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BACKGROUND Quality leaders are concerned that creation of multi-hospital health systems may lead to surgeons traveling to and from distant hospitals and thus to more fragmented surgical care and worse outcomes for their patients. Despite this concern, little empirical data exist on outcomes of multi-site vs. single-site surgeons. METHODS Using national Medicare data, we assessed trends in the number of multi-site vs. single-site surgeons from 2011 to 2016. We performed a multivariable regression analysis to compare overall 30-day mortality differences, stratified by system and rural status, and examined trends over time. RESULTS The number of multi-site surgeons and the percentage of multi-site surgeons per hospital decreased over time (24.2% to 19.0%; 44.3% to 41.8%). Overall, multi-site surgeons had lower 30-day mortality than single-site surgeons (2.24% vs. 2.50%, p < 0.01). When stratified by system status, multi-site surgeons performed better in-system (2.47% vs. 2.58%, p < 0.01); by rural status, multi-site surgeons had lower mortality in non-rural hospitals (2.42% vs. 2.51%, p < 0.01). The statistically significant but small mortality advantage of multi-site vs. single-site surgeons decreased over time, such that by 2016 there was no difference in outcomes between multi-site and single-site surgeons. CONCLUSION For the majority of study years, multi-site surgeons had lower 30-day mortality than single-site surgeons, but this trend narrowed until outcomes were equivalent by 2016. Surgeons operating at multiple hospitals can provide surgical care to patients without any evidence of increased mortality.

OBJECTIVE The aim of this study was to investigate whether our previously reported improvements in short-term cancer esophagectomy outcomes after large-scale regionalization in the U.S. translated to longer-term survival benefit. BACKGROUND Regionalization is associated with better early postoperative outcomes following cancer esophagectomy; however, data regarding its effect on long-term survival is mixed. METHODS We retrospectively reviewed 461 patients undergoing cancer esophagectomy before (2009-2013, N = 272) and after (2014-2016, N = 189) regionalization. Kaplan-Meier curves and χ2 tests were used to describe 1- and 3-year survival in each era. Hierarchical logistic regression models examined the adjusted effect of regionalization on mortality. RESULTS Compared to pre-regionalization patients, post-regionalization patients had significantly higher 1-year survival (83.1% versus 73.9%, p = 0.02) but not 3-year survival (52.9% versus 58.2%, p = 0.26).Subgroup analysis by cancer stage revealed that 1-year survival benefit was only significant among mid-stage (IIB-IIIB) patients, whereas differences in 3-year survival only approached significance among early-stage (IA-IIA) patients.In multivariable analysis, only regionalization was a predictor of lower mortality at 1 year (OR 0.54, 95%CI:0.29,1.00), and only thoracic specialty at 3 years (OR 0.62, 95%CI:0.38,0.99). Older age, more advanced stage, and complications were associated with higher 1- and 3-year mortality. Comorbidity, minimally invasive approach, surgeon volume, facility volume, and neoadjuvant treatment were not significant in this model. CONCLUSIONS Regionalization was associated with improved 1-year survival after cancer esophagectomy, independent of factors such as morbidity or volume in our adjusted models. This survival benefit did not persist at 3 years, likely due to the aggressive nature of the disease.

Introduction: Studies have shown that patients would like to receive more medication education while hospitalized. Higher patient satisfaction has been correlated with lower mortality and fewer hospital readmissions. Methods: This was a quasi-experimental study. Four Doctor of Pharmacy students were assigned 1 medicine inpatient unit to provide education on new medications during the study period, June to September. The primary endpoint was the change in HCAHPS scores for the medication communication domain composite for the intervention unit and a similar control unit that was not receiving the intervention from the pre-intervention to the intervention periods. Results: A total of 124 patients were educated during the intervention period, with an average age of 65 and 2.2 new medications. Average HCAHPS scores for the medication communication domain for the intervention unit increased from 68% pre-intervention to 91% during the intervention ( P = .389) while the control unit remained unchanged at 78% both pre- and during the intervention ( P = .13). Conclusion: An increase in the medication communication HCAHPS score for the intervention unit was observed, while the control unit remained stable. This study has the potential to drive change by implementing pharmacy students throughout inpatient units to educate patients on new medications thereby improving patient satisfaction.

Introduction The Nellix endovascular aneurysm sealing (EVAS) system has been a topic of discussion. Early results were promising but did not deliver on the long-term and the device has been recalled from the market. This study compares literature for EVAS and conventional endovascular aneurysm repair (EVAR). Methods A systematic review and analysis was conducted according to the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines. PubMed, Embase, and Cochrane Library were searched and identified the eligible studies. Proportion rates for the outcomes of interest were extracted. Subgroup analyses were performed for EVAS and EVAR. Results A total of 12 studies were included (EVAS n = 4, EVAR n = 8) including 10,255 patients (EVAS n = 784, EVAR n = 9441). The longest duration of follow-up was 3.4 years for EVAS and 5.0 years for EVAR studies. Throughout follow-up the overall all-cause mortality rates were 6% for EVAS and 13% for EVAR, and endoleak of any type was described in 10% of EVAS and 17% of EVAR patients. The migration rate >10 mm was 8% for EVAS and 0% for EVAR and aneurysm growth >5 mm was found in 11% of EVAS and 3% of EVAR cases. Total reintervention rate was 13% for EVAS and 7% for EVAR patients. For all analyzed outcome parameters heterogeneity was >50%. Conclusion There is a tendency toward lower mortality and overall endoleak rates for EVAS compared to EVAR but with a higher rate of migration, aneurysm growth, and reintervention. Despite lower overall endoleak rates there was a tendency toward less type II and more type I endoleaks after EVAS compared to EVAR. Substantial heterogeneity however limits robust statistical analyses, and is probably caused by significant instructions for use breach in EVAS-treated patients. We call for more high-quality and long-term follow-up studies on both EVAS and EVAR in order to confirm the trends found in this study.

Background: Heart failure (HF) affects many patients who are older and frail, presenting multiple physical barriers to accessing specialty care in a traditional ambulatory clinic model. Here, we present an assisted virtual care model in which a home visiting nurse facilitated video visits with a HF cardiologist to follow homebound, frail, and older patients with HF. Methods: This is a pragmatic, quasi-experimental, pre–post, single-centre study. It included homebound, frail, and older patients with HF from 2015 to 2019 who were followed for 1 year; in-person clinic visits were completely replaced by nurse-facilitated virtual video visits. Outcomes evaluated included annualized hospitalization rate, number of hospitalization days, and number of emergency department visits. Results: A total of 49 patients were included, with a median age of 86 (83-93) years, and were followed for 1 year after enrollment. Among patients enrolled, HF with preserved ejection fraction was the most common subtype (57%). Compared to the year prior to enrollment, patients had a lower mortality-adjusted all-cause annualized hospitalization rate in the year following enrollment (2.57 vs 1.78, P < 0.0001). Compared to the year prior, the number of mortality-adjusted all-cause hospitalization days was significantly lower in the year following enrollment (27.2 vs 21.4, P < 0.0001). There was a reduction in the number of all-cause annualized emergency department visits (3.10 vs 2.27, P = 0.003). Conclusions: Nurse-assisted virtual visits may be a preferable strategy for homebound, frail, and older patients with HF to receive longitudinal care. This approach may represent a plausible strategy to care for other patients with significant barriers to accessing specialized cardiac care. Résumé: Contexte: L’insuffisance cardiaque (IC) touche de nombreux patients âgés et fragiles, et dresse maints obstacles physiques à l’accès aux soins spécialisés au sein d’un modèle classique de soins cliniques ambulatoires. Dans le présent article, nous exposons un modèle de soins virtuels assistés où une infirmière visiteuse assure par vidéoconsultation, avec un cardiologue, le suivi de patients âgés et fragiles atteints d’IC confinés à la maison. Méthodologie: Une étude monocentrique et pragmatique, quasi expérimentale de type « avant-après », a été menée de 2015 à 2019 auprès de patients âgés et fragiles atteints d’IC confinés à la maison. Les patients ont été suivis durant un an; les consultations en personne ont été entièrement remplacées par des vidéoconsultations effectuées par une infirmière. Les paramètres évalués comprenaient le taux annualisé d’hospitalisation, le nombre de jours d’hospitalisation et le nombre de consultations aux urgences. Résultats: Au total, 49 patients dont l’âge médian était de 86 ans (83-93 ans) ont été suivis durant un an à compter de leur admission à l’étude. L’IC à fraction d’éjection préservée était le sous-type d’IC le plus fréquent (57 %) chez les patients participant à l’étude. Par comparaison à l’année précédente, le taux annualisé d’hospitalisation toutes causes confondues ajusté en fonction de la mortalité a été plus faible chez les patients au cours de l’année où ils ont été suivis dans le cadre de l’étude (2,57 vs 1,78, P < 0,0001). Toujours par comparaison à l’année précédente, le nombre de jours d’hospitalisation toutes causes confondues ajusté en fonction de la mortalité a été significativement inférieur chez les patients au cours de l’année où ils ont été suivis dans le cadre de l’étude (27,2 vs 21,4, P < 0,0001). Le nombre annualisé de consultations aux urgences toutes causes confondues a quant à lui diminué (3,10 vs 2,27, P = 0,003). Conclusions: Les consultations virtuelles assistées par une infirmière peuvent constituer une stratégie à privilégier dans la prestation de soins longitudinaux à des patients âgés et fragiles atteints d’IC qui sont confinés à la maison. Cette approche pourrait représenter une stratégie plausible pour prodiguer des soins à d’autres patients qui sont confrontés à d’importants obstacles limitant leur accès à des soins spécialisés en cardiologie.

BACKGROUND Dexamethasone implementation for COVID-19 management represented a milestone but data regarding its impact and safety has not been consistently reproduced. OBJECTIVE We aimed to evaluate in-hospital mortality before and after the implementation of corticosteroid treatment (CS-T) for severe and critical COVID-19. METHODS We conducted a cohort study that included patients admitted with severe and critical COVID-19. Primary outcome was death during hospitalization. Secondary outcomes included length of stay (LOS), need for invasive mechanical ventilation (IMV), time to IMV initiation, IMV duration and development of hospital acquired infections (HAIs). Bivariate, multivariate and propensity-score matching analysis were performed. RESULTS Among 1,540 patients, 688 (45%) received CS-T. Death was less frequent in the CS-T group (18% vs 31%, p

Aim. In patients with chronic heart failure (HF), the benefit of repeating the assessment of left ventricle (LV) systolic and diastolic function over time remains uncertain. We assessed the prognostic value of repeated echocardiographic assessment of LV filling pressure (LVFP) and its interaction with cardiac index (CI) in ambulatory patients with chronic HF and reduced ejection fraction (HFrEF)Methods and results. We enrolled 367 patients (age 68±11 years; 22% female) with chronic HFrEF. Patients underwent a clinical and echocardiographic examination at baseline and were re-evaluated after 6±3 months. The 2016 recommendations were used to estimate normal or increased LVFP. CI was evaluated as the product of LV outflow tract area and velocity-time integral multiplied by heart rate and divided by body surface area. After the second examination, patients were followed for a median of 30 months. The study endpoint included all-cause death and hospitalization for worsening HF. Patients who normalized LVFP or showed persistently normal LVFP at the follow-up examination had a significantly lower mortality rate than those with worsening or persistently raised LVFP. After further stratification by CI, patients with elevated LVFP and CI 2 had a further worse outcome than those with elevated LVFP and CI ≥ 2.0 L/min/m2. Multivariate survival analysis confirmed an independent prognostic impact of changes in LVFP, incremental to that of established clinical, laboratory and echocardiographic predictors. Conclusions. Repeated evaluation based on a full diastolic function assessment of LVFP and CI significantly improved risk stratification of stable HFrEF outpatients compared to baseline evaluation.

Objective: To explore the use of therapeutic plasma exchange as adjunctive therapy in COVID-19 patients with and without diabetes mellitus. Study Design: Prospective, observational study. Place and Duration of Study: Pakistan Emirates Military Hospital Rawalpindi, from Jan to Feb 2021. Methodology: A total of 90 male patients with laboratory-confirmed coronavirus infection were selected based on our inclusion criteria and their management and outcomes were recorded. The data were analyzed using SPSS-22 and Microsoft Excel. Results: The mortality rate was lower in patients who received 1 or more sessions of plasma exchange compared to those who did not receive plasma exchange (7.5% vs 12%). A lower mortality rate was seen in patients without diabetes who received therapeutic plasma exchange in addition to standard therapy compared to patients who received standard therapy alone (0 vs 14.82%, p=0.112). In patients with diabetes, a higher mortality rate was found in the group that had received therapeutic plasma exchange in addition to standard therapy instead of standard therapy alone (20% vs 8.7%, p=0.365). Conclusion: Overall our study supports the use of therapeutic plasma exchange in COVID-19 patients. However, although statistically insignificant, there appears to be a higher mortality rate in patients with diabetes who received therapeutic plasma exchange in addition to standard therapy. As such, we recommend further investigation of this aspect. © 2021, Army Medical College. All rights reserved.

Hypertensive brainstem hemorrhage (HBSH) is of high morbidity and mortality rate. But many clinical studies were written in Chinese and had not been reviewed. A systemic review of Chinese clinical studies for HBSH was performed. A systemic literature search in PubMed, Web of Science, China National Knowledge Infrastructure, and Weipu database and Wanfang database up to March 2020 was performed. Clinical control studies including a surgical evacuation (SE) group and a conservative management (CM) group were included. The clinical outcome and mortality rate were compared. Ten cohort studies were included, involving 944 participants (304 in the SE group and 640 in the CM group). All included patients were comatose, with the average age ranged from 45 to 65 years old. Among five studies using mRS or GOS as outcome score, a total of 16.6% (89/535) of patients achieve self-maintenance with minor disabilities, including 26.8% (34/127) in the SE group and 13.5% (55/408) in the CM group. The overall mortality rate in the SE group was 27.6%, ranged from 9.3 to 60% among different studies. The overall mortality rate in the CM group was 60.6%, ranged from 18.5 to 100.0%. Elder and comatose HBSH patients are not contraindicated for surgery. The review showed that this group of patients obtained a better outcome and lower mortality rate after surgical treatment. The quality of included studies was relatively low, but a high-level clinical study on HBSH is of great difficulty, as both clinicians and patients faced various sociological issues rather than pure medical problems.

Common fragranced consumer products, such as cleaning supplies and personal care products, emit chiral compounds such as limonene that have been associated with adverse effects on human health. However, those same compounds abound in nature, and at similar concentrations as in products, but without the same apparent adverse human health effects. We investigated whether different types of limonene may elicit different biological effects. In this study, we investigated the mortality rate of mosquito larvae in response to changes in their environment. Specifically, we tested different sources of naturally occurring R-limonene and chemically synthetized limonene, containing one of its enantiomeric forms (R-, S-) in mortality bioassays with Aedes aegypti mosquito larvae. We found that a natural source of limonene extracted from oranges induced lower mortality of mosquito larvae compared to synthetic sources at the same concentration. However, enantiomeric forms did not differ in their effects on mortality. Our results provide novel evidence that natural sources of a chemical can cause lower rates of mortality than synthetic sources.

Objective The treatment of severe trauma patients requires a fast and accurate method to diagnose life-threatening conditions. Computerized tomography (CT)-PANSCAN has been widely used for the last 20 years to diagnose many patients in critical condition. However, no research has been performed into the efficacy of CT-PANSCAN. This research aims to compare the mortality rate of trauma patients who underwent CT-PANSCAN versus conventional CT scan. Methods This retrospective cohort study enrolled patients who were at triage ESI level 1-2 in the emergency department of Ramathibodi Hospital from January 2013 to December 2018 and analyzed the mortality rate between those who underwent CT-PANSCAN and conventional CT scan. Results The study enrolled 123 trauma patients; 61 patients underwent CT-PANSCAN, whereas 62 patients underwent conventional CT scan. There were 1 and 7 patients who expired in the CT-PANSCAN and conventional CT scan groups, respectively. After multivariate regression analysis, the result revealed that patients who underwent CT-PANSCAN had a lower mortality rate (adjusted odds ratio = 0.023; p-value = 0.018; 95% CI 0.001-0.518). Conclusion Undergoing a CT-PANSCAN can reduce the mortality rate in trauma patients, especially in ESI level 1, 2 traumatic patients, and CT-PANSCAN available facilities.

In Egypt, little attention has been paid to the isolation and application of C. perfringens phages for treating necrotic enteritis at the farm level. This study aims to evaluate the efficiency of the podovirus C. perfringens phage in treating necrotic enteritis in broiler chickens. Accordingly, C. perfringens phage was isolated from cecal samples of apparently healthy chickens and characterized by transmission electron microscopy, thermal stability test, and pH stability test. Commercial 14-day-old Arbor Acres broiler chickens were allocated to three groups: group Ӏ received BHI broth and assigned as a negative control, group П served as a positive control group that was challenged with C. perfringens via oral gavage for four successive days, and group Ш was administrated six phage doses on several occasions after oral gavage challenge with C. perfringens. Daily clinical symptoms and mortality were recorded. At three-time intervals, necrotic enteritis lesions were scored. Cecal samples were examined for re-isolation and counting of C. perfringens. The isolated C. perfringens phage was a podovirus with an icosahedral head diameter of 78.7 nm and a short non-contractile tail length of 22.2 nm. It remained stable for 60 min at 30 °C and 50 °C at pH values of 2, 4, 8, and 10. The phage-treated group (Ш) showed mild gross lesions with a lower mortality rate and reduced colony-forming units than the positive control group (П). The findings revealed that the isolated C. perfringens phage effectively treated experimental necrotic enteritis in broiler chickens.

The first wave of the COVID-19 pandemic has led to excess mortality across the globe, and Canada has been no exception. Nonetheless, the pandemic experience has been very different across provinces, and the objective of this paper is to investigate these differences focusing on two extreme cases. We contrast the mortality experience of British Columbia with that of Québec to understand how large differences in mortality during the first wave of the pandemic emerged across these two provinces. We find that most of the differences can be found in excess mortality in institutions (nursing homes) and that travel restrictions, differences in how deaths are recorded, differences in the seasonality of the flu, or differences in how the pandemic spread across different economic segments of the population are unlikely explain these large differences. We document that the reported death toll from COVID-19 is about 30% larger than excess mortality in Quebec due to lower mortality from other causes of death, in particular malignant tumors, heart disease, and respiratory problems. We do not find evidence of an income gradient (measured by postal code level income) in relative excess death for the first wave.La première vague de la pandémie de la COVID-19 a entraîné une surmortalité dans plusieurs pays à travers le monde, incluant le Canada. Par contre, l’ampleur fut bien différente à travers les provinces canadiennes et l'objectif de cette analyse est d'étudier ces différences en se concentrant sur deux provinces spécifiques. Pour ce faire, nous comparons la mortalité de la Colombie-Britannique avec celle du Québec pour tenter de comprendre les grandes différences observées entre ces deux provinces durant la première vague de la pandémie. On constate qu’une grande partie de la surmortalité différentielle est observée chez les personnes vivant en institutions de santé (maisons de soins). De plus, on remarque aussi que les restrictions concernant les déplacements internationaux, les processus d’enregistrement des décès, l’évolution de la grippe saisonnière ou les différences dans la façon dont la pandémie s'est propagée à travers les groupes sociaux-économiques de la population sont peu susceptibles d'expliquer ces grandes différences. Notre analyse montre que le nombre de décès attribués à la COVID-19 est d'environ 30% plus élevé que la surmortalité observée au Québec durant la première vague. Cet écart est, en partie, attribuable à une mortalité plus faible de d'autres causes de décès, en particulier les tumeurs malignes, les maladies cardiaques et les problèmes respiratoires durant la même période. Finalement, nous n’avons pas été en mesure de calculer un gradient de revenu (mesuré par le revenu au niveau du code postal) pour les décès excédentaires survenus lors de la première vague.Mots clés: excès de mortalité, COVID-19, institutions de santé, cause de décès.

Aim To investigate temporal trends in inpatient vs. outpatient diagnosis of new-onset heart failure (HF) and the subsequent risk of death and hospitalization. Methods and results Using nationwide registers, 192 581 patients with a first diagnosis of HF (1997–2017) were included. We computed incidences of HF, age-standardized mortality rates, and absolute risks (ARs) of death and hospitalization (accounting for competing risk of death) to understand the importance of the diagnosis setting in relation to subsequent mortality and hospitalization. The overall incidence of HF was approximately the same (170/100 000 persons) every year during 1997–2017. However, in 1997, 77% of all first diagnoses of HF were made during a hospitalization, whereas the proportion was 39% in 2017. As inpatient diagnoses decreased, outpatient diagnoses increased from 23% to 61%. Outpatients had lower mortality and hospitalization rates than inpatients throughout the study period, although the 1-year age-standardized mortality rate decreased for each inpatient (24 to 14/100-person) and outpatient (11 to 7/100-person). One-year and five-year AR of death decreased by 11.1% and 17.0%, respectively, for all HF patients, while the risk of hospitalization for HF did not decrease significantly (1.13% and 0.96%, respectively). Conclusion Between 1997 and 2017, HF changed from being primarily diagnosed during hospitalization to being mostly diagnosed in the outpatient setting. Outpatients had much lower mortality rates than inpatients throughout the study period. Despite a significant decrease in mortality risk for all HF patients, neither inpatients nor outpatients experienced a reduction in the risk of an HF hospitalization.

ObjectiveMyocardial injury after non-cardiac surgery (MINS) is strongly associated with mortality, but few studies assessed treatment strategies. This study aimed to identify whether evaluation by cardiologists could reduce mortality in MINS patients.MethodsFrom a single-centre retrospective cohort, we enrolled a total of 5633 adult patients diagnosed with MINS between January 2010 and June 2019. The patients were divided into two groups based on evaluation by cardiologist, which was defined as a cardiology consultation or transfer to the cardiology department. For the outcome, 30-day mortality was compared in crude and propensity-score matched populations.ResultsOf a total of 5633 patients, 2120 (37.6%) were evaluated by cardiologists and 3513 (62.4%) were not. Mortality during the first 30 days after surgery was significantly lower in MINS patients who were evaluated by cardiologists compared with those who were not (5.8% vs 8.3%; HR, 0.64; 95% CI 0.51 to 0.80; pConclusionsCardiologist evaluation was associated with lower mortality in patients diagnosed with MINS. Further studies are needed to identify effective treatment strategies for MINS.Trial registration numberKCT0004244.

BACKGROUND: Cisplatin (CIS) is an important chemotherapy agent which is widely used for the treatment of many types of solid tumors, which can cause decreased ovarian function. Nigella sativa has been shown to have an anti-inflammatory and anti-oxidant activity that might protect the ovaries from damage due to CIS. AIM: This study aims to understand the benefits of N. sativa protecting the ovaries due to CIS chemotherapy. METHODS: Thirty-two female Rattus norvegicus aged 8 weeks weighing 160–200 g were divided into four groups: Negative control, Positive control, Treatment-1 (CIS 6 mg/KgBW and NS 500 mg/KgBW/day), and Treatment-2 (CIS 6 mg/KgBW and NS 1000 mg/kgBW/day) for 2 weeks. On the 14th day the rats were sacrificed, blood was drawn from the heart, followed by taking ovaries. RESULTS: There was lower mortality and morbidity in CIS + NS 1000 and CIS + NS 500 mg group (p = 0.01 and 0.001). The mean estradiol levels, follicle-stimulating hormone levels, and anti-mullerian hormone levels were not statistically significant among the four groups. The highest number of primary, secondary, tertiary follicles are seen at the CIS + NS 500 mg and CIS + NS 1000 mg groups (p = 0.05). The lowest number of atretic follicles is seen at the CIS + NS 1000 mg group, and the highest number of atretic follicles was in CIS only. CONCLUSION: There is a trend that N. sativa is beneficial in protecting the ovaries from damage caused by CIS.

OBJECTIVES Although there are disparities in both risk of developing dementia and accessibility of dementia services for certain minority ethnic groups in the United States and United Kingdom, disparities in survival after a dementia diagnosis are less well-studied. Our objective was to systematically review the literature to investigate racial/ethnic differences in survival and mortality in dementia. METHODS We searched Embase, Ovid MEDLINE, Global Health and PsycINFO from inception to November 2018 for studies comparing survival or mortality over time in at least two race/ethnicity groups. Studies from any country were included but analysed separately. We used narrative synthesis and random-effects meta-analysis to synthesise findings. The Newcastle-Ottawa Scale was used to assess quality and risk of bias in individual studies. RESULTS We identified 22 articles, most from the United States (n = 17), as well as the United Kingdom (n = 3) and the Netherlands (n = 1). In a meta-analysis of US studies, hazard of mortality was lower in Black/African American groups (Pooled Hazard Ratio = 0.86, 95% CI = 0.82-0.91, I2 = 17%, from four studies) and Hispanic/Latino groups (Pooled HR = 0.65, 95% CI = 0.50-0.84, I2 = 86%, from four studies) versus comparison groups. However, study quality was mixed, and in particular, quality of reporting of race/ethnicity was inconsistent. CONCLUSION Literature indicates that Black/African American and Hispanic/Latino groups may experience lower mortality in dementia versus comparison groups in the United States, but further research, using clearer and more and consistent reporting of race/ethnicity, is necessary to understand what drives these patterns and their implications for policy and practice.

Differentiating Acinetobacter baumannii complex (ABC) infection from colonization remains difficult and further complicated in polymicrobial infections. To assess the frequency of polymicrobial ABC infections and associated mortality. We hypothesized a lower mortality in polymicrobial infections if ABC isolation reflects colonization in some polymicrobial infections. A systematic review was conducted in PubMed, Scopus and CENTRAL for studies reporting ABC pulmonary and bloodstream infections. The proportion of infections that were polymicrobial and the magnitude of the association between polymicrobial (vs monomicrobial) infection and mortality were estimated with meta-analyses. Based on 80 studies (9759 infections) from 23 countries, the pooled proportion of polymicrobial infection was 27% (95% CI 22–31%) and was similarly high for bloodstream and pulmonary infections. Polymicrobial infection was variably and insufficiently defined in most (95%) studies. Considerable heterogeneity (I2 = 95%) was observed that persisted in subgroup analyses and meta-regressions. Based on 17 studies (2675 infections), polymicrobial infection was associated with lower 28-day mortality (OR = 0.75, 95% CI 0.58–0.98, I2 = 36%). However, polymicrobial infection was not associated with in-hospital mortality (OR = 0.97, 95% CI 0.69–1.35, I2 = 0%) based on 14 studies (953 infections). The quality of evidence (GRADE) for the association of polymicrobial (vs monomicrobial) infection with mortality was low and at high risk of bias. Polymicrobial ABC infections are common and may be associated with lower 28-day mortality. Considering the heterogeneity of polymicrobial infections and limitations of the available literature, more research is required to clarify the clinical impact of polymicrobial (vs monomicrobial) ABC infection.

Objective Patients undergoing hemodialysis (HD) have different physical activity (PA) patterns on HD and non-HD days. Nonetheless, whether these differences are associated with clinical outcomes remains unclear. We examined the association of PA levels on HD and non-HD days with cardiovascular (CV) hospitalizations and mortality. Methods Outpatients undergoing HD from 2002 to 2019 were retrospectively enrolled. The number of steps performed over 3 HD days and 4 non-HD days was recorded via accelerometry. Outcomes were all-cause mortality and a composite of CV hospitalizations and mortality. Patients were divided into two groups, each according to the median number of steps performed on HD (2371 steps/day) and non-HD days (3752 steps/day). Further, we categorized them into 4 groups according to each median values: "more active on HD/more active on non-HD (MM)," "more active on HD/less active on non-HD (ML)," "less active on HD/more active on non-HD (LM)," and "less active on HD/less active on non-HD (LL)." Cox and mixed-effects Poisson regression models were used for these outcomes. Results We analyzed 512 patients (median follow-up, 3.4 years). Higher PA on HD (hazard ratio [HR], 0.59; 95% confidence interval [CI], 0.54–0.65), and non-HD (HR, 0.84; 95% CI, 0.80–0.88) was associated with lower mortality risk, respectively. Further, the ML group (HR, 1.20; 95% CI, 1.13–1.28), LM group (HR, 1.82; 95% CI, 1.53–2.17), and LL group (HR, 1.83; 95% CI, 1.65–2.02) had higher mortality risks than the MM group. Associations of PA with multiple CV hospitalizations and mortality were similar to those between PA and mortality. Conclusions Higher PA on HD and non-HD days was associated with lower risks of CV hospitalizations and mortality. However, higher PA levels on either HD or non-HD days alone did not improve clinical outcomes.

Aims: \ud Iron deficiency (ID) and anaemia are common in heart failure; less is known about changes over time.\ud \ud Methods and results: \ud We investigated prevalence, incidence and resolution of ID and anaemia in 906 patients with chronic heart failure (median age 73 (65–79) years, 70% men, 51% with heart failure with reduced ejection fraction) 1 year apart. ID was defined as serum iron ≤13 µmol/L and anaemia as haemoglobin 13 µmol/L), mortality was higher in those with persistent or incident ID at 1 year [hazard ratio (HR) 1.81 (1.23–2.67), and HR 1.40 (0.91–2.14), respectively] in multivariable models (P = 0.02). Compared to persistent ID, resolution of ID was associated with a lower mortality [HR 0.61 (0.44–0.86); P = 0.004]. Changes in ID defined by FAIR-HF criteria were not similarly associated with mortality. Anaemia was associated with a poor outcome even if it resolved.\ud \ud Conclusions: \ud The prevalence and incidence of ID and anaemia are high in chronic heart failure but so is the rate of resolution. Persistent or incident ID, defined by a serum iron ≤13 µmol/L, is associated with higher mortality and resolution of ID with lower mortality.

Purpose The gold standard for the treatment of complex (TASC II C and D) atherosclerotic aortoiliac lesions is still open surgical repair. Endovascular techniques have a lower mortality and morbidity rate but this comes at the cost of worse patency rates when compared with open repair. Improved short- and mid-term results have been reported using the covered endovascular reconstruction of aortic bifurcation (CERAB) technique. The aim of this study was to report our initial experience with the CERAB technique and report long-term patency rates. Materials and Methods All patients treated with the CERAB technique between 2012 and 2018 were prospectively registered in an institutional database and included in this study. Patient demographics, characteristics, symptoms, procedural, and follow-up details were collected and analyzed retrospectively. Perioperative complications and reinterventions were also identified. The Kaplan-Meier survival method was used to assess cumulative rates of patency. Results A total of 44 patients were treated with the CERAB technique and included in this study. The majority of the treated aortoiliac occlusions were classified as complex: TASC II C (n=7; 15.9%) or TASC II D (n=25; 56.8%). Primary patency rate at 60 months was 83.3%, assisted primary patency was 90.9% and secondary patency 95%. No significant differences were found in patency rates comparing noncomplex (TASC II A and B) and complex (TASC II C and D) aortoiliac lesions. Seven patients (15.9%) required at least one additional procedure to maintain either assisted primary patency or secondary patency during follow-up. The 30-day complication rate in this series was 20.5% (n=9), of which 55.6% (n=5) were minor complications. All major 30-day complications (n=4) occurred during or directly after the CERAB procedure. Thirty-day mortality was 0%. No limb occlusions occurred within 30 days of the procedure. Conclusion Good long-term patency rates can be achieved with the CERAB technique to treat aortoiliac stenosis or occlusions while maintaining advantages associated with endovascular interventions. This remains true even when a CERAB is used to treat complex aortoiliac lesions. An endo-first approach to treat complex aortoiliac lesions seems viable.

Background/aim Since the outbreak of the COVID-19, numerous therapies to counteract this severe disease have emerged. The benefits of Tocilizumab for severely infected COVID-19 patients and the methodologies of ongoing clinical trials are explored. Materials and methods A systematic search adhering to PRISMA guidelines was conducted in PubMed, Cochrane Central, medRxiv, and bioRxiv using the following keywords: “Tocilizumab,” “Actemra,” “COVID-19.” An additional subsearch was conducted on Clinicaltrials.gov to locate ongoing tocilizumab trials. Results A total of 13 studies were included in the meta-analysis comprising 2120 patients. The treatment group had lower mortality compared to the control group (OR = 0.42, 95% CI = 0.26 to 0.69, P = 0.0005, I2 = 55%). A descriptive analysis of 50 registered trials was conducted. Conclusion This review meta-analyzed the therapeutic benefits of tocilizumab in COVID-19 patients with severe disease for mortality, mechanical ventilation, and the characteristics of COVID-19 registered trials.

BACKGROUND Over the last several decades in the United States, socioeconomic life-expectancy inequities have increased 1-2 years. Declining labor-union density has fueled growing income inequities across classes and exacerbated racial income inequities. Using Panel Study of Income Dynamics (PSID) data, we examined the longitudinal union-mortality relationship and estimated whether declining union density has also exacerbated mortality inequities. METHODS Our sample included respondents ages 25-66 to the 1979-2015 PSID with mortality follow-up through age 68 and year 2017. To address healthy-worker bias, we used the parametric g-formula. First, we estimated how a scenario setting all (versus none) of respondents' employed-person-years to union-member employed-person-years would have affected mortality incidence. Next, we examined gender, racial, and educational effect modification. Finally, we estimated how racial and educational mortality inequities would have changed if union-membership prevalence had remained at 1979 (vs. 2015) levels throughout follow-up. RESULTS In the full sample (respondents = 23,022, observations = 146,681), the union scenario was associated with lower mortality incidence than the nonunion scenario (RR = 0.90, 95% CI = 0.80, 0.99; RD per 1,000 = -19, 95% CI = -37, -1). This protective association generally held across subgroups, although it was stronger among the more-educated. However, we found little evidence mortality inequities would have lessened if union membership had remained at 1979 levels. CONCLUSIONS To our knowledge, this was the first individual-level US-based study with repeated union-membership measurements to analyze the union-mortality relationship. We estimated a protective union-mortality association, but found little evidence declining union density has exacerbated mortality inequities; importantly, we did not incorporate contextual-level effects. See video abstract at, http://links.lww.com/EDE/B839.

BACKGROUND Hip fractures (HFs) are common and pose a significant burden to both the individual and the community. Prompt operative management and aggressive rehabilitation have been shown to improve outcomes. However, there is often a delay in treatment due to lack of theatre availability and appropriate perioperative multi-disciplinary care. This study reviews the literature and reports on outcomes of HFs treated in dedicated units with allocated theatre time and pre-determined multi-disciplinary perioperative pathways. It also provides comparison against outcomes data from HF registries, both domestically and internationally. METHODS An electronic literature search was performed to identify original, English language studies reporting on patient outcomes from dedicated HF units (HFUs). Studies were graded using the Journal of Bone and Joint Surgery criteria. Data were extracted from the text, table and figures of the selected studies. RESULTS Five appropriate studies, with a total cohort of 6633 patients (4032 of whom were treated in a dedicated HFU), were identified. Patients treated in these units sustained a lower mortality rate (Risk Ratio = 0.62, p = 0.01). CONCLUSIONS This review demonstrates that centres with dedicated HFUs result in improved 30-day mortality. Further research may demonstrate more sustained improvements in outcomes. The implementation of dedicated HFUs within health systems should be considered.

The paper is exploring the problem of the vital rate data in the Lower Volga region during the famine of 19321933. Despite the ample quantity of papers presenting this problem the estimations and indicators differ even in the papers of the same authors and valuation methods are not always reliable. The birth rate of the Lower Volga region was 76223 while the mortality was 184570 during the 1933 famine peak by our estimate. However, there are no vital rate data on the Kalmykia in the central statistical administration archives and the registration of 15,2 thousand deaths were not ascertained identically. The real losses from the famine of 19321933 in the Lower Volga region (excluding Kalmykia) are estimated at 175 thousand maximum and birth rate losses are 147 thousand in 19321934. The mortality of the Lower Volga region had clear geographical distribution and location. The high mortality regions were allocated on the Volga Upland and abutting the Oka-Don plain eastern frontier and on the Medium Syrt frontier in Saratov Krai. The allocation of high mortality regions to the Volga River is interpreted as associating with regions containing major cities and towns with high mortality neighborhoods to the Volga. Stalingrad Krai is defined as a region with lower mortality and gradual slow in its increase with a low peak displaced to July 1933. In 1933 the Lower Volga mortality dynamics was from north to south epidemic; whereas in the south there was time to assume the measures as opposed to northern regions. Some Lower Volga regions in 1933 were characterized by a catastrophic low birth rate and high mortality and at the same time by high birth rate and low mortality and positive vital rate data. The distribution of high mortality regions was determined by the character of local authorities activities and local conditions including geographical description (orthometric height), that requires background study.

Conflicting results have been reported on the possible existence of sex differences in mortality after myocardial infarction (MI). There is also a scarcity of data on the impact of sex on outcomes after ST-segment elevation myocardial infarction (STEMI) and non-STEMI (NSTEMI). The aim of this study was to analyze sex difference trends in sex-related differences in mortality for STEMI and NSTEMI.A retrospective analysis of 445 145 episodes of MI (2005-2015) was carried out using information from the Spanish National Health System. The incidence rates were expressed as events per 10 000 person-years. The denominators (age-specific groups) were obtained from the nationwide census. We calculated crude and adjusted (multilevel logistic regression) mortality. Poisson regression analysis was used to study temporal trends for in-hospital mortality.A total of 69.8% episodes occurred in men. The mean age in men was 66.1±13.3 years, which was significantly younger than in women, 74.9±12.1 (P.001). A total of 272 407 (61.2%) episodes were STEMI, and 172 738 (38.8%) were NSTEMI. Women accounted for 28.8% of STEMI and 33.9% of NSTEMI episodes (P.001). The effect of female sex on risk-adjusted models for in-hospital mortality was the opposite in STEMI (OR for women, 1.18; 95%CI, 1.14-1.22; P.001) and NSTEMI (OR for women, 0.85; 95%CI, 0.81-0.89; P.001). MI hospitalization rates were higher in men than in women for all age groups [20 vs 7.7 per 10 000 individuals aged 35-94 years (P.001)], with a trend to diminish in both sexes.Women had a slight but significantly increased risk of in-hospital mortality after MI, but the effect of sex depended on MI type, with women exhibiting higher mortality for STEMI and lower mortality for NSTEMI.

To assess the association between time of birth and mortality among preterm infants. Population-based study of infants born 22–36 weeks gestation (GA) in Canada from 2010 to 2015 (n = 173 789). Multivariable logistic regression models assessed associations between timing of birth and mortality. Among infants 22–27 weeks GA, evening birth was associated with higher mortality than daytime birth (adjusted odds ratio [AOR] 1.14, 95% CI 1.01–1.29). Among infants 28–32 weeks GA and 33–36 weeks GA, night birth was associated with lower mortality than daytime birth (AOR 0.75, 95% CI 0.59–0.95; AOR 0.78, 95% CI 0.62–0.99, respectively). Sensitivity analysis excluding infants with major congenital anomaly revealed that associations between hour of birth and mortality among infants born 28–32 and 33–36 weeks GA decreased or were not statistically significant. Higher mortality among extremely preterm infants during off-peak hours may suggest variations in available resources based on time of day.

Contains fulltext : 235066.pdf (Publisher’s version ) (Open Access) To determine the effect of COVID-19 convalescent plasma on mortality, we aggregated patient outcome data from 10 randomized clinical trials, 20 matched control studies, 2 dose-response studies, and 96 case reports or case series. Studies published between January 1, 2020, and January 16, 2021, were identified through a systematic search of online PubMed and MEDLINE databases. Random effects analyses of randomized clinical trials and matched control data demonstrated that patients with COVID-19 transfused with convalescent plasma exhibited a lower mortality rate compared with patients receiving standard treatments. Additional analyses showed that early transfusion (within 3 days of hospital admission) of higher titer plasma is associated with lower patient mortality. These data provide evidence favoring the efficacy of human convalescent plasma as a therapeutic agent in hospitalized patients with COVID-19.

espanolFundamento. Describir la supervivencia y evolucion clinica de pacientes sometidos a cirugia de revascularizacion miocardica, identificando los factores predictores del resultado quirurgico a corto y largo plazo. Metodo. Estudio de una cohorte de 175 pacientes sometidos a cirugia de revascularizacion miocardica coronaria pura o mixta en un servicio de Cirugia Cardiaca, reclutada entre 2008 y 2010 y seguida durante diez anos. Se realizo analisis descriptivo, de regresion logistica (OR e IC95%) y de supervivencia por (Kaplan Meier y regresion de Cox uni y multivariante (HR e IC95%) a corto (un ano) y largo plazo (diez anos). Resultados. Cohorte con predominio masculino (85,1%), media de edad 67 anos (45-84), y EuroSCORE medio de 5,3%. La mortalidad fue 6,8% al ano y 26,9% a los 10 anos La media de supervivencia de los fallecidos fue 40 meses (32,2-47,8). A corto plazo, un mejor grado funcional preoperatorio NYHA≤III se asocio no significativamente a menor mortalidad (OR :0,11; IC95%: 0,01-1,08; p=0,058), mientras que el sexo femenino (OR: 2,94; IC95%: 1,01-8,57; p=0,048) y un EuroSCORE >4% (OR: 4,94; IC95%: 1,52-16,1; p=0,008) incrementaron el riesgo de presentar eventos cardiacos adversos. A largo plazo, mayor edad (HR: 1,06; IC95%: 1,01-1,10; p=0,026) y menor indice de masa corporal tras el primer ano postoperatorio (HR: 0,90; IC95%: 0,81-0,99; p=0,040) fueron predictores independientes de mortalidad. Conclusiones. La edad fue predictor independiente de mortalidad a largo plazo, mientras que el sexo femenino y un EuroSCORE >4% se asociaron con mayor riesgo de padecer eventos cardiovasculares a corto plazo. EnglishBackground. This study sets out to describe the survival and clinical evolution of patients who undergo myocardial revascularisation surgery, and identifies the short- and long-term predictive factors for surgical outcomes. Methods. Study of a cohort of 175 patients undergoing pure or mixed coronary myocardial revascularisation surgery at a heart surgery unit, recruited between 2008 and 2010 and monitored for ten years. Descriptive and logistic regression (OR and 95%CI) analysis were carried out, along with an analysis of survival by Kaplan Meier and Cox uni- and multivariate regression (HR and 95%CI) in the short- (one year) and long-term (ten years). Results. Predominantly male cohort (85.1%), mean age of 67 years (45-84), and mean EuroSCORE of 5.3%. Mortality was 6.8 and 26.9% at 1 and 10 years, respectively. Mean survival of deceased individuals was 40 months (32.2-47.8). In the short-term, a better NYHA ≤III preoperative functional level was not significantly associated with lower mortality (OR: 0.11; 95%CI: 0.01-1.08; p=0.058), while being female (OR: 2.94; 95%CI: 1.01-8.57; p=0.048) and having a EuroSCORE of >4% (OR: 4.94; 95%CI: 1.52-16.10; p=0.008) showed an increased risk of presenting adverse cardiac events. In the long-term, greater age (HR: 1.06; 95%CI: 1.01-1.10; p=0.026) and lower rates of body mass index after the first postoperative year (HR: 0.90; 95%CI: 0.81-0.99; p=0.040) were independent predictors of mortality. Conclusion. Age was an independent predictor of long-term mortality, while being female and a EuroSCORE >4% were associated with a higher risk of suffering from short-term cardiovascular events.

O arroz está entre os grãos mais consumidos e produzidos no mundo, sendo responsável por alimentar em torno de 2,5 bilhões de pessoas, porém muito se perde devido ao ataque de insetos no armazenamento. Baseado nisso, se objetivou avaliar o uso da terra de diatomácea em grãos de arroz com casca quando infestados por adultos de Sitophilus zeamais. Foram utilizados grãos com teor de umidade inicial de 12 e 14%, sendo cada umidade tratada com doses de 0, 500, 1500 e 2500 g t-1 em dois períodos de infestação: 1 hora e 15 dias após a aplicação. Cada dose foi composta de cinco repetições contendo 100 g de grãos e 20 insetos adultos, para cada teor de umidade e período de infestação. Aos 30 e 60 dias após cada infestação, a mortalidade e emergência de Sitophilus zeamais foram analisadas. Perda de peso dos grãos e teor de umidade foram verificados somente aos 60 dias. Grãos livres de tratamento apresentaram menores valores de mortalidade de Sitophilus zeamais, diferindo estatisticamente dos demais, independente dos períodos de infestação. Independente do teor de umidade inicial e período de infestação, doses de terra de diatomácea de 1500 e 2500 g t-1 apresentaram mortalidade de Sitophilus zeamais entre 98 e 100%. Todos os tratamentos apresentaram teor de umidade final abaixo de 12%. Maiores perdas de peso foram verificadas em grãos com maior teor de umidade inicial. Desta forma, pode-se concluir que a terra de diatomácea apresenta ação satisfatória no controle de S. zeamais em grãos de arroz com casca quando estes entram em equilíbrio higroscópico abaixo de 12%.

To assess whether stroke patients admitted to stroke units (SU) have a better short-term outcome than those treated in conventional wards (CW). A total of 20 hospitals from 16 provinces in China were initially selected in this study. Finally, 24,090 consecutive admissions in 2013–2015 treated in CW and 21,332 consecutive entries in 2017–2019 treated in SU were included. The primary endpoint of this study was the all-cause death or dependency condition three months after admission. Patients in the SU group were more likely receiving thrombolytic therapy (3.9 vs 2.1%) and intravascular treatment (1.2 and 0.7%). In-hospital death were lower in the SU group than the CW group (SU vs CW: 2.93 vs 4.58% [absolute difference, − 2.28% {95% CI, − 3.32% to − 0.93%}, odd ratio {OR}, 0.72{95% CI, 0.61 to 0.82}]. Death after discharge was also lower in the SU group than the CW (SU vs CW: 5.07 vs 6.72% [absolute difference, − 2.33% {95% CI, − 3.39% to − 0.90%}, odd ratio {OR}, 0.75{95% CI, 0.68 to 0.84}]. In addition, patients who received SU care were less likely to be dead or disabled than those patients who received CW care after adjusting for other variability (SU vs CW: 36.20 vs 44.33% [absolute difference, − 11.33% {95% CI, − 15.32% to − 7.14%}, odd ratio {OR}, 0.78{95% CI, 0.80 to 0.85}]. Among patients with stroke, admission to a designated SU was associated with modestly lower mortality at discharge, reduced probability of death, or being disabled at the end of follow-up.

This paper applies the Kuznets (1955) curve approach to road traffic crashes in Algeria based on active population, motorization rate, income per capita, and land artificialization. It aims to establish a link between economic development and road safety by estimating the terms of quadratic equations related to the occurrence of traffic collisions. The results reveal that a link between economic development and road safety can be validated by two econometric specifications for the Kuznets curve (KC). Indeed, because economic conditions remained favorable, the Algerian economy reached its inflection point in 2011 and then entered the second phase of the KC. The increase in the level of economic development then in turn led to an improved road-safety situation in terms of lower mortality rates on the roads.

Introduction Primary cardiac sarcomas (PCSs) are an extremely rare and aggressive type of malignancies that have been described only by a limited number of observational studies. This study aimed to evaluate the currently existing evidence comparing surgical to multimodality treatment of PCS. Methods We systematically reviewed Embase, MEDLINE, Cochrane Database, and Google Scholar, from inception to December 2020, for original articles about surgical and multimodality treatment of PCS. The outcomes included were mortality at various time points, resection margin status, and mean estimated survival. The pooled treatment effects were calculated using a random-effects model. Results Ten studies including a total of 1570 patients met our inclusion criteria. Surgery was associated with significantly lower mortality when compared to conservative treatment at 1, 2, and 3 years, whereas no significant difference was found at 5 years. Furthermore, multimodality treatment showed significantly lower mortality at 1 year when compared to surgery alone, but not at 2 and 5 years. We found no difference in mortality between angiosarcomas and other PCS subtypes. Conclusion Overall, surgery was found to provide a significant mortality advantage to PCS patients up to 3 years following treatment. Multimodality treatment might be of additional benefit, although only within the first year. Prospective randomized studies are needed to further explore these differences in the treatment of PCS.

Mortalitas sepsis dan syok sepsis hampir 20% per tahun dari semua kematian global. Sepsis dan syok sepsis merupakan penyebab 50% pasien dirawat di Intensive Care Unit (ICU). Kristaloid menjadi terapi cairan yang tepat menurut “The Surviving Sepsis Campaign Bundle: 2018 (SSC 2018)”. Kristaloid terbagi menjadi dua jenis, yaitu balanced dan unbalanced crystalloids. Perbedaan kandungan elektrolit keduanya dapat memengaruhi outcome pasien. Penelitian ini bertujuan mengetahui perbedaan pengaruh balanced dan unbalanced crystalloids pada sepsis dan syok sepsis dalam aspek mortalitas, kejadian hiperkloremia, dan lama tinggal di rumah sakit (RS). Metode yang digunakan adalah systematic review. Tempat penelitian berupa pencarian artikel penelitian pada online database dengan waktu penelitian, yaitu artikel dari tahun 2017 hingga 2021. Seleksi studi menggunakan PRISMA, kirteria restriksi dan PICO. Telaah artikel didapatkan 6 dari 249 artikel yang memenuhi syarat. Hasil analisis adalah mortalitas lebih rendah pada grup balanced crystalloids, kejadian hiperkloremia lebih tinggi pada unbalanced crystalloids, namun lama tinggal di RS di kedua grup tidak ada perbedaan signifikan. Simpulan penelitian adalah balanced crystalloids lebih efektif daripada unbalanced crystalloids dalam aspek menurunkan mortalitas dan kejadian hiperkloremia, namun tidak mengenai lama tinggal. Differences in the Effect of Balanced and Unbalanced Crystalloids as Fluid Therapy in Sepsis and Septic Shock: A Systematic Review Sepsis and septic shock contribute to almost 20% per year to the global total deaths. Sepsis and septic shock are also the the leading causes for patients to be treated in the Intensive Care Unit (ICU), with 50% of the patients treated in this unit due to sepsis and septic shock. Crystalloid is the appropriate thereapy for these conditions according to “The Surviving Sepsis Campaign Bundle: 2018 (SSC 2018)”. Crystalloids are divided into two types: balanced and unbalanced crystalloids. This study aimed to determine the difference between the effects of balanced and unbalanced crystalloids in sepsis and septic shock in terms of mortality, incidence of hyperchloremia, and length of stay in hospital. This was a systematic review on articles from the last five years using PRISMA, restriction criteria, and PICO. The review resulted in 6 out of 249 eligible articles. The results of the analysis demonstrated a lower mortality rate in the balanced crystalloids group while the incidence of hyperchloremia was higher in the unbalanced crystalloids group. No significant difference was found in the length of stay in hospital in both groups. Therefore, balanced crystalloids is more effective than unbalanced crystalloids in the aspect of reducing mortality and the incidence of hiperchloremia, with no significant difference in the length of stay in hospital.

Women have consistently lower mortality rates than men at all ages and with respect to most causes. However, gender differences regarding hospital admission rates are more mixed, varying across ages and causes. A number of intuitive metrics have previously been used to explore changes in hospital admissions over time, but have not explicitly quantified the gender gap or estimated the cumulative contribution from cause-specific admission rates. Using register data for the total Danish population between 1995 and 2014, we estimated the time to first hospital admission for Danish men and women aged 60. This is an intuitive population-level metric with the same interpretive and mathematical properties as period life expectancy. Using a decomposition approach, we were able to quantify the cumulative contributions from eight causes of hospital admission to the gender gap in time to first hospital admission. Between 1995 and 2014, time to first admission increased for both, men (7.6 to 9.4 years) and women (8.3 to 10.3 years). However, the magnitude of gender differences in time to first admission remained relatively stable within this time period (0.7 years in 1995, 0.9 years in 2014). After age 60, Danish men had consistently higher rates of admission for cardiovascular conditions and neoplasms, but lower rates of admission for injuries, musculoskeletal disorders, and sex-specific causes. Although admission rates for both genders have generally declined over the last decades, the same major causes of admission accounted for the gender gap. Persistent gender differences in causes of admission are, therefore, important to consider when planning the delivery of health care in times of population ageing. Supplementary Information The online version contains supplementary material available at 10.1007/s10433-021-00614-w.

We assessed whether race moderates the association between flourishing and all-cause mortality. We used panel data from the Midlife in the United States Study (MIDUS) (1995–2016; n = 2,851). Approximately 19% of White respondents and 23% of Black respondents in the baseline sample died over the course of the 21-year study period (n = 564). Cox proportional hazard models showed that Blacks had a higher mortality rate relative to Whites and higher levels of flourishing were associated with a lower mortality rate. Furthermore, a significant interaction between flourishing and race in predicting death was observed. Blacks with higher levels of flourishing had a mortality rate that was not significantly different from that of Whites. However, Blacks, but not Whites, with low flourishing scores had a higher mortality rate. As such, health-promotion efforts focused on enhancing flourishing among Black populations may reduce the Black–White gap in mortalityrate.

Background:The effectiveness of mechanical thrombectomy (MT) in elderly stroke patients remains debated. We aimed to describe outcomes and their predictors in a cohort of patients aged ≥ 85 years treated with MT.Methods:Data from consecutive patients aged ≥ 85 years undergoing MT at two stroke centers between January 2016 and November 2019 were reviewed. Admission National Institutes of Health Stroke Scale (NIHSS), pre-stroke, and 3-month modified Rankin scale (mRS) were collected. Successful recanalization was defined as modified thrombolysis in cerebral ischemia score ≥ 2b. Good outcome was defined as mRS 0–3 or equal to pre-stroke mRS at 3 months.Results:Of 151 included patients, successful recanalization was achieved in 74.2%. At 3 months, 44.7% of patients had a good outcome and 39% had died. Any intracranial hemorrhage (ICH) and symptomatic ICH occurred in 20.3% and 3.6%, respectively. Logistic regression analysis identified lower pre-stroke mRS score (adjusted odds ratio [aOR], 0.52; 95% CI, 0.36–0.76), lower admission NIHSS score (aOR, 0.90; 95% CI, 0.83–0.97), successful recanalization (aOR, 3.65; 95% CI, 1.32–10.09), and absence of ICH on follow-up imaging (aOR, 0.42; 95% CI, 0.08–0.75), to be independent predictors of good outcome. Patients with successful recanalization had a higher proportion of good outcome (45.3% vs 34.3%, p = 0.013) and lower mortality at 3 months (35.8% vs 48.6%, p = 0.006) compared to patients with unsuccessful recanalization.Conclusions:Among patients aged ≥ 85 years, successful recanalization with MT is relatively common and associated with better 3-month outcome and lower mortality than failed recanalization. Attempting to achieve recanalization in elderly patients using MT appears reasonable.

In the present study we used one hundred and twenty-five broiler chicks (Arbo) one- day old used as experimental birds, the experimental chicks were divided into five groups each of twenty-five chicks. The first group kept as control, the 2nd group was non-vaccinated and challenged, the 3rd group was infected with Emeria tenella at 15th days of age and challenged, the 4th group was vaccinated and challenged, the 5th group was vaccinated and challenged. The vaccinated chicks in group 4 was vaccinated by locally prepared NE vaccine adjuvinated with Aluminum hydroxide by dose of 0.5ml subcutaneously at age of seven days and boostered at age of eighteen days. While the chicks of 5th group were vaccinated by locally prepared NE vaccine adjuvinated with Montanide oil. The challenged groups (2, 3, 4 and 5) were challenged at age of 27, 28 and 29 days with C. perfringes type A whole culture by dose of 3ml contains 109 Cfu. Serum samples were collected after challenge at thirty-five days. The results showed that higher immune response, lower mortality rate, increase in body weight and low feed conversion rate in chicks of group 5 compared to chicks of groups (1, 2, 3 and 4).

For almost 20 years, therapeutic hypothermia has been a cornerstone of modern post-cardiac arrest care lowering mortality, and improvin neurologic outcome compared to conventional therapy. This was challenged by the first TTM-trial in 2013, which did not show a benefit for hypothermia at 33°C compared to controlled normothermia at 36°C. Now, the TTM2 trial showed no benefit of hypothermia compared to fever prevention alone. While TTM1 and TTM2 suggest that hypothermia might not be helpful, a deep dive into the trials reveals that this conclusion does not hold true. Here, we focus on patient selection, suboptimal application of hypothermia, interaction of standard sedation with hypothermia, high incidence of post-arrest fever, and withdrawal of life support based on per-protocol neurologic prognostication in the TTM2-trial. Of particular interest, contemporary trials and registries using intravascular cooling in TTM-like patients repeatedly reported much lower mortality rates than those described in both TTM1 and TTM2.

To estimate provincial all-cause mortality rates of Saskatchewan people with rheumatoid arthritis (RA) for comparison with the general population over time and between different geographic regions.Saskatchewan provincial administrative health databases (2001-2019) were utilized as data sources. Two RA case definitions were employed: (1) ≥ 3 physician billing diagnoses, at least 1 from a specialist (rheumatologist, general internist or orthopaedic surgeon) within 2 years; (2) ≥ 1 hospitalization diagnosis (ICD-9 code 714, and ICD-10-CA codes M05, M06). Data from these definitions were combined to create an administrative data RA cohort. All-cause mortality rates across geographic regions, between rural/urban residences and between sexes were examined.Over an 18-year span, between fiscal-year 2001-2002 and fiscal-year 2018-2019, age- and sex-adjusted mortality rates ranged from 17.10 to 21.04 (95% CI 14.77, 19.44; 18.03, 24.05)/1000 RA person-years, compared with mortality rates for the general Saskatchewan population without RA, which ranged from 9.37 to 10.88 (95% CI 9.23, 9.51; 10.72, 11.05)/1000 person-years. Fiscal-year mortality rate ratios ranged from 1.82 to 2.13 (95% CI 1.56, 2.13; 1.83, 2.46). Provincial mortality rates were higher in men than in women for both general and RA populations. Northern Saskatchewan mortality rates were significantly higher in the general population but did not achieve significance compared with other provincial regions for the RA population. Regression analysis identified age, male sex, RA and geographic region as factors contributing to increased mortality. A trend towards lower mortality rates over time was observed.Higher mortality rates were observed in the RA population overall. Men had higher mortality rates, as did residents of Northern Saskatchewan compared with residents of other regions for the general population.RéSUMé: OBJECTIFS: Estimer les taux de mortalité provinciaux, toutes causes confondues, des habitants de la Saskatchewan atteints de polyarthrite rhumatoïde (PR) pour les comparer aux taux dans la population générale au fil du temps et entre différentes régions géographiques. MéTHODE: Nos données sont extraites des bases de données administratives sur la santé de la Saskatchewan (2001–2019). Deux définitions de cas ont été employées pour la PR : 1) ≥ 3 factures de diagnostic médical, dont au moins une d’un(e) spécialiste (rhumatologue, interniste général[e] ou chirurgien[ne] orthopédiste) en l’espace de deux ans; 2) ≥ 1 diagnostic d’hospitalisation (code CIM-9 714 et codes CIM-10-CA M05 et M06). Les données de ces définitions ont été combinées pour créer une cohorte de personnes atteintes de PR dans les données administratives. Les taux de mortalité toutes causes confondues entre les régions géographiques, entre les lieux de résidence urbains et ruraux et entre les sexes ont été examinés. RéSULTATS: En l’espace de 18 ans, entre les exercices 2001-2002 et 2018-2019, les taux de mortalité rajustés selon l’âge et le sexe ont varié entre 17,10 et 21,04 (IC de 95 % : 14,77-19,44; 18,03-24,05)/1000 personnes-années pour les personnes atteintes de PR, tandis que les taux de mortalité de la population générale de la Saskatchewan non atteinte de PR se sont situés entre 9,37 et 10,88 (IC de 95 % : 9,23-9,51; 10,72-11,05)/1000 personnes-années. Les rapports de taux de mortalité par exercice ont varié entre 1,82 et 2,13 (IC de 95 % : 1,56-2,13; 1,83-2,46). Les taux de mortalité provinciaux des hommes étaient supérieurs à ceux des femmes, tant dans la population générale que chez les personnes atteintes de PR. Les taux de mortalité dans le Nord de la Saskatchewan étaient sensiblement plus élevés que dans les autres régions de la province pour la population générale, mais pas sensiblement plus élevés pour la population atteinte de PR. Selon les analyses de régression, l’âge, le sexe masculin, la PR et la région géographique étaient des facteurs contribuant à une mortalité accrue. Une tendance à la baisse des taux de mortalité au fil du temps a été observée. CONCLUSION: Dans la population atteinte de PR, des taux de mortalité plus élevés ont été observés globalement. Dans la population générale, les taux de mortalité des hommes et ceux des résidents du Nord de la Saskatchewan étaient plus élevés que ceux des résidents des autres régions.

Although many factors affect the welfare of hens housed in cage and non-cage systems, welfare issues in cage systems often involve behavioural restrictions, whereas many welfare issues in non-cage systems involve health and hygiene. This review considers and compares the welfare of laying hens in cages, both conventional and furnished cages, with that of hens in non-cage systems, so as to highlight the welfare implications, both positive and negative, of cage housing. Comparisons of housing systems, particularly in commercial settings, are complex because of potentially confounding differences in physical, climatic and social environments, genetics, nutrition and management. Furthermore, some of the confounding factors are inherent to some specific housing systems. Nevertheless, research in commercial and experimental settings has indicated that hens in conventional and furnished cages have lower (or similar), but not higher, levels of stress on the basis of glucocorticoid concentrations than do hens in non-cage systems. Furthermore, caged hens, generally, have lower mortality rates than do hens in non-cage systems. However, the behavioural repertoire of laying hens housed in conventional cages is clearly more compromised than that of hens in non-cage systems. In contrast to conventional cages, furnished cages may provide opportunities for positive emotional experiences arising from perching, dust-bathing, foraging and nesting in a nest box. Some have suggested that the problems with modern animal production is not that the animals are unable to perform certain behavioural opportunities, but that they are unable to fill the extra time available with limited behaviours when they have no need to find food, water or shelter. Environmental enrichment in which objects or situations are presented that act successfully, and with a foreseeable rewarding outcome for hens by also providing regular positive emotional experience, is likely to enhance hen welfare. Research on cage systems highlights the importance of the design of the housing system rather than just the housing system per se.

Objective Randomized controlled trials of the effectiveness of statins on rheumatic disease outcomes have shown limited or no benefit. On the other hand, observational studies have reported remarkable effectiveness of statins at reducing mortality in patients with rheumatic diseases. We evaluated these observational studies for the presence of immortal time bias, which tends to exaggerate the effectiveness of drugs by creating a survival advantage for exposed patients. Methods We searched PubMed for observational studies investigating the impact of statins in patients with common rheumatic diseases, including rheumatoid arthritis, osteoarthritis, lupus, ankylosing spondylitis, gout and systemic autoimmune diseases. Studies were included if estimates for all-cause mortality among statin users compared to non-users were reported. We evaluated each study for the presence of immortal time bias and estimated the impact of the bias on the published results. Results We found eight observational studies investigating the impact of statins on mortality among patients with rheumatic diseases. Four studies were affected by the classical variant of immortal time bias, while the others introduced immortal time into the comparator via random-calendar date assignment. The studies with the classical form of immortal time bias, which tends to exaggerate drug effectiveness, reported protective effects of statins on mortality ranging from 13% to 57% reductions. In contrast, immortal time bias through random-calendar date assignment, which tends to play down the effectiveness by introducing immortal time in the comparator, reported 16% to 37% reductions in mortality. Conclusion Bias in observational studies may explain the discrepancy in findings with randomized controlled trials on the effectiveness of statins in patients with rheumatic diseases. Future observational studies will need to rely on incident and prevalent new-user designs that emulate randomized trials and avoid immortal time bias.

Contemporary data on outcomes in open thoracoabdominal aortic aneurysm (TAAA) repair are limited to reports from major aortic referral centers showing excellent outcomes. This study aimed to characterize the national experience of open TAAA repair using national outcomes data, with a primary focus on the association of hospital volume with mortality and morbidity.The Nationwide Inpatient Sample was queried from 1998 to 2011, and all patients with a diagnosis of TAAA who underwent open operative repair were included. These patients were further stratified into tertiles based on the operative volume of the institution that performed the operation: low volume (LV), 3 cases/y; medium volume (MV), 3 to 11 cases/y; and high volume (HV), ≥12 cases/y. Baseline demographics as well as perioperative outcomes were compared between these groups. Multivariable logistic regression was performed to determine predictors of operative mortality and morbidity. Subgroup analyses were performed for patients presenting for elective surgery and for those presenting for urgent and emergent surgery.Overall operative mortality was 21% for the entire cohort. Operative mortality was higher at LV (26%) and MV (21%) centers compared with HV centers (15%; P .001). This difference was similar in both elective surgery (LV, 18%; MV, 14%; HV, 12%; P .001) and urgent and emergent surgery (LV, 34%; MV, 30%; HV, 19%; P .001). Furthermore, rates of blood transfusion and acute renal failure were significantly lower in the HV group. Multivariable analysis revealed that compared with the HV group, patients operated on at LV centers (odds ratio [OR], 1.9, 95% confidence interval [CI], 1.7-2.1; P .001) and MV centers (OR, 1.5; 95% CI, 1.4-1.7; P .001) had at least 1.5 times the odds of in-hospital mortality. The HV group also had significantly lower odds of dying in the subgroup analyses of both elective surgery and urgent and emergent surgery. Increasing TAAA volume was associated with increased use of distal aortic perfusion (OR, 1.03; 95% CI, 1.02-1.03; P .001).Patients with TAAA in the United States operated on at HV centers have significantly lower mortality and morbidity compared with patients operated on at lower volume centers. Consideration of referral to HV centers may be warranted, but further research is required to justify this conclusion.

Objective. Evaluate the efficiency and calculate the economic feasibility of using a new strain of lactic acid bacteria Lactobacillus sp. 13/2 in rabbit breeding technology under industrial conditions. Methods. Microbiological, economical, statistical. Results. The average weight of animals at the end of fattening was almost the same in both groups. However, when using a strain of lactic acid bacteria Lactobacillus sp. 13/2 in rabbit breeding technology, lower mortality rate in young animals and reduction of feed costs for their fattening was reported in comparison with the control. In the experimental group, animal mortality rate was 2.94 % versus 12.5 % in the control group, the average feed consumption for fattening per 1 kg of live weight gain decreased by 9 %. A positive economic effect in the experimental group was observed when the cost of sales increased per 1 head by UAH 7.48 (4 %) if the carcass price was UAH 140/kg. At the same time, the prime cost of 1 kg of gain decreased by UAH 1.98 (9 %). Also, the use of lactic acid bacteria reduced the cost of feed consumed per 1 head by UAH 1.77 (5 %) if the cost of feed was UAH 6/kg. Despite the decrease in the profitability of rabbit production by 1.5 %, the use of a new promising strain of lactic acid bacteria Lactobacillus sp. 13/2 during the fattening of rabbits had a positive effect on the maintenance of livestock, resulting in the decreased lost profit in the experimental group by UAH 277.08 (75 %). In terms of 1 head, the lost profit in the experimental and control groups was UAH 2.79 and UAH 13.99, respectively, due to which the use of lactic acid bacteria is completely regained. Conclusion. The positive effect of the use of Lactobacillus sp. 13/2 in rabbit breeding technology, which is manifested by a reduction in animal mortality and a reduction in feed costs for fattening, was established. The use of lactic acid bacteria helps to increase the economic efficiency of rabbit breeding, especially due to the reduction of lost profits. The economic effect is achieved without significant additional costs. The additional costs associated with the use of lactic acid bacteria are regained.

Surgical management of mitral valve disease in neonates and infants is challenging. When repair is no longer feasible, replacement may become inevitable, but should only be considered as an option of last resort due to the remarkably high rate of associated morbidity and mortality. Mechanical valves are the preferred choice in large annuli, while stented conduits seem promising in smaller ones. In patients with a preoperative mitral valve annulus equal or larger than 15-16 mm, an intra-annular placement of the smallest mechanical valve available should be attempted. In patients with smaller annuli, the placement of a stented valved conduit seems to display a lower mortality risk. Supra-annular implantation of prostheses should be reserved for exceptional cases and to those familiar with this technique because of the high rate of associated complications.

An experiment was undertaken to identify suitable shade house for different high value vegetables during the winter season of 2019-20 at the research farm of Olericulture Division, HRC, BARI, Gazipur. The experiment was randomized complete block design with 3 replications. Four vegetable varieties viz., tomato (V1), brinjal (V2), capsicum (V3), broccoli (V4) and 4 shading treatments [1) UV stabilized polyethylene film with 60 mesh insect net along with green shade net (T1); 2) UV stabilized polyethylene film with 60 mesh insect net (T2); 3) 60 mesh insect net (T3) and 4) Open field (control) (T4)] were included in this study. Different vegetables responded differently with the changes of shade house irrespective of different characters. Brinjal (V2) resulted in the maximum seed germination (93.58%) with the lowest mortality (5.58%), in case of shading treatment, UV stabilized polyethylene film with 60 mesh insect net along with green shade net (T1) exhibited the maximum seed germination (94.83%) with lower mortality (3.33%). In case of combined effect, maximum seed germination (93.58%) and the lowest mortality (2.08%) were observed in V2T1. The tallest seedlings were produced in V3T1 at every growth stage (15 days, 20 days, 25 days, 30 days). The maximum no. of leaves was produced in V3T2. The minimum insect infestation was observed in V1T1, V1T2, V2T1, V2T2, V3T1, V3T2, V4T1, V4T2 (0.67% at 15 days and 20 days).

Background and Purpose: The benefit of bridging intravenous thrombolysis (IVT) in acute ischaemic stroke patients eligible for endovascular thrombectomy (EVT) is unclear. This may be particularly relevant where reperfusion is achieved with multiple thrombectomy passes. We aimed to determine the benefit of bridging IVT in first and multiple-pass patients undergoing EVT ≤6 h from stroke onset to groin puncture. Methods: We compared 90-day modified Rankin Scale (mRS) outcomes in 187 consecutive patients with large vessel occlusions (LVOs) of the anterior cerebral circulation who underwent EVT ≤6 h from symptom onset and who achieved modified thrombolysis in cerebral ischaemia (mTICI) 2c/3 reperfusion with the first pass to those patients who required multiple passes to achieve reperfusion. The effect of bridging IVT on outcomes was examined. Results: Significantly more first-pass patients had favourable (mRS 0–2) 90-day outcomes (68 vs. 42%, p = 0.001). Multivariate analysis showed an association between first-pass reperfusion and favourable outcomes (OR 2.25; 95% CI 1.08–4.68; p = 0.03). IVT provided no additional benefit in first-pass patients (OR 1.17; CI 0.42–3.20; p = 0.76); however, in multiple-pass patients, it reduced the risk of disabling stroke (mRS ≥4) (OR 0.30; CI 0.10–0.88; p = 0.02) and mortality (OR 0.07; CI 0.01–0.36; p = 0.002) at 90 days. Conclusion: Bridging IVT may benefit patients with anterior circulation stroke with LVO who qualify for EVT and who require multiple passes to achieve reperfusion.

Negative interactions with humans resulting from livestock predation is a major factor influencing the decline of African lion Panthera leo populations across Africa. Here we investigate lion depredation within two Maasai communities in southern Kenya where people and lions coexist in the absence of any formal protected areas. We explore the factors that increase the frequency and severity of lion attacks on pastoralists and their livestock and assess the effectiveness of livestock guarding to reduce damage. Finally, we examine in which circumstances lion depredation triggers retaliation by people. Over a period of 26 months, lions attacked livestock 29 times, resulting in 41 livestock deaths and 19 injuries. There were also two attacks on people. Lions preferred cattle over the more numerous sheep and goats. Attacks on livestock occurred mostly during the dry season and were not affected by changes in prey density or variation in pastoral settlement that brought livestock into closer proximity with lions. Livestock were guarded during 48.2% of lion attacks. Active guarding at pasture disrupted the majority of lion attacks, resulting in lower mortality rates. Passive guarding in corrals at night also disrupted attacks but did not lead to lower livestock mortality.

OBJECTIVE The association between ED crowding and mortality has been established internationally, but not in New Zealand. The aim was to determine which measures of crowding were associated with mortality for new patients presenting to New Zealand EDs. The primary outcome was mortality for patients within 7 days of arrival in the ED. METHODS This was a retrospective cohort study, using administrative data from 2006 to 2012. The crowding conditions at the time of presentation of each patient were recreated. Multivariable Cox proportional hazard modelling was used to determine the probability of death within 7 days of the presentation to ED. Each crowding measure was added independently to the optimum mortality model to determine how each crowding metric influenced the model. RESULTS Twenty-five of 28 (89%) eligible acute hospitals in New Zealand were included, with 5 793 767 ED visits by 2 214 865 individuals. Seven-day mortality was higher for patients arriving at times when there was more than 10% hospital access block (hazard ratio [HR] 1.10, 95% confidence interval [CI] 1.05, 1.17) or non-compliance with the 4-h emergency access target (HR 1.07, 95% CI 1.01, 1.12). ED occupancy did not influence the model importantly, while the number of arrivals in the previous 6 h was associated with lower mortality (HR 0.90, 95% CI 0.84, 0.97). CONCLUSION Access block had the strongest association with 7-day mortality. That ED occupancy and the number of arrivals were not associated with increased mortality suggests that system issues related to long ED stays may be most important in the link between ED crowding and mortality.