bluuebunny/crossref_metadata_2025_split huggingface dataset:
Traditional Healers' Practices and the Spread of HIV/AIDS in South Eastern Nigeria
Authors: Peters E J , Immananagha K K , Essien O E , Ekott J U 
Published: January 2017

A 3-year (1997-1999) prospective study was carried out to evaluate the possible role of traditional healers (THs) in the spread of HIV/AIDS in south eastern Nigeria. Their patients' knowledge of HIV infection was also ascertained during the review period. Four contiguous states in south eastern Nigeria with high prevalent rates of HIV infection were chosen for the survey. Sixtynine patients of THs were randomly selected and contacted from the patients' list of five selected THs in each state. Thus, a total of 20 THs and 69 patients formed subjects of the study. The study involved a face-to-face interview of the subjects by trained health personnel in each state using a prepared structured questionnaire. The questionnaire elicited information on their biodata, past/present medical history, social/family history, nature and mode of treatment received or administered, and their knowledge of HIV infection, where applicable. The results showed that there was a serious HIV/AIDS related risk inherent in the practices of Nigerian THs patronized by over 60% of the population. This was suggested by the continuous usage of unsterilized instruments and crosscontamination with patients' blood and body fluid in their practices. It was further revealed that, the patients' HIV/AIDS related knowledge was poor (30%). Basic education on HIV/AIDSmust be given to all groups in Nigeria inciudingTHs, their patients and general public. The World Health Organization and other agencies involved in the fight against HIV infection should focus on the safety of THs' practices as a possible mode of transmission of HIV infection in Africa. Unlessthis aspect is taken seriously along with other preventive strategies already adopted, the epidemic of the disease condition may continue to spread in Africa.
Acute Poisoning in the Emergency Room
Authors: Tunwashe O L , Odukoya O O , Atiba J O 
Published: January 2017

This paper reviews 146 cases of acute poisoning seen and treated by us at the adult accident and emergency centre of Lagos University Teaching Hospital, Nigeria, between 1979 and 1982. Barbiturates (19%) and benzodiazepines (17%) were the commonest drugs used in acute poisoning. The highest incidence (41%) was found among persons aged 18–25 years. There were 67 males and 79 females (1:1.2). About 14% took a “cocktail” of more than one drug. Self-poisoning occurred in 74%; 8.6% were apparently suicidal; 15.8% were accidental; and 1.4% were homicidal. Fifty of the patients (33%) were unconscious on admission. The centre's management technique is briefly discussed and the need for a poisons information centre in the country is highlighted.
External Cephalic Version at Term with Tocolysis
Authors: Hofmeyr G Justus 
Published: January 2017

The problems associated with breech presentation are of particular importance in developing countries. The risk of vaginal breech delivery may be increased because of a high prevalence of cephalopelvic disproportion. Caesarean section presents specific risks to women who may not have medical care in subsequent pregnancies and may desire large families. External cephalic version (ECV) before term has not been proved conclusively to influence the outcome of pregnancy. ECV performed at term (37 or more weeks gestation), using tocolytic agents to relax the uterus, has been shown in a technologically developed setting to reduce the incidence of breech presentation and of Caesarean section. The application of this procedure when technological facilities are limited is discussed and the technique is described.
On an Average: The Rural Hospital in Sub-Saharan Africa
Authors: Hamel Jaap L , Janssen Peter W 
Published: January 2017

The general impression of a heavy workload for rural hospitals in sub-Saharan Africa is illustrated by a quantification for 16 parameters, based on data in 120 annual reports from 40 hospitals. The figures presented in this study can be looked upon as “figures of reference” which hospitals can use for reflection on their own data. Comparison with other studies is made possible by presenting the figures after conversion to an assumed population of 100 000. Marginal notes are made on the comparability of the data as presented by the hospitals.
Spontaneous Healing in Nomas of the Eyelid
Authors: Sihota R , D'Souza P , Lamba P A 
Published: January 2017

A noma is an acute, necrotizing ulcerative mucositis, also known as cancrum oris, which occurs commonly in children, 2–5 years of age, having a debilitating illness or severe malnourishment. This gangrene lives up to the meaning of its Greek name, by rapidly devouring all adjacent soft tissues, and in some cases even bone. It generally affects the mouth and genitalia and infrequently involves the lid and other extraocular tissues1–3. A noma spreads painlessly and has been reported to leave extensive and complex facial defects2,4,5. Surprisingly, the nomas seen at the Lady Hardinge Medical College and Smt. Kalawati Saran Children's Hospital have been noted to heal without any disfiguring defects when maintained on supportive nutritional therapy and antibiotics without any surgical manipulation during the active or healing phases of the disease. We detail the history and findings in one such case to emphasize the excellent cosmetic and functional results obtained by this purely conservative management.
Experience with 103 Cases of Intestinal Gangrene in Ile-Ife, Nigeria
Authors: Fashakin E O 
Published: January 2017

One hundred and three patients with intestinal gangrene were managed in Ile-Ife, Nigeria over a 10-year period. The overall mortality in the series was 25.2%. Strangulated hernias were responsible for 65 cases (63%), intussusception 20.4%, adhesions 11.7% and volvulus 2.9%. Avoidable deaths resulted from anastomotic breakdown and inadequate preoperative fluid therapy. Primary intestinal resection and end-to-end anastomosis of large bowel involved in gangrene gave very good results. It was found to be quite safe and economical, and avoided the inconveniences and complications of a colostomy.
Prevention of Transfusion-Associated HIV Transmission with the Use of a Transfusion Protocol for under 5s
Authors: Craighead I B , Knowles J K 
Published: January 2017

Recently there has been an increasing realization that for the prevention of transfusion-associated HIV infection, HIV screening alone is insufficient1. In 1988, a treatment protocol for children under 5 years with severe anaemia, was introduced in Ekwendeni Hospital2. Initial results showed that it was possible to reduce the number of blood transfusions without increasing the mortality rate. By January 1992 the protocol was being widely disregarded by ward staff, and transfusion rates had increased. Strict enforcement of the transfusion protocol from the 16 January produced a sharp drop in the percentage transfused from 44% to 11%. Mortality rates remained similar throughout the period of the study. Thus, it would appear to be possible, with the use of the transfusion protocol, to reduce the number of blood transfusions carried out, without affecting mortality rates, and hence to reduce the risk of transfusion-associated HIV.
The Impact of Training and Supervision on Traditional Birth Attendants
Authors: Lynch Oona , Derveeuw Marc 
Published: January 2017

A survey of 40 trained and 40 untrained traditional birth attendants (TBAs) was done over a 3-week period in two counties in Uganda to evaluate the impact of training and supervision on TBAs. Forty womens' groups and 20 mothers were also interviewed. The result showed that the most utilized birth attendants were mothers-in-law, trained and untrained TBAs, and the pregnant woman herself. Childbirth was regarded as a normal, private event and the birth attendants were normally called when labour was well advanced or in case of complications. Trained TBAs were attending three times the number of deliveries as untrained TBAs. There was no difference in the knowledge and practices of trained and untrained TBAs, and in the performance of supervised versus unsupervised trained TBAs. All TBAs demonstrated poor knowledge and practices in the management of complications of pregnancy and labour. Reasons suggested for the poor performance included an over ambitious, inappropriate initial training, and lack of useful supervision. Overall the study concluded that there was a case for continuing with the training and supervision of TBAs provided changes were made to the selection, training and supervision processes.
An Innovative Method of Tourniquet Application in Proximal Lower Limb Surgery
Authors: Sangwan S S , Aggarwal Aditya K , Siwach R C , Sharma S C 
Published: January 2017

A novel method is presented by which a tourniquet can be applied just proximal to the greater trochanter, without interfering with asepsis. The distal migration of the tourniquet cuff is prevented by a Steinmann pin passed through the greater trochanter. This method has been tried in 20 cases of proximal lower limb surgery with great success. The use of a tourniquet in limb surgery is often required1. A common site of application of the tourniquet for lower limb surgery is at the junction of middle and upper third of the thigh. However, it is difficult to use such a tourniquet for extensive resection of malignant tumours around the knee joint where proximal limits of the incision may reach almost up to the subtrochanteric region. One can apply the tourniquet at the root of the limb just below and parallel to the inguinal ligament, but it may fail as a thigh is conical from proximal to distal and hence the tourniquet cuff or bandage slips downward, thus making it loose2. We have devised a method by which a tourniquet can be applied at the root of the thigh and can be maintained in the same position without any distal migration and loosening, thus making the thigh a bloodless field even up to the subtrochanteric level. We have used this technique for Van Nes rotation plasty and also for osteosynthesis of the middle third of the femur.
Early Diagnosis of Septicaemia in Infants with Respiratory Distress in the Tropics
Authors: Rabasa Adamu I , Okolo Angela A 
Published: January 2017

A prospective study of buffy coat microscopy of 108 infants with respiratory distress during the first 48 h of life was undertaken. Thirty-two infants (29.6%) had positive blood cultures. The buffy coat was stained with methylene blue and with Gram's stain. Using methylene blue staining 94% shared organisms in the buffy coat. Whereas using Gram's stain only 50% were positive — all of which were also positive with methylene blue. Twenty-four infants with negative blood cultures had radiological signs of pneumonia. Of these 83% showed organisms in the buffy coat with both methylene blue and Gram staining. We conclude that buffy coat microscopy provides a simple and reliable guide in the early diagnosis of neonatal septicaemia or lung infection in infants with respiratory distress.
AIDS in Africa: What Drugs do the Carers Want or Need?
Authors: Lamont A C , Greiff M , Rosenberg D S , Wiggin T R 
Published: January 2017

Our objectives were: (1) to discover requirements for treatment of patients with AIDS (PWAs) for healthcare workers in eight English-speaking African countries; (2) to establish policies for supply of drugs, and develop a method for determining the contents of parcels (PWA-BOXes) for the relief of PWAs. Fifty-seven questionnaires were sent to non-government medical units treating PWAs, supplied by the charity Inter Care. Of these 37 units replied, two had no known PWAs, three were swamped by refugees; therefore, the total number analysed was 32. Only 24 units had access to HIV testing and the mean number of PWAs per unit was 58. The reported complications of AIDS were: diarrhoea 28 units; tuberculosis 27 units; pneumonia 28 units; sexually transmitted diseases 26; candidiasis 28 units; and herpes zoster 20. Lists of drug requirements were received. We present a protocol for calculation of contents of PWA-BOXes in the hope that this will provide guidelines for other workers in this field.
Day-Case Laparoscopy in a Ghanaian Teaching Hospital: The Patients' Perspective
Authors: Nkyekyer Kobinah 
Published: January 2017

A questionnaire survey was carried out to determine the acceptability to patients of various aspects of day-case laparoscopy in Korle-Bu Teaching Hospital. One hundred consecutive patients were interviewed within 2 weeks after operation. Sources of dissatisfaction include inadequate explanation about the operation and its aftermath, hospital reporting time, the waiting times at various stages of the process, the mechanism for sending patients from the ward to the theatre and the total length of time spent in hospital. Almost half the patients felt they were not well enough to be sent home at the time of discharge. More than half would have preferred overnight stay post-operatively. The main causes of morbidity were dizziness, abdominal pain, shoulder pain, nausea and vomiting. To make day-case laparoscopy more acceptable to patients a dedicated day care surgery unit with formal anaesthetic cover should be established. The operation and its aftermath should be fully explained to patients well before the day of operation. Stricter criteria should be established for patient discharge, and where appropriate, patients should be allowed the option of overnight stay post-operatively.
Systematic Inspection of Insulin Injection Sites for Local Complications Related to Incorrect Injection Technique
Authors: Seyoum Berhane , Abdulkadir Jemal 
Published: January 2017

We systematically inspected insulin injection sites in 100 insulin-requiring patients attending the Diabetic Clinic of the Tikur Anbassa Hospital (TAH) in order to identify local complications related to incorrect injection technique: local complications were found in 53 cases: skin hyperpigmentation and/or indurations in 30 patients; and fat atrophy or hypertrophy in 31 patients. Illiteracy was significantly more common among those with local complications (18/53 versus 6/47, χ2 5.03, P < 0.05). Mean fasting blood glucose on the day of the inspection was significantly higher (14.9 +6.3 mmol/l versus 10.5 + 6.1 mmol/l, P < 0.001) and a fasting blood glucose > 10 mmol/l more common (41/53 versus 20/47, χ2 14.1, P < 0.0005) in those with than in those without local complications. There was no significant difference between the two groups in mean duration of diabetes (6.9 + 5.6 years versus 6.6 + 5.8 years), frequency of hypoglycaemic episodes (12/53 versus 5/47, χ2 1.76, P > 0.05) or mean daily insulin dose (44 + 18 units versus 44 + 22 units per day). Therefore, we concluded that local complications resulting from incorrect injection technique, a common finding in the group of patients studied, may be common among insulin requiring diabetic patients in general. Incorrect insulin injection causes local complications and disfigurement which may compromise compliance. Furthermore, insulin absorption tends to be erratic from intradermal and fat hypertrophy sites thus interfering with effective diabetic control. Insulin injection sites should be inspected routinely to detect and correct faulty technique promptly.
The Impact of Renal Impairment on the Management of Patients with Lower Urinary Tract Obstruction
Authors: Ogbonna B C , Madziga A G , Anteyi E A 
Published: January 2017

One hundred patients with lower urinary tract obstruction (LUTO) seen over a 10-month period were prospectively studied. Nineteen (19%) had an elevated serum creatinine (>125 μmol/l); 13% had benign prostatic hyperplasia (BPH); 4% had urethral strictures; and two had congenital anomalies. Though urethral strictures are more common than BPH they cause less renal impairment, probably because the patients are younger and also because a urinary fistula may form proximal to the stricture when the intravesical pressure rises very high. Eighty per cent of the patients with renal impairment had a urinary tract infection (UTI), and in these the reduction in serum creatinine following relief of obstruction was slow and erratic. In three patients who did not have UTI the serum creatinine dropped steadily at a rate which varied from 6.8–845 μmol/l/week following continuous bladder drainage and appropriate supportive management. All patients with elevated serum creatinine had delayed surgery and required prolonged preoperative hospitalization, with a resultant sharp increase in the cost of their treatment.
Where There is no Anaesthetist: A Study of 282 Consecutive Patients Using Intravenous, Spinal and Local Infiltration Anaesthetic Techniques
Authors: Adesunkanmi A R K 
Published: January 2017

Two hundred and eighty-two consecutive surgical operations were performed over a period of 11 months, February–September, 1991, December 1991–February 1992 at two private medical centres. Anaesthesia was conducted by the surgeon assisted by the theatre nurses. Intravenous ketamine was given in 72% of operations, xylocaine infiltration in 12.8%, spinal anaesthesia in 11.3% and intravenous thiopentone anaesthesia in 4% of the patients. Major and minor surgical operations were performed on 180 (63.9%) and 102 (36.2%) patients, respectively. With ketamine anaesthesia side effects included transient intra-operative hypertension in 76.8%, delirium/confusion in 56.7% and dreams in 5.4% of the patients. Hypotension at induction and postoperative headache/neck stiffness were the principal side effects in spinal anaesthesia occurring in 59.2% and 12.8%, respectively. Reversible apnoea occurred in three patients and cardiac arrest in one patient of those who had intravenous thiopentone. It appeared, therefore, that where there is no anaesthetist as is often the case in under-doctored areas, after careful patient selection, intravenous ketamine, spinal and local infiltration anaesthetic techniques are safe and useful for many surgical procedures. There is the need to avoid intravenous thiopentone by untrained personnel and in settings poorly equipped for cardiopulmonary resuscitations.
Blood Transfusion in Developing Countries: Problems, Priorities and Practicalities
Authors: Wake D J , Cutting W A M 
Published: January 2017

The acute medical services could not exist without blood transfusions—life-savers in many situations. But transfusions can also be a quick and easy route for the transmission of infectious agents such as HIV, HBV, HCV and malaria. Infection through blood supply is a major issue in all countries but particularly in those with economic constraints which limit safety. This study was carried out in India (March—May 1997) and involved centres in Delhi, Calcutta and Vellore. It examined many aspects of blood transfusion including donor screening, use of professional donors, blood testing and criteria for blood use1. The many problems in Indian blood transfusion services are mirrored in other countries. Here we examine the problems, priorities and practicalities of blood transfusion particularly in developing countries.
Effectiveness of Excision of Pre-Ulcerative Buruli Lesions in Field Situations in a Rural District in Ghana
Authors: Amofah George , Asamoah Samuel , Afram-Gyening Comfort 
Published: January 2017

The effectiveness of excision of pre-ulcerative Buruli lesions in field situations was assessed in a prospective study in an endemic focus in rural Ghana. All 50 patients, clinically diagnosed as having pre-ulcerative Buruli lesions, had their lesions excised followed by primary suturing. The patients were then followed up until the wound healed and thereafter for a year or until recurrence. The median duration for complete healing after excision was 31.5 days while the 1-year recurrence rate was 16%. None of the patients had any form of deformity after healing in contrast with the usual consequences of other forms of treatment. Our findings suggest that excision of pre-ulcerative Buruli lesions is effective in preventing deformities but less so for preventing recurrence of lesion.
Puerperal Sepsis: A Preventable Post-Partum Complication
Authors: Dare F O , Bako A U , Ezechi O C 
Published: January 2017

Patients with puerperal sepsis following delivery at Ife State Hospital (ISH) of Obafemi Awolowo University Teaching Hospitals Complex (OAUTHC) Ile-Ife over a 10-year period spanning January 1986 to December 1995 were reviewed. One hundred and forty-six patients were diagnosed as having puerperal sepsis and there were 8428 deliveries giving an incidence of 1.7%. The incidence was higher among the unbooked patients 71.2%. Predisposing factors were: anaemia in pregnancy, 69.2%; prolonged labour (labour lasting up to 12 h or more), 65.7%; frequent vaginal examinations in labour (more than five), 50.7%; premature rupture of membranes, 31.5%; and non-adherence to asepsis during delivery. The case mortality rate was 4.1 %. Antenatal care and supervised hospital delivery should be encouraged in order to prevent or reduce this serious post-partum morbidity.
Is Vitamin B6 Supplementation of Isoniazid Therapy Useful in Childhood Tuberculosis?
Authors: Mbala L , Matendo R , Nkailu R 
Published: January 2017

We present the results of a prospective single blind placebo controlled study performed to establish whether vitamin B6 supplementation of isoniazid therapy is useful in childhood tuberculosis. Eighty-five children suffering from tuberculosis (TB) and admitted between 1 October 1993 and 31 March 1995 to the Hospital of IME-Kimpese (Lower Zaire) were included. All were treated with isoniazid and other antitubercular drugs and were randomized to receive either vitamin B6 supplementation or placebo. No case of neurological or neuropsychiatric disorder was observed in the two groups during the 6 months of the treatment and 3 months after the treatment. These results suggest that the vitamin B6 supplementation of isoniazid therapy is unnecessary in childhood TB.
Quantitative Analysis of the Role of Biomass in Latin America
Authors: Sanchez-Sierra Gabriel , Umaña-Quesada Alvaro 
Published: January 2017

Biomass, particularly that in the form of fuelwood, is considered to be the principal source of energy for a majority of Third World countries. However, quantitative assessment of fuelwood utilization is often difficult, both because of its ‘non-commercial’ status in many areas, and because of the lack of informaton arising from an unwillingness to officially acknowledge the high reliance of much of the population on this ‘unsophisticated’ fuel. This paper attempts to outline the current biomass utilization trends for Latin American countries. There, it can be shown that a high degree of correlation exists between low per capita income and a high proportion of fuelwood utilization and that the majority of fuelwood is used by the rural public sector, not the commercial and residential sectors. Generally, the trend is towards increased use of biomass energy both as a result of increased growth rates of rural populations and accelerated growth of marginal rural areas. The effect of this increased use has been to increase prices of fuelwood, and the systematic destruction of forest resources may have serious environmental consequences for these regions, with what is essentially a renewable energy source being rendered non-renewable. Recommendations are made as how to provide an integrated approach to the assessment of biomass as a national energy resource in Latin America, with implications for other areas of the world.