Case management of cholera.

Cholera still affects about three million people a year and kills approximately 100,000. Cholera can be effectively managed in the majority of cases with oral rehydration solution alone. Up to one third of patients present with severe dehydration, which can be diagnosed clinically, and will require rapid intravenous rehydration with Ringers Lactate or other appropriate fluid before being managed with oral rehydration solution. Antibiotics reduce the duration of illness and should be used in patients with severe dehydration. Resistance is common and local sensitivities should guide the choice of antibiotic. All children between six months and five years should receive zinc supplements. Effective case management with strict attention to detail including infection control and the use of protocolized approaches can reduce the mortality to around 1% even in resource poor settings.

Emergence of multidrug-resistant NDM-1-producing Gram-negative bacteria in Bangladesh.

The main objective of this study was to investigate the prevalence of bla (NDM-1) in Gram-negative bacteria in Bangladesh. In October 2010 at the International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR,B) laboratories, 1,816 consecutive clinical samples were tested for imipenem-resistant Gram-negative organisms. Imipenem-resistant isolates were tested for the bla (NDM-1) gene. Among 403 isolates, 14 (3.5 %) were positive for bla (NDM-1), and the predominant species were Klebsiella pneumoniae, Acinetobacter baumannii, and Escherichia coli. All bla (NDM-1)-positive isolates were resistant to multiple antibiotics. Among ß-lactamase genes, bla (CTX-M-1-group) was detected in ten isolates (eight bla (CTX-M-15)), bla (OXA-1-group) in six, bla (TEM) in nine, bla (SHV) in seven, and bla (VIM) and bla (CMY) in two isolates each. The 16S rRNA methylase gene, armA, was detected in five K. pneumoniae isolates and in one E. coli isolate. rmtB and rmtC were detected in a Citrobacter freundii and two K. pneumoniae isolates, respectively. qnr genes were detected in two K. pneumoniae isolates (one qnrB and one qnrS) and in an E. coli isolate (qnrA). Transferable plasmids (60-100 MDa) carrying bla (NDM-1) were detected in 7 of the 11 plasmid-containing isolates. Pulsed-field gel electrophoresis (PFGE) analysis grouped K. pneumoniae isolates into three clusters, while E. coli isolates differed significantly from each other. This study reports that approximately 3.5 % of Gram-negative clinical isolates in Bangladesh are NDM-1-producing.

Tuberculosis and patient gender in Bangladesh: sex differences in diagnosis and treatment outcome.

SETTING: The public health sector of Bangladesh. OBJECTIVE: To assess gender differences in access to tuberculosis diagnosis and in tuberculosis treatment outcome in Bangladesh. METHODS: Information on the age and sex of a sample of patients in 1997 was collected from out-patient registers and tuberculosis laboratory and treatment registers in 59 thanas in three divisions in Bangladesh. RESULTS: The female/male ratio was 0.79 among 42,877 out-patients with respiratory complaints, 0.51 among 5,665 tuberculosis suspects undergoing sputum smear microscopy, 0.36 among 869 tuberculosis suspects with positive sputum smears, and 0.35 among 5,632 patients registered for tuberculosis treatment. Treatment was successful (cured or treatment completed) in 86% of female and 84% of male patients. CONCLUSION: Women in Bangladesh appear to have less access to public out-patient clinics than men, and if they present with respiratory symptoms they are less likely to undergo sputum smear examination. If examined, women are less likely than men to be smear-positive. No gender bias was observed in tuberculosis treatment outcome. It is recommended to focus further research on exploration of sex differences in the incidence of respiratory conditions, identification of constraints among women in accessing out-patient clinics and verification of the quality of sputum submitted by women for examination.

Research in orthopaedic training: the trainees' experience.

Although a higher surgical degree is considered de rigeur for trainees aspiring to the senior registrar grade in general surgery (2,7,4) the same does not appear to be true of orthopaedic surgery. Fifty of 51 registrars and senior registrars in orthopaedic surgery in the North East Thames Region completed a carefully structured and confidential questionnaire which focused on two major aspects. For those who had not undertaken a period in full time research, questions examined future intentions in this area, and the reasons for those intentions. For those who had completed such a period, particular attention was paid to assessing the trainees' views of the educational experience, the value of this experience and the level of supervision received. Registrars and senior registrars are in a phase of training generally referred to as higher training. The majority (56 per cent) of higher orthopaedic trainees (HTs) do not expect to undertake a period of full time research. This is in stark contrast to the situation in general surgery (7). Fourteen of the 50 HTs (28 per cent) had completed a mean of 9.7 months, and 8 (16 per cent) indicated an intention to take such an opportunity, should it arise. For this latter group, the greatest stimulus to this type of work was a specific interest in a certain field, followed by a belief that time spent in full-time research is of value as an end in itself. For those who had been in such a post, a high level of satisfaction in the level of supervision was demonstrated. Two important conclusions arise. For the orthopaedic trainee full-time research is considered a positive choice rather than a hurdle. Trainees also feel they are well supervised and find the exposure to research stimulating and satisfying. This is in clear contrast with the experience of those in general surgery.

The assessment of competence in surgical trainees.

Trainers have an increasingly important role in the assessment of competence in their surgical trainees. This article outlines the philosophy behind the assessment of competence, and offers a range of such tests from which to select what is valid, reliable and feasible.

Future training of hospital doctors.

Many changes are occurring in the organization and management of postgraduate medical education and training. Hospital Doctors: Training for the Future (Department of Health, 1993) highlights the need for shorter training programmes and structured curricula. A number of issues still require analysis, particularly the resource implications of expanding the consultant grade.

Quality in medical education and training.

Quality in medical education and training is difficult to define, and even more difficult to monitor. To ease these tasks a working party in the North East Thames Region produced a contract-monitoring document to act as a framework for monitoring the contract between clinical tutors and the postgraduate dean.