Impact of Parallel Anesthesia and Surgical Provider Training in Sub-Saharan Africa: A Model for a Resource-poor Setting

Background  

The lack of appropriate numbers of anesthesia and surgical care providers in many resource-poor countries around the world, especially in rural populations, prevents adequate care of the large numbers of patients who require surgery in these settings.     

Reliability of mean power recorded during indoor and outdoor self-paced 40 km cycling time-trials.

The purpose of this study was to assess reliability of both indoor and outdoor 40 km time-trial cycling performance. Eight trained cyclists completed three indoor 40 km time-trials on an air-braked ergometer (Kingcycle) and three outdoor 40 km time-trials on a local course. Power output was measured for all trials using the SRM powermeter. Mean performance time across three indoor trials was 54.21 +/- 2.59 (min:sec) and was significantly different (P<0.05) to mean time across three outdoor trials (57.29 +/- 3.22 min:sec). However, there was no significant difference (P = 0.34) for mean power across three indoor trials (303+/-35W) when compared to outdoor performances (312 +/- 23 W). Within-subject variation for mean power output expressed as a coefficient of variation (CV) improved in both indoors and outdoors for trials 2 and 3 (CV = 1.9%, 95% CI 1.0 - 3.4 and CV = 2.1 %, 95 % CI 1.1 - 3.8) when compared to trials 1 and 2 (CV=2.1%, 95% CI 1.2-3.8 and CV=2.4%, 95% CI 1.3-4.3). These findings indicate that power output measured using the SRM powermeter is highly reproducible for both laboratory-based and actual 40 km time-trial cycling performance.     

Abnormal function of endocrine pancreas and anterior pituitary in Friedreich's ataxia. Studies in a family.

A family had three siblings affected with classic Friedreich's ataxia. One sibling died at age 20 with fulminant diabetic ketoacidosis. The other two affected siblings are identical twin sisters without clinical diabetes but with an abnormality in the metabolism of exogenously administered glucose. These twins also have abnormal hypothalamic-pituitary control of prolactin and possibly of growth-hormone secretion. This study extends the previous reports of endocrine deficienceis associated with Friedreich's ataxia. The mechanisms underlying this association are undetermined but could represent pleiotropic effects of the Friedreich's ataxia gene or secondary manifestations of the primary central nervous system degeneration, or both.     

Application of the IML Resistograph to the infield assessment of basic density in plantation eucalypts

Average bark-to-bark resistance of the IML Resistograph PD400 (hereafter referred to as ‘Resi’) was found to provide strong linear correlations with the basic density of 12-mm-diameter increment cores taken from standing plantation eucalypt trees. Relationships between Resi values and approximately 2 000 cores (predominantly Eucalyptus globulus but some E. nitens) were examined across seven studies (representing samples from nine distinct sites) in Tasmania, Victoria and Western Australia. Custom-written software was developed to process the Resi traces to automatically perform a linear baseline correction of the trace, and extract:

• over-bark and under-bark diameter

• bark thickness

• average resistance of the bark-to-bark (under-bark) trace

• average resistance of the outer 50 mm on the entry and exit side of the traces.

Baseline correction was needed to counter the variable effects among trees of needle drag across the diameter, largely a function of tree diameter and wood density.

Individual traces were collected in less than 20 s tree^?1. The sampling conditions of 150 cm min^?1 speed of forward movement (feed speed) and 3 500 revolutions per minute (rpm) were identified as optimal for the plantation eucalypts studied. The relationship between different feed speeds and rpm were linear and coefficients determined to allow average Resi resistance to be converted to a common set of sampling conditions. A simple linear regression was identified in each study to define a slope and intercept to convert the Resi values to basic density and determine the variance between them. Resi traces from different studies were not always collected using the same instrument and this is believed to explain most of the between-study variance in slope and intercept.

Trace processing software was built into a web-based package that is available to make trace processing easy, with defined variables downloadable for use in routine plantation assessment. Users can change the default slope and intercept values to suit their individual instruments or species as required. Further work is required to fully define the effects of instrument, site and species on these relationships.

The IML Resistograph PD400 was found to be an accurate and quick (40–70 trees hour^?1 person^?1) infield tool for estimating diameter and wood density in standing trees. When combined with automated, web-based processing software the methodology is among the lowest cost options conceivable for wood density assessment of plantation eucalypts.     

Use of an ammonia electrode for rapid quantification of Helicobacter pylori urease: its use in the endoscopy room and in the assessment of urease inhibition by bismuth subsalicylate.

The use of an ammonia electrode to quantify ammonia liberated by urease from Helicobacter pylori was assessed in an in vitro study. It was found to be highly sensitive (down to 0.7 ppm NH3) and highly reproducible (coefficient of variation 6.0%). Inhibition of urease by bismuth subsalicylate was evaluated as urease testing is often used to assess clearance of H. pylori in patients treated with bismuth. Concentrations of bismuth subsalicylate up to 5 mg/ml had no inhibitory effect but bismuth subsalicylate at 50 mg/ml resulted in 21% inhibition of the urease activity of an ultrasonicated H. pylori suspension. As a preliminary study, the ammonia electrode was assessed in the endoscopy room in comparison with conventional techniques for H. pylori diagnosis. Antral biopsies from 39 patients attending for routine diagnostic endoscopy were subjected to culture, histology, detection of urease activity with a commercially available slide test (CLO) and with the ammonia electrode to detect ammonia liberated from samples placed in urea solution. 21 patients were positive after 1 h with the ammonia electrode, compared to only 17 with the commercially available slide test. 20 were positive on histology and 19 by culture. All samples positive with the ammonia electrode were either positive by culture or by histology. The ammonia electrode offers a quick, sensitive, quantitative and cheap method for the detection and quantification of H. pylori.     

Interleukin-10 promoter polymorphisms in rheumatoid arthritis and Felty's syndrome

OBJECTIVE: To examine whether promoter polymorphisms associated with variation in interleukin-10 (IL-10) production are relevant to the development of rheumatoid arthritis (RA) or Felty's syndrome (FS). METHODS: DNA was obtained from 44 FS patients, 117 RA patients and 295 controls. The promoter region between -533 and - 1120 was amplified by polymerase chain reaction, and polymorphisms detected by restriction enzyme digest or sequence-specific oligonucleotide probing. RESULTS: We found no significant difference in allele or haplotype frequencies between the groups. CONCLUSION: There is no association between FS or RA and these recently identified IL-10 promoter polymorphisms. Other genetic or environmental factors could explain the alterations in IL-10 levels seen in these conditions.      

Asymptomatic glomerulonephritis after nonstreptococcal upper respiratory infections.

Two hundred forty previously healthy military personnel with nonstreptococcal upper respiratory infections were prospectively studied to define the incidence and clinicopathologic characteristics of possible virus-associated glomerulonephritis. Nine patients without preceding streptococcal infection had erythrocyte casts on urinalysis and glomerulonephritis on biopsy. Of these nine, four had a reduction in total hemolytic complement and five had serologic evidence of infection with adenovirus, influenza A, or influenza B. Initial renal biopsy showed either focal or diffuse mesangial proliferation in all nine, with mesangial C3 deposits in six specimens. Repeat biopsy in three showed histologic improvement or loss of immunofluorescent staining, or both. Sequential creatinine clearances were reduced to 74 to 90 mL/min.1.73 m2 in five patients for the duration of follow-up. We conclude that nonstreptococcal upper respiratory infection is frequently associated with glomerulonephritis and that abnormal glomerular structure and decreased creatinine clearances may persist for at least 2 to 8 months.