[Epidemiological analysis of the incidence of diseases and traumas among soldiers of stabilization forces and local population in the Center South Zone of Iraq]

The results of own studies concerning the incidence of diseases and traumas occurred among soldiers of Stabilization Forces serving in the Center South Zone of Iraq and local civilian population living in the Karbala Province (treated within the confines of humanitarian assistance) are presented in the article. The epidemiological analysis was based on the medical documentation of the patients treated in the Medical Support Group (Polish Field Hospital) of the Multinational Division Center South in the period 01 October 2003- 30 June 2004. The research showed that among the treated population (N=440) traumatic profile was dominating (50,3%), whereas contagious, parasitic and sexually transmitted diseases caused no epidemiological problem in the analyzed period. The main reason of treatment were gunshot / shrapnel wounds (11,6%).

The role of the physician in modern military operations: 12 months experience in Southern Iraq

OBJECTIVES

To examine the profile of medical morbidity and the role of the physician in modern conflict.

METHODS

Retrospective survey of admission records at a British Military Field Hospital on operational duty in Southern Iraq.

RESULTS

62.5% of 4870 admissions to the Field Hospital in Shaibah during the first 12 months of military operations in Iraq were under the care of physicians. Of these 1531 (31.4%) were due to diarrhoea and vomiting (D&V) and 764 (15.7%) due to heat illness. The incidence of heat illness rose with ambient temperature, but soldiers were more likely to be admitted with heat illness shortly after arrival in theatre than when fully acclimatised. There was also a steady flow of admissions with a broad spectrum of medical pathology requiring the clinical skills of a general physician.

CONCLUSIONS

A general physician is a necessary part of the clinical team in modern conflict. The incidence of D&V and of heat illness on military operations remains high. Planners for any operation in tropical climates should take this into consideration and put preventative measures into place early.

A Randomized Outpatient Trial of a Decision-Support Information Technology Tool

BACKGROUND

Decision-support information technology is often adopted to improve clinical decision making, but it is rarely rigorously evaluated. Congress mandated the evaluation of Problem-Knowledge Couplers (PKC Corp, Burlington, Vt), a decision-support tool proposed for the Department of Defense's new health information network.

METHODS

This was a patient-level randomized trial conducted at 2 military practices. A total of 936 patients were allocated to the intervention group and 966 to usual care. Couplers were applied before routine ambulatory clinic visits. The primary outcome was quality of care, which was assessed based on the total percentage of any of 24 health care quality process measures (opportunities to provide evidence-based care) that were fulfilled. Secondary outcomes included medical resources consumed within 60 days of enrollment and patient and provider satisfaction.

RESULTS

There were 4639 health care opportunities (2374 in the Coupler group and 2265 in the usual-care group), with no difference in the proportion of opportunities fulfilled (33.9% vs 30.7%; P = .12). Although there was a modest improvement in performance on screening/preventive measures, it was offset by poorer performance on some measures of acute care. Coupler patients used more laboratory and pharmacy resources than usual-care patients (logarithmic mean difference, 71 dollars). No difference in patient satisfaction was observed between groups, and provider satisfaction was mixed.

CONCLUSION

This study provides no strong evidence to support the utility of this decision-support tool, but it demonstrates the value of rigorous evaluation of decision-support information technology.

Burn support for Operation Iraqi Freedom and related operations, 2003 to 2004

Thermal injury historically constitutes approximately 5% to 20% of conventional warfare casualties. This article reviews medical planning for burn care during war in Iraq and experience with burns during the war at the US Army Burn Center; aboard the USNS Comfort hospital ship; and at Combat Support Hospitals in Iraq and in Afghanistan. Two burn surgeons were deployed to the military hospital in Landstuhl, Germany, and to the Gulf Region to assist with triage and patient care. During March 2003 to May 2004, 109 burn casualties from the war have been hospitalized at the US Army Burn Center in San Antonio, Texas, and US Army Burn Flight Teams have moved 51 critically ill burn casualties to the Burn Center. Ten Iraqi burn patients underwent surgery and were hospitalized for up to 1 month aboard the Comfort, including six with massive wounds. Eighty-six burn casualties were hospitalized at the 28th Combat Support Hospital for up to 53 days. This experience highlights the importance of anticipating the burn care needs of both combatants and the local civilian population during war.

[Testicular neoplasms. Evaluation of the experience during 25 years in a military hospital]

OBJECTIVES

The testicular tumors are frequent in the young adult, coinciding with the incorporation to the Military Service. The objective of our work is to evaluate the tumoral characteristic, its evolution with the time and the result of the treatments used in our center for this type of tumors.

MATERIAL AND METHODS

We carried out a retrospective longitudinal study in a cohort of 98 patients with an average age of 28.6 years, subjected to orchiectomy for testicular tumor in our center between 1979 to 2004. In the study, we collected data referred to the age of the patients, the tumoral characteristic, the outcome of the treatment and the evolution of the tumor.

RESULTS

In 61% of the cases, the affected testicle was the right (significant differences). The most common histologyc type was the non seminomatous germ cell tumors (NSGCT) (65.3%). Followed by the pure seminomas (27.6%), and non germinal cell tumors (NGC) (7.1%). The NSGCT was diagnosed to a average age (23.2 years) significantly smaller that the other two types. The stage I was the most frequent (58%). The seminomas presented a stage I in a significantly bigger frequency (80%) that the others tumors. The data picked up during the 25 years didn't show a significant variation regarding the tumoral characteristic. The survival análisis indicated that the tumoral characteristic with better pronostic regarding the probability of tumoral recurrences were the seminomas and the tumoral stages I and II.

CONCLUSIONS

The non seminomatous germ cell tumors (NSGCT) are the most frequent testicular tumors in young adults. Most of the tumors are diagnosed in initial stages, and their pronostic is better in the case of the seminomas and in the stages I and II.

Frequency of visits for health care by low-birth-weight and preterm Saudi infants in the first year of life

A retrospective hospital-based cross-sectional survey in a Saudi Arabian hospital compared the frequency of visits to hospital of low-birth-weight and normal-birth-weight infants and of preterm and full-term infants during the first year of life. A multivariate analysis of the visits for health care with birth weight, term, Apgar score, mode of delivery and sex was made for 1892 infants. The number of visits for health care was significantly higher for low-birth-weight and preterm infants. While the mode of delivery had no effect on the frequency of visits, male sex and poor Apgar score 5 minutes after birth were associated with greater frequency of visits to specialty clinics and higher rates of hospitalization.

Psychiatric Referrals during Peace and Wartimes: A Nigerian Experience

Using a questionnaire administered by us, we sought to investigate the differences between patients referred to the psychiatric department of a Nigerian military general hospital during peacetime and those referred during the civil war in Liberia in which Nigerian soldiers were involved as peacekeepers. Referrals to psychiatry in peacetime were quite few but increased considerably during the period of combat in direct relation to the increase in the number of surgical wounded in action cases. Organic mental disorders and anxiety disorders were more frequently referred in peacetime than in war, whereas substance abuse disorders were more frequent during the combat period. Non-psychotic psychiatric conditions were less referred in the wartime group, partly because of nonrecognition at the mission areas and also because of recovery in front-line areas or consideration of their evacuation as a nonpriority. Mental health workers engaged at the mission areas require more training in the identification of such cases.

An internet-based referral/consultation system for the U.S.-associated Pacific Islands: its contribution to orthopedic graduate medical education at Tripler Army Medical Center

To evaluate the benefit of the Pacific Island Health Care Project (PIHCP) to our orthopedic graduate medical education program, we performed a retrospective review of our 8-year operative experience with patients referred through this program. Between July 1994 and June 2002, 69 patients underwent 79 orthopedic operative procedures. Patients were categorized by primary diagnosis, anatomic site involved, and surgical treatment rendered. Because many of the patients referred from the PIHCP with tumors were noted to have either unusually large lesions or advanced-stage disease, further analyses of tumor stage and pathologic grade were made. Seven of the 14 oncologic cases surgically treated in our department in the past 8 years were referrals from the PIHCP. Unique operative procedures performed for these tumor patients included one forequarter amputation, one hip disarticulation, one hemipelvectomy, two partial scapulectomies, and one distal ulna excision. We conclude that the PIHCP referrals provide an important and relatively unique contribution to the clinical and operative experience of our orthopedic residents. These patients from the Pacific basin also enhance our orthopedic graduate medical education program by exposing our residents to the special socioeconomic and cultural issues related to caring for people from developing insular countries.

Patient gender preferences in a large military teaching hospital

OBJECTIVE

To quantify preferences for female providers among obstetric-gynecology patients in a large military teaching hospital in California.

METHODS

A questionnaire regarding patient preferences for female provider was distributed to and collected from 1,544 obstetric-gynecology patients over a two-month period. Responses were tabulated overall and for several demographic subgroups.

RESULTS

Sixty percent of respondents indicated they had no provider gender preference or they preferred a male. Significant ethnic preferences were noted among Asian, Pacific Islander, and Native-American women. Junior officers, wives, and daughters of service members also showed a greater preference for a female physician provider.

CONCLUSION

The majority of obstetric-gynecology patients surveyed had no strong preferences for female providers. In the interest of patient satisfaction, where strong gender preferences exist, attempts to accommodate could be made without overburdening female staff.

LEVEL OF EVIDENCE

III.

Clinical case mix adjustment of cesarean delivery rates in U.S. military hospitals, 2002

OBJECTIVE

To assess whether significant variations in observed cesarean rates in U.S. military hospitals may be attributed to differences in clinical case mix.

METHODS

Hospital discharge records for births in U.S. military hospitals in 2002 were grouped into mutually exclusive clinical strata to calculate predicted cesarean rates for subgroups defined by maternal race, health plan, hospital location, delivery volume, teaching status, and neonatal intensive care unit (NICU) status. The 95% confidence interval (CI) around each standardized ratio (SR) of the observed-to-predicted cesarean rate was used to assess statistical significance.

RESULTS

Observed cesarean rates were significantly higher than predicted rates for small hospitals (23.1% and 20.4%, respectively, SR 1.13, 95% CI 1.08-1.19), teaching hospitals (23.7% and 22.5%, respectively, SR 1.05, 95% CI 1.02-1.08), black women (25.1% and 22.8%, respectively, SR 1.10, 95% CI 1.05-1.14), and other minorities (22.7%, and 21.6%, respectively, SR 1.05, 95% CI 1.01-1.09). No significant differences between observed and predicted cesarean rates were found across hospital locations or NICU status. Significant differences found for non-managed care beneficiaries were attributed to teaching status of the hospitals in which they delivered.

CONCLUSION

Clinical case mix does not adequately account for the relatively high rates of cesarean delivery observed for small hospitals and teaching hospitals and among black women in the study population. Further study is recommended to identify additional clinical and nonclinical factors that should be considered when comparing performance across institutions, health plans, or individual providers.

Default from Colposcopy and Loop Excision Electrocautery Procedure Appointments in a Military Clinic

OBJECTIVE

To determine the extent of nonadherence and impediments to care in a military colposcopy and loop excision electrocautery procedure (LEEP) clinic.

MATERIALS AND METHODS

The nonadherence rate for colposcopy and LEEP appointments was determined for a 6-month period at Walter Reed Army Medical Center. Nonadherence was defined as failure to keep an appointment or cancellation within 24 hours of the scheduled time. A nurse coordinator telephoned all nonadherent women. Women who agreed to participate were administered a structured survey to elicit their reasons for default from their appointments.

RESULT

Sixty-one (15%) of 405 women were nonadherent. Of the 61 nonadherent women, 55 (90%) agreed to participate, 4 (7%) were unable to be contacted, and 2 (3%) declined participation. The average age of participants was 30 years. Beneficiary status of the 55 women was as follows: dependent, 27 (49%); active duty, 25 (45%); retired, 2 (4%); and veteran, 1 (2%). The most common reasons for default overall for 55 women were onset of menses (15 [27%]), unplanned family or personal event (9 [16%]), forgetting (8 [15%]), and work conflict (7 [13%]). Leading reasons for 25 active duty women included work conflict (7 [28%]) and menses (6 [24%]). Leading reasons for 27 dependent women included menses (9 [33%]), unplanned family or personal event (6 [22%]), and forgetting (5 [19%]).

CONCLUSIONS

Despite unrestricted access to care in the military clinic, the default rate was similar to rates reported for civilian clinics. Previsit interventions likely to improve compliance include sending informational packets to patients, better attention to scheduling around the time of expected menses, and initiating an appointment reminder system. To decrease the high percentage of nonadherence attributable to work conflicts for active duty women, supervisors need to be better informed about both medical and deployment implications of an unevaluated abnormal Pap smear.

Operation Iraqi Freedom: Surgical Experience of the 212th Mobile Army Surgical Hospital

Seven hundred one patients were treated at and 394 were admitted to the 212th Mobile Army Surgical Hospital in Central Iraq during the combat phase of Operation Iraqi Freedom. Ninety of those patients underwent 100 operations, with 187 procedures in 19 days. At the peak of hostilities, 48 patients were admitted, 15 operations were performed, and 56 patients were medically evacuated during different 24-hour periods. Thirty-three patients required the surgical expertise of a general or thoracic surgeon. Although 82% of injuries and 70% of the procedures were orthopedic in nature, orthopedic operating room utilization was only 60% of total operating room time (156 hours). The general and thoracic injuries were labor-intensive, frequently requiring two surgeons. Although orthopedic injury remains the predominant reason for surgical intervention on the battlefield, there remains a need to forward-deploy general and thoracic surgeons, because of the presence and complexity of nonorthopedic trauma.

Incidence des infections du site opératoire étude prospective à l'hôpital militaire d'instruction Mohamed-V de Rabat, Maroc

OBJECTIVES

The authors had for aim to determine prospectively the incidence of surgical site infections (SSI) in a visceral surgery department, in the Mohamed V military hospital (Rabat), and to identify risk factors.

PATIENTS AND METHODS

All patients who had undergone surgery between April 1 and September 30, 2002 and were then admitted in the visceral surgery unit were included in this study. Patients were assessed within the following month. For each patient, data including perioperative factors, type of procedure, and SSI occurrence were collected on a standardized form.

RESULTS

During the study, 310 patients were operated. The number of surgical wound infections was 16 (5.2%). This analysis pointed out: 11 superficial wounds, 5 deep wounds, and 1 organ/site wound. Emergency, age, ASA score, Altemeier classification, and procedure duration were found to be risk factors for SSI in visceral surgery. According to the NNIS index, SSI rates increase from 2.7% for patients with a risk index of 0 to 10.2% for patients with a risk index of 3.

CONCLUSION

The high incidence of SSI emphasizes the importance of implementing SSI surveillance in surgery to obtain standardized incidence ratios necessary for adapted control measures.

[Some aspects regarding the activity analysis of a military hospital]

Providing secondary health care for military staff and related personnel, Clinical Emergency Military Hospital "Dr. Iacob Cihac" it is the biggest hospital among those having the same profile. There are many factors with influence upon hospital's activities. Some factors can be measured (number of beds, the prevalence of a certain disease in population), but also some of them are subjective, creating pressures in hospitals utilization (costs, status of the professionals and hospital, desires of patients and their families). Good statistical information about hospitalized morbidity provides the basis for planning, control and efficient administration and can also serve as an input into the development of more effective preventive health strategies. There are some important differences between public own hospital and military hospital: for public hospitals, the main cause of morbidity is represented of respiratory disease, while for the military hospital on the top are nervous and psychiatric diseases; also, it is different the proportion of inpatients according to age groups - for public hospitals the main proportion of inpatients is aged more than 45-60 years old, but for the military hospital there are also well represented those aged under 29 years old. The differences between the average length of stay in hospitals is due to hospitalization of psychiatric diseases in public hospitals.

Paediatric casualties during OP TELIC

AIM

To audit all paediatric attendances to a British Army Field Hospital during warfighting.

POPULATION

All patients <16-years-old who presented to 34 Field Hospital Accident & Emergency (A&E) Department during warfighting phase of OPTELIC (27 Mar 03 to 01 May 03).

METHOD

A retrospective analysis of A&E attendance register, A&E clinical records, and A&E trainees' logbooks from the department of 34 Field Hospital.

RESULTS

Seventy eight children were treated, mean age 7.9 years. 65.4% were male and 34.6% female. Children accounted for 2.9% of all patients (total attendances 2720) and 32.9% of non-coalition patients (non-coalition attendances 237). 44 (56%) children had burns as the principal injury; 7 (9%) had shrapnel injuries, 5 (6%) had blunt trauma from a road traffic accident. Only one child had GSW. 17% of attendances were related to 'medical' complaints rather than trauma. 78% of children required transfer to a specialist facility.

CONCLUSIONS

Recognition of the potential for paediatric casualties is required to facilitate appropriate planning, training and equipping of medical units deployed on future operations.

Appropriateness of admission and length of stay in a Turkish Military Hospital

The purpose of this study was to determine the extent of inappropriate days of stay in a Turkish military hospital, and to explore the variables correlated with these. A review was made of the medical records of surgery patients admitted to the hospital of Gülhane Military Medical Academy. To determine the appropriateness of lengths of hospitalization, a Turkish version of the Appropriateness Evaluation Protocol (AEP) was applied retrospectively. A total of 375 patients'files were reviewed; and 21.3% of the hospital admissions were evaluated as inappropriate. Multiple logistic regression analysis showed that inappropriate length of stay was significantly increased with relation to age, emergency status, military rank, and distance from the hospital to the patient's home. The results of the study suggest that changes in physicians' behavior and in the organization of hospital activities may be effective in improving the quality and efficiency of hospital care.

Predictors of Length of Stay in a Psychiatric Ward Serving Active Duty Military and Civilian Patients

Admission data from 6366 patients on the psychiatry service at Naval Medical Center San Diego were used to form a linear regression model to examine variables that might influence length of stay. Information was available on active duty status, primary diagnosis, age, gender, and marital status. Active duty service, older age, single marital status, and a primary diagnosis of a psychotic or mood disorder were all significantly associated with longer hospital stays. Primary diagnosis of an adjustment or personality disorder was associated with a shorter stay. Taking into account these variables, lengths of stay for active duty personnel averaged 4.00 +/- 0.39 days longer than for equivalent civilian admissions. Although military personnel are generally thought of as a healthy population, psychiatric hospital stays were found to be longer in service members than in their civilian counterparts. Financial repercussions and possible reasons for this are discussed.

The Pope Air Force Base Aircraft Crash and Burn Disaster

This report describes the initial hospital and burn center management of a mass casualty incident resulting from an aircraft crash and fire. One hundred thirty soldiers were injured, including 10 immediate fatalities. Womack Army Medical Center at Fort Bragg, North Carolina, managed the casualties and began receiving patients 15 minutes after the crash. As a result of repetitive training that included at least two mass casualty drills each year, the triage area and emergency department were cleared of all patients within 2 hours. Fifty patients were transferred to burn centers, including 43 patients to the US Army Institute of Surgical Research. This constitutes the largest single mass casualty incident experienced in the 57-year history of the Institute. All patients of the US Army Institute of Surgical Research survived to hospital discharge, and 34 returned to duty 3 months after the crash. The scenario of an on-ground aircraft explosion and fire approximates what might be seen as a result of an aircraft hijacking, bombing, or intentional crash. Lessons learned from this incident have utility in the planning of future response to such disasters.

The occupational burden of mental disorders in theU.S. military: psychiatric hospitalizations, involuntary separations, and disability

OBJECTIVE

A recent study showed that among U.S. military personnel, mental disorders were the leading medical correlate of separation from military service. The reasons for this association have not been determined. The purpose of this study was to characterize the risk and reasons for service separation for soldiers hospitalized with mental disorders compared with those hospitalized for other illnesses.

METHOD

Population-based electronic health care data were linked with data on separations and disability. The authors constructed a cohort of 13,971 U.S. Army soldiers first hospitalized in 1998 and followed them for up to 2 years following this first hospitalization.

RESULTS

The rate of service separation 6 months after first hospitalization was 45% among personnel whose primary hospital discharge diagnosis was a mental disorder, 27% among those with a secondary mental disorder discharge diagnosis, and 11% among those hospitalized for all other medical conditions. Separation from military service due to medical disability, misconduct and other legal problems, unauthorized work absences, behavior related to personality disorders, and alcohol rehabilitation failure was significantly more common following hospitalization for a mental disorder than for other medical conditions. Mental disorders were also significantly associated with medical separations in which there was evidence that the condition existed prior to service.

CONCLUSIONS

In the military, the occupational impact of mental disorders compared with other medical conditions appears to be mediated not only by greater disease chronicity and severity but also by a variety of behavioral problems including misconduct, legal problems, unauthorized absences, and alcohol/drug-related problems. The study also points to the difficulties inherent in screening for mental disorders prior to entry into military service.

Status of trauma care in U.S. Army hospitals

OBJECTIVE

This study documents the recent trends and current state of inpatient trauma care in U.S. Army hospitals.

METHODS

Inpatient trauma cases from Army hospitals worldwide from October 1988 through April 2001 were analyzed. Facilities included 3 Certified Trauma Centers (CTCs), 7 non-CTC Army Medical Centers, and 42 Army Community Hospitals. Logistic regression identified mortality risk factors.

RESULTS

Overall, the Army treated 166,124 trauma cases, with a mortality rate of 0.8% (trend of 0.66% to 1.18% in fiscal years 1989-2000, p < 0.0001). The number of Army hospitals decreased by 44% and the number of trauma cases decreased by nearly 75%. Injury severity, patient age, hospital trauma volume, beneficiary category, hospital type, and a resource intensity measure were all significantly associated with the probability of death.

CONCLUSIONS

The overall trauma mortality rate at Army hospitals during the study period was lower than that reported for civilian trauma centers. However, changes in patient profiles, increased average severity, and decreased trauma volume might have contributed to a 13% increase in mortality rates at CTCs.

Nucleoplasty With or Without Intradiscal Electrothermal Therapy (IDET) as a Treatment for Lumbar Herniated Disc

BACKGROUND AND OBJECTIVE

In industrialized societies, the prevalence of radicular low back pain has exploded in recent years. The growing economic and personal costs of this challenging entity have led to the development of a wide array of new treatments, ranging from pharmacotherapy with neuropathic medications to open surgical treatment. Among the therapeutic options to emerge are a plethora of minimally invasive treatments aimed at removing nuclear material and lowering intradiscal pressure through devices inserted percutaneously into intervertebral discs. Yet there is a compelling lack of clinical evidence to support the use of these procedures. This study was undertaken to determine the treatment outcomes of 16 consecutive patients with lumbar radicular pain secondary to a herniated disc who underwent nucleoplasty as their primary therapy.

METHODS

Included in this series were nine patients with significant axial back pain, sitting intolerance, and positive discography who also underwent intradiscal electrothermal therapy (IDET). Among the 7 patients who only had nucleoplasty, 4 had 2 discs treated and 3 had 1 disc. In the 9 patients who also had IDET, 6 had 1 disc treated and 3 had 2 discs treated. Of the 32 total disc treatments, 20 were at L5-S1, 10 were at L4-5 and 2, one each for IDET and nucleoplasty, were at L3-4.

RESULTS

In the overall cohort, the average Visual Analogue Scale (VAS) pain score decreased from 6.7 to 5.6 at a mean follow-up of 9 months. In the seven patients who underwent only nucleoplasty, the mean VAS score decreased from 6.0 to 4.8. Only one patient reported a >/=50% reduction in pain score.

CONCLUSIONS

We conclude that with use of the present selection criteria, nucleoplasty is not an effective long-term treatment for lumbar radiculopathy, either alone or with IDET. Before conducting future clinical trials, we recommend modifying these criteria to include only those patients with small (<6-mm) contained disc herniations whose annular integrity is documented by computed tomography discography and corresponding radicular symptoms confirmed by either selective nerve root blocks or electromyography and nerve conduction studies.

Kidney transplantation at the Chinese People's Liberation Army General Hospital

Between October 1977 and December 2004, 2,037 kidney transplants were performed in 1,804 patients with ESRD at the Peoples Liberation Army General Hospital Postgraduate Medical School. Overall graft survival rates at one, 5, 10, 15, and 20 years were 91.6%, 79.3%, 64.3%, 53.8%, and 47.6%, respectively. The number of transplants significantly increased during the past decade. One-year patient and graft survival rates have increased from 40% and 35% in the 1970s to 98% and 96% in the 2000s, respectively. Since CSA was introduced to our clinic, one-year graft survival rates have increased from 33% to 93% and the half-lives have significantly improved from 13.1 years to 21.7 years. Also, the graft survival rate for patients on CSA-based triple therapy using MMF was about 18% higher at 5 years than those for patients using AZA (92% vs. 74%, p < 0.001), and 11% higher at 10 years (71% vs. 60%, p < 0.01). Our analysis showed that transplant year, DGF, rejection, immunosuppressive regimen, ABO blood group, and original disease were independent factors impacting on graft survival and poor HLA matching with 5-6 mismatches had an adverse effect on graft survival compared with 1-2 mismatches. Infection, cardio- and cerebral accidents and hepatic failure were the 3 main causes of death in transplant recipients.

Morbidity and Mortality Characteristics of Infants Hospitalized in the Pediatrics Department of the Largest Turkish Military Hospital in 2001

A descriptive study was conducted in the pediatric inpatient unit of Gulhane Military Medical Academy, to investigate the morbidity and mortality characteristics of 532 infants hospitalized between January 1 and December 31, 2001, for treatment purposes. Of the study participants, 55.8% were boys and 44.2% were girls. The most common cause of hospitalization was neonatal hyperbilirubinemia (19.7%). The most common admission month was January (12.4%). Of 532 infants, 510 (95.9%) were discharged, whereas 22 patients died in the hospital. Twenty-one patients died in the neonatal period, and respiratory distress syndrome and neonatal sepsis were identified as the most common causes of death. Our finding of associations between male gender and low birth weight and hospital death is consistent with previous knowledge. Despite the high frequencies of pneumonia and gastroenteritis as admission diagnoses, the finding of only one pneumonia-related death and no gastroenteritis-related deaths in the study population is pleasing.