Clinical characteristics and variables associated with COVID-19 morbidity and mortality in Luanda, Angola, in the first year of the pandemic

Background: The impact of SARS-CoV-2 infection in Africa is still unclear. In comparison to Europe and North America, morbidity and death rates are lower. Several factors have been proposed, including geographical variation in virus impact, environmental factors, differences in age distribution, and the impact of infectious diseases such as malaria, HIV infection and tuberculosis. Objectives: We investigated the clinical characteristics and putative determinants linked with COVID-19 in Angolan patients. Methods: Cross-sectional study undertaken at Military Hospital, Luanda, from March 2020 to March 2021. The survey collected sociodemographic and clinical information. Results: The sample included 1,683 patients aged ≥18 years, 64% men, with mean age of 46.3 years. SARS-CoV-2 was positive in 39% of the cases with RT-PCR. Patients ≥46 years with a level of education of ≥12 years had a considerably higher likelihood of testing positive. About 58% of positive patients had at least one comorbidity, of which hypertension and Diabetes were associated with SARS-CoV-2 infection. HIV and pulmonary TB were putative protective factors. About 14% of positive patients died. Most deaths occurred in patients ≥46 years, with less education and unemployed. Working as a healthcare practitioner was linked to a protective effect. Malignant diseases were the most common comorbidities associated with death. Conclusions: We identified putative factors related to SARS-CoV-2 infection and mortality. HIV and TB were protective and not associated with mortality. Further study with a broader scope should be conducted to explain the main features related to COVID-19 mortality in Angola

Neonatal morbidity and mortality: A 5-year analysis at federal medical centre, Gusau, Zamfara State, Northwest Nigeria

OBJECTIVES: Neonatal morbidity and mortality have remained embarrassingly high in Nigeria compared to some countries in Sub-Saharan Africa. Nigeria ranked first in the burden of neonatal deaths in Africa. Therefore, there is need to know causes of newborn diseases and deaths in our neonatal unit. The objective of the study was to describe the morbidity and mortality of newborns admitted into Special Care Baby Unit of Federal Medical Centre, Gusau, Nigeria over a 5-year period. MATERIAL AND METHODS: This is a retrospective study covering January 2012 to December 2016. The case folders of all newborns admitted during this period were retrieved and the following information were extracted: Sex of babies, diagnoses, outcome in terms of discharges, deaths, referrals, and discharge against medical advice (DAMA). RESULTS: A total of 3,553 neonates were admitted during the period under review. The sex ratio for males and females was 1.4:1, respectively. The major diagnoses were neonatal sepsis (NNS) 36.5%, birth asphyxia 25.6%, and prematurity 16.1%. Mortality rate was 6.6% with major contributions from birth asphyxia (35.6%), prematurity (28.1%), and NNS (12.0%). DAMA rate was 1.7%. CONCLUSION: This study has shown that NNS, birth asphyxia, and prematurity are the dominant causes of morbidity and mortality. These are largely preventable.

Morbidity and mortality of tetanus at Kenyatta National Hospital: a ten-year case audit

Introduction: Tetanus is a major health problem in developing countries, and is associated with high a morbidity and mortality. There are no recent local data in Kenya on the impact of the disease in terms of morbidity and mortality. The objective of this study was to describe the type, severity, risk factors, immunization history and outcome of tetanus patients at Kenyatta National Hospital (KNH). Method: This was a retrospective descriptive study of patients with a clinical diagnosis of tetanus admitted to KNH over ten years, who were aged 13 years and above. All available files with tetanus diagnosis were selected, and the patients' data were retrieved and analysed using SPSS Software version 21.0. Results: Out of 53 patients with tetanus, 50 (94.3%) were males and 3 (5.7%) were females. The mean age at presentation was 33.2 years (SD= 15.6). Only 4 (7.5%) patients had prior tetanus immunization. The commonest risk factor was acute injury - seen in 37 (69.8%) patients. The common site of injury was the lower limb - seen in 26 (49.1%) patients. The incubation period ranged from 3 to 90 days (IQR 7-17). Generalized tetanus was the commonest form found in 50 (94.3%) patients. Only 16 (30.2%) patients were managed in the Intensive Care Unit (ICU). The overall mortality was 49.1%. Conclusion: Tetanus mortality is still high as reported in many other studies. Most patients were males without prior immunization history. Only few patients were managed in Intensive Care Unit. We recommend advocacy on tetanus immunization and booster dosing

Taxa de morbimortalidade entre homens e mulheres com diagnóstico de infarto agudo do miocárdio / Morbidity and mortality rate among men and women diagnosed with myocardial infarction / Tasa de morbimortalidad entre hombres y mujeres diagnosticados con infarto agudo del miocardio

Objetivo: verificar se existe diferença na taxa de morbimortalidade entre homens e mulheres com diagnóstico de infarto agudo do miocárdio em um hospital de ensino. Método: estudo transversal, descritivo e quantitativo, com amostra de 647 prontuários, comparando-se fatores de risco, dados sociodemográficos e referentes à internação hospitalar. Resultados: de 647 pacientes, 415 eram homens e 232 mulheres, com idade variando entre 61 e 80 anos. Dos fatores de risco, 74,96% eram hipertensos em ambos os sexos, sendo que o percentual de hipertensão, diabetes e dislipidemia foi maior no sexo feminino. A taxa de mortalidade foi de 17,24% nas mulheres e 9,64% nos homens. Dentre os fatores de risco relacionados ao óbito, o mais significante foi a hipertensão arterial, seguido de diabetes e dislipidemia. Conclusão: houve maior prevalência de infarto do miocárdio no sexo masculino, entretanto, a taxa de morbidade e mortalidade foi maior no sexo feminino.

Objective: to identify any difference in morbidity and mortality rate between men and women diagnosed with acute myocardial infarction. Method: this quantitative, descriptive, cross-sectional study, involving a sample of 647 medical records, compared risk factors, and sociodemographic and hospitalization-related data. Results: of 647 patients, 415 were men and 232 women aged from 61 to 80 years. Risk factors included 74.96% of both sexes were hypertensives. Percentages of hypertension, diabetes, and dyslipidemia were higher in women. Mortality rates were 17.24% in women and 9.64% in men. The most significant risk factors for mortality were arterial hypertension, followed by diabetes and dyslipidemia. Conclusion: prevalence of myocardial infarction was higher in men, but morbidity and mortality rates were higher in women.

Objetivo: : verificar si existe alguna diferencia en la tasa de morbimortalidad entre hombres y mujeres diagnosticados con infarto agudo de miocardio en un hospital universitario. Método: se trata de un estudio transversal, descriptivo y cuantitativo, que involucró una muestra de 647 historias clínicas, comparando factores de riesgo, datos sociodemográficos y relacionados con la hospitalización. Resultados: de 647 pacientes, 415 eran hombres y 232 mujeres con edades comprendidas entre 61 y 80 años. En cuanto a los factores de riesgo, el 74,96% era hipertenso en ambos sexos. El porcentaje de hipertensión, diabetes y dislipidemia se mostró superior entre las mujeres. La tasa de mortalidad fue del 17,24% en mujeres y del 9,64% en hombres. Entre los factores de riesgo relacionados con la muerte, el más significativo fue la hipertensión arterial, seguido de la diabetes y la dislipidemia. Conclusión: hubo una mayor prevalencia de infarto de miocardio entre hombres, sin embargo, la tasa de morbilidad y mortalidad fue más alta entre mujeres.

Factores ambientales en la transmisión del SARS-CoV-2/COVID 19: panorama mundial y colombiano / Environmental factors in the transmission of SARS-COV-2/COVID 19: World and Colombian outlook

Resumen Introducción: Diversas investigaciones han intentado establecer el impacto de algunos parámetros meteorológicos y de calidad del medio ambiente en la transmisión del SARS-CoV-2, tomando en consideración las características geográficas de cada país y con el fin de mitigar el avance de la enfermedad mediante el control de esos factores. Objetivo: Analizar la evidencia existente sobre la posible relación entre factores ambientales y la morbilidad y mortalidad por SARS-CoV-2/COVID-19 en el panorama mundial y colombiano. Metodología: Se realizó una revisión exhaustiva de la literatura científica en las bases de datos electrónicas. Además, se analizó el impacto de algunas variables ambientales y la gravedad de los casos de COVID-19 durante el período del 8 de abril al 29 de julio de 2020 en la ciudad Bogotá. Resultados: El análisis correlacional entre la ocupación de camas UCIs en Bogotá con los factores ambientales como temperatura, las concentraciones de PM2 5, O3, NO, NO2 y CO mostraron una relación inversamente significativa. Entre tanto, se presentó una correlación positiva entre los niveles de óxidos de nitrógeno (NO/NO2) y el monóxido de carbono (CO). Algunos de estos resultados posiblemente están relacionados con los efectos de la cuarentena impuesta por el gobierno local. Conclusión: Nivel mundial existe suficiente evidencia para relacionar algunas condiciones y parámetros ambientales con un aumento en la morbilidad y mortalidad por COVID-19. Las evidencias a nivel nacional aún son escasas.

Abstract Introduction: Several investigations have attempted to establish the impact of some meteorological and environmental parameters on the transmission of SARS-CoV-2, considering each country's geographical characteristics and seeking to mitigate the disease's advancement by controlling these factors. Objective: Analyze the evidence on the possible relationship between environmental factors, morbidity, and mortality due to SARS-CoV-2/COVID-19, both globally and within Colombia. Methodology: A comprehensive review of the scientific literature was carried out in the electronic databases. Additionally, the impact of some environmental variables and the severity of COVID-19 cases were analyzed during the period from April 8 to July 29, 2020, for the city of Bogotá. Results: The correlational analysis between the ICU admission rates in Bogotá and the environmental factors like temperature, PM2 5, O3, NO, NO2 y CO levels, and ozone concentration showed an inversely significant relationship. Meanwhile, there was a positive correlation between the levels of nitrogen oxides (NO/NO2) and carbon monoxide (CO). Some of these results could be related to the effects of the quarantine imposed by local governments. Conclusion: Globally, there is enough evidence to link environmental conditions and parameters with increased morbidity and mortality for COVID-19. Evidence at the national level is still scarce.

Epidemiological characteristics of the notifiable infectious diseases reported in Zhejiang Province, 2020 / 预防医学

Objective@#To analyze the epidemiological characteristics of notifiable infectious diseases reported in Zhejiang Province in 2020 for prevention and control.@*Methods@#Data of notifiable infectious diseases reported in Zhejiang Province in 2020 were extracted from China Information System for Disease Control and Prevention. The incidence and death of notifiable infectious diseases were analyzed and compared with the averages from 2015 to 2019; then the characteristics of some key diseases such as coronavirus disease 2019 ( COVID-19 ), influenza and other infectious diarrhea were summarized. @*Results@#Totally 487 271 cases of 30 kinds of infectious diseases were reported. The incidence and mortality rate was 832.94/100 000 and 0.615 4/100 000, which were 7.05% and 14.60% lower than the average value of 2015-2019.The weekly morbidity of Class A and Class B infectious diseases fluctuated between 1.24/100 000 and 3.68/100 000, and hit the bottom in the sixth to eighth week. The morbidity of Class C infectious diseases was 154.19/100 000 in the first week, then dropped to 4.83/100 000 in the second to sixth week and maintained at a low level. High morbidity of infectious diseases were reported in Hangzhou ( 1 412.62/100 000 ), Jinhua ( 960.35/100 000 ) and Ningbo ( 921.25/100 000 ). The morbidity of class C infectious diseases in Hangzhou was 1 248.80/100 000, which was far higher than that of other ten prefecture-level cities. The diseases with high reported morbidity were influenza (438.45/100 000), other infectious diarrhea (140.29/100 000 ), hand-foot-and-mouth disease ( 99.64/100 000 ), pulmonary tuberculosis ( 41.92/100 000 ), syphilis (41.37/100 000) and viral hepatitis ( 30.48/100 000 ). More deaths were reported in AIDS and pulmonary tuberculosis, and the mortality were 0.482 1/100 000 and 0.116 2/100 000. A total of 1 306 confirmed cases, 302 asymptomatic infections and 1 death of COVID-19 were reported. @*Conclusion@#In 2020, the incidence rate of notifiable infectious diseases in Zhejiang decreased compared with the average value of 2015-2019. Pulmonary tuberculosis, syphilis and hepatitis B still have high morbidity, and the COVID-19 epidemic spread widely. The morbidity of some respiratory infectious diseases and imported infectious diseases have dropped significantly compared with previous years.

Reporte de caso: manejo multidisciplinario en gestante con embarazo de 31 semanas y COVID-19 positivo con evolución grave / Case report: multidisciplinary management in case of 31 weeks pregnant woman and COVID 19 infection with severe disease presentation

INTRODUCCIÓN: En diciembre de 2019 se reporta un brote de neumonía atípica causada por un nuevo coronavirus: SARS-CoV-2 (Severe Acute Respiratory Syndrome-Coronavirus-2), cuya enfermedad se denomina COVID-19 (Coronavirus Disease 2019). Desde entonces su distribución se ha ampliado mundialmente causando una emergencia en los sistemas de salud. MÉTODO: Corresponde al reporte de caso clínico. Este estudio es descriptivo y se basa en el manejo realizado a paciente embarazada con COVID-19 confirmado. Esta publicación cuenta con la autorización del comité de ética local para la revisión de ficha clínica. CASO: Mujer de 40 años con un embarazo de 31 semanas, se le diagnostica COVID-19 tras contacto estrecho con caso confirmado. Evoluciona con disnea y por posibilidad de interrupción del embarazo se traslada a centro de mayor complejidad. Allí se pesquisa compromiso de función pulmonar, uso de musculatura accesoria y alteración sensorial, requiriendo oxigenoterapia. Se evalúa interdisciplinariamente decidiendo intubar y realizando manejo en unidad de cuidados intensivos (UCI). Se realiza cesárea de urgencia a las 31+4 semanas debiendo realizarse histerectomía total por inercia uterina. Tras el procedimiento evoluciona tórpidamente con deterioro de función pulmonar, describiéndose un pronóstico catastrófico con probabilidad de fallecer por insuficiencia respiratoria. Un mes después despierta con una mejoría en su función pulmonar, sin otra falla orgánica. Actualmente se encuentra en buenas condiciones y es tratada multidisciplinariamente para lograr una rehabilitación integral. DISCUSIÓN: En epidemias pasadas, las embarazadas mostraron altas tasas de letalidad y riesgo de ingreso a UCI. Basados en una revisión de reportes de casos, parece ser que COVID-19 durante el embarazo se asocia a morbilidad materna severa, riesgo que aumenta en mujeres con comorbilidades, lo cual hace cuestionarnos si la infección por COVID-19 intensifica el riesgo materno o estos casos ya eran embarazos de riesgo. Se necesitan futuras investigaciones al respecto.

INTRODUCTION: The coronavirus disease 2019, caused by severe acute respiratory syndrome coronavirus 2, was first reported in december 2019 in China as an atypipical pneumonia. Since then its distribution has globally expanded causing a public health emergency. METHOD: Corresponds to a case report. A descriptive study about the management of a pregnant woman whith COVID-19. CASE: A 40 year old pregnant woman, 31 weeks gestational age, was admitted with a diagnosis of COVID-19. She developed dyspnea and preterm birth risk that needed a more complex hospital level. Thereafter, the patient developed respiratory distress, use of accessory breathing muscles and neurological alteration, requiring oxygen therapy. An interdisciplinary medical team evaluation decided to manage her condition at intensive care unit (ICU). Cesarean delivery was performed at 31+4 weeks. After the procedure, the pulmonary function declined to a life threatening condition. A month later, the patient woke up with improved pulmonary function, without any organ failure. Currently the patient is in a good general condition with a multidisciplinary rehabilitation treatment ongoing. DISCUSSION: In previous epidemic outbrakes, pregnant women presented high fatality rates and intensive care tratment risk. Based on a case report review, COVID-19 in pregnancy is associated with severe maternal morbidity, specially in women with associated comorbidities. This situation raises the question whether the COVID-19 infection intensifies the maternal risk or whether these cases were already a high risk pregnancies. Additional studies are needed to answer this issue.

A re-emerging coronavirus (2019-ncov) : a review

@#SARS-CoV-2 or 2019-nCov is the Coronavirus first named in 2019 that originated in the city of Wuhan in Hubei province China in December 2019. It causes severe acute respiratory syndrome (SARS). The clinical disease is called COVID-19 by the World Health Organization. SARS-CoV-2 enters the cell via the ACE-2 receptor. COVID-19 rapidly evolved into a pandemic by late February 2020. This review article focuses on the epidemiology, biology, pathogenesis, management and prevention of this virus that has high morbidity and mortality globally. The epicenter of the pandemic rapidly moved from China to Europe, with Italy being the most severely affected; it has since moved to USA, with New York State as the most severely affected. It is transmitted via aerosols and fomites. It causes severe upper and lower respiratory infections. The symptoms include fever, dry cough and malaise. These often rapidly progress to respiratory failure needing aggressive respiratory support. Confirmation of the diagnosis is usually by using Reverse Transcriptase Polymerase Chain Reaction (RTPCR). Some of the WHO recommended preventive measures include, among others, using alcohol based sanitizers, N95 facemask and strict quarantine of patients and contacts.

Ingresos a Unidad de Cuidados Intensivos de mujeres durante el embarazo y periodo puerperal / Admission of women to an intensive care unit during pregnancy or the postpartum period

Introducción: las complicaciones del embarazo y parto constituyen las principales causas de muerte entre las mujeres en edad reproductiva. Las embarazadas o puérperas que ingresan a Unidad de Cuidados Intensivos (UCI) son en su mayoría casos agudos críticos con riesgo de muerte, que necesitan tratamiento especializa do y complejo. Constituyen un grupo significativo de la práctica obstétrica. Objetivo: determinar las características clínicas y demográficas de las pacientes gestantes o puérperas que ingresaron a UCI del Hospital Nacional de Itauguá durante 5 años (2011-2015) Materiales y métodos: diseño observacional descriptivo de corte trasverso. Fueron incluidas gestantes y puérperas que requirieron ingreso a UCI por complicaciones obstétricas y no obstétricas, descompensación materna, con y sin morbilidad previa. Resultados: necesitaron ingreso a UCI 135 pacientes (0,48%). La edad media fue 27 ± 6,7 años. La muestra estuvo conformada por 21 gestantes (15,5%), 85 puérperas (63%), 27 mujeres con post aborto (20%) y 2 con embarazo ectópico (1,5 %). La complicación obstétrica más frecuente que motivó el ingreso a UCI fue la sepsis y entre las no obstétricas la cardiopatía descompensada. El tiempo medio de internación en la UCI fue 6,47 ± 8,5 días y 50 pacientes (37,03%) necesitaron asistencia respiratoria mecánica. Hubo 19 óbitos (14%) Conclusiones: el ingreso a UCI se observó en 0,48%. La mortalidad en UCI fue 14%.

Introduction: complications of pregnancy and childbirth are the main causes of death among women of childbearing age. Pregnant women or postpartum women entering the Intensive Care Unit (ICU) are mostly acute cases with a high risk of death, which require specialized and complex treatment. They constitute a significant group of obstetric practice. Objective: to determine the clinical and demographic characteristics of the pregnant or puerperal patients who entered the ICU of the National Hospital of Itauguá for 5 years (2011-2015) Materials and methods: descriptive observational cross-sectional design. Pregnant women and postpartum women who required admission to the ICU due to obstetric and non-obstetric complications, maternal decompensation, with and without prior morbidity were included. Results: 135 patients required admission to the ICU. The mean age was 27 ± 6.7 years. The sample consisted of 21 pregnant women (15.5%), 85 postpartum women (63%), 27 women with post abortion (20%) and 2 with ectopic pregnancy (1.5%). The most frequent obstetric complication that led to ICU admission was sepsis and non-obstetric heart disease was decompensated. The mean ICU admission time was 6.47 ± 8.5 days and 50 patients (37.03%) required mechanical ventilation. There were 19 deaths (14%) Conclusions: ICU admission was observed at 0.48%. Mortality in ICU was 14%.

Acute renal failure in pregnancy at a tertiary level hospital in Mumbai: An epidemiological profile.

Background: To study the clinical profile of pregnancy related acute renal failure, management and outcome in terms of cure, maternal morbidity and maternal – fetal mortality. Methods: This is a prospective observational study carried out on hospitalized patients in our hospital over a period of fourteen months (August 2007 – September 2008) after approval from the ethical clearance committee. Results: A total of 41 patients, with age ranging between 15 – 45 years. The majority of the patients 25 (60.98%) were multigravida and 16 (39.02%) were primigravida. The bimodal frequency pattern were also observed in our study, first between 19 to 24 weeks of gestation and second around 31 to 36 weeks of gestation. The incidence of PR-ARF was about 1 in 270 pregnancies. Sepsis was the commonest cause of PR-ARF (46.34 %) followed by Toxaemia of Pregnancy (31.69%) and Haemorrhage (14.62%). The incidence of septic abortion as a cause of PR-ARF has declined to 7.31%. Oliguria was the commonest symptom (58.53%). Fluid overload was the most common complication encountered (33.33%). Conclusion: Incidence of PR-ARF is still high in our country as compared to western countries. Multigravidas were more commonly affected than primigravidas. Sepsis was the commonest cause of PR-ARF followed by toxaemia of pregnancy and haemorrhage. Maternal and fetal mortality were high , 17.07 % and 2.43 % respectively.

Impact on Morbidity & Mortality by Rodenticidal Poisoning.

Background : Rodenticidal poisoning is a very common clinical entity regularly encountered in outdoor & emergency department in various parts of India. This is the commonest type of poisoning. We present the prospective study of clinical profile, course, complication & outcome of various rodenticidal poisoning in 170 patients. Objectives : To determine the clinical symptoms, morbidity and mortality in various rodenticidal poisoning. To study the clinical profile & laboratory investigations. To study the course, complications & outcome. Methods : Study period was from 01 May 2011 to 30 April 2012. Historically and documented evidence of 170 patients of various rodenticidal poisoning admitted in the emergency, medical wards & I.C.U. under department of medicine, undergone for various laboratory investigations and imaging study. Statistical analysis was done in mean, range, standard deviation and percentage. Results : A total of 170 cases of various rodenticidal poisoning admitted in MBS hospital, Govt. Medical College, Kota were studied. The age of patients ranged from 10 to 65 years. Age groups were divided in four group, 10-18, 19-30, 31-45 & 45-65. Most common age group was ranged from 18-30 year. Most common gender was female (females 92 males 78). Mode of poisoning were suicidal, accidental & homicidal. Commonest mode of poisoning was suicidal uptake of poison. Route of poisoning was ingestion. Common presenting signs & symptoms were nausea & vomiting seen in 157(92.35%), Tachycardia in 156(91.7%), Tachypnoea in 137(80.62%), & Abdominal pain 129(75.8%). Few patients presented with Headache, Palpitation & Sweating. Deranged laboratory findings on day third of admission include Anemia in 21.76%, Leucocytosis in 20.59%, prolonged Prothrombin time (PT) in 16.47% & increased serum Bilirubin in 11.18%. Morbidity developed in 8 cases(4.71%), Of which four have Hemorrhagic complication ( e.g. Bleeding gums, Purpura Melena & Hematuria) by Dicoumarol , Bromadiolone and Brodifacoum. Three patients of Zinc phosphide poisoning produced cardiac insult and one patient of Barium carbonate poisoning developed cardiac arrhythmia. Transient arrhythmias and respiratory failure developed in other rodenticidal poisoning. All patients treated symptomatically and according to complications. Six cases of our study remained asymptomatic for two to three days then they developed delayed hemorrhagic complication ( Bleeding gums, Purpura, Melena & Hematuria). These patients had deranged liver function test (LFT) & prolonged Prothrombin time (PT). Mortality was seen in 1.76%( 3 cases). By Zinc phosphide in 2 patient and Barium carbonate in 1 patient. Conclusion : We concluded that bleeding, bruising & other hemorrhagic complications should be treated and monitored according to Prothrombin time (PT) & INR. Awareness should be increased especially for Zinc phosphide and arrhythmia produced by Barium carbonate.

Epidemiology and control of malaria in Colombia

Malaria is currently one of the most serious public health problems in Colombia with an endemic/epidemic transmission pattern that has maintained endemic levels and an average of 105,000 annual clinical cases being reported over the last five years. Plasmodium vivax accounts for approximately 70 percent of reported cases with the remainder attributed almost exclusively to Plasmodium falciparum. A limited number of severe and complicated cases have resulted in mortality, which is a downward trend that has been maintained over the last few years. More than 90 percent of the malaria cases in Colombia are confined to 70 municipalities (about 7 percent of the total municipalities of Colombia), with high predominance (85 percent) in rural areas. The purpose of this paper is to review the progress of malaria-eradication activities and control measures over the past century within the eco-epidemiologic context of malaria transmission together with official consolidated morbidity and mortality reports. This review may contribute to the formulation of new antimalarial strategies and policies intended to achieve malaria elimination/eradication in Colombia and in the region.

Transporte neonatal seguro en la población abierta del estado de Jalisco: impacto del programa S.T.A.B.L.E. en la morbilidad y mortalidad / Safe neonatal transport in Jalisco state: impact of S.T.A.B.L.E. program on morbidity and mortality

Introducción. El transporte neonatal desde las unidades médicas hasta las unidades de tercer nivel en muchos casos es desorganizado y arriesgado, situación que compromete aún más el estado de salud del neonato enfermo. El objetivo del estudio fue analizar el impacto del programa S.T.A.B.L.E. (de las siglas en inglés: Sugar and Safe care, Temperature, Airway, Blood, Lab work, Emotional support) en la morbimortalidad de los neonatos trasladados del interior del estado de Jalisco y de la zona metropolitana de Guadalajara, a la Unidad de Cuidados Intensivos Neonatales Externos (UCIN-EX) del Hospital Civil de Guadalajara. Métodos. Se diseñó un estudio prospectivo de 2005 a 2009. El proceso de intervención se basó en la aplicación del programa S.T.A.B.L.E. a todo neonato que requirió ser trasladado. Esto se logró con la intervención de los médicos reguladores del Sistema de Atención Médica de Urgencias (SAMU) del estado de Jalisco. Se implementó un curso de capacitación para el personal médico y paramédico de los centros de atención que refieren pacientes a nuestra unidad, con el fin darles a conocer el programa S.T.A.B.L.E. y su forma de aplicación. Resultados. Un total de 3,277 neonatos fueron incluidos en el estudio, 384 antes de implementar el programa y 2,893 con la aplicación del programa S.T.A.B.L.E. En el grupo con intervención se observó una frecuencia mayor de pacientes con temperatura corporal normal a su ingreso a la unidad receptora [516 (87%) vs. 227 (59%) p < 0.01 ], así como cifras de glicemia en rangos normales [690 (93%) vs. 173 (45%) p < 0.001]. La mortalidad durante el periodo de hospitalización en la unidad receptora fue menor en el grupo con intervención [405 (14%) vs. 84 (22%) p < 0.05]. Después del proceso de intervención, más pacientes fueron trasladados en incubadora [2,806 (97%) vs. 200 (52%) p < 0.001]; de igual forma, en más pacientes se aplicaron métodos de monitoreo de oximetría de pulso [2,575 (89%) vs. 235 (61 %) p < 0.01 ]. En cuanto al número de transportes neonatales regulados y autorizados por el sistema SAMU, se observó un incremento a favor del grupo con intervención [2,806 (97%) vs. 234(61%) p < 0.001]. La frecuencia de defunciones durante el transporte neonatal no presentó diferencias [30 (1 %) vs. 10 (2.6%) p = NS]. Conclusiones. El traslado de neonatos enfermos al tercer nivel de atención médica en el estado de Jalisco se realizó de forma segura, con una mejoría importante en la morbilidad. El programa S.T.A.B.L.E. fue altamente eficiente y de fácil aplicación. La disminución de la mortalidad de los pacientes con intervención del programa durante el periodo de hospitalización requiere estudios especialmente diseñados para establecer posibles asociaciones.

Background. Transporting newborn infants to third-level units is often disorganized, thus entailing several risks that may further compromise the health of newborn patients. Methods. A prospective study was designed in orderto assess the impact ofthe S.T.A.B.L.E. program (Sugarand Safe Care, Temperature, Airway, Blood, Lab work, Emotional support) from 2005 to 2009 in regard to morbidity and mortality rates of newborn patients who had to be transferred from other regions within Jalisco state or within Guadalajara's metropolitan area to the Neonatal Intensive Care Unit ofthe Civil Hospital in Guadalajara. The intervention process was based on applying the S.T.A.B.L.E. program to all newborns who needed to be transferred and was achieved with the intervention ofthe physicians regulating the Emergency Medical Assistance System (SAMU) of the state of Jalisco. A training course, as well as an educational brochure, was given to medical and paramedical staff from the medical assistance centers referring patients to our unit in orderto provide them with information on the S.T.A.B.L.E. program and its implementation. Results. A total of 3,277 newborn infants were included in the study, 384 before the intervention program and 2,893 once the S.T.A.B.L.E. program was implemented. Within the group transferred after the program's implementation, we observed a greater incidence of patients with normal body temperature upon admission to the receiving unit [516 (87%) vs. 227 (59%); p < 0.01 ] as well as with blood glucose figures within the normal range [690 (93%) vs. 173 (45%); p < 0.001]. Mortality during the hospitalization period in the receiving unit was lower in the group treated after the program's implementation [405 (14%) vs. 84 (22%); p < 0.05]. After the intervention process, more patients were transported in incubators [2,806 (97%) vs. 200 (52%); p < 0.001] and equally, pulse oximetry monitoring methods were applied in a greater number of patients [2,575 (89%) vs. 235 (61 %); p < 0.01 ]. With regard to the number of transfers of newborns that were regulated and authorized by the SAMU system, we also observed an increase in such numbers for the group treated after the intervention program [2,806 (97%) vs. 234 (61 %); p < 0.001]. There was no difference in the incidence of death during the newborns' transport [30 (1%) vs. 10 (2.6%); p = NS]. Conclusions. Transfer of ill newborns to third-level medical care units in the state of Jalisco was safely undertaken with a significant improvement in morbidity rates. The S.T.A.B.L.E. program was highly effective and easy to implement. The decrease in mortality during the hospitalization period of patients treated after the intervention program merits further studies especially designed to establish possible associations.

Pressure ulcers in the medical wards of RIPAS Hospital: Incidence and risk factors

Introduction: Pressure ulcers are very common, however their incidence varies widely between hospitals. To date there are no published data available for pressure ulcers in Brunei Darussalam. This study was designed to look at the incidence and risk factors of pressure ulcers among medical patients in RIPAS Hospital. Materials and Methods: All medical patients admitted to all five medical wards during the month of May 2010 were included and identified. A proforma based on the European Pressure Ulcer Advisory Panel (EPUAP) model was used and modified to include several factors that may contribute to the risk of developing new pressure ulcers. The proforma was completed by the attending physician during the patient's admission and then subsequently followed up by the parent admitting team until discharge. Results: There were a total of 305 patients (104 male and 201 female) with a mean age of 48.9 ± 20.4 years. There were five patients with pressure ulcers (1.6%), four of which developed during hospital stay and one patient admitted with an ongoing pressure ulcer. All five patients were female, had co-morbidities, were bed-bound and unwell during admission. On comparison to those without pressure ulcers, patients were significantly older, had more co-morbidities, being bed bound, admissions to intensive care unit and had lower serum haemoglobin (p<0.05), albumin (p<0.05) and total protein (p<0.05) on admission. Two patients died during their in-patient stay due to other medical illness. The remaining patients had prolonged hospital stay (over 30 days). Conclusions: The study showed an incidence of 1.6% pressure ulcers among medical patients in RIPAS Hospital. We identified several factors that are significant in increasing patients’ risk of developing pressure ulcers.

Thirty-Day Morbidity and Mortality after Simultaneous Bilateral Total Knee Arthroplasty

The safety of simultaneous bilateral total knee arthroplasty (TKA) remains controversial. The objective of the current study was to investigate perioperative morbidity and mortality rates within 30 days of simultaneous bilateral TKA. A detailed analysis of medical, surgical and anaesthesia records of 183 consecutive patients who underwent total knee arthroplasty between 2002 and 2006 was performed. The mean age of the patients was 67.6 years old. More than 80% had one or more co-morbidities, but none of them had ASA score greater than class 2. The mean hospital stay was 10 days, and the mean surgical time 156 minutes. Less than half of the patients (42.6%) required blood transfusion. The rate of perimorbidity was 15.3 % and there was no mortality in this series. We believe that simultaneous bilateral total knee arthroplasty is a safe and cost effective option for our patients, provided that patients are selected and informed appropriately.

Chagas disease: what is known and what is needed - A background article

Chagas disease began millions of years ago as an enzootic disease of wild animals and started to be transmitted to man accidentally in the form of an anthropozoonosis when man invaded wild ecotopes. Endemic Chagas disease became established as a zoonosis over the last 200-300 years through forest clearance for agriculture and livestock rearing and adaptation of triatomines to domestic environments and to man and domestic animals as a food source. It is estimated that 15 to 16 million people are infected with Trypanosoma cruzi in Latin America and 75 to 90 million people are exposed to infection. When T. cruzi is transmitted to man through the feces of triatomines, at bite sites or in mucosa, through blood transfusion or orally through contaminated food, it invades the bloodstream and lymphatic system and becomes established in the muscle and cardiac tissue, the digestive system and phagocytic cells. This causes inflammatory lesions and immune responses, particularly mediated by CD4+, CD8+, interleukin-2 (IL) and IL-4, with cell and neuron destruction and fibrosis, and leads to blockage of the cardiac conduction system, arrhythmia, cardiac insufficiency, aperistalsis, and dilatation of hollow viscera, particularly the esophagus and colon. T. cruzi may also be transmitted from mother to child across the placenta and through the birth canal, thus causing abortion, prematurity, and organic lesions in the fetus. In immunosuppressed individuals, T. cruzi infection may become reactivated such that it spreads as a severe disease causing diffuse myocarditis and lesions of the central nervous system. Chagas disease is characterized by an acute phase with or without symptoms, and with entry point signs (inoculation chagoma or Romaña's sign), fever, adenomegaly, hepatosplenomegaly, and evident parasitemia, and an indeterminate chronic phase (asymptomatic, with normal results from electrocardiogram and x-ray of the heart, esophagus, and colon) or...

Pediatric morbidity and mortality in DakLak Provincial Hospital between 1999 and 2001

The diseases model of children visited and pediatric in patients at DakLak Provincial Hospital between 1999 and 2001 maily were infections, parasitic diseases such as diarrhea, pneumonia, malaria, especially in perinatal period. Ratio of pediatric inpatients/total of pediatric examination was 20.41%.The average hospitalized days was 6.39. Ratio of pediatric death/total pediatric inpatients accounts for 3.09%, among them 75.48% were children of 0-4 years old. There are significant differences of morbidity rate, hospitalized treatment, and mortality rate between groups according to ICD-10