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This case report describes the use of a simple appliance for the control of the urinary stream in four patients who experienced difficulty voiding after radical vulvar surgical procedures.
Effects of time-releasing toilet bowl sanitizers and their main constituents, detergents, on immunological fecal occult blood tests were examined. Six kinds of toilet sanitizers and 19 kinds of detergents were included. Patients' fecal samples and hemoglobin solutions were measured by means of quantitative immunological fecal occult blood tests after being mixed with sanitizer or detergent solutions. Marked reduction in hemoglobin concentration or antigenicity was observed after the addition of sanitizers or detergents at a final concentration of 0.5 g/l. Most of these inhibitory reactions were dose dependent. In contrast with the immunological method, the chemical method using o-tolidine and guaiac were not affected by the detergents tested. In sampling feces for immunological fecal occult blood tests, contact of samples with sanitizer solutions should be avoided.
Mechanical patient-lifting devices have been available for hospital use for at least the past 100 yr. Mobile hoists have been available since the 1950s and the most common U.K. hospital mobile hoist, the Mecanaids' Ambulift, has been available since 1966. Recent investigations have confirmed that these devices are not being used to any significant extent to ease most of the patient-lifting problems in hospital wards. Attention to four variables, the patient, the attendant, the task and the environment, is essential in determining the right systematic approach to equipment design and selection.
A prevalent difficulty in urodynamics studies employing ultrasonography is associated with the manual application of the imaging transducer to the perineum. We have developed an electromechanically operated device for remote positioning of an ultra-sound probe during voiding studies of the lower urinary tract. The mechanical arm holds the probe inside a funnel that is mounted underneath a modified portable commode on which the patient is seated. External manually operated mechanical slides are used to translate the probe along the three primary axes for initial lateral and vertical positioning. Backwards/forwards and left/right pivoting of the transducer is then accomplished via linear stepper motors that are operated with a hand-held controller. A preliminary evaluation has shown that the device is easy to use, safe, and allows excellent visualization of the bladder outlet and proximal urethra in both male and female patients. The capability to remotely adjust the imaging angle allows the patient to void in a more private setting behind a drawn curtain, thereby minimizing the psychological distress associated with this test and facilitating the acquisition of more physiological test results.
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A survey of various types of on-site sanitation systems in Dar es Salaam and Gaborone showed that many were infested with larvae of flies (mainly Chrysomya putoria) and Culex mosquitoes (mainly Cx quinquefasciatus). The mosquitoes only occurred where the pit contents had a free water surface but the flies were found in both wet and scum covered pits. The infestation rate was much higher where the latrine vent pipe had no insect-proof screen. Exit traps were placed on the vent pipes and drop holes to determine by which route the emerging flies and mosquitoes left the pit. Provided that the latrine door was kept closed (thus producing a relatively greater light intensity in the vent pipe), over 90% of flies went up the vent pipe. In most cases about 80% of Cx quinquefasciatus did the same, but in two pits very dense mosquito infestations were found and over 1000 mosquitoes per night were caught leaving the pit through the drop hole. In such cases traps on the drop holes might be used as a semi-permanent control method. Entry traps were placed on the vent pipe and drop hole to catch females attempting to enter to lay eggs. All the flies and the majority of the mosquitoes caught were trying to enter the vent pipe which indicates that odour from this source is attractive to these insects. Various possible modifications to the methods of using latrines to minimize associated insect problems are discussed; the simplest and most important is to ensure that all vent pipes are effectively screened.
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An outbreak of cholera caused by Vibrio cholerae 01, biotype El Tor, serotype Inaba, phage type 4, occurred in an institution for the aged in Singapore in August and September 1984. 96 inmates were infected (21 symptomatic and 75 asymptomatic) and 5 died. The index case was a 72-year-old male inmate who continued to assist in food preparation in the kitchen from the time of onset of diarrhoea until he was seriously ill and hospitalized 4 days later. Another kitchen helper was found to have asymptomatic V. cholerae 01 infection. The infection rate for males was significantly higher than that for females (P less than 0.025), associated with the use of unsanitary toilets. The main mode of transmission was through food contaminated by the 2 kitchen helpers who probably accounted for most of the infections, while poor personal hygiene of the inmates helped to sustain person-to-person spread. The outbreak was confined within the institution as the result of the prompt and effective implementation of control measures.
In the town of Makunduchi, Zanzibar, wet pit latrines provided breeding places for Culex quinquefasciatus and there were few other mosquito breeding places available. The adult mosquito population in bedrooms was monitored for a year and found to consist almost entirely of Cx quinquefasciatus of which 2.45% carried infective larvae of Wuchereria bancrofti. It was estimated that each person received about 24,993 bites per year, of which 612 were potentially infective. After a year of baseline data collection, polystyrene beads were expanded in boiling water and applied to form floating layers on all infested pits. Subsequently the adult mosquito population declined remarkably so that the estimated number of bites per person per year was only about 439. To retain control, surveillance for newly wet pits continued to be necessary. Initially the microfilarial rate in the human population was 49.5%, with many cases of filarial disease. The microfilarial rate was reduced to 10.3% by mass treatment with diethylcarbamazine, with no sign of resurgence a year after treatment. The infective rate among mosquitoes was reduced to 0.41% and the combined effect of the vector and microfilarial control was to reduce the number of infective bites per person per year by 99.7%.
An integrated hookworm control programme, involving mass chemotherapy and improvements in public health, was conducted in the Burma Valley and Vumba areas of Zimbabwe between 1985 and 1990. Three sequential annual mass chemotherapy programmes were implemented. Infection status was monitored annually throughout. Initial observations indicated asymptotic age prevalence and intensity profiles, with peak infection levels in adults. Mass chemotherapy was shown to have immediate and medium term benefits for community health. Reinfection was slow to develop, and average intensity had not returned to pre-intervention levels 39 months after the cessation of chemotherapy. The results support the existence of age-dependency in reinfection. Despite a marked increase in the number of sanitation units, no relationship was found between latrine availability and reinfection intensity on individual farms. This result is consistent with observations that the effect of sanitation is slow to develop, and indicates that repeated anthelmintic intervention should be maintained until sanitation has an impact on transmission.
Stool samples from 880 residents in an urban slum in Dhaka, Bangladesh, were collected on 3 occasions over one year, and examined for intestinal parasites. Information on many potential risk factors for infection was obtained by questionnaire from a respondent in each household studied. In a crude univariate analysis of the data, several of the factors were found to be significantly associated with Strongyloides stercoralis infection. Most of these factors were co-variate with one another, and with poverty generally. Using Mantel-Haenszel chi 2 tests to control for confounding effects of each variable individually, the following 4 factors remained independently associated with S. stercoralis infection: respondent's use of a community latrine rather than a private latrine, living in a house with an earth floor rather than a cement floor, being of Bihari ethnicity, and being 7-10 years of age. Implications of these results for the epidemiology and control of strongyloidiasis are briefly discussed.
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The effect of control of houseflies on the incidence of diarrhoea and shigellosis was evaluated in a prospective crossover intervention study at two military field bases several kilometers apart. In early summer, 1988, intensive fly control measures (mainly bait and trap strategy) were introduced on one base, while the other served as a control. After 11 weeks, as new cohorts arrived, the intervention was abruptly discontinued in the first base and instituted in the second for the next 11 weeks. The study was repeated the next summer. Overall, fly counts were 64% lower on the bases exposed to fly control measures (p = 0.024). Concomitantly, clinic visits dropped by 42% (p = 0.146) for diarrhoeal diseases and by 85% for shigellosis (p = 0.015), as did rates of seroconversion, by 76% (p = 0.024) for antibodies to Shigella and by 57% (p = 0.006) for antibodies to enterotoxigenic Escherichia coli. The findings indicate that houseflies, acting as mechanical vectors, transmit Shigella (and possibly enterotoxigenic E coli) diarrhoeal infections.
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