RESUMEN
Introduction: Sudan has a large and growing private health sector. No survey was done in Sudan to show the extent of the use of private health care services by the population. Also precise data on tuberculosis (TB) diagnosis and treatment in the private sector are not available. Material and methods A facility-based cross-sectional survey was carried out during February2007-June 2007 in Khartoum state; whereby consented private physicians working in the all private clinics (n=110) were interviewed. Results This study showed that a large private sector exist in the country and deliver care to TB patients and reported the non-adherence of this sector to National Tuberculosis Program (NTP) guidelines. 59.1of the interviewed physicians correctly mentioned the TB treatment regimens; only 8(12.3) physicians that reported management of TB patients actually prescribed these regimens to their patients. Similarly; only 10(15.4) physicians requested sputum smear examination for TB diagnosis. Conclusion A considerable proportion of cases is inadequately managed by the private sector and is not notified to NTP. The information delivered by this study can be used to develop a workable Public-private mix (PPM) model with the private sector
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Manejo de Atención al Paciente , Sector Privado , Tuberculosis/prevención & control , Tuberculosis/terapiaRESUMEN
SETTING: Yemen. OBJECTIVE: To review the epidemiological situation of tuberculosis (TB) in Yemen by conducting a tuberculin survey and by comparing the results obtained with those of a previous tuberculin survey from 1991. DESIGN: A nationwide tuberculin survey enrolling 31,276 schoolchildren aged between 7 and 12 years. RESULTS: Skin indurations were recorded for 28,499 schoolchildren, of whom 16,927 (59.4%) had no bacille Calmette-Guérin (BCG) scar. Analysis of the distribution of indurations was difficult as it did not show any bimodal pattern. Prevalence of infection and annual risk of tuberculosis infection (ARTI) were thus estimated using the mirror image and mixture methods, and not the cut-off point method. The two methods indicated similar results: respectively 0.45% and 0.51% for prevalence of infection, and 0.05% and 0.05% for ARTI. In comparison with the 1991 tuberculin survey, the average annual decline of ARTI was 9.0% by the mirror method and 5.5% by the mixture method. CONCLUSION: Yemen seems to have a low ARTI (0.05%), and TB infection seems to be declining considerably. Analysis of the survey results highlighted the limitations of tuberculin surveys in countries with comparable epidemiological situations.
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Prueba de Tuberculina , Tuberculosis/epidemiología , Niño , Estudios Transversales , Femenino , Humanos , Masculino , Vigilancia de la Población , Prevalencia , Medición de Riesgo , Factores de Tiempo , Tuberculosis/diagnóstico , Yemen/epidemiologíaRESUMEN
To estimate the annual risk of tuberculosis (TB) infection (ARTI) in Somalia a tuberculin survey was conducted in February/March 2006. Stratified cluster sampling was carried out within the 18 regions and 101 randomly selected primary schools. Tuberculin testing was done in 10 680 grade 1 schoolchildren. Transverse tuberculin reaction size was measured 72 hours later. The number of children with a satisfactory test read was 10 364. The overall BCG coverage was 54%. Based on frequency distribution of tuberculin reaction sizes, the ARTI in Somalia was estimated at 2.2% (confidence interval: 1.5%-3.2%). There was an annual decline of 2.6% comparing with a previous study in 1956.
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Tuberculosis/epidemiología , Adolescente , Adulto , Distribución por Edad , Vacuna BCG , Niño , Protección a la Infancia/estadística & datos numéricos , Preescolar , Análisis por Conglomerados , Notificación de Enfermedades/estadística & datos numéricos , Femenino , Humanos , Incidencia , Indicadores y Reactivos , Pacientes Internos/estadística & datos numéricos , Masculino , Vigilancia de la Población , Prevalencia , Características de la Residencia/estadística & datos numéricos , Factores de Riesgo , Distribución por Sexo , Somalia/epidemiología , Estudiantes/estadística & datos numéricos , Tuberculina , Tuberculosis/diagnóstico , Tuberculosis/prevención & control , Vacunación/estadística & datos numéricosRESUMEN
To estimate the annual risk of tuberculosis [TB] infection [ARTI] in Somalia a tuberculin survey was conducted in February/March 2006. Stratified cluster sampling was carried out within the 18 regions and 101 randomly selected primary schools. Tuberculin testing was done in 10 680 grade 1 schoolchildren. Transverse tuberculin reaction size was measured 72 hours later. The number of children with a satisfactory test read was 10 364. The overall BCG coverage was 54%. Based on frequency distribution of tuberculin reaction sizes, the ARTI in Somalia was estimated at 2.2% [confidence interval: 1.5%-3.2%]. There was an annual decline of 2.6% comparing with a previous study in 1956
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Tuberculosis , Encuestas Epidemiológicas , Prueba de Tuberculina , Factores de Edad , Vacuna BCG , Factores de Riesgo , Mycobacterium tuberculosisRESUMEN
UNLABELLED: In the paediatric section, two papers relating to the upper urinary tract are presented. The first, from Hungary, describes simultaneous bilateral percutaneous nephrolithotomy in 13 patients, where it was deemed feasible; this is the first such report. Authors from London report on unilateral nephrectomy in patients with nephrogenic hypertension, and found that it was successful in normalising blood pressure in patients with renal hypertension with a normal contralateral kidney. OBJECTIVE: To evaluate the efficacy of removing bilateral kidney stones simultaneously from children, in one session. PATIENTS AND METHODS: Thirteen patients (three girls and 10 boys, 26 kidneys; mean age 8 years, range 3-14) underwent simultaneous bilateral percutaneous nephrolithotomy (PCNL) in the same session, under general anaesthesia, starting with ureteric catheter insertion into both kidneys and using a 26 F adult nephroscope. The mean (range) stone diameter was 2 (1-3.5) cm. Three patients had staghorn stones in one of their kidneys. Ultrasonic disintegration was used; two patients had bilateral and two others unilateral endopylotomy, and one patient had percutaneous suprapubic cystolithotomy in the same session. The mean (range) operative duration was 65 (55-90) min. RESULTS: All patients were rendered stone-free; there was no severe bleeding or any other complication. On one side in one of the patients, a second session was needed because of residual stone. The nephrostomy tubes were removed 3 and 4 days after PCNL and the hospital stay was 6 (1-11) days. CONCLUSION: The advantages of simultaneous bilateral PCNL are reduced psychological stress, one cystoscopy and anaesthesia, less medication and a shorter hospital stay and convalescence, with considerable savings in cost. In experienced hands this method can be used not only in adults but also in children. To our knowledge this is the only report of this technique in children.
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Cálculos Renales/cirugía , Nefrostomía Percutánea/métodos , Adolescente , Niño , Preescolar , Femenino , Humanos , Lactante , Cálculos Renales/química , Tiempo de Internación , Masculino , Resultado del TratamientoRESUMEN
To determine the late gestational development of copper-zinc (CnZn) and manganese (Mn) superoxide dismutases (SOD) in human lung, immunohistochemical localization was performed for each SOD. The lung samples were taken from five aborted fetuses, four fetuses in which intrauterine death occurred, one full-term neonate, two premature infants with hyaline membrane disease and one premature infant with bronchopulmonary dysplasia (BPD). Morphometry was performed, and the percent area of positive staining was computed. The bronchial epithelium was intensely stained from the early stages of gestation (i.e. 17 weeks), while the staining intensity for both CuZnSOD and MnSOD in the peripheral airways increased gradually during lung development. The mean percent area of the staining for CuZn-SOD and MnSOD from 16 to 38 weeks was increased 30-fold and 8-fold, respectively, and further increases were observed postnatally. CuZnSOD staining was markedly decreased in lungs with respiratory disorders. However, proliferating type II pneumocytes were intensely stained for MnSOD in the BPD lungs, making the staining area 3-fold larger than that in the control lungs. These results clearly depict age-related increases in staining for both CuZnSOD and MnSOD and an alteration in SOD distribution associated with neonatal respiratory disorders.
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Displasia Broncopulmonar/enzimología , Feto/enzimología , Enfermedad de la Membrana Hialina/enzimología , Pulmón/enzimología , Superóxido Dismutasa/análisis , Displasia Broncopulmonar/patología , Humanos , Enfermedad de la Membrana Hialina/patología , Inmunohistoquímica , Recién Nacido , Recien Nacido Prematuro , Pulmón/patologíaRESUMEN
We investigated the developmental profile of copper-zinc and manganese superoxide dismutase (CuZnSOD and MnSOD) in tissue sections obtained from fetal (Day 12 to 21 of gestation) and neonatal (Day 0 and 6) rats. Tissues were stained immunohistochemically with specific antisera against the respective rat SODs. There was a general trend towards richness of SODs in the epithelial linings and metabolically active sites, although differential distribution between the two SODs also existed. At Day 12 of gestation, immunoreactivity for both SODs was detected in the cardiomyocytes but not in other tissues. Hepatocytes expressed CuZnSOD at Day 14 and MnSOD at Day 17. By Day 18 CuZnSOD was detected in the epithelial cells of the gastrointestinal tract, respiratory tract, pancreatic islets, kidneys, and adrenals. These tissues exhibited MnSOD staining at Day 19. CuZnSOD occurred in the epithelia of the thyroid, thymus, and salivary glands at Day 19, while MnSOD was seen at Day 21. The increase in intensity of the staining for SODs occurred no later than postnatal Day 0, indicating that most tissues accumulated SODs during late gestation. Breathing atmospheric oxygen during early extrauterine life did not appreciably intensify the SOD staining. These results suggest that perinatal increase in SODs occurs as a general mechanism of preparation for birth.
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Animales Recién Nacidos , Feto/enzimología , Superóxido Dismutasa/metabolismo , Animales , Western Blotting , Femenino , Inmunohistoquímica , Masculino , Ratas , Ratas Sprague-Dawley , Distribución TisularRESUMEN
Alveolar macrophages obtained by bronchoalveolar lavage (BAL) were evaluated by electron dispersive microanalysis (EDX) for the presence of elemental gold. EDX revealed gold in 90% (9/10) of patients with RA who were currently receiving chrysotherapy or who had discontinued chrysotherapy less than 24 months before BAL. All patients who had discontinued chrysotherapy more than 24 months before BAL (range: 3-14 years) were EDX negative (4/4), as were patients with RA who had never received gold therapy (5/5). Seven patients with RA (7/19) had clinical evidence of interstitial lung disease and 12 patients (12/19) had no interstitial lung disease. There was no correlation between chrysotherapy and the development of interstitial lung disease. These results demonstrate that gold is retained for prolonged periods in pulmonary tissue macrophages but do not identify any relationship between gold and chronic rheumatoid lung disease.
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Artritis Reumatoide/metabolismo , Oro/metabolismo , Macrófagos/metabolismo , Alveolos Pulmonares/metabolismo , Artritis Reumatoide/tratamiento farmacológico , Microanálisis por Sonda Electrónica , Tiomalato Sódico de Oro/efectos adversos , Tiomalato Sódico de Oro/uso terapéutico , Humanos , Estudios Prospectivos , Fibrosis Pulmonar/inducido químicamenteRESUMEN
An 18-yr-old male involved in a motor vehicle accident developed acute traumatic mitral regurgitation with fulminant pulmonary edema and death. He had prominent V waves on his pulmonary arterial trace, a history of chest trauma, frothy pink pulmonary edema, and elevated pulmonary artery, wedge, and CVP. His ECG was normal and physical exam was negative for a typical murmur. He was on a ventilator and had copious secretions, making the diagnosis of a murmur difficult. A high index of suspicion is necessary when any patient is admitted with a history of chest trauma so that the diagnosis of a ruptured mitral valve is not missed.