East African medical journal
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Randomized Controlled Trial Comparative Study Clinical Trial
Treatment of hyperkalaemia by altering the transcellular gradient in patients with renal failure: effect of various therapeutic approaches.
Ten patients with acute and 60 with chronic renal failure (both groups having hyperkalaemia), were managed at Kenyatta National Hospital in the medical wards and Renal Unit between August, 1995 and January, 1996. They were divided into seven different treatment groups, each consisting of ten patients. Treatment A glucose 25g i.v. with insulin 10 units i.v., treatment B 50 mmol of 8.4% sodium bicarbonate infusion, treatment C 0.5mg of salbutamol i.v. in 50mls 5% dextrose, treatment D was a combination of treatments A and B, treatment E was a combination of treatment B and C, treatment F was a combination of treatments A and C while treatment G was a combination of treatments A and B and C. ⋯ If dialysis cannot be instituted early enough it seems reasonable to repeat treatment every 4-6 hours to sustain the effect. Repeated administration of glucose with insulin may not be safe because of the hypoglycaemic effect. Other single and combination therapies can theoretically be repeated regularly until dialysis is initiated although this requires further clinical evaluation.
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Drainage after thyroid surgery has been widely used to prevent life-threatening complications. However, it is well known that drains do not always prevent haematoma formation. In this retrospective study, we reviewed our experience with 1057 thyroidectomies with and without drains in order to assess this issue. ⋯ Reoperation for bleeding was done in twelve patients in the drainage group and two patients in the non-drainage group (p < 0.05). Wound infection was seen in seven patients in the drainage group and none in the no-drainage group (p < 0.05). This study suggests that routine drainage after thyroid surgery is not necessary and a selective policy can be applied safely.
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We designed a study to assess the nutritional status of children under five years of age attending MCH clinics in Dar es Salaam. This was a cross-sectional anthropometric study involving children 6-24 months who from July to August 1993 were attending Magomeni MCH clinic and those aged 18 months to five years who were attending Lugalo and Mwananyamala MCH clinics for routine growth monitoring and for vaccination between May to August 1994. The data collected included age, birthweight, sex, weight, height, breastfeeding status and HIV-1 serostatus. ⋯ HIV seropositivity and low birthweight were both associated with stunting and wasting. We conclude that malnutrition is still a sizeable problem among children attending urban MCH clinics in Dar es Salaam especially among those aged less than three years, to whom special malnutrition control strategies should be targeted. There is also a need to identify factors responsible for the observed decline in MCH attendance with age and correct the situation.
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A prospective study was undertaken to determine the clinical pattern and outcome among children admitted with acute severe malaria into the emergency paediatric unit (EPU) at the Jos University Teaching Hospital (JUTH) over a 15-month period (between August 1991-October 1992). Five hundred and one (25%) children were admitted with acute severe malaria, out of a total of 2008 admissions into the EPU during the study period. Blood smears for malaria parasites were positive in 287 (57.7%) of the children and P. falciparum was the only species identified in the study. ⋯ Sixteen out of the 501 children died, giving a mortality of 3.2%. Cerebral malaria, which accounted for only 17.6% of the admissions, was responsible for 56.3% of all the deaths. Mortality was also associated with hypoglycaemia, severe anaemia, shock and repeated, prolonged seizures.