Rescue Emergencies Due to High-Altitude Illnesses Are Rare in Switzerland

Background: Despite a potential high risk of acute mountain sickness (AMS) in the Swiss Alps, there is a lack of analyses concerning its relevance over longer periods. In consequence, the aim of this study is to analyze the prevalence of AMS in comparison to other causes of mountain emergencies in recent years in Switzerland. Material and Methods: Based on the central registry of mountain emergencies of the Swiss Alpine Club (SAC), all cases in the period between 2009 and 2020 were analyzed for AMS including the most severe forms of high-altitude pulmonary edema (HAPE) and high-altitude cerebral edema (HACE). Emergencies were assessed for the severity of the event with a National Advisory Committee for Aeronautics (NACA) score. Results: From a total of 4596 high-altitude mountaineering emergencies identified in the observational period, a total number of 352 cases of illnesses were detected. Detailed analysis revealed 85 cases of AMS, 5 cases of HAPE, and 1 case of HACE. The average altitude was 3845 ± 540 m. Most cases were in the canton of Valais, especially in the Monte Rosa region and the mountains of the Mischabel group (Täschhorn, Dom, Südlenz, Nadelhorn, Hohberghorn). There were only three deaths related to high-altitude illnesses; all the other events could be identified as moderate to severe but not life-threatening. Discussion: An emergency due to AMS that requires rescue is unlikely in the Swiss Alps. This does not imply that AMS is not a concern. However, the facts that the maximal altitude is relatively low and that fast self-descents often seem possible probably minimize the likelihood that mountaineers with symptoms contact emergency services.

Predictive Value of the PaO2/FIO2 Ratio for Mortality in Patients with Acute Respiratory Distress Syndrome: A Systematic Review and Meta-Analysis

Background PaO2 /FIO2 (P/F) ratio has been used to define the severity of acute respiratory distress syndrome (ARDS) despite the controversy of its clinical utility. This systematic review and meta-analysis (SRMA) aimed to obtain summary estimates of predictive performance of the P/F ratio for predicting mortality in ARDS patients. Methods We included a study wherein the study population comprised ARDS patients in any clinical setting. Medline and Cochrane Central Registry of Controlled Trials were searched for all English language articles. We performed a SRMA on the accuracy of diagnostic prognostic tests using QUADAS-2 tool to evaluate the risk of bias. To pool the results, we applied the bivariate model and obtained summary point estimates of sensitivity and specificity with 95% CIs. Results Twenty-eight trials and 38270 patients were included in the meta-analysis. Most of the study settings were in the intensive care units. The overall risk of bias was high. The pooled sensitivity of the P/F ratio in all included studies for a P/F ratio of 100 was 43.6% (95% CI, 36.9-50.5%) and the specificity was 71.1% (95% CI, 66.7-75.1%) and those for a P/F ratio of 200 were 83.2% (95% CI, 78.2-87.2%) and 26.2% (95% CI, 21.2-31.9%). Interpretation The P/F ratio had high sensitivity and moderate specificity at a P/F ratio of 200 and 100 respectively, which supports the use of the P/F ratio for screening ARDS patients who are at risk of deterioration.Trial registration: The study was registered in UMIN with registration number 64 000041058.

Incident diabetes risk is not increased in transgender individuals using hormone therapy

Background In trans women receiving hormone therapy, body fat and insulin resistance increases, with opposite effects in trans men. These metabolic alterations may alter the risk of developing type 2 diabetes in trans women and trans men. We aimed to compare the incidence of type 2 diabetes of adult trans women and trans men during hormone therapy with rates from their birth sex in the general population. Methods Retrospective data from the Amsterdam Cohort of Gender Dysphoria with transgender individuals on hormone therapy between 1972 and 2018 were linked to a nationwide health data registry. Because no central registry of diabetes is available, the occurrence of diabetes was inferred from the first dispense of a glucose-lowering agent. Standardized incidence ratios (SIR) were computed for trans women and trans men in comparison with the same birth sex from the general population. Results Compared to their birth sex in the general population, no difference in the incidence of type 2 diabetes mellitus was observed in trans women (N=2585, 90 cases, SIR 0.94 95%CI 0.76–1.14) or trans men (N=1514, 32 cases, SIR 1.40 95%CI 0.96–1.92). Conclusion Despite studies reporting an increase in insulin resistance in feminizing hormone therapy and a decrease in insulin resistance in masculinizing hormone therapy, the incidence of diabetes in transgender individuals after initiation of hormone therapy was not different compared to the general population.

Real world evidence of calcifediol or vitamin D prescription and mortality rate of COVID-19 in a retrospective cohort of hospitalized Andalusian patients

COVID-19 is a major worldwide health problem because of acute respiratory distress syndrome, and mortality. Several lines of evidence have suggested a relationship between the vitamin D endocrine system and severity of COVID-19. We present a survival study on a retrospective cohort of 15,968 patients, comprising all COVID-19 patients hospitalized in Andalusia between January and November 2020. Based on a central registry of electronic health records (the Andalusian Population Health Database, BPS), prescription of vitamin D or its metabolites within 15–30 days before hospitalization were recorded. The effect of prescription of vitamin D (metabolites) for other indication previous to the hospitalization was studied with respect to patient survival. Kaplan–Meier survival curves and hazard ratios support an association between prescription of these metabolites and patient survival. Such association was stronger for calcifediol (Hazard Ratio, HR = 0.67, with 95% confidence interval, CI, of [0.50–0.91]) than for cholecalciferol (HR = 0.75, with 95% CI of [0.61–0.91]), when prescribed 15 days prior hospitalization. Although the relation is maintained, there is a general decrease of this effect when a longer period of 30 days prior hospitalization is considered (calcifediol HR = 0.73, with 95% CI [0.57–0.95] and cholecalciferol HR = 0.88, with 95% CI [0.75, 1.03]), suggesting that association was stronger when the prescription was closer to the hospitalization.

Does Whole-Body Vibration Training Have a Concurrent Effect on Bone and Muscle Health? A Systematic Review and Meta-Analysis

Background: Aging results in musculoskeletal disorders, which are a leading cause of disability worldwide. While conventional nonpharmacological treatments have included interventions such as resistance exercise, there are subgroups of people who may be at risk of exercise-related injuries, for example, falls. Whole-body vibration (WBV) is an intervention that helps improve musculoskeletal function and is viable for those with limited mobility. Objectives: Whether WBV has a dual effect on bone and muscle conditions remains unknown. We aim to assess the evidence of the effects of WBV on bone and muscle parameters concurrently in older people. Methods: Under Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines, a systematic literature search was performed in MEDLINE, EMBASE, EMCARE, and the Cochrane Central Registry of Controlled Trials. The main outcomes were changes in bone and muscle parameters. Results: Our meta-analysis showed that WBV does not have significant synergistic effects on measured bone (bone mineral density [BMD] in the hip and lumbar spine) and muscle (lean muscle mass and sit-to-stand time) outcomes, compared to controls (i.e., no WBV included). Conclusion: While there were no significant results, the included studies are limited by small sample size and variable intervention protocols and follow-up periods. Further trials should endeavor to measure both bone and muscle outcomes concurrently with a longer follow-up time. Osteoporosis status in participants must also be considered as it is not yet possible to exclude that WBV may have a significant effect on BMD in people with known osteoporosis. WBV does not appear to simultaneously influence bone and muscle health in older people, and future research is required to establish a regimen that may lead to measurable clinical efficacy.

Predictive Value of the PaO2/FIO2 Ratio for Mortality in Patients with Acute Respiratory Distress Syndrome: A Systematic Review and Meta-Analysis

BackgroundPaO2/FIO2 (P/F) ratio has been used to define the severity of acute respiratory distress syndrome (ARDS) despite the controversy of its clinical utility. This systematic review and meta-analysis (SRMA) aimed to obtain summary estimates of predictive performance of the P/F ratio for predicting mortality in ARDS patients.MethodsWe included a study wherein the study population comprised ARDS patients in anyclinical setting. Medline and Cochrane Central Registry of Controlled Trials were searched for all English language articles. We performed a SRMA on the accuracy of diagnostic prognostic tests using QUADAS-2 tool to evaluate the risk of bias. To pool the results, we applied the bivariate model and obtained summary point estimates of sensitivity and specificity with 95% CIs.ResultsTwenty-eight trials and 38270 patients were included in the meta-analysis. Most of the study settings were in the intensive care units. The overall risk of bias was high. The pooled sensitivity of the P/F ratio in all included studies for a P/F ratio of 100 was 43.6% (95% CI, 36.9-50.5%) and the specificity was 71.1% (95% CI, 66.7-75.1%) and those for a P/F ratio of 200 were 83.2% (95% CI, 78.2-87.2%) and 26.2% (95% CI, 21.2-31.9%). ConclusionThe P/F ratio had high sensitivity and moderate specificity at a P/F ratio of 200 and 100 respectively., which supports the use of the P/F ratio for screening ARDS patients who are at risk of deterioration.Trial registration: The study was registered in UMIN with registration number 000041058.

Thrombotic Events in COVID-19 Patients Undergoing Convalescent Plasma Therapy: A Systematic Review

INTRODUCTION Convalescent plasma therapy (CPT) has been proposed as a mechanism of passive immunization against COVID-19. Current guidelines on the efficacy of its use is not well delineated with limited studies analyzing the risk of thromboembolic events during treatment. The goal of this systematic review and meta-analysis was to assess the risk of arterial and venous thromboembolisms from CPT in patients with COVID-19. METHODS We conducted a comprehensive literature review of Ovid MEDLINE, Cochrane Central Registry of Controlled Trials (CENTRAL), and EMBASE from inception to June 2021. Title and abstract screening and full-text screening was done in duplicate by two independent reviewers. All randomized controlled trials and cohort studies that analyzed adult COVID-19 patients undergoing CPT were included for analysis. Editorials, conference abstracts, narrative reviews, case series, containing less than 100 patients were excluded. The primary outcome analyzed was the risk of thrombotic events in CPT + standard therapy vs standard therapy alone. Meta-analysis was done using a random-effects model using the Revman 5 software. RESULTS Of 1774 studies identified from our search, three randomized (n= 660 patients), and one non-randomized matched cohort study) (n = 96 patients) were included for analysis. The risk ratio for thrombotic events was 2.33, favoring the CPT group (95% CI, [0.70, 7.72], P = 0.17, I2 = 29%). Subgroup analyses showed that CPT + standard therapy was associated with a decreased risk of in-hospital mortality (RR = 0.70 [0.49, 0.98], P = 0.04, I2 = 0%). No significant difference in cardiovascular events (RR = 0.90 [0.67, 1.20], P = 0.48, I2 = 0%), hypertension (RR = 1.67 [0.56, 4.98], P = 0.35, I2 = 0%), and septic shock (RR = 0.97 [0.40, 2.35], P = 0.94, I2 = 41%) was found between CPT + standard therapy and standard therapy alone. CONCLUSION We found treatment of COVID-19 with standard therapy + CPT was not associated with an increase in the risk of thromboembolic events. CPT was associated with a decreased risk of in-hospital mortality but not of MACE, hypertension, or septic shock. Disclosures Crowther: Hemostasis reference laboratories: Honoraria; Bayer: Speakers Bureau; CSL Behring: Speakers Bureau; Precision Biologicals: Honoraria; Pfizer: Speakers Bureau; Syneos Health: Honoraria.

Do hospitals have a higher mortality rate on weekend admissions? An observational study to analyse weekend effect on urgent admissions to hospitals in Catalonia

Background‘Weekend effect’ is a term used to describe the increased mortality associated with weekend emergency admissions to hospital, in contrast with admission on weekdays. The objective of the present study is to determine whether the weekend effect is present in hospitals in Catalonia.MethodsWe analysed all urgent admissions in Catalonia in 2018, for a group of pathologies. Two groups were defined (those admitted on a weekday and those admitted on a weekend). We obtained mortality at 3, 7, 15 and 30 days, and applied a proportions test to both groups. Additionally, we used Cox’s regression for mortality at 30 days, using the admission on a weekend as the exposition, adjusting by socioeconomic and clinical variables. We used the hospital discharge database and the Central Registry of the Insured Population.Results72 427 admissions for the selected pathologies during 2018 were found. No statistically significant differences in mortality at 30 days (p=0.524) or at 15 days (p=0.119) according to the day of admission were observed. However, significant differences were found in mortality at 7 days (p=0.025) and at 3 days (p=0.002). The hazard rate associated with the weekend was 1.13 (95% CI: 1.04 to 1.23). By contrast, the adjusted HR of the weekend interaction with time was 0.99 (95% CI: 0.99 to 1.00).ConclusionsThere is a weekend effect, but it is not constant in time. This could suggest the existence of dysfunctions in the quality of care during the weekend.

The Impact of The Covid-19 Pandemic on Investor Risk Tendency: The Case of Turkey

Introduction and Aim: It is an important issue that what kind of changes occur in the risks that people face in the face of emerging problems and the role of people in possible pandemics in the last twenty years and in the future. The solution of the problems that arise in the control and management of these risks attracts the attention of many researchers. In this study, the causality effect of the COVID-19 pandemic on risk appetites representing the attitudes and behaviors of securities investors. Materials and Methods: In the study; To represent the pandemic, weekly time series data of the number of COVID-19 cases (COVID) and the Risk Appetite index (RISK) announced by the Central Registry Agency for the period 30.03.2019-30.08.2021 were used. In order to determine the causality relationship, the Hatemi-J Causality test was performed. Results: It was determined that the negative shocks of the COVID variable were a cause of the positive shocks of the RISK variable at a statistical significance level of 1%. Conclusion and Suggestions: The effect of the pandemic process on the investment decisions of the investors is reduced, with the expectation that the economy and financial markets will improve, positively affecting the behavior and risk perceptions of the investors, and this expectation causes the investment behavior and risk appetite to increase. can be expressed. Keywords: COVID-19, Risk appetite, Pandemic, Hatemi-J

The Impact of The Covid-19 Pandemic on Investor Risk Tendency: The Case of Turkey

Introduction and Aim: It is an important issue that what kind of changes occur in the risks that people face in the face of emerging problems and the role of people in possible pandemics in the last twenty years and in the future. The solution of the problems that arise in the control and management of these risks attracts the attention of many researchers. In this study, the causality effect of the COVID-19 pandemic on risk appetites representing the attitudes and behaviors of securities investors. Materials and Methods: In the study; To represent the pandemic, weekly time series data of the number of COVID-19 cases (COVID) and the Risk Appetite index (RISK) announced by the Central Registry Agency for the period 30.03.2019-30.08.2021 were used. In order to determine the causality relationship, the Hatemi-J Causality test was performed. Results: It was determined that the negative shocks of the COVID variable were a cause of the positive shocks of the RISK variable at a statistical significance level of 1%. Conclusion and Suggestions: The effect of the pandemic process on the investment decisions of the investors is reduced, with the expectation that the economy and financial markets will improve, positively affecting the behavior and risk perceptions of the investors, and this expectation causes the investment behavior and risk appetite to increase. can be expressed. Keywords: COVID-19, Risk appetite, Pandemic, Hatemi-J