Category Of Mortality Research Articles

ОБРАЗ СМЕРТИ В ТЕКСТАХ КЕТСКОЙ ЛИНГВОКУЛЬТУРЫ

A fragment of the linguistic view of the world of the Kets, a minority ethnos, whose language is going through a period of shift, is reconstructed. The category of mortality is implicated on the basis of vocabulary united by the meanings “death”, “to die”. Through the analysis of contexts, including this vocabulary, the peculiarities of the linguistic representation of ideas about the category of death are revealed and cognitive-figurative models that order these representations are identified. As a result of the study, it is found that metaphorization and description of visual signs in the Ket language act as key mechanisms for the linguization of the phenomenon of death, and the meanings expressed in discourse reveal an ambivalent and antinomic character. Along with such metaphors as “eternal sleep,” “withdrawal into another world,” the Ket discourse of death also contains direct descriptions of objective ones, i.e. visible manifestations of the category under discussion - cessation of breathing, inability to move, etc. An analysis of the Ket discourse of death indicates that the belief in the immortality of the soul and the other world, expressed in it, is intended to neutralize the fear of death. On the other hand, plots are revealed that express the possibility of struggle and victory over death. This indicates that death is understood as an undesirable, frightening phenomenon that opposes the successful course of a person’s life events.

Womb to womb: Maternal litter size and birth weight but not adult characteristics predict early neonatal death of offspring in the common marmoset monkey.

A singular focus on maternal health at the time of a pregnancy leaves much about perinatal mortality unexplained, especially when there is growing evidence for maternal early life effects. Further, lumping stillbirth and early neonatal death into a single category of perinatal mortality may obscure different causes and thus different avenues of screening and prevention. The common marmoset monkey (Callithrix jacchus), a litter-bearing nonhuman primate, is an ideal species in which to study the independent effects of a mother's early life and adult phenotypes on pregnancy outcomes. We tested two hypotheses in 59 marmoset pregnancies at the Southwest National Primate Research Center and the Barshop Institute for Longevity and Aging Studies. We explored 1) whether pregnancy outcomes were predicted independently by maternal adult weight versus maternal litter size and birth weight, and 2) whether stillbirth and early neonatal death were differentially predicted by maternal variables. No maternal characteristics predicted stillbirth and no maternal adult characteristics predicted early neonatal death. In univariate Poisson models, triplet-born females had a significantly increased rate of early neonatal death (IRR[se] = 3.00[1.29], p = 0.011), while higher birth weight females had a decreased rate (IRR[se] = 0.89[0.05], p = 0.039). In multivariate Poisson models, maternal litter size remained an independent predictor, explaining 13% of the variance in early neonatal death. We found that the later in the first week those neonates died, the more weight they lost. Together these findings suggest that triplet-born and low birth weight females have distinct developmental trajectories underlying greater rates of infant loss, losses that we suggest may be attributable to developmental disruption of infant feeding and carrying. Our findings of early life contributions to adult pregnancy outcomes in the common marmoset disrupt mother-blaming narratives of pregnancy outcomes in humans. These narratives hold that the pregnant person is solely responsible for pregnancy outcomes and the health of their children, independent of socioecological factors, a moralistic framing that has shaped clinical pregnancy management. It is necessary to differentiate temporal trajectories and causes of perinatal loss and view them as embedded in external processes to develop screening, diagnostic, and treatment tools that consider the full arc of a mother's lived experience, from womb to womb and beyond.

DEMOGRAPHIC AND CLINICAL PROFILES AND MORTALITY OF ALUMINIUM PHOSPHIDE POISONING CASES IN KHYBER PAKHTUNKHWA PROVINCE, PAKISTAN

Background: The prevalence of aluminium phosphide (AlP) poisoning is on the rise in Asian countries. The objectives of our study were to determine the distribution of AIP poisoning by sex, age groups & district and its presentation by blood pressure category and oxygen saturation category and its mortality in Khyber Pakhtunkhwa Province, Pakistan. Materials & Methods: This cross-sectional study was conducted at Emergency Department of Lady Reading Hospital, Peshawar, Pakistan from June 1, 2020 to September 30, 2020. Fifty eight cases of AIP registered during 2019 were included. The diagnosis was made by history and clinical suspicion. All these cases were managed by standard management protocols. Sex, age groups, district, blood pressure category, oxygen saturation category and presence of mortality were variables; all being categorical were analyzed by count and percentage with 80% confidence interval. Results: Out of 58 AlP poisoning cases, women 34 (58.62%) were more than men 24 (41.38%), with most cases 30 (51.73%) in 10-19 years age group. Most cases 17 (29.31%) were from district Swabi, followed by district Peshawar 16 (27.58%). Most cases presented in non-recordable blood pressure category 19 (32.76%). Most cases 22 (37.93%) presented in oxygen saturation category of ≥ 90%. Out of 58 cases, mortality was 72.41% (42/58), involving more women 24/58 (41.38%) than men 18/58 (31.03%), with most cases 23 (39.66%) in 10-19 years age group. Mortality was highest in non-recordable blood pressure category 19 (32.76%). Mortality was highest 19 (32.76%) in oxygen saturation category of below 90%. Conclusion: Aluminium phosphide (AlP) poisoning is an uncommon, but a dreadful public health problem in population of Khyber Pakhtunkhwa Province, Pakistan. It involves women more than men, with most cases in adolescent age group, and in non-recordable blood pressure category. AlP poisoning mortality is very high 72.41% in our population, involving more women than men, with most cases in adolescent age group. Mortality is highest in non-recordable blood pressure category and in oxygen saturation category of below 90%.

Mortality Following Durable Left Ventricular Assist Device Implant by Timing and Category of First Infection

<h3>Purpose</h3> While infections are common following left ventricular assist device (LVAD) implant, the relationship between timing and category of first infection and mortality is less well understood. <h3>Methods</h3> STS Intermacs patients (>19 yrs) receiving a primary, durable continuous flow LVAD from 4/2012 to 5/2017 were included. The primary exposure was defined in 3 ways: any infection, timing of first post-implant infection (early: <90d, intermediate: 90-180d, late: >180d), and first infection category (VAD-specific, VAD-related, non-VAD). Cox proportional-hazards regression models were used to estimate the association between first infection and all-cause mortality, adjusting for comorbidities & post-implant stroke. <h3>Results</h3> A total of 12,957 patients (228,742 person-months of follow-up) were implanted (DT: 47.4%, BTT: 41.2%) at 166 centers. First infections were most often non-VAD (54.2%), followed by VAD-specific (25.4%) & VAD-related (20.4%). Rates of first infection (per 100 person-months) were highest in the early interval (10.7) vs intermediate (3.7) or late (2.7), p<0.001. Relative to patients without infection, patients with any infection had a significantly higher hazard of death (HR 3.46). First infection in the intermediate interval following implant was associated with the largest increase in hazard of death (HR 3.97), followed by late (HR 3.65) and early intervals (HR: 3.31). VAD-related infections were associated with the largest increase in hazard of death (HR 4.04) followed by non-VAD (HR 3.34), and VAD-specific infections (HR 3.23). <h3>Conclusion</h3> First infections were most often non-VAD-related and rates were highest early after implant. VAD-related infections and infections occurring in the intermediate interval were associated with the largest increase in hazard of death. A mixed-methods evaluation could explore these findings at the institutional level and why these patterns occur.

"Nonroutine Events" as a Nonroutine Outcome for Perioperative Systems Research.

"Nonroutine Events" as a Nonroutine Outcome for Perioperative Systems Research.

Identification of psychiatric patients with high mortality and low medical utilization: a population-based propensity score-matched analysis

BackgroundThe decreased life expectancy and care costs of mental disorders could be enormous. However, research that compares mortality and utilization concurrently across the major category of mental disorders is absent. This study investigated all-cause mortality and medical utilization among patients with and without mental disorders, with an emphasis on identifying the psychiatric category of high mortality and low medical utilization.MethodsA total of 570,250 individuals identified from the 2002–2013 Taiwan National Health Insurance Reearch Database consistuted 285,125 psychiatric patients and 285,125 non-psychiatric peers through 1:1 dual propensity score matching (PSM). The expenditure survival ratio (ESR) was proposed to indicate potential utilization shortage. The category of mental disorders and 13 covariates were analyzed using the Cox proportional hazard model and general linear model (GLM) through SAS 9.4.ResultsPSM analyses indicated that mortality and total medical expenditures per capita were both significantly higher in psychiatric patients than those in non-psychiatric patients (all P <.0.0001). Patients with substance use disorders were reported having the youngest ages at diagnosis and at death, with the highest 25.64 of potential years of life loss (YPLL) and relevant 2904.89 of ESR. Adjusted Cox model and GLM results indicated that, compared with anxiety disorders, affective disorders and substance use disorders were significantly associated with higher mortality (HR = 1.246 and 1.064, respectively; all P < 0.05); schizophrenia was significantly associated with higher total medical expenditures per capita (P < 0.0001). Thirteen additional factors were significantly associated with mortality or utilization (all P < 0.05).ConclusionSubstance use disorders are the category of highest YPLL but notably in insufficient utilization. Health care utilization in patients with substance use disorders should be augmented timely after the diagnosis, especially toward home and community care. The factors related to mortality and utilization identified by this study merit clinical attention.

Coronary Flow Velocity Reserve Reduction Is Associated with Cardiovascular, Cancer, and Noncancer, Noncardiovascular Mortality

Coronary flow velocity reserve (CFVR) measured in the left anterior descending artery during high-dose vasodilator stress echocardiography interrogates both epicardial and microcirculatory coronary function and has been inversely associated with chronic inflammation and microvascular dysfunction, as well as with the presence of obstructive coronary artery disease. Microvascular dysfunction and chronic inflammation are common mechanisms of disease in cardiovascular (CV) and non-CV conditions. We aimed to assess whether CFVR is associated with all-cause death, but more specifically with CV, cancer, and non-CV and noncancer (NCVNC) mortality, independently and increasingly over other demographic, clinical, and echocardiography variables. One thousand two patients who underwent stress echocardiography were followed for a median of 8.2years, with clinical, regional wall motion abnormalities (RWMAs), and CFVR data. The independent prognostic value of RWMA and CFVR regarding CV, cancer, or NCVNC mortality was evaluated adjusting for clinical variables. A prespecified subgroup of subjects with no RWMA or revascularization procedures during follow-up was also analyzed (n=752), to exclude most participants with possible coronary artery disease and remove such confounding from the assessment of the potential association of CFVR and mortality. A total of 161 patients (16%) died, 63 deaths being CV (39%), 52 from cancer (32%), and 46 (29%) from NCVNC causes. In comparison to CV mortality, cancer and NCVNC mortality were not associated with an ischemic RWMA at univariable analysis, while a CFVR < 2 was significantly associated with each category of cause-specific mortality. A CFVR < 2 or ≥2 separated a group of patients with 8-year 14.6% versus 1.2% CV mortality, 10.3% versus 0.4% cancer mortality, and 9.5% versus 1.5% NCVNC mortality. The reduction of CFVR is independently associated with CV, cancer, and NCVNC death in a population clinically referred for suspected/known coronary artery disease. CFVR can act as a marker or a mechanism preceding and predicting mortality from a wide variety of diseases.

Mortality in Three-Toed Box Turtles (Terrapene mexicana triunguis) at Two Sites in Missouri.

Once ubiquitous, North American box turtles are experiencing reductions in abundance and range, but the magnitude of these losses is largely unknown. In Missouri, native box turtles (Terrapene mexicana triunguis and Terrapene ornata ornata) are declining across the state due to anthropogenic disturbances such as urbanization, habitat fragmentation, and vehicle collisions. Through radio-tracking over a period of 7 years, we documented the survival of adult three-toed box turtles at two sites in Missouri: Forest Park (urban park) and Tyson Research Center (TRC) (a protected rural forest). Estimated annual survival of adult turtles in Forest Park was 79% (95% CI: 0.68–0.87) while at TRC annual survival was 93% (95% CI: 0.83–0.97). The odds of annual survival for a turtle at TRC were 3.5 times that of a turtle living in Forest Park. “Winter kill,” which refers to box turtles found dead on the surface during brumation or within 2 weeks of emergence, was the most frequently documented category of mortality in Forest Park. At TRC, winter kill was not documented; however, the reasons for most deaths were unknown. These data raise questions about the potential of large urban parks as refuges for box turtles, which we may answer by future studies that compare box turtles living in multiple urban and rural settings. Our preliminary data suggest that even the largest urban parks may not be able to sustain populations of box turtles which has severe implications as urbanization continues to degrade and eliminate box turtle habitat throughout their range.

Commentary: Opioid use disorder and suicide: An important opportunity to address two significant public health epidemics

Nationwide, the opioid epidemic continues to have a significant and widespread adverse impact on morbidity and mortality. The number of individuals dying by suicide and unintentional overdose has continued to increase over the past decade, with opioids being involved in a significant proportion of each category of mortality in 2017. Currently, most strategies for decreasing opioid-overdose deaths do not include systematic screening for suicide risk, nor do they address the necessity to customize interventions for those who misuse opioids to decrease near-term suicide risk (defined here as less than 72 h) factors. Improved screening of near-term and chronic suicide risk along with rapid access to treatment is of critical importance to prevent opioid-related deaths by suicide.

Epidemiology, Patterns of treatment, and Mortality of Pediatric Trauma Patients in Japan

Limited information exists regarding the epidemiology, patterns of treatment, and mortality of pediatric trauma patients in Japan. To evaluate the characteristics and mortality of pediatric trauma patients in Japan, especially in traffic accidents. This was a retrospective cohort study between 2004 and 2015 from a nationwide trauma registry in Japan. Pediatric trauma patients divided into four age groups: <1 years; 1 ≤ 5 years; 6 ≤ 10 years; and 11 ≤ 15 years. Data on patients’ demographics, trauma mechanism and severity, treatments and in-hospital mortality were analyzed between the groups. There were 15,441 pediatric trauma patients during the study period. Among 15,441 pediatric patients, 779 belonged to the <1 year age group, 3,933 to the 1 ≤ 5 years age group, 5,545 to the 6 ≤ 10 age group, and 5,184 to the 11 ≤ 15 years age group. Male injuries (69%) were more frequent than female injuries. Head injuries (44%) were the most frequent and severe. Traffic accidents were the leading cause of trauma (44%). Overall in-hospital mortality was 3.9% and emergency department mortality was 1.4%. In-hospital mortality was 5.3%, 4.7%, 3.0% and 4.0% for the <1 year, 1 ≤ 5 years, 6 ≤ 10 years, and 11 ≤ 15 years age groups respectively. A total of 57% of all trauma deaths were before or upon arrival at hospital. Traffic accidents for the <1 year age group was the highest category of mortality (15%). The overall in-hospital mortality of Japanese pediatric trauma patients was 3.9% based on the nationwide trauma registry of Japan. The main cause of severe trauma was traffic accidents, especially in patients <1 year of age whose mortality was 15%.

Effects of chlorhexidine gluconate oral care on hospital mortality: a hospital-wide, observational cohort study

PurposeChlorhexidine oral care is widely used in critically and non-critically ill hospitalized patients to maintain oral health. We investigated the effect of chlorhexidine oral care on mortality in a general hospitalized population.MethodsIn this single-center, retrospective, hospital-wide, observational cohort study we included adult hospitalized patients (2012–2014). Mortality associated with chlorhexidine oral care was assessed by logistic regression analysis. A threshold cumulative dose of 300 mg served as a dichotomic proxy for chlorhexidine exposure. We adjusted for demographics, diagnostic category, and risk of mortality expressed in four categories (minor, moderate, major, and extreme).ResultsThe study cohort included 82,274 patients of which 11,133 (14%) received chlorhexidine oral care. Low-level exposure to chlorhexidine oral care (≤ 300 mg) was associated with increased risk of death [odds ratio (OR) 2.61; 95% confidence interval (CI) 2.32–2.92]. This association was stronger among patients with a lower risk of death: OR 5.50 (95% CI 4.51–6.71) with minor/moderate risk, OR 2.33 (95% CI 1.96–2.78) with a major risk, and a not significant OR 1.13 (95% CI 0.90–1.41) with an extreme risk of mortality. Similar observations were made for high-level exposure (> 300 mg). No harmful effect was observed in ventilated and non-ventilated ICU patients. Increased risk of death was observed in patients who did not receive mechanical ventilation and were not admitted to ICUs. The adjusted number of patients needed to be exposed to result in one additional fatality case was 47.1 (95% CI 45.2–49.1).ConclusionsThese data argue against the indiscriminate widespread use of chlorhexidine oral care in hospitalized patients, in the absence of proven benefit in specific populations.

Adherence to Mediterranean Diet and Risk of Cancer: An Updated Systematic Review and Meta-Analysis.

The aim of the present systematic review and meta-analysis was to gain further insight into the effects of adherence to Mediterranean Diet (MedD) on risk of overall cancer mortality, risk of different types of cancer, and cancer mortality and recurrence risk in cancer survivors. Literature search was performed using the electronic databases PubMed, and Scopus until 25 August 2017. We included randomized trials (RCTs), cohort (for specific tumors only incidence cases were used) studies, and case-control studies. Study-specific risk ratios, hazard ratios, and odds ratios (RR/HR/OR) were pooled using a random effects model. Observational studies (cohort and case-control studies), and intervention trials were meta-analyzed separately. The updated review process showed 27 studies that were not included in the previous meta-analysis (total number of studies evaluated: 83 studies). An overall population of 2,130,753 subjects was included in the present update. The highest adherence score to a MedD was inversely associated with a lower risk of cancer mortality (RRcohort: 0.86, 95% CI 0.81 to 0.91, I2 = 82%; n = 14 studies), colorectal cancer (RRobservational: 0.82, 95% CI 0.75 to 0.88, I2 = 73%; n = 11 studies), breast cancer (RRRCT: 0.43, 95% CI 0.21 to 0.88, n = 1 study) (RRobservational: 0.92, 95% CI 0.87 to 0.96, I2 = 22%, n = 16 studies), gastric cancer (RRobservational: 0.72, 95% CI 0.60 to 0.86, I2 = 55%; n = 4 studies), liver cancer (RRobservational: 0.58, 95% CI 0.46 to 0.73, I2 = 0%; n = 2 studies), head and neck cancer (RRobservational: 0.49, 95% CI 0.37 to 0.66, I2 = 87%; n = 7 studies), and prostate cancer (RRobservational: 0.96, 95% CI 0.92 to 1.00, I2 = 0%; n = 6 studies). Among cancer survivors, the association between the adherence to the highest MedD category and risk of cancer mortality, and cancer recurrence was not statistically significant. Pooled analyses of individual components of the MedD revealed that the protective effects appear to be most attributable to fruits, vegetables, and whole grains. The updated meta-analysis confirms an important inverse association between adherence to a MedD and cancer mortality and risk of several cancer types, especially colorectal cancer. These observed beneficial effects are mainly driven by higher intakes of fruits, vegetables, and whole grains. Moreover, we were able to report for the first time a small decrease in breast cancer risk (6%) by pooling seven cohort studies.

External validation of a risk score in the prediction of the mortality after esophagectomy for cancer.

This study was designed as an external evaluation of the Steyerberg score in the prediction of different categories of postoperative mortality after esophagectomy on a large nationwide database of thoracic surgeons. Data collection was obtained from the Epithor national database encompassing the majority of thoracic procedures performed in France. We retrospectively compared the predicted to the observed postoperative 30-day (30DM), 90-day (90DM) and in-hospital mortality (IHM) rate in each decile of equal patient. Patients included in the study were operated for an esophageal cancer and Gastroesophageal junction (GEJ). Steyerberg score was determined according to its logarithmic formula obtained from a sum score including age, comorbidities, neoadjuvant treatment and hospital volume. Deviation of observed from theoretically expected number of deaths was investigated using the calibration test of Hosmer-Lemeshow. Discrimination of the score was determined using the measure of the area under the receiver operating characteristic curve (AUC) of each category of mortality. Over a 9-year period, 1039 consecutive patients underwent an esophagectomy over 42 centers. Among them, 18 centers were considered as intermediate or high-volume institutions, and 24 were low-volume institutions. There were 841 males (81%) with a mean age of 62.3 ± 10years. Preoperative treatment was allocated to 420 patients (40%). Numbers of comorbidity was: 1 in 261 patients (25%), 2 in 264 patients (25%), 3 in 383 patients (36%) and 4 in 5 patients (1%). The 30DM, 90DM and IHM rate were, respectively, 5.6%, 9.2% and 9.6%. The main causes of postoperative deaths were related to pulmonary complications (44%), complications of the gastric interposition (28%), cardiologic and thromboembolism events (10%). For 30DM, there were significant differences between predicted/observed mortalities in four deciles, whereas there was no significant difference for 90DM and for IHM. In term of calibration, there was a fair agreement of the Steyerberg score with observed 30DM. Predictions were above 20% for seven deciles. Calibration seemed more adequate for 90DM and for IHM. Predictions were above 20% for only three deciles but deviations were not significant. In terms of discrimination, for the 30DM the Steyerberg score overpredicted, the observed mortality rate and AUC was 0.64 (CI 95%: 0.57-0.71). For the 90DM, AUC indicated 0.63 (CI 95%: 0.57-0.68). For the IHM, AUC indicated 0.63 (CI 95%: 0.58-0.68). Steyerberg scoring system seems to be a moderate risk score of the prediction of the IHM and 90DM. This score appears to have a fair discrimination for the 30DM. Nevertheless, because of its simplicity, we believe that this simple predictive score is relevant and transportable to others institution performing such surgery for benchmarking purposes. A reappraisal of the score adapted to current surgical cohort is required.

Adherence to Mediterranean diet and risk of cancer: an updated systematic review and meta-analysis of observational studies.

The aim of the present systematic review and meta‐analysis of observational studies was to gain further insight into the effects of adherence to Mediterranean Diet (MD) on overall cancer mortality, incidence of different types of cancer, and cancer mortality risk in cancer survivors. Literature search was performed using the electronic databases PubMed, and EMBASE until 2 July 2015. We included either cohort (for specific tumors only incidence cases were used) or case–control studies. Study specific risk ratios, hazard ratios, and odds ratios (RR/HR/OR) were pooled using a random effect model. The updated review process showed 23 observational studies that were not included in the previous meta‐analysis (total number of studies evaluated: 56 observational studies). An overall population of 1,784,404 subjects was included in the present update. The highest adherence score to an MD was significantly associated with a lower risk of all‐cause cancer mortality (RR: 0.87, 95% CI 0.81–0.93, I 2 = 84%), colorectal cancer (RR: 0.83, 95% CI 0.76–0.89, I 2 = 56%), breast cancer (RR: 0.93, 95% CI 0.87–0.99, I 2=15%), gastric cancer (RR: 0.73, 95% CI 0.55–0.97, I 2 = 66%), prostate cancer (RR: 0.96, 95% CI 0.92–1.00, I 2 = 0%), liver cancer (RR: 0.58, 95% CI 0.46–0.73, I 2 = 0%), head and neck cancer (RR: 0.40, 95% CI 0.24–0.66, I 2 = 90%), pancreatic cancer (RR: 0.48, 95% CI 0.35–0.66), and respiratory cancer (RR: 0.10, 95% CI 0.01–0.70). No significant association could be observed for esophageal/ovarian/endometrial/and bladder cancer, respectively. Among cancer survivors, the association between the adherence to the highest MD category and risk of cancer mortality, and cancer recurrence was not statistically significant. The updated meta‐analyses confirm a prominent and consistent inverse association provided by adherence to an MD in relation to cancer mortality and risk of several cancer types.

Erectile Dysfunction is Associated with Subsequent Cardiovascular and Respiratory Mortality in Cohort of 1,436 Chinese Elderly Men.

Erectile dysfunction (ED) is commonly shown to be associated with subsequent cardiovascular mortality, but not respiratory mortality, despite respiratory disease being highly prevalent among ED patients. We aim to examine associations of ED with all-cause and cause-specific (i.e., cardiovascular and respiratory) mortality in a prospective cohort of 1,436 Chinese men, followed up from 2001 for a median of 11.5 years. ED measurement was based on a single question of four categories at the 4-year follow up. Outcome measures include all-cause and cause-specific mortality (i.e., cardiovascular and respiratory mortality, classified according to the International Classification of Disease-version 10 [ICD-10]). Multivariable regression models estimated associations between ED and all-cause and cause-specific mortality, adjusting for the presence of chronic conditions, and socio-demographics and lifestyle factors. For each category of disease-specific mortality, subjects with the corresponding diseases and death cases from other causes were excluded. Cancer mortality was included for comparison. Participants who were completely impotent had significantly increased risk of all-cause (HR = 1.63, 95% CI = 1.20-2.23), cardiovascular (HR = 3.94, 95% CI = 1.77-8.76) and respiratory mortality (HR = 3.16, 95% CI = 1.46-6.81) compared with non-impotent participants, adjusting for chronic conditions, and socio-demographics and lifestyle factors. ED is significantly associated with subsequent all-cause mortality, possibly via its association with cardiovascular and respiratory mortality. Primary care practitioners should pay attention to ED patients' cardiovascular and respiratory risk profiles, which may benefit their prognosis.

Dietary patterns and mortality in a Chinese population , ,

Limited research has examined the association between dietary patterns and mortality, especially in non-Western populations. We examined the association of dietary patterns with all-cause mortality and cause-specific mortality in the Singapore Chinese Health Study, which included a unique ethnic population with strong Western and South Asian cultural influences. We conducted a prospective data analysis of the Singapore Chinese Health Study, which included 52,584 Chinese men and women (aged 45-74 y) who were free of diabetes, cardiovascular disease (CVD), and cancer at baseline (1993-1998) and followed through 2011 with 10,029 deaths. The following 2 major dietary patterns were identified by using a principal components analysis: a vegetable-, fruit-, and soy-rich (VFS) pattern and a dim sum- and meat-rich (DSM) dietary pattern. Pattern scores for each participant were calculated and examined with all-cause and cause-specific mortality risks by using a Cox proportional hazards regression. The VFS pattern was inversely associated with all-cause mortality and each cause-specific category (CVD, cancer, and respiratory) of mortality during the follow-up period. Compared with the lowest quintile of the VFS pattern, HRs for quintiles 2-5 for all-cause mortality were 0.90, 0.79, 0.80, and 0.75, respectively (P-trend < 0.0001). The DSM pattern was positively associated with CVD mortality in the whole population (HR for fifth quintile compared with first quintile: 1.23; 95% CI: 1.07, 1.40; P-trend = 0.001). Positive associations between the DSM pattern and cancer and all-cause mortality were only present in ever-smokers. In ever-smokers, relative to the first quintile, HRs for quintiles 2-5 of the DSM pattern for all-cause mortality were 1.04, 1.04, 1.13, and 1.24, respectively (P-trend < 0.0001). Similarly, HRs for quintiles 2-5 for cancer mortality were 1.08, 1.03, 1.25, and 1.34, respectively (P-trend < 0.0001). The DSM pattern was not associated with respiratory mortality. Dietary patterns are strongly associated with mortality in Chinese Singaporeans.

67. A case of sudden unexpected death in epilepsy (SUDEP) in a patient affected by septic shock

Sudden unexpected death in epilepsy (SUDEP) represents a significant category of mortality in the population with chronic epilepsy. A consistent feature is that most of these deaths are unwitnessed. We report the case of an aged woman (85 years old) who was admitted in Department of Emergency. She was affected by an ovarian cancer complicated by septic shock. After about six hours she presented myoclonic jerks. The EEG recording was undertaken using a digital EbNeuro (BElight model), jasper montage, 7 μV/mm amplitude, 30 HZ filter; 0.01 s. time constant. The ECG recording was obtained from monitor that registered all vital parameters (Body Temperature, Arterial Pressure, Oxygen Saturation, Cardiac Frequency). At the beginning of the EEG activity myoclonic jerks were registered with recurrent spike waves, after 20 s the patient presented generalised seizure (monitored by EEG with continuous diffused spike waves) and than suddenly she died. On EEG the seizure activity abruptly terminated and EEG became a flat line. At the beginning of the registration ECG registered tachycardia (110 Cardiac Frequency media value) and after the generalised seizure ECG rhythm rapidly changed and finally became a flat line. We hypothesized that death was due to SUDEP caused by septic shock.

English

AIMS: This study aimed to find out prevalence of grand multipara, reasons for current pregnancy, knowledge and use of family planning methods, maternal and perinatal outcome in grand multipara. MATERIALS AND METHODS: The study was conducted in Department of Obstetrics and gynecology, Tertiary care centre, Bhopal during 1 year period from 1st March 2011 to 28th February 2012. It is a hospital based clinical prospective study. RESULTS: In study period 327 grand multiparous women admitted out of total obstetric admission of 13202 at Tertiary care centre, Bhopal. The prevalence of grand multiparity was 2.47%. Most of grand multipara cases belong to age group between 26-30 years mean age in the study was 30.9 year. Maximum numbers of cases were fourth para 58.4%; ninth para constitutes only 0.6%. Maximum number of cases 61% belonged to rural areas. Booked cases were only 25% and referred cases were 65%. Most of the grand multipara i.e. 91% belonged to low socioeconomic class. About 37.3% of grand multipara were illiterate. Anaemia is the most common maternal complication i.e. 36.1%. Hypertensive disorder of pregnancy is the 2nd most common (22.9%) complication. Other complications includes IUFD (14.2%), Abruptio placentae (12.6%), malpresentation (11.1%), post partum haemorrhage (10%) preterm labour (5.9%), Placenta previa (5.1%) In this study rate of caesarean section is 21% and most common indications found were foetal distress (33.3%). Rupture uterus (1.9%) was an outstanding hazard is grand multipara. Perinatal mortality was more in grand multiparous women than in lesser parity group. CONCLUSION: Grand multipara constitutes one category of high risk pregnancies Maternal and fetal mortality and morbidity increases with parity. The Grand multiparity a high risk pregnancy and its complication can be prevented by strengthening of referral services, by providing Logistic solution to communication and transport problems, Health Education to mothers and implementing compulsory family planning programme.

Prediction of in-hospital mortality and admission to ICU using vital signs - a study of Early Warning Score as an alternative to traditional triage

Background Triage of patients in the Emergency Department includes scoring of vital parameters. The objective of this study was to compare two such triage systems for assessing vital parameters - a single-parameter system, T-vital, as used in Danish Emergency Process Triage, and a multiple-parameter system, T-EWS, which we based on Early Warning Score (EWS) - and correlate the triage scores to in-hospital mortality and admission to ICU. Studies examining EWS in triage are currently limited in number. Methods Using data from the Acute Admission Database of Nordsjaellands Hospital (n = 6164 admissions), we calculated and stratified EWS into four T-EWS colour codes (red, orange, yellow, and green), testing different stratifications’ correlation to in-hospital mortality and admission to ICU. Afterwards, we compared the ability of the chosen T-EWS and T-vital to predict patients at risk (red and orange category) of in-hospital mortality or admission to ICU. The data were analysed using area under the receiver operating curve (AUROC), sensitivity, specificity, overtriage, undertriage, and diagnostic rates. Results

Mortality Associated with Phaeochromocytoma

Two major categories of mortality are distinguished in patients with phaeochromocytoma. First, the effects of excessive circulating catecholamines may result in lethal complications if the disease is not diagnosed and/or treated timely. The second category of mortality is related to development of metastatic disease or other neoplasms. Improvements in disease recognition and diagnosis over the past few decades have reduced mortality from undiagnosed tumours. Nevertheless, many tumours remain unrecognised until they cause severe complications. Death resulting from unrecognised or untreated tumour is caused by cardiovascular complications. There are also numerous drugs and diagnostic or therapeutic manipulations that can cause fatal complications in patients with phaeochromocytoma. Previously it has been reported that operative mortality was as high as 50% in unprepared patients with phaeochromocytoma who were operated and in whom the diagnosis was unsuspected. Today mortality during surgery in medically prepared patients with the tumour is minimal. Phaeochromocytomas may be malignant at presentation or metastases may develop later, but both scenarios are associated with a potentially lethal outcome. Patients with phaeochromocytoma run an increased risk to develop other tumours, resulting in an increased mortality risk compared to the general population. Phaeochromocytoma during pregnancy represents a condition with potentially high maternal and foetal mortality. However, today phaeochromocytoma in pregnancy is recognised earlier and in conjunction with improved medical management, maternal mortality has decreased to less than 5%.