Solar-powered oxygen delivery: proof of concept

SETTING

A resource-limited paediatric hospital in Uganda.

OBJECTIVE

Pneumonia is a leading cause of child mortality worldwide. Access to life-saving oxygen therapy is limited in many areas. We designed and implemented a solar-powered oxygen delivery system for the treatment of paediatric pneumonia.

DESIGN

Proof-of-concept pilot study. A solar-powered oxygen delivery system was designed and piloted in a cohort of children with hypoxaemic illness.

RESULTS

The system consisted of 25 × 80 W photovoltaic solar panels (daily output 7.5 kWh [range 3.8-9.7kWh]), 8 × 220 Ah batteries and a 300 W oxygen concentrator (output up to 5 l/min oxygen at 88% [±2%] purity). A series of 28 patients with hypoxaemia were treated with solar-powered oxygen. Immediate improvement in peripheral blood oxygen saturation was documented (median change +12% [range 5-15%], P < 0.0001). Tachypnoea, tachycardia and composite illness severity score improved over the first 24 h of hospitalisation (P < 0.01 for all comparisons). The case fatality rate was 6/28 (21%). The median recovery times to sit, eat, wean oxygen and hospital discharge were respectively 7.5 h, 9.8 h, 44 h and 4 days.

CONCLUSION

Solar energy can be used to concentrate oxygen from ambient air and oxygenate children with respiratory distress and hypoxaemia in a resource-limited setting.

Global Survey of the Frequency of Atrial Fibrillation–Associated Stroke

Background and Purpose—

Atrial fibrillation (AF) is increasingly recognized as the single most important cause of disabling ischemic stroke in the elderly. We undertook an international survey to characterize the frequency of AF-associated stroke, methods of AF detection, and patient features.

Methods—

Consecutive patients hospitalized for ischemic stroke in 2013 to 2014 were surveyed from 19 stroke research centers in 19 different countries. Data were analyzed by global regions and World Bank income levels.

Results—

Of 2144 patients with ischemic stroke, 590 (28%; 95% confidence interval, 25.6–29.5) had AF-associated stroke, with highest frequencies in North America (35%) and Europe (33%) and lowest in Latin America (17%). Most had a history of AF before stroke (15%) or newly detected AF on electrocardiography (10%); only 2% of patients with ischemic stroke had unsuspected AF detected by poststroke cardiac rhythm monitoring. The mean age and 30-day mortality rate of patients with AF-associated stroke (75 years; SD, 11.5 years; 10%; 95% confidence interval, 7.6–12.6, respectively) were substantially higher than those of patients without AF (64 years; SD, 15.58 years; 4%; 95% confidence interval, 3.3–5.4; P <0.001 for both comparisons). There was a strong positive correlation between the mean age and the frequency of AF ( r =0.76; P =0.0002).

Conclusions—

This cross-sectional global sample of patients with recent ischemic stroke shows a substantial frequency of AF-associated stroke throughout the world in proportion to the mean age of the stroke population. Most AF is identified by history or electrocardiography; the yield of conventional short-duration cardiac rhythm monitoring is relatively low. Patients with AF-associated stroke were typically elderly (>75 years old) and more often women.

Evaluation of asthma control using Global Initiative for Asthma criteria and the Asthma Control Test in Uganda

SETTING

Chest clinic of a national referral hospital in a resource-limited country.

OBJECTIVES

To determine the level of asthma control, factors influencing asthma control and the accuracy of the Asthma Control Test (ACT).

DESIGN

We collected demographic and clinical data and administered the Global Initiative for Asthma (GINA) criteria test and the ACT. The proportions of patients in each of the GINA and ACT control categories (uncontrolled, partly controlled and well controlled) were calculated. Multivariate analysis was performed to identify factors associated with asthma control. Diagnostic test parameters for the ACT using GINA criteria as gold standard were calculated.

RESULTS

Of 88 asthma patients enrolled, 67% were female. The median age was 34 years (range 12-85). Using GINA criteria, respectively 59 (67%), 17 (19%) and 12 (14%) patients had uncontrolled, partly controlled and well controlled asthma; per ACT, the corresponding figures were respectively 40% (35/88), 43% (38/88) and 17% (15/88). ACT sensitivity, specificity, positive predictive and negative predictive value were respectively 95%, 92%, 99% and 73%. Nasal congestion was associated with uncontrolled asthma (P = 0.031).

CONCLUSION

The majority of the patients at the Mulago Hospital have inadequately controlled asthma, and this is associated with nasal congestion. A simple symptom questionnaire, the ACT, can correctly classify asthma control.

Severity of juvenile onset recurrent respiratory papillomatosis is not associated with socioeconomic status in a setting of universal health care

BACKGROUND

Juvenile onset recurrent respiratory papillomatosis (JORRP) results from HPV transmission. Cervical cancer, also transmitted via HPV, is known to be correlated with socioeconomic status (SES). This study aims to determine if an association exists between SES and severity of JORRP.

METHODS

Cross-sectional study of all active JORRP patients at the Hospital for Sick Children in Toronto in 2005. SES information from Hollingshead surveys, Postal walk Census data, and Low Income Cutoff Data were compared with Derkay-Wiatrak disease severity scores, peak annual surgical frequency, and age of diagnosis. Statistical analysis was performed using Spearman, Mann-Whitney, and linear regression analyses.

RESULTS

Twenty-one patients were surveyed. Hollingshead results were as follows: two patients (10%) were class I (major business and professional); 11 patients (52%) were class II (medium business, minor professional, technical); 4 patients (19%) were class III (skilled craftsmen, clerical, sales workers); 4 patients (19%) were class IV (machine operators, semiskilled workers); 0% were from class V (unskilled laborers, menial service workers). Interestingly, based on postal code data nine patients (45%) were below the low income cutoff as compared to the Toronto (metropolitan) and Ontario (provincial) rates of low income (17% and 14%, respectively). There was significant correlation between each of the SES measures and between disease severity measures. However, analysis of the SES measures versus disease severity measures did not demonstrate any significant relationship.

CONCLUSIONS

Though almost half the patients lived below the low income cutoff, this study did not demonstrate a significant correlation between socioeconomic status and severity of disease in JORRP. One possible explanation is that universal access to the Canadian health care system is able to provide support despite a large proportion of patients being socioeconomically vulnerable. A national level study is underway to further detect any relationship between SES and JORRP severity in the general population.

Stool viruses among paediatric patients from a Nairobi clinic, Kenya

OBJECTIVE

To document the clinical presentation and prevalence of stool viruses among children presenting with symptoms of acute gastroenteritis (AGE) at Gertrude's Garden Children's Hospital, Nairobi, Kenya.

DESIGN

Retrospective case-control study.

SETTING

A private paediatric clinic in Nairobi.

RESULTS

Viral antigen was detectable in the stool samples of 21 (rotavirus alone in ten cases, adenovirus alone in seven cases, and both viruses in four cases). Diarrhoea was almost universally present (20/21 cases) and was reported more frequently than in a control group of ten children with clinical acute gastroenteritis whose stools tested negative for viruses. Fever, an elevated total leukocyte count, and neutrophilia were commonly observed in patients with viral gastroenteritis. Eight children with viral AGE were treated with antibiotics and eight children were admitted to hospital.

CONCLUSION

A viral etiology can frequently be identified among children in Nairobi with AGE. Fever, an elevated leukocyte count, and neutrophilia were not helpful in differentiating viral from non-viral AGE in this series. Supportive management consisting of outpatient oral rehydration therapy without antibiotic treatment should be considered in the non-toxic child with AGE.

Iso-electric focusing of aqueous humour IgG in multiple sclerosis

Samples of aqueous fluid were obtained from 35 "controls" who were people undergoing routine cataract surgery. Similar samples were taken from seven patients with clinically definite multiple sclerosis (MS) and a previous history of optic neuritis, either at cataract surgery or as an elective procedure. Oligoclonal bands were found in only one subject who suffered from the MS-uveitis syndrome.