Surgical and anesthetic mortality in Mackay Memorial Hospital 1988-1989]

The mortality associated with 52128 anesthetics administered over two years (1988-1989) at Mackay Memorial Hospital, Taipei, was reported. The frequency of death to which anesthesia contributed was 0.4/10000 (2 cases in 52128 anesthetics). The total mortality rate from surgery within one week was 0.2% (105 cases in 52128 anesthetics). Anesthetic deaths were responsible for 1.9% of the total mortality. There were 25 cases of cardiac arrest with 18 fatal cases (7 cases were recovered after cardiopulmonary resuscitation). The causes of cardiac arrest during anesthesia included anesthetic factors (24%), surgical factors (24%) and patients' pathological factors (52%).     

Dietary sodium intake and subsequent risk of cardiovascular disease in overweight adults

CONTEXT: Dietary sodium is positively associated with blood pressure, and ecological and animal studies both have suggested that high dietary sodium intake increases stroke mortality. OBJECTIVE: To examine the risk of cardiovascular disease associated with dietary sodium intake in overweight and nonoverweight persons. DESIGN: Prospective cohort study. SETTING: The first National Health and Nutrition Examination Survey Epidemiologic Follow-up Study, conducted in 1982-1984, 1986, 1987, and 1992. PARTICIPANTS: Of those aged 25 to 74 years when the survey was conducted in 1971 -1975 (14407 participants), a total of 2688 overweight and 6797 nonoverweight persons were included in the analysis. MAIN OUTCOME MEASURES: Dietary sodium and energy intake were estimated at baseline using a single 24-hour dietary recall method. Incidence and mortality data for cardiovascular disease were obtained from medical records and death certificates. RESULTS: For overweight and nonoverweight persons, over an average of 19 years of follow-up, the total number of documented cases were as follows: 680 stroke events (210 fatal), 1727 coronary heart disease events (614 fatal), 895 cardiovascular disease deaths, and 2486 deaths from all causes. Among overweight persons with an average energy intake of 7452 kJ, a 100 mmol higher sodium intake was associated with a 32% increase (relative risk [RR], 1.32; 95% confidence interval [CI], 1.07-1.64; P = .01) in stroke incidence, 89% increase (RR, 1.89; 95% CI, 1.31-2.74; P<.001) in stroke mortality, 44% increase (RR, 1.44; 95% CI, 1.14-1.81; P = .002) in coronary heart disease mortality, 61% increase (RR, 1.61; 95% CI, 1.32-1.96; P<.001) in cardiovascular disease mortality, and 39% increase (RR, 1.39; 95% CI, 1.23-1.58; P<.001) in mortality from all causes. Dietary sodium intake was not significantly associated with cardiovascular disease risk in nonoverweight persons. CONCLUSIONS: Our analysis indicates that high sodium intake is strongly and independently associated with an increased risk of cardiovascular disease and all-cause mortality in overweight persons.     

Death caused by recreational cocaine use. An update

The epidemiologic, pathological, and toxicological findings of 60 cocaine-related overdose deaths from middle 1978 through 1982 were studied and compared with a previous publication by this office. In addition, 180 deaths where cocaine was an incidental toxicological finding are also discussed. Currently, the average street cocaine fatality victim is 29 years old, and 42% of the victims are female. Blacks comprise 39% of the cases. The blood cocaine concentration in "street cocaine" fatality victims averaged 6.2 mg/L with a wide range, necessitating careful interpretation of the toxicological results in conjunction with terminal events. Although autopsy findings were generally nonspecific, multiple needle-puncture marks with surrounding ecchymoses are typical of IV cocaine abuse. An increase in cocaine-related overdose deaths is anticipated because of its popularity, increasing availability, and, currently, the increased purity of street cocaine.     

Impact of the human immunodeficiency virus epidemic on mortality in women of reproductive age, United States

To assess the effect of the human immunodeficiency virus (HIV) on mortality in US women 15 to 44 years of age and to identify associated causes of death, we examined final (1980 through 1987) and provisional (1988) national mortality statistics. Between 1985 and 1988, the death rate for HIV/acquired immunodeficiency syndrome (AIDS) quadrupled (0.6 per 100,000 to 2.5 per 100,000), and by 1987, HIV/AIDS had become one of the 10 leading causes of death. In 1988, the death rate for black women (10.3 per 100,000) was nine times the rate for white women (1.2 per 100,000). The majority of deaths in both black and white women occurred in women 25 to 34 years of age, for whom HIV-related deaths accounted for 11% and 3% of all deaths in 1988, respectively. Among 1157 death certificates that included any mention of HIV/AIDS in 1987, other leading diagnoses included drug abuse (27%), Pneumocystis carinii pneumonia (20%), other pneumonias (14%), septicemia (10%), other infections not in the AIDS surveillance definition (7%), nephritis (6%), liver diseases (4%), and anemias (4%). If current mortality trends continue, HIV/AIDS can be expected to become one of the five leading causes of death by 1991 in women of reproductive age. Because women infected with HIV are the major source of infection for infants, these trends in AIDS mortality in women forecast the impact of HIV on mortality in children as well.     

Effect of medical thromboprophylaxis on mortality from pulmonary embolus and major bleedingy

Background

Several studies have failed to discover a beneficial effect of medical thromboprophylaxis on mortality.

Aims

To examine the relative influence of acute fatal pulmonary embolism (PE) and fatal major haemorrhage on overall mortality in medical patients treated with low molecular weight heparin (LMWP) for prophylaxis.

Methods

The author compared deaths from the above factors using data from a recent Cochrane Collaboration meta-analysis. Data from trials satisfying the criteria of the Cochrane analysis plus additional exclusions to avoid bias were pooled to produce point estimates of mortality from PE and major bleeds to estimate net mortality benefit. Estimates were then subject to limited sensitivity analysis based on reported epidemiological data.

Results

Reported PE and major bleeds were 0.44 per cent and 0.27 per cent, respectively. The corresponding case-specific mortality rates were 30.8 per cent and 12.8 per cent and the relative risk reduction (RRR) for PE was 23.2 per cent. Estimated deaths from major bleeds exceeded PE deaths avoided by a small margin (3/100,000 patients given prophylaxis). This excess increased to 30/100,000 when more plausible literature values for PE case fatality rates were applied.

Conclusion

Medical thromboprophylaxis has a finely balanced effect on mortality but may increase it. Such an effect would explain the failure to discover a mortality benefit from medical thromboprophylaxis. Further work, including a formal meta-analysis and additional clinical studies, is required to confirm this picture.     

Deaths associated with diabetic ketoacidosis and hyperosmolar coma. 1973-1988

We assessed the possibility of improvements in the management of the potentially fatal acute hyperglycaemic complications of diabetes by a review of all deaths in patients who presented to the Alfred Hospital, Melbourne, with diabetic ketoacidosis or hyperosmolar coma during the 16 years, 1973-1988. All late deaths of patients during hospitalization were included in the mortality data. In the 610 episodes of diabetic ketoacidosis (pH, 7.30 or lower) or hyperosmolar coma (osmolality, 350 mOsmol/kg or greater), only one death occurred as a result of the acute metabolic disturbance--in a patient who had suffered a cardiac arrest before admission to hospital. The over-all mortality rate was 6.2% (38 deaths). The mortality rate was 4.9% (26 deaths) for 528 episodes of diabetic ketoacidosis and 14.6% (12 deaths) for 82 episodes of hyperosmolar coma. Patients with diabetic ketoacidosis who died were older than were those who survived (64 +/- 13 years compared with 40 +/- 21 years, respectively; P less than 0.001). Mortality in patients with hyperosmolar coma did not relate to age, initial blood-glucose level or osmolality. Twelve deaths resulted from bacterial pneumonia and two deaths resulted from aspiration pneumonia. Other major causes of death were mesenteric and iliac thromboses (six cases), myocardial infarction (eight cases) and cerebral haemorrhage (two cases). Of the 26 deaths that were associated with diabetic ketoacidosis, only two deaths--as a result of aspiration pneumonia and bowel infarction, respectively--were assessed as potentially avoidable after the patient's admission to hospital. Eight of the 12 hyperosmolar-coma-associated deaths occurred in newly recognized diabetic patients in whom there were avoidable delays in diagnosis. We conclude that further improvements in outcome will be difficult to achieve, but that efforts should be directed towards the earlier diagnosis of diabetes and the earlier recognition and treatment of associated acute pulmonary and vascular complications.     

Ambient Temperature and Mortality From Unintentional Cocaine Overdose

Context.— Hot weather taxes cardiovascular function and is associated with increased deaths from heart disease. Cocaine can cause hypertension, tachycardia, coronary vasospasm, arrhythmias, and increased core temperature. Objective.— To determine the association between mortality from cocaine overdose and hot weather. Setting.— New York, NY. Design.— Retrospective review of medical examiner cases from 1990 through 1995. Subjects.— All fatal unintentional cocaine overdoses from 1990 through 1992 (n=1382) and all hyperthermia deaths of cocaine users (n=10) were used to identify a maximum daily temperature threshold above which mortality from cocaine intoxication increased. The study population consisted of all fatal unintentional cocaine overdoses from 1993 through 1995 (n=2008) and 4 contemporaneous comparison groups that included fatal unintentional opiate overdoses (n=793), all other fatal unintentional overdoses (n=85), and a subset of homicides (n=4638) and fatalities from motor vehicle crashes (n=815). Main Outcome Measures.— The number of overdose deaths and the proportion of homicides and traffic fatalities with a positive cocaine toxicology test result on days with a maximum temperature above or below the temperature threshold. Results.— A threshold temperature of 31.1°C (88°F) was identified, above which the mean daily number of fatal cocaine overdoses increased steadily. On days with a maximum daily temperature of 31.1°C (88°F) or higher ("hot days"), the mean daily number of cocaine overdose deaths was 2.34 (SD=1.68), which was 33% higher than the mean on days with a maximum temperature of less than 31.1°C (88°F) (mean=1.76 [SD=1.37] (P<.001). In contrast, the mean number of opiate overdose deaths per day was 0.81 (SD=0.94) on hot days and 0.71 (SD=0.86) on other days (P=.28). For other drug overdose deaths, the mean number of deaths per day was 0.08 (SD=0.28) on hot days and 0.08 (SD=0.28) on other days (P=.69). Among homicides, the proportion with a positive cocaine toxicology test result was 18.9% on hot days and 19.5% on other days (P=.69), and among traffic fatalities, the proportions with positive cocaine toxicology test results were 9.5% on hot days and 10.3% on other days (P=.91). Conclusions.— High ambient temperature is associated with a significant increase in mortality from cocaine overdose. Based on our comparison groups, the increase is not explained by changes in cocaine use among the general population. Although cocaine use is dangerous on all days, it appears to be even more dangerous on hot days.      

The effect of a reduction in heroin supply on fatal and non-fatal drug overdoses in New South Wales, Australia

OBJECTIVE: To examine the impact of a sudden and dramatic decrease in heroin availability, concomitant with increases in price and decreases in purity, on fatal and non-fatal drug overdoses in New South Wales, Australia. DESIGN AND SETTING: Time-series analysis was conducted where possible on data on overdoses collected from NSW hospital emergency departments, the NSW Ambulance Service, and all suspected drug-related deaths referred to the NSW Coroner's court. MAIN OUTCOME MEASURES: The number of suspected drug-related deaths where heroin and other drugs were mentioned; ambulance calls to suspected opioid overdoses; and emergency department admissions for overdoses on heroin and other drugs. RESULTS: Both fatal and non-fatal heroin overdoses decreased significantly after heroin supply reduced; the reductions were greater among younger age groups than older age groups. There were no clear increases in non-fatal overdoses with cocaine, methamphetamines or benzodiazepines recorded at hospital emergency departments after the reduction in heroin supply. Data on drug-related deaths suggested that heroin use was the predominant driver of drug-related deaths in NSW, and that when heroin supply was reduced overdose deaths were more likely to involve a wider combination of drugs. CONCLUSION: A reduction in heroin supply reduced heroin-related deaths, and did not result in a concomitant increase, to the same degree, in deaths relating to other drugs. Younger people were more affected by the reduction in supply.     

Raised serum urate concentration as risk factor for premature mortality in middle aged men: relation to death from cancer

Low serum cholesterol concentrations are associated with deaths from cancer. This association was found in a prospective study of middle aged men in Malm? and consideration of possible explanations for the lowering of serum cholesterol prompted an analysis of serum urate in relation to deaths from cancer. A total of 127 of the 7725 participants in the Malm? study had died since screening. A weakly positive but significant correlation between raised serum urate concentration and total mortality was found. This correlation was wholly explained by neoplastic deaths (p less than 0.01), while there were no associations with alcohol related deaths or with deaths from coronary heart disease. When the deaths from cancer were classified as "early" or "late"--that is, occurring less than or more than 2.5 years after the screening--the correlation between raised urate concentrations and cancer mortality was confined to the "early" deaths (p less than 0.001). Further studies are needed to substantiate the relation between raised serum urate concentrations and fatal neoplasia. Nevertheless, these findings weigh against recent suggestions that uric acid has an antioxidant protective effect against cancer.     

The quantification of alcohol-caused morbidity and mortality in Australia: a critique.

One of the more controversial conclusions of the Commonwealth Department of Community Services and Health's report on The quantification of drug caused morbidity and mortality in Australia 1988 is that alcohol "causes" about 5% of all deaths in Australia. Against the background of this conclusion, this paper reviews current concepts of what constitutes a causal relationship and how the existence of causation is diagnosed in a nonexperimental setting. The conclusion of the report appears to rest on the assumption that all differences in disease rates between users and non-users of alcohol (or other drugs) are causal in nature--an assumption which is tantamount to equating statistical association with causation. Moreover, the estimate of alcohol-caused deaths, derived from the summation of alcohol-caused deaths from a large number of medical conditions, is at considerable variance with an estimate of total alcohol-caused deaths computed directly from total death rates. The latter estimate actually indicates that alcohol prevents more deaths than it causes in the population as a whole, a conclusion that is compatible with the findings of several recent large cohort studies, from which it is in fact derived. The discrepancy between the two estimates casts doubt on the validity of the assumptions underlying the methodology that has been applied.     

Fatal ischaemic heart disease in Belfast: a comparison of two community surveys

Data from two community surveys in Belfast were used to compare all deaths attributed to ischaemic heart disease during two one-year periods (1965/66 and 1981/82). There was an increase in mortality in men of all ages from 3.3 to 4.4 per 1,000 population (33%) and in women from 1.6 to 3.1 per 1,000 population (94%). Only in men aged less than 70 years was the mortality rate unchanged (2.2 per 1,000 population). The proportion of deaths in persons whose fatal attack began outside the hospital was virtually unchanged (65% in 1965/66 compared with 69% in 1981/82). Survival time was markedly decreased in the later survey, as were delay times in initiating medical care. The increase in mortality probably is due to an increase in the incidence of acute myocardial infarction. The introduction of mobile coronary care in Belfast in 1965 seems to have had equal effects in reducing mortality inside and outside hospital.     

我院近八年小儿麻醉死亡率的分析

1988年～1995年间记录完整的小儿麻醉10223例,手术总死亡人数184例,手术总死亡率为1.80％。与麻醉因素有关的死亡4例,麻醉死亡率为0.04％。分析了近八年来小儿麻醉死亡情况,虽然手术总数与1988年以前的35年相近,但麻醉死亡率却明显降低,分析了小儿麻醉死亡的原因,总结了降低小儿麻醉死亡率的经验,并提出了今后要注意的问题。     

Fatalities associated with the use of gamma-hydroxybutyrate and its analogues in Australasia

OBJECTIVE: To identify deaths in Australasia associated with overdose of gamma-hydroxybutyrate (GHB) and its precursors (gamma-butyrolactone and 1,4-butanediol). DESIGN: A retrospective search of medical and scientific information sources, as well as popular newsprint, for the period January 2000-August 2003, with formal clinical, toxicological and forensic evaluation of retrieved data. MAIN OUTCOME MEASURE: Death associated with forensic data implicating GHB or its analogues. RESULTS: Ten confirmed GHB-associated deaths were identified, with eight considered to be directly attributable to GHB. Only two of these eight cases were positive for ethanol toxicology. CONCLUSIONS: Our study supports the existing evidence that GHB overdose is associated with fatalities, and that fatal overdoses occur in the context of isolated use.     

AIDS prevention: what are we talking about?

A psychiatrist from Calcutta objects to the colonial culture which still dominates India. Specifically the call for prevention of AIDS and the spread of HIV made by developed countries, yet socioeconomic conditions in India hinder any prevention efforts. India faces other more common and preventable fatal diseases. The basic needs (food, shelter, health, and education) of most people cannot even be met. Thus an AIDS prevention program is an expensive luxury and probably would not reach those whose needs are already not met. 65% of AIDS cases are in Africa especially central Africa and almost 90% of AIDS cases in developing countries are in the most productive age group (20-49 years). The HIV/AIDS epidemic is indeed dealing countries an economic blow. For example, in 1988, AIDS related medical costs in the US stood at US$8.5 billion; lost wages US$55.6 billion; and research, education, and blood screening US$2.3 billion. Developing countries cannot absorb such an economic impact. The AIDS epidemic can strain a developing country's health system such as Zaire. For example, the cost of providing proper care for only 10 AIDS patients is higher than the entire budget of the largest hospital. Yet this hospital's physicians diagnose as many as 15 new cases daily. Economic loss/year due to AIDS deaths in Zaire will equal 8% of the gross national product by 1995. The poor often do not have access to health services. illiteracy (88%) in Brazil impedes AIDS prevention messages from reaching remote rural populations. Brazil already faces a high infant mortality rate and 33% of the population has malaria. Health and social problems in developing countries are so common that AIDS is just 1 more disease. Another obstacle to AIDS prevention in developing countries is that the poor cannot afford to buy condoms. The root cause of AIDS in developing countries is poverty.     

2013—2016年134例精神疾病患者死亡案例的回顾性分析

 目的 分析精神疾病患者死亡的法医学特征,为司法鉴定和临床关怀提供实践指导。 方法 收集上海市公安局虹口分局2013—2016年受理的精神疾病患者死亡案例,通过系统的案情调查、尸表检验,对所有死者的死亡原因、死亡方式及与相关因素进行统计学分析。 结果 2013—2016年间共有134例精神疾病患者死亡。男女比例为1∶1.23,平均年龄为(54.9±17.6)岁。89人(66.4%)精神病史超过3年,106人(79.1%)生前服用精神药物。抑郁症最常见(94例),其次为精神分裂症(35例)和焦虑症(5例)。死亡方式分别为自杀(117例)、猝死(16例)和意外(1例)。自杀案件以高坠最常见(79例,58.9%)。猝死案例较自杀案例具有更长的精神病史和用药史,多发生于住宅内。 结论 应重视精神疾病患者的精神和心理状况,同时注重预防和治疗其他躯体疾病。     

严重急性呼吸综合征134例死亡病例特征分析

目的:分析严重急性呼吸综合征死亡病例的特征,为早期诊断和治疗该疾病提供参考.方法:收集某市SARS死亡病例134例和同期临床诊断病例2 522例的资料,如发病-死亡时间、性别、年龄、临床症状等进行计算和比较.结果:死亡病例中男性74例,女性60例.患者从发病到死亡的时间中位数为11 d.随着年龄的增大,病死率增高.死亡病例中,31～50岁者占28.36%,51岁以上者占66.41%.死亡病例早期症状中咳痰、胸闷、呼吸困难和气促出现比例较高.结论:发病后11 d是SARS病例死亡的高峰;51岁以上人群是患者死亡的高危人群;早期呼吸道症状在死亡病例中的出现比例较高.     

Suicide risk among recently released prisoners in New South Wales, Australia

OBJECTIVE: To determine the risk of suicide and drug overdose death among recently released prisoners. DESIGN, SETTING AND PARTICIPANTS: Retrospective cohort study of 85 203 adult offenders who had spent some time in full-time custody in prisons in New South Wales between 1 January 1988 and 31 December 2002. MAIN OUTCOME MEASURES: Association between time after release and risk of suicide and overdose death. RESULTS: Of 844 suicides (795 men, 49 women), 724 (86%) occurred after release. Men had a higher rate of suicide than women both in prison (129 v 56 per 100,000 person-years) and after release (135 v 82 per 100,000 person-years). The suicide rate in men in the 2 weeks after release was 3.87 (95% CI, 2.26-6.65) times higher than the rate after 6 months. Male prisoners admitted to the prison psychiatric hospital had a threefold higher risk than non-admitted men both in prison and after release. No suicides among women were observed in the 2 weeks after release. No increased risk of suicide was observed among Aboriginal Australians in the first 2 weeks after release. Of 1674 deaths due to overdose, 1627 (97%) occurred after release. Drug-related mortality in men was 9.30 (95% CI, 7.80-11.10) times higher, and in women was 6.42 (95% CI, 3.88-10.62) times higher, in the 2 weeks after release than after 6 months. CONCLUSIONS: Prisoners are at a heightened risk of suicide and overdose death in the immediate post-release period. After 6 months post-release, the suicide rate approaches the rate observed in custody.     

Contributing death factors in very low-birth-weight infants by path method analysis

Background:

Neonatal deaths account for 40% of deaths under the age of 5 years worldwide. Therefore, efforts to achieve the UN Millennium Development Goal 4 of reducing childhood mortality by two-thirds by 2015 are focused on reducing neonatal deaths in high-mortality countries. The aim of present study was to determine death factors among very low-birth-weight infants by path method analysis.

Materials and Methods:

In this study, medical records of 2,135 infants admitted between years 2008 and 2010 in neonatal intense care unit of Alzahra Educational-Medical centre (Tabriz, Iran) were analysed by path method using statistical software SPSS 18.

Results:

Variables such as duration of hospitalisation, birth weight, gestational age have negative effect on infant mortality, and gestational blood pressure has positive direct effect on infant mortality that at whole represented 66.5% of infant mortality variance (F = 1018, P < 0.001). Gestational age termination in the positive form through birth weight, and also gestational blood pressure in negative form through hospitalisation period had indirect effect on infant mortality.

Conclusion:

The results of the study indicated that the duration of low-birth-weight infant''s hospitalisation is also associated with infant''s mortality (coefficient -0.7; P < 0.001). This study revealed that among the maternal factors only gestational blood pressure was in relationship with infants’ mortality.     

7712例围产儿出生缺陷监测分析

监测围产儿7712例,发现先天畸形儿67例,占8.68‰。同期围产儿死亡148例,围产儿死亡率19.19‰。125例作尸检,尸检率84.46％。148例死亡围产儿中先天畸形29例,占195.94‰,在围产儿死因中占第2位。7564例活产儿中发现畸形38例,占5.02‰。畸形以神经系统畸形、心脏缺陷,呼吸器官发育畸形等为多见,平均每例含2.09畸形次。指出加强孕期自身防护、加强产前监护、染色体检查、B型超声波检查及血清α-FP测定,可降低出生缺陷发生率。