Risk factors associated with in-hospital mortality in critically ill elderly patients with venous thromboembolism

Background: Venous thromboembolism (VTE) is a major cause of morbidity and mortality for patients admitted to the intensive care unit (ICU). The present study aims to investigate the risk factors for in-hospital mortality among critically ill elderly patients with VTE. Methods: This was a retrospective cohort study utilizing data from the large medical information mart for intensive care IV (MIMIC-IV) database. All elderly patients diagnosed with VTE were included in the analysis. The analyses were conducted using SPSS version 26.0 software and MedCalc version 19.6. Univariable and multivariable logistic regression models were conducted to explore potential risk factors associated with in-hospital mortality. Results: The study population had a median age of 75 years, with a range from 69.0 to 82.0 years, and males represented 50.4% of the cohort. Among critically ill VTE patients, the in-hospital mortality rate was 18.5% (237 out of 1282). Multivariable regression analysis revealed that longer ICU stays [OR: 1.034; 95% CI: 1.010-1.059, p=0.005], higher Charlson comorbidity index (CCI) scores [OR: 1.090; 95% CI: 1.001-1.187, p=0.046], elevated simplified acute physiology score II (SAPS II scores) [OR: 1.039; 95% CI: 1.023-1.056, p<0.001], increased red blood cell distribution width (RDW) levels [OR: 1.088; 95% CI: 1.006-1.178, p=0.035], lower mean arterial pressure (MAP) [OR: 0.975; 95% CI: 0.957-0.994, p=0.011], presence of severe liver disease [OR: 2.036; 95% CI: 1.051-3.941, p=0.035], and the necessity for renal replacement therapy (RRT) [OR: 2.478; 95% CI: 1.315-4.671, p=0.005] were significantly associated with an increased risk of in-hospital mortality among elderly ICU patients with VTE. Conclusions: The study identifies numerous independent risk factors associated with in-hospital mortality among critically ill elderly patients with VT. These factors include prolonged length of ICU stay, elevated scores on the CCI and SAPS II, increased RDW, reduced MAP, the presence of severe liver disease, and the necessity for RRT

Araneophagy by Hyllus semicupreus (Araneae: Salticidae)

Sharma, Manoj, Oli, Buddhi Ram (2021): Araneophagy by Hyllus semicupreus (Araneae: Salticidae). Peckhamia 244 (1): 1-2, DOI: http://doi.org/10.5281/zenodo.636020

Trend of Antimicrobial Use in Food-Producing Animals from 2018 to 2020 in Nepal

Antimicrobial resistance is a global public health problem and is primarily driven by the widespread overuse of antibiotics. However, antimicrobial use data in animals are not readily available due to the absence of a national database in many developing countries, including Nepal. This study was conducted to estimate the quantities of antimicrobials available in Nepal as an indicator of their use in food-producing animals between 2018 and 2020. Data were collected through surveys targeting major stakeholders: (i) the Department of Drug Administration (DDA), the Government of Nepal (GoN) for the authorized antimicrobials for veterinary use in Nepal, (ii) veterinary pharmaceuticals for antimicrobials produced in Nepal, (iii) the DDA and Veterinary Importers Association for antimicrobials bought by veterinary drug importers, and (iv) the Department of Customs, GoN, for antibiotics sourced through customs. Data showed that in the 3 years, a total of 96 trade names, comprising 35 genera of antibiotics representing 10 classes, were either produced or imported in Nepal. In total, 91,088 kg, 47,694 kg, and 45,671 kg of active ingredients of antimicrobials were available in 2018, 2019, and 2020, respectively. None of the antibiotics were intended for growth promotion, but were primarily for therapeutic purposes. Oxytetracycline, tilmicosin, and sulfadimidine were among the most-used antibiotics in Nepal in 2020. Oxytetracycline was primarily intended for parenteral application, whereas tilmicosin was solely for oral use. Sulfadimidine was available for oral use, except for a small proportion for injection purposes. Aminoglycosides, fluroquinolones, nitrofurans, sulfonamides, and tetracyclines were mostly produced locally, whereas cephalosporins, macrolides and “other” classes of antimicrobials were imported. Amphenicols and penicillins were exclusively imported and nitrofurans were produced locally only. In general, except for tetracyclines, the volume of antimicrobials produced locally and/or imported in 2020 was lower than that in 2018, which corresponded to a decreasing trend in total antimicrobials available. Furthermore, the subsequent years have seen a decrease in the use of critically important antibiotics, particularly class I antibiotics. Finally, this study has firstly established a benchmark for future monitoring of antimicrobial usage in food-producing animals in Nepal. These data are useful for risk analysis, planning, interpreting resistance surveillance data, and evaluating the effectiveness of prudent use, efforts, and mitigation strategies

Clinical efficacy and safety outcomes of bempedoic acid: An updated systematic review and meta-analysis after CLEAR Outcomes trial

Purpose: Statins are the cornerstone therapy for primary or secondary prevention of atherosclerotic cardiovascular disease (ASCVD). However, a significant portion of patients are intolerant to statin or show inadequate lipid-lowering. Bempedoic acid (BA) has been shown to decrease low-density lipoprotein cholesterol (LDL-C) in clinical trials. However, the evidence on the effect of BA on clinical cardiovascular outcomes was limited until the CLEAR Outcomes trial. Thus, to fully appraise the available data, we performed this meta-analysis. Methods: PubMed, Pubmed Central, Embase, and Scopus databases were searched for relevant articles published before May 1, 2023. Pertinent data from the included studies were extracted and analyzed using RevMan v5.4. Results: Out of 2209 studies evaluated, five randomized control trials with 17,384 patients with established ASCVD or at high risk of ASCVD were included for analysis. The BA therapy reduced major adverse cardiovascular events (OR 0.85, CI 0.77-0.93; <0.0001), non-fatal myocardial infarction (OR 0.75, 95 % CI 0.64-0.88; p <0.0001), hospitalization for unstable angina (OR 0.69, CI 0.53-0.89; p = 0.005) and coronary revascularization (OR 0.80, CI 0.61-0.91; <0.0001) significantly without decreasing the risk of all-cause death (OR 1.19, CI 0.73-1.94; p = 0.49), cardiovascular death (OR 1.04, CI 0.87-1.25; p = 0.68) and non-fatal stroke (OR 0.84, CI 0.66-1.06; p = 0.15). Conclusion: Based on our analysis the bempedoic acid addition to therapy reduced cardiovascular events in selective patients who are either intolerant to statins or do not achieve recommended LDL-C levels despite being on a maximum dose of statins and/or ezetimibe