bluuebunny/crossref_metadata_2025 huggingface dataset:
Low educational level: a risk factor for sexually transmitted infections among commercial sex workers in Quito, Ecuador
Authors: Solomon M M , Smith M J , Del Rio C
Published: June 2008

Few studies have assessed the effect of educational level on sexually transmitted infections (STIs) and risk-taking behaviours among commercial sex workers (CSWs). This study analysed this association among female CSWs in Quito, Ecuador. Eighty-five CSWs were given a Spanish-language questionnaire on behaviours, socioeconomics and demographics. The correlation between years of education and number of prior STIs was calculated. Three groups of varying education level were formed and risk factors were analysed by Chi-square tests and analysis of variances. Lower educational level was associated with more STIs ( r = –0.36; F = 4.2; P = 0.04), poorer knowledge of HIV/AIDS ( P = 0.03), earlier first prostitution ( P = 0.05) and first sex ( P = 0.00), willingness to engage in group sex ( P = 0.05) and work on the street ( P = 0.02), and presence of non-paying sexual partners ( P = 0.05). CSWs with lower educational levels were disproportionately afflicted with STIs and participated in more high-risk behaviours. Low educational level may predispose CSWs to STIs and associated risk factors.
Microcalcification of testis presenting as epididymo-orchitis
Authors: Mohanty Kailash
Published: June 2008

We report two cases who attended the genitourinary medicine clinic for the treatment of epididymo-orchitis. They did not respond to treatment and subsequent ultrasound sonography (USS) of testis confirmed microlithiasis and excluded any inflammatory process or carcinoma in situ. Because of its association with testicular cancer, these patients should be followed up by USS at least once a year on a long-term basis after diagnosis. Patients should be encouraged for testicular self-examination.
Study on Peer-Led School-Based HIV/AIDS Prevention among Youths in a Medium-Sized City in China
Authors: Huang Hong , Ye Xiuxia , Cai Yong , Shen Lixiao , Xu Gang , Shi Rong , Jin Xinming
Published: June 2008

HIV/AIDS epidemic is crucial in China; however, few studies were performed on youths. This study was performed to examine the effectiveness of peer-led HIV prevention intervention on HIV-related knowledge, attitudes and behaviour intention in senior high-school students in San-ming, a medium-sized city in Fujian province. Three thousand and sixty-eight students completed self-administered questionnaires before and after intervention, of which 981 students (the intervention group) accepted peer-led HIV/AIDS prevention intervention and others (the control groups) continued the usual teacher-led health education curriculum. Significant increases were observed in the intervention group in HIV-related knowledge, in attitudes and in behaviour intention after intervention. The results of this research also indicated an inconsistent level of HIV/AIDS knowledge and attitude among students, with a significant gender, health education history and style difference in session delivery. More concerted efforts in HIV prevention are needed to improve young people's sexual health.
Frequent Complaints of Testicular Lumps by Young Prisoners
Authors: Mohanty Kailash C
Published: June 2008

The definition of the age of young offenders was changed by an Act of Parliament (The Crime and Disorder Act 1998), which was implemented by the Home Office on 1 April 2000. This Act brought down the upper-age limit of young offenders from 20 to 17. Our objective was to investigate the sexually transmitted infections (STIs) among this redefined group of young offenders. Among various types of STIs, we observed that a significant number of young prisoners had complaints of testicular lumps (35%), which were not reported in the past. We tried to find out the reason for this common complaint and believe that this was due to extra vigilance, and testicular self-examination in conjunction with sex and relationship programmes which ran alongside other programmes developed as a joint venture by Prisoner Learning and Skills Unit, Prison Health Policy Unit and Sex Education Forum.
Changes in the provision of post-exposure prophylaxis for HIV after sexual exposure following introduction of guidelines and publicity campaigns
Authors: Roedling S , Reeves I , Copas A J , Beattie A , Edwards S G , Fisher M , Benn P
Published: June 2008

In July 2004, British Association of Sexual Health and HIV (BASHH) published guidelines for post-exposure prophylaxis following sexual exposure (PEPSE) and the Terence Higgins Trust (THT) launched a campaign promoting PEPSE among men who have sex with men (MSM). We evaluated subsequent changes in PEPSE attendances. Individuals requesting PEPSE in 2004 were identified from clinic databases. Comparisons of clinical data, exposure characteristics and follow-up were made pre and post campaign. Data were available for 197/216 (91%) PEP attendances. The proportion requesting PEP following sexual exposure increased significantly following the campaign. The majority commencing PEPSE were MSM, with the proportion of MSM increasing significantly from 36/46 (78%) pre to 76/80 (95%) following the campaign. Most prescriptions were in high-risk groups and within guidelines. Times to initiation and completion rates were unchanged. Access to PEPSE following the THT campaign and introduction of BASHH guidelines increased. Promotion of earlier initiation of PEPSE and improvement of completion and follow-up is required.
An Unusual Case of Pelvic Pain: Retention of Fetal Bone after Abortion
Authors: Samraj S , Crawford S , Singh N , Patel R , Rowen D
Published: June 2008

We present a 21-year-old woman with a short history of pelvic pain. The history was unremarkable apart from that of undergoing a surgical termination of pregnancy (TOP) some three-and-half years ago. Examination revealed a foreign body at the cervical os. Subsequent investigations revealed more foreign bodies within the cervical canal and uterine cavity, which were removed. Histologically these were found to be bones. Removal of the bone fragment initially discovered lead to an improvement of symptoms. Although the patient was treated for pelvic-inflammatory disease, no infective cause could be established. The condition of intrauterine retained fetal bones is recognized, but rare. Patients experiencing pelvic pain usually present sooner after TOP than did this patient. Although rare, it is an important condition to diagnose as it represents a treatable cause of infertility.
Sensorineural Hearing Loss Due to Secondary Syphilis
Authors: Jeans A R , Wilkins E G L , Bonington A
Published: June 2008

We present a case of sudden sensorineural hearing loss occurring as a complication of secondary syphilis. Syphilis affecting the inner ear, or otosyphilis, is well described in historical literature, but has rarely been reported in recent times. However, following the resurgence of syphilis in the UK, unusual manifestations such as otosyphilis are likely to be seen increasingly commonly.
Assessment of cardiac function with Doppler tissue imaging in asymptomatic HIV-infected patients
Authors: Karavidas Apostolos , Foukarakis Manolis , Lazaros George , Chini Maria , Fotiadis Ioannis , Arapi Sophia , Gialernios Theodoros , Potamitis Nicolaos , Gargalianos Panos , Matsakas Evangellos , Stefanadis Christodoulos
Published: June 2008

Doppler tissue imaging (DTI) is a useful tool for the detection of subtle systolic function abnormalities related to the longitudinal contraction. We assessed left ventricular (LV) systolic function with DTI in 45 human immunodeficiency virus (HIV)-infected patients without any heart-related symptoms and in 30 healthy control subjects. Although conventional echocardiography showed no differences between groups, DTI revealed lower peak systolic velocities in group A patients when compared with group B ones (Sms: 8.84 ± 0.94 cm/s vs. 9.42 ± 0.84 cm/s, respectively, P < 0.001 and Sml: 9.58 ± 1.86 cm/s vs. 10.78 ± 2.07 cm/s P = 0.003). In group A patients, both peak systolic myocardial velocities at the septal (Sms) and lateral mitral annulus (Sml) correlated with CD4 lymphocyte count (P = 0.034 and 0.009, respectively). We conclude that pulse wave DTI reveals subtle and non-otherwise detectable abnormalities of the longitudinal LV contractile function in asymptomatic patients with positive HIV serology. DTI study should potentially be expanded in the population of HIV-infected patients, aiming at an early identification of LV systolic dysfunction.
Treatment Outcome and Cost-Effectiveness of Different Highly Active Antiretroviral Therapy Regimens in the Uk (1996–2002)
Authors: Beck E J , Mandalia S , Youle M , Brettle R , Fisher M , Gompels M , Kinghorn G , Mccarron B , Pozniak A , Tang A , Walsh J , Williams I , Gazzard B ,   The Npms – Hhc Steering Group
Published: June 2008

The aim of this study was to estimate the outcome and cost-effectiveness per life-year-gained (LYG) of first-, second- and third-line non-nucleoside reverse transcriptase inhibitors (NNRTI) versus protease inhibitor (PI) containing highly active antiretroviral therapy regimens. Hospital care costs (2002 US dollars discounted 3.5% per annum) were linked to treatment failure times. Results show that the median time-to-treatment failure for first-line (nucleoside reverse transcriptase inhibitors) 2NRTIs + NNRTI was substantially longer than that for 2NRTIs + PIboosted, 2NRTIs + PI and 2NRTIs + 2PIs, whereas for second- and third-line they were similar. Comparing first-line 2NRTIs + NNRTI with 2NRTIs + PIboosted cost per LYG was US$ 12,375; US$ 12,139 per LYG when compared with 2NRTIs + PI and US$ 2948 per LYG when compared with 2NRTIs + 2PIs. For second-line cost per LYG comparing 2NRTIs + NNRTI with 2NRTIs + PIboosted was US$ 19,501; US$ 18,364 per LYG when compared with 2NRTIs + PI and cost-saving when compared with 2NRTIs + 2PIs. For third-line cost per LYG comparing 2NRTIs + NNRTI with 2NRTIs + PIboosted was US$ 2708; US$ 11,559 per LYG when compared with 2NRTIs + PI and cost-saving when compared with 2NRTIs + 2PIs. In conclusion, first-line 2NRTIs + NNRTI was cost-effective or cost-saving when compared with PI-containing regimens for all lines of therapy. Such information is required by clinicians and managers of HIV services to make appropriate treatment decisions based on clinical and financial grounds, and given the increasing number of people living with HIV, such information will become more important over time.
Efficacy of Antiretroviral Therapy in Africa: Effect on Immunological and Virological Outcome Measures – A Meta-Analysis
Authors: Hammond Rebecca , Harry Tubonye C
Published: June 2008

This study is a systematic literature review exploring the efficacy of antiretroviral therapy (ART) in Africa through a meta-analysis of immunological and virological outcome measures at baseline and six subsequent time points. A literature search was conducted through two databases and references of relevant papers searched. The inclusion criteria were papers with data from the African continent with predominantly an adult population, who were ART naïve and human immunodefieciency virus-1-positive, data on the CD4 count and/or percentage undetectable viral load (UDVL) at a subsequent time-point following ART initiation. The search identified 368 papers. Of these 320 were excluded by title and abstract, 48 papers were accessed with a further 19 papers then excluded. Twenty-nine papers from 12 countries were included in the meta-analysis. All papers showed evidences of Grade III or IV. The mean CD4 count (cells/mm3) at baseline was 141.0 and viral load was 5.2 log10. The mean CD4 count was 243.8, 248.9, 277.1, 274.1, 298.4, 374 at 3, 6, 12, 18, 24 and >24 months, respectively. The mean percentage with UDVL was 73.3, 74.7, 66.9, 68.1, 64.6, 73.5 at 3, 6, 12, 18, 24 and >24 months, respectively. In conclusion, the meta-analysis provides evidence that ART increases the CD4 count from three months until three years, and the majority of subjects had an UDVL (<400 copies/mL) at each analysed time-point. Though the grade of evidence is low, this analysis suggests that ART can be provided successfully within the continent of Africa even with the limitations of a resource-poor setting.
Oral Manifestations after Immune Reconstitution in HIV Patients on Haart
Authors: Ortega Karem L , Ceballos-Salobreña Alejandro , Gaitán-Cepeda Luis A , Magalhães Marina G
Published: June 2008

In order to verify possible association between immune reconstitution inflammatory syndrome (IRIS) and oral manifestations (OMs), we selected AIDS patients who had low CD4 count before the initiation of highly active antiretroviral therapy (HAART) and who returned three months later for therapy evaluation. The oral lesions observed three months after the initiation of HAART were evaluated and associated with the type of antiretroviral therapy (ART), CD4 count and HIV-RNA load levels (before and three months after HAART initiation). A total of 105 patients matched the selected criteria. Immune reconstitution (IR) was identified in 35.2%. Among these patients, the mean CD4 cell count rose from 105.97 to 330.29 and the mean viral load dropped from 168.005 (log 5.22) to 21.852 (log 4.33). There was no significant difference in age (P = 0.78), sex (P = 0.41) or previous history of ART (P = 0.55) between IR and non-IR patients. In the IR group, the most common OM was parotid enlargement (57.14%) (P = 0.019), whereas in the non-IR group candidiasis (46.15%) was the most common OM. The results of our study suggest that the parotid gland enlargement found in the studied population might be an IRIS event, as it was found in patients with IR three months after the initiation of HAART.
Partner Notification of Sexually Transmitted Infections among Pregnant Women
Authors: Thurman Andrea Ries , Holden Alan E C , Shain Rochelle , Perdue Sondra , Piper Jeanna
Published: June 2008

The object of this study was to determine the factors associated with partner notification (PN) of sexually transmitted infection (STI) exposure among pregnant, low income, Mexican-American (MA) and African-American (AA) women and their male sexual partners.

We used a cross-sectional analysis of 166 pregnant women with an STI, enrolled in a randomized controlled trial of behavioural intervention to prevent recurrent STIs. The primary outcome, PN, is notification of, or intent to notify male sexual partner(s) of STI exposure.

Pregnant women with one (n = 136) versus multiple (n = 30) partners reported PN for 88.2% and 54.5% of male partners, respectively (P < 0.001). Multivariate logistic regression demonstrated three variables that independently predicted PN: a steady relationship, with one male sexual partner and recent (<30 days) intercourse with the partner. Among the low income, pregnant MA and AA women, the three relationship variables predicted 81.6% of PN and correctly classified 78.5% of males notified and 65.7% of males not notified.
Undetectable HIV-1 Viral Load in the Fluid of Bullous Skin Lesion in a Patient Receiving Highly Active Antiretroviral Therapy
Authors: Tattevin Pierre , Maillard Anne , Tribut Olivier , Saíkali Emilie , Arvieux Cedric , Michelet Christian
Published: June 2008

Health-care workers may be exposed to bullous fluid while caring for bullous skin diseases in HIV-infected patients. Given that bullous fluid is a filtrate of plasma, it may be assumed that HIV viral load (VL) in bullous fluid is close to plasma VL. This was documented in a patient who had discontinued antiretroviral therapy because of nevirapine-associated toxic epidermal necrolysis, but no data are available in patients receiving antiretrovirals. An HIV-infected woman was admitted for leg cellulitis with a large bullous lesion. Her plasma HIV RNA had been undetectable for two years under the combination of efavirenz and boosted lopinavir. Bullous fluid analysis revealed undetectable HIV-1 RNA, while efavirenz and lopinavir concentrations were 1.4 and 3.4 μg/mL, respectively. The ratio of bullous fluid/plasma concentrations was 0.74 for efavirenz and 0.26 for lopinavir. These data may help us evaluate the need for antiretroviral prophylaxis after occupational exposure to bullous lesions fluid.
Acknowledging a persistent truth: domestic violence in pregnancy
Authors: Cook Joanna , Bewley Susan
Published: June 2008

Summary

Violence against women has a devastating effect on women's sexual and reproductive health, and also affects the health of their children. Such behaviour is rooted in gender inequality, which is sadly persistent, arguably throughout all societies. This phenomenon is a serious health and development concern, in addition to a violation of a woman's human rights. Violence can begin or escalate in pregnancy and has significant consequences for the woman, fetus and child. Questioning pregnant women about the presence of violence and offering referral to a secondary agency can help to break the pattern of abuse.
Analysis of consultants' NHS and private incomes in England in 2003/4
Authors: Morris Stephen , Elliott Bob , Ma Ada , McConnachie Alex , Rice Nigel , Skåtun Diane , Sutton Matt
Published: June 2008

Summary

Objective

Consultants employed by the NHS in England are allowed to undertake private practice to supplement their NHS income. Until the introduction of a new contract from October 2003, those employed on full-time contracts were allowed to earn private incomes no greater than 10% of their NHS income. In this paper we investigate the magnitude and determinants of consultants' NHS and private incomes.

Design

Quantitative analysis of financial data.

Setting

A unique, anonymized, non-disclosive dataset derived from tax returns for a sample of 24,407 consultants (92.3% of the total) in England for the financial year 2003/4.

Main outcome methods

The conditional mean total, NHS and private incomes earned by age group, type of contract, specialty and region of place of work.

Results

The mean annual total, NHS and private incomes across all consultants in 2003/4 were £110,773, £76,628 and £34,144, respectively. Incomes varied by age, type of contract, specialty and region of place of work. The ratio of mean private to NHS income for consultants employed on a full-time contract was 0.26. The mean private income across specialties ranged from £5,144 (for paediatric neurology) to £142,723 (plastic surgery). There was a positive association between mean private income and NHS waiting lists across specialties.

Conclusions

Consultants employed on full-time contracts on average exceeded the limits on private income stipulated by the 10% rule. Specialty is a more important determinant of income than the region in which the consultant works. Further work is required to explore the association between mean private income and waiting lists.
How fast is fast enough? An audit and league table of response times of acute hospital NHS Trust switchboards in England
Authors: Shokrollahi Kayvan , Tadiparthi Sujatha , Jayagopal Sathish
Published: June 2008

Summary

Objective

To audit response times by all acute NHS hospital switchboards in England for external incoming calls. As with any audit, we set out to draw attention to efficiencies and deficiencies in the system, highlight problems, and suggest the first steps towards improving standards in a very important and poorly acknowledged part of our healthcare system.

Design

Telephone calls were made to hospital switchboards, and time to response was measured. The results were then audited.

Setting

Acute hospital NHS Trust switchboards in England.

Main outcome measures

Time to response by hospital switchboards. The target time was 20 seconds.

Results

Only 36% of 219 hospital switchboards met the 20 second target, with the average answering time across all switchboards being 45 seconds. The best performer was University Hospital North Durham (mean = 1 second) and the worst Bristol Royal Infirmary (mean = 381 seconds). We found that automated answer systems substantially increase the answer time to an operator; the fastest automated service was at Princess Royal University Hospital, which was ranked 69th.

Conclusions

We recommend a formal NHS-wide audit system for switchboard response times.
Neonatal septicaemia in Calabar, Nigeria
Authors: Anah M U , Udo J J , Ochigbo S O , Abia-Bassey L N
Published: June 2008

SUMMARY

A three-year survey of neonatal septicaemia (363 bacteriologically proven cases) in the University of Calabar Teaching Hospital, Calabar, has demonstrated that the dominant blood isolate was Staphylococcus aureus (53%) followed by unclassified Coliforms (20%), an unexpected Chromobacterium violaceum (5%). The incidence of neonatal septicaemia was 54.9 per 1000 live births for inborn infants. The predominant organisms were largely susceptible to gentamicin, ceftriazone and cefuroxime with a mortality rate of 19% with most (60.9%) of the fatalities being due to Gram-negative organisms.
Tetanus in a rural Ethiopian hospital
Authors: Ramos Jose Manuel , Reyes Francisco , Tesfamariam Abraham
Published: June 2008

SUMMARY

Despite the widespread availability of a safe and effective vaccine, tetanus continues to be a significant public health problem in the developing countries.
Causes of gas gangrene seen at the University of Nigeria Teaching Hospital, Enugu, Nigeria
Authors: Nwankwo Okechukwu Emmanuel
Published: June 2008

SUMMARY

Gas gangrene (clostridial myonecrosis) is rarely seen and this rarity, coupled with its dramatic presentation and often devastating outcome, makes each case of gas gangrene a spectacular and memorable experience. This study analyses the cases managed, the causes and outcome. Gunshot wounds, compounded by late presentation with its accompanying florid infections, were seen as the causes in 14 cases of gas gangrene seen at the University of Nigeria Teaching Hospital, Enugu during the four-year study period from July 2000 to June 2004.
The prevalence of congenital malaria among neonates with suspected sepsis in Calabar, Nigeria
Authors: Ekanem A D , Anah M U , Udo J J
Published: June 2008

SUMMARY

We studied the prevalence of congenital malaria among neonates with suspected sepsis and its outcome at the University of Calabar Teaching Hospital, Calabar, Nigeria. All in-born neonates admitted to the newborn unit with clinical features suggestive of sepsis were recruited. They were screened for bacterial sepsis and malaria. The mothers of the neonates that had parasitaemia were further screened for malaria and anaemia.

A total of 546 in-born neonates were admitted to the neonatal unit and 202 (37%) presented with clinical signs suggested of sepsis. Of these, 71 babies (35% of 202 or 13% of the total in-born nursery admissions) had congenital malaria and 14 also had sepsis. Sixty-three (88.7%) of the parasitaemic babies were delivered by mothers who received antenatal care at our centre. Eighty-six percent of the mothers of the 71 babies also had the malaria parasite in their blood. The majority (67%) of the 71 mothers were gravidae 2 and below. Thirty (42.3%) of the affected neonates were anaemic and 5 (7%) of them required a blood transfusion.

Congenital malarial is not uncommon in Calabar among babies with suspected sepsis. It appears that the antenatal chemoprophylaxis with pyrimethamine (25 mg weekly) currently used for malaria in our centre no longer protects the mother and fetus. An alternative is needed in order to stem maternal, fetal and neonatal morbidity and wastage. Babies with features of sepsis should be routinely screened for malaria.
The clinical spectrum of chronic liver disease in children presenting to a tertiary level teaching hospital in New Delhi
Authors: Rajeshwari K , Gogia S
Published: June 2008

SUMMARY

We report on the clinical spectrum of chronic liver disease (CLD) in children presenting to a tertiary level teaching hospital. Children aged <14 years with suspected CLD presenting to the paediatric gastroenterology department of Maulana Azad Medical College between January 1999 and December 2004, were prospectively studied. They were all given liver function tests, abdominal ultrasonography, endoscopy, viral markers and were checked for Wilson's disease, autoimmune hepatitis and liver biopsy wherever feasible. Other tests for metabolic liver diseases were done when indicated. CLD was diagnosed in 174 children over the six-year period. Cryptogenic cirrhosis was the most common entity, followed by hepatitis B-induced liver disease and Wilson's disease. Most patients presented late with evident portal hypertension.
The role of antibiotic prophylaxis in mesh repair of primary inguinal hernias using prolene hernia system: a randomized prospective double-blind control trial
Authors: Jain S K , Jayant M , Norbu C
Published: June 2008

SUMMARY

Antibiotic prophylaxis is being commonly used in mesh repair of inguinal hernia but its role has been questioned in a recent Cochrane analysis performed in 2003. Routine use of antibiotic prophylaxis in mesh repair of inguinal hernia can lead to bacterial resistance and increase in cost. In a present double-blind placebo controlled trial involving 120 patients undergoing inguinal hernia repair using prolene hernia system, we did not find any benefit of the routine use of antibiotic prophylaxis in terms of wound infection rate.
Diarrhoeal outbreak of Vibrio cholerae 01 Inaba in Delhi
Authors: Rajeshwari K , Gupta Ashish , Dubey A P , Uppal Beena , Singh M M
Published: June 2008

SUMMARY

V. cholerae O1 Eltor serotype Ogawa has been causing most of the cholera outbreaks in India till recently. However this communication reports the occurrence of Vibrio Cholerae O1 Inaba in Delhi in 2005, as a predominant causative organism of cholera in children. All strains isolated were sensitive to gentamicin and a high level of resistance towards nalidixic acid and amoxicillin was seen. There was no case fatality.
Child maltreatment at a violence recovery centre in Kenya
Authors: Saidi Hassan , Odula Paul , Awori Kirsten
Published: June 2008

SUMMARY

Kenyan media reports indicate escalating levels of child maltreatment, but the characteristics of the offence are undefined. At the Gender and Violence recovery Center of the Nairobi Women's Hospital, we analysed 342 consecutive children for age, gender, perpetrator characteristics, time and scene of assault and the nature of injuries between February 2003 and April 2004. The children comprised 43.5% of all assault survivors. The mean age was 10.0 years and about 20% of the children were ≤5 years. Most (71.5%) of the child sexual abuse (CSA) was perpetrated by people known to the victim. Intra-family CSA (incest) was highest among the one to five year olds. The proportion of assaults committed against boys reduced with the age of the child. Older children were more likely to be assaulted later in the day and by multiple perpetrators. Most recorded injuries were perineal. The majority of children are assaulted by people they had trusted. The epidemiological correlates of maltreatment differ for younger and older children. More effort is needed to further characterize child violence and protect this vulnerable section of the population.
Clinical profile of pleural empyema and associated factors with prolonged hospitalization in paediatric tertiary centre in Angola, Luanda
Authors: de Britto Murilo Carlos Amorim , da Conceicao Silvestre Silvia Maria Mendes , do Carmo Menezes Duarte Maria , de Matos Bezerra Patricia Gomes
Published: June 2008

SUMMARY

In a case series of 152 children aged from 2 to 132 months will pleural emphema from a paediatric tertiary hospital in Luanda, Angola between September 2004 and March 2005, the authors found a high prevalence of anaemia and malnutrition. The most prevalent bacteria in pleural fluid were: D pneumoniae, Haemophyllus and S aureus. The median for hospital stay was 25 days. The lethality was 7.8% and was not statistically associated with malnutrition, although this variable was associated, in multivariate analysis, with prolonged hospitalization time.
Health-care seeking behaviour for TB symptoms in two provinces of Uzbekistan
Authors: Hasker Epco , Khodjikhanov Maksad , Usarova Shakhnoza , Yuldasheva Umida , Uzakova Gulnoza , Veen Jaap
Published: June 2008

SUMMARY

In Uzbekistan, mass X-ray screening for TB is still used. The groups targeted are broad and include at least 50% of the population. Of all pulmonary TB cases, 73% are reported to be detected by this method. However, in this study of 85 randomly selected pulmonary TB patients, only 16% confirmed were been detected through this method. Having known risk factors for TB did not increase the likelihood of its being detected, which highlights the need to revise the current screening policy.
The use of the condom-catheter for the treatment of postpartum haemorrhage – the Sokoto experience
Authors: Airede Lydia R , Nnadi Daniel C
Published: June 2008

SUMMARY

Postpartum haemorrhage (PPH) is the most common cause of maternal mortality globally. In about 50% of cases PPH is due to uterine atony. When conservative and medical methods of treating PPH due to uterine atony fail, surgical intervention is required to save the woman's life. As an alternative in such cases, intrauterine tamponade has been used successfully to stop bleeding, thus avoiding surgery. We report four cases of PPH due to uterine atony in which intrauterine tamponade with an inflated condom was effective in arresting haemorrhage. We advocate the use of a similar device in carefully selected cases, especially in low-resource settings.
Assessment of the therapeutic efficacy of chloroquine in the treatment of uncomplicated Plasmodium falciparum malaria in a tribal block of the Kalahandi district of Orissa, India
Authors: Kerketta A S , Mohapatra S S S , Kar S K
Published: June 2008

SUMMARY

The study on therapeutic efficacy of chloroquine was carried out in a tribal dominated block of Kalahandi district of Orissa, India. It revealed 94% treatment failure with standard dose of chloroquine in the treatment of uncomplicated P. falciparum malaria cases. The study warrants the change to alternate antimalarials in this region.
Improvised cost-effective halo vest brace using a recycled Ilizarov ring and a threaded rod
Authors: Jayaram Manju , Kumar Pankaj , Khanal Guru Prasad , Singh M P , Singh Girish Kumar , Karn Navin Kumar , Shrestha Aman
Published: June 2008

SUMMARY

We designed less expensive halo vest brace using an Ilizarov ring and a threaded rod, which is as effective as the normal halo vest. It can be used in any orthopedic set-up.
A simple and improved method for diagnosis of tuberculosis using hypertonic saline and sodium hydroxide to concentrate and decontaminate sputum
Authors: Ricaldi Jessica N , Guerra Humberto
Published: June 2008

SUMMARY

We report the use of hypertonic saline and sodium hydroxide (HS-SH) for concentration-decontamination of sputum samples for the diagnosis of tuberculosis. This method increases detection of mycobacteria in smears compared to examination of direct smears, is comparable and reduces contamination in cultures compared to NALC-NaOH.
Perinatal outcome of primiparous teenagers in northern Namibia
Authors: van Dillen Jeroen , van Beijeren Eline , van Roosmalen Jos
Published: June 2008

SUMMARY

Internationally, teenagers are at risk for pregnancy-related morbidity and mortality. We assessed the obstetric and perinatal outcomes of teenage pregnancies compared with their older counterparts in northern Namibia.

We made a retrospective study using birth records from February 2002 to August 2002. The data collected included perinatal mortality, delivery mode, birth weight, in-hospital days and frequency of antenatal care (ANC) attendance. They were compared with primiparous women in different age groups ( n = 612). No differences were found in obstetric and perinatal outcomes between the three different age groups. Overall ANC attendance was high.

The perinatal outcome for pregnant teenagers was comparable with their older counterparts in northern Namibia. In this region, ANC succeeds in reaching pregnant teenagers and teenage pregnancies are not at an increased risk for obstetric complications.
Risk factors for drug resistant tuberculosis in southeast Turkey
Authors: Tanrikulu A Cetin , Hosoglu Salih , Ozekinci Tuncer , Abakay Abdurrahman , Gurkan Fuat
Published: June 2008

SUMMARY

We undertook a cross-sectional survey of 116 patients at Dicle Hospital, Turkey, who had with bacteriologically confirmed tuberculosis (TB). Demographic and clinical features, including age, gender, pulmonary TB history, associated diabetes mellitus, previous TB treatment, residential area and education, were collected from charts. Eighty-four of the strains were found to be susceptible to all drugs. The resistance to one or more drug(s) was found in 32 strains. Multi-drug resistant (MDR) TB was found in 13 strains (11.3% of the total and 40.7% of the drug resistant strains). The resistance to isoniazid was the most frequently seen (25 strains, 21.5%). In the multivariable analysis, only previous TB treatment ( P = 0.000) remained a significant predictor for drug resistance; in MDR, previous TB treatments ( P = 0.002) remained significant in the final model. The patient's educational status was found to be negatively correlated with the risk of MRD-TB ( P = 0.035). Previous TB treatment and low educational status were found to important risk factors for the development of MDR-TB.
A fatal case of streptococcal toxic shock syndrome
Authors: Doganci Levent , Tanyel Esra , Basıbuyuk Hakki , Darka Ozge
Published: June 2008

SUMMARY

In daily medical practice, streptococcal toxic shock syndrome is an infrequent clinical entity which carry a very high risk of fatality. Early recognition of this toxin mediated immunopathological disease is very important to apply necessary invasive procedures such as an prompt amputation of the effected areas to save the patient. Here, we report a 47 year-old male farmer with a fatal streptococcal toxic shock syndrome to highlight the importance of emergency care and aggresive surgical intervention in similar situations.
A simple and cheap alternative to spring loaded syringe for the identification of epidural space
Authors: Malhotra Naveen , Jangra Anil
Published: June 2008

SUMMARY

A simple and cheap alternative to spring-loaded syringe for the identification of epidural space is described. It is easily assembled using a syringe and a rubber band. This assembly is reusable and is especially useful for beginners.
Endometrial resection/vaporization: a patient-friendly first-option treatment for menorrhagia in rural areas
Authors: Gnanaraj J , Lionel Jessie
Published: June 2008

SUMMARY

Hysterectomy, a major surgical procedure, is often an unacceptable procedure for many patients from rural areas who attend small rural hospitals. Near total endometrial resection/vaporization is a more acceptable procedure which can control menorrhagia. This procedure can be carried out with standard urology instruments.
Kestrel: An Interface from Optimization Modeling Systems to the NEOS Server
Authors: Dolan Elizabeth D. , Fourer Robert , Goux Jean-Pierre , Munson Todd S. , Sarich Jason
Published: July 2008

The NEOS server provides access to a variety of optimization resources via the Internet. The new Kestrel interface to the server enables local modeling environments to request NEOS optimization services and retrieve the results for local visualization and analysis so that users have the same convenient access to remote NEOS solvers as to those installed locally. Kestrel agents have been implemented for the AMPL and GAMS modeling environments; these agents have been designed so that subproblems can be queued for execution and later retrieval of results, making possible a rudimentary form of parallel processing.
Revenue Management for a Primary-Care Clinic in the Presence of Patient Choice
Authors: Gupta Diwakar , Wang Lei
Published: July 2008

In addition to having uncertain patient arrivals, primary-care clinics also face uncertainty arising from patient choices. Patients have different perceptions of the acuity of their need, different time-of-day preferences, as well as different degrees of loyalty toward their designated primary-care provider (PCP). Advanced access systems are designed to reduce wait and increase satisfaction by allowing patients to choose either a same-day or a scheduled future appointment. However, the clinic must carefully manage patients' access to physicians' slots to balance the needs of those who book in advance and those who require a same-day appointment. On the one hand, scheduling too many appointments in advance can lead to capacity shortages when same-day requests arrive. On the other hand, scheduling too few appointments increases patients' wait time, patient-PCP mismatch, and the possibility of clinic slots going unused.

The capacity management problem facing the clinic is to decide which appointment requests to accept to maximize revenue. We develop a Markov decision process model for the appointment-booking problem in which the patients' choice behavior is modeled explicitly. When the clinic is served by a single physician, we prove that the optimal policy is a threshold-type policy as long as the choice probabilities satisfy a weak condition. For a multiple-doctor clinic, we partially characterize the structure of the optimal policy. We propose several heuristics and an upper bound. Numerical tests show that the two heuristics based on the partial characterization of the optimal policy are quite accurate. We also study the effect on the clinic's optimal profit of patients' loyalty to their PCPs, total clinic load, and load imbalance among physicians.
The pathogenesis and surgical treatment of tears of the rotator cuff
Authors: Rees J. L.
Published: June 2008

This review discusses the pathogenesis and surgical treatment of tears of the rotator cuff.
Measurement of blood flow in the rotator cuff using laser Doppler flowmetry
Authors: Levy O. , Relwani J. , Zaman T. , Even T. , Venkateswaran B. , Copeland S.
Published: June 2008

The aim of this study was to define the microcirculation of the normal rotator cuff during arthroscopic surgery and investigate whether it is altered in diseased cuff tissue.

Blood flow was measured intra-operatively by laser Doppler flowmetry. We investigated six different zones of each rotator cuff during the arthroscopic examination of 56 consecutive patients undergoing investigation for impingement, cuff tears or instability; there were 336 measurements overall.

The mean laser Doppler flowmetry flux was significantly higher at the edges of the tear in torn cuffs (43.1, 95% confidence interval (CI) 37.8 to 48.4) compared with normal cuffs (32.8, 95% CI 27.4 to 38.1; p = 0.0089). It was significantly lower across all anatomical locations in cuffs with impingement (25.4, 95% CI 22.4 to 28.5) compared with normal cuffs (p = 0.0196), and significantly lower in cuffs with impingement compared with torn cuffs (p < 0.0001).

Laser Doppler flowmetry analysis of the rotator cuff blood supply indicated a significant difference between the vascularity of the normal and the pathological rotator cuff. We were unable to demonstrate a functional hypoperfusion area or so-called ‘critical zone’ in the normal cuff. The measured flux decreases with advancing impingement, but there is a substantial increase at the edges of rotator cuff tears. This might reflect an attempt at repair.
Ankle fractures in diabetic neuropathic arthropathy
Authors: Ayoub M. A.
Published: June 2008

Between 2000 and 2006 we performed salvage tibiotalar arthrodesis in 17 diabetic patients (17 ankles) with grossly unstable ankles caused by bimalleolar fractures complicated by Charcot neuro-arthropathy. There were ten women and seven men with a mean age of 61.6 years (57 to 69). A crossed-screw technique was used. Two screws were used in eight patients and three screws in nine. Additional graft from the malleoli was used in all patients. The mean follow-up was 26 months (12 to 48) and the mean time to union was 5.8 months (4 to 8). A stable ankle was achieved in 14 patients (82.4%), nine of whom had bony fusion and five had a stiff fibrous union. The results were significantly better in underweight patients, in those in whom surgery had been performed three to six months after the onset of acute Charcot arthropathy, in those who had received anti-resorptive medication during the acute stage, in those without extensive peripheral neuropathy, and in those with adequate peripheral oxygen saturation (> 95%). The arthrodesis failed because of avascular necrosis of the talus in only three patients (17.6%), who developed grossly unstable, ulcerated hindfeet, and required below-knee amputation.
The effect of quadriceps contraction during weight-bearing on four patellar height indices
Authors: Yiannakopoulos C. K. , Mataragas E. , Antonogiannakis E.
Published: June 2008

The effect of weight-bearing on the height of the patellar using four radiological indices was studied in 25 healthy men using lateral radiographs of the knee in 30° of flexion non-weight-bearing and weight-bearing. The position of the patella was quantified using the Insall-Salvati, the modified Insall-Salvati, the Blackburne-Peel and the Caton indices. The contraction of the quadriceps on weight-bearing resulted in statistically significant proximal displacement of the patella with all four indices studied. The mean Insall-Salvati index was 0.919 (sd 0.063) before and 1.109 (sd 0.042) after weight-bearing (p = 0.001), while the mean modified Insall-Salvati index was 0.734 (sd 0.039) before and 0.896 (sd 0.029) after weight-bearing (p = 0.041). Similarly, the Blackburne-Peel index was 0.691 (sd 0.09) before and 0.807 (sd 0.137) after weight-bearing (p = 0.012). The mean Caton index was 0.861 (sd 0.09) before and 0.976 (sd 0.144) after weight-bearing (p = 0.023).

The effect of quadriceps contraction should be considered in clinical studies where the patellar position indices are reported.
Pseudotumours associated with metal-on-metal hip resurfacings
Authors: Pandit H. , Glyn-Jones S. , McLardy-Smith P. , Gundle R. , Whitwell D. , Gibbons C. L. M. , Ostlere S. , Athanasou N. , Gill H. S. , Murray D. W.
Published: June 2008

We report 17 patients (20 hips) in whom metal-on-metal resurfacing had been performed and who presented with various symptoms and a soft-tissue mass which we termed a pseudotumour. Each patient underwent plain radiography and in some, CT, MRI and ultrasonography were also performed. In addition, histological examination of available samples was undertaken.

All the patients were women and their presentation was variable. The most common symptom was discomfort in the region of the hip. Other symptoms included spontaneous dislocation, nerve palsy, a noticeable mass or a rash. The common histological features were extensive necrosis and lymphocytic infiltration. To date, 13 of the 20 hips have required revision to a conventional hip replacement. Two are awaiting revision.

We estimate that approximately 1% of patients who have a metal-on-metal resurfacing develop a pseudotumour within five years. The cause is unknown and is probably multifactorial. There may be a toxic reaction to an excess of particulate metal wear debris or a hypersensitivity reaction to a normal amount of metal debris. We are concerned that with time the incidence of these pseudotumours may increase. Further investigation is required to define their cause.
A technique of fusion for failed total replacement of the ankle
Authors: Thomason K. , Eyres K. S.
Published: June 2008

Salvage of a failed total ankle replacement is technically challenging and although a revision procedure may be desirable, a large amount of bone loss or infection may preclude this. Arthrodesis can be difficult to achieve and is usually associated with considerable shortening of the limb.

We describe a technique for restoring talar height using an allograft from the femoral head compressed by an intramedullary nail. Three patients with aseptic loosening were treated successfully by this method with excellent symptomatic relief at a mean follow-up of 32 months (13 to 50).
The determination of linear and angular penetration of the femoral head into the acetabular component as an assessment of wear in total hip replacement
Authors: Geerdink C. H. , Grimm B. , Vencken W. , Heyligers I. C. , Tonino A. J.
Published: June 2008

We have compared four computer-assisted methods to measure penetration of the femoral head into the acetabular component in total hip replacement. These were the Martell Hip Analysis suite 7.14, Rogan HyperOrtho, Rogan View Pro-X and Roman v1.70. The images used for the investigation comprised 24 anteroposterior digital radiographs and 24 conventional acetate radiographs which were scanned to provide digital images. These radiographs were acquired from 24 patients with an uncemented total hip replacement with a follow-up of approximately eight years (mean 8.1; 6.3 to 9.1). Each image was measured twice by two blinded observers. The mean annual rates of penetration of the femoral head measured in the eight-year single image analysis were: Martell, 0.24 (SD 0.19); HyperOrtho, 0.12 (SD 0.08); View Pro-X, 0.12 (SD 0.06); Roman, 0.12 (SD 0.07). In paired analysis of the six-month and eight-year radiographs: Martell, 0.35 (SD 0.22); HyperOrtho, 0.15 (SD 0.13); View Pro-X, 0.11 (SD 0.06); Roman, 0.11 (SD 0.07). The intra- and inter-observer variability for the paired analysis was best for View Pro-X and Roman software, with intraclass correlations of 0.97, 0.87 and 0.96, 0.87, respectively, and worst for HyperOrtho and Martell, with intraclass correlations of 0.46, 0.13 and 0.33, 0.39, respectively.

The Roman method proved the most precise and the most easy to use in clinical practice and the software is available free of charge. The Martell method showed the lowest precision, indicating a problem with its edge detection algorithm on digital images.
Deep-seated ordinary and atypical lipomas
Authors: Billing V. , Mertens F. , Domanski H. A. , Rydholm A.
Published: June 2008

Deep-seated lipomas are often atypical histologically and are considered by some to have a high risk of recurrence after excision. We reviewed 215 deep-seated lipomas of the extremities and trunk wall with reference to histology, cytogenetics, clinical features and local recurrence. We classified tumours with atypical features and/or ring chromosomes as atypical lipomas. These were more common in men, larger than ordinary lipomas and more often located in the upper leg. The annual incidence was estimated as ten per million inhabitants and the ratio of atypical to ordinary lipomas was 1:3. In total, six tumours (3%), recurred locally after a median of eight years (1 to 16); of these, four were classified as atypical.

The low recurrence rate of deep-seated lipomas of the extremity or trunk wall, irrespective of histological subtype, implies that if surgery is indicated, the tumour may be shelled out, that atypical lipomas in these locations do not deserve the designation well-differentiated liposarcoma, and that routine review after surgery is not required.
Antibiotic prophylaxis before invasive dental procedures in patients with arthroplasties of the hip and knee
Authors: Uçkay I. , Pittet D. , Bernard L. , Lew D. , Perrier A. , Peter R.
Published: June 2008

More than a million hip replacements are carried out each year worldwide, and the number of other artificial joints inserted is also rising, so that infections associated with arthroplasties have become more common. However, there is a paucity of literature on infections due to haematogenous seeding following dental procedures. We reviewed the published literature to establish the current knowledge on this problem and to determine the evidence for routine antibiotic prophylaxis prior to a dental procedure.

We found that antimicrobial prophylaxis before dental interventions in patients with artificial joints lacks evidence-based information and thus cannot be universally recommended.