bluuebunny/crossref_metadata_2025 huggingface dataset:
Discharge against Medical Advice in Some Paediatric Wards
Authors: Goyea H S
Published: January 2017

Sixty-four cases of discharge against medical advice (DAMA) from 3 paediatric units in the University of Benin Teaching Hospital within a period of 18 months were analysed. The incidence was highest among the very young, even when they were still very ill. Financial problems accounted for 65.6% of the cases. Other reasons included difficulties related to the siblings (9.4%), the wish to try traditional methods (7.8%), family opposition (1.6%) and distance from the hospital (4.1%). It is recommended that greater attention be given to preventive health care, and placing the cost of hospital care within the reach of the poor. Improved communication is also recommended as a way of helping parents seek alternatives to DAMA.
On an Average: The Rural Hospital in Sub-Saharan Africa
Authors: Hamel Jaap L , Janssen Peter W
Published: January 2017

The general impression of a heavy workload for rural hospitals in sub-Saharan Africa is illustrated by a quantification for 16 parameters, based on data in 120 annual reports from 40 hospitals. The figures presented in this study can be looked upon as “figures of reference” which hospitals can use for reflection on their own data.

Comparison with other studies is made possible by presenting the figures after conversion to an assumed population of 100 000. Marginal notes are made on the comparability of the data as presented by the hospitals.
Pancreatic Pseudocysts in Ile-Ife, Nigeria: A Report of 6 Cases
Authors: Akinola D O
Published: January 2017

Pancreatic pseudocysts are uncommon and very few cases have been reported in Nigeria. Six cases of pancreatic pseudocysts were treated at Ife University Teaching Hospitals Complex from 1984 to 1986. The striking presenting symptoms were abdominal pain, nausea, vomiting and weight loss. Investigative procedures of serum amylase, barium studies and ultrasonography were performed. One resolved spontaneously, 5 patients had internal drainage and one of these died. The surviving patients are still being followed up.
Spontaneous Healing in Nomas of the Eyelid
Authors: Sihota R , D'Souza P , Lamba P A
Published: January 2017

A noma is an acute, necrotizing ulcerative mucositis, also known as cancrum oris, which occurs commonly in children, 2–5 years of age, having a debilitating illness or severe malnourishment. This gangrene lives up to the meaning of its Greek name, by rapidly devouring all adjacent soft tissues, and in some cases even bone. It generally affects the mouth and genitalia and infrequently involves the lid and other extraocular tissues1–3. A noma spreads painlessly and has been reported to leave extensive and complex facial defects2,4,5.

Surprisingly, the nomas seen at the Lady Hardinge Medical College and Smt. Kalawati Saran Children's Hospital have been noted to heal without any disfiguring defects when maintained on supportive nutritional therapy and antibiotics without any surgical manipulation during the active or healing phases of the disease.

We detail the history and findings in one such case to emphasize the excellent cosmetic and functional results obtained by this purely conservative management.
Non-Traumatic Coma in Zambia
Authors: Sinclair J R , Watters D A K , Bagshaw A
Published: January 2017

A series of 170 patients with non-traumatic coma seen over a 16-month period is reported. The Glasgow coma scale significantly correlated with outcome ( P<0.001). The diagnosis was also important in determining outcome. Hospital mortality was lowest in patients with cerebral malaria (22.7%), eclamptic coma (36.4%), and organophosphorous poisoning (30.4%). A diagnostic approach to non-traumatic coma is outlined and the management of the different causes is discussed. Most hospitals in tropical Africa should be able to diagnose up to 90% of cases with non-traumatic coma and simple therapy is likely to be effective in the majority of cases.
Infectious Diseases in a Nicaraguan Refugee Camp in Costa Rica
Authors: Diaz Theresa , Achi R
Published: January 2017

Some Nicaraguans living in Costa Rica are in refugee camps. The types and rates of infectious diseases in the Pueblo Nuevo refugee camp were measured by examining medical records for 1985 and performing stool and blood testing. The incidence of infections was 320 episodes per 1000 persons per year. Respiratory infections represented 63% of all illnesses and pulmonary tuberculosis was high. Malaria was not found in blood samples and no childhood illnesses preventable by immunizations were recorded in the records. Intestinal parasites were found in 56% of the persons examined, considerably higher than the 15% prevalence noted in surveys of Costa Rica as a whole. Trichuris trichiura was found in 40% of the positive stool samples. The deficient hygienic conditions and overcrowding in the camp are responsible for the high rates of infections and the continued presence of infections many of which probably were acquired in Nicaragua. Improvement of hygienic conditions can be accomplished by involving the refugees in education, cleaning and identifying problem areas. Adequate sanitation and improved water supply, and reducing overcrowding are also recommended.
Experience with 103 Cases of Intestinal Gangrene in Ile-Ife, Nigeria
Authors: Fashakin E O
Published: January 2017

One hundred and three patients with intestinal gangrene were managed in Ile-Ife, Nigeria over a 10-year period. The overall mortality in the series was 25.2%. Strangulated hernias were responsible for 65 cases (63%), intussusception 20.4%, adhesions 11.7% and volvulus 2.9%.

Avoidable deaths resulted from anastomotic breakdown and inadequate preoperative fluid therapy. Primary intestinal resection and end-to-end anastomosis of large bowel involved in gangrene gave very good results. It was found to be quite safe and economical, and avoided the inconveniences and complications of a colostomy.
Ocular Trauma
Authors: Anderson J D C , Foster A
Published: January 2017

Well over half a million people in the world are blind as a result of eye injuries. It is not known how much of the final visual damage is the result of delayed or inappropriate management at the primary care level. However, it is certain that the general doctor can greatly influence the final outcome of ocular trauma by prompt action that will prevent serious loss of sight. He or she requires neither specialist knowledge, nor expensive instruments, but only the common sense application of a few basic clinical skills.
Treating Childhood Respiratory Illness in Developing Countries: Mist Therapy without Electricity
Authors: Hauck Fern R , Ryan Michelle C
Published: January 2017

We have developed an effective and well-accepted method of providing mist for children with acute respiratory distress. This method can be especially useful in areas of the world where resources are limited.
The Provision of Safe Blood—Policy Issues in the Prevention of Human Immunodeficiency Virus Transmission
Authors: van Dam C J , Sondag-Thull D , Fransen L
Published: January 2017

The AIDS epidemic has focused attention on the constraints and deficiencies present in many blood transfusion services in the developing world. We discuss a variety of options for reducing transfusion-related HIV transmission, and suggest how new transfusion strategies may be implemented. We show that a transfusion service cannot rely solely on the screening of donor blood for anti-HIV antibodies and that a more comprehensive approach is needed. Important components of this approach include donor selection and improved clinical practice, in which blood and blood products are prescribed only when really necessary.
Human Bites and Finger Infections: A Survey at Dodoma Regional Hospital, Tanzania
Authors: Loro A , Franceschi F
Published: January 2017

We describe 26 patients with finger infections following human bites, who were admitted to Dodoma Regional Hospital in Tanzania between 1983 and 1991. Most patients came to hospital too late for the finger to be saved, and amputation was necessary in nearly all cases. The extreme seriousness of the bite seems to have been overlooked by both the patients and the health workers of the peripheral units of our region.
Gastric Carcinoma—A Study of 100 Cases in Northern Pakistan
Authors: Ahmed Manzoor , Manssor Adnan , Khan Amir H , Iqbal Javed
Published: January 2017

We describe 100 consecutive patients with histologically proven gastric carcinoma who were admitted to various hospitals in Northern Pakistan. Twenty-six per cent of patients were under 40 years of age. In a majority of patients the tumour was of a morphological type associated with poor prognosis. In most cases the disease was already at an advanced stage at the time of diagnosis, and most patients died within one year.
Rapid Rural Appraisal: Its Role in Health Planning in Developing Countries
Authors: Melville B
Published: January 2017

There is an urgent need for a quick inexpensive and reliable method for identifying groups and individuals most in need of primary health care. The Rapid Rural Appraisal (RRA) is the most appropriate approach. It is a method by which resources can be quickly deployed to alleviate the problems of the poor. If properly used it can play a major role in identifying community health needs thereby aiding the health planning process and improving the health of the people. Nevertheless, RRA techniques should not be regarded as separate and apart from other research methodologies but complementary to them.
Prevention of Transfusion-Associated HIV Transmission with the Use of a Transfusion Protocol for under 5s
Authors: Craighead I B , Knowles J K
Published: January 2017

Recently there has been an increasing realization that for the prevention of transfusion-associated HIV infection, HIV screening alone is insufficient1. In 1988, a treatment protocol for children under 5 years with severe anaemia, was introduced in Ekwendeni Hospital2. Initial results showed that it was possible to reduce the number of blood transfusions without increasing the mortality rate. By January 1992 the protocol was being widely disregarded by ward staff, and transfusion rates had increased. Strict enforcement of the transfusion protocol from the 16 January produced a sharp drop in the percentage transfused from 44% to 11%. Mortality rates remained similar throughout the period of the study.

Thus, it would appear to be possible, with the use of the transfusion protocol, to reduce the number of blood transfusions carried out, without affecting mortality rates, and hence to reduce the risk of transfusion-associated HIV.
Blast Injuries of the Eye
Authors: Zerihun Negussie
Published: January 2017

Ninety-four cases of ocular blast injuries (122 eyes) were studied. Sixty-five per cent of the cases were between 15 and 25 years of age. The right and the left eyes were involved in 38% and 32% of the cases, respectively, while bilateral involvement was seen in 30%. Ninety of the eyes (74%) were blind. Twenty-one per cent of the patients with binocular injuries had bilateral blindness. Injuries of the iris, conjunctival and corneal foreign-bodies, and corneal and/or scleral lacerations were the most frequent types of injury seen.
Paraprofessional Women as Health Care Facilitators in Mother and Child Health
Authors: Gökçay Gülbin , Bulut Ayşen , Neyzi Olcay
Published: January 2017

The aim of the study was to compare the performance of midwives with that of lady home visitors (LHV; paraprofessionals). The project area was divided into six according to the population map. One midwife or one LHV was assigned to each visiting area. Home visits were carried out to identify and offer guidance on family planning (FP), antenatal care, well-child control, immunizations and other mother and child health related issues to those at high risk. Criteria taken for evaluation were the numbers of pregnant women identified in the last trimester; pregnant women receiving antenatal care; deliveries attended by a health care provider; modern FP users; continuation rate of the new users; pregnancy rate in new users; immunization status of children; well-child visits of the children. No significant differences were found in these health measurements between areas visited by LHV and areas visited by midwives. Response rates to the invitation was also similar in both areas. An important observation was the good performance of the LHV in communicating with the families. Women with limited school attainment from the community can be used effectively and efficiently in community health services.
Another Look at Acute Appendicitis in Tropical Africa: And the Value of Laparoscopy in Diagnosis
Authors: Ogbonna B C , Obekpa P O , Momoh J T , Ige J T , Ihezue C H
Published: January 2017

Acute appendicitis is believed to be one of the commonest causes of the acute abdomen in tropical Africa. Negative appendicectomy rates are usually above 20%, which is now considered unacceptably high because of increased risk to patients and the availability of diagnostic facilities to aid clinical decision-making. Our negative appendicectomy rate over a 4-year retrospective period was 29.7% in males, and 47% in females. These reduced to 11 % and 10%, respectively, after the introduction of laparoscopy for doubtful cases of acute abdominal pain.
The Impact of Training and Supervision on Traditional Birth Attendants
Authors: Lynch Oona , Derveeuw Marc
Published: January 2017

A survey of 40 trained and 40 untrained traditional birth attendants (TBAs) was done over a 3-week period in two counties in Uganda to evaluate the impact of training and supervision on TBAs. Forty womens' groups and 20 mothers were also interviewed. The result showed that the most utilized birth attendants were mothers-in-law, trained and untrained TBAs, and the pregnant woman herself. Childbirth was regarded as a normal, private event and the birth attendants were normally called when labour was well advanced or in case of complications.

Trained TBAs were attending three times the number of deliveries as untrained TBAs. There was no difference in the knowledge and practices of trained and untrained TBAs, and in the performance of supervised versus unsupervised trained TBAs. All TBAs demonstrated poor knowledge and practices in the management of complications of pregnancy and labour. Reasons suggested for the poor performance included an over ambitious, inappropriate initial training, and lack of useful supervision.

Overall the study concluded that there was a case for continuing with the training and supervision of TBAs provided changes were made to the selection, training and supervision processes.
Fetal Decapitation: The Application and Safety of the Stout Embryotomy Scissors
Authors: Obed J Y
Published: January 2017

Transverse lie with impacted shoulder and hand prolapse of the dead fetus was treated in 21 cases by decapitation of the fetus, performed with stout blunt-ended embryotomy scissors. Surgical complications were minimal and the procedure was simple, effective and safe.
Upper Gastrointestinal Endoscopy in an Urban Hospital in Northern Nigeria: Association of Presenting Features with Endoscopic Findings
Authors: Andrew P J , Dixon R A , Iya D , Park G T
Published: January 2017

In 326 fibreoptic upper gastrointestinal (GI) endoscopies performed in Evangel Hospital (Jos, Nigeria), pathology was found in 210 patients, and of a major nature such as peptic ulcer disease or cancer in 129 of these. The three most useful features to predict the presence of major pathology were epigastric tenderness (the single most useful feature), loss of weight and epigastric pain of a burning nature. These features were selected by stepwise discriminant analysis, which also led to the conclusion that the presence of at least two of these three features is an even more powerful predictor of major pathology.
An Innovative Method of Tourniquet Application in Proximal Lower Limb Surgery
Authors: Sangwan S S , Aggarwal Aditya K , Siwach R C , Sharma S C
Published: January 2017

A novel method is presented by which a tourniquet can be applied just proximal to the greater trochanter, without interfering with asepsis. The distal migration of the tourniquet cuff is prevented by a Steinmann pin passed through the greater trochanter. This method has been tried in 20 cases of proximal lower limb surgery with great success.

The use of a tourniquet in limb surgery is often required1. A common site of application of the tourniquet for lower limb surgery is at the junction of middle and upper third of the thigh. However, it is difficult to use such a tourniquet for extensive resection of malignant tumours around the knee joint where proximal limits of the incision may reach almost up to the subtrochanteric region. One can apply the tourniquet at the root of the limb just below and parallel to the inguinal ligament, but it may fail as a thigh is conical from proximal to distal and hence the tourniquet cuff or bandage slips downward, thus making it loose2. We have devised a method by which a tourniquet can be applied at the root of the thigh and can be maintained in the same position without any distal migration and loosening, thus making the thigh a bloodless field even up to the subtrochanteric level. We have used this technique for Van Nes rotation plasty and also for osteosynthesis of the middle third of the femur.
The Value of Naked Eye Examination of Biopsied Lymph Nodes in the Diagnosis of Tuberculous Lymphadenitis
Authors: Bem Chris
Published: January 2017

Tuberculous lymphadenitis is common in Central Africa, where diagnosis by histological examination of a biopsied node is often delayed. In the present study, the naked eye appearance of the cut surface of 306 consecutive biopsied lymph nodes was compared with the histological diagnosis. One hundred and eight-eight nodes showed tuberculosis on histology (including two with coexisting second pathology). One hundred and forty-eight (79%) cases of tuberculous lymphadenitis (including both with coexisting second pathology) showed non-caseating tuberculomata or caseation visible on naked eye examination. Such signs were not seen in other nodes. Other signs were seen in another 18 (10%) tuberculous nodes. It is concluded that naked eye examination of nodes provides useful information for the diagnosis of tuberculous lymphadenitis, pending confirmation by histology.
Maternal Mortality in Kwazulu/Natal: Need for an Information Database System and Confidential Enquiry into Maternal Deaths in Developing Countries
Authors: Moodley D , Payne A J , Moodley J
Published: January 2017

In a 2-year retrospective analysis of 147 maternal deaths in South African urban and rural hospitals, the maternal mortality rate (MMR) was estimated to be 144 per 100 000 live births. MMR was significantly higher ( P = 0.025) in urban hospitals (160 per 100 000) and the main causes of death were hypertensive disease in pregnancy (33%), of which eclampsia contributed to 70% of deaths, and haemorrhage (18%). Only 49.7% of women who died, attended an antenatal clinic. The MMR in South Africa is lower than sub-Saharan countries but unacceptably high for a country with a mix of private and public medicine. Disparities have been noted in maternal mortality rates within the country due to different study designs and poor documentation. Structural changes in the health care system would only be possible if a common information database system were established and confidential enquiries held into maternal deaths.
Early Diagnosis of Septicaemia in Infants with Respiratory Distress in the Tropics
Authors: Rabasa Adamu I , Okolo Angela A
Published: January 2017

A prospective study of buffy coat microscopy of 108 infants with respiratory distress during the first 48 h of life was undertaken. Thirty-two infants (29.6%) had positive blood cultures. The buffy coat was stained with methylene blue and with Gram's stain. Using methylene blue staining 94% shared organisms in the buffy coat. Whereas using Gram's stain only 50% were positive — all of which were also positive with methylene blue.

Twenty-four infants with negative blood cultures had radiological signs of pneumonia. Of these 83% showed organisms in the buffy coat with both methylene blue and Gram staining. We conclude that buffy coat microscopy provides a simple and reliable guide in the early diagnosis of neonatal septicaemia or lung infection in infants with respiratory distress.
Pharmaceutical Inventory Control Software: Bhandari 2.2 (1995)
Authors: Zijp J J
Published: January 2017

This article describes specialized software to manage pharmaceutical logistics and medicine inventories in hospitals and central/regional stores. It has been written especially for application in the developing world to support the administration of such departments. Features include ordering, inventory control, supplying, reporting and accounting.
AIDS in Africa: What Drugs do the Carers Want or Need?
Authors: Lamont A C , Greiff M , Rosenberg D S , Wiggin T R
Published: January 2017

Our objectives were: (1) to discover requirements for treatment of patients with AIDS (PWAs) for healthcare workers in eight English-speaking African countries; (2) to establish policies for supply of drugs, and develop a method for determining the contents of parcels (PWA-BOXes) for the relief of PWAs. Fifty-seven questionnaires were sent to non-government medical units treating PWAs, supplied by the charity Inter Care. Of these 37 units replied, two had no known PWAs, three were swamped by refugees; therefore, the total number analysed was 32. Only 24 units had access to HIV testing and the mean number of PWAs per unit was 58. The reported complications of AIDS were: diarrhoea 28 units; tuberculosis 27 units; pneumonia 28 units; sexually transmitted diseases 26; candidiasis 28 units; and herpes zoster 20. Lists of drug requirements were received.

We present a protocol for calculation of contents of PWA-BOXes in the hope that this will provide guidelines for other workers in this field.
Day-Case Laparoscopy in a Ghanaian Teaching Hospital: The Patients' Perspective
Authors: Nkyekyer Kobinah
Published: January 2017

A questionnaire survey was carried out to determine the acceptability to patients of various aspects of day-case laparoscopy in Korle-Bu Teaching Hospital. One hundred consecutive patients were interviewed within 2 weeks after operation.

Sources of dissatisfaction include inadequate explanation about the operation and its aftermath, hospital reporting time, the waiting times at various stages of the process, the mechanism for sending patients from the ward to the theatre and the total length of time spent in hospital. Almost half the patients felt they were not well enough to be sent home at the time of discharge. More than half would have preferred overnight stay post-operatively. The main causes of morbidity were dizziness, abdominal pain, shoulder pain, nausea and vomiting.

To make day-case laparoscopy more acceptable to patients a dedicated day care surgery unit with formal anaesthetic cover should be established. The operation and its aftermath should be fully explained to patients well before the day of operation. Stricter criteria should be established for patient discharge, and where appropriate, patients should be allowed the option of overnight stay post-operatively.
Meningococcal Meningitis in Patients with Falciparum Malaria
Authors: Wolday Dawit , Kibreab Tsehaye , Bukenya Daraus , Hodes Richard
Published: January 2017

Between October 1994 and January 1995 a field hospital saw nine cases of falciparum malaria associated with meningococcal meningitis among Rwandan patients residing in Kibumba refugee camp in Goma, Zaire. All except one presented with signs and symptoms suggestive of meningeal irritation; all but one responded to intravenous quinine and chloramphenicol or ampicillin. Two had recrudescence of malaria and responded to treatment with pyrimethamine-sulphadoxine (Fansidar). There were no sequelae seen. Meningococcal meningitis is uncommon but frequently fatal if it occurs in patients with falciparum malaria. Early diagnosis and treatment are urgent to decrease morbidity and mortality.
Systematic Inspection of Insulin Injection Sites for Local Complications Related to Incorrect Injection Technique
Authors: Seyoum Berhane , Abdulkadir Jemal
Published: January 2017

We systematically inspected insulin injection sites in 100 insulin-requiring patients attending the Diabetic Clinic of the Tikur Anbassa Hospital (TAH) in order to identify local complications related to incorrect injection technique: local complications were found in 53 cases: skin hyperpigmentation and/or indurations in 30 patients; and fat atrophy or hypertrophy in 31 patients. Illiteracy was significantly more common among those with local complications (18/53 versus 6/47, χ2 5.03, P < 0.05). Mean fasting blood glucose on the day of the inspection was significantly higher (14.9 +6.3 mmol/l versus 10.5 + 6.1 mmol/l, P < 0.001) and a fasting blood glucose > 10 mmol/l more common (41/53 versus 20/47, χ2 14.1, P < 0.0005) in those with than in those without local complications. There was no significant difference between the two groups in mean duration of diabetes (6.9 + 5.6 years versus 6.6 + 5.8 years), frequency of hypoglycaemic episodes (12/53 versus 5/47, χ2 1.76, P > 0.05) or mean daily insulin dose (44 + 18 units versus 44 + 22 units per day).

Therefore, we concluded that local complications resulting from incorrect injection technique, a common finding in the group of patients studied, may be common among insulin requiring diabetic patients in general. Incorrect insulin injection causes local complications and disfigurement which may compromise compliance. Furthermore, insulin absorption tends to be erratic from intradermal and fat hypertrophy sites thus interfering with effective diabetic control. Insulin injection sites should be inspected routinely to detect and correct faulty technique promptly.
Persistent Cough in Patients Using an Urban Chest Clinic in Malawi
Authors: Nwanyanwu Okey , Nyangulu Daniel , Salaniponi Felix
Published: January 2017

In many sub-Saharan African countries, tuberculosis (TB) cases have been increasing steadily since 1985. In Malawi, they have increased by 38% from 1990 to 1993, and extrapulmonary TB increased by 79%. Among 385 patients with a history of persistent cough presumed to be TB, 360 (94%) initially consented to be tested for both HIV and TB. Of these, 301 completed testing and 95% returned for their test results. Among test completers ( n = 301), 280 (93%) were found to be HIV-infected. Seropositivity rates were similar for males and females, and higher for urban dwellers than for rural dwellers (94% versus 79%). TB was found in only 48 (16%) patients. Among TB patients, 33 (77%) were HIV positive. This study suggests that TB may not be the main cause of persistent cough among persons using urban chest clinics in Malawi; HIV without sputum positive TB appears to be a major contributor. Clinicians in areas of high HIV prevalence should therefore suspect other HIV-related infections in a patient with persistent cough and in whom TB has been ruled out.
Fever of Unknown Origin: A Prospective Study
Authors: Handa R , Singh S , Singh N , Wali J P
Published: January 2017

Fever of unknown origin (FUO) is a problem frequently faced by clinicians all over the world. One hundred and twenty-one cases of FUO presenting to a large teaching hospital in northern India were prospectively studied over a period of 2 years. Infections were the commonest cause accounting for 43.8% cases of FUO, with tuberculosis (TB) being the commonest infection encountered. Collagen vascular diseases and tumours accounted for 15.7 and 8.3% cases, respectively. No cause could be found out in a substantial number of cases (19%) even after invasive investigations. Knowledge of the current patterns of FUO is important since many patients present with potentially treatable diseases.
Self-Reported Concepts about Oral Rehydration Solution, Drug Prescribing and Reasons for Prescribing Antidiarrhoeals for Acute Watery Diarrhoea in Children
Authors: Nizami S Q , Khan I A , Bhutta Z A
Published: January 2017

Sixty-seven general practitioners (GPs) and 27 paediatricians practising in Karachi were interviewed to evaluate their knowledge and attitude towards use of oral rehydration solution (ORS) and management of acute watery diarrhoea (AWD) in children and to define factors for their self-reported prescribing of antidiarrhoeals. Whilst nearly 50% of them reported ORS to be palatable and acceptable by children, 80% reported that ORS was not accepted by parents as sole treatment. Eighty per cent of GPs and 37% of paediatricians reported prescribing antidiarrhoeals for AWD in children, and ‘parental pressure’ and ‘use as placebo’ were the commonest reasons. In addition 45% of GPs believed in the efficacy of antidiarrhoeals and thought these drugs necessary for the control of diarrhoea.
Mycetoma Due to Madurella Grisea Acquired in Mexico
Authors: Southern Paul M
Published: January 2017

Mycetomas due to Madurella grisea have been reported from South America, Central America, the Caribbean Islands, Africa, and Asia, but only rarely from Mexico1–3. We report a case of mycetoma due to M. grisea acquired in northern Mexico.
The Impact of Renal Impairment on the Management of Patients with Lower Urinary Tract Obstruction
Authors: Ogbonna B C , Madziga A G , Anteyi E A
Published: January 2017

One hundred patients with lower urinary tract obstruction (LUTO) seen over a 10-month period were prospectively studied. Nineteen (19%) had an elevated serum creatinine (>125 μmol/l); 13% had benign prostatic hyperplasia (BPH); 4% had urethral strictures; and two had congenital anomalies. Though urethral strictures are more common than BPH they cause less renal impairment, probably because the patients are younger and also because a urinary fistula may form proximal to the stricture when the intravesical pressure rises very high.

Eighty per cent of the patients with renal impairment had a urinary tract infection (UTI), and in these the reduction in serum creatinine following relief of obstruction was slow and erratic. In three patients who did not have UTI the serum creatinine dropped steadily at a rate which varied from 6.8–845 μmol/l/week following continuous bladder drainage and appropriate supportive management. All patients with elevated serum creatinine had delayed surgery and required prolonged preoperative hospitalization, with a resultant sharp increase in the cost of their treatment.
Autotransfusion and Ectopic Pregnancy: An Experience from Tanzania
Authors: Jongen V H W M
Published: January 2017

Intraoperative autotransfusion was performed in 48 of 90 women with ectopic pregnancy, seen between 1990 and 1995. Autotransfusion was performed more frequently in the presence of hypovolaemic shock and more severe haemoperitoneum. The procedure appeared safe and useful. Contraindications and complications are discussed.
Where There is no Anaesthetist: A Study of 282 Consecutive Patients Using Intravenous, Spinal and Local Infiltration Anaesthetic Techniques
Authors: Adesunkanmi A R K
Published: January 2017

Two hundred and eighty-two consecutive surgical operations were performed over a period of 11 months, February–September, 1991, December 1991–February 1992 at two private medical centres. Anaesthesia was conducted by the surgeon assisted by the theatre nurses. Intravenous ketamine was given in 72% of operations, xylocaine infiltration in 12.8%, spinal anaesthesia in 11.3% and intravenous thiopentone anaesthesia in 4% of the patients.

Major and minor surgical operations were performed on 180 (63.9%) and 102 (36.2%) patients, respectively. With ketamine anaesthesia side effects included transient intra-operative hypertension in 76.8%, delirium/confusion in 56.7% and dreams in 5.4% of the patients. Hypotension at induction and postoperative headache/neck stiffness were the principal side effects in spinal anaesthesia occurring in 59.2% and 12.8%, respectively. Reversible apnoea occurred in three patients and cardiac arrest in one patient of those who had intravenous thiopentone.

It appeared, therefore, that where there is no anaesthetist as is often the case in under-doctored areas, after careful patient selection, intravenous ketamine, spinal and local infiltration anaesthetic techniques are safe and useful for many surgical procedures. There is the need to avoid intravenous thiopentone by untrained personnel and in settings poorly equipped for cardiopulmonary resuscitations.
Intranasal Anaesthesia in Lepromatous Leprosy
Authors: Soni N K
Published: January 2017

Intranasal sensation was assessed in a group of 25 lepromatous leprosy patients. It was found that 17 patients showed partial or complete impairment of intranasal common sensation. The intranasal anaesthesia is found to be related to the advancement of intranasal disease. Loss of sensation may lead to repeated trauma, ulceration and epistaxis, due to repeated ‘picking’ of the nose in an attempt to remove the crustings. It is suggested therefore, that the lepromatous leprosy patient should be taught to take care of the nose just as they are instructed in the care of their hands and feet.
An Audit to Assess the Impact of a Strategy to Reduce Inappropriate Red Cell Transfusions at Honiara Hospital
Authors: Lucas Richard E , Oberli Hermann
Published: January 2017

A blood transfusion committee was established at Honiara Central Hospital (HCH), a national referral hospital for the Solomon Islands to promote a rational, safe and cost-effective blood transfusion service and to audit the use of blood particularly in the perioperative context. Following the education strategy, a 29.7% reduction in the number of units of blood crossmatched as a proportion of total admissions was achieved as well as a 30.1% reduction in the number of units transfused per 100 operations. The failure of the education strategy to increase the proportion of ‘group and hold’ requests confirms the need for an integrated approach between the different hospital departments involved to ensure a fully satisfactory result.
Blood Transfusion in Developing Countries: Problems, Priorities and Practicalities
Authors: Wake D J , Cutting W A M
Published: January 2017

The acute medical services could not exist without blood transfusions—life-savers in many situations. But transfusions can also be a quick and easy route for the transmission of infectious agents such as HIV, HBV, HCV and malaria. Infection through blood supply is a major issue in all countries but particularly in those with economic constraints which limit safety.

This study was carried out in India (March—May 1997) and involved centres in Delhi, Calcutta and Vellore. It examined many aspects of blood transfusion including donor screening, use of professional donors, blood testing and criteria for blood use1. The many problems in Indian blood transfusion services are mirrored in other countries. Here we examine the problems, priorities and practicalities of blood transfusion particularly in developing countries.
Monitoring Diabetic Control in Developing Countries: A Review of Glycated Haemoglobin and Fructosamine Assays
Authors: Rahlenbeck Sibylle I
Published: January 2017

Measurement of glycated proteins, especially haemoglobins, is now a routine procedure for monitoring previous glycaemic control in diabetic patients in the developed world. Until recently, however, the assays were sophisticated and costly and, therefore, were only rarely used in developing countries. With easier and cheaper tests now available, the measurement of glycaemic control could be also introduced into regional hospitals in developing countries. This paper reviews feasible methods for clinical laboratories with limited resources. Recent experiences from African countries are included.
Evaluation of Best Surgical Procedures in Typhoid Perforation — An Experience of 60 Cases
Authors: Pal Dilip K
Published: January 2017

The results of treatment of 60 cases of typhoid perforation were reviewed over a period of 4.5 years. Closure of the perforation was the method of treatment in 28 (46.66%) cases and closure of the perforation with side-to-side ileotransverse anastomosis was done in 32 (53.33%) cases. Faecal fistula was the most severe postoperative complication following simple closure of the perforation, causing death in all patients and leading to a 25% mortality in those treated by this technique. No fistula was found following closure of the perforation with side-to-side ileotransverse anastomosis, leading to a much lower mortality of 6.22%. The overall mortality in this series was 15%. Apart from toxaemia, surgical failure was the main contributory factor to such a high mortality. In this series, closure of the perforation with side-to-side ileotransverse anastomosis was the better surgical procedure.
Cryptococcosis at the University Hospital, Kuala Lumpur
Authors: Doi S A R , Tan C T , Liam C K , Naganathan K
Published: January 2017

We review our experience with 27 cases of pulmonary and meningeal cryptococcosis at the University Hospital, (Kuala Lumpar, Malaysia) where this is the most common cause of adult meningitis in patients without debilitating illnesses. Of the 27 cases analysed, six presented primarily with pulmonary symptomatology which usually were mainly cough, chest pain and low grade fever. The rest presented with primarily central nervous system (CNS) symptomatology of which headaches and fever were the most consistent symptoms although a third of these patients also had pulmonary lesions noted on chest radiographs. Treatment in all cases was with amphotericin B and 5-fluorocytosine and usually till a total cumulative dose of 1.5 g of amphotericin had been reached (an average of 10 weeks). Primary pulmonary presentations, if symptomatic, were treated as per CNS cryptococcosis due to the high likelihood of CNS dissemination. Incidental pulmonary cryptococcoma found on routine chest radiographs were confirmed by biopsy under ultrasound or fluoroscopy guidance and booked for surgical resection. Death usually occurred early in patients who presented late. Once patients responded to therapy, mortality was usually avoided. The only cause of morbidity in survivors was visual impairment or blindness, and this was attributed mainly to intracranial hypertension with residual deficits determined by the measures taken to lower intracranial pressures. Our experience suggests that: (i) symptomatic patients should have combination therapy with 5-fluorocytosine and amphotericin B till at least a cumulative dose of 1.5 g amphotericin B is reached irrespective of whether they have primary CNS or pulmonary symptomatology; (ii) non-symptomatic pulmonary cryptococcoma could be treated primarily by surgical resection; (iii) visual failure or papilloedema should be treated aggressively; and (iv) prognosis is good with adequate therapy and early presentation.
Giardiasis in the Adult Population of Dakshina Kannada District of South India
Authors: Shenoy Shalini , Prabhu Ganesh , Antony George , Urs Shivaraj , Mathew Bin , Bharati B
Published: January 2017

A 10-year study of Giardia intestinalis infections in adults was conducted in the Dakshina Kannada District of Karnataka State, South India. Coproparasitological investigations were made on 10000 stool specimens collected from selected patients. The infection rate was 37.1% with a male disease rate of 91.4%. The highest incidence rate was recorded in the age group 15–26 years. A possible reason for this preponderance of giardiasis in these males, is discussed. The optimum time for transmission appeared to be during the warmer months of the year (May to October) which coincided with the greatest amount of rainfall. The most common symptoms were abdominal discomfort, flatulence, diarrhoea, weight loss and anorexia. The predominating symptoms in our series varied with socio-economic level. There appeared to be some correlation between the clinical manifestations and the immune status of the individual.
Drug Prescribing in Rural Health Facilities in China: Implications for Service Quality and Cost
Authors: Shao-Kang Zhan , Sheng-Lan Tang , You-De Guo , Bloom Gerald
Published: January 2017

Overuse of drugs in rural areas of China has led to a growing concern regarding service quality and cost. The study found evidence of high levels of drug use in some rural health facilities in comparison with a number of other developing countries. Such a result was significantly associated with the government policy of financing health care, regulation and monitoring of health services, and users' attitudes and behaviour. It underlines the need for measures to be taken in China to improve drug use in order to allow its population access to effective care at reasonable cost.
Effectiveness of Excision of Pre-Ulcerative Buruli Lesions in Field Situations in a Rural District in Ghana
Authors: Amofah George , Asamoah Samuel , Afram-Gyening Comfort
Published: January 2017

The effectiveness of excision of pre-ulcerative Buruli lesions in field situations was assessed in a prospective study in an endemic focus in rural Ghana. All 50 patients, clinically diagnosed as having pre-ulcerative Buruli lesions, had their lesions excised followed by primary suturing. The patients were then followed up until the wound healed and thereafter for a year or until recurrence.

The median duration for complete healing after excision was 31.5 days while the 1-year recurrence rate was 16%. None of the patients had any form of deformity after healing in contrast with the usual consequences of other forms of treatment. Our findings suggest that excision of pre-ulcerative Buruli lesions is effective in preventing deformities but less so for preventing recurrence of lesion.
Episiotomy in Burkina Faso
Authors: Lorenz N , Nougtara A , Garner P
Published: January 2017

Episiotomy is a common obstetric intervention in many countries of the world, although little is known about rates in African countries. In recent years, the effectiveness of routine episiotomy to prevent severe tears and neonatal asphyxia has been questioned, and evidence shows that the procedure results in considerable maternal morbidity. This study estimates episiotomy rates in Burkina Faso. A high proportion of primigravidae (46%) received an episiotomy when trained midwives attended the delivery; a level which indicates the procedure has to be regarded as routine practice. The episiotomy rate was lower (26%) in primigravidae delivered by auxiliary midwives. This proportion is closer to recommended selective approaches derived from good research summaries. The tear rate in women assisted by midwife and auxiliary staff was similar, suggesting that women tear even when the procedure is performed. These results indicate that obstetricians and midwives in Burkina Faso should critically appraise whether routine episiotomy should be abandoned. The introduction of a labour chart is a good vehicle to introduce a policy on avoiding episiotomies.
Puerperal Sepsis: A Preventable Post-Partum Complication
Authors: Dare F O , Bako A U , Ezechi O C
Published: January 2017

Patients with puerperal sepsis following delivery at Ife State Hospital (ISH) of Obafemi Awolowo University Teaching Hospitals Complex (OAUTHC) Ile-Ife over a 10-year period spanning January 1986 to December 1995 were reviewed.

One hundred and forty-six patients were diagnosed as having puerperal sepsis and there were 8428 deliveries giving an incidence of 1.7%. The incidence was higher among the unbooked patients 71.2%. Predisposing factors were: anaemia in pregnancy, 69.2%; prolonged labour (labour lasting up to 12 h or more), 65.7%; frequent vaginal examinations in labour (more than five), 50.7%; premature rupture of membranes, 31.5%; and non-adherence to asepsis during delivery. The case mortality rate was 4.1 %.

Antenatal care and supervised hospital delivery should be encouraged in order to prevent or reduce this serious post-partum morbidity.
Treatment of Malnutrition in Brazil: Simple Solutions to Common Problems
Authors: Cavalcante Ana A M , Pinheiro Livia M P , Monte Cristina , Guimarães Augusto R P , Ashworth Ann
Published: January 2017

At the largest rehabilitation centre in Ceará, Brazil, the World Health Organization (WHO) guidelines for improved dietary management of severe malnutrition were implemented. Rates of weight gain increased fourfold, daily food costs were reduced, and staff time was saved. Implementation was achieved within 1 week, including training. Other centres are encouraged to adopt similar measures.
Appropriate Technology in Transportation of Sick Newborns in Developing Countries
Authors: Gosavi D V , Swaminathan M , Daga S R
Published: January 2017

Thirty-two high-risk newborns requiring continuing special care were transported to one hospital or another. They were transported in styropor boxes in order to maintain temperature. Oxygen was bubbled through the ventilatory hole of the box. The babies receiving inotrope infusion continued to receive it during transportation. Babies getting intragastric feed received their feeds 30–45 min before transportation. No baby became hypothermic or failed to maintain colour or required resuscitation during transportation. Heart rate and respiratory rate remained in an acceptable range.
Is Vitamin B6 Supplementation of Isoniazid Therapy Useful in Childhood Tuberculosis?
Authors: Mbala L , Matendo R , Nkailu R
Published: January 2017

We present the results of a prospective single blind placebo controlled study performed to establish whether vitamin B6 supplementation of isoniazid therapy is useful in childhood tuberculosis.

Eighty-five children suffering from tuberculosis (TB) and admitted between 1 October 1993 and 31 March 1995 to the Hospital of IME-Kimpese (Lower Zaire) were included. All were treated with isoniazid and other antitubercular drugs and were randomized to receive either vitamin B6 supplementation or placebo.

No case of neurological or neuropsychiatric disorder was observed in the two groups during the 6 months of the treatment and 3 months after the treatment. These results suggest that the vitamin B6 supplementation of isoniazid therapy is unnecessary in childhood TB.
Rhinosporidiosis in the Nasal Cavity
Authors: Nwana E J C , da Lilly-Tariah O B , Manasseh A
Published: January 2017

A case of nasal rhinosporidiosis in a 17-year-old patient from the Middle Belt area of Nigeria is described, the first such case seen in 16 years since this centre was established. The clinical features and the results of gross and microscopic examination of biopsy material are presented.
Editorial: Research and the School or Educational Psychologist
Authors: Lowenstein L.F.
Published: January 2017

The terms ‘school psychologist’ and ‘educational psychologist’ will be used interchangeably, and in most instances the term ‘psychologist’ will refer to both male and female. There is obviously some difference in the use of the terms and in the functions of the educational psychologist and the school psychologist in different parts of the world. For example, in the United States, ‘educational psychologist’ is rarely used for those psychologists who are attached to non-university services and are regular visitors to schools and who carry out the day-to-day work of helping children attending schools. Instead, school psychologists in the United States carry out the function of advising teachers, testing or dealing with the educational or psychological problems of children in the classroom and doing other practical work.
Raven Coloured Progressive Matrices Intelligence Test in Thailand and in Denmark
Authors: Poulsen Anders
Published: January 2017

It might appear retrogressive to occupy oneself with, and write about, Raven's 1956 intelligence test. Presumably it is no longer applied at all in Denmark. Danish school psychologists have never considered it a good and reliable test, but it was at one time used for certain screening purposes, and now and then it was included in the ‘battery’ that had to be applied in attempts to penetrate as far as possible into a child's wholly special problems.