Significant Decrease In Mortality Research Articles

Extracorporeal cardiopulmonary resuscitation versus conventional CPR in cardiac arrest: an updated meta-analysis and trial sequential analysis

BackgroundExtracorporeal cardiopulmonary resuscitation (ECPR) may reduce mortality and improve neurological outcomes in patients with cardiac arrest. We updated our existing meta-analysis and trial sequential analysis to further evaluate ECPR compared to conventional CPR (CCPR).MethodsWe searched three international databases from 1 January 2000 through 1 November 2023, for randomised controlled trials or propensity score matched studies (PSMs) comparing ECPR to CCPR in both out-of-hospital cardiac arrest (OHCA) and in-hospital cardiac arrest (IHCA). We conducted an updated random-effects meta-analysis, with the primary outcome being in-hospital mortality. Secondary outcomes included short- and long-term favourable neurological outcome and survival (30 days–1 year). We also conducted a trial sequential analysis to evaluate the required information size in the meta-analysis to detect a clinically relevant reduction in mortality.ResultsWe included 13 studies with 14 pairwise comparisons (6336 ECPR and 7712 CCPR) in our updated meta-analysis. ECPR was associated with greater precision in reducing overall in-hospital mortality (OR 0.63, 95% CI 0.50–0.79, high certainty), to which the trial sequential analysis was concordant. The addition of recent studies revealed a newly significant decrease in mortality in OHCA (OR 0.62, 95% CI 0.45–0.84). Re-analysis of relevant secondary outcomes reaffirmed our initial findings of favourable short-term neurological outcomes and survival up to 30 days. Estimates for long-term neurological outcome and 90-day–1-year survival remained unchanged.ConclusionsWe found that ECPR reduces in-hospital mortality, improves neurological outcome, and 30-day survival. We additionally found a newly significant benefit in OHCA, suggesting that ECPR may be considered in both IHCA and OHCA.

Age- and cause-specific contributions to increase in life expectancy at birth in Korea, 2000–2019: a descriptive study

BackgroundKorea’s life expectancy at birth has consistently increased in the 21st century. This study compared the age and cause-specific contribution to the increase in life expectancy at birth in Korea before and after 2010.MethodsThe population and death numbers by year, sex, 5-year age group, and cause of death from 2000 to 2019 were acquired. Life expectancy at birth was calculated using an abridged life table by sex and year. The annual age-standardized and age-specific mortality by cause of death was also estimated. Lastly, the age and cause-specific contribution to the increase in life expectancy at birth in the two periods were compared using a stepwise replacement algorithm.ResultsLife expectancy at birth in Korea increased consistently from 2010 to 2019, though slightly slower than from 2000 to 2009. The cause-specific mortality and life expectancy decomposition analysis showed a significant decrease in mortality in chronic diseases, such as neoplasms and diseases of the circulatory system, in the middle and old-aged groups. External causes, such as transport injuries and suicide, mortality in younger age groups also increased life expectancy. However, mortality from diseases of the respiratory system increased in the very old age group during 2010–2019.ConclusionsLife expectancy at birth in Korea continued to increase mainly due to decreased mortality from chronic diseases and external causes during the study period. However, the aging of the population structure increased vulnerability to respiratory diseases. The factors behind the higher death rate from respiratory disease should be studied in the future.

Incidence-Based Breast Cancer Mortality Trends in Estonia Before and After the Introduction of Organized Mammography Screening: A Register-Based Study.

Despite the relatively low breast cancer incidence in Estonia, mortality remains high, and participation in mammography screening is below the recommended 70%. The objective of this register-based study was to evaluate incidence-based (IB) breast cancer mortality before and after the introduction of organized mammography screening in 2004. Breast cancer deaths individually linked to breast cancer diagnosis were obtained from the Estonian Cancer Registry and used for calculating IB mortality. We compared age-specific IB mortality rates across 5-year birth cohorts and 5-year periods. Poisson regression was used to compare IB mortality for one age group invited to screening (50-63) and three age groups not invited to screening (30-49, 65-69, and 70+) during two periods before and after screening initiation (1993-2003 and 2004-2014). Joinpoint regression was used for age-standardized incidence and IB mortality trends. Age-standardized IB mortality has been decreasing since 1997. Age-specific IB mortality for birth cohorts never exposed to screening showed a continuous increase with age, while in cohorts exposed to organized screening the mortality curve flattened or declined after the age of first invitation. Significant decreases in mortality from 1993-2003 to 2004-2014 were seen in the 30-49 (age-adjusted rate ratio 0.51, 95% CI 90.42-0.63) and 50-63 (0.65, 95% CI 0.56-0.74) age groups, while no decline was seen in the 65-69 and 70+ age groups. The age specific IB mortality curves in birth cohorts exposed to screening and the significant mortality decline in the target age group after the initiation of the organized program suggest a beneficial effect of screening. Improved treatment without screening has not reduced mortality in older age groups. Our results support raising the upper screening age limit to 74 years.

Augmenting Neutrophil Extracellular Traps with Carbonized Polymer Dots: A Potential Treatment for Bacterial Sepsis.

Sepsis is a life-threatening condition that can progress to septic shock as the body's extreme response to pathogenesis damages its own vital organs. Staphylococcus aureus (S. aureus) accounts for 50% of nosocomial infections, which are clinically treated with antibiotics. However, methicillin-resistant strains (MRSA) have emerged and can withstand harsh antibiotic treatment. To address this problem, curcumin (CCM) is employed to prepare carbonized polymer dots (CPDs) through mild pyrolysis. Contrary to curcumin, the as-formed CCM-CPDs are highly biocompatible and soluble in aqueous solution. Most importantly, the CCM-CPDs induce the release of neutrophil extracellular traps (NETs) from the neutrophils, which entrap and eliminate microbes. In an MRSA-induced septic mouse model, it is observed that CCM-CPDs efficiently suppress bacterial colonization. Moreover, the intrinsic antioxidative, anti-inflammatory, and anticoagulation activities resulting from the preserved functional groups of the precursor molecule on the CCM-CPDs prevent progression to severe sepsis. As a result, infected mice treated with CCM-CPDs show a significant decrease in mortality even through oral administration. Histological staining indicates negligible organ damage in the MRSA-infected mice treated with CCM-CPDs. It is believed that the in vivo studies presented herein demonstrate that multifunctional therapeutic CPDs hold great potential against life-threatening infectious diseases.

Intraoperative Goal-Directed Perfusion in Cardiac Surgery with Cardiopulmonary Bypass: The Roles of Delivery Oxygen Index and Cardiac Index.

Goal-directed perfusion (GDP) refers to individualized goal-directed therapy using comprehensive monitoring and optimizing the delivery of oxygen during cardiopulmonary bypass (CPB). This study aims to determine whether the intraoperative GDP protocol method has better outcomes compared to conventional methods. We searched the PubMed, Central, and Scopus databases up to October 12, 2023. We primarily examined the GDP protocol in adult cardiac surgery, using CPB with oxygen delivery index (DO2I) and cardiac index (CI) as the main parameters. In all, 1128 participants from seven studies were included in our analysis. The results showed significant differences in the duration of intensive care unit (ICU) stays (p = 0.01), with a mean difference of -0.33 (-0.59 to 0.07), and hospital length of stay (LOS) (p = 0.0002), with a mean difference of -0.84 (-1.29 to -0.39). There was also a notable reduction in postoperative complications (p <0.00001), odds ratio (OR) of 0.43 (0.32-0.60). However, there was no significant decrease in mortality rate (p = 0.54), OR of 0.77 (0.34-1.77). Postoperative acute kidney injury and ICU and hospital LOS are significantly reduced when GDP protocols with indicators of flow management, oxygen delivery index, and CI are used in intraoperative cardiac surgery using CPB.

Enhancement of the efficacy of Tylvalosin by administration with Eucalyptus oil or Bromhexine against Mycoplasma gallisepticum-infected broiler chickens

Abstract Tylvalosin tartrate is a macrolide antibiotic that has antibacterial activity against Gram-positive, some Gram-negative organisms, and mycoplasma. It acts by inhibiting protein synthesis in bacterial cells. Mycoplasma gallisepticum causes chronic respiratory disease in poultry, especially in the presence of management stresses and other respiratory pathogens. The disease is characterized by coryza, conjunctivitis, sneezing, and sinusitis, particularly in turkeys and birds. It can result in loss of production downgrading of meat-type birds, and loss of egg production. In the current study, the efficacy of tylvalosin on performance parameters, hematological and biochemical profile alone, and in combination with eucalyptus oil and bromhexine were studied. A total of 56-day adult chickens were used in the experiment and infection occurred by Mycoplasma gallisepticum. The birds were classified into seven groups and treated as follows; non-infected non-treated group (control negative), infected non-treated group (control positive), group infected and treated by tylvalosin alone, group infected and treated by eucalyptus oil, group infected and treated by bromhexine, group infected and treated by tylvalosin plus eucalyptus oil, and group infected and treated by tylvalosin plus bromhexine. Clinical symptoms, bacterial re-isolation, mortality rate, and hematobiochemical and histopathological parameters were investigated. The results showed a significant decrease in mortality &amp; improved growth performance (increased weight gain and feed utilization efficiency) in combined treated groups compared to tylvalosin group as well as improvement in hematobiochemical and histopathological parameters of combined treated groups. Furthermore, the combination of tylvalosin and eucalyptus oil or bromhexine was more potent in the treatment of Mycoplasmosis in chickens than each treatment alone and alleviated or partially reduced the severity of chronic respiratory disease induced by Mycoplasma gallisepticum in broiler chickens. Finally, this protective effect could improve the use of antibiotics in poultry farms as well as reduce the problem of antibiotic residues and bacterial resistance to antibiotics.

Effect of denosumab on the incidence of fractures and mortality in patients undergoing hemodialysis: A retrospective cohort study.

Patients undergoing hemodialysis are at an elevated risk of fractures; however, substantial evidence for osteoporosis treatment in this population is lacking. We explored the efficacy of denosumab, an anti-IgG2 antibody that targets the receptor activator of nuclear factor-kappa B ligand, in reducing fracture incidence and all-cause mortality in patients undergoing hemodialysis. This retrospective cohort study-conducted from December 2013 to December 2022-evaluated the effects of denosumab on fracture incidence and all-cause mortality. Patients who initiated denosumab treatment during the study period were defined as the denosumab group, while those without a history of denosumab administration were defined as the non-denosumab group. Kaplan-Meier curves and log-rank tests were used to assess survival and fracture/mortality risks, respectively. Cox proportional hazards models were used to analyze both fractures and all-cause mortality. Among 214 patients undergoing hemodialysis, 52 (24.3%) received denosumab. The median age was 73.0 ± 11.5 years, with 92 (43.0%) females, and the median dialysis duration was 59 months (interquartile range, 6-126). During the study, thirty-seven non-denosumab-treated patients had fractures compared to eight in the denosumab group. No significant differences were observed in the unadjusted model (HR, 0.53; 95% confidence interval (CI), 0.24-1.14). Adjusting for competing mortality and clinical factors, the HR remained at 0.64 (95% CI, 0.27-1.51). Regarding all-cause mortality, we found a statistically significant difference in the unadjusted model (HR, 0.61 [95% CI, 0.38-0.98]). A significant reduction in mortality was observed in the adjusted model (HR, 0.46 [95% CI, 0.26-0.80]). Notably, the denosumab group showed a significant decrease in mortality, particularly in cardiovascular disease-related cases (HR, 0.33 [95% CI, 0.14-0.78]). Denosumab may reduce all-cause mortality in patients undergoing hemodialysis, particularly in those with cardiovascular complications. This finding offers a promising direction for osteoporosis treatment in patients undergoing hemodialysis.

Clinical Outcomes of Surgical Management of Liver Abscess: A Systematic Review

Background: Treatment for liver abscess, a major source of intra-abdominal infection, depends on how it presents. Over time, the method of treating PLA has changed, moving from open surgical drainage to percutaneous drainage assisted by imaging. Objectives: This systematic review aims to investigate the efficacy of surgical approaches to manage liver abscesses. Methods: PubMed, SCOPUS, Web of Science, and Science Direct, were systematically searched to include the relevant literature. Rayyan QRCI was used throughout this systematic approach. Results &amp; interpretation: included nine studies with a total of 632 patients. Antibiotics and/ or US or CT-guided PNA are the first line of treatment to manage liver abscesses. However, the relatively few individuals in whom aspiration was impossible because of thick pus, a septated or loculated abscess, or an abscess that had ruptured in any body cavity were indications for open or laparoscopic surgery. Additionally, we demonstrated that successful surgical procedures were linked to a significant decrease in mortality and a shorter hospital stay in patients with ruptured ALA. Only generalized peritonitis or further infections refractory to non-surgical treatment necessitate surgery. Additional randomized controlled studies involving a suitable patient population should be conducted to raise the level of evidence.

Abstract B143: Temporal trends in colorectal cancer mortality in the five regions of Georgia, 1975-2018: A Joinpoint regression analyses

Abstract Background: Colorectal cancer (CRC) is the third leading cause of death in Georgia. There remain significantly higher CRC mortality rates in the five public health regions of Georgia (Clayton, West Central, East Central, Southeast, and Northeast regions) in comparison to the rates in the State of Georgia. However, studies that examined temporal trends in CRC mortality rates in small geographic regions are still limited. The aim of this study was to analyze the time trends in mortality due to CRC within five regions of Georgia, stratified by age groups to assess any changes in mortality trends for the period 1975 -2018. Methods: Surveillance, Epidemiology, and End Results (SEER) Program SEER*Stat Database: Mortality - All COD, Aggregated with County, Total U.S. were used to select 1975-2018 CRC mortality data. We conducted Joinpoint regression analyses of the trends in age-adjusted mortality rates (ADMRs) due to CRC, stratified by the five regions of Georgia. Age differences in mortality were also examined. The average annual percent change (AAPC) and annual percent change (APC) with confidence intervals of 95% were calculated. Results: A total of 12,972 deaths from CRC were reported in these five regions during the period 1975-2018. The ADMR of CRC were 24.4, 24.9, 23.4, 22.7, and 25.7 per 100,000 in Clayton, East Central, Southeast, Northeast, and West Central regions, respectively. The mortality rates for CRC decreased from 1975 to 2018 in Clayton, Northeast, and Southeast regions (AAPC: -1.7% to -3.4%, p-value&amp;lt;0.05). One Joinpoint trend found a significant reduction in mortality in the East Central (1984-2018) (APC: -4.1%, p-value&amp;lt;0.001) and West Central (1981-2018) regions (APC: -3.2%, p-value=0.003). When examining age differences, patients aged 75 years or older had a significant decrease in mortality from 1975 to 2018 except in the East Central region (AAPC: -2.4% to -4.5%, p-value&amp;lt;0.05). In the East Central region, one Joinpoint demonstrated a significant decrease in mortality during 1987-2018 for the 60-74 age group and during 1984 -2018 for 75+ age group (APC: -5.1% &amp; -6.1%, respectively; both p-value&amp;lt;0.05). Reduced mortality rates were also found from 1984 to 2018 in the 60-74 age group in the Northeast region (APC: -4.3%, p-value&amp;lt;0.001). However, Northeast Georgians aged 15-59 years demonstrated a non-significant trend for increase in mortality from 1975 to 2018 (AAPC: 2.1%, p-value=0.181). Conclusion: The regional burden of colorectal cancer varied across the five regions of Georgia with CRC mortality rates decreased significantly in the Clayton, Northeast, and Southeast regions. Although reduced mortality rates were found in older patients in most regions, younger patients living in Northeast regions demonstrated a slight increase in mortality. Increased CRC risk awareness, culturally tailored prevention strategies through timely CRC screening uptake, and improved access to cancer treatment are extremely important to reduce the CRC burden, especially in the most affected regions in Georgia. Citation Format: Meng-Han Tsai, Daramola N. Cabral, Justin X. Moore, Jorge Cortes. Temporal trends in colorectal cancer mortality in the five regions of Georgia, 1975-2018: A Joinpoint regression analyses [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr B143.

Newcard telemonitoring system improves survival at a lower cost than traditional approaches in chronic heart failure patients as assessed by data extract from the French National Health Data System

Abstract Background Despite widespread use of telemonitoring (TLM) for chronic heart failure (CHF) patients, outcome data remain scarce and medico – economic assessment not routinely addressed. In this setting, the French National Health Data System (SNDS) can be used to comprehensively collect health care costs for the entire French population whatever the type of TLM system. Purpose The aim of this study is to assess the health economic impact of telemonitoring among 1057 patients presenting heart failure matched with a control group selected in the SNDS Methods All patients TLM at least 3 months between 2017 and 2020 were included. For each patient identified by his single social security number (case), anonymised data was retrieved from the SNDS. A control group (CG) was randomly selected from an exhaustive extraction of SNDS of patients with heart failure without TLM. This CG was matched in a 1:3 ratio to TLM patients using a propensity score including baseline characteristics (i.e. gender, age group, social disadvantage index, presence of comorbidities (renal insufficiency, coronary disease, diabetes, cancer), presence of treatments (beta blockers, Sacubitril, aldosterone antagonists, aspirin/Clopidogrel, anticoagulants)). Costs were evaluated using French National Health Insurance perspective using €2022. Binomial negative GEE models were used on matched data sets to assess differences. Results The matching rate between patients included in the TLM arm and the SNDS database was excellent at 99%. Hence, 1,057 TLM patients were matched to 3,171 patients with heart failure. In the telemonitoring group (TLM), patients were 74 years old (±12,3), 68.4 % male, mean left ventricular ejection fraction 41 % and the mean follow-up by the TLM system was 618 days. At 1-year, 2-year and 3-year follow-up, survival rates were respectively of 96%, 91% and 87% for TLM patients vs 93%, 83% and 76% among CG patients (p&amp;lt;0.0001, figure 1). At 6 months, the monthly cost for managing patients was 1,403.2 € in the TLM group vs 1,251.5 € in the CG (p=0.0064). At 12 months, 949.52 € in the TLM group vs 1,114.40 in the CG (p&amp;lt;0.0001). At 24 months, 591.31 € in the TLM group vs 1,064.20 in the CG (p&amp;lt;0.0001). Conclusion While using common evaluation methods seems to be unsatisfactory, economic evaluation both costs and outcomes of an intervention could be more appropriate. The French SNDS is a powerful tool to implement such a type of study. The results presented here show on one hand a significant decrease in mortality in the TLM. On the economic hand, we show here an increase in cost during the first 6 months of the telemonitoring balanced with a significant decrease at 12 and 24 months. Especially, those data place telemonitoring of heart failure as a real improvement in the care pathway which needs time to be effective but is able to have an effect even on the mortality rate

Abstract 14774: Differences in the In-Patient Mortality in Marantic Endocarditis Per Etiology: Systematic Review of Case Reports

Introduction: Non-bacterial thrombotic endocarditis (NBTE; also known as marantic endocarditis) is a unique entity characterized by sterile fibrin deposits on valves caused by hypercoagulability and endocardial injury. Literature is limited regarding the distinction between its causes based on in-hospital mortality. Hypothesis: Would a significant difference in in-patient mortality be present in NBTE admissions depending on etiology? Methods: A review of the literature using the PubMed, Embase, Cochrane, and Web of Science databases was conducted to obtain case reports and series reporting NBTE from inception to September 2022. Crude and univariate analyses were performed. Results: 396 case reports and 20 case series were identified, of which 450 patients were extracted. Females represented 64% of our sample (median age: 46, interquartile range [IQR]: 32 - 60) while 36% were males (median age: 50, IQR: 36 - 64). Overall all-cause in-hospital mortality was 36%. NBTE was associated with cancer in 202 (47%), autoimmune disease in 191 (45%), and other causes in 34 (8%) cases. Older population and cancer etiology were associated with higher mortality (OR: 1.77, CI 95%: 1.19 - 2.62 &amp; OR: 8.29, CI 95%: 4.97 - 13.83, respectively). A significant decrease in mortality is noted in the more recent years compared to the 20 th century (OR: 0.10, 95% CI: 0.06 - 0.18). Conclusions: Although an improvement in all-cause in-hospital mortality for admission related to NBTE has been noticed in recent years, cancer as an etiology and old age are two risk factors associated with higher mortality.

Intracellular delivery of nuclear localization sequence peptide mitigates COVID-19 by inhibiting nuclear transport of inflammation-associated transcription factors

The novel coronavirus SARS-CoV-2, responsible for COVID-19, can trigger dysregulated immune responses known as cytokine release syndrome (CRS), leading to severe organ dysfunction and respiratory distress. Our study focuses on developing an improved cell-permeable nuclear import inhibitor, iCP-NI, capable of blocking the nuclear transport of inflammation-associated transcription factors (IATFs), specifically nuclear factor kappa B (NF-κB). By fusing advanced macromolecule transduction domains (aMTD) and nuclear localization sequences (NLS) from human NF-κB, iCP-NI selectively interacts with importin α5, effectively reducing the expression of pro-inflammatory cytokines. In mouse models with SARS-CoV-2-induced pneumonitis, iCP-NI treatment demonstrated a significant decrease in mortality rates by suppressing pro-inflammatory cytokine production and immune cell infiltration in the lungs. Similarly, in hamsters infected with SARS-CoV-2, iCP-NI effectively protected the lung from inflammatory damage by reducing TNF-α, IL-6, and IL-17 levels. These promising results highlight iCP-NI's potential as a therapeutic approach for COVID-19-related lung complications and other inflammatory lung diseases.

Role of Thyroid Hormones in Adaptation to Volcanic Contamination of Freshwater Habitats in Charr of the Genus Salvelinus (Salmonidae)

The balance between phenotypic plasticity and adaptive specialization in response to environmental pressures remains a hot topic in evolutionary biology. In fish, one of the strongest impact factors is the chemical pollution of habitats. In an attempt to assess the consequences of heavy pollution of fresh waters for resident fishes, we studied Kamchatkan charr, which undergo paedomorphosis in the case of isolation in streams of volcanic areas contaminated with heavy metals. Experiments were carried out on the resistance of charr to metal mixtures during normal development and in six experimental groups with therapeutically altered intensity of metabolism and the secretory activity of thyroid gland. Water from volcanically contaminated streams was found to be lethally toxic for embryos and early juveniles of unadapted charr. The success of acclimation to toxic exposure was correlated with an increase in thyroid status. In experiments, the group with significantly elevated thyroid status showed a significant decrease in mortality and attenuation of oxidative stress in solutions of heavy metals. Under natural conditions, hyperthyroidism provokes a redistribution of the charr’s organism resources from somatic growth and morphological differentiation to stress counteracting and accelerated maturation, which is necessary for the long-term survival of the population under conditions of increased risk of individual mortality. Our experiments highlight the role of thyroid hormones in the rapid response to habitat pollution and the subsequent adaptation of fish populations to chronic deterioration.

Pulmonary Rehabilitation Is Associated With Decreased Exacerbation and Mortality in Patients With COPD: A Nationwide Korean Study

Poor uptake to pulmonary rehabilitation (PR) is still challenging around world. There have been few nationwide studies investigating whether PR impact patient's outcome in COPD. We investigated the change of annual PR implementation rate, medical costs, and COPD outcomes including exacerbation rates and mortality between year 2015 to 2019. Does PR implementation improve outcomes in patients with COPD in terms of direct cost, exacerbation and mortality? Data of patients with COPD extracted from a large Korean Health Insurance Review and Assessment service database (2015-2019) were analyzed to determine the trends of annual PR implementation rate and direct medical costs of PR. Comparison of COPD exacerbation rates between pre- and post-PR, as well as the time to first exacerbation and mortality rate according to PR implementation, were also assessed. Among all patients with COPD in Korea, only 1.43% received PR. However, the annual PR implementation rate gradually increased from 0.03% to 1.4% during 4 years, especially after health insurance coverage commencement. The direct medical cost was significantly higher in the PR than non-PR group, but the costs in these groups showed decreasing and increasing trends, respectively. Both the incidence rate and frequency of moderate-to-severe and severe exacerbations were lower during the post-PR compared to pre-PR period. The time to the first moderate-to-severe and severe exacerbations was longer in the PR than non-PR group. Finally, PR implementation was associated with a significant decrease in mortality. We concluded that health insurance coverage increases PR implementation rates. Moreover, PR contributes towards improving outcomes including reducing exacerbation and mortality in patients with COPD. However, despite the well-established benefits of PR, its implementation rate remains suboptimal.

Checklist application for intrahospital safe transfer of patients in ICUs in Alexandria Main University Hospital and its effect on patients’ outcome

Introduction Patient safety is a vast field of knowledge aiming to prevent errors and harm to the patients, and it is a key indicator of the health-care quality. Transport of critically ill patients from the ICU to other departments for diagnostic or therapeutic procedures is often a necessary part of the critical care process. Indeed, some guidelines on optimal intrahospital transfer (IHT) are available but they are not easily translated into practical measures to reduce incidents. As an alternative, checklists are practical and can provide tools to improve safety. Objective The aim of this study was to apply a checklist covering the pretransport preparation phase, the actual transport phase, and the ICU reinstallation (posttransport) phase and to assess its effect on patient outcome. This was to improve safety during IHT of adult critically ill patients. Patients and methods The present study was performed over a 12-month period, 6 months retrospectively including 86 patients and 6 months prospectively after application of a checklist including 93 patients. All patients in the study were subjected to history taking including demographic data, past medical history, physical examination including vital signs and acute physiology and chronic health evaluation (APACHE II) score. Results IHT checklist improves the presence of needed equipment for each phase Regarding changes in blood pressure, heart rate and respiratory rate, occurrence of arrhythmias, hypoxemia, and cardiopulmonary arrest, there was a statistically significant difference between pre-checklist and post-checklist implementation favoring the post-checklist phase. There was significant decrease in mortality rates after application of the checklist, as the mortality rate in the retrospective group was 31.6 and 19.3% in the prospective group. Conclusion Adverse events were significantly higher in the pre-checklist phase than the post-checklist phase. IHT checklist enhanced patient safety and decreased mortality significantly.

The Role of Anticoagulants and Antiplatelets in Reducing Mortality in COVID-19 Patients: A Systematic Review and Meta-Analysis of Studies Reporting Adjusted Data.

The coronavirus disease 2019 (COVID-19) is associated with prolonged prothrombin time (PT), active partial thromboplastin time (aPTT), and increased D-dimer levels. Therefore, we aim to investigate if anticoagulants (AC) and antiplatelet (AP) therapy playa role in mitigating COVID-19 and its associated thrombosis along with its effect on the mortality rate, the need for mechanical ventilation, and the risk of hospital admission. Electronic databases were searched from their inception to July 19, 2022. The studies were divided into two groups: Group A (any dose of AC/AP versus no AC/AP) and Group B (therapeutic dose of AC (tAC)/AP versus prophylactic dose of AC (pAC)/AP). Review Manager (RevMan) version 5.4.1 (The Nordic Cochrane Centre, The Cochrane Collaboration, Copenhagen, Denmark) was used for all statistical analyses. Adjusted data ratios were extracted from all included studies and pooled using the random effects model. A total of 33 studies were taken for the analysis of two groups (Group A: 285,065COVID-19-positive patients, Group B: 2,421 COVID-19-positive patients). Overall analysis in Group A showed that the AC/AP group had a low risk of mortality in COVID-19 patients compared to the control group (risk ratio (RR): 0.77, 95% confidence interval (CI): 0.69-0.86). There was no significant difference in the need for mechanical ventilation (RR: 0.80, 95% CI: 0.60-1.08) and hospital admission (RR: 1.12, 95% CI: 0.78-1.59) between the AC/AP and no AC/AP group. Alongside, in Group B, tAC/AP did not demonstrate a significant decrease in mortality as compared to pAC/AP (RR: 0.62, 95% CI: 0.37-1.06). Treatment with AC and AP drugs can significantly decrease the mortality rate in COVID-19-infected patients, while AC also significantly reduces the need for mechanical ventilation.

A Standardized Botanical Composition Mitigated Acute Inflammatory Lung Injury and Reduced Mortality through Extracellular HMGB1 Reduction.

HMGB1 is a key late inflammatory mediator upregulated during air-pollution-induced oxidative stress. Extracellular HMGB1 accumulation in the airways and lungs plays a significant role in the pathogenesis of inflammatory lung injury. Decreasing extracellular HMBG1 levels may restore innate immune cell functions to protect the lungs from harmful injuries. Current therapies for air-pollution-induced respiratory problems are inadequate. Dietary antioxidants from natural sources could serve as a frontline defense against air-pollution-induced oxidative stress and lung damage. Here, a standardized botanical antioxidant composition from Scutellaria baicalensis and Acacia catechu was evaluated for its efficacy in attenuating acute inflammatory lung injury and sepsis. Murine models of disorders, including hyperoxia-exposed, bacterial-challenged acute lung injury, LPS-induced sepsis, and LPS-induced acute inflammatory lung injury models were utilized. The effect of the botanical composition on phagocytic activity and HMGB1 release was assessed using hyperoxia-stressed cultured macrophages. Analyses, such as hematoxylin-eosin (HE) staining for lung tissue damage evaluation, ELISA for inflammatory cytokines and chemokines, Western blot analysis for proteins, including extracellular HMGB1, and bacterial counts in the lungs and airways, were performed. Statistically significant decreases in mortality (50%), proinflammatory cytokines (TNF-α, IL-1β, IL-6) and chemokines (CINC-3) in serum and bronchoalveolar lavage fluid (BALF), and increased bacterial clearance from airways and lungs; reduced airway total protein, and decreased extracellular HMGB1 were observed in in vivo studies. A statistically significant 75.9% reduction in the level of extracellular HMGB1 and an increase in phagocytosis were observed in cultured macrophages. The compilations of data in this report strongly suggest that the botanical composition could be indicated for oxidative-stress-induced lung damage protection, possibly through attenuation of increased extracellular HMGB1 accumulation.

Burden of AML, 1990-2019: Estimates From the Global Burden of Disease Study

PURPOSE AML accounts for 80% of acute leukemia in adults. While progress has been made in treating younger patients in the past 2 decades, there has been limited improvement for older patients until recently. This study examines the global and European Union (EU) 15+ trends in AML between 1990 and 2019. METHODS We extracted age-standardized incidence rates (ASIRs), age-standardized death rates (ASMRs), and disability-adjusted life years, stratified by sex from the Global Burden of Disease Study database, and mortality-to-incidence ratio (MIR) were computed. Trends were compared using Joinpoint regression. RESULTS The findings show a global increase in AML incidence for both sexes from 1990 to 2019. In the EU15+ countries, most countries exhibited an increase in ASIR for both sexes. Joinpoint revealed that globally for male patients, ASIR steadily increased until 2010, remained stable until 2015 followed by a decline till 2019. Similar trends were observed in female patients. For ASMR, although there was an increase globally and in most EU15+ countries, there was a statistically significant decrease in mortality rates globally and in the majority of EU15+ countries in recent years. MIR improved in both sexes globally. On age stratification, AML burden was highest among older groups (55 years and older), while the lowest rates were observed in younger than 20 years. CONCLUSION The findings from our study indicate a global rise in AML incidence and mortality in both sexes and decrease in MIR from 1990 to 2019 suggesting a better survival. However, on Joinpoint analysis, there is no change in MIR in women in the past decade and past 4 years in men indicating plateau in survival trends despite recent advances.

Disparities in Neonatal Mortalities in the United States.

We aimed to look for the mortality of Black and White Neonates and compare the Black and White neonates' mortalities after stratifying the population by many significant epidemiologic and hospital factors. We utilized the National Inpatient Sample (NIS) dataset over seven years from 2012 through 2018 for all neonates ≤ 28 days of age in all hospitals in the USA. Neonatal characteristics used in the analysis included ethnicity, sex, household income, and type of healthcare insurance. Hospital characteristics were urban teaching, urban non-teaching, and rural. Hospital location was classified according to the nine U.S. Census Division regions. Neonatal mortality continues to be higher in Black populations: 21,975 (0.63%) than in White populations: 35,495 (0.28%). Government-supported health insurance was significantly more among Black populations when compared to White (68.8% vs. 35.3% p < 0.001). Household income differed significantly; almost half (49.8%) of the Black population has income ≤ 25th percentile vs. 22.1% in White. There was a significant variation in mortality in different U.S. In the Black population, the highest mortality was in the West North Central division (0.72%), and the lower mortality was in the New England division (0.51%), whereas in the White population, the highest mortality was in the East South-Central division (0.36%), and the lowest mortality was in the New England division (0.21%). Trend analysis showed a significant decrease in mortality in Black and White populations over the years, but when stratifying the population by sex, type of insurance, household income, and type of hospital, the mortality was consistently higher in Black groups throughout the study years. Disparities in neonatal mortality continue to be higher in Black populations; there was a significant variation in mortality in different U.S. In the Black population, the highest mortality was in the West North Central division, and the lower mortality was in the New England division, whereas in the White population, the highest mortality was in the East South Central division, and the lowest mortality was in the New England division. There has been a significant decrease in mortality in Black and White populations over the years, but when stratifying the population by many significant epidemiologic and hospital factors, the mortality was consistently higher in Black groups throughout the study years.

Trauma system establishment and outcome improvement: a retrospective national cohort study in South Korea.

Trauma is a major cause of mortality, disability, and health care costs worldwide. The establishment of a trauma system is known to solve these problems, but few studies have objectively evaluated the impact of a trauma system on outcomes. Since 2012, South Korea has established a national trauma system based on the implementation of 17 regional trauma centers nationwide and the improvement of the prehospital transfer system. This study aimed to measure the changes in performance and outcome according to the established national trauma system. In this national cohort-based, retrospective follow-up observational study, the authors calculated the preventable trauma death rate (PTDR) by conducting a multipanel review of patients who died in 2015, 2017, and 2019. Furthermore, the authors constructed a risk-adjusted mortality prediction model of 4767876 patients between 2015 and 2019 using the extended-International Classification of Disease Injury Severity Scores to compare outcomes. The PTDR was lower in 2019 than in 2015 (15.7 vs. 30.5, P <0.001) and 2017 (15.7 vs. 19.9%, P <0.001) representing 1247 additional lives saved in 2019 compared to that in 2015. In the risk-adjusted model, total trauma mortality was highest in 2015 at 0.56%, followed by that in 2016 and 2017 (0.50%), 2018 (0.51%), and 2019 (0.48%), revealing a significant decrease in mortality over the years ( P <0.001 for trend), representing nearly 800 additional lives saved. The number of deaths for more severe patients with a probability of survival less than 0.25 significantly decreased from 81.50% in 2015 to 66.17% in 2019 ( P <0.001). The authors observed a significant reduction in the PTDR and risk-adjusted trauma mortality in the 5-year follow-up since 2015 when the national trauma system was established. These findings could serve as a model for low-income and middle-income countries, where trauma systems are not yet established.