Short-Duration Prednisolone in Children with Nephrotic Syndrome Relapse: A Noninferiority Randomized Controlled Trial

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Leprosy in infants--report of two cases

Two infants, one 4 months old and the other 2 months old, having histologically confirmed indeterminate leprosy are reported. The route of infection, mode of transmission, and incubation period are discussed with reference to these two cases of infantile leprosy.     

Drug compliance among self-motivated leprosy patients

Regularity of DDS intake among 366 leprosy patients attending our out patient department voluntarily was assessed by urine spot test. It was found that only 54.6% of them had taken their last dose of drug within the previous three days. Those who kept their appointment showed better compliance than those who did not. Urinary DDS positivity was found to be unrelated to sex, occupation or the type of the disease. In the younger age group the compliance was low, as also among the patients coming from nearby places as compared to those who were residing in far off districts.     

Type O renal glucosuria

We observed a 7-year-old boy with virtual absence of renal tubular glucose reabsorption (type O renal glucosuria). Glucose titration studies in his family revealed severe type A renal glucosuria in a younger brother, a mild type A defect in the mother and normal glucose reabsorption in the father; thus a spectrum of renal glucose transport defects was observed in members of the same family.     

Effect of chronic tobacco-betel-lime "quid" chewing on human salivary secretions

Salivary flow rates by mechanical stimulation with forced spitting method and by chemical stimulation with 10% citric acid were determined in 25 healthy adult subjects with a history of chronic tobacco-betel-lime "quid" chewing and in 25 healthy control adults with no history of chewing. The chewers secreted more saliva as compared to nonchewers on chemical, but not on mechanical stimulation. The salivary amylase, potassium, and sodium levels were lower in chewers, but the reductions of the first two components only were significant. These reductions were thought to be due to increased salivary flow with its dilutional effect. There was no difference between the two groups with respect to salivary pH. The salivary flow rates by either method had significant positive correlation with the duration of chewing, but not with the amount of tobacco chewed. Salivary potassium was inversely correlated with the amount of tobacco chewed. It was concluded that chronic tobacco-betel-lime quid chewing induces excessive secretion of more watery saliva leading to a concomitant decrease in enzyme and electrolyte content. One or more of the following factors were considered to be operating in causing increased salivary flow in chewers effect of nicotine or tobacco on other constituents of the quid, chronic salivary gland hyperplasia, or chronic hypertrophy of the muscles of mastication.     

The impact of post-partum haemorrhage in “near-miss” morbidity and mortality in developing countries

The global maternal mortality ratio (MMR) of 400 per 100,000 live births results in an estimated 529,000 maternal deaths annually. Most of these deaths occur in developing countries and only about 1% in developed countries. Besides mortality data, the identification and accurate documentation of “near-miss” morbidity (a more sensitive index) is extremely important to assess the quality of health care systems. It can suitably guide to adopt appropriate measures to reduce maternal mortality and morbidity. Haemorrhage remains a major cause of maternal mortality in both developing and developed countries followed by anaemia and infection, which are more common in developing countries. Post-partum haemorrhage (PPH) is a frequent complication of delivery. PPH occurred in 10.5% of all live births worldwide resulting in 13,795,000 cases in the year 2000. The case fatality rate for PPH was 1% and there were 132,000 deaths attributable to PPH. Anaemia as a consequence of PPH was estimated to occur in 1.6 million women every year. Thus, the prevention and adequate management of obstetric haemorrhage are likely to result in a significant reduction in the MMR and in the less frequently monitored “near-miss” morbidity. Strategies to be adopted with regard to PPH in developing countries may differ from those routinely available and practised in developed countries because of limited access to health care facilities and low institutional delivery rate in the former countries. Some low cost, simple techniques to prevent and manage PPH are described. These need to be tested in a wider population to determine which is most suitable for a particular area or country. The mortality and “near-miss” morbidity data should be continually assessed and only then will the impact of these strategies be known. First level midwifery care plus backup by well-equipped hospitals must be developed concomitantly. Anyone can conduct a normal delivery when all is going well but only those with good clinical judgement and the necessary skills will be able to anticipate and manage a problem. This is especially important in the context of PPH where the under-estimation of blood loss coupled with the rapidity of development of serious consequences is the key issue.     

How Well Do Patients Understand Written Instructions?: Health Literacy Assessment in Rural and Urban Rheumatology Outpatients

The aim of this study was to assess health literacy (word recognition and comprehension) in patients at a rural rheumatology practice and to compare this to health literacy levels in patients from an urban rheumatology practice.Inclusion criteria for this cross-sectional study were as follows: ≥18-year-old patients at a rural rheumatology practice (Mid-North Coast Arthritis Clinic, Coffs Harbour, Australia) and an urban Sydney rheumatology practice (Combined Rheumatology Practice, Kogarah, Australia). Exclusion criteria were as follows: ill-health precluding participation; poor vision/hearing, non-English primary language. Word recognition was assessed using the Rapid Estimate of Adult Literacy in Medicine (REALM). Comprehension was assessed using the Test of Functional Health Literacy in Adults (TOFHLA). Practical comprehension and numeracy were assessed by asking patients to follow prescribing instructions for 5 common rheumatology medications.At the rural practice (Mid-North Coast Arthritis Clinic), 124/160 patients agreed to participate (F:M 83:41, mean age 60.3 ± 12.2) whereas the corresponding number at the urban practice (Combined Rheumatology Practice) was 99/119 (F:M 69:30, mean age 60.7 ± 17.5). Urban patients were more likely to be born overseas, speak another language at home, and be employed. There was no difference in REALM or TOFHLA scores between the 2 sites, and so data were pooled. REALM scores indicated 15% (33/223) of patients had a reading level ≤Grade 8 whereas 8% (18/223) had marginal or inadequate functional health literacy as assessed by the TOFHLA. Dosing instructions for ibuprofen and methotrexate were incorrectly understood by 32% (72/223) and 21% (46/223) of patients, respectively.Up to 15% of rural and urban patients had low health literacy and <1/3 of patients incorrectly followed dosing instructions for common rheumatology drugs.There was no significant difference in word recognition, functional health literacy, and numeracy between rural and urban rheumatology patients.