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Biomedical subjects

A D Harries

Publications and source records attributed to A D Harries.

At least 127 records · Page 7Linked to original sources
PubMed1995

An audit of HIV testing and HIV serostatus in tuberculosis patients, Blantyre, Malawi.

SETTING: Queen Elizabeth Central Hospital, Blantyre, Malawi. OBJECTIVE: An audit of voluntary HIV testing, with pre- and post-test counselling, of adult patients diagnosed with all types of tuberculosis. DESIGN: A review of case files of adult patients with tuberculosis registered with the District Tuberculosis Officer, Blantyre, between April 1993 and March 1994. RESULTS: There were 1095 tuberculosis patients, mean age 32 years, of whom 665 (60.7%) had HIV-serological testing. 496 patients (74.6% of those tested) were HIV seropositive. 73% of patients who were hospitalized for the initial intensive phase of treatment were HIV-tested compared with 37% of patients who received ambulatory chemotherapy (P < 0.001). In patients HIV-tested, 5 did not wish to know their results and post-test counselling was done in 516 (78%). 23 patients refused HIV testing. 362 (84%) patients not HIV-tested never received pre-test counselling. Of 664 patients who received 2SRHZ/6HT(E) in hospital, 84 (12.6%) patients died and 8 (1.2%) absconded. The abscondee rate was unrelated to HIV serostatus. CONCLUSION: A large proportion of tuberculosis patients who receive supervised treatment in hospital accept confidential HIV testing and the abscondee rate is low. The clinical management of patients is improved.

AIDS Serodiagnosis↗
PubMed1995

The use of sputum induction for establishing a diagnosis in patients with suspected pulmonary tuberculosis in Malawi.

SETTING: There has been a marked increase in notified cases of smear-negative pulmonary tuberculosis in Malawi since 1986. One reason for this may be related to the difficulties of getting adequate samples of expectorated sputum from patients. Sputum induction with nebulized hypertonic saline may be a simple way of obtaining a better specimen. OBJECTIVE: To examine the value of sputum induction for detecting cases of smear-positive tuberculosis. DESIGN: Sputum induction was performed on 82 adults presenting to the Queen Elizabeth Central Hospital, Blantyre, Malawi with clinically suspected pulmonary tuberculosis who were expectorated sputum smear-negative or unproductive of sputum. The induced sputum smear was examined for acid-fast bacilli and cultured for mycobacteria. RESULTS: Sputum was successfully induced from 73 of the 82 patients (26 previously smear-negative and 47 previously unproductive). The induced sputum was smear-positive in 18 patients (5 previously smear-negative and 13 unproductive). Cultures were positive for Mycobacterium tuberculosis in the 18 smear-positive patients and a further 12 that had been smear-negative. 94 cases of smear-positive pulmonary tuberculosis were notified during the study period. 18 (19%) were as a result of sputum induction. CONCLUSION: Sputum induction is a useful technique for improving the case detection rate of smear-positive tuberculosis in Malawi.

Adolescent↗
PubMed1995

The changing pattern of mortality in an African medical ward.

The pattern of adult medical deaths in Queen Elizabeth Central Hospital, Blantyre, Malawi was documented over a 12 month period between April 1992 and March 1993. Results were compared with mortality data collected from the same wards in the pre-AIDS era in 1973. Tuberculosis and AIDS together accounted for 49% of all medical deaths in 1992-93. Eighty-two per cent of deaths occurred in the age group 13-49 years; tuberculosis, AIDS, gastroenteritis, pneumonia, pyogenic meningitis and septicaemia were the most important causes of death in these young patients. These findings are very different to those observed in the same wards 20 years previously when tuberculosis was responsible for 13% of deaths and there were no deaths due to AIDS. The predicted upsurge in AIDS-related deaths in sub-Saharan Africa in the 1990s will have grave consequences not only for the health sector, but for the social and economic fabric of the countries concerned.

Acquired Immunodeficiency Syndrome↗
PubMed1994

Retinal findings in Malawian patients with AIDS.

The purpose of this study was to determine the prevalence of retinal disease in a group of patients with AIDS in Malawi. Indirect ophthalmoscopy was performed on 99 patients with AIDS who were admitted consecutively to a medical ward at a central hospital. Necrotising retinitis was present in one eye of one patient examined. Non-infectious retinopathy was present in 13%. Retinitis is less common in AIDS patients from Africa compared with those from developed countries; it is believed that most patients die before acquiring it. Non-infectious retinopathy may also be less common.

AIDS-Related Opportunistic Infections↗
PubMed1993

Use and costs of antimicrobial drugs in medical wards of a central hospital in Malawi.

Economic constraints experienced by many African countries make it vital that reliable information is collected about the cost of patient care in health institutions. Case files and treatment charts of 509 patients admitted to non-fee paying medical wards of Queen Elizabeth Central Hospital, Blantyre, Malawi for the month of September 1992 were analysed in order to determine the amount and costs of drugs and antimicrobial agents given to inpatients. Infectious diseases accounted for 76% of all admissions. A total of 59 different drug items were used (cost U.S. $732). In all, 18 antimicrobial agents were given (31% of all drug items) at a cost of U.S. $615 (84% of all drug costs). Calculated costs of antimicrobial agents for each patient and for annual admissions (10325 in 1992) were U.S. $1.21 and U.S. $12,558 respectively. Although the present study has its limitations, it provides a rational basis for planning departmental drug budgets.

Anti-Bacterial Agents↗
PubMed1992

Helicobacter pyrlori in Malawi, central Africa.

A total of 160 adult Malawians with epigastric pain for longer than 2 weeks was investigated by endoscopy and serologically for evidence of infection with Helicobacter pylori. The organism was demonstrated histologically and/or by culture in 141 (88%) patients. With histological means and/or culture as the 'gold standard', the histological technique was 100% sensitive while culture was only 81% sensitive. All isolates tested were sensitive to amoxycillin and tetracycline; 74% were resistant to metronidazole. Endoscopic findings were normal in 104 (65%) patients (86.5% H. pylori positive). Evidence of duodenal ulcer was found in 41 (25%) patients (95% H. pylori positive). Histologically, gastritis was common, severe gastritis being associated with increased colonisation by H. pylori. Two kinds of urease test were found to be 100% specific for the presence of H. pylori. The sensitivity of the serological test (Helico-G test) was 98% but its specificity was only 27%. These results provide important background information for planned therapeutic studies in patients with upper gastro-intestinal disease in Malawi.

Adolescent↗
PubMed1992

Longitudinal study of cortical bone loss in patients with inflammatory bowel disease.

Bone mineral density of the radius was measured by single-photon absorptiometry in 50 patients with inflammatory bowel disease. Thirty-three had Crohn's disease and 17 ulcerative colitis; 25 were women. The mean age was 45 years (range, 18-70 years). Measurements were repeated in 39 of them after a mean follow-up period of 7.9 years (range, 7.1-8.2 years). In female patients the mean (95% confidence interval) annual change in radial bone mineral density was -0.74% (-1.34% to -0.14%) (P = 0.022), the greatest bone loss occurring in postmenopausal women (mean, -1.16% (-2.01% to -0.30%)). In male patients the mean annual rate of bone loss was -0.07% (-0.41% to 0.28%) (P = NS). Patients with abnormally low values at the first measurement remained osteopenic at the second measurement, whilst some others with normal values initially showed increased rates of bone loss and had a subnormal bone mineral density after the follow-up period. These results show increased rates of cortical bone loss in some patients with inflammatory bowel disease and emphasize the need to monitor bone mass in these patients so that prophylactic measures can be instituted.

Absorptiometry, Photon↗
PubMed1992

Acute gastroenteritis: effect on nutritional status.

Anthropometric measurements were performed on admission and at four weeks post discharge on 25 adults referred to hospital with acute gastroenteritis. There was a significant change in weight (P < 0.001) and mid-arm circumference (P < 0.05), but no change in skinfold thickness, arm muscle area or arm fat area. The results suggest that weight change during acute gastroenteritis is more a consequence of dehydration than of malnutrition.

Acute Disease↗