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The hemolytic-uremic syndrome consists of microangiopathic hemolytic anemia, acute renal failure, and thrombocytopenia following a prodromal illness of gastroenteritis or upper respiratory infection. The syndrome can present in dramatic fashion with severe abdominal pain and signs of peritonitis suggesting an acute surgical crisis. In a series of 25 patients, 40% had abdominal pain, 25% had abdominal tenderness, and 20% had peritoneal signs. Clues to diagnosis in the early stages of the acute illness were mild to moderate hypertension, abnormal peripheral blood smear, anemia despite dehydration, and proteinuria. Significant abdominal pain and x-ray evidence of colitis may occur before development of typical laboratory findings, and these were evident in at least one case. Three patients underwent laparotomy for suspected bowel perforation. Colitis without perforation was found in all cases. In the absence of documented perforation, toxic megacolon, or intussusception, the decision to perform laparotomy in patients with hemolytic-uremic syndrome who have signs of peritonitis must be individualized. Failure to recognize the underlying renal problem can lead to serious errors in fluid and electrolyte management and delay of appropriate therapy.
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PMID:Hemolytic-uremic syndrome: a diagnostic and therapeutic dilemma for the surgeon. 73 58

This paper describes an infant with gastroenteritis, who developed hypertension and oedema after administration of inaccurately prepared oral glucose salt solution. The renin aldosterone system was suppressed in this child and it was suggested that this may be a factor in the development of hypernatraemia when abnormal water losses occur in infants fed on hyperosmolar feeds. Unless salt can be given accurately in small amounts it may be safer to advise feeds of glucose only in infants with mild diarrhoea.
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PMID:Hypertension, oedema, and suppressed renin aldosterone system due to unsupervised salt administration. 119 Aug 14

Using computerized in-patients' discharge records, a descriptive analysis was carried out of all medical admission in 1987 in a general hospital. The survey found that there were a total of 4053 admissions in 1987. A wide range of medical disorders were seen reflecting the lack of subspecialization. Cardiovascular disorders topped accounting for 25.6% of all admissions, followed by gastrointestinal and hepatobiliary disorders 12.8% and respiratory disorders 10.7%. The commonest specific medical disorders seen were hypertension 13.8%, diabetes mellitus 10.2%, ischaemic heart disease 7% and asthma 4.5%. The age, sex, ethnic and geographical distributions of the common medical disorders seen appear to conform to two broad pattern; hypertension, diabetes, ischaemic heart disease and cerebrovascular disease affected the older patients, had even ethic distribution and predominantly urban. Malaria, non-specific fever, viral hepatitis and acute gastroenteritis affected the younger patients, predominantly rural and Malay. Information from such surveys may be useful for planning and organization of medical services.
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PMID:Descriptive analysis of total medical admissions and common medical disorders in 1987 Kuantan General Hospital, using computerized in-patients' discharge record. 183 19

The opinions of 142 doctors on the relevance of anatomy to the diagnosis and management of common clinical problems in their current medical and dental practice were analysed. This was in a bid to determine the relevant anatomy course content for the new primary health care oriented medical and dental curriculum of the College of Medicine, University of Lagos. The respondents gave high scores to the relevance of anatomy knowledge to the management of acute abdomen (mean = 3.5), dislocated shoulder (3.3), Colles' fracture (3.2), palmar space abscess (3.2), obstructed labour (3.2), carcinoma of the breast (3.2), ectopic pregnancy (3.1), flail chest (3.1) and upper respiratory obstruction (3.0). They gave minimal scores to helminthiasis (mean = 1.5) common cold and anaemia (1.6), sickle cell disease (1.7), gastroenteritis (1.8), dental abscess (2.0), hypertension (2.2) and asthma (2.2). A basis for selecting relevant anatomy course content is deduced for an undergraduate curriculum in which the responsibilities and competence of the graduates is known. A nationwide extension of the study, especially amongst general practitioners and first-line doctors in rural areas, would be useful for identification of health problems that require little or no knowledge of anatomy and which can be safely managed by lower cadres of health personnel, traditional practitioners and members of the lay community.
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PMID:What anatomy shall we teach medical and dental students in a primary health care curriculum? 320 92

In Finland, the combinations of ethinyl estradiol (EE) and levonorgestrel (LNG) or desogestrel are most used for oral contraception (OC) and LNG, linestrol or nethisterone are employed in the pills containing only progestogen. Their effect is reduced by antiepileptics primarily phenytoin, carbamazepine, barbiturates, and primidone, however, clonazepam and sodium valproate do not exert any influence. The cause is the effect of the drugs on the liver as they accelerate the metabolism of steroids by enzyme induction. Phenytoin induces sex hormones binding globulin (SHGB) synthesized by the liver. In addition to natural hormones also LNG and norethisterone are bound to SHGB. The decrease of the effect of progestogens has not been documented, in fact, some research data indicate that progesterone exerts a beneficial effect in the treatment of epilepsy. Thus, combination OC tablets that contain at least 50 mcg of EE can be used for hormonal contraception of epileptics. Rifampicin applied in chemotherapy of tuberculosis (TB) also exhibits an effect inducing liver enzymes, and that is the reason why rifampicin treatment resulted in undesired pregnancy and bleeding disorders during contraception by combination tablets. Therefore, the concomitant use of both agents is contraindicated. In Finland data are scarce on this effect, as TB is very rare there. In the case of other antibiotics the incompatibility with OCs is proven. It must be noted, however, that as a secondary effect, diarrhea and gastroenteritis treated by antibiotics can produce an unwanted pregnancy. The treatment of diabetes and hypertension can also be contraindication to the use of hormonal contraception, although it may be permitted under medical supervision and control of diabetes.
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PMID:[Hormonal contraception and other drug treatments]. 333 Nov 52

Dr. Grayson (February 21, p. 445) asks about changes in vital statistics of 3rd world populations as they develop. Of African populations, those in Johannesburg and other large South African cities, while still in transition, have now reached a relatively high level of sophistication. Their health pattern is likely to be that of other African countries as they prosper. The (IMR) infant mortality rate of blacks in Soweto, Johannesburg, is about 40/1000 live births, although nearer 30 in the regularly employed elite. This figure is similar to that for blacks in New York in 1965 and for class 5 persons in the United Kingdom. Small-town dwellers have higher IMRs and in rural areas the rates are higher still although they are decreasing everywhere. Family size is decreasing; in urban areas the average family has 3-4 children and the elite have 2-3. In Johannesburg during the 1960s, the birth rate was about 40/1000 and it is now 25. While the rate is higher in rural areas, it is falling. In the very young, gastroenteritis with or without malnutrition is still the leading cause of sickness and death in both urban and rural areas. Rates are however decreasing. Deficiency diseases, especially pellagra, remain a health problem in some areas. Tuberculosis still continues to be a major hazard although it is being dealt with. With the rise in socioeconomic status and associated changes in diet and lifestyle, obesity, especially in urban areas and especially among women, is becoming very prominent. Hypertension is more common and is the leading cause of natural death among urban dwellers. The toll from coronary heart disease and noninfective bowel disease remains inexplicably low, but diabetes is only somewhat less prevalent than it is among whites. Changes in cancar pattern and rates are slight; however, esophageal cancer in men and cervical cancer in women are the main causes of concern in the urban centers and some rural areas. Rising alcohol consumption is a major problem with its ramifications in pancreatic, liver, and heart problems. Cigarette smoking is now as common as among whites. Because of low rates for most degenerative diseases, blacks have, at middle age, a life expectancy exceeding that of whites. As sections of the 3rd world population prosper, the IMR decreases enormously as does family size. However, infections and malnutrition among the very young and tuberculosis in older groups remain important problems. Among adults, rises occur in some degenerative diseases but not in others, and diseases linked with hypertension and alcohol consumption have become formidably common, as they have in other developing and developed countries.
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PMID:Third World policies and realities. 611 Sep 78

A prospective study over two and a half years analysed 48 children of acute renal failure requiring dialysis therapy. The mean age was 3 years 9 months and M:F ratio was 1.8:1. Renal causes predominated, accounting for 65%, with prerenal and postrenal causes responsible for 19% and 16%. Acute glomerulonephritis was seen in 13 cases, hypovolemia secondary to gastroenteritis in 9, tubular necrosis in 6, and hemolytic uremic syndrome in 5. A delay in seeking medical attention was present in as many as 48%, and was especially common with female children. All had oligo-anuria, with fluid overload present in 18.7%, hypertension in 23%, hypotension in 16.6%, neuropsychiatric manifestations in 20%, and infections in 47%. Peritoneal dialysis was carried out in 95%, and hemodialysis in 6.2%. Urine output and renal function returned to normal within 1.5 to 16 days (mean 5.9) in the survivors. Of the 28 who survived, 19 were followed up regularly for a mean of 4.25 months and all except one had normal renal function. Factors associated with a poor prognosis included female sex, age < 1 year, neurological manifestations, and hypotension, though these were not statistically significant. Mortality in our series was 41.5%. While etiological factors have shown changing trends, mortality still remains high inspite of dialysis.
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PMID:Acute renal failure in children requiring dialysis therapy. 789 66

An analysis has been made of causes of admission of black patients in 1991 to Murchison Hospital, Port Shepstone, Natal. Of 6675 total admissions, 6329 (95%) were classifiable. Of the latter, 1462 (23%) were aged 12 years and-younger, namely, 763 boys and 699 girls. Their chief causes of admission were pneumonia, gastroenteritis, trauma, acute glomerular nephritis, and malnutritional diseases. Of 4867 adults (73%), 1536 were males and 3331 females. Among men, chief causes were tuberculosis, congestive cardiac failure, hypertension and cerebral vascular accidents. Among women, apart from pregnancy, chief causes of admission were disorders of pregnancy, tuberculosis, congestive cardiac failure, pneumonia, diabetes, and hypertension. Of western diseases, 3.9% of adults were admitted for diabetes, and 2.8% for asthma. The general pattern of admissions is similar to that in other rural hospitals. The causes of admissions are discussed, regarding (1) public health improvements occurring, and (2) means of promoting further improvements by (a) community self-help, and (b) help from State health and other services.
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PMID:Causes of admissions of rural African patients to Murchison Hospital, Natal, South Africa. 816 43

The hemolytic-uremic syndrome (HUS) is an acute disorder, characterized by the triad of microangiopathic hemolytic anemia, nephropathy and thrombocytopenia. The great majority of patients are children, usually under 4 years of age, although adults can be affected. The onset is abrupt and usually follows gastroenteritis or upper respiratory infection. Later, clinical manifestations based on the triad, such as pallor, jaundice, edema, hypertension and purpura soon develop. The urinary output is reduced and the urine may appear dark yellow or tea-colored. Laboratory tests of peripheral blood show severe hemolytic anemia associated with fragmented red blood cells and thrombocytopenia, usually below 50,000/microliters. The blood urea nitrogen, serum creatinine and lactate dehydrogenase concentrations are elevated. Proteinuria and microscopic hematuria, which are indicative of active glomerular damage are also seen. Profound understanding of these manifestations is sufficient to permit an early diagnosis of HUS.
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PMID:[Diagnosis and clinical features of hemolytic uremic syndrome]. 843 21

Fifty-five patients with psoriatic arthritis were treated with a low dose of cyclosporin A (CyA) (mean dose 2.7 mg/kg per day) for a period of 6 months to investigate the efficacy of CyA on disease parameters. Significant improvement in the joint complaints and inflammation parameters was observed including a decrease in the number of painful (-46%) and swollen (-45%) joints, tenderness (Ritchie Index: -50%) and degree of swelling (-46%), patient's assessment of pain (-35%), the duration of morning joint stiffness (-37%), as well as a decrease in C-reactive protein (-52%). A 50% reduction of joint complaints required a total of 24 weeks, whereas a 50% reduction of skin involvement was achieved after 5-6 weeks of treatment. Four patients left the study due to adverse events: creatinine level increase in two patients, hypertension in one patient and gastroenteritis in the fourth patient. Joint scintigraphy in 18 patients indicated an improvement or stable condition in 61% of cases after a mean follow-up of approximately 8 months. The results of this prospective study show that low-dose CyA effectively improves not only skin lesions, but also joint complaints in psoriatic arthritis.
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PMID:Anti-inflammatory efficacy of low-dose cyclosporin A in psoriatic arthritis. A prospective multicentre study. 897 76


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