Tropical Doctor

Rheumatic fever and rheumatic heart disease are still major causes of disease in the developing world today. Diagnosis and prevention, particularly secondary prophylaxis, will become even more important as increased urbanization, with greater population pressure and economic problems, increase the prevalence. The number of children and young adults in their most crucial years of life who would avoid chronic disease and death would more than repay the investment of time and resources.

A 1-year hospital-based study was undertaken on 212 patients at Muhimbili Medical Centre (MMC) from October 1994 to October 1995. The objective was to determine the aetiology of corneal ulceration. A comparison of the prevalence of HIV infection between patients with fungal keratitis and those with non-fungal keratitis was included. Bacterial infection (32.1%), and mycotic infection (15.1%) were the leading causes of corneal ulceration. There were 32 patients with fungal keratitis and 180 patients with non-fungal keratitis. The male:female ratio for patients with fungal keratitis was 1.7:1 and the peak age group was 20–50 years. Fusarium solani was the commonest organism accounting for 75% of cases with fungal keratitis. Twenty of 32 (81.2%) cases with fungal keratitis were found to be HIV positive; 33% of those with non-fungal keratitis were HIV positive (P-value was < 0.001).

With the rapid spread of tuberculosis (TB) in Zimbabwe the disease is becoming a major paediatric health problem. Children are at high risk of TB, are prone to disseminated disease and the diagnosis of paediatric TB may be difficult, since complaints often are unspecific and contacts may not been known. Data from 265 children, aged between 2 weeks and 12 years, being treated for TB in Gweru Hospital in 1995, are analysed. In 72% pericardial effusion was found as a sign of early dissemination. Cultures of gastric aspirates for Mycobacterium tuberculosis were positive in 31%. In optimal circumstances the yield for isolates of M. tuberculosis is less than 50%, and these results under limited conditions are acceptable, and may reflect the true incidence. Given the epidemiology of TB in Zimbabwe, pericardial effusions should be considered indicative of TB until proven otherwise.

Butterfly needle (18 G) was used for intraosseous administration of fluids and drugs in 22 children with shock. All except one patient could be stabilized successfully. Fifteen children had severe dehydration because of diarrhoea. The intraosseous route needs to be popularized as an option for rehydration in areas, where diarrhoeal dehydration continues to be an important cause of child mortality.

This study reviews available data on HIV/AIDS in Pakistan and is the first to analyse a clinical series of HIV-infected patients thus giving a wider perspective of the epidemic in Pakistan. A retrospective analysis of all medical records of patients with HIV/AIDS since 1986 was conducted in March 1998 at a Karachi hospital. There were 67 patients. Twenty-two were overseas (Middle East) contract workers. None were sex workers or drug users. Fifty-four had travelled or lived abroad. High risk sexual behaviour was reported in 35 patients of whom 26 men reported contact with commercial sex workers, mostly in the Middle East (21). The most common AIDS indicator condition was chronic diarrhoea. HIV in Pakistan is currently a disease of those Pakistanis (and their sexual partners) who have travelled abroad, overseas contract workers and those who, prior to 1989, were transfused abroad or received imported blood products.

Of 68 patients who were admitted with acute quadriparesis to a hospital in northern India, over 70% were found to be hypokalaemic. The most common cause of hypokalaemia was that associated with gastroenteritis (54%). These patients had all received intravenous fluids previously. It is likely that their hypokalaemia was caused by gastrointestinal loss compounded by parenteral fluid replacement. The next most common group of hypokalaemia-associated quadriparesis had no obvious cause for hypokalaemia (38%).

Hypokalaemia-induced quadriparesis is a potentially life-threatening illness which can be readily treated with potassium supplements. The physician should consider hypokalaemia in patients who present with acute onset quadriparesis, and even if diagnostic tests for hypokalaemia are not available, should consider a judicious trial of potassium supplementation empirically, provided that there are no contraindications.

An important consideration in planning services for disabled children is to establish the need, including the size of the potential beneficiary group. However, surveys are expensive and time consuming (especially surveys of disability, which has a low prevalence within the population), and can raise expectations of service for patients who are often very unsure about how to cope with their disabled child. The World Health Organization (WHO) has produced a series of survey tools¹ which have been used to identify disabled children in settings where a service is planned. Zaman et al. ² produced the ‘10 Question Screen’, a simple screening tool for use by community health staff to identify disabilities among children in the community. Both the WHO survey tools and the 10 Question Screen rely on trained primary health care (PHC) or community-based rehabilitation (CBR) staff. The small study reported here shows that schoolchildren are effective identifiers of disabled children within their home communities and may be a useful resource when there are no trained CBR or PHC workers to conduct surveys. Furthermore, the children's ability to identify within the five major disability groups was relatively robust when compared with medical diagnosis.

A randomized trial to compare two methods of umbilical cord tying in neonates, immediately after birth, was undertaken from February to April 1997 in the Department of Obstetrics & Gynaecology, Zewditu Memorial Hospital, Addis Ababa, Ethiopia. In less than 3 months, we investigated 300 neonates, of whom 150 infants were randomly assigned to the traditional ligation of the umbilical cord (using a piece of thread) and the rest to a rubber ring clamping method. Among the former group, 13.3% (20/150) of the neonates bled from their umbilical cords which necessitated re-tying, whereas in the later group, there was no sign of haemorrhage or infection within 12 h of clamping. We suggest that the rubber ring method described is a superior procedure and can easily replace the traditional, cumbersome and time-consuming umbilical cord ligation.

Colonic atresia is usually managed surgically by resection and end-to-end anastomosis but preferably with a venting enterostomy, if presentation is delayed. A new technique of appendicostomy was performed as a venting enterostomy in eight cases of colonic atresia with good results in our children's hospital during the period 1990–1995.