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Bilchenko AO, Gritsenko OV, Kolisnyk VO, Rafalyuk OI, Pyzhevskii AV, Myzak YV, Besh DI, Salo VM, Chaichuk SO, Lehoida MO, Danylchuk IV, Polivenok IV. Acute myocardial infarction complicated by cardiogenic shock in Ukraine: multicentre registry analysis 2021-2022. Front Cardiovasc Med 2024; 11:1377969. [PMID: 38606380 PMCID: PMC11007039 DOI: 10.3389/fcvm.2024.1377969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Accepted: 03/15/2024] [Indexed: 04/13/2024] Open
Abstract
Background Data on the results and management strategies in patients with acute myocardial infarction complicated by cardiogenic shock (AMI-CS) in the Low and Lower-Middle Income Countries (LLMICs) are limited. This lack of understanding of the situation partially hinders the development of effective cardiogenic shock treatment programs in this part of the world. Materials and methods The Ukrainian Multicentre Cardiogenic Shock Registry was analyzed, covering patient data from 2021 to 2022 in 6 major Ukrainian reperfusion centres from different parts of the country. Analysis was focusing on outcomes, therapeutic modalities and mortality predictors in AMI-CS patients. Results We analyzed data from 221 consecutive patients with CS from 6 hospitals across Ukraine. The causes of CS were ST-elevated myocardial infarction (85.1%), non-ST-elevated myocardial infarction (5.9%), decompensated chronic heart failure (7.7%) and arrhythmia (1.3%), with a total in-hospital mortality rate for CS of 57.1%. The prevalence of CS was 6.3% of all AMI with reperfusion rate of 90.5% for AMI-CS. In 23.5% of cases, CS developed in the hospital after admission. Mechanical circulatory support (MCS) utilization was 19.9% using intra-aortic balloon pump alone. Left main stem occlusion, reperfusion deterioration, Charlson Comorbidity Index >4, and cardiac arrest were found to be independent predictors for hospital mortality in AMI-СS. Conclusions Despite the wide adoption of primary percutaneous coronary intervention as the main reperfusion strategy for AMI, СS remains a significant problem in LLMICs, associated with high in-hospital mortality. There is an unmet need for the development and implementation of a nationwide protocol for CS management and the creation of reference CS centers based on the country-wide reperfusion network, equipped with modern technologies for MCS.
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Affiliation(s)
- Anton O. Bilchenko
- Department of Prevention and Treatment of Emergency Conditions, L.T. Malaya Therapy National Institute of the National Academy of Medical Sciences of Ukraine, Kharkiv, Ukraine
| | - Olga V. Gritsenko
- Department of Interventional Cardiology, V.T. Zaitcev Institute of General and Urgent Surgery of the National Academy of Medical Sciences of Ukraine, Kharkiv, Ukraine
| | | | - Oleg I. Rafalyuk
- Department of Interventional Radiology, Lviv Regional Clinical Treatment and Diagnostic Cardiology Center, Lviv, Ukraine
| | - Andrii V. Pyzhevskii
- Department of Interventional Radiology, Lviv Regional Clinical Treatment and Diagnostic Cardiology Center, Lviv, Ukraine
| | - Yaroslav V. Myzak
- Department of Interventional Radiology, 1st Territorial Medical Union, Lviv, Ukraine
| | - Dmytro I. Besh
- Department of Interventional Radiology, 1st Territorial Medical Union, Lviv, Ukraine
- Department of Family Medicine, Danylo Halytsky National Medical University, Lviv, Ukraine
| | - Victor M. Salo
- Department of Interventional Radiology, 1st Territorial Medical Union, Lviv, Ukraine
| | - Sergii O. Chaichuk
- Department of Interventional Cardiology, Oleksandrivska Clinical Hospital, Kyiv, Ukraine
| | - Mykhailo O. Lehoida
- Department of Cardiology, Vinnytsia Regional Clinical Treatment and Diagnostic Center of Cardiovascular Pathology, Vinnytsia, Ukraine
| | - Ihor V. Danylchuk
- Department of Cardiology, Vinnytsia Regional Clinical Treatment and Diagnostic Center of Cardiovascular Pathology, Vinnytsia, Ukraine
| | - Ihor V. Polivenok
- Department of Interventional Cardiology, V.T. Zaitcev Institute of General and Urgent Surgery of the National Academy of Medical Sciences of Ukraine, Kharkiv, Ukraine
- Department of Therapy No 1, Kharkiv National Medical University, Kharkiv, Ukraine
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Koller Á, Márkus E, Ferenci T, Nardai G. [Determining factors of survival in patients with severe coronavirus infection admitted to intensive care unit in the third and fourth waves of COVID-19 pandemic]. Orv Hetil 2023; 164:651-658. [PMID: 37120810 DOI: 10.1556/650.2023.32762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 02/22/2023] [Indexed: 05/01/2023]
Abstract
INTRODUCTION During COVID-19 pandemic, a high mortality rate (20-60%) of patients admitted to intensive care unit has been observed. Identification of risk factors can support the understanding of disease pathophysiology and the recognition of vulnerable patients, prognostication and selection of appropriate treatment. OBJECTIVE Beyond characterisation of a local, critically ill COVID-19 population, analysis of the associations between demographic/clinical data and patient survival were investigated. METHOD Retrospective, observational study has been performed by recording demographic, clinical data and outcome parameters on patients with severe respiratory insufficiency caused by COVID-19. RESULTS 88 patients were enrolled. Median age was 65 years and 53% of patients were male, median BMI was 29 kg/m2. Noninvasive ventilation was used in 81%, endotracheal intubation in 45%, prone positioning in 59% of all cases. Vasopressor treatment was introduced in 44%, secondary bacterial infection was detected in 36% of all cases. Hospital survival rate was 41%. Risk factors for survival and the effect of evolving treatment protocols were analyzed with multivariable regression model. A better survival chance was associated to younger age, lower APACE II score and non-diabetic status. Effect of the treatment protocol was found to be significant (OR = 0.18 [95% CI: 0.04-0.76], p = 0.01976) after controlling for APACHE II, BMI, sex, two comorbidities and two pharmaceutical agents (tocilizumab, remdesivir). CONCLUSION Survival rate was favourable if patients were younger, with lower APACHE II score and if non-diabetic. Low initial survival rate (15%) significantly improved (49%) in association with the protocol changes. We would like to facilitate Hungarian centres to publish their data and initiate a nationwide database to improve the management of severe COVID disease. Orv Hetil. 2023; 164(17): 651-658.
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Affiliation(s)
- Ábel Koller
- 1 Dr. Manninger Jenő Baleseti Központ Budapest, Fiumei út 17., 1081 Magyarország
| | - Eszter Márkus
- 1 Dr. Manninger Jenő Baleseti Központ Budapest, Fiumei út 17., 1081 Magyarország
| | - Tamás Ferenci
- 2 Óbudai Egyetem, Élettani Szabályozások Kutatóközpont Budapest Magyarország
- 3 Budapesti Corvinus Egyetem, Statisztika Tanszék Budapest Magyarország
| | - Gábor Nardai
- 1 Dr. Manninger Jenő Baleseti Központ Budapest, Fiumei út 17., 1081 Magyarország
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Zuleta D, Arellano G, Muller-Landau HC, McMahon SM, Aguilar S, Bunyavejchewin S, Cárdenas D, Chang-Yang CH, Duque A, Mitre D, Nasardin M, Pérez R, Sun IF, Yao TL, Davies SJ. Individual tree damage dominates mortality risk factors across six tropical forests. New Phytol 2022; 233:705-721. [PMID: 34716605 DOI: 10.1111/nph.17832] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 10/21/2021] [Indexed: 06/13/2023]
Abstract
The relative importance of tree mortality risk factors remains unknown, especially in diverse tropical forests where species may vary widely in their responses to particular conditions. We present a new framework for quantifying the importance of mortality risk factors and apply it to compare 19 risks on 31 203 trees (1977 species) in 14 one-year periods in six tropical forests. We defined a condition as a risk factor for a species if it was associated with at least a doubling of mortality rate in univariate analyses. For each risk, we estimated prevalence (frequency), lethality (difference in mortality between trees with and without the risk) and impact ('excess mortality' associated with the risk, relative to stand-level mortality). The most impactful risk factors were light limitation and crown/trunk loss; the most prevalent were light limitation and small size; the most lethal were leaf damage and wounds. Modes of death (standing, broken and uprooted) had limited links with previous conditions and mortality risk factors. We provide the first ranking of importance of tree-level mortality risk factors in tropical forests. Future research should focus on the links between these risks, their climatic drivers and the physiological processes to enable mechanistic predictions of future tree mortality.
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Affiliation(s)
- Daniel Zuleta
- Forest Global Earth Observatory, Smithsonian Tropical Research Institute, Washington, DC, 20560, USA
| | - Gabriel Arellano
- Ecology and Evolutionary Biology, University of Michigan, Ann Arbor, MI, 48109, USA
- Oikobit LLC, Albuquerque, NM, 87120, USA
| | - Helene C Muller-Landau
- Smithsonian Tropical Research Institute, Apartado, Balboa, 0843-03092, República de Panamá
| | - Sean M McMahon
- Smithsonian Environmental Research Center, Edgewater, MD, 21037, USA
| | - Salomón Aguilar
- Smithsonian Tropical Research Institute, Apartado, Balboa, 0843-03092, República de Panamá
| | - Sarayudh Bunyavejchewin
- Department of National Parks, Wildlife and Plant Conservation, Forest Research Office, Bangkok, 10900, Thailand
| | - Dairon Cárdenas
- Herbario Amazónico Colombiano, Instituto Amazónico de Investigaciones Científicas Sinchi, Bogotá, 110311, Colombia
| | - Chia-Hao Chang-Yang
- Department of Biological Sciences, National Sun Yat-sen University, Kaohsiung, 80424, Taiwan
| | - Alvaro Duque
- Departamento de Ciencias Forestales, Universidad Nacional de Colombia Sede Medellín, Medellín, 050034, Colombia
| | - David Mitre
- Smithsonian Tropical Research Institute, Apartado, Balboa, 0843-03092, República de Panamá
| | - Musalmah Nasardin
- Forestry and Environment Division, Forest Research Institute Malaysia, Kepong, Selangor, 52109, Malaysia
| | - Rolando Pérez
- Smithsonian Tropical Research Institute, Apartado, Balboa, 0843-03092, República de Panamá
| | - I-Fang Sun
- Center for Interdisciplinary Research on Ecology and Sustainability, National Dong Hwa University, Hualien, 94701, Taiwan
| | - Tze Leong Yao
- Forestry and Environment Division, Forest Research Institute Malaysia, Kepong, Selangor, 52109, Malaysia
| | - Stuart J Davies
- Forest Global Earth Observatory, Smithsonian Tropical Research Institute, Washington, DC, 20560, USA
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Munblit D, Nekliudov NA, Bugaeva P, Blyuss O, Kislova M, Listovskaya E, Gamirova A, Shikhaleva A, Belyaev V, Timashev P, Warner JO, Comberiati P, Apfelbacher C, Bezrukov E, Politov ME, Yavorovskiy A, Bulanova E, Tsareva N, Avdeev S, Kapustina VA, Pigolkin YI, Dankwa EA, Kartsonaki C, Pritchard MG, Fomin V, Svistunov AA, Butnaru D, Glybochko P. Stop COVID Cohort: An Observational Study of 3480 Patients Admitted to the Sechenov University Hospital Network in Moscow City for Suspected Coronavirus Disease 2019 (COVID-19) Infection. Clin Infect Dis 2021; 73:1-11. [PMID: 33035307 PMCID: PMC7665333 DOI: 10.1093/cid/ciaa1535] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Indexed: 01/09/2023] Open
Abstract
Background The epidemiology, clinical course, and outcomes of COVID-19 patients in the Russian population are unknown. Information on the differences between laboratory-confirmed and clinically-diagnosed COVID-19 in real-life settings is lacking. Methods We extracted data from the medical records of adult patients who were consecutively admitted for suspected COVID-19 infection in Moscow, between April 8 and May 28, 2020. Results Of the 4261 patients hospitalised for suspected COVID-19, outcomes were available for 3480 patients (median age 56 years (interquartile range 45-66). The commonest comorbidities were hypertension, obesity, chronic cardiac disease and diabetes. Half of the patients (n=1728) had a positive RT-PCR while 1748 were negative on RT-PCR but had clinical symptoms and characteristic CT signs suggestive of COVID-19 infection.No significant differences in frequency of symptoms, laboratory test results and risk factors for in-hospital mortality were found between those exclusively clinically diagnosed or with positive SARS-CoV-2 RT-PCR.In a multivariable logistic regression model the following were associated with in-hospital mortality; older age (per 1 year increase) odds ratio [OR] 1.05 (95% confidence interval (CI) 1.03 - 1.06); male sex (OR 1.71, 1.24 - 2.37); chronic kidney disease (OR 2.99, 1.89 – 4.64); diabetes (OR 2.1, 1.46 - 2.99); chronic cardiac disease (OR 1.78, 1.24 - 2.57) and dementia (OR 2.73, 1.34 – 5.47). Conclusions Age, male sex, and chronic comorbidities were risk factors for in-hospital mortality. The combination of clinical features were sufficient to diagnoseCOVID-19 infection indicating that laboratory testing is not critical in real-life clinical practice.
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Affiliation(s)
- Daniel Munblit
- Department of Pediatrics and Pediatric Infectious Diseases, Institute of Child's Health, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia.,Inflammation, Repair, and Development Section, National Heart and Lung Institute, Faculty of Medicine, Imperial College London, London, United Kingdom.,Soloviev Research and Clinical Center for Neuropsychiatry, Moscow, Russia
| | - Nikita A Nekliudov
- Department of Pediatrics and Pediatric Infectious Diseases, Institute of Child's Health, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Polina Bugaeva
- Department of Pediatrics and Pediatric Infectious Diseases, Institute of Child's Health, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Oleg Blyuss
- Department of Pediatrics and Pediatric Infectious Diseases, Institute of Child's Health, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia.,School of Physics, Astronomy, and Mathematics, University of Hertfordshire, Hatfield, United Kingdom
| | - Maria Kislova
- Department of Pediatrics and Pediatric Infectious Diseases, Institute of Child's Health, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Ekaterina Listovskaya
- Department of Pediatrics and Pediatric Infectious Diseases, Institute of Child's Health, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Aysylu Gamirova
- Department of Pediatrics and Pediatric Infectious Diseases, Institute of Child's Health, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Anastasia Shikhaleva
- Department of Pediatrics and Pediatric Infectious Diseases, Institute of Child's Health, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Vladimir Belyaev
- Biobank, Institute for Regenerative Medicine, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Peter Timashev
- Institute for Regenerative Medicine, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia.,Chemistry Department, Lomonosov Moscow State University, Moscow, Russia.,Department of Polymers and Composites, N. N. Semenov Institute of Chemical Physics, Moscow, Russia
| | - John O Warner
- Inflammation, Repair, and Development Section, National Heart and Lung Institute, Faculty of Medicine, Imperial College London, London, United Kingdom
| | - Pasquale Comberiati
- Department of Clinical and Experimental Medicine, Section of Pediatrics, University of Pisa, Pisa, Italy
| | - Christian Apfelbacher
- Institute of Social Medicine and Health Systems Research, Faculty of Medicine, Otto von Guericke University Magdeburg, Magdeburg, Germany
| | - Evgenii Bezrukov
- Institute for Urology and Reproductive Health, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Mikhail E Politov
- Department of Intensive Care, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Andrey Yavorovskiy
- Department of Intensive Care, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Ekaterina Bulanova
- Department of Intensive Care, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Natalya Tsareva
- Clinic of Pulmonology, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Sergey Avdeev
- Clinic of Pulmonology, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Valentina A Kapustina
- Department of Internal Medicine No. 1, Institute of Clinical Medicine, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Yuri I Pigolkin
- Department of Forensic Medicine, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | | | - Christiana Kartsonaki
- Medical Research Council Population Health Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Mark G Pritchard
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom.,Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Oxford, United Kingdom
| | - Victor Fomin
- Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Andrey A Svistunov
- Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Denis Butnaru
- Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Petr Glybochko
- Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
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Kayaaslan B, Eser F, Kaya Kalem A, Bilgic Z, Asilturk D, Hasanoglu I, Ayhan M, Tezer Tekce Y, Erdem D, Turan S, Mumcuoglu I, Guner R. Characteristics of candidemia in COVID-19 patients; increased incidence, earlier occurrence and higher mortality rates compared to non-COVID-19 patients. Mycoses 2021; 64:1083-1091. [PMID: 34085319 PMCID: PMC8242769 DOI: 10.1111/myc.13332] [Citation(s) in RCA: 60] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 05/28/2021] [Accepted: 05/31/2021] [Indexed: 12/16/2022]
Abstract
Severe COVID‐19 patients in ICU are at high risk for candidemia due to exposure to multiple risk factors for candidemia. We aimed to compare the incidence of candidemia in ICU patients with and without COVID‐19, and to investigate epidemiologic and clinical characteristics of candidemia patients and risk factors for mortality in candidemia patients. This retrospective study was conducted in patients followed in the ICUs of Ankara City Hospital for 2 years, divided into pre‐pandemic and pandemic periods. The incidence (event per 1000 patient‐days) and epidemiology of candidemia, clinical and laboratory characteristics of patients were compared in COVID‐19 and non‐COVID‐19 groups. Candidemia incidence was higher in the COVID‐19 group (2.16, 95% CI 1.77–2.60) than the non‐COVID‐19 group (1.06, 95% CI 0.89–0.125) (p < .001). A total of 236 candidemia episodes (105 in COVID‐19 patients and 131 in non‐COVID‐19 patients) were detected during the study periods. COVID‐19 cases had a higher rate of corticosteroid use (63.8% vs. 9.9%, p < .001). Epidemiology of candidemia and antifungal susceptibility were similar. Candidemia developed 2 weeks earlier in COVID‐19 groups and resulted in higher mortality (92.5% vs. 79.4%, p .005). One‐third of candidemia patients died before receiving any antifungal treatment, and this rate was higher in the COVID‐19 group. In multivariate logistic regression analysis, corticosteroid use, presence of sepsis and age older than 65 years were independent risk factors for mortality in candidemia patients. Candidemia with high mortality is a more serious problem for COVID‐19 patients due to its increased incidence, earlier occurrence and a higher rate of mortality.
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Affiliation(s)
- Bircan Kayaaslan
- Department of Infectious Disease and Clinical Microbiology, Ankara Yildirim Beyazit University, Ankara City Hospital, Ankara, Turkey
| | - Fatma Eser
- Department of Infectious Disease and Clinical Microbiology, Ankara Yildirim Beyazit University, Ankara City Hospital, Ankara, Turkey
| | - Ayşe Kaya Kalem
- Department of Infectious Disease and Clinical Microbiology, Ankara Yildirim Beyazit University, Ankara City Hospital, Ankara, Turkey
| | - Zeynep Bilgic
- Department of Infectious Disease and Clinical Microbiology, Ankara City Hospital, Ankara, Turkey
| | - Dilek Asilturk
- Department of Infectious Disease and Clinical Microbiology, Ankara City Hospital, Ankara, Turkey
| | - Imran Hasanoglu
- Department of Infectious Disease and Clinical Microbiology, Ankara Yildirim Beyazit University, Ankara City Hospital, Ankara, Turkey
| | - Muge Ayhan
- Department of Infectious Disease and Clinical Microbiology, Ankara City Hospital, Ankara, Turkey
| | - Yasemin Tezer Tekce
- Department of Infectious Disease and Clinical Microbiology, Ankara City Hospital, Ankara, Turkey
| | - Deniz Erdem
- Department of Intensive Care Unit, Ankara City Hospital, Ankara, Turkey
| | - Sema Turan
- Department of Intensive Care Unit, Ankara City Hospital, Ankara, Turkey
| | - Ipek Mumcuoglu
- Department of Medical Microbiology, Ankara City Hospital, Ankara, Turkey
| | - Rahmet Guner
- Department of Infectious Disease and Clinical Microbiology, Ankara Yildirim Beyazit University, Ankara City Hospital, Ankara, Turkey
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Bellin EY, Hellebrand AM, Kaplan SM, Ledvina JG, Markis WT, Levin NW, Kaufman AM. Epidemiology of nursing home dialysis patients-A hidden population. Hemodial Int 2021; 25:548-559. [PMID: 34132036 PMCID: PMC8596662 DOI: 10.1111/hdi.12943] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Revised: 03/11/2021] [Accepted: 05/23/2021] [Indexed: 11/29/2022]
Abstract
Introduction Dialysis patients are often discharged from hospitals to skilled nursing facilities (SNFs), but little has been published about their natural history. Methods Using electronic medical record data, we conducted a retrospective cohort study of nursing home patients treated with in‐SNF hemodialysis from January 1, 2018 through June 20, 2020 within a dialysis organization across eight states. A dialytic episode began with the first in‐SNF dialysis and was ended by hospitalization, death, transfer, or cessation of treatment. The clinical characteristics and natural history of these patients and their dialytic episodes are described. Findings Four thousand five hundred and ten patients experienced 9274 dialytic episodes. Dialytic episodes had a median duration of 18 days (IQR: 8–38) and were terminated by a hospitalization n = 5747 (62%), transfer n = 2638 (28%), death n = 568 (6%), dialysis withdrawal n = 129 (1.4%), recovered function n = 2 (0.02%), or other cause n = 6 (0.06%). Increased patient mortality was associated with advancing age, low serum creatinine, albumin, or sodium, and low pre‐dialytic systolic blood pressure (sBP). U‐shaped relationships to mortality were observed for intradialytic hypotension frequency and for post‐ > pre‐hemodialysis sBP frequency. Prescription of dialysis five times weekly in the first 2 weeks was associated with better survival in the first 90 days (HR 0.77, CI 0.62–0.96; p < 0.02). Discussion Provision of in‐SNF dialysis by an external dialysis organization enables discharge from the acute care setting for appropriate treatment with increased nursing contact time in an otherwise under‐resourced environment. SNF ESRD patient clinical characteristics and outcomes are extensively characterized for the first time.
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Affiliation(s)
- Eran Y Bellin
- Departments of Epidemiology & Population Health and Medicine, Albert Einstein College of Medicine, Bronx, New York, USA
| | | | | | | | | | - Nathan W Levin
- Internal Medicine, Mount Sinai Icahn School of Medicine, New York, New York, USA
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Bang GA, Savom EP, Oumarou BN, Ngamy CKM, Moto GB, Boukar YME, Binyom PR, Essomba A, Sosso MA. Clinical epidemiology and mortality risk factors of gastric cancer in a sub-Saharan African setting: a retrospective analysis of 120 cases in Yaoundé (Cameroon). Pan Afr Med J 2020; 37:104. [PMID: 33425137 PMCID: PMC7757231 DOI: 10.11604/pamj.2020.37.104.25422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Accepted: 09/14/2020] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION in sub-Saharan Africa, there is scare published data on cancer in general and gastric cancer in particular. METHODS we conducted a multicenter retrospective analysis of the medical records of patients followed for gastric cancer in 5 hospital departments in the city of Yaoundé (Cameroon) over 6 years. RESULTS we recorded a total of 120 patients with a mean age of 53.4 ± 13.7 years. There were 62 females (51.7%). The most common risk factors for gastric cancer in our patients was Helicobacter pylori infection (59 cases, 49.1%). Seventy-six patients (63.3%) consulted within 1 to 6 months of symptoms on set at the forefront of which chronic epigastralgia (74.1%). At endoscopy, the tumor was mostly located at the antrum and was locally advanced or metastatic in 25.8% and 58.4 of cases respectively. Adenocarcinoma was the main histologic type found in 105 (87.5%) cases. Curative treatment could only be implemented in 26.7% of patients. We noted a total of 85 deaths (70.8%) with a mean survival time of 5.91 ± 7.51 months. Survival rate at 3 and 5 years was 10.1% and 4.6%, respectively. On multivariable analysis, variables independently associated with overall survival included: WHO stage 3 performance status (p = 0.042), palpable epigastric mass on examination (p = 0.042), pyloric localization (p = 0.007), and liver metastasis (p = 0.012). CONCLUSION clinical epidemiology of gastric cancer in our study is comparable to those of other African studies with a predominance of locally advanced/metastatic forms. Prognosis is grim with diagnostic delay behind all of the identified mortality risk factors.
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Affiliation(s)
- Guy Aristide Bang
- Department of Surgery and Subspecialties, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon
- Surgical Unit, Yaoundé University Teaching Hospital, Yaoundé, Cameroon
| | - Eric Patrick Savom
- Department of Surgery and Subspecialties, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon
- Surgical Unit, Yaoundé General Hospital, Yaoundé, Cameroon
| | - Blondel Nana Oumarou
- Digestive Surgery Unit, National Insurance Fund Health Centre, Yaoundé, Cameroon
| | | | - Georges Bwelle Moto
- Department of Surgery and Subspecialties, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon
- Yaoundé Central Hospital, Yaoundé, Cameroon
| | | | | | - Arthur Essomba
- Department of Surgery and Subspecialties, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon
- Surgical Unit, Yaoundé University Teaching Hospital, Yaoundé, Cameroon
| | - Maurice Aurélien Sosso
- Department of Surgery and Subspecialties, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon
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8
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Liu JQ, Cai GY, Liang S, Wang WL, Wang SY, Zhu FL, Nie SS, Feng Z, Chen XM. Characteristics of and risk factors for death in elderly patients with acute kidney injury: a multicentre retrospective study in China. Postgrad Med J 2018. [PMID: 29514995 PMCID: PMC5931240 DOI: 10.1136/postgradmedj-2017-135455] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Purpose of the study The incidence of acute kidney injury (AKI) with a poor prognosis in the elderly has been increasing each year. This study aimed to investigate the clinical characteristics of and risk factors for death from AKI in the elderly and help improve prognosis. Study design This study was a retrospective cohort study based on data from adult patients (≥18 years old) admitted to 15 hospitals in China between 1 January 2009 and 31 December 2011. The characteristics of AKI in the elderly were compared with those in younger patients. Results In elderly patients with AKI, rates of hypertension, cardiovascular disease and multiple organ dysfunction syndrome (MODS) were higher than in younger patients (44.2% vs 31.2%, 16.1% vs 4.6% and 20.9% vs 16.9%, respectively), the length of ICU stay was longer (3.8 days vs 2.7 days, P=0.019) and renal biopsy (1.0% vs 7.13%, P<0.001) and dialysis (9.6% vs 19.2%, P<0.001) were performed less. Hospital-acquired (HA) AKI was more common than community-acquired (CA) AKI (60.3% vs 39.7%), while the most common cause of AKI was pre-renal (53.5%). Multiple logistic regression analysis showed that age (OR 1.041, 95% CI 1.023 to 1.059), cardiovascular disease (OR 1.980, 95% CI 1.402 to 2.797), cancer (OR 2.302, 95% CI 1.654 to 3.203), MODS (OR 3.023, 95% CI 1.627 to 5.620) and mechanical ventilation (OR 2.408, 95% CI 1.187 to 4.887) were significant risk factors for death. Conclusions HA-AKI and pre-renal AKI were more common in the elderly. Age, cardiovascular disease, cancer, MODS and mechanical ventilation were independent risk factors for death in the elderly with AKI.
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Affiliation(s)
- Jie-Qiong Liu
- Department of Nephrology, Chinese PLA General Hospital, Chinese PLA Institute of Nephrology, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing, China.,Department of Nephrology, Chinese PLA 401 Hospital, Qingdao, China
| | - Guang-Yan Cai
- Department of Nephrology, Chinese PLA General Hospital, Chinese PLA Institute of Nephrology, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing, China
| | - Shuang Liang
- Department of Nephrology, Chinese PLA General Hospital, Chinese PLA Institute of Nephrology, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing, China
| | - Wen-Ling Wang
- Department of Nephrology, Chinese PLA General Hospital, Chinese PLA Institute of Nephrology, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing, China
| | - Si-Yang Wang
- Department of Nephrology, Chinese PLA General Hospital, Chinese PLA Institute of Nephrology, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing, China
| | - Fang-Lei Zhu
- Department of Nephrology, Chinese PLA General Hospital, Chinese PLA Institute of Nephrology, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing, China
| | - Sa-Sa Nie
- Department of Nephrology, Chinese PLA General Hospital, Chinese PLA Institute of Nephrology, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing, China
| | - Zhe Feng
- Department of Nephrology, Chinese PLA General Hospital, Chinese PLA Institute of Nephrology, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing, China
| | - Xiang-Mei Chen
- Department of Nephrology, Chinese PLA General Hospital, Chinese PLA Institute of Nephrology, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing, China
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Lakshminarayana GR, Sheetal LG, Mathew A, Rajesh R, Kurian G, Unni VN. Hemodialysis outcomes and practice patterns in end-stage renal disease: Experience from a Tertiary Care Hospital in Kerala. Indian J Nephrol 2017; 27:51-57. [PMID: 28182039 PMCID: PMC5255991 DOI: 10.4103/0971-4065.177210] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
This study was planned to analyze the hemodialysis practice patterns from a tertiary care referral centre as there is very limited data from India. All patients of ESRD on maintenance hemodialysis (MHD) in dialysis unit at AIMS, Kochi, Kerala for a minimum period of 3 months were included. A total of 134 patients (M: F 2:1) with age of 20 to 84 years (Mean: 59.83; SD: 11.98) were studied. The most common causes of ESRD in study population were diabetic nephropathy (DN) (59.7%) followed by unclassified group (19.4%), chronic glomerulonephritis (CGN) (11.9%). Majority (81%) were initiated on MHD through temporary vascular access on emergency basis. Majority (79%) of the patients were on twice weekly MHD. The range of eGFR (ml/min/1.73 m2) at the time of initiation of MHD was 1.26-11.78 by CG formula and 2.18-16.4 by MDRD equation. The mean duration on hemodialysis was 37.16 months and 50.7% patients had died during the follow-up period (3-108 months). The mean survival time on hemodialysis was 40.31 months (SD = 26.69). The mean survival time was lower in diabetic nephropathy (35.93 months) than in non-diabetic renal disease (47.46 months). The most common causes of deaths were cardiovascular events (51.5%), and infections (26.5%). In conclusion, males outnumbered females, among those on hemodialysis. There was no significant difference in eGFR at initiation of MHD based on etiologies. Initiation of MHD via temporary access, presence of LVH, acute coronary syndrome, use of acetate dialysate, need for parenteral iron therapy had impact on mortality. Survival rates while on hemodialysis at end 1st, 3rd, 5th and 7th years were 87.31, 45.52, 21.64 and 7.46 percentages respectively.
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Affiliation(s)
- G R Lakshminarayana
- Department of Nephrology, EMS Memorial Cooperative Hospital and Research Centre, Malappuram, Kerala, India
| | - L G Sheetal
- Department of Physiology, MES Medical College, Malappuram, Kerala, India
| | - A Mathew
- Department of Nephrology, Amrita Institute of Medical Sciences and Research Centre, Kochi, Kerala, India
| | - R Rajesh
- Department of Nephrology, Amrita Institute of Medical Sciences and Research Centre, Kochi, Kerala, India
| | - G Kurian
- Department of Nephrology, Amrita Institute of Medical Sciences and Research Centre, Kochi, Kerala, India
| | - V N Unni
- Senior Consultant, Nephrology, CoE Nephrology and Urology, Aster Medicity, Kochi, Kerala, India
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Majumder MS, Kluberg SA, Mekaru SR, Brownstein JS. Mortality Risk Factors for Middle East Respiratory Syndrome Outbreak, South Korea, 2015. Emerg Infect Dis 2016; 21:2088-90. [PMID: 26488869 PMCID: PMC4622268 DOI: 10.3201/eid2111.151231] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
As of July 15, 2015, the South Korean Ministry of Health and Welfare had reported 186 case-patients with Middle East respiratory syndrome in South Korea. For 159 case-patients with known outcomes and complete case histories, we found that older age and preexisting concurrent health conditions were risk factors for death.
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Agbenorku P, Agbenorku E, Akpaloo J, Obeng G, Agbley D. Electrical burns: The trend and risk factors in the Ghanaian population. Ann Burns Fire Disasters 2014; 27:176-183. [PMID: 26336364 PMCID: PMC4544427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 06/27/2014] [Indexed: 06/05/2023]
Abstract
The usefulness of electricity in daily life offers several advantages which cannot be underestimated. Electricity is needed by industries for manufacturing and also in homes for lighting, cooking, washing, etc. However, electricity can cause severe life-threatening complications. This study investigates the trend and mortality risk factors of electrical burn injuries at the Burns Intensive Care Unit (BICU) of the Komfo Anokye Teaching Hospital (KATH), Ghana. The Burns Registry at KATH BICU containing information on patients who were admitted for electrical burns was used. Data on the sex, age, occupation, cause of injury, Total Body Surface Area burned (TBSA) and outcome of admissions was obtained. GraphPad version 5 was used for the analysis. There were 13 (2.7%) electrical burns, suffered by 11 males (84.6%) and 2 females (15.4%) out of a total 487 BICU admissions over a 4-year period (July 1, 2009 - June 30, 2013); the mean age of the electrical burn victims was 37.8 years (range = 22-56); the TBSA ranged from 5.0% - 98.0%. Mortality risk factors identified were high voltage electrical burns, older age (P=0.0250) and TBSA>20% (P=0.048). Four cases (30.8%) were transferred to the Main Burns Ward (Ward D2C); 6 cases (46.1%) were discharged home; 3 patients (23.1%) died; all deaths were recorded in persons who had high voltage electrical burns. Electrical burns can be severe and can cause death. Even though the current study showed that a small population was affected by electrical burns, society has to be continually conscious of the detrimental effects of electrical energy and take the necessary precautions to minimize this type of accident.
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Affiliation(s)
- P. Agbenorku
- Reconstructive Plastic Surgery & Burns Unit, Department of Surgery, Komfo Anokye Teaching Hospital, School of Medical Sciences, Kwame Nkrumah University of Science & Technology, Kumasi, Ghana
| | - E. Agbenorku
- College of Computing and Engineering, University of Salford, Media City Campus, Salford, UK
| | - J. Akpaloo
- Reconstructive Plastic Surgery & Burns Unit, Department of Surgery, Komfo Anokye Teaching Hospital, School of Medical Sciences, Kwame Nkrumah University of Science & Technology, Kumasi, Ghana
| | - G. Obeng
- Reconstructive Plastic Surgery & Burns Unit, Department of Surgery, Komfo Anokye Teaching Hospital, School of Medical Sciences, Kwame Nkrumah University of Science & Technology, Kumasi, Ghana
| | - D. Agbley
- Department of Surgery, Volta Regional Hospital, Ho, Ghana
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12
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Agbenorku P, Agbenorku M, Fiifi-Yankson PK. Pediatric burns mortality risk factors in a developing country's tertiary burns intensive care unit. Int J Burns Trauma 2013; 3:151-8. [PMID: 23875121 PMCID: PMC3712406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 04/24/2013] [Accepted: 06/11/2013] [Indexed: 06/02/2023]
Abstract
AIM This study aimed at identifying risk factors related to pediatric burns mortality in a middle income country such as Ghana. METHODS The data for the three years retrospective study (May 2009 - April 2012) was obtained from the pediatric burn admissions records and patients' folders of the Reconstructive Plastic Surgery & Burns Unit (RPSBU), Komfo Anokye Teaching Hospital (KATH), Ghana. Data retrieved included: Demographic features, Total Burned Surface Area (TBSA) incurred; Aetiology of burns; Duration of the admission; Outcome of admission; Part of the body affected and Cost incurred. Ethical approval for this study was obtained from the KNUST-SMS/KATH Committee on Human Research, Publications and Ethics. Data analyses were performed with SPSS 17.0 version. RESULTS Information on 197 patients was completely retrieved for the study. Burns mortality rate for the study was identified to be 21.3% (N=42). The mean age of the 42 dead patients was 3.7±0.3 years, ranging from 0-13 years, while, males (54.8%, N= 23) outnumbered females (45.2%, N=19). The TBSA burned interquartile range was 48%. In terms of etiology of burns Scald (73.8%, N=31) was the commonest cause of injury. Mortality risk factors identified were Age <6 years (P=0.028); Scald especially hot water and soup (P=0.016); TBSA >36% (P=0.028) and Inhalation injury (P=0.040). CONCLUSION Age, scald, TBSA and Inhalation Injury were identified as pediatric burns mortality risk factors in a developing country such as Ghana's RPSBU. These identified factors will serve as a guideline for plastic surgeons and other health professionals practicing in countries such as Ghana.
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Affiliation(s)
- Pius Agbenorku
- Reconstructive Plastic Surgery and Burns Unit, Kwame Nkrumah University of Science & TechnologyKumasi, Ghana
- Department of Surgery, Kwame Nkrumah University of Science & TechnologyKumasi, Ghana
- Komfo Anokye Teaching Hospital, Kwame Nkrumah University of Science & TechnologyKumasi, Ghana
- School of Medical Sciences, Kwame Nkrumah University of Science & TechnologyKumasi, Ghana
- Kwame Nkrumah University of Science & TechnologyKumasi, Ghana
| | - Manolo Agbenorku
- Reconstructive Plastic Surgery and Burns Unit, Kwame Nkrumah University of Science & TechnologyKumasi, Ghana
- Department of Surgery, Kwame Nkrumah University of Science & TechnologyKumasi, Ghana
- Komfo Anokye Teaching Hospital, Kwame Nkrumah University of Science & TechnologyKumasi, Ghana
| | - Papa Kwesi Fiifi-Yankson
- Reconstructive Plastic Surgery and Burns Unit, Kwame Nkrumah University of Science & TechnologyKumasi, Ghana
- Department of Surgery, Kwame Nkrumah University of Science & TechnologyKumasi, Ghana
- Komfo Anokye Teaching Hospital, Kwame Nkrumah University of Science & TechnologyKumasi, Ghana
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Volakli E, Sdougka M, Tamiolaki M, Tsonidis C, Reizoglou M, Giala M. Demographic profile and outcome analysis of pediatric intensive care patients. Hippokratia 2011; 15:316-322. [PMID: 24391412 PMCID: PMC3876846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
BACKGROUND Demographic profile and outcome can vary in pediatric intensive care unit (PICU) patients. The aim of our study was to analyze demographic profile and outcome in a Greek PICU. METHODS Prospective observational study. DATA COLLECTED demographic profile; co morbidities; source and diagnosis at admission; Pediatric Risk of Mortality (PRISM III-24); Glasgow Coma Scale (GCS, pediatric); Injury Severity Score (ISS); procedures; treatment; mechanical ventilation (MV); MV days; length of stay (LOS) and the outcome at PICU discharge. STATISTICAL ANALYSIS Student's t-test; Mann-Whitney U test; Kruskall-Wallis test; χ(2) criterion with relative risk (RR) estimation; Cox regression analysis; as appropriate. Values are mean ± SD, p < 0.05. RESULTS 300 patients (196 boys/104 girls), aged 54.26 ± 49.93 months, were admitted due to respiratory failure (22.3%), head trauma (15.3%), seizures (13.7%), coma (9.7%), postoperative care (7.7%), polytrauma (7%), accidents (5.3%), sepsis-septic shock (5.3%), cardiovascular diseases (4.7%), metabolic diseases (3.3%), multiple organ failure syndrome (3%) and miscellaneous diseases (2.7%). PRISM III-24 score was 8.97 ± 7.79 and predicted mortality rate was 11.16% ± 18.65. MV rate was 67.3% (58.3% at admission) for 6.54 ± 14.45 days, LOS 8.85 ± 23.28 days and actual PICU mortality rate 9.7%. Patients who died had statistically worse severity scores. Significant mortality risk factors were inotropic use, PRISM III-24 > 8, MV, arterial and central venous catheterization, nosocomial infections, complications, and cancer. COX regression analysis showed that PRISM III-24 score and inotropic use were independent predictors of mortality. CONCLUSIONS Demographic profile followed similar patterns to relevant studies while there were major differences in case mix and the severity of the disease. Mortality rate (9.7%) was relatively high but better than predicted and in accordance with the characteristics of our population.
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Affiliation(s)
- E Volakli
- Pediatric Intensive Care Unit, Hippokratio General Hospital, Thessaloniki, Greece
| | - M Sdougka
- Pediatric Intensive Care Unit, Hippokratio General Hospital, Thessaloniki, Greece
| | - M Tamiolaki
- Pediatric Intensive Care Unit, Hippokratio General Hospital, Thessaloniki, Greece
| | - C Tsonidis
- 2 Department of Neurosurgery, School of Medicine, Aristotle University of Thessaloniki, Hippokratio General Hospital, Thessaloniki, Greece
| | - M Reizoglou
- Department of Anesthesiology and Intensive Care, School of Medicine, Aristotle University of Thessaloniki, Greece
| | - M Giala
- Department of Anesthesiology and Intensive Care, School of Medicine, Aristotle University of Thessaloniki, Greece
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