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The American Journal of Emergency... Apr 2024Myocarditis is a serious condition that carries with it a high rate of morbidity and mortality. (Review)
Review
INTRODUCTION
Myocarditis is a serious condition that carries with it a high rate of morbidity and mortality.
OBJECTIVE
This review highlights the pearls and pitfalls of myocarditis, including presentation, diagnosis, and management in the emergency department (ED) based on current evidence.
DISCUSSION
Myocarditis is an inflammatory syndrome of myocardium, most often resulting from a viral infection, that can cause life-threatening cardiovascular collapse. It has a highly variable presentation and no widely available specific diagnostic test, making it a challenging diagnosis. Emergency clinicians should obtain an electrocardiogram and perform bedside ultrasound to assess cardiac function. Treatment in the ED is largely supportive, focusing on resuscitation, cardiovascular support, cardiology specialist consultation, and appropriate disposition.
CONCLUSIONS
An understanding of myocarditis can assist emergency clinicians in diagnosing and managing this potentially deadly disease.
Topics: Humans; Myocarditis; Prevalence; Myocardium; Electrocardiography; Virus Diseases
PubMed: 38241774
DOI: 10.1016/j.ajem.2024.01.007 -
Pediatric Allergy and Immunology :... May 2024The morbidity burden of respiratory syncytial virus (RSV) in infants extends beyond hospitalization. Defining the RSV burden before implementing prophylaxis programs is...
BACKGROUND
The morbidity burden of respiratory syncytial virus (RSV) in infants extends beyond hospitalization. Defining the RSV burden before implementing prophylaxis programs is essential for evaluating any potential impact on short- to mid-term morbidity and the utilization of primary healthcare (PHC) and emergency services (ES). We established this reference data using a population-based cohort approach.
METHODS
Infants hospitalized for RSV from January 2016 to March 2023 were matched with non-hospitalized ones based on birthdate and sex. We defined the exposure as severe RSV hospitalization. The main study outcomes were as follows: (1) PHC and ES visits for RSV, categorized using the International Classification of Primary Care codes, (2) prescriptions for respiratory airway obstructive disease, and (3) antibacterial prescriptions. Participants were followed up from 30 days before hospitalization for severe RSV until the outcome occurrence or end of the study. Adjusted incidence rate ratios (IRRs) of the outcomes along with their 95% confidence intervals (CI) were estimated using Poisson regression models. Stratified analyses by type of PHC visit (nurse, pediatrician, or pharmacy) and follow-up period were undertaken. We defined mid-term outcomes as those taking place up to 24 months of follow-up period.
RESULTS
The study included 6626 children (3313 RSV-hospitalized; 3313 non-hospitalized) with a median follow-up of 53.7 months (IQR = 27.9, 69.4). After a 3-month follow-up, severe RSV was associated with a considerable increase in PHC visits for wheezing/asthma (IRR = 4.31, 95% CI: 3.84-4.84), lower respiratory infections (IRR = 4.91, 95% CI: 4.34-5.58), and bronchiolitis (IRR = 4.68, 95% CI: 2.93-7.65). Severe RSV was also associated with more PHC visits for the pediatrician (IRR = 2.00, 95% CI: 1.96-2.05), nurse (IRR = 1.89, 95% CI: 1.75-1.92), hospital emergency (IRR = 2.39, 95% CI: 2.17-2.63), primary healthcare emergency (IRR: 1.54, 95% CI: 1.31-1.82), as well as with important increase in prescriptions for obstructive airway diseases (IRR = 5.98, 95% CI: 5.43-6.60) and antibacterials (IRR = 4.02, 95% CI: 3.38-4.81). All findings remained substantial until 2 years of post-infection.
CONCLUSIONS
Severe RSV infection in infants significantly increases short- to mid-term respiratory morbidity leading to an escalation in healthcare utilization (PHC/ES attendance) and medication prescriptions for up to 2 years afterward. Our approach could be useful in assessing the impact and cost-effectiveness of RSV prevention programs.
Topics: Humans; Respiratory Syncytial Virus Infections; Infant; Male; Female; Primary Health Care; Longitudinal Studies; Spain; Hospitalization; Infant, Newborn; Incidence; Respiratory Syncytial Virus, Human; Morbidity; Cost of Illness
PubMed: 38700124
DOI: 10.1111/pai.14131 -
Surgery Feb 2024Sepsis is a life-changing condition that can occur in patients undergoing cardiothoracic surgery. It is characterized by a dysregulated inflammatory response to...
Sepsis is a life-changing condition that can occur in patients undergoing cardiothoracic surgery. It is characterized by a dysregulated inflammatory response to infection, often leading to higher rates of organ dysfunction and mortality. The importance of early recognition and prompt intervention in managing sepsis-related complications in cardiothoracic surgery is pivotal to adequate surgical practice. Due to the multiple subsections that construct the broad spectrum of cardiothoracic surgery, it is important to address the presence of sepsis in elective cardiothoracic surgery, urgent/emergency cardiothoracic surgery, solid organ transplantation, and both temporary and permanent mechanical circulatory support (ie, left ventricular assist devices, extracorporeal membrane oxygenation, and percutaneous temporary devices [eg, Impella series]). Exploring the incidence, prevalence, and risk factors of said subsections can lead to improvement in postoperative outcomes. The impact of accompanying infections can progress into further operative morbidity and mortality. To this effect, the perioperative management of cardiothoracic surgery transcends surgical techniques and should undergo additional recognition of other occurrences such as wound infections, bloodstream infections, urinary tract infections, and pneumonia. Sepsis remains a concern in cardiothoracic surgery, as it can lead to devastating consequences. Hence, there is an evident need for heightened vigilance, early recognition, and effective management strategies to mitigate the risk of sepsis in this patient population. The purpose of this article is to provide an overview of sepsis in the different cardiothoracic surgery areas.
Topics: Humans; Pneumonia; Morbidity; Incidence; Elective Surgical Procedures; Sepsis
PubMed: 37996343
DOI: 10.1016/j.surg.2023.10.015 -
Cell Reports. Medicine Sep 2023The long-term clinical outcomes of severe obesity due to leptin signaling deficiency are unknown. We carry out a retrospective cross-sectional investigation of a large...
The long-term clinical outcomes of severe obesity due to leptin signaling deficiency are unknown. We carry out a retrospective cross-sectional investigation of a large cohort of children with leptin (LEP), LEP receptor (LEPR), or melanocortin 4 receptor (MC4R) deficiency (n = 145) to evaluate the progression of the disease. The affected individuals undergo physical, clinical, and metabolic evaluations. We report a very high mortality in children with LEP (26%) or LEPR deficiency (9%), mainly due to severe pulmonary and gastrointestinal infections. In addition, 40% of surviving children with LEP or LEPR deficiency experience life-threatening episodes of lung or gastrointestinal infections. Although precision drugs are currently available for LEP and LEPR deficiencies, as yet, they are not accessible in Pakistan. An appreciation of the severe impact of LEP or LEPR deficiency on morbidity and early mortality, educational attainment, and the attendant stigmatization should spur efforts to deliver the available life-saving drugs to these children as a matter of urgency.
Topics: Child; Humans; Cross-Sectional Studies; Leptin; Morbidity; Obesity, Morbid; Retrospective Studies
PubMed: 37659411
DOI: 10.1016/j.xcrm.2023.101187 -
Clinics in Chest Medicine Sep 2023Over 80% of the morbidity and mortality related to acute and chronic respiratory diseases occur in low- and middle-income countries (LMICs), a reflection of vast... (Review)
Review
Over 80% of the morbidity and mortality related to acute and chronic respiratory diseases occur in low- and middle-income countries (LMICs), a reflection of vast disparities in care for these conditions. Over the next decade, the prevalence of respiratory diseases is expected to increase, as population growth in LMICs exceeds high-income countries (HICs). Pediatric morbidity and mortality from lower respiratory tract infections and asthma occur almost exclusively in LMICs, contributing to a greater loss of quality adjusted life years from these conditions when compared with HICs.
Topics: Humans; Child; Developing Countries; Health Equity; Asthma; Respiration Disorders; Prevalence
PubMed: 37517840
DOI: 10.1016/j.ccm.2023.03.015 -
Journal of Epidemiology and Community... Nov 2023For women whose first pregnancy was complicated by pre-eclampsia (PE), particularly if severe and requiring early birth, the risk of recurrence and maternal and neonatal... (Observational Study)
Observational Study
BACKGROUND
For women whose first pregnancy was complicated by pre-eclampsia (PE), particularly if severe and requiring early birth, the risk of recurrence and maternal and neonatal outcomes at subsequent birth are important considerations.
METHODS
In this observational cohort study, all primiparous women who gave birth in Denmark between 1997 and 2016 were identified using nationwide registries. Women were stratified by whether they developed PE and followed from date of birth until subsequent birth, emigration, death or end of study (December 2016). The cumulative incidences of subsequent birth among women with versus without PE were assessed using the Aalen-Johansen estimator. Subsequent outcomes including PE recurrence and maternal and neonatal morbidity and mortality were also examined. Factors associated with subsequent birth and recurrent PE were examined using multivariable Cox regression models.
RESULTS
Among 510 615 primiparous women with singleton pregnancies, 21 683 (4.2%) developed PE, with 1819 (0.4%) being early-onset PE (birth <34 weeks). Women with PE had a lower subsequent birth rate (57.4%) compared with women without PE (61.2%), and it was considerably lower among women with early-onset PE (49.4%). Among women with PE who had a subsequent birth, the overall recurrence rate of PE was 15.8% and higher among those with early-onset PE (31.5%). The gestational age increased with a median of 3 days (IQR -5 to 14) overall and 50 days (IQR 35-67) among those with early-onset PE. Moreover, neonatal and maternal morbidity and mortality were substantially improved in a subsequent pregnancy.
CONCLUSIONS
Primiparous women with PE have a significantly lower rate of a subsequent birth than women without PE, yet the absolute difference was modest. Although the overall risk of recurrent PE is 1 in 6, maternal and neonatal morbidity and mortality at subsequent birth are substantially improved.
Topics: Pregnancy; Infant, Newborn; Female; Humans; Pre-Eclampsia; Cohort Studies; Gestational Age; Parity; Incidence; Pregnancy Outcome
PubMed: 37541773
DOI: 10.1136/jech-2023-220829 -
Intensive Care Medicine Apr 2024The aim of this study is to provide a summary of the existing literature on the association between hypotension during intensive care unit (ICU) stay and mortality and... (Meta-Analysis)
Meta-Analysis
PURPOSE
The aim of this study is to provide a summary of the existing literature on the association between hypotension during intensive care unit (ICU) stay and mortality and morbidity, and to assess whether there is an exposure-severity relationship between hypotension exposure and patient outcomes.
METHODS
CENTRAL, Embase, and PubMed were searched up to October 2022 for articles that reported an association between hypotension during ICU stay and at least one of the 11 predefined outcomes. Two independent reviewers extracted the data and assessed the risk of bias. Results were gathered in a summary table and studies designed to investigate the hypotension-outcome relationship were included in the meta-analyses.
RESULTS
A total of 122 studies (176,329 patients) were included, with the number of studies varying per outcome between 0 and 82. The majority of articles reported associations in favor of 'no hypotension' for the outcomes mortality and acute kidney injury (AKI), and the strength of the association was related to the severity of hypotension in the majority of studies. Using meta-analysis, a significant association was found between hypotension and mortality (odds ratio: 1.45; 95% confidence interval (CI) 1.12-1.88; based on 13 studies and 34,829 patients), but not for AKI.
CONCLUSION
Exposure to hypotension during ICU stay was associated with increased mortality and AKI in the majority of included studies, and associations for both outcomes increased with increasing hypotension severity. The meta-analysis reinforced the descriptive findings regarding mortality but did not yield similar support for AKI.
Topics: Humans; Critical Care; Morbidity; Hospital Mortality; Hypotension; Acute Kidney Injury; Intensive Care Units
PubMed: 38252288
DOI: 10.1007/s00134-023-07304-4 -
Fertility and Sterility Aug 2023
Topics: Pregnancy; Humans; Female; Maternal Mortality; Morbidity; Pregnancy Complications
PubMed: 37271370
DOI: 10.1016/j.fertnstert.2023.05.168 -
JAMA Sep 2023
Topics: Morbidity; Mortality
PubMed: 37750877
DOI: 10.1001/jama.2023.16849 -
Future Oncology (London, England) Dec 2023Cancer is one of the leading causes of morbidity and mortality in India. Despite recent medical and technological advances, the cancer burden in India remains high and... (Review)
Review
Cancer is one of the leading causes of morbidity and mortality in India. Despite recent medical and technological advances, the cancer burden in India remains high and continues to rise. Moreover, substantial regional disparities in cancer incidence and access to essential medical resources exist throughout the country. While innovative and effective cancer therapies hold promise for improving patient outcomes, several barriers hinder their development and utilization in India. Here we provide an overview of these barriers, including challenges related to patient awareness, inadequate infrastructure, scarcity of trained oncology professionals, and the high cost of cancer care. Furthermore, we discuss the limited availability of cancer clinical trials in the country, along with an examination of potential avenues to enhance cancer care in India. By confronting these hurdles head-on and implementing innovative, pragmatic solutions, we take an indispensable step toward a future where every cancer patient in the country can access quality care.
Topics: Humans; Morbidity; Incidence; India; Neoplasms
PubMed: 37675499
DOI: 10.2217/fon-2023-0047