Malnutrition in pre-dialysis chronic kidney disease patients in a teaching hospital in Southern Nigeria.

Background: Malnutrition is a complication in chronic kidney disease (CKD) known to affect quality of life and prognosis although not often diagnosed. It is associated with rapid progression to end stage renal disease (ESRD) and mortality. Early identification and treatment will slow down progression to ESRD and mortality. Objective: To determine the prevalence and pattern of malnutrition in pre-dialysis CKD patients in Southern Nigeria. Methods: One hundred and twenty consecutive pre-dialysis CKD and 40 control subjects without CKD were studied. Data obtained from participants were demographics, body mass index (BMI), and aetiology of CKD. Indices used to assess presence of malnutrition were low BMI, hypocholesterolaemia and hypoalbuminaemia. Statistical significance was taken at 0.05 level. Results: The mean age of the CKD subjects was 48.8±16.6years with a male: female ratio of 1.7:1. Prevalence of malnutrition in the CKD subjects was 46.7%, higher than 27.5% observed in the controls (p=0.033). Prevalence of malnutrition increased significantly across CKD stages 2 to 5 (p=0.020). It was significantly commoner in elderly patients (p=0.047) but not significantly different between males and females(p=0.188). Conclusion: Malnutrition is common in pre-dialysis CKD patients even in early CKD stages. Prevalence of malnutrition increases with worsening kidney function and increasing age.

Is facility based neonatal care in low resource setting keeping pace? A glance at Uganda’s National Referral Hospital.

Objectives: To identify reasons for neonatal admission and death with the aim of determining areas needing improvement. Method: A retrospective chart review was conducted on records for neonates admitted to Mulago National Referral Hospital Special Care Baby Unit (SCBU) from 1st November 2013 to 31st January 2014. Final diagnosis was generated after analyzing sequence of clinical course by 2 paediatricians. Results: A total of 1192 neonates were admitted. Majority 83.3% were in-born. Main reasons for admissions were prematurity (37.7%) and low APGAR (27.9%).Overall mortality was 22.1% (Out-born 33.6%; in born 19.8%). Half (52%) of these deaths occurred in the first 24 hours of admission. Major contributors to mortality were prematurity with hypothermia and respiratory distress (33.7%) followed by birth asphyxia with HIE grade III (24.6%) and presumed sepsis (8.7%). Majority of stable at risk neonates 318/330 (i.e. low APGAR or prematurity without comorbidity) survived. Factors independently associated with death included gestational age <30 weeks (p 0.002), birth weight <1500g (p 0.007) and a 5 minute APGAR score of < 7 (p 0.001). Neither place of birth nor delayed and after hour admissions were independently associated with mortality. Conclusion and recommendations: Mortality rate in SCBU is high. Prematurity and its complications were major contributors to mortality. The management of hypothermia and respiratory distress needs scaling up. A step down unit for monitoring stable at risk neonates is needed in order to decongest SCBU.

Mean Platelet Volume (MPV), Platelet Distribution Width (PDW), Platelet Count and Plateletcrit (PCT) as predictors of in-hospital paediatric mortality: a case-control Study.

Background: Thrombocytopenia has been shown to predict mortality. We hypothesize that platelet indices may be more useful prognostic indicators. Our study subjects were children one month to 14 years old admitted to our hospital. Aim: To determine whether platelet count, plateletcrit (PCT), mean platelet volume (MPV) and platelet distribution width (PDW) and their ratios can predict mortality in hospitalised children. Methods: Children who died during hospital stay were the cases. Controls were age matched children admitted contemporaneously. The first blood sample after admission was used for analysis. Receiver operating characteristic (ROC) curve was used to identify the best threshold for measured variables and the ratios studied. Multiple regression analysis was done to identify independent predictors of mortality. Results: Forty cases and forty controls were studied. Platelet count, PCT and the ratios of MPV/Platelet count, MPV/PCT, PDW/Platelet count, PDW/PCT and MPV x PDW/Platelet count x PCT were significantly different among children who survived compared to those who died. On multiple regression analysis the ratio of MPV/PCT, PDW/Platelet count and MPV/ Platelet count were risk factors for mortality with an odds ratio of 4.31(95% CI, 1.69-10.99), 3.86 (95% CI, 1.53-9.75), 3.45 (95% CI, 1.38-8.64) respectively. In 67% of the patients who died MPV/PCT ratio was above 41.8 and PDW/Platelet count was above 3.86. In 65% of patients who died MPV/Platelet count was above 3.45. Conclusion: The MPV/PCT, PDW/Platelet count and MPV/Platelet count, in the first sample after admission in this case control study were predictors of mortality and could predict 65% to 67% of deaths accurately.

Ear-related problems among children attending the paediatric and otorhinolaryngology out-patients clinics of the University of Nigeria Teaching Hospital, Enugu.

Background: Ear related diseases are commonly seen in clinics worldwide especially among children. They are associated with significant morbidity and frequent hospital visits. Limited data exists regarding the burden of ear disease among Nigerian children. Objective: To determine the prevalence of ear-related problems among children presenting at the Paediatric and Otorhinolaryngology clinics of the University of Nigeria Teaching Hospital, Enugu. Materials and methods: This was a cross-sectional study conducted at the Paediatric and Otorhinolaryngology Clinics of the University of Nigeria Teaching Hospital Enugu. All children aged 0 and 17 years presenting between 1st June and 31st August 2006 with ear-related problems were enrolled consecutively into the study. Data analysis was by SPSS version 11. Results: Three thousand and twenty-one children were seen during the study period. Out of these, 248 children (8.2%) presented with ear-related problems. Chronic otitis media (30.5%), acute otitis media (29.9%), cerumen auris (11.3%), otitis externa(10.1%), hearing impairment (7.3%) and foreign body in the ear (5.7%) were the most commonly diagnosed ear-related problems. Conclusion: Ear-related problems among children presenting at the UNTH Enugu were not uncommon. However, otitis media was the most commonly diagnosed ailment affecting the ears in children.

Factors influencing the recommendation of the Human Papillomavirus vaccine by South African doctors working in a tertiary hospital.

Background: In South Africa, HPV vaccination programme has been incorporated recently in the school health system. Since doctors are the most trusted people regarding health issues in general, their knowledge and attitudes regarding HPV infections and vaccination are very important for HPV vaccine program nationally. Objective: The objective of this study was to investigate factors contributing to recommendation of HPV vaccines to the patients. Methods: This was a quantitative cross-sectional study conducted among 320 doctors, using a self-administered anonymous questionnaire. Results: All the doctors were aware of HPV and knew that HPV is transmitted sexually. Their overall level of knowledge regarding HPV infections and HPV vaccine was poor. But the majority intended to prescribe the vaccine to their patients. It was found that doctors who knew that HPV 6 and 11 are responsible for >90% of anogenital warts, their patients would comply with the counselling regarding HPV vaccination, and received sufficient information about HPV vaccination were 5.68, 4.91 and 4.46 times respectively more likely to recommend HPV vaccination to their patients, compared to their counterparts (p<0.05). Conclusion: There was a knowledge gap regarding HPV infection and HPV vaccine among the doctors.

Factors associated with gastro-duodenal disease in patients undergoing upper GI endoscopy at the Korle-Bu Teaching Hospital, Accra, Ghana.

Background: There is a high prevalence of gastro-duodenal disease in sub-Saharan Africa. Peptic ulcer disease in dyspeptic patients, 24.5%, was comparable to prevalence of gastro-duodenal disease among symptomatic individuals in developed countries (12 – 25%). Limited data exists regarding its associated risk factors despite accumulating evidence indicating that gastroduodenal disease is common in Ghana. Objectives: This study investigates risk factors associated with gastro-duodenal disease at the Korle-Bu Teaching Hospital, Accra, Ghana. Methods: This study utilized a cross-sectional design to consecutively recruit patients referred with upper gastro-intestinal symptoms for endoscopy. The study questionnaire was administered to study participants. Helicobacter pylori infection was confirmed by rapid-urease examination at endoscopy. Results: Of 242 patients sampled; 64 had duodenal ulcer, 66 gastric ulcer, 27gastric cancer and 64 non-ulcer dyspepsia. Nineteen (19) had duodenal and gastric ulcer while 2 had gastric ulcer and cancer. A third (32.6%) of patients had history of NSAIDuse. H. pylori was associated with gastric ulcer (p=0.033) and duodenal ulcer (p=0.001). There was an increased prevalence of duodenal ulcer in H. pylori-infected patients taking NSAIDs, P=0.003. Conclusion: H. pylori was a major risk factor for peptic ulcer disease. However, NSAID-related gastro-duodenal injury has been shown to be common in H. pylori infected patients. It highlights the need for awareness of the adverse gastro-intestinal effects in a H. pylori endemic area.

Sero-prevalence and associated factors of Helicobacter pylori infection among adult patients with dyspepsia attending the gastroenterology unit in a tertiary hospital in Mwanza, Tanzania.

Background: Prevalence of H. pylori infection varies greatly between populations in different countries. This study was conducted to determine the magnitude of H.pylori among adult patients with dyspepsia attending the gastroenterology unit at Bugando medical centre. Methods: A cross sectional study involving 202 dyspeptic patients was conducted between June and July 2014. A Standardized data collection tool was used to collect socio-demographic characteristics. H.pylori antibodies were detected using rapid immunochromatographic tests according to manufacturer’s instructions. Results: The median age of study population was 42 (IQR: 33-54). Females 105 (51.9%) formed majority of the population studied. Of 202 participants; 119 (58.9%) were from rural areas. Seroprevalence of H.pylori infection was found to be 79/202 (39.1%, 95% CI: 32.3 -45.7). As the age increased the risk of having H.pylori infection also increased (OR: 1.02 95% CI: 1-1.04, P=0.02). On multivariate logistic regression analysis untreated drinking water was found to predict H.pylori seropositivity (OR: 2.33, CI: 1.09-4.96, p=0.028). Conclusion: The seroprevalence of H.pylori among dyspeptic patients is high in this setting. Therefore the community in Mwanza should be educated on the use of safe drinking water in order to minimize H. pylori infections.

Experience of collaboration between a Dutch surgical team in a Ghanaian Orthopaedic Teaching Hospital.

Background: Surgery is an indivisible, indispensable part of healthcare. In Africa, surgery may be thought of as the neglected stepchild of global public health. We describe our experience over a 3-year period of intensive collaboration between specialized teams from a Dutch hospital and local teams of an orthopaedic hospital in Effiduase-Koforidua, Ghana. Intervention: During 2010-2012, medical teams from our hospital were deployed to St. Joseph’s Hospital. These teams were completely self-supporting. They were encouraged to work together with the local-staff. Apart from clinical work, effort was also spent on education/ teaching operation techniques/ regional anaesthesia techniques/ scrubbing techniques/ and principles around sterility. Results: Knowledge and quality of care has improved. Nevertheless, the overall level of quality of care still lags behind compared to what we see in the Western world. This is mainly due to financial constraints; restricting the capacity to purchase good equipment, maintaining it, and providing regular education. Conclusion: The relief provided by institutions like Care-to-Move is very valuable and essential to improve the level of healthcare. The hospital has evolved to such a high level that general European teams have become redundant. Focused and dedicated teams should be the next step of support within the nearby future.

A psicomotricidade em saúde infanto-juvenil na área de pedopsiquiatria do Hospital Dona Estefânia, Clínica da Encarnação

O presente relatório expõe o trabalho efetuado no âmbito do estágio profissionalizante, em saúde mental infanto-juvenil, inserido na unidade curricular Ramo de Aprofundamento de Competências Profissionais do Mestrado em Reabilitação Psicomotora. O estágio foi realizado no Serviço de Psicomotricidade da Clínica da Encarnação, pertencente ao Hospital Dona Estefânia. A intervenção psicomotora realizou-se com crianças e adolescentes com idades compreendidas entre os 3 e os 16 anos, maioritariamente em dinâmica grupal, numa perspetiva sistémica e multidisciplinar. Foram acompanhadas, ao longo do ano letivo, 43 crianças, 30 das quais numa intervenção mais autónoma, em co-terapia ou em observação participada, onde os diagnósticos mais prevalentes se inseriam nas Perturbações da Ansiedade. Este relatório é constituído por uma revisão teórica acerca da saúde mental, psicomotricidade e aspetos psicopatológicos e pela caracterização da instituição e do Serviço de Psicomotricidade. É feita, ainda, a caracterização das atividades de estágio e dos aspetos referentes às mesmas, onde constam dois estudos de caso como ilustrativos do trabalho realizado, o primeiro com um diagnóstico de Mutismo Seletivo e o outro com uma sintomatologia que se inscreve nas Perturbações da Comunicação e da Relação. No final são apresentadas as dificuldades e limitações e uma reflexão final acerca do percurso de estágio.

A psicomotricidade em saúde mental infantil e juvenil : Serviço de Pedopsiquiatria do Hospital Dr. Nélio Mendonça

O presente relatório reflete o elenco das atividades desenvolvidas no âmbito do estágio profissionalizante, do Mestrado em Reabilitação Psicomotora, realizado no Serviço de Pedopsiquiatria do Hospital Dr. Nélio Mendonça, Funchal. A intervenção psicomotora no âmbito da saúde mental e infantil pretende compreender e resolver os conflitos internos da criança, recorrendo à mediação corporal para a construção e restruturação do psiquismo. No decorrer do estágio foram encaminhados para a Psicomotricidade 24 crianças entre os 5 e os 10 anos de idade, que foram acompanhas em regime de avaliação ou de intervenção. De entre os casos acompanhados em processo de intervenção, será apresentada a análise de dois estudos de caso acompanhados em contexto individual, que comprovam os efeitos benéficos desta intervenção, verificando-se melhorias ao nível do perfil de desenvolvimento psicomotor, emocional e comportamental. O presente relatório de estágio é constituído, ainda, por uma revisão da literatura acerca da saúde mental, da psicomotricidade e das psicopatologias mais prevalentes, bem como da caracterização da instituição acolhedora. Além disto, na parte final do relatório, é apresentada uma reflexão acerca dos problemas nas áreas de desempenho definidas e do percurso realizado ao longo deste ano letivo.

Sensitization to indoor aeroallergens in children who attended the Allergy Service of the “Dr. José Eleuterio González” University Hospital of Monterrey, Mexico

Background: Indoor aeroallergens are the main cause of sensitization in children and represent a risk factor for the development of allergic diseases. Objective: Identify the major indoor aeroallergens most often sensitized to pediatric patients treated at the Allergy Service at the “Dr. José Eleuterio González” University Hospital of Monterrey Methods: We performed an observational and descriptive study where we reviewed reports of positive skin tests to the following common indoor aeroallergens: Dermatophagoides farinae (D. farinae), Dermatophagoides pteronyssinus (D. pteronyssinus), Canis familiaris (C. familiaris), Felis domesticus (F. domesticus), Blattella germanica (B. germanica) and Periplaneta americana (P. americana), found in patients under 16 years with symptoms of allergy, during the period of 2011-2012. Results: We performed 439 skin tests to aeroallergens in pediatric patients. Of these, 57.6% were male and 42.4% were female. Mean age was 6.3 years. The age groups were under 3 years: 17.8%, 3-5 years: 35%, 6-12 years: 36%, and 13-16 years: 11.2%. The main diagnoses were: allergic rhinitis (71.8%), asthma (16.6%), and atopic dermatitis (4.3%). In 57.9% of the cases, they had at least one positive skin test to any aeroallergen. The rate of sensitization to speciic aeroallergens was: D. Pteronyssinus 49.0%, D. farinae 44.6%, B. germanica 13.9%, P. Americana 10.9%, F. domesticus 10.7%, and C. familiaris 5.9%. Conclusion: Indoor aeroallergen sensitization can occur early in life, although it was more frequent in the preschooler and elementary school group. Dust house mites were the most commom cause of allergic sensitization.

Sostenibilidad de los servicios de salud en el área No. 6, Centro de Salud Hospital de Baba, Los Ríos, año 2001

El proceso de investigación buscará determinar si los servicios de salud brindados a la población que pertenecen al área n. 6, Centro de Salud Hospital Baba, de la provincia de Los Ríos, tiene una sustentación económica y pueden seguir siendo entregados a la población geográfica de la zona, determinando además los problemas que sobre acceso a los servicios d salud tenga la comunidad del área.-au

Prevalencia de la ruptura prematura de membranas y la vía de finalización del parto en el Hospital Vicente Corral Moscoso, período 2014

Antecedente. La ruptura prematura de membranas (RPM) es causa importante de morbimortalidad materno fetal por asociarse a complicaciones riesgosas como la corioamnionitis. Objetivo. Establecer la prevalencia de ruptura prematura de membranas y la vía de terminación del parto según la variante de ruptura. Material y métodos. Con un diseño transversal se recopiló información de 360 historias clínicas de maternas atendidas en el Servicio de Obstetricia y Ginecología del hospital Vicente Corral Moscoso de Cuenca, durante el 2014. Resultados. La prevalencia de RPM fue del 8.2% (7.4 – 9.05). La edad promedio fue de 24.0 ± 6.2 años entre un rango de 14 a 44. El 46% cursó la secundaria, el 69% se dedica a actividades domésticas y el 61% reside en zona urbana. La rotura de membranas a término ocurrió en el 66%, la rotura prolongada en el 20% y la rotura pre-término en el 12%. El 71% terminó su parto vía vaginal y el 28% mediante cesárea. El parto vaginal fue más frecuente en rotura de membranas a término (P = 0.0005) y la cesárea en rotura pre-término (P = 0.002). En rotura prolongada, la frecuencia fue similar. Conclusión. La prevalencia de rotura prematura de membranas y la vía de terminación del parto, están dentro de las cifras reportadas por la literatura en estudios similares nacionales y extranjeros. Las variantes de RPM no parecen influenciar sobre la terminación del parto

Evaluación de las causas de los eventos adversos o incidentes que afectan la seguridad del paciente, en el hospital central de la policía de enero 2012 a diciembre 2013

TITULO DEL TRABAJO: Evaluación de las causas de los eventos adversos o incidentes que afectan la seguridad del paciente, en el hospital central de la policía de enero 2012 a diciembre 2013. OBJETIVO: Determinar y analizar la causa raíz de los principales factores de riesgo que afectan la seguridad del paciente que puedan ocasionar eventos adversos en la atención de los pacientes, con el uso de la teoría de restricciones TOC en el Hospital Central de la Policía HOCEN. MATERIALES Y METODO: Se realizó una investigación descriptiva de naturaleza mixta – cuantitativa de tipo correlacional, la población es la totalidad de pacientes atendidos en el hospital de la policía entre enero de 2012 a diciembre de 2013, en el cual se presentaron un total de 189 eventos adversos los cuales sirvieron de objeto a esta investigación, la recolección de datos se realizó por medio de tablas de Excel 2010, posterior a esto se exporto la información al software de IBM SPSS Statistics 19 donde se analiza la información arrojando datos descriptivos y tablas de frecuencia. Finalmente haciendo uso de la Teoría de restricciones TOC se identificó la causa raíz para la ocurrencia de eventos adversos y plantear una intervención estratégica que promueva un sistema efectivo de seguridad del paciente en pro de la búsqueda de la mejora continua. RESULTADOS: Se analizaron 189 eventos adversos, de los cuales 89 fueron reportados en el turno de la noche, seguido por el turno de la mañana con 57, el turno tarde con 27, 28 eventos que no registraron horario, el servicio con mayor ocurrencia es el de medicina interna con 25 eventos, y finalmente la caída de pacientes, lo relacionado con medicamentos, nutriciones y accesos vasculares son los eventos con mayor incidencia. CONCLUSIONES: Se pudo concluir que es necesario que los procesos de seguridad del paciente deben tener un lineamiento directo desde la dirección de la organización permitiendo que las mejoras sean de inmediata aplicación, también es importante generar en el personal una actitud de compromiso frente al proceso de mejora, hay que redefinir las políticas institucionales ya que se concluyó por medio de la teoría de restricciones TOC que el principal factor para la ocurrencia de eventos adversos son las multitareas que el personal tiene que realizar en el proceso de atención.