Chronic unilateral vestibular loss.

Chronic unilateral vestibular loss is a condition defined by the presence of reduced function of the peripheral vestibular system on one side, which has generally persisted for 3 or more months. The deficit is demonstrated by a reduction of the vestibular-ocular reflex either at the bedside or on laboratory testing. Though some patients with chronic vestibular loss have disabling symptoms, others are asymptomatic. Causes include a viral/postviral disorder, Menière's disease, structural lesions, ischemia, and trauma. Any other systemic or genetic disorder would be expected to involve both sides at some point.

Experiences with perinatal death reviews in South Africa--the Perinatal Problem Identification Programme: scaling up from programme to province to country.

The Perinatal Problem Identification Programme (PPIP) was designed and developed in South Africa as a facility audit tool for perinatal deaths. It has been used by only a few hospitals since the late 1990s, but since the country's commitment to achieve Millennium Development Goal 4-the use of PPIP is now mandatory for all facilities delivering pregnant mothers and caring for newborns. To date 588 sites, representing 73% of the deliveries captured by the District Health Information System for South Africa, provide data to the national database at the Medical Research Council Unit for Maternal and Infant Health Care Strategies in Pretoria.

Newborn survival in low resource settings--are we delivering?

The annual toll of losses resulting from poor pregnancy outcomes include half a million maternal deaths, more than three million stillbirths, of whom at least one million die during labour and 3.8 million neonatal deaths--up to half on the first day of life. Neonatal deaths account for an increasing proportion of child deaths (now 41%) and must be reduced to achieve Millennium Development Goal (MDG) 4 for child survival. Newborn survival is also related to MDG 5 for maternal health as the interventions are closely linked. This article reviews current progress for newborn health globally, with a focus on the countries where most deaths occur. Three major causes of neonatal deaths (infections, complications of preterm birth, intrapartum-related neonatal deaths) account for almost 90% of all neonatal deaths. The highest impact interventions to address these causes of neonatal death are summarised with estimates of potential for lives saved. Two priority opportunities to address newborn deaths through existing maternal health programmes are highlighted. First, antenatal steroids are high impact, feasible and yet under-used in low resource settings. Second, with increasing investment to scale up skilled attendance and emergency obstetric care, it is important to include skills and equipment for simple immediate newborn care and neonatal resuscitation. A major gap is care during the early postnatal period for mothers and babies. There are promising models that have been tested mainly in research studies in Asia that are now being adapted and evaluated at scale including through a network of African implementation research trials.

Disequilibrium in older people: a prospective study.

OBJECTIVE: To identify the clinical and neuroimaging features in older people with disequilibrium of unknown cause. BACKGROUND: Many older people show a deterioration of balance without an identifiable cause. Whether the disequilibrium is a normal aging phenomenon, the result of yet unidentified neuropathology, or a combination of the two is unknown. METHODS: Twenty-nine patients who complained of disequilibrium (ages 75 to 92) and 29 age- and sex-matched control subjects completed five yearly examinations including history and semiquantitative neurologic examination, activities of daily living, visual acuity, mini-mental status, bedside gait and balance score (Tinetti), Purdue pegboard, and vestibular function testing. Concerns about falling and number of falls were quantified. Subcortical white matter lesions (WML) and frontal atrophy (FA) were graded (blindly), and the ventricular-brain ratio (VBR) was measured from MRIs of the brain. RESULTS: On entry, patients differed from control subjects only in measures of balance, concerns about falling, and falls. Over the 5 years, patients were four times more likely to fall than control subjects. The number of falls was highly correlated with measures of balance (p < 0.001). The VBR as well as the frequency of WML and FA were all significantly (p < 0.001) greater in patients than in control subjects. CONCLUSION: Disequilibrium of unknown cause in older people is associated with frequent falls, concerns about falling, brain atrophy, and WML on MRI. Some cases are probably caused by small-vessel ischemic disease.

The adult with bleeding esophageal varices.

Bleeding esophageal varices are a life-threatening complication of portal hypertension. During the emergent phase, nurses have an important role in assessing the patient's response to volume replacement and in monitoring interventions to control hemorrhage. Complications contribute to the high mortality associated with variceal hemorrhage. Knowledge of the pharmacologic side effects of vasopressin and of the potential complications associated with endoscopic injection sclerotherapy and esophagogastric balloon tamponade is critical for successful nursing management of the adult with bleeding esophageal varices. The goal of long-term management is to prevent recurrent hemorrhage. This is accomplished by repeated injection sclerotherapy and strategies to reduce portal pressure. Patient education is focused on modification of behaviors that increase the risk for bleeding and on the early recognition of recurrent bleeding.