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Query: UMLS:C0036690 (sepsis)
 59,461 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Infection, while a major cause of morbidity, should not be considered an inevitable consequence of injury. Good aseptic technique, compulsive attention to detail, and thorough understanding of the points addressed in the following list of critical points are the best guarantee that infection will not add avoidable morbidity to misfortune. Critical points regarding infectious problems in care of the injured child: 1. Polymicrobial infection is the rule with 50% of isolates being mixed aerobic and anaerobic bacteria. 2. It is a misnomer to consider antibiotic use in a pediatric trauma victim as prophylactic. Antimicrobials used in this setting are best considered adjunctive. 3. The major indication for anti-infective therapy in pediatric trauma is an injury with a high probability of infection. 4. Antibiotics do not sterilize the wound or body cavity; they limit bacterial proliferation, thereby supplementing effective immune control. 5. Available studies suggest that 24 hours is as efficacious as a longer treatment duration in a purely adjunctive mode. 6. In bites inflicted by dogs and cats, Pasturella species are frequent. 7. Human bites may result in infection by Eikenella corrodens. 8. Based on this bacteriology, adjunctive intravenous ampicillin sulbactam or oral amoxicillin clavulanate are recommended for human and animal bites. 9. Tetanus prophylaxis is indicated in all significant soft tissue injuries. 10. Risk of osteomyelitis correlates directly with the extent of the associated soft tissue injury and vascular compromise. 11. The majority of infectious complications in the injured child are not a consequence of the injury itself, but rather in the treatment thereof. 12. In the injured child the most common nosocomial infection is lower respiratory followed by primary blood stream and the urinary tract. 13. The management of nosocomial pneumonia in the injured child is based on the time of diagnoses. Early evidence of pulmonary infection requires treatment with a third generation cephalosporin with or without an antistaphylococcal penicillin. Late pneumonia is treated with an aminoglycoside with or without an antipseudomonal added. 14. Catheter related infection is, in the injured child, overwhelmingly gram positive with coagulase negative staphlococcal species accounting for 30-60% of isolates. Staphlococcus aureus is responsible for an additional 15-20%. 15. The role of antibiotics in the prevention of catheter related meningitis is controversial. Recent adult studies suggest no advantage to their routine use. If utilized, they should only be employed prophylactically and not continued throughout the monitoring period. 16. Lack of response to treatment of sepsis may represent an inappropriate antimicrobial agent, improper dosage, inability to achieve adequate levels at the site of infection. (eg, CSF) fungal pathogen, and/or ongoing contamination or undrained purulent focus.
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PMID:Infection control: avoiding the inevitable. 1211 72

A study of 165 maternal deaths at the University of Benin Teaching Hospital, Benin City over a 13-year period (from April 1, 1973 to December 31, 1985) is presented. All patients' case files were recovered from the central records library and each case file was carefully analyzed. With a total delivery of 29,324, the maternal mortality rate, inclusive of death from abortion, was 563/100,000 deliveries. There was a general increase in maternal mortality rate with age and this became alarming from 35 years. There was an equally high mortality rate among teenagers, mainly accounted for by illegally induced abortion. Indeed, abortion accounted for 72% of teenage mortality. A statistically significant association between maternal deaths and parity (p, 0.001) was observed. The most important causes of death were hemorrhage with a total of 26 out of 42 deaths, sepsis, and abortion. Other important causes were hypertensive disorders such as eclampsia, liver and respiratory disease, anemia, trophoblastic diseases, caesarean sections, and acute renal failure. Additional causes of maternal deaths include tetanus, sickle-cell disease, anesthetic death, drug reactions, pulmonary embolism, acute pyogenic meningitis, typhoid disease, urinary bladder tumor, acute lymphoblastic leukemia, and carcinoma of the breast thyroid. Factors identified with these deaths included such health services factors as deficient medical treatment of obstetric complications, lack of adequate personnel at primary and secondary health care levels, lack of access to maternal health services, and consequently, lack of prenatal care. Extreme reproductive age, grandmultiparity, and unwanted pregnancies, especially among teenagers, also contributed to maternal deaths. Overhaul of the maternal health care services at national level to include organization of such programs as provision of adequate blood transfusion facilities, prompt treatment of infections, early referrals of patients at risk to secondary and tertiary health centers, intensified family planning programs, and liberalization of abortion laws are recommended in order to reduce the unacceptably high maternal mortality.
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PMID:Maternal mortality at the University of Benin Teaching Hospital Benin City, Nigeria. 1217 71

In a 13-year review of maternal deaths of the University of Benin Teaching Hospital, Benin City, abortion was one of the 3 major causes of death, accounting for 37 (22.4) out of 165 deaths. Induced abortion was responsible for 34 (91.9%) of these deaths. The usual victim is the teenage and inexperienced school girl who has no ready access to contraceptive practice. Death was mainly due to sepsis, (including tetanus) hemorrhage, and trauma to vital organs, complication directly attributable to faulty techniques by unskilled abortion providers, by- product of the present restrictive abortion laws. Total overhaul of maternal child health services and family health education system, as well as integration of planned parenthood at primary health care level into the health care delivery system, are suggested. Contraceptive practice should be made available to all categories of women at risk and the cost subsidized by governmental and institutional bodies. Where unwanted pregnancies occur, the authors advocate termination in appropriate health institutions where lethal and sometimes fatal complications are unlikely to occur. In effect, from the results of this study and review of studies on abortion deaths in Nigeria and other developing countries, it is obvious that a revision of abortion laws as they operate, notable, in the African continent, is overdue.
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PMID:Preventable factors in abortion-related maternal mortality in Africa: focus on abortion deaths in Benin City, Nigeria. 1217 74

The objectives of this study are to determine the trend of maternal mortality at the University of Ilorin Teaching Hospital, to identify the causes of death, and to identify ways of minimizing the frequency of preventable deaths. Analysis of 75 cases of maternal deaths seen over 3 1/2 years (January 1983-June 1986) was conducted. During this period, there were 26,905 births, giving a maternal mortality rate of 279/100,000. 84% of the deaths were due to direct causes while the remaining 16% were classified under the indirect and pregnancy related categories. The main direct causes of death include hemorrhage (35.6%), septicemia (24.7%), and anemia (13.7%). Other direct obstetric causes include eclampsia, anesthetic death, hemoglobinopathy, and ruptured uterus. The most important indirect causes were native drug intoxication (6.8%), fulminant hepatitis (5.5%), and pulmonary embolism (2.7%). The maternal mortality was highest in the age ranges 25-29 years (31.5%). Median age and parity were 27 years and 4.5 respectively. While the maternal mortality rate of 2.8/1000 is an improvement over the previous years' (1972-1982) record of 4.3/1000, it is still unacceptable. The majority of these deaths could have been prevented if delivery had occurred in a well equipped hospital where blood transfusion and surgical facilities are available, if sterile manipulations for pregnant women had been employed, if appropriate antenatal care was available, and if specialist anesthetist services were accessible. Recommendations to reduce the maternal mortality rate include improved education and training of traditional birth attendants, improved immunization of women against tetanus, and increased community involvement through education. Furthermore, policy makers must set new priorities such as encouraging greater investment in improving clinics and hospital facilities, improving access to contraception, increasing awareness of the magnitude of the problem and encouraging community leadership and action.
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PMID:Maternal mortality at Ilorin, Nigeria. 1217 82

This is a retrospective study of limb amputations in Ile-Ife, Nigeria during a thirteen-year period (1987-1999). 82 patients were studied with a mean age of 35 +/- 22 years. 63 of the patients were adults, while 19 patients were children aged 15 years and below. Trauma was indicated as a reason for amputation in 60 patients (73.4%). Road traffic accident with peripheral vascular compromise was the single most common reason for amputation (41.7%). Forty-seven of the 82 patients had lower limb amputations, while the others were in the upper limbs. There was delay in performing amputation in some patients due to refusal to accept the procedure in 10(12.1%), logistics in 5(6.1%) and lack of finance in 3 (3.7%). The average healing time of the amputation stump wounds was 47 +/- 36 days. In 68.3% of cases, there was wound infection and the wound healing time was 63 +/- 45 days, much longer than than the general average. Other complications were flap necrosis, gas gangrene, osteomyelitis of the bony stump, and tetanus. Six patients died from sepsis and one from chronic renal failure, a hospital mortality rate of 8.5%. Prosthesis could not be fitted in any of the patients during the hospital admission and only three of the diabetic patients attended follow up clinic for up to two years; others absconded within 3 months of discharge from hospital. It will be possible to reduce the rate of amputation and improve the quality of life of patients with amputation if more attention is placed on accident prevention and injury control.
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PMID:Indications for amputations in Ile-Ife, Nigeria. 1222 53

Female genital mutilation is associated with immediate, long-term, pregnancy-related, and psychosexual complications. Immediate complications can cause death and include severe pain, shock, hemorrhage, tetanus or sepsis, urine retention, ulceration of the genital region, and injury to adjacent tissues. Long-term complications include formation of cysts, abscesses, and keloid scars, damage to the urethra resulting in incontinence, painful sexual intercourse, sexual dysfunction, recurrent urinary tract infections, chronic pelvic inflammatory disease, and infertility. During child birth, survivors of female genital mutilation may require Cesarean section or suffer obstructed labor leading to fetal death and/or vesico-vaginal fistulae and large perineal tears. The psychological consequences of female genital mutilation may involve loss of trust and confidence in care-givers, feelings of incompleteness, anxiety, depression, chronic irritability, and sexual problems. In many women, flashbacks of the infibulation process are triggered by touch. Deinfibulation must be accompanied by adequate pain relief, but the use of local or epidural anesthesia is not appropriate.
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PMID:Consequences of genital mutilation. 1222 23

Skin and soft tissue infections (SSTIs) are common among injection drug users (IDUs). Subcutaneous and intramuscular injection ("skin-popping") and the injection of "speedballs" (a mixture of heroin and cocaine) are important risk factors for SSTIs in this patient population. Female IDUs appear to be at greater risk of SSTIs than male IDUs, probably because of more difficult venous access. There are conflicting data regarding the impact of HIV and human T-cell lymphotrophic virus II infection on the risk of SSTIs in IDUs; however, an expanding body of evidence suggests that immunosuppressive effects of the drugs themselves may play a role. Most information regarding the microbiology of SSTIs in IDUs comes from data on skin and subcutaneous abscesses, where Staphylococcus aureus and organisms that originate from the oral flora predominate. Clonal outbreaks and uncommon infections including tetanus, wound botulism, and a sepsis/myonecrosis syndrome due to Clostridium species have been recently reported in IDUs.
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PMID:Skin and Soft Tissue Infections in Injection Drug Users. 1222 28

53 of 3100 abortions at Bombay hospital were septic abortions, giving an incidence of 1.7%. Various factors of possible etiological significance were analyzed, including age, parity, marital status, duration of gestation, and the mode of interference leading to sepsis. 36 of 53 patients were aged 20-30 years, but other age groups were represented. In the present study, gravidity was not relevant, for all gravidity groups, from primipara to grand multipara 5 and above, had patients suffering septic abortions. 9 patients were married and gave a history of interference; in all, 38 patients were married, 22 were unmarried, and 4 were widows. 23 patients gave a definite mode of interference, and the most common method was interference with a stick. 43% mortality occurred in patients giving a history of interference, and 36% mortality occurred in others. Vaginal and cervical cultures revealed (16 cases studied) 5 cases of CL. tetani, 1 case of E. coli, and 10 patients showing strepto-, staphylo-, pneumococcal infections. In this series, 21 of 53 patients died: 8 of tetanus, 3 or renal failure, 4 of septicemia, 2 of hemorrhagic diathesis, and 3 of endotoxic shock. 1 patient had acute bacterial endocarditis and pulmonary embolism at sutopsy. It is this article's contention that the main cause of sepsis is using an instrument to induce abortion during an unwanted pregnancy; hence, a plea is made for more liberalized abortion legislation.
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PMID:Septic abortion. 1226 87

The spectacular decline of infant mortality in Costa Rica from 68/1000 live births in 1970 to 20/1000 in 1980 was largely due to the implementation of public health programs in the 1970s. The abrupt decline was even more notable because deaths of infants constituted the major health problem of the country during the 1960s, accounting for 40% of all registered deaths. Socioeconomic development and reduced fertility contributed to the reduction, but 3/4 of the improvement can be attributed to extension of primary health care to previously unserved rural populations and to better secondary health care, according to a study by the Costa Rican demographer Luis Rosero Bixby. The programs targeted at less privileged groups substantially reduced class and geographic differentials in infant mortality. Infant mortality began to decline at an accelerating rate in 1972, coinciding with the first national health plan and the law of universal social security in 1971, the transfer of public hospitals to the social security system and promulgation of a general health law in 1973, and application of the rural health program in 1973 and community health program in 1976. By 1980, home services reached 60% of the population and immunization programs were in place for measles and diphtheria, pertussis, and tetanus. There was a doubling of outpatient services and a tripling of hours contracted by doctors between 1970-80. Also in 1980, 78% of the Costa Rican population was fully covered by health insurance. After 1972, infant mortality declined from all causes except complications of pregnancy and congenital anomalies. The decline was most rapid for deaths due to prematurity, illnesses avoidable by vaccination, and illnesses such as septicemia and meningitis in which prompt diagnosis and treatment can be lifesaving. Although impressive gains were made in neonatal mortality, the main share of the decline between 1970-80 was in postneonatal mortality. Reductions in deaths due to diarrheal diseases and respiratory infections through sanitation measures and immunization accounted for 3/4 of infant mortality decline before 1972 and 1/2 the reduction afterwards. After 1972, the introduction of improvements in neonatology and prenatal care and improvements in family planning service deliver produced a gradual and constant decline in neonatal mortality. Rosero Bixby's application of correlation and multiple regression analysis to census and vital statistics data for Costa Rica's 79 counties indicated that 41% of the decline in infant mortality from 1972-80 could be attributed to extension of primary health care principally in rural areas, while 75% could be attributed to improvements in primary and secondary health care together. Socioeconomic progress contributed about 22% to the decline and reduced fertility about 5%. The analysis did not take into account fertility declines or socioeconomic progress achieved before the 1970s.
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PMID:[Public health programs have greatly reduced infant mortality in Costa Rica]. 1226 50

Tetanus is an infectious disease that can occur at any age and is highly lethal. In the present study, a review was made of all cases of tetanus between January 1979 and June 1985 at the University Hospital "Dr. Eleuterio Gonzalez" in Monterrey, Nuevo Leon, Mexico. Out of a total of 76 cases, 10 were newborns. Of these, 5 were female and 5 male. The average age at admission was 8.5 days and the period of Collis was 32.3 hours. All had been born in a septic environment at term and with an average birthweight of 3120 kgs. Using Jandra's classification, 3 cases were considered mild, 5 moderate, and 2 severe. The laboratory tests were not relevant. 9 patients were given Phenobarbital and Diazepam as sedatives; 6 received total parenteral alimentation, and 5 newborns were given mechanical ventilation during an average of 26.6 days. The most common complications were respiratory problems and septicemia. The average length of hospitalization was 26.3 days with a mortality rate of 50%. (author's)
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PMID:[A study of 10 cases of neonatal tetanus]. 1228 Oct 9


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