East African medical journal
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Comparative Study Clinical Trial
Halothane consumption under varying breathing circuit designs.
Thirty one patients at the Eldoret District Hospital, currently being used as a referral and teaching hospital, were anaesthetised and allowed to breathe through any of the three standard Maplesons circuits. The quantity of halothane required to maintain a satisfactory level of anaesthesia was measured and expressed in millilitres per kilogramme body weight, per minute. This value was used to compare the cost-effectiveness of the three circuits under different modes of ventilation.
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The aim of this study was to investigate the resuscitative effects of various intravenous solutions on intestinal mucosal damage and bacterial translocation due to haemorrhagic shock. Seventy Sprague-Dawley rats were anaesthetised and subjected to thirty minutes of haemorrhagic shock (systolic blood pressure 40 mmHg). Resuscitation was established with either autologous-blood, three per cent hypertonic saline (HS), 7.5% HS, 0.9% NaCl and Ringer's lactate and Dextran 70 solution. ⋯ A statistically significant difference was observed between the groups resuscitated with HS solution and the other solutions. No meaningful difference was noted between the various concentrations of hypertonic saline solution. The reduction in the rate bacterial translocation with hypertonic solution is assumed to be due to preservation of intestinal microcirculation and thus prevention of intestinal ischaemia.
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Steady state concentrations of three anticonvulsant drugs (phenobarbitone, phenytoin and carbamazepine) were measured in plasma samples from fifteen patients (eight males and seven females; ages: 13-49 years; body weights: 44-70 kg), attending the outpatient Neurology Clinic at Kenyatta National Hospital. In addition, total protein and albumin levels were measured in plasma from patients taking phenytoin. Total protein levels were normal (range: 6.3-7.6 g/dl) in all patients except in one patient (10.7 g/dl). ⋯ Most patients in the study complied with the prescribed treatment and their epilepsy was controlled. Cases where drug levels were undetectable probably arose from a lack of money to purchase all prescribed medicines rather than deliberate non-compliance. Routine monitoring of anticonvulsant drug levels may improve management of epileptic patients.
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Fifty eight children underwent rigid bronchoscopy under general anaesthesia for suspected aspirated foreign bodies. There were 36 boys and 22 girls with a median age of thirty three months. Physical examination showed decreased breath sounds and wheezing over the affected site in forty seven cases. ⋯ Post endoscopic complications included mild to moderate croup in fifteen patients (26%), fever in four and pneumothorax in one. Rigid bronchoscopy of aspirated foreign bodies in children is a safe, effective and often life saving procedure. Morbidity is low and although mortality was 1.8% in this series zero mortality should be achievable.
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This study examined the pattern of psychiatric consultation-liaison service in a West African general hospital setting over a period of five years. Cases seen were recorded in a register and later analysed. The rate of referral was found to be lower than those of Britain and USA. ⋯ The commonest psychiatric syndromes encountered were acute brain syndrome, brief reactive psychosis, depressive disorder and dementia. A negative attitude towards patients with psychiatric co-morbidity was identified. Areas of improving consultation-liaison psychiatric services in West Africa are suggested.