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Background We compared long-term mortality and readmission rates after COVID-19 hospitalization based on rural-urban status and assessed the impact of COVID-19 vaccination introduction on clinical outcomes by rurality. Methods The study comprised adults hospitalized for COVID-19 at 17 hospitals in 4 US states between March 2020 and July 2022, followed until May 2023. The main analysis included all patients, whereas a sensitivity analysis focused on residents from 4 states containing 17 hospitals. Additional analyses compared the pre- and postvaccination periods. Results The main analysis involved 9325 COVID-19 hospitalized patients: 31% were from 187 rural counties in 31 states; 69% from 234 urban counties in 44 states; the mean age was 65 years (rural, 66 years; urban, 64 years); 3894 women (rural, 41%; urban, 42%); 8007 Whites (rural, 87%; urban, 83%); 1738 deaths (rural, 21%; urban, 17%); and 2729 readmissions (rural, 30%; urban, 29%). During a median follow-up of 602 days, rural residence was associated with a 22% higher all-cause mortality (log-rank, P <.001; hazard ratio, 1.22; 95% confidence interval, 1.10-1.34, P <.001), and a trend toward a higher readmission rate (log-rank, P =.038; hazard ratio, 1.06; 95% confidence interval,.98-1.15; P =.130). The results remained consistent in the sensitivity analysis and in both pre- and postvaccination time periods. Conclusions and Relevance Patients from rural counties experienced higher mortality and tended to be readmitted more frequently following COVID-19 hospitalization over the long term compared with those from urban counties, a difference that remained even after the introduction of COVID-19 vaccines. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the demographic profile, clinical severity, and outcome of Covid-19 infection in hospitalised vaccinated individuals. Methods: An observational, cross-sectional study was conducted among Covid-19 infected hospitalised patients. Clinicodemographic profile, severity, and outcome of Covid-19 infection among the vaccinated group (VG) were recorded. These patients were also compared with unvaccinated group (UVG) with Covid-19 infection admitted during the study period. Cox proportional hazards models was used to estimate hazard ratios for mortality risk in both groups. Results: Out of 580 participants, 48.2% were vaccinated with either one (71%) or two doses (28.9%). In both, VG and UVG, majority 55.8% belonged to 51–75 years. Males were predominant with 62.9% in both VG and UVGs. Day of illness at admission from symptom onset (DOI), progression of disease, ICU stay, oxygen requirement, mortality was significantly higher in UVG than in VG (p < 0.05). Steroid duration (p < 0.001) and anti-coagulation time (p < 0.001) were significantly higher in UVG than in VG. D dimer levels were significantly higher in UVG than in VG (p < 0.05). Increased age, (p < 0.0004), severity of disease, (p < 0.0052), increased oxygen requirement (p < 0.001), elevated C-reactive protein levels (Moderate: P < 0.0013; Severe P < 0.0082), and elevated IL-6 levels (p < 0.001) were the significant determinants of Covid-19-related mortality in both VG and UVGs. Conclusion: Vaccinated individuals have shown milder severity, had reduced hospital stay and better outcomes as compared to unvaccinated individuals suggesting a potential vaccine efficacy against Covid-19.

Objective: To evaluate the demographic profile, clinical severity, and outcome of Covid‑19 infection in hospitalised vaccinated individuals. Methods: An observational, cross‑sectional study was conducted among Covid‑19 infected hospitalised patients. Clinicodemographic profile, severity, and outcome of Covid‑19 infection among the vaccinated group (VG) were recorded. These patients were also compared with unvaccinated group (UVG) with Covid‑19 infection admitted during the study period. Cox proportional hazards models was used to estimate hazard ratios for mortality risk in both groups. Results: Out of 580 participants, 48.2% were vaccinated with either one (71%) or two doses (28.9%). In both, VG and UVG, majority 55.8% belonged to 51–75 years. Males were predominant with 62.9% in both VG and UVGs. Day of illness at admission from symptom onset (DOI), progression of disease, ICU stay, oxygen requirement, mortality was significantly higher in UVG than in VG (p < 0.05). Steroid duration (p < 0.001) and anti‑coagulation time (p < 0.001) were significantly higher in UVG than in VG. D dimer levels were significantly higher in UVG than in VG (p < 0.05). Increased age, (p < 0.0004), severity of disease, (p < 0.0052), increased oxygen requirement (p < 0.001), elevated C‑reactive protein levels (Moderate: P < 0.0013; Severe P < 0.0082), and elevated IL‑6 levels (p < 0.001) were the significant determinants of Covid‑19‑related mortality in both VG and UVGs. Conclusion: Vaccinated individuals have shown milder severity, had reduced hospital stay and better outcomes as compared to unvaccinated individuals suggesting a potential vaccine efficacy against Covid‑19. [ABSTRACT FROM AUTHOR]

This study investigated the Cause-Effect of Five Child-Killer Diseases on Under-Five Mortality (Deaths) in Adamawa State, Nigeria. The study used Ex post facto and quantitative design. A secondary data was obtained from Adamawa State Primary Health Care Development Agency (PHCDA), Yola across the study area for the period of 2001 to 2020. The study used Multiple Regression Analysis to determine the Cause-effect of the Five Childkiller Diseases on Under-Five Mortality in the study area. The study revealed that; Polio needs to be excluded from the Five Child-Killer Disease since there is no death associated with polio disease for the period under review in the study area. The results also revealed that the deaths due to diarrhoea have a significant causal relationship on Under-Five Mortality, while deaths due pneumonia, measles and tetanus has insignificant causal relationship on Under-Five Mortality in the study area. Based on the overall model, the Five Child-Killer Diseases have a Causeeffect of 64% on Under-Five Mortality in the study area. In view of the above, the study recommends that Adamawa State Primary Health Care Development Agency, Yola whose primary responsibility among orders is to curb and reduce the spread of Child-Killer Diseases among vulnerable children of ages; needs to review and strategies their action plans, since the Cause-effect is still high. [ABSTRACT FROM AUTHOR]

Abstract Objective This study was aimed to assess the enzymatic activity and pathogenicity potential of Beauveria bassiana and Metarhizium anisopliae against whiteflies in Ethiopia. Results The data showed that Beauveria bassiana AAUMB-29, AAUMFB-77, and AAUEB-59 generated the highest chitinase (EI = 3.41), lipase (EI = 4.45), and protease activities (EI = 5.44) respectively. The pathogenicity study of isolates on whitefly nymphs and adults indicated significant variation (P

Background:Stroke is characterised as the sudden onset of a vascular cause of focal neurological deficit leading to a loss of blood flow to an area of the brain [1]. A stroke can be categorised into a hemorrhagic and ischemic stroke [2].10 percent of all strokes are intracerebral haemorrhage (ICH) [3]. Approximately 45 percent of ICH patients die in the first 30 days. OBJECTIVES: To predict clinical outcome and mortality in patients with acute Intracerebral hemorrhage based on ICH score. MATERIAL & METHODS: Study Design: Prospective hospital based observational study. Study area:Department of General Medicine, Sapthagiri Institute of medical sciences and research centre, Bengaluru. Study Period: October. 2021 - September. 2022 Study population: Patients aged more than18 years with acute Intracerebral hemorrhage, admitted to the wards of the department of General Medicine, Sapthagiri Institute of medical sciences and research centre, Bengaluru. Study tools and Data collection procedure: Total of 114 patients satisfying inclusion and exclusion criteria were included in the study. They were enrolled in the study only after obtaining written consent from the patient, in case where patient is not in state to give consent, consent was obtained from the patient's relatives. Patients demographic details, History, Comorbid condition like Type 2 DM and Systemic Hypertension, History of smoking and alcohol consumption. Patient examination including, Blood pressure, GCS score, central nervous system examination was recorded in the proforma sheets. Results: Mean ICH score was 2.50 ±1.305.10(8.8%) patients had ICH score of 0, 13(11.4%) patients had ICH score of 1, 30(26.3%) patients had ICH score of 2, 40(35.1%) patients had ICH score of 3, 15(13.2%) patients had ICH score of 4, 4 (3.5%) patients had ICH score of 5 and 2(1.8%) patients had a score of 6. CONCLUSION:This study concludes that ICH score is simple, easy to use and can be easily trained to others. It predicts 30 days' mortality reliably. Individual parameters of ICH by themselves also predicts 30 days' mortality. ICH score can be used as a tool prognosticate a patient with ICH. [ABSTRACT FROM AUTHOR]

Objective: This study was aimed to assess the enzymatic activity and pathogenicity potential of Beauveria bassiana and Metarhizium anisopliae against whiteflies in Ethiopia. Results: The data showed that Beauveria bassiana AAUMB-29, AAUMFB-77, and AAUEB-59 generated the highest chitinase (EI = 3.41), lipase (EI = 4.45), and protease activities (EI = 5.44) respectively. The pathogenicity study of isolates on whitefly nymphs and adults indicated significant variation (P < 0.05) with mortality ranging from 71.67 to 98.33% and 60 to 100% against Bemisia tabaci and Trialeurodes vaporariorum nymphs respectively. The mortality of adults was between 58 and 94.27% against B. tabaci and 59.03 to 95.37% against T.vaporariorum. The result also showed that AAUMB-29, AAUMFB-77, and AAUDM-43 were the most virulent with LC50 values of 2.7 × 104, 5.3 × 104, and 5.4 × 104 conidia/ml against nymphs of B. tabaci, and with LC50 values 6.8 × 104, 8.2 × 104, and 7.2 × 104 conidia/ml against nymphs of T. vaporariorum, respectively. The B. bassiana AAUMB-29, B. bassiana AAUMFB-77, and M. anisopliae AAUDM-43 induced the highest whitefly mortality than other isolates. These isolates can be recommended for further tests under field conditions to fully realize their potential as effective biocontrol agents against whitefly pests in tomato. [ABSTRACT FROM AUTHOR]

Abstract Background Despite different preventive strategies that have been implemented in different health institutions in the country, neonatal mortality and morbidity are still significantly increasing in Ethiopia. Perinatal asphyxia is the leading cause of neonatal morbidity and mortality worldwide. As a result, this systematic review and meta-analysis aimed to assess the prevalence and associated factors of perinatal asphyxia in Ethiopia. Methods Online databases (PubMed, HINARI, EMBASE, Google Scholar and African Journals), other gray and online repository accessed studies were searched using different search engines. Newcastle-Ottawa Quality Assessment Scale (NOS) was used for critical appraisal of studies. The analysis was done using STATA 11 software. The Cochran Q test and I2 test statistics were used to test the heterogeneity of studies. The funnel plot and Egger’s test were used to detect publication bias of the studies. The pooled prevalence of perinatal asphyxia and the odds ratio (OR) with a 95% confidence interval was presented using forest plots. Result Nine studies were included in this review, with a total of 12,249 live births in Ethiopia. The overall pooled prevalence of perinatal asphyxia in Ethiopia was 24.06% (95 95%CI: 18.11–30.01). Associated factors of perinatal asphyxia included prolonged labor (OR = 2.79, 95% CI: 1.98, 3.93), low birth weight (OR = 6.52, 95% CI: 4.40, 9.65), meconium-stained amniotic fluid (OR = 5.91, 95% CI: 3.95, 8.83) and instrumental delivery (OR = 4.04, 95% CI: 2.48, 6.60) were the determinant factors of perinatal asphyxia in Ethiopia. Conclusions The overall pooled prevalence of perinatal asphyxia was remarkably high. Duration of labor, meconium-stained amniotic fluid, instrumental deliveries, and birth weight were the associated factors of perinatal asphyxia in Ethiopia. Therefore, efforts should be made to improve the quality of intrapartum care service to prevent prolonged labor and fetal complications and to identify and make a strict follow up of mothers with meconium-stained amniotic fluid. This finding is important to early recognition and management of its contributing factors, might modify hypoxic-ischemic encephalopathy and may improve the implementation of the standard guideline effectively and consistently.

Aims: Right Bundle Branch Block (RBBB) has been reported in 5-11% of the acute myocardial infarctions (AMI), and it could be the only electrocardiographic abnormality in this group of patients. We investigated the mortality in patients with AMI and the presence of RBBB.Materials and Methods: A retrospective cohort study was conducted between January 2011 to December 2017 at a university hospital in Bogotá, Colombia. Records were obtained from all patients who presented at the emergency department with AMI; patients with early transfer and incomplete follow-up were excluded.Results: 1015 patients were included, the mean age was 66 years, 67% of the patients were men, and 38% had STEMI. RBBB was documented in 8% of patients and LBBB in 4% of patients. In-hospital mortality was higher in the group of patients with RBBB vs. patients without RBBB (8.64% vs. 3.74%, p = 0.034). The percentage of patients with Killip ≥II classification was higher in patients with new RBBB vs. patients with old or unknown duration RBBB (23% vs. 13%, p = 0.216).Conclusions: In patients with AMI, the presence of RBBB was associated with a statistically significant increase of in-hospital mortality. [ABSTRACT FROM AUTHOR]

Background: Despite different preventive strategies that have been implemented in different health institutions in the country, neonatal mortality and morbidity are still significantly increasing in Ethiopia. Perinatal asphyxia is the leading cause of neonatal morbidity and mortality worldwide. As a result, this systematic review and meta-analysis aimed to assess the prevalence and associated factors of perinatal asphyxia in Ethiopia.Methods: Online databases (PubMed, HINARI, EMBASE, Google Scholar and African Journals), other gray and online repository accessed studies were searched using different search engines. Newcastle-Ottawa Quality Assessment Scale (NOS) was used for critical appraisal of studies. The analysis was done using STATA 11 software. The Cochran Q test and I2 test statistics were used to test the heterogeneity of studies. The funnel plot and Egger's test were used to detect publication bias of the studies. The pooled prevalence of perinatal asphyxia and the odds ratio (OR) with a 95% confidence interval was presented using forest plots.Result: Nine studies were included in this review, with a total of 12,249 live births in Ethiopia. The overall pooled prevalence of perinatal asphyxia in Ethiopia was 24.06% (95 95%CI: 18.11-30.01). Associated factors of perinatal asphyxia included prolonged labor (OR = 2.79, 95% CI: 1.98, 3.93), low birth weight (OR = 6.52, 95% CI: 4.40, 9.65), meconium-stained amniotic fluid (OR = 5.91, 95% CI: 3.95, 8.83) and instrumental delivery (OR = 4.04, 95% CI: 2.48, 6.60) were the determinant factors of perinatal asphyxia in Ethiopia.Conclusions: The overall pooled prevalence of perinatal asphyxia was remarkably high. Duration of labor, meconium-stained amniotic fluid, instrumental deliveries, and birth weight were the associated factors of perinatal asphyxia in Ethiopia. Therefore, efforts should be made to improve the quality of intrapartum care service to prevent prolonged labor and fetal complications and to identify and make a strict follow up of mothers with meconium-stained amniotic fluid. This finding is important to early recognition and management of its contributing factors, might modify hypoxic-ischemic encephalopathy and may improve the implementation of the standard guideline effectively and consistently. [ABSTRACT FROM AUTHOR]

Aim: Renin-angiotensin-aldosterone system inhibitors (RASIs) are widely used in high-risk cardiovascular (CV) diseases, including acute myocardial infarction (AMI). However, it is not yet clear which class of RASIs provides specific benefits to patients with AMI. The present study aimed to evaluate whether angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin II type 1 receptor blockers (ARBs) had any different effects on long-term CV and all-cause mortality in patients with AMI who received either agent from admission and were discharged alive from the hospital.Methods: We analyzed data of patients with AMI from the Korea Acute Myocardial Infarction Registry-National Institutes of Health registry. Cardiovascular and all-cause mortality at 12 months after AMI were assessed.Results: Among 12 481 patients with AMI who were discharged alive, RASI treatment was as follows: ACEIs (n = 5910), ARBs (n = 4009), and no RASI (n = 2562). After adjustment for multiple factors, compared with no RASI therapy, ACEI therapy was associated with lower hazard ratios (HRs) for 1-year CV and total mortality rates, whereas ARB therapy was not. In a direct comparison, compared with ARB treatment, ACEI treatment was associated with lower HRs (95% confidence interval) for CV and total mortality: 0.562 (0.420-0.753) and 0.567 (0.451-0.713), respectively. The superiority of ACEI to ARB was also observed across several subgroups. The mortality differences between the 2 treatment groups were reproduced in a propensity-score matched analysis (n = 2855 each).Conclusions: Our study of a recent AMI registry data revealed that ACEI therapy in patients with AMI was associated with better long-term survival benefits than ARB therapy. [ABSTRACT FROM AUTHOR]

Abstract Many previous literatures suggested that high temperature and diurnal temperature range (DTR) are prominent risk factors to increase risk of mortality. However, the role of effect modification of temperature on the DTR-related mortality is unclear. We examined whether temperature was an effect modifier on the DTR-mortality association and how the modification patterns differed by cause of deaths and different regional climates using a nationwide 47 prefecture data in Japan (1972–2015). We used a two-stage analysis. For the first stage, we used a time-series regression with a distributed lag model to estimate the DTR-mortality association according to five levels of temperature (extreme cold, cold, moderate, hot, and extreme hot days) for each prefecture stratified by twelve cause-specific deaths. Then, we applied a meta-analysis to pool the estimates across the 47 prefectures in Japan and separately by cooler vs. warmer regions. Our findings showed that the risk of mortality associated with DTR was strongly modified by temperature for all causes and cardiovascular deaths (p < 0.001) in the total population, suggesting that the influence of DTR on mortality increases at higher levels of temperature. These findings were consistent across warmer and cooler regions. Similar patterns were observed for respiratory and renal disease deaths which demonstrated the associations with DTR were the highest during extreme hot days, although it was statistically not significant and varied depending on the climate regions. Our findings suggest that the DTR-related mortality may be modified by daily mean temperature and the most elevated during extremely hot temperatures. Highlights • We aimed to identify the DTR-related mortality with cause-specific deaths. • Weather and 12-specific deaths data of Japan (47 prefectures; 1972–2015) were used. • We found the DTR-related risks were highest in respiratory and renal deaths. • The modification of temperature was significant in total and cardiovascular deaths. • The DTR-related mortality changed during the study period. [ABSTRACT FROM AUTHOR]

Ninety-five percent of the World's populations have a mean salt intake between 6 and 12 g, which is much lower than the tolerated daily level of up to 55 g/d. In spite of this, the recommended upper level by many health institutions is as low as 5.8 g/day. When reviewing the evidence for an upper level of 5.8 g/day, it becomes apparent that neither the supporting studies selected by the health institutions, nor randomized controlled trials and prospective observational studies disregarded by the health institutions, document that a salt intake below this 5.8 g, has beneficial health effects. Although there is an association between salt intake and blood pressure, both in randomized controlled trials and in observational studies, this association is weak, especially in non-obese individuals with normal blood pressure. Furthermore a salt intake below 5.8 g is associated with the activation of the renin-angiotensin-aldosteron system, an increase in plasma lipids and increased mortality. A redesign of the salt dietary guidelines, therefore, seems to be needed. [ABSTRACT FROM AUTHOR]

To see the percentage, the different groups affected and pattern of injury by road traffic accidents among patients attending a unit of surgery in a teaching hospital. Objectives: To see the percentage of trauma among patients admitted in one surgical unit of a tertiary hospital in one year and to compare this with the patients admitted in all surgical units of same tertiary unit. To evaluate the pattern of trauma, male to female ratio, affected age groups, mechanism of injury, the organs affected, and the mortality rate in one surgical unit of a tertiary hospital of 3rd most populated city of Pakistan during one year. Study Design: Prospective study. Setting: Surgical Unit II at Allied Hospital Faisalabad. Period: January 2009 to February 2010. Materials and Methods: Patients admitted during this period for road traffic accidents in surgical unit II of Allied Hospital Faisalabad were 94 (4.8 %) out of total 1956 patients presented and admitted in surgical unit II during this year. Total number of patients admitted in all surgical units of this hospital were 7388 while 21,400, patients received and admitted by all other specialties through emergency units of Allied Hospital Faisalabad. Patients with road traffic accidents admitted in surgical unit II through emergency unit of this hospital were part of this study. Among these 94 patients 78 patients (82.97%) were adults and 18 children (19.14%). Patients with all other emergencies modalities and minor injuries treated and discharged from emergency were excluded from this study. Results: Out of 1956 patients admitted in Surgical Unit II from total 7388 of all surgical admissions and 21400 all emergencies ward patients, 94 patients (4.8%, 1.27%, and 0.439% respectively) were injured by road traffic accidents. Out of these 94 patients, 78 patients (82.97%) were adults and 18 children (19.14%) patients. 58 patients (61.70%) were males and 36 patients (38.29%) were females. 43 patients (45.74%) were pedestrians, 10 patients were (10.63%) on bicycles, 26 patients were (27.65%) on motorcycle while 15 patients (15.95%) were in other vehicles. 52 patients (55.31%) developed head injuries, 10 patients (10.93%) blunt trauma abdomen, 5 patients (5.31%) blunt trauma chest and 26 patients (27.65%) skeletal injuries (10 patients forearm bones fracture, 6 patients with fracture mid-shaft of tibia, another 5 patients with fracture lower 1/3rd of femur and 5 patients with hand bones fracture). All patients were treated by combined specialty trauma surgeons. 3 patients (3.19%) died out of which 2 patients (2.12%) with severe head trauma and one pedestrian (1.06%) with blunt trauma abdomen and lower chest. All other patients survived and recovered with some morbidity. Conclusion: Road traffic trauma is one of major dilemma of our society. 94 road traffic accidents causalities were admitted during one year in one surgical unit of a tertiary care center and 3 patients died. It is an alarming sign to properly protect people, educate general population, employ dedicated road safety staff and follow rules and regulation of traffic authorities. [ABSTRACT FROM AUTHOR]

With the objective of describing mortality from traffic accidents in Bayamo, Cuba, in 2011 a review was performed of injured and deceased patients due to traffic accidents, recorded in the Hospital Carlos M. de Céspedes. Of the 1,365 injured patients treated in the emergency room, the predominant groups were individuals aged 25 to 44 years comprising 372 patients (27.3%) and men comprising 1,071 (78.5%). 46 people died, most from the same age group and male. Multiple traumatisms (52.6%) and craniofacial trauma (34.2%) were the predominant injuries. Motor vehicle-pedestrian accidents stood out with a mortality of 26.3%. In conclusion, mortality from traffic accidents predominately occurs in young male adults, whose fatal consequences are due to multiple traumatisms from road accidents. [ABSTRACT FROM AUTHOR]

• The multimorbidity frailty index developed using ICD-10 codes is a multidimensional and data-driven approach to identify older people at increased risk of mortality, unplanned hospitalization, and ICU admission • Although the prevalence of frailty increased in Taiwan, the magnitude of mortality decreased, which is possibly attributed to the combined impact of composition difference between the two mFIs (mFIvs. mFI-v10) and the improvement of the healthcare technology over the years. • The mFI-v10 can be applied to a broad population and serve as a tool to stratify the risk of frailty in the ICD-10 era. This study aims to develop an updated mFI (multimorbidity frailty index) using ICD-10-CM codes and to examine the association between frailty and all-cause mortality, unplanned hospitalization, and ICU admission by adopting the updated mFI in the contemporary ICD-10-CM era. From NHIRD, subjects aged 65–100 years with full National Health Insurance coverage in 2017 were included. We constructed the renewed mFI using ICD-10 CM codes (mFI-v10) by the cumulative deficit approach and categorized the study subjects according to the mFI-v10 quartiles: fit, mild frailty, moderate frailty, and severe frailty. Outcomes of interests (1-year mortality, unplanned hospitalization, and intensive care unit (ICU) admission) were assessed using Cox regression analyses, adjusted by sex and age. Compared with the fit group, those with severe frailty were associated with a 4-fold (adjusted HR 3.86, 95% CI 3.54–4.20) higher risk for death at one year. Subjects with moderate frailty or mild frailty were associated with a 2.4-fold (adjusted HR 2.35, 95% CI 2.18–2.55) or 1.6-fold (adjusted HR 1.57, 95% CI 1.47–1.69) higher risk for death at one year than the fit group. Similar risk trends can also be observed in unplanned hospitalization and intensive care unit (ICU) admission among the study population. The renewed multimorbidity frailty index constructed from ICD-10 codes is associated with an increased risk of 1-year of all-cause mortality, unplanned hospitalization, and ICU admission. It can provide updated information contributing to risk stratification using frailty index in the ICD-10 era. [ABSTRACT FROM AUTHOR]

This performance text explores how people “craft liveable truths” after a cancer diagnosis. Interviews with 26 members of Gilda’s Club, a meeting place for people whose lives have been touched by cancer, serve as the data source for the study. Weaving together excerpts from the interviews, a composite character named Henry is created to explore stories of diagnosis, changes in relationships, and the healing nature of shared experiences. Henry’s interactions with his doctor, daughter, and “cancer friends” reveal his struggle for dignity, hope, and transcendence throughout his cancer journey. This story is about living, not dying, with cancer. It is simultaneously a text about emotions (fear, happiness, friendship, anxiety, sadness, and optimism) and the institutional processes that shape them. The text invites a discussion of “emotion work” and institutional thinking fostered by support groups such as Gilda’s Club. [ABSTRACT FROM PUBLISHER]

Objective: To examine the gradual association between self-reported health status and mortality in patients with heart failure (HF) as current research has focused on poor health status and increased risk of mortality.Method: This is a substudy of the DANISH (Defibrillator Implantation in Patients with Nonischemic Systolic HF) trial in which 1116 patients were randomized to receive or not receive an implantable cardioverter-defibrillator. Health status was assessed by a single question of the Short-Form 36. Patients were classified as having excellent/very good, good, fair (reference) or poor health status. We assessed the association between health status and mortality using multivariable Cox proportional hazard models.Results: Self-reported health status was completed by 943 (84%) patients at randomization with a median follow-up of 67 months and a health status distribution of; excellent/very good (n = 79, 8%), good (n = 369, 39%), fair (n = 409, 43%), and poor (n = 86, 9%). All-cause mortality (death events/ 100 person-years) occurred with gradual differences according to health status from excellent/ very good (2.14), good (3.74), fair (5.21) to poor health status (5.57). The gradual difference yielded a crude hazard ratio (HR) of 0.40, 95% CI 0.20-0.80 (adjusted HR 0.47 (95% CI 0.23-0.95) for excellent/ very good health status, HR 0.71, 95% CI 0.52-0.97 (adjusted HR 0.78 (95% CI 0.56-1.08) for good health status. Poor being worse than fair health status yielded a crude HR of 1.07, 95% CI 0.67-1.69.Conclusion: Excellent/very good self-reported health status as assessed by a single question was associated with lower long-term mortality in patients with HF. [ABSTRACT FROM AUTHOR]

Background: Immune thrombotic thrombocytopenic purpura (iTTP) is a life-threatening blood disorder, primarily resulting from autoantibodies against ADAMTS13. Infection or inflammation often precedes acute iTTP. However, the association of inflammation and inflammatory mediators with disease severity and outcome of acute iTTP is not fully assessed., Objectives: Here, we determined plasma levels of S100A8/A9, histone/DNA complexes, citrullinated histone H3 (CitH3), and cell-free DNA (cfDNA) in a cohort of 108 acute episodes from 94 unique iTTP patients and healthy controls, and assessed the association of each of these biomarkers with the disease severity and mortality., Results: All acute iTTP patients had significantly increased plasma levels of S100A8/A9 (median 84.8, interquartile range [IQR] 31.2-157.4 µg/mL), histone/DNA complexes (median 55.7, IQR 35.8-130.8 U/mL), CitH3 (median 3.8, IQR 2.2-6.4 ng/mL), and cfDNA (median 937.7, IQR 781.3-1420.0 ng/mL) on the admission blood samples when compared with healthy controls. An increased plasma level of S100A8/A9, histone/DNA complex and cfDNA was associated with organ damage, coagulopathy, and mortality in iTTP. After being adjusted for age and history of hypertension, Cox proportional hazard regression analysis demonstrated that a hazard ratio (95% confidence interval) for an elevated plasma level of S100A8/A9, histone/DNA complexes, and cfDNA was 11.5 (1.4-90.9) (P = .021), 10.3 (2.7-38.5) (P = .001), and 12.8 (3.9-42.0) (P = .014), respectively., Conclusion: These results indicate that inflammation or plasma inflammatory mediators such as S100A8/A9 or NETosis markers such as histone/DNA complexes and cfDNA may play a role in pathogenesis of iTTP, which may help stratify patients with a high risk of death during acute iTTP episodes., (© 2020 International Society on Thrombosis and Haemostasis.)

Aim: Renin-angiotensin-aldosterone system inhibitors (RASIs) are widely used in high-risk cardiovascular (CV) diseases, including acute myocardial infarction (AMI). However, it is not yet clear which class of RASIs provides specific benefits to patients with AMI. The present study aimed to evaluate whether angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin II type 1 receptor blockers (ARBs) had any different effects on long-term CV and all-cause mortality in patients with AMI who received either agent from admission and were discharged alive from the hospital., Methods: We analyzed data of patients with AMI from the Korea Acute Myocardial Infarction Registry-National Institutes of Health registry. Cardiovascular and all-cause mortality at 12 months after AMI were assessed., Results: Among 12 481 patients with AMI who were discharged alive, RASI treatment was as follows: ACEIs (n = 5910), ARBs (n = 4009), and no RASI (n = 2562). After adjustment for multiple factors, compared with no RASI therapy, ACEI therapy was associated with lower hazard ratios (HRs) for 1-year CV and total mortality rates, whereas ARB therapy was not. In a direct comparison, compared with ARB treatment, ACEI treatment was associated with lower HRs (95% confidence interval) for CV and total mortality: 0.562 (0.420-0.753) and 0.567 (0.451-0.713), respectively. The superiority of ACEI to ARB was also observed across several subgroups. The mortality differences between the 2 treatment groups were reproduced in a propensity-score matched analysis (n = 2855 each)., Conclusions: Our study of a recent AMI registry data revealed that ACEI therapy in patients with AMI was associated with better long-term survival benefits than ARB therapy.