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[en] To report our experience of managing extensive retroperitoneal hematoma (RH) in patients with blunt trauma and to determine any associated factors affecting causation and mortality. In this retrospective observational study, patients diagnosed with extensive RH following blunt trauma admitted to King Saud Medical Complex, Riyadh, Kingdom of Saudi Arabia between January 2004 and December 2009 were included. Patient data were explored for injury severity score (ISS), associated injuries, location of hematoma, amount of blood transfusions, coagulation profile, operative management, hospital stay, and mortality. The outcomes in surviving and non-surviving patients were compared. Out of 290 patients presenting with RH, extensive RH was found in 46 patients (15.8%). The overall mortality was 32.6%. The pelvis was the most frequent location of RH in combination with lateral and central zones (65.2%). The lower extremity and pelvic fractures were the most common injury. Associated intra-peritoneal injuries were present in 39.1% patients. An exploratory laparotomy was performed in 58.7% patients (n=27). A high ISS (55.9 versus 35.5, p<0.0001), abnormal coagulation profile (odds ratio [OR] 7.8, 95% confidence interval [CI] 1.974-30.932, p=0.005, and associated chest injuries OR 5.94, 95% CI 1.528-23.19, p=0.014) were independent factors associated with mortality. Multiple musculoskeletal injuries in addition to intra-abdominal injuries and abnormal coagulation are major factors associated with the presence of extensive RH. High ISS, abnormal coagulation, and associated chest injuries are independent factors associated with mortality (Author).
[en] Between 2002 and 2003, an outbreak of a trout's mass death occurred at the intensive fish culture a Peruvian rural town (Marcara, Huaraz, Peru) where 15,000 from 20,000 fish died. Our objective in the present study was to investigate the high mortality of the trout biomass occurred in period of two months. This study was conducted after the peak of the outbreak has occurred. We collected samples of fishes, water and fish foodstuff which were examined for aflatoxin, metals, toxics and bacteria. We interviewed people who administered the feed pellet. Feed sample preparation, transport and storage. The processing of fish feed was at room temperature which was below 16 deg C. Once prepared the diet it was keep under an appropriate room for a few days before sending to Marcara town. Fishes. 20,000 immature trout larval of rainbow trout (Oncorhynchus mykiss) was acquired from an official Peruvian fish culture. The fishes were fed twice a day. Adjusted of feed ration was based from the monthly sample weight. Pellet sample analysis. The samples were analyzed for aflatoxin Bl (AFB1) according to the method previously published. The sensitivity is 0.1 μg per 1 kg of sample. During the fish development until the peak of the outbreak, the foodstuff to fishes was maintained in plastic bags. At this time the storage room temperature was 18-20 deg. C between 1.00-2.00 P.M. and the humidity rose close to 90 % at the Marcara facilities. Mortality development and Effect on survival. The fishes maintained in 4 pods had a normal surviving until end of November, less than 10 specimen dead by month. The fish outbreaks started the first week of December and continuing until the fourth week of January totalizing 15,000 dead fish from 20,000. The survival of the fish at the first month was less than 50 %. The mortality continues throughout January totalizing 15,000 dead fish and leaving only 25% survival. Laboratory data. The collected samples for analysis were frozen and transported in dry ice to the analysis laboratory. We took the samples on January 23 and it was analyzed on January 25. Aflatoxin Bl was detected in three samples of fish muscle and in the 3 samples of fish feed but it was negative in the 3 water samples. The AFB1 concentration was 10 times in the fish feed than in the fish muscle. In spite of heavy metal residues (lead, mercury and arsenic) were found in the fish samples, those concentrations were below the permissible levels. Volatile toxic residues were negative in water, fish and feed. Only the fish feed samples were contaminated by bacteria (Staphylococcus aureaus). Under favourable conditions of temperature and humidity, the Aspergillus flavus grows on certain foods and feeds, resulting in the production of aflatoxin Bl. For the trout, the highest admissible amount of AFBI in feed is 0.1 μg per kg. The data showed suggest that an improper handling of fish foodstuff (18-20 deg. C and 90 % humidity) was the cause growing of mould and/or spores and consequently it produced an increased concentration of AFBI in fish feed. Liver is strategically located between intestinal tract and general circulation. As AFBI concentration ranged in liver between 10 and 100 ppb, this level is capable to produce an acute hepatotoxicity in the fish stocks. (author)
[en] This paper provides the estimate of cancer mortality caused by high-level radiation exposure. The method to estimate it is life table method. Throughout this method, we can obtain the lifetime and age-conditional probability of developing or dying of cancer. Moreover we can see the loss of rest of life. We obtain the result that the excess cancer mortality risk is not so serious. (author)
[en] Malaria has protean clinical manifestations and renal complications, particularly acute renal failure that could be life threatening. To evaluate the incidence, clinical profile, ou come and predictors of mortality in patients with malarial acute renal failure, we retrospectively studied the last two years records of malaria induced acute renal failure in patients with peripheral smear positive for malarial parasites. One hundred (10.4%) (63 males, 37 females) malaria induced acute renal failure amongst 958 cases of acute renal failure were evaluated. Plasmodium (P). falciparum was reported in 85%, P. vivax in 2%, and both in 13% patients. The mean serum creatinine was 9.2 ± 4.2 mg%, and oligo/anuria was present in 82%; 78% of the patients required hemodialysis. Sixty four percent of the patients recovered completely, 10% incompletely, and 5% developed chronic kidney failure; mortality occurred in 21% of the patients. Low hemoglobin, oligo/anuria on admission, hyperbilirubinemia, cerebral malaria, disseminated intravascular coagulation, and high serum creatinine were the main predictors of mortality. We conclude that malaria is associated with acute renal failure, which occurs most commonly in plasmodium falciparum infected patients. Early diagnosis and prompt dialysis with supportive management can reduce morality and enhance recovery of renal function (Author).
[en] Several studies have observed both higher mortality rates and lower utilization of endovascular aneurysm repair (EVAR) at low-volume centers. This article presents the results of elective abdominal aortic aneurysm (AAA) repair at a low-volume center in the endovascular era and investigates whether postprocedural mortality can be improved by extension of EVAR application also in this setting. This is an 11.6-year retrospective cohort study of 132 patients undergoing elective surgical or endovascular AAA repair at a tertiary care academic hospital between 1997 and July 2008, i.e., a median volume of 12 cases per year. The study was divided into two periods of time according to the respective indications and contraindications for EVAR, which substantially changed in 2005. During period 1, only aneurysms with necks ≥20 mm long and not involving the iliac arteries were treated endoluminally. Beginning in 2005, indication for EVAR was expanded to aortoiliac aneurysms with a minimum neck length of 15 mm. Preoperative risk was assessed by the SVS/AAVS comorbidity score. During the first period (1997-2004) 18.4% (16/87) of all patients received EVAR. By extending anatomical confines and indications for EVAR in 2005, the utilization rate of EVAR increased to 40.0% (18/45) during the second period (2005-July 2008; p = 0.007). Prevalence of preoperative risk factors did not change during the two observation periods. In contrast to period 1, high-risk patients were preferentially treated endoluminally during the second period, resulting in a significantly higher median SVS/AAVS score in the EVAR group (p < 0.001). A significant decrease in median length of stay at the intensive/intermediate care unit (5 vs. 2 days; p = 0.006) and length of in-hospital stay (20 vs. 12.5 days; p < 0.001) was observed during period 2. Overall perioperative mortality was reduced from 6.9% during the first period to 2.2% during the second period (p = 0.256). EVAR mortality was 0%, mortality after open repair was reduced from 8.5% to 3.7% (p = 0.414). In conclusion, by risk-adjusted selection of treatment and frequent application of EVAR, it is possible to improve perioperative outcome of elective AAA repair at a low-volume hospital. Mortality figures are similar to those of recent trials at high-volume centers, as reported in the literature.
[en] Heat waves may become a serious threat to the health and safety of people who currently live in temperate climates. It was therefore of interest to investigate whether more deprived populations are more vulnerable to heat waves. In order to address the question on a fine geographical scale, the spatial heterogeneity of the excess mortality in France associated with the European heat wave of August 2003 was analysed. A deprivation index and a heat exposure index were used jointly to describe the heterogeneity on the Canton scale (3,706 spatial units). During the heat wave period, the heat exposure index explained 68% of the extra-Poisson spatial variability of the heat wave mortality ratios. The heat exposure index was greater in the most urbanized areas. For the three upper quintiles of heat exposure in the densely populated Paris area, excess mortality rates were twofold higher in the most deprived Cantons (about 20 excess deaths/100,000 people/day) than in the least deprived Cantons (about 10 excess deaths/100,000 people/day). No such interaction was observed for the rest of France, which was less exposed to heat and less heterogeneous in terms of deprivation. Although a marked increase in mortality was associated with heat wave exposure for all degrees of deprivation, deprivation appears to be a vulnerability factor with respect to heat-wave-associated mortality.