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1.
BMC Nephrol ; 23(1): 274, 2022 08 04.
Article in English | MEDLINE | ID: mdl-35927678

ABSTRACT

BACKGROUND: Haemostatic derangements are thought to be due to an imbalance between hepatic synthesis of pro-coagulants and urinary losses of anticoagulants. OBJECTIVES: This study evaluated the coagulation profile of Nigerian children with nephrotic syndrome and examined the relationship between coagulation variables, disease state and steroid responsiveness. METHODS: A cross- sectional hospital based study on evaluation of coagulation profile of children with nephrotic syndrome compared with their age- and gender- matched controls. RESULTS: The median fibrinogen level in subjects and controls was the same (2.9 g/L). Sixteen of 46 (35%) children with nephrotic syndrome had hyperfibrinogenaemia. The median fibrinogen level of children in remission was 2.3 g/L and differed significantly when compared with those of children in relapse (p = 0.001). The median APTT of children with nephrotic syndrome was 45.0 s and differed significantly compared with those of controls (42.0 s) (p value = 0.02). The median prothrombin time in children with and without nephrotic syndrome were 12.0 and 13.0 s respectively, (p = 0.004). About 90% of children with nephrotic syndrome had INR within reference range. Thrombocytosis was found in 15% of children with nephrotic syndrome. The median platelet count in children with new disease was 432 × 103cells/mm3 and differed significantly when compared with those of controls (p = 0.01). INR was significantly shorter in children with steroid resistant nephrotic syndrome (SRNS) (median 0.8 s; IQR 0.8 -0.9 s) compared with controls (median 1.0 s; IQR 1.0 -1.1 s) (p = 0.01). Steroid sensitivity was the strongest predictor of remission in children with nephrotic syndrome; steroid sensitive patients were 30 times more likely to be in remission than in relapse (OR 30.03; CI 2.01 - 448.04). CONCLUSION: This study shows that the haemostatic derangements in childhood nephrotic involve mostly fibrinogen, APTT, PT, INR and platelet counts. Antithrombin levels are largely unaffected. Variations in fibrinogen, APTT, PT and INR values may be due to the heterogeneous nature of the disease.


Subject(s)
Hemostatics , Nephrotic Syndrome , Child , Fibrinogen , Hospitals, Teaching , Humans , Nephrotic Syndrome/drug therapy , Nigeria/epidemiology , Recurrence , Steroids/therapeutic use
2.
BMC Cardiovasc Disord ; 22(1): 361, 2022 08 07.
Article in English | MEDLINE | ID: mdl-35934708

ABSTRACT

BACKGROUND: Management of life-threatening arrhythmia can be incredibly challenging in advanced health systems. In sub-Saharan Africa (SSA), this is likely more challenging because of weak pre-hospital and in-hospital critical care systems. Little is known about life-threatening arrhythmia and their outcomes in SSA. The aim of this study was to examine the types and outcomes of arrhythmias among haemodynamically unstable patients presenting at a tertiary hospital in Accra-Ghana. METHOD: This was a retrospective case series study conducted at the Korle-Bu Teaching Hospital (KBTH), Accra-Ghana. Medical records of patients who presented with or developed haemodynamically unstable arrhythmias within 24h of admission from January 2018 to December 2020 were reviewed. The demographic characteristics and clinical data including outcomes of patients were collected. Descriptive statistics were used and results presented in frequency tables. RESULTS: A total of 42 patients with life-threatening arrhythmias were included. Haemodynamically unstable tachyarrhythmias were the most common arrhythmias found among the patients (66.7%). Approximately 52% of patients had structural heart diseases whereas 26.2% had no apparent underlying cause or predisposing factor. Cardioversion (52.4%), commonly electrical (63.6%), and transvenous pacemaker implantation (23.8%) were the common initial interventions. The majority of the patients (88.1%) survived and were discharged home. CONCLUSION: Tachyarrhythmias are the most common haemodynamically unstable arrhythmias seen among patients presenting emergently in a leading tertiary hospital in Ghana. A high survival rate was observed and cannot be extrapolated to other healthcare settings in sub-Saharan Africa with limited resources to manage these clinical entities.


Subject(s)
Arrhythmias, Cardiac , Hospitals, Teaching , Arrhythmias, Cardiac/diagnosis , Arrhythmias, Cardiac/therapy , Ghana/epidemiology , Humans , Retrospective Studies , Tertiary Care Centers
3.
Pan Afr Med J ; 41: 342, 2022.
Article in English | MEDLINE | ID: mdl-35909428

ABSTRACT

Lutembacher syndrome (LS) is a rare syndrome comprising a combination of atrial septal defect (ASD) and mitral stenosis. We present the case of a 28-year-old man, who presented with progressively worsening dyspnea of 2 months associated with orthopnea, paroxysmal nocturnal dyspnea, bilateral leg swelling and productive cough. Chest X-ray revealed plethoric lung fields with prominent pulmonary conus and cardiomegaly. Transthoracic echocardiography revealed a large ostium secundum ASD with left to right shunt, mild mitral stenosis, severe mitral and tricuspid regurgitations and pulmonary hypertension. A diagnosis of Lutembacher syndrome in heart failure with pulmonary hypertension was made. The patient was managed conservatively, but declined surgery primarily because of financial reasons. This rare case of LS presenting with heart failure and complicated by pulmonary hypertension is the first reported case in our centre and our region. The patient's inability to afford the cost of definitive care posed a significant problem in his management.


Subject(s)
Heart Failure , Heart Septal Defects, Atrial , Hypertension, Pulmonary , Lutembacher Syndrome , Mitral Valve Stenosis , Adult , Dyspnea/etiology , Heart Failure/diagnosis , Heart Failure/etiology , Heart Failure/therapy , Heart Septal Defects, Atrial/complications , Heart Septal Defects, Atrial/diagnosis , Hospitals, Teaching , Humans , Hypertension, Pulmonary/diagnosis , Hypertension, Pulmonary/etiology , Lutembacher Syndrome/complications , Lutembacher Syndrome/diagnosis , Male , Mitral Valve Stenosis/complications , Nigeria , Universities
4.
Med Trop Sante Int ; 2(2)2022 Jun 30.
Article in French | MEDLINE | ID: mdl-35919249

ABSTRACT

Introduction: A benign tumor of middle-aged women, mucinous cystadenoma accounts for about 20% of tumors of the ovary. It can reach very large sizes. Clinical observation: We report the case of a 42-year-old patient received for a voluminous abdomino-pelvic mass. The examination found a soft, rounded, fairly mobile abdomino-pelvic mass going up to the level of the xiphoid appendix with a light skin and collateral venous circulation. Imaging showed a circumscribed fluid formation occupying the abdomino-pelvic cavity of 40.1 x 29 x 25.7 cm developed at the expense of the ovary. A laparotomy brought to light a voluminous cyst at the expense of the left ovary with fluid content cowardly adhering to the abdominal wall and intimately to the left proboscis. The uterus and right adnexa were unremarkable. We performed a left adnexectomy with satisfactory hemostasis taking away the cyst. The adnexectomy piece weighed 13.5 kg. The surgical follow-ups were simple. Anatomo-pathological examination confirmed a mucinous cystadenoma of the ovary. Conclusion: Mucinous cystadenoma of the ovary is a benign tumor which can reach very large volumes. Its treatment is surgical and the follow-ups are usually simple.


Subject(s)
Cystadenoma, Mucinous , Cysts , Ovarian Neoplasms , Adult , Burkina Faso , Cystadenoma, Mucinous/diagnosis , Female , Hospitals, Teaching , Humans , Middle Aged , Ovarian Neoplasms/diagnosis
5.
Can Vet J ; 63(8): 811-818, 2022 Aug.
Article in English | MEDLINE | ID: mdl-35919463

ABSTRACT

A 4-year-old castrated male golden retriever dog was brought to a veterinary teaching hospital for evaluation of acute progressive paraparesis. Neurological examination indicated a spinal cord lesion between the third thoracic vertebra and third lumbar vertebrae. Magnetic resonance imaging (MRI) revealed an intradural, extra medullary, and/or intramedullary mass centered over the eleventh and twelfth thoracic disc space. The dog underwent cytoreductive surgery and histopathologic analysis diagnosed a nephroblastoma. Following this, the dog underwent multimodal therapy, including multiple surgeries, 2 courses of radiation, and combination chemotherapy. The dog had serial restaging using MRI, computed tomography (CT), and fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography throughout the course of therapy. The dog survived 350 d from date of first presentation until humane euthanasia was elected due to worsening of neurologic status. During postmortem examination, extensive infiltration of the spinal cord by nephroblastoma cells was discovered as well as pulmonary metastatic disease. Key clinical message: Based on the literature search, this is the first case in which surgery, radiation therapy, and chemotherapy were all used for the treatment of canine spinal nephroblastoma. This case report details the aggressive nature of a case of canine spinal nephroblastoma despite multi-modal therapy.


Méthode d'imagerie et de thérapies multimodales utilisées dans un cas de néphroblastome spinal canin. Un chien golden retriever mâle castré âgé de 4 ans a été présenté dans un hôpital d'enseignement vétérinaire pour l'évaluation d'une paraparésie progressive aiguë. L'examen neurologique a révélé une lésion de la moelle épinière entre la troisième vertèbre thoracique et la troisième vertèbre lombaire. L'imagerie par résonance magnétique (MRI) a révélé une masse intradurale, extra-médullaire et/ou intramédullaire centrée sur les onzième et douzième espace de disque thoracique. Le chien a subi une chirurgie de cytoréduction et une analyse histopathologique a diagnostiqué un néphroblastome. Par la suite, le chien a subi une thérapie multimodale, comprenant plusieurs interventions chirurgicales, deux cycles de radiothérapie et une chimiothérapie combinée. Le chien a subi une reclassification en série par MRI, tomodensitométrie (CT) et tomographie par émission de positrons au fluor-18 fluorodésoxyglucose/tomodensitométrie tout au long du traitement. Le chien a survécu 350 jours à partir de la date de la première présentation jusqu'à ce que l'euthanasie soit choisie en raison de l'aggravation de l'état neurologique. Au cours de l'examen post-mortem, une infiltration étendue de la moelle épinière par des cellules de néphroblastome a été découverte ainsi qu'une maladie métastatique pulmonaire.Message clinique clé :D'après la recherche documentaire, il s'agit du premier cas dans lequel la chirurgie, la radiothérapie et la chimiothérapie ont toutes été utilisées pour le traitement du néphroblastome spinal canin. Ce rapport de cas détaille la nature agressive d'un cas de néphroblastome spinal canin malgré une thérapie multimodale.(Traduit par Dr Serge Messier).


Subject(s)
Dog Diseases , Kidney Neoplasms , Wilms Tumor , Animals , Dog Diseases/diagnostic imaging , Dog Diseases/surgery , Dogs , Hospitals, Animal , Hospitals, Teaching , Kidney Neoplasms/diagnostic imaging , Kidney Neoplasms/therapy , Kidney Neoplasms/veterinary , Magnetic Resonance Imaging/veterinary , Male , Positron Emission Tomography Computed Tomography , Thoracic Vertebrae/diagnostic imaging , Thoracic Vertebrae/pathology , Wilms Tumor/diagnostic imaging , Wilms Tumor/therapy , Wilms Tumor/veterinary
6.
Inquiry ; 59: 469580221108335, 2022.
Article in English | MEDLINE | ID: mdl-35942588

ABSTRACT

There is a paucity of evidence-based information regarding healthcare professionals' awareness and views toward counterfeit medicines in developing countries. Therefore; this is aimed to assess health care providers' knowledge, attitude, and practice toward counterfeit medicines in Mizan-Tepi University Teaching Hospital, South West Ethiopia. A cross-sectional study was conducted among health care providers working in Mizan-Tepi University Teaching Hospital from December 2020 to January 2021. A total of 171 health care providers participated in the study. Data were collected through self-administered structured questionnaires developed by reviewing similar surveys with some modifications. The data analyzed using a Statistical Package for Social Sciences (SPSS, version 21). Variables with P value <.05 were considered as statistically significant. Large proportions of the study participants (84.2%) have information on counterfeit drugs and 15.8% of them described counterfeit medicine as product with toxic impurities. 50.3% of them were able to distinguish a counterfeit drug from the genuine drug. 8.2% of the participants demonstrated that counterfeit medicine can be identified by physical observation of labeling, color appearance and packaging. 61.4% of the study respondents revealed that strong legal action can prevent circulation of counterfeit medicine. Professional distribution was significantly associated with the attitude of health care providers toward counterfeit medicines (P < .05). Accordingly, public health officers and midwifery health care providers were more likely to have poor attitude toward counterfeit medicines (AOR = 6.09, CI (1.798-20.69) and (AOR = 3.98(1.54-10.25)) respectively as compared to nurses. This study demonstrated the importance of awareness creation to all health care providers. Drug regulatory bodies and concerning bodies must play an active role in designing appropriate program and policy to enhance health professionals' knowledge and attitude toward CFM. There is also a need of empowering the practitioners in identifying counterfeit drugs by simple observations.


Subject(s)
Counterfeit Drugs , Cross-Sectional Studies , Ethiopia , Health Knowledge, Attitudes, Practice , Health Personnel , Hospitals, Teaching , Humans , Surveys and Questionnaires , Universities
8.
BMC Med Educ ; 22(1): 519, 2022 Jul 02.
Article in English | MEDLINE | ID: mdl-35780159

ABSTRACT

BACKGROUND: Comfort of patients with medical students is important and promotes appropriate clinical reasoning and skills development in the students. There is however limited data in this field in Uganda. In this study, we examined the attitudes and comfort of patients attending care at the medical and obstetrics/gynecology specialties in teaching hospitals of three public universities in Uganda. METHODS: We conducted a cross sectional study among patients attending care at teaching hospitals for three public universities; Makerere University (Mak), Mbarara University of Science and Technology (MUST), and Gulu University (GU). Logistic regression was used to determine the magnitude of associations between independent and dependent variables. Two-sided p < 0.05 was considered statistically significant. RESULTS: Eight hundred fifty-five patients participated in the study. Majority were aged 18 - 39 years (54%, n = 460), female (81%, n = 696) and married (67%, n = 567). Seventy percent (n = 599) of participants could recognize and differentiate medical students from qualified physicians, and had ever interacted with medical students (65%, n = 554) during earlier consultations. Regarding attitudes of patients towards presence of medical students during their consultations, most participants (96%; n = 818) considered involvement of medical students in patients' care as essential ingredient of training of future doctors. Most participants prefer that medical students are trained in the tertiary public hospitals (80%; n = 683) where they attend care. Participants who were single/never married were 68% less likely to recognize and differentiate medical students (aOR = 0.32, 95%CI: 0.22 - 0.53) from other members of the healthcare team as compared with married participants. Participants with university education had 55% lower odds of being comfortable with presence of medical students during consultation compared to those with primary education (aOR = 0.45, 95%CI: 0.21 - 0.94). Participants from MUST teaching hospital had twofold higher odds of being comfortable with presence of medical students compared to participants from Mak teaching hospitals (aOR = 2.01; 95%CI: 1.20 - 3.39). CONCLUSION: Patients are generally comfortable with medical students' involvement in their care; they prefer to seek care in hospitals where medical students are trained so that the students may contribute to their care. Medical students need to introduce themselves appropriately so that all patients can know them as doctors in training; this will promote patients' autonomy and informed decisions.


Subject(s)
Students, Medical , Attitude , Cross-Sectional Studies , Female , Hospitals, Teaching , Humans , Surveys and Questionnaires , Uganda , Universities
9.
BMC Health Serv Res ; 22(1): 894, 2022 Jul 09.
Article in English | MEDLINE | ID: mdl-35810290

ABSTRACT

BACKGROUND: Surgical perioperative deaths and major complications are important contributors to preventable morbidity, globally and in sub-Saharan Africa. The surgical safety checklist (SSC) was developed by WHO to reduce surgical deaths and complications, by utilising a team approach and a series of steps to ensure the safe transit of a patient through the surgical operation. This study explored barriers and enablers to the utilisation of the Checklist at the University Teaching Hospital (UTH) in Lusaka, Zambia. METHODS: A qualitative case study was conducted involving members of surgical teams (doctors, anaesthesia providers, nurses and support staff) from the UTH surgical departments. Purposive sampling was used and 16 in-depth interviews were conducted between December 2018 and March 2019. Data were transcribed, organised and analysed using thematic analysis. RESULTS: Analysis revealed variability in implementation of the SSC by surgical teams, which stemmed from lack of senior surgeon ownership of the initiative, when the SSC was introduced at UTH 5 years earlier. Low utilisation was also linked to factors such as: negative attitudes towards it, the hierarchical structure of surgical teams, lack of support for the SSC among senior surgeons and poor teamwork. Further determinants included: lack of training opportunities, lack of leadership and erratic availability of resources. Interviewees proposed the following strategies for improving SSC utilisation: periodic training, refresher courses, monitoring of use, local adaptation, mobilising the support of senior surgeons and improvement in functionality of the surgical teams. CONCLUSION: The SSC has the potential to benefit patients; however, its utilisation at the UTH has been patchy, at best. Its full benefits will only be achieved if senior surgeons are committed and managers allocate resources to its implementation. The study points more broadly to the factors that influence or obstruct the introduction and effective implementation of new quality of care initiatives.


Subject(s)
Checklist , Hospitals, Teaching , Humans , Patient Safety , Universities , World Health Organization , Zambia
10.
J Stroke Cerebrovasc Dis ; 31(8): 106619, 2022 Aug.
Article in English | MEDLINE | ID: mdl-35780718

ABSTRACT

OBJECTIVES: There are urban-rural geographic health disparities in intracerebral hemorrhage (ICH) outcomes. However, there is limited data regarding the relationship between intensive care (ICU) availability and ICH outcomes. We examined whether ICU availability was a significant contributor to ICH outcomes by US geographic region. MATERIALS AND METHODS: We used de-identified Medicare inpatient datasets from January 2016 to December 2019 and identified all index ICH admissions, stratifying by ICU care received during the hospitalization. Distributions of teaching hospital status, quartile of ICH volume, hospital urban-rural designation, and ICU availability were obtained using chi-square test. Propensity-score matching was utilized to compare outcomes of more favorable outcome, inpatient mortality, and 30-day all-cause readmissions by ICU availability at each hospital. RESULTS: Out of a total of 119,891 hospitalizations for ICH, 66,306 (55.3%) received ICU-level care. Of hospitals that treated at least one ICH, 42.6% did not provide ICU level care for any ICH admission during the study period. Teaching hospitals (48.0% vs 7.0%; p<0.0001), hospitals with higher ICH case volumes (p<0.0001) and in larger metropolitan areas (p<0.0001) were more likely to have an ICU available. Propensity score-matched models showed that hospital ICU availability was associated with a lower likelihood of inpatient mortality (29.4% vs 33.7%; p=0.0016) CONCLUSIONS: Rural-urban disparities in ICH outcomes are likely multifactorial, but ICU availability likely contributes to the disparity. Additional studies are necessary to elucidate other contributing mechanisms.


Subject(s)
Intensive Care Units , Medicare , Aged , Cerebral Hemorrhage/diagnosis , Cerebral Hemorrhage/therapy , Critical Care , Hospital Mortality , Hospitals, Teaching , Humans , Retrospective Studies , United States/epidemiology
11.
Indian J Public Health ; 66(2): 147-151, 2022.
Article in English | MEDLINE | ID: mdl-35859496

ABSTRACT

Background: Despite several efforts to limit the viral transmission, the COVID-19 vaccine has been the only "the ray of hope" to end the pandemic. However, vaccine hesitancy could reduce coverage and hinder herd immunity. People's intention to get vaccinated can be shaped by several factors, including risk perception which, in turn, is influenced by effect. The need to acquaint oneself to the beliefs, concerns, and circumstances of one's own population in the community becomes important for successful implementation of the program. Therefore, the present study was conducted to gain insights into perceptions of vaccination. Objectives: The objective is to understand the felicitating factors and hindering factors for acceptance of vaccines by the population among people aged 50 years in urban field practice area of the Department of Community Medicine in a Tertiary care teaching hospital, Hyderabad. Subjects and Methods: Data were extracted from audio recording of five focus group discussions that were conducted in the urban field practice care of a tertiary care teaching hospital in Hyderabad through open-ended questions. Categories, subcategories, and themes were created by deductive approach. Results: The motivating factors for vaccine acceptance were found to be fear of getting disease, wanting to return normalcy, and trust in treating doctors, whereas, barriers were fear of death due to vaccine, opacity in vaccine details, anxiety, and misinterpretation of adverse events. Conclusion: Having a clear understanding about the belief system of the target population could help in designing the guidelines for vaccination program to escalate the immunization and increase the acceptance.


Subject(s)
COVID-19 , Vaccines , COVID-19/prevention & control , COVID-19 Vaccines , Community Medicine , Focus Groups , Health Knowledge, Attitudes, Practice , Hospitals, Teaching , Humans , India , Patient Acceptance of Health Care , Phobic Disorders , Tertiary Healthcare , Vaccination
12.
F1000Res ; 11: 492, 2022.
Article in English | MEDLINE | ID: mdl-35811790

ABSTRACT

Background: Kikuchi-Fujimoto disease (KFD) is a rare, benign condition of unknown etiology, presenting as cervical lymphadenitis. Lymphadenopathy is usually tender and maybe associated with systemic symptoms. Despite the extensive literature on this disease, it continues to be misdiagnosed owing to its misleading clinical presentation. METHODS: A retrospective hospital-based descriptive cross-sectional study was conducted in tertiary care hospitals from 2011 to 2019. All patients with confirmed KFD diagnosis were included and after ethics committee approval the clinical details and histopathological data was retrieved from the medical records department and analyzed. RESULTS: A total of 67 cases were included. The mean age was 26.9±11.3 years with a female: male ratio of 1.9:1. There were 50 patients with tender cervical lymphadenopathy which was the most common clinical presentation. The mean length and width of palpable lymph nodes were 2.3±1.0 cm and 2.2±0.7 cm respectively. Histology revealed proliferative stage in majority of patients ( n=40, 59.7%). Lymphadenopathy resolved in 83.6% within 2 months. There were 42 patients who had complete recovery with symptomatic treatment within a period of 9 months. CONCLUSIONS: KFD is prevalent in young, female patients of Asian descent and often presents as tender cervical lymphadenopathy. Early diagnosis with excisional lymph node biopsy is crucial to avoid unnecessary investigations and treatment. Treatment is symptomatic unless complicated, where steroid therapy is considered. KFD has an excellent prognosis with almost no risk of fatality.


Subject(s)
Histiocytic Necrotizing Lymphadenitis , Lymphadenopathy , Adolescent , Adult , Cross-Sectional Studies , Female , Histiocytic Necrotizing Lymphadenitis/diagnosis , Hospitals, Teaching , Humans , Lymphadenopathy/complications , Lymphadenopathy/diagnosis , Male , Retrospective Studies , Tertiary Healthcare , Young Adult
13.
Niger J Clin Pract ; 25(7): 997-1003, 2022 Jul.
Article in English | MEDLINE | ID: mdl-35859457

ABSTRACT

Background: Zinc is particularly involved in cellular growth, neurodevelopment, and immune function, which is critical for child survival. To reduce neonatal mortality in developing countries, cost-effective and evidence-based interventions that can enhance growth, development, and immunity, need to be considered. Determining the zinc levels of neonates and how it relates to both gestational age is therefore imperative. Subjects and Methods: A descriptive cross-sectional study was carried out at the University of Nigeria Teaching Hospital, aimed at determining the umbilical cord serum zinc levels among neonates and their relationship with their gestational age. Two hundred and seventy-five neonates of gestational ages 28 to 42 weeks were enrolled in the study. Serum zinc levels were determined using the flame atomic absorption spectrophotometer (AAS model no. FS 240 AA.USA, Agilent Technology Ltd.). Results: Among the 275 neonates, there were 27 (9.82%), 28 (10.18%), and 220 (80%) preterms, moderate-to-late preterms, and term neonates, respectively. The mean serum zinc level of all neonates was 87 ± 16.07 µg/dL and within the normal limit of serum zinc. Their mean serum zinc level increased with increasing gestational age (F = 90.424, P < 0.001). Very preterm and moderate-to-late preterm neonates had mean serum zinc levels of 65.13 µg/dL ± 6.15 and 69.85 µg/dL ± 9.63 µg/dL, respectively. Conclusion: This study revealed that though the overall mean serum zinc of neonates was normal, preterms (especially those of lower gestational ages) were zinc deficient. Routine zinc supplementation at birth should be considered in preterm neonates to reduce the untoward effects of zinc deficiency.


Subject(s)
Hospitals, Teaching , Zinc , Cross-Sectional Studies , Female , Gestational Age , Humans , Infant , Infant, Newborn , Nigeria , Umbilical Cord
14.
Indian J Public Health ; 66(2): 109-112, 2022.
Article in English | MEDLINE | ID: mdl-35859490

ABSTRACT

Background: Access to pain management has been recognized as a fundamental human right. Inadequate pain relief hampers the quality of life and has a physiological and psychosocial impact on the patient and caregivers. Inadequate pain relief remains the leading cause of suffering in hospitalized patients worldwide. Objective: The objective of this article is to provide adequate pain relief to hospitalized patients through proper assessment, treatment, and monitoring of pain by the trained health-care workers through a sustainable and effective institutional pain management policy. Methods: The formulation of pain management policy at a tertiary care teaching institute was conducted in three phases - Phase 1: need assessment by an open-label, uncontrolled, prospective observational study over 1 month period, Phase 2: teaching, training, and awareness of health-care workers, and Phase 3: constitution of the committee at the institute level with the formation of pain resource teams. Results: An open-label, prospective observational study conducted over 1 month revealed that among 814 hospitalized patients, 108 out of 235 (46%) patients in medical and 385 out of 579 (66.5%) patients in the surgical cohort had NRS score of ≥3, implying an inadequate pain relief even at 24 h following medical or surgical intervention, respectively. Conclusion: The provision of effective and adequate pain relief to hospitalized patients requires trained health-care workers and a uniform and structured pain management policy at the institutional level. Recognition and addressal of the barriers and challenges while framing an institutional pain policy is of utmost importance.


Subject(s)
Hospitals, Teaching , Organizational Policy , Pain Management , Tertiary Care Centers , Humans , India , Prospective Studies
15.
Eur J Dermatol ; 32(2): 214-219, 2022 04 01.
Article in English | MEDLINE | ID: mdl-35866901

ABSTRACT

Background: The involvement of a dermatologist in inpatient care can result in accurate diagnosis and prescription of appropriate treatment more promptly. Objectives: We aimed to analyse the main reasons for dermatological inpatient consultation in a tertiary centre. Materials & Methods: A retrospective analysis was performed based on clinical registries that included inpatients observed in emergency dermatology consultation between January 1st 2016 to December 31st 2020 at the Hospital de Santa Maria, a tertiary teaching hospital in Lisbon, Portugal. Results: In our dermatology emergency department, we performed 1,052 inpatient consultations during this five-year period. The most frequent diagnostic groups were infections and parasitic diseases (31.1%), inflammatory skin disorders (18.1%) and reactive erythemas (17.7%). Requests were most commonly (85.1%) made by medical specialities. Conclusion: Inpatient dermatological consultations grant access to expert management of drug-induced dermatoses, flares of chronic skin diseases, skin manifestations of systemic diseases and cutaneous infections. Prompt dermatological evaluation is essential for early diagnosis, thus enabling a better prognosis.


Subject(s)
Dermatology , Skin Diseases , Data Analysis , Hospitals, Teaching , Humans , Inpatients , Portugal , Referral and Consultation , Retrospective Studies , Skin Diseases/diagnosis , Skin Diseases/therapy
16.
Sichuan Da Xue Xue Bao Yi Xue Ban ; 53(4): 688-695, 2022 Jul.
Article in Chinese | MEDLINE | ID: mdl-35871742

ABSTRACT

Objective: To investigate the distribution of pathogenic bacteria in blood samples and changes in their drug resistance in our hospital from 2016 to 2020, and to provide evidence for the diagnosis and treatment of clinical bloodstream infections. Methods: Bruker Corporation's matrix-assisted laser desorption ionization time-of-flight mass spectrometry (MALDI-TOF MS) was used for bacterial identification, VITEK 2 Compact was used for antimicrobial susceptibility test, some of which was done with the Kirby-Bauer method, and the data was statistically analyzed with WHONET 5.6 software. Results: A total of 8931 bacterial strains, including 4502 (50.4%) Gram-positive bacteria and 4429 (49.6%) Gram-negative bacteria, were isolated from the blood samples between 2016 and 2020. Among the isolated bacteria of the order Enterobacterales, Escherichia coli (1773, 19.9%) ranked first, followed by Klebsiella pneumoniae (1067, 11.9%). The non-fermenting bacteria identified were predominantly Acinetobacter baumannii (293, 3.3%) and Pseudomonas aeruginosa (238, 2.7%). The top three Staphylococcus species were Staphylococcus epidermidis (970 strains, 10.9%), Staphylococcus hominis (713, 8.0%) and Staphylococcus aureus (541, 6.1%). Escherichia coli showed high in vitro susceptibility to cefoperazone/sulbactam, amikacin, polymyxin B, tigecycline, and carbapenems, and the sensitivity rate was consistently over 90%. The resistance rate to imipenem showed a trend of slow growth, and the resistance rate of meropenem was 2.2% to 3.4%. Klebsiella pneumoniae showed higher in vitro resistance rate to common antibiotics than that of Escherichia coli, with only the sensitivity rates to tigecycline and polymyxin B being higher than 90%, and the resistance rate to imipenem and meropenem increasing year by year. The resistance rate of Pseudomonas aeruginosa to imipenem decreased since 2017 (from 25.6% to18.6%), and the resistance rate of Acinetobacter baumanniito imipenem and meropenem were 73.7%-91.3% and 73.0%-91.3%. Staphylococcus resistant to vancomycin or linezolid was not found. Enterococci showed rather low resistance to vancomycin and linezolid. Conclusion: The distribution of common species of pathogenic bacteria in clinical blood samples in our hospital did not show significant changes, but the problem of multi-drug resistant bacteria is becoming increasingly more serious, especially so for carbapenem-resistant Klebsiella pneumoniae.


Subject(s)
Drug Resistance, Bacterial , Vancomycin , Anti-Bacterial Agents/pharmacology , Bacteria , Escherichia coli , Gram-Negative Bacteria , Hospitals, Teaching , Imipenem , Klebsiella pneumoniae , Meropenem , Microbial Sensitivity Tests , Polymyxin B , Pseudomonas aeruginosa , Tigecycline
17.
PLoS One ; 17(7): e0271449, 2022.
Article in English | MEDLINE | ID: mdl-35839238

ABSTRACT

BACKGROUND: Community-acquired pneumonia (CAP) is a frequent cause of death worldwide, and in sub-Saharan Africa particularly. Human immunodeficiency virus infection (HIV) and tuberculosis (TB) influence pathogen distribution in patients with CAP. Previous studies in sub-Saharan Africa have shown different frequencies of respiratory pathogens and antibiotic susceptibility compared to studies outside Africa. This study aimed to investigate the aetiology, presentation, and treatment outcomes of community-acquired pneumonia in adults at the University Teaching Hospital in Lusaka, Zambia. MATERIALS AND METHODS: Three-hundred-and-twenty-seven patients were enrolled at the University Teaching Hospital in Lusaka between March 2018 and December 2018. Clinical characteristics and laboratory data were collected. Sputum samples were tested by microscopy, other TB diagnostics, and bacterial cultures. RESULTS: The commonest presenting complaint was cough (96%), followed by chest pain (60.6%), fever (59.3%), and breathlessness (58.4%). The most common finding on auscultation of the lungs was chest crackles (51.7%). Seventy percent of the study participants had complaints lasting at least a week before enrolment. The prevalence of HIV was 71%. Sputum samples were tested for 286 patients. The diagnostic yield was 59%. The most common isolate was Mycobacterium tuberculosis (20%), followed by Candida species (18%), Klebsiella pneumoniae (12%), and Pseudomonas aeruginosa (7%). Streptococcus pneumoniae was isolated in only four patients. There were no statistically significant differences between the rates of specific pathogens identified in HIV-infected patients compared with the HIV-uninfected. Thirty-day mortality was 30%. Patients with TB had higher 30-day mortality than patients without TB (p = 0.047). CONCLUSION: Mycobacterium tuberculosis was the most common cause of CAP isolated in adults at the University Teaching Hospital in Lusaka, Zambia. Gram-negative organisms were frequently isolated. A high mortality rate was observed, as 30% of the followed-up study population had died after 30 days.


Subject(s)
Community-Acquired Infections , HIV Infections , Mycobacterium tuberculosis , Pneumonia , Tuberculosis , Adult , Community-Acquired Infections/diagnosis , Community-Acquired Infections/epidemiology , HIV Infections/complications , HIV Infections/epidemiology , Hospitals, Teaching , Humans , Pneumonia/diagnosis , Pneumonia/epidemiology , Prognosis , Tuberculosis/diagnosis , Tuberculosis/drug therapy , Tuberculosis/epidemiology , Universities , Zambia/epidemiology
18.
Sex Reprod Health Matters ; 30(1): 2088058, 2022 Dec.
Article in English | MEDLINE | ID: mdl-35848504

ABSTRACT

There is evidence that women in Ethiopia often face disrespect and abuse in health care facilities during childbirth. Disrespect and abuse (D&A) violate women's right to dignified, respectful health care and decrease their trust in health care facilities. There is a need for more insight into women's perspectives on D&A during childbirth in different contexts. Therefore, this study aimed to explore women's perspectives on D&A during childbirth in a teaching hospital in South-West Ethiopia. A qualitative study was conducted from November 2017 to February 2018 using in-depth interviews and focus group discussions. Postnatal women were purposively chosen and scheduled for interviews six weeks postpartum. Data saturation occurred once 32 women were interviewed, and four focus group discussions were conducted. A thematic analysis method was used to analyse the data using MAXQDA qualitative analysis software. Three main themes emerged from the data: disrespect and abuse, its contributors, and perceived consequences. The subthemes of D&A include neglected care, non-consented care, physical abuse, lack of privacy, loss of autonomy, objectification, lack of companionship, and verbal abuse. The subthemes of contributors include health care provider-related, health care system-related, and women-related contributors. The subthemes of perceived consequences include the fear of using health care facilities. Women in Ethiopia experienced D&A. Health system factors, such as the teaching environment and scarcity of supplies, contribute the most to the identified D&A. Therefore, providers, administrators, training institutions, and researchers must collaborate to address these health system factors to reduce disrespect and abuse during childbirth in teaching hospitals.


Subject(s)
Maternal Health Services , Attitude of Health Personnel , Ethiopia , Female , Hospitals, Teaching , Humans , Pregnancy , Professional-Patient Relations
19.
PLoS One ; 17(7): e0271771, 2022.
Article in English | MEDLINE | ID: mdl-35900982

ABSTRACT

BACKGROUND: Ethiopia is among sub-Saharan African countries with a high number of malaria cases each year, with most of the landmass favoring the breeding of the vectors. There have been extensive efforts to control and prevent the transmission of malaria, which is part of the country's prevention-based health policy. OBJECTIVE: This study aimed to determine malaria prevalence and associated risk factors among patients visiting Mizan-Tepi University Teaching Hospital (MTUTH). MATERIALS AND METHODS: A cross-sectional study was conducted from September to December 2021 among patients visiting MTUTH, Southwest Ethiopia. A pretested structured questionnaire was used to collect sociodemographic data, and a capillary blood sample was collected after obtaining written informed consent from the study participants. The data were entered into Epi-data manager (v4.0.2.101) and analyzed with SPSS version 25.0, with a P-value of < 0.05 set as a significance. RESULTS: A total of 439 patients participated, of which 20.7% (91) were positive for malaria parasites, with a higher prevalence observed among the age group interval of 25-34 years (5.5%). Inadequate access to insecticide-treated bed net (ITN) 23.9% (105) and a low level of ITN usage 20.5% (90) were recorded. Patients living in areas of stagnant water were more likely to get infected with the malaria parasite (AOR = 16.191, 95% CI: 9.137, 28.692) compared to those who live away from stagnant water, and individuals living in houses not sprayed with insecticides were more susceptible to malaria infection (AOR = 0.215, 95% CI: 0.128, 0.360). CONCLUSION: The overall malaria prevalence in this study was 20.7% (91), which proves that malaria remains a major threat to the communities in the study area, with Plasmodium falciparum contributing to most of the cases. Improving the habits of ITN usage and indoor residual spray through health education may help to reduce the impact of malaria in the study area.


Subject(s)
Malaria , Adult , Cross-Sectional Studies , Ethiopia/epidemiology , Hospitals, Teaching , Humans , Malaria/epidemiology , Malaria/prevention & control , Prevalence , Risk Factors , Universities , Water
20.
PLoS One ; 17(7): e0263948, 2022.
Article in English | MEDLINE | ID: mdl-35901057

ABSTRACT

BACKGROUND: Coagulation abnormality is a significant complication and cause of mortality in children with uncorrected congenital heart defects (CHD). The aim of this study was to determine the prevalence of coagulation abnormalities and the associated factors in children with uncorrected CHD. METHOD: A cross sectional study conducted to determine the prevalence of coagulation abnormalities among 70 children with uncorrected CHD aged six months to 17 years and 70 age and sex matched apparently healthy controls. Coagulation abnormalities was determined using complete blood count, prothrombin time, activated partial thromboplastin time and D-dimer assay. RESULTS: The prevalence of coagulation abnormalities among children with CHD and controls was 37.1% and 7.1% respectively. Children with Cyanotic CHD had a significantly higher prevalence of coagulation abnormalities compared to children with Acyanotic CHD (57.1% versus 17.1%). Haematocrit and oxygen saturation levels were significantly associated with coagulation abnormalities. CONCLUSION: This study affirms that coagulation abnormalities are frequent in children with uncorrected CHD. Oxygen saturation and haematocrit are risk factors of coagulation abnormalities. Routine coagulation screen is recommended especially in children with cyanotic congenital heart defects to improve their quality of life and reduce morbidity and mortality while awaiting definitive surgeries.


Subject(s)
Blood Coagulation Disorders , Heart Defects, Congenital , Blood Coagulation Disorders/complications , Child , Cross-Sectional Studies , Cyanosis/complications , Developing Countries , Heart Defects, Congenital/surgery , Hospitals, Teaching , Humans , Infant , Quality of Life
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