Predictive factors for in-hospital mortality and delayed mortality following aneurysmal subarachnoid hemorrhage

It is important to detect predictive factors for in-hospital and delayed mortality of patients with subarachnoid hemorrhage (SAH) due to ruptured aneurysm. Forty-eight patients with initial bleeding of aneurysmal SAH were referred to our hospital from January 1982 to December 1985. In-hospital mortality was 16.7% (8 to 48), and 15% (6) of forty patients died later during the follow-up period. Using the Kaplan-Meier method we were able to conclude that, cumulatively, there was 70.8% probability that much patients would survive for 10 years. We analysed predictive factors of in-hospital and delayed mortality retrospectively. The most significant predictive factor for in-hospital mortality was SAH grading on admission, and for delayed mortality (29.2%) age on admission was the best predictive factor. In fact, two patients died with cardiac event during the follow-up period. This result suggests that, although the SAH grading on admission was the second most significant factor for delayed mortality, patients who survived in the acute phase had a survival probability similar to those in a normal control group.     

Nutritional status and aminoglycoside dosing

Serum amyloid P component (SAP) is a glycoprotein in human plasma. We previously showed that SAP is specifically localized in human atherosclerotic lesions, suggesting that SAP may play a role in atherogenesis. In this study, the interactions between human SAP and high density lipoprotein (HDL), low density lipoprotein (LDL) and very low density lipoprotein (VLDL) were investigated by using a solid phase plate assay. Biotinylated SAP bound to immobilized HDL and VLDL in a calcium-dependent, saturable manner. The SAP-HDL and SAP-VLDL bindings reached saturation at 4 nM and 16 nM of SAP, respectively. The bindings were inhibited by native SAP in a dose-dependent manner. No binding between SAP and LDL was found in the presence of calcium or EDTA, which indicates the specificity of SAP-lipoproteins interactions. These results suggest that the function of SAP is related to its capability to interact with lipoproteins and this may have important implications in atherosclerosis and in amyloidosis.     

Occupational exposure to mercury in dentistry and dentist mortality

In response to public concern, Health Canada recently conducted a review of amalgam safety and released a position statement entitled The Safety of Dental Amalgam. Essentially, the department has concluded that the levels of mercury absorbed by the body due to the release of mercury vapor from amalgam restorations, while detectable, do not approach those recognized to cause illness. It has therefore confirmed that amalgam restorations can be used safely in most patients, with some notable caveats. Despite Health Canada's position statement in support of amalgam, patient doubts about amalgam safety remain, including the tenuous hypothesized link between amalgam restorations and specific diseases. This article reviews the available studies of dentist mortality to identify possible links between mercury exposure and negative health effects. A lack of evidence to suggest a detrimental health outcome in dentists who are occupationally exposed to higher levels of mercury than their patients, and are known to have higher levels of mercury in their blood, provides an important reassurance concerning the safety of amalgam. The reviewed data indicates that the 10 leading causes of death in the United States and Canada are the same for both dentist and non dentist population groups, and that the percentage of deaths by the same cause are remarkably similar. By 1975, the year of the most recent U.S. study, the average age at death for white male dentists was about three years higher than for all adult white males. Although suicide standard mortality rates are known to be higher for dentists, suicide deaths have also been shown to be a factor in many other occupations, particularly those where there is easy access to drugs. Although updated actuarial data for dentist mortality are needed, the available data indicate no reduction in the life expectancy of practising dentists, nor any specific or disproportionate rates of disease associated with high mercury exposure. In fact, the available mortality studies are generally optimistic about the health of dentists, which should reassure patients about the safety of dental amalgam.     

Differences in mortality between elderly and younger adult trauma patients: geriatric status increases risk of delayed death

BACKGROUND: Elderly patients suffer higher mortality rates after trauma than younger patients. This increased mortality is attributable to age, preexisting disease, and complications as well as injury severity. METHODS: Records from 5,139 adult patients from a Level I trauma center were retrospectively reviewed. Injury Severity Score (ISS), Revised Trauma Score (RTS), early mortality (<24 hours), and late mortality (>24 hours) were determined for elderly (> or =65 years) and younger (16-64 years) patients. Preexisting diseases and complications were identified by International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis coding. RESULTS: Mortality in elderly patients was twice that in younger patients despite equivalent injury severity (p < 0.001), and elderly patients were more likely to suffer later death than younger patients (p < 0.005). The prevalence of preexisting disease was greater in the elderly, as was the incidence of complications. Using logistic regression, ISS, RTS, preexisting cardiovascular or liver disease, the development of cardiac, renal, or infectious complications, and geriatric status were all independently predictive of late mortality (p < 0.05). CONCLUSION: Elderly trauma patients more frequently suffer late mortality than younger patients because of the combination of injury and increased preexisting disease and complications after injury. Aggressive treatment of the elderly trauma patient is warranted; however, in the face of significant preexisting disease or complications, survival is less likely. Predictive models of survival can be developed, taking into account preexisting disease and complications as well as admission parameters such as age, ISS, and RTS, and specific risk of mortality quantitated.     

The influence of mortality and socioeconomic status on risk and delayed rewards: A life history theory approach.

Why do some people take risks and live for the present, whereas others avoid risks and save for the future? The evolutionary framework of life history theory predicts that preferences for risk and delay in gratification should be influenced by mortality and resource scarcity. A series of experiments examined how mortality cues influenced decisions involving risk preference (e.g., $10 for sure vs. 50% chance of $20) and temporal discounting (e.g., $5 now vs. $10 later). The effect of mortality depended critically on whether people grew up in a relatively resource-scarce or resource-plentiful environment. For individuals who grew up relatively poor, mortality cues led them to value the present and gamble for big immediate rewards. Conversely, for individuals who grew up relatively wealthy, mortality cues led them to value the future and avoid risky gambles. Overall, mortality cues appear to propel individuals toward diverging life history strategies as a function of childhood socioeconomic status, suggesting important implications for how environmental factors influence economic decisions and risky behaviors. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Concomitant alveolitis and asthma following exposure to triphenylmethane triisocyanate

A 36-year-old man was admitted to hospital with increasing breathlessness. He had been exposed to triphenylmethane triisocyanate. Pulmonary function tests demonstrated physiological abnormalities consistent with both asthma and alveolitis. Exposure to less common isocyanates may not be immediately apparent. Asthma developing after isocyanate exposure is well recognized. Pneumonitis is a relatively rare complication. Measurement of gas transfer may be helpful in the investigation of isocyanate toxicity.     

Nutritional and socioeconomic factors in relation to prostate cancer mortality: a cross-national study

BACKGROUND: Large international variations in rates of prostate cancer incidence and mortality suggest that environmental factors have a strong influence on the development of this disease. The purpose of this study was to identify predictive variables for prostate cancer mortality in data from 59 countries. METHODS: Data on prostate cancer mortality, food consumption, tobacco use, socioeconomic factors, reproductive factors, and health indicators were obtained from United Nations sources. Linear regression models were fit to these data. The influence of each variable fit in the regression models was assessed by multiplying the regression coefficient b by the 75th (X75) and 25th (X25) percentile values of the variable. The difference, bX75 - bX25, is the estimated effect of the variable across its interquartile range on mortality rates measured as deaths per 100000 males aged 45-74 years. Reported P values are two-sided. RESULTS: Prostate cancer mortality was inversely associated with estimated consumption of cereals (bX75 - bX25 = -7.31 deaths; P = .001), nuts and oilseeds (bX75 - bX25 = -1.72 deaths; P = .003), and fish (bX75 - bX25 = -1.47 deaths; P = .001). In the 42 countries for which we had appropriate data, soy products were found to be significantly protective (P = .0001), with an effect size per kilocalorie at least four times as large as that of any other dietary factor. Besides variables related to diet, we observed an association between prostate cancer mortality rates and a composite of other health-related, sanitation, and economic variables (P = .003). CONCLUSIONS: The specific food-related results from this study are consistent with previous information and support the current dietary guidelines and hypothesis that grains, cereals, and nuts are protective against prostate cancer. The findings also provide a rationale for future study of soy products in prostate cancer prevention trials.     

Exencephaly in fetal hamsters following exposure to hyperthermia

This paper reports a rare malformation syndrome which is observed in two sibs (brother and sister) of a family. It consists of nearly symmetric reductive defects of the limbs, flexon contractures of various joints, cleft lip and cleft palate, multiple minor abnormalities including capillary hemangioma of the forehead, hypoplastic cartilages of ears and nose, micrognathia, intrauterine growth retardation, and possibly mental retardation. Chromosomes of both parents and propositi are normal. Genetic data suggest autosomal recessive inheritance.     

IgE antibody suppression following aerosol exposure to antigens

Exposure of mice to aerosolized antigens induced a low level IgG1 response but not detectable IgE antibodies. Subsequent intraperitoneal immunization of these mice demonstrated immunoglobulin class-specific IgE suppression. Low concentrations of nebulized antigen induced IgE suppression which was antigen specific and persisted on subsequent secondary and tertiary injections. Although a single aerosolized antigen exposure significantly decreased the IgE response, maximal suppression was observed when the mice were exposed to nebulized antigen once weekly for at least 6 weeks. The suppression was not observed until 3 weeks following nebulizer exposure. Mice exposed once weekly to nebulized antigen for 6 weeks and then rested for 2 months before intraperitoneal immunization still demonstrated suppression. However, animals first immunized intraperitoneally and then exposed to nebulized antigen produced normal secondary IgE and IgG1 responses. These results suggest that antigen exposure by aerosol may profoundly alter the IgE response.     

Neurodevelopmental consequences of early exposure to phencyclidine and related drugs

In the early development of the central nervous system, stimulation of N-methyl-D-aspartate (NMDA) receptors may be critical for neuronal cell survival and differentiation, as well as the establishment of neural networks resulting from "experience-dependent plasticity." The trophic influence of NMDA receptor stimulation may be present only during a certain critical period of development. There are, therefore, major concerns associated with the administration of noncompetitive NMDA receptor antagonists (such as MK-801 [dizocilpine]) as neuroprotective and anticonvulsant agents to pregnant women, neonates, infants, and young children. Several studies showing disruptive effects of noncompetitive NMDA receptor antagonists on normal neurobehavioral development are reviewed in this article. This research has important public health implications because phencyclidine (PCP), a noncompetitive NMDA receptor antagonist, is a frequently-abused drug that may disrupt brain development in utero when abused by pregnant women. The article also reviews studies of neonatal blockade of the NMDA receptor complex in animals; studies that may lead to useful models of human neurodevelopmental disorders. These models may even mimic the relevant neurodevelopmental aspects of at least some forms of schizophrenia, especially the early developmental disconnection of circuits between the hippocampus and frontal cortex.     

Immune system dysfunction during exposure to poult enteritis and mortality syndrome agents

Poult Enteritis and Mortality Syndrome (PEMS) is a condition of yet undefined etiology. Affected flocks may exhibit 100% morbidity with mortality up to 50% or more between 2 to 4 wk of age. The current study reports the immune status of poults experimentally infected with PEMS agent(s) in various trials. When compared with the unchallenged controls, PEMS-infected poults had significant atrophy of the bursa (up to 2-fold), thymus (up to 11-fold), and spleen (up to 2-fold) (P < or = 0.05). When challenged with SRBC, PEMS-infected poults had 1 to 2 log2 lower anti-SRBC antibody titers than the controls (P < or = 0.05). Responsiveness to a mitogenic lectin, phytohemagglutinin-P, was reduced significantly in PEMS poults (P < or = 0.05). These data show that the immune system of the poults is compromised significantly during PEMS infection in terms of lymphoid organ integrity and humoral and cell-mediated immunity. These findings imply, therefore, that immune dysfunction may contribute to the mortality observed during PEMS outbreaks.     

Occupational exposure to phenoxy herbicides and chlorophenols and cancer mortality in The Netherlands

As part of the "IARC International Register of Persons Exposed to Phenoxy Herbicides and Contaminants," a cohort of workers who manufacture and prepare chlorophenoxy herbicides was recruited in The Netherlands. The cohort comprised 2,310 workers from two plants, operated by different companies, who were followed during the periods 1955-1985 and 1965-1986, respectively. In 1963, there had been an industrial accident in one factory with concomitant release of dioxin into the environment. Loss to follow-up was 3%. Mortality data on 963 exposed and 1,111 nonexposed men were evaluated by external and internal comparison. Compared with national rates, total mortality (94 deaths, standardized mortality ratio [SMR] = 101; 95% confidence interval [CI], 82-124) and cancer mortality (31 deaths, SMR = 107; 95% CI, 73-152) for exposed workers were not significantly increased. A statistically insignificant increase was observed for non-Hodgkin's lymphoma (2 deaths, SMR = 299; 95% CI, 36-1,078). No cases of soft-tissue sarcoma were encountered. There was no increase in either total mortality (25 deaths, SMR = 111; 95% CI, 72-163) or cancer mortality (10 deaths, SMR = 137; 95% CI, 66-252) among the 139 workers probably exposed to dioxins during the 2,4,5-trichlorophenol production accident or the subsequent clean-up operations. Compared with nonexposed workers, exposed workers did not exhibit a higher total mortality (rate ratio [RR] = 1.28; 95% CI, 0.89-1.82). Mortality due to all cancers (RR = 1.7; 95% CI, 0.9-3.4) and respiratory cancer (RR = 1.7; 95% CI, 0.5-6.3) was insignificantly elevated. These findings suggest that the increases in cancer mortality among workers exposed to phenoxy herbicides and chlorophenols may be attributable to chance. Lack of power prevented evaluation with respect to specific cancers.     

Unconditioned stress-induced analgesia following exposure to brief footshock.

Four experiments, with 136 male Sprague-Dawley rats, examined the properties of unconditioned analgesia elicited by electric footshock stimuli using UCS parameters typical of aversive conditioning paradigms. In all experiments, analgesia was inferred from the latency to paw lick in response to painful thermal stimulation in the hot-plate assay. In Exp I, Ss exposed to a 1-sec, 2-mA shock UCS showed significantly longer latencies to respond to painful thermal stimulation than nonshocked controls, whereas nonsignificant increases in response latencies were observed with 1-sec shock UCS of either 0.5 or 1.25 mA. In Exp II, Ss exposed to a 2-mA electric shock UCS showed systematic increases in latencies to respond to painful thermal stimulation as the duration of the shock was varied between 0.5 and 2 sec. Exp III showed that this form of shock-induced analgesia was of short temporal duration. Specifically, significant increases in latencies to respond to painful thermal stimulation occurred 30 but not 90 or 300 sec following exposure to shock. Exp IV demonstrated that this form of analgesia was unaffected by pretreatment with the opiate receptor antagonist naloxone HCl in ip dosages of 1, 5, 10, or 20 mg/kg. Finally, there was no evidence showing that environmental stimuli paired with shock presentations acquired the capacity to evoke analgesia as a conditioned response. Implications of shock-induced analgesia for the study of aversive conditioning and behavior are discussed. (26 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cost-effectiveness of post-exposure prophylaxis following sexual exposure to HIV

OBJECTIVES: To assess the cost-effectiveness, relative to other health-related interventions in the U.S., of post-exposure prophylaxis (PEP) following potential HIV exposure through sexual contact with a partner who may or may not be infected, and to compare the relative cost-effectiveness of dual- and triple-combination PEP. METHODS: Standard techniques of cost-utility analysis were used to assess the cost-effectiveness of PEP with a four-week regimen of zidovudine and lamivudine, or zidovudine, lamivudine, and indinavir. Due to a lack of empirical data on the effectiveness of PEP with combination drug regimens, the analysis assumed that combination PEP was no more effective than PEP with zidovudine alone. The main outcome variable is the cost per quality-adjusted life year (QALY) saved by the program. RESULTS: Providing PEP to a cohort of 10,000 patients who report receptive anal intercourse with a partner of unknown HIV status (who is assumed to be infected with probability equal to 0.18) would prevent about 20 infections, at an average net cost of about US$ 70,000 per infection averted. The cost-utility ratio, US$ 6316 per QALY saved, indicates that PEP is highly cost-effective in this instance. Moreover, triple-combination PEP would need to be about 9% more effective than dual-combination PEP for the addition of indinavir to the regimen to be considered cost-effective. Prophylaxis following receptive vaginal exposure is cost-effective only when it is nearly certain that the partner is infected; PEP for insertive anal and vaginal intercourse does not appear to be cost-effective. CONCLUSIONS: From a purely economic standpoint, PEP should be restricted to partners of infected persons (e.g., serodiscordant couples), to patients reporting unprotected receptive anal intercourse (including condom breakage), and possibly to cases where there is a substantial likelihood that the partner is infected. Providing PEP to all who request it does not appear to be an economically efficient use of limited HIV prevention and treatment resources.