Pseudotumoral allergic fungal sinusitis with skull base involvement.

Here we report a case of pseudotumoral recurrence of allergic fungal sinusitis with involvement of the skull base that was successfully treated with systemic corticosteroids and itraconazole without surgery. This report discusses the sometimes misleading radiological and clinical features as well as the diagnostic and therapeutic challenges of a condition that should be recognized by ENT specialists, neurosurgeons, ophtalmologists and radiologists.

Deaths among women of reproductive age in Cape Verde: causes and avoidability.

SUBJECT: In 1992-93 all deaths (n=97) of women 15 to 49 years old in three islands of Cape Verde were investigated to determine the cause of death, the maternal mortality ratio, the reliability of cause-of-death ascertainment, and the level of avoidability. METHOD: Data were obtained through interviews with the deceased person's family members and other knowledgeable persons (verbal autopsy) and through hospital files. RESULTS: The overall mortality rate was 163 per 100,000 women 1549 years old, and the maternal mortality ratio was 127 per 100,000 live births. A plausible diagnosis could be determined in 77%. The most frequent causes of death were circulatory disorders, external causes, maternal causes, infectious diseases. and neoplasms. CONCLUSIONS: It was estimated that three of four of the deaths were avoidable with locally available resources. Since access to health care in the study area is not a major hindrance, a further decrease of female mortality depends mainly on improved quality of care in health facilities.

Risk factors for perinatal death in Cape Verde.

Risk factors for perinatal death in the Cape Verde islands were assessed among 104 bereaved mothers and 292 mothers of surviving infants in an area-based case-control study in 1992-93. Prospectively gathered information on risk factors was obtained from medical records supplemented with post-partum interviews and anthropometric measurements of mothers and infants. No autopsies were performed. Multiple logistic regression analysis was applied. Out of 23 alleged maternal and two alleged infant risk factors, the following seven proved significantly and independently correlated with perinatal death: first pregnancy (odds ratio [OR] = 2.9); previous hypertensive disease (OR = 4.2); previous perinatal death (OR = 4.6); pre-eclampsia (OR = 7.0); non-cephalic fetal presentation (OR = 17.1); male infant (OR = 2.1) and maternal post-partum fever (OR = 3.1). The perinatal mortality rate was calculated as 37-46/1000 total births. A reduction in the mortality rate warrants antenatal and obstetric care with emphasis on primiparous women; improved detection and treatment of hypertensive disorders and genital infections; and improved intrapartum fetal observation and resuscitation routines.

PIP: Findings are presented from a study conducted to assess the perinatal mortality rate and explore the association between alleged maternal and pregnancy-related risk factors and perinatal death in Cape Verde. Risk factors for perinatal death were assessed among 104 bereaved mothers and 292 mothers of surviving infants in an area-based case-control study during 1992-93 using data on risk factors obtained from medical records, postpartum interviews, and anthropometric measurements of mothers and infants. The following alleged maternal and infant risk factors were significantly and independently correlated with perinatal death: first pregnancy, previous hypertensive disease, previous perinatal death, pre-eclampsia, noncephalic fetal presentation, male infant gender, and maternal postpartum fever. The perinatal mortality rate was calculated to be 37-46/1000 total births. Providing antenatal and obstetric care with emphasis upon primiparous women, improving the detection and treatment of hypertensive disorders and genital infections, and improving intrapartum fetal observation and resuscitation routines will help reduce the level of mortality.

Genital infections among antenatal care attendees in Cape Verde.

In a cross-sectional study, 350 pregnant Capeverdian women were examined to assess the prevalence of Chlamydia trachomatis infection (CT), Neisseria gonorrhoeae infection (NG) and Bacterial vaginosis (BV). Among various analytic methods used, the polymerase chain reaction PCR (for NG, CT) yielded a higher detection rate than did direct microscopy or culture (NG), or direct immuno-fluorescence (CT). Since the PCR analytic of air-dried specimens is not hampered by harsh storage and transport conditions, it could serve to validate other detection methods where laboratory facilities are suboptimal. Among sociodemographic risk factors young age, and currently living alone, were significantly associated with infection.

Evaluation of antenatal risk factors lit Cape Verde.

The prevalence of antenatal risk factors and their association with adverse pregnancy outcome were prospectively studied in the county of Praia, Cape Verde. Of 4693 women registering for antenatal care, 8% were randomly selected from October 1991 through December 1992. Eventually 358 women were observed until puerperium when a physical examination and a structured interview took place. Three out of four women of the cohort were exposed to risk factors according to the existing risk classification in Praia, and 9% presented high risk factors. Thirty two percent of the cohort faced adverse pregnancy outcomes. Adverse pregnancy outcomes were significantly increased among women who presented high risk factors, but 82% of all adverse outcomes occurred among other women. The antenatal risk classification investigated cannot be considered an effective tool for detection of women at risk of adverse pregnancy outcome.

Maternal risk factors for preterm birth and low birthweight in Cape Verde.

BACKGROUND: Fifteen years after the implementation of an antenatal risk screening program in Cape Verde, the first assessment of an association between maternal obstetric characteristics and preterm birth or low birthweight (LBW) infants was undertaken. METHODS: A cohort of 353 systematically selected antenatal clinic attenders in the county of Praia, Cape Verde, was studied prospectively during the period October 1991 through December 1992. The cohort was followed past the perinatal period and information was obtained according to a pretested structured questionnaire. In the analysis of preterm birth and LBW, multiple logistic regression was listed to estimate the relative risks of ll background variables. RESULTS: The prevalence of preterm birth (<37 gestational weeks) was 12%, and the prevalence of LBW infants was 8%. Low birthweight (<2500 grams) was significantly associated with low maternal age (< or = 19 years, RR=3.7); nulliparity (RR=5.2) and obstetric history of previous LBW infant (RR-6.5). The risk of preterm birth was significantly increased if the woman had an obstetric history of hypertension or convulsions (RR=2.6). CONCLUSIONS: In the setting studied, teenage women and women with previous pregnancy hypertension should be given selective attention in antenatal care to achieve improved pregnancy outcome. Primary prevention is needed to lower the prevalence of teenage pregnancies.

Better health data with a portable microcomputer at the periphery: an anthropometric survey in Cape Verde.

A portable microcomputer was programmed to record anthropometric nutritional data from children aged under 7 years in either a clinic or a population survey situation. An alarm sounds when the anthropometric measurements of a child are below a predetermined value; an immediate check thus avoids the need for subsequent data cleaning and discarding of doubtful information. Data cut-off points in the computer can be adjusted to suit the survey or service needs of the situation. A print-out at the end of the clinic session provides immediate feedback for the staff and a record of the nutritional status of the group.In Cape Verde, 14 670 children attending clinics were surveyed; 26% were identified as stunted, 3% as wasted, and 1% as stunted and wasted. While a portable microcomputer can improve precision, speed and motivation, nutrition surveys still depend on accurate scales, careful measurements and competent staff.