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[Causes of death of alcoholics].

An analysis of the representative material revealed a high rate of mortality among alcoholics, which was much higher than the similar rate among sex- and age-matched control subjects. The leading causes of death were accidents, injuries, poisoning, cardiovascular diseases and neoplasms. Other causes of mortality include suicide, liver cirrhosis and lung tuberculosis.

Adult↗

Causes of reproductive age mortality in low socioeconomic settlements of Karachi.

The Maternal and Infant Mortality Survey (MIMS) was conducted in eight squatter settlements of Karachi. The female mortality rate was 151.0 per 100,000 women aged 10-49 years and the maternal mortality ratio was 281 per 100,000 livebirths. The leading causes of deaths among women were complications of pregnancy (28.1%), infectious diseases (24.8%), cardiovascular diseases (20.7%), neoplasia (10.7%) and trauma (10.7%). Hemorrhage (47.1% of all maternal deaths), tuberculosis (40.0% of all infectious disease deaths), oropharyngeal cancer (23.1% of all neoplastic deaths), and burns (61.5% of all trauma deaths) were among the major causes identified. Maternal deaths were associated with young age and nulliparity (p-value < 0.01), and a higher proportion occurred in the hospital or on the way to the hospital as compared to non-maternal deaths.

Adolescent↗

Complications of HIV disease and antiretroviral therapy. Highlights of the 11th Conference on Retroviruses and Opportunistic Infections, February 8-11, 2004, San Francisco, California, USA.

This year's conference provided newer insights on the complications of antiretroviral therapy, as well as into the complications that arise from HIV infection itself. Many presentations at the conference centered around metabolic complications of therapy, including lipid abnormalities, diabetes, body composition changes, bone disorders, and cardiovascular disease. New data on complications of HIV infection itself were presented, including those on coinfections with hepatitis B, C, and herpes simplex viruses, malaria, and tuberculosis, as well as complications that are important during pregnancy. This article summarizes these presentations.

Anti-Retroviral Agents↗

Pericardial disease and human immunodeficiency virus in Dar es Salaam, Tanzania.

The number of patients admitted to Muhimbili Medical Centre, Tanzania, with pericardial effusions rose after the epidemic of acquired immunodeficiency syndrome (AIDS) began. To investigate a possible relation all patients with suspected pericardial disease admitted between Oct 1, 1987, and March 31, 1989, were studied. 28 of 42 patients (67%) were seropositive for human immunodeficiency virus (HIV). 28 of 39 patients (72%) with pericardial effusion were HIV-seropositive compared with 0 of 3 without effusion. More HIV-seronegative than HIV-seropositive patients were receiving antituberculous chemotherapy and had ascites at enrollment. Only 5 of 28 HIV-seropositive patients had clinical signs of AIDS. 9 of 14 HIV-seropositive patients tested had positive Mantoux tests. There were no significant differences between the HIV-seropositive and seronegative groups in the duration of symptoms, laboratory results, X-ray or ultrasound findings, frequency of tamponade, or mortality. 38 patients were treated for tuberculosis. Pericardial effusion is strongly associated with, and an early manifestation of, HIV infection in Tanzania.

Acquired Immunodeficiency Syndrome↗

Addressing racism as a clinical competence: Robert Wilson, Jr. (1867-1946).

Addressing health inequity is now recognized as a clinical competency in medical education. We examined the career and writings of Robert Wilson Jr. (1867-1946), longtime dean of the Medical College of the State of South Carolina during the Jim Crow Era, using primary and secondary sources within the context of systemic and structural racism, particularly in South Carolina. Wilson used public health data to refute the "Black Extinction Hypothesis" rooted in social Darwinism. He challenged assumptions of inherent Black susceptibility to tuberculosis, linking disease instead to social determinants of health. He also identified disproportionate mortality from kidney and cardiovascular disease among Black populations, anticipating modern health disparities research. Wilson further acknowledged systemic injustice and implicated structural conditions, including housing, in shaping outcomes. In an era of continuing health inequity and racial health disparities, Wilson applied empirical evidence to reject biological determinism, identify outcomes disparities, and advocate for racial justice.

History, 20th Century↗

Survey of the medical history questionnaire.

The purpose of this study was to examine and to compare the type of information requested on representative health history questionnaires commonly used by the dental profession. Samples of medical history questionnaires were obtained from American and Canadian dental schools, commercial vendors, and the American Dental Association. Results indicated that more than 140 questions have been included on questionnaires and more than 92% of these appeared in some type of yes-or-no format. The number of questions per form ranged from 32 to 88, with an average of 58 items. Although there was wide variation in the range of information requested, the 25 most frequently asked questions occurred in 70% of the forms. The majority of questions focused on noninfectious disease conditions that affect the cardiovascular system and major organ functions, allergies, and blood disorders; infectious diseases such as hepatitis, tuberculosis, mumps, and venereal disease; and health care status and special treatment considerations.

Health Status Indicators↗

[Incidence of infective diseases at an internal medicine service].

In the clinical records between 1980-1989, there are 3,386 diagnosis of diseases, 34 percent of them were infections, the first great cause of diseases in ten years; the second cause was cardiovascular 16.3%. Infectious disease were localized in urinary tract 19%, Typhoid Fever 15%, pneumonia 11%, tuberculosis 8.5%, cellulitis 8.5%, Viral Hepatitis 8%, Brucellosis 5%, gastrointestinal Tract infections 5% and others 20%. It is necessary improve the epidemiological criteria in the practice of internal medicine, because the elevated numbers of infectious diseases that we are seeing in the Internal Medicina Section.

Communicable Diseases↗

[Estimation of the impact of the principal diseases in rural Mali].

The authors assess the health impact of major diseases in the circles of Kita, Bafoulabé and Kenieba (Western Mali) by measuring, for each of them, the number of healthy days of life lost through illness, disability and death. Malaria, birth diseases, infant gastro-enteritis and pneumopathies, measles, malnutrition and hemoglobinopathies account for 58.1% of healthy life lost due to all studied diseases. Parasitic diseases (except malaria), tuberculosis, leprosy are less important than usually said; on the contrary, the impact of hepatic, cardiovascular, and eyes diseases is great. In developing countries assessing the number of healthy days lost by the community due to different diseases is usefull to choose the health priorities and to compare the cost/effectiveness ratio of different health programs.

Adult↗

Autopsy findings in diabetic patients: a 27-yr clinicopathologic study with emphasi on opportunistic infections and cancers.

Diabetes mellitus has become a growing epidemic in the Asia-Pacific region. The aims of this study were to determine at autopsy the prevalence and characteristics of pathologic lesions in patients with diabetes mellitus. The 13,215 autopsy reports in our institution were examined for the diagnosis of diabetes mellitus. In patients with diabetes mellitus, the demographic data and the different pathologic lesions noted were analyzed. Diabetes mellitus was found in 820 patients (426 men and 394 women), comprising 6.2% of all autopsies. The two most common types of disease were cardiovascular diseases and infections, found in 69 and 53% of diabetic patients, respectively. Bacterial infection, in particular tuberculosis, was the most common type of infection noted. Localized and disseminated fungal infections were also common. In addition, urinary tract diseases were noted in 48%, hepatobiliary tract lesions in 42%, central nervous system disorders in 25%, and tumors in 29% of the diabetic patients. Malignant tumors were more often seen than benign tumors (18 vs 11% of patients, respectively). Many of the tumors were adenocarcinomas, and the most common neoplastic lesions were carcinomas of the lung, pancreas, liver, large intestine, stomach, and esophagus. Diabetic complications and associated diseases are common problems in this population. Adequate health care resources are needed for their prevention and treatment.

Adolescent↗

Autopsy findings and clinical diagnoses: a review of 1,000 cases.

The protocols of 1,000 consecutive adult patients autopsied during the period June 1983 to December 1988 were retrospectively analyzed and the findings were compared with clinical diagnoses. The autopsy rates during this period ranged between 23% and 27% of hospital deaths. Eighty-seven percent of the autopsied patients were between 15 and 59 years of age. Major discrepancies between the autopsy reports and the clinical diagnoses were present in 31.7% of all autopsy reports reviewed. Infectious diseases were the most common cause of death (46.8%), followed by cardiovascular diseases (17.1%) and neoplastic diseases (14.3%). Infections were clinically recognized in 66.7% of cases and were missed or found to be incorrect in 33.3% of cases. Tuberculosis comprised 33.8% of the major bacterial infections and was clinically diagnosed in 82% of cases. Eighty-nine percent of the major fungal infections were not suspected clinically. Rheumatic heart disease (43.8%) was the most common cardiovascular disorder and was clinically diagnosed in 93.3% of cases. Pulmonary vascular episodes were the least common cause of death and were not suspected clinically in 62.9% of cases. Malignancies were incorrectly diagnosed in 25.8% of cases. We conclude from this study that routine autopsies revealed major unexpected findings that are of clinical importance, and that a continued emphasis on autopsy evaluation is necessary for the improvement of the quality of patient care.

Adolescent↗

[Enhanced work efficiency in agricultural workers with surgically treated pulmonary tuberculosis].

Recommendations were developed and proposed for rational employment of agricultural workers operated on for pulmonary tuberculosis. The proposals were formulated with regard to the volume of the work done, impairment of the respiration and cardiovascular systems, activity of the specific lesions in the remaining lung tissue, character of the previous job and differential periods: short-term periods up to 1 year, medium-term periods up to 2 years and continuous periods of over 2 years.

Agricultural Workers' Diseases↗