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Infanticide in Malaysia: two case reports and a review of literature

Ong BB, Green M

Am J Forensic Med Pathol, 2003 Mar;24(1):64-9.
PMID: 12605001

In a strict and conservative society like Malaysia, the number of cases of infanticide has continued to occur. The authors present two typical cases of infanticide in Malaysia. Case 1 concerned a body of a fully mature newborn fetus disposed in a rubbish bin. The head was traumatically amputated by the rubbish truck's compactor. The umbilical cord was still attached to the body, with no reddening around the insertion. The severed neck showed features consistent with post-mortem amputation. The significant finding was expanded crepitant lungs, which floated in water. The histology of the lungs showed expanded alveoli. It was concluded that the baby had been born alive, but no cause of death could be elicited. Case 2 concerned a decomposed mature newborn found in a scrub forest. The internal organs showed advanced putrefaction, the lungs being collapsed, congested, and hemorrhagic, typical of decomposed lungs. No conclusion could be made about the state of birth or the cause of death because of the putrefied state of the body. The two cases illustrate the typical cases and problems faced by pathologists locally and probably elsewhere in the world. Most of the bodies are found in a putrefied state. Pathologists have to ascertain not only maturity and live birth but also the cause of death, which may be very subtle or masked by putrefaction. The problems of diagnosis of live birth are discussed.
Unravelling the temporal association between lameness and body condition score in dairy cattle using a multistate modelling approach

Lim PY, Huxley JN, Willshire JA, Green MJ, Othman AR, Kaler J

Prev Vet Med, 2015 Mar 1;118(4):370-7.
PMID: 25579605 DOI: 10.1016/j.prevetmed.2014.12.015

Recent studies have reported associations between lameness and body condition score (BCS) in dairy cattle, however the impact of change in the dynamics of BCS on both lameness occurrence and recovery is currently unknown. The aim of this longitudinal study was to investigate the effect of change in BCS on the transitions from the non-lame to lame, and lame to non-lame states. A total of 731 cows with 6889 observations from 4 UK herds were included in the study. Mobility score (MS) and body condition score (BCS) were recorded every 13-15 days from July 2010 until December 2011. A multilevel multistate discrete time event history model was built to investigate the transition of lameness over time. There were 1042 non-lame episodes and 593 lame episodes of which 50% (519/1042) of the non-lame episodes transitioned to the lame state and 81% (483/593) of the lame episodes ended with a transition to the non-lame state. Cows with a lower BCS at calving (BCS Group 1 (1.00-1.75) and Group 2 (2.00-2.25)) had a higher probability of transition from non-lame to lame and a lower probability of transition from lame to non-lame compared to cows with BCS 2.50-2.75, i.e. they were more likely to become lame and if lame, they were less likely to recover. Similarly, cows who suffered a greater decrease in BCS (compared to their BCS at calving) had a higher probability of becoming lame and a lower probability of recovering in the next 15 days. An increase in BCS from calving was associated with the converse effect, i.e. a lower probability of cows moving from the non-lame to the lame state and higher probability of transition from lame to non-lame. Days in lactation, quarters of calving and parity were associated with both lame and non-lame transitions and there was evidence of heterogeneity among cows in lameness occurrence and recovery. This study suggests loss of BCS and increase of BCS could influence the risk of becoming lame and the chance of recovery from lameness. Regular monitoring and maintenance of BCS on farms could be a key tool for reducing lameness. Further work is urgently needed in this area to allow a better understanding of the underlying mechanisms behind these relationships.
Area of hock hair loss in dairy cows: risk factors and correlation with a categorical scale

Lim PY, Huxley JN, Green MJ, Othman AR, Potterton SL, Brignell CJ, et al.

Vet J, 2015 Feb;203(2):205-10.
PMID: 25577022 DOI: 10.1016/j.tvjl.2014.11.005

Data from 3691 dairy cows from 76 farms were used to investigate the risk factors associated with the area of hair loss over the lateral aspect of the hock and the correlation between the area of hair loss (as calculated using a hock map) and hock lesion scores determined using a pre-existing categorical scale. Six factors were associated with a greater area of hair loss, including cows with locomotion score 3, a cleanliness score (10/28 to 18/28), high daily milk yield (25.1-58.1 kg), poor body condition score (1-1.5), duration of winter housing (≥41 days) and some combinations of cubicle base and bedding materials. Compared with cows housed in cubicles with a concrete base and whole straw or rape straw bedding, cows housed in cubicles with concrete bases with sand or chopped straw bedding had smaller areas of hair loss and cows housed on a mattress base with whole straw or rape straw bedding had larger areas of hair loss. Area of hair loss, as measured on hock maps, was not significantly different between cows with score 1 (median 23.6 cm(2)) and score 2 (median 20.3 cm(2)) on the categorical scale for hock lesions. This suggests that the categorical scale was not reflecting the extent of hair loss and that hock maps are a good alternative for studying the dynamics of hock lesions over time.
Sedation Intensity in the First 48 Hours of Mechanical Ventilation and 180-Day Mortality: A Multinational Prospective Longitudinal Cohort Study

Shehabi Y, Bellomo R, Kadiman S, Ti LK, Howe B, Reade MC, et al.

Crit Care Med, 2018 06;46(6):850-859.
PMID: 29498938 DOI: 10.1097/CCM.0000000000003071

OBJECTIVES: In the absence of a universal definition of light or deep sedation, the level of sedation that conveys favorable outcomes is unknown. We quantified the relationship between escalating intensity of sedation in the first 48 hours of mechanical ventilation and 180-day survival, time to extubation, and delirium.
DESIGN: Harmonized data from prospective multicenter international longitudinal cohort studies SETTING:: Diverse mix of ICUs.
PATIENTS: Critically ill patients expected to be ventilated for longer than 24 hours.
INTERVENTIONS: Richmond Agitation Sedation Scale and pain were assessed every 4 hours. Delirium and mobilization were assessed daily using the Confusion Assessment Method of ICU and a standardized mobility assessment, respectively.
MEASUREMENTS AND MAIN RESULTS: Sedation intensity was assessed using a Sedation Index, calculated as the sum of negative Richmond Agitation Sedation Scale measurements divided by the total number of assessments. We used multivariable Cox proportional hazard models to adjust for relevant covariates. We performed subgroup and sensitivity analysis accounting for immortal time bias using the same variables within 120 and 168 hours. The main outcome was 180-day survival. We assessed 703 patients in 42 ICUs with a mean (SD) Acute Physiology and Chronic Health Evaluation II score of 22.2 (8.5) with 180-day mortality of 32.3% (227). The median (interquartile range) ventilation time was 4.54 days (2.47-8.43 d). Delirium occurred in 273 (38.8%) of patients. Sedation intensity, in an escalating dose-dependent relationship, independently predicted increased risk of death (hazard ratio [95% CI], 1.29 [1.15-1.46]; p < 0.001, delirium hazard ratio [95% CI], 1.25 [1.10-1.43]), p value equals to 0.001 and reduced chance of early extubation hazard ratio (95% CI) 0.80 (0.73-0.87), p value of less than 0.001. Agitation level independently predicted subsequent delirium hazard ratio [95% CI], of 1.25 (1.04-1.49), p value equals to 0.02. Delirium or mobilization episodes within 168 hours, adjusted for sedation intensity, were not associated with survival.
CONCLUSIONS: Sedation intensity independently, in an ascending relationship, predicted increased risk of death, delirium, and delayed time to extubation. These observations suggest that keeping sedation level equivalent to a Richmond Agitation Sedation Scale 0 is a clinically desirable goal.
Fulltext The Global Burden of Cancer 2013

Global Burden of Disease Cancer Collaboration, Fitzmaurice C, Dicker D, Pain A, Hamavid H, Moradi-Lakeh M, et al.

JAMA Oncol, 2015 Jul;1(4):505-27.
PMID: 26181261 DOI: 10.1001/jamaoncol.2015.0735

IMPORTANCE: Cancer is among the leading causes of death worldwide. Current estimates of cancer burden in individual countries and regions are necessary to inform local cancer control strategies.
OBJECTIVE: To estimate mortality, incidence, years lived with disability (YLDs), years of life lost (YLLs), and disability-adjusted life-years (DALYs) for 28 cancers in 188 countries by sex from 1990 to 2013.
EVIDENCE REVIEW: The general methodology of the Global Burden of Disease (GBD) 2013 study was used. Cancer registries were the source for cancer incidence data as well as mortality incidence (MI) ratios. Sources for cause of death data include vital registration system data, verbal autopsy studies, and other sources. The MI ratios were used to transform incidence data to mortality estimates and cause of death estimates to incidence estimates. Cancer prevalence was estimated using MI ratios as surrogates for survival data; YLDs were calculated by multiplying prevalence estimates with disability weights, which were derived from population-based surveys; YLLs were computed by multiplying the number of estimated cancer deaths at each age with a reference life expectancy; and DALYs were calculated as the sum of YLDs and YLLs.
FINDINGS: In 2013 there were 14.9 million incident cancer cases, 8.2 million deaths, and 196.3 million DALYs. Prostate cancer was the leading cause for cancer incidence (1.4 million) for men and breast cancer for women (1.8 million). Tracheal, bronchus, and lung (TBL) cancer was the leading cause for cancer death in men and women, with 1.6 million deaths. For men, TBL cancer was the leading cause of DALYs (24.9 million). For women, breast cancer was the leading cause of DALYs (13.1 million). Age-standardized incidence rates (ASIRs) per 100 000 and age-standardized death rates (ASDRs) per 100 000 for both sexes in 2013 were higher in developing vs developed countries for stomach cancer (ASIR, 17 vs 14; ASDR, 15 vs 11), liver cancer (ASIR, 15 vs 7; ASDR, 16 vs 7), esophageal cancer (ASIR, 9 vs 4; ASDR, 9 vs 4), cervical cancer (ASIR, 8 vs 5; ASDR, 4 vs 2), lip and oral cavity cancer (ASIR, 7 vs 6; ASDR, 2 vs 2), and nasopharyngeal cancer (ASIR, 1.5 vs 0.4; ASDR, 1.2 vs 0.3). Between 1990 and 2013, ASIRs for all cancers combined (except nonmelanoma skin cancer and Kaposi sarcoma) increased by more than 10% in 113 countries and decreased by more than 10% in 12 of 188 countries.
CONCLUSIONS AND RELEVANCE: Cancer poses a major threat to public health worldwide, and incidence rates have increased in most countries since 1990. The trend is a particular threat to developing nations with health systems that are ill-equipped to deal with complex and expensive cancer treatments. The annual update on the Global Burden of Cancer will provide all stakeholders with timely estimates to guide policy efforts in cancer prevention, screening, treatment, and palliation.
Erratum to "The histology of ovarian cancer: Worldwide distribution and implications for international survival comparisons (CONCORD-2)" [Gynecol. Oncol. 144 (2017) 405-413]

Matz M, Coleman MP, Sant M, Chirlaque MD, Visser O, Gore M, et al.

Gynecol Oncol, 2017 Jul 05.
PMID: 28687170 DOI: 10.1016/j.ygyno.2017.06.032