The effect of a supplement containing sunflower oil, vitamins, amino acids, and peptides on the severity of symptoms in horses suffering insect bite hypersensitivity.

Insect bite hypersensitivity (IBH) is most often caused by Culicoides spp., although other insect species are also thought to play a role in causing this disease. The disease has been reported to occur in most countries, with a prevalence of up to 28% in some countries in some breeds. The only truly effective therapy currently available is to prevent horses from coming into contact with Culicoides midges, which can be achieved by stabling horses during certain times of the day or by covering them with insect blankets. The effect of a new dietary supplement containing vitamins, polypeptides, and amino acids on IBH severity was tested at the start of the Culicoides season (April 2009). Fifty horses participated in this placebo-controlled, double-blinded study: 25 horses received the supplement and 25 received placebo for 30 days; thereafter all horses received the supplement for a further 30 days. The investigators scored the severity of IBH in all horses, based on clinical evaluation and digital photographs taken before and after the first 30 days of the trial. The owners were asked to assess the severity of the signs prior to the investigation and after the first and second 30-day periods. For each period, IBH clinical symptoms were classified as increased, decreased, or the same. Results showed that investigator-assessed symptoms became worse in more horses receiving placebo than in horses receiving supplement, indicating a positive effect of the supplement. However, there were no treatment-group differences when symptom severity was scored by the horse owners. No side-effects were observed.

Plasma concentration profiles after pre-operative rectal administration of a solution of paracetamol in children.

An exploratory study in paediatric surgical patients was performed to describe the behaviour of a rectal solution of paracetamol at 20 mg/kg. Four of six patients were able to complete the study. Peak concentration (Cmax) and time to peak concentration (tmax) found in the children are comparable to adults studied earlier. After 1.6 hrs (tmax) a peak concentration of 11.7 mg/l (Cmax) was reached. The area under the curve (AUC t = 6) and the mean residence time (MRT) were respectively 48.3 mghr/l and 5.2 hrs. The solution appears promising for further study in daily clinical practise.

Rectal administration of paracetamol: a comparison of a solution and suppositories in adult volunteers.

The pharmacokinetics and tolerability of two dosage forms for rectal administration of paracetamol were compared. A fatty suppository was compared with a solution of 60 mg/ml paracetamol. Both dosage forms were given as 1000 mg doses to 10 healthy adult volunteers. The solution produced peak plasma concentrations significantly faster (t (max)) than did the suppository. The peak concentration (C(max)) and the area under the curve (AUC(6)) were also significantly greater. The pharmacokinetic characteristics of the solution were superior to those of the suppository. No difference in irritation score was identified and no discomfort was reported.

The management of operative urethral injury an experience with ten patients at Muhimbili Medical Cenntre

10 patients were treated at Muhimbili Medical Centre (MMC) for operative injury of the ureter following gynaecologic surgery. 7 were referred from up-country while three sustained injury during operation at MMC. The age range was 27 to 52 years with a mean of 36.5 years. Abdominal hysterectomy was the operation at which the ureter was most commonly injured. Only two of the injuries were discovered interpretively; a trend common to most series. Ureteric re-implantation or end-to-end anastomosis were performed according to the circumstances; with good results in all patients. The main shortcoming was prolonged delay before treatment in the majority of patients. A ureteric catheter inserted cystoscopically before operation; avoidance of excessive dissection of the ureter; constant consciousness about the possibility of urethral injury during abdominal and pelvic surgery and an intravenous urogram (IUV) in cases where difficulties are anticipated are useful preventive measures

[Prevention and control of pain in (adeno)tonsillectomy]. / Pijnpreventie en pijnbestrijding bij (adeno)tonsillectomie.

Pain prevention and analgesia in (adeno)tonsillectomy OBJECTIVE. To study the efficacy of three analgesia protocols in children subjected to (adeno)tonsillectomy. SETTING. Twenteborg District Hospital, Almelo, the Netherlands. PATIENTS AND METHODS. In 64 children with body weights ranging from 15 to 25 kg (mean 20.4 kg) subjected to (adeno) tonsillectomy according to the procedure most current in the Netherlands (according to Sluder with administration of a volatile anaesthetic without intubation in day treatment), three protocols for preventing and treating postoperative pain were applied, with the analgetics most current in the Netherlands. Permission from the Medical Ethical Committee and written informed consent from the parents were obtained. According to protocol I 240 mg paracetamol was given, according to protocol II, 500 mg paracetamol and according to protocol III, 500 mg paracetamol plus 10 mg codeine, in suppository form, every 4 hours always starting 60 minutes before operation. Initially, protocol I was carried out, subsequently randomization of protocols II and III. After a pilot study use of a control group was omitted for ethical reasons because of the severe pain in a placebo group. MEASUREMENTS. The efficacy of the analgesia was evaluated by means of pain assessments by the children themselves using the Oucher test, 1, 3 and 6 hours after operation. The statistical processing of the children's pain scores was performed primarily in a descriptive sense, with simultaneous comparison of the three groups using a single variance analysis for comparison of several groups. Multiple comparisons were carried out according to Ducans' multiple range test. The level of significance was put at p less than or equal to 0.05. RESULTS. One hour postoperatively there was no significant difference among the mean pain scores (0: no pain and 10: very bad pain) of the three groups, viz. 5.2 (SD 3.0), 4.7 (SD 2.9) and 4.7 (SD 2.3), respectively; three hours postoperatively there was a significant difference between the mean pain scores of group I (4.5; SD 2.4) and group II (2.7; SD 2.4) but not between group I and group III (3.3; SD 1.5); six hours postoperatively there was a significant difference between the mean pain scores of group I (4.1; SD 2.1) on the one hand and of groups II (2.1; SD 1.5) and III (2.6; SD 1.6) on the other. CONCLUSION. The findings indicate existence of violent pain immediately after recovery from anaesthesia after (adeno)tonsillectomy as shown by the pain assessments by the children themselves one hour postoperatively, in spite of preventive administration of a high dose of a 'minor' analgetic according to each of the three protocols. Modification of the anaesthetic technique should be considered to effect adequate prevention or suppression of pain.

Postpartum pelvic arthropathy with unusual features.

Eleven patients seen in Malawi are described with a syndrome of postpartum pelvic arthropathy. They complained of severe pain mainly located in the symphysis pubis and all were unable to walk. The following unusual features were noted: the absence of obstetric trauma, a symptom-free interval between the delivery and the onset of the syndrome, the absence of gross widening of the symphysis pubis and the lack of abnormal mobility in the same joint. It is speculated that the syndrome described is not caused by rupture of the symphysis or softening under the influence of hormones but by swelling inside the intact fibrous confines of the joint.

Serum progesterone and oestradiol concentrations in women with unexplained infertility.

Twenty-eight patients with longstanding, unexplained infertility were studied during one menstrual cycle by serial serum progesterone and oestradiol assays. For comparison the serum concentrations of these hormones were also measured during one cycle in ten fertile control subjects. Of the patients with infertility, one had an anovulatory cycle and one had a cycle with a short luteal phase. In the other 26 patients the length of the cycle, the preovulatory peak oestradiol concentration and the maximum oestradiol concentration during the luteal phase were less than in the controls but these differences were not statistically significant (p > 0.10). However, the duration of progesterone secretion and the maximum progesterone concentration during the luteal phase were significantly less (p < 0.01) in the patients with infertility than in the controls. It is, however, uncertain whether the subnormal progesterone secretion is responsible for the infertility.

The significance of dating an endometrial biopsy for the prognosis of the infertile couple.

Two hundred and thirty-two women with primary or secondary infertility were divided into four groups according to their endometrial biopsy result: 114 (49%) with no delay of the secretory phase, 36 (16%) with a secretory phase with a delay of 2 days, 26 (11%) with a secretory delay of 3 days or more, and 56 (24%) with an endometrium which could not be dated because of inadequate material. The cumulative pregnancy rate of all patients was 53% within 2 years and the pregnancy rates of the four groups did not differ significantly. In our department the histological dating of an endometrial biopsy as part of the initial investigation of the infertile couple is not worthwhile.

The nutritional status of children ages 0-5 years in Nkhotakota, Malawi.

A nutritional status survey of children aged 0-5 years was carried out in a lake shore district in Malawi. Anthropometric and clinical studies indicated a high overall prevalence (14%) of Protein-Calorie Malnutrition (PCM), particularly among the 1- to 1 1/2-year-olds. Few signs of vitamin deficiencies were seen but iron deficient anaemia was common at all ages, 68% being below the acceptable haemoglobin level. Sixty percent of children had malaria parasitaemia and 25% conjunctivitis. Under-five mortality was estimated to lie between 31 and 44%. Muslim children had a higher mortality and prevalence of PCM and fewer of their fathers had been to school. It is suspected that many cases of undernutrition go unrecognized because of uniform stunting occurs and ages are not known. It is recommended therefore that medical units use a local calendar, similar to that evolved for the survey, in order to estimate ages more accurately.

Obstetric problems: a manual

This manual has been written for those in Malawi who deal with obstetric problems at the hospital level: state registered nurses-midwives; clinical officers; and doctors. It assumes a basic training in obstetrics and some practical experience of obstetric problems as well. It is not a book for beginners