Severity of upper-limb panga injuries and infection rates associated with early v. late tendon repair.

BACKGROUND: Panga or machete attacks are a common cause of significant upper-limb trauma in South Africa. Pangas are a multipurpose household tool used predominantly for foraging and agricultural purposes and are highly contaminated. While some centres advocate immediate primary repair if no concern exists regarding the risk of infection, others delay definitive repair until satisfied there is no evidence of infection. OBJECTIVES: To compare infection rates and tendon re-rupture following early primary repair (within 24 h), primary repair after 24 h, and delayed repair following initial debridement. METHODS: We conducted a multicentre, retrospective, observational study of 49 patients (mean age 28.9 years; range 17 - 69), who were followed up for a mean of 3.4 months (range 0 - 8). The injuries sustained included 32 flexor tendon injuries, 14 extensor tendon injuries, 9 fractures and 21 peripheral nerve injuries. RESULTS: Of the patients, 17 underwent early primary repair (within 24 h), 19 delayed primary repair, and 13 delayed repair following primary washout. Wounds were assessed postoperatively using the ASEPSIS wound scoring system and patients were clinically assessed for tendon rerupture. No significant differences were found in the comparative infection rates for early primary repair (5.9%; 1/17), delayed primary repair (10.5%; 2/19) and delayed repair following primary washout (23.1%; 3/13; p=0.662). CONCLUSION: Our results indicate indicate that panga injuries can be repaired safely at first presentation with no increased risk of infection or re-rupture.

The use of diverting colostomies in paediatric peri-anal burns: experience in 45 patients.

BACKGROUND: Peri-anal burns are common in children. Continual exposure to enteric organisms may lead to a contaminated burn wound, invasive sepsis, graft loss, scar contracture, anal and urinary malfunction, and delayed discharge from hospital. Use of a temporary diverting colostomy has been advocated to reduce complications. OBJECTIVES: To review the incidence, indications, methods, bacteriology, therapeutic effects and outcomes of colostomy for perianal burns. METHODS: A prospective study of children with peri-anal burns and stomas over a 17-year period. Prophylactic or therapeutic faecal diversion was achieved by temporary, divided sigmoid end-colostomy with Hartmann's closure of the distal end. RESULTS: Between 1995 and 2012, 45 children with peri-anal burns received a colostomy. The mean total body surface area burned was 35% (range 3 - 80%). There were 28 flame burns, 16 fluid burns and 1 contact burn. Prophylactic colostomies were performed in 29 children, on average on day 6 after admission, and therapeutic colostomies to counteract deep wound infection and septicaemia in 16 patients, on average on day 24. In all but 2 cases there was a marked improvement in clinical appearance, graft take and healing. The bacterial profile changed from gut-derived organisms to Pseudomonas aeruginosa or no pathogens. Complications occurred in 5 patients (11.1%). Three stomas required manual reduction. Two children died of established septic shock, compounded by stomal dehiscence in 1 case. Reversal of the colostomy was performed on average at 4 months. CONCLUSION: Diverting colostomy has therapeutic advantages in a select group of paediatric burns patients in whom continual faecal soiling poses a threat to both graft and life.

Towards a national burns disaster plan.

The International Society for Burns Injuries (ISBI) has published guidelines for the management of multiple or mass burns casualties, and recommends that 'each country has or should have a disaster planning system that addresses its own particular needs.' The need for a national burns disaster plan integrated with national and provincial disaster planning was discussed at the South African Burns Society Congress in 2009, but there was no real involvement in the disaster planning prior to the 2010 World Cup; the country would have been poorly prepared had there been a burns disaster during the event. This article identifies some of the lessons learnt and strategies derived from major burns disasters and burns disaster planning from other regions. Members of the South African Burns Society are undertaking an audit of burns care in South Africa to investigate the feasibility of a national burns disaster plan. This audit (which is still under way) also aims to identify weaknesses of burns care in South Africa and implement improvements where necessary.

Ethics in the mentoring of gerontologists: rights and responsibilities.

This article examines professional codes of ethics as they apply to the mentoring of gerontology students, supervisees, or proteges. Ethics codes from the disciplines represented in professional gerontology were evaluated according to the specificity of their ethical mentoring guidelines. Three levels of specificity were identified. General "do no harm" statements are most common. Clear, explicit guidelines or rules are much less frequent. Where explicit mentoring guidelines exist, they focus on the use or misuse of the power of the professional/mentor in the mentoring relationship. Specific suggestions regarding the rights and responsibilities of both parties in the mentoring relationship, reflecting both formal ethics codes and the authors, experiences, are made.

Partial cloning and sequencing of chick fibrillin-1 cDNA.

The recent identification of numerous matrix genes and gene products has allowed a detailed examination of their roles in development. Two of these extracellular matrix proteins, fibrillin-1 and fibrillin-2, are components of the elastin-associated microfibrils. Given what is known about the distribution of the fibrillins in normal tissues and the abnormalities that result when mutations occur, a basic hypothesis has emerged: fibrillin-1 is primarily responsible for load bearing and providing structural integrity, whereas fibrillin-2 may be a director of elastogenesis. Nevertheless, examination of phenotypes in disorders caused by mutations in fibrillin-1 or fibrillin-2 suggests some common functions. To better understand these similar and diverse roles, it would be helpful to examine these proteins during chick development. To accomplish this goal, it is first necessary to characterize the chick homologs of the known fibrillins. In this study, the partial chick FBN1 cDNA was identified by polymerase chain reaction-aided cloning as a first step toward elucidating these goals. Sequence analysis indicated that there is striking conservation between chick and mammalian fibrillin-1 at the DNA and protein levels. Antisense and sense riboprobes were synthesized and used in in situ hybridization in stage 14 chick embryos and high levels of FBN1 transcripts were observed in the heart.

Phenomenology and the meaning of aging for young and old adults.

Qualitative methods were used to examine the similarities and differences in the meaning of aging for young and old adults. Nineteen young adults and seventeen older adults were asked to describe in detail a specific event or time in their lives that suggested to them that they were aging. Their responses were reduced to significant statements by two independent coders, until a thematic structure became apparent. Younger adults associated aging with major events in their lives, and even though these events tended to be positive, aging had a negative meaning for them. Young adults tended to associate aging with increased responsibility and lost freedom. By contrast, older adults associated aging with everyday events or no specific events at all, and they perceived aging positively. Both young and old adults mentioned themes of times, the body, and others.

Biaryl acids: novel non-nucleoside inhibitors of HIV reverse transcriptase types 1 and 2.

A series of biaryl acids has been found to show micromolar inhibition of the HIV reverse transcriptase (RT) from types 1 and 2 with IC50S in the micromolar range. The series was discovered by consideration of the polymerase active site and sub-structure searching of the company compound collection. Synthesis of analogues to investigate the SAR is described. Two of these compounds have shown inhibition of HIV-2 RT only.

Prenatal and presymptomatic diagnosis of the Marfan syndrome using fluorescence PCR and an automated sequencer.

The Marfan syndrome (MFS) is a heritable connective tissue disorder characterized by skeletal, ocular, and cardiovascular abnormalities. Defects in fibrillin, an elastin-associated microfibrillar protein, are now known to cause MFS. Since the discovery of fibrillin as the gene responsible for MFS, requests for prenatal and presymptomatic diagnosis have become common-place. Here we report the use of the polymerase chain reaction (PCR), using fluorescence labelled primers and an automated sequencer, to establish linkage data for 'molecular diagnosis'. The mistaken clinical diagnosis of MFS based on the appearance of a common cardiovascular manifestation, mitral valve prolapse, and a positive family history is also discussed.

Prospective study of the quality of life in patients assessed for liver transplantation: outcome in transplanted and not transplanted groups.

The quality of life in adult patients with chronic liver disease who were considered for transplantation was assessed prospectively over a 2 year period, for both those who did and did not subsequently receive transplants. The main outcome measures were the Nottingham Health Profile and survival. Of the 109 patients who completed an entry profile, 27 were transplanted, 71 not transplanted during the study period, and 11 rejected for transplant. Quality of life and severity of liver disease at entry was worse for the transplant group, whose survival at 15 months from entry was 81% compared with 78% for those not transplanted. Among transplant survivors there were marked improvements in quality of life, whilst amongst those not receiving transplants there was little change. In conclusion, liver transplantation was effective in improving quality of life in patients with chronic liver disease, but comparison between transplant and non-transplant patients is difficult because of differences between the groups.

Age, education, and literacy skills of adult Mississippians.

This study examined the literacy skills of 1791 black and white Mississippi residents aged 16 to 75, with varying levels of education. Using a new literacy test developed by the Educational Testing Service (ETS), three kinds of literacy were assessed: prose literacy, document literacy, and quantitative literacy. Results revealed that very few Mississippians were totally illiterate, but that the level of literacy was associated with education, age, and race. Within age groups, educated persons scored higher than less educated persons. However, both highly-educated and little-educated older persons scored lower on all three measures of literacy than equally educated younger persons.

Equity and medical practice variation: relationships between standardised discharge ratios in total and for selected conditions in English districts.

STUDY OBJECTIVE: The aim was to investigate relationships for residents of English district health authorities between rates of discharges from acute hospitals for all conditions and variations in discharge rates for eight common conditions (five surgical, three medical). DESIGN: Hospital Inpatient Enquiry data on discharges for 1984 were analysed. Standardised discharge ratios (ratios of actual to expected numbers of discharges x 100) were derived for selected conditions and all conditions; and correlation coefficients for these statistics were calculated. Districts were grouped into quintiles according to the value of the standardised discharge ratio, and systematic variation within each quintile was calculated for the selected conditions. SETTING: The study involved all 192 English district health authorities, but 57 were excluded because the proportion of unspecified diagnoses exceeded 5%. PATIENTS: The analyses were based on 336,799 cases from 135 districts. MEASUREMENTS AND MAIN RESULTS: Discharge ratios for the medical conditions and one surgical condition were significantly correlated with the levels of total discharge rates (p less than 0.01). The medical conditions showed greater systematic variation in discharge ratios than the surgical conditions. There was no consistent pattern in the values of systematic variation for the selected conditions across the different levels of discharge ratios for all conditions. CONCLUSIONS: It is argued that the changes in the NHS introduced in April 1991 are intended to introduce greater equity in the standardised discharge ratios and increase the total numbers of discharges. The results of this analysis suggest that, even if these objectives were achieved, they may not result in increased levels of elective care, nor result in greater equity in terms of rates of discharge for individual conditions.

Associations of excessive irritability with common illnesses and food intolerance.

In a national study of almost 7000 primary school children, parents' perceptions were used to test the hypothesis that the child's irritability was associated with food intolerance independently of other symptoms. After adjustment in a multiple regression analysis for asthma or wheeze, cough, eczema, hives, diarrhoea and vomiting, rhinitis, hay fever and headache, and the social factors of father's social class, maternal education and maternal age, a highly significant association between perception of food intolerance and irritability (P less than 0.001) remained. Though we cannot rule out that irritable children's parents could be biased towards diagnosing food intolerance the possibility that some children do have behavioural disturbance associated with reactions to food needs to be explored further, preferably with a double blind challenge assessment.

Sleep habits and height at ages 5 to 11.

Shorter durations of slow wave sleep and lower growth hormone responses have been reported in children with short stature caused by psychosocial deprivation. We investigated whether lower total sleep duration was associated with shorter stature in a sample of children taking part in the National Study of Health and Growth. Parental responses to a self administered questionnaire were used to estimate usual times for going to sleep at night and usual times for waking in the morning for 5145 children aged 5 to 11 years of age. After adjusting for the effects of other variables known to be associated with height, it was shown that there was a weak negative association between sleep duration and height. It is concluded that variation in sleep duration between children is unlikely to have an important influence on growth.

Need for new reference curves for height.

Data from the National Study for Health and Growth, on children aged from 4.0 to 12.0 years measured in 1972, 1985, and 1986 were used to assess whether new growth standards are required, and which subgroups of children might require separate standards. The change over this period, from just over half a centimetre in the youngest girls to over a centimetre in the oldest boys, warrants the use of revised reference curves, which are also needed for Afro-Caribbean children.

The secular trend in height of primary school children in England and Scotland 1972-79 and 1979-86.

The recent secular trend in height of primary school children was estimated using data from schools participating in the National Study of Health and Growth in 1972, 1979 and 1986. About 50% of the trends from 1972 to 1979 for English and Scottish boys and girls were accounted for by changes in family size, with some contribution from increases in parental height and from birthweight, but almost none from changes in social class distribution. Estimates for 1979-1986 showed that the trend towards increased height in five-to eleven-year-old children has now ceased.