BACKGROUND Hypertension usually clusters with multiple comorbidities.However,the association between cardiometabolic multimorbidity(CMM)and mortality in hypertensive patients is unclear.This study aimed to investigate...BACKGROUND Hypertension usually clusters with multiple comorbidities.However,the association between cardiometabolic multimorbidity(CMM)and mortality in hypertensive patients is unclear.This study aimed to investigate the association between CMM and all-cause and cardiovascular disease(CVD)mortality in Chinese patients with hypertension.METHODS The data used in this study were from the China National Survey for Determinants of Detection and Treatment Status of Hypertensive Patients with Multiple Risk Factors(CONSIDER),which comprised 5006 participants aged 19–91 years.CMM was defined as the presence of one or more of the following morbidities:diabetes mellitus,dyslipidemia,chronic kidney disease,coronary heart disease,and stroke.Cox proportional hazard models were used to calculate the hazard ratios(HR)with 95%CI to determine the association between the number of CMMs and both all-cause and CVD mortality.RESULTS Among 5006 participants[mean age:58.6±10.4 years,50%women(2509 participants)],76.4%of participants had at least one comorbidity.The mortality rate was 4.57,4.76,8.48,and 16.04 deaths per 1000 person-years in hypertensive patients without any comorbidity and with one,two,and three or more morbidities,respectively.In the fully adjusted model,hypertensive participants with two cardiometabolic diseases(HR=1.52,95%CI:1.09–2.13)and those with three or more cardiometabolic diseases(HR=2.44,95%CI:1.71–3.48)had a significantly elevated risk of all-cause mortality.The findings were similar for CVD mortality but with a greater increase in risk magnitude.CONCLUSIONS In this study,three-fourths of hypertensive patients had CMM.Clustering with two or more comorbidities was associated with a significant increase in the risk of all-cause and cardiovascular mortality among hypertensive patients,suggesting more intensive treatment and control in this high-risk patient group.展开更多
BACKGROUND The current understanding of the magnitude and consequences of multimorbidity in Chinese older adults with coronary heart disease(CHD)is insufficient.We aimed to assess the association and population-attrib...BACKGROUND The current understanding of the magnitude and consequences of multimorbidity in Chinese older adults with coronary heart disease(CHD)is insufficient.We aimed to assess the association and population-attributable fractions(PAFs)between multimorbidity and mortality among hospitalized older patients who were diagnosed with CHD in Shenzhen,China.METHODS We conducted a retrospective cohort study of older Chinese patients(aged≥65 years)who were diagnosed with CHD.Cox proportional hazards models were used to estimate the associations between multimorbidity and all-cause and cardiovascular disease(CVD)mortality.We also calculated the PAFs.RESULTS The study comprised 76,455 older hospitalized patients who were diagnosed with CHD between January 1,2016,and August 31,2022.Among them,70,217(91.9%)had multimorbidity,defined as the presence of at least one of the predefined 14 chronic conditions.Those with cancer,hemorrhagic stroke and chronic liver disease had the worst overall death risk,with adjusted HRs(95%CIs)of 4.05(3.77,4.38),2.22(1.94,2.53),and 1.85(1.63,2.11),respectively.For CVD mortality,the highest risk was observed for hemorrhagic stroke,ischemic stroke,and chronic kidney disease;the corresponding adjusted HRs(95%CIs)were 3.24(2.77,3.79),1.91(1.79,2.04),and 1.81(1.64,1.99),respectively.All-cause mortality was mostly attributable to cancer,heart failure and ischemic stroke,with PAFs of 11.8,10.2,and 9.1,respectively.As for CVD mortality,the leading PAFs were heart failure,ischemic stroke and diabetes;the corresponding PAFs were 18.0,15.7,and 6.1,respectively.CONCLUSIONS Multimorbidity was common and had a significant impact on mortality among older patients with CHD in Shenzhen,China.Cancer,heart failure,ischemic stroke and diabetes are the primary contributors to PAFs.Therefore,prioritizing improved treatment and management of these comorbidities is essential for the survival prognosis of CHD patients from a holistic public health perspective.展开更多
Background Motoric cognitive risk(MCR)syndrome as a pre-dementia syndrome often co-occurring with chronic health condi-tions.This study aims to investigate the prevalence of MCR and its association with cardiometaboli...Background Motoric cognitive risk(MCR)syndrome as a pre-dementia syndrome often co-occurring with chronic health condi-tions.This study aims to investigate the prevalence of MCR and its association with cardiometabolic and panvascular multimorb-idity among older people living in rural China.Methods This population-based study included 1450 participants who were aged≥60 years(66.2%women)and who underto-ok the second wave examination of the Confucius Hometown Aging Project in Shandong,China when information to define MCR was collected.Data were collected through in-person interviews,clinical examinations,and laboratory tests.Cardiometabolic and pa-nvascular multimorbidity were defined following the international criteria.MCR was defined as subjective cognitive complaints and slow gait speed in individuals free of dementia and functional disability.Multivariable logistic regression models were used to exa-mine the associations of MCR with multimorbidity.Results MCR was present in 6.3%of all participants,and the prevalence increased with advancing age.Cerebrovascular disea-se,ischemic heart disease,heart failure,and increased serum cystatin C were associated with increased likelihoods of MCR(mult-ivariable-adjusted odds ratio range:1.90-3.02,P<0.05 for all).Furthermore,there was a dose-response relationship between the nu-mber of cardiometabolic diseases and panvascular diseases and the likelihood of MCR.The multivariable-adjusted odds ratio(95%CI)of MCR associated with cardiometabolic and panvascular multimorbidity were 2.47(1.43-4.26)and 3.85(2.29-6.47),respectiv-ely.Conclusions Older adults with cardiometabolic and panvascular multimorbidity are at a higher likelihood of MCR.These fin-dings may have implications for identifying older adults at pre-dementia state as targets for early preventive interventions to delay dementia onset.展开更多
To the editor:Two recent advisories from the US surgeon general have underscored the unprecedented public health crisis in youth mental health and emphasised the need for“timely data collection and research to identi...To the editor:Two recent advisories from the US surgeon general have underscored the unprecedented public health crisis in youth mental health and emphasised the need for“timely data collection and research to identify and respond to youth mental health needs more rapidly”.1 Increased rates of suicidal behaviour,depression and anxiety symptoms and substance use.展开更多
BACKGROUND Radical surgery combined with systemic chemotherapy offers the possibility of long-term survival or even cure for patients with pancreatic ductal adenocar-cinoma(PDAC),although tumor recurrence,especially l...BACKGROUND Radical surgery combined with systemic chemotherapy offers the possibility of long-term survival or even cure for patients with pancreatic ductal adenocar-cinoma(PDAC),although tumor recurrence,especially locally,still inhibits the treatment efficacy.The TRIANGLE technique was introduced as an extended dissection procedure to improve the R0 resection rate of borderline resectable or locally advanced PDAC.However,there was a lack of studies concerning postoperative complications and long-term outcomes of this procedure on patients with resectable PDAC.PDAC.METHODS Patients with resectable PDAC eligible for PD from our hospital between June 2018 and December 2021 were enrolled in this retrospective cohort study.All the patients were divided into PDstandard and PDTRIANGLE groups according to the surgical procedure.Baseline characteristics,surgical data,and postoperative morbidities were recorded.All of the patients were followed up,and the date and location of tumor recurrence,and death were recorded.The Kaplan-Meier method and log-rank test were used for the survival analysis.RESULTS There were 93 patients included in the study and 37 underwent the TRIANGLE technique.Duration of operation was longer in the PDTRIANGLE group compared with the PDstandard group[440(410-480)min vs 320(265-427)min](P=0.001).Intraoperative blood loss[700(500-1200)mL vs 500(300-800)mL](P=0.009)and blood transfusion[975(0-1250)mL vs 400(0-800)mL](P=0.009)were higher in the PDTRIANGLE group.There was a higher incidence of surgical site infection(43.2%vs 12.5%)(P=0.001)and postoperative diarrhea(54.1%vs 12.5%)(P=0.001)in the PDTRIANGLE group.The rates of R0 resection and local recurrence,overall survival,and disease-free survival did not differ significantly between the two groups.CONCLUSION The TRIANGLE technique is safe,with acceptable postoperative morbidities compared with standardized PD,but it does not improve prognosis for patients with resectable PDAC.展开更多
Background: Episiotomy is a very common obstetric surgery, and it could be associated with serious complications. However, these complications largely are not noticed due to the shift of attention from mother to baby,...Background: Episiotomy is a very common obstetric surgery, and it could be associated with serious complications. However, these complications largely are not noticed due to the shift of attention from mother to baby, after a successful delivery. Objective: To identify the morbidities associated with episiotomies and factors associated with such morbidities. Method: This was a questionnaire based cross sectional descriptive study among women who attended the Obstetric Department of Alex Ekwueme Federal University Teaching Hospital Abakaliki Ebonyi State, between 1st July and 31st Nov, 2023. The study population consisted of parturients who had episiotomies in their previous confinements, attending either the antenatal clinic or the postnatal clinic at Alex Ekwueme Federal University Teaching Hospital Abakaliki Ebonyi State. Results: Macrosomia was the most common indication of episiotomy at a rate of 31.6%. The majority of episiotomies were performed on the parturients in their first confinement at a rate of 64.5% and the majority of repairs were performed by the Registrar at a rate of 65.0%. Informed consent was obtained from 45.79% of parturients while 54.21% were not informed before the episiotomy was administered. Only 55.3% of the parturient received analgesia before episiotomy was administered. The majority of the parturients had their episiotomy repaired between 10 - 15 minutes at a rate of 40.3%. Postoperative pain at the rate of 44.5% was the most common complication and dyspareunia as a form of sexual complication was the commonest at a rate of 31.3%. Conclusion: The parturient needs to be properly counselled before administration of episiotomy and adequate analgesia should be given, as episiotomy is a surgical procedure. Proper training of health workers on both the technique of administering and repairing episiotomy is important. Restrictive use of routine episiotomy in primigravidae is advised to reduce the rate of episiotomy.展开更多
Introduction: Neonatal pathology remains a real public health problem in developing countries. In Burkina Faso, this mortality has declined over the last ten years but remains below compared to the Sustainable Develop...Introduction: Neonatal pathology remains a real public health problem in developing countries. In Burkina Faso, this mortality has declined over the last ten years but remains below compared to the Sustainable Development Goals, which is 12 per 1000 living births at most by 2030. This study aims to identify specific causes of neonatal morbidity and mortality and will contribute to the implementation of preventive and curative measures aimed at reducing neonatal mortality at HOSCO. Method: This was a retrospective study using the records and database of newborns hospitalized from January 1<sup>srt</sup>, 2017 to December 31<sup>srt</sup>, 2020. Using logistic regression, the factors associated with mortality were determined. Results: During the study period, 3020 newborns were hospitalized. Most newborns (83.71%) were referred by a peripheral health facility. The average age at admission was 0.3 days ± 0.9 and the sex ratio was 1.2. Prematurity was the leading cause of hospitalization (61.13%) followed by neonatal infection (38.34%) and neonatal suffering (23.88%). The mortality rate was 40.6% with 82.71% cases of death in the early neonatal period. The main causes of death were low birth weight (47.39%), respiratory distress (18.76%), neonatal suffering (17.37%) and neonatal infection (13.87%). Home delivery, gestational age 36 weeks, number of PNC 4, concept of resuscitation, Apgar at the 5th minute 7, birth weight 2000 g and >4000 g, respiratory distress, hypothermia, neurological disorders were factors associated with deaths. Conclusion: Neonatal mortality is influenced by both maternal and fetal factors and many of them are preventable.展开更多
Background and objective: Classically, diabetic subjects are at high risk of anaesthesia compared with general population. However, some recent publications have shown contrasting and sometimes contrary results. The a...Background and objective: Classically, diabetic subjects are at high risk of anaesthesia compared with general population. However, some recent publications have shown contrasting and sometimes contrary results. The aim of our study was to evaluate morbidity and mortality during and after anaesthesia in patients with versus without diabetes operated on at Monkole Hospital over the last ten years. Methods: Retrospective cohort study including all patients who underwent all-comers surgery excluding cardiac surgery between 2011 and 2021. Each diabetic patient was matched to 2 non-diabetic controls on age and sex. The evaluation criterion was the frequency of occurrence of at least one perioperative complication and/or death up to day 30. A multivariate analysis using a Cox model was used to determine the factors associated with the occurrence of this morbidity and mortality. The model was adjusted for comorbidities, preoperative hyperglycaemia, ASA score, type of anaesthesia and severity of surgery. Results: A total of 351 diabetic patients (mean age 53.3 ± 14.18 years) and 701 non-diabetic patients (mean age 53.52 ± 14.7 years) were included and analysed. Preoperatively, hyperglycaemia (blood glucose > 180 mg/dl) was observed in 24.3% of diabetic patients compared with 1.6% of non-diabetic patients. The incidence of overall perioperative complications was 25.6% in diabetic patients compared with 28.6% in non-diabetic patients (p = 0.27). The risk factors associated with this morbidity were general anaesthesia with oro-tracheal intubation vs loco-regional anaesthesia (OR = 3.06 [95%CI: 1.91 - 4.94];p Conclusion: This study shows that there is not significant increase in perioperative morbidity and mortality in diabetic patients compared with non-diabetic ones of similar severity. These results suggest that diabetes itself (excluding associated comorbidities) has only a minor impact on perioperative morbidity and mortality.展开更多
Introduction: Total knee arthroplasty (TKA) has been established as a transformative solution in the treatment of advanced degenerative diseases of the knee, such as osteoarthritis, rheumatoid arthritis, and posttraum...Introduction: Total knee arthroplasty (TKA) has been established as a transformative solution in the treatment of advanced degenerative diseases of the knee, such as osteoarthritis, rheumatoid arthritis, and posttraumatic arthritis. In this sense, TKA surgery, which seeks to replace the damaged joint with prosthetic components, has proven to be highly effective in relieving pain, improving joint function, and, ultimately, significantly increasing patients’ quality of life. The present study describes the TKA and revision knee arthroplasty (RKA) rates and, identifies the associated co morbidities in the Colombian context. Methods: A retrospective cohort study was carried out. It describes demographic and clinical characteristics between two groups of patients, TKA or RKA, and its association with mortality at 30 days, 90 days, or one year after the intervention. Results: The incidence rate of the population undergoing TKA was approximately 11.71 cases per 100,000 inhabitants. Furthermore, the incidence rate for revision knee arthroplasty (RKA) procedures in the same period was around 0.96 per 100,000 inhabitants. In both groups at 30 days postoperatively, a total mortality rate of 0.09%was recorded. When the follow-up was extended to 90 days, it increased to 0.15%;at one year postoperatively, it rose to 0.88%. Conclusion: Mortality after surgery was low in Colombia in 2019. Although RKA is a beneficial procedure, in certain circumstances, it was noted that it carries a higher risk compared to primary TKA. Our results emphasize the importance of careful evaluation of co morbidities and risk factors in patients undergoing these surgical procedures. The application of quality-of-life questionnaires should be considered in future studies on effectiveness and mortality for TKA and RKA in our country.展开更多
Introduction: Worldwide, 2.3 million children died in the first 20 days after birth in 2022, according to the WHO. In Mali, according to the sixth Demographic and Health Survey, the neonatal mortality rate was estimat...Introduction: Worldwide, 2.3 million children died in the first 20 days after birth in 2022, according to the WHO. In Mali, according to the sixth Demographic and Health Survey, the neonatal mortality rate was estimated at 33% live births in 2018. The Timbuktu region had the highest neonatal mortality rate in the country with 44%. The objective of this work was to study the causes of neonatal morbidity and mortality and related factors in the paediatrics department of Timbuktu hospital. Materials and method: This was a descriptive, cross-sectional study conducted from 1 January to 31 December 2023 in the neonatology unit of the paediatrics department of Timbuktu hospital, including all newborns admitted to hospital. Results: Our study took place over 12 months, during which 618 admissions were made to the paediatric ward, including 244 newborns, i.e. 39.48%. The majority of newborns (86.5%) were admitted in the first week of life. The mean age was 3 days, with a sex ratio of 1.1 for males. Weight under 2500 g was 54.1% for an average weight of 2372 g. The main mode of admission was transfer from the hospital maternity unit (62%). The main reasons for admission were acute foetal distress (27.9%) and prematurity (26.2%). The average age of the mothers was 24, with extremes of 15 and 49. The mothers were housewives (87.3%), uneducated and primiparous (59% and 36.5% respectively);only 40.2% had made more than 3 antenatal care visits. Newborns born by vaginal delivery accounted for 80.7% and those born by caesarean section for 19.3%. The risk of infection was present in 52.5% of cases. The three leading causes of hospitalisation were birth asphyxia (40.2%), neonatal infection (32.4%) and prematurity (25%). The mortality rate was 21.7%. The main causes of death were prematurity (39.6%), birth asphyxia (32.1%) and neonatal infection (24.5%). Conclusion: Neonatal morbidity and mortality remain a concern in Timbuktu. Despite the unfavourable security situation, morbidity and mortality indicators are close to those in some hospitals in Mali. The correct application of Essential Newborn Care and antenatal care remains a major challenge for the hospital and the Timbuktu region.展开更多
Introduction: Infant and child morbidity and mortality linked to infections remain a major concern in both developed and developing countries. The general objective was to determine the characteristics of hospital mor...Introduction: Infant and child morbidity and mortality linked to infections remain a major concern in both developed and developing countries. The general objective was to determine the characteristics of hospital morbidity and mortality linked to infectious pathologies in the pediatric department of the King Baudouin hospital center in Dakar. Methods: This was a retrospective, descriptive and analytical study focusing on children hospitalized from January 1, 2018 to December 31, 2021 in the pediatric department of the King Baudouin hospital center in Dakar. Results: During the study period, 1474 children were hospitalized for an infectious pathology in the pediatric department. The sex ratio was 1.48. Children aged between one and twelve months represented 34.12%. Morbidity due to respiratory and digestive infections was 42.33% and 33.45%, respectively. Pediatric hospital mortality was 0.75% with a predominance noted in infants between 1 and 12 months (55.86%). Respiratory, digestive infections, sepsis and neurological infections were the main causes of death. Factors associated with mortality were age (1 to 12 months) with p Conclusion: Reducing infant and child mortality linked to infectious diseases remains a crucial challenge to address for improving children’s health. Early detection of related signs, prevention of infections, and adequate care and monitoring of infants and children can contribute to this reduction.展开更多
The mode of delivery and gestational age for very-low-birth-weight (VLBW) preterm infants are not yet well established and are constant topics of debate. Objective: To analyze the impact of delivery mode on morbidity ...The mode of delivery and gestational age for very-low-birth-weight (VLBW) preterm infants are not yet well established and are constant topics of debate. Objective: To analyze the impact of delivery mode on morbidity in preterm infants weighing less than 1500 g. Results: Among 21,957 births, 81 were analyzed;53 were delivered vaginally, and 28 were delivered by cesarean section. The median maternal age, gestational age and body mass index among those delivered vaginally and by cesarean section were 20 years and 22.5 years, 27.6 weeks and 30.1 weeks, and 26.0 kg/m2 and 27.8 kg/m2, respectively. With respect to neonatal blood gas parameters, for those born vaginally and by cesarean section, the median pH was 7.32 and 7.24, the pCO2 was 41.5 mmHg and 51.1 mmHg, and the pO2 was 22.3 mmHg and 16 mmHg. The median fetal weight among those born by cesarean section and vaginally were 1180 g and 955 g, respectively. The median Apgar scores at the first and fifth minutes among those born by cesarean section and vaginally were 5.00 and 8.00 and 4.50 and 7.00, respectively. Conclusion: There was no significant difference between the results of vaginal and cesarean delivery for VLBW infants. Thus, further studies on this subject are needed.展开更多
Introduction: Prematurity is the leading cause of neonatal death in Africa. More than a million children die each year due to co-morbidities related to prematurity. In addition to being one of the causes of neonatal d...Introduction: Prematurity is the leading cause of neonatal death in Africa. More than a million children die each year due to co-morbidities related to prematurity. In addition to being one of the causes of neonatal deaths, the health problems associated with prematurity can also lead to severe lifelong impairment in those who survive. Objectives: This paper aims to determine the epidemiology and identify co-morbidities of prematurity in the neonatology units of the Douala General Hospital (DGH) and the Laquintinie Hospital of Douala (LHD). Patients and Methodology: We conducted an analytical retrospective cohort study from January 2015 to January 2018 in the neonatology department of the GDH and the LHD, which are considered reference hospitals for the management of preterm babies in Cameroon. We included all newborns aged less than 37 weeks admitted to the neonatology units of the GDH and the LHD. The descriptive component was based on the analysis of quantitative variables using measures of central tendency. The analytical component was evaluated using Spearman correlations and the Chi-square and Fisher tests. Simple and multiple logistic regressions measured factors predictive of mortality. The Kaplan Meier survival curve used the Log Rank test and significance at p ≤ 0.05. Results: We recorded 908 preterm newborns in neonatal service and 1,124 preterm deliveries in maternity, representing an incidence of 32.5% in neonatal unit and 10.6% in maternity. 51% of whom were girls, given a sex ratio M/F of 0.9. Hypertension was the main prenatal pathology (9.1%), while premature rupture of membranes: PROM (35.5%) and eclampsia/pre-eclampsia (18.6%) were the most common obstetrical pathologies. 75.9% of deliveries were vaginal with 65.2% being performed in our referral hospitals. Gestational age ranged from 22 to 36 weeks, with a mean of 32.4 weeks. Late preterm birth rate was 53.7%, and birth weight varied between 590 and 3200 g with an average of 1747 ± 479 g. The percentage of low birth weight (1500 - 2499 g) preterm infants was predominant (65.3%), and the intrauterine growth restriction (IUGR) was estimated to be 12.4%. The majority (96.7%) had pathologies in the neonatal period, the most common being neonatal infection (86.9%). The case-fatality rate was 27.4%, compared to 72.6% live births. Factors influencing mortality are risk of premature labour, gestational age ≤ 32 SA, premature birth in hospitals other than our two referral hospitals, birth weight ≤ 1500 g, Apgar at the 10th minute, late secondary anaemia, hospital resuscitation, oxygen therapy, and duration of hospitalization Conclusion: The incidence of prematurity and the mortality rate remains high in neonatal units in Cameroon. Adequate monitoring of pregnancies and management of preterm infants remains a challenge in our context.展开更多
Introduction: The incidence of acute renal failure (ARF) varies between 20% and 40% of cases for COVID-19 patients admitted to the intensive care unit, with very high mortality, but heterogeneous according to the diff...Introduction: The incidence of acute renal failure (ARF) varies between 20% and 40% of cases for COVID-19 patients admitted to the intensive care unit, with very high mortality, but heterogeneous according to the different epidemic waves, probably due to the genetic variant phenomenon of the virus. The aim of this study is to determine the morbidity and mortality of COVID-19 patients admitted with ARF to the intensive care unit of the Grand H?pital Est Francilien (GHEF) according to the waves and variants. Methods: Cross-sectional observational study of COVID-19 patients with ARF admitted to the intensive care unit of the GHEF site in Meaux covering the period from March 1<sup>st</sup> 2020 to December, 31<sup>st</sup> 2021. Per-hospitalisation and outcome data were collected and analysed with SPSS version 25.0 software using the Chi-square or Fischer’s exact test or Student’s t-test and logistic regression for p Results: A total of 86 patients were included. The mean age was higher (70 ± 8.5) in patients in the fourth wave than in the other waves (p = 0.015), with male predominance in all waves without significant difference. Co-morbidities: hypertension, diabetes, heart disease, dyslipidaemia and arrhythmia complete with fibrillation were present in all waves. The majority of patients were classified as KDIGO 1 for the different waves (1st: 61.9%, 2nd: 86.5%, 3rd: 80%, and 4th: 75%), with the same trend according to variant (alpha: 80%, beta: 75%, delta: 81.3%, omicron: 75%). Mortality by the wave was: 1st: 28.5%, 2nd: 37.5%, 3rd: 23% and 4th: 11%) and by variant: alpha: 24.2%, beta: 44.8%, delta: 20.7%, omicron: 10.3%). Overall mortality was 33.7%. Case fatality was higher in the fourth wave. Hypertension, shock, failure to recover renal function, acute lung oedema, ventilator-associated lung disease and hyperkalaemia were factors associated with mortality (p Conclusion: Acute renal failure is common in COVID-19 patients admitted to the intensive care unit, and mortality is not negligible. The beta variants and the second wave presented more cases of renal impairment, although the mechanism is still unknown. Further studies are needed to understand this mechanism and perhaps to be able to identify the cause.展开更多
BACKGROUND There are few if any life-span population-based studies of psychiatric disorderassociated biomedical and biophysical disorders and diseases(morbidity).AIM To scope the present state of research regarding th...BACKGROUND There are few if any life-span population-based studies of psychiatric disorderassociated biomedical and biophysical disorders and diseases(morbidity).AIM To scope the present state of research regarding the biomedical and biophysical morbidity associated with affective and mental disorder in epidemiological samples,and to examine the life-span relationship between affective disorders and biomedical/biophysical disorders to illustrate a novel approach employing the odds ratio to represent the intensity of biomedical and biophysical morbidity associated in time in a population.METHODS A repeatable systematic literature search of PubMed was represented in summary.Additionally,a regional population-based dataset was constructed and analyzed to represent the age-and sex-specific diagnoses(International Classification of Diseases Version 9,ICD-9)for those with and without affective disorder.The analysis presents a novel index of the relative age-specific frequency of life-span biomedical and biophysical diagnoses associated with affective disorder.RESULTS The volume of biomedical and biophysical morbidity associated with mental disorder literature has increased,yet few studies measure comprehensive temporal hyper-morbidity(over-representation of diseases over time,either before or after the index diagnostic event)in populations.Further,there have been only a few population-based studies examining the morbidity associated with affective disorder and only one that examines the full diagnostic range of lifespan morbidity.Substantial differences arose between males and females with more females than males having greater frequencies of diagnoses.The age-specific distributions of the maximum proportional diagnosis frequency ratios for each sex illustrate the greatest diagnosis-specific differences when comparing the biomedical and biophysical diagnoses of those with and without affective disorder when the same diagnosis was represented in each grouping at the same age.CONCLUSION Clinical research needs to focus on more than one or two comorbid biomedical or biophysical disorders at a time.Comprehensive population-based examination of the lifespan biomedical and biophysical multi-morbidity associated with affective disorder has the potential to directly inform clinical practice.Representing the proportional ratios of age-specific frequency of diagnoses for the full range of ICD-9 diagnoses is a novel analytical model.Diagnostic frequency appears a viable representation of a given disease state,such as affective disorder.Fortunately,the WPA has developed a global education section to better understand the biomedical and biophysical morbidity associated with all psychiatric disorders.This has been identified by the WPA as the psychiatric practice challenge of the 21st century.展开更多
The present protocol describes an observational cohort study that was designed to propose a therapeutic scheme and formulate an individualized treatment strategy for frail elderly patients diagnosed with multiple dise...The present protocol describes an observational cohort study that was designed to propose a therapeutic scheme and formulate an individualized treatment strategy for frail elderly patients diagnosed with multiple diseases in a Chinese,multicenter setting.Over a 3-year period,we will recruit 30,000 patients from 10 hospitals and collect baseline data including patient demographic information,comorbidity characteristic,FRAIL scale,age-adjusted Charlson comorbidity index(aCCI),relevant blood tests,the results of imaging examination,prescription of drugs,length of hospital stay,number of overall re-hospitalizations and death.Elderly patients(≥65 years old)with multimorbidity and receiving hospital care are eligible for this study.Data collection is being performed at baseline and 3,6,9 and 12 months after discharge.Our primary analysis was all-cause death,readmission rate and clinical events(including emergency visits,stroke,heart failure,myocardial infarction,tumor,acute chronic obstructive pulmonary disease,etc).The study is approved by the National Key R&D Program of China(2020YFC2004800).Data will be disseminated in manuscripts submitted to medical journals and in abstracts submitted to international geriatric conferences.Clinical Trial Registration:[www.ClinicalTrials.gov],identifier[ChiCTR2200056070].展开更多
Background Patients who suffer comorbidity of major depressive disorder(MDD)and chronic pain(CP)maintain a complex interplay between maladaptive prospective memory(PM)and retrospective memory(RM)with physical pain,and...Background Patients who suffer comorbidity of major depressive disorder(MDD)and chronic pain(CP)maintain a complex interplay between maladaptive prospective memory(PM)and retrospective memory(RM)with physical pain,and their complications are still unknown.Aims We aimed to focus on the full cognitive performance and memory complaints in patients with MDD and CP,patients with depression without CP,and control subjects,considering the possible influence of depressed affect and chronic pain severity.Methods According to the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders and the criteria given by the International Association of Pain,a total of 124 participants were included in this cross-sectional cohort study.Among them,82 depressed inpatients and outpatients from Anhui Mental Health centre were divided into two groups:a comorbidity group(patients with MDD and CP)(n=40)and a depression group(patients with depression without CP)(n=42).Meanwhile,42 healthy controls were screened from the hospital’s physical examination centre from January 2019 to January 2022.The Hamilton Depression Rating Scale-24(HAMD-24)and Beck Depression Inventory-II(BDI-II)were used to evaluate the severity of depression.The Pain Intensity Numerical Rating Scale(PI-NRS),Short-Form McGill Pain Questionnaire-2 Chinese version(SF-MPQ-2-CN),Montreal Cognitive Assessment-Basic Section(MoCA-BC),and Prospective and Retrospective Memory Questionnaire(PRMQ)were used to assess pain-related features and the global cognitive functioning of study participants.Results The impairments in PM and RM differed remarkably among the three groups(F=7.221,p<0.001;F=7.408,p<0.001)and were severe in the comorbidity group.Spearman correlation analysis revealed the PM and RM were positively correlated with continuous pain and neuropathic pain(r=0.431,p<0.001;r=0.253,p=0.022 and r=0.415,p<0.001;r=0.247,p=0.025),respectively.Regression analysis indicated a significant positive relationship between affective descriptors and total BDI-II score(β=0.594,t=6.600,p<0.001).Examining the mediator pathways revealed the indirect role of PM and RM in patients with comorbid MDD and CP.Conclusions Patients with comorbid MDD and CP presented more PM and RM impairments than patients with MDD without CP.PM and RM are possibly mediating factors that affect the aetiology of comorbid MDD and CP.展开更多
Background Social relationships are associated with mortality and chronic conditions.However,little is known about the effects of social relationship satisfaction on multiple chronic conditions(multimorbidity).Aims To...Background Social relationships are associated with mortality and chronic conditions.However,little is known about the effects of social relationship satisfaction on multiple chronic conditions(multimorbidity).Aims To examine whether social relationship satisfaction is associated with the accumulation of multimorbidity.Methods Data from 7694 Australian women who were free from 11 chronic conditions at 45–50 years of age in 1996 were analysed.Five types of social relationship satisfaction(partner,family members,friends,work and social activities)were measured approximately every 3 years and scored from 0(very dissatisfied)to 3(very satisfied).Scores from each relationship type were summed to provide an overall satisfaction score(range:≤5–15).The outcome of interest was the accumulation of multimorbidity in 11 chronic conditions.Results Over a 20-year period,4484(58.3%)women reported multimorbidities.Overall,the level of social relationship satisfaction had a dose–response relationship with the accumulation of multimorbidities.Compared with women reporting the highest satisfaction(score 15),women with the lowest satisfaction(score≤5)had the highest odds of accumulating multimorbidity(odds ratio(OR)=2.35,95%confidence interval(CI):1.94 to 2.83)in the adjusted model.Similar results were observed for each social relationship type.Other risk factors,such as socioeconomic,behavioural and menopausal status,together explained 22.72%of the association.Conclusions Social relationship satisfaction is associated with the accumulation of multimorbidity,and the relationship is only partly explained by socioeconomic,behavioural and reproductive factors.Social connections(eg,satisfaction with social relationships)should be considered a public health priority in chronic disease prevention and intervention.展开更多
Hypertension(HTN)and type 2 diabetes mellitus(T2DM)are interconnected metabolic diseases[1,2]that considerably increase susceptibility to microvascular and macrovascular disorders.In many patients,HTN and diabetes com...Hypertension(HTN)and type 2 diabetes mellitus(T2DM)are interconnected metabolic diseases[1,2]that considerably increase susceptibility to microvascular and macrovascular disorders.In many patients,HTN and diabetes comorbidity(HDC)is caused by mutual pathogenic pathways,such as endothelial dysfunction,atherosclerosis,oxidative stress,and vascular inflammation[1].Hence.展开更多
Airway management of morbidly obese patients is challenging due to inherent anatomical and physiological variations.[1]The frequent association of compromised hemodynamics,hypoxemia,or acidosis in an emergency departm...Airway management of morbidly obese patients is challenging due to inherent anatomical and physiological variations.[1]The frequent association of compromised hemodynamics,hypoxemia,or acidosis in an emergency department(ED)setting adds to the difficulty of the procedure.Rapid airway management position(RAMP),awake fiber-optic guided intubation,use of intubating laryngeal mask airway(ILMA),and video-laryngoscope are a few techniques that have been described to tackle difficult airways in these patients.[2]Studies have shown that the availability of fi ber-optic scopes(3%–60%),videolaryngoscopes(39%–88%),and laryngeal mask airways(LMA)(65%–83%)varies in different ED settings.[3,4]Furthermore,a lack of adequate training and the need for time-bound resuscitation make implementation of the above techniques challenging.展开更多
基金supported by the National Key Research and Development Program of China(2022YFC 3602501)the Pfizer Inc.(New York,USA)offices in Beijing,China。
文摘BACKGROUND Hypertension usually clusters with multiple comorbidities.However,the association between cardiometabolic multimorbidity(CMM)and mortality in hypertensive patients is unclear.This study aimed to investigate the association between CMM and all-cause and cardiovascular disease(CVD)mortality in Chinese patients with hypertension.METHODS The data used in this study were from the China National Survey for Determinants of Detection and Treatment Status of Hypertensive Patients with Multiple Risk Factors(CONSIDER),which comprised 5006 participants aged 19–91 years.CMM was defined as the presence of one or more of the following morbidities:diabetes mellitus,dyslipidemia,chronic kidney disease,coronary heart disease,and stroke.Cox proportional hazard models were used to calculate the hazard ratios(HR)with 95%CI to determine the association between the number of CMMs and both all-cause and CVD mortality.RESULTS Among 5006 participants[mean age:58.6±10.4 years,50%women(2509 participants)],76.4%of participants had at least one comorbidity.The mortality rate was 4.57,4.76,8.48,and 16.04 deaths per 1000 person-years in hypertensive patients without any comorbidity and with one,two,and three or more morbidities,respectively.In the fully adjusted model,hypertensive participants with two cardiometabolic diseases(HR=1.52,95%CI:1.09–2.13)and those with three or more cardiometabolic diseases(HR=2.44,95%CI:1.71–3.48)had a significantly elevated risk of all-cause mortality.The findings were similar for CVD mortality but with a greater increase in risk magnitude.CONCLUSIONS In this study,three-fourths of hypertensive patients had CMM.Clustering with two or more comorbidities was associated with a significant increase in the risk of all-cause and cardiovascular mortality among hypertensive patients,suggesting more intensive treatment and control in this high-risk patient group.
基金supported by the National Natural Science Foundation of China(Grants 12126602)the R&D project of Pazhou Lab(Huangpu)under Grant 2023K0610+5 种基金the National Natural Science Foundation of China(Grants 82030102)the Shenzhen Medical Academy of Research and Translation(Grants C2302001)the Shenzhen Science and Technology Innovation Committee(No.ZDSYS20200810171403013)the Chinese Postdoctoral Science Foundation(No.2022M721463)the SUSTech Presidential Postdoctoral Fellowshipthe Ministry of Science and Technology of China(Grants 2022YFC3702703).
文摘BACKGROUND The current understanding of the magnitude and consequences of multimorbidity in Chinese older adults with coronary heart disease(CHD)is insufficient.We aimed to assess the association and population-attributable fractions(PAFs)between multimorbidity and mortality among hospitalized older patients who were diagnosed with CHD in Shenzhen,China.METHODS We conducted a retrospective cohort study of older Chinese patients(aged≥65 years)who were diagnosed with CHD.Cox proportional hazards models were used to estimate the associations between multimorbidity and all-cause and cardiovascular disease(CVD)mortality.We also calculated the PAFs.RESULTS The study comprised 76,455 older hospitalized patients who were diagnosed with CHD between January 1,2016,and August 31,2022.Among them,70,217(91.9%)had multimorbidity,defined as the presence of at least one of the predefined 14 chronic conditions.Those with cancer,hemorrhagic stroke and chronic liver disease had the worst overall death risk,with adjusted HRs(95%CIs)of 4.05(3.77,4.38),2.22(1.94,2.53),and 1.85(1.63,2.11),respectively.For CVD mortality,the highest risk was observed for hemorrhagic stroke,ischemic stroke,and chronic kidney disease;the corresponding adjusted HRs(95%CIs)were 3.24(2.77,3.79),1.91(1.79,2.04),and 1.81(1.64,1.99),respectively.All-cause mortality was mostly attributable to cancer,heart failure and ischemic stroke,with PAFs of 11.8,10.2,and 9.1,respectively.As for CVD mortality,the leading PAFs were heart failure,ischemic stroke and diabetes;the corresponding PAFs were 18.0,15.7,and 6.1,respectively.CONCLUSIONS Multimorbidity was common and had a significant impact on mortality among older patients with CHD in Shenzhen,China.Cancer,heart failure,ischemic stroke and diabetes are the primary contributors to PAFs.Therefore,prioritizing improved treatment and management of these comorbidities is essential for the survival prognosis of CHD patients from a holistic public health perspective.
基金Supported by the Department of Science and Technology(No.2008GG30002058)the Department of Health(No.2009-067)+1 种基金the Department of Natural Science Foundation(ZR2010HL031)in Shandong,China,the Swedish Research Council(No.2017-00740&No.2017-05819)the Swedish Foundation for International Cooperation in Research and Higher Education(CH2019-8320),Stockholm,Sweden.
文摘Background Motoric cognitive risk(MCR)syndrome as a pre-dementia syndrome often co-occurring with chronic health condi-tions.This study aims to investigate the prevalence of MCR and its association with cardiometabolic and panvascular multimorb-idity among older people living in rural China.Methods This population-based study included 1450 participants who were aged≥60 years(66.2%women)and who underto-ok the second wave examination of the Confucius Hometown Aging Project in Shandong,China when information to define MCR was collected.Data were collected through in-person interviews,clinical examinations,and laboratory tests.Cardiometabolic and pa-nvascular multimorbidity were defined following the international criteria.MCR was defined as subjective cognitive complaints and slow gait speed in individuals free of dementia and functional disability.Multivariable logistic regression models were used to exa-mine the associations of MCR with multimorbidity.Results MCR was present in 6.3%of all participants,and the prevalence increased with advancing age.Cerebrovascular disea-se,ischemic heart disease,heart failure,and increased serum cystatin C were associated with increased likelihoods of MCR(mult-ivariable-adjusted odds ratio range:1.90-3.02,P<0.05 for all).Furthermore,there was a dose-response relationship between the nu-mber of cardiometabolic diseases and panvascular diseases and the likelihood of MCR.The multivariable-adjusted odds ratio(95%CI)of MCR associated with cardiometabolic and panvascular multimorbidity were 2.47(1.43-4.26)and 3.85(2.29-6.47),respectiv-ely.Conclusions Older adults with cardiometabolic and panvascular multimorbidity are at a higher likelihood of MCR.These fin-dings may have implications for identifying older adults at pre-dementia state as targets for early preventive interventions to delay dementia onset.
基金The funder or sponsor had no role in the study design,analysis,data interpretation or preparation of the manuscript.The effort was supported in part by NIDA(K12 DA041449,KYX)the APA Psychiatric Research Fellowship funded by NIDA(KYX).BYL was an APA/APA Foundation Public Psychiatry Fellow at the time of acceptance.The contents of this publication are solely the responsibility of the author and do not necessarily represent the official views of the Department of Health and Human Service,APA or APA Foundation.Mention of trade names,commercial practices or organisations does not imply endorsement by the US Government.ASK receives research funding from Alto Neuroscience,Liva Nova,Curemark and Beam Diagnostics.
文摘To the editor:Two recent advisories from the US surgeon general have underscored the unprecedented public health crisis in youth mental health and emphasised the need for“timely data collection and research to identify and respond to youth mental health needs more rapidly”.1 Increased rates of suicidal behaviour,depression and anxiety symptoms and substance use.
基金Supported by the National Natural Science Foundation of China,No.31971518.
文摘BACKGROUND Radical surgery combined with systemic chemotherapy offers the possibility of long-term survival or even cure for patients with pancreatic ductal adenocar-cinoma(PDAC),although tumor recurrence,especially locally,still inhibits the treatment efficacy.The TRIANGLE technique was introduced as an extended dissection procedure to improve the R0 resection rate of borderline resectable or locally advanced PDAC.However,there was a lack of studies concerning postoperative complications and long-term outcomes of this procedure on patients with resectable PDAC.PDAC.METHODS Patients with resectable PDAC eligible for PD from our hospital between June 2018 and December 2021 were enrolled in this retrospective cohort study.All the patients were divided into PDstandard and PDTRIANGLE groups according to the surgical procedure.Baseline characteristics,surgical data,and postoperative morbidities were recorded.All of the patients were followed up,and the date and location of tumor recurrence,and death were recorded.The Kaplan-Meier method and log-rank test were used for the survival analysis.RESULTS There were 93 patients included in the study and 37 underwent the TRIANGLE technique.Duration of operation was longer in the PDTRIANGLE group compared with the PDstandard group[440(410-480)min vs 320(265-427)min](P=0.001).Intraoperative blood loss[700(500-1200)mL vs 500(300-800)mL](P=0.009)and blood transfusion[975(0-1250)mL vs 400(0-800)mL](P=0.009)were higher in the PDTRIANGLE group.There was a higher incidence of surgical site infection(43.2%vs 12.5%)(P=0.001)and postoperative diarrhea(54.1%vs 12.5%)(P=0.001)in the PDTRIANGLE group.The rates of R0 resection and local recurrence,overall survival,and disease-free survival did not differ significantly between the two groups.CONCLUSION The TRIANGLE technique is safe,with acceptable postoperative morbidities compared with standardized PD,but it does not improve prognosis for patients with resectable PDAC.
文摘Background: Episiotomy is a very common obstetric surgery, and it could be associated with serious complications. However, these complications largely are not noticed due to the shift of attention from mother to baby, after a successful delivery. Objective: To identify the morbidities associated with episiotomies and factors associated with such morbidities. Method: This was a questionnaire based cross sectional descriptive study among women who attended the Obstetric Department of Alex Ekwueme Federal University Teaching Hospital Abakaliki Ebonyi State, between 1st July and 31st Nov, 2023. The study population consisted of parturients who had episiotomies in their previous confinements, attending either the antenatal clinic or the postnatal clinic at Alex Ekwueme Federal University Teaching Hospital Abakaliki Ebonyi State. Results: Macrosomia was the most common indication of episiotomy at a rate of 31.6%. The majority of episiotomies were performed on the parturients in their first confinement at a rate of 64.5% and the majority of repairs were performed by the Registrar at a rate of 65.0%. Informed consent was obtained from 45.79% of parturients while 54.21% were not informed before the episiotomy was administered. Only 55.3% of the parturient received analgesia before episiotomy was administered. The majority of the parturients had their episiotomy repaired between 10 - 15 minutes at a rate of 40.3%. Postoperative pain at the rate of 44.5% was the most common complication and dyspareunia as a form of sexual complication was the commonest at a rate of 31.3%. Conclusion: The parturient needs to be properly counselled before administration of episiotomy and adequate analgesia should be given, as episiotomy is a surgical procedure. Proper training of health workers on both the technique of administering and repairing episiotomy is important. Restrictive use of routine episiotomy in primigravidae is advised to reduce the rate of episiotomy.
文摘Introduction: Neonatal pathology remains a real public health problem in developing countries. In Burkina Faso, this mortality has declined over the last ten years but remains below compared to the Sustainable Development Goals, which is 12 per 1000 living births at most by 2030. This study aims to identify specific causes of neonatal morbidity and mortality and will contribute to the implementation of preventive and curative measures aimed at reducing neonatal mortality at HOSCO. Method: This was a retrospective study using the records and database of newborns hospitalized from January 1<sup>srt</sup>, 2017 to December 31<sup>srt</sup>, 2020. Using logistic regression, the factors associated with mortality were determined. Results: During the study period, 3020 newborns were hospitalized. Most newborns (83.71%) were referred by a peripheral health facility. The average age at admission was 0.3 days ± 0.9 and the sex ratio was 1.2. Prematurity was the leading cause of hospitalization (61.13%) followed by neonatal infection (38.34%) and neonatal suffering (23.88%). The mortality rate was 40.6% with 82.71% cases of death in the early neonatal period. The main causes of death were low birth weight (47.39%), respiratory distress (18.76%), neonatal suffering (17.37%) and neonatal infection (13.87%). Home delivery, gestational age 36 weeks, number of PNC 4, concept of resuscitation, Apgar at the 5th minute 7, birth weight 2000 g and >4000 g, respiratory distress, hypothermia, neurological disorders were factors associated with deaths. Conclusion: Neonatal mortality is influenced by both maternal and fetal factors and many of them are preventable.
文摘Background and objective: Classically, diabetic subjects are at high risk of anaesthesia compared with general population. However, some recent publications have shown contrasting and sometimes contrary results. The aim of our study was to evaluate morbidity and mortality during and after anaesthesia in patients with versus without diabetes operated on at Monkole Hospital over the last ten years. Methods: Retrospective cohort study including all patients who underwent all-comers surgery excluding cardiac surgery between 2011 and 2021. Each diabetic patient was matched to 2 non-diabetic controls on age and sex. The evaluation criterion was the frequency of occurrence of at least one perioperative complication and/or death up to day 30. A multivariate analysis using a Cox model was used to determine the factors associated with the occurrence of this morbidity and mortality. The model was adjusted for comorbidities, preoperative hyperglycaemia, ASA score, type of anaesthesia and severity of surgery. Results: A total of 351 diabetic patients (mean age 53.3 ± 14.18 years) and 701 non-diabetic patients (mean age 53.52 ± 14.7 years) were included and analysed. Preoperatively, hyperglycaemia (blood glucose > 180 mg/dl) was observed in 24.3% of diabetic patients compared with 1.6% of non-diabetic patients. The incidence of overall perioperative complications was 25.6% in diabetic patients compared with 28.6% in non-diabetic patients (p = 0.27). The risk factors associated with this morbidity were general anaesthesia with oro-tracheal intubation vs loco-regional anaesthesia (OR = 3.06 [95%CI: 1.91 - 4.94];p Conclusion: This study shows that there is not significant increase in perioperative morbidity and mortality in diabetic patients compared with non-diabetic ones of similar severity. These results suggest that diabetes itself (excluding associated comorbidities) has only a minor impact on perioperative morbidity and mortality.
文摘Introduction: Total knee arthroplasty (TKA) has been established as a transformative solution in the treatment of advanced degenerative diseases of the knee, such as osteoarthritis, rheumatoid arthritis, and posttraumatic arthritis. In this sense, TKA surgery, which seeks to replace the damaged joint with prosthetic components, has proven to be highly effective in relieving pain, improving joint function, and, ultimately, significantly increasing patients’ quality of life. The present study describes the TKA and revision knee arthroplasty (RKA) rates and, identifies the associated co morbidities in the Colombian context. Methods: A retrospective cohort study was carried out. It describes demographic and clinical characteristics between two groups of patients, TKA or RKA, and its association with mortality at 30 days, 90 days, or one year after the intervention. Results: The incidence rate of the population undergoing TKA was approximately 11.71 cases per 100,000 inhabitants. Furthermore, the incidence rate for revision knee arthroplasty (RKA) procedures in the same period was around 0.96 per 100,000 inhabitants. In both groups at 30 days postoperatively, a total mortality rate of 0.09%was recorded. When the follow-up was extended to 90 days, it increased to 0.15%;at one year postoperatively, it rose to 0.88%. Conclusion: Mortality after surgery was low in Colombia in 2019. Although RKA is a beneficial procedure, in certain circumstances, it was noted that it carries a higher risk compared to primary TKA. Our results emphasize the importance of careful evaluation of co morbidities and risk factors in patients undergoing these surgical procedures. The application of quality-of-life questionnaires should be considered in future studies on effectiveness and mortality for TKA and RKA in our country.
文摘Introduction: Worldwide, 2.3 million children died in the first 20 days after birth in 2022, according to the WHO. In Mali, according to the sixth Demographic and Health Survey, the neonatal mortality rate was estimated at 33% live births in 2018. The Timbuktu region had the highest neonatal mortality rate in the country with 44%. The objective of this work was to study the causes of neonatal morbidity and mortality and related factors in the paediatrics department of Timbuktu hospital. Materials and method: This was a descriptive, cross-sectional study conducted from 1 January to 31 December 2023 in the neonatology unit of the paediatrics department of Timbuktu hospital, including all newborns admitted to hospital. Results: Our study took place over 12 months, during which 618 admissions were made to the paediatric ward, including 244 newborns, i.e. 39.48%. The majority of newborns (86.5%) were admitted in the first week of life. The mean age was 3 days, with a sex ratio of 1.1 for males. Weight under 2500 g was 54.1% for an average weight of 2372 g. The main mode of admission was transfer from the hospital maternity unit (62%). The main reasons for admission were acute foetal distress (27.9%) and prematurity (26.2%). The average age of the mothers was 24, with extremes of 15 and 49. The mothers were housewives (87.3%), uneducated and primiparous (59% and 36.5% respectively);only 40.2% had made more than 3 antenatal care visits. Newborns born by vaginal delivery accounted for 80.7% and those born by caesarean section for 19.3%. The risk of infection was present in 52.5% of cases. The three leading causes of hospitalisation were birth asphyxia (40.2%), neonatal infection (32.4%) and prematurity (25%). The mortality rate was 21.7%. The main causes of death were prematurity (39.6%), birth asphyxia (32.1%) and neonatal infection (24.5%). Conclusion: Neonatal morbidity and mortality remain a concern in Timbuktu. Despite the unfavourable security situation, morbidity and mortality indicators are close to those in some hospitals in Mali. The correct application of Essential Newborn Care and antenatal care remains a major challenge for the hospital and the Timbuktu region.
文摘Introduction: Infant and child morbidity and mortality linked to infections remain a major concern in both developed and developing countries. The general objective was to determine the characteristics of hospital morbidity and mortality linked to infectious pathologies in the pediatric department of the King Baudouin hospital center in Dakar. Methods: This was a retrospective, descriptive and analytical study focusing on children hospitalized from January 1, 2018 to December 31, 2021 in the pediatric department of the King Baudouin hospital center in Dakar. Results: During the study period, 1474 children were hospitalized for an infectious pathology in the pediatric department. The sex ratio was 1.48. Children aged between one and twelve months represented 34.12%. Morbidity due to respiratory and digestive infections was 42.33% and 33.45%, respectively. Pediatric hospital mortality was 0.75% with a predominance noted in infants between 1 and 12 months (55.86%). Respiratory, digestive infections, sepsis and neurological infections were the main causes of death. Factors associated with mortality were age (1 to 12 months) with p Conclusion: Reducing infant and child mortality linked to infectious diseases remains a crucial challenge to address for improving children’s health. Early detection of related signs, prevention of infections, and adequate care and monitoring of infants and children can contribute to this reduction.
文摘The mode of delivery and gestational age for very-low-birth-weight (VLBW) preterm infants are not yet well established and are constant topics of debate. Objective: To analyze the impact of delivery mode on morbidity in preterm infants weighing less than 1500 g. Results: Among 21,957 births, 81 were analyzed;53 were delivered vaginally, and 28 were delivered by cesarean section. The median maternal age, gestational age and body mass index among those delivered vaginally and by cesarean section were 20 years and 22.5 years, 27.6 weeks and 30.1 weeks, and 26.0 kg/m2 and 27.8 kg/m2, respectively. With respect to neonatal blood gas parameters, for those born vaginally and by cesarean section, the median pH was 7.32 and 7.24, the pCO2 was 41.5 mmHg and 51.1 mmHg, and the pO2 was 22.3 mmHg and 16 mmHg. The median fetal weight among those born by cesarean section and vaginally were 1180 g and 955 g, respectively. The median Apgar scores at the first and fifth minutes among those born by cesarean section and vaginally were 5.00 and 8.00 and 4.50 and 7.00, respectively. Conclusion: There was no significant difference between the results of vaginal and cesarean delivery for VLBW infants. Thus, further studies on this subject are needed.
文摘Introduction: Prematurity is the leading cause of neonatal death in Africa. More than a million children die each year due to co-morbidities related to prematurity. In addition to being one of the causes of neonatal deaths, the health problems associated with prematurity can also lead to severe lifelong impairment in those who survive. Objectives: This paper aims to determine the epidemiology and identify co-morbidities of prematurity in the neonatology units of the Douala General Hospital (DGH) and the Laquintinie Hospital of Douala (LHD). Patients and Methodology: We conducted an analytical retrospective cohort study from January 2015 to January 2018 in the neonatology department of the GDH and the LHD, which are considered reference hospitals for the management of preterm babies in Cameroon. We included all newborns aged less than 37 weeks admitted to the neonatology units of the GDH and the LHD. The descriptive component was based on the analysis of quantitative variables using measures of central tendency. The analytical component was evaluated using Spearman correlations and the Chi-square and Fisher tests. Simple and multiple logistic regressions measured factors predictive of mortality. The Kaplan Meier survival curve used the Log Rank test and significance at p ≤ 0.05. Results: We recorded 908 preterm newborns in neonatal service and 1,124 preterm deliveries in maternity, representing an incidence of 32.5% in neonatal unit and 10.6% in maternity. 51% of whom were girls, given a sex ratio M/F of 0.9. Hypertension was the main prenatal pathology (9.1%), while premature rupture of membranes: PROM (35.5%) and eclampsia/pre-eclampsia (18.6%) were the most common obstetrical pathologies. 75.9% of deliveries were vaginal with 65.2% being performed in our referral hospitals. Gestational age ranged from 22 to 36 weeks, with a mean of 32.4 weeks. Late preterm birth rate was 53.7%, and birth weight varied between 590 and 3200 g with an average of 1747 ± 479 g. The percentage of low birth weight (1500 - 2499 g) preterm infants was predominant (65.3%), and the intrauterine growth restriction (IUGR) was estimated to be 12.4%. The majority (96.7%) had pathologies in the neonatal period, the most common being neonatal infection (86.9%). The case-fatality rate was 27.4%, compared to 72.6% live births. Factors influencing mortality are risk of premature labour, gestational age ≤ 32 SA, premature birth in hospitals other than our two referral hospitals, birth weight ≤ 1500 g, Apgar at the 10th minute, late secondary anaemia, hospital resuscitation, oxygen therapy, and duration of hospitalization Conclusion: The incidence of prematurity and the mortality rate remains high in neonatal units in Cameroon. Adequate monitoring of pregnancies and management of preterm infants remains a challenge in our context.
文摘Introduction: The incidence of acute renal failure (ARF) varies between 20% and 40% of cases for COVID-19 patients admitted to the intensive care unit, with very high mortality, but heterogeneous according to the different epidemic waves, probably due to the genetic variant phenomenon of the virus. The aim of this study is to determine the morbidity and mortality of COVID-19 patients admitted with ARF to the intensive care unit of the Grand H?pital Est Francilien (GHEF) according to the waves and variants. Methods: Cross-sectional observational study of COVID-19 patients with ARF admitted to the intensive care unit of the GHEF site in Meaux covering the period from March 1<sup>st</sup> 2020 to December, 31<sup>st</sup> 2021. Per-hospitalisation and outcome data were collected and analysed with SPSS version 25.0 software using the Chi-square or Fischer’s exact test or Student’s t-test and logistic regression for p Results: A total of 86 patients were included. The mean age was higher (70 ± 8.5) in patients in the fourth wave than in the other waves (p = 0.015), with male predominance in all waves without significant difference. Co-morbidities: hypertension, diabetes, heart disease, dyslipidaemia and arrhythmia complete with fibrillation were present in all waves. The majority of patients were classified as KDIGO 1 for the different waves (1st: 61.9%, 2nd: 86.5%, 3rd: 80%, and 4th: 75%), with the same trend according to variant (alpha: 80%, beta: 75%, delta: 81.3%, omicron: 75%). Mortality by the wave was: 1st: 28.5%, 2nd: 37.5%, 3rd: 23% and 4th: 11%) and by variant: alpha: 24.2%, beta: 44.8%, delta: 20.7%, omicron: 10.3%). Overall mortality was 33.7%. Case fatality was higher in the fourth wave. Hypertension, shock, failure to recover renal function, acute lung oedema, ventilator-associated lung disease and hyperkalaemia were factors associated with mortality (p Conclusion: Acute renal failure is common in COVID-19 patients admitted to the intensive care unit, and mortality is not negligible. The beta variants and the second wave presented more cases of renal impairment, although the mechanism is still unknown. Further studies are needed to understand this mechanism and perhaps to be able to identify the cause.
文摘BACKGROUND There are few if any life-span population-based studies of psychiatric disorderassociated biomedical and biophysical disorders and diseases(morbidity).AIM To scope the present state of research regarding the biomedical and biophysical morbidity associated with affective and mental disorder in epidemiological samples,and to examine the life-span relationship between affective disorders and biomedical/biophysical disorders to illustrate a novel approach employing the odds ratio to represent the intensity of biomedical and biophysical morbidity associated in time in a population.METHODS A repeatable systematic literature search of PubMed was represented in summary.Additionally,a regional population-based dataset was constructed and analyzed to represent the age-and sex-specific diagnoses(International Classification of Diseases Version 9,ICD-9)for those with and without affective disorder.The analysis presents a novel index of the relative age-specific frequency of life-span biomedical and biophysical diagnoses associated with affective disorder.RESULTS The volume of biomedical and biophysical morbidity associated with mental disorder literature has increased,yet few studies measure comprehensive temporal hyper-morbidity(over-representation of diseases over time,either before or after the index diagnostic event)in populations.Further,there have been only a few population-based studies examining the morbidity associated with affective disorder and only one that examines the full diagnostic range of lifespan morbidity.Substantial differences arose between males and females with more females than males having greater frequencies of diagnoses.The age-specific distributions of the maximum proportional diagnosis frequency ratios for each sex illustrate the greatest diagnosis-specific differences when comparing the biomedical and biophysical diagnoses of those with and without affective disorder when the same diagnosis was represented in each grouping at the same age.CONCLUSION Clinical research needs to focus on more than one or two comorbid biomedical or biophysical disorders at a time.Comprehensive population-based examination of the lifespan biomedical and biophysical multi-morbidity associated with affective disorder has the potential to directly inform clinical practice.Representing the proportional ratios of age-specific frequency of diagnoses for the full range of ICD-9 diagnoses is a novel analytical model.Diagnostic frequency appears a viable representation of a given disease state,such as affective disorder.Fortunately,the WPA has developed a global education section to better understand the biomedical and biophysical morbidity associated with all psychiatric disorders.This has been identified by the WPA as the psychiatric practice challenge of the 21st century.
基金the National Key R&D Program of China(2020YFC2004800).
文摘The present protocol describes an observational cohort study that was designed to propose a therapeutic scheme and formulate an individualized treatment strategy for frail elderly patients diagnosed with multiple diseases in a Chinese,multicenter setting.Over a 3-year period,we will recruit 30,000 patients from 10 hospitals and collect baseline data including patient demographic information,comorbidity characteristic,FRAIL scale,age-adjusted Charlson comorbidity index(aCCI),relevant blood tests,the results of imaging examination,prescription of drugs,length of hospital stay,number of overall re-hospitalizations and death.Elderly patients(≥65 years old)with multimorbidity and receiving hospital care are eligible for this study.Data collection is being performed at baseline and 3,6,9 and 12 months after discharge.Our primary analysis was all-cause death,readmission rate and clinical events(including emergency visits,stroke,heart failure,myocardial infarction,tumor,acute chronic obstructive pulmonary disease,etc).The study is approved by the National Key R&D Program of China(2020YFC2004800).Data will be disseminated in manuscripts submitted to medical journals and in abstracts submitted to international geriatric conferences.Clinical Trial Registration:[www.ClinicalTrials.gov],identifier[ChiCTR2200056070].
基金This study was supported by funding of key research and development projects of Anhui Province(grant number:2022e07020002)Applied medicine research project of Anhui Health Committee(grant number:AHWJ2021a036)+4 种基金hospital project of Hefei Fourth People’s Hospital(grant number:HFSY2020YB21)Shanghai Key Laboratory of Psychotic Disorders Open Grant(grant number:13dz2260500 and 21-K04)Natural science research projects in Anhui Universities(grant number:KJ2020A0218)Projects supported by public welfare scientific research institutes(grant number:GY2020G-3)the Applied medicine research project of Hefei Health Committee(grant number:Hwk2020zd0016 and Hwk2021zd011).
文摘Background Patients who suffer comorbidity of major depressive disorder(MDD)and chronic pain(CP)maintain a complex interplay between maladaptive prospective memory(PM)and retrospective memory(RM)with physical pain,and their complications are still unknown.Aims We aimed to focus on the full cognitive performance and memory complaints in patients with MDD and CP,patients with depression without CP,and control subjects,considering the possible influence of depressed affect and chronic pain severity.Methods According to the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders and the criteria given by the International Association of Pain,a total of 124 participants were included in this cross-sectional cohort study.Among them,82 depressed inpatients and outpatients from Anhui Mental Health centre were divided into two groups:a comorbidity group(patients with MDD and CP)(n=40)and a depression group(patients with depression without CP)(n=42).Meanwhile,42 healthy controls were screened from the hospital’s physical examination centre from January 2019 to January 2022.The Hamilton Depression Rating Scale-24(HAMD-24)and Beck Depression Inventory-II(BDI-II)were used to evaluate the severity of depression.The Pain Intensity Numerical Rating Scale(PI-NRS),Short-Form McGill Pain Questionnaire-2 Chinese version(SF-MPQ-2-CN),Montreal Cognitive Assessment-Basic Section(MoCA-BC),and Prospective and Retrospective Memory Questionnaire(PRMQ)were used to assess pain-related features and the global cognitive functioning of study participants.Results The impairments in PM and RM differed remarkably among the three groups(F=7.221,p<0.001;F=7.408,p<0.001)and were severe in the comorbidity group.Spearman correlation analysis revealed the PM and RM were positively correlated with continuous pain and neuropathic pain(r=0.431,p<0.001;r=0.253,p=0.022 and r=0.415,p<0.001;r=0.247,p=0.025),respectively.Regression analysis indicated a significant positive relationship between affective descriptors and total BDI-II score(β=0.594,t=6.600,p<0.001).Examining the mediator pathways revealed the indirect role of PM and RM in patients with comorbid MDD and CP.Conclusions Patients with comorbid MDD and CP presented more PM and RM impairments than patients with MDD without CP.PM and RM are possibly mediating factors that affect the aetiology of comorbid MDD and CP.
基金This study was funded by Universities of Queensland and Newcastle,National Health and Medical Research Council Principal Research Fellowship(grant number:APP1121844)the University of Queensland,Australian Government Department of Health.
文摘Background Social relationships are associated with mortality and chronic conditions.However,little is known about the effects of social relationship satisfaction on multiple chronic conditions(multimorbidity).Aims To examine whether social relationship satisfaction is associated with the accumulation of multimorbidity.Methods Data from 7694 Australian women who were free from 11 chronic conditions at 45–50 years of age in 1996 were analysed.Five types of social relationship satisfaction(partner,family members,friends,work and social activities)were measured approximately every 3 years and scored from 0(very dissatisfied)to 3(very satisfied).Scores from each relationship type were summed to provide an overall satisfaction score(range:≤5–15).The outcome of interest was the accumulation of multimorbidity in 11 chronic conditions.Results Over a 20-year period,4484(58.3%)women reported multimorbidities.Overall,the level of social relationship satisfaction had a dose–response relationship with the accumulation of multimorbidities.Compared with women reporting the highest satisfaction(score 15),women with the lowest satisfaction(score≤5)had the highest odds of accumulating multimorbidity(odds ratio(OR)=2.35,95%confidence interval(CI):1.94 to 2.83)in the adjusted model.Similar results were observed for each social relationship type.Other risk factors,such as socioeconomic,behavioural and menopausal status,together explained 22.72%of the association.Conclusions Social relationship satisfaction is associated with the accumulation of multimorbidity,and the relationship is only partly explained by socioeconomic,behavioural and reproductive factors.Social connections(eg,satisfaction with social relationships)should be considered a public health priority in chronic disease prevention and intervention.
基金supported by grants from the National Natural Science Foundation of China[grant numbers 82003454,81903314,and 81872626]National Natural Science Foundation of Henan Province[grant number 222300420337]+3 种基金Chinese Nutrition Society-Bright Moon Seaweed Group Nutrition and Health Research Fund[grant number CNS-BMSG2020A63]Chinese Nutrition Society Zhendong National Physical Fitness and Health Research Fund[grant number CNS-ZD2019066]key R&D and promotion projects in Henan Province[grant numbers 212102310219,212102310110,and 202102310120]National Natural Science Foundation of China[grant number 81903314].
文摘Hypertension(HTN)and type 2 diabetes mellitus(T2DM)are interconnected metabolic diseases[1,2]that considerably increase susceptibility to microvascular and macrovascular disorders.In many patients,HTN and diabetes comorbidity(HDC)is caused by mutual pathogenic pathways,such as endothelial dysfunction,atherosclerosis,oxidative stress,and vascular inflammation[1].Hence.
文摘Airway management of morbidly obese patients is challenging due to inherent anatomical and physiological variations.[1]The frequent association of compromised hemodynamics,hypoxemia,or acidosis in an emergency department(ED)setting adds to the difficulty of the procedure.Rapid airway management position(RAMP),awake fiber-optic guided intubation,use of intubating laryngeal mask airway(ILMA),and video-laryngoscope are a few techniques that have been described to tackle difficult airways in these patients.[2]Studies have shown that the availability of fi ber-optic scopes(3%–60%),videolaryngoscopes(39%–88%),and laryngeal mask airways(LMA)(65%–83%)varies in different ED settings.[3,4]Furthermore,a lack of adequate training and the need for time-bound resuscitation make implementation of the above techniques challenging.
