Consumption of Olive Oil and Risk of Total and Cause-Specific Mortality Among U.S. Adults.

BACKGROUND: Olive oil consumption has been shown to lower cardiovascular disease risk, but its associations with total and cause-specific mortality are unclear. OBJECTIVES: The purpose of this study was to evaluate whether olive oil intake is associated with total and cause-specific mortality in 2 prospective cohorts of U.S. men and women. METHODS: The authors used multivariable-adjusted Cox proportional-hazards models to estimate HRs for total and cause-specific mortality among 60,582 women (Nurses' Health Study, 1990-2018) and 31,801 men (Health Professionals Follow-up Study, 1990-2018) who were free of cardiovascular disease or cancer at baseline. Diet was assessed by a semiquantitative food frequency questionnaire every 4 years. RESULTS: During 28 years of follow-up, 36,856 deaths occurred. The multivariable-adjusted pooled HR for all-cause mortality among participants who had the highest consumption of olive oil (>0.5 tablespoon/day or >7 g/d) was 0.81 (95% CI: 0.78-0.84) compared with those who never or rarely consumed olive oil. Higher olive oil intake was associated with 19% lower risk of cardiovascular disease mortality (HR: 0.81; 95% CI: 0.75-0.87), 17% lower risk of cancer mortality (HR: 0.83; 95% CI: 0.78-0.89), 29% lower risk of neurodegenerative disease mortality (HR: 0.71; 95% CI: 0.64-0.78), and 18% lower risk of respiratory disease mortality (HR: 0.82; 95% CI: 0.72-0.93). In substitution analyses, replacing 10 g/d of margarine, butter, mayonnaise, and dairy fat with the equivalent amount of olive oil was associated with 8%-34% lower risk of total and cause-specific mortality. No significant associations were observed when olive oil was compared with other vegetable oils combined. CONCLUSIONS: Higher olive oil intake was associated with lower risk of total and cause-specific mortality. Replacing margarine, butter, mayonnaise, and dairy fat with olive oil was associated with lower risk of mortality.

Impact of birth season on the years of life lost from respiratory diseases in the elderly related to ambient PM2.5 exposure in Ningbo, China.

BACKGROUND: Ambient fine particle (PM2.5) pollution is an important public health problem in China. Short-term ambient PM2.5 exposure is associated with increased mortality of respiratory diseases. However, few evidence was available on the effect of exposure to ambient PM2.5 on the years of life lost (YLL) from respiratory diseases in the elderly. Furthermore, birth season which is frequently applied as a proxy for environmental exposure in early life may influence the health outcome in the later life. Nevertheless, the modification effect of birth season on the relationship of PM2.5 exposure and respiratory health need to be explored. METHODS: A time-stratified case-crossover design was used to analyze YLL from respiratory diseases in the elderly related to ambient PM2.5 exposure between 2013 and 2016 in Ningbo, China. The modification effect of birth season was explored by subgroup comparisons between different birth seasons. RESULTS: Each 10 µg/m3 increase in daily ambient PM2.5 was associated with an increment of 1.61 (95% CI 0.12, 3.10) years in YLL from respiratory diseases in the elderly population. Individuals who were born in winter had significantly higher YLL from respiratory diseases associated with ambient PM2.5 exposure than those who were born in other seasons. CONCLUSIONS: Birth season which reflects the early-life PM2.5 exposure level that may influence the lung development has a potential effect on the disease burden of respiratory diseases related to ambient PM2.5 exposure in later life. The results would provide theoretical basis to protect vulnerable population defined by birth season when exploring the adverse effects of ambient PM2.5 in the respiratory health.

Cardiorespiratory fitness assessment using risk-stratified exercise testing and dose-response relationships with disease outcomes.

Cardiorespiratory fitness (CRF) is associated with mortality and cardiovascular disease, but assessing CRF in the population is challenging. Here we develop and validate a novel framework to estimate CRF (as maximal oxygen consumption, VO2max) from heart rate response to low-risk personalised exercise tests. We apply the method to examine associations between CRF and health outcomes in the UK Biobank study, one of the world's largest and most inclusive studies of CRF, showing that risk of all-cause mortality is 8% lower (95%CI 5-11%, 2670 deaths among 79,981 participants) and cardiovascular mortality is 9% lower (95%CI 4-14%, 854 deaths) per 1-metabolic equivalent difference in CRF. Associations obtained with the novel validated CRF estimation method are stronger than those obtained using previous methodology, suggesting previous methods may have underestimated the importance of fitness for human health.

Preexisting respiratory diseases and clinical outcomes in COVID-19: a multihospital cohort study on predominantly African American population.

BACKGROUND: Comorbidities play a key role in severe disease outcomes in COVID-19 patients. However, the literature on preexisting respiratory diseases and COVID-19, accounting for other possible confounders, is limited. The primary objective of this study was to determine the association between preexisting respiratory diseases and severe disease outcomes among COVID-19 patients. Secondary aim was to investigate any correlation between smoking and clinical outcomes in COVID-19 patients. METHODS:  This is a multihospital retrospective cohort study on 1871 adult patients between March 10, 2020, and June 30, 2020, with laboratory confirmed COVID-19 diagnosis. The main outcomes of the study were severe disease outcomes i.e. mortality, need for mechanical ventilation, and intensive care unit (ICU) admission. During statistical analysis, possible confounders such as age, sex, race, BMI, and comorbidities including, hypertension, coronary artery disease, congestive heart failure, diabetes, any history of cancer and prior liver disease, chronic kidney disease, end-stage renal disease on dialysis, hyperlipidemia and history of prior stroke, were accounted for. RESULTS:  A total of 1871 patients (mean (SD) age, 64.11 (16) years; 965(51.6%) males; 1494 (79.9%) African Americans; 809 (43.2%) with ≥ 3 comorbidities) were included in the study. During their stay at the hospital, 613 patients (32.8%) died, 489 (26.1%) needed mechanical ventilation, and 592 (31.6%) required ICU admission. In fully adjusted models, patients with preexisting respiratory diseases had significantly higher mortality (adjusted Odds ratio (aOR), 1.36; 95% CI, 1.08-1.72; p = 0.01), higher rate of ICU admission (aOR, 1.34; 95% CI, 1.07-1.68; p = 0.009) and increased need for mechanical ventilation (aOR, 1.36; 95% CI, 1.07-1.72; p = 0.01). Additionally, patients with a history of smoking had significantly higher need for ICU admission (aOR, 1.25; 95% CI, 1.01-1.55; p = 0.03) in fully adjusted models. CONCLUSION:  Preexisting respiratory diseases are an important predictor for mortality and severe disease outcomes, in COVID-19 patients. These results can help facilitate efficient resource allocation for critical care services.

Comparison of Mortality Rate and Severity of Pulmonary Involvement in Coronavirus Disease-2019 Adult Patients With and Without Type 2 Diabetes: A Cohort Study.

OBJECTIVES: Patients with diabetes are potentially at higher risk of mortality due to coronavirus disease-2019 (COVID-19). In this study, we aimed to compare the outcomes and severity of pulmonary involvement in COVID-19 patients with and without diabetes. METHODS: In this cohort study, we recruited patients with diabetes who were hospitalized due to COVID-19 during the period from February 2020 to May 2020. Hospitalized individuals without diabetes were enrolled as control subjects. All patients were followed for 90 days and clinical findings and patients' outcomes were reported. RESULTS: Over a period of 4 months, 127 patients with diabetes and 127 individuals without diabetes with a diagnosis of COVID-19 were recruited. Their mean age was 65.70±12.51 years. Mortality was higher in the group with diabetes (22.8% vs 15.0%; p=0.109), although not significantly. More severe pulmonary involvement (p=0.015), extended hospital stay (p<0.001) and greater need for invasive ventilation (p=0.029) were reported in this population. Stepwise logistic regression revealed that diabetes was not independently associated with mortality (p=0.092). Older age (odds ratio [OR], 1.054; p=0.003), aggravated pulmonary involvement on admission (OR, 1.149; p=0.001), presence of comorbidities (OR, 1.290; p=0.020) and hypothyroidism (OR, 6.576; p=0.021) were associated with mortality. Diabetic foot infection had a strong positive correlation with mortality (OR, 49.819; p=0.016), whereas insulin therapy had a negative correlation (OR, 0.242; p=0.045). CONCLUSIONS: The mortality rate due to COVID-19 did not differ significantly between patients with or without diabetes. Older age, macrovascular complications and presence of comorbidities could increase mortality in people with diabetes. Insulin therapy during hospitalization could attenuate the detrimental effects of hyperglycemia and improve prognosis of patients with COVID-19 and diabetes.

Repurposing Ophthalmologic Timolol for Dermatologic Use: Caveats and Historical Review of Adverse Events.

Ophthalmic timolol solution is increasingly being repurposed as a topical therapeutic for a variety of dermatologic diseases, including pyogenic granulomas, infantile hemangiomas, and chronic wounds. There are no published guidelines or protocols for use in these indications in adults, and the dermatologic community may not be familiar with adverse events that have been extensively documented relating to its ophthalmic use. We review the evidence available relating to adverse events to topical timolol use to evaluate its safety in dermatologic applications and to alert clinicians to screening and monitoring that is needed when repurposing this drug for dermatologic use. The majority of serious adverse events associated with ophthalmic timolol were reported in the first 7 years of use, between 1978 and 1985, of which most common were cardiovascular and respiratory events, but also included 32 deaths. The available evidence suggests that ophthalmic timolol safety profiling may have been incomplete prior to widespread use. Recent clinical trials for dermatologic indications have focused on documenting efficacy and have not had rigorous monitoring for potential adverse events. Topical timolol may be safe and effective for the treatment of various dermatologic conditions in patients whose medical histories have been carefully reviewed for evidence of pre-existing cardiac or pulmonary disease and are monitored for potential adverse events. Despite the wide use of timolol in ophthalmologic practice, safe dermatologic repurposing requires recognition of the potential for facilitated systemic absorption though the skin and appreciation of its history of adverse events.

Impact of birth season on the years of life lost from respiratory diseases in the elderly related to ambient PM

BACKGROUND@#Ambient fine particle (PM@*METHODS@#A time-stratified case-crossover design was used to analyze YLL from respiratory diseases in the elderly related to ambient PM@*RESULTS@#Each 10 μg/m@*CONCLUSIONS@#Birth season which reflects the early-life PM

The contribution of specific non-communicable diseases to the achievement of the Sustainable Development Goal 3.4 in Peru.

BACKGROUND: Non-communicable diseases (NCDs) have received political attention and commitment, yet surveillance is needed to measure progress and set priorities. Building on global estimates suggesting that Peru is not on target to meet the Sustainable Development Goal 3.4, we estimated the contribution of various NCDs to the change in unconditional probability of dying from NCDs in 25 regions in Peru. METHODS: Using national death registries and census data, we estimated the unconditional probability of dying between ages 30 and 69 from any and from each of the following NCDs: cardiovascular, cancer, diabetes, chronic respiratory diseases and chronic kidney disease. We estimated the contribution of each NCD to the change in the unconditional probability of dying from any of these NCDs between 2006 and 2016. RESULTS: The overall unconditional probability of dying improved for men (21.4%) and women (23.3%). Cancer accounted for 10.9% in men and 13.7% in women of the overall reduction; cardiovascular diseases also contributed substantially: 11.3% in men) and 9.8% in women. Consistently in men and women and across regions, diabetes moved in the opposite direction of the overall reduction in the unconditional probability of dying from any selected NCD. Diabetes contributed a rise in the unconditional probability of 3.6% in men and 2.1% in women. CONCLUSIONS: Although the unconditional probability of dying from any selected NCD has decreased, diabetes would prevent Peru from meeting international targets. Policies are needed to prevent diabetes and to strengthen healthcare to avoid diabetes-related complications and delay mortality.

Mortality and its predictors among patients treated for acute exacerbations of chronic obstructive respiratory diseases in Jimma Medical Center; Jimma, Ethiopia: Prospective observational study.

BACKGROUND: Chronic obstructive pulmonary disease (COPD) and asthma exacerbations are associated with ill health, increased mortality, and health care costs. However, there is limited evidence regarding mortality and its predictors among patients treated for COPD and asthma exacerbations in low-income nations, particularly in Ethiopia. METHODS: A-6 month prospective observational study was conducted from April 20-September 20, 2019. Data were collected on socio-demographic, baseline clinical characteristics and outcomes of asthma and COPD exacerbations. Data were entered into Epi-Data version 4.02.01 for cleaning and exported to STATA 14.0 for analysis. Kaplan-Meier (Log-rank test) was used to compare the baseline survival experience of the study participants and Cox proportional hazard regression analysis was conducted to determine the predictors of mortality. Adjusted hazard ratios (AHRs) with two-sided p-value <0.05 were considered statistically significant. RESULTS: A total of 130 patients (60% males) were included. The median (interquartile range (IQR)) age of the study participants was 59(50-70) years. The median (IQR) survival time to death was 17.5 (10-26) days. The total proportion of in-hospital mortality was 10.78% (14/130), and the incidence rate of mortality was 2.56 per 1000 person-years. The duration of oxygen therapy ≥16hours/day (AHR = 6.330, 95% CI [1.092-36.679], and old age (AHR = 1.066, 95% CI [1.0001-1.136] were the independent predictors of in-hospital mortality. CONCLUSION: In this study, the in-hospital mortality rate was very high. Moreover, prolonged oxygen therapy (≥16hours/day) and old age were independently associated with in-hospital mortality. Therefore, special attention should be given to recipients of prolonged oxygen therapy and the elderly during hospital stay.

Mortality among workers employed in the mining industry in the United States: A 29-year analysis of the National Health Interview Survey-Linked Mortality File, 1986-2014.

BACKGROUND: Working in the mining industry increases the risk of chronic diseases and mortality. We investigated overall and cause-specific mortality rates among workers employed in the mining sector in the United States. METHODS: We pooled 29 years of National Health Interview Survey (NHIS) public-use data from 1986 to 2014, with mortality follow-up until 31 December 2015. We grouped respondents into the mining and nonmining sectors based on the responses given at the time of the NHIS interview. We compared the overall and cause-specific mortality rates using standardized mortality ratios (SMR) and 95% confidence interval (CI) adjusted for the competing cause of death. RESULTS: From 1986 to 2014, an estimated 14 million deaths were recorded among subjects eligible for mortality follow-up. Of these, an estimated 50,000 deaths occurred among those working in the mining sector. A significantly higher overall mortality (SMR = 1.26, 95% CI: 1.17-1.36), and mortality from heart diseases (adjusted SMR = 1.56, 95% CI: 1.31-1.83), cancer (adjusted SMR = 1.30, 95% CI: 1.14-1.48) and unintentional injuries (adjusted SMR = 1.41, 95%CI: 1.03-1.85) were observed among those employed in the mining sector. When the analyses were restricted to men, only the SMRs for heart disease and cancer remained statistically significant. No elevated SMR for deaths from chronic lower respiratory disease was observed in the study. CONCLUSION: Workers employed in the mining sector have a significantly increased total death rate and death rates from heart disease, cancer, and unintentional injuries.

Risk for respiratory and cardiovascular disease and mortality after non-trauma fracture and the mediating effects of respiratory and cardiovascular disease on mortality risk among adults with epilepsy.

BACKGROUND: Non-trauma fracture (NTFx), an indicator of skeletal fragility, is a risk factor for mortality among adults with epilepsy. NTFx may elicit its effect on mortality through development of respiratory disease (RD) and cardiovascular disease (CVD). Therefore, the objective was to determine if NTFx increases risk for RD and CVD, and if incident RD and CVD mediates the association between NTFx and mortality for adults with epilepsy. METHODS: Data were gathered from Optum Clinformatics® Data Mart years 2011-2016 for this retrospective cohort study. Diagnosis codes identified adults (≥18 years) with epilepsy, NTFx, RD (pneumonia, chronic obstructive pulmonary disease, interstitial/pleura disease), CVD (ischemic heart disease, heart failure, cerebrovascular disease), and baseline comorbidities. Crude incidence rate (IR) and crude IR ratio (IRR and 95 % confidence intervals [CI]) was estimated for mortality and incidence of RD and CVD for up to 2 years of follow up. Cox regression estimated hazard ratios (HR and 95 % CI) for each outcome, comparing adults with vs. without NTFx after adjusting for sociodemographics and baseline comorbidities. Separate mediation analyses estimated the extent that incident RD and CVD mediated the association between NTFx and mortality. RESULTS: Adults with epilepsy with vs. without NTFx had a higher crude incidence of mortality (IRR = 2.42; 95 %CI = 2.24-2.60) and each RD and CVD measure (IRR = 1.60-2.02). After adjustments, the HR remained elevated for mortality (HR = 1.66; 95 %CI = 1.54-1.79) and each RD and CVD measure (HR = 1.18-1.61). Incident pneumonia and interstitial/pleura disease mediated 9.82 % and 7.51 %, respectively, of the association between NTFx and mortality. CONCLUSIONS: In a relatively short follow up of 2 years, NTFx was a robust risk factor for mortality, RD, and CVD among adults with epilepsy, and post-NTFx incidence of RD mediated a portion of the association between NTFx and mortality.

Applying landscape metrics and structural equation modeling to predict the effect of urban green space on air pollution and respiratory mortality in Tehran.

Green space and its spatial formation are important elements of public welfare in urban environments and green ecosystems in big cities largely contribute to the mental and physical health of citizens. Tehran is Iran's biggest and most polluted city and air pollution in this city causes loss of human lives due to respiratory diseases. The effect of green area has been less studied in former researches in Tehran, and the reducing effects of green landscape on the mortality of respiratory diseases have not yet been evaluated. To measure the effects of green area landscape patterns (fragmentation, area-edge, shape, and aggregation) on public health, the current study evaluated the pathways and effects of green space on air pollution and the mortality of respiratory diseases using structural equation modeling approach and the partial least squares method. The results of the study indicated green space has a significant mitigating effect on air pollution and mortality of respiratory diseases and also air pollution has a meaningful increasing effect on mortality due to respiratory diseases in Tehran. The most important latent variable in green space is class area that indicates more area of green space is correlated with less mortality of respiratory diseases. The most important indicator of air pollution was the PM2.5 that needs to be considered and controlled by urban policymakers. Accordingly, maximizing the green area and its cohesion and minimizing fragmentation and green patch edge can contribute to a reduction in air pollution and consequently lower mortality of citizens.

Reversal of the seasonality of temperature-attributable mortality from respiratory diseases in Spain.

A growing number of epidemiological studies have recently assessed temporal variations in vulnerability and/or mortality attributable to hot and cold temperatures. However, the eventual changes in the seasonal distribution of temperature-attributable mortality remain unexplored. Here, we analyse countrywide daily time-series of temperature and mortality counts from respiratory diseases by sex, age group and province of residence during the period 1980-2016 in Spain. We show the complete reversal of the seasonality of temperature-attributable mortality, with a significant shift of the maximum monthly incidence from winter to summer, and the minimum monthly incidence from early and late summer to winter. The reversal in the seasonal distribution of the attributable deaths is not driven by the observed warming in both winter and summer temperatures, but rather by the very large decrease in the risk of death due to cold temperatures and the relatively much smaller reduction due to hot temperatures. We conclude that the projected decrease in the number of moderate and extreme cold days due to climate warming will not contribute to a further reduction of cold-attributable respiratory deaths.

Associations between exposure to ethylene oxide, job termination, and cause-specific mortality risk.

BACKGROUND: Previous analyses of mortality were conducted in a large cohort of ethylene oxide (EtO) exposed workers employed at 13 sterilization facilities throughout the U.S. and followed from the start of operation through 1998. Statistically significant elevated mortality was reported from hematopoietic cancer in men and breast cancer in women compared to the general population. Possible healthy worker survivor bias was not addressed. METHODS: To examine survivor bias in this cohort, employment termination was analyzed with statistical models stratified on sex and race that included age, employment duration, and cumulative EtO exposure. To reduce survivor bias employment duration was included in Poisson regression model specifications for estimating standardized mortality ratios for several cancer outcomes. RESULTS: Strong statistically significant effects of unlagged cumulative EtO exposure were observed on rate of employment termination, indicating potential healthy worker survivor effect bias. Adjustment for employment duration in analyses of mortality resulted in statistically significant and stronger associations between cumulative EtO exposure and lung cancer, female breast cancer and hematopoietic cancer. There was a striking reduction in nonmalignant respiratory disease mortality risk with increasing employment duration with a further (nonsignificant) reduction with cumulative EtO, suggesting that EtO itself is driving termination of workers with respiratory morbidity even though the average EtO exposures in this population were generally far below odor and acute irritancy thresholds. CONCLUSIONS: Important survivor bias was present in this EtO cohort and may be present in many occupational settings involving irritant exposures.

Complications and mortality after acute traumatic spinal cord injury in Saint Petersburg, Russia.

STUDY DESIGN: Retrospective cohort study. OBJECTIVES: We studied complications during early rehabilitation and their relation to length of stay (LOS) in the hospital as well as to survival in people with traumatic spinal cord injury (TSCI). SETTING: All specialized hospitals of Saint Petersburg. METHODS: We analysed all charts of patients admitted with acute TSCI to the city hospitals, 2012-2016. Patient characteristics, complications, time and cause of death, and LOS were recorded. Mean values with standard deviations and t-tests were used. We analysed mortality rate using the Kaplan-Meier method and calculated relative risks (RRs). RESULTS: A total of 311 patients with TSCI were included. Complications occurred in 34% of patients; most were respiratory complications and pressure ulcers. Complications occurred more often in those with concomitant traumatic brain injury (TBI) (RR = 1.4, 95% CI: 1.2-1.8). All complications prolonged LOS (median, 11 days) and increased mortality in the acute phase (p < 0.001). In the early phase, 15% died, with a median time to death of 13 days. Respiratory complications markedly increased the death rate (RR = 18, 95% CI: 15-22). Mortality rate correlated also with age, TSCI severity and level, and concomitant TBI. Alcohol/drug consumption before TSCI increased the likelihood for complications (RR = 1.7, 95% CI: 1.3-2.1) and mortality (RR = 2.2, 95% CI: 1.6-3.1). CONCLUSION: Focus on prevention as well as early and optimal treatment of complications, together with no or low alcohol/drug consumption may reduce mortality in the early phase after TSCI and at the same time shorten LOS.

Spatial analysis of PM2.5 concentrations in Bogotá according to the World Health Organization air quality guidelines for cardiopulmonary diseases, 2014-2015 / [Análisis espacial de las concentraciones de PM2,5 en Bogotá según los valores de las guías de la calidad del aire de la Organización Mundial de la Salud para enfermedades cardiopulmonares, 2014-2015].

Introduction: The World Health Organization (WHO) points out that 3 million deaths per year caused by cardiopulmonary diseases are related to exposure to air pollution. Objective: To estimate areas of concentration of PM2.5 in Bogotá according to the WHO Air Quality Guidelines (AQG) for cardiopulmonary diseases during the period 2014-2015. Materials and methods: We conducted an ecological study with geostatistical techniques. We calculated the PM2.5 averages for six hour-periods distributed throughout the day in four time slots, which were classified according to daily and annual WHO AQG. Results: The locality of Kennedy presented the highest concentrations of PM2.5 in all time slots. The values registered in this area classified within the daily and annual AQG showed that the locality would present an increase of 1.2% and 9% in cardiopulmonary mortality in the short and long term, respectively. Conclusion: The time slots from 0:00 to 6:00 h y from 12:00 to 18:00 h met the annual AQG value of 10 µg/m3 in a part of the eastern zone of the city; in the rest of the city, in these same time slots, intermediate objectives 2 and 3 were met, which means increases by 9% and 3% in the cardiopulmonary mortality according to the AQG, respectively.

Introducción. La Organización Mundial de la Salud señala que tres millones de muertes al año por enfermedades cardiopulmonares están relacionadas con la exposición a la contaminación del aire. Objetivo. Estimar las superficies de concentración de partículas en suspensión de menos de 2,5 µm (Particulate Matter, PM2,5) en Bogotá entre el 2014 y el 2015, clasificándolas según las guías de calidad del aire de la Organización Mundial de la Salud para enfermedades cardiopulmonares. Materiales y métodos. Se hizo un estudio ecológico mediante técnicas geoestadísticas. Se calcularon los promedios de PM2,5 en lapsos de seis horas a lo largo del día en cuatro franjas horarias. Las concentraciones se clasificaron según los valores diarios y anuales de las guías de calidad del aire de la OMS. Resultados. La localidad de Kennedy presentó las mayores concentraciones de PM2,5 en todas las franjas horarias. Los valores registrados en esta zona y clasificados según las guías diarias y anuales de calidad del aire, evidenciaron que la localidad presentaría un incremento de 1,2 % en la mortalidad cardiopulmonar en el corto plazo y de 9 % en el largo plazo. Conclusión. Las franjas horarias de las 0:00 a las 6:00 h y de las 12:00 a las 18:00 h, cumplieron con el valor anual de las guías de calidad del aire de 10 µg/m3 en una parte de la zona oriental de la ciudad. En el resto de la ciudad, en las franjas horarias de las 6:00 h a las 12:00 h y de las 18:00 h a las 24:00 h se registraron valores que cumplían los objetivos intermedios 2 y 3, lo que representa incrementos de 9 y 3 % en la mortalidad cardiopulmonar, respectivamente.

Pooled analysis of Day 100 survival for defibrotide-treated patients with hepatic veno-occlusive disease/sinusoidal obstruction syndrome and ventilator or dialysis dependence following haematopoietic cell transplantation.

For patients with untreated hepatic veno-occlusive disease (VOD)/sinusoidal obstruction syndrome (SOS) with multi-organ dysfunction (MOD), mortality is >80%. We conducted a pooled analysis of three studies that assessed Day 100 survival in relationship to MOD severity, with dialysis and/or ventilator dependence representing the most severe organ dysfunction. All patients in the analysis were diagnosed using Baltimore criteria/biopsy. This analysis of patients with VOD/SOS and MOD after haematopoietic cell transplantation (HCT; n = 651) demonstrated higher Day 100 survival rates amongst defibrotide-treated patients with VOD/SOS with less versus more severe forms of MOD. Even patients with severe forms of MOD post-HCT benefitted from defibrotide.

Analysis of early respiratory-related mortality after radiation therapy of non-small-cell lung cancer: feasibility of automatic data extraction for dose-response studies.

Purpose: To examine the feasibility of automatic data extraction from clinical radiation therapy (RT) databases at four hospitals to investigate the impact of mean lung dose (MLD) and age on the risk of early respiratory-related death and early overall death for patients treated with RT for non-small-cell lung cancer (NSCLC).Material and methods: We included adult patients with NSCLC receiving curatively intended RT between 2002 and 2017 at four hospitals. A script was developed to automatically extract RT-related data. The cause of death for patients deceased within 180 days of the start of RT was retrospectively assessed. Using logistic regression, the risks of respiratory-related death and of overall death within 90 and 180 days were investigated using MLD and age as variables.Results: Altogether, 1785 patients were included in the analysis of early overall mortality and 1655 of early respiratory-related mortality. The respiratory-related mortalities within 90 and 180 days were 0.9% (15/1655) and 3.6% (60/1655). The overall mortalities within 90 and 180 days were 2.5% (45/1785) and 10.6% (190/1785). Higher MLD and older age were associated with an increased risk of respiratory-related death within 180 days and overall death within 90 and 180 days (all p<.05). For example, the risk of respiratory-related death within 180 days and their 95% confidence interval for patients aged 65 and 75 years with MLDs of 20 Gy was according to our logistic model 3.8% (2.6-5.0%) and 7.7% (5.5-10%), respectively.Conclusions: Automatic data extraction was successfully used to pool data from four hospitals. MLD and age were associated with the risk of respiratory-related death within 180 days of the start of RT and with overall death within 90 and 180 days. A model quantifying the risk of respiratory-related death within 180 days was formulated.

Complications of the surgical treatment of esophageal cancer and microbiological analysis of the respiratory tract.

AIM: The aim of this study was to reduce the severe respiratory complications of esophageal cancer surgery often leading to death. METHODS: Two groups of patients operated on for esophageal cancer were evaluated in this retrospective analysis. The first group was operated between 2006-2011, prior to the implementation of preoperative microbiological examination while the second group had surgery between 2012-2017 after implementation of this examination. RESULTS: In total, 260 patients, 220 males and 40 females underwent esophagectomy. Between 2006-2011, 113 (87.6%) males and 16 (12.4%) females and between 2012-2017, esophagectomy was performed in 107 (81.7%) males and 24 (18.3%) females. In the first cohort, 10 patients died due to respiratory complications. The 30-day mortality was 6.9% and 90-day was 9.3%. In the second cohort, 4 patients died from respiratory complications. The 30-day mortality was 1.5% and 90-day mortality was 3.1%. With regard to the incidence of respiratory complications (P=0.014), these occurred more frequently in patients with sputum collection, however, severe respiratory complications were more often observed in patients without sputum collection. Significantly fewer patients died (P=0.036) in the group with sputum collection. The incidence of respiratory complications was very significantly higher in the patients who died (P<0.0001). CONCLUSION: The incidence of severe respiratory complications (causing death) may be reduced by identifying clinically silent respiratory tract infections.