Tocilizumab for reduction of mortality in severe COVID-19 patients: how should we GRADE it?

Coagulopathy-related intracerebral hemorrhage (ICH) is life-threatening. Recent studies have shown promising results with minimally invasive neurosurgery (MIN) in the reduction of mortality and improvement of functional outcomes, but no published data have recorded the safety and efficacy of MIN for coagulopathy-related ICH. Seventy-five coagulopathy-related ICH patients were retrospectively reviewed to compare the surgical outcomes between craniotomy (n = 52) and MIN (n = 23). Postoperative rebleeding rates, morbidity rates, and mortality at 1 month were analyzed. Postoperative Glasgow Outcome Scale Extended (GOSE) and modified Rankin Scale (mRS) scores at 1 year were assessed for functional outcomes. Morbidity, mortality, and rebleeding rates were all lower in the MIN group than the craniotomy group (8.70% vs. 30.77%, 8.70% vs. 19.23%, and 4.35% vs. 23.08%, respectively). The 1-year GOSE score was significantly higher in the MIN group than the craniotomy group (3.96 ± 1.55 vs. 3.10 ± 1.59, p = 0.027). Multivariable logistic regression analysis also revealed that MIN contributed to improved GOSE (estimate: 0.99650, p = 0.0148) and mRS scores (estimate: −0.72849, p = 0.0427) at 1 year. MIN, with low complication rates and improved long-term functional outcome, is feasible and favorable for coagulopathy-related ICH. This promising result should be validated in a large-scale prospective study.

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The decomposition of life expectancy for age and cause of death in Tuscany, Italy

European Journal of Public Health ◽

10.1093/eurpub/ckz185.638 ◽

2019 ◽

Vol 29 (Supplement_4) ◽

Author(s):

N Nante ◽

L Kundisova ◽

F Gori ◽

A Martini ◽

F Battisti ◽

...

Keyword(s):

Life Expectancy ◽

Causes Of Death ◽

National Level ◽

Age Groups ◽

Resistant Bacteria ◽

Mortality Data ◽

Life Expectancy At Birth ◽

Icd 10 ◽

Reduction Of Mortality ◽

The Impact

Abstract Introduction Changing of life expectancy at birth (LE) over time reflects variations of mortality rates of a certain population. Italy is amongst the countries with the highest LE, Tuscany ranks fifth at the national level. The aim of the present work was to evaluate the impact of various causes of death in different age groups on the change in LE in the Tuscany region (Italy) during period 1987-2015. Material and methods Mortality data relative to residents that died during the period between 1987/1989 and 2013/2015 were provided by the Tuscan Regional Mortality Registry. The causes of death taken into consideration were cardiovascular (CVS), respiratory (RESP) and infective (INF) diseases and cancer (TUM). The decomposition of LE gain was realized with software Epidat, using the Pollard’s method. Results The overall LE gain during the period between two three-years periods was 6.7 years for males, with a major gain between 65-89, and 4.5 years for females, mainly improved between 75-89, <1 year for both sexes. The major gain (2.6 years) was attributable to the reduction of mortality for CVS, followed by TUM (1.76 in males and 0.83 in females) and RESP (0.4 in males; 0.1 in females). The major loss of years of LE was attributable to INF (-0.15 in females; -0.07 in males) and lung cancer in females (-0.13), for which the opposite result was observed for males (gain of 0.62 years of LE). Conclusions During the study period (1987-2015) the gain in LE was major for males. To the reduction of mortality for CVS have contributed to the tempestuous treatment of acute CVS events and secondary CVS prevention. For TUM the result is attributable to the adherence of population to oncologic screening programmes. The excess of mortality for INF that lead to the loss of LE can be attributed to the passage from ICD-9 to ICD-10 in 2003 (higher sensibility of ICD-10) and to the diffusion of multi-drug resistant bacteria, which lead to elevated mortality in these years. Key messages The gain in LE during the period the 1987-2015 was higher in males. The major contribution to gain in LE was due to a reduction of mortality for CVS diseases.

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REDUCTION OF MORTALITY IN SWINE FROM COMBINED TOTAL BODY RADIATION AND THERMAL BURNS BY STREPTOMYCIN

Annals of Surgery ◽

10.1097/00000658-195304000-00004 ◽

1953 ◽

Vol 137 (4) ◽

pp. 450-455 ◽

Cited By ~ 19

Author(s):

Hamilton Baxter ◽

John A. Drummond ◽

L. G. Stephens-Newsham ◽

Robert G. Randall

Keyword(s):

Thermal Burns ◽

Reduction Of Mortality ◽

Total Body

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Abstract 12571: Successful Catheter Ablation of Ventricular Tachycardia is Associated With Reduction of Mortality in Patients With Ventricular Tachycardia and Nonischemic Dilated Cardiomyopathy

Circulation ◽

10.1161/circ.130.suppl_2.12571 ◽

2014 ◽

Vol 130 (suppl_2) ◽

Author(s):

Borislav Dinov ◽

Arash Arya ◽

Valentina Schirripa ◽

Livio Bertagnolli ◽

Lukas Fiedler ◽

...

Keyword(s):

Ventricular Tachycardia ◽

Catheter Ablation ◽

Dilated Cardiomyopathy ◽

Cardiac Mortality ◽

Recurrence Rates ◽

Success Group ◽

Nonischemic Dilated Cardiomyopathy ◽

Group 2 ◽

Reduction Of Mortality ◽

Group 1

Introduction: Recent publications reported on higher recurrence rates and lack of survival benefit after catheter ablation (CA) of ventricular tachycardia (VT) in nonischemic dilated cardiomyopathy (NIDCM). Methods: We aimed to investigate the VT recurrence and cardiac mortality in patients with NIDCM ablated for VT. The studied cohort was divided in 2 groups depending on procedure success: complete success (group 1), and failure or incomplete success (group 2). Success definition was based on the VT inducibility after CA. The patients were prospectively followed for cardiac mortality and VT recurrence. Results: 104 patients with NIDCM (87 males, mean age 59.65 ± 14.69 years, mean ejection fraction 33.42 ± 11.42 %) underwent VT ablation. Ventricular stimulation after CA was not attempted in 13 (12.5%) patients. Out of the rest 91, complete success was achieved in 62 (68.1%) patients (group1), and incomplete success or failure in 29 (31.9%) patients (group 2). During 2-years follow-up, VT recurrence was observed in 56.5% in group 1 vs. 82.8% in group 2. Incomplete success was associated with higher VT recurrence (HR 1.91; 95% CI 1.13-3.22; p=0.015). The 2-years mortality was 14.5% in group 1 vs 34.5% in group 2. The probability for death was 3-times higher in group 2 (adjusted HR 3.18; 95% CI 1.18-8.56; p=0.022). The primary and secondary endpoints were comparable between patients with idiopathic, post-myocarditis and secondary NIDCM. Conclusion: Procedure success, defined as complete VT noninducibility after CA of VT, was associated with reduced VT recurrence and improved survival in patients with nonischemic dilated cardiomyopathy.

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The role of Dietitian in cardiac rehabilitation and prevention

Monaldi Archives for Chest Disease ◽

10.4081/monaldi.2008.418 ◽

2016 ◽

Vol 70 (3) ◽

Author(s):

Susanna Agostini ◽

Barbara Biffi ◽

Silvia Brazzo ◽

Letizia Da Vico ◽

Maria Luisa Masini ◽

...

Keyword(s):

Risk Factors ◽

Cardiovascular Disease ◽

Cardiac Rehabilitation ◽

Serum Lipids ◽

Scientific Literature ◽

Psychosocial Interventions ◽

Pharmacological Interventions ◽

Nutritional Interventions ◽

Reduction Of Mortality

Rehabilitation and secondary prevention programs are recognized as an essential part of the overall care of patients with cardiovascular disease. They consist of multidisciplinary strategies aiming at the reduction of modifiable risk factors for cardiovascular disease. Cardiac rehabilitation includes non-pharmacological interventions as: Patients’ evaluation. Nutritional counseling. Risk factors management (serum lipids, blood pressure, weight, diabetes, smoking). Psychosocial interventions. Physical activity and cardiovascular physical training counseling. Their effectiveness in the reduction of mortality through the decrease of risk factors has been proven in the last twenty years. Guidelines on appropriate and well-framed interventions have been released and nutritional interventions have a ringside seat in all programs. During 2007, the Italian Association of Dietitians, ANDID, created a working group of expert dietitians, with the goals of making a review of available scientific literature and of elaborating a Professional Position Papers on the role of Dietitian in cardiac rehabilitation and prevention. This Position Paper retrieves and remarks the available evidence that are important for the dietitians, according to their professional role and their contribution in the management of the topic.

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Remdesivir Use in Patients Requiring Mechanical Ventilation due to COVID-19

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa481 ◽

2020 ◽

Vol 7 (11) ◽

Author(s):

Giuseppe Lapadula ◽

Davide Paolo Bernasconi ◽

Giacomo Bellani ◽

Alessandro Soria ◽

Roberto Rona ◽

...

Keyword(s):

Mechanical Ventilation ◽

Hospital Discharge ◽

Multivariable Analysis ◽

Competing Risk ◽

Lower Mortality ◽

Hospital Death ◽

Related Factors ◽

Cox Models ◽

Treatment Groups ◽

Reduction Of Mortality

Abstract Background Remdesivir has been associated with accelerated recovery of severe coronavirus disease 2019 (COVID-19). However, whether it is also beneficial in patients requiring mechanical ventilation is uncertain. Methods All consecutive intensive care unit (ICU) patients requiring mechanical ventilation due to COVID-19 were enrolled. Univariate and multivariable Cox models were used to explore the possible association between in-hospital death or hospital discharge, considered competing-risk events, and baseline or treatment-related factors, including the use of remdesivir. The rate of extubation and the number of ventilator-free days were also calculated and compared between treatment groups. Results One hundred thirteen patients requiring mechanical ventilation were observed for a median of 31 days of follow-up; 32% died, 69% were extubated, and 66% were discharged alive from the hospital. Among 33 treated with remdesivir (RDV), lower mortality (15.2% vs 38.8%) and higher rates of extubation (88% vs 60%), ventilator-free days (median [interquartile range], 11 [0–16] vs 5 [0–14.5]), and hospital discharge (85% vs 59%) were observed. Using multivariable analysis, RDV was significantly associated with hospital discharge (hazard ratio [HR], 2.25; 95% CI, 1.27–3.97; P = .005) and with a nonsignificantly lower mortality (HR, 0.73; 95% CI, 0.26–2.1; P = .560). RDV was also independently associated with extubation (HR, 2.10; 95% CI, 1.19–3.73; P = .011), which was considered a competing risk to death in the ICU in an additional survival model. Conclusions In our cohort of mechanically ventilated patients, RDV was not associated with a significant reduction of mortality, but it was consistently associated with shorter duration of mechanical ventilation and higher probability of hospital discharge, independent of other risk factors.

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Effects of glycine–metal compounds onAscaridia galli-infected chickens expressed by a kinetic model

Journal of Helminthology ◽

10.1079/joh2003204 ◽

2004 ◽

Vol 78 (1) ◽

pp. 25-32 ◽

Cited By ~ 4

Author(s):

M. Gabrashanska ◽

S.E. Teodorova ◽

M. Galvez-Morros ◽

M. Mitov

Keyword(s):

Body Weight Gain ◽

Biogenic Elements ◽

Model Parameters ◽

Ascaridia Galli ◽

Mineral Deficiency ◽

Metal Compounds ◽

High Infection ◽

Gain Reduction ◽

Reduction Of Mortality ◽

Host Parasite

AbstractThe biogenic elements zinc, manganese and cobalt are essential for metabolic processes in animals. Compounds of nGly.Me2+A. mH2O (Me2+=Zn2+, Mn2+, Co2+; A=Cl−, SO42−, n=1, 2; m=2, 5), as supplements in the diet, were used separately on different experimental groups of male Hisex chickens to correct the mineral deficiency caused byAscaridia galliinfections. An amelioration of body weight gain, reduction of mortality and restoration of trace element levels were estimated in infected chickens. A mathematical model has been proposed forA. gallipopulation kinetics in chickens, taking into account the stimulating effect of these elements on the nematodes. The model parameters are considered as phenomenological constants of the host–parasite system. An agreement with experimental data is observed using, for the parametersψ,α,μandμs, values equal to those calculated in previously investigatedA. galli–chicken systems. For parameterν(immunological constant) the same value was obtained as in a previous experiment with high infection. This model is likely to be suitable for a range of host–nematode systems, including varying degrees of infection and treatment with different trace elements.

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Antibiotic usage rates in bacterial versus nonbacterial diseases: a new way to monitor hospital-acquired infections in children: a retrospective case analysis

International Journal of Contemporary Pediatrics ◽

10.18203/2349-3291.ijcp20204540 ◽

2020 ◽

Vol 7 (11) ◽

pp. 2176

Author(s):

Jayendra R. Gohil ◽

Chintu C. Chaudary ◽

Sheena D. Sivanandan

Keyword(s):

Antibiotic Usage ◽

Retrospective Case ◽

Hospital Acquired Infections ◽

Group A ◽

Added Benefit ◽

Reduction Of Mortality ◽

Group B ◽

The Cost ◽

Hospital Acquired ◽

Selection Of

Background: While treating children, the selection of antibiotics, when indicated, should be from the point of its effectiveness, safety, suitability, and cost. However, this flow of action does not take place in all cases. Aim of the study was to assess the antibiotic usage in admitted children and mortality.Methods: The case records between January to July 2012 in children wards was evaluated for the use of antibiotics. Patients were grouped into; group A- ‘must use' antibiotic in all, and group B- where antibiotics are not indicated.Results: There were 1852 admissions, including 719 Thalassemia cases. Antibiotic usage was 63% in 1133 cases after excluding thalassemia. Out of 1133 cases, 423 were in group A and 710 cases were in group B. In group B the antibiotic usage was 41%. The mortality was 6.6% and 4.8% in group A and B. Inside group B, mortality was 5.9% versus 4.0% in those administered versus not administered, antibiotics.Conclusions: There was no increase in mortality in patients in whom antibiotics were not prescribed, and no added benefit of prescribing antibiotics was observed in nonbacterial group B disease patients. The mortality was similar in both the groups. In nonbacterial group B, the antibiotics did not offer any advantage in the reduction of mortality, but increased the cost of the treatment, and possibly the chance of development of drug resistance and adverse events. When analysing the hospital antibiotic usage, only the nonbacterial diseases should be considered to get a true picture of the inappropriate prescription of antibiotics.

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Use of modern forensic methods for post-mortem diagnosis of blood loss

RUDN Journal of Medicine ◽

10.22363/2313-0245-2021-25-2-154-161 ◽

2021 ◽

Vol 25 (2) ◽

pp. 154-161

Author(s):

D. V. Sundukov ◽

V. A. Putintsev ◽

V. V. Shekera ◽

D. V. Bogomolov ◽

O. L. Romanova

Keyword(s):

Blood Loss ◽

Cause Of Death ◽

Medical Practice ◽

Medical Personnel ◽

Sufficient Information ◽

Acute Blood Loss ◽

Circulating Blood Volume ◽

Medical Documents ◽

Methodological Approaches ◽

Reduction Of Mortality

In forensic medical practice, when diagnosing the cause of death from blood loss, it is often necessary to solve questions related to the etiology of loss of circulating blood volume (CBV), the degree and severity of the injury, as well as its role in thanatogenesis and the duration of the terminal (agonal) period. When investigating the cases of death from acute blood loss, the authorities often ask forensic experts to solve issues related to the possibility of performing active targeted actions by the dying person, as well as to assess the timeliness of medical care and the actions of medical personnel. The solution of these issues is often difficult for experts, and it is associated with both objective and subjective reasons. For example, in cases where the circumstances of death are unknown, or there are no medical documents, or they do not contain sufficient information, without which it is impossible to conduct a retrospective clinical and anatomical analysis for the purpose of differential diagnosis between hemolytic shock and post-hemorrhagic anemia. The article deals with the use of new methodological approaches in postmortem morphological diagnostics of blood loss by the rate of its development and its role in thanatogenesis, in forensic medical practice. For example, a particular forensic expertise (case study) shows that the application of two new methods allowed to solve the issues for the investigator related to the cause of death and duration of dying from blood loss. Experts knowledge of new methodological approaches to the forensic diagnosis of acute blood loss will help law enforcement authorities to counteract crimes against the life of citizens, as well as to development the measures to improve the methods for prevention and reduction of mortality from traumatic injuries with blood loss.

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