Neurodevelopmental outcome in neonates with hypoxic-ischaemic encephalopathy managed with therapeutic hypothermia in a tertiary-level public hospital outside an intensive care unit setting.

BACKGROUND: Management of hypoxic-ischaemic encephalopathy (HIE) by therapeutic hypothermia (TH) is a major challenge in low- and middle-income countries (LMIC) because of the limited resources. Clinicians in LMIC offer this intervention outside neonatal intensive care units (NICU). The effect of this practice on neurodevelopmental outcome is not well known. AIM: To determine neurodevelopmental outcome in neonates with HIE managed with TH outside NICU settings. METHODS: : This was a retrospective descriptive study of neonates with HIE managed with TH and followed up for neurodevelopmental assessment at 12 and 18-24 months postnatal age. Patients were reviewed over a 24-month period. Outcome at 12 and 18-24 months was compared. RESULTS: Of 178 neonates with HIE attending the clinic, there was information on TH for 155 (87.1%), 113 of whom (72.9%) received TH. HIE was moderate in 88% and severe in 10%. Twenty-seven (23.9%) and 16 (14.1%) were assessed at one time-point at 12 or 18-24 months, respectively, 40 (35.3%) at both time-points, and 30 (26.6%) were not assessed. At 18-24 months, 32% had moderate-to-severe disability compared with 6% at 12 months, with the sensitivity and specificity of assessment at 12 months being 50% and 100%, respectively. The disability attrition rate at 18-24 months was 50%. CONCLUSIONS: The relatively low prevalence of disability (32%) at 18-24 months suggests that use of TH in a Level 2 nursery is feasible and possibly beneficial. More studies are needed to confirm these findings. ABBREVIATIONS: aEEG: amplitude electroencephalogram; CP: cerebral palsy; GMDS: Griffiths mental developmental scales; GQ: general quotient; HIC: high-income countries; HIE: hypoxic-ischaemic encephalopathy; LMIC: low- and middle-income countries; LTFU: loss to follow-up; NICU: neonatal intensive care unit; TH: therapeutic hypothermia; TOBY: total body hypothermia.

Outcomes in laparoscopic cholecystectomy in a resource constrained environment.

BACKGROUND: Laparoscopic cholecystectomy (LC) is a common surgical procedure performed for symptomatic gallstones. There is a trend towards early cholecystectomy for patients with acute cholecystitis who present timeously. Local inflammation has been identified as a risk factor for bile duct injuries. This study sought to assess the outcomes of LC in patients managed within a resource constrained environment where late presentation is common. METHOD: We performed a retrospective analysis of laparoscopic cholecystectomy performed from January 2010 to June 2011. The mode of presentation, co-morbidities, timing of cholecystectomy and complications were analysed. RESULTS: One hundred and sixty seven patients were evaluated. The median age was 43 years with range (17-78) years and 93% were female and 7% male. There were 44%, 23%, 20% and 13% who presented with biliary colic, acute pancreatitis, acute cholecystitis and obstructive jaundice respectively. Nine (5.4%) patients required conversion to an open cholecystectomy. Complications occurred in 16.2% and bile duct injuries and bile leaks in 1.2% and 1.8% respectively. One patient died. CONCLUSION: Most patients had a delayed laparoscopic cholecystectomy. There was no difference in outcomes for the different presentations and the complications are similar to other reports.

The early management of pancreatitis associated with hypertriglyceridaemia.

INTRODUCTION: In triglyceridaemia-associated pancreatitis, decreasing the serum triglyceride level below 5.65 mmol/l alleviates abdominal pain and is purported to improve outcome. We analysed hypertriglyceride level normalisation and outcome in a patient cohort of acute pancreatitis. PATIENTS AND METHODS: Patients presenting with pancreatitis and hypertriglyceridaemia were assessed. All patients with presenting triglycerides levels >10 mmol/l were assessed for resolution to a level below 5.65 mmol/l at days 3 and 5. Patients with triglyceride levels in excess of 10 mmol/l were treated with either standard supportive therapy or an insulin dextrose infusion. RESULTS: In the period June 2001 to April 2008, there were 503 admissions of 439 patients with a diagnosis of acute pancreatitis; 26 (6%) had hypertriglyceridaemia >10 mmol/l at admission. Standard therapy was used in all patients; in 6 patients, it was the sole therapy. A dextrose and insulin infusion was used in 20 cases. On day 3, 7 (32%) of the measured triglyceride levels had fallen below 5.65 mmol/l and, on day 5, all but 4 (83%) were <5.65 mmol/l. Three patients died. CONCLUSION: Standard therapy was equivalent to the use of dextrose and insulin in the resolution of hypertriglyceridaemia. Our methods to reduce triglyceride levels produce morbidity and mortality rates similar to those attained when alternate lipid-lowering strategies are employed.