Manappallil R.,National Hospital
Italian Journal of Medicine | Year: 2016
Patients with Parkinson's disease are prone to mental disturbances like psychosis and delirium. Psychosis has been attributed to drugs like dopamine agonists, while delirium is commonly seen during the days of hospital stay and infections. This is a case of a 62-year-old lady, a known case of Parkinson's disease on levodopa therapy, who has had repeated episodes of delirium over the past year. Her delirium episodes were usually associated with urinary tract infection and hyponatremia or as a part of levodopa therapy. However, this time on further evaluation, she was found to have cryptococcal meningitis as the culprit for her delirium. ©Copyright R. Manappallil, 2016.
Ogunfowokan O.,National Hospital
West African journal of medicine | Year: 2011
Envenomation from snake bites is a public health hazard in tropical countries. The observed mortality among in-hospital patients bitten by carpet viper (Echis ocellatus) in northern Nigeria has drastically reduced, related to the use of a mono-specific ovine Fab anti-snake venom. However, many victims survive with temporary or permanent physical or psychological sequelae. Our aim was to find the relationship between bite-to-hospital time and morbidity in patients bitten by carpet viper. A prospective study was conducted in North-Central Nigeria. The signs of morbidity scored were oedema, tenderness, prolonged whole blood clotting time, blister, ulcer, need for blood transfusion, coma, hypotension, convulsion, length of hospital stay, need for disarticulation, and need for skin graft. A score of 1 was given to each objective and verifiable sign. Bite-to-hospital time of 233 subjects was obtained. Most of the subjects, 150(64%) came to the hospital within six hours of snake bite, out of whom two(1%) came within one hour. The median bite-to-hospital time was five hours with a range of 0.5-216 hours. Major morbidities were oedema accounting for 212 (91.0%; 95% CI =86.6-94.3%). incoagulable blood was seen in 205(88%; 95% CI = 83.1-91.9%) and tenderness in 201(86.3%; 95% CI = 81.2-90.4%). The mean morbidity score was 8 ± 4. For every unit increase in log bite-to-hospital time, the morbidity score increased by 1.85 (p < 0.001). Morbidity caused by carpet viper bite is high in Nigeria and worsens with increasing bite-to-hospital time.
Thabah M.,JIPMER |
Ravindran V.,National Hospital
Rheumatology International | Year: 2015
Physiological changes during normal pregnancy are likely to give rise to musculoskeletal symptoms. On the other hand, autoimmune rheumatological diseases disproportionately affect women, often presenting during the childbearing years and sometimes during pregnancy. Contrary to autoimmune rheumatological diseases, the management of non-autoimmune musculoskeletal manifestations is generally conservative and often tends to resolve after pregnancy. It is therefore important to be aware of various musculoskeletal problems seen in the course of pregnancy. In this narrative review, commonly encountered non-autoimmune musculoskeletal problems during pregnancy have been described. © 2014, Springer-Verlag Berlin Heidelberg.
Agboghoroma C.O.,National Hospital
African journal of reproductive health | Year: 2011
Over 50% of the 33.3 million HIV-positive persons are women within the reproductive age group. With increasing availability and use of highly active antiretroviral therapy (HAART), the prognosis, life expectancy and quality of life of infected persons has improved. HIV-positive women, like their uninfected counterparts, may desire to plan pregnancies, limit their families, or avoid pregnancy. The effective use of contraception by HIV-positive clients can contribute significantly to reduction in both sexual and vertical transmission of the virus. HIV-positive clients can use most of the available contraception methods including barrier, hormonal, intrauterine devices and sterilization. However, some antiretroviral drugs interact with hormonal contraceptives with potentials for reduction in efficacy. Dual protection with concomitant use of a more effective contraceptive method and male or female condom to prevent HIV and Sexually transmitted infections (STIs) is the standard. It is necessary to make provision for contraceptive service as part of comprehensive care for the HIV-positive client.
Isanaka S.,Epicentre |
Isanaka S.,Harvard University |
Langendorf C.,Epicentre |
Berthe F.,Epicentre |
And 8 more authors.
New England Journal of Medicine | Year: 2016
BACKGROUND High-quality evidence supporting a community-based treatment protocol for children with severe acute malnutrition, including routine antibiotic use at admission to a nutritional treatment program, remains limited. In view of the costs and consequences of emerging resistance associated with routine antibiotic use, more evidence is required to support this practice. METHODS In a double-blind, placebo-controlled trial in Niger, we randomly assigned children who were 6 to 59 months of age and had uncomplicated severe acute malnutrition to receive amoxicillin or placebo for 7 days. The primary outcome was nutritional recovery at or before week 8. RESULTS A total of 2412 children underwent randomization, and 2399 children were included in the analysis. Nutritional recovery occurred in 65.9% of children in the amoxicillin group (790 of 1199) and in 62.7% of children in the placebo group (752 of 1200). There was no significant difference in the likelihood of nutritional recovery (risk ratio for amoxicillin vs. placebo, 1.05; 95% confidence interval [CI], 0.99 to 1.12; P = 0.10). In secondary analyses, amoxicillin decreased the risk of transfer to inpatient care by 14% (26.4% in the amoxicillin group vs. 30.7% in the placebo group; risk ratio, 0.86; 95% CI, 0.76 to 0.98; P = 0.02). CONCLUSIONS We found no benefit of routine antibiotic use with respect to nutritional recovery from uncomplicated severe acute malnutrition in Niger. In regions with adequate infrastructure for surveillance and management of complications, health care facilities could consider eliminating the routine use of antibiotics in protocols for the treatment of uncomplicated severe acute malnutrition. Copyright © 2016 Massachusetts Medical Society. All right reserved.