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Biomedical subjects

J Richens

Publications and source records attributed to J Richens.

At least 19 recordsLinked to original sources
PubMed1998

Cardiac failure in children with pneumonia in Papua New Guinea.

BACKGROUND: Cardiac failure is suspected of contributing to mortality from pneumonia in children in developing countries, but its role has not been clearly defined. METHODS: A convenience sample of 47 children admitted to Goroka Hospital in Papua New Guinea was studied prospectively with ultrasound, chest radiographs and assays of creatine kinase and lactate dehydrogenase. Results. Seven (15%) of the 47 children died. Of the 43 children who had a chest radiograph, 31 (72%) had severe or very severe pneumonia. No child had poor contractility of the heart on ultrasound examination or unequivocally raised cardiac isoenzymes; therefore no evidence of myocardial injury from sepsis was found. However, ultrasound examination showed dilatation of the right ventricle or hepatic veins in 12 (26%) of the children (both were dilated in 7 children) and 4 (33%) of these children died; this suggests that right ventricular cardiac failure secondary to pulmonary hypertension was present in 26% (95% confidence interval, 14 to 40%) of these children with severe pneumonia. Tachycardia was not associated with right ventricular dilatation on ultrasound, but 3 of the 4 children with more than 3 cm of liver palpable in the abdomen had right ventricular dilatation. Only 4 of the 12 children with right heart failure had hepatomegaly, tachycardia, raised jugular venous pressure or peripheral edema. CONCLUSIONS: Right ventricular failure is common in children with severe pneumonia, and it is probably caused by pulmonary hypertension rather than septic toxemia. The clinical signs of heart failure are unreliable. There is no evidence that digoxin is effective treatment for right ventricular failure secondary to pulmonary hypertension.

Cause of Death↗
PubMed1996

Safety, tolerance, and efficacy of atevirdine in asymptomatic human immunodeficiency virus-infected individuals.

Atevirdine is a nonnucleoside reverse transcriptase inhibitor of human immunodeficiency virus type 1 (HIV-1). In this study we investigated the effect of atevirdine in asymptomatic antiretroviral naive HIV-infected patients with CD4+ cell counts of between 200 and 750 cells per mm3. Patients were randomized to receive 600 mg of atevirdine (n = 15) or a placebo (n = 15) three times a day for 12 weeks. There was no statistically significant effect of atevirdine on viral loads (HIV p24 antigen and HIV-1 RNA levels by PCR) or CD4+ cell counts. The data do not support the use of atevirdine as a monotherapy in the treatment of HIV-infected patients.

Adult↗
PubMed1995

The spondyloarthropathies.

The spondyloarthropathies occur with variable frequency in the tropics. Ankylosing spondylitis, in particular, is thought to be rare in tropical Africa, reflecting a low frequency of the HLA B27 gene. However, in the Melanesian populations of Papua New Guinea where there is a relatively high frequency of HLA B27, ankylosing spondylosis is infrequent. These diverse observations may be related to variations in B27 sub-types. Reactive arthritis is a common and important form of acute arthritis in the tropics and in Papua New Guinea at least has a strong association with HLA B27. In Africa an increasing prevalence of reactive arthritis may be related to the spread of HIV infection. Extra-articular features such as balanitis and enthositis are helpful pointers to the diagnosis. Disseminated gonococcal infection and tuberculosis must always be considered and treatment offered if doubt exists. The mainstay of treatment of reactive arthritis is, as always, an anti-inflammatory drug, supplemented by hydrocortisone injections; docycline is available for chlamydia-triggered arthritis and chloroquine or dapsone for more chronic, unresponsive cases.

Arthritis, Psoriatic↗
PubMed1995

Typhoid in the highlands of Papua New Guinea 1984-1990: a hospital-based perspective.

A first-hand account is given of the epidemic of typhoid in the Goroka area as it evolved from 1984 to 1990. The monthly admissions for typhoid to Goroka Base Hospital showed a peak in 1988. The sex and age distribution showed a predominance of young adults. The overall case fatality rate of hospitalized patients was of the order of 10-15%; in a carefully documented group of 374 patients 27% were assessed as having severe typhoid and this subgroup had a case fatality rate of 44%. The clinical features were studied in 516 patients. The high mortality appeared to result from septic shock; ileal perforation was found in only 1.3% of patients. A skin lesion equivalent to but significantly different from the classic rose spot was found in 30% of patients. The typhoid facies was commonly encountered in patients with well-established typhoid. Cerebellar tremor and hearing loss were frequent diagnostic findings. Blood and bone marrow cultures were used to confirm the diagnosis; bone marrow culture proved practicable but gave little increased yield over blood culture. A clinical algorithm to help distinguish typhoid and malaria was developed, principally for use in health centres in the highlands. The mainstay of treatment was chloramphenicol and very few problems were encountered with its use in inpatients. Bacteriological resistance to chloramphenicol did not develop over the study period. Other drugs, such as fluorinated quinolones, may be more effective when all aspects are considered, despite higher cost, but this remains to be investigated. Hydrocortisone in patients with severe disease was evaluated and shown to be ineffective but whether high-dose dexamethasone would reduce the mortality from typhoid in patients in Papua New Guinea still remains an unanswered question.

Adult↗
PubMed1992

An algorithm for the clinical differentiation of malaria and typhoid: a preliminary communication.

The objective of this study was to determine which clinical features of typhoid and malaria are most helpful in distinguishing the two diseases among Papua New Guinean highlanders. In a study of 35 patients with culture-positive typhoid and 49 with blood-slide-positive malaria (Group 1), the odds of typhoid were increased most in patients with altered bowel habit, an illness of more than 2 week's duration, tremor or the presence of typhoid facies. The odds of typhoid were lowest in patients with pallor or jaundice. These findings were used to derive a clinical diagnostic algorithm, which was then evaluated in a further group of 34 typhoid patients and 41 malaria patients (Group 2). The sensitivity of the algorithm in diagnosing malaria was 91% in Group 1 and 71% in Group 2, with specificities of 85% and 79% respectively. For typhoid, the sensitivity of the algorithm was 85% and 79% for Groups 1 and 2, respectively, and the specificities were 91% and 71%. We conclude that the algorithm merits further evaluation in a primary health care setting and may prove useful in making an earlier diagnosis of typhoid.

Algorithms↗
PubMed1992

Travel to the coast by highlanders and its implications for malaria control.

Three groups of highland subjects were questioned about malaria and their visits to coastal areas: patients admitted to Goroka Base Hospital with malaria, patients admitted with diagnoses other than malaria who had visited the coast within the previous six months, and health staff working in Goroka. Nearly a third in all groups reported having had two or three attacks of malaria. 82% of malaria patients had visited the coast in the previous 4 weeks compared to 26% of patients without malaria. Most malaria seen in Goroka is imported from the coast. Most patients in the survey came from rural areas and were uneducated. However, health workers also failed in most cases to take adequate precautions when they visited the coast. It is suggested that a malaria prophylaxis station should be set up at the gateway to the highlands on the Highlands Highway, where malaria education and the means for chemoprophylaxis and protection from mosquitoes could be made available for all travellers.

Adult↗
PubMed1991

The diagnosis and treatment of donovanosis (granuloma inguinale).

Donovanosis is a predominantly tropical cause of genital ulcer occurring chiefly in small endemic foci in all continents except Europe. Diagnosis requires the careful collection, staining and examination of smears or biopsies of characteristic genital and, occasionally, extragenital lesions for demonstration of the pathognomonic Donovan bodies (Calymmatobacterium granulomatis) within histiocytes. Successful isolation of C. granulomatis has rarely proved feasible, the last report being in 1962. Donovanosis has a characteristic histopathological picture which occasionally simulates epithelioma. The antibiotics reported as showing good activity in donovanosis are those with good activity against gram negative bacilli and whose lipid solubility ensures good intracellular penetration. They include streptomycin, chloramphenicol, erythromycin, lincomycin, cotrimoxazole and the tetracyclines. More recently, good results have been reported with norfloxacin and thiamphenicol. The treatment of donovanosis in pregnant women and patients with AIDS poses special problems. Complications of donovanosis such as elephantiasis, stricture and pelvic abscess may require surgery. Contacts should be traced for examination but only treated if lesions are found.

Acquired Immunodeficiency Syndrome↗
PubMed1991

Management of bowel perforation in typhoid fever.

The best survival rates after ileal perforation in typhoid fever are to be found in patients undergoing operation within 24 h. Conservative management of typhoid perforation, which was widely advocated after the introduction of chloramphenicol, appears to be associated with a substantially increased mortality compared to surgery, although randomized comparisons have never been conducted. Clinical, radiological and ultrasound examination assist in the diagnosis of perforation. After vigorous resuscitation, simple surgical closure of the perforation and abdominal irrigation will suffice for most cases. Antibiotics effective against S. typhi, coliforms and anaerobes are required.

Adult↗
PubMed1991

The diagnosis and management of common forms of arthritis in adults in Papua New Guinea.

Reactive arthritis is the leading cause of arthritis in Papua New Guinea, followed probably by gonococcal arthritis. Indomethacin and local hydrocortisone acetate are useful in the treatment of reactive arthritis. Refractory cases of reactive arthritis may be helped by weekly low-dose oral methotrexate or by long courses of doxycycline. When Neisseria gonorrhoeae is thought to be involved treatment should cover penicillinase-producing strains. Infective arthritis due to Staphylococcus aureus and Mycobacterium tuberculosis is less common but should be considered in all patients because prompt and specific treatment is required to avoid permanent damage.

Anti-Inflammatory Agents↗
PubMed1990

Pyoderma gangrenosum in Papua New Guinea.

A severe case of pyoderma gangrenosum in a Papua New Guinean girl aged 11 years in reported. Multiple lesions of the arms, legs, buttocks and mouth were present. There was no associated disease. She was treated with very high doses of prednisolone and slow resolution over 3 months in hospital was observed.

Acute Disease↗
PubMed1990

Fatal post-splenectomy sepsis in a Papua New Guinean highlander.

A fatal case of overwhelming post-splenectomy sepsis (OPSS) occurring 5 years after splenectomy for trauma in a Papua New Guinean highlander is presented. The diagnosis of pneumococcal infection was made from a peripheral blood smear. The finding of OPSS in Papua New Guinea is cited as additional evidence in favour of a policy of conservative management, where possible, of ruptured spleen.

Adult↗
PubMed1990

Hepatitis B surface antigen, e antigen and HBV DNA in healthy antenatal patients attending Goroka Hospital and their relationship to tattooing practices.

The prevalence of hepatitis B surface antigen (HBsAg) in women attending the antenatal clinic at Goroka Hospital was 14%. 32% of those positive for HBsAg also had hepatitis B e antigen (HBeAg), indicative of an infectious state. The mean HBV DNA level in HBeAg-positive women was 1800 pg/ml. These results suggest that vertical transmission of hepatitis B virus may be of importance in Papua New Guinea. Tattooing is common in this population: 91% of women in the study had tattoos. Methods employed in tattooing are a potential health risk but in a community which is now exposed to hepatitis B virus early in life tattooing practices are not important in the transmission of hepatitis B infection.

Adolescent↗