The mortality rates in registries of patients with STEMI are highly affected by inclusion criteria and population characteristics

2021 ◽  
pp. 1-13
Author(s):  
Elie Martins ◽  
Julien Magne ◽  
Valérie Pradel ◽  
Gilles Faugeras ◽  
Sebastien Bosle ◽  
...  
Keyword(s):  
Mortality Rates ◽  
Population Characteristics ◽  
Inclusion Criteria

scholarly journals Allograft Augmentation of Hamstring Anterior Cruciate Ligament Grafts is Associated with Increased Graft Failure

2018 ◽  
Vol 6 (7_suppl4) ◽  
pp. 2325967118S0014
Author(s):  
Crystal Perkins ◽  
Michael T. Busch ◽  
Melissa A. Christino ◽  
S. Clifton Willimon
Keyword(s):  
Soft Tissue ◽  
Acl Reconstruction ◽  
Graft Failure ◽  
Activity Level ◽  
Population Characteristics ◽  
Hamstring Autograft ◽  
Inclusion Criteria ◽  
Graft Rupture ◽  
Graft Diameter

Objectives: ACL reconstruction in adolescents is commonly performed with hamstring autografts. In the adolescent population with very high activity levels, graft rupture is the most feared complication of ACL reconstruction. Young age, higher activity level, allografts, and small graft diameter have been shown to be predictors of graft failure. The applicability of this data to pediatric ACL reconstructions is limited due to heterogeneity of ages, graft constructs, and tunnel techniques. The purpose of this study is to evaluate the association of soft tissue graft constructs and graft rupture following pediatric transphyseal ACL reconstruction. Our hypothesis is that allograft-augmentation of grafts is associated with an increased risk of graft rupture. Methods: A single-institution retrospective review was performed of consecutive patients. Inclusion criteria were age less than 20 years and transphyseal ACL reconstruction with hamstring autograft, with or without allograft augmentation. Graft constructs included 4-strand doubled semitendinosus and gracilis (4-STG), 5-strand tripled semitendinosus and doubled gracilis (5-STG), 6-strand doubled gracilis and semitendinosus plus allograft (6-STGAllo), and 7-strand tripled semitendinosus and doubled gracilis plus allograft (7-STGAllo). Exclusion criteria included multiligament reconstruction and less than 6 months follow-up. The primary outcome was graft rupture. Results: Three hundred fifty-five patients (157 males, 198 females) with an average age of 15.3 years were identified to meet inclusion criteria. Graft constructs included 4-STG (198), 5-STG (91), 6-STGAllo (65), and 7-STGAllo (1). Average graft diameter was 8.3 mm 4-STG, 8.9 mm 5-STG, and 9.2 mm 6-STGAllo. Age and graft sizes were significantly different across groups with older patients (p <0.001) and larger graft sizes (p <0.001) being found in patients with allograft-augmented grafts. Mean duration of follow-up was 26 months (range 6-56 months). There were 51 graft ruptures (14.3%). The failure rate of each construct was 13.6% 4-STG, 11.9% 5-STG, and 19.7% 6-STGAllo. Time to graft failure was 16 months (range 2-40 months), with 49% of failures occurring before 12 months and 24% after 24 months. Twenty-four patients (6.7%) had a contralateral ACL tear during the follow-up period. Table 1 provides population characteristics by graft rupture status. This data suggests that patients who sustain a graft rupture may be slightly younger (p=0.07) and have lower BMI (p=0.07) than those patients without graft rupture. Odds ratios for graft failure by graft construct, controlling for age and graft size were calculated. Patients with 6-STGAllo grafts had an odds ratio of 2.6 (95% CI: 1.02, 6.50) of graft rupture as compared to 4-STG. Conclusion: ACL reconstruction with hamstring autograft combined with soft tissue allograft have a 2.6 times risk of graft rupture as compared to hamstring autograft without augmentation. In situations where the surgeon harvests an inadequately sized 4-strand autograft, we recommend tripling the semitendinosus to produce a larger graft diameter rather than augment with an allograft.

scholarly journals Variation in hospital mortality in an Australian neonatal intensive care unit network

2017 ◽  
Vol 103 (4) ◽  
pp. F331-F336 ◽  
Author(s):  
Mohamed E Abdel-Latif ◽  
Gen Nowak ◽  
Barbara Bajuk ◽  
Kathryn Glass ◽  
David Harley
Keyword(s):  
Logistic Regression ◽  
Intensive Care ◽  
Hospital Mortality ◽  
Neonatal Intensive Care ◽  
Severity Of Illness ◽  
Mortality Rates ◽  
Population Characteristics ◽  
South Wales ◽  
Graphical Tool ◽  
Funnel Plots

BackgroundStudying centre-to-centre (CTC) variation in mortality rates is important because inferences about quality of care can be made permitting changes in practice to improve outcomes. However, comparisons between hospitals can be misleading unless there is adjustment for population characteristics and severity of illness.ObjectiveWe sought to report the risk-adjusted CTC variation in mortality among preterm infants born <32 weeks and admitted to all eight tertiary neonatal intensive care units (NICUs) in the New South Wales and the Australian Capital Territory Neonatal Network (NICUS), Australia.MethodsWe analysed routinely collected prospective data for births between 2007 and 2014. Adjusted mortality rates for each NICU were produced using a multiple logistic regression model. Output from this model was used to construct funnel plots.ResultsA total of 7212 live born infants <32 weeks gestation were admitted consecutively to network NICUs during the study period. NICUs differed in their patient populations and severity of illness.The overall unadjusted hospital mortality rate for the network was 7.9% (n=572 deaths). This varied from 5.3% in hospital E to 10.4% in hospital C. Adjusted mortality rates showed little CTC variation. No hospital reached the +99.8% control limit level on adjusted funnel plots.ConclusionCharacteristics of infants admitted to NICUs differ, and comparing unadjusted mortality rates should be avoided. Logistic regression-derived risk-adjusted mortality rates plotted on funnel plots provide a powerful visual graphical tool for presenting quality performance data. CTC variation is readily identified, permitting hospitals to appraise their practices and start timely intervention.

scholarly journals Systematic review of temporal trends of congenital syphilis in Brazil

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Maicon Madureira ◽  
Paulo Henrique de Araújo Guerra ◽  
Charles Junior Finco ◽  
Thais Nascimento Helou ◽  
Paulo Roberto Barbato
Keyword(s):  
Systematic Review ◽  
Low Income ◽  
Congenital Syphilis ◽  
Temporal Trends ◽  
Population Characteristics ◽  
Inclusion Criteria ◽  
Unified Health System ◽  
Black Skin ◽  
Low Education ◽  
Ethnic Factors

The present study was aimed to retrieve and analyse the temporal trends of congenital syphilis (CS) in Brazil, as well as to list its main associated factors. Methods: In August 2019 a systematic review was developed in four electronic databases (Lilacs, Pubmed, Scielo and Web of Science) and in manual searches on reference lists. It was established that the synthesis of this review would be composed by ecological studies with CS temporal trends in the Brazilian territory, regardless of the population characteristics and data representativeness. More specifically, it was also established that the prevalence of CS of the first and last year of the time series would be presented in the descriptive synthesis. Results: Of the 2,157 initial studies, 14 adequately met the inclusion criteria and composed the synthesis. Twelve (85.7%) of these studies showed increases in time trends, with particular emphasis on the two nationwide studies, which showed positive trends between 2003–2008 (0.4) and 2010–2015 (3.7). Associations were found between CS and socioeconomic and ethnic factors, especially in the groups of women with low income, low education, brown / black skin colour and who had untreated partners. Conclusion: most of the available research showed an increase in the temporal trends of CS, highlighting that these data were observed at the national, state and municipal levels. Since mothers socioeconomic and ethnic factors are associated with higher CS frequencies, efforts are needed to increase the coverage of the Unified Health System to vulnerable women.

scholarly journals Definitive fixation of pelvic and acetabular fractures – current concepts

2021 ◽  
Vol 86 (3) ◽  
pp. 80-82
Author(s):  
Michał Kułakowski ◽  
◽  
Paweł Reichert ◽  
Karol Elster ◽  
Wojciech Piotrowski
Keyword(s):  
Pelvic Ring ◽  
Damage Control ◽  
Treatment Strategies ◽  
Mortality Rates ◽  
Pelvic Trauma ◽  
Definitive Treatment ◽  
Acetabular Fractures ◽  
Inclusion Criteria ◽  
Damage Control Orthopedics ◽  
Final Treatment

Introduction. The most challenging injury in orthopedic surgery is pelvic trauma. There are different concepts of treatment strategies, specially in final treatment of pelvic ring and acetabular fractures. Objectives. Analysis of recent studies and evaluation of treatment methods. Materials and Methods. Analysis of 22 recent studies. Five papers met our inclusion criteria, that equated 745 patients. Results. Patients hemodynamically unstable need to be resuscitated and „damage control” orthopedics is widely accepted method. Definitive treatment after fourth day should be performed. Some papers show that early, within 48 hours, definitive treatment of pelvic ring and acetabular fractures give similar or better results. Conclusions. Tendency to early definitive treatment is widely observed and decreases mortality rates and complications.

scholarly journals Internal Fixation Versus Hemiarthroplasty for Displaced Intra-Capsular Femoral Neck Fractures in ASA 3-5 Geriatric Patients

2016 ◽  
Vol 10 (1) ◽  
pp. 765-771 ◽  
Author(s):  
W. Rezaie ◽  
W. Wei ◽  
B.I. Cleffken ◽  
C.H. van der Vlies ◽  
B.I. Cleffken ◽  
...  
Keyword(s):  
Femoral Neck ◽  
Internal Fixation ◽  
Femoral Neck Fracture ◽  
Geriatric Patients ◽  
Mortality Rates ◽  
Femoral Neck Fractures ◽  
Inclusion Criteria ◽  
Operation Rate ◽  
Neck Fracture ◽  
The Mean

Background: The treatment of choice for elderly with a displaced intra-capsular femoral neck fractures is prosthetic replacement. This is however a major surgical procedure for geriatric patients with multiple co-morbidities which can threaten hemodynamic stability and lead to death. In this study we compared the outcome of internal fixation (IF) versus hemiarthroplasty (HA) for the management of intra-capsular femoral neck fractures in the elderly with severe co-morbidities. Methods: We conducted a retrospective cohort study of all the patients who were admitted to our Level-II trauma centre with a femoral neck fracture between January 2009 and June 2011. Inclusion criteria were: 70 years or older, ASA 3 or higher, a displaced femoral neck fracture and treatment with either internal fixation or a cemented hemiprosthesis. The primary outcome was 6-month mortality rate. Secondary outcomes were 30-day mortality, post-operative complications, re-operation rate and length of hospital stay. Results: 80 patients met our inclusion criteria. The mean age of the IF group was 81.6 years and in the HA group it was 84.5 years (P=0.07). The medical records were retrieved 34-64 months after surgery. Two intra-operative deaths due to cement implantation syndrome were found in the HA group and none in the IF group. Twelve patients (21.8%) in the HA group died within 30 days after surgery and 2 (8.0%) in the IF group (P=0.21). The mean operating time was 83 min. for the HA group and 51 min. for the IF group (P=0.000). There were more implant-related complications in the IF than in the HA group (36% vs 9.1% respectively, P=0.008). The 6-month mortality rates didn’t differ between the IF and the HA groups (respectively 28.0% vs 34.5%, P=0.62). Conclusion: The post-operative mortality rates did not differ between the IF and the HA groups in elderly patients with a displaced femoral neck fracture and ASA 3 to 5. However, the HA associated with less implant-related complications than the IF in this group and it is therefore the treatment of choice.

scholarly journals A Review of Radiographic Findings in Sars-Cov-2 Patients

2020 ◽  
pp. 48-54
Author(s):  
Denise Freitas Santana ◽  
Kárita Amanda Ribeiro de Melo ◽  
Agrinazio Geraldo Nascimento Neto ◽  
Wellington Carlos da Silva ◽  
Fábio Alves dos Santos ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Literature Review ◽  
Exercise Tolerance ◽  
Respiratory Muscle ◽  
Mortality Rates ◽  
Inclusion Criteria ◽  
Radiological Findings ◽  
Radiographic Findings ◽  
Literature Reviews ◽  
Glass Pattern

Introduction: At the end of 2019, more specifically in December, the outbreak of the new coronavirus - Sars-Cov-2, which caused pneumonia, emerged in Wuhan, and soon spread throughout China, where researchers began to suspect a possible pandemic. , being a disease that causes a deficiency of structures of the respiratory system, leading to alterations in breathing functions, with respiratory muscle deficiencies and exercise tolerance. During the pandemic peak still in Wuhan, the main radiographic findings in hospitalized patients revealed bilateral opacity on computed tomography (CT) examination, lobular and subsegmental consolidation areas, ground-glass opacities, consolidation with rounded morphology, and peripheral pulmonary distribution. Aims: Analyze through the available literature review the main radiological alterations caused by Sars-Cov-2. Methodology: This is an integrative literature review using PubMed, Scielo, Google Scholar, Microsoft Academic databases. Inclusion criteria were complete and original articles in English and Portuguese. Duplicates and other literature reviews were excluded. Results: Radiographic findings are different in the early and advanced phases of the disease, but characteristic signs such as the matte glass pattern were found in both phases. Conclusion: The radiographic findings of patients diagnosed with COVID-19 are not the main criteria for clinical diagnosis, but knowledge of characteristic symptoms is fundamental. Therefore, the multidisciplinary team must discuss the radiological findings most common to the virus, this will directly aid early diagnosis, in addition to reducing the high mortality rates globally.

Increased Serum Inflammatory Markers have worsened Clinical Outcomes and Mortality in Sars-Cov-2 Infection Irrespective of High or Low Serum Viral Load

2021 ◽  
Vol 15 (7) ◽  
pp. 1640-1643
Author(s):  
Zahid Asgher ◽  
Saed Aftab Ahmad ◽  
Mahnoor Mohydin ◽  
Hira Babar ◽  
Wali Zaidi ◽  
...  
Keyword(s):  
Viral Load ◽  
Inflammatory Markers ◽  
Poor Prognosis ◽  
Mortality Rates ◽  
Study Data ◽  
Prognostic Indicators ◽  
Inclusion Criteria ◽  
Serum Viral Load ◽  
D Dimer ◽  
Serum Inflammatory Markers

Aim: To determine the viral load in the patients admitted in Covid-19 isolation and its correlation with the inflammatory markers and the following clinical outcome. Methodology: A retrospective study was conducted in the Pathology Department of Doctors Hospital and Medical Centre in Lahore, Pakistan from November 2020 to January 2021. IRB approval was granted. A total of 86 patients met the inclusion criteria for the study. Data was analyzed using research tool SPSS 24. Results: Increased serum viral load in SARS-CoV-2 infection showed positive correlation with inflammatory markers IL-6 (P =0.04) and D-dimer (P =0.029). Inflammatory markers LDH, Ferritin, Procalcitonin, D-Dimers and viral load itself (CT) all correlated with higher mortality while IL-6 did not. Conclusion: Serum viral load in patients infected with SARS-CoV-2 correlates with higher mortality rates itself and also raises certain inflammatory markers (IL-6, D-Dimers), which are independently accountable for causing higher mortality as well. Hence, increased inflammatory markers resulted in poor prognosis regardless of high or low viral load. Their correlation with mortality can still serve as prognostic indicators. Keywords: viral load, inflammatory markers, Covid-19, mortality

scholarly journals Is mortality-to-incidence ratio associated with health disparity in pancreatic cancer? A cross-sectional database analysis of 57 countries

BMJ Open ◽  
2018 ◽  
Vol 8 (7) ◽  
pp. e020618 ◽  
Author(s):  
Hsiang-Lin Lee ◽  
Cheng-Ming Peng ◽  
Cheng-Yu Huang ◽  
Shin-Yi Wu ◽  
Ming-Chang Tsai ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
Healthcare Disparities ◽  
Secondary Analysis ◽  
Mortality Rates ◽  
Inclusion Criteria ◽  
Database Analysis ◽  
Cross Sectional ◽  
Incidence And Mortality ◽  
Similar Association ◽  
Colorectal Cancer Mortality

ObjectiveThe colorectal cancer mortality-to-incidence ratio (MIR) can reflect healthcare disparities. However, a similar association has not yet been established between the MIR of pancreatic cancer and healthcare disparities.MethodsIn this study, the incidence and mortality rates of pancreatic cancer were obtained from the GLOBOCAN 2012 database. The WHO rankings and total expenditures on health/gross domestic product (e/GDP) were obtained from a public database. Linear regression was performed to determine correlations between the variables.Results57 countries met the inclusion criteria according to the data quality. Developed regions (Europe and the Americas) had high pancreatic cancer incidence and mortality rates. The MIRs were over 0.90 in all regions. No significant correlation was found between MIRs and the WHO rankings, e/GDP or per capita total expenditure on health for analysis in the 57 countries, indicating no association between MIRs and cancer care disparities for pancreatic cancer.ConclusionsThe MIR variations for pancreatic cancer do not correlate with healthcare disparities among countries. Further investigation is necessary to confirm this observation with secondary analysis of databases.

scholarly journals Influence of nutrients involved in one-carbon metabolism on DNA methylation in adults—a systematic review and meta-analysis

2020 ◽  
Vol 78 (8) ◽  
pp. 647-666 ◽  
Author(s):  
Sophia D Amenyah ◽  
Catherine F Hughes ◽  
Mary Ward ◽  
Samuel Rosborough ◽  
Jennifer Deane ◽  
...  
Keyword(s):  
Systematic Review ◽  
Dna Methylation ◽  
Functional Analysis ◽  
Vitamin B12 ◽  
Carbon Metabolism ◽  
Meta Analysis ◽  
Molecular Techniques ◽  
Population Characteristics ◽  
Global Dna Methylation ◽  
Inclusion Criteria

Abstract Context Aberrant DNA methylation is linked to various diseases. The supply of methyl groups for methylation reactions is mediated by S-adenosylmethionine, which depends on the availability of folate and related B vitamins. Objectives To investigate the influence of key nutrients involved in 1-carbon metabolism on DNA methylation in adults. Data sources Systematic literature searches were conducted in the Cochrane Library, Medline, Embase, Cumulative Index to Nursing and Allied Health Literature Plus, Scopus, and Web of Science databases. Studies that met the inclusion criteria and were published in English were included. Data extraction The first author, study design, sample size, population characteristics, type and duration of intervention, tissue type or cells analyzed, molecular techniques, and DNA methylation outcomes. Data synthesis A meta-analysis of randomized, controlled trials (RCTs) was conducted to investigate the effect of 1-carbon metabolism nutrients on global DNA methylation. Functional analysis and visualization were performed using BioVenn software. Results From a total of 2620 papers screened by title, 53 studies met the inclusion criteria. Qualitative analysis indicated significant associations between 1-carbon metabolism nutrients and DNA methylation. In meta-analysis of RCTs stratified by method of laboratory analysis, supplementation with folic acid alone or in combination with vitamin B12 significantly increased global DNA methylation in studies using liquid chromatography–mass spectrometry, which had markedly lower heterogeneity (n = 3; Z = 3.31; P = 0.0009; I2 = 0%) in comparison to other methods. Functional analysis highlighted a subset of 12 differentially methylated regions that were significantly related to folate and vitamin B12 biomarkers. Conclusion This study supports significant associations between 1-carbon metabolism nutrients and DNA methylation. However, standardization of DNA methylation techniques is recommended to reduce heterogeneity and facilitate comparison across studies. Systematic Review registration PROSPERO registration number: CRD42018091898.

Population characteristics of the estuarine isopod Gnorimosphaeroma insulare in three contrasting habitats: sedge marsh, algal bed, and wood debris

1987 ◽  
Vol 65 (8) ◽  
pp. 2097-2104 ◽  
Author(s):  
M. J. Stanhope ◽  
D. W. Powell ◽  
E. B. Hartwick
Keyword(s):  
Body Size ◽  
Growth Rates ◽  
Carrying Capacity ◽  
Development Time ◽  
Mortality Rates ◽  
Population Characteristics ◽  
Fucus Distichus ◽  
Wood Debris ◽  
Contrasting Habitats ◽  
Similar Growth

Population characteristics of Gnorimosphaeroma insulare (Isopoda: Sphaeromatidae) were investigated in three habitats within the Squamish estuary, British Columbia: a log debris area, an embankment along the perimeter of a Carex lyngbyei marsh, and a Fucus distichus community. Gnorimosphaeroma insulare annual production was highest in the Fucus habitat (39.54–48.05 g dry wt∙m−2∙year−1) followed by "bank" (22.97–27.74 g∙m−2∙year−1) and then wood debris habitats (4.72–6.43 g∙m−2∙year−1). Cohort figures indicated that male productivity was greater than female productivity in all locations. Production:biomass ratios were similar in all three habitats and ranged between 2.47 and 3.17. Mortality rates were greatest in Fucus; those in wood debris and bank habitats were similar. Growth rates were highest in the bank habitat; those in wood debris and Fucus were similar. Growth and mortality rates of males were greater than those of females. Gnorimosphaeroma insulare is an annual semelparous species. Males died soon after mating, females soon after brood release. Fecundity was linearly related to body size but differed between locations (females from wood debris produced more eggs). Brood mortality was dependent on habitat: females from the bank habitat possessed the highest brood mortality followed by those from wood debris; females from Fucus did not possess any significant brood mortality. Egg development time was estimated at 120 days. The reduced carrying capacity of wood debris substrate is thought to be due to a paucity of microbial epiphytes, particularly fungi.

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