Declining Mortality Rate of Hospitalised Patients in the Second Wave of the COVID-19 Epidemics in Italy: Risk Factors and the Age-Specific Patterns

Background: Mortality rate from COVID-19 in Italy is among the world’s highest. We aimed to ascertain whether there was any reduction of in-hospital mortality in patients hospitalised for COVID-19 in the second-wave period (October 2020–January 2021) compared to the first one (February–May 2020); further, we verified whether there were clusters of hospitalised patients who particularly benefitted from reduced mortality rate. Methods: Data collected related to in-patients’ demographics, clinical, laboratory, therapies and outcome. Primary end-point was time to in-hospital death. Factors associated were evaluated by uni- and multivariable analyses. A flow diagram was created to determine the rate of in-hospital death according to individual and disease characteristics. Results: A total of 1561 patients were included. The 14-day cumulative incidence of in-hospital death by competing risk regression was of 24.8% (95% CI: 21.3–28.5) and 15.9% (95% CI: 13.7–18.2) in the first and second wave. We observed that the highest relative reduction of death from first to second wave (more than 47%) occurred mainly in the clusters of patients younger than 70 years. Conclusions: Progress in care and supporting therapies did affect population over 70 years to a lesser extent. Preventive and vaccination campaigns should focus on individuals whose risk of death from COVID-19 remains high.

The Impact of Bushfire Smoke on Cattle—A Review

In 2019–2020, a particularly bad bushfire season in Australia resulted in cattle being exposed to prolonged periods of smoke haze and reduced air quality. Bushfire smoke contains many harmful pollutants, and impacts on regions far from the fire front, with smoke haze persisting for weeks. Particulate matter (PM) is one of the major components of bushfire smoke known to have a negative impact on human health. However, little has been reported about the potential effects that bushfire smoke has on cattle exposed to smoke haze for extended periods. We explored the current literature to investigate evidence for likely effects on cattle from prolonged exposure to smoke generated from bushfires in Australia. We conducted a search for papers related to the impacts of smoke on cattle. Initial searching returned no relevant articles through either CAB Direct or PubMed databases, whilst Google Scholar provided a small number of results. The search was then expanded to look at two sub-questions: the type of pollution that is found in bushfire smoke, and the reported effects of both humans and cattle being exposed to these types of pollutants. The primary mechanism for damage due to bushfire smoke is due to small airborne particulate matter (PM). Although evidence demonstrates that PM from bushfire smoke has a measurable impact on both human mortality and cardiorespiratory morbidities, there is little evidence regarding the impact of chronic bushfire smoke exposure in cattle. We hypothesize that cattle are not severely affected by chronic exposure to smoke haze, as evidenced by the lack of reports. This may be because cattle do not tend to suffer from the co-morbidities that, in the human population, seem to be made worse by smoke and pollution. Further, small changes to background mortality rates or transient morbidity may also go unreported.

Epidemiology of Coronavirus Disease (COVID-19) in Assiut Province in Egypt

Background: Mortality, severity, and recovery of COVID-19 are the main concern all over the world and are still not fully understood, particularly in the Middle East area. Objective: To analyze the prevalence and the characteristics of COVID-19 in Assiut Province in Egypt. Patients and Methods: This is a retrospective study that includes RT-q PCR- confirmed COVID-19 cases during the period from March7th 2020 to September17th 2020 in Assiut Province. Results: A total of 1201 cases are confirmed out of 2750 suspected cases. The breakdown of the cases is as follows; 84% fully recovered, 14.6% died and 1.4% are still in quarantine at the time of writing this article. Severe cases occur in old ages with no deaths below 21 years of age. Male and female deaths are 59.4% and 40% respectively. The associated co-morbidities are mainly chronic obstructive pulmonary disease, diabetes mellites, heart failure, ischemic heart disease, and obesity. Conclusion: The total percentage of infection in Assiut is 0.04%; it is lower than the percentage of the total infection in the country (0.1%). Respiratory failure is the leading cause of death in all patients.

THE RELATIONSHIP PREDICE SCORE AND MORTALITY 30 DAYS IN CHRONIC HEART FAILURE PATIENTS

The Background : Mortality rate of heart failure patients are increasing even they have a good treatment. Therefore, it should be possible to make a prognostic for chronic heart failure patients with use an easy parameter namely predice score. The aim of the study : To assess the ability of the predice score to predict mortality within 30 days in patients with chronic heart failure. The Method : We did this prospective research started from 1st July 2016 until 31st December 2016 with concerned chronic heart failure patients as many as 44 patients. We counted the association grade with use Man whitney U. The Result : The results showed that there was a signicant relationship between predice score and mortality (p = 0.004). The mean predice score in the living subjects was 11.77 (SD: 4.07) Meanwhile, the mean predice score of the subjects who died was 17.18 ( SD:2,85). The Conclusion: Predice Score can be used to predict 30-day mortality in chronic heart failure patients who experience worsening because it is statistically signicant (p<0,05).

Predisposing factors’ effects on mortality of oak (Quercus) and hickory (Carya) species in mature forests undergoing mesophication in Appalachian Ohio

Background Mature oak (Quercus spp.) and hickory (Carya spp.) trees are gradually being replaced by more shade-tolerant tree species across the eastern U.S., likely due to fire suppression and increased precipitation. Oaks and hickories are highly valuable to wildlife; therefore, studying their mortality patterns can provide information on the longevity of habitat quality for many animal species. Oak mortality has most often been studied following large oak decline events, but background mortality rates in forests with aging oak and hickory canopies warrant equal attention, especially in the context of widespread oak and hickory regeneration failure. Methods We studied background mortality rates of five oak and one hickory species over a 23–25 year time period (1993–1995 to 2018), using 82 1/20th hectare permanent plots on the Marietta Unit of the Wayne National Forest in southeastern Ohio. We calculated mortality rates based on remeasurement of individual trees for white oak (Quercus alba), chestnut oak (Quercus montana), northern red oak (Quercus rubra), black oak (Quercus velutina), scarlet oak (Quercus coccinea), and pignut hickory (Carya glabra). For each of these species other than scarlet oak, we also modeled the relationships of mortality probability with a priori topographic, soil, stand structural, and individual tree covariates, using a mixed-effects logistic regression framework. Results The species with the highest mortality rate was scarlet oak (61.3%), followed by northern red oak (41.4%), black oak (26.7%), pignut hickory (23.9%), white oak (23.4%), and chestnut oak (19.1%). In our models, northern red oak mortality was associated with more mesic slope positions, shallower solums, more acidic soils, and older stand ages. Pignut hickory and chestnut oak mortality rates were associated with higher basal areas on the plot, while white oak mortality showed the opposite pattern. Conclusions Our data suggest that red oak subgenus trees in mature forests of our area will become increasingly uncommon relative to white oak subgenus trees, as the result of higher mortality rates likely related to the shorter lifespans of these species. Particularly vulnerable areas may include more mesic topographic positions, shallower or more acidic soil, and older stands. Since maintaining oak subgenus diversity is beneficial to wildlife diversity in the eastern U.S., managers in areas with extensive mature mixed-oak forests could choose to favor the red oak subgenus when conducting silvicultural treatments.

Pathologic Risk Factor in Retinoblastoma: An Institutional Experience Based on Analysis of Enucleated Eyes

Background: Mortality resulting from the metastasis of retinoblastoma is uncommon in the developed world, however it still constitutes a major problem in developing countries like Nepal. The cases of retinoblastoma with increased risk of metastasis even after enucleation can be predicted from the histopathological examination of the enucleated specimen. We conducted this study aiming to assess the frequency and spectrum of high-risk histological features in enucleated specimens of retinoblastoma. Materials and methods: Forty-two specimens of primary enucleation done for treatment of retinoblastoma received in the Department of Pathology at UCMS from 1st January 2016 to 31st December 2018 were included in the study. All slides were reviewed for high-risk histological features along with tumor differentiation, tumor extension, necrosis, and staging. Correlation of high-risk histological features with age and tumor size was calculated using unpaired t-test and correlation with tumor differentiation, necrosis and staging was done using Pearson Chi square test. Results: The median age at enucleation was 24 months. All patients had endophytic lesion with a mean tumor size of 1.8cm. One or more high-risk histological features were identified in 30.9% (13/42). The most common high-risk histological feature was retrolaminar optic nerve invasion (10/12, 71.4%). Statistically significant correlation of high risk histological features was noted with tumor size (p=0.011) and AJCC stage of tumor (p=0.0001). Conclusion: Complete histopathological evaluation of retinoblastoma requires searching for high-risk histological features, the presence of which will guide the clinician in timely planning for subsequent neoadjuvant therapy.

Condition for Global Stability for a SEIR Model Incorporating Exogenous Reinfection and Primary Infection Mechanisms

A mathematical model incorporating exogenous reinfection and primary progression infection processes is proposed. Global stability is examined using the geometric approach which involves the generalization of Poincare-Bendixson criterion for systems of n -ordinary differential equations. Analytical results show that for a Susceptible-Exposed-Infective-Recovered (SEIR) model incorporating exogenous reinfection and primary progression infection mechanisms, an additional condition is required to fulfill the Bendixson criterion for global stability. That is, the model is globally asymptotically stable whenever a parameter accounting for exogenous reinfection is less than the ratio of background mortality to effective contact rate. Numerical simulations are also presented to support theoretical findings.

ROLE OF INTRA-ABDOMINAL PRESSURE IN PREDICTING OUTCOME IN ACUTE SEVERE PANCREATITIS

Background mortality in patients with severe acute pancreatitis (SAP) remains high. Some of these patients develop increased intra-abdominal pressure (IAP) which may contribute to organ dysfunction. The aims of this study was to evaluate intra-abdominal pressure as a marker of severity in severe acute pancreatitis and to evaluate the relationship between intra-abdominal pressure and development of complications like SIRS, organ failure, pancreatic necrosis in patients with severe acute pancreatitis.

Anticoagulation in COVID-19: Effect of Enoxaparin, Heparin, and Apixaban on Mortality

Background Mortality in coronavirus disease of 2019 (COVID-19) is associated with increases in prothrombotic parameters, particularly D-dimer levels. Anticoagulation has been proposed as therapy to decrease mortality, often adjusted for illness severity. Objective We wanted to investigate whether anticoagulation improves survival in COVID-19 and if this improvement in survival is associated with disease severity. Methods This is a cohort study simulating an intention-to-treat clinical trial, by analyzing the effect on mortality of anticoagulation therapy chosen in the first 48 hours of hospitalization. We analyzed 3,625 COVID-19+ inpatients, controlling for age, gender, glomerular filtration rate, oxygen saturation, ventilation requirement, intensive care unit admission, and time period, all determined during the first 48 hours. Results Adjusted logistic regression analyses demonstrated a significant decrease in mortality with prophylactic use of apixaban (odds ratio [OR] 0.46, p = 0.001) and enoxaparin (OR = 0.49, p = 0.001). Therapeutic apixaban was also associated with decreased mortality (OR 0.57, p = 0.006) but was not more beneficial than prophylactic use when analyzed over the entire cohort or within D-dimer stratified categories. Higher D-dimer levels were associated with increased mortality (p < 0.0001). When adjusted for these same comorbidities within D-dimer strata, patients with D-dimer levels < 1 µg/mL did not appear to benefit from anticoagulation while patients with D-dimer levels > 10 µg/mL derived the most benefit. There was no increase in transfusion requirement with any of the anticoagulants used. Conclusion We conclude that COVID-19+ patients with moderate or severe illness benefit from anticoagulation and that apixaban has similar efficacy to enoxaparin in decreasing mortality in this disease.

Occurrence but not intensity of mortality rises towards the climatic trailing edge of tree species ranges in European forests

AimTree mortality is increasing worldwide, leading to changes in forest composition and altering global biodiversity. Yet, due to the multi-faceted stochastic nature of tree mortality, large-scale spatial patterns of mortality across species ranges and their underlying drivers remain difficult to understand. Our main goal is to describe the geographical patterns and drivers of the occurrence and intensity of tree mortality in Europe. We hypothesize that the occurrence of mortality represents background mortality and is higher in the margin than the core populations, whereas the intensity of mortality could have a more even distribution according to the spatial and temporal stochasticity of die-off events.LocationEurope (Spain, France, Germany, Belgium, Sweden and Finland)Time period1981 to 2014.Major taxa studiedMore than 1.5 million trees belonging to 20 major forest tree speciesMethodsWe develop hurdle models to tease apart the occurrence and intensity of tree mortality in National Forest Inventory plots at range-wide scale. The occurrence of mortality indicates that at least one tree has died in the plot and the intensity of mortality refers to the number of trees dead per plot.ResultsThe highest mortality occurrence was found in peripheral regions and the climatic trailing edge linked with drought, whereas the intensity of mortality was driven by competition, drought and high temperatures and was uniformly scattered across species ranges.Main conclusionsOur findings provide a new perspective in our understanding of tree mortality across species ranges. We show that tree background mortality but not die-off is generally higher in the trailing edge populations, but whether other demographic traits such as growth, reproduction and regeneration would also decrease at the trailing edge of European tree populations needs to be explored.