High-dose vitamin D3 supplementation in children and young adults with HIV: a randomized, placebo-controlled trial.

Background: Suboptimal vitamin D status is prevalent in HIV-infected patients and associated with increased risk of disease severity and morbidity. We aimed to determine 12-month safety and efficacy of daily 7000 IU vitamin D3 (vitD3) versus placebo to sustain increased serum 25-hydroxyvitamin D (25(OH)D) and improve immune status in HIV-infected subjects.

Methods: This was a double-blind trial of perinatally acquired HIV (PHIV)-infected subjects or behaviorally acquired HIV (BHIV)-infected subjects (5.

Pilot study of nasal expiratory positive airway pressure devices for the treatment of childhood obstructive sleep apnea syndrome.

Study Objectives: Alternative therapies for childhood obstructive sleep apnea syndrome (OSAS) are needed as OSAS may persist despite adenotonsillectomy, and continuous positive airway pressure (CPAP) adherence is low. Nasal expiratory positive airway pressure (NEPAP) devices have not been studied in children. We hypothesized that NEPAP would result in polysomnographic improvement.

The role of seizure disorders in burn injury and outcome in Sub-Saharan Africa.

Patients with epilepsy have higher incidence and severity of burn injury. Few studies describe the association between epilepsy and burns in low-income settings, where epilepsy burden is highest. The authors compared patients with and without seizure disorder in a burn unit in Lilongwe, Malawi.

Association between rating of respiratory distress and vital signs, severity of illness, intubation, and mortality in acutely ill subjects.

Background: When deciding whether mechanical ventilation is indicated, physicians integrate their findings on physical examination in a gestalt known as respiratory distress. Despite its importance, this gestalt is poorly understood. This study aims to describe the association between the rating of the severity of respiratory distress and vital signs, severity of illness, use of mechanical ventilation, and death.

Pediatric surgical care in Lilongwe, Malawi: outcomes and opportunities for improvement.

Background: One of the objectives of the Millennium Development Goals is to improve child health. We describe the burden of pediatric surgical disease at a tertiary hospital in Malawi.

Methods: We conducted a retrospective analysis of a pediatric surgery database at Kamuzu Central Hospital in Malawi for the calendar year 2012.

Application of SIRS criteria to a paediatric surgical population in Malawi.

Introduction: Little is known regarding systemic inflammatory response syndrome (SIRS) criteria and mortality in developing countries. We evaluated the utility of the SIRS criteria to predict death among a paediatric surgical population in Lilongwe, Malawi.

Methods: Age, SIRS variables (temperature, heart rate, systolic blood pressure, respiratory rate and leucocyte count), diagnosis, surgical procedure and outcome were analysed for paediatric surgical patients during 2012.

Validating a verbal autopsy tool to assess pre-hospital trauma mortality burden in a resource-poor setting.

Objectives: To present the validation of a verbal autopsy (VA) tool using inpatient deaths in order to ultimately assess the burden of adult pre-hospital trauma mortality in Lilongwe, Malawi.

Methods: A WHO VA tool was administered at the Kamuzu Central Hospital (KCH) morgue in Lilongwe to family members of inpatient deceased. Two physicians assigned cause of death as 'trauma' or 'non-trauma' as well as a standard VA cause of death based on the VA tool.

Delivery of operative pediatric surgical care by physicians and non-physician clinicians in Malawi.

Background: Specialized pediatric surgeons are unavailable in much of sub-Saharan Africa. Delegating some surgical tasks to non-physician clinical officers can mitigate the dependence of a health system on highly skilled clinicians for specific services.

Methods: We performed a case-control study examining pediatric surgical cases over a 12 month period.

Akt-mediated cardioprotective effects of aldosterone in type 2 diabetic mice.

Studies have shown that aldosterone would have angiogenic effects and therefore would be beneficial in the context of cardiovascular diseases. We thus investigated the potential involvement of aldosterone in triggering a cardiac angiogenic response in the context of type-2 diabetes and the molecular pathways involved. Male 3-wk-old aldosterone synthase (AS)-overexpressing mice and their control wild-type (WT) littermates were fed a standard or high-fat, high-sucrose (HFHS) diet.

Multi parametric voice assessment: sri ramachandra university protocol.

Emergence of "Voice specialty clinics" in ENT and Speech Language Pathologist (SLP) practice in India necessitates development of standard protocols for assessment and management of voice disorders. Based on recommendations from European Laryngological Society in Dejonckere (Eur Arch Otorhinolaryngol 258:77-82, 2001), a comprehensive voice assessment protocol was adapted for Indian population. This study aimed at verifying the face validity and feasibility of using the developed voice assessment protocol in a multi specialty tertiary care hospital.

Prevalence of HIV and Disease Outcomes on the Medical and Surgical Wards at Kamuzu Central Hospital, Lilongwe, Malawi.

Introduction: The World Health Organization (WHO) recommends HIV Counseling and Testing (HCT) in a range of clinical settings. We describe the characteristics of patients diagnosed with HIV on the medical and surgical wards at a tertiary care hospital in Malawi.

Methods: Under the universal opt-out HCT protocol we characterized the number of new HIV/AIDS infections and associated clinical features among hospitalized surgical and medical patients diagnosed during the course of admission.

Unusual presentation of Streptococcus pneumoniae in human immunodeficiency virus infection.

Streptococcus pneumoniae usually produces infection of the respiratory tract, inner ear or meninges. Unusual sites of infection have rarely been reported among HIV-1 seropositive patients. We report a case of post auricular subcutaneous abscess caused by Streptococcus pneumoniae in a Human Immunodeficiency Virus (HIV) infected child who also had B cell lymphoma.

Is Lidocaine Infiltration Really Necessary in Micro Ear Surgeries performed Under General Anaesthesia?

To study the role of infiltrating 2% Lidocaine in Micro ear surgeries performed under general anaesthesia. To measure the impact of infiltration of 2% Lidocaine in post operative pain relief and per operative bleeding. A Double blinded, Prospective randomized comparative study was conducted in a tertiary care referral centre.

Water residing in small ultrastructural spaces plays a critical role in the mechanical behavior of bone.

Water may affect the mechanical behavior of bone by interacting with the mineral and organic phases through two major pathways: i.e. hydrogen bonding and polar interactions.

A case of acute necrotizing pancreatitis: Practical and ethical challenges of a North-South partnership.

Introduction: The Departments of Surgery at the University of North Carolina (UNC) and Kamuzu Central Hospital (KCH) in Lilongwe, Malawi, formed a partnership of service, training, and research in 2008. We report a case of recurrent pancreatitis leading to pancreatic necrosis treated at KCH.

Presentation Of Case: A 42 year-old male presented to KCH with his fourth episode of abdominal pain, nausea and vomiting.

Statistical mechanics of ribbons under bending and twisting torques.

We present an analytical study of ribbons subjected to an external torque. We first describe the elastic response of a ribbon within a purely mechanical framework. We then study the role of thermal fluctuations in modifying its elastic response.

Chicken or the leg: Sigmoid colon perforation by ingested poultry fibula proximal to an occult malignancy.

Introduction: Colonic perforation by ingested foreign bodies is exceedingly rare, with the diagnosis made more challenging by patients infrequently recalling any inadvertent ingestion and the poor sensitivity of plain radiography.

Presentation Of Case: The presented case demonstrates that bony perforation of the large bowel might occur immediately proximal to an otherwise occult colonic malignancy.

Discussion: Ingestion of foreign bodies is common and rarely results in colonic perforation.

Cancer Treatment in Malawi: A Disease of Palliation.

Background: Worldwide, new cancer cases will nearly double in the next 20 years while disproportionately affecting low and middle income countries (LMICs). Cancer outcomes in LMICs also remain bleaker than other regions of the world. Despite this, little is known about cancer epidemiology and surgical treatment in LMICs.

Sex differences in interpersonal violence in Malawi: analysis of a hospital-based trauma registry.

Background: Although interpersonal violence ("assault") exists in every society, the World Health Organization (WHO) estimated that 90 % of the exposure burden occurs in low- and middle-income countries. The objectives of this study were to define the incidence of assault-related injuries among subjects presenting for emergency room care secondary to sustained trauma in Lilongwe, Malawi; to measure the impact of sex on incidence, injury type, and care received; and to measure the effect of both sex and geographic location of the injury on time to presentation for medical care.

Methods: This is a retrospective cohort analysis of data prospectively collected in the Kamuzu Central Hospital Trauma Surveillance Registry from July 2008 to December 2010 (n = 23,625).

Graphene-enhanced environmentally-benign cutting fluids for high-performance micro-machining applications.

A canola-based cutting oil enhanced with graphene platelet (GPL) additives has been developed to fulfill the need for environmentally benign cutting oils for high performance micro-machining applications. Carboxyl-functionalized graphene platelets are used to enable stable GPL dispersion in the polar oil. Three oil formulations consisting of 0.