Clinical and laboratory features of severe and complicated falciparum malaria the experience from Gonder Hospital

Over a period of 6 months in 1988, 104 patients with severe and complicated falciparum malaria were admitted to the Gonder College Hospital (GCH), Gonder, Ethiopia; 85 male (81.7%) and 19 female (18.3%). The age ranged between 14 and 70 years with a mean age of 31 years. Eighty-one patients (78.3%) had moved from a nonendemic to a malariaendemic area shortly before their illness. Altered state of consciousness, hyperparasitaemia and severe anaemia were the most frequent complications found. Fifty-three patients (51.0%) died. Non-immune status and unknown duration of symptoms were significantly associated with mortality. Among those who died, comatose state on admission, hyperparasitaemia and acute renal failure were more frequently seen. Forty-six (86.8%) had developed two or more complications and 15 (28.3%) had superimposed bacterial infections. Inadequate preventive measures and treatment facilities may be two important factors accounting for the high mortality.     

Antral mucosal perfusion is not increased in GAVE

Objectives: Although a common cause of intestinal blood loss, the pathophysiology of gastric antral vascular ectasia (GAVE) is not well understood. We aimed to evaluate gastric antral and body mucosal flow in GAVE patients compared to a control population using laser Doppler flowmetry.

Methods: 27 patients with GAVE and 11 control patients without GAVE were evaluated using an endoscopic LDF probe. The probe was placed in the gastric antrum and body in order to calculate standardized mucosal flow rates recorded as perfusion units (PU).

Results: Despite its hyperemic appearance and propensity to bleed, antral blood flow was not increased in GAVE: 115.5 PU (IQR: [94.4, 135.9 PU]) in GAVE versus 123.7 PU (IQR: [109.7, 186.5 PU]) in controls. There was a significant gradient between the gastric body and antral blood flow in GAVE (p < 0.001) that was not evident in controls.

Conclusion: These results indicate that antral mucosal blood flow is not increased in GAVE despite its grossly hyperemic appearance. A mild but statistically significant gradient was noted between the gastric antrum and body in patients with GAVE compared to controls. The pathophysiological significance of this finding is uncertain.     

The role of milk and lactose intolerance in Ethiopian patients with non-ulcer dyspepsia: a case control study

Milk intolerance, lactose intolerance and non-ulcer dyspepsia are common among Ethiopians. This study, therefore, was designed to find out if milk intolerance associated with lactase deficiency account for non-ulcer dyspepsia. Ninety-eight patients with non-ulcer dyspepsia and 95 controls were examined and interviewed for demographic data and milk drinking habits. Then each had a lactose tolerance test (LTT), stool examination for pH, ova and parasites. The demographic characteristics and the number of milk drinkers were comparable in the 2 groups. However, milk intolerance and lactose intolerance were significantly higher among the patients with non-ulcer dyspepsia than among the control group (p less than 0.01, p less than 0.05 respectively). The combination of milk intolerance, lactose intolerance and LTT was also significantly different (p less than 0.01). The mean stool pH was markedly reduced after lactose ingestion and there were more ova and parasites in the stools of the control group. These observations suggest that milk intolerance and/or lactose intolerance account significantly for the symptoms of the patients with non-ulcer dyspepsia. However, since lactose intolerance and abnormal LTT are very common among adult Ethiopians symptoms related to the drinking of milk should be interpreted with caution vis-a-vis the results of the lactose loading test.     

Cryptosporidium and Giardia infection and drinking water sources among children in Lege Dini, Ethiopia

We assessed the prevalence of Cryptosporidium and Giardia infections among children using protected and unprotected water sources in the Lege Dini watershed, Eastern Ethiopia, in November 2005 and May 2006. Of 655 children examined, 80 (12.2%) were infected with Cryptosporidium and 231 (35.3%) with Giardia. No difference was observed in the prevalence of cryptosporidiosis and giardiasis (P > 0.05) between children drinking water from protected and unprotected sources.     

Percutaneous Gastrostomy Tube Placement to Perform Transgastrostomy Endoscopic Retrograde Cholangiopancreaticography in Patients with Roux-en-Y Anatomy

Background

Roux-en-Y gastric bypass (RYGB) surgery is one of the most commonly performed bariatric surgeries in the United States. Patients with prior RYGB are not amenable to conventional endoscopic retrograde cholangiopancreaticography (ERCP). Surgical gastrostomy (SG) tube placement enables transgastrostomy ERCP (TG-ERCP).

Materials and Methods

Eleven patients with RYGB anatomy received open Stamm gastrostomy after which the tract was then allowed to mature for an average of 45 days before therapeutic TG-ERCP. The success rate and procedure-related complications of both gastrostomy and ERCP were assessed.

Results

TG-ERCP was performed on eleven patients (median age 52 years, range 37?C61 years) with prior RYGB and pancreatobiliary diseases. Indications for ERCP in these patients included suspected gallstone pancreatitis (n = 4), ampullary/biliary strictures (n = 5), pancreas divisum (n = 1), and common bile duct clipping as a result of RYGB surgery (n = 1). Two individuals developed post surgical complications with stomal-related infections. TG-ERCP with therapeutic intervention was successfully performed in all patients. Intervention included stone extractions (n = 11), biliary stricture dilation (n = 11), biliary sphincterotomy (n = 11), biliary (n = 3) and pancreatic (n = 1) stent placement, ampullary biopsies (n = 3), choledochoscopy (n = 1), and pseudocyst drainage (n = 1). Complications included post-ERCP pancreatitis (n = 2), post-sphincterotomy bleeding (n = 1), gastrostomy site bleed (n = 1), and gastric perforation (n = 1). The total number of ERCP sessions for the eleven patients was 15 (1 or 2 per patient). Median follow-up was 42 days (range 7?C123 days).

Conclusion

Surgical open gastrostomy followed by TG-ERCP enables therapeutic intervention but is associated with significant complications.     

Self-rated sleep characteristics and bother from nocturia

Purpose: The aim of this study was to evaluate if men with varying degrees of bother from a similar number of nocturia episodes differ with respect to self‐rated sleep characteristics and fatigue. Materials and methods: As part of the baseline assessments during a nocturia treatment trial, 55 participants reported frequency and bother of nocturia using the AUA Symptom Inventory and completed 7‐day sleep diaries prior to treatment. Participants who reported moderate nocturia (either two or three episodes nightly) were further grouped into categories of LOW (nocturia is no problem or a very small problem) or HIGH bother (nocturia is a big problem). Information from the participant completed sleep diaries was abstracted, including information on daytime napping, total sleep time, mean time needed to return to sleep, nighttime ratings of fatigue, and daytime ratings of fatigue. Results: Of the 55 individuals who completed the pilot study, 24 study participants reported two or three episodes of nocturia and had either HIGH (n = 11) or LOW (n = 13) bother. Participants categorised with HIGH bother were significantly more likely than those with LOW bother to report difficulty initiating sleep (47.7 ± 34.4 vs. 23.5 ± 13.6 min, p = 0.05), difficulty returning to sleep after an awakening (28.9 ± 16.1 vs. 15.4 ± 9.6 min, p = 0.03) and greater morning fatigue (3.3 ± 0.7 vs. 2.5 ± 1.0, p = 0.04 on a 7‐point scale). Conclusions: Since bother related to nocturia is linked to sleep quality, interventions targeting fatigue and sleep maintenance may provide useful targets in the management of nocturia in men.     

Sleep-disordered breathing and nocturia in older adults

OBJECTIVES: To investigate the relationship between sleep-disordered breathing (SDB) and nocturia episodes in community-dwelling older adults. DESIGN: A cross-sectional study. SETTING: Community. PARTICIPANTS: Community-dwelling older adults (N=72) recruited from independent living facilities and adult learning centers in Atlanta, Georgia. MEASUREMENTS: Three-day voiding diary, ambulatory sleep recording, focused physical examination, Epworth Sleepiness Scale, and Geriatric Depression Scale. RESULTS: Fifty-eight of the 72 subjects completed the study. The mean age+/-standard deviation was 77.7+/-6.7; 44 (76%) were female. Of the 58 subjects, 26 (45%) had an apnea-hypopnea index (AHI) of less than 10 per hour of sleep, 21 (36%) had an AHI between 10 and 24 per hour sleep, and 11 (19%) had an AHI of 25 or higher per hour of sleep. The mean nocturia episodes were 1.7+/-1.1, 1.6+/-0.9, and 2.6+/-1.4 for subjects in these groups, respectively (F=3.82; P=.028). Those with an AHI of 25 or higher had more nocturia episodes, higher mean arterial blood pressure, and higher body mass index than those with a lower AHI. CONCLUSION: These results suggest that older adults with severe SDB have a greater number of nocturia episodes. These findings underscore the importance of considering SDB as a differential diagnosis in the evaluation of older patients with nocturia.     

Development and testing of a de novo clinical staging system for podoconiosis (endemic non-filarial elephantiasis)

Objective To develop and test a robust clinical staging system for podoconiosis, a geochemical disease in individuals exposed to red clay soil. Methods We adapted the Dreyer system for staging filarial lymphoedema and tested it in four re‐iterative field tests conducted in an area of high‐podoconiosis prevalence in Southern Ethiopia. The system has five stages according to proximal spread of disease and presence of dermal nodules, ridges and bands. We measured the 1‐week repeatability and the inter‐observer agreement of the final staging system. Results The five‐stage system is readily understood by community workers with little health training. Kappa for 1‐week repeatability was 0.88 (95% CI 0.80–0.96), for agreement between health professionals was 0.71 (95% CI 0.60–0.82), while that between health professionals and community podoconiosis agents without formal health training averaged 0.64 (95% CI 0.52–0.78). Conclusions This simple staging system with good inter‐observer agreement and repeatability can assist in the management and further study of podoconiosis.