Excess mortality and suicide risk in treatment-seeking individuals with schizotypal disorder: A population-based study using Swedish national registers.

This study investigates the excess mortality, both all-cause and due to suicide, among individuals with schizotypal disorder (SD) compared to the general population. Using individual-level data from the Swedish National Patient Register and the Cause of Death Register, we analyzed mortality in 998 patients diagnosed with SD from 2006 to 2017. Our primary outcomes were all-cause mortality and suicide mortality, with baseline variables including sex, age, and psychiatric comorbidities. Results indicated significantly elevated mortality rates for both all-cause mortality (Standardized Mortality Ratio (SMR) 5.2) and suicide (SMR 23.4). Substance use disorders, personality disorders, and ADHD were identified as significant predictors of increased all-cause mortality. Notably, having a personality disorder in conjunction with schizotypal disorder resulted in a markedly increased risk of suicide. The study underscores the urgent need for targeted interventions and improved diagnostic precision to reduce premature mortality in this vulnerable population. Additionally, the relatively low prevalence of SD diagnoses in Sweden highlights a potential underdiagnosis or misclassification issue. These findings have critical implications for clinical practice and public health efforts, emphasizing the necessity for comprehensive care strategies and suicide prevention interventions to improve outcomes for individuals with schizotypal disorder.

Long-term mortality outcomes and mortality predictors in patients with myelomeningocele.

OBJECTIVE: Despite advances, myelomeningocele remains a major cause of mortality and disability. This study aims to analyze factors influencing mortality and suggest ways to reduce it. METHODS: We reviewed 173 patients who underwent surgery for myelomeningocele from January 2010 to December 2021. Variables affecting mortality were categorized into patient-related and indirectly related factors. Data were collected through patient file reviews and phone interviews with parents. RESULTS: Mortality is influenced by multiple factors: female gender (3.2-fold increase), paraplegia (3.1-fold increase), absence of tethered cord release surgery (9.4-fold increase), scoliosis (4.2-fold increase), and renal failure (5.28-fold increase). Defect size and father's education level also significantly impact mortality. The overall mortality rate was 20.8 %, with hydrocephalus being the leading cause. CONCLUSION: Mortality and disability in myelomeningocele patients remain high, with over 50 % of deaths being preventable. Effective management could significantly improve mortality rates. Long-term studies are crucial for advancing research in this field.

A critical review of health and financial implications of obesity during the COVID-19 pandemic.

The COVID-19 was reported in Wuhan, China, in December 2019. There is a link between increased mortality and obese individuals with the disease. The disease has been claimed to have disproportionately affected non-Hispanic blacks and Hispanics. The rise in food accessibility and the drop in the relative cost of junk food items are the two most significant changes in dietary patterns. Around the world, 2.8 million people die from being overweight or obese, and those with more body fat also have a higher risk of diabetes (44%) and heart disease (23%). Obesity weakens the immune system because adipose cells infiltrate the bone marrow, spleen, and thymus. Obesity was substantially more common among COVID-19 patients who were hospitalized than those who were not hospitalized. Over 900 000 adults in the United States are hospitalized due to a COVID-19 infection. Hospitalizations in 271 700 (30.2%) cases have been attributed to obesity. Obese patients may be experiencing reduced thoracic expansion following bariatric surgery. Less tracheal collapse and air-trapping at end-expiration chest computed tomography (CT) were observed post-surgery, and patients reported reduced dyspnea. COVID-19 is estimated to cost the European Union €13.9 billion in secondary care, with 76% of that cost attributed to treatment for overweight and obese individuals. The average price per hospitalized patient also increased with increasing BMI. Screening for obesity, preventive measures, and recommendations for healthy lifestyle changes should be of the utmost importance to decrease both the health and financial implications of COVID-19.

Advancing life: innovative approaches to enhance survival in sickle cell anemia patients.

Sickle cell anemia (SCA) is a severe genetic disorder characterized by the production of abnormal hemoglobin S, leading to the formation of sickle-shaped red blood cells that cause chronic anemia, pain, and organ damage. This review explores recent innovative strategies aimed at improving survival rates and quality of life for SCA patients. Genetic therapies, particularly gene editing with CRISPR-Cas9 and gene therapy using lentiviral vectors, have shown significant potential in correcting the genetic defects responsible for SCA. Clinical trials demonstrate that these approaches can reduce sickle cell crises and minimize the need for blood transfusions by enabling the production of healthy red blood cells. Novel pharmacological treatments such as voxelotor, crizanlizumab, and L-glutamine provide additional mechanisms to prevent hemoglobin polymerization, reduce vaso-occlusive episodes, and decrease oxidative stress, respectively. These therapies offer new hope for patients, particularly those who do not respond adequately to existing treatments. Improved blood transfusion protocols, including automated red cell exchange and advanced donor-matching techniques, have enhanced the safety and efficacy of transfusions, reducing complications like alloimmunization. Comprehensive care models, integrating multidisciplinary care teams, patient education, and telemedicine, have further contributed to better disease management. By providing holistic care that addresses both medical and psychosocial needs, these models improve patient adherence to treatment and overall health outcomes. This review highlights the importance of these innovative strategies and calls for continued research and development to sustain and expand these advancements in SCA care.

Simultaneous Silencing of Gut Nucleases and a Vital Target Gene by Adult dsRNA Feeding Enhances RNAi Efficiency and Mortality in Ceratitis capitata.

Ceratitis capitata, known as the Mediterranean fruit fly (Medfly), is a major dipteran pest significantly impacting fruit and vegetable farming. Currently, its control heavily relies mainly on chemical insecticides, which pose health risks and have effects on pollinators. A more sustainable and species-specific alternative strategy may be based on double-stranded RNA (dsRNA) delivery through feeding to disrupt essential functions in pest insects, which is poorly reported in dipteran species. Previous reports in Orthoptera and Coleoptera species suggested that dsRNA degradation by specific nucleases in the intestinal lumen is among the major obstacles to feeding-mediated RNAi in insects. In our study, we experimented with three-day adult feeding using a combination of dsRNA molecules that target the expression of the ATPase vital gene and two intestinal dsRNA nucleases. These dsRNA molecules were recently tested separately in two Tephritidae species, showing limited effectiveness. In contrast, by simultaneously feeding dsRNA against the CcVha68-1, CcdsRNase1, and CcdsRNase2 genes, we observed 79% mortality over seven days, which was associated with a decrease in mRNA levels of the three targeted genes. As expected, we also observed a reduction in dsRNA degradation following RNAi against nucleases. This research illustrates the potential of utilizing molecules as pesticides to achieve mortality rates in Medfly adults by targeting crucial genes and intestinal nucleases. Furthermore, it underscores the importance of exploring RNAi-based approaches for pest management.

Age-specific all-cause mortality trends in the UK: Pre-pandemic increases and the complex impact of COVID-19.

OBJECTIVES: This study aims to analyse age-specific all-cause mortality trends in the UK before and after COVID-19 emergence to determine if pre-pandemic trends contributed to increased mortality levels in the post-pandemic era. STUDY DESIGN: Statistical analysis of UK mortality data. METHODS: We utilised age-structured population and mortality data for all UK countries from 2005 to 2023. Mortality rates were calculated for each age group, and excess mortality was estimated using the Office for National Statistics (ONS) method. RESULTS: Our most concerning finding is an increase in all-cause mortality rates for middle-aged adults (30-54 years) starting around 2012. The COVID-19 pandemic may have further impacted these rates, but the pre-existing upward trend suggests that current elevated mortality rates might have been reached regardless of the pandemic. This finding is more alarming than the slowdown in the decline of cardiovascular disease death rates for individuals under 75 noted by the British Heart Foundation. CONCLUSION: Our results highlight the importance of considering both immediate pandemic impacts and long-term mortality trends in public health strategies. This underscores the need for targeted interventions and improved healthcare planning to address both ongoing and future challenges.

Education and Information to Improve Adherence to Screening for Breast, Colorectal, and Cervical Cancer-Lessons Learned during the COVID-19 Pandemic.

The objective of this study was to determine the correlation between adherence to cancer screening programs and earlier diagnosis of the 14 most common types of cancers in the adult population, before and during the COVID-19 pandemic. National data concerning number of admissions and operations in Italy for adult patients admitted with oncologic problems during the COVID-19 pandemic (2020 to 2022) and in the pre-pandemic period (2015 to 2019) were analyzed. We selected 14 types of cancer that present the most common indications for surgery in Italy. This study included 1,365,000 adult patients who had surgery for the 14 most common types of cancer in the period 2015-2022, and interviews concerning adherence rates to screening for breast, colorectal, and cervical cancer were conducted for 133,455 individuals. A higher decrease in the number of operations for the 14 types of cancer (-45%) was registered during the first three acute phases of the pandemic, and it was more evident for screenable cancers like breast, colorectal, and cervical cancer (p < 0.001). During the first year of the COVID-19 pandemic, the number of screened individuals for breast, colorectal, and cervical cancer decreased by 33.8% (from 7,507,893 to 4,969,000) and the number of diagnoses and operations for these three types of cancer decreased by 10.5% (from 107,656 to 96,405). The increase and return to normality of the number of screened individuals in the last year of the pandemic (2022) and in the first post-pandemic year (2023) was associated with a return to the pre-pandemic levels of diagnoses and operations. The adherence rates were lower for individuals living in rural areas, with low socio-economic status, and unmarried persons; however, the most statistically significant factor for reduced adherence was a lower level of educational attainment. Free screening through nationally organized programs reduced social disparities. There were no significant differences between the pre-pandemic and pandemic periods for several types of cancers (stomach, esophagus, pancreas, liver) that are diagnosed for the occurrence of symptoms and for which nationally organized programs might increase the possibility of earlier diagnosis and improved clinical outcomes. Education, information, and appropriate expenditure for preventive care have the potential to reduce cancer mortality. Nationally organized screening programs for several types of cancers, which are often detected for the occurrence of symptoms, may increase the possibility of diagnosis at earlier stages.

Investigating sex, race, and geographic disparities in bronchus and lung cancer mortality in the United States: a comprehensive longitudinal study (1999-2020) utilizing CDC WONDER data.

Background: Lung and bronchus cancer has become the leading cause of cancer-related mortality in the United States. Understanding the patterns of mortality is an absolute requirement. Methods: This study analyzed Lung and Bronchus cancer-associated mortality rates from 1999 to 2020 using death certificate data from the Centers for Disease Control and Prevention Wide-Ranging OnLine Data for Epidemiologic Research (CDC WONDER). Age-adjusted mortality rates (AAMRs), per 100 000 people, and annual percentage change (APCs) were also calculated. Results: 3 599 577 lung and bronchus cancer-related deaths occurred in patients aged younger than 1-85+ years between 1999 and 2020. Overall AAMRs declined from 59.1 in 1999 to 58.9 in 2001 (APC: -0.1364) then to 55.9 in 2005 (APC: -1.4388*) 50.5 by 2010 (APC: -2.0574*) 44.7 by 2014 (APC: -2.9497*) and 35.1 by 2020 (APC: -4.1040*). Men had higher AAMRs than women (overall AAMR men: 61.7 vs. women: 38.3). AAMRs were highest among non-Hispanic (NH) Black or African American (52.7) patients followed by NH White (51.8), NH American Indian or Alaska Native (38.6), NH Asian or Pacific Islander (24.7) and Hispanic or Latino race (20.2). AAMRs varied in region (overall AAMR; South: 52.4; Midwest: 52.3; Northeast: 46.3; West: 39.1). Non-metropolitan areas had a higher AAMR (55.9) as compared to metropolitan areas (46.7). The top 90th percentile states of Lung and Bronchus cancer AAMR were Arkansas, Kentucky, Mississippi, Tennessee, and West Virginia. Conclusion: An overall decreasing trend in AAMRs for lung and bronchus cancer was seen. Public health measures to regulate risk factors and precipitating events are needed.

Does Disaster Severity Have a Long-Term Effect on Survivors' Disaster Preparedness? A Survey a Decade after the 2008 Wenchuan Earthquake in China.

OBJECTIVES: Disaster experiences have long-term effects on disaster preparedness. This study examined the long-term (10-y) effect of disaster severity of the 2008 Wenchuan earthquake on survivors' disaster preparedness and the moderating effects of household vulnerability. METHODS: The data were collected in January 2018 covering 30 counties in Wenchuan earthquake-stricken areas. The dependent variable was survivors' disaster preparedness (including overall, material, knowledge and awareness, and action preparedness) in 2018. Disaster severity included survivors' housing damage and county death rate caused by the earthquake in 2008. Household vulnerability is a set of conditions that negatively affects the ability of people to prepare for and withstand disaster, proxied by households' per-capita income and the highest years of schooling of household members. We performed multivariable linear regression models to answer the research questions. RESULTS: A higher county death rate was associated with better overall preparedness (ß = 0.043; P < 0.05) and knowledge and awareness preparedness (ß = 0.018; P < 0.05), but housing damage was not significantly associated with disaster preparedness. The positive association of county death rate with overall preparedness (ß = -0.065; P < 0.05) becomes weaker when a household has a higher per-capita income. Also, with the household per-capita income increasing, the associations of county death rate with material preparedness (ß = -0.037; P < 0.05) and action preparedness (ß = -0.034; P < 0.01) become weaker. CONCLUSIONS: Disaster severity has positive and long-term effects on survivors' disaster preparedness. Also, the positive and long-term effects are affected by household vulnerability. Specifically, the positive and long-term effects of disaster severity on disaster preparedness are more substantial when a household is more vulnerable.

Gastrointestinal stromal tumours: incidence, recurrence and mortality. A decade of patients from a New Zealand tertiary surgical centre.

BACKGROUND: Gastrointestinal stromal tumours (GISTs) are the most common mesenchymal tumours of the gastrointestinal tract. The New Zealand (NZ) population incidence has not previously been documented nor has the potential effect of ethnicity been reviewed. We furthermore wanted to assess the difference between those undergoing a wedge resection versus a more extensive operation which we hypothesised would correlate with recurrence and mortality. METHODS: All patients (n = 103) with a GIST diagnosed and treated at Te Whatu Ora Waitemata (Auckland, New Zealand) between 2012 and 2021 are presented. Patient demographics, method of GIST detection, management approach, index surgery, histological features, use of adjuvant and neoadjuvant imatinib, follow-up, recurrence and mortality rates were analysed. RESULTS: This paper reports the largest NZ GIST cohort to date and estimates an incidence of 17 cases per million per year. Eighty-four patients underwent surgical resection, 58 received a wedge resection and 17 received a more extensive operation. Five-year disease-free survival rates were 100% in the low/very low risk, 90% in the intermediate and 59% in the high risk groups as determined by the modified NIH criteria. Our overall 5-year GIST-specific survival rate was 83%; it was 91% in those who underwent a wedge resection and 60% in the extensive operation group. There is evidence that Maori have higher rates of GIST recurrence compared to non-Maori and are more likely to require an extensive surgical resection.

Burden of 30 cancers among men: Global statistics in 2022 and projections for 2050 using population-based estimates.

BACKGROUND: Men exhibit higher prevalence of modifiable risk factors, such as smoking and alcohol consumption, leading to greater cancer incidence and lower survival rates. Comprehensive evidence on global cancer burden among men, including disparities by age group and country, is sparse. To address this, the authors analyzed 30 cancer types among men in 2022, with projections estimated for 2050. METHODS: The 2022 GLOBOCAN estimates were used to describe cancer statistics for men in 185 countries/territories worldwide. Mortality-to-incidence ratios (MIRs) were calculated by dividing age-standardized mortality rates by incidence rates. RESULTS: In 2022, a high MIR (indicating poor survival) was observed among older men (aged 65 years and older; 61%) for rare cancer types (pancreatic cancer, 91%) and in countries with low a Human Development Index (HDI; 74%). Between 2022 and 2050, cancer cases are projected to increase from 10.3 million to 19 million (≥84%). Deaths are projected to increase from 5.4 million to 10.5 million (≥93%), with a greater than two-fold increase among men aged 65 years and older (≥117%) and for low-HDI and medium-HDI countries/territories (≥160%). Cancer cases and deaths are projected to increase among working-age groups (≥39%) and very-high-HDI countries/territories (≥50%). CONCLUSIONS: Substantial disparities in cancer cases and deaths were observed among men in 2022, and these are projected to widen by 2050. Strengthening health infrastructure, enhancing workforce quality and access, fostering national and international collaborations, and promoting universal health coverage are crucial to reducing cancer disparities and ensuring cancer equity among men globally.

Impact of hypertensive heart disease, risk factors, and age-period-cohort models across 204 nations and regions from 1990 to 2019: a global perspective from the 2019 global burden of disease study.

Background: Hypertensive heart disease (HHD) is a major global public health issue resulting from hypertension-induced end-organ damage. The aim of this study was to examine the global impact, risk factors, and age-period-cohort (APC) model of HHD from 1990 to 2019. Methods: Data from the 2019 Global Burden of Disease were used to assess age-adjusted HHD prevalence, disability-adjusted life years (DALYs), mortality rates, and contributions of HHD risk factors with 95% uncertainty intervals (UIs). APC models were used to analyze global age, period, and cohort mortality trends for HHD. Results: In 2019, 18.6 million prevalent HHD cases led to 1.16 million fatalities and 21.51 million DALYs. Age-adjusted rates were 233.8 (95%UI = 170.5-312.9) per 100,000 individuals for prevalence, 15.2 (11.2-16.7) for mortality, and 268.2 (204.6-298.1) for DALYs. Regionally, the Cook Islands (703.1), Jordan (561.6), and Kuwait (514.9) had the highest age-standardized incidence of HHD in 2019. There were significant increases in HHD prevalence in Andean Latin America (16.7%), western sub-Saharan Africa (5.6%), and eastern sub-Saharan Africa (4.6%). Mortality rate varied widely among countries. Risk factors like elevated systolic blood pressure and high body mass index significant influenced DALY rates, especially in females. The APC model revealed an association between mortality rates and age, with a decreasing mortality risk over time and improved survival rates for a later birth cohort. Conclusions: Despite the reduction in prevalence, HHD remains a significant public health issue, particularly in nations with low sociodemographic indices. To alleviate the impact of HHD, prevention efforts should concentrate on the management of hypertension, weight loss, and lifestyle improvement.

Treatment Adherence Rates and Long-Term Mortality in a Quaternary Multidisciplinary Heart Team: An Observational Cohort.

BACKGROUND: A multidisciplinary heart team (HT) approach to patients with complex coronary artery disease has a class IB recommendation, yet there are limited data on adherence to HT treatment recommendations and long-term clinical follow-up. The objective of this study was to assess adherence rates to HT recommendations and assess long-term mortality rates among patients with complex CAD. METHODS AND RESULTS: Six hundred eighty-four sequential HT cases for complex coronary artery disease from January 2015 to May 2017 were reviewed. After excluding cases with significant comorbid valve disease, baseline characteristics were compared based on HT treatment recommendations: optimal medical therapy, percutaneous coronary intervention, and coronary artery bypass grafting. Adherence rates were manually extracted, and 5-year mortality rates were obtained from the Michigan Death Registry. Seventy-two percent of 405 included patients were men (mean age 66±11 years), with high rates of medical comorbidities. Estimated surgical risk scores were lowest in the coronary artery bypass grafting group. Optimal medical therapy was recommended in 138 patients (34%), percutaneous coronary intervention in 95 (23%), and coronary artery bypass grafting in 172 (42%). Adherence to HT recommendations across groups was high (96%) and did not differ between treatment groups. Over 5 years of follow-up, there were 119 deaths, resulting in a cumulative mortality rate of 29%. CONCLUSIONS: In the largest HT cohort in the United States to date, high rates of adherence to HT recommendations were observed among high-risk patients with coronary artery disease. High rates of adherence to HT recommendations were observed irrespective of treatment group recommendation, suggesting that HT recommendations were individualized and acceptable to both patients and physicians alike.

The impact of sociodemographic, health status and resources, macroeconomic, and environmental factors on infant mortality rates in Qatar, Kingdom of Saudi Arabia, and the United Arab Emirates.

OBJECTIVES: This study aims to study the impact of sociodemographic (SD), health status and resources (HSR), macroeconomic (ME), and Environmental (EV) factors on the infant mortality rate (IMR) in Qatar, Kingdom of Saudi Arabia (KSA), and the United Arab Emirates (UAE) and from 1990 to 2022. DESIGN: A retrospective time-series study employing yearly data was conducted. A generalized least squares model was utilized to construct an exploratory model of IMR determinants for each country. RESULTS: In SD, the risk of IMR may be increased with a higher crude birth rate, adolescent fertility rate, and married women percentage. In HSR, immunization coverage shows a significant effect in preventing neonatal diseases and reducing IMR. In ME, the effect of parents' employment seems contradicted among the three countries. In EV, greenhouse emissions have also had contradictory effects among the three countries, suggesting a complex relationship with IMR. Some were consistent with global findings, whereas others contradicted the prevailing narrative. CONCLUSIONS: This study highlights the need for tailored public health interventions addressing socio-demographic, healthcare, and environmental contexts to effectively reduce IMR and enhance infant health outcomes.

Decreasing levels of atmospheric pollution and simultaneous reduced number of cardiovascular hospital admissions and operations with improved results. Analysis of the Italian National Registries.

BACKGROUND: The aim of our study was to determine a correlation between decrease of levels of atmospheric pollution (as determined by air levels of Particulate Matters with a diameter equal or less to 2.5 microns) and reduced number of hospital admissions and operations for patients with common cardiovascular diseases in Italy. METHODS: We correlated number of hospital admissions and cardiovascular operations and atmospheric levels of PM.2.5 from 2015 to 2019 in Italy. This time interval was chosen because the possibility to analyze data about other established cardiovascular risk factors as reported by the European Union Eurostat. RESULTS: A statistically significant decrease of hospital admissions for cardiovascular and pulmonary emergencies was registered in Italy from 2015 to 2019 (p<0.01). The number also of cardiovascular operations showed a trend towards reduction with improved 30-days results, without reaching a statistically significant correlation (p =0.10). In the period 2015-2019, there was a steady decrease of atmospheric levels of pM2.5, either in urban or rural areas (p<0.01). The decrease of atmospheric levels of PMs2.5 started in 2010 and continued with a steady trend until the year 2019. In the period 2015-2019 exposure of the Italian population to established risk factors for cardiovascular diseases showed a small increase. The number of admissions and operations for non- cardiovascular and non-pulmonary diseases remained unchanged in the period 2015-2019. CONCLUSIONS: The findings of our study underline the possibility that decrease of atmospheric pollution may determine almost immediate decrease of cardiovascular and pulmonary diseases.

Assessing the influence of nursing home size and care models on COVID-19 case and mortality rates.

INTRODUCTION: This study examines the impact of COVID-19 on older adults in traditional nursing homes, Green Houses (GHs), and Continuing Care Retirement Communities-Nursing Homes (CCRCNHs). METHODS: COVID-19 cases and deaths from CMS and LTCFocus data across 11 states from 6/2020 to 9/2022 were used, and Poisson regressions to compare care settings while adjusting for covariates. RESULTS: CCRCNH and GH residents were older (84.4 and 83.1 years) than those in traditional NHs (77.5 and 77.6 years, p < 0.0001), with more female and White individuals. COVID-19 risk was higher in CCRCNHs (RR 1.51, 95 % CI 1.10-2.07), large NHs (RR 1.57, 95 % CI 1.14-2.15), and highest in small NHs (RR 1.80, 95 % CI 1.32-2.47). Mortality rates across NH types showed no significant difference. CONCLUSION: The study shows that smaller, person-centered GHs are more effective in controlling COVID-19 infection, suggesting a need to rethink care models to incorporating GH features for better outcomes. GEORGE2 07-AUG-2024 11:31.

Risk and mediation analyses of hemoglobin glycation index and survival prognosis in patients with sepsis.

An increasing number of studies have reported the close relation of the hemoglobin glycation index (HGI) with metabolism, inflammation, and disease prognosis. However, the prognostic relationship between the HGI and patients with sepsis remains unclear. Thus, this study aimed to analyze the association between the HGI and all-cause mortality in patients with sepsis using data from the MIMIC-IV database. In this study, 2605 patients with sepsis were retrospectively analyzed. The linear regression equation was established by incorporating glycated hemoglobin (HbA1c) and fasting plasma glucose levels. Subsequently, the HGI was calculated based on the difference between the predicted and observed HbA1c levels. Furthermore, the HGI was divided into the following three groups using X-tile software: Q1 (HGI ≤ - 0.50%), Q2 (- 0.49% ≤ HGI ≤ 1.18%), and Q3 (HGI ≥ 1.19%). Kaplan-Meier survival curves were further plotted to analyze the differences in 28-day and 365-day mortality among patients with sepsis patients in these HGI groups. Multivariate corrected Cox proportional risk model and restricted cubic spline (RCS) were used. Lastly, mediation analysis was performed to assess the factors through which HGI affects sepsis prognosis. This study included 2605 patients with sepsis, and the 28-day and 365-day mortality rates were 19.7% and 38.9%, respectively. The Q3 group had the highest mortality risk at 28 days (HR = 2.55, 95% CI: 1.89-3.44, p < 0.001) and 365 days (HR = 1.59, 95% CI: 1.29-1.97, p < 0.001). In the fully adjusted multivariate Cox proportional hazards model, patients in the Q3 group still displayed the highest mortality rates at 28 days (HR = 2.02, 95% CI: 1.45-2.80, p < 0.001) and 365 days (HR = 1.28, 95% CI: 1.08-1.56, p < 0.001). The RCS analysis revealed that HGI was positively associated with adverse clinical outcomes. Finally, the mediation effect analysis demonstrated that the HGI might influence patient survival prognosis via multiple indicators related to the SOFA and SAPS II scores. There was a significant association between HGI and all-cause mortality in patients with sepsis, and patients with higher HGI values had a higher risk of death. Therefore, HGI can be used as a potential indicator to assess the prognostic risk of death in patients with sepsis.

Numerical and Thermal Response of the Bacterivorous Ciliate Colpidium kleini, a Species Potentially at Risk of Extinction by Rising Water Temperatures.

We investigated the food-dependent growth and thermal response of the freshwater ciliate Colpidium kleini using numerical response (NR) experiments. This bacterivorous ciliate occurs in lotic water and the pelagial of lakes and ponds. The C. kleini strain used in this work was isolated from a small alpine lake and identified by combining detailed morphological inspections with molecular phylogeny. Specific growth rates (rmax) were measured from 5 to 21 °C. The ciliate did not survive at 22 °C. The threshold bacterial food levels (0.3 - 2.2 × 106 bacterial cells mL-1) matched the bacterial abundance in the alpine lake from which C. kleini was isolated. The food threshold was notably lower than previously reported for C. kleini and two other Colpidium species. The threshold was similar to levels reported for oligotrich and choreotrich ciliates if expressed in terms of bacterial biomass (0.05 - 0.43 mg C L-1). From the NR results, we calculated physiological mortality rates at zero food concentration. The mean mortality (0.55 ± 0.17 d-1) of C. kleini was close to the mean estimate obtained for other planktonic ciliates that do not encyst. We used the data obtained by the NR experiments to fit a thermal performance curve (TPC). The TPC yielded a temperature optimum at 17.3 °C for C. kleini, a maximum upper thermal tolerance limit of 21.9 °C, and a thermal safety margin of 4.6 °C. We demonstrated that combining NR with TPC analysis is a powerful tool to predict better a species' fitness in response to temperature and food.

Improving colorectal cancer screening programs.

In this editorial we comment on the article by Agatsuma et al published in the World Journal of Gastroenterology. They suggest policies for more effective colorectal screening. Screening is the main policy that has led to lower mortality rates in later years among the population that was eligible for screening. Colonoscopy is the gold standard tool for screening and has preventive effects by removing precancerous or early malignant polyps. However, colonoscopy is an invasive process, and fecal tests such as the current hemoglobin immunodetection were developed, followed by endoscopy, as the general tool for population screening, avoiding logistical and economic problems. Even so, participation and adherence rates are low. Different screening options are being developed with the idea that if people could choose between the ones that best suit them, participation in population-based screening programs would increase. Blood tests, such as a recent one that detects cell-free DNA shed by tumors called circulating tumor DNA, showed a similar accuracy rate to stool tests for cancer, but were less sensitive for advanced precancerous lesions. At the time when the crosstalk between the immune system and cancer was being established as a new hallmark of cancer, novel immune system-related biomarkers and information on patients' immune parameters, such as cell counts of different immune populations, were studied for the early detection of colorectal cancer, since they could be effective in asymptomatic people, appearing earlier in the adenoma-carcinoma development compared to the presence of fecal blood. sCD26, for example, detected 80.37% of advanced adenomas. To reach as many eligible people as possible, starting at an earlier age than current programs, the direction could be to apply tests based on blood, urine or salivary fluid to samples taken during routine visits to the primary health system.

Efficacy of Remdesivir on Clinical Outcomes in COVID-19 Patients: A Study in a Tertiary Care Hospital in Pakistan.

Background: As of October 3, 2023, the global COVID-19 case tally exceeded 696 million, with almost 7 million fatalities. Remdesivir, approved for treatment of COVID-19 by regulatory bodies, has seen varying recommendations by the World Health Organization over time. Despite certain studies questioning its efficacy, others highlight potential benefits. The objective of this study was to gauge the impact of remdesivir on clinical outcomes in a Pakistani tertiary care hospital. Methods: An analytical cross-sectional study was conducted on 108 COVID-19 patients at Mayo Hospital Lahore between September 2020 and August 2021. Of these, 52 received remdesivir. The study employed a structured proforma for data collection, with analyses conducted using SPSS version 26, considering a p-value of less than 0.05 as statistically significant. Results: Demographic distribution between remdesivir-treated and untreated groups was similar. Significant improvement was observed in the remdesivir cohort in terms of oxygen saturation (58%), ferritin levels (58.2%), chest X-ray results (67.8%), and discharge rates (66.7%) when compared to the untreated group. Stratification based on disease severity showed that remdesivir was particularly beneficial for moderate illness cases in several parameters. Conclusion: This study suggests that remdesivir can be associated with improved outcomes, especially in patients with moderate COVID-19 severity. The data emphasizes the importance of the disease stage when considering therapeutic interventions and calls for more region-specific research to guide health responses amid diverse epidemiological landscapes.