Early child health in Lahore, Pakistan: VIII. Microbiology

The causative agents of acute diarrhoea were investigated in children under the age of five years from 1985–1991 in three socio-economically different areas in Lahore, Pakistan. The aim was to determine the frequencies of the most common enteropathogens in faeces. The total isolation rate was 73.4%; two thirds (53.5%) were of bacterial and one third (19.9%) of viral origin. ETEC-LT (23.4%), Rota virus (19.9%), EPEC (15%) and Campylobacter (12%) were the single most frequent pathogens in all age groups and areas of living. The positivity of Campylobacter increased from 1.6% to 12% after the change of isolation technique. Shigella was isolated significantly ( p >0.001) more in children over than under one year of age. The incidence of bacterial infections was high during all seasons, while in certain years Rota virus was relatively low in the summer compared to the cooler months. The prevalence of ETEC-LT diarrhoea was higher in the periurban slum as compared to the village and the urban slum. The study is the first of its kind in Pakistan, and the results are similar to other comparable studies. It is thus possible to establish a well functioning and reliable microbiological laboratory in developing countries in a setting with restricted trained personnel and material resources.     

Follow up of victims of fabricated illness (Munchausen syndrome by proxy)

Fifty four children were studied 1-14 (mean 5.6) years after fabrications of illness had been identified. Thirty of the 54 children were living in families with their biological mothers and 24 were with other family members or in substitute families. Further fabrications were identified for 10 children who had been living with their mothers and there were 'other concerns' for a further eight children. Thirteen children residing with mother and 14 not residing with mother at follow up had a range of disorders including conduct and emotional disorders, and problems related to school, including difficulties in attention and concentration and non-attendance. Overall, 20 children (49% of those successfully followed up) had outcomes that were considered to be unacceptable.     

PREVALENCE OF ENDEMIC GOITRE IN SCHOOL CHILDREN: SHIRUR (DIST. PUNE,MAHARASHTRA)

A survey for estimation of goitre in school children in the Rural Health Training Centre, Shirur area was undertaken. A total of 4664 students from 17 schools were surveyed. The goitre prevalence was found to be 59.8% with visible goitre rate of 6.2% in pre- and peri-adolescent (10–19 years) age group. Thus a highly endemic goitre focus was located in Shirur, area in Pune District (Maharashtra). This area is located on the eastern tail-end slopes of Sahyadri Hills in Balaghat ranges, situated at an altitude of 533 metres. The area is generally drought prone and receives scanty rain, with poor agricultural practices. Environmental deficiency of iodine was found to be the main cause for this high prevalence of goitre.KEY WORDS: Goitre endemic, Iodine     

Pixel overflow artifacts in SPECT evaluation of the skeleton

The successful application of single photon emission computed tomography (SPECT) techniques to radionuclide evaluation of the skeleton depends on strict quality control measures, recognition of potential artifacts, and the selection of appropriate cases for specific reprocessing techniques. The application of simple image-processing routines to problems of "hot spot" and bladder pixel overflows facilitated a reduction in the technical inadequacy rate from 19% to 2% for SPECT evaluation of 100 hips, as well as improvement in diagnostic image quality in a variety of additional cases.     

The Density and Distribution of Melanocytes Adjacent to Melanoma and Nonmelanoma Skin Cancers

BACKGROUND: The determination of clear margins during Mohs surgery for melanoma in situ arising on sun-damaged skin is often made difficult by the presence of background atypical melanocytic hyperplasia. OBJECTIVE: To determine the density and distribution patterns of melanocytes adjacent to melanoma and nonmelanoma skin cancers. METHODS: 180 skin specimens obtained during the routine repair of defects resulting from the removal of melanoma and nonmelanoma skin cancers were analyzed using H and E-stained permanent sections to determine the quantity and distribution of epidermal melanocytes. RESULTS: The mean melanocyte density was 7.97 melanocytes per 1 mm of epidermis (SD,+/-6.7). Contiguous melanocytes were found in 30 (16.7%), atypical melanocytes were observed in 8 (4.4%), and follicular extension of melanocytes was observed in 11 (6.1%) of the specimens. These features were significantly associated with higher melanocyte densities (p< .001) and were more commonly observed in specimens from patients with melanoma. CONCLUSIONS: There is a high degree of variability in melanocyte densities seen adjacent to melanoma and nonmelanoma skin cancers. Contiguous melanocytes, atypical melanocytes, and follicular melanocytes can be seen in the sun-damaged skin surrounding both melanoma and nonmelanoma skin cancers, but especially with melanoma. Because some of the features of melanoma in situ can be seen in chronically sun-damaged skin, the Mohs surgeon should be cautious when assessing the margins for melanoma in this setting.     

Endoscopic management of bile leaks after blunt abdominal trauma

Background and Study Aims:  Endoscopic retrograde cholangiopancreaticography (ERCP) has been found to be useful for the diagnosis and treatment of post-traumatic bile leaks, but data on outcome after therapeutic ERCP is limited. We performed a prospective study on evaluation of ERCP for diagnosis and treatment of bile leaks following blunt abdominal trauma.
Patients and Methods:  Ten patients of bile leaks following blunt abdominal trauma were evaluated for modes of injury, clinical presentations, investigations, ERCP findings, modes of therapy and outcome. The time interval between trauma and ERCP, ERCP and healing of bile leak and complications of ERCP were also recorded.
Results:  Ten patients (age 21.9 ± 14.5 years, 6 males) presented 24.6 ± 17.1 days following trauma. The modes of injury were motor vehicle accident ( n  = 6), and fall from height ( n  = 4). The ERCP revealed bile leak from the right hepatic duct ( n  = 7), both right and left hepatic ducts ( n  = 1), mid-common bile duct ( n  = 1), and peripheral branches of right hepatic duct ( n  = 1). Procedures for ERCP included endoscopic sphincterotomy (ES) with stenting in nine patients and ES with nasobiliary drainage in one patient. Bile leak resolved in all the patients in 8.5 ± 8.2 days. Biliary stents and the nasobiliary drain were removed after 36.4 ± 16.2 days of their insertion and all the patients remain asymptomatic for follow up of 33 ± 20.8 months.
Conclusions:  Therapeutic ERCP procedures like endoscopic sphincterotomy with stenting or nasobiliary drainage are effective in management of bile leaks following blunt abdominal trauma.