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Transfusion associated in-hospital mortality and morbidity in isolated Coronary Artery Bypass Graft surgery

100%
Salehiomran A., Ahmadi H., Karimi A., Tazik M., Dowlatshahi S., Fathollahi M., Abbasi S.
Open Medicine
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2009
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vol. 4
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issue 3
286-292
EN
Transfusion after cardiac surgery is very common. This rate varies between institutions and has remained high despite established transfusion guidelines. We analyzed our database of patients who underwent isolated CABG (Coronary Artery Bypass Graft) to determine the predictive factors of homologous transfusion and associated postoperative morbidity, mortality and resource utilization. All 14,152 patients who underwent first-time isolated CABG, with or without cardiopulmonary bypass (CPB) who had postoperative homologous transfusion between February 2002 and March 2008 in Tehran Heart Center, were evaluated retrospectively. Overall, 16.5% of patients received transfusion. Transfused patients demonstrated a significantly higher incidence of postoperative complications (cardiac, infectious, ischemic, reoperation) and mortality (p<0.001). Homologous blood transfusion effect on mortality, morbidity and resource utilization. By Multivariable logistic regression analysis adjusted for confounders: Homologous blood transfusion effect on Mortality (30-days) (OR=3.976, p<0.0001), Prolonged ventilation hours (OR=4.755, p<0.0001), Total ICU hours (β =14.599, p<0.0001), Hospital length of stay (β =1.141, p<0.0001), Post surgery length of stay (β =0.955, p<0.0001). We conclude that the isolated CABG patients receiving blood transfusion have significantly higher mortality, morbidity and resource utilization. Homologous blood transfusion is an independent factor of increased resource utilization, morbidity and mortality.
2
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Genetic bottleneck among daghestan highlanders migrating to lowlands

75%
Bulayeva K., Marchani E., Kurbatova O., Watkins S., Bulayev O., Harpending H.
|
EN
We present results of Short tandem repeat polymorphisms (STRPs) analysis and epidemiology study of indigenous ethnic highlanders of Daghestan and of the migrants from highlands to the lowland area in 1944, in comparison with native lowlanders. Results obtained show that demographically ancient highland ethnics have achieved a relatively stable equilibrium in their native environment and are characterized by optimal level of the main viability parameters (fertility, mortality, lifespan and morbidity). Migrants from highlands to the lowlands experienced dramatically increased morbidity and mortality in 1944–1947: up to 65–70% of total migrants had suffered malaria, typhus and other new infections and about 35–37% of total migrants had died. Genetic-epidemiological study support that non-survived migrants were characterized by a higher inbreeding rate, lower heterozygosity and higher physiological sensitivity to the environmental stress. This inter-connected complex had advantage for adaptation of the highlanders to the native environment but diminished their adaptability in the new and/or changing environment. A detailed study using STRP we performed in 1995–1999 in one highland isolate of ethnic Avars of whom about 50% were moved to the lowland area. We found significant differences in genetic and demographical structures between these highland and migrant parts of the isolate: the genetic bottleneck among migrants had a great qualitative and quantitative impact on their gene pool, i.e., lost of rare native population alleles, as well as of about 1/3 of total migrants with certain genotypes. Survived migrants demonstrate shorter lifespan and higher morbidity rate that support their still ongoing genetic adaptation to the lowland environment.
3
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Urban morbidity in summer: ambulance dispatch data, periodicity and weather

63%
Petralli M., Morabito M., Cecchi L., Crisci A., Orlandini S.
Open Medicine
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2012
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vol. 7
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issue 6
775-782
EN
Over recent years the impact of weather on human health has become more severe, especially for people living in urban areas. Even though many studies have analysed the impact of weather on human mortality, few have quantified the impact of heat on morbidity, including ambulance response calls. In this study, 13,354 calls collected in the city of Florence (Italy) during summer were analyzed by month, day of the week, hour, and time slot of the day. An objective air mass classification was used to classify days and time slots with similar weather characteristics and a multiple variable analysis was applied to evaluate the relationship between emergency calls and weather. A positive trend was observed in the morning and a negative one during the night for all emergency calls, but only for food poisoning and alcoholic diseases. Calls for cardiovascular events increased in the morning and on hot days. Calls for psychiatric disorders rose significantly with temperature during the afternoon. The total number of calls and those for alcoholic diseases rose during the hottest nights. Our results, which show a clear relationship between ambulance response calls, periodicity, and weather, could contribute to an understanding the impact of weather on morbidity.
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