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1
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Causes of death in HIV-infected patients in the region of Lodz, Poland from 1995 through 2005

100%
Jabłonowska E., Małolepsza E.
Open Medicine
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2009
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vol. 4
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issue 2
179-183
EN
In 2005, 440 patients infected with HIV were registered in the AIDS center in Lodz, Poland. The aim of our study was to analyze the causes of death in 70 fatal cases. We analyzed the data from 70 fatal cases from 1995 through 2005. Of the fatal cases we investigated, 10 were in women and 60 in men. The most common route of HIV transmission was intravenous drug use (50%). At the time of death, the mean age of patients was 36,48 years, and the mean CD4 count was 115,14 cells per microliter. The mean time from HIV diagnosis to death was 3,75 years. The leading cause of death in the group from 1995 through 2004 was AIDS. In 2002, liver diseases resulting from hepatitis C virus (HCV) infection were the cause of death in two patients. In 2005, two patients died as a result of myocardial infarction. The prevalence of fatal cases decreased from 9,09 % in 1995 to 1,59 % in 2005. Hepatitis B surface antigen (HBsAg) was found in 4 of 62 patients (6,45%), anti-HCV in 28 patients (45,16%), and both hepatitis B virus (HBV) and HCV infection in 5 patients (8,07%). Coinfections occurred most frequently in intravenous drug users (IDUs). In conclusions: (1) AIDS is still the leading cause of death in HIV-positive patients in the Lodz region; (2) the emerging cause of death in HIV-positive patients is liver disease as the sequel of HBV and HCV coinfections; (3) heart disease is becoming an important cause of death in HIV-positive patients.
2
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Mortality in surgical units and postoperative care

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Piechota M., Piechota A., Rysz J.
Open Medicine
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2008
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vol. 3
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issue 3
346-357
EN
In the year 2005, 10 public health care institutions in Lodz contained general surgery units. The lowest mortality rate, 0,35%, was recorded in the surgical unit of University Teaching Hospital No. 5 (UH No. 5). We performed a retrospective comparative analysis of mortality in this hospital and in the two remaining university teaching hospitals, University Teaching Hospital No. 1 (UH No. 1) and University Teaching Hospital No. 2 (UH No. 2). The study was comprised of data from 18911 patients treated in these units from 01.01.2003 to 31.12.2005. The statistical data were collected by the Provincial Centre of Public Health in Lodz. The structure of the analysed units and the structure of the selected groups of diagnoses were compared. A relative structure similarity index was used to compare the structure of hospitalised patients in the analysed units, in an attempt to discover the reasons for significantly lower mortality among patients hospitalised in surgical unit of UH No. 5. A detailed analysis of the selected diagnoses and of mortality indicated that early postoperative intensive care in severely ill patients and immediate admission to the ICU, when indicated, significantly decrease mortality.
3
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Coronary artery bypass graft surgery in the elderly patients

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Oktar G., Imren V., Erer D., Iriz E., Gokgoz L., Soncul H.
Open Medicine
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2009
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vol. 4
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issue 2
218-221
EN
The purpose of this retrospective study was to determine the results of coronary artery surgery in the elderly patients and to compare the outcome with a younger group. Two hundred thirteen patients aged 70 years and older who underwent on-pump coronary artery surgery were retrospectively studied and data were compared with those of 524 patients aged 50–69. The groups were similar with respect to preoperative characteristics except for sex distribution and the incidences of peripheral vascular disease and prior cerebrovascular accident. The use of internal mammarian artery grafts was significantly lower in the elderly patients (80.3% versus 91.6%, p<0.001). The 30-day mortality for the elderly group was 4.7% while that of younger group was 2.3%. The elderly patients had a significantly higher incidence of postoperative low cardiac output, pulmonary complications and acute renal failure. The elderly group also had also significantly longer intensive care unit length of stay (1.9 versus 1.7 days, p=0.006) and postoperative length of stay (10.1 versus 7.4 days, p<0.001). Although mortality and complication rates are higher, coronary artery surgery can be performed with acceptable risk in the elderly patients. Old age alone should not be a deterrent factor for surgical revascularization in coronary artery disease.
4
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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.
5
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Prognostic value of serum cystatin C levels in cirrhotic patients with normal serum creatinine

100%
Teneva B., Karaslavova E.
Open Medicine
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2014
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vol. 9
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issue 5
625-631
6
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Preoperative anemia associated in-hospital mortality and morbidity in isolated coronary artery bypass graft surgery

88%
Shirzad M., Karimi A., Dowlatshahi S., Ahmadi S., Davoodi S., Marzban M., Movahedi N., Abbasi K., Tazik M., Fathollahi M.
Open Medicine
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2010
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vol. 5
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issue 3
308-314
EN
Anemia is an indisputable finding in patients scheduled for coronary artery bypass graft (CABG) that can occur any time preoperatively. In presence of severe coronary artery disease, anemia can dramatically affect surgical outcomes. Therefore, we conducted this study to determine the effect of low preoperative hemoglobin (Hgb) on postoperative outcome in patients who underwent coronary artery bypass graft (CABG). In all, 4432 patients who had undergone isolated CABG at Tehran Heart Center over the 2-year period from March 2006 to February 2008 were studied. All medical records of the aforementioned patients were derived from our hospital surgery data bank. After adjustment for confounders, the association of different preoperative levels of Hgb with risk of cardiac, pulmonary, infectious, and ischemic complications, and also with prolonged ventilation and resource utilization, were assessed in a multivariable model. After adjustment for confounders that may affect mortality and morbidities, we found that cardiac, infectious, ischemic, and pulmonary complications, as well as postoperative mortality, were significantly higher in anemic patients compared to those with normal Hgb levels. In addition, total ventilation time, total intensive care unit hour stay (ICU), hospital length of stay (HLOS), and postsurgery length of stay (PLOS) were significantly longer in anemic patients. We concluded that isolated CABG patients with preoperative anemia have significantly higher mortality and morbidity, and use more health care resources. Preoperative anemia is an independent variable for increased resource utilization, morbidity, and mortality.
7
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Systemic capillary leak syndrome due to systemic inflammatory response syndrome in infants: a report on 31 patients

88%
Yang C.-Y., Xu P., Yang Y.-J., Li B.-Y., Sun S.-Z., Yang Q.-Z., Wang L.-X.
Open Medicine
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2014
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vol. 9
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issue 3
477-480
EN
The aim of this study was to describe the clinical features, management strategies and outcomes of 31 infants with systemic capillary leak syndrome (SCLS) secondary to sepsis or systemic inflammatory response syndrome. There were 23 boys and 8 girls, with an average age 9.6 ± 2.1 days (range, 3.1 to 20 days). The primary disease was pneumonia in 11 patients and sepsis in other 20. Within 72 hrs of admission, all had progressive skin and mucosal edema, septic shock, respiratory distress, oliguria and severe hypoalbuminemia (10–20g/L). Other complications were pulmonary edema or hemorrhage, disseminated intravascular coagulopathy, heart failure, renal or liver dysfunction. All patients were treated with mechanical ventilation with a mean mechanical ventilation time of 19.7± 3.5 days. Intravenous hydroxyethyl starch was also applied at an early stage for 4–12 days, together with broad spectrum antibiotics, plasma and albumin infusion. Twenty one patients (67.0%) were discharged from the neonatal intensive care unit after a median stay of 29 days, and 7 died (37.0%) in the hospital. During a 6.3-month follow-up, 4 patients had hydrocephalus and another 4 had muscle spasm or rigidity in the lower-limbs. We conclude that SCLS is a serious complication of neonatal sepsis with a high rate of in-hospital mortality and post-discharge disability.
8
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Predictions of cancer mortality in Poland in 2020

88%
Wojtyś P., Antczak A., Godlewski D.
Open Medicine
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2014
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vol. 9
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issue 5
667-675
9
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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.
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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.
10
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Blood pressure categories and mortality during a thirty-six-year follow-up

75%
Stojanov V., Paunović K., Jakovljević B., Lović D., Jurisić V.
Open Medicine
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2013
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vol. 8
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issue 2
229-236
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