Neonatal hypotension survey: a South African perspective

Background. Neonatal hypotension remains one of the most controversial topics in neonatology. Various definitions are used but lack an evidence base. Owing to the variation in defining a low blood pressure (BP), significant differences in pharmacological manipulation of BP are evident. Objectives. The aim of the present research was to determine (1) the diagnostic criteria for neonatal hypotension and (2) management strategies for neonatal hypotension in South Africa. Methods. A 29-point questionnaire was designed to determine the criteria used by South African neonatologists and paediatricians to diagnose and manage neonatal hypotension. The survey was conducted at two different time points in 2017. Results. The combination of the two surveys resulted in a 9.3% (47/507) response rate. A BP below the gestational age (in weeks) was the most common definition used for neonatal hypotension (75%). Most clinicians (86%) administered fluid prior to initiating inotrope therapy. Dopamine, dobutamine and adrenaline were the most common first-, second- and third-line anti-hypotensive drugs used. Most clinicians (77%) did not use a hypotension management guideline. Conclusion. Neonatal hypotension definition and management in South Africa are similar to international patterns, despite a lack of evidence to support the diagnosis and management strategies

Uso de las tecnologías de información y comunicación para el cuidado del binomio materno-fetal: revisión de tema / Use of information and communications technology to care for the maternal-fetal binomial: Topic review / Uso das tecnologias de informação e comunicação para o cuidado do binômio materno-fetal: revisão do assunto

La existencia de foros clínicos y redes sociales de pacientes que intercambian información sobre su enfermedad y tratamiento, sitios web con información especializada en patologías y en lenguaje accesible al público en general, entre otros cambios, han modificado la asimetría de información que hace que la gente consulte los servicios de salud. Si se tienen en cuenta estas nuevas posibilidades virtuales, la escasez del personal de salud y los demás factores contemplados, la telesalud tiene todas las posibilidades en el futuro inmediato. El propósito de esta revisión es identificar el uso de la telesalud como estrategia para superar barreras de acceso, disponibilidad y oportunidad de servicio para el binomio materno fetal. Para establecer conceptos se retoman definiciones de informática biomédica, e-salud, telesalud, telemedicina y teleeducación. Es preciso evaluar los modelos de telesalud para el cuidado del binomio materno fetal con el fin de identificar las lecciones aprendidas y factores de éxito necesarios para nuevas implementaciones de modelos. Dentro de las tecnologías aplicadas se encuentran medios masivos de comunicación, teléfono convencional, celular, mensajes de texto, internet, videoconferencias, correo electrónico, ultrasonido y ecocardiografía fetal. Después de evaluar las experiencias se encuentran ventajas como: adherencia a tratamientos, aumento de la cobertura y en la capacidad de detección temprana de acontecimientos, entre otras. Dentro de las desventajas: problemática de cobertura de internet y de señal de celular, y resistencia al uso de tecnologías de información y comunicación (TIC). En cuanto a los aspectos económicos, no hay pruebas concluyentes de que la telemedicina y la teleasistencia son rentables en comparación con la atención tradicional de la salud. Sin embargo, la evidencia sugiere que la telesalud en el hogar tiene el potencial de reducir costos, pero su impacto, desde una perspectiva social, es incierto mientras no se disponga de estudios de mayor calidad. El uso de las tecnologías de telemedicina a través del tiempo (monitoreo remoto fetal, ultrasonido, y teleconsultas) ha dado lugar a una marcada reducción en la mortalidad perinatal en comparación con un grupo equivalente de pacientes obstétricas con estrategias tradicionales.

The existence of clinical forums, social networks where patients exchange information about their disease and treatment, web sites specializing in diseases and accessible to the general public language, among many other changes have modified, at least in part, information asymmetry that makes people visit health services. Taking into account these new virtual possibilities, the shortage of health personnel, and other factors referred to, telehealth has every chance in the near future. The purpose of this review is to identify the use of telehealth as a strategy to overcome some of the barriers to access, availability, and timeliness of service for the maternal-fetal binomial. To establish concepts, definitions are taken from biomedical informatics, e-health, telehealth, telemedicine, and tele-education. It is important to evaluate the different models of telehealth care of the maternal-fetal binomial in order to identify lessons learned and success factors necessary for new implementations of models. The technologies applied include mass media, conventional phone, cell phone, text messaging, internet, video conferencing, e-mail, ultrasound, and fetal echocardiography. After evaluating the experiences, advantages included adherence to treatment, increased coverage, and increased capacity for early detection of events, among others. The disadvantages identified involved problems with internet coverage and poor cell phone signal, and resistance to the use of Information and Communications Technology (ICT). With regard to costs, there is no conclusive evidence that telemedicine interventions and telecare are cost-effective compared to traditional health care. However, current evidence suggests that home telehealth has the potential to reduce costs, but its impact from a social perspective remains uncertain pending the availability of higher quality studies. The general use of telemedicine technologies over time (remote fetal monitoring, ultrasound, and teleconsultation) has resulted in a marked reduction in perinatal mortality when compared to an equivalent group of obstetric patients receiving traditional treatment.

A existência de foros clínicos e redes sociais de pacientes que intercambiam informação sobre sua doença e tratamento, páginas web com informação especializada em patologias e em linguagem acessível ao público em geral, entre outras mudanças, hão modificado a assimetria de informação que faz que as pessoas consulte os serviços de saúde. Se se tem em conta estas novas possibilidades virtuais, a escassez de pessoal de saúde e os demais fatores contemplados, a tele-saúde têm todas as possibilidades no futuro imediato. O propósito desta revisão é identificar o uso da tele-saúde como estratégia para superar barreiras de acesso, disponibilidade e oportunidade de serviço para o binômio materno fetal. Para estabelecer conceitos se retomam definições de informática biomédica, e-saúde, tele-saúde, tele-medicina tele-educação. É necessário avaliar os modelos de tele-saúde para o cuidado do binômio materno fetal com o fim de identificar as lições aprendidas e fatores de sucesso necessários para novas implementações de modelos. Dentro das tecnologias aplicadas se encontram meios massivos de comunicação, telefone convencional, celular, mensagens de texto, internet, videoconferências, correio electrônico, ultrassom e ecocardiografia fetal. Depois de avaliar as experiências se encontra vantagens como: aderência a tratamentos, aumento da cobertura e na capacidade de detecção precoce de acontecimentos, entre outras. Dentro das desvantagens: problemática de cobertura de internet e de sinal de celular, e resistência ao uso de tecnologias de informação e comunicação (TIC). Enquanto aos aspectos económicos, não há provas concluintes de que a tele-medicina e a teleassistência são rentáveis em comparação com a atenção tradicional da saúde. Mas, a evidência sugere que a tele-saúde no lar tem o potencial de reduzir custos, mas seu impacto, desde uma perspectiva social, é incerto enquanto não se disponha de estudos de maior qualidade. O uso das tecnologias de tele-medicina através do tempo (monitoração remoto fetal, ultrassom, e tele-consultas) há dado lugar a uma marcada redução na mortalidade perinatal em comparação com um grupo equivalente de pacientes obstétricas com estratégias tradicionais.

Iron Deficiency is an Ominous Predictor of Mortality in Elderly Patients with Stable Heart Failure: a Community Based Study.

Background: Iron deficiency (ID) has been shown to be linked with poor outcomes within heart failure (HF) populations in previous clinical trials. The impact of ID has not been evaluated in stable chronic heart failure (HF) patients in the community. Our objective was to study the role of ID in stable HF patients and its impact on short term survival. Methods: In this study we analysed 512 patients with stable HF under the care of a regional nurse-led community heart failure team. The study started in June 2007 and ended in June 2010. Results: There were 92% of patients on loop diuretics; 83% on ACE Inhibitors, 92% on b- blockers and 48% on aldosterone antagonists. Mean age of the patients was 77.9 years, 43% were females and mean NYHA class was 2.2. Absolute Iron deficiency (ID) and anemia were defined as ferritin <100μg/L and hemoglobin (Hb)<12g/dl, respectively. Mean Hb levels were 14.1; 13.9; 14.0 and 13.7g/dL at 0, 6, 12 and 24 months. Mean serum ferritin levels in the entire study population were 212μg/L at the start, and 197μg/L at the end. The prevalence of ID and anemia was 21.3% and 9.4%at the start, and was 21.5% and 8.4% at the end of the study. The prevalence of ID was 63%vs. 19% in subjects with vs. without anemia [p<0.001]. Risk-adjusted hazard ratios for 24-month mortality were 1.42 (95% confidence interval: 1.09-1.98) for ID and 1.05 (95% confidence interval; 0.87-1.51) for anemic patients respectively. Conclusions: In our study, ID was prevalent in stable HF patients in the community and was linked with poor clinical outcomes. In addition, ID was a predictor for mortality than additionally to anemia.

Leukocyte, Haemostatic and Inflammatory Biomarkers are Activated in Patients with Cardiovascular Disease (CVD): A Pilot Study.

Background: Cardiovascular disease (CVD) provides a huge economic strain worldwide and is responsible for over 4 million deaths in Europe annually. Atherosclerosis, a key component of CVD, is recognised as an inflammatory process. This clinical pilot-study aimed to compare a range of selective leukocyte, haemostatic and inflammatory biomarkers in patients with CVD to healthy volunteers. Original Research Article British Journal of Medicine & Medical Research, 4(26): 4392-4406, 2014 4393 Patients and Methods: Fifty participants were recruited, 21 patients with CVD (due to atherosclerosis) and 29 healthy volunteers (with no history of CVD or diabetes). All participants for the study provided a non-fasting venous blood sample prior to analysis (n=50). The biomarkers measured included the Cluster of Differentiation 11b (CD11b) cell surface expression in monocytes and neutrophils, neutrophil elastase, fibrinogen, von Willebrand Factor (vWF), protein C and C-Reactive Protein (CRP). Results: vWF levels were significantly raised in CVD patients (186.8±106.6 %vWF:Ag) compared to healthy volunteers (109.9±85.2 %vWF:Ag), (p<0.001). CRP was significantly raised (3mg/dL) in CVD patients compared to healthy volunteers (<3mg/dL), (p=0.036), with the CD11b cell surface expression in monocytes being higher (0.64±0.55 MFI) in CVD patients compared to healthy volunteers (0.37±0.44 MFI), (p<0.005). No differences were observed for protein C, fibrinogen, neutrophil elastase or neutrophil CD11b in CVD patients compared to healthy volunteers (p>0.05). Discussion and Conclusion: Patients with CVD have elevated levels of vWF, CRP and CD11b cell surface expression (monocytes) compared to healthy volunteers. The results of this study support the premise of leukocyte, haemostatic and inflammatory involvement during CVD, and that measuring biomarkers such as vWF and leukocyte CD11b cell surface expression, may aid in the diagnosis and monitoring of patients with CVD. However, further large-scale prospective studies are required to fully understand the relationship between these markers and CVD.

A model to integrate pathology teaching using technology.

Purpose: Use of technology to integrate pathology teaching in the third year of medical training. The teaching of pathology and disease includes several sections that have been taught by separate departments of immunology, haematology, microbiology, histopathology and biochemistry. It has been noted that students are not able to integrate the teaching from all these departments. To address this problem we have developed a model to integrate the teaching of the different sections by providing additional cases and materials in the computer laboratory. Methods: The eight week course of general pathology has been chosen for this model as it is the first section of pathology and the availability of teaching materials in the server of the computer. Three practical sessions are given to each section, histopathology, microbiology, haematology, immunology and clinical chemistry. Additional information was made available to students in the new thin client computer laboratory. A questionnaire was administered at the end of the course to half of the students. The responses which targeted in three areas, content, relevance, and acceptance and analyzed. Results: The eight week course was received enthusiastically by the students. The data indicated that the students generally accepted a computer-based instruction in teaching pathology. There was no improvement in performance of the class at the end of the term examinations as compared to the previous year. Conclusions: Computer-based instruction is possible in low resource countries. Use of technology can address challenges relating to integration of teaching .This model could serve as a nucleus for more extensive restructuring of teaching in the entire Medical School as well in other Medical Schools in Kenya and the rest of Africa.

First record of Anopheles albimanus from St Kitts / Primer registro de Anopheles albimanus de Saint Kitts

ABSTRACT OBJECTIVE: Previous mosquito surveys performed in the Federation of St Kitts and Nevis identified Anopheles albimanus in Nevis but there is no recorded occurrence of this mosquito in St Kitts. To determine the presence of this and other species in St Kitts and Nevis, a mosquito survey was conducted. METHODS: Surveys were performed in two phases - the dry season (March 16-23, 2010, in St Kitts), and the rainy season (October 18-25, 2010) in St Kitts and Nevis. BG SentinelTM mosquito traps baited with BG Lure® and CO2 were set in a variety of habitats (urban, rural, semi-urban, dry forest and mangrove). Identification was performed using morphological keys. RESULTS: The most abundant species during both phases were Culex quinquefasciatus, Aedes taeniorhynchus and Aedes aegypti. A new record for St Kitts was Anopheles albimanus which was trapped during the rainy season near a mangrove site. CONCLUSION: This is the first time a potential malaria vector has been identified in St Kitts.

OBJETIVO: Las encuestas previas sobre mosquitos realizadas en la Federación de Saint Kitts y Nevis identificaron al Anopheles albimanus en Nevis, pero no hay registro de este mosquito en Saint Kitts. El objetivo de esta investigación fue determinar la presencia de esta u otra especie de mosquito en Saint Kitts. MÉTODOS: Se realizaron encuestas en dos fases - la estación seca (16-23 de marzo de 2010, en Saint Kitts), y la estación lluviosa (18-25 de octubre de 2010) en Saint Kitts y Nevis. Trampas BG SentinelTM para mosquitos preparadas con BG Lure® y CO2 se colocaron en diversos habitats (urbano, rural, semi-urbano, bosque seco y manglar). La identificación fue realizada usando claves morfológicas. RESULTADOS: Las especies más abundantes durante ambas fases fueron Culex quinquefasciatus, Aedes taeniorhynchus y Aedes aegypti. Un nuevo registro para Saint Kitts fue Anopheles albimanus, atrapado durante la estación de lluvias cerca de un manglar. CONCLUSIÓN: Esta es la primera vez que se identifica un vector potencial de la malaria en Saint Kitts.

Predictors of Survival in Infants with Congenital Diaphragmatic Hernia - Systemic Oxygenation Status Versus Dynamic Compliance of the Respiratory System

Objective. To compare whether early measurement of blood gases and/or dynamic compliance of the respiratory system (CRSdyn) predicts outcome in high-risk infants with unilateral congenital diaphragmatic hernia (CDH). Patients and methods. A retrospective study was performed at Tygerberg Children's Hospital between January 1992 and August 2001. High-risk infants with unilateral CDH; who presented with respiratory distress within 6 hours of birth; were included. Patients with other lethal congenital abnormalities were excluded. The first arterial blood gas value after endotracheal intubation was documented and the arterial-alveolar oxygen tension (a:A) ratio was calculated. CRSdyn was measured within 24 hours of birth. The ability of these measurements to predict outcome (survival or death during the newborn period) was determined. Results. Seventeen of 40 infants with CDH were categorised as high risk and included in the study. Eight of them (47) survived the neonatal period. The best single predictors of outcome were; in order; partial pressure of oxygen in arterial blood (PaO2); a:A ratio and dynamic compliance of the respiratory system standardised for body weight (CRSdyn/kg). The specificity and sensitivity at a PaO2 cut-off of 19.3 kPa were 7/8 (95confidence interval (CI): 0.473 - 0.997) and 9/9 (95CI: 0.634 - 1.000) respectively. Results for a:A ratio were cut-off 0.321; specificity 6/8 (95CI: 0.349 - 0.968); and sensitivity 9/9 (95CI: 0.634 - 1.000). Results for CRSdyn/kg were cut-off 0.259; specificity 6/8 (95CI: 0.349 - 0.968); and sensitivity 9/9 (95CI: 0.634 - 1.000). A linear discriminant function based on the 3 best single predictors was found to be no more effective than the first PaO2. Conclusions. Early oxygenation status predicts outcome better than the CRSdyn/kg in infants with unilateral CDH. However; both measurements predict outcome with high accuracy

The Potential Impact of Male Circumcision on HIV in Sub-Saharan Africa

Background: A randomized controlled trial (RCT) has shown that male circumcision (MC) reduces sexual transmission of HIV from women to men by 60(32?76; 95CI) offering an intervention of proven efficacy for reducing the sexual spread of HIV. We explore the implications of this finding for the promotion of MC as a public health intervention to control HIV in sub-Saharan Africa. Methods and Findings :Using dynamical simulation models we consider the impact of MC on the relative prevalence of HIV in men and women and in circumcised and uncircumcised men. Using country level data on HIV prevalence and MC; we estimate the impact of increasing MC coverage on HIV incidence; HIV prevalence; and HIV-related deaths over the next ten; twenty; and thirty years in sub-Saharan Africa. Assuming that full coverage of MC is achieved over the next ten years; we consider three scenarios in which the reduction in transmission is given by the best estimate and the upper and lower 95confidence limits of the reduction in transmission observed in the RCT. MC could avert 2.0 (1.1?3.8) million new HIV infections and 0.3 (0.1?0.5) million deaths over the next ten years in sub-Saharan Africa. In the ten years after that; it could avert a further 3.7 (1.9?7.5) million new HIV infections and 2.7 (1.5?5.3) million deaths; with about one quarter of all the incident cases prevented and the deaths averted occurring in South Africa. We show that a) MC will increase the proportion of infected people who are women from about 52to 58; b) where there is homogenous mixing but not all men are circumcised; the prevalence of infection in circumcised men is likely to be about 80of that in uncircumcised men; c) MC is equivalent to an intervention; such as a vaccine or increased condom use; that reduces transmission in both directions by 37. Conclusions: This analysis is based on the result of just one RCT; but if the results of that trial are confirmed we suggest that MC could substantially reduce the burden of HIV in Africa; especially in southern Africa where the prevalence of MC is low and the prevalence of HIV is high. While the protective benefit to HIV-negative men will be immediate; the full impact of MC on HIV-related illness and death will only be apparent in ten to twenty years

A newly identified SOCS protein family: one of the mechanisms of metabolic changes during stress and malnutrition in vivo / 中国临床营养杂志

Suppressor of cytokine sigaling (SOCS) genes encode a family of protein recently identified as negative feedback inhibitors of signaling by eytokine receptors. We have previously shown that endotoxin markedly stimulates SOCS gene expression in rat liver, that correlates with observed resistance to growth hormone-signaling during endotoxemia. The objective of this study was to determine the expression of SOCS genes in state of fasting that have been shown to cause altered responses in pro-inflammatory cytokines and anzbolic hormones. Male Sprague-Dawley rats (～200g) were fasted for 1, 2 or 3 days, or refed for 3 days following a 3-day period of fasting. Liver and muscle mRNAs were determinedby Northern blotting using specific rat cDNA probes cloned in our laboratory. In liver, after a l-day lag period, there was a progressive 2-fold increase in SOCS-3 and 75% decrease in SOCS-2 mRNA afte 2 and 3 of fasting. Both SOCS mRNAs were normalized by 3 days of refeeding. There was no measurable changes in tyrosine phosphorylation of STAT1, STAT3, STAT5a or STAT5b, nor activation of MAP kinases including ERK 1/2, p38, and JUNK 1/2 in liver by 3 days of fasting. In muscle, there was a similar 75% decrease in SOCS-2 mRNA, but no change in SOCS-3 mRNA following 3 days of fasting. These data suggest that malnutrition regulates SOCS-2 and SOCS-3 in a different way, and this regulation is tissue specific. The changes of SOCS mRANs are independent of measurable phosphoryiation of multiple STATs and activation of MAP kinasea. The altered SOCS expressions during fasting may explain the changes of biological effects of multiple cytokines and anabolie hormones in malnutrition states.

Cout des traitements des urethrites masculines en milieu urbain au Cameroun en 1992

Une etude a ete menee dans les grands centres urbains du Cameroun pour essayer d'evaluer le cout des traitements prescrits dans les urethrites masculines. Il ressort d'abord de cette etude que l'utilisation des preservatifs est devenue monnaie courante au Cameroun. Ensuite; la standardisation du prix de ces traitements a permis de reduire nettement les depenses des malades. Cela a ete finalement un grand succes pour les autorites sanitaires du Cameroun

Comportement sexuel et rapports proteges en milieu urbain camerounais en 1992

Les auteurs rapportent les resultats de quatre enquetes menees en 1991 et 1992 dans la population generale masculine; les lieux de travail et ceux de detente nocturne des villes de Yaounde et de Douala. Cette population masculine; sexuellement tres active; est caracterisee par un partenariat sexuel multiple et un recours frequent aux prostituees. En moyenne 10 pour cent d'entre eux relatent un episode de maladies sexuellement transmissibles dans le semestre ecoule. La pratique des rapports proteges entre dans les moeurs car 62 a 79 pour cent des personnes interrogees ont deja utilise un preservatif mais moins de 10 pour cent en font un usage systematique

Isolation of Aeromonas spp. from canal water.

Aeromonas sobria was identified from soil and canal water at the East End of London. There was a correlation between water and faecal isolates from children attending the nearby Children's Hospital. In view of the potential risk of enteric and non-enteric infections due to Aeromonas spp, efforts are needed to ensure that canals, rivers, natural water sources and domestic water supply are free of these organisms.

The Second Rahima Dawood Memorial Lecture: Developments in surgical sepsis

The paper concentrates on prophylaxis; the newer antibiotics and the management of severe sepsis. The treatment of severe sepsis remains hazardous with high morbidity and mortality. The message that prevention is better than cure

tRNA rRNA sequence matches from inter- and intraspecies comparisons suggest common origins for the two RNAs

1. Comparisons were made of the results of searches within and among different species of organisms for sequence matches between transfer RNAs and ribosomal RNAs. The purpose was to determine whether the matching sequences might result form selection acting on the two RNAs within a common cellular environment. 2. The results indicate that most matches do not reflect such selection. The matches described we more frequent than those found in searches among randomized sequences and the frequency of intraspecific matches was not significantly higher than that of interspecific matches. 3. The matches ara thought to identify conserved vestiges of a molecule or molecules ancestral to both classes of RNAs (Bloch, D.P., McArthur, B. and Mirrop, S (1985), BioSystems, 17:209-225). The matching sequences are interpreted as homologies