Prospective cohort study of referred Malawian children and their survival by hypoxaemia and hypoglycaemia status

Objective To investigate survival in children referred from primary care in Malawi, with a focus on hypoglycaemia and hypoxaemia progression. Methods The study involved a prospective cohort of children aged 12 years or under referred from primary health-care facilities in Mchinji district, Malawi in 2019 and 2020. Peripheral blood oxygen saturation (SpO2) and blood glucose were measured at recruitment and on arrival at a subsequent health-care facility (i.e. four hospitals and 14 primary health-care facilities). Children were followed up 2 weeks after discharge or their last clinical visit. The primary study outcome was the case fatality ratio at 2 weeks. Associations between SpO2 and blood glucose levels and death were evaluated using Cox proportional hazards models and the treatment effect of hospitalization was assessed using propensity score matching. Findings Of 826 children recruited, 784 (94.9%) completed follow-up. At presentation, hypoxaemia was moderate (SpO2: 90­93%) in 13.1% (108/826) and severe (SpO2: < 90%) in 8.6% (71/826) and hypoglycaemia was moderate (blood glucose: 2.5­4.0 mmol/L) in 9.0% (74/826) and severe (blood glucose: < 2.5 mmol/L) in 2.3% (19/826). The case fatality ratio was 3.7% (29/784) overall but 26.3% (5/19) in severely hypoglycaemic children and 12.7% (9/71) in severely hypoxaemic children. Neither moderate hypoglycaemia nor moderate hypoxaemia was associated with mortality. Conclusion Presumptive pre-referral glucose treatment and better management of hypoglycaemia could reduce the high case fatality ratio observed in children with severe hypoglycaemia. The morbidity and mortality burden of severe hypoxaemia was high; ways of improving hypoxaemia identification and management are needed.

Towards rational regulation and legislation of herbal medicines

Though modern medicine is well developed in most of the world, large sections of the population in developing countries still rely on heral medicines and other natural products for their primary care. In recent years public interest in Industrialized countries has increased greatly towards the natural therapies with the expanding use of medicinal plants and herbal medicine. Traditional medicinal products have evolved against widely different ethnological, cultural, climatic, geographical and even philosophical backgrounds; nevertheless they face many regulatory challenges in ensuring their safety and efficacy. The efforts of WHO in the development of modern guidelines in this field have been very helpful in recognition of the role of herbal remedies in health care and in supporting their potential use in national health care system in different parts of the world

Role of mitomycin C as an adjuvant to endoscopic resection of superficial bladder tumours

An experience in 171 cases of suuperficial urinary bladder tumors treated with transurethral resection [TURT] at the Mayo Hospital Lahore between 1985 to 1990 is reported. In 160 cases out of 171, the tumors were resected endoscopically followed by intravesical instillation of Mitomycin-C 20mg. This resulted in significant reduction in the number of recurrences. In the remaining 11 cases, the tumors were too numerous for endoscopic resection. In these cases the intravesical Mitomycin-C 20mg twice weekly for 4 weeks resulted in marked improvement and the tumors were either rendered resectable or disappeared completely