Showing papers in "International Journal of Medicine and Medical Sciences in 2017"
TL;DR: Trainings on BSE practice will be important to improve the practice level of health professionals and their counseling skill for the clients, as well as to assess the magnitude of BS practice and its associated factors among female health professionals working in public health facilities in Western Ethiopia.
Abstract: Breast cancer is the leading cause of cancer mortality worldwide. Breast cancer incidence is increasing both in developed and developing regions. Regular breast self-examination (BSE) is one of the most cost effective methods for early detection of breast cancer in asymptomatic women. The aim of this study is to assess the magnitude of BSE practice and its associated factors among female health professionals working in public health facilities in Western Ethiopia. The study applied is health facility based cross-sectional study design. Simple random sampling technique was used to recruit a total of 390 female health professionals. The study was conducted from January to March, 2015. Bivariate and multivariable logistic regression model was used, odds ratios with 95% confidence intervals were computed and significance of all tests was decided at p-value of 0.05. From the total respondents, 77% had ever practiced BSE and only one third (33.7%) of them practiced regularly. Not experiencing breast problem (12.7%) was the main reason for not practicing regular BSE. After adjusting for possible confounders; personal history of breast cancer (AOR=4.7, 95%CI: 1.32-17.07), having knowledge of BSE (AOR=4.1, 95%CI: 1.36-5.65), positive attitude (AOR, 3.8, 95%CI: 2.10-9.17) and ever taught BSE to a client (AOR=5.2, 95%CI: 2.35-8.14) were found to be statistically significant predictors of BSE. Even though the life time BSE practice in this study was high, the regular BSE practice was low. Thus, trainings on BSE practice will be important to improve the practice level of health professionals and their counseling skill for the clients.
Key words: Breast self-examination, health professionals, practice, females.
20 citations
TL;DR: The overall, KAP score recorded in this study is an indication of low overall awareness level in the study area, which reflects the urgent need for rabies awareness programmes within the community.
Abstract: Rabies is a fatal neglected viral zoonosis which causes encephalitis in many warm-blooded animals and humans. It is an incurable disease once the clinical signs appear. However, it can be prevented via vaccination and community awareness. This study was therefore designed to determine the level of community knowledge, attitude and practices (KAP) regarding rabies. Cross sectional study was conducted from December 2016 to January 2017 in Dedo district, Jimma zone, southwestern Ethiopia. Multistage sampling technique was employed for selection of sample unit and data were collected from 135 household by face-to-face interview using a semi structured and validated questionnaire. Logistic regression was used for assessing the association of independent variable with KAP score. Out of 135 participants interviewed, 71.1% were urban and 57% were male respondents. All (100%) participants had heard about rabies and 88.9% were aware that rabies is zoonotic. However, there were misperceptions about the causes, transmission and incubation period of rabies. Overall KAP score revealed that 51.9% of the respondents had a good KAP, whereas 48.1% was found to have poor KAP score. Multivariable analysis showed that a good KAP score was significantly higher in male than female (OR= 37.16, CI=4.7- 92.1, p= 0.001), in age group >46 years than 15 to 30 years (OR=8.9, CI=1.6-47.2) in urban than rural residents (OR=4.35, CI=1.3-14.14, p= 0.014), education (P= 0.040), in respondent who were at secondary school education level than illiterate (OR=7.7, CI=1.05 - 56.64), in dog owners than those who had no dog (OR=2.9, CI=1.12-7.93, P=0.029), and in trained respondents than non-trained respondents (OR=3.37 CI=1.17-9.69, p=0.024). Generally, the overall, KAP score recorded in this study is an indication of low overall awareness level in the study area. This reflects the urgent need for rabies awareness programmes within the community. Thus, close collaboration of public health, veterinary sector and local authorities is a key element for preventing this fatal incurable disease.
Key words: Attitudes, knowledge, rabies, practices, Dedo.
14 citations
TL;DR: There were poor outcomes of patients admitted to intensive care units of Nigist Eleni Mohammed Memorial Hospital of Hosanna so that it was strongly recommended to improve quality of care.
Abstract: An intensive care unit is a special department of hospital or health care facility that provides intensive treatment medicine. Critically ill patients are admitted to the intensive care unit to reduce morbidity and mortality associated with acute illness, trauma or surgical procedures. This study aimed to assess clinical outcomes of patients admitted in intensive care units of Nigist Eleni Mohammed Memorial Hospital of Hosanna from January 2015 to January 2016. Institutional based cross sectional study design was conducted. All the study participants admitted to intensive care unit were included. Regular supervision and follow up was made. Data was entered into Epi info version 7 by investigators and was transported to SPSS version 20 for analysis. Bivariate and multivariate analysis was used to identify factors associated with patient’s outcome. A total of 280 clients were enrolled into the study of which 46.42% died. About 26% of patients were found in the age group of 20 to 24 years and majority of them were male (58.2%). Patient with head injury is about six times more likely to die in the intensive care unit than patients with small bowel obstruction (AOR 6.620 (95% CI ((468-93.584). There were poor outcomes of patients admitted to intensive care unit so that it was strongly recommended to improve quality of care.
Key word: Ethiopia, intensive care unit, cause of death, hospital discharge.
10 citations
TL;DR: There is an urgent need for proper medical waste management in Kumbo East and Kumbo West to minimise threats to human health and the environment and regular supervision and enforcement of policy onMedical waste management is paramount.
Abstract: The provision of healthcare generates waste which can be detrimental to health and the environment. Management of healthcare waste is still a challenge in developing countries as practices, capacities and policies on waste disposal are grossly inadequate and require intensification. With the growing trend of biomedical services in Kumbo Cameroon, the medical waste management practices in this area was investigated to generate data that could guide policy in planning for an effective and sustainable waste management program. A qualitative cross sectional study was conducted in 30 of the 52 health facilities in study area. Participating facilities were selected by convenience sampling and personnel by random sampling. Data was collected using questionnaires, interviews and direct field observations and results analyzed using SPSS V 17.0. P-values <0.05 were considered significant. Participants aware of the existence of a national policy guide on waste management were mostly administrators (66.7%). Only 2 (6.6%) health facilities had a copy of this document. None of the participating facilities kept records of their medical waste management practices. All participants were aware of the health risk of healthcare waste. Use of PPE varied among participants and was highest among employed waste handlers (EWH) (100%) and laboratory technicians (100%) while the lowest (69%) was among pharmacy attendants. Gloves were the most commonly used PPE. Most of the EWH (55.6%) used examination gloves which was inappropriate. Not all participants segregated or disinfected waste. Waste bins were not colour-coded and all facilities had appropriate safety boxes for sharps. In 86.7% of health facilities, waste disposal was by burning in pits located within 400 m away from the facility. These pits were not protected from scavengers. Only 4 facilities had incinerators and all did not meet the required standards, as none was equipped with a scrubber. Even after segregation at the point of generation, wastes were mixed at the point of final disposal. Waste management practices in study site did not meet standard practices. There is an urgent need for proper medical waste management in Kumbo East and Kumbo West to minimise threats to human health and the environment. Regular supervision and enforcement of policy on medical waste management is paramount.
Key words: Medical waste, medical waste management, disposal, Kumbo
8 citations
TL;DR: Irrespective of different forms of interventions in the country, the prevalence of female genital mutilation is still very high in the study area and revealed that palatable and very convenient intervention strategies need to be crafted to curb the problem at large and for those rural villagers who are at higher risk in particular.
Abstract: Female genital mutilation is still a serious health problem in Ethiopia. Female genital mutilation conceptualizes harmful traditional practice and is among existing traditional attitudes and practices on practice in different corners of the world. Other than demographic and health survey data, studies showing the prevalence of female genital mutilation is scarce and in some areas nonexistent. Its existence is only, time and again recognized as the practice has various health, social and psychological adversities. This study team found it imperative as the problem warranty study with the aim to assess prevalence of female genital mutilation (FGM) as well as identifying its associated factors among high school students. Institution based cross sectional study design was employed. 95% confidence level and 3% margin of error were used to study the magnitude and associated factors of FGM among 798 high school and preparatory students. A multi stage sampling procedure was employed to select female students in the schools. This research showed percentages and association among the variables by univariate, bivariate and multivariate analysis. Data were collected from 769 study participants with a response rate of 96.4%. About 78%, 95% CI (74.9%, 80.7%) of the study participants underwent the procedure. Age ≥17 [AOR=1.8, 95% CI (1.28, 2.61)], grades 11 and 12 [AOR =2.98; 95% CI (1.45, 6.12)] and [AOR=6.52, 95% CI (1.85, 22.94)], respectively, being from rural area [AOR= 1.6, 95% CI (1.01, 2.52)], and house wife and merchant mother occupation [AOR= 2.38, 95% CI (1.07, 5.29)] and [AOR= 2.72, 95% CI (1.04, 7.12)], respectively were independently associated to higher prevalence of female genital mutilation. Irrespective of different forms of interventions in the country, the prevalence of female genital mutilation is still very high in the study area. This study thus revealed that palatable and very convenient intervention strategies need to be crafted to curb the problem at large and for those rural villagers who are at higher risk in particular.
Key words: Female genital mutilation (FGM), high school students, Ethiopia.
8 citations
TL;DR: The evidence that MEBO is an effective treatment for phlebitis is encouraging, but not conclusive due to the low methodological quality of the RCTs, therefore, more high-quality R CTs with larger sample sizes are required.
Abstract: To evaluate the therapeutic effects of moisture exposed burn ointment (MEBO) on phlebitis, seven electronic databases where checked until September, 2016 for randomized controlled trials (RCTs) of MEBO on phlebitis. Risk of bias was assessed using Cochrane handbook guidelines. Thirty eight randomized controlled trials met the inclusion criteria in which the aggregated results indicated that comparison revealed significant differences in total effectiveness rate of MEBO versus conventional therapy (RR=1.27, 95% confidence interval [CI]=1.06, 1.52, and P=0.009), and there were some beneficial evidence regarding the effects on reducing incidence of phlebitis MEBO versus conventional therapy in preventing phlebitis (RR=2.73, 95% confidence interval [CI]=1.94, 3.85, and P<0.00001). The evidence that MEBO is an effective treatment for phlebitis is encouraging, but not conclusive due to the low methodological quality of the RCTs. Therefore, more high-quality RCTs with larger sample sizes are required.
Key words: External application of moisture exposed burn ointment, prevention and (or) treatment, phlebitis.
7 citations
TL;DR: Almost all patients in this study do not use pain assessment tools and 78.85% of the respondents do not know about multimodal analgesia, showing that there is a knowledge gap on postoperative pain managements.
Abstract: Pain is defined as any an unpleasant sensory and emotional experience associated with actual or potential tissue damage. Adequate postoperative pain management can reduce the patients‟ length of hospitalization and decrease postoperative complications. However, post-operative pain has not been satisfactorily relieved. Thus, the aim of this work is to assess professionals’ knowledge on post-operative pain management. Institutional based cross sectional study design was conducted. All health professionals who have worked in operation room, surgical ward, recovery room, and post anesthesia care unit were included. Data was entered into Epi info version 7 and transported to SPSS version 21 for analysis. Tables and narratives were used to determine descriptive statistics. A total of 52 participants were included in the study of which 59.6% were male. 69% of the respondents were found to be between the age of 20 and 23 years. Almost all patients in this study (94.23%) do not use pain assessment tools and 78.85% of the respondents do not know about multimodal analgesia. Approximately, one third of the respondents 32.69% mentioned that the drug is administered when the patient complain of pain. These showed that there is a knowledge gap on postoperative pain managements. Therefore, it was strongly recommended to improve professionals’ knowledge on postoperative pain management.
Key words: Pain, postoperative pain management, Asella Teaching Referral Hospital.
5 citations
TL;DR: This study reveals that the percentage prevalence of cough, phlegm, wheeze, breathlessness and chest tightness was 64.7, 55, 39, 41 and 43% for exposed respondents, respectively and 25.5, 14, 8, 6 and 0% for control subjects, respectively.
Abstract: In many of the textile industries, workers are largely exposed to cotton dust, which can leave workers with respiratory disorders. The aim of this study was to evaluate respiratory status of workers exposed to cotton dust in Arba Minch textile factory, Southern Ethiopia, 2017. A comparative cross sectional study was done and 51 workers exposed to cotton dust in the factory and 51 age and sex matched controls were investigated. Their lung function was measured with a pocket size digital Spirometer. A standardized questionnaire based on British Medical Research Council Questionnaire was used to assess respiratory system symptoms and use of personal protective devices. This study reveals that the percentage prevalence of cough, phlegm, wheeze, breathlessness and chest tightness was 64.7, 55, 39, 41 and 43% for exposed respondents, respectively and 25.5, 14, 8, 6 and 0% for control subjects, respectively. Lung function indices such as, forced vital capacity (FVC), forced expiratory volume in one second (FEV1), peak expiratory flow rate (PEFR) and forced mid expiratory flow between 25 and 75% of FVC (FEF25-75%) were higher in control respondents than in exposed respondents and the mean difference was found to be statistically significant (p<0.05) and the mean difference of predicted percentage values of FVC and FEV1 between the groups was found to be statistically significant (P<0.05). FEV1% was higher in the control group than in exposed group. Therefore, the factory management should provide personal protective devices (PPDs) to exposed employees and should train them.
Key words: Cotton dust, textile, lung functions, respiratory symptoms.
4 citations
TL;DR: The level of knowledge on cardiopulmonary resuscitation among anesthetists working in Addis Ababa governmental and private hospitals was found to be poor and those participants who were trained by CPR specialists, trained very recently, have higher degree and higher experience scored higher than their counter parts in items oflevel of knowledge.
Abstract: Cardiopulmonary resuscitation (CPR) is an important medical procedure which is needed for individuals who face sudden cardiac arrest. Sudden cardiac arrest is a life-threatening condition and a leading cause of death among adults over the age of 40 years in the United States and other countries. Reports showed that about 1,000,000 people die of cardiac arrest every year in the United States and Europe. To assess knowledge, attitude and associated factors of cardiopulmonary resuscitation among anesthetists working in governmental and private hospitals in Addis Ababa, Ethiopia. Institutional based cross-sectional study design was conducted in Addis Ababa governmental and private hospitals from March to August, 2014. Simple random sampling was used and structured questionnaires on cardiopulmonary resuscitation which is adopted from American Heart Association were distributed. The questionnaire had 20 items related to anesthetists’ knowledge regarding cardiopulmonary resuscitation and 8 items related to their attitude towards cardiopulmonary resuscitation. Anesthetists were divided on the base of their age, gender, experience, private and governmental hospitals, training they took previously and level of education. Descriptive statistics were employed to analyze the data using SPSS version 20 and participants’ level of attitude was measured by using a Likert scale. Percentages were worked out and the results were interpreted. From a total of 150 anesthetist participants, 140 of them or 93.3% scored below 84%. Those participants who were trained by CPR specialists, trained very recently, have higher degree and higher experience scored higher than their counter parts in items of level of knowledge. The level of knowledge on cardiopulmonary resuscitation among anesthetists working in Addis Ababa governmental and private hospitals was found to be poor (93.3%) according to 84% American Heart Association reference for CPR certification.
Key words: Anesthetists, attitude, cardiopulmonary resuscitation, knowledge.
4 citations
TL;DR: MEBO may be effective for treating DFU but a firm conclusion could not be reached because of the poor quality of the included trials, and further trials with higher quality are justified.
Abstract: This meta-analysis aimed to assess the effectiveness of moist exposed burn ointment (MEBO) for diabetic foot ulcers (DFU). Two researchers independently assessed the quality and validity of included randomized controlled trials (RCTs) in 7 electronic databases. Risk of bias was assessed using Cochrane handbook guidelines. Twenty seven trials which include 1,979 patients were involved for analysis. Comparison of the same intervention strategies revealed significant differences in total effectiveness rates between BEBO and conventional therapy group (Risk Ratio [RR], 6.36, [95% confidence interval (CI), 3.20, 12.64], P < 0.00001); MEBO combined with standard therapy (Risk Ratio [RR], 1.19, [95% confidence interval (CI), 1.08, 1.31], P = 0.0007); and healing time of DFU (Mean Difference [MD], 14.15, [95% confidence interval (CI), -18.14, -10.17], P < 0.00001). MEBO may be effective for treating DFU. However, a firm conclusion could not be reached because of the poor quality of the included trials. Further trials with higher quality are justified.
Key words: Exposed wound ointment (MEBO), diabetic foot ulcers (DFU), recombinant bovine, basic fibroblast growth factor (rb-bFGF), vacuum sealing drainage (VSD).
3 citations
TL;DR: In end stage renal disease (ESRD) patient receiving hemodialysis, lymphocyte count was negatively correlated with NLR value and positively with serum calcium level, while in ESRD patients undergoing he modialysis as compared to the healthy control subjects.
Abstract: Low lymphocyte count in end stage renal disease (ESRD) patients receiving maintenance hemodialysis was documented. This study aims to correlate the levels of lymphocyte count with serum calcium level, and neutrophil-to-lymphocyte ratio (NLR) in ESRD patient receiving hemodialysis in Northeast Nigeria. Seventy eight (78) patients receiving hemodialysis and 75 clinically healthy subjects (control) participated in the present study. Full blood count and serum calcium level were determined by using a Sysmex XP-300 Hematology Analyzer and a Selectra Pro-S Chemistry Analyzer, respectively. The mean levels of lymphocyte count, packed cell volume, hemoglobin and serum calcium level were significantly lower (p<0.001), while neutrophil, and NLR values were significantly higher (p<0.001) in ESRD patients undergoing hemodialysis as compared to the healthy control subjects. Lymphocyte count was negatively correlated with NLR value (r=-0.341; 0.05) but positively with serum calcium (r=0.904; p<0.001). In end stage renal disease (ESRD) patient receiving hemodialysis, lymphocyte count was negatively correlated with NLR value and positively with serum calcium level.
Key words: Lymphocyte count, serum calcium level, neutrophil to lymphocyte ratio (NLR), hemodialysis.
TL;DR: It is concluded that malignant otitis externa still has a significant mortality despite aggressive therapy, and extensive temporal bone/intracranial disease, poor blood sugar control, and diagnostic delay portend a poorer prognosis.
Abstract: Although the mortalities from malignant otitis externa (MOE) have greatly reduced, it is still a potentially fatal clinical condition. This study was undertaken to review the treatment outcomes and prognostic factors in MOE and to compare the behavioral pattern of cases caused by pseudomonas and non-pseudomonas organisms. A retrospective chart review of patients diagnosed with MOE in a tertiary institution over a 13 year period was conducted. Treatment outcome was divided into survival and mortalities groups. Demographic and disease factors were analyzed regarding mortalities using univariate and multivariate analysis. Seventeen of 22 cases were analysed. Nine (53%) were diabetic while 5 were HIV positive. After average of 7 weeks of antibiotic therapy ± surgical debridement, the disease resolved in 59%. Mortality was 41%. Diagnostic delay, poor blood sugar control, and extensive disease were found to predict mortality (P = 0.051, 0.048, and 0.006 respectively). Age, sex, causative organism, HIV infection, facial nerve and other cranial involvement did not significantly predict mortality. Pseudomonas aeruginosa was isolated in 11 patients. The rest had atypical organisms, Staphylococcus aureus and Proteus spp. There was no significant difference in the disease extension, mortality, duration of treatment and facial nerve involvement between pseudomonas and non-pseudomonas groups. However the pseudomonas group were predominantly diabetic (p = 0.03). It is concluded that malignant otitis externa still has a significant mortality despite aggressive therapy. Extensive temporal bone/intracranial disease, poor blood sugar control, and diagnostic delay portend a poorer prognosis. S. aureus is an increasingly important causative organism in MOE especially in non-diabetic patients.
Key words: Malignant otitis externa, mortality, risk factors, causative organisms.
TL;DR: Errors in filling Medical Certificates of Cause of Death (MCCD) greatly affect global mortality statistics and hence create challenges for public health programs to be executed effectively.
Abstract: The importance of death certification goes beyond the benefits to the health facility as they also provide invaluable legal and epidemiological benefits. Errors in filling Medical Certificates of Cause of Death (MCCD) greatly affect global mortality statistics and hence create challenges for public health programs to be executed effectively. The present study used both retrospective and prospective study design to review 617 death certificates. Male mortality rate was prevalent, accounting for 54.0% (p=0.033), modal age range was from 40 to 59 years (p=0.000), while most certificates were issued in January (p=0.000). Most death cases and errors were from the medicine specialty with Bachelor of Medicine, Bachelor of Surgery/Chirurgery (MBCHB) qualification. Single, double and multiple errors were recorded in the present study. Absence of time interval of cause of death, incomplete cause of death and abbreviations were the prevailing errors. Others include absence of physician qualification and department/ward, handwriting and cause of death queries (p=0.000). Errors can be reduced by organizing periodic seminar on death certification for clinicians, especially trainees/interns.
Key words: Death certification, errors, benefits, clinician.
TL;DR: It is concluded that moderate increase of TSS with increase RrD leads to moderate existence of RrDM, and the relative risk of diabetes mellitus was also quantified.
Abstract: This study aimed to evaluate stress among general population of Karachi, Pakistan and to categorize the relative risk of diseases through body mass index (BMI), as well as to categorize the relative risk of diabetes through questionnaire based scoring pattern. Study consisted of two phase study duration. Total 377 individuals were approached; only 269 individuals completed the study procedures. In phase-I, data was collected through standardized questionnaire of American Institute of Stress (AIS), to determine total stress scores (TSS). In phase-II, anthropometric markers (e.g., body weight, height, waist and body mass index) were measured, to evaluate the Relative Risk of Disease (RrD). With the aid of socio-demographic variables and questionnaire, the relative risk of diabetes mellitus (RrDM) was also quantified. 71% was the participation rate, in which 51.3% were male and 48.7% were female. Cronbach’s alpha (α) value was 69%. The mean scores of TSS (57.31±5.28) were moderate. Averages of body weight, height, waist and body mass index (BMI) were 164.6±13.5, 1.67±0.06, 35.75±2.5, 27.35±1.8, and RrDM (34.17±7.8), respectively. Through categorizing the RrD, 87.7% respondents were found to have increased risk, whereas, a least proportion were with high risk. Spearman R coefficient of gender variables showed indirect significant (p≤0.01) association with RrDM score. Pearson r coefficient of age variable showed direct significant (p≤0.01) association with RrDM score. Findings concluded that moderate increase of TSS with increase RrD leads to moderate existence of RrDM.
Key words: Diabetes mellitus, Karachi, body mass index, metabolic diseases, Pakistan, stress.
TL;DR: RDTs are appropriate tools for the management of childhood febrile diseases and will help in the follow-up and treatment of fever patients according to the guidelines on Integrated Management of Childhood Illness (IMCI).
Abstract: Improper diagnosis and management of febrile patients results in the persistence of malaria and other conditions with similar symptoms. The algorithm established here with Rapid Diagnostic Tests (RDTs) will help in the follow-up and treatment of fever patients according to the guidelines on Integrated Management of Childhood Illness (IMCI). This study aimed at determining the causes of fever in children and at valorizing the use of RDTs for the diagnosis of febrile diseases. Fifty children with fever, aged between 0 and 5 years, were recruited in a cross-sectional study at the Ekounou Baptist Clinic in Yaounde. RDTs were used to assess for the four common causes of febrile illness in the area. Microscopy was done and the Plasmodium species were confirmed by nested Polymerase Chain Reaction (PCR). Of the 50 febrile children, none was rubella seropositive, while 8% had malaria, 22% had toxoplasmosis infection, 8% had Salmonella typhi, 14% had a malaria-typhoid fever co-infection, 4% had a malaria-toxoplasmosis co-infection, 6% had a malaria-toxoplasmosis-typhoid fever co-infection, and 38% were negative for all the suspected common causes of fever in the health district. The overall frequencies of occurrence attributed 32% to malaria, 32% to toxoplasmosis and 28% to typhoid fever. Among all the positive malaria cases (n=16 (32%)) Plasmodium falciparum, Plasmodium malariae and Plasmodium ovale were identified by nested PCR. Malaria RDT results agreed significantly with the microscopy (kappa=0.81; p<0.0001) and PCR (kappa=0.84; p<0.0001) results; and the microscopy results also concurred significantly with the PCR results (kappa=0.77; p<0.0001). Malaria was not the exclusive cause of fever. Toxoplasmosis was found to occur in the same proportion as malaria (32%) in the study population. S. typhi was the third most important infection. Therefore RDTs are appropriate tools for the management of childhood febrile diseases.
Key words: Fever, malaria, toxoplasmosis, typhoid, rubella, rapid diagnostic test (RDT), Cameroon.
TL;DR: Young age, being a trader and Anglican Christian denomination were significantly associated with increased risk of premalignant lesions of the cervix, and the prevalence of cervical cytological abnormalities among the HIV positive women attending the HIV clinic in NAUTH was high.
Abstract: Women living with human immunodeficiency virus (HIV) infection have a higher burden of premalignant lesion of the cervix. This may be influenced by their sociodemographic profile. To study the sociodemographic determinants of abnormal cervical cytology among HIV-positive women attending the adult HIV clinic in Nnamdi Azikiwe University Teaching Hospital Nnewi (NAUTH), Nnewi, Nigeria, the Pap smears of 110 HIV-positive women attending the adult HIV clinic at the hospital were evaluated for cytological abnormalities using the Bethesda system of classification. Data on sociodemographic factors were obtained with the aid of semi structured questionnaires. Epi info statistical package was used to analyze the data. Majority of the women were married (61.8%; n=68), traders (67.3%; n=74) and who had attained at least secondary education (85.5%; n=94). All of them were Christians. The mean age and parity were 37.7±9.5 years and 2.8±2.3, respectively. The mean CD4 count was 557.1± 26 cells/ml and 89.1% (n= 98) of the women were on highly active antiretroviral therapy (HAART). The prevalence of cervical cytological abnormalities among the studied women was 28.2% (n=31). The mean age (35.4 vs. 38.9 years; p<0.05) was significantly lower among women with positive cervical cytological abnormalities and the prevalence of cytological abnormalities was significantly high among women aged 25 to 29 years (c2=9.30, p=0.05), traders (c2=10.7, p=0.03) and the Anglicans (c2=6.7, p=0.04). The prevalence rate was also the highest among women who were para 0-1 (36.6%), unemployed (100.0%), with no formal education (33.3%), and those who were separated from their husbands (100.0%), but these were not statistically significant. The prevalence of cervical cytological abnormalities among the HIV positive women attending the HIV clinic in NAUTH was high. Younger age, being a trader and Anglican Christian denomination were significantly associated with increased risk of premalignant lesions of the cervix.
Key words: Cervical, cytological, premalignant lesions, human immunodeficiency virus (HIV) positive.
TL;DR: It was found that unconscious patients had about two times more likelihood to have prolonged length of stays in intensive care unit than conscious patients (AOR 1.724; 95% CI: 809 to 3.676).
Abstract: The reason for a long stay in the Intensive Care Unit (ICU) is unknown in most cases, but there are some risk factors that can prolong the patients’ stay in the ICU. However, the threshold of prolonged length of stay is useful in analyzing the quality of health care and hospital costs. The main objective of this study was to assess the factors affecting prolonged intensive care unit stay in Nigist Eleni Mohammed Memorial Hospital from January, 2015 to January, 2016. Institutional based cross sectional study design was conducted. Census was used to include all study participants admitted to intensive care. Regular supervision and follow up was made. Data was entered into Epi info version 7 by investigators and was transported to statistical package for social sciences (SPSS) version 20 for analysis. Bivariate and multivariate analysis was used to identify factors associated with patient’s outcome. A total of 280 patients were included in the study by census. The mean length of stay in the intensive care unit was 5.49 ± 4.36. Majority of patients (61.4%) had poor nutrition status. In addition to their underlying diseases, majority of the patients in the intensive care units had one or more comorbidities. Poor nutritional status, male sex, presence of comorbidity and unplanned extubation was significantly associated with length of stays in intensive care unit at p-value less than 0.05. In this study, it was found that unconscious patients had about two times more likelihood to have prolonged length of stays in intensive care unit than conscious patients (AOR 1.724; 95% CI: 809 to 3.676). Higher proportions of patients stayed in the intensive care unit for more than three days. Therefore, the implication of this study was to recommend the decrease in length of intensive care unit stays in medically appropriate ways.
Key words: Intensive care unit, Ethiopia, length of stay, patient management.
TL;DR: Evaluating the number and size of cytoplasmic and nuclear vacuoles in polymorphonuclear neutrophil (PMN) obtained from a peripheral blood smear stained with the May-Grunwald-Giemsa method found that severe hemorrhagic shock induces greater vacuolization of PMNs as compared to mild trauma.
Abstract: Tissue trauma induces migration and activation of neutrophils through specific mediators. Vacuolated neutrophils in peripheral blood smear of septic patients correlated with mortality. However, scarce data exist with respect to findings in hemorrhagic shock (HS) trauma patients. The aim of this work was to evaluate the number and size of cytoplasmic and nuclear vacuoles in polymorphonuclear neutrophil (PMN) obtained from a peripheral blood smear stained with the May-Grunwald-Giemsa method in trauma patients with hemorrhagic shock. Seven sequential blood samples were taken from 20 patients with severe hemorrhagic shock and 20 patients who sustained mild thoracic trauma (control group). The first sample was obtained shortly after admission to the hospital followed by new samples taken at 6, 12, 18, 24, 48 and 72 h. Blood smears from both groups were processed to assess vacuolization and vacuole morphology in one hundred PMNs at each time point. The number and the area of vacuoles in the nucleus and the cytoplasm were determined using the program Image-Pro Express version 4.0 for Windows (Media Cybernetics, Bethesda, MD, USA). The number and the area of vacuoles in the cytoplasm and nucleus were significantly different (p <0.05) between shock and control groups. Moreover, serum lactate and heart rate correlated directly with the number (r=0.634) and the area (r=0.624) of cytoplasmic vacuoles as shown by multivariate analysis (p<0.05). Severe hemorrhagic shock induces greater vacuolization of PMNs as compared to mild trauma. PMN vacuolization has direct correlation with serum lactate, a known marker of severe shock.
Key words: Hemorrhagic shock, trauma, lactate, inflammatory response, blood smear, neutrophils, vacuolization, apoptosis.
TL;DR: Occult celiac disease should be suspected among patients with functional dyspepsia complaining of bloating, especially in age 14 to 20, where subtotal villous atrophy and high anti-tTG-IgA could be considered as occult Celiac disease.
Abstract: This is a study to answer the question: Is there a relationship between occult celiac disease and functional dyspepsia? The study was carried out on 400 dyspeptic patients. Upper gastrointestinal tract (GIT) endoscopy was done for all patients and those with non-functional dyspepsia were excluded from the study. Duodenal biopsies with histopathological examination according to the Marsh-Oberhuber criteria were done. Serum tissue transglutaminase IgA antibody (anti-tTG-IgA) was done for patients with histopathological findings suggestive to have celiac disease (subtotal and total villous atrophy). 172 patients with endoscopic findings explaining their dyspeptic symptoms were excluded. Only patients with functional dyspepsia were enrolled in this study (228 patients). Bloating was the most common symptom (46.5%). Normal villous pattern was found in 199 cases (87.2%). Villous atrophy was found in 29 patients, subtotal atrophy in 20 cases (8.7%) and total atrophy in 9 cases (3.9%). Age group of 14-20 years (20/29, 90.9% patients) with villous atrophy was reported to have statistically significant difference (P value =0.000). Serum anti-tTG-IgA level was measured in all cases of abnormal villous pattern. Nine patients (3.9%) were proved to have a celiac disease (total villous atrophy and high serum anti-tTG-IgA) and fourteen dyspeptic patients (6.1%) had subtotal villous atrophy with high anti-tTG-IgA level could be diagnosed as occult celiac disease. Occult celiac disease should be suspected among patients with functional dyspepsia complaining of bloating, especially in age 14 to 20. Subtotal villous atrophy and high anti-tTG-IgA could be considered as occult celiac disease.
Key words: Celiac disease, endoscopy, duodenal biopsy, functional dyspepsia.
TL;DR: There was a high rate of abnormal laparoscopy findings among the studied women which were mainly tubal occlusion and pelvic adhesions, indicating the need to incorporate laparoscopic findings in the initial evaluation of all infertility cases in the authors' environment.
Abstract: This research aims to study the findings from diagnostic laparoscopy among infertile women managed in a secondary healthcare center in Nigeria. This is a prospective study of eighty infertile women who had diagnostic laparoscopy in a secondary healthcare facility in Nigeria. The age range of the women was 24 to 45 years with most of them belonging to the parity group of 0 to 1 (90.0%; n=0.72). Primary infertility accounted for 43(53.8%) of cases, whereas the mean duration of infertility was 4.3+/- 2.4 years. Fifty-seven (71.3%) of the women had abnormal findings at laparoscopy. This comprised mainly of tubal pathologies (63.8%, n=51), pelvic adhesions (33.8%, n=27) and uterine fibroids (31.3%, n=25). Tubal occlusion was found in 39(48.8%) of the women, compromised bilateral tubal occlusion in 12(15.0%) and unilateral tubal occlusion in 27(33.8%) of cases. Distal tubal occlusion accounted for 24(30.0%) while proximal tubal occlusion was seen in 15(18.8%) of cases. While there were 21(26.3%) cases of polycystic ovaries, there was no significant difference in prevalence of abnormal laparoscopy (p=0.8), tubal pathology (p=0.5) and tubal occlusion (p=0.18) with respect to the type of infertility. There was a high rate of abnormal laparoscopy findings among the studied women which were mainly tubal occlusion and pelvic adhesions. These findings indicate the need to incorporate laparoscopy in the initial evaluation of all infertility cases in our environment.
Key words: Abnormal laparoscopy findings, Nigerian infertile women, Nnewi secondary health care centre.
TL;DR: Diagnostic hysteroscopy is strongly recommended in infertile women seen in 2 new Fertility/ Gynaecological Endoscopy units in Nigeria because of the significantly associated findings with secondary infertility, menstrual abnormalities, secondary dysmenorrhea and abnormal HSG findings.
Abstract: This study aimed to evaluate the correlates of abnormal hysteroscopy among infertile women seen in 2 new Fertility/ Gynaecological Endoscopy units in Nigeria. Data was collected on biosocial and clinical characteristics of the patients as well as the findings at hysteroscopy and was analyzed with STATA software, version 12.0 SE (Stata Corporation, TX, USA) for the correlates of abnormal hysteroscopy using the Pearson’s chi square test. P- value of less than 0.05 at a confidence interval of 95% was taken as significant. One hundred and twelve (70.4%) out of 159 women had abnormal findings at hysteroscopy. The mean age of the women was 36.6 ± 6.2 years. The uterine lesions found on hysteroscopy were mainly intrauterine adhesions (47.8%), endometrial polyps (17.6%), submucous fibroids (11.9%) and mullerian duct abnormalities (10.7%). Abnormal hysteroscopy was significantly associated with secondary infertility (X2=5.4; p=0.02), duration of infertility more than 2 years (X2=16.5; p<0.001), menstrual abnormalities (X2=4.6; p=0.03), secondary dysmenorrhea (X2=4.9; p=0.03) and abnormal hysterosalpingogram findings (X2=5.0; p=0.03). There was no significant relationship of abnormal hysteroscopy with pelvic ultrasound findings (X2=1.82; p=0.18). Abnormal hysteroscopy was significantly associated with secondary infertility, menstrual abnormalities, secondary dysmenorrhea and abnormal HSG findings. Therefore, diagnostic hysteroscopy is strongly recommended in these classes of women.
Key word: Clinical, correlates, abnormal hysteroscopy, infertile women, Nigeria, Nnewi.
TL;DR: There is a need to ensure proper and effective supply chain management of these anti-malarials in these hospitals to maintain adequate quantities of these medications inThese hospitals and RMS.
Abstract: The aim of the study was to assess the supply chain management of anti-malarials in the five district hospitals in the Kumasi Metropolitan Area (KMA) including the Regional Medical Store (RMS) and also to assess the level of knowledge of respondents on malaria in these facilities. Cross sectional study was conducted at the facilities and purposeful sampling technique was applied to select the clients and interviewed. All the hospitals sourced their anti-malarials from the regional medical store (RMS) with tablet artemether-lumefantrine, tablet artesunate-amodiaquine, injection artesunate and sulphadoxinepyrimethamine (SP) being dispensed by all the hospitals from January to December 2015. All health facilities transport their anti-malarials from RMS by vans. The commonly known anti-malarials by respondents were tablet artemether-lumefantrine (84.08%, n=169) and tablet artesunate-amodiaquine (81.09%, n =163), with 5.47% (n =11) of respondents not knowing any type of anti-malarial. Antimalarials used for the treatment of malaria was given to 65.67% (n=132) of the clients at the hospital. Most of these anti-malarials were available at the hospitals though some facilities encountered periodic shortages and also had stocks expiring within the studied period. Respondents had fair knowledge of the side effects of a few of the anti-malarials. There is a need to ensure proper and effective supply chain management of these anti-malarials in these hospitals to maintain adequate quantities of these medications in these hospitals and RMS.
Key words: Malaria, anti-malarial, supply chain management, plasmodia, female anopheles mosquito.
TL;DR: It is demonstrated that pharmacologically induced proteasome inhibition is sufficient to activate autophagy in cardiomyocytes in both intact animals and cell cultures, and unveiled a potential cross-talk between the two major degradation pathways in cardiac PQC.
Abstract: Protein quality control (PQC) senses and repairs misfolded and or unfolded proteins. However, if the repair fails, it degrades the terminally misfolded polypeptides through an intricate collaboration between molecular chaperones and targeted proteolysis. Proteolysis of damaged proteins is performed primarily by the ubiquitin-proteasome system (UPS). Macroautophagy (commonly known as autophagy) may also play a role in PQC-associated proteolysis, especially when UPS function becomes ineffective. The development of a range of heart diseases, including bona fide cardiac proteinopathies and various forms of cardiac dysfunction has been linked to proteasome functional insufficiency (PFI). Proteasome functional insufficiency and activation of autophagy have been observed in the heart of mouse models of cardiac proteinopathy. Recent studies demonstrated that pharmacologically induced proteasome inhibition is sufficient to activate autophagy in cardiomyocytes in both intact animals and cell cultures. This had unveiled a potential cross-talk between the two major degradation pathways in cardiac PQC.
Key words: Proteasome, autophagy, cardiomyocytes.