Private practitioners in the slums of Karachi: what quality of care do they offer?

Private health services have expanded in many developing countries over the last 10 yr. Qualified private practitioners provide basic health care for poorer groups in urban areas, although health care planners frequently criticize them for providing poor quality of care, charging high fees and failing to provide preventive health advice. In Karachi, a large city with more than 400 slums, private practitioners are important providers of care to the poor. This study assessed the nature and quality of care provided by 201 practitioners selected from four districts of the city. Vignettes of specific medical problems were used to assess their knowledge and their practice was measured by observing 658 doctor-patient contacts. The results show that knowledge was closer to accepted medical management than was their actual prescribing practice. On the other hand, their manners and interpersonal behaviour were good. Thus poor prescribing practice, which might equally stem from market influences as lack of knowledge, is the cause of low standards of care. In these circumstances, didactic in-service training to improve prescribing practice is unlikely to be successful.     

Persistence of fetal cardiopulmonary circulation: one manifestation of transient tachypnea of the newborn

Five cyanotic newborn infants underwent cardiac catheterization between 8 and 36 hours of age with a tentative diagnosis of cyanotic congenital heart disease. All had normal cardiovascular anatomy. Cyanosis was the result of persistence of fetal cardiopulmonary circulation with right-to-left shunting across the ductus arteriosus. In all infants, cyanosis resolved spontaneously and the infants survived without sequelae. Admission chest roentgenograms of all infants showed marked hyperinflation of the lungs. Except for severe hypoxemia, the clinical presentation, chest films, and course of illness of these infants were consistent with transient tachypnea of the newborn. It is proposed that an increase in pulmonary vascular resistance, due to hyperinflation of the lungs, was the mechanism which reopened the fetal cardiopulmonary circulatory channels and produced hypoxemia, and that these infants suffered from a rare manifestation of a usually benign newborn respiratory condition. Further, given these pathophysiologic mechanisms, the use of continuous transpulmonary pressure gradients in the management of such infants would be contraindicated.     

Leucocyte-migration inhibition induced by uveoretinal antigen in patients with diabetic retinopathy

Leucocyte-migration inhibition was to determine the state of hypersensitivity in 65 diabetic patients with different stages of retinopathy and 21 nondiabetic controls. About one third of the patients with simple or proliferative retinopathy exhibited significant leucocyte-migration inhibition of 0.2 mg/ml. protein concentration of uvreoretinal antigen. In contrast, only one of 15 patients with minimal retinopathy and none of the controls showed significant leucocyte-migration inhibition. Corneal and lenticular antigens did not evoke a cellular immune response in any of the tested individuals. These findings suggest that cell-mediated hypersensitivity to uveoretinal antigen may develop in diabetic patients with prolonged, progressive, simple or proliferative retinopathy.     

Regulation of the immune system by synthetic polynucleotides. VI. Amplification of the immune response in young and aging mice

Model systems for study of the action of adjuvants in immunodeficient states were developed in 10- to 14-day-old BALB/aj mice and aging BALB/aj mice (12 to 16 months). With sheep red blood cells as antigen polyadenylicpolyuridylic acid complexes (poly A:U) were found to be stimulatory in both the neonatal and aging mice. The effect of poly A:U was similar to that seen when 5 X 10(6) thymocytes from immunologically mature mice were given with antigen. Cell-free supernatant fluids induced by incubation of poly A:U with thymocytes likewise were capable of restoring the number of antibody-forming cells to normalcy in aging mice.     

Hypertension--the fledgling of modern medical practice

The treatment of hypertension was discovered long before the mechanisms of the disease became known. Only recently has it been appreciated that blood pressure is controlled physiologically in many ways. Hypertension has suddenly achieved celebrity status. It is now recognized as the second leading cause of death in the United States. New programs have made the public aware of it and have prompted many individuals to have their blood pressure checked. Office diagnostic measures usually suffice to determine the presence of the disease. Treatment should generally be initiated with a slow-acting diuretic or with propranolol; other drugs may be added later. Treatment is a lifelong undertaking, and engaging the patient as a partner in the venture by means of home blood pressure measurements and an educational program contributes to its success. Treatment of hypertension is the first step in the prophylaxis of atherosclerosis.     

Women's attitudes to mastectomy for breast cancer

One hundred patients who had been subjected to mastectomy for carcinoma were interviewed retrospectively to gauge their attitudes to any physical and/or emotional disabilities relating to their operation or disease. It was found that 40% of the patients had delayed for longer than a month after the onset of symptoms before seeking medical advice, but the reasons for this were not readily forthcoming. However, fear of mastectomy was not a common cause. Anxiety and embarassment due to an absent breast occurred in about one-third of patients, and did not diminish with time. Knowledge and the use of mammary prostheses was far from universal, and disturbingly only two-thirds were counselled in these matters by their medical advisers. Physical complications were common, particularly lymphoedema of the arm, and as expected this was closely related to the type and extent of treatment undertaken.     

Inversion of rational polynomial matrices

The letter is concerned with automatic computational procedures for the inversion of a matrix where every element is a rational function. Two possible methods are considered: one based on the Gaussian elimination algorithm and the other based on the Faddeev algorithm.     

Radiation patterns of paraboloid with log-periodic dipole feed

The effect of axial displacement of phase centre on the secondary performance of a parabolic reflector is described, with particular reference to a log-periodic dipole-array feed. Computed and experimental results are presented.