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PubMed2005

[Sudden infant death syndrome].

The Disability-SIDS Research Committee, Ministry of Health and Welfare defines sudden infant death syndrome (SIDS) as "a syndrome that causes sudden death of an infant in which the demise of the victim cannot be anticipated by his prior health status or medical history and the cause of death cannot be determined from the circumstances surrounding the final moment or from the results of an autopsy". A diagnostic autopsy is obligatory. SIDS brings a profound psychological shock to the victim's family. If the incidence takes place at a nursery or a certain medical facility (such as that involved in delivery), it may develop into a civil or criminal case related to professional responsibility for placing the infant in a prone position or a possible fault in nursing care. The current study describes the epidemiology, pathogenesis, and physiopathology of SIDS, as well as prospects for its prevention and related social problems.

Humans↗

PubMed1991

Peering into the black hole--the quality of black mortality data in Port Elizabeth and the rest of South Africa.

In the year ending 30 June 1989, 26.8% of 5,345 deaths in the Port Elizabeth area were classified as ill-defined. A study was undertaken in an attempt to identify the reasons for the high proportion of such deaths. Copies of all death notifications and death register forms of black people in the area served by the Port Elizabeth City Health Department were collected for a 6-week period. Of the 316 deaths, 154 (48.7%) were certified by medical practitioners at a hospital, 158 (50%) by the police and 4 (1.3%) by private medical practitioners. Of the police-certified deaths 116 (73.4%) were recorded as due to 'natural causes', with the remainder being submitted to autopsy. Of the hospital deaths, 26% were not adequately described in the section for the cause of death on the death certificate. Review of national mortality data for 1985 showed that only 29.9% of ill-defined deaths (in all population groups) were certified by a medical practitioner. The prime source of deaths classified as ill-defined, both in Port Elizabeth and nationally, were those not certified by a medical practitioner. Strategies aimed at minimising the number of deaths certified by the police need to be developed.

Black or African American↗

PubMed1984

Comparability of cancer mortality data in different regions of Yugoslavia.

The standardized cancer mortality ratio based on well-defined causes of death (MSMR) was analysed. It was shown how the use of MSMR gave wrong results just because differences related to the age structure of compared populations were not eliminated. In this paper, the presented calculation pointed out that, actually, MSMR only standardizes age distribution of well-defined causes of death. The age standardization can be obtained with MSMR only if compared populations have the same age specific rates from all causes of death. At the same time standard population must also have the same age specific rates from all causes of death or have the same or similar ratios of age specific rates from all causes of death as populations under comparison.

Adolescent↗

PubMed1998

[Information campaign on child care practices: measure of the effects on sleep position and sudden infant death syndrome].

BACKGROUND: To define the prevalence of the child care practices questioned in the sudden infant death syndrome (SIDS), especially the prone sleep position, before and after an information campaign. To evaluate the effects of this action on the postneonatal mortality. METHOD: A population survey was conducted in four French departments among mothers of infants born in March 1994 and March 1995 and aged 5 days and 2.5 months. A specific information campaign was conducted among health personnel in October 1994. RESULTS: After the information campaign, the prevalence of prone sleeping dramatically decreased at both ages studied: from 6.8% to 1.1% at 5 days and from 24.5% to 7.2% at 2.5 months. Duvets were used less whereas the other practices (bed sharing, using pillow, breastfeeding, maternal smoking) did not change. The postneonatal SIDS rate significantly decreased, from 1.1 p. 1000 live births in 1994 to 0.7 in 1995, the mortality from others causes also declined; the overall postneonatal mortality was 2.7 p. 1000 before the action and 2.1 p. 1000 after. CONCLUSION: The sleeping position which is the main factor questioned in SIDS was modified, and the postneonatal mortality decreased. The specific action conducted for the present epidemiological research is probably not the only contributor in these positive results.

Adult↗

PubMed2002

Risk factors for mortality within first 24 hours of head injury.

OBJECTIVE: Immediate or instantaneous death following cranial trauma occurs due to unpreventable primary brain insults. However, death occurring within 24 hours of head injury can be averted by timely institution of the therapeutic measures that could prevent secondary brain insults. From the management point of view, this is the most important subset of all head injured patients. Therefore, it is important to study risk factors associated with such deaths. METHODS: In a retrospective study undertaken at Trauma Center, Safdarjang Hospital, New Delhi, the demographic characteristics, neurological and radiological findings were studied for 100 head injured children admitted in the pediatric surgical ward, who later died after surviving the initial neurosurgical resuscitation. Death occurring within first 24 hours of head injury was defined as "early" death; and "late death", if it occurred thereafter. RESULTS: Bivariate analysis revealed the severity of head injury GCS<=8 (OR: 3.09; 95% CI: 1.22-7.8), a finding of diffuse brain edema, (OR: 3.73; 95% CI: 0.95-14.74), midline shift (OR: 4.8; 95% CI: 1.03-22.37) on cranial CT scans were found to be statistically associated with early deaths. Child's age or gender, the mode of injury and the presence of extracerebral injuries were not found to be significantly associated. When these variables were simultaneously considered in a multivariate logistic regression model, the diffuse brain edema on head CT scan was found to be both clinically and statistically significant of early death (Adj. OR: 527; 95% CI: 1.23-22.6). However, absence of hemorrhagic contusion was clinically important predictor of an early death (Adj. OR: 6.45; 95% CI: 0.68.-62.5) though not statistically significant

Child↗

PubMed2000

Hepatitis C virus co-infection is a negative prognostic factor for clinical evolution in human immunodeficiency virus-positive patients.

A longitudinal study of human immunodeficiency virus (HIV)-infected individuals followed-up in 13 centres was performed to assess the influence of hepatitis C virus (HCV) on the clinical and immunological evolution of HIV-infected patients. Eight-hundred and twelve HIV-infected patients with known HIV acquisition date, 89 co-infected with HCV, were included in the cohort. Clinical progression was defined as: 30% decrease of Karnofsky's index; and/or 20% body weight loss; and/or acquired immune deficiency syndrome (AIDS)-defining illness; and/or death (except by accident, suicide, or overdose). Immunological progression was defined as a decrease of initial CD4 count to below 200 mm(-3). If immunological progression was not statistically different between groups (P=0.25), clinical progression was significantly faster in HCV-HIV co-infected patients in univariate (P=0.02) and multivariable survival analysis (hazard ratio=1.63, P=0.03). This argues for active management of hepatitis C chronic infection among HCV-HIV co-infected patients.

Adult↗

PubMed2005

Serial angiographic follow-up beyond 10 years after coronary artery bypass grafting.

BACKGROUND: The long-term prognosis and serial angiographic follow-up beyond 10 years in patients who underwent coronary artery bypass grafting (CABG) have not been fully studied in Japan. METHODS AND RESULTS: In the present study data from 71 patients who underwent CABG before 1992 were analyzed. Thirty patients had a saphenous vein graft (SVG) only group, and the remaining 41 had a left internal thoracic artery graft to the left anterior descending coronary artery (LITA) group; 6 patients died from malignancy, which was the most common cause of death after CABG. The major adverse cardiac events (MACE) were defined as cardiac death, Q-wave or nonQ-wave myocardial infarction, and congestive heart failure. The MACE-free rate was significantly higher in the LITA group than in the SVG group (p < 0.05). However, among the patients with an ejection fraction < 0.40, there was no significant difference in MACE-free rate between the 2 groups. The LITA patency rate was significantly higher than that for SVG (p < 0.05) and the SVG patency rate was lower in the patients with hyperlipidemia (p < 0.05); cholesterol-lowering therapy improved the SVG patency rate. CONCLUSION: The long-term outcome of CABG was favorable, particularly if using an arterial graft. Although the patency rate was lower for the SVG than LITA, the patient's lipid profile might be an important factor in the SVG patency rate.

Adult↗

PubMed1992

[The cerebellar cortex in sudden infant death].

The author examined the cerebellar cortex in 190 post-mortem examinations, incl. 79 sudden infant deaths and 56 infants under one year with a clearly defined cause of death, six sudden deaths of toddlers and 8 toddlers with other causes of death and 41 death of subjects aged 17 months to 66 years who died from violent deaths. In 50 sudden infant deaths the authors observed a persistence of the external granular layer, as compared with a control group, in 29 infants no difference was detected. The external granular layer persisted in a 16-month-old toddler who died suddenly and in a 22-month old toddler who was drowned. A persisting external granular layer may be a supporting sign of retarded development of the cerebellar cortex in sudden infant deaths.

Adolescent↗

PubMed1987

Sudden nontraumatic death in adolescence. Deaths at school.

Sudden and unexpected nontraumatic death of adolescents in a school setting was studied in a defined population. All deaths of Allegheny County, Pennsylvania, residents between 12 and 21 years of age for a nine-year period were reviewed. One hundred twenty-four sudden, nontraumatic events were identified. Fourteen events (11.3%) were school related, of which seven were associated with physical exertion. Of the four events occurring during organized school sports, no subject had a condition that would have been easily detectable by preathletic screening. Further evaluation of preventive measures, such as identification and treatment of individuals at high risk for sudden death, and improved cardiopulmonary resuscitation by trained personnel, is recommended.

Adolescent↗

PubMed2000

Metabolic aspects of programmed cell survival and cell death in the heart.

Normal cardiac function requires a tight interaction between metabolism, contractile function and gene expression. The main perturbation challenging this equilibrium in vivo is ischemia, which alters energy flux through the control of key enzymes. The review highlights metabolic imprints and energetic aspects of programmed cell survival, programmed cell death, and of necrosis. When sustained and severe, ischemia leads to a total collapse of energy transfer, to the accumulation of metabolic endproducts, and to the development of myocardial necrosis. When moderate, ischemia results in a coordinated cellular response including enhanced anaerobic glucose metabolism, a modification of cardiac gene expression, and the development of specific mechanisms for programmed cell survival (preconditioning, stunning, hibernation). Repetitive stress results in a decrease of contractile function, a downregulation of gene expression and an impairment of energy transfer, which eventually cause the heart to fail. When the failing heart becomes energy-depleted, the programs of cell survival are no longer operational and programmed cell death ensues. To define the point of departure from programmed cell survival to cell death remains a major challenge.

Adenosine Triphosphate↗

PubMed1996

Daily peaks in the incidence of sudden cardiac death and fatal stroke in Niigata Prefecture.

To clarify the circadian variation in sudden death (SD) in Japan, where the causes of sudden death differ from those in the USA, we examined all of the death certificates from 1984 to 1986 in Niigata Prefecture, Japan. We defined SD as death which occurred within 1 h from the onset of the underlying cause. A significant circadian variation, with a high incidence between 6 and 8 am and a secondary peak between 6 and 8 pm, was found in the occurrence of sudden cardiac death (SCD, n = 2953). Although the proportion of SCD due to acute myocardial infarction (AMI) was as low as 28% of SCD cases, the circadian variation of SCD was similar to that previously reported in the USA. In SCD due to AMI in males (n = 487), a significant circadian variation with 3 peaks, including a primary peak between 4 and 6 am, was evident. There was also a marked increase in the incidence of fatal stroke between 6 and 8 pm (n = 529). We concluded that 1) a circadian variation with two peak incidences, one between 6 and 8 am, and one between 6 and 8 pm, was characteristic of SCD in general, 2) there was a primary peak between 4 and 6 am for SCD due to AMI in males, and 3) there was a peak between 6 and 8 pm in the incidence of fatal stroke for both men and women.

Cerebrovascular Disorders↗

PubMed1995

United States mortality from ill-defined causes, 1968-1988: potential effects on heart disease mortality trends.

BACKGROUND: Deaths are coded to the International Classification of Diseases (ICD) category, 'Symptoms, Signs, and ill-defined Conditions' when there is insufficient information for cause of death determination. Due to difficulties of diagnosis of coronary heart disease (CHD) death and since CHD is the leading cause of death among US adults, CHD is the most likely cause of ill-defined deaths. METHODS: Vital statistics and census data were used to create annual age-adjusted ill-defined rates, unrevised CHD rates, and CHD rates revised to include ill-defined deaths for US African Americans and whites, ages 35-74 years, during 1968-1988. Ill-defined and CHD mortality trend analyses were conducted. RESULTS: In 1968, African American/white ratios of ill-defined mortality were 5 among men and 7 among women; following steep declines in ill-defined mortality among African Americans, ratios were 3 among men and 2 among women in 1988. In 1968, approximately 3% and 1% of all deaths among African Americans and whites, respectively, were certified to ill-defined causes; in 1988, approximately 1.5% of deaths among African Americans were coded ill-defined, with no change among whites. Revised CHD rates showed substantially higher excess CHD mortality among African Americans than whites compared to unrevised CHD rates. Declines in revised CHD mortality steepened throughout the study period among men, and among women began to decelerate after 1978. CONCLUSIONS: Ill-defined mortality was of sufficient magnitude to potentially contribute to substantial underestimation of racial disparities in CHD mortality. Also, temporal changes in ill-defined mortality may have affected CHD trends which are used to evaluate the efficacy of public health interventions.

Adult↗

PubMed2003

Mechanisms of death in the early postoperative period following coronary artery bypass grafting for acquired heart disease. A clinicopathological study of 32 cases.

OBJECTIVES: A retrospective cardiopathological and clinical study was conducted in order to determine causes of perioperative death following coronary artery bypass grafting (CABG). EXPERIMENTAL DESIGN: Between January 1992 and June 1995, a total of 5749 CABG procedures were performed at the Heart Center Duisburg (Germany). Following the procedures, 218 patients died in hospital (mortality rate 3.8%). Fifty-eight were autopsied at the Institute of Pathology, Bethesda Hospital, Duisburg, and 32 autopsied cases were amenable to our study. Basis for selection was accessibility of clinical and morphological data and a postoperative death within 30 days. METHODS: In each case, morphological analysis of the heart and an evaluation of surgical and clinical data were performed in order to draw a conclusion on the mechanism of death. RESULTS: Using criteria defined by us, the following causes of death were determined: (1) surgical complications (43%); (2) severe coronary artery disease with incomplete revascularization (41%); (3) congestive heart failure (13%); (4) non-cardiac complications (3%). CONCLUSION: Criteria defined in this study may be useful in evaluations of causes of death after open heart surgery and may help to compare results in future series. Determination of the cause of death is important for the cardiac surgeon to reconsider indications and quality of surgical procedure.

Adult↗

PubMed2004

The prognostic importance of changes in CD4+ cell count and HIV-1 RNA level in women after initiating highly active antiretroviral therapy.

BACKGROUND: The prognostic value of CD4+ cell counts and HIV-1 RNA levels attained after the initiation of highly active antiretroviral therapy (HAART) compared with before the initiation of HAART has not been well defined. OBJECTIVE: To determine the prognostic value for clinical outcomes of CD4+ cell counts and HIV-1 RNA levels attained after initiating therapy. DESIGN: Prospective cohort study. SETTING: Women's Interagency HIV Study. PATIENTS: 1132 participants in the Women's Interagency HIV Study. MEASUREMENTS: HIV-1 RNA level, CD+ cell counts, AIDS-defining illness, and death. RESULTS: In multivariate analyses with a median follow-up of 3.9 years, women with CD4+ cell counts of less than 0.200 x 10(9) cells/L compared with women with CD4+ cell counts of greater than 0.350 x 10(9) cells/L after HAART initiation had a relative hazard of death from all causes of 2.66 (95% CI, 1.42 to 4.99) and a relative hazard of death from AIDS of 47.61 (CI, 5.69 to 398.40). The relative hazard of all-cause death was 3.44 (CI, 1.67 to 7.09) in women with RNA levels of more than 10 000 copies/mL compared with women with attained RNA levels of less than 80 copies/mL. The relative hazard of AIDS-related or all-cause death did not increase for women with post-HAART CD4+ cell counts between 0.200 and 0.350 x 10(9) cells/L compared with women with CD4+ cell counts of greater than 0.350 x 10(9) cells/L. Also, the relative hazard did not increase in women with post-HAART HIV-1 RNA levels between 80 and 10 000 copies/mL compared with women with post-HAART HIV-1 RNA levels of less than 80 copies/mL. Of the laboratory markers, only the post-HAART CD4+ cell count and HIV-1 RNA level were predictive of new AIDS-defining illness. CONCLUSION: Post-HAART laboratory markers predicted death and new AIDS-defining illness. Pre-HAART CD4+ cell count and HIV-1 RNA level were not predictive of clinical outcomes if adjusted for values attained after HAART initiation, suggesting that even advanced immune suppression can be overcome with HAART that results in CD4+ cell counts of greater than 0.200 x 10(9) cells/L and RNA levels of less than 10 000 copies/mL.

Acquired Immunodeficiency Syndrome↗

PubMed2000

Inhaled nitric oxide for respiratory failure in preterm infants.

BACKGROUND: This section is under preparation and will be included in the next issue. OBJECTIVES: To determine whether, in preterm newborn infants who have hypoxic respiratory failure, treatment with inhaled nitric oxide improves oxygenation and reduces the rates of death, or adverse neurodevelopmental outcome. SEARCH STRATEGY: Electronic and hand searching of pediatric/neonatal literature and personal data files. SELECTION CRITERIA: Randomized and quasi randomized studies in preterm infants with hypoxic respiratory failure. Administration of inhaled nitric oxide. Clinically relevant outcomes, including death, oxygenation, intraventricular haemorrhage. DATA COLLECTION AND ANALYSIS: One randomized controlled trial of nitric oxide therapy was found in preterm infants with a high risk of developing bronchopulmonary dysplasia (Subhedar 1997). MAIN RESULTS: No significant effect of inhaled nitric oxide on any outcome variable was found. In particular there was no effect on the primary outcome variable of death or bronchopulmonary dysplasia. REVIEWER'S CONCLUSIONS: There is currently no published information to support the use of inhaled nitric oxide in preterm infants. Preterm infants should not be treated with inhaled nitric oxide except in the context of prospective, randomized controlled trials.

Administration, Inhalation↗

PubMed2004

Causes of death in HIV infection: the key determinant to define the clinical response to anti-HIV therapy.

Studies have shown an increased risk of new AIDS/death among injecting drug users (IDU) starting highly active antiretroviral therapy (HAART). Of 3872 patients starting HAART in the EuroSIDA study, 819 were IDU (21.2%). During 14 769 person-years of follow-up, 499 patients progressed to new AIDS/death. Compared with homosexual individuals, IDU had an increased incidence of new AIDS/death, but only for non-HIV deaths. There is an urgent need to define and standardize causes of death in observational studies.

Acquired Immunodeficiency Syndrome↗

PubMed2006

Defined by her dying, not her death: the guardian ad litem's view of Schiavo.

One of the most controversial legal and political events in the death of Theresa Marie Schiavo was the passage, by the Florida Legislature, of what become known as "Terri's Law," allowing the Florida Governor to replace her feeding and hydration tube, and requiring the appointment of a special guardian ad litem who reported to the Governor and the courts. In this article, that appointed guardian ad litem shares distinctive experiences and observations about artificial nutrition and hydration and about other related circumstances in Ms. Schiavo's case.

Adult↗

PubMed1997

Meta-analysis of five randomized controlled trials comparing continuation of zidovudine versus switching to didanosine in HIV-infected individuals.

A meta-analysis of the original data from 2411 patients in the ACTG 116A, ACTG116B/117, ACTG175, BMS010 and CTN002 trials was conducted to improve the estimate of the effect of switching from zidovudine to didanosine on rates of clinical progression, to better quantify the rates of neurological events (including AIDS dementia and peripheral neuropathy) and to examine the effects of switching from zidovudine to didanosine among women and racial subgroups. In total, 1012 patients received zidovudine therapy, 557 received high-dose didanosine and 842 received didanosine. The median duration of follow-up was 15 months. Ninety-one percent of patients were male, 78% were white, mean age was 36.5 years. The median CD4 count was 195 cells/mm3 (range: 0-762) and the median duration of prior zidovudine therapy was 14 months (range: 0.1-94). There were 336 deaths and 686 new AIDS-defining illnesses (ADIs) or deaths. After stratification by study and adjusting for baseline CD4 count and presence of an AIDS diagnosis prior to baseline, the relative risks of death associated with switching from zidovudine to high-dose didanosine or to didanosine were 0.94 (P = 0.64) and 0.77 (P = 0.07), respectively. The relative risks of a new ADI or death associated with switching from zidovudine to high-dose didanosine and didanosine were 0.78 (P = 0.01) and 0.66 (P = 0.0001), respectively. There were 21 documented cases of AIDS dementia complex (ADC) during the entire follow-up period. The rates per 100 person years of follow-up were 0.70, 0.65 and 0.41 for the zidovudine, high-dose didanosine and didanosine arms, respectively. There were no significant differences in risks of ADC between treatment arms (zidovudine versus high-dose didanosine: P = 0.30, zidovudine versus didanosine: P = 0.97, didanosine versus high-dose didanosine: P = 0.41). Our data confirm a clinical benefit and CD4 increase associated with a switch from zidovudine to didanosine therapy. No statistical differences were detected between doses of didanosine with respect to survival or progression to a new ADI or death. Furthermore, there was no statistical difference in the frequency of ADC between treatment arms.

AIDS Dementia Complex↗