Death Rate Research Articles

Long-term prognosis and predictors of death in chronic Chagas cardiomyopathy in women and men

Abstract Background Chronic Chagas cardiomyopathy (CCC) is one of the leading causes of heart failure (HF) in Latin America and carries high morbidity and mortality. Previous studies showed conflicting results in epidemiological and clinical evidence of a gender-associated risk of death in patients with HF due to CCC. Purpose This study analysed the long-term prognosis and the main predictors of death in women and men with HF due to CCC. Methods From March 2009 to January 2023, we followed a cohort of outpatients with HF due to CCC. Specific serological tests diagnosed Chagas disease. Baseline data included clinical characteristics and echocardiographic findings. Statistical analyses were performed using the Kaplan-Meier (K-M) method to analyse time-to-event data and Cox proportional hazards methods to search for predictors of death. Results We studied 739 patients, with a mean age of 57.0 ± 12.1 years, 387 (52%) male. Women had a higher mean age (58.4 ± 11.7 vs. 55.8 ± 12.3 years; p=0.001), had a higher mean baseline left ventricular ejection fraction (LVEF) (44.3±14.5 % vs. 37.0±14.5%; p<0.001) and a smaller left ventricular diastolic diameter (LVDD) (56.8±8.9 vs. 62.5±9.4 mm; p<0.001). Over a median follow-up period of 10 years, 213 (56%) men and 169 (44%) women died (K-M: log-rank p=0.043; Figure). Men received more beta-blocker therapy (52.4% vs. 47.6%; p=0.040) and had a higher prevalence of chronic kidney disease (CKD) (p=0.003) and stroke (p=0.007). HFpEF was more prevalent in women and HFrEF in men (p<0.001). Device implantation and transplant were similar between women and men. Cox regression analysis for death adjusted for age, sex, myocardial infarction, diabetes, CKD, stroke, atrial fibrillation (AF), and LVEF showed LVEF (HR= 0.98;95%CL:0.97-0.98), age (HR=1.03;95%CL1.02-1.04) and CKD (HR= 1.32;95%CL:1.10-1.64) as the main predictors of death. In men, the main predictors were age (HR=1.02;95%CL:1.01-1.04), CKD (HR=1.409;95%CL:1.07-1.86), and LVEF (HR=0.98;95%CL:0.97-0.99), and in women AF (HR=1.41;95%CL:1.03-1.91), age (HR=1.03;95%CL:1.01-1.04), and LVEF (HR=0.97;95%CL:0.96 -0.98). Conclusion women had a better prognosis than men, but gender was not an independent predictor of death. Prevention of comorbidities, especially CKD in men and AF in women, and higher beta-blocker therapy can significantly reduce the death rate in women and men with HF from CCC.

Anti-Apolipoprotein A-1 IgG, incident cardiovascular events and lipid paradox in rheumatoid arthritis

Abstract Objectives To validate the prognostic accuracy of anti-apolipoprotein A-1 IgG (AAA1) for incident major adverse cardiovascular (CV) events (MACE) in rheumatoid arthritis (RA) and study their associations with the lipid paradox at a multicentric scale. Methods Baseline AAA1 -, lipid profile, atherogenic indexes, and cardiac biomarkers were measured on the serum of 1472 RA patients included in the prospective Swiss Clinical Quality Management registry with a median follow-up duration of 4.4 years. MACE was the primary endpoint defined as CV death, incident fatal or nonfatal stroke, or myocardial infarction (MI), while elective coronary revascularisation (ECR) was the secondary endpoint. Discriminant accuracy, and incidence rate ratios (IRR) were respectively assessed by C-statistics and Poisson regression models. Results During follow-up, 2.4% (35/1472) patients experienced MACE, consisting in 6 CV deaths, 11 MI and 18 strokes. ECR occurred in 2.1% (31/1472) of patients. C-statistics indicated that AAA1 had a significant discriminant accuracy for incident MACE (C-statistics: 0.60, 95% confidence intervals [95%CI]: 0.57-0.98, p=0.03), mostly driven by CV deaths (C-statistics:0.77; 95%CI: 0.57-0.98, p=0.01) and without predicting incident ECR. IRR indicated that for every unit increase in AAA1, incident CV death rate increased by 5-fold (95%CI:3.6-7.3), independently of various models’ adjustments. At the predefined and validated cut-off, AAA1 displayed negative predictive values above 97% for the MACE components. AAA1 inversely correlated with total, and HDL cholesterol, but not with atherogenic indexes. Conclusions AAA1 independently predict CV deaths in RA. Whether AAA1 could improve CV risk stratification by identifying in particular low CV risk patients remains to be demonstrated.

On the interpretability of the SVM model for predicting infant mortality in Bangladesh

BackgroundAlthough machine learning (ML) models are well-liked for their outperformance in prediction, greatly avoided due to the lack of intuition and explanation of their predictions. Interpretable ML is, therefore, an emerging research field that combines the performance and interpretability of ML models to create comprehensive solutions for complex decision-making analysis. Conversely, infant mortality is a global public health concern affecting health, social well-being, socio-economic development, and healthcare services. The study employs advanced interpretable ML techniques to anticipate and understand the factors affecting infant mortality in Bangladesh, overcoming the shortcomings of the conventional logistic regression (LR) model.MethodsBy utilizing the global surrogate model and local individual conditional expectation (ICE) interpretability technique, the interpretable support vector machine (SVM) has been used in this study to reveal significant characteristics of infant mortality using data from the Bangladesh Demographic and Health Survey (BDHS) 2017–18. To investigate intricate decision-making analysis of infant mortality, we adapted SVM and LR techniques with the hyperparameter tuning parameters. These models’ performances were initially assessed using the receiver operating characteristics (ROC) curve, run-time, and confusion matrix parameters with 100 permutations. Afterward, the SVM model’s model-agnostic explanation and the LR model’s interpretation were compared to enhance advanced comprehension for further insights.ResultsThe results of the 100 permutations demonstrated that the LR model (Average: accuracy = 0.9105, precision = NaN, sensitivity = 0, specificity = 1, F1-score = 0, area under the ROC curve (AUC) = 0.6780, run-time = 0.0832) outperformed the SVM model (Average: accuracy = 0.8470, precision = 0.1062, sensitivity = 0.0949, specificity = 0.9209, F1-score = 0.1000, AUC = 0.5632, run-time = 0.0254) in predicting infant mortality, but the LR model had a slower run-time and it was unable to predict any positive cases. The interpretation of LR analysis revealed that infant mortality rates decrease when mothers give birth after over two years, with higher educational attainment, overweight or obese mothers, working mothers, and families with polluted cooking fuel having lower rates. The local ICE interpretability technique, which depicts individual influences on the average likelihood of dying within the first birthday, explores the interpretable SVM model that mothers with normal BMIs, giving birth within two years, using less polluted cooking fuel, working mothers, and having male infant were more likely to experience infant death. The interpretable SVM model based on the global surrogate model also reveals that working mothers who used polluted cooking fuel at home and working women who used less polluted cooking fuel but had a longer period between pregnancies than two years would have higher infant death rates. Even among non-working mothers who used polluted cooking fuel and gave birth within two years of the preceding one, infant death rates were higher.ConclusionsThe interpretable SVM model reveals global interpretations help clinicians understand the entire conditional distribution, while local interpretations focus on specific instances, providing different insights into model behavior. Interpretable ML models aid policymakers, stakeholders, and families in understanding and preventing infant deaths by improving policy-making strategies and establishing effective family counseling services.

Association of Ramadan and Death Rates in a Metropolitan City in Turkey: A Review of Literature and a Seasonally Adjusted Study.

In this study, death rates for a metropolitan city were analyzed over a period of 33years to investigate any potential relationship between the month of Ramadan and death rates. The study also aimed to obtain seasonally adjusted results using time series analysis. Ultimately, the total evaluation of the 33-year period revealed no significant variation in death rates between Ramadan and non-Ramadan periods. Separate analyses for each season with time series also yielded no significant findings for most parameters, with the exception that the number of female deaths during Ramadan in winter was significantly higher than expected. According to these results, the increase in the number of deaths observed among women during the winter Ramadan period requires further investigation to determine whether a causal relationship exists. The use of seasonally adjusted approaches and time series analyses in future Ramadan and health studies is crucial for the accuracy of the results.

Risk and Benefit for Basket Trials in Oncology: A Systematic Review and Meta-Analysis.

Oncology research is increasingly adopting new clinical trial models that implement the concept of precision medicine. One of these is the basket clinical trial design. Basket clinical trials allow new treatments to be evaluated across multiple tumor types. Patients recruited to basket clinical trials share certain molecular characteristics of their cancer that are predictive of clinical benefit from the experimental treatment. Our aim was to describe the risks and benefits of basket clinical trials in oncology. Our study was prospectively registered in PROSPERO (CRD42023406401). We systematically searched PubMed, Embase, and ClinicalTrials.gov for reports of basket clinical trials in oncology published between 1 January, 2001, and 14 June, 2023. We measured the risk by treatment-related adverse events (grades 3, 4, and 5), and the benefit by objective response rate. We also extracted and analyzed data on progression-free survival and overall survival. When possible, data were meta-analyzed. We included 126 arms of 75 basket clinical trials accounting for 7659 patients. The pooled objective response rate was 18.0% (95% confidence interval [CI] 14.8-21.1). The rate of treatment-related death was 0.7% (95% CI 0.4-1.0), while 30.4% (95% CI 24.2-36.7) of patients experienced grade 3/4 drug-related toxicity. The median progression-free survival was 3.1 months (95% CI 2.6-3.9), and the median overall survival was 8.9 months (95% CI 6.7-10.2). Our results provide an empirical basis for communicating about the risks and benefits of basket clinical trials and for refining new models of clinical trials applied in precision medicine.

Time trends and advances in the management of global, regional, and national diabetes in adolescents and young adults aged 10–24 years, 1990–2021: analysis for the global burden of disease study 2021

BackgroundEstimation of global diabetes burden in adolescents and young adults (10–24 years) from 1990 to 2021.MethodsData were extracted from the 2021 Global Burden of Disease Study. Joinpoint regression analysis was employed to examine trends over the past 30 years, frontier analysis identified regions with potential for improvement, and the slope index of inequality and the relative concentration index were used to assess health inequalities.ResultsFrom 1990 to 2021, the age-standardized prevalence rates (ASPR) and age-standardized disability-adjusted life years rates (ASDR) of diabetes in adolescents and young adults increased globally, while age-standardized death rates (ASMR) remained stable. Oceania bore the highest burden regionally, East Asia experienced the fastest rise in ASPR and ASDR, and High-income Asia Pacific saw the most significant decrease in ASMR. Among 204 countries, Marshall Island and Hait reported the highest ASPR, ASDR, and ASMR in 2021. Health inequality analysis confirmed that the burden was concentrated in countries with lower Socio-Demographic Index (SDI). Frontier analysis showed that ASMR and ASDR were negatively correlated with SDI, with Yemen and Honduras, which have lower socio-demographic indices, exhibiting more smaller overall differences from frontier boundaries.ConclusionsThe analysis revealed a sharp increase in the global ASPR and ASDR of diabetes in adolescents and young adults. Additionally, the disease burden is typically concentrated in countries with lower SDI, highlighting an urgent need for governments to develop flexible health policies to mitigate the escalating threat of diabetes in this demographic.

Effect of correcting iron deficiency on the risk of serious infection in heart failure: Insights from the IRONMAN trial.

Concerns exist that intravenous (IV) iron might increase the risk of infections. The IRONMAN trial provided an opportunity to investigate whether giving IV ferric derisomaltose (FDI) to patients with heart failure and iron deficiency alters the rate of hospitalization or death due to infections. IRONMAN was a randomized trial of IV FDI versus usual care in patients with symptomatic heart failure, left ventricular ejection fraction (LVEF) ≤45%, and transferrin saturation (TSAT) <20% or ferritin <100 μg/L. Infection was a pre-specified, blindly-adjudicated, safety endpoint. The primary analysis of interest was infection as the main reason for hospitalization or death, using first and recurrent events analyses. The composite primary event of interest tended to be lower in those randomized to FDI when analysed as first (hazard ratio [HR] 0.79, 95% confidence interval [CI] 0.62-1.01, p = 0.055) or recurrent event (rate ratio 0.85, 95% CI 0.64-1.13, p = 0.089). The composite results were driven by fewer hospitalizations for infection (HR 0.76, 95% CI 0.49-0.98, p = 0.032), with 5% fewer patients (absolute reduction) experiencing such an event if assigned to FDI. Similar trends were observed for recurrent events (HR 0.82, 95% CI 0.62-1.10). Further analyses suggested that the reduction in hospitalizations due to infection with FDI was restricted to patients with TSAT <20%. In patients with heart failure and a reduced LVEF, correction of iron deficiency is not associated with an increased risk of hospitalization or death from infection, and may reduce such events, especially when TSAT is <20%. ClinicalTrials.gov, NCT02642562.

Searching for Hub Genes of Quince–Basil Co-Administration Against Atherosclerosis Using Bioinformatics Analysis and Experimental Validation

Background: Atherosclerosis (AS) has one of the highest rates of morbidity and death globally. Cydonia oblonga Mill. (quince, COM) and Ocimum basilicum L. (basil, OB) are Uyghur medicines that are often used for anti-inflammatory, anti-tumor, and cardiovascular disease treatment. This study aimed to uncover the hub genes of the quince-basil co-administration against AS and validate them. Methods: Network pharmacology analysis and bioinformatics analysis methods were utilized to map the network and obtain four hub genes. Experiments were performed in vivo and in vitro using HUVEC and zebrafish to validate the therapeutic effect of COM-OB co-administration against AS. Finally, the hub genes were validated by Western blot. Results: Screening by network pharmacology analysis and bioinformatics analysis obtained a total of 3302 drug targets, 1963 disease targets, and 1630 DEGs. A series of bioinformatic analyses were utilized to ultimately screen four hub genes, and the stability was also verified by molecular docking and molecular dynamics. COM-OB total flavonoids co-administration significantly decreased PA-induced lipid deposition in HUVEC and reduced high cholesterol-induced fat accumulation in zebrafish. Western blot results showed that COM-OB co-administration significantly affected the expression of hub genes. Conclusions: The study identified and validated four hub genes, COL1A1, COL3A1, BGLAP, and NOX4, thus providing a rationale for the treatment of AS with COM and OB co-administration.

Isolation, Potential Beneficial Properties, and Assessment of Storage Stability of Direct-Fed Microbial Consortia from Wild-Type Chicken Intestine.

Direct-fed microorganisms (DFM) are recognized as an alternative to antibiotic-based growth promoters in poultry production due to their health benefits. DFM, however, should undergo rigorous safety testing to ensure they meet the criteria to be "Generally Recognized as Safe." This study assessed eight bacterial consortia (BC) isolated from the ileal and cecal intestinal regions of wild-type chickens, subjecting them to probiotic tests. Subsequently, they were spray- and freeze-dried to evaluate their storage stability for 30days. BC5-I and BC7-I, isolated from the ileum, emerged as promising DFM, displaying a high content of Lactobacillales using a selective medium and higher susceptibility to Gram-positive and Gram-negative antibiotics. These BC showed a high tolerance to temperature (> 90%), pH > 4 (88-98%), and antagonist effects against Escherichia coli and Salmonella. BC5-I exhibited superior survival in the simulated gastric conditions and satisfactory intestine mucus adhesion. Freeze-drying was the best method to obtain BC5-I and BC7-I powders, with a survival efficiency of 80.3% and 73.2%, respectively, compared to the beginning of storage. BC5-I presented the lowest cell death rate and prolonged half-life through survival storage kinetics. BC5-I only contained Lactobacillus, and Limosilactobacillus reuteri was the predominant species in liquid (78.3%) and freeze-dried (59.8%) forms. BC5-I stands out as a promising Lactobacillus-based DFM that could improve chicken intestinal health and enhance meat and egg production.

Estimating the impact of social distance policy in mitigating COVID-19 spread with factor-based imputation approach

AbstractWe identify the effectiveness of social distancing policies in reducing the transmission of the COVID-19 spread. We build a model that measures the relative frequency and geographic distribution of the virus growth rate and provides hypothetical infection distribution in the states that enacted the social distancing policies, where we control time-varying, observed and unobserved, state-level heterogeneities. Using panel data on infection and deaths in all US states from February 20 to April 20, 2020, we find that stay-at-home orders and other types of social distancing policies significantly reduced the growth rate of infection and deaths. We show that the effects are time varying and range from the weakest at the beginning of policy intervention to the strongest by the end of our sample period. We also found that social distancing policies were more effective in states with higher income, better education, more white people, more democratic voters, and higher CNN viewership.

Impact of co-presence of malnutrition-inflammation-atherosclerosis factors on prognosis in lower extremity artery disease patients after endovascular therapy.

Malnutrition and inflammation are common problems of adverse outcomes in various diseases as atherosclerosis. Recently, the concept of malnutrition-inflammation-atherosclerosis (MIA) syndrome is known to a crucial prognostic factor in patients with end-stage renal disease. We investigated the prognostic impact of the co-presence of MIA factors in patients with lower-extremity artery disease (LEAD) after endovascular therapy (EVT). This retrospective study included 284 patients with LEAD who underwent EVT. MIA factors were defined in patients with: low geriatric nutritional risk index (< 92) as "malnourished"; greater high-sensitivity C-reactive protein levels (≥ 0.1mg/dL) as "inflamed"; a history of coronary artery revascularization, lacunar or atherothrombotic brain infarction as "atherosclerotic". We examined the relationship between baseline characteristics and major adverse cardiovascular and cerebrovascular events (MACCE) including all-cause mortality. Sixty-two patients (22%) died and 72 patients (25%) had MACCE, including all-cause death. Forty-four (16%) patients had every 3 of MIA (3-MIA) factors. The mean follow-up period was 737days. Multivariate Cox proportional hazards regression analysis models revealed that 3-MIA factors correlated significantly with all-cause death [hazard ratio (HR) 3.46, 95% confidence interval (CI) 1.89-6.34; p < 0.001] and MACCE (HR 2.91, 95% CI 1.62-5.22; p < 0.001), after adjusting for relevant factors. Kaplan-Meier analysis revealed that the rates of all-cause death (p < 0.001) and MACCE (p < 0.001) were significantly higher when the MIA factors overlapped and are observed in patients with chronic limb-threatening ischemia. Among patients with LEAD after EVT, the co-presence of MIA factors was an independent risk factor for all-cause death and MACCE.

Modelling the impact of vaccination on COVID-19 in African countries.

The rapid development of vaccines to combat the spread of COVID-19, caused by the SARS-CoV-2 virus, is a great scientific achievement. Before the development of the COVID-19 vaccines, most studies capitalized on the available data that did not include pharmaceutical measures. Such studies focused on the impact of non-pharmaceutical measures such as social distancing, sanitation, use of face masks, and lockdowns to study the spread of COVID-19. In this study, we used the SIDARTHE-V model, an extension of the SIDARTHE model, which includes vaccination rollouts. We studied the impact of vaccination on the severity of the virus, specifically focusing on death rates, in African countries. The SIRDATHE-V model parameters were extracted by simultaneously fitting the COVID-19 cumulative data of deaths, recoveries, active cases, and full vaccinations reported by the governments of Ghana, Kenya, Mozambique, Nigeria, South Africa, Togo, and Zambia. Using South Africa as a case study, our analysis showed that the cumulative death rates declined drastically with the increased extent of vaccination drives. Whilst the infection rates sometimes increased with the arrival of new coronavirus variants, the death rates did not increase as they did before vaccination.

Niosome-loaded Tet-Amp against S. aureus, K. pneumoniae, and P. aeruginosa.

Biofilm-associated disorders contribute to elevated morbidity and death rates among patients. We propose synthesizing niosomal structures containing the antibiotics tetracycline and ampicillin ((Tet/Amp)-Nio) and investigating their impact on standard strains of S. aureus, K. pneumoniae, and P. aeruginosa. The antibacterial and anti-biofilm effects of synthesized niosomes against standard pathogenic bacterial strains were studied, and also its cytotoxic activity was investigated against human foreskin fibroblast (HFF) cell line. The optimal formulation (F2) had an average particle size of 196.90 ± 4.57nm, a PDI of 0.223 ± 0.013, a Zeta-potential of -19.25 ± 1.19 mV, a %EE of 70.92 ± 1.75% for Tet and 58.34 ± 1.85% for Amp, and a %Release rate of 49.34 ± 1.78% for Tet and 62.67 ± 1.19% for Amp. The release of Tet and Amp drugs over 48h was 47% and 61%, respectively, from the (Tet/Amp)-Nio formulation. Also, our findings demonstrated that the Tet/Amp)-Nio have potent antibacterial, anti-biofilm, and lower cytotoxic activity compared to the Tet + Amp. In addition, (Tet/Amp)-Nio can upregulate the expression level of matrix metallopeptidase 2 (MMP2) and matrix metallopeptidase 9 (MMP9) genes, which shows their great activity in the wound healing process. The findings of the current investigation suggest that (Tet/Amp)-Nio enhances its antibacterial and antibiofilm effects against S. aureus, P. aeruginosa, and K. pneumoniae isolates. These formulations may serve as a novel approach for targeted drug delivery.

Immunohistochemistry-Assisted Mohs Surgery for Invasive Eyelid and Periorbital Cutaneous Melanoma.

Prior studies describe wide local excision and "slow Mohs" outcomes for periocular melanoma. Mohs micrographic surgery (MMS) with immunohistochemistry maximizes tissue preservation and offers same-day comprehensive margin evaluation, which facilitates expedited repair, and coordination of oculoplastic reconstruction when necessary. To describe oncologic and reconstructive outcomes of invasive periocular cutaneous melanoma treated with immunohistochemistry-assisted MMS. Invasive melanoma cases affecting the eyelids or periorbital region treated with MMS between 2008 and 2018 were reviewed. Eyelid tumors and those in adjacent subunits were compared. Main outcome measures were recurrence, melanoma-specific death, and postreconstructive complications. Of 42 cases, 28 were classified as periorbital and 14 as eyelid involving. Most were T1 (37, 88.1%). There was 1 local recurrence in a patient with persistent positive conjunctival margin (2.4%). No local recurrences were observed in cases where negative Mohs margins were achieved, and no melanoma-related deaths occurred. Eyelid tumors were more likely to result in lid margin involving defects and require oculoplastic reconstruction. Eyelid complications developed in 10 cases (23.8%), and 5 (11.9%) required revision surgery. Mohs micrographic surgery for periocular melanoma results in low rates of local recurrence and melanoma-specific death. Initial tumor location can aid in reconstructive planning.

All-cause and cause-specific mortality among older migrant and non-migrant adults in Finland: a register study on all deaths, 2002-2020.

Migrant mortality advantage is established in various studies, but there is a lack of evidence on migrant mortality trends in old age. Previous studies have primarily concentrated on all-cause mortality, and few include older age groups. Discussions about the migrant mortality advantage continue due to concerns about data availability and accuracy. Additionally, the mechanisms explaining the migrant mortality advantage remain unclear. This study examines all-cause and cause-specific mortality among older migrant and nonmigrant adults aged 70 and above using Finnish Cause of Death register data (2002-20) and the corresponding risk population. We investigate differences in overall and cause-specific mortality between migrant and Finnish-born population and by geographical region of origin. We calculated direct age-standardized mortality rates and age group-specific death rates followed by Poisson regression to study relative mortality differences. Age at death, sex, income, region of residence, and year of death were controlled for in the regression analysis. We found evidence of migrant mortality advantage across various causes of death, but there was variation by regions of origin groups and sex. Notably, women exhibit the strongest advantage in respiratory and digestive system diseases, while men demonstrated pronounced advantages in external causes and respiratory diseases. Our study challenges the notion of a general diminishing healthy migrant effect in old age. Our findings emphasize the need for nuanced investigations into socioeconomic factors and tailored interventions for older migrants.

Impact of Home Mobile Phone-Based Telemonitoring in Preventing Exacerbations and Hospitalizations Among Patients with Chronic Obstructive Pulmonary Disease: An IMTEC Study.

COPD is a major public health problem due to its high morbidity and mortality. The evolution of COPD is marked by the occurrence of acute exacerbations (AECOPD). One of the major causes of AECOPD is non-adherence treatment. Telemedicine is an accessible educational tool that can help physicians to provide continuous, accessible educational support and monitoring for patients with COPD. Objectives: This study aimed to determine the impact of therapeutic education via phone-based telemedicine on ED visits and/or hospitalizations for AECOPD. Methods: This is a randomized controlled trial carried out in the emergency department (ED) of Fattouma Bourguiba Monastir over a period of 7 consecutive months, including patients admitted with a final diagnosis of AECOPD. Patients were randomly assigned to receive standard care (STD) or weekly phone-based telemonitoring (TLM). Outcomes (exacerbation and the need for hospitalization for AECOPD) were assessed at a 1-, 3-, and 6-month follow-up after being discharged from the hospital. Results: We included 163 patients (57 patients in the TLM group and 106 patients in the STD group). The mean age of the study population was 66.5 ± 12.5 years. The TLM group exhibited a significantly lower risk of ED visits for AECOPD compared to the STD group, with an odds ratio of 0.13 (95% CI: 0.04-0.40) and a p-value ≤ 0.001. Additionally, the TLM group had a notably lower hospitalization rate for AECOPD compared to the control group (15.8% vs. 44.3%, respectively), with an odds ratio of 0.23 (95% CI: 0.10-0.52) and a p-value < 0.001. The all-cause death rate was also lower in the TLM group at the 6-month follow-up. Conclusions: Telemedicine represents an innovative approach that could improve the management of patients with COPD.

Analysis of Alzheimer's Disease-Related Mortality Rates Among the Elderly Populations Across the United States: An Analysis of Demographic and Regional Disparities from 1999 to 2020.

Alzheimer's Disease (AD) is the leading cause of dementia and a significant public health concern, characterized by high incidence, mortality, and economic burden. This study analyzes the mortality patterns and demographic disparities in Alzheimer's disease-related deaths among the elderly population in the United States from 1999 through 2020. Alzheimer's disease mortality data for individuals 65 and older were obtained from the CDC WONDER database, utilizing ICD-10 codes G30.0, G30.1, G30.8, and G30.9 for identification. Demographic and regional variables included age, gender, race/ethnicity, place of death, urban- rural status, and geographic region. Crude death rates (CR) and age-adjusted mortality rates (AAMR) per 100,000 individuals were calculated. Joinpoint Regression Program 5.0.2 was used to analyze trends, calculating Annual Percentage Changes (APCs) and Average Annual Percentage Changes (AAPCs). From 1999 to 2020, 1,852,432 deaths were attributed to AD among individuals aged 65 and older. The AAMR increased from 128.8 in 1999 to 254.3 in 2020, with an AAPC of 2.99% (95% CI = 2.61-3.48). The age-adjusted mortality rate (AAMR) was higher in females (218.5) than in males (163.5). Among racial and ethnic groups, non-Hispanic whites had the highest AAMR, followed by Non-Hispanic Blacks and Hispanics. Regionally, the West reported the highest AAMR, while the Northeast recorded the lowest. Most deaths occurred in nursing homes (57.3%), with a significant portion also occurring at decedents' homes (22.4%). AD mortality rates in the U.S. have risen significantly, with notable disparities across age, gender, race, and geographic regions. These findings highlight the need for targeted interventions and research to address the growing burden of AD, particularly among the most affected demographic groups.

Mortality and Years of Life Lost from Diabetes Mellitus in Poland: A Register-Based Study (2000-2022).

The aim of the study was to assess mortality and years of life lost from diabetes mellitus in Poland between 2000 and 2022. The database was created from death cards made available for the purposes of this study by Statistics Poland. The study used data on deaths caused by type 1 diabetes mellitus, T1DM (N = 33,328), and type 2 diabetes mellitus, T2DM (N = 113,706). Standardized death rates (SDRs) and standard expected years of life lost per person (SEYLLp) and per death (SEYLLd) were calculated. A time trend analysis was performed using joinpoint models. The annual percentage change (APC) and the average annual percentage change (AAPC) were estimated. Between 2000 and 2022, 33,328 people died from T1DM in Poland. The SDR rate increased from 6.0 to 8.8 per 100,000 population in the analyzed period. The APC was 1.3% (p < 0.05). SEYLLp rates per 100,000 population were 79.3 in 2000 and 109.2 in 2022. SEYLLd rates were 22.9 and 17.9 years, respectively (APC = -1.0%, p < 0.05). The mean age of those who died from T1DM increased from 66.1 in 2000 to 72.5 in 2022. Between 2000 and 2022, 113,706 people died from T2DM. The SDR increased from 12.5 to 37.7 per 100,00 (APC = 5.5%, p < 0.05). SEYLLp rates were 88.8 and 296.0 per 100,000 population (APC = 6.4%, p < 0.05). SEYLLd rates decreased from 16.9 in 2000 to 13.4 in 2022 (AAPC = -1.0%, p < 0.05). The mean age of those who died from T2DM increased from 73.1 to 78.1 years. The study showed a growing problem of diabetes as a cause of death and years of life lost.

The Fossilised Birth-Death Model is Identifiable.

Time-dependent birth-death sampling models have been used in numerous studies for inferring past evolutionary dynamics in different biological contexts, e.g. speciation and extinction rates in macroevolutionary studies, or effective reproductive number in epidemiological studies. These models are branching processes where lineages can bifurcate, die, or be sampled with time-dependent birth, death, and sampling rates, generating phylogenetic trees. It has been shown that in some subclasses of such models, different sets of rates can result in the same distributions of reconstructed phylogenetic trees, and therefore the rates become unidentifiable from the trees regardless of their size. Here we show that widely used time-dependent fossilised birth-death (FBD) models are identifiable. This subclass of models makes more realistic assumptions about the fossilisation process and certain infectious disease transmission processes than the unidentifiable birth-death sampling models. Namely, FBD models assume that sampled lineages stay in the process rather than being immediately removed upon sampling. Identifiability of the time-dependent FBD model justifies using statistical methods that implement this model to infer the underlying temporal diversification or epidemiological dynamics from phylogenetic trees or directly from molecular or other comparative data. We further show that the time-dependent fossilised-birth-death model with an extra parameter, the removal after sampling probability, is unidentifiable. This implies that in scenarios where we do not know how sampling affects lineages we are unable to infer this extra parameter together with birth, death, and sampling rates solely from trees.

Current Insights into Therapeutic Potential of Terpenoids as Anticancer Agents.

Cancer is regarded as one of the main causes of death globally. Future predictions indicate that the death rate from cancer will keep rising, which may reach 11.4 million in 2030. Carcinogenesis refers to the phenomenon of transforming a normal cell into a cancer cell. Cancer is characterized by unregulated and uncontrolled cell division due to alterations at the molecular and genetic levels. Gene mutations can speed up the rate of cell division, which leads to cancer. Metastasis entails the dissemination of cancer cells from the primary site to distant regions of the body via the circulatory or lymphatic systems. This review is mainly focusing on the anticancer properties of terpenoids. In the case of human beings, several types of cancers can be treated clinically based on the form and phase of the cancer. So, there are different types of treatment regimens available for the management of cancer, such as immunotherapy, hormonal therapy, radiation therapy, and chemotherapy. Several problems are associated with cancer therapy, including chemoresistance, severe toxicity, relapse, and metastasis. To minimize these complications, natural products like terpenoids seem to be beneficial for the effective management of cancer. Experimental results revealed that the anticancer potential of terpenoids is due to activation of apoptosis and stimulation of cell cycle arrest. Some of the terpenoids exhibit anticancer effects by inhibiting angiogenesis and metastasis via the regulation of several signaling pathways intracellularly. Certain terpenoids have been shown to work in concert with anticancer medications (doxorubicin, cisplatin, paclitaxel, and 5-fluorouracil) to provide synergistic effects. These terpenoids have also been shown to be effective against cancer cells that are resistant to several drug therapies. The current study will focus on signaling pathways and mode of action of several types of terpenoids as anticancer agents. Further, it will provide insights into the ongoing clinical trials and prospective pathways for the advancement of terpenoids as possible anti-cancer agents.