ACADEMIC EMERGENCY MEDICINE, Issue 1 2010
Ethan Brandler MD
Abstract Objectives:, Beta-blockade is currently recommended in the early management of patients with acute coronary syndromes (ACS). This was a systematic review of the medical literature to determine if early beta-blockade improves the outcome of patients with ACS. Methods:, The authors searched the PubMed and EMBASE databases for randomized controlled trials from 1965 through May 2009 using a search strategy derived from the following PICO formulation of our clinical question: Patients included adults (18+ years) with an acute or suspected myocardial infarction (MI) within 24 hours of onset of chest pain. Intervention included intravenous or oral beta-blockers administered within 8 hours of presentation. The comparator included standard medical therapy with or without placebo versus early beta-blocker administration. The outcome was the risk of in-hospital death in the intervention groups versus the comparator groups. The methodologic quality of the studies was assessed. Qualitative methods were used to summarize the study results. In-hospital mortality rates were compared using a forest plot of relative risk (RR; 95% confidence interval [CI]) between beta-blockers and controls. Statistical analysis was done with Review Manager V5.0. Results:, Eighteen articles (total N = 72,249) met the inclusion/exclusion criteria. For in-hospital mortality, RR = 0.95 (95% CI, 0.90,1.01). In the largest of these studies (n = 45,852), a significantly higher rate (p < 0.0001) of cardiogenic shock was observed in the beta-blocker (5.0%) versus control group (3.9%). Conclusions:, This systematic review failed to demonstrate a convincing in-hospital mortality benefit for using beta-blockers early in the course of patients with an acute or suspected MI. ACADEMIC EMERGENCY MEDICINE 2010; 17:1,10 © 2010 by the Society for Academic Emergency Medicine [source]

Reduced Mortality Rate Associated with Annual Mammograms after Breast Cancer Therapy

THE BREAST JOURNAL, Issue 1 2006
Timothy L. Lash DSc
Abstract: Guidelines have been developed for appropriate posttherapy surveillance for breast cancer recurrence. One purpose of posttherapy surveillance is to detect potentially curable local recurrences and new cancers in the opposite breast. The objective of this investigation was to assess the impact of annual mammography on all-cause mortality in breast cancer survivors. We conducted a case,control analysis nested in a cohort of 865 stage I or II breast cancer patients diagnosed from 1996 to 1999. The exposure variable was the number of mammograms received after completing primary therapy. Cases were decedents and we used risk-set sampling to match eight controls to each case on follow-up time. The mortality rate declined with an increasing number of mammograms (p for trend = 0.007). The age- and therapy-adjusted odds ratio associating receipt of an additional mammogram, compared with receipt of no mammogram, equaled 0.77 (95% confidence interval [CI] 0.53,1.1). These results are consistent with a protective effect of regular surveillance mammography after completing therapy for early stage breast cancer. [source]

Evaluation of 6 Prognostic Models Used to Calculate Mortality Rates in Elderly Heart Failure Patients With a Fatal Heart Failure Admission

CONGESTIVE HEART FAILURE, Issue 5 2010
Andria L. Nutter
The objective was to evaluate 6 commonly used heart failure (HF) prognostic models in an elderly, fatal HF population. Predictive models have been established to quantify risk among HF patients. The validation of these models has not been adequately studied, especially in an elderly cohort. Applying a single-center, retrospective study of serially admitted HF patients who died while in the hospital or within 30 days of discharge, the authors evaluated 6 prognostic models: the Seattle Heart Failure Model (SHFM), Heywood's model, Classification and Regression Tree (CART) Analysis, the Heart Failure Survival Score (HFSS), Heart Failure Risk Scoring System, and Pocock's score. Eighty patients were included (mean age, 82.7 ± 8.2 years). Twenty-three patients (28.75%) died in the hospital. The remainder died within 30 days of discharge. The models' predictions varied considerably from one another and underestimated the patients' actual mortality. This study demonstrates that these models underestimate the mortality risk in an elderly cohort at or approaching the end of life. Moreover, the predictions made by each model vary greatly from one another. Many of the models used were not intended for calculation during hospitalization. Development of improved models for the range of patients with HF syndromes is needed. Congest Heart Fail. 2010;16:196,201. © 2010 Wiley Periodicals, Inc. [source]

Universal Health Insurance and the Effect of Cost Containment on Mortality Rates: Strokes and Heart Attacks in Japan

JOURNAL OF EMPIRICAL LEGAL STUDIES, Issue 2 2009
J. Mark Ramseyer
For more than four decades, Japan has offered universal health insurance. Despite the demand subsidy entailed, it has kept costs low by regulatorily capping the amounts it pays doctors, particularly for the most modern and sophisticated procedures. Facing subsidized demand but stringently capped prices on complex procedures, Japanese physicians have had little incentive to invest in specialized expertise. Instead, they have invested in small private clinics and hospitals. The resulting proliferation of primitive clinics and hospitals has cut both the number of complex modern medical procedures performed, and the number of hospitals with any substantial experience in those procedures. With a quarter of the heart disease in the United States, Japan performs less than 3 percent as many coronary bypass operations and less than 6 percent as many angioplasties. Of the 855 cities and regions in Japan, 77 percent lack any hospital with substantial experience in the sophisticated modern treatment (defined below) of cerebrovascular disease, and 89 percent lack much experience in angioplasties. In this article, I estimate one of the costs of this regulatorily-driven lack of expertise. Toward that end, I combine mortality data from 855 cities with information on local hospital expertise and local demographic composition. In the typical city, I find that the addition of one hospital with substantial experience in modern stroke treatment would cut annual stroke mortality by 7 to 16 deaths. The addition of one hospital with substantial experience in angioplasties would cut the annual deaths from heart attacks in the city by over 19. [source]

Reducing Infant Mortality Rates Using the Perinatal Periods of Risk Model

PUBLIC HEALTH NURSING, Issue 1 2005
Paulette G. Burns
Abstract, Despite decreases in the last 50 years, infant mortality rates in the United States remain higher than in other industrialized countries. Using overall infant mortality rates to determine the effectiveness of interventions does not help communities focus on particular underlying factors contributing to static, and sometimes increasing, community rates. This study was designed to determine and rank contributing factors to fetal-infant mortality in a specific community using the Perinatal Periods of Risk (PPOR) model. The PPOR model was used to map fetal-infant mortality for 1995 to 1998 in the Tulsa, Oklahoma, Healthy Start Program as compared to traditional calculation methods. The overall fetal-infant mortality rate using the PPOR model was 12.7 compared to 7.11 calculated using the traditional method. The maternal health cell rate was 5.4, maternal care cell rate was 2.9, newborn care cell was 1.9 compared to a 4.1 neonatal death rate calculated using the traditional method, and the infant health cell was 2.4 compared to a 2.9 postneonatal rate calculated using the traditional method. Because the highest infant mortality was in the maternal health cell, intervention strategies were designed to promote the health of women prior to and between pregnancies. The PPOR model was helpful in targeting interventions to reduce fetal-infant mortality based on the prioritization of contributing factors. [source]

Covariate Adjustment and Ranking Methods to Identify Regions with High and Low Mortality Rates

BIOMETRICS, Issue 2 2010
Huilin Li
Summary Identifying regions with the highest and lowest mortality rates and producing the corresponding color-coded maps help epidemiologists identify promising areas for analytic etiological studies. Based on a two-stage Poisson,Gamma model with covariates, we use information on known risk factors, such as smoking prevalence, to adjust mortality rates and reveal residual variation in relative risks that may reflect previously masked etiological associations. In addition to covariate adjustment, we study rankings based on standardized mortality ratios (SMRs), empirical Bayes (EB) estimates, and a posterior percentile ranking (PPR) method and indicate circumstances that warrant the more complex procedures in order to obtain a high probability of correctly classifying the regions with the upper,100,%,and lower,100,%,of relative risks for,,= 0.05, 0.1, and 0.2. We also give analytic approximations to the probabilities of correctly classifying regions in the upper,100,%,of relative risks for these three ranking methods. Using data on mortality from heart disease, we found that adjustment for smoking prevalence has an important impact on which regions are classified as high and low risk. With such a common disease, all three ranking methods performed comparably. However, for diseases with smaller event counts, such as cancers, and wide variation in event counts among regions, EB and PPR methods outperform ranking based on SMRs. [source]

Growth and Mortality Rates of the Liana Machaerium cuspidatum in Relation to Light and Topographic Position1

BIOTROPICA, Issue 2 2002
Jacob Nabe-NielsenArticle first published online: 15 MAR 200
First page of article [source]

Adult mortality and oviposition rates in field and captive populations of the blowfly Lucilia sericata

ECOLOGICAL ENTOMOLOGY, Issue 6 2004
K. M. Pitts
Abstract., 1. Adult mortality and oviposition rates were determined for populations of the blowfly Lucilia sericata (Meigen) (Diptera: Calliphoridae). This species is of economic importance as the primary agent of sheep myiasis throughout north-western Europe. 2. Populations of marked flies in six, 1 m3, outdoor field cages and unmarked wild flies at two farms in south-west England were studied simultaneously between May and September 1998. 3. In the field, wild female L. sericata were caught and aged using a combination of wing-fray and ovarian dissection techniques. Survivorship analysis gave estimates of mortality of 1.94% (± 0.037) and 2.09% (± 0.044) per day-degree and mean life expectancy of 51.5 and 47.9 day-degrees above a threshold of 11 °C, at the two farms studied. Mean lifetime reproductive output in the field was estimated to be 159.6 and 138.4 eggs per female at the two farms respectively. 4. The survivorship of cohorts of marked female flies in cages was followed by counting the number of dead individuals each day; the mortality rate of these flies was 0.81% per day-degree (± 3.49 × 10,4%) and the mean life expectancy was 123.1 day-degrees above a threshold of 11 °C. Mortality rate was shown to increase significantly with average ambient temperature and relative humidity lagged for two sample periods (approximately 10 days). Oviposition rate also increased with average temperature but declined with average relative humidity. A best-fit multiple regression model incorporating both ambient temperature and humidity explained 60.5% of the variance in the pattern of oviposition. 5. The differences between the field and cage populations highlight the caution required when extrapolating life-history parameters from artificial to natural habitats. [source]

Mortality rate during interferon alfa-ribavirin combination therapy of chronic hepatitis C

HEPATOLOGY, Issue 1 2003
Alejandro Soza M.D.
No abstract is available for this article. [source]

Trends of mortality and causes of death among HIV-infected patients in Taiwan, 1984,2005

HIV MEDICINE, Issue 7 2008
C-H Yang
Background The aim of this study was to analyse the trends of mortality and causes of death among HIV-infected patients in Taiwan from 1984 to 2005. Methods Registered data and death certificates for HIV-infected patients from Taiwan Centers for Disease Control were reviewed. Mortality rate and causes of deaths were compared among patients whose HIV diagnosis was made in three different study periods: before the introduction of highly active antiretroviral therapy (HAART) (pre-HAART: from 1 January 1984 to 31 March 1997), in the early HAART period (from 1 April 1997 to 31 December 2001), and in the late HAART period (from 1 January 2002 to 31 December 2005). A subgroup of 1161 HIV-infected patients (11.4%) followed at a university hospital were analysed to investigate the trends of and risk factors for mortality. Results For 10 162 HIV-infected patients with a mean follow-up of 1.97 years, the mortality rate of HIV-infected patients declined from 10.2 deaths per 100 person-years (PY) in the pre-HAART period to 6.5 deaths and 3.7 deaths per 100 PY in the early and late HAART periods, respectively (P<0.0001). For the 1161 patients followed at a university hospital (66.8% with CD4 count <200 cells/,L), HAART reduced mortality by 89% in multivariate analysis, and the adjusted hazard ratio for death was 0.28 (95% confidence interval 0.24, 0.33) in patients enrolled in the late HAART period compared with those in the pre-HAART period. Seventy-six per cent of the deaths in the pre-HAART period were attributable to AIDS-defining conditions, compared with 36% in the late HAART period (P<0.0001). The leading causes of non-AIDS-related deaths were sepsis (14.7%) and accidental death (8.3%), both of which increased significantly throughout the three study periods. Compared with patients acquiring HIV infection through sexual contact, injecting drug users were more likely to die from non-AIDS-related causes. Conclusions The mortality of HIV-infected patients declined significantly after the introduction of HAART in Taiwan. In the HAART era, AIDS-related deaths decreased significantly while deaths from non-AIDS-related conditions increased. [source]

Early detection of resistance to tebufenozide in field populations of Cydia pomonella L.: methods and mechanisms

JOURNAL OF APPLIED ENTOMOLOGY, Issue 7 2007
C. Ioriatti
Abstract:, Four populations of codling moth Cydia pomonella L. were collected as overwintering larvae from apple orchards with different pesticide pressure (S. Michele, Roncafort, Revò and Vervò) in the Trento province (northern Italy). Mortality rate caused by a predetermined discriminating concentration of tebufenozide topically applied on overwintering larvae was evaluated. Neonate F1 progeny of the same populations were assayed for susceptibility to tebufenozide by feeding them on thinning apples treated with an appropriate discriminating dose of the insecticide. The activities of the main enzyme systems involved in the detoxification of insecticides were also evaluated in each population and related to their susceptibility to tebufenozide. The topical test detected a significant loss in susceptibility to tebufenozide in two populations, S. Michele and Roncafort, while all the overwintering larvae collected in the orchards of Revò and Vervò died when treated topically with the discriminating concentration. The apple-dipping test performed on the neonate larvae showed a highly significant reduction in the susceptibility of the two populations of S. Michele and Roncafort. A less significant reduction in mortality rate was found in the Revò population; however, no statistical difference was found between the Vervò population and the susceptible reference. None of the four field populations significantly differed from the susceptible strain for Glutathione- S -transferase and esterase activity. A significantly higher frequency of individuals of the S. Michele and Roncafort populations exhibited a higher mixed function oxidase activity than the susceptible strain. The small resistance ratio values found for the two populations together with the low frequency of individuals exibiting enhanced enzymatic activity, reveals that the selection process was still at the early stage. Because of its efficiency in early detection of resistance to tebufenozide, topical application on diapausing larvae can thus be considered an appropriate, simple and robust tool for implementing resistance monitoring programmes for tebufenozide. [source]

Prognostic Factors for Mortality and Thromboembolism in Canine Immune-Mediated Hemolytic Anemia: A Retrospective Study of 72 Dogs

JOURNAL OF VETERINARY INTERNAL MEDICINE, Issue 5 2002
Anthony P. Carr
Medical records of 72 dogs diagnosed with immune-mediated hemolytic anemia (IMHA) were reviewed to find risk factors for the disease, for mortality, and for thromboembolism. Coagulation data of 32 patients were evaluated for mortality or thromboembolism risk factors. Cocker Spaniels were at increased risk for IMHA (P= .012). Timing of vaccination was not associated with development of IMHA. PCV ranged from 5 to 33%, with a mean of 16 ± 5%. Autoagglutination was present in 42% of the dogs. Platelet counts (n = 60) varied from 3,000 to 793,000/,L (mean, 160,117 ± 133,571; median, 144,000). Thrombocytopenia (platelet count, <200,000/,L) was present in 70% of the dogs, with severe thrombocytopenia (platelet count, <50,000/,L) being present in 22%. One-step prothrombin time (OSPT) was prolonged in 28% of the dogs tested, and activated partial thromboplastin time (APTT) was prolonged in 47% of the dogs tested. Fibrin(ogen) degradation products (FDPs) were detected in 16 of 28 dogs tested (57%). Disseminated intravascular coagulation (DIC) was diagnosed in 10 of 31 (32%) dogs and was suspected in 8 dogs. Thromboemboli were found in 20 of 25 dogs given postmortem examinations. Mortality rate was 58%. Thrombocytopenia (P= .008) and serum bilirubin concentration of >5 mg/dL (P= .015) were risk factors for mortality, and hypoalbuminemia approached significance (P= .053). Severe thrombocytopenia (P= .046), serum bilirubin concentration of >5 mg/dL (P= .038), and hypoalbuminemia (P= .016) were risk factors for thromboembolism. On evaluation of continuous data, decreased platelet count (P= .057), increased bilirubin (P= .062), and decreased albumin (P= .054) approached significance for decreased survival. A higher risk for thrombosis was found with increased alkaline phosphatase (ALKP) (P= .042), increased bilirubin (P= .047), and decreased albumin (P= .012). [source]

Baroreceptor sensitivity and baroreceptor effectiveness index in cirrhosis: the relevance of hepatic venous pressure gradient

LIVER INTERNATIONAL, Issue 2 2010
Simonetta Genovesi
Abstract Background: Autonomic dysfunction has been reported as one of the complications of cirrhosis. Aims: The aim of this study was to test autonomic dysfunction in cirrhotic patients by analysing the baroreflex sensitivity and the baroreceptor effectiveness index (BEI), in order to determine its correlation with the severity and the aetiology of liver disease. Moreover, we explored the relationship between baroreceptor function and mortality in our cohort of patients. Methods: Clinical and laboratory evaluation, hepatic venous pressure gradient (HVPG) and haemodynamic setting and baroreceptor function were assessed in 45 cirrhotic patients (median age 55, range 38,72 years) divided in groups according to the severity of their disease (26 patients Child A, 13 patients Child B and six patients Child C). Results: Baroreceptor sensitivity and BEI were impaired in more advanced cirrhotic patients compared with subjects with milder disease (P<0.001). HVPG was significantly, independently and inversely correlated with baroreceptor sensitivity (P=0.003). More severe impairment of baroreceptor function was associated with a higher mortality (P=0.04) and subjects with alcohol-related cirrhosis presented worse baroreceptor function (P=0.032) and poorer survival (P=0.003) compared with subjects with post-viral liver disease. Conclusions: These data support the hypothesis that liver disease severity and particularly portal hypertension have an important role in the derangement of baroreceptor function. The aetiology of cirrhosis seems to be related to baroreceptor impairment as well. Mortality rate is higher in subjects with a more damaged autonomic system, strengthening the idea of a worse prognosis in cirrhotic patients with autonomic neuropathy. [source]

Intracranial hemorrhage following allogeneic hematopoietic stem cell transplantation,

AMERICAN JOURNAL OF HEMATOLOGY, Issue 5 2009
Yuho Najima
Charts and radiographs of 622 allogeneic hematopoietic stem cell transplant (HSCT) recipients, over a 20-year period, were retrospectively reviewed for intracranial hemorrhage (ICH) following transplant. A total of 21 cases of ICH were identified (3.4%) including 15 cases of intraparenchymal hemorrhage (IPH), two cases of subarachnoid hemorrhage (SAH), and four cases of subdural hematoma (SDH). The median time from transplantation to the onset of ICH was 63 days (range, 6,3,488 days). The clinical features of post-transplant ICH patients were similar and included hypertension, diabetes mellitus, chronic graft-versus-host disease (GVHD), systemic infection, and veno occlusive disease (VOD), recently referred to as sinusoidal obstruction syndrome, in addition to severe thrombocytopenia. Mortality rate was especially high (89%) after IPH with a median survival of 2 days (range, 0,148 days). In contrast, all patients with SAH or SDH following HSCT survived. The cause of post-transplant ICH appears to be multifactorial, including thrombocytopenia, hypertension, acute GVHD, VOD, and radiation therapy. Most patients in our series displayed severe thrombocytopenia at the onset of ICH, even though adequate prophylactic platelet transfusions were given. By univariate analysis, cord blood transplantation, acute GVHD, systemic infection, and VOD were related to the incidence of ICH, whereas prior CNS episodes and radiation therapy did not reach statistical significance. A multivariate analysis with logistic regression identified acute GVHD as the only factor that significantly influenced ICH occurrence. Am. J. Hematol. 2009. © 2009 Wiley-Liss, Inc. [source]

Clinical features of neonatal sepsis caused by resistant Gram-negative bacteria

PEDIATRICS INTERNATIONAL, Issue 3 2009
Mohammad Khassawneh
Abstract Background:, Clinical features and outcomes of neonatal sepsis caused by resistant Gram-negative bacteria are not well described in Jordan. The aim of the present study was therefore to describe microbiology and clinical features, laboratory findings and outcomes of early- and late-onset Gram-negative neonatal sepsis. Methods:, All patients with Gram-negative bacteremia between July 2003 and June 2005 were retrospectively included. Resistance profiles, clinical features and outcomes of early and late-onset neonatal sepsis were compared. Results:, A total of 79 patients (after excluding all nine cases of Gram-positive bloodstream infection (BSI) were identified as having Gram-negative BSI (25 had early-onset and 54 had late-onset neonatal sepsis). Respiratory distress, metabolic acidosis and requirement of ventilation were found in 74.7%, 40.5%, and 58.2%, respectively. Hypotension was found in 22.9% of patients. Klebsiella pneumoniae was responsible for 43 cases (54.4.2%). Klebsiella pneumoniae resistance rates to ampicillin and ceftazidime were 100% and 50%, respectively. Mortality rate was 30.9%. Forty-eight percent of deaths occurred within 3 days of sepsis. Meningitis was diagnosed in five cases. Elevated C-reactive protein (CRP) and thrombocytopenia were seen in 28% and 24% of infants with early-onset sepsis, respectively, and in 79.6%, 59.3% of infants with late-onset sepsis respectively. Conclusion:, Both early- and late-onset neonatal sepsis are caused by highly resistant Gram-negative bacteria. Mortality of sepsis is high. Elevated CRP and thrombocytopenia is seen more commonly in late-onset neonatal sepsis. [source]

Dilatation for Assisted Ventilation-Induced Laryngotracheal Stenosis

THE LARYNGOSCOPE, Issue 9 2005
Philippe Clément MD
Abstract Objective: To assess the long-term results of dilatation and our experience with dilatation for assisted ventilation-induced laryngotracheal stenosis. Design: A retrospective study of 32 patients primarily treated with dilatation for assisted ventilation-induced laryngotracheal stenosis between 1977 and 2002. Setting: A tertiary care center and university teaching hospital. Patients: There were 19 men and 13 women aged 15 to 76 years. The stenosis was cicatricial with some inflammatory process in 27 patients and completely mature in 5 patients. The stenosis involved the cricoid and the trachea in four patients. In 28 patients, the stenosis involved only the trachea. Methods: Dilatation was performed with serially sized rigid bronchoscopes. Endoscopic laser vaporization was never performed in this series. Six patients were treated with only one dilatation. The 26 remaining patients were treated with successively 2 to 10 dilatations (mean, 3.3 dilatations). The dilatation success rate was analyzed using the Kaplan-Meier method. Results: Median duration of follow-up was 1.8 years. Mortality rate was 9.4%. The overall failure rate was 71.8%. Twenty patients presented with recurrent stenosis. The treatment of recurrent stenosis consisted of tracheal resection with end-to-end anastomosis (11 patients, 55%), cricotracheal anastomosis (5 patients, 25%), tracheal endoprosthesis (2 patients, 10%), and tracheotomy (1 patient, 5%). All patients who underwent tracheal or cricotracheal anastomosis were successfully treated. None of the variables under analysis (sex, age, medical history, cause for intubation, intubation type and duration, delay from initial injury, degree of stenosis, length of trachea involved, number of dilatations) were statistically related to the incidence of complications and the success rate of dilatations. Conclusions: We do not recommend dilatation technique as the sole treatment for assisted ventilation-induced laryngotracheal stenosis. This technique is helpful in case of emergency to restore an airway and useful for the assessment of stenosis. [source]

Primary central nervous system vasculitis: analysis of 101 patients

ANNALS OF NEUROLOGY, Issue 5 2007
Carlo Salvarani MD
Objective To analyze the clinical findings, response to therapy, outcome, and incidence of primary central nervous system vasculitis (PCNSV) in a large cohort from a single center Methods We retrospectively studied 101 patients with PCNSV, selected by predetermined diagnostic criteria, who were seen during a 21-year period. This was a collaborative study by five departments at a large multispecialty clinic. Clinical findings and outcomes were compared among patients categorized by method of diagnosis, response to therapy, survival, and degree of disability. An annual incidence rate was calculated Results Seventy patients were diagnosed by angiography and 31 by central nervous system biopsy. Three histological patterns were observed during biopsy. Although most patients responded to therapy, an increased mortality rate was observed. Relapses occurred in one fourth of patients. Mortality rate and disability at last follow-up were greater in those who presented with a focal neurological deficit, cognitive impairment, cerebral infarctions, and angiographic large-vessel involvement but were lower in those with prominent gadolinium-enhanced lesions when evaluated by magnetic resonance imaging. The annual incidence rate of PCNSV was 2.4 cases per 1,000,000 person-years Interpretation PCNSV is a rare disease that may result in serious neurological outcomes or death. Angiography and brain biopsy may complement each other when determining the diagnosis. Early recognition and treatment may reduce poor outcomes. PCNSV is a variable syndrome that appears to consist of several subsets of heterogeneous diseases. Ann Neurol 2007 [source]

Soluble haemoglobin scavenger receptor (sCD163) in patients with suspected community-acquired infections,

APMIS, Issue 2 2006
SHAHIN GAÏNI
The aim of our study was to evaluate soluble haemoglobin scavenger receptor (sCD163) as a molecular marker in patients with community-acquired infections. One hundred and ninety-four adult patients admitted to the Department of Internal Medicine, Odense University Hospital, with suspected community-acquired infection were included in a prospective study. Plasma and serum were sampled from all patients on day of admission and sCD163 and interleukin-6 levels were measured. Demographic data, co-morbidity, microbiological aetiology, biochemical parameters, focus of infection, severity score and mortality on day 28 were recorded. Median age was 68 (range 18,92) years. Mortality rate among infected patients on day 28 was 3.8%. sCD163 concentrations (median and range) were: 2.99 mg/l (1.22,12.65) in non-infected patients, 3.62 mg/l (1.59,74.04) (p=0.08) in infected patients without systemic inflammatory response syndrome, 3.2 mg/l (0.54,22.51) (p=0.4) in patients with sepsis, 3.63 mg/l (1.71,28.4) (p=0.01) in patients with severe sepsis, and 4.9 mg/l (2.66,28.4) (p=0.003) in patients with bacteraemia. In this cohort dominated by mild infections, a moderate elevation of sCD163 was observed only in patients with severe sepsis and/or bacteraemia. sCD163 did not discriminate between infected and non-infected patients. [source]

The effect of maternal size on larval characteristics of Persian sturgeon Acipenser persicus

AQUACULTURE RESEARCH, Issue 9 2009
Rajab Mohammad Nazari
Abstract The objective of this work was to study the relationship between female size (weight) and variables of egg and larval stage of Persian sturgeon Acipenser persicus. In this study, 19 female breeders were captured in Caspian Sea and fertilized by routine methods. Positive significant correlations (P<0.05) were established between female weight and ovulated eggs per female, time of second mitosis division and volume of yolk-sac at hatching. There was not significant correlation (r=0.33, P=0.161) between female weight and egg diameter. Female weight was not affected weight of larvae at hatching time (r=0.37, P=0.119), as well as larval length (r=,0.14, P=0.558) and larval weight at the end of the experiment (48 hours after first feeding) (r=0.16, P=0.491). Mortality rate during yolk-sac absorption was higher with increased female weight but their correlation was not significant (r=0.40, P=0.076). During the first feeding stage, mortality rate was 13.39% and there was no significant correlation between mortality rate in this period and female weight (r=,0.12, P=0.613). Conclusively, as a result female size influenced fecundity, time of second mitosis division and yolk-sac volume at hatching time without affecting mortality rate during yolk-sac absorption and first feeding stage in Persian sturgeon. Thus, smaller female broods do not cause more mortality than larger ones in larval production and they can be used in reproduction procedure. [source]

A comparison of three land-based containment systems for use in culturing green sea urchins, Strongylocentrotus droebachiensis (Müller) (Echinodermata: Echinoidea)

AQUACULTURE RESEARCH, Issue 4 2006
Tara L Daggett
Abstract Worldwide, most sea-urchin populations are in decline. Future market demands will likely be met through aquaculture, which may consist of gonad enhancement of wild-caught sea urchins. In this context, we examined three land-based containment systems for suitability in maintaining commercial-size green sea urchins (Strongylocentrotus droebachiensis). Mortality rate, gonad quantity, gonad quality (colour, brightness, firmness, texture) and cleaning efficiency associated with each containment system were the criteria for comparing the effectiveness of the systems (large raceways, small raceways and washtub tanks). After 6 weeks, urchins maintained in large raceways displayed significantly higher mortality rates than urchins maintained in either the small raceways or washtub tanks (mean±SD: 24.3±10.4%, 8.0±3.5% and 4.3±1.5% respectively). Significant differences in cleaning time were detected among the three systems with washtub tanks requiring significantly more cleaning time (0.11±0.02 min urchin,1) than the other two systems and large raceways requiring significantly less cleaning time (0.06±0.02 min urchin,1) than the other two systems. No significant differences in gonad characteristics were detected among the three containment systems. Because of the higher mortality rate in the large raceways and the increased cleaning time required for the washtub tanks, the small raceways were considered to be the best of the three systems tested. [source]

Pediatric Heart Transplant Candidates With Failed Donor Heart Allocation After Eurotransplant Urgency Listing Profit From Pretransplant Mechanical Circulatory Support Bridging

ARTIFICIAL ORGANS, Issue 4 2009
Takeshi Komoda
Abstract:, Due to the Eurotransplant organ allocation policy, urgency listing for heart transplantation (HTx) remains in force until ventricular assist device (VAD) implantation in Germany. We studied the prognosis of HTx candidates after failed donor heart allocation in urgent status. We studied all adult and pediatric (<18 years) HTx candidates who underwent primary HTx after Eurotransplant urgency listing between January 2001 and December 2006 (Group A-uHTx [A-"u"rgent status "HTx"], n = 99; Group P-uHTx [P-"u"rgent status "HTx"], n = 24) and those to whom donor heart was not urgently allocated before VAD implantation or death in the same period (Group A-fHA [A-"f"ailed "H"eart "A"llocation], n = 21, Group P-fHA [P-"f"ailed "H"eart "A"llocation], n = 10). Mortality rate after urgency listing or primary VAD implantation was studied in each group. In adult patients, 1-year mortality rate after urgency listing in Group A-fHA was 56.8% and significantly higher than in Group A-uHTx (30.6%, P < 0.001, log-rank test). After failed urgent heart allocation, 15 out of 21 patients in Group A-fHA had VAD implantation and two patients (9.5%) underwent HTx after VAD implantation. In pediatric patients, 1-year mortality rate in Group P-fHA was 40.0% and significantly higher than in Group P-uHTx (8.5%, P < 0.05). In Group P-fHA, all 10 patients underwent VAD implantation after failed urgent heart allocation and six patients (60.0%, P < 0.01 vs. Group A-fHA, Fisher's exact test) underwent HTx after VAD implantation. After failed urgent donor heart allocation, pediatric HTx candidates seem to profit more from mechanical circulatory support than adults. [source]

Trends in Pediatric Melanoma Mortality in the United States, 1968 through 2004

DERMATOLOGIC SURGERY, Issue 2 2008
KEVAN G. LEWIS MD
BACKGROUND AND OBJECTIVE Mortality from melanoma in children is a poorly understood and controversial problem in dermatology. There is paucity of research into this important public health dilemma. The purpose of this study was to characterize pediatric melanoma mortality in the United States and to evaluate trends over time. METHODS AND MATERIALS Deaths were derived from a database of more than 75 million records of the U.S. Center for National Health Statistics based on routine death certification. Information on age, race, gender, and geographic location was available for years 1968 through 2004. RESULTS During the 37-year period, there were 643 deaths attributed to melanoma in children under 20 years of age in the United States, an average of 18 per year. The overall age-adjusted mortality rate for melanoma in children was 2.25 deaths per year (per 10 million at-risk individuals). Mortality rates were strongly associated with age. In the oldest age group (age 15,19 years) the mortality rate was approximately an order of magnitude 8,18 times higher compared to younger age groups. Mortality among males was 25% higher than females. Mortality rates for white children were more than twice as high as black children. Overall mortality from melanoma in children declined steadily from 1968 to 2004. The highest mortality rates were observed in Idaho, Nevada, Arizona, and New Mexico. CONCLUSIONS Although mortality from melanoma among children in the United State is low, the magnitude of the public health burden from this preventable cause of death is substantial. In contrast to results of studies suggesting that the incidence of melanoma may be rising in children and adolescents, the data suggest that mortality in these groups may be falling. Additional study is warranted to further characterize and ultimately reduce mortality from childhood melanoma. [source]

Charlson Index Is Associated with One-year Mortality in Emergency Department Patients with Suspected Infection

ACADEMIC EMERGENCY MEDICINE, Issue 5 2006
Scott B. Murray MD
Abstract Objectives: A patient's baseline health status may affect the ability to survive an acute illness. Emergency medicine research requires tools to adjust for confounders such as comorbid illnesses. The Charlson Comorbidity Index has been validated in many settings but not extensively in the emergency department (ED). The purpose of this study was to examine the utility of the Charlson Index as a predictor of one-year mortality in a population of ED patients with suspected infection. Methods: The comorbid illness components of the Charlson Index were prospectively abstracted from the medical records of adult (age older than 18 years) ED patients at risk for infection (indicated by the clinical decision to obtain a blood culture) and weighted. Charlson scores were grouped into four previously established indices: 0 points (none), 1,2 points (low), 3,4 points (moderate), and ,5 points (high). The primary outcome was one-year mortality assessed using the National Death Index and medical records. Cox proportional-hazards ratios were calculated, adjusting for age, gender, and markers of 28-day in-hospital mortality. Results: Between February 1, 2000, and February 1, 2001, 3,102 unique patients (96% of eligible patients) were enrolled at an urban teaching hospital. Overall one-year mortality was 22% (667/3,102). Mortality rates increased with increasing Charlson scores: none, 7% (95% confidence interval [CI] = 5.4% to 8.5%); low, 22% (95% CI = 19% to 24%); moderate, 31% (95% CI = 27% to 35%); and high, 40% (95% CI = 36% to 44%). Controlling for age, gender, and factors associated with 28-day mortality, and using the "none" group as a reference group, the Charlson Index predicted mortality as follows: low, odds ratio of 2.0; moderate, odds ratio of 2.5; and high, odds ratio of 4.7. Conclusions: This study suggests that the Charlson Index predicts one-year mortality among ED patients with suspected infection. [source]

Latitudinal patterns in abundance and life-history traits of the mole crab Emerita brasiliensis on South American sandy beaches

DIVERSITY AND DISTRIBUTIONS, Issue 2 2004
Omar Defeo
ABSTRACT Demographic and life-history attributes of the mole crab Emerita brasiliensis were analysed along 2700 km of the Atlantic coast of South America, including sandy beaches at the southernmost limit (Uruguay) and at the core of its geographical range (Brazil). Population features varied markedly within this range and exhibited systematic geographical patterns of variation. Abundance significantly increased from temperate to subtropical beaches, and the same held true for the asymptotic weight of males. Conversely, length at maturity and asymptotic weight of females increased from subtropical to temperate beaches, being inversely related to sea water temperature. Macroecological patterns in abundance and body weight showed the first large-scale evidence of scaling of population density to body size for a sandy beach population. Mortality rates (both sexes) followed a nonlinear increase from low-density temperate beaches to high-density subtropical beaches. The effect of habitat quality and availability could explain discontinuities in the species distribution within its range, and also differential responses in life-history attributes at a local scale. Asymmetries and converse latitudinal trends between sexes suggest that there is not a single general factor determining large-scale patterns in life-history traits of this species. Our results reinforce the view that density-dependent and environmental factors operating together regulate sandy beach populations. The need to develop macroecological studies in sandy beach ecology is highlighted, as knowledge acquired from local to large spatial scales throws light on population structure and regulation mechanisms. [source]

Autumnal moth , why autumnal?

ECOLOGICAL ENTOMOLOGY, Issue 6 2001
Toomas Tammaru
Summary 1. As for some other spring-feeding moths, adult flight of Epirrita autumnata (Lepidoptera: Geometridae) occurs in late autumn. Late-season flight is a result of a prolonged pupal period. Potential evolutionary explanations for this phenological pattern are evaluated. 2. In a laboratory rearing, there was a weak correlation between pupation date and the time of adult emergence. A substantial genetic difference in pupal period was found between two geographic populations. Adaptive evolution of eclosion time can thus be expected. 3. Metabolic costs of a prolonged pupal period were found to be moderate but still of some ecological significance. Pupal mortality is likely to form the main cost of the prolonged pupal period. 4. Mortality rates of adults, exposed in the field, showed a declining temporal trend from late summer to normal eclosion time in autumn. Lower predation pressure on adults may constitute the decisive selective advantage of late-season flight. It is suggested that ants, not birds, were the main predators responsible for the temporal trend. 5. Egg mortality was estimated to be low; it is thus unlikely that the late adult period is selected for to reduce the time during which eggs are exposed to predators. 6. In a laboratory experiment, oviposition success was maximal at the time of actual flight peak of E. autumnata, however penalties resulting from sub-optimal timing of oviposition remained limited. [source]

Trends in Parkinson's disease related mortality in England and Wales, 1993,2006

EUROPEAN JOURNAL OF NEUROLOGY, Issue 9 2009
A. Q. N. Mylne
Background:, This paper describes changes in Parkinson's disease (PD) mortality in England and Wales between 1993 and 2006 using all information on death certificates. Methods:, Information on deaths was obtained from the Office for National Statistics. Mortality rates for any mention of PD on death certificates were directly age-standardized using the European standard population. Average yearly changes in mortality rates were estimated using linear regression. The underlying cause of death on death certificates where PD was mentioned was examined by sex and calendar period. Results:, Male PD age-standardized mortality rates for any mention of PD decreased from 15.0 to 11.7 per 100 000 between 1993 and 2006. Female PD mortality rates fell from 6.3 to 4.9 per 100 000. Decreases were greater for older age-groups. The proportion of deaths with PD recorded as the underlying cause increased by 50% in 2001 following implementation of the 10th revision of the International Classification of Diseases (ICD). Conclusion:, Parkinson's disease mortality rates in England and Wales are decreasing, especially for men and for older age-groups. Because of data limitations we are unable to ascertain whether the decrease of PD recorded on death certificates is because of a reduction in PD incidence, or to improved survival for PD patients resulting from advancements in PD treatments or to improvements in general medical care. The dramatic increase in PD as the underlying cause of death following ICD revision in 2001 demonstrates the dangers of using underlying cause of death to investigate mortality trends without being aware of the potential for artifacts. [source]

Mortality associated with catch and release of striped bass in the Hudson River

FISHERIES MANAGEMENT & ECOLOGY, Issue 5 2003
M. J. Millard
Abstract Catch-and-release fishing has increased in many fisheries, but its contribution to fishing mortality is rarely estimated. This study estimated catch and release mortality rates of striped bass, Morone saxatilis (Walbaum), for the spring recreational fishery in the Hudson River. Treatment fish (caught with live bait on spinning gear) and control fish (captured by electric fishing) were placed in in situ holding pens for 5 days. Mortality rates were estimated using conditional instantaneous mortality rates and additive finite mortality rates. Influences of variables (playing and handling time, hook location, degree of bleeding and fish length) on hooking mortality rates were examined by logistic regression. Conditional instantaneous mortality rates and additive finite mortality rates were 31 and 28%, respectively. Hook location significantly affected the survival of striped bass. Angling catch, effort, and release rates must be integrated with associated hooking mortality rates before this component of overall population mortality can be incorporated into management decisions. [source]

Survival of sea-water-adapted trout, Salmo trutta L. ranched in a Danish fjord

FISHERIES MANAGEMENT & ECOLOGY, Issue 4 2000
S. S. Pedersen
The effect of seawater adaptation on the survival of coastally released post-smolt trout, Salmo trutta L., was investigated by release: (1) directly (with no adaptation); (2) after retention in net pens in the sea for 29,131 days (delayed release); (3) after feeding with a high-salt diet (12,13.5% NaCl) for 4 weeks; and (4) after a combination of (2) and (3). In total, 17 640 trout (age = 1+, 1.5 and 2+ years; mean fork lengths = 18.2,25.6 cm) were released in 14 batches in the summer or autumn months of 1986,1989. All fish were of domesticated origin and Carlin tagged. Survival and instantaneous mortality rates (total and fishing mortality) were estimated from reported recaptures. Mortality rates were estimated for: (1) the post-smolt period; (2) the period until the legal size of capture (40 cm) was attained; and (3) for larger sea-trout. Release with a delay of 4 weeks gave an increased survival rate. A longer adaptation period did not increase survival. On average, survival was increased by 36%. Survival was not increased by high-salt diets. Until attainment of the legal size for capture, survival was 9.6% higher on average, with extremes as low as 1.7% and as high as 38% in individual batches. [source]

Antiplatelet drug use preceding the onset of intracerebral hemorrhage is associated with increased mortality

FUNDAMENTAL & CLINICAL PHARMACOLOGY, Issue 3 2007
Karine Lacut
Abstract Recent studies highlight the contribution of antiplatelet therapy to clinical severity and increased mortality of intracerebral hemorrhage (ICH) but results are discrepant. The aim of this report was to evaluate the association between antiplatelet drug use preceding the onset of ICH and the mortality, assessed at regular intervals, among patients with acute ICH. We analyzed data from a randomized study which enrolled consecutive patients with a documented acute ICH to evaluate the efficacy of intermittent pneumatic compression of the legs in venous thrombosis prevention. Clinical characteristics and treatment used before the onset of ICH were checked at the time of inclusion. Mortality was assessed at regular intervals until 3 months after ICH diagnosis. Among 138 patients included in this report, 30 were current users of antiplatelet therapy at the time of ICH; they were significantly older and less frequently heavy drinkers than non-users of antiplatelet drugs. Mortality rates were 20% at 8 days, 40% at 1 month, and 47% at 3 months among antiplatelet drug users compared with 6.5%, 13% and 19% among non-users. The corresponding estimated risks for mortality related to antiplatelet drug use were 3.6 (95% CI 1.1,12), 4.5 (95% CI 1.8,11), and 3.6 (95% CI 1.5,8.6). Adjusted for age, hypertension and alcohol over use, antiplatelet therapy remained significantly associated with an increased mortality rate of acute ICH. Current antiplatelet drug use preceding the onset of ICH is associated with increased short-term ICH mortality, independently of age. [source]

Mortality rates of community-residing adults with and without dentures

GERIATRICS & GERONTOLOGY INTERNATIONAL, Issue 3 2008
Kakuhiro Fukai
Aim: To prospectively study how dental status with and without dentures could become a predictor of overall mortality risk. Methods: Five thousand six hundred eighty-eight community residents over 40 years old in the Miyako Islands, Okinawa Prefecture, Japan, were followed up for 15 years from 1987,2002. Results: We found that female subjects with less than 10 functional teeth and without dentures showed a significantly higher mortality rate than those with dentures. There was no significant difference of mortality rates in male subjects. There were no significant differences of mortality rates between subjects with 10 or more functional teeth with and without dentures. Conclusion: The present study suggests that dentures are one of the factors associated with mortality rates especially in female subjects with less than 10 functional teeth. [source]