Articles: disease.
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Comparative Study
Comparison of arm circumference against standard anthropometric indices using data from a high density town near Harare, Zimbabwe.
In a limited controlled sample, the performance of the middle upper arm circumference (MUAC) was compared to those of standard indices (weight for age, height for age and weight for height), using 90 children aged one to four years living in a high density town near Harare, Zimbabwe. Using a cut off point of 15,5 cm, the MUAC performed best in relation to the weight for age (sensitivity 66,7 pc (95 pc confidence interval (CI) 53,3-80,0 pc), specificity 76,2 pc (95 pc CI 61,7-80,5 pc)) than to any other standard index. Nevertheless, this performance was unsatisfactory because about 30 in every 100 (28,9 pc) children would have been inaccurately identified as healthy or diseased. Although we do not have evidence from the present study to recommend the use of the MUAC in identifying children who are malnourished and living in similar high density areas, the MUAC may be applicable to children living in areas of higher prevalence of malnutrition.
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From 1982 the Ministry of Health of Egypt implemented the National Control of Diarrhoeal Diseases Project (NCDDP) which attempted to improve case management of childhood diarrhoea by making oral rehydration salts (ORS) widely available and used, to improve feeding patterns during diarrhoea, and other measures. National data indicate a high level of success in achieving the targets. ⋯ Consequently, in 1988 the area was revisited to examine subsequent changes. Findings showed marked improvement in case management of diarrhoea and rapid mortality decline, with diarrhoeal mortality apparently declining somewhat faster than mortality from other causes.
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Review Comparative Study
BCG vaccination in India and tuberculosis in children: newer facets.
With the extended programme of immunisation and since 1985 the universal programme of immunisation and the coverage status of BCG vaccination in India has been very good, although it is still unsatisfactory in the eastern states. It is emphasized that BCG vaccination cannot prevent natural tuberculous infection of the lungs and its local complications, although it reduces the haematogenous complications of primary infection. However, this is not true for malnourished children who, inspite of BCG vaccination, develop serious, and often fatal types of tuberculosis such as miliary, meningitic and disseminated tuberculosis. ⋯ Similarly, vaccinated children may present with hepatomegaly, splenomegaly or isolated organ disease. It is important to relearn the new patterns of tuberculosis disease seen in vaccinated, non-malnourished children, and to a lesser extent in children with grade 1 to 2 protein energy malnutrition (PEM). With these limitations of BCG vaccination, other strategies like chemoprophylaxis need multicentric trials in high risk children, in different parts of the country.
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Review Case Reports
Streptococcal toxic shock-like syndrome as an unusual complication of laparoscopic tubal ligation. A case report.
Toxic shock-like syndrome due to Streptococcus pyogenes is an unusual occurrence. Previously reported cases have been the result of focal infections with S pyogenes. We present a case in which manipulation of a colonized mucosal surface during laparoscopic tubal ligation was the presumed cause of the sepsis syndrome. Whereas other reports of this syndrome have all noted concurrent infections with S pyogenes, in this instance it was unclear if toxin-mediated disease was initiated by mild endometritis or iatrogenic manipulation of a colonized mucosal surface.