Investigation of presumptive tuberculosis cases by private health providers: lessons learnt from a survey in Pakistan

Pakistan''s National Tuberculosis Control Programme (NTP) is missing data on many tuberculosis (TB) cases who visit private providers. A survey on the incidence and under-reporting of TB in Pakistan provided a database for exploring the investigation and referral of presumptive TB cases by private health providers. The survey showed that private health providers requested both sputum smear and X-ray for diagnostic investigations. Of 2161 presumptive TB cases referred, 1189 (55%) were sent for investigations to a district NTP TB centre, of whom only 314 (26.4%) were registered. This indicates an urgent need to strengthen the link between private health providers and NTP to enhance TB notification.     

Reduced acetabular depth in hip instability in the newborn.

This study assessed the frequency of ultrasonographic hip instability and compared the results with clinical and morphological ultrasonographic evaluations of the hip in the newborn infant. Hip stability in 2016 consecutive births (1074 boys and 942 girls) was assessed clinically and ultrasonographically. Ultrasonography included dynamic stability testing and morphologic evaluations. Compared with ultrasonography, clinical stability testing had a specificity of 0.998 and a sensitivity of 0.667. The incidence of instability was 0.007 for hips and 0.010 for babies. Acetabular depth in 3994 normal hips was 8.3 +/- 0.9 mm, femoral head diameter was 15.4 +/- 1.3 mm, and acetabular bony coverage of the femoral head was 54 +/- 4.3%. Hip instability was significantly associated with a reduced acetabular depth. As the femoral head diameter was within normal in the unstable hips, coverage was significantly reduced.     

Teilausschreibung eines Vertragsarztsitzes

Abstrakt 1. Der Sinn und Zweck des § 103 Abs. 4 SGB V besteht im Erhalt der wirtschaftlichen Verwertungsf?higkeit einer Praxis. 2. Auch im Falle der Beschr?nkung des Versorgungsauftrags auf einhalb besteht ein Recht des Arztes, einen Teil seines Vertragsarztsitzes wirtschaftlich zu verwerten.     

Mycosis fungoides presenting with extensive pyoderma gangrenosum-like ulcers

Mycosis fungoides (MF) may present with atypical clinical manifestations. Usually it mimics various chronic dermatoses, with the appearance of ulcers during the tumour stage. Infrequently, cutaneous ulcers are the main or initial sign of lymphoma. We report the case of a man who presented multiple skin lesions that clinically appeared to be pyoderma gangrenosum (PG). However, histological and immunohistochemical examination revealed MF. This case illustrates that PG-like ulcers maybe atypical cutaneous manifestations of MF and exceptionally the presenting sign of this disease.     

Konsiliararzt und „unechter“ („schwarzer“) Belegarzt

Abstrakt 1. Eine mit der Ausübung vertrags?rztlicher T?tigkeit unvereinbare Interessen- und Pflichtenkollision liegt vor bei einer faktischen Wahrnehmung der T?tigkeit eines Krankenhausarztes durch einen zugelassenen Arzt. 2. Ein Konsiliararzt ist ein Arzt mit einer anderen Fachgebietsbezeichnung, der in einem konkreten Behandlungsfall w?hrend eines station?ren Aufenthalts auf seinem Fachgebiet untersucht und Behandlungsvorschl?ge macht, weil die entsprechende Fachkompetenz in dem Krankenhaus nicht vorhanden ist. (Leits?tze des Bearbeiters)     

Vergütung psychotherapeutischer Leistungen; Korrekturbeschluss des Bewertungsausschusses vom 16.2.2000

Ohne Zusammenfassung     

Severe acute maternal morbidity and associated deaths in conflict and post-conflict settings in Africa

Setting:

 Five hospitals in four conflict and post-conflict countries (Democratic Republic of Congo, Somaliland, Sierra Leone and Burundi).

Objectives:

 To report among hospital deliveries: 1) the proportion of severe acute maternal morbidity (SAMM), 2) the pattern of SAMM, and 3) maternal deaths according to type of SAMM.

Methods:

 An audit of data from a standardised database implemented in all the sites in the study.

Results:

 Of the 18 675 deliveries, there were 6314 (34%) known SAMM cases with 63 associated deaths, implying that for every 100 SAMM cases there was one maternal death. In descending order, the death-to-SAMM ratios per 1000 deliveries were: 1:7 for sepsis, 6 for haemorrhage 1:70 for hypertensive disorder and 1:398 for obstructed labour. A substantial proportion of deaths (38%) that occurred in hospitals could not be categorised into the standardised SAMM conditions available in the database.

Conclusion:

 As this is the first study using multi-centre data from conflict and post-conflict countries, these findings are relevant to improving maternal health in such settings. Findings, implications and possible ways forward in addressing various challenges are discussed.     

Effect of flow on polymorphonuclear leukocyte/endothelial cell adhesion

The effect of flow on the adhesion of polymorphonuclear leukocytes (PMNL) to vascular endothelium was investigated using a parallel plate chamber with a well-defined flow field. Washed PMNL were perfused over a monolayer of primary human umbilical vein endothelial cells (HUVEC) pretreated with formyl-methionyl-leucyl-phenylalanine (FMLP, 1 X 10(-7) mol/L) for five minutes. In other experiments HUVEC were pretreated with interleukin 1 (IL1,2 U/mL) for four hours. PMNL adhesion to stimulated and control HUVEC was measured over a physiologic range of wall shear stresses. PMNL adhesion to nylon-coated surface was also studied. At a wall shear stress of 0.98 dynes/cm2,283 +/- 37.3 PMNL/mm2 (mean +/- SEM) adhered to FMLP-treated HUVEC while 195 +/- 20.3 PMNL/mm2 adhered to control HUVEC. At 1.96 dynes/cm2, 68 +/- 14.1 PMNL/mm2 adhered to FMLP-treated HUVEC and 42 +/- 6.0 PMNL/mm2 adhered to control HUVEC. At 3.92 dynes/cm2, virtually no PMNL adherence was noted on either control or FMLP-treated HUVEC. On IL 1-treated HUVEC at 1.96 dynes/cm2, 371 +/- 25.8 PMNL/mm2 adhered while 28 +/- 2.9 PMNL/mm2 adhered to control HUVEC. PMNL adhesion to IL 1-treated and control HUVEC dropped to 10.2 +/- 3.8 and 6.8 +/- 3.5 PMNL/mm2, respectively, at 3.01 dynes/cm2. The effect of flow on PMNL adhesion appears to be an important factor in determining the outcome of the PMNL/HUVEC adhesive interaction under these experimental conditions.