The Central African journal of medicine
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Notable progress has been achieved in our understanding of the pathogenesis of pulmonary hypertension, in particular the role of vasodilators, vasoconstrictors and the intracellular signaling pathways, cytokines, chemokines and growth factors involved. A comprehensive history and clinical examination is mandatory in the assessment and determination of the cause of pulmonary hypertension. This should be complemented by a rationale approach to investigation. ⋯ General measures include oxygen therapy and judicious use of diuretics in patients with overt right heart failure. Newer therapies that have been developed for the treatment of idiopathic pulmonary hypertension include prostanoids, modulators of vascular remodelling such as bosentan and its analogues and PGE-5 inhibitors such as sildenafil. New therapies are likely to become available in the future as our understanding of the pathogenesis of pulmonary hypertension evolves.
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To describe anaesthetic associated mortality in a district hospital in Zimbabwe. ⋯ Most of the anaesthetic factors are preventable. These results, although very poor, are consistent with reports from hospitals in the region. By comparison, developed countries are at least 10 times better. Improving the provision, skills, support and profile of anaesthesia providers in the care of peri operative patients, would reduce anaesthesia-associated factors in peri operative mortality. A system of national audit data collection comparable to the CEPOD or Confidential Enquiry into Maternal Deaths is overdue in Zimbabwe.
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To describe the status of ethics review as pertaining to medical research in Zimbabwe, to compare this with international guidelines, and thus to identify potential improvements in the process. ⋯ A focus on research ethics education for researchers and IREC members, as well as ensuring appropriate respect for IREC review, are opportunities for improvement in the process.
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To find out if the status of a patient on arrival in the intensive care unit had any bearing on the immediate ICU outcome and if there are any correctable factors. ⋯ Some simple measures could be undertaken to improve immediate ICU outcome in surgical patients in a resource limited environment, such as improving the ambient temperature in OT during surgery and standardising transportation to PICU.