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Biomedical subjects

B Lowe

Publications and source records attributed to B Lowe.

63 records · Page 4Linked to original sources
PubMed1978

Computed tomography in leptomeningeal infections.

In a review of CT scans of 6,078 patients, 47 patients with well documented leptomeningeal infections were identified; 45 were infants or children. Most of the infections were bacterial; 53% were due to Haemophilus influenzae. The 47 patients were divided into two groups according to whether the initial scan was obtained during the acute illness (group A) or after initial treatment had been completed (group B). The 30 patients in the acute group A had 24 complications: 18 with areas of diminished attenuation in the brain parenchyma and six with dilated ventricles. Eleven patients had initially normal scans, but three of these subsequently developed complications. In group B, the 17 patients had 28 complications: nine with enlarged ventricles; eight with subdural effusion; seven with areas of diminished attenuation; and four with abscess formation. An unusually high percentage (40%) of the patients with areas of diminished attenuation had involvement of the anterior poles of the frontal lobes. Of the patients who showed this predilection for the frontal lobes, 72% had Haemophilus influenzae meningitis. CT was found to be useful in early detection of complications of leptomeningeal infections, as well as in evaluation of the extent of the lesions.

Adult↗
PubMedDate not supplied

Towards optimal regimens of parenteral quinine for young African children with cerebral malaria: unbound quinine concentrations following a simple loading dose regimen.

Nine children with severe falciparum malaria were treated with an intravenous quinine regimen which did not require burettes or infusion pumps, to determine its practicability and to ensure that therapeutic drug concentrations were achieved and maintained throughout the dose interval. The regimen comprised quinine dihydrochloride (15 mg/kg; 12.5 mg/kg of the free base), which was added to a bag of intravenous fluid (after wastage of all but 100 mL), and given via standard giving sets over 2 h. Blood was drawn sequentially during the infusion, and for 12 h thereafter; plasma water was obtained by ultrafiltration of samples at the bedside, and quinine concentration was measured, in plasma and plasma water, by high performance liquid chromatography. Drug administration was practicable without burettes or infusion pumps; unbound drug concentrations exceeded the 99% inhibitory concentration for local parasites within 0.5 h, and remained within the therapeutic range for the entire dose interval. This loading dose regimen can now be recommended for young children in African hospitals; maintenance doses of 10 mg/kg should be given at 12 h intervals until oral antimalarial drugs are possible. These recommendations will need to be modified if susceptibility to quinine declines.

Child↗
PubMedDate not supplied

The disposition of intramuscular artemether in children with cerebral malaria; a preliminary study.

The disposition of intramuscular artemether (AM) was studied in 26 Kenyan children with cerebral malaria. Antimalarial activity determined by bioassay was compared with total plasma AM plus dihydroartemisinin (DHA) determined by high power liquid chromatography (HPLC). Therapeutic levels were achieved in most subjects (21/26) within 1 h of receiving intramuscular AM (3.2 mg/kg), with close correlation between bioassay and HPLC measurements (r = 0.706). However, there was marked inter-individual variation, antimalarial activity was undetectable in 5 subjects ('non-absorbers'), and plasma concentrations were lower in subject with respiratory distress. The 50% parasite clearance time was significantly longer in non-absorbers (mean = 13.1 h, SD = 10.8 vs. mean = 7.8 h, SD = 5.5; P = 0.013). We conclude that the bioavailability of intramuscular AM in children with severe malaria may be highly variable, particularly in the presence of respiratory distress, and may be associated with an inadequate therapeutic response.

Antimalarials↗
PubMedDate not supplied

Geophagy, iron status and anaemia among pregnant women on the coast of Kenya.

In a cross sectional survey based in an antenatal clinic at Kilifi District Hospital, Coast Province, Kenya, 154 of 275 pregnant women (56%) reported eating soil regularly. Geophagous women had lower haemoglobin and serum ferritin concentrations than non-geophagous women (mean haemoglobin level 9.1 vs. 10.0 g/dL, P < 0.001; median ferritin level 4.5 vs. 9.0 micrograms/L, P < 0.001). In multiple linear regression analyses, geophagy was a significant predictor of haemoglobin (beta = -6.4, P = 0.01) and serum ferritin concentrations (beta = -6.6, P = 0.002), while controlling for gestational age and malaria and hookworm infection. Another 38 pregnant women, who reported eating soil regularly, participated in focus group discussions and were interviewed on geophagy. The most commonly eaten soil was from the walls of houses. The median estimated daily intake was 41.5 g (range 2.5-219.0 g). Twenty-seven of these women assisted in the collection of soil samples which were then analysed for their content of iron, zinc and aluminium after extraction with 0.1 M HC1. The average daily soil intake supplied the geophagous women with 4.3 mg of iron, corresponding to 14% of the recommended dietary allowance of iron for pregnant women. The study revealed a strong negative association between geophagy and both haemoglobin and ferritin status. At the same time it demonstrated the potential of soil as a source of dietary iron for geophagous women. These seemingly contradictory results might be due to other components in the soil interfering with iron uptake or metabolism. Alternatively, it may be that the geophagous women had extremely depleted iron stores before starting to eat soil. From these cross-sectional data, no inference about causality could be made.

Anemia, Iron-Deficiency↗
PubMedDate not supplied

Bacteraemia complicating severe malaria in children.

Bacteraemia associated with severe malaria in childhood is a sporadically reported phenomenon but its incidence and clinical importance are unknown. We have reviewed clinical and laboratory data from 783 Kenyan children sequentially admitted with a primary diagnosis of severe malaria. The overall incidence of bacteraemia in children with severe malaria was 7.8% (95% CI 5.5-10.0); however, in children under 30 months of age the incidence was 12.0% (95% CI 8.3-15.7). The presence of bacteraemia was associated with a 3-fold increase in mortality (33.3% vs. 10.4%, P < 0.001). We conclude that invasive bacterial disease may contribute to the pathophysiology of the clinical syndrome of severe malaria in an important subgroup of children. We recommend that young children with severe malaria be treated with broad-spectrum antibiotics in addition to antimalarial drugs.

Anti-Bacterial Agents↗
PubMedDate not supplied

Reexamining the associate degree curriculum. Assessing the need for community concepts.

Significant changes taking place in health care delivery in our community in Louisiana have led faculty to reexamine the associate degree nursing curriculum. We recognized the trend toward the decreased need for inpatient care and the greater need for outpatient care and home care in the community. In addition, we noted the need for nursing care to assist the elderly in the management of chronic illness and provide education on health promotion and disease prevention.

Chronic Disease↗