Rheumatic disorders at a Zambian Teaching Hospital.
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Adolescent↗
Biomedical subjects
J E Jellis
Publications and source records attributed to J E Jellis.
Orthopaedic surgery and HIV disease in Africa.
Human immunodeficiency virus (HIV) infection has radically changed African orthopaedic practice within a decade. In Lusaka, a third of adults are infected, but most have no physical signs of the disease. Early experience showed that closed fractures healed normally, the risk of sepsis during osteosynthesis was increased and most open fractures became septic. Major orthopaedic surgery in HIV-positive patients has increased risks of sepsis which rise steeply in those with physical signs of HIV disease. Musculoskeletal infections such as tropical pyomyositis, adult haematogenous long-bone osteomyelitis, and late haematogenous infection of implants, appear as immune competence wanes. There is a dual epidemic of tuberculosis and HIV, and bone and joint tuberculosis is now common. Atypical features suggest that traditional diagnostic criteria for spinal tuberculosis may be inadequate. Rheumatoid diseases, especially reactive arthritis, are common and serious complications of HIV disease. The risk of transmission of HIV between patient and surgeon is small, especially if recommended precautions are universally applied.
Africa↗
Viral infections: musculoskeletal infection in the human immunodeficiency virus (HIV) infected patient.
HIV disease has reached epidemic proportions in Africa over the last decade and is severely stretching the health services of the many poor countries of the region. Increased sepsis during fracture surgery and the late infection of implants impels us to rethink many standard methods of treatment. Musculoskeletal infections, including tropical pyomyositis and long bone haematogenous osteomyelitis, are now common manifestations of advanced HIV disease in adults. Despite their severe infections, such patients may survive for more than 5 years and certainly cannot be written off as terminally ill. Treatment is often prolonged and, in the case of osteomyelitis, may necessitate amputation. These patients now occupy many of the available orthopaedic beds.
Adolescent↗
Viral infections: arthritis in the human immunodeficiency virus (HIV) infected patient.
Reactive arthritis is common in HIV-positive patients and may be mistaken for septic arthritis. We feel that the association is probably, in part, due to the increased incidence of diarrhoeal diseases in HIV-infected patients rather than a specific effect of HIV on the synovium. Disabling, chronic, sero-negative polyarthritis is common in the later stages of HIV infection and further palliative therapeutic strategies are urgently needed.
Adult↗
Bacterial infections: bone and joint tuberculosis.
In many countries of the world, there is now a dual epidemic of tuberculosis and HIV disease. HIV specifically eliminates the tissue macrophages and CD4 lymphocytes, the very cells that provide immunity against tuberculosis. Tuberculosis is one of the more virulent opportunistic infections and it therefore appears fairly early in HIV disease. For the same reasons, bone and joint tuberculosis is becoming much more common. The disturbances of the lymphocyte count, ESR and antigen skin tests associated with HIV, now often make tuberculosis difficult to distinguish from other inflammatory lesions. The only change in the pattern of disease that we have so far registered is an increased incidence of disease affecting the lumbar spine. HIV-positive patients respond poorly to chemotherapy and are subject to drug sensitivity reactions. Major surgery is fraught with infectious complications and should be avoided. Once Pott's paraplegia has developed, the demise of the HIV-positive patient is rapid.
Humans↗
The incidence of the human immunodeficiency virus in injured patients in Lusaka.
Patients may present with pathology that is not directly related to their primary complaint. The possibility of the presence of an infecting agent may not be considered and precautions that should be taken may be inappropriately forsaken. A multispecialty study is being undertaken at the University of Zambia to assess the influence of the human immunodeficiency virus (HIV) on the presentation, treatment and outcome of surgical pathology. This study examines the HIV status of 100 patients presenting through the Accident Department with long bone fractures. Assessment using the World Health Organization (WHO) clinical staging system for HIV disease has been compared with the patient's response to the potential immunological challenge and HIV serological status. Thirty-two per cent of adults in the age range 16-55 years were seropositive for HIV but this rose to 50 per cent in those aged between 21 and 40 years. The majority of patients were male, but both sexes had similar patterns of serological status. All patients were in WHO stage 0, 1 or 2 but assessment with the WHO clinical criteria alone led to a high level of diagnostic inaccuracy. Clinical assessment of 18 patients suggested freedom from HIV influence but their serum was seropositive on ELISA testing. The absolute lymphocyte count was below 2000 cells/mm3 in patients found to be seropositive and with disease of clinical stage 1 or 2.
Adolescent↗
Childhood sciatic palsies: congenital and traumatic.
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Accidents, Traffic↗
The use of diflunisal in post-operative pain.
A single-blind trial of diflunisal (Dolobid) against osyphenbutazone (Tanderil) was performed in a randomised series of 50 patients undergoing various orthopaedic operations. The patients were screened for the known contra-indications to both drugs. All those admitted to the trial had considerable pain on the first post-operative morning. Diflunisal was found significantly more efficacious in the relief of orthopaedic post-operative pain. No significant side-effects were recorded for either drug.
Adolescent↗