Increasing longevity and a growing older population are being accompanied by a higher prevalence of dementia and concomitant demand for care. In this connection, the University of Cape Town/Groote Schuur Hospital (UCT/ GSH) Memory Clinic provides a valuable service to patients, families and health professionals. High levels of behavioural and psychological symptoms of dementia need expert tertiary level assessment and management. Public education on dementia, early referral for assessment by primary care health professionals, and advanced training of health professionals are needed to encourage early recognition and appropriate management. Community-based care services too are needed to support caregivers of cognitively impaired older individuals.
Background. Advances in oncology have greatly improved the prognosis of testicular cancer. In developing countries, however, the outcome is still poor.
Patients and methods. Twenty-four patients managed for testicular cancer at two centres (University of Nigeria Teaching Hospital, Enugu, Nigeria, and JAMA Urological Clinic, Enugu) between April 1984 and March 2003 were prospectively studied. Histopathological data were obtained in all cases.
Results. Peak age incidence was 20 - 29 years. Testicular swelling was the principal complaint in 23 patients. The mean interval between onset of symptoms and presentation was 5.3 months. Two patients (8.3%) presented with stage 1 disease, 7 (29.2%) with stage 2, 7 (29.2%) with stage 3, and 8 (33.3%) with stage 4. Seventy-five per cent of tumours were right-sided, and 25% were left-sided. Treatment consisted of radical orchidectomy in all patients and cisplatin-based chemotherapy and radiotherapy in some patients. One patient with a tumour in an intra-abdominal testis underwent laparotomy. The most common histological types were seminoma and embryonal carcinoma. A fifth of the patients died, while half were lost to follow-up. The mean follow-up period was 9 months.
Conclusion. Morbidity and mortality of testicular cancer is high in developing countries. Late presentation, poverty, paucity of resources and the high cost of newer imaging modalities and treatment are major challenges to management. Better health funding and education regarding testicular self-examination is essential.
Objectives. To determine the outcome, seasonal variation, and death pattern of snakebite cases admitted at the tertiary health care centre in the last 10 years.
Methods. This was a record-based retrospective descriptive study at the Dr Shankarrao Chavan Government Medical College and Hospital in Vazirabad, a tertiary health care centre in Maharashtra, India.
Results. Out of 5 639 admitted snakebite cases, 65.24% were male. The 16 - 45-year age group accounted for 84.7% of cases; 46% were referred from other health centres, mostly from rural areas; 55.2% occurred during July to September, which coincided with the rainy season in this region; 94.6% of the snakebite patients survived; and 5.4% died. Case fatality rates were higher for females (8.78%) and for bites by neurotoxic snakes (8.91%).
Conclusions. Snakebite is a common life-threatening emergency in the study area. Ready availability and appropriate use of antivenom, early referral when required and close monitoring of patients in the hospital will help to reduce mortality from snakebites.