Impact of season and discharge weight on complications and growth of Kangaroo Mother Care treated low birthweight infants in Mozambique

This study aimed to determine the impact of season and weight at discharge on growth rate and complications in low birthweight infants treated with Kangaroo Mother Care (KMC) in Maputo, Mozambique. The study population included 246 infants of birthweight < 2000 g. Follow-up until 2400 g was obtained in 64%. There were no seasonal differences in weight gain and the risk of complications of infants treated with KMC in hospital. During the cold season after discharge, the risk of serious complications, including death, was higher (risk ratio 1.96; p = 0:02) and more readmissions occurred (risk ratio 2.77; p = 0:04). We postulate that after discharge mothers are unable to comply with the kangaroo position at all hours of the day and that exposure to low ambient temperatures may explain the more frequent occurrence of complications in the cold season. The weight at discharge did not affect complications or growth rate. We conclude that the current policy to discharge infants when having gained weight on 3 consecutive days, regardless of the actual weight, or whether the weight at birth has been regained, is adequate. In the cold season particularly, more efforts may be needed to ensure compliance with kangaroo position after discharge and to educate mothers on early signs of complications such as bronchopneumonia to encourage timely care seeking. With this method, low birthweight infants can grow adequately.     

Daily Assessment of Stressful events and Coping in early post‐operative recovery after colorectal cancer surgery

This study describes the most stressful events and coping strategies used by patients with colorectal cancer 4–6 weeks after surgery and whether the coping strategies were considered helpful or not. For the investigation of situational coping, an exploratory design was used. One hundred and five patients from three Swedish hospitals were included to fill in the Daily Coping Assessment. Most stressful event, number and types of pre‐defined coping strategies used, and if the coping strategy used was considered helpful or not, were measured for 5 days. Of 523 diary entries, 180 reported no stressful events. The most stressful event, also with worst level of control and expectation, was “Pain,” followed by “Nausea/vomiting.” The areas causing most stressful events were “Bowel‐related” and “Surgery and treatment‐related problems.” Acceptance and Direct action were the most frequently used coping strategies. There was a wide range of perceived helpfulness if coping strategies were placed in relation to specific areas of events. The conclusion was that patients revealed several strategies for coping with stressful events but needed a higher level of preparedness for what might come and therefore need to be given appropriate support to cope during the early recovery phase. Such support is suggested to be person‐centred and oriented towards individually adapting standardised regimens, given the variety of situations to which the stressful events reported in the study were related.     

Histological validation of ultrasound‐guided neurography in early nerve regeneration

Ultrasound‐guided near‐nerve neurography is a new tool that can be used to assess nerve regeneration before reinnervation occurs. In this study, ultrasound‐guided near‐nerve measurements were validated against axon diameter counts in rabbits during a 15‐week regeneration period after a crush lesion of their peroneal nerve. The course of the nerve was determined ultrasonically, and the active near‐nerve needle electrode was maneuvered just next to the nerve under ultrasound guidance. Measured action potentials were compared with axon diameter counts from histological sections of these same nerves. A moderate to good positive correlation was found, which reached a maximum of 0.7 at a cut‐off of 3 μm, corresponding to the minimal size of the myelinated axons. Our results suggest that, following a similar validation study in humans, ultrasound‐guided near‐nerve neurography may be clinically useful when early evaluation of nerve activity is needed. Muscle Nerve, 2009     

淋病流行特征与淋球菌药物敏感性的流行病学研究

目的 为控制淋病的增长，探讨淋病流行病特征与淋球菌对常用药物敏感性的流行病学关系。方法 完整收集淋病的流行病学资料，测定每年淋球菌对各种药物的敏感度及耐药率，药物包括青霉素，四环素，环丙沙星，壮观霉素和头孢三嗪。结果 性病流行在10年内稳定上升，但淋病则由1993年开始呈稳定的负增长，壮观霉素及头孢三嗪在4年间未发现耐药菌株；环丙沙星的耐药率显上升，由1998年的56.4%上升至2001年的71.4%，产青霉素的耐药菌株（PPNG）和四环素耐药菌株（TRNG）在4年内分别上升10%和16.3%，结论 随淋病的有效控制，淋球菌对常用药物的敏感性降低，PPNG和TRNG菌株的明显上升表明淋球菌的耐药趋势正逐渐增强，喹诺酮类药物的高耐药率表明该类药物已不再适宜被推荐用于治疗淋病的首选药物，头孢三嗪和壮观霉素尚没有耐药菌株，但必须强调规范使用，保证在性病防治工作中有足够可供选择有效药物。     

Sub-optimal CD4 recovery on long-term suppressive highly active antiretroviral therapy is associated with favourable outcome

Objectives To examine risk factors for sub-optimal CD4 recovery on suppressive highly active antiretroviral therapy (HAART) and assess long-term clinical and immunological outcomes.
Methods Retrospective analysis of 286 HIV-positive patients from a university clinic who initiated HAART with CD4 count <350 cells/μL between January 1996 and July 2006 and achieved ≥52 weeks of viral suppression (VS). Sub-optimal and optimal CD4 count recovery were defined by gains of <150 and ≥150 cells/μL during the first year of VS, respectively. Risk factors were analysed by multivariate logistic regression and markers of immune maturation and activation were evaluated prospectively for a sub-group of patients with prolonged (>5 years) VS.
Results One hundred and two (36%) patients had sub-optimal CD4 recovery. Male gender, lower pre-HAART viral load, HAART toxicity and use of opportunistic infection (OI) prophylaxis were independent risk factors on multivariate analysis ( P <0.05). Outcomes of duration of VS on HAART (4 years), new OI events (1%) and mortality (5%) were similar between groups. Markers of immune maturation and activation were higher among patients with sub-optimal CD4 recovery ( P <0.05).
Conclusions Among HIV-positive patients with long-term VS, sub-optimal CD4 recovery was common but morbidity and mortality remained low. In addition, persistent CD4 T-cell activation appeared to blunt long-term CD4 gains.     

Post-traumatic tension faecopneumothorax in a young male: case report

Diaphragmatic rupture due to trauma is both well recognised and uncommon. The difficulties in diagnosing traumatic diaphragmatic rupture at the first admission are the most common causes of latent morbidity and mortality. Herniation of the abdominal viscera is the most common sequel with strangulation and perforation the most serious complication. This case outlines the delayed presentation of diaphragmatic rupture and herniation presenting as an acute tension faecopneumothorax. We review the relevant literature, with particular emphasis on the difficulties in diagnosis at presentation.