Reduction In Overall Mortality Rate Research Articles

Drug Metabolism for the Identification of Clinical Biomarkers in Breast Cancer.

Breast cancer is classified into four major molecular subtypes, and is considered a heterogenous disease. The risk profiles and treatment of breast cancer differ according to these subtypes. Early detection dramatically improves the prospects of successful treatment, resulting in a reduction in overall mortality rates. However, almost 30% of women primarily diagnosed with the early-stage disease will eventually develop metastasis or resistance to chemotherapies. Immunotherapies are among the most promising cancer treatment options; however, long-term clinical benefit has only been observed in a small subset of responding patients. The current strategies for diagnosis and treatment rely heavily on histopathological examination and molecular diagnosis, disregarding the tumor microenvironment and microbiome involving cancer cells. In this review, we aim to praise the use of pharmacogenomics and pharmacomicrobiomics as a strategy to identify potential biomarkers for guiding and monitoring therapy in real-time. The finding of these biomarkers can be performed by studying the metabolism of drugs, more specifically, immunometabolism, and its relationship with the microbiome, without neglecting the information provided by genetics. A larger understanding of cancer biology has the potential to improve patient care, enable clinical decisions, and deliver personalized medicine.

Impact of an antimicrobial stewardship program at a university hospital of respiratory diseases

Background: Antimicrobial Stewardship Programs (ASP's) have the potential to reduce antimicrobial exposure and decrease microbial resistance, and to decrease costs. The objective of this study was to characterize the overall impact of an ASP on antimicrobial utilization, antimicrobial resistance and mortality rates. Methods & Materials: Quasi-experimental study, before and after ASP implementation, from January to May 2016 and from January to May 2017 respectively, in an 8-bed adult intensive care unit at a university hospital of respiratory diseases. ASP included: elaboration of local guides (LG's); empiric therapy according to LG's; taking cultures before starting antibiotic therapy (AT); de-escalation of therapy as soon as culture results were available; discontinuation of AT if evidence of infection was absent; short courses of AT. Outcomes for analyses included: retrospective data for antimicrobial utilization measured as defined daily doses (DDD); bacterial susceptibilities of the first five most frequent organisms isolated in each period; and mortality rates for all causes and for infectious causes according to ICD-10 classification. Results: The overall reduction of all antibiotic utilization was 19%, including a decrease by 81% in meropenem use, 11% for imipenem, 39% for ciprofloxacin, 93% for ceftriaxone, 23% for ceftazidime and 33% for vancomycin. The most frequently isolated organism in the ASP period were Pseudomonas aeruginosa, with a reduction by 50% of Acinetobacter baumanii, the most frequent isolation in the pre-ASP period. Pseudomonas aeruginosa showed resistance to ceftazidime and cefepime in 55% of the cases in the pre-ASP period, whereas only 5% were resistant to the same antibiotics in the ASP period. The susceptibility pattern of Klebsiella pneumoniae in the pre-ASP period was 50% KPC and 83% ESBL, in the ASP period there was no carbapenem resistance and 75% ESBL. There was a 71% reduction in overall mortality rates and a 35% reduction in mortality due to infectious causes in the ASP period. Conclusion: There were limitations in this study due to missing individual patient data. There is a trend towards a decrease in the utilization of antibiotics and a shift of the epidemiological and susceptibility patterns of multidrug resistance organisms. The implementation of ASP was not accompanied by an increase in mortality.

Vitamin B12 Deficiency in Older Diabetic Patients: Is it Necessary to Create Guidelines for Early Diagnosis, Monitoring and Treatment of this Nutritional Problem?

Copyright: © 2014 Masferrer D, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. According to reports from the World Health Organization, the aging population in both developed and in developing countries it has been possible due an improvement in access and coverage of health systems which has enabled a reduction in overall mortality rates and increased life expectancy of individuals [1]. However, this situation represents a challenge because it is necessary to maintain the achievements made in health and also generate environmental and sanitary conditions to ensure healthy aging and prevent pharmacological latrogenesis during the treatment of chronic diseases.

Postoperative adjuvant chemoradiotherapy versus radiotherapy alone for head and neck squamous cell carcinoma: A meta-analysis evaluating the role of chemotherapy schedules.

5583 Background: To compare concurrent post-operative chemoradiotherapy (POCRT) with post operative radiotherapy alone (PORT) for head and neck squamous cell carcinoma (HNSCC), evaluating different chemotherapy regimens used. Methods: A meta-analysis of RCT was performed comparing POCRT to PORT for HNSCC. The MEDLINE, EMBASE, and Cochrane Library databases, as well as abstracts published in the annual proceedings were systematically searched. We assessed methodological quality for each outcome by grading the quality of evidence using the Grading of Recommendations Assessment. Results: Pooled results from 8 randomized trials (1,808 patients) evaluating POCRT (3 trials using cisplatin alone, 2 mitomycin –c, 2 carboplatin and 1 cisplatin + 5-FU) in HNSCC showed significant decreased of mortality (OR=0.68, CI95%-0.52, 0.86, p<0.0001) as compared to PORT. In the subgroup analysis cisplatin alone was the only chemotherapy schedule that showed a reduction in overall mortality rate when compared to PORT (OR=0.62, CI95%-0.47, 0.82, p=0.0008). There was significant difference for local recurrence among those patients receiving PORCT and PORT (OR=0.46, CI 95% 0.37-0.58, p<0.0001). In the subgroup analysis the carboplatin schedule was the only subgroup that there was not any difference for local recurrence rates when compared to PORT (OR=0.72, CI 95% 0.46-1.13, p=0.25). Conclusions: Our data demonstrate that adjuvant cisplatin-enhanced radiation therapy is more effective than PORT for high-risk tumors in terms of locoregional control and survival, when compared to other regimens. Results of the present study failed to demonstrate that the addition of carboplatin to PORT provides a statistically significant benefit in terms of local control and survival rate. No significant financial relationships to disclose.

Using Varying Levels of Formic Acid to Limit Growth of Salmonella gallinarum in Contaminated Broiler Feed

Reported here are the effects of added formic acid on inhibitory effect of Salmonella gallinarum in poultry feed. Two experiments were conducted to investigate the viability of S. gallinarum and pH of poultry feed using different dietary formic acid levels (0.0, 0.5, 1.0 and 1.5%) on inhibitory effect of S. gallinarum in broiler feed. Experiment one was conducted to investigate the viability of S. gallinarum and pH of artificially contaminated diet at 0, 1, 3, 5 and 7 days after treatment in vitro. Formic acid showed a significant (p<0.05) reduction in the viability for all treatments with time after treatment. Various formic acid levels in vitro showed a reduction in the pH of the diet depending upon the concentration of treated acid, and the diet remained acidic below the growth range of S. gallinarum. This meant that the bacterial cells were exposed to stressful conditions that made them unable to grow. Experiment two was conducted to find out the effect of dietary formic acid levels on S. gallinarum colonization and pH in the contents of crop, small intestine, large intestine and ceca and mortality rate of broiler chicks at 7, 14 and 21 days of age when fed artificially contaminated diet with S. gallinarum. The numbers of S. gallinarum re-isolated from all treated groups except in groups treated with 0.5% formic acid, decreased significantly (p<0.05) compared with the control group. The treatment significantly (p<0.05) lowered the pH of the crop, small intestine, large intestine and ceca contents in all groups except the groups treated with 0.5% formic acid compared with the control. All treated groups showed a significant (p<0.05) reduction in overall mortality rate during the experimental period (3 to 21 days) compared with the control. The results indicate that addition of formic acid in a total concentration of 1.5% to the diet of newly hatched broiler chicks significantly decreases the contamination of diet with S. gallinarum. (Asian-Aust. J. Anim. Sci. 2005. Vol 18, No. 3 : 390- 395)

Screening Mammography Controversies: Resolved, Partly Resolved, and Unresolved

Since the 1960s, multiple randomized clinical trials have measured differences in breast cancer mortality between women 40 and 70 years of age who were offered screening mammography and control group women. This article describes briefly these trials, which nearly universally documented statistically significant reductions in breast cancer deaths. These trials also underestimated the benefit, regardless of age, due to screening parameters that were not optimized. In recent years, published articles analyzing studies of Swedish women have claimed that there is no reduction in overall mortality from breast cancer and other causes among women offered screening. Critical assessment of these articles noted that breast cancer deaths were less than 5% of all deaths and that no statistically significant reduction in overall mortality rates should be expected within the population that had been analyzed. The latest screening mammography controversies involve potential adverse consequences and risks, such as X-ray exposure, detection of ductal carcinoma in situ (DCIS), and "excessive" callback rates for additional imaging studies. Despite these controversies, the preponderance of scientific evidence continues to strongly support annual screening mammography for women 40 years of age and older.

Meta-analysis of low molecular weight heparin in the prevention of venous thromboembolism in general surgery.

Low molecular weight heparins (LMWHs) have become routine thromboprophylaxis in general surgery. However, their actual clinical effect, its magnitude relative to that of unfractionated heparin (UFH), and the optimal dose are still debated. A meta-analysis was performed of all available randomized trials in general surgery comparing LMWH with placebo or no treatment, or with UFH. Comparison versus placebo or no treatment confirmed that the significant reduction in asymptomatic deep vein thrombosis (DVT) obtained with LMWH (n = 513; relative risk (RR) 0.28 (95 per cent confidence interval 0.14-0.54)) was associated with a significant reduction in clinical pulmonary embolism (n = 5456; RR 0.25 (0.08-0.79)) and clinical venous thromboembolism (VTE) (n = 4890; RR 0.29 (0.11-0.73)), and a trend towards a reduction in overall mortality rate. Comparison versus UFH showed a trend in favour of LMWH, with a significant reduction in clinical VTE (P = 0.049), a trend also found for cancer surgery. LMWH at doses below 3400 anti-Xa units seemed to be as effective as, and safer than, UFH, while higher doses yielded slightly superior efficacy but increased haemorrhagic risk, including that of major haemorrhage. Asymptomatic DVT may be regarded as a reliable surrogate endpoint for clinical outcome in studies investigating thromboprophylaxis in general surgery. LMWH seems to be as effective and safe as UFH. Determination of the optimal dose regimen of LMWH for this indication requires further investigation.

Comparison of past versus recent physical activity in the prevention of premature death and coronary artery disease

Background: People who are physically active live longer, but it is unclear whether this is because of physical activity in the distant or more recent past. Methods: We assessed activity levels in 5209 men and women in the Framingham Heart Study from 1956 to 1958 and again from 1969 to 1973. We included individuals who were alive and without cardiovascular disease in the period 1969 to 1973. The primary outcome was death from all causes during the 16 years after the 1969 to 1973 assessment. Secondary outcomes were incidence and mortality rate of cardiovascular disease. We used Cox proportional hazards regression to calculate the relative risk of being sedentary, both unadjusted and controlling for smoking, weight, systolic blood pressure, cholesterol, glucose intolerance, left ventricular hypertrophy, chronic obstructive pulmonary disease, and cancer. Results: The overall 16-year mortality rate was 37% for men and 27% for women. When both distant and recent activity levels were included along with major cardiovascular disease risk factors, for recent activity the most active tertile had lower overall mortality rate than the least active tertile for men (risk ratio 0.58, 95% confidence interval, 0.43-0.79) and women (risk ratio 0.61, 95% confidence interval, 0.45-0.82). For distant activity there was no difference in overall mortality rate between the most and least active tertiles either for men or for women. Adjusting for major cardiovascular disease risk factors had little effect on the results. Conclusions: The reduction in overall mortality rates is more associated with recent activity than distant activity. These results suggest that for sedentary patients, it may never be too late to begin exercising. (Am Heart J 1999;138:900-7.)