Tertiary Health Facility Research Articles

An Algorithm for the Microsurgical Resection of Cerebellar Cavernomas.

Cavernous malformations (CMs) account for 8% to 15% of all cerebrovascular anomalies and pose clinical significance due to their potential to cause symptomatic hemorrhage, seizures, and focal neurological deficits. While the majority of CMs are located supratentorial, the less common posterior fossa, particularly cerebellar CMs (cCMs), pose a unique treatment challenge. This study aims to contribute to the understanding and management of cerebellar CMs, thereby assisting in the decision-making process for clinical interventions in this patient population. We conducted a retrospective analysis of all patients who were treated for CMs from 2010 to 2023 at our tertiary healthcare facility. Patients with cCMs were further analyzed concerning their treatment strategy and functional outcome based on the modified Rankin Scale. Nine hundred fourteen patients with CMs were treated between 2013 and 2023 at our center. Among these subjects, 6.5% (n = 59) presented with cerebellar lesions. The median age was 54 [37-64] years, and 15 (25.4%) patients showed associated developmental venous anomalies. Nearly half of these patients (49.0%) were surgically treated. Surgical approaches were tailored and individualized to the specific CM location based on a treatment algorithm and encompassed supracerebellar-infratentorial, telovelar, suboccipital transcortical, retrosigmoid transcortical, and retrosigmoidal transhorizontal fissure approaches. Univariate analysis revealed no risk factors concerning postoperative morbidity. The surgically treated patients showed a significant improvement between preoperative and follow-up functional outcomes. cCMs are rare but frequently necessitate surgical intervention. This study enhances the current understanding of cCMs, underscoring the intricate challenges associated with their management. Differentiated algorithms with tailored approaches ensure the optimization of outcomes in the treatment of these challenging lesions.

Knowledge, attitude and practice of food hygiene and safety among food vendors in a rural tertiary health facility in south South Nigeria

Background: Food hygiene and safety is a public health concern that requires the practices to prevent microbial and other contaminants of food from production to consumption. Study design: A descriptive cross-sectional study. Methods: One hundred (100) food handlers/vendors from ten food premises within the teaching hospital environment were interviewed using a semi-structured validated questionnaire. All food handlers/vendors who consented to participate in the study were interviewed (total population). Data were entered and analyzed using SPSS version 23. Statistical significance was set at 95% confidence level with p<0.05. Results were presented in tables and charts. Results: One hundred (100) participants were interviewed and of this, 44% were cooks and 67% had good knowledge of food hygiene and safety. Majority (70%) had positive attitude towards food hygiene and safety and about half (53%) had good practice of food hygiene and safety. Majority of those who had work experience of 26 years and above (77.8%) had good practice and positive attitude (88.9%) towards food hygiene and safety. More with no formal education (62.5%) had good practice of food hygiene and safety but this association was found not to be statistically significant. Conclusion: Two third of the respondents had good knowledge of food hygiene and safety with majority of them having positive attitude. This positive attitude and good knowledge of the respondents did not quite translate to good practice as only about half of them had good practice of food hygiene and safety.

Assessment of relationship between emotional intelligence and conflict resolution among nurse managers at tertiary Health Institutions of North Eastern States of Nigeria

Conflict in health care settings may be effectively managed if nurse managers possess conflict management skills such as reconciliation, listening, and effective communication to bring individuals closer and work together to find fair solutions and meet balanced needs. The study aimed at identifying the relationship between emotional intelligence and conflict resolution among nurse managers at tertiary Health Facilities, in the Northern States of Nigeria. The objectives of the study are to assess the level of emotional intelligence among nurse managers, also to identify the most common types of conflict, determine the causes of conflict, determine the conflict resolution strategies applied by the nurse managers and to identify relationship between emotional intelligence and conflict resolution among nurse managers in tertiary health institutions of North Eastern States. A mixed methods research design (quantitative and qualitative methods) was used. A total of 188 nurse managers and three Head Nursing Services departments formed the sample size. The nurse managers were given structured questionnaires and the Head of the Nursing Services department was interviewed (key informant interview). Three instruments were employed for data collection; Interview Guide, Structured Questionnaire and Participants Demographics Sheet. A simple random sampling technique was used for the study. The obtained data were coded and computed in an SPSS Version 26 and analyzed using percentages, mean and standard deviation for descriptive statistics while the Pearson Correlation Coefficient was used for the inferential statistics. The result of the study revealed that most of the nurse managers have a fair level of emotional intelligence when dealing with conflict among nurse managers. It also revealed that the most common type of conflict among nurses was related to environmental factors. The working environment was the highest cause of conflict among nurses. Social skill strategy was mostly used in conflict resolution. The study revealed that there was no significant relationship between years of experience and conflict resolution r=0.173. Based on the findings the researcher concluded that most of the respondents highly make use of social awareness in the application of emotional intelligence in conflict resolution, most of the causes of conflict among nurses were related to a working environment, and social skills were mostly used in conflict resolution among nurses. Based on the findings of the study, the researcher recommended that other sources of conflict management should be identified for nurse managers to manage conflict, nurse managers should use the skills they have to solve problems and conflict management to be part of a school of nursing curriculum.

Metabolic profile of acute ischemic stroke patients in a tertiary care hospital

Background: When the blood supply to a portion of the brain is blocked or diminished, brain tissue cannot get oxygen and nutrients, resulting in an ischemic stroke. This study aimed to investigate the prevalence of hyperglycemia and dyslipidemia among patients with acute stroke in a tertiary healthcare setting in Bangladesh. Methods: This cross-sectional study was conducted from January 2022 to December 2022 at a tertiary healthcare facility in Bangladesh, focusing on patients with acute ischemic stroke. Data was collected through a face-to-face interview, and medical records were reviewed. The study included 40 patients with acute stroke, evidenced by clinical findings and a CT scan of the Brain. Written informed consent was obtained after proper explanation, and participants were free to refuse or withdraw at any point. Confidentiality and privacy were maintained. Results: The majority of participants (37.5%) were aged 60-69, with more males (57.5%) than females (42.5%). Most (70%) lived in urban areas. Among the participants, 82.5% had hypertension, and 52.5% had diabetes mellitus. The mean of HbA1c was 7.6% and of triglyceride was 205.0 mg/dl. Of the participants with acute stroke, 47.5% had extracranial carotid stenosis. Conclusions: Nearly half of those who had an acute stroke also had diabetes, and four out of five had a history of hypertension. Among the patient hyperglycemia and dyslipidemia was common. Nearly half of those who suffered an acute stroke also experienced carotid stenosis. Consideration should be given to managing hypertension, DM, dyslipidemia, and carotid stenosis among patients with acute stroke. J Shaheed Suhrawardy Med Coll 2023; 15(1): 50-54

Isolation and antibiogram of some bacterial isolates from patients with ear infection in a tertiary health care facility at Benin City, Edo State, Nigeria

Ear infection has been reported as a common health concern globally, impacting individuals across diverse demographic factors. Causative bacterial agents of this infection are constantly changing and require continuous surveillance to monitor emerging trends. This study investigated the bacterial etiologic agents and their susceptibility patterns among patients with ear infection at the study Centre. A total of 43 patients who visited the Ear, Nose and Throat clinic of the University of Benin Teaching Hospital that were diagnosed with ear infection were evaluated. Patient data and specimen were collected after which isolated bacteria were subjected to antimicrobial susceptibility testing against some antibiotics (Sparfloxacin, Azythromycin Amoxicillin-clavulanic acid and amoxicillin) using standard methods. Results obtained showed that patients aged 16-25 years were more predisposed to ear infection and substantial number of them (60.5%) reported previous history of the infection. Staphylococcus (48.70%) and Pseudomonas (26.30%) were the most predominant bacterial isolated from these patients. Other isolates included; Bacillus (14.5%), Corynebacterium (3.90%), Enterobacterium (1.30%), and Klebsiella (3.9%). Antibiogram revealed that 78.9% of the isolates were susceptible to the killing effects of Azithromycin and only 39.3% were susceptible to amoxicillin. However. 69.8% of isolates were susceptible to amoxicillin- clavulanic acid combination therapy. Conclusively, Staphylococcus and Pseudomonas, were the leading cause of ear infection at the study center. Azithromycin as well as amoxicillin- clavulanic acid combination were the most effective antibiotics against the encountered bacterial isolates and these antibiotics can be used as a first line drug in the management of ear infection at the study.

Influence of postpartum depression on maternal-infant bonding and breastfeeding practices among mothers in Abeokuta, Ogun state

BackgroundPostpartum Depression (PPD) is a severe mental health condition that adversely affects mothers and their infants. The influence of PPD on maternal-infant bonding and breastfeeding practices has been scarcely reported in Nigeria. Therefore, we examined the prevalence of PPD, the associated factors, and the relationship with maternal-infant bonding and breastfeeding practices in Abeokuta, Nigeria.MethodA descriptive cross-sectional survey was conducted among 600 mothers within the extended postpartum period (≤ 1 year) from three government-owned immunisation clinics at primary, secondary, and tertiary health facilities in Abeokuta, Ogun State. PPD was assessed using the Edinburgh postnatal depression Scale (EPDS ≥ 13), and maternal-infant bonding was evaluated using the Postpartum Bonding Questionnaire (PBQ ≥ 50). We also examined breastfeeding practices (i.e. the time to initiation by 30 min, exclusive breastfeeding for 6 months and early commencement of complementary feeding by 2 months). Data was analysed using chi-square and logistics regression models at a 5% significance level.ResultsThe prevalence of PPD was 21.8%, 95% CI (18.7–25.3). Factors associated with PPD were maternal age: 25–34 years [AOR = 0.52; 95% CI (0.29–0.90)]; ≥ 35 years [AOR = 0.44; 95% CI (0.20–0.96)], being married [AOR = 0.43; 95% CI (0.21–0.85)], perceived stress increased the odds of PPD: moderate stress level [AOR = 8.38; 95% CI (3.50–19.9)]; high-stress level [AOR = 47.8; 95% CI (8.65–263.7)] and self-reported history of emotional problems [AOR = 3.25; 95% CI (1.43–7.38)]. There was a significant direct association between PPD and poor maternal-infant bonding [AOR = 3.91; 95% CI (1.04–4.60)]. PPD reduces the odds of early breastfeeding initiation [AOR = 0.43; 95% CI (0.28–0.68)], but no association was found between PPD and exclusive breastfeeding [AOR = 1.07; 95% CI (0.07–1.67)].ConclusionThe prevalence of PPD was high in our study population and associated with poor maternal-infant bonding and late breastfeeding initiation but not with exclusive breastfeeding. Promoting maternal mental health to foster stronger mother-infant relationships and better breastfeeding practices has become crucial.

MISCONCEPTIONS ABOUT ASTHMA AMONG PATIENTS VISITING THE TERTIARY CARE HOSPITAL OF KARACHI

Asthma is a common respiratory condition that significantly impacts patient quality of life, with many individuals lacking adequate knowledge about triggers and proper inhalation therapy. Understanding patient awareness of asthma management is crucial in designing interventions that enhance their ability to prevent and manage symptoms effectively. Objective: This study aimed to assess the awareness of asthma triggers, perceptions of inhalation therapy, and the effect of a teaching intervention among patients visiting a tertiary healthcare facility in Karachi, Pakistan. Methods: A cross-sectional descriptive survey was conducted in the Department of Pulmonary Medicine at Aga Khan University Hospital, Karachi, from January to June 2024. A total of 200 asthma patients were included through convenience sampling. Data were collected using a standardized questionnaire that assessed participants' knowledge of primary asthma triggers, correct inhaler usage, and relevant socio-demographic factors. The statistical analysis was performed using SPSS Version 25, and frequencies, percentages, and chi-square tests were used to examine associations between patient knowledge and other variables. Results: The study revealed that asthma awareness among participants was limited. Only 45% of respondents could identify common asthma triggers accurately, while 30% believed that asthma was solely caused by smoking or pollution. Additionally, 35% of patients expressed concerns about frequent reliance on inhalers, and 40% indicated that they were unsure of the correct way to use their inhalers. The teaching intervention demonstrated an improvement in inhaler usage knowledge and reduced anxiety related to inhalation therapy. Conclusion: This study highlights a significant gap in patient awareness regarding asthma triggers and the proper use of inhalers. These findings emphasize the importance of developing targeted educational interventions to improve asthma management, particularly in low-resource settings. Future efforts should focus on enhancing patient education to prevent asthma-related complications and improve overall disease control.

Drug resistance profiling, antimicrobial susceptibility and demographic characteristics of children with acute bacterial meningitis in a Southeastern tertiary health facility

Background: Over the years, varying patterns of bacterial susceptibility and multidrug resistance (MDR) rates have been reported in different settings. Detailed evaluation of the drug profile of the bacterial pathogens implicated in children with invasive bacterial infection helps to reduce the heightened risk of adverse events that could follow poorly managed or complicated cases in resource limited environment like ours. This study therefore, aimed to highlight the antibiotic susceptibility and MDR rate, and establish the relationship if any, between demographic characteristics and positive CSF- bacterial isolates of post neonatal children with suspected acute bacterial meningitis (ABM). The findings would guide practitioners on the empirical antimicrobials to consider in the event of clinical suspicion of ABM pending the availability of CSF isolates' antibiogram. Methods: A prospective review of 100 children with clinical suspicion of ABM from January 2016- December 2020. Descriptive statistics, chi square and regression analysis were used to establish MDR rates, Isolates' susceptibility pattern and the relationship between demographic variables and positive isolates respectively. P<0.05 was accepted as significant. Results: Fluroquinolones, cephalosporins, imipenem and aminoglycosides were susceptible anti-microgram in children with ABM. Sixty-four (85.5%) of the isolates showed MDR pattern, and young children (infants and toddlers) were significantly associated with positive CSF bacterial isolates. Conclusions: ABM should be treated with combination of CNS penetrating empirical antibiotics due to rising rate of MDR pathogens. Young children with febrile illnesses should be thoroughly evaluated for possibility of CNS infection.

Prevalence of Hepatitis E Virus Infection among Blood Donors in a Tertiary Healthcare Facility in Osun State, Nigeria

Hepatitis E virus (HEV) is currently the most common cause of viral hepatitis in developing countries. While prospective blood donors are routinely screened for HIV, Hepatitis B and C globally in endemic areas, HEV is not included in the protocol, despite the increase in global prevalence of HEV. Till date, only a handful of studies exist on the prevalence of HEV in Nigeria. The aim of this study was to fill this knowledge gap by determining the prevalence of HEV among blood donors at the LAUTECH Teaching Hospital, Osogbo, Osun State, Nigeria. A total of 102 consenting individuals were enrolled into the study between ages 20 and 55. A volume of 5ml blood sample was collected, and the serum harvested, stored at 20°C until ready for analysis. A double antibody sandwich HEV ELISA was performed to analyze the sera in duplicate for HEV antigen, using an ELISA Kit. Of the 102 samples analyzed, 15 (14.7%) tested positive for HEV antigen, confirming the presence of HEV infection among blood donors in the study population. There was significant association between HEV seropositivity and contact with animals (P=0.010) and alcohol consumption (P=0.000), which means there was a higher chance of donors who consumed alcohol or have had contact with animals to get infected with HEV. However, age, educational status, occupation and gender did not show any statistically significant association with HEV infection. The prevalence of HEV seropositivity was high (14.7%) and a cause for concern as HEV continues to be a major public health issue especially in developing countries.

Endoscopic management of postcholecystectomy complications at a Nigerian tertiary health facility

BackgroundCholecystectomy and common bile duct exploration for biliary stone disease are common hepatobiliary surgeries performed by general surgeons in Nigeria. These procedures can be complicated by injury to the biliary tree or retained stones, requiring repeat surgical intervention. This study presents the experience of using endoscopic retrograde cholangiopancreatography (ERCP) in the management of hepatobiliary surgery complications at the academic referral center of Obafemi Awolowo University Teaching Hospital (OAUTHC) Ile-Ife, Nigeria.MethodsAll patients with postcholecystectomy complications referred to the endoscopy unit at OAUTHC from March 2018 to April 2023 were enrolled. Preoperative imaging included a combination of abdominal ultrasound, CT, MRI, magnetic resonance cholangiopancreatography (MRCP), and T-tube cholangiogram. All ERCP procedures were performed under general anesthesia.ResultsSeventy-two ERCP procedures were performed on 45 patients referred for postcholecystectomy complications. The most common mode of presentation was ascending cholangitis [16 (35.6%)], followed by persistent biliary fistula [12 (26.7%)]. The overall median duration of symptoms after cholecystectomy was 20 weeks, with a range of 1-162 weeks. The most common postcholecystectomy complication observed was retained stone [16 (35.6%)]. Other postcholecystectomy complications included bile leakage, bile stricture, bile leakage with stricture, and persistent bile leakage from the T-tube in 12 (26.7%), 11 (24.4%), 4 (8.9%), and 2 (4.4%) patients, respectively. Ampullary cannulation during ERCP was successful in all patients (45, 100%). Patients with complete biliary stricture (10/12) required hepaticojejunostomy.ConclusionEndoscopic management of postcholecystectomy complications was found to be safe and reduce the number of needless surgeries to which such patients are exposed. We recommended prompt referral of such patients for ERCP.

Assessment of age specific serum Prostate Specific Antigen (PSA) levels for Indian population: A retrospective analysis at a tertiary healthcare facility.

Prostate-specific antigen (PSA) is a key marker for prostate cancer screening, but its utility is debated, prompting exploration of PSA derivatives for improved accuracy. While racial variations in serum PSA levels are documented, limited data exists for the Indian population. Given increasing life expectancy and heightened awareness of prostate cancer, this study aims to establish age-specific PSA ranges in an Indian cohort, contributing vital insights for population-specific screening and diagnosis. A cross-sectional study was conducted on 4860 men with lower urinary tract symptoms (LUTS). Data, collected from April 2016 to March 2023, included age, PSA levels, digital rectal examination (DRE), and biopsy results. Statistical analysis involved Spearman's correlation, descriptive statistics, and confidence intervals. Of the studied participants, 809 underwent prostatic biopsy, revealing malignancy in 500 cases. Age-specific PSA values were studied in 4170 subjects and showed positive correlation with increasing age and prostate size. Most cancers were metastatic (66%), emphasizing the need for early detection. Age-specific PSA ranges were lower in the Indian population compared to the West. This study's Indian cohort exhibited higher PSA values than some previous Indian studies but lower than Western populations, aligning with global trends. The rising incidence of prostate cancer in India underscores the importance of understanding the disease burden. PSA levels exhibit race-specific variations, cautioning against direct extrapolation of Western data to the Indian population. This study contributes age-specific PSA ranges for an Indian cohort, facilitating nuanced prostate cancer screening strategies.

Altered Surrogate Markers of Inflammation in Perinatal HIV-Exposed Children with Caries.

Dental caries is associated with immunologic response, yet its association with hematologic parameters and inflammatory markers is unclear. This study aimed to examine the relationship between some surrogate markers of inflammation and dental caries in the context of perinatal exposure to human immunodeficiency virus (HIV). This cross-sectional study involved 2 groups of children aged 4 to 11 y who were (1) HIV exposed but uninfected (HEU) and (2) HIV unexposed/uninfected (HUU) and recruited from HIV pediatric and child outpatient clinics, respectively, at a tertiary health facility in Nigeria. Medical records were reviewed, and trained dentists conducted oral and dental examinations. Five milliliters of EDTA blood was obtained and used for CD4 and CD8 and complete blood analysis, from which other inflammatory markers such as the neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), systemic inflammatory index (SII), CD4/CD8 ratio were calculated using referenced formulas. In total, 245 (125 HEU and 120 HUU) children with a mean (standard deviation) age of 7 (2) y were included in this study. No differences in caries experience were observed in both groups of children (38 children [16%] were caries affected; 19 [16%] and 19 [15%] from the HEU and HUU groups, respectively). Examining the relationship between studied inflammatory markers and caries showed that leucocyte counts were slightly lower in caries-affected children compared with their caries-free counterparts (P = 0.05). Lower levels of neutrophils (P = 0.04) and higher levels of lymphocytes (P = 0.02) were associated with caries prevalence. Although not significant, NLR, PLR, and SII were lower in caries-affected children. Caries is associated with leucocytes and some of its subsets in both groups of children and independent of perinatal HIV exposure, highlighting the potential of evaluating inflammatory markers in caries prevention, treatment, and research. This study provides evidence that a relationship exists between dental caries, HIV exposure, and inflammation using affordable methods and advocates the inclusion of these markers in caries care in resource-limited settings.

Pattern Of Renal Analytes Following Renal Function Assessment Of Infants In A Tertiary Health Facility In Southern Nigeria

Background/Objectives Electrolyte imbalance is a common finding in infants, and the story is so in the tropical countries, where most patients are usually victims of fluid losses from various etiologies. This study is aimed at assessing the profile and pattern of electrolytes imbalance and other parameters of renal function assessmentamong infants (0-12 months) in our environment. Methods/Subjects This cross-sectional study was carried out over a 6-month period on infants who wereadmitted into University of Calabar Teaching Hospital (UCTH) and investigated forelectrolyte, urea and creatine, after a hospitalstay of ≥24 hours. Blood samples were taken from such patients, analyzed and values obtained were compared with the reference intervals to ascertain the level of deviation from the expected normal for age. Results The total number of children that participated on the study was 200, made up of 106(53.0%)males and 94(47.0%) females. The children were classified based on their different ages from 0 to 12 months. Children aged 0-1month made up the bulk of the study population (57.0%). Low level of bicarbonate occurred in 65.5% of all the children. Hyponatremia (37.7%) and Hyperkalemia (28.9%), occurred in 0 -1month age group. These derangements have been known to contribute negatively to the outcome of the admitted infant if not corrected. Most of the infants had normal values of the individual electrolytes. Conclusion In view of the fact that infants are more vulnerable to electrolyte imbalance, prevention of electrolyte imbalances is preferable to treatment.

Objective audiometric evaluation of individuals with type 2 diabetes mellitus: A cross-sectional survey in South West Nigeria

Aims: Diabetes mellitus affects more than 450 million people around the world. The relationship between diabetes and sensorineural hearing loss has been an area of interest. The aim of this study is to evaluate hearing loss, among type 2 diabetes diagnosed in the endocrinology unit of a private tertiary health facility in South West Nigeria. Methods: This was a hospital-based cross-sectional study carried out among type 2 diabetic patients and normal healthy non-diabetic individuals as control. A total of 120 participants were recruited for the test and control. Otoacoustic emission and auditory steady-state response audiometry were carried out on all the participants. Result: The total number of study participants was 120 (60 for test and control) with an age range of 30–79 years for the test and 20–80 years for the control. Otoacoustic emission showed passes for both ears, 61.7% pass in both ears for the test group and 76.7% pass in both ears for the control group. 21.7% of the test and control were referred for both ears. 16.6% of the test group was referred in one ear compared to 1.7% in the control group. Auditory steady-state response (ASSR) audiometry showed mild to profound hearing loss in all test groups while in the control group 20% had normal hearing. Moderate to moderately severe hearing loss in at least one ear was 38.4% in the test ear compared to 16.7% in the control group. Conclusion: Hearing loss is an established complication of type 2 diabetes. Therefore, it is necessary to incorporate regular hearing screening for patients with diabetes for early detection, counseling, and rehabilitation for those with disabling hearing loss.

Should fathers witness childbirth? A survey of attitudes of expectant mothers attending a tertiary hospital in Kano, northern Nigeria

Background Increased paternal involvement during childbirth can enhance maternal and neonatal outcomes. However, in resource-constrained settings, cultural and health system factors often hinder the involvement of fathers in the birthing process. This study aimed to identify the factors influencing antenatal clients’ attitudes toward their partner’s presence during childbirth in northern Nigeria. Methods We administered a pre-tested, culturally adapted questionnaire to antenatal clients at a tertiary health facility (n=351). Attitudinal scores were measured on a Likert scale, and logistic regression was used to compute adjusted odds ratios (aORs) for predictors. Results Only 15.4% of respondents agreed or strongly agreed with the presence of their male partner during childbirth. Women opposed or strongly opposed the suggestion that their partner’s presence provided emotional support (35.9% and 59.8%, respectively), reduced labor pain perception (45.1% and 33.1%, respectively), strengthened the couple’s relationship (40.2% and 52.7%, respectively), or enhanced father-child bonding (32.3% and 46.6%, respectively). More than half of the respondents (57.0%) strongly disagreed that their partner’s presence enhanced paternal responsibility. Rather, the presence of the partner was considered unhelpful (49.3%), culturally unacceptable (37.9%), and against religious rulings (51.6%). Younger maternal age (<30 years, aOR=7.6, 95% CI=2.12-14.40) and higher parity (≥5 children, aOR=2.08, 95% CI=1.21-8.38) were associated with a more positive attitude towards the presence of the father during labor. Conclusions Most women did not favor having their partners present during childbirth. Policymakers and healthcare providers should integrate cultural sensitivity considerations into guidelines and initiatives that promote male involvement in childbirth in similar settings.

Intravenous versus oral iron for anaemia among pregnant women in Nigeria (IVON): an open-label, randomised controlled trial

Oral iron for anaemia in pregnancy is often not well tolerated, with poor adherence. Iron administered intravenously might address these tolerance and adherence issues. We investigated the effectiveness and safety of intravenous ferric carboxymaltose versus oral ferrous sulphate on anaemia and iron deficiency among pregnant women in Nigeria. We did a multicentre, open-label, parallel, randomised controlled trial of pregnant women (aged 15-49 years) with haemoglobin (Hb) concentrations of less than 10 g/dL at 20-32 weeks' gestation from 11 primary, secondary, or tertiary health facilities in Nigeria (five in Lagos and six in Kano). Exclusion criteria included vaginal bleeding, blood transfusion or major surgery within the past 3 months, symptomatic anaemia, anaemia known to be unrelated to iron deficiency, clinically confirmed malabsorption syndrome, previous hypersensitivity to any form of iron, pre-existing maternal depression or other major psychiatric illness, immune-related diseases, such as systemic lupus erythematosus or rheumatoid arthritis, or severe allergic reactions. Participants were randomly assigned (1:1) by nurses and doctors using a web-based randomisation service to either receive a single dose of intravenous ferric carboxymaltose (20 mg/kg to a maximum of 1000 mg) or oral ferrous sulphate (200 mg; 65 mg elemental iron) three times daily until 6 weeks postpartum. The study was primarily unmasked. Primary outcomes were maternal anaemia (Hb <11 g/dL) at 36 weeks' gestation and preterm birth at before 37 weeks' gestation, with analysis by intention to treat in participants with available data. This study was registered at the ISRCTN registry on Dec 10, 2020 (ISRCTN63484804) and on ClinicalTrials.gov (NCT04976179) on April 7, 2021. Between Aug 10, 2021, and Dec 15, 2022, 13 724 pregnant women were screened for eligibility. 12 668 were excluded due to ineligibility for inclusion, and 1056 provided consent to participate and were randomly assigned to either the intravenous or oral administration groups. 527 were assigned to the intravenous ferric carboxymaltose group and 529 were assigned to the oral ferrous sulphate group. 518 in the intravenous group were assessed at 36 weeks' gestational age and after 518 deliveries, and 511 completed the 6 weeks postpartum visit. 513 in the oral ferrous sulphate group were assessed at 36 weeks' gestational age and after 512 deliveries, and 501 completed the 6 weeks postpartum visit. No significant difference was found in anaemia at 36 weeks (299 [58%] of 517 in the intravenous group vs 305 [61%] of 503 in the oral group; risk ratio 0·95, 95% CI 0·85-1·06; p=0·36), nor in preterm birth (73 [14%] of 518 vs 77 [15%] of 513; 0·94, 0·70-1·26; p=0·66). There were no significant differences in adverse events. The most common adverse events were diarrhoea (in six participants) and vomiting (in three participants) in the oral group and fatigue (in two participants) and headache (in two participants) in the intravenous group. Although the effect on overall anaemia did not differ, intravenous iron reduced the prevalence of iron deficiency to a greater extent than oral iron and was considered to be safe. We recommend that intravenous iron be considered for anaemic pregnant women in Nigeria and similar settings. Bill & Melinda Gates Foundation.

Antimicrobial resistance profiles of and associated risk factors for Pseudomonas aeruginosa nosocomial infection among patients at two tertiary healthcare facilities in Lusaka and Copperbelt Provinces, Zambia.

Antimicrobial resistance (AMR) of pathogens such as Pseudomonas aeruginosa is among the top 10 threats to global health. However, clinical and molecular data are scarce in Zambia. We, therefore, evaluated the AMR profiles of P. aeruginosa nosocomial infections (NIs). A year-long hospital-based cross-sectional study was conducted at two large tertiary-level hospitals in Zambia. Patients with current or previous hospital contact were screened for NIs. The current study focused on patients diagnosed with P. aeruginosa NIs. Clinical specimens were collected for bacteriological culture, and PCR amplification of 16S rRNA gene fragments was performed on pure isolates. Hospital or NIs were defined as infections that arise during hospitalization, occurring at least 48 h after admission. The Kirby-Bauer's disk diffusion method was used to evaluate antibiotic resistance patterns. The association between AMR and risk factors was analysed using the χ2 test. Eight hundred and forty-one patients were screened, and clinical specimens were collected and analysed. Of them, 116 (13.7%) were diagnosed with P. aeruginosa NIs. The participants' ages ranged from 15 to 98 years, with a mean of 51 (SD ± 18). Catheter-associated urinary tract infections (57%) were the most common, followed by pressure sores (38.7%). P. aeruginosa isolates were primarily susceptible to amikacin, which had the highest resistance to FEP. We observed a high prevalence of multidrug resistance (73.6%). The AMR was associated with carbapenem-hydrolysing β-lactamase gene blaOXA-51 and surgical care. This study has demonstrated that multidrug-resistant P. aeruginosa is prevalent in hospitals in Zambia's Lusaka and Ndola districts and possibly countrywide.

Treatment Adherence and Health-Related Quality of Life Among Patients with Hypertension at Tertiary Healthcare Facility in Lalitpur, Nepal: A Cross-Sectional Study.

Measurement of medication adherence and health-related quality of life is extremely important when planning different health policies. Drug therapy and adherence to medication are critical to prevent complications of hypertension, especially in countries like Nepal, where hypertension is one of the most prevalent diseases. However, this has not been studied in Nepal. This study, hence, aimed to explore medication adherence, factors affecting medication adherence, health-related quality of life, and the correlation between medication adherence and health-related quality of life in hypertensive patients visiting tertiary care health facilities in Lalitpur district of Nepal. This quantitative cross-sectional study was conducted among 380hypertensive patients at KIST Medical College and Teaching Hospital, Lalitpur, Nepal. The Nepali version of the European Quality of Life tool EQ-5D-5L and the Hill-Bone Compliance to High Blood Pressure Therapy Scale (HBCTS) were used. Intergroup differences in medication adherence, the EQ-5D index and EQ-VAS scores were assessed for statistical significance using either the Mann-Whitney or Kruskal-Wallis tests for numerical data. Spearman correlation coefficient was used to identify the relationship among medication adherence, EQ-5D-5L index values, and EQ-VAS scores. The mean treatment score was 22.43 ± 4.12. Age, sex, and occupation were significant factors that affected treatment adherence. The EQ-5D score was 0.72 with age, sex, income, and educational status as significant factors and marital status as an insignificant factor. A slightly negative correlation was found between the total treatment adherence score and the EQ-5D index. The treatment adherence of patients to antihypertensive therapy was suboptimal, which could affect the outcome of therapy. Better treatment adherence was correlated with a better health-related quality of life. Hence, both health-care providers and patients should make efforts to increase treatment adherence to attain better HRQOL.

Laryngotracheal stenosis: a single-center retrospective analysis of endoscopic treatment strategies and recurrence.

Laryngotracheal stenosis is a process of fibrosis that results in airway obstruction; it may be congenital or acquired. Acquired cases are due to iatrogenic, traumatic, infectious and autoimmune causes. Patients present with a spectrum of breathing difficulties that might be fatal. This article presents a unique retrospective cross-sectional study of patients with laryngotracheal stenosis who had endoscopic dilatation, and some had open surgical procedures to describe the evolution after the therapy, to compare the outcomes of the dilatation in comparison to surgical interventions and associated complications in other studies, to provide knowledge to help in dealing with these patients, and to enable educated, independent patient decision-making. In this observational and descriptive study, we aimed to highlight the clinical features, management, and treatment outcomes among twenty-nine patients with laryngotracheal stenosis who were managed by open and endoscopic surgical intervention over a period of 5 years. Data were collected retrospectively from the patients' medical records from February 2016 until July 2022 at a hospital in Jerusalem, which is a tertiary healthcare facility and the only referral center for similar cases from the West Bank, East Jerusalem, and Gaza, with a population of around 8 million. Tables and graphs are used to highlight the statistical study's findings. Data were analyzed using Microsoft Excel software. Twenty-nine patients were involved in the study, with an average age of 32.2 years; 51.7% of them were males. The patients had one or more chronic conditions, such as hypertension and coronary artery disease. The majority of patients (65.5%) had stenosis as a result of orotracheal intubation, and the most common site was the subglottic (68.9%). According to the Cotton-Myer classification, 44.8% of the patients were classified in grade III, 34.4% were included in grade I, 13.7% in grade II, and 6.8% in grade IV. Six patients (20.68%) received surgery for stenosis, and 23 patients had an endo-laryngeal dilatation. Restenosis happened in (58.6%). Mortality rates are almost negligible. Subglottic stenosis is still a challenging condition to manage. The authors describe a single-center experience approach dealing with these conditions. Long-term follow-up for these cases is mandatory as the recurrence rate is still high.

Investigation and successful control of a Candida auris outbreak at a tertiary health care facility in Kenya

ObjectivesThis study aimed to conduct an epidemiological and genomic investigation of a hospital outbreak of Candida auris, and implement measures for its control. MethodsWe collected demographic and clinical data from medical records of patients with C. auris from January 2017 to June 2019 after identifying increased cases in April 2019. Point-prevalence surveys for C. auris colonisation were conducted in the critical care units (CCU). Antifungal susceptibility testing and genomic sequencing of isolates were performed. A bundle of infection prevention and control measures was instituted. ResultsThirty-two patients with C. auris were identified. All patients had a history of CCU admission. A total of 283 screening swabs were obtained and 57 isolates of C. auris identified. Antifungal susceptibility testing was performed on 48 isolates. All but two isolates were resistant to fluconazole; one isolate was also resistant to amphotericin B. Forty-one of 46 isolate genomes were clonally related and formed a distinct genetic cluster in Clade III. C. auris colonisation reduced from 42% in June 2019 to 1% in August 2019, and no new hospital-acquired colonisation was identified in the subsequent 9 months. ConclusionsWe identified a new genetic subcluster of Clade III C. auris. We also show that strict implementation of infection prevention measures can lead to substantial reductions in C. auris transmission.