Pattern of in-hospital pediatric mortality over a 3-year period at University teaching hospitals in Iran

Introduction:

Causes of death are different and very important for policy makers in different regions. This study was designed to analyze the data for our in-patient children mortality.

Materials and Methods:

In this cross-sectional study from March 2011 to March 2013, all patients from 2 months to 18 years who died in pediatric intensive care unit, emergency room or medical pediatric wards in the teaching hospitals were studied.

Results:

From a total of 18,915 admissions during a 2-year-period, 256 deaths occurred with a mean age of 4.3 ± 5 years and mortality 1.35%. An underlying disease was present in 70.7% of the patients and in 88.5% of them the leading causes of death were related to the underlying diseases. The most common underlying diseases were congenital heart disease and cardiomyopathy in 50 (27.6%). The four main causes of deaths were sepsis (14.8%), pneumonia (14.5%), congestive heart failure (9.8%), and hepatic encephalopathy (9.8%).

Conclusion:

We may conclude that after sepsis and pneumonia, congestive heart failure, and hepatic encephalopathy are the leading causes of death. Most patients who died had underlying diseases including malignancies, heart and liver diseases as the most common causes.     

Epidemiology of liver cirrhosis and associated complications: Current knowledge and future directions

Cirrhosis causes a heavy global burden. In this review, we summarized up-to-date epidemiological features of cirrhosis and its complications. Recent epidemiological studies reported an increase in the prevalence of cirrhosis in 2017 compared to in 1990 in both men and women, with 5.2 million cases of cirrhosis and chronic liver disease occurring in 2017. Cirrhosis caused 1.48 million deaths in 2019, an increase of 8.1% compared to 2017. Disability-adjusted life-years due to cirrhosis ranked 16th among all diseases and 7th in people aged 50-74 years in 2019. The global burden of hepatitis B virus and hepatitis C virus-associated cirrhosis is decreasing, while the burden of cirrhosis due to alcohol and nonalcoholic fatty liver disease (NAFLD) is increasing rapidly. We described the current epidemiology of the major complications of cirrhosis, including ascites, variceal bleeding, hepatic encephalopathy, renal disorders, and infections. We also summarized the epidemiology of hepatocellular carcinoma in patients with cirrhosis. In the future, NAFLD-related cirrhosis will likely become more common due to the prevalence of metabolic diseases such as obesity and diabetes, and the prevalence of alcohol-induced cirrhosis is increasing. This altered epidemiology should be clinically noted, and relevant interventions should be undertaken.     

Retrospective radiological evaluation to study the prevalence and pattern of maxillofacial fracture among Military personal at Prince Sultan Military Medical City [PSMMC], Riyadh: An institutional study

PurposeThe aim of the present study was to analyze the prevalence, causes, and patterns of maxillofacial fractures retrospectively in patients who were treated at Prince Sultan Military Medical City, Riyadh, Saudi Arabia.MethodsPatients′ medical records were reviewed from 2005 to 2014. Patient′s age, gender, cause, and the pattern of maxillofacial fractures were studied. Associated body injuries were also recorded.ResultsOut of 263 patients, 207 (78.7%) were male and 56 (21.3%) were female. The age range was from 3 to 67 yr with a mean age of 26.21 yr. Road traffic accidents 236 (89.8%) were the most commonly reported cause of maxillofacial fractures, followed by falls 14 (5.3%), assaults 4 (1.5%), gunshot 3 (1.1%), and sport accidents 2 (0.8%). Most of the cases of maxillary fracture were Le Fort II 27 (36.5%), followed by LeFort I 23 (31.1%), LeFort III 20 (27.0%) and palatal fractures 4 (5.4%). Of the mandibular fractures, parasymphysis fractures constituted 61 (27.4%), body 50 (22.4%), condyle 45 (20.2%), angle 40 (17.9%), symphysis 16 (7.2%), ramus 7 (3.1%) and coronoid 4 (1.8%). Zygomatic complex fractures 110 (94.8%) were the most commonly reported fractures in the mid and upper facial region. Other facial fractures included orbital floor 61 (97.0%), naso-orbito-ethmoidal 18 (19.8%), and frontal 12 (13.2%).ConclusionRoad traffic accidents were the most common cause of maxillofacial fractures. Spreading awareness among young drivers regarding road safety regulations is highly recommended.     

Analysis of cases of forensic veterinary opinions produced in a research and teaching unit

The aim of the study was to present the results of necropsies carried out in the years 2000–2014 in the Department of Pathological Anatomy, Faculty of Veterinary Medicine, University of Life Sciences in Lublin.The material used for the analysis consisted of expert opinions prepared on the basis of a decision by a judicial body to admit an expert opinion as evidence.An increase was observed in the demand for the services of veterinary forensic experts, beginning in 2006 and persisting through 2014. The response to the growing popularity of veterinary forensic examinations should be systematization of knowledge and exchange of experience, which would enable the further development of this interdisciplinary science.     

青少年儿童近视成因及防控进展

众所周知,近视可由遗传、外界环境、不良用眼习惯等综合性因素导致,主要预防措施为定期进行视力筛查,并及时对症治疗,与此同时养成良好用眼习惯,保持充足睡眠,保证一定运动量及营养均衡。若判定为近视,可通过光学镜片、西药治疗及中医治疗等方式延缓度数增加,若以上方式均无效,还可通过手术方式进行矫正。目前,近视给青少年的健康及成长带来的重大影响已成为公论,故我国近视低龄化问题也越发受到社会各界的关注。针对社会人群而言,了解近视成因,对精准预防与有效控制格外重要。本文对近年来文献报道进行总结,从近视形成原因、预防、筛查及控制措施等方面进行综述。     

Ten-year epidemiological study of chemical burns in Jinshan,Shanghai, PR China

Background

The epidemiological pattern of chemical burns varies widely in different areas of the world. To analyse effective preventive approaches, an insight into the pattern of injury is desirable. However, our data are only limited to Shanghai area, China.

Methods

A 10-year retrospective review includes all patients with chemical burns admitted to the Department of Burn and Plastic Surgery from January 2001 to December 2010; those who were admitted to the ophthalmologic department or other departments were excluded. The data collected included age, gender, injury pattern, patient workplaces, aetiological agents, incidence by month and year, burn size, burn depth and site, time for immediate irrigation, length of hospital stay and outcome.

Results

A total of 615 patients admitted to our department for in-hospital treatment of chemical burn injury were included in the study. The mean age was 32.1 ± 12.3 years with a range of 2–66 years. A total of 562 cases (91.4%) were male and 53 cases (8.6%) female. The mean total burn surface area (TBSA) was 30.3 ± 24.7% with a mean full-thickness burn area of 17.5 ± 23.8%. Most chemical burns took place in summer and fall. The majority of chemical burns were work related (93.0%); among them accidents that happened in private factories were predominant (70.8%). Although caustic soda was the leading cause of all chemical burns (15.8%), acid burn was the most common (45.2%). The extremities were the most frequent areas of injuries, followed by head and neck. Most cases had none (30.4%) or insufficient (61.1%) immediate irrigation after injury. In all patients, 47 cases had inhalation injuries, 94 cases accompanying ophthalmologic burns, 51 cases accompanying other associated injuries and 67 cases chemical toxicity. A total of 212 cases (34.5%) underwent early total or tangential excision and skin or skin flap grafting in the first week after injury. The mean length of hospital stay was 44.1 ± 24.7 days. Sixteen cases died of respiratory failure, sepsis or multiple organ dysfunction syndrome (MODS), giving a mortality rate of 2.6%.

Conclusion

Safety training, preventive measures and following safety rules and strict regulation are of paramount importance for workers to prevent and reduce chemical burns in chemical enterprises, especially in private factories. Appropriate first-aid training that includes copious spot lavage should be emphasised. Eschar excision as early as possible and skin or skin flap grafting in deep wounds could reduce the possibility of poisoning and disability.     

191例用药差错的成因与对策

目的 分析用药差错的成因并寻求降低差错的对策.方法 针对药剂科用药差错登记、门诊用药咨询记录和护理部临床护理质量检查记录中的用药差错,按差错来源、出现差错人员的工作年限、差错后果或严重程度进行分类汇总.结果 191例用药差错来源于医师的106例,占55.50%;药师46例,占24.08%;护士31例,占16.23%;患者8例,占4.19%.按差错后果或严重程度分类,尚未出现错误97例,占50.79%;出现错误但未造成伤害88例,占46.07%;出现错误并造成伤害6例,占3.14%;未发生致死性错误.结论 建立良好的用药安全文化、及时分析用药差错的根源,并寻求解决办法、降低用药风险非常必要.     

双J管拔管困难的处理及预防分析（附16例报告）

目的 分析双J管拔管困难的常见原因,探讨相关处理方法及预防措施.方法 回顾性分析2005年8月至2013年10月间共收治双J管使用膀胱镜或输尿管镜拔管困难16例患者的临床资料.结果 拔管困难原因：并发输尿管结石10例,肾结石3例,双J管打结2例,部分双J管输尿管外异位1例.所有病例均拔管成功,其中采取单纯输尿管镜取石术后拔管7例,体外冲击波碎石后拔管3例,体外冲击波碎石和输尿管镜取石交替使用后拔管1例,经皮肾镜取石后拔管1例,肾切开取石后拔管1例,输尿管镜配合钬激光切割双J管后拔管2例,输尿管镜配合钬激光切开输尿管壁后拔管1例.结论 双J管拔管困难原因很多,针对原因进行预防是减少双J管拔管困难发生的关键.出现后应联合多种手段,以达微创处理的目的.     

上消化道出血322例分析

目的探讨上消化道出血的原因和相关因素。方法回顾性分析我科2年来322例上消化道出血的临床资料。结果322例中通过检查有明确病因者293例,主要病因依次为消化性溃疡、急性胃粘膜病变、食管胃底静脉曲张、胃癌;男性明显高于女性;消化性溃疡占各年龄组上消化道出血的首位,中、青年组以十二指肠溃疡多见,老年组以胃溃疡多见;胃癌位于老年组上消化道出血的第二位,显著高于中、青年组(P<0.01)。结论上消化道出血的病人以消化性溃疡、胃癌、食道胃底静脉曲张、急性胃粘膜病变为最常见的病因,性别、年龄等均为上消化道出血的相关因素。     

远航期间任务人员晕船反应调查及原因分析

目的:研究和平方舟医院船上任务人员在远航期间晕船反应发生情况,分析晕船反应发生的原因,为今后医院船合理配置任务人员及降低任务人员晕船反应发生率提供参考依据。方法:根据自愿原则,采用自制问卷对和平方舟医院船上260名任务人员进行问卷调查,问卷内容主要包括两部分,第一部分基本情况调查,包括性别、年龄、体质量、吸烟史等;第二部分影响晕船反应发生的因素调查,包括出海次数、人员类别、住舱所在甲板位置、登船前是否每日进行体育锻炼、登船后是否每日进行体育锻炼等信息。回收有效问卷251份。采用SPSS 19.0统计软件及Empower Stats软件对数据进行统计分析。结果:单因素分析发现晕船反应发生与性别、体质量、是否抽烟、既往是否执行过出海任务、住舱所在甲板位置、人员类别之间明显相关( P<0.05)。多元回归分析表明,女性及既往未执行过出海任务是晕船反应发生的危险因素( P<0.05)。阈值饱和效应分析显示,从第2个航段开始,每经历1个航段,任务人员晕船反应发生率降低0.51%。 结论:医院船在配置任务人员时应综合评估任务人员基本情况,在安排住舱位置时,应将晕船人员尽量安排在靠近船体中部底层。任务人员平时应注重身体锻炼,保持营养摄入平衡,增强抗晕船适应性训练。