Estimating cause-related mortality among the dead is not common, yet for clinical and public health purposes, a lot can be learnt from the dead. HIV/AIDS accounted for the third most frequent cause ...of deaths in Kenya; 39.7 deaths per 100,000 population in 2019. OraQuick Rapid HIV-1/2 has previously been validated on oral fluid and implemented as a screening assay for HIV self-testing in Kenya among living subjects. We assessed the feasibility and diagnostic accuracy of OraQuick Rapid HIV-1/2 for HIV screening among decedents.
Trained morticians collected oral fluid from 132 preembalmed and postembalmed decedents aged >18 months at Jaramogi Oginga Odinga Teaching and Referral Hospital mortuary in western Kenya and tested for HIV using OraQuick Rapid HIV-1/2. Test results were compared with those obtained using the national HIV Testing Services algorithm on matched preembalming whole blood specimens as a gold standard (Determine HIV and First Response HIV 1-2-O). We calculated positive predictive values, negative predictive values, area under the curve, and sensitivity and specificity of OraQuick Rapid HIV-1/2 compared with the national HTS algorithm.
OraQuick Rapid HIV-1/2 had similar sensitivity of 92.6% 95% confidence interval (CI): 75.7 to 99.1 on preembalmed and postembalmed samples compared with the gold standard. Specificity was 97.1% (95% CI: 91.9 to 99.4) and 95.2% (95% CI: 89.2 to 98.4) preembalming and postembalming, respectively. Preembalming and postembalming positive predictive value was 89.3% (95% CI: 71.8 to 97.7) and 83.3% (95% CI: 65.3 to 94.4), respectively. The area under the curve preembalming and postembalming was 94.9% (95% CI: 89.6 to 100) and 93.9% (95% CI: 88.5 to 99.4), respectively.
The study showed a relatively high-performance sensitivity and specificity of OraQuick Rapid HIV-1/2 test among decedents, similar to those observed among living subjects. OraQuick Rapid HIV-1/2 presents a convenient and less invasive screening test for surveillance of HIV among decedents within a mortuary setting.
In resource-limited settings, underlying causes of death (UCOD) often are not ascertained systematically, leading to unreliable mortality statistics. We reviewed medical charts to establish UCOD for ...decedents at two high volume mortuaries in Kisumu County, Kenya, and compared ascertained UCOD to those notified to the civil registry.
Medical experts trained in COD certification examined medical charts and ascertained causes of death for 456 decedents admitted to the mortuaries from April 16 through July 12, 2019. Decedents with unknown HIV status or who had tested HIV-negative >90 days before the date of death were tested for HIV. We calculated annualized all-cause and cause-specific mortality rates grouped according to global burden of disease (GBD) categories and separately for deaths due to HIV/AIDS and expressed estimated deaths per 100,000 population. We compared notified to ascertained UCOD using Cohen's Kappa (κ) and assessed for the independence of proportions using Pearson's chi-squared test.
The four leading UCOD were HIV/AIDS (102/442 23.1%), hypertensive disease (41/442 9.3%), other cardiovascular diseases (23/442 5.2%), and cancer (20/442 4.5%). The all-cause mortality rate was 1,086/100,000 population. The highest cause-specific mortality was in GBD category II (noncommunicable diseases; 516/100,000), followed by GBD I (communicable, perinatal, maternal, and nutritional; 513/100,000), and III (injuries; 56/100,000). The HIV/AIDS mortality rate was 251/100,000 population. The proportion of deaths due to GBD II causes was higher among females (51.9%) than male decedents (42.1%; p = 0.039). Conversely, more men/boys (8.6%) than women/girls (2.1%) died of GBD III causes (p = 0.002). Most of the records with available recorded and ascertained UCOD (n = 236), 167 (70.8%) had incorrectly recorded UCOD, and agreement between notified and ascertained UCOD was poor (29.2%; κ = 0.26).
Mortality from infectious diseases, especially HIV/AIDS, is high in Kisumu County, but there is a shift toward higher mortality from noncommunicable diseases, possibly reflecting an epidemiologic transition and improving HIV outcomes. The epidemiologic transition suggests the need for increased focus on controlling noncommunicable conditions despite the high communicable disease burden. The weak agreement between notified and ascertained UCOD could lead to substantial inaccuracies in mortality statistics, which wholly depend on death notifications.
Objectives. To describe RDS in neonatal deaths at the CHAMPS-Kenya site between 2017 and 2021. Methods. We included 165 neonatal deaths whose their Causes of death (COD) were determined by a panel of ...experts using data from post-mortem conducted through minimally invasive tissue specimen testing, clinical records, and verbal autopsy. Results. Twenty-six percent (43/165) of neonatal deaths were attributable to RDS. Most cases occurred in low birthweight and preterm neonates. From these cases, less than half of the hospitalizations were diagnosed with RDS before death, and essential diagnostic tests were not performed in most cases. Most cases received suboptimal levels of supplemental oxygen, and critical interventions like surfactant replacement therapy and mechanical ventilation were not adequately utilized when available. Conclusion. The study highlights the urgent need for improved diagnosis and management of RDS, emphasizing the importance of increasing clinical suspicion and enhancing training in its clinical management to reduce mortality rates.
This manuscript describes the Child Health and Mortality Prevention Surveillance (CHAMPS) network approach to pathologic evaluation of minimally invasive tissue sampling (MITS) specimens, including ...guidelines for histopathologic examination and further diagnostics with special stains, immunohistochemistry, and molecular testing, as performed at the CHAMPS Central Pathology Laboratory (CPL) at the Centers for Disease Control and Prevention, as well as techniques for virtual discussion of these cases (telepathology) with CHAMPS surveillance locations. Based on review of MITS from the early phase of CHAMPS, the CPL has developed standardized histopathology-based algorithms for achieving diagnoses from MITS and telepathology procedures in conjunction with the CHAMPS sites, with the use of whole slide scanners and digital image archives, for maximizing concurrence and knowledge sharing between site and CPL pathologists. These algorithms and procedures, along with lessons learned from initial implementation of these approaches, guide pathologists at the CPL and CHAMPS sites through standardized diagnostics of MITS cases, and allow for productive, real-time case discussions and consultations.
Uppermost Cretaceous (Maastrichtian) continental deposits in the Transylvanian region of western Romania contain a diverse and important assemblage of fossil vertebrates, including lissamphibians. ...Bones of anurans (frogs) and albanerpetontids are abundantly represented at multiple vertebrate microfossil localities in the region, but there continues to be no evidence for urodeles (salamanders) at any locality. Using previously reported and new collections of isolated bones, here we provide an up-to-date and comprehensive account of the anuran component of the Romanian assemblage, with particular emphasis on new specimens exhibiting features that are informative for differentiating species and resolving their higher level affinities. We recognise at least five species belonging to two or three families of moderately primitive (i.e. non-neobatrachian), crown-clade anurans: the alytids
Paralatonia transylvanica
, cf.
Bakonybatrachus
sp. and cf.
Eodiscoglossus
sp.; the bombinatorid
Hatzegobatrachus grigorescui
; and an indeterminate, possible pelobatid. Ilia previously reported as cf.
Paradiscoglossus
(a monotypic alytid genus reliably known only from the Maastrichtian of western North America) are here referred to
Paralatonia
. Also present are indeterminate alytids and at least two potentially distinctive, but indeterminate, taxa of uncertain family affinities. New specimens allow
Hatzegobatrachus
, formerly regarded as incertae sedis, to be assigned to Bombinatoridae as the geologically oldest member of that family. The Romanian Maastrichtian anuran assemblage is the most diverse yet documented for the European Late Cretaceous. It contains a mix of endemic taxa (
Paralatonia
and
Hatzegobatrachus
), a relict taxon (cf.
Eodiscoglossus
sp.), and one taxon (cf.
Bakonybatrachus
) possibly resulting from a pre-Maastrichtian dispersal from present-day Hungary. Compared to contemporaneous and older (Santonian–Campanian) anuran assemblages elsewhere in Europe, the Romanian assemblage is similar in containing alytids and a pelobatid-like taxon, but differs in having more alytid taxa (
n
= 3) and a bombinatorid, and in lacking the palaeobatrachids seen in the Campanian–Maastrichtian of Western Europe and the probable ranoid
Hungarobatrachus
reported from the Santonian of Hungary.
To asses the role and the effects of primary or secondary occlusal trauma after bone resorption and dental migration, Finite Elements Method (FEM) was applied by various authors 3,4. In patients with ...systemic pathologies that cause disturbances of bone metabolism and the appearance of osteoporosis, a phenomenon known as affecting the quality of the alveolar bone, in cases of occlusion trauma, periodontal changes, whicht can not be effectively compensated by apposition and causing dental mobility, occur through bone lysis 12-14. Considering the above observations, the present paper evaluates the occlusal trauma effect on the progression of both treated and untreated periodontal disease, evidencing the relationship between the treatment and / or the absence and progression of the periodontal disease, as assessed by measuring the depth of the periodontal pocket, mobility and clinical outcome. 2. RESULTS 41 patients followed all treatment recommendations (control group), 18 patients received non-surgical treatment (partial treatment group) and 30 other patients refused treatment (untreated group).
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