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1.
J Assoc Physicians India ; 67(10): 20-24, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31571446

RESUMO

Background: Polycythemia is characterized by rise in hemoglobin and hematocrit, either as a result of hematopoietic clonal expansion (Vera) or secondary to hypoxic stimuli (secondary polycythemia).It is of great importance to detect early and identify the type of polycythemia and also asses the thrombotic risk so that timely and appropriate treatment can be given. The present study aims to characterize the different presentations and complications of polycythemia, evaluate genetic factors and differences between the two categories of polycythemia in ethnic Goan subjects. Aims and objectives: 1. To identify common presentations and etiologies of polycythemia 2. To evaluate and compare the differences in clinical features, hematological parameters and complications of polycythemia in primary (vera) and secondary polycythemia 3. To study the profile of JAK 2 V617F mutation in Goan patients with polycythemia Vera. Materials and Methods: This was a retrospective observational cohort study, conducted at the Department of Internal Medicine, Goa Medical College, a tertiary care, teaching institute in the state of Goa. We analysed clinical and laboratory data of patients of polycythemia due to all causes (polycythemia Vera and secondary causes) previously admitted or following up at the hospital from January 2014 to December 2017. In each of these 2 groups, we studied the various clinical parameters including the age at presentation,sex,residence, symptomatology and clinical findings,presence of hypertension, as well as complications arising due to polycythemia (past and at present) hematological data including Hb,HCT, total WBC count, absolute neutrophil count, RBC and platelet count, ESR, rouleaux formation, EPO levels and JAK 2 V617F mutation analysis (done by real time PCR technique) and requirement of phlebotomies in the last 4 years. Commonest clinical presentations and complications arising due to polycythemia, in each group were analysed and compared. Results: A total of 44 patients were included in the study out of which 33 were males. Polycythemia Vera was seen in 43.18% while secondary causes were seen in 56.8 % patients. Patients with Vera were found to be more symptomatic with higher levels of mean Hb, HCT, cell counts and with a higher requirement of phlebotomy and more thrombotic complications. Amongst Vera group, patients having high WBC count, increased Rouleau formation, and JAK2 positivity were found to be more prone for thrombosis. Hypertension was frequently seen to be associated with both groups. Obstructive sleep apnea followed by COPD was found to be the commonest causes of secondary polycythemia. Conclusion: Our study revealed that patients with polycythemia Vera are more symptomatic and have a higher requirement of phlebotomy and a higher thrombotic tendency (arterial being more common than venous) as compared to the secondary polycythemia owing to a higher hyperviscocity in the former. Leukocytosis and JAK 2 617F positivity were found to be important predictors of thrombotic risk. Hypertension was found to be frequently associated with Vera as well as in secondary causes due to OSA.


Assuntos
Policitemia/epidemiologia , Estudos de Coortes , Humanos , Índia , Masculino , Policitemia Vera , Estudos Retrospectivos , Centros de Atenção Terciária
2.
Pan Afr Med J ; 33: 183, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31565143

RESUMO

Introduction: There is a great scarcity of literature in Pakistan investigating the proportion of end stage renal disease (ESRD) patients undergoing hemodialysis (HD) who meet the recommended kidney diseases outcome quality initiative (K/DOQI) guidelines for serum calcium (Ca), phosphorus (P), calcium phosphorus product (Ca x P) and parathyroid hormone (PTH) levels. Our study aimed to determine frequencies of patients who met the K/DOQI targets for these minerals at a tertiary care hospital's dialysis unit. Methods: 111 ESRD patients on maintenance HD were selected from a tertiary care hospital. Serum Ca and P were assayed on chemistry analyser. PTH was measured through electrochemiluminescence sandwich method. Data were compared with K/DOQI targets and analysed using SPSS-21. Results: The mean age of patients was 55.85 years (SD ± 13.95). Gender distribution was almost equal with 49.5% males and 50.5% females. The patients had mean corrected serum Calcium 9.12 ± 0.64 mg/dL, Phosphorus 4.57 ± 1.54 mg/dL and Parathyroid hormone 333.8 ± 278.4 pg/mL. The patients had achieved K/DOQI target ranges of Ca, P, PTH, Ca x P product and all 4 criteria in 63.1%, 47.6%, 38.7%, 84.7% and 10.8% respectively. Conclusion: Majority of patients on maintenance HD at our institution did not achieve the recommended K/DOQI target ranges. Further studies pertaining to the Asian subcontinent will prove resourceful for comparison of mineral metabolism and dialysis outcome of ESRD patients.


Assuntos
Cálcio/sangue , Falência Renal Crônica/terapia , Hormônio Paratireóideo/sangue , Fósforo/sangue , Diálise Renal/métodos , Adulto , Idoso , Estudos Transversais , Técnicas Eletroquímicas , Feminino , Humanos , Medições Luminescentes , Masculino , Pessoa de Meia-Idade , Paquistão , Guias de Prática Clínica como Assunto , Centros de Atenção Terciária
3.
Pan Afr Med J ; 33: 186, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31565146

RESUMO

Introduction: Acute gastroenteritis (AGE) is a leading cause of mortality in children in developing countries. Management of AGE consumes medical resources, including antibiotics and intra-venous fluids, but factors affecting resource utilization in the management of AGE are under-studied. We hope to identify clinical predictors of resource utilization in AGE. Methods: We performed a retrospective chart review of patients 1-60 months of age admitted to a tertiary hospital in Northern Ghana between January 2013 and December 2014 with an admitting diagnosis of AGE. We collected data on patient demographics, presenting symptoms, and subsequent management. Our primary outcome was prolonged hospital length of stay, defined as >4 days. Secondary outcomes included other measures of resource utilization, such as use of antibiotics, antimalarials and intravenous fluids. Demographic and clinical characteristics were compared between groups with Pearson chi square test for categorical variables and ANOVA for continuous variables. Multivariable logistic regression modeling for each outcome included all variables found to be significant in the bivariate analysis. Results: We reviewed charts for 473 patients admitted for AGE during this timeframe. 264 (56%) were male, median age was 12 months. 448 (95%) received antibiotics, 396 (84%) received antimalarials and 365 (77.2%) received intravenous fluids. 167 (35.3%) had prolonged LOS >4 days. Following multiple logistic regression analysis, clinical features associated with prolonged LOS included fever duration (OR 2.87, 95% CI 2.28-3.61 per 1-day increase), mild (OR 2.39, 95% CI 1.12-5.08) or moderate (OR 3.13, 95% CI 1.57-6.21) dehydration (compared to none) and symptom duration (OR 1.13, 95% CI 1.01-1.27 per 1-day increase). Conclusion: Dehydration and duration of symptoms prior to presentation predict prolonged hospital LOS in young children with AGE in Northern Ghana.


Assuntos
Desidratação/terapia , Gastroenterite/terapia , Hospitalização/estatística & dados numéricos , Doença Aguda , Antibacterianos/administração & dosagem , Antimaláricos/administração & dosagem , Pré-Escolar , Desidratação/epidemiologia , Feminino , Febre/epidemiologia , Hidratação/estatística & dados numéricos , Gana , Recursos em Saúde/estatística & dados numéricos , Humanos , Lactente , Tempo de Internação/estatística & dados numéricos , Modelos Logísticos , Masculino , Estudos Retrospectivos , Centros de Atenção Terciária
4.
Bone Joint J ; 101-B(10): 1280-1284, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31564150

RESUMO

AIMS: A number of methods have been described to remove a well-fixed humeral implant as part of revision shoulder arthroplasty. These include the use of cortical windows and humeral osteotomies. The router bit extraction technique uses a high-speed router bit to disrupt the bone-implant interface. The implant is then struck in a retrograde fashion with a square-tip impactor and mallet. The purpose of this study was to determine the characteristics and frequency of the different techniques needed for the removal of a well-fixed humeral stem in revision shoulder arthroplasty. PATIENTS AND METHODS: Between 2010 and 2018, 288 revision shoulder arthroplasty procedures requiring removal of a well-fixed humeral component were carried out at a tertiary referral centre by a single surgeon. The patient demographics, indications for surgery, and method of extraction were collected. RESULTS: Of the 288 revisions, 284 humeral stems (98.6%) were removed using the router bit extraction technique alone. Four humeral stems (1.39%) required an additional cortical window. Humeral osteotomy was not necessary in any procedure. Most of the humeral stems removed (78.8%) were cementless. Of the four humeral stems that required a cortical window, three involved removal of a hemiarthroplasty. Two were cemented and two were cementless. CONCLUSION: The router bit extraction technique removed a well-fixed humeral component in a very high proportion of patients (98.6%). This method allows surgeons to avoid more invasive approaches involving a cortical window or humeral osteotomy, and their associated complications. Cite this article: Bone Joint J 2019;101-B:1280-1284.


Assuntos
Artroplastia do Ombro/efeitos adversos , Remoção de Dispositivo/métodos , Hemiartroplastia/métodos , Falha de Prótese , Idoso , Artroplastia do Ombro/métodos , Estudos de Coortes , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Recuperação de Função Fisiológica/fisiologia , Sistema de Registros , Estudos Retrospectivos , Medição de Risco , Prótese de Ombro/efeitos adversos , Centros de Atenção Terciária , Fatores de Tempo , Resultado do Tratamento
6.
J Assoc Physicians India ; 67(9): 14-16, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31561681

RESUMO

Aims: To study the clinical, radiological, cerebrospinal fluid profile of noncompressive myelopathy and to study various etiologies of non-compressive myelopathies in causation of quadriplegia and paraplegia. Study Design: Observational study. Place and Duration of Study: Department of Neurology, Govt. Medical College, Kota in year 2015 and 2016. Methodology: All the patients presented with myelopathy and MRI spine not showing any significant compression included in study. To know the etiology of non-compressive myelopathy patients were investigated including routine blood tests, cerebrospinal fluid analysis and visual evoked potentials, MRI of the brain, and immunological, infectious, and metabolic profile based on the pattern of involvement. Results: The study had 80 patients with a median age of 38 years and male: female ratio 1.5:1. Patients were divided into acute myelopathy and chronic myelopathy. Forty four patients presented with acute myelopathy whereas 36 patients had chronic myelopathy. The causes of Acute myelopathy were post infectious myelitis (13), neuromyelitis optica spectrum disorder (NMOSD) (6), multiple sclerosis (MS) (2), connective tissue disorders (1), acute disseminated encephalomyelitis (4) and Idiopathic (18). The causes of Chronic myelopathy were Vitamin B12 deficiency (8), MS (2), mixed connective tissue disease (1), Copper deficiency (1), hepatic myelopathy (1), radiation (1), hereditary spastic paraparesis (1) and idiopathic (21). Conclusion: Underlying etiology like demyelinating, infectious/post infectious, autoimmune or nutritional was found in 52% patients of non-compressive myelopathy.


Assuntos
Doenças da Medula Espinal/epidemiologia , Adulto , Potenciais Evocados Visuais , Feminino , Humanos , Masculino , Mielite Transversa , Neuromielite Óptica , Doenças da Medula Espinal/etiologia , Centros de Atenção Terciária
7.
J Assoc Physicians India ; 67(9): 27-29, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31561684

RESUMO

Introduction: Hepatitis B (HBV) and Hepatitis C (HCV) are two common viral infections causing cirrhosis. Aim: The aim of this study was to find the seroprevalence of HBV and HCV along with occurrence of co-infection of HBV and HCV in patients attending a tertiary care hospital. Materials and Methods: The study was done for a period of one year (January to December 2016) in the Department of Microbiology, Medical College, Kolkata. After obtaining ethical clearance and informed consent from the patients, serum samples were collected from all patients referred to Department of Microbiology for antibody to HCV and Hepatitis B surface antigen (HBsAg) screening. ELISA was performed for anti HCV antibody and HBsAg. The results and relevant clinical information were noted and analysis was done. Results: A total of 10802 samples were received, of which 316 (2.92 %) were HBsAg positive, 115 (1.06%) were HCV antibody positive and a total of 7 (0.07%) patients were positive both for HBsAg and Anti HCV antibody. There was male preponderance. Anti HCV antibody was more common in age below 10 years and in thalassemia patients. Out of 7 patients positive for both, 5 patients were on regular blood transfusion due to beta thalassemia and 2 patients had history of chronic liver disease. Conclusion: In this study, it was found that there was seroprevalence of 2.92 % of HBsAg, 1.06% of HCV antibody and 0.07% positive both for HBsAg and HCV antibody among the patients of a tertiary care centre in Eastern India.


Assuntos
Coinfecção , Infecções por HIV/epidemiologia , Hepatite B/epidemiologia , Hepatite C/epidemiologia , Humanos , Índia/epidemiologia , Masculino , Estudos Soroepidemiológicos , Centros de Atenção Terciária
8.
J Assoc Physicians India ; 67(9): 34-38, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31561686

RESUMO

Context: The MCI has laid down a basic framework for interns, which it expects all prospective doctors to be well versed in. Asking students to demonstrate their understanding of the subject, ability to think critically, analyze, infer and act accordingly is imperative to the learning process. Aims: To assess competency levels in medical interns post internship via a questionnaire developed based on MCI framework and departmental expectations of clinical capabilities. Settings and Design: This descriptive cross-sectional study was done in a tertiary care hospital involving 74 interns nearing end of internship in the year 2017. Methods and Material: A questionnaire consisting of core competencies such as professionalism, communication skills, learning competency, clinical problem solving amongst others was provided to each and competency levels were assessed against a pre-defined scale. Answers were graded as Poor, Average, Good and Excellent with corresponding numerical equivalents 0, 1, 2 and 3 respectively. Statistical analysis used: The values obtained were analysed using Weighted Sum technique through Microsoft Excel tool. Results: An ideal average competency score was initially established and overall competency of each intern was adjudged against the same. Out of 74 candidates that answered the questionnaire, a vast majority of 50 were found at below average competency. Cardio pulmonary resuscitation was known only to 13 students. Around 50 students were severely lacking with regards to knowledge about the use of preferred antibiotic in sepsis and seizures. Conclusion: There seems to exist significant disconnect in the expectations of MCI on one hand and actual knowledge and skill acquisition of the doctors on other. A departmental wise curriculum and exams at the end of each departmental posting which is more skill based will enable a well-trained doctor with reasonable skills and knowledge to obtain his license to practice.


Assuntos
Competência Clínica , Internato e Residência , Estudos Transversais , Humanos , Índia , Estudos Prospectivos , Inquéritos e Questionários , Centros de Atenção Terciária
9.
J Assoc Physicians India ; 67(9): 42-45, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31561688

RESUMO

Introduction: The incidence of the urinary tract infections caused by Candida species, are becoming more common. Recently, an increase in the incidence of infection caused by fungi especially non albicans candida species (NAC) has been reported. Several virulence factors like biofilm formation, toxin production and presence of adhesins contribute to its pathogenesis. Objectives: This study was undertaken to determine species distribution, biofilm formation and in-vitro antifungal susceptibility of candida isolated in our tertiary care hospital. Method: Eighty seven clinical isolates obtained from urine specimens were subjected to wet mount, Gram's stain and cultured on Sabouraud's Dextrose agar (SDA) medium. Conventional method for yeast identification was done. Biofilm forming ability of each isolate was detected using microtitre plate method. Antifungal susceptibility against posaconazole, amphotericin-B, fluconazole, itraconazole, ketoconazole, 5-flucytosine, voriconazole, and caspofungin was tested using Sensititre® Yeastone® (Trek diagnostic systems). Results and Discussion: Out of 87 candida isolates, 31.03% (n=27) were C. albicans and 68.97% (n=60) were non albicans candida species (NAC). Among 60 NAC, C. kruseii 29.89% (n=26), C. glabrata 24.14% (n=21), C. tropicalis 14.94% (n=13). Among all isolates, 36.78% (n=32) were biofilm producers and biofilm positivity more among C. albicans 55.56% (n=15) as compared to NAC 28.33% (n=17) (Pvalue<0.002). The maximum positivity was observed with isolates from plastic devices (61.8%). The minimum inhibitory concentrations of all antifungal drugs against all isolates were within susceptible range except for fluconazole which was resistant to C. kruseii. Conclusion: C. albicans remains the major isolate from urine samples and also biofilm formation as a virulence factor might have a higher significance for C. albicans than for NAC and its ability to form biofilm is intricately linked with ability of organisms to adhere, colonize and subsequently cause infection.


Assuntos
Antifúngicos/uso terapêutico , Biofilmes/crescimento & desenvolvimento , Candida/efeitos dos fármacos , Infecções Urinárias/tratamento farmacológico , Antifúngicos/farmacologia , Candida/isolamento & purificação , Humanos , Testes de Sensibilidade Microbiana , Centros de Atenção Terciária , Infecções Urinárias/microbiologia
10.
J Assoc Physicians India ; 67(8): 31-34, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31562713

RESUMO

Background: To evaluate the diagnostic accuracy of the Xpert MTB/RIF assay for the detection of M. tuberculosis in pulmonary and extra pulmonary specimens and to compare it with conventional techniques. Methods: A prospective study was conducted with the introduction of GeneXpert in a tertiary care hospital which relied on microscopy and culture for diagnosis of tuberculosis. All patients for whom geneXpert was ordered by the physician were included in the study. Samples which did not have accompanying microscopy or MGIT culture requests were excluded from the analysis of the results. Sensitivity and specificity of GeneXpert was calculated using liquid culture as the reference test. Results: Xpert MTB/RIF assay was performed on 742 samples of which 116 were positive for Mycobacterium tuberculosis. Rifampicin resistance was seen in 6 samples. The pulmonary samples showed a positivity rate of 16.8% while 17.1% of the extrapulmonary samples were positive by GeneXpert. A comparative analysis of microscopy, liquid culture and GeneXpert could be done for 88 samples. Of the 88 geneXpert positive samples, 42 were positive by smear microscopy and MGIT culture while 46 showed discordant results. Of these, 18 samples were positive by geneXpert but showed no growth in MGIT culture. 15 of these patients had undergone anti-tuberculous treatment (ATT) within the past 12 months. The sensitivity of geneXpert was 89.7% and specificity was 95.1% when compared to liquid culture as a gold standard. Sensitivity for extrapulmonary samples was 85.7% and specificity was 98.05%. Conclusion: To conclude, though GeneXpert detects tuberculosis within the shortest possible time, it still suffers from intermediate level sensitivity, which makes culture facilities relevant even in settings that offer an Xpert/Rif assay.


Assuntos
Bioensaio/métodos , Mycobacterium tuberculosis , Centros de Atenção Terciária , Tuberculose/diagnóstico , Farmacorresistência Bacteriana/genética , Humanos , Índia , Microscopia , Estudos Prospectivos , Rifampina , Sensibilidade e Especificidade , Escarro , Tuberculose/microbiologia
11.
BMC Surg ; 19(1): 139, 2019 Sep 18.
Artigo em Inglês | MEDLINE | ID: mdl-31533694

RESUMO

BACKGROUND: Chronic pancreatitis is a progressive and persistent inflammatory disease resulting in pancreatic insufficiency leading to diabetes and steatorrhea. Abdominal pain is the most debilitating feature and is often refractory to treatment. Medical management with adequate analgesia and replacement of pancreatic enzyme supplements is the first line in management of chronic pancreatitis. Surgery is reserved for those who fail medical management. The choice of surgical procedure and timing of surgery is a topic of debate. The objective of this study was to analyze surgical safety along with short- and long- term outcomes of Frey's procedure for patients suffering from chronic pancreatitis. METHODS: This was a retrospective review of cases of chronic pancreatitis who underwent Frey's procedure from 2016 January to 2019 February at Tribhuvan University Teaching Hospital. Demographics, intraoperative findings, perioperative outcomes, and short- and long-time outcomes were analyzed. RESULTS: Total of 26 patients (age ranged 17-52, male - 14) underwent Frey's procedure in the study period. Alcohol was etiology in six patients while the majority (76.9%) were nonalcoholic. Half of the patients had tropical pancreatitis. Intractable pain was present in all cases along with pseudocyst in three and pseudoaneurysm in one case. The mean preoperative Izbicki scores were 53.4 ± 17.6. Six patients had diabetes and two patients had steatorrhea. Major complications were seen in 11.5% of cases while mortality was in one patient. The median duration of the hospital stay was seven days. Over a median follow up of 17 months (range, 3-38), there were significantly lower pain scores postoperatively and 92% were pain-free. Only one new case of diabetes developed postoperatively. CONCLUSION: Our early experiences suggests that Frey's procedure can be a safe option for patients with chronic pancreatitis, with acceptable perioperative morbidity with adequate pain relief without worsening of pancreatic endocrine and exocrine function.


Assuntos
Pancreatectomia/métodos , Pancreaticojejunostomia/métodos , Pancreatite Crônica/cirurgia , Adolescente , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Nepal , Pancreatite Crônica/etiologia , Estudos Retrospectivos , Centros de Atenção Terciária , Resultado do Tratamento , Adulto Jovem
12.
J Assoc Physicians India ; 67(7): 22-24, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31559763

RESUMO

Background: Cardiovascular disease (CVD) is the leading cause of mortality in patients with rheumatoid arthritis (RA). Along with traditional cardiovascular risk factors and systemic inflammation, metabolic syndrome (MetS) contributes to CVD and increased mortality in patients with RA. In this study we determine the prevalence of MetS in RA patients presenting to a tertiary care centre in north India. Methods: This is a case control study involving 114 patients of RA with disease duration of ≥1 year and 114 healthy controls who are age and sex matched. Components of MetS were assessed in all the subjects and disease activity of RA was determined by DAS28-ESR. MetS was defined according to modified ATP-III criteria and consensus definition of metabolic syndrome for adult Asian Indians. Results: Women constituted 81.6% in RA group and 80.5% in control group. Mean age of subjects was 44.81±12.7 years in RA group and 43.27±12.6 years in control group. According to modified ATP-III criteria, 36 (31.6%) RA subjects and 17 (14.9%) controls had MetS (p=0.03). According to the consensus definition of metabolic syndrome for adult Asian Indian criteria, 40 (35.1%) RA subjects and 18 (15.8%) controls had MetS (P=0.01). There was no significant difference in disease activity between subjects of RA with or without MetS (p=0.276). Conclusion: The prevalence of MetS was higher in RA subjects compared to controls. There is no association of MetS with disease activity in our cohort. Larger studies are needed to determine the relation between MetS and disease activity.


Assuntos
Artrite Reumatoide/epidemiologia , Síndrome Metabólica/epidemiologia , Adulto , Estudos de Casos e Controles , Feminino , Humanos , Índia/epidemiologia , Pessoa de Meia-Idade , Prevalência , Fatores de Risco , Centros de Atenção Terciária
13.
J Assoc Physicians India ; 67(7): 30-33, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31559765

RESUMO

Objectives: Individual with diabetes may have several from of Dyslipidemia. Dyslipidemia has been considered to be factor that plays a risk in progression of micro vascular disease, especially in diabetes.1 The present study is intended to Study of correlation between Apolipoprotein B and Dyslipidemia in type 2 diabetes patients and prevalence of dyslipidemia in type 2 diabetic patients. Material and Methods: Prospective cross- sectional study conducted on 100 cases of type 2 diabetes mellitus. Groups are divided according to A/C ratio and association of dyslipidemia was seen. Serum Apolipoprotein B was measured using immunoturbidimetric method. Results: Pearson's correlation analysis of Apo B with lipid parameters in diabetic patients showed that, LDL, TC and Tg were positively correlated with Apo- B. There was a positive and linear correlation between LDL and Tg. Apo- B was negatively correlated with HDL-C. Conclusion: The majority of patients studied had low HDL-C, elevated non HDL- C, elevated total cholesterol, elevated triglycerides, elevated LDL -C and elevated apo B. Apolipoprotein B had a positive linear correlation with total cholesterol, triglycerides, LDL-C, non-HDL-C. The strongest positive correlation was with nonHDL-C. Patients with low HDL-C had high apo B levels.


Assuntos
Apolipoproteínas B/metabolismo , Diabetes Mellitus Tipo 2/epidemiologia , Dislipidemias/epidemiologia , Proteinúria/metabolismo , HDL-Colesterol , Humanos , Estudos Prospectivos , Centros de Atenção Terciária , Triglicerídeos
14.
Pan Afr Med J ; 33: 91, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31489069

RESUMO

Introduction: Haemodialysis (HD) which is a form of renal replacement therapy commonly prescribed for patients with chronic kidney disease (CKD). However, it is not without deleterious haemodynamic responses which may occur either during or immediately after the termination of the procedure. These may include hypotension or hypertension. Methods: This was a retrospective study that reviewed chronic kidney disease (CKD) patients on maintenance haemodialysis at the renal unit of University of Calabar Teaching Hospital, Calabar, Nigeria. In all, 71 patients were reviewed but only 64 patients had complete data for analysis. Socio-demographic, clinical and biochemical data were obtained from the records in the dialysis unit. Results: There were more males 38 (59.4%) than females 26 (40.6%) in the study. The mean age was 51.71±15.43 years and 43.04±14.03years for males and females respectively. The prevalence of intradialysis hypertension 29 (45.3%) was higher than that of intradialysis hypotension 20 (31.3%) and the commonest cause of CKD requiring haemodialysis was diabetic nephropathy. The factors associated with intradialysis hypotension were lower post-dialysis systolic blood pressure (PDSBP), diastolic blood pressure (DBP), mean arterial pressure (MAP) and less number of antihypertensive medications; while the factors associated with intradialysis hypertension were higher post-dialysis systolic blood pressure (SBP), MAP, greater number of antihypertensive medications and longer duration of haemodialysis. Conclusion: Our study shows that there are several modifiable factors associated with blood pressure fluctuations among CKD patients on maintenance haemodialysis in the renal unit of the University of Calabar Teaching Hospital, Calabar.


Assuntos
Hipertensão/epidemiologia , Hipotensão/epidemiologia , Diálise Renal/métodos , Insuficiência Renal Crônica/terapia , Adolescente , Adulto , Idoso , Anti-Hipertensivos/administração & dosagem , Pressão Sanguínea , Feminino , Hospitais de Ensino , Humanos , Hipertensão/etiologia , Hipotensão/etiologia , Masculino , Pessoa de Meia-Idade , Nigéria , Prevalência , Estudos Retrospectivos , Fatores de Risco , Centros de Atenção Terciária , Fatores de Tempo , Adulto Jovem
15.
Rev Col Bras Cir ; 46(4): e2211, 2019 Sep 09.
Artigo em Português, Inglês | MEDLINE | ID: mdl-31508734

RESUMO

OBJECTIVE: to evaluate the applicability of the "Timing of Acute Care Surgery" (TACS) color classification system in a tertiary public hospital of a developing country. METHODS: we conducted a longitudinal, retrospective study in a single center, from March to August 2016 and the same period in 2017. We opted for the selection of four surgical specialties with high demand for emergencies, previously trained on the TACS system. For comparisons with the previous classifications, we considered emergencies as reds and oranges and urgencies, as yellow, with an ideal time interval for surgery of one hour and six hours, respectively. RESULTS: non-elective procedures accounted for 61% of the total number of surgeries. The red, orange and yellow classifications were predominant. There was a significant improvement in the time before surgery in the yellow color after the TACS system. Day and night periods influenced the results, with better ones during the night. CONCLUSION: this is the first study to use the TACS system in the daily routine of an operating room. The TACS system improved the time of attendance of surgeries classified as yellow.


Assuntos
Tratamento de Emergência/classificação , Triagem/métodos , Brasil , Cor , Emergências , Tratamento de Emergência/estatística & dados numéricos , Humanos , Estudos Longitudinais , Sistemas de Informação em Salas Cirúrgicas , Salas Cirúrgicas , Estudos Retrospectivos , Especialidades Cirúrgicas/classificação , Especialidades Cirúrgicas/estatística & dados numéricos , Procedimentos Cirúrgicos Operatórios/classificação , Procedimentos Cirúrgicos Operatórios/estatística & dados numéricos , Centros de Atenção Terciária , Fatores de Tempo
16.
Niger Postgrad Med J ; 26(3): 169-173, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31441455

RESUMO

Background: Intussusception in adults is considered rare in surgical practice. It is the causative lesion in a small proportion of cases of intestinal obstruction and lower gastrointestinal bleeding. In the last decade, the incidence of adult intussusception appears to be increasing at our centre. Aims: This study aims to document the pattern of presentation and management outcome of adult intussusception at our institution during the last decade. We also observed the occurring trends of this lesion. Patients and Methods: This was a 10-year retrospective study of consecutive adult patients with intussusception seen at our institution from July 2008 to June 2018. Information on biodata, clinicopathological features and management outcome retrieved from case notes and pathology records were analysed on a personal computer using SPSS version 23. Results: Twenty adult patients who had intussusception were seen during this period. There were 9 (45%) males and 11 (55%) females giving a male-to-female ratio of 1:1.2. The mean age of presentation was 45 (range 18-66) years. Clinical features were abdominal pain (85%), abdominal distension (80%), vomiting (70%), rectal bleeding (70%) and palpable abdominal mass (35%). Majority of patients (70%) presented with features of intestinal obstruction. Idiopathic intussusception (55%) accounted for more than half of the cases with the jejunoileal variety (30%) as the most common pathological type. One patient who had intussusception in the postoperative period was treated with manual reduction at laparotomy. Bowel resections were performed in the remaining 19 (95%) patients. Conclusion: Adult intussusception is still uncommon in our general surgical practice. Bowel resection is the mainstay of treatment.


Assuntos
Procedimentos Cirúrgicos do Sistema Digestório/métodos , Obstrução Intestinal/etiologia , Intussuscepção/diagnóstico , Intussuscepção/cirurgia , Dor Abdominal/etiologia , Adolescente , Adulto , Idoso , Feminino , Humanos , Intussuscepção/patologia , Masculino , Pessoa de Meia-Idade , Nigéria , Estudos Retrospectivos , Centros de Atenção Terciária , Vômito/etiologia , Adulto Jovem
17.
West Afr J Med ; 36(2): 116-121, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31385596

RESUMO

BACKGROUND: Hand hygiene (HH) practices are emphasized as the single most important way of reducing HealthCare-Associated Infection (HCAIs). This study was done to assess the compliance with hand hygiene and knowledge about standard HH practices by health care workers as well as to assess the availability of HH materials in the largest tertiary Hospital in Nigeria. METHODS: A cross-sectional, observational study involving consecutive observations during routine patient care in various units of the University College Hospital (UCH), Ibadan; using a checklist and compliance forms adapted from the WHO guidelines was done. HH knowledge scores were categorized as < 4 = poor, 4-6=fair and >7 = good. RESULTS: A total of 559 HH opportunities were identified and overall compliance was 30.4% (170/ 559). Compliance differed by units: Neonatology SCBU (68.2%), Intensive Care Unit (41.8%), Obstetrics & Gynaecology (39.4%), Adult emergency (26.7%), Children emergency (24.6%), Medicine (22.4%), Surgery (14.9%) and Paediatrics (12.8%). Nurses were more likely to practice hand hygiene (33.2%) compared to doctors (29.0%) [c2 = 33.270, CI= 95%, P<0.001]. Female HCWs had higher hand hygiene compliance (30.6% vs. 25.4%) [c2= 2.129, CI= 95%, P= 0.345]. Soap and water were employed more (95.5%) compared to alcohol-based hand rub (4.5%). Only 12.1% had good HH knowledge scores (>7). CONCLUSION: Poor HH compliance is observed at the facility and is attributable to inadequate education, poor knowledge of standard HH practices and unavailability of HH materials in most of the units. A multidimensional approach is advocated to tackle these issues.


Assuntos
Infecção Hospitalar , Fidelidade a Diretrizes , Higiene das Mãos , Adulto , Criança , Estudos Transversais , Feminino , Pessoal de Saúde , Humanos , Nigéria , Centros de Atenção Terciária/normas
18.
West Afr J Med ; 36(2): 122-128, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31385597

RESUMO

BACKGROUND: Oxygen is like any other medication that can cause severe consequences if administered inappropriately. OBJECTIVE: To audit the pattern of acute oxygen therapy on regular hospital wards of a referral centre in Ilorin, Nigeria. METHODS: We reviewed 150 patients that received or had a prescription for acute oxygen therapy in three months and extracted relevant information using a proforma. RESULTS: About one-third of the patients (30%) were >65 years of age and the male to female ratio was 1:1. The commonest indication and medical condition for acute oxygen administration were hypoxemia (70.7%) and pneumonia (26.0%), respectively. Pneumonia accounted for most (41.2 %) of the oxygen therapy in childhood. The majority of patients (88.0%) had written order for oxygen prescription, 40.7% had a prescription to target oxygen saturation and only 31.3% achieved their target saturation. Oxygen prescription was adequate (documentation of delivery device, flow rate of oxygen, and target oxygen saturations) in 40.7% of patients. The assessment, monitoring and titration of oxygen therapy were adequate in 92.7%, 65.3% and 28 % of patients respectively. Overall mortality was 27.3% in patients receiving acute oxygen supplementation. Eleven patients had unstable COPD, and 63.6 %, 54.5 % and 45.6 % of them had adequate oxygen prescription, monitoring and titration respectively. The challenges to oxygen use were faulty delivery devices, emptied oxygen cylinders, inability to routinely do arterial blood gas analysis and lack of hospital oxygen protocol. CONCLUSION: The current practice of acute oxygen therapy is not satisfactory and interventions are advocated to improve the healthcare providers' administration of oxygen.


Assuntos
Hipóxia/terapia , Auditoria Médica/estatística & dados numéricos , Oxigenoterapia/estatística & dados numéricos , Pneumonia/terapia , Centros de Atenção Terciária/normas , Idoso , Criança , Feminino , Humanos , Masculino , Nigéria , Oxigênio , Oxigenoterapia/métodos , Encaminhamento e Consulta
19.
West Afr J Med ; 36(2): 183-188, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31385606

RESUMO

OBJECTIVE: There is paucity of information on delirium in sub-Saharan Africa (SSA) particularly in the older persons (>60 years of age), leaving questions about the burden of the disease in an environment with lower health care standards. In this article, we set out to determine the frequency, precipitants and symptomatology of delirium in elderly patients admitted into medical wards in a teaching hospital in South-West Nigeria. METHODS: This was a descriptive study involving a pre-planned sample of one hundred and fifty patients aged 60 years and over, assessed for cognitive impairment and delirium using the previously validated IDEA cognitive screen, and the Confusion Assessment Method (CAM) respectively. Diagnosis of delirium was made using the CAM and DSM-IV criteria. RESULTS: Delirium was diagnosed in 32 patients giving a frequency of 21.3% (95%CI: 14.7-30.0%). Patients with delirium were significantly older (p<0.05). A quarter of the patients had dementia. Hypertension was a notable co-morbid condition. All the patients had altered sleep wake cycle, inattention, disorientation, and altered consciousness. Neurological diseases were the most common precipitant. There was a good agreement between the DSM-IV and CAM diagnoses. CONCLUSION: Delirium is common in hospitalised elderly patients particularly those with neurological diseases. Co-morbidities like hypertension, dementia, and depression should be looked for in delirious elderly patients.


Assuntos
Disfunção Cognitiva/diagnóstico , Confusão/diagnóstico , Delírio/diagnóstico , Demência/diagnóstico , Idoso , Idoso de 80 Anos ou mais , Disfunção Cognitiva/epidemiologia , Comorbidade , Confusão/psicologia , Delírio/epidemiologia , Delírio/psicologia , Demência/epidemiologia , Manual Diagnóstico e Estatístico de Transtornos Mentais , Humanos , Hipertensão/epidemiologia , Entrevista Psiquiátrica Padronizada/estatística & dados numéricos , Pessoa de Meia-Idade , Doenças do Sistema Nervoso/epidemiologia , Testes Neuropsicológicos/estatística & dados numéricos , Nigéria/epidemiologia , Transtornos do Sono-Vigília/epidemiologia , Centros de Atenção Terciária
20.
Biochem Med (Zagreb) ; 29(3): 030703, 2019 Oct 15.
Artigo em Inglês | MEDLINE | ID: mdl-31379461

RESUMO

Introduction: Communication of laboratory critical risk results is essential for patient safety, as it allows early decision making. Our aims were: 1) to retrospectively evaluate the current protocol for telephone notification of critical risk results in terms of rates, efficiency and recipient satisfaction, 2) to assess their use in clinical decision making and 3) to suggest alternative tools for a better assessment of notification protocols. Materials and methods: The biochemical critical risk result notifications reported during 12 months by routine and STAT laboratories in a tertiary care hospital were reviewed. Total number of reports, time for the notification and main magnitudes with critical risk results were calculated. The use of notifications in clinical decision making was assessed by reviewing medical records. Satisfaction with the notification protocol was assessed through an online questionnaire to requesting physicians and nurses. Results: Critical result was yielded by 0.1% of total laboratory tests. Median time for notification was 3.2 min (STAT) and 16.9 min (routine). The magnitudes with a greater number of critical results were glucose and potassium for routine analyses, and troponin, sodium for STAT. Most notifications were not reflected in the medical records. Overall mean satisfaction with the protocol was 4.2/5. Conclusion: The results obtained indicate that the current protocol is appropriate. Nevertheless, there are some limitations that hamper the evaluation of the impact on clinical decision making. Alternatives were proposed for a proper and precise evaluation.


Assuntos
Tomada de Decisão Clínica , Análise Química do Sangue , Humanos , Laboratórios Hospitalares , Registros Médicos/normas , Potássio/sangue , Estudos Retrospectivos , Sódio/sangue , Centros de Atenção Terciária , Fatores de Tempo
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