Tanzania is one of many nations attempting to decrease the neonatal mortality rate (NMR). Kangaroo Mother Care (KMC) is one method recommended by the World Health Organization to reduce NMR, particularly in low birth weight infants (LBWI). [1] This paper examines implementation of KMC and potential barriers to successfully using this method at Nyakahanga Designated District Hospital (NDDH) in rural Tanzania as part of a broader study of maternal and neonatal mortality at this facility. Retrospective medical record analyses of single births (N=14,858) from 2009-2013 at Nyakahanga DDH shows a perinatal mortality rate (PMR) of 56, while the national average is only 21.[2] The number of LBWI is also elevated (11%) compared to only 8.4% nationally. The high PMR and proportion of LBWI demonstrate the importance of implementing KMC with high-risk infants as one strategy to promote survival and growth of LBWI. The barriers are assessed through personal observations and an analysis of four cases in which KMC was utilized during June 2014. This investigation found that although the hospital and staff want to implement KMC, barriers include lack of education, lack of staff to train mothers, misinformation about and lack of resources to provide adequate infant nutrition, and lack of supplies. The KMC initiative at Nyakahanga DDH is
Over the past two decades, roughly 20,000 people in Central America have died from chronic kidney disease of unknown origins (CKDu).[1] CKDu is growing into an unsolvable epidemic due to the mysterious cause of the disease and the little treatment available in the underdeveloped region. CKDu primarily affects sugarcane workers in Nicaragua and El Salvador, but it has also appeared in the rice paddy fields of Sri Lanka. Researchers from Sri Lanka, Boston University, and University of Colorado have proposed causes for the disease such as the pesticide glyphosate, occupational hazards like heat and dehydration, and sugar consumption, respectively; however disagreements still persist. The goal of this paper is to add to the claims already made so that a clearer hypothesis is formed. The paper will also focus on CKDu in Nicaragua to raise more awareness and to pressure the sugarcane companies into changing the country’s policy. Many aspects of CKDu will be analyzed including a history of sugarcane and pesticide usage, medical information about CKDu and Nicaragua’s treatment of the disease, ethics of the companies, and the environmental impact. The methods used in this research include observations and discussions with former sugarcane workers and their relatives during a two week trip to Nicaragua.
Evaluation of non febrile seizure disorder on MRI with correlation with seizure type and EEG records in children.Objectives: The aim of this retrospective study was to investigate the spectrum of abnormality on MRI, to correlate MRI findings with the seizure type and EEG findings wherever available in children presenting with non febrile seizure disorder.Patients And Methods: A retrospective hospital based study was done of 271 children who underwent brain MRI for seizure disorder with exclusion of febrile conditions, recent trauma and metabolic conditions from the study.The MRI findings were interpreted independently and subsequently correlated with clinical history and EEG findings wherever available from patients' records.Results: More than half of the patients (53%) were in the age group of 11-15 years.Generalised seizures were the most common seizure pattern in all age groups.Out of the 271 children included in the study, 106(39%) had abnormal cranial MRI scans.The most common abnormality detected on MRI was granulomatous lesion in 56 cases (33.3%), followed by periventricular leukomalacia/hypoxic ischemic encephalopathy in 12 cases (7.1%) , focal gliotic and encephalomalacic changes in 9 cases (5.4%), congenital/developmental anomalies including leukodystrohies in 8 cases(4.8%),mesial temporal sclerosis in 5 cases(3%), hydrocephalous in 4 cases(2. 4%), and demyelinating conditions in 3 cases(2%), while tumors (2 cases), cerebral atrophy (2 cases), vascular malformations (2 cases),non traumatic intracranial bleed (2 cases)and cerebral venous thrombosis (1 case)comprised the rest of the causes.Children with unclassified and partial seizures had high rate of abnormality detection on MRI, while those with primary generalized seizures had relatively lower rate of abnormality detection on MRI.Interictalawake scalp EEG findings were available in 100(37%) cases.There was moderate positive correlation between abnormality detection on EEG and MRI(Pearson correlation coefficient,r=0.65).Conclusions: This study shows that CNS granulomatous pathology andhypoxic ischemic encephalopathy were the two most common abnormalities detected on MRI and primary generalized seizures were the most common presentation in children presenting with non febrile seizures.Prior knowledge of seizure type and EEG records can be helpful factors in increasing diagnostic efficacy of MRI and avoiding unnecessary imaging.
Ocimum sanctum is a medicinal plant which has been used studied for various properties and used in various conditions.In the present study, ocimum sanctum was investigated for its effects against swimming stress induced ulcers in albino rats. The effects were compared with ranitidine. The leaf extract of ocimum sanctum showed significant antiulcer activity in the dose of 100 mg/kg and 200 mg/kg. The results were comparable to ranitidine though ranitidine was found to be more potent. Ocimum sanctum may be operating by antagonism of H2 receptors, by antisecretory mechanism or by antioxidant property as an antiulcer agent against stress induced gastric ulcers. Since this drug has been documented to have antiulcerogenic property earlier and has shown significant activity in the present study, more studies are required to explore its complete therapeutic usefulness.
Worldwide maxillofacial injuries have become a social problem, since there has been an alarming increase of this type of injury. In the Northeast region of the Dominican Republic the facial trauma constitutes a significant proportion of all trauma, although epidemiological studies in the country are few. A retrospective study was undertaken to assess causes of maxillofacial trauma in the San Vicente de Paul Regional University Hospital in the town of San Francisco de Macoris, Duarte State, Dominican Republic. Between July 2002 and July 2011, 786 cases of maxillofacial fractures were seen at the Oral and Maxillofacial Surgery Unit of this Hospital. Most fractures occurred in adults with ages ranging from 21 to 30 years (30.2%). Men (58.5%) were more affected than women (41.5%) and most patients treated were from the locality of San Francisco de Macoris (34.2%). Traffic accidents/motorcycles (39.7%) were the major cause of trauma, followed by automobile accidents (18.7%) and physical violence (16.4%). Hard tissue injuries (63.5%) were more common. The mandible (22.1%) was found to be the most commonly fractured bone in the facial skeleton, followed by the zygomatic complex (12.7%). Wounds or lacerations (24.0%), edema (4.6%) and hematoma (4.6%) were the most common types of soft injuries.
A case of haemoperitoneum in a neonate secondary to liver laceration following birth trauma is presented. The neonate was in a state of shock. The patient required an exploratory laparotomy & did very well postoperatively. It is a very rare form of birth trauma following assisted vaginal breech delivery. CASE A 36 weeks gestation baby was delivered at a district health facility by assisted breech delivery with grade 2 meconium & APGAR score 3, 4 & 7 . After initial resuscitation & subsequent nasotracheal intubation baby was referred to neonatal unit at our hospital. On examination the baby was 2.28 kg wt , pink in colour, no obvious congenital anomalies, swollen & decreased movement of left upper limb, right cephal haematoma, mild oozing from mouth from torn frenulum & considerable bruising noticed around the body. Radiological examination revealed fracture left clavicle. Patients Hgb was-14.gm/dl,WBC-40.3 x10 / , PLT115 x10 / μl Fourteen hours after admission to baby developed sudden pallor, was noted to be very lethargic with mild to moderate abdominal distension. Intra abdominal bleeding was suspected, baby was then electively ventilated by endotracheal tube, an urgent USS was done & referred to Paediatric Surgery. Hgb was then 5.7gm /dl, PLT-71 x10 / , WBC-24.5 x10 / μl USS of abdomen revealed 2.7cm x 2.3cm x2.3cm heterogeneous lesion noted in the posterior segments of right lobe of liver with free fluid in pelvis & around the liver. Diagnostic peritoneal aspiration revealed haemoperitoneum. Informed consent was obtained from parents & an emergency exploratory laparotomy was performed-due to sudden & severe decompensation –findings were :50ml blood around the liver, with a 2.5cm x 2cm sub-capsular hematoma on the inferior surface of right lobe of liver, the rest of abdominal findings were normal. The liver was packed with gel foam.
Ovarian fibrothecomas represent an ovarian stromal neoplasm developing in a wide spectrum of clinical settings. Fibrothecomas have been described as rare ovarian neoplasms. Here we present an unusual clinical manifestation of ovarian fibrothecoma with abdominal distension in a young female, which must be differentiated from massive edema of the ovary and sclerosing stromal tumor of the ovary.
IntroductionFemale genital mutilation (FGM) is a serious problem occurring very commonly in the developing world and it has serious health implications. The purpose of this study was to determine the practice of FGM among the Malays living in a rural region of north Malaysia. Methods: The study is a descriptive survey supplemented by qualitative information conducted in five villages in north Malaysia comprising entirely of Muslim Malays. Results: 597 women who experienced FGM were interviewed and they cited religion as the main reason for the practice. It was commonly performed by a traditional practitioner of the art called ‘Mak Bidan’, but the more recent FGM were done in clinics by doctors (P=0.000). All female adults interviewed wanted the practice to go on (P=0.05). Comparatively the FGM practiced in these villages was less traumatic than that practiced in most other countries. In contrast with studies conducted elsewhere, the responders in this study believed that FGM actually helps to increase the female libido. Conclusion: The public and especially the ‘Mak Bidan’s’ need to be educated on the dangers of female circumcision and the true requirements of circumcision in religion using an advocacy and social movement approach. This is best done by those from the state religious authority and it should be multisectoral, sustained and community led
Background : Acute upper gastrointestinal bleeding (UGIB) is a common life threatening emergency resulting in a large number of hospital admissions. Endoscopy done within the first 24 hours of bleeding has been shown to be the most reliable means of establishing the source of upper gastrointestinal haemorrhage. Aims and objectives : The aim of this study is to determine the causes and outcome of patients with UGIB presenting at two tertiary hospitals in north-eastern Nigeria. Materials and Methods : The study was carried out at the University of Maiduguri Teaching Hospital and the Federal Medical Centre Gombe, both located in north-eastern Nigeria. The records of 106 patients who underwent endoscopy for upper GI bleeding over a period of 6 years (2003-2008) were retrospectively analysed. Results: A total of 106 patients were studied. Seventy-four (69.8%) were males while 32 (30.2%) were females. Their ages ranged from 14 to 75 years with a mean of 43.3 ±15.1SD years. Oesophageal varices were the most frequent cause of bleeding (45.3%) followed by non-ulcer peptic acid disease (23.7%) and peptic ulcer disease (16.9%). Gastric cancer and Mallory-Weiss syndrome were rare with each accounting for 1.9% of the cases. In 11 (10.4%) patients no source of bleeding could be identified. Nineteen patients died giving a mortality rate of 17.9%. All the mortalities were recorded among those with variceal bleeding. Conclusion: Oesophageal varices are the commonest cause of upper gastrointestinal bleeding in this environment and responsible for most of the mortalities associated with this condition.
Intestinal parasites are regarded as important public health problems in tropical Africa and cause malnutrition, diarrhea and anaemia in humans. A study and was undertaken to determine the impact of socio-demographic and economic factors on the prevalence of intestinal parasites among women in Makurdi, Benue State-Nigeria. Using formol ether concentration technique to process the faeces, an infection rate of 426 (56.80%) was recorded out of the 750 women examined. Five parasite species were found: Entamoeba coli 28.48%, Entamoeba histolytica 22.00% and Ascaris lumbricoides 17.20%. The peak prevalence of 75.00% was observed among women with no level of education, those that had primary and secondary level of education recorded 73.13% and 66.66% respectively, no significant difference was observed between infection rate and level of education(X = 85.93, P > 0.05). An infection rate of 68.60% was observed among female students. Traders, housewives and farmers recorded 65.50%, 64.50% and 60.00% respectively, there was no significant difference between the occupation of the women and prevalence of infection (X = 32.30, P > 0.05). It is recommended that government should enforce many of the docile environmental laws in order to make people live in healthy environments and observe hygiene rules which are necessary for good health and longevity.
Stroke is a major cause of death in adults’ world wild and it contributes to disability and reduced quality of life. In this study stroke patients constituted 2.3% of the total hospital admissions and 9.3% of medical admissions. In order to understand the pattern of stroke in Bayelsa state, a total number of 28 stroke patients out of 300 patients that were admitted over a period of seven months, between November 2007 and June 2008 at the Niger Delta University Teaching Hospital, Okolobiri were studied. Questionnaires which assessed their biodata, clinical and laboratory data’s were used. Risk factors assessed were hypertension (89%), alcohol (57%), tobacco smoking (53.5%), Male factor (m: f =1.15:1). The mean age of the study group was 62.2±9. 64% of the stroke patients were in the active social segment of the society. Stroke affected more of the poor society who lived in the rural areas. The prevalence of ischaemic stroke was higher than haemorrhagic stroke. In conclusion, hypertensive heart disease was a major co-morbidity of stroke.
Background: A mixed endemic focus of cutaneous and visceral leishmaniasis has emerged along the Sutluj river valley of Himachal Pradesh (India). Methods: The laboratory work up of 218 new consecutive cases of localized cutaneous leishmaniasis (LCL) and 14 patients of visceral leishmaniasis (VL) from this focus is analyzed. Results: Tissue smears were positive in 44.42% of LCL and 78.57% of VL patients. Positivity was higher (73.97%) in LCL lesions of 6months duration. Only modified NNN medium supplemented with RPMI 1640 and 10% heat inactivated fetal bovine serum was found to be the most suitable for primary isolation of the parasite while other seven media used did not yield significant growth. Culture for the organism was positive in 38 of 112 (33.92%) patients of LCL and 9 of 14 (64.28%) patients of VL. The cultured organisms from 4 each of LCL and VL samples were identified by PCR as Leishmania donovani. Although subculture/bulk cultivation of this Leishmania spp. was unsuccessful in the various media tried, the two of the primary cultures could be maintained for 50 days by just replenishing the liquid overlay. Conclusion: This new focus of leishmaniasis appears peculiar where cutaneous and visceral forms co-exist, and both Leishmania donovani and Leishmania tropica are producing LCL all the while L. donovani being the predominant pathogen. The difficulty in culturing the isolates is also reminiscent of LCL caused by Leishmania infantum suggesting that these isolates, both from LCL and VL patients, perhaps belong to Leishmania donovani-infantum complex.
Pulsatile drug delivery system is defined as the rapid and transient release of certain amount of drug molecules within a short time period immediately after a predetermined off-release period, i.e., lag time. [1] Pulsatile drug delivery aims to release drug on programmed pattern i.e. at appropriate time and at appropriate site of action. Pulsatile systems are gaining a lot of interest as the drug is released completely after defined lag time. Pulsatile drug delivery system is timeand site-specific drug delivery system, thus providing special and temporal delivery and increasing patient compliance.
The aim of this study is to measure the affordability of drugs used in treating common chronic diseases. The study was conducted in the Universiti Sains Malaysia (USM) and in 5 private retail pharmacies. The study measured prescriptions contents of Universiti Sains Malaysia panel of clinics claim forms of patients for the year 2006. Affordability of medicines used was
Primary adenocarcinoma arising from the umbilicus is an uncommon malignancy, with only a handful of cases reported in the modern medical literature. The diagnosis is however, important because metastatic tumors of umbilicus are much commoner. A case of primary adenocarcinoma of umbilicus is being described in a 28 year male patient treated with surgical excision of nodule followed by combination chemotherapy. Introduction Metastatic tumors of the umbilicus are much commoner than primary neoplasms 1 . Primary malignancies of umbilicus accounts one fourth or one sixth of the metastatic tumors at this location 2 . A primary adenocarcinoma arising at the umbilicus is a very rare occurrence 3 Quick Response Code Case Report A 28 year male presented with complaints of discharge from umbilicus for one year duration. Discharge was thick and purulent in nature, associated with off-on pain abdomen which was mild to moderate in intensity and non-referred type. There were no complaints of vomiting and diarrhea. There was no significant past medical and surgical history. Physical and general examination of the patient was normal. On local examination there was a reddish brown swelling of 2.5 x 3.0 cm in size present in the umbilical region which was subcutaneous, round, tender, mobile and hard in consistency (Fig.1). Figure 1: Reddish brown swelling of 2.5 x 3.0 cm in size present in the umbilical region On examination, there was no other similar swelling anywhere else in the body. Abdominal Ultrasonography showed irregular hypo echoic mass with micro calcification seen in the umbilical region not extending into peritoneal cavity. CT scan showed a tiny soft tissue nodule at posterior aspect of the umbilicus, abutting linea alba which was compressing and displacing linea alba by extending inside it. There was no communication with bowel loops (Fig.2). Figure 2: CT scan showed a tiny soft tissue nodule at posterior aspect of umbilicus There was no significant regional and retroperitoneal lymphadenopathy. Fine needle aspiration cytology of the nodule revealed malignancy. The initial diagnosis of this lesion was being thought as metastatic deposit and an x ray chest, barium enema, upper gastrointestinal endoscopy, and colonoscopy were performed but all were normal and no other primary was detected. Carcino embryonic antigen (CEA) was found to be 2.81ng/ml. (Normal <3.00) Then patient underwent surgical excision of the swelling. Per operative findings revealed an ulcerated nodule of 5 x 5 cm on the umbilicus. Swelling was not seen extending to peritoneum and adjacent structures were not infiltrated. Histopathology of excised nodule was suggestive of adenocarcinoma of umbilicus (Fig.3, Fig.4). Followed by this, patient received six courses of combination chemotherapy with carboplatin and doxorubicin at three weekly intervals. Figure 3: Photomicrograph showing skin with underlying malignant cells arranged in glandular fashion H&E (40x). Figure 4: Photomicrograph showing malignant cells arranged in glandular fashion H&E (100x).
OBJECTIVE:Knowledge, attitude and practice of pregnant women toward prevention of mother to child transmission of HIV infection have not been evaluated in any tertiary health facility in the Northeast region of Nigeria.METHODS:A structured questionnaire was used to obtain data from 172 women that consecutively attended the antenatal clinic of University of Maiduguri Teaching Hospital to determine their level of knowledge, practice and attitude toward HIV/AIDS issues with respect to PMTCT.RESULTS:The survey revealed a high level of knowledge on modes of transmission, risks behaviours and prevention of HIV and other sexually transmitted infections among the pregnant women. However, the use of breast milk substitute (BMS) by HIV positive nursing mothers and use of condom during sexual intercourse did not receive very encouraging responses from 42 (24.4%) and 58 (33.7%) of the women respectively. Those that do not encourage use of BMS indicated spouse dislike as a major reason and the fact that the community places higher premium on breastfeeding than BMS. Majority of those that discouraged condom use 28 (48.3%), said the practice was against their religions beliefs while a few believes withdrawal before ejaculation and use of antibiotics after sex can equally prevent HIV infection. Majority of the respondents, 106 (61.6%) admit their willingness to support their spouses that tested positive for HIV.CONCLUSION:The pregnant women accepted PMTCT as a veritable means of preventing infants from HIV infection as well as an opportunity to know ones HIV status through voluntary testing. Majority implored greater involvement of their male partners and other significant family members during PMTCT counselling sessions to guard against ejection, stigma and discrimination if tested HIV positive. Staff training, awareness creation and community mobilization were identified as key to success of PMTCT programmes and fight against stigma and discrimination.
Eleven locally used medicinal plants were selected for an intensive in-depth literature review, the purpose of which was to learn more of their therapeutic activity, local effects and chemical constituents.
Branded drugs play an important role in medications, but generics are their cost effective alternatives. Generics are similar to branded drugs in terms of purity, efficacy and are perceived to be safer as compared to new drug molecules, as they tend to be older and time tested. Indian pharmaceutical market of generic drugs is increasing day by day. The present communication describes various aspects and prospects of generic drugs in Indian Pharmaceutical Sector.
