The Central African journal of medicine最新文献

Objectives: To determine the number of patients with intussusception treated at HCH over a 10 year period. To describe the ages and sex of children operated for intussusceptions. To determine if there is seasonal variation in the number of cases presenting to HCH. To determine the type and method of treatment of intussusception at HCH.

Design: This was a descriptive retrospective study. Theatre records were inspected to identify eligible patients. Information regarding sex, age, anatomical subtype and procedure performed was recorded.

Setting: Harare Central Hospital, Zimbabwe.

Subjects: Two hundred and seventeen (217) participants were enrolled. All patients who underwent surgery for intussusception between September 2003 and August 2013 were eligible. One re-operation was excluded.

Results: There were 129 boys and 83 girls. The modal age was 6 months. 61.3% of patients had ileo-colic intussusception, 4.1% colo-colic and 0.5% ileo-ileal. The peak incidence was in September. There was an increase in annual cases in the period under review from 9 cases in 2003/2004 to 34 cases in the 2012/2013 period. 47.5%of patients had resection and primary anastomosis while 24.0% had manual reduction at laparotomy.

Conclusion: Intussusception is one of the most common paediatric surgical emergencies at Harare Central Hospital. The age and sex of patients are the same as those found in literature. In contrast with previous data, a strong statistically significant seasonal incidence was observed. The majority of cases were ileo-colic. The most common procedure at laparotomy was resection as opposed to manual reduction.

Objectives: To determine whether earlier application of the Non-pneumatic Anti-Shock Garment (NASG) at clinic level compared to the referral hospital level reduces maternal morbidity and mortality and recovery time from shock due to severe Obstetric Haemorrhage (OH) and to determine the safety of the NASG when applied at clinic level.

Design: A cluster Randomized Controlled Trial (RCT)

Setting: Harare and Parirenyatwa Referral Hospitals (RH) in Harare and the twelve Harare City Council clinics that offer maternity care.

Subjects: Women who had suffered severe OH at clinic level and were being transferred to a Referral Hospital (RH).

Iterventions: The clinics were randomized into two groups. In the early NASG group eligible women were given the standard management for OH and had the NASG applied at the clinic level before transport to RH. In the control group, eligible women were given the standard management for OH at the clinic level, transferred to the RH, and received the NASG at the RH. All women received equivalent OH/hypovolemic shock management at the RH.

Main outcome measures: The main outcome measures were maternal mortality and morbidity, blood loss, recovery from shock and the occurrence of side effects whilst in the NASG.

Results: There were few maternal deaths and morbidities, and no statistically significant differences between the two groups were noted. Women in the early NASG group spent a statistically significant shorter time in the NASG at referral hospital level (OR 0.64, 95% CI 0.52 - 0.79, p < 0.001) and had a non-significant 40% faster recovery from shock (HR 1.39; 95% CI 0.98-1.97, p=0.07). There were no differences in reported side effects.

Conclusion: Earlier NASG application at the clinic level was associated with faster recovery from shock in women who had suffered severe OH and appears safe to use.

Objectives: To determine occupational therapy needs of adolescents and young adults with cerebral palsy living in an urban setting, to identify participation levels in activities of daily living and social activities, to identify factors influencing participation and to determine the contribution of occupational therapy in participating in these activities.

Design: Descriptive cross-sectional.

Setting: Community rehabilitation outreach points in Epworth, Mufakose, Glenview, Dzivarasekwa, Mabvuku and Norton.

Participants: Thirty-five randomly selected primary caregivers of adolescents and young adults with cerebral palsy.

Data analysis: Data collected on the questionnaires was analysed using SPSS/16.0 for frequencies and means.

Results: Fourteen (41%) of the adolescents and young adults were independent in self-care activities such as toileting, grooming, dressing, mobility and bathing. Twenty-one (59%) were totally dependent or needed some assistance in performing activities of daily living. Factors reported to influence participation included upper and lower limb contractures, transport challenges, financial constraints and the home environment. Occupational therapy needs of adolescents and young adults as reported by their caregivers included further training in activities of daily living (74%), home adaptations (66%), vocational skills training (20%) and provision of appropriate assistive devices (6%).

Conclusion: In light of these findings performance areas that still needed occupational therapy interventions included activities of daily living, vocational skills training, use of assistive devices and home adaptations. Therefore adolescents and young adults with cerebral palsy living in Zimbabwe still have functional performance deficits that can be addressed by provision of follow-up community occupational therapy interventions.

Introduction: Postnatal depression is a common cause of morbidity but is rarely diagnosed or managed in busy primary care settings in most resource limited countries like Zimbabwe.

Objectives: This study sought to determine the prevalence of postnatal depression and establish factors associated with postnatal depression.

Methods: The study utilized a cross-sectional descriptive design where 295 consenting women (mean age=25.4 years; SD= 5.6 years) attending post natal care services at Mbare Polyclinic were recruited. Data were collected using the validated Shona version of the Edinburgh Postnatal Depression Scale (EPDS) questionnaire. Associations between variables were computed using the chi-square test statistic and where appropriate the Fisher’s exact statistic.

Results: Prevalence for postnatal depression was 34.2% among women in the study. Univariate analysis revealed that there were no statistically significant associations between mother’s age (p=0.120), parity (p=0.396), marital status (p=0.523), level of education (p=0.805), and age of child (p=0.489) and postnatal depression.

Conclusion: Findings from this study indicate that there is a high prevalence of postnatal depression in women in Mbare, Zimbabwe. This therefore calls for further studies to identify and address the causes of postnatal depression among women attending postnatal care in Zimbabwe.

Objective: To determine the histological effects of different frequencies of loading in a healing Achilles tendon following partial rupture.

Design: Experimental laboratory study.

Setting: University of Zimbabwe, Department of Physiology, Animal house.

Subjects: Sixty female Sprague-Dawley rats.

Intervention: Partial tenotomies of the right Achilles tendon were performed surgically. From day 1 post operatively, the animals were allocated to treadmill running at different frequencies (once (OD), two (BD), three (TDS) and four (QID) times daily) up to 21 days. Histological sides of the tendons were made at days 7,14 and 21 and interpreted by a blinded pathologist.

Main outcome measures: Collagen fibre orientation, inflammatory cell populations, fibroblast morphology and neoangiogenesis were observed and scored using the Grande Biomechanical Histological Correlation Score.

Results: Mean weight was 209.67g ±30.14. The best and worst arrangements of collagen were in the QID group (73%) and OD group (46.7%) respectively. These differences were not statistically significant (p=0.487). The BD group had the most mature fibroblast nuclei and the QID tendons had the least mature (p=0.577). Inflammatory cell populations were independent of loading frequency (p=0.132).

Conclusion: Changing the frequency of the same type of loading in a healing tendon does not have an effect on the healing process in partially ruptured Achilles tendons during the inflammatory and proliferative phases.

Objective: To determine etiology and risk factors of meningitis in patients admitted a tertiary referral Hospital in Harare.

Design: Cross-Sectional Study.

Setting: Urban Referral Health Facility.

Subjects: Patients suspected of having Meningitis admitted at Parirenyatwa Hospital were consecutively consented and recruited into the study until sample size accrual.

Main outcome measures: Prevalence of pathogens associated with Meningitis. Risk factors of meningitis.

Results: Two Hundred and Ninety Six (296) clinically suspected meningitis patients were recruited into the study, 51.7 %( n=115) were male. Meningitis was confirmed in 20.6% (n=61) cases with the following pathogen proportions, C. neoformans - 45.9 %( n=28), S. pneumoniae – 27.9 % (n=17), TBM – 4.9 %( n=3), probable viral meningitis – 6.6% (n=4 and other bacteria- 14.8% (n=9). Patients from crowded households were also more likely to suffer from meningitis than those from sparsely populated households (p<0.001).

Conclusion: The use of Latex agglutination increases the proportion of detected pathogens both fungal and bacterial when used in conjunction with CSF gram stain and culture. Cryptococcus neoformans and S. pneumoniae are the leading causes of meningitis in patients admitted at Parirenyatwa Hospital.

Introduction: Rheumatic heart disease is still a common problem in Zimbabwe. It has a significant mortality rate due to heart failure, stroke or endocarditis. Timely surgical interventions can reduce mortality. An echocardiography audit was performed to determine the proportion of patients referred for echocardiography who had a diagnosis of rheumatic heart disease, the pattern of valvular involvement and the presence of surgical indications on echocardiography.

Objective: To determine the number of echocardiograms done in 2012 and the proportion with a diagnosis of rheumatic heart disease. To determine which valve lesions were present and whether there were any echocardiographic indications for surgical intervention.

Method: A record review of all echocardiograms performed by the investigator during the period January to December 2012 was performed. A data collection form was used to extract the data and the findings were tabulated and analysed.

Results: 308 echocardiograms were performed by the investigator during the year of review. 236 of these were abnormal and rheumatic heart disease was diagnosed in 16% of them. The commonest valve lesion was mitral regurgitation and half of the patients had surgical indications. The common complications were pulmonary hypertension and left atrial enlargement.

Conclusion: This audit shows that rheumatic heart disease is still quite common in patients referred for echocardiography. Lesions are severe and the majority of patients are in need of surgical intervention.