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COMPARATIVE STUDY OF HAEMODYNAMIC RESPONSES TO ACTIVE AND PASSIVE POSTURE INDUCING HEAD-WARD POOLING OF' BLOOD IN MAN
No full textObjective: To study the relative effects of passive head-down tilt and squatting on thecardiovascular dynamics in man.Design: A pre-testlpost -test study.Serfting: Physiology Research Laboratories in the Schools of Medicine at Addis AbabaUniversity and the University of Dundee, UK.Subjects: Ten normal healthy subjects aged nineteen to twenty two years.Intervention: Cardiovascular variables measured in Passive body tilt and squatting.Mlzin outcome measures. Similar responses in forearm blood flow, arterial blood pressure,peripheral vascular resistance, and pulse rate observed in both active and passive posturalchanges.Results: A change from the sitting to the squatting position resulted in marked changes offorearm blood flow (FBF=1.63niV100 mumin, p<0.05), mean arterial blood pressure(BP=9mmHg, p<0.05), mean forearm vascular resistance I PVR=-10 PRU, p<0.05) and meanpulse rate (PR =-5 beats/min, p>0.05). The corresponding changes in the head-down positionwere: FRF=2.37mV100 mumin, p<0.05; BP=11.0 mmHg. p<0.05; VR=-12.85 PRU, p<0.05;PR=-10 beatslmin, p>0.05)Conclusion: These results wggest that the movement of blood towards the head is onlyslightly more marked in the head-down tilt than in the squatting position. The changes inflow and arterial blood pressure are similarly correlated 1 r=0.6291 in squatting and r=0.553in 30' head-down tilt). In both positions, blood moves to the thorax, neck and the head thustraversing the same baroreflex regions. This means that changes in cardiovascular variablesin the two positions are detected by the same receptors signalling information to integratingcentres via the same afferent pathways. Squatting and head-down tilt can, therefore, be usedalternately to counteract orthostatic dizziness and to assess the significance of cardiovascularautonomic neuropathy in patients with disease conditior~s like diabetes mellitus
Perforated Meckel’s diverticulitis presenting as a mesenteric abscess: Case report
No full textOnly 2% of patients with Meckel’s diverticulae (MD) will manifest clinical problems. Diverticulitis occurs in approximately 10-20% of patients with symptomatic MD and more often in the elderly population. We report a case of Meckels diverticulitis presenting with perforation and mesenteric abscess in a young African man. The authors present information on diagnostic pitfalls and advise a lower threshold for consideration of MD as a differential diagnosis of acute right iliac fossa pain especially when the CT scan denotes a normal appendix in a male patient
CORONARY ARTERIAL VESSELS IN RELATION TO SUDDEN CARDIAC DEATH: A REVIEW
No full textObjective: To review literature on the coronary vascular factors related to the syndrome ofsudden cardiac death.Data source/synthesis: Major published articles and case reports on the nature of suddencardiac death were searched electronically (Medline, Internet) and through hand scanning.Comparison of the different studies with regard to common themes was undertaken andconsensus opinions highlighted.Results: The aetiology of sudden cardiac death is diverse. Many conditions, hithertoconsidered benign, including coronary arterial anomalies and muscle bridges have beenshown to cause sudden cardiac death. Coronary atherosclerosis, hypoplastic coronaryvessels, coronary artery dissections are the commoner causes. The role of coronary arterialthrombi is controversial. The protective role of exercise is seriously questioned by the manyreports of sudden cardiac death in long distance runners.Conclusion: Cases of sudden cardiac death are increasingly being reported. As a minimum,autopsy worksheets for cases of sudden death should include atherosclerosis, congenitalcoronary anomalies, tunneling of coronary vessels and hyposplastic vessels in addition tovalvular and myocardial disorders
GEOMETRIC MEASUREMENTS OF THE ACETABULUM IN ADULT MALAWIANS: RADIOGRAPHIC STUDY
No full textABSTRACTObjectives: To determine the acetabular depth as well as acetabular and centre edgeangles; to assess the influence of sex, if any, in these geometric measurements; and todetermine the prevalence of hip dysplasia in adult Malawians.Design: A retrospective study.Setting: Queen Elizabeth Central Hospital (QECH) and Blantyre Adventist Hospital(BAH).Main outcome measures: The acetabular and centre edge angles, acetabular depth andthe prevalence of hip dysplasia were determined.Materials and methods: Two hundred and fifty three bilateral radiographs of the hipfrom adults, 133 men and 129 women, were used to measure the acetabular depth, angleand centre edge angle using a calliper and goniometer. The radiographs were takenfrom patients with no underlying bone disease between January 1997 and February2001 at QECH and BAH.Results: The prevalence of hip dysplasia was 11.54% for men and 13.16% for womenwith respect to centre edge angles but this difference by sex was not significant (P>0.1).However, the prevalence of hip dysplasia with respect to centre edge angle showedsignificantly more dysplasia in Malawian men than Nigerian and Chinese men (P<0.001and P<0.05, respectively). Centre edge angles also showed a wider range in Malawianmen (19 - 51° right, and 15 - 52° left) than women (18 - 45° right, 20 - 46° left). Inboth hips, the acetabular angles were more obtuse in men (35.52° right, 34.21° left)than women (29.43° right, 29.29° left), and this difference was significant (P<0.001).The ranges of acetabular angles were wider in women (11 - 38° right, 8 - 40° left)than men (24 - 49° right, 20 - 40° left). Acetabular depth was also greater in men thanin women (P<0.01 right hip, P<0.02 left hip).Conclusion: Sex influences geometrical measurements of the acetabulum. The prevalenceof hip dysplasia with respect to centre edge angle was significantly higher in women thanmen and the prevalence for men with respect to centre edge angle was significantly differentwhen compared with Nigerian and Chinese men. This information will assist cliniciansin the region and Malawi in particular to interpret hip X-rays of African patients
HIV PREVALENCE AND DEMOGRAPHIC RISK FACTORS IN BLOOD DONORS
No full textObjectives: To estimate HIV prevalence in various blood donor populations, to identity sociodemographicrisk factors associated with prevalent HIV and to assess the feasibility ofoffering routine voluntary counselling services to blood donors.Design: Cross-sectional study.Setting: Thyolo district, Malawi.Methods: Data analysis involving blood donors who underwent voluntary counselling andHIV testing between January 1998 and July 2000.Results: Crude HIV prevalence was 22%, while the age standardised prevalence (>15 years)was 17%. Prevalence was lowest among rural donors, students and in males of the age group15-19 years. There was a highly significant positive association of HIV prevalence withincreasing urbanisation. Significant risk factors associated with prevalence for both maleand female donors included having a business-related occupation, living in a semi-urban orurban area and being in the age group 25-29 years for females and 30-34 years for males. Allblood donors were pre-test counselled and 90% were post test counselled in 2000.Conclusions: HIV prevalence in blood donors was alarmingly high, raising importantconcerns on the potential dangers of HIV transmission through blood transfusions. Limitingblood transfusions, use of a highly sensitive screening test, and pre-donation selection ofdonors is important. The experience also shows that it is feasible to offer pre and post testcounselling services for blood donors as an entry point for early diagnosis of asymptomaticHIV infection and, broader preventive strategies including the potential of early access todrugs, for the prevention of opportunistic infections
NON-FUNCTIONING OVARIAN FIBROMA WITH EXTENSIVE CALCIFICATION: CASE REPORT
No full textA case of a non-functioning ovarian fibroma with extensive calcification in a young Ugandanfemale is described. Ovarian fibromas occasionally may be bilateral and associated withbenign ascites and pleural effusion called Meigs' syndrome or related to a rare hereditarycondition known as Gorlin's syndrome. Rarely if functioning, the tumour may producehormones to cause diabetes mellitus or hypoglycaemia or secrete carbohydrate antigen 125to clinically simulate ovarian carcinoma
TERRORIST BOMBING AT THE US EMBASSY IN NAIROBI
No full textBackground: On 7th August 1998, a terrorist bomb destroyed the American Embassyin Nairobi, killing and injuring thousands of people.Objectives: To describe the media component of the (larger) mental health response.To evaluate the impact of the intervention.Design: Descriptive cross sectional studySetting: Nairobi, three months after the explosion.Subjects: Residents of Nairobi and outlying areas, exposed to the bomb blast and whoreceived Radio and TV coverage about the explosion.Interventions: Radio and TV broadcasts, starting hours after the explosion andcontinuing for two weeks thereafter.Results: Of a sample of 400 respondents interviewed, 172 reported they were affectedby the bomb blast, either directly or through friends and relatives. T.V., and radiohad the highest reach, (89% and 85%) respectively. 70% felt the programmes gavevictims hope and 90% felt the programmes should continue, as they were helpful tothe needy.Conclusion: The media is a controversial, sometimes overused and at times underusedresource in Disaster Management. Judicious use of the media was shown to be helpfulin this study. Literature supports media interventions in disaster. Doctors working indisaster areas need to understand the media and to prepare for its use as it complimentsother interventions
CLINICO-PATHOLOGIC CHARACTERISTICS AND TREATMENT OUTCOMES IN CHILDREN WITH NEUROBLASTOMA AT THE KENYATTA NATIONAL HOSPITAL, NAIROBI
No full textObjective: To determine clinical-pathologic characteristics, treatment modalities andtreatment outcomes of children diagnosed with neuroblastoma.Design: Cross- sectional descriptive study based on secondary data from patientrecords.Setting: Records department of Kenyatta National Hospital (KNH), a tertiary teachingand referral hospital based in Nairobi.Subjects: Children aged 15 years and below, admitted with the diagnosis ofneuroblastoma, between January 1997 and December 2005.Main outcome measures: Presenting clinical features, diagnostic modalities includinglaboratory and imaging data, treatment modalities, response to treatment and patientsurvival.Results: Twenty six patients were eligible for the study; 13 males and 13 femalesgiving a M: F ratio of 1: 1. The age range was 5 days to 12 years, with a median ageof five years. Abdominal swelling (53.8%), inability to walk due to bone pains,(50%), and cranial or periorbital swelling, (38.5%) were the commonest presentingfeatures. Diagnosis of neuroblastoma was based on tissue biopsy in 50% (95% CI40.6-79.8%) of the patients, and on fine needle aspiration cytology of mass or bonemarrow in the rest. Bone marrow involvement was present in 16, (75%). Anaemia,was common with 72.7% patients having a haemoglobin (HB) <8g/dl at presentation.Immunohistochemistry and cytological grading were done in two, (8%), patients.Urinary vanilly l mandelic acid (VMA), screening was positive in 50% (95% CI 29.9%-70.1%). The most frequently involved organs were abdomen (88.9%), and skeleton,(84.6%). Majority of patients, (92.3%), presented with advanced stage IV disease.Three patients died before commencement of treatment. All treated patients (100%),received cytotoxic therapy. Only two patients (8.6%) had surgery as part of treatmentwhile one, (4.3%) was treated with radiotherapy. The initial treatment regimen wassimilar for all the patients. Although most patients had a complete initial response totreatment, early relapse, treatment failure, death or loss to follow up of patients withprogressive disease were common. Overall survival (OS) at one year and two yearswere 19.2% (95% CI 6.6-39.4%) and 7.7% (95% CI 0.9%-25 1%) respectively. Only onepatient was alive, (also free of disease), five years after diagnosis.Conclusion: Although other clinical- pathologic findings of the patients were similarto those reported elsewhere, virtually all study patients presented with advanced stageIV disease, which would be associated with poor prognosis irrespective of quality ofcare. Priority must therefore be on ensuring early diagnosis and referral of patientswith neuroblastoma before any other interventions can be expected to positively impacton outcome. The limited role of surgery and radiotherapy observed over the studyperiod may be attributed to late presentation of the patients. Pathologic evaluation ofpatients was inadequate, to some extent due to unavailability of facilities, but extra important information could have been availed at minimal extra cost. To be at par withcurrent internationally accepted treatment approaches that have been associated withimproved survival, there is need to base choice of regimens for individual patients onclinical and readily accessible pathologic markers
PERINATAL MORBIDITY AT THE MOI TEACHING AND REFERRAL HOSPITAL, ELDORET
No full textBackground: Perinatal morbidity (PNM) is highest in the developing countries includingKenya. Studies on the perinatal morbidity in Moi Teaching and Referral Hospital (MTRH)have not been carried out. Furthermore, factors associated with PNM are unknown at theMTRH.Objective: To establish the causes and incidence of perinatal morbidity at the MTRHNewBorn Unit (NBU).Design: A retrospective study using case notes.Setting: The NBU of the MTRH in Eldoret, Kenya.Subjects: Babies who were admitted to the MTRH's Newborn Unit from January toDecember 1997.Results: The perinatal morbidity was 667 per 1000 babies admitted to the NBU. The mostcommon reason for admission was mother under anaesthesia. The most common cause ofmorbidity was asphyxia. The mean maternal age was 24 years. The mean level of educationwas 1.7 years. More than fifty five per cent of the mothers were housewives. The meanbirthweight was 2.75 kg (B.9 SD), 55.9 % had normal birthweight, 37 % were low birthweightand three per cent were large babies. The mean duration of stay in the NBU was 3.8 days.Conclusion: Most of the admissioas were Caesarean section babies who did not requireadmission. Younger mothers were more likely to have babies with neonatal sepsis,convulsions,pneumonia and asphyxia
BACTERIAL FLORA OF COMMONLY USED SOAPS IN THREE HOSPITALS IN NIGERIA
No full textABSTRACTObjectives: To obtain general information on soap use and soap bacterial fl ora, and to assess therisk of transmission of organisms from contaminated soap to patients.Design: Descriptive study.Setting: Three hospitals in an urban area of Lagos, Nigeria. A teaching (761 bed) hospital, a generalhospital (a 51 bed secondary healthcare facility) and a private hospital (a 30 bed private communitywith a surgical specialty).Results: Bar soaps were much more commonly used than liquid soaps. Out of the thirty six barsoaps and their receptacles studied, 19 (52.8%) were found wet, nine (25%) dry, fi ve (13.9%) very dry,and three (8.3%) in a pool of water. A total of 39% soaps and 75% of receptacles were contaminated.Thirty three percent of the dry soaps and 68.4% of the wet soaps were contaminated. None of thevery dry soaps and all in a pool of water were contaminated. The bacteria isolated from soapsincluded Pseudomonas aeruginosa (89.5%) and Klebsiella pneumoniae (10.5%), while Pseudomonasaeruginosa (70.6%), Klebsiella pneumoniae (14.7%), Staphylococcus aureus (11.8%) and Serratiamarcescens (2.9%) were isolated from the receptacles. The antibiogram showed that the Pseudomonasaeruginosa isolated from the soaps and their containers (sinks) were distinct from those obtainedfrom colonised or infected wounds. The soap contamination rates correlated with the conditionsin which the soaps were kept.Conclusion: The type of soap containers in particular, played a vital role in keeping the soap dryor wet. In all the hospitals studied, the policies on soap use, if any, were not in agreement with therecommended guidelines. The healthcare workers need to be re-educated on these guidelines