Preliminary study on acute rheumatic fever at high and low altitudes of Assir region

The objective was to study the profile of acute rheumatic fever [ARF] at high and low altitudes [hot and temperate areas respectively] with particular attention to the influence of these differences on the frequency or severity of carditis. Methodology: Thirty eight children with initial attack of ARF, diagnosed between November 1987 and July 1995, were studied. Result: Twenty seven were living at altitude, temperate climate [group-1] while 11 were living at low altitudes of Tihama, hot climate [group-2]. Twenty two were males and 16 were females. The mean age was 9.7 years. Arthritis was the commonest feature [86.8%] and carditis [68.4%] came second. Mitral regurgitation occurred in 96.2% of those with carditis, aortic regurgitation occurred in 19.2% and tricuspid regurgitation in 7.7%. Mitral stenosis and aortic stenosis were not encountered. A comparison between group-1 and group-2 showed the frequency of carditis to be 66.7% and 72.7% respectively and the frequency of severe carditis in those affected to be 27.8% and 25% respectively. Chorea, erythema marginatum and subcutaneous nodules were uncommon. The study indicates that altitude and climate may not affect the frequency nor severity of carditis

High resolution sonography: a useful tool in the diagnosis of acute appendicitis

High resolution sonography [US] was performed in 282 patients with clinically suspected acute appendicitis. In 166 [82%] of 203 patients with surgically confirmed acute appendicitis, the appendix could be visualized unequivocally by US [true-positive cases]. There were 7 false-positive examinations [2.7%] in patients with a sonographically visible appendix whose symptoms spontaneously resolved. Perforation of the appendix was predictable, in 38 patients [21.4%]. In 46 patients without appendicitis, the appendix was not visualized. There were 9 false-negative examinations [3.5%] due to retrocecal or pelvic location of the appendix. Nondiagnostic studies were presented in another 28 patients [10.9%] due to inability to compress the cecum and right lower quadrant adequately. US was very accurate in diagnosis of other causes of acute abdominal pain in 26 of the cases. When interpreted in light of the clinical examination, sonography should significantly reduce the rate of false negative appendectomies, particularly in women and children. The results suggest that high resolution sonography is indicated to establish the diagnosis of acute appendicitis in patients with equivocal clinical findings. The overall sensitivity was 95%. The specificity was 87%, and the predictive accuracy was 96%

Ultrasonography in the diagnosis of acute surgical conditions

The study deals with 89 cases of acute abdominal conditions admitted to the 3rd. surgical unit for the period between 1988 and 1991, of whom 58 were females and 31 were males. All were examined by ultrasound [u/s] before being operated upon. The operative findings coincided with those of U/S in most of the cases. It was 100% diagnostic in liver abscessess, and certain gynaecological conditions like ectopic gestation and twisted ovarian cyst. It was 95% in acute cholecystitis due to stones, and was 81.1% diagnostic in complications of acute appendicitis, like perforation and appendicular mass. The diagnostic rate was high in obstructive jaundice. We therefore advice the use of U/S in the diagnosis of acute abdominal conditions, within and after the working hours, and that its facilities be made available in the waiting surgical wards

Infecçöes respiratórias agudas / Respiratory tract acute infections

Os autores apresentaram revisäo sobre infecçöes respiratórias agudas (Ira), focalizando principalmente as normas de assistência e controle das Ira em menores de cinco anos, que se encontram em fase de implantaçäo no Brasil. O programa de Ira insere-se nas açöes básicas de saúde infantil em nosso meio

Clinical and bacteriological study of acute otitis media

Between February 1986 and February 1987 eighty patients presented with Acute Otitis media. Adolescent and adults formed the majority in this group, 36% of patients presented when they already had a perforation in the tympanic membrane. Bacteriological cultures revealed Staph. pyogenes, Staph. aureus, Strept. pneumonae and Haemophilus, to be the common organisms. These Patients were divided into two groups for a double blind trial half recieving Bacampicillin and half placebo. There was satisfactory clinical response to Bacampicillin with 36 patients improving with treatment. The importance of antihistamine and decongestants was also realized in the management of the condition