Related Mortality Research Articles

Association between triglyceride-glucose related indices and mortality among individuals with non-alcoholic fatty liver disease or metabolic dysfunction-associated steatotic liver disease

BackgroundThe prognostic value of triglyceride-glucose (TyG) related indices in non-alcoholic fatty liver disease (NAFLD) or metabolic dysfunction-associated steatotic liver disease (MASLD) is still unclear. This study aimed to determine the associations between TyG-related indices and long-term mortality in this population.MethodsThe data came from the National Health and Nutrition Examination Survey (NHANES III) and National Death Index (NDI). Baseline TyG, TyG combining with body mass index (TyG-BMI), and TyG combining with waist circumference (TyG-WC) indices were calculated, and mortality status was determined through 31 December 2019. Multivariate Cox and restricted cubic spline (RCS) regression models were performed to evaluate the relationship between TyG-related indices and long-term mortality among participants with NAFLD/MASLD. In addition, we examined the association between TyG-related indices and all-cause mortality within subgroups defined by age, sex, race/ethnicity, and fibrosis-4 index (FIB-4).ResultsThere were 10,390 participants with completed ultrasonography and laboratory data included in this study. NAFLD was diagnosed in 3672/10,390 (35.3%) participants, while MASLD in 3556/10,390 (34.2%) amongst the overall population. The multivariate Cox regression analyses showed high levels of TyG-related indices, particularly in TyG-BMI and TyG-WC indices were significantly associated with the all-cause mortality, cardiovascular mortality, and diabetes mortality in either NAFLD or MASLD. The RCS curves showed a nonlinear trend between three TyG-related indices with all-cause mortality in either NAFLD or MASLD. Subgroup analyses showed that TyG-BMI and TyG-WC indices were more suitable for predicting all-cause mortality in patients without advanced fibrosis.ConclusionOur study highlights the clinical value of TyG-related indices in predicting the survival of the NAFLD/MASLD population. TyG-BMI and TyG-WC indices would be the surrogate biomarkers for the follow-up of the population without advanced fibrosis.

Evaluation of Vitamin (A) Deficiency among Critically Ill Children with Sepsis

Abstract Background Vitamin A is an immunomodulatory, and its deficiency may cause impaired immune function, which are found in sepsis. There is a biological rationale that vitamin A deficiency (VAD) may be a contributing factor related to poor clinical outcomes in patients with sepsis. Aim of the Work to assess the prevalence of vitamin A deficiency in critically ill children with sepsis and its association with clinical outcomes. Patients and Methods This cross-sectional study included 40 critically ill children with sepsis who were admitted to the paediatric intensive care unit. The control group consisted of 40 age- and sex-matched approximate-health children from outpatient clinic. For the measurement of serum vitamin A status, blood samples were taken from all patients within the first 24 hours of admission. The vitamin A status of the sepsis and control groups were compared. Univariate and multivariate approaches were used to assess the link between vitamin A deficiency and sepsis. Results The study enrolled 40 children with sepsis and 40 matched healthy children so there was no statistically significant difference between controls and patients among age and sex, with median age 4 (2 – 12) months for both groups with male predominance (60.0%). Regarding body measures there was a high statistically significant lower values among patients group than controls group for z score of weight, height/length, body mass index (BMI) and mid arm circumference (MAC) of the studied subjects, that indicated increased malnutrition prevalence among septic children than control group. In the present study, by comparing VAD between patients and controls, there was high statistically significant difference as all septic patients (100%) had VAD and the VAD among healthy control was found in 30% of them. We also found that patients with septic shock, patients who were nothing per os (NPO), patients on ventilators and died patients were more deficient in vitamin A level than other patients compared with them (high statistically significant difference), illustrated that VAD may be had a role in sepsis related morbidity and mortality. There was a positive correlation between vitamin A and BMI z score and MAC while there was a negative correlation with prism 3 and prism 4.ROC curve for assessment of vitamin A as a predictor of sepsis, found that at cut off value ≤9 μg/dl, the Sensitivity, Specificity, positive predictive value (PPV) and negative predictive value (NPV) were 100% for each. Conclusion low level of vitamin A, lower than or equal to 9 μg/dl was associated with sepsis, septic shock, and higher PRISM score. Vitamin A deficiency may be a marker of morbidity and mortality in critically ill children with sepsis.

Particulate matter and black carbon exposure in Seoul subway: Implications for human health risk

Air pollution and the associated health risks to humans caused by exposure to particle matter in enclosed subway systems are currently concerns. This research first time investigated the substantial health hazards (cancerous, non-cancerous, relative risk, and excess mortality rates associated with all-cause, cardiovascular, and respiratory mortality) posed by metals and black carbon (BC) bound to particulate matter (PM10, PM2.5) within subway systems. The Seoul subway system has been found to show notably higher levels of PM (2–1.5 times) and BC (2.3–1.3 times) compared to outdoor environments. Inhalation of PM-containing trace metals such as Cr, Ni, Cd, Pb, and BC significantly contributes to cancer risk, irrespective of age or PM type. The risk of developing inhalation-related cancer due to PM10 and PM2.5-bound metals is notably higher (1.2–2 times) within the subway environment compared to outdoors. Inhalation cancer risk levels (ICRBC) associated with PM-bound BC are 1.8 times greater at subway stations compared to outdoor stations, with a strong association (1.93–1.98 times) with PM2.5-bound BC compared to PM10. Notably, PM levels in subway stations have a considerable impact on relative mortality risk, with approximately 1.98 times the observed increase in mortality attributed to PM2.5-bound BC. The trace metals and BC bound to PM that contribute to human health risks might originate from vehicle emissions. This includes both surface and underground transportation systems. These findings underscore the significance of addressing air quality within subway systems to mitigate health risks.

Endoscopic Glue Injection vs Glue Plus BRTO or TIPSS for Preventing Gastric Variceal Bleeding: A Randomized Controlled Trial

Background and aimsTo compare the efficacy of endoscopic injection sclerotherapy with N-butyl cyanoacrylate glue (EIS-CYA) vs EIS-CYA plus a radiologic intervention (either transjugular intrahepatic portosystemic shunt (TIPSS) or balloon-occluded retrograde transvenous obliteration (BRTO)) for secondary prophylaxis in patients with liver cirrhosis who presented with acute variceal bleeding (AVB) from cardiofundal varices. Primary outcome measure was gastric varix (GV) rebleed rates at 1 year. MethodsConsecutive cirrhosis patients with AVB from cardiofundal varices were randomized into two arms (45 in each) after primary hemostasis by EIS-CYA. In the ‘endoscopic intervention’ (EI) arm, EIS-CYA was repeated at regular intervals (1, 3, 6 and 12 months), while in the ‘radiological intervention’ (RI) arm, patients underwent TIPSS or BRTO followed by endoscopic surveillance. ResultsGV rebleed rates at 1 year were higher in the EI arm compared to the RI arm: 11 (24·4%; 95% CI: 12·9%-39·5%) versus 1 (2·2%; 95% CI: 0·1%-11·8%); (p=0·004) [ARD: 22.2% (95% CI: 8.4%-36.6%)]. GV rebleed related mortality in the EI arm [8 (17·8%; 95% CI: 8·0%-32·1%)] was significantly higher than in the RI arm [1 (2·2%; 0·1%-11·8%)] (p=0.030) [ARD: 15.6 (95% CI: 2.9%-29.2%)], however, there was no difference in all-cause mortality between the two groups (12 [26·7%; 95% CI: 14·6 to 41·9] versus 7 [15·6%; 95% CI: 6·5 to 29·5]). Numbers needed to treat (NNT) to prevent one GV-related rebleed at 1 year was 4.5. ConclusionRadiological intervention for secondary prophylaxis reduces rebleeding from gastric varices and GV rebleeding related mortality in patients with gastric variceal hemorrhage. (CTRI/2021/02/031396)

A pattern of admission and outcome of patients admitted to the intensive care unit of a tertiary hospital in a low resource setting: a cohort study

Background: ICU is a specialized department designed to serve critical care for severely ill patients. It needs an adequate number of highly trained and skilled human power and costly materials, which has limited its number and functionality in low resource settings. As a result, intensive care medicine or critical care services are poorly developed, or at most, still in the infancy stage. Due to the multifactorial limitations, ICU treatment outcomes were lower compared to high-income countries from the limited available literature. The objective of this study was to depict ICU treatment patterns and patient outcomes at low resources and limited setup. Methods: A retrospective cohort study was conducted on patients admitted to ICU from January 2017 to 31 December 2020, on a sample of 420 cases using a systematic sampling technique. Patient data were collected from the medical record and filled into a prevalidated checklist from admission to discharge or death. Data were analyzed using a statistical package for social sciences version 25.0. Result: A total of 419 patients’ data was qualified for analysis with ICU mortality being 40.8%. The majority of the admissions to the ICU were from the surgical department followed by trauma admissions. Some of the factors significantly associated with ICU mortality were: vasopressor use during the course of ICU follow up adjusted odd ratio (aOR)=4.3 with 95% CI: 1.83–10.03, P-value <0.001, patients who were put on mechanical ventilator aOR=3.6 with 95% CI: 1.90–6.63, P-value <0.001, enteral feeding aOR=0.31 at 95% CI: 0.16–0.59, P-value <0.001and admissions from internal medicine aOR=4.2, 95% CI: 1.66–10.41, P-value=0.01. Conclusion: The pattern of ICU admissions in developing countries were characterized by surgical and trauma related, younger patients, and high mortality rate. Hypotension, being on mechanical ventilator, vasopressor use, and enteral feeding were some of the factors associated with ICU outcome.

A Novel and Simple Method for a Differentiation of Alcohol Types.

Alcohol poisoning is a significant global problem that has become an epidemic. The determination of the alcohol type is hereby essential as it may affect the course of the treatment; however, there is no routine laboratory diagnostic method for alcohol types other than for ethanol. In this study, we aimed to define a simple method for alcohol type differentiation by utilizing a combination of breathalyzer and spectrophotometrically measured serum ethanol results. A breathalyzer and spectrophotometry were used to measure four different types of alcohol: ethanol, isopropanol, methanol, and ethylene glycol. To conduct serum alcohol analysis, four serum pools were created, each containing a different type of alcohol. The pools were analyzed using the spectrophotometric method with an enzymatic ethanol test kit. An experiment was conducted to measure the different types of alcohol using impreg-nated cotton and a balloon, simulating a breathalyzer test. An algorithm was created based on the measurements. Based on the results, the substance consumed could be methanol or isopropanol if the breathalyzer test indicates a positive reading and if the blood ethanol measurement is negative. If both the breathalyzer and the blood measurements are negative, the substance in question may be ethylene glycol. This simple method may determine methanol or isopropanol intake. This straightforward and innovative approach could assist healthcare professionals in different fields with diagnosing alcohol intoxication and, more precisely, help reducing related morbidity and mortality.

How COVID-19 Impacted Colonoscopy Utilization and Colorectal Cancer Detection in Hawai'i in 2020.

The Coronavirus Disease of 2019 (COVID-19) pandemic had a profound impact on colorectal cancer (CRC) screening and diagnostic testing. During the initial months of the pandemic, there was a sharp decline in colonoscopies performed as many areas were on lockdown and elective procedures could not be performed. In later months, even when routine procedures started being scheduled again, some patients became fearful of contracting COVID during colonoscopy or lost their health insurance, leading to further delays in CRC diagnosis by colonoscopy. Previous studies have reported the dramatic decrease in colonoscopy rates and CRC detection at various institutions across the country, but no previous study has been performed to determine rates of colorectal screening by colonoscopy in Hawai'i where the demographics of CRC differ. The team investigated the pandemic's impact on colonoscopy services and colorectal neoplasia detection at several large outpatient endoscopy centers in Hawai'i and also classified new CRC cases by patient demographics of age, sex, and ethnicity. There were fewer colonoscopies performed in these endoscopy centers in 2020 than in 2019 and a disproportionate decrease in CRC cases diagnosed. Elderly males as well as Native Hawaiians/Pacific Islanders were most impacted by this decrease in CRC detection. It is possible there will be an increase in later stage presentation of CRC and eventual CRC related mortality among these patients.

Molecular Players at the Sorting Stations of Malaria Parasite 'Plasmodium falciparum'.

The apicomplexan pathogenic parasite 'Plasmodium falciparum' (Pf) is responsible for most of the malaria related mortality. It resides in and refurbishes the infected red blood cells (iRBCs) for its own survival and to suffice its metabolic needs. Remodeling of host erythrocytes involves alteration of physical and biochemical properties of the membrane and genesis of new parasite induced structures within the iRBCs. The generated structures include knobs and solute ion channels on the erythrocyte surface and specialized organelles i.e. Maurer's clefts (MCs) in the iRBC cytosol. The above processes are mediated by exporting a large repertoire of proteins to the host cell, most of which are transported via MCs, the sorting stations in parasitized erythrocytes. Information about MC biogenesis and the molecules involved in maintaining MC architecture remains incompletely elucidated. Here, we have compiled a list of experimentally known MC resident proteins, several of which have roles in maintaining its architecture and function. Our short review covers available data on the domain organization, orthologues, topology and specific roles of these proteins. We highlight the current knowledge gaps in our understanding of MCs as crucial organelles involved in parasite biology and disease pathogenesis.

Reporting on Antibiotic Resistance in Two US Newspapers Before and During Covid-19

Antibiotic resistance (AR) is a growing health crisis that has remained underrepresented in coverage across major news publications in the U.S. despite increasing rates of related disease outbreaks and mortality worldwide. This study used content analysis to examine the coverage of AR in two major U.S. news publications before the COVID-19 pandemic (2018-2019) and during it (2020-2021). Coverage of AR in The New York Times (NYT) and The Washington Post (WP) was analyzed according to the use of frames, the quantity of articles published, and a number of other variables including stakeholders, diseases, and terms referring to AR. These factors were used to assess how coverage of AR differed before and during the COVID-19 pandemic, and how it differed between the two newspapers. Pre-COVID-19 coverage focused on AR as an isolated pandemic, while coverage during the early years of the COVID-19 pandemic often used AR as a supplementary component of the coverage to the main topic of COVID-19. This study found that both before and during the outbreak of COVID-19, the majority of the observed articles did not fully explain the scope, severity, or solution for the AR crisis. Instead, they provided readers with baseline information, framing AR as a contemporary issue and generally encouraging action but included very few tangible suggestions for every day, individual action for readers. KEYWORDS: Superbugs; Frames; Antibiotic Resistance; Coronavirus; COVID-19; Media Coverage; Health Crises; Medicine

Recommendations for broadening eligibility criteria in esophagus cancer clinical trials: the mortality disparity of esophagus cancer as a first or second primary malignancy.

Esophagus cancer as a second primary malignancy (esophagus-2) is increasingly common, but its prognosis is poorly understood. This study aims to examine the overall, non-cancer related and cancer-specific survival of patients diagnosed with esophagus-2 compared to the first primary esophagus cancer (esophagus-1). We included primary esophagus cancer patients diagnosed from 1975 to 2019 in the Surveillance, Epidemiology, and End Results program. Esophagus-2 was identified in patients with a previous diagnosis of non-esophageal primary malignancy. Hazard ratios of overall, esophagus cancer-specific and non-cancer related mortality were estimated among patients with esophagus-2 compared to esophagus-1, adjusting for age, gender, tumor stage and other demographic and clinical characteristics. A total of 74,521 and 14,820 patients were identified as esophagus-1 and esophagus-2 respectively. Esophagus-2 patients suffered lower risk of esophagus cancer-specific mortality in initial 5 years but with similar risk thereafter, independent of tumor characteristics and treatment. In the first 5 years after diagnosis, patients with esophagus-2 had similar risk of overall mortality with those with esophagus-1 but increased risk thereafter. As for non-cancer related mortality, esophagus-2 patients had higher risk all along. Esophagus-2 patients should not be entirely excluded from clinical trial and a 3-year exclusion window is suggested. A conservative approach to manage esophagus-2 solely based on malignancy history is not supported but effort should be put into surveillance, prevention and management of the comorbidities and complications for the first malignancy.

The level of implementation of COVID-19 measures in workplaces: Ideas for the future

Objective: The initial phases of Coronavirus Disease 2019 (COVID-19) pandemic required a wide range of preventive measures for various settings, including workplaces. The evaluation of workplace applications may guide all stakeholders for future similar outbreaks. This study aimed to evaluate the practice of Turkish occupational safety and health (OSH) professionals regarding COVID-19. Materials and Methods: The study included responses of OSH professionals who were members of three national organizations. Data were collected during the third peak of COVID-19 cases in Turkey. Results: Of 457 respondents, 92.6% reported at least one infected worker, and 12.7% reported mortality among workers due to COVID-19. Multiple regression analyses revealed an association with workplace size ≥250 for any COVID-19 infection among workers (OR=6.70, 95% CI:2.64–16.98, p<0.001) and for COVID-19 related mortality (OR=3.37, 95% CI:1.59–7.13, p=0.002). Moreover, working in governmental business enterprises was related to COVID-19 related mortality (OR=4.83, 95% CI:2.33–10.01, p<0.001). The mean number of available measures was significantly lower (p<0.001) in governmental business enterprises, the service sector, and workplaces with less than 250 workers. Conclusion: The results indicate a need for improvement in small- and large-sized workplaces, governmental business enterprises, and service sector workplaces.

Association of hepatitis B virus treatment with all-cause and liver-related mortality among individuals with HBV and cirrhosis: a population-based cohort study

We evaluated the association of hepatitis B virus (HBV) treatment with all-cause, and liver-related mortality among individuals with HBV and cirrhosis in British Columbia (BC), Canada. This analysis included people diagnosed with HBV and had cirrhosis in the BC Hepatitis Testers Cohort, including data on all individuals diagnosed with HBV from 1990 to 2015 in BC and integrated with healthcare administrative data. We followed people with cirrhosis from the first cirrhosis diagnosis date until death or December 31, 2020. We compared all-cause and liver related mortality between those who received treatment and those who did not. HBV treatment was considered a time-varying variable. We performed multivariable Cox proportional hazards model and competing risk regression models to assess the association of HBV treatment with all causes, and liver-related mortality respectively using inverse probability of treatment weighted population. Among 4962 individuals with HBV and cirrhosis, 48.1% received HBV treatment. Treated individuals had a median follow-up of 2.97 years, compared to 2.87 years for untreated individuals. The treated group was older (median age 57 vs 54 years), had higher proportion of treated of males [1802 (75.50%) vs 1766 (68.8%)], from urban area [2318 (97.2%) vs 2355 (91.8%)], and from East and South Asian ethnicity [1506 (63.1%) vs 709 (27.5%)] compared to untreated group. Untreated people experienced higher all-cause mortality (115.47 vs. 35.72 per 1000 person-years) and liver-related mortality (49.86 vs. 11.39 per 1000 person-years). Multivariable models showed that HBV treatment significantly lowered the risk of all-cause mortality (adjusted hazard ratio (aHR) 0.74; 95% CI: 0.65, 0.84) and liver-related mortality (adjusted subdistribution hazard ratio (asHR) 0.72; 95% CI: 0.58, 0.89) compared to untreated individuals. Among untreated individuals with HBV, those with HCV coinfection had a higher risk of both all-cause and liver-related mortality (aHR 1.57; 95% CI: 1.22, 2.04, and asHR 1.60; 95% CI: 1.25, 2.05, respectively). HBV treatment was associated with a significant reduction in all-cause and liver-related mortality among individuals with cirrhosis. The findings highlight the need for treatment among individuals with HBV related cirrhosis especially those with coinfection with hepatitis C virus. This work was supported by the BC Centre for Disease Control and the Canadian Institutes of Health Research (CIHR) [Grant # NHC-142832, PJT-156066, and SC1 -178736]. JDM has received doctoral fellowship from the Canadian Network on Hepatitis C (CanHepC). DJ has received Doctoral Research Award (#201910DF1-435705-64343) from the Canadian Institutes of Health Research (CIHR) and doctoral fellowship from the CanHepC. CanHepC is funded by a joint initiative of the Canadian Institutes of Health Research (CIHR) (NHC-142832) and the Public Health Agency of Canada (PHAC).

Risk and Prognosis of Cancer in Patients with Obstructive Uropathy Compared with the General Danish Population.

To examine whether obstructive uropathy is associated with increased risk of cancer and whether mortality differs between patients with cancer with and without obstructive uropathy. In a nationwide population-based Danish cohort study including 37,275 adult patients with a first-time hospital-related diagnosis of obstructive uropathy in 1996 to 2022, we assessed cumulative cancer incidence (risk) and standardized incidence ratios (SIR). Furthermore, we compared the mortality of 7,485 patients diagnosed with cancer after obstructive uropathy diagnosis with that of 69,785 patients with cancer without obstructive uropathy matched by age, sex, cancer site, stage, and calendar year of cancer diagnosis. The 3-month risk of cancer after an obstructive uropathy diagnosis was 9.6%. The 3-month SIR was 34.2 [95% confidence interval (CI), 33.1-35.4] while the 1 to <5 year SIR was 1.2 (95% CI, 1.1-1.3). The 3-month SIRs were 82.7 (95% CI, 79.3-86.2) for urological cancer, 88.8 (95% CI, 79.8-98.5) for gynecological cancer, and 13.9 (95% CI, 12.0-15.9) for colorectal cancer. After 1 year of follow-up, the excess number of urological cancers decreased to 0.1 per 100 person-years, whereas we observed no excess risk of gynecological and colorectal cancers. The 5-year all-cause mortality following cancer was 64.1% (95% CI, 62.9-65.2) in patients with an obstructive uropathy diagnosis before cancer diagnosis and 53.2% (95% CI, 52.9-53.6) in those without. A first-time diagnosis of obstructive uropathy can be a clinical marker of underlying undiagnosed cancer and elevated mortality in relation to any cancer diagnosed after obstructive uropathy. These findings can inform the follow-up recommendations for obstructive uropathy.

Incidence of Parkinson’s disease in Germany based on prevalence data from 70 million patients of the statutory health insurance

BackgroundParkinson’s disease (PD) is a progressive neurodegenerative disorder characterized by motor and nonmotor system manifestations and psychiatric symptoms. The aim of this study was to estimate the age- and sex-specific incidence of PD in Germany using an illness-death model and a corresponding partial differential equation (PDE) based on prevalence and mortality data.MethodsBased on a PDE that describes the dynamics in an illness-death model, the age- and sex-specific incidence of PD in Germany was estimated using published prevalence and mortality rates. Prevalence rates were provided by the Central Institute for Statutory Health Insurance (Zi) for the period from 2010 to 2019. Parkinson’s related mortality was estimated based on comparable population data from Norway. Bootstrapping was used for incidence estimation (median of 5000 samples) and to obtain 95% confidence intervals to interpret the accuracy of the incidence estimation.ResultsMen had higher incidences of PD than women at all ages. The highest incidences (median of 5000 bootstrap samples) for both groups were estimated for the age of 85 years with an incidence of 538.49 per 100,000 person-years (py) in men and 284.09 per 100,000 py in women, with an increasing width of bootstrapping 95% CIs showing greater uncertainty in the estimation at older ages.ConclusionThe illness-death model and the corresponding PDE, which describes changes in prevalence as a function of mortality and incidence, can be used to estimate the incidence of PD as a chronic disease. As overestimation of incidence is less likely with this method, we found incidence rates of Parkinson’s disease that are suitable for further analyses with a lower risk of bias.

Metformin use correlated with lower risk of cardiometabolic diseases and related mortality among US cancer survivors: evidence from a nationally representative cohort study

BackgroundIn the USA, the prolonged effective survival of cancer population has brought significant attention to the rising risk of cardiometabolic morbidity and mortality in this population. This heightened risk underscores the urgent need for research into effective pharmacological interventions for cancer survivors. Notably, metformin, a well-known metabolic regulator with pleiotropic effects, has shown protective effects against cardiometabolic disorders in diabetic individuals. Despite these promising indications, evidence supporting its efficacy in improving cardiometabolic outcomes in cancer survivors remains scarce.MethodsA prospective cohort was established using a nationally representative sample of cancer survivors enrolled in the US National Health and Nutrition Examination Survey (NHANES), spanning 2003 to 2018. Outcomes were derived from patient interviews, physical examinations, and public-access linked mortality archives up to 2019. The Oxidative Balance Score was utilized to assess participants’ levels of oxidative stress. To evaluate the correlations between metformin use and the risk of cardiometabolic diseases and related mortality, survival analysis of cardiometabolic mortality was performed by Cox proportional hazards model, and cross-sectional analysis of cardiometabolic diseases outcomes was performed using logistic regression models. Interaction analyses were conducted to explore the specific pharmacological mechanism of metformin.ResultsAmong 3995 cancer survivors (weighted population, 21,671,061, weighted mean [SE] age, 62.62 [0.33] years; 2119 [53.04%] females; 2727 [68.26%] Non-Hispanic White individuals), 448 reported metformin usage. During the follow-up period of up to 17 years (median, 6.42 years), there were 1233 recorded deaths, including 481 deaths from cardiometabolic causes. Multivariable models indicated that metformin use was associated with a lower risk of all-cause (hazard ratio [HR], 0.62; 95% confidence interval [CI], 0.47–0.81) and cardiometabolic (HR, 0.65; 95% CI, 0.44–0.97) mortality compared with metformin nonusers. Metformin use was also correlated with a lower risk of total cardiovascular disease (odds ratio [OR], 0.41; 95% CI, 0.28–0.59), stroke (OR, 0.44; 95% CI, 0.26–0.74), hypertension (OR, 0.27; 95% CI, 0.14–0.52), and coronary heart disease (OR, 0.41; 95% CI, 0.21–0.78). The observed inverse associations were consistent across subgroup analyses in four specific cancer populations identified as cardiometabolic high-risk groups. Interaction analyses suggested that metformin use as compared to non-use may counter-balance oxidative stress.ConclusionsIn this cohort study involving a nationally representative population of US cancer survivors, metformin use was significantly correlated with a lower risk of cardiometabolic diseases, all-cause mortality, and cardiometabolic mortality.

The effect of late presentation on HIV related mortality among adolescents in public hospitals of north showa zone Oromiya, Ethiopia; 2022: a retrospective cohort study

BackgroundLate human immunodeficiency virus (HIV) diagnosis is the most prominent cause of HIV/AIDS-related mortality and also increases the risk of transmission and spread of the disease in society. Adolescents are the most vulnerable population’s age group for HIV infection in several settings, but expanding access to early HIV testing remains a challenge. Consequently, a significant proportion of adolescents are still dying of HIV-related causes, and the current study aimed at assessing the effect of late presentation on HIV-related mortality among adolescents living with HIV.MethodsAn institutional-based retrospective cohort study was conducted from August 21–November 21, 2022, at selected public hospitals in the North Showa Zone of Oromiya, Ethiopia. All adolescents living with HIV who had received no ART and presented for ART follow-up at public hospitals from September 1, 2012, to August 31, 2021, were included in the study. Data entry was done by Epi-data version 3.1.1 software and exported to Stata version 16 for further analysis. Both bi-variable and multivariable analyses were performed using the Cox proportional hazard model to compare the HIV-related mortality of early and late-presented adolescents using an adjusted hazard ratio at a 95% confidence interval (CI).ResultsA total of 341 medical records of adolescents were included in the study, contributing an overall incidence rate of 3.15 (95% CI: 2.21–4.26) deaths per 100 person-years of observation throughout the total follow-up period of 1173.98 person-years. Adolescents with late presentation for HIV care had three times the higher hazard of mortality (adjusted hazard ratio (aHR) = 3.00; 95% CI: 1.22–7.37) as compared to those with early presentation for HIV/AIDS care. Adolescents within the age range of 15–19 years old (aHR = 3.56; 95% CI: 1.44–8.77), rural residence (aHR = 2.81; 95% CI: 1.39–5.68), poor adherence to ART (aHR = 3.17; 95% CI: 1.49–6.76), and being anemic (aHR = 3.09; 95% CI: 1.52–6.29) were other independent predictors of HIV-related mortality.ConclusionThe study found a substantial link between HIV late presentation to care and mortality among adolescents. Residence, age, antiretroviral therapy (ART) medication adherence, and anemia status were also found to be other independent predictors of HIV-related mortality. To achieve the ultimate aim of lowering mortality among adolescents living with HIV, rigorous emphasis must be placed on early presentation for HIV/AIDS care. In addition, counseling on adherence and prompt diagnosis and treatment of anemia are highly recommended to reduce mortality.

Meteorology-driven trends in PM2.5 concentrations and related health burden over India

As a heavily polluted country, India has made great efforts on mitigating severe PM2.5 pollution during last several years. Quantifying meteorological impacts on PM2.5 pollution and related health burden is essential to accurately assess pollution control effects and therefore provides a reference for air quality policy in India. This study identifies meteorological influences on PM2.5 trends and related mortality during 2014–2021 in five Indian megacities (Chennai, Kolkata, Hyderabad, Mumbai, Delhi). Decreasing trends in PM2.5 concentrations are observed in all cities and seasons with the maximum trend of −7.24 μg m−3 yr−1 in Delhi during winter. Meteorology causes PM2.5 decreases in all cities and seasons with meteorology-driven downward trends of −6.51 ∼ −0.36 μg m−3 yr−1. Meteorology dominates PM2.5 decreases in Delhi during summer/monsoon and Chennai/Mumbai/Delhi during winter, where meteorology-driven PM2.5 trends contribute 65% ∼ 105% of observed PM2.5 decreases. Better ventilation condition is identified as the primary meteorological factor for PM2.5 decrease. Anthropogenic emissions almost play positive roles in improving India's PM2.5 air quality, confirming the effectiveness of pollution control measures in India during recent years. Meteorological conditions dominate decreases in PM2.5-related deaths in 25% of cities and seasons. The most significant meteorology-driven PM2.5-related mortality trend of −127.12 deaths yr−1 occurs in Delhi during winter.

Association of Life’s essential 8 score with the risk of all-cause mortality and cardio-cerebrovascular mortality in patients with stroke

BackgroundA higher Life's Essential 8 (LE8)-based cardiovascular health (CVH) has been reported to be associated with a lower risk of both all-cause mortality and cardio-cerebrovascular diseases (CCVDs) related mortality in adults in the United States. At the same time, multiple studies have shown a significant negative association of CVH with the risk of stroke and CCVDs. Since no research has investigated the applicability of the LE8 in stroke patients, this study aimed to explore the association of LE8 with all-cause mortality and cardio-cerebrovascular mortality in stroke patients.MethodsData of patients were extracted from the National Health and Nutrition Examination Surveys (NHANES) database in 2007–2018 in this retrospective cohort study. Weighted univariate and multivariate COX regression analyses were utilized to investigate the associations of LE8 with all-cause mortality and cardio-cerebrovascular mortality. We further explored these relationships in subgroups of age, gender, body mass index (BMI), cancer, congestive heart failure (CHF), and coronary heart disease (CHD). The evaluation indexes were hazard ratios (HRs) and 95% confidence intervals (CIs).ResultsAmong the eligible patients, 278 died from all-cause and 89 (8.38%) of them died due to CCVDs. After adjusting for covariates, patients with LE8 score ≥ 58.75 seemed to have both lower risk of all-cause mortality (HR = 0.46, 95%CI: 0.31–0.69) and cardio-cerebrovascular mortality (HR = 0.51, 95%CI: 0.26–0.98), comparing to those with LE8 score < 48.123. Higher LE8 scores were associated with lower risk of all-cause mortality in patients aged < 65 years old, without cancer, and whatever the gender, BMI, CHF or CHD conditions (all P < 0.05). The relationships between high LE8 scores and low cardio-cerebrovascular mortality risk were only found in age < 65 years old and non-cancer subgroups (all P < 0.05).ConclusionA higher LE8 score was associated with lower risk of both all-cause mortality and cardio-cerebrovascular mortality in patients with stroke, which may provide some reference for risk management and prognosis improvement in stoke. However, more evidences are needed to verify this beneficial role of high LE8 score in stroke prognosis.

Demographic and geographical trends in chronic lower respiratory diseases mortality in the United States, 1999 to 2020

Chronic lower respiratory disease (CLRD) related mortality has decreased in the United States due to increasing awareness in the general population and advancing preventative efforts, diagnostic measures, and treatment. However, demographic and regional differences still persist throughout the United States. In this study, we analyzed the temporal trends of demographic and geographical differences in CLRD-related mortality. Data was extracted from the Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research (CDC WONDER) database. Using this data, age-adjusted mortality rates per 100,000 people (AAMR), annual percentage change (APC), and average annual percentage changes with 95% confidence intervals (CIs) were assessed. The Joinpoint Regression Program was used to determine mortality trends between 1999 and 2020 based on demographic and regional groups.During this study period, there were 3,064,049 CLRD-related deaths, with most demographics and regional areas showing an overall decreasing trend. However, higher mortality rates were seen in the non-Hispanic White population and rural areas. Interestingly, mortality rates witnessed a decreasing trend for males throughout the study duration compared to females, who only began to show decreases in mortality during the latter half of the 2010s. Using these results, one can target efforts and build policies to improve CLRD-related mortality and reduce disparities in the coming decades.

Prevalence of Cadmium and Lead Residues in Fried Meat (Suya) Sold in Kaduna Metropolis, Kaduna State, Nigeria

Study’s Novelty/Excerpt This study is novel as it provides the first comprehensive analysis of cadmium (Cd) and lead (Pb) contamination in various types of suya meat in Kaduna, Nigeria, using Atomic Absorption Spectrophotometry. Unlike previous research, this study uniquely examines multiple animal sources and local government areas, offering a detailed comparison of contamination levels across species and regions. Additionally, the findings highlight the widespread public health risk due to Cd and Pb levels exceeding international safety standards, emphasizing the urgent need for regulatory measures to mitigate environmental pollution and protect public health. Full Abstract Heavy metals are of public health concern worldwide due to their damaging effects on human and animal health. The study was aimed at analyzing the presence of cadmium (Cd) and lead (Pb) residues in suya meats; cattle meat (beef), sheep meat (mutton), goat meat (chevon), fowl meat (chicken) and dog meat sold in the Kaduna metropolis, Kaduna State. A descriptive-quantitative research design was used, with fifty samples collected from four Local Government Areas (Chikun, Igabi, Kaduna North and Kaduna South). Atomic Absorption Spectrophotometery was used to analyze and quantify the presence of these heavy metals. Microsoft Excel (Version 2019) and one-way ANOVA are the statistical tools used for result analysis and Cd and Pb were found to be present in all the suya samples analyzed. The results showed statistical significance (p&lt;0.05) between the overall mean concentration of Cd (0.049 mg/kg) and Pb (0.44 mg/kg) in the samples. Even though the mean concentration of Cd in suya samples varied with regards to which the animal originates viz: cattle (0.033 mg/kg), sheep (0.058 mg/kg), goat (0.048 mg/kg), dog (0.04 mg/kg) and chicken (0.078 mg/kg); likewise that of Pb: cattle (0.47 mg/kg), sheep (0.41 mg/kg), goat (0.41 mg/kg), dog (0.39 mg/kg) and chicken (0.51 mg/kg); the animal species from which the meat used in making the suya had no statistically significant influence on the heavy metal content of the meat (p˃0.05). The mean concentration of Cd and Pb obtained within the study areas, in mg/kg were: Chikun (0.046 and 0.43), Igabi (0.044 and 0.43), Kaduna North (0.054 mg/kg) and (0.49 mg/kg), Kaduna South (0.053 mg/kg) and (0.41 mg/kg) respectively. The mean concentration of cadmium and lead in the suya samples was above the permissible limits set by EC and FAO limits of 0.01ug/g lead and 0.003ug/g for cadmium (FAO, 1983), indicating the general contamination of suya meats by heavy metals. The study recommends public measures to minimize environmental pollution and bioaccumulation of Cd and Pb to prevent related ailments and mortality; enforcing regulations governing industrial activities and waste disposal to protect the public from heavy metals pollution.