Improving eye care in the primary health care setting

One of the challenges facing primary health care in South Africa is the delivery of quality eye care to all South Africans. In this regard the role of the primary health care worker, as the first point of contact, is crucial. This paper reports on the problems primary health care workers experience in providing quality eye care in Region B of the Free State. Problems identified by those involved in the study include the cumbersome referral system, the unavailability of appropriate medicine at clinics, the insufficient knowledge of primary health care workers regarding eye conditions and the lack of communication between the various eye care service providers. Suggestions to address the problems identified included more in-service training of primary health care workers regarding eye conditions, liaison with NGO's providing eye care, decentralization of services and the establishment of an eye care committee in the region.     

Efficacy of mupirocin in methicillin-resistant Staphylococcus aureus burn wound infection.

Methicillin-resistant Staphylococcus aureus strains (MRSA) have become increasingly prevalent as nosocomial pathogens, especially in burn wounds. MRSA constituted 38% of all S. aureus isolates in our 25-bed burns unit despite the utilization of a combination of 1% silver sulfadiazine and 0.2% chlorhexidine as topical therapy. Mupirocin, a new antibiotic, has proved in vitro and in vivo to be highly effective in the treatment of MRSA infections. A prospective clinical trial with mupirocin ointment in MRSA burn wound infection was untertaken. Forty-five children with 59 discrete burn wounds and from whom MRSA were isolated were treated with 2% mupirocin ointment under occlusive dressings, applied twice daily for 5 days. The average burned area treated was 8% (range, 2 to 20%) of the total body surface area. The burn wounds were assessed clinically and bacteriologically daily. Mupirocin eliminated MRSA in all 59 wounds treated, with the maximum therapeutic response seen within 4 days. In three wounds, gram-negative organisms persisted after 5 days of topical therapy. Treatment was well tolerated by all children. We recommend that mupirocin in its present polyethylene glycol base should be used only on a selective basis, when current prophylactic topical therapy has failed to control MRSA infection in burns of less than 20% of the total body surface area, and that it should be applied only for a limited period of 5 days. The safety and the efficacy of mupirocin in burns exceeding 20% of the total body surface area need to be established.     

Hyperstimulation affects vascular permeability at implantation sites in the rat endometrium

Purpose It has previously been shown that deleterious changes occur in the epithelium and stroma of the endometrium of the rat following ovarian hyperstimulation by exogenous gonadotropins. The purpose of the present study was to investigate the formation of possible implantation sites following hyperstimulation. Female rats (n =8) were injected in phase with their estrous cycle with follicle stimulating hormone (FSH), followed by human chorionic gonadotropin (hCG), and mated at proestrous. Control rats (n =6) were uninjected and mated at proestrous. Animals were killed at 5.5 days of pregnancy. The pontamine blue technique was used to demonstrate the permeability of the uterine vessels. Implantation sites were demonstrated in the uterine horns of all control animals by segmental blue banding. Results Blue staining occurred only in a portion of one horn of one hyperstimulated animal. While fenestrations were found in the walls of capillaries of control animals, similar fenestrations were not observed in the vessels of hyperstimulated animals.Conclusion As the walls of vessels in the hyperstimulated animals failed to become permeable, and as no implanting embryos were found in these animals, it is concluded that there was an inability of the endometrium to form implantation sites. These changes may impede attachment and implantation of the embryo.     

Penetrating wounds of the heart and pericardium.

Fifty-seven patients with penetrating cardiac or pericardial trauma were treated at the Department of Cardio-Thoracic Surgery, University of Stellenbosch at the Tygerberg Hospital during a 6 1/2 year period from June 1971 to January 1978. Eleven patients were treated by aspiration alone because tamponade was mild, or because they were seen between 24 hours and 3 weeks after injury. Six patients underwent late elective surgery. Cardiopulmonary bypass had to be employed in four patients to correct intracardiac lesions. All other patients underwent emergency operations 8 minutes to 2 hours after admission to hospital. The hospital mortality was 4 of 57 patients (7%), lower than rates reported in other series. Some selected cases will be described more fully and our present plan of management is outlined.     

Uterine contraction regularity during labour in White and Black patients

Irregularity of uterine contractions during labour was compared in 50 White and 50 Black patients. The standard deviation of distances between contractions as seen on cardiotocography and of maximal pressures was used to compare contraction regularity in the two groups of patients. A small standard deviation (SD) indicated regular contractions; a larger SD signified irregular contractions. Mean SDs of peak-to-peak and of base-to-base measurements were both 6,3 mm for White patients and both 7,6 mm for Black patients. The mean SD for maximal uterine pressures was 9,5 mmHg for White patients but 12,7 mmHg for Black patients. All these differences were statistically highly significant, and this implies that uterine contractions are more irregular in Black patients.