Promptness Of Intervention Research Articles

Non-streptococcal Bacteria as the Leading Cause of Infection-related Glomerulonephritis in Adults

Infection-related glomerulonephritis (IRGN) is a kidney disorder characterized by inflammation of the glomeruli, the kidney's filtering units, triggered by infections elsewhere in the body. Recent data reveal a shift in the United States, with non-streptococcal bacteria emerging as significant causes of IRGN in adults, replacing the historical dominance of streptococcal infections. This condition arises when the body's immune response to an infection deposes immune complexes in the kidney's glomeruli, resulting in inflammation and damage. Factors like the type and virulence of the bacteria, host immune response, and genetic predisposition contribute to its pathogenesis. Non-streptococcal bacterial infections, including staphylococcal and Escherichia coli (E. coli), are now prominent contributors to adult IRGN. This shift in epidemiology may vary over time and by region. Patients with non-streptococcal bacterial IRGN commonly present with acute kidney injury symptoms, such as swelling, hypertension, hematuria, and proteinuria. Diagnosis involves clinical evaluation, laboratory tests, and kidney biopsy to reveal characteristic glomerular changes. Management focuses on treating the underlying infection with targeted antibiotics, controlling inflammation, and providing supportive care. Severe cases may require dialysis until kidney function recovers. This comprehensive narrative review aims to provide an up-to-date perspective on non-streptococcal bacteria as the leading cause of IRGN in adults. It covers epidemiology, etiology, clinical presentation, diagnosis, and treatment. The prognosis varies based on factors such as the underlying infection and promptness of intervention. This evolving landscape underscores the importance of early diagnosis and tailored management to enhance outcomes in changing IRGN epidemiology among adults. Staying vigilant in diagnosing and managing IRGN remains crucial as it presents new challenges and opportunities for improved patient care.

Surgical Management of Gunshot Wound at Level-II Hospital in Central African Republic in 2019/2020

Background: Gunshot wounds (GSW) are common in Central African Republic (CAR). There are about eighteen rebel groups in Central Africa. Arms are available among the rebel groups and also the civilians. For the very simple region they open the fire against the opponent. The aim of this study is outcome of surgical management of gunshot wounds at Bangladeshi Level-II hospital in the CAR during our tenure.
 Methods: This was a prospective study of 14 patients with gunshot wounds who were treated at level-II hospital, Kagabandoro, CAR from Dec 2019 to Nov 2020 for a period of 12 months. Wound debridement and removal of bullets were done in 8 (57.14%) cases, keep bullets in situ position in 2(14.29%) cases and surgical toileting followed by primary closure of wound were done in 3 (21.42%) cases and one female patient transferred to level-III hospital in Bangui.
 Results: Out of 14 patients there were 13 male and 1 female patients. Mean age of the patients was 32.21 (18-55 years). High velocity injuries were common in 10 (71.43%). Injuries involved the limbs in 10 (71.43%), chest in 2 (14.29%), abdomen in 1 (7.14%) and external genitalia in 1(7.14%). Most of the patients 12 (85.71%) presented to the hospital within 12 hours of the injury. The average length of stay in the hospital was 14 days (Range 2- 60 days). Fractures of the long bone were in 5 (35.71%) cases. Open reduction and internal fixation was done in 3 (21.43%) cases. One female patient was transferred to level-III hospital in Bangui due to fracture neck of femur following gunshot injuries with 9 months of pregnancy. Mean follow-up was 5 months (Range 1-12 months). Post trauma pain developed in 3 (21.43%) cases, deformities of the extremities was found in 2 (14.29%) cases.
 Conclusion: Outcome of surgical management of the gunshot wounds were depends on the nature of tissue injury and availability of the resources with promptness of intervention.
 CBMJ 2021 January: vol. 10 no. 01 P: 04-08

Evaluation of Wait Time in the Children's Emergency and Outpatient Units of a Tertiary Hospital in Southeast Nigeria.

Background:Promptness of intervention in the emergency room (ER) or outpatient unit is a major determinant of outcome in acutely ill children. Time is, therefore, of the essence in trying to reduce complications and mortality associated with children.Methods:This was a cross-sectional study conducted in the children ER and the children outpatient unit of the Enugu State University Teaching Hospital (ESUTH), Enugu, Southeast Nigeria. Waiting time defined as the time between arrival and doctor consultation was calculated.Results:A total of 248 respondents were enrolled during the study period. In the emergency unit, majority (67.5%) of the respondents' sick children were attended to almost immediately, while 13.3% and 19.3% waited for ≤10 and >10 min, respectively, before being attended to by a doctor. The mean waiting time in the emergency unit was approximately 9.27 ± 29.2 min (95% confidence interval [CI]: 2.90–15.65 min) with a range of 0–56 min. In the outpatient unit, the mean waiting time was 12.67 ± 15.3 min (95% CI: 10.31–15.01 min) with a time range of 5–245 min. Eighty-five (51.5%) of the 165 respondents waited for <10 min, 60 (36.4%) waited for between 10 and 30 min, while 20 (12.1%) waited for >30 min before their sick children were attended by a doctor.Conclusion:The mean waiting times reported in this study in the emergency and outpatient units of the ESUTH were within acceptable standards. However, there were cases where the waiting time in both children's units was exceptionally long. There is need for continued monitoring and evaluation of waiting times in these units for prompt attention to patients.