Impact of universal immunization programme on the incidence of tetanus neonatorum.

The standard WHO cluster sampling technique was applied to 30 randomly selected villages covering a population of 89,470 and 2010 live births in Jasra Community Development Block with a population of 123,000 distributed in 123 villages and 27 subcenters. In each cluster, 67 mothers were interviewed who gave birth between March 1989 and April 1990. Immunization history of tetanus toxoid given during the antenatal period and the delivery was recorded by 2 teams. There were 49 neonatal deaths: 30 (61.2%) were caused by tetanus neonatorum, 10 (30.4%) died of high fever of undetermined etiology, 5 (10.2%) of pneumonia, 3 (6.1%) of diarrhea, and there was 1 case of death of undetermined cause. The tetanus neonatorum rate was 18.7/1000 live births. 93% of the births were assisted by family members and untrained dais, and 2.4% by trained traditional birth attendants. In 69 deliveries (3.4%), a doctor was called, while in 24 cases a multipurpose female worker assisted. 46.7% of neonates with tetanus were brought to the district hospital for treatment, the rest were either taken to private practitioners or to traditional healers. 1336 (66.5%) of 2010 mothers interviewed had not received tetanus toxoid, 359 (17.8%) had received only 1 dose of toxoid, and 315 (15.7%) had been immunized with 2 doses. The mothers of 27 (90.0%) of those 30 neonates who died of tetanus had not received a dose of toxoid during the antenatal period, whereas 3 mothers obtained only 1 dose. None of the newborn of mothers immunized with 2 doses during pregnancy contracted tetanus. 61% of the neonatal deaths were attributed to tetanus. The causes of neonatal tetanus include unhygienic cutting of the cord and lack of immunization of mothers with tetanus toxoid during pregnancy. The administration of 2 doses of antenatal tetanus toxoid and health education regarding the importance of conducting hygienic deliveries could eliminate this disease.     

Spectrum of poisonings among children in Afghanistan

Two hundred and ten cases of poisoning were seen during a 2-year study period accounting 1.2 per cent of all children hospitalised for medical disorders. About 80 per cent of children were under 5 years of age. Poisoning due to various therapeutic agents was commonest (67.1%) followed by chemical agents (10%), hydrocarbons (8.6%), plants (6.7%), food (5.7%) and carbon monoxide gas (2.4%). Overdosage due to wrong advice of the Physician or ignorance of mother was responsible for drug poisoning in 46.8 per cent of all poisonings due to medicaments. Chlorpromazine alone accounted for 33.3 percent cases of drug poisonings. The mortality rate was 3.3 percent and all deaths were apparently due to home made or proprietary drug formulations.     

Cyclodialysis cleft diagnosed by conventional ultrasonography

This case report describes the diagnosis and management of a traumatic cyclodialysis cleft, in the absence of newer investigating modalities like ultrasonic biomicroscopy (UBM). This entity is frequently difficult to recognize clinically owing to the extreme hypotony and media haze that these patients usually present with, which makes gonioscopy particularly taxing. Adding to the diagnostic dilemma is the difficulty in delineating the lesion ultrasonically due to the extreme anterior location of the cleft. In these situations, high frequency ultrasound has been found to be extremely helpful, but the availability of such sophistication is difficult. Presented here is demonstration of the cleft with a microconvex ultrasound probe of 9 MHz frequency. The patient was successfully managed conservatively. This modality could prove to be a valuable adjunct to the diagnosis of such cases even in the situations of nonavailability of high frequency ultrasonography.     

Testicular torsion unravelled

Testicular torsion is a true vascular emergency-prompt diagnosis and surgical management is critical. If treatment is not instigated within 4-6 hours of the onset of pain, irreversible testicular infarction may result, necessitating orchidectomy. This review presents the key features, management principles and medicolegal considerations of this serious condition.     

Current concepts in the pharmacotherapy of benign prostatic hyperplasia

Benign prostatic hyperplasia is a major men's health issue, with approximately 80% of all men developing this condition within their lifetime. A variety of oral treatments is available, including alpha-adrenoceptor antagonists (alpha-blockers), 5alpha reductase inhibitors, aromatase inhibitors and phytotherapy. A large number of alpha-blockers can be administered, but no single agent has demonstrated a clear superiority over the other drugs. 5alpha Reductase inhibitors have demonstrated similar efficacy in larger volume prostates but most evidence suggests that there is no benefit in combining them with alpha-blockers. The use of phytotherapy is not entirely novel but requires further long-term evaluation before it can be endorsed for clinical use in benign prostatic hyperplasia.