The establishment of a burns unit in a developing country--a collaborative venture in Malawi.

In September 1993, the recently completed 32-bedded Burns Unit in the Queen Elizabeth Central Hospital, Blantyre, Malawi, was officially opened. This represented the culmination of 3 years' planning and construction; this paper presents our experience in developing this type of project, and an analysis of the early results of treatment in the unit. The widespread neglect of this common injury in developing countries is highlighted and the importance of input from specialists in this field working in collaboration with local medical and nursing staff is emphasized. The potential for making a significant impact in reducing the morbidity and mortality in burn injuries is highlighted.     

Perifused ovine placental tissue secretes beta-endorphin immunoreactivity

In vitro release of one of the pro-opiomelanocortin (POMC)-derived peptides, the endogenous opioid beta-endorphin (beta EP) has been examined in the sheep placenta by means of a perifusion system. Two zones of the cotyledon, the chorionic villus (highly vascularized fetal and maternal tissues in close apposition) and the maternal basal plate (or capsule), were examined in placenta at two stages of gestation--120 days (119.0 +/- 4.7, N = 4) and 140 days (143 +/- 1.8, N = 5) just before term. The chorionic villous tissue released more beta EP-like immunoreactivity (beta EP-IR) than did the basal plate tissue at both gestational ages. At 120 days' gestation the basal concentration of beta EP-IR released from the chorionic villus was 52 +/- 0.5 fmol mL-1 (n = 4), almost double the maternal basal plate tissue at 28.4 +/- 0.4 fmol mL-1 (n = 8). beta EP-IR secretory capacity increased significantly (P less than 0.05) with advancing gestational age. By Day 140, release had increased 3-4-fold to 181.8 +/- 0.8 fmol mL-1 (n = 16) in the chorionic villous tissue, and to a lesser extent in the basal plate tissue to 50.7 +/- 0.6 fmol mL-1 (n = 14). No stimulation of beta EP-IR secretion was observed in any tissue as a result of 30 min exposure to corticotrophin-releasing hormone (100 nmol L-1), a vital physiological secretagogue.(ABSTRACT TRUNCATED AT 250 WORDS)     

Magnesium in drinking water supplies and mortality from acute myocardial infarction in north west England

OBJECTIVES—To examine whether higher concentrations of magnesium in drinking water supplies are associated with lower mortality from acute myocardial infarction at a small area geographical level; to examine if the association is modified by age, sex, and socioeconomic deprivation.
DESIGN—Small area geographical study using 13 794 census enumeration districts. Water constituent concentrations (magnesium, calcium, fluoride, lead) measured at water supply zone and assigned to enumeration districts.
SETTING—305 water supply zones in north west England.
SUBJECTS—Resident population of 1 124 623 men and 1 372 036 women (1991 census) aged 45 years or more.
MAIN OUTCOME MEASURE—Mortality from acute myocardial infarction, International Classification of Diseases, ninth revision (ICD-9) 410. Subsidiary analysis examined deaths from ischaemic heart disease, ICD 410-414.
RESULTS—There were 21 339 male and 17 883 female deaths from acute myocardial infarction in 1990-92. Drinking water magnesium concentrations in water zones ranged from 2 mg/l to 111 mg/l (mean (SD) 19 (20) mg/l, median 12 mg/l); 24% of variation in magnesium concentrations was within zone and 76% was between zone. The relative risk of mortality from acute myocardial infarction (standardised for age, sex, and Carstairs deprivation quintile) for a quadrupling of magnesium concentrations in drinking water (for example, 20 mg/l v 5 mg/l) was 1.01 (95% confidence interval (CI) 0.99 to 1.03). When adjusted for north-south and east-west trends in mortality from acute myocardial infarction and for drinking water calcium, fluoride, and lead concentrations, this relative risk was 1.01 (95% CI 0.96 to 1.06). There was no evidence of a protective effect for acute myocardial infarction even among age, sex, and deprivation groups that were likely to be relatively magnesium deficient. For ischaemic heart disease mortality there was an apparent protective effect of magnesium and calcium (with calcium predominating in the joint model), but these were no longer significant when the geographical trends were incorporated.
CONCLUSIONS—No evidence was found of an association between magnesium concentrations in drinking water supplies and mortality from acute myocardial infarction. These results do not support the hypothesis that magnesium is the key water factor in relation to mortality from heart disease.


Keywords: magnesium; drinking water; myocardial infarction; mortality     

Conflicting priorities: evaluation of an intervention to improve nurse-parent relationships on a Tanzanian paediatric ward

Background  

Patient, or parent/guardian, satisfaction with health care provision is important to health outcomes. Poor relationships with health workers, particularly with nursing staff, have been reported to reduce satisfaction with care in Africa. Participatory research approaches such as the Health Workers for Change initiative have been successful in improving provider-client relationships in various developing country settings, but have not yet been reported in the complex environment of hospital wards. We evaluated the HWC approach for improving the relationship between nurses and parents on a paediatric ward in a busy regional hospital in Tanzania.     

PET, CT, and MRI imaging of neuronal migration anomalies in epileptic patients

During the investigation of intractable epilepsy, neuronal migration anomalies [NMA] were discovered in three patients. The first patient had abnormally positioned gray matter within the walls of both lateral ventricles. The second patient had a post operative cystic area in the right parietal-occipital lobes and an area of NMA within the right temporal lobe. The third patient had abnormally thickened gray matter in the right operculum. Long term CCTV-EEG monitoring of these three patients revealed ictal discharges originating from the area of abnormal gray matter in patients 2 and 3. PET scanning showed the areas of NMA in all three patients to have similar metabolic activity to normal gray matter. These cases illustrate the value of various imaging modalities and suggest some interesting physiology of a spectrum of neuronal migration anomalies.     

Modified great toe wrap for thumb reconstruction

Reconstruction of the traumatically amputated thumb can be achieved with good cosmetic and functional results utilizing autogenous bone graft and a neurosensory free wrap-around flap from the great toe. The donor area of the toe is modified to create a wrap-around flap to transfer innervated glabrous skin from the medial and lateral borders of the toe. This modification includes nail and nail matrix while preserving toe length and the important plantar weight-bearing skin of the great toe. A series of three patients who have undergone thumb reconstruction utilizing this method are reported. Postoperative follow-up averages 15 months. Sensory recovery is comparable to that reported in the literature; cosmetic appearance of the thumb and nail growth are good.