Zinc supplementation as adjunct therapy in children with measles accompanied by pneumonia: a double-blind,randomized controlled trial

BACKGROUND: Zinc deficiency, common in developing countries, is associated with decreased immunocompetence. Zinc supplementation benefits children with acute and persistent diarrhea and prevents pneumonia. Most deaths from vaccine-preventable diseases are from measles and whooping cough; pneumonia is the most common complication of measles and often the proximate cause of related deaths. OBJECTIVE: We evaluated the effect of zinc supplementation on episodes of illness in children with measles accompanied by pneumonia. DESIGN: In a double-blind, randomized controlled trial, children aged 9 mo-15 y who were admitted to the Infectious Diseases Hospital in Calcutta with clinically severe measles accompanied by pneumonia and who had been ill for 相似文献   

Understanding levels of morbidity and hospitalization in Kerala,India

The prevalence of ailments and hospitalization in Kerala was examined using data from the 52 nd National Sample Survey Data on Health Care in Kerala in 1995-6. The survey included 24401 people from 4928 households. Age and seasonality had considerable effects on the morbidity of individuals. The burden of ill health was higher in rural areas than in urban areas. People who were more likely to have a better lifestyle had a higher level of morbidity and hospitalization. Regional differences were seen, with levels of morbidity and hospitalization higher in the comparatively developed regions of Southern Kerala than in Northern Kerala. Factors like physical accessibility of health care services and capacity to seek health care services could create artificial differences in morbidity and hospitalization among different subgroups of the population in Kerala.     

Biomechanical evaluation of immediate stability with rectangular versus cylindrical interbody cages in stabilization of the lumbar spine

Background

Recent cadaver studies show stability against axial rotation with a cylindrical cage is marginally superior to a rectangular cage. The purpose of this biomechanical study in cadaver spine was to evaluate the stability of a new rectangular titanium cage design, which has teeth similar to the threads of cylindrical cages to engage the endplates.

Methods

Ten motion segments (five L2-3, five L4-5) were tested. From each cadaver spine, one motion segment was fixed with a pair of cylindrical cages (BAK, Sulzer Medica) and the other with paired rectangular cages (Rotafix, Corin Spinal). Each specimen was tested in an unconstrained state, after cage introduction and after additional posterior translaminar screw fixation. The range of motion (ROM) in flexion-extension, lateral bending, and rotation was tested in a materials testing machine, with +/- 5 Nm cyclical load over 10 sec per cycle; data from the third cycle was captured for analysis.

Results

ROM in all directions was significantly reduced (p < 0.05) with both types of cages. There was no significant difference in reduction of ROM in flexion-extension (p = 0.6) and rotation (p = 0.92) between the two cage groups, but stability in lateral bending was marginally superior with the rectangular cages (p = 0.11). Additional posterior fixation further reduced the ROM significantly (p < 0.05) in most directions in both cage groups, but did not show any difference between the cage groups.

Conclusions

There was no significant difference in immediate stability in any direction between the threaded cylindrical cage and the new design of the rectangular cage with endplate teeth.     

Virilising adrenocortical carcinoma

A 16-year-old, Hindu, female presented with rapidly growing abdominal lump for 6 months, primary amenorrhoea and non-development of secondary sex characters. Her BP was 180/120 mmHg. There was an excessive hirsutism involving face, neck, shoulders, abdomen and thighs. A lump was felt at left lumbar region extending on to left hypochondrium and part of umbilical region. Her serum testosterone level was 224 ng/dl and cortisol level was 15 microg/dl. Ultrasonography revealed a solid mass arising from the upper pole of left kidney. Exploratory laparotomy revealed a huge left adrenal tumour which was removed completely. Histopathology of the resected mass showed sheets of large round to polyhedral cells with hyperchromatic nuclei and eosinophilic granular cytoplasm with numerous giant cells. The case was diagnosed as virilising adrenocortical carcinoma.     

Neurobehaviour rounds and interdisciplinary education in neurology and psychiatry

Increasing emphasis on interdisciplinary medical treatment and education suggests that something valuable has arisen from medical specialization beyond the further development of specialty knowledge: an integration of specialty knowledge that compliments and extends the integrating aspects of the primary care approach to medicine. Several educational models have been described which serve this function. In this paper the authors describe interdisciplinary clinical teaching, and research team linking neurology, neuroradiology, psychiatry and neuropsychology. The team provides neurobehavioural evaluations and sponsors monthly Neurobehaviour Rounds, an interdisciplinary patient conference that is the main formal teaching vehicle for the programme. After the model had been in place for 1 year, eight of nine neurology residents had Residency In-Service Training Examination scores in behavioural neurology that exceeded their overall average scores. This suggests that encouraging neurology residents to see patients through the eyes of different specialists may have contributed to improvement in their performance on a test of interdisciplinary knowledge. A neurobehavioural programme anchored to a formal neurobehaviour conference may encourage interdisciplinary learning within the related disciplines of neurology, neuropsychology and psychiatry.     

Outcomes of pancreas transplants for patients with type 2 diabetes mellitus

BACKGROUND: The objective of this study was to examine how effectively pancreas transplants provide long-term glucose control in patients with type 2 diabetes mellitus (DM). We used guidelines from the American Diabetes Association (ADA) and the World Health Organization (WHO) to appropriately classify recipients with type 2 DM (vs. type 1 DM). RESULTS: From 1994 through 2002, a total of 17 patients with type 2 DM underwent a pancreas transplant at our center. Mean recipient age was 52.5 yr. The mean age at diabetes onset was 35.7 yr; mean duration, 16.8 yr. Most recipients had one or more secondary complications related to their diabetes: retinopathy (94%), neuropathy (76%), or nephropathy (65%). At the time of their transplant, three (18%) were on oral hypoglycemic agents alone and 14 (82%) were on insulin therapy. Of the 17 transplants, seven (41%) were a simultaneous pancreas-kidney transplant (SPK); four (24%), pancreas after kidney transplant (PAK); and six (35%), pancreas transplant alone (PTA). One recipient died during the perioperative period because of aspiration. The other 16 recipients became euglycemic post-transplant and had a functional graft at 1 yr post-transplant (patient and graft survival rates, 94%). Now, with a mean follow-up of 4.3 yr post-transplant, the patient survival rate is 71%. The four additional deaths were because of sepsis (n = 2), suicide (n = 1), and unknown cause (n = 1). All four of these recipients were insulin-independent at the time of death, although one was on an oral hypoglycemic agent. Of the 12 recipients currently alive, 11 remain euglycemic without requiring insulin therapy or oral hypoglycemic agents; one began insulin therapy 1.2 yr post-transplant (current daily dose, 60 units). CONCLUSION: These findings suggest that pancreas transplants can provide excellent glucose control in recipients with type 2 DM. All 16 (94%) of our recipients whose transplant was technically successful were rendered euglycemic. Long-term results were comparable with those seen in transplant recipients with type 1 DM.     

Late anastomotic leaks in pancreas transplant recipients - clinical characteristics and predisposing factors

BACKGROUND: Anastomotic leaks after pancreas transplants usually occur early in the postoperative course, but may also be seen late post-transplant. We studied such leaks to determine predisposing factors, methods of management, and outcomes. RESULTS: Between January 1, 1994 and December 31, 2002, a total of 25 pancreas transplant recipients at our institution experienced a late leak (defined as one occurring more than 3 months post-transplant). We excluded recipients with an early leak or with a leak seen immediately after an enteric conversion. The mean recipient age was 40.3 yr; mean donor age, 31.3 yr. The category of transplant was as follows: simultaneous pancreas-kidney (n = 5, 20%), pancreas after kidney (n = 10, 40%), and pancreas transplant alone (n = 10, 40%). At the time of their leak, most recipients (n = 23, 92%) had bladder-drained pancreas grafts; only two recipients (8%) had enteric-drained grafts. The mean time from transplant to the late leak was 20.5 months (range = 3.5-74 months). A direct predisposing event or risk factor occurring in the 6 wk preceding leak diagnosis was identified in 10 (40%) of the recipients. Such events or risk factors included a biopsy-proven episode of acute rejection (n = 4, 16%), a history of blunt abdominal trauma (n = 3, 12%), a recent episode of cytomegalovirus infection (n = 2, 8%), and obstructive uropathy from acute prostatitis (n = 1, 4%). Non-operative or conservative care (Foley catheter placement with or without percutaneous abdominal drains) was the initial treatment in 14 (56%) of the recipients. Such care was successful in nine (64%) of the 14 recipients; the other five (36%) required surgical repair after failure of conservative care at a mean of 10 d after Foley catheter placement. Of the 25 recipients, 11 underwent surgery as their initial leak treatment: repair in nine and pancreatectomy because of severe peritonitis in two. After appropriate management (conservative or operative) of the initial leak, five (20%) of the 25 recipients had a recurrent leak; the mean length of time from initial leak to recurrent leak was 5.6 months. All five recipients with a recurrent leak ultimately required surgery. CONCLUSIONS: Late anastomotic leaks are not uncommon; they may be more common with bladder-drained grafts. One-third of the recipients with a late leak had experienced some obvious preceding event that predisposed to the leak. For two-thirds of our stable recipients with bladder-drained grafts, non-operative treatment of the leak was successful.     

Intravesical wire as foreign body in urinary bladder

Foreign bodies in the urinary bladder are frequently the objects of jokes among doctors, but they may sometimes cause serious implications to the patients. Here we present our experiences in 3 such cases where long segments of wire were introduced into the urinary bladder through the urethra.