Acute extradural haematomas in children: A single neurosurgery unit's 12-year experience.

BACKGROUND: Acute extradural haematomas (AEDHs) occur infrequently in children. This study was undertaken to review our experience with management and outcomes of this condition in children treated in the Neurosurgery Unit at Inkosi Albert Luthuli Central Hospital. METHOD: A retrospective review of medical records of all children (age less than or equal to (≤) 12 years) with a diagnosis of AEDH admitted from January 2003 to December 2014 was performed. Records were analyzed for demographics, mechanisms of injury, clinical presentation, neuroradiology findings, management and outcomes at discharge. RESULTS: A total of 150 children with AEDHs were admitted during this period. The mean age was 6.6 ± 3.8 years with a peak incidence in the 7-9 year age group. There were 84 (56%) males, (M: F= 1.3:1). Sixty AEDHs resulted from road traffic crashes (40%). On admission 104 (69.3%) children were Glasgow coma scale (GCS) 13-15, 26 (17.3%) GCS 9-12 and 20 (13.4%) GCS 3-8. Haemoglobin was less than (<) 8 g/dl in 56% of infants (p < 0.001). Skull fractures were identified in 78% of cases. Surgical management was undertaken in 83% of children and the mean hospital stay was 6.9 ± 6.1 days. Four children (2.7%) died during in-hospital stay period. One hundred and forty one (94%) children had a favourable Glasgow outcome scale (GOS) at discharge. CONCLUSION: AEDHs in children carry a good prognosis, but can be potentially fatal. A vigilant approach is required when assessing these children, as early diagnosis and treatment yields gratifying results.

Spread of an emerging Mycobacterium tuberculosis drug-resistant strain in the western Cape of South Africa.

BACKGROUND: South Africa has a high burden of drug-resistant tuberculosis (TB). METHODS: Routine drug susceptibility testing was performed prospectively over a 2-year period on Mycobacterium tuberculosis isolates in two health districts of the Western Province, South Africa. A cluster of drug-resistant strains that shared a rare mutation in katG315 was found in 64 of the 450 cases identified as having been infected with drug-resistant TB. Isolates belonging to this cluster were phenotypically and genotypically characterised. Epidemiological and clinical characteristics were used to identify mechanisms leading to the acquisition and spread of this drug-resistant strain. RESULTS: An outbreak of an emerging non-Beijing drug-resistant strain infecting 64 pulmonary tuberculosis (PTB) cases was identified. This previously undetected genotype (now designated DRF150) is characterised by five IS6110 insertions, specific spoligotypes and high levels of resistance to the first-line TB medications isoniazid, streptomycin and rifampicin. In 45% of the cases it is also resistant to ethambutol and pyrazinamide. Key factors leading to the development and spread of this drug-resistant genotype were inappropriate chemotherapy, poor adherence to treatment and prolonged periods of infectiousness due to delays in susceptibility testing. CONCLUSIONS: Molecular markers allowed early identification of an emerging non-Beijing drug-resistant strain.

Perinatal mortality in the Cape Province, 1989-1991.

OBJECTIVE: To determine the number of deliveries, the low-birth-weight rate and the perinatal mortality rate at provincial and province-aided hospitals and clinics in each planning region of the Cape Province. DESIGN: A record of the number of deliveries, low-birth-weight infants, stillbirths and early neonatal deaths in provincial and province-aided hospitals and clinics in each planning region of the Cape Province between 1 January 1989 and 31 December 1991. SETTING: All provincial and province-aided hospitals and clinics in the Cape Province. PARTICIPANTS: Hospital and clinic staff of all provincial and province-aided hospitals and clinics in the Cape Province. MAIN OUTCOMES MEASURED: Number of deliveries, low-birth-weight infants, stillbirths and early neonatal deaths in each planning region of the Cape Province. RESULTS: A total of 373,768 births were recorded during the 3-year period with a low-birth-weight rate of 14.7%, a stillbirth rate of 17.9 per 1,000 and an early neonatal mortality rate of 9.1 per 1,000. All rates differed widely between regions. The regions with the highest perinatal mortality rates were in the northern and eastern Cape. CONCLUSION: The perinatal demographics of most regions in the Cape Province are typical of a developing country. Regions which have been identified as having the highest low-birth-weight, stillbirth and early neonatal mortality rates are in greatest need of improved perinatal health care.

Priorities for provision of health care services for children in the Cape Province.

Geographical areas in the Cape Province are ranked by their need for resources for child health care as determined by several proxy indicators of child health. Low birthweight and perinatal mortality rates for 1989, infant and age-specific childhood death rates, as well as death rates for tuberculosis, gastroenteritis and measles for 1985 are used as indicators of need. The ten magisterial districts having the highest priority for resources are, in decreasing order of need: De Aar, Colesberg, Uitenhage, Sterkstroom, Gordonia, Prince Albert, Philipstown, Victoria West, Kirkwood and Richmond. Limitations in the data are: wide, unquantifiable confidence limits, non-independence of different indicators, lack of timeliness, and incomplete statistics. Despite these problems with the data there are several reasons for employing them. Firstly, the quality of the data is only likely to be improved if they are actually used, and, secondly, there is no alternative. Areas identified as high priority need investigation in situ because corrective action is required for either the data collection system, or child health. Recommendations for improvements in resource management in child health care are: regionalisation of a unitary health care service, more timely data collection in geographically standardised regions, introduction of management objectives, and resource allocation guided by health status indicators.

Addition of rabbit serum to EMJH medium improves isolation of Leptospira interrogans serovar hardjo.

The addition of 2% pooled rabbit serum to semi-solid commercial EMJH medium with EMJH enrichment and 0,5 mg of 5-fluorouracil per ml was found to enhance the growth rate and success of isolation of Leptospira interrogans serovar hardjo from bovine urine. Cultures made on media without serum had to be kept for more than 130 days before being discarded as negative.

Procedures involving lipid media for detection of bacterial contamination in breweries.

The liquid equivalent of universal beer agar, designated universal beer liquid medium, and its beer-free equivalent, universal liquid medium (UL), were equally effective in demonstrating bacterial contamination in 120 of 200 samples from different stages of commercial brewing process. Growth of the contaminants after 3 days was consistently more luxuriant in the UL medium. A yeast-water substrate medium failed to reveal many contaminants detected with UL in 392 samples from three breweries and revealed only a few not detected with UL. The use of UL and a lactose-peptone medium, with microscope examination of the media for bacterial growth, permitted detection of 93% of the known contaminants compared to 87%, detected with UL alone; this combination or universal beer liquid medium plus lactose-peptone medium can therefore be recommended for the detection of bacterial contaminants in brewery samples. Bacterial contamination of pitching yeasts appeared to be a particular problem in the breweries investigated.

Characterization of bluetongue virus ribonucleic acid.

An improved purification procedure yielded bluetongue virus free from any single-stranded ribonucleic acid (RNA) component. Double-stranded RNA obtained from purified virus or isolated from infected cells was fractionated into 5 components by means of sucrose gradient sedimentation analysis, and into 10 components by electrophoresis on polyacrylamide gels. The size of these components vary from 0.5 x 10(6) to 2.8 x 10(6) daltons, with a total molecular weight estimate of about 1.5 x 10(7) for the viral nucleic acid. The denaturation of the genome and separation of the resulting fragments are also discussed.