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Biomedical subjects

P Courtright

Publications and source records attributed to P Courtright.

At least 73 records · Page 4Linked to original sources
PubMed1994

Acceptance of surgery for trichiasis among rural Malawian women.

We sought to determine the proportion of women with trichiasis who subsequently accepted surgery and to evaluate factors related to acceptance. Women who accepted surgery were more likely to be widows, to be of low socioeconomic status, to live close to a main road, to know another woman who had surgery for trichiasis, and to have trichiasis in both eyes than women who did not accept surgery. Our results suggest that considerable education and encouragement are needed to increase acceptance of surgery for trichiasis.

Eyelashes↗
PubMed1994

Knowledge and attitudes toward onchocerciasis in the Thyolo highlands of Malawi.

In preparation for mass distribution of ivermectin to control onchocerciasis in the Thyolo highlands of Malawi a survey was conducted to determine knowledge and attitudes toward onchocerciasis which could assist in developing educational messages. Since onchocerciasis is not known by a specific name in the Thyolo highlands, information was sought about individual perceptions of common symptoms of infection. Itching, skin thickening, nodules, or depigmentation (leopard skin) were reported by 95% of those interviews. Effective treatment was often thought by the community to be available when actually it was not. Traditional healers were not thought to be an important source for treatment of lesions associated with onchocerciasis. None of those interviewed associated Simulium damnosum s.l. with any symptoms other those related to the actual bite. Based on the information gathered, various options for ivermectin educational messages are discussed.

Adult↗
PubMed1993

Ocular fundus findings in Malawian children with cerebral malaria.

BACKGROUND: Cerebral malaria is a major cause of mortality and morbidity in children in tropical regions. The pathogenesis of this important complication of Plasmodium falciparum infection is not well understood. A number of observers have commented on the presence of retinal pathology in various types of malaria. Previous reports have not demonstrated that fundus findings are significantly associated with outcome. METHODS: The authors examined the ocular fundi, by direct and indirect ophthalmoscopy, of 56 children admitted consecutively with cerebral malaria. RESULTS: Every child with a normal fundus on admission recovered fully, but two conditions were found to be associated with a poor outcome. Patients with papilledema had a relative risk of poor outcome 5.2 times greater than those without this finding (P < 0.01). Patients with retinal edema outside the posterior vascular arcades had a relative risk of poor outcome 3.9 times greater than those without this finding (P < 0.01). These two fundus findings were independently predictive of a poor outcome. CONCLUSION: Fundus findings are useful as predictors of outcome in children with cerebral malaria. The authors' findings suggest that there may be two distinct mechanisms associated with poor outcome in these children.

Antimalarials↗
PubMed1993

Cell-mediated immunity in trachomatous scarring. Evidence from a leprosy population.

BACKGROUND: There is limited understanding of the mechanisms that mediate immunity after infection by Chlamydia trachomatis. Since it is known that the clinical course of leprosy is related to cell-mediated immunity and that such immunity contributes to the development of trachomatous conjunctival scarring, the authors examined patients to determine if there might be an association between leprosy status and trachomatous conjunctival scarring. METHODS: Leprosy patients registered at Shashemane Hospital were interviewed, examined, and patients with siblings residing in the vicinity were asked to return for further clinical examination. A subsample of sibships was selected for laboratory evaluation of cell-mediated immunity, measured by lymphocyte proliferative responses in vitro to stimulation by mycobacterial antigens. RESULTS: Conjunctival scarring was less severe in multibacillary leprosy patients (with suppressed cell-mediated immunity) than in their healthy siblings and more severe in paucibacillary leprosy patients (with enhanced cell-mediated immunity) than in their healthy siblings. The mean lymphocyte proliferative responses to mycobacterial antigens were greater in the sibling (whether leprous or healthy) with more severe conjunctival scarring, regardless of type of leprosy. CONCLUSION: The specific cellular immune responses to Mycobacterium leprae and p65 antigen in patients with increased conjunctival scarring provide evidence that early in the course of infection with C. trachomatis, factors related to an individual's cellular response are crucial to the development of conjunctival scarring. A delayed-type hypersensitivity reaction ("reversal reaction") found in paucibacillary leprosy patients could contribute to the increased trachomatous conjunctival scarring in these patients.

Adolescent↗
PubMed1993

Sociocultural aspects of blindness in an Egyptian delta hamlet: visual impairment vs. visual disability.

Through ophthalmological exams, structured interviews and participant observation, this study examines the experience of blindness in rural Egypt, and finds that villagers' subjective assessments of their vision differ substantially from ophthalmic measurements of their vision. Individuals with profound visual loss remain independent in their daily activities and contribute to their families' subsistence. While they may agree that they have "weak eyesight," they do not perceive themselves to be disabled. Stigmatizing attitudes that the blind are completely dependent and unable to fulfill their social roles further encourage those with decreased vision to deny the extent of their visual loss.

Adolescent↗
PubMed1993

The epidemiology of burns in rural Ethiopia.

STUDY OBJECTIVE: The aims were (1) to review inpatient burn records of Attat Hospital (Ethiopia) for the years 1983-1989, and (2) to determine the prevalence of burns and knowledge of first aid for burns in 16 communities served by Attat Hospital in rural Ethiopia. DESIGN: A retrospective review of all records was used to describe characteristics of the inpatient with burns and cost of the service. Adult members of a systematic random sample (20%) of households from 16 communities (total population = 10,183) were interviewed. Questions focused on what to do to put out the fire, what to do for first aid for a burn, the major cause of adult and childhood burns, and a history of burn in any household member. SETTING: The study was conducted at Attat Hospital and in the surrounding Gurage-Chaha Region of West Shoa Province of Ethiopia. STUDY SUBJECTS: There were 271 burn inpatients during the 7 year period from 1983-1989; 163 households were selected for interview; there were no refusals. MAIN RESULTS: During the 7 year period the cost of tertiary inpatient burn treatment at Attat Hospital has been estimated to be US$86,366.72, of which the hospital absorbed 66%. From community based information the cumulative incidence of burns in this population was found to be 5-11%. The absence of a cumulative increase in burns over time in men suggests that female respondents may not fully recall burn histories in adult male household members. The study population possess inadequate knowledge regarding burn prevention and burn first aid. Deleterious traditional compounds were used on 32% of burn patients in the villages. CONCLUSIONS: Since most burns are related to household fires, generally in the domain of women in rural Ethiopia, women's groups may be the most appropriate setting for education on burn prevention and first aid. Burn prevention and first aid education should also be recognised as a priority in schools and in the training of community health workers.

Adolescent↗
PubMed1993

The epidemiology of blindness and visual loss in Hamar tribesmen of Ethiopia. The role of gender.

We conducted a population-based survey in the Hamar tribe of Ethiopia to assess the problem of blindness and ocular morbidity. Blindness was detected in 1.9% of the Hamar. Among the age group 40 and over < 1.0% of men and 13% of women were blind. Women with low vision or blindness comprised 30% of all women while men with low vision or blindness only comprised 8% of men in the age stratum. Cataract is responsible for the excess blindness in women. Even mild visual disability is less common in men. In Hamar society men have two roles: as herders and as warriors. Warriors with visual loss will be less successful in defending themselves. We suggest that Hamar men who develop visual loss have increased mortality compared to women with visual loss. Vision loss in women does not appear to have life-threatening consequences. Cessation of hostilities between the Hamar and their neighbours could, conceivably, lead to an 'increase' in the incidence of vision loss among men.

Adolescent↗
PubMed1992

Considerations in the integration of eye care into leprosy care services.

Little attention has been directed to the development, management and evaluation of eye care programmes for leprosy patients. This paper examines when an eye care programme for leprosy patients is needed, methods for integrating eye care into leprosy control programmes and lists of available ocular leprosy teaching materials.

Eye Diseases↗
PubMed1991

Comparison of the old and new W.H.O. leprosy disability grading scheme for ocular disabilities.

We compared the old (1970) and new (1988) World Health Organization schemes for classifying the ocular disabilities in leprosy patients. 509 leprosy patients from eight resettlement villages in central South Korea were examined and graded by eye according to both of the schemes. A more liberal definition of severely disabled in 1988 resulted in a 119% increase in eyes graded as severely disabled in this population. 59 eyes were graded as severely disabled by the old scheme and 129 eyes were so graded according to the new scheme. Keratitis, one of three measures of moderate disability in the old scheme, was replaced by corneal anaesthesia in the new scheme, but this change did not make a substantial difference in the number of patients in the moderately impaired category. In the absence of longitudinal studies documenting the significance of keratitis, it is unclear whether the change in an improvement. The new disability scheme improved upon the old by removing the criteria for mild impairment.

Adult↗
PubMed1991

Anatomical factors influencing development of trichiasis and entropion in trachoma.

There has been no published investigation into the reasons why some patients with severe trachomatous conjunctival scarring develop entropion and trichiasis while others do not. In a population of leprosy patients with severe trachomatous conjunctival scarring the authors found that lagophthalmos correlated with the absence of trichiasis and entropion. We suggest that orbicularis oculi muscle function, as well as other anatomical variations among individuals, may contribute to the development of trachomatous entropion and trichiasis in patients with conjunctival scarring.

Adult↗
PubMed1991

Latrine ownership as a protective factor in inflammatory trachoma in Egypt.

We investigated the association between inflammatory trachoma in children aged 1-5 and environmental and sociodemographic risk factors in a rural Nile Delta hamlet. Inflammatory trachoma clustered in households, emphasising the child-to-child nature of transmission in the hamlet. Multiple logistic regression analysis revealed three factors predicting inflammatory trachoma in children: the absence of a latrine in the household, school-age siblings with inflammatory trachoma, and additional same-age siblings (with or without disease) in the household. In the Egyptian setting the presence of pit latrines in all houses, even when full and unscreened, might result in a reduction in trachoma prevalence in this population from the current 49% to 35%. The construction of pit latrines may offer the simplest and most acceptable environmental method for reducing trachoma in this trachoma endemic area.

Child, Preschool↗
PubMed1990

Problems with current concepts of the epidemiology of Mooren's corneal ulcer.

Results from an analysis of 287 patients in 20 series do not support widely held concepts of the descriptive epidemiology of Mooren's corneal ulcer, i.e., that bilateral disease is more common in younger patients and blacks. Our review shows that the disease is reported 1.6 times more frequently in males than in females regardless of race or age. Black patients are five times more likely to be young than are white patients. However these figures may be misleading since they are not calculated from population-based estimates. Our analysis highlights misconceptions and emphasizes the hazards of drawing conclusions about the epidemiologic characteristics of this disease based on currently available data.

Adult↗
PubMed1990

Intraocular pressure and iris denervation in Hansen's disease.

We retrospectively analyzed 255 Hansen's disease patients and found low intraocular pressure (less than 7 mm Hg) in 12% of them. We showed a correlation between low intraocular pressure and avascular keratitis and iritis. We also found that patients with low intraocular pressures had abnormally large postural changes in intraocular pressure. We speculate that abnormalities in the autonomic innervation of the anterior segment of the eye may be related to the intraocular pressure abnormalities. Further investigations along this line may increase our understanding not only of the pathophysiology of Hansen's disease but also of the mechanisms regulating homeostasis of intraocular pressure.

Autonomic Nervous System↗
PubMed1990

Training for primary eye care in leprosy.

Reported are the results of a primary eye care training programme for community-based leprosy control workers in the Republic of Korea. The 20-hour programme emphasized the detection and management of lagophthalmos (and its complications) and chronic iridocyclitis. Leprosy patients in four resettlement villages were examined independently by the health workers and an ophthalmologist. Agreement between the health workers and the ophthalmologist was good for the detection of most signs (lagophthalmos, acute iridocyclitis, and chronic iridocyclitis). Based on these preliminary results it is recommended that primary eye care be included as a part of the training for leprosy paramedical workers.

Community Health Workers↗
PubMed1989

Low intraocular pressure and postural changes in intraocular pressure in patients with Hansen's disease.

We found intraocular pressures of less than 7 mm Hg in 11 of 72 patients (15%) with early Hansen's disease. Furthermore, significant postural changes in intraocular pressure (greater than 30%) occurred in 43 of 72 patients (60%). This loss of intraocular pressure homeostasis, which results from reduced aqueous humor production or increased uveoscleral outflow with reduced local adrenergic control in the ciliary body-iris-trabecular meshwork region, suggests that early autonomic neuropathy of the eye may occur in Hansen's disease. The only predictive value for significant postural change in intraocular pressure was the presence of immunologically unstable disease.

Homeostasis↗
PubMed1989

Epidemic keratoconjunctivitis in a university medical center ophthalmology clinic; need for re-evaluation of the design and disinfection of instruments.

During the period from early December 1987 to late January 1988, an outbreak of epidemic keratoconjunctivitis (EKC) caused by adenovirus type 8 occurred at a university medical center eye clinic. A telephone survey of patients revealed an attack rate of 17% among patients seen during the epidemic period. A case-control study demonstrated that development of EKC was associated with exposure to pneumotonometry and to three caregivers. After controlling for exposure to pneumotonometry, however, only exposure to one caregiver was significantly associated with risk of the disease. On January 19, 1988, after recognition of the outbreak, the eye clinic instituted additional infection control measures. A survey of patients seen the following week showed a substantial decrease in the attack rate (1.9%). Before these control measures were implemented, clinic personnel had followed the manufacturer's recommendations and disinfected pneumotonometer tips with 70% isopropyl alcohol, fearing that other disinfectants would corrode the instrument metal. Isopropyl alcohol, shown to have limited activity against adenovirus in vitro, also was being used to "disinfect" pneumotonometer tips between uses at six other area eye clinics polled by telephone. The results of this study demonstrate the need for changes in the design and manufacture of equipment used in the eye clinic.

Academic Medical Centers↗