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1.
J Am Vet Med Assoc ; 259(2): 184-189, 2021 Jul 15.
Artigo em Inglês | MEDLINE | ID: mdl-34227865

RESUMO

CASE DESCRIPTION: A 16-year old castrated male domestic shorthair cat was evaluated at a veterinary teaching hospital because of polyuria, polydipsia, and weight loss of 2 months' duration. CLINICAL FINDINGS: Hematologic and biochemical examination results were within respective reference ranges except for moderately high pancreas-specific lipase concentration. Ultrasonographic and cytologic evaluation revealed a hepatic mass with findings consistent with mild cholestasis and inflammation and a pancreatic mass that was initially identified as a neuroendocrine tumor. TREATMENT AND OUTCOME: The cat underwent additional CT assessment and stereotactic body radiation therapy (SBRT; 3 fractions of 8 Gy, administered every other day) for treatment of the pancreatic tumor. Follow-up ultrasonographic and CT examinations indicated a partial response to SBRT, with a maximum CT-measured size reduction from 3.6 × 4.8 × 4.0 cm at the time of treatment planning to 2.0 × 2.0 × 1.9 cm 8 months later. Increased pancreatic tumor size and signs of carcinomatosis were detected 15 months after SBRT treatment; the initial cytologic diagnosis was changed to exocrine pancreatic carcinoma on reevaluation of the slides by another veterinary pathologist. Carboplatin treatment was elected, and signs of carcinomatosis resolved. The cat was euthanized without further testing because of weakness 589 days after SBRT was started. CLINICAL RELEVANCE: To the authors' knowledge, this is the first report of SBRT for suspected exocrine pancreatic carcinoma in a cat. Further investigation is needed to determine optimal fractionation schedules for SBRT of pancreatic tumors and utility of SBRT of exocrine pancreatic carcinoma in cats.


Assuntos
Doenças do Gato , Neoplasias Pancreáticas , Radiocirurgia , Animais , Gatos , Fracionamento da Dose de Radiação , Hospitais Veterinários , Hospitais de Ensino , Masculino , Neoplasias Pancreáticas/radioterapia , Neoplasias Pancreáticas/veterinária , Radiocirurgia/veterinária
2.
Niger J Clin Pract ; 24(7): 1072-1076, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34290185

RESUMO

Background: Colonoscopy is an investigation modality used for colorectal examination; it is the most accurate technique for the diagnosis and surveillance of important colorectal diseases such as cancers (colorectal cancer) and polyps. Aims: Most studies on colonoscopy in Nigeria were conducted in southwest such as Ilorin, Ife, Ibadan, and Lagos. We therefore feel the need to get information from other regions such as northwest, the area of this study. The aim of this study was to identify the common indications as well as colonoscopic findings among patients who had colonoscopy in Aminu Kano Teaching Hospital, Kano. Methodology: It was a 10-year retrospective descriptive study of patients who had colonoscopy between January 2008 and December 2017 at the study center. Colonoscopy register was used to extract information concerning the patient's age, gender, symptoms that necessitated the request for the procedure, and the endoscopic findings. Results: A total of 839 patient records were reviewed, males constituted 62.2% of the patients. The mean age ± standard deviation was 43.86 ± 18.36 years, with a range of 8-96 years. The 30-39 years constituted the modal age group, followed by 40-49 years and 50-59 years. The commonest indications for the procedure were rectal bleeding (52.4%), chronic abdominal pain (51.3%), and diarrhea (48.8%). The cecal intubation rate was 98.2% with hemorrhoids as the commonest finding (42.3%) followed by suspected inflammatory bowel disease lesions (18.1%) and suspected colorectal tumors (16.2%). Conclusion: The commonest reason for colonoscopy was rectal bleeding while the commonest colonoscopic finding was hemorrhoids.


Assuntos
Pólipos do Colo , Colonoscopia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Ceco , Criança , Hospitais de Ensino , Humanos , Masculino , Pessoa de Meia-Idade , Nigéria/epidemiologia , Estudos Retrospectivos , Adulto Jovem
3.
BMC Res Notes ; 14(1): 277, 2021 Jul 21.
Artigo em Inglês | MEDLINE | ID: mdl-34289878

RESUMO

OBJECTIVES: Strengthening the organizational agility of the hospital can lead to decreased production costs and increased market share, better serving to patients' needs, introduction of new services and increased competitiveness; therefore, this study aimed to investigate the agility of Shiraz public teaching hospitals. RESULTS: The results showed that organizational intelligence had a positive and significant effect on organizational agility with a path coefficient of 0.172. Organizational forgetting and organizational learning also played a mediating role between organizational intelligence and organizational agility. This means that organizational intelligence had positive effect on organizational forgetting with path coefficient of 0.482, organizational forgetting on organizational learning with path coefficient of 0.40 and subsequently organizational learning on organizational agility with path factor of 0.07. Organizational forgetting also played a mediating role between organizational intelligence and organizational learning.


Assuntos
Inteligência , Aprendizagem , Hospitais de Ensino , Humanos , Organizações , Inquéritos e Questionários
4.
J Am Vet Med Assoc ; 259(3): 300-305, 2021 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-34242080

RESUMO

OBJECTIVE: To describe a technique for basihyoid-ceratohyoid disarticulation (BCD) in standing sedated horses affected by temporohyoid osteoarthropathy (THO) and report outcomes for horses that underwent the procedure. ANIMALS: 6 client-owned horses. PROCEDURES: Electronic medical records of a veterinary teaching hospital were searched to identify horses that underwent BCD for treatment of THO from 2018 to 2019. Signalment, clinical data, use of the horse, and complications were recorded. Follow-up data obtained by telephone interview with owners included the clinical outcome and time to improvement after surgery, any persistent clinical signs, horse's activity level before onset of clinical signs and after BCD, subsequent use of the horse, and whether they would pursue the same treatment again. RESULTS: All horses tolerated the procedure well, with no complications and improved neurologic function after BCD. Five of 6 horses had a reported activity level equal to or greater than that prior to having signs of THO. Three of 3 horses with acute ataxia prior to BCD reportedly had full resolution of this sign; 3 of 4 horses with facial nerve deficits prior to BCD had mild residual facial nerve deficits at follow-up. All owners indicated they would pursue BCD again. CONCLUSIONS AND CLINICAL RELEVANCE: The BCD procedure was performed safely in this sample of THO-affected horses that were sedated while standing, avoiding risks associated with general anesthesia and resulting in no adverse effects such as iatrogenic injury to neurovascular structures.


Assuntos
Doenças dos Cavalos , Animais , Desarticulação/veterinária , Nervo Facial , Doenças dos Cavalos/cirurgia , Cavalos , Hospitais Veterinários , Hospitais de Ensino , Estudos Retrospectivos
5.
Artigo em Inglês | MEDLINE | ID: mdl-34231819

RESUMO

Many infants are nurtured with milk supplied by human banks, whose bacteriological and physical-chemical profiles are a major issue. We investigated the bacteriological and physical-chemical characteristics, as well as genotypic and phenotypic and profiles of Staphylococcus species isolated from 240 samples of breast milk from a bank in a teaching hospital. Dornic acidity of milk revealed that 95.4% (229/240) had acceptable limits (< 8.0 oD). Caloric intake showed a wide variation in cream content (4%), fat (4%) and energy values (559.81 Kcal/L). Staphylococcus (105/186 or 56.5%) and Enterobacter (25/186 or 13.4%) were the most prevalent genera, although other microorganisms were identified, including Klebsiella pneumoniae and Pseudomonas aeruginosa. Amoxicillin/clavulanic acid (125/157 or 79.6%), vancomycin (115/157 or 73.2%), and cephalexin (112/157 or 71.3%) were the most effective antimicrobials. High resistance rates of isolates were found to penicillin G (141/157 or 89.8%), ampicillin (135/157 or 86%), and oxacillin (118/157 or 75.2%). Multidrug resistance to ≥ 3 antimicrobials occurred in 66.2% (123/186) of the isolates. Residues of microbial multiplication inhibitory substances were found in 85% (204/240) of samples. Among the coagulase-positive-CPS and negative-CoNS staphylococci, the mecA gene was detected in 53.3% (8/15) and 75% (30/40), respectively. Genes sea, seb and sec were detected in 20% (3/15) of CPS, while tsst-1 was detected in 13.34% (2/15). In addition, 13.3% (2/15) of S. aureus were toxin-producers. Genes sea, seb and sec were detected in 90% (36/40), 5% (2/40) and 15% (6/40) CoNS, respectively. Enterotoxin production was identified in 5% (2/40) of CoNS. The identification of multidrug-resistant bacteria, staphylococci species toxin-producers harboring methicillin-resistance genes, and residues of microbial multiplication inhibitory substances reinforce the need for a continuous vigilance of milk quality offered to infant consumption by human banks.


Assuntos
Leite Humano , Infecções Estafilocócicas , Animais , Antibacterianos/farmacologia , Coagulase , Feminino , Hospitais de Ensino , Humanos , Testes de Sensibilidade Microbiana , Leite , Staphylococcus/genética , Staphylococcus aureus
6.
BMC Infect Dis ; 21(1): 703, 2021 Jul 23.
Artigo em Inglês | MEDLINE | ID: mdl-34301184

RESUMO

BACKGROUND: Lower respiratory tract infections continue to contribute significantly to morbidity and mortality across all age groups globally. In sub-Saharan Africa, many studies of community acquired pneumonia in adults have focused on HIV-infected patients and little attention has been given to risk factors and etiologic agents in an urban area with a more moderate HIV prevalence. METHODS: We prospectively enrolled 77 patients admitted to a 280 bed teaching hospital in Kenya with radiographically confirmed community acquired pneumonia from May 2019 to March 2020. The patients were followed for etiology and clinical outcomes. Viral PCR testing was performed using the FTD respiratory pathogen-21 multiplex kit on nasopharyngeal or lower respiratory samples. Additional microbiologic workup was performed as determined by the treating physicians. RESULTS: A potential etiologic agent(s) was identified in 57% including 43% viral, 5% combined viral and bacterial, 5% bacterial and 4% Pneumocystis. The most common etiologic agent was Influenza A which was associated with severe clinical disease. The most common underlying conditions were cardiovascular disease, diabetes and lung disease, while HIV infection was identified in only 13% of patients. Critical care admission was required for 24, and 31% had acute kidney injury, sometimes in combination with acute respiratory distress or sepsis. CONCLUSION: Viruses, especially influenza, were commonly found in patients with CAP. In contrast to other studies from sub-Saharan Africa, the underlying conditions were similar to those reported in high resource areas and point to the growing concern of the double burden of infectious and noncommunicable diseases.


Assuntos
Infecções Comunitárias Adquiridas/epidemiologia , Infecções Comunitárias Adquiridas/virologia , Pneumonia Viral/epidemiologia , Adulto , Idoso , Feminino , Infecções por HIV/epidemiologia , Hospitalização , Hospitais de Ensino , Humanos , Quênia/epidemiologia , Masculino , Pessoa de Meia-Idade , Orthomyxoviridae/isolamento & purificação , Orthomyxoviridae/patogenicidade , Estudos Prospectivos , Fatores de Risco
7.
Int J Qual Health Care ; 33(3)2021 Jul 14.
Artigo em Inglês | MEDLINE | ID: mdl-34213554

RESUMO

BACKGROUND: Despite all the resourcefulness and efforts in the last 30 years for quality in healthcare, safety and quality considerations are recognized with up to 17% of total hospital activity and expenditure related to adverse events. A knowledge gap is identified in the literature that few studies have reported from a whole hospital perspective on what and how quality activities are being performed, particularly in the Australian context. OBJECTIVE: This study aims to describe the characteristics of quality activities in a tertiary quaternary hospital in Western Australia. METHODS: Data from the study hospital's electronic quality management system Governance, Evidence, Knowledge and Outcome between 1 January 2015 and 31 December 2019 was analysed by using descriptive and thematic methods. RESULTS: Quality assurance (QA) accounted for 68.3% of all quality activities in the study hospital. Principal investigators of activities were mostly in clinical roles and relatively senior in their profession. Collaboration within the same profession and same team was common, but much less so across departments. The median quality cycle length measured by proposal submission to completion was 202 days, but 190 days when measured by proposal approval to completion. A majority (93.2%) of quality activities were undertaken as part of everyday business. Common issues outlined in activity reports were documentation and compliance 44.8% (n = 100), data and tool limitations 10.8% (n = 24), variation in care 9.9% (n = 22), process 9.4% (n = 21), and knowledge and awareness 9.0% (n = 20). Common recommendations to address the issues were communicating findings to relevant teams and governance committees 26.8% (n = 104), further data collection including re-audit 26.0% (n = 101), education and training 20.4% (n = 79), process review and/or development 13.9% (n = 54), and policy/guidelines review and/or development 4.4% (n = 17). CONCLUSION: Understanding the characteristics of quality activities from a whole hospital perspective provides insights and informs discussions relating to the efficiency and effectiveness of quality activities in hospitals. Embedding quality activities into everyday business is achievable for hospitals but considerations need to occur on how to sustain staff motivation and enthusiasm by helping individuals and teams reach the ultimate goals for improvement and keeping performance monitoring as close to the real time of care as possible. There is a need to transform QA into quality improvement, with the 90-day cycle being a feasible target for QA in hospitals.


Assuntos
Atenção à Saúde , Instalações de Saúde , Austrália , Hospitais de Ensino , Humanos , Austrália Ocidental
8.
West Afr J Med ; 38(6): 556-560, 2021 Jun 26.
Artigo em Inglês | MEDLINE | ID: mdl-34177309

RESUMO

BACKGROUND: Vitiligo is an acquired progressive melanocytopenia of unknown cause. It manifests clinically as well circumscribed depigmented macules and patches often associated with poliosis. AIM: To determine the pattern of presentation of patients with vitiligo in the University of Benin Teaching Hospital, Benin City, Nigeria. MATERIALS AND METHODS: Records of patients managed for vitiligo over a 5-year period between December 2014- December 2019 were retrieved and the following information extracted: socio-demographic data of patients, duration of symptom, pattern of vitiligo, distribution, and percentage body surface area of affectation. SPSS version 21 was used to tabulate and analyze the data. The continuous data were presented as means and categorical variables were presented as frequencies and percentages. RESULTS: There were 52 patients with vitiligo amongst 1600 new cases seen over the 5year period constituting a prevalence of 3.3%. The male to female ratio was 1:1.1. The Median (IQR) of the age at presentation was 29.5 (14.75-49.50). The mean (SD) duration of symptom at presentation was 18.3±21.5 months. Children constituted 10 (19.2%), adolescents 8(15.4%), adults 31(59.6%) and elderly 3(5.8%). Family history of vitiligo was absent in all patients. The percentage body surface area (BSA) affected was 30% in 19(36.5%) of participants. The most common clinical type of vitiligo in this study was the generalized pattern accounting for 27(51.9%) of cases. Segmental pattern and focal pattern accounted for 13(25.0%) and 12(23.1%) respectively. The face, upper limbs and lower limbs were the most commonly affected anatomical sites found in the study accounting for 19(36.5%), 18(34.6%) and 17 (32.7%) respectively. CONCLUSIONS: Vitiligo is an uncommon skin disease that affects both genders almost equally. Generalized vitiligo remains the commonest form of vitiligo and the face and extremities are the most commonly affected sites. Furthermore, the prevalence of vitiligo has not changed in the last 20 years.


Assuntos
Vitiligo , Adolescente , Adulto , Idoso , Criança , Feminino , Hospitais de Ensino , Humanos , Masculino , Nigéria , Estudos Retrospectivos , Centros de Atenção Terciária
9.
Soins ; 66(856): 25-30, 2021 Jun.
Artigo em Francês | MEDLINE | ID: mdl-34187650

RESUMO

If the Bégin military teaching hospital, a level 1 health facility, managed to maintain its position during the covid-19 crisis, it is thanks to the total commitment of its staff. To face the crisis, the hospital director ensured a very good level of preparedness and mobilisation of the teams.


Assuntos
COVID-19 , Hospitais de Ensino , Humanos , SARS-CoV-2
10.
Front Cell Infect Microbiol ; 11: 656070, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34150672

RESUMO

Background: Due to the critical condition and poor immunity of patients, the intensive care unit (ICU) has always been the main hospital source of multidrug-resistant bacteria. In recent years, with the large-scale use of antibiotics, the detection rate and mortality of carbapenem-resistant Klebsiella pneumoniae (CRKP) have gradually increased. This study explores the molecular characteristics and prevalence of CRKP isolated from the ICU ward of a tertiary hospital in China. Methods: A total of 51 non-duplicated CRKP samples isolated from the ICU were collected from July 2018-July 2020. The enzyme production of the strains was preliminarily screened by carbapenemase phenotypic test, and drug-resistant and virulence genes were detected by PCR. The transferability of plasmid was verified by conjugation test. The minimal inhibitory concentration (MIC) was determined by microbroth dilution method and genetic diversity was detected by multilocus sequence typing and pulsed-field gel electrophoresis. Results: blaKPC-2 was the only carbapenemase detected. The major virulence genes were uge (100%), mrkD (94.1%), kpn (94.1%), and fim-H (72.5%), while wcag, ironB, alls and magA genes were not detected. One sequence type ST1373 strain, hypervirulent K. pneumoniae (hvKP), was detected. CRKP strains were highly resistant to quinolones, cephalosporins, aminoglycosides, and polymyxin, but susceptive to tigecycline and ceftazidime-avibactam. The success rate of conjugation was 12.2%, indicating the horizontal transfer of blaKPC-2 . Homology analysis showed that there was a clonal transmission of ST11 CRKP in the ICU of our hospital. Conclusion: The present study showed the outbreak and dissemination in ICU were caused by ST11 CRKP, which were KPC-2 producers, and simultaneously, also carried some virulence genes. ST11 CRKP persisted in the ward for a long time and spread among different areas. Due to the widespread dispersal of the transferable blaKPC-2 plasmid, the hospital should promptly adopt effective surveillance and strict infection control strategies to prevent the further spread of CRKP. Ceftazidime-avibactam showed high effectiveness against CRKP and could be used for the treatment of ICU infections.


Assuntos
Infecções por Klebsiella , Klebsiella pneumoniae , Antibacterianos/uso terapêutico , Carbapenêmicos , China , Surtos de Doenças , Hospitais de Ensino , Humanos , Unidades de Terapia Intensiva , Infecções por Klebsiella/epidemiologia , Klebsiella pneumoniae/genética , Testes de Sensibilidade Microbiana , Tipagem de Sequências Multilocus , beta-Lactamases
11.
J Equine Vet Sci ; 102: 103617, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-34119200

RESUMO

To resolve large colon impactions, frequent enteral administration of large volumes of water (8-10 liters in a 500 kg horse) has been suggested. Furthermore, in large colon volvulus, the simultaneous presence of gastric impaction has been described as a possible predisposing factor. To describe the clinical and surgical features of horses with large colon volvulus associated with aggressive enteral fluid therapy performed to resolve an initial large colon impaction. Records of horses that underwent exploratory laparotomy at the Veterinary Teaching Hospital of Turin between 2012-2019 were reviewed. Clinical and surgical features of cases initially diagnosed with large colon impaction that developed a large colon volvulus after enteral administration of large volumes of fluids were retrieved. Four horses met the criteria. In all horses an initial diagnosis of large colon impaction was made by the referring veterinarian. In all cases a sudden increase in pain was noticed shortly after enteral administration of large volumes (8-10 liters) of water. Administration of analgesic didn't resolve the pain in any of the horses that were then referred. A large colon volvulus was found during exploratory laparotomy in all cases. A moderate gastric impaction was also found intraoperatively, which was confirmed by gastroscopy postoperatively. Nasogastric administration of large quantity of fluids with a pre-existing gastric and colon impaction, may reduce the available space in the abdominal cavity and potentially predispose the colon volvulus. More frequent enteral administration of smaller volumes of fluids might be preferred when treating large colon impactions.


Assuntos
Cólica , Doenças dos Cavalos , Volvo Intestinal , Animais , Cólica/veterinária , Colo/diagnóstico por imagem , Hidratação/veterinária , Cavalos , Hospitais Veterinários , Hospitais de Ensino , Volvo Intestinal/etiologia , Volvo Intestinal/veterinária
12.
Pan Afr Med J ; 38: 252, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34104300

RESUMO

Introduction: vital sign monitoring is a key component of safe facility-based obstetric care. We aimed to assess quality of care around vital sign monitoring during obstetric hospitalizations in a tertiary-care facility in a resource-limited setting. Methods: retrospective review of obstetric records at a tertiary care facility. We assessed documentation of vital signs including fetal and maternal heart rate, and maternal blood pressure, temperature, oxygen saturation and urine output. The primary outcome was the quality of vital sign monitoring (high- versus low-quality based on frequency of monitoring). We compared quality of monitoring with timing of admission, presence of complication, and delivery mode using chi-squared tests. Results: among 360 records of obstetric admissions (94% of a planned random sample), 96% documented a delivery. Of these, 8% of pregnant women and 11% of postpartum women had high-quality vital sign monitoring documented on initial evaluation at admission. For women delivering during the hospitalization, 0.8% of women delivering had high-quality monitoring in the first four hours postpartum, with higher rates of high-quality monitoring in women delivering vaginally compared to those delivered by cesarean (1.4% versus 0%, p<0.001). There were no differences in rates of quality monitoring by time of admission, or obstetric complication. Conclusion: very few obstetric hospitalizations had high-quality vital sign monitoring. Attention towards improving vital sign monitoring is a critical need.


Assuntos
Parto Obstétrico/métodos , Hospitalização , Monitorização Fisiológica/métodos , Sinais Vitais , Cesárea/estatística & dados numéricos , Parto Obstétrico/normas , Feminino , Hospitais de Ensino , Humanos , Gravidez , Qualidade da Assistência à Saúde , Estudos Retrospectivos , Centros de Atenção Terciária , Uganda
13.
Niger J Clin Pract ; 24(6): 841-846, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-34121731

RESUMO

Background: Obesity is an important cosmopolitan cause of morbidity in children and adolescence age groups. Information on obesity in this age group in Nigeria is scant. Aim: To determine the prevalence of obesity and the associated morbidities seen at the Paediatric Endocrinology clinic of Ekiti State University Teaching Hospital, South West, Nigeria. Methods: A retrospective review of all obese children attending the Paediatric Endocrinology clinic. Sociodemographic and other information related to paediatric obesity and associated morbidities were extracted from the case notes. Data obtained was analyzed using Statistical Package for Social Sciences (SPSS) version 20. Results: A total of 21 obese children attended the clinic in the 10 years of study. The 21 children were made of 14 (66.7%) girls and 7 (33.3%) boys, giving a 2:1 female to male ratio. The ages of the children ranged from 1 to 16 years with a mean age of 8.79 ± 4.35 years. Obesity was secondary to a nutritional cause in 16 (76.2%) of the cases and Type 1 diabetes mellitus, Type 2 diabetes mellitus, Cushing's syndrome, Iatrogenic Cushing's syndrome and post-meningitis in the remaining 1 (4.8%) case each. Seventeen (81%) of the children were from the higher socioeconomic class, and the remaining three (19.0%) from lower socioeconomic class. Four (19.0%) of the children had hypertension with their blood pressure (BP) above the 95th percentile for age and sex. Hypertension was more common among the higher socioeconomic group, children older than 10 years and the female gender. This association was not statistically significant. A greater proportion of children with body mass index (BMI) >30 had significantly higher rates of hypertension (P < 0.001). Conclusion: Obesity is a common disease condition amongst children attending paediatric endocrine clinic. Strategies to control obesity and progression of severity of obesity may have a place in reducing the prevalence of hypertension in obese children and adolescents.


Assuntos
Diabetes Mellitus Tipo 2 , Obesidade Pediátrica , Adolescente , Índice de Massa Corporal , Criança , Pré-Escolar , Feminino , Hospitais de Ensino , Humanos , Lactente , Masculino , Nigéria/epidemiologia , Obesidade Pediátrica/epidemiologia , Prevalência , Estudos Retrospectivos , Fatores de Risco
14.
Afr J Reprod Health ; 25(1): 56-66, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-34077111

RESUMO

Maternal death is a major global health issue with the highest impact in low-income countries. Despite some modest decline in the maternal mortality rates in Ghana since the 1990's, this has been below expectation. The aim of this study was to describe the trends and contributory factors to maternal mortality at the Korle Bu Teaching Hospital (KBTH), Accra, Ghana. We performed a retrospective chart review of all maternal deaths at KBTH from 2015 to 2019. Data were analyzed using SPSS version 23. A p-value of <0.05 was considered statistically significant. Over the period, there were 45,676 live births, 276 maternal deaths and a maternal mortality ratio of 604/100,000 live births (95% CI: 590/100,000 - 739/100,000). The leading causes of maternal death were hypertensive disorders (37.3%), hemorrhage (20.6%), Sickle cell disease (8.3%), sepsis (8.3%), and pulmonary embolism (8.0%). Significant factors associated with maternal mortalities at the KBTH were: women with no formal education [AOR 3.23 (CI: 1.73- 7.61)], women who had less than four antenatal visits [AOR 1.93(CI: 1.23-3.03)], and emergency cesarean section [AOR 3.87(CI: 2.51-5.98)]. Hypertensive disorders remain the commonest cause of the high maternal mortality at KBTH. Formal education and improvement in antenatal visits may help prevent these deaths.


Assuntos
Hospitais de Ensino/estatística & dados numéricos , Morte Materna/estatística & dados numéricos , Mortalidade Materna , Complicações na Gravidez/mortalidade , Adolescente , Adulto , Causas de Morte , Feminino , Gana/epidemiologia , Humanos , Hipertensão Induzida pela Gravidez/mortalidade , Morte Materna/etnologia , Paridade , Gravidez , Estudos Retrospectivos , Adulto Jovem
15.
J Vet Intern Med ; 35(4): 1873-1883, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34105831

RESUMO

BACKGROUND: Vascular endothelial growth factor (VEGF) is a key molecular driver of angiogenesis and vascular permeability and is expressed by a wide variety of neoplasms. Although blood VEGF concentrations have been quantified in intracranial tumors of dogs, cerebrospinal fluid (CSF) VEGF concentration might be a more sensitive biomarker of disease. OBJECTIVE: Concentrations of VEGF in CSF are higher in dogs with central nervous system (CNS) neoplasia compared to those with meningoencephalomyelitis and other neurologic disorders. ANIMALS: One hundred and twenty-six client-owned dogs presented to a veterinary teaching hospital. METHODS: Case-control study. Cerebrospinal fluid was archived from dogs diagnosed with CNS neoplasia and meningoencephalomyelitis. Control dogs had other neurological disorders or diseases outside of the CNS. A commercially available kit was used to determine VEGF concentrations. RESULTS: Detectable CSF VEGF concentrations were present in 49/63 (77.8%) neoplastic samples, 22/24 (91.7%) inflammatory samples, and 8/39 (20.5%) control samples. The VEGF concentrations were significantly different between groups (P < .0001), and multiple comparison testing showed that both neoplastic and inflammatory groups had significantly higher concentrations than did controls (P < .05), but did not differ from each other. Gliomas and choroid plexus tumors had significantly higher VEGF concentrations than did the control group (P < .05). CONCLUSIONS AND CLINICAL IMPORTANCE: Cerebrospinal fluid VEGF concentrations may serve as a marker of neoplastic and inflammatory CNS disorders relative to other conditions.


Assuntos
Doenças do Sistema Nervoso Central , Doenças do Cão , Animais , Estudos de Casos e Controles , Doenças do Sistema Nervoso Central/veterinária , Líquido Cefalorraquidiano , Cães , Hospitais Veterinários , Hospitais de Ensino , Fator A de Crescimento do Endotélio Vascular
16.
Front Public Health ; 9: 673536, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34178928

RESUMO

The key challenges to any health care setup during emergency situations, such as that of the COVID-19 pandemic would be to rapidly address hospital preparedness and response tailored to the local population, societal influences, political factors within the existing infrastructure, and workforce. Second, to adopt and moderate policies, standard operating procedures (SOPs) and guidelines issued by national and international agencies, such as WHO, CDC, and the Indian Council for Medical Research (ICMR) were tailor-made to the local conditions of the hospital and community. In this publication, we have discussed the challenges and experiences in preparation and responses to the ongoing COVID-19 pandemic at a tertiary teaching hospital situated at a suburban locale in a small union territory. Puducherry is located in the South Eastern Coromandel Coast of India. The core processes, such as hospital preparedness, adoption, and amendments to SOPs based on dynamic changes in guidelines released by the central and local government, training given to health care workers, setting up the in-house diagnostic facility, surge capacity, management of supplies during the lockdown, infection prevention, and control and patient care are discussed. We have also reinforced our experiences in translating COVID-related opportunities for research and innovation in the form of awards and research proposals for the faculty and students of our institute. The lessons learned in terms of strength and limitations on the ground level of public health during this process is worth sharing as it would provide guidance in preparing the health care setups for pre- and post-pandemic.


Assuntos
COVID-19 , Pandemias , Controle de Doenças Transmissíveis , Hospitais de Ensino , Humanos , Índia/epidemiologia , SARS-CoV-2 , Atenção Terciária à Saúde
17.
Saudi Med J ; 42(7): 742-749, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34187918

RESUMO

OBJECTIVES: To identify the prevalence of COVID-19 antibodies among operating room and critical care staff. METHODS: In this cross-sectional study, we recruited 319 Healthcare workers employed in the operation theater and intensive care unit of King Abdulaziz University Hospital (KAUH), a tertiary teaching hospital in Jeddah, Saudi Arabia between August 9, 2020 and November 2, 2020. All participants completed a 20-item questionnaire on demographic data and COVID-19 risk factors and provided blood samples. Antibody testing was performed using an in-house enzyme immunoassay and microneutralization test. RESULTS: Of the 319 participants, 39 had detectable COVID-19 antibodies. Five of them had never experienced any symptoms suggestive of COVID-19, and only 19 were previously diagnosed with COVID-19. The odds of developing COVID-19 or having corresponding antibodies increased if participants experienced COVID-19 symptoms (odds ratio [OR], 3.1; 95% confidence interval [CI], 1.2-7.5) or reported contact with an infected family member (OR, 5.3; 95% CI, 2.5-11.2). Disease acquisition was not associated with employment in the ICU and involvement in the intubation of or close contact with COVID-19 patients. Of the 19 previously diagnosed participants, 6 did not possess any detectable COVID-19 antibodies. CONCLUSIONS: Healthcare workers may have undiagnosed COVID-19, and those previously infected may not have long-lasting immunity. Therefore, hospitals must continue to uphold strict infection control during the COVID-19 pandemic.


Assuntos
Teste Sorológico para COVID-19/estatística & dados numéricos , COVID-19/diagnóstico , Pessoal de Saúde , SARS-CoV-2/isolamento & purificação , Adulto , Anticorpos Neutralizantes/sangue , Anticorpos Antivirais/sangue , COVID-19/epidemiologia , Cuidados Críticos , Estudos Transversais , Ensaio de Imunoadsorção Enzimática , Feminino , Hospitais de Ensino , Humanos , Transmissão de Doença Infecciosa do Paciente para o Profissional , Masculino , Pessoa de Meia-Idade , Salas Cirúrgicas , Pandemias , Prevalência , Reação em Cadeia da Polimerase Via Transcriptase Reversa , SARS-CoV-2/genética , Arábia Saudita/epidemiologia
18.
J Ayub Med Coll Abbottabad ; 33(2): 213-216, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34137531

RESUMO

BACKGROUND: This study has been done in children with Steroid dependent nephrotic syndrome (SDNS) to check for the response to cyclophosphamide and relapse on follow up for one year after completion of treatment. METHODS: This study was conducted over two years and nine months. Patients were taken as steroid dependent when there were two consecutive relapses occur on steroids tapering or within two weeks of stopping treatment. Children of either sex between ages of 1-14 years, diagnosed case of SDNS were included in this study. Renal biopsy was not done in any patient. After achieving remission with oral steroids, cyclophosphamide was given after calculation of maximum cumulative dose 168 mg/kg for 8 - 12 weeks along with oral steroids. Follow up done every two weeks till completion of treatment for response and adverse effects and thereafter for one year. RESULTS: There were 31 patients, 23 (74.2%) male and 8 (25.8%) females. Age ranged from 1.5 years to 11 years with mean age 5.44±2.39 years. There was full response to cyclophosphamide as none of patient had proteinuria on cyclophosphamide therapy. After completion of cyclophosphamide course, four patients (12.9%) relapsed on follow up while 87.9% remain in complete remission. Only one female patient (3.23%) had adverse effect in form of hair fall and she recovered after completion of treatment. None of patient showed any other adverse effect including haematuria. CONCLUSIONS: Cyclophosphamide is an effective therapy in management of childhood SDNS with minimum adverse effects in medium term.


Assuntos
Ciclofosfamida/uso terapêutico , Síndrome Nefrótica/tratamento farmacológico , Esteroides/uso terapêutico , Adolescente , Criança , Pré-Escolar , Feminino , Hospitais de Ensino , Humanos , Lactente , Masculino , Recidiva , Indução de Remissão
19.
J Ayub Med Coll Abbottabad ; 33(2): 305-310, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34137550

RESUMO

BACKGROUND: Traumatic spinal cord injury is a debilitating condition that may cause long term disabilities with tremendous socioeconomic impact on affected individuals and their families. Secondary injuries can best prevent or minimized by appropriate pre hospital management and proper referral and transfer. This study was conducted to assess the clinical profile of traumatic spinal cord injuries and level of pre-hospital care provided to patients either at the site of injury or at other healthcare facilities. METHODS: This prospective study was conducted in the Department of Neurosurgery Ayub Teaching Hospital Abbottabad, from January 2012 to January 2017. All patients with suspected spinal injury were included in the study. Age, gender, mode of injuries and the pre-tertiary care provided were recorded. RESULTS: Out of 4464 patients with suspected spinal cord injury, 3685 (82.5%) were male, 779 (17.4%) were female. Age ranged from 10-70 years. 1685 (37.8%) were diagnosed as having spinal injury. Cervical spine was the most common affected level 743 (44.09%), followed by thoracic spine 135 (8.01%). 1441 (85.5%) were incomplete while 224(14.5%) were complete spinal cord injuries. Road traffic accident was the most common mechanism of injury 884 (52.4%). Only 4 (0.23%) patients directly received in our unit were properly transported, 66 (3.91%) were brought after proper spinal immobilization, intravenous line was maintained in 584 (34.66%) patients, 410 (24.3%) patients received some fluid resuscitation, parenteral analgesia was given to 441 (26.17%) patients while urinary catheterization was done in 195 (11.75%) patients. Those received from other healthcare facilities only 4 (0.23%) were brought by properly equipped ambulance, intravenous access was maintained in 438 (25.99%),320 (18.99%) received some fluid resuscitation, urinary catheterization was done in 229(13.59%) while proper parenteral analgesia was given to 988 (58.63%) patients. CONCLUSIONS: There is a complete lack of proper transport and referral of trauma patients in our area which reflects almost non-existent emergency medical (rescue) services, deficient health care facilities.


Assuntos
Hospitais de Ensino/organização & administração , Centros de Atenção Terciária/organização & administração , Adolescente , Adulto , Idoso , Analgésicos/administração & dosagem , Vértebras Cervicais/lesões , Criança , Serviço Hospitalar de Emergência , Feminino , Hidratação , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Encaminhamento e Consulta , Traumatismos da Medula Espinal/etiologia , Traumatismos da Medula Espinal/fisiopatologia , Traumatismos da Medula Espinal/terapia , Vértebras Torácicas/lesões , Cateterismo Urinário , Adulto Jovem
20.
J Ayub Med Coll Abbottabad ; 33(2): 299-302, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34137549

RESUMO

BACKGROUND: The permanent maxillary lateral incisor (PMLI) shows morphological variations, in the form of different crown shapes such as peg-shaped, cone-shaped, barrel-shaped and canine-shaped. The frequency of developmentally malformed permanent maxillary lateral incisors varies among different populations. The aim of this study was to document the frequency of different shapes of developmentally malformed permanent maxillary lateral incisors in patients visiting the three teaching dental hospitals of Peshawar. METHODS: It was a cross-sectional study conducted in the Oral Diagnosis department of Peshawar Dental College, Sardar Begum Dental College, and Khyber College of Dentistry from 1st Sep 2018 to 15th June 2019. A total of 82 subjects were included that fulfilled the inclusion criteria. Shape of the malformed PMLI was determined using Computer-aided design/Computer-aided manufacturing software. Descriptive statistics including frequencies and percentages for observed developmental malformation and their types were computed and Chi-square test was applied to see the relation between various shapes and their occurrence with respect to site and position within the jaws. RESULTS: The peg shaped PMLI was seen in 81 (98.87%) patients and barrel shaped was present in 1 (1.22%) patient. The malformed PMLIs was found to be unilateral in 38 (46.3%) and bilateral in 44 (53.7%) patients, with more common presence on both sides 44 (53.7%) followed by right side 20 (24.4%) and left side 18 (22.0%). CONCLUSIONS: The subjects having predominant developmental malformation in case of permanent maxillary lateral incisor was peg-shaped permanent maxillary lateral incisor.


Assuntos
Incisivo/patologia , Maxila/patologia , Adulto , Distribuição de Qui-Quadrado , Desenho Assistido por Computador , Estudos Transversais , Odontologia , Hospitais Especializados , Hospitais de Ensino , Humanos , Masculino , Paquistão , Adulto Jovem
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