Congenital diaphragmatic hernia in a developing country

INTRODUCTION: Outcome of neonates with congenital diaphragmatic hernia (CDH) varies widely and the data from developing countries is scanty. We aimed to study the management and outcome of CDH. We also aimed to ascertain prenatal and postnatal factors affecting the outcome. METHODS: A retrospective review of neonates with CDH admitted to a teaching hospital was conducted. Demographical data, prenatal and postnatal factors, birth details, management and outcomes were studied. Survival was the primary outcome. RESULTS: 16 live-born neonates with diaphragmatic hernia were admitted during the study period. All neonates had hernia on the left side. Mean (standard deviation) gestational age and birth weight were 38.6 (1.5) weeks and 2,616.6 (457) g, respectively. Polyhydramnios was associated in one patient, and additional anomalies in five patients (31.3 percent). Overall survival was 56.3 percent. The CDH was detected prenatally in four and postnatally in 12 patients. 12 neonates underwent surgery and nine survived. Prenatally-detected cases had significantly reduced survival to surgery, overall survival and lower Apgar scores at one minute (p-value is less than 0.04). Median age at surgery was 48 hours. Average duration of mechanical ventilation among survivors was 91.5 hours. Neonatal intensive care unit stay ranged from five to 27 (median nine) days. Six of seven deaths occurred within 72 hours of life. Non-survivors had significantly low Apgar scores and were symptomatic within 12 hours of life (p-value is less than 0.03). CONCLUSION: Greater than 50 percent survival of neonates with CDH was observed in a centre with conventional ventilation. Poor outcome is likely in neonates who present within 12 hours of life.     

A blood pressure clinic in a developing country

There are few studies of hypertension in Sudan. In this report, 124 patients attending a newly established hypertension clinic are studied, most of whom were taking irregular treatment initially. Seventy-three (59%) had a strong family history of hypertension. There was a very low incidence of cigarette smoking (13.7%), and alcohol consumption (4.8%). As with blacks in the U.K. and the U.S.A., the commonest complications were cerebrovascular accidents and congestive cardiac failure. Most of the patients had moderately elevated blood pressures on the first visit, which fell significantly after 3 and 6 months of clinic attendance. Methyldopa and thiazides were the commonest drugs used, but a small pilot survey demonstrated that beta-blockers were effective. The high cost and poor availability of drugs contribute to poor compliance in these patients.     

Problems with a renal replacement programme in a developing country

Since August 1984 patients with end-stage renal disease in Kenya have been started on haemodialysis with a view to renal transplantation. In a two year period (August 1984-August 1986) 77 patients mean age 29.6 years (49 males), have been dialysed. The mean duration on dialysis prior to death or transplantation was 2.9 months (range 1 day to 11 months). Fifty patients (65%) died while on dialysis, including 2 who had had unsuccessful transplantation. Fourteen patients were still on dialysis, 11 had discharged themselves to peripheral hospitals for conservative management, and 2 had had successful renal transplantation. The possible causes of this abysmal experience include admission of critically ill patients, shortage of trained staff, over-dependence on arteriovenous shunts for vascular access, lack of centralization of patient management, recurrent shortage of essential equipment and reagents and a slow pace of transplantation.     

双胎妊娠围产儿不良结局的影响因素分析

目的：探讨双胎妊娠围产儿不良结局的原因。方法：选取2013年1月1日至2013年12月31日在重庆市妇幼保健院住院分娩的双胎孕妇251例,回顾性分析孕妇及围产儿的临床资料,对影响围产儿不良结局的因素进行分析比较。结果：（1）251例双胎妊娠中,围产儿不良结局有87例,不良结局发生率高达34.66%,围产儿死亡21例,围产儿死亡率8.37%。（2）单因素分析结果：受孕方式、绒毛膜性、孕妇合并未足月胎膜早破、妊娠期糖尿病双胎妊娠围产儿结局有明显差异（P<0.050）。（3）多因素分析结果：剖宫产分娩是双胎围产儿结局的保护性因素（P=0.000,OR=0.086,95%CI=0.023~0.321）。未足月胎膜早破和单绒毛膜性是双胎妊娠围产儿结局不良的危险因素（P=0.010,OR=2.979;P=0.043,OR=5.689）。结论：单绒毛膜性、孕妇合并未足月胎膜早破双胎是双胎妊娠围产儿结局不良的主要危险因素,而分娩方式剖宫产术是保护性因素。     

足月新生儿高间接胆红素血症的围生因素分析

目的探讨围产期各种相关因素与高间接胆红素血症发病的关系。方法选择2010年11月～2O11年6月180例足月高间接胆红素血症患儿,同时随机抽取同期产科出生150例无高间接胆红素血症足月儿作对照组。采用单因素分析和逐步logistk回归分析的方法,筛选高间接胆红素血症发病的危险因素。结果引起高间接胆红素血症的围生因素包括胎龄、产式、窒息、开奶时间延迟、胎粪排出时间延迟、喂养方式、出血和出生体质量下降。其中引起高间接胆红素血症独立的高危围生因素为胎龄、开奶时间延迟、喂养方式、出血和出生体质量下降。结论临床对具有多种高危围生因素的患儿应提高对其发生高间接胆红素血症可能的预见性,及早采取预防措施。     

有卒中危险因素的住院患者对卒中危险因素及卒中风险的认识

目的 调查神经内科住院患者中有卒中危险因素的人群对卒中危险因素、自身卒中风险、卒中预防的认知情况.方法 2012年1-8月,采用自制调查问卷,以面对面的方式,对重庆医科大学附属第二医院神经内科住院患者中500例有卒中危险因素者进行调查.调查内容主要为要求患者回答卒中危险因素、自身是否存在卒中风险以及卒中预防措施等,并应用Logistic回归分析方法对相关因素进行分析.结果 共完成调查问卷467份.其中,46.3％的患者能正确回答至少1个卒中危险因素,15.5％能回答≥3个.回答卒中危险因素中比例最高的分别为高血压(39.4％)、高脂血症(17.1％)及糖尿病(14.6％).44.8％的患者意识到自己存在卒中风险,多因素Logistic回归分析显示,文化程度、高脂血症、心脏病、既往卒中病史与卒中风险认识水平独立相关.55.2％的患者认为卒中能够预防.卒中预防措施中提到最多的是合理饮食(29.3％)、适当锻炼(28.5％)、避免情绪激动或跌倒(18.4％).结论 神经内科住院的卒中高危患者缺乏对危险因素、卒中风险及卒中预防措施的认识,有必要加强健康教育以提高其对卒中预防的认识水平.