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AIM: Conventional care of prematurely born infants involves extended maternal-infant separation and incubator care. Recent research has shown that separation causes adverse effects. Maternal-infant skin-to-skin contact (SSC) provides an alternative habitat to the incubator, with proven benefits for stable prematures; this has not been established for unstable or newborn low-birthweight infants. SSC from birth was therefore compared to incubator care for infants between 1200 and 2199 g at birth. METHODS: This was a prospective, unblinded, randomized controlled clinical trial; potential subjects were identified before delivery and randomized by computerized minimization technique at 5 min if eligible. Standardized care and observations were maintained for 6 h. Stability was measured in terms of a set of pre-determined physiological parameters, and a composite cardio-respiratory stabilization score (SCRIP). RESULTS: 34 infants were analysed in comparable groups: 3/18 SSC compared to 12/13 incubator babies exceeded the pre-determined parameters (p < 0.001). Stabilization scores were 77.11 for SSC versus 74.23 for incubator (maximum 78), mean difference 2.88 (95% CI: 0.3-5.46, p = 0.031). All 18 SSC subjects were stable in the sixth hour, compared to 6/13 incubator infants. Eight out of 13 incubator subjects experienced hypothermia. CONCLUSION: Newborn care provided by skin-to-skin contact on the mother's chest results in better physiological outcomes and stability than the same care provided in closed servo-controlled incubators. The cardio-respiratory instability seen in separated infants in the first 6 h is consistent with mammalian "protest-despair" biology, and with "hyper-arousal and dissociation" response patterns described in human infants: newborns should not be separated from their mothers.

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Kangaroo mother care is becoming an integral part of the care of low birth weight infants worldwide. It provides economic savings to families and health care facilities and many physiologic and psychobehavioral benefits to mothers and infants, the most important of which is the promotion of successful breastfeeding. The benefits of breastfeeding, of human milk over formula, and of feeding from the breast per se, are beyond dispute, and so KMC should be actively promoted. The full impact of KMC on breastfeeding low birth weight infants is yet to be realized.

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An epidemiological and clinical study of Parabuthus transvaalicus scorpionism was conducted in Zimbabwe. Ten per cent of stings resulted in severe scorpionism. The clinical features of 17 patients with severe envenomation were primarily neuromuscular, with significant parasympathetic nervous system and cardiac involvement. The clinical course was prolonged compared to other scorpion syndromes, and significant therapeutic benefit was demonstrated in terms of hospital stay in response to species specific antivenom. The case fatality rate was 0.3%, with deaths in children below 10 years and adults above 50 years. The mortality rate in the district was 2.8 per 100,000 per year. This syndrome from a buthid scorpion resembles in many respects buthid scorpionism described elsewhere in the world, but shows important differences, notably cardiac involvement in the absence of clinical evidence of circulating catecholamines. The relevance of these findings to buthid scorpionism generally are presented as a hypothesis, in which it is postulated that the cardiac effects of the toxins are direct and primary, and autonomic effects secondary but synergistic, determining the ultimate clinical picture.

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OBJECTIVE: To describe the epidemiological and clinical features of scorpion stings in a district with potentially lethal scorpions. DESIGN: Case series of consecutive scorpion sting victims. SETTING: Manama Hospital and all seven rural health centres in Gwanda South District, Zimbabwe (population 62500). PARTICIPANTS: All known cases of scorpion sting reporting to health centres in the district; all severe cases in which the scorpions had been identified, and who were admitted and examined by the author between September 1991 and September 1993. MAIN OUTCOME MEASURES: Description of clinical features of severe Parabathus transvaalicus scorpionism. RESULTS: Two hundred and forty-four cases, of which 184 were P. transvaalicus Purcell, 1899. Seventeen patients with severe P. transvaalicus scorpionism showed sensory and motor nerve stimulation, with generalised hyperaesthesia, weakness, ptosis, dysphagia, muscle tremors and abnormal reflexes. There was cardiac involvement, and respiration was compromised secondary to muscular weakness. Parasympathetic nervous system stimulation was seen in the absence of sympathetic stimulation, with profuse sialorrhoea, sweating and urinary retention. CONCLUSIONS: The clinical features of P. transvaalicus scorpionism are described for the first time. These resemble those of P. granulatus scorpionism which, however, has significant sympathetic nervous system stimulation, the distinguishing features being visual disturbances, anxiety, restlessness and raised blood pressure. Scorpion antivenom should be given for both. General recommendations on management of scorpion stings are given.

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A "treatment score" for primary and pulmonary tuberculosis is presented. In view of the difficulty in diagnosing sputum negative pulmonary tuberculosis, and the numerous adverse consequences of over and under diagnosing this disease, a standardised method of deciding which patients need anti-tuberculosis therapy is advantageous. By means of "weighting" various factors in the clinical presentation, adding these and setting a cutoff point at which to treat for tuberculosis, such a standardisation is achieved. The "treatment score" relies on microscopy and radiography, with symptoms, signs and laboratory tests as important adjuncts. Primary and pulmonary tuberculosis present differently in children under five years old and, the "weighting" of the various factors in the clinical presentation differs from that of adults, with less risk of under-diagnosis. The treatment score is designed to be useful in government, mission and other hospitals in developing countries.

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The results of introducing the 'kangaroo method' (constant nursing of the baby skin to skin on the mother's chest), as the exclusive means of treating low birth weight (LBW) babies is reported, in the context of a mission hospital in a developing country without incubators and standard equipment for care of LBW neonates. Details of the method developed are described. The survival of babies born under 1500 g improved from 10% to 50%, whereas that of babies 1500-1999 g improved from 70% to 90%. The method is well accepted by the community, and easily grasped by all hospital staff. Staff expectations concerning survival have dramatically improved, and a considerable saving in workload is experienced. The kangaroo method as described is strongly recommended to all units in developing countries treating LBW babies without modern equipment.

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