Risk Factors For Death Research Articles

Terror Death of Election Officials: What Are the Effects of Stress and Hypoxia?: A Literature Review

Background: This essay examines the most recent news, namely the passing of a voting committee member (PPS) in the general election (Pemilu), which included candidates for president, vice president, and legislature (Caleg). PPS saw 35 fatalities and 3.909 illnesses. Given that the counting and recapitulation process is still in progress, the likelihood of deaths and illnesses will only rise. Objective: The aim of this research is to find the relationship between hypoxia and stress in PPS officers who died due to physical exhaustion during election activities in Indonesia Methods: Articles containing information on hypoxia, comorbidity, stress, physical exhaustion, and its connection to death were included as inclusion criteria. There was a total of 25 papers that met the inclusion criteria after the literature analysis procedure was completed. Result: Along with the comorbid status, physical exhaustion, and stress play a significant part (comorbidities). This connection arises from the fact that physical exhaustion and stress induce hypoxia, which in turn affects immunity. The drop in blood oxygen levels, or hypoxia, disrupts and dysregulates the innate and adaptive immune systems. The chance of dying can rise when hypoxia and ongoing stress are present. Writing this paper proposes more investigation into the role that hypoxia and stress play as death risk factors. Conclusion: Hypoxia results from stress. what makes HIF the primary transcription factor active. When PPS officers activate their HIF in order to fulfill their mandate and fulfill their obligations under Law Number 7 of 2017 concerning General Elections, there is an elevated risk of death and morbidity.

Epidemiology of reinfections by SARS-CoV-2 variants during the third and fourth waves of the COVID-19 pandemic

Introduction: The coronavirus disease 2019 (COVID-19) pandemic is a global health concern and has persisted through the emergence of variants that have caused subsequent waves of COVID-19 due to the high dispersion and contagiousness of the virus. The aim of this work was to analyze the epidemiology of the cases of reinfection by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variants during the third and fourth wave of the COVID-19 pandemic at the Hospital Juárez de México (HJM). Methodology: A prospective study of the cases of SARS-CoV-2 reinfection, variants detected, symptoms, and associated comorbidities was carried out on 1,347 patients who attended the HJM from September 2021 to July 2022. Results: 760 (56.4%) and 587 (43.6%) patients were negative and positive for SARS-CoV-2, respectively. The Omicron variant was the most frequent and the most common symptoms were: cough (80%), headache (61.32%), fever (51.6%), and dyspnea (40%). A higher proportion of females were vaccinated, ranging from one dose to the complete schedule. The factors that were associated with a greater risk of death from complications of SARS-CoV-2 reinfection were male gender, diabetes mellitus, and arterial hypertension. Conclusions: Females were the most susceptible to an Omicron reinfection event, even though they were vaccinated. However, the risk of death was higher when the patient was male; being male was a potential risk factor for death from COVID-19 and comorbidities.

Characterisation of Patients with Self-Neglect – `Room to Improve' with a New Potential Geriatric Giant?

Abstract Background Self-Neglect is an under-reported and often veiled diagnosis which is defined as ‘an adult’s inability due to physical or mental impairment or diminished capacity to perform essential self-care tasks. Self-Neglect is an independent risk factor for death and is associated with morbidity, heavy utilisation of healthcare services and safeguarding issues. Self-Neglect affects more older persons and is more commonly seen in people with cognitive deficits and social isolation. Methods Using HIPE data, patients were selected for a Descriptive Retrospective Chart Review with a diagnosis of Self-Neglect and under the care of a Consultant Geriatrician within a 2-year timeframe from April 2022 to April 2024. Data was compiled and demographics were collated. Charlson Co-Morbidity Index, Adult Comorbidity Evaluation-27 and Clinical Frailty Scores were employed. Results Twenty patient's charts were reviewed retrospectively. Of the twenty patients 65% were male, 40% are rural dwelling and 70% live alone. 95% of patients have an underlying cognitive impairment, and over 90% have a current or remote history of substance abuse. All 20 patients had significant concerns highlighted about their housing and 60% of patients required alternative accommodation while their home was updated or cleaned. All 20 patients required discharge planning with many requiring complex multi-disciplinary input regarding their safe discharge and had prolonged inpatient stays. Conclusion Recognition and resourcing ‘Self Neglect’ pathways will remain an issue in the health service in Ireland and worldwide. Patients presenting to hospitals with Self-Neglect are multi-morbid, socially complex and tread the line between autonomy and public health issues. Creating a service pathway that puts this vulnerable cohort at the centre and that could span both inpatient and community streams would be beneficial to the over-stretched health service but most importantly to the patient.

Risk factors for death among children with severe malaria, Ivukula sub-county, Namutumba district, Eastern Uganda, september 2021–february 2022

BackgroundIn February 2022, the Ministry of Health received reports of more than 100 child deaths from a ‘strange disease’ in Namutumba District over a period of 6 months from politicians through the media. Preliminary investigations by the district rapid response team confirmed the strange disease to be severe malaria. The scope of severe malaria deaths was investigated, associated factors identified, and recommendations made for control measures to inform early malaria treatment strategies in Namutumba District.MethodsA retrospective study was conducted in March 2022 in the most affected subcounty (Ivukula Subcounty) involving cases and controls. A case was defined as a death with a positive malaria test, fever and any of the following: convulsions, difficulty breathing, yellowing of eyes or palms, tea-coloured urine, anaemia (evidenced by pale eyes or palms, or clinically-identified in medical records), loss of consciousness, or reduced urine output (very little or no urine in a day) in a child ≤ 12 years from September 2021 to February 2022 in Ivukula Subcounty, Namutumba District. Controls were survivors with the same signs and symptoms, recruited in a 2:1 ratio with cases. Cases and controls were actively searched using a door-to-door approach with the help of community health workers. Caretakers were interviewed to obtain data on signs and symptoms, socio-demographic information, health-seeking behaviours and health system risk factors. Drugs and bloodstock status information was obtained from health workers using an interview guide. Factors associated with death were identified using multivariate logistic regression and thematic analysis for qualitative data.ResultsAmong 46 cases, 29 (63%) were < 5 years, and 23 (50%) were female. Death among children with severe malaria was significantly associated with treatment non-completion (aOR = 9.7, 95%CI 1.8–53) and inability to receive blood transfusion for anaemic patients (aOR = 7.1, (95%CI 1.4–36). Healthcare workers reported that inability to reach referral sites due to transport costs, stockouts of anti-malarials and blood products at health facilities, and absence of integrated community case management of childhood illnesses (iCCM) contributed to deaths among children with severe malaria.ConclusionLack of access to anti-malarial treatment and to blood transfusions among anaemic patients due to stockouts were associated with severe malaria deaths among children ≤ 12 years in Ivukula Subcounty. Recommendations made were: accurate quantification of anti-malarials for health facilities, offering transport support to severe patients referred to higher-level facilities, and increasing access to blood products. Activation of iCCM could facilitate public health efforts against severe malaria in the district.

Impact of a transformative health literacy model for Thai older adults with hypertension

BackgroundHypertension is the important risk factor for cause disability and death, particularly if there is a loss of self-care knowledge. Health literacy encompasses the comprehension and awareness of health-related information, which is beneficial for managing the health of older adults with hypertension. Therefore, the objective of this study was to examine the impact of a transformative health literacy model to develop the health literacy levels among Thai senior citizen with hypertension.MethodThis research employed an experiment. Thirty-six participants engaged in the transformative health literacy model. The instrument is the health literacy in hypertension scale, which had acceptable reliability and validity.ResultsThe study revealed that the level of health literacy in the post-test and follow-up phases of the experimental group who received the health literacy promotion model was significantly higher than the pre-test level of health literacy at a significance level of 0.05.ConclusionThe study outcomes create a new pathway to enhancements of health literacy in Thai older adults with hypertension.

Trend Analysis of the Burden of Hypertensive Heart Disease in China from 1990 to 2021

Objective: To quantitatively analyze the burden of hypertensive heart disease (HHD) in China and provide a scientific basis for prevention and control strategies. Methods: Data from the Global Burden of Disease 2021 database were used to assess the disease burden, deaths, years lived with disability (YLDs), and risk factors for HHD in the Chinese population from 1990 to 2021. Results: From 1990 to 2021, HHD cases in China increased from 1.5 million to 3.9 million, with an average annual growth rate of 2.83%. Prevalence rose from 127.76/100,000 to 259.00/100,000, while age-standardized prevalence decreased by 0.68% annually. HHD deaths increased from 232,478 to 320,247, with a mortality rate rise from 19.76/100,000 to 22.56/100,000, though age-standardized mortality decreased by 2.68% annually. YLDs rose from 124,386 to 301,426, with the rate increasing by 2.20% annually, while age-standardized YLDs decreased by 0.67% annually. High sodium intake and low fruit consumption were key risk factors for HHD deaths. Deaths related to low vegetable intake decreased until 2005 and then rose, while deaths from lead exposure showed a similar pattern. Conclusion: HHD cases and prevalence increased significantly, but age-standardized prevalence and mortality rates declined, reflecting the impact of an aging population and improved health interventions. The rise in YLDs highlights the long-term impact on patients’ quality of life. Key risk factors included high sodium intake and low fruit consumption, emphasizing the importance of dietary improvements in HHD prevention. HHD remains a significant public health challenge in China, requiring continuous research and targeted prevention strategies.

Prognostic Value of CD14 Expression in Peripheral Blood Mononuclear Cell Membrane in Patients with Severe COPD Complicated with Pulmonary Infection.

Severe chronic obstructive pulmonary disease (COPD) patients with pulmonary infections face higher morbidity and mortality. To investigate mononuclear cell membrane CD14 as a prognostic marker for their outcome. A total of 311 participants were included: 122 in the coinfection group, 127 in the severe COPD group, and 62 in the control group. The patients in the coinfection group were categorized into survival (n=106) and death (n=16) groups based on hospitalization prognosis. The CD14%, CD14MFI, and CD14IND values were compared between the groups. Death risk factors were assessed by COPD grading, FEV1% pred, FEV1/FVC, CD14%, CD14MFI, and CD14IND. Correlations between CD14 parameters and mortality, COPD grade, FEV1%pred, and FEV1/FVC were analyzed. The critical value for CD14IND to predict patient death was determined and survival rates were compared between the high and the low-risk groups. CD14% values were significantly lower in the COPD and co-infection groups than in the control groups (p<0.05). The survival group showed a steady increase in mCD14 expression, while the death group showed fluctuating low levels. Low value of CD14% was identified as a risk factor for death and correlated with mortality and COPD severity (p<0.001). CD14IND≤74.36 predicted death with 91.22% sensitivity and 95.51% specificity. The high-risk group had a significantly lower 30-day survival rate (68.42%) compared with the low-risk group (95.24%) (log-rank χ2=10.067, p=0.002). The CD14 parameters of mononuclear cell membranes prove to be promising markers for predicting prognosis and death in severe COPD patients with lung infection.

The French registry of sudden unexpected death in infancy (SUDI): a 7-year review of available data.

This article details the objectives and methods of the French registry of SUDI. It provides initial results relating to thepopulation included in the register and the procedure for accessing the data. • In Western Europe, France is one of the countries with the highest SUDI rate, making it the first cause of death of infants between 28 and 364days. • The development of epidemiological tools on a national and international scale is essential to advance research into the determinants and risk factors of unexpected death in children under 2years of age. • The OMIN registry was created in France in 2015 to collect nationwide standardised social, environmental, clinical, and paraclinical data for cases of unexpected death in children aged 0 to 2years. • To date, the OMIN registry has included 680 data from almost 2000 children unexpectedly deceased, completed by a biocollection since 2020. • Data from the OMIN registry, unique in its field, are freely available for scientific research teams, after acceptation by the scientific committee of the registry.

Three-Tesla Magnetic Resonance Imaging Characteristics of Hypertrophic Cardiomyopathy: A Comparison with Several Echocardiography Parameters.

Hypertrophic cardiomyopathy (HCM) is a primary cardiac disorder characterized by myocardial hypertrophy without increased afterload. This study set out to describe the cardiac magnetic resonance (CMR) imaging characteristics of HCM and to evaluate correlations of selected CMR parameters with echocardiography. This cross-sectional study enrolled 46 patients diagnosed at the Vietnam Heart Institute with HCM and underwent CMR at the Radiology Center, Bach Mai Hospital, from July 2021 to September 2022. A left ventricular outflow tract (LVOT)/aortic valve (AO) diameter ratio of ≥0.38 on CMR was consistent with an LVOT pressure gradient (PG) of <30 mmHg on echocardiography. The LVOT diameter and the LVOT/AO diameter ratio differed significantly between obstructive and non-obstructive HCM. The predominant phenotypes were diffuse asymmetric HCM (32.6%) and septal HCM (37%), followed by apical HCM (6.5%). Most late gadolinium enhancement (LGE) lesions were observed in the mid-wall of the hypertrophic segments. The mean LGE mass was significantly higher in the obstructive group than in the non-obstructive HCM group (p < 0.05). A strong negative correlation (r = -0.66) was found between the LVOT/AO diameter ratio on the CMR and the LVOT PG via echocardiography. Moreover, echocardiography detected morphologic risk factors for sudden cardiac death (SCD) in 80.4% of patients, whereas the corresponding proportion detected by CMR was 91.3%. Patients with systolic anterior motion (SAM) had a risk for a LVOT/AO diameter ratio <0.38, which was 5.7 times the risk observed in their counterparts without SAM. The LVOT/AO diameter ratio detected by CMR is a precise index for classifying hemodynamic HCM groups. CMR was better than echocardiography for SCD risk stratification.

Impact of Medicaid expansion on kidney transplantation in the State Oklahoma.

There is no data evaluating the impact of Medicaid expansion on kidney transplants (KT) in Oklahoma. To investigate the impact of Medicaid expansion on KT patients in Oklahoma. The UNOS database was utilized to evaluate data pertaining to adult KT recipients in Oklahoma in the pre-and post-Medicaid eras. Bivariate analysis, Kaplan Meier analysis was used to estimate, and cox proportional models were utilized. There were 2758 pre- and 141 recipients in the post-Medicaid expansion era. Post-expansion patients were more often non-United States citizens (2.3% vs 5.7%), American Indian, Alaskan, or Pacific Islander (7.8% vs 9.2%), Hispanic (7.4% vs 12.8%), or Asian (2.5% vs 8.5%) (P < 0.0001). Waitlist time was shorter in the post-expansion era (410 vs 253 d) (P = 0.0011). Living donor rates, pre-emptive transplants, re-do transplants, delayed graft function rates, kidney donor profile index values, panel reactive antibodies levels, and insurance types were similar. Patients with public insurance were more frail. Despite increased early (< 6 months) rejection rates, 1-year patient and graft survival were similar. In Cox proportional hazards model, male sex, American Indian, Alaskan or Pacific Islander race, public insurance, and frailty category were independent risk factors for death at 1 year. Medicaid expansion was not associated with graft failure or patient survival (adjusted hazard ratio: 1.07; 95%CI: 0.26-4.41). Medicaid expansion in Oklahoma is associated with increased KT access for non-White/non-Black and non-United States citizen patients with shorter wait times. 1-year graft and patient survival rates were similar before and after expansion. Medicaid expansion itself was not independently associated with graft or patient survival outcomes. Ongoing research is necessary to determine the long-term effects of Medicaid expansion.

Recent advancements in targeting the immune system to treat hypertension

Hypertension is the key leading risk factor for death globally, affecting ∼1.3 billion adults, particularly in low- and middle-income countries. Most people living with hypertension have uncontrolled high blood pressure, increasing their likelihood of cardiovascular events. Significant issues preventing blood pressure control include lack of diagnosis, treatment, and response to existing therapy. For example, monotherapy and combination therapy are often unable to lower blood pressure to target levels. New therapies are urgently required to tackle this issue, particularly those that target the mechanisms behind hypertension instead of treating its symptoms. Acting via an increase in systemic and tissue-specific inflammation, the immune system is a critical contributor to blood pressure regulation and is considered an early mechanism leading to hypertension development. Here, we review the immune system's role in hypertension, evaluate clinical trials that target inflammation, and discuss knowledge gaps in pre-clinical and clinical data. We examine the effects of anti-inflammatory drugs colchicine and methotrexate on hypertension and evaluate the blockade of pro-inflammatory cytokines IL-1β and TNF-α on blood pressure in clinical trials. Lastly, we highlight how we can move forward to target specific components of the immune system to lower blood pressure. This includes targeting isolevuglandins, which accumulate in dendritic cells to promote T cell activation and cytokine production in salt-induced hypertension. We discuss the potential of the dietary fibre-derived metabolites short-chain fatty acids, which have anti-inflammatory and blood pressure-lowering effects via the gut microbiome. This would limit adverse events, leading to improved medication adherence and better blood pressure control.

Predictive Mortality of the Prognostic Nutritional Index Combined with APACHE II Score for Critically Ill Tuberculosis Patients.

High mortality rates are commonly found in critically ill patients with tuberculosis (TB), which is due partially to limitations in the existing prognostic evaluation methods. Therefore, we aimed to find more effective prognostic evaluation tools to reduce the mortality rate. Data from critically ill patients with TB admitted to the intensive care unit of The Second Hospital of Nanjing, Nanjing, China, between January 2020 and December 2022 were analyzed retrospectively. A total of 115 patients were enrolled and divided into a survival group (n = 62) and a death group (n = 53) according to 30-day survival. Univariate and least absolute shrinkage and selection operator (LASSO) regression analyses were used to investigate the risk factors for 30-day death in critically ill patients with TB. A prediction model for risk of 30-day mortality was developed for critically ill patients with TB in the intensive care unit. The LASSO regression model showed that the prognostic nutritional index (PNI) and Acute Physiology and Chronic Health Status (APACHE II) scores on the third day after admission to the intensive care unit were independent risk factors for 30-day mortality in critically ill patients with TB (P <0.05). The area under the curve value and that PA3 represents the combination of the PNI and APACHE II score on the third day, which was 0.952 (95% CI: 0.913-0.991, P <0.001), was significantly higher than that of the PNI or the APACHE II score on the third day. The new model is as follows: PA3 = APACHE II score (on the third day) × 0.421 - PNI × 0.204. The PNI combined with the APACHE II score on the third day could well predict the 30-day mortality risk of critically ill patients with TB.

RISK FACTORS FOR DEATH FROM COVID-19 IN A HOSPITAL IN THE SOUTHEAST REGION OF MATO GROSSO

Objectives: This study aimed to analyze the risk factors for death by COVID-19. Methods: Retrospective study with cases of hospitalization for COVID-19 in a referral hospital in southeastern Mato Grosso from January 2021 to December 2022. Data were collected from the IndicaSUS System of the State Department of Mato Grosso. The Poisson regression model was applied. Results: A total of 963 individuals, 19.21% (n=185) died as the outcome. The variables associated with the outcome of death were age older than 60 years (RR= 2.47; 95% CI= 1.23-4.95), having lung disease (RR= 1.80; 95% CI= 1.24-2.59), obesity (RR= 1.58; 95% CI= 1.06-2.36), being hospitalized in intensive or semi-intensive (RR= 2.40; 95% CI= 1.82-3.16) and requiring mechanical ventilation (RR= 4.54; 95% CI= 3.47-5.93). Conclusions: These data contribute to the understanding of the epidemiology of the disease in hospitals and may support actions aimed at the care of individuals with severe respiratory syndromes.

Prognostic thresholds of outcome predictors in severe accidental hypothermia.

Hemodynamically unstable patients with severe hypothermia and preserved circulation should be transported to dedicated extracorporeal life support (ECLS) centers, but not all are eligible for extracorporeal therapy. In this group of patients, the outcome of rewarming may sometimes be unfavorable. It is, therefore, crucial to identify potential risk factors for death. Furthermore, it is unclear what criterion for hemodynamic stability should be adopted for patients with severe hypothermia. The aim of this study is to identify pre-rewarming predictors of death and their threshold values in hypothermic patients with core temperature ≤ 28°C and preserved circulation, who were treated without extracorporeal rewarming. We conducted a multicenter retrospective study involving patients in accidental hypothermia with core temperature 28°C or lower, and preserved spontaneous circulation on rewarming initiation. The data were collected from the International Hypothermia Registry, HELP Registry, and additional hospital data. The primary outcome was survival to hospital discharge. We conducted a multivariable logistic regression and receiver operating characteristic curve (ROC) analysis. In the multivariate analysis of laboratory tests and vital signs, systolic blood pressure (SBP) adjusted for cooling circumstances and base excess (BE) were identified as the best predictor of death (OR 0.974 95% CI 0.952-0.996), AUC ROC 0.79 (0.70-0.88). The clinically relevant cutoff for SBP was identified at 90mmHg with a sensitivity of 0.74 (0.54-0.89) and a specificity of 0.70 (0.60-0.79). The increased risk of death among hypothermic patients with preserved circulation occurs among those with an SBP below 90mmHg and in those who developed hypothermia in their homes.

Stable excess mortality in a multiple sclerosis cohort diagnosed 1970-2010.

Multiple sclerosis (MS) is associated with excess mortality. The use of disease-modifying treatments (DMTs) has recently been associated with survival benefits. A regional MS database was linked with national registries. People with MS (pwMS) diagnosed in 1971-2010 were included and followed up until the end of the year 2019. Five matched controls were acquired for every person with MS. DMTs included in the analyses were interferon and glatiramer acetate. Median follow-up time of the 1795 pwMS was 20.0 years (range 0.1-48.7 years). Survival did not differ between decades of diagnosis (p = 0.20). Amongst pwMS, male sex (adjusted hazard ratio [aHR] 1.70; 95% confidence interval [CI] 1.41-2.06), higher age at diagnosis (aHR 1.83; 95% CI 1.65-2.03 per 10-year increment) and primary progressive disease course (aHR 1.29; 95% CI 1.04-1.60) were independently associated with poorer survival. DMT use was associated with better survival (p < 0.0001) and better survival during follow-up (aHR 0.56; 95% CI 0.38-0.81). Compared to matched controls, median life expectancy was 8-9 years shorter in pwMS with survival diverging from controls during the first decade after diagnosis, more clearly in men than women. Despite DMT use being associated with better survival, relative life expectancy of pwMS did not change over five decades in Western Finland. Male sex was an independent risk factor for death amongst pwMS, but excess mortality was higher in women. More work and methods are needed to improve survival in pwMS.

Survival and cardiovascular disease mortality among primary liver cancer patients: A population-based study

BackgroundThe prognosis of primary liver cancer (PLC) was influenced by death due to non-cancer causes, particularly death related to cardiovascular disease (CVD). This study aimed to analyze mortality of non-cancer causes and identify the independent risk factors associated with CVD-related deaths in PLC patients. MethodsIn total, 112140 patients were enrolled from the Surveillance, Epidemiology, and End Results (SEER) database (2000–2019). Independent risk factors for death from CVD in patients with PLC were identified by Cox proportional hazards model. ResultsThe median follow-up time of all PLC patients was 76 months (interquartile range (IQR): 36–129). The median overall survival (OS) was 12 months (IQR: 3–40). Patients with intrahepatic cholangiocarcinoma (ICC) had shorter OS than patients with hepatocellular carcinoma (HCC) (8 vs. 14 months; P < 0.001). A total of 87299 deaths were observed, among which 61477 (70.42 % of all deaths) were from PLC, and 12727 (14.58 % of all deaths) were from other cancers. Of all non-cancer deaths (9276, 10.63 %), 2860(30.86 %) were results of CVD. PLC patients had higher risks on CVD-related deaths, compared with general population (standard mortality ratio, SMR, 2.20; 95 % confidence interval, CI, 2.12–2.28). Typically, the highest SMRs appeared in the first year following cancer diagnosis. The multivariable analysis revealed the characteristics listed as followed to be independently risk factors of CVD: age, male (hazard ratio, HR: 1.248, 95%CI: 1.147–1.359), black race (HR: 1.334, 95%CI: 1.195–1.490), year 2016–2019 of diagnosis (HR 0.758, 95%CI: 0.671–0.856), ICC (HR: 1.202, 95%CI: 1.086–1.330), without surgery (HR: 2.479, 95%CI: 2.266–2.711) and without chemotherapy (HR: 2.211, 95%CI: 2.033–2.403). ConclusionIt is essential to take cardiovascular health into consideration at the time of diagnosis for PLC patients as the risk of CVD mortality is significantly higher than that of general population.

Bacterial infections and outcomes of inpatients with COVID-19 in the intensive care unit during the delta-dominant phase: the worst wave of pandemic in Iran.

Epidemiological data regarding the prevalence of bacterial multidrug-resistant (MDR) Gram-negative infections in patients with COVID-19 in Iran are still ambiguous. Thus, in this study we have investigated the epidemiology, risk factors for death, and clinical outcomes of bacterial infections among patients with COVID-19 in the intensive care unit (ICU). This retrospective cohort study included patients with COVID-19 hospitalized in the ICU of a university hospital in Iran between June 2021 and December 2021. We evaluated the epidemiological, clinical, and microbiological features, outcomes and risk factors associated with death among all COVID-19 patients. Data and outcomes of these patients with or without bacterial infections were compared. Kaplan-Meier plot was used for survival analyses. In total, 505 COVID-19 patients were included. The mean age of the patients was 52.7 ± 17.6 years and 289 (57.2%) were female. The prevalence of bacterial infections among hospitalized patients was 14.9%, most of them being hospital-acquired superinfections (13.3%). MDR Klebsiella pneumoniae and Staphylococcus aureus were the most common pathogens causing respiratory infections. Urinary tract infections were most frequently caused by MDR Escherichia coli and K. pneumoniae. The overall in-hospital mortality rate of COVID-19 patients was 46.9% (237/505), while 78.7% (59/75) of patients with bacterial infections died. Infection was significantly associated with death (OR 6.01, 95% CI = 3.03-11.92, p-value <0.0001) and a longer hospital stay (p < 0.0001). Multivariate logistic regression analysis showed that Age (OR = 1.04, 95% CI = 1.03-1.06, p-value <0.0001), Sex male (OR = 1.70, 95% CI = 1.08-2.70, p-value <0.0001), Spo2 (OR = 1.99, 95% CI = 1.18-3.38, p-value = 0.010) and Ferritin (OR = 2.33, 95% CI = 1.37-3.97, p-value = 0.002) were independent risk factors associated with in-hospital mortality. Furthermore, 95.3% (221/232) of patients who were intubated died. Our findings demonstrate that bacterial infection due to MDR Gram-negative bacteria associated with COVID-19 has an expressive impact on increasing the case mortality rate, reinforcing the importance of the need for surveillance and strict infection control rules to limit the expansion of almost untreatable microorganisms.

Central Nervous System Infections in Patients With Ventriculoperitoneal Shunts Admitted for Primary Abdominal Infections: A US Nationwide Cohort Analysis.

Although ventriculoperitoneal (VP) shunts are a common treatment for hydrocephalus, there are complication risks including infections. Late complications such as ventriculitis from ascending abdominal infections can have severe consequences. However, the incidence of central nervous system (CNS) infections in VP shunt patients with abdominal infections is not well understood. We aimed to determine the incidence of CNS infections in VP shunt patients admitted with abdominal infections. Using the National Inpatient Sample, we studied patients from 2016 to 2019 to determine the incidence of CNS infections in VP shunt patients admitted with abdominal infections. Results were compared with VP shunt patients admitted for primary pneumonia. Among 725 VP shunt patients presenting with abdominal infections, 20 (2.8%) had CNS infections. Chronic obstructive pulmonary disease, hypertension, older age, and a smoking history were more common in patients with CNS infections and primary abdominal infection (P < .05). Patients who developed CNS infection had a significantly higher likelihood of both blood transfusion and coma but a lower likelihood of seizures. VP shunt patients with CNS infections were more likely to undergo shunt removal (odds ratio [OR] = 23.167, P < .001). 4.1% of VP shunt patients with primary abdominal infections died during admission. In a population of primary abdominal infection and pneumonia patients with VP shunts, a multivariate logistic regression analysis controlling for age, sex, and comorbidities identified abdominal infection as an independent risk factor for both CNS infection (OR = 51.208, P < .001) and inpatient death (OR = 3.417, P < .001). Among 6620 VP shunt patients admitted with primary pneumonia, only 5 (0.1%) had CNS infection compared with 20 (2.8%) in those with a primary abdominal infection (OR = 37.532, P < .001), and mortality was 1.6% vs 4.1% for those with a primary abdominal infection (P < .05). CNS infections in VP-shunted patients with abdominal infections are relatively rare but may lead to increased risks of death and other serious adverse outcomes.

Clinical outcomes among patients with concurrent blunt cerebrovascular injury and traumatic intracranial hemorrhage

BackgroundBlunt cerebrovascular injury (BCVI) accounts for 1–3 % of patients with blunt trauma, which should be promptly diagnosed and managed due to risk of cerebral infarction and death. Antithrombotic therapy had been proven to reduce risk of stroke and mortality. However, due to concern of hematoma progression, treatment suggestion is still inconclusive for patients with concurrent traumatic intracranial hemorrhage. Materials and methodsWe performed a retrospective, observational study from 2002 to 2020 at a Level I trauma center, all patients with BCVI and concurrent traumatic intracranial hemorrhage were recruited. Patients' demographics, initial CT findings, severity of BCVI, treatment and outcomes were documented and analyzed to define possible risk factors of death and stroke. ResultsAmong all 57 patients, 49 (86.0 %) patients had injury at ICA, 6 (10.5 %) had VA injury, and 2 (3.5 %) suffered from both. Targeted treatments for BCVI were provided to 33 (57.9 %) patient, mostly endovascular intervention (78.8 %), antithrombotic treatment was given to 11 (19.3 %) patients. At 3-month follow-up, 17 (29.8 %) patients expired, and 18 (31.6 %) patients had cerebral infarction due to BCVI. We identified more severe initial CT findings (p = 0.016), higher head Abbreviated Injury Scale (p = 0.049) and initial life-threatening events (p = 0.047) as risk factors of death, and traumatic basal cistern subarachnoid hemorrhage(SAH) (p = 0.040) as single risk factor of cerebral infarction. ConclusionsAround one-thirds of patients with concurrent BCVI and traumatic intracranial hemorrhage were death or suffered from cerebral infarction within 3 months, with severity of initial head injury and SAH at basal cistern as risk factors, respectively.

Clinical characteristics and prognostic impact of atrial fibrillation among older patients with heart failure with preserved ejection fraction hospitalized for acute heart failure.

Heart failure with preserved ejection fraction (HFpEF) and atrial fibrillation (AF) are often coexisting conditions, but their interrelationship has not yet been clarified. This study investigated the clinical characteristics and prognostic impact of AF among older patients with HFpEF hospitalized for acute HF (AHF). The study included patients 65years of age and older who were admitted to the Emergency Department due to AHF from 1 January 2016 to 31 December 2019. Patients were divided into two groups according to the presence of AF. The primary endpoint was all-cause, in-hospital mortality. Overall, 770 patients with HFpEF were included, mean age 82years, 53% were females. Nearly, a third (30%) of these patients had a concomitant AF and they were significantly older and had higher N-Terminal pro-B-type natriuretic peptide (NT-proBNP) values. Overall, the in-hospital mortality rate was much higher among HFpEF patients with AF compared to those without AF (11.4% vs 6.9%, respectively; p = 0.037). At multivariate analysis, AF emerged as an independent risk factor for death (OR 1.73 [1.03-2.92]; p = 0.038). Among older patients with HFpEF admitted for AHF, the coexistence of AF was associated with a nearly twofold increased risk of all-cause in-hospital mortality. Patients with HFpEF and AF describe a phenotype of older and more symptomatic patients, with higher NT-proBNP, left atrial enlargement, right ventricular dysfunction, and higher CV mortality.