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Biomedical subjects

R N Pugh

Publications and source records attributed to R N Pugh.

At least 37 records · Page 2Linked to original sources
PubMed1991

Clinical presentation of enteric fever: its changing pattern in Kuwait.

The clinical experience with enteric fever (1985-89) at a general hospital in Kuwait is presented. There were 90 cases of typhoid and 10 cases of paratyphoid fever, with a mortality rate of 2%. Typhoid complications of bowel perforation, haemorrhage or septic shock were present in 5% and abortion in 2%. Neurological or psychiatric manifestations were a feature in 15%. Most infections were imported (78%). Despite rapid economic development, enteric fever may still be acquired locally but less frequently with time. This contributed to initial diagnostic uncertainty in 18% of cases, and especially in children. Another changing pattern emerged with the recent finding of five drug-resistant Salmonella typhi isolates, two in 1988 and three in 1989. Efforts are clearly needed to diagnose enteric fever more rapidly and to utilize new antibiotics for drug-resistant cases.

Adolescent↗
PubMed1991

Clinical report of Blastocystis hominis infection in children.

During a 9-month hospital-based survey, the intestinal parasite Blastocystis hominis was detected in high numbers (five or more organisms per oil immersion field) in faecal specimens from 39 (2%) of 1960 children under 13 years old. Abdominal pain or discomfort with or without diarrhoea was present in 32 children categorized as acute (14), subacute (7) or chronic (11) cases with respective mean ages of 6.4, 7.3 and 8.7 years. They included three with other enteropathogens (Giardia lamblia, Cryptosporidium sp. or Hymenolepis nana). The remaining seven children had no gastrointestinal symptoms. The 14 acute cases (symptoms duration 1-11 days) were characterized by cramp-like abdominal pain, watery diarrhoea and vomiting. The seven subacute (3-4 weeks) and 11 chronic (3-12 months) cases presented with abdominal discomfort and/or loose non-watery stools. Four complained of flatus and eosinophilia was noted in six. All symptoms resolved with eradication of B. hominis or reduction to low numbers after metronidazole chemotherapy (28 cases) or with no treatment (four cases). This study would appear to support the role of the parasite as an enteropathogen in some children. A case control study is clearly needed to clarify the status of B. hominis as a pathogen.

Animals↗
PubMed1990

Leprosy in Kuwait: an epidemiological study of new cases.

The latency of infection in leprosy is long so that new cases may present several years after emigration from endemic areas. This is of concern to the health authorities in Kuwait, since there is a sizeable immigrant population. An epidemiological study of new cases was, therefore, conducted to assess the extent of the leprosy problem. A total of 121 (99 male, 22 female) consecutive new leprosy patients were diagnosed nationwide over a six-year period (1983-1988). Over 95% of the patients were foreign born, emphasizing that the problem in Kuwait is mainly a reflection of immigration patterns. There were 74 cases of Asio-Indian origin, 13 Oriental and 34 Arab (including two Kuwaiti). This represents a respective mean incidence of the disease in Kuwaitis and other nationalities of 0.49 and 18.92 per 100,000 per year. Polar lepromatous (LL) leprosy was the most frequent type in the Arab group (44.1%) and polar tuberculoid (TT) the most frequent in the Asio-Indian group (37.8%). LL and borderline lepromatous (BL) types of leprosy were significantly more frequent in patients over 45-years-old and in females (P less than 0.05), contributing to the higher rate of LL in the Arab cases. The mean lag time from symptoms onset to presentation to doctor was 9.4 (range 0-192) months, with lepromatous cases tending to present later than other types. The longest lag times occurred in Arab women with LL, suggesting that cultural influences may delay presentation of leprosy. The mean interval from presentation to diagnosis was 4.1 weeks. The mean latency from entry into Kuwait to diagnosis was 44.7 (range 0-180) months; which stresses the need for physicians to remain vigilant in considering leprosy, especially in any patient with dermatological, neurological or ophthalmic manifestations of disease.

Adolescent↗
PubMed1990

Cryptosporidium gastroenteritis in immunocompetent children from Kuwait.

During an 18 months' survey of children admitted to hospital with gastroenteritis, oocysts of the protozoan Cryptosporidium were detected in 35 cases (1.6% of the total 2205 surveyed). The affected children (age range 5 months to 8 years; mean 34.2 months) were immunocompetent, and had green and offensive watery diarrhoea. Vomiting (94%) with dehydration (80%), fever (66%) and abdominal pain (26%) were major clinical features of the diarrhoeal illness which lasted a mean 8.2 (range 3-14) days. Five children were infected with other enteropathogens. The illness was self-limiting in all cases and none were excreting oocysts 2 weeks after cessation of diarrhoea. Peak incidence occurred during the months of March and April, with no cases during the hottest months of July and August. There was no known contact with animals or pets; 4 children had other siblings affected and 2 conformed to cases of travellers' diarrhoea. The significance of cryptosporidiosis in Kuwait and the need for epidemiological studies are discussed.

Animals↗
PubMed1987

A clinical study of viper bite poisoning.

Thirty-one consecutive cases of snake bite were studied in the Benue Valley, Nigeria where carpet viper (Echis carinatus) bite constitutes a serious health problem. E. carinatus was responsible for 26 cases, the night adder (Causus maculatus) for three and the puff adder (Bitis arietans) for two. There were two fatalities, both late admissions following E. carinatus poisoning. One patient died after a subarachnoid haemorrhage and the other after tissue necrosis and the complications of a tightly applied tourniquet. Another fatality after E. carinatus bite was suspected in a patient who discharged himself from hospital after Behringwerke antivenom failed to control bleeding and coagulopathy. Other cases of Behringwerke antivenom's failure and of slow response to treatment confirmed the pressing need for a more effective Echis antivenom in West Africa. The enzyme-linked immunosorbent assay (ELISA) was used for diagnosing the biting species and was the only means of identifying the three cases bitten by C. maculatus and one case bitten by B. arietans.

Adult↗
PubMed1984

Long-term efficacy of single-dose oral treatment in schistosomiasis haematobium.

A two-year follow-up was conducted in children who had been the subjects of a six-month double-blind trial in the single-dose treatment of Schistosoma haematobium infection. The trial had assessed therapeutic efficacy of three oral preparations-praziquantel 40 mg/kg, metrifonate 10 mg/kg, and the 'combination' (concurrent niridazole 25 mg/kg and metrifonate 10 mg/kg administration). Reduction in urinary egg excretion remained high up to follow-up at two years, based on a comparison of pre- and post-treatment geometric mean counts-praziquantel 96.9% (n = 96 at six months, 51 at two years); the 'combination' 93.9% (n = 97 at six months, 48 at two years); and metrifonate 90.3% (n = 92 at six months, 49 at two years). The differences in percentage reduction were not significant (p greater than 0.1). However, a significantly greater reduction in egg output was produced by praziquantel (81.7%) and the 'combination' (82.5%) than by metrifonate (54.2%), on comparing pre- and post-treatment arithmetic mean counts (p less than 0.01). A significantly smaller percentage of subjects were excreting greater than or equal to 125 ova/10 ml urine two years after treatment with praziquantel (10.3%), compared to treatment with the 'combination' (25.7%) and metrifonate (35.8%) (p less than 0.01). The cure rate was significantly higher in the praziquantel group (47.4%) compared to the 'combination' (24.7%) and metrifonate (17.4%) groups, for the six to 24-month follow-up period (p less than 0.001). The pattern and level of transmission had contributed to the long-term efficacy recorded in this study.

Administration, Oral↗
PubMed1983

Single dose oral treatment in urinary schistosomiasis: a double blind trial.

A double blind trial of three oral preparations given in single doses for the treatment of Schistosoma haematobium infection was carried out in schoolchildren; selection was biased towards those who excreted large quantities of eggs. Praziquantel 40 mg/kg was the most effective drug giving a greater than 97% reduction in egg output six months after treatment; combined treatment with niridazole 25 mg/kg and metrifonate 10 mg/kg gave a reduction of greater than 92% and metrifonate 10 mg/kg alone a reduction of greater than 86%. Fewer children continued to have moderate to heavy infections (excretion greater than 124 ova/10 ml urine) six months after treatment with praziquantel (5%) and the combined regimen (7%) than with metrifonate (16%). Though our findings show that praziquantel appears to be the most effective and convenient drug available for individuals with S haematobium infection, the combined regimen is a cheaper alternative for treatment where cost is important and parasitological cure not an essential objective.

Administration, Oral↗
PubMed1981

Enzyme-linked immunosorbent assay of venom-antibodies in human victims of snake bite.

The development, incidence, persistence, and significance of specific venom-antibodies were studied in 357 human victims of snake bite in Nigeria using the enzyme-linked immunosorbent assay (ELISA). Venom-antibody was not detected within 2 weeks of envenoming but was present within 2 months of the bite despite therapeutic antivenom being given. ELISA confirmed the medical importance of the carpet viper Echis carinatus in Nigeria but also showed that bites by other venomous species are more common than previously suspected. Venom-antibodies may wane with time but nevertheless were still present 40 years after the original envenoming. Clinical studies suggested that venom-antibody titres too low to be detected by ELISA may be boosted with further bites; and more importantly, homologous venom-antibody may afford significant protection against further envenoming. ELISA can help both in advancing the epidemiology of snake bite and in exploring the role of active immunization.

Adolescent↗
PubMed1980

Incidence and mortality on snake bite in savanna Nigeria.

Snake bite is a major medical problem among farming communities in the Benue and Niger Valley savanna region of Nigeria. Surveys in the more densely populated northern savanna areas such as Malumfashi (incidence 48 per 100 000 population, mortality 5.1%) show that the spitting cobra, Naja nigricollis, was the predominant species of medical importance. In the less cultivated Benue Valley area the annual snake-bite incidence was estimated to be 497 per 100 000 population, with a 12.2% mortality due mainly to the carpet viper, Echis carinatus. From these findings we estimate a yearly total of almost 10 000 deaths from snake bite in savanna Nigeria and about 23 000 deaths in West Africa. To rectify this serious health problem, concerted efforts are urgently needed.

Health Services↗