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EARLY GROWTH OF VERY LOW BIRTH WEIGHT INFANTS
No full textBackground: Early growth in very low birth weight (VLBW) infants has been found predictive of their later outcomes. This has led to increased interest in establishing measures to optimise such growth. In facilities without the resources required to undertake long-term audits for all the high risk infants they graduate, these growth parameters may also be used as selection criteria for those meriting such follow up reducing costs.Objectives: To describe early growth patterns among a cohort of VLBW infants and determine some of the factors associated with poor growth among them.Design: Cross section survey.Setting: Kenyatta National Hospital, Nairobi, Kenya.Subjects: One hundred and seventy five neonatal survivors.Results: Of the 175 infants recruited, the male/female ratio was 4:6, sixty four (36.6%) were intrauterine growth retarded while significant illnesses during the neonatal period were reported in 109 (62.3%). Forty seven percent of the infants had been fed on exclusive breast milk, 33% on mixed feeds while 20% received exclusive preterm formula.The mean neonatal weight gain for the whole cohort was 13.5 (3.9) g/kg/day, length of 0.34 (0.11) cm/week and head circumference of 0.32 (0.71) cm/week. By term only 33 (18.9%), 37 (21.1%) and 48(28%) had reached the expected (the 3rd percentile) weight, length and head circumference respectively. Sixty percent of the infants gained weight at <15g/kg/day while 70% and 78% grew in head circumference and length at <0.5cm/week respectively. At term weight, head and linear growthfaultering were recorded in 81%, 72% and 79% respectively. The factors that were associated with better growth at this stage included feeding on preterm formula (P<0.001) and absence of neonatal morbidity (P<0.001). Infants who were appropriate for gestational age at birth also had better catchup growth at term compared to those born small for gestation (P<0.001) but their neonatal growth itself was not significantly better.Conclusion: The mean neonatal growth in all anthropometric measures was less than expected and by the time of their expected delivery, less than 30% of these infants had reached the 3rd percentile of the expected measurement in all the three growth parameters. Choice of milk and neonatal morbidity influenced these growth patterns.Recommendations: Routine fortification of mother’s milk or addition of preterm formula and reorganised care of sick newborns is recommended to improve early growth
Life-threatening lithium-induced diabetes insipidus after colonic surgery
Get PDFColonic surgery is associated with major disturbances to patients’ fluid balance as aresult of pre-operative starvation, intra-operative blood loss, insensible losses, andpost-operative ‘third space’ losses. In the post-operative period, junior surgeons arewell trained to manage oliguria, but have little experience of the management ofpost-operative polyuria. Nephrogenic diabetes insipidus occurs in 12% of patientson lithium therapy and may present in the immediate post-operative period withmassive polyuria, profound dehydration and life threatening hypernatraemia, aspatients are unable to ingest large volumes of fluid orally. We report two cases, onelife threatening, of lithium induced nephrogenic diabetes insipidus (LINDI) whichpresented in the early postoperative period after emergency colonic surgery whilstthe patients were denied oral intake. The first patient attained a peak serum sodiumconcentration of 185mmol/l and required ventilation after a respiratory arrest. Wesuggest any surgical patient who describes a history of bipolar disorder or lithiumtherapy should be questioned directly to ascertain confirmatory features of LINDI,and have post-operative polyuria treated with aggressive fluid replacement
HAEMATOLOGICAL, LIPID PROFILE AND OTHER BIOCHEMICAL PARAMETERS IN NORMAL AND HYPERTENSIVE SUBJECTS AMONG THE POPULATION OF THE EASTERN PROVINCE OF SAUDI ARABIA
No full textObjective: To determine the lipid profile complete blood count and other biochemical parameters in normotensive and hypertensive individuals.Design: Cross-sectional population-based epidemiological household survey.Setting: Population sample of the Eastern Province of Saudi Arabia.Results: Hypertensive individuals had significantly higher mean levels of glucose, Tc, LDL-c, HDL-c, triglycerides and HBAIc, compared to normotensive individuals while there were no significant difference in the mean levels of Apo AI and Apo B. Within the same group there were variations in the levels of certain parameters between male and female. While the mean levels of haemoglobin, WBC and platelets were significantly higher in the hypertensive group compared to normotensive, there were no significant differences between these two groups in the levels of RBC, MCV, HCT, MCH and MCHC. However, the mean levels haemoglobin, RBC count and HCT were significantly higher in male compared to female within the same group with no significant difference in levels of WBC, MCV, MCH and MCHC. Furthermore, the mean concentration of platelets was significantly higher in females compared to male within the same group.Hypertensive individuals had significantly higher serum sodium, chloride and calcium levels but a significantly lower potassium level when compared to normotensive with no siginificant differences between male and female within the same group.Conclusion: The lipid and electrolyte profile of hypertensive individuals differ from that of normotensive individuals in this population. This study has contributed towards establishing the normal values for a number of parameters involved in the aetiology of cardiovascular diseases in the population of Eastern province
GASTRO INTESTINAL HYPERPERMEABILITY: A REVIEW
No full textABSTRACTObjectives: To present a wide overview of the recent developments in the understanding ofthe aetiopathogenesis of gastrointestinal hyperpermeability.Data sources: Medline, from 1985, was sourced for relevant articles. Review articles wereincluded in order to minimise the number of references in the reference list.Study selection: Results from experiments and observations on humans and other mammalianspecies were studied.Data synthesis: The major mechanisms elucidated in the aetiopathogenesis of thegastrointestinal hyperpermeability were integrated and consolidated into a flow diagramand the major factors responsible for normal permeability presented for comparison.Conclusion: The occurrence of increased gastrointestinal hyperpermeability is probablyvastly underestimated. In addition to the hyperpermeability commonly associated withchronic gastro intestinal disorders, an increase in gastrointestinal permeability may occur inany condition of metabolic depletion, enterocyte ATP-depletion, stimulation of gastrointestinalpro-inflammatory cytokine production and disturbances of the normal gastrointestinal floraas with prolonged use of antibiotics
BURDEN OF MENTAL ILLNESS ON FAMILY MEMBERS, CARE-GIVERS AND THE COMMUNITY
No full textObjective: To determine the burden of mental illness in the family/caregiver and thecommunity.Design: A cross-sectional descriptive study.Setting: Rehabilitation centres, community day centres, resettlement villages and in thecommunity in three provinces (Harare, Bulawayo and Masvingo), Zimbabwe.Subjects: A sample size comprising sixty six care-givers and 126 patients were consecutivelyinterviewed for the study.Results: The care-givers had a mean ± s.d. age of 48.8 ±15.7 years. The majority were females(80.3%), married males, 76.9% (p=0.073), unemployed females, 94.3% (p=0.0004) andparents of the patients accounted for 51.5%. Many respondents believed that the cause ofmental illness was witchcraft (31%), they experienced financial constraints (63.6%), andspent a lot of money on food (56.1%). Patients were younger than their caregivers, with amean ± s.d. age of 37.7 ± 12.8 years and mostly on medications (91.3%).Conclusion: The caregivers were mainly women and unemployed, whereas patients weremostly male. Caregivers were faced with multiple problems, but they were more tolerant topatients’ behaviour than the community at large
BURKITT’S LYMPHOMA AND EMERGING THERAPEUTIC STRATEGIES FOR EBV AND AIDS-ASSOCIATED LYMPHOPROLIFERATIVE DISEASES IN EAST AFRICA
No full textBURKITT’S LYMPHOMA AND EMERGING THERAPEUTIC STRATEGIES FOR EBV ANDAIDS-ASSOCIATED LYMPHOPROLIFERATIVE DISEASES IN EAST AFRIC
SOCIAL SUPPORT NEEDS AND ADJUSTMElrlT OF CANCER PATIENTS
No full textBackground: Given the limited health care funds and increasing survival from cancer,services should be targeted to meet patients' post-trea rment need.Objectives: To identify which of the needs that patienis consider important; examine howthey compare the role of the family, nurses and friends in meeting these needs; and assess therelationship between social support and adjustment tc8 cancer.Setting: Radiotherapy clinic, University College Hospital, Ibadan, Nigeria.Design: Cross-sectional study.Measurements: A 29-item needs questionnaire for assessing patients' expressedand perceivedinformational, physical (reltef of pain), emotional and instrumental (economic) needs1support from family, friends and nurses; and indicts of social adjustment (self-esteem,coping, acceptance).Subjects: Seventy two (20 males and 52 females) consc!cutive attendees mean age, 41.1, SD12.7.Results: The highest needs expressed were physical 195.8%) and informational (81.7%),while emotional support was the most perceived as provided. Nurses and families weresimilarly perceived as significant providers of tota social support, with nurses beingidentified as best providers of physical and instrumental support. Over 75% felt sociallyadjusted. Informational support was the most imp01 tant predictor of social adjustment,while total social support predicted self-esteem.Conclusion: The findings support previous work indic: rting that clinicians should drop theirreticence and provide adequate information to canc rr patients and their relatives. Staffsocial support is appreciated by patients and is predicti r.e of social adjustment. Policy makersshould consider social welfare measures to relieve thc burden of cancer on families
INFERTILITY IN A COMMUNITY AND CLINIC-BASED SAMPLE OF COUPLES IN MOSHI, NORTHERN TANZANIA
No full textBackground: Previous research on the aetiology of infertility in sub-Saharan Africa wasgenerally clinic based and it is not known whether findings from this work arerepresentative of the general population. A better understanding of the medical causesof infertility is crucial for reducing the incidence of infertility and for improving theclinical management.Objective: To determine the type and aetiology of infertility in a community and clinicbasedsample.Design: Couples identified as infertile in a representative cross-sectional survey froma community-based sample of 2019 women aged 20-44 years and couples seeking carefor infertility at a tertiary health facility.Setting: The community-based sample was drawn from Moshi Urban District and theclinic-based sample from patients seeking care at Kilimanjaro Christian Medical Centre(KCMC) in 2002 and 2003.Participants: Sixty six couples identified as infertile in the community-based sample and112 couples seeking care for infertility.Results: The percentage of primary infertility was 37.1% and secondary infertility was62.9%. Female only factor infertility was identified in 65.9% of the couples, male onlyfactor in 6.8%, male and female factors in 15.2% and unexplained infertility in 12.1%.Conclusion: The type and aetiology of infertility were the same in the community andclinic-based sample suggesting that the couples seeking infertility health care wererepresentative of the general infertile population. Tubal factor infertility was thecommonest cause
SEXUAL BEHAVIOUR AMONG PERSONS LIVING WITH HIV/AIDS IN KAMPALA, UGANDA
No full textObjective: To identify sexual behaviour and reproductive health needs of people living with HIV/AIDS (PLWHAs).Design: A cross sectional study.Setting: Joint Clinical Research Centre, Kampala Uganda.Participants: Three hundred and eighty PLWHAs, 50% of whom had initiated antiretroviral therapy (ART).Main outcome measures: PLWHAs answered questions regarding sexual behaviour, number and type of sexual partners, symptoms of sexually transmitted infections, having been pregnant or causing a pregnancy, social demographic characteristics, consumption of alcohol, having biological children, desire for more children and useof condoms.Results: In the past 12 months 227 (60%) of the PLWHAs were sexually active. Of the sexually active 42 (19%) never used a condom, and 92 (40%) used condoms inconsistently, thus 134 (35%) of PLWHAs engaged in high risk sex. Two hundred and sixty five (70%) said that PLWHAs can have healthy children and 115 (30%) desired more children with21 (10%) of the women in the reproductive age group reporting a pregnancy and 22 (17%) of the men reporting having caused a pregnancy. Only three (7%) of the pregnancies were unplanned. Desire for more children was a strong independent predictor of engaging in high risk sex (Adjusted Odds Ratio 2.44, 95% CI 1.35-4.42).Conclusions: This study demonstrates that abstinence and use of condoms on their own may not be enough for HIV prevention among PLWHAs who desire children.Additional methods such as use of ART to reduce HIV infectiousness and sperm washing are needed