Showing papers in "The Journal of tropical medicine and hygiene in 1993"

The impact of human immunodeficiency virus on presentation and diagnosis of tuberculosis in a cohort study in Zambia.

Abstract: Two hundred and forty-nine patients with tuberculosis were recruited to a cohort study to investigate the interaction between tuberculosis and HIV in Lusaka, Zambia; findings at presentation are presented here. One hundred and eighty-two (73%; 95% confidence interval 67-79%) of the cases were HIV-1 antibody positive. The diagnosis of tuberculosis was confirmed by microscopy for acid-alcohol fast bacilli, culture of Mycobacterium tuberculosis, or histology in 74% of all cases. HIV negative and positive cases differed in site of disease: among HIV negative patients 72% had pulmonary disease alone, 16% extrapulmonary disease alone and 12% had both, whereas among HIV positive patients 40% had pulmonary disease alone, 34% extrapulmonary disease alone and 26% both (P < 0.001). HIV negative and positive cases were compared with regard to outcome of diagnostic procedures: 55% of HIV negative cases could be diagnosed at enrollment by sputum smear, but only 35% of HIV positive cases (P < 0.01). Among pulmonary cases confirmed by sputum culture, 76% of HIV negative patients had a positive sputum smear, compared with 57% of HIV positive patients (P = 0.09). Pleural and pericardial disease were difficult to confirm, but culture of pleural fluid was positive in 12/46 HIV positive patients, compared with 0/11 HIV negative patients. Lymph node disease was readily confirmed by biopsy. The tuberculin test was positive in only 30/110 (27%) of HIV positive cases, but in 21/38 (55%) of HIV negative cases (P < 0.01). Mycobacterium tuberculosis was cultured in 57% of HIV negative cases and 54% of HIV positive cases; no atypical mycobacteria were isolated. Initial resistance to isoniazid was present in isolates from 5% of cases with a positive culture.

Seroepidemiology of hepatitis B, delta and human immunodeficiency virus infections in Hamadan province, Iran: a population based study.

Abstract: The epidemiologic features of HBV, HDV and HIV in the general population of Hamadan province of Iran were studied. A total of 4930 subjects (1649 males and 3281 females) constituted the study population. Seropositivity for any HBV marker was found in 25.72% of the subjects. Of these, 2.49% were carriers of HBsAg, 18.09% were positive for anti-HBs and 5.13% for anti-HBc alone. HBeAg, anti-HBC IgM, and anti-HDV were present in 13.8, 6.5 and 2.4% of HBSAg carriers, respectively. Antibody to HIV was detected in none of the 4930 sera tested. Prevalence of HBV infection was lowest in children and young adults 60 years. No significant difference was observed between the rates in males and females. Family size and prevalence of HBV infection were unrelated but an inverse relation was found between HBV infection and education. Unmarried men and women showed the lowest (18.26%) and widows and divorcees the highest (51.59%) rate of HBV infection. Our results suggest that horizontal transmission is likely to be the primary mode of acquisition of HBV infection in children and young adults. Also infection is partly transmitted before or soon after birth to babies of HBsAg-carrier mothers. Socioeconomic and demographic variables have a greater impact on the prevalence of HBV infection than blood or medical care variables in our population.

Prevalence of toxoplasmosis in humans and domestic animals in Ahwaz, capital of Khoozestan Province, south-west Iran.

Abstract: From 1984 to 1988 sera from 1806 apparently healthy persons and 1096 patients suspected of toxoplasmosis in and around Ahwaz city, capital of Khoozestan province, Iran were examined by immunofluorescent antibody test (IFA). Prevalence of Toxoplasma antibodies at a titre of < or = 1:20 was found in 49.6% of healthy persons compared to 72.3% in suspected patients. The seropositivity rate was lowest in the new-born and children under 6 months of age and highest in persons 14-19 years old. Blood samples from 142 cattle, 138 sheep and 130 goats, collected from Ahwaz abattoir, were tested by the latex-agglutination test (LAT). The infection rates were 14.8, 13.8 and 13.1% respectively. The consumption of uncooked meat seems to be the most probable cause of the high infection rate of toxoplasmosis in the area.

Factors related to the utilization of prenatal care in Vietnam.

Abstract: Data from the 1988 Vietnam Demographic and Health Survey and 1990 Vietnam Accessibility of Contraceptives Survey were used in this analysis of the influence of selected individual and community characteristics on the utilization of prenatal care in Vietnam. Specific analysis of the impact of availability of health services and other development characteristics of the community on utilization of prenatal care was done in a rural subsample. The woman's educational level and total number of living children were the most significant predictors of prenatal care utilization. Age independent of parity did not significantly affect the use of prenatal care. Rural women and women living in provinces with the highest infant mortality rates were significantly less likely to use prenatal services than their counterparts in the urban areas and provinces with low infant mortality rates. Non-physician health care providers were the main sources of prenatal care for women in both rural and urban areas.

Analysis of medical needs during disasters caused by tropical cyclones: anticipated injury patterns.

Abstract: This paper is a summary of the data for describing the distribution of injuries among people affected by tropical cyclones that have occurred during the past 20 years. The most striking feature of the data gathered from a review of the epidemiologic literature on tropical cyclones is its lack of uniformity. The absence of an international classification and coding scheme for recording injuries sustained in cyclones also makes planning medical assistance difficult following future cyclones and hurricanes. We propose here a simple injury classification scheme comprising three components for categorizing injury data. Such a standardized disaster injury classification scheme, coupled with other types of information about injuries, will greatly aid relief officials in efficiently matching available resources to needs, in effectively managing health relief operations, and in developing strategies to prevent future cyclone-related morbidity and mortality.

Assessment of the response in vivo and in vitro of Plasmodium falciparum to sulphadoxine-pyrimethamine in the malarious areas of Iran.

Abstract: Studies of drug resistance of Plasmodium falciparum cases from SE Iran were carried out in vivo and in vitro during 1990-91. In a study of 26 chloroquine-resistant infections, using amodiaquine (25 mg kg-1 over 3 days), followed by two-thirds of the standard dose of sulphadoxine-pyrimethamine, six cases were resistant at the RI(3) and RII(3) levels. An additional study testing the standard dose of sulphadoxine-pyrimethamine in 43 chloroquine-resistant cases revealed five (11.6%) resistant at the RI(2) and RII(3) levels. Six of the above resistant infections were contracted in Hormozgan, three in Sistan-Baluchestan, one in Kerman provinces of Iran and one in Pakistan. In five of 22 successful in-vitro tests, carried out on different isolates, the parasites grew to schizonts (> or = 8 nuclei) in the wells containing 1000 pmol sulphadoxine and 12.5 pmol pyrimethamine, indicative of resistance.

Microbiology of cerebral abscess: a four-year study in Malaysia.

Abstract: A prospective study was carried out to determine the aetiology of cerebral abscess in relation to the primary source of infections. Seventy-five patients with cerebral abscess were included in the study in the period January 1985 to December 1988. More than half of the patients studied had single lesions and the overall most common sites were in the frontal and parietal regions. Chronic suppurative otitis media, cyanotic congenital heart diseases and meningitis were among the important predisposing conditions in these patients. Approximately 25% of the patients with cerebral abscesses had no documented antecedent infections. Pure cultures were found to be predominant (66.7%) and sterile cultures were obtained from 10 (13.3%) patients. Streptococci were isolated from 23 (30.7%) patients, the commonest species being Streptococcus milleri. Proteus sp, Pseudomonas aeruginosa, Pseudomonas putrifaciens and Bacteroides sp were almost exclusively found in cerebral abscesses secondary to chronic suppurative otitis media; these organisms were found in mixed cultures. Streptococcus milleri, Bacteroides sp and Eikenella corrodens were found in pure cultures in patients with cyanotic congenital heart disease. In patients with ventriculoperitoneal shunts in-situ, Staphylococcus aureus, Staphylococcus epidermidis and diphtheroids were common. Anaerobes were found in 15 (20.0%) patients, the majority in mixed cultures. Culture, as well as gas-liquid chromatographic analysis of volatile fatty acids of cerebral pus, was carried out to enhance the detection of the anaerobes. Based on these findings, an antibiotic regimen consisting of penicillin, chloramphenicol and metronidazole is recommended as an initial therapy while awaiting culture and sensitivity results.

Prevalence of leptospiral agglutinins among conservancy workers in Madras City, India.

Abstract: In a study of 584 Corporation conservancy (sanitation) workers who lived mostly in slums, and who worked in four Corporation Circles of Madras City, India, 192 (32.9%) were found to be positive for agglutinins to Leptospira interrogans. Seropositivity prevalence increased with age, but was similar in males and females except in the youngest age group, where males predominated. Prevalence in the four study areas ranged between 17.8 and 40.5% (P < 0.01). Among 152 sera in which one serogroup predominated, Autumnalis was the most commonly recorded (33.6%), followed by Icterohaemorrhagiae (15.1%), Panama (15.1%), Sejroe (14.5%) and others (21.7%). Forty sera reacted to two or more serogroups at the same (highest) titre, most frequently to the first three serogroups above. The titre range was 1:50-1:3200 (geometric mean titre 149). Among a group of 46 male automobile industry workers who lived in middle-class housing, seropositivity prevalence (17.4%) was approximately half that of the sanitation workers (P < 0.05), and the titre range was lower (1:50-1:200, GMT 84). The predominating serogroups were those found in the sanitation workers. Bearing in mind that sanitation workers are the urban group probably at highest risk of leptospiral infection, the prevalence rate (< 33%) found in our study is not considered to be particularly high.

HIV breast-feeding and under-5 mortality: modelling the impact of policy decisions for or against breast-feeding.

Abstract: A computer model was developed to assess the impact on under-5 child mortality of breast-feeding practices in developing countries in the context of HIV infection. The model was used to estimate the effect on mortality of cessation of breast-feeding among mothers HIV-positive and mothers HIV-negative at birth, for both urban and rural settings. Using parameter values for a hypothetical East African country, cessation of breast-feeding in urban areas was predicted to result in increases in under-5 mortality of 108% for children of mothers HIV-negative at birth, and 27% for those HIV-positive at birth, with slightly larger increases in rural areas, suggesting that breast-feeding should continue to be promoted. A sensitivity analysis was conducted to identify critical values of key variables for which a review of policies encouraging breast-feeding is indicated. This showed that, even under extreme assumptions, cessation of breast-feeding among mothers HIV-negative at birth (but at risk of acquiring HIV during the lactation period) would increase under-5 mortality. For mothers HIV-positive at birth, the key variables are the additional risk of vertical transmission attributable to breast-feeding, the under-5 mortality rate (U5MR) in breast-fed children, and the relative risk of mortality in non-breast-fed compared to breast-fed children. Depending on the values of these key variables, there may be some urban populations with low U5MR in which the positive and negative effects on under-5 mortality of a policy change are finely balanced. However, no change in policy should be made in these areas until more precise information is available on the key variables, and the many adverse consequences of such a change have been fully explored.

Are reminder stickers effective in reducing immunization dropout rates in Addis Ababa, Ethiopia?

Abstract: Between October 1991 and February 1992 in Ethiopia community health providers followed 703 6-week-old to 23-month-old children who came to 4 vaccination centers in the Lideta and Nefas-Silk districts in Addis Ababa to determine whether reminder stickers applied to the inside of their home front door would reduce immunization dropout rates. The health workers gave a circular sticker with a picture of a child receiving a vaccination and an appointment date to the mothers of 343 children after they received their first diphtheria-pertussis-tetanus (DPT1) vaccination. The health workers did not give a sticker to the mothers of the 360 remaining children. They visited the homes of 35% of the children in the intervention group to determine compliance with applying the sticker. No statistically significant sociodemographic and maternal differences between the 2 groups existed. The immunization dropout rate of children whose mothers received a reminder sticker was 55% lower than that of the control group (7.3% vs. 13.3%; p < .01). The researchers compared the immunization dropout rate of the study control group with that of a historical control group who received their DPT1 in July 1991. They found that the study control group was less likely to drop out than the historical control group (relative risk = 0.68; p < 0.01). The mothers of just 4.7% of the intervention children who had a home visit did not apply the sticker. The dropout rate for the intervention subjects whose mothers did not apply the sticker was very high (30%) but it was not statistically significant. The leading reasons for dropouts not applying the sticker were child illness and unawareness of the need for another dose. These findings showed that stickers effectively reminded mothers to bring their children to the vaccination centers for another vaccination thereby reducing the immunization dropout rate.

Efficacy of chloroquine on Plasmodium falciparum transmitted at Amani, eastern Usambara Mountains, north-east Tanzania: an area where malaria has recently become endemic.

Abstract: In order to assess the response of newly endemic falciparum malaria to currently used antimalarials, a field study was conducted in Amani, Tanzania. The efficacy of chloroquine (CQ) on Plasmodium falciparum was assessed by in-vivo and in-vitro methods. Fifty-four patients with pure falciparum malaria were treated with CQ and followed daily for 3 days and weekly for one month. Eighty-three per cent of infections exhibited some degree of in-vivo resistance to CQ (46% RI, 28% RII and 9% RIII). Pretreatment blood samples were obtained from all 54 patients for in-vitro sensitivity testing for CQ, amodiaquine (AQ), quinine (QN), and mefloquine (MQ). In-vitro data correlated well with in-vivo data; 80% of successful isolates were resistant to CQ. Forty-five per cent of successful isolates were resistant to AQ, 2% to QN, and none to MQ. The antimalarial levels yielding 99% inhibition (EC99) for CQ, AQ, QN, and MQ were 12.86, 3.24, 24.09 and 0.81 microM respectively. Urine HPTLC revealed CQ metabolites in 15% of study patients who denied recent CQ ingestion and had a negative Dill-Glazko test. This implies the high rate of CQ resistance observed in this study could be due in part to the widespread use of CQ for self-medication. Although the day 3 mean CQ plasma level was higher for sensitive and RI infections than for RII and RIII infections, the difference did not reach statistical significance. Our study results confirm that P. falciparum transmitted at Amani is highly resistant to CQ.

Prospects for the use of larvivorous fish for malaria control in Ethiopia: search for indigenous species and evaluation of their feeding capacity for mosquito larvae.

Abstract: Because of problems with drug and insecticide resistance, the National Organization for the Control of Malaria and other Vectorborne Diseases, Ethiopia, has embarked on a programme of research on alternative malaria control methods, including the use of biological control agents, such as larvivorous fish. The objectives of the study were to identify indigenous larvivorous fish species which could be potential candidates for use as biological control agents; to extend knowledge of their distribution in Ethiopia; and to conduct laboratory tests to determine their feeding capacity. An extensive search resulted in the identification of 11 larvivorous fish species indigenous to Ethiopia, including five species previously unrecorded in the country. Seven species were assessed under standard laboratory conditions for their feeding capacity on larvae of Anopheles gambiae s.l. and Culex andersoni. All species tested were efficient larvivores in the laboratory. However, their larvivorous capacity should be tested further in field trials. Based on the findings of this study, two priority areas for the assessment of biological control using larvivorous fish were identified, the port city of Assab, using the local species Aphanius dispar, and the Ogaden, south-eastern Ethiopia, using the local species Oreochromis spilurus spilurus.

Bancroftian filariasis in the Kassena Nankana District of the upper east region of Ghana: a preliminary study.

Abstract: A filariasis prevalence survey was conducted in April 1992 in the Southern sector of the Kassena Nankana District which was the site of the Ghana Vitamin A Supplementation morbidity trial. In all, 106 compounds from five different communities were randomly selected from the vitamin A trial database. All resident compound members of 10 years and above were clinically examined and blood was taken for thick films between 2100 and 0200 hours. Haemoglobin levels were also measured. All the blood slides were examined by the investigators in Navrongo. Two reference laboratories examined 10% each of the slides for quality control. In all, 531 people were examined, 247 males and 284 females. The results showed an overall microfilaraemia rate of 41.1% (95% CI 36.9-45.3%). The only species identified was Wuchereria bancrofti. The most important clinical manifestation was hydrocele, 30.8% of males (95% CI 25-36.6%); followed by elephantiasis of the leg, 3.6% of the study population (95% CI 2.0-5.2%). The mean haemoglobin level of the population was 12.4 g dl-1. There were no significant differences between the communities in clinical or parasitological findings.

Impact of Schistosoma haematobium infection and of praziquantel treatment on anaemia of primary school children in Bertoua, Cameroon.

Abstract: There is some debate as to the extent to which Schistosoma haematobium haematuria may be the cause of anaemia Our goal was to evaluate the impact of a single 40 mg kg-1 dose of praziquantel on anaemia Since praziquantel does not reduce the hookworm intensity of infection (a major cause of anaemia in children in the area) changes in the prevalence of anaemia in the study population should be due only to the elimination of S haematobium Seven hundred and seventy-one primary schoolboys from Bertoua (East Cameroon) were divided into four groups: high infection, moderate infection treated with praziquantel or placebo, and non-infected Haemoglobin concentrations of the children were determined at the onset of the study and 6 months after the praziquantel intervention Mean haemoglobin concentrations were not significantly different for no infection or for mild or heavy infection by S haematobium A factorial analysis of variance using S haematobium intensity of infection, malaria and intestinal parasite infections and age as independent variables and haemoglobin concentration as the dependent variable show that only age and malaria infection show a significant relationship with haemoglobin concentration Despite treatment with praziquantel, all the children in the treatment groups had lower mean haemoglobins 6 months after intervention A factorial analysis of variance using age, malaria infection and the treatment category as independent variables and the difference in haemoglobin concentration as the dependent variable shows that only malaria infection showed a significant relationship with haemoglobin concentration(ABSTRACT TRUNCATED AT 250 WORDS)

Ophthalmomyiasis in Kuwait: first report of infections due to the larvae of Oestrus ovis before and after the Gulf conflict

Abstract: We report for the first time four cases of ophthalmomyiasis due to the larvae of Oestrus ovis in Kuwait, before and after Operations Desert Shield and Desert Storm. The larvae were easily removed under local anaesthetic. The symptom complex of acute foreign body sensation, irritation, redness, lacrimation and photophobia resolved rapidly. Ophthalmic antibiotic and corticosteroid drops were also instilled and recovery was uneventful. The ophthalmomyiasis may not always be associated with contact with sheep-rearing per se. Medical personnel should therefore be aware that in cases of what might appear initially as acute, non-specific catarrhal conjunctivitis, patients with the persistent symptom complex should be re-examined to exclude ophthalmomyiasis due to the larvae of O. ovis in endemic areas.

Significance of Cryptosporidium as an aetiologic agent of acute diarrhoea in Calcutta: a hospital based study.

Abstract: The significance of Cryptosporidium as a causative agent of acute diarrhoea has been assessed in a year long hospital based study. A significantly higher detection of Cryptosporidium (P < 0.01) was observed in cases as compared to controls. Cryptosporidium was detected alone from 3% of acute diarrhoeal patients and from 5.5% in combination with other enteric pathogens. However, only 1.1% of control subjects were positive for Cryptosporidium. The highest detection rate of Cryptosporidium oocysts was in the first two years of life, in both cases and controls. No sex specific predilection for Cryptosporidium was observed in either the cases or controls.

Surgical services and training in the context of national health care policy: the Malawi experience.

Abstract: Malawi has a pyramidal health care structure, featuring at its broad base health centres and outreach stations in villages and rural areas; at the middle the district hospitals which receive cases from the villages and outreach health stations, and at its narrow apex the few central hospitals one of which is located in each of the three regions as a referral centre. Primary health care is practised at the health centres mostly by paramedical workers. The district hospitals are manned by general duty doctors and the central hospitals by specialists. Medical auxiliaries (clinical officers and medical assistants) play a vital role in the surgical and anaesthetic services of Malawi. Surgical education is community based and aims at providing staff for the various tiers of the health care pyramid, the surgical training being now jointly supervised by both government and non-government organizations and the new College of Medicine of Malawi. The internship programme is designed to prepare doctors for service in the districts where the bulk of their clinical hospital duties is of a surgical nature.

Acute chloroquine administration increases renal sodium excretion.

Abstract: The effect of a 2-hour intravenous chloroquine infusion (0.015, 0.030 and 1.25 micrograms min-1) on renal fluid and electrolyte handling was investigated in the saline infused, Inactin anaesthetized rat. Blood pressure and glomerular filtration rate were not affected by chloroquine administration, remaining around 128 mmHg and 2.4 ml min-1, respectively throughout the 5-hour post-equilibration period. Chloroquine produced an increase in Na+ and Cl- excretion without affecting the urine flow. By 1 hour after the start of treatment (0.03 micrograms chloroquine min-1) the Na+ excretion rate had increased to 14.5 +/- 2.1 mumol min-1 (n = 6), and was significantly (P < 0.01) greater than in control animals (8.6 +/- 1.0 mumol min-1) at the corresponding time. Parallel but lesser increases in Cl- excretion rates were also observed. The plasma aldosterone and corticosterone levels following either 10, 30 or 120 minutes infusion of chloroquine at 0.03 micrograms min-1 did not differ statistically from each other or from control values. It is concluded that acute chloroquine administration induces an increase in Na+ excretion. The mechanism of this natriuresis cannot be established from the present study, but is likely to involve altered tubular handling of Na+.

Malaria with bacteraemia in acutely febrile preschool children without localizing signs: coincidence or association/complication?

Abstract: Data were collected on 642 preschool children who presented consecutively to casualty with fever and no localizing signs. Four hundred and forty-six (69%) had malaria parasitaemia. The proportion of children with bacteraemia was similar in those children with malaria (43/446, 9.6%) and those without malaria (24/196, 12.2%, P < 0.5). The pathogens in both groups of children were mainly Staphylococcus aureus and coliform bacteria. Although children with malaria/bacteraemia had a significantly higher prevalence of anaemia (P = 0.001), hepatosplenomegaly (P < 0.01) and combination of hepatosplenomegaly and severe anaemia (P = 0.02), compared with children with malaria alone, there was no correlation between the severity of parasitaemia and prevalence of malaria with bacteraemia. The association of malaria with bacteraemia appears to be coincidental.

A serological survey for leptospirosis in the Enugu area of eastern Nigeria among people at occupational risk.

Abstract: A serological examination of sera from 661 human volunteers in various occupations comprising 248 coal miners, 138 butchers and abattoir workers, 213 local farmers and 62 hospital laboratory personnel from various communities in Enugu and environs of eastern Nigeria was undertaken between January 1990 and March 1991. Leptospiral antibody titres of 1:100 and above were present in 89 (13.5%). The highest prevalence of antibodies to individual serovars were canicola 21 (23.6%), hardjo 17 (19.1%), pomona 13 (14.6%), icterohaemorrhagiae 11 (12.4%), pyrogenes 8 (9.0%), autumnalis 8 (9.0%) and grippotyphosa 7 (7.9%). Among the occupational groups examined, the coal miners were particularly at risk with a prevalence rate of 41 (46%), followed by the butchers/abattoir workers 26 (29.2%), farmers 18 (20.2%) and hospital laboratory personnel 4 (4.5%).

Infectious diarrhoea in Hong Kong.

Abstract: The role of enteric pathogens in diarrhoeal patients presenting at a large general hospital in Hong Kong from May 1984 to December 1990 was assessed. A total of 3267 organisms were isolated. The gastroenteric salmonellae were the most common pathogens (45%), followed by rotavirus (34%) and campylobacters (11%). Shigellae or vibrios constituted 5% or less of the total isolations. Both salmonellae and campylobacters were isolated more often from infants while rotavirus was more common in young children aged 1-4 years. Shigellae commonly affected young adults and vibrios mainly older patients. Rotavirus was most commonly isolated in the winter months while salmonellae and vibrios were more common in the hotter months. There was no seasonal predominance for shigellosis. Multiple infections occurred in 86 patients (3% of total cases); 42 of these patients had concurrent Salmonella and rotavirus infections and 22 had Campylobacter and rotavirus infections. Salmonellae remain a major public health problem in Hong Kong.

Low incidence of hypercalcaemia in tuberculosis in Malaysia.

Abstract: In this study we examined the incidence of hypercalcaemia among patients with tuberculosis in Malaysia. Serum calcium concentration and other calcium metabolism parameters were studied in 43 newly diagnosed tuberculous patients from the Kuala Lumpur General Hospital and the National Tuberculosis Centre. Forty-four patients admitted to the medical wards of the General Hospital, Kuala Lumpur were recruited as controls. The incidence of hypercalcaemia was found to be only 1/43 (2.3%). There was no significant difference between the mean serum calcium and other calcium metabolism parameters between the patients and the controls. Despite earlier reported incidences of 30-50%, this study showed that hypercalcaemia in tuberculosis is uncommon in Malaysia.

Interpersonal violence: patterns in a Basotho community.

Abstract: This study was conducted to quantify the importance of trauma and death due to interpersonal violence in rural Lesotho and to gain an insight into the profile of the assault victims, the circumstances of the violent incidents and the type of weapons wielded and wounds inflicted. During a one-year period starting June 1988 information was recorded on all patients with assault trauma attending Quthing District Hospital. The annual incidence rate of assault on men between 20 and 49, the most affected age group, was estimated to be as high as 30 per 1000. The crude homicide rate could reliably be calculated as 44 per 100,000 per year. The male to female sex ratio amongst the 506 identified victims was 1.7:1. The assailants were male in 89% of the incidents; other men were their victim in 68% of these events. Only 26% of the consulting women suffered at the hands of their husband or partner. Over 55% of injuries (and deaths) inflicted by men were caused by beating with traditional sticks; 15% were due to stabbing. Women used stones, teeth or bare hands and feet equally frequently. The limited presence of firearms may have prevented higher death rates. It is suggested that the disruption of the social structure of the Basotho society through its dependence on migrant labour leads to weakened normative reference, the moral net, which is the underlying cause for the serious violence problem of the country.

Causes of morbidity among a sample of elderly hospital patients in Riyadh, Saudi Arabia.

Abstract: The causes of admission to hospital over a 5-year period of 3539 persons aged 60 years and above in Riyadh, Saudi Arabia have been analysed; 54.2% were males and 45.8% females and 68.5% were aged 65 years and above. The causes of morbidity were chronic degenerative disorders of which cardiovascular diseases were the most frequent followed by acute respiratory problems, diabetes, and digestive and neoplastic diseases. The pattern of disease was very similar to that in the industrialized countries. The median stay in hospital was 10.7 days. Respiratory diseases and diabetes mellitus were significantly higher in females than males (P < 0.02), while cardiovascular diseases, particularly ischaemic heart disease and heart failure, as well as malignant neoplastic diseases mainly of the digestive system, were more prevalent in males.

Tinea capitis in Trinidad.

Abstract: Characteristics of clinically diagnosed cases of tinea capitis from Trinidad are described. Tinea capitis comprised 29.5% of all dermatophytoses seen at one general hospital out-patient dermatology clinic during a one-year period. Males were more often affected than females and there was a predominance of patients of African descent. Among the dermatophytes cultured Trichophyton tonsurans was the most prevalent (52.9%), followed by Microsporum canis (20.0%) and M. audouinii (18.6%). Less frequent isolates included M. gypseum (1.9%), T. mentagrophytes var granulare (1.4%) and T. rubrum (1.4%).

A case of acute aconitine poisoning caused by chuanwu and caowu.

Abstract: A case of aconitine poisoning following the ingestion of 'chuanwu', the main root of Aconitum carmichaeli, and 'caowu', the root of Aconitum kusnezoffii is described. A 35-year-old man became unwell about 90 minutes after ingesting these herbs and his symptoms lasted for about two days. In addition to the typical gastrointestinal (nausea and vomiting) and neurological (generalized weakness, numbness and paraesthesia) features of aconitine poisoning, there was evidence of cardiotoxicity (hypotension and ventricular ectopics). Management of such patients should include measures to enhance elimination and close monitoring for cardiotoxicity. Legislation controlling the use of such herbs should be considered. Language: en

Dengue fever complicated by pulmonary haemorrhage manifesting as haemoptysis.

Abstract: A 17-year-old girl was admitted to hospital with dengue fever. On the ninth day of fever she developed haemoptysis and chest X-ray changes consistent with haemorrhage in her lungs. Thrombocytopaenia and mild coagulopathy were the most likely cause of this unusual haemoptysis in this patient. Investigations excluded other causes for the haemoptysis.

The disease pattern of elderly medical patients in Rwanda, central Africa.

Abstract: In a study of the disease pattern of the elderly in Rwanda, all patients aged 60 or more, hospitalized in a one-year period at the Medical Department, University Hospital, Butare, were examined prospectively. One hundred and ninety-two patients were included; most were subsistence farmers having a mainly vegetarian diet and living in large families. Infections (37.5% of the patients) and liver cirrhosis (31.8%) were the problems most frequently encountered. Primary hepatocellular cancer was diagnosed in 5.7% of the patients and was the most frequent malignancy. The hospitalized elderly occupied 17.5% of the available beds in the Medical Department. Their disease pattern was different from that of younger patients, making heavier demands on the medical resources. Malaria and upper intestinal inflammation were less frequent in the elderly; liver cirrhosis, primary hepatocellular cancer, pneumonia, prostatic cancer, cardiovascular pathology, chronic renal pathology and chronic lung disease were more prevalent. Several age-related conditions frequently observed in industrialized countries (e.g. coronary heart disease, stroke, gallstones, renal cysts, dementia) were rare. The study thus illustrates the concept of 'secondary aging': to the primary changes induced by the aging process, additional alterations are added which depend upon the environment and the lifestyle, resulting in a varying disease pattern. Health policies thus must take into account that the demographic transition in developing countries may result in a pattern of diseases different from that seen in industrialized countries; care must be taken when transposing data obtained from elderly populations in industrialized countries.

Human brucellosis in Dhofar, Sultanate of Oman.

Abstract: Sera were collected, mostly from school children, in six localities of the southern region of the Sultanate of Oman. Macro and micro-agglutination tests were used to indicate positive Brucella serology. Four of the 525 sera tested had titres of at least 1:200, which were considered positive, and two had borderline values. The frequency of serologically positive sera in the six localities ranged between zero and 2%. No relevant difference was observed between titres using antigen of B. abortus or B. melitensis.

Protocol for out-patient management of dengue illness in young adults.

Abstract: A prospective study on the practicality of an out-patient management protocol for dengue infection in adults was carried out during a 2-month period. Doctors were requested to follow the protocol and assessment was done on the patients' outcome, the admission rate, and the compliance to the protocol by doctors and patients. One hundred and sixty-two patients (mean age 27.3 years) were clinically diagnosed to have dengue illness. Among them, 82.7% had dengue fever (DF); 13.0% had dengue haemorrhagic fever (DHF) and 4.3% had dengue shock syndrome (DSS). Dengue aetiology was confirmed in 69.4% of the DF group and 85.7% of the DHF and DSS groups. There were no deaths among the 162 patients. The admission rate was 43.8%. A high compliance rate of 86.4% by the doctors and a low patient default rate of 16.4% showed that the protocol was practical.