Safe duration of silicon catheter replacement in urological patients

Objectives: This study compared the infection rates, degree of encrustation, symptoms, and complications in patients regarding the duration of urethral catheterisation (three weeks, six weeks, and eight weeks). Design: A cross-sectional study with stratified simple random sampling Setting: Urology Unit, Korle Bu Teaching Hospital Participants: One hundred and thirty-seven male patients with long-term urinary catheters Interventions: Participants were grouped into 3 weeks, 6 weeks, and 8 weeks duration of catheter replacementsPrimary outcomes measures: Symptoms due to the urinary catheters, urinalysis, urine and catheter tip cultures, sensitivity, and catheter encrustations were assessed. Results: Eighty-six patients had a primary diagnosis of benign prostatic hyperplasia (BPH), 35 had urethral strictures,13 had prostate cancer, two had BPH and urethral strictures, and one participant had bladder cancer. There was no difference in the symptoms the participants in the different groups experienced due to the urinary catheters (p > 0.05). The frequency of occurrence of complications (pyuria, p = 0.784; blocked catheter, p=0.097; urethral bleeding, p=0.148; epididymo-orchitis, p=0.769 and bladder spasms, p=1.000) showed no differences in the three groups. There was no statistical difference in the urinalysis for the three groups (p>0.05) and the degree of encrustations (3 weeks: 0.03 ± 0.06, 6 weeks: 0.11±0.27 and eight weeks: 0.12 ±0.27) with p=0.065. Conclusions: In this study, the duration of urinary catheterisation using silicone Foley's catheters did not influence the complication and symptom rates; hence silicon catheters can be placed in situ for up to 8 weeks before replacement instead of the traditional three-weekly change.

National action plan on antimicrobial resistance: An evaluation of implementation in the World Health Organization Africa region

In line with global instruments, within the last five years, two-thirds of all countries in the WHO Africa Region (WHO AFR) have developed a National Action Plan (NAP) on Antimicrobial Resistance (AMR). We sought to evaluate progress made across the countries implementing NAP for effective response to AMR. A semi-structured survey tool was administered to obtain information from national focal persons on the implementation of strategic elements of NAP on AMR. This was followed by a Lessons Learnt Workshop in June 2019 at Douala, Cameroon, where focal persons made presentations on the country's progress. Later, a desktop review of the LLW report and other key documents was conducted. Countries in WHO AFR that have set up a national surveillance system and are enrolled into the WHO global antimicrobial resistance surveillance system have progressively increased to 30 (of 47 countries), of which 15 are already submitting surveillance data. Of the 20 countries at the Lessons Learnt Workshop, 14 have infection prevention and control (IPC) policies and functional healthcare facility IPC programs, 15 participate in the commemoration of the annual world hand hygiene days. Although almost all countries surveyed have national standard treatment guidelines, only five have incorporated the WHO AWaRe classification into the national essential medicines list. Fourteen of 20 countries have established an active/functional national secretariat/coordinating center for AMR. Discernible progress is being made on the implementation of NAP in WHO AFR region. Gaps identified in the strategic elements of action plans need to be filled for effective AMR control.

IgG4-related disease manifesting with portal vein thrombosis : a case report - case report

IgG4-related disease (IgG4-RD) is a newly recognized disorder characterized by increased level of IgG4 and tumefaction or tissue infiltration by IgG4+ plasma cells.1,2 IgG4-RD can affect multiple organ systems. In this case report, we describe a patient who presented with portal vein thrombosis complicated with portal hypertension and esophageal varices. To our knowledge, this complication of IgG4-RD has not yet been described in the medical literature

Vestibular assessment in chronic noise exposure subjects

Background: The damaging effect of noise on vestibular disturbance is well known, first described in 1890 by Haberman in tinkers with occupational hearing loss. Others have reported vestibular disturbances and abnormalities, such as balance disorders, dizziness, vertigo, and even spontaneous nystagmus in workers exposed to various kinds of occupational noise. Objective: To evaluate vestibular function in subjects with chronic noise exposure.Subjects and methods: Eighty subjects were included in the study, divided into 2 groups: 60 subjects exposed to noise in laundry with mean age 41.53±11.15 (study group) and 20 subjects not exposed to noise with mean age 38.60±6.48 (Control group). All subjects underwent audiovestibular evaluations (puretone audiometry, tympanometry, vedionystagmography, and posturography).Results: This study demonstrated elevated hearing threshold at audiometric frequencies 2-8 KHz (pv <0.001) and speech discrimination (pv <0.001). in addition, marked caloric weakness and reduced SOT composite scores (pv = <0.001), reduced SOT equilibrium scores in noise exposure subjects (pv<0.001), reduced SOT sensory scores in VEST and PREF (Pv <0.001). Furthermore, there was a positive correlation between duration of exposure and auditory and vestibular implications. Conclusion: this study revealed apparent effect of noise on auditory and vestibular system

Les étiologies des urgences obstétricales à la maternité du centre hospitalier universitaire départemental de l'Ouémé-plateau (CHUD O/P) au Bénin

Objectif : Décrire les étiologies des urgences obstétricales dans le service de gynécologie et d'obstétrique du Centre Hospitalier Universitaire Départemental de l'Ouémé-Plateau.Patientes et Méthodes : Il s'agissait d'une étude transversale, descriptive et analytique menée à la maternité du CHUD O/P sur une période de 06 mois allant de Février 2016 à Aout 2016. Les critères d'inclusion étaient constitués de toutes les patientes admises à la maternité du CHUD O/P et traitées pour des complications de la gravido-puerpéralité. N'étaient pas inclues les urgences non obstétricales.L'analyse et les tests statistiques ont été effectués sur les logiciels CS PRO 6.2 et SPSS en comparant les moyennes et les écarts, en utilisant le chi carré de Pearson pour les variables dichotomiques en acceptant une probabilité significative p0,05. Les considérations éthiques, la confidentialité et l'anonymat étaient respectés. Résultats et conclusion : La fréquence d'admission des urgences obstétricales était de 34,8%. L'âge moyen était de 27,3 +/- 5,7 ans. Elles étaient nullipares (31,4%), aux activités professionnelles peu rémunératrices (69,3%). La référence était dans 70,4% le mode d'admission mais inadéquate. Les causes retrouvées par ordre de fréquence, étaient : les dystocies (30,7%) ; les urgences hémorragiques (25,9%) ; les urgences hypertensives (21,5%) ; les hypoxies foetales (17,8%) et les infections 4,0%). La létalité maternelle et néonatale étaient respectivement de 3,8% et 11,5%.L'anticipation des SONU s'avère indispensable dans la prise en charge des urgences obstétricales

Factors affecting willingness to HIV Counseling and Testing among patients presenting with conventional Sexually Transmitted Infections in Addis Ababa

Background: There is ample scientific evidence that a person with an untreated sexually transmitted infection (STI); particularly those inducing ulcers or discharge; is at an increased risk of passing on or acquiring HIV during sexual intercourse. HIV counseling and testing (HIV CT) for STI cases is thus an important tool in the public health responseto HIV/AIDS. Objective: To assess factors affecting willingness towards HIV CT among patients with conventional STIs in Addis Ababa. Methods: A cross-sectional study; involving 422 STI cases; was conducted in Addis Ababa from December 2006 to April 2007. STI patients were consecutively selected during an outpatient visit in ten government health centers; which were purposively selected mainly on the basis of their high STI case load. A pre-tested; interviewer administered;structured questionnaire was applied for data collection. The Pearson chi-square test was used to assess statisticalsignificance of associations between willingness towards HIV CT and respondents' socio-demographic status;knowledge; and behavior. Moreover; bivariate and multivariate logistic regression analyses were done to identifypredictors of willingness for HIV CT. For all statistical significance tests; the cut- off value set was p0.05.Results: Nearly 74of STI patients said that they would be willing to undergo HIV CT at the time or 3 months after their STI diagnosis. Furthermore; 97.4and 71.8of STI patients had heard about HIV/AIDS and STIs; respectively. The majority; 93of STI patients knew at least one prevention method; and 61.2identified all the three major methods for preventing HIV/AIDS. Overall; 43.8of the STI patients had at least one misconception; and 38had comprehensive knowledge about HIV/AIDS. Ever tested for HIV and being in the age group of 15-34 years were found to be significantly and positively associated with willingness towards HIV CT whereas perceiving small or moderate chance of contracting HIV infection was found to have a significant and negative association. Conclusion: The findings of this study indicated the need for promotion and expansion of sustainable provider initiated HIV CT with subsequent follow up of STI patients as part of a range of services and support; and intensive patient-centered risk reduction counseling for STI patients during the initial visit to health care facilities

Aspergilloma of the Lungs: Operative Experience from Tikur Anbessa Hospital; Ethiopia

Background: Pulmonary aspergilloma represents a potentially life-threatening disease caused by saprophytic growth of Aspergillus fumigates in pulmonary cavities. This is the first report of its operative treatment from Ethiopia.The aim of this study was to determine the clinical presentations; operative treatments and post operative outcome of patients with pulmonary aspergilloma. Methods: This was a retrospective review of patients' record with post operative diagnosis of pulmonary aspergilloma treated over a period of three years between April 2005-March 2008 at The Tikur Anbessa hospital which is a teaching and referral hospital in Addis Ababa. Results: Eleven patients were included; 81.8of whom were males. Cough and hemoptysis were the two most common presenting symptoms; occurring in 11(100) and 10(90.9). The chest x-ray features typical for aspergilloma was seen in only 4(36.4). The left lung was involved in 8(72.75) and the upper lobes were the most commonly affected lobes occurring in 10 (90.9). The most frequent clinical indication for surgery was severe hemoptysis in 8 (72.75). Left upper lobectomy was the most frequently performed surgery in 4(36.4) and left pneumonectomy in 3(27.3). Four significant complications occurred in the postoperative period and one patient died; making the postoperative mortality 9.1. Histopathologic confirmation of the fungal ball was possible in 10 patients and the most common underlying cavitary disease was tuberculosis in 9(90). Conclusion: Aspergilloma is not an uncommon disease in Ethiopia and the diagnosis should be considered in patients who present with hemoptysis or chronic non-resolving cough. Surgery for pulmonary aspergilloma accounted for 5.8of all thoracotomies done at the hospital and we have adopted the policy of early surgical treatment for all cases. In our series; the commonest lung pathology behind the aspergillus lesions was cavitary pulmonary tuberculosis; similar to many reports. Since the typical x/ray finding is not present in all patients; we believe that a supportive x/ray finding is sufficient enough an investigation to decide on early surgery in patients who present with suggestive symptoms

Assessment of Insecticide Treated Nets Coverage for Malaria Control in Kafta-Humera District; Tigray: Possession versus Use by High-risk Groups

Background: In endemic areas; children under five and pregnant women are vulnerable to malaria and are likely to benefit most from the use of mosquito nets. Use of insecticide treated nets (ITNs) for protection against mosquito bite during sleep is highly effective. Nevertheless; prioritization pertaining to the use of nets does not seem to be optimal inmost endemic setups. Objective: To examine the status of ITNs coverage; use and its determinants for malaria control among children under five and/or pregnant women in Kafta-Humera District in Tigray Regional State. Methods: A comparative cross-sectional quantitative study was conducted in the rural and urban areas of the District. Qualitative data were also collected through focus group discussions (FGDs) to identify views of participants; pertaining to possession and utilization. An early morning survey was also carried out in order to observe the actual behavior of the community towards net use. Result: Net and ITN possession was 84.5and 80.0for rural; but 96.1and 91.1for urban settings; respectively. Net possession was higher among urban (OR 3.33; 95CI 1.39; 7.98) compared to rural areas. Observed net and ITN use during the preceding night by children under five years of age was 68.6and 67.0for rural; and 84.6and 79.5for urban areas; respectively. Likewise; similar practice for net and ITN in 52.1and 64.7of pregnant women was observed in rural and urban areas; respectively. The FGD results of this study suggested that lower net possession in rural areas could be due to insufficiency of mosquito net provision and inequity during distribution. Occupation; family size in rural areas; radio possession in urban areas and relative wealth and number of sleeping places had significant effect in both settings to own a net. Relative wealth; radio possession; malaria education message in rural and occupation in both settings had a positive effect on net use. Conclusion: Not all nets owned by the households were being utilized properly. Yet; maldistribution and shortage of ITN were also observed within rural and urban settings. Effective Information; Education and Communication (IEC) should be promoted and continuous availability of ITNs should be in place to achieve effective control of malaria among the high-risk groups

Status of ANC-Linked HIV Counseling and Testing as an Intervention for PMTCT in Public Health Facilities in Addis Ababa: Quality of HIV Counseling Given to Pregnant Women for PMTCT

Background: A high quality of PMTCT is essential for success: done well; it will result in significant reduction in child mortality through decreased peri-natal and postnatal HIV transmission; done badly; it could lead to deaths; increased drug resistance; and poor infant feeding. Objective: the aim of this study was to assess the quality of antenatal-based HIV counseling and testing as an intervention for PMTCT at ten public Health Centers in Addis Ababa City. Methodology: a cross sectional study was conducted at purposively selected 10 health centers in Addis Ababa from April to May 2008. Methods included observations of counseling sessions; and interview of key informants at PMTCT sites. Data on counselors' communication skills; duration and content of pre- and post test counseling was collected using a structured questionnaire adapted from UNAIDS tools. SPSS Version 15.0 was used to enter; clean; and analyze the data. Results: A total of 66 (31 pre- and 35 post test) counselling sessions were observed. The mean duration of pre-test counselling was 5.37 minutes (+3.34) and that of post test was 3.0 minutes (+ 2.24). In 78.8of the sessions; the counsellors gave clear and simple information to mothers; in 25.8of the sessions; the mothers were not given the chance to freely consent or dissent for blood test. In the post test sessions; 42.9of the mothers' understanding of the meaning of their test results was not explored. Conclusions: The communication skill of the counselors was generally 'satisfactory'. The majority of pre- and post test sessions included the basic information on HIV and PMTCT/MTCT. However; the discussions were unusually brief; rudimentary and lacked depth and coverage

Laparoscopic Repair of Penetrating Injury of the Diaphragm: an Experience from a District Hospital

In this study we review our experience in using laparoscopy as a diagnostic and therapeutic tool in dealing with penetrating diaphragmatic injuries due to stab wounds and look at the feasibility of using this procedure in other similar institutions. Thirty patients; all of whom were males 20-30 years of age; presented to the surgical emergency unit of our hospital with upper abdominal and lower chest wall stab wounds between 01-05-1998 and 30-11-2006. Diagnosis of the diaphragm injury was either obvious with omentum herniating through the chest wall; or occult with confirmation of the injury at laparoscopy. All patients underwent diagnostic laparoscopy; which resulted in identification and efficient treatment of eight patients with diaphragmatic injury; and thereby laparotomy was avoided. The procedure converted to open surgery in one patient because of a small left-sided colonic tear. Laparoscopy is an efficient tool for the diagnosis and management of diaphragmatic injuries. It should be used routinely instead of exploratory laparotomy in haemodynamically stable patients with penetrating lower chest injuries

The effect of gum Arabic oral treatment on the iron and protein status in chronic renal failure patients under regular hemodialysis in Central Sudan

Objective To assess the effect of gum arabic (Acacia Senegal) oral treatment on the iron and protein status in chronic renal failure patients. Material and Methods Thirty-six chronic renal failure (CRF) patients (under regular hemodialysis); and 10 normal subjects participated in this study. The patients were randomly allocated into the following groups: Group A (n=12): CRF patients under low protein diet (LPD) (less than 40 gram/day); and gum arabic (50 g/day) treatment; Group B (n=14): CRF patients under LPD; gum arabic; iron (ferrous sulphate 200 mg/day) and folic acid (5 mg/day) treatment; Group C (control group; n=10): CRF patients under LPD; iron and folic acid treatment; Group D (n=10): normal volunteers who were kept on normal diet beside a daily dose of 50 gm gum arabic. Each of the above treatments was continued for three consecutive months. Predialysis blood samples were collected from each subject before treatment; and twice per month for three months. Hemoglobin (Hb); hematocrit; total protein; albumin; globulin and 24-hour urine volume as well as serum iron; total iron-binding capacity (TIBC);transferrin saturation; packed cell volume (PCV) and; mean corpuscular hemoglobin concentration (MCHC) were determined. Results Following administration of gum arabic oral treatment for three months; serum iron increased by 5.85and 4.81for groups A and B; respectively. These increases were significantly different from the baseline (P0.05); and control group C (P0.01). TIBC was significantly decreased in group A (4.44) and in group B (4.31) as compared with the baseline and control group C (P0.05). Transferrin saturation was significantly increased by 7.77; and 9.59for groups A and B; respectively; compared with the baseline (P0.05) and control group C (P0.01). Hb; PCV; MCHC; serum total protein; albumin and globulin; and 24-hour urine volume showed no statistically significant differences from the baseline and control groups. Conclusion The improvement in iron status due to oral administration of gum arabic could reduce the need for oral iron prescription

Health risks associated with obesity

The association of obesity with a number of pathological disorders; such as hypertension; type 2 diabetes mellitus; cardiovascular diseases; neoplasms; gallstones; respiratory system diseases and sleep apnoea; is discussed. Also; the different factors that determine the degree of impairment in obesity are discussed; these include the amount of body fat; distribution of fat and presence of other risk factors. Brief discussions on the prevalence of obesity in South Africa and the effects of obesity on reproductive function are also presented

Les acces febriles de l'enfant a l'hopital general de Yaounde : causes et traitement symptomatiques

Les affections febriles figurent parmi les maladies les plus frequentes de l'enfant dans les pays en voie de developpement. Une analyse retrospective des dossiers des malades ages de 1 mois a 15 ans recus a l'hopital general de Yaounde de fevrier 1991 a janvier 1995; a permis de recenser 1122 affections febriles. Les principales causes etaient les suivantes dans l'ordre de frequence : paludisme (43;67 pour cent); infections respiratoires aigues (29;68 pour cent); gastro-enterites febriles (10;87 pour cent); fievres eruptives (4;55 pour cent). Les acces febriles lies a ces affections etaient traites en premiere ligne par les antipyretiques et parfois les anti-convulsants a des doses correctes selon des indications rigoureuses. Ce traitement a ete efficace et aucune intoxication n'a ete observee. La prevention des principales affections febriles diagnostiquees constitue la meilleure approche therapeutique dans le contexte economique actuel