Regional University Teaching Hospital Research Articles

Neonatal Bacterial Infections in Parakou in 2013

Objective: Neonatal bacterial infections are a leading cause of mortality in developing countries, including Benin. This study aimed to investigate the epidemiological, clinical and bacteriological aspects of neonatal bacterial infections and their outcomes in the neonatal care unit of the Borgou Regional University Teaching Hospital (CHUD-Borgou). Study design: This manuscript described a cross-sectional study with prospective data collection and an analytical purpose that was performed over the course of 3 months. It was conducted in the neonatal care unit of CHUD-Borgou and focused on 203 newborns who were admitted for suspected bacterial infection. Results: Neonatal bacterial infections accounted for 63.75% of admissions. The sex ratio was 1:1. Prematurity was the main reason for admission (25.1%), and respiratory distress was the most common physical symptom (22.2%). From a bacteriological point of view, 14.7% of blood cultures were positive, and the main isolated pathogens were Escherichia coli (35.8%), Staphylococcus aureus (21.5%) and Klebsiella pneumoniae (14.3%). These pathogens were more sensitive to aminoglycosides than to other antibiotics. Lethality was 21.6%. Place of birth (p < 10-3), age of the newborn at admission (p = 0.003) and maternal history of infectious diseases during pregnancy (p = 0.02) were factors associated with neonatal bacterial infections. Conclusion: This study identified the main pathogens responsible for neonatal bacterial infections and their level of sensitivity to antibiotics. It also determined the different factors associated with neonatal bacterial infections that should be considered in newborn care.

Catecholamine use is associated with enterocyte damage in critically ill patients.

Small bowel damage is frequent but underdiagnosed among critically ill patients with shock. High catecholamine doses may have a deleterious effect on mesenteric blood flow. Plasma intestinal fatty acid-binding protein (I-FABP) concentration is a marker of enterocyte damage, whereas plasma citrulline concentration is a marker of functional enterocyte mass. We hypothesized that high doses of catecholamines in critically ill patients may be associated with enterocyte damage. This study aimed to determine the link between catecholamine use and dose with enterocyte damage. This is a prospective observational study performed in a large regional university teaching hospital. Critically ill patients requiring epinephrine and/or norepinephrine at admission to a medical intensive care unit (ICU) were included, as well as controls not receiving catecholamines. We evaluated at admission plasma I-FABP and citrulline concentrations, abdominal perfusion pressure (APP), and variables relating to prognosis and treatment. Patients were categorized according to the quartiles of catecholamine dose at ICU admission. Sixty critically ill patients receiving catecholamines and 27 not receiving catecholamines were included. Plasma I-FABP was higher among patients receiving catecholamine than in controls. Among patients receiving catecholamines, a dose of 0.48 γ kg min or more at ICU admission was associated with a higher I-FABP concentration. A Sepsis-related Organ Failure Assessment score higher than 11 and plasma I-FABP more than 524 pg mL at ICU admission were independently associated with 28-day mortality (odds ratio, 4.0 [1.24-12.95] and odds ratio, 4.90 [1.44-16.6], respectively). Catecholamine use is associated with I-FABP elevation in critically ill patients. Critically ill patients receiving more than 0.48 γ kg min of epinephrine and/or norepinephrine at ICU admission have high I-FABP concentrations. This suggests that enterocyte damage reflects the severity of shock, and an adverse effect of catecholamines per se is possible.

Prognostic Factors of Pregnancy and Childbirth in Adolescents at the Borgou Regional University Teaching Hospital in Parakou (Benin)

Objective: Identify the prognostic factors of pregnancyand childbirth in adolescents at Regional University Teaching Hospital (CHDU) Borgou. Method: We conducted a cross-sectional study with descriptive and analytical purpose which make a prospective comparison of 110 adolescent primiparous (14-19 years) with 220 control primiparous (20-34 years). The study was carried out from March 1 to August 31, 2014 at the Borgou Regional University Teaching Hospital. Results: Childbirth prevalence in adolescents was 11.2%. After comparative analysis, pregnancy prognostic factors in the adolescent were poor pregnancy monitoring, hospitalization during pregnancy for malaria and anemia. During childbirth, the prognostic factors were fever, episiotomy, perineal lacerations, artificial labor and long postpartum hospitalization. As regards newborns, low birth weight, transfer to neonatal care unit and perinatal deaths were the prognostic factors associated with childbirth in adolescents at CHUD-B/A in Parakou in 2014. Conclusion: In the adolescent living in Parakou pregnancy is common and seems to occur with high risk. It is therefore necessary to promote efficient antenatal follow-up and good quality childbirth for pregnant adolescents.

Management of Pregnancy and Childbirth among Adolescents at the Regional University Teaching Hospital of Parakou

Objective: Investigation on the management of childbirth among adolescents at the CHD-U of Parakou (Benin). Patients and study method: It was a cross-sectional study with descriptive purpose carried out during the period from March 1 to August 31, 2014. Its target consisted of 110 primiparous adolescents aged 14-19 years. The study was conducted in the gynecology and obstetrics unit of the Regional University Teaching Hospital of Borgou/Alibori in Parakou. Results: Childbirth prevalence among female adolescents was 12.7%. The mean age of those adolescents was 17.7 ± 1.4 years. The adolescent mothers with student status dominated with 33.6%, 56.4% were married, 32.7% were not educated. 72.7% of them had a low socioeconomic status. 60.0% of the cases did not benefit from a lack of pregnancy monitoring or the latter was of poor quality among them. Dystocia were the diagnosis most encountered on admission. Vaginal delivery was dominant with 60.9% of the cases but about seven out of ten of those childbirths needed an episiotomy (67.2%). One childbirth out of ten (10.5%) got complicated by a perineal tear. Stillbirth rate was 8.2% and newborns had on average a good APGAR score at birth. Thirty-five (35) newborns i.e., 32.7% had a weight below 2500 g. Among the reasons for transfers to the neonatology division the leading ones are low birth weight (LBW), immediate neonatal distress and existence of pathologies during pregnancy. Conclusion: Among the adolescents in Parakou, pregnancy is a common reality and seems to be characterized by high risk.

L’introduction d’un audit obstétrical quotidien : une solution pour diminuer le taux de césarienne ?

To evaluate the impact of a medical audit assessing the accuracy of caesarean indications on the final caesarean section rate of an obstetrics department. Comparative observational study conducted in a regional university teaching hospital on the two first quadrimester periods of 2013. During the first quadrimester, there was no cesarean section audit introduced for the daily reports meetings, while an audit was introduced during the second quadrimester. The caesarean rate and the instrumental delivery rate on both quadrimesters were compared. In the first quadrimester period, there were 248 caesarean sections for 947 deliveries (26.2%), while in the second quadrimester period, there were 246 for 1033 deliveries (23.8%), P=0.014. The emergency caesarean rate decreased from 19.6 to 16.7%, P=0.02 in the second quadrimester period while the instrumental delivery rate increased from 14.4 to 17.2%, P=0.0004. Mothers and children's health was not modified between the two periods. In our experience, the introduction of a daily obstetric audit of the caesarean indications is effective to decrease the emergency caesarean section rate and it encourages us to be active in the first like in the second part of the labor.

Longitudinal Changes of Cardiac Structure and Function in CKD (CASCADE Study)

Little is known regarding the natural longitudinal changes in cardiac structure and function in CKD. We hypothesized that baseline CKD stage is associated with progressive worsening in cardiac structure and function. We conducted a prospective longitudinal study, recruiting 300 patients with stages 3-5 CKD from a major regional tertiary center and university teaching hospital in Hong Kong. Baseline CKD stages were studied in relation to natural longitudinal changes in echocardiographic and tissue Doppler imaging-derived parameters. Over 1 year, the prevalence of left ventricular (LV) hypertrophy increased from 40.3% to 48.9%, median left atrial volume index increased 4.8 (interquartile range [IQR], 2.1, 7.7) ml/m(2) (P<0.001), peak systolic mitral annular velocity decreased 0.5 (IQR, -1.5, 0.5) cm/s (P<0.001), early diastolic mitral annular velocity decreased 0.5 (IQR, -1.5, 0.5) cm/s (P<0.001), and eGFR declined 2.0 (IQR, -5.0, 0.0) ml/min per 1.73 m(2). CKD stages 4 and 5 were associated with more baseline abnormalities in cardiac structure and function and predicted greater longitudinal progression in LV mass index (odds ratio [OR], 3.02; 95% confidence interval [95% CI], 1.39 to 6.58), volume index (OR, 2.58; 95% CI, 1.18 to 5.62), and left atrial volume index (OR, 2.61; 95% CI, 1.20 to 5.69) and worse diastolic dysfunction grade (OR, 3.17; 95% CI, 1.16 to 8.69) compared with stage 3a in the fully adjusted analysis. In conclusion, more advanced CKD at baseline may be associated with larger longitudinal increases in LV mass and volume and greater deterioration in diastolic function.

Quality of Life of Stroke Survivors: A 1-Year Follow-Up Study

Kwok T, Lo RS, Wong E, Wai-Kwong T, Mok V, Kai-Sing W. Quality of life of stroke survivors: a 1-year follow-up study. Objectives To examine the changes in and to identify determinants of health-related quality of life (HRQOL) during the first year after stroke. Design Prospective cohort study. Setting Regional university teaching hospital in China. Participants Chinese survivors of stroke (N=303). Patients who were previously physically handicapped were excluded. Interventions Not applicable. Main Outcome Measures Barthel Index, Lawton Instrumental Activities of Daily Living (IADL), Chinese Mini-Mental State Examination, Geriatric Depression Scale (GDS), and the abbreviated Hong Kong Chinese version of the World Health Organization Quality of Life measure domain scores at 3, 6, and 12 months after the stroke. Results A total of 268 (88%) subjects completed the study. HRQOL data were available in 247 (82%) subjects at 3 months. Between 3 and 12 months, there was no significant change in Barthel Index and IADL scores, but there was significant increase in GDS scores. On multivariate analysis and multilevel modeling, there was a small but significant decrease in social interaction and environment HRQOL domain scores with time. GDS score was negatively associated with all 4 domains of HRQOL, whereas the Barthel Index score was associated with physical and psychological HRQOL domains only. Female sex, nursing home residence, welfare assistance, pain in affected limbs, soft diet or tube feeding, and lack of physical exercise were associated with poorer HRQOL. Conclusions Environment and social interaction HRQOL may decrease after 1 year of stroke among Chinese stroke patients. Depression has a more generalized adverse effect on HRQOL than basic functional disabilities. Health care professionals should focus on treating depression; group exercises and self-help group activities may help in promoting socialization and reintegration into community life.

A prospective cohort study of the effectiveness of clinical pathways for the in-patient management of acute exacerbation of chronic obstructive pulmonary disease (COPD)

The aim of this study was to compare the clinical and functional outcomes of patients with an acute exacerbation of chronic obstructive pulmonary disease (COPD) treated with standard care to those treated with a clinical pathway at a regional Victorian university teaching hospital. An eighteen-month prospective cohort study was conducted comprising 178 patients admitted via the emergency department with a primary diagnosis of acute exacerbation of COPD. Of these, 90 were treated with standard care and 88 using a coordinated multidisciplinary clinical pathway. Clinical outcome measures included: oxygen saturation, subjective dyspnoea and anxiety levels, length of stay, complication rates and readmission within 28 days. Results indicated that there was no significant difference between the groups on length of stay, clinical and functional outcome apart from significantly reduced anxiety levels in the pathway group. Pathway patients had a 0.89-day (13.2%) shorter length of stay than standard care patients did and numerically less complications and readmissions. We conclude that patients cared for under a clinical pathway for COPD in this study did not experience worse clinical outcomes compared to those receiving standard care.

Self‐Esteem, Social Support, and Satisfaction Differences in Women With Adequate and Inadequate Prenatal Care

This descriptive, retrospective study examined levels of self-esteem, social support, and satisfaction with prenatal care in 193 low-risk postpartal women who obtained adequate and inadequate care. The participants were drawn from a regional medical center and university teaching hospital in New Mexico. A demographic questionnaire, the Coopersmith self-esteem inventory, the personal resource questionnaire part 2, and the prenatal care satisfaction inventory were used for data collection. Significant differences were found in the level of education, income, insurance, and ethnicity between women who received adequate prenatal care and those who received inadequate care. Women who were likely to seek either adequate or inadequate prenatal care were those whose total family income was $10,000 to $19,999 per year and high school graduates. Statistically significant differences were found in self-esteem, social support, and satisfaction between the two groups of women. Strategies to enhance self-esteem and social support have to be developed to reach women at risk for receiving inadequate prenatal care.