scholarly journals Diabetes mellitus and extrapulmonary tuberculosis: site distribution and risk of mortality

2016 ◽  
Vol 144 (10) ◽  
pp. 2209-2216 ◽  
Author(s):  
M. J. MAGEE ◽  
M. FOOTE ◽  
S. M. RAY ◽  
N. R. GANDHI ◽  
R. R. KEMPKER
Keyword(s):  
Medical Records ◽  
Extrapulmonary Tuberculosis ◽  
Multivariable Analysis ◽  
Site Distribution ◽  
Risk Of Death ◽  
Risk Of Mortality ◽  
Diabetes Status ◽  
All Cause Mortality ◽  
The Difference ◽  
The Relationship

SUMMARYScarce data exist on the relationship between diabetes and extrapulmonary tuberculosis (EPTB). We evaluated whether diabetes impacts site of TB and risk of death in patients with EPTB. We evaluated a cohort of TB cases from the state of Georgia between 2009 and 2012. Patients aged ⩾16 years were classified by diabetes status according to medical records. Site of EPTB was determined by culture and/or state TB classification. Death was defined by all-cause mortality. Of 1325 eligible reported TB cases, 369 (27·8%) had any EPTB including 258 (19·5%) with only EPTB and 111 (8·4%) with pulmonary TB and EPTB. Of all TB cases, 158 had diabetes (11·9%). In multivariable analysis, the odds of any EPTB was similar in patients with and without diabetes [adjusted odds ratio 1·04, 95% confidence interval (CI) 0·70–1·56]. The risk of death was 23·8% in patients with EPTB and diabetes vs. 9·8% in those with no diabetes (P < 0·01); after adjusting for covariates the difference was not significant (aRR 1·19, 95% CI 0·54–2·63). Diabetes was common in patients with EPTB and risk of death was high. Improved understanding of the relationship between diabetes and EPTB is critical to determine the extent that diabetes affects TB diagnosis and clinical management.

scholarly journals Sudden death in patients with sleep apnea: a systematic review and meta-analysis

2020 ◽  
Author(s):  
Emily S. Heilbrunn ◽  
Paddy Ssentongo ◽  
Vernon M. Chinchilli ◽  
Anna E. Ssentongo
Keyword(s):  
Sleep Apnea ◽  
Sudden Death ◽  
Cardiovascular Mortality ◽  
Meta Analysis ◽  
Cardiac Mortality ◽  
Risk Of Death ◽  
Risk Of Mortality ◽  
Obstructive Sleep ◽  
Increased Risk ◽  
All Cause Mortality

AbstractBackgroundOver 1 billion individuals across the globe experience some form of sleep apnea, and this number is steadily rising. Obstructive sleep apnea (OSA) can negatively influence one’s quality of life and potentially increase the risk of mortality. However, this association between OSA and mortality has not been comprehensively and thoroughly explored. This meta-analysis was conducted to conclusively estimate the risk of death for all-cause mortality and cardiovascular mortality in OSA patients.Study Design4,613 articles from databases including PUBMED, OVID & Joana Briggs, and SCOPUS were comprehensively assessed by two reviewers (AES & ESH) for inclusion criteria. 28 total articles were included, with 22 of them being used for quantitative analysis. Pooled effects of all-cause mortality, cardiac mortality, and sudden death were calculated by utilizing the metaprop function in R Statistical Software and the random-effects model with appropriate 95% confidence intervals.ResultsAnalysis on 42,032 individuals revealed that those with OSA were twice as likely to die from cardiac mortality compared to those without sleep apnea (HR= 1.94, 95%CI 1.39-2.70). Likewise, individuals with OSA were 1.7 times as likely to die from all-cause sudden death compared to individuals without sleep apnea (HR= 1.74, 95%CI 1.40-2.10). There was a significant dose response relationship between severity of sleep apnea and incidence risk of death, where those with severe sleep apnea wereConclusionsIndividuals with obstructive sleep apnea are at an increased risk for all-cause mortality and cardiac mortality. Further research related to appropriate interventions and treatments are necessary in order to reduce this risk and optimize survival in this population.Key MessagesWhat is the key question?Are individuals with sleep apnea at an increased risk for cardiovascular mortality and sudden death?What is the bottom Line?Sleep apnea is associated with an increased risk of cardiovascular mortality and sudden death, with a dose response relationship, where those with severe sleep apnea are at the highest risk of mortality.Why read on?This is the first systematic review and meta-analyses to synthesize and quantify the risk of mortality in those with sleep apnea, highlighting important directions for future research.Prospero Registration IDCRD42020164941

Sarcopenia and Frailty in PD: Impact on Mortality, Malnutrition, and Inflammation

2018 ◽  
Vol 38 (6) ◽  
pp. 447-454 ◽  
Author(s):  
Yuka Kamijo ◽  
Eiichiro Kanda ◽  
Yoshitaka Ishibashi ◽  
Masayuki Yoshida
Keyword(s):  
Muscle Mass ◽  
Secondary Outcome ◽  
Related Factors ◽  
Clinical Frailty Scale ◽  
Risk Of Mortality ◽  
All Cause Mortality ◽  
Comorbidity Index ◽  
The Relationship ◽  
Worse Prognosis

Background It is known that sarcopenia is related to malnutrition-inflammation-atherosclerosis (MIA) syndrome and is an important problem in dialysis patients. The notion of frailty includes various physical, psychological, and social aspects. Although it has been reported that sarcopenia is associated with poor prognosis in patients with hemodialysis, reports on peritoneal dialysis (PD) patients are rare. In this study, we examined the morbidity and mortality of sarcopenia and frailty in PD patients. We also investigated the MIA-related factors. Methods We evaluated 119 patients cross-sectionally and longitudinally. The Asian Working Group for Sarcopenia criteria and the Clinical Frailty Scale (CFS) were used to diagnose sarcopenia and frailty. The primary outcome is all-cause mortality with sarcopenia and frailty. The secondary outcome is the relationship between various MIA-related factors. Results Morbidity of sarcopenia and frailty in PD patients was 8.4% and 10.9%, respectively. Old age, high values of Barthel Index, Charlson Comorbidity Index, CFS, and low values of body mass index (BMI), muscle strength, muscle mass, and slow walking were associated with sarcopenia. Interleukin-6, albumin, and prealbumin were significantly correlated with muscle mass. During follow-up, the presence of sarcopenia or frailty was associated with the risk of mortality. In multivariate analysis, CFS was related to the mortality rate of PD patients. Conclusions The presence of sarcopenia or frailty was associated with a worse prognosis.

Lower serum retinoic acid level for prediction of higher risk of mortality in ischemic stroke

Neurology ◽  
2019 ◽  
Vol 92 (15) ◽  
pp. e1678-e1687 ◽  
Author(s):  
Wen-Jun Tu ◽  
Han-Cheng Qiu ◽  
Yiqun Zhang ◽  
Jian-lei Cao ◽  
Hong Wang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Ischemic Stroke ◽  
Retinoic Acid ◽  
Prognostic Significance ◽  
Multivariable Analysis ◽  
Net Reclassification Improvement ◽  
Risk Of Mortality ◽  
Increased Risk ◽  
All Cause Mortality ◽  
Cvd Mortality

ObjectiveTo explore the association between serum retinoic acid (RA) level in patients with acute ischemic stroke (AIS) and mortality risk in the 6 months after admission.MethodsFrom January 2015 through December 2016, patients admitted to 3 stroke centers in China for first-ever AIS were screened. The primary endpoint was all-cause mortality or cardiovascular disease (CVD) mortality in the 6 months after admission. The significance of serum RA level, NIH Stroke Scale score, and established risk factors in predicting mortality were determined. The integrated discrimination improvement (IDI) and net reclassification improvement (NRI) statistics were applied in statistical analysis.ResultsOf the 1,530 patients enrolled, 325 died within 6 months of admission, with an all-cause mortality of 21.2% and CVD-related mortality of 13.1%. In multivariable analysis, RA levels were expressed as quartiles with the clinical variables. The results of the second to fourth quartiles (Q2–Q4) were compared with the first quartile (Q1); RA levels showed prognostic significance, with decreased all-cause and CVD mortality of 55% and 63%, respectively. After RA was added to the existing risk factors, all-cause mortality could be better reclassified, in association with only the NRI statistic (p = 0.005); CVD mortality could be better reclassified with significance, in association with both the IDI and NRI statistics (p < 0.01).ConclusionsLow circulating levels of RA were associated with increased risk of all-cause and CVD mortality in a cohort of patients with first-incidence AIS, indicating that RA level could be a predictor independent of established conventional risk factors.

scholarly journals Socioeconomic inequality in recent adverse all-cause mortality trends in Scotland

2019 ◽  
Vol 73 (10) ◽  
pp. 971-974 ◽  
Author(s):  
Lynda Fenton ◽  
Grant MA Wyper ◽  
Gerry McCartney ◽  
Jon Minton
Keyword(s):  
Socioeconomic Inequality ◽  
Mortality Trends ◽  
Socioeconomic Gradient ◽  
Period 2 ◽  
All Cause Mortality ◽  
The Difference ◽  
Mortality Improvement ◽  
The Relationship ◽  
Mortality Improvements ◽  
Index Of Multiple Deprivation

BackgroundGains in life expectancies have stalled in Scotland, as in several other countries, since around 2012. The relationship between stalling mortality improvements and socioeconomic inequalities in health is unclear.MethodsWe calculate the difference, as percentage change, in all-cause, all-age, age-standardised mortality rates (ASMR) between 2006 and 2011 (period 1) and between 2012 and 2017 (period 2), for Scotland overall, by sex, and by Scottish Index of Multiple Deprivation (SIMD) quintile. Linear regression is used to summarise the relationship between SIMD quintile and mortality rate change in each period.ResultsBetween 2006 and 2011, the overall ASMR fell by 10.6% (138/100 000), by 10.1% in women, and 11.8% in men, but between 2012 and 2017 the overall ASMR fell by only 2.6% (30/100 000), by 3.5% in women, and by 2.0% in men. Within the most deprived quintile, the overall ASMR fell by 8.6% (143/100 000) from 2006 to 2011 (7.2% in women; 9.8% in men), but rose by 1.5% (21/100 000) from 2012 to 2017 (0.7% in women; 2.1% in men).The socioeconomic gradient in ASMR improvement more than quadrupled, from 0.4% per quintile in period 1, to 1.7% per quintile in period 2.ConclusionFrom 2012 to 2017, socioeconomic gradients in mortality improvement in Scotland were markedly steeper than over the preceding 6 years. As a result, there has not only been a slowdown in overall reductions in mortality, but a widening of socioeconomic mortality inequalities.

scholarly journals Prognosis of Patients Victim of Spontaneous Subarachnoid Hemorrhage: A Comparison between Radiologic Scales

2020 ◽  
Vol 39 (01) ◽  
pp. 001-004
Author(s):  
Luiza Maria Dias Abboud Hanna ◽  
Sarah Eloisa Biguelini ◽  
Francisco Alves de Araujo Junior ◽  
Anderson Matsubara ◽  
Pedro Helo dos Santos Neto
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Medical Records ◽  
Early Mortality ◽  
Clinical Scale ◽  
Risk Of Death ◽  
Risk Of Mortality ◽  
Life Habits ◽  
Spontaneous Subarachnoid Hemorrhage ◽  
The City ◽  
Better Than

Abstract Objective To analyze the population and the early mortality rate (up to thirty days) of patients victim of spontaneous subarachnoid hemorrhage (SAH) according to the Hunt-Hess clinical scale and the Fisher and modified Fisher radiological scales. Materials and Methods We analyzed 46 medical records and skull computed tomography (CT) scans of patients with spontaneous SAH admitted between February 2014 and December 2017 at Hospital Universitário Evangélico Mackenzie, in the city of Curitiba, state of Paraná, Brazil. The method of the study was exploratory-descriptive, transversal and retrospective, with a quantitative approach. We analyzed epidemiological (gender, age), clinical (life habits, pathologies, Glasgow coma scale and Hunt-Hess scale) and radiological (Fisher and modified Fisher scales) variables, and the Hunt-Hess and the Fisher scales were correlated with risk of death. The data was submitted to statistical analysis considering values of p < 0.05. Result There was a higher prevalence of spontaneous SAH among women (69.5%), as well as among patients aged between 51 and 60 years (34.7%). Regarding the grades on the scales, there was higher prevalence of Fisher 4, Modified Fisher 4 and Hunt-Hess 2. Evolution to death was higher among women (76.4%) and patients aged between 61 and 70 years (35,2%). Conclusion Mortality was higher among patients classified as Fisher 3, Modified Fisher 4 and Hunt-Hess ≥ 3. The Fisher scale is better than the modified Fisher scale to assess the risk of mortality.

The importance of surgical margins in dedifferentiated liposarcoma survival.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e22528-e22528
Author(s):  
Sara Albagoush ◽  
Jonathan Gootee ◽  
Kevin Nguyen ◽  
Sarah J Aurit ◽  
Christina Curtin ◽  
...  
Keyword(s):  
Multivariable Analysis ◽  
Soft Tissue Sarcomas ◽  
Residual Tumor ◽  
Surgical Margins ◽  
Dedifferentiated Liposarcoma ◽  
High Grade ◽  
Anatomic Site ◽  
Risk Of Death ◽  
Risk Of Mortality ◽  
Increased Risk

e22528 Background: Among the types of soft tissue sarcomas (STS), liposarcoma is the most common malignant STS. Considering therapeutic options, surgical resection is the most utilized therapeutic option. In this study, we aim to explore the effects of varying degrees of surgical margins on survival in patients with dedifferentiated liposarcoma. Methods: The National Cancer Database (NCDB) was used to select patients with dedifferentiated liposarcoma to determine if surgical margins and other variables were associated with worse overall survival after accounting for age, gender, race, Charlson-Deyo score, anatomic site, treatment approach, tumor size, tumor grade, and presence of metastases through multivariable analysis. Results: Of the 1,004 patients, 64.4% were male, 87.0% were white, and the median age was 63 years. Approximately 95% had no metastases at the time of diagnosis, and 91.5% had high grade liposarcoma. For the status of surgical margins, 50.8% had no residual tumors, 26.1% had microscopic residual tumors, and 4.3% had macroscopic residual tumors. In general, the risk of death was higher for older males (25.8% increased risk of mortality) and those with metastases (312.9% increased risk of mortality) as well as patients with high grade liposarcoma (112.4% increased risk of mortality). When compared to no residual tumor after surgery, patients with macroscopic residual tumors, had a 96.7% increased risk of death (HR 95% CI:1.24 to 3.13; p= 0.004). Conclusions: Older age, presence of metastasis, male patients, retroperitoneal/abdomen primary site, high grade tumors, and macroscopic or residual tumor present after surgery led to an increased risk of mortality.

scholarly journals Ultrasonographic findings of re-epithelialized skin after partial-thickness burns

2018 ◽  
Vol 6 ◽  
Author(s):  
Jong Dae Kim ◽  
Suk Joon Oh ◽  
Sun Gyu Kim ◽  
Song Vogue Ahn ◽  
Yu Jin Jang ◽  
...  
Keyword(s):  
Medical Records ◽  
Normal Skin ◽  
Healing Time ◽  
Ultrasound Images ◽  
Strongly Correlated ◽  
Varying Thickness ◽  
Partial Thickness ◽  
The Difference ◽  
Partial Thickness Burns ◽  
The Relationship

Abstract Background This study aimed to investigate the difference between ultrasonographic findings of normal skin and those of re-epithelialized skin after partial-thickness burns and to evaluate the relationship between these findings and clinical outcomes. Methods This study retrospectively analysed the ultrasound images of re-epithelialized skin after partial-thickness burns and contralateral normal skin from January 2016 to December 2016. A total of 155 lesions from 148 patients were analysed with ultrasound images, and healing time was documented. The scar status of each lesion was evaluated through medical records and photographs. We analysed the difference in ultrasonographic findings between normal skin and re-epithelialized skin after partial-thickness burns and statistically analysed the relationship between healing time, scar status and ultrasonographic findings. Results The re-epithelialized skin after partial-thickness burns was significantly thicker than the contralateral normal skin, and the echogenicity was significantly lower. The ultrasound images of the re-epithelialized skin after partial-thickness burns showed the characteristic findings of low-echogenic bands (LEB), and the proportion of LEB thickness is strongly correlated with healing time. In the multivariate analysis of scar status, only the proportion of LEB thickness was statistically significant. Conclusion In this study, we found that there were ultrasonographic differences between re-epithelialized skin after partial-thickness burns and normal skin and that an LEB of varying thickness was formed after re-epithelialization. The thickness of the LEB in re-epithelialized skin after partial-thickness burns increased with healing time and was related to scar status.

scholarly journals Validation of The 2018 FIGO Staging System for Predicting The Prognosis of Patients With Stage IIIC Cervical Cancer

2021 ◽  
Author(s):  
Xingtao Long ◽  
Qi Zhou ◽  
Dongling Zou ◽  
Dong Wang ◽  
Jingshu Liu ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Multivariable Analysis ◽  
Staging System ◽  
Risk Of Death ◽  
T Stage ◽  
Figo Staging ◽  
Gynecology And Obstetrics ◽  
Risk Of Mortality ◽  
Increased Risk ◽  
Standardized Treatment

Abstract Purpose We aimed to validate the prognostic performance of the 2018 International Federation of Gynecology and Obstetrics(FIGO) IIIC staging system for patients with cervical cancer. Methods We conducted a retrospective analysis of patients with stage III cervical cancer according to the 2018 FIGO staging system who received standardized treatment from January 2011 to December 2014. Results Multivariable analysis revealed that stage IIIC1 was not significantly associated with increased risk of death compared with stages IIIA (hazard ratio [HR] = 1.432; 95% confidence interval [CI]: 0.867 to 2.366; P = 0.161) and IIIB (HR = 1.261; 95% CI: 0.871 to 1.827; P = 0.219). Stage IIIC2 was an independent indicator of increased risk of mortality compared with stages IIIA (HR = 2.958; 95% CI :1.757 to 4.983; P < 0.001) and IIIB (HR = 2.606; 95% CI: 1.752 to 3.877; P < 0.001). We stratified patients with stage IIIC1 according to T stage and compared survival outcomes. Stage IIIC1 (T1) was associated with longer 5-year overall survival (OS) compared with stages IIIA (P = 0.004) or IIIB (P < 0.001). An optimal cut-off value (= 2) was established for predicting the prognosis of stage IIIC1p(T1/T2a), which was associated with the number of pelvic lymph nodes metastases (PLNMs). Patients with stage IIIC1pN1-2 experienced longer 5-year OS compared those with stages IIIA (P = 0.01) or IIIB (P < 0.001). Conclusion Patients with stage IIIC1 cervical cancer exhibited heterogeneous clinical characteristics reflecting their variable prognoses, depending on T-stage and the extent of PLNMs

The Effect of Smoking on the Relationship between Alcohol Consumption and All-Cause Mortality in Canadian Women

2005 ◽  
Vol 32 (3) ◽  
pp. 373-386
Author(s):  
Jürgen Rehm ◽  
Bo Zhang ◽  
Susan Bondy ◽  
Mary Jane Ashley ◽  
Joanna Cohen ◽  
...  
Keyword(s):  
Alcohol Consumption ◽  
Protective Effect ◽  
Lower Risk ◽  
Smoking Status ◽  
Moderate Drinking ◽  
Risk Of Mortality ◽  
Heavy Drinkers ◽  
All Cause Mortality ◽  
The Relationship ◽  
Effect Of Light

The protective effect of light to moderate drinking on all-cause mortality in general is well established, but there have been questions on its generalizability to women and non-smokers. The present study addresses these questions with a large cohort of Canadian middle-aged women. The key findings indicate that light to moderate drinkers have a markedly lower risk of mortality compared with current abstainers and that this effect is independent of smoking status. Part of this effect may be due to ex-drinkers who are part of the current abstainers group. Heavy drinkers have a higher mortality risk than light to moderate drinkers.

The influence of treatment facility volume on the mortality of multiple myeloma patients.

2016 ◽  
Vol 34 (7_suppl) ◽  
pp. 284-284
Author(s):  
Ronald S. Go ◽  
Adam C Bartley ◽  
Cynthia S Crowson ◽  
Nilay D. Shah ◽  
Elizabeth B. Habermann ◽  
...  
Keyword(s):  
Cox Regression ◽  
Multivariable Analysis ◽  
Geographic Area ◽  
Cancer Registries ◽  
Treatment Facility ◽  
Cancer Data ◽  
Risk Of Death ◽  
Co Morbidity ◽  
The Us ◽  
All Cause Mortality

284 Background: MM is an uncommon cancer with annual incidence of only 27,000 cases in the US. Our study determined the extent to which the number of MM patients treated annually in a treatment facility affected all-cause mortality. Methods: We used the National Cancer Data Base (NCDB) to identify adult patients with MM diagnosed from 2003-2011. NCDB is sourced from over 1,500 Commission on Cancer-accredited cancer registries representing 70% of cancer cases in the US. We classified treatment facilities by quartiles based on facility volume (mean patients/year): Quartile 1 (Q1: < 3.6), Quartile 2 (Q2: 3.6-6.1), Quartile 3 (Q3: 6.1-10.3) and Quartile 4 (Q4: > 10.3). We used hot deck imputation to account for missing data, Cox regression to analyze the association between facility volume and time-to-death, and random intercepts to adjust for multiple patients per facility. Results: There were 94,722 MM patients cared for at 1,333 facilities. Most patients (73.5%) were diagnosed and treated in the same facility. The median age at diagnosis was 67 years and 54.7% were males. The median annual facility volume was 6.1 patients/year (IQR: 3.6-10.3; range: 0.2-109.9). The distribution of patients according to facility volume was Q1 (5.2%), Q2 (12.6%), Q3 (21.9%) and Q4 (60.3%). The unadjusted median overall survival by facility volume was: Q1: 26.9 months, Q2: 29.1 months, Q3: 31.9 months and Q4: 49.1 months. After multivariable analysis adjusting for demographic (sex, age, race, ethnicity), socioeconomic (income, education, insurance type), geographic (area of residence, treatment facility location), co-morbidity (Charlson-Deyo score), and disease-specific (year of diagnosis) factors, we show that facility volume remains an independent predictor of all-cause mortality. Compared to patients treated at Q4 facilities, patients treated at lower quartile facilities had a higher risk of death (Q3 HR: 1.16 [95% CI, 1.12-1.20]; Q2: 1.21 [1.17-1.26]; Q1: 1.27 [1.22-1.34]). We observed an inverse volume-outcome relationship up to an annual facility volume of approximately 60 patients. Conclusions: MM patients treated at higher volume facilities had lower risk of mortality compared to those treated at lower volume facilities.

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