Cystic lung disease in Down's syndrome: a report of two cases

Previously unreported lung disease found at autopsy in 2 young infants with Down's syndrome and congenital heart disease (complete atrioventricular canal malformation with left-to-right shunt) is described. The perinatal and neonatal period was unremarkable, and there was no history of mechanical ventilation or administration of high concentration of oxygen for extended periods. In 1 of the cases respiratory symptoms and hyperinflation with focal cystic changes in the lung fields on chest X-ray were noted at 5-7 months of age. Pathologically there was cystic dilatation of alveoli with focal cuboidal metaplasia of alveolar epithelium and mild to moderate focal alveolar septal fibrosis. Wilson-Mikity syndrome, congenital pulmonary lymphagiectasia, bronchopulmonary dysplasia, and idiopathic interstitial fibrosis of lungs were ruled out on clinical and/or pathologic grounds. Factors such as compression of bronchi by enlarged pulmonary arteries or cardiac chambers, peribronchiolar accumulation of fluid, pulmonary hypoplasia occurring in Down's syndrome, and episodes of pulmonary arterial hypoperfusion associated with severe congenital heart disease may be related to the pathogenesis of the lesion.     

A woman with leg cramps and rash

A 68-year-old woman presented with generalized weakness and a rash on her lower extremities. The weakness began one week earlier, shortly after treatment for leg cramps and two days before the rash appeared. She had also had blood-streaked sputum a few days before admission. There was no history of bleeding diathesis, nose bleeding, hematuria, vasculitis, muscle or joint aches, cinchonism, or exposure to tuberculosis. She denied fever, chills, night sweats, leg pain or swelling, chest pain, or abdominal pain.     

Prevalence of cryptosporidiosis in Dammam and Alkhobar, Saudi Arabia

This report presents results from a 6-month study over the period 16 November 1986 to 15 May 1987 which was designed to investigate the prevalence of cryptosporidiosis in Dammam and Alkhobar, Saudi Arabia. A total of 209 stool specimens from children and 112 from adults with diarrhoea were examined. Only two (1%) of the children, both aged 2 years, were positive for Cryptosporidium spp. Giardia lamblia was found in 13 (4%) cases and was found to be the most common protozoan parasite, whereas Salmonella spp. was seen in 19 (6%) cases. Stool specimens were examined for rotavirus from children under 2 years of age; 31 (41%) of the specimens were positive.     

Hypocalcemia and hyperphosphatemia in severely dehydrated children with and without convulsions

Tetanic convulsions are not uncommon among severely dehydrated children in the developing countries. This raises the question whether these children have disturbances in the homeostasis of divalent ions. Serum values are reported of calcium, magnesium, phosphorus, sodium and potassium, as well as blood pH in children below 3 years of age with acute watery diarrhoea and with an estimated weight loss of about 10%. The study was performed on dehydrated children with (DC) or without (D) convulsions. Values were obtained on admission and following rehydration therapy (RT). On admission serum calcium was low in both D and DC children. Serum phosphorus was likewise elevated in both D and DC children. Serum magnesium was slightly elevated in the DC but not in the D group. No patient had hypernatremia. During RT, serum calcium increased significantly and serum phosphorus decreased significantly in D and DC children. Serum calcium showed a significant inverse correlation with serum phosphorus and a significant direct correlation with blood pH. Treatment of DC children with i.v. calcium and i.m. magnesium had no immediate effect on the convulsions. Our conclusion is that severely dehydrated children will develop hypocalcemia. The cause may be a redistribution of calcium into the cells, parallelled by a redistribution of phosphorus from the intra- to the extracellular space.     

The use of the myouterine flap in closure of defects of the bladder

A new surgical technique to close bladder defects using well vascularized myouterine flap is described. The flap serves as a temporary scaffold while the bladder is being bridged by natural bladder regeneration. The advantage of this flap is that it is not a free flap, being well vascularized through its pedicle, enhancing optimal bladder regeneration. This technique may be a useful surgical alternative for repair of large bladder defects.     

Role of breast feeding in preventing acquisition of roundworm and hookworm in Dhaka slum children

Breast feeding was found to give protection against many gastrointestinal infections in infants. A study has been conducted to examine whether breastfeeding protects children from contracting ascaris lumbricoides and hookworm infections. History of breast feeding and supplementation in urban children from low economic strata were obtained and stools were examined for ova of ascaris and hookworm. There was no significant difference in the presence of hookworm ova between the only breastfed group and the breastfed with supplemented group by two years of age. By the age of six and 24 months the presence of ascaris ova was significantly higher in the breastfed with supplemented group than the breastfed only group. It appears that exclusive breast feeding may have some role in preventing acquisition of ascaris infection in urban slums with poor sanitation facilities.     

Decreased Length of stay,cost savings and descriptive findings of enhanced patient care resulting from and integrated traumatic brain injury programme

Traumatic brain injury (TBI) has enormous economic consequences. The primary objective was to evaluate the effect of implementation of an integrated TBI programme on patient-care. The research design was a retrospective institutional review for which 1875 patient records were reviewed, healthcare professionals were interviewed, patient care was observed, and a literature review of the prognostic variables for mild, moderate and severe TBI was conducted. The implementation of an integrated TBI programme has reduced the average length of stay from 30.5 to 12 days and resulted in tremendous cost savings of $21.8 million over 6 years. 'Blueprinting' the continuum of TBI patients' care identified the weakest links to be the transfer of patients from the tertiary-care TBI programme to rehabilitation institutions and provision of long-term rehabilitative care due to information asymmetry. This was addressed by the development of comprehensive on-line TBI transfer documents. This study emphasizes the importance of comprehensive neurotrauma programmes.     

Hemiarthroplasty versus internal fixation for displaced intracapsular hip fractures in the elderly. A randomised trial of 455 patients

A total of 455 patients aged over 70 years with a displaced intracapsular fracture of the proximal femur was randomised to be treated either by hemiarthroplasty or internal fixation. The preoperative characteristics of the patients in both groups were similar. Internal fixation has a shorter length of anaesthesia (36 minutes versus 57 minutes, p < 0.0001), lower operative blood loss (28 ml versus 177 ml, p < 0.0001) and lower transfusion requirements (0.04 units versus 0.39 units, p < 0.0001). In the internal fixation group 90 patients required 111 additional surgical procedures while only 15 additional operations on the hip were needed in 12 patients in the arthroplasty group. There was no statistically significant difference in mortality between the groups at one year (61/226 versus 63/229, p = 0.91), but there was a tendency for an improved survival in the older less mobile patients treated by internal fixation. For the survivors assessed at one, two and three years from injury there were no differences with regard to the outcome for pain and mobility. Limb shortening was more common after internal fixation (7.0 mm versus 3.6 mm, p = 0.004). We recommend that displaced intracapsular fractures in the elderly should generally be treated by arthroplasty but that internal fixation may be appropriate for those who are very frail.     

Adopting integrated management of childhood illness module at local level in Bangladesh: implications for recurrent costs

This study estimated the recurrent cost implications of adopting Integrated Management of Childhood Illness (IMCI) at the first-level healthcare facilities in Bangladesh. Data on illnesses of children who sought care either from community health workers (CHWs) or from paramedics over a four-month period were collected in a rural community. A total of 5,505 children sought care. About 75% of symptoms mentioned by mothers were directly related to illnesses that are targeted in the IMCI. Cough and fever represented 64% of all reported complaints. Referral of patients to higher facilities varied from 3% for the paramedics to 77% for the CHWs. Had the IMCI module been followed, proportion of children needing referral should have been around 8%. Significant differences were observed between IMCI-recommended drug treatment and current practice followed by the paramedics. Adoption of IMCI should save about US$ 7 million on drugs alone for the whole country. Proper implementation of IMCI will require employment of additional health workers that will cost about US$ 2.7 million. If the current level of healthcare use is assumed, introduction of IMCI in Bangladesh will save over US$ 4 million.