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At least 19 recordsLinked to original sources
PubMedDate not supplied

The case of Elizabeth Bouvia: a strain on our ethical reasoning.

Society has not reached consensus about the right of patients who are not terminally ill to refuse treatment or about the acceptability of foregoing artificial nutrition and hydration for any patients. Both these issues have been raised by the case of Elizabeth Bouvia, a woman with cerebral palsy whose desire to refuse nasogastric feeding has been the subject of at least three court decisions, the most recent in April 1986. In that decision, the Second District Court of Appeal of California ruled that High Desert Hospital must honor Ms. Bouvia's request that she not be fed through a tube.

Adult↗
PubMed1992

The OR experience during operation Desert Storm.

1. Setting up an operating room from scratch tests basic OR knowledge. The usual high-technology equipment was absent in the desert. The hospital had to make due with the basics, including a bovie machine, suction machine, Gigli saw, minor orthopedic setup, and a basic laparoscopy set-up. 2. Much training focused on erecting and taking down the hospital; once the war began, urgency was a crucial factor. 3. The majority of the patients were Iraqi prisoners of war with shrapnel wounds to the abdomen, broken bones, and chest injuries; the Americans who were treated were seriously injured. Most of the procedures were orthopedic, thoracic, vascular, and general surgery cases.

Humans↗
PubMed2004

[Comparative study of neonatal bacterial meningitis in Lomé, Bobo-Dioulasso, Casablanca and Lyon].

UNLABELLED: Bacterial meningitis in new-borns remains a serious event because of its high mortality and morbidity rates in Africa. OBJECTIVE: To identify the clinical and bacteriological epidemiology and the outcome of neonatal bacterial meningitis in three African cities. METHOD: We have analysed and compared three hospital studies done in humid tropical, Sahelian, and desert Africa with a European study. RESULTS: Compared with the European study this African study is characterized by a high mean frequency of neonatal meningitis (6 cases per year against 1.4), more important risk factors linked to pregnancy and childbirth (50% against 33%), high rates of death (61 to 68% against 5%) and sequelae (25 to 40% against 30%), rarity of Streptococcus agalactiae (7 to 15% against 38%) and absence of Listeria. Enterobacteriaceae were predominant both in African (50 to 68%) and European (43%) studies. E. coli appeared as the most frequent germ in both European and African studies and Salmonella as more frequent in Sub-Saharan Africa than in occidental countries. CONCLUSION: The epidemiological, bacteriological and evolutional aspects of the neonatal meningitis were identical in the three African cities. The African studies were different from the European only by their high incidence, the rarity of S. agalactiae and Listeria and the difficulties of bacterial diagnosis and management, all might explain the high rates of death and sequelae. An epidemiological survey and adequate antimicrobial therapy according to antibiotic susceptibility may improve the outcome.

Burkina Faso↗
PubMed2006

Impact of the 1998 Gobi dust event on hospital admissions in the Lower Fraser Valley, British Columbia.

The adverse public health impacts of anthropogenically derived particulate matter have been well documented, with measurable increases in both morbidity and mortality rates associated with high particulate matter pollution events. Most current research has focussed on the health impacts of anthropogenically derived particulate matter, and there is a distinct scarcity of literature that examines the role of naturally derived particulate matter and adverse health impacts in the urban context. This study of a Gobi desert dust event in the Greater Vancouver region of British Columbia, Canada, in spring of 1998 provided a unique opportunity to identify the adverse health effects related to naturally derived particulate matter in a large urban setting. Respiratory and cardiac hospitalizations were examined for a three-year period (January 1997 to December 1999), with the Gobi dust event occurring in late April 1998. A meteorological analogue was identified for spring 1997 in order to identify the public health impacts associated with anthropogenically derived particulate matter and those impacts associated with the presence of the Gobi desert dust. Results indicate that this Gobi dust event was not associated with an excess of hospitalizations in the Greater Vancouver region. Peak particulate matter concentrations of Gobi desert dust in the airshed were only associated with an additional one or two hospitalizations per 100,000 population for respiratory and cardiac illnesses, and these increases were not distinguishable from the 'normal' variability in hospitalization rates. Despite high particulate matter concentrations, fine particle size, presence of heavy metals in the dust and extended exposure periods, it appears that the Gobi desert dust event was not associated with significant risk to public health in Greater Vancouver, British Columbia. Therefore it is concluded that naturally derived particulate matter is more benign than particulate matter of anthropogenic origin, and thus poses a low risk to health for the general public.

Air Pollutants↗
PubMedDate not supplied

[Nutritional and dietary assessment of feeding at a hospital with its own kitchen services].

Within the hospital setting, food, nutrition, and the composition of the diets, acquires special relevance, given the particular physiopathological characteristics of the recipients thereof. We intended to know the composition and adequacy of the diets, as well as determining the degree of utility given to the facilities used. This is a transversal study of a week's duration, on the diets of the basic menu of the Alto Deba Hospital, by means of a random selection of 20% of the daily occupancy of each floor (N = 140), marking the trays and weighing the respective remains. The economic calculation was conducted by direct and indirect cost evaluation. The theoretical caloric supply (2372-3375 kcal/day) turns out to be excessive, with it being adequate in proteins (11.5-14.5%), deficient in carbohydrates (33.3-44%), and excessive in fats (42.4-53.4%). 19.3% fo the patients made changes between the two free choice diets of the menu with there being a high acceptance of the vegetables, as well as a high index of remains of those foods rich in bony residues, such a chicken, rabbit, or trout. The choice of deserts is balanced. On the whole, excepting breakfast and mid-afternoon snacks, there is a high percentage of remains (33.7%). We deem neccessary to have the knowledge of personnel qualified in hospital food services, to make, control and adapt the diets to the needs and tastes of the patients, as well as to achieve efficient food services.

Adolescent↗
PubMed1987

Asthma and serum IgE levels in children in a desert country.

The frequency of asthma admissions to the paediatric outpatient clinic in a teaching hospital in Kuwait was found to increase from 8.8 to 14.9% of all admissions during a 3-year period. Seasonal variation of admissions was consistent, with peak incidences during the cold and humid months. The incidence of asthma was remarkably well correlated to low temperature and high frequency of upper respiratory infections but not to pollen seasons or occurrence of dust storms. In agreement with the clinical impression that atopic allergy is frequent in Kuwait, high levels of IgE were found in different groups of individuals. In umbilical cord serum, elevated IgE levels in blood donors and in children with asthma or other diseases were clearly higher than those found in corresponding groups in Western countries. Possible factors contributing to the generally increased IgE levels may be endemic diseases, like viral hepatitis and brucellosis.

Asthma↗
PubMed2006

Coccidioidomycosis after renal transplantation in an endemic area.

Coccidioidomycosis is an endemic fungal infection of the desert southwestern United States of particular concern for immunosuppressed renal transplant recipients. The clinical course of coccidioidomycosis can be severe in immunosuppressed patients, with high rates of dissemination and mortality, and antifungal prophylaxis is routinely administered to high-risk patients. We sought to determine the impact of coccidioidomycosis on patients who received their renal transplant at our hospital in Phoenix, Arizona. A retrospective records review of the first 205 patients who received a renal transplant between June 1999 and December 2003 identified 6 patients (3%) who had contracted coccidioidomycosis after transplantation. All six cases occurred more than 6 months after transplantation. Two of these six patients had disseminated coccidioidomycosis. Two patients, one with pulmonary infection and one with disseminated infection, died. None of the six patients with coccidioidomycosis after transplantation had identified risk factors before transplantation. No high-risk patient who received targeted antifungal prophylaxis had a reactivation of coccidioidomycosis after transplantation. Treatment for acute rejection and induction with antithymocyte globulin did not appear to increase the risk of subsequent coccidioidomycosis.

Adolescent↗
PubMed1998

Neural tube defects and congenital hydrocephalus in the Sultanate of Oman.

A retrospective study was carried out in Oman to determine the incidence of neural tube defects (NTD) and congenital hydrocephalus (CH) and to identify any possible associations. National data retrieved from hospital records revealed the incidence of NTD in Oman to be comparatively low (1.25 per 1000), but the incidence of CH was much higher than that seen in Western Europe (0.44 per 1000) and was found to be associated with high rates of other congenital anomalies and neonatal death. There were no specific environmental factors associated with NTD and high environmental temperatures during the tropical desert summer (temperatures reach 48 degrees C) were excluded as a causative factor. In spina bifida families, later born children were more likely to be affected and there was also an association with increased maternal but not paternal age. Much higher consanguinity rates were noted in families with NTD and CH than in the general population.

Cohort Studies↗
PubMed2003

[My insanity in the year 1783].

The aim of this paper is twofold: to defend the validity of the manic-depressive psychosis as a disease entity and to make an incursion into the history of psychiatry. The two intentions meet as far as the recognition of a clinical case straight through space and time supports the ontological status of a disease entity. An autobiographical work from 1801 "My insanity in the year 1783" written by the Danish vicar C.S. Andresen, who lived from 1760 to 1832 is briefly summed up. Andresen tells that he as a young student of divinity made a journey from the small town Rørvig in Zeeland to his then place in Copenhagen. The weather was intolerably hot, the coach was uncomfortable, the landscape deserted and empty-and just in the hardships the most unhappy and deplorable event happened: He faced the gruesome truth that he was deprived of the most precious gift of his Creator, his reason and faculties. A fellow passenger brought him to an inn where he literally ran up the walls alternately in high spirits and in deep dispair. When he arrived in Copenhagen he was blead, probably by a surgeon, but later that day admitted to King Frederik's Hospital where he was treated with bleds and leechs and baths. However, as the illness dragged on he was according to his own will accompanied by his custodian to his parental home in the Isle of Bornholm where he recovered while nursed by his mother and mother's mother who themselves had suffered from periodical melancholy when they were young. He completed his academic studies and became a highly respected scholar and vicar in the isle of Funen - but almost twenty years after his recovery he was made to suffer the humiliation that he - a true representative of the Age of Enlightment and rationalistic theologician - was suspected to have invoted his insanity by a sinful life in his youth. Thus his work may be regarded as a defensive pamphlet written at a time when a neutral and clinical view of mental diseases had given place to a moralistic and religious concept. The case serves as a modification of the general assumption that psychotic patients in "the classic age of confinement" under all circumstances were brutally treated and locked up. Even the fluent and subjective style is charming and reminds the Danes of Johannes Ewald (1743-81) and perhaps - were it to be translated - the English of Lawrence Sterne (1713-68). Maybe the booklet of just 75 pages is worthy of a translation?

Autobiographies as Topic↗
PubMedDate not supplied

A pediatrician and his mothers and infants.

Pediatricians are in a unique place in society by being able not only to care for the health and well-being of mothers and which, are their clinical responsibility, but also by being able to act as advocates for those patients who are often among the most vulnerable of our population. This article illustrates some of these points by referring to Australian Aboriginals from the vast desert areas of Westerns Australia. In remote areas of Western Australia, Aboriginal infants have high rates of low birth weight, failure to thrive and undernutrition. They also have high rates of respiratory, gastrointestinal and other infections. Aboriginal infant mortality has improved significantly over recent years, but Aboriginal health and mortality rates are still much worse than those of non-Aboriginal children and tend to be worst in more remote parts of the state. Overall, Aboriginal infants less than one year in age were hospitalized 9.5 times more frequently than non-Aboriginal infants for respiratory diseases (such as pneumonia, acute bronchiolitis and asthma); diarrheal diseases and skin infections were other very important causes of hospitalization for Aboriginal infants. Another poorly understood aspect of Aboriginal health is their widespread proneness to urinary tract infections. This is very important now in Australian Aboriginals in whom end-stage renal failure is becoming very prevalent. Rapid social and lifesyle changes have been very important in the poor health status of Aboriginals. They are also subject to severe socio-economic discrimination, underemployment, limited education, overcrowding, social depression and severely depressed housing conditions, relative inaccessibility to adequate and nutritious foodstuffs, and limited access to clinical services. Aboriginal people are prone to obesity, hypertension, type-2 diabetes mellitus and cardiovascular diseases. Overuse of alcohol and tobacco smoking have also become important challenges, particularly among adolescents and young adults. For the past twenty years or so, special programs have been developed to help overcome some of these problems; these include immunization programs, an extensive child health care program, special childhood screening programs, and oral rehydration therapy to reduce the high rates of mortality and morbidity associated with diarrheal diseases. These improvements have been achieved despite a set of socio-economic circumstances that face Aboriginal infants and children who live with adverse social factors. This was termed "Down and Out in 1996" in an editorial in The New Scientist (27 January 1996). A strategy that Australian Aboriginals are using now is to increase their own role through Aboriginal-controlled health and medical services including child health programs.

Adult↗
PubMed2000

Comparison of the epilepsy surgery programs in Cartagena, Colombia, and Zürich, Switzerland.

The organization, financing, productivity, quality of work, and cost-effectiveness of the Epilepsy Center in Cartagena, Colombia, were studied and compared with the epilepsy surgery program at the University Hospital Zürich, Switzerland. During a 2-month visit, one of the authors (I.T.) evaluated the center in Cartagena as a welfare institution and evaluated its epilepsy surgery program. The postoperative results of the Cartagena program were compared with those reported at the Second International Palm Desert Conference 1992, which revealed a similar rate of postoperative seizure control in temporal lobe epilepsy, slightly inferior results with hemispherectomy, and slightly better results with anterior callosotomy. A comparison between the two epilepsy centers showed that pre and postoperative antiepileptic drug treatment is more restricted in Colombia because of high costs. Although important diagnostic tools such as electroencephalography, seizure monitoring, neuropsychology, computed tomography, and magnetic resonance imaging are available in both centers, the Zürich program also has access to positron emission tomography, single photon emission computed tomography, magnetic resonance spectroscopy, and intracarotid and selective amobarbital tests. The postoperative seizure outcome is similar in surgical temporal lobe epilepsy patients (temporal lobectomy series, Cartagena; selective amygdalohippocampectomy series, Zürich). The comparison of direct costs of epilepsy surgery in Cartagena and Zürich showed that for the average patient undergoing epilepsy surgery in Cartagena, the cost is 5.5% of that in Zürich. This study presents evidence that epilepsy surgery is an inexpensive and efficient treatment option for epilepsy patients in developing countries. Epilepsy surgery in developing countries may even be considered at an early stage in patients who cannot afford the costs of lifetime medical treatment but can afford the one-time cost of a surgical treatment.

Anticonvulsants↗
PubMed1997

Severe and complicated malaria in Bikaner (Rajasthan), western India.

Severe and complicated malaria is an important cause of mortality in Plasmodium falciparum infection. We describe in this study the details of 532 cases of such syndromes admitted to hospital during an outbreak of malaria between September-December 1994. Increase in the annual rain fall, collection of water around Indra Gandhi Canal, forestation of shrubs around it and migration of labor, adaptation of Anopheles stephensi to desert climate and favorable breeding of An. culicifacies in the areas under impact of irrigation were presumptive causes of the outbreak in this region. Cerebral malaria (25.75%), hepatic involvement (11.47%), spontaneous bleeding (9.58%), hemoglobinuria (7.89%), severe anemia (5.83%), algid malaria (5.26%), ARDS (3%) and renal failure (2.07%) were the important manifestations. The overall mortality was 11.09%, which was high because of infection in the non-immune population of this area. Ignorance about the severity of this disease and lack of transportation facility was another important factor. Morality was highest in ARDS (81.25%) followed by severe anemia (70.97%), algid malaria (46.43%), renal failure (45.45%), jaundice (36.06%) and cerebral malaria (33.57%). Pregnancy was an important determinant increasing the mortality in female patients. Mortality was very high (82.35%) in those persons who presented with more than 3 syndromes together.

Acute Kidney Injury↗
PubMed2002

Post-partum mental disorders: pattern and problems of management in Wesley Guild Hospital, Ilesa, Nigeria.

Sixty-seven consecutive women who presented with postpartum mental disorder within 1 year after delivery over a 5-year period in a teaching hospital serving rural and semi-urban communities were evaluated. All patients were followed-up until they defaulted or for a maximum period of 1 year after presentation. There were more primiparous women (43.3%) than women of other parities. In 16.4%, a previous history of mental disorder was elicited. Family history of mental disorder was present in 13.4%. Premorbidly, marital disharmony was present in 23.9%, obstetric complications in 22.4%, neonate/infant mortality in 19.4% and unwanted pregnancy in 16.4%. Onset of illness occurred during the peurperium in majority of cases (58.2%). Schizophrenia topped the list of clinical types. Short-term prognosis was good but defaulting rate was high. Breastfeeding was stopped permanently by nine patients and two babies died. Ten husbands deserted their wives. The pattern of postpartum mental disorders has remained stable in the past two decades. Although the cause and effect relationship is difficult to establish in our study, the relative stability of some sociocultural factors suggests their usefulness in planning preventive strategies. A multidisciplinary approach is essential.

Adolescent↗
PubMed1997

Hirschsprung's disease in Oman.

The incidence of Hirschsprung's disease (HD) was studied retrospectively in Oman using hospital-based data. In Oman there is a single pediatric surgery unit where a register has been kept from 1989 to 1994, and because all cases are referred to this unit, a national survey could be carried out. There were 85 children with HD born between 1989 and 1994, and during the period there were 261,000 livebirths among Omani nationals. The population frequency in Oman is 1 in 3,070 (0.3/1,000). Eighty percent of cases presented in the first 6 months. The incidence in different regions and within different tribes of Oman was also studied. The highest frequency (1 in 1,800) is in the North Sharqiya region. There was not a significant seasonal influence in spite of the very high temperatures seen in the desert summer. The ratio of male to female cases was 2.9:1 overall, but less for longer-segment involvement. The consanguinity rate (first and second cousins) was 75%, which is higher than the level of consanguinity in the Omani population. Down's syndrome was observed in nine cases (11%), and a variety of other malformations were seen, including piebaldism, deafness, and HD in two sibships.

Abnormalities, Multiple↗
PubMed2005

[Control of peri-operative smoking: A challenge for the pneumologists].

The experts conference on control of smoking in surgical patients led a synthesis of the literature which reveals among smokers 3 times more complications of the surgical site, twice more transfer in intensive care unit, an increase length of hospital stay, a 8-fold increase of the risk of non consolidation of bone, whereas quitting tobacco 6-8 weeks before the surgical procedure and until the end of the consolidation makes disappear surgical over risk related to tobacco smoke. An organization must urgently set up in all surgical units, so that the 2 millions smokers who underwent surgical procedure each year in France may be advertised and help to quit. If the mobilization of the decision makers, health care staff and patient is strong, the excepted health and financial benefit will be high and may contribute to reduce significantly the deficit of French national health insurance organization since 2006. The lung specialists have a key role to play in the implementation of these new practices.

France↗
PubMed2004

Prevalence of the sickle cell gene in Yemen: a pilot study.

To determine the prevalence of the sickle cell gene (betaS) in Yemen and amongst people from different regions of the country living in the capital, Sana'a City, cord blood samples from 1,500 consenting mothers were collected from hospitals in Sana'a City between July and December 2001. The names and original homes of the parents were recorded. Cation exchange high performance liquid chromatography (HPLC) analysis was used for screening, while isoelectric focusing (IEF) and DNA polymerase chain reaction (PCR) were used to confirm Hb S [beta6(A3)Glu-->Val]. Thirty-three samples were found to show Hb FAS, giving an overall likely betaS gene frequency of 0.011. The betaS gene frequency varied with the part of the country from which the parents came. Amongst people from Taiz and Haja in the west, the gene frequency was more than 0.04, but less than 0.004 amongst people from Ibb, adjacent to the governorate (administrative division) of Taiz. Of 66 chromosomes from babies carrying the betaS gene, only 1.5% also carried the -158 (C-->T) Ggamma-globin gene XmnI site compared with 16.1% of 168 chromosomes from babies without the betaS gene from the same regions. The results of this study show a higher betaS gene frequency in the western coastal part of Yemen than in the central mountainous and eastern desert areas. The incidence of affected homozygous births may therefore reach 20/10,000 in certain areas, although it is much lower than this overall. Limited health resources can best be invested in developing a program of education, screening and health care, initially prioritizing those communities residing in the western areas of Yemen with the highest betaS gene frequency.

Gene Frequency↗