People, not cases.

While attempting to find out why so many of our elderly patients could not be discharged from hospital, we again observed the value of a knowledge of the patient's social background. Not only was it of great help in making a diagnosis and planning therapy, but it also stimulated our interest in the patient as a person, and was thus of mutual benefit to doctor and patient.     

Secretion of the gastrokinetic agent cisapride in human milk

Summary Ten puerperal women were treated with the gastrokinetic agent Cisapride 20 mg 8-h by oral tablets. Breast milk levels of Cisapride had reached a steady state by treatment day 3. Day 4 breast milk levels were 6.2±1.3 and serum levels 137±8.1 ng/ml (mean±SEM). The breastfeeding infant of a woman on the above treatment would ingest an amount of Cisapride 600–800 times lower than the usual therapeutic dose.     

Grey Hospital, King William's Town. Its formative years

Sir George Grey, Cape Governor and High Commissioner of British Kaffraria from 1854 to 1861, was the moving force behind the creation of proper hospital facilities in King William's Town for the Xhosa population of Ciskei and further afield. Grey's first step was to appoint Dr J. P. FitzGerald as Superintendent of Native Hospitals. FitzGerald opened the forerunner of Grey Hospital on 28 April 1956 in 18 cottages in the Pensioners' Village in King William's Town. During this phase the Superintendent played a major role in relieving the suffering during the cattle-killing mania in which an estimated 50,000 Xhosa eventually perished. He and Grey were also largely responsible for the erection of the Native Hospital which was designed by Woodford Pilkington. This imposing building cost over 16,000 pounds and was opened on 14 June 1859. As a fitting tribute to Sir George Grey the building was officially named Grey Hospital in 1887. This declared monument is today the oldest and best known institution in King William's Town and is still in use as a hospital.     

Circadian rhythm of locomotor activity in the four-striped field mouse, Rhabdomys pumilio: a diurnal African rodent

Although humans are diurnal in behaviour, animal models used for the study of circadian rhythms are mainly restricted to nocturnal rodents. This study focussed on the circadian behaviour of a rodent from South Africa that has a preference for daylight, the four-striped field mouse, Rhabdomys pumilio. In order to characterise the behavioural pattern of daily activity, locomotor rhythms were studied under different light regimes using an automated data recording system. Under conditions of natural daylight, which include dawn and dusk transitions, R. pumilio exhibited activity restricted to the daytime period. Activity was concentrated around morning and evening with a decrease during mid-day. A similar diurnal preference pattern of behaviour was recorded under a light-dark cycle of artificial illumination. Under conditions of constant darkness, the four-striped field mouse exhibited a free-running circadian rhythm of locomotor activity with activity concentrated during the subjective day. Free-running rhythms varied greatly between individuals, from slightly less to slightly more than 24 h (range = 23.10 to 24.80 h). Under conditions of constant light, the mice were more active during subjective day, but the free-running rhythm in all individuals was consistently longer than 24 h (range = 24.30 to 24.79 h).     

Tongue position and its relation to the cause of death and sequential stages of body decomposition observed during 608 forensic post-mortems

The purpose of this study was to document tongue position and its relation to the cause of death and sequential stages of body decomposition, as observed during the routine forensic pathological examination of bodies. The sample of 608 included all bodies examined by the first and third authors during the period April 2016 to September 2016. Tongue position was recorded in all cases where position of the tongue could be visually determined. The condition of the body was recorded as follows: fresh flaccid, fresh with rigor mortis, early decomposition, and advanced decomposition. The cause of death was recorded where known. The results showed that 86% of all bodies examined did not show a protruded tongue and that 92.8% of the bodies were in a state of fresh rigor mortis. The study also showed that tongue protrusion was more prevalent in certain causes of death, namely, hanging, burning, and drowning, but was never absolute. The authors believe that due to the low numbers of bodies presenting with protruded tongues, this phenomenon has previously been overlooked, the significance thereof underestimated, and the pathophysiology and pathomorphology never fully investigated.

     

Déterminants du faible poids de naissance chez des enfants nés de mères séropositives pour le VIH,non éligibles au traitement antirétroviral,en Afrique

BackgroundLow birth weight (LBW) increases the risk of infant death, but little is known about its rate and determinants among babies born to HIV-infected mothers in sub-Saharan Africa.MethodsThis study was conducted in South Africa, Burkina Faso, Uganda and Zambia, during the recruitment process of the PROMISE-PEP (ANRS 12174) clinical trial. The study sample included 1196 subjects screened between August 2009 and December 2011, respectively 254 in South Africa, 221 in Burkina Faso, 197 in Uganda and 524 in Zambia, all ineligible for antiretroviral therapy. Data were collected during ANRS12174 clinical trial antenatal and postnatal screening visits, and during an inclusion visit for completion of an electronic case report form (eCRF).ResultsThe mean (± SD) age of mothers was 27 ± 5 years and their mean CD4 count was 576 ± 195 cells/μL. Most mothers lived in a couple (78.7%), had no employment (72.3%) and had a good level of education (74% had gone to school). Male newborns predominated (51.7%). The mean birth weight was 3043 g ± 435 g, and 7.8% ([95%CI: 6.3%–9.3%]) of newborns weighed less than 2500 g. In univariate analyses, being married or cohabiting, body mass index, WHO HIV disease stage II, female newborn and low gestational age were associated with risk of LBW. In multivariate regression model, low gestational age (aOR = 3.74, P < 0.0001) and female newborn (aOR = 1.63, P = 0.04) were significantly associated with LBW.ConclusionThe risk factors for LBW found in HIV-infected women ineligible for antiretroviral therapy were the same as in the general population. There was no evidence of additional risk factors associated with HIV infection.