#29: Analysis of Mortality Due to Infections in Pediatric Patients in the Oncology Unit of a Third Level Hospital in La Paz, Bolivia

Abstract Background In recent decades, advances in cancer treatment have made it possible to improve the prognosis of hemato-oncological patients, however, mortality is still high in developing countries. One of the most important causes of morbidity and mortality during the treatment of children with cancer is infectious complications, especially in the induction phase. The multiple interventions that are carried out during treatment, such as the use of catheters, increase the risk of developing these infections, which can be more frequent if the recommended strategies to prevent them are not applied. The objective of this study was to investigate what were the causes of death in children with cancer at our institution. Methods The medical records of deceased patients were analyzed in the onco-hematology unit of the Children′s Hospital “Dr. Ovidio Aliaga Uria” in the city of La Paz, Bolivia. The causes of mortality, the stage of chemotherapy in which the death occurred, its relationship with infections and the microorganism identified during 2020 were classified. Results During 2020, 19 deaths were found in cancer patients, the mean age was 8.5 years and of which 52% were male. Regarding the basic diagnosis, there was a higher proportion of hematological diseases 68% and solid tumors 32%. Among the causes of death, 58% were due to their underlying pathology where most of the patients were in palliative care or in relapse and 42% were due to infectious causes, of which 62% were in induction phase of chemotherapy. Among the 8 patients who died from infections, the following causes were found: 50% neutropenic colitis, 25% bacteremia and 25% necrotizing fasciitis; in 7 (87.5%) patients the microorganism was isolated in blood culture, these were E. coli 43%, Klebsiella spp 43% and Bacillus spp 14%. Gram negative bacilli (GNB) represented 86% of the isolates and 50% were producers of extended spectrum beta-lactamases (ESBL). Conclusions Considering that infections are preventable and are among the most important causes of mortality in children with cancer in our hospital, it is essential that infection control teams are developed that apply evidence-based strategies to prevent these infections and thus achieve a reduction in morbidity and mortality, applying programs with training of human resources and equipment to reduce these deaths.

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Morbidity and mortality of patients with haemophilia in Germany 2007/2008

Hämostaseologie ◽

10.1055/s-0037-1617208 ◽

2009 ◽

Vol 29 (S 01) ◽

pp. S7-S12

Author(s):

M. Spannagl ◽

W. Schramm ◽

H. Krebs ◽

Keyword(s):

Causes Of Death ◽

Severity Of Illness ◽

Von Willebrand Disease ◽

Morbidity And Mortality ◽

Haemophilia A ◽

Hiv Status ◽

Von Willebrand ◽

Existing Data

SummarySince 1978 an annual multicentric survey regarding the epidemiology of patients suffering of haemophilia is performed with support of haemophilia treating centres of any size. Again the actual compilation is resting upon a broad database returning to over 30 years of inquiry well representing both the actual and retrospective status of mortality. Prompted was exclusively information about patients with haemophilia A, B and von Willebrand disease. In particular anonymous data concerning the last 12 months about number of treated patients, type and severity of illness, HIV-status and detailed information about causes of death was inquired. This data was merged with existing data and analyzed statistically. In the 2007/2008 survey, a total

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#53: High Burden of Serious Bacterial Infections in African Children Treated for Cancer

Journal of the Pediatric Infectious Diseases Society ◽

10.1093/jpids/piaa170.019 ◽

2021 ◽

Vol 10 (Supplement_1) ◽

pp. S6-S6

Author(s):

G Naidu ◽

A Izu ◽

R Wainwright ◽

S Poyiadjis ◽

D MacKinnon ◽

...

Keyword(s):

Bacterial Infections ◽

Case Fatality ◽

Morbidity And Mortality ◽

Coagulase Negative Staphylococci ◽

Children With Cancer ◽

Indwelling Catheter ◽

High Burden ◽

African Children ◽

Serious Bacterial Infections ◽

Living With Hiv

Abstract Background Infectious complications in children treated for cancer contribute to their morbidity and mortality. There is a paucity of studies on the incidence, microbiological etiology, risk factors, and outcome of serious bacterial infections in African children treated for cancer. Aim The aim of the study was to delineate the epidemiology of infectious morbidity and mortality in South African children with cancer. Methods This prospective, single-center, longitudinal-cohort study enrolled children one-19 years old hospitalized for cancer treatment at the Paediatric Oncology Unit, Chris Hani Baragwanath Academic Hospital, Soweto, South Africa. Children were investigated for infection as part of the standard of care. Results In total, 169 children were enrolled, 82 with hematological malignancy (HM), 87 with a solid tumor (ST), median age was 68.5 months and 10.7% were living with HIV. The incidence (per 100 child-years) of septic episodes (SE) and microbiologically confirmed SE (MSCE) was 101 (138 vs. 70, P < 0.001) and 70.9 (99.1 vs. 47.3; P < 0.001), respectively; higher in children with HM than ST. The incidence of MCSE in children with high-risk HM (137.7) was 4.32-fold greater compared with those with medium-risk HM (30.3; P < 0.001). Children with metastatic ST had a higher incidence (84.4) of MSCE than those with localized ST (33.6; aOR: 2.52; P < 0.001). The presence of an indwelling catheter was 3-fold (P < 0.001) more likely to be associated with MCSE compared with those without. There was no association for age group, nutritional status or HIV-status, and incidence of MCSE. The incidence of gram-positive (GPB) and gram-negative (GNB) SEs was 48.5 and 37.6, respectively, and higher in children with an HM. The most commonly identified GPB were Coagulase-negative Staphylococci, Streptococcus viridans and Enterococcus faecium; while the most common GNB were Escherichia coli, Acinetobacter baumannii, and Pseudomonas species. The median CRP was higher in children with MSCE compared with those with culture-negative SE (CNSE) (116.5 vs. 92; P < 0.001) in both HM (132.5 vs. 117; P < 0.001) and ST (87.5 vs. 46; P < 0.001). The procalcitonin was higher in those with MSCE compared with those with CNSE (2.30 vs. 1.40; P < 0.001) in both HM (2.95 vs. 1.60; P = 0.002) and ST (2.10 vs. 1.20; P < 0.001). The case fatality risk was 40.4%; 80% was attributed to sepsis. Of these, 35 (72.92%) had HM and 34 of the 35 (97.14%) had HR-HM. Children with HM had an overall sepsis CFR of 42.68%. Four (30.77%) of the 13 sepsis-related deaths in STs had metastatic disease and 8 (16.67%) of the total number of sepsis-related deaths were in children living with HIV. There was no association between malnutrition or HIV-positivity and death. The odds of dying from sepsis were higher in children with profound (aOR 3.96; P = 0.004) and prolonged (aOR 3.71; P = 0.011) neutropenia. Pneumonia (58.85% vs. 29.23%; aOR 2.38; P = 0.025) and tuberculosis (70.83% vs. 34.91%; aOR 4.3; P = 0.005) were independently associated with a higher CFR. Conclusion The current study emphasizes the high burden of sepsis in African children treated for cancer, and especially HM, and highlights the association of tuberculosis and pneumonia as independent predictors of death in children with cancer.

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Atrioesophageal Fistula as a Complication of Radiofrequency Ablation for Atrial Fibrillation

Prehospital and Disaster Medicine ◽

10.1017/s1049023x21000522 ◽

2021 ◽

pp. 1-3

Author(s):

Mustafa Emin Canakci ◽

Cengiz Ovali ◽

İrem Aydogdu ◽

Betul Tiryaki Bastug ◽

Obaidullah Ahmadzai ◽

...

Keyword(s):

Atrial Fibrillation ◽

Emergency Department ◽

Radiofrequency Ablation ◽

Gastrointestinal Bleeding ◽

Male Patient ◽

Delayed Diagnosis ◽

Infectious Complications ◽

Morbidity And Mortality ◽

Important Complication ◽

Atrioesophageal Fistula

Abstract Atrioesophageal fistula (AEF) is an important complication of radiofrequency ablation (RFA). Delayed diagnosis is associated with increased morbidity and mortality. Despite the name “atrioesophageal fistula,” fistulas functionally act esophageal to atrial, which accounts for the neurologic and infectious complications. This report presents the management of a 60-year-old male patient who was admitted to the emergency department (ED) with AEF-caused gastrointestinal bleeding. The patient was operated urgently, but he had serious comorbidities and died after the operation. The aim of this case was to evaluate patients who underwent RFA, within 10 days to two months, carefully in the ED and to know the possible complications.

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Narrowing the mindware gap in medicine

Diagnosis ◽

10.1515/dx-2020-0128 ◽

2021 ◽

Vol 0 (0) ◽

Author(s):

Pat Croskerry

Keyword(s):

United States ◽

Cognitive Performance ◽

Clinical Reasoning ◽

Medical Errors ◽

Medical Error ◽

Causes Of Death ◽

The United States ◽

Morbidity And Mortality ◽

Medical Educators ◽

High Degree

Abstract Medical error is now recognized as one of the leading causes of death in the United States. Of the medical errors, diagnostic failure appears to be the dominant contributor, failing in a significant number of cases, and associated with a high degree of morbidity and mortality. One of the significant contributors to diagnostic failure is the cognitive performance of the provider, how they think and decide about the process of diagnosis. This thinking deficit in clinical reasoning, referred to as a mindware gap, deserves the attention of medical educators. A variety of specific approaches are outlined here that have the potential to close the gap.

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Causes of Mortality in Older People With Intellectual Disability: Results From the HA-ID Study

American Journal on Intellectual and Developmental Disabilities ◽

10.1352/1944-7558-123.1.61 ◽

2018 ◽

Vol 123 (1) ◽

pp. 61-71 ◽

Cited By ~ 11

Author(s):

Alyt Oppewal ◽

Josje D. Schoufour ◽

Hanne J.K. van der Maarl ◽

Heleen M. Evenhuis ◽

Thessa I.M. Hilgenkamp ◽

...

Keyword(s):

Older Adults ◽

Intellectual Disability ◽

Cause Of Death ◽

Causes Of Death ◽

Circulatory System ◽

Bacterial Diseases ◽

Specific Mortality ◽

Causes Of Mortality ◽

Insight Into

Abstract We aim to provide insight into the cause-specific mortality of older adults with intellectual disability (ID), with and without Down syndrome (DS), and compare this to the general population. Immediate and primary cause of death were collected through medical files of 1,050 older adults with ID, 5 years after the start of the Healthy Ageing and Intellectual Disabilities (HA-ID) study. During the follow-up period, 207 (19.7%) participants died, of whom 54 (26.1%) had DS. Respiratory failure was the most common immediate cause of death (43.4%), followed by dehydration/malnutrition (20.8%), and cardiovascular diseases (9.4%). In adults with DS, the most common cause was respiratory disease (73.3%), infectious and bacterial diseases (4.4%), and diseases of the digestive system (4.4%). Diseases of the respiratory system also formed the largest group of primary causes of death (32.1%; 80.4% was due to pneumonia), followed by neoplasms (17.6%), and diseases of the circulatory system (8.2%). In adults with DS, the main primary cause was also respiratory diseases (51.1%), followed by dementia (22.2%).

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Adverse events in emergency oncological spine surgery: a prospective analysis

Journal of Neurosurgery Spine ◽

10.3171/2014.7.spine131007 ◽

2014 ◽

Vol 21 (5) ◽

pp. 698-703 ◽

Cited By ~ 53

Author(s):

Nicolas Dea ◽

Anne Versteeg ◽

Charles Fisher ◽

Adrienne Kelly ◽

Dennis Hartig ◽

...

Keyword(s):

Adverse Events ◽

Spine Surgery ◽

Patient Population ◽

Infectious Complications ◽

Morbidity And Mortality ◽

Morbidity Rate ◽

Inclusion Criteria ◽

True Incidence ◽

Related Quality ◽

Incidental Durotomy

Object Most descriptions of spine surgery morbidity and mortality in the literature are retrospective. Emerging prospective analyses of adverse events (AEs) demonstrate significantly higher rates, suggesting underreporting in retrospective and prospective studies that do not include AEs as a targeted outcome. Emergency oncological spine surgeries are generally palliative to reduce pain and improve patients' neurology and health-related quality of life. In individuals with limited life expectancy, AEs can have catastrophic implications; therefore, an accurate AE incidence must be considered in the surgical decision-making process. The purpose of this study was to determine the true incidence of AEs associated with emergency oncological spine surgery. Methods The authors carried out a prospective cohort study in a quaternary care referral center that included consecutive patients admitted between January 1, 2009, and December 31, 2012. Inclusion criteria were all patients undergoing emergency surgery for metastatic spine disease. AE data were reported and collected on standardized AE forms (Spine AdVerse Events Severity System, version 2 [SAVES V2] forms) at weekly dedicated morbidity and mortality rounds attended by attending surgeons, residents, fellows, and nursing staff. Results A total of 101 patients (50 males, 51 females) met the inclusion criteria and had complete data. Seventysix patients (76.2%) had at least 1 AE, and 11 patients (10.9%) died during their admission. Intraoperative surgical AEs were observed in 32% of patients (9.9% incidental durotomy, 16.8% blood loss > 2 L). Transient neurological deterioration occurred in 6 patients (5.9%). Infectious complications in this patient population were significant (surgical site 6%, other 50.5%). Delirium complicated the postoperative period in 20.8% of cases. Conclusions When evaluated in a rigorous prospective manner, metastatic spine surgery is associated with a higher morbidity rate than previously reported. This AE incidence must be considered by the patient, oncologist, and surgeon to determine appropriate management and preventative strategies to reduce AEs in this fragile patient population.

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A single institutional review of pediatric Bacillus spp. bloodstream infections demonstrates increased incidence among children with cancer

Pediatric Blood & Cancer ◽

10.1002/pbc.27568 ◽

2018 ◽

pp. e27568

Author(s):

David S. Shulman ◽

Preeti Mehrotra ◽

Traci M. Blonquist ◽

Andrew Capraro ◽

Leslie E. Lehmann ◽

...

Keyword(s):

Bloodstream Infections ◽

Children With Cancer ◽

Institutional Review ◽

Bacillus Spp

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ANALYSIS OF THE MORTALITY RATE AMONG THE POPULATION OF THE POLTAVA REGION AND THE WAYS OF ITS REDUCTION

Wiadomości Lekarskie ◽

10.36740/wlek201905226 ◽

2019 ◽

Vol 72 (5) ◽

pp. 1087-1091

Author(s):

Valentyn M. Dvornyk ◽

Inna V. Bielikova ◽

Ludmyla M. Shylkina ◽

Valentyna L. Filatova ◽

Natalia M. Martynenko

Keyword(s):

Mortality Rate ◽

Digestive System ◽

Causes Of Death ◽

Health Care Systems ◽

Second Neoplasms ◽

Care Systems ◽

Causes Of Mortality ◽

External Causes Of Death ◽

External Causes

Introduction: Saving and improvement of population’ health is one of the main priorities of the policy in any country. Studying of the level and causes of mortality is a powerful tool for assessing the effectiveness of health care systems. WHO recommends using of the European classification of preventable causes of death that based on three levels of prevention. The aim of this study is to compare the level and structure of mortality of the population of Ukraine and the Poltava region, to substantiate scientific approaches to the study and identification of those causes of death that can be prevented in order to formulate prevention programs at different level. Materials and methods: In research are used the information from the State Statistics Service of Ukraine and from the Center for Medical Statistics of the MoH of Ukraine. Review: Despite the positive dynamics of mortality in recent years, both in the Poltava region and in Ukraine, the indicators remain extremely negative. About 73.3% of all fatalities in Ukraine are three main types of causes cardiovascular diseases, external causes of death and neoplasms. In the Poltava region, 70.56% of all causes of death are due to cardiovascular disease; neoplasms occupy 13.88%; external causes - 4.87%; diseases of the digestive system - 3,06%; respiratory diseases - 1.31% of the causes of death. Conclusions: The mortality rate both in the Poltava region and in Ukraine has tendency for declines, but remains rather high. General trends in the structure of causes of death: in the first place are diseases of the cardiovascular system, the second - neoplasms, the third -external causes. Structuring of the causes of death that based on the principle of prevention in Ukraine do not conduct.

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