Background: Community-acquired pneumonia (CAP) is the most important cause of hospitalisation in Malaysia and the 6th most important cause of mortality in patients aged 65 years and above. CAP is a lower respiratory tract infection that includes signs and symptoms like cough, fever, dyspnoea, the presence of new focal chest signs and new radiographic shadowing with no prior cause. To assist clinical judgement in deciding whether to admit the patient for in-ward treatment or otherwise, the severity of CAP is most commonly graded using the CURB-65 score as the components are more readily accessible in the Accidents and Emergency Department. We believe that cardiopulmonary diseases, immunosuppressive diseases like HIV infection or diabetes mellitus and other co-morbidities may affect the severity of CAP and are thus aspects of a patients’ history that should play a more significant role in influencing a clinician’s judgement of CAP severity. The general objective of the study is therefore to identify the relationship between co-morbidities and initial severity assessment of a patient admitted for community acquired pneumonia. The 3 specific objectives are i) to determine if presence of co-morbidities affects initial severity assessment in a patient admitted with CAP ii) To identify which co-morbidities affects initial severity assessment and iii) to determine whether having multiple co-morbidities increases initial severity assessment. Methodology: A retrospective study was carried out from the month of February 2013 to July 2013 at Hospital Tuanku Ja’afar, Seremban (HTJS). Patients admitted to the four Medical wards – 6A, 6B, 7A, and 7B – from July 2012 to December 2012 and have been diagnosed with CAP were chosen. A checklist was used as a survey instrument. Using statistical analysis, the severity of CAP in patients was compared in patients with different factors like gender, different co-morbidities and the number of co-morbidities. Results: A total of 63 patients in the control group had no co-morbidities and 54 patients were of low risk, 7 patients had moderate risk, and 2 patients had high risk CAP. Of the remaining 337 patients in the sample population, 124 patients had one co-morbidity, while 213 patients had multiple co-morbidities. Among those with a single co-morbidity, 100 patients had low risk, 19 patients had moderate risk, and 5 patients had high risk CAP. For the group with multiple co-morbidities, 135 patients had low risk, 58 patients had moderate risk, and 20 patients had high risk CAP. This study found that the presence and number of co-morbidities present in a patient affected the severity of CAP. Co-morbidities like diabetes mellitus, hypertension and asthma had significant correlation to the severity of CAP in patients. The gender of the patient had no significant correlation to the severity of CAP. Conclusion: The presence and number of co-morbidities present in a patient increases the severity of CAP. Hypertension, diabetes mellitus, and asthma are comorbidities that are prerequisites for increased caution and alert when judging the severity of CAP in patients. Comparison of patients with single and multiple comorbidities showed that patients in the latter group present with higher severity scores (p-value = 0.004).
Morbidity

Background: Multiple gestations, including twin gestations are commonly associated with adverse maternal, perinatal and neonatal outcomes compared with singleton pregnancies. Its incidence has shown a significant increase over the last decades. A retrospective cohort study was made at the Department of Obstetrics and Gynecology by review of medical records of twin pregnancies and their neonates. Objective: The purpose of this study is to describe and compare the outcomes of twin gestation against singleton pregnancies, in terms of the following: the presentation of the twin gestation, chorionicity, the mode and timing of delivery and fetomaternal complications. This study aimed to determine whether an association exists between the twin gestation and adverse perinatal outcomes. Methodology: The study included singletons and twin gestations admitted at a tertiary government hospital admitting section within a ten-year period, 2006-2015. Confirmation of diagnosis of multiple pregnancies was obtained by ultrasound. This retrospective cohort study conducted at a tertiary government hospital included 228 singletons and 110 twin gestations in a ten-year period. Results: Results showed women with twin pregnancies had a higher incidence of preterm labor and delivery. Compared to singleton pregnancies, complications of prematurity are not uncommon in twin gestations. This should encourage prenatal and antenatal care in women who have twin gestations. Conclusion The incidence of preterm labor and delivery for twin gestation, relative to singletons, was high in the study. Twin gestations are 3-4 times more likely to present with preterm labor relative to singletons.
Morbidity

Geography ; Morbidity

Introduction: CAD accounts for 25% of mortality in Malaysia public hospitals. CABG is one of treatment for patients with CAD, but requires RBC transfusion, which is associated with morbidity and mortality. This study was to evaluate the association between RBC transfusion and morbidity and mortality in CABG patients at the National Heart Centre, Malaysia (IJN). Methods: Retrospective cross-sectional study performed using data from 434 patients who underwent CABG in 2013 and 2014. Subjects had systematic random sampling every fifth subject of the patients in the sequence of dates of the year. Data related to the relationship between RBC transfusion with mortality and morbidity, and the predicting factors captured. Results: 64.3% of CABG patients (n = 279) received RBC transfusion perioperatively. Age, gender, BMI, and EF, were factors that contributed for RBC transfusion. RBC transfusion was a contributor to longer intensive care unit length of stay (ICULOS) and hospital length of stay (HLOS). Multiple logistic regression revealed, for every 1 year increase of age, there is 3.5% higher chance of transfusion. Whereas an increase of 1 kg/m2 of BMI and 1% of EF reduced the odds of RBC transfusion by 13.0% and 3.0% respectively. Conclusions: Age, gender, BMI, and EF determine the probability of needing RBC transfusion during CABG, and RBC transfusion will result in longer ICULOS, and HLOS. Probability of RBC transfusion will be higher in older patients and reduced in those with higher BMI and EF.
; Morbidity ; Mortality

Objectives: To describe the treatment outcomes of patients who underwent open repair of infrarenal abdominal aortic aneurysm (AAA) and to determine the risk factors affecting morbidity and mortality. Methods: Data were obtained from patients with infrarenal AAAs who underwent open surgical repair at the University of the Philippines-Philippine General Hospital (UP-PGH) from January 2013 to October 31, 2023. These patients’ demographic and clinical profile, and treatment outcomes were evaluated using frequencies and percentages. Student’s t-test and chi-square test were used for the inferential analysis. Multivariable logistic regression analysis was used to identify factors associated with in-hospital mortality and morbidity. Results: In this study, 131 patients underwent open surgical repair of AAA. 82.4% of the patients were males, and 45.8% were between 61-70 years old. The majority of them had hypertension (81.4%) and were smokers (75%). The mortality rate was 17.6%, while the morbidity rate was 35.9%. For elective operations, the mortality was 8.9%, and for ruptured aneurysms, it was 56.5%. Eleven factors associated with mortality included ruptured aneurysm (OR=11.5, 95%CI=4.1 to 32.2), decreased hemoglobin (OR=1.1, 95%CI=1.05 to 1.2), decreased hematocrit (OR=1.1, 95%CI=1.06 to 1.4), emergency surgery (OR=10.3, 95%CI=2.9 to 36.3), higher volume of blood loss (OR=1.5, 95%CI=1.5 to 1.9), higher red cell transfusion (OR=1.3, 95%CI=1.1-1.5), intraoperative cardiopulmonary (CP) arrest (OR=15.9, 95%CI=1.6 to 159.2), need for multiple inotropes (OR=2.7, 95%CI=1.5-4.8), intraoperative hypotension (OR=3.6, 95%CI=1.4-9.7), juxta-renal location (OR=5.0, 95%CI=1.2 to 10.0), and presence of any complication (OR=5.7, 95%CI=2.1-15.1). Seven factors associated with morbidity included ruptured aneurysm (OR=3.9, 95%CI=1.5 to 9.8), decreased preoperative hemoglobin (OR=1.2, 95%CI=1.1 to 1.4), decreased preoperative hematocrit (OR=1.5, 95%CI=1.1 to 1.7), elevated preoperative creatinine (OR=1.1, 95%CI=1.06 to 1.9), higher intra-operative blood loss (OR=1.4, 95%CI=1.1 to 1.6), higher red cell transfusion (OR=1.6, 95%CI=1.3-2.1), and preexisting chronic renal disease (OR=3.3, 95%CI=1.4 to 7.5). Other preoperative and intraoperative factors did not show a significant association with mortality or morbidity. Conclusion The open repair of an infrarenal AAA is linked to high overall mortality (17.6%) and morbidity (35.9%). The mortality rate for elective repair was 8.9%, but it significantly increased to 56.5% in cases of ruptured aneurysms. Factors with very high Odds Ratio such as emergency surgery, ruptured aneurysm, cardiac arrests during surgery, complex juxtarenal anatomy, and postoperative complications can lead to a high chance of mortality. Healthcare professionals should be vigilant and focus on early detection and repair of abdominal aneurysms to prevent emergency surgery, rupture, and mortality. It is crucial to prevent acute kidney injury, acute respiratory failure, and pneumonia, as these are common complications of open repair.
morbidity ; mortality

The study surveyed the morbidity and hospital admission of Bac Giang city population in the year 2001, especially the prevalence of cancer. 3.000 households were enrolled in the study. Data were collected and interviews were conducted. Analysis showed people had a high demand of health care in hospital, especially with cancer management. 31.1% of urban population demanded a hospital admission. In 5 year period in the city, the cancer incidence was 158.9/100.000 people in average. The highest was in 50-69 age group, and this incidence was higher in male than female
Therapeutics ; Inpatients/morbidity ; Morbidity ; Epidemiology

An inquiry by interview was conducted on Thanh Luong ward, Hai Ba Trung district and on Xuan Dinh commune, Tu Liem district in Hanoi, concerning the morbidity and the use of medical services for elderly. The inquiry showed a high incidence of morbidity (acute and chronical) with the common disease such as mainly arthrose, respiratory diseases, neurological diseases. Most of the elderly preferred the care at home, at private medical workers. There was a difference between urban and rural area in the morbid pattern and the use of medical services
Morbidity ; Delivery of Health Care/morbidity ; Aged ; Epidemiology

In 6 communes, representative of 3 social economic zones of An Hai district of Hai Phong city, 1.597 old people were enrolled in this study. Among them, there was a rather high prevalence of chronical diseases. The most common diseases were: periodontosis 51%, blood lipid disorders in hypertensive patients 47.5%, cataract 42.4%, hypertension 40.8%, arthrose 38.8%, prostate tumor 26.3%, insomnia 19.5%, risk of obesis 10.8%, gastroduodenal ulcer 9.7%, constipation 8.4%, chronic bronchitis 8.4%. The prevalence was higher in > 80 -year - old age group than in the group aged 60-79 years old. In female subjects, the prevalences of cataract, arthrose, headache, insomnia, constipation were higher than in male, while in male, coronary arterical failure, lung tuberculosis, hemorrhoid, gastroduodenal ulcer,… were higher. In average, there were 3.8 diseases each elderly subject.
Morbidity ; Aged ; Epidemiology

The study carried on 6122 patients hospitalized in Nam Dong district hospital, Hue province from 2000 to 2002. The results were ranked according to proportion morbidity by disease chapter of ICD 10: Most common ten diseases were diseases of the respiratory system, accidents injury, poisoning, infectious and parasitic, pregnancy, delivery and puerperium, disease of digestive system, disease of the genitourinary system, disease of the musculoskeletal system, disease of the circulatory system, disease of the skin and subcutaneous system, disease of the nervous system. Major cause of morbidity in children under 15 years old were respoiratory and infectious disease. 15 to 19 group mainly hospitalized due to accidents, injury and poisoning. Over 60 group primary hospitalized due to respiratory system, disgestive system, circulatory system, infectious and parasitic diseases
Epidemiology ; Disease ; Morbidity

Results of the investigation performed on 1058 elderly subjects show a largest frequency of osteo-arthritis, pulmonary diseases and arterio-vascular diseases. Majority of the subjects (66,1% and 65,4%) had a sustainable state of health
Epidemiology ; Health ; aged ; Morbidity