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Biomedical subjects

C B D Lavy

Publications and source records attributed to C B D Lavy.

16 recordsLinked to original sources
PubMed2006

Does long-term chloramphenicol cause anaemia in Malawi?

Common clinical practice in many tropical paediatric departments is that chloramphenicol courses are limited to 2 weeks due to concerns about anaemia. However, this approach is not supported by current research and animal models. We used chloramphenicol for 6 weeks in 146 children with septic arthritis. All the children improved clinically. Most children were anaemic on presentation (mean haemoglobin [Hb] 8.43 SD 1.9), but the anaemia improved rapidly with clinical resolution of the infection and was maintained at 6 months after presentation (mean Hb 10.57 SD 1.86).

Anemia↗
PubMed2006

Correlation of clinical and ultrasonographic findings after Achilles tenotomy in idiopathic club foot.

Achilles tenotomy is a recognised step in the Ponseti technique for the correction of idiopathic congenital talipes equinovarus in most percutaneous cases. Its use has been limited in part by concern that the subsequent natural history of the tendon is unknown. In a study of 11 tendons in eight infants, eight tendons were shown to be clinically intact and ten had ultrasonographic evidence of continuity three weeks after tenotomy. At six weeks after tenotomy all tendons had both clinical and ultrasonographic evidence of continuity.

Achilles Tendon↗
PubMed2005

The incidence of septic arthritis in Malawian children.

The incidence of septic arthritis in Malawian children was estimated by assessing the incidence in the relatively enclosed district of Chikwawa. We found an incidence of approximately one in 5,000 in the under-five age group and one in 13,000 in the 5-15 age group.

Adolescent↗
PubMed2005

Clinical features and microbiology in 204 cases of septic arthritis in Malawian children.

We examined 204 children (137 boys and 67 girls) aged 12 years and under with septic arthritis. Their mean age was 31.1 months (1 to 144; SD 41.6). The most common joints affected were the knees and shoulders. Joints in the upper limb were affected more often in younger children and in the lower limb in those who were older. The mean age for an infection was 12 months in the shoulder and 73 months in the hip. The most common organisms cultured were species of Salmonella.

Age Distribution↗
PubMed2004

One-year follow-up of orthopaedic implants in HIV-positive patients.

We followed prospectively 38 orthopaedic implants in 36 HIV-positive patients. X-rays and clinical examination were used to assess union, and observation was made for early and late wound sepsis for 12 months from the time of surgery. Two patients died of causes unrelated to the implantation, two patients had implants removed for reasons other than infection and eight cases were lost to follow-up. Of the 26 cases that were reviewed at 1 year, no late sepsis was identified. All of the fractures, non-unions, osteotomies and arthrodeses united. The literature indicates that late sepsis following arthroplasty occurs more frequently in haemophiliacs who are HIV positive than their HIV-negative counterparts. It is still not certain whether or not such a risk also applies to HIV-positive patients who are not haemophiliacs and have undergone internal fixation of fractures or non-unions. This study increases the confidence that fixation in immune-compromised patients with intact skin is safe, at least for the time period that the implant is required. Further studies are required to know whether or not fixation implants should be removed.

Adult↗
PubMed2004

Open fractures of the tibia in HIV positive patients: a prospective controlled single-blind study.

Twenty-seven patients with severe open fractures were studied prospectively analysing infection and union as outcome measures. A standard treatment regime was applied. Seven patients were HIV positive, and 20 patients HIV negative. Wound infection and delayed union were more common in HIV positive patients. The difference in rate of infection was statistically significant (P = 0.020), while that in union did not quite reach significance (P = 0.059). The authors have developed an algorithm for treatment of these injuries in areas of high seroprevalence of HIV infection.

Adult↗
PubMed2003

Racial and gender variations in adult hip morphology.

Pelvic X-rays of 99 adult patients (198 hips) were analysed in 58 men and 41 women to determine the morphology of the adult hip in Malawians. For each hip the centre edge angle of Wiberg, the acetabular angle of Sharp and the acetabular head index were measured. For each parameter, women were more dysplastic than men, and for the acetabular angle of Sharp there was a significant gender difference ( p<0.05, t test). Our figures were compared to those of Fujii et al. who had measured the same parameters in Japanese and British hips. His results taken with ours showed that within a racial group, women were more dysplastic that men and that Japanese hips were more dysplastic than British hips, which were in turn more dysplastic than Malawian hips.

Adult↗
PubMed2003

Geometric measurements of the acetabulum in adult Malawians: radiographic study.

OBJECTIVES: To determine the acetabular depth as well as acetabular and centre edge angles; to assess the influence of sex, if any, in these geometric measurements; and to determine the prevalence of hip dysplasia in adult Malawians. DESIGN: A retrospective study. SETTING: Queen Elizabeth Central Hospital (QECH) and Blantyre Adventist Hospital (BAH). MAIN OUTCOME MEASURES: The acetabular and centre edge angles, acetabular depth and the prevalence of hip dysplasia were determined. MATERIALS AND METHODS: Two hundred and fifty three bilateral radiographs of the hip from adults, 133 men and 129 women, were used to measure the acetabular depth, angle and centre edge angle using a calliper and goniometer. The radiographs were taken from patients with no underlying bone disease between January 1997 and February 2001 at QECH and BAH. RESULTS: The prevalence of hip dysplasia was 11.54% for men and 13.16% for women with respect to centre edge angles but this difference by sex was not significant (P>0.1). However, the prevalence of hip dysplasia with respect to centre edge angle showed significantly more dysplasia in Malawian men than Nigerian and Chinese men (P<0.001 and P<0.05, respectively). Centre edge angles also showed a wider range in Malawian men (19-51 degrees right, and 15-52 degrees left) than women (18-45 degrees right, 20-46 degrees left). In both hips, the acetabular angles were more obtuse in men (35.52 degrees right, 34.21 degrees left) than women (29.43 degrees right, 29.29 degrees left), and this difference was significant (P<0.001). The ranges of acetabular angles were wider in women (11-38 degrees right, 8-40 degrees left) than men (24-49 degrees right, 20-40 degrees left). Acetabular depth was also greater in men than in women (P<0.01 right hip, P<0.02 left hip). CONCLUSION: Sex influences geometrical measurements of the acetabulum. The prevalence of hip dysplasia with respect to centre edge angle was significantly higher in women than men and the prevalence for men with respect to centre edge angle was significantly different when compared with Nigerian and Chinese men. This information will assist clinicians in the region and Malawi in particular to interpret hip X-rays of African patients.

Acetabulum↗
PubMed2002

Delay in skeletal maturity in Malawian children.

The atlas of Greulich and Pyle for skeletal maturity and epiphyseal closure is widely used in many countries to assess skeletal age and to plan orthopaedic surgery. The data used to compile the atlas were collected from institutionalised American children in the 1950s. In order to determine whether the atlas was relevant to subSaharan Africa, we compared skeletal age, according to the atlas, with chronological age in 139 skeletally immature Malawian children and young adults with an age range from 1 year 11 months to 28 years 5 months. The height and weight of each patient were also measured in order to calculate the body mass index. The skeletal age of 119 patients (85.6%) was lower than the chronological age. The mean difference was 20.0+/-24.1 months (t-test, p = 0.0049), and the greatest difference 100 months. The atlas is thus inaccurate for this group of children. The body mass index in 131 patients was below the normal range of 20 to 25 kg/m2. The reasons for the low skeletal age in this group of children are discussed. Poor nutrition and chronic diseases such as malaria and diarrhoea which are endemic in Malawi are likely to be contributing factors. We did not find any correlation between the reduction in body mass index in our patients and the degree of retardation of skeletal age.

Adolescent↗
PubMed2002

Wound healing after implant surgery in HIV-positive patients.

We performed a prospective, blind, controlled study on wound infection after implant surgery involving 41 procedures in patients infected with the human immunodeficiency virus (HIV) and 141 in HIV-negative patients. The patients were staged clinically and the CD4 cell count determined. Wound infection was assessed using the asepsis wound score. A risk category was allocated to account for presurgical contamination. In HIV-positive patients, with no preoperative contamination, the incidence of wound infection (3.5%) was comparable with that of the HIV-negative group (5%; p = 0.396). The CD4 cell count did not affect the incidence of infection (r = 0.16). When there was preoperative contamination, the incidence of infection in HIV-positive patients increased markedly (42%) compared with that in HIV-negative patients (11%; p = 0.084). Our results show that when no contamination has occurred implant surgery may be undertaken safely in HIV-positive patients.

Adolescent↗
PubMed2002

Septic arthritis of the shoulder in children in Malawi. A randomised, prospective study of aspiration versus arthrotomy and washout.

We undertook a prospective study of 61 children in Malawi with septic arthritis of the shoulder. They were randomised into two groups, treated by aspiration (group 1, 31 patients) or arthrotomy (group 2, 30 patients). Both received antibiotics for six weeks. We studied the results of blood tests, microbiology, and the clinical and radiological outcome one year after diagnosis. Only one patient was sickle-cell positive and three were HIV-positive. Non-typhoidal Salmonella species accounted for 86% (19/22) of the positive joint cultures in group 1 and 73% (16/22) in group 2. Of the 33 radiographs available for review at follow-up at six months, 23 (70%) showed evidence of glenohumeral damage. There was no statistical difference in radiological outcome for the two groups. We devised and validated a scoring system, the Blantyre Septic Joint Score, for the assessment of joints based upon swelling, tenderness, function and range of movement. Despite the radiological changes only one of the 24 joints examined at one year had any deficit in these parameters. There was no statistical difference in the clinical outcome for the two treatment groups at any stage during the period of follow-up.

Anti-Bacterial Agents↗