Significant Decrease In Mortality Research Articles

Magnesium and Potassium Supplementation for Systolic Blood Pressure Reduction in the General Normotensive Population: A Systematic Review and Subgroup Meta-Analysis for Optimal Dosage and Treatment Length

Background/Objectives: Studies have shown that consistent reductions of 2 mm Hg in systolic blood pressure (SBP) for the general normotensive population can result in significant decreases in mortality from heart disease and stroke. The purpose of this meta-analysis was to determine the optimal dose and duration of treatment for magnesium and potassium supplementation, having previously discovered that both reduce SBP by −2.79 and −2.10 mm Hg, respectively. Methods: Placebo-controlled, randomized clinical trials examining the effects of magnesium and potassium supplementation on SBP were identified. Pairwise meta-analyses with subgroups for dosage and treatment duration were run. Results: Magnesium at dosages of ≤360 mg/day and durations greater than 3 months reduced SBP by −3.03 and −4.31 mm Hg, respectively. Potassium at dosages of ≤60 mmol/day and durations greater than 1 month reduced SBP by −2.34 and −2.80 mm Hg, respectively. Conclusions: Both supplements demonstrated greater reductions in SBP for the general population at lower dosages and longer treatment durations. Future studies are needed to validate these findings and provide tailored recommendations. These studies could investigate varying dosages over long-term follow-up to provide robust data on optimal dosages and treatment durations, as our findings were limited due to reliance on previously published trials.

Association between physical activity and mortality in patients with osteoporosis: a cohort study of NHANES.

To determine the impact of physical activity on mortality in osteoporotic patients. A total of 5606 participants were included in this study, including 716 osteoporosis patients. Physical activity was assessed using standardized questionnaire. Participants were categorized into four groups: inactive (no physical activity), low active (physical activity volumes < 150min/week), moderate active (≥ 150min/week but < 300min/week), and high active (≥ 300min/week). Multivariable Cox regression models, using the inactive group as the reference and adjusted for potential confounders, were performed to estimate the hazard ratio (HR) and 95% confidence interval (CI). Osteoporotic patients demonstrated higher mortality rates attributed to various causes compared to non-osteoporosis participants. Physical activity was associated with lower mortality regardless of osteoporosis status. However, Multivariable Cox regression analysis indicated that among osteoporosis patients, only those engaging in ≥ 300min/week physical activity experienced a significant decrease in mortality (all-cause mortality, HR (95% CI) 0.453 (0.268, 0.767) and cardiovascular mortality, HR (95% CI) 0.521 (0.259, 1.049)), surpassing the threshold of 150min observed in non-osteoporosis patients. In sensitivity analysis, or when the proportion of vigorous physical activity was included as a confounder in the multivariate Cox regression analysis, only the high active group still showed a significant reduction in mortality. No significant interactions were observed when the analysis was stratified according to age, sex, and body mass index (P for interaction > 0.05). Restricted cubic spline analysis revealed a linear relationship between physical activity volume and all-cause mortality (P < 0.01 [overall] and P = 0.470 [non-linearity]) and cardiovascular-specific mortality (P = 0.003 [overall] and P = 0.610 [non-linearity]) in patients with osteoporosis. In contrast, these relationships were non-linear in participants without osteoporosis. Patients with osteoporosis need to engage in ≥ 300min/week physical activity to significantly reduce their mortality risk. And the higher the volume of physical activity, the lower the risk of death.

Half-century trend in morbidity, mortality, lethality from acute myocardial infarction in persons aged 25–64 years and the influence on the risk of developing acute myocardial infarction of psychosocial factors in conditions in Russia / Siberia from the perspective of the WHO international programs Register of Acute Myocardial Infarction, MONICA

Purpose of the study: To establish over half a century (1977–2022) trends in morbidity, mortality, mortality from acute myocardial infarction (AMI) in people aged 25–64 years and the influence of psychosocial factors (PSF) on the risk of developing AMI in Russia/Siberia with positions of the international programs of the World Health Organization (WHO) Register of Acute Myocardial Infarction (RAMI), MONICA.Material and methods. The study under the “RАMI” program began on 01/01/1977 in Oktyabrsky, and on 01/01/1981 – in the Leninsky and Kirovsky districts of Novosibirsk among people aged 25–64. In these same areas, since 1983, Institute of internal and preventive medicine, as a WHO center, has been implementing the MONICA program. Differences in AMI case-finding programs have not been identified. Both programs continue to operate to this day. All cases of acute MI for the entire study period were coded as ST-segment elevation myocardial infarction (STEMI) or non-ST-segment elevation myocardial infarction (NSTEMI). For prehospital deaths, the variable “died outpatients from AMI (DOPAMI)” was introduced. Random representative samples of people aged 25–64 years (n = 4800) were examined in the Oktyabrsky district at standard epidemiological screenings (1984, 1988, 1994), where trait anxiety (A) was studied using the Spielberger test (the presence of levels of population stress); Social support was determined using the Berkman – Syme test. To determine the risk of developing AMI depending on HR for 20 years, all new cases of AMI were recorded in the studied sample of three screenings that did not have CVD at the time of examination. Statistical analysis was performed using the free software computing environment R (v.3.6.3).Results. The incidence of AMI per 1000 residents of people aged 25–64 years in Russia/Siberia, according to international AMI programs, MONICA, is one of the highest in the world and is relatively stable throughout the entire half-century observation period, with the exception of some years of growth due to socio-economic instability in society, and is twice as high as Rosstat data. Mortality per 100,000 inhabitants from AMI resembles the dynamics of incidence, with the exception of 1977–1978 – a decrease. For the first time, in our study, a significant decrease in mortality and mortality of patients with AMI in 1978 compared to 1977 was obtained due to a decrease in inpatient mortality and mortality as a result of work under the WHO AMI program. For the first time, in our study, the cause of death in excess of the population in Russia was determined in the period 1988, 1993–1994, 1998 – these are acute cardiovascular diseases, not alcohol consumption. Prehospital mortality and mortality prevail throughout all years of observation and are 2–3 times higher than in-hospital mortality and are based on sudden death. Mortality, like morbidity, for RАMI is 2 times higher than according to official statistics. For the first time, our study showed that the increase in morbidity and mortality from AMI in Russia is associated with psychosocial factors.Conclusions. It has been established that the morbidity, mortality and mortality rates of the population from AMI in Russia/Siberia are one of the highest in the world and are relatively stable throughout the entire half-century observation period, with the exception of some years of growth due to socioeconomic instability in society. Prehospital mortality and mortality prevail throughout all years of observation and are 2–3 times higher than hospital mortality. Indicators of morbidity, mortality and lethality of the population from AMI, when increasing, are the main markers of increasing social stress in the population.

Angiotensin 1-7 – a peptide that increases the resistance of the heart to ischemia and reperfusion: narrative review

Background. The high mortality rate among patients with acute myocardial infarction (AMI) is an important problem of modern cardiology. In recent years, there has not been a significant decrease in mortality in AMI. Drugs used to treat AMI are not effective enough, so there is a need to develop fundamentally new drugs that can significantly increase the heart’s tolerance to ischemia/reperfusion (I/R). Angiotensin 1-7 peptide, which can increase cardiac tolerance to I/R by activating Mas receptor in myocardial tissue, could become a prototype of such drugs. The following enzymes are involved in the formation of the cardioprotective effect of angiotensin 1-7: NO-synthase, soluble guanylyl cyclase, phosphoinositide 3-kinase, extracellular signal-regulated kinases-1/2, Akt kinase and, possibly, protein kinase G. Indirect data indicate that the hypothetical end effector in the cardioprotective impact of angiotensin 1-7 could be mitochondrial or sarcolemmal ATP-sensitive K+ channel.Aim: To review 1-7 role in increasing the heart resistance to ischemia and reperfusion. The literature search was carried out in the PubMed database with queries “angiotensin 1-7 receptors”, “stress”, “angiotensin 1-7”, “mas receptor”, “cardioprotective effects of angiotensin 1-7”.

Increased Reaction Vessel Surface Area Decreases the Overall Mortality Rate of Rana catesbeiana Larvae during Chemically Induced Metamorphosis

Stimulating precocious metamorphosis in anuran larvae is an important pedagogical tool for understanding vertebrate development. However, historically, artificially provoking metamorphosis by immersing tadpoles in exogenous inducing agents (e.g., thyroxine, and iodine) compromises the longevity of the experimental animals, resulting in up to 100% mortality within a week. In our undergraduate teaching lab, we house our experimental tadpoles in circular glass dishes having a surface area of 182 cm2. Over the past four academic years this lab was performed, we observed 100% mortality of experimental animals within 10, 12, or 15 days when treated with 10-5 M, 10-6 M, or 10-7 M thyroxine, respectively. Here, we investigated whether increasing the surface area to 413 cm2 using square glass dishes would reduce the mortality of the treated animals. Omnibus Kaplan-Meier survival analysis demonstrates a statistically significant decrease in mortality in tadpoles reared in the larger square dishes compared to those housed in the smaller round dishes (P &lt; 0.05). However, increasing the surface area of our reaction vessels could not rescue survivability of those tadpoles immersed in thyroxine, but did increase survivability of control tadpoles maintained in pond water (P &lt; 0.01), tadpoles subjected to iodine (P &lt; 0.05) or treated with actinomycin D (P &lt; 0.05). These data demonstrate that increasing available reaction vessel surface area reduces overall tadpole mortality during chemically modified metamorphosis in an undergraduate teaching lab setting.

Temporal patterns in adolescent psychiatric treatment and outcomes: a nationwide register-based cohort follow-up.

The rise in mental health problems among adolescents in high-income countries presents a challenge to service systems. For the development of services, there is a need for better insight into temporal psychiatric treatment-trends and outcomes. This study aims to analyze time-trends in both psychiatric treatment patterns and outcomes, utilizing a national sample of all adolescents receiving psychiatric treatment in Finland from 2003 to 2013. For time-trend-analysis, the sample was divided into two cohorts, using the onset year of 2008 as a cutoff. For each case, information on psychiatric treatment was gathered from registers within a five-year follow-up period from the onset of treatment or to death. The association between the inclusion year and outcome variables was studied via weighted generalized linear models. Adolescents in the latter cohort had a greater proportion (p < 0.001) of mood and anxiety diagnoses, a lower likelihood of hospitalization, a higher average of outpatient visits, and greater usage of psychotropics (excluding benzodiazepines). Those whose treatment began after 2008 were more likely to be alive (baseline characteristic adjusted Odds Ratio (aOR): 0.7, 95%CI: 0.6-0.8) and still in treatment contact (aOR: 1.4, 95%CI: 1.3-1.4) after four years from the onset. There was no difference in the long-term disability ratio. The results indicate favorable developments towards outpatient care in mental health services for adolescents with a significant decrease in mortality. Approaches to further developing cost-effective, personalized mental health services are discussed.

Reducing Capillary Leak Syndrome Mortality in Extremely Premature Infants: A Pilot Investigation.

Neonatal capillary leak syndrome (CLS) is a rare, but life-threatening condition following neonatal sepsis or inflammatory injury. The objective of this study was to describe a standardized treatment approach for CLS that improves mortality and neonatal outcomes. A retrospective cohort study of 10 infants born at 22 to 26 weeks of gestation who developed CLS following a significant inflammatory insult was performed. Time to diagnosis and treatment approaches over 2 epochs were recorded and described. In epoch 2, with increased clinical awareness of CLS and implementation of a standardized treatment approach, there was a non-statistically significant decrease in the time to treatment with a significant decrease in mortality. An early targeted treatment approach for neonatal CLS can decrease mortality rates in this highly morbid condition.

Comparative Efficacy of Inhaled and Intravenous Corticosteroids in Managing COVID-19-Related Acute Respiratory Distress Syndrome.

Acute respiratory distress syndrome (ARDS) is a life-threatening condition in which the lungs fail to provide sufficient oxygen to the body's vital organs. It is commonly associated with COVID-19 patients. Severe cases of COVID-19 can lead to lung damage and organ failure due to an immune response in the body. To mitigate these effects, corticosteroids, which are known for their anti-inflammatory properties, have been suggested as a potential treatment option. The primary focus of this study was to assess the impact of various corticosteroid administration methods on the outcomes of patients with COVID-19. Methods: The current study was conducted on COVID-19 patients divided into three groups. The first group was administered 6 mg of intravenous (IV) dexamethasone; the second group received 1 mg/kg of IV methylprednisolone (methylprednisolone); and the third group received budesonide respirable solution at a dosage of 1mg twice daily. The neubilizer used was a vibrating mesh nebulizer (VMN). All patients received standard care. We found that dexamethasone administered intravenously led to a significant reduction in C-reactive protein levels, surpassing the effectiveness of both IV methylprednisolone and inhaled budesonide. Oxygen saturation without mask change over time showed statistically significant differences (p = 0.004) in favor of the budesonide and dexamethasone groups for all days. Individuals who received methylprednisolone showed a significant decrease in mortality rate and an extended survival duration, with statistical significance observed at p = 0.024. The rest of the parameters, including ferritin, lymphocytes, total leukocyte count, platelets, hemoglobin, urea, serum potassium, serum sodium, serum creatinine, serum glutamic-pyruvic transaminase, serum glutamic-oxaloacetic transaminase, uric acid, albumin, globulin, erythrocyte sedimentation rate, international normalized ratio, oxygen saturation with flow, and oxygen flow, showed no statistically significant differences between the three drugs. In conclusion, treatment with IV methylprednisolone (1 mg/kg) resulted in a shorter hospital stay, decreased reliance on ventilation, and improved health outcomes for COVID-19 patients compared to using dexamethasone at a daily dosage of 6 mg or budesonide respirable solution at a dosage of 1mg twice daily.

COST-ANALYSIS OF REDUCING MORTALITY RATE FOR LBW BABIES AT FATMAWATI HOSPITAL'S NICU

Background: As a developing country that still struggles with infant mortality, Indonesia needs high-quality and efficient neonatal care. However, due to the complexity of neonatal care, the neonatal intensive care unit (NICU) still has a high cost, approximately USD 950 - 31,000, as the last line of care. Aims: This study analyzes the cost incurred due to service improvement at Fatmawati General Hospital. The cost analysis may serve as useful evidence for other hospitals with NICUs that seek to improve their service. Methods: We used cost analysis to examine pre-intervention costs in 2015 and post-intervention costs in 2021. Our data were gathered primarily in the NICU of Fatmawati General Hospital for three months in 2023. Results: The results showed an increase in total cost of IDR 1,898,040,489 (55%). The largest cost increase was personnel and supplies costs, which accounted for 83.8% of the cost increase. However, this cost increase was also followed by a significant decrease in mortality rates, from 128 deaths per 1,000 births to 17 deaths per 1,000 births. Conclusion: This study found a correlation between investment in service improvements and decreased infant mortality rates in the NICU of Fatmawati General Hospital. Although the 55% increase in total cost was associated with a significant decrease in infant mortality rates in the NICU of Fatmawati General Hospital, further studies are needed to determine the effectiveness of improvements in the NICU's services. Keywords: cost, Indonesia, LBW, NICU

Establishing delivery route-dependent safety and efficacy of living biodrug mesenchymal stem cells in heart failure patients.

Mesenchymal stem cells (MSCs) as living biopharmaceuticals with unique properties, i.e., stemness, viability, phenotypes, paracrine activity, etc., need to be administered such that they reach the target site, maintaining these properties unchanged and are retained at the injury site to participate in the repair process. Route of delivery (RoD) remains one of the critical determinants of safety and efficacy. This study elucidates the safety and effectiveness of different RoDs of MSC treatment in heart failure (HF) based on phase II randomized clinical trials (RCTs). We hypothesize that the RoD modulates the safety and efficacy of MSC-based therapy and determines the outcome of the intervention. To investigate the effect of RoD of MSCs on safety and efficacy in HF patients. RCTs were retrieved from six databases. Safety endpoints included mortality and serious adverse events (SAEs), while efficacy outcomes encompassed changes in left ventricular ejection fraction (LVEF), 6-minute walk distance (6MWD), and pro-B-type natriuretic peptide (pro-BNP). Subgroup analyses on RoD were performed for all study endpoints. Twelve RCTs were included. Overall, MSC therapy demonstrated a significant decrease in mortality [relative risk (RR): 0.55, 95% confidence interval (95%CI): 0.33-0.92, P = 0.02] compared to control, while SAE outcomes showed no significant difference (RR: 0.84, 95%CI: 0.66-1.05, P = 0.11). RoD subgroup analysis revealed a significant difference in SAE among the transendocardial (TESI) injection subgroup (RR = 0.71, 95%CI: 0.54-0.95, P = 0.04). The pooled weighted mean difference (WMD) demonstrated an overall significant improvement of LVEF by 2.44% (WMD: 2.44%, 95%CI: 0.80-4.29, P value ≤ 0.001), with only intracoronary (IC) subgroup showing significant improvement (WMD: 7.26%, 95%CI: 5.61-8.92, P ≤ 0.001). Furthermore, the IC delivery route significantly improved 6MWD by 115 m (WMD = 114.99 m, 95%CI: 91.48-138.50), respectively. In biochemical efficacy outcomes, only the IC subgroup showed a significant reduction in pro-BNP by -860.64 pg/mL (WMD: -860.64 pg/Ml, 95%CI: -944.02 to -777.26, P = 0.001). Our study concluded that all delivery methods of MSC-based therapy are safe. Despite the overall benefits in efficacy, the TESI and IC routes provided better outcomes than other methods. Larger-scale trials are warranted before implementing MSC-based therapy in routine clinical practice.

Role of Melatonin in Management of COVID-19: A Systematic Review

Background: the COVID-19 pandemic has significantly impacted global healthcare and economic systems. The clinical manifestation of the disease varies from flu-like symptoms to severe pneumonia and, in some cases, death. Melatonin and its metabolites play a crucial role in immunomodulation and possess anti-oxidative properties, capable of directly and indirectly scavenging reactive oxygen species. Objective: the aim of the present systematic review was to assess the effectiveness of melatonin in the management of COVID-19 patients and its role in expediting the return of patients to their baseline health. Methodology: the literature review was conducted up to August 2022, resulting in the identification of 533 articles after sorting them by authors and year of publication. Following the removal of 223 duplicate articles, 310 abstracts were screened, leading to the exclusion of 281. Subsequently, 29 full-text studies were evaluated for eligibility, with 22 being excluded. Finally, seven studies met the inclusion criteria and were included for further qualitative and quantitative analyses. Results: the findings revealed a noteworthy reduction in hospital stay among patients who received melatonin compared to those who received a placebo (standardized mean difference: -0.50, Standard error: 0.15, 95% CI: -0.80, -0.20, P value: 0.001). Melatonin was associated with a significant decrease in mortality in COVID-19 patients when compared to the placebo (Pooled RR: 0.21, 95% CI: 0.08, 0.56, P value: 0.002). However, there were no significant differences between melatonin and placebo regarding the need for hospitalization, ICU admission, artificial ventilation, and the requirement for oxygen therapy. Conclusion: melatonin may decrease the mortality rate among patients with COVID-19. Melatonin may reduce the duration of hospital stay in patients with COVID-19. Melatonin had no effect on the following outcomes in COVID-19 patients: the need for hospitalization, ICU admission, artificial ventilation and the need for oxygen therapy.

An overview of the treatments for hypertrophic cardiomyopathy.

Hypertrophic cardiomyopathy (HCM) is a very prevalent inherited disease with a wide global distribution and a prevalence rate of approximately 0.2% in the general population. Left ventricular hypertrophy (LVH) caused by sarcomere mutation is the primary reason of HCM. The histopathology feature is that cardiomyocyte hypertrophy, myocyte disorder and myocardial fibrosis lead to diminished diastolic function, left ventricular outflow tract obstruction (LVOTO) and arrhythmia, all of which result in serious cardiac complications. Previously, HCM was considered a malignant disease that was almost untreatable. With the improvement of medical standards and increasing awareness of HCM, it has become a highly treatable disease in contemporary times, with a significant decrease in mortality rates. However, there are still significant unmet requirements in the therapy of HCM. This paper draws on more than 100 references from the past four decades and summarizes current advances in the treatment of HCM. The article will review the pathogenesis and types, recent development in pharmacotherapy, invasive treatments and gene therapies, as well as dilemma and future development of HCM.

Impact of hormone replacement therapy on all-cause and cancer-specific mortality in colorectal cancer: A systematic review and dose‒response meta-analysis of observational studies.

The effect of hormone replacement therapy (HRT) on colorectal cancer (CRC) mortality and all-cause mortality remains unclear. We conducted a systematic review and dose-response meta-analysis to determine the effects of HRT on CRC mortality and all-cause mortality. We searched the electronic databases of PubMed, Embase, and The Cochrane Library for all relevant studies published until January 2024 to investigate the effects of HRT exposure on survival rates for patients with CRC. Two reviewers independently extracted individual study data and evaluated the risk of bias between the studies using the Newcastle‒Ottawa Scale. We performed a two-stage random-effects dose-response meta-analysis to examine a possible nonlinear relationship between the year of HRT use and CRC mortality. Ten cohort studies with 480,628 individuals were included. HRT was inversely associated with the risk of CRC mortality (hazard ratios (HR)=0.77, 95% CI (0.68, 0.87), I2=69.5%, p<0.05). The pooled results of seven cohort studies revealed a significant association between HRT and the risk of all-cause mortality (HR=0.71, 95% CI (0.54, 0.92), I2=89.6%, p<0.05). A linear dose-response analysis (p for nonlinearity=0.34) showed a 3% decrease in the risk of CRC for each additional year of HRT use; this decrease was significant (HR=0.97, 95% CI (0.94, 0.99), p<0.05). An additional linear (p for nonlinearity=0.88) dose-response analysis showed a nonsignificant decrease in the risk of all-cause mortality for each additional year of HRT use. This study suggests that the use of HRT is inversely associated with all-cause and colorectal cancer mortality, thus causing a significant decrease in mortality rates over time. More studies are warranted to confirm this association.

Nanoantibiotics: A Tool Against Antimicrobial Resistance

Antimicrobial Resistance (AMR), is one of the biggest emerging threats to human health and healthcare systems. Experts are suggesting that the post-antibiotic era, in which microbial infections and minor injuries will again become fatal, is near. A report published by the Antibiotics Resistance Collaborators, in the Lancet,reported that 1.27 million people died due to antibiotic-resistant bacterial infections in 2019.1 Deaths could reach 10 million by 2050 if the problem is not addressed. Antimicrobial resistance arises as a natural adaptation of microorganisms to environmental challenges. One typical self-defense mechanism is by producing enzymes that inactivate antimicrobial agents. Bacteria can also become resistant to β-lactams by producing β-lactamase, and by altering binding sites for antimicrobials agents (resistance to glycopeptide antibiotic agents), expressing multidrug efflux pumps such as tigecycline resistance to Acinetobacter baumannii, and limiting cell permeability for antibiotics such as Acinetobacter baumannii and pseudomonas aeruginosa.2,3th In the early 20 century, infectious diseases were the major cause of death. The advent of antibiotics led to a significant decrease in mortality.4 However, antibiotics resistance has now reached a threshold that is invalidating commonly used antibiotic agents. Currently the attempts to manage microbial resistance to antibiotics include the development of novel antimicrobial agents. However, there is no guarantee that the introduced new antimicrobial agents would be able to cope with the microbial resistance effectively andefficiently.5 Apart from developing new antibiotics, the chemical modification of existing antimicrobial agents is emerging as an upcoming strategy to combat antimicrobial resistance.4-6 Research on the effect of antibiotic associated nanoparticles on bacterial function is being conducted with the hope that advances in nanotechnology will lead to strategies for reconfiguration of presently available antibiotic molecules.Several nanomaterials have been identified as alternates for combating antimicrobial resistant strains. Each metallic and ceramic nanomaterials and more specifically their nanoparticles have their own peculiar antimicrobial properties. Studies have reported that these nanoparticles can be surface-functionalized withantimicrobial agents or molecules to further enhance their antimicrobial efficacy.6 Engineering antibiotics into nanoscale or functionalizing nanoparticles with antibiotic agents allows them to penetrate microbial cells and reach their target sites with precision and accuracy. Studies have shown that in contrast to free antibiotics, tailored functionalized nanoparticles and small antibiotic molecules have improved binding affinities andtarget specificity.6 Currently, these nanotechnology-based solutions have reported some problems like cytotoxicity, targeted selectivity, and bulk production. However, with concrete planning and a cohesive approach from academia, industry, and government, the development of nanoantibiotics drugs of unique shapes and sizes, high surface areas, ability to carry antibiotic drugs to target sites, and protein disruption will help overcome antimicrobial resistance. Editor-in-Chief How to cite this: Alamgir W, Adnan H. Nanoantibiotics: A Tool Against Antimicrobial Resistance. Life and Science. 2024; 5(2): 130-131. doi: http://doi.org/10.37185/LnS.1.1.657

Impact of Cardiac Pacemaker Implantation in Patients With Acute Traumatic Cervical Spinal Cord Injury.

Cardiac pacemaker implantation may be indicated in patients with refractory bradycardia following a cervical spinal cord injury (CSCI). However, evidence about the impact of this procedure on outcomes is lacking. We planned a study to assess whether the implantation of a pacemaker would decrease mortality and hospital resource utilization in patients with CSCI. Adult patients with CSCI in the Trauma Quality Improvement Program (TQIP) database between 2016 and 2019 were retrospectively analyzed. Patients were divided into "pacemaker" and "non-pacemaker" groups, and their baseline characteristics and clinical outcomes were analyzed. A total of 6774 cases were analyzed. The pacemaker group showed higher in-hospital rates of cardiac arrest, myocardial infarction, and longer duration of mechanical ventilation and ICU stay than the non-pacemaker group. Nevertheless, pacemaker placement was associated with a significant decrease in mortality (4.2% vs 26.0%, P < .01). Patients with CSCI requiring a pacemaker placement had better survival than those treated without a pacemaker. Pacemaker implantation should be highly considered in patients who develop refractory bradycardia after CSCI.

Temporal Analysis in Outcomes of Long-Term Mechanical Circulatory Support: Retrospective Study.

Mechanical assist device indications have changed in recent years. Reduced incidence of complications, better survival, and the third generation of mechanical support devices contributed to this change. In this single-center study, we focused on two time periods that are characterized by the use of different types of mechanical support devices, different patient characteristics, and change in the indications. The data were processed from the European Registry for Patients with Mechanical Circulatory Support (EUROMACS). We retrospectively defined two time intervals to reflect changes in ventricular assist device technology (period 1: 2007-2015; period 2: 2016-20222). A total of 181 patients underwent left ventricular assist device implantation. Device utilization was the following: HeartMate II = 52 (76.4%) and HeartWare = 16 (23.6%) in period 1 and HeartMate II = 2 (1.8%), HeartMate 3 = 70 (61:9%), HeartWare = 29 (25.7%), SynCardia TAH = 10 (8.8%), and BerlinHeart EXCOR = 2 (1.8%) in period 2. The outcomes of the time intervals were analyzed and evaluated. Survival was significantly higher during the second time period. Multivariate analysis revealed that age and bypass pump time are independent predictors of mortality. Idiopathic cardiomyopathy, bypass time, and the Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) score are independent predictors of adverse events. Furthermore, the first period was noted to be at an increased risk of the following adverse events: pump thrombosis, gastrointestinal bleeding, and bleeding events. Despite the higher risk profile of the patients and persistent challenges, during the second period, there was a significant decrease in mortality and morbidity. The use of the HeartMate 3 device may have contributed to this result.

436 Use of Ventriculostomy for Severe Traumatic Brain Injury Is Associated With Reduced Mortality Compared to Intraparenchymal Monitor Use: A Propensity Score-Matched Analysis

INTRODUCTION: There is a lack of data on whether intracranial pressure (ICP)-guided therapy with an intraparenchymal fiberoptic monitor (IPM) or an external ventricular drain (EVD) leads to superior mortality outcomes. METHODS: Retrospective analysis of patients with severe TBI that required IPM or EVD placement for ICP-guided therapy from 1/1/2010-12/31/2020. The data was obtained from the Pennsylvania Trauma Systems Foundation (PTSF) registry. RESULTS: A total of 2,305 patients met the inclusion criteria with 1,048 (45.5%) IPM and 1,257 (54.5%) EVD placed. A craniectomy was performed in 47.0% of the patients in the IPM cohort and 66.0% of the EVD cohort (p &lt; 0.001). Multivariable logistic regression analysis showed that older age (OR 1.03, p &lt; 0.001), decreasing GCS score (OR 1.16, p &lt; 0.001), requiring craniectomy (OR 1.22, p = 0.049), and an IPM (OR 1.40, p = 0.001) were significant predictors of mortality. A propensity score-matched analysis was performed, adjusting the cohorts for age, gender, race, GCS, ISS, and craniotomy. EVD use is associated with a significant 28% decrease in inpatient mortality when compared to IPM (OR 0.72, p &lt; 0.001). Hospital length of stay was also significantly shorter in the EVD cohort (OR 0.86, p = 0.03). CONCLUSIONS: A significant decrease in mortality was associated with the use of EVD in comparison to IPM based on our propensity score-matched analysis. Further investigation.

Clinical impact and cost-consequence analysis of ePlex® blood culture identification panels for the rapid diagnosis of bloodstream infections: a single-center randomized controlled trial

PurposeTo assess clinical impact and perform cost-consequence analysis of the broadest multiplex PCR panels available for the rapid diagnosis of bloodstream infections (BSI).MethodsSingle-center, randomized controlled trial conducted from June 2019 to February 2021 at a French University hospital with an institutional antimicrobial stewardship program. Primary endpoint was the percentage of patients with optimized antimicrobial treatment 12 h after transmission of positivity and Gram stain results from the first positive BC.ResultsThis percentage was significantly higher in the multiplex PCR (mPCR) group (90/105 = 85.7% %, CI95% [77.5 ; 91.8] vs. 68/107 = 63.6%, CI95% [53.7 ; 72.6]; p < 10− 3) at interim analysis, resulting in the early termination of the study after the inclusion of 309 patients. For patients not optimized at baseline, the median time to obtain an optimized therapy was much shorter in the mPCR group than in the control group (6.9 h, IQR [2.9; 17.8] vs. 26.4 h, IQR [3.4; 47.5]; p = 0.001). Early optimization of antibiotic therapy resulted in a non-statistically significant decrease in mortality from 12.4 to 8.8% (p = 0.306), with a trend towards a shorter median length of stay (18 vs. 20 days; p = 0.064) and a non-significant reduction in the average cost per patient of €3,065 (p = 0.15). mPCR identified all the bacteria present in 88% of the samples.ConclusionDespite its higher laboratory cost, the use of multiplex PCR for BSI diagnosis leads to early-optimised therapy, seems cost-effective and could reduce mortality and length of stay. Their impact could probably be improved if implemented 24/7.

The effect of locally extracted and imported aloe vera oil on some productive traits of broilers

The study was conducted at a poultry field, Agricultural Research and Experiment Station at the College of Agriculture, Al-Muthanna University, to determine the effect of locally extracted and imported aloe vera oil on some productive traits of broilers, different levels of oil extracted from the leaves of the aloe vera plant were used, from 22/2/2022 to 29/3/2022. A total of 405 unsexed, one-day-old chicks of Ross 308 broiler were used; chicks were randomly distributed to nine treatments with three replicates for each, 45 chicks per treatment (15 chicks for each replicate), the treatments were followed; T1: without any addition, as for the treatments T2, T3, T4 and T5, they were local aloe vera oil and the treatments T7, T6, T8 and T9, they were imported aloe vera oil, the addition of oil was at the levels 0.3 and 0.4 per kg feed. The results of the experiment indicated a significant improvement in some productive traits, including Body Weight (BW), Weight Gain (WG), Feed Intake (FI) and Feed Conversion (FC), with a significant decrease in mortality for all treatments of locally extracted and imported oil compared to the control treatment, the treatments of the oil extracted locally showed the best results in a significant way compared to the rest of the treatments of the imported oil of the aloe vera plant. Keywords: Locally extracted, imported, aloe vera oil, productive traits, broilers.

The effect of locally extracted and imported aloe vera oil on some productive traits of broilers

The study was conducted at a poultry field, Agricultural Research and Experiment Station at the College of Agriculture, Al-Muthanna University, to determine the effect of locally extracted and imported aloe vera oil on some productive traits of broilers, different levels of oil extracted from the leaves of the aloe vera plant were used, from 22/2/2022 to 29/3/2022. A total of 405 unsexed, one-day-old chicks of Ross 308 broiler were used; chicks were randomly distributed to nine treatments with three replicates for each, 45 chicks per treatment (15 chicks for each replicate), the treatments were followed; T1: without any addition, as for the treatments T2, T3, T4 and T5, they were local aloe vera oil and the treatments T7, T6, T8 and T9, they were imported aloe vera oil, the addition of oil was at the levels 0.3 and 0.4 per kg feed. The results of the experiment indicated a significant improvement in some productive traits, including Body Weight (BW), Weight Gain (WG), Feed Intake (FI) and Feed Conversion (FC), with a significant decrease in mortality for all treatments of locally extracted and imported oil compared to the control treatment, the treatments of the oil extracted locally showed the best results in a significant way compared to the rest of the treatments of the imported oil of the aloe vera plant. Keywords: Locally extracted, imported, aloe vera oil, productive traits, broilers.