Recent mortality rates due to complications of medical and surgical care in the US.

OBJECTIVES: Medical errors and complications pose a major threat to the safety of healthcare systems worldwide. This article was hence aimed at determining the current burden of complications of medical and surgical care in the US. METHODS: We searched the latest version of the US Centers for Disease Control and Prevention (CDC) WONDER online database (years 2018-2022) using ICD-10 codes Y40-Y84 (complications of medical and surgical care). RESULTS: The age-adjusted death rate for complications of medical and surgical care increased from 1.17 × 100,000 in 2018 to 1.49 × 100,000 in 2021, but then declined to 0.85 × 100,000 in 2022. The gender-specific analysis showed a similar trend, with the age-adjusted death rate values always being higher in men than in women. A clear age-dependent relationship was also found in the crude mortality rate for complications of medical and surgical care, as higher death rates were observed in older patients. CONCLUSIONS: This analysis reveals that the burden of complications of medical and surgical care has increased over time, especially during the COVID-19 pandemic, but has then considerably declined in 2022. However, root cause analysis and actions are still needed for preventing the still noticeable consequences of medical complications.

Physical Activity, Long-COVID, and Inactivity: A Detrimental Endless Loop.

The risk of developing medium- and long-term sequelae after recovery from COVID-19 is validated. Long-COVID burden represents a major health care issue, thus paving the way to effective prevention and/or treatment measures. Physical activity prevents many human pathologies, including COVID-19. Being physically active before and immediately after a severe acute respiratory syndrome coronavirus 2 infection substantially lowers the risk of developing long-COVID. In addition, long-COVID is an important cause of physical inactivity. Physically inactive individuals are at increased risk of developing long-COVID, while patients with long-COVID are more likely to reduce their physical activity levels after recovering from the acute infection, with the risk of generating a continuous loop. This harmful interaction needs to be recognized by public health institutions, and the adoption of physical activity as a routine clinical practice in all individuals after a severe acute respiratory syndrome coronavirus 2 infection needs to be proactively promoted.

Red blood cell distribution width (RDW) reflects disease severity in patients with carbon monoxide poisoning: systematic literature review and meta-analysis.

No definitive prognostic biomarkers for carbon monoxide (CO) poisoning have been proposed. The aim of this study is to investigate, through a systematic literature review and pooled analysis, whether red blood cell distribution width (RDW) can predict disease severity in CO-poisoned patients. We performed an electronic search in Scopus and PubMed using the keywords: 'red blood cell distribution width' OR 'RDW' AND 'carbon monoxide' AND 'poisoning,' with no time or language restrictions (i.e. through August 2023) to find clinical studies that examined the value of RDW in patients with varying severity of CO poisoning. The analysis was performed according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 2020 reporting checklist. We identified 29 articles, seven of which were included in our analysis, with a total of 1979 CO-poisoned patients, 25.9% of whom were severely ill. In all but one of the studies, the RWD mean or median value was higher in CO-poisoned patients with severe disease. The weighted mean difference (WMD) of RDW was 0.36 (95% confidence interval (CI), 0.26-0.47)%. In the three articles in which the severity of illness in CO-poisoned patients was defined as cardiac injury, the WMD of the RDW was 1.26 (95%CI, 1.02-1.50)%. These results suggest that monitoring RDW in CO-poisoned patients may help to determine the severity of disease, particularly cardiac injury.

Artificial intelligence in the pre-analytical phase: State-of-the art and future perspectives.

The use of artificial intelligence (AI) has become widespread in many areas of science and medicine, including laboratory medicine. Although it seems obvious that the analytical and post-analytical phases could be the most important fields of application in laboratory medicine, a kaleidoscope of new opportunities has emerged to extend the benefits of AI to many manual labor-intensive activities belonging to the pre-analytical phase, which are inherently characterized by enhanced vulnerability and higher risk of errors. These potential applications involve increasing the appropriateness of test prescription (with computerized physician order entry or demand management tools), improved specimen collection (using active patient recognition, automated specimen labeling, vein recognition and blood collection assistance, along with automated blood drawing), more efficient sample transportation (facilitated by the use of pneumatic transport systems or drones, and monitored with smart blood tubes or data loggers), systematic evaluation of sample quality (by measuring serum indices, fill volume or for detecting sample clotting), as well as error detection and analysis. Therefore, this opinion paper aims to discuss the state-of-the-art and some future possibilities of AI in the preanalytical phase.

Diagnostic value of D-dimer in differentiating Multisystem Inflammatory Syndrome in Children (MIS-C) from Kawasaki disease: systematic literature review and meta-analysis.

Coronavirus disease 2019 (COVID-19) is frequently associated with thrombo inflammation, which can predispose to developing of life-threatening conditions in children such as the multisystem inflammatory syndrome (MIS-C) and Kawasaki disease. Because of the consistent overlap in pathogenesis and symptoms, identifying laboratory tests that may aid in the differential diagnosis of these pathologies becomes crucial. We performed an electronic search in PubMed, Web of Science and Scopus, without date or language restrictions, to identify all possible studies reporting D-dimer values in separate cohorts of children with MIS-C or Kawasaki disease. Three multicenter cohort studies were included in our analysis, totaling 487 patients (270 with MIS-C and 217 with Kawasaki disease). In this meta-analysis, significantly higher D-dimer values were found in MIS-C compared to Kawasaki disease in all three studies, yielding an SMD of 1.5 (95 % CI, 1.3-1.7) mg/L. Thus, very high D-dimer values early in the course of disease should raise the clinical suspicion of MIS-C rather than Kawasaki disease. Further studies should be planned to identify harmonized D-dimer diagnostic thresholds that may help discriminate these conditions.

Systematic literature review and critical analysis of RDW in patients with aortic pathologies.

Diseases of the aorta, such as aortic aneurysm, dissection, and rupture, account for a large proportion of acute clinical emergencies. The red blood cell distribution width (RDW), which directly reflects anisocytosis (i.e., the heterogeneity of erythrocyte volumes), has emerged as a promising biomarker for many cardiovascular pathologies. Thus, we aimed to explore the implication of RDW in aortic pathologies. We searched Scopus and PubMed using the keywords "RDW" OR "red blood cell distribution width" AND "aortic aneurysm" OR "aortic dilatation" OR "aortic dissection" for identifying studies in which RDW values were measured in patients with these aortic diseases. Ten observational studies were finally included. In all studies, RDW value was increased in patients with aortic diseases. In the four studies in which sufficient RDW data were available for pooling, the weighted mean difference (WMD) of RDW in patients with or without complicated aortic pathologies was 0.575 (95 %CI, 0.254-0.896). RDW may be a valuable diagnostic and prognostic biomarker in patients with aortic pathologies.

Red blood cell distribution width (RDW) is a significant predictor of survival in laryngeal cancer patients: Systematic literature review and meta-analysis.

Background: This systematic literature review and meta-analysis investigated whether the red blood cell distribution (RDW) may predict survival outcomes in laryngeal cancer patients undergoing curative treatment. Methods: We conducted an electronic search in Medline and Scopus using the keywords "red blood cell distribution width" OR "RDW" AND "laryngeal cancer" OR "larynx cancer" OR "laryngeal carcinoma" OR "larynx carcinoma," without time or language restrictions (up to February 2023), for identifying studies investigating the prognostic value of RDW in patients with any form of laryngeal cancer and with a primary endpoint that was set as survival rate and/or disease-free survival between 1 and 10 years after curative treatment. The research was conducted according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 2020 reporting checklist.

Updated statistics on Influenza mortality.

OBJECTIVES: We have planned this analysis to provide current statistics on mortality directly caused by Influenza viruses in recent years in the US. METHODS: We performed an electronic search in the online database CDC WONDER to obtain current statistics on direct mortality caused by Influenza viruses in the US. Mortality data are derived from information on all death certificates issued in the 50 states and the District of Columbia, excluding deaths of nonresidents. Our basic query criteria included Influenza-specific ICD-10 codes. RESULTS: Influenza caused an average of 7,670 deaths per year from 2018 to 2020 based on Influenza-specific ICD-10 codes, with a corresponding mean death rate of 2.3 × 100,000. The death rate increased in parallel with the age of the US resident population, from 0.2 × 100,000 in the 5-24 age group to 37.4 × 100,000 in US residents aged 85 years or older. No substantial differences were observed in males vs. females. CONCLUSIONS: The results of this analysis show that Influenza remains a significant clinical burden in the general population, with a cumulative mortality rate of approximately 2.3 × 100,000, but increasing more than tenfold (to over 37 × 100,000) in older persons.

Correlation between relative age-standardized mortality rates and COVID-19 mortality over time in Italy.

BACKGROUND AND AIM: This study was planned to estimate the contribution of coronavirus disease 2019 (COVID-19) related mortality on excess deaths recorded in Italy since the beginning of the pandemic. METHODS: Official data on weekly number of COVID-19 related deaths in Italy were retrieved from the website of the Italian Ministry of Health, whilst information on weekly relative age-standardised mortality rates (rASMRs) in Italy during the COVID-19 pandemic was downloaded from the UK Office for National Statistics website. Univariate and multivariate correlation was conducted to explore the association between these two variables throughout the pandemic. RESULTS: Significant univariate correlation was found between rASMR and number of official COVID-19 related deaths throughout the pandemic period. Such correlation was especially high during predominance of pre-Alpha and Alpha variants, remained significant during Delta variant predominance, but become no longer significant during Omicron variant predominance. In multivariable analysis, we estimated that COVID-19 may have contributed to 72% of the excess mortality recorded in Italy throughout the pandemic. The impact was higher during pre-Alpha and Alpha periods (i.e., 78% and 89%, respectively), decreased to 41% during Delta variant predominance, and became no longer significant after emergence of the Omicron variant. CONCLUSIONS: These results would suggest that COVID-19 may have largely contributed to excess mortality in Italy until the recent emergence of the Omicron variant, by which time previous loss of vulnerable people and radical changes in delivering healthcare may have paradoxically contributed to improve the cumulative death rate in the country.

The general interest in running and walking has increased during the COVID-19.

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