Significant Increase In Deaths Research Articles

Resuscitation Decisions for Extremely Premature Infants: A UK NICU Experience

Background: Improvements in extreme preterm infant outcomes have led to an increasing recognition of the importance of antenatal optimization and delivery room (DR) management strategies for these infants. Methods: Retrospective cohort evaluation of every infant born at 22+0 to 25+6 weeks gestation in St Mary’s tertiary NICU between 2008 and 2018. Aiming to evaluate utilization of chest compressions and resuscitation medications during DR-resuscitation of extremely premature infants. Results: This study found that 90% of infants 22+0 to 22+6 weeks did not receive antenatal steroids. Whereas, for infants born between 23+0 and 23+6 weeks gestation, 75% did receive antenatal steroids. This difference is significant ( P value = .00006). This study shows there is a predisposition to not provide DR-chest compressions (DR-CC) and/or adrenaline (DR-CC+/−A) to extremely preterm For infants that received DR-CC, there was no statistically significant increase in death and no clear association with poorer long-term outcomes in survivors. Conclusions: Marked differences in provision of perinatal care were found dependent on gestational age. If infants are inadequately prepared for delivery and resuscitative measures are not fully utilized, it cannot be clear whether subsequently increased rates of death in the lower gestational age groups are solely due to gestational age or are influenced by the lack of preparative management.

Effectiveness of education using ha-man module on self-efficacy of adults in preventing coronary heart disease

Every year, there is a significant increase in deaths caused by coronary heart disease (CHD). Many programs have been implemented to reduce the morbidity and mortality of CHD. Early detection and control of CHD risk factors is a challenge in educating adults about lifestyle changes. Also, it is recognized that self-efficacy is a vital factor in initiating and maintaining healthy behaviors. Health education is given as an effort to increase self-efficacy, but educational media that are innovative in promoting CHD health are limited. This study aimed to determine differences in the self-efficacy of adults in preventing coronary heart disease before and after given health education. This was a quasi-experimental study with a pretest-posttest control group design. The sample were 60 respondents which were grouped into 30 respondents in the intervention group and control group through purposive sampling. The HA-Man education intervention was given 3 times for a-week, self-efficacy was evaluated through a structured questionnaire interview. The results showed that there were differences in self-efficacy before and after intervention in the intervention group (p <0.05). This research is expected to provide information in the development of educational media in increasing awareness and self-efficacy of people who are at risk of CHD

Abstract 12811: Dual Antiplatelet Therapy Duration and Long-Term Risks of Adverse Outcomes After Percutaneous Coronary Intervention With Second-Generation Drug-Eluting Stents

Introduction: Randomized trials show that short dual antiplatelet (DAPT) regimens have similar adverse events to longer regimens in patients treated by percutaneous coronary intervention (PCI) using second-generation drug-eluting stents (DES2). However, these studies are underpowered for death. Hypothesis: After PCI with DES2, patients discontinuing DAPT before six months had higher risks of adverse ischemic outcomes than patients continuing DAPT for longer durations. Methods: We assessed adverse outcomes in patients having PCI between 2008-2016 in the Veterans Affairs Clinical Assessment Report and Tracking (CART) database. DAPT use was determined from the VA Pharmacy database. Outcomes after PCI were all-cause death (from the VA death index), and myocardial infarction, recurrent coronary revascularization, and major bleeding from ICD 9, ICD 10 and CPT codes in VA and Medicare/Medicaid records. Hazard ratios (HR) and 95% confidence intervals (95%CI) from Cox proportional hazards models weighted with a stabilized inverse probability of treatment weight were used to assess the risk of outcomes from stopping DAPT in 4 time intervals after PCI (1-5, 6-9, 10-12, and 13-18 months). Results: After exclusions, there were 40,871 PCIs with DES2 during the study period. Outcomes were followed for an average of 4.6 years. Compared to continuing DAPT, the risks for death were significantly higher for stopping DAPT 1-5 months after PCI (HR=2.04, 95%CI=1.82, 2.29) and stopping DAPT 6-9 months after PCI (HR=2.2, 95%CI=1.98, 2.44). There was no significant increase in death from stopping DAPT more than 10 months after PCI. Stopping DAPT 10 or more months after the index PCI associated with lower rates of myocardial infarction (HR=0.74, 95%CI=0.68, 0.81) and major bleeding (HR=0.81, 95%CI 0.73, 0.91), and lower repeat revascularization at all time periods. There was no interaction of effects with acute coronary syndrome at index PCI. Conclusion: Among Veterans having PCI with DES2, stopping DAPT less than 10 months after PCI was associated with a higher risk of death but no increased risk in myocardial infarction or major bleeding. Short DAPT regimens after PCI may increase the risk of death. Clinical trials of short DAPT duration should powered to assess this endpoint.

Reproductive health crisis during waves one and two of the COVID-19 pandemic in India: Incidence and deaths from severe maternal complications in more than 202,000 hospital births.

BackgroundThe SARS-CoV-2 pandemic in India has adversely affected many aspects of population health. We need detailed evidence of the impact on reproductive health in India so that lessons can be learnt.MethodsHospital-based repeated monthly survey of nine severe maternal complications and death in 15 hospitals across five states in India covering a total of 202,986 hospital births, December-2018 through to May-2021. We calculated incidence rates (with 95% confidence intervals (CIs)) per 1000 hospital births, case-fatality and rate ratios (RR) with 95% CIs. Linear regression was used to examine the association between the Government Response Stringency Index (GRSI) for India and changes in hospital births, incidence and case-fatality.FindingsThere was a significant decrease in hospital births per month during the pandemic period with a 4.8% decrease per 10% increase in the GRSI scores (p < 0.001). The overall incidence of severe complications in the pandemic period was not significantly different from the pre-pandemic period, but hospital admissions from septic abortion was 56% higher (RR=1.56; 95% CI=1.22–1.99; p < 0.001). The overall case-fatality of complications increased by 23% (RR=1.23; 95% CI=1.03–1.46; p = 0.022) and remained high across the different phases of the pandemic with a notable significant increase in deaths from heart failure in pregnancy.InterpretationOur study supports the legitimacy of the calls made to maintain sexual and reproductive health services as essential services during the pandemic. Lessons learnt should be used to avert the ongoing reproductive health crisis while India plans to manage a third wave of the pandemic.FundingThe MaatHRI platform and this study are funded by a Medical Research Council Career Development Award to MN (Ref:MR/P022030/1). The funder has no role in the study design, data collection, analysis, or writing the paper

Improving End-of-Life Care for People with Dementia in LTC Homes During the COVID-19 Pandemic and Beyond.

COVID-19 pandemic has resulted in a significant increase in deaths in long-term care homes (LTCH). People with dementia living in LTCHs represent one of the most frail and marginalized populations in Canada. The surge of COVID-19 cases in LTCHs and rationing of health-care resources during the pandemic have amplified the pre-existing need for improvements in palliative and end-of-life care in LTCHs. This position statement, created by a task force commissioned by the Alzheimer Society of Canada, provides recommendations for a multipronged coordinated approach to improving palliative and end-of-life care of people with dementia living in LTCHs during the COVID-19 pandemic and beyond.

The Mental Well-Being of Health Care Workers during the Peak of the COVID-19 Pandemic-A Nationwide Study in Poland.

Introduction: The current epidemiological situation has quickly led to several changes in the daily functioning of people around the world, especially among medical personnel, who in this difficult period were burdened with new professional duties, which significantly affects their mental health. Materials: This study aims to assess the mental health of health professionals at a critical point in their workload, to compare the results with those the general population, and to explore the potential determinants affecting it. The CAWI survey includes a sociodemographic section, work experience and a standardised psychometric tool (GHQ-28). Data were collected during the second wave of the COVID-19 pandemic in Poland (3–29 November 2020), which had the highest mortality rates and SARS-CoV-2 morbidity rates, as well as during the period of a significant increase in deaths, compared to the corresponding pre-pandemic period. Results: A total of 2150 surveys were eligible for analysis. Among them, 848 (39.4%) were active health professionals. In the analysis of the scores of the GHQ-28 scale and its sub-scales, evaluating anxiety/insomnia and somatic symptoms, medical workers scored significantly higher scores than non-medical professions (p < 0.001). Frontline medical workers (p < 0.001) and those who were forcibly seconded to work with COVID-19-infected patients (p = 0.011) achieved significantly higher GHQ-28 scores. Conclusions: The COVID-19 pandemic has had a significant impact on mental deterioration among health professionals, especially among those directly working with SARS-CoV-2-infected patients and those who were forcibly seconded to work with such patients. To mitigate the effects of the pandemic, appropriate psychological care for medical personnel needs to be implemented.

Left Ventricular Assist Devices in Patients With Active Malignancies

BackgroundThere are limited data to guide oncology and cardiology decision-making in patients with a left ventricular assist device (LVAD) and concurrent active malignancy. ObjectivesThe goal of this study was to describe cancer treatment approaches, complications, and survival among patients with active cancer on LVAD support in 2 tertiary heart failure and oncology programs. MethodsIn this retrospective cohort study, LVAD databases were reviewed to identify patients with a cancer diagnosis at the time of or after LVAD implantation. We created a 3:1 matched cohort based on age, sex, etiology of cardiomyopathy, LVAD implant strategy, and INTERMACS profile stratified by site. Kaplan-Meier analysis and Cox proportional hazards models were used to compare survival between patients with cancer and non-cancer comparators. ResultsAmong 1,123 patients who underwent LVAD implantation between 2005 and 2019, 22 patients with LVADs with active cancer and 66 matched non-cancer comparators were identified. Median age was 62 years (range 41 to 73 years); 50% of patients with cancer were African-American, and 27% were women. Prostate cancer, followed by renal cell cancer and hematologic malignancies were the most common diagnoses. There was no significant difference in unadjusted Kaplan-Meier median survival estimates from the time of LVAD placement between patients with cancer (3.53 years; 95% confidence interval [CI]: 1.41 to 5.33) and non-cancer comparators (3.03 years; 95% CI: 1.83 to 5.26; log-rank P = 0.99). In Cox proportional hazard models, cancer diagnosis as a time-varying variable was associated with a statistically significant increase in death (hazard ratio: 2.05; 95% CI: 1.03 to 4.12; P = 0.04). Patients with cancer had less gastrointestinal bleeding compared with matched non-cancer comparators (P = 0.016). Other complications were not significantly different. ConclusionsOur study provides initial feasibility and safety data and set a framework for multidisciplinary team management of patients with cancer and LVADs.

Outcomes of a multi-ethnic Asian population on combined treatment with clopidogrel and omeprazole in 12,440 patients.

Omeprazole is commonly co-prescribed with clopidogrel. Clopidogrel requires bio-activation by cytochrome P450 CYP2C19. Omeprazole may reduce clopidogrel's antithrombotic efficacy by inhibiting CYP2C19. Studies in Caucasians receiving omeprazole with clopidogrel showed no significant increase in death and myocardial infarction with this drug-drug interaction. There are limited large-scale studies in Asians, who may have a greater prevalence of CYP2C19 loss-of-function polymorphisms. A single centre retrospective cohort study was undertaken based on a review of medication records and prescription data. Patients prescribed clopidogrel from 2009 to 2012 were followed-up with until December 2012 (median:29months). The primary outcome was all-cause mortality and secondary outcomes were myocardial infarction (MI), cerebrovascular accidents, and subsequent coronary interventions. Of 12,440 patients prescribed clopidogrel, 62%(n = 7714) were on omeprazole (63.8% Chinese, 13.9% Malay, 12.4% Indian, 10.0% others), and 38%(n = 4726) were not on omeprazole or other proton pump inhibitors (62.6% Chinese, 13.5% Malay, 10.7% Indian, 13.2% others). Mortality after co-prescription occurred in 14.3%(n = 1101) of patients, compared to 6.3%(n = 300) of patients prescribed clopidogrel only. Multivariate analysis using propensity score adjusted analysis showed no significant increase in all-cause mortality with co-prescription (adjusted hazards ratio [AHR] 1.13, [95%CI 0.95-1.35]). Patients on co-prescription had a higher risk of subsequent MI (16% vs 3.8%; AHR 2.03 [95%CI 1.70-2.44]), but not of cerebrovascular accidents (5.0% vs 2.0%; AHR 0.98 [95%CI 0.76-1.27]) or coronary interventions (1.7% vs 0.7%; AHR 1.28 [95%CI 0.83-1.96]). The risk of a subsequent MI was higher in the Malay (AHR 2.43 [95%CI 1.68-3.52]) and Chinese (AHR 2.06 [95%CI 1.63-2.60]) population as compared to the Indian (AHR 1.56 [95%CI 1.06-2.31]) population. In conclusion, the use of clopidogrel with omeprazole is associated with an increased risk of MI, but not mortality or stroke, in this multi-ethnic Asian population. These risks appear to vary among different ethnic groups.

Reproductive Health Crisis During Waves One and Two of the COVID-19 Pandemic in India: Incidence and Deaths From Severe Maternal Complications in More than 202000 Hospital Births

Background: The SARS-CoV-2 pandemic in India has adversely affected many aspects of population health. We need detailed evidence of the impact on reproductive health in India so that lessons can be learnt. Methods: Hospital-based repeated monthly survey of nine severe maternal complications and death in 15 hospitals across five states in India covering a total of 202,986 hospital births, December-2018 through to May-2021. We calculated incidence rates (with 95% Confidence Intervals (CIs)) per 1000 hospital births, case-fatality and rate ratios (RR) with 95% CIs. Linear regression was used to examine the association between the Government Response Stringency Index (GRSI) for India and changes in hospital births, incidence and case-fatality. Results: There was a significant decrease in hospital births per month during the pandemic period with a 4.8% decrease per 10% increase in the GRSI scores (p<0.001). The overall incidence of severe complications in the pandemic period was not significantly different from the pre-pandemic period, but hospital admissions from septic abortion was 56% higher (RR=1.56; 95% CI=1.22–1.99; p<0.001). The overall case-fatality of complications increased by 23% (RR=1.23; 95% CI=1.03–1.46; p=0.022) and remained high across the different phases of the pandemic with a notable significant increase in deaths from heart failure in pregnancy. Conclusion: Our study supports the legitimacy of the calls made to maintain sexual and reproductive health services as essential services during the pandemic. Lessons learnt should be used to avert the ongoing reproductive health crisis while India plans to manage a third wave of the pandemic. Funding Information: The MaatHRI platform and this study was funded by a Medical Research Council Career Development Award to MN (Ref:MR/P022030/1). Declaration of Interests: The authors declare that they have no competing interests. Ethics Approval Statement: The MaatHRI platform and the repeated monthly survey have been approved by the institutional review boards (IRB) of each coordinating Indian institution, namely: Srimanta Sankaradeva University of Health Sciences, Guwahati, Assam (No.MC/190/2007/Pt-1/126); Nazareth hospital, Shillong, Meghalaya (Ref No. NH/CMO/IEC/COMMUNICATIONS/18-01); Emmanuel Hospital Association, New Delhi (Ref. Protocol No.167); Mahatma Gandhi Institute of Medical Sciences, Sevagram, Maharashtra (Ref No. MGIMS/IEC/OBGY/118/2017); and the Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh (No.Dean/2018/EC/290). The project has also been approved by the Government of India’s Health Ministry’s Screening Committee, the Indian Council of Medical Research, New Delhi (ID number 2018-0152) and by the Oxford Tropical Research Ethics Committee (OxTREC), University of Oxford, UK (OxTREC Ref: 7-18).

Investigating the Male and Older People Susceptibility to Death from (COVID-19) Using Statistical Models

Introduction: Coronavirus disease 2019 (COVID-19) is one of the serious infectious diseases that is caused by a specific virus called syndrome coronavirus 2 viruses (SARSCoV-2). The rapid spread of COVID19 raises serious concerns about the globally growing death rate. Currently, cases are doubled in one week around the world. Recorded data shows that COVID-19 does not infect all patients equally. This opportunistic virus can affect people of any age and gender. Information about the reason for high mortality in the age group 60 and older is limited. The gender differences among all deceased are poorly known. To understand more about COVID-19, this study aims to examine the different age groups among the death and focuses on comparing genders between males and females. Method: Statistical analysis including Pearson’s Chi-squared (χ2) and binary logistic regression was conducted based on existing data to examine factors relating to death, such as age and gender. Adjusted odds ratios (ORs) with 95% confidence intervals (CIs) were calculated for death. Results: The results show that males were 2.51 more likely to die of coronavirus COVID-19 than females. Moreover, the study found a significant increase in death for patients age 60 and older compared to patients age less than 40. Thus, males of 80+ age were found to be highly associated with death. Conclusions: Older people and male are more susceptible to death from COVID-19,we should pay more attention to the elderly people and male with COVID-19. This imposes providing careful health care for this population.

Cause-of-death distributions and mortality trends in Turkey between 2009 and 2017.

BackgroundMaking the right decisions in the field of public health depends on the reliable recording of statistical data such as death and birth. There have been radical changes and innovations in the death registration since 2009 in Turkey to improve reporting.AimsTo examine the distribution and the trend of causes of death between the years 2009 and 2017 in Turkey.Study DesignDescriptive study.MethodsIn this study, the causes of death were evaluated in three groups used in the Global Burden of Disease study. Group I included infectious, maternal, perinatal, and nutritional conditions; group II included noncommunicable diseases; and group III included injuries. Age-standardized mortality rates were calculated per 100,000 according to age, sex, and cause of death. Joinpoint regression was used to evaluate the trend in mortality rates. In addition, the leading causes of death were also determined.ResultsIn total, age-standardized mortality rates increased significantly on average annually (1.5% per year). When the trends of causes of death were examined according to gender, there was a significant increase in deaths from group I in both genders and a significant increase in deaths from group III in males, whereas there was no statistically significant change in deaths from group II between 2009 and 2017.ConclusionA significant quantitative improvement in death registration was seen in Turkey between the years 2009 and 2017. This is due to the increase in the number of reported deaths. The change in the distribution of causes of death is noteworthy. This research can provide the basis for further researches that will examine the change in causes of death.

A brief outline of respiratory viral disease outbreaks: 1889-till date on the public health perspectives.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is currently causing the respiratory illness termed as the coronavirus disease 2019 or the COVID-19 pandemic. Indeed, the significant increase in deaths in the current days due to influenza around the world started in 1889 is a continued public health threat because of its intermittent style of pandemic outbreaks. An array of research on the influenza viruses has been conducted especially pointing on (1) the development of the anti-viral drugs and the design of probable vaccines on trial basis, (2) the biochemical and genetic aspects underlying the viral pathogenicity, (3) the viral epidemiology, and on (4) the protective immunity against the influenza viruses. Current review briefly discussed the epidemic/ pandemic history of influenza and correlated with the current epidemiology, the possible preventive measures that may be taken by the public health professionals as well as to increase the protective awareness among the general people. The viral reassortments during the initiation of pandemics have also been focused based on the previous literatures.

Next generation sequencing and in vivo pathogenicity study of multidrug-resistance efflux pump genesoqxAB-encoding plasmids in Escherichia coli

Background: Multidrug-resistant efflux pump genes oqxAB-encoding plasmids are wildly disseminated in livestock, and also identified in human samples. Giving the high presence in environment and multidrug-resistant nature of oqxAB, deeper understanding of oqxAB-encoding plasmids is necessary. Objective: To investigate the prevalence, virulence, and phylogenetic of oqxAB-encoding plasmids. Method: A total of 43 oqxAB carrying Escherichia coli were isolated from human and livestock from China and Hong Kong, these isolates were characterised by disc-diffusion susceptibility test and PCR. The 43 samples were sequenced using PacBio or Illumina platforms, and analysied with five oqxAB-encoding plasmid sequences extracted from Genbank. in vivo pathogenicity study performed by injecting E. coli J53 transconjugants containing oqxAB plasmid into Galleria mellonella larvae. Result: Among the 48 oqxAB-encoding plasmids, 27 were IncFII F18 plasmids, 12 F16 plasmids, six F33 plasmids, two F24 plasmids, and one F14 plasmid. Virulence regions in plasmids with same Inc group encoded similar set of virulence factors and antibiotic resistance genes. Co-existence of blaCTX-M, fosA3, and oqxAB genes was identified in all F33 plasmids and one F18 plasmid. in vivo pathogenicity study suggested oqxAB plasmids caused significant health deterioration in larvae but no significant increase in death. Conclusion: Our data shows similar sets of pathogenic factors are frequently co-carried by oqxAB plasmids of same Inc group, suggesting high correlation between plasmids identified from China and Hong Kong. Co-existence of fosA3, blaCTX-M, and oqxAB suggests resistance to most clinical antibiotics. in vivo test indicates oqxAB plasmid can increase pathogenicity of the host bacteria.

“Hydroxychloroquine in patients with COVID-19: A Systematic Review and meta-analysis.”

Backgrounds and aimsThe role of hydroxychloroquine (HCQ) in the treatment of COVID-19 is not fully known. We studied the efficacy of HCQ compared to the control in COVID-19 subjects on - a. viral clearance measured by reverse transcriptase polymerase chain reaction (RT-PCR) and, b. death due to all cause. MethodsPubMed, Scopus, Cochrane and MedRxiv database were searched using the specific keywords up to April 30, 2020. Studies that met our objectives were assessed for the risk of bias applying various tools as indicated. Three studies each that reported the outcome of viral clearance by RT-PCR and death due to all cause, were meta-analyzed by applying inverse variance-weighted averages of logarithmic risk ratio (RR) using a random effects model. Heterogeneity and publication bias were assessed using the I2 statistic and funnel plots, respectively. ResultsMeta-analysis of 3 studies (n = 210) on viral clearance assessed by RT-PCR showed no benefit (RR, 1.05; 95% CI, 0.79 to 1.38; p = 0.74), although with a moderate heterogeneity (I2 = 61.7%, p = 0.07). While meta-analysis of 3 studies (n = 474) showed a significant increase in death with HCQ, compared to the control (RR, 2.17; 95% 1.32 to 3.57; p = 0.002), without any heterogeneity (I2 = 0.0%, p = 0.43). ConclusionsNo benefit on viral clearance but a significant increase in mortality was observed with HCQ compared to control in patients with COVID-19.

Door-to-balloon time and mortality in patients with ST-elevation myocardial infarction undergoing primary angioplasty.

The evidence are not conclusive that a small incremental increase in door-to-balloon (D2B) time leads to a significant increase in death of ST-elevation myocardial infarction (STEMI) patients. In a previous study, we described a quality improvement intervention that reduced D2B time in 333 patients with STEMI. The aim of the current study was to compare mortality rates of the patients, before and after the intervention. We examined the survival of 133 consecutive patients with STEMI treated prior to an intervention to decrease D2B time and 200 treated after the intervention. The mortality rate was the same before and after the quality intervention. The median D2B time for the entire cohort was 55 min. The number of patients with D2B time >55 min prior to the intervention was 82/133 (61%) and after the intervention 74/200 (37%) P < 0.00001. Thirty-day mortality among the patients with D2B time ≤55 min was 5/178 (2.8%) and among those with D2B time >55 min was 15/155 (9.7%), P < 0.008. The hazard ratio for 30-day mortality when the D2B time was >55 min was 3.7 (1.3-10.4). Mortality and non-fatal complications did not differ significantly between STEMI patients before and after a quality improvement intervention. However, the number of patients treated within 55 min from arrival was significantly higher after the intervention; and coronary intervention within this time was associated with a lower death rate.

Proximal femur fractures in COVID-19 emergency: the experience of two Orthopedics and Traumatology Departments in the first eight weeks of the Italian epidemic.

Introduction:CoVID-19 (Coronavirus disease) is a worldwide infection which is causing millions of deaths. A significant number of elderly patients require hospitalization and develop serious and sometimes life-threatening complications. The aim of this study is to evaluate the preliminary impact (8 weeks) of CoVID-19, focusing on proximal femur fractures, analyzing data and results compared to the same period of 2019.Materials and methods:From February 22nd to April 18th, 2020 we surgically treated 121 proximal femur fractures (61 in Piacenza; 60 in Parma, 16 male, 44 female, mean age 81.1). In the same period of 2019, we treated 169 proximal femur fractures (90 in Piacenza, 33 male, 57 female, mean age 81.9; 79 in Parma, 29 males, 50 female, mean age 80.2). We had 21/61 (34.4%) patients resulted positive for COVID-19 and 11/61 in Parma (18.3%), based on nasal-pharyngeal swab, chest CT scan and/or lung US findings.Results:The incidence of proximal femur fractures had a significant reduction during CoVID-19 spread in Piacenza and Parma. Authors have noticed an elevated number of deaths within 21 days after surgery. Piacenza: 4 cases in 2019 (4.4%) and 11 in 2020 (18.0%), of which 9 cases CoVID positive. In Parma in 2019 two deaths were encountered; in 2020 6 patients died and 5 cases were CoVID positive.Conclusion:In the first two months of the Italian epidemic, in the cities of Piacenza and Parma over 80% of deaths have occurred in patients over 70 years old. Even if preliminary, our study shows a significant increase in death in elderly patients surgically treated for proximal femur fractures, particularly in the Piacenza Hospital. (www.actabiomedica.it)

Invasive cervical cancer in HIV-infected women in low-income countries: experience from Côte d'Ivoire

Aims: To assess experience in the management of invasive cervical cancer in HIV- infected women in a sub-medical setting.&#x0D; Methods: Retrospective cohort study of patients with cervical cancer at the University Hospital of Treichville between 2012 and 2016. The association between HIV infection and epidemiological data was investigated using the chi-square test. Survival data were calculated according to the Kaplan-Meier method.&#x0D; Results: A total of 99 women with cervical cancer were included in the study; 49 (49.5%) of whom were HIV positive. The average age of patients was 51.5 years. HIV testing was performed in 53.1% after the diagnosis of cancer. Virtually all (98%) of women living with HIV had received antiretroviral therapy. Their median CD4 was 382 elements / ml. HIV infected Women were significantly younger than HIV-negative women. The median survival rate for patients living with HIV was 9.6 months Versus 15 months for HIV-negative patients. HIV infection was associated with a significant increase in deaths and a shorter survival among patients with cervical cancer.&#x0D; Conclusions: Cervical cancer is more aggressive in HIV infected women. Overall survival was significantly shorter when the patients were infected with HIV.

Mortality in Microscopic Colitis - A Nationwide Cohort Study in Sweden

Background and Aims: Microscopic colitis is one of the common causes of chronic diarrhea among the elderly. We sought to examine the rates of all-cause and cause-specific mortality in patients with microscopic colitis. Methods: We conducted a nationwide cohort study of all microscopic colitis cases (n = 14,520) diagnosed from 1990 - 2017 in Sweden. Cases of microscopic colitis were identified using SNOMED codes from gastrointestinal histopathology reports collected across Sweden's 28 pathology departments. Each microscopic colitis case was matched to 5 population comparators (n = 69,489). Mortality data were ascertained from the Cause of Death Register. We used Cox proportional hazard modeling to estimate adjusted hazard ratios (aHRs) and 95% CIs. Results: Through December of 2017, we confirmed 3028 deaths in microscopic colitis patients (27.1/1000 person-years) and 12,536 deaths in matched population comparators (23.0/1000 person-years). This corresponded to a 10-year absolute risk difference of 2.5% [1.8%-3.1%] and an aHR of 1.2 [1.1-1.22]. The risk increased with longer disease duration (Ptrend < 0.001) and appeared to be stronger in the collagenous colitis subtype (aHR=1.3; 1.2-1.4) compared to the lymphocytic colitis subtype (1.1; 1.1-1.2, Pheterogeneity = 0.006). In analyses of cause-specific death, microscopic colitis was associated with an increased risk of cardiovascular(adjusted HR = 1.3 [1.2-1.4]), gastrointestinal (aHR = 2.0 [1.6-2.4]), and infection(aHR = 1.7 [1.3-2.2]) -related deaths but not cancer-related death (aHR = 1.0 [0.9-1.1]). Conclusions: In a nationwide cohort study in Sweden, in addition to an increase in risk of all-cause death, microscopic colitis was associated with a significant increase in death from cardiovascular, infection, and gastrointestinal diseases. Funding Statement: This project was funded by the Karolinska Institutet (Ludvigsson), the Stockholm county council (Drs. Ludvigsson and Bergman) and from Janssen corporation. Declaration of Interests: Dr Khalili receives grant funding from Takeda and Pfizer. He has received consulting fees from Abbvie. Dr Ludvigsson coordinates a study on behalf of the Swedish IBD quality register (SWIBREG). Ethical Approval Statement: This study was approved by the Regional Ethics Committee, Stockholm, Sweden (Protocol no 2014/1287-31/4).

Epidemiology of cervix cancer in Brazil (2005-2015): study of mortality and hospital intervention rates

Cervical neoplasia has high morbidity and mortality and is the main female gynecological neoplasia, but it is susceptible to early detection and cure. A major challenge for developing countries such as Brazil is the expansion of prevention programs, which becomes more effective when the epidemiology is known. The objective of this study was to conduct an epidemiological survey to evaluate the Brazilian panorama of this neoplasm. A temporal aggregate study was performed using the mortality and hospital admission rates for cervical neoplasia throughout the Brazilian territory during the years 2005 to 2015, data obtained through DATASUS and IBGE. During the years 2005 to 2015, there was a significant drop (p&lt;0.05) in hospital admission rates in the 0-19, 20-39, 40-59, 60-79 years, with an average fall of 36 % and a death increase in the age group 20-39 years. The North region had a significant increase in death in the range ≥ 80 years, 140%, p&lt;0.02. The mean mortality rate in Brazil was 5.14, with a 95% CI of 5.01 to 5.27. Cervical neoplasia is still present in Brazil, although mortality has a tendency to decrease, this tendency is unequally distributed in Brazil, with the north and northeast regions showing the highest rates. Better public policies are fundamental.

Time trend of breast cancer mortality in BRAZILIAN men: 10-year data analysis from 2005 to 2015

BackgroundMale Breast Cancer (MBC) is rare, which makes its understanding and treatment be extrapolated from what is known about the occurrence in women, with few epidemiological studies. Therefore, the aim of the present paper was to study breast cancer mortality in adult males in Brazil and its administrative regions between 2005 and 2015.MethodsEcological study with data on MBC mortality in adults between 2005 and 2015. Data were obtained from the Mortality Information System of the Department of Informatics of SUS (the Unified Health System of the country). Descriptive statistics were used for MBC mortality and linear regression to analyze the relationship between mortality and the country’s administrative regions. Percentage Change (PC) and Annual Percentage Change (APC) were the trend measures used for MBC mortality for the period.ResultsBetween 2005 and 2015, there were 1521 deaths due to MBC in adults in Brazil. Regarding mortality by region, there was great oscillation in the rates of the country as a whole (PC = 113,87; β = 0,009 (IC95% 0,000 – 0,018); r2 = 0,381; P = 0,043). The highest increase in MBC mortality occurred in patients aged 80 years or older (PC = 161,04; β = 0,201 (IC95% 0,640 - 0,339); r2 = 0,550; P = 0,009) and there was significant increase in deaths for the 50–54-year age group (PC = 224,01; β = 0,135 (CI95% 0,052; 0,218); r2 = 0,601; P = 0,005).ConclusionMortality in adults due to MBC increased in Brazil during the study period with the highest percentage increase occurring for individuals aged 80 years or older.