Neonatal hypothermia in a developing country

Fifty newborn Iraqi children with hypothermia were studied to determine causes and incidence of the precipitating factors. The majority of infants more than three days old (late-onset) had evidence of infection, particularly septicemia. The overall mortality rate was 26 per cent--(42 per cent in low birth weight infants (LBW). Early-onset hypothermia in the first three days of life is due to exposure to cold without evidence of infection and has a good prognosis. The most common finding in our series was a high incidence of aspiration pneumonia in late-onset hypothermia. Antibiotics effective against Escherichia coli, such as gentamicin, should be given from the outset to all patients with late-onset hypothermia without waiting for laboratory proof of infection.     

Medical negligence in a developing country

This article reviews medical malpractice in developing black African countries in the context of the limitations and constraints placed on professional practice in these countries. Financial, infrastructural, educational, cultural, religious, political and historical factors all play a crucial role in the provision of health care, and societal values are reflected in patients' expectations regarding acceptable professional performance and the liability of doctors for medical negligence.     

Evaluation and management of pediatric major trauma

Proper management of the pediatric trauma patient involves most of the components contained within standard trauma protocols. By paying strict attention to the anatomical and physiological differences among the pediatric population, the clinician will be assured the best outcomes. This article outlines the fundamentals of proper management of pediatric trauma patients.     

Impact of an educational program on antibiotic use in a tertiary care hospital in a developing country

A multi-cross-sectional study was conducted in a 2000-bed tertiary care university hospital in Bangkok, Thailand, from September 1993 to May 1994 to assess the effectiveness of an educational program on the use of antibiotics. Data on the study covered antibiotic usage both in-patients and out-patients. Data were collected for a 24-hour period every 2 weeks for 7 days for each 3-month period. The target population were residents, general practitioners, and sixth-year medical students. The educational program provided information derived from the data of inappropriate use of antibiotics during the pre-intervention period and guidelines on the use of antibiotics which were agreed to by a consensus among the faculty in all clinical departments. The study revealed: (1) the prevalence of antibiotic use and the cost of antibiotics during post-intervention period was significantly decreased by 20%; (2) the use of antibiotic prophylaxis for obstetrics patients and patients undergoing cataract surgery decreased significantly; (3) there was a shift from second or third generation cephalosporins to cefazolin for surgical prophylaxis; (4) the duration of perioperative antibiotic prophylaxis was reduced to under 2 days; (5) there was a shift from netilmicin or amikacin to gentamicin for the treatment of community acquired infection; and (6) the mortality, median length of hospital stay, and nosocomial infection rate among the patients who received antibiotics during the post-intervention period were not significantly different from those during the pre-intervention period. These results suggest that this educational program comprising information feedback and antibiotic usage guidelines was effective in improving antibiotic use at this tertiary care university hospital in Thailand.     

Work motivation in a developing country.

Used a critical incidents technique requiring respondents to provide incidents that would make them work very hard or very little to examine work motivation in Zambia. Content analyses of the incidents mentioned by 341 Zambian workers, aged 19–67 yrs, from 11 organizations and 5 occupational groups yielded 6 major sets of items: (a) growth and advancement opportunity concerns, (b) items dealing with the nature of the work itself, (c) material and physical provisions elements, (d) items relating to interpersonal relationships, (e) concern about fairness in organizational practices, and (f) personal problems items. These items were then used to construct a questionnaire to which 80 Ss responded. Frequency of mention of motivating and demotivating items correlated highly with responses to the questionnaire constructed from the critical incidents. The motivational items contain elements of several popular work motivation theories developed and investigated in American workplaces, but some items may be unique to developing countries. Further, there was evidence that some elements were more frequently mentioned as demotivators and others as motivators, which is consistent with the general notion underlying the 2-factor theory of motivation. (21 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The ABCs of developing a trauma newsletter

Two basic patterns of venous drainage of the stomach were found in rabbits. In the first, which is highly prevalent (27 cases-90.0%), the v. gastroepiploica dextra is present while no such vein is present in the second one. Other venous channels are represented by the v. gastrica sinistra and by tributaries of the v. lienalis. In cats there are also two basic patterns of the stomach venous drainage. The first highly prevalent type without the v. gastroepiploica dextra was found in 23 cases (76.0%); in the second type this vein was present. In rabbits the v. gastroepiploica sinistra was observed in 25 cases (82.5%), in cats in only two cases (6.6%). The v. gastroepiploica dextra in the rabbit is usually a tributary of the v. portae, while in cats it is a tributary of the v. lienalis. In ten rabbits (33.3%) there was a venous arch around the curvatura ventriculi major, while in cats it was absent. The great difference in the stomach venous pattern in rabbits and cats can be explained by the different zoological position of these two kinds of animals.     

A retrospective descriptive study of pediatric trauma in a desert country

OBJECTIVE: To determine the optimal initial depth of tube placement in nasotracheal intubation (NTI) of adult patients, measured at the naris, prior to obtaining a chest radiograph (CXR). METHODS: Part 1: A prospective, observational study was performed to compare the initial depth of NTI, measured at the naris, with the observed height of the endotracheal tube (ETT) tip above the carina on the initial CXR. Optimal depths were predicted by gender. Part 2: Results from Part 1 were prospectively validated by measuring the frequency of adequate placement when ETTs were placed to this depth. ETT placement was considered adequate if the tip was at least 2 cm above the carnia and below the larnx on the CXR. RESULTS: Part 1: The mean depth measured at the naris was 27.5 +/- 1.5 cm in women (n = 50) and 27.8 +/- 1.0 cm in men (n = 74). The mean distance of the tip of the ETT to the carina was 3.9 +/- 2.7 cm in women and 6.4 +/- 2.2 cm in men. Initial tube position was adequate in 39 (78%) of the women and 72 (97%) of the men. It was determined that if a depth of 26 cm had been used in the women and 28 cm in the men, 45 (90%) of the women and 70 (95%) of the men would have had adequate tube placement, resulting in statistically significant improvement in the women (p < 0.05; McNemar chi 2). Part 2: These calculated depths (26 and 28 cm) were then prospectively applied in 26 women and 52 men. Twenty-five (96%) of 26 women and 51 (98%) of 52 men had adequate placement, with a mean height above the carina of 4.5 +/- 1.4 cm in women and 5.6 +/- 1.8 cm in men. CONCLUSION: Initial placement of NTI at 26 cm in women and 28 cm in men, measured at the naris, resulted in adequate initial placement for most adult patients.     

Neuroleptanalgesia for intra-ocular surgery: experience in a developing country

A technique of neuroleptanalgesia is described for effective and reliable sedation during intra-ocular surgery under local analgesia. The absence of side effects using modified neuroleptanalgesia was of particular value in a situation in a developing country in which large numbers of patients had to be handled in a comparatively short period of time.     

A case of multiple trauma following a motor cycle accident

This paper reports a fractured femur, jejunal laceration and a torn aorta in a young man who appeared reasonably well on admission to hospital. The diagnostic problems and treatment of this case are discussed.     

Long-term results of intramedullary pinning of forearm fractures in a developing country

BACKGROUND: Patients with fractured forearms who were treated with intramedullary Rush pins/nails at Port Moresby General Hospital (Papua New Guinea) were studied. METHODS: Sixteen patients were reviewed 24 months after insertion of the pins/nails. RESULTS: The results indicate that good outcomes could be achieved by the use of intramedullary pins in developing countries. There were no major specific short- or long-term complications (re-fracture or non-union). Disability in terms of pain and stiffness was noted in only three out of six patients with pins in situ. These were considered temporary disabilities. CONCLUSIONS: The pins are much cheaper than plates and screws, require minimal expertise for insertion, and removal was performed under local anesthetic as outpatient cases. They remain a valuable method for managing patients with forearm fractures in developing countries.     

Helicobacter pylori infection in children with abdominal ailments in a developing country

Retrospective maternal report of fetal activity level was compared with developmental diagnosis in 608 consecutively referred children. Maternal history of fetal activity level was also obtained from 140 unmatched well children in a general pediatric clinic. Fetal hyperactivity was positively associated with a diagnosis of child hyperactivity, and fetal hypoactivity was positively associated with a diagnosis of mental retardation in the children. Maternal histories of fetal activity level in the control group weakened the strength of the association between fetal hyperactivity and child hyperactivity but did not affect the association between fetal hypoactivity and mental retardation in children.     

Conservative treatment in major kidney trauma

The kidney is frequently involved in penetrating abdominal injuries, and less so in closed abdominal traumatism. This paper presents one case of major renal trauma with total renal fracture and development of urinoma that separated both segments that, after a minimally invasive manoeuvre (percutaneous drainage), evolved favourably thus avoiding a surgical procedure which, quite reasonably, would have led to nephrectomy.     

Epidemiology of major trauma and trauma deaths in Los Angeles County

The aims of this study were to identify differences in the centre of buoyancy (CB) and centre of mass (CM) locations of male and female collegiate swimmers, and to assess the influence that buoyancy has on freestyle kicking performance. Sixteen female collegiate swimmers (mean +/- s: age 19.1 +/- 1.2 years) had significantly more adipose tissue (20.2 +/- 4.4%) than 15 male collegiate swimmers (19.9 +/- 1.0 years, 12.6 +/- 3.8%). The ratio of the sum of abdominal and suprailiac skinfolds to the thigh skinfold was significantly greater for the males (2.07 +/- 0.37) than the females (1.31 +/- 0.32), implying that females had proportionately more fatty tissue caudally than males. The distance d between the centres of buoyancy and mass was significantly larger for the males (0.79 +/- 0.43 cm) than the females (0.16 +/- 0.34 cm). Both points were more caudal in the female subjects (59.9 +/- 0.7% and 59.8 +/- 0.7% of body height respectively) than in the male subjects (61.7 +/- 0.8% and 61.2 +/- 0.9% respectively). These data suggest that the difference in d may be attributed to the difference in the location of the centre of buoyancy, because the centre of mass difference was not significant and was characterized by a smaller effect size. The amount and distribution of adipose tissue accounted for a significant proportion of variance in d (R2 = 0.25 and 0.29 respectively). Males had a significantly higher proportional kick time, defined as the ratio of times to complete a 22.9 m sprint when kicking and swimming respectively, than females (1.57 +/- 0.09 and 1.51 +/- 0.13 respectively). This shows that the male swimmers kicked proportionally more slowly than the female swimmers. However, the distance d did not account for a significant proportion of variance in the proportional kick time. Therefore, our results do not support the notion that skilled male swimmers are at a performance disadvantage in terms of natural buoyancy characteristics.     

The status of the developing occlusion of 8-9 year-old children from a lower socio-economic group in a developing country

The aim of this study was to determine the percentage of developing malocclusions that are present at the age of 8-9 years. This data will be used for a follow-up study on the same sample two years hence, in order to formulate soundly based recommendations to Public Health Authorities on the implementation of a community directed, preventive and interceptive orthodontic programme. A total of 936 children were examined by 3 investigators, at 9 primary schools in the lower socio-economic suburbs of a large urban area. The majority of subjects (66.5 per cent) presented with Class I malocclusions. A significantly higher percentage of white children however, presented with Class II malocclusions, while black children showed a higher tendency toward Class III malocclusion. Well circumscribed anterior openbites were found in 27.8 per cent of black children, but no specific causative factors could be identified. Early loss of primary molars and canines occurred in both groups. There was a statistically significant difference (p < 0.05) between the mean posterior arch lengths of the two groups, the black children having on average 2.2 mm longer arch lengths.     

Prediction of posttraumatic stress disorder by immediate reactions to trauma: a prospective study in road traffic accident victims

Road traffic accidents often cause serious physical and psychological sequelae. Specialists of various medical faculties are involved in the treatment of accident victims. Little is known about the factors which might predict psychiatric disorders, e.g. Posttraumatic Stress Disorder (PTSD) after accidents and how psychological problems influence physical treatment. In a prospective study 179 unselected, consecutively admitted road traffic accident victims were assessed a few days after the accident for psychiatric diagnoses, severity of injury and psychopathology. All were inpatients and had to be treated for bone fractures. At 6-months follow-up assessment 152 (85%) of the patients were interviewed again. Of the patients, 18.4% fulfilled the criteria for Posttraumatic Stress Disorder (DSM-III-R) within 6 months after the accident. Patients who developed PTSD were injured more severely and showed more symptoms of anxiety, depression and PTSD a few days after the accident than patients with no psychiatric diagnosis. Patients with PTSD stayed significantly longer in the hospital than the other patients. Multiple regression analysis revealed that the length of hospitalization was due mainly to a diversity of factors such as severity of injury, severity of accident, premorbid personality and psychopathology. Posttraumatic stress disorder is common after road traffic accidents. Patients with PTSD at follow-up can be identified by findings from early assessment. Untreated psychological sequelae such as PTSD cause longer hospitalization and therefore more costs than in non-PTSD patients.     

Long-term outcome of trauma in adults: the psychological impact of a fatal bus accident

The psychological impact of trauma on 36 parents and spouses was examined 1 year (1989), 3 years (1991), and 5 years (1993) after a fatal school bus accident in Western Norway in 1988. The course and outcome of posttraumatic symptoms (Impact of Event Scale [IES]) and symptoms of general psychological distress (SCL-90) were examined in relation to type of trauma (loss vs. no loss) and prior exposure to trauma. A large proportion of the sample reported high levels of symptoms on SCL-90 and IES (Intrusion). No associations were observed between type of trauma and any of the symptom measures. Prior exposure to trauma did not affect the scores on IES but was associated with a sustained vulnerability for general psychological distress (SCL-90). Different trajectories of the symptoms indicate that two psychological processes may be involved in long-term adjustment to trauma.     

Otogenic intracranial abscess: concurrent craniotomy and mastoidectomy--changing trends in a developing country

OBJECTIVES: To evaluate (1) the clinical profile, treatment, and outcome of adult and pediatric patients presenting with intracranial abscess of otogenic origin and (2) the advantages of concurrent craniotomy and mastoidectomy. DESIGN: A prospective case series. SETTING: An academic tertiary referral center in India. PATIENTS: Thirty-six patients clinically diagnosed as having intracranial abscess that was secondary to suppurative otitis media and confirmed by computed tomographic scanning. INTERVENTION: Concurrent craniotomy and mastoidectomy. RESULTS: Children were more commonly affected than adults, and there was a male preponderance. All patients had cholesteatoma at surgery, although one third of the children had only granulation tissue on otoscopy. More than two thirds of the patients in both the groups presented with more than one intracranial complication and definitive surgical intervention was done later than 24 hours. Meningitis was the most frequent intracranial complication, followed by cerebellar abscess. There was no significant intraoperative or postoperative morbidity, mortality, recurrence of intracranial complications, or residual neurological deficits. Three children (14%) showed evidence of recidivism cholesteatoma requiring revision surgery. CONCLUSIONS: In suppurative otitis media with intracranial complications, it is accepted practice to treat the neurosurgical complication first, followed by mastoidectomy at a later date after the patient has been stabilized. Craniotomy with concurrent mastoidectomy is not only safe, but it also removes the source of infection at the same time the complications are being treated, thus avoiding reinfection while the patient is awaiting the ear surgery. In addition, the treatment is completed with a single, shorter hospital stay, which is more economical for the patient.