Acute lower respiratory tract infections in children admitted to Port Moresby General Hospital

The clinical pattern of acute lower respiratory tract infection (ALRTI) in children admitted to Port Moresby General Hospital (PMGH) was studied. Most patients (60%) were less than twelve months of age. Common symptoms were cough, fever and shortness of breath. Common signs were crepitations, chest recession, elevated temperature and tachypnoea. Concurrent illness was common, with evidence of malnutrition in 62% patients. Most patients were anaemic (haemoglobin less than 10g per dl). Blood cultures isolated pathogens in 13% of patients in which it was done, the most common isolate being Haemophilus influenzae. Chest radiograph showed most patients had multisegmental changes, with the lower lobes commonly involved. Of the 129 patients, discharges accounted for 106 (82%), while 15 (12%) absconded and eight (6%) died. Of those 121 discharged or absconding, 15 (12%) were readmitted within three months of departure. Sixty-six (51%) patients stayed in hospital for four days or less. Of the eight patients who died, six (75%) were malnourished, six (75%) were less than eighteen months of age, seven (87.5%) were sick for one week or less before admission, five (62.5%) had received antibiotics before admission and chest radiograph showed more lung zones affected than in those not dying. Of the eight patients who died, six had white cell counts (WCC) performed and none of these was more than 30,000.     

Survey of neonatal jaundice in Port Moresby

Neonatal jaundice is a common problem in Port Moresby. A survey was carried out on 50 consecutive jaundiced neonates in an attempt to delineate the causes of severe neonatal jaundice (bilirubin 15 mg. % or more). ABO blood group incompatibility, G-6-P-D deficiency and infection accounted for 62% of cases while no cause could be found in 38% of cases. Low birth weight, multiple births, male sex, asphyxia, delivery occuring outside the hospital, and vacuum extraction were associated more commonly with jaundiced neonates than with the controls. There was a statistically significant association between the use of promethazine in the mother during and after labour and jaundice in the newborn. The association between the use of sulphonamides in the mother after delivery and neonatal jaundice was suggestive but not statistically significant.     

Trends in infant feeding in Port Moresby

A survey of infant feeding practices was conducted among children aged less than 1 year attending an urban health clinic and the main Children's Outpatients Department (COPD) in Port Moresby in 1986. A further survey was conducted in 1987 to assess the short-term trends. The use of artificial milk increased by 60%, from 9.4% in the first to 15.2% in the second survey. This increase was particularly marked in the COPD sample. Bottle feeding accounted for 95% of artificial feeding methods. In 67% of cases the reason given for using artificial feeding was that the mother was working. Legislation and an explicit government policy to foster the establishment of creches in the work place may be necessary to counter the worrying increase in artificial feeding.     

Yaws in the periurban settlements of Port Moresby,Papua New Guinea

Yaws is a re-emerging disease in Papua New Guinea. A resurgence of yaws is documented in the periurban settlements around Port Moresby. A total of 494 cases were identified from April 2000 to September 2001. The age distribution ranged from 2 years to adult (median 9 years). Presenting symptoms were adequately recorded in 286 cases (58%). Of these, 42% presented with raised painless sores, 47% with bone/joint symptoms only and 11% with both sores and bone/joint symptoms. Children in communities with a suspected high prevalence were surveyed and examined for presence of primary yaws sores. 33 out of 227 children examined (15%) had evidence of primary yaws sores. Initial control measures have been case-finding and treatment of contacts, but in areas of known high prevalence mass treatment is planned.     

Blood pressure distribution in children at Port Moresby, Papua New Guinea

A study of blood pressure levels in 626 apparently healthy children aged 8 to 16 years in Port Moresby, Papua New Guinea showed that blood pressure gradually increased with age, was generally higher in females and correlated positively (p less than 0.001) with age, body weight, height and an index of obesity. Body weight and height appear to be the most important predictors of blood pressure. Of the children examined, 32 (5.1%) had elevated blood pressures which were more than two standard deviations above the mean.     

膜固思达治疗慢性糜烂性胃炎的疗效观察

目的:观察新型胃黏膜保护剂膜固思达[成分为瑞巴派特(rebamipide),化学名为2-(4-氯苯甲酰胺基)-3-(1,2-二氯-2-氧代-4-喹啉基)-丙酸]治疗慢性糜烂性胃炎(CEG)8周的疗效.方法:本研究共纳入经内镜确诊的慢性糜烂性胃炎60例.分组给药治疗8周后评估症状改善程度,内镜取胃黏膜标本,观察病理、检测PGE2和MDA水平.结果:56例患者完成8周治疗疗程.试验组与对照组症状均较治疗前有显著性改善(P＜0.05),但两组间无明显差异.胃组织病理显示试验组腺体密度和腺体形态恢复明显优于对照组(P＜0.05).试验组与对照组内镜下糜烂愈合总有效率差异无显著性(P＞0.05).试验组和对照组中PGE2及MDA的含量较治疗前均有明显改变(P＜0.05),试验组中PGE2的含量较对照组升高明显,MDA的含量较对照组下降明显,试验组与对照组间差异有显著性(P＜0.05).结论:膜固思达对CEG患者的症状有改善作用,促进胃黏膜糜烂的愈合,减轻炎症反应,提高胃黏膜内PGE2水平及降低MDA水平,膜固思达是一种有效的胃黏膜保护剂.     

隆起糜粒性胃炎108例分析

隆起糜烂性胃炎(convex erosive gastritis，简称CEG)又称慢性糜烂性胃炎或疣状胃炎，是一种在内镜下具有特征性改变的胃黏膜病变，现将我院近几年来经胃镜诊断的108例总结分析如下，并着重讨论其临床特征及可能的发病机理。     

糜烂性胃炎756例内镜分析

目的：探讨内镜下糜烂性胃炎（EG）的特点。方法：回顾性分析756例EG的内镜资料。结果：胃窦炎的病变程度与胃体炎差异无显著性（P＞0.05）,合并十二指肠溃疡30.0％,胃溃疡12.6％,有较高的肠化检出率（36.4％）,幽门螺杆菌（Hp）与糜烂类型、糜烂程度、有无肠化生及不典型增生,差异均无显著性（P＞0.05）,与有无炎症活动及炎症程度差异均有显著性（P＜0.005）。结论：EG内镜下分型及病变程度的划分,对病情判断和治疗随访有指导意义;要积极治疗肠化生和不典型增生;Hp可以促使该病的发展。     

内镜下氩离子凝固术治疗隆起糜烂性胃炎的疗效观察

本院从2002年2月起于消化内镜下应用氩离子凝固术(APC)治疗隆起糜烂性胃炎,疗效满意,现报道如下. 1 临床资料 1.1 一般资料共114例,男性75例,女性39例,年龄(42.2±2.1)岁(24～77岁).所有病例均有不同程度的消化不良症状,进食后腹胀,腹部闷痛,返酸,嗳气,偶有早饱感,其中3例伴有黑便.     

A case-control study of stillbirths at the Port Moresby General Hospital

From September 1995 to May 1997, 315 consecutive stillbirths and 315 randomly selected controls were studied at the Port Moresby General Hospital to determine the causes of the deaths, to describe the sociodemographic and reproductive characteristics of the mothers, and to see if there were any avoidable factors in the stillbirths and where the responsibility for them lay. 249 (79%) of the stillbirths were antepartum and 14% were intrapartum; the timing of death could not be determined in the remaining 21 (7%). 36% of the stillbirths were unexplained. The common identified causes were: syphilis (VDRL and TPHA positive) 10%, intrauterine growth restriction/placental insufficiency 9%, antepartum haemorrhage 9%, malaria 6%, major congenital abnormalities 6%, cord accidents 6%, pregnancy-induced hypertension 5% and acute intrapartum asphyxia 4%. Multiple logistic regression analysis showed a significant association between stillbirth and the following variables: husband's occupation unskilled, age over 35 years, poor antenatal attendance, a past history of stillbirth, syphilis and malaria. An avoidable factor was established in 41% of the cases; in 60% the responsibility for the avoidable factor lay with the patient and her relatives.     

Total lymphocyte counts in adult HIV/AIDS patients in Port Moresby General Hospital

We carried out a prospective study of total lymphocyte counts in 124 adult patients who were diagnosed with HIV (human immunodeficiency virus) infection and/or AIDS (acquired immune deficiency syndrome) and were admitted to Port Moresby General Hospital (PMGH) from January to June 2003. The median and mean values of lymphocyte counts in these patients were found to be 0.7 x 10(9)/l and 0.9 x 10(9)/l, respectively, with a standard deviation of 0.7, both of which counts are significantly lower (p < 0.0001) than those found in members of a control population who were well and HIV-antibody-negative. We found that the lower the total lymphocyte count, the more clinically advanced was the HIV disease state. Haemoglobin values were also significantly lower in these patients. For 35% of these patients, tuberculosis was the principal diagnosis made upon being admitted. An apparent 11% of the patients who had a clinical suspicion of AIDS were HIV-antibody-negative. Total lymphocyte count methods could be used in developing countries that do not have appropriate facilities for CD4 count and viral load assays in order to monitor the patient's disease state and progression towards AIDS.     

Oral health status of teenage schoolchildren in Port Moresby, Papua New Guinea.

In Papua New Guinea the main dental problem has been periodontal disease and related conditions. Dental caries appears to be low in many community groups. The aim of this study was to explore the prevalence of dental caries and the periodontal health status of teenage schoolchildren in Port Moresby. 200 children of mean age 15.4 years were examined from two urban community high schools in Port Moresby. 44% of the children examined were caries-free and the average decayed, missing or filled teeth (DMFT) score was 1.43, while only 2.5% of the children had totally healthy periodontal tissues. 18% of them showed pathological periodontal pockets of 4 or 5mm in depth, the remaining children having either gingival bleeding, calculus or both. The results indicated that this group of children showed a low prevalence of dental caries and a high prevalence of periodontal problems. No cases with deep periodontal pockets of 6mm or more were found.     

安徽省消化性溃疡和糜烂性胃炎的治疗状况调查分析

目的:调查分析安徽省使用质子泵抑制剂(proton pump inhibitor,PPI)治疗消化性溃疡和糜烂性胃炎患者的现状.方法:将安徽省和全国消化性溃疡和糜烂性胃炎的治疗调查资料作对比分析.结果:安徽省和全国消化性溃疡的幽门螺杆菌(Hp)感染率差异有统计学意义(P＜0.01),而糜烂性胃炎感染率无统计学意义(P＞0.05);安徽省对消化性溃疡Hp感染采用Hp根除 维持治疗高于全国(P＜0.05),而对消化性溃疡Hp阴性、糜烂性胃炎Hp阳性及阴性患者的治疗,抗Hp治疗方案差异均无统计学意义(P＞0.05).结论:安徽省对消化性溃疡Hp阳性者以Hp根除 维持治疗为主,其它治疗与全国相仿.     

A case-control study of singleton low birthweight babies at the Port Moresby General Hospital

A retrospective study of 432 consecutive singleton low birthweight babies and 432 unmatched controls was carried out at the Port Moresby General Hospital from January to December 1988. Of the 432 low birthweight babies 65% were preterm, 27% were light for gestational age, 6% were both preterm and light for gestational age and 2.5% could not be classified. The results of the analysis showed low birthweight to be significantly associated with the past delivery of a low birthweight infant, very young and elderly mothers, lack of antenatal care, poor family planning, hypertensive disease in pregnancy and intrauterine death. This study reveals that maternal education and improved antenatal care and family planning would ultimately reduce the incidence of low birthweight babies and perinatal mortality in Papua New Guinea.     

The aetiology of severe anaemia among antenatal patients of the Port Moresby General Hospital

Between October 1998 and September 2000, 111 consecutive pregnant patients admitted to the Port Moresby General Hospital antenatal ward with a haemoglobin level of 6 g/dl or less were studied. The main causes of the severe anaemia were as follows: iron deficiency on its own or in combination with another factor 66%--iron deficiency on its own 43% and combined folate and iron deficiency 23%--and folate deficiency 18%. Malaria was a contributory factor in 13 patients (12%). A combination of blood film, bone marrow study, serum assays of ferritin, folate and vitamin B12, and mean corpuscular volume (MCV) was used to determine the cause of the anaemia. Ferritin levels on their own poorly correlated with the presence of iron in the bone marrow. A low MCV correlated well with iron deficiency anaemia while a high MCV was associated with folic acid deficiency. It would seem therefore that while a bone marrow study is mandatory to reach a definitive diagnosis of severe anaemia, MCV, in conjunction with the red cell morphology on blood film, would be a good marker for iron and folic acid deficiency anaemia, especially as we do not have serum assays readily available for folate, ferritin and vitamin B12 in Papua New Guinea.