Outcomes in Malnourished Children at a Tertiary Hospital in Swaziland after Implementation of the World Health Organization Treatment Guidelines

Background. Swaziland adopted the World Health Organization (WHO) guidelines for the inpatient treatment of severely malnourished children in 2007; with the aim of reducing high case fatality rates for childhood malnutrition. However; no follow-up studies have been conducted to determine the reduction in these rates after implementation of the guidelines.Objectives. To determine the case fatality rate for childhood malnutrition after implementation of the WHO treatment guidelines.Methods. A retrospective observational study was undertaken. Demographic; anthropometric and clinical characteristics and outcomes for all children aged under 5 years admitted for inpatient treatment of malnutrition between January 2010 and December 2011 were recorded and analysed. Results. Of the 227 children who met the study inclusion criteria; 179 (64.6) were severely malnourished and 98 (35.4) had moderate malnutrition; 111 children died during admission; giving an overall case fatality rate of 40.1. Mortality was significantly higher among severely malnourished children than among those with moderate malnutrition (46.9 v. 27.6) (odds ratio (OR) 3.0; 95 confidence interval (CI) 1.7 - 5.3). Co-morbid pneumonia and gastroenteritis were significant predictors of mortality (OR 2.0; 95 CI 1.2 - 3.4 and OR 1.9; 95 CI 1.1 - 3.2; respectively). Conclusion. Case fatality rates for childhood malnutrition remain high despite adoption of the WHO treatment guidelines. There is a need for periodic clinical audits and mortality review meetings to reduce deaths from childhood malnutrition so as to meet the WHO mortality target of less than 5 and improve child survival

Relação bidirecional entre a doença periodontal e a diabetes mellitus / Bidirectional relationship between periodontal disease and diabetes mellitus

O diabetes mellitus é uma doença de natureza crônica, que resulta de uma perturbação no metabolismo dos carboidratos em virtude de a insulina não exercer seus efeitos metabólicos. A doença periodontal pode ser definida como um processo de infecção e inflamação que destrói os tecidos de proteção e sustentação dos elementos dentários. O diabetes tem sido amplamente considerado como um importante fator de risco para doenças periodontais, por sua vez, a periodontite dificulta o controle do diabetes, sendo considerada a complicação oral mais importante do diabetes. Essas doenças apresentam uma relação bidirecional, na qual o diabetes favorece o desenvolvimento da doença periodontal, e esta, quando não tratada, piora o controle metabólico do diabetes. Portanto, o objetivo deste trabalho é o de realizar uma revisão de literatura acerca dessa relação e as condutas possíveis para o tratamento odontológico do paciente.

Diabetes mellitus is a disease of chronic nature, which results from a disturbance in the metabolism of carbohydrates because the insulin does not exert its metabolic eff ects. Periodontal disease can be defined as a process of infection and inflammation that destroys tissue protection and support of the teeth. Diabetes has been widely regarded as an important risk factor for periodontal disease, in turn, periodontitis difficult to control diabetes, is considered the most important oral complication of diabetes. These diseases have a bidirectional relationship in which diabetes promotes the development of periodontal disease. If this disease is not going to be treat, worst is going to be the metabolic control of diabetes. It is, therefore, aim of this study the review of the literature about this relationship and the possible behaviors of the dental patient.

A randomized comparison of the effects of aspirin and clopidogrel on thrombotic risk factors and C-reactive protein following myocardial infarction: the CADET trial.

A randomized, double-blind multicenter trial-the Clopidogrel and Aspirin: Determination of the Effects on Thrombogenicity (CADET) trial-was carried out to compare the effects of clopidogrel vs. aspirin on thrombotic variables and C-reactive protein (CRP), over a 6-month period of treatment, in patients with an acute myocardial infarction within the previous 3-7 days, who were not scheduled for major surgery including coronary artery bypass grafting. Patients (n = 184) were randomly allocated to aspirin (75 mg day(-1)) or clopidogrel (75 mg day(-1)). Blood samples were taken at baseline and then at clinic visits at 1, 3 and 6 months. By 1 month, clottable and immunonephelometric fibrinogen, D-dimer, von Willebrand factor, factor VIII and CRP were significantly (P < 0.05) reduced from baseline values in both treatment groups; as well as tissue plasminogen activator antigen in the aspirin group only. At 6 months, there were no differences between treatment groups (P > 0.05) for any of the variables, whether or not potential confounding variables were adjusted for. Similarly, there were no differences between treatments in the difference between baseline and final values for any of the variables. Aspirin and clopidogrel were thus found to have similar effects on thrombotic variables and CRP in this patient population.

Virulence of Bordetella bronchiseptica from pigs with or without atrophic rhinitis.

The virulence of 17 isolates of Bordetella bronchiseptica from 13 pig herds was compared by intranasal infection of gnotobiotic piglets and LD50 tests on mice. Of 59 piglets given 8.1-10-5 log 10 colony-forming units (cfu) of isolates from two herds with atrophic rhinitis (AR isolates) or isolates from six unaffected herds (non-AR isolates), 16 died of acute pneumonia; the survivors developed non-progressive turbinate hypoplasia and chronic pneumonia. Infection of 11 piglets with c. 3.0 log to cfu of three AR isolates or three non-AR isolates caused turbinate hypoplasia, but only slight pneumonia and no deaths. There were no significant differences between the virulence of AR and non-AR isolates in piglets. In LD50 tests in mice, there were no significant differences between the results from six AR isolates and six non-AR isolates, or from toxin prepared from two AR isolates and one non-AR isolates was fairly uniform, and that other factors must be responsible for the occurrence of progressive lesions of atrophic rhinitis in some but not all infected herds.

Field use of an irradiated blood vaccine to protect cattle against redwater (Babesia divergens infection) on a farm in Dorset.

A field trial was conducted in Dorset to determine whether calves could be protected against babesiosis by the prior inoculation of irradiated blood infected with Babesia divergens. The trial involved 99 Friesian heifers. Forty were inoculated with infected blood from a donor calf after the blood had been irradiated to a dose of 28 kilorads, 31 were immune animals which had grazed on the infected site the previous year and 28 were susceptible animals. After exposure on a hillside where there was a high risk of contracting the disease, 21 of 28 susceptible animals became clinically affected by redwater and required treatment whereas no animals in the other two groups were affected. It was shown that there was a 100 per cent risk of disease at the site and serological and haematological evidence corroborated the clinical results in demonstrating total protection of the vaccinated animals. Vaccination against redwater appears preferable to therapy, since vaccination before exposure on an infected pasture can replace frequent monitoring of the animals and subsequent therapy late in the course of the disease.