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Biomedical subjects

Y Hofvander

Publications and source records attributed to Y Hofvander.

At least 55 records · Page 3Linked to original sources
PubMed1990

Endemic bacterial meningitis in Sudanese children: aetiology, clinical findings, treatment and short-term outcome.

During the period April 1985 to November 1986 (18 months), 196 children (of age greater than 1 month) admitted to the Children's Emergency Hospital in Khartoum, Sudan, with clinical suspicion of meningitis/meningoencephalitis were followed up prospectively. Bacterial meningitis was diagnosed by culture, direct microscopy and/or antigen-detecting assays (co-agglutination and enzyme immunoassay) in 44 infants (25 Haemophilus influenzae type b, 8 Neisseria meningitidis, 7 Streptococcus pneumoniae, 3 enterobacteria and one mixed infection), aseptic meningitis in 52, cerebral malaria in 4 and febrile convulsions in 96. The majority of cases of bacterial meningitis were boys and 57% of those in whom H. influenzae was the commonest isolate were less than 1 year old. The presenting signs and symptoms are described as well as the transient and permanent short-term sequelae. The total mortality from bacterial meningitis was 19%, permanent neurological sequelae were seen in 26% of survivors. Prospective follow-up, including audiometry, of 35 children 1-2 months after discharge showed that 11% had hemiplegia and 20% had hearing impairment. The potential impact of vaccination against invasive H. influenzae infections is discussed.

Bacterial Infections↗
PubMed1990

Clinical features and complications of epidemic group A meningococcal disease in Sudanese children.

The clinical presentation and laboratory features in relation to short-term outcome in 118 prospectively studied Sudanese children who were admitted with meningococcal (MC) meningitis and/or septicaemia during the 1988 group A MC epidemic in Greater Khartoum are described. Their ages ranged from 25 days to 15 years (mean: 78 months) and 42% were less than 5 years old. The male:female ratio was 1.6:1. Forty (34%) came from one of the peri-urban shanty towns encircling Greater Khartoum. A history of MC immunization (A and C vaccine) was obtained in 22%, but only five children (4.8%) had the vaccine between 4 weeks and 1 year before their illness. The commonest symptoms on admission were vomiting, neck rigidity and diarrhoea. Convulsions were significantly more frequent in children under 5 years old (p = 0.0005). Fifty-six (47%) had evidence of malnutrition. In descending order, fever, neck stiffness and Kernig's sign were the most commonly observed signs, the latter two being significantly more often detected in children older than 1 year. Twenty-four patients 20%) had disturbed consciousness. The case fatality rate was 6.3% and this was significantly higher in those presenting with meningococcal septicaemia (p = 0.0006). Other significant associations with mortality were short duration (less than 1 day) of symptoms (p = 0.0006) and clinical shock detected on admission p = 0.003). Transient complications were infrequent and permanent neurological sequelae were confined to bilateral profound sensorineural hearing loss in three children (2.9%) and hemiplegia in two 1.9%.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1990

Features of a large epidemic of group A meningococcal meningitis in Khartoum, Sudan in 1988.

A large epidemic (February-August 1988) of group A sulphonamide resistant, clone III-1 meningococcal meningitis in Khartoum, Sudan is described. A total of 10,099 cases were admitted to treatment centers with 8,397 cases during March and April, corresponding to an annual incidence of 1,679/100,000 inhabitants during this period. The age profile showed a high morbidity in adults (31% of the cases greater than or equal to 20 years). The male dominance was marked especially in the adult cases with a proportion of 3.2:1. The epidemic started during the hot and dry season and declined when the clouds came, humidity rose, temperature fell and a mass vaccination campaign had been implemented together with other epidemic precautions. Vaccination with a combined group A/C polysaccharide vaccine had been given 4 weeks-1 year before hospitalization to 11% of the children, 80% of whom were greater than 18 months of age. The estimated case fatality rate was 6.3%. Since 47% of the cases came from periurban and rural areas, the actual mortality during the epidemic might have been higher when considering those who may have died before reaching any of the treatment centres. Fatal cases had a short history of acute illness and a septic condition. Septicaemia was rare and seen in only 3.7% of the cases, the rest had acute purulent meningitis. Hearing loss/impairment and hemiplegia was diagnosed in 2-3% of the cases. The epidemiology, based on detailed typing/subtyping and restriction enzyme patterns of meningococcal strains, was apparently associated with the Mecca outbreak in August 1987.

Adult↗
PubMed1989

Rapid diagnosis of bacterial meningitis by an enzyme immunoassay of cerebrospinal fluid.

A total of 250 cerebrospinal fluid (CSF) specimens were analyzed using a rapid enzyme immunoassay (Pharmacia Meningitis EIA-Test) (EIA) for the detection of antigens of Haemophilus influenzae type b, Neisseria meningitidis (serogroups A,B,C) and Streptococcus pneumoniae (25 selected types). The test is performed in less than 1 h and read by the naked eye. EIA and coagglutination (CoA) were compared with a constructed reference that comprised samples which were either positive by culture and/or on direct microscopy (DM), or in which there were positive results with both EIA and CoA for the bacteria covered by the assays. Using this reference for CSF samples assayed in a period between two meningococcal meningitis epidemics, the sensitivity was 0.86 for EIA and 0.69 for CoA, the specificity 0.95 (EIA) and 0.97 (CoA), the predictive value for a positive result 0.81 (EIA) and 0.87 (CoA) and, the predictive value for a negative result 0.96 (EIA) and 0.93 (CoA). Antibiotics had been given to 54% of the patients before admission. All of the 56 samples that were positive in any of the tests taken during an epidemic of group A meningococcal disease were detected by EIA; CoA was negative in 45% and culture/DM was negative in 32%. Sequential dilutions of two CSF samples from which H. influenzae type b had been isolated, showed the EIA to be 16-32 times more sensitive than CoA. With both technical feasibility and good sensitivity and specificity, the EIA seems to be useful and reliable for the rapid diagnosis of bacterial meningitis, especially in situations where pretreatment with antibiotics are likely.

Antigens, Bacterial↗
PubMed1989

Prevalence of IDDM in schoolchildren in Khartoum, Sudan.

The prevalence of insulin-dependent diabetes mellitus (IDDM) in 42,981 schoolchildren (aged 7-14 yr) in Khartoum, Sudan, was determined. With the 1985 World Health Organization revised criteria for diagnosis and classification of diabetes mellitus, the overall crude prevalence rate of IDDM was 0.95/1000 in the age groups studied. This figure is thought to reflect the minimum prevalence of IDDM in that population, because there is an inherent tendency in the method of screening used toward underestimating the true prevalence rate. The prevalence of IDDM was found to increase significantly with age and was slightly higher in girls than boys, but this was not statistically significant. Of 41 children with IDDM detected in the survey, 7 were not known to have IDDM before but were showing suggestive symptoms at the time of the study. This study showed that IDDM in childhood is not rare in Sudan and that probably a substantial number of undiagnosed cases exist.

Age Factors↗
PubMed1988

The ecological context of child health in Saudi Arabia.

The general background to child health in Saudi Arabia is reviewed. Information is provided on the social and demographic characteristics of the population, on common health indicators, on the health care system and its utilization, and on the general pattern of childhood morbidity and mortality. The unprecendented socioeconomic development has transformed the health care system. In 15 years the number of nurses have increased from 3261 to 29896, physicians from 1172 to 14335, primary health care centers from 591 to 1821, and hospital beds from 9036 to 30707. In spite of this progress, the disease pattern seems to resemble that of some developing countries with more limited resources. Parasitic diseases are still widespread, and sample surveys have indicated suboptimal nutrition of rural preschool children. Recent estimates on the infant mortality rate have ranged from 65 to 120 per 1000 live births. The preferred marriage partner is a close relative, and genetic diseases, such as hemoglobin disorders, are common in certain areas. Thus, the prevalence of alpha thalassemia is reported at 50 percent, and the sickle cell trait at 4.4-20 percent in sample surveys from the Eastern Province. The modest educational attainment of the mother, the heavy reliance on foreign manpower in all sectors, including the health sector, and the further development of the primary health care system are key issues today. It is emphasized that demographic and epidemiological information from Saudi Arabia is scarce and frequently uncertain, and that further studies are needed to identify the health needs of Saudi children.

Breast Feeding↗
PubMed1988

Patterns of breastfeeding and weaning in Saudi Arabia.

The patterns of breastfeeding and weaning were studied in 4 groups of Saudi children: Privileged urban children; children representing the average urban population; less privileged urban children, and rural children from 3 different areas. The data represented retrospective and actual information and were analyzed according to the life table technique. The median duration of breastfeeding of rural, urban low, urban average and urban privileged children was 17.8 months, 10.8 months, 7.5 months and 2.1 months, respectively. In all groups the rate of breastfeeding was lower in young compared with old mothers. Thus the median duration of breastfeeding was 11.7 months for rural mothers less than 23 years and 23.6 months for mothers greater than 31 years. Corresponding figures for urban low mothers were 3.4 months and 11.4 months, respectively. By one month 52 percent of privileged and 42 percent of urban low children were started on bottle. By contrast, 26 percent of rural children were started on bottle at 6 months. At 6 months, 6 percent of rural children were started on any kind of solid foods compared with 90 percent of privileged children; at 12 months the figures were 33 and 96 percent, respectively. The data indicated a successive decline in the duration of breastfeeding with increasing affluence, and late introduction of weaning foods to rural children.

Bottle Feeding↗
PubMed1986

Long-term follow-up of children breast-fed by mothers using oral contraceptives.

In a long-term follow-up study 48 breast-fed children, whose mothers had used oral contraceptives containing 50 micrograms of ethinylestradiol while lactating, were compared to a matched control group whose mothers had not used any hormonal contraceptives during lactation. In spite of a very large number of data collected from several different sources of information, no effect could be demonstrated of the ingested steroid, neither upon the panorama of diseases nor upon intellectual or psychological behaviour of the infants and children up to 8 years of age. The mothers who used oral contraceptives lactated a significantly shorter period of time than the controls, but no differences were found in weight gain and height increase in the children between cases and controls.

Breast Feeding↗
PubMed1986

Diets of healthy Swedish children 4-24 months old. II. Energy intake.

In a semi-longitudinal investigation comprising a total of 81 infants studied at one or more of the ages 4, 9, 15 and 24 months, the food intake was recorded on three consecutive days at 4 months and on seven consecutive days at 9, 15 and 24 months (40, 40, 38 and 40 infants, respectively in the four age groups). The median energy intake was lower than the Recommend Dietary Allowances in all age groups. The energy intake derived from fat was low among some of the 9-month-old infants. The contribution of sucrose to energy was as high as 10% at 24 months.

Age Factors↗
PubMed1986

Diets of healthy Swedish children 4-24 months old. III. Nutrient intake.

In a semi-longitudinal investigation comprising a total of 81 infants studied at one or more of the ages 4, 9, 15 and 24 months, the food intake was recorded on three consecutive days at 4 months and on seven consecutive days at 9, 15 and 24 months (40, 40, 38 and 40 infants, respectively in the four age groups). The formula-fed 4-month-old infants had a markedly higher intake of all nutrients, except fat and retinol, than the breast-fed ones. In the three oldest age groups the nutrient intake was high as compared with RDA. The protein intake was exceptionally high. Median intakes that were definitely lower than RDA were noted only for vitamin D, iron and zinc. The nutrient density changed from the age of 9 to 24 months, indicating a transition during that period from infant to adult food habits.

Age Factors↗
PubMed1985

Comparative study of nursing mothers in Africa (Zaire) and in Europe (Sweden): breastfeeding behaviour, nutritional status, lactational hyperprolactinaemia and status of the menstrual cycle.

A total of 1036 nursing mothers were investigated for their nursing behaviour, status of nutrition and menstrual cycle, serum prolactin and progesterone; 61 in Sweden, 457 in an urban area of Zaïre (Bukavu, Kivu) and 518 in a rural area of the same region (Kabare, Kivu). Lactational hyperprolactinaemia is influenced by the frequency but not by the duration of suckling. The return of luteinization of follicles, but not that of menstrual bleeding, was inversely related to the degree of lactational hyperprolactinaemia. Significant luteinization took place in only some 10% of the mothers during the first three months of lactation in Sweden and within the first year in Zaïre. In these mothers with luteinized follicles the average progesterone was only slightly above 1.0 ng/ml indicating poor luteinization. Lactational hyperprolactinaemia, the return of menstruation and luteinization during lactation were not related to the nutritional status as evaluated by the body weight indices and serum albumin. However, suckling and hyperprolactinaemia do not appear to be the only factors involved in the control of fertility during lactation. When serum prolactin levels were equally low, i.e. below 500 microU/ml, twice the number of lactating mothers with signs of luteinization were found in the urban than in the rural population of Zaïre.

Body Weight↗
PubMed1985

Studies of human milk. II. Concentration of antibodies against Salmonella and Shigella in milk of women from different populations and the daily intake by their breast-fed infants.

The concentration in human milk of IgA antibodies against six Salmonella and two Shigella groups were determined in specimens obtained from Swedish and Guatemalan nursing mothers of three different socioeconomic levels. The daily intakes of milk antibodies by their children were also estimated. The results show that the concentrations of specific IgA antibodies in milk vary among the different population groups. There is, however, no difference in daily intake of specific IgA by the children.

Breast Feeding↗
PubMed1984

Endemic goitre in the Darfur region (Sudan). Epidemiology and aetiology.

In the Darfur region of Sudan, 85.5% of 7134 subjects examined, mainly school children, had goitre and in 23.9% the goitre was large (stage II or III). The prevalence of goitre was high in prepubertal children of both sexes and in adult females. There was a higher frequency of large goitre in the rural than in the urban areas (40.9 and 11.4%, respectively). In Port Sudan on the Red Sea Coast the goitre rate was 13.5% among 7697 schoolchildren, but here visible goitre was extremely rare. Of the subjects from Darfur, 54.5% excreted less than 50 micrograms of iodine/g creatinine, while all except one subject in Port Sudan excreted more than that. The median urinary excretion of iodine was 45.3 micrograms/g in subjects from Darfur and 171.2 in those from Port Sudan, the mean value being significantly lower in the former than in the latter (p less than 0.001). The iodine content of all water samples was very low, and the contents of calcium and fluoride were not high. Other goitrogenic factors could not be excluded. However, iodine deficiency is the major cause of goitre in the Darfur region and a prophylactic programme is urgently needed.

Adolescent↗