An audit of consent practices and perceptions of lumbar puncture, Botswana inpatient setting experience

Introduction:The epidemic of HIV/AIDS in sub-Saharan Africa has led to significant increases in the burden of meningitis; especially cryptococcal meningitis. Morbidity and mortality resulting from meningitis occur partly due to delays in performing lumbar punctures both for diagnostic and therapeutic purposes. This study was conducted with the primary objective of exploring the attitudes and concerns that patients have with regard to lumbar puncture; and also to assess current consenting practices of doctors with regard to lumbar puncture. Methods : A descriptive cross-sectional study was conducted in medical wards of Princess Marina Hospital; a tertiary hospital in Gaborone; Botswana. Data were collected by means of a questionnaire-based survey involving patients or their next of kin; and doctors. Other relevant information was obtained from patient charts. Data collection involved 12 patients and 23 doctors. Results :Of the 12 patients interviewed; four stated that the reasons for doing lumbar puncture (LP) were explained to them. One respondent stated that LP risks were mentioned; while two stated that they were given the option to refuse LP. Most patients' possible reasons for refusal of LP was attributed to fear of pain. Five (42.7) patients/next of kin had never heard of LP before; and most of the interviewed patients associated the procedure with death and paralysis; while none associated with meningitis or HIV. Twenty-two (95.7) of 23 doctors stated that they routinely consent patients for LP; 11 (47.8) mentioned risks; and nine (39.1) stated that the patient has the option to decline the procedure. Only 26 of doctors routinely used local anaesthesia while 22 routinely asked for written consent. Conclusion: Contrasting responses between doctors and patients indicates a need for standard consenting practices among doctors. Also; patients' attitudes and receptiveness to lumbar punctures can be improved through education on lumbar puncture indications; benefits; and risks

Angiogénesis inducida por colágena polivinilpirrolidona y heparina en el músculo isquémico / Angiogenesis induced by polivinilpirrolidone collagen and heparin in the ischemic muscle

Estudio de investigación experimental, prospectivo y comparativo, con el objeto de evaluar los efectos de la aplicación exógena de colágena tipo I, Polivinilpirrolidona (PVP) y heparina, en túneles musculares fibrocolágenos, en la extremidad isquémica de la rata, para inducir neovascularización o angiogénesis. Se usó un modelo de isquemia en la extremidad posterior derecha de 40 ratas Wistar en dos tiempos. 1º Ligadura de la arteria iliaca común vía abdominal y colocación de una protesis de silasticpoliéster en el músculo gracilis para la generación de un túnel fibrocolágeno. 2º Ocho semanas después, exposición del paquete vascular femoral, ligadura de esta arteria, localización y extracción de la prótesis, perforación y lavado del túnel fibrocolágeno y aplicación de sustancias. En el grupo I se aplicó solución fisiológica, en el grupo II colágena tipo I con PVP, en el grupo III heparina sódica y grupo IV colágena tipo I con (PVP) y heparina sódica. Para la valoración se llevó a cabo angiografía de las extremidades tratadas, cuantificando el número de intersecciones en una superficie milimétrica de 50 x 50 mm. El mayor número de intersecciones se obtuvo en el grupo IV con una medida de 20.22 contra una media de 13.5 intersecciones en el grupo I (control con sol. fisiológica) = p de 0.14 mediante el análisis de varianza para comparar dos grupos (ANOVA). El estudio demuestra mayor angiogénesis en el músculo isquemico de la rata, si se aplica colágena tipo I con (PVP) y heparina

Molecular approaches to malaria and Babesisosis diagnosis

The development of additional methods for detecting and identifuing Babesia and Plasmodium infections may be useful in disease monitoring, management and control efforts. To preliminarily evaluate sunthetic peptide-based serodiagnosis, a hydrophilic sequence (DDESEFDKEK)was selected from published BabR gene of B. bovis. Immunization of rabbits and cattle with the hemocyanin-conjugated peptide elicited antibody responses that specifically detected both P. falciparum and B. bovis antigens by immunofluorescence and Western blots. Using a dot-ELISA with this peptide, antisera from immunized and naturally-infected cattle, and immunized rodents, were specifically detected. Reactivity was weak and correlated with peptide immunization or infection. DNA-based detection using repetitive DNA was species-specific in dot-blot formats for B. bovis DNA, and in both dot-blot and in situ formats for P. falciparum; a streamlined enzymelinked synthetic DNA assay for P. falciparum detected 30 parasites/mm(cúbicos) from patient blood using either colorimetric (2-15 h color development) or chemiluminescent detection (0.5-6-min. exposures). Serodiagnostic and DNA hybridization methods may be complementary in the respective detection of both chronic and acute infections. However, recent improvements in the polymerase chain reaction (PCR) make feasible a more sensitive and uniform approach to the diagnosis of these and other infectious disease complexes, with appropriate primers and processing methods. An analysis of ribosomal DNA genes of Plasmodium and Toxoplasma identified Apicomplexa-conserved sequence regions. Specific and distinctive PCR profiles were obtained for primers spanning the internal transcribed spacer locus for each of several Plasmodium and Babesia species

Sigmoid Volvulus: an alternative operation?

Article discribes how to treat sigmoid volvulus by fixation; application and retro-peritonealisation of the sigmoid colon

Sigmoid volvulus: an alternative operation?

Presents the activities of Queen Elizabeth Central Hospital in treating sigmoid volvulus

Early Malawian medical history

The medical history of Malawi from when David Livingstone and John Kirk first arrived in 1859 to the Livingstonia Mission founded by Yuriah Chirwa and Robert Laws. Other medical missions discussed are at Magomero - where John Dickinson became the first resident doctor in Malawi; Chikwawa; Cape Maclear - site of first operation in Central Africa; Bandawe - where first medical assistants were trained; Likoma Island; and Blantyre

The story of medicine and disease in Malawi: 130 years since Livingstone

A look at the history of medicine in Malawi from 1859 to present with emphasis of individual doctors and missions and specific diseases