Prevalence of Neisseria gonorrhoeae infection in patients attending an antenatal clinic

Neisseria gonorrhoeae infection was diagnosed by culture using a selective medium (Thayer-Martin) in 140 (11.7%) of 1 200 pregnant black women attending an antenatal clinic in 1981. The study confirmed the need for specimens from three sites (endocervix, urethra and rectum)--endocervical cultures were positive in only 75.9% of infected women, in the remainder only the urethral and/or rectal cultures were positive. Rectal cultures were positive in 41.6%. Cultures of throat swabs from 200 women were all negative for N. gonorrhoeae. In comparison with endocervical specimens directly plated, high vaginal swab specimens placed in Stuart's transport medium before plating gave a lower yield of positive cultures. No penicillinase-producing N. gonorrhoeae strains were detected.     

Previous birth outcome of antenatal clinic attenders in northern KwaZulu--perinatal and infant mortality rates.

A questionnaire survey was undertaken among pregnant women presenting for the first time to antenatal clinics attached to Mosvold Hospital in rural northern KwaZulu. They were asked details of the outcome of their previous pregnancies and the survival of their last-born children. Of 2,388 mothers interviewed, 1,795 had given birth previously. Of these, 41% had had their last deliveries at home, 47% in hospital and 10% at clinics. The perinatal mortality rate was 38/1,000, with no significant differences between home and hospital or clinic births. The infant mortality rate for live-born children was 62/1,000. Fifty per cent of child deaths occurred at home. The study methodology was easily applied and provided an acceptable alternative technique for measuring child mortality rates, which are so difficult to obtain in rural areas in southern Africa.     

The impact of a pregnancy confirmation clinic on the commencement of antenatal care.

OBJECTIVE: To introduce a pregnancy confirmation clinic as part of antenatal care and to determine whether this would alter the gestational age at which patients commence antenatal care. SETTING: Three municipal antenatal clinics in Atteridgeville and Central Pretoria. METHOD: A pregnancy confirmation clinic was set up at three sites. At the clinic any woman wishing to confirm whether she was pregnant was offered a urine beta-HCG test. If this test was positive, on-site testing for syphilis, anaemia and rhesus status, dipstick testing of the urine, clinical examination and ultrasound examination were performed. Women with abnormal test results were commenced on appropriate treatment immediately and women requiring further medical care or investigation were referred appropriately. RESULTS: The study recruited 382 women, 145 of whom were defaulters from contraception. Half of the women (191) had a positive pregnancy test. The mean presenting gestational age was 12 weeks 4 days (standard deviation 5 weeks, range 5 weeks-25 weeks 2 days). Treatable conditions with the potential to influence pregnancy outcome were identified in 37 of the pregnant women (19.4%) Forty-three of the pregnant women intended to terminate the pregnancy. CONCLUSION: It is possible to shift the commencement of antenatal care to an earlier gestational age.     

Experiences of primiparas participating in the antenatal clinic service: a qualitative research

目的 了解参加助产士产前门诊的孕晚期初产妇的体验,为开展助产士产前门诊提供依据.方法 运用质性研究方法,对符合纳入标准的11例产前在助产士门诊就诊的孕妇进行深度访谈,用现象学方法分析访谈资料.结果 产妇对助产士产前门诊的体验主要有3个方面:助产士关注心理建设;门诊内容更丰富、交流形式更多样、时间跨度长;提高分娩过程的应对能力.结论 助产士产前门诊能使孕产妇在围生期加强心理适应,增强自然分娩的信心,提高产时应对能力.     

孕晚期初产妇对助产士产前门诊体验的质性研究

目的了解参加助产士产前门诊的孕晚期初产妇的体验,为开展助产士产前门诊提供依据。方法运用质性研究方法,对符合纳入标准的11例产前在助产士门诊就诊的孕妇进行深度访谈,用现象学方法分析访谈资料。结果产妇对助产士产前门诊的体验主要有3个方面:助产士关注心理建设;门诊内容更丰富、交流形式更多样、时间跨度长;提高分娩过程的应对能力。结论助产士产前门诊能使孕产妇在围生期加强心理适应,增强自然分娩的信心,提高产时应对能力。     

Prevention of hepatitis B in the surgical clinic

The introduction of prophylactics of hepatitis B in surgical departments results in 2 times lower growth of HBsAg carriers among medical men. The main prophylactic measures consist in an analysis of the donor blood and HBsAg examination of surgical patients, treatment of HBsAg carriers as acutely contagious persons, centralized sterilization of medical instruments and individual protection of the personnel.     

Incidence of loose bodies in an osteoarthritic hip.

In a prospective study of 75 consecutive primary Charnley low friction arthroplasties carried out for osteoarthritis, loose bodies were found in nine hip joints; an incidence of 12%. Whether their presence is the cause or the effect of the condition remains unclear. Their discoid or spherical shape suggests that they were free and had been subjected to sliding or rolling motion. Those of irregular shape may have remained partly attached within the capsule, or become confined to a space.     

Clinical and laboratory characteristics of hypernatraemia in an internal medicine clinic.

BACKGROUND: Hypernatraemia is a frequent electrolyte disorder in hospitalized patients that has been mainly studied in an entire hospital population. The aim of this study was to determine the incidence, clinical characteristics, concomitant electrolyte abnormalities and outcome of hypernatraemia in an internal medicine clinic. Also, we sought to identify differences between patients who were admitted with hypernatraemia and those who developed hypernatraemia during hospitalization. METHODS: We prospectively studied patients who either on admission to our internal medicine clinic or during their hospitalization were found to have hypernatraemia (sodium concentration greater than 148 meq/l, 148 mmol/l). One hundred and thirteen patients out of 9158 patients at risk had hypernatraemia (incidence 1.2%). Of those, fifty patients had hypernatraemia on admission, whereas 63 had hospital-acquired hypernatraemia. RESULTS: Patients who developed hypernatraemia before hospital admission had a much lower mortality rate than patients with hospital-acquired hypernatraemia (28% vs 47.6%, P=0.03), despite the fact that they had a higher peak serum sodium concentration (160.4+/-9.9 vs 154.4+/-2.4 meq/l, P=0.000). Furthermore, they did not differ in either age or the frequency of concomitant electrolyte abnormalities in comparison with patients who developed hypernatraemia during hospitalization. There were two main subgroups of patients with hospital-acquired hypernatraemia. A total of 26 Patients (41%) exhibited a biochemical profile consistent with extracellular volume depletion, whereas 32 patients (51%) with euvolaemia. On the contrary, the majority of patients (82%) who were hypernatraemic on admission had hypovolaemic hypernatraemia. The construction of the receiver operating characteristics (ROC) plots revealed that the urea to creatinine ratio was the best predictor of the extracellular volume status. Indeed, a urea to creatinine value of 57 could differentiate between the groups with euvolaemic or hypovolaemic hypernatraemia with a sensitivity of 96.5% and a specificity of 100%. CONCLUSION: The incidence of hypernatraemia in the present study was 1.2% with a high mortality rate mainly in patients with hospital-acquired hypernatraemia. There were two main profiles of hospital-acquired hypernatraemia, one consistent with extracellular volume depletion and another with euvolaemia. On the contrary, the majority of hypernatraemic patients on admission exhibited hypovolaemia. Almost half of our hypernatraemic patients had at least one additional electrolyte disturbance.     

Eight years' experience of clinical activity in an outpatient fracture clinic.

Major changes to the method of planning and provision of health care in Britain have led to the introduction of contracts as the main means through which services are procured. Never before has the need for accurate and comprehensive clinical information been greater. Yet comprehensive outpatient information, though planned, is not yet available, and there is relatively little experience of such systems which have been introduced in individual localities. Fracture clinic patients are an important group of outpatient, not least because interventions are often undertaken as an integral part of the outpatient episode. This is relevant for estimating resource use and for pricing, but until now has been 'hidden' work as far as conventional information systems are concerned. This study describes the establishment and manifestation of a clinical information system based on a fracture clinic serving the majority of a population of 850,000. Information was gathered over 8 years on 61,635 patients, who had 72,984 diagnoses and received 93,878 treatments. An information system of the type described in this study can be of great value as part of the contracting process (for both purchasers and providers of orthopaedic services), as a basis for clinical audit and research, and to facilitate undergraduate and postgraduate teaching.     

Incidence of diabetes mellitus requiring insulin treatment after renal transplantation in patients with hepatitis C.

BACKGROUND: Hepatitis C virus (HCV) infection has been associated with an increased incidence of diabetes mellitus, both in the general population and among transplant patients. METHODS: To test this hypothesis, we reviewed the records of 1614 patients who had undergone renal transplant at six Spanish centres between 1992 and 1998. We established the rate of onset of diabetes mellitus requiring >1 month of treatment with insulin (insulin-treated diabetes mellitus, I-TDM) among the 177 patients showing HCV antibody seropositivity at the time of transplant (HCV+ group). As controls, 177 HCV patients were selected who had received a kidney allograft immediately before or after the study patients at the same centre. RESULTS: The HCV+ patients were well matched with controls in terms of characteristics (except a longer time on dialysis) and immunosuppressive treatment. After a mean follow-up of 44 months, 28 cases of I-TDM were diagnosed (9.6% in HCV+ and 6.2% HCV-, not significant (NS); odds ratio 1.6; 95% confidence interval 0.75-3.50). The onset of I-TDM was somewhat later in HCV+ patients (467 days vs. 292 days in HCV- patients, NS). Multivariate analysis identified the following prognostic factors for I-TDM onset: age and BMI at the time of transplant, and polycystic kidney disease as the underlying cause of chronic renal insufficiency. No correlation was found with HCV positivity or time on dialysis. CONCLUSIONS: We were unable to confirm a greater incidence of post-renal transplant insulin-requiring diabetes in association with HCV infection. However, the observed tendency towards such an association suggests that the follow-up period would need to be extended.