ABSTRACT
Background. Neonatal hypotension remains one of the most controversial topics in neonatology. Various definitions are used but lack an evidence base. Owing to the variation in defining a low blood pressure (BP), significant differences in pharmacological manipulation of BP are evident. Objectives. The aim of the present research was to determine (1) the diagnostic criteria for neonatal hypotension and (2) management strategies for neonatal hypotension in South Africa. Methods. A 29-point questionnaire was designed to determine the criteria used by South African neonatologists and paediatricians to diagnose and manage neonatal hypotension. The survey was conducted at two different time points in 2017. Results. The combination of the two surveys resulted in a 9.3% (47/507) response rate. A BP below the gestational age (in weeks) was the most common definition used for neonatal hypotension (75%). Most clinicians (86%) administered fluid prior to initiating inotrope therapy. Dopamine, dobutamine and adrenaline were the most common first-, second- and third-line anti-hypotensive drugs used. Most clinicians (77%) did not use a hypotension management guideline. Conclusion. Neonatal hypotension definition and management in South Africa are similar to international patterns, despite a lack of evidence to support the diagnosis and management strategies
Subject(s)
Infant, Newborn , South AfricaABSTRACT
Objective. To compare whether early measurement of blood gases and/or dynamic compliance of the respiratory system (CRSdyn) predicts outcome in high-risk infants with unilateral congenital diaphragmatic hernia (CDH). Patients and methods. A retrospective study was performed at Tygerberg Children's Hospital between January 1992 and August 2001. High-risk infants with unilateral CDH; who presented with respiratory distress within 6 hours of birth; were included. Patients with other lethal congenital abnormalities were excluded. The first arterial blood gas value after endotracheal intubation was documented and the arterial-alveolar oxygen tension (a:A) ratio was calculated. CRSdyn was measured within 24 hours of birth. The ability of these measurements to predict outcome (survival or death during the newborn period) was determined. Results. Seventeen of 40 infants with CDH were categorised as high risk and included in the study. Eight of them (47) survived the neonatal period. The best single predictors of outcome were; in order; partial pressure of oxygen in arterial blood (PaO2); a:A ratio and dynamic compliance of the respiratory system standardised for body weight (CRSdyn/kg). The specificity and sensitivity at a PaO2 cut-off of 19.3 kPa were 7/8 (95confidence interval (CI): 0.473 - 0.997) and 9/9 (95CI: 0.634 - 1.000) respectively. Results for a:A ratio were cut-off 0.321; specificity 6/8 (95CI: 0.349 - 0.968); and sensitivity 9/9 (95CI: 0.634 - 1.000). Results for CRSdyn/kg were cut-off 0.259; specificity 6/8 (95CI: 0.349 - 0.968); and sensitivity 9/9 (95CI: 0.634 - 1.000). A linear discriminant function based on the 3 best single predictors was found to be no more effective than the first PaO2. Conclusions. Early oxygenation status predicts outcome better than the CRSdyn/kg in infants with unilateral CDH. However; both measurements predict outcome with high accuracy
Subject(s)
Blood Gas Analysis , Congenital Abnormalities , Hernia , Respiratory SystemABSTRACT
Background: A randomized controlled trial (RCT) has shown that male circumcision (MC) reduces sexual transmission of HIV from women to men by 60(32?76; 95CI) offering an intervention of proven efficacy for reducing the sexual spread of HIV. We explore the implications of this finding for the promotion of MC as a public health intervention to control HIV in sub-Saharan Africa. Methods and Findings :Using dynamical simulation models we consider the impact of MC on the relative prevalence of HIV in men and women and in circumcised and uncircumcised men. Using country level data on HIV prevalence and MC; we estimate the impact of increasing MC coverage on HIV incidence; HIV prevalence; and HIV-related deaths over the next ten; twenty; and thirty years in sub-Saharan Africa. Assuming that full coverage of MC is achieved over the next ten years; we consider three scenarios in which the reduction in transmission is given by the best estimate and the upper and lower 95confidence limits of the reduction in transmission observed in the RCT. MC could avert 2.0 (1.1?3.8) million new HIV infections and 0.3 (0.1?0.5) million deaths over the next ten years in sub-Saharan Africa. In the ten years after that; it could avert a further 3.7 (1.9?7.5) million new HIV infections and 2.7 (1.5?5.3) million deaths; with about one quarter of all the incident cases prevented and the deaths averted occurring in South Africa. We show that a) MC will increase the proportion of infected people who are women from about 52to 58; b) where there is homogenous mixing but not all men are circumcised; the prevalence of infection in circumcised men is likely to be about 80of that in uncircumcised men; c) MC is equivalent to an intervention; such as a vaccine or increased condom use; that reduces transmission in both directions by 37. Conclusions: This analysis is based on the result of just one RCT; but if the results of that trial are confirmed we suggest that MC could substantially reduce the burden of HIV in Africa; especially in southern Africa where the prevalence of MC is low and the prevalence of HIV is high. While the protective benefit to HIV-negative men will be immediate; the full impact of MC on HIV-related illness and death will only be apparent in ten to twenty years
Subject(s)
HIV , Circumcision, Male , Sexually Transmitted DiseasesABSTRACT
Une etude a ete menee dans les grands centres urbains du Cameroun pour essayer d'evaluer le cout des traitements prescrits dans les urethrites masculines. Il ressort d'abord de cette etude que l'utilisation des preservatifs est devenue monnaie courante au Cameroun. Ensuite; la standardisation du prix de ces traitements a permis de reduire nettement les depenses des malades. Cela a ete finalement un grand succes pour les autorites sanitaires du Cameroun
Subject(s)
Cost-Benefit Analysis , Sexually Transmitted Diseases/prevention & control , Urban Health , Urethritis , Urethritis/drug therapyABSTRACT
Les auteurs rapportent les resultats de quatre enquetes menees en 1991 et 1992 dans la population generale masculine; les lieux de travail et ceux de detente nocturne des villes de Yaounde et de Douala. Cette population masculine; sexuellement tres active; est caracterisee par un partenariat sexuel multiple et un recours frequent aux prostituees. En moyenne 10 pour cent d'entre eux relatent un episode de maladies sexuellement transmissibles dans le semestre ecoule. La pratique des rapports proteges entre dans les moeurs car 62 a 79 pour cent des personnes interrogees ont deja utilise un preservatif mais moins de 10 pour cent en font un usage systematique
Subject(s)
Condoms , Sex Work , Sexually Transmitted Diseases , Urban PopulationABSTRACT
The paper concentrates on prophylaxis; the newer antibiotics and the management of severe sepsis. The treatment of severe sepsis remains hazardous with high morbidity and mortality. The message that prevention is better than cure