Why Are COVID-19 Mortality Rates by Country or Region So Different?:                    An Ecologic Study of Factors Associated with Mortality from Novel Coronavirus                    Infections by Country

AbstractRisk factors associated with mortality in invasive pneumococcal disease remain unclear. The present work is a meta-analysis of studies that enrolled only patients with invasive pneumococcal disease and reported on mortality. Potentially eligible reports were identified from PubMed, CHAHL, and Web of Science, comprising 26 reports in total. Overall mortality for invasive pneumococcal disease was reported as 20.8% (95% confidence interval (CI) 17.5–24%). Factors associated with mortality were age (odds ratio (OR) 3.04, 95% CI 2.5–3.68), nursing home (OR 1.62, 95% CI 1.13–2.32), nosocomial infection (OR 2.10, 95% CI 1.52–2.89), septic shock (OR 13.35, 95% CI 4.54–39.31), underlying chronic diseases (OR 2.34, 95% CI 1.78–3.09), solid organ tumor (OR 5.34, 95% CI 2.07–13.74), immunosuppressed status (OR 1.67, 95% CI 1.31–2.14), and alcohol abuse (OR 3.14, 95% CI 2.13–4.64). Mortality rates with invasive pneumococcal disease remained high, and these findings may help clinicians provide appropriate initial treatment for this disease.

Download Full-text

Long-term mortality rates and associated risk factors following primary and revision knee arthroplasty

The Bone & Joint Journal ◽

10.1302/0301-620x.104b1.bjj-2021-0753.r1 ◽

2022 ◽

Vol 104-B (1) ◽

pp. 45-52

Author(s):

Liam Zen Yapp ◽

Nick D. Clement ◽

Matthew Moran ◽

Jon V. Clarke ◽

A. Hamish R. W. Simpson ◽

...

Keyword(s):

General Population ◽

Knee Arthroplasty ◽

Mortality Rates ◽

Factors Associated ◽

Revision Knee Arthroplasty ◽

Risk Of Mortality ◽

Increased Risk ◽

Male Sex ◽

Long Term Mortality

Aims The aim of this study was to determine the long-term mortality rate, and to identify factors associated with this, following primary and revision knee arthroplasty (KA). Methods Data from the Scottish Arthroplasty Project (1998 to 2019) were retrospectively analyzed. Patient mortality data were linked from the National Records of Scotland. Analyses were performed separately for the primary and revised KA cohorts. The standardized mortality ratio (SMR) with 95% confidence intervals (CIs) was calculated for the population at risk. Multivariable Cox proportional hazards were used to identify predictors and estimate relative mortality risks. Results At a median 7.4 years (interquartile range (IQR) 4.0 to 11.6) follow-up, 27.8% of primary (n = 27,474/98,778) and 31.3% of revision (n = 2,611/8,343) KA patients had died. Both primary and revision cohorts had lower mortality rates than the general population (SMR 0.74 (95% CI 0.73 to 0.74); p < 0.001; SMR 0.83 (95% CI 0.80 to 0.86); p < 0.001, respectively), which persisted for 12 and eighteight years after surgery, respectively. Factors associated with increased risk of mortality after primary KA included male sex (hazard ratio (HR) 1.40 (95% CI 1.36 to 1.45)), increasing socioeconomic deprivation (HR 1.43 (95% CI 1.36 to 1.50)), inflammatory polyarthropathy (HR 1.79 (95% CI 1.68 to 1.90)), greater number of comorbidities (HR 1.59 (95% CI 1.51 to 1.68)), and periprosthetic joint infection (PJI) requiring revision (HR 1.92 (95% CI 1.57 to 2.36)) when adjusting for age. Similarly, male sex (HR 1.36 (95% CI 1.24 to 1.49)), increasing socioeconomic deprivation (HR 1.31 (95% CI 1.12 to 1.52)), inflammatory polyarthropathy (HR 1.24 (95% CI 1.12 to 1.37)), greater number of comorbidities (HR 1.64 (95% CI 1.33 to 2.01)), and revision for PJI (HR 1.35 (95% 1.18 to 1.55)) were independently associated with an increased risk of mortality following revision KA when adjusting for age. Conclusion The SMR of patients undergoing primary and revision KA was lower than that of the general population and remained so for several years post-surgery. However, approximately one in four patients undergoing primary and one in three patients undergoing revision KA died within tenten years of surgery. Several patient and surgical factors, including PJI, were associated with the risk of mortality within ten years of primary and revision surgery. Cite this article: Bone Joint J 2022;104-B(1):45–52.

Download Full-text

Central nervous system as a target of novel coronavirus infections: Potential routes of entry and pathogenic mechanisms

Journal of Biosciences ◽

10.1007/s12038-021-00232-9 ◽

2021 ◽

Vol 46 (4) ◽

Author(s):

Sapana Sharma ◽

Harsha Jagadeesh ◽

Ambrish Saxena ◽

Harshini Chakravarthy ◽

Vasudharani Devanathan

Keyword(s):

Central Nervous System ◽

Nervous System ◽

Pathogenic Mechanisms ◽

Novel Coronavirus ◽

Coronavirus Infections

Download Full-text

Does the novel coronavirus 2019 like heart more than the other family members of coronaviruses?

Journal of Cardiovascular and Thoracic Research ◽

10.34172/jcvtr.2020.27 ◽

2020 ◽

Vol 12 (2) ◽

pp. 156-157

Author(s):

Mohammad Mostafa Ansari Ramandi ◽

Mohammadreza Baay ◽

Nasim Naderi

Keyword(s):

Middle East ◽

Severe Acute Respiratory Syndrome ◽

Family Members ◽

Middle East Respiratory Syndrome ◽

The Other ◽

The Novel ◽

The World ◽

Future Challenges ◽

Novel Coronavirus ◽

Coronavirus Infections

The disaster due to the novel coronavirus disease 2019 (COVID-19) around the world has made investigators enthusiastic about working on different aspects of COVID-19. However, although the pandemic of COVID-19 has not yet ended, it seems that COVID-19 compared to the other coronavirus infections (the Middle East Respiratory Syndrome [MERS] and Severe Acute Respiratory Syndrome [SARS]) is more likely to target the heart. Comparing the previous presentations of the coronavirus family and the recent cardiovascular manifestations of COVID-19 can also help in predicting possible future challenges and taking measures to tackle these issues.

Download Full-text

Short-term outcomes after emergency surgery for complicated peptic ulcer disease from the UK National Emergency Laparotomy Audit: a cohort study

BMJ Open ◽

10.1136/bmjopen-2018-023721 ◽

2018 ◽

Vol 8 (8) ◽

pp. e023721 ◽

Cited By ~ 7

Author(s):

Benjamin E Byrne ◽

Michael Bassett ◽

Chris A Rogers ◽

Iain D Anderson ◽

Ian Beckingham ◽

...

Keyword(s):

Peptic Ulcer ◽

Cohort Study ◽

Peptic Ulcer Disease ◽

Fatal Outcome ◽

Mortality Rates ◽

Emergency Laparotomy ◽

Ulcer Disease ◽

Factors Associated ◽

Institutional Volume ◽

National Emergency

ObjectivesThis study used national audit data to describe current management and outcomes of patients undergoing surgery for complications of peptic ulcer disease (PUD), including perforation and bleeding. It was also planned to explore factors associated with fatal outcome after surgery for perforated ulcers. These analyses were designed to provide a thorough understanding of current practice and identify potentially modifiable factors associated with outcome as targets for future quality improvement.DesignNational cohort study using National Emergency Laparotomy Audit (NELA) data.SettingEnglish and Welsh hospitals within the National Health Service.ParticipantsAdult patients admitted as an emergency with perforated or bleeding PUD between December 2013 and November 2015.InterventionsLaparotomy for bleeding or perforated peptic ulcer.Primary and secondary outcome measuresThe primary outcome was 60-day in-hospital mortality. Secondary outcomes included length of postoperative stay, readmission and reoperation rate.Results2444 and 382 procedures were performed for perforated and bleeding ulcers, respectively. In-hospital 60-day mortality rates were 287/2444 (11.7%, 95% CI 10.5% to 13.1%) for perforations, and 68/382 (17.8%, 95% CI 14.1% to 22.0%) for bleeding. Median (IQR) 2-year institutional volume was 12 (7–17) and 2 (1–3) for perforation and bleeding, respectively. In the exploratory analysis, age, American Society of Anesthesiology score and preoperative systolic blood pressure were associated with mortality, with no association with time from admission to operation, surgeon grade or operative approach.ConclusionsPatients undergoing surgery for complicated PUD face a high 60-day mortality risk. Exploratory analyses suggested fatal outcome was primarily associated with patient rather than provider care factors. Therefore, it may be challenging to reduce mortality rates further. NELA data provide important benchmarking for patient consent and has highlighted low institutional volume and high mortality rates after surgery for bleeding peptic ulcers as a target for future research and improvement.

Download Full-text

Survival and factors predicting mortality after major and minor lower-extremity amputations among patients with diabetes: a population-based study using health information systems

BMJ Open Diabetes Research & Care ◽

10.1136/bmjdrc-2020-001355 ◽

2020 ◽

Vol 8 (1) ◽

pp. e001355

Author(s):

Silvia Cascini ◽

Nera Agabiti ◽

Marina Davoli ◽

Luigi Uccioli ◽

Marco Meloni ◽

...

Keyword(s):

Risk Factors ◽

Lower Extremity ◽

Renal Disease ◽

High Mortality ◽

Chronic Renal Disease ◽

Mortality Rates ◽

Population Based ◽

Term Survival ◽

Factors Associated ◽

Patients With Diabetes

IntroductionThe aim of the study was to identify the sociodemographic and clinical factors associated with death after the first lower-extremity amputation (LEA), minor and major separately, using data from regional health administrative databases.Research design and methodsWe carried out a population-based cohort study including patients with diabetes residing in the Lazio region and undergoing a primary amputation in the period 2012–2015. Each individual was followed up for at least 2 years. Kaplan-Meier analysis was used to evaluate long-term survival; Cox proportional regression models were applied to identify factors associated with all-cause mortality.ResultsThe cohort included 1053 patients, 72% were male, 63% aged ≥65 years, and 519 (49%) died by the end of follow-up. Mortality rates at 1 and 4 years were, respectively, 33% and 65% for major LEA and 18% and 45% for minor LEA. Significant risk factors for mortality were age ≥65, diabetes-related cardiovascular complications, and chronic renal disease for patients with minor LEA, and age ≥75 years, chronic renal disease and antidepressant drug consumption for subjects with major LEA.ConclusionsThe present study confirms the high mortality rates described in patients with diabetes after non-traumatic LEA. It shows differences between minor and major LEA in terms of mortality rates and related risk factors. The study highlights the role of depression as specific risk factor for death in patients with diabetes after major LEA and suggests including its definition and management in strategies to reduce the high mortality rate observed in this group of patients.

Download Full-text

An Analysis of 38 Pregnant Women With COVID-19, Their Newborn Infants, and Maternal-Fetal Transmission of SARS-CoV-2: Maternal Coronavirus Infections and Pregnancy Outcomes

Archives of Pathology & Laboratory Medicine ◽

10.5858/arpa.2020-0901-sa ◽

2020 ◽

Vol 144 (7) ◽

pp. 799-805 ◽

Cited By ~ 241

Author(s):

David A. Schwartz

Keyword(s):

Pregnant Women ◽

Pregnancy Outcomes ◽

Viral Infections ◽

Clinical Laboratory ◽

Newborn Infants ◽

Public Health Problem ◽

Obstetric Outcomes ◽

Maternal Fetal Transmission ◽

Novel Coronavirus ◽

Coronavirus Infections

The emergence of a novel coronavirus, termed SARS-CoV-2, and the potentially life-threatening respiratory disease that it can produce, COVID-19, has rapidly spread across the globe, creating a massive public health problem. Previous epidemics of many emerging viral infections have typically resulted in poor obstetric outcomes including maternal morbidity and mortality, maternal-fetal transmission of the virus, and perinatal infections and death. This article reviews the effects of 2 previous coronavirus infections—severe acute respiratory syndrome (SARS) caused by SARS-CoV and Middle East respiratory syndrome (MERS) caused by MERS-CoV—on pregnancy outcomes. In addition, it analyzes literature describing 38 pregnant women with COVID-19 and their newborns in China to assess the effects of SARS-CoV-2 on the mothers and infants, including clinical, laboratory, and virologic data, and the transmissibility of the virus from mother to fetus. This analysis reveals that unlike coronavirus infections of pregnant women caused by SARS and MERS, in these 38 pregnant women COVID-19 did not lead to maternal deaths. Importantly, and similar to pregnancies with SARS and MERS, there were no confirmed cases of intrauterine transmission of SARS-CoV-2 from mothers with COVID-19 to their fetuses. All neonatal specimens tested, including placentas in some cases, were negative by RT-PCR for SARS-CoV-2. At this point in the global pandemic of COVID-19 infection there is no evidence that SARS-CoV-2 undergoes intrauterine or transplacental transmission from infected pregnant women to their fetuses. Analysis of additional cases is necessary to determine if this remains true.

Download Full-text