Significant Increase In Mortality Research Articles

Impact of duration of cardiopulmonary bypass on recovery after open heart surgery

Background: Objective of the study was to examine the impact of cardiopulmonary bypass (CPB) duration on recovery from cardiac surgery. Methods: This is an observational retrospective study. Data from adult cardiac surgical patients presented at Queen Alia Heart Institute (QAHI) in the duration between September 2023 and February 2024 was retrospectively analysed. The impact of CPB duration was examined. Patients were divided into groups according to CPB duration (0 to 60 minutes, 60 to 120 minutes, 120 to 180 minutes, 180 to 240 minutes and 240 to 300 minutes). For each group intra-operative and post-operative variable were examined. The intra-operative variables studied were need for blood transfusion, haemofiltration and intra-aortic balloon pump. The post-operative variables studied were duration of post-operative mechanical ventilation, intensive care unit (ICU) stay, hospitalization time and mortality. Results: Consecutive data of 202 adult cardiac surgical patients (34 females and 168 males) was analysed. Average age of patients was 57.149 years. Average duration of CPB was 109.9 minutes (ranged from 29 to 300 minutes). Half of the patients (50.5%) had CPB duration between 1 and 2 hours. Blood transfusion was needed in 88 patients (43.6%). Haemofiltration was used in 32 patients (15.8%) and intra-aortic balloon pump (IABP) was used in 29 patients (14.4%). The average postoperative time of mechanical ventilation was 34 hours and the average ICU stay was 5.5 days. Chest re-exploration was needed in 30 patients (15%). Hospital stay was on average 12 days and in-hospital mortality was witnessed in 20 patients (9.9%). Patients who had CPB for less than one hour (17.3%) had the lowest incidence of blood transfusion (37.1%), lowest incidence of haemofiltration (8.6%), low incidence of IABP use (11%). They also had lowest incidence of chest re-opening (5.7%), shortest time of postoperative mechanical ventilation (13 hours) and shortest ICU and hospital stay (4.1 and 8.5 days, respectively). There was a significant increase in postoperative sternal re-opening and postoperative mortality when the duration of CPB exceeded 3 hours. Conclusions: Duration of CPB is a key predictor of recovery and outcome of cardiac surgery. Shorter CPB time was associated with earlier extubation, less ICU stay and shorter hospitalisation time. Prolonged CPB was associated with higher rates of complications, delayed recovery, longer ICU stay, protracted hospitalisation and higher mortality rates.

The significance of light chronodestruction in the development of the embryotoxic effect in the experiment

Objective. To assess the significance of light chronodestruction in the development of the embryotoxic effect in the experiment. Materials and methods. The experiment was conducted on 60 female rats of the Wistar line. To assess the significance of chronodestruction in the development of embryotoxic effect, the uterus was isolated in the experiment, in which the number of implantation sites, the total number of embryos, the number of live and dead embryos, and the number of resorptions were estimated. The number of corpus luteum in the harvested ovaries was estimated. In addition, the mean embryo weight (g) and mean craniocaudal size (mm) were recorded. Indicators of embryotoxic effects of light deprivation were determined by pre- and post-implantation death, which was calculated in accordance with methodological recommendations. Results. Exposure to light deprivation reduces the number of implantation sites as of 7th, 14th and 21st days by 1,5-1,8 times, the total number of embryos by 1,6-1,8 times, the number of living embryos by 2,2-9 times and increases the number of dead embryos as of 14th and 21st days by 4-5,5 times, the number of resorptions – 1,6-11 times. The average craniocaudal size (mm) of embryos in experimental animals was recorded below control values by 1,5 times, 1,3 and 3,7 times by 7th, 14th, 21st days respectively. In females exposed to light deprivation, there was a significant increase in pre-implantation mortality by 35-41,8 times and post-implantation mortality by 7,2-20,4 times compared to the control. Conclusion. Light deprivation may have a negative effect on pregnancy and fetal development in female rats, which is confirmed by an increase in pre- and post-implantation mortality.

Radiological Parameters for the Detection of Pulmonary Hypertension in Severe Aortic Valve Stenosis and Their Influence on Mortality: Does Sex Matter?

Background: Echocardiography has long been established as the primary noninvasive method for diagnosing pulmonary hypertension (PH) prior to transcatheter aortic valve replacement (TAVR) in patients with severe aortic valve stenosis (AS). In recent years, radiological methods for diagnosing PH have been investigated. Measurements such as the computed tomography angiography (CTA)-derived pulmonary artery (PA) diameter and PA diameter/body surface area (PA/BSA) have shown promising results regarding their diagnostic strength. However, it has yet to be determined if a patient's sex has any impact on the effectiveness of these diagnostic measurements. Methods: In all, 271 patients (51.3% male, mean age 82.6 ± 4.8 years) with severe AS undergoing TAVR were separated into male and female groups. The cut-off values for the diagnosis of PH were calculated for the CTA-derived PA diameter and PA/BSA based on different systolic pulmonal artery pressure values (40-45-50 mmHg). Patients were then subclassified according to measurements above or below these PA diameters and PA/BSA cut-off values. A PA diameter ≥29.5 mm and PA/BSA ≥ 15.7 mm/m2 qualified for PH. The 1-5 year survival rate in these cohorts was further analyzed. Results: Patients with a PA diameter ≥29.5 mm showed a significantly higher 1 year mortality rate (p = 0.014). This observation could only be confirmed for the male sex (p = 0.018) and not for the female sex (p = 0.492). As for the PA/BSA, in patients over the cut-off value, no significant increase in mortality was noted in the overall cohort. However, the male patients showed increased 3 year (p = 0.048) and 5 year mortality rates (p = 0.033). Conclusions: The CTA-obtained PA diameter and PA/BSA are both useful in the diagnosis of PH and mortality risk stratification in patients with severe AS undergoing TAVR, especially in males. Male patients with PA ≥ 29.5 mm or PA/BSA ≥ 15.7 mm/m2 seem to be at a higher risk of death during follow-up after undergoing TAVR. In females, no such correlation was observed.

Impact of therapeutic hypothermia (whole body cooling) on severely asphyxiated term neonates: a prospective non-randomized comparative study in an Indian tertiary care setting

Background: Early application of Therapeutic Hypothermia within 6 hours of birth is neuroprotective. We aimed at examining whether therapeutic hypothermia alongside standard optimal intensive care improves immediate survival outcome and reduces neuro-disability. Methods: This was a prospective non-randomized study involving inborn and out born newborns admitted at NICU, carried out from March 2022 to December 2022. Eligible candidates were enrolled as cases and therapeutic hypothermia was offered while rest were included as a control group and monitored likewise for the overall survival and neurological outcome. These babies were followed up till 1 month and 3 months of age to assess neurological outcome. Results: In this study, a total of 47 patients were enrolled both from extramural and intramural NICU set ups. Of them, 22 patients were offered Therapeutic Hypothermia and 25 patients were given standard post asphyxia care. 7 out of 9 inborn patients and 3 out of 13 out born neonates who were offered therapeutic hypothermia survived whereas 5 out of 11 inborn and 4 out of 14 out born neonates who were offered standard post asphyxia care survived. Conclusions: Therapeutic hypothermia cannot be attributed to significant increase or decrease in mortality when compared with standard care group. No inference could be made about hypothermic neuroprotection in the follow up study. Overall survival outcome was better in inborn patients than that of outborn. Inborn neonates subjected to therapeutic hypothermia, showed a trend towards better survival than those given standard post asphyxia care.

Factors associated with the uptake of intermittent preventive treatment for malaria during pregnancy in Cameroon: An analysis of data from the 2018 Cameroon Demographic and Health Survey.

Malaria in pregnancy is a major public health concern that contributes to a significant increase in maternal and child mortality and morbidity. Intermittent preventive treatment of malaria during pregnancy using sulfadoxine-pyrimethamine (IPTp-SP) is a key intervention recommended by the World Health Organization (WHO) and implemented in Cameroon to reduce the morbidity associated with malaria during pregnancy. This study aimed to assess the distribution of the poor uptake of IPTp-SP (i.e. fewer than three doses) in Cameroon and the factors associated. We conducted a secondary analysis of data extracted from the 2018 Cameroon Demographic and Health Survey. Data was collected using a face-to-face questionnaire administered to mothers with at least one child under the age of five. The participants were selected using a two-stage stratified sampling process. We estimated the frequencies of mothers receiving fewer than three doses of IPTp-SP. Multilevel logistic regression modeling was used to assess the associations between key suspected determinants and uptake of fewer than three doses of IPTp-SP. Crude and adjusted Odds-Ratio (ORs) were estimated. A total of 13,527 women of childbearing age were interviewed, of whom 5,528 (40.9%) met our selection criteria. Among them, 845 (15.3%) women had no antenatal consultation (ANC) visit, 1,109 (20%) had 1-3 visits, 3,379 (61.1%) had 4-7 visits, and only 195 (3.5%) had at least eight visits. Moreover, 3,398 (61.5%, CI: 60.2-62.8) had received fewer than three doses of IPTp-SP. Our findings show that the predictors of poor uptake of IPTp-SP include attending the first ANC visit after the third month of pregnancy (aOR = 1.52, CI: 1.30-1.77), attending fewer than four ANC visits (aOR = 1.29, CI: 1.06-1.56), and not being attended to by a healthcare professional during the prenatal period (aOR = 4.63, CI: 2.81-7.64). Residing in the Sahelian regions was not increasing the risk of poor IPTp-SP uptake on its own but was positively modifying the effect of not being attended by a healthcare professional (p < 0.001). We did not find a significant association between a higher level of education and the uptake of IPTp-SP (aOR = 1.10, CI: 0.90-1.32). Nearly two third of the pregnant women in Cameroon have a poor uptake of IPTp-SP. Interventions focused on ANC provision ought to be explored and tested to address this gap, with priority assigned to the Sahelian region.

Risk Score for Prediction of Dialysis After Transcatheter Aortic Valve Replacement.

Dialysis is a rare but serious complication after transcatheter aortic valve replacement. We analyzed the large multicenter TRITAVI (transfusion requirements in transcatheter aortic valve implantation) registry in order to develop and validate a clinical score assessing this risk. A total of 10 071 consecutive patients were enrolled in 19 European centers. Patients were randomly assigned (2:1) to a derivation and validation cohort. Two scores were developed, 1 including only preprocedural variables (TRITAVIpre) and 1 also including procedural variables (TRITAVIpost). In the 6714 patients of the derivation cohort (age 82±6 years, 48% men), preprocedural factors independently associated with dialysis and included in the TRITAVIpre score were male sex, diabetes, prior coronary artery bypass graft, anemia, nonfemoral access, and creatinine clearance <30 mL/min per m2. Additional independent predictors among procedural features were volume of contrast, need for transfusion, and major vascular complications. Both scores showed a good discrimination power for identifying risk for dialysis with C-statistic 0.78 for TRITAVIpre and C-statistic 0.88 for TRITAVIpost score. Need for dialysis increased from the lowest to the highest of 3 risk score groups (from 0.3% to 3.9% for TRITAVIpre score and from 0.1% to 6.2% for TRITAVIpost score). Analysis of the 3357 patients of the validation cohort (age 82±7 years, 48% men) confirmed the good discrimination power of both scores (C-statistic 0.80 for TRITAVIpre and 0.81 for TRITAVIpost score). Need for dialysis was associated with a significant increase in 1-year mortality (from 6.9% to 54.4%; P=0.0001). A simple preprocedural clinical score can help predict the risk of dialysis after transcatheter aortic valve replacement.

Evaluating potential developmental toxicity of perfluoroalkyl and polyfluoroalkyl substances in Xenopus laevis embryos and larvae.

As part of the US Environmental Protection Agency's perfluoroalkyl and polyfluoroalkyl substances (PFAS) Action Plan, the agency is committed to increasing our understanding of the potential ecological effects of PFAS. The objective of these studies was to examine the developmental toxicity of PFAS using the laboratory model amphibian species Xenopus laevis. We had two primary aims: (1) to understand the developmental toxicity of a structurally diverse set of PFAS compounds in developing embryos and (2) to characterize the potential impacts of perfluorooctanesulfonic acid (PFOS), perfluorohexanesulfonic acid (PFHxS), perfluorooctanoic acid (PFOA), and hexafluoropropylene oxide-dimer acid (HFPO-DA a.k.a. GenX), on growth and thyroid hormone-controlled metamorphosis. We employed a combination of static renewal and flow-through exposure designs. Embryos were exposed to 17 structurally diverse PFAS starting at the midblastula stage through the completion of organogenesis (96 h). To investigate impacts on PFOS, PFOA, PFHxS, and HFPO-DA on development and metamorphosis, larvae were exposed from premetamorphosis (Nieuwkoop Faber stage 51 or 54) through pro metamorphosis. Of the PFAS tested in embryos, only 1H,1H,10H,10H-perfluorodecane-1,10-diol (FC10-diol) and perfluorohexanesulfonamide (FHxSA) exposure resulted in clear concentration-dependent developmental toxicity. For both of these PFAS, a significant increase in mortality was observed at 2.5 and 5mg/L. For FC10-diol, 100% of the surviving embryos were malformed at 1.25 and 2.5mg/L, while for FHxSA, a significant increase in malformations (100%) was observed at 2.5 and 5mg/L. Developmental stage achieved was the most sensitive endpoint with significant effects observed at 1.25 and 0.625 mg/L for FC10-diol and FHxSA, respectively. In larval studies, we observed impacts on growth following exposure to PFHxS and PFOS at concentrations of 100 and 2.5mg/L, respectively, while no impacts were observed in larvae when exposed to PFOA and HFPO-DA at concentration of 100 mg/L. Further, we did not observe impacts on thyroid endpoints in exposed larvae. These experiments have broadened our understanding of the impact of PFAS on anuran development.

Extreme weather events induced mortalities in Jammu and Kashmir, India during 2010-2022

A study has been conducted on Extreme Weather Events (EWEs) induced mortalities in Jammu and Kashmir, India during 2010-2022. In the present study, we used the frequency of heavy rain, heavy snow, lightning/thunderstorm, Hailstorm and squall during the period 2010 to 2022 of 10 stations of J&amp;K from India Meteorological Department. The mortalities occurred due to these extreme weather events for each district were collected from the Meteorological Centre Srinagar. The mean monthly precipitation and number of rainy days for each month was calculated for each station based on 40 years data (1982 to 2022). During the past 12 years, (2010-2022) a total of 2863 EWEs occurred over J&amp;K in which 552 deaths occurred till 31st December 2022. Among the various EWEs, lightning (1942) and heavy rainfall (409) events were more frequent. When we compare the mortality per event, the heavy snow was more destructive compared to any other EWEs. The mortality per event due to heavy snow was highest (4.33) as compared to other extreme events, although the number of events of heavy snow is less (42) as compared to heavy rain (409), flash floods (168) and lightning (1942). District wise results of EWEs results revealed the highest deaths due to heavy snow were observed over Kupwara, Bandipora, Baramulla and Ganderbal. Similarly for flash floods, the highest deaths were observed over Kishtwar, Anantnag, Ganderbaland Doda. The Pearson correlation results revealed highest correlation of total deaths for heavy rain (0.77) and heavy snow (0.69) (significant at p value p&lt;0.01) followed by flash floods (0.492) (significant at p value p&lt;0.05). Negative correlation result was observed between heavy snow and windstorm (0.584) (significant at p value p&lt;0.05). The present study has shown that, for the union territory as a whole, the heavy rain and heavy snow have been two major disasters causing mortality, though flashfloods, thunderstorms and windstorms are gaining importance. The trend analysis results also revealed that there is a significant increase in mortality over the years particularly due to flash floods (R2 value 0.434) and windstorm (R2 value 0.371).

Effect of 24 h glucose fluctuations on 30-day and 1-year mortality in patients with acute myocardial infarction: an analysis from the MIMIC-III database.

It is recognized that patients' blood glucose fluctuates over time during acute disease episodes, especially during the outbreak of cardiovascular events, regardless of the presence of an abnormal blood glucose profile prior to admission to the hospital. Glucose fluctuations in patients with acute myocardial infarction (AMI) in the intensive care unit (ICU) are currently not adequately monitored and studied. We focused on blood glucose fluctuation values within 24 h of admission to assess their association with 30-day and 1-year mortality. Data of patients with AMI aged 18 years or older from the Critical Care Medical Information Marketplace database III V1.4 were available for analysis in this research. Glucose data were obtained by measurement. A total of 390 of them were treated with PCI. The principal consequence was 30-day and 1-year mortality in patients with AMI. The effect of different glucose fluctuations within 24 h of admission on mortality was predicted by constructing a multivariate Cox regression model with four model adjustments and Kaplan-Meier survival curves. Additionally, we performed curve-fitting analyses to show the correlation between blood glucose fluctuations and risk of death. We selected 1,699 AMI patients into our study through screening. The included population was categorized into three groups based on the tertiles of blood glucose fluctuation values within 24 h of admission to the ICU. The three groups were <25 mg/dl, 25-88 mg/dl and >88 mg/dl. By cox regression analysis, the group with the highest blood glucose fluctuation values (>88 mg/dl) had the most significant increase in 30-day and 1-year mortality after excluding confounding factors (30-day mortality adjusted HR = 2.11; 95% CI = 1.49-2.98 p < 0.001; 1-year mortality adjusted HR = 1.83; 95% CI = 1.40-2.39 p < 0.001). As demonstrated by the Kaplan-Meier survival curves, the group with the greatest fluctuations in blood glucose has the worst 30-day and 1-year prognosis. The extent of glucose fluctuations in patients with AMI in the first 24 h after ICU admission is an essential predictor as to 30-day as well as 1-year mortality. When blood glucose fluctuates more than 88 mg/dl within 24 h, mortality increases significantly with the range of blood glucose fluctuations.

A comparative study of mortality rate in operated elderly patients of fracture neck of femur, within 90 days of surgery before and during COVID-19 pandemic in the Indian population

Fracture neck of the femur is a significant cause of morbidity and mortality in the elderly and surgical interventions are the preferred treatment. The COVID-19 pandemic caused a reduction in operative cases and emphasized non-operative management. We studied the impact of the COVID-19 pandemic on post-operative 90 days mortality of hip fracture in the elderly Indian population. We, retro-prospectively compared data from our hospital over a two-year time frame on a large group. The first confirmed case in Maharashtra was reported on 9th March 2020 in Pune. The cases reported until one year from this date were termed ‘Covid period’ and cases one year before this date were termed ‘Pre-covid period’. After applying exclusion criteria to 638 patients from 2 years of data, 379 patients(208 in Pre-covid and 171 in Covid period) were included and analyzed for mortality rate and secondary outcomes.The pandemic caused a statistically significant increase in postoperative 90 days mortality in the elderly by 75.7% compared to pre-covid mortality. The decrease in incidence of operated fracture neck femur was non-significant during Covid compared to incidence in pre-covid. Pneumonia caused six times more mortality during Covid period.The COVID-19 pandemic caused a statistically significant increase in postoperative mortality. Pneumonia was the significant cause of death in Covid period and should be diagnosed and treated early. A specific subset of the consent process is a must in elderly neck femur fracture undergoing surgery and shared guidelines of this study will help in the decision-making process of future covid pandemic situations.

Mortality associated with carbapenem resistance in Klebsiella pneumoniae bloodstream infection: A propensity score-matched study.

Klebsiella pneumoniae are common pathogens causing bloodstream infection (BSI) that increasingly express carbapenem resistance worldwide. To date, no study has precisely investigated the impact of carbapenem resistance in K. pneumoniae (CRKP) BSI on mortality. This retrospective study included 87 patients with CRKP BSI and 321 patients with carbapenem-susceptible K. pneumoniae (CSKP) BSI from 2015 to 2020. Propensity score analyses with stabilized inverse probability of treatment weighting (IPTW-S) was applied to balance covariates. The hazard ratio for 30-day mortality associated with carbapenem resistance was estimated using Cox regression and Kaplan-Meier curves. The 30-day crude mortality rates were 43.7% in patients with CRKP BSI and 17.8% in patients with CSKP BSI (P < .001). Age ≥55 years, underlying hematological malignancies and hemodialysis were independently associated with mortality in CRKP BSI. A skin or soft-tissue infection source, urinary catheter, and underlying chronic obstructive pulmonary disease were predictors of mortality in CSKP BSI. The group characteristics were well balanced after IPTW-S. The adjusted hazard ratio for 30-day mortality for CRKP BSI was 1.607 (interquartile range, 0.814-3.171). Carbapenem resistance was not associated with a significant increase in 30-day mortality in KP BSI; patient and disease factors were primary determinants of outcomes.

Mortality for Time-Sensitive Conditions at Urban vs Rural Hospitals During the COVID-19 Pandemic

COVID-19 pandemic-related disruptions to the health care system may have resulted in increased mortality for patients with time-sensitive conditions. To examine whether in-hospital mortality in hospitalizations not related to COVID-19 (non-COVID-19 stays) for time-sensitive conditions changed during the pandemic and how it varied by hospital urban vs rural location. This cohort study was an interrupted time-series analysis to assess in-hospital mortality during the COVID-19 pandemic (March 8, 2020, to December 31, 2021) compared with the prepandemic period (January 1, 2017, to March 7, 2020) overall, by month, and by community COVID-19 transmission level for adult discharges from 3813 US hospitals in the State Inpatient Databases for the Healthcare Cost and Utilization Project. The COVID-19 pandemic. The main outcome measure was in-hospital mortality among non-COVID-19 stays for 6 time-sensitive medical conditions: acute myocardial infarction, hip fracture, gastrointestinal hemorrhage, pneumonia, sepsis, and stroke. Entropy weights were used to align patient characteristics in the 2 time periods by age, sex, and comorbidities. There were 18 601 925 hospitalizations; 50.3% of patients were male, 38.5% were aged 18 to 64 years, 45.0% were aged 65 to 84 years, and 16.4% were 85 years or older for the selected time-sensitive medical conditions from 2017 through 2021. The odds of in-hospital mortality for sepsis increased 27% from the prepandemic to the pandemic periods at urban hospitals (odds ratio [OR], 1.27; 95% CI, 1.25-1.29) and 35% at rural hospitals (OR, 1.35; 95% CI, 1.30-1.40). In-hospital mortality for pneumonia had similar increases at urban (OR, 1.48; 95% CI, 1.42-1.54) and rural (OR, 1.46; 95% CI, 1.36-1.57) hospitals. Increases in mortality for these 2 conditions showed a dose-response association with the community COVID-19 level (low vs high COVID-19 burden) for both rural (sepsis: 22% vs 54%; pneumonia: 30% vs 66%) and urban (sepsis: 16% vs 28%; pneumonia: 34% vs 61%) hospitals. The odds of mortality for acute myocardial infarction increased 9% (OR, 1.09; 95% CI, 1.06-1.12) at urban hospitals and was responsive to the community COVID-19 level. There were significant increases in mortality for hip fracture at rural hospitals (OR, 1.32; 95% CI, 1.14-1.53) and for gastrointestinal hemorrhage at urban hospitals (OR, 1.15; 95% CI, 1.09-1.21). No significant change was found in mortality for stroke overall. In this cohort study, in-hospital mortality for time-sensitive conditions increased during the COVID-19 pandemic. Mobilizing strategies tailored to the different needs of urban and rural hospitals may help reduce the likelihood of excess deaths during future public health crises.

DIAGNOSTIC IMAGING OF CHRONIC OBSTRUCTIVE PULMONARY DISEASE: A TEN YEARS SYSTEMATIC REVIEW

Background: Exacerbations of chronic obstructive pulmonary disease (COPD) impose a great burden on patients’ quality of life and healthcare systems. In addition to causing significant increases in mortality and disease progression, exacerbations of COPD amount to $18 billion in direct costs annually, as well as further spending associated with care and losses in productivity. Newer modalities such as OCT and MRI have distinct advantages to CT in such areas as image resolution and functional assessment of lung tissue. The aim: The aim of this study to show about diagnostic imaging of chronic obstructive pulmonary disease. Methods: By the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) 2020, this study was able to show that it met all of the requirements. This search approach, publications that came out between 2014 and 2024 were taken into account. Several different online reference sources, like Pubmed, SagePub, and Google Scholar were used to do this. It was decided not to take into account review pieces, works that had already been published, or works that were only half done. Result: In the PubMed database, the results of our search get 100 articles, whereas the results of our search on SagePub get 1608 articles, on Google Scholar 3870 articles. Records remove before screening are 4887, so we get 691 articles fos screening. After we screened based on record exclude, we compiled a total of 10 papers. We included five research that met the criteria. Conclusion: Imaging and image analysis offers new insight into pulmonary disease processes that were previously available only on tissue necropsy. Current techniques can offer detailed measures of lung structure and with newer modalities previously immeasurable things like regional lung function. Imaging in the context of clinical investigation may offer the ability to define more homogeneous subsets of subjects with COPD and to potentially provide an intermediate biomarker of disease progression in lieu of a declining FEV.

Chronic Obstructive Pulmonary Disease Mortality and Hospitalization during the COVID-19 Pandemic Compared with before the Pandemic: A Systematic Review and Meta-Analysis.

This study aimed to assess the impact of the pandemic on hospitalization and mortality rates among patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD). We conducted a systematic search across three medical databases for studies comparing the AECOPD mortality and hospitalization rates during the COVID-19 pandemic with those before the pandemic, up until December 2023. Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses and Meta-analysis of Observational Studies in Epidemiology guidelines, we performed a meta-analysis with a random-effects model to pool odds ratios (ORs), 95% confidence intervals (CIs), and heterogeneity (I2). From 4689 records, 21 studies met our inclusion criteria. Our analysis revealed a significant increase in in-hospital mortality during the pandemic (pooled OR = 1.27, 95% CI = 1.17-1.39, I2 = 50%). Subgroup analysis highlighted a more pronounced mortality risk in single-center studies and smaller populations. Conversely, hospitalization rates for AECOPD significantly declined during the pandemic (pooled OR = 0.39, 95% CI = 0.18-0.85, I2 = 99%). The study demonstrates that during the COVID-19 pandemic, there was a substantial decrease in hospital admissions for AECOPD and an increase in in-hospital deaths. This shows that better healthcare plans and pandemic preparedness are needed to help people with chronic conditions.

Outcomes for Pediatric Oncology and Hematopoietic Stem Cell Transplantation Patients Who Undergo Tracheostomy Placement: A Pediatric Health Information System Database Cohort Study, 2009-2020.

To describe the epidemiology, surgical complications, and long-term outcomes after tracheostomy in pediatric oncology and/or hematopoietic stem cell transplantation (HSCT) patients in U.S. Children's Hospitals. Retrospective cohort from the Pediatric Health information System (PHIS) database, 2009-2020. The PHIS dataset incorporates data from 48 pediatric hospitals in the Children's Hospital Association. Patients 0-21 years old with an oncologic diagnosis and/or underwent HSCT, received a tracheostomy, and were discharged from hospital between January 1, 2009, and December 31, 2020. None. There were 1061 patients included in the dataset, and 217 (20.5%) had undergone HSCT. The annual prevalence in tracheostomy usage did not change over the study period. The majority of patients (62.2%) underwent tracheostomy early (< 30 d) in the admission and those who underwent the procedure later (> 90 d) had a significant increase in mortality (52.6% vs. 17.6%; p < 0.001) and mechanical ventilation (MV) at discharge (51.9% vs. 24.5%; p < 0.001) compared with the early tracheostomy patients. Complications reported included tracheostomy site bleeding (< 1%) and infection (24%). The overall rate of MV at discharge was 32.6% and significantly associated with chronic lung (adjusted odds ratio [OR], 1.54; 95% CI, 1.03-2.32) and acute lung disease (OR, 2.18; 95% CI, 1.19-3.98). The overall rate of mortality was 19.6% within the cohort and significantly associated with HSCT (OR, 5.45; 95% CI, 3.88-7.70), diagnosis of sepsis (OR, 2.09; 95% CI, 1.28-3.41), and requirement for renal replacement therapy (OR, 2.76; 95% CI, 1.58-4,83). This study demonstrated a static prevalence of tracheostomy placement in the cohort population relative to the increasing trends in other reported groups. Regardless of underlying diagnosis, the study patients incurred substantial morbidity and mortality. However, tracheostomy specific complication rates were comparable with that of the general pediatric population and were not associated with increased odds of mortality within this population.

Traumatic Brain Injury: Current Trends Towards the Increase of the Number of Cases and Its Diagnosis

Introduction The global medical community calls traumatic brain injury (TBI) a "silent epidemic" because the latter causes a significant increase in mortality and disability more than any other mechanical injury. Although today's world achievements demonstrate powerful technical capabilities for accurate diagnosis of the time of occurrence and mechanism of TBI, however, the commission examination departments of the forensic medical examination bureau are considering more and more cases of diagnostic errors made by forensic medical experts during autopsies , which later caused protracted legal proceedings.&#x0D; Aim. In this study, we aimed to evaluate the modern diagnostic possibilities of methods for verifying the diagnosis and the time formation of TBI.&#x0D; Methods. Literary data on the prevalence and methods of diagnosing TBI at the present time were analyzed.&#x0D; Results. The degree and severity of TBI, as well as its course, after the initial mechanical injury depends on many factors. In the last decade, there has been an intensification of research on protein biomarkers based on biofluids (blood, cerebrospinal fluid) for intravitality diagnosis. However, not all markers provide reliable information that would correlate with the presence of TBI. Until now, the "gold standard" of diagnosis is an autopsy, next to which radiological studies are effectively used.&#x0D; Conclusion.&#x0D; Taking into account the global statistical data, postmortem diagnosis of TBI is an important issue of forensic traumatology, which requires a careful approach.&#x0D;

TGF-β3 increases the severity of radiation-induced oral mucositis and salivary gland fibrosis in a mouse model

Purpose Toxicities from head and neck (H&N) radiotherapy (RT) may affect patient quality of life and can be dose-limiting. Proteins from the transforming growth factor beta (TGF-β) family are key players in the fibrotic response. While TGF-β1 is known to be pro-fibrotic, TGF-β3 has mainly been considered anti-fibrotic. Moreover, TGF-β3 has been shown to act protective against acute toxicities after radio- and chemotherapy. In the present study, we investigated the effect of TGF-β3 treatment during fractionated H&N RT in a mouse model. Materials and methods 30 C57BL/6J mice were assigned to three treatment groups. The RT + TGF-β3 group received local fractionated H&N RT with 66 Gy over five days, combined with TGF-β3-injections at 24-hour intervals. Animals in the RT reference group received identical RT without TGF-β3 treatment. The non-irradiated control group was sham-irradiated according to the same RT schedule. In the follow-up period, body weight and symptoms of oral mucositis and lip dermatitis were monitored. Saliva was sampled at five time points. The experiment was terminated 105 d after the first RT fraction. Submandibular and sublingual glands were preserved, sectioned, and stained with Masson’s trichrome to visualize collagen. Results A subset of mice in the RT + TGF-β3 group displayed increased severity of oral mucositis and increased weight loss, resulting in a significant increase in mortality. Collagen content was significantly increased in the submandibular and sublingual glands for the surviving RT + TGF-β3 mice, compared with non-irradiated controls. In the RT reference group, collagen content was significantly increased in the submandibular gland only. Both RT groups displayed lower saliva production after treatment compared to controls. TGF-β3 treatment did not impact saliva production. Conclusions When repeatedly administered during fractionated RT at the current dose, TGF-β3 treatment increased acute H&N radiation toxicities and increased mortality. Furthermore, TGF-β3 treatment may increase the severity of radiation-induced salivary gland fibrosis.

Impact of multimorbidity patterns on outcomes and treatment in patients with coronary artery disease.

With an aging population and better survival rates, coronary artery disease (CAD) with multimorbidity has become more prevalent, complicating treatment and impacting life quality and longevity. This study identifies multimorbidity patterns in CAD patients and their effect on clinical outcomes, emphasizing treatment strategies. The study analysed data from the DCEM registry (173 459 patients) and BleeMACS cohort (15 401 patients) to categorize CAD patients into three multimorbidity patterns. The focus was on how these patterns influence outcomes, especially concerning the efficacy and safety of dual antiplatelet therapy (DAPT). The study identified three distinct multimorbidity patterns: Class 1 encompassed cardiovascular-kidney-metabolic comorbidities indicating the highest risk; Class 2 included hypertension-dyslipidaemia comorbidities, reflecting intermediate risk; and Class 3 involved non-specific comorbidities, indicating the lowest risk. Class 1 patients demonstrated a six-fold increase in in-hospital mortality and a four-fold increase in severe in-hospital complications compared with Class 3. Over a 1-year period, Class 1 was associated with the highest risk, displaying a significant increase in all-cause mortality [adjusted hazard ratio (HR) 1.87, 95% confidence interval (CI) 1.52-2.31, P < 0.001] and a notable risk for major bleeding (adjusted HR 1.74, 95% CI 1.36-2.24, P < 0.001) compared with Class 3. The use of DAPT, particularly aspirin combined with clopidogrel, significantly reduced the 1-year all-cause mortality in Class 1 patients (adjusted HR 0.60, 95% CI 0.37-0.98, P = 0.04) without increasing in major bleeding. Coronary artery disease patients with a cardiovascular-kidney-metabolic profile face the highest mortality risk. Targeted DAPT, especially aspirin and clopidogrel, effectively lowers mortality without significantly raising bleeding risks. DCEM registry (NCT05797402) and BleeMACS registry (NCT02466854).

Drug treatment of portal hypertension - Current approaches

AbstractIn western industrialized nations, liver cirrhosis is the most common cause of portal hypertension. Portal hypertension is defined by a persistent increase in portal pressure &gt;7mmHg. An HVPG &gt;10mmHg defines the presence of clinically significant portal hypertension. The presence of clinically significant portal hypertension (CSPH) in patients with liver cirrhosis is a key risk factor for the transition from a compensated to a decompensated stage of the disease. CPSH can be determined invasively by measuring HPVG or noninvasively by measuring liver stiffness, platelet count and spleen stiffness. If acute decompensation manifests itself (e.g. ascites, esophageal variceal bleeding), this is associated with a significant increase in patient morbidity and mortality. Non-selective beta blockers (NSBB) are the standard medical therapy for portal hypertension in the presence of CSPH. Due to the additional α1-antiadrenergic effects, carvedilol leads to a greater reduction in portal pressure compared to traditional NSBB (e.g. Propanolol). In patients with compensated liver cirrhosis, carvedilol is better than traditional NSBB at reducing the risk of variceal bleeding and the occurrence of hepatic decompensation. The early identification of CSPH and evaluation of drug therapy to reduce portal hypertension is therefore crucial to improve the prognosis of patients.

Projections and patterns of heat-related mortality impacts from climate change in Southeast Asia

This study aims to investigate the impact of climate change on heat-related mortality in Southeast Asia in the future. The ensemble mean from five General Circulation Models (GCMs) including the Flexible Global Ocean-Atmosphere-Land System Model: Grid-Point Version 3 (FGOALS-g3), Max Planck Institute Earth System Model Version 1.2 (MPI-ESM1-2-LR), EC-Earth3, The Meteorological Research Institute Earth System Model Version 2.0 (MRI-ESM2-0), and Geophysical Fluid Dynamics Laboratory Earth System Model Version 4 (GFDL-ESM4) was used to project severe temperatures and heat indices in Southeast Asia under the Coupled Model Intercomparison Projects Phase 6 (CMIP6). This data was used to correlate with mortality data from the Global Burden of Disease database to quantify heat-related mortality in the region. The ensemble mean results show a reasonable level of accuracy in capturing temperature patterns in the Southeast Asian region with an R2 of 0.96, root mean square error (RMSE) of 0.84 and a standard deviation of residual (SDR) of 0.02. When compared to the baseline (1990–2019), temperature extreme indices are rising across all climatic scenarios, with a substantial increase in the SSP3–7.0 and SSP5–8.5 scenarios, ranging from 10% to 50% over the regions, with the heat index predicted to peak in the middle of the century. The two low-emission scenarios, SSP1-2.6 and SSP2-4.5, on the other hand, anticipate more moderate increases, indicating a potentially less severe impact on the region. As a result, under high-emission scenarios, there is expected to be a significant increase in heat-related mortality across Southeast Asia. The expected impact is estimated to affect between 200 and 300 people per 100,000 people from 2030 to 2079, accordingly. Our results highlight the critical need to address health-related impacts of climate change in this region.