Thoracic empyema in Dar es Salaam, Tanzania

A review of 114 thoracic empyema cases attended in the thoracic unit of the Muhimbili Medical Centre from July 1986 to July 1990 is presented. 87.7% of the cases were males. Their ages ranged from 9 to 79 years with a mean of 32 years. Tuberculosis was the major cause accounting for 63.2% of all the cases. 53.4% of the patients underwent either open chest drainage decortication or thoracoplasty. The duration of hospital stay ranged from 2-8 months with a mode around 3.5 months. A 7% mortality was noted.     

Some notes about the occurrence of intestinal parasites in Dar es Salaam, Tanzania

Stress ulcers were induced by subjecting rats to forced immobilisation and cold (4 degrees to 7 degrees C) for 4 hrs. The nature of drugs which afford varying degrees of protection against such ulceration, bring out the complexity of the factors involved in the study of pathogenesis of acute gastric ulceration due to stress.     

Clinical predictors of HIV-1 infection among preschool children in Dar es Salaam, Tanzania

Seroprevalence of HIV-1 infection was determined in children aged between eighteen months and five years, attending maternal and child health (MCH) clinics in Dar es Salaam, Tanzania. A total of 889 children were eligible for the study, however seven children could not be enrolled because their mothers/guardians absconded and blood could not be drawn from 21 children due to refusal of mothers/guardians and from another 12 children due to technical reasons. Therefore, the participation rate was 95.5%. Of the 849 children screened, 14 (1.65%) were found to have IgG anti HIV-1 antibodies in their sera. The main clinical features found in children with symptomatic HIV-1 disease were weight loss, generalized lymphadenopathy, recurrent fevers, and prolonged diarrhoea. The utility of clinical features suggestive of HIV-1 infection (according to CDC classification) in identifying HIV-1 infection in children was evaluated and found to have high sensitivity (100%), specificity (96.9%) and negative predictive value (100%), but a low positive predictive value (35%). Marked variations in progression to symptomatic phase were noted, whereby some relatively young children had progressed to symptomatic phase (CDC class P-2A), while some older children were still in the asymptomatic stage (CDC class P-1 C). None of the symptomatic HIV-1 infected children presented with neurological disease, severe opportunistic infections, or malignancies. Although reduced mid-upper arm circumference and weight-for-age were associated with HIV seropositivity, these clinical parameters had low positive predictive values compared to the CDC classification.     

The incidence of HIV infection among women using family planning methods in Dar es Salaam, Tanzania

Animal caps isolated from Xenopus laevis embryos at the blastula stage were treated sequentially with NH4Cl, a known cement gland inducer, and with 12-O-tetradecanoyl phorbol-13-acetate (TPA), a known neural inducer. The two artificial inducers were also used in reverse order to see if they can mimic the natural inducers acting during the progressive determination of the ectodermal organ. Immunofluorescence and whole-mount in situ hybridization were used to study the expression of tubulin, taken to indicate an early step on the pathway of cell elongation, and neural cell adhesion molecule (N-CAM) taken to indicate an early step in the determination of the nervous system. The expression of XCG-1, a marker of early specification of the cement gland, was also studied. The results showed that the two artificial inducers can mimic the effects of the natural inducers in animal cap explants. The TPA behaves like a neural inducer, reducing the number and the extension of the cement gland when added to the medium in addition to NH4Cl, before or after NH4Cl treatment. In the process of cement gland/neural induction, it is possible to redirect the ectoderm already specified as cement gland to neural tissue, but it does not seem possible to respecify the neural tissue as cement gland. Moreover, the animal caps were also cut into dorsal and ventral parts and the two halves were treated separately. The results were similar to those obtained with treatment of the entire animal cap, suggesting that a dorsal-ventral pattern is not yet established before the gastrula stage, and that in normal embryos there are boundaries between the effects of different inducers.     

Performance of a modified HIV-1 p24 antigen assay for early diagnosis of HIV-1 infection in infants and prediction of mother-to-infant transmission of HIV-1 in Dar es Salaam, Tanzania

Food additive intake has been estimated in Finland by means of a stepwise system using simultaneously two different methods. The first method, based on food consumption and food control analysis, can be classified into the group of Estimated Daily Intake methods (EDI). The second method, a questionnaire to food manufacturers concerning the use of food additives, has been employed five times. Estimates have been timed to reflect legislative changes and their influence on the intake. The intake of most food additives and sweeteners by Finnish diabetic adolescents was well below Acceptable Daily Intakes (ADIs). The average nitrite intake, especially by children and adolescents, was greater. Estimates of nitrite intake by children varied between 39% and 89% of ADIs depending on the method used and the new ADIs given by the Joint FAO/WHO Expert Committee on Food Additives (JECFA). Diabetic children's and the mothers' daily intake of nitrite was shown to be greater when compared with that of non-diabetics and the results of that other Finnish study gives support the evidence that dietary nitrites may be associated with the development of Type I diabetes. New estimates of additive intakes, based on a nationwide control project carried out in 1994, will be worked out. The results will reflect the situation in Finland before EU membership.     

Blood transfusion practices in Mwanza Region, Tanzania. Bugando Medical Centre

Uncertainty exists about the forces applied by dentists during dental crown cementation. A measuring system was developed based around a commercially available miniature (3.8 mm high and 12.7 mm diameter) load cell. The load cell was mounted in a finger stall and the applied force measured. Experimental results suggest that dentists typically apply a force to metal crowns of about 60 N for a few seconds, followed by the application of a steady force of about 20 to 30 N. Lower forces are applied to porcelain crowns.     

Antenatal phenobarbital therapy and neonatal outcome. II: Neurodevelopmental outcome at 36 months

X-linked liver glycogenosis type II (XLG II) is a recently described X-linked liver glycogen storage disease, mainly characterized by enlarged liver and growth retardation. These clinical symptoms are very similar to those of XLG I. In contrast to XLG I patients, however, XLG II patients do not show an in vitro enzymatic deficiency of phosphorylase kinase (PHK). Recently, mutations were identified in the gene encoding the liver alpha subunit of PHK (PHKA2) in XLG I patients. We have now studied the PHKA2 gene of four unrelated XLG II patients and identified four different mutations in the open reading frame, including a deletion of three nucleotides, an insertion of six nucleotides and two missense mutations. These results indicate that XLG II is due to mutations in PHKA2. In contrast to XLG I, XLG II is caused by mutations that lead to minor structural abnormalities in the primary structure of the liver alpha subunit of PHK. These mutations are found in a conserved RXX(X)T motif, resembling known phosphorylation sites that might be involved in the regulation of PHK. These findings might explain why the in vitro PHK enzymatic activity is not deficient in XLG II, whereas it is in XLG I.     

Severity of brain injury following neonatal extracorporeal membrane oxygenation and outcome at age 5 years

Neurodevelopmental evaluation in childhood provides an opportunity to study complex neurological compensation following documented neonatal brain injury, and furnishes important clinical information which may have an impact on patient care. We studied 152 term children treated with extracorporeal membrane oxygenation (ECMO) as neonates and who received routine neonatal neuroimaging and comprehensive neurodevelopmental evaluation at age 5 years. The cohort was divided into four groups based on an independent neuroimaging score: No lesion, N=88; Mild lesion, N=38; Moderate lesion, N=12; and Severe lesion, N=14. Standardized testing at age 5 included complete neuropsychological assessment, neurological evaluation, and assessment of motor function. All testing was conducted without knowledge of the neuroimaging score. The occurrence of disability by severity of neuroimaging was: No lesion=10%; Mild=13%; Moderate=33%; Severe=57%. The relative risk within the ECMO population for disability at age 5 after moderate or severe neonatal lesion was 4.3 (CI=1.0 to 17.5) and 11.7 (CI=3.3 to 41.3), respectively. The remaining non-disabled children who had moderate to severe lesions functioned within normal limits. Severity of neonatal neuroimaging was inversely associated with IQ scores, pre-academic skills, and neuromotor function. The effect size was small but the rank order was predictable. Our data identify in 5-year-old children an impact of brain lesion severity demonstrated on routine neonatal neuroimaging. The results indicate potential compensation following moderate and severe lesions, and suggest a subtle but consistent influence of even mild neonatal brain injury.     

Indications for laparoscopic colorectal surgery. Results from the Medical Centre Alkmaar, The Netherlands

The Boyden chamber method showed that the invasiveness to reconstituted blood vessel endothelium of metastatic gynecologic cancer cell lines of the uterine cervix (MS751 and ME-180), endometrium (AN3 CA), and ovary (SK-OV-3 and PA-1) was significantly higher than of primary cancer cell lines of the cervix (HeLa and C-33 A), endometrium (Ishikawa, HEC-1-A and HHUA), and ovary (MCAS and Caov-3), and that the invasiveness was inhibited by estradiol or progestin in the metastatic cells but not in the primary cells. These results suggest that metastatic cancer cells by themselves increase the potential of blood vessel invasion, which can be inhibited by estrogen and progestin administration.     

Relation of deranged neonatal cerebral oxidative metabolism with neurodevelopmental outcome and head circumference at 4 years

Cerebral oxidative metabolism was studied using phosphorus magnetic resonance spectroscopy during the first week of life and neurodevelopmental outcome was assessed at 4 years in 62 infants who had clinical and/or biochemical evidence consistent with birth asphyxia (critically impaired intrapartum gas exchange). Twenty-one died and the neurodevelopmental status of the 41 who survived was assessed by a range of tests at age 4 years. The minimum recorded values for the cerebral phosphocreatine:inorganic phosphate concentration ratio (an index of oxidative metabolism) were related to outcome. The results showed significant relations between the extent of derangement of neonatal oxidative metabolism and a range of adverse outcomes, including death, and at 4 years reduced head growth and the presence and severity of neuromotor impairments, overall neurodevelopmental impairments, and cognitive functioning. Strong correlations between the extent of derangement of neonatal oxidative metabolism and outcome at 1 and 4 years were also shown. We conclude that the severities of adverse outcomes at 1 and 4 years of age were closely related to the extent of cerebral energy derangement in the first week of life, and we also conclude that primary intrapartum hypoxic-ischaemic cerebral injury was generally responsible for the events that led to death, microcephaly, and impaired     

Delivering at the right price--the costs of primary maternity care at the Diepkloof Community Health Centre, Soweto

This paper reports on a study of the costs of primary maternity care services at the Diepkloof Community Health Centre (DK) in Soweto. DK, the Soweto community health centre system as a whole and numerous other non-hospital settings provide a wide range of maternal health services to substantial numbers of women, and relieve hospitals of a major potential clinical burden. However, no research has been done in South Africa on the relative costs of the provision of these services in different settings and by different types of health worker. The cost structure of these services at DK is presented and the costs of antenatal care, deliveries in midwife-run labour wards, postnatal care (at the health centre and at home) and family planning services detailed. Some comparisons are made with existing data for another community health centre and with Baragwanath Hospital. These results are relevant to policy and planning of maternal health services. They are also shown to be of relevance to management and several areas of potential improvement of these services are noted.     

Placental histopathology in premature rupture of membranes. Its relationship with microbiological findings, maternal, and neonatal outcome

BACKGROUND: There is a close relationship between premature membrane rupture, bacterial infections and premature labor. AIM: To study placental histological changes in patients with preterm membrane rupture. To establish a relationship between pathological findings, amniotic fluid and lower genital tract microbiological studies, maternal and neonatal outcome. PATIENTS AND METHODS: Patients with premature membrane rupture of membranes between 24 and 34 weeks of gestation participated in this study. On admission, patients had no evidence of clinical chorioamnionitis, labor or fetal distress. Microbiological studies of the amniotic fluid and cervicovaginal secretions were performed and the placenta was sent for pathological study. RESULTS: Seventy one placentas were available for the study. The main pathological findings were acute chorioamnionitis in 58%, trophoblastic proliferation in 38%, funisitis in 37%, villitis in 16%, fetal vascular lesions in 14% and no findings in 17%. Microbial invasion of amniotic cavity was present in 89% of acute chorioamnionitis. Sixty one percent of trophoblastic proliferation and all fetal vascular lesions were associated with negative amniotic and cervical cultures. Newborns with acute funisitis had a higher frequency of neonatal death (29%), severe asphyxia (42%) and neonatal infections (29%). CONCLUSIONS: Acute chorioamnionitis is the most frequent finding in patients with preterm membrane rupture and microbial invasion of amniotic cavity. In the absence of intra amniotic infection, proliferation of the trophoblast and the presence of fetal vascular lesions predominate. Acute funisitis is strongly associated with adverse fetal outcome.     

Skin colonization of Staphylococcus aureus in atopic dermatitis patients seen at the National Skin Centre, Singapore

BACKGROUND: Combinatorial chemistry has become an important method for identifying effective ligand-receptor binding, new catalysts and enzyme inhibitors. In order to distinguish the most active component of a library or to obtain structure-activity relationships of compounds in a library, an efficient quantitative assay is crucial. Electrospray mass spectrometry has become an indispensable tool for qualitatively screening combinatorial libraries and its use for quantitative analysis has recently been demonstrated. RESULTS: This paper describes the use of quantitative electrospray mass spectrometry for screening libraries of inhibitors of enzymatic reactions, specifically the enzymatic glycosylation by beta-1,4-galactosyltransferase, which catalyzes the transfer of galactose from uridine-5'-diphosphogalactose to the 4-position of N-acetylglucosamine beta OBn (Bn: benzene) to form N-acetyllactosamine beta OBn. Our mass spectrometric screening approach showed that both nucleoside diphosphates and triphosphates inhibited galactosyltransferase while none of the nucleoside monophosphates, including uridine-5'-monophosphate, showed any inhibition. Additional libraries were generated in which the concentrations of the inhibitors were varied and, using mass spectrometry, uridine-5'-diphosphate-2-deoxy-2-fluorogalactose was identified as the best inhibitor. CONCLUSIONS: This report introduces quantitative electrospray mass spectrometry as a rapid, sensitive and accurate quantitative assaying tool for inhibitor libraries that does not require a chromophore or radiolabeling. A viable alternative to existing analytical techniques is thus provided. The new technique will greatly facilitate the discovery of novel inhibitors against galactosyltransferase, an enzyme for which there are few potent inhibitors.     

Client distress disclosure, characteristics at intake, and outcome in brief counseling.

Client tendencies to disclose versus conceal personally distressing information (termed distress disclosure) were hypothesized to relate to measures of social support, personality, perceived stress, and symptomatology at intake, as well as improvement over the course of counseling. Seventy-nine college counseling center clients completed questionnaires at intake; 45 of these clients also completed measures at termination. Distress disclosure was related to social support, trait positive affectivity, and trait negative affectivity at intake; and distress disclosure was associated with a decrease in client-rated stress and symptomatology over the course of counseling. These findings point to the importance of attending to client differences in tendencies to disclose versus conceal personally distressing information both at intake and as it relates to change in counseling. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Factors associated with participation, attrition, and outcome in a smoking cessation program at the workplace.

Of 66 24–58 yr old smokers in 2 worksites, 67% participated in a smoking cessation program. 55% completed the program. Of those, 29% had quit smoking by posttest, and 17% were abstinent at the 6-mo follow-up. Different variables predicted participation, attrition, and outcome. Significant predictors of smokers who participated were length of cessation in previous abstinence attempts, number of years they smoked, and belief regarding personal vulnerability in contracting a smoking-related disease. Levels of pretest carbon monoxide and attitudes regarding adoption of smoking restrictions in the worksite predicted attrition. Posttest cessation was related to nicotine levels of cigarette brand smoked at pretest and pretest beliefs regarding postcessation weight gain. Abstinence at the 6-mo follow-up was predicted by number of co-workers who smoked and pretest concerns related to postcessation weight gain. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Ageing and social rank effects on the reproductive system of free-ranging yellow baboons (Papio cynocephalus) at Mikumi National Park, Tanzania

The Wnts can be classified into two classes based on their ability to transform cells. The Wnt5a class can antagonize the effects of transforming Wnts partly through effects on cell migration. To understand the mechanisms of regulation of Wnt5a, we investigated its expression in human normal and breast cancer cell lines. Elevation of Wnt5a in HB2, a normal breast epithelial cell line, was linearly correlated with cell density, but this did not occur in cancer cell lines. We examined intracellular events responsible for the regulation of Wnt5a by cell to cell contacts, using various metabolic agents known to affect signal transduction pathways. Agents that selectively blocked protein kinase C (calphostin C) or protein tyrosine kinases (genistein) reduced the level of Wnt5a expression markedly. Protein kinase C activation by phorbol 12-myristate 13-acetate up-regulated Wnt5a partly through prolongation of Wnt5a mRNA half-life. Cytoskeleton reorganization following cytochalasin D treatment caused an induction of Wnt5a, which was associated with changes in cell morphology. Calphostin C did not block these effects, showing that protein kinase C is acting upstream of cytoskeletal modulation. However, the cancer cell lines treated with cytochalasin D showed no changes in cell morphology or Wnt5a induction, suggesting disruption of this regulatory pathway in cancer.     

Experimental determinations of carcass processing by Plio-Pleistocene hominids and carnivores at FLK 22 (Zinjanthropus). Olduvai Gorge, Tanzania

Published and unpublished skeletal and surface mark data from the large, well-preserved, bovid dominated FLK 22 (Zinjanthropus) archaeofauna are analyzed using data derived from four different experimental control samples. The control samples are realistic because they are based on natural history and paleoecological data collected from FLK 22, and other Olduvai Gorge assemblages; they are precise because independent experimental studies following the same methods have generated the same results; and they restore generality to the study of site formation because each one models a different hominid and/or carnivore scenario of site formation. Comparability between FLK 22 and the control samples is established by excluding specimens from the former which do not meet identification and reporting standards derived from the latter. As in two previous studies, a comprehensive analysis of tooth marks and tool marks on long bone specimens from FLK 22 indicates that they were processed in three stages. In stage one, carnivores defleshed long bones, as inferred from the high percentage of tooth marks on midshaft fragments. In stage two, hominids processed intact long bones for marrow, as inferred from percussion mark percentages. Cut marks suggest that long bones retained flesh, but the amount, as yet, cannot be determined using cut mark percentages. In stage three, carnivores processed long bone epiphyses for grease, as inferred from the under-representation of long bone epiphyses and the high percentage of tooth marks on near-epiphyses and surviving epiphyses. The lack of comprehensive skeletal and surface mark data on cranial, axial, compact, and other specimens currently limits the application of experimental results. However, the available data suggest that the condition and representation of these items in the FLK 22 assemblage are also consistent with a carnivore to hominid to carnivore sequence of site formation. The variety of elements present, and their extensive processing by hominids, indicates that FLK 22 functioned as a central place/refuge where hominids could transport a variety of carcass parts and process them in an unhurried fashion. The presence of numerous small and medium sized individuals also indicates that hominids could have passively scavenged carcasses from a number of different sources including lions, leopards, sabertooth cats, and mass drownings.     

Evaluating the options for developing databases to support research-based medicine at the NHS Centre for Reviews and Dissemination

The internalisation of metabotropic glutamate receptor (mGluR1alpha) and its splice variant (mGluR1beta), in response to agonist and phorbol esters (PMA), has been studied. Both mGluR1alpha and mGluR1beta exhibit a similar rate of internalisation following PMA treatment, with a shift in their distribution from plasma membrane to endosome-enriched membrane fractions. Agonist challenge however caused a rapid loss, within 5-10 min, of mGluR1beta but not mGluR1alpha from the cell surface. These results show that the two forms of mGluR1 show different internalisation responses to agonist and suggest that the C-terminal region of the molecule plays an important role in this phenomenon.     

Head Orientation position during birth and in infant neonatal period, and hand preference at nineteen weeks

This study of lateral preferences of normal full-term infants found, as predicted, that infants who were delivered from a left occiput anterior or transverse birth position (head turned to the right) exhibited a neonatal right supine head orientation and a right-hand preference in visually guided reaching tasks at 19 weeks. Contrary to prediction, infants delivered from a right occiput anterior or transverse birth position (head turned to the left) did not exhibit a left-sided preference in either neonatal head position or hand preference. Results are discussed in relation to other research which found a right shift in neonates' head orientations and in the distribution of hand preference in the human population. The findings suggest further investigation into the relationship between prenatal and postnatal postural asymmetries and the continuing development of laterality.