Epidemiology module of practical skills for mbbs student

Death certificate

International Statistical Classification of Diseases and Related Health Problems, (ICD-10)

World Health Organization 1991

Cause of death		Approximate interval between onset and death
I
Disease or condition directly leading to death*	(a)………………………………………….	………………..
	Due to (or as a consequence of)
Antecedent causes Morbid conditions, if any, Giving rise to the above cause, stating the underlying condition last	(b)………………………………………….	………………..
	Due to (or as a consequence of)
	(c)………………………………………….	………………..
	Due to (or as a consequence of)
	(d)………………………………………….	………………..
II
Other significant conditions contributing to the death, but not related to the disease or condition causing it
	……………………………………………..	………………..
	……………………………………………..	……………….
This does not mean the mode of dying, e.g. heart failure, respiratory failure. It means the disease, injury, or complication that caused death.

Case history
History: Four years before his final hospital admission, this 64-year old man had an admission to hospital for acute shortness of breath. Lung function showed reduced FEV ₁ with response to bronchodilator. He was treated with inhaled beta agonists and beclomethasone. One year later, he was again admitted to hospital and required a period of artificial ventilation for respiratory failure. Subsequently, he regular ambulatory oxygen at home. He returned to hospital on this occasion because of breathlessness. He started smoking cigarettes at age 16, averaged 30 per day and stopped smoking after his last admission.
Examination: CVS – pulse 78 / min; regular. RR 50 / min; prolonged expiration with expiratory wheeze; increased anteroposterior diameter to the chest with hyper resonance; cyanosis noted.
Other examination normal.
Investigations: Hb 11,8 g / dl; Urine – no protein or sugar; Spirometry showed reduced FEV ₁ (18% of predicted) with reduced FEV / FVC (40%).
Arterial blood gases – paO ₁ markedly reduced and paCO ₂ elevated.
Clinical course: Admitted to the Intensive Care Unit and intubated; following day developed fever and left shift to WBC; tracheal secretions yielded Pseudomonas aerugenosa resistant to all common antibiotics; developed progressive infiltration on chest radiographs; oxygenation progessively deteriorated; developed acute chest pain, ventricular fibrillation and expired.

Post mortem: not performed.

3. The Incidence rate of a disease is the rate per unit time at which the previously unaffected develop the disease. The prevalence ratio of a disease at any time is the proportion of the population affected.

What will tend to raise or lower the prevalence ratio of a disease apart from its incidence rate?
How might you measure incidence and prevalence, for example, of asthma?

INTERNATIONAL CLASSIFICATION OF DISEASE 10^th REVISION
Ischemic heart disease

(I20-I25)