bluuebunny/crossref_metadata_2025_split huggingface dataset:
Paediatric HIV and neurodevelopment in sub‐Saharan Africa: a systematic review
Authors: Abubakar Amina , Van Baar Anneloes , Van de Vijver Fons J. R. , Holding Penny , Newton Charles R. J. C. 
Published: August 2010

SummaryObjective  To determine the degree of motor, cognitive, language and social‐emotional impairment related to HIV infection in children living in sub‐Saharan Africa (SSA).Methods  Literature searches using MEDLINE and PsycINFO. Additionally, the reference lists of previous reviews were checked to ensure that all eligible studies were identified. Cohen’s d, a measure of effect size, was computed to estimate the level of impairment.Results  Six reports met the inclusion criteria. In infancy a consistent delay in motor development was observed with a median value of Cohen’s d = 0.97 at 18 months, indicating a severe degree of impairment. Mental development showed a moderate delay at 18 months, with a median value d = 0.67. Language delay did not appear until 24 months of age, d = 0.91. Less clear findings occurred in older subjects.Conclusion  Although HIV has been shown to affect all domains of child functioning, motor development is the most apparent in terms of severity, early onset, and persistence across age groups. However, motor development has been the most widely assessed domain while language development has been less vigorously evaluated in SSA, hence an accurate quantitative estimate of the effect cannot yet be made.
Evaluating skilled care at delivery in Burkina Faso: principles and practice
Authors: Graham Wendy , Themmen Ellen , Bassane Brahima , Meda Nicolas , De Brouwere Vincent 
Published: August 2010

SummaryThere are strong expectations of what could be achieved by skilled care at delivery for maternal and newborn survival and health. Meeting these expectations involves the translation of the concepts and principles of skilled attendance into the reality of routine programmes. This process of translation brings to light some of the tensions which lie behind the consensus on the ideal package and particularly the alternative configurations of provider and place necessary in the immediate term. Lessons learnt from the implementation of specific projects and initiatives have a crucial role to play in informing scaling‐up and the achievement of universal coverage.The Skilled Care Initiative implemented in Burkina Faso by Family Care International, evaluated and reported here, provides many lessons for moving from concepts to practice. Firstly, there is the crucial issue of local contextual adaptation, as no one‐size‐fits‐all for skilled attendance. Secondly, interventions to achieve skilled care require and imply different levels of intensity of implementation, depending on the functionality of the wider health system in the intervention area. Thirdly, there is the crucial issue of the balance and sequencing of supply‐ and demand‐side interventions. Finally, the concept of skilled attendance at delivery does not exist in a vacuum in space or time, and concurrent health initiatives and cross‐sectoral developments, such as transport and road improvements, can strongly influence outcomes. This not only presents challenges for the implementation of specific interventions within health institutions and communities, but also for the evaluation of their effects.
Effects of a Skilled Care Initiative on pregnancy‐related mortality in rural Burkina Faso
Authors: Hounton Sennen , Menten Joris , Ouédraogo Moctar , Dubourg Dominique , Meda Nicolas , Ronsmans Carine , Byass Peter , De Brouwere Vincent 
Published: August 2010

SummaryObjective  The aim of this paper is to assess to what extent a Skilled Care Initiative (SCI) was associated with pregnancy‐related mortality in Ouargaye district, Burkina Faso.Methods  We used a quasi‐experimental design to compare pregnancy‐related mortality within the intervention district (health facility areas covered by the SCI vs. areas not covered) and between the intervention district (Ouargaye) and a comparison district (Diapaga). Population‐based data were used to examine differences in pregnancy‐related mortality levels, their determinants and how they related to uptake of care, as well as examining contexts and mechanisms of pregnancy‐related deaths that occurred. Data analyses included descriptive statistics, univariate and multivariate regression analyses.Results  The main risk factors for pregnancy‐related mortality in rural Burkina Faso were age (extreme ages of reproductive period), low coverage of antenatal care and low institutional delivery. The introduction of the SCI, as implemented within the study reference period, had no appreciable effect on pregnancy‐related mortality.Conclusion  Although the SCI was conceptually well designed and implemented, structural constraints may have limited its effectiveness for reducing pregnancy‐related mortality within its period of implementation. Lessons have been identified which might enable similar skilled attendance strategies to make their full potential impact on pregnancy‐related mortality in remote and rural settings.
Disappearance of phantom limb pain following hyperbaric oxygen therapy
Authors: BANHAM NEIL D G , KEETLEY SHARON 
Published: August 2010

ABSTRACTA 67 year old man with severe peripheral vascular disease and subsequent bilateral below knee amputations was treated with hyperbaric oxygen therapy for non‐healing ulcers on his right leg stump.After one treatment on a 10 metre table (105 minutes) his previously severe phantom limb pain resolved and has since not returned. This has not previously been described and warrants further study.
The increasing impact of asthma on a metropolitan emergency department
Authors: MEEK R 
Published: August 2010

ABSTRACTStatistics relating to asthma were collected at Ryde Hospital from 1983 and 1988. Particular attention was paid to the amount of time emergency department staff devoted to the assessment and treatment of patients with asthma.Asthma attendances increased by 52% over the five years with the proportion of patients admitted increasing from 24% to 32%. The peak times of presentation were the evenings; April, May and June were the busiest months. The time taken in the emergency department for assessment and treatment increased over the five years from 2.3 to 4,2 hours per day, an 83% increase.While the factors behind this rising incidence are debatable and require attention in their own right, it is clear that the work load from asthma is increasing for emergency departments. Important issues raised include emergency department staffing and outpatient asthma education.
Oxygen therapy in emergency medicine Part 1. Physiology and oxygen delivery systems
Authors: SMART DAVID R , MARK PAUL D 
Published: August 2010

ABSTRACTOxygen is essential to life, and supplemental oxygen is the most frequently used drug in the treatment of acutely ill and injured patients. There are sound physiological reasons for the use of supplemental oxygen in emergency medicine, however the rationale for oxygen therapy is poorly understood by junior staff and the prescription of oxygen dosage often haphazard. An understanding of oxygen, its side effects, systems of delivery and reasons for precise dosage is essential in the management of very ill patients.Oxygen should be regarded as a drug and careful titration of its dosage against clinical response is necessary for maximum benefit. This article reviews the physiology of oxygen, systems of delivery and the rationale for their use.
Headache in the emergency department
Authors: FISCHER DAVID 
Published: August 2010

ABSTRACTNon‐traumatic headache is an unusual presenting complaint in emergency medicine, representing only 1.4% of all patients seen over 45 consecutive days at the Royal Hobart Hospital Department of Emergency Medicine.Computerised tomographic (CT) scanning was used to assist diagnosis in 28% of cases, with nearly half (47%) of CT scans positive. Twenty three percent of patients were admitted to hospital.Emergency physicians are reminded that patients with headache commonly have serious underlying pathology.
Computerisation of emergency department clinical attendance records
Authors: CAMERON PETER A , COLERIDGE JOHN , EPSTEIN JOSEPH 
Published: August 2010

ABSTRACTA relatively simple computerised emergency department (ED) attendance record was installed at the Western Hospital with no increase in staffing. The system allows for the entry of patient information and file creation, triage classification, diagnosis and disposition details. A McDonnell Douglas ED module (1988 version), upgraded at Western Hospital, was installed one year prior to the study period. Such systems have the potential to allow data from the 4,000,000 ED annual attendances in Australia to be analysed productively. The recent interest in workload indices and casemix funding formulae has added impetus to the need to computerise ED attendance records.Data entry was performed by clerical staff at the time of registration and following discharge. Diagnostic coding was performed by hospital medical officers. The introduction of the computerised attendance records was associated with no increase in staffing and was accepted by the staff with minimum difficulty.
Intravenous regional calcium gluconate for hydrofluoric acid burns of the digits
Authors: WILKES GARRY J 
Published: August 2010

ABSTRACTObjective:To describe an alternative, simple and effective treatment of digital burns from hydrofluoric acid.Clinical features:Two patients are described with typical presentations from digital exposure to hydrofluoric acid. In both cases topical treatment with calcium gluconate gel was unsuccessful in relieving symptoms.Intervention and outcome:Both patients were successfully treated with intravenous regional calcium gluconate based on a Bier's block technique.Conclusion:Digital burns from hydrofluoric acid resistant to treatment with calcium gluconate gel may be successfully treated with this technique, without the need for removal of finger nails or the complicated, protracted technique of intra‐arterial calcium infusions.
Repeat cylindrical battery ingestion
Authors: KAPLAN GARY , TOTTEN VICKEN Y 
Published: August 2010

ABSTRACTCylindrical batteries are not commonly ingested. Their size and shape may pose problems different from those seen with disk battery ingestion. We present a case of repeat cylindrical battery ingestion in a schizophrenic woman. The presentation and course, potential treatment modalities and complications of cylindrical battery ingestion are discussed.
Hypomagnesaemic hypocalcaemia and status epilepticus
Authors: HITCHCOCK TOM , MARINOVICH NORM 
Published: August 2010

ABSTRACTObjective: To describe and discuss a case of status epilepticus as a result of hypomagnesaemic hypocalcaemia and the implications for the investigation of the fitting patient.Clinical features: A 69 year old man with a recent illness characterised by weight loss and diarrhoea presented in status epilepticus. Tetany was absent in the post‐ictal period. Investigation revealed hypomagnesaemic hypocalcaemia, macrocytic anaemia and hypoalbuminaemia.Intervention: After initial resuscitation with oxygen and anticonvulsants, magnesium replacement alone corrected the biochemical abnormality.Conclusion: Both hypocalcaemia and hypomagnesaemia can cause seizure activity. Calcium and magnesium levels are useful investigations in the fitting patient even without signs of tetany. When hypomagnesaemic hypocalcaemia occurs, the likely cause is magnesium deficiency and magnesium replacement alone is indicated.
Diabetic ketoacidosis
Authors: PREISZ PAUL , HAMER WAYNE , FULDE GORDIAN 
Published: August 2010

ABSTRACTDiabetic ketoacidosis is a common medical emergency and may represent up to 14% of all diabetic admissions with an annual incidence of about 4.6 cases per 1,000 diabetics per year.A spectrum of disease is encountered and mortality rates vary in different series from 1.9% to 15%. The pathogenesis of diabetic ketoacidosis is discussed in detail with particular emphasis on interpretation of biochemistry results and on fluid and electrolyte resuscitation.A flexible approach to fluid resuscitation, careful interpretation of biochemistry results, and close monitoring should be combined with other standard aspects of management such as titratable insulin infusions and early treatment of identifiable precipitants in order to minimise morbidity and mortality.
Premature labor precipitated by red‐back spider envenomation
Authors: KNOX IAN , CAVE DON 
Published: August 2010

ABSTRACTObjective: To present the first reported case of premature labor complicating severe red‐back spider envenomation and the use of antivenom in its treatment.Clinical features: A 33 year old multiparous woman, 30 weeks pregnant, arrived at hospital almost a day after being bitten. She displayed classical features of red‐back spider envenomation and was having regular, moderately strong, uterine contractions. She had a history of premature labor with previous pregnancies.Intervention: She was treated initially with red‐back spider antivenom followed shortly afterwards by an indomethacin suppository. This markedly improved her symptoms of envenomation and significantly reduced the strength and frequency of uterine contractions. A second ampoule of antivenom with another indomethacin suppository all but resolved the patient's clinical problems. She was discharged without sequelae.Data synthesis: Medline search was undertaken for reports of the complications of Latrodectus envenomation in pregnancy.Conclusion: Premature labor is a rare complication of red‐back spider envenomation. Antivenom is a safe and essential part of its management.
Axillary vein thrombosis and compartment syndrome in upper limb trauma
Authors: Cullen Paul 
Published: August 2010

AbstractAxillary thrombophlebitis and compartment syndrome are potential complications of upper limb trauma with significant morbidity and mortality. A 25 year old man presented 24 hours following an isolated limb injury with these synchronous complications. Early systemic anticoagulation and fasciotomy resulted in significant bleeding and anaemia. Renal function remained normal despite evidence of significant rhabdomyolysis (CK>16 000U/L). Several attempts at closure of fasciotomies were frustrated by major swelling and finally, devitalised biceps brachii was debrided in toto. He was discharged with residual sensory and motor deficits. Three months later, he had marked disability from weakness, sensory disturbance and post‐phlebitic swelling.
Pharmacokinetics of prilocaine in intravenous regional anaesthesia
Authors: SMYTH JAMES , HENDRIE JAMIE , BERLINSKI NEIL , O'CALLAGHAN CHRIS , LOUIS WJ 
Published: August 2010

ABSTRACTTo determine the acute pharma‐cokinetics of prilocaine in intravenous regional anaesthesia (IVRA), plasma prilocaine levels before and after tourniquet release were measured for sixteen patients (including six children) with forearm fractures. A dose of 2.5mg/kg was used with a minimum cuff occlusion time of 20 minutes. No patients had detectable drug levels prior to tourniquet release. Peak drug concentrations were reached within 10 minutes of tourniquet release in all patients. Average peak drug concentration was 1.23mcg/ml. By 30 minutes, drug levels had reached an average of 0.34mcg/ml (range <0.3–0.6mcg/ml). The pharmacokinetic curves of the children were similar in profile to the adults, with analysis of variance failing to demonstrate a significant difference between curves. In no patients did prilocaine reach toxic levels. These results show that prilocaine used at a dose of 2.5 mg/kg is safe and that an observation period of 30 minutes following IVRA is adequate. IVRA does not appear to be contraindicated in children.
The emergency department management of torsades de pointes
Authors: Carey Martin J 
Published: August 2010

AbstractThis case report describes the features of polymorphic ventricular tachycardia known as torsades de pointes. The arrhythmia was probably triggered as a result of the patient taking a small dose of sotalol, in conjunction with other risk factors. The treatment of torsades de pointes is discussed, including the role of transcutaneous cardiac pacing in the emergency management of this arrhythmia.
Hypobaric decompression sickness
Authors: Whitfield Ann , Scheinkestel Carlos D , Miller Ian L , Cooper D Jamie , Tuxen David V 
Published: August 2010

AbstractThe Royal Australian Air Force (RAAF) mimics emergency aircraft decompression and hypoxia in a chamber decompressed over two to six minutes to a simulated altitude of 25,000 feet (7500m). Air crews in the chamber are trained to use oxygen apparatus including positive pressure breathing systems under these conditions. Over a seven year period, the RAAF has performed approximately 2500 subject decompressions and the Alfred Hospital Hyperbaric Service has treated 11 patients suffering decompression sickness (DCS) following this hypobaric exposure.The 11 patients (eight males, three females, mean age 26±4 years) presented with typical DCS, with joint pains (9), paraesthesiae (7) and concentration and memory deficits (6). One had major neurological deficits including ataxia and dysarthria. Patients required a mean of seven treatments (range 2–25) to a depth of 18m on 100% oxygen. Two patients with refractory symptoms were recompressed with a 50: 50 mix of helium and oxygen and the patient with severe neurological deficit required recompression to 30m.Nine patients had complete resolution of DCS with treatment, one patient resolved fully by one month after treatment, the patient with more severe neurologic deficit recovered completely by 12 months and one patient with persistent mild sensory deficits was lost to follow‐up by the Alfred Hospital. There were no major differences in presenting symptoms, number of treatments, or outcome between these patients and 422 treated patients suffering DCS following diving over the same time period.DCS may occur with exposure to high altitude. The severity and treatment is similar to that occurring following diving. Resolution of symptoms and signs may be achieved by recompression therapy.
Depressed myocardial contractility following massive envenomation by an unknown snake
Authors: Wilson Glenda M 
Published: August 2010

AbstractObjectiveTo describe a case of severe envenomation following snake‐bite requiring multiple doses of polyvalent antivenom, and associated with marked hypotension and left ventricular failure.Clinical featuresA 24 year old man developed signs and symptoms of severe envenomation following a definite bite from an unidentified snake. There was a delay in seeking treatment, during which time he ingested a quantity of alcohol. He developed a profound coagulopathy, and refractory hypotension following the commencement of antivenom, the cause and management of which constituted a difficult clinical problem in his initial management in a small country hospital. He later developed left ventricular failure.OutcomeHe required a brief period of intensive care management, including continuous positive airway pressure (CPAP) ventilation, despite having received four ampoules of polyvalent antivenom, the initial three ampoules prior to arrival at a tertiary hospital. He recovered fully and was discharged five days after the bite.ConclusionThis case supports the animal and limited clinical data which suggest that snake venoms may depress myocardial contractility. It highlights the need for more antivenom in this clinical situation.
From whom do students learn in emergency departments?
Authors: Kelly Anne‐Maree 
Published: August 2010

AbstractThis prospective survey of medical students was conducted to identify the occupational groups within the emergency department from whom students felt they were learning and to estimate the relative contribution to learning of each occupational group. The results suggest that major contributions to learning are made by a variety of occupational groups including registrars, consultants, resident medical officers and nursing staff.
Sudden death following butane inhalation
Authors: May Christopher R 
Published: August 2010

AbstractDespite vigorous resuscitation, two young males died shortly after recreational inhalation of butane gas from cigarette lighter refilling cylinders. Inhaled hydrocarbons may predispose to lethal myocardial arrhythmias. The use of adrenaline in resuscitating such patients should be reconsidered.
Emergency department recognition and management of dissecting thoracic aneurysm
Authors: Richards Karen A 
Published: August 2010

AbstractDissecting thoracic aneurysm is a rapidly fatal disease if left untreated. A high clinical suspicion is essential in making the diagnosis. Treatment with β blockade and vasodilation is begun before definitive diagnostic investigations are performed. In Australia, contrast CT scanning and increasingly transoesophageal echocardiography are readily available tests and may be preferred to angiography in many centres. However, cases of dissecting thoracic aneurysm are still missed as they may present in a variety of subtle ways. Dissecting thoracic aneurysm should always be considered in the differential diagnosis of patients in the emergency department with unexplained symptoms or signs, particularly the combination of chest pain, pulse deficits and neurological dysfunction.
Light‐guided tracheal intubation as an alternative for difficult intubation
Authors: Burne Scott G , Navaratnam Siva , Bishai Maher Nassis 
Published: August 2010

AbstractAirway management is an important skill in resuscitation. Failure to ensure adequate ventilation may have disastrous consequences. Anatomical and pathological causes may preclude tracheal intubation by direct laryngoscopy. A case is described of successful tracheal intubation with laryngoscopic grades III and IV, by two separate light‐guided intubations. The device used was the Trachlight® which has the advantages of being safe and inexpensive, and can enable rapid intubation without manipulation of the head and neck. The technique has been shown to be easily learnt. The authors recommend its use in emergency departments where it has applications in patients with cervical spine injuries and in cases of difficult or failed intubations.
Upper airway trauma
Authors: Little Roderick W 
Published: August 2010

AbstractTwelve cases of injury to the upper airway due to external trauma seen over a seven year period in the emergency department are presented. Four injuries resulted from penetrating trauma and eight from blunt trauma.Active airway management was initially required in seven patients. Two patients died of severe neurological injury despite appropriate airway management. Surgical intervention was undertaken in five of the ten survivors, with good results. One patient was discharged with a tracheostomy.All patients presented with symptoms or signs of airway injury. However, airway injuries are uncommon, patients may present without signs or symptoms and these injuries may be overlooked, with potentially disastrous consequences. Airway trauma should be suspected in all cases of blunt or penetrating trauma to the head, neck or chest. Emphasis should be placed on control of the airway and judicious performance of diagnostic procedures, followed by surgical repair where indicated.
Splenic complications of pancreatitis: A case report and review of the literature
Authors: Raftos John R , Ethell Anthony T , Freiman John S 
Published: August 2010

AbstractA 44 year old male with pancreatitis developed the complications of splenic artery and vein thrombosis, resulting in splenic necrosis, an infected perisplenic haematoma and bleeding gastric varices. He was successfully treated with antibiotics, surgical debridement and splenectomy. The aetiological mechanisms of the involvement of the spleen and the importance of splenic complications in pancreatitis are discussed.