Search

BACKGROUND: Given the paucity of epidemiological studies on thyroid storm, we aimed to estimate the incidence rate and case fatality of thyroid storm in Germany based on a large claims database. METHODS: Using the German Pharmacoepidemiological Research Database (GePaRD) we identified patients with at least one inpatient discharge diagnosis of thyroid storm (International Statistical Classification of Diseases and Related Health Problems, 10th revision, German modification; ICD-10-GM E05.5) between 2007 and 2017 and calculated age-standardized and age-specific incidence rates in males and females (no age restriction). We defined deaths occurring within 30 days of the diagnosis as thyroid storm-associated and determined case fatality by sex and age group. Point estimates were reported with confidence intervals [CIs]. RESULTS: We identified 1690 patients with an incident diagnosis of thyroid storm. Of these, 72% were females (n = 1212). The mean age was 60 years (standard deviation: 18.6 years). The age-standardized incidence rate per 100,000 persons per year was 1.4 [CI 1.2–1.7] in females and 0.7 [CI 0.5–0.9] in males. In females ≤60 and >60 years of age, the incidence rate was 0.9 [CI 0.9–1.0] (males: 0.4 [CI 0.3–0.4]) and 2.7 [CI 2.5–2.9] (males: 1.7 [CI 1.5–1.9]), respectively. The case fatality of thyroid storm was 1.4% [CI 0.6–2.8] in females ≤60 years and 10.9% [CI 8.6–13.7] in females >60 years. In males, the case fatality was 1.0% [CI 0.2–4.0] in those aged ≤60 years and 16.7% [CI 12.6–21.7] in those >60 years. CONCLUSIONS: Incidence rates of thyroid storm were markedly higher in females than in males and were three times higher in persons >60 years compared with younger age groups. The case fatality was below 2% in persons aged ≤60 years and markedly higher in older persons (males: 17 times and females: 8 times).

Jing Han,1,&ast; Jie Liu,1– 4,&ast; Yakun Wu,1,5,&ast; Qiuxing Lin,1– 3,5 Dandan Guo,1 Xin Zhang,1 Jun Tu,1– 3,5 Xianjia Ning,1– 3,5 Jinghua Wang1– 3,5 1Department of Neurology, Tianjin Medical University General Hospital, Tianjin, 300052, People’s Republic of China; 2Laboratory of Epidemiology, Tianjin Neurological Institute, Tianjin, 300052, People’s Republic of China; 3Tianjin Neurological Institute, Key Laboratory of Post-Neuroinjury Neuro-Repair and Regeneration in Central Nervous System, Ministry of Education and Tianjin City, Tianjin, 300052, People’s Republic of China; 4Center of Clinical Epidemiology & Evidence-Based Medicine, The Jizhou People’s Hospital, Tianjin, 301999, People’s Republic of China; 5Department of Neurology, Tangshan Gongren Hospital, Tangshan, 063000, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Jinghua Wang; Xianjia Ning Email jwang3@tmu.edu.cn; xning@tmu.edu.cnObjective: Although stroke mortality has remained stable over the past decade, the long-term trends of stroke burden are scarce in China, especially in low-income populations. Thus, we aimed to explore the secular trends in the prognosis of stroke in a low-income population in China.Methods: This was a population-based stroke surveillance study that included all of the participants in the Tianjin Brain Study. Stroke management and outcomes were evaluated for all stroke patients. Trends in the burden of stroke were assessed as annual percentage changes.Results: Overall, 1462 stroke cases occurred from 1992 to 2018, and 58.7% of patients were male. The rates of diagnosis by neuroimaging and of hospitalization increased noticeably across sexes and ages for all stroke types, and the greatest increases were observed among elderly women; diagnosis by neuroimaging increased by 4.7% and the rate of hospitalization increased by 12.4% (all P< 0.001). Stroke fatality decreased by 3.7% annually among those aged < 65 years and by 3.1% among patients aged ≥ 65 years; the corresponding rates were 7.4% and 3.5%, respectively, for women. The recurrence rate of ischemic stroke significantly decreased among all men, by 9.6% for those aged < 65 years and by 3.1% for those aged ≥ 65 years; however, for women, this rate only significantly decreased for those aged ≥ 65 years.Conclusion: Our findings suggest that the allocation of medical resources has improved over the past decades. However, it is crucial to enhance secondary stroke prevention for women aged < 65 years by controlling risk factors in low-income populations.Keywords: stroke burden, case fatality, recurrence, trends, low-income population

Background To provide age- and sex-specific incidence and case fatality rates for non-traumatic aneurysmal subarachnoid hemorrhage (aSAH) in Norway. We also studied time trends in incidence and case fatality, as well as predictors of death following aSAH. Methods A nationwide study using discharge data for patients admitted with aSAH between 2008 and 2014. Results A total of 1732 patients with aSAH were included. The mean age was 60 years (SD 14) and 63% were females. Crude annual incidence was 5.7 per 100,000 person-years (95% CI 5.4–6.0) and was higher in females (6.3 per 100,000, 95% CI 5.9–6.7) compared with males (4.9 per 100,000, 95% CI 4.5–5.3). The annual decline in aSAH incidence was 3.2% per year (p = 0.007). The cumulative proportions of fatalities at days 30, 90, and 1 year were 22%, 25%, and 37%, respectively. The 30-day mortality rate did not change during the study period. Age (HR 0.7–2.2) and aneurysms in the posterior circulation (HR 1.7, 95% CI 1.3–2.3, p = 0.001) were associated with higher 30-day case fatality following aSAH, while aneurysm repair (HR 0.2, 95% CI 0.2–0.3, p Conclusions The incidence of aSAH declined in Norway between 2008 and 2014. Case fatality following aSAH continues to be high, and the 30-day mortality during the study period was unchanged. Increasing age and aneurysms in the posterior circulation were associated with increased risk of death within 30 days following aSAH.

BACKGROUND Eclampsia is a life-threatening emergency & requires proper treatment to decrease maternal morbidity & mortality. We wanted to determine the incidence of maternal mortality associated with eclampsia, modes of death in eclampsia & demographic profile of women influencing the maternal death. METHODS This retrospective longitudinal study was done in the Department of Obstetrics & Gynaecology of Malda Medical College & Hospital for a period of three years from 1 st January, 2017 to 31st December, 2019. Total maternal deaths during this period was 186 & total eclampsia deaths during this period was 62. Records of death & demographic profiles were retrieved from the Medical Record Library of aforementioned hospital. RESULTS Eclampsia accounted for 33.33% of total maternal deaths (186) with a case fatality rate of 4.092%. Commonest mode of death in eclampsia is pulmonary oedema. Eclampsia death commonly occurs in younger age & in primigravida. Eclampsia death is also common in unbooked & lower socioeconomic status. Antepartum eclampsia contributes to most of the eclamptic deaths. CONCLUSIONS Eclampsia still remains the major cause of maternal death in India in unbooked & unsupervised pregnancies & deliveries. Hence, regular antenatal check-up, strict vigilance & appropriate treatment during deliveries may reduce maternal deaths in eclampsia.

Background Influenza is an acute infection affecting all age groups; however, elderly patients are at an increased risk. We aim to describe the clinical characteristics and the circulation of influenza virus types in elderly patients admitted for severe acute respiratory infection (SARI) to a tertiary care hospital in Bucharest, Romania, part of the I‐MOVE+ hospital network. Methods We conducted an active surveillance study at the National Institute for Infectious Diseases “Prof. Dr Matei Balș,” Bucharest, Romania, during three consecutive influenza seasons: 2015/16, 2016/17, and 2017/18. All patients aged 65 and older admitted to our hospital for SARI were tested for influenza by PCR. Results A total of 349 eligible patients were tested during the study period, and 149 (42.7%) were confirmed with influenza. Most patients, 321 (92.5%) presented at least one underlying condition at the time of hospital admission, the most frequent being cardiovascular disease, 270 (78.3%). The main influenza viral subtype circulating in 2015/16 was A(H1N1)pdm09, followed by A(H3N2) in 2016/17 and B influenza in 2017/18. Case fatality was highest in the 2015/16 season (3.7%), 0% in 2016/17, and 1.0% in 2017/18. Vaccination coverage in elderly patients with SARI from our study population was 22 (6.3%) over the three seasons. Conclusions Our study has highlighted a high burden of comorbidities in elderly patients presenting with SARI during winter season in Romania. The influenza vaccine coverage rate needs to be substantially increased in the elderly population, through targeted interventions.

����������������. �� ������������ ���������������� ���������������������������� ���������� 500 ������. �������������� ������������������, ���������������� �������������� ���������� 3000 �������������� (20,1 ������������ ���� 100 ������. ������������������). ������������������ ���������������� ������������������ ���������� �� ������������������ ������������ ��������������������. ������������������ ���������������������������� ���������������������������� ���������������������� �� �������������������� ���� ������ ���� ������������������ ����������������������. �������� ������������������������ ������������ ������������������ �� ���������������� �������������������� ���� ������������������ ���������� ������������������ ���������������� �������������� �� ���������������� ���������������� ������������ ������������������������������ ���������������������� COVID-19. ������������������ �� ������������ ������������������������. ���������������������������� ������������ ������ �������������� �������� ���������� ���� �������������� ������������������������ ���������������������������� �������������� ���������������� ��������������. ������ �������� ������������������ �������������������� ���������� ���������������������� �� ������������������ �������������� �������������������� ������������������, �� �������������� �� �������������� ���������������� ������������ acme. exe (CDC, USA) ���������������������������� ���������������������������� ������������������������������ ���� ���������������� ������-��. �������������������� �� ���� ��������������������. �������� �������������� �������������������� ���� ������������������ ������������������ �� �������������������� �������������������� ���� COVID-19, ������ ������������������ ���� ������������������ ������������������ ������������������ ������������������ ���� ������������ ������������ ������������������������ SARS CoV-2 (U07.1-U07.2). ���������� �������������������� �������������������� �� ���������� ���� �������������� 2021 �������� ���������������� ���� ���������������� ������ ���� ������������������������ ���������������� �������������������� ���������������������� ���������������������� ���������������� �� �������������������� ���� ���������������� ��������������. ��������������������. �������������������� �������������������������� ������������������ �������������������� ������������������������������ �������������������� ������������������������������ ���������������������� ���������������������������� �������������� ������������, ���������������������� �� �������������� ������������������������ ���������������������������� �������������� ���������������� ��������������, �� ���������� �� ���������������� ������������ ���������������� ���������������������� �������������������������� ������������ ������������. ������������������������ ���������������������� ������������������������ ���������������� �� ���������������� ������ ���� ������������������ �������������������������� �������������������� �� ���������� ���������������������������� ���������������� ������������������������������ ������., Introduction. In Russia, more than 500 thousand cases of pneumonia are annually registered, about 3000 people die every year (20.1 cases per 100 thousand population). Pneumonia ranks fourth in the structure of causes of death. The incidence of community-acquired pneumonia and mortality from them in certain territories are being studied. The research purpose is to assess the extent and dynamics of mortality from pneumonia among the population of the Tula region in the context of a pandemic of a new coronavirus disease COVID-19. Materials and research methods. Statistical data for analysis were taken from the network regional information system of the Tula region. At the same time, the primary input materials were loaded into the regional register of population mortality, in which, using the external module acme. exe (CDC, USA) was automatically transcoded according to the ICD-X rules. Results and its discussion. Peaks in pneumonia deaths coincided with spikes in deaths from COVID-19, indicating a possible underestimation of spikes from the new SARS CoV-2 strain of coronavirus (U07.1-U07.2). More stable indicators from March to December 2021 depended on the measures taken to equip medical institutions with modern medical equipment and improve its development by doctors. Conclusion. The necessity of equipping healthcare institutions with the means of automatically determining the initial cause of death, built into the network regional information system of the Tula region, as well as training doctors in the rules for coding multiple causes of death, was determined. The possibility of monitoring the situation and taking measures to improve the reliability of statistics in order to take organizational measures in a timely manner was confirmed.

Timely arrival at a hospital capable of percutaneous coronary intervention (PCI) is critical in treating acute myocardial infarction (AMI). We examined the association between driving time to the nearest PCI-capable hospital and case fatality among AMI patients. A total of 142,474 AMI events during 2013–2019 from the Beijing Cardiovascular Disease Surveillance System were included in this cross-sectional study. The driving time from the residential address to the nearest PCI-capable hospital was calculated. Logistic regression was used to estimate the risk of AMI death associated with driving time. In 2019, 54.5% of patients lived within a 15-min drive to a PCI-capable hospital, with a higher proportion in urban than peri-urban areas (71.2% vs. 31.8%, p < 0.001). Compared with patients who had driving times ≤15 min, the adjusted odds ratios (95% CI, p value) for AMI fatality risk associated with driving times 16–30, 31–45, and >45 min were 1.068 (95% CI 1.033–1.104, p < 0.001), 1.189 (95% CI 1.127–1.255, p < 0.001), and 1.436 (95% CI 1.334–1.544, p < 0.001), respectively. Despite the high accessibility to PCI-capable hospitals for AMI patients in Beijing, inequality between urban and peri-urban areas exists. A longer driving time is associated with an elevated AMI fatality risk. These findings may help guide the allocation of health resources.

Objective To describe utilization of health services for, and case fatality from, abortion in Mexico. Method A historical cohort study using a census of state‐level aggregate hospital discharge and primary care clinic data across Mexico's 32 states from January 2000 to December 2016. Abortive events and changes over time in utilization per 1000 women aged 15–44 years, and case fatality per 100 000 abortion‐related events were described by year, health sector, and state. Associations of location (Mexico City vs 31 other states) and time (Mexico City implemented legal abortion services in 2007) with outcomes were tested by linear regression, controlling for secular trends. Results The national abortion utilization rate was 6.7 per 1000 women in 2000, peaked at 7.9 in 2011, and plateaued to 7.0 in 2016. In Mexico City, utilization peaked at 16.7 in 2014 and then plateaued. Nationwide, the case‐fatality rate declined over time from 53.7 deaths per 100 000 events in 2000 to 33.0 in 2016. Case fatality declined more rapidly in Mexico City than in the other 31 states to 12.3 in 2015. Conclusion Case fatality from abortive events has decreased across Mexico. Where abortion became legal, utilization increased sharply but plateaued afterward., In Mexico City, abortion services utilization increased until 2014 and then plateaued. Case fatality due to abortion decreased nationally and more sharply in Mexico City.

Background Escherichia coli is the most common cause of bloodstream infections (BSIs) and mortality is an important aspect of burden of disease. Using a multinational population-based cohort of E. coli BSIs, our objectives were to evaluate 30-day case fatality risk and mortality rate, and determine factors associated with each. Methods During 2014–2018, we identified 30-day deaths from all incident E. coli BSIs from surveillance nationally in Finland, and regionally in Sweden (Skaraborg) and Canada (Calgary, Sherbrooke, western interior). We used a multivariable logistic regression model to estimate factors associated with 30-day case fatality risk. The explanatory variables considered for inclusion were year (2014–2018), region (five areas), age ( Results From 38.7 million person-years of surveillance, we identified 2961 30-day deaths in 30,923 incident E. coli BSIs. The overall 30-day case fatality risk was 9.6% (2961/30923). Calgary, Skaraborg, and western interior had significantly increased odds of 30-day mortality compared to Finland. Hospital-onset and 3GC-resistant E. coli BSIs had significantly increased odds of mortality compared to community-onset and 3GC-susceptible. The significant association between age and odds of mortality varied with sex, and contrasts were used to interpret this interaction relationship. The overall standardized 30-day mortality rate was 8.5 deaths/100,000 person-years. Sherbrooke had a significantly lower 30-day mortality rate compared to Finland. Patients that were either ≥70-years-old or male both experienced significantly higher mortality rates than those Conclusions In our study populations, region, age, and sex were significantly associated with both 30-day case fatality risk and mortality rate. Additionally, 3GC resistance and location of onset were significantly associated with 30-day case fatality risk. Escherichia coli BSIs caused a considerable burden of disease from 30-day mortality. When analyzing population-based mortality data, it is important to explore mortality through two lenses, mortality rate and case fatality risk.

Background Mortality is a key component of the natural history of COVID-19 infection. Surveillance data on COVID-19 deaths and case diagnoses are widely available in the public domain, but they are not used to model time to death because they typically do not link diagnosis and death at an individual level. This paper demonstrates that by comparing the unlinked patterns of new diagnoses and deaths over age and time, age-specific mortality and time to death may be estimated using a statistical method called deconvolution. Methods Age-specific data were analysed on 816 deaths among 6235 cases over age 50 years in Victoria, Australia, from the period January through December 2020. Deconvolution was applied assuming logistic dependence of case fatality risk (CFR) on age and a gamma time to death distribution. Non-parametric deconvolution analyses stratified into separate age groups were used to assess the model assumptions. Results It was found that age-specific CFR rose from 2.9% at age 65 years (95% CI:2.2 – 3.5) to 40.0% at age 95 years (CI: 36.6 – 43.6). The estimated mean time between diagnosis and death was 18.1 days (CI: 16.9 – 19.3) and showed no evidence of varying by age (heterogeneity P = 0.97). The estimated 90% percentile of time to death was 33.3 days (CI: 30.4 – 36.3; heterogeneity P = 0.85). The final age-specific model provided a good fit to the observed age-stratified mortality patterns. Conclusions Deconvolution was demonstrated to be a powerful analysis method that could be applied to extensive data sources worldwide. Such analyses can inform transmission dynamics models and CFR assessment in emerging outbreaks. Based on these Australian data it is concluded that death from COVID-19 occurs within three weeks of diagnosis on average but takes five weeks in 10% of fatal cases. Fatality risk is negligible in the young but rises above 40% in the elderly, while time to death does not seem to vary by age.

As COVID-19 is posing a serious threat to global health, the emerging mutation in SARS-CoV-2 genomes, for example, N501Y substitution, is one of the major challenges against control of the pandemic. Characterizing the relationship between mutation activities and the risk of severe clinical outcomes is of public health importance for informing the healthcare decision-making process. Using a likelihood-based approach, we developed a statistical framework to reconstruct a time-varying and variant-specific case fatality ratio (CFR), and to estimate changes in CFR associated with a single mutation empirically. For illustration, the statistical framework is implemented to the COVID-19 surveillance data in the United Kingdom (UK). The reconstructed instantaneous CFR gradually increased from 1.0% in September to 2.2% in November 2020 and stabilized at this level thereafter, which monitors the mortality risk of COVID-19 on a real-time basis. We identified a link between the SARS-CoV-2 mutation activity at molecular scale and COVID-19 mortality risk at population scale, and found that the 501Y variants may slightly but not significantly increase 18% of fatality risk than the preceding 501N variants. We found no statistically significant evidence of change in COVID-19 mortality risk associated with 501Y variants, and highlighted the real-time estimating potentials of the modelling framework.

As of October 2020, there are >1 million documented deaths with COVID‐19. Excess deaths can be caused by both COVID‐19 and the measures taken. COVID‐19 shows extremely strong risk stratification across age, socioeconomic factors, and clinical factors. Calculation of years‐of‐life‐lost from COVID‐19 is methodologically challenging and can yield misleading over‐estimates. Many early deaths may have been due to suboptimal management, malfunctional health systems, hydroxychloroquine, sending COVID‐19 patients to nursing homes, and nosocomial infections; such deaths are partially avoidable moving forward. About 10% of the global population may be infected by October 2020. Global infection fatality rate is 0.15‐0.20% (0.03‐0.04% in those

Background: This study aimed to present the development process and characteristics of the Korean Registry of Acute Myocardial Infarction for Regional Cardiocerebrovascular Centers (KRAMI-RCC). Methods: We developed KRAMI-RCC, a web-based registry for patients with AMI. Patients from 14 RCCs were registered for more than three years from July 2016. It includes an automatic error-checking system, and user training and on-site monitoring are performed to manage data quality. Results: A total of 11,700 AMI patients were registered in KRAMI-RCC over three years (73.9% men). The proportions of patients with ST-elevation and non-ST-elevation myocardial infarction at discharge were 43.4% and 56.6%, respectively. Of the total three-year patients, 5.6% died in the hospital, and 4.4% died 12 months after discharge. The case fatality within 12 months was 9.7%. Pre-hospital care data showed delayed arrival time after onset of symptoms (median 153 min) and low transportation rate by public ambulance (25.2%). Post-hospital care data showed lower participation rate in the second rehabilitation program (16.8%). Conclusions: The recently developed KRAMI-RCC registry has been more focused on pre-hospital and post-hospital data, which will be helpful in understanding the current state of AMI disease management and in making policy decisions to reduce case fatality in Korea.

Rifampicin-Resistant/Multidrug-Resistant Tuberculosis (RR/MDR-TB) is recognized as a major public health concern globally. In Armenia, the proportion of RR/MDR-TB is increasing among all people affected with TB. We conducted a nationwide cohort study involving analysis of programmatic data to investigate the rates of and factors associated with unfavourable treatment outcomes among patients with RR/MDR-TB registered by the national TB programme from 2014 to 2017 in Armenia. We used Cox regression to identify factors associated with the outcome. Among 451 RR/MDR-TB patients, 80% were men and median age was 46 years. Of them, 53 (11.8%) had Extensively Drug-Resistant Tuberculosis (XDR-TB) and 132 (29.3%) had pre-XDR-TB. Almost half (224, 49.7%) of the patients had unfavourable treatment outcome, which included 26.8% Loss To Follow-Up (LTFU), 13.3% failures and 9.5% deaths. In multivariable analysis, people with pre-XDR-TB [adjusted Hazard Ratio [aHR] 3.13, 95% confidence intervals [CI] 2.16-4.55] and XDR-TB (aHR 4.08, 95% CI 2.45-6.79) had a higher risk of unfavourable outcomes. Patients receiving home-based treatment (71/451, 15.7%) and treatment with new drugs (172/451, 38.1%) had significantly lower risk (aHR 0.45, 95% CI 0.28-0.72 and aHR 0.26, 95% CI 0.18-0.39) of unfavourable treatment outcome. The proportion of MDR-TB patients reaching favourable treatment outcome in Armenia was substantially lower than the recommended level (75%). The most common treatment outcome was LTFU indicating the need for further assessment of underlying determinants. Home-based treatment looks promising and future studies are required to see if expanding it to all RR/MDR-TB patients is feasible and cost-effective.

BackgroundThere is limited information on the difference in epidemiology, clinical characteristics and outcomes of the initial outbreak of the coronavirus disease (COVID-19) in Wuhan (the epicenter) and Sichuan (the peripheral area) in the early phase of the COVID-19 pandemic. This study was conducted to investigate the differences in the epidemiological and clinical characteristics of patients with COVID-19 between the epicenter and peripheral areas of pandemic and thereby generate information that would be potentially helpful in formulating clinical practice recommendations to tackle the COVID-19 pandemic.MethodsThe Sichuan & Wuhan Collaboration Research Group for COVID-19 established two retrospective cohorts that separately reflect the epicenter and peripheral area during the early pandemic. The epidemiology, clinical characteristics and outcomes of patients in the two groups were compared. Multivariate regression analyses were used to estimate the adjusted odds ratios (aOR) with regard to the outcomes.ResultsThe Wuhan (epicenter) cohort included 710 randomly selected patients, and the peripheral (Sichuan) cohort included 474 consecutive patients. A higher proportion of patients from the periphery had upper airway symptoms, whereas a lower proportion of patients in the epicenter had lower airway symptoms and comorbidities. Patients in the epicenter had a higher risk of death (aOR=7.64), intensive care unit (ICU) admission (aOR=1.66), delayed time from illness onset to hospital and ICU admission (aOR=6.29 and aOR=8.03, respectively), and prolonged duration of viral shedding (aOR=1.64).ConclusionsThe worse outcomes in the epicenter could be explained by the prolonged time from illness onset to hospital and ICU admission. This could potentially have been associated with elevated systemic inflammation secondary to organ dysfunction and prolonged duration of virus shedding independent of age and comorbidities. Thus, early supportive care could achieve better clinical outcomes.

To evaluate factors associated with tuberculosis (TB) treatment outcomes in human Immunodeficiency Virus-Associated (HIV) TB patients in Armenia, we conducted a nation-wide cohort study using routine programmatic data of all HIV-associated TB patients receiving TB treatment with first- or second-line drugs from 2015 to 2019. Data were obtained from the TB and HIV electronic databases. We analysed occurrence of the combined unfavourable outcome (failure, lost to follow-up, death and not evaluated) and death separately, and factors associated with both outcomes using Cox regression. There were 320 HIV-associated TB patients who contributed a total of 351 episodes of TB treatment. An unfavourable TB treatment outcome was registered in 155 (44.2%) episodes, including 85 (24.2%) due to death, 38 (10.8%) lost to follow up, 13 (3.7%) failure and 19 (5.4%) not evaluated. Multivariable analysis showed that receipt of Antiretroviral Treatment (ART) [ART start before TB treatment: adjusted hazard ratio (aHR)=0.3, 95% confidence interval (CI): 0.2-0.5, aHR=, 95% CI:, 95% CI:, 95% CI:TB meningitis (aHR=4.4, 95% CI: 1.6-11.9) increased the risk. The risk of death was affected by the same factors as above in addition to the low BMI (aHR=2.5, 95% CI: 1.3-4.5) and drug resistance (aHR=2.3, 95% CI: 1.0-5.4). In the subsample of episodes receiving ART, history of interruption of ART during TB treatment increased the risk of unfavourable outcome (aHR=2.1 95% CI: 1.2-3.9), while ART start during TB treatment was associated with lower risk of both unfavourable outcome (within first 8 weeks: aHR: 0.5, 95% CI: 0.3-0.9; after 8 weeks: aHR: 0.4, 95% CI: 0.2-1.0) and death (within first 8 weeks: aHR: 0.2, 95% CI: 0.1-0.4; after 8 weeks: aHR: 0.1, 95% CI: 0.01-0.3). The rates of unfavourable TB treatment outcomes, and death in particular, among HIV-associated TB patients in Armenia are high. Our findings emphasize the protective effect of ART and the importance of proper management of cases complicated by drug resistance or meningitis.

As of October 2020, there are >1 million documented deaths with COVID-19. Excess deaths can be caused by both COVID-19 and the measures taken. COVID-19 shows extremely strong risk stratification across age, socioeconomic factors, and clinical factors. Calculation of years-of-life-lost from COVID-19 is methodologically challenging and can yield misleading over-estimates. Many early deaths may have been due to suboptimal management, malfunctional health systems, hydroxychloroquine, sending COVID-19 patients to nursing homes, and nosocomial infections; such deaths are partially avoidable moving forward. About 10% of the global population may be infected by October 2020. Global infection fatality rate is 0.15-0.20% (0.03-0.04% in those

The Middle East respiratory syndrome coronavirus (MERS-CoV) emerged in 2012. The objective of the study was to describe the epidemiology, risk factors, clinical characteristics, and outcome of MERS-CoV in Qatar. A total of 28 cases of MERS-CoV were identified, corresponding to an incidence of 1.7 per 1,000,000 population. Most patients had a history of contact with camels 15, travel to Kingdom of Saudi Arabia 7 or known contact with individuals with confirmed MERS-CoV infection 7. Majority of patients had acute kidney injury (AKI) 17 and 9 needed renal replacement therapy. All patients were hospitalized, 14 required critical care support. Overall, total of 10 died. The immediate cause of death was multiorgan failure with acute respiratory syndrome (ARDS) 9. MERS-CoV is a rare infection in the State of Qatar. There was no hospital outbreaks or healthcare worker reported infection. The infection causes severe respiratory failure and acute renal failure. Patients with AKI and on ventilator support carry higher risk of mortality.

Background Geographical variations in stroke incidence and case fatality in China have been reported. Nonetheless, pooled estimates in major Chinese regions are unknown. Objective This systematic review and meta-analysis aims to investigate pooled estimates of incidence and short-term case fatality of stroke in Mainland China, Hong Kong, and Macao. Methods Longitudinal studies published in English and indexed in PubMed/MEDLINE, Embase, CINAHL, and Web of Science, or in Chinese and indexed in SinoMed and CQVIP will be targeted. Articles reporting on adults living in China who experience first-ever stroke or die within 1 year from newly onset stroke will be included. The 95% confidence intervals of the event will be estimated using the exact method based on the Poisson distribution. The log incidence rates together with their corresponding log standard errors will be meta-analyzed using DerSimonian and Laird random effects models. Pooled case fatality rates will also be estimated using a random effect model. Time trends in pooled age-standardized stroke incidence and case fatality will be estimated. The heterogeneity of the included studies will be measured using the I2 statistic and meta-regressions will be run to analyze the effect of reported covariates on found heterogeneity. Risk of bias will be examined using the Newcastle-Ottawa Scale. Publication bias will be tested using funnel plots and Egger tests. Sensitivity analysis will be run by risk of bias. Results This study was funded and registered in 2020. The systematic searches, study selections, and quality assessments were completed in July 2021. Data extraction and analysis and manuscript writing are scheduled to be completed by December 2021. Conclusions This will be the first study to provide regional differences in pooled estimates of stroke incidence with case fatality in Mainland China, Hong Kong, and Macao. This study will assist in addressing inequalities in stroke care across China. Trial Registration PROSPERO International Prospective Register of Systematic Reviews CRD42020170724; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=170724 International Registered Report Identifier (IRRID) PRR1-10.2196/32566

Introduction While there is a general agreement that stroke incidence among the elderly is declining in the developed world, there is a concern that it may be increasing among the young. The present study investigates this issue for the Norwegian population for the years 2010–2015. Cerebrovascular accidents (CVAs) for patients younger than 55 years were identified through the Norwegian Patient Registry and the Norwegian Cause-of-death Registry. Methods Negative binomial regression modelling was used to estimate temporal trends in the CVA incidence rates for the young, aged 15–54, with 10-year sub-intervals, and for children below the age of 18. The main outcomes were CVA incidence per 100,000 person-years at risk (PY), 30-day stroke mortality per 100,000 PY, and 30-day case-fatality rates. Results The analysis showed a negative and non-significant temporal trend in the CVA incidence (\documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$p = 0.052$$\end{document}p=0.052) as well as for 30-day mortality (\documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$p = 0.074$$\end{document}p=0.074) for the age group 15–54. Overall, the inclusion of an interaction for age in the bracket 45–54 suggested that any temporal decline is restricted to this age bracket. The analyses of the 10-year age brackets 15–24, 25–34, and 34–45, provided evidence neither for an increase, nor for a decrease, in incidence. Among the children, the estimated temporal coefficients were positive, but non-significant, consistent with a stationary trend. Conclusion Weak statistical evidence was found for a decline in CVA incidence and for overall stroke 30-day case fatality for 15–54 year olds, but the decline was significant only for the 45–54 age band. All results considered, the study suggests a stationary or decreasing temporal trend in CVA incidence and stroke fatality for children (0–18) and young (15–54) in Norway. Even larger data sets are needed to estimate these temporal trends accurately.

Background To determine if tuberculosis (TB) screening improves patient outcomes, we conducted two systematic reviews to investigate the effect of TB screening on diagnosis, treatment outcomes, deaths (clinical review assessing 23 outcome indicators); and patient costs (economic review). Methods Pubmed, EMBASE, Scopus and the Cochrane Library were searched between 1/1/1980-13/4/2020 (clinical review) and 1/1/2010-14/8/2020 (economic review). As studies were heterogeneous, data synthesis was narrative. Findings Clinical review: of 27,270 articles, 18 (n=3 trials) were eligible. Nine involved general populations. Compared to passive case finding (PCF), studies showed lower smear grade (n=2/3) and time to diagnosis (n=2/3); higher pre-treatment losses to follow-up (screened 23% and 29% vs PCF 15% and 14%; n=2/2); and similar treatment success (range 68-81%; n=4) and case fatality (range 3-11%; n=5) in the screened group. Nine reported on risk groups. Compared to PCF, studies showed lower smear positivity among those culture-confirmed (n=3/4) and time to diagnosis (n=2/2); and similar (range 80-90%; n=2/2) treatment success in the screened group. Case fatality was lower in n=2/3 observational studies; both reported on established screening programmes. A neonatal trial and post-hoc analysis of a household contacts trial found screening was associated with lower all-cause mortality. Economic review: From 2841 articles, six observational studies were eligible. Total costs (n=6) and catastrophic cost prevalence (n=4; range screened 9-45% vs PCF 12-61%) was lower among those screened. Interpretation We found very limited patient outcome data. Collecting and reporting this data must be prioritised to inform policy and practice. Funding WHO and EDCTP.

The World Health Organization call to halve global snakebite deaths by 2030 will require substantial progress in India. We analyzed 2833 snakebite deaths from 611,483 verbal autopsies in the nationally representative Indian Million Death Study from 2001 to 2014, and conducted a systematic literature review from 2000 to 2019 covering 87,590 snakebites. We estimate that India had 1.2 million snakebite deaths (average 58,000/year) from 2000 to 2019. Nearly half occurred at ages 30–69 years and over a quarter in children < 15 years. Most occurred at home in the rural areas. About 70% occurred in eight higher burden states and half during the rainy season and at low altitude. The risk of an Indian dying from snakebite before age 70 is about 1 in 250, but notably higher in some areas. More crudely, we estimate 1.11–1.77 million bites in 2015, of which 70% showed symptoms of envenomation. Prevention and treatment strategies might substantially reduce snakebite mortality in India.

Background: Hyperglycemia is implicated as deleterious in acute stroke, although the impact may vary by stroke subtype. We sought to determine the frequency of admission hyperglycemia (subcategorized as diabetes related or reactive) and explore the relationship to stroke severity and functional motor outcome in acute ischemic stroke (AIS) and intracerebral hemorrhage (ICH) stroke subtypes. Methods: This cross-sectional study recruited 170 stroke patients (85 AIS, 85 ICH) presenting within 72 h of onset. Baseline characteristics including stroke severity (National Institutes of Health Stroke Scale score), random blood glucose (RBG), and glycated hemoglobin (HBA1C) were documented. The outcomes were 30-day case fatality rate (CFR) and functional motor outcome. Results: The frequency of admission hyperglycemia was 24.7% in AIS and 22.4% ICH, with 18.8%/5.9% of AIS and 9.4%/12.9% of ICH presumed diabetes related and reactive, respectively. Stroke severity and infarct size were positively correlated with admission RBG and HBA1C (P = 0.000) in AIS but not ICH. Presumed mechanism of hyperglycemia did not relate significantly with either infarct size or hematoma volume (P > 0.05). Thirty days CFR was higher in AIS with hyperglycemia (42.9%) compared to normoglycemia (12.5%) (P = 0.003), but did not vary significantly in ICH (42.1% with and 36.4% without hyperglycemia; P = 0.65). There was no significant relationship of hyperglycemia to functional outcome in either stroke subtype. Conclusions: The association of admission hyperglycemia to stroke severity and short-term case fatality is evident in AIS. In ICH, hyperglycemia was not associated with significantly greater stroke severity and death at 30 days, even though case fatality was higher in those with hyperglycemia.

Objectives: The role of postmenopausal hormone therapy (HT) in the incidence of acute coronary syndrome (ACS) has been studied extensively, but less is known of the impact of HT on the mortality risk due to an ACS. Study design and main outcome measures: We extracted from a population-based ACS register, FINAMI, 7258 postmenopausal women with the first ACS. These data were combined with HT use data from the National Drug Reimbursement Register; 625 patients (9%) had used various HT regimens. The death risks due to ACS before admission to hospital, 2-28, or 29-365 days after the incident ACS were compared between HT users and non-users with logistic regression analyses. Results: In all follow-up time points, the ACS death risks in HT ever-users were smaller compared to non-users. Of women with FIT ever use, 42% died within one year as compared with 52% of non-users (OR 0.62, p = 5 year FIT use (OR 0.54, p

Aims: Our aim was to investigate whether there is social inequality in access to invasive examination and treatment, and whether access explains social inequality in case fatality in a nationwide sample of patients admitted for the first time with unstable angina or non-ST-elevation myocardial infarction (NSTEMI) in Denmark. Methods and results: All patients admitted for the first time with NSTEMI (n=16,625) or unstable angina (n=8,800) from 2001 to 2009 in Denmark were included. We measured time from admission to coronary angiography (CAG), percutaneous coronary intervention (PCI) or coronary artery bypass graft (CABG). The outcomes were 30-day and one-year case fatality. We found social inequality in access to CAG and one-year case fatality for both NSTEMI and unstable angina patients, but the time waited for CAG did not explain the social inequality in case fatality. Conclusions: Despite nominal equal access to health care, social inequality in case fatality after NSTEMI and unstable angina exists in Denmark. The patients with the shortest education waited longer for angiography; however, this did not seem to explain inequality in case fatality. This register-based study was approved by the Danish Data Protection Agency (Approval number 2010-41-5263). Register-based studies do not need approval by a medical ethics committee in Denmark.

Background: Social and health inequities predispose vulnerable populations to adverse morbidity and mortality outcomes of epidemics and pandemics. While racial disparities in cumulative incidence (CmI) and mortality from the influenza pandemics of 1918 and 2009 implicated Blacks with survival disadvantage relative to Whites in the United States, COVID-19 currently indicates comparable disparities. We aimed to: (a) assess COVID-19 CmI by race, (b) determine the Black&ndash, White case fatality (CF) and risk differentials, and (c) apply explanatory model for mortality risk differentials. Methods: COVID-19 data on confirmed cases and deaths by selective states health departments were assessed using a cross-sectional ecologic design. Chi-square was used for CF independence, while binomial regression model for the Black&ndash, White risk differentials. Results: The COVID-19 mortality CmI indicated Blacks/AA with 34% of the total mortality in the United States, albeit their 13% population size. The COVID-19 CF was higher among Blacks/AA relative to Whites, Maryland, (2.7% vs. 2.5%), Wisconsin (7.4% vs. 4.8%), Illinois (4.8% vs. 4.2%), Chicago (5.9% vs. 3.2%), Detroit (Michigan), 7.2% and St. John the Baptist Parish (Louisiana), 7.9%. Blacks/AA compared to Whites in Michigan were 15% more likely to die, CmI risk ratio (CmIRR) = 1.15, 95% CI, 1.01&ndash, 1.32. Blacks/AA relative to Whites in Illinois were 13% more likely to die, CmIRR = 1.13, 95% CI, 0.93&ndash, 1.39, while Blacks/AA compared to Whites in Wisconsin were 51% more likely to die, CmIRR = 1.51, 95% CI, 1.10&ndash, 2.10. In Chicago, Blacks/AA were more than twice as likely to die, CmIRR = 2.24, 95% CI, 1.36&ndash, 3.88. Conclusion: Substantial racial/ethnic disparities are observed in COVID-19 CF and mortality with Blacks/AA disproportionately affected across the United States.

BACKGROUND: Respiratory complications are uncommon, but often life-threatening features of Plasmodium vivax malaria. This study aimed to estimate the prevalence and lethality associated with such complications among P. vivax malaria patients in a tertiary hospital in the Western Brazilian Amazon, and to identify variables associated with severe respiratory complications, intensive care need and death. Medical records from 2009 to 2016 were reviewed aiming to identify all patients diagnosed with P. vivax malaria and respiratory complications. Prevalence, lethality and risk factors associated with WHO defined respiratory complications, intensive care need and death were assessed. RESULTS: A total of 587 vivax malaria patients were hospitalized during the study period. Thirty (5.1%) developed respiratory complications. Thirteen (43.3%) developed severe respiratory complications, intensive care was required for 12 (40%) patients and 5 (16.6%) died. On admission, anaemia and thrombocytopaenia were common findings, whereas fever was unusual. Patients presented different classes of parasitaemia and six were aparasitaemic on admission. Time to respiratory complications occurred after anti-malarials administration in 18 (60%) patients and progressed very rapidly. Seventeen patients (56.7%) had comorbidities and/or concomitant conditions, which were significantly associated to higher odds of developing severe respiratory complications, need for intensive care and death (p < 0.05). CONCLUSION: Respiratory complications were shown to be associated with significant mortality in this population. Patients with comorbidities and/or concomitant conditions require special attention to avoid this potential life-threatening complication.

BACKGROUND In Switzerland, the heptavalent (PCV7) and 13-valent pneumococcal conjugate vaccine (PCV13) were recommended for all infants aged

Journal of Nobel Medical College Vol. 2, No.2 Issue 4 May-October 2013 Page 35-43 DOI: http://dx.doi.org/10.3126/jonmc.v2i2.8803

Background Studies from several countries indicate that the incidence and mortality of bloodstream infection (BSI) have been increasing over time. Methods We studied the burden of disease and death related to BSI in a defined geographical area of Mid-Norway, where BSI episodes were prospectively recorded by the same microbiological department during 12 consecutive years. Death from BSI was defined as death within 30 days of BSI detection. Age and sex standardized incidence and mortality rates and case fatality rates were calculated. Results Between 2002 and 2013, 1995 episodes of BSI in 1719 patients aged 16 to 99 years were included. The overall incidence of BSI was 215 per 100,000 person-years. The incidence increased exponentially with age, particularly in males. The incidence increased from 205 to 223 per 100,000 person-years from 2002–07 to 2008–13. Escherichia coli was the most frequently isolated infective agent, followed by Streptococcus pneumoniae and Staphylococcus aureus. The rate of S. pneumoniae BSI decreased over time in males (on average by 9.2% annually), but not in females. The total rate of BSI microbes with acquired resistance increased slightly over time, but did not exceed 2 episodes per 100,000 person-years. The mortality of BSI was 32 per 100,000 person-years, higher in males than in females (36 vs. 28 per 100,000 person-years) and was significantly higher in old age, particularly in males. The total BSI mortality was similar in the first and second halves of the study period, but the mortality of S. pneumoniae BSI decreased in males (15.0% annually). The crude case fatality decreased from the first to the second half of the study period (17.2% to 13.1%; p = 0.014). The rate of blood culture sampling increased more than twofold during the study period. Conclusions The mortality of BSI remained stable during 2002–2013. At the same time, BSI incidence increased and case fatality rate decreased, perhaps because an increased rate of blood culture sampling may have led to improved detection of milder BSI episodes. Very low, yet slightly increasing rates of microbes with acquired resistance were observed. © The Author(s). 2017. This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

SummaryBackgroundClostridium difficile is a major infectious cause of healthcare-associated diarrhea. The epidemiology of C. difficile infection (CDI) is changing, with evidence of increased incidence and severity. The first patient with a hypervirulent strain type in Pirkanmaa Hospital District, Finland was reported in September 2008.MethodsWe reviewed all culture-positive C. difficile episodes that occurred in Pirkanmaa Hospital District during the period September 2008 to May 2010.ResultsA total of 780 episodes of C. difficile occurred in 622 patients. A hypervirulent strain caused 14.2% of all episodes. The day 30 case fatality associated with CDI was 8.5% in episodes with a non-hypervirulent strain and 20.7% in episodes with a hypervirulent strain type (p

Background: Although the mortality of coronary heart disease (CHD) has declined in Western countries during the last decades, studies have suggested that the prevention and treatment of CHD may not have been as effective in women as in men. We examined gender- and age-specific trends in incidence, case fatality and the severity of first myocardial infarction (MI) in a large Norwegian population-based study. Design: Prospective population-based cohort study. Methods: A total of 31,323 participants enrolled between 1974 and 2001 were followed throughout 2004 for a total of 400,572 person-years. Suspected coronary events were adjudicated by a review of hospital records and death certificates. A total of 1669 events fulfilled standardized criteria of first-ever fatal or non-fatal MI. Results: In the age group 35–79 years, the age-adjusted incidence of MI declined significantly in men, whereas an increase was observed in women. For men and women ≥80 years the incidence rates remained unchanged. The severity of MI and the 28-day and 1-year case fatality rates declined significantly and similarly in men and women. Conclusion: Trends in MI incidence differed by sex and age; in the age group 35–79 years a marked decrease was observed among men but an increase was observed among women, while no change was observed among older patients. MI severity and case fatality were clearly reduced for both sexes. These data suggest that the burden of CHD is shifting from middle-aged men toward middle-aged women and elderly patients.

Objectives: The present study analyzed in-hospital first-time stroke mortality in southwestern Saudi Arabia over one-year to assess the in-hospital stroke case fatality rate, mortality rate and explore the factors associated with in-hospital stroke mortality. Study Design: Hospital based follow-up study. Methods: First-time stroke patients admitted to all hospitals in Asser region over one-year period (January through December 2016) were included in the study. Data about personal characteristics, pre-stroke history and clinical criteria, on admission clinical criteria, in-hospital complications and survival status were collected. The last reported Aseer region population was used to calculate age and sex stroke mortality rate per 100,000 population/year. Hazard ratios (HR) and concomitant 95% confidence intervals (95% CI) were computed using multivariate Cox regression survival analysis. Kaplan-Meier curve survival analysis for stroke patients were plotted. Results: A total of 121 in-hospital deaths out of 1249 first-time stroke patients giving an overall case fatality rate (CFR) of 9.7%. Non-significant difference with gender and age were observed in CFR. Overall, in-hospital stroke mortality rate was 5.58 per 100,000/year. Males and elders showed a significantly higher mortality rates. Multivariable Cox regression analyses revealed pre-stroke smoking (HR = 2.36), pre-stroke hypertension (HR = 1.77), post-stroke disturbed consciousness (HR = 6.86), poor mobility (HR = 2.60) and developing pulmonary embolism (HR = 2.63) as significant predictors of in-hospital stroke mortality. Conclusions: In Southwestern Saudi Arabia, the in-hospital stroke mortality rate is higher in men and increases with aging. The prognosis of acute stroke could be improved by smoking cessation, better control of hypertension and prevention of in hospital complication particularly pulmonary embolism.

We estimated the incidence and mortality of bacteraemia in the County of North Jutland and examined factors that could explain the changes observed. A population-based survey of bacteraemia was conducted in the Danish County of North Jutland during 1981-1994. Data were retrieved from a regional bacteraemia register. The mortality was determined through linkage to the Danish Civil Registration System. A total of 7198 bacteraemias were detected, and the annual incidence increased from 76 per 100,000 person-years in 1981 to 153 in 1994. One major determining factor was a change in blood culture system with a higher volume of blood per sample, but annual numbers of blood cultures also increased. The 30-day mortality rate increased from 17 to 40 per 100,000 person-years during the study period, whereas the case-fatality rate remained constant (23.6%; 95% confidence intervals 22.6%-24.6%). The number of bacteraemias increased significantly. This observation could be explained only partly by changes in demography, in blood culture system, and in diagnostic activity. The case fatality rate remained constant despite the fact that more people were diagnosed with bacteraemia ; this indicates that, with recent blood culture practice, more clinically significant bacteraemias are diagnosed.

Background: Stroke is the second leading cause of death and the leading cause of adult disability worldwide. A better understanding of stroke risk factors and outcome may help guide efforts at reducing the community burden of stroke. This study aimed to understand stroke risk factors, imaging subtypes, and 30‑day outcomes among adult Nigerians. Materials and Methods: We prospectively recruited all patients presenting with acute stroke at the National Hospital Abuja between January 2010 and June 2012. We assessed clinical and laboratory variables, as well as brain computerized tomography, magnetic resonance imaging, and carotid Doppler ultrasound scans. We also assessed case fatality and functional outcome at 30 days after stroke. Results: Of 272 patients studied, 168 (61.8%) were males. Age at presentation (mean ± standard deviation) was 56.4 ± 12.7 years in males and 52.9 ± 14.8 years in females (P = 0.039). Neuroimaging was obtained in 96.7% patients, revealing cerebral infarction (61.8%), intracerebral hemorrhage (ICH) (34.8%), and subarachnoid hemorrhage (SAH) (3.4%). Carotid plaques or stenosis ≥50% were detected in 53.2% patients with cerebral infarction. Stroke risk factors included hypertension (82.7%), obesity (32.6%), diabetes (23.5%), hyperlipidemia (18.4%), atrial fibrillation (9.2%), and cigarette smoking (7.7%). At 30 days after stroke, case‑fatality rate was 18.8%, whereas modified Rankin Scale (mRS) scores for cerebral infarction, ICH, and SAH were 3.71, 4.21, and 4.56, respectively. Atrial fibrillation, a previous stroke, and age older than 50 years were all associated with worse mRS scores at 30 days. Conclusion: Although hypertension, obesity, diabetes mellitus, and atrial fibrillation were important stroke risk factors, in many patients, these were detected only after a stroke. While the commonest stroke subtype was cerebral infarction, observed in almost two‑third of patients, SAH was associated with the highest case‑fatality rate at 30 days of 44.4%. Larger population‑based studies may provide additional data on stroke incidence and outcome among Nigerians.Keywords: Case fatality, cerebral infarction, hypertension, Nigeria, strokeNigerian Medical Journal | Vol. 54 | Issue 2 | March-April | 2013

Objective To determine the prevalence, risk factors, co-morbidities and case fatality rates of Protein Energy Malnutrition (PEM) admissions at the paediatric ward of the University of Nigeria Teaching Hospital Enugu, South-east Nigeria over a 10 year period. Design A retrospective study using case Notes, admission and mortality registers retrieved from the Hospital’s Medical Records Department. Subjects All children aged 0 to 59 months admitted into the hospital on account of PEM between 1996 and 2005. Results A total of 212 children with PEM were admitted during the period under review comprising of 127 (59.9%) males and 85(40.1%) females. The most common age groups with PEM were 6 to 12 months (55.7%) and 13 to 24 months (36.8%). Marasmus (34.9%) was the most common form of PEM noted in this review. Diarrhea and malaria were the most common associated co-morbidities. Majority (64.9%) of the patients were from the lower socio-economic class. The overall case fatality rate was 40.1% which was slightly higher among males (50.9%). Mortality in those with marasmic-kwashiokor and in the unclassified group was 53.3% and 54.5% respectively. Conclusion Most of the admissions and case fatality were noted in those aged 6 to 24 months which coincides with the weaning period. Marasmic-kwashiokor is associated with higher case fatality rate than other forms of PEM. We suggest strengthening of the infant feeding practices by promoting exclusive breastfeeding for the first six months of life, followed by appropriate weaning with continued breast feeding. Under-five children should be screened for PEM at the community level for early diagnosis and prompt management as a way of reducing the high mortality associated with admitted severe cases.

Sepsis is the clinical syndrome derived from the host response to an infection and severe sepsis is the leading cause of death in critically ill patients. Several biomarkers have been tested for use in diagnosis and prognostication in patients with sepsis. Soluble urokinase-type plasminogen activator receptor (suPAR) levels are increased in various infectious diseases, in the blood and also in other tissues. However, the diagnostic value of suPAR in sepsis has not been well defined, especially compared to other more established biomarkers, such as C-reactive protein (CRP) and procalcitonin (PCT). On the other hand, suPAR levels have been shown to predict outcome in various kinds of bacteremia and recent data suggest they may have predictive value, similar to that of severity scores, in critically ill patients. This narrative review provides a descriptive overview of the clinical value of this biomarker in the diagnosis, prognosis and therapeutic guidance of sepsis., Journal Article, Review, SCOPUS: sh.j, info:eu-repo/semantics/published

A comparison of mean corpuscular volume (MCV) and packed cell volume (PCV) was made between cattle undergoing lethal and non-lethal reactions following experimental infections with the apicomplexan protozoa, Theileria parva Katete. This work confirmed that anaemia occurs in infected animals. However, the fall in PCV was steeper in lethal reactions compared to non-lethal reactions. Our results show that animals with initially lower MCV values are more prone to fatal reaction, despite having normal PCV profiles. The study also found that small red blood cells are more likely to be infected with T. parva. These findings suggest that animals with a higher proportion of small red blood cells in circulation will be more likely to succumb to T. parva infections. The potential for using MCV as a predictor of the outcome of infection challenge is discussed.

Background and objective: cardiovascular diseases are increased in each year in India. Cardiovascular diseases more are occurred in the economically productive age group. This will affect their family and also the nation. Aim of the study is to find out the different types of heart diseases and the case fatality rate of cardiovascular disease from 1st April 2005 to 31st March 2010 in a teaching hospital. Materials and Methods: The retrospective study conducted on hospitalized patients admitted with cardiovascular diseases from 1st April 2005 to 31st March 2010. Medical records department follows the guide lines of International Classification of Diseases (ICD)-10 coding for entering the data, from that data were collected. Results: Of 10427 cases, 6324 (60.65%) were males and 4103(39.35%) females. Cardiovascular disease was more among males than females. It was more occurred in ≥60 years. Most of them were occurred due to cerebrovascular disease (33.7%). Ischemic heart disease was more among males than females. Total number of deaths due to cardiovascular disease was 797. Of them 525(65.87%) were males and 272(34.13%) females. Case fatality due to cardiovascular diseases was 7.64%. Case fatality among males (8.3%) were more than females (6.63%) (P=0.00). Conclusion: This study mentioned that most of the cases and deaths were occurred in 60 and above years. Second leading age group is 25-59 years. Accident in economically productive people was high. It will affect their family and also the nation. Hence it can be reduced by conducting health awareness programme.

Context: The community incidence of acute bacterial meningitis in India is not known. There is a need for a periodic review of bacterial meningitis worldwide, since the pathogens responsible for the infection vary with time, geography, and patient age. Aims: To study some epidemiological factors of acute meningitis. Setting and Design: Hospital based cross sectional study. Materials and Methods: Detailed clinical examination of all clinically suspected cases of meningitis was done. Blood and cerebro spinal fluid culture was done. Statistical Analysis Used: Fisher exact test, P < 0.05 was considered as statistically significant. Results: There were 79 suspected cases of meningitis, majority of cases (74.7%) were under-fives. The case fatality rate (CFR) was 13.9% with a confidence interval ranging from 5.9 to 21.5%. The association between the age and the mortality was not statistically significant. (Fisher′s exact test, P = 1). The association between the gender and the mortality was not statistically significant (Fisher′s exact test, P = 0.3). Based on the culture examination there were 16 cases of confirmed bacterial meningitis. Commonest isolate was Klebsiella pneumoniae as seen in five cases (31.2%). Neisseria meningitides, H influenzae, or Streptococcus pneumoniae were not isolated in any case. Conclusion: Acute bacterial meningitis is still an important public health problem with a high case fatality rate.

The epidemiology of stroke may be changing over time as a result of a number of factors, including an aging population and advances in the prevention and treatment of stroke. Epidemiological indicators and research of stroke have great significance in estimating the impact of this disease on the population. Such research states the distribution of this illness and factors by which it is influenced, follows short-term and long-term consequences, as well as socio-economic burden of stroke for the whole community. Data on stroke prevalence is important for creating the right strategies for health care in a specific area. Stroke-related mortality in any population is dependent upon three main factors: the incidence of stroke in the population, quality of medical care available, and the prevalence of cardiovascular diseases and comorbidities that can affect the likelihood of surviving stroke events. The quality of medical care available influences both the number of individuals suffering from stroke and the proportion of case-fatality among them. Epidemiological data shows that stroke is one of the leading causes of death and long-term disability in most industrialized populations, and the same is true for Croatia. The existing systemof health care for stroke patients does not meet the needs and is not in accordance with latest trends in developed countries.Hence, there is a need for its reorganization and design of the national project for stroke prevention and treatment similar to those in European countries with favorable epidemiological data.