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PubMed1995

The changing pattern of mortality in an African medical ward.

The pattern of adult medical deaths in Queen Elizabeth Central Hospital, Blantyre, Malawi was documented over a 12 month period between April 1992 and March 1993. Results were compared with mortality data collected from the same wards in the pre-AIDS era in 1973. Tuberculosis and AIDS together accounted for 49% of all medical deaths in 1992-93. Eighty-two per cent of deaths occurred in the age group 13-49 years; tuberculosis, AIDS, gastroenteritis, pneumonia, pyogenic meningitis and septicaemia were the most important causes of death in these young patients. These findings are very different to those observed in the same wards 20 years previously when tuberculosis was responsible for 13% of deaths and there were no deaths due to AIDS. The predicted upsurge in AIDS-related deaths in sub-Saharan Africa in the 1990s will have grave consequences not only for the health sector, but for the social and economic fabric of the countries concerned.

Acquired Immunodeficiency Syndrome↗
PubMed1995

Sympathetic skin response in Guillain-Barré syndrome.

Dysautonomia is a common feature of Guillain-Barré (GB) syndrome and is sometimes the cause of significant morbidity and death. Changes in sympathetic skin response (SSR) may be one of the accompaniments of dysautonomia. An attempt was made to correlate SSR changes with clinical and electrophysiologic features in a group of 24 patients with GB syndrome fulfilling NINDS (National Institute of Neurological Disorders and Stroke) criteria. A total of nine patients had absent SSR. Thirteen patients had clinical dysautonomia, of whom five had absent SSR. Five patients had features of predominant axonal damage and preserved SSR. A trend towards correlation of SSR abnormalities with common peroneal nerve conduction parameters (velocity and compound muscle action potential amplitude) was noted. We conclude that SSR abnormalities are common in GB syndrome and may be complementary to bed-side tests for autonomic dysfunction.

Action Potentials↗
PubMed1990

[The causality of lunar changes on cardiovascular mortality].

The author confirmed, based on different ways of processing of 1437 sudden cardiovascular deaths, that the frequency of these deaths changes in the course of the synodic moon with two maxima during the lunar quarters. Processing by the method of transfer of epochs made it possible to shift steadily the mortality curves according to the phase of solar activity. This made the author assume that the cause of the phenomenon of two-phasic change of mortality during lunation cannot be only gravitation (sudden tides) and that in addition the interfering influence of solar corpuscular radiation is involved. It is known that this radiation causes geomagnetic disorders. Consistent with the above view it was proved that in the course of lunation the greatest number of geomagnetic disorders occur at a time close to the lunar quarters. Then, as the author proved--aurora polaris is more frequent. The increased cardiovascular mortality is thus associated with an increased geomagnetic activity. The relationship is certainly not direct. The author indicates further trends of research to disclose the immediate causes which exert an unfavourable effect on our cardiovascular system.

Cardiovascular Diseases↗
PubMed1995

Growth inhibition and cell killing by N-methyl-N-nitrosourea: metabolic alterations that accompany poly(ADP-ribosyl)ation.

The effect of inhibition of poly(ADP-ribose) polymerase (PARP) on the growth arrest and cell killing induced by N-methyl-N-nitrosourea (MNU) was studied in L929 fibroblasts. Depletion of NAD and ATP preceded the cell killing by a 1-h exposure to 10 or 15 mM MNU. 3-Aminobenzamide (ABA), an inhibitor of PARP, spared the depletion of NAD and ATP and prevented the cell killing. With 5 mM MNU, a depletion of NAD was promptly reversed, and there was no loss of ATP and no cell death. Aphidicolin, a DNA polymerase inhibitor, prevented the restoration of NAD, with resulting depletion of ATP and death of the cells, effects that were prevented by ABA. Azide together with 2-deoxyglucose depleted ATP, followed by a loss of NAD and cell death, changes that occurred in the absence of DNA single strand breaks (DNA SSB). ABA prevented the depletion of NAD, but not that of ATP, nor the cell killing. MNU (2.5 mM) inhibited cell growth without effect on the viability of the cells. ABA potentiated the cell growth inhibition. Thus, inhibition of PARP potentiates cell growth inhibition by limiting DNA repair mechanisms. Alternatively, inhibition of the DNA repair response to more extensive DNA damage prevents cell killing. The ATP depletion caused by poly(ADP-ribosyl)ation, rather than DNA SSB and the loss of NAD, is the more critical event in the cell killing.

Adenosine Triphosphate↗
PubMed1990

Perinatal mortality in Matlab, Bangladesh: a community-based study.

Perinatal deaths, comprising stillbirths and deaths during the first week of life, were monitored over the eight-year period 1979 to 1986 in a rural Bangladeshi population of 196,000. The perinatal mortality rate was 75 per 1000 total births. The rate was 13% higher in males than females. Stillbirth and early neonatal mortality rates were 37 and 38 per 1000 total births, respectively. The major causes of perinatal deaths are presented, as well as some of the maternal determinants. During the period under study, perinatal mortality declined regularly and significantly over time in an area covered by an intensive Family Planning and Health Services programme, but not in the adjacent control area. This raises the issue of the impact of such a programme upon perinatal mortality, and the need to include a strong maternity care component into primary healthcare strategies if further reductions of perinatal mortality are to be achieved.

Bangladesh↗
PubMed1993

Changes of perinatal statistics in a semiurban setup between two time periods in Malaysia.

Hospital University Sains Malaysia (HUSM) functions as the state referral centre and the only hospital for the state of Kelantan that can offer neonatal intensive care service. The deliveries in HUSM with grand multiparity, late booking and problems of late referrals resembles a hospital serving a semiurban rather than an urban community. A comparison between the year 1989 and 1991 showed marked improvement of perinatal mortality rate from 41.32 to 24.88, which is significantly better than the improvement achieved from 1987 to 1989 (46.0 to 41.32). This was possible due to a marked fall in the early neonatal mortality rate from 10.02 in 1989 to 5.45 in 1991 and fall in the stillbirth rate from 31.61 to 19.53.

Female↗
PubMed1989

Perinatal mortality in rural Tanzania.

Prolonged labour was the most frequent cause of perinatal death in a rural hospital in the south western highlands of Tanzania. After the introduction of an obstetric policy aiming to prevent prolonged labour by making use of the guidelines of the partogram, perinatal mortality was reduced from 71 to 39 per 1000 births. Baird's clinico-pathological classification is still considered a useful instrument for the discovery of avoidable factors in perinatal deaths. The concept of the partogram should be an integral part of the training of medical auxiliaries in the field of maternal and child health (MCH).

Delivery, Obstetric↗
PubMed1989

Classification of perinatal death.

Three paediatric pathologists, one perinatal paediatrician, one obstetrician, and one epidemiologist separately used information collected on 239 babies in an attempt to validate the Wigglesworth classification of perinatal deaths. This was first done using clinical data only, then using the combination of clinical and gross necropsy findings and finally using clinical, gross necropsy, histological and any other information (for example, chromosome analyses, microbiological investigations). Only 14 (6%) of deaths changed groups within the Wigglesworth classification when gross necropsy findings were considered as well as clinical findings, and altogether only 21 (9%) changed classification when complete investigations were available. There was an unacceptable amount (15%) of disagreement between the classifiers, largely the result of failure to comply with the rules laid down for classification. We set out amendments to Wigglesworth's original definitions to clarify certain ambiguities.

Autopsy↗
PubMed1994

Intracellular calcium concentrations during metabolic inhibition in the motoneuron cell line NSC-19.

Changes in the concentrations of intracellular free calcium ([Ca2+]i) and adenine nucleotides were determined in response to metabolic inhibitors in the motoneuron cell line NSC-19. The NADH dehydrogenase inhibitor amobarbital (Amytal) and the mitochondrial uncoupler carbonylcyanide m-chlorophenylhydrazone (CCCP) were used to alter energy metabolism. Exposure of cells to 5 mM Amytal did not significantly change ATP concentrations but produced transient elevations of [Ca2+]i of approximately 80 nM, which were reduced by 32% when cells were studied in Ca(2+)-free solutions. CCCP (10 microM) caused a transient reduction in ATP concentration of 33%. CCCP also produced sustained elevations of [Ca2+]i of about 280 nM, which were reduced by 47% when in Ca(2+)-free solutions. In spite of the sustained elevation of [Ca2+]i induced by CCCP, NSC-19 showed no reduction in cell viability after 48 h compared with controls. Ruthenium red, a blocker of Ca2+ uptake by mitochondria, had little effect on the CCCP-induced [Ca2+]i increment. KCl or glutamate did not produce significant changes in [Ca2+]i, indicating that these cells do not possess significant numbers of voltage-dependent Ca2+ channels or excitatory amino acid receptor-gated channels. [Ca2+]i values in these cells were modified by changes in extracellular Ca2+ concentrations. In Ca(2+)-containing solutions, inhibition of Na+/Ca2+ exchange by amiloride and bepridil led to increased [Ca2+]i, as did blockade of Ca2+ ATPase by vanadate, suggesting that membrane transporters are important in Ca2+ efflux in NSC-19. The present studies indicate that exposure of NSC-19 cells to Amytal and CCCP produces Ca2+ increments by release from internal stores, as well as by transmembrane influx. These results demonstrate that small increments in [Ca2+]i can be produced by metabolic inhibitors or other compounds and that such changes are not associated with immediate cell death. Changes in [Ca2+]i could potentially result in abnormal cell function secondary to altered action of Ca(2+)-dependent enzymes.

Adenine Nucleotides↗
PubMed1985

Changing patterns of perinatal and infant mortality in Western Australia: implications for prevention.

Perinatal and infant mortality rates have fallen dramatically in the developed world this century. A review of perinatal and infant mortality in Western Australia from 1970 to 1981 was undertaken, to examine trends in birthweight-specific and cause-specific rates. The predominant causes of death are now congenital malformation, stillbirth of unknown cause, preterm birth and cot death. Perinatal and infant mortality rates are unlikely to be reduced substantially until the reasons for these four causes of death are elucidated.

Australia↗
PubMedDate not supplied

Experiences of patients and significant others with automatic implantable cardioverter defibrillators after discharge from the hospital.

Sudden cardiac death (SCD) is a leading cause of mortality in this country. The automatic implantable cardioverter defibrillator (AICD) is a technology which has proven successful in reducing the risk of SCD in patients who qualify for it. However, little is known about how individuals adjust to living with the device. This field study used a focus group technique to investigate the question "What are the experiences of patients and their significant others (S.O.) in the time since being discharged from the hospital with an AICD?" Fifteen AICD recipients and 14 S.O.s each attended one of three focus groups which were tape recorded. Data from the transcriptions were analyzed by a combination of content analysis and ethnographic summary. The major concerns of the patients were [Physiologic], the sensations of being shocked, medications, trouble sleeping, dizziness (accompanied by heat intolerance at times), physical awareness of the device; [Psychosocial], fear, including fear of death and preparation for death, changes in mental functioning, changes in lifestyle including clothing not fitting, loss of control, driving an automobile, and spousal overprotectiveness. The primary psychosocial concerns of the S.O.s were fears, including fear of death and preparation for death, family and role changes, being overprotective and driving an automobile. Mental changes and heat intolerance have not been addressed in the literature previously.

Adaptation, Psychological↗
PubMed1991

Perinatal mortality statistics in Harare 1980-1989.

Perinatal and neonatal mortality rates, in the Greater Harare Maternity Unit, which showed a modest decline from 1980 to 1985, have rise dramatically since then. Half of the rise in neonatal mortality rate is due to increased numbers and an increased mortality rate in babies of birth weight less than 1001g. There is also an increase in the numbers of deaths of large babies. There is a strong case for a broad-based on-going enquiry into the reasons for such changes.

Birth Rate↗
PubMed1990

[Topics in clinical thanatology. Autopathothanatobiographies, -diaries, -epistulographies in comparison with Angloamerican clinical thanatologic experiences].

Extensive results of thanatologic sciences since the first decades of 20. century and multivarious practical knowledge in clinical thanatology are discussed--relating to the central problem of understanding different forms of "realisation of death". Possibilities of thanatologic information, forms of dialogue, communicative engagement and self-attitude in care-situations are critically conferred--this even in regard to mourning, grief and sorrow of the bereaved. The confrontation of thanatologic data in short-time illness until death to autopathothanatobiographic insights in long-time illness until death seems comparable in respect to relations between present clinical findings and anamnestic data. Awareness of approaching death seems not seldom due to "presentiment", averbal-communicative "preinformation" or impressions in face to progressive illness without successful therapy. Not only this is to think over in treatment and care, but also some new thanatologic experiences of the last years--for instance in respect to the question of timing, various circumstances and possible forms of informations and clearing up. Apart from individual forms of "living until death" there are certain pithy types in awareness, feeling, thinking, exposition or attitude. Some autobiographic, diaristic or epi-stulographic dates to long-time illness until death are characterized by striking limited possibilities of self-description and verbalization in situations of vital-existential distress. Silent suffering can be caused by loss of possibility in verbalization. Autothanatobiographic insights and experiences in thanatologic praxis in long-time illness until death lead to more differentiated insights than short-time illness until death--especially in respect of changing and contrary courses. Insight "evidences" of life continuities in the face of danger of death, changes in awareness of time, intensifications in intensities of perception, of feelings of the own life and changes in perception of the own ill organism, just as intensivation of partnership-relations ("synchronisation") can pass in the foreground. The last seems especially evident in special forms of "partnerautobiography" with alternating informations of the two. This illustrates the "two-sided aspect of death" death as a "dyadic event" (A. Toynbee), which is an important view relating to care of bereaved with changes in personal identity and awareness of time. Processes of dying and reactions of bereaved are integrated in complex anthropologic, psychologic, psychosociologic and psychosomatic factors. Certainly it is not possible such catastrophic incidents merely to interpret in psychoanalytic categories.

Attitude to Death↗
PubMed1989

Trends in perinatal and neonatal mortality and morbidity in India.

Although the infant mortality rate (IMR) has reduced by 50% during the past century, it compares poorly with the advanced countries and some developing countries. The observed fall in IMR has been mostly in post-neonatal mortality, with the result that neonatal deaths now account for over 60% of all infant deaths. The overall perinatal mortality rate (PMR) in India is still over 50 per 1000 and has shown virtually no decline during the past decade, However, PMR differs widely in different states, urban/rural areas, different hospitals and so on. PMR is seen to correlate better with social development than economic development of the representative community. The causes of perinatal deaths suggest poor health of mother and poor health facilities and are hence potentially preventable. Various studies have shown that PMR can be significantly reduced within a short span of time. The registration of vital statistics continue to be highly unsatisfactory especially in rural areas.

Cause of Death↗