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Aims: To investigate ocular disease in patients with tuberculosis (TB) and HIV in Africa presenting with fever, and to determine if indirect ophthalmoscopy is useful in the diagnosis of mycobacteraemia. Methods: A prospective study of all adult patients admitted with fever to a large central hospital in Malawi, Africa. All recruited patients had an ophthalmic examination, HIV tests, chest x ray, sputum examinations, bacterial and mycobacterial blood cultures, and malaria slide to observe the presence of parasites. Results: 307 patients were recruited; 109 (36%) had TB, including 53 (17%) with mycobacteraemia; 255 (83%) had HIV and 191 (62%) had AIDS. Of the patients with TB 102 (94%) had HIV. Choroidal granulomas were found in four patients, all of whom had AIDS; three (2.8% of those with TB) had disseminated TB with mycobacteraemia, and one had persistent fever but no other evidence of TB. Among the patients with AIDS, 32 (17%) had microangiopathy manifest by cotton wool spots; one (0.5%) had signs of active cytomegalovirus (CMV) retinitis. The presence of microangiopathy was not related to TB. Conclusions: In Malawian patients with TB presenting acutely with fever, choroidal granulomas were found in 2.8%, and were concurrent with mycobacteraemia and AIDS. Ophthalmoscopy was not a useful aid in the diagnosis of mycobacteraemia. Cytomegalovirus (CMV) retinitis is rarely seen in African AIDS patients. This may be the result of mortality early in the disease course, or differences in race, HIV subtype, or comorbidity.

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Introduction: Paraphenylene Diamine (PPD) is an aromatic amine not found in nature. It is used in a variety of industrial products and in different hair dye formulations. It is well known that PPD is an allergen that may cause contact dermatitis, erythematous urticarial papules and eczema in susceptible individuals. However, the major systemic problem occurs when it is ingested accidentally, for purposes of suicidal intent or during attempted murder. Information on the systemic effects and outcome of hair dye poisoning in children is limited. In this article we review the literature for PPD intoxication in children. Review: PPD intoxication is a major health problem in eastern Africa, particularly Sudan, and in Morocco. It is also common in the Indian subcontinent. In two large series from Morocco and Sudan, Children constituted 11.5% and 18% of affected individuals respectively. Acute poisoning by PPD causes characteristic severe angio-edema of the upper airway, often requiring tracheostomy, accompanied by a swollen, dry, hard and protruding tongue. PPD intoxication results in multisystem involvement and can cause rhabdomyolysis and acute kidney injury (AKI), flaccid paralysis, severe gastro-intestinal manifestations, cardiotoxicity and arrhythmias. This form of severe intoxication is fatal if not treated aggressively. There is no specific antidote and treatment is mainly supportive with renal replacement therapy commonly used in cases with AKI. Reported mortality rates range between 12-42%. Conclusion: PPD intoxication is a life threatening condition. Clinical outcomes rely on early recognition, prompt referral, and aggressive supportive treatment in collaboration with different specialties.

We performed a cross sectional study to evaluate treatment results of the paying antiretroviral therapy clinic of Queen Elizabeth Central Hospital, Blantyre. The only antiretroviral therapy was a fixed drug combination of stavudine, lamivudine and nevirapine. Methods:Interviews, laboratory tests (CD4 count, virbl load, nevirapine plasma levels, ffansaminases) and data extraction from files. 422 (59 Vo) of the patients who started antiretroviral therapy since 2000 were lost to follow up. The 176 patients enrolled in the study had good virological and excellent clinical treatment results. The most cornmon side effect was peripheral neuropathy. Nevirapine plasma levels were remarkably high and associated with successful virological treatment results. Two simple adherence questions pertaining to the use of medication in the previous 8 days corresponded well with nevirapine levels. The most important reasons for non-adherence were shortage of drugs in the hospital pharmacy ald personal financial constraints.Conclusions: