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Biomedical subjects

H B Gernaat

Publications and source records attributed to H B Gernaat.

15 recordsLinked to original sources
PubMed2001

A psychiatric ward in an African district hospital.

In most African district hospitals there are no separate facilities for psychiatric patients. Aformer general medical officer describes how a ward for these patients was set up at a rural district hospital in Zimbabwe using the already available resources. The effects on the psychiatric care at the hospital and the district are illustrated by two case reports. It is concluded that psychiatric care integrated in primary healthcare, with due regard for the cultural aspects and with cooperation of local healers is feasible, provided that it is supported by additional diagnostic and treatment facilities at the district hospital.

Adult↗
PubMed2000

A new classification of acute protein-energy malnutrition.

Current schemes to classify protein-energy malnutrition (PEM) in hospitalized children below 5 years of age in developing countries are of limited usefulness, because age is often not known and wasted children are insufficiently discriminated. In this study, a newly proposed scheme, based on the presence of wasting (weight-for-height < or = -2 z scores) and oedema, was compared with clinical and the original Wellcome criteria to classify PEM in 538 under-fives hospitalized for PEM in a rural hospital in Nchelenge, Zambia. Wasting in the absence of oedema was clinically false-positively diagnosed in 34.0 per cent, whereas the Wellcome classification gave rise to 28.6 per cent false-positive and 39.9 per cent false-negative diagnosis. In the presence of oedema, clinical diagnosis of wasting was 44.7 per cent false-positive and 41.4 per cent false-negative, while the Wellcome scheme had a false-negative rate of 54.3 per cent. We conclude that the Wellcome classification did not add to the clinical diagnostic accuracy of PEM as opposed to the proposed scheme, which merits further study. In an Appendix the use and calculation of z scores of weight-for-height is further explained.

Body Height↗
PubMed1998

Clinical epidemiology of paediatric disease at Nchelenge, north-east Zambia.

In a combined retrospective and prospective 4-year study of 6412 children consecutively admitted to St Paul's Hospital, Nchelenge, north-east Zambia, the clinical epidemiology of paediatric disease was described. One diagnosis per admission was noted. Protein-energy malnutrition (PEM) was diagnosed clinically and by means of a modified Wellcome scheme using weight-for-height and Z scores. Correlation coefficients were calculated between monthly admission rates and relative humidity, rainfall and temperature. The age distribution of admitted children showed several distinct groups. Type I (malaria, acute gastro-enteritis, pneumonia and meningitis) had its peak in the 1st 7 months of age, type II (burn wounds and measles) had its main prevalence between the ages of 2 and 4 years, and type III (trauma, typhoid fever, snake bite and tropical ulcer) occurred mainly between 4 and 14 years of age. Admission rates for PEM, PEM subtypes, pneumonia, trauma and snake bite correlated with wet season variables. Malaria and acute gastro-enteritis were extremely common throughout the year. A measles epidemic in the dry season was initially followed by an increase in marasmus, whereas oedematous malnutrition only assumed epidemic proportions associated with a post-measles rise in admission rates of pneumonia. Clinical epidemiological data at the district level is a powerful tool for understanding the pattern of serious paediatric disease in the community.

Adolescent↗
PubMed1998

Mortality in severe protein-energy malnutrition at Nchelenge, Zambia.

At St Paul's Hospital, Nchelenge district, north-eastern Zambia, routine clinical management of 299 children up to 5 years of age with severe and/or complicated protein-energy malnutrition (PEM) was monitored and predictors of outcome analysed. PEM was typed according to a modified Wellcome classification. Overall mortality was 25.8 per cent with 13.4 per cent for kwashiorkor, 17.8 per cent for marasmus, 28.0 per cent for marasmic kwashiorkor, and 48.3 per cent for untyped cases of PEM. Mortality up to 18 months of age was related to the presence of dehydration, pneumonia or another infectious disorder, severe stunting, and a mid-upper arm circumference < or = 104 mm, suggesting that these children may have been born pre- and/or dysmaturely. At ages 19-60 months, the main predictor of mortality was pneumonia, with other infectious disorders and dehydration showing less impact. Routine administration of broad-spectrum antibiotics, irrespective of clinical signs of infection, is most probably the single most effective measure to reduce the high case-fatality rate due to PEM in developing countries.

Age Distribution↗
PubMed1998

Experience of negative symptoms: comparison of schizophrenic patients to patients with a depressive disorder and to normal subjects.

OBJECTIVE: Three hypotheses were tested: 1) schizophrenic patients would report more impairments on a self-rating scale for negative symptoms than normal subjects and attribute higher levels of distress to these impairments, 2) schizophrenic patients would report fewer impairments than patients with a depressive disorder and attribute lower levels of distress to these impairments, and 3) schizophrenic patients would attribute their impairments less often to mental illness than would patients with a depressive disorder. METHOD: A self-rating scale for negative symptoms was administered to 86 patients with schizophrenia, 20 patients with a depressive disorder, and 33 normal subjects. The scale items were derived from the Scale for the Assessment of Negative Symptoms (SANS). Two psychiatrists also rated all of the patients on the SANS. RESULTS: The hypotheses were supported. The differences between the two groups of patients in the rates of reported impairments and the levels of reported distress remained statistically significant after control for differences in age, sex, length of current admission, length of illness, dose of neuroleptic medication, use of clozapine, and severity of negative symptoms. CONCLUSIONS: The results suggest that a large number of schizophrenic patients are somewhat aware of negative symptoms but that they are less aware of these impairments and less concerned about them than are patients with a depressive disorder.

Adolescent↗
PubMed1996

Physical growth of children under five years of age in Nchelenge, Zambia: results from a district survey.

This study focuses on the physical growth of children aged 0-60 months in Nchelenge District, northeast Zambia. By means of a two-stage clustered and random sampling method, 193 households were selected. Weight, height, and mid-upper-arm circumference (MUAC) of children 0-60 months were measured. Underweight, stunting, and wasting were defined as weight for age, height for age, and weight for height (W/H), respectively, < or = 2 z scores below the median of the National Center for Health Statistics (NCHS) reference population. Among 250 children, prevalence rates of 30% underweight, 69.2% stunting, and 4.4% wasting were found, with the highest rates at age 12- < 24 months. Prevalence of stunting, underweight, and wasting in children aged 0- < 6 months and 6- < 12 months suggested that a substantial proportion of infants were premature and/or small for gestational age. The literature suggests that prematurity and intrauterine growth retardation may be quite common in Africa, and this may have important implications for the interpretation of growth data and under nutrition rates. Use of the MUAC < 125 mm as an indicator of wasting resulted in higher estimates of wasting compared to W/H < or = -2 z scores, and seemed unsuitable as a screening test for wasting in this Zambian population.

Aging↗
PubMed1996

Absolute values or Z scores of mid-upper arm circumference to identify wasting? Evaluation in a community as well as a clinical sample of under fives from Nchelenge, Zambia.

The purpose of the study was to compare the use of absolute cut off values of the mid-upper arm circumference (MUAC) with age- and sex-adjusted z scores of the MUAC in the identification of acute undernutrition (wasting) in children up to 60 months of age. In Nchelenge, northern Zambia, 275 children from the community, selected by a two-stage cluster sampling procedure, and 105 hospitalized children with protein energy malnutrition (PEM) individually matched for age, sex, village and under-five clinic attendance with 104 controls, were clinically and anthropometrically (weight, height, MUAC) examined. zScores for weight for height and MUAC were calculated and PEM was classified according to a modified Wellcome scheme. For community prevalence rates of wasting in various age groups, MUAC < or = -4 z scores more closely paralleled W/H < or = -2 z scores than MUAC <125 mm. To identify individual children with wasting, MUAC < or = -2 z scores gave a better sensitivity than MUAC <125 mm. In hospitalized PEM children, z scores appeared to offer no advantages over absolute MUAC values in identifying the presence of wasting. Applicability of the MUAC and optimal cut off values may differ according to the setting in which the MUAC is to be applied.

Anthropometry↗
PubMed1995

Tranylcypromine in narcolepsy.

The narcolepsy syndrome consists of excessive daytime somnolence, cataplexy, hallucinations, and sleep paralysis. Data on the effects of tranylcypromine are scant. We report on a patient with severe narcolepsy in whom administration of tranylcypromine led to freedom from hallucinations, nightmares, sleep paralysis, and rapid eye movements (REM), with considerable amelioration of cataplexy and increased daytime alertness. Muscle atonia and low-voltage desynchronized cortical activity during REM sleep did not change. Tranylcypromine warrants further study in narcolepsy.

Adult↗
PubMed1992

[Parkinsonism following addition of fluoxetine to the treatment with neuroleptics or carbamazepine].

This article describes three patients who developed parkinsonism when fluoxetine was added to their existing medication (neuroleptics or carbamazepine). Based on published pharmacological and neuroanatomical research we postulate a serotonin-dopamine antagonism to be operative in the development of drug-induced parkinsonism. Alternatively, the possibility of a pharmacokinetic interaction remains.

Adult↗
PubMed1990

Chloroquine-resistant Plasmodium falciparum malaria at Nchelenge, northeastern Zambia. Follow-up on 515 hospital patients.

From 1986 until 1988 chloroquine sensitivity of Plasmodium falciparum malaria was monitored in 515 hospital patients in Nchelenge district, northeastern Zambia. After treatment with chloroquine 30 mg base/kg, bloodslides were examined on day 2, 4, 6 and 7. The overall resistance rate was 21.4%, of which 29% was R1-, 30% R2-, 18% R3- and 23% R2-3 resistance. Resistance rates were negatively correlated with age and positively with the initial parasitemia. It is suggested that in vivo tests of chloroquine sensitivity also reflect the host's immune status for malaria. In rural areas with chloroquine resistance in vivo testing should be performed on all malaria patients.

Adolescent↗