Determinants of 30-day mortality of spontaneous intracerebral hemorrhage in Pakistan

BACKGROUND: The present study was undertaken to evaluate the determinants of acute (30-day) mortality after spontaneous intracerebral hemorrhage (ICH) in a developing country setting, and to compare these findings with those available from studies conducted in the West. METHODS: Medical records of 146 patients admitted to a major tertiary hospital in Karachi, Pakistan between 1990 and 1991 with a diagnosis of spontaneous ICH were reviewed. The level and intensity of care provided to these patients was similar to that available at modern neurosurgical centers. The salient prognostic indicators that were studied included hypertension, pulse pressure, GCS score, neurologic deficits, and CT-scan predictors including site, size, and intraventricular spread of hemorrhage. These data were used to determine independent predictors of 30-day mortality by univariate and multivariate analysis. Additionally, 30-day survival probabilities for these outcome predictors were also computed. RESULTS: The 30-day mortality after spontaneous ICH was 39.7%. Two-thirds of the patients had a history of hypertension. The important clinical predictors at the multivariate level included GCS score < or =8 and progressive increase in pulse pressure. The CT scan predictors included intraventricular spread of hemorrhage, ventricular enlargement, and size of the bleed. Location of the lesion did not appear to significantly influence mortality. Survival analysis showed a large clustering of deaths within the first 72 hours of hospitalization. CONCLUSIONS: The 30-day mortality rate and prognostic predictors for spontaneous intracerebral hemorrhage were found to be similar to those reported in the Western hemisphere. However, the correlation of incremental increase in pulse pressure with deteriorating prognosis was a new and significant finding.     

未成年刑事犯罪人适用罚金刑的再探究

罚金刑对于一些以谋取经济利益为目的的刑事犯罪人具有普遍适用的意义.而对于特殊的犯罪主体-未成年人,由于罚金刑的自身特点及在适用时并不违背刑法和刑罚的基本原则,也可以适用.在适用时除了遵循刑罚的公平、正义、平等的原则外,还应遵循刑罚必然性和刑罚适度性原则.     

The relationship of hospital ownership and teaching status to 30- and 180-day adjusted mortality rates

Hospital characteristics have been shown previously to be associated with variations in the probability of death within 30 days of admission. In the current study, the authors extend the examination of the relationship between hospital type to both short-term and long-term adjusted mortality. Observed and predicted 1988 hospital mortality rates were obtained from the Health Care Financing Administration (HCFA). A total of 3,782 acute care hospitals were divided into six mutually exclusive groups on the basis of their status as osteopathic, private for-profit, public teaching, public nonteaching, private teaching, and private nonteaching hospitals. After adjusting for the HCFA predicted mortality, Medicaid admissions, and emergency visits, 30-day and 30-to-180-day patient mortality rates were compared for these hospital types. Separate comparisons also were performed after stratifying hospitals into three groups defined by community size. The risk-adjusted 30-day mortality per 1,000 patients was 91.5, ranging from 85.4 for private teaching hospitals to 95.3 for nonteaching public hospitals, and 97.4 for osteopathic hospitals. The adjusted 30-to-180-day mortality was 84.7, ranging from 82.6 for nonteaching public hospitals to 87.4 and 88.2, respectively for public teaching and osteopathic hospitals. Differences among hospital types were minimal for small communities and increased with community size. In the large communities, the types of hospitals with high 30-day mortality also had higher mortality after 30 days. There was a strong association of hospital type with adjusted 30-day mortality, which should depend on the quality of hospital care, and a much weaker association with post-30-day mortality, which may be more dependent on patient risk. There was no evidence that types of hospitals with low 30-day mortality were postponing rather than preventing mortality.     

Orthostatic stability in cosmonauts following 30- and 63-day flights in orbital station "Salyut-4"

Reactions of the circulation system of cosmonauts to the up and down body movements were studied after 30-day and 63-day flights. All the four cosmonauts showed a decline in the orthostatic tolerance. An improved system of countermeasures against unfavourable effects of weightlessness used in the 63-day flight helped to maintain a better orthostatic tolerance of the crewmembers than that of the 30-day cosmonauts. It is assumed that a rapid increase of orthostaic tolerance postflight indicates an adequate maintenance of functional capabilities of circulation and suggests possible stimulation of its antigravity mechanisms prior to reentry in order to prevent postflight orthostatic disorders. An exposure to weightlessness increased the capacity of circulation to counteract the blood redistribution in the cranial direction in the head-down position. This capacity became more pronounced and stable with an increase in the flight time.     

Violence in psychiatric hospitals: are certain staff prone to being assaulted?

BACKGROUND: A number of enzymatic techniques have recently been developed to detect DNA fragmentation in apoptosis at the cellular level. However, since DNA fragmentation also occurs in cellular necrosis, we studied to which extent the use of DNA polymerase (nick translation) or terminal transferase (tailing) allows the differentiation between internucleosomal DNA degradation, typical for apoptosis, and the more random DNA destruction in necrosis. EXPERIMENTAL DESIGN: We compared these techniques on in vitro and in vivo models for apoptotic or necrotic cell death. Apoptosis of thymocytes in vitro was induced by gamma-irradiation, necrosis by the cytotoxic action of antibody and complement. Cell death in vivo was examined on paraffin-embedded tissue material from animals with autoimmune encephalomyelitis that served as a model for apoptosis, or in kainic acid-induced nerve cell degeneration as a model for necrosis. RESULTS: DNA fragmentation was visualized by the incorporation of labeled nucleotides into the nuclei of affected cells utilizing tailing or nick translation techniques. In the early stages of cell degeneration in vitro, cells undergoing apoptosis were preferentially labeled by tailing, whereas necrotic cells were identified by nick translation. Similarly, early stages of necrosis in vivo were preferentially detected by nick translation, whereas tailing was slightly more sensitive for the detection of apoptosis. Results obtained with these enzymatic techniques were in accord with the assessment of cell death by morphologic criteria. Both techniques could be applied in tissue samples even after prolonged fixation in paraformaldehyde if the sections were pretreated with proteinase K digestion. CONCLUSIONS: Our studies show that both in situ nick translation and in situ tailing are useful in detecting DNA fragmentation in cell suspensions and tissue sections. These techniques may help to define the molecular mechanisms leading to cell death in experimental conditions and eventually in human tissue.     

Altruism in psychiatric patients: how socially concerned are the emotionally disturbed?

Blood clotting and fibrinolytic systems were studied in the plasma of a sei whale (Balaenoptera borealis). The sei whale belongs to the suborder baleen whales of the order Cetacea. Whale plasma had a greatly prolonged kaolin-activated partial thromboplastin time and was deficient in Hageman factor (factor XII), Fletcher factor (a plasma prekallikrein), and PTA (factor XI). All other clotting factor activities were present in amounts comparable to that of normal human plasma. Whale plasminogen was activated by human urokinase, but not by streptokinase. Whale plasma contained inhibitory activities against thrombin, activated Stuart factor, activated PTA, activated Fletcher factor, and plasmin.     

Psychotherapy for chronic psychiatric patients who are survivors of child sexual abuse.

Discusses the efficacy of psychotherapy for patients with severe, chronic mental illnesses who are survivors of child sexual abuse. Three case illustrations taken from work with outpatients in a day-treatment center show how therapeutic work on childhood abuse can help impulsive, acting-out borderline patients moderate their intense affects and gain some control over their impulses. Psychotherapy can be useful in understanding and alleviating the psychotic symptoms of chronic schizophrenic patients, and even brief therapeutic work can be helpful to chronic mental patients who are suffering from chronic low self-esteem associated with abuse. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Reactions of the cardio-respiratory system of cosmonauts to dosed physical loads following 30- and 63-day flights in orbital station "Salyut-4"

Cardiorespiratory responses of Salyut-4 crewmembers to exercises of 600 kgm/min performed for 7 min on a bicycle ergometer in the supine position were studied. It was found that the 30- and 63-day flights induced a certain decrease in the body response which included a less economic functioning of the cardiorespiratory system during exercise. The degree of postflight changes of the 30- and 63-day crewmembers was similar. At the same time the cardiorespiratory system of the 63-day crewmembers returned to the preflight level more rapidly than that of the 30-day cosmonauts.     

Carotid endarterectomy in the U.K. and Ireland: audit of 30-day outcome. The Audit Committee for the Vascular Surgical Society

OBJECTIVES AND DESIGN: A prospective study of 709 patients undergoing carotid surgery in the U.K. and Ireland was performed to evaluate the performance of vascular surgeons. MATERIALS AND METHODS: Fifty-nine surgeons (range 2-39 cases each) were sampled and all patients undergoing surgery over a 6-month period (1 March 1994-31 August 1994) were included in the study. Indications for surgery were TIA (35.9%), AF (23.3%), CVA (21.4%) and "others" (19.6%). RESULTS: Mean ipsilateral stenosis was 82% (30%-99%). Thirty-one percent of patients had preoperative neurological consults. Shunts were used in 67.6%, tacking sutures in 40.1%, drains in 71.9% and patches in 54.4% of cases. At 30 days there were nine (1.3%) deaths (four cardiac, three neurological). There were 15 ipsilateral postoperative CVAs (2.1%); 19% of patients had one or more complication, usually minor. Statistical analysis showed no independent risk factor for CVA other than seniority of the surgeon. CONCLUSIONS: A combined stroke/death rate of 3% for the series was obtained at 30 days for all cases. This large, validated study suggests that members of the Vascular Society of G.B. and Ireland currently have a very low morbidity/mortality rate for performing carotid surgery. Continued audit is required to ensure that this quality of service does not deteriorate.     

Outcome of schizophrenia--extended observation (more than 30 years) of 129 typical schizophrenic cases [III]

We had already made a report on outcome of schizophrenia (1986). The patients, 129 typical schizophrenia, were continuously observed over 30 years in the Kawagoe Dojinkai Hospital. Recently, we again evaluated their prognoses according to the same criteria as adopted in the first report, and divided them into the following five groups. [symbol: see text]: completely remitted group (21 persons, 16.3%), [symbol: see text]: almost remitted cases now holding jobs (23 persons, 17.8%), [symbol: see text]: Slightly remitted group showing good adjustment at home or hospital (41 persons, 31.8%), [symbol: see text]: maladjusted cases always showing an unfavorable condition (25 persons, 19.4%), x : incurable cases (19 persons, 14.7%). 1) In the last 8 years, there were 30 persons (23.3% of the whole patients) who showed prognostic changes (10 persons improved, 20 persons worsen). While the second group ([symbol: see text]) has seen fewer persons (12 persons down) than previous study, the third group ([symbol: see text]) has seen more persons (9 persons up). Each three groups, that is, the first two groups ([symbol: see text] + [symbol: see text], 44 persons, 34.1%), the third group ([symbol: see text], 41 persons, 31.8%), and the forth and fifth groups ([symbol: see text] + x, 44 persons, 34.1%) accounted for a third of the whole patients. It is after 32 years on the average (extending from 21 to 50 years) from the onset of illness that they showed prognostic changes. 2) Generally speaking, catatonic patients had favorable prognoses, hebephrenic patients unfavorable ones, and paranoid patients medium ones. But 4 improved persons in the forth and fifth groups were all hebephrenic type. 3) 17 among the 30 persons who showed prognostic changes were unstable type. They took a wave-like course. 4) 27 of all the 129 patients were dead. 25 were dead from disease mentioned below. Malignancy (8 persons), Cerebral vascular disease, Pneumonia and Diabetes (3 persons), Heart-failure (2 persons), Ileus, Myocardial infarction, Hepato-cirrhosis, Gastric ulcer, Tuberculosis and Natural death (1 person). 2 persons committed suicide. 5) Outcome of 45 patients who discontinued our medical therapy became clear as follows. [symbol: see text] + [symbol: see text]: 18 persons (40.0%), [symbol: see text]: 9 persons (20.0%), [symbol: see text] + x : 18 persons (40.0%). A smaller percentage of the patients belongs to the third group ([symbol: see text]) than that of our patients who were continuously followed by us.     

21-day outpatient methadone detoxification: an evaluation

A population consisting of all consecutive admissions between May 29, 1974 and July 30, 1974 was studied. Of the 169 applicants, 63 began the detoxification regimen. Persons participating in this program were in contact with the program only during their 21-day detoxification episode. The treatment setting was highly permissive. The primary objective was to help and assist individuals in their efforts to either reduce their use of opiates or attain a drug-free state. Thirty-one of the 63 individuals completed the program. Forty-five persons had lower opiate readings when their last three urine samples were analyzed. Interpretation of the data is guarded.     

Prophylactic antibiotics administration head and neck cancer surgery with major flap reconstruction: 1-day cefoperazone versus 5-day cefotaxime

Patients who undergo surgery of the head and neck cancer with major flap reconstruction, benefit from perioperative antibiotic prophylaxis. Head and neck surgery, especially ablative cancer surgery with major flap reconstruction is potentially contaminated iatrogenic wound, and the use of preoperative, perioperative and post operative chemoprophylaxis for infection is mandatory. This study is being done to determine if shorter course of antibiotic administration (Cefoperazone) would be more effective than conventional 5-day antibiotic administration (Cefotaxime). Patients who are identified as requiring major flap reconstruction after extensive ablative surgery for head and neck cancer, are considered as potential candidates for this study. The choice of ideal antibiotics and duration period are still under discussion. Patients were assigned randomly to receive Cefoperazone sodium for either 24 hr. (study group) or Cefotaxime sodium for 120 hr. (control group). A total of fifty patients were studied. The incidence of wound infection, flap death and major complications are evaluated. Out of the fifty patients studied, twenty-eight were assigned to 1-day prophylaxis. Incidence of failure of prophylaxis (F. P.) was 7.1% in this group. Twenty-two patients were assigned to 5-day prophylaxis, in whom F. P. rate was 9.8%. This study suggests that, there is no beneficial effect from administration of antibiotics for more than 24 hr. postoperatively in patients two undergo major flap reconstruction for head and neck cancer after extensive radical ablation surgery.     

Illustrious psychiatric administrators

The authors found several common themes in intensive interviews with 20 prominent psychiatric administrators. The decision to go into administrative work resulted from strong interest in public service, frustration in other roles, and/or situational factors. Administration was learned by doing and by interaction with colleagues in the field or other knowledgeable individuals. The job of administrator is often perceived as stressful, but it offers rewards such as increased autonomy, opportunities for self-growth, prestige, and the potential for a broader contribution to mental health.