bluuebunny/crossref_metadata_2025 huggingface dataset:
Mechanics of High Speed Texturing
Authors: Li Wei , Kang Tae Jin , El-Shiekh Aly
Published: January 2017

This paper presents experimental studies of belt and ring twisting mechanisms. The effects of twister parameters such as the yarn crossing angle, the speed ratio, and the externally applied pressure are investigated, and the results support the theoretical analyses presented in the previous parts of this series. The preferred operating ranges of these twisters are also suggested.
Influence of HIV Infection on Presentation of Kaposi's Sarcoma
Authors: Ahmed Adamu , Isa Mohamed S , Garba Habib A , Kalayi G D , Muhammad I , Egler L J
Published: January 2017

We report a retrospective review of 57 patients with endemic Kaposi's sarcoma (EKS) seen between 1981 and 1990 and 40 prospectively diagnosed patients with and without human immunodeficiency virus (HIV) infection seen between 1991 and 1995. In the retrospective study 52 patients were males and five were females. Their ages ranged between 15 and 62 years with a mean of 39 years. Thirty-five (61%) patients had symptoms for more than 1 year. Nodular KS was seen in 75% of the patients. In the prospective study 26 patients had EKS while 14 had AIDS associated KS (AAKS). Among the patients with EKS 24 were males and two were females. The mean duration of symptoms was 20 months. The CD4 count done on nine patients ranged between 900 and 1300 cells/mm3 and there was no mortality within 1 year of presentation. Eleven of the patients with AAKS were males and three were females. Their ages ranged between 22 months and 41 years with a mean of 26. Nine patients had symptoms for less than 6 months. Ten patients had peripheral lymphadenopathy. CD4 counts done on 11 patients ranged between 200 and 800 cells/mm3. Five patients (35%) died within 6 months of presentation. Between 1991 and 1995, 486 patients were seen with HIV infection. Patients with AAKS present with fulminant disease which seemed quickly fatal.
Perceptions, Beliefs and Practices of Mothers in Sub-Urban and Rural Areas towards Measles and Measles Vaccination in Northern Nigeria
Authors: Ambe Jose P , Omotara Babatunji A , Baba Marycelin Mandu
Published: January 2017

Measles is of particular concern in Nigeria because of the high fatality rate, and high morbidity rate, particularly in young children. Measles and its complications are a common reason for hospitalization, indicating very low immunization coverage. This study was carried out to elucidate the contributing factors from attitudes, beliefs and practices of mothers towards measles and its vaccination. A cross-sectional survey was conducted in Konduga Local Government Area. One per cent of the 500 mothers interviewed believed that measles is prevented by immunization, 16% that it is contagious or due to an infectious agent, 26% that it is caused by evil spirits, witchcraft and heat, and 25% had never heard of measles immunization. Twenty-seven per cent said they did not believe immunization was effective and 4% were not allowed to go for immunization by their husbands. Of those mothers whose children had developed measles, only 31% had been treated in formal health facilities. These results indicate an unfavourable attitude and practice by mothers in relation to measles and measles vaccination. There is the need for an intensive health education campaign to improve this state of affairs and to reduce the morbidity and mortality from measles.
A Modified Technique of Devascularization for Surgical Management of Portal Hypertension in Children
Authors: Sharma Dhananjaya , Agrawal Sunil , Saxena Arjun , Raina Vijay K
Published: January 2017

In developing countries surgery is indicated in patients with portal hypertension for a variety of reasons. This study prospectively evaluates a modified technique of devascularization for secondary prophylaxis of variceal bleeding in patients with portal hypertension of different aetiologies.

Transabdominal extensive oesophagogastric devascularization combined with transmural ligation of oesophageal and gastric varices was performed in 16 paediatric patients (nine with extrahepatic portal venous obstruction, and seven with non-cirrhotic portal fibrosis) in an elective setting. The Sugiura devascularization procedure was modified to minimize the operating time and to avoid the problems associated with oesophageal transection and anastomosis.

The operative mortality rate as well as the oesophageal leak rate was zero. One patient developed an oesophageal stricture. During a 12-month follow-up, patients were seen with residual varices (2), recurrent varices (3) and rebleeding (1). Porto-systemic encephalopathy was seen in one patient only.

This technique is a simple, straightforward, safe and effective modification of the Sugiura procedure in controlling bleeding, providing good quality of life with minimal porto-systemic encephalopathy.
Development of Reactive Onchocercal Skin Lesions during a Placebo-Controlled Trial with Ivermectin among Persons without Lesions at Baseline
Authors: Brieger William R , Kale Oladele O , Ososanya O Olukayode
Published: January 2017

Clinical trials of the effects of ivermectin on onchocercal skin disease have documented reduction in itching, but a less than clear benefit on reactive skin lesions. It has been suggested that one of the positive effects might be the prevention of new lesions. A study among a rural adult farming population in southwestern Nigeria provided ivermectin in three treatment groups and a placebo to community members who were examined and treated at 3-monthly intervals over a 15-month period. Among the 1206 people recruited for the study, 627 (52%) had no lesions at baseline examination. A total of 291 participants without baseline lesions attended all five follow-up examinations, and only their results were analysed. Members of all four groups developed new lesions, but those receiving ivermectin had a consistently lower proportion of lesions than the placebo group. This difference reached statistical significance at the 5% level in three of the five periods and was below the 10% level at the other two periods. These findings are suggestive of an inhibiting effect of ivermectin among those without lesions at the beginning of a community treatment programme, and justify community treatment as a way of limiting morbidity and social stigma associated with these lesions.
The Outcome of Tuberculosis Treatment at a Rural Hospital in Southern Ethiopia
Authors: Lindtjørn Bernt , Madebo Tesfaye
Published: January 2017

We evaluated the treatment results of 239 patients with sputum positive pulmonary tuberculosis (TB) and describe potential factors associated with reduced programme performance in a TB treatment programme in Ethiopia. The TB registry was incomplete and 64 (26.8%) patients were not recorded in the control programme. Of the 239 patients, 34.3% received short-course chemotherapy (SCC) as a first treatment, 5.9% received SCC having previously been treated with standard long-course chemotherapy (LCC), and 54.4% were initially put on LCC. After excluding the 75 patients (31.4%) who were transferred to other health institutions outside the control area, 100 (61.0%; 95% CI 53.0–68.4) were cured (22.6%) or completed the treatment (38.4%) falling short of the target of 85%. Five months or later during treatment 1.8% remained smear-positive, 7.3% died and 29.9% interrupted their treatment. Sputum tests were done in 78% of the eligible patients at 2 months, in 20% at 5 months and in 60.2% at the expected time of treatment completion. By July 1998, 5.4% of the patients initially on LCC had relapsed and were retreated with SCC. None of those initially cured with SCC needed to be retreated. Compared with patients in the TB registry, non-registered patients had lower treatment completed and cure rates (42.3% versus 65.2%; P=0.047), more patients were transferred out of the TB programme (59.4% versus 21.1%; P<0.001) and the defaulter rate was higher (57.7% versus 24.6%; P=0.002). Weaknesses in the programme performance include organizational issues such as the under use of the TB registry, deficient follow-up procedures, the common usage of LCC and unsatisfactory rates of defaulting.
Drug Prescribing Pattern of Interns at a Government Healthcare Centre in Northern India
Authors: Rehan Harmeet Singh , Lal Panna
Published: January 2017

Prescribing habits of interns posted at a primary health centre for a period of 2 months (January 1994 and February 1994) were studied. Among the 1457 prescriptions collected, the average number of drugs per prescription was 2.47. The commonest groups of drugs prescribed were antibiotics (33.9%), analgesics and anti-inflammatories (17.0%), vitamins (13.0%), cough syrups (10.5%) and antihistamines (8.6%). The use of injectables was uncommon (0.9%). Most of the drugs prescribed were from the local drugs list of the centre (84.2%) consisting of 36 drugs. The list contained 20 drugs with proprietary names of which six were fixed-dose combinations. The local drug list needs modification. The proportion of drugs prescribed by generic name was 49.5%. As per Kunin's criteria, 57.9% of the antibiotics used were appropriate. Interns often forget to write the diagnosis (43%), signs and symptoms (50.2%), dosages and frequency of treatment. The result of this baseline study may be useful in promoting the education necessary in order to achieve the objectives of good prescribing.
Epidemic Dropsy: Observations on Pathophysiology and Clinical Features during the Delhi Epidemic of 1998
Authors: Sharma B D , Bhatia V , Rathee M , Kumar R , Mukharjee A
Published: January 2017

Epidemic dropsy results from the consumption of edible oils adulterated with Argemone mexicana oil by unscrupulous traders. Twenty consecutive ‘in-door’ patients of dropsy were intensively studied during the recent Delhi epidemic. Samples of edible oil used by them, their urine and their serum samples tested positive for sanguinarine on thin layer chromatography. The illness starts as a gastro-enteric illness followed by oliguria and pedal oedema. The following are often observed: cutaneus erythema with blanching and tenderness on pressure; violacious pigmentation of the skin; shortness of breath with orthopnoea; right-sided heart failure with normal left ventricle (LV) functions; as well as severe anaemia and hypoalbuminaemia. Renal function tests showed: bland urinary sediments; decreased glomerular filtration rate (GFR); mild to moderate azotaemia; acute tubular necrosis; patchy pneumonitis; moderate hypoxia with respiratory alkalosis; and restrictive ventilatory defects on blood gas analysis; and spirometry suggestive of interstitial pulmonary oedema of non-cardiogenic origin.99mTc colloid sulphur liver scans showed colloid shift. There was marked dilatation and proliferation of dermal capillaries in the absence of significant inflammation in the biopsy specimens.

Toxic alkaloids of Argemone mexicana oil induce widespread capillary dilatation and permeability causing leakage of protein rich plasma into the interstitial tissues of various organs. A hypovolaemic state is thus induced producing renal hypoperfusion which may progress to acute tubular necrosis. Interstitial fluid in alveoli causes restrictive ventilatory dysfunction with hypertension and right-sided failure with well-preserved LV function. The hepatic venous congestion induces Kupffer's cell dysfunction, which results in colloid shift on a radionuclide liver scan.
Sigmoid Volvulus in Rural Bengal
Authors: De Utpal
Published: January 2017

Between January 1995 and December 2000, 197 patients (44.97%) were treated for sigmoid volvulus at Bankura Medical College and Hospital, Bankura, West Bengal, India. The mean age was 45.06 years and the male to female ratio was 2.07:1. The various aetiological factors, clinical features and management have been reviewed. Abdominal distension with obstipation was the common clinical presentation. Straight X-ray of the abdomen suggested the diagnosis. Management included celiotomy and primary resection and anastomosis without intraoperative lavage in 196 patients and sigmoidopexy in one patient. The overall mortality rate was 1.01%. There was only one recurrence in the patients who had undergone sigmoidopexy. Primary resection and anastomosis at initial presentation proved a safe operative treatment and avoided unnecessary repeated hospitalization.
Patterns of Use of Oral Rehydration Therapy in Srinagar (Garhwal), Uttaranchal, India
Authors: Rishi Rakesh Kumar , Bodakhe S H , Tailang M
Published: January 2017

A study was conducted to assess the knowledge of preparing packet oral rehydration solution (ORS) and home-made salt-sugar solution (SSS) among mothers in Srinagar (Garhwal), Uttaranchal. Two hundred and twenty-five mothers were interviewed. Only a small proportion recognized the ORS packets (18.66%) and only 17.77% mentioned the correct method of preparing a solution from a packet (even after reading the instructions on the packet). Home-made SSS was adequately discussed by only 6.22% mothers and they were taught to correctly prepare and administer ORS and home-made SSS. After the educational programme, significant ( P<0.001) improvement in their knowledge was found. Eighty-six per cent knew the correct method of preparing packet ORS and 80.88% the correct method of preparing home-made SSS ( P<0.001). Interventions of this kind should be carried out to improve the knowledge and skills of mothers in treating childhood diarrhoea.
Complications of Classical Tracheostomy and Management
Authors: Onakoya P A , Nwaorgu O G B , Adebusoye L A
Published: January 2017

Tracheostomy can prevent many deaths in otherwise fatal airway diseases and problems but has numerous complications that are mostly avoidable if the procedure is carefully performed together with strict postoperative management. This is a retrospective review of tracheostomy complications over a 10 year period (1991–2002) in the Department of Otorhinolaryngology (ORL), University College Hospital, Ibadan. A total of 179 tracheostomies performed on 168 patients with 69 complications (38.6%) were documented. There was a significantly greater number of complications in the 43 emergency cases (54%) than in the 26 elective cases [(46%), P=0.0002]. The overall mortality rate was 2.2%. The most common complications of tracheostomy were infective in origin, representing 43% of all complications.

This study highlights the complications and mortality and gives details of management that will prevent or minimize their occurrences. Those who require long-term tracheostomy must be on regular follow-up and taught home-care of the tracheostomy before discharge from the hospital.
Drug Resistant Tuberculosis in Diabetes Mellitus: A Retrospective Study from South India
Authors: Subhash H S , Ashwin I , Mukundan U , Danda D , John G , Cherian A M , Thomas K
Published: January 2017

This study was conducted in a tertiary care teaching hospital in south India to evaluate the association of drug resistant tuberculosis (TB) in diabetic subjects. There were: 361 subjects with positive mycobacterial culture and susceptibility tests results over a 3-year period; 267 (74%) acid-fast bacillus smear positive; and 94 (26%) smear negative cases. One hundred and seventy-seven (49%) had resistant isolates to any one first line anti TB drugs (resistant group) and 184 (51%) had isolates sensitive to all drugs (non-resistant group). In the resistant and non-resistant subjects the mean duration of TB symptoms was, respectively, 22 months and 4.5 months, past history of TB 126 (71%) and 48 (26%), past anti TB drug therapy 126 (71%) and 47 (25%), inadequate anti TB drug therapy 42 (24%) and 23 (13%), HIV positive six and 13 subjects. There were 72 diabetic subjects [35 and 37, respectively] with a duration of diabetes 5.8 ± 7.5 years and 3.7 ± 5.0 years in the resistant and non-resistant groups. Twenty-six per cent of the diabetic subjects (19/72) had multi-drug resistant TB. Drug resistance to first line anti-TB drugs was not found to be associated with diagnosis or duration of diabetes mellitus.
Evaluation of the Concentration Sputum Smear Technique for the Laboratory Diagnosis of Pulmonary Tuberculosis
Authors: Gebre-Selassie Solomon
Published: January 2017

The microbiological diagnosis of pulmonary tuberculosis (PTB) plays a key role in routine and Tuberculosis (TB) Control Programmes in developing countries. Concentration of acid-fast bacilli (AFB) in clinical specimens is an important step in the laboratory diagnosis of mycobacterial diseases. Microscopy of smears of sputum by direct and after mechanical sedimentation and centrifugation methods followed by treatment with 5% sodium hypochlorite (NaOCl) solution for concentration of the organisms were compared and evaluated. The rate of recovery of AFB from sputum was 8.5%, 25.5% and 38.0% for direct smear microscopy, concentration by sedimentation of NaOCl-treated sputa followed by Ziehl-Neelsen staining and concentration by centrifugation after use of NaOCl respectively. Both the concentration methods by the use of NaOCl solution increased the yield of the AFB by more than threefold compared with the direct microscopy of sputum ( P<0.05). The concentration methods by sedimentation, and centrifugation by the treatment of NaOCl, increased the sensitivity to 75% and 77.9%, respectively, and the specificity to 100% for both techniques.

In conclusion, the use of NaOCl in the concentration of AFB in sputum is recommended for use in routine laboratory diagnosis of PTB in developing countries.
Reducing Burden of Hookworm Disease in the Management of Upper Abdominal Pain in the Tropics
Authors: Anyaeze Chineme Michael
Published: January 2017

A prospective study of the stool samples of 129 rural patients with symptoms of upper abdominal pain, tenderness and indigestion was carried out from 2 February 1998 to 31 December 1998 and followed up to June 1999. The age range was 11–85 years, female: male ratio 2.4:1: 102 specimens were positive for helminths — Ancylostoma duodenale (hookworm) 80 (62%); Trichuris trichuria (threadworm) 12 (9.3%); Ascaris lumbricoides (large roundworm) 10 (7.76%); Strongyloides stercoralis three (2.3%); Taenia saginata (tapeworm) three (2.3%). The female: male ratio for hookworm was 3:1.

Treatment with appropriate anthelminthic agents were given serially at each visit according to the result of faecal examination. At 6 months follow up 88 patients were free of symptoms, 60 of which were caused by helminths the hookworm group. Stool ‘test and treat’ strategy appears to be a cost-effective approach in the management of these patients.
Did Maternal Mortality Ratio Increase in Malawi between 1992–1998? Review of Malawi Demographic and Health Surveys and other Data Sources
Authors: Muula Adamson S , Phiri Angela
Published: January 2017

Despite various programmes aimed at reducing the maternal mortality ratio (MMR) and improving reproductive health globally, and in Malawi especially, the 2000 Malawi Demographic and Health Survey (DHS) reported an MMR for Malawi as 1221 deaths per 100 000 live births. This represented an almost 80% rise from the 620 maternal deaths/100 000 live births estimated in the 1992 DHS. The possible reasons behind the rise in the MMR include: the growing HIV/AIDS pandemic in Malawi with an estimated infection rate of 14%; and the deteriorating healthcare situation and inherent inaccuracies in the estimation of maternal mortality. Continued surveillance and identification of factors responsible for the deterioration of Malawi's MMR are suggested. It is necessary to design, implement and evaluate corrective measures in order to improve the situation.
A Multi-Centre Study of Community-Directed Ivermectin Distributors' (CDDs') Involvement in other Healthcare and Development Programme Activities in Cameroon, Togo, Sudan, Nigeria and Uganda
Authors: Sama M T , Homeida M , Ngang P , Liese B H , Amazigo U , Seketeli A
Published: January 2017

A multi-centre study to determine whether community-directed distributors (CDDs) are capable of carrying out additional healthcare and developmental activities in their communities was carried out in Cameroon, Nigeria, Sudan, Uganda and Togo to ascertain the potential effects of their involvement on the implementation of community-directed treatment with ivermectin (CDTI).

Both quantitative and qualitative methods were used to collect data from households, community-directed distributors, community leaders, and health workers. The results showed no major decrease in the CDDs' performance in CDTI: On the contrary, the involvement of CDDs in other health and development activities motivated them to perform their CDTI functions better. However, the results did not show any significant increase in therapeutic coverage of ivermectin distribution.

The expansion of the CDDs' experience to include additional healthcare and development related activities would be of interest to onchocerciasis control programmes – it will strengthen CDTI sustainability through greater integration.
Drainage of Deep-Seated Amoebic Liver Abscess by Supra Cath®
Authors: Singh R B , Bakshi N , Pavithran Nevil M
Published: January 2017

Supra cath® is an effective alternative to trocar for drainage of deep-seated liver abscess especially in obese or muscular patients with a thick parietal wall.
Strangulated External Hernia
Authors: Fahner T
Published: January 2017

Thirty-six cases of strangulated external hernia were operated upon in Bethesda Hospital Ikachi, Eastern Nigeria, during a period of 27 months. Gut resection was necessary in nine. The causes of an increased case fatality rate after resection are reviewed. Three lesscommon conditions — Reduction en masse, lumbar hernia and Richter's hernia — are discussed. The overall case fatality rate from strangulated external hernia in Nigeria is not very different from that in Europe and the USA, although in Nigeria the resection rate is high.
Cervical Polyp Presenting as Inevitable Abortion
Authors: Adinma J I B
Published: January 2017

An unusual case of a 30-year-old pregnant woman with a bleeding cervical polyp clinically misdiagnosed as inevitable abortion is presented. Polypectomy was performed and the pregnancy was carried to term.
Profile of Cataract Patients in the Eye, Ear, Nose and Throat Hospital, Rangoon
Authors: Le-Le-Win  , Thein-Hlang  , San-Shwe  , Than-Htun-Oo  , Ko-Ko-Tin
Published: January 2017

We report on our experience of cataract surgery in the Eye, Ear, Nose and Throat Hospital (EENTH), Rangoon.

Cataract patients constituted 52070 of all those admitted with eye diseases to the EENTH in a year. The mean number of cataract cases operated per month was 282. Among cataracts the senile form was the commonest. The female to male ratio for senile cataract patients was 1.2, and the average age at admission was 68 years. The mean duration of stay in hospital was 7 days with an operation time of 19min. The patients had to come to hospital for follow-up for an average period of 3.1 months to complete treatment.

The need to consider cataract surgery as an outpatient procedure is discussed.
Aetiological Factors in Low Birth Weight in a Nigerian Population
Authors: Ogunniyi S O
Published: January 2017

Low birth weight babies delivered at Wesley Guild Hospital, Ilesa, Nigeria, from January 1982 to December 1986 were reviewed. They constituted 11.5070 of the total births within the period. The common aetiological factors' were multiple pregnancy, nulliparity, preterm rupture of fetal membranes, hypertensive disorders, antepartum haemorrhage and anaemia in pregnancy.
Use of Physiotherapy Records to Monitor the Efficacy of a Poliomyelitis Vaccination Programme in Ilorin, Nigeria 1981–1988
Authors: Babaniyi O A , Yeye-Agba B , Parakoyi D B
Published: January 2017

During the 8 years of a poliomyelitis control programme in Ilorin Local Government Area, Nigeria, a maximum of 85% of children aged 12–23 months were estimated to have received three doses of trivalent oral polio vaccine (TOPV). The estimated incidence of paralytic poliomyelitis decreased by 65%, suggesting a low vaccine efficacy of approximately 76% for the currently used TOPV. A more detailed study of TOPV efficacy (eg case control or cohort study) is required, however, to provide a more accurate estimate.

Similar low-cost efforts at documenting the impact of TOPV on the incidence of poliomyelitis, using physiotherapy clinics as independent sentinels, are needed from many other centres.

To increase the efficacy of the primary series of TOPV in Nigeria, the number of doses constituting the primary series should be increased to four (including one at birth), as recommended by the World Health Organization.
The Taylor Pressure Reducer in Cataract Surgery
Authors: Hughes D S
Published: January 2017

A retrospective study was undertaken to determine whether the use of the Taylor pressure reducer during routine intracapsular cataract surgery lowered the incidence of vitreous loss. A significant reduction in the vitreous loss rate was noted. The Taylor pressure reducer is a useful device for the prevention of this complication in the Third World.
Hyperreactive Malarial Splenomegaly in Pregnancy
Authors: Bates Imelda
Published: January 2017

Hyperreactive malarial splenomegaly (HMS) is common in many tropical areas and particularly affects women of reproductive age. It is associated with anaemia which can be debilitating in patients already compromised by anaemia due to poor nutrition and pregnancy. The course of the disorder in pregnancy is commonly punctuated by episodes of haemolytic anaemia which can be life-threatening to the mother and cause increased fetal morbidity and loss. Management of the chronic state consists of lifelong anti-malarial therapy supplemented by haematinics. Blood transfusions may be required to treat episodes of severe haemolysis.
Ectopic Pregnancies and Intraoperative Autotransfusion
Authors: Laskey Jennifer , Wood Philip B
Published: January 2017

Ruptured ectopic pregnancies are common in the tropics. They rapidly lead to anaemia and shock, but autotransfusion is simple and safe and can be practised easily by the simplest of surgical departments.
A Hospital Study of the Complications of Female Circumcision
Authors: Dirie Mahdi A , Lindmark Gunilla
Published: January 2017

During one year 118 patients were admitted to the operative gynecological ward of Banadir Maternity Hospital, Mogadishu, Somalia, with diseases related to the practice of female circumcision. Fifty-five per cent of the patients were suffering from a dermoid cyst at the site of the excised clitoris. Thirty-six per cent had a vaginal stenosis and 9% an abscess at the site of the excised clitoris. These patients occupied the beds of the hospital for a total period of 1967 days which posed a significant constraint to the health services of the hospital.
How Many Bloods will a ‘HIVCHEK’ Check? Multiple Tests for HIV Antibody for a Single Screening Kit
Authors: Wannan G J , Cranefield M J , Cutting W A M , Fischer P R , Hargreaves F D , Inglis J M
Published: January 2017

Detection of HIV infection in blood donors or populations is usually by testing sera for antibodies to HIV-1 and HIV-2. Screening tests are now highly sensitive and specific, but still expensive and scarce in Africa. We tested the commercially available kits ‘HIVCHEK 1 + 2′ in two field laboratories, on specimens from blood donors and antenatal women in rural Zaire. We describe a method of using one test kit for up to five serum samples, saving money and time. In 491 antenatal mothers in Eastern Zaire, among whom the HIV seroprevalence was 3.3%, we compared ‘HIVCHEK’ results with results obtained by ELISA and Western blot. The ‘HIVCHEK’ multiple-sample method had a sensitivity of 82% and a specificity of 99.6%. In an area with an HIV seroprevalence of <4%, using ‘HIVCHEK’ by the multiple sample method would lead to a saving of about £2400 for every 1000 individuals tested.
Aluminium Phosphide Poisoning
Authors: Khosla S N , Handa R , Khosla P
Published: January 2017

Aluminium phosphide is a solid fumigant pesticide widely used in the Indian subcontinent as a grain preservative. Over the last 5 years there has been a dramatic increase in the number of cases of aluminium phosphide poisoning in India. Ninety-two patients with aluminium phosphide poisoning due to ingestion were studied over a period of 3 years. Abdominal pain, vomiting and restlessness were the common initial features followed by alteration in sensorium and shock unresponsive to conventional treatment. Electrocardiographic abnormalities were very common and highly variable. Routine serum biochemistry was usually unremarkable. Severe metabolic acidosis was common and mortality high (49%). The survivors recover completely without any residual organ damage. There is no known antidote.
A Simple Scheme to Improve Compliance in Patients Taking Tuberculosis Medication
Authors: Hill Jeremy P , Ramachandran G
Published: January 2017

Compliance with prescribed treatment remains a major problem in the control of tuberculosis worldwide. We describe a simple method of improving patient compliance with hospital-based treatment. Eighty-two patients paid a deposit at the start of their treatment which entitled them to cheaper drugs and was refundable on completion of the prescribed course. Sixty-two per cent of patients completed the course compared with 23% of retrospective controls. A direct relationship was found between the amount of deposit paid and the rate of completion. Reasons why poor patients (who paid a lower deposit) may default are discussed, as are the merits of short-course drug regimens. It is recommended that similar schemes be assessed elsewhere.
Drug Resistance of Mycobacterium Tuberculosis in Karachi, Pakistan
Authors: Khan Javaid , Islam Najmul , Ajanee Nadya , Jafri Wasim
Published: January 2017

We determined the primary and secondary resistance of isolates of M. tuberculosis to the standard anti-tuberculous drugs in Karachi (Pakistan). Primary resistance to one or more anti-tuberculous drugs was found in 17% of 123 isolates of M. tuberculosis (obtained from patients with no history of previous treatment for tuberculosis). Secondary resistance was found in 36% of 33 isolates (obtained from individuals who had received anti-tuberculous treatment in the past). The drug to which organisms were most commonly resistant was isoniazid (11% primary resistance, 30% secondary resistance). Fifteen per cent of isolates obtained from previously-studied patients showed secondary resistance to rifampicin. We discuss the importance of these findings for tuberculosis treatment and control.
Setting Standards for Primary Health Services
Authors: Garner P , Thomason J
Published: January 2017

Primary health service coverage has increased in many developing countries over the last 10 years. The number of components included in the basic package has also expanded. This has led in some countries to primary health workers becoming overloaded with responsibilities.

To maintain high quality care, primary health workers not only need appropriate training, but clear performance guidelines, as well as essential resources and supportive supervision. We report on the establishment of standards for primary health services by the Ministry of Health in Papua New Guinea (PNG).
Onchocerciasis and Women's Reproductive Health: Indigenous and Biomedical Concepts
Authors: Amazigo Uche
Published: January 2017

Women in a rural farming community in Etteh, Nigeria, have traditional beliefs about onchocerciasis which differ from the concepts of modern science. Recognizing these beliefs may allow health workers to gain the confidence and participation of the people and increase the effectiveness of control programmes.
Clinical Pattern of Perforated Prepyloric and Duodenal Ulcer at Ile-Ife, Nigeria
Authors: Lawal O O , Oluwole S F , Fadiran O A , Campbell B
Published: January 2017

High morbidity and mortality often attend perforation of duodenal ulcer. Over a 6-year period at Obafemi Awolowo University Teaching Hospital, Ile-Ife, Nigeria, 22 patients presented with prepyloric or duodenal ulcer perforations- a relatively low yearly rate of about four. Of the 15 patients evaluated, approximately three-quarters were working class young men and eight 53%) had no ulcer history. The high morbidity, and 20% mortality rate, observed were attributable to late presentation and the presence of advanced bacterial peritonitis in 67% of the patients at admission. Imprecise clinical features in those with small perforations led to misdiagnosis in a third of cases. Treatment of perforations in the majority (93%) of patients was by simple closure or truncal vagotomy and pyloroplasty.

An increase in patients' awareness of the potentials of optimal operative management should encourage earlier presentation.
Enhancing Participation of Women of Child-Bearing Age in a Literacy for Health Project in Southeastern Nigeria
Authors: Stephens Torrance T , Oriuwa Chibuzo L , Uzoho Mgbechikwere
Published: January 2017

This paper summarizes the approach of a ‘literacy for health project’ in southeastern Nigeria to recruit and maintain participants. Literacy for health projects enhance and develop the educational abilities of women while at the same time acting as a vehicle to combat the problems associated with maternal and child health. We describe ways to foster and enhance the participation of women of child-bearing age in a literacy for health project operated in Igbo-speaking southeastern Nigeria. Findings reveal that of four literacy centres, participation rates ranged from 50.35% to 61.1%. We maintain that efforts designed to impart the transference of literacy and numeracy skills to such women in southeastern Nigeria must: ( a) address the farming needs, practices and operations of the target community prior to programme implementation; ( b) consider the inclusion of counsellors in addition to traditional village health workers and/or literacy instructors; ( c) determine the impact of using other sites based on community activities; as opposed to traditional locations such as schools and churches; ( d) use incentives to motivate participants; and ( e) extend the current level of participation beyond focus groups to planning beyond curriculum development.
Poncet's Disease in a North Indian Hospital
Authors: Sood Rita , Wali Jyoti P , Handa Rohini
Published: January 2017

Although the entity of tuberculous rheumatism or Poncet's disease has sometimes been the subject of debate, it has been reported infrequently in the English literature. We discuss here seven patients (5 women, 2 men; age 18–48 years) who presented primarily with polyarthritis and fever and developed pulmonary, pleural or nodal tuberculosis later in the course of disease. Rheumatoid arthritis, collagen vascular diseases and other common causes of polyarthritis were ruled out by appropriate investigations. Polyarthritis resolved in all the patients after the institution of antitubercular treatment and did not recur, thus providing a therapeutic confirmation of the clinical diagnosis.
Cancer Awareness among a Nigerian Population
Authors: Uche E E O
Published: January 2017

We conducted a population survey with the objective of identifying the level of cancer awareness. In Nigeria many patients present late for medical care. We analysed data from 460 literate Nigerians. Three hundred and sixty (78.3%) had heard about cancer, 34.1% identified particular risk age categories, while 62.2% said that cancer could occur at any time. Awareness of warning signs and sites of cancer location was very poor and only 33% recognized that a breast lump was a warning sign. Knowledge of methods of early detection was also very low and only 50% said that cancer is curable when detected early.

This investigative survey highlighted a considerable ignorance and lack of awareness of cancer among the Nigerian population.
Traditional Herbal Preparations and Acute Renal Failure in South West Nigeria
Authors: Kadiri S , Arije A , Salako B L
Published: January 2017

Fifty-three cases (36 men; mean age 30.2 ± 9.5 years) of acute renal failure (ARF) in which traditional herbal preparations were implicated were seen over a 10-year period. The preparations had been taken to treat a febrile illness (38 cases), abdominal upset (seven cases) and for no clear reason (five cases). Vaginal pessaries had been used to induce abortion in two cases and for infertility in one case. The few identified plant materials included leaves and bark of the mango ( Mangifera indica), shoots of cashew leaves ( Anacardium occidentale), paw-paw leaves ( Carica papaya), lime-leaves ( Citrus aurantifolia), Solanium erianthum, Morinda lucida leaves and bark, Azadirachta indica leaves. The major presenting features were oliguria or anuria (41); jaundice (39); and anaemia (25). Oliguria occurred 3.5 ± 0.7 days after the ingestion of the herbs. The picture was consistent with acute tubular necrosis in all the cases and the mechanisms were: by intravascular haemolysis (34); hepatotoxicity (5); and presumably direct nephrotoxicity (14). Forty-five patients received dialysis and three deaths were recorded. These cases of ARF could have been prevented by proper education and awareness.
Medical Liability Insurance and Damage Caps: Getting beyond Band Aids to Substantive Systems Treatment to Improve Quality and Safety in Healthcare
Authors: Liang Bryan A. , Ren LiLan
Published: January 2017

The medical liability crisis is affecting our healthcare system. Medical liability and limited physician and hospital access to malpractice insurance have pushed many providers to leave their states, reduce their services, or simply retire. For many, a labor of love has become an agonizing search for insurance to ensure continued practice in an industry for which they trained eight, fifteen, or even twenty years. Limited insurance and potential liability has also led to defensive medicine, in which providers try to avoid lawsuits by ordering tests, procedures, and anything else that might help protect against liability. Moreover, providers may also attempt to avoid high-risk patients or practices altogether to limit opportunities for lawsuits. Although it is questionable whether these efforts actually help, the provider perception of self-preservation through defensive medicine is undeniable—and providers, like everyone, act on their perceptions.
FDA Statutory Authority to Regulate the Safety of Dietary Supplements
Authors: Hutt Peter Barton
Published: January 2017

For almost a century, the Food and Drug Administration (FDA) has regulated nutrients and other dietary supplement ingredients and products under the food provisions initially of the Federal Food and Drugs Act of 1906 and now of the Federal Food, Drug and Cosmetic Act of 1938 (“FD&C Act”), as amended. Congress amended the FD&C Act through the Food Additives Amendment of 1958 and the Color Additive Amendments of 1960 to strengthen FDA authority over food ingredient safety. In 1976, Congress enacted the Vitamin-Mineral Amendments which provides that FDA may limit the contents of dietary supplements only for safety reasons. In 1994, Congress enacted the Dietary Supplement Health and Education Act (“DSHEA”) to continue the regulation of dietary supplements under the food provisions of the FD&C Act but to replace the food additive provisions with separate safety requirements for dietary supplements and dietary ingredients.
The New Dietary Ingredient Safety Provision of DSHEA: A Return to Congressional Intent
Authors: Bass Scott , Marden Emily
Published: January 2017

In the ten years since the passage of the Dietary Supplement Health and Education Act of 1994 (“DSHEA”), dietary supplements have become a widely available and important element of individualized preventative healthcare. Congress created DSHEA in response to great consumer demand, thereby embracing the dietary supplement category and opening the door for the growth of the dietary supplement industry. DSHEA introduced an expansive definition of dietary supplements and laid out available claims and strict safety standards for such products.

While the statute has remained unchanged since its passage in 1994, the Food and Drug Administration (“FDA”) appears to be in the process of re-interpreting sections of DSHEA in ways that could fundamentally limit the availability of dietary supplements. Specifically, FDA has been utilizing DSHEA's “new dietary ingredient” (“NDI”) safety provision to narrow the scope of ingredients that can be considered, even before addressing their safety, for use in dietary supplements.
Overcoming Barriers and Ensuring Access to HPV Vaccines in Low-Income Countries
Authors: Tsu Vivien Davis
Published: January 2017

The inequitable burden of cervical cancer falls on women in poorer countries, due primarily to a disparity in access to screening services. To ensure that access to the new human papillomavirus (“HPV”) vaccines is not similarly skewed toward higher-income populations, it is important to understand the appropriate priority group for receiving vaccines, the potential barriers to reaching that group, and the options for overcoming those barriers. Based on vaccine efficacy data, the likelihood of achieving high coverage with various groups, and the resultant cost-effectiveness ratios, it is widely agreed that young adolescent girls should be the primary recipients. Potential barriers include the fact that young adolescents are not currently reached by many health services; that there might be stigma attached to a vaccine for a sexually transmitted infection; that financing for the vaccine must be allocated; and that there is limited political commitment to women's health, to cancer prevention, or to this particular vaccine when so many other new vaccines are also becoming available. Despite these very real challenges, there is reason to be cautiously optimistic that those most in need of an HPV vaccine can receive it in programs that are affordable, effective, and acceptable to girls, their families, and their societies.
The Death of Jesse Gelsinger: New Evidence of the Influence of Money and Prestige in Human Research
Authors: Wilson Robin Fretwell
Published: January 2017

Ten years ago, Jesse Gelsinger died while participating in a human genetherapy trial at the University of Pennsylvania (“Penn”). His death came to signify the corrosive influence of financial interests in human subjects research. After Jesse's death, the media reported that one researcher, Dr. James Wilson, held shares in a biotech company, Genovo, which stood to gain from the research's outcome—shares that The Wall Street Journal later valued at $13.5 million, although Wilson maintains he did not make nearly this much. At the time Penn authorized Wilson's deal, internal Penn documents implicitly valued Wilson's stake in Genovo at approximately $28.5 to $33 million.

Jesse's death sparked two separate lawsuits: one by the family, who sued in tort, and one by the federal government, which framed alleged errors in the research trial as a civil False Claims Act violation.
Vein Patch Repair of the Common Bile Duct
Authors: Ellis Harold , Hoile R W
Published: January 2017

Two cases of successful vein patch repair of the common bile duct are reported, with follow-up periods of 9 years and one year respectively.
Ectopic Parathyroid Adenomas
Authors: Linch D C , Watson L C A , Cowie A G A
Published: January 2017

Two cases of parathyroid tumours occurring in unusual situations are described. Such cases may cause difficulty in both the diagnosis and the surgical treatment of hyperparathyroidism. The cases described illustrate the importance of a definitive aetiological diagnosis in hypercalcaemia, if appropriate surgery is to be performed. The value of discriminant function analysis and hydrocortisone suppression tests are discussed.
Late Results of Optical Urethrotomy
Authors: Smith P J B , Kaisary A V , Ball A J
Published: January 2017

Of 46 patients who underwent optical urethrotomy for differing strictures of the urethra, 41 (89.1%) remained free of stricture symptoms at follow up 6 years later. The initial effectiveness of this procedure in improving stricture symptoms is sustained in the long term.
Use of Collagen Implant for Posterior Rectopexy in Complete Rectal Prolapse: Preliminary Communication
Authors: Kaisary Amir V , Luck Richard J , Pendower John E H
Published: January 2017

A variety of materials has been used for perirectal implantation in the treatment of complete rectal prolapse. A new material (Zenoderm) prepared from porcine corium has been used successfully in 4 patients. The material proved to be inert, biologically non-irritant, pliable, workable and strong.
Adult Community-Acquired Pneumonia in Central London
Authors: McNabb W R , Shanson D C , Williams T D M , Lant A F
Published: January 2017

Strep. pneumoniae was diagnosed as the cause of pneumonia in 40 (50%) of 80 consecutive adults admitted to St Stephen's Hospital with community-acquired pneumonia. None of the patients had evidence of Mycoplasma pneumoniae infection, and Legionella pneumophila serology was positive on only one occasion. In 29 patients (36%) no causative organism was demonstrated. The diagnosis of pneumococcal infection was obtained in 15 cases by isolating Strep. pneumoniae from the sputum, in 13 further cases by demonstrating pneumococcal capsular antigen in sputum, and in 12 other cases by detecting pneumococcal antigen in serum only. Only 2 cases with pneumococcal pneumonia were bacteraemic and 3 patients (7%), all aged more than 75 years, died. The relatively low bacteraemic and mortality rates suggest that community-acquired pneumococcal pneumonia currently seen in patients admitted to hospital in central London may not be so severe as in some other areas.
Outlet Syndrome: Is There a Surgical Option?
Authors: Keighley M R B , Shouler P
Published: January 2017

Of 46 patients investigated for constipation, 21 were found to have some other primary abnormality, leaving 25 patients for study: 6 had evidence of the outlet syndrome alone, 5 had slow transit constipation, 8 had both abnormalities and 6 had no apparent physiological disorder in the colon or rectum. Although colectomy and ileorectal anastomosis gave good results for slow transit constipation, partial pelvic floor division provided satisfactory long-term improvement in only one of the 7 patients with the outlet syndrome.
Hypercalcaemia in Cleveland: A Hospital-Based Survey
Authors: Rajathurai A , Cove-Smith R
Published: January 2017

Over a period of six months all reports in the South Tees Health District of serum calcium levels greater than 2.70 mmol/1 were extracted and patient records examined to establish the associated diseases and patterns of management. A total of 235 reports were evaluated, and after exclusion of doubtful cases 196 patients were included in the study. No cause had been identified in 57 (29%). Many of these were elderly females in whom hypercalcaemia may have been due to primary hyperparathyroidism, but parathyroid hormone levels had not been measured. Of those in whom a diagnosis had been made, 62 (45%) were associated with malignancy and 50 (36%) with chronic renal failure. 72% of cases of hypercalcaemia reported to general practitioners and 13% of those reported to hospital doctors were not investigated further. Despite the inclusion of serum calcium estimation on routine biochemical profiles, many cases of hypercalcaemia are being ignored or not investigated further. The study emphasizes the need for a reliable screening test for primary hyperparathyroidism.
Crystal Deposition in the Knee and Great Toe Joints of Asymptomatic Gout Patients
Authors: Kennedy T D , Higgens C S , Woodrow D F , Scott J T
Published: January 2017

Crystal deposition in asymptomatic knee and first metatarsophalangeal (MTP) joints has been studied in 31 patients with previously proven gout. All had had clinical gout in their MTP joints but their knee joints had never been the site of acute gout. Knee arthroscopy was performed permitting synovial membrane inspection, photography and biopsy. Crystalline material was seen in 9 knees (28%) and confirmed histologically as monosodium urate (MSU) in 4 (12.5%). Synovial fluid analysis on 26 samples using a polarizing light microscope demonstrated MSU crystals in 4 (12.5%) and calcium pyrophosphate dihydrate (CPPD) in 2 (6%). Fluid aspirated from 27 of the metatarsophalangeal joints revealed MSU crystals in 14 (52%) and no CPPD crystals.