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BACKGROUND: Improving maternal health has been a primary goal of international health agencies for many years, with the aim of reducing maternal and child deaths and improving access to antenatal care (ANC) services, particularly in low-and-middle-income countries (LMICs). Health interventions with these aims have received more attention from a clinical effectiveness perspective than for cost impact and economic efficiency. METHODS: We collected data on resource use and costs as part of a large, multi-country study assessing the use of routine antenatal screening ultrasound (US) with the aim of considering the implications for economic efficiency. We assessed typical antenatal outpatient and hospital-based (facility) care for pregnant women, in general, with selective complication-related data collection in women participating in a large maternal health registry and clinical trial in five LMICs. We estimated average costs from a facility/health system perspective for outpatient and inpatient services. We converted all country-level currency cost estimates to 2015 United States dollars (USD). We compared average costs across countries for ANC visits, deliveries, higher-risk pregnancies, and complications, and conducted sensitivity analyses. RESULTS: Our study included sites in five countries representing different regions. Overall, the relative cost of individual ANC and delivery-related healthcare use was consistent among countries, generally corresponding to country-specific income levels. ANC outpatient visit cost estimates per patient among countries ranged from 15 to 30 USD, based on average counts for visits with and without US. Estimates for antenatal screening US visits were more costly than non-US visits. Costs associated with higher-risk pregnancies were influenced by rates of hospital delivery by cesarean section (mean per person delivery cost estimate range: 25-65 USD). CONCLUSIONS: Despite substantial differences among countries in infrastructures and health system capacity, there were similarities in resource allocation, delivery location, and country-level challenges. Overall, there was no clear suggestion that adding antenatal screening US would result in either major cost savings or major cost increases. However, antenatal screening US would have higher training and maintenance costs. Given the lack of clinical effectiveness evidence and greater resource constraints of LMICs, it is unlikely that introducing antenatal screening US would be economically efficient in these settings--on the demand side (i.e., patients) or supply side (i.e., healthcare providers). TRIAL REGISTRATION: Trial number: NCT01990625 (First posted: November 21, 2013 on https://clinicaltrials.gov ).
Assuntos
Cesárea , Países em Desenvolvimento , Criança , Feminino , Humanos , Pobreza , Gravidez , Gestantes , Cuidado Pré-NatalRESUMO
Diamond possesses many extreme properties that make it an ideal material for fabricating nanofocusing x-ray optics. Refractive lenses made from diamond are able to focus x-ray radiation with high efficiency but without compromising the brilliance of the beam. Electron-beam lithography and deep reactive-ion etching of silicon substrates have been used in a transfer-molding technique to fabricate diamond optics with vertical and smooth sidewalls. Latest generation compound refractive lenses have seen an improvement in the quality and uniformity of the optical structures, resulting in an increase in their focusing ability. Synchrotron beamline tests of two recent lens arrays, corresponding to two different diamond morphologies, are described. Focal line-widths down to 210 nm, using a nanocrystalline diamond lens array and a beam energy of E = 11 keV, and 230 nm, using a microcrystalline diamond lens at E = 15 keV, have been measured using the Diamond Light Source Ltd. B16 beamline. This focusing prowess is combined with relatively high transmission through the lenses compared with silicon refractive designs and other diffractive optics.
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This descriptive, cross-sectional study of Sudanese medical schools aimed to describe and analyse the proportion of their curricula currently allocated for teaching of communicable diseases and to assess the teaching methods and student assessment tools. Qualitative and quantitative data were collected from heads of departments and students in 20 of the 27 medical faculties and from ministry of health staff at federal and state levels. Curriculum designs ranged from traditional to innovative, community-oriented programmes. Problems regarding student evaluations were identified. Major limitations included shortages of staff, reference materials and teaching aids. Poor knowledge of students about different aspects of diseases endemic in Sudan was found. Recommendations include curriculum development, staff recruitment and training, and improvement of teaching and training of students.
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Competência Clínica , Doenças Transmissíveis/epidemiologia , Educação Médica/normas , Doenças Endêmicas , Faculdades de Medicina , Doenças Transmissíveis/diagnóstico , Doenças Transmissíveis/terapia , Estudos Transversais , Currículo , Educação Médica/tendências , Avaliação Educacional/normas , Feminino , Humanos , Masculino , Aprendizagem Baseada em Problemas , Sudão/epidemiologia , Ensino/métodosRESUMO
': Kinnow' mandarin (Citrus nobilis L.× Citrus deliciosa T.) is an important marketable fruit of the world. It is mainstay of citrus industry in Pakistan, having great export potential. But out of total production of the country only 10% of the produce meets the international quality standard for export. Pre-harvest fruit drop and poor fruit quality could be associated with various issues including the plant nutrition. Most of the farmers do not pay attention to the supply of micro nutrients which are already deficient in the soil. Furthermore, their mobility within plants is also a question. Zinc (Zn) is amongst those micronutrients which affect the quality and postharvest life of the fruit and its deficiency in Pakistani soils is already reported by many researchers. Therefore, this study was carried out to evaluate the influence of pre-harvest applications of zinc sulfate (ZnSO4; 0, 0.4%, 0.6% or 0.8%) on pre-harvest fruit drop, yield and fruit quality of 'Kinnow' mandarin at harvest. The treatments were applied during the month of October i.e. 4 months prior to harvest. The applied Zn sprays had significant effect on yield and quality of the "Kinnow" fruit. Amongst different foliar applications of ZnSO4applied four months before harvest, 0.6% ZnSO4 significantly reduced pre-harvest fruit drop (10.08%) as compared to untreated control trees (46.45%). Similarly, the maximum number of fruits harvested per tree (627), fruit weight (192.9 g), juice percentage (42.2%), total soluble solids (9.5 °Brix), ascorbic acid content (35.5 mg 100 g-1) and sugar contents (17.4) were also found significantly higher with 0.6% ZnSO4 treatment as compared to rest of treatments and control. Foliar application of 0.6% ZnSO4 also significantly improved total antioxidants (TAO) and total phenolic contents (TPC) in fruit. In conclusion, foliar spray of ZnSO4 (0.6%) four months prior to harvest reduced pre-harvest fruit drop, increase yield with improved quality of 'Kinnow' mandarin fruit.
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Citrus , Frutas , Antioxidantes , Ácido Ascórbico , Sulfato de Zinco/farmacologiaRESUMO
Maize is considered one of the most imperative cereal crops worldwide. In this work, high throughput silica nanoparticles (SiO2-NPs) were prepared via the sol-gel technique. SiO2-NPs were attained in a powder form followed by full analysis using the advanced tools (UV-vis, HR-TEM, SEM, XRD and zeta potential). To this end, SiO2-NPs were applied as both nanofertilizer and pesticide against four common pests that infect the stored maize and cause severe damage to crops. As for nanofertilizers, the response of maize hybrid to mineral NPK, "Nitrogen (N), Phosphorus (P), and Potassium (K)" (0% = untreated, 50% of recommended dose and 100%), with different combinations of SiO2-NPs; (0, 2.5, 5, 10 g/kg soil) was evaluated. Afterward, post-harvest, grains were stored and fumigated with different concentrations of SiO2-NPs (0.0031, 0.0063. 0.25, 0.5, 1.0, 2.0, 2.5, 5, 10 g/kg) in order to identify LC50 and mortality % of four common insects, namely Sitophilus oryzae, Rhizopertha dominica, Tribolium castaneum, and Orizaephilus surinamenisis. The results revealed that, using the recommended dose of 100%, mineral NPK showed the greatest mean values of plant height, chlorophyll content, yield, its components, and protein (%). By feeding the soil with SiO2-NPs up to 10 g/kg, the best growth and yield enhancement of maize crop is noticed. Mineral NPK interacted with SiO2-NPs, whereas the application of mineral NPK at the rate of 50% with 10 g/kg SiO2-NPs, increased the highest mean values of agronomic characters. Therefore, SiO2-NPs can be applied as a growth promoter, and in the meantime, as strong unconventional pesticides for crops during storage, with a very small and safe dose.
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Two field experiments were conducted at the experimental farm of the Faculty of Agriculture (Saba Basha), Abess Region, Alexandria University, Egypt, over two harvest seasons (2016/2017 and 2017/2018) to study the effect of a nanoparticle fertilizer (Hyper Feed Amino NPs) compound on productivity and genotoxicity in two wheat cultivars compared with conventional mineral fertilizer. Total yield, its components, and yield components were measured. After harvest, grains of both cultivars were collected and germinated to produce root tip. Mitosis division and chromosomal aberrations were observed. Mitotic indexes (%) were obtained from an analysis of about 2000 cells. Root tips of control treatments showed normal mitotic stages, and the mitotic index ranged from 61.67⯱â¯8.40 to 68.49⯱â¯11.23%. Although fertilization with NPK NPs produced an increase in yield, and root-tip cells showed various types of chromosomal aberrations such as multinuclei, micronuclei, abnormal metaphase, stickiness, nucleus erosion, nucleus elongation, fragments, c-metaphase, chromosome deletion, c-chromosome, gab chromosome, lagging chromosome, distributed anaphase, bridge, abnormal telophase, telophase with unequal division, cell membrane damage, cell elongation, and increased nuclear content. The 100% NPK NPs treatment produced 35.79⯱â¯9.32% and 38.98⯱â¯4.22% abnormal cells in Sids 12 and Al-Rasheed, respectively. Our results demonstrate that wheat root tip cells readily internalize NPK NPs which can interfere with normal cell function.
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Dano ao DNA , Fertilizantes/toxicidade , Nanopartículas/toxicidade , Triticum/efeitos dos fármacos , Agricultura/métodos , Aberrações Cromossômicas/induzido quimicamente , Mitose/efeitos dos fármacos , Triticum/genéticaRESUMO
BACKGROUND: To investigate the relative effectiveness of mesh and suture repair of ventral abdominal hernias in terms of clinical outcome, quality of life and rate of recurrence in both the techniques. METHODS: This is a retrospective descriptive analysis of 236 patients with mesh and non-mesh repair of primary ventral hernias performed between January 2000 to December 2004 at Surgery Department, Liaquat University of Medical and Health Sciences, Jamshoro. The record sheets of the patients were analyzed and data retrieved to compare the results of both techniques for short-term and long-term results. The data retrieved is statistically analyzed on SPSS version 11. RESULTS: There were 43 (18.22%) males and 193 (81.77%) females with a mean age of 51.79 years and a range of 59 (81-22). Para-umbilical hernia was the commonest of ventral hernia and accounted for 49.8% (n=118) of the total study population followed by incisional hernia comprising 24% (n=57) of the total number. There was a significant difference in the recurrent rate at 3 years interval with 23/101 (22.77%) recurrences in suture-repaired subjects compared to 10/135 (7.40%) in mesh repair group. Chronic pain lasting up to 1-2 years was noted in 14 patients with suture repair. Wound infection is comparatively more common (8.14%) in mesh group. The other variables such as operative and postoperative complications, total hospital stay and quality of life is also discussed. CONCLUSION: Mesh repair of ventral hernia is much superior to non-mesh suture repair in terms of recurrence and overall outcome.
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Hérnia Ventral/cirurgia , Telas Cirúrgicas , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Hérnia Ventral/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Paquistão/epidemiologia , Complicações Pós-Operatórias/epidemiologia , Qualidade de Vida , Recidiva , Técnicas de Sutura , Resultado do TratamentoRESUMO
BACKGROUND: An overall increase in the incidence of paediatric cholelithiasis forms the basis of this study, which aims to investigate the overall changing clinical pattern of cholelithiasis. METHODS: This is a retrospective observational descriptive study including twenty three (23) patients with gallstones admitted and operated during June 2006-June 2008 in surgical department of a teaching hospital. All the patients with sonological evidence of gallstones, less than 10 years of age with history of acute or chronic abdominal symptoms are included in the study population. After admission all the subjects were investigated and finally operated by open approach (21 patients) during the same admission. The details of all the patients were recorded on a proforma and statistical analysis done on SPSS version 12. RESULTS: Of the total study population, there were 19 (82.6%) males and 4 (17.39%) females with a mean age of 7 years and a range of 4-10 years. Ultrasound revealed gallstones in all the patients with a varying proportion of the walls of gallbladder. The commonest presentation was abdominal pain in the right upper quadrant, which was vague, and of mild to moderate intensity. In 21 (91.30%) patients, no specific underlying cause was found while two patients (8.6%) had haematological disorder as underlying cause for the gallstones. CONCLUSION: This study indicates an alarming increase in the incidence of idiopathic gallstones in children less than 10 years of age with a distinct male predominance.
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Cálculos Biliares/diagnóstico , Criança , Pré-Escolar , Feminino , Cálculos Biliares/terapia , Hospitais de Ensino/estatística & dados numéricos , Humanos , Tempo de Internação , Masculino , Estudos Retrospectivos , Resultado do TratamentoRESUMO
'Kinnow' mandarin (Citrus nobilis L.× Citrus deliciosa T.) is an important marketable fruit of the world. It is mainstay of citrus industry in Pakistan, having great export potential. But out of total production of the country only 10% of the produce meets the international quality standard for export. Pre-harvest fruit drop and poor fruit quality could be associated with various issues including the plant nutrition. Most of the farmers do not pay attention to the supply of micro nutrients which are already deficient in the soil. Furthermore, their mobility within plants is also a question. Zinc (Zn) is amongst those micronutrients which affect the quality and postharvest life of the fruit and its deficiency in Pakistani soils is already reported by many researchers. Therefore, this study was carried out to evaluate the influence of pre-harvest applications of zinc sulfate (ZnSO4; 0, 0.4%, 0.6% or 0.8%) on pre-harvest fruit drop, yield and fruit quality of Kinnow mandarin at harvest. The treatments were applied during the month of October i.e. 4 months prior to harvest. The applied Zn sprays had significant effect on yield and quality of the "Kinnow" fruit. Amongst different foliar applications of ZnSO4applied four months before harvest, 0.6% ZnSO4 significantly reduced pre-harvest fruit drop (10.08%) as compared to untreated control trees (46.45%). Similarly, the maximum number of fruits harvested per tree (627), fruit weight (192.9 g), juice percentage (42.2%), total soluble solids (9.5 °Brix), ascorbic acid content (35.5 mg 100 g-¹) and sugar contents (17.4) were also found significantly higher with 0.6% ZnSO4 treatment as compared to rest of treatments and control. Foliar application of 0.6% ZnSO4 also significantly improved total antioxidants (TAO) and total phenolic contents (TPC) in fruit. In conclusion, foliar [...].
A tangerina 'Kinnow' (Citrus nobilis L. × Citrus deliciosa T.) é uma importante fruta comercializável do mundo. É o esteio da indústria cítrica no Paquistão, com grande potencial de exportação. Mas, da produção total do país, apenas 10% da produção atendem o padrão internacional de qualidade para exportação. A queda da fruta antes da colheita e a baixa qualidade da fruta podem estar associadas a vários problemas, incluindo a nutrição da planta. A maioria dos agricultores não se preocupa com o fornecimento de micronutrientes que já são deficientes no solo. Além disso, sua mobilidade dentro das plantas também é uma questão. O zinco (Zn) está entre os micronutrientes que afetam a qualidade e a vida pós-colheita da fruta, e sua deficiência em solos paquistaneses já é relatada por diversos pesquisadores. Portanto, este estudo foi realizado para avaliar a influência da aplicação pré-colheita de sulfato de zinco (ZnSO4; 0, 0,4%, 0,6% ou 0,8%) na queda dos frutos na pré-colheita, produtividade e qualidade dos frutos da tangerina 'Kinnow' em colheita. Os tratamentos foram aplicados durante o mês de outubro, ou seja, 4 meses antes da colheita. As pulverizações de Zn aplicadas tiveram efeito significativo no rendimento e na qualidade da fruta 'Kinnow'. Entre as diferentes aplicações foliares de ZnSO4 efetuadas quatro meses antes da colheita, 0,6% de ZnSO4 reduziu significativamente a queda de frutos antes da colheita (10,08%) em comparação com as árvores de controle não tratadas (46,45%). Da mesma forma, número máximo de frutos colhidos por árvore (627), peso do fruto (192,9 g), porcentagem de suco (42,2%), sólidos solúveis totais (9,5 ° Brix), teor de ácido ascórbico (35,5 mg / 100 g-¹) e os teores de açúcar (17,4) também foram significativamente maiores com o tratamento com 0,6% de ZnSO4 em comparação com o restante dos tratamentos e o controle. A aplicação foliar de 0,6% de ZnSO4 também melhorou significativamente os [...].
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Citrus/crescimento & desenvolvimento , Citrus/efeitos dos fármacos , Sulfato de Zinco/administração & dosagemRESUMO
Abstract Kinnow mandarin (Citrus nobilis L.× Citrus deliciosa T.) is an important marketable fruit of the world. It is mainstay of citrus industry in Pakistan, having great export potential. But out of total production of the country only 10% of the produce meets the international quality standard for export. Pre-harvest fruit drop and poor fruit quality could be associated with various issues including the plant nutrition. Most of the farmers do not pay attention to the supply of micro nutrients which are already deficient in the soil. Furthermore, their mobility within plants is also a question. Zinc (Zn) is amongst those micronutrients which affect the quality and postharvest life of the fruit and its deficiency in Pakistani soils is already reported by many researchers. Therefore, this study was carried out to evaluate the influence of pre-harvest applications of zinc sulfate (ZnSO4; 0, 0.4%, 0.6% or 0.8%) on pre-harvest fruit drop, yield and fruit quality of Kinnow mandarin at harvest. The treatments were applied during the month of October i.e. 4 months prior to harvest. The applied Zn sprays had significant effect on yield and quality of the Kinnow fruit. Amongst different foliar applications of ZnSO4applied four months before harvest, 0.6% ZnSO4 significantly reduced pre-harvest fruit drop (10.08%) as compared to untreated control trees (46.45%). Similarly, the maximum number of fruits harvested per tree (627), fruit weight (192.9 g), juice percentage (42.2%), total soluble solids (9.5 °Brix), ascorbic acid content (35.5 mg 100 g-1) and sugar contents (17.4) were also found significantly higher with 0.6% ZnSO4 treatment as compared to rest of treatments and control. Foliar application of 0.6% ZnSO4 also significantly improved total antioxidants (TAO) and total phenolic contents (TPC) in fruit. In conclusion, foliar spray of ZnSO4 (0.6%) four months prior to harvest reduced pre-harvest fruit drop, increase yield with improved quality of Kinnow mandarin fruit.
Resumo A tangerina Kinnow (Citrus nobilis L. × Citrus deliciosa T.) é uma importante fruta comercializável do mundo. É o esteio da indústria cítrica no Paquistão, com grande potencial de exportação. Mas, da produção total do país, apenas 10% da produção atendem o padrão internacional de qualidade para exportação. A queda da fruta antes da colheita e a baixa qualidade da fruta podem estar associadas a vários problemas, incluindo a nutrição da planta. A maioria dos agricultores não se preocupa com o fornecimento de micronutrientes que já são deficientes no solo. Além disso, sua mobilidade dentro das plantas também é uma questão. O zinco (Zn) está entre os micronutrientes que afetam a qualidade e a vida pós-colheita da fruta, e sua deficiência em solos paquistaneses já é relatada por diversos pesquisadores. Portanto, este estudo foi realizado para avaliar a influência da aplicação pré-colheita de sulfato de zinco (ZnSO4; 0, 0,4%, 0,6% ou 0,8%) na queda dos frutos na pré-colheita, produtividade e qualidade dos frutos da tangerina Kinnow em colheita. Os tratamentos foram aplicados durante o mês de outubro, ou seja, 4 meses antes da colheita. As pulverizações de Zn aplicadas tiveram efeito significativo no rendimento e na qualidade da fruta Kinnow. Entre as diferentes aplicações foliares de ZnSO4 efetuadas quatro meses antes da colheita, 0,6% de ZnSO4 reduziu significativamente a queda de frutos antes da colheita (10,08%) em comparação com as árvores de controle não tratadas (46,45%). Da mesma forma, número máximo de frutos colhidos por árvore (627), peso do fruto (192,9 g), porcentagem de suco (42,2%), sólidos solúveis totais (9,5 ° Brix), teor de ácido ascórbico (35,5 mg / 100 g-1) e os teores de açúcar (17,4) também foram significativamente maiores com o tratamento com 0,6% de ZnSO4 em comparação com o restante dos tratamentos e o controle. A aplicação foliar de 0,6% de ZnSO4 também melhorou significativamente os antioxidantes totais (TAO) e os teores fenólicos totais (TPC) nas frutas. Em conclusão, a pulverização foliar de ZnSO4 (0,6%) quatro meses antes da colheita reduziu a queda de frutos antes da colheita e aumentou o rendimento com a melhoria da qualidade da fruta tangerina Kinnow.
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AIMS: Important transformations in psychiatric healthcare (HC) delivery have been implemented in Latin America during the beginning of 21st century. However, information on current service uses patterns is scant, obstructing the estimates and proper planning of service needs for general population. The current investigation aims to describe patterns and estimates predictors of 12-month HC use by individuals with mental disorders in São Paulo metropolitan area, Brazil. METHOD: Data are from São Paulo Mental Health Survey, a cross-sectional multistage representative study. Participants were face-to-face interviewed in their household, using a structured diagnostic interview, the World Mental Health Survey Initiative version of the Composite International Diagnostic Interview. A total of 5037 respondents, non-institutionalised, aged 18 years and older were interviewed. The response rate was 81.3%. We determined the percentages of individuals with 12-month DSM-IV anxiety, mood and substance disorders that received treatment in the 12 months prior to assessment in main service sectors (specialty mental health, general medicine, human services (HS), and complementary and alternative medicine). The number of visits and percentage of individuals who received treatment at minimally adequacy also was estimated. Multilevel regression controlled contextual variables that influenced the use of service and treatment adequacy. RESULTS: Only 10.1% of respondents used some HC service in the 12 months prior to assessment for their psychiatric problems, including 3.9% of them being treated either by a psychiatrist, 3.5% by a non-psychiatrist mental health specialist, 3.3% by a general medical (GM) provider, 1.5% by a HS provider and 1.4% by a complementary and alternative medical provider. In general, those participants who received service in the mental health specialty sector reported more visits than those in the GM sector (median 3.9 v. 1.5 visits). The cases seen in specialty sector outnumber those visiting GM treatment in terms of minimally adequate treatment (54.6 v. 23.2%). The likelihood of receiving treatment was significantly greater among individuals diagnosed with any anxiety and mood disorder, presenting more severe disorders, and with possession of HC insurance. CONCLUSIONS: The great majority of individuals with an active mental disorder in São Paulo were either untreated or insufficiently treated. Awareness and training programmes to GM professionals are advocated to improve recognition, care take and referral to specialty care when needed. Proper integration among HC sectors is recommended.
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Atenção à Saúde/métodos , Disparidades em Assistência à Saúde , Transtornos Mentais/terapia , Serviços de Saúde Mental/estatística & dados numéricos , Visita a Consultório Médico/estatística & dados numéricos , Vigilância da População/métodos , População Urbana , Adolescente , Adulto , Brasil/epidemiologia , Estudos Transversais , Feminino , Pesquisas sobre Atenção à Saúde , Humanos , Transtornos Mentais/epidemiologia , Transtornos Mentais/psicologia , Saúde Mental , Prevalência , Índice de Gravidade de Doença , Fatores Socioeconômicos , Adulto JovemRESUMO
BACKGROUND/AIMS: Landmines have long been used in conventional warfare. These are antipersonnel mines which continue to injure people long after a ceasefire without differentiating between friend or foe, soldier or civilian, women or children. This study focuses on Afghan non-combatants engaged in mine clearing operations in Afghanistan in the aftermath of the Russo-Afghan war. The patterns and types of injuries seen are described and experiences in their management, ways, and means to prevent them, and recommendations for the rehabilitation of the affected individuals are given. METHODS: It is a retrospective and analytical study of 84 patients aged 19-56 years who sustained mine blast injuries during mine clearing operations in Afghanistan from November 1992 to January 1996. The study was carried out at a military hospital with tertiary care facilities. The patients were divided into three groups on the basis of their injuries. Group 1 required only general surgical attention, group 2 sustained only ocular injuries, while group 3 had combined ocular and general injuries. Patients in groups 2 and 3 were treated in two phases. The first phase aimed at immediate restoration of the anatomy, while restoration of function wherever possible was done in subsequent surgical procedures in the second phase. RESULTS: It was observed that 51 out of 84 patients (60.7%) had sustained ocular trauma of a variable degree as a result of the blasts. The mean age of the victims was 29 years and they were all male. A total of 91 eyes of 51 patients (89.2%) had been damaged. Bilaterality of damage was seen in 40 (78.4%) patients. Most, 34 (37.3%), eyes became totally blind (NPL). Only a few escaped with injury mild enough not to impair vision. Foreign bodies, small and multiple, were found in the majority of eyes; most, however, were found in the anterior segment, and posterior segment injuries were proportionally less. CONCLUSIONS: The prevalence of blindness caused by mine blast injuries is quite high. The resulting psychosocial trauma to the patients and their families is tremendous and has not been adequately highlighted. These injuries are a great drain on the country's resources. Enforcement of preventive measures and the use of protective gear and sophisticated equipment by the mine clearing personnel would prove to be far more economical in terms of human life as well as medical and economic resources. There is also need for greater attention towards the establishment of support groups and rehabilitation programmes for these individuals.
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Traumatismos por Explosões/cirurgia , Ferimentos Oculares Penetrantes/cirurgia , Guerra , Adulto , Afeganistão , Traumatismos por Explosões/etiologia , Cegueira/etiologia , Efeitos Psicossociais da Doença , Corpos Estranhos no Olho/etiologia , Corpos Estranhos no Olho/cirurgia , Ferimentos Oculares Penetrantes/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos RetrospectivosRESUMO
Twenty one patients of leprosy were studied for gastrointestinal symptoms and submitted to detailed intestinal absorption tests and jejunal biopsy before and after the institution of Clofazimine therapy. Fifteen patients were administered 100 mg orally daily for 3 months, while six patients with ENL received 300 mg of the drug for 6 weeks initially and then 100 mg daily. Mild diarrhoea and abdominal symptoms occurred in four patients, fecal fat excretion increased in one patient but Schilling's and d-Xylose tests did not alter. No significant changes were produced by Clofazimine therapy in jejunal mucosa. Clofazimine crystals were seen in the lamina properia of one patient, the overlying mucosa was normal. No correlation was found between the abnormality in mucosal pattern, crystal deposition, absorption parameters or symptomatology and doses of drug taken.
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Clofazimina/efeitos adversos , Intestino Delgado/efeitos dos fármacos , Hanseníase/tratamento farmacológico , Adolescente , Adulto , Clofazimina/uso terapêutico , Feminino , Gastroenteropatias/induzido quimicamente , Humanos , Absorção Intestinal/efeitos dos fármacos , Intestino Delgado/metabolismo , Intestino Delgado/patologia , Hanseníase/metabolismo , Masculino , Pessoa de Meia-IdadeRESUMO
OBJECTIVE: To find the frequency of hepatitis B and C virus (HBV and HCV) infection and their coinfection in chronic liver disease and any differences in the clinical features of single and coinfections. METHODOLGY: All clinically recognisable adult CLD patients admitted to Military Hospital, Rawalpindi in years 1999-2000, were included in the study. Their history and clinical features were recorded. Seromarkers for HBV (HBsAg, anti-HBc) and HCV (anti-HCV) were done. RESULTS: A total of 97 (52 male, 45 female) patients were included in the study. Mean age was 51.6 years (range 16-75 years). Cirrhosis was present in 74.2%, chronic hepatitis (Ch Hep) in 18.6% and hepatocellular carcinoma (HCC) in 7.2%. Among the 74.1% patients with cirrhosis 28.5% were HBsAg positive, 55.5% anti-HBc positive and 68.1% anti HCV positive. In the chronic hepatitis cases 27.8% were HBsAg positive, 23.6% anti-HBc positive and 61.1% anti HCV positive. Among the patients of HCC 59.7% were HBsAg positive, 71.4% anti-HBc positive and 42% anti HCV positive. Regarding coinfection 7.2% were anti-HCV and HBsAg positive while 35.1% were anti-HCV and anti-HBc positive. CONCLUSION: Ninety percent of patients with CLD had evidence of HBV, HCV or coinfection. Disease was more severe in patients with coinfection. Anti-HBc was found to be a sensitive indicator of past HBV.
Assuntos
Hepatite B/epidemiologia , Hepatite C/epidemiologia , Cirrose Hepática/epidemiologia , Adolescente , Adulto , Distribuição por Idade , Idoso , Estudos de Coortes , Comorbidade , Países em Desenvolvimento , Feminino , Hepatite B/diagnóstico , Hepatite C/diagnóstico , Humanos , Incidência , Cirrose Hepática/diagnóstico , Testes de Função Hepática , Masculino , Pessoa de Meia-Idade , Paquistão/epidemiologia , Probabilidade , Fatores de Risco , Índice de Gravidade de Doença , Distribuição por Sexo , Fatores SocioeconômicosRESUMO
OBJECTIVE: To determine the frequency of Campylobacter jejuni infection in children suffering from diarrhoea/dysentery in the Department of Microbiology, Army Medical College and Military Hospital, Rawalpindi, from 29 August 2002 to 29 November 2002. METHODS: The study was carried out on one hundred stool samples of children up to the age of twelve years admitted with diarrhoea/dysentery in Military hospital, Rawalpindi. The samples were collected in clean polypropylene containers containing Cary Blair medium. These were transported to the Microbiology Department, Army Medical College, Rawalpindi within 1-2 hours. The samples were inoculated on Modified Preston (Oxoid) and Karmali media (Oxoid) beside other routine stool culture media. The cultures were incubated at 42 degrees C under microaerophilic conditions. The growth after 48 hours was provisionally identified by colonial morphology, oxidase test, Gram staining and motility. The organisms were identified to species level by hippurate hydrolysis, urease test, nitrate reduction, catalase test, H2S production and resistance to cephalothin. RESULTS: Eighteen percent of samples yielded the growth of Campylobacter jejuni. Mean age of children with Campylobacter jejuni infection was 18 months with peak incidence from 12 to 21 months. Male female ratio was 1.7:1. All the children had loose motions. Seven out 18 (39%) had a combination of symptoms of loose motions, vomiting and pain abdomen. Those having fever with or without other complaints constituted 11 out of 18 (61.11%) i.e. more than 50% of all the children yielding C. jejuni had fever. About 90% of diarrhoeal stools had blood and fifty percent also had mucous. There was either history of chicken meat consumption or contact with cattle and pets in most of the cases and both in some of them. CONCLUSION: Campylobacter jejuni is a frequent cause of diarrhoea/dysentery in children in our set up. In children it is often related to pets keeping and chicken meat consumption. In the remaining, untreated drinking water may be the source. Campylobacter jejuni frequently presents with blood and mucous in stools with sporadic cases presenting with watery diarrhoea.
Assuntos
Infecções por Campylobacter/epidemiologia , Campylobacter jejuni , Disenteria/microbiologia , Campylobacter jejuni/isolamento & purificação , Pré-Escolar , Fezes/microbiologia , Feminino , Humanos , Incidência , Lactente , Masculino , Paquistão/epidemiologiaRESUMO
Concentrations of Na, K, Ca ions, oxalic and uric acids, total Ca, P as well as urease activity, the ability to form crystals, speed of crystallization, crystal chemical composition, pH stability were evaluated in the urine from 40 urolithiasis patients and 40 patients with recurrent nephroliths. It was found that fast or moderate crystallization, high urease activity and ability to form crystals, unstable urine pH indicate a high risk of both primary and recurrent nephrolith formation.
Assuntos
Cálculos Renais/diagnóstico , Urina/química , Cálcio/urina , Cristalização , Humanos , Concentração de Íons de Hidrogênio , Cálculos Renais/química , Cálculos Renais/urina , Ácido Oxálico/urina , Potássio/urina , Prognóstico , Recidiva , Fatores de Risco , Sódio/urina , Urease/urina , Ácido Úrico/urinaRESUMO
BACKGROUND: In 1988 a new constitution in Brazil brought the creation of a national health system, the Unified Health System (Sistema Unico de Saúde; SUS). A GROWING INTEREST IN QUALITY: Accountability is not yet a strong feature of the health system, even though the Ministry of Health has made efforts to encourage the federal district and 26 states to participate in some quality-of-care projects. Initiatives include certification by the International Standards Organization (ISO; Geneva); consulting services, especially in managerial processes; total quality management; patient satisfaction; and development of new technologies to increase efficiency. ISSUES AND CONCLUSIONS: Physicians' oft-repeated claim that they know all it takes to offer patients high-quality care makes it difficult to enlist their help in quality programs in general and in establishing protocols and guidelines in particular. State licenses are a prerequisite for hospitals, but this is not always enforced; the local health authority may be relieved that hospital care is at least being provided. Similarly, the government may find it important that the population has access to health services, even if the service is not considered adequate. Government can encourage quality initiatives and assess and disseminate the findings.
Assuntos
Programas Nacionais de Saúde/normas , Gestão da Qualidade Total/organização & administração , Brasil , Difusão de Inovações , Pesquisa sobre Serviços de Saúde , Humanos , Seguro Saúde , Avaliação de Processos e Resultados em Cuidados de SaúdeRESUMO
OBJECTIVE: Type II lunate bones have an "extra" facet that articulates with the hamate bone, which frequently leads to arthritis. Because the only prior studies, to our knowledge, on this common and clinically significant variant involved dissection of cadavers, we performed an MR imaging study of the type II lunate. MATERIALS AND METHODS: We retrospectively reviewed MR images obtained at 1.5 T of 186 wrists for frequency of type II lunates, size of the extra facet, amount of hamatolunate apposition, and presence of hamate subchondral edema. Of the 186 wrists, 28 also had correlation with findings on wrist arthroscopy. RESULTS: One hundred seven wrists (57.5%) had type II lunates with an average extra facet size of 4.6 mm (range, 1.2-12.0 mm). Apposition (articulation) of the extra lunate facet with the hamate averaged 77.4% (range, 0-100%). Hamate edema was seen in only nine wrists (4.8%), all of which had type II lunates. Arthroscopic evidence of focal hamate chondromalacia and MR imaging evidence of marrow edema were seen in six of these nine wrists; marrow edema was seen only in wrists with frank cartilage changes on arthroscopy. CONCLUSION: An extra facet (type II lunate) was seen in approximately half of 186 wrists. On MR imaging, type II lunates usually have an innocuous appearance. A large percentage of patients with type II lunates also have chondromalacia, which often is occult on MR imaging. When visible, such chondromalacia is the cause of marrow edema similar to that seen in patients with carpal fractures.