Epidemiological Characterization and the Impact of Healthcare-Associated Pneumonia in Patients Admitted in a Northern Portuguese Hospital

Pneumonia is one of the main causes of hospitalization and mortality. It’s the fourth leading cause of death worldwide. Healthcare-associated infections are the most frequent complication of healthcare and affect hundreds of millions of patients around the world, although the actual number of patients affected is unknown due to the difficulty of reliable data. The main goal of this manuscript is to describe the epidemiological characteristics of patients admitted with pneumonia and the impact of healthcare-associated pneumonia (HCAP) in those patients. It is a quantitative descriptive study with retrospective analysis of the clinical processes of 2436 individuals for 1 year (2018) with the diagnosis of pneumonia. The individuals with ≤5 years old represented 10.4% (n = 253) and ≥65 were 72.6% (n = 1769). 369 cases resulted in death, which gives a sample lethality rate of 15.2%. The severity and mortality index were not sensitive to the death event. We found 30.2% (n = 735) individuals with HCAP and 0.41% (n = 59) with ventilator-associated pneumonia (VAP). In only 59 individuals (2.4%) the agent causing pneumonia was isolated. The high fatality rate obtained shows that pneumonia is a major cause of death in vulnerable populations. Moreover, HCAP is one of the main causes of hospital admissions from pneumonia and death and the most pneumonias are treated empirically. Knowledge of the epidemiology characterization of pneumonia, especially associated with healthcare, is essential to increase the skills of health professionals for the prevention and efficient treatment of pneumonia.

Excess All-Cause Mortality in 2020 for People Living with Sickle Cell Disease in New York City

Background The COVID pandemic resulted in excess all-cause mortality in 2020 in the United States, especially among people who identify as Black and/or Latino. While many of these deaths were due to COVID-19 infection, others have been attributed to strain on the overburdened health care system and delays in patients seeking medical care due to the pandemic. We sought to examine the overall mortality in individuals with sickle cell disease (SCD) who received their care at our Sickle Cell Center in Bronx New York in 2020 and investigated whether the number and causes of death in 2020 differed from the previous 3 years. Methods: Death date was collected from electronic medical records (EMR) and death certificates. Clinical variables collected from EMR included age, gender, race, genotype, history of comorbidities, hydroxyurea use, and health care utilization in the 12 months prior to death date. To determine cause of death, two hematologists performed manual review of the EMR blinded from each other and deaths were categorized as due to: sudden death, cardiovascular causes, sepsis, stroke, acute organ failure (including multi organ failure syndrome), chronic organ failure, hemorrhage, and unknown when records of the death event were not available. A third hematologist served as a tie breaker in cases of disagreement. Patients were also categorized as having: 1) sepsis present or absent during the death event, 2) acute (new or newly worsened) renal or liver failure present or absent during the death event, and 3) COVID status at death (acute COVID, past COVID, no COVID, or unknown COVID status). Acute COVID infection was defined by a positive PCR swab during the hospitalization leading to death or in the prior two weeks. Past COVID infection was defined by a negative PCR swab during the hospitalization and a positive PCR swab and/or antibody test more than two weeks before the death event with documented resolution of symptoms. No COVID infection was defined by a negative PCR swab or antibody test documented in the EMR and no positive tests present or noted per patient report. Unknown COVID status was unknown if no testing was present in the EMR. To examine how 2020 decedents differed from decedents in the prior 3 years, we compared clinical variables using the Kruskal Wallis test for continuous variables and chi 2 tests for dichotomous variables. To examine differences between 2020 decedents between known COVID (acute or chronic) vs. no COVID, we repeated similar tests among the 2020 decedents only. Results: In the years 2017, 2018, 2019, and 2020, there were 9, 10, 8, and 22 patient deaths respectively. Compared with decedents in the prior 3 years, patients who died in 2020 were more likely to have acute liver failure during the hospitalization, were more likely to have history of stroke, and had more heme clinic visits in the prior 12 months. Otherwise, there was no difference in age, gender, genotype, hydroxyurea use, history of disease morbidity, hospital utilization in the prior 12 months, or sepsis before death (Table 1). Among the 22 who died in 2020, 3 had an acute COVID infection, five had past COVID, 8 had no COVID, and 6 had unknown COVID status. Among 2020 decedents, acute or past covid was associated with acute organ failure (p=0.02) and less hydroxyurea use (p=0.04). (Table 2). Conclusions: SCD deaths at our center more than doubled in 2020 compared to prior years, but fewer than half of the decedents had acute or prior COVID. Compared with prior years, 2020 decedents were more likely to have acute organ failure. This could be explained by COVID infection, delays in seeking care, or changes in care delivery during the COVID pandemic. This study emphasizes the need for further studies on the impact the pandemic had on the health of adults with SCD, as well as the need for prospective studies of patients with SCD who recover from COVID. Figure 1 Figure 1. Disclosures Curtis: GBT: Consultancy. Minniti: Forma: Consultancy; GBT: Consultancy; Novartis: Consultancy; Novo Nordisk: Consultancy; Chiesi: Consultancy; F. Hoffmann-La Roche: Consultancy; Bluebird Bio: Other: Endpoint adjudicator; CSL Behring: Other: Endpoint adjudicator.

The hidden interplay between sex and COVID-19 mortality: the role of cardiovascular calcification

Recent clinical and demographical studies on COVID-19 patients have demonstrated that men experience worse outcomes than women. However, in most cases, the data were not stratified according to gender, limiting the understanding of the real impact of gender on outcomes. This study aimed to evaluate the disaggregated in-hospital outcomes and explore the possible interactions between gender and cardiovascular calcifications. Data was derived from the sCORE-COVID-19 registry, an Italian multicentre registry that enrolled COVID-19 patients who had undergone a chest computer tomography scan on admission. A total of 1683 hospitalized patients (mean age 67±14 years) were included. Men had a higher prevalence of cardiovascular comorbidities, a higher pneumonia extension, more coronary calcifications (63% vs.50.9%, p<0.001), and a higher coronary calcium score (391±847 vs. 171±479 mm3, p<0.001). Men experienced a significantly higher mortality rate (24.4% vs. 17%, p=0.001), but the death event tended to occur earlier in women (15±7 vs. 8±7 days, p= 0.07). Non-survivors had a higher coronary, thoracic aorta, and aortic valve calcium score. Female sex, a known independent predictor of a favorable outcome in SARS-CoV2 infection, was not protective in women with a coronary calcification volume greater than 100 mm3. There were significant differences in cardiovascular comorbidities and vascular calcifications between men and women with SARS-CoV2 pneumonia. The differences in outcomes can be at least partially explained by the different cardiovascular profiles. However, women with poor outcomes had the same coronary calcific burden as men. The presumed favorable female sex bias in COVID-19 must therefore be reviewed in the context of comorbidities, especially cardiovascular ones.

Case Report: The Physiology of a Preventable Near Death in a Hot Tub

This is a case report of a very preventable near-death event involving a 6-year-old female who had a syncopal event due to hyperthermia in an overheated hot tub and drowned. She was resuscitated but due to the combination of anoxia and hyperthermia has been left with permanent brain damage.

Exploring the Prospective of Dark Tourism in Pashupatinath: A Hindu Pilgrimage Site, Nepal

A unique and increasingly pervasive feature within the tourism landscapes in the post-modern world is the special interests of tourists in death and anything associated with death. It is often believed that those who indulge in death and disaster site tours could potentially awaken their spiritual journey. The visitor immersions, in the spaces of death, and the events that have taken place or are re-created, triggers social conscience, or some shared emotion or an experience of involvement, with the death event. Reckoning to this facet, Pashupatinath temple- a place of pilgrimage for the followers of Santana Vedic religion which shows the comprehensive aspect of Hindu death rituals, symbols and processes has been chosen. The study proposes the site as a dark tourism destination and explores the convergence of cultural heritage site, pilgrimage and death rituals in the area that is associated with its characterization- particularly with reference to the witnessing of live open pyre burning death rituals at the cremation ground (ghat) that exclusively showcases the eastern phenomenon of death-spectatorship exhibited by Hindu death ritual. Despite an immense influence of the site in the tourism industry, the eastern dark tourism potential induced by the site has not been recognized formally by the tourism stakeholders. Even though it is widely consumed by the western visitors as a tourist element. The phenomenon of Hindu death tradition in the ghats of Pashupatinath is inclusive of all the death-related rituals and is a threshold of transition and transgression, a place in between life and death. Henceforth, as the central tenet of dark tourism being “the death”, Hindu death rituals in Pashupatinath could be firmly brought into the realms of dark tourism discourse. The findings are based on the prevalence of push factors that encourages consumption of the proposed site as a dark tourist product in liminal conditions (an in-between position). To be more specific, the practice of intellectualization of emotion, convenience of visits, edutainment elements, practice of moral disengagement. The prospective of dark tourism in Pashupatinath, if entitled to the mere promotion of the crematory site, may send a negative connotation and raise moral and ethical concerns. Hence, tourism stakeholders should consciously introduce the phenomenon as an accompaniment to the popularized mainstream religious and cultural value of the site.

Anxiety Level of Pregnant Mother in Facing Childbirth

Background: Pregnancy is a dramatic episode of biological conditions, psychological changes, and adaptation for any woman experiencing it. Aim: Some women may assume that pregnancy is an inevitable nature to pass, while others deem it a determining event between life and death event for a new chapter of life. Some researches reveal the increasing level of anxiety shared by pregnant women at the time of delivery. Methods: This study used an observational analytical method with a cross-sectional approach. The samples were 74 respondents taken using quota sampling. It applied the standard questionnaire for data collection, the HARS questionnaire. The data were then analyzed with bivariate data of Chi-Square. It is revealed that 55.4% of respondents experienced anxiety, which was triggered by several factors, including employment factors (ρ = 0.001), parity (ρ = 0.001), and maternal age factors (0.021). Results: Women facing childbirth in Gamping II Primary Health Center mostly experienced anxiety due to risky age with ρ = 0.002, primigravida with ρ = 0.001. In contrast, the mothers with low education experienced anxiety with ρ = 0.080, and pregnant women with low education experienced ρ = 0.001. Keywords: Anxiety, pregnant women, childbirth

Morphology of Intersectionality

Forensic anthropologists operate within a medico-legal context, performing analyses to estimate a biological profile (ancestry, age, sex, stature) and make observations on trauma, pathological conditions, taphonomy, and other anomalies evident in skeletal remains. These findings are reported to the appropriate requesting agency to narrow down the possible identity of the unknown individual and to understand the death event. Boundaries of identity and the terminology used to describe and explain identity are dynamic and intersectional. Ancestry estimation is important because there is a bridge between ancestral categories and sociocultural labels. Yet, a lack of agreement between ancestry estimates and social identifiers exists for certain groups. To better understand why this disagreement exists, a three-component concept (bio-origin identity, public ancestral-racial identity, and self ancestral-racial identity) modeled after sociological frameworks is employed. This article explores the identity of a single individual within the study sample using the three-component concept. Results highlight that discordance exists between the identity approximated by ancestry estimation and the application of this identity to the sociocultural context. Understanding the importance of the intersectional nature of the terminology used in instances of forensic identification is imperative so as to not hinder identifications and marginalize groups.

Automatic daily remote monitoring in heart failure patients implanted with a cardiac resynchronisation therapy-defibrillator: a single-centre observational pilot study

IntroductionThe impact of remote monitoring (RM) on clinical outcomes in heart failure (HF) patients with cardiac resynchronisation therapy-defibrillator (CRT-D) implantation is controversial. This study sought to evaluate the performance of an RM follow-up protocol using modified criteria of the PARTNERS HF trial in comparison with a conventional follow-up scheme.Material and methodsWe compared cardiovascular (CV) mortality (primary endpoint) and hospitalisation events for decompensated HF, and the number of ambulatory in-office visits (secondary endpoint) in CRT-D implanted patients with automatic RM utilising daily transmissions (RM group, n = 45) and conventional follow-up (CFU group, n = 43) in a single-centre observational study.ResultsAfter a median follow-up of 25 months, a significant advantage was seen in the RM group in terms of CV mortality (1 vs. 6 death event, p = 0.04), although RM follow-up was not an independent predictor for CV mortality (HR = 0.882; 95% CI: 0.25–3.09; p = 0.845). Patient CV mortality was independently influenced by hospitalisation events for decompensated HF (HR = 3.24; 95% CI: 8–84; p = 0.022) during follow-up. We observed significantly fewer hospitalisation events for decompensated HF (8 vs. 29 events, p = 0.046) in the RM group. Furthermore, a decreased number of total (161 vs. 263, p < 0.01) and unnecessary ambulatory in-office visits (6 vs.19, p = 0.012) were seen in the RM group as compared to the CFU group.ConclusionsFollow-up of CRT-D patients using automatic RM with daily transmissions based on modified PARTNERS HF criteria enabled more effective ambulatory interventions leading indirectly to improved CV survival. Moreover, RM directly decreased the number of HF hospitalizations and ambulatory follow-up burden compared to CRT-D patients with conventional follow-up.

River Culture in Nepal

Most of the world civilizations are developed in the river basins. However, we do not have too big rivers in Nepal, though Nepalese culture is closely related with water and rivers. All the sacraments from birth to the death event in Nepalese society are related with river. Rivers and ponds are the living places of Nepali gods and goddesses. Jalkanya and Jaladeviare known as the goddesses of rivers. In the same way, most of the sacred places are located at the river banks in Nepal. Varahakshetra, Bishnupaduka, Devaghat, Triveni, Muktinath and other big Tirthas lay at the riverside. Most of the people of Nepal despose their death bodies in river banks. Death sacrement is also done in the tirthas of such localities. In this way, rivers of Nepal bear the great cultural value. Most of the sacramental, religious and cultural activities are done in such centers. Religious fairs and festivals are also organized in such a places. Therefore, river is the main centre of Nepalese cultural activities and we can find the remains of ld cultural remains in river basins.