Breakdancers may risk ‘headspin hole’ caused by repetitive headspins, doctors warn

Breakdancers may be at risk of developing a condition caused by repeatedly doing a cardinal move of their practice and performance-the headspin-warn doctors in the journal BMJ Case Reports.

Dubbed the ‘headspin hole,’ or ‘breakdance bulge,’ the condition is unique to breakdancers, and appears as a protruding lump on the scalp, often accompanied by hair loss and tenderness.

Breakdancers are particularly prone to injuries because of the complexities and physical demands of the moves, note the authors. Sprains, strains, and tendinitis are particularly common. Head and brain injuries, including subdural haematomas (pooling of blood between the skull and the brain), have also been reported.

Prolonged breakdancing often leads to ‘breakdancer overuse syndrome’ which includes various conditions, such as carpal tunnel syndrome and swollen and inflamed tendons (tenosynovitis) as well as hair loss and scalp irritation, add the authors.

They treated a man in his early 30s with a growth on his scalp. The man said that he had performed various types of headspin manoeuvres for more than19 years.

He practised his moves 5 times a week for around 1.5 hours a time. During these sessions direct pressure was applied to the top of his head for between 2 and 7 minutes.

Despite hair loss and a burgeoning lump on his head, he continued to practise headspins, but was prompted to act when the lump started to grow a lot larger and his scalp began to feel tender.

A head scan revealed thickening of the skin, tissue, and skull around the lump, but no obvious signs of cancer, which was confirmed on biopsy.

The lump was removed, but the surrounding skin tissue remained thickened. Nevertheless, the man was happy with the result and felt able to go out in public once again without having to wear a cap.

This report represents just one case, and details of only one other have been published to date, so the findings should be interpreted in this context.

But the authors conclude: “This case underscores the importance of recognising chronic scalp conditions in breakdancers and suggests that surgical intervention can be an effective treatment.” 

Reference:

https://casereports.bmj.com/lookup/doi/10.1136/bcr-2024-261854

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Dexmedetomidine as adjunct may help manage One-Lung Ventilation in high-risk pediatric thoracic surgery, finds study

Recent paper investigates the effects of dexmedetomidine on oxygenation and pulmonary shunt fraction in high-risk pediatric patients undergoing one-lung ventilation (OLV) for thoracic surgery. The study highlights the unique considerations of pediatric thoracic surgery due to the immaturity of the respiratory system and the common technique of OLV. The randomized controlled trial involved 63 children undergoing thoracic surgery with OLV, divided into two groups – one receiving dexmedetomidine and the other receiving a placebo. The study measured parameters such as partial pressure of arterial oxygen (PaO2), pulmonary shunt fraction (Qs/Qt), mean arterial pressure (MAP), heart rate (HR), and peak inspiratory pressure (PIP) at various time points during the surgery.

Main Findings

The findings indicate that dexmedetomidine significantly improved PaO2 and decreased Qs/Qt compared to the placebo group during OLV. Additionally, dexmedetomidine was shown to decrease PIP during OLV and maintain hemodynamic stability, including MAP and HR. The study demonstrated that dexmedetomidine infusion during OLV in high-risk pediatric thoracic surgery reduces shunt and pulmonary shunt fraction Qs/Qt, improves PaO 2 and body oxygenation, reduces PIP, and maintains hemodynamic stability. These findings reinforce the potential of dexmedetomidine as a beneficial adjunct in managing OLV in pediatric thoracic surgery.

Study Methodology

The paper provides detailed insights into the unique anatomical and physiological characteristics of the pediatric cardiovascular and respiratory systems, as well as the challenges associated with OLV in pediatric patients. The study discusses the methodology, including the rigorous design of a double-blind, randomized controlled trial with a parallel-group design, as well as the inclusion and exclusion criteria, and the administration protocol for the intervention group.

Conclusion and Limitations

The conclusion emphasizes the potential value of dexmedetomidine as an adjunct for managing OLV in high-risk pediatric thoracic surgery, particularly in improving oxygenation and reducing pulmonary shunt fraction. The paper also acknowledges the limitations of the study, such as the relatively small sample size and the need for further research into alternative dosing regimens and larger patient populations to validate the findings. Overall, the paper provides comprehensive and detailed insights into the effects of dexmedetomidine in pediatric thoracic surgery, highlighting its potential benefits in improving patient outcomes during OLV.

Key Points

– The study investigated the effects of dexmedetomidine on oxygenation and pulmonary shunt fraction in high-risk pediatric patients undergoing one-lung ventilation (OLV) for thoracic surgery, considering the unique considerations of pediatric thoracic surgery due to the immaturity of the respiratory system and the common technique of OLV.

– The randomized controlled trial involved 63 children undergoing thoracic surgery with OLV, divided into two groups – one receiving dexmedetomidine and the other receiving a placebo. Parameters such as partial pressure of arterial oxygen (PaO2), pulmonary shunt fraction (Qs/Qt), mean arterial pressure (MAP), heart rate (HR), and peak inspiratory pressure (PIP) were measured at various time points during the surgery.

– The findings indicated that dexmedetomidine significantly improved PaO2 and decreased Qs/Qt compared to the placebo group during OLV. Additionally, dexmedetomidine was shown to decrease PIP during OLV and maintain hemodynamic stability, including MAP and HR. – The study demonstrated that dexmedetomidine infusion during OLV in high-risk pediatric thoracic surgery reduces shunt and pulmonary shunt fraction Qs/Qt, improves PaO2 and body oxygenation, reduces PIP, and maintains hemodynamic stability.

– The paper provided detailed insights into the unique anatomical and physiological characteristics of the pediatric cardiovascular and respiratory systems, as well as the challenges associated with OLV in pediatric patients. The methodology involved a double-blind, randomized controlled trial with a parallel-group design, as well as the inclusion and exclusion criteria and the intervention group’s administration protocol.

– The conclusion highlighted the potential value of dexmedetomidine as an adjunct for managing OLV in high-risk pediatric thoracic surgery, particularly in improving oxygenation and reducing pulmonary shunt fraction, while acknowledging the study’s limitations, such as the relatively small sample size and the need for further research into alternative dosing regimens and larger patient populations to validate the findings.

Reference –

Khddam A, Rostom F, Hajeer M (September 18, 2024) Effects of Dexmedetomidine in Improving Oxygenation and Reducing Pulmonary Shunt in High-Risk Pediatric Patients Undergoing One-Lung Ventilation for Thoracic Surgery: A Double-Blind Randomized Controlled Trial. Cureus 16(9):e69659. DOI 10.7759/cureus.69659

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More than 4 hour emergency care wait may increase risks of death and prolong hospital stay for hip fracture patients: Study

Waiting more than 4 hours in emergency care for treatment is linked to heightened risks of death and a longer hospital stay for hip fracture patients, reveals a single centre study, published online in Emergency Medicine Journal.

The waiting time for more than 1 in 3 of these patients exceeded the 4 hour national standard, which now requires that 76% of emergency department patients must either be discharged or admitted to hospital within that time frame.

By the age of 80 an estimated third of women and 17% of men will have fractured a hip-figures which are slated to likely double by 2033, explain the researchers.

Early surgery is associated with lower risks of death and perioperative complication rates, but with emergency department waiting times currently lengthening across the UK and elsewhere, it’s highly likely that hip fracture surgery may end up being delayed, they add.

To assess the potential impact on hip fracture patients of 4+ hour waits in the emergency department, the researchers retrospectively evaluated local hip fracture database entries for all patients aged at least 50, admitted to a single trauma centre between 1 January 2019 and 30 June 2022, and subsequently monitored for at least 8 months until February 2023.

The trauma centre in question serves a population of 916,310 people in Lothian, Scotland and manages more than 1000 hip fractures annually.

Details on demographics, treatment, progress through the service, and death were collected from the patients’ case notes and the trauma centre’s documentation.

Some 3611 patients were admitted to the centre with a hip fracture during the study period. After various exclusions, including those with incomplete admission and discharge time data, 3266 patients were included in the analysis.

Their average age was 81, but ranged from 50 to 104, and 2359 (72%) were women. They spent an average of 3.9 hours in the emergency care department.

The average length of time before surgery was 27 hours, with the average time between admission and surgery 22.5 hours. Average length of their hospital stay was 9 days, with subsequent follow-up lasting 529 days, during which time 1314 (just over 40%) of these patients died.

In all, more than a third (1261; 39%) patients waited longer than 4 hours in the emergency department. They were significantly more likely to be admitted during the winter, to pose more of a surgical risk, to have sustained a fracture that is more difficult to repair, and to have waited longer for their surgery than those who spent 4 hours or less in the emergency department.

Almost 96% of those who waited less than 4 hours were alive at 90 days compared with almost 93% for those waiting longer—equivalent to one additional death at 90 days for every 36 patients who waited more than 4 hours, say the researchers.

The 90 day risk of death rose in tandem with the length of delay before surgery, reaching around 14% after 24 hours.

Male sex, older age, admission during the winter months, higher operative risk, care home residence, and longer time between admission and surgery were also all independently associated with death at 90 days.

After taking account of potentially influential factors, a 4+ hour wait was associated with 29%, 36%, and 15% heightened risks of death at 60 days, 90 days, and at final check-up, respectively.

Patients who waited 4+ hours in the emergency department were also much more likely to spend 1 day longer in hospital, adding up to around £770,000 in total, if costed at £610/day (2014 prices), note the researchers.

This is an observational study, so cause can’t be confirmed. And the researchers acknowledge the relatively small size of their study and the lack of adjustment for the patients’ overall state of health and factors delaying their admission, all of which may have influenced their outcomes.

But while it isn’t clear exactly why spending more than 4 hours in the emergency department should be associated with poorer outcomes for hip fracture patients, given that there is a link, direct transfer to theatre from the emergency department might improve the chances of survival for these patients, the researchers suggest.

Reference:

Clement ND, Farrow L, Chen B, et alDelayed admission of patients with hip fracture from the emergency department is associated with an increased mortality risk and increased length of hospital stayEmergency Medicine Journal Published Online First: 08 October 2024. doi: 10.1136/emermed-2023-213085.

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Dexmedetomidine’s Expanding Role: Study Reveals Promising Insights into Postoperative Kidney Health and Sleep Quality

France: A recent editorial published in Anaesthesia Critical Care & Pain Medicine explores the multifaceted role of dexmedetomidine, posing the question: Is it more than just an anesthetic aid? The article provides an overview of the latest evidence regarding this highly selective alpha-2 adrenergic agonist, highlighting its potential benefits beyond traditional anesthetic applications.  

Dexmedetomidine is a highly selective alpha-2 agonist recognized for its analgesic, sedative, and anti-anxiolytic properties, all with minimal respiratory depression. Recently, its organ-protective and anti-inflammatory effects have gained attention. Traditionally, dexmedetomidine has played an adjunctive role in anesthesia, helping to reduce the need for hypnotic agents, facilitating opioid-free anesthesia, and improving postoperative outcomes related to nausea, vomiting, delirium, and pain.

Emerging research highlights additional potential benefits, such as reducing postoperative sleep disturbances and acute kidney injury (AKI), both of which are associated with inflammation. These issues are prevalent in surgical settings and can lead to increased mortality, prolonged hospital stays, and heightened patient distress.

This raises the question: does the perioperative use of dexmedetomidine offer more than just anesthetic support? Beyond its traditional role, it may positively influence the physiological and emotional outcomes of surgery.

In their article, Raphael Cinotti, MethodS in Patients-centered Outcomes and HEalth Research, SPHERE, Nantes, France, and colleagues present a comprehensive overview of dexmedetomidine regarding sleep disturbances and acute kidney injury while also offering a broader perspective on its effects during perioperative administration.

Two recent studies have shed light on the role of dexmedetomidine in addressing postoperative acute kidney injury (AKI) and sleep disturbances.

In a meta-analysis by Zhuang et al., which reviewed 23 randomized control trials, compelling evidence emerged linking intraoperative administration of dexmedetomidine—either as a bolus (0.4 to 1.5 mg/kg) or continuous infusion (0.1 to 1 mg/kg/h)—to a reduction in postoperative AKI, assessed by established criteria. This study highlighted secondary benefits, including improved urine output, inflammation markers, and overall renal function, alongside reduced nausea and vomiting. Although some secondary outcomes received low-GRADE scores, the primary findings on AKI received high GRADE ratings, reinforcing the drug’s potential renal protective effects.

Meanwhile, Dong et al. conducted a double-blind randomized control trial focusing on postoperative sleep disturbances in women undergoing breast surgery. Utilizing a clinical insomnia scale and Fitbit data for sleep analysis, the study found no significant difference in sleep disturbance between those receiving dexmedetomidine (1.0 mg/kg before induction) and a placebo. However, improvements in sleep structure—specifically nocturnal wakefulness and deep sleep—were noted with dexmedetomidine across different anesthesia regimens.

While these studies suggest dexmedetomidine’s potential in mitigating AKI and enhancing sleep quality, they also raise questions about dosing protocols and the consistency of results. There were increased incidences of hypotension and bradycardia, although some literature suggests dexmedetomidine might present a safer profile compared to traditional opioids like remifentanil.

To conclude, the findings of Zhuang et al. and Dong et al. provide valuable insights into dexmedetomidine’s effects on AKI and sleep disturbances. However, further research is needed to clarify optimal dosing and timing and to explore its impact across diverse patient populations.

Reference:

Cinotti R, Studd H, Forget P. Dexmedetomidine, more than just an anaesthetic aid? An overview of latest evidence. Anaesth Crit Care Pain Med. 2024 Jul 9;43(5):101406. doi: 10.1016/j.accpm.2024.101406. Epub ahead of print. PMID: 38992467.

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Maternal Inflammation During Pregnancy Linked to Lower Infant Cognitive and Communication Skills, Study Reveals

China: A recent longitudinal study has unveiled concerning associations between inflammation-related prenatal adversities and the offspring’s neurodevelopment by one year. The research, conducted as part of a prospective birth cohort, highlights significant impacts on cognitive and communication skills linked to elevated inflammation during pregnancy.

“Our findings indicate a notable link between elevated Inflammation related Prenatal Adversity Index (IPAI) scores and reduced performance in cognitive abilities, receptive communication, expressive communication, and fine motor skills,” the researchers wrote in BMC Pregnancy and Childbirth. Additionally, they found an increased risk of developmental challenges, particularly in cognition and receptive communication.

The recent Maternal Immune Activation (MIA) theory proposes that systemic inflammation in mothers may play a key role in linking prenatal adversities to neurodevelopmental disorders in their children. However, as pregnant individuals often face multiple adversities simultaneously, it remains uncertain whether a quantitative index can be created to assess the level of inflammation-related exposure. Furthermore, it is unclear how this index correlates with neurodevelopmental delays in offspring.

Against the above background, Yichun Guan, Department of Reproductive Medicine Center, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China, and colleagues sought to develop an IPAI and to investigate the relationships between IPAI and the neurodevelopment of children at one year of age, utilizing data from the Jiangsu Birth Cohort (JBC).

For this purpose, the researchers included 3,051 infants from the JBC in the analysis. IPAI was developed using data gathered from mothers. Neurodevelopmental outcomes were evaluated at one year of age using the Bayley Scales of Infant and Toddler Development, Third Edition, screening test. Multivariate linear regression and Poisson regression models explored the associations between IPAI and offspring neurodevelopment.

The following were the key findings of the study:

  • Compared with the “low IPAI” group, offspring with the “high IPAI” have lower cognition, receptive communication, expressive communication, and fine motor scores.
  • The adjusted β were − 0.23, -0.47, -0.30, and − 0.20.
  • There was an elevated risk for noncompetent development of cognition and receptive communication among the “high IPAI”.
  • The relative risk [RR] were 1.35 and 1.37.

In this prospective birth cohort study, the authors developed the Inflammation-Related Prenatal Adversity Index for the first time, incorporating six maternal adversity factors. The findings indicate a significant association between higher IPAI scores and reduced performance in cognitive abilities, receptive communication, expressive communication, and fine motor skills, along with an increased risk of developmental challenges in cognition and receptive communication.

“These results provide substantial population-level evidence supporting the Maternal Immune Activation hypothesis, and underscore the critical importance of mitigating maternal inflammation-related adversities to prevent neurodevelopmental delays in infants,” the researchers concluded.

Reference:

Gan, M., Zhu, X., Wang, W. et al. Associations of inflammation related prenatal adversities with neurodevelopment of offspring in one year: a longitudinal prospective birth cohort study. BMC Pregnancy Childbirth 24, 636 (2024). https://doi.org/10.1186/s12884-024-06839-8

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Intake of metformin by potential fathers for diabetes not linked to birth defects among kids: BMJ

Potential fathers with type 2 diabetes can be reassured that taking the drug metformin is not associated with birth defects in their offspring, concludes a large study of more than 3 million pregnancies published by The BMJ today.

The researchers say the findings show that metformin can continue to be considered a suitable drug for managing blood sugar levels in men with type 2 diabetes who plan on having children.

Metformin is widely used to treat type 2 diabetes in men of reproductive age, but a recent Danish study reported a link between metformin use by fathers-to-be and an increased risk of congenital malformations, particularly genital, in male infants.

However, questions about the biological plausibility and causality between paternal metformin use and risk of congenital malformations in offspring remain unresolved.

To provide further guidance on this issue, researchers set out to evaluate the association between paternal metformin use and risk of congenital malformations in offspring from Norway and Taiwan.

Using national birth registries and prescription databases, they identified 619,389 offspring with paternal data during the period of sperm development (three months before pregnancy) in Norway during 2010-21 and 2,563,812 in Taiwan during 2004-18.

Among these, fathers of 2,075 (0.3%) offspring in Norway and 15,276 (0.6%) offspring in Taiwan used metformin during the sperm development period.

In Norway, congenital malformations were found in 24,041 (3.9%) offspring of fathers who did not use metformin during the period of sperm development, compared with 104 (5%) offspring of fathers who used metformin.

Similarly, in Taiwan, congenital malformations were found in 79,278 (3.1%) offspring of fathers who did not use metformin, compared with 512 (3.4%) offspring of fathers who used metformin.

But after restricting analyses to fathers with type 2 diabetes, and adjusting for other important factors, such as father’s age and related conditions, no increased risk of any congenital malformations among infants born to fathers who used metformin during the sperm development period was found in either Norway or Taiwan.

And no notable increases in risk were found for any specific organ malformations, including genital malformations.

These are observational findings, so can’t establish cause, and the authors acknowledge that diagnostic data may not be completely accurate and there may have been misclassification of drug use. Nor can they rule out the possibility that other unmeasured factors may have affected their results.

However, findings were consistent after further analyses accounting for genetic and family factors, suggesting that they withstand scrutiny.

As such, they conclude: “These results provide reassurance and can assist clinicians in making informed treatment decisions when selecting metformin in the treatment of type 2 diabetes mellitus among men who are planning a family.”

In a linked editorial, researchers in Australia say differences in the quality of the data available and the analyses conducted may help explain the inconsistent findings of this and the Danish study.

The lack of a known biological mechanism also adds to the case against a link between paternal metformin use and fetal malformations.

“For some, these findings may not completely lay to rest concerns raised by the Danish analyses, and further confirmatory studies are worthwhile,” they write. “At the very least, however, these findings provide some reassurance for clinicians, and for fathers-to-be prescribed metformin preconception.”

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Granules India appoints Ramraj Rangarajulu as President, Head of Formulations Operations

New Delhi: Granules India Limited has recently announced the appointment of Ramraj Rangarajulu as President and Head of Formulations Operations, effective October 14, 2024. Rangarajulu will be part of the company’s Senior Management Personnel (SMP).

Anil Arora, the current President of Formulations Operations, will be superannuating in November 2024 and will be handing over all his responsibilities to Rangarajulu in the interim.

Ramraj is M. Pharm. from Dr. M.G.R. Medical University, Chennai and brings over 28 years of experience in the pharmaceutical industry, with expertise in formulation manufacturing, plant management, quality and regulatory affairs, operational excellence, productivity improvement, new product scale-up and launches, and customer service. He has worked with various dosage forms, including oral solid dosage (OSD), small volume parenterals, and topical formulations.

Prior to joining Granules India, Rangarajulu held leadership positions at Zydus Life Sciences, Aurobindo Pharma, Medreich, and Dr. Reddy’s Laboratories. His most recent role was Senior Vice President & Cluster Head of Finished Dosage Manufacturing Operations at Zydus Life Sciences.

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Maharashtra: Doctor kills self after harassment from husband, in-laws over Rs 1 crore demand

A doctor died by suicide in Maharashtra’s Parbhani district after she was allegedly harassed by her husband and in-law who were pressuring her to bring Rs 1 crore from her parents, police said on Wednesday.
According to the FIR, Dr Priyanka Bhumre married Beed resident Nilesh Vharkate in 2022. After about two months, her in-laws allegedly demanded Rs 1 crore to set up a hospital and started harassing her mentally and physically.
For more information, click on the link below:

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SMS Medical College Resident Doctors threaten to boycott duty over pending demands

Jaipur: Expressing frustration over the unfulfilled promises made 45 days ago after their last protest, the Jaipur Association of Resident Doctors (JARD) of Sawai Man Singh (SMS) Medical College, Jaipur has threatened to boycott work completely from October 18 if the government fails to initiate a discussion with the association within the next 48 hours. The association is currently on strike, which has now entered its tenth day. 

In a press release, the association highlighted that despite their ongoing strike for the past eight days, the government has shown no commitments and the assurances given in their last protest have not been fulfilled yet. It also pointed out that the government made no initiative for a dialogue with the delegation of resident doctors to address their demands.

Also read- ‘Feel unsafe at workplace’: Jaipur doctor alleges threats from male colleague

“Despite 45 days having passed since the assurances given by the government after the last agitation and the strike going on in the state for the last 8 days, the promises and demands made by the government have not been fulfilled nor has the delegation of resident doctors been called for any talks. It clearly appears that the government is showing insensitivity towards ending the strike and the problems being faced by the patients,” mentioned the press release. 

The resident doctors associated with the association had submitted eight charter demands to the government, which had not been addressed despite months of discussions. As a result, the association called for an indefinite strike on October 8 which they are continuing by suspending elective services at the hospital. Their demands include- 

1. Strengthen security and infrastructure in all medical colleges as per previous agreements.

2. Increase the stipend and provide timely increments, as the current stipend in Rajasthan is lower than even neighboring and economically weaker states like Bihar.

3. Amend the current unjust mandatory bond policy. The penalty for leaving a seat and the provision of the surety bond should be removed, as has been done by the governments of Uttar Pradesh and Madhya Pradesh following NMC recommendations.

4. Direct recruitment of Specialist Medical Officers (SMO) should be carried out to provide merit-based jobs to postgraduate/super-specialist doctors and ensure proper specialist healthcare services for the people of Rajasthan.

5. Recruit Junior Specialists (JS) in all branches where postgraduate degrees are offered.

6. Improve hostel living conditions and provide HRA (House Rent Allowance) to all residents who do not opt for government accommodation as per NMC guidelines.

7. Address the wage disparity between academic and non-academic senior residents. Doctors completing super-specialty courses (DM/MCh) while in service should be given the same promotions and pay hikes as they receive after completing postgraduate degrees. This will help address the severe shortage of super-specialist doctors across the state.

8. Resolve the pay disparity between in-service doctors earning degrees in homoeopathy/ayurveda and allopathy.

Due to the lack of progress and communication with the government, the association has announced that they will be forced to escalate their protest by initiating a work boycott from tomorrow if no action is taken by the government in the next 48 hours. 

“If there is no positive response to our demands, the movement will be further intensified and the government and administration will be solely responsible for any kind of problem faced by the patients,” added the press release. 

Also read- RG Kar Case: Junior doctors hold Droher Carnival, Deceased Doctor’s Father Calls It ‘Victory for Doctors’

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Study: Children with multiple long-term conditions hospitalized with COVID are almost three times more likely to die

Individuals with multiple long-term conditions are two and a half times more likely to die following COVID-19 infection than others. When children were assessed separately, the risk for mortality among those with multiple long-term conditions increased to almost three times (2.8) the risk of those without. The mortality rates are 22% and 8% respectively.

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