Upper gastrointestinal findings in diabetic outpatients at Kenyatta National Hospital, Nairobi.

OBJECTIVE: To determine the prevalence of H. pylori and the associated upper gastrointestinal endoscopic lesions in diabetic outpatients with dyspepsia. DESIGN: Cross-sectional study. SETTING: Kenyatta National Hospital (KNH), Nairobi, Kenya. SUBJECTS: Adult diabetic outpatients with dyspepsia attending the KNH diabetic clinic. RESULTS: Of the 257 randomly selected diabetic outpatients screened, 137 (53.3%) had dyspepsia. Seventy one of these patients underwent an upper gastrointestinal endoscopy. Fifty five (77.5%) of the 71 patients had H.pylori infection identified by rapid urease test and histology. The prevalence of H. pylori increased with HbA1c level but there was no statistically significant association with poor glycaemic control (HbA1c >7.0%). Forty eight (67.6%) of the 71 had gastritis, 17 (25.7%) had duodenitis, eight (11.3%) had oesophageal candidiasis, seven (9.9%) had bile reflux, six (8.5%) had reflux oesophagitis, six (8.5%) had ulcers (five duodenal, one gastric) and one (1.4%) had gastric cancer. Fourteen (19%) had endoscopically normal mucosa. The prevalence of H. pylori was 82.3% (32/38) in patients with antral gastritis. All ulcers and the cancer lesion (adenocarcinoma) were associated with H. pylori. Histological gastritis was found in 57 (81.8%) and was significantly associated with H. pylori. CONCLUSION: Although dyspepsia is common in diabetic outpatients at KNH, endoscopic findings and H. pylori status are not significantly different from those of non-diabetic population.

Does pre-scan oxygen improve ultrasonic imaging of the pancreas?

Ultrasonic imaging of the pancreas is often impaired by overlying bowel gas. Oxygen therapy has, in the past, been shown to be effective in reducing the gas in the cysts of pneumatosis coli. Using the same hypothesis, a randomized, single blind study comparing ultrasonic imaging of the pancreas with and without prior oxygen therapy was carried out. Fifty-eight consecutive patients with acute abdominal complaints were randomized to two groups: Group 1, control - no oxygen (n = 30, 14 male, 16 female, mean age 61.9 +/- 17.8 years); Group 2, treatment (n = 28, 14 male, 14 female, mean age 61.4 +/- 14.5 years) received oxygen therapy (100% humidified at 101/min for 8-10 h prior to the ultrasound). Pancreatic visualization was graded good, moderate or poor. Mean paO2 in Group 1 was 10.9 +/- 1kP and in Group 2 was 36 +/- 10.5kP (P < 0.001 unpaired t-test). Pancreatic visualization was: GOOD-Group 1, 8; Group 2, 19; MODERATE - Group 1, 8; Group 2, 4; POOR - Group 1, 14; Group 2, 5. Oxygen therapy is a safe, cheap, non-invasive method of improving pancreatic visualization and may act by reducing overlying bowel gas.

Diagnostic yield from barium enemas: a study among patients referred by general practitioners and hospital outpatient departments.

Although the double contrast barium enema is the standard radiological examination of the colon, it is not universally available to patients referred by their general practitioners. A retrospective survey of all double contrast barium enemas carried out over a two year period in one health district was undertaken to determine the diagnostic yield of pathological findings for patients referred by general practitioners and hospital outpatient departments and for patients who had rigid sigmoidoscopy prior to the enema and those who did not. A total of 530 patients were studied. The diagnostic yield for the hospital outpatients was 41.6% and in the general practitioner group 35.6%. In the patients who had rigid sigmoidoscopy the yield was 42.7% compared with 32.6% in those who had no prior sigmoidoscopy. It is concluded that the withdrawal of direct access for barium enemas to general practitioner patients in this district because of a low diagnostic yield cannot be justified. The lower diagnostic yield in the patients who did not have sigmoidoscopy supports the policy of requiring this examination prior to all barium enemas.

Low-dose oral administration of human interferon alpha can control the development of Theileria parva infection in cattle.

Two natural human interferon alpha preparations, (nHuIFN-alpha [Cantell]) and (nHuIFN-alpha [ISI]), were used for the oral treatment of cattle experimentally infected with Theileria parva parva. In the first experiment, 8 Friesian bulls were inoculated with a 1 in 10 dilution of a sporozoite stabilate of T.p. parva (Marikebuni) stock. Four of the cattle were treated daily with 1 international unit/kg body weight (i.u./kg bwt) of nHuIFN-alpha (Cantell) from day -2 to day 8 p.i. None of the 4 calves given IFN developed clinical theileriosis, but 3 of the 4 control calves died of theileriosis while the fourth had a mild infection. Three of 4 treated calves and the 1 surviving control calf developed a detectable antibody response to T.p. parva schizont antigen but, on challenged with a 10-fold higher dose of stabilate, the surviving control animal and only 1 of the 4 treated calves proved to be immune. In a second experiment, 4 groups of 4 calves were inoculated with the same stabilate dilution. Three treatment groups were given either 1 i.u. nHuIFN-alpha (Cantell), 1 i.u. nHuIFN-alpha (ISI), or 10 i.u. nHuIFN-alpha (ISI)/kg bwt from day -2 to day 8 p.i. once daily and the fourth group were controls. Clinical theileriosis occurred in 2 controls, 2 calves given 10 i.u. nHuINF-alpha (ISI), 1 calf given 1 i.u. nHuIFN-alpha (ISI) and no calves given 1 i.u. nHuIFN-alpha (Cantell)/kg bwt. Of these, 2, 1, 0 and 0 cattle died in the respective groups.(ABSTRACT TRUNCATED AT 250 WORDS)

High prevalence of abdominal aortic aneurysm in men with peripheral vascular disease: screening by ultrasonography.

A study was carried out to see if an ultrasonic examination of the abdominal aorta was indicated in every patient who attended an outpatient clinic with peripheral vascular disease (PVD). One hundred consecutive patients were studied and compared with a control group. The incidence of abdominal aortic aneurysm (AAA) in the control group was 2 per cent. In the study group, the male patients had an incidence of 20 per cent of aneurysm and ectasia, while the female patients had an incidence of 12 per cent. Of all the abnormal aortas found by ultrasound, only 31 per cent were palpable clinically. Two aneurysms that required operation were found, while the remainder are to be followed by regular ultrasound assessment. Further studies are necessary to conclude if screening of a high risk group, such as patients with PVD, is worthwhile.