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Biomedical subjects

J Mielke

Publications and source records attributed to J Mielke.

At least 37 records · Page 2Linked to original sources
PubMed2000

An evaluation of the management of epilepsy by primary health care nurses in Chitungwiza, Zimbabwe.

In order to design an effective training program for nurses on the management of epilepsy in Zimbabwe, the drug management of epilepsy by community health nurses without prior training in epilepsy management was evaluated. Epilepsy patients in Chitungwiza, a high-density suburb of Harare, were routinely managed at four health clinics run by nurses. The patients also attended a monthly epilepsy support group (ESG) program, which provided them with vocational and social rehabilitative support. Neurologists evaluated the drug therapy of all patients attending this support group program over a 2-year period. The specialist interventions required to drug therapy in patients with inadequate seizure control or drug side effects were noted. A total of 114 epilepsy patients (age range 8-56 years, M:F=1:1.2) were seen, of these 84.2% had generalized seizures, 40.3% of patients had been seizure-free for at least 6 months, 71.9% of patients were on phenobarbitone, while 59.6% were on monotherapy. No drug intervention was required to on-going drug therapy in 43% of patient consultations. The most important intervention in patients with inadequate seizure control was an increase in drug dose, required in 29% of consultations. Of serum drug level estimations in clinically indicated cases, 58% were below the therapeutic ranges. This tendency to sub-therapeutic dosing with AED amongst nurses implied that a written AED drug therapy protocol specifying optimal maintenance doses and dose increment schedules may be beneficial to the community-based nursing management of epilepsy.

Adolescent↗
PubMed2000

The impact of epilepsy on the quality of life of people with epilepsy in Zimbabwe: a pilot study.

Epilepsy is a common cause of psychosocial disability and has been perceived to have a profound impact on the social functioning of individuals with epilepsy. In Zimbabwe a combination of developing world economic priorities (with provision of social and health services for disabled people not a major goal) and culturally mediated perceptions of epilepsy as a non-medical and feared stigma may further disadvantage people with epilepsy (PWE) in this respect. In order to assess both the level of psychosocial functioning of individuals with epilepsy and their own perception of it, three groups of people were sampled: attenders at a specialized epilepsy clinic and members of two community-based support groups. All completed a brief quality-of-life questionnaire with activities of daily living added. Those carers present completed the same questionnaire at the time of sampling. The results indicated that 36 of 38 people with epilepsy sampled, and their carers, did not perceive themselves to have sufficient cognitive impairment to interfere with social functioning, work performance or relationships with other as assessed by a subsection of the WHO SIDAM (objective evaluation of cognitive performance) interview. However, an adapted activities of daily Living Questionnaire (ADLQ) showed that three-quarters of carers (and two-thirds of PWE) felt that functioning was mildly to moderately reduced, particularly in the areas of solving daily problems and speed of thinking. One-quarter of PWE experienced problems with relationships to others, just less than one-fifth of PWE reported more than four areas of reduced functioning. Of special interest was the fact that 25 (66%) reported sexual functioning as not applicable, although only four of these were of an age group which is not sexually active (less than 15 years old). In addition one-third of the central Hospital Group reported difficulties with using public transport, but none of the Community Support Group members, implying that the use of Public transport becomes an issue when it is necessary to travel long distances and that PWE curtail their travel but do not necessarily view this as a restriction. The samples chosen were from groups which, compared with PWE as a whole, are likely to include more disabled individuals, because attenders at a specialized epilepsy clinic and members of support groups self-select for more symptomatic epilepsy and a visibility. Therefore the proportion of PWE perceived to have difficulties with ADL in this project is not representative for PWE as a whole. The implications of our study are firstly that there is a significant need for selected groups of PWE in Zimbabwe to receive attention to psychosocial abilities and secondly that there are certain specific areas such as sexual functioning and the use of transport which deserve special attention. A much more detailed inventory of neuro-psychological tests will be of value to plan treatment strategies for those selected by the crude screening instruments used in this project. An important future comparison will be a survey of ADL and psychosocial functioning amongst PWE in rural communities, because it is uncertain whether PWE in rural communities are generally more or less disabled than those in the city.

Activities of Daily Living↗
PubMed2000

[Tübingen 1895-1899. Incidence, diagnosis and therapy of selected optic nerve, uveal and retinal diseases 100 years ago].

BACKGROUND: The records of the University Eye Clinic are almost completely preserved at the historical archive of the University of Tübingen since 1865 and shell now be reduced. MATERIALS AND METHODS: 150 records from the historical archive of the University of Tübingen were selected. We were interested in those patients treated for the first time at the University Eye Clinic between 1895 and 1899. Only diseases of the optic nerve, the uveal tract and the retina were considered. The records were distributed into groups following historical classification and statistics of the same period. These statistics were also used to compare our selection with all patients treated. For information about frequency, diagnostics and therapy a questionnaire was developed. RESULTS: Glaucoma: The data of the subgroup "Glaucoma simplex" showed high correspondence with the historical data regarding the frequency (24.3 vs. 25.5%). The data of the subgroup "Glaucoma secundaria" differed (34.5 vs. 25.5%). Testing the visual acuity was the first step of examination here and in all groups (100%). Measurement of intraocular pressure with digital palpation followed (86.3%). First of all Eserin eye drops were applicated (76.5%). Iritis: The frequency of acute iritis was 16.8 vs. 25.0%, and of chronic iritis 59.6 vs. 52.2%. As typical symptoms ciliar injections, fixed anisocore pupil and exudation were often seen (80.0%). Chronic iritis showed as typical symptom posterior synechia (80.9%). Atropin eye drops were firstly applied in acute iritis (100%), chronical iritis was treated by iridectomy (57.1%). Myopia: In all subgroups our data differed from the historical data. Staphyloma posticum was the characteristic diagnosis (65.8%). Myopia was treated by decision of the lens. Retinal detachment: The frequency 37.2 vs. 28.0%. In nearly all cases retinal detachment was described after ophthalmoscopic examination (92.8%). The first therapeutical step was to keep the patients staying in bed (53.8%). CONCLUSIONS: As expected, diagnostic and therapeutical options were strongly limited in Tübingen 100 years ago. Nevertheless, therapeutic successes were achieved in certain cases.

Germany↗
PubMed2000

Community leader education to increase epilepsy attendance at clinics in Epworth, Zimbabwe.

OBJECTIVE: To determine whether educating community leaders about epilepsy would lead to an increase in epilepsy cases being diagnosed and treated at primary health centers. METHODS: This was a single-arm cohort study performed in Epworth, a periurban township outside Harare, Zimbabwe. The subjects were Epworth community leaders (Local Board members, teachers, nurses, police officers, traditional healers, prophets). Educational workshops were given on epilepsy, its cause, and its management, and the number of new epilepsy cases on local primary health clinic registers 6 months after the workshops was measured. RESULTS: Six new cases were recorded, all among patients previously diagnosed with epilepsy. This was a significant increase (p = 0.02) compared with the null hypothesis. CONCLUSION: Although there was a significant increase in new cases, these did not represent newly diagnosed patients. Significant prejudice within the community may still prevent identified patients with epilepsy from seeking treatment. Alternative methods must be sought to increase the awareness of epilepsy within low-income communities and to reach "hidden" people with epilepsy.

Attitude to Health↗
PubMed1998

[Diode laser cyclophotocoagulation of secondary glaucoma caused by anterior, necrotizing scleritis].

PATIENT: A 60-year-old female patient presented with recurrent anterior, necrotizing scleritis with inflammation and a newly developed secondary glaucoma in the right eye. Anterior uveitis occurred some years before. Severe scleral thinning was circumferentially present and focal scleral ectasia was found. Physical examination revealed no systemic association of scleritis. Immunosuppressive therapy with metotrexate was initiated and control of scleritis achieved. Intraocular pressure elevation persisted and was refractory to glaucoma medication. Diurnal pressure curve showed IOP-values of 40 mm Hg despite the use of systemic carbonic anhydrase inhibitors. Visual acuity was 20/50 in the right and 20/25 in the left eye. METHOD: Diode laser cyclophotocoagulation (Oculight SLx 810 nm, Iris Medical Instruments Inc. California, USA) was performed under general anaesthesia using reduced parameters for application (12 laser spots, 1 second, 1.25 W). No complications occurred during and after laser application. Postoperatively, intraocular pressure was within normal range between 14 and 18 mm Hg. No reactivation of scleritis or uveitis was seen. CONCLUSION: In our experience, diode laser cyclophotocoagulation is effective and safe in treating secondary glaucoma associated with anterior, necrotizing scleritis with inflammation and uveitis using reduced parameters for application.

Female↗
PubMed1998

Cryptococcal meningitis in human immunodeficiency virus-infected patients in Harare, Zimbabwe.

A prospective observational study was conducted over a 10-month period to determine the clinical and laboratory manifestations of cryptococcal meningitis in Zimbabwe, a country where antifungal agents are not widely available. Eighty-nine patients with cryptococcal meningitis (median age, 34 years; range, 11-63 years; 56 males) were identified from 406 patients for whom a clinical diagnosis of meningitis had been made. All patients tested were positive for antibody to human immunodeficiency virus. Cryptococcal meningitis was the first AIDS-defining illness in 88% of patients. Typical presentations were headache, mental impairment, and meningism (median duration, 14 days; range, 1-180 days). The median CD4+ cell count was 70/microL (range, 0-651/microL). The cumulative median survival from the time of diagnosis was 14 days (range, 0-233 days); 22% of patients survived for >30 days. Independent indicators of a good prognosis were not identified. This study provides a unique basis for the development of novel management strategies for patients with cryptococcal meningitis who reside in resource-poor countries.

AIDS-Related Opportunistic Infections↗
PubMed1997

Alcohol in the South Pacific: the mid-1990s.

In the mid-1990s data were obtained on alcohol consumption in the Cook Islands, Fiji, Kiribati, Samoa, the Solomon Islands and Tonga. These data are reported together with a discussion of the nature of alcohol related problems in the island nations. Per capita consumption is highest in the Cook Islands, which compared with other countries has the highest ratio of liquor outlets and lowest alcohol taxation regime. As an alcohol problem prevention measure, it is concluded that the promotion of responsible consumption, together with the option of abstinence for those who wish it, is an acceptable strategy for the Pacific.

Journal Article↗
PubMed1997

Knowledge and attitudes of teachers towards epilepsy in Zimbabwe.

OBJECTIVE: As a preliminary to designing a health education programme on epilepsy for teachers in Zimbabwe, we evaluated the knowledge and attitudes to epilepsy of teachers in Epworth, a poor, high density suburb of Harare, Zimbabwe. MATERIALS AND METHODS: All teachers in Epworth were invited to awareness workshops on epilepsy. A questionnaire on knowledge and attitude of epilepsy was distributed to all consenting participants. RESULTS: 165 teachers (Male:Female 1:1.9) responded. Of the respondents 89% had heard or read about epilepsy, while 70.6% had observed an epileptic seizure. Epilepsy was considered hereditary by 34.6%, while 12.6% thought it was a form of insanity. Only 0.6% thought evil spirits were a cause, 22.6% thought that epilepsy was contagious, 82% would allow their child to play with an epileptic child, 76% would marry an epileptic while 55.7% would employ an epileptic. The majority would accommodate an epileptic and teach an epileptic child in class. CONCLUSIONS: These positive attitudes towards epilepsy by teachers may be attributed to their higher level of education and may imply that with increasing levels of formal education in the general African population, a more tolerant attitude towards epilepsy can be expected.

Adult↗
PubMed1997

Peripheral neuropathy in individuals with HIV infection in Zimbabwe.

Peripheral neuropathy is associated with HIV infection. The prevalence and types of peripheral neuropathy encountered in a randomly-selected HIV infected African population at different stages of disease were investigated. HIV positive individuals were categorized into 1 of 3 groups: asymptomatic, symptomatic and AIDS. HIV negative individuals formed the control group. Nerve conduction data were obtained using standard electrophysiological procedures and CD4+ levels were measured. The type of neuropathy was determined from the history, clinical presentation and electrophysiological abnormalities. The prevalence of peripheral neuropathy was 44%: subclinical neuropathy (SCN) accounted for 56%, acute inflammatory demyelinating polyneuropathy (AIDP) for 15% and distal symmetrical polyneuropathy (DSPN) for 22% of cases of neuropathy. SCN was found in all categories whereas AIDP predominated in the symptomatic category and DSPN in individuals with AIDS. The pattern and frequency of neuropathies seen in our African population is similar to that reported from other continents.

Adult↗
PubMed1996

The pattern of utilization of EEG services in Harare, Zimbabwe.

OBJECTIVE: In developing countries, EEG services represent a considerable investment in terms of financial costs and staffing requirements which demand appropriate and effective utilization. This study is an evaluation of the pattern of utilization of EEG services in our hospital. DESIGN: Cases series. SETTING: The EEG Department of the Parirenyatwa Hospital, Harare, over the six month period between January and June 1995. SUBJECTS: The EEG records of 237 patients (age range four months to 70 years, M:F ratio 1.5:1) recorded over a six month period were retrospectively studied. RESULTS: 47.3% of EEG records were normal while 52.7% were abnormal. Outpatient referrals accounted for 62.9% of all EEG recordings. While there was a broad spread of referrals from the major medical specialties, only 4.2% of all referrals were from the district hospitals. The majority of referrals were to confirm the diagnosis of epilepsy. Epileptiform abnormalities were detected in 49.4% of patients referred for epilepsy. A total of 47.2% of patients were on psychotropic or anti-epileptic drugs with potential confounding influences on the interpretation of EEG records. CONCLUSION: The major indication for EEG in our study is the confirmation of the diagnosis of epilepsy. All the indications for EEG referral in this study are further evaluated in the light of current clinical practice.

Adolescent↗
PubMed1994

Advances in electrodiagnosis in Zimbabwe. Part II: "Evoked potentials".

This paper is a short review of the electrodiagnostic technique of "evoked potentials", a technique recently introduced to Zimbabwe. The types of evoked potentials recorded, the method of recording and their clinical applications are discussed. Abnormal evoked potentials from a variety of neurological disorders are illustrated. "Advances in electrodiagnosis in Zimbabwe" Part I discussed peripheral nerve conduction measurements and electromyography. This paper (Part II) will review the physiological basis of "Evoked Potentials" and their clinical applications.

Electrodiagnosis↗