 6.41%. Conclusion: Factors such as male gender, dyspnea, C-reactive protein, frosted glass and bilateral images of severe COVID-19 patients were correlated with the CT extent of lung lesions. Their understandings would make it possible to predict the unfavorable evolution of these lesions on a CT scan, thus reducing mortality

Significance of plasma fibrinogen and malondialdehyde in the post-inflammatory period in patients with cystic fibrosis.

Evaluation of selected inflammatory parameters and serum malondialdehyde (MDA) significance in the post-inflammatory period in adult patients with cystic fibrosis. Laboratory biomarkers can be integrated into clinical practice as part of monitoring the effectiveness of treatment. After recovery from an acute exacerbation of lung infection, selected inflammatory parameters (fibrinogen, IL-1, IL-6, SAA, hs-CRP) and serum MDA were examined in 30 adult patients with cystic fibrosis. Their correlation with FEV1, frequency and duration of subsequent hospitalizations and 6-year prognosis in terms of mortality or need for lung transplantation was evaluated. FEV1 negatively correlated with fibrinogen, but positively with MDA. No significant correlation with hs-CRP, IL-1, IL-6 and SAA was recorded. Plasma fibrinogen predicted the frequency and duration of subsequent hospitalizations. The 6-year prognosis was negatively associated with plasma fibrinogen whereas its association with MDA was positive. However, the prognosis of patients in the multivariate analysis was significantly associated only with FEV1. Plasma fibrinogen examined in the post-inflammatory period is a marker of lung damage in patients with cystic fibrosis and can be used to predict the prognosis. The positive correlation of serum MDA with FEV1 in the post-inflammatory period may be important to the interpretation of treatment interventions (Tab. 3, Fig. 2, Ref. 17).

Pneumothorax and/or Pneumomediastinum Worsens the Prognosis of COVID-19 Patients with Severe Acute Respiratory Failure: A Multicenter Retrospective Case-Control Study in the North-East of Italy.

Pneumothorax (PNX) and pneumomediastinum (PNM) are potential complications of COVID-19, but their influence on patients’ outcomes remains unclear. The aim of the study was to assess incidence, risk factors, and outcomes of severe COVID-19 complicated with PNX/PNM. Methods: A retrospective multicenter case-control analysis was conducted in COVID-19 patients admitted for respiratory failure in intermediate care units of the Treviso area, Italy, from March 2020 to April 2021. Clinical characteristics and outcomes of patients with and without PNX/PNM were compared. Results: Among 1213 patients, PNX and/or PNM incidence was 4.5%. Among these, 42% had PNX and PNM, 33.5% only PNX, and 24.5% only PNM. COVID-19 patients with PNX/PNM showed higher in-hospital (p = 0.02) and 90-days mortality (p = 0.048), and longer hospitalization length (p = 0.002) than COVID-19 patients without PNX/PNM. At PNX/PNM occurrence, one-third of subjects was not mechanically ventilated, and the respiratory support was similar to the control group. PNX/PNM occurrence was associated with longer symptom length before hospital admission (p = 0.005) and lower levels of blood lymphocytes (p = 0.017). Conclusion: PNX/PNM are complications of COVID-19 associated with a worse prognosis in terms of mortality and length of hospitalization. Although they are more frequent in ventilated patients, they can occur in non-ventilated, suggesting that mechanisms other than barotrauma might contribute to their presentation.

Self-care Behavior and Frailty Syndrome among Elderly Patients with Heart Failure

BACKGROUND: The development of technology gives an impact on life expectancy in the elderly. In Yogyakarta, the total of the elderly was higher than in other provinces in Indonesia. The elderly experience a decreased functional state that may lead to impaired body organs, such as heart failure. Heart failure has increasingly become a serious health problem. At present, 80% of elderly patients experience heart failure because of a decrease in functional status. The elderly may also experience frailty syndrome, which can provide a poor prognosis in terms of mortality, rehospitalization, and quality of life. It needs complex management; one of these is self-care behavior that can prevent the spread of frailty syndrome. AIM: The study aims to assess the correlation between self-care behavior and frailty syndrome in elderly patients with heart failure. METHODS: The study included 87 elderly patients with heart failure who visited the cardiology outpatient unit in two private hospitals. Self-care was measured using the self-care heart failure index, and frailty syndrome was assessed using the frailty index. A correlation test was conducted using Spearman rho. RESULTS: The result showed inadequate self-care behavior with a mean score of 48.70. The mean score of frailty syndrome was 0.142, categorized in the pre-frail phase. No correlation was found between self-care behavior and frailty syndrome with p=0.20. CONCLUSION: Self-care behavior in elderly patients with heart failure is still inadequate and in the pre-frail phase. Nurses and other health professionals should consider intervention to increase self-care behavior among the elderly and screening to increase their awareness of frailty syndrome.

The efficacy and safety of itopride in feeding intolerance of critically ill patients receiving enteral nutrition: a randomized, double-blind study

BackgroundEnteral feeding intolerance (EFI) is a frequent problem in the Intensive care unit (ICU) and is associated with poor clinical outcomes leading to worse prognosis in terms of mortality and ICU stay. Nowadays, prokinetic drugs are the mainstay of therapy in EFI. However, available prokinetics have uncertain efficacy and safety profiles. Itopride, is a prokinetic agent which is different and unique from the available prokinetics because of its dual mode of action as well as its tolerability and safety. The current study compared the efficacy and safety of Itopride against metoclopramide for EFI in critically ill patients. Moreover, it tested the utility and applicability of ultrasonography to measure gastric residual volume (GRV) in this population.MethodsThis randomized, double-blind study included 76 EFI patients who were randomly assigned to either Itopride or metoclopramide group. The primary outcome was to measure GRV by ultrasonography. Secondary outcomes included the percentage ratio of enteral feed volume, energy and protein received by patients over 7 days of treatment, ICU length of stay, safety parameters and occurrence of infectious complications or vomiting.ResultsThirty-five patients of each group completed the study. At day 7, itopride significantly decreased GRV compared with metoclopramide group (p = 0.001). Moreover, there was a significant increase in the ratios of received enteral nutrition feed volume, calories, and protein after the one-week therapy in the itopride group more than the metoclopramide group (p = 0.001), (p = 0.002), (p = 0.01), respectively and there were no differences in any secondary outcomes or adverse events between the two groups.ConclusionIn critically ill patients with EFI, itopride was well tolerated with superior efficacy to metoclopramide. In addition, we demonstrated that ultrasonography is a simple, non-invasive, inexpensive, and undemanding method for GRV measurements and can offer reliable assessments in the gastric emptying modality.Trial registrationThe trial was registered in ClinicalTrials.gov (NCT03698292). Date: October 5, 2018

Mortality Rates in Alzheimer's Disease and Non-Alzheimer's Dementias: A Systematic Review and Meta-Analysis

Background: People with dementia die prematurely. Identifying differences in mortality rates between different types of dementia may aid in the development of preventive interventions for these most vulnerable populations. Methods: A systematic search of the MEDLINE, PubMed, EMBASE, and Cochrane Library from inception to May 31, 2020 was conducted for case-control or cohort studies providing mortality and survival-related outcomes among people with different types of dementia. The primary outcomes were the all-cause mortality rate and survival time from dementia diagnosis between the general population, people with Alzheimer’s disease (AD), and those with non-AD dementias. The secondary outcomes were age at death and survival time from disease onset. Random-effects meta-analyses were conducted. Effect sizes included hazard ratios (HRs) and mean differences (MDs) with 95% confidence intervals (CIs). Potential moderators were identified through meta-regression and subgroup analyses. The Newcastle Ottawa Scale was used to measure the methodological quality of eligible studies. Heterogeneity was assessed with the I2 statistic and sensitivity analyses were undertaken. Findings: Data were extracted from 78 eligible studies encompassing 152,353 controls and 63,125 cases of dementia. All-cause mortality occurred in 20,927 of 152,174 controls and in 2,684 of 8,102 cases of dementia during a median 5-year follow-up. After diagnosis, the median survival time for people with AD was 4·4 (range, 1·3, 10) years. Compared to controls, the HR of all-cause mortality was highest for Lewy body dementia (17·88; 95% CI, 5·87, 54·46). Compared to AD, a diagnosis of any non-AD dementia was associated with a higher risk of all-cause mortality (HR, 1·33; 95% CI, 1·21, 1·46), a shorter survival time from diagnosis (MD, -1·12; 95% CI, -1·52, -0·72), and a younger age at death (MD, -1·76; 95% CI, -2·67, -0·85). However, group differences between distinct subtypes of non-AD dementia were not significant. Interpretation: AD is the most common type of dementia and the leading cause of mortality world-wide, but non-AD dementias have a worse prognosis in terms of mortality and survival. Funding: None to declare. Declaration of Interest: None to declare

The anticholinergic effect on cognition (AEC) scale: Associations with mortality, hospitalisation and cognitive decline following dementia diagnosis

AbstractObjectivesTo investigate associations between central anticholinergic burden (using the AEC scale), and mortality, hospitalisation and cognitive decline in patients with dementia.MethodsThe South London and Maudsley NHS Foundation Trust (SLaM) Clinical Records Interactive Search (CRIS) application was used to identify patients 65 years or older at their first recorded diagnosis of dementia. Data were linked to national mortality and hospitalisation sources, and serially recorded Mini‐Mental State Examination (MMSE) scores were used to investigate cognitive decline over the 36 months after diagnosis in mixed models.ResultsPatients for whom a review of their medication was indicated (AEC score ≥ 2 for any individual drug or total AEC score ≥ 3) had an increased risk of mortality (hazard ratio 1.07; 95% CI 1.01‐1.15) and emergency hospitalisation (1.10; 95% CI 1.04‐1.17), but there were no associations with duration of hospitalisation. Cognitive trajectory analyses showed that this exposure group had lower MMSE scores at diagnosis and a sharper increase in MMSE scores over the subsequent 6 months, but similar slopes for the 6‐36 months period to the remainder of the sample.ConclusionsPatients with dementia receiving medication with high central anticholinergic activity (as measured on the AEC scale), appear to have worse prognosis in terms of mortality and hospitalisation risk, but have primarily acutely impaired cognitive function, rather than longer term differences in cognitive decline.

Clinical impact of diabetes mellitus and anti-diabetic treatment on long-term follow-up of patients at a Heart Failure Unit

Abstract Introduction Diabetes Mellitus (DM) is a very prevalent metabolic disease in our environment which represents a very frequent comorbidity in patients with heart failure (HF) and is associated with a poorer prognosis. Our aim is to characterize the population with HF that has DM, and to analyze its treatment and impact on the long-term prognosis in terms of mortality and hospital readmissions due to heart failure. Material and methods We selected HF cases assisted at the heart failure unit of the HURS, and classified the patients into two groups: Group 1 (without DM) and Group 2 (with DM). Clinical, echocardiographic, and treatment variables were collected, and the impact of DM and its treatment was evaluated in the long term as far as all-cause mortality and hospital readmissions due to heart failure. Results A total of 396 patients were selected, out of which 151 had DM (38.1%). The mean age of the cohort was 66±14 years, with a male predominance (66.2%). In relation to non-diabetics, Group 2 had a higher percentage of hypertension (83% vs 56%; p=0.000), hypercholesterolemia (74% vs 40%; p=0.000), ischemic etiology (48% vs 22%; p=0.000), chronic renal disease (40% vs 25%; p=0.001), anemia (35% vs 25%; p=0.037), peripheral vascular disease (38% vs 12%; p=0,000), and there was also greater use of ACEi (73% vs 62%; p=0,022) and thiazides (24% vs 9%; p=0,000). Regarding the treatment used in Group 2 for the metabolic control of hyperglycemia, a predominance of metformin (54.3%), I-SGLT2 (39.7%) and insulin (39.1%) was observed while there was a lower percentage of sulphonylureas (6%). With a mean 70±6 months of follow-up, Group 2 had a similar rate of hospital readmission for HF as non-diabetic patients (49.2% vs 52%; p=0.778). Likewise, with a mean of 58.5±7 months of follow-up, diabetic patients had a similar rate of all-cause mortality as non-diabetic patients (24% vs 22.8%; p=0.460). In relation to the use of I-SGLT2, with a mean of 116.5±7 months of follow-up, HF patients taking I-SGLT2 had a lower all-cause mortality rate than those not taking I-SGLT2 (3.8% vs 30.6%; p=0.019). In diabetic patients taking I-SGLT2, with a mean of 116.5±5 months of follow-up, they had a lower all-cause mortality rate than those not taking I-SGLT2 (3.8% vs 35.8%; p=0.002). In diabetic patients taking sulphonylureas, with a mean of 33±5 months of follow-up, they had a higher all-cause mortality rate than those not taking sulphonylureas (44.4% vs 14.8%; p=0.006). Conclusion Diabetic patients with HF have a greater number of comorbidities, although, in our series, it has not been associated with a poorer prognosis in terms of mortality or readmissions due to heart failure. Regarding the treatment used for the metabolic control of hyperglycemia, patients with HF and DM who are treated with I-SGLT2 have a lower all-cause mortality rate. However, diabetic patients with HF who were taking sulfonylureas had a poorer prognosis in terms of mortality. Kaplan-Meier Analysis Funding Acknowledgement Type of funding source: None

Atrial fibrillation with or without structural abnormalities. Analysis from a nationwide database

Abstract Background Atrial Fibrillation (AF) is often associated with underlying heart failure, valvular disease, ischemic heart disease, as well as other structural heart diseases, but can also occur as an independent entity which may be named pure AF or lone AF. Small cohort studies have suggested that lone AF patients may have a favorable prognosis in terms of mortality and ischemic stroke rates. We aimed to assess, at a nationwide scale, the prognosis of patients hospitalized with lone AF and AF associated with cardiac disease. Methods From the French administrative hospital-discharge PMSI database (Programme de Médicalisation des Systèmes d'Information) covering hospital care and representative of the whole French population, all consecutive patients with AF diagnosis hospitalized between 2010 and 2018 were included. From this huge database, 2,793,234 patients were included: group lone FA: 665,431, group AF and cardiac disease: 2,727,803. Incidence rates (%/year) for the outcomes (all-cause death, cardiovascular [CV] death, or ischemic stroke) during follow-up were compared between groups using incidence rate ratios (RR) for the whole cohort and also for a subgroup of 539,654 propensity score matched patients for non-cardiovascular conditions (269,827 with AF alone and 269,827 with AF and CD). Results The majority of this population had AF associated with a cardiac disease (n=2,127,803; 76.2%). At follow-up (median [IQR] 1.1 [0.1–3.4] years), patients with AF and CD were at higher risk of all-cause mortality (yearly incidence 13.6% vs 9.0%, RR [95% CI] 1.51 [1.50–1.52], p&amp;lt;0.00001) and CV death (4.4% vs 1.9%, RR 2.33 [2.30–2.36], p&amp;lt;0.00001) than those with lone AF. In the propensity score matched population (median follow-up [IQR] 1.9 [0.3–4.4] years), patients with AF and CD also had worse outcomes than patients with lone AF (yearly incidence rates for all-cause mortality: 10.6% vs 7.4%, RR 1.43 [1.42–1.45], p&amp;lt;0.00001; and for CV death: 3.3% vs 2.0%, RR 1.64 [1.61–1.68], p&amp;lt;0.00001). However, lone AF patients were at higher risk of ischemic stroke: yearly incidence rates 2.75% in those with lone AF vs 1.69% in patients with AF and CD (RR 0.62 [0.60–0.63], p&amp;lt;0.00001). Conclusion In our large study from a nationwide database about patients hospitalized with AF, two distinct clinical entities were identified, that could explain the results highlighted: 1) the consistently higher mortality in the group associating AF and underlying heart disease (AF may bea marker for poor outcome when there is a structural heart disease; 2) Lone AF group which prognosis may be related to a higher incidence of thromboembolic events. These results could have important implications in terms of thromboembolic prevention but further studies are still needed to investigate the underlying mechanisms of embolic pathophysiology and its specific management. Funding Acknowledgement Type of funding source: None

Clinical impact of the determination of natriuretic peptides on long-term follow-up of patients treated in the Heart Failure Unit

Abstract Introduction The use of natriuretic peptides has spread in recent years as a diagnostic tool in patients with heart failure (HF). However, its influence on the prognosis of these patients has not been clearly established. Thus, our main aim was to know the characteristics of patients with increased levels of NT-proBNP and to analyze its impact on long-term prognosis in terms of mortality and readmissions due to heart failure. Material and methods We selected cases from the heart failure unit at HURS which had a NT-proBNP determination at first consultation. Patients were divided into two groups: GROUP 1 (NT-ProBNP &amp;lt;10000) and GROUP 2 (NT-ProBNP &amp;gt;10000). Clinical, echocardiographic and treatment variables were collected and patients were followed up for readmissions due to heart failure and all-cause mortality. Results A total of 280 patients were selected. The mean age of the cohort was 66.74±13.88 years and was male-dominated (64%). In group 1, there was a higher initial left ventricular ejection fraction (LVEF) (43.19% vs 40.36%; p=0.057), lower basal creatinine (1.13 mg/dL vs 1.53 mg/dL; p=0.001), lower creatinine at the end of follow-up (1.27 mg/dL vs 1.79 mg/dL; p=0.001) and a lower NT-proBNP at the end of follow-up (4039 pg/mL vs 17140 pg/mL; p=0.000) than in group 2. In addition, group 2 showed a higher percentage of chronic kidney disease (55% vs 29%; p=0.000) than group 1, with no differences in their main variables. With 110 months of follow-up, patients with NT-proBNP levels&amp;gt;10000 had a similar hospital readmission rate compared to the group with lower NT-proBNP levels (81.2% vs 84.8% log rank p=0.133).With a mean of 130.01±9.11 months of follow-up, patients with NT-proBNP levels&amp;gt;10000 had a tendency to higher mortality from any cause than those with lower NT-proBNP levels (84.4% vs 48.4%, log rank p=0.000). Conclusion Patients with NT-proBNP levels&amp;gt;10000 are associated with a lower LVEF at baseline and a higher proportion of chronic kidney disease. In the long term, patients with NT-proBNP levels&amp;gt;10000 had the same rate of readmissions for heart failure but a higher rate of death from any cause. Kaplan-Meier analysis Funding Acknowledgement Type of funding source: None

Network Meta-Analysis of Drug Therapies for Lowering Uric Acid and Mortality Risk in Patients with Heart Failure.

This network meta-analysis aimed to assess the current efficacy of decreasing the uric acid (UA) level with drugs to reduce mortality in patients with heart failure (HF). Electronic literature searches using EMBASE and MEDLINE of studies published from 1 Jan 1950 to 26 Dec 2019 were conducted for randomized controlled trials or non-randomized cohort studies that included at least one group of patients who took UA-lowering drugs and with a study outcome of all-cause mortality. A random-effects network meta-analysis was performed within a frequentist framework. Hierarchy of treatments was expressed as the surface under the cumulative ranking curve (SUCRA) value, which is in proportion to mean rank (best is 100%). Nine studies, which included seven different types of groups, were eligible for analysis. The "untreated uricemia" group in which patients had hyperuricemia but without treatment had a significantly higher risk of mortality than the "no uricemia" group in which patients had no hyperuricemia (relative risk (RR)(95% confidence interval (CI), 1.43 (1.08-1.89)). The "start-allo" group wherein patients started to take allopurinol did not have a significantly lower risk of mortality than the "untreated uricemia" group (RR (95% CI), 0.68 (0.45-1.01)). However, in the "start-allo" group the SUCRA value was comparable to that in the "no uricemia" group (SUCRA: 65.4% for "start-allo"; 64.1% for "no uricemia"). Results suggested that allopurinol therapy was not associated with a significantly improved prognosis in terms of mortality but could potentially counteract the adverse effects associated with longstanding hyperuricemia in HF patients.

ISCHEMIA Trial and the Significance of MI.

During the past decade, the treatment of choice for chronic coronary syndromes (CCS) has been a contentious issue. Whether revascularisation, either percutaneous or surgical, or optimal medical therapy, offers better prognosis in terms of mortality, MI, and symptom relief, has yet to be confirmed. The long-awaited and recently published International Study of Comparative Health Effectiveness with Medical and Invasive Approaches (ISCHEMIA) trial randomised more than 5,000 patients into a revascularisation plus optimal medical therapy group and an optimal medical therapy alone group. The authors analyse the trial, with particular emphasis on the incidence of MI. They propose a patient-centred approach to incorporate the results of the ISCHEMIA trial into daily practice and determine the best treatment strategy for patients with CCS.

Post head injury neurobehavioral sequelae: severity among alcoholics

Background: Alcohol use and traumatic brain injury (TBI) are closely linked public health problems. Alcohol intoxication is one of the major risk factor for TBI, and is a main determinant of prognosis in terms of mortality and functional outcome. The aim of the study is to find out the impact of alcoholism in the neurobehavioral outcome following TBI.Methods: A total of 150 head injury patients were divided into two groups: alcoholics and non-alcoholics, and evaluated between six weeks to one year after injury using the revised neurobehavioral rating scale by Levin et al (NRS-R) for the evaluation of neurobehavioral sequelae and the outcome was compared between groups.Results: The study showed significant difference between the groups indicating that the neurobehavioral sequelae were more in the chronic alcoholics group. In the comparison of individual factors, all except factors III (negative symptoms) and IV (mood and affect) were found to be significantly different. The factors I (executive), II (positive symptoms), V (oral and motor), and VI (not loading on any of the factors) were significant at 0.01 level.Conclusions: Chronic alcoholism significantly increases the risk of developing neurobehavioral sequelae after traumatic brain injury.

The anticholinergic effect on cognition (AEC) scale-Associations with mortality, hospitalisation and cognitive decline following dementia diagnosis.

To investigate associations between central anticholinergic burden (determined through the anticholinergic effect on cognition [AEC] scale) and mortality, hospitalisation and cognitive decline in patients with dementia. The South London and Maudsley NHS Foundation Trust (SLaM) Clinical Records Interactive Search (CRIS) application was used to identify patients with a first diagnosis of dementia. Medication exposure was extracted through a natural language processing algorithm, allowing for calculations and comparisons of AEC scores. Data were linked to national mortality and hospitalisation data sources, and serially recorded Mini-Mental State Examination (MMSE) scores were used to investigate cognitive decline. We identified 14 093 patients with dementia, 60.7% were female and the mean age at diagnosis was 79.8 years. Patients for whom a review of their medication was indicated (AEC score ≥ 2 for any individual drug or total AEC score ≥ 3) had an increased risk of mortality (hazard ratio 1.07; 95% confidence interval [CI]: 1.01-1.15) and emergency hospitalisation (1.10; 95% CI: 1.04-1.17), but there were no associations with duration of hospitalisation. Cognitive trajectory analyses showed that this exposure group had lower MMSE scores at diagnosis and a sharper increase in MMSE scores over the subsequent 6 months, but similar slopes for the 6 to 36 months period compared to the remainder of the sample. Patients with dementia receiving medication with high central anticholinergic activity appear to have worse prognosis in terms of mortality and hospitalisation risk, but have, primarily, acutely impaired cognitive function, rather than longer-term differences in cognitive decline. J Am Geriatr Soc 68:-, 2020.