Tropical and geographical medicine最新文献

The pattern of presentation and management of 90 patients treated for sigmoid volvulus over a 7-year period was studied. There was a 9:1 male preponderance and 64% were under 50 years of age. Intestinal obstruction was the presenting feature in 84%, while the rest presented with acute abdomen or pain. Unlike other African series, this constituted only 8% of intestinal obstruction. Sixty-one per cent were managed by sigmoidoscopic decompression and semi-elective sigmoidectomy, and 30% had an emergency operation. A primary anastomosis was undertaken in 71% while others, mainly emergency cases, had a temporary colostomy. There was a 20% morbidity and 12% mortality, 80% of which was in the emergency operation group. It is concluded that the pattern of sigmoid volvulus among Durban Africans differs from that reported in other African countries where young males predominate, and from that in Western societies with elderly female preponderance. When volvulus necessitates emergency surgery, it carries a substantial mortality even in relatively young patients and therefore we advocate resection in all patients during the same hospital admission even in those whose torsion is easily reduced at sigmoidoscopy lest a recurrence fails to reduce.

A previously healthy and immuno-competent 22-year-old man presented in confusional psychosis. Cryptococcal meningitis was later found to be the underlying cause as proven by culturing Cryptococcus neoformans serotype A from the cerebrospinal fluid. Combined antifungal therapy with amphotericin B and 5-fluorocytosine resulted in sustained improvement of all mental and physical functions. Cryptococcosis has rarely been reported from the Middle East. This represents the second case from Kuwait.

To assess the image quality of radiographic units we developed a set of three relatively simple tests. With this set we investigated the performance of two small film x-ray units and seven dark rooms in chest disease clinics in Egypt. As a reference we performed the same tests at the Consultation Bureau for Tuberculosis and at the Radiology Department of the Medical Centre, Leeuwarden, The Netherlands. The tests revealed deficiencies during several phases of the production of radiographs at the chest disease clinics in Egypt, as well as at the Consultation Bureau for Tuberculosis, Leeuwarden, The Netherlands. The results of the tests were used to advise the radiology units tested on how to improve their quality. We believe, that this set of tests can be applied to any radiography unit to find ways for image quality improvement.

Various types of ready-to-serve food items purchased at the Awassa open market were evaluated for their bacteriological profile and holding temperatures. The food items included roasted offals, fish soup, cooked and sauced macaroni and spaghetti, and shiro sauce. Spaghetti and macaroni were held at ambient temperatures (20-30 degrees C) and had high aerobic mesophilic count (> 10(6) cfu/g) and Enterobacteriaceae count (> 10(5) cfu/g). They also yielded Shigella and Staphylococcus spp. Most of the other food items were held at higher temperatures (> 40 degrees C) and the aerobic mesophilic count in most cases was relatively lower (< 10(5) cfu/g). Several bacterial genera were isolated and Micrococcus and Bacillus spp. dominated the aerobic microflora. The unhygienic conditions of the food service environment, possibilities of cross contamination from utensils and keeping food items at ambient temperatures for several hours were considered to be critical points.

The impact of selective treatment with praziquantel (40 mg/kg) on Schistosoma mansoni prevalence and intensity of infection in two annual follow-up examinations was measured. The target population was the entire rural area of the northern Nile Delta Governorate, Kafr El Sheikh, from which a probability sample was drawn. The sample included 44 villages and hamlets (ezba). Baseline prevalence was determined by the examination of stool by two Kato slides and all infected persons treated and reexamined one year later. Those found infected in the second round were treated and examined again one year later. The prevalence and geometric mean egg count declined across all ages in each follow-up (prevalence: 39.3% (SE +/- 3.3), 28.4% (SE +/- 2.6), and 22.4% (SE +/- 2.3), respectively; and GMEC: 72.9 (SE +/- 7.3), 52.5 (SE +/- 4.5), and 41.9 (SE +/- 2.4), respectively). Reduction in prevalence varied considerably by village and ezba and was strongly related to the proportion of the village or ezba population that was infected and treated (r2 = 0.29). This latter observation provides a rationale for the maximum application of chemotherapy in the endemic Nile Delta community.

Though the World Health Organization (WHO) has acted to reduce the price of anti-HIV assays for developing countries, the cost of the large-scale testing to be done may still be prohibitive to the health budget of these countries. GACPAT, a modified commercial particle assay, is ten times cheaper than the WHO price of ELISAs. In this study GACPAT was introduced in three district hospital laboratories (DHL) in Tanzania, and the results compared with those on the same sera in a reference laboratory (RL). Sensitivity and specificity were 92.6% and 98.7%, respectively at DHL. It is concluded that GACPAT is a valid, feasible and cheap alternative for ELISA anti-HIV-testing also at district hospital laboratory level.

The demographic and clinical features of severe malaria in children on the south coast of Papua New Guinea have never been clearly documented. This prospective study sought to define the associations between ethnic origin, domain, age, nutritional status and severe malaria in this group and to assess significant clinical features, evaluate the use of a coma score as a prognostic indicator in cerebral malaria and to determine the ultimate outcome. Twenty patients with severe malaria (17 cerebral malaria and 3 severe anaemia) were studied. Their mean age of 4.96 years was significantly greater than that of matched controls with uncomplicated. Plasmodium falciparum infection with mean age 3.79 years (0.02 < p < 0.05). Nutritional status was not a significant independent risk factor when controlled against inpatients with other diagnoses. Low coma scores (Adelaide scale 4/14 or less) sensitively predicted the risk of dying vs survival. The mortality of 18% was comparable with other series. Current standard treatment with quinine and Fansidar was effective and no early recrudescence was encountered in the survivors. The degree of intermarriage and migration between regions precluded firm conclusions from being drawn as to the relevance of ethnic and geographical factors in the epidemiology of severe malaria in this region.

A hospital-based cross-sectional study was conducted in Dar es Salaam, Tanzania, using a questionnaire to assess the extent of self-medication with antimalarial drugs and malaria treatment-seeking behaviour among patients attending out-patient treatment at Mnazi mmoja dispensary. It was found that 15.3% of respondents admitted to having ever used malaria chemoprophylaxis while 8.0% reported to be current users of chemoprophylaxis. Among the current users of malaria chemoprophylaxis, some reported having used quinine and Fansidar. While 71.7% reported having treated themselves with home-kept antimalarial drugs for a suspected malaria fever, 14.7% consulted traditional healers. The data suggest the need for increasing public awareness on malaria and appropriate use of antimalarial drugs.

A study of all new patients seen over a 12-month period in a teaching hospital eye clinic in anambra State, Nigeria shows that 257 out of 820 (31.3%) had low vision in at least one eye. Of the 257 patients, 36 (14%) had bilateral blindness, 71 (27.6%) had uniocular blindness and 181 (70%) had visual impairment in at least one eye. Cataract (33.3%), glaucoma (22.2%) and macular degeneration (11%) were the leading causes of bilateral blindness. The major causes of monocular blindness were cataract (28.2%), glaucoma (21%), trauma (16.9%) and ocular infections (9.9%). Visual impairment was caused mainly by cataract (33.2%), uncorrected refractive errors (19.5%), glaucoma (15.5%) and infective keratoconjunctivitis 7%. A population-based blindness and visual impairment survey in the area is necessary. Also preventive and curative measures should be instituted to tackle the leading causes of blindness and visual impairment in the subregion.