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Background@#The purpose of this study was to identify predictors of the time from initial presentation to total shoulder arthroplasty (TSA) in patients with primary glenohumeral osteoarthritis (OA) and rotator cuff (RTC) arthropathy who were conservatively managed with corticosteroid injections. @*Methods@#We conducted a retrospective cohort study of patients who underwent TSA from 2010 to 2021. Kaplan-Meier survival analysis was used to estimate median time to TSA for primary OA and RTC arthropathy patients. The Cox proportional hazards model was used to identify significant predictors of time to TSA and to calculate hazard ratios (HRs) with 95% confidence intervals (CIs). Statistical significance was set at P<0.05. @*Results@#The cohort included 160 patients with primary OA and 92 with RTC arthropathy. In the primary OA group, median time to TSA was 15 months. Significant predictors of shorter time to TSA were older age at presentation (HR, 1.02; 95% CI, 1.00–1.04; P=0.03) and presence of moderate or severe acromioclavicular joint arthritis (HR, 1.45; 95% CI, 1.05–2.01; P=0.03). In the RTC arthropathy group, median time to TSA was 14 months, and increased number of corticosteroid injections was associated with longer time to TSA (HR, 0.87; 95% CI, 0.80–0.95; P=0.003). @*Conclusions@#There are distinct prognostic factors for progression to TSA between primary OA patients and RTC arthropathy patients managed with corticosteroid injections. Multiple corticosteroid injections are associated with delayed time to TSA in RTC arthropathy patients.
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Introduction: Intensivists routinely works in a demanding, highly complicated environment where mor-tality and morbidity are common events and it affects their own physical as well mental health. Objective: The aim was to assess psychological factors and the various influencing factors on psycholog-ical health among study participants. Methods: The list of tertiary care hospitals in Chennai were collected and Ten hospitals were selected randomly by lottery method and 15 doctors who were working in Intensive Care Units (ICU) were se-lected from each hospital by systematic random sampling to arrive at the calculated sample size of 150. The Data was collected using the Pretested semi structured questionnaire and validated DASS-21 Scale. Results: The prevalence of Depression, Anxiety and Stress was found to be 78.6%, 86% and 60.6% re-spectively among ICU doctors. It was found that, having a history of either diabetes or hypertension and working more than 8 hours per day was an important predictor for depression and stress respectively with statistically significant association (P<0.05). Conclusions: Routine screening of physical health and mental health for doctors involved in the diag-nostic as well as treatment aspects of work towards patients in Intensive Care Unit (ICU) should be con-ducted periodically.
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Background: Adolescence is the transition period from childhood to adulthood and adolescent obesity can lead to systemic complications affecting the quality of life in later stages. This study aimed to assess the risk factors of obesity among school children of adolescent age. Methods: This Case control study included 110 obese and 110 non-obese adolescents between 10 and 17 years of age. Children with Body Mass Index (BMI) >+2 SD of WHO growth reference median for their age and sex were included as cases. Children with BMI between -2SD and +1SD were included as controls. Data was collected using a structured questionnaire and analyzed with SPSS software. Results: The risk factors which showed a statistically significant association with adolescent obesity were less educated father and mother, being a single child in the family, adolescents from nuclear type of family, having an obese parent, increased waist hip ratio and lack of exclusive breastfeeding during infancy. Conclusion: Educating children and parents on the importance of preventing obesity and harmful effects of adolescent obesity is the need of the hour. This can be done through intensive health education cam-paigns in community and schools, and regular reinforcement on primary preventive measures.
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Background: The purpose of this study is to measure the number of visually impaired students who are capable of doing and managing their own work and also to evaluate their state of mind due to their impairment. The study is also to bring awareness about the rehabilitation centres and special training on mobility for the children. Objective: To find out the level of independence and the mental status of visually challenged students. Methods: This is a descriptive cross-sectional study. Sixty visually impaired students were included in the study by random sampling method. Male students from class 9th to 12th standard were evaluated. Data relevant to the study are gathered by interview schedule method and questionnaire was designed for the study beforehand. Result: It is evident from the current study that 83.3% of the impaired have not been trained to walk independently. Almost 78.3% of the students are not even aware of the rehabilitation centres. However, about 98.3% of students are independent in grooming and washing & also taking care of their personal work. As per the survey, only 26.6 % of students are feeling isolated, whereas, the balance 73.4% students feel very comfortable while dealing with sighted students. About 96.6% feel very happy and satisfied as they get enough support from their parents.
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Background: Smart phones have become an integral part of our life, especially among the younger population. Due to its overuse, the effects caused by mobile phones and electromagnetic field also show an increasing trend. Hence this study was conducted to assess the ill effects of mobile phone use among the college students in Chennai. Methods: Cross sectional study was conducted among college students, Chennai, from May 2019 to June 2019. Males and Females between 17 to 23 years of age were included in the study. A total of 125 students selected by convenient sampling technique were included in the study. The study was conducted using a questionnaire, covering particulars related to mobile phone usage and its ill effects on them. Data entry and analysis was done using SPSS version 23. Results: Proportion of participants with different ill effects includes pimples (18.4%), sleep disturbances (16%), loss of interest in studies (15.2%), fatigue (11.2%), headache (9.6%), restlessness (8.8%), and redness of eye (6.4%), irritability (6.4%), dizziness (4.8%), thumb pain (3.2%) and earache (1.6%). Conclusion: Students needs to be educated regarding the health problems owing to the over usage of mobile phones and large-scale studies are needed to assess the extent of the problem.
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Many Countries struggle to tackle the consequences of under nutrition and infectious diseases. At the same time, they are also now showing a rapid increase in non-communicable diseases and their risk factors like obesity and overweight, especially in urban areas. In the present era, it is quite common to find co-existence of under nutrition and obesity within a country, within a community and even within a household. Children living in developing and under-developed countries are more susceptible to poor nutrition during antenatal period, infancy and childhood. On the contrary, children also have easy access to food products with increased salt and fat percentage, decreased levels of micro nutrients and more junk calories. The synergistic effects of high calorie intake and low physical activity lead to increase in prevalence of childhood overweight and obesity. This article discusses about the aetiology, epidemiology and determinants of adolescent obesity.
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Objective@#To investigate the association between functional tumor burden of peritoneal carcinomatosis (PC) derived from diffusion-weighted imaging (DWI) and overall survival in patients with advanced ovarian carcinoma (OC). @*Materials and Methods@#This prospective study was approved by the local research ethics committee, and informed consent was obtained. Fifty patients (mean age ± standard deviation, 57 ± 12 years) with stage III–IV OC scheduled for primary or interval debulking surgery (IDS) were recruited between June 2016 and December 2021. DWI (b values: 0, 400, and 800 s/mm2 ) was acquired with a 16-channel phased-array torso coil. The functional PC burden on DWI was derived based on K-means clustering to discard fat, air, and normal tissue. A score similar to the surgical peritoneal cancer index was assigned to each abdominopelvic region, with additional scores assigned to the involvement of critical sites, denoted as the functional peritoneal cancer index (fPCI). The apparent diffusion coefficient (ADC) of the largest lesion was calculated. Patients were dichotomized by immediate surgical outcome into high- and low-risk groups (with and without residual disease, respectively) with subsequent survival analysis using the Kaplan-Meier curve and log-rank test. Multivariable Cox proportional hazards regression was used to evaluate the association between DWI-derived results and overall survival. @*Results@#Fifteen (30.0%) patients underwent primary debulking surgery, and 35 (70.0%) patients received neoadjuvant chemotherapy followed by IDS. Complete tumor debulking was achieved in 32 patients. Patients with residual disease after debulking surgery had reduced overall survival (p = 0.043). The fPCI/ADC was negatively associated with overall survival when accounted for clinicopathological information with a hazard ratio of 1.254 for high fPCI/ADC (95% confidence interval, 1.007–1.560; p = 0.043). @*Conclusion@#A high DWI-derived functional tumor burden was associated with decreased overall survival in patients with advanced OC.
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Background: Pulmonary aspergillosis (PA) is common among patients with tuberculosis (TB). With both infections presenting with similar clinical and radiologic features, diagnosis of PA is often made too late or missed completely due to lack of clinical suspicion and poor diagnostic laboratory capacity for mycotic infections prevalent in our settings. We present a case of preventable mortality caused by delayed diagnosis and treatment of PA in a patient with pulmonary TB (PTB). Case presentation: A 13-year-old female was diagnosed and treated for PTB, having received anti-TB regimen for 8 months in a mission hospital from where she was referred due to worsening cough, chest pain and progressive breathlessness. The patient was re-assessed and investigated, with GeneXpert detecting Mycobacterium tuberculosis, susceptible to rifampicin. Diagnosis of pulmonary tuberculosis complicated by right pneumothorax was made indicating an emergency thoracotomy and chest tube insertion and continuation of the first line anti-TB regimen. At about 2 weeks into admission, patients had features of superimposed acute bacterial sepsis with fever becoming high grade, marked neutrophilia with toxic granulation and elevated sepsis biomarker, and this necessitated empiric antibiotic treatment with parenteral meropenem and vancomycin. However, the patient only had mild clinical improvement following which there was progressively worsening respiratory symptoms and massive haemoptysis. Result of sputum fungal study was available on admission day 20 and revealed a growth of Aspergillus flavus. Treatment with intravenous voriconazole was however commenced rather late when the fungal respiratory disease could no longer be remedied. The patient died on admission day 23. Conclusion: Diagnosis of PA in patients with background TB is often made too late to guarantee timely and effective antifungal treatment with negative consequences on patients' outcomes. Improving clinical and laboratory capacities is essential to reducing mortality from PA in healthcare facilities.
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Humans , Tuberculosis , Diagnosis , Pulmonary Aspergillosis , Mycobacterium tuberculosis , Voriconazoleالملخص
The incidence of extremity amputation is estimated at about 200,000 cases annually. Over 25% of patients suffer from terminal neuroma or phantom limb pain (TNPLP), resulting in pain, inability to wear a prosthetic device, and lost work. Once TNPLP develops, there is no definitive cure. Therefore, there has been an emerging focus on TNPLP prevention. We examined the current literature on TNPLP prevention in patients undergoing extremity amputation. A literature review was performed using Ovid Medline, Cochrane Collaboration Library, and Google Scholar to identify all original studies that addressed surgical prophylaxis against TNPLP. The search was conducted using both Medical Subject Headings and free-text using the terms “phantom limb pain,” “amputation neuroma,” and “surgical prevention of amputation neuroma.” Fifteen studies met the inclusion criteria, including six prospective trials, two comprehensive literature reviews, four retrospective chart reviews, and three case series/technique reviews. Five techniques were identified, and each was incorporated into a targetbased classification system. A small but growing body of literature exists regarding the surgical prevention of TNPLP. Targeted muscle reinnervation (TMR), a form of physiologic target reassignment, has the greatest momentum in the academic surgical community, with multiple recent prospective studies demonstrating superior prevention of TNPLP. Neurorrhaphy and transposition with implantation are supported by less robust evidence, but merit future study as alternatives to TMR.
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The incidence of extremity amputation is estimated at about 200,000 cases annually. Over 25% of patients suffer from terminal neuroma or phantom limb pain (TNPLP), resulting in pain, inability to wear a prosthetic device, and lost work. Once TNPLP develops, there is no definitive cure. Therefore, there has been an emerging focus on TNPLP prevention. We examined the current literature on TNPLP prevention in patients undergoing extremity amputation. A literature review was performed using Ovid Medline, Cochrane Collaboration Library, and Google Scholar to identify all original studies that addressed surgical prophylaxis against TNPLP. The search was conducted using both Medical Subject Headings and free-text using the terms “phantom limb pain,” “amputation neuroma,” and “surgical prevention of amputation neuroma.” Fifteen studies met the inclusion criteria, including six prospective trials, two comprehensive literature reviews, four retrospective chart reviews, and three case series/technique reviews. Five techniques were identified, and each was incorporated into a targetbased classification system. A small but growing body of literature exists regarding the surgical prevention of TNPLP. Targeted muscle reinnervation (TMR), a form of physiologic target reassignment, has the greatest momentum in the academic surgical community, with multiple recent prospective studies demonstrating superior prevention of TNPLP. Neurorrhaphy and transposition with implantation are supported by less robust evidence, but merit future study as alternatives to TMR.
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Background@#Guillain-Barre syndrome (GBS) is an acute monophasic paralyzing illness that typically occurs after gastroenteritis and respiratory tract infection. Antecedent surgical procedures are less recognized trigger of GBS.@*Objectives@#This paper aims to report a case of demyelinating variety of GBS that developed after appendectomy.@*Methods@#This is a case of a 39-year-old Filipino male who was admitted due to acute appendicitis. He developed lower extremity weakness 4 days after appendectomy. His motor deficit initially presented distally from lower extremities, which advanced to the trunk, upper extremities, and muscles of speech and deglutition. Paresthesia of the fingers and toes and distal areflexia on both lower extremities were also elicited.@*Results@#Diagnosis was done clinically. Nerve conduction study showed demyelinating variant, uncommon for a post traumatic GBS. Supportive care was rendered which resulted in complete recovery.@*Conclusion@#Surgery is a known but less identified cause of GBS. Although rare, we should consider GBS in patients presenting with ascending or progressive weakness after recent surgery because its early identification renders immediate and appropriate treatment.
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Guillain-Barre Syndrome , Guillain-Barre Syndrome , Appendectomyالملخص
@#<p style="text-align: justify;"><strong>OBJECTIVE:</strong> Crooked nose deformity is a commonly seen reason for septorhinoplasty in the otolaryngology clinic. The purpose of this study is to initially determine the different etiologies of patients with crooked nose deformities who underwent septorhinoplasty, and to describe the different types of crooked nose by their level of deviation and surgical management in our institution.<br /><strong>METHODS:</strong><br /> <strong> Design:</strong> Case Series<br /> <strong> Setting:</strong> Tertiary Public University Hospital<br /> <strong> Participants:</strong> A chart review of all patients with a crooked nose deformity who were admitted at the otorhinolaryngology ward of the National University Hospital and underwent septorhinoplasty from January 2012 to January 2015 was conducted, and data consisting of age, sex, etiology of crooked nose deformity, level of deviation, cartilage source, and surgical intervention were obtained and analyzed.<br /><strong>RESULTS:</strong> A total of 21 patients underwent septorhinoplasty for crooked nose deformity in the study period. The most common etiology for crooked nose was physical violence (13/21 or 62%), followed by sports injury (4/21 or 19%), vehicular accidents (2/21 or 9%), and accidental fall (1/21 or 5%). There were more upper and middle third deviations than lower third deviations. Sixteen out of 21patients (76%) underwent open rhinoplasty, while the rest underwent an endonasal approach. Twelve (57%) underwent intervention on the nasal fracture after at least a year (old or neglected fracture) as compared to the 9 (43%) who had immediate intervention after less than two weeks. Thirteen used septal cartilage, while 4 used conchal cartilage, and 1 used tragal cartilage. The most common grafts used were spreader and camouflage, followed closely by dorsal onlay, and columellar strut grafts.<br /><strong>CONCLUSION:</strong> The majority of crooked nose deformities that were subjected to septorhinoplasty in our department were secondary to old nasal bone fractures caused by physical violence. Upper and middle third level deviations were more common, and most underwent open rhinoplasty with autologous cartilage grafts. Future studies may increase our understanding of, and improve our techniques in septorhinoplasty for crooked nose deformities in Filipino noses in particular, and Asian noses in general. </p>
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Humans , Male , Female , Middle Aged , Adult , Young Adult , Rhinoplasty , Nose , Wounds and Injuriesالملخص
@#<p style="text-align: justify;"><strong>OBJECTIVES:</strong> Axial flap surgery is associated with numerous complications. The purpose of this study is to determine the frequency of these complications, and identify possible factors contributory to their occurrence.<br /><br /><strong>METHODS:</strong><br /><strong>Design: </strong>Cross-Sectional Study<br /><br /><strong>Setting: </strong>Tertiary Public University Hospital<br /><br /><strong>Subjects: </strong>Records of all patients who underwent axial pedicled flap reconstruction at the otorhinolaryngology ward of our tertiary public university hospital from January 2013 to July 2015 were retrospectively reviewed, and data consisting of age, sex, diagnosis, disease stage, smoking history, alcohol intake, co-morbidities, past operations, pre-operative hemoglobin and albumin, total operative time, total blood loss, location and total area of the surgical defect and length of hospitalization were tabulated. All complications were listed. Data were analyzed for any potential trends.<br /><br /><strong>RESULTS:</strong> A total of 38 patients underwent axial pedicled flap reconstruction in the study period. Nineteen out of 38 (50%) cases involved complications. The most common complication was infection. Most of the complications occurred in males with history of alcohol intake, advanced cancer stage, significant blood loss, recurrent tumors, low pre-operative hemoglobin and albumin levels, and a large area of surgical defect.<br /><br /><strong>CONCLUSIONS:</strong> The complication rate for axial flap surgery in our series was significant at 50%. Potential risk factors identified were male gender, advanced cancer stage, tumor recurrence, alcohol intake, low pre-operative hemoglobin and albumin levels, significant blood loss, longer operative time, and a larger surgical defect.</p>
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Humans , Male , Female , Aged , Middle Aged , Adult , Surgical Flapsالملخص
OBJECTIVE: Axillary crutches are simple rehabilitative devices that are globally used temporarily or permanently to assist in ambulation of patients and rarely present with complication. This report is about bilateral wrist drop incidentally noticed in a young adult patient mobilized on axillary crutches after internal fixation of a simple right tibia fracture. METHODS: The fracture was fixed by intramedullary nailing and the patient was mobilized on axillary crutches. At six weeks, patient fearfully refused to be commenced on partial weight bearing and at 12 weeks after surgery he was noticed to be totally weightbearing on the bars of the appropriately long axillary crutches and had developed bilateral wrist drop. There was radiological evidence of healing at the fracture sites. Treatment included mobilization on one elbow crutch on the left, physical therapy and nerve stimulation. RESULTS: At six weeks of physiotherapy, the power of the dorsiflexors of the wrists had recovered completely. CONCLUSION: Bilateral posterior cord palsy of brachial plexus could occur even in young healthy patients but total recovery could occur if the diagnosis and treatment are prompt. Patients should be told in unequivocal terms not to weight bear directly on axillary bars.
OBJETIVO: Las muletas axilares son simples dispositivos de rehabilitación que se utilizan en todo el mundo de manera temporal o permanentemente para ayudar a caminar a los pacientes, y raramente presentan complicación. Este trabajo trata de la mano péndula o mano caída, observada incidentalmente en un paciente adulto joven movilizado en muletas axilares, después de la fijación interna de una fractura simple de la tibia derecha. MÉTODOS: La fractura fue fijada mediante clavo intramedular, y el paciente fue movilizado con muletas axilares. A las seis semanas, el paciente se negó temeroso a la iniciación para sostener parcialmente todo su peso con ayuda de muletas, y a las 12 semanas después de la cirugía, se le vio sostener todo su peso sobre las barras de las muletas axilares de longitud adecuada, y había desarrollado mano péndula bilateral. Había evidencia radiológica de curación en los sitios de fractura. El tratamiento incluyó la movilización con una muleta de codo a la izquierda, terapia física, y estimulación nerviosa. RESULTADOS: A las seis semanas de fisioterapia, la capacidad de los dorsiflexores de las muñecas se había recuperado completamente. CONCLUSIÓN: La parálisis del fascículo posterior bilateral del plexo braquial podría ocurrir incluso en pacientes jóvenes sanos, pero la recuperación total podría ocurrir si el diagnóstico y el tratamiento se hacen a tiempo. A los pacientes se les debe decir en términos inequívocos que no deben soportar todo su peso directamente en las barras axilares.
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Humans , Male , Adolescent , Brachial Plexus Neuropathies/etiology , Crutches/adverse effects , Brachial Plexus/anatomy & histology , Brachial Plexus Neuropathies/rehabilitation , Resistance Trainingالملخص
<p><b>OBJECTIVE</b>To compare the efficacy and safety of gefitinib or docetaxel in Chinese patients with locally advanced or metastatic non-small cell lung cancer (NSCLC) who had failed previous platinum-based first-line chemotherapy.</p><p><b>METHODS</b>We retrospectively reviewed 222 Chinese NSCLC patients in the subgroup of INTEREST (gefitinib versus docetaxel in previously treated non-small cell lung cancer) study. Survival analysis was evaluated by Kaplan-Meier method, and Functional Assessment of Cancer Therapy-Lung (FACT-L) was used to compare the quality of life between gefitinib group and docetaxel group.</p><p><b>RESULTS</b>A total of 222 patients were analyzed in this subgroup study. 107 patients were treated with gefitinib, and 115 patients treated with docetaxel. There were all balanced between the two groups in terms of sex, age, staging and pathology in patient characteristics. The median overall survival in the two groups was similar (11 months in the gefitinib group vs. 14.0 months in the docetaxel group, P = 0.783). The progression-free survival (PFS) was also similar between the two groups (median PFS: 3.4 months in gefitinib group vs. 3.8 months in docetaxel group, P = 0.214). The response rate in gefitinib group was significantly higher than that in the docetaxel group (21.9% vs. 9.1%, P = 0.016).</p><p><b>CONCLUSION</b>The efficacy of gefitinib is similar with that of docetaxel in pretreated patients with locally advanced or metastatic NSCLC, however, gefitinib is more favorable in the tolerance and quality of life improvement.</p>
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Adult , Female , Humans , Male , Antineoplastic Agents , Therapeutic Uses , Carcinoma, Non-Small-Cell Lung , Drug Therapy , Pathology , Diarrhea , Disease-Free Survival , Exanthema , Lung Neoplasms , Drug Therapy , Pathology , Neoplasm Staging , Neutropenia , Platinum , Therapeutic Uses , Quality of Life , Quinazolines , Therapeutic Uses , Randomized Controlled Trials as Topic , Remission Induction , Retrospective Studies , Survival Rate , Taxoids , Therapeutic Usesالملخص
Opsismodysplasia is a rare osteochondrodysplasia with micromelia and platyspondyly. The authors report on a neonate with opsismodysplasia. During the antenatal period, polyhydramnios was noted. This is the first report of opsismodysplasia from India. Significant observation was antenatal polyhydramnios.
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Abnormalities, Multiple/pathology , Diagnosis, Differential , Female , Humans , Infant, Newborn , Osteochondrodysplasias/pathologyالملخص
Hepatitis B virus [HBV] displays a distinct hepatotropism and a narrow host range in vivo. However, very little is known about the interaction of HBV with its host cells, mainly because of difficulties in the development of suitable tissue culture system. We present here confirmatory evidence of a putative role of annexin-V in HBV infection. HBV from both human sera and from culture supernatants from HepG2 2.15 cells were used to infect FTO9.1 cells [a rat hepatoma cell line transfected with a construct containing human annexin-V]. Cells and culture supernatants were assayed at various times post-infection by immunofluorescent microscopy [HBcAg staining in nucleus], and by HBV cccDNA-specific PCR. Supernatants from these initially infected cells were then used to infect fresh FTO9.1 cells with a similar outcome to primary infection. Core and surface gene PCRs were positive on days 2, 5 and following transfer experiments. cccDNA-specific PCR confirmed internalisation of the virus into the nucleus. HBcAg fluorescence showed nuclear staining on days 2, 5 and following transfer experiments. Addition of recombinant annexin-V and DMSO to the cell culture medium resulted in a greater efficiency of infection. Later washes were negative for HBV-DNA, ruling out contamination of the cells by external HBV particles. This cell line does appear to be useful in the study of the early stages of HBV infection, but requires further evaluation
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Humans , Animals, Laboratory , Hepatitis B virus , Rats , Carcinoma, Hepatocellular , Liver Neoplasms, Experimental , Cell Line , Annexin A5الملخص
The relevance of bacterial index (BI) for understanding the prognosis of leprosy patients on treatment has been extensively debated, as it does not give a very clear idea of the viability of the bacteria in patients under treatment. Here we used slit-skin smear samples of leprosy patients to test the suitability for studying viability of Mycobacterium leprae using reverse transcription polymerase chain reaction (RT-PCR). For this purpose, we recruited 13 multibacillary (MB) leprosy patients (8 lepromatous and 5 borderline lepromatous). Of these, 7 were relapse cases, 3 were under treatment (MB-MDT), 2 were new cases and 1 had completed treatment. We carried out extraction of RNA using Trizol reagent (Life Technologies, UK) from the slit-skin smear samples from these patients. The RNA preparation was then used for the RT-PCR using Mycobacterium leprae-specific primers for the fragment of 16s ribosomal RNA gene. Samples from both the new cases, 4 suspected relapse cases and 1 patient under treatment showed positive RT-PCR results. Other 6 patients whose smear samples did not show any amplification by RT-PCR were on MB-MDT from 8 to 30 months. The usefulness of the technique needs to be validated using mouse footpad technique and also should be more extensively explored for studying the viability of M. leprae, the efficacy of treatment and the presence of other mycobacteria in the slit-skin smear samples.
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Adult , Aged , Electrophoresis, Agar Gel , Female , Humans , Leprosy, Borderline/microbiology , Leprosy, Lepromatous/microbiology , Male , Middle Aged , Mycobacterium leprae/genetics , RNA, Bacterial/chemistry , RNA, Ribosomal, 16S/chemistry , Reverse Transcriptase Polymerase Chain Reactionالملخص
The case fatality ratio (CFR) in acute protein-energy malnutrition (PEM) achieved in the Tropical Metabolism Research Unit (TMRU) was compared with that of other tertiary care facilities in Kingston. Trends in admission and fatality rates, case severity and complications were also examined. From ward admission registers for Bustamante Hospital for Children (BHC), the University Hospital of the West Indies (UHWI), children's wards and the TMRU all cases of PEM admitted from 1982 through 1991 were enumerated and there was a docket search for random subsamples. Ten-year mean CFR percent for BHC was 8.8 (n=1974); for UHWI wards 5.5 (n=658); for TMRU 7.1 (n=662). BHC has the least restrictions on admission and showed most clearly that the peak time in Kingston for admission of PEM was around 1985, falling to a minimum in 1988 - 1990 and rising again in 1991; however, the other sites also showed similar trends. BHC had a range of CFR precent p.a. of 20.0 to 3.0, with a striking fall in the second half of the decade. There was no temporal CFR trend for the UHWI or TMRU. The latter institution had the highest proportion of admissions with marasmic-kwashiorkor and the lowest proportion with recorded infection. The annual variation in numbers of PEM deaths at BHC was best accounted for by (a) percentage change in consumer price index and (b) percentage change in the US$ value of the Jamaican $, in the preceding year, and (c) annual number of admissions, together. Generally, our findings suggest a minor role for expert in-patient management in reducing deaths from PEM