bluuebunny/crossref_metadata_2025 huggingface dataset:
Unprecedented Decline in Measles Morbidity and Mortality in Calabar, South-Eastern Nigeria
Authors: Ekanem E E , Ochigbo S O , Kwagtsule J U
Published: January 2017

The features of measles presenting at the University of Calabar Teaching Hospital, in south-eastern Nigeria between January 1992 to December 1996, were compared with those of a previous period (January 1984 to December 1987) in the same institution. The aim was to detect any changes in trends, morbidity and mortality from the infection in this environment. There were only 36 cases (7.2 per year) in the current period compared with 436 (109 per year) in the previous period (χ2=48.4, P< 0.001). There were also highly significant falls in the incidence of malnutrition and bronchopneumonia ( P<0.05) in the current period. Notably, there were no cases of dehydration or keratomalacia in the current period. The case fatality rate was 2.8% compared with 20.0% in the previous period ( P< 0.02). These unprecedented changes in the incidence, morbidity and mortality from measles are attributed to the continuing Expanded Programme on Immunization, oral rehydration therapy, appropriate nutritional management and vitamin A prophylaxis. With maintenance and strengthening of these strategies, the elimination of measles and measles deaths in the near future is feasible in this environment.
Frequency of Pruritus in Plasmodium Vivax Malaria Patients Treated with Chloroquine in Thailand
Authors: Bussaratid Valai , Walsh Douglas S , Wilairatana Polrat , Krudsood Sivicha , Silachamroon Udomsak , Looareesuwan Sornchai
Published: January 2017

Chloroquine-induced itch in black-skinned African malaria patients is common and frequently leads to poor compliance or treatment defaulting. To assess the frequency and severity of chloroquine-induced pruritus in an Asian population, we reviewed case records of 1189 Plasmodium vivax malaria patients treated with chloroquine (25 mg/kg over 3days) at the Bangkok Hospital for Tropical Diseases from 1992 through 1997. The majority of patients were Thais or ethnic Burmese (light brown skin), referred from the western border of Thailand. Overall, there were 23 patients (1.9%) with complaints of pruritus during chloroquine therapy. Of these, 12 (52%) had palm and sole involvement, eight (35%) had generalized pruritus including the palms and soles, and three (13%) had palm itching only. One patient developed pruritus on the palms and soles on two consecutive admissions. The pruritus did not interfere with daily activity, was reduced in intensity by anti-histamine therapy, and did not affect the patient's willingness to complete the chloroquine regimen. Therapeutic responses in the 23 patients with chloroquine itch was similar to those without itch. Among the itch patients, there was no association with gender or level of parasitaemias. Our findings indicate that the frequency of chloroquine-induced pruritus in Asian patients treated with chloroquine for P. vivax malaria is low in comparison with black-skinned Africans. This may be related to pharmacogenetic factors, the infective Plasmodium species, drug metabolism or drug-parasite interactions, or a lower affinity of chloroquine for less pigmented skin.
Tuberculosis in Swaziland: A Health Needs Assessment in Preparation for a Community-Based Programme
Authors: Pushpananthan S , Walley J D , Wright J
Published: January 2017

This study was undertaken to assess the healthcare needs of people with tuberculosis (TB) in the rural district of Lubombo in Swaziland, with a view to improving the delivery of healthcare services. Qualitative and quantitative methodologies were used to describe the knowledge, attitudes and behaviour of TB patients, the epidemiology of TB, and the strengths and weaknesses of the current TB control programme.

The incidence of TB is rising rapidly in this rural region of Swaziland. Poor treatment completion rates indicate low levels of knowledge about the importance of compliance with TB treatment among many other factors. If local health services are to cope with future rising demands, then efforts must be made to implement a community-based TB treatment strategy. Key practical steps in establishing such a programme are discussed, and the experience from Lubombo is used to demonstrate the steps in performing a health needs assessment in a developing country.
Endoscopy in Nasal Myiasis
Authors: Soni N K
Published: January 2017

Nasal myiasis is a common disease in tropical and developing countries. The maggots cause extensive necrosis, sloughing and destruction of intranasal tissue and reach to deep and inaccessible areas of the nose and paranasal sinuses. In such a situation removal of maggots is difficult by manual extraction and several sittings are required. To overcome this problem nasal endoscope is being used for removal of maggots under direct vision. In comparing both methods nasal endoscopic procedure is found to be superior to the manual extraction method for removal of maggots. The maggots located in deep and inaccessible area can be approached more easily by endoscopic procedure. The disease is being controlled in shorter time and in few sittings. Thus quick and complete eradication of myiasis is possible before the maggots cause irreparable damage to the intranasal tissues.
Clinico-Histopathological Concordance in Leprosy
Authors: Singh Premala Anthony , Agarwal Ranjan , Misra Vatsala , Gupta Suresh Chand , Bajaj Ashok Kumar
Published: January 2017

Histopathological examination of biopsies from 111 patients with clinically diagnosed leprosy was carried out in order to observe the clinico-histopathological correlation. Clinical diagnosis was based on Ridley and Jopling (R-J) classification and World Health Organization (WHO) classification. The concordance rate between the two clinical classifications was 73.8%. Sections were stained with haematoxylin and eosin (H&E) and Ziehl-Neelsen's (Z-N) stains. The histological classification was as per the R-J criteria. Skin biopsy showed evidence of leprosy in 104 cases (93.69%). Overall concordance was observed in 58.6% (R-J) and 85.6% (WHO classification). The kappa test, when applied, showed significant agreement between clinical and histopathological diagnosis ( z=11.775; P<0.001). Individual subtypes showed variable concordance rates — which were again higher using WHO classification. When some of the subtypes were combined, the concordance rate was 83.02% for TT+BT; 72.58% for BT+BB+BL; 73.91% for BL+LL; 80.77% for BL+HL and 100% for LL+HL. (See Introduction for definitions of abbreviations.

The present study highlights the importance of histopathological examination for exact subtyping of leprosy, so as to facilitate the institution of accurate mode of therapy and regular follow-up of patients to prevent undesirable complications.
Surgical Drainage of Primary Iliopsoas Abscess — Safe and Cost-Effective Treatment
Authors: Afaq Aamir , Jain Bhupendra K , Dargan Puneet , Bhattacharya Shyamal K , Rauniyar Raj K , Kukreti Ranjan
Published: January 2017

The report evaluates surgical drainage (SD) as a primary treatment of primary iliopsoas abscess (PIA). Seventy-two patients, who underwent SD for PIA at B P Koirala Institute of Health Sciences, Dharan, Nepal were studied. SD was performed through a lower abdominal, extra peritoneal, muscle splitting incision. Ultrasonography was used to diagnose the abscess in 53/54 patients (98%). Staphylococcus aureus was the most frequent organism grown in 45/65 patients (69%). The mean duration of drainage was 3.2 ± 1.4 days (range, 1–7 days). The treatment was successful in resolving the abscesses in all patients. The mean hospital stay was 9.0 ± 5.4 days (range, 3–40 days). Two patients (2.8%) developed a recurrence, 10 months and 1 year after the operation, respectively. Another patient developed an incisional hernia. There were no deaths. The average cost of treatment to the patient was approximately Nepali rupees 2800 (US$ 40). Surgical drainage appears to be a cost-effective and safe treatment for PIA.
Oral Desensitization in Papular Urticaria in Children
Authors: Giraldi Susana , Ruiz-Maldonado Ramón , Tamayo Lourdes , Sosa-de-Martínez Cristina
Published: January 2017

Papular urticaria (PU) is among the commonest skin ailments in children. Induced specific desensitization to insect bites is theoretically an effective means of prevention of PU. In this double blind placebo controlled study, an oral vaccine prepared from insect saliva was compared with placebo (stable vaccine solvent). Vaccine and placebo effectiveness were tested by counting active PU lesions, serum eosinophils, and IgE, before and after 4 months of treatment. Statistically significant differences between oral vaccine and placebo were not found in the clinical or the immunological variables tested. We conclude that, although a lack of oral vaccine efficacy was suspected, larger study samples are needed to strengthen our conclusion.
Fine Needle Aspiration Diagnosis of Tuberculous Lymphadenitis
Authors: Handa Uma , Palta Anshu , Mohan Harsh , Punia R P S
Published: January 2017

The diagnosis and management of peripheral lymph node tuberculosis remains a major problem in most of the developing countries. We retrieved 584 cases of tuberculous lymphadenitis from a total 1124 lymphnode aspirations done over a period of 3 years (1995–1998). Overall acid-fast bacillus positivity was 37.4%, being highest in the cases in which purulent material was aspirated. Fine needle aspiration (FNA) of tuberculous lymphadenopathy provided a high level of diagnostic accuracy as shown by 1.7% false negative and a zero false positive rate. FNA is reliable as an initial evaluating procedure for diagnosis of tuberculous lymphadenitis making it suitable for wider application in developing countries with scant resources.
Where There is No Ultrasound: Delay and Failure of Antenatal Diagnosis of Twin Pregnancy
Authors: Groot M C , Buchmann E J
Published: January 2017

We investigate the problem of late diagnosis of twin pregnancy in Soweto, South Africa, where routine antenatal ultrasound is not available. One hundred consecutive pairs of twins were studied, using the notes of mothers who delivered twins at Chris Hani Baragwanath Hospital and the referring Soweto clinics. A positive history was found in 31 mothers (22 family history, nine previous history of twins). Six mothers did not attend for antenatal care. Twenty-five twin pregnancies were discovered at delivery, 15 of them in the second stage of labour, and 27 were diagnosed accidentally in the third trimester. Only 15 pregnancies were referred specifically for suspicion of twin pregnancy.

Most twin pregnancies are detected only in the third trimester or at delivery. Until routine ultrasound is available to all pregnant women, the teaching of antenatal care in South Africa must give emphasis to clinical suspicion of twin pregnancy.
324 Cases of Misplaced IUCD — A 5-Year Study
Authors: Barsaul Meenakshi , Sharma Neeraj , Sangwan Krishna
Published: January 2017

Copper-T remains the mainstay of family planning measures in developing countries but is associated with serious complications like bleeding, perforation and migration to adjacent organs or omentum. Patients with misplaced intrauterine contraceptive device (IUCD) may present with pregnancy or lost strings or may remain asymptomatic for years. In our series of 324 cases with misplaced IUCD1; in 258 (79.93%) cases copper-T was found in the uterine cavity and in 47 cases (14.51%) it was removed from cervical canal. In only 18 cases (5.56%), it was translocated and of these 66.67% were inserted at primary health centres. Laparoscopic retrieval was successful in 61.11% cases. Endoscopy thus helps in the localization and retrieval of misplaced IUCDs. A regular follow up of IUCDs for visible threads would help in earlier detection of misplaced IUCDs. Proper training of paramedical staff is mandatory in developing countries to provide safe and better family planning services.
Experience with a Low-Cost Telemedicine System in Three Developing Countries
Authors: Vassallo D J , Swinfen P , Swinfen R , Wootton R
Published: January 2017

The Swinfen Charitable Trust was established in 1998 with the aim of helping the poor, sick and disabled in the developing world. It does this by setting up simple telemedicine links based on e-mail to support doctors in isolated hospitals. The first telemedicine link was established to support the lone orthopaedic surgeon at the Centre for the Rehabilitation of the Paralysed (CRP) in Savar, near Dhaka in Bangladesh in July 1999. An evaluation of the 27 referrals made during the first year of operation showed that the telemedical advice had been useful and cost effective. Based on the success of the Bangladesh project, the Swinfen Charitable Trust supplied digital cameras and tripods to more hospitals in other developing countries. These are Patan Hospital in Nepal (March 2000), Gizo Hospital in the Solomon Islands (March 2000), Helena Goldie Hospital on New Georgia in the Solomon Islands (September 2000), and LAMB Hospital in Bangladesh (September 2000).
Telemedicine — The Way Ahead for Medicine in the Developing World
Authors: Graham L E , Zimmerman M , Vassallo D J , Patterson V , Swinfen P , Swinfen R , Wootton R
Published: January 2017

An e-mail link with the facility to send high-resolution digital images is a cheap and uncomplicated telemedicine method. The Swinfen Charitable Trust helped establish such a link in Patan Hospital Kathmandu, Nepal in March 2000. Over 12 months using this link 42 telemedicine referrals were sent to specialists throughout the world. Referrals were: 36% respiratory medicine; 21% neurology, 21% dermatology; 14% cardiology; 5% nephrology; and 3% radiology — 28 had digital pictures attached, of which 96% were of high enough quality on which specialists were able to comment.

Thirty-nine replies were received. The average time for a specialist reply was 2 days, and 45% were answered within 24 hours. All replies were judged by independent assessors to be helpful or very helpful for diagnosis, management and education. The assessors decided that in 50% of cases the advice if acted upon would have shortened hospital stay.

This pilot study has shown that a low-cost telemedicine link is technically feasible and can be of significant benefit for diagnosis, management and education in a developing world setting.
Correlation between Serum-Ascites Albumin Concentration Gradient with Gastrointestinal Bleeding in Patients of Portal Hypertension
Authors: Mene Anirudh , Sharma Dhananjaya , Raina V K
Published: January 2017

Non-availability of endoscopic screening to detect portal hypertensive patients at a high risk of index gastrointestinal (GI) haemorrhage led us to examine the relationship between serum-ascitic albumin concentration gradient (SAAG) measurements and the occurrence of GI haemorrhage in patients with portal hypertension and ascites.

Fifty-six consecutive patients of portal hypertension with ascites attending the GI surgery outpatients clinic were divided into two groups on the basis of history: ( a) those who had no history of GI bleeding; and ( b) those who had an episode of GI bleeding within the past 21 days. Child—Pugh score was calculated for all patients. All the patients were assessed by ultrasonography and SAAG was estimated. Groups ( a) and ( b) were compared and sensitivity, specificity, positive and negative predictive value of using SAAG as a possible screening test for GI bleeding were calculated.

SAAG values correlated significantly with bleeding and splenomegaly. For prediction of bleeding, SAAG had a sensitivity of 100% and specificity of 33.33%, positive predictive value of SAAG for GI bleeding was 71.4% and the negative predictive value was 100%.

Estimation of SAAG is possible even in a small, modestly equipped laboratory, and could provide a new means for the identification of high-risk patients for GI bleeding and define patients more accurately for future clinical studies. The results of the present study are encouraging for clinicians working in developing countries and may help in optimizing prophylactic therapy and where available, improving the cost effectiveness of screening endoscopy.
The Prevalence and Pattern of Skin Diseases in Relation to CD4 Counts Among HIV-Infected Police Officers in Dar es Salaam
Authors: Bakari Muhammad , Lyamuya Eligius , Mugusi Ferdinand , Aris Eric , Chale Stella , Magao Paul , Josiah Robert , Moshi Adeline , Swai Andrew , Pallangyo Ndetiyo , Sandstrom Eric , Mhalu Fred , Biberfeld Gunnel , Pallangyo Kisali
Published: January 2017

Among HIV-infected individuals, skin diseases cause significant morbidity and are frequently the initial indication of immunosuppression. From an on-going cohort study to determine prevalence and incidence of HIV infection among police officers (POs) and their suitability for HIV vaccine trials, a sub-study was carried out to determine the prevalence and pattern of skin diseases among HIV-infected POs and relate this to their immunodeficiency status. Consenting HIV-infected POs and their age and sex-matched HIV-negative officers were assessed for presence and type of skin diseases at their workplaces. A questionnaire was used for data collection. Immunodeficiency was measured by plasma CD4+ lymphocytes using flow cytometry. Between November 1998 and 31 December 2000, 716 POs were assessed. Overall HIV-1 prevalence was 17.7% (127/716). One hundred and ninety-one POs (26.7%) had at least one skin diagnosis. HIV-infected POs had significantly higher (41.7%) prevalence of skin diseases than HIV-uninfected POs (26.4%), P=0.002. Fungal infections were common in both HIV-infected and uninfected POs. Among the HIV infected, other common diseases were: Herpes zoster (11.8%); pruritic papular eruption (PPE) (7.1%); seborrheic dermatitis (5.5%); and Kaposi's sarcoma (KS) (1.6%). KS and PPE were associated with severe immunodeficiency, with mean absolute (percentage) CD4+ counts of 75.5 cells/μL (4.0%) and 71.7 cells/μL (4.8%), respectively. The values for herpes zoster and seborrheic dermatitis were 271.1 cells/μL (12.4%) and 206.3 cells/μL (11.3%), respectively. Skin diseases were common among HIV-infected POs. PPE and KS are markers of severe immunodeficiency due to HIV. PPE, herpes zoster and KS strongly suggest underlying HIV-related immunodeficiency and patients with these conditions should be counselled and tested for HIV.
Primary Healthcare Workers' Perceptions about Barriers to Health Services in Zambia
Authors: Birbeck Gretchen L , Kalichi Ellie M N
Published: January 2017

In Zambia, health policy reforms have recently focused upon decentralization of care with an emphasis upon community-based services. The perspective of primary healthcare workers (PHCWs), who provide these services, may offer valuable insight into this changing health system. To explore the perspective of PHCWs in Zambia, we conducted a written survey of 80 PHCWs. Several barriers to care, many surrounding issues of access to care, were consistently and independently reported by the PHCWs surveyed.

Shifting care into the community will only be beneficial if primary care clinics can offer a reasonable minimal standard of care. From the perspective of healthcare workers on the frontline of primary care delivery in Zambia, expanded training of providers and an increased number of providers is needed. Improving access to drugs and supplies is also necessary. User fees that might increase financial resources for the healthcare system may also deter needed care among vulnerable patient populations.
Knowledge, Attitudes and Practices towards Malaria among Primary School Pupils in Ndirande, Blantyre, Malawi
Authors: Muula Adamson S , Chimalizeni Yamikani
Published: January 2017

A qualitative cross-sectional study was conducted at Ndirande Primary School in the peri-urban area of Blantyre, Malawi in 2002. The aim was to describe the knowledge, attitudes and practices towards malaria among pupils. Forty pupils (20 boys and 20 girls) were recruited into four focus group discussions. There was very good knowledge about the role of the female Anopheles mosquito as an agent for transmission of malaria. Respondents were also aware of the clinical features of malaria and what measures could be taken to prevent the disease. However, the survey showed that many of the environmental modification measures were difficult to implement in the overcrowded peri-urban areas. Respondents did not believe that they could influence parents or other authorities in instituting environmental modification interventions. We conclude that children are unlikely to be effective change agents if the social environment does not offer them the opportunity to influence key community figures.
An Accurate and Portable System for Glycated Haemoglobin Measurement in the Tropics
Authors: Gebrekidan Atakilt , Gill Geoffrey , Wile David , Gill Alison , Tesfaye Solomon
Published: January 2017

Measurement of glycated haemoglobin (HbAlc) is vital to provide meaningful diabetic care, but the assay is difficult and expensive, making its availability limited in resource-poor countries. We have field-tested a novel near-patient HbAlc meter (Glycosal™; Provalis Diagnostics Ltd, UK) in northern Ethiopia. The machine was easy to use and gave results which correlated well (r=0.96) with standard laboratory methods. The meter also performed well and retained accuracy at high ambient temperature (34.0°C). Though still relatively expensive (£4 per test), this meter does give the opportunity for practical and appropriate HbAlc testing in tropical climes, and should be considered for at least intermittent use in diabetic patients.
Post-Part um Practices among Women in Calabar, Nigeria
Authors: Ekanem A D , John M E , Ekott M E , Udoma E J
Published: January 2017

We carried out a study on post-partum practices amongst women in Calabar at the maternal and child health clinic at University of Calabar Teaching Hospital between 1March and 31 May 2002. Three hundred women were interviewed. One hundred and ninety-three (64.3%) resumed coitus prior to 6 weeks of puerperium. There was no significant difference in parity ( P=0.20) and educational status ( P=0.10) between women who resumed coitus earlier than 6 weeks and those who resumed later. One out of every 10women resumed coitus without any contraception. The majority [212 (70.7%)] sat in hot water (sitz bath) to aid perineal wound healing and improve vaginal tone.
Availability of Donor Corneal Tissue for Transplantation
Authors: Raychaudhuri Amitabha , Raychaudhuri Manjima , Banerjee Asit Ranjan
Published: January 2017

The utilization rate of available donor corneas is very low almost everywhere. The present work was undertaken to study the rate of acceptability of donor corneas in a city eye bank in India. Donor eyes were evaluated under slit lamp examination and tissue quality was categorized as: very good; good; fair; and poor -following the guidelines laid down by the Eye Bank Association of America in 1992. One hundred and eight eyes (from 54 donors) were studied. The mean age of the donors was 75.9 years (range 30–97 years). Thirty-nine (36%) eyes were of very good to good quality and of these 37 (34.3%) were acceptable for grafting either for optical or therapeutic purposes. Sixty-one (56.4%) eyes were not acceptable owing to fair to poor tissue quality. Four (3.7%) eyes were discarded on medical grounds and six (5.6%) were discarded both because of fair to poor tissue quality and on medical grounds. Twenty-three of 50 tissues (46%) available from donors aged 75 years or younger were acceptable while 14 of 58 (24.1%) tissues from donors over 75 years were acceptable.
Bacteriological Profile in Chronic Suppurative Otitis Media in Eastern Nepal
Authors: Sharma Satyender , Rehan Harmeet Singh , Goyal Arun , Jha Ashok Kumar , Upadhyaya Sanjib , Mishra S C
Published: January 2017

Aural swabs were collected from 250 patients with chronic suppurative otitis media (CSOM) (tubotympanic disease). Duration of ear discharge was more than 6 months for culture and sensitivity test. The disease was unilateral in 178(71.2%)and bilateral in 72 (28.8%) patients. From a total of 322 aural swab cultures, 324 organisms were isolated with predominance of Pseudomonas aerugimosa (36.4%) followed by Staphylococcus aureus (30.2%). All the isolated Gram-negative organisms showed in vitro sensitivity to ciprofloxacin, amikacin, ofloxacin, and gentamycin whereas cloxacillin, ofloxacin, erythromycin, ciprofloxacin, gentamicin and tetracycline were more effective against Gram-positive isolates. Most isolates were resistant to amoxycillin. It is concluded that ciprofloxacin is preferred to aminoglycosides as an important tool in the treatment of CSOM because of its lower cost, lack of ototoxicity and availability astopical oral preparations.
Hysterectomies Amongst Teenagers in Calabar, Nigeria
Authors: Udoma Edem J , John Mildred E , Ekanem Asuquo D , Etuk Saturday J
Published: January 2017

A 10-year retrospective study of hysterectomies performed on teenagers in Calabar was carried out.
Recurrence of Multicystic Ameloblastoma in Soft Tissue
Authors: Olasoji H O , Nggada H A , Tahir A A
Published: January 2017

Ameloblastoma is characteristically considered to be a benign but locally aggressive and infiltrative odontogenic tumour with a high recurrence rate. Most recurrences of the solid or multicystic ameloblastoma occurred at the edges of the initial tumour or at the bony cavity left after the excision of a tumour. A case of an isolated soft tissue recurrence of ameloblastoma of the mandible in a 58-year-old man is presented. The report illustrates the need to take into consideration the adjacent soft tissue in cases of tumour with cortical bone perforation during surgical treatment. This is especially important in an environment where patients are not likely to attend follow-up review fora long period. It also demonstrates the ability of intraosseous ameloblastoma to grow in soft tissues.
Pharmacokinetics of Artesunate following Oral and Rectal Administration in Healthy Sudanese Volunteers
Authors: Awad M I , Eltayeb I B , Baraka O Z , Behrens R H , Alkadru A M Y
Published: January 2017

The aims of this study were to determine the pharmacokinetic parameters of a single dose of 200 mg oral and rectal artesunate in healthy volunteers, and to suggest a rational dosage regimen for rectal administration. The study design was a randomized open cross- over study of 12 healthy volunteers; the analytical method used was a reversed phase high performance liquid chromatography with post column derivatization and subsequent ultraviolet detection.

Pharmacokinetic parameters were derived from the main metabolite α-dihydroartemisinin data due to the rapid disappearance of artesunate from the plasma.

Dihydroartemisinin following oral administration of artesunate had a significantly higher AUC0-∞ ( P<0.05 95% confidence interval (Cl) −1168.73, −667.61 ng.h/mL−1) and Cmax( P<0.05;95%Cl −419.73, −171.44 ng/mL− 1, and had shorter tmax ( P<0.05; 95% Cl −0.97, −0.10 h) than that following rectal artesunate. There was no statistically significant difference in the elimination halflife between both routes of administration ( P> 0.05; 95% Cl −0.14, 0.53 h). The relative bioavailability of rectal artesunate was [mean (coefficient of variation%)54.9(24.8%)%]. On the basis of these data an 8 hourly dosing regimen per day with rectal artesunate is proposed.
Using Body Diagrams and Disease Protocols as Part of an Integrated Approach to the Medical Consultation in Nepal
Authors: McKellar Angus T , Rutland-Brown Wesley
Published: January 2017

Neither medical assistants nor doctors in Nepal receive adequate training in medical consultation techniques. Patients often leave the consultation with poor understanding of their disease. Moreover, disease management counselling and preventative health counselling are rarely done. In order to address these issues, simple body diagrams and disease protocols were developed and tested in a random cohort survey of 300 outpatients. While 72% of patients who were shown a body diagram achieved basic understanding of their disease, only 38% of patients who were not shown a body diagram understood their disease. This improvement was significant and independent of other factors. Satisfactory disease management counselling was given in 38% of cases, and preventative health counselling in 36%. There was correlation between use of body diagrams and provision of disease management counselling and preventative health counselling. These findings emphasize the need for simple consultation tools such as body diagrams and disease management protocols in developing countries.
Maternal and Neonatal Profile and Immediate Outcome in Extremely Low Birth Weight Babies in Delhi
Authors: Sehgal Arvind , Telang Sucheta , Passah S M , Jyothi M C
Published: January 2017

We studied the maternal and neonatal profile and outcome of extremely low birth weight (ELBW) babies at the level III neonatal intensive care unit (NICU) in Delhi. Case records of ELBW inborn babies delivered between August 2000 and August 2001 were analysed by using a pre-set proforma. Atotal of 52 ELBW babies were admitted to the NICU in the relevant period, of whom 30 (57%) survived. Maternal anaemia, previous preterm delivery and pregnancy-induced hypertension (PIH) were the common predisposing factors for preterm delivery. Mean gestational age was 27.8 weeks and mean birth weight was 831 g. The highest mortality (55%) was seen in babies with 25–28 weeks'gestation and those in the birth weight category of <800 g. Neonatal hyperbilirubinaemia (78%) and hyaline membrane disease/respiratory distress syndrome (65%) were the most common causes of morbidity. A total of 25 babies were mechanically ventilated while 24 (46%) received total parenteral nutrition. Sepsis, pulmonary haemorrhage, intracranial haemorrhage and necrotizing enterocolitis accounted for the deaths in the study population. Retinopathy of prematurity screening was performed in 35 babies (68%), of whom 22 were found to be normal. According to the International Classification of Retinopathy of Prematurity, most babies (72%) had involvement of zone 3 and stage I (63%). The incidence was highest in 26–28 weeks'gestation babies (71%) and the <800 g birth weight category (62%). Maternal risk factors such as anaemia and PIH commonly predispose to preterm delivery. There is an alarmingly high mortality in this population. Effective steps are required not only to avoid extreme prematurity but also to reduce morbidity and mortality of all newborns weighing <1000 g at birth.
Primary Small Bowel Volvulus in Nepal
Authors: Ray Dipankar , Harishchandra B , Mahapatra Sanjay
Published: January 2017

Small bowel volvulus is a rare cause of intestinal obstruction. Primary small bowel volvulus occur; without any predisposing cause. It is rare in Western countries but common in Africa and Asia. It is the most common cause of bowel obstruction in Nepal (excluding incarcerated external hernias). Early diagnosis and management is essential to avoid infarction of bowel. Persistent central abdominal pain is characteristic. There is no single specific diagnostic clinical sign or abnormality in laboratory or radiological findings. There is no role of conservative management and, in suspected cases, early laparotomy should be done to avoid bowel infarction. In follow-up patients may present with stricture formation or recurrence of bowel volvulus.
Brain Hydatid Cyst in Basrah
Authors: Ameen Ameen Abbas
Published: January 2017

Although infestation with Echinococcus granulosus is common in Iraq, brain hydatid cysts are rare. The first case since the establishment of the neurosurgical unit in Basrah (population 1.5 million) four years ago is reported. It was successfully treated by operation.

The two points emphasized are the rarity of this problem, and the technical steps to maintain the integrity of the cyst during surgery. This seems to be the most important factor in preventing recurrence, which contributes largely to the outcome after surgery.
Feeding Patterns of Children with Protein-Energy Malnutrition in Nigeria
Authors: Jinadu M K , Ojofeitimi E O , Osifor E O
Published: January 2017

The feeding patterns of 115 consecutive cases of children suffering from protein-energy malnutrition (PEM) seen at Ile-Ife University Teaching Hospital, were investigated. The majority of the children were from Ile-Ife township and nearly all their mothers were working outside their respective homes. The survey shows an earlier mean age (27 months) of onset of kwashiorkor compared with Naismith's (1973) study. About two-thirds of the mothers had stopped breastfeeding their children by the age of 17 months. Artificial milk was introduced briefly, in token quantity, and was replaced by “corn-pap” and other starchy foods such as “yam” and “hard-pap”. Over 80% of mothers would not feed their children on meat and fish because they believed these foods would cause worms which, in turn, would cause abdominal pain and loss of weight. Cow's milk, groundnut and cowpeas were said to cause diarrhoea by about two-thirds of the mothers.

Our study shows that cessation of breastfeeding, inadequate feeding on artificial milk, and cultural beliefs about appropriate weaning diets for the infants were the major causes of PEM in this part of the world.
Scabies and Streptococcal Skin Infection in Ghana
Authors: Acheampong J W , Whittle H C , Addy H A , Obasi E O , Parry E H O , Harman R R M , Adjei Ohene
Published: January 2017

The observation of the predominance of scabies and streptococcal skin infection in the skin diseases occurring in the outpatient department of the Komfo Anokye Teaching Hospital, Kumasi, Ghana, led to a survey being conducted. It began with an exploratory survey in two well-defined communities, a medium security prison with a population of 1063 and a village with a population of 3000. This was later followed by an epidemiological survey in the village. The results showed that the most common skin disease in middle Ghana (a tropical rainforest area) was scabies with about 17.6% of the population having the disease.
A New Instrument for the Delivery of the Impacted Dead Fetus
Authors: Belfort M A
Published: January 2017

A new destructive instrument for the delivery of the dead impacted fetus is presented. The efficiency of the instrument is demonstrated in three cases and the diminished risk of maternal trauma highlighted. The instrument consists of a perforator, an introducer, a screw holder and a fetal bone screw.
Malaria in Saudi Arabia
Authors: Sebai Zohair A
Published: January 2017

In the 1940s Anopheles mosquitoes were abundant about the wells and marshy areas in Saudi Arabia. Nearly 100% of the population in many villages and oases had suffered from malaria at one time or another. However, the progress made in the malaria program in Saudi Arabia from the time of its inception in 1948 is possibly one of the most significant achievements in public health in the Kingdom over the last 40 years. The challenge which the country now faces is to control malaria in the Southern Province and in the residual foci in the Western Province, while maintaining the rest of the country malaria free.
Stroke in a Subsaharan Nigerian Hospital—A Retrospective Study
Authors: Bwala S A
Published: January 2017

The case records of 53 consecutive Nigerian inpatients with stroke in the University of Maiduguri Teaching Hospital, Maiduguri were retrospectively reviewed. The mean age at presentation was 55 years and the male to female ratio was 2.5: 1. The mean duration of symptoms before presentation was 11.1 weeks and the average duration of stay in hospital was 3 weeks. Thirty-three (63%) of the lesions were infarctive and 19 (37%) were haemorrhagic. Only 3 (6%) patients gave a history of prior transient ischaemic attacks (TIAs). Forty-two (79%) patients were hypertensive at presentation out of which 27 (64%) had the hypertension diagnosed for the first time. Four (8%) patients were non-insulin dependent diabetics. There were 11 hospital deaths (21%). Thus hypertension, more than half undiagnosed at admission, was the most common risk factor for stroke in the hospital population studied.
Knee Surgery and the Indian Knee: The Importance of the Preservation of Flexion
Authors: Villar R N , Solomon V K , Rangam J
Published: January 2017

The pattern of knee pathology seen in an Indian mission hospital following the introduction of knee clinics is described. This paper reports the results of the first 200 consecutive patients seen at these clinics, relating the findings to anticipated treatments. The occurrence of degenerative disease was high. The importance of knee flexion, in order to be able to squat, is highlighted. The necessity to adopt this position materially alters the types of treatment that can be offered to this group of people. It is concluded that treatments common to the West are not always suitable for patients in the Third World.
Immunogenicity of Measles Vaccine from a Hospital Based and Outreach Programme in Rural Kenya
Authors: Kaan J A , van Vlokhoven P C A , Schneeberger P M , Nijhof W
Published: January 2017

Data on efficacy of rural immunization programmes are scarce. We investigated the seroconversion rate following measles vaccination in an outreach programme in Kakamega District, Kenya.

Of 170 children, 120 (71%) showed seroconversion after vaccination. Haemagglutination inhibition test was performed on paired blood samples before and 30 days or more (mean 46, range 30–70 days) after vaccination. These results are comparable to results found by other studies in developing countries. Geometrical mean titres before vaccination of children in the age group above 14 months were significantly lower than in the younger age groups ( P < 0.001).

This investigation indicates that seroconversion rate studies are feasible in remote rural areas.
The Value of the Autopsy in a Rural Hospital of Haiti
Authors: Ollé-Goig Jaime E , Canela-Soler Jaume
Published: January 2017

We conducted a retrospective study of the autopsies performed during a 28-month period in the Department of Medicine of the Hôpital Albert Schweitzer in Haiti. We found that of 77 autopsies, the main clinical diagnosis was not confirmed at autopsy in 15 patients (19.5%). The results obtained at autopsy would have changed the treatment in 19 patients (24.7%) and the new therapeutical regimens could have had a significant impact on the outcome in six patients (7.8%). Important new information was also gained from the macroscopical examination only. The authors stress the value of the postmortem examination in areas with limited resources.
Reusable Needles — A Major Risk Factor for Acute Virus B Hepatitis
Authors: Narendranathan M , Philip Mathew
Published: January 2017

We conducted a case control study to find the extent to which acute virus B hepatitis was hospital acquired. One hundred and sixty consecutive cases of acute virus B hepatitis were compared with age (±3 years) and sex matched healthy hospital visitors. Exposure to reusable needles, blood or blood products, therapeutic and diagnostic procedures, common razors and sexual practices were elicited by means of a questionnaire. Only exposures in the incubation period (6 weeks to 6 months before the onset of symptoms) were included in the analysis. The odds ratio (OR) for injections for reusable needles was 6.3 [95% confidence interval (CI) = 3.8–10.6]. The OR for single injection (OR = 3.9; 95% CI = 2.0–7.3) was less than that for multiple injections (OR = 9.8; 95% CI = 3.8–26.3), showing a dose response relationship. The proportion of cases of acute virus B hepatitis attributable to hospital related exposures was 67%. Proper aseptic techniques and sterilization practices can substantially reduce the incidence of acute hepatitis B in the population.
Osmotic Production of Sterile Oral Rehydration Solutions — An Economic, Low-Technology Method
Authors: Wilson Michael , Monro Phillip , Cutting William AM
Published: January 2017

A sterile oral rehydration solution can be produced by immersing in water a semi-permeable cellulose tube containing glucose and salts. Osmotically driven ultrafiltration excludes all microbes and particulate matter even when the immersion water contains 45 × 106 cfu/ml of Pseudomonas aeruginosa, 25 × 107 cfu/ml of Staphylococcus aureus or 20 × 107 cfu/ml of Escherichia coli. Solutions of consistent composition can be obtained by having a standard amount of glucose-electrolytes in a cellulose tube of appropriate dimensions and immersing this in a fixed volume of water for a minimum period of time. The method is simple, inexpensive, low-technology and requires no external source of power. It has potential for producing sterile solutions for injections and intravenous use in situations with very limited and simple resources, in emergencies and during natural disasters. Further studies are now needed to determine whether the method can be adapted to provide the large quantities of oral rehydration fluid needed in field conditions.
External Skeletal Fixation: Experience in a Small Rural Hospital in Northern Kenya
Authors: Galvagno S
Published: January 2017

The author describes the use of external skeletal fixation in the management of complicated septic limb fractures. Eight fractures in seven patients were treated at Sololo General Hospital using a low cost, simple external device, with good results. The report emphasizes how external fixation can solve difficult fracture cases in small up-country hospitals; a good example of appropriate technology at district level.
The Reasons for Amputations in Children (0–18 Years) in a Developing Country
Authors: Loro Antonio , Franceschi Fulvio , Dal Lago Annamaria
Published: January 2017

This study describes 49 young amputees who either have attended or have been operated at the Orthopaedic Department of Dodoma Regional Hospital from 1983 to 1991. Emphasis has been put on the aetiological factors of 56 amputations under review, underlying those that are typical of the Least Developed Countries in Africa and highlighting how they interrelate with the beliefs and traditions of the African society. Apart from 14 amputations performed for trauma of different type, important roles were played by home environment, tumours, wild animal bites and the health system itself.

Nine amputations have been carried out for burns, while complications after medical care, particularly operative, have called for 12 amputations. Bone tumours have been responsible for eight and hyena assaults and snake bites have resulted in seven amputations. Special interest has been raised by four amputations performed for the so-called ‘idiopathic tropical lower limbs gangrene’ whose aetiology is still unknown.
Experience of Autologous Blood Transfusion at a District General Hospital in Zambia
Authors: Manda Winfred , Duffy Gillian
Published: January 2017

SUMMARY

An Autologous Blood Transfusion Programme has been in operation at Ndola Central Hospital (NCH) since April 1992. This paper describes a method of cell salvage and reviews the two types of autologous transfusion [acute isovolaemic haemodilution (AIH) and cell salvage] practised over the 6 month period November 1992 to April 1993. No complications or adverse effects were encountered and the benefits include reduction of immunological reactions and transmission of infection, which are risks associated with homologous transfusion. There is need to minimize homologous transfusions because of these risks and hospitals should develop reasonable, practical guidelines for safer transfusion, including the use of autologous blood whenever possible.
Meconium Stained Liquor: A View from a District Hospital
Authors: Apers Ludwig M
Published: January 2017

Meconium stained liquor (MSL) is a common problem in obstetrics, but its management at district level causes some specific questions. Recent literature was reviewed to obtain an insight in the current knowledge about the significance, the related pathology and the possible strategies to prevent adverse fetal outcome. The acquired data were used to propose some recommendations to tackle this problem at district level.
Microcytosis: Guidelines for Family Doctors
Authors: Abdul-Ghaffar Naser U A M A , El-Sonbaty Mohammed Riad , Kumar Ramesh
Published: January 2017

In our studies of microcytosis, the complete blood count (CBC) of 82 830 randomly selected patients was analysed. Of these 34.3% showed microcytosis, and 5.5% were not anaemic. Emphasis was given to study the extent, causes and patterns of non-iron deficient microcytosis. Haematological data was adequate to differentiate iron deficient (ID) from non-iron deficient (NID) patients with microcytosis in 285 subjects. Of these 21.4% were found to be NID. A majority (73.8%) had showed a form of haemoglobinopathy, the commonest being β-thalassaemia minor (60.7%). Of non-invasive investigations, mean corpuscular haemoglobin (MCH), mean corpuscular haemoglobin concentration (MCHC), red cell size distribution width (RDW), anisocytosis in blood smears, serum iron (SI) and haemoglobin electrophoresis, the parameter which separated ID from NID patients most effectively was haemoglobin electrophoresis. It showed an abnormal pattern in 82% of NID subjects and normal pattern in 96.4% ID subjects. In the 18% of the NID subjects with a normal pattern, raised serum iron levels characterized 11 % additional subjects with NID.
The Increased Burden of Tuberculous Lymphadenitis in Central Africa: Lymph Node Biopsies in Lusaka, Zambia, 1981 and 1990
Authors: Bem Chris , Patil Prahlad Shripad , Luo Nkandu
Published: January 2017

In order to assess the effect of the HIV epidemic on lymph node biopsies in Central Africa, HIV-1 serology was tested on a cohort of patients undergoing node biopsy in Lusaka in 1990 and the histology of all lymph nodes biopsied in Lusaka in 1981 and 1990 was reviewed. One hundred and eighteen lymph nodes were biopsied in 1981 and 351 in 1990. Cases of tuberculous lymphadenitis increased from 52 (31 children and 21 adults) in 1981 to 186 (22 children, 160 adults, four patients unknown age) in 1990. Sixty-eight of 77 adults (88%) with tuberculous lymphadenitis in 1990 tested HIV-positive. Cases of histology suspicious of primary HIV lymphadenopathy and nodal Kaposi's disease also increased. Cases of malignant lymphadenopathy and overall number of surgical biopsies remained equivalent for 1981 and 1990. The study concludes that the HIV epidemic has led to a large increase in diagnostic lymph node biopsies in Lusaka, mostly through an increase in HIV-related adult tuberculous lymphadenitis.
Pattern of Rheumatic Heart Disease in Adults in Maiduguri — North East Nigeria
Authors: Onwuchekwa A C , Ugwu E C
Published: January 2017

The pattern of rheumatic heart disease in 84 adolescent and adult patients seen over a 9 year period (1982–1990) at the University of Maiduguri Teaching Hospital (UMTH) is presented. Over 70% were in the second and third decades of life. Pure mitral incompetence and mixed mitral valve disease were the commonest valvular lesions. This pattern appears similar to those in other developing countries. Congestive cardiac failure was the commonest complication. Declining economic fortunes of the developing countries, over crowding, malnutrition and inadequate medical facilities may further perpetuate the condition. Early recognition and the management of rheumatic carditis and early valvular lesions will reduce the morbidity and mortality.
Antibiotic Resistance of Shigella in Monrovia
Authors: Guyot A
Published: January 2017

Twenty Shigella strains were isolated from bloody stools, of which 10 had been collected from children. Eighty per cent of the Shigella isolates were serogrouped as S. flexneri. All 20 Shigella strains were susceptible to gentamicin, nalidixic acid and ciprofloxacin. More than 80% were resistant to ampicillin, cotrimoxazole and tetracycline and 65% were resistant to chloramphenicol. Ten of 20 Shigella isolates showed a quadruple resistance to all four antibiotics. The usefulness of nalidixic acid for the treatment of multiresistant Shigella infections is discussed.
Severe Infections following Fish Bone and Spine Injuries
Authors: de Wind Christina M
Published: January 2017

Injuries by fish bones and spines can cause severe infections and tissue necrosis, more extensive than one would expect in such small wounds. This paper describes the injuries and the treatment of 25 patients.