Association of acute COVID-19 with 24 hours-pulse wave velocity in cameroonian workers

Introduction. COVID-19appears to have a vascular tropism responsible for diffuse vasculitis-like cell damage. The aim of our study was to evaluate the impact of Sars-Cov-2 infection on arterial stiffness.Material and methods. This was a cross-sectional analytical case-controlstudy with 1:1 matching (1 case to 1 control) over a six-month period from January 1, 2021 to June 30, 2021 at the medical-social centerof the autonomous port of Douala. We measured the pulse wave velocity (PWV) in two groups of patients (group 1: COVID-19and group 2: non-COVID-19) using a MOBIL-O-GRAPH 24h PWA MonitorTM. A p-value < 0.05 was considered significant.Result. A total of 122 patients (61 COVID-19and 61 non-covid) were included in this study, among which 68 (55.7%) male. The mean age was 41±11 years. PWV as well as POV adjusted for age and mean BP were similar in both groups. The mean 24-hour, diurnal and nocturnal PWV were slightly higher in COVID-19patients than in controls by 0.1 m/s (p=0.67), 0.2m/s (p=0.37) and 0.2m/s (p=0.25) respectively. COVID-19infection was not significantly associated with PWV (p=0.082).Conclusion. PWV were slightly higher in COVID-19patients and increased arterial stiffness was not significantly associated with COVID-19status in the acute phase of infection.

In-hospital interventions to promote relational practice with families in acute care settings: A scoping review

Relational practice is characterised by genuine interaction between families and healthcare professionals that promotes trust and empowerment. Positive clinical outcomes have been associated with relational practice. To assess and examine in-hospital interventions designed to promote relational practice with families in acute care settings of emergency departments, intensive care units and high care units. The preferred reporting Items for Systematic Reviews and Meta-Analyses guidelines informed the design of this scoping review. To identify relevant studies, databases (Academic Search Complete; CINAHL; PubMed; PsyInfo) and the search engine Google Scholar were searched using terms for core elements of relational practice and family engagement. Of the 117 articles retrieved, eight interventional studies met the search criteria. The interventions focused on relational practice elements of collaborating with and creating safe environments for families, whilst only one addressed healthcare professionals being respectful of families' needs and differences. In relation to the nature of engagement of families in interventions, the focus was mainly on improving family functioning. Family engagement in the interventions was focused on involving families in decision-making. The scoping review revealed a limited number of in-hospital interventions designed to promote relational practice with families in acute care settings. Further research is encouraged to develop such interventions. Contribution: The scoping review has highlighted specific elements of relational practice that have been overlooked in the mapped interventions. This provides guidance on where future interventional research may be focused.

The role of diffusion-weighted and fluid attenuated inversion recovery magnetic resonance imaging in diagnosis and timing of acute ischemic stroke

Background: Ischemic stroke causes serious long-term disability and a great number of economic losses. Thrombolytic therapy is used only if the time of stroke onset was <4.5 hours. However, new categories such as wake-up and day un-witnessed strokes, patients unable to tell exact time of last seen well. The importance of study is to use diffusion weighted/Fluid attenuated inversion recovery (DWI/FLAIR) mismatch as a radiological marker which can help to identify patients with lacunar and non-lacunar stroke within 4.5 hours of onset and use it to determine whether patients with unknown onset stroke qualify for thrombolytic therapy or not. Patients and methods: prospective cohort study was conducted on 72 patients with known time of symptoms onset, imaged within 24 hours from stroke onset. Patients underwent the admission Computed tomography CT and magnetic resonance scans (DWI and FLAIR only) with time gap was no longer than one hour. The presences of lesions in the neuroradiological modalities were assessed in correlation with the duration of the stroke.Results: The time from stroke onsetto neuroimaging was significantly shorter with ischemic lesions visible in DWI/FLAIR mismatch group when compared to other modalities. The DWI/FLAIR was characterized by global specificity 100%, sensitivity 91.9%, PPV 100% and NPV 92.1%. It succeeded to diagnose 12 patients with lacunar stroke before 4.5 hours from the stroke onset.Conclusion: The presence of acute ischemic lesions only in DWI/FLAIR mismatch group can help to identify both lacunar and non-lacunar stroke patients who are within 4.5 hours' time window for intravenous thrombolysis

Functional Medicine: How Dysfunction Leads to Disease

Functional medicine is part of integrative medicine. There are three phases in the movement from health to disease. The first phase concerns lifestyle and how poor lifestyle choices move the system into increasing dysfunction. If the changes are rapid and severe then this is called acute disorder; and if slow and persistent then this is called chronic disorder. In the early phase of dysfunction there may be few symptoms and signs but the symptoms and signs rapidly or slowly become more obvious. The symptoms and signs at first are only recording the fact that the system as a whole in under stress and not functioning well. Over time dysfunction may lead to disease. The conventional model of medicine tends to focus its management on treating symptoms or treating the disease if possible. The integrative model pays attention to lifestyle changes; moving the dysfunction back to optimum function and only treating the disease if indicated

Prospective Evaluation of the Bengezi and Al-Fallouji Modified Alvarado Score for Presumptive Accurate Diagnosis of Acute Appendicitis in University of Port Harcourt Teaching Hospital; Port Harcourt

Background: The accurate diagnosis of acute appendicitis (AP) in a patient is valuable to the busy clinician. Decision making in cases of AP poses a clinical challenge especially in developing countries where advanced radiological investigations are not readily available and do not appear cost effective; clinical parameters remain the mainstay of diagnosis. Time and resources wasted on surgical intervention; with the added risks of surgery and anaesthesia; only to discover that this was unnecessary remains a big challenge. This prospective study was carried out to assess the accuracy of the Bengezi and Al-Fallouji modified Alvarado score in presumptive diagnosis of AP and its effect on the negative appendicectomy rate (NAR) at the University of Port Harcourt Teaching Hospital. Methods: A retrospective study of the NAR of this hospital between June 2000 and May 2002 was carried out. All consecutive patients (128) who presented with presumptive diagnosis of AP between June 2003 and May 2004 were scored using the Bengezi and Al-Fallouji modified Alvarado scoring system and correlated with histological diagnosis. Patients discharged without surgery based on score; were reviewed in the outpatient's clinic for one month to ascertain that they did not need surgical intervention. The NAR for all appendicectomies performed by surgeons for presumptive diagnosis of AP without scoring between June 2004 and May 2005 was determined as control. Validity of the scoring system was assessed by calculating sensitivity; specificity; positiveand negative predictive values. Results: A total of 128 patients were scored. Forty patients with scores less than 4 after eight hours observations and re-evaluation at the Accident and Emergency were discharged without surgery. Eighty eight patients had appendicectomies as treatment for scores 5- 10. There were 39 males and 49 females. In eighty patients; the appendix was histologically inflammed and 8 were normal; giving a NAR of 9.09. High sensitivity of 92.93and specificity of 92.93were recorded in the study. The NAR of the retrospective study was 26.4and 19.05for the control group operated without scoring

New thoughts on Acute Volume Therapy

Modern fluid therapy requires an understanding of the underlying physiological abnormalities induced by acute illness; the nature of the fluids to be administered; the differences between the various intravenous fluid preparations and concepts regarding appropriate amounts of volume to be given. Crystalloid solutions expand the extracellular fluid (ECF) space and are redistributed between the intravascular and extracellular compartments in a ratio of 1:4 in proportion to the normal distribution of fluid between these two spaces. The most widely used crystalloids; 0.9saline and balanced salt solutions such as Ringer's lactate; fall well short of the desired composition. 'Normal' saline is significantly hypertonic (osmolality 308 mOsm/l) and has a very high chloride content (154 mmol/l; normal plasma range 95 - 105 mmol/l). Infusions of as little as 2 litre 0.9saline during surgical procedures will produce a significant; metabolic acidosis owing to the chloride load. Ringer's lactate (or acetate); like 0.9saline; is not an ideal solution. The Cl- content is substantially higher than plasma chloride (111mmol/l); the Na+ content lower (131 mmol/l) and the osmolarity of the solution is 274 mOsm/l. Colloids are suspensions of particles of various sizes that aim to maintain plasma volume by maintaining the colloid osmotic pressure in plasma; thus retaining the administered volume within the circulation. Recently the 'third space' concept has been questioned and attention has focused on the potential adverse effects of excess administration of crystalloid solutions. Intravenous fluid loading is often used as first-line therapy for patients with hypotension or circulatory failure; but in only half of patients does cardiac output respond positively after fluid challenge. For the remainder of patients fluid loading may be associated with adverse consequences. Mechanically ventilated patients have a higher mean CVP; more indicative of mean intrathoracic pressure than of cardiac filling or intravascular fluid status. The patient who demonstrates a positive response to passive leg raising has been reliably shown to benefit from the administration of intravenous fluid. It has recently been established that not only systolic pressure variation but also several analogous derivatives provide valuable clinical information on a continuous basis. The predictive value of systolic pressure variation is well attested to in ventilated patients. Patients breathing spontaneously demonstrate the same phenomenon; but critical assessment is more difficult

Invagination et occlusions intestinales aigues (OIA) chez l'enfant: à propos de 127 observations

Il s'agit d'une etude retrospective de 07 ans sur les enfants de 0-15 ans admis dans le service de chirurgie infantile pour occlusions intestinales. Nous avons collige 127 cas. Les objectifs fixes etaient les suivants: determiner la frequence des affections responsables d'occlusions et invaginations; determiner la mortalite dans tous les cas; faire des recommandations allant dans le sens de l'amelioration du pronostic. En somme; il est a noter que les occlusions et invaginations occupent une place importante dans la chirurgie de l'enfant. En moyenne 18 cas

Les appendicites aigues de l'enfant a l'Hopital Gabriel Toure: a propos de 20 cas

L'appendicite aigue est une pathologie d'urgence chirurgicale assez frequente chez l'enfant qui pose un probleme de diagnostic et exige une prise en charge adequate. L'etude a pour objectifs de determiner la frequence des appendicites aigues par rapport aux autres urgences chirurgicales abdominales de l'enfant et de degager les facteurs pronostiques afin de preconiser des solutions visant a ameliorer le pronostic vital. Il s'agit d'une etude prospective qui a porte sur les enfants ages de 0 a 15 ans. Dans les resultats on note que: les appendicites aigues constituent la seconde cause des urgences chirurgicales abdominales chez les enfants apres les occlusions intestinales ; - elles augmentent de frequence avec l'age ; - le sexe n'a aucune influence sur la frequence ; - la guerison a ete obtenue chez tous les malades apres appendicectomie precoce ; - la constatation de 13 cas d'appendicite perforee revelee sous forme de peritonite montre le risque evolutif de l'affection. Les appendicites aigues constituent une urgence chirugicale abdominale frequente surtout chez le grand enfant et son pronostic est favorable si l'intervention chirurgicale est faite precocement

Autopsy study of acute pancreatitis

The autopsy incidence of acute pancreatitis as a cause of death in Uganda is similar to that seen in the U.S.A. The aetiological factors in acute pancreatitis in Uganda appears to be different from those in the western world. In 21 out of 26 patients (81 percent) whose cause of death was acute pancreatitis the aetiology of the pancreatitis was not determined. About 21 patients had associated chronic pancreatic disease

A guide to the management of common acute cardiopulmonary problems

This manuscript is merely meant to be a broad guideline to the overall management of acute and or chronic cardiac and respiratory emergencies. It was first concerned with the drawn up as a short guideline 12 years ago to assist junior staff in the management of patients in critical care situations. Its scope has been progressively widened to encompass many of the problems that commonly confront the clinician and are still controversial today. It is by no means a substitute for textbook material but summarises the experience of the compiler which it is hoped will be a value to his colleagues - medical; nursing and paramedical. Not all agents discussed are currently available in this country but a total profile of the therapeutic agents in each section is overviewed. Other physicians may have their own ideas about managment of therapeutic regimes and the presented data is; therefore published as a guideline and reflects basically my own experience. [abstract terminated]

ARI training manual for health workers

The main objectives of the programme are: 1) To reduce mortality from pneumonia in children under 5 years of age. 2) To reduce the severity of and complications from Acute Upper Respiratory Infections (AURI) e.g. deafness and rheumatic carditis through early and appropriate treatment of acute otitis media and streptococcal sore throat. 3) To reduce the inappropriate use of antibiotics andother drugs for the treatment of ARI