The organisational response of a hospital critical care service to the COVID-19 pandemic: The Groote Schuur Hospital experience

Background. There are limited data about the coronavirus disease-19 (COVID-19)-related organisational responses and the challenges of expanding a critical care service in a resource-limited setting.Objectives. To describe the ICU organisational response to the pandemic and the main outcomes of the intensive care service of a large state teaching hospital in South Africa.Methods. Data were extracted from administrative records and a prospective patient database with ethical approval. An ICU expansion plan was developed, and resource constraints identified. A triage tool was distributed to referring wards and hospitals. Intensive care was reserved for patients who required invasive mechanical ventilation (IMV). The total number of ICU beds was increased from 25 to 54 at peak periods, with additional non-COVID ICU capacity required during the second wave. The availability of nursing staff was the main factor limiting expansion. A ward-based high flow nasal oxygen (HFNO) service reduced the need for ICU admission of patients who failed conventional oxygen therapy. A team was established to intubate and transfer patients requiring ICU admission but was only available for the first wave. Results. We admitted 461 COVID-19 patients to the ICU over a 13-month period from 5 April 2020 to 5 May 2021 spanning two waves of admissions. The median age was 50 years and duration of ICU stay was 9 days. More than a third of the patients (35%; n=161) survived to hospital discharge. Conclusions. Pre-planning, leadership, teamwork, flexibility and good communication were essential elements for an effective response. A shortage of nurses was the main constraint on ICU expansion. HFNO may have reduced the requirement for ICU admission, but patients intubated after failing HFNO had a poor prognosis.

Can Facebook® be used to administer a distance-learning module of evidence-based medicine? An observational study

Introduction: There is a small volume of published literature describing the use of social networking sites, such as Facebook®, in medical education. However where this literature is available, only poor outcome measures such as learner satisfaction have been measured.Objectives: The primary aim of this study was to create and measure the use of a novel distance-learning module on the practice of evidence based medicine (EBM). This programme was to be delivered using an established and free web-based social-networking site, Facebook®.Methods: A prospective observational study was performed. 31 postgraduate residents enrolled to participate in a module that was delivered by Facebook® over five simultaneous weeks. A standardised tool, the Columbia EBM Instrument, was used to measure outcome measures such as "comfort-level", "self-reported practice", and "knowledge" before and after the module. Results: 12 residents (40%) engaged with the Facebook® activities. The residents' knowledge of EBM did increase, though a quasiexperimental analysis revealed that this increase of knowledge could not be attributed to the Facebook® group.were aged 3 years and younger. Scalds were by far the commonest type of burn occurring in 93% of the patients. Partial thickness burns accounted for 91.7% of cases. The average length of hospital stay was 20.9 days and the mortality rate 16.7%. Total Body Surface Area (TBSA) burned greater than 25% and full thickness burns were associated with mortality.Conclusion: Residents did not engage with the Facebook® groups despite the feasibility of doing so being high. The results of this study should guide educators to use Facebook® with caution as students may not engage with the activities

Paediatric nephrology at the University Hospital of the West Indies a walk through time / Nefrología pediátrica en el Hospital Universitario de West Indies un recorrido a través del tiempo

Paediatric nephrology at the University Hospital of the West Indies has grown over the last five decades into an established paediatric subspecialty offering to Jamaica and other Caribbean territories the benefit of paediatricians with training and exposure in this field. Dissemination of information to medical practitioners within the island has reduced mortality and morbidity associated with potentially treatable atypical renal disease. Clear investigative guidelines for urinary tract infection have made earlier diagnosis of urological malformations possible. Patterns of glomerular disease in Jamaican children have now been aetiologically and histologically documented. Children with chronic kidney disease now have clear management guidelines and the possibility of renal replacement therapy. Future goals include community education about renal disease and the development of a paediatric dialysis and transplantation unit.

La nefrología pediátrica en el Hospital Universitario de West Indies se ha desarrollado en las últimas cinco décadas, convirtiéndose en una sub-especialidad pediátrica establecida, que ofrece a Jamaica y otros territorios caribeños, el beneficio de pediatras con entrenamiento y experiencia en este campo. La diseminación de la información entre los médicos dentro de la isla, ha reducido la mortalidad y la morbosidad asociadas con la enfermedad renal atípica potencialmente tratable. Los claros lineamientos de la investigación de las infecciones del tracto urinario, han hecho posible un diagnóstico más temprano de las malformaciones urológicas. Los patrones de enfermedad glomerular en los niños jamaicanos han sido ahora documentados tanto etiológica como histológicamente. Los niños con enfermedad renal crónica tienen a hora a su disposición lineamientos claros para el tratamiento así como la posibilidad de la terapia del reemplazo renal. Las metas futuras incluyen la educación de la comunidad sobre la enfermedad renal y el desarrollo de una unidad pediátrica de diálisis y trasplante.

Evaluation and selection of elite plant growth-promoting rhizobacteria for suppression of sheath blight of rice caused by rhizoctonia solani in a detached leaf bio-assay.

Sheath blight (ShB) of rice, caused by Rhizoctonia solani, is one of the most important rice diseases worldwide. The objective of this study was to screen selected plant growth-promoting rhizobacteria (PGPR) strains for suppression of ShB under controlled conditions. Sclerotia of R. solani were produced on PDA and immature sclerotia (< 5-day-old) were harvested. Leaves of 60-day-old rice plants grown under greenhouse conditions were used to screen PGPR strains by detached leaf assay. Leaf sections of 8 cm in length were cut and placed in Petri dishes, inoculated with immature sclerotia, and incubated in a growth chamber. Approximately 70 PGPR strains were screened. The disease was quantified by the Relative Lesion Height (RLH) method. Among 70 strains, 31 significantly suppressed the RLH of ShB lesions compared to the control. Among these, Bacillus subtilis strain MBI 600 resulted in greatest suppression of ShB disease severity under the conditions tested.

Clinicopathological features of atypical nephrotic syndrome in jamaican children / Características clínico-patológicas del síndrome nefrótico atípico en los niños jamaicanos

OBJECTIVES: To document the histopathological spectrum of atypical nephrotic syndrome in Jamaican children and to make clinicopathological correlations which will assist physicians in identifying patients needing nephrology consultation. METHODS: This was a retrospective review of renal biopsy data of Jamaican children who were referred to the University Hospital of the West Indies and the Bustamante Hospital for Children between January 1985 and December 2008. The study population consisted of children < 12 years old with atypical nephrotic syndrome. RESULTS: Biopsies were done in 157 children - 85 males and 72 females (mean age 8.91 ± 3.44 years). Indications for biopsy were steroid resistance (35%), frequent relapses (8.9%) and other atypical presentations (56.1%). Overall, mesangial proliferative glomerulonephritis (MesGN) was the commonest histology (49/157, 31.2%), followed by minimal change disease (MCD) (36/157, 22.9%) and diffuse proliferative glomerulonephritis (DPGN) (26/157, 16.6%). Infection was present in 38/157 (24%) cases. Diffuse proli ferative glomerulonephritis was the predominant type associated with streptococcal infection (52.9%) while Hepatitis B was seen in 83% ofcases ofmembranous nephropathy. CONCLUSION: Mesangial proliferative glomerulonephritis is the commonest histology seen in Jamaican children with atypical nephrotic syndrome. Most membranous nephropathy is Hepatitis B related. Hypertension with hypocomplementaemia, renal failure and anaemia are features ofmore serious renal disease (eg membranoproliferative glomerulonephritis and crescentic nephritis) rather than MCNS and should warrant urgent nephrology consultation for renal biopsy.

OBJETIVOS: Documentar el espectro histopatológico del síndrome nefrótico atípico en los niños jamaicanos y hacer correlaciones clínico-patológicas que ayuden a los médicos a identificar pacientes que necesitan la consulta de nefrología.. MÉTODOS: Se trata de un estudio retrospectivo de datos de biopsias renales de niños jamaicanos remitidos al Hospital Universitario de West Indies y al Hospital Pediátrico Bustamante, entre enero de 1985 y diciembre de 2008. La población del estudio consistió en niños < 12 años de edad que padecían el síndrome nefrótico atípico. RESULTADOS: Se realizaron biopsias a 157 niños - 85 varones y 72 hembras (edad promedio 8.91 + 3.44 años). Las indicaciones para la biopsia se debieron a resistencia a los esteroides (35%), recaídas frecuentes (8.9%) y otras manifestaciones atípicas (56.1%). En general, la glomerulonefritis proliferativa mesangial (GNMes) fue la histología más común con 49/157 (31.2%), seguida por la enfermedad de cambio mínimo (ECM) con 36/157(22.9%) y la glomerulonefritis proliferativa difusa (GNPD) con 26/157 (16.6%). La infección estuvo presente en 38/157 (24%) de los casos. La glomerulonefritis proliferativa difusa fue el tipo predominante asociado con la infección estreptocóccica (52.9%), mientras que Hepatitis B fue observada en el 83% de los casos de nefropatía membranosa. CONCLUSIÓN: La glomerulonefritis proliferativa mesangial es la histología que con mayor frecuencia se observa en los niños jamaicanos que padecen el síndrome nefrótico atípico. La mayoría de los casos de nefropatía membranosa guardan relación con la hepatitis B. La hipertensión con hipocomplementemia, la insuficiencia renal y la anemia son rasgos más bien de enfermedades renales más serias (p.ej, glomerulonefritis membranoproliferativa, nefritis crescéntica) que del síndrome nefrótico de cambios mínimos (SNCM) y debe asegurarse la consulta urgente con el nefrólogo para se realice una biopsia renal.

Renal biopsy findings in Jamaican children / Hallazgos en las biopsias renales en niños jamaicanos

OBJECTIVE: To document the histological findings in Jamaican children undergoing renal biopsy in order to determine the relative prevalence of varying types of glomerular disease in the island. METHODS: This study analyses retrospectively the renal histology in all Jamaican children less than age 12 years undergoing their first adequate renal biopsy between January 1985 and December 2008. Clinicopathological data were obtained solely from the histology reports from the University Hospital of the West Indies where all paediatric renal biopsies are processed. RESULTS: Of the 270 children, aged 1 month to 11 years (mean 7.58 years), 147 [58.1%] were males. The commonest indications for renal biopsy were nephrotic syndrome (57.4%) and glomerulonephritis (30%). Most biopsied children (260/270) had glomerular disease. The predominant glomerulonephritides were diffuse proliferative glomerulonephritis (DPGN) (27.7%) and mesangialproliferative glomerulonephritis (MesGN) (25.5%). Glomerular disease was idiopathic in 136/260 (53%) but was infection-associated in 32.3% (84 cases) of which Poststreptococcal glomerulonephritis (PSGN) was the commonest (75%) -predominantly DPGN (74.6%). Hepatitis B followed at 15.5% (13/84) manifested as membranous nephropathy in 83.3% (10/12). In patients with SS disease, DPGN was the commonest histology (47.4%). Systemic lupus erythematosus accounted for 5% ofall renal biopsies. Over time, PSGNoccurred less frequently, with a parallel reduction in DPGN and MesGN. CONCLUSION: In Jamaican children, DPGN is the commonest nephritis. Membranous nephropathy is primarily due to Hepatitis B. The commonest histology in SS disease is DPGN. The role ofinfection in the pathogenesis ofrenal disease in Jamaican children is probably underestimated.

OBJETIVO: Documentar los hallazgos histológicos en niños jamaicanos a los que se les ha realizado biopsias renales para determinar la prevalencia relativa de los diversos tipos de enfermedad glomerular en la isla. MÉTODOS: Este estudio analiza retrospectivamente la histología renal en todos los niños jamaicanos menores de 12 años sometidos a su primera biopsia renal adecuada entre enero de 1985 y diciembre de 2008. Los datos clinicopatológicos fueron obtenidos exclusivamente de los reportes de histología del Hospital Universitario de West Indies, dónde se procesan todas las biopsias renales. RESULTADOS: De 270 niños, cuyas edades fluctuaban de 1 mes a 11 años (media 7.58 años), 147 [58.1%] eran varones. Las indicaciones más comunes para la biopsia renal fueron el síndrome nefrótico (57.4%) y la glomerulonefritis (30%). La mayoría de los niños sometidos a biopsia (260/270) tenían la enfermedad del glomerular. Las glomerulonefritis predominantes fueron la glomerulonefritis proliferativa difusa (GNPD) (27.7%) y glomerulonefritis proliferativa mesangial (GNMes) (25.5%). La enfermedad glomerular fue idiomática en 136/260 (53%) pero estuvo asociada con infecciones en 32.3% (84 casos) en los cuales la glomerulonefritis poststreptocóccica (GNPS) fue la más común (75%) - predominantemente GNDP (74.6%). La hepatitis B siguió con 15.5% (13/84), manifestada como nefropatía membranosa en 83.3% (10/12). En los pacientes con la enfermedad de la hemoglobina SS, la GNDP fue la histología más común (47.4%). El lupus eritematoso sistémico representó el 5% de todas las biopsias renales. Al pasar el tiempo, la GNPS ocurrió menos frecuentemente, con una reducción paralela en GNPD y GNMes. CONCLUSIÓN: En los niños jamaicanos, la GNPD es la nefritis más común. La nefropatía membranosa se debe principalmente a la Hepatitis B. La histología más común en el caso de la enfermedad de hemoglobina SS es la GNPD. Probablemente se subestima el papel que las infecciones desempeñan en la patogénesis de la enfermedad renal en los niños jamaicanos.

Renal manifestations in HIV-infected Jamaican children / Manifestaciones renales en niños jamaicanos infectados por el VIH

BACKGROUND: Documentation regarding the renal complications of paediatric HIV infection from developing countries is scarce. In the era prior to highly active antiretroviral therapy (HAART), HIV-infected children in Jamaica who developed HIV-associated nephropathy (HIVAN) progressed to end stage renal disease (ESRD) and death within a few months of diagnosis. With increased public access to antiretroviral therapy since 2002 and subsequent survival, renal complications are increasingly recognized among the surviving cohort of infected children. METHODS: A cohort of 196 HIV-infected children was followed in four multicentre ambulatory clinics from September 1, 2002 to August 31, 2005 as part of the Kingston Paediatric and Perinatal HIV/AIDS Programme, Jamaica. We describe the clinical presentations and natural history of those patients who developed renal complications. RESULTS: Urinary tract infections were the most common diagnosis, occurring in 16.8% of patients, with a high recurrence rate and the most common organism was Escherichia coli. Four of seven patients who started indinavir developed complications of nephrolithiasis and tubulointerstitial nephropathy. Six patients (3%) fulfilled the criteria for HIVAN, five of whom were male. Median age at diagnosis was five years; all presented with advanced HIV disease, nephrotic syndrome or nephrotic range proteinuria and three with chronic renal failure. Patients received standard medical management and were initiated on angiotensin-converting enzyme (ACE) inhibitors and HAART. While the mortality ratio was 50%, only one death was associated with HIVAN and the median survival time was 3.1 years. CONCLUSIONS: HIV-infected children present with a variety of renal complications. With improved survival since the introduction of HAART, the incidence of HIVAN is expected to increase among this maturing paediatric cohort. Early detection and treatment will optimize the outcomes for these children.

ANTECEDENTES: La documentación en relación con las complicaciones renales de la infección pediátrica por VIH en países en vías de desarrollo, es escasa. En la era de la terapia antiretroviral pre-altamente activa (TARAA), los niños infectados por VIH en Jamaica que desarrollaron nefropatía asociada con VIH evolucionaron hacia la enfermedad renal en fase terminal (ERFT) y la muerte dentro de pocos meses de hecho el diagnóstico. Con el aumento del acceso público a la terapia antiretroviral a partir de 2002 y la subsiguiente supervivencia, cada vez más las complicaciones renales se observan entre la cohorte sobreviviente de niños infectados. MÉTODOS: A una cohorte de 196 niños infectados con VIH, se le practicó un seguimiento en cuatro clínicas ambulatorios multicentros, desde septiembre 1 de 2002 hasta agosto 31 de 2005, como parte del Programa VIH/SIDA Prenatal y Pediátrico de Kingston, Jamaica. El trabajo describe las presentaciones clínicas y la historia natural de los pacientes que desarrollaron complicaciones renales. RESULTADOS: Las infecciones de las vías urinarias fueron el diagnóstico más común en 16.8% de los pacientes, acompañadas de una alta tasa de recurrencia, y el organismo más común fue el Escherichia coli. Cuatro de siete pacientes que comenzaron tratamiento con indinair, desarrollaron complicaciones de nefrolitiasis y nefropatía tubulointersticial. Seis pacientes (3%), cinco de ellos varones, satisfacían los criterios de NAVIH. La edad promedio al momento del diagnóstico fue de cinco años. Todos representaron con la enfermedad de VIH avanzada, síndrome nefrótico o proteniuria de rango nefrótico, y tres con fallo renal crónico. Los pacientes recibieron tratamiento médico estándar y se iniciaron en el uso de inhibidores de enzimas convertidoras de angiotensina (IECAs) y el TARAA. Si bien la proporción de la mortalidad fue 50%, sólo una muerte estuvo asociada con NAVIH y el tiempo medio de supervivencia fue 3.1 años. CONCLUSIONES: Los niños infectados con VIH se presentaron con una variedad de complicaciones renales. Con el mejoramiento de la supervivencia a partir de la introducción del TARAA, se espera que la incidencia de NAVIH aumente entre la cohorte pediátrica en maduración. La detección precoz y el tratamiento temprano optimizarán los resultados obtenidos con estos niños.

Sedación en la endoscopia digestiva / Sedation for digestive endoscopy

Los espectaculares avances de la exploración endoscópica han requerido la necesidad de implementar distintas técnicas de sedación que se adecuen a los procedimientos diagnósticos y terapéuticos de esta área. Tanto las condiciones propias de la técnica a emplear, como las de cada paciente, juegan un rol determinante a la hora de seleccionar la aproximación ideal para cada caso, considerando además que una adecuada tolerancia tiene directa relación con la efectividad de éstos. Entre las alternativas se encuentran la exploración sin anestesia, el uso de una sedación conciente, sedación profunda y en algunos casos la anestesia general. El objetivo de este artículo es revisar y analizar las diferentes opciones disponibles para el desarrollo de exploraciones endoscópicas.

Intra-Abdominal Hypertension and the Abdominal Compartment Syndrome

The phenomenon of intra-abdominal hypertension (IAH) and its progression to abdominal compartment syndrome (ACS) is a common and frequently under-recognised condition in critically ill patients. IAH is defined as an intra-abdominal pressure (IAP) greater than 12 mmHg. The ACS occurs once IAH is associated with organ dysfunction. Early detection is the cornerstone of management in the critically ill patient and the regular measurement of IAP in patients at risk for developing raised IAP is encouraged. The intravesical technique of measurement is relatively non-invasive and provides excellent correlation with direct measurement of IAP. The consequences of ACS are multi-systemic; resulting in organ dysfunction. The respiratory; cardiovascular; renal and gastrointestinal systems are particularly affected. The vicious cycle of organ dysfunction may be perpetuated by excessive fluid resuscitation. Early intervention is essential to prevent complications; which carry significant morbidity and; if untreated; possible mortality. Definitive management of this condition is the prompt surgical decompression of the abdomen followed by temporary abdominal closure

Morphology offers no clues to asexual vs. sexual origin of small Acropora cervicornis (Scleractinia: Acroporidae) colonies / La morfología no ofrece pistas sobre el origen asexual o sexual de las colonias pequeñas de Acropora cervicornis (Scleractinia: Acroporidae)

Sexual recruitment of the staghorn coral, Acropora cervicornis, is accepted to be very rare. Instead, these branching corals proliferate through fragmentation leading to dense mono-specific and possibly monoclonal stands. For acroporid corals, which have suffered drastic population declines, dominance of asexual reproduction results in low levels of genotypic diversity and limited ability to re-colonize extirpated areas. Small colonies with a single encrusting, symmetrical base, and few incipient branches are frequently presumed to be the result of a settled planula (i.e. sexual reproduction). Here, we show that colonies fitting this description (i.e., presumed sexual recruits) can result from asexual fragmentation. Acropora cervicornis colonies (~20 cm diameter) were tagged and observed over eighteen months. In several cases, colony offshoots fused with the adjacent substrate forming secondary disc-like attachment points. Following natural fragmentation, these discs of tissue became separated from the original colony, and were observed to heal and give rise to smaller colonies with striking similarity to the expected morphology of a sexual recruit. Thus, presuming a colony is a sexual recruit based on appearance is unreliable and may lead to inflated expectations of genetic diversity among populations. The accurate assessment of recruitment and genetic diversity is crucial to predicting the recovery potential of these imperiled and ecologically irreplaceable reef corals. Rev. Biol. Trop. 54 (Suppl. 3): 145-151. Epub 2007 Jan. 15.

Se ha aceptado que el reclutamiento sexual del coral asta de venado, Acropora cervicornis, es muy raro. Por el contrario, estos corales ramificados proliferan a través de fragmentación, generando densas bases monoespecíficas e incluso monoclonales. Para corales acropóridos, los cuales han sufrido disminuciones de población drásticas, la dominancia de reproducción asexual resulta en bajos niveles de diversidad genotípica y abilidad limitada para recolonizar áreas de donde han sido erradicados. Frecuentemente se presume que las colonias pequeñas con una sola base incrustante simétrica y unas pocas ramas incipientes, son el resultado del asentamiento de una plánula (reproducción sexual). Aquí, nosotros demostramos que algunas colonias que calzan con esta descripción (supuesta reproducción sexual) pueden resultar de fragmentación asexual. Se etiquetaron y observaron colonias de Acropora cervicornis (~20 cm de diámetro) durante 18 meses. En muchos casos, los retoños de la colonia se fusionaron con el sustrato adyacente formando puntos de acoplamiento con forma de disco. Siguiendo con la fragmentación natural, estos discos de tejido se separaron de la colonia original, cicatrizaron y dieron paso a pequeñas colonias con tremenda similitud a la morfología esperada para un recluta sexual. Por lo tanto, asumir que una colonia es un recluta de origen sexual basándose en apariencia es poco fiable y puede generar expectativas infladas de diversidad genética entre poblaciones. La evaluación certera del reclutamiento y la diversidad genética es crucial para predecir la recuperación potencial de estos arrecifes de coral, los cuales están en peligro y son irremplazables.

Manejo anestésico en enfermedad de Charcot-Marie-Tooth: a propósito de un caso / Anesthetic management in Charcot-Marie-Tooth disease: report of a case

La enfermedad de Charcot-Marie-Tooth(CMT) es una neuropatía periférica hereditaria que resulta en atrofia muscular y pérdida de la propiocepción en las áreas afectadas. Existe controversia en cuanto a la técnica anestésica ideal a utilizarse en esta enfermedad. La situación basal de los pacientes, la urgencia quirúrgica y los riesgos asociados con las diferentes técnicas anestésicas deben ser tomados en consideración al momento de decidir la técnica a utilizar. Esta descripción de un caso clínico y posterior revisión bibliográfica tiene por objetivo orientar al anestesiólogo en el manejo de la paciente embarazada portadora de la enfermedad de CMT.

Chronic renal failure in Jamaican children

In order to document the incidence, aetiology and outcome of chronic renal failure in Jamaican children, paediatric surgeons and hospital based paediatricians island-wide were contacted, and the nephrology records at the island's paediatric nephrology centres searched for data on children < 12-year-old with chronic renal failure diagnosed for the first time between January 1985 and December 2000. Thirty-four children were identified, 21 were male. The cumulative annual incidence of chronic renal failure was 3.2 per million children aged < 12 years. The incidence is likely underestimated, as some children may have been undiagnosed and/or not referred. Glomerulonephritis was the commonest cause of chronic renal failure (50) followed by obstructive uropathy, reflux nephropathy, renal dysplasia and chronic pyelonephritis (41.2). Five children (14.7) had reflux nephropathy (post obstructive in four). Half the children were already in chronic renal failure at time of presentation. Mortality was 65. In Jamaica, childhood chronic renal failure is due mainly to potentially treatable diseases. Local physicians should be more aware of potentially progressive renal diseases and their prevention. Earlier referral of difficult cases for nephrological consultation is recommended. A paediatric dialysis/transplant programme is needed

Antimicrobial sensitivity of Haemophilus influenzae isolates from bacterial conjunctivitis

Haemophilus influenzae is one of the common bacterial pathogens which affect children. Resistance to frequently used antibiotics is becoming a significant problem in community isolates of common pathogens. A retrospective review was conducted of the serotypes and antimicrobial sensitivity of H influenzae isolates from bacterial conjunctivitis, over an 18-month period. Data on antimicrobial sensitivity (obtained by the National Committee for Clinical Laboratory Standards disk diffusion method) and beta-lactamase production, and typing results, were analysed. Ninety-nine isolates were recovered, of which 87 were typed. Most isolates were recovered from children under one year of age. Ninety-three percent were unencapsulated and biotypes I and IV were most common. H influenzae type b was recovered only twice. beta-lactamase was produced by 41 isolates while four isolates were ampicillin-resistant but did not produce beta-lactamase. All isolates were sensitive to chloramphenicol and 45 were co-trimoxazole sensitive. H influenzae is commonly isolated from bacterial conjunctivitis in Barbados and, as elsewhere, the majority of isolates are from small children and are non-encapsulated. However, there is a high prevalence of beta-lactamase production, which may serve as a reservoir for transfer to more invasive encapsulated strains of H influenzae within the oropharyngeal flora.

Routine hepatitis B immunisation in India: cost-effectiveness assessment.

Based on World Bank guidelines, hepatitis B immunization would be an excellent public health investment, saving each life year for well below the per-capita gross domestic product. This would be one of the most cost-effective investments India could make in the field of health.

A cellular approach to the study of complex natural behavior patterns in the ragged sea hare (Bursatella leachii), a marine invertebrate indigenous to Puerto Rico

The ragged sea hare (Bursatella leachii), an aplysiid mollusc indigenous to the tropical waters of Puerto Rico, possesses numerous properties that make it suitable for a neuroethological approach to the study of complex behavior patterns. Field studies spanning three years have established a location and season of Bursatella availability on the north coast of the island. In the natural habitat, the Bursatella exhibit a daily rhythm of behavior patterns in which feeding-related activities predominate during the day and reproductive behaviors predominate at night. Some aspects of this natural pattern persist in animals held in the laboratory. The Bursatella nervous system contains large neurons, some of which appear to be homologous to cells that have been characterized extensively in related species. Following isolation of the nervous system, neural centers associated with feeding movements and locomotion retain extraordinarily robust rhythm generating capabilities. It is proposed that this species offers unique opportunities for deriving general principles governing the regulation and integration of central pattern generator circuits underlying complex natural behavior patterns

Systemic lupus erythematosus.

Systemic Lupus Erythematosus (SLE) of childhood is a complex and challenging disease which can occur at any age. Identification of disease early in it's course and aggressive, appropriate management leads to improved outcome for an individual child. The history of SLE indicates how much progress has been made in the last quarter century. A discussion of the etiopathogenesis of SLE demonstrates the complexity of the syndrome. This is followed by a description of clinical manifestations, including diagnostic criteria, differential diagnosis and suggested methods for eliciting important symptoms to make the diagnosis. Evaluation of specific organs is next reviewed highlighting critical organ manifestations that are significant for future prognosis. Treatment of SLE includes a variety of medications, including non-steroidal anti-inflammatory medications, steroids and immuno-suppressive drugs. Attention to physical activity, stress and nutrition is equally important. Signs and symptoms that indicate disease flare or infection are described. Lastly, related syndromes are reviewed.

Tumores abdominopelvianos retroperitoneales, error diagnostico en ginecologia. Aporte de dos observaciones. / Retroperitoneal pelvic abdominal tumors, diagnostic error in gynecology.Contribution to 2 observations

Se realiza una revision del espacio retroperitoneal y de su patologia. Los autores consideran dos casos de pacientes portadoras de patologia organica retroperitoneal que requirieron tratamiento quirurgico. Se pone enfasis en la importancia de un diagnostico preoperatorio acertado, el que no siempre es sencillo. Los tumores retroperitoneales deben ser incluidos en el diagnostico diferencial de cualquier masa abdominal. El tratamiento quirurgico es de eleccion para todos los tumores, exceptuando los linfomas que son radiosensibles