Contributory Causes Research Articles

Hypernatraemia in South African hospitalised patients

Background: Hypernatraemia is a common electrolyte problem in hospitalized patients and is associated with a high mortality rate. We aimed to determine the incidence, causes, management, and outcomes of hypernatraemia in adult hospitalized patients at a large South African tertiary hospital. Methods : A retrospective study was conducted at Tygerberg Hospital in Cape Town, South Africa. Adult patients with hypernatraemia (at least one serum sodium concentration ≥150 mmol/L) during a 3-month period in 2014 were identified from our laboratory database for inclusion. Results : There were 204 patients with hypernatraemia, an incidence of 1.5%. Of these patients, 101 (49.5%) were male, and the mean age was 53 years. There were 66 patients (32.4%) who had hypernatraemia on admission, and 138 who developed it during the course of their hospital stay. The overall in-hospital mortality was 38.7%, with higher rates for older patients and those with more severe degrees of hypernatraemia. Contributory causes which were most commonly present included dehydration/hypovolaemia (45%), followed by sepsis (39%). Net sodium gain, rather than water deficit, was identified as the main mechanism in most of the patients who developed hypernatraemia in the intensive care units. We found little evidence of any diagnostic work-up and also found that the details of fluid therapy and intake-output charting were poorly documented. Conclusions : There is a very high mortality rate in our hospitalized patients with hypernatraemia. The diagnostic work-up and therapy was often inadequate or poorly documented. The management of this important condition needs to be improved with the aid of standardized protocols.

Contribution of smoking and alcohol consumption to income differences in life expectancy: evidence using Danish, Finnish, Norwegian and Swedish register data

BackgroundDespite being comparatively egalitarian welfare states, the Nordic countries have not been successful in reducing health inequalities. Previous studies have suggested that smoking and alcohol contribute to this pattern. Few...

RETRACTED ARTICLE: Automatic detection of lung cancer from biomedical data set using discrete AdaBoost optimized ensemble learning generalized neural networks

Today, most of the people are affected by lung cancer, mainly because of the genetic changes of the tissues in the lungs. Other factors such as smoking, alcohol, and exposure to dangerous gases can also be considered the contributory causes of lung cancer. Due to the serious consequences of lung cancer, the medical associations have been striving to diagnose cancer in its early stage of growth by applying the computer-aided diagnosis process. Although the CAD system at healthcare centers is able to diagnose lung cancer during its early stage of growth, the accuracy of cancer detection is difficult to achieve, mainly because of the overfitting of lung cancer features and the dimensionality of the feature set. Thus, this paper introduces the effective and optimized neural computing and soft computing techniques to minimize the difficulties and issues in the feature set. Initially, lung biomedical data were collected from the ELVIRA Biomedical Data Set Repository. The noise present in the data was eliminated by applying the bin smoothing normalization process. The minimum repetition and Wolf heuristic features were subsequently selected to minimize the dimensionality and complexity of the features. The selected lung features were analyzed using discrete AdaBoost optimized ensemble learning generalized neural networks, which successfully analyzed the biomedical lung data and classified the normal and abnormal features with great effectiveness. The efficiency of the system was then evaluated using MATLAB experimental setup in terms of error rate, precision, recall, G-mean, F-measure, and prediction rate.

Maxillofacial Trauma: Peri Operative Challenges in the Management of Facial Bone Fractures

Facial trauma and fractures of the facial bones may have associated brain and cervical spine injuries. Assault, gunshot wounds and motor vehicle accidents (MVA) are major contributory causes. Trauma units must be competent in airway management. Death may result from trauma itself, haemorrhage, aspiration or hypoxia. Initial screening of neurological injury must be followed by neural imaging studies and neurological examination.

Retrospective analysis of the frequency and contributory causes of ascites syndrome in broilers in South Banat

Ascites syndrome is a multi-factorial, noncontagious disease of broilers. Chickens selected for rapid growth have a high basal metabolism and consequently increased demands for oxygen. Poor environmental conditions and other unfavourable factors which reduce the amount of available oxygen cause hypoxia, pulmonary hypertension, right ventricular dilation and right heart failure, which results in generalized passive hyperaemia of organs and ascites as the most striking gross pathology manifestation. The aim of the study was to investigate, retrospectively, the frequency of the disease in a selected district with widespread poultry production and to identify main factors that contribute to the outbreak of the disease. In the period from 2011 to 2017 ascites syndrome was diagnosed by post mortem examination of chickens in 12 out of 91 flocks with health disorders, examined in the Veterinary Specialized Institute "Pancevo". Based on anamnesis, signs of disease and pathomorphological findings, poor environmental conditions and inadequate feed were identified as main contributory factors. In the majority of cases ascites syndrome occurred in small flocks, raised in unsuitable environmental conditions.

LA PACE E LA GIUSTIZIA COME “DIRITTI ESSENZIALI” DELL’UOMO

The link between peace and justice, in the system of sources of Italian law is often expressed through the two antithetic categories, namely the idea of war and the concept of social injustice. In fact, the Constitution sometimes makes a direct reference to peace; other times, recalls the peace in an indirect way, through its opposite, war, that repudiates firmly. In the history of humanity, the issues of social injustice have been contributory causes expressions of dissatisfaction, in the face of existential human rights ignored, injury and lack of respect for the dignity of the person. Therefore, the phenomenon of peace has become more not only a legal but also economic, ethical and social importance. In this perspective, the right to peace and the right to social justice may be included among the essential rights of man, worthy of absolute protection and unconditional.

Major Causes of Death in Preterm Infants in a Low Resource Setting: A Prospective Observational Study in Ethiopia (The SIP Study)

Background: Preterm birth is the leading cause of neonatal deaths. Neonatal deaths account for 46% of under-five deaths. Just over a third of neonatal deaths are a result of preterm-related causes. With the increasing contribution of neonatal deaths to overall child mortality, urgent action is needed to determine the major causes of preterm mortality. Methods: A multi-centre prospective observational study was undertaken in 5 tertiary hospitals in Ethiopia over a period of nearly 2 years to determine the causes of preterm mortality in the first 28 days of life. An independent panel of experts determined the primary and contributory causes of preterm mortality using data on maternal/obstetric history, clinical conditions, laboratory investigations and post-mortem examinations (both complete diagnostic autopsy [CDA] and minimally invasive tissue sampling [MITS]) when consent is obtained. Findings: A total of 4,919 preterm infants were enrolled in the study. Of these 3,852 were admitted to NICU's and of these 1109 died. The main causes of death were RDS (45%), sepsis, pneumonia and meningitis (30%) and asphyxia 14%. Hypothermia was the most common contributory cause of preterm mortality (69%). Interpretation: Three conditions were the primary causes of death among preterm infants accounting for 89% of all deaths. There is a need to scale up interventions against these conditions and in particular those specific to RDS such as continuous positive airway pressure (CPAP), and blended oxygen to contribute to the reduction of neonatal mortality. Funding: This study was funded by grants from the Bill & Melinda Gates Foundation. Declaration of Interest: The authors declare no conflicts of interest. Ethical Approval: The study was approved by the Institutional Review Board of each hospital and at the College of Health Sciences of the Addis Ababa University. Written consent for participation in the study was obtained, with a separate written consent for autopsy and MITS, in cases of death. Consent was obtained in English, Amharic and Oromifa languages, as appropriate. Confidentially of the information was maintained.

Work-Relatedness.

Work-Relatedness.

Place of death and factors associated with hospital death in patients who have died from liver disease in England: a national population-based study

Liver disease is a major cause of mortality, with high numbers of hospital deaths, and disproportionately affects people younger than 65 years. This study aims to examine the place of death and factors associated with hospital death for people who died from liver disease. We did a national population-based, observational study using the National Death Registration Database from the Office for National Statistics, 2001-14. All non-accidental adult deaths (hospital and non-hospital) from liver disease in England were included. Explanatory variables were underlying cause of death, contributory causes of death (number and specific causes), age at death, sex, marital status, year of death, index of multiple deprivation, rural or urban settlement, and residential region. We applied modified Poisson regression models to assess the strength of association between hospital death and explanatory variables using an adjusted prevalence ratio (PR). 135 953 decedents were included, of whom 56 065 (41·2%) died from alcohol-related liver disease. Annual deaths from liver disease increased from 7811 in 2001, to 11 017 in 2014. Hospitals were the main place of death (66·9% [95% CI 66·6-67·1]) for patients who died from liver disease. The proportion of hospital deaths reduced from 71·5% in 2001 to 60·0% in 2014. After adjusting for sociodemographic factors, patients who died from alcohol-related liver disease had the highest chance of hospital death; people who died from liver cancer were less likely to die in hospital than people with alcohol-related liver disease (adjusted PR 0·61 [95% CI 0·60-0·61]). People with four or more contributory causes of death were more likely to die in hospital than those with no contributory causes (1·45 [1·42-1·47]). Patients with sepsis (1·24 [1·23-1·25]), hepatorenal syndrome (1·22 [1·21-1·22]), and peritonitis (1·18 [1·17-1·20]) had higher chances of hospital death than those without these respective contributory causes, and those with alcohol-related disorders (0·67 [0·66-0·69]) had lower chances of hospital death. The high risk of hospital death in patients with sepsis, hepatorenal syndrome, or peritonitis warrants further investigation, and the low chance of hospital death in patients with alcohol-related disorders also needs to be explored. Prevention strategies and end-of-life care services are urgently needed to prevent and tackle harms from liver disease. National Institute of Health Research Health Services and Delivery Research Programme, and Collaboration for Leadership in Applied Health Research and Care South London.

Brief Report: Regional Variations in Characteristics of ASD Hospitalizations in the U.S.

Regional differences in ASD inpatient care remain understudied. We used the Nationwide Inpatient Sample to examine contributory causes and potential determinants associated with regional variations in ASD hospitalizations. We performed univariate and multivariate analyses to identify differences in ASD hospitalizations across four U.S. Census Bureau-defined regions. Our results revealed considerable variations in ASD hospitalizations across U.S. regions. Compared with patients in the Northeast, those in the Midwest, South, and West were less likely to be hospitalized for ASD. Significant differences were observed among regions with regard to the effect of health insurance type, hospital length of stay, hospital bed size, hospital location and teaching status on ASD hospitalizations. The region-specific analysis provides direction for further investigation.

A Prospective Study of Causes of Illness and Death in Preterm Infants in Ethiopia: The SIP Study Protocol

BackgroundWith nearly 15 million annual preterm births globally, preterm birth is the most common cause of neonatal death. Forty to 60 % of neonatal deaths are directly or indirectly associated with preterm mortality. As countries aim to meet the Sustainable Development Goals to reduce neonatal mortality, significant reductions in preterm mortality are needed. This study aims to identify the common causes of preterm illness and their contribution to preterm mortality in low-resource settings. This article will describe the methods used to undertake the study.MethodsThis is a prospective, multi-centre, descriptive clinical study. Socio-demographic, obstetric, and maternal factors, and clinical and laboratory findings will be documented. The major causes of preterm mortality will be identified using clinical, laboratory, imaging, and autopsy methods and use the national Ethiopian guidelines on management of preterm infants including required investigations to reach final diagnoses. The study will document the clinical and management protocols followed in these settings. The approach consists of clinical examinations and monitoring, laboratory investigations, and determination of primary and contributory causes of mortality through both clinical means and by post-mortem examinations. An independent panel of experts will validate the primary and contributory causes of mortality.To obtain the estimated sample size of 5000 preterm births, the study will be undertaken in five hospitals in three regions of Ethiopia, which are geographically distributed across the country. All preterm infants who are either born or transferred to these hospitals will be eligible for the study. Three methods (last menstrual period, physical examination using the New Ballard Score, and ultrasound) will be used to determine gestational age.All clinical procedures will be conducted per hospital protocol and informed consent will be taken from parents or caretakers prior to their participation in the study as well as for autopsy if the infant dies.DiscussionThis study will determine the major causes of death and illness among hospitalized preterm infants in a low-resource setting. The result will inform policy makers and implementers of areas that can be prioritized in order to contribute to a significant reduction in neonatal mortality.

Extreme hypomagnesemia: characteristics of 119 consecutive inpatients

Extreme hypomagnesemia (hypoMg) can be encountered in many situations, but little data currently exist. Our aim is to describe the epidemiological, clinical, etiological characteristics, and the biological abnormalities of consecutive inpatients with extreme hypomagnesemia. In our observational monocentric study, between 1st July 2000 and April 2015, all inpatients with extreme hypomagnesemia, defined by at least one plasma magnesium concentration (PMg) below 0.3mmol/L, were included. Demographic, clinical, biological characteristics and the drugs prescribed before the qualifying PMg measurement were retrospectively collected. 41,069 patients had at least one PMg assessment. The prevalence of extreme hypomagnesemia is 0.3% (119 inpatients). The median age is 70years, 52% are women. The patients were mainly hospitalized in intensive care (n = 37, 31.1%), oncology (n = 21, 17.6%), gastroenterology (n = 18, 15.1%) and internal medicine (n = 16, 13.4%) departments. One hundred patients (84%) had a medical history of gastrointestinal disease (39% with bowel resections, 24% with stoma), and 50 (42%) had a cancer history. The drugs most commonly prescribed (known to induce hypoMg) are proton pump inhibitors (PPI) (n = 77, 70%), immunosuppressive regimens (n = 25, 22.5%), platinum salt-based chemotherapies (n = 19, 17.1%), and diuretics (n = 22, 19.8%). The suspected causes of hypomagnesemia are often multiple, but drugs (46%, including PPI in 19%) and chronic gastrointestinal disorders (37%) are prominent. Associated electrolyte disturbances include hypocalcemia (77%) and mild hypokalemia (51%). The 1-month mortality from all causes is 16%. Extreme hypomagnesemia is rare in inpatients, and is frequently associated with severe hypocalcemia. Digestive disorders and drugs are the main contributory causes.

Fuzzy logic system interference in ship accidents

AbstractPoor lookout, lack of situation awareness, and delayed response have been continuously recognized as contributory causes of navigation accidents (i.e., collisions and groundings). It is claimed that such negative behavioral characteristics can be corrected when the navigation system is equipped with the automation capability to intervene upon their detection. Building on the results of my previous work, this study sets the starting line in exploring this technological innovation under a conceptual framework, where it is attempted to employ simple, quantifiable, and measurable ways to assess the deck officer's (navigator's) complex aspect of mental task reliability. To deal with this challenge, the navigator's behavior when performing navigation tasks is described by the Markov method and the uncertainty, ambiguity, and weakness in perceiving accurately the environment and traffic conditions is determined by fuzzy logic. The proposed concept is demonstrated through its practical application in collision and grounding accidents, where it is argued that further research is required for its validation.

Aggregate analysis of sentinel events as a strategic tool in safety management can contribute to the improvement of healthcare safety.

To examine if clustering of root causes of sentinel events (SEs) can contribute to organisational improvement of healthcare and patient safety by providing insight into organisational risk factors, patterns and trends. Retrospective, cross-sectional review of SEs from a hospital database reported to the Board of directors in 2016. A regional teaching hospital in the Netherlands. Clustering of characteristics and variables of SEs to establish vulnerabilities and patterns of failure factors of the organisation. Characteristics and contributory causes of failure of SEs identified via root cause analysis (RCA). Outcomes reported using descriptive statistics. A total of 21 events were included involving 21 patients. Mean age was 56.7 years (SD 24.4), 71.4% were above 50 years of age. In 81.8%, the care was multi-disciplinary and in 76.2% the event resulted in permanent harm or injury. Of the 132 identified contributory root causes, most were related to human factors (53.8%) and organisational factors (40.2%). Technical and patient-related factors were identified in 3.0%. Organisational improvement strategies focused on the care of elderly patients, patients subjected to multi-disciplinary care and on improving knowledge, protocols and coordination of care. Clustering variables of SEs and contributory factors of failure through RCA helps to delineate a hospital-specific profile by providing a detailed insight into risk factors, patterns and trends in an organisation and to determine the best strategies for improvement by drawing lessons across events.

The Diagnosis and Treatment of Functional Dyspepsia.

Functional dyspepsia (FD) is one of the more common functional disorders, with a prevalence of 10-20%. It affectsthe gastrointestinal tract. This article is based on publications retrieved by a selective search of PubMed, with special attention to controlled trials, guidelines, and reviews. Typical dyspeptic symptoms in functional dyspepsia include epigastric pain, sensations of pressure and fullness, nausea, and early subjective satiety. The etiology of the disorder is heterogeneous and multifactorial. Contributory causes include motility disturbances, visceral hypersensitivity, elevated mucosal permeability, and disturbances of the autonomic and enteric nervous system. There is as yet no causally directed treatment for functional dyspepsia. Its treatment should begin with intensive patient education regarding the benign nature of the disorder and with the establishment of a therapeutic pact for long-term care. Given the absence of a causally directed treatment, drugs to treat functional dyspepsia should be given for no more than 8-12 weeks. Proton-pump inhibitors, phytotherapeutic drugs, and Helicobacter pylori eradication are evidence-based interventions. For intractable cases, tricyclic antidepressants and psychotherapy are further effective treatment options. The impaired quality of life of patients with functional dyspepsia implies the need for definitive establishment of the diagnosis, followed by symptom-oriented treatment for the duration of the symptomatic interval.

Bath-related Deaths in Korea between 2008-2015.

BackgroundThe diagnostic criteria for bathtub drownings are not standardized, and the risk factors associated with bath-related deaths are unclear.MethodsWe analyzed a Korean nationwide database of bath-related deaths that occurred between January 2008 and December 2015. Eighty-four cases were enrolled after reviewing 31,123 autopsy records.ResultsThe subjects' ages ranged from 18 to 91 years, with a mean age ± standard deviation of 61.3 ± 16.0 years. Bath-related deaths in the winter were approximately 4.6-fold greater than those in the summer. Of the 84 subjects, the primary cause of death in 57 (67.9%) was drowning in the bath; 24 (28.6%) drowned of other causes such as natural diseases, and 3 (3.6%) died of acute alcohol intoxication. We analyzed water-inhalation signs to establish criteria for bathtub drowning diagnosis. There were significantly higher incidences of hyperinflated lungs, water in the sphenoid sinus and stomach/duodenal contents, and Paltauf's spots (subpleural hemorrhage) in bathtub-drowned subjects compared to non-drowned individuals (P < 0.01). Multiple signs of water inhalation were significantly associated with bathtub drowning (P < 0.01). The two leading contributory causes of bath-related death were cardiovascular diseases and alcohol intoxication (binge drinking before bathing).ConclusionThe diagnosis of bath-related deaths could present considerable medico-legal problems; therefore, a comprehensive autopsy with a thorough scene investigation can clarify the cause of death in these situations. Preventive strategies for reducing such deaths should target alcohol drinking before bathing and long soaking times in bathtubs, especially among elderly individuals with preexisting cardiovascular diseases.

Antibiotics prescription pattern and compliance for common childhood illnesses – an observational study

Introduction: Antibiotics are generally overused in children. Frequent inappropriate use of antibiotics and poor compliance contributes to antibiotic resistance. An observational study was undertaken to determine the pattern of antibiotic use and compliance for common ailments in children attending a tertiary care hospital in Puducherry, South India. Methods: Data was obtained from 197 consecutive children who had visited a health care provider during the previous two weeks for any ailment, in a pretested semi structured questionnaire. Data was entered on MS Excel spreadsheet and analysed using Stata14.0 (Stata Corp, College Station, Tx). Chi square test with Fisher’s modification and logistic regression models were used in the analysis. Results: Acute respiratory infections were the most common infections in all age groups followed by diarrheal disorders in infants and fever in older children. Proportion of illnesses which received antibiotics was 75% for respiratory illnesses, 78% for fever, 50% for diarrheal disorders and 64% for other infections, there being no statistically significant difference between them. Out of 143 children who were prescribed antibiotics, 127 (89%) gave the medicines as prescribed. However, only 53 (37%) completed the full course of antibiotics. Compliance with treatment was not associated with age or the type of illness. Most of the parents (73%) discontinued antibiotics because of worsening of symptoms. Adverse reaction to antibiotics was seen in 32 (22%) children. Conclusion: Overuse of antibiotics for common ailments and poor compliance with treatment were perhaps important contributory causes for development of antimicrobial resistance in this region.

Decreased viability and proliferation of CHANG conjunctival epithelial cells after contact with ultraviolet light-irradiated pollen

Context: Contact with pollen is the major reason for the development of allergic symptoms on the ocular surface leading to a significant increase of allergic diseases worldwide. Environmental changes such as increased ultraviolet (UV) radiation and air pollution are discussed as contributory causes for this increase.Objective: We investigated the effect of UV light on the histamine content of pollen and examined if an irradiation of pollen affects the viability and proliferation of conjunctival cells.Materials and methods: Alder (Alnus glutinosa) and hazel (Corylus avellana) pollen were irradiated for different time periods with sunlight, UV-A or UV-B light and the histamine content was analysed and compared with non-irradiated pollen. Conjunctival epithelial cells (CHANG cells) were exposed to irradiated and non-irradiated pollen followed by an assessment of cell viability with the colorimetric MTS test and the impedance-based measurement of cell proliferation using the xCELLigence real-time analysis system.Results: UV light irradiation increased the histamine level of alder and hazel pollen in a dose-dependent manner. CHANG cells treated with irradiated pollen induced a statistically significant higher decrease of cell viability than treatment with non-irradiated pollen.Discussion and conclusions: Our results indicate that UV light is able to alter pollen thus making them more harmful for conjunctival cells.

Tuberculosis mortality and the male survival deficit in rural South Africa: An observational community cohort study.

BackgroundWomen live on average five years longer than men, and the sex difference in longevity is typically lower in populations with high mortality. South Africa—a high mortality population with a large sex disparity—is an exception, but the causes of death that contribute to this difference are not well understood.MethodsUsing data from a demographic surveillance system in rural KwaZulu-Natal (2000–2014), we estimate differences between male and female adult life expectancy by HIV status. The contribution of causes of death to these life expectancy differences are computed with demographic decomposition techniques. Cause of death information comes from verbal autopsy interviews that are interpreted with the InSilicoVA tool.ResultsAdult women lived an average of 10.4 years (95% confidence Interval 9.0–11.6) longer than men. Sex differences in adult life expectancy were even larger when disaggregated by HIV status: 13.1 (95% confidence interval 10.7–15.3) and 11.2 (95% confidence interval 7.5–14.8) years among known HIV negatives and positives, respectively. Elevated male mortality from pulmonary tuberculosis (TB) and external injuries were responsible for 43% and 31% of the sex difference in life expectancy among the HIV negative population, and 81% and 16% of the difference among people living with HIV.ConclusionsThe sex differences in adult life expectancy in rural KwaZulu-Natal are exceptionally large, atypical for an African population, and largely driven by high male mortality from pulmonary TB and injuries. This is the case for both HIV positive and HIV negative men and women, signalling a need to improve the engagement of men with health services, irrespective of their HIV status.

Medication overuse headache (MOH) -the controversies and the consensus

Medication Overuse Headache (MOH) is well established as one of the important contributory causes of chronic headache. MOH is defined as daily or near-daily headache that occurs in patients with primary headache disorders who overuse acute headache medications. Based on recent evidence, revisions have been proposed to the diagnostic criteria for MOH.