Browsing by Subject "Death"

Now showing 1 - 10 of 12
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    The Before and After
    (Springer, 2020-06) Vater, Laura B.; Medicine, School of Medicine
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    Cardiovascular complications in chronic kidney disease: a review from the European Renal and Cardiovascular Medicine Working Group of the European Renal Association
    (Oxford University Press, 2023) Zoccali, Carmine; Mallamaci, Francesca; Adamczak, Marcin; Bueno de Oliveira, Rodrigo; Massy, Ziad A.; Sarafidis, Pantelis; Agarwal, Rajiv; Mark, Patrick B.; Kotanko, Peter; Ferro, Charles J.; Wanner, Christoph; Burnier, Michel; Vanholder, Raymond; Wiecek, Andrzej; Medicine, School of Medicine
    Chronic kidney disease (CKD) is classified into five stages with kidney failure being the most severe stage (stage G5). CKD conveys a high risk for coronary artery disease, heart failure, arrhythmias, and sudden cardiac death. Cardiovascular complications are the most common causes of death in patients with kidney failure (stage G5) who are maintained on regular dialysis treatment. Because of the high death rate attributable to cardiovascular (CV) disease, most patients with progressive CKD die before reaching kidney failure. Classical risk factors implicated in CV disease are involved in the early stages of CKD. In intermediate and late stages, non-traditional risk factors, including iso-osmotic and non-osmotic sodium retention, volume expansion, anaemia, inflammation, malnutrition, sympathetic overactivity, mineral bone disorders, accumulation of a class of endogenous compounds called 'uremic toxins', and a variety of hormonal disorders are the main factors that accelerate the progression of CV disease in these patients. Arterial disease in CKD patients is characterized by an almost unique propensity to calcification and vascular stiffness. Left ventricular hypertrophy, a major risk factor for heart failure, occurs early in CKD and reaches a prevalence of 70-80% in patients with kidney failure. Recent clinical trials have shown the potential benefits of hypoxia-inducible factor prolyl hydroxylase inhibitors, especially as an oral agent in CKD patients. Likewise, the value of proactively administered intravenous iron for safely treating anaemia in dialysis patients has been shown. Sodium/glucose cotransporter-2 inhibitors are now fully emerged as a class of drugs that substantially reduces the risk for CV complications in patients who are already being treated with adequate doses of inhibitors of the renin-angiotensin system. Concerted efforts are being made by major scientific societies to advance basic and clinical research on CV disease in patients with CKD, a research area that remains insufficiently explored.
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    COVID-19 Diagnosis and Risk of Death Among Adults With Cancer in Indiana: Retrospective Cohort Study
    (JMIR Publications, 2022-10-06) Valvi, Nimish; Patel, Hetvee; Bakoyannis, Giorgos; Haggstrom, David A.; Mohanty, Sanjay; Dixon, Brian E.; Surgery, School of Medicine
    Background: Prior studies, generally conducted at single centers with small sample sizes, found that individuals with cancer experience more severe outcomes due to COVID-19, caused by SARS-CoV-2 infection. Although early examinations revealed greater risk of severe outcomes for patients with cancer, the magnitude of the increased risk remains unclear. Furthermore, prior studies were not typically performed using population-level data, especially those in the United States. Given robust prevention measures (eg, vaccines) are available for populations, examining the increased risk of patients with cancer due to SARS-CoV-2 infection using robust population-level analyses of electronic medical records is warranted. Objective: The aim of this paper is to evaluate the association between SARS-CoV-2 infection and all-cause mortality among recently diagnosed adults with cancer. Methods: We conducted a retrospective cohort study of newly diagnosed adults with cancer between January 1, 2019, and December 31, 2020, using electronic health records linked to a statewide SARS-CoV-2 testing database. The primary outcome was all-cause mortality. We used the Kaplan-Meier estimator to estimate survival during the COVID-19 period (January 15, 2020, to December 31, 2020). We further modeled SARS-CoV-2 infection as a time-dependent exposure (immortal time bias) in a multivariable Cox proportional hazards model adjusting for clinical and demographic variables to estimate the hazard ratios (HRs) among newly diagnosed adults with cancer. Sensitivity analyses were conducted using the above methods among individuals with cancer-staging information. Results: During the study period, 41,924 adults were identified with newly diagnosed cancer, of which 2894 (6.9%) tested positive for SARS-CoV-2. The population consisted of White (n=32,867, 78.4%), Black (n=2671, 6.4%), Hispanic (n=832, 2.0%), and other (n=5554, 13.2%) racial backgrounds, with both male (n=21,354, 50.9%) and female (n=20,570, 49.1%) individuals. In the COVID-19 period analysis, after adjusting for age, sex, race or ethnicity, comorbidities, cancer type, and region, the risk of death increased by 91% (adjusted HR 1.91; 95% CI 1.76-2.09) compared to the pre-COVID-19 period (January 1, 2019, to January 14, 2020) after adjusting for other covariates. In the adjusted time-dependent analysis, SARS-CoV-2 infection was associated with an increase in all-cause mortality (adjusted HR 6.91; 95% CI 6.06-7.89). Mortality increased 2.5 times among adults aged 65 years and older (adjusted HR 2.74; 95% CI 2.26-3.31) compared to adults 18-44 years old, among male (adjusted HR 1.23; 95% CI 1.14-1.32) compared to female individuals, and those with ≥2 chronic conditions (adjusted HR 2.12; 95% CI 1.94-2.31) compared to those with no comorbidities. Risk of mortality was 9% higher in the rural population (adjusted HR 1.09; 95% CI 1.01-1.18) compared to adult urban residents. Conclusions: The findings highlight increased risk of death is associated with SARS-CoV-2 infection among patients with a recent diagnosis of cancer. Elevated risk underscores the importance of adhering to social distancing, mask adherence, vaccination, and regular testing among the adult cancer population.
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    Cryo-EM confirms a common fibril fold in the heart of four patients with ATTRwt amyloidosis
    (bioRxiv, 2024-03-09) Nguyen, Binh An; Singh, Virender; Afrin, Shumaila; Singh, Preeti; Pekala, Maja; Ahmed, Yasmin; Pedretti, Rose; Canepa, Jacob; Lemoff, Andrew; Kluve-Beckerman, Barbara; Wydorski, Pawel; Chhapra, Farzeen; Saelices, Lorena; Pathology and Laboratory Medicine, School of Medicine
    ATTR amyloidosis results from the conversion of transthyretin into amyloid fibrils that deposit in tissues causing organ failure and death. This conversion is facilitated by mutations in ATTRv amyloidosis, or aging in ATTRwt amyloidosis. ATTRv amyloidosis exhibits extreme phenotypic variability, whereas ATTRwt amyloidosis presentation is consistent and predictable. Previously, we found an unprecedented structural variability in cardiac amyloid fibrils from polyneuropathic ATTRv-I84S patients. In contrast, cardiac fibrils from five genotypically-different patients with cardiomyopathy or mixed phenotypes are structurally homogeneous. To understand fibril structure's impact on phenotype, it is necessary to study the fibrils from multiple patients sharing genotype and phenotype. Here we show the cryo-electron microscopy structures of fibrils extracted from four cardiomyopathic ATTRwt amyloidosis patients. Our study confirms that they share identical conformations with minimal structural variability, consistent with their homogenous clinical presentation. Our study contributes to the understanding of ATTR amyloidosis biopathology and calls for further studies.
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    Development of a Real-Time Dashboard for Overdose Touchpoints: User-Centered Design Approach
    (JMIR, 2024-06-11) Salvi, Amey; Gillenwater, Logan A.; Cockrum, Brandon P.; Wiehe, Sarah E.; Christian, Kaitlyn; Cayton, John; Bailey, Timothy; Schwartz, Katherine; Dir, Allyson L.; Ray, Bradley; Aalsma, Matthew C.; Reda, Khairi; Pediatrics, School of Medicine
    Background: Overdose Fatality Review (OFR) is an important public health tool for shaping overdose prevention strategies in communities. However, OFR teams review only a few cases at a time, which typically represent a small fraction of the total fatalities in their jurisdiction. Such limited review could result in a partial understanding of local overdose patterns, leading to policy recommendations that do not fully address the broader community needs. Objective: This study explored the potential to enhance conventional OFRs with a data dashboard, incorporating visualizations of touchpoints-events that precede overdoses-to highlight prevention opportunities. Methods: We conducted 2 focus groups and a survey of OFR experts to characterize their information needs and design a real-time dashboard that tracks and measures decedents' past interactions with services in Indiana. Experts (N=27) were engaged, yielding insights on essential data features to incorporate and providing feedback to guide the development of visualizations. Results: The findings highlighted the importance of showing decedents' interactions with health services (emergency medical services) and the justice system (incarcerations). Emphasis was also placed on maintaining decedent anonymity, particularly in small communities, and the need for training OFR members in data interpretation. The developed dashboard summarizes key touchpoint metrics, including prevalence, interaction frequency, and time intervals between touchpoints and overdoses, with data viewable at the county and state levels. In an initial evaluation, the dashboard was well received for its comprehensive data coverage and its potential for enhancing OFR recommendations and case selection. Conclusions: The Indiana touchpoints dashboard is the first to display real-time visualizations that link administrative and overdose mortality data across the state. This resource equips local health officials and OFRs with timely, quantitative, and spatiotemporal insights into overdose risk factors in their communities, facilitating data-driven interventions and policy changes. However, fully integrating the dashboard into OFR practices will likely require training teams in data interpretation and decision-making.
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    Examining the Legal Consciousness of Residence Life Staff
    (Association of College and University Housing Officers - International, 2018) Nguyễn, David Hòa Khoa; Collier, Joan; Watts, Angela; Cartwright, Camille; King-Kostelac, Amelia; School of Education
    Understanding the law has become an integral part of the work of higher education professionals, especially residence life staff. For decades, courts have contributed an increasingly important role in shaping the litigious nature of society at large and within higher education (Greenleaf, 1982). Barr and Associates (1988) noted the increasingly major influence of the law on campus life. Even in the mid-1990s, Gehring and Penney (1995) highlighted the critical need to understand legal issues for those professionals entering the field of higher education and student affairs. Since Olivas (2013) found that higher education law is a rapidly changing area in the field, knowledge of the law is critical to anyone in a professional position in higher education. [Discussion questions developed by Amelia King-Kostelac.]
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    Indiana State Board of Health. Monthly Bulletin, 1907 Vol. 9 No. 8
    (8/1/1907) Farrand, Livingston, 1867-1939; Rucker Jr., J. B.; Knopf, S. Adolphus (Sigard Adolphus), 1857-1940; Barnard, H. E.; Fisher, Irving
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    Medical fruits of labor
    (Taylor & Francis, 2015-08) Isaacs, Michael; Department of Medicine, IU School of Medicine
    My grandfather's death made a profound impact on my life personally and professionally. Our family was able to share in his last joyous days thanks to a caring physician who first suggested palliative care. During these final days in which friends and family said their goodbyes, I realized as a medical student the immense impact we as healthcare workers truly make in our patients' lives. Reflections on palliative care, faith, medicine, and death following this experience influenced my formation as a Catholic, grandson, and as a physician in training. Lay summary: This article describes the personal experience of a medical student who witnesses the final days of his grandfather's life. Life, death, faith, palliative care, and the impact of physicians on families during these times is the subject of his reflection following his grandfather's death.
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    Survival Analysis for the Association between Anti-hypertensive Medication and Time to Dementia with Competing Risk
    (2019-06) Hu, Xinhua Flora; Gao, Sujuan; Zhang, Ying; Katz, Barry P.
    Background: High blood pressure (HBP) is a common risk factor for dementia in elder population. Anti-hypertensive medications have been reported to associate with lower incidence rate of dementia in elder African Americans. The Apolipoprotein E (ApoE) epsilon 4 allele has been shown to be associated with both increased dementia and hypertension risk. However, previous studies had not examined the association between anti-hypertensive medications by ApoE status accounting for the competing risk from death. Methods: This is a prospective observational cohort study in 1236 community-dwelling hypertensive African Americans aged 65 years and older without dementia at baseline, with follow-up cognitive assessment and clinical evaluation for dementia diagnosis. Dementia-free mortality was considered as the competing risk. Of these, 707 participants were genotyped for ApoE status. Anti-hypertensive medication use was obtained from prescription records in the electronic medical records of the Indiana Network for Patient Care (INPC). Cox proportional cause-specific hazard (CSH) regression models were applied to assess the association between anti-hypertensive medication use and CSHs for dementia and death in ApoE epsilon 4 carriers and non-carriers separately. Key results: In ApoE epsilon 4 carriers, participants using anti-hypertensive medications had lower CSH of dementia compared to those not on anti-hypertensive medications before adjusting for blood pressure (BP) (hazard ratio (HR), 0.365; 95% CI, 0.170 – 0.785; p = 0.0099). The HR was no longer significant once BP control was adjusted (HR, 0.784; 95% CI, 0.197 – 3.123; p = 0.7303). Anti-hypertensive medications were not associated with dementia rate in non-carriers. In ApoE epsilon 4 non-carriers, participants on anti-hypertensive treatment showed significantly lower CSH of death compared to those not on mediations adjusting for covariates and BP control (HR, 0.237; 95% CI, 0.149 – 0.375; p < 0.0001). There was no significant association between anti-hypertensive medication use and death in ApoE epsilon 4 carriers. Conclusions: Anti-hypertensive medication was associated with lower dementia rate in ApoE epsilon 4 carriers and that rate was primarily mediated through BP control. In non-carriers, anti-hypertensive medication was significantly associated with lower mortality rate and this association appears to be independent of BP control.