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Presented here is our own experience acquired in the course of one war-year in the Republic of Bosnia and Herzegovnia. Numerous factors that have altered the picture of a number of diseases, their frequency, character and intensity, and as a result, their diagnostica and therapy, have been noticed. Most frequent factors are the following: poorer personal and general states of hygiene, lower standard of living with general lack of food of all kinds, physical strains, exposure to psychotraumas, temperature and climatic changes, life in collective centres and siege, constant migrations of the population, captivity molesting and stay in prisoners camps. The problems, that the health service has, and that are greater than those of the population, have been pointed out. The following diseases have been registered: "common colds" which affect respiratory tract, peptic ulcers, dyspeption, gastritis, malnutrition, enterocolytis and TBC. The most frequent diseases of endocrine glands are: diabetes mellitus, thyreotoxicosis and hypertension. The prolonged hospital stay of the wounded and the patients, as long as 6-7 months, because of their waiting to be transported abroad, or to their homes, is criticized, because as a result of that hospitalisation of the acute patients has been impossible.
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PMID:[Internal diseases with special emphasis on endocrine disorders during war conditions]. 775 95

Important nutrition concepts will aid primary care/generalist physicians to implement practical aspects of health promotion and disease prevention in their practice, and improve the overall health of their patients. In today's society, chronic diseases that are related variably to overnutrition and dietary excesses or imbalances (obesity, diabetes mellitus, hypertension and atherosclerotic cardiovascular disease, some cancers) warrant knowledgeable diet modifications in high-risk individuals. However, serious nutritional deficiency diseases also still occur (as in alcoholic patients), and instituting appropriate diet and supplements will aid in preventing further morbidity and mortality. Nutrition knowledge changes with new scientific evidence, and the physician must be aware of reliable sources of continuing education and information appropriate for the practitioner and the patient.
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PMID:Nutrition concepts for the primary care/generalist physician. 783 65

The burden of disease in end-stage renal disease (ESRD) is high. The cost of end-stage renal disease therapy is also high. The age and co-morbidity of patients is increasing, and many patients are started on therapy with little hope of rehabilitation, and with a high likelihood of death within a short period of time. Data from large prospective studies are necessary to help patients and doctors to make decisions concerning the initiation and cessation of dialysis. Inadequate dialysis and malnutrition may adversely influence clinical outcome, and cardiovascular disease exerts a large influence on morbidity and mortality. Clinical trials are necessary concerning the effect on clinical outcome of dialysis prescription, interventions to improve malnutrition, hypertension, anemia, hyperparathyroidism, hyperlipoproteinemia, and diabetes mellitus.
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PMID:Clinical epidemiology in chronic uremia. 786 52

Chronic renal disease is associated with fluid retention, electrolyte disturbances, anemia, platelet dysfunction, malnutrition, and, often, underlying disease such as diabetes, hypertension, and coronary artery disease. The mortality and morbidity of trauma increases when the victim has pre-existing renal disease. Special attention must be given to fluid resuscitation in these patients because of their limited or absent ability to excrete solutes and fluids. Invasive hemodynamic monitoring is helpful in guiding the resuscitation efforts because urine output and acid-base balance are unreliable markers. Knowledge of pharmacokinetics and pharmacodynamics is necessary in patients with renal disease. Choice of therapy for solute and fluid removal depends on the patient's hemodynamic status, the presence or absence of coagulopathy, and the type of traumatic injury. Renal replacement therapies are recommended for hemodynamically compromised patients.
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PMID:Management of the trauma patient with pre-existing renal disease. 792 36

Of 147 diabetic patients with end-stage renal disease who were treated in our CAPD program between 1978 and 1991, 6 men and 1 woman (5 had type II and 2 type I diabetes) with a mean age of 54 (range 21-70) years have been on CAPD for more than five years (mean: 76 mos, range: 65-109 mos) and on peritoneal dialysis (IPD+CAPD) for an average of 85 (range: 67-118) mos. They had a variety of comorbid conditions at the start of CAPD: Retinopathy (5/7), blindness (3/7), hypertension (5/7), peripheral neuropathy (7/7), peripheral vascular disease (3/7), congestive heart failure (3/7), myocardial infarction (1/7), ischemic heart disease (2/7). Two were smokers and five over the age of 65. Peritonitis rate was 1 episode/11.4 pt mos, exit-site infection 1/76.4 pt mos and average hospitalization rate 32.8 days/patient/year. Hypertension was well-controlled with discontinuation of all medications; after initiation of CAPD two of them remained without medications throughout the study but in the rest, medications had to be restarted. As assessed by HbA1c, blood glucose control improved with IP administration of insulin. Residual renal function progressively decreased. None of them developed severe hyperparathyroidism. Peripheral neuropathy remained stable in four and deteriorated in two. Total protein, albumin, cholesterol and triglycerides decreased during the last two years indicating a degree of malnutrition. Our experience with these seven patients suggests that diabetic patients, even the aged and those with many comorbid conditions and complications, can survive for long periods on CAPD.
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PMID:Long-term continuous ambulatory peritoneal dialysis in diabetics. 792 68

Records of 523 consecutive diabetic patients attending a diabetic clinic in Wad Madeni, Central Region, Sudan, were reviewed to determine epidemiologic features and the relation between their diabetes and nutritional state. The male to female ratio was 0.97:1. The age at diagnosis ranged between 0-61 years with a mean age of 51.7 +/- 11.9 years for males and 49.4 +/- 11.4 for females. Obesity was a feature, in that 47.4% of females and 30% of males were determined to be in excess of normal body mass index (BMI) standards. A family history of diabetes was present in 67% of cases. Hypertension was present in 38% of cases; it was slightly more common among females than males (52% vs 48%), respectively. Insulin was employed for control of diabetes in 75% of cases, and oral hypoglycaemics in 20%. The remainder were on diet therapy alone. Thirty-four percent of the patients are rural dwellers that should be saved from disabling and even fatal complications of the disease in combination with malnutrition and infectious diseases that hasten death in rural areas. It is hoped that the interest of those concerned regarding public health implications of the findings in this study will be stimulated.
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PMID:A pilot epidemiologic study of diabetes mellitus in the Sudan. 793 94

Death certificates of all persons who died in in the State of S.Paulo, Brazil and which presented Chagas' disease as the principal cause of death, were studied with a view to analysing the existing additional information available as to contributory causes. After a direct reading of the 1,308 death certificates, the contributory causes were identified and registered. They were mentioned in 261 (20%) of the certificates, 185 of them presenting only one, and 75 two of them. The 6 more frequent contributory causes were: "megas", embolism, chronic pulmonary disease, infections (other than Chagas' disease), arterial hypertension and malnutrition. When analysing the presence of the contributory causes in two groups-persons of less than 50 years old, and those older than 50 a higher proportion of them was observed in the older group and a distinct profile of causes was found for each group. No statistic association was observed between contributory causes and sex or site of residence.
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PMID:[Chagas' disease as main cause of death in the southeastern region of Brazil: presence of contributory causes]. 799 25

The Italian Registry of Pediatric Chronic Peritoneal Dialysis (CPD) carried out a special study on patient hospitalization during the years 1989-1992. Ninety-two children (mean age 8.4 +/- 4.7 years) entered the study, for a total of 1406 CPD-months. The contribution of the different causes of hospitalization for a total of 4683 hospital days was: CPD training 31%; routine controls 14%; CPD-related complications 35%; clinical complications 14%; other causes 6%. The rate of patient hospitalization that resulted was 3.33 days/CPD-month; it was higher in the first year (4.32 days/CPD-month) than in the second year (1.64 days/CPD-month) or in the third year (2.25 days/CPD-month). This difference was mainly due to the need for the training at the start of the CPD treatment. The evaluation of the hospitalization rate in different age groups showed a statistically significant difference (p < 0.05) between the group 0-2 years (5.47 days/CPD-month) and the group 3-15 years (2.78 days/CPD-month). Complications were the cause of 150 admissions to the hospital (1:9.6 CPD-months). Ninety-eight admissions were due to CPD-related complications: peritonitis (33%), problems with the catheter (19%), abdominal hernias (4%), and others (9%). Among clinical complications (52 admissions), the main cause of hospitalization was hypertension (15%), followed by infections (4%), and malnutrition (3%).
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PMID:A multicenter study on the hospitalization of pediatric patients on chronic peritoneal dialysis. 799 56

The National Institutes of Health Consensus Development Conference on Morbidity and Mortality of Dialysis brought together experts in general medicine, nephrology, pediatrics, biostatistics, and nutrition as well as the public to address the following questions: (1) How does early medical intervention in predialysis patients influence morbidity and mortality? (2) What is the relationship between delivered dialysis dose and morbidity/mortality? (3) Can co-morbid conditions be altered by non-dialytic interventions to improve morbidity/mortality in dialysis patients? (4) How can dialysis-related complications be reduced? and (5) What are the future directions for research in dialysis? Following 1 1/2 days of presentations by experts and discussion by the audience, a consensus panel weighted the evidence and prepared their consensus statement. Among their findings, the consensus panel concluded that (1) patients in the predialysis phase, including children, should be referred to a renal team in an effort to reduce the morbidity and mortality incurred both during the predialysis period and when receiving subsequent dialysis therapy; (2) the social and psychological welfare and the quality of life of the dialysis patient are favorably influenced by the early predialytic and continued involvement of a multidisciplinary renal team; (3) attempts should be made to avoid a catastrophic onset of dialysis by instituting predialytic intervention and the appropriate initiation of dialysis access; (4) quantitative methods now available to objectively evaluate the relationship between delivered dose of dialysis and patient morbidity and mortality suggest that the dose of hemodialysis and peritoneal dialysis has been suboptimal for many patients in the United States; (5) factors contributing to underdialysis of some patients include problems with vascular and peritoneal access, nonadherence to dialysis prescription, and underprescription of the dialysis dose; (6) cardiovascular mortality accounts for approximately 50 percent of deaths in dialysis patients, and relative risk factors such as hypertension, smoking, and chronic anemia should be treated as soon as possible after diagnosis of chronic renal failure; (7) early detection and treatment of malnutrition contribute to improved survival of patients on dialysis; and (8) until prospective, randomized, controlled trials have been completed, a delivered hemodialysis dose at least equal to a measured fractional urea clearance of Kdrt/V of 1.2 (single pool) and a delivered peritoneal dialysis dose at least equal to a measured Kprt/V of 1.7 (weekly) are recommended.
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PMID:Morbidity and mortality of dialysis. 800 33

Starting in 1985, at the Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India, modifications concerning teaching community medicine and epidemiology were introduced. Students were encouraged to conduct epidemiological investigations for better understanding of the subject. First-year students were free to participate in a hospital-based case control study involving 3-7 students over a period of 6-8 months. 5 projects were completed between 1990 and 1992 pertaining to risk factor analysis in oral cancers, protein-energy malnutrition, myocardial infarction, birth asphyxia, and cervical carcinoma. Methodology included objectives, review of the literature, definitions, questionnaires, and statistical methods. Faculty members monitored progress. Each student made a presentation to a gathering of 1st- and 2nd-year students and answered their questions. 2nd-year students undertook projects in community medicine lasting 2 months during vacation. Each student had a separate project of value for planning urban and rural field practice areas. Between 1987 and 1992, field studies were carried out on immunization coverage and mothers' knowledge about child immunization; the prevalence of caries among preschool children; cultural and economic factors affecting pregnancy; the epidemiology of cataract; blood pressure and hypertension; the nutritional status of preschool and school-age children; and drug compliance by leprosy patients. Case school studies were also undertaken on risk-factor analysis of low birth weight; factors affecting the acceptance of tubectomy; and treatment-seeking behavior among patients with cervical carcinoma. Similar public presentations were made. Interns were invited to assist in difficult subjects. A hospital study was completed by 2 students on injections given unnecessarily to children aged under 5 years. 111 out of 149 1st- year students questioned stated that they had gained knowledge and skills. Benefits reported included improved thinking, communication, statistical knowledge, understanding of human behavior, and a social view on health and disease.
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PMID:Research as a tool for the teaching of epidemiology. 814 77


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