Covid Adult Mortality in Brazil: An Analysis of Multiple Causes of Death

ObjectiveThis study aimed to analyze the chain of events and contributing causes associated with COVID-19 adult mortality (30–69 years old), based on qualified data on CoD from three Brazilian capitals cities, Belo Horizonte, Salvador, and Natal, in 2020.MethodsData of all deaths among residents in the three capitals in 2020 were provided by these municipalities' routine Mortality Information System (SIM). Mentions B34.2 with the markers U07.1 and U07.2 in the death certificate identified COVID-19 deaths. We used a multiple-cause-of-death approach better to understand the complexity of the morbid process of COVID-19. Conditions that appeared more frequently in the same line or above the COVID-19 mentions in the death certificate were considered a chain-of-event. Conditions that occurred more often after the codes for COVID-19 were considered as contributing.ResultsIn 2020, 7,029 records from COVID-19 as the underlying cause of death were registered in SIM in the three capitals. Among these, 2,921 (41.6%) were deceased between 30 and 69 years old, representing 17.0% of deaths in this age group. As chain-of-events, the most frequent conditions mentioned were sepsis (33.4%), SARS (32.0%), acute respiratory failure (31.9%), unspecified lower respiratory infections (unspecified pneumonia) (20.1%), and other specified respiratory disorders (14.1%). Hypertension (33.3%), diabetes unspecified type (21.7%), renal failure (12.7%), obesity (9.8%), other chronic kidney diseases (4.9%), and diabetes mellitus type 2 (4.7%) were the most frequent contributing conditions. On average, 3.04 conditions were mentioned in the death certificate besides COVID-19. This average varied according to age, place of death, and capital.ConclusionThe multiple-cause analysis is a powerful tool to better understand the morbid process due to COVID-19 and highlight the importance of chronic non-communicable diseases as contributing conditions.

Mesto strikturoplastike u lecenju Crohn-ove bolesti

Crohn's disease is pandigestive disease of unknown ae-thiology, with tendency to recurrences. Until now it is impossible to heal this disease either by medical or surgical treatment. All unfavorable consequences of this disease are result of inadequate treatment of complications which are leading to systemic weakening, with further progression of morbid process. Therefore, the principle of timely and minimal invasive surgical procedure has been generally adopted. Introduced in eighties, strictureplasty is a procedure of such characteristics. During the period 1980-2001 this method was used in 1/3 of 126 patients with Crohn's disease. There were 79 strictureplaties performed, 9 long and 70 short. Out of these 42, 12(28,6%) were postoperative recurrences, and there was one case of duodenal strictureplatsty. Postoperative small bowel fistulae were not observed, and there was no mortality in this group. During the follow up period of at least 5 years, in only two cases (4,76%) some functional disturbances of digestive functions were observed, without indications for reoperation. In this article indications and details of operative technique are discussed.

Aetiological Heterogeneity of Schizophrenia: The Problem and the Evidence

When Kraepelin formulated the concept of dementia praecox, he lumped together a number of diagnostic categories. One of his reasons for doing so was that he had seen many patients who ended up in the same kind of demented state, even though their initial symptoms might have been quite different. He noted that even some cases presenting with mania, or melancholia, took the same downhill course as did the more classic cases of dementia praecox. Kraepelin, aware of the striking paradigm of general paresis, stated that “a single morbid process” explained the downhill course (Kraepelin, 1983, p. 68).

Disease as Suffering, Deviation, Danger, Signal, and Stimulus

This paper attempts to outline a comprehensive concept of disease, focusing on five aspects present in every morbid process: suffering, deviation, danger, signal, and stimulus. The historical development of each of these aspects of disease is traced, and the role they have played in health care organization is examined.

The suprarenal glands in diphtheria

In recent years, it has become apparent that lesions of the suprarenal glands occur more often in human disease than had formerly been suspected. The evident effect of such lesions is the production of profound general disturbances, which are seen in a chronic phase if the morbid process in the suprarenal tissue is slowly progressive, as, for example, in the ordinary case of Addison's disease, and in an acute phase if the lesion is of sudden onset, as in suprarenal haemorrhage, or if chronically diseased suprarenal tissue is subjected to sudden excessive demands, as in the critical stage of Addison's disease. In both phases, there is evidence to show that the best measures to employ in combating these disturbances, whether for prophylaxis or for therapy, consist of the administration to the patient of an extract of suprarenal cortex or, alternatively, of sodium chloride.

Pachymeningitis Interna Hæmorrhagica as a Cause of Death

There are some pathological conditions which, though of considerable interest to the student of morbid anatomy, appear to have very little importance from the point of view of clinical study. The reason for this, sometimes at least, lies in the fact that it is difficult, if not impossible, to diagnose the onset and follow the progress of the morbid process during the life of the patient. Pachymeningitis interna hemorrhagica is essentially a condition of this kind. It is a morbid state which has been named and described for years, and yet it is a condition the diagnosis of which during life is extremely difficult. As a rule, when it is demonstrated at the post mortem, the clinical records of the case furnish us with no definite information suggestive of its presence. Often when symptoms point to the likelihood of its presence no lesion is found, while it occurs in cases which during life showed nothing special to indicate the possibility of such a condition.

Auto-suggestion and Delusional Insanity

The presence of delusions, whether arising primarily or following other mental states, is significant of a faulty cerebral action, yet the co-existence of normal ideas suggests that the morbid process is limited to certain groups of nerve-cells. It is thus reasonable to suppose that many of the nerve-cells associated with ideation are in such cases working normally. There would appear to be “wrong thought centres” or “wrong series of associations” giving rise to delusions.

Changes in the Cerebellar Neuroglia in Progressive Paralysis [Die Gliaveränderungen im Kleinhirn bei den progressiven Paralyse]. (Arch. f. Psychiat. u. Nervenkr., B. xxxiv, H. 2, p. 523.) Raecke, Dr

Fifteen cases in which the changes in the cerebellar neuroglia were specially studied are given in some detail. The results correspond generally to those of Weigert. In the molecular layer, Bergman's fibres are increased in numbers, but unevenly. Most of the new fibres run vertically, but some obliquely or transversely, the last often forming bands at two levels, viz. along the outer margin of the cortex and at the boundary of the granular layer. In the latter position they form basketworks enclosing Purkinje's cells. The transverse fibres are mostly delicate, but a number of large spider-cells at the border of the granule layer give off coarse fibres, running to the surface. The largest collection of glia-nuclei is in the same situation. In the granule layer also the changes are of unequal degree. They consist in loss of granules, the place of which is taken by hypertrophied neuroglia fibre and nuclei. In the medulla the hypertrophy is rarely of great extent, and appears to prefer the immediate neighbourhood of the vessels, where large, coarse-fibred spider-cells are also found. Fibres and nests of glia-nuclei occur, however, between the nerve-bundles. Jn general, the rule is that in progressive paralysis the molecular layer is most involved, then the granule layer, more in spots, and last and least the medulla. Hence it is the dendrites of Purkinje's cells which appear to be chiefly affected in this disease, and their bodies also vanish in advanced cases. The morbid process thus seems to advance from without inwards. Little clinical value is claimed for these results, owing to the irregular distribution and frequently slight degree of the foci of disease; but it may be supposed that the changes contribute to the ataxy and incoordination. The paralytic seizures are more likely, from these cases, to be connected with diseased foci in the thalamus. No relation could be detected between the cerebellar changes and absence or increase of the reflexes.