scholarly journals Racial and Ethnic Variations in Mortality Associated with Common Pediatric Gastrointestinal Disorders in Children's Hospitals in the US

2021 ◽  
Vol 4 (1) ◽  
Author(s):  
Kadija Kanu ◽  
Jean P. Molleston ◽  
William E. Bennett, Jr.
Keyword(s):  
Acute Pancreatitis ◽  
Mortality Rate ◽  
Liver Failure ◽  
Liver Transplant ◽  
Mixed Race ◽  
Black Race ◽  
Asian Race ◽  
Children’S Hospitals ◽  
The Us ◽  
Icd Codes

Background: The objective of this study is to determine the mortality, risk factors, and disease associations of eight common pediatric gastrointestinal (GI) disorders: cystic fibrosis (CF), cirrhosis, gastrointestinal bleeding (GIB), inflammatory bowel disease (IBD), liver failure (LF), liver transplant, acute pancreatitis, and short bowel syndrome (SBS).     Methods: Diagnoses were found using the International Classification of Disease (ICD) codes from 2004 through 2020. We performed a retrospective cohort study using the Pediatric Health Information System (PHIS) database from 50 children’s hospitals in the US. We analyzed all encounters with ICD codes for these disorders, then determined the per-encounter mortality rate for each. We performed a mixed-effects logistic regression modeling hospital as a random effect, mortality as the dependent variable, and patient demographics and medical history as independent variables. We hypothesized that demographic factors such as Black race, Hispanic ethnicity, and markers of socioeconomic status would be associated with increased mortality.     Results: The per-encounter mortality for each diagnosis was: cirrhosis (2.19%), CF (0.66%), GIB (4.22%), IBD (0.21%), LF (7.03%), liver transplant (0.37%), acute pancreatitis (2.23%), and SBS (1.13%). There was a higher (p<0.05) mortality for those of Asian race and mixed-race populations in GIB (OR 1.76 and 1.37, respectively) and acute pancreatitis (OR 1.94 and 1.34, respectively). For those of Black race, there was a higher mortality in liver transplant and liver failure (OR 1.31 and 1.65 respectively). Additionally, mortality was increased in Hispanic/Latino patients with CF, GIB, and SBS (OR 2.34, 1.39, and 1.41, respectively). Coincident cardiovascular, renal/urologic, and neurologic/neuromuscular abnormalities were also associated with a significant higher mortality.     Conclusion: The degree of variation associated with race and ethnicity is unlikely to be accounted for by variation in clinical features, thus the impact of social determinants of health should be the focus of future study.      Cirrhosis  CF  GIB  IBD  LF  Liver Transplant  Acute Pancreatitis  SBS  Mortality Rate  2.19%  0.66%  4.22%  0.21%  7.03%  0.37%  2.23%  1.13%  Asian Race OR  1.10  3.77  1.76*  1.71  1.08  0.89  1.94*  1.35  Black Race   OR  0.90  0.48  1.03  1.55  1.31*  1.65*  1.15  1.14  Mixed Race OR  1.16  1.12  1.37*  1.44  1.23  0.85  1.34*  1.16  Hispanic/Latino OR  1.13  2.34*  1.39*  1.53  1.16  1.65  1.13  1.41*  *Significant OR numbers with an associated p<0.05  

scholarly journals Prevalence, Severity, and Impact of Renal Dysfunction in Acute Liver Failure on the US Liver Transplant Waiting List

2015 ◽  
Vol 61 (1) ◽  
pp. 309-316 ◽  
Author(s):  
Nathalie H. Urrunaga ◽  
Laurence S. Magder ◽  
Matthew R. Weir ◽  
Don C. Rockey ◽  
Ayse L. Mindikoglu
Keyword(s):  
Liver Failure ◽  
Liver Transplant ◽  
Acute Liver Failure ◽  
Renal Dysfunction ◽  
Waiting List ◽  
The Us ◽  
Liver Transplant Waiting List

scholarly journals Leading cancers contributing to educational disparities in cancer mortality in the US, 2017

2021 ◽  
Author(s):  
Diana R. Withrow ◽  
Neal D. Freedman ◽  
James T. Gibson ◽  
Mandi Yu ◽  
Anna M. Nápoles ◽  
...  
Keyword(s):  
Lung Cancer ◽  
High School ◽  
Mortality Rate ◽  
Cancer Mortality ◽  
Death Certificate ◽  
Bachelor's Degree ◽  
Educational Disparities ◽  
Individual Level ◽  
Death Certificate Data ◽  
The Us

Abstract Purpose To inform prevention efforts, we sought to determine which cancer types contribute the most to cancer mortality disparities by individual-level education using national death certificate data for 2017. Methods Information on all US deaths occurring in 2017 among 25–84-year-olds was ascertained from national death certificate data, which include cause of death and educational attainment. Education was classified as high school or less (≤ 12 years), some college or diploma (13–15 years), and Bachelor's degree or higher (≥ 16 years). Cancer mortality rate differences (RD) were calculated by subtracting age-adjusted mortality rates (AMR) among those with ≥ 16 years of education from AMR among those with ≤ 12 years. Results The cancer mortality rate difference between those with a Bachelor's degree or more vs. high school or less education was 72 deaths per 100,000 person-years. Lung cancer deaths account for over half (53%) of the RD for cancer mortality by education in the US. Conclusion Efforts to reduce smoking, particularly among persons with less education, would contribute substantially to reducing educational disparities in lung cancer and overall cancer mortality.

Systematic review with meta-analysis: liver transplant provides survival benefit in patients with acute on chronic liver failure

2020 ◽  
Vol 52 (2) ◽  
pp. 222-232 ◽  
Author(s):  
Mohamed A. Abdallah ◽  
Muhammad Waleed ◽  
Matthew G. Bell ◽  
Morgan Nelson ◽  
Robert Wong ◽  
...  
Keyword(s):  
Systematic Review ◽  
Liver Failure ◽  
Liver Transplant ◽  
Survival Benefit ◽  
Meta Analysis ◽  
Chronic Liver ◽  
Chronic Liver Failure

Modern imagine methods in diagnostics of acute pancreatitis in clinical practice

2020 ◽  
pp. 14-25
Author(s):  
G. R. Ahunova ◽  
R. R. Ahunova
Keyword(s):  
Acute Pancreatitis ◽  
Clinical Practice ◽  
Mortality Rate ◽  
High Mortality ◽  
Surgical Pathology ◽  
Diagnostic Radiology ◽  
Common Disease ◽  
Review Of The Literature ◽  
Abdominal Organs ◽  
Comprehensive Examination

Acute pancreatitis is one of the most frequent and formidable diseases, and rates as one of the most common disease in the structure of acute surgical pathology of the abdominal organs. In the last decade, there has been an increase in the proportion of necrotic forms of the disease with damage to various departments of the retroperitoneal space and a stably high mortality rate. The diagnostics problem of acute pancreatitis is still relevant due to difficulties that persist despite the possibility of a comprehensive examination of patients upon admission to the hospital and during treatment. This article presents a review of the literature, reflecting the state of the problem and aspects of diagnostic radiology of acute pancreatitis.

Warning against long-acting sulphonamides

1966 ◽  
Vol 4 (4) ◽  
pp. 13-13
Keyword(s):  
United States ◽  
Mortality Rate ◽  
Erythema Multiforme ◽  
The United States ◽  
Stevens Johnson Syndrome ◽  
Warning Letter ◽  
Johnson Syndrome ◽  
The Us ◽  
Mucous Membranes ◽  
Long Acting

Last month the US Food and Drug Administration required American manufacturers of long-acting sulphonamides (sulphamethoxypyridazine, Lederkyn - Lederle and Midicel - PD; sulphadimethoxine - Madribon - Roche) to warn prescribers that in rare cases the Stevens-Johnson syndrome may develop as a severe and sometimes fatal side effect. This syndrome is a type of erythema multiforme in which large blisters appear on the skin and especially on the mucous membranes. The manufacturers were also to advise doctors ‘to consider prescribing short-acting sulphonamides first because they are effective for most of the same conditions’. The three drug firms concerned accordingly sent a joint warning letter to all doctors, pointing out that the Stevens-Johnson syndrome is a serious complication with a mortality rate of about 25%. So far 116 cases of this syndrome have been reported in association with the use of long-acting sulphonamides, most of them in the United States. Almost two thirds of the patients were children.

scholarly journals The Role of Acetyl Cysteine in Cocaethylene (Non-Acetaminophen) Acute Liver Failure

2018 ◽  
Vol 2018 ◽  
pp. 1-4
Author(s):  
Getaw Worku Hassen ◽  
Amaninder Dhaliwal ◽  
Catherine Ann Jenninigs ◽  
Hossein Kalantari
Keyword(s):  
Emergency Department ◽  
Substance Abuse ◽  
Liver Failure ◽  
Liver Transplant ◽  
Acute Liver Failure ◽  
Active Substance ◽  
Vital Signs ◽  
Normal Limits ◽  
History Of ◽  
Acetyl Cysteine

Background.Acute liver failure can result from acetaminophen overdose, viral infection, toxins, and other disease conditions. Liver transplant is available in limited fashion and the criteria are strict as to who should get an available liver. N- Acetyl Cysteine (NAC) has been used in non-acetaminophen induced liver failure with success. Here we report a case of acute liver failure from cocaethylene that was reversed with NAC along with other medical therapy.Case Presentation.A 50-year-old female patient presented to the Emergency Department (ED) with a two-day history of coffee ground vomiting and hematemesis. She reported occasional substance abuse and heavy alcoholism. She reported shortness of breath and chest pain from the recurrent forceful vomiting. The rest of the review of systems was unremarkable except a fall from intoxication. Physical examination revealed anicteric conjunctiva and nontender abdomen and her vital signs were within normal limits. Initial blood work revealed acute liver and renal failure. The patient was started with general medical management and liver transplant service rejected the case due to active substance abuse. She underwent brief hemodialysis and was started on NAC. Over the course of her hospital stay her liver function and kidney function improved significantly and patient was discharged to home.Conclusion.In cases where liver transplant is not an option for various reasons including active substance abuse, a trial of N-Acetyl Cysteine may be beneficial and should be considered in the Emergency Department.

scholarly journals Racism as a Leading Cause of Death: Measuring Excess Deaths in the US

2021 ◽  
Author(s):  
Daisy Massey ◽  
Jeremy Faust ◽  
Karen Dorsey ◽  
Yuan Lu ◽  
Harlan Krumholz
Keyword(s):  
Black Women ◽  
Mortality Rate ◽  
Black Men ◽  
Cause Of Death ◽  
White Women ◽  
Black People ◽  
Mortality Rates ◽  
White People ◽  
The Us ◽  
Excess Deaths

Background: Excess death for Black people compared with White people is a measure of health equity. We sought to determine the excess deaths under the age of 65 (<65) for Black people in the United States (US) over the most recent 20-year period. We also compared the excess deaths for Black people with a cause of death that is traditionally reported. Methods: We used the Multiple Cause of Death 1999-2019 dataset from the Center of Disease Control (CDC) WONDER to report age-adjusted mortality rates among non-Hispanic Black (Black) and non-Hispanic White (White) people and to calculate annual age-adjusted <65 excess deaths for Black people from 1999-2019. We measured the difference in mortality rates between Black and White people and the 20-year and 5-year trends using linear regression. We compared age-adjusted <65 excess deaths for Black people to the primary causes of death among <65 Black people in the US. Results: From 1999 to 2019, the age-adjusted mortality rate for Black men was 1,186 per 100,000 and for White men was 921 per 100,000, for a difference of 265 per 100,000. The age-adjusted mortality rate for Black women was 802 per 100,000 and for White women was 664 per 100,000, for a difference of 138 per 100,000. While the gap for men and women is less than it was in 1999, it has been increasing among men since 2014. These differences have led to many Black people dying before age 65. In 1999, there were 22,945 age-adjusted excess deaths among Black women <65 and in 2019 there were 14,444, deaths that would not have occurred had their risks been the same as those of White women. Among Black men, 38,882 age-adjusted excess <65 deaths occurred in 1999 and 25,850 in 2019. When compared to the top 5 causes of deaths among <65 Black people, death related to disparities would be the highest mortality rate among both <65 Black men and women. Comment: In the US, over the recent 20-year period, disparities in mortality rates resulted in between 61,827 excess deaths in 1999 and 40,294 excess deaths in 2019 among <65 Black people. The race-based disparity in the US was the leading cause of death among <65 Black people. Societal commitment and investment in eliminating disparities should be on par with those focused on other leading causes of death such as heart disease and cancer.

scholarly journals The course and survival of patients with liver cirrhosis and acute liver failure on the background of chronic

2020 ◽  
Vol 98 (2) ◽  
pp. 137-141
Author(s):  
S. A. Avezov ◽  
S. M. Azimova ◽  
M. H. Abdulloev
Keyword(s):  
Liver Cirrhosis ◽  
Mortality Rate ◽  
Liver Failure ◽  
Organ Failure ◽  
Predictive Factors ◽  
Clinical Signs ◽  
Multiple Organ ◽  
Kaplan Meier ◽  
Short Term Mortality ◽  
Acute Decompensation

Aims. We comparative investigated the frequency, precipitating factors, lifetimes and predictive factors of survival in patients with liver cirrhosis (LC) and acute-on-chronic liver failure (ACLF). Material and methods. We collected data from 310 hospitalized patients with LC. Patients divided into groups: 1 — patients with compensation of LC; 2 — patients with decompensation of LC, but without organ failure (OF) and 3 — patients with ACLF. Diagnostic criteria for ACLF based on consensus recommendations of EASL. Survival was assessed according to the Kaplan-Meier method. Results. 48 patients with LC reported clinical signs of ACLF. 28-day mortality was in 4,8% of patients without ACLF and in 42,0% of patients with ACLF. 90-day mortality of patients with ACLF was 50% versus 11.6% in patients without ACLF. 6-month survival rate of patients with the development of acute decompensation with organ failure was only 33,3%. The lifetimes of patients with ACLF was only 136,65 ± 18,96 days. The predictive factors of survival of patients with LC and ACLF are: the number of organ failure, indicators of CLIF-SOFA and MELD, Child-Pugh score, degree of hepatic encephalopathy, leukocytosis, hyperbilirubinemia, hypercreatininemia and increased INR. Conclusion. The prevalence of ACLF in patients with LC is 15,5% and develops against a background of stable compensated or decompensated CP. The frequent trigger of ACLF is infection, which causes acute decompensation with the development of multiple organ failure and a high incidence of short-term mortality. The 28-day mortality rate in patients with ACLF was 8.7 times greater than the mortality rate in patients with decompensated LC without ACLF.

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