Secondary Health Care Centers Research Articles

No. 225-Management Guidelines for Obstetric Patients and Neonates Born to Mothers With Suspected or Probable Severe Acute Respiratory Syndrome (SARS).

ObjectiveThis document summarizes the limited experience of SARS in pregnancy and suggests guidelines for management.OutcomesCases reported from Asia suggest that maternal and fetal outcomes are worsened by SARS during pregnancy.EvidenceMedline was searched for relevant articles published in English from 2000 to 2007. Case reports were reviewed and expert opinion sought.ValuesRecommendations were made according to the guidelines developed by the Canadian Task Force on Preventive Health Care.SponsorsThe Society of Obstetricians and Gynaecologists of Canada.Recommendations1.All hospitals should have infection control systems in place to ensure that alerts regarding changes in exposure risk factors for SARS or other potentially serious communicable diseases are conveyed promptly to clinical units, including the labour and delivery unit (III-C).2.At times of SARS outbreaks, all pregnant patients being assessed or admitted to the hospital should be screened for symptoms of and risk factors for SARS (III-C).3.Upon arrival in the labour triage unit, pregnant patients with suspected and probable SARS should be placed in a negative pressure isolation room with at least 6 air exchanges per hour. All labour and delivery units caring for suspected and probable SARS should have available at least one room in which patients can safely labour and deliver while in need of airborne isolation (III-C).4.If possible, labour and delivery (including operative delivery or Caesarean section) should be managed in a designated negative pressure isolation room, by designated personnel with specialized infection control preparation and protective gear (III-C).5.Either regional or general anaesthesia may be appropriate for delivery of patients with SARS (III-C).6.Neonates of mothers with SARS should be isolated in a designated unit until the infant has been well for 10 days, or until the mother’s period of isolation is complete. The mother should not breastfeed during this period (III-C).7.A multidisciplinary team, consisting of obstetricians, nurses, pediatricians, infection control specialists, respiratory therapists, and anaesthesiologists, should be identified in each unit and be responsible for the unit organization and implementation of SARS management protocols (III-C).8.Staff caring for pregnant SARS patients should not care for other pregnant patients. Staff caring for pregnant SARS patients should be actively monitored for fever and other symptoms of SARS. Such individuals should not work in the presence of any SARS symptoms within 10 days of exposure to a SARS patient (III-C).9.All health care personnel, trainees, and support staff should be trained in infection control management and containment to prevent spread of the SARS virus (III-A).10.Regional health authorities in conjunction with hospital staff should consider designating specific facilities or health care units, including primary, secondary, or tertiary health care centres, to care for patients with SARS or similar illnesses (III-A).

Attitude of Supporting Staffs and Patient Satisfaction – A Study in Secondary Health Care Centre

Attitude of Supporting Staffs and Patient Satisfaction – A Study in Secondary Health Care Centre

Frequency of angina and quality of life in outpatients with stable coronary artery disease in Turkey: insights from the PULSE study.

Cardiologists' approach to angina in outpatients with stable coronary artery disease (CAD) is unclear. Therefore, we analysed data from the national multicentre, observational PULSE study to evaluate the frequency of angina, clinical variables affecting angina frequency and the impact of frequent angina on quality of life (QoL) in outpatients with stable CAD managed by cardiologists in secondary and tertiary health-care centres in Turkey. Adult outpatients with stable CAD in sinus rhythm were included. Data were collected at a single study visit from 83 centres. Patients were divided into five categories according to angina attack frequency. QoL was measured by the MacNew heart disease health-related QoL Questionnaire. The mean (standard deviation; SD) age of all patients (n = 2661) was 61.2 (10.2) years. Of 2,661 patients, 48.7% had no anginal attacks while 16.5% had minimal, 14.5% occasional, 12.2% regular and 8.1% frequent attacks. Angina attack frequency correlated positively with female sex, heart rate, the severity of angina. Emotional, physical, social, and global scores of QoL tended to decrease across angina attack frequency categories. Short- and long-acting nitrates, ivabradine were significantly more preferred in patients with higher frequency of angina attacks rather than beta blockers and calcium channel blockers. Insufficient angina control in outpatients with stable CAD requires reassessment of medical approach since it has a negative impact on QoL. The social and economic consequences of this burden should be sought on a national basis.

Epidemiology of odontogenic infections in a secondary healthcare centre in Southern Nigeria

Association of odontogenic infections with several systemic diseases is of public health importance in Nigeria. This study aimed at determining the epidemiological and microbiological profiles of odontogenic infections and it aetiologic agents in dental patients in Benin City metropolis. Surface and deep socket swabs were collected from each patient before and after tooth extraction and processed for aerobic bacteria. Antimicrobial susceptibility test was carried out on each isolate using standard microbiological methods. Demographics of patients were collected with standard data recording format. Patients aged 20-29 years were more predisposed to odontogenic infections, predominantly peridontitis (51.5%) followed by caries (18.6%) and irreversible pulpitis (9.3%). Teeth in the right lower quadrant of the mouth were most frequently excised in both sexes. Predominant isolates were: β-haemolytic Streptococci (34%), Enterococci (20.6%), Corynebacteria (11.9%), Staphylococci (9.3%), γ-haemolytic Streptococci (5.2%), Neisseria (1.5%), Bacillus (1%), and α-haemolytic Streptococci (0.5%). There was low level of susceptibility of isolates to amoxicillin 30% and high level of susceptibility to perfloxacin (80%). A total of 19.1% of isolates were resistant to the five classes of antibiotics, indicative of multiple drug resistance (MDR) phenomenon. Our study has shown that, treatment of odontogenic infection in the study centre must change and be guided by antimicrobial susceptibility test result to ensure rational use of available antimicrobials.Keywords: Odontogenic infections; Antimicrobial activity; Epidemiological profile; Isolates

Interdisciplinary approach at the primary healthcare level for Bolivian immigrants with Chagas disease in the city of São Paulo.

Background/MethodsIn a pioneering cross-sectional study among Bolivian immigrants in the city of São Paulo, Brazil, the epidemiological profile, clinical manifestations and morbidity of Chagas disease were described. The feasibility of the management of Chagas disease at primary healthcare clinics using a biomedical and psychosocial interdisciplinary approach was also tested. Previously, a Trypanosoma cruzi (T. cruzi) infection rate of 4.4% among 633 immigrants was reported. The samples were screened using two commercial enzyme-linked immunoassay (ELISA) tests generated with epimastigote antigens, and those with discrepant or seropositive results were analyzed by confirmatory tests: indirect immunofluorescence (IFI), TESA-blot and a commercial recombinant ELISA. PCR and blood cultures were performed in seropositive patients.ResultsThe majority of the 28 seropositive patients were women, of whom 88.89% were of child-bearing age. The predominant clinical forms of Chagas disease were the indeterminate and atypical cardiac forms. Less than 50% received the recommended antiparasitic treatment of benznidazole. An interdisciplinary team was centered on primary healthcare physicians who applied guidelines for the management of patients. Infectologists, cardiologists, pediatricians and other specialists acted as reference professionals. Confirmatory serology and molecular biology tests, as well as echocardiography, Holter and other tests, were performed for the assessment of affected organs in secondary healthcare centers. The published high performance of two commercial ELISA tests was not confirmed.ConclusionAn interdisciplinary approach including antiparasitic treatment is feasible at the primary healthcare level for the management of Chagas disease in Bolivian immigrants. The itinerant feature of immigration was associated with a lack of adherence to antiparasitic treatment and was considered a main challenge for the clinical management of this population. This approach is recommended for management of the infected population in endemic and nonendemic areas, although different strategies are needed depending on the severity of the disease and the structure of the healthcare system.

Assessment of provider-initiated HIV screening in Nigeria with sub-Saharan African comparison

BackgroundDespite Nigeria’s high HIV prevalence, voluntary testing and counselling rates remain low. UNAIDS/WHO/CDC recommends provider-initiated testing and counselling (PITC) for HIV in settings with high HIV prevalence. We aimed to assess the acceptability and logistical feasibility of the PITC strategy among adolescents and adults in a secondary health care centre in Idekpa Benue state, Nigeria.MethodAll patients (aged ≥ 13 years) who visited the out-patient department and antenatal care unit of General Hospital Idekpa, Benue state, Nigeria were offered PITC for HIV. The intervention was implemented by trained health professionals for the period spanning (June to December 2010).ResultsAmong the 212 patients who were offered PITC for HIV, 199 (94%) accepted HIV testing, 10 patients (4.7%) opted out and 3 patients (1.4%) were undecided. Of the 199 participants who were tested for HIV, 9% were HIV seropositive. The PITC strategy was highly acceptable and feasible, and increased the number of patients who tested for HIV by 5% compared to voluntary counselling and testing. Findings from this assessment were consistent with those from other sub-Saharan African countries (such as Uganda and South Africa).ConclusionPITC for HIV was highly acceptable and logistically feasible, and resulted in an increased rate of HIV testing among patients. Public health initiatives (such as the PITC strategy) that facilitate early detection of HIV and referral for early treatment should be encouraged for broader HIV control and prevention in Nigerian communities.

Assessing and managing wounds of Buruli ulcer patients at the primary and secondary health care levels in Ghana.

BackgroundBeyond Mycobacterium ulcerans—specific therapy, sound general wound management is required for successful management of Buruli ulcer (BU) patients which places them among the large and diverse group of patients in poor countries with a broken skin barrier.MethodsClinically BU suspicious patients were enrolled between October 2013 and August 2015 at a primary health care (PHC) center and a municipal hospital, secondary health care (SHC) center in Ghana. All patients were IS2404 PCR tested and divided into IS2404 PCR positive and negative groups. The course of wound healing was prospectively investigated including predictors of wound closure and assessment of infrastructure, supply and health staff performance.Results53 IS2404 PCR positive patients—31 at the PHC center and 22 at the SHC center were enrolled—and additionally, 80 clinically BU suspicious, IS2404 PCR negative patients at the PHC center. The majority of the skin ulcers at the PHC center closed, without the need for surgical intervention (86.7%) compared to 40% at the SHC center, where the majority required split-skin grafting (75%) or excision (12.5%). Only 9% of wounds at the PHC center, but 50% at the SHC center were complicated by bacterial infection. The majority of patients, 54.8% at the PHC center and 68.4% at the SHC center, experienced wound pain, mostly severe and associated with wound dressing. Failure of ulcers to heal was reliably predicted by wound area reduction between week 2 and 4 after initiation of treatment in 75% at the PHC center, and 90% at the SHC center. Obvious reasons for arrested wound healing or deterioration of wound were missed additional severe pathology; at the PHC center (chronic osteomyelitis, chronic lymphedema, squamous cell carcinoma) and at the SHC center (malignant ulceration, chronic lymphedema) in addition to hygiene and wound care deficiencies.When clinically suspicious, but IS2404 PCR negative patients were recaptured in the community, 76/77 (98.7%) of analyzed wounds were either completely closed (85.7%) or almost closed (13%). Five percent were found to have important missed severe pathology (chronic osteomyelitis, ossified fibroma and suspected malignancy).ConclusionThe wounds of most BU patients attending the primary health care level can be adequately managed. Additionally, the patients are closer to their families and means of livelihood. Non-healing wounds can be predicted by wound area reduction between 2 to 4 weeks after initiation of treatment. Patients with clinically BU suspicious, but PCR negative ulcers need to be followed up to capture missed diagnoses.

Quality of Care of Patients with Diabetes in Primary Health Services in Southeast Brazil.

Background Diabetes management involves multiple aspects that go beyond drug therapy as a way of providing high quality care. The objective of this study was to describe quality of care indicators for individuals with diabetes in southeast Brazil and to explore associations among these indicators. Methods In this cross-sectional, observational study, health care providers filled out a questionnaire addressing health care structure and processes at 14 primary health care units (PHCUs). Clinical and laboratory data of diabetic patients attending the PHCUs and from patients referred to a secondary health care (SHC) center were collected. Results There was a shortage of professionals in 53.8% of the PHCUs besides a high proportion of problems regarding referrals to SHC. At the PHCU, glycated hemoglobin results were available only in half of the medical records. A low rate of adequate glycemic control was also observed. An association between structure and process indicators and the outcomes analyzed was not found. Conclusion Major deficiencies were found in the structure and processes of the PHCUs, in addition to unsatisfactory diabetes care outcomes. However, no association between structure, process, and outcomes was found.

Turkish assessment of SURF (SUrvey of Risk Factor Management) study: Control rates of cardiovascular risk factors derived from databases of 15 different levels of health centers in Turkey.

The aim of this study was to evaluate the adherence to recommendations for secondary prevention and the achievement of treatment targets for the control of risk factors in patients with established coronary heart disease (CHD) who were followed-up at various healthcare facilities in Turkey. According to the protocol of the international Survey of Risk Factor Management study, questionnaire forms were completed and demographic, anthropometric, and laboratory data of CHD patients who were followed-up at a total of 15 selected primary, secondary, and tertiary healthcare centers were recorded. Among a total of 724 CHD patients (69.8% male; mean age: 63.3±10.7 years) included in the study, 18.4% were current smokers, only 19.1% had normal body mass index, and 22.1% had waist circumference below the limit of abdominal obesity. Physical activity was insufficient in 53% of the patients, 47.3% had low high-density lipoprotein cholesterol value, 46% had triglyceride level above 150 mg/dL, and 67% had glycated hemoglobin value of 6.5% or above. Of all the patients, 88.1% were using antiplatelet drugs, 71.4% were using beta-blockers, 55.7% were using statins, and 41.9% were using angiotensin-converting enzyme inhibitors/angiotensin receptor blockers. Blood pressure was under control in 56.7% of the hypertensive patients using antihypertensive drugs, and the proportion of diabetic patients who reached glycemic control targets using antidiabetic drugs was 35.9%. Low-density lipoprotein cholesterol was below 70 mg/dL in 12.2% of the patients using statins. According to the data obtained, among Turkish CHD patients, the control rate of cardiovascular risk factors is low, and implementation of the recommendations regarding lifestyle modification and medication use for secondary prevention in the current guidelines are insufficient.

Hypertension treatment by primary care physicians in Lagos

Background: Globally, hypertension (HTN) control is poor. We studied the contribution of primary care physicians to this. Methods: Lagos-based primary care physicians were studied using anonymous self-administered questionnaire on HTN treatment goals and drug therapy. Results: Data from 403 respondents with a mean age and experience of 40 ± 11.34 years and 14.3 ± 11.1 years, respectively, were analyzed. Two hundred and twenty-eight physicians (61.1%) practiced in primary health-care facilities, while 125 (33.5%) and 20 (5.4%) practiced in facilities affiliated to the secondary and tertiary health-care centers, respectively. One hundred and twenty-three (35.7%) of the respondents correctly indicated the treatment blood pressure goal for uncomplicated HTN. Eighty (26.1%), 37 (12.2%), and 54 (18.5%) of respondents correctly indicated the treatment goals in hypertensive patients with diabetes mellitus (DM), old stroke, and coronary artery disease (CAD), respectively. The correct choice(s) of antihypertensive drugs vis-a-vis compelling/possible indications were made by 259 (76%) for uncomplicated HTN, 194 (63.4%) for hypertensives with chronic kidney disease, 128 (44.3%) for hypertensives with previous stroke, 250 (76.7%) for pregnant hypertensives, 166 (57%) for hypertensives with CAD, and 165 (61.6%) for hypertensives with DM. Choice(s) of antihypertensive medications were determined by the patient's age 302 (79.4%), gender 233 (58.4%), race 234 (59.8%), associated clinical condition 365 (90.6%), duration of action of antihypertensive drugs 340 (85.5%), and the cost of antihypertensive medications: 334 (85%). Conclusions: The physicians' knowledge of HTN management is suboptimal. This may be contributory to the poor HTN control in Nigeria. These deficiencies may be addressed through continuing medical education together with popularizing and simplifying of the guidelines.

Traditional eye medicine use among ophthalmic patients attending a secondary health care center in Southeast Nigeria

Introduction: The perceived high cost of eye care services has been implicated as one of the reasons for the use of traditional eye medications (TEMs) in the country. Other factors including distance, tradition, ignorance, and failure of medical treatment among others have also been documented as determinants of TEM use. TEMs constitute a wide range of unorthodox therapies utilized for treatment of ocular disorders. They have been reported to have no beneficial effect rather causing more harm than good. Aim: This study sought to determine the prevalence, types, and ocular indications for TEM use in the study population. Methods: This was a cross-sectional study in which a structured questionnaire was used to collect relevant data from consecutive patients attending the eye clinic during the study. Results: At a prevalence of 15.8%, the highest use of TEM was noted among artisans, those in the seventh decade of life, with low level of education, ocular complaints of poor vision, and illness of <1 year duration. Its use though high, was not significantly associated with age, sex, education, occupation and illness duration. Roots and herbs were the most common types of TEM used. Conclusion: There was a high prevalence of use of TEM in this study. The deleterious effect of its use is known and has been reported in literature. Education and enlightenment of the public are needed and highly recommended.

Overdiagnosis and overtreatment of malaria in children in a secondary healthcare centre in Sekondi-Takoradi, Ghana.

Overdiagnosis and overtreatment of malaria is a major problem in children in malaria-endemic countries. This retrospective study identified children who were admitted with fever and were treated with or without anti-malarial medications and discharged at the Paediatric Unit of the Effia-Nkwanta Regional Hospital. The medical records of all children were searched, retrieved and assessed. A total of 1160 records from children (age range, 0-12 years) were reviewed and evaluated. Of the total number, 21.3% had laboratory confirmed malaria, 38.4% were malaria negative, while 40.3% had no malaria tests performed. In addition, the results showed that 4.5% of the laboratory confirmed malaria positive cases were not given anti-malarial medication while 84.1% of the malaria negative cases were given these incorrectly. Furthermore, 78.2% of the children with no malaria tests were prescribed anti-malarial medication. The presumptive diagnosis of malaria should be abandoned and the installation of a functional laboratory services promoted.

Awareness and Practice of Weaning : A Cross Sectional Survey Among the Mothers Attending Secondary Health Care Center in Bangladesh

This was a description type of cross sectional study conducted among 210 rural mothers having 0-6 months child, attending the out patient department of Sirajdikhan Upazilla Heath Complex, Munshigonj. Total 210 women were selected by purposive sampling method. Data were collected through structured questionnaire by face to face interview Out of 210 respondents, majority (59.52%) was in the age group 18-27 years and only 0.48% was above 47 years. Mean age of the respondents was 26.29 years. Most of the respondents (43.33%) completed SSC and only 3.8% were uneducated. Among the respondents 83.33% were house wives. Monthly incomes of the respondents (39.05%) were more than 12000 taka. Most of the mother (80.95%) had children of age 1-3 years. Majority of mothers (77.14%) had conception about requirement of initiation of weaning at 6 months and 15.24% had at 5 months. Maximum respondents (44.76%) had given khichury, 44.29% Shuji and rest of them (10.95%) had given home made food. Mothers (78.57%) continued breast feeding with weaning. About 74.76% respondents complained of occasional vomiting with weaning. Majority (62.38%) of children had given food on time, those children who were provided complementary feeding was physically normal. Majority (57.14%) of mothers had no complained during weaning period. Registered physicians (76.19%) were the health care provider when the children were sick. Although most of the mothers started weaning at appropriate times, we cannot consider it satisfactory. As we must think about all the children and keep all of them healthy, we need to improve this rate up to 100%. Unless we achieve this level we can't achieve our goals of health for all.

Morbidity and mortality pattern among neonates admitted to the general paediatric ward of a secondary health care centre in the Niger delta region of Nigeria

Introduction: In Nigeria’s public hospitals, facilities for specialized neonatal care are few and available only in tertiary hospitals. However a greater number of neonates are delivered at the primary and secondary health care centres where these facilities are lacking. Thus, sick newborns are managed in the general paediatric ward along with other children and there is a likelihood of increased mortality in this group of neonates compared to those managed in standard neonatal units. Objective: To determine the morbidity and mortality pattern among neonates admitted to a general paediatric ward of a secondary health care facility. Method: This was a prospective cross sectional study of neonatal admissions and mortalities from January 2012 to December 2013. Result: A total of 655 neonates were admitted during the study period of which 68 were excluded. Of the 587 neonates analysed. 360 were males. The leading causes of admissions were neonatal sepsis, prematurity, perinatal asphyxia, haemorrhagic disease of the newborn and neonatal jaundice. There were 122 (20.3%) deaths with a male: female ratio of 1.7:1. Neonatal jaundice, prematurity and birth asphyxia had the highest case fatality rate. Conclusions: There were 20.3% deaths. The leading causes of admissions were neonatal sepsis, prematurity, perinatal asphyxia, haemorrhagic disease of the newborn and neonatal jaundice. DOI: http://dx.doi.org/10.4038/sljch.v45i2.7981 (Key words: Neonate, mortality, general paediatric ward)

Outcome of Fertility after Radical Conservative Surgery in Grade III-IV Endometriosis Lesions: A Retrospective Analysis

Purpose: Researching reproductive outcome after laparoscopic radical resection of grade III and IV endometrial lesions. Methods and Materials: A retrospective analysis of 54 women was carried out. The patients underwent laparoscopic radical resection in the Gynecology Department of a secondary health care center between January 2009 and December 2013. Diagnostic investigation, with histological confirmation of moderate to severe endometriosis, preceded surgical intervention in a multidisciplinary setting. Thirty seven of the 54 patients had an active desire for pregnancy. The outcome measure was the number of pregnancies in the subgroup of 37 women with an active desire for pregnancy. Results: Within the subgroup of 37 patients, 28 women became pregnant within the study period. Twelve patients became pregnant spontaneously and 16 had medically assisted pregnancies. Within the medically assisted group, 4 patients conceived after Intra-Uterine Insemination (IUI) and 12 after In- Vitro Fertilization (IVF). The pregnancy rate was 76%, a result similar to findings of earlier studies. Conclusion: The results of this retrospective analysis suggest that extensive laparoscopic surgery for moderate to severe endometriosis has a beneficial effect on fertility in both spontaneous and medically assisted pregnancies.

Biological profile of oral health subscribers in both tertiary and secondary healthcare centres: A postmorterm analysis and policy implication

Oral health and dentistry in Africa have been afflicted by the problems characterizing the world’s developing regions, such as poverty, malnutrition, high incidence of infectious diseases and child mortality, lack of oral health policy, and inadequate national budget for oral health. The retrospective study period of 10 years, in both centres revealed 72,818 subscribers, of which 54.23% were from tertiary health centre (UBTH). Female subscribers were dominant in both centres; 54.89% (UBTH) and 56.06% (Central Hospital, Benin City), with the means and the analysis of variable between means and within means (ANOVA), with an F-test, one tail probability of P&gt;0.05. We conclude that a well articulated strategy and policy on increased oral health subscription in our communities is most desirable. Integration of oral health into national and community health programs is recommended.

Comparison of Negative Pressure Wound Therapy (NPWT) Using Polyvinyl Alcohol (PVA) Sponge with Advanced Wound Dressings

Objective: The primary purpose of this study is to compare appearance of granulation tissue, rate of wound infection, period of hospital stay and duration for complete wound healing using two different methods of wound dressing at secondary healthcare centres. Material and Methods: 127 patients between the age group 14-68 years with an average age of 42 years were included in this study. Out of these 127 cases, 1 died due to urosepsis with severe lung infection and 6 cases did not turn up for follow up treatment. The remaining 120 cases were divided into two groups i.e. A and B. Group A was subjected to modified negative pressure wound therapy (NPWT) using sterilized polyvinyl alcohol sponge as an alternative to standard Granu Foam. A Ryle’s tube with additional pores were created and interposed between the PVA sponges. The Ryle’s tube was attached to the suction drain and another end of the suction drain connected directly to wall suction which is programmed to produce a pressure of 125 mmHg. At the end of 72 hours, a new cycle was repeated. Group B was subjected to daily dressing with advanced wound dressings (dermacyn and solcoseryl gel). Results: Statistically better result was obtained in favour of NPWT for wound dressing. The appearance of granulation tissue was more rapid in group A patients. The infection rate of group A patients was very low when compared to group B patients. The mean time (duration) to complete healing was faster in Group A, however the mean length of hospital stay was longer as compared to group B patients. Conclusion: Healing is more rapid with less infection rate in NPWT group compared to advanced wound dressing group. NPWT using wall suction and PVA sponge can be performed in secondary healthcare centres with low resources as well as for patients who could not have afforded charges of commercially available standard VAC device or advance wound dressings.

Assessment and barriers to medication adherence for secondary prevention of cardiovascular disease among patients with coronary artery disease in Chandigarh, India

Context: Medication adherence is critical for the secondary prevention of cardiovascular disease (CVD). Nonadherence to prescribed treatment is associated with adverse health outcomes and higher costs of care. Aims: The present study aimed to assess medication adherence among patients diagnosed with coronary artery disease (CAD) in Chandigarh, India. Settings and Design: This cross-sectional study was conducted in five different hospitals or health centers of Chandigarh. Materials and Methods: The standardized Morisky Medication Adherence Scale-8 item was used to assess medication adherence among adult patients with CAD seen during a visit to major tertiary hospitals, secondary and primary health-care center in Union Territory, Chandigarh. In a separate qualitative study, barriers and facilitators to adherence were assessed through twenty in-depth interviews (ten males and ten females) and one focus group discussion. Statistical analysis was completed using SPSS 16.0 software and simple frequencies and proportions were computed. Results: A total of 260 patients were included in the cross-sectional survey, of which 70.4% were males with a mean age of 58.61 years. More than half (52.7%) of the respondents were from the age group of 41 to 60 years. Low to medium adherence to treatment was observed in about half (47.3%) of the respondents with low adherence among females. Adherence was better in a tertiary hospital as compared to the primary or secondary facility. Provider barriers and access to drugs due to cost barriers were found to be major barriers to treatment adherence in the in-depth interviews. Conclusions: Medication adherence to the secondary prevention of CVD among the CAD patients surveyed in Chandigarh, India, is poor and increased access to essential drugs and improved provider-patient communication is required.

Study on Outcome of Eclampsia Patients in District Hospital in Bangladesh

The study was carried out to evaluate the fate and outcome of eclampsia patients and their neonates. This hospital based prospective study was done in Chuadanga Sadar Hospital, a 100 bed secondary health care centre in Chuadanga district in Bangladesh, from January 2007 to December 2009. The number of study population was 50, which include antepartum, intrapartum and postpartum eclampsia. Among them, 70% had spontaneous vaginal delivery, 10% had assisted vaginal delivery and 10% had caesarian section. 86% of the patient have good maternal outcome with the use of anti convulsant therapy. 46% of baby of total population have good neonatal outcome with or without immediate resuscitation. The outcome of eclampsia is satisfactory if immediate treatment is started. Hence, every patient should be admitted in hospital as soon as possible and receive anticonvulsant therapy immediately, even before admission in hospital. Patient should be delivered with special care as a high risk mother and neonatal support should be given to reduce both maternal and neonatal mortality and morbidity.J Dhaka Medical College, Vol. 23, No.2, October, 2014, Page 223-226

Minimal Hepatic Encephalopathy: The Reality Beyond Our Eyes.

Minimal hepatic encephalopathy refers to a mild neurocognitive impairment not detectable by clinical examination that can be present in cirrhotic patients. To determine the prevalence of minimal hepatic encephalopathy in a secondary healthcare center in Northern Portugal. A cross-sectional study was conducted. Cirrhotic outpatients were included. overt hepatic encephalopathy, illiteracy, active alcohol consumption, psychotropic drug use and therapy with lactulose. The presence of minimal hepatic encephalopathy was defined as a value ≥ -4 on the Psychometric Hepatic Encephalopathy Score, calculated according to the Portuguese norms. Variables analyzed: etiology and severity of liver disease and venous blood ammonia concentration. p values < 0.05 were considered significant. From the 102 patients who were evaluated, 41 were included: 31 males, mean age 57 ± 10 years, mean education 5 ± 2 years, 31 in Child-Pugh class A, mean MELD score 6 ± 3. Minimal hepatic encephalopathy was diagnosed in 14 (34%) patients. The presence of minimal hepatic encephalopathy was unrelated to severity of liver disease. Despite being more elevated, the mean venous ammonia concentration in minimal hepatic encephalopathy patients was not statistically different from the mean venous ammonia concentration in non-minimal hepatic encephalopathy patients (48.5 ± 13.3 vs. 45.6 ± 15.6 μmol/L, p = 0.555). The prevalence of minimal hepatic encephalopathy reported is in accordance with the international published data. Minimal hepatic encephalopathy is a frequent condition that is present early in the course of cirrhosis, even in compensated cirrhotic patients. Therefore, this hidden entity should be actively pursued and managed properly.