Identifying and documenting osseous trauma from shark attacks by post mortem CT examination and autopsy

A 15-year-old male was attacked by a large white shark while surfing. CT examination revealed an above-knee amputation of the right lower extremity with stripping of soft tissues from the groin distally. 3-dimensional volume rendering did not show any fragments of shark teeth but did reveal linear gouges, areas of shaving of cortical bone and an inverted 'V'-shaped defect at the distal margin of the femoral shaft. At autopsy these injuries were confirmed in addition to areas with fine parallel cross-striations matching the marginal serrations of the teeth of a white shark. Thus, while post mortem CT with 3-dimensional reconstruction at high resolution can show the nature and number of the bony injuries following shark attack, it is complimented by pathological examination which may find fine parallel grooves from teeth serrations. Post mortem 3-dimensional volume rendering may also help to find or exclude fragments of teeth, and silicone casting may provide a permanent record of bone lesions.

Investigating factors underlying why householders remain in at-risk areas during bushfire disaster in Australia

Although most homes lack design and construction features to withstand bushfires, there is a growing trend of householders relocating to bushfire-prone areas. Notably, many bushfire-related fatalities have occurred within proximity, specifically within 100 m of bushland. Therefore, this paper explores the factors that drive householders to remain in at-risk areas, despite the imminent threat of bushfires. Thirty semi-structured interviews were conducted with participants residing in the southeastern region of New South Wales (NSW). The interviews were recorded, transcribed using Otter.AI, and subjected to thematic analysis using NVivo 12 Pro. The findings shed light on why certain householders decided to stay on their properties during the catastrophic 2019/2020 bushfires. Upon analysis, we uncovered thirty-six distinct factors that underlie householders' choices to remain during bushfires. These factors were categorized into nine groups: protection-related, attitude-related, information-related, operation-related, road-related, shelter-related, finance-related, health-related, and rebuilding-related factors. The study underscores the importance of understanding gender-based differences and pet ownership in bushfire evacuation decisions, emphasizing the need for tailored communication strategies. These findings hold several important implications for research and practice regarding early self-evacuation from bushfires.

Death after smoking of fentanyl, 5F-ADB, 5F-MDMB-P7AICA and other synthetic cannabinoids with a bucket bong

PURPOSE

We report a case of a polydrug user who consumed various synthetic cannabinoids and fentanyl from a transdermal patch via a bucket bong. Toxicological results from postmortem matrices with special focus on synthetic cannabinoids are discussed in terms of their relevance to the death.

METHODS

The samples were analyzed by toxicological screening procedures involving immunoassays and gas chromatography-mass spectrometry (GC-MS) as well as quantitative analyses by means of GC-MS and high-performance liquid chromatography-tandem mass spectrometry (LC-MS/MS).

RESULTS

At the autopsy, coronary artery disease and signs of liver congestion were noted, in the absence of acute myocardial ischemic changes. Femoral blood concentrations of fentanyl and pregabalin were 14 ng/mL and 3,200 ng/mL, respectively. In addition, 2.7 ng/mL 5F-ADB and 13 ng/mL 5F-MDMB-P7AICA were detected together with relatively low amounts of 5 other synthetic cannabinoids in cardiac blood. A total number of up to 17 synthetic cannabinoids were detected in kidney, liver, urine and hair. Fentanyl and 5F-ADB were also detected in the water of the bucket bong.

CONCLUSIONS

The cause of death could be attributed to an acute mixed intoxication by fentanyl and 5F-ADB (both Toxicological Significance Score (TSS) = 3) with a contribution of pregabalin and 5F-MDMB-P7AICA (TSS = 2), in a subject suffering from pre-existing heart damage. The most plausible mechanism of death consists in a respiratory depression. This case report demonstrates that use of opioids in combination with synthetic cannabinoids might be particularly dangerous.

Fatal and Near-Fatal Anaphylaxis: Data From the European Anaphylaxis Registry and National Health Statistics

BACKGROUND

Anaphylaxis is a serious systemic reaction-data on fatal and near-fatal reactions are limited.

OBJECTIVE

To better understand clinical patterns and risks factors of severe anaphylaxis by a deep analysis of data from fatal and near-fatal anaphylaxis.

METHODS

Data from the European Anaphylaxis Registry on fatal/near-fatal anaphylactic reactions and national data on anaphylaxis fatalities were investigated.

RESULTS

A total of 305 fatal/near-fatal reactions among children and adults including 35 fatalities from the European Anaphylaxis Registry were identified. The most frequent elicitors were drugs, insects, and food. Male patients (66%/60%) were more frequently affected. Male sex, higher age, concomitant mastocytosis, and cardiovascular disease were associated with a more severe outcome. With increasing reaction severity, skin symptoms were less frequently observed (45% of fatal reactions). In parallel, anaphylaxis mortality rates were studied. The data show that anaphylaxis mortality rates increased in Germany from 0.48 (2009) to 0.59 per 1,000,000 population per year (2020). This increase was apparent only in the female population. In this data set, drugs were the most frequent elicitor of anaphylaxis fatalities, and the rate for this increased over time.

CONCLUSIONS

We identified not only elicitors but also individual factors to be associated with an increased risk of fatal anaphylaxis. Such patients should be recognized and managed with great caution. The increase in drug-induced fatalities points to the need for a better allergological care of patients suffering from drug hypersensitivity.

Impact of uncertainty induced by fatality function on future tropical cyclone risk assessment

Tropical cyclones (TCs) are among the deadliest extreme events occurring under a warming climate. Future TC risk assessment depend on TC projection from climate models and impact function relating TC to its possible consequence. Few studies have explored the uncertainty of impact function in future TC risk assessment compared to uncertainty in future TC characteristics. In this study, we investigate the uncertainty in TC fatality risk assessment induced by geographic and TC category-dependence of fatality function. We focus on all provinces in the mainland of China with historically recorded TC-induced fatalities and examine their TC fatality risks by assessing the difference in the annual average fatalities between current and future climate conditions. Synthetic TCs derived from four climate models and fatality functions parameterized from three grouped historical TC disaster datasets are used to observe the uncertainty induced by climate model and fatality function. Results show that the changes in the TC frequency, wind, TC-induced rainfall intensity, and exposure due to climate change in each province are dependent on the climate models. And the changes in the annual average fatality of each province are dependent on both the climate models and fatality functions. Climate models play a dominant role in determining the spatial pattern of future risk, while the fatality functions can alter the direction and magnitude of the risk change for certain provinces. Our results highlight the role of fatality function in detecting future TC risk under climate change, and inspire further TC impact studies that consider the heterogeneity of both climate conditions and geographical locations.

A network system for the prevention and treatment of mushroom poisoning in Chuxiong Autonomous Prefecture, Yunnan Province, China: implementation and assessment

BACKGROUND

Mushroom poisoning is a major public health issue in China. The integration of medical resources from different institutes of different levels is crucial in reducing the harm of mushroom poisoning. However, few studies have provided comprehensive implementation procedures and postimplementation effectiveness evaluations. To reduce the harm caused by mushroom poisoning, a network system for the prevention and treatment of mushroom poisoning (NSPTMP) was established in Chuxiong, Yunnan Province, a high-risk area for mushroom poisoning.

METHODS

The NSPTMP consists of three types of institutions, namely, centers for disease prevention, hospitals, and health administration departments, with each kind of institution comprising prefecture, county/city, town, and village levels. After three years of implementation, the network was evaluated by comparing the indices before and after network implementation using data from the "Foodborne Disease Outbreak Surveillance System" and 17 hospitals in Chuxiong. The indices included the fatalities caused by mushroom poisoning, the composition ratios of different types of mushrooms for both outpatients and inpatients and the hospitalization rates.

RESULTS

Compared to the average fatality rate of mushroom poisoning from 2015 to 2017, the average fatality rate from 2018 to 2020 significantly decreased from 0.57 to 0.06% (P < 0.001). Regarding the poisonous genus containing lethal mushrooms, the outpatient and inpatient composition ratios significantly decreased for Amanita (9.36-2.91% and 57.23-17.68%, respectively) and Russula (15.27-8.41%) (P < 0.05). Regarding poisonous mushrooms that caused mild symptoms, the outpatient and inpatient composition ratios significantly increased for Scleroderma (5.13-13.90% and 2.89-18.90%, respectively) and Boletaceae (19.08-31.71%) (P < 0.05), and the hospitalization rates significantly increased for Scleroderma (6.33-18.02%) and Boletaceae (5.65-12.71%) (P < 0.05).

CONCLUSIONS

These findings suggest that the NSPTMP effectively reduced the harm caused by mushroom poisoning. In addition to the integration of medical resources, the development of poisonous mushroom identification, hierarchical treatment systems in hospitals, public education, and professional training also played important roles in improving the system's effectiveness. The establishment and evaluation of the NSPTMP in Chuxiong Prefecture can provide valuable insights and serve as a model for other regions facing similar challenges in managing mushroom poisoning.

COVID-19 fatality rates in hospitalized patients: A new systematic review and meta-analysis

BACKGROUND

SARS-COV2 or COVID-19 disease is an infectious illness that emerged for the first time at the end of 2019, in Wuhan, China and rapidly turned out to be an international pandemic with deleterious effects all over the world. In March 2021, A. Macedo et al., has published the first meta-analysis of hospital mortality, so the authors decided to update those data at a time of emergence of new therapies and increasing vaccination rates.

METHODS

As the outcome of interest was the mortality in hospitalized general patients, the authors looked for articles evaluating the clinical characteristics of those patients, consulting PUBMED (The US National Library of Medicine) and EMBASE (Medical database) in an independent selection using predefined terms of search. A meta-analysis random-effect model was estimated using Mantel-Haenszel method. Heterogeneity among studies was tested using Tau2 statistics and Chi2 statistics.

RESULTS

In a first instance 25 articles were included for final analysis with a total of 103,840 patients, but as the goal was to update the anterior data, these studies were analysed together with the 21 studies of the previous meta-analysis, with a total of 114609 patients. The mortality rate of COVID-19 general patients admitted to the hospital was 16% (95% CI 12; 21, I2 =100%).

CONCLUSION

Global hospital mortality of COVID-19 of general patients was 16%, with quite different rates according to the different geographic areas analysed.

Fatal fall-from-height accidents: Statistical treatment using the Human Factors Analysis and Classification System - HFACS

INTRODUCTION

The civil construction industry (CCI) is one of the most dangerous sectors for occupational accidents. Studies conducted in several countries show that occupational accidents involving falls from height are the main cause of deaths in recent years.

METHOD

This article analyzed the combinations of causal factors with the highest likelihood of accidents involving falls from height in construction to assist in decision-making. The methodology was divided into four stages: accident collection and sample definition; accident analysis; probability determination; and obtaining the theoretical curve of an accident probability distribution. The methodology was applied to reports of fatal fall-from-height accidents that occurred in the United States between 1997 and 2020.

RESULTS

The results show that among the accidents analyzed, the highest probability of fatality is when a roofer aged between 31 and 44 years performs their activity on a roof between 10:00 and 11:59 am. It is also noted that the three causal factors most present in the accidents were: organizational process (97.7%); poor management of worker resources (96.6%); and organizational climate (95.4%). From the probability distribution curve, 68% of the fatal accidents occurred after reaching between 18 and 34 causal factors present in the HFACS method categories.

Epilepsy-related mortality during the COVID-19 pandemic: A nationwide study of routine Scottish data

OBJECTIVE

To examine whether epilepsy-related deaths increased during the COVID-19 pandemic and if the proportion with COVID-19 listed as the underlying cause is different between people experiencing epilepsy-related deaths and those experiencing deaths unrelated to epilepsy.

METHODS

This was a Scotland-wide, population-based, cross-sectional study of routinely-collected mortality data pertaining to March-August of 2020 (COVID-19 pandemic peak) compared to the corresponding periods in 2015-2019. ICD-10-coded causes of death of deceased people of any age were obtained from a national mortality registry of death certificates in order to identify those experiencing epilepsy-related deaths (coded G40-41), deaths with COVID-19 listed as a cause (coded U07.1-07.2), and deaths unrelated to epilepsy (death without G40-41 coded). The number of epilepsy-related deaths in 2020 were compared to the mean observed through 2015-2019 on an autoregressive integrated moving average (ARIMA) model (overall, men, women). Proportionate mortality and odds ratios (OR) for deaths with COVID-19 listed as the underlying cause were determined for the epilepsy-related deaths compared to deaths unrelated to epilepsy, reporting 95% confidence intervals (CIs).

RESULTS

A mean number of 164 epilepsy-related deaths occurred through March-August of 2015-2019 (of which a mean of 71 were in women and 93 in men). There were subsequently 189 epilepsy-related deaths during the pandemic March-August 2020 (89 women, 100 men). This was 25 more epilepsy-related deaths (18 women, 7 men) compared to the mean through 2015-2019. The increase in women was beyond the mean year-to-year variation seen in 2015-2019. Proportionate mortality with COVID-19 listed as the underlying cause was similar between people experiencing epilepsy-related deaths (21/189, 11.1%, CI 7.0-16.5%) and deaths unrelated to epilepsy (3,879/27,428, 14.1%, CI 13.7-14.6%), OR 0.76 (CI 0.48-1.20). Ten of 18 excess epilepsy-related deaths in women had COVID-19 listed as an additional cause.

CONCLUSIONS

There is little evidence to suggest there have been any major increases in epilepsy-related deaths in Scotland during the COVID-19 pandemic. COVID-19 is a common underlying cause of both epilepsy-related and unrelated deaths.

Vaccine effectiveness and the epidemiological characteristics of a COVID-19 outbreak in a tertiary hospital in Republic of Korea

BACKGROUND

Healthcare facilities are high-risk sites for infection. This study analyzed the epidemiological characteristics of a coronavirus disease 2019 (COVID-19) outbreak in a tertiary hospital after COVID-19 vaccination had been introduced in Republic of Korea. Vaccine effectiveness (VE) and shared anti-infection strategies are also assessed.

METHODS

The risk levels for 4,074 contacts were evaluated. The epidemiological characteristics of confirmed cases were evaluated using the chi-square test. The "1 minus relative risk" method was used to determine VE in preventing infection, progression to severe disease, and death. In the largest affected area (the 8th floor), a separate relative risk analysis was conducted. A multivariate logistic regression analysis (with 95% confidence interval [CIs]) was used to identify transmission risk factors with a significance level <10% via the backward elimination method.

RESULTS

In total, 181 cases of COVID-19 were confirmed, with an attack rate of 4.4%. Of those cases, 12.7% progressed to severe disease, and 8.3% died. In the cohort isolation area on the 8th floor, where 79.0% of the confirmed cases occurred, the adjusted odds ratio was 6.55 (95% CI, 2.99-14.33) and 2.19 (95% CI, 1.24-3.88) for caregivers and the unvaccinated group, respectively. VE analysis revealed that 85.8% of the cases that progressed to severe disease and 78.6% of the deaths could be prevented by administering a second vaccine.

CONCLUSION

Caregiver training for infection prevention and control is necessary to reduce infection risk. Vaccination is an important intervention to reduce the risk of progression to severe disease and death.

A Reservoir Computing with Boosted Topology Model to Predict Encephalitis and Mortality for Patients with Severe Fever with Thrombocytopenia Syndrome: A Retrospective Multicenter Study

INTRODUCTION

Severe fever with thrombocytopenia syndrome virus (SFTSV) is an emerging tick-borne virus associated with a high rate of mortality, as well as encephalitis. We aim to develop and validate a machine learning model to early predict the potential life-threatening conditions of SFTS.

METHODS

The clinical presentation, demographic information, and laboratory parameters from 327 patients with SFTS at admission in three large tertiary hospitals in Jiangsu, China between 2010 to 2022 are retrieved. We establish a reservoir computing with boosted topology (RC-BT) algorithm to obtain the models' predictions of the encephalitis and mortality of patients with SFTS. The prediction performances of encephalitis and mortality are further tested and validated. Finally, we compare our RC-BT model with the other traditional machine learning algorithms including Lightgbm, support vector machine (SVM), Xgboost, Decision Tree, and Neural Network (NN).

RESULTS

For the prediction of encephalitis among patients with SFTS, nine parameters are selected with equal weight, namely calcium, cholesterol, muscle soreness, dry cough, smoking history, temperature at admission, troponin T, potassium, and thermal peak. The accuracy for the validation cohort by the RC-BT model is 0.897 [95% confidence interval (CI) 0.873-0.921]. The sensitivity and negative predictive value (NPV) of the RC-BT model are 0.855 (95% CI 0.824-0.886) and 0.904 (95% CI 0.863-0.945), respectively. Area under curve of the RC-BT model for the validation cohort is 0.899 (95% CI 0.882-0.916). For the prediction of fatality among patients with SFTS, seven parameters are selected with equal weight, namely calcium, cholesterol, history of drinking, headache, field contact, potassium, and dyspnea. The accuracy of the RC-BT model is 0.903 (95% CI 0.881-0.925). The sensitivity and NPV of the RC-BT model are 0.913 (95% CI 0.902-0.924) and 0.946 (95% CI 0.917-0.975), respectively. The area under curve is 0.917 (95% CI 0.902-0.932). Importantly, the RC-BT models outperform the other artificial intelligence-based algorithms in both prediction tasks.

CONCLUSIONS

Our two RC-BT models of SFTS encephalitis and fatality demonstrate high area under curves, specificity, and NPV, with nine and seven routine clinical parameters, respectively. Our models can not only greatly improve the early prognosis accuracy of SFTS, but can also be widely applied in underdeveloped areas with limited medical resources.

The final destination: Incorporating 'Death by GPS' into forensic and legal sciences

This article seeks to give visibility to a growing program: Motorists who set out for travel following directions from their GPS device and never return. These occurrences have gained the moniker 'Death by GPS'. From giving incorrect directions, to taking motorists to isolated areas, to directing motorists into unsafe neighborhoods, GPS technology has led several people into catastrophic scenarios. This article is split into two sections. In the first section, the varying causes of Death by GPS are examined, alongside notable cases. In the second section, as Death by GPS is understudied in forensic science and legal spaces, the author explores the societal and scientific benefits of filling this gap. Relying on relevant collision figures, cultural trends, death science, legal studies, and ethics literature, this article produces groundwork on the growing issue of Death by GPS and identifies areas for future exploration.

Nationwide epidemiologic study for fibrosing interstitial lung disease (F-ILD) in South Korea: a population-based study

BACKGROUND

Fibrosing interstitial lung disease (F-ILD) is a major public health concern due to its poor prognosis. Recent clinical evidence shows that antifibrotic approaches such as pirfenidone and nintedanib provide better clinical outcome prediction in idiopathic pulmonary fibrosis (IPF) as well as selected progressive fibrosing ILD (PF-ILD) patients. Having epidemiologic insight into these diseases will be essential for the efficient utilization of these therapeutic resources. This study aimed to estimate the current prevalence, incidence, and mortality of F-ILD classified as idiopathic pulmonary fibrosis (IPF), PF-ILD other than IPF, and non-progressive F-ILD and their temporal trend in Korea.

METHODS

Population-based retrospective cohort study was conducted using the Korean Health Insurance Review and Assessment (HIRA) database (2011-2018). Patients with IPF were identified using ICD-10 code, RID code, and differential diagnosis approach. By leveraging medical records available from claim data and referencing those used in clinical trials, rigorous diagnostic criteria for PF-ILD detection were implemented.

RESULTS

For the past eight years, the prevalence of IPF and PF-ILD has progressively increased, while non-progressive F-ILD has remained stable. IPF, PF-ILD, and non-progressive F-ILD prevalence per 100,000 in 2018 were 16.9, 10.4, and 11.7, respectively. The incidence of IPF in 2018 was more than twice that of 2012. The incidence of PF-ILD in 2018 was 1.5 times higher than that in 2012. In 2018, the mortalites were 10.3% and 12.2% for IPF and PF-ILD, respectively. The mortality rate of PF-ILD was greater than that of IPF in all years. Unclassifiable PF-ILD and rheumatoid arthritis-PF-ILD had the highest proportion and mortality among the PF-ILD subtypes.

CONCLUSION

The prevalence and incidence of IPF and PF-ILD have been steadily increasing in recent years. The mortality rate of PF-ILD remained consistently high and exceeded those of IPF in all years.

Dog-related deaths registered in England and Wales from 2001 to 2021

OBJECTIVE

This study aimed to describe the incidence and demographics of fatal dog bites or strikes, as defined in English and Welsh mortality data (2001-2021).

STUDY DESIGN

A descriptive analysis of the Office for National Statistics registered deaths data set.

METHODS

Individuals whose cause of death was defined as 'bitten or struck by a dog' were identified. The average annual number of dog-related deaths and trends in incidence were calculated. Age and sex demographics of victims were described.

RESULTS

In total, there were 69 registered deaths, a mean of 3.3 (95% confidence interval 0.3-6.3) dog-related deaths per year, and a mean annual incidence of 0.59 (95% confidence interval 0.06-1.11) deaths per 10 million population. There was no year-on-year change in incidence. Of victims, 59% were male, 10% were <5 years, and 30% were ≥75 years.

CONCLUSIONS

Dog-related deaths are rare in England and Wales and have not increased between 2001 and 2021. Further contextual information about the incidents is needed to be able to develop public health strategies and interventions.

Pediatric poisoning deaths in Saudi Arabia: A systematic review

Poisons are potentially harmful substances that can cause damage to the human body. Children are a vulnerable group to poisoning. This article aims to review the deaths due to poisoning among children in Saudi Arabia. A comprehensive search was conducted on 13 January 2022 using PubMed, Scopus, and Web of Science databases to identify articles that reported on pediatric poisoning deaths in Saudi Arabia. Eight articles met the inclusion criteria and were included in this systematic review. Some articles included one city, for instance, Jeddah or Riyadh, while others included different regions of the country. Children got poisoned most commonly at their homes by accidental ingestion. The common substances that caused fatality included drugs and pesticides. Low caregiver awareness and neglect were recognized as risk factors for pediatric poisoning. Further studies should be conducted to provide comprehensive details about the victims, the poisons involved, and the circumstances of pediatric poisonings in Saudi Arabia at the national and sub-national levels. Public awareness campaigns should be organized to raise community awareness about safety measures and risks of neglect to prevent pediatric poisonings.

Social and demographic characteristics of child maltreatment fatalities among children ages 5-17 years

BACKGROUND

While risk factors have been identified among infants and young children, less is known about child maltreatment fatalities among older children.

OBJECTIVES

To describe the social and demographic characteristics of children where abuse or neglect was determined to cause or contribute to their death, compare characteristics and circumstances of the deaths by cause and manner of death and type of maltreatment, and explore the role of abuse and neglect in child suicides.

PARTICIPANTS AND SETTING

Secondary analysis of deaths due to child abuse or neglect among children ages 5-17 years old occurring during 2009-2018 and documented in the National Fatality Review-Case Reporting System.

METHODS

Child, family, and social characteristics were compared by child age (5-10 years vs. 11-17 year-olds), and by cause and manner of death. Frequencies and proportions were reported and compared using chi-square statistics.

RESULTS

1478 maltreatment-related deaths were identified. Higher proportions of older children were non-Hispanic white, had a history of chronic disease or disability, had problems in school, and had a history of mental health issues. Forty-three percent of the maltreatment deaths were due to homicide and 10 % by suicide. Higher proportions (65 %) of younger children (5-10 years old) died by homicide, compared to older children (35 % among ages 11-17y). While 58 % of deaths overall were related to neglect, 68 % of deaths in older children were related to neglect, including 80 % of suicides.

CONCLUSIONS

The causes of child maltreatment deaths among children 5-17y vary by age. Child neglect caused and/or contributed to most child suicides.

Crash characteristics for classic/historic vehicles and comparisons to newer vehicles

INTRODUCTION

Older vehicles, commonly referred to as "classic," "vintage," or "historic" vehicles (CVH), share the roadways with newer vehicles. Older vehicles lacking safety systems likely come with an increased risk of fatality, however there is no study examining the typical conditions for crashes involving CVH.

METHOD

This study utilized information from crashes occurring in 2012 to 2019 to estimate fatal crash rates for vehicles grouped by model year deciles. Data from crashes documented in the National Highway Traffic Safety Administration's (NHTSA) FARS and GES/CRSS data sets were utilized to examine roadway, temporal, and crash types for passenger vehicles produced in 1970 or earlier (CVH).

RESULTS

These data show CVH crashes are rare (<1% of crashes), but carry a relative risk of fatality from 6.70 (95th CI: 5.44-8.26) for impacts with other vehicles, which was the most common crash, to 9.53 (7.28-12.47) for rollovers. Most crashes occurred in dry weather, typically during summer, in rural areas, most frequently on two lane roads, and in areas with speed limits between 30 and 55 mph. Factors associated with fatality for occupants in CVH included alcohol use, lack of seat belt use, and older age.

CONCLUSIONS AND PRACTICAL APPLICATIONS

Crashes involving a CVH are a rare event but have catastrophic consequences when they do occur. Regulations that limit driving to daylight hours may lower the risk of crash involvement, and safety messaging to promote belt use and sober driving may also help. Additionally, as new "smart" vehicles are developed, engineers should keep in mind that older vehicles remain on the roadway. New driving technologies will need to safely interact with these older, less safe vehicles.

The Epidemiology of Moderate and Severe Traumatic Brain Injury in Central Norway

INTRODUCTION

Few studies account for prehospital deaths when estimating incidence and mortality rates of moderate and severe traumatic brain injury (msTBI). In a population-based study, covering both urban and rural areas, including also prehospital deaths, the aim was to estimate incidence and mortality rates of msTBI. Further, we studied the 30-day and 6-month case-fatality proportion of severe TBI in relation to age.

METHODS

All patients aged ≥17 years who sustained an msTBI in Central Norway were identified by three sources: (1) the regional trauma center, (2) the general hospitals, and (3) the Norwegian Cause of Death Registry. Incidence and mortality rates were standardized according to the World Health Organization's world standard population. Case-fatality proportions were calculated by the number of deaths from severe TBI at 30 days and 6 months, divided by all patients with severe TBI.

RESULTS

The overall incidence rates of moderate and severe TBI were 4.9 and 6.7 per 100,000 person-years, respectively, increasing from age 70 years. The overall mortality rate was 3.4 per 100,000 person-years, also increasing from age 70 years. Incidence and mortality rates were highest in men. The case-fatality proportion in people with severe TBI was 49% in people aged 60-69 years and 81% in people aged 70-79 years.

CONCLUSION

The overall incidence and mortality rates for msTBI in Central Norway were low but increased from age 70 years, and among those ≥80 years of age with severe TBI, nearly all died. Overall estimates are strongly influenced by high incidence and mortality rates in the elderly, and studies should therefore report age-specific estimates, for better comparison of incidence and mortality rates.

Hospital Strain and COVID-19 Fatality - England, April 2020-March 2022

What is already known about this topic?

During the coronavirus disease 2019 (COVID-19) pandemic, tremendous efforts have been made in countries to suppress epidemic peaks and strengthen hospital services to avoid hospital strain and ultimately reduce the risk of death from COVID-19. However, there is limited empirical evidence that hospital strain increases COVID-19 deaths.

What is added by this report?

We found the risk of death from COVID-19 was linearly associated with the number of patients currently in hospitals, a measure of hospital strain, before the Omicron period. This risk could be increased by a maximum of 188.0%.

What are the implications for public health practice?

These findings suggest that any (additional) effort to reduce hospital strain would be beneficial during early large COVID-19 outbreaks and possibly also others alike. During an Omicron outbreak, vigilance remains necessary to prevent excess deaths caused by hospital strain as happened in Hong Kong Special Administrative Region, China.

Cardiac disease and driver fatality

To determine the role of cardiac disease in driver fatalities, a retrospective review of autopsy files at Forensic Science SA in Adelaide, Australia, was undertaken over a 13-year-period January 2005-December 2017 for individuals aged ≥ 40 years who had died while driving a motor vehicle. The incidence of significant coronary artery atherosclerosis (CAA) and cardiomegaly was evaluated with comparisons between drivers and a control group of passengers. Autopsy examinations were performed on 303 drivers and 72 passengers who died of trauma and on 63 drivers who died of a cardiac event while driving. The average age for drivers dying of trauma was 58.5 years (range 40-93 years) with 48 (15.8%) having CAA and 31 (10.2%) having cardiomegaly. This was not statistically different to passengers (aged 63.3 years; range 40-93 years; 20.8% having CAA; 11 (15.2%) cardiomegaly; (p > 0.2). Drivers with significant cardiac disease did not, therefore, have increased rates of death in crashes, although a distinct subgroup of drivers consisted of those who had died from cardiac events and not trauma, while driving. The latter may be increasing in number given the aging population.

Effects of corticosteroids treatment in patients with Severe Fever with Thrombocytopenia Syndrome:A single-center retrospective cohort study

OBJECTIVES

To evaluate the effect and safety of corticosteroids(CS) treatment in patients with severe fever with thrombocytopenia syndrome(SFTS).

METHODS

Patients with and without CS were retrospectively compared by COX regression and 1:1 propensity score matching analysis to evaluate the effects of CS on mortality and secondary infections in patients with SFTS.

RESULTS

A total of 467 SFTS patients were enrolled in the cohort study, there were 52 fatal cases and 415 nonfatal cases,the overall fatality rate was 11.1%. The mortality were observed in 36/144 (25%) and 16/323 (5%) patients in the CS-treated and non-CS-treated groups,respectively (P<0.001).Multivariate cox regression analysis showed that the difference was not statistically significant for CS treatment in the fatality (P>0.05, aHR 1.003, 95%CI 0.49-2.06).Difference in survival time between CS-treated and non-CS-treated groups after propensity score matching had no statistically significant (Log-Rank test P=0.390),whereas there was a significant difference in secondary infections between the CS-treated and non-CS-treated groups (P=0.007).

CONCLUSIONS

Although the CS treatment had no influence on fatality in patients with SFTS, it increased the risk of secondary infections.Administration of CS in patients with SFTS should be carefully considered and take into account the balance between therapeutic efficacy and adverse effects.

Diagnosis and prognosis of COVID-19 employing analysis of patients' plasma and serum via LC-MS and machine learning

OBJECTIVE

To implement and evaluate machine learning (ML) algorithms for the prediction of COVID-19 diagnosis, severity, and fatality and to assess biomarkers potentially associated with these outcomes.

MATERIAL AND METHODS

Serum (n = 96) and plasma (n = 96) samples from patients with COVID-19 (acute, severe and fatal illness) from two independent hospitals in China were analyzed by LC-MS. Samples from healthy volunteers and from patients with pneumonia caused by other viruses (i.e. negative RT-PCR for COVID-19) were used as controls. Seven different ML-based models were built: PLS-DA, ANNDA, XGBoostDA, SIMCA, SVM, LREG and KNN.

RESULTS

The PLS-DA model presented the best performance for both datasets, with accuracy rates to predict the diagnosis, severity and fatality of COVID-19 of 93%, 94% and 97%, respectively. Low levels of the metabolites ribothymidine, 4-hydroxyphenylacetoylcarnitine and uridine were associated with COVID-19 positivity, whereas high levels of N-acetyl-glucosamine-1-phosphate, cysteinylglycine, methyl isobutyrate, l-ornithine and 5,6-dihydro-5-methyluracil were significantly related to greater severity and fatality from COVID-19.

CONCLUSION

The PLS-DA model can help to predict SARS-CoV-2 diagnosis, severity and fatality in daily practice. Some biomarkers typically increased in COVID-19 patients' serum or plasma (i.e. ribothymidine, N-acetyl-glucosamine-1-phosphate, l-ornithine, 5,6-dihydro-5-methyluracil) should be further evaluated as prognostic indicators of the disease.

Passenger Presence and the Relative Risk of Teen Driver Death

PURPOSE

This study examines the relative risk of death among crash-involved teenage drivers in relation to the number and ages of passengers present.

METHODS

We performed cross-sectional analysis of police-reported crashes in the United States in years 2016-2019 to estimate rate ratios for death among drivers aged 16-17 years by passenger composition (no passengers, one teen, ≥two teens, teens and adults aged 20-34 years, adults aged 20-34 years only, ≥one adult aged 35-64 years). Models were adjusted for confounding and effect modification related to driver, crash, and environmental factors.

RESULTS

Crash-involved teen drivers carrying ≥2 teen passengers were twice as likely to die as teens driving alone. The driver was seven times as likely to die when carrying a mix of teen and young adult passengers compared with teens driving alone. Teen drivers' risk of death was lowest in the presence of an adult passenger aged 35-64 years. Carrying one teen passenger presents greater risk of death than driving alone for male teen drivers but not for females.

DISCUSSION

When teen drivers crash, they are more likely to die if they are carrying teen and/or young adult passengers than if they are driving alone or with a mature adult. The results support the current graduated licensing policies restricting young novice drivers from carrying teenage passengers. Results also help to clarify why previous studies have found that young passengers are associated with increased risk of fatal crashes, but not nonfatal crashes: it appears that passengers may have an effect on crash severity.

Assessment of Recovery Time, Worsening and Death, among COVID-19 inpatients and outpatients, under treatment with Hydroxychloroquine or Chloroquine plus Azithromycin Combination in Burkina Faso

OBJECTIVES

Our study aimed to assess the statistical relationship between the use of chloroquine phosphate or hydroxychloroquine plus azithromycin (CQ/HCQ + AZ) and virological recovery, disease worsening, and death among out- and inpatients with COVID-19 in Burkina Faso.

METHODS AND DESIGNS

This was a retrospective observational study that compared outcomes in terms of time to recovery, worsening, and death in patients who received CQ/HCQ + AZ and those who did not using a multivariable Cox or Poisson model before and after propensity matching.

RESULTS

Of the 863 patients included in the study, about 50% (432/863) were home-based follow-up patients and 50% were inpatients. Of these, 83.3% (746/863) received at least 1 dose of CQ/HCQ + AZ and 13.7% (118/863) did not. There were no significant differences in associated time to recovery for patients receiving any CQ/HCQ + AZ (adjusted HR 1.44; 95% CI 0.76-2.71). Similarly, there was no significant association between CQ/HCQ + AZ use and worsening (adjusted IRR 0.80; 95% CI 0.50-1.50). However, compared with the untreated group, the treated group had a lower risk of death (adjusted HR 0.20; 95% CI 0.10-0.44).

CONCLUSIONS

The study provided valuable additional information on the use of CQ/HCQ in patients with COVID-19 and did not show any harmful outcomes of CQ/HCQ + AZ treatment.

Accident or suicide? Improvement in the classification of suicides among road traffic fatalities in Sweden by extended psychosocial investigations, during the years 2010-2019

INTRODUCTION

Suicide is the second leading cause of death in the ages 15-29 worldwide, exceeded only by road injury. However, fatalities in road traffic may be either accidents or suicides. In 2010 Sweden began efforts to separately report deaths in road traffic as either accidents or suicides.

METHOD

Three alternative criteria defining what constitutes a fatality by suicide were introduced. After exclusion of natural deaths, fatalities were also classified on a five-level graded scale, which distinguished between accident, undetermined, and suicide. The investigations of fatalities were complemented by extended psychosocial investigations in 2012. The improvement in the classification of suicide deaths was evaluated by an intra-year 2012 comparison, as well as using the 2010-2012 period as a control to evaluate the continued use of extended psychosocial investigations during the 2013-2019 period.

RESULTS

The 2012 intra-year comparison showed a 63% increase in the number of identified suicides when using extended psychosocial investigations. The additional 14 suicides identified in 2012 were mainly attributed to a resolution of 12 "undetermined" causes of deaths. Suicides of all road fatalities increased from 5.7-6.8% in 2010-2011, to 11.2% in 2012. Over the subsequent period 2013-2019 with extended psychosocial investigations, suicides of all road fatalities averaged 10%, a 60% increase over prior years. An average of ∼9 additional suicides was identified each year during 2013-2019, which was accompanied by an annual reduction of ∼6 "undetermined" fatalities.

CONCLUSION

The use of extended psychosocial investigations is of major importance for our knowledge about the occurrence of suicides in road traffic. Practical applications: A standardized and in-depth classification of suicide deaths is a basic prerequisite needed for the cooperation, implementation, and effect-evaluations of suicide intervention and prevention efforts, with potential to include the entire Swedish transportation system.

CNS and PNS manifestation in immune checkpoint inhibitors: A systematic review

INTRODUCTION

Immunomodulatory therapies, including the use of immune checkpoint inhibitors (ICIs), have made a profound impact on treatment of advanced cancers in recent decades. Neurologic immune-related adverse events (irAEs) related to use of these agents are rare but potentially fatal sequelae. This systematic reviewed aimed to describe onset, clinical features, treatment, and outcome of neurological irAEs following ICI usage.

METHODS

A systematic literature search was conducted to identify all case reports (n = 168) and case series (n = 29) describing neurological irAEs (n = 255 patients). Patient demographics, clinical features, and clinical courses were extracted and used to assess statistical relationships between reported variables.

RESULTS

Of reports describing neurological irAEs related to ICI use, the majority of cases were in men (66%) and patients above the age of fifty (85%). Disorders of the peripheral nervous system (PNS, 83%) were more common than central nervous system involvement. Neuromuscular disorders were the most common type of neurological irAE (e.g. myasthenia gravis, 36%), followed by peripheral neuropathies (16%), followed by all CNS disorders combined (15%). Most cases presented within the first 5 doses of ICI treatment. Most patients improved clinically, but 24% of cases were fatal. Mortality was highest in patients with neuromuscular irAEs, such as myasthenia gravis and myositis.

CONCLUSION

This systematic literature review describes the largest collection of neurological irAEs to date including both CNS and PNS manifestations of ICIs. The information described herein can be used to better inform monitoring and treatment of patients undergoing treatment with ICIs.

Motor vehicle crashes on tribal reservations: mapping and statistics

Background

Motor vehicle crashes (MVC’s) in the American Indian/Alaska Native (AI/AN) communities account for 43% of unintentional injury deaths. This article introduces MVC data and geographic information system (GIS) mapping for tribal reservations.

Methods

Utilizing a sample of Montana Department of Transportation (DOT) data for the Flathead reservations to calculate frequencies and proportions of crash types (i.e., property damage or no-injury, injury, fatality or unknown), while also mapping these data to provide a cross-sectional snapshot of MVC’s.

Results

Overall, 515 MVC’s occurred for years 2016 through 2018, with no-injury, injury, and fatality accounting for 72.2%, 24.9% and 1.8% of all crashes, respectively, with the number of MVC’s ranging up to 30 per square mile.

Conclusion

Examining DOT data and utilizing it for visual representation of MVC’s can be used as an additional source in uncovering patterns and trends on Tribal reservations and supporting MVC prevention efforts.

EPIDEMIOLOGICAL DETERMINANTS FOR THE SPREAD OF COVID-19 IN RIYADH PROVINCE OF SAUDI ARABIA

Background and objective

Coronavirus Disease 2019 (COVID-19) has affected millions of individuals all over the world. In addition to the patients' compelling indications, various sociodemographic characteristics were identified to influence infection complications. The purpose of this study was to assess the impact of the aforementioned parameters on the dissemination of COVID-19 among residents of Saudi Arabia's Riyadh region.

Materials and Methods

In the Saudi Arabian province of Riyadh, a cross-sectional retrospective analysis of COVID-19 incidences, recoveries, and case-fatality ratio (CFR) was undertaken. The study was carried out by gathering daily COVID-19 records from the ministry of health's official websites between October 2020 and September 2021. The influencing factors were obtained from the statistical authority. Using the SPSS IBM 25 software, the data was examined. The association between demographic factors as well as the presence of comorbidity on the COVID-19 outcome was determined using Spearman's correlation and regression tests. P<0.05 was considered to indicate the significance of the results.

Results

The data from the study indicated that the highest number of COVID-19 cases were recorded in June 2021, and peak recovery was observed in July 2021. The CFR declined progressively from October 2020 to just over 1, even when the cases peaked. A significant (p<0.05) correlation between diabetes and COVID-19 incidences was observed . The recovery rate had a significant (p<0.05) association with the literacy rate and those aged 14 - 49 years old. Presences of co-morbidities such as Dyslipidemia, hypertension, diabetes, asthma, stroke and heart failure have negatively affected the recovery from COVID-19 in the population. The CFR is significantly (p< 0.05) associated with people over 60, hypertensive patients, and asthma patients. Regression analysis suggested that the risk of complications due to COVID-19 infection is more in males, people above 60 years age and those suffering from co-morbidities .

Conclusions

The findings of the study indicate an association between several of the characteristics studied, such as gender, age, and comorbidity, and the spread of infection, recovery, and mortality. To restrict the spread of COVID-19 and prevent its complications, effective measures are required to control the modifiable risk factors.

Nighttime pedestrian fatalities: A comprehensive examination of infrastructure, user, vehicle, and situational factors

INTRODUCTION

Pedestrian fatalities in the United States increased 45.5% between 2009 and 2017. More than 85% of those additional pedestrian fatalities occurred at night.

METHOD

We examine Fatality Analysis Reporting System (FARS) data for fatal pedestrian crashes that occurred in the dark between 2002 and 2017. Within-variable and before/after examinations of crashes in terms of infrastructure, user, vehicle, and situational characteristics are performed with one-way analysis of variance (ANOVA) and two-sample t-tests. We model changes in crash characteristic proportions between 2002-2009 and 2010-2017 using linear regressions and test for autocorrelation with Breusch-Godfrey tests.

RESULTS

The increase in fatal nighttime pedestrian crashes is most strongly correlated with infrastructure factors: non-intersection unmarked locations (saw 80.8% of additional fatalities); 40-45 mph roads (54.6%); five-lane roads (40.7%); urban (99.7%); and arterials (81.1%). In addition, SUVs were involved in 39.7% of additional fatalities, overrepresenting their share of the fleet. Increased pedestrian alcohol and drug involvement warrant further investigation. The age of pedestrians killed increased more (18.1%) than the national average (3.2%).

CONCLUSIONS

By identifying factors related to the increase in nighttime pedestrian fatalities, this work constitutes a vital first step in making our streets safer for pedestrians. Practical Applications: More research is needed to understand the efficacy of different solutions, but this paper provides guidance for such future research. Engineering solutions such as road diets or traffic calming may be used to improve identified infrastructure issues by reducing vehicle speeds and road widths. Rethinking vehicle design, especially high front profiles, may improve vehicle issues. However, the problems giving rise to these pedestrian fatalities are likely a result of not only engineering issues but also interrelated social and political factors. Solutions may be correspondingly comprehensive, employing non-linear, systems-based approaches such as Safe Systems.

Disease-modifying therapies and progressive multifocal leukoencephalopathy in multiple sclerosis: A systematic review and meta-analysis

Background High efficacy disease modifying therapies (DMT) in the management of Multiple Sclerosis (MS) have a favorable effect on relapse rate and disability progression; however, they can expose patients to significant risks, such as progressive multifocal leukoencephalopathy (PML). Objective The study aims to investigate prognostic factors that can determine outcome in MS-related PML patients. Methods We conducted a literature review and meta-analysis of 194 patients from 62 articles in PubMed, SCOPUS and EMBASE. Results Out of 194 patients (66.5% women, 33.5% men), 81% had progression in their EDSS score by at least 1 point from the time of PML diagnosis (EDSS-P group). The remaining patients had either stable or improved EDSS (EDSS-S group). In univariate analysis, older age at the time of PML diagnosis was associated with higher probability of disability accumulation and worsening of EDSS by at least 1 point (mean age = 44.8, p = 0.046). After adjusting for other variables, age at time of PML diagnosis remained a significant predictive variable in the multivariable logistic model (OR = 0.93, 95% CI: 0.88-0.99, p = 0.037). Natalizumab is the most commonly associated DMT linked to PML, followed by fingolimod and others including dimethyl fumarate, ocrelizumab, alemtuzumab. Among the different treatments used, no therapeutic agent was found to be superior in improving post-PML EDSS. Conclusions Younger age and lower JCV viral load at the time of PML diagnosis were associated with better outcome in MS-associate PML, while none of the PML therapies was superior over the others or associated with favorable outcome.

Estimates of global SARS-CoV-2 infection exposure, infection morbidity, and infection mortality rates in 2020

We aimed to estimate, albeit crudely and provisionally, national, regional, and global proportions of respective populations that have been infected with SARS-CoV-2 in the first year after the introduction of this virus into human circulation, and to assess infection morbidity and mortality rates, factoring both documented and undocumented infections. The estimates were generated by applying mathematical models to 159 countries and territories. The percentage of the world's population that has been infected as of 31 December 2020 was estimated at 12.56% (95% CI: 11.17-14.05%). It was lowest in the Western Pacific Region at 0.66% (95% CI: 0.59-0.75%) and highest in the Americas at 41.92% (95% CI: 37.95-46.09%). The global infection fatality rate was 10.73 (95% CI: 10.21-11.29) per 10,000 infections. Globally per 1000 infections, the infection acute-care bed hospitalization rate was 19.22 (95% CI: 18.73-19.51), the infection ICU bed hospitalization rate was 4.14 (95% CI: 4.10-4.18). If left unchecked with no vaccination and no other public health interventions, and assuming circulation of only wild-type variants and no variants of concern, the pandemic would eventually cause 8.18 million deaths (95% CI: 7.30-9.18), 163.67 million acute-care hospitalizations (95% CI: 148.12-179.51), and 33.01 million ICU hospitalizations (95% CI: 30.52-35.70), by the time the herd immunity threshold is reached at 60-70% infection exposure. The global population remained far below the herd immunity threshold by end of 2020. Global epidemiology reveals immense regional variation in infection exposure and morbidity and mortality rates.

Mortality due to circulatory causes in hot and cold environments in Greece

Ambient temperature can affect the survival rate of humans. Studies have shown a relationship between ambient temperature and mortality rate in hot and cold environments. This effect of ambient temperature on mortality seems to be more pronounced in older people. The aim of this study is to examine the effects of thermal stress on cardiovascular mortality and the associated relative risk per degree Celsius in Greek individuals ≥70 years old. Mortality data 1999-2012 were matched with the midday temperature. The present study found a higher circulatory mortality when ambient temperature is below or above the temperature range 6 to 39 °C.

Effectiveness of contact tracing to reduce fatality from COVID-19: preliminary evidence from Colombia

Objectives

Conducting contact tracing (CT) programs in low- and middle-income countries is challenging, and there is no evidence of their effectiveness in Latin America. We evaluated the effectiveness of CT on reducing fatality from COVID-19 in Colombia.

Study design

The study design is a retrospective cohort study with nation-wide data of suspected and confirmed cases of severe acute respiratory syndrome (SARS-CoV-2) infection and their registered contacts.

Methods

We analyzed confirmed and suspected COVID-19 cases and their chains of contact using a nation-wide registry from March 28, 2020 to January 13, 2021. To estimate the effect of CT on fatality, we adjusted a multilevel negative binomial model using the number of deaths and the number of people within a chain of contacts as the outcome variable and offset variable, respectively. Sensitivity analysis was conducted using different cutoff values of contacts traced and a logistic model for the effect of CT on death at an individual level.

Results

We analyzed 1.4 million cases, 542,936 chains of contact, and 46,087 deaths. Only, 5.8% of total cases and contacts were included in a chain of a case and five or more contacts. We found that tracing of at least five contacts per case reduces fatality by 48% (95% confidence interval: 45–51), and, at the current levels of tracing in Colombia, it prevents 1.8% of deaths. Results obtained from the sensitivity analysis were consistent with the reduction of fatality at an individual level and higher protective effect with the higher number of contacts traced.

Conclusions

In Colombia, tracing of at least five contacts per case reduces fatality from COVID-19. The coverage and intensity of tracing needs to be increased as a strategy to mitigate fatality in Colombia.

Upper and lower limb amputations in vehicle-related fatalities

Traumatic limb amputation is rare in occupants following a motor vehicle collision (MVC). A retrospective analysis of autopsy reports at Forensic Science South Australia (FSSA) over a 19 year period from January 2000 to December 2018 was performed to determine the incidence of limb amputation in lethal collisions and to identify predisposing factors. Only 18 cases (1.54%) of occupant fatalities had a traumatic limb amputation with an age range of 18-78 years (mean 44.2 years), male to female ratio 13:5, and an average body mass index (BMI) of 28.5 (overweight). There were nine cases of upper limb amputation and nine cases of lower limb amputation (one case had both upper and lower limb amputations). Head on impacts without subsequent rollover were the most common collision type in both upper and lower amputation. The likely cause of limb amputation in vehicle crashes is, therefore, speed on impact rather than rollovers as has been previously suggested.

Case-fatality, disability and recurrence rates after first-ever stroke: A study from bigdata observatory platform for stroke of China

BACKGROUND

There is currently a lack of data on stroke hospitalizations and long-term outcomes in China. Therefore, we investigated 12-month stroke fatality, disability, and recurrence rates after the first-ever stroke.

METHODS

This was a prospective nationwide hospital-based cohort study. From August to September 2019, all patients with first-ever stroke (ischemic stroke [IS], intracerebral hemorrhage [ICH], and subarachnoid hemorrhage [SAH]) and with symptom onset within 14 days from 232 hospitals were included. Case fatality, disability, and recurrence rates for one year were estimated.

RESULTS

In total, 36250 first-ever stroke patients from 194 hospitals were recruited (median age was 65(IQR, 56-73) years and 61.4 % were male). The rate of intravenous thrombolysis and endovascular treatment for IS were 9.5 % and 4.4 %, respectively. In-hospital death rate was 1.9 % (95 %CI: 1.7 %-2.0 %) for stroke inpatients, ranging from 0.9 % (0.8 %-1.1 %) for IS to 5.1 % (4.6 %-5.6 %) for ICH. The 12-month fatality rate was 8.6 % (95 %CI: 8.3 %-8.9 %) for discharged stroke patients, ranging from 6.0 % (5.7 %-6.3 %) for IS to 17.7 % (16.7 %-18.7 %) for ICH. The 12-month disability rate was 16.6 % (95 %CI: 16.2 %-17.0 %) for stroke survivors, ranging from 11.1 % (9.3 %-12.8 %) for SAH to 29.2 % (27.9 %-30.4 %) for ICH. The stroke recurrence rate was 5.7 % (5.5 %-6.0 %) for stroke survivors, ranging from 2.5 % (1.7 %-3.3 %) for SAH to 6.4 % (6.0 %-6.7 %) for IS.

CONCLUSION

Our results support the hypothesis that the prognosis of Chinese stroke patients appears to have improved and is not very bad.

Application of data linkage techniques to Pacific Northwest commercial fishing injury and fatality data

Background

Commercial fishing consistently has among the highest workforce injury and fatality rates in the United States. Data related to commercial fishing incidents are routinely collected by multiple organizations which do not currently coordinate or automatically link data. Each data set has the potential to generate a more complete picture to inform prevention efforts. Our objective was to examine the utility of using statistical data linkage methods to link commercial fishing incident data when personally identifiable information is not available.

Methods

In this feasibility study, we identified true matches and discrepancies between de-identified data sets using the Python Record Linkage Toolkit. Four commercial fishing data sets from Oregon and Washington were linked: the Commercial Fishing Incident Database, the Vessel Casualty Database, the Nonfatal Injuries Database, and the Oregon Trauma Registry. The data sets each covered different date ranges within 2000–2017, containing 458, 524, 184, and 11 cases respectively. Several data linkage classifiers were evaluated.

Results

The Naïve-Bayes classifier returned the highest number of true matches between these small data sets. A total of 41 true matches and 8 close matches were identified, of which 29 were determined to be duplicates. In addition, linkage highlighted 4 records that were not commercial fishing cases from Oregon and Washington. The optimum match parameters were the date, state, vessel official number, and number of people on board.

Conclusions

Statistical data linkage enables accurate, routine matching for small de-identified injury and fatality data sets such as those in commercial fishing. It provides information needed to improve the accuracy of existing data records. It also enables expanding and sharpening details of individual incidents in support of occupational safety research.

Prevalence and impact of comorbidities on disease prognosis among patients with COVID-19 in Bangladesh: A nationwide study amid the second wave

BACKGROUND

Socio-demographics and comorbidities are involved in determining the severity and fatality in patients with COVID-19 suggested by studies in various countries, but study in Bangladesh is insufficient.

AIMS

We designed the study to evaluate the association of sociodemographic and comorbidities with the prognosis of adverse health outcomes in patients with COVID-19 in Bangladesh.

METHODS

A multivariate retrospective cohort study was conducted on data from 966 RT-PCR positive patients from eight divisions during December 13, 2020, to February 13, 2021. Variables included sociodemographic, comorbidities, symptoms, Charlson comorbidity index (CCI) and access to health facilities. Major outcome was fatality. Secondary outcomes included hospitalization, duration of hospital stay, requirement of mechanical ventilation and severity.

RESULTS

Male (65.8%, 636 of 966) was predominant and mean age was 39.8 ± 12.6 years. Fever (79%), dry cough (55%), and loss of test/smell (51%) were frequent and 74% patients had >3 symptoms. Fatality was recorded in 10.5% patients. Comorbidities were found in 44% patients. Hypertension (21.5%) diabetes (14.6%), and cardiovascular diseases (11.3%) were most prevalent. Age >60 years (OR: 4.83, 95% CI: 2.45-6.49), and CCI >3 (OR: 5.48, 95% CI: 3.95-7.24) were predictors of hospitalizations. CCI >4 (aOR: 3.41, 95% CI: 2.57-6.09) was predictor of severity. Age >60 years (aOR: 3.77, 95% CI: 1.07-6.34), >3 symptoms (aOR: 2.14, 95% CI: 0.97-4.91) and CCI >3 vs. CCI <3 (aOR: 5.23, 95% CI: 3.77-8.09) were independently associated with fatality.

CONCLUSIONS

Increased age, >3 symptoms, increasing comorbidities, higher CCI were associated with increased hospitalization, severity and fatality in patients with COVID-19.

Prevalence and incidence of advanced schistosomiasis and risk factors for case fatality in Hunan Province, China

Advanced schistosomiasis has become a major public health problem in areas with a heavy burden of schistosomiasis infection. Our objective was to determine the incidence and prevalence of advanced schistosomiasis and risk factors associated with case fatality of advanced schistosomiasis. Data were abstracted from hospitalization records of patients with advanced schistosomiasis from Hunan Province, China. The incidence and prevalence of advanced schistosomiasis were determined and the risk factors for death in advanced patients were assessed using logistic regression analysis. A total of 10,362 patients with advanced schistosomiasis were recruited into our study and 65% of them were categorized as the ascites type. There were 1249 deaths between 2005 and 2018 and the case fatality was 12.05%. The incidence of advanced schistosomiasis increased from 2002 to 2010, peaked in 2010 and then leveled off. The prevalence of advanced schistosomiasis increased from 2005 to 2014, and was stable afterwards. HBV was a risk factor for death in advanced patients (adjusted odds ratio (aOR=1.93, 95% confidence interval (CI: 1.55 to 2.41). Patients without splenectomy had a higher risk of death (aOR=1.29, 95%CI: 1.08 to 1.56). Upper gastrointestinal bleeding was positively associated with the risk of death (aOR=1.42, 95% CI: 1.15 to 1.76). Besides, abnormal ALT, ascites and anemia were also significantly associated with the risk of death in advanced patients. Advanced schistosomiasis was effectively controlled in recent years. Splenectomy could reduce the case fatality of advanced patients. HBV infection, abnormal ALT, upper gastrointestinal bleeding and anemia also predicted the risk of death for advanced patients.

Prevalence and impact of diabetes and cardiovascular disease on clinical outcome among patients with COVID-19 in Bangladesh

BACKGROUND

Patients with coronavirus disease-2019 (COVID-19) with preexisting diabetes and cardiovascular metabolic diseases have higher fatality rate. The circulation of new variants with emerging clinical characteristics requires more studies focusing the impact of preexisting health conditions on outcome of COVID-19 accurately.

AIMS

Main aim of this study was to investigate the impact of diabetes and cardiovascular disease (CVD) on disease prognosis and severe health outcomes among patients with COVID-19.

METHODS

A retrospective study was performed on 799 patients with COVID-19 during December 10, 2020, to February 10, 2020 in Bangladesh. Logistic regression analysis was performed for age, sex, diabetes, CVD and symptoms on fatality. Kaplan-Meier survival analysis was conducted to predict the survival rate.

RESULTS

Fatality was detected in 40% (318 of 799) patients with COVID-19. Among 318 fatalities, 90.6% were detected in patients with CVD and 74.5% in patients with diabetes. Case fatality rate was highest in patients with COVID-19, CVD and diabetes (94, 184 of 195). Fever (91%) and dry cough (71%) were the most frequent symptoms. CVD (42.2%), diabetes (32.7%) and obesity (18%) were prevalent. The highest odds of risk was detected in patients with COVID-19, CVD and diabetes (OR: 6.98, 95% CI, 4.21 to 7.34). Female patients had the highest survival rate.

CONCLUSIONS

In this study, 318 fatality was seen in 799 patients with COVID-19. The highest odds of fatality risk was detected in patients with COVID-19, CVD and diabetes. The risk increased many folds when CVD and diabetes coexisted in patients.

Predictors of Covid-19 case fatality rate: An ecological study

Background

The outbreak of novel coronavirus (Covid-19) has a significant burden on global health and could be associated with significant mortality. Limited information exists about determinants of its fatality worldwide. Thus, this ecological study examined the association of various predictors with Covid-19 fatality.

Methods

International data bases of Covid-19 statistics and health metrics available primarily at WHO were reviewed to collect information for 113 countries. The dependent variable was Covid-19 case fatality rate. Independent variables were demographic, social, clinical, economic, heath care and child health factors.

Results

Case fatality rate of Covid-19 varies across countries with an average of 4.2 ± 3.8%, and about half of countries had fatality rate >3.2% (median). Significant relationships were observed between Covid-19 fatality rate and socio-economic, clinical, and health variables at the unadjusted regression analysis. At the multivariate adjusted model, percentage of population with age>60 years was positively associated with Covid-19 fatality (B = 0.032, p = 0.005), while Polio-3 immunization at 1-year old was inversely related (B = −0.057, p = 0.017).

Conclusions

This ecological investigation highlights the higher risk of death among elderly with Covid-19 pandemic and suggests that Polio-3 immunization coverage among 1-year-olds may be associated with better survival. Future research is warranted to validate these findings.

•

Covid-19 pandemic spread globally and associated with emergent mortality.

•

Predictors of covid-19 case-fatality rate are presented among 113 countries.

•

Percentage of people with age>60 years was positively associated with covid-19 fatality.

•

Polio-3 immunization at 1-year old was inversely associated with covid-19 fatality.

Causes of death among dengue patients causes of death among hospitalized adults with dengue fever in Tainan, 2015: Emphasis on cardiac events and bacterial infections

INTRODUCTION

The 2015 dengue outbreak in southern Taiwan caused substantial mortality. We analyzed the causes of death among these patients.

MATERIALS AND METHODS

This retrospective study was conducted at a medical center in Tainan from August 2015 to December 2015. Dengue was diagnosed based on the detection of serum dengue NS1 antigen, IgM, or viral RNA in the blood. Causes of death were retrieved from chart reviews by three clinicians.

RESULTS

There were 4488 cases of dengue in the study hospital, with an in-hospital fatality rate of 1.3% (60 cases). The mean age of the 60 fatal cases was 73 years, among whom 90% were aged ≥65 years. Twenty-eight (46.7%) patients died of severe dengue, and 29 (48.3%) deaths were possibly related to dengue. Of the latter, 24 (40%) died of secondary infections. Thirteen cardiac arrest events, including out-of-hospital (5 events) and in-hospital (8) cardiac arrests in the emergency department, occurred during the dengue epidemic. Seven (53.8%) patients did not receive medical aid before the event. Of the 40 deaths that occurred within one week after hospitalization, 60% died of severe dengue. In contrast, 50% of 20 deaths that occurred one week after hospitalization were related to hospital-acquired infections, mainly pneumonia.

CONCLUSION

Of 60 fatal cases, with a predominance of elderly patients, deaths were related to severe dengue within the first week after admission and secondary infections thereafter. The absence of medical care before cardiac arrest events highlights the importance of health education for warning signs of dengue.

COVID-19 fatality in Mexico's indigenous populations

OBJECTIVE

The aim of the study was to explore the factors that could explain the differences in fatality rates among indigenous groups with COVID-19 diagnosis compared with the rest of the population in Mexico.

STUDY DESIGN

We analyzed the public data of COVID-19 surveillance, of the Mexican Ministry of Health, to estimate COVID-19 fatality rates by ethnicity.

METHODS

We explored associated factors using Cox proportional hazards models stratified by outpatient and hospital management at diagnosis; analysis was conducted in three scenarios: national level, states with 89% of the indigenous population, and South Pacific region.

RESULTS

A total of 412,017 COVID-19 cases were included, with 1.1% of the indigenous population. The crude fatality rate per 1000 person-weeks was 64.8% higher among indigenous than among non-indigenous people (29.97 vs. 18.18, respectively), and it increased more than twice within outpatients (5.99 vs. 2.64, respectively). Cox analysis revealed that indigenous people who received outpatient management had higher fatality rate than non-indigenous outpatients, at the national level (hazard ratio [HR] = 1.63; 95% confidence interval [CI] = 1.34-1.98), within the subgroup of 13 states (HR = 1.66; 95% CI = 1.33-2.07), and in the South Pacific region (HR = 2.35; 95% CI = 1.49-3.69). Factors associated with higher fatality rates among non-indigenous and indigenous outpatients were age, sex, and comorbidities.

CONCLUSIONS

COVID-19 fatality is higher among indigenous populations, particularly within cases managed as outpatients.

Emergency department presentation of opioid use disorder and alcohol use disorder

Mixing alcohol and opioid prescription medications can have serious health consequences. This study examines demographic and geographic differences in opioid use disorders (OUD) and alcohol use disorders (AUD) in emergency department (ED) presentations in the state of Texas. Using all diagnosis codes, the study examined discharge records for ED visits related to AUD and OUD in Texas for 2017. The study classified visits into three mutually exclusive groups (AUD-only, OUD-only, and AUD/OUD) and reported the number of visits, fatalities, total charges, proportions, and rates per 100,000 population by patient demographic characteristics. Chi square statistics assessed the association between patient characteristics and ED visit type, and the study used analysis of variance to compare ED visit rates by patient demographics. The study also fitted a multinomial logistic regression w to predict ED visit type by patient demographic and geographic characteristics. There were 221,363 OUD and AUD ED visits from Texans in 2017. Among them, 3863 had both AUD and OUD. There were 2443 fatalities related to AUD-only ED visits, whereas this rate was 292 for OUD-only ED visits. The majority of these patients had Medicare and Medicaid. AUD-only ED visits were more prevalent (680.7 vs 112.5 per 100,000 population) and resulted in higher overall charges than OUD-only ED visits ($6.1 billion vs $1 billion in total charges). However, AUD/OUD ED visits resulted in higher total charges on average than either OUD-only or AUD-only ED visits. Compared to patients with outpatient discharge, patients with inpatient admissions were more likely to belong to the OUD-only visit group (OR = 1.20, 95% CI: 1.17-1.23) or the AUD/OUD visit group (OR = 2.44, 95% CI: 2.28-2.61) than to the AUD-only visit group. Compared to urban patients, rural patients were less likely to belong to OUD-related visit groups than the AUD-only visit group. In conclusions, AUD was more prevalent than OUD among ED visits and resulted in a higher number of fatalities and higher medical charges. Current health policy regarding substance use that is heavily tilted toward curbing the opioid crisis remains woefully tolerant to AUDs. While efforts to curb opioid misuse should continue, future efforts should raise awareness among ED providers of the disease burden of and social harms caused by alcoholism and alcohol addiction.

COVID-19 fatality rates in hospitalized patients: systematic review and meta-analysis

Background

Coronavirus disease (COVID-19) is an infectious disease caused by a newly discovered coronavirus. Although general and local public health report deathly cases, case fatality rates are still largely unknown. Thus, we sought to evaluate the mortality of COVID-19.

Methods

We searched PubMed and EMBASE databases for articles evaluating the clinical characteristics of COVID-19 patients that included clinical outcomes, between December 2020 and 24 April 2020. Two authors performed an independent selection using predefined terms of search.

Results

We retrieved 33 studies with a total of 13,398 patients with COVID-19 diagnosis. The mortality rate of the COVID‐19 patients was 17.1% (95% CI 12.7; 22.7, I² = 96.9%). For general patients admitted to the hospital (excluding critical care-only studies) the mortality rate of the COVID‐19 was 11.5% (95% CI 7.7; 16.9, I² = 96.7%). Among critical illness studies (n = 7) we found a 40.5% mortality (95% CI 31.2; 50.6, I² = 91.8%).

Conclusion

High COVID-19 mortality among general admitted patients and critical care cases should guide resources allocations and economic burden calculations during the pandemics.

Elevated glucose level leads to rapid COVID-19 progression and high fatality

Objectives

We aimed to identify high-risk factors for disease progression and fatality for coronavirus disease 2019 (COVID-19) patients.

Methods

We enrolled 2433 COVID-19 patients and used LASSO regression and multivariable cause-specific Cox proportional hazard models to identify the risk factors for disease progression and fatality.

Results

The median time for progression from mild-to-moderate, moderate-to-severe, severe-to-critical, and critical-to-death were 3.0 (interquartile range: 1.8–5.5), 3.0 (1.0–7.0), 3.0 (1.0–8.0), and 6.5 (4.0–16.3) days, respectively. Among 1,758 mild or moderate patients at admission, 474 (27.0%) progressed to a severe or critical stage. Age above 60 years, elevated levels of blood glucose, respiratory rate, fever, chest tightness, c-reaction protein, lactate dehydrogenase, direct bilirubin, and low albumin and lymphocyte count were significant risk factors for progression. Of 675 severe or critical patients at admission, 41 (6.1%) died. Age above 74 years, elevated levels of blood glucose, fibrinogen and creatine kinase-MB, and low plateleta count were significant risk factors for fatality. Patients with elevated blood glucose level were 58% more likely to progress and 3.22 times more likely to die of COVID-19.

Conclusions

Older age, elevated glucose level, and clinical indicators related to systemic inflammatory responses and multiple organ failures, predict both the disease progression and the fatality of COVID-19 patients.

A global analysis of replacement of genetic variants of SARS-CoV-2 in association with containment capacity and changes in disease severity

OBJECTIVES

To examine severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variant replacement in association with containment capacity and changes in case fatality at country level.

METHODS

Altogether, 69 571 full SARS-CoV-2 genomes collected globally within the first 6 months of the pandemic were examined. The correlation between variant replacement and containment capacity was examined by logistic regression models using the WHO International Health Regulation (IHR) score, the Oxford COVID-19 Government Response Tracker (OxCGRT) and the vulnerability index INFORM as proxies, while correlation with changes in monthly crude case fatality ratios was examined by a mixed effect model.

RESULTS

At the global level, variant lineage G∗, characterized by the S-D614G mutation, replaced the older lineages L and S in March 2020. European countries-including Finland, France and Italy-were the first to reach a 50% increment of G∗, whereas only Singapore and South Korea had non-G∗ persisting throughout the first 6 months. Countries with higher IHR scores (β-coefficient -0.001, 95%CI -0.016, -0.001; p 0.034) and higher stringency indexes (OxCGRT) (β-coefficient -0.011, 95%CI -0.020, -0.001; p 0.035) were associated with lower levels of G∗ replacement, whereas higher vulnerability indexes (INFORM) (β-coefficient 0.049, 95%CI 0.001, 0.097; p 0.044) were associated with higher replacement levels. Crude case fatality ratio showed a positive correlation with G∗ replacement (β-coefficient: 0.034, 95%CI 0.011, 0.058; p 0.004), even after adjusting for testing capacity and other country-specific characteristics.

CONCLUSIONS

SARS-CoV-2 variant lineage G∗ (S-D614G) replaced older lineages more efficiently in countries with lower containment capacity, and its possible association with increased disease severity deserves further investigation.