Association of cardiometabolic multimorbidity with all-cause and cardiovascular disease mortality among Chinese hypertensive patients

BACKGROUND Hypertension usually clusters with multiple comorbidities.However,the association between cardiometabolic multimorbidity(CMM)and mortality in hypertensive patients is unclear.This study aimed to investigate the association between CMM and all-cause and cardiovascular disease(CVD)mortality in Chinese patients with hypertension.METHODS The data used in this study were from the China National Survey for Determinants of Detection and Treatment Status of Hypertensive Patients with Multiple Risk Factors(CONSIDER),which comprised 5006 participants aged 19–91 years.CMM was defined as the presence of one or more of the following morbidities:diabetes mellitus,dyslipidemia,chronic kidney disease,coronary heart disease,and stroke.Cox proportional hazard models were used to calculate the hazard ratios(HR)with 95%CI to determine the association between the number of CMMs and both all-cause and CVD mortality.RESULTS Among 5006 participants[mean age:58.6±10.4 years,50%women(2509 participants)],76.4%of participants had at least one comorbidity.The mortality rate was 4.57,4.76,8.48,and 16.04 deaths per 1000 person-years in hypertensive patients without any comorbidity and with one,two,and three or more morbidities,respectively.In the fully adjusted model,hypertensive participants with two cardiometabolic diseases(HR=1.52,95%CI:1.09–2.13)and those with three or more cardiometabolic diseases(HR=2.44,95%CI:1.71–3.48)had a significantly elevated risk of all-cause mortality.The findings were similar for CVD mortality but with a greater increase in risk magnitude.CONCLUSIONS In this study,three-fourths of hypertensive patients had CMM.Clustering with two or more comorbidities was associated with a significant increase in the risk of all-cause and cardiovascular mortality among hypertensive patients,suggesting more intensive treatment and control in this high-risk patient group.

Multimorbidity and mortality among older patients with coronary heart disease in Shenzhen,China

BACKGROUND The current understanding of the magnitude and consequences of multimorbidity in Chinese older adults with coronary heart disease(CHD)is insufficient.We aimed to assess the association and population-attributable fractions(PAFs)between multimorbidity and mortality among hospitalized older patients who were diagnosed with CHD in Shenzhen,China.METHODS We conducted a retrospective cohort study of older Chinese patients(aged≥65 years)who were diagnosed with CHD.Cox proportional hazards models were used to estimate the associations between multimorbidity and all-cause and cardiovascular disease(CVD)mortality.We also calculated the PAFs.RESULTS The study comprised 76,455 older hospitalized patients who were diagnosed with CHD between January 1,2016,and August 31,2022.Among them,70,217(91.9%)had multimorbidity,defined as the presence of at least one of the predefined 14 chronic conditions.Those with cancer,hemorrhagic stroke and chronic liver disease had the worst overall death risk,with adjusted HRs(95%CIs)of 4.05(3.77,4.38),2.22(1.94,2.53),and 1.85(1.63,2.11),respectively.For CVD mortality,the highest risk was observed for hemorrhagic stroke,ischemic stroke,and chronic kidney disease;the corresponding adjusted HRs(95%CIs)were 3.24(2.77,3.79),1.91(1.79,2.04),and 1.81(1.64,1.99),respectively.All-cause mortality was mostly attributable to cancer,heart failure and ischemic stroke,with PAFs of 11.8,10.2,and 9.1,respectively.As for CVD mortality,the leading PAFs were heart failure,ischemic stroke and diabetes;the corresponding PAFs were 18.0,15.7,and 6.1,respectively.CONCLUSIONS Multimorbidity was common and had a significant impact on mortality among older patients with CHD in Shenzhen,China.Cancer,heart failure,ischemic stroke and diabetes are the primary contributors to PAFs.Therefore,prioritizing improved treatment and management of these comorbidities is essential for the survival prognosis of CHD patients from a holistic public health perspective.

Cardiometabolic and panvascular multimorbidity associated with motoric cognitive risk syndrome in older adults

Background Motoric cognitive risk(MCR)syndrome as a pre-dementia syndrome often co-occurring with chronic health condi-tions.This study aims to investigate the prevalence of MCR and its association with cardiometabolic and panvascular multimorb-idity among older people living in rural China.Methods This population-based study included 1450 participants who were aged≥60 years(66.2%women)and who underto-ok the second wave examination of the Confucius Hometown Aging Project in Shandong,China when information to define MCR was collected.Data were collected through in-person interviews,clinical examinations,and laboratory tests.Cardiometabolic and pa-nvascular multimorbidity were defined following the international criteria.MCR was defined as subjective cognitive complaints and slow gait speed in individuals free of dementia and functional disability.Multivariable logistic regression models were used to exa-mine the associations of MCR with multimorbidity.Results MCR was present in 6.3%of all participants,and the prevalence increased with advancing age.Cerebrovascular disea-se,ischemic heart disease,heart failure,and increased serum cystatin C were associated with increased likelihoods of MCR(mult-ivariable-adjusted odds ratio range:1.90-3.02,P<0.05 for all).Furthermore,there was a dose-response relationship between the nu-mber of cardiometabolic diseases and panvascular diseases and the likelihood of MCR.The multivariable-adjusted odds ratio(95%CI)of MCR associated with cardiometabolic and panvascular multimorbidity were 2.47(1.43-4.26)and 3.85(2.29-6.47),respectiv-ely.Conclusions Older adults with cardiometabolic and panvascular multimorbidity are at a higher likelihood of MCR.These fin-dings may have implications for identifying older adults at pre-dementia state as targets for early preventive interventions to delay dementia onset.

Morbidity and Mortality of Newborns in a Context of Limited Resources in Tombouctou, Mali

Introduction: Worldwide, 2.3 million children died in the first 20 days after birth in 2022, according to the WHO. In Mali, according to the sixth Demographic and Health Survey, the neonatal mortality rate was estimated at 33% live births in 2018. The Timbuktu region had the highest neonatal mortality rate in the country with 44%. The objective of this work was to study the causes of neonatal morbidity and mortality and related factors in the paediatrics department of Timbuktu hospital. Materials and method: This was a descriptive, cross-sectional study conducted from 1 January to 31 December 2023 in the neonatology unit of the paediatrics department of Timbuktu hospital, including all newborns admitted to hospital. Results: Our study took place over 12 months, during which 618 admissions were made to the paediatric ward, including 244 newborns, i.e. 39.48%. The majority of newborns (86.5%) were admitted in the first week of life. The mean age was 3 days, with a sex ratio of 1.1 for males. Weight under 2500 g was 54.1% for an average weight of 2372 g. The main mode of admission was transfer from the hospital maternity unit (62%). The main reasons for admission were acute foetal distress (27.9%) and prematurity (26.2%). The average age of the mothers was 24, with extremes of 15 and 49. The mothers were housewives (87.3%), uneducated and primiparous (59% and 36.5% respectively);only 40.2% had made more than 3 antenatal care visits. Newborns born by vaginal delivery accounted for 80.7% and those born by caesarean section for 19.3%. The risk of infection was present in 52.5% of cases. The three leading causes of hospitalisation were birth asphyxia (40.2%), neonatal infection (32.4%) and prematurity (25%). The mortality rate was 21.7%. The main causes of death were prematurity (39.6%), birth asphyxia (32.1%) and neonatal infection (24.5%). Conclusion: Neonatal morbidity and mortality remain a concern in Timbuktu. Despite the unfavourable security situation, morbidity and mortality indicators are close to those in some hospitals in Mali. The correct application of Essential Newborn Care and antenatal care remains a major challenge for the hospital and the Timbuktu region.

Neonatal Morbidity and Mortality at Hospital Saint Camille de Ouagadougou (HOSCO): A Study from 2017 to 2020

Introduction: Neonatal pathology remains a real public health problem in developing countries. In Burkina Faso, this mortality has declined over the last ten years but remains below compared to the Sustainable Development Goals, which is 12 per 1000 living births at most by 2030. This study aims to identify specific causes of neonatal morbidity and mortality and will contribute to the implementation of preventive and curative measures aimed at reducing neonatal mortality at HOSCO. Method: This was a retrospective study using the records and database of newborns hospitalized from January 1srt, 2017 to December 31srt, 2020. Using logistic regression, the factors associated with mortality were determined. Results: During the study period, 3020 newborns were hospitalized. Most newborns (83.71%) were referred by a peripheral health facility. The average age at admission was 0.3 days ± 0.9 and the sex ratio was 1.2. Prematurity was the leading cause of hospitalization (61.13%) followed by neonatal infection (38.34%) and neonatal suffering (23.88%). The mortality rate was 40.6% with 82.71% cases of death in the early neonatal period. The main causes of death were low birth weight (47.39%), respiratory distress (18.76%), neonatal suffering (17.37%) and neonatal infection (13.87%). Home delivery, gestational age 36 weeks, number of PNC 4, concept of resuscitation, Apgar at the 5th minute 7, birth weight 2000 g and >4000 g, respiratory distress, hypothermia, neurological disorders were factors associated with deaths. Conclusion: Neonatal mortality is influenced by both maternal and fetal factors and many of them are preventable.

Post Episiotomy Morbidity among Parturient in Alex Ekwueme Federal University Teaching Hospital Abakaliki, Ebonyi State

Background: Episiotomy is a very common obstetric surgery, and it could be associated with serious complications. However, these complications largely are not noticed due to the shift of attention from mother to baby, after a successful delivery. Objective: To identify the morbidities associated with episiotomies and factors associated with such morbidities. Method: This was a questionnaire based cross sectional descriptive study among women who attended the Obstetric Department of Alex Ekwueme Federal University Teaching Hospital Abakaliki Ebonyi State, between 1st July and 31st Nov, 2023. The study population consisted of parturients who had episiotomies in their previous confinements, attending either the antenatal clinic or the postnatal clinic at Alex Ekwueme Federal University Teaching Hospital Abakaliki Ebonyi State. Results: Macrosomia was the most common indication of episiotomy at a rate of 31.6%. The majority of episiotomies were performed on the parturients in their first confinement at a rate of 64.5% and the majority of repairs were performed by the Registrar at a rate of 65.0%. Informed consent was obtained from 45.79% of parturients while 54.21% were not informed before the episiotomy was administered. Only 55.3% of the parturient received analgesia before episiotomy was administered. The majority of the parturients had their episiotomy repaired between 10 - 15 minutes at a rate of 40.3%. Postoperative pain at the rate of 44.5% was the most common complication and dyspareunia as a form of sexual complication was the commonest at a rate of 31.3%. Conclusion: The parturient needs to be properly counselled before administration of episiotomy and adequate analgesia should be given, as episiotomy is a surgical procedure. Proper training of health workers on both the technique of administering and repairing episiotomy is important. Restrictive use of routine episiotomy in primigravidae is advised to reduce the rate of episiotomy.

Morbidity and Mortality Related to Infectious Diseases in the Roi Boudouin Paediatric Ward in Senegal

Introduction: Infant and child morbidity and mortality linked to infections remain a major concern in both developed and developing countries. The general objective was to determine the characteristics of hospital morbidity and mortality linked to infectious pathologies in the pediatric department of the King Baudouin hospital center in Dakar. Methods: This was a retrospective, descriptive and analytical study focusing on children hospitalized from January 1, 2018 to December 31, 2021 in the pediatric department of the King Baudouin hospital center in Dakar. Results: During the study period, 1474 children were hospitalized for an infectious pathology in the pediatric department. The sex ratio was 1.48. Children aged between one and twelve months represented 34.12%. Morbidity due to respiratory and digestive infections was 42.33% and 33.45%, respectively. Pediatric hospital mortality was 0.75% with a predominance noted in infants between 1 and 12 months (55.86%). Respiratory, digestive infections, sepsis and neurological infections were the main causes of death. Factors associated with mortality were age (1 to 12 months) with p Conclusion: Reducing infant and child mortality linked to infectious diseases remains a crucial challenge to address for improving children’s health. Early detection of related signs, prevention of infections, and adequate care and monitoring of infants and children can contribute to this reduction.

Morbidity and Mortality during Anaesthesia in Patients with versus without Diabetes: Single-Centre Cohort Study

Background and objective: Classically, diabetic subjects are at high risk of anaesthesia compared with general population. However, some recent publications have shown contrasting and sometimes contrary results. The aim of our study was to evaluate morbidity and mortality during and after anaesthesia in patients with versus without diabetes operated on at Monkole Hospital over the last ten years. Methods: Retrospective cohort study including all patients who underwent all-comers surgery excluding cardiac surgery between 2011 and 2021. Each diabetic patient was matched to 2 non-diabetic controls on age and sex. The evaluation criterion was the frequency of occurrence of at least one perioperative complication and/or death up to day 30. A multivariate analysis using a Cox model was used to determine the factors associated with the occurrence of this morbidity and mortality. The model was adjusted for comorbidities, preoperative hyperglycaemia, ASA score, type of anaesthesia and severity of surgery. Results: A total of 351 diabetic patients (mean age 53.3 ± 14.18 years) and 701 non-diabetic patients (mean age 53.52 ± 14.7 years) were included and analysed. Preoperatively, hyperglycaemia (blood glucose > 180 mg/dl) was observed in 24.3% of diabetic patients compared with 1.6% of non-diabetic patients. The incidence of overall perioperative complications was 25.6% in diabetic patients compared with 28.6% in non-diabetic patients (p = 0.27). The risk factors associated with this morbidity were general anaesthesia with oro-tracheal intubation vs loco-regional anaesthesia (OR = 3.06 [95%CI: 1.91 - 4.94];p Conclusion: This study shows that there is not significant increase in perioperative morbidity and mortality in diabetic patients compared with non-diabetic ones of similar severity. These results suggest that diabetes itself (excluding associated comorbidities) has only a minor impact on perioperative morbidity and mortality.

Impact of Delivery Mode on Morbidity in Preterm Infants with Very Low Birth Weights (<1500 Grams)

The mode of delivery and gestational age for very-low-birth-weight (VLBW) preterm infants are not yet well established and are constant topics of debate. Objective: To analyze the impact of delivery mode on morbidity in preterm infants weighing less than 1500 g. Results: Among 21,957 births, 81 were analyzed;53 were delivered vaginally, and 28 were delivered by cesarean section. The median maternal age, gestational age and body mass index among those delivered vaginally and by cesarean section were 20 years and 22.5 years, 27.6 weeks and 30.1 weeks, and 26.0 kg/m2 and 27.8 kg/m2, respectively. With respect to neonatal blood gas parameters, for those born vaginally and by cesarean section, the median pH was 7.32 and 7.24, the pCO2 was 41.5 mmHg and 51.1 mmHg, and the pO2 was 22.3 mmHg and 16 mmHg. The median fetal weight among those born by cesarean section and vaginally were 1180 g and 955 g, respectively. The median Apgar scores at the first and fifth minutes among those born by cesarean section and vaginally were 5.00 and 8.00 and 4.50 and 7.00, respectively. Conclusion: There was no significant difference between the results of vaginal and cesarean delivery for VLBW infants. Thus, further studies on this subject are needed.

Morbidity and Mortality of Acute Renal Failure in COVID-19 Patients in Intensive Care According to Waves/Variant: Case of the Grand Hôpital de l’Est Francilien Site de Meaux

Introduction: The incidence of acute renal failure (ARF) varies between 20% and 40% of cases for COVID-19 patients admitted to the intensive care unit, with very high mortality, but heterogeneous according to the different epidemic waves, probably due to the genetic variant phenomenon of the virus. The aim of this study is to determine the morbidity and mortality of COVID-19 patients admitted with ARF to the intensive care unit of the Grand H?pital Est Francilien (GHEF) according to the waves and variants. Methods: Cross-sectional observational study of COVID-19 patients with ARF admitted to the intensive care unit of the GHEF site in Meaux covering the period from March 1st 2020 to December, 31st 2021. Per-hospitalisation and outcome data were collected and analysed with SPSS version 25.0 software using the Chi-square or Fischer’s exact test or Student’s t-test and logistic regression for p Results: A total of 86 patients were included. The mean age was higher (70 ± 8.5) in patients in the fourth wave than in the other waves (p = 0.015), with male predominance in all waves without significant difference. Co-morbidities: hypertension, diabetes, heart disease, dyslipidaemia and arrhythmia complete with fibrillation were present in all waves. The majority of patients were classified as KDIGO 1 for the different waves (1st: 61.9%, 2nd: 86.5%, 3rd: 80%, and 4th: 75%), with the same trend according to variant (alpha: 80%, beta: 75%, delta: 81.3%, omicron: 75%). Mortality by the wave was: 1st: 28.5%, 2nd: 37.5%, 3rd: 23% and 4th: 11%) and by variant: alpha: 24.2%, beta: 44.8%, delta: 20.7%, omicron: 10.3%). Overall mortality was 33.7%. Case fatality was higher in the fourth wave. Hypertension, shock, failure to recover renal function, acute lung oedema, ventilator-associated lung disease and hyperkalaemia were factors associated with mortality (p Conclusion: Acute renal failure is common in COVID-19 patients admitted to the intensive care unit, and mortality is not negligible. The beta variants and the second wave presented more cases of renal impairment, although the mechanism is still unknown. Further studies are needed to understand this mechanism and perhaps to be able to identify the cause.

Protocol for the FACE study:frailty and comorbidity in elderly patients—a multicenter,Chinese observational cohort study

The present protocol describes an observational cohort study that was designed to propose a therapeutic scheme and formulate an individualized treatment strategy for frail elderly patients diagnosed with multiple diseases in a Chinese,multicenter setting.Over a 3-year period,we will recruit 30,000 patients from 10 hospitals and collect baseline data including patient demographic information,comorbidity characteristic,FRAIL scale,age-adjusted Charlson comorbidity index(aCCI),relevant blood tests,the results of imaging examination,prescription of drugs,length of hospital stay,number of overall re-hospitalizations and death.Elderly patients(≥65 years old)with multimorbidity and receiving hospital care are eligible for this study.Data collection is being performed at baseline and 3,6,9 and 12 months after discharge.Our primary analysis was all-cause death,readmission rate and clinical events(including emergency visits,stroke,heart failure,myocardial infarction,tumor,acute chronic obstructive pulmonary disease,etc).The study is approved by the National Key R&D Program of China(2020YFC2004800).Data will be disseminated in manuscripts submitted to medical journals and in abstracts submitted to international geriatric conferences.Clinical Trial Registration:[www.ClinicalTrials.gov],identifier[ChiCTR2200056070].

Intermediary roles of prospective memory and retrospective memory in the comorbidity of depression and pain

Background Patients who suffer comorbidity of major depressive disorder(MDD)and chronic pain(CP)maintain a complex interplay between maladaptive prospective memory(PM)and retrospective memory(RM)with physical pain,and their complications are still unknown.Aims We aimed to focus on the full cognitive performance and memory complaints in patients with MDD and CP,patients with depression without CP,and control subjects,considering the possible influence of depressed affect and chronic pain severity.Methods According to the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders and the criteria given by the International Association of Pain,a total of 124 participants were included in this cross-sectional cohort study.Among them,82 depressed inpatients and outpatients from Anhui Mental Health centre were divided into two groups:a comorbidity group(patients with MDD and CP)(n=40)and a depression group(patients with depression without CP)(n=42).Meanwhile,42 healthy controls were screened from the hospital’s physical examination centre from January 2019 to January 2022.The Hamilton Depression Rating Scale-24(HAMD-24)and Beck Depression Inventory-II(BDI-II)were used to evaluate the severity of depression.The Pain Intensity Numerical Rating Scale(PI-NRS),Short-Form McGill Pain Questionnaire-2 Chinese version(SF-MPQ-2-CN),Montreal Cognitive Assessment-Basic Section(MoCA-BC),and Prospective and Retrospective Memory Questionnaire(PRMQ)were used to assess pain-related features and the global cognitive functioning of study participants.Results The impairments in PM and RM differed remarkably among the three groups(F=7.221,p<0.001;F=7.408,p<0.001)and were severe in the comorbidity group.Spearman correlation analysis revealed the PM and RM were positively correlated with continuous pain and neuropathic pain(r=0.431,p<0.001;r=0.253,p=0.022 and r=0.415,p<0.001;r=0.247,p=0.025),respectively.Regression analysis indicated a significant positive relationship between affective descriptors and total BDI-II score(β=0.594,t=6.600,p<0.001).Examining the mediator pathways revealed the indirect role of PM and RM in patients with comorbid MDD and CP.Conclusions Patients with comorbid MDD and CP presented more PM and RM impairments than patients with MDD without CP.PM and RM are possibly mediating factors that affect the aetiology of comorbid MDD and CP.

Social relationship satisfaction and accumulation of chronic conditions and multimorbidity:a national cohort of Australian women

Background Social relationships are associated with mortality and chronic conditions.However,little is known about the effects of social relationship satisfaction on multiple chronic conditions(multimorbidity).Aims To examine whether social relationship satisfaction is associated with the accumulation of multimorbidity.Methods Data from 7694 Australian women who were free from 11 chronic conditions at 45–50 years of age in 1996 were analysed.Five types of social relationship satisfaction(partner,family members,friends,work and social activities)were measured approximately every 3 years and scored from 0(very dissatisfied)to 3(very satisfied).Scores from each relationship type were summed to provide an overall satisfaction score(range:≤5–15).The outcome of interest was the accumulation of multimorbidity in 11 chronic conditions.Results Over a 20-year period,4484(58.3%)women reported multimorbidities.Overall,the level of social relationship satisfaction had a dose–response relationship with the accumulation of multimorbidities.Compared with women reporting the highest satisfaction(score 15),women with the lowest satisfaction(score≤5)had the highest odds of accumulating multimorbidity(odds ratio(OR)=2.35,95%confidence interval(CI):1.94 to 2.83)in the adjusted model.Similar results were observed for each social relationship type.Other risk factors,such as socioeconomic,behavioural and menopausal status,together explained 22.72%of the association.Conclusions Social relationship satisfaction is associated with the accumulation of multimorbidity,and the relationship is only partly explained by socioeconomic,behavioural and reproductive factors.Social connections(eg,satisfaction with social relationships)should be considered a public health priority in chronic disease prevention and intervention.

Early Morbidity and Mortality in Neonates of Mothers with Sickle Cell Disease at the Borgou/Alibori Center Departmental Teaching Hospital in Benin

Introduction: Association of sickle cell disease and pregnancy is a risky situation for both the mother and neonate. Objective: To determine the early morbidity and mortality among neonates of mothers with sickle cell disease at Borgou/Alibori Center Departmental Teaching Hospital (CHUD B/A) in Benin. Patients and Methods: This was a descriptive and analytical observational study conducted at CHUD-B/A from January 1, 2015, to August 31, 2019. It included pregnant women with sickle cell disease who gave birth to a liveborn neonate at the term of at least 28 weeks of amenorrhea. Variables studied were sociodemographic, clinical, and evolutionary. Analysis of the factors associated with early death was also carried out with a significance threshold set at p Results: Out of a total of 119 pregnant women, 95 neonates were recorded. Main morbidities were: prematurity and intrauterine growth restriction (49.5%);respiratory distress (40%), bacterial infection (30.5%), and perinatal asphyxia (21.1%). Early mortality rate was 8.4%. In bivariate analysis, the factors associated with early death were: parity (p < 0.001), the severity of maternal anemia (p < 0.008), birth weight under 1500 g (p < 0.002), the birth term under 32 weeks of amenorrhea (p < 0.001), resuscitation for at least 5 minutes (p = 0.001). In multivariate analysis, resuscitation for at least 5 minutes (p = 0.007) was mainly associated with early death. Conclusion: One out of two neonates of mothers with sickle cell disease has a low birth weight. Early mortality is high due to perinatal asphyxia. Hence the multidisciplinary care of these mothers.

Interactions of Vitamin D Receptor Polymorphisms with Hypertriglyceridemia and Obesity in Chinese Individuals Susceptible to Hypertension and Diabetes Comorbidity

Hypertension(HTN)and type 2 diabetes mellitus(T2DM)are interconnected metabolic diseases[1,2]that considerably increase susceptibility to microvascular and macrovascular disorders.In many patients,HTN and diabetes comorbidity(HDC)is caused by mutual pathogenic pathways,such as endothelial dysfunction,atherosclerosis,oxidative stress,and vascular inflammation[1].Hence.

Morbidity and Mortality of Emergency Hernia Surgery in Adults in Bujumbura: Analysis of Favourable Factors

Background: Abdominal parietal hernia, a temporary or permanent exit of viscera through an anatomically pre-existing zone of weakness, is a frequent pathology in surgery. So, the management of emergency hernias surgery should include some complications most often up after 30 days of the operation. Aim: To analyze the factors contributing to morbidity and mortality after 30 days of emergency hernia surgery in adults in the surgical departments of Bujumbura hospitals. Methodology: This is a prospective study over a period of one year that included all hernias operated on in emergency from January 2022 to February 2023. Results: During the period, 251 patients were admitted to the operating room for abdominal parietal hernias, including 49 for emergency hernia surgery. There were 43 men (87.76%) and 6 women (12.24%), i.e. a sex ratio of 7.1. The average age was 49.6 years, with extremes of 18 and 84 years. The occupation of strength (farmer, labourer, mechanic, mason, mason’s helper) represented 75.51% of the cases. Inguino-scrotal hernia was preponderant (65.31%) followed by inguinal hernia (25.58%), umbilical hernia (4.08%);femoral hernia represented 4.08%. Hernial strangulation represented 89.80% and engorged hernia 10.20%. Morbidity was minor, 2.04% of complications (suppuration, hematoma, urinary retention). No deaths were found. Altemeir stage and occupation were statistically related to morbi-mortality of emergency hernia surgery in adults at 30 days postoperative (p = 0.0028 and p = 0.0284 respectively). Conclusion: Abdominal parietal hernias are frequent, dominated by groin hernias. The high frequency of strangulation calls for awareness of cold hernia cures.

Morbidity and Mortality of Emergency Hernia Surgery in Children in Bujumbura: Analysis of Favourable Factors

Background: Management of emergency hernias surgery should include certain complications most often up after 30 days of the operation. Aim: To analyze the factors contributing to morbidity and mortality after 30 days of emergency hernia surgery in children in the surgical departments of 8 Bujumbura hospitals. Patients and Methods: This is a prospective study over a period of one year which included all hernias operated on in emergency from January 1, 2022 to February 29, 2023. Results: During the period, 282 patients (children) were admitted to the operating theatre for abdominal parietal hernias, of which 46 were admitted for emergency hernia surgery. Males accounted for 86.96% (40), sex ratio 6.6. The average age was 3.4 years. The persistence of the peritoneo-vaginal canal represented 52.17% of cases. Inguino-scrotal hernia was prevalent (43.48%). The main complication was strangulation (80.43%). Morbidity accounted for 1.3% of complications (infection, residual pain, testicular atrophy, hernia recurrence). No deaths were found. Altemeier stage and gender were statistically related to morbi-mortality of emergency hernia surgery in adults at 30 days post-op (p = 0.0260 and p = 0.0212 respectively). Conclusion: Abdominal parietal hernias are common in children, dominated by groin hernias. The high frequency of strangulation calls for awareness of cold hernia repairs.

Study on incidence of lamb morbidity and mortality and associated risk factors in the mixed crop‑livestock production system of Gewata District, Kaffa zone, southwestern Ethiopia

Lamb morbidity and mortality cause significant loss in a smallholder production system. A longitudinal prospectivesurvey was conducted on 408 randomly selected farmers located in six purposefully selected kebeles in Gewataworeda from June 2020 to July 2021 to determine the incidence of morbidity and mortality in lambs and to identifyrisk factors. For this purpose, 408 lambs from the Gewata district’s mixed crop-livestock production system wereexamined every day from birth to three months of age. The data was analyzed using the Kaplan-Meier (K-M) method,the log-rank test, and Cox proportional hazards regression. Results showed that the cumulative incidence of allcauseof morbidity and mortality at the end of three month was 12.86% (95% CI: 10.26–16.13%), and 6.86% (95% CI:5.03–9.35%), respectively. Diarrhea was the leading cause of morbidity and mortality, accounting for 49.33 and 50%morbidity and mortality, respectively. Pneumonia was the second most frequent cause of morbidity and death. In theK-M hazard analysis, the greatest risk of lamb morbidity and mortality was observed during the first month of life, andthen the risk decreased significantly as the lamb grew. Of the 17 potential risk factors studied, the multivariable Coxproportional hazards regression model showed that lamb sex, birth weight, umbilical care, time and method of colostrumfeeding were the five predictors that were significantly associated with a higher risk of morbidity, whereas birthweight, lambing difficulty, dams’ parity, method and time of colostrum feeding were the five predictors that weresignificantly associated with a higher risk of mortality. Moreover, a higher risk of morbidity was observed in lambswith methods of colostrum feeding after birth (HR = 3.158;p = 0.000) and with variations in birth weight (HR = 1.418;p = 0.003). Similarly, the mortality risk was 4.926 (p = 0.047), 4.023 (p = 0.012), and 3.206 (p = 0.000) times higher inlambs with lambing difficulties, at the time of colostrum feeding, and by the method of colostrum feeding, respectively.According to this research, lamb morbidity and mortality rates in the study area are significantly high whichhas a great impact on the replacement stock and production. Hence, awareness should be created among farmersconcerning improved lamb management practices.

Influence of Haptoglobin and Hemoglobin Phenotypic Polymorphisms on Sickle Cell Disease Morbidity

Objectives: Sickle cell disease (SCD) has a varied clinical and biological expression depending on the hemoglobin phenotype: SSFA2, SFA2, SAFA2 and SC. Considering the antioxidant properties of the different haptoglobin phenotypes (Hp 1-1, Hp 2-1, Hp 2-2), it seemed relevant to know their influence on the morbidity of the different hemoglobin phenotype of SCD. Thus, the objective of this study was to identify associations between haptoglobin phenotype and morbidity of different SCD phenotypes. Methods: In a retrospective cross-sectional descriptive and analytical study, with a cohort of 170 black African carriers of hemoglobin S, in Ivory Coast, West Africa, hemoglobin and haptoglobin phenotypes were determined by electrophoretic methods. Results: The three major phenotypes of haptoglobin polymorphism were found in the SCD cohort: Hp 1-1 (24.1%), Hp 2-1 (56.5%), Hp 2-2 (19.4%). Vaso-occlusions were associated with haptoglobin phenotype Hp 1-1, (OR = 2.03;CI95% = [1.06 - 3.9];p Conclusions: Haptoglobin phenotype was associated to morbidity-adjusted hemoglobin phenotype. The study revealed a greater probability of a worse morbidity when the hemoglobin phenotype is homozygous. Unexpectedly, the worse morbidity is associated to Hp 1-1 haptoglobin phenotype, the most powerful antioxidant within the different haptoglobin phenotypes. Associations found were not systematic and need further studies to enlighten the determinism of SCD morbidity.

Redefying the therapeutic strategies against cardiorenal morbidity and mortality:Patient phenotypes

Chronic kidney disease(CKD)patients face an unacceptably high morbidity and mortality,mainly from cardiovascular diseases.Diabetes mellitus,arterial hypertension and dyslipidemia are highly prevalent in CKD patients.Established therapeutic protocols for the treatment of diabetes mellitus,arterial hypertension,and dyslipidemia are not as effective in CKD patients as in the general population.The role of non-traditional risk factors(RF)has gained interest in the last decades.These entail the deranged clinical spectrum of secondary hyperparathyroidism involving vascular and valvular calcification,under the term“CKDmineral and bone disorder”(CKD-MBD),uremia per se,inflammation and oxidative stress.Each one of these non-traditional RF have been addressed in various study designs,but the results do not exhibit any applied clinical benefit for CKD-patients.The“crusade”against cardiorenal morbidity and mortality in CKD-patients is in some instances,derailed.We propose a therapeutic paradigm advancing from isolated treatment targets,as practiced today,to precision medicine involving patient phenotypes with distinct underlying pathophysiology.In this regard we propose two steps,based on current stratification management of corona virus disease-19 and sepsis.First,select patients who are expected to have a high mortality,i.e.,a prognostic enrichment.Second,select patients who are likely to respond to a specific therapy,i.e.,a predictive enrichment.