Carriage of Staphylococcus aureus among hospital personnel in a Nigerian hospital environment

Among the 395 hospital staff examined during this study, 35.2pc of them were found to carry S. aureus in their anterior nares. The carriage was slightly higher in females (35.8pc) compared with 34.4pc in males, although it was not statistically significant. When the different age groups and professions were considered, the carriage was highest among the age group of 21-30 years and with the Nursing staff, who incidentally, are closest to the patients and had the highest number among the staff members examined. The carrier rate was also significantly higher (P less than 0.05) among staff members who had worked in the hospital for 7-10 months compared with other staff. There was a good correlation (97pc) between coagulase positivity and mannitol fermentation, while Methicillin, Claforan and Gentamycin were found to be very effective against most of the isolates. On re-examination of those staff members who ar closely associated with the patients two years after the initial exercise in 1987, it was evident that a significant number (P less than 0.05) of those carriers of Staph aureus in our hospital are not persistent ones.     

胸部X线透视检查在精神科体检中的应用价值

目的 探讨胸部X线透视检查(胸透)在精神科体检中阳性检出率及应用价值.方法 搜集22 683例住院精神病患者的胸透资料,按照年龄进行分组,计算阳性检出率,采用x2检验进行统计学处理.结果 精神病患者胸透阳性检出率为0.71％,40岁以上各年龄组各种疾病阳性检出率增加明显;40 ～49岁组与30～39岁组[0.50％( 21/4174)比0.22％(9/4081),P＜0.05],50～59岁组与40～49岁组[1.01％( 35/3473)比0.50％ (21/4174),P＜0.05],≤39岁与≥40岁组的阳性检出率差异具有统计学意义(P＜0.01).结论 胸透在精神科体检中阳性检出率低,且受X线照射剂量大,不应作为入院常规体检项目,应根据受检者的年龄、症状、既往病史等有选择地进行胸部X线摄影.     

Sexual function in males following abdomino-perineal resection in Nigeria.

Twenty-six male patients who had abdomino-perineal resection for ano-rectal carcinoma between 1980 and 1988 were interviewed during their follow-up visits. Emphasis was on their sexual function. The age range was between 19 to 40 years with a mean of 27 years. Eight patients (31 pc) had complete loss of sexual function. Eighteen patients (69 pc) had complete or partial sexual function. 15 patients (57 pc) had normal sexual function. Compared to what obtains in developed countries, cancer of the ano-rectum is relatively commoner in the young in our region. A good proportion of these will develop impaired sexual function after abdomino-perineal resection. It is important that this probable complication be discussed fully with the patient before the operation, since the loss of sexual function in a young male is a major form of morbidity in this sub-region.     

Pattern of HIV-infection in Hurungwe district, Mashonaland West, Zimbabwe.

After the first case of HIV-infection had been diagnosed in 1986 in a Northern district of Zimbabwe, a local hospital based surveillance system, was introduced. In order to monitor the spread of the epidemic in the district, residence, age, sex and clinical presentation of all newly diagnosed HIV-patients were recorded. After three years, the data were compiled and analysed with the following results. Altogether 887 symptomatic HIV-patients (0.5 pc of the district population) were diagnosed. The most common HIV-associated signs and symptoms were PGL (47 pc), chest infection (29 pc), herpes zoster (24 pc) and chronic STDs (15 pc). The female-to-male ratio in adults was 1.4. The average age on diagnosis in women was 26.0 +/- 6.7 years and in men 30.7 +/- 8.6 years. The three years' cumulative incidence of HIV-cases was 27.2/1,000 in the urban area and 3/1,000 in the rural areas of the district.     

Raised intracranial pressure of obscure cause: prospective clinical review on African Tanzanian patients.

This paper reports a clinical review of 13 patients with raised intracranial pressure of obscure cause seen over a six-year period. Patients were young in the 8 to 40 years age range. Female patients accounted for 54 pc. About half of the females had menstrual abnormalities. 15 pc were obese while the rest were normal or underweight. A previous long history of headache was present in patients with focal neurological signs. The main presenting symptoms were headache and reduction in visual acuity. Main signs were papilloedema and reduced visual Acuity. After a short term follow-up period of one to six years, (mean three years), the general outcome was good with recurrence in one patient. Headache and visual symptoms recovered early after treatment. Focal long tract signs recovered rather slowly. Twelve patients are at present free of symptoms. One died from mesenteric vessel thrombosis and was presumed to have pregnancy related sagittal sinus thrombophlebitis.     

Assessment of oesophageal motor function in patients with dysphagia or chest pain - the Clinical Outcomes Research Initiative experience

BACKGROUND: Available prospectively acquired data on the distribution of oesophageal motor abnormalities in patients being evaluated for non-cardiac chest pain and/or dysphagia are relatively scarce. AIM: To evaluate the distribution of oesophageal motor abnormalities in patients with dysphagia, non-cardiac chest pain or both using the national Clinical Outcomes Research Initiative (CORI) database. METHODS: The CORI oesophageal motility database originates from 19 community, university and VA medical centres. Data were collected using a computerized motility report-generating program, combined with the CORI module. Data from each site were encrypted and sent to the CORI National Repository for analysis. The database includes the assessment of the lower and upper oesophageal sphincter function and the motor activity of the oesophageal body. RESULTS: Five hundred and eighty-seven consecutive patients who underwent motility studies between 1998 and 2001 were included in the CORI database and analysed for this report. Four hundred and three patients (69%) had dysphagia as their primary indicator for the examination, 140 patients (24%) had non-cardiac chest pain and 44 patients (7%) had both dysphagia and non-cardiac chest pain. In all three groups, a normal motility study was the most frequent finding (dysphagia, 53%; chest pain, 70%; both, 55%). The most common motility abnormality in the group with non-cardiac chest pain was a hypotensive lower oesophageal sphincter (61%). Nutcracker oesophagus and non-specific oesophageal motility disorders were each diagnosed in only 10% of patients with non-cardiac chest pain. In patients with dysphagia, ineffective peristalsis was the most common oesophageal dysmotility (27%), followed by achalasia and non-specific oesophageal motility disorders (18% and 14%, respectively). Achalasia and non-specific oesophageal motility disorders were the most common oesophageal motility abnormalities in patients with both chest pain and dysphagia (35% and 25%, respectively). CONCLUSIONS: The most common oesophageal motility abnormality in patients with non-cardiac chest pain is a hypotensive lower oesophageal sphincter; nutcracker oesophagus and non-specific oesophageal motility disorders are relatively uncommon; the most common oesophageal motility abnormality in patients with dysphagia is ineffective peristalsis and, for those with both dysphagia and non-cardiac chest pain, it is achalasia.     

HIV infection in newly diagnosed tuberculosis patients in Ndola, Zambia

Between June and December 1987, 131 patients newly admitted to the tuberculosis wards of the Ndola Central Hospital, underwent a history and examination, chest radiography, sputum examination and an enzyme linked immuno sorbent assay (ELISA) (Wellcome), for human immuno deficiency virus (HIV) antibodies. For all sera testing positive, the ELISA was repeated on two different occasions before HIV seropositivity was confirmed. Eighty-three patients (67 pc) had tubercle bacilli on microscopy, whilst 76 patients (58 pc) were HIV positive (7 patients had no sputum on admission). Nine patients (7 pc) had signs of disseminated tuberculosis while the rest had evidence of pulmonary tuberculosis. Four patients (3 pc) had normal chest radiography, whereas the remainder had intrapulmonary lesions in their films. No association was found between presence or absence of bacilli and HIV seropositivity (P greater than 0.05). HIV seropositive tuberculosis patients were more likely to be younger and female when compared to HIV seronegative tuberculosis patients (P less than 0.05). It was concluded that HIV infection is common in newly diagnosed tuberculosis patients and that young and female patients are more likely to be HIV seropositive than their male counterparts.     

Infection after Harare valve V-P shunt operations: a review of 92 cases.

Case files of 92 patients who had their hydrocephalus relieved by the insertion of the Harare Valve shunt system were reviewed. All patients had undergone surgery for shunt insertion at the Harare Central and Parirenyatwa Teaching Hospitals in Harare, Zimbabwe, between January 1986 and January 1988. All but one patient reviewed had Harare valve ventriculoperitoneal shunt insertions. The commonest indication for shunt insertion was congenital hydrocephalus alone or coexisting with other abnormalities (62 pc). Post meningitic hydrocephalus and hydrocephalus associated with intracranial tumours were next in frequency at 26 pc and 9 pc respectively. The etiology of hydrocephalus was not diagnosed in one four-year-old patient. The ages of the patients on admission ranged from one day to seven years (mean 12.4 months). Infection rates correlated well with the etiology of hydrocephalus; lowest (2 and half pc) in patients with simple congenital hydrocephalus and highest (29.2 pc) in post meningitic patients. A variety of organisms were isolated from CSF, blood, wounds and catheter tips. Lactose fermenting coliforms, S. epidermidis and E. coli predominated. Infection was combated by antibiotics, shunt removal or a combination of both. The antibiotics most commonly used were the penicillins, chloramphenicol, cloxacillin and gentamycin.     

The use of drug level measurements in adult patients receiving theophylline, anti-epileptic drugs and amikacin.

This prospective study was conducted to determine how frequently measurement of drug levels was used in the management of adult patients receiving theophylline, phenytoin, phenobarbitone, carbamazepine or aminoglycosides in a large hospital. Fifty consecutive outpatients with asthma and 40 with epilepsy were interviewed and their records reviewed to determine which drugs had been prescribed and whether a level of the appropriate drug had been measured in the previous six months. Also, the records of 40 in-patients who were currently receiving amikacin were studied to determine whether serum levels had been measured at any stage during therapy with this drug. Serum theophylline levels were measured in only four (eight pc) patients who were taking this drug and were below the target range in two patients. Serum levels had been measured in 21 (52.5 pc) of 40 patients who were receiving 45 anti-epileptic drugs and were within the target in only nine. Serum amikacin levels were measured in 15 (37.5 pc) patients; blood had been taken for both peak and trough levels in 10 patients and found to exceed the target range in two patients. This study revealed that measurement of serum concentrations of theophylline, anti-epileptic drugs and amikacin was underutilised in the management of adult patients receiving these drugs at this hospital.     

Radiographic findings in cotton textile workers and the relationship to cigarette smoking

A group of 140 cotton textile workers from Shanghai, Shandong, Guangxi, and Beijing have had their chest radiographs taken using similar requirements. Most had come from the preparatory departments of cotton mills and had a history of exposure to cotton dust for at least 20 years. As controls, 140 healthy individuals with no dust exposure were matched with respect to sex, age, and smoking history. All the radiographs were read according to the ILO International Pneumoconiosis Classification, and the manifestations belonging to categories 0/0 and 0/1 were grouped as "normal," whereas categories 1/0, 1/1, and 1/2 and above as "abnormal." There was no significant difference in X-ray abnormalities between cotton textile workers and controls (P greater than 0.05). But when the data on the cotton textile workers and controls were combined, an appreciable difference in the incidence of radiographic abnormalities was found between smokers and non-smokers (P less than 0.001). Cotton dust exposure may induce nonspecific interstitial pulmonary changes, but these changes were exaggerated by cigarette smoking. These two factors appeared to have an additive effect on the pulmonary X-ray findings.     

Cavernous sinus thrombophlebitis in Zimbabwe.

Cavernous sinus thrombophlebitis (CST) was diagnosed in 19 black African patients who presented to two large, general hospitals in Harare, Zimbabwe, over an eight-year period. Diagnosis was based on clinical criteria. The mean age of patients was 22.5 years (range 8 months-70 years). Only three patients (15.5 pc), all of whom were promptly diagnosed and commenced on a regimen including intravenous, high-dose cloxacillin, recovered completely. In ten cases (52.6 pc), initial treatment was penicillin and chloramphenicol. Four of the 19 patients who had serious sequelae including residual blindness, complete ophthalmoplegia or unilateral proptosis, and six patients (31.6 pc) died. The higher than usual mortality rate in this series can be attributed to various factors including late presentation, delay in diagnosis and delay before initiation of effective antibiotic treatment. Whenever CST is suspected, antibiotic treatment should be administered without delay pending further evaluation, and the initial regimen should include high-dose antistaphylococcal antibiotics.     

Contact screening procedures for tuberculosis in Auckland

A five year audit of tuberculosis notifications for the three Auckland health districts revealed that 10.7% of notifications were the result of contact screening procedures. Most notifications from this source were children (73.2%) up to 16 years of age. By far the greatest yield from contact screening procedures was among contact of patients with infectious pulmonary tuberculosis (whose sputum is smear positive on direct microscopy): 78.8% of cases found by contact procedures were contacts of these infectious patients. The yield was particularly high for children who were close contacts of these cases: 23.8% of such children were considered to be infected by tubercle bacilli compared with only 1.1% of children who were casual contacts of these infectious cases. Few adults were found by contact procedures because: (a) only those with pulmonary disease were found, whereas among children all those who had been infected, the majority of whom had not developed tuberculous disease (so-called primary occult tuberculosis) were found, and (b) many adult contacts of smear positive pulmonary index cases were not followed with chest radiographs for long enough: only one half had six months of surveillance. By restricting contact screening procedures to contacts at highest risk the workload could be substantially reduced with minimal reduction in the yield of new cases.     

Ultrasonography as an adjunct to hydrotubation in the management of female infertility.

Thirty one female patients who were being investigated for infertility had hydrotubation with ultrasound monitoring (sonosalpingography) in addition to the standard tubal patency tests of hysterosalpingography (HSG) and dye test at laparoscopy. Compared to the standard tests, sonosalpingography (SSG) had a sensitivity of 90 to 100 pc and a specificity of 95 pc in detecting bilateral tubal occlusion. In the detection of side-specific patency of the tubes, SSG had a sensitivity of 94 pc and 89 pc when compared with HSG and laparoscopy respectively. The corresponding specificity values were 83 pc and 85 pc. Hydrotubation enhanced the ability of ultrasonography to detect such uterine abnormalities as uterine synechae, intrauterine septa and submucous fibroids. It was concluded that sonosalpingography is a sensitive and relatively safe screening method for assessing tubal patency in infertile women. It also provides valuable information about the uterine wall and uterine cavity.     

Possibilities of the strong posterior wall of inguinal canal in women

Three hundred and twenty-nine females aged 15-81 years (mean 51.5 years) and 1,928 males aged 17-76 years (mean 42.9 years) who presented with inguinal hernia over a ten-year period were reviewed. Combined ipsilateral direct = indirect (pantaloon) hernia appeared only from the fourth decade in both sexes with 7 (1.8 pc) and 111 (5.6 pc) cases occurring in females and males respectively. 3.5 pc of the total herniae in females and 18.6 pc in males were of primary direct type. 40 (12.2 pc) females and 270 (14 pc) males had bilateral hernia. There was a marked rise in the incidence of primary direct and bilateral hernia in males from the fourth and fifth decades. It is postulated that this is because defective collagen synthesis in the tissues of the inguinal region occurs more in males than in females.     

A clinical evaluation of children under the age of five years who are household contacts of adults with sputum positive tuberculosis in Harare, Zimbabwe

OBJECTIVE: To determine the prevalence and risk factors for transmission of tuberculosis in children under five years of age who are household contact of sputum smear positive tuberculosis adults in Harare, Zimbabwe. DESIGN: Cross sectional study. SETTING: City Health Infectious Diseases Hospital Outpatient Department. SUBJECTS: 174 children in contact with 102 index cases. MAIN OUTCOME MEASURES: TB infection status in children according to modified WHO classification of tuberculosis. METHODS: Under five year old contacts of sputum smear positive TB adults were recruited over a three month period. A coded questionnaire was used to document the following: socio-demographic profile of caregivers, duration of stay with the index case and presenting complaints. Contacts were evaluated by clinical examination, Mantoux testing, HIV antibody testing and chest radiographs. RESULTS: Of the 174 children in contact with 102 index cases evaluated, 109 (62.6%) were Mantoux positive (> or = 10 mm), 42% had abnormal chest X-ray, with hilar lymphadenopathy being the commonest abnormality. Forty nine percent of the children evaluated had probable TB, 28% had suspected TB and 23% had no TB. High alcohol acid fast load (AAFB) in the index case was independently associated with probable and suspected TB (OR 2.27 95% CI (1.05 to 4.87). CONCLUSION: The documented high transmission rate among under five years contacts in the study justifies the need for strengthening contact tracing and appropriate therapeutic management of identified children.     

Long-term treatment with antipsychotic drugs in conventional doses prolonged QTc dispersion, but did not increase ventricular tachyarrhythmias in patients with schizophrenia in the absence of cardiac disease

Objective: The aim of this study was to examine the hypothesis that long-term treatment with antipsychotic drugs in conventional doses prolongs QTc dispersion and increases ventricular tachyarrhythmias in patients with schizophrenia in the absence of cardiac disease. Methods: We measured QTc and QTc dispersion and ventricular tachyarrhythmias in 64 patients with schizophrenia, including 59 patients who received psychiatric medications, and five patients who did not receive psychiatric medications, and 45 healthy volunteers. None of the subjects had a history of cardiac disease or showed any abnormality in chest radiograph and transthoracic echocardiographic studies. None of the subjects had electrolyte abnormality. None of the subjects were taking drugs known to influence the QT interval, other than psychiatric medications. Results: QTc and QTc dispersion were significantly (P < 0.017) increased in patients who received psychiatric medications compared with patients who did not receive psychiatric medications, or with healthy volunteers [QTc: 0.442 (0.029), 0.418 (0.029), 0.417 (0.028) s, QTc dispersion: 0.054 (0.013), 0.038 (0.017), 0.038 (0.009) s]. Daily ventricular premature beats were 183 (689), 77 (23), and 86 (149), respectively. No ventricular tachycardia was observed. There were no correlation between QTc and QTc dispersion and ventricular premature beats. Conclusion: Long-term treatment with antipsychotic drugs in conventional doses prolonged both QTc and QTc dispersion in patients with schizophrenia, but did not increase ventricular tachyarrhythmias in patients with schizophrenia in the absence of cardiac disease. However, despite the negative findings, ventricular tachyarrhythmias may occur as a rare side-effect of antipsychotic drugs, particularly if a patient has additional risk factors. Received: 28 September 1998 / Accepted in revised form: 27 January 1999     

Pulmonary embolism in Ibadan, Nigeria: five years autopsy report.

The autopsy findings and clinical features in 60 patients with fatal pulmonary embolism (PE) in University College Hospital, Ibadan, between 1985 and 1989 are analysed in the current study. Pulmonary embolism occurred in 3,8 pc of all autopsied patients during this period. There was a male to female ratio 1,4 to one and average age was 47 years. Malignant neoplasms, infections and cardiac failure were the leading predisposing factors to PE identified. The ante-mortem clinical features consisted largely of non-specific respiratory symptoms of dyspnoea, cough, chest pain and haemoptysis. Of these patients, 15,6 pc were diagnosed ante-mortem as having PE. Pulmonary infarction occurred in 13,3 pc of the cases and was commoner in females and in patients with underlying cardiac diseases. This study emphasises the need for a high clinical index of suspicion to improve the antemortem diagnosis of this potentially fatal condition and to advocate a greater use of prophylactic anti-coagulant therapy in high risk patients.     

Radiological progression and lung function in silicosis: a ten year follow up study.

Chest radiographs and spirometric tests were performed on 81 patients who had silicosis from two granite quarries in 1975, 73 of whom were followed up for two to 10 (mean 7.2) years. Each patient's initial and most recent chest radiographs were assessed independently by three experienced readers, and the yearly declines in forced expiratory volume in one second and forced vital capacity were estimated from two to four (mean 3.45) serial spirometric readings. Estimates of individual dust exposure were based on extensive historical data on hygiene. All but 11 patients were no longer exposed to dust by the start of follow up, but 24 (45%) of 53 patients who had simple silicosis and 11 (55%) of 20 who had the complicated disease showed radiological evidence of disease progression. In patients who had simple silicosis and showed no radiological progression the yearly declines in forced expiratory volume in one second and forced vital capacity were modest (64 ml/year and 59 ml/year, respectively), whereas significantly greater declines in lung function were seen in those who showed radiological evidence of progression (97 ml/year and 95 ml/year, respectively). In addition to radiological progression the previous average dust concentration to which patients had been exposed also influenced declines in both forced expiratory volume in one second and forced vital capacity after allowing for the effects of age, smoking, duration of exposure, history of tuberculosis, initial state of disease, and baseline lung function. The probability of radiological progression was most strongly influenced by the average dust concentration previously exposed to. The progression of simple silicosis is thus accompanied by appreciable declines in lung function and is strongly affected by previous levels of exposure to dust.     

Fetal alcohol spectrum disorders (FASD) among Japanese children of alcoholic mothers]

OBJECTIVE: This study was carried out to examine fetal alcohol spectrum disorders (FASD) among Japanese children of alcoholic mothers. This is the first report concerning FASD in Japan. METHODS: The subjects were 30 alcoholic women who were inpatients in the Kurihama Alcoholism Center and had given birth to children. They were subjected to a semi-structured interview by the author. Sixty healthy women who had not drunk during pregnancy were used as a control group, and they also underwent semi-structured interviews. The alcoholic women were divided into two groups, 13 who drunk during pregnancies and 17 who did not drink. Twenty children experienced of prenatal alcohol exposure and 40 children did not. The three groups; i.e., 13 alcoholic mothers who had drunk during pregnancy and their 20 children (ALD group), 17 alcoholic mothers who had not drunk during pregnancy and their 40 children (ALND group) and 60 non-alcoholic control mothers and their 80 children (Control group), were compared concerning the mothers' drinking problems and abnormal deliveries, children's birth weights, congenital abnormalities, abnormalities of the central nervous system and psychological problems. RESULTS: The mean age of onset of problem drinking of the mothers in the ALD group was significantly lower than that in the mothers of the ALND group, and some of the mothers in the ALD group showed alcohol dependence before their pregnancies. The mean birth weights of the children of the ALD group, ALND group and Control group were 2816 g, 3128 g and 3142 g, respectively and the differences were significant. The children of the ALD group had significantly more abnormal birth episodes, developmental retardation and psychiatric symptoms than those in the other two groups. Among 20 children in the ALD group, FASD was suspected in 6 children (10% of the children of alcoholic mothers). Six children had low birth weights, abnormal birth episodes, mental retardation and psychiatric symptoms. CONCLUSION: One third of the Japanese children of alcoholic mothers had experiences of prenatal alcohol exposure and 10% of them had suspected FASD abnormalities.     

Oesophagectomy for carcinoma of the oesophagus--early results

Oesophagectomy for squamous cell carcinoma of the oesophagus was performed in 25 consecutive patients over a 3.5 years period, for an overall resection rate of 11 pc. It was an Ivor-Lewis in 19 and a left thoracotomy in six. The stage of the disease was II in two, III in six and IV in 17 cases. Seventeen patients had uneventful postoperative evolution. Complications occurred in eight patients: heart failure in three, anastomotic leak in three, massive chest wall infection in two and four of these patients died: a mortality rate of 16 pc. All the 21 patients who left the hospital were able to take normal diet. The mortality of oesophagectomy for cancer can be as high as 30 pc but decreases with better selection of patients and surgical experience. Cure is rarely achieved. Resective surgery, when successful, offers the best palliation for dysphagia. Resectability rate in all African series is very low. There is a need for a more aggressive surgery therapeutic attitude. Our series shows that it is possible in our environment to achieve an acceptable operative morbidity and mortality. With increasing experience, results can only improve.