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Biomedical subjects

A F Fleming

Publications and source records attributed to A F Fleming.

125 records · Page 7Linked to original sources
PubMedDate not supplied

Tropical obstetrics and gynaecology. 1. Anaemia in pregnancy in tropical Africa.

Major causes of anaemia in pregnancy in tropical Africa are malaria, iron deficiency, folate deficiency and haemoglobinopathies: now there is added also the acquired immune deficiency syndrome (AIDS). Anaemia is often multifactorial, with the different causes interacting in a vicious cycle of depressed immunity, infection and malnutrition. Anaemia progresses through 3 stages: compensation, with breathlessness on exertion only; decompensation, with breathlessness at rest and haemoglobin (Hb) below about 70 g/litre; cardiac failure, with Hb below about 40 g/litre. Without treatment, over half of the women with haematocrit less than 0.13 and heart failure die. Maternal anaemia, malaria and deficiencies of iron and folate cause intrauterine growth retardation, premature delivery and, when severe, perinatal mortality. Surviving infants have low birthweights, immune deficiency and poor reserves of iron and folate. They have entered already the vicious cycle of infection, malnutrition and impaired immunity. Treatment with blood transfusions is even more hazardous since the advent of AIDS, and should be limited to saving the life of the mother. Treatment of malaria is complex as chloroquine-resistant strains are now common. Prevention remains relatively easy with proguanil and supplements of iron and folic acid and is highly cost-effective in the improvement of maternal and infant health; it is more important than ever as it avoids the unnecessary exposure of women and infants to HIV transmitted through blood transfusion.

Acquired Immunodeficiency Syndrome↗
PubMedDate not supplied

'Improved sensitivity of direct microscopy for detection of acid-fast bacilli in sputum in developing countries.

Diagnosis of pulmonary tuberculosis depends on the bacteriological examination of sputum. Sputum smear microscopy is efficient and can confirm the disease. However, direct microscopy of sputum, though rapid, has low sensitivity. There is, therefore, an urgent need to develop rapid, much more sensitive and specific methods. In a field study we collected sputum samples from 488 tuberculosis suspects and compared the results of examining smears prepared after treatment with sodium hypochlorite (NaOCl) and concentration of bacteria by centrifugation and direct staining with Ziehl-Neelsen stain. Direct smears stained with auramine-phenol were the reference standard. The use of NaOCl increased the sensitivity from 43.4% to 76.3%, with a specificity of 100% for both methods. The method is simple and cheap. As a potent disinfectant, NaOCl also reduces the risk of laboratory-acquired infection. Its application would increase the efficiency of tuberculosis control programmes.

Centrifugation↗