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 59,461 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Female genital mutilation is perhaps currently the most dangerous traditional practice in terms of health. An estimated 100 million women worldwide have undergone this procedure, most commonly performed between the ages of 4 and 10 years old by a traditional birth attendant. In one study, acute complications occurred in 39% of procedures. Hemorrhage and infection leading to gangrene, septicemia, or tetanus are the main causes of mortality. Late complications are estimated to occur in 37% of women. Chronic pelvic inflammatory disease and dysmenorrhea occur in 14-65%. Persistence of female genital mutilation is based, in part, on cultural beliefs about women, a perceived need to reduce sexual desire, and assurance of virginity and marriageability. Women who do not comply face social ostracism. In 1982, the World Health Organization recommended that female genital mutilation should not be carried out by any health professional under any circumstances. Although legislation outlawing the practice is important, it may be unenforceable in many areas. Key to the eradication of this practice are attitudinal changes through the education of both men and women and improvements in women's status.
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PMID:Female genital mutilation. 931 Feb 17

This study examines the impact of the Maternal-Child Health and Family Planning (MCH-FP) program in the Matlab, Bangladesh. Data were obtained from the Matlab surveillance system for treatment and comparison areas. This study reports the trends in maternal mortality since 1976. The MCH-FP area received extensive services in health and family planning since 1977. Services included trained traditional birth attendants and essential obstetric care from government district hospitals and a large number of private clinics. Geographic ease of access to essential obstetric care varied across the study area. Access was most difficult in the northern sector of the MCH-FP area. Contraception was made available through family welfare centers. Tetanus immunization was introduced in 1979. Door-to-door contraceptive services were provided by 80 female community health workers on a twice-monthly basis. In 1987, a community-based maternity care program was added to existing MCH-FP services in the northern treatment area. The demographic surveillance system began collecting data in 1966. During 1976-93 there were 624 maternal deaths among women aged 15-44 years in Matlab (510/100,000 live births). 72.8% of deaths were due to direct obstetric causes: postpartum hemorrhage, induced abortion, eclampsia, dystocia, and postpartum sepsis. Maternal mortality declined in a fluctuating fashion in both treatment and comparison areas. Direct obstetric mortality declined at about 3% per year. After 1987, direct obstetric mortality declined in the north by almost 50%. After the 1990 program expansion in the south, maternal mortality declined, though not significantly, in the south. Maternal mortality declined in the south comparison area during 1987-89 and stabilized. The comparison area of the north showed no decline.
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PMID:Decline in maternal mortality in Matlab, Bangladesh: a cautionary tale. 973 75

A cohort of 98 consecutive very-low-birth-weight infants (under 1500 g) born at Port Moresby General Hospital (Papua New Guinea) over a 12-month period was followed from birth until either death or discharge from the Special Care Nursery. The infants were managed with warming, "blind" antibiotic prophylaxis, intravenous fluids, nasopharyngeal oxygen for respiratory distress, and phototherapy and/or exchange transfusion for jaundice. The majority of these infants had intrauterine growth retardation. Mean weekly weight gain was 142 g, while the mean weekly increase in head circumference was 6.46 mm. Overall mortality was 54% and markedly inversely associated with birth weight. The major causes of death were intraventricular hemorrhage (31%), hyaline membrane disease (31%), and septicemia (10%). Since only 40% of discharged infants were returned for review beyond 6 weeks, late outcomes could not be assessed. One-third of infants who were examined after 6 weeks showed signs of subtle or isolated neurodevelopmental delay and there was one case of cerebral palsy. Prevention of very low birth weight depends on attention to intrauterine growth retardation--a result of poor maternal health and nutrition. Recommended are measures such as iron and chloroquine prophylaxis, tetanus toxoid vaccination, and improved nutrition during pregnancy.
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PMID:How should very low birthweight babies best be managed in Papua New Guinea? 952 45

Major congenital malformations are unrecognised as a major cause of neonatal morbidity in many African countries. We have studied the contribution of major congenital malformations to morbidity among neonates referred to the University College Hospital, Ibadan, Nigeria over a four year period (1992-1995). Major congenital malformations were found in 11.1% of 1276 neonatal referrals and ranked fourth among the most common problems in such neonates (after sepsis, jaundice and tetanus but ahead of prematurity and perinatal asphyxia). The commonest malformations seen included spina bifida (22.5%), anorectal malformation (13.4%), omphalocoele (9.9%) and tracheo-oesophageal fistula (8.5%). Neonates with major congenital malformations presented significantly earlier than other neonates but mortality during the first admission was similar in the two groups. It is concluded that major congenital malformations pose a significant burden of morbidity in referred neonates to the hospital. Health services planners should take this into account in order to allocate the necessary resources for the diagnosis and management of such children.
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PMID:Major congenital malformations among neonatal referrals to a Nigerian university hospital. 955 39

Long term effects of BMT in thalassemia were monitored in 33 patients transplanted between 1987 and 1995 and compared with 155 patients matched for age and treated during the same period with conventional therapy (CT). The incidence of fulminant sepsis and growth impairment was significantly higher in transplanted patients, whereas the occurrence of hypothyroidism, hypogonadism, and cardiopathy was higher in CT patients. For diabetes, liver disease, and severe infections, the differences were not statistically significant. After BMT we performed monthly erythrocytaferesis for iron removal in 23 (70%) patients, obtaining a complete normalization of iron stores in 91% of cases; among untreated patients, 60% had evidence of iron up to 8.3 years after BMT. Protection against poliovirus, tetanus, diphtheria, and hepatitis B has been lost in 74%, 47%, 78%, and 44%, respectively. After BMT a careful follow-up is needed to monitor and treat late transplant-related and thalassemia-related complications.
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PMID:Late effects of bone marrow transplantation for thalassemia. 966 51

In this study, 207 patients with neonatal tetanus admitted to Erciyes University, Faculty of Medicine, Unit of Neonatology between 1976 and 1994 were investigated retrospectively. One hundred and sixty-seven (80.6%) patients had non-hygienic home deliveries and none of the mothers of the children had been immunised with tetanus toxoid. Of the 207 patients, 161 (77.8%) were males, 46 (22.2%) were females. Failure to suck and twitching were the most frequent symptoms. The mean age of patients who died or survived was 6.9 and 8.8 days respectively (p > 0.05). Mean birth weight was 3092 g for the fatal cases and 3317 g for the survivors (p < 0.05). Mean age of onset of symptoms was 5.5 days for the fatal cases and 6.5 days for the survivors (p < 0.05). Mean period between onset of symptoms and hospital admission was 1.5 days for the fatal cases and 2.1 days for the survivors (p > 0.05). Ninety-seven (46.8%) of the 207 patients died. Mean age of death was 9.3 days and most of the patients died at the fifth day of admission to hospital. Sex, age on admission and duration of symptoms did not affect the prognosis. In addition, the efficacy of the diazepam, phenobarbital sodium and chlorpromazine used for sedation in neonatal tetanus was investigated. Of 207 patients, 43 patients were treated with diazepam, 33 patients with phenobarbital sodium, another 33 patients with phenobarbital sodium + chlorpromazine and 94 patients were treated with diazepam + phenobarbital sodium +/- chlorpromazine called as "combined therapy". The least mortality rate was found in the group treated with "combined therapy" and the highest mortality rate in the group treated with phenobarbital sodium + chlorpromazine (p < 0.001). The most frequent cause of death was apnea in the first week and sepsis in the later period.
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PMID:A review of 207 newborn with tetanus. 978 42

A 3-yr-old female patient exhibited interleukin 12 (IL-12) deficiency that was associated with recurrent episodes of pneumococcal pneumonia with sepsis and other infections in the absence of fevers. The patient's peripheral blood mononuclear cells (PBMCs) exhibited normal proliferative responses to antigens. Immune responses, including in vivo production of antibodies to diphtheria, tetanus, or pneumococcal antigens, were normal. Ig levels and B cell and T cell phenotypes were also normal. In contrast, IL-12 p70 heterodimer production was undetectable by using supernatants of the patient's stimulated PBMCs when compared with control cells treated similarly. Although present, interferon gamma (IFN-gamma) was reduced. The addition of recombinant IFN-gamma to control cells enhanced the production of IL-12 by up to sixfold. By contrast, IL-12 was undetectable in supernatants of the patient's cells in the presence of recombinant IFN-gamma. IL-12 p40 subunit mRNA by using the patient's PBMCs after stimulation with Staphylococcus aureus Cowan strain 1 or lipopolysaccharide was also undetectable by reverse transcription-PCR when compared with control cells. Production of IL-2, IL-6, tumor necrosis factor alpha, or IFN-gamma of the patient's PBMCs after appropriate stimulation was observed. This patient has either a defect in Staphylococcus aureus Cowan strain 1-lipopolysaccharide- or staphylococcal enterotoxin A-induced signaling pathways for the activation of IL-12 p40 gene expression, or an abnormality in the IL-12 p40 gene itself.
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PMID:Interleukin 12 deficiency associated with recurrent infections. 978 52

In Trinity Hospital, a district hospital in the south of Malawi, over a period of 4 years 60 patients were admitted following injury by crocodiles. All patients were treated by extensive surgical cleaning and debridement, anti-tetanus treatment and broad spectrum antibiotics. Twenty-four patients (40%) had serious injuries resulting in permanent deformity. Only one patient died from sepsis.
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PMID:Crocodile bite injury in southern Malawi. 980 43

105 consecutively admitted neonates with tetanus were screened for sepsis to determine the prevalence of sepsis in neonatal Tetanus (NNT) patients and identify the bacterial pathogens causing septicaemia in them. The presence of omphalitis, poor colour, hypothermia and hyperthermia were found to be sensitive predictors of septicaemia in NNT patients. 50 bacterial pathogens were isolated from 50 babies. Klebsiella pneumoniae (20.7%), and Enterobacter cloacae (19.0%) were the leading gram negatives, while staphylococcus aureus (19.2%) was the prevalent gram positive organism isolated. Antimicrobial susceptibility profile heavily favours ofloxacin but a combination of cloxacillin and gentamicin is recommended as first line. Ceftazidime with about 60% susceptibility across board is the favoured cephalosporin.
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PMID:Bacteria causing septicaemia in neonates with tetanus. 981 79

This study examines some of the socioeconomic cost of treating 102 cases of Buruli ulcer between 1994 and 1996 at the St. Martin's Catholic Hospital in Agroyesum in the Amansie West district of the Ashanti region of Ghana. Seventy percent of the cases were children (up to 15 years of age). There was no sex difference in the distribution of cases. Hospitalization was prolonged (average = 186 days in 1994, 103 days in 1995, and 102 days in 1996) with no significant age and sex differences. There were 10 limb amputations, 12 patients were left with contracture deformities, one patient lost sight in one eye, and two died of sepsis and tetanus. The average total treatment cost per patient was $966.85 (62% indirect) in 1994, $706.08 (75% indirect) in 1995, and $658.74 (79% indirect) in 1996. With increasing number of cases, high treatment costs, and serious complications, urgent attention should be given to the disease in terms of control and research efforts aimed at early detection and treatment.
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PMID:Socioeconomic implications of Buruli ulcer in Ghana: a three-year review. 988 16


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