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At least 1,333 records · Page 74Linked to original sources
PubMed1993

[Mortality and morbidity at young ages in a stable hyperendemic malaria region, community Nyanza-Lac, Imbo South, Burundi].

A malaria control programme based on the extensive use of impregnated bednets is planned in an stable hyperendemic malaria area in Burundi (Nyanza-Lac district) where the average number of infective bites per person per year was 312 during the preintervention period. In order to be able to evaluate in depth this important intervention, vital events such as mortality and morbidity were studied in under five-year-old-children during a full year period between June 1990 and May 1991 before the intervention. Village reporters have visited every three weeks 1,200 randomly selected households and completed specific mortality and morbidity questionnaires (prevalence and incidence with a 7 day recall period) adapted from "MRC" questionnaires in the Gambia. Infant and child mortality rates were respectively 108 and 24/1000/y. The definition of a malaria death was based on the opinion of 2 physicians (by consensus) and on the following symptoms alone or in combination: fever < 8 days, convulsions or unconsciousness in the absence of symptoms suggesting an alternative diagnosis. According to this previous definition, malaria was responsible for more than 30% of mortality in under five-year-old-children (specific mortality rate 0-4 year: 14.4/1000/y; specific rate 0-1 year: 38/1000/y; specific rate 1-4 year: 8/1000/y). Diarrhoea (8.1/1000/y) and respiratory tract infections (6.0/1000/y) were respectively the second and third major causes of death. Malaria was also the first cause of morbidity with a yearly average incidence rate of 1.17/person in children under 5 years. Malaria morbidity incidence was highest in children aged 1-2 years (1.79 malaria episodes/person/y).(ABSTRACT TRUNCATED AT 250 WORDS)

Africa↗
PubMed1994

[Estimation of energy expenditure in patients with morbid obesity].

BACKGROUND: The equations available for the prediction of basal energy expenditure (BEE) may not be applicable in morbid obese individuals since the contribution of the fat free mass (FFM) over the BEE is not constant. The aim of this study was to obtain new equations for the prediction of BEE which are specific for patients with morbid obesity. METHODS: In 26 women with morbid obesity age, weight, body composition by bioelectric impedance and BEE by open circuit indirect calorimetry were determined. The BEE observed was compared with that estimated from the previously described equations. The multiple regression method was used to obtain the BEE prediction equations. RESULTS: Upon comparison of the BEE observed with the BEE estimated by the described equations a significant relation was found between both parameters. The differences were also significant except when the Harris-Benedict equation was used. Multiple regression analysis demonstrated that when the variables of body composition were included, the FFM explained 75% of the variation in BEE and on forcing the entrance of fatty mass, the explanation increased to 79%. When only the anthropometric variables were included, weight explained 69% of the variation. CONCLUSIONS: In morbid obesity, most of the equations described for estimating basal energy expenditure are not applicable. New equations are reported for the prediction of energy expenditure.

Adult↗
PubMed1993

Inter-hospital mortality and morbidity variation in Pennsylvania.

A 1986 Pennsylvania law requires the public disclosure of hospital mortality and morbidity rates. This study of hospital admissions in 1989 and 1990 examines the variation in these health-outcome indicators for the 10 most frequently occurring DRGs in the adult medical service in a sample of 20 Pennsylvania hospitals. These mortality and morbidity rates are adjusted for admission severity, DRG, age, and sex, using a logistic regression model. The null hypothesis of no significant variation among hospitals is rejected by the statistically significant (p < 0.01) results of a likelihood ratio test on the hospital variables in logit models for both mortality and morbidity. Test results also show that 4 (20 percent) of 20 hospitals have statistically significant (p < 0.05) adjusted mortality rates, and 4 (20 percent) of 20 hospitals have significant morbidity rates. Such information may impact hospital management practices in a variety of ways.

Adult↗
PubMed1993

Influence of maternal insulin-dependent diabetes mellitus on neonatal morbidity.

OBJECTIVE: To compare the neonatal morbidity rates (corrected for gestational age at delivery and method of delivery) among infants of women with insulin-dependent diabetes mellitus and those of women without diabetes. DESIGN: Historical cohort analysis. SETTING: Tertiary care centre. PATIENTS: All liveborn infants of women with insulin-dependent diabetes mellitus (IDM group) born between Jan. 1, 1980, and Dec. 31, 1989, each matched for gestational age at delivery, method of delivery and year of birth with two newborns of women without diabetes (control group). MAIN OUTCOME MEASURES: Neonatal respiratory distress, jaundice, hypoglycemia, polycythemia, hypocalcemia, intraventricular hemorrhage, seizure and macrosomia. RESULTS: There were 230 infants in the IDM group and 460 in the control group. Compared with the control group the IDM group had significantly higher incidence rates of glucose infusion (odds ratio [OR] 5.38), birth weight above the 90th percentile (OR 4.15) and neonatal jaundice (OR 1.94). No significant difference was found in the incidence rate of respiratory distress, polycythemia or hypocalcemia. The maternal serum hemoglobin A (HbA) level was not significantly related to birth weight, and neither the serum HbA level nor the presence of macrosomia was predictive of neonatal morbidity. Nearly 25% of the infants in the IDM group were born before 37 weeks' gestation; 48.2% of these were delivered early because of maternal hypertension. CONCLUSIONS: Neonatal morbidity in infants of women with diabetes is determined more by gestational age at delivery than by the maternal diabetes. Within the limits obtained in this study the degree of control of the diabetes does not seem to affect neonatal morbidity.

Adult↗
PubMedDate not supplied

A community study of gynecological and related morbidities in rural Egypt.

This study assesses the prevalence of gynecological and related morbidity conditions in a rural Egyptian community. A medical examination was conducted on a sample of 509 ever-married, nonpregnant women. For gynecological morbidities, genital prolapse was diagnosed in 56 percent, reproductive tract infections in 52 percent, and abnormal cervical cell changes in 11 percent of the women. For related morbidities, anemia was present in 63 percent of the women, followed by obesity (43 percent), hypertension (18 percent), and urinary tract infection (14 percent). Regression analysis of risk factors demonstrated the contribution of social conditions and medical factors to these diseases. Reproductive tract infections were shown to occur more frequently with uterovaginal prolapse, IUD use, presence of husband (regular sexual activity), and unhygienic behavior. Genital prolapse increased with age and number of deliveries. Age, recent pregnancy, education, socioeconomic class, and workload showed significant associations with related morbidity conditions. This evidence challenges national health programs to go beyond safe motherhood, child survival, and family planning in its services to women, and to consider the social context of health as well.

Adult↗
PubMed1993

[Mortality (1951-1986) and morbidity (1977-1988) from appendicitis in Spain].

The study describes the mortality (1951-1986) and morbidity (1977-1988) from appendicitis in Spain. Mortality decreased steadily throughout the study period; it was higher in men and in the elderly, both men and women. Hospital morbidity from appendicitis decreased by 40% from 1977 to 1988; this decrease was more pronounced in elderly patients; morbidity was higher in patients 15 to 24 years old. Possible causes of this evolution in morbidity are discussed.

Adolescent↗
PubMed1977

Prediction of morbidity in Hemophilus influenzae meningitis.

A dramatic decrease in mortality from Hemophilus influenzae meningitis has occurred in recent years. Morbidity and long-term sequellae remain significant problems. A follow-up investigation of 73 cases of H. influenzae meningitis seen over a three-year period revealed: 2 deaths, 6 children with major sequellae (retardation, spastic quadriplegia, blindness, persistent seizure disorder), 10 with minor residua, and 55 with no detectable disability. Statistical analysis of clinical parameters demonstrated a significant risk of death or major morbidity in those patients who, at the time of admission, had seizures, coma, hypothermia, shock, age less than 12 months, hemoglobin less than 11 gm/100 ml, pretreatment symptoms for longer than three days, a spinal fluid white blood cell count less than 1,000/cu mm, or a spinal fluid glucose value less than 20 mg/100 ml. Using these parameters, those patients at highest risk of having lasting major morbidity with H. influenzae meningitis can be predicted, allowing more vigorous intensive care which may reduce the mortality and morbidity further.

Colorado↗
PubMed1993

Morbidity and mortality of CAPD and hemodialysis.

We have reappraised studies on morbidity and mortality in continuous ambulatory peritoneal dialysis (CAPD), comparing it with hemodialysis (HD), the standard treatment for end-stage renal disease (ESRD). More hospitalization is required for CAPD, the difference being related to peritonitis, to the more frequent presence of some risk factors (such as diabetes and atherosclerosis) in the patients selected for CAPD, and to the lack of experience in the early years of CAPD practice. CAPD patients have less acute morbidity during treatment that not always requires hospitalization: hypotension, hypertension, arrhythmias, and myocardial ischemia. Cardiac performance is also better in CAPD patients, who develop less myocardial hypertrophy than HD patients. Hospitalization due to infectious disease not referable to technique, beta 2-microglobulin related morbidity, signs of uremic neuropathy, osteodystrophy, and malnutrition are similar in both groups. Method survival is better for HD, the difference being completely accounted for by peritonitis. Patient survival adjusted for pre-treatment differences is similar in CAPD and HD, and this is not an artifact of more drop-outs on CAPD. A high incidence of peritonitis is accompanied by an increased risk of death. Older patients have a lesser risk of death on CAPD than on HD. Diabetics have a worse survival than non-diabetics, with no difference between the two methods. Although patient survivals on CAPD and HD are the same, differences in the mode of blood purification have an interesting impact on particular aspects of morbidity.

Amyloidosis↗
PubMed1995

Mortality and morbidity after mitral valve repair: the importance of left ventricular dysfunction.

A retrospective study of 219 consecutive patients who underwent mitral valve repair for mitral regurgitation or mixed mitral valve disease with at least moderate regurgitation was undertaken. The etiology was degenerative in 151 (68.9%) patients, endocarditis in 24 (10.9%), rheumatic in 22 (10.0%), ischemic in 13 (5.9%), congenital in five (2.3%) and cardiomyopathy in two (0.9%). The average age was 64.8 +/- 10.9 years, the average follow up 30.2 +/- 24.1 months. Pre-operatively, 74% were in NYHA functional class III or IV. Left ventricular function was assessed by angiography and echocardiography, and moderate or severe impairment (ejection fraction < or = 40%) was assumed to represent significant left ventricular dysfunction. There were six (2.7%) hospital deaths, four of which were due to left ventricular dysfunction. The seven-year mortality and seven-year combined mortality and morbidity were 14.4% and 37.1% respectively for complications related to left ventricular dysfunction, and 2.5% and 24.2% respectively for unrelated complications. Subgroup analysis showed that five-year mortality and five-year combined mortality and morbidity due to left ventricular dysfunction were significantly worse in patients who had pre-operative left ventricular dysfunction than those who did not: 28.5% vs. 6.1% (p < 0.001) and 52.4% vs. 17.8% (p < 0.001). There was nevertheless a significant incidence of postoperative left ventricular dysfunction in patients with satisfactory preoperative left ventricular function. In this group, five-year mortality and five-year combined mortality and morbidity due to left ventricular dysfunction were higher in patients who were in NYHA class III or IV preoperatively than in those who were not: 11.2% vs. 0% (NS) and 25.9% vs. 0% (p < 0.01) respectively, particularly if they also had early (3-10 days) post-operative left ventricular dysfunction: 20.4% (p < 0.001) and 41.7% (p < 0.001) respectively. Despite preservation of the mitral apparatus, left ventricular dysfunction remains a major cause of mortality and morbidity following mitral valve repair for mitral regurgitation.

Adolescent↗
PubMedDate not supplied

[Endocrine metabolic and arterial pressure changes in morbidly obese patients treated with vertical gastroplasty].

When overweight surpasses 100% of the ideal weight, morbid obesity, the obese patients is condemned to a complete inability to work, social and sexual inability, and shall suffer from an increase in its morbidity and mortality. This depends to a large degree on the additions to the obesity of insulin resistance, carbohydrates intolerance, hypertriglyceridemia, hypercholesterolemia, and arterial hypertension, all of which is enveloped in a atmosphere of neuroendocrine alterations. An efficient method of treating this syndrome is weigh loss. Medical treatments have not achieved prolonged weight losses during long periods in morbid obese patients, which is a reason for surgery to try and propose new lines of treatment for these patients. The purpose of our study is to examine the effect of weight loss in 100 patients treated with vertical gastroplasty, on the metabolic disorders (triglycerides, cholesterol, glucose) and the arterial hypertension, which are considered to be risk factors in the mortality associated with morbid obesity. Our results indicate that the weight loss modified the metabolic conditions of the patients, with there being a decrease of the levels of triglycerides, cholesterol, glucose, and arterial pressure, after 6 to 12 months after the weigh loss.

Blood Pressure↗
PubMed1996

[Long-term results of vertical banded gastroplasty for morbid obesity].

UNLABELLED: Morbid obesity, defined by Body Mass Index (BMI) > 40 kg/m2, has an adverse effect on longevity due to a variety of illnesses. Among the numerous techniques proposed to control morbid obesity, Vertical Banded Gastroplasty (VBG) changes eating behavior. The aim of this study was to analyse the long term results of VBG. MATERIAL AND METHODS: Between October 1987 and July 1993, 62 patients, 7 men and 55 women, from 20 to 68 years old (Mean: 37.4 +/- 9 ans), underwent VBG for morbid obesity. Preoperative mean weight and BMI were 123 +/- 27 kg and 47.3 +/- 9.8 kg/m2 respectively. Associated diseases were diabetes mellitus (n = 31), hypertension (N = 29), hypercholesterolemia (N = 10), hypertriglyceridemia (N = 21) and joint diseases (N = 18). RESULTS: VBG was performed with a 50 mm marlex mesh in 20 cases and with a 47 to 50 mm silastic ring in 42 cases. On patient died 3 years later from alcoholic liver cirrhosis and 4 were lost to follow-up. With a mean follow-up of 31 months, mean weight and BMI were 86 +/- 21 kg (p < 0.001) and 32.1 +/- 9.8 kg/m2 (p < 0.001) respectively. Removal of the ring was performed in 3 cases, 1 because of neurologic complications and 2 at the patient's request. Eight patients (13%) failed to achieve satisfactory weight loss. Diabetes mellitus and hypertension resolved in 19 cases, hypercholesterolemia resolved in 7 cases and hypertriglyceridemia resolved in 11. CONCLUSION: VBG provides significant weight loss which reduces the frequency of medical disorders associated with obesity. This result was achieved in 87% of patients. The surgical procedure for morbid obesity must be decided conjointly with endocrinologist, psychiatrist and surgical staff for good long-term results.

Adult↗
PubMed1996

Choledochoduodenostomy: influence of risk factors in post-operative morbidity.

BACKGROUND: Choledochoduodenostomy is performed for a variety of lower common bile duct lesions. AIMS: To analyse the influence of risk factors on the post-operative morbidity following choledochoduodenostomy. METHODS: Relation of risk factors including age more than 60 years, medical Illness, hemoglobin less than 10 g/dL, albumin less than 3 g/dL, bilirubin more than 10m/dL, presence of cholangitis at admission (treated pre-operatively), use of pre-operative endoscopic sphincterotomy and common bile duct diameter at surgery were related to the occurrence of post-operative morbidity was studied using univariate analysis. RESULTS: Fifty patients underwent choledochoduodenostomy. One patient (2%) died; major post-operative morbidity occurred in 12 patients (24%). Presence of cholangitis at admission was the only factor related (p = 0.00012) to the occurrence of post-operative morbidity. No long-term complications were encountered in 35 patients (70%) mean with followup period of 28 (range 8-60) months. CONCLUSIONS: Choledochoduodenostomy is a safe permanent drainage procedure for benign lower biliary obstruction.

Age Factors↗
PubMed1996

Response to the hepatitis B virus vaccine in haemodialysis patients: influence of malnutrition and its importance as a risk factor for morbidity and mortality.

OBJECTIVE: To assess if malnutrition influences the response to the hepatitis B virus vaccine in haemodialysis patients and whether this correlates with morbidity and mortality in these patients. DESIGN: A 4-year prospective open study. SETTING: Haemodialysis unit of a 434-bed University Hospital. PATIENTS: Sixty-four patients with end-stage chronic renal failure on maintenance haemodialysis. INTERVENTIONS: Three-dose vaccination series with recombinant hepatitis B virus vaccine. MEASUREMENTS: Antibody formation against the vaccine, predialysis serum urea, serum albumin and prealbumin, dialysis efficacy (Kt/V), protein catabolic rate (PCR), arm muscle circumference, triceps skinfold, serum parathyroid hormone concentration, mortality and morbidity (hospital days per year of dialysis). RESULTS: Increase in age negatively influences the formation of antibodies (P = 0.01), whereas serum albumin (P = 0.008) and predialysis blood urea concentration (P = 0.004) are positively correlated with the formation of antibodies. Responders had significantly higher levels of serum albumin and prealbumin and predialysis blood urea than non-responders. The percentage of non-responders was higher (70%) in the group with predialysis blood urea concentration between 90 and 125 mg/dl than in those with predialysis blood urea concentrations between 176 and 225 mg/dl (14.2%). Patients with serum albumin levels between 3 and 3.5 g/dl were non-responders in a higher percentage (87.5%) than those with serum albumin levels between 4.5 and 5 g/dl (18.8%). After a 4-year follow-up, survival was 20% higher in the responder group (P < 0.05). Morbidity, expressed as hospital days per year of haemodialysis, was markedly lower in the responder group (10.4 +/- 2 versus 32 +/- 14 days, P = 0.03). CONCLUSIONS: Malnutrition negatively influences the response to the hepatitis B virus vaccine in haemodialysis patients. Non-responders have higher morbidity and mortality than responders, and therefore the absence of response to the hepatitis B vaccine can be considered as a risk factor in the haemodialysis population.

Adolescent↗
PubMed1996

Host and parasite determinants of morbidity in Egyptian children with schistosomiasis.

The relation of morbidity due to schistosomiasis in Egyptian children to egg count, eosinophilic count, antibodies mediating eosinophil damage to schistosomula, total immunoglobulins and specific antischistosomal antibodies IgG and IgM anti-cercarial antigen preparation (CAP), anti-soluble worm antigen preparation (SWAP) and anti-soluble egg antigen preparation (SEA) were evaluated. The behavior of the immune parameters after treatment was also determined. The studied children were 78 males, aged 9-11 years. They were classified to control (14), simple intestinal (26) and hepatosplenic schistosomiasis (38) groups according to the clinical, parasitological and sonographic basis. The egg count was found higher in hepatosplenic schistosomiasis compared to that in simple group. Eosinophilic count did not differ between the two groups. Studies of immune responses revealed that antibodies mediating eosinophil adherence and damage to schistosomula rose in both groups particularly in hepatosplenic group. The levels of total and specific immunoglobulins were not significantly differed in both groups. The immune response was measured 2 months after treatment. The level of total IgA was increased in simple and decreased in hepatosplenic group. Total IgG and IgM were not affected by treatment in simple but IgM increased in hepatosplenic after treatment. Total IgE was decreased after treatment in both groups. This denotes that the behavior of the two groups after treatment was similar as regards the levels of IgG and IgE and differed as regards IgA and IgM. IgG anti-CAP and anti-SEA were declined after treatment but IgG- anti SWAP was elevated after treatment in both groups. The treatment has no effect on the levels of specific IgM against all used antigens. The antibodies mediating eosinophil adherence and damage to schistosomula rose in both groups after treatment. These indicated consistency of specific immune responses after treatment in schistosomal children. It is concluded that high intensity of infection may be one of the determinants of morbidity due to Schistosoma mansoni infection in Egypt. The elevated response of antibodies mediating adherence and damage to schistosomula may be associated or play a role with morbidity. Eosinophilic count, total IgA, IgG, IgM, IgE and specific antischistosomiasis IgG and IgM (Anti-CAP, anti-SWAP and anti-SEA) are not related to morbidity.

Animals↗
PubMed1997

Medical factors in the morbidity and mortality associated with emergency colorectal cancer surgery.

OBJECTIVE: To review the results of the analysis and quantification of the influence of medical factors on the morbidity and mortality associated with emergency surgery for colorectal cancer. PATIENTS AND METHODS: We analyze retrospectively the data for 51 patients who underwent emergency surgery: 34 (67%) to treat acute obstruction and 17 (33%) for perforation. The median follow-up period was 18.5 months (3 to 62 months). RESULTS: The main tumor was located in the right colon in 13 patients (25%), in the left colon in 35 (69%) and in, the rectum in 3 (6%). Primary resection was performed in 94% of the patients: without anastomosis in 35% (18 of 51) and with primary anastomosis in 59% (30 of 51); 6% of the tumors were not resectable. The postoperative morbidity was 41%: 29% (10 of 34) occurring in obstructions and 65% (11 of 17) in perforations. The mortality rate was 14% (9% and 23%, respectively). There were statistically significant associations between mortality and the American Society of Anesthesia grading (p < 0.01) and between both the mortality and morbidity and the score for the acute physiology component of APACHE II (p = 0.01, respectively) and the total APACHE II score (p < 0.01 in both cases). The rate of actuarial disease-free survival was 26% at 36 months. Overall survival was 15% at 62 months. A recurrence rate of 48% (14 of 29) has been recorded. CONCLUSIONS: Emergency surgery for colorectal cancer is associated with a high postoperative morbidity and mortality rate, which correlate with the medical status and, particularly, with the acute physiology score of the APACHE II risk stratification system.

APACHE↗
PubMed1997

High-risk obstetric patients. Maternal morbidity after cesareans.

OBJECTIVE: To assess maternal morbidity associated with cesarean delivery among high-risk obstetric patients in a private practice setting. STUDY DESIGN: Maternal outcome parameters were prospectively studied in 1,000 consecutively delivered patients over a one-year period. RESULTS: Three hundred forty-one patients (34%) delivered by cesarean; 194 of the procedures were performed without labor. The incidence of febrile morbidity and wound infection in patients undergoing cesarean delivery without labor, 0.5%, was no greater than that of patients who delivered vaginally (P = 1.0). There was a higher incidence of transfusion in patients delivered by cesarean without labor, but these patients were more likely to have preoperative anemia (P = .036). Patients undergoing cesarean with labor or ruptured membranes had an increased incidence of both febrile morbidity (P = .023) and wound seroma (P = .008). CONCLUSION: Maternal morbidity following cesarean delivery in high-risk obstetric patients in a private practice setting is low.

Cesarean Section↗
PubMedDate not supplied

Trends in registered psychiatric morbidity and forecasting psychotropic drug needs in Bulgarian hospitals.

Registered psychiatric morbidity in Bulgaria as a whole and particularly in Plovdiv, the second largest region of the country, was assessed. Three aspects of psychotropic drug usage were analysed, namely, changes in registered psychotropic drugs, the prescribed daily dose (PDD) values for 2 years, and the preferred therapeutic schemes, and drug usage and needs in a psychiatric hospital with 365 beds. This was done by time series analysis for evaluation of psychiatric morbidity and drug consumption data, calculation of PDD for psychotropic medicines, and, based on a modification of the World Health Organization's morbidity method, assessment and prediction of drug use and needs in Plovdiv hospital. The results indicated that the registered morbidity had increased by 4% over the period 1989-93 to 2,427 psychiatric patients per 100,000 people. The increased consumption of especially benzodiazepines and sedative medicines was analyzed. Diazepam was prescribed the most often (91.1%), followed by levomepromazine (86.4%), haloperidol (82.7%), etc. Future drug consumption in Plovdiv hospital is expected to decrease because therapeutic practice in hospitals has been revised and improved on the basis of the World Health Organization's recommendations.

Bulgaria↗
PubMedDate not supplied

Twins, asymmetric growth restriction, and perinatal morbidity.

OBJECTIVE: Our objective in this study was to evaluate decreased weight/length ratio as a correlate of perinatal morbidity in twins. STUDY DESIGN: Rates of weight/length ratio less than 10% (low WL) were compared in 986 neonates from twin gestations and 4929 matched singletons. Low WL was compared with birth weight less than 10% (SGA) and 25% birth weight discordance as a marker for perinatal depression and neonatal mortality. RESULTS: Both SGA (42% vs 8%) and low WL (38% vs 8%) occurred more commonly in twins. Low WL was a better correlate of depression and mortality than SGA or 25% birth weight discordance. After adjustment for major anomalies, prematurity, and low WL, perinatal morbidity in twins and singletons did not differ. CONCLUSIONS: Low WL, a marker of asymmetric growth restriction, is a better marker for perinatal morbidity in twins than SGA or 25% discordance. Twins and singletons have similar rates of perinatal morbidity and mortality after adjustment for anomalies, prematurity, and growth restriction.

Body Height↗