National Center Hospital Research Articles

Profile and outcome of patients with upper gastrointestinal bleeding presenting to urban emergency departments of tertiary hospitals in Tanzania

BackgroundUpper gastrointestinal bleeding (UGIB) is a common emergency department (ED) presentation with high morbidity and mortality. There is a paucity of data on the profile and outcome of patients who present with UGIB to EDs, especially within limited resource settings where emergency medicine is a new specialty. We aim to describe the patient profile, clinical severity and outcomes of the patients who present with UGIB to the ED of tertiary referral hospitals in Tanzania.MethodsThis was a prospective cohort study of consecutive adult (≥18 years) patients presenting to the EDs of Muhimbili National Hospital (ED-MNH) and MUHAS Academic Medical Centre (ED-MAMC), in Tanzania with non-traumatic upper gastrointestinal bleeding (UGIB) from July 2018 to December 2018. Patient demographic data, clinical presentation, and ED and hospital management provided were recorded. We used the clinical Rockall score to assess disease severity. The primary outcome of 7- day mortality was summarized using descriptive statistics. Regression analysis was performed to identify predictors of mortality.ResultsDuring the study period, 123 patients presented to one of the two EDs with an UGIB. The median age was 42 years (Interquartile range (IQR) 32–64 years), and 87 (70.7%) were male. Hematemesis with melena was the most frequently encountered ED complaint 39 (31.7%). Within 7 days, 23 (18.7%) patients died and one-third 8 (34.8%) of these died within 24 h. There were no ED deaths. About 65.1% of the patients had severe anemia but only 60 (48.8%) received blood transfusion in the ED. Amongst those with history of (h/o) esophageal varices 7(41.2%) did not receive octreotide. Upper GI endoscopy, was performed on 46 (37.4%) patients, of whom only 8 (17.4%) received endoscopy within 24 h (early UGI endoscopy). All patients who received early UGI endoscopy had a low or moderate clinical Rockall score i.e. < 3 and 3–4. No patient with scores of > 4 received early UGI endoscopy. Age > 40 years was a significant independent predictor of mortality (OR = 7.00 (95% CI 1.7–29.2). Having a high clinical Rockall score of ≥ 4 was a significant independent predictor of mortality (OR = 6.4 (95% CI 1.8–22.8).ConclusionsIn this urban ED in Sub-Saharan Africa, UGIB carried a high mortality rate. Age > 40 years and clinical Rockall score ≥ 4 were independent predictors of higher mortality. Future studies should focus on evaluating how to improve access to UGI endoscopy so as to improve outcomes.

The utility of point of care serum lactate in predicting serious adverse outcomes among critically ill adult patients at urban emergency departments of tertiary hospitals in Tanzania

BackgroundElevated serum lactate levels have been shown in numerous studies to be associated with serious adverse events, including mortality. Point of care lactate level is increasingly available in resource-limited emergency department (ED) settings. However, little is known about the predictive ability of for serious adverse events.Aim of the studyWe aimed to describe the utility of serum lactate level as a predictor of 24-h serious adverse events among adult patients presenting at the Emergency Medicine Department (EMD) of Muhimbili National Hospital (MNH) and MUHAS Academic Medical Center (MAMC).MethodsThis was a prospective observational study involving adult patients presenting to the EMD-MNH and MAMC from 1 September 2018 and 31 October 2018. Eligible patients with at least one lactate level test drawn while in the ED were examined in terms of their demographics, relevant clinical characteristics, and any serious adverse event (SAE) within 24 h of arrival. The sensitivity and specificity of lactate level to predict outcomes of interest were determined using the best cut-off point constructed from AUROC to see how well lactate level could discriminate which patients would have adverse events in the next 24 h. Categorical and continuous variables were compared with the chi-square test and two-sample t test, respectively.ResultsWe screened 2057 (20.9%) out of 9828 patients who presented during study period, and enrolled 387 (18.8%). The overall median age was 54 years (interquartile range 40–68 years) and 206 (53.2%) were male. Using local triaging system, a total of 322 (83.2%) was triaged as an emergency category. The mean lactate level was 3.2 ± 3.6 mmol/L, 65 (16.8%) patients developed at least one SAE, with 42 (11%) who required ICU/HDU, 37 (10%) needed ventilator support, 10 (3%) required inotropes, and 9 (2%) developed cardiac arrest. The overall 24-h mortality was 28 (7%). The AUC of serum lactate level for overall 24-h mortality was 0.801 (95%CI, 0.7–0.9, P ≤ 0.001). At the optimal cutoff value (3.8 mmol/L), lactate level had a sensitivity and specificity for 24-h mortality of 64% and 85%, respectively. Mortality of the high-lactate level group (33.8 mmol/L) was significantly higher than that of the low-lactate level group (< 3.8 mmol/L), 23.8% vs. 2.9%, respectively (95%CI 3.8–17.2, p < 0.001), with the relative risk of mortality in the high-lactate level group being 8.1 times higher compared to the low-lactate level group.ConclusionThe utility of lactate level in predicting mortality was similar to that seen in high-resource settings. A serum lactate level of 33.8 mmol/L predicted 24-h serious adverse events in unselected patients seen in the high-acuity area of our ED. Incorporating serum lactate level in ED in lower- and middle-income countries (LMICs) can help identify patients at risk of developing serious adverse events.

Antibiotic Resistance and Production of Extended Spectrum β-Lactamases by Clinical Gram-negative Bacteria in Benin

Aims: The aim of this work was to determine the resistance profile and to investigate the production of extended spectrum β-lactamases (ESBL) by clinically relevant Gram-negative Bacillus (GNB) strains.&#x0D; Methodology: About 191 strains were isolated from 1823 samples collected at the HKM National Hospital and University Center of Cotonou (Benin). Species identification was done with the Api 20th gallery. Two methods were used to search for β-lactamase production: the liquid acidimetric test for penicillinases and double halo method for ESBL. The susceptibility to conventional antibiotic molecules was investigated by the disk diffusion method. Polymerase Chain Reaction (PCR) was used to identify blaTEM and blaSHV genes in the β-lactamases.&#x0D; Results: A prevalence of 10.48% of GNB was recorded. Among the isolated strains, 51.31% came from samples collected from in-patients and 48.69% from out-patients’ samples. The most contaminated samples were urine (43.98%), pus (34.58%) and blood (9.42%). Majority of the isolated species included: Klebsiella pneumoniae (28.27%), Acinetobacter spp. (18.32%), Pseudomonas aeruginosa (15.72%), Escherichia coli (14.15%) and Enterobacter cloacae (12.04%). More than the half (57.07%) of the strains produced penicillinases; whereas 16.76% were ESBL-producers and these occurred only among Klebsiella pneumoniae, Enterobacter cloacae, Escherichia coli and Enterobacter agglomerans. The ESBL-producing strains were cross-resistant to beta-lactams. Imipenem is the most effective antibiotic on all isolated strains. ESBL-producing GNB strains possessed both the blaTEM gene and the blaSHV gene in a proportion of 25%; 37.5% of the strains had only the blaTEM gene and 12.5% of the strains had only the blaSHV gene.&#x0D; Conclusion: ESBL-producing strains of K. pneumonia in the hospital environment were the major carriers of blaTEM and blaSHV. Given this situation, it is necessary to continue research to identify resistance genes.

Osteoid Endometrial Metaplasia in Postabortion: About Three Cases at the National Hospital Center of Pikine; Dakar, Senegal

Osteoid Endometrial Metaplasia in Postabortion: About Three Cases at the National Hospital Center of Pikine; Dakar, Senegal

Fecal human β-defensin-2 (hBD-2) levels and gut microbiota patterns in preterm neonates with different feeding patterns

Human β-defensin-2 (hBD-2) is an essential antibacterial peptide involved in innate immunity and is expressed in breast milk and intestinal mucosa. The aim of this study was to investigate fecal hBD-2 levels and gut microbiota in preterm neonates with different feeding patterns. This study was cross-sectionally designed and included 44 preterm neonates categorized into four groups as follows: breast milk only, breast milk predominant, formula milk predominant, formula milk only. The study was conducted at the Neonatology Ward, National Center Hospital Cipto Mangunkusumo, Jakarta from November 2016 to April 2017. hBD-2 levels were measured by ELISA. Intestinal bacteria were quantified by qPCR. hBD-2 levels were significantly different between groups (one-way ANOVA, p=0.004) and the highest value of hBD-2 was found in the formula milk predominant group (344.87±61.2 ng/mL). hBD-2 levels were positively correlated with feeding pattern (Spearman correlation test, p=0.009, r=0.391). There were no significant differences in the total number of specific intestinal microbiota (Bifidobacterium, Lactobacillus and Klebsiella) among groups (one-way ANOVA, p>0.05). Interestingly, the formula milk only group had the highest amount of Klebsiella compared with other groups. hBD-2 levels were not correlated with the quantity of Bifidobacterium, Lactobacillus and Klebsiella (Pearson correlation test, p>0.05). hBD-2 levels were significantly higher in the formula milk predominant group compared with the breast milk only group. Gut microbiota patterns showed that Bifidobacterium and Lactobacillus were higher in the breast milk only group, while Klebsiella was higher in formula milk group, although this difference was not statistically significant.

Epidemiological profile of lung cancer in a Nepalese population: A single-institution review.

e13087 Background: Lung cancer is one of the common cancers worldwide, and is the commonest cancer in Nepal, with an incidence of 16%. There is a high incidence of smoking in Nepal, being highest in the mountain region in the north and lowest in the tarai region in the south. Smoking kills around 15,000 people per year. The prevalence of smoking in the urban population of Kathmandu over the age of 15 has been estimated at 64.6% in men and 14.2% in women. Nepal has diverse population with various ethnicities and different cultures. The aim of this study was to determine the relation of smoking, epidemiology of lung cancer and distribution of lung cancer in various ethnicities of Nepal. Methods: All patients attending National Hospital and Cancer Research Center in Kathmandu who were diagnosed with lung cancer between January 2012 and December 2018 were enrolled in the study. Informed consent was taken before enrollment and data was collected by the nursing staffs prospectively using a preset questionnaire for interviewing patients. Results: Data was collected from 250 patients over the seven years with histologically proven lung cancer. About 85.6 % of patients were male and 80% of them were smokers. 50% of men and 30 % of the women were smokers. Most common age to start smoking was in 11-20 years group (60%). 58% of patients were from Kathmandu valley, and 42% of patients from outside the valley. 38% of male were literate and 16% were illiterate where as 13.6% of female were literate and 32.4% were illiterate. Among the various ethnic groups, 44% were Newars, 20% Mongols, 18% in Chhetris and 18% Brahmins. The incidence of lung cancer was highest (57.6%) in the age 61-80 years age group. 14.4% of the patients had family history of cancer M = 8.6% and F = 6.0%). Squamous cell carcinoma was the highest (51.2%) followed by small cell carcinoma (22%) and adenocarcinoma (26.8%). Carcinoma of right lung was frequent (62%) compared to the left lung (38%). Local cigarette were used by 82.5% of the smokers and 54.5% of them used filtered cigarettes. 40% practiced relighting the butt ends. Conclusions: The study shows that smoking is a single major contributing factor observed in lung cancer in Nepal across various age groups as well as diverse ethnic groups. Given the high incidence of smoking starting before the age of 20, there is an urgent need for organized mass anti-smoking campaigns, especially in schools targeting the younger age group. Need of awareness against the smoking and the cause of lung cancer needs to emphasized to reduce the burden of the lung cancer.

Nonvestibular Schwannoma Tumors in the Cerebellopontine Angle: A Single-Surgeon Experience.

Background:The most common cerebellopontine angle (CPA) tumor is a vestibular schwannoma. Schwannomas account for 8.5% of all intracranial tumors and more than 90% of the tumors originate from the eighth cranial nerve, but one in five CPA tumors are not vestibular schwannoma. These tumors may have different manifestations and require different management strategies.Methods:We report 224 consecutive NVCPAT operated in the Department of Neurosurgery, P.D. Hinduja National Hospital and Medical Research Centre, Mumbai, by the senior author between 2001 and 2014 and discuss the different approaches and outcomes in NVCPAT.Results:The age range was 20–60 years and there were 129 females and 95 male patients. The clinical material consisted of 81 cases of meningioma (36.1%), 44 cases of epidermoid (19.64%), 34 cases of trigeminal schwannoma (15.17%), 26 cases of jugular foramen schwannoma (11.60%), and 39 cases of other tumors (17.41%). In nonvestibular schwannoma (NVS), symptoms and signs from cranial nerve VIII are less frequent and other cranial nerves and cerebellar symptoms and signs predominate.Conclusion:Symptoms and signs are different in NVCPAT from those found in patients with vestibular schwannoma. Hearing loss is not the predominant symptoms. Cerebellar signs and trigeminal dysfunction are more common. The most common approach used in the current series was retrosigmoid craniotomy. Gamma knife radiosurgery was a useful adjunct in a subset of these patients.

Applicability of the Clavien-Dindo classification in the evaluation of postoperative complications at the Surgery Department of the National Hospital Center of Nouakchott: observational study of 834 cases

RésuméIntroductionLes complications postopératoires ne sont pas rares; certaines sont transitoires, d'autres peuvent être graves, mais elles sont toutes importantes pour les patients. L'une des plus importantes lacunes dans la recherche chirurgicale est le manque de consensus sur le résultat préféré, comment la mesurer ou l'évaluer.MéthodesNous rapportons une étude rétrospective des complications post opératoires survenues au service de chirurgie générale du centre hospitalier national de Nouakchott. Huit cents trente-quatre patients opérés pendant sept mois (1er janvier 2017 au 31 juillet 2017). Les paramètres démographiques et cliniques ont été étudiés, analysés statistiquement sur le logiciel SPSS 20.RésultatsIl s'agit de 834 patients dont 426 (51,1%) hommes. L'âge moyen: 34,81 ans (1-90ans). Quatre cents trente-deux (51,2%) patients opérés en urgence. Le sexe ratio (H/F): 1.04. L'ethnie arabo berbère représentait (77,8%). La pathologie appendiculaire (41,12%), pathologie hépatobiliaire (17,76%), pathologie de la paroi abdominale (16,1%). La pathologie thyroïdienne (5,6%). Cent quatre-vingt-trois (21,94%) patients ont développé des complications postopératoires dont 4 (2,1%) décès. Le grade II clavien-Dindo est le plus représenté avec 82,5% des compliquées et représente 17,91% de tous les opérés. L'infection du site opératoire a été de 62.8% de toutes les complications.ConclusionCette étude a montré que la classification de Clavien-Dindo peut être appliquée pour les patients ayant subi une chirurgie élective et une chirurgie d'urgence. Nous pensons que le manque de suivi et le manque de moyen de lutte contre l'infection et le non-respect rigoureux des mesures d'asepsie et d'antisepsie jouerait un rôle important.

Support Epidemiology and Prognosis of Premature Rupture of Membranes in Pikine National Hospital Center

Premature rupture of membranes (PROM) complicates 3% of preterm pregnancies and occurs in 60% to 80% of term pregnancies. However, its management remains largely controversial. The objective of this study was to establish the epidemiological profile, to study the management and the prognosis of Premature rupture of membranes (PROM) in our practice. Patients and methods: It was a prospective, descriptive and analytical study from May 1st 2016 to January 31st 2017 at the Pikine National Hospital Center. The target population consisted of all patients received at the hospital with premature rupture of membranes and who had given birth in the structure. The variables studied were: marital status, mode and reason for admission; risk factors; antecedents; prenatal care; the clinical and paraclinical examinations; support and immediate maternal and fetal neonatal complications. Results and comments: The mean maternal age was 27.34 years and the majority of women were aged between 18 and 39 years (94.4%). Fifty-one point three percent of patients were primiparous, large multiparous represented only 2.5%. The majority of patients (385 patients or 66.9%) had consulted in the first 12 hours following the onset of fluid flow. For 20.1% of them this flow was associated with uterine contractions. Hidden risk factors were dominated by the twin pregnancy. The blood count showed that 38.8% of patients had leukocytosis and CRP was positive in 18.3% of patients. An ampicillin-based antibiotics was established in 42.6% of cases, corticosteroid therapy in 5.2% and 1% in tocolysis. An expectation was adopted in 65.7% of cases, induction of labor in 7.3% and a cesarean section immediately in 27% of cases. In total, 65.7% of patients had vaginal delivery and 34.3% cesarean. The perinatal mortality rate was 3.6% or 22 newborns on 610. Two cases of endometritis were observed and one case of immediate postpartum hemorrhage. No maternal deaths were recorded. Conclusion: These results show that the prognosis of premature rupture of membranes remains favorable in our practice. To improve this prognosis, we recommend sensitization of patients during prenatal care regarding signs of danger, a systematic bacteriological sample from all pregnant at the end of their pregnancy and the health personnel to direct patients’ references to structures in case of PROM.

Operative outcomes of patients with cervical spondylotic myelopathy at Cipto Mangunkusumo National Central Hospital 2014-2016

Introduction: Cervical spondylotic myelopathy (CSM) is the most common type of myelopathy with cervical spondylosis as the underlying disorder. To this date, there has been ongoing debate regarding operative approach in CSM treatment that there is still no established treatment proven superior one over the other. This study aims to investigate the operative outcomes of CSM. Methods: We retrospectively reviewed patients with CSM who had undergone anterior approach and posterior surgery at Cipto Mangunkusumo Hospital, Jakarta, Indonesia, between January 2014 and December 2016. The average followup time was 13-42 months, with an average of 27 months. The clinical data of patients were observed, including age, sex, operation records, pre- and post-operative Japanese Orthopaedic Association (JOA) scores, cervical spine canal stenosis, cervical curvature, and the presence of ossification of the posterior longitudinal ligament. Results: Eight patients (6 male, 2 female) with CSM were enrolled in this study with mean age of 55.6 ± 9 years. Two patients experienced minor complication, and one patient had major complication of Frankel grade decrement and phrenic nerve paralysis that led to prolonged intensive care. The preoperative cervical JOAs of the eight patients were 11.2 ± 2.81 and post operative JOAs were 13.1 ± 3.44. (p< 0.05). Seven patients were satisfied with the outcomes of their surgery. Conclusion: A definite conclusion could not be drawn regarding the most effective surgical approach for CSM. Further studies with larger number of samples and centres are required to investigate the comparison of best treatment choice for CSM.

Molecular characterization and Antibiotic resistance profiles of Escherichia coli extended-spectrum β-lactamases producer strains isolated from urine samples in Benin

Urinary tract infections are the second common reason of medical consultations and antibiotics prescription. Escherichia coli is known to cause most urinary tract infections. The aim of this study was to characterize and determine the antibiotic resistance profile of E. coli extended-spectrum βlactamases (ESBL) producer strains isolated from urine samples. The urine samples collected came from hospitalized and non-hospitalized patient referred to Hubert Koutoukou Manga (HKM), National and University Hospital Center (Cotonou, Benin). The resistance to antibiotics was determined according to the disk diffusion method. The production of penicillinase and ESBLs was researched respectively by the acidimetric test and double disk synergy method. The presences of genes encoding βlactamases were detected by Polymerase Chain Reaction (PCR). Our data revealed that 60 % of E. coli strains (101) were isolated from female patients. Also, 69.31 % of the strains were isolated from non-hospitalized patients. The high resistance levels were recorded with amoxicillin (96.04 %) and amoxicillin + clavulanic acid (66.34 %). Twenty percent (20%) of strains were ESBLs. Among ESBLs strains, 70% comes from non-hospitalized patients. Eighty percent of E. coli strains produced penicillinase among which 25 % were ESBL producers. All the ESBL producers strains carried blaTEM gene whereas only 30 % carried the blaSHV gene. This study updates the data on the prevalence to antibiotic resistance of E. coli ESBL producers strains for better management of urinary tract infections.

Resistance profile and treatment outcomes in HIV-infected children at virological failure in Benin, West Africa.

In Africa a high percentage of HIV-infected children continue to experience HIV treatment failure despite enormous progress. In Benin (West Africa), there are currently no data on HIV drug resistance at failure in paediatric populations. To assess the frequency and patterns of HIV drug resistance among children with virological ART failures. Dried blood spots from 62 HIV-infected children with virological failure were collected at the paediatric clinic of the National Hospital Center in Cotonou for genotyping and plasma drug concentration determination. Characteristics of the population show a median age of 10 years (IQR 6-13) and a median duration on ART of 5 years (IQR 3-7). Viruses from 53 children were successfully amplified. Of these, 76% of patients were on an NNRTI-based regimen and 24% on a boosted PI-based regimen. NRTI, NNRTI and dual-class resistance was present in 71%, 84% and 65% of cases, respectively. Only 4% of the children had major resistance mutations to PIs and none had major resistance mutations to integrase inhibitors. Among the participants, 25% had undetectable antiretroviral concentrations. Our results showed that the development of drug resistance could be one of the main consequences of high and continuous viral replication in HIV-infected children in Benin. Thus, inadequate attention to monitoring lifelong ART in children may prevent achievement of the goal of the United Nations Program on HIV and AIDS (UNAIDS) of 90% viral suppression among patients receiving ART.

Complications and In-Hospital Mortality After On- Pump Vs Off-Pump Coronary Artery Bypass Grafting

Off-pump surgery has involved into the most frequently adopted alternative technique to conventional on-pump coronary artery bypass grafting (CABG) in the treatment of patients with coronary artery disease. Our aim was to compare data analyses of complications and in-hospital mortality after on-pump vs off-pump CABG. Materials and methods: Retrospective data analyses research is based on 402 patients, ranging in 37-75 years of age. Operations CABG were performed in 2009- 2012, at the West Georgian Interventional Medicine National Center Hospital, Kutaisi; Aleksandre Aladashvili Clinic, Tbilisi; and L.T.D. Lancet, Tbilisi. 253 cases were performed off pump and 149 cases were performed on pump. Groups were diversified by the F Fischer’s criteria. Odds ratio (OR) was made using regression analysis. Statistical analysis was made using SPSS 22 program. Results: While on pump during surgery, intraoperative shock occurred in 8(5.37%) cases, Thrombosis – 3(2.01%); Dissection – 3(2.01%), Stroke – 1(0.67%) and Myocardial Infarction – 1(0.67%). These complications were not detected during off pump CABG. Frequency of in-hospital mortality after off pump and on pump CABG are respectively 7(2.77%) and 15(10.07%) - p&lt;0.0018. Totallyperi operative complications were during off pump CABG – 35(13.83%) and on pump CABG – 41(27.51%)(p&lt;0.0007). In the cases of on pump surgery, odds ratio of complications that arise: bleeding OR=4.48(95CI;1.38-14.54); atrial fibrillation – OR=6.64(95%CI:1.82-24.21); pulmonary complications - OR=2.24(95%CI:1.19-4.21), renal insufficiency - OR=8.75(95%CI:1.01- 75.63); in-hospital mortality – OR=2.365(95%CI:1.425-3.924). Conclusion: Off pump CABG seems to significantly reduce postoperative renal failure, bleeding, atrial fibrillation, and respiratory complications, while perioperative myocardial infarction rates remain significantly unchanged. Considering in-hospital mortality and perioperative complications, off pump CABG has much better results.

What are patients with Rett syndrome interested in?

[Purpose] Rett syndrome is a severe neurodevelopmental disease; individuals typically have no verbal skills or purposeful hand movements. In clinical settings, knowledge of their interests would be helpful for therapy. Therefore, we investigated the interests of Rett syndrome patients. [Subjects and Methods] In 2016, we sent a questionnaire regarding the interests of individuals with Rett syndrome to 1,016 directors of schools for special needs education and 204 directors of rehabilitation departments (130 facilities for persons with severe motor and intellectual disabilities, 73 wards for patients with severe motor and intellectual disabilities, and the National Hospital Organization and National Center Hospital, and the National Center of Neurology and Psychiatry) in Japan. We used descriptive statistics and content analysis to examine the answers to the questionnaires. [Results] Information was acquired from 216 individuals (3–53 years old) with Rett syndrome. 92.9% of the individuals were reported to have some interests (e.g., in people, music, things to see, animation, or books). [Conclusion] Individuals with Rett syndrome were observed to be interested in various things despite their having severe motor and intellectual disabilities. These findings suggest that family members and care staff might facilitate various changes or developments of these individuals and discover their hidden strengths by focusing on their interests.

Satisfaction of Patients Treated in Physical Medicine and Rehabilitation Department in CNHU-HKM of Cotonou

Satisfaction of patients is an important dimension of the hospital management and the evaluation of the quality of care and services offered to patients. Objective: To estimate the degree of satisfaction of patients admitted in Physical Medicine and Rehabilitation Department in the National Hospital and University Center (CNHU-HKM) in Cotonou. Method: Cross-sectional study with descriptive and analytical aim. It was led from June 15th to October 15th 2013, on 158 patients or guides of children or not communicating patients having ambulatory care in the Department of Physical Medicine and Rehabilitation and who agree to participate to the study. The level of global satisfaction of the subjects was estimated with a digital scale from 0 to 10. It was secondarily transformed into a discreet qualitative variable. Result: Rate of participation was 63.2%. Patients had deficiencies of rheumatilogical origine (41.1%), neurological (27.2%), traumatological (24.1%). Their pathologies were evolving since 1 month to 10 years. It was about their first attendance of the Rehabilitation Department of CNHU-HKM in 72.2%. Patients’ degree of satisfaction was good for the deadliness of expectation, reception (80%), cleanliness of the building, respect of patients’ intimacy. Global satisfaction of patients was good in 72%. It was influenced by the deadline of evolution of the pathologies. Discussion-Conclusion: The level of satisfaction of patients admitted in the Rehabilitation Department in CNHU-HKM was acceptable. However, they are parameters that remain to be improved.

Spectrum of histomorphological diagnosis in cystoscopic bladder biopsies

Background: Urinary bladder lesions are the main source of significant clinical symptoms which are more disabling than lethal. Bladder tumors constitute one of the most common urological pathology. Urothelial carcinoma accounts for 90% of all primary tumors of the bladder. This study aimed to determine the frequency of different types of lesions of the urinary bladder and to determine the grade and stage of urothelial tumors.Materials and Methods: This is a 2 years cross sectional study of cystoscopic biopsies carried out in the Department of Pathology, Medicare National Hospital and Research Centre, Kathmandu, Nepal.Results: Out of 87 cases, 58 (66.67%) cases were neoplastic lesions and 29(33.33%) cases were non- neoplastic lesions. Majority of neoplastic lesions 96.55% were urothelial (transitional cell) tumors comprising predominantly of low grade papillary urothelial carcinoma 50.91%. Muscle invasion was seen only in high grade papillary urothelial carcinomas.Conclusion: Among bladder tumors low grade papillary urothelial carcinoma is the most common.

Malnutrition and cachexia among cancer out-patients in Nairobi, Kenya.

Cancer is the third leading cause of death in Kenya. However, there is scarce information on the nutritional status of cancer patients to guide in decision making. The present study sought to assess the risk of malnutrition, and factors associated with malnutrition and cachexia, among cancer out-patients, with the aim of informing nutrition programmes for cancer management in Kenya and beyond. This was a facility-based cross-sectional study performed at Kenyatta National Hospital and Texas Cancer Centre in Nairobi, Kenya. The risk of malnutrition was assessed using the Malnutrition Universal Screening Tool (MUST). Diagnoses of malnutrition and cachexia were done using the European Society of Clinical Nutrition and Metabolism (ESPEN) and Fearon criteria, respectively. A total of 512 participants were assessed. Those at risk of malnutrition were 33·1% (12·5% at medium risk, 20·6% at high risk). Prevalence of malnutrition was 13·4%. The overall weight loss >5% over 3 months was 18·2% and low fat-free mass index was 43·1%. Prevalence of cachexia was 14·1% compared with 8·5% obtained using the local criteria. Only 18·6% participants had received any form of nutrition services. Age was a predictor of malnutrition and cachexia in addition to site of cancer for malnutrition and cigarette smoking for cachexia. The use of the MUST as a screening tool at the first point of care should be explored. The predictive value of current nutrition assessment tools, and the local diagnostic criteria for malnutrition and cachexia should be reassessed to inform the development of appropriate clinical guidelines and future capacity-building initiatives that will ensure the correct identification of patients at risk for timely care.

Predictive accuracy of the Historical-Clinical-Risk Management-20 for violence in forensic psychiatric wards in Japan.

Most structured assessment tools for assessing risk of violence were developed in Western countries, and evidence for their effectiveness is not well established in Asian countries. Our aim was to examine the predictive accuracy of the Historical-Clinical-Risk Management-20 (HCR-20) for violence in forensic mental health inpatient units in Japan. A retrospective record study was conducted with a complete 2008-2013 cohort of forensic psychiatric inpatients at the National Center Hospital of Neurology and Psychiatry, Tokyo. Forensic psychiatrists were trained in use of the HCR-20 and asked to complete it as part of their admission assessment. The completed forms were then retained by the researchers and not used in clinical practice; for this, clinicians relied solely on national legally required guidelines. Violent outcomes were determined at 3 and 6 months after the assessment. Receiver operating characteristic analysis was used to calculate the predictive accuracy of the HCR-20 for violence. Area under the curve analyses suggested that the HCR-20 total score is a good predictor of violence in this cohort, with the clinical and risk sub-scales showing good predictive accuracy, but the historical sub-scale not doing so. Area under the curve figures were similar at 3 months and at 6 months. Our results are consistent with studies previously conducted in Western countries. This suggests that the HCR-20 is an effective tool for supporting risk of violence assessment in Japanese forensic psychiatric wards. Its widespread use in clinical practice could enhance safety and would certainly promote transparency in risk-related decision-making. Copyright © 2016 John Wiley & Sons, Ltd.

Colorectal Cancers in Mauritania: Clinical Aspects and Treatment

The aim of our study was to determine epidemiological, clinical and therapeutic profile of colorectal cancers in Mauritania. Patients and Methods: It was a retrospective multicentric study conducted over 5 years in Nouakchott National Hospital Centre and in private clinics of Mauritania. All cases of colorectal cancers histologically confirmed were included. The Astler and Coller classification was used to classify lesions by level of extension. Results: 225 patients were included with a sex ratio (M/F) of 1.39, an average age of 52.3 years. Location of the lesion was rectal (37.7%) and colonic (62.3%). Clinical manifestations were dominated by rectal bleeding (26.9%), occlusive syndrome (16.5%) and transit disorders (11.6%). Endoscopic lesions were of stenosing (45.2%), ulcero-burgeoning (39%), ulcerous (7.5%) and burgeoning (4.7%) types. Histological profiles were adenocarcinoma (88.9%), carcinoma (3.1%) and lymphoma (2.6%). The work-up for extension revealed metastasis in 33.6% of cases. These were stage B (49%) and C (36%) among the 95 cancers that received the Astler and Coller classification. The treatment was curative (80.83%) and palliative (19.16%). Conclusion: Colorectal cancer is a reality in Africa. However, its diagnosis still remains delayed, which increases the prognosis, hence the need to promote screening tests.

정부 및 공공기관의 보건 관련 웹 사이트의 웹 접근성 - 자동 및 전문가 평가 -

본 연구는 정부 및 공공기관의 보건 관련 웹 사이트들의 웹 접근성을 한국형 지침에 따라 평가하여 장애인이나 노령자들과 같은 정보이용 소외집단들이 겪을 수 있는 문제점들을 파악하고자 하였다. 본 연구에서는 총 27개의 보건 관련 웹 사이트의 접근성을 자동평가 및 전문가 평가를 수행하여 측정하였다. 두 단계의 평가를 실시한 결과를 종합해 볼 때, 국립병원이나 국립재활원 등과 같은 의료기관들은 웹 접근성 오류가 거의 없는 것으로 나타났으며, 그 외에도 건강보험심사평가원, 보건복지부, 보건사업진흥원, 식품의약품안전처, 그리고, 한국의료분쟁 조정중재원 등은 웹 접근성 준수율이 매우 높았다. 그러나 전문가 평가를 실시한 결과, 자동평가에서는 오류가 없는 것으로 나타났던 적절한 대체텍스트의 제공이 매우 미흡한 것으로 나타났으며, 텍스트 콘텐츠의 명도 대비가 표준에 미치지 않아 전맹자나 저시력자들의 웹 접근성을 지원하기 힘든 것으로 평가되었다. 그 외에도 기본언어표시와 마크업 오류 등 정확한 정보의 전달을 어렵게 하는 문제들이 나타났고, 반복영역 건너뛰기, 콘텐츠 선형화, 그리고 키보드 사용보장을 준수하지 않는 문제들이 발견되어 시각장애뿐 아니라 인지장애 내지 운동장애가 있는 이용자에게는 웹 접근성을 심각하게 방해하는 요소가 될 수 있는 것으로 파악되었다. 본 연구는 국내 연구로서는 처음으로 정부 및 공공기관의 보건관련 웹 사이트들의 접근성을 한국형 지침에 따라 평가했다. 또한, 이러한 웹 사이트들을 대상으로 자동 평가로 측정하기 어려운 웹 접근성의 정도와 상세한 내용 분석을 포괄하는 전문가 평가를 수행했다는 점에서 웹 접근성 연구 분야에 기여했다고 볼 수 있다. The purpose of this study was to identify Web accessibility issues of healthcare websites of the Korean government and public agencies by evaluating these websites' accessibility in accordance with the Korean Web Contents Accessibility Guideline. This study conducted both automated and expert testing to assess the accessibility of a total of 27 health-related websites. The results of the assessment which was conducted in two stages indicated that institutions such as the National Hospital and National Rehabilitation Center demonstrated almost no Web accessibility error. In addition, the Korea Health Insurance Review and Assessment Service, the Ministry of Health and Welfare, the Health Services Agency, the Ministry of Food and Drug Safety, and the Korea Medical Dispute Mediation and Arbitration Agency attained very high web accessibility. However, the results of an expert evaluation highlighted that there were considerable errors in providing appropriate alternative text, which was not found in the automated test, and the color contrast of the text content did not comply with Web accessibility standard. Therefore, these websites did not support web accessibility for the sight-impaired. Furthermore, the present study found that it was difficult to deliver accurate information to users due to errors in the default language display and markup, and also, issues of skipping repeated content, content linearization, and compliance with keyboard use were considered as challenges that might arise for people with sight, cognitive and mobility impairments with respect to Web accessibility. It is the first study that evaluated accessibility of healthcare websites of the Korean government and public agencies based on the Korean Web Contents Accessibility Guideline. The present study made a contribution to research on Web accessibility by conducting expert testing, which provided a more complete assessment that identified the degree and specific issues of accessibility errors when compared to automated testing.