Trends of morbidity in general medicine at United Bulawayo Hospitals, Bulawayo, Zimbabwe.

OBJECTIVE: To determine the trends of the 10 most common diseases in the Medical Department. DESIGN: Retrospective descriptive study of patients' discharge summaries. SETTING: United Bulawayo Hospital, tertiary level hospital and referral centre for district hospitals. SUBJECTS: All patients admitted and discharged from the medical wards from 1987 to 1994, excluding all those who died. MAIN OUTCOME MEASURES: Number of discharges, patients' origin, paying status, diagnoses, staffing levels, reasons for transfer out. RESULTS: The top 10 diseases encountered in 12,280 patients were: pneumonia, HIV/AIDS, pulmonary tuberculosis, hypertension, Diabetes mellitus, malaria, gastro-enteritis, congestive cardiac failure secondary to cardiomyopathy, congestive cardiac failure secondary to hypertension, and asthma. They respectively accounted for 11% and 49% of all hospital and departmental admissions. Most disease prevalences increased from 1987 to 1994, with HIV/AIDS showing the sharpest rise. Tuberculosis was the most frequent disease and hypertension proved to be the leading non communicable disease. A positive diagnosis was made in 76% of cases. Patients' median age was 37 years and sex ratio M/F was 1.7:1. Staffing levels and bed capacity remained unchanged despite an increasing number of patients. Of these, 22% came from rural areas and 77% with low incomes did not pay for services. Transfers out effected mainly for special diagnostic procedures accounted for 0.2%. CONCLUSIONS: Infections and cardiovascular diseases alone accounted for 50% of the diagnoses made in patients discharged from the Medical Department of United Bulawayo Hospitals from 1987 to 1994. The 10 commonest diseases accounted for 49% of the morbidity and most of them increased in frequencies, while in case of HIV/AIDS, the increase was six fold. Cardiovascular diseases showed unexpectedly high prevalences. Diagnoses were confirmed in 76% of cases. The main problem encountered was multi pathology mainly due to added super infections and inability of 77% of patients to afford adequate health care. They resulted in frequent readmissions, heavy workload and high costs which threatened the quality of care.

A further case of Gaucher's disease in a black Zimbabwean.

We present a further case of Gaucher's disease in a 23 year old black Zimbabwean woman treated in Bulawayo. The patient underwent a splenectomy for hypersplenism due to massive splenomegaly. The patient did well post-operatively and has continued to honour her outpatient follow-up appointments. At the last review, 8 months after splenectomy, she still continues to enjoy good health. There was no family history suggestive of Gaucher's disease and there is no possibility that this patient could be related to the other 2 cases (sisters) reported by Muguti et al in 1987.

A new method of blood pressure recording that may enhance patient compliance.

We describe a new method of self-recording of blood pressure (BP) that requires only a BP cuff. The method is easy and fast but cannot be used by all subjects. We describe 21 normal subjects, 14 hypertensive patients, and 20 patients studied at cardiac catheterization. In all three groups the new technique, the sensory detection method (SDM), showed no significant differences from the routine indirect BP and from the direct arterial BP in patients undergoing catheterization. Some 15% of patients who were unable to use this method were easily identified during the testing and instructing of the technique. The simplicity of the SDM may increase patient vigilance and compliance to antihypertensive regimens.

Halothane-induced nephrotoxicity.

Two cases are reported of combined renal and hepatic failure following exposure to halothane anesthesia. Both patients presented with postoperative fever and rapidly deteriorating liver and kidney function. Both required peritoneal dialysis. Both patients died, and in both cases this was the second exposure to halothane. The pathologic features of the 2 cases were similar in that the liver changes were typical of those seen with halothane hepatitis and the renal lesion was similar to that of methoxyflurane nephritis. This is, to our knowledge, the third report of renal failure occurring after halothane anesthesia. Possible mechanisms regarding its toxicity are discussed.

Amylase-creatinine clearance ratios and serum amylase isoenzymes in moderate renal insufficiency.

Both the amylase-creatinine clearance ratio (normal 1.55%) and proportion of pancreatic isoamylase in serum (normal 41.0%) increase in acute pancreatitis, and are therefore useful measurements to support that diagnosis. Whether renal insufficiency interferes with the accuracy and specificity of these tests has been debated. Our study indicates that even moderate renal insufficiency (creatinine clearance 30.5 ml/minute) raises the amylase-creatinine clearance ratio (3.23%) close enough to values characteristic of acute pancreatitis (4.41%) to cause potential diagnostic confusion. The fraction of pancreatic isoamylase in serum is also increased (69.9%), but not to the levels of acute pancreatitis (91.0%). We therefore caution against the use of the amylase-creatinine clearance ratio for the diagnosis of acute pancreatitis in patients with moderate renal insufficiency.

Acute renal failure after total hip replacement.

Eight of forty-one patients undergoing total hip replacement experienced acute but not fatal renal failure postoperatively. All forty-one patients received transfusions of frozen blood and albumin and their wounds were irrigated with a bacitracin-neomycin-polymyxin solution. All subsequently had some relative hypotension. None of a second, prospective group of fifty-five patients who received the transfusion of albumin, but not frozen blood or the bacitracin-neomycin-polymyxin irrigant, had renal failure. The incidence of hypotension in this group was comparable to that in the first group, yet no cases of renal failure were seen. We therefore recommend that the combination of frozen blood and potentially nephrotoxic drugs be avoided in patients undergoing total hip replacement.

Renal carbuncle: early diagnosis by retroperitoneal ultrasound.

The diagnosis of renal carbuncle has been prolonged from the time of onset of symptoms to the institution of treatment producing a significant rate of mortality. The use of retroperitoneal ultrasound is demonstrated as a noninvasive method for making an earlier diagnosis of renal carbuncle than has been afforded by more conventional means. This report illustrates the technique of nephrosonography and briefly reviews the medical and surgical approaches to this disorder. To our knowledge, this is the first reported case wherein ultrasound, and not pyelography, demonstrated a carbuncle without the aid of invasive arteriography.