bluuebunny/crossref_metadata_2025 huggingface dataset:
Associated Morbidities in Children with Sickle-Cell Anaemia Presenting with Severe Anaemia in a Malarious Area
Authors: Ambe J P , Fatunde J O , Sodeinde O O
Published: January 2017

A prospective study of 104 consecutive cases of patients with sickle-cell anaemia (SCA) presenting with severe anaemia (packed cell volume ≤ 15%) was carried out in the Children's Emergency Ward of the University College Hospital, Ibadan, in 1991.

The patients were classified according to the type of anaemic crisis, by physical findings, serum bilirubin and reticulocyte counts. Other investigations included a blood film for malaria parasites, blood culture, radiological investigation and lumbar puncture when necessary. The most common problems associated with SCA patients in anaemic crisis were malaria and bacterial infections − 68 (66%) and 18 (17.3%) of cases, respectively. Acute chest syndrome was significantly more frequent in patients with hyperhaemolytic and acute splenic sequestration crisis compared with aplastic crisis ( P < 0.05).

Conjugated hyperbilirubinaemia was also significantly more frequent among patients with hyperhaemolytic crisis compared with all other anaemic crises (χ2=13.18, P=0.001).

The overall case fatality was 86.5/1000 SCAs, with no fatalities in those with aplastic crisis. There were complications in six of the nine mortalities.

Co-existing bacterial infections and conjugated hyperbilirubinaemia were associated with increased morbidity and mortality in patients with anaemic crisis. Patients with SCA crisis should have early evaluation and prompt treatment for associated infections.
Outcome of Extracapsular Cataract Surgery plus Posterior Chamber Intraocular Lens Insertion for Age-Related Cataract in Eastern Nepal
Authors: Kaini K R , Thakur S K D , Panda A
Published: January 2017

As age-related cataract is the leading cause of blindness in Nepal, much more attention should be given to improving surgical outcomes. The aim of our study was to determine the effectiveness and risks of extracapsular cataract surgery (ECCE) for age-related cataract in a tertiary hospital of eastern Nepal. ECCE with posterior chamber intraocular lens (PC IOL) insertion on 797 eyes (754 patients) revealed improved visual acuity in 97.9%. In 595 (74.6%) the best corrected visual acuity was 6/18 or better, and 167 (20.9%) had 6/24 to 6/60 with negligible operative/postoperative complications. Thus it is concluded that ECCE with PC IOL could be performed safely and effectively even in developing countries where people are unaware that surgery is available and of the good surgical outcome.
Distribution of ABO and Rh-D Blood Groups among Blood Donors in a Tertiary Care Centre in South India
Authors: Das P K , Nair S C , Harris V K , Rose D , Mammen J J , Bose Y N , Sudarsanam A
Published: January 2017

The distribution of ABO and Rh-D blood groups was studied among 150 536 blood donors screened at the Dr John Scudder Memorial Blood Bank, Christian Medical College Hospital, Vellore, over a period of 11 years (April 1988 to March 1999). The most common blood group was found to be group O [58 330 (38.75%)], followed by group B [49 202 (32.69%)], and group A [28 372 (18.85%)]. The least common blood group was AB group [7930 (5.27%)]. A2 or A2B groups were found in 3.01% and 1.43% of donors, respectively. The prevalence of Rh-D negative group was found in 8225 (5.47%) donors. Bombay group (H negative non-secretor, genotype hh phenotype Oh) was found in six donors (0.004%). Although the incidence of Rh-D negative group was identical to previously published data from North India, the most common blood group was O group in our study as opposed to B group.
Influence of Place of Delivery on Immediate Perinatal Outcomes: A Study from Northern India
Authors: Banerjee Neelam , Kriplani Alka , Takkar Deep
Published: January 2017

One hundred and six women giving birth in a rural hospital in Northern India were compared with 100 women delivering in a tertiary care urban hospital located in an adjacent state. The women in the rural hospital were younger and more likely to be multiparous. Their antenatal course was characterized by fewer antenatal check-ups, significantly lower haemoglobin values, but equal weight gain during pregnancy. They were more likely to have a spontaneous vaginal delivery, and less likely to undergo caesarean section and episiotomy. Neonatal birth weights were lower in the rural group; other indices of neonatal well-being were comparable.
Single-Stage Lumbar Sympathectomy and Omentopexy: A New Surgical Approach towards Patients with Buerger's Disease
Authors: Talwar Sachin , Prasad Pranesh
Published: January 2017

Single-stage lumbar sympathectomy and omentopexy were performed in six patients with Buerger's disease at the Department of Surgery, Jawahar Lal Nehru Medical College and Hospital, Ajmer, India, between January 1994 and December 1996. All were male smokers and had limb coldness, intermittent claudication and rest pain. Four had limb discoloration and three had ulcers of toes unresponsive to medical treatment. Post-operatively there was relief of symptoms in all, with improvement of tissue oxygen saturation and increase in claudication distance. We conclude that single-stage lumbar sympathectomy and omentopexy is an effective new surgical approach towards patients with Buerger's disease.
Diagnosis of Pneumonia by Community Health Volunteers: Experience of BRAC, Bangladesh
Authors: Hadi Abdullahel
Published: January 2017

The study assessed the validity of community health volunteers' diagnosis of pneumonia in children through simple clinical signs. Data were collected by a group of research physicians who observed the case management performance of 120 health volunteers in Bangladesh where the Bangladesh Rural Advancement Committee has been providing community-based acute respiratory infection control since mid-1992. 1,166 children age 3–60 months were assessed at household level by both a community health volunteer and a research physician. Using physician diagnosis as gold standard, health volunteers' diagnosis of pneumonia was 67.6% sensitive and 95.2% specific. Cohen's k for agreement between volunteers and physicians was 0.67. Of the clinical signs elicited, chest in drawing and noisy breathing predicted physician's diagnosis of pneumonia most strongly ([positive predictive value (PPV)] 84% and 79%, respectively). The study concludes that less educated health volunteers can be effectively used in diagnosing pneumonia at grassroots level in developing countries.
Anaesthesia in Rural Tanzania
Authors: Kimaro Ernestina , Towey R M
Published: January 2017

A survey of the anaesthetic services in rural Tanzania was carried out in an area of 67 500 km2 and population of 4 million in order to assess the quality of anaesthesia and the major obstacles to good practice. Lack of draw-over vaporizers, Ayre's T-pieces, and a supply of oxygen were found to be the major obstacles to safe practice in this area of Africa.
Management of Enterocutaneous Fistulae in Benin City Nigeria
Authors: Ohanaka Chibundu E , Momoh I M , Osime U
Published: January 2017

We report a prospective study of 17 cases of enterocutaneous fistulae managed at the University of Benin Teaching Hospital, Benin City, Nigeria between June 1992 and June 1999. All the cases were iatrogenic in origin and all age groups (6 weeks to 68 years, mean 27) were represented. There were 10 males and 7 females. Emergency surgery for acute appendicitis and intestinal obstruction were the commonest causes.

Management should be conservative initially but surgery should be resorted to if there is no significant improvement, particularly in circumstances where facilities for total parenteral nutrition are not available. A literature review has been carried out and measures to prevent the development of enterocutaneous fistula are outlined.
Subacute Sclerosing Panencephalitis — A Pakistan Perspective
Authors: Tariq Waheed-Uz-Zaman , Waqar Talal , Ghani Ejaz
Published: January 2017

Subacute sclerosing panencephalitis (SSPE) remains a problem in areas of the world where measles virus is prevalent because of a lack of commitment to universal vaccination. We recently studied 89 cases compatible with a clinical diagnosis of SSPE and tested for antibody in serum or cerebrospinal fluid for measles virus. Eleven cases were confirmed to be SSPE on the basis of strongly supportive laboratory data.
Anti-CagA Antibodies in Helicobacter Pylori-Positive Patients and Blood Donors from Nigeria
Authors: Rocha Andreia Maria Camargos , Rocha Gifone Aguiar , Queiroz Dulciene Maria de Magalhães , Ani Agatha E , Okeke E N , Bello C S S , Malu A O
Published: January 2017

The prevalence of antibodies to CagA protein was evaluated in 174 Helicobacter pylori-positive subjects: 110 patients submitted to upper gastrointestinal endoscopy and 64 male blood donors. The patients were from different regions of Nigeria: Jos, North, Benue, West and East and the blood donors were from Jos. Sera were assayed for anti-CagA antibodies using Helicobacter p120, CagA ELISA (Viva Diagnostika, Hürth, Germany). Anti-CagA antibodies were detected in 104 (94.5%) patients and in 61 (95.3%) blood donors ( P=1.0). Patients from the Benue region presented a lower frequency of anti-CagA antibodies than patients from the other regions ( P=0.0004). When the subjects were stratified by age, a significant increase in IgG concentration was observed among the men ( P=0.03) but not among the women ( P=0.57) or among the blood donors ( P=0.83). In conclusion, similarly to Asian countries, CagA-positive H. pylori infection is highly frequent in Nigeria.
Thyroid Function Testing in Eastern Nepal and the Impact of CME on Subsequent Requests
Authors: Baral N , Koner B C , Lamsal M , Niraula I , Dhungel S
Published: January 2017

This study reveals 1 year's experience of the introduction of thyroid function tests (TFT) in B P Koirala Institute of Health Sciences (BPKIHS), a Medical University situated in eastern Nepal. These were performed on the advice of doctors working in this region. The rational TFT advice by the medical practitioners was evaluated according to how closely the advice was in line with the algorithms recommended in the textbooks. Only about 14% of the TFT advice followed some rational strategy. A retrospective analysis showed that rational TFT advice could have reduced the cost of a TFT investigation to 43.11% without altering the patient management and disease outcome. Continuing medical education (CME) lectures arranged for a limited number of doctors were found to improve the quality of the subsequent TFT advising pattern. This emphasizes the importance of CME while introducing a costly laboratory test panel (e.g. TFT, lipid profile) needing a strategic approach.
The Use of Misoprostol for Mid-Trimester Therapeutic Termination of Pregnancy
Authors: Munthali J , Moodley J
Published: January 2017

Extra-amniotic prostaglandin F2α (PG F2α) is probably the most widely used medical method for mid-trimester termination of pregnancy. The method is highly effective but is financially costly, particularly for poor countries faced with restricted health budgets.

The aim of this study was to establish whether misoprostol administered vaginally is as effective as PG F2α. Sixty-one patients were prospectively randomized to receive either misoprostol ( n=30) vaginally, or PG F2α ( n=31) extra-amniotically. The overall success rate was 83.6%. The success rates in the misoprostol and PG F2α groups were 83.3% and 83.8% respectively. There was no statistical difference in the groups in relation to side effects.

In this carefully selected group of patients, misoprostol was as safe and effective as PG F2α in mid-trimester termination of pregnancy. In these days of financial constraints, misoprostol is the preferred method for mid-trimester termination of pregnancy.
The Improvised Atraumatic Suture: A Cost-Reducing Technique, Not Only for the Tropics?
Authors: Freudenberg S , Samel S , Sturm J , Trede N
Published: January 2017

A simple technique to produce your own atraumatic suture is described. All that is needed is a simple injection needle and any kind of thread. The thread is introduced into the cavity of the needle and fixed by squeezing its end after having broken the hub. This method is very easy to apply and extremely economical.
Kerosene Poisoning in Children: A Report from Northern Jordan
Authors: Abu-Ekteish F
Published: January 2017

A prospective study was conducted over 4 years to evaluate the children with kerosene ingestion in northern Jordan. One hundred and twenty children aged 11 months to 6 years (mean age 2.2) were studied. The majority of patients (90%) were below the age of 4. Most of the cases (42%) were seen during the summer season. The most common presenting symptoms were: cough (70.6%); tachypnoea (59.6%), and fever (55.1%). In 25 patients the parents had induced vomiting before arrival. The main sites of storage for kerosene were: under stairs (36.7%); the kitchen; (33.3%) and bathroom (11.7%). The main containers used were soft drink bottles, water jugs and water glasses. The patients were treated symptomatically, and all except one who was comatose on admission made a complete recovery. Health education and preventive measures are given.
Corrosive Oesophagitis in Nigeria: Clinical Spectrums and Implications
Authors: Ogunleye A O A , Nwaorgu O G B , Grandawa Hamman
Published: January 2017

Ingested corrosive agents produce oro-pharyngeal and gastro-oesophageal injuries ranging from minor burns to severe necrosis, depending on the agent, amount, concentration and duration of exposure. A 10-year (1990–1999) study of 23 corrosive oesophagitis patients depicting the clinical spectrums and implications was done. There were 17 (74%) males and 6 (26%) females, with an average age of 16 years: 35% were in the first decade of life and 39% in the second, with an average occurrence of three new cases a year.

The main corrosive agents were alkali (NaOH) 48% and sulphuric acid 39%. The factors that predisposed to corrosive ingestion included: accidental 43%; suicidal 35%; homicidal 13% and ‘therapy’ 9%. Of the accidental cases 60% were seen in children; 75% of suicide attempts were in the second decade of life. Eleven (48%) patients developed complications, namely laryngeal stenosis 4% and oesophageal strictures 44%. The hospital stay ranged from 2–4 weeks.

Awareness of the dangers of corrosive ingestion should be extensively publicized. Government regulations permitting the sales and procurement of corrosive substances should be strictly enforced and, if not yet in place, should be enacted without further delay.
Impact of Sanitation and Health Education on Intestinal Parasite Infection among Primary School Aged Children of Sherpur, Bangladesh
Authors: Hosain G M Monawar , Saha Subas , Begum Afroza
Published: January 2017

This study was carried out in 1999–2000 in the northern part of Bangladesh to determine the impact of sanitary latrine use and of health education on intestinal parasites in school-aged children. The children were between 5 and 13 years of age and stool samples revealed that more than half (53%) of the study sample was still infected with one or more intestinal parasites even after 4 years of intervention. Ascariasis was found to have the highest prevalence rate (36.2%) and hookworm the lowest (10.7%). Intestinal parasite infection was significantly lower ( P<0.05) among those who used a sanitary latrine and received health education. This result is consistent with observations that the effect of sanitation and health education is slow to develop. Concerted primary healthcare activities with community development efforts should be undertaken to improve the overall living condition of the people of this area to control this problem.
Providing Safe Surgery for Neonates in Sub-Saharan Africa
Authors: Ameh Emmanuel A , Ameh Nkeiruka
Published: January 2017

Advances in neonatal intensive care, total parenteral nutrition and improvements in technology have led to a greatly improved outcome of neonatal surgery in developed countries. In many parts of sub-Saharan Africa, however, neonatal surgery continues to pose wide-ranging challenges. Delivery outside hospital, delayed referral, poor transportation, and lack of appropriate personnel and facilities continue to contribute to increased morbidity and mortality in neonates, particularly under emergency situations. Antenatal supervision and hospital delivery needs to be encouraged in our communities. Adequate attention needs to be paid to providing appropriate facilities for neonatal transport and support and training of appropriate staff for neonatal surgery. Neonates with surgical problems should be adequately resuscitated before referral where necessary but surgery should not be unduly delayed. Major neonatal surgery should as much as possible be performed by those trained to operate on neonates. Appropriate research and international collaboration is necessary to improve neonatal surgical care in the environment.
Uncommon Locations of Abdominal Hydatid Disease
Authors: Manterola Carlos , Vial Manuel , Losada Héctor , Fonseca Flery , Bustos Luis , Muñoz Sergio , Barroso Manuel
Published: January 2017

South Chile is an endemic zoonosis area of hydatid disease, where prevalence rates can be 30 to 40/100 000 habitants. Not only is surgery performed on a great number of liver and lung hydatid cysts every year, but also upon cysts found in uncommon abdominal locations such as spleen, peritoneum and kidney. Information on this subject is scarce. We reviewed PubMed index from 1975 to 2001 and found only five related articles, reporting more than 30 cases.
Acceptability and Technical Problems of the Female Condom Amongst Commercial Sex Workers in a Rural District of Malawi
Authors: Zachariah R , Harries A D , Buhendwa L , Spielman M P , Chantulo A , Bakali E
Published: January 2017

A study was conducted among commercial sex workers (CSWs) in rural southern Malawi, in order to (a) assess the acceptability of the female condom and (b) identify common technical problems and discomforts associated with its use. There were 88 CSWs who were entered into the study with a total of 272 female condom utilizations. Eighty-six (98%) were satisfied with the female condom, 80% preferred it to the male condom and 92% were ready to use the device routinely. Of all the utilizations, the most common technical problem was reuse of the device with consecutive clients, 6% after having washed it, and 2% without any washing or rinsing. The most common discomforts that were reported included too much lubrication (32%), device being too large (16%), and noise during sex (11%).

This study would be useful in preparing the introduction of the female condom within known commercial sex establishments in Malawi.
Prevalence and Perception of Nocturnal Enuresis in Children of a Rural Community in Southwestern Nigeria
Authors: Osungbade K O , Oshiname F O
Published: January 2017

Nocturnal enuresis after the fifth year of life is a distressing problem. In Nigeria, there is a dearth of information about the condition. This cross-sectional study was carried out to determine the prevalence and perception of the condition among children in Igbo-Ora, a rural community in southwestern Nigeria.

Four hundred parents/guardians were interviewed and information obtained on 644 children aged 6–12 years. Overall enuresis prevalence was 17.6% (19.9% among boys and 14.9% among girls). The reported causes of nocturnal enuresis included urinary tract infection (33.5%), excessive play (27.5%) and deep sleep (25%). A majority (74.5%) of the respondents would use herbs or traditional medicine to treat enuresis, while only 6.8% of the respondents sought orthodox healthcare facilities for its management. Only 18 (25%) of the 71 parents/guardians with enuretic children had ever consulted a health worker. The misconceptions and inappropriate enuresis management methods among the parents/guardians require health education intervention.
Intermittent Peritoneal Dialysis
Authors: Jeyarajah R , Jayatissa S K , Senivaratne N , Dharmasena B D
Published: January 2017

A study has been made of 61 periods of peritoneal dialysis (PD), in 58 patients, Each period lasted 24–36 hours (mean 27.6 hours), using 18–40 litres (mean 27.31) of dialysis fluid per period. Due to technical faults PD was unsuccesful in 5 instances. In the remaining 56 periods of PD mean reduction of blood urea and serum potassium per period were 19.85 mmol/1 and 1.96 mEq/1 respectively. Clinical improvement was observed in 60.6% of patients. Of 11 patients with pulmonary oedema, 9 improved; and one patient with gross generalized oedema responded. Among 17 patients who died in hospital, only one death could be directly attributed to PD. Peritonitis was not encountered following PD. Dialysis for a period not exceeding 36 hours is adequate to avert life-threatening complications of renal failure in most patients. This “short-period” PD will be advantageous in developing countries with limited facilities.
Experience with Ultrasound on a Medical Ward in Papua New Guinea
Authors: Richens John
Published: January 2017

Self-Instruction in the use of ultrasound is straight forward and will yield much information on medical wards. The findings in 200 consecutive scans from a small provincial hospital in Papua New Guinea are presented. The value of ultrasound in demonstrating fluid or soft tissues in a wide variety of situations is discussed.
Knowledge of Immunization
Authors: Alakija Wole
Published: January 2017

It has been suggested that ready availability of services and non-payment for these services are the main requirements for improving immunization coverage. This hypothesis has not been entirely supported by the results of a project carried out among the staff of the University of Benin Teaching Hospital. Here it has been found that parents' level of education is also critical. Knowledge and use of services varied with the parents' sex, their educationallevel, and their beliefs about the effectiveness of immunization; and with the part of the hospital in which the particular vaccine was given.
Psychosocial Counselling of Patients Infected with Human Immunodeficiency Virus (Hiv) in Lusaka, Zambia
Authors: Peltzer K , Hira S K , Wadhawant D , Kamanga J , Ferguson D C E , Perine P L
Published: January 2017

We describe a method of psychosocial counselling that we have used with HIV-infected patients in Zambia. The protocol included providing the patient with factual information about HIV infection, understanding the patient's concept of their illness, and teaching the need to change sexual behaviour, reduce alcohol consumption, prevent stress, and adjust to family changes. Our aims have been to enable HIV-infected persons to avoid behaviour that might damage their own health, to minimize further transmission of HIV, and to prolong the period of asymptomatic HIV infection and life expectancy.
Abdominal Pain in Sickle Cell Anaemia
Authors: Lee M G
Published: January 2017

Acute abdominal pain occurs frequently in patients with sickle cell anaemia (SCA), and presents a difficult diagnostic and management problem as the clinical presentation may mimic an acute surgical condition. Good clinical judgement and careful observation are necessary to avoid increased morbidity and mortality. Chronic recurrent upper abdominal pain is also a common problem and in many the cause is unknown. These patients usually respond to simple symptomatic therapy.
Corrosive Acid Gastric Stricture: A Plea for Conservative Surgery
Authors: Cotton M H
Published: January 2017

Acid ingestion is known to cause a corrosive stricture of the stomach. Subsequent metaplasia in the gastric mucosa has been noted and cases of malignant change shown to have occurred. Gastrectomy has, therefore, been advocated. A less radical approach of gastrojejunostomy with regular endoscopic follow-up is here recommended.
Determinants of Severity of Neonatal Hyperbilirubinaemia in ABO Incompatibility in Nigeria
Authors: Owa J A , Durosinmi M A , Alabi A O
Published: January 2017

The study was designed to determine factors responsible for the severe neonatal hyperbilirubinaemia sometimes found in ABO incompatibility in Nigeria. In 50 jaundiced babies who were ABO-incompatible it was found that the mean serum bilirubin level was significantly higher in outpatients than inpatients; this difference was probably due to the delay in recognizing jaundice among the outpatients and, possibly also to the slightly higher number of G-6-PD deficient babies in the same group, and their greater exposure to icterogenic agents. The results of serological studies suggest that ABO-incompatibility was responsible for neonatal jaundice in only 36% of these babies. Among the inpatients the need for exchange blood transfusion was more common in babies of mothers with immune anti-A or anti-B titres of 1:64 or more ( P < 0.001). Neonates at risk of ABO-haemolytic disease can be identified at birth by direct positive Coombs test and detection of immune anti-A or anti-B antibodies in the mother's serum.
A Comparative Study of Pyuria and Asymptomatic Bacteriuria in School Children
Authors: Dogunro A S
Published: January 2017

Urine samples were collected from 1000 school children aged between 4 and 15 years. Twenty-eight children had significant bacteriuria, while 32 had significant pyuria. Seventeen pupils had both significant bacteriuria and pyuria. The study shows that although there is a positive association between pyuria and bacteriuria, the absence of pus cells in urine samples cannot be taken as evidence of absence of bacteriuria, nor can the presence of pyuria alone be considered as an indication of infection. Escherichia coli is the commonest agent in school children with significant bacteriuria.
Integration of Mother and Child Health Services in Ethiopia
Authors: Walley J D , McDonald M
Published: January 2017

In Wollo region of Ethiopia, various non-governmental officers have been working closely with each other and with the Regional Health Department to implement the policy of daily integrated mother and child health services. The record cards, registers, procedures and training courses of the separate ‘vertically’ organized services were brought together to enable the development of a model integrated service. There were improvements in accessibility, acceptability and output of the services. The system was evaluated by a joint Ministry of Health and UNICEF team, and was adopted for use in the rest of Ethiopia.
A Comparison of Wound Complications after Inguinal Hernia Repair under Local and General Anaesthesia
Authors: Ofili O P
Published: January 2017

Ninety-one male patients with unilateral reducible inguinal hernia were randomly allocated to receive either general or local anaesthesia in order to compare the incidence of postoperative wound complications following both methods of anaesthesia. Forty-seven patients received local anaesthesia while 44 received general anaesthesia.

Two patients (4.3%) who received local anaesthesia and three patients (6.8%) who received general anaesthesia developed various types of postoperative wound complications. Chi-squared test however showed no significant difference in the incidence of wound complications between the two groups of patients.
Some Unusual Presentations of Hepatic Amoebiasis in Enugu, Nigeria
Authors: Ihekwaba A E , Ukabam S O
Published: January 2017

Eighty-two cases of hepatic amoebiasis were diagnosed and treated at the University of Nigeria Teaching Hospital during a 4-year period. Typical or classical features were observed in 75 (91.4%) of the cases while the remaining seven presented atypically or unusually. These were obstructive jaundice (three cases), coma (two cases) and pyrexia of unknown origin (two cases). All the cases had positive gel diffusion precipitation test for amoebic antibodies, and in all but one there was demonstration of an abscess cavity. In the three cases of obstructive jaundice, the abscess cavities were located close to the hilum and compressed the main bile duct. There was no mortality recorded especially in the jaundiced cases despite the grave prognosis associated with jaundice in hepatic amoebiasis. This study demonstrates the need to consider hepatic amoebiasis in an area when patients present with either obstructive jaundice, coma or pyrexia of unknown origin and to do ultrasonography as an initial investigation in such patients.
An Approach to the Management of Tuberculosis in HIV Endemic Areas
Authors: Elliott Alison M
Published: January 2017

The epidemic of HIV-associated tuberculosis is having a severe impact on tuberculosis control in sub-Saharan Africa, as well as the United States of America, and is expected to spread. Where facilities are limited, the association between HIV and sputum-smear negative tuberculosis hampers diagnosis; trials of anti-tuberculous therapy are indicated in some cases. Standard treatment regimens are effective, but thiacetazone should be avoided because of its association with severe, cutaneous adverse reactions. Treatment may have to be prolonged in HIV positive cases. Measures to maximize compliance with therapy are paramount. These include the use of the shortest possible regimens, of recognized potency, and emphasis on ensuring that the regimen is understood by and readily accessible to the patient.
Paederus (Nairobi Fly) Vesicular Dermatitis in Tanzania
Authors: Fox Ray
Published: January 2017

Four cases of dermatitis following contact with insects of the genus Paederus are described. The insects are known in East Africa as Nairobi fly and cause an acute, painful toxic epidermolysis when crushed on skin. Local clinicians are familiar with the condition, but it should also be borne in mind as a cause of unusual skin lesions in visitors returning from East Africa.
Do Ascariasis, Trichuriasis and Hookworm Infections Predispose to Non-Specific Abdominal Symptoms among Adults in Endemic Areas?
Authors: Raj S Mahendra , Anteson R , Sivakumaran S , Abdullah M Riduan , Low H C
Published: January 2017

Despite the ubiquity of intestinal helminthiasis in the third world, morbidity data are scarce. While acute pancreatitis and cholangitis are recognized complications of ascariasis, less is known on the propensity of helminthiasis to cause non-specific abdominal symptoms of a less dramatic nature, which may nevertheless produce chronic distress. Practitioners in endemic areas not infrequently incriminate intestinal helminths as the cause of non-specific abdominal symptoms not only in children but also in adults. We had previously found an association between abdominal symptoms and intestinal helminthiasis among adult women but not among men. The aim of this study was to test the reproducibility of our previous observation on a larger sample and to determine the independent effects of the three major worm infections in our area (ascariasis, trichuriasis and hookworm infection) on abdominal symptoms among adults.
Dengue Haemorrhagic Fever in Adults: A Prospective Study of 110 Cases
Authors: Wali J P , Biswas A , Handa R , Aggarwal P , Wig N , Dwivedi S N
Published: January 2017

One hundred and ten adult patients hospitalized with dengue haemorrhagic fever (DHF) during the recent outbreak in North India were prospectively studied. Of these, 48 (43.6%) were grade 1, 40 (36.4%) grade II, 10 (9.1%) grade III and 12 (10.9%) grade IV DHF. Dengue shock syndrome (DSS) was seen in 22 (20%) patients. Fever, headache, myalgias and arthralgias were the common symptoms seen in 100%, 80.9%, 76.2% and 52.3% patients, respectively. Spontaneous bleeding was seen in 62 patients (56.4%) with mucocutaneous bleeding being the most common (46 patients). Gastrointestinal bleeding was seen in 38 (34.5%) patients. In as many as 40 patients, the haemorrhagic manifestations occurred after the fever had come down. Fifty-five patients (50%) required platelet transfusions. Twelve patients died, giving a mortality rate of 10.9% in the present study. Prompt recognition and supportive treatment can be lifesaving.
Human Rabies in India: Epidemiological Features, Management and Current Methods of Prevention
Authors: Dutta J K
Published: January 2017

In most endemic countries stray dogs are the main source of rabies infection in humans. In India 95–97% of rabies patients are infected by dogs. Most pet dogs do not regularly receive booster doses of vaccine. In Thailand, most rabies patients develop the disease within 1 month of exposure. Rabies immunoglobulin is costly and usually not available. So in India nervous tissue vaccine is commonly used — it is inexpensive and freely available despite frequent neurological complications. The cost of immunization by tissue culture vaccines may be reduced by nearly 60% by intradermal vaccination.
A Clinical and Histopathological Study of Macular Type of Post-Kala-Azar Dermal Leishmaniasis
Authors: Ramesh V , Singh Navjeevan
Published: January 2017

Post-kala-azar dermal leishmaniasis (PKDL) is an uncommon sequel seen in patients with a previous attack of kala-azar (KA). It is characterized by hypopigmented macules and erythematous eruptions leading to the formation of papules, plaques and nodules. Little attention has been paid to the rare group of patients who present with only hypopigmented macules. The present study has described the distribution of lesions in macular PKDL and their histopathology.
Remote Village Survey for Agents Causing Hepatosplenic Disease in the Republic of Yemen
Authors: Gray Gregory C , Kassira Edward N , Rodier Guénaël R , Myers Martha C , Calamaio Craig A , Gregory Martin , Nagi Musaid Ahmed M , Kamal Karim , Botros BAM , Soliman Atef Kamal , Hassan Nassef F , Gregory Rosamund , Arunkumar B K , Cope Amyanne , Hyams Kenneth C
Published: January 2017

The objective of this study was to epidemiologically describe potential infectious agents among rural people in the Republic of Yemen. This would aid clinicians in designing empirical therapy and public health officials in planning disease prevention. We sought to examine evidence for the geographical distribution of pathogens causing human hepatic and splenic disease among villagers and domestic animals living in three remote areas with differing altitudes.

In June 1992, a cross-sectional survey was conducted at three survey sites of differing altitudes: 3080, 1440 and 250 m above sea level. Questionnaires, parasitic and serological tests were administered to 627 human volunteers. Additionally 317 domestic animals were studied.

Malaria, schistosomiasis, and hepatitis B and C infections were found to be likely causes of human hepatic or splenic disease. Additionally, evidence of human and animal infections with the agents of brucellosis and Q fever was found: IgG antibodies against hepatitis E virus were discovered in two (2.0%) of the 100 volunteers.

The prevalence of markers for human and animal disease was often lowest at the village of highest elevation, suggesting that increasing altitude, as a surrogate or a true independent risk factor, was protective against infection with the agents studied.
A Nutritional Profile of Non-Pregnant Women from the Slums of Dinajpur, Bangladesh
Authors: Rahman Shafiqur , Hilderbrand Katherine , Kolsteren Patrick , Diniz Alcides
Published: January 2017

The health and nutritional status of many urban slum dwellers in the developing world is said to be deteriorating. The nutritional profile of 328 adult, nonpregnant women from the slums of Dinajpur, Bangladesh, confirms this. Results of a cross-sectional survey showed that approximately half the women were acutely malnourished and all but six were anaemic. This, despite the fact that the slums of Dinajpur are considered relatively ‘better-off’ than many in the developing world; most families having permanent land tenureship, and access to basic education and health services.
Quackery
Authors: Mehlman Maxwell J.
Published: January 2017

Everyone condemns medical quackery. Government regulators seek to protect us from it. Alternative providers strive to distance themselves from it. Orthodox medicine wants to stamp it out.

The question is: What constitutes “quackery”? How do we distinguish quacks from mainstream practitioners? Even more problematic, how do we distinguish between quackery, which everyone agrees is beyond the pale and therefore should be fair game for sanction, and practices that, while unorthodox, should be tolerated in the interests of promoting medical progress and patient choice? These are particularly challenging questions now, when a number of factors are combining to undermine the hegemony of mainstream medicine, when some of the same forces that spurred the growth of quackery in the 19th century are remerging, and when neo-conservatives are clamoring for greater freedom of choice for health care consumers.

This article begins with a brief history of quackery in America and the factors that encourage its growth. The article then attempts to distinguish between quackery and acceptable medical practice.
Compulsory Licenses: A Tool to Improve Global Access to the HPV Vaccine?
Authors: Maybarduk Peter , Rimmington Sarah
Published: January 2017

Cervical cancer disproportionately affects women in lower- and middle-income countries. But the new vaccines developed to prevent infection with some strains of the human papillomavirus (HPV) that cause cervical cancer are priced beyond the reach of most women and health agencies in these regions, due in part to the monopoly pricing power of brand-name companies that hold the patents on the vaccines. Compulsory licenses, which authorize generic competition with patented products, could expand access to HPV vaccines under certain circumstances. If high-quality biogeneric HPV vaccines can be produced at low cost and be broadly and efficiently registered, and if Merck and GSK are unwilling to grant licenses on a voluntary basis, compulsory licensing could play a pivotal role in ensuring vaccinations against HPV are available to all, around the world, regardless of ability to pay.
Following the Money in Health Care Fraud: Reflections on a Modern-Day Yellow Brick Road
Authors: Krause Joan H.
Published: January 2017

Who cheats? Well, just about anyone if the stakes are right.

Stealing a million dollars or more is remarkably easy, and carries with it little chance of getting caught. You don’t even need to know much about health care.
Constipation: What Does the Patient Mean?
Authors: Moore-Gillon Victoria
Published: January 2017

Constipation is a very common complaint but, in the absence of a universally accepted definition, misunderstandings may result between doctor and patient. Two hundred and eighty-seven patients attending this hospital completed a questionnaire which attempted to establish what patients themselves mean by the term. Almost half considered constipation purely in terms of frequency of bowel action, without considering difficulty or pain on defaecation. Women were more likely to have infrequent bowel actions than men, and men more likely to consider such infrequency harmful. A quarter of respondents believed in the benefits of regular purgation, surprisingly with no difference in attitude between age groups, but men were much less likely to have heeded their own advice.
Gastrointestinal Complications of Mycosis Fungoides
Authors: Slater David N , Bleehen Stanley S , Beck Stephen
Published: January 2017

Mycosis fungoides (MF) is an uncommon T-cell lymphoma which characteristically involves the skin. Two patients with MF are described who developed fatal complications secondary to involvement of the gastrointestinal tract. One developed malabsorption due to small intestinal involvement; the other had a massive haemorrhage from an ulcerated nodule of tumour in the stomach. The potential for extracutaneous spread is discussed, and it is emphasized that bowel infiltration should be considered in any patient with MF who develops gastrointestinal symptoms or complications.
Fine Needle Aspiration Biopsy in Diagnosis of Metastases to Thyroid Gland
Authors: Lennard Thomas W J , Wadehra Viney , Farndon John R
Published: January 2017

Three cases of metastasis to the thyroid gland are reported, in each of which fine needle aspiration biopsy confirmed the diagnosis and obviated the need for surgery. Fine needle aspiration biopsy is able to confirm suspected intrathyroid metastasis and can be performed as an outpatient or bedside procedure.
Rectal Biopsies: Inaccuracy of Histological Grading in Carcinoma of the Rectum
Authors: Smedley F H , Hoile R W , Macfarlane D A
Published: January 2017

In a consecutive series of 70 patients with carcinoma of the rectum, 42 had operable tumours and in these the histology of the initial biopsy was compared with that of the excised specimen. In 9 of the 42 patients the histological grading of the original biopsy was different from that of the final specimen; in 3 the carcinoma was missed despite repeated preoperative biopsies; and in 5, errors were made in the diagnosis of carcinoma in polyps. In 5 of 7 cases of poorly differentiated carcinoma the initial biopsies indicated moderate differentiation: there was therefore a 70% inaccuracy in the preoperative diagnosis of poorly differentiated carcinoma of the rectum. The implications of this inaccuracy for the surgery of rectal cancer are discussed.
Factors Affecting the Extrusion Rates of Ventilation Tubes
Authors: Mackenzie I J
Published: January 2017

A survey in which 939 ventilation tubes of 8 different patterns were inserted and reviewed (up to a maximum of 2 1/4 years) is analysed. Various factors determining the rate of extrusion are discussed. The Sheehy Collar Button tube remained functional for a longer period than any of the other tubes included in the survey.
Scrotal Ultrasound
Authors: Desai K M , Haworth J M , Gingell J C
Published: January 2017

Scrotal ultrasonography has been performed in 105 men with a variety of intrascrotal conditions. The range of pathology interpreted by this technique is presented and its diagnostic accuracy evaluated. The clinical application and usefulness of this noninvasive method of imaging scrotal contents is discussed.
Type 1 Free Perforation of the Gallbladder
Authors: Harland Christopher , Mayberry John F , Toghill Peter J
Published: January 2017

A series of 4 cases of free perforation of the gallbladder into the peritoneal cavity associated with peritonitis are reported. Two were diagnosed at laparotomy and 2 at post-mortem. The 3 patients who died were men who were either elderly or had serious concomitant diseases, including diabetes, atherosclerosis or alcoholism. The sole survivor was a fit young woman.
Trends in the Severity of Self-Poisoning
Authors: McAleer J J A , Murphy G J J , Taylor R H , Moran J L C , O'Connor F A
Published: January 2017

Of 2947 patients admitted to a district general hospital over an 11-year period for the management of self-poisoning, 148 (5%) required intensive care unit (ICU) treatment. There was a significant increase in the number of self-poisonings admitted each year, whereas the number requiring ICU admission did not change. Therefore the proportion of patients requiring ICU admission fell significantly over the study period ( P< 0.0005). Of 898 patients admitted from 1973 to 1977, 62 (6.9%) were treated in ICU. Of 2049 patients admitted from 1978 to 1983, 86 (4.2%) required ICU treatment. It is felt that this trend is explained by a rise in parasuicidal self-poisonings. The impact of change in drug availability is evident in the significant reduction in ingestion of sedative barbiturates.
Detecting Alcohol Consumption as a Cause of Emergency General Medical Admissions
Authors: Lockhart S P , BSc Y H Carter , Straffen A M , Pang K K , McLoughlin J , Baron J H
Published: January 2017

In a general medical unit 27% of 104 admissions and 17% of bed occupancy were attributed to alcohol consumption, although only 10 of these 28 patients had classical alcohol-related conditions. Questioning on the amount of alcohol consumed was the most accurate method of screening for these patients. The brief MAST questionnaire, mean red cell volume, γ-glutamyl transferase, aspartate transaminase and urate were all inadequate as screening tests. Only 13% of the admissions were defined as ‘problem drinkers’ on the brief MAST questionnaire, suggesting that harmful effects of alcohol are not confined to ‘alcoholics’. Clinical suspicion and questions on the level of alcohol consumption are more efficient than questionnaire, biochemical or haematological screening tests in detecting alcohol-related medical problems.
Cognitive Processes in Anxiety and Depression: Discussion Paper
Authors: Mathews A
Published: January 2017

‘Unfortunately the literature on depressive disorders, like that of other psychiatric disorders, is composed of isolated research reports, with few attempts at systematically integrating them. Different schools of thought utilize dissimilar dialects, thereby hindering communication … Our scientific understanding of psychiatric syndromes, including the phenomenon of depression has been hampered by methodological and linguistic barriers that prevent communication among psychoanalysts, behaviourists, experimental psychologists, and psychiatrists …’
Efficacy of Dantrolene Sodium in Management of Tetanus in Children
Authors: Bernal O R Aguilar , Bender M A , Lacy ME
Published: January 2017

The effectiveness of dantrolene sodium in controlling tetanic spasms was evaluated in 21 children (aged 4 days-13 years) with tetanus. These dantrolene-treated patients were compared with an historical control group of 26 children previously treated for tetanus by traditional means at the same institution. The groups were comparable in terms of age, other treatments, and severity of disease. All patients received standard treatments for tetanus, including sedatives, antibiotics, and tetanus-immune globulin. Patients in the dantrolene-treated group also received dantrolene, either intravenously (Dantrium® Intravenous) or orally, in divided doses totalling 4–6 mg/kg/day. Mortality was 73% (neonates 83%, non-neonates 50%) in the control group, compared with 33% (neonates 50%, non-neonates 0%) in the dantrolene-treated group. Dantrolene did not cause additional respiratory depression when administered alone or in combination with other drugs routinely used to treat tetanus. In this study, the use of dantrolene with traditional conservative therapy significantly reduced mortality from tetanus.
Has the Incidence of Radiation-Induced Bowel Damage following Treatment of Uterine Carcinoma Changed in the Last 20 Years?
Authors: Allen-Mersh T G , Wilson E J , Hope-Stone H F , Mann C V
Published: January 2017

Radiation-induced bowel damage occurred in 4.3% of patients treated primarily by irradiation for uterine carcinoma during the period 1962–1982. There has been a progressive rise in the incidence of radiation damage and radiation-induced rectovaginal fistula during this 20-year period. Radiation from intracavitary sources was a contributory factor in 92% of injured cases. The rising incidence of bowel damage in our patients may be due to an increase in the number of patients receiving a high rectal dose from the intracavitary source. There was a significantly ( P>0.01) higher incidence of radiation injury in cases of cervical carcinoma compared to endometrial carcinoma. This was because cervical carcinoma tended to present at a more advanced stage than endometrial carcinoma and was more frequently treated with combined external and intracavitary irradiation. There was no significant increase in the incidence of complications among patients undergoing hysterectomy.
Aetiological Role of Viruses in Multiple Sclerosis: A Review
Authors: Larner Andrew J
Published: January 2017

Introduction