Pattern of liver enzymes and maternal outcome in eclamptic patients admitted to the Intensive Care Unit, University College Hospital, Nigeria

Introduction: Eclampsia, a hypertensive disorder, is one of the leading causes of maternal mortality in developing countries like Nigeria. We evaluated the relationship between the pattern of liver enzymes and maternal mortality in eclamptic women. Method: A retrospective study of 55 eclamptic women admitted to the Intensive Care Unit (ICU), University College Hospital, Nigeria, was conducted. Data were obtained on their demographic, obstetric, and clinical characteristics, liver enzyme patterns, and maternal outcome. Analysis was by descriptive statistics, univariate analysis, and non-parametric tests with level of significance set at p<0.05. Results: Maternal deaths occurred in 27.3% and elevation of liver enzymes was observed more among the dead patients compared with those who survived. Alanine aminotransferase (ALT) was the most commonly elevated liver enzyme, occurring in almost all (90.9%) the patients. Maternal mortality was significantly associated with age (p=0.001), saturated oxygen levels (p=0.007), elevated alkaline phosphatase (p=0.008), alanine aminotransferase (p=0.013), aspartate aminotransferase (p=0.016), and total bilirubin (p<0.001). Conclusion: Maternal mortality due to eclampsia was clinically associated with age, elevated liver enzymes and a lower serum level of total bilirubin. Liver transaminases are therefore important prognostic indicators associated with eclampsia.

Factors associated with COVID-19 fatality among patients admitted in Mashonaland West Province, Zimbabwe 2020-2022: a secondary data analysis

Introduction: approximately 15% of COVID-19 patients develop symptoms necessitating admission. From 2020 to 2022, Mashonaland West Province had an institutional case fatality rate of 23% against a national rate of 7%. Therefore, we evaluated the COVID-19 admissions in the province to determine the factors associated with COVID-19 mortality. Methods: we conducted an analytical cross-sectional study based on secondary data from isolation centers across the province using all 672 death audit forms and patient records. We obtained data on patient demographics, signs and symptoms, clinical management and oxygen therapy administered, among other things. Data were entered into an electronic form and imported into Epi-info 7 for analysis bivariate and multivariate was conducted. Results: we found that being an older man, aOR 1.04 (1.03-1.05), who had diabetes aOR 6.0 (95% CI: 3.8-9.2) and hypertension aOR 4.5 (95% CI: 2.8-6.5) were independent risk factors. Patients put on dexamethasone aOR 2.4 (95% CI: 1.6-3.4) and heparin/clexane aOR 1.6 (95% CI: 1.1-2.2) had a higher mortality risk. However, vitamin C aOR 0.48 (95% CI: 0.31-0.71) and oxygen therapy aOR 0.14 (95% CI: 0.10-0.19) and being pregnant aOR 0.06 (95% CI: 0.02-0.14) were protective. Conclusion: mortality risk increased in older male patients with comorbidities and with those on dexamethasone and heparin therapy. Oxygen therapy and vitamin C were protective. There is a need to conduct further study of the source of these variations in risk across patients to establish the true impact of differences in individuals' mortality.

Emergency centre patients in the Democratic Republic of Congo: Some epidemiological and clinical aspects at Beni General Referral Hospital

Introduction: Little information is available regarding the characteristics of patients attending the emergency centre (EC) in the Democratic Republic of Congo. This study aims to provide some epidemiological and clinical aspects of patients admitted to the emergency centre at Beni General Referral Hospital. Methodology: For a year, from January to December 2021, a cross-sectional study was conducted. Data regarding patients' characteristics, admission modality, stay duration, reason for admission, and discharge modality was anonymously collected from patients' registers. A descriptive analysis was done with Epi-Info 7. Result: A total of 1404 patients were admitted to the EC, with a male-to-female ratio of 1.2 to 1. The age group below 18 years accounted for 35.4%. Most of the patients (75.7%) originated from urban areas. In 83% of cases, there was no recommendation from another medical facility for EC admission. The most common reasons for admission are non-traumatic gathering on top of neuropsychiatric and non-specific symptoms. Road traffic accidents are the most frequent causes of trauma symptoms. Few patients (14.7%) spent less than 12 hours in the EC. Globally, 7.3% of patients admitted to the EC were discharged after being managed, and 89% were transferred to different wards. The intra-emergency centre mortality rate was 11.8% among admitted patients in the ER at Beni General Referral Hospital. Conclusion: This epidemiology database underlines the need for developing globalizing and multi-sectoral interventions (diagnosis, therapeutic strategy, organization, health program, or health policies) in the perspective of bringing change and/or taking action in the Democratic Republic of Congo's emergency medical system.

Characteristics of hospitalised COVID-19 patients during the first two pandemic waves, Gauteng

Background: Gauteng province (GP) was one of the most affected provinces in the country during the first two pandemic waves in South Africa. We aimed to describe the characteristics of coronavirus disease 2019 (COVID-19) patients admitted in one of the largest quaternary hospitals in GP during the first two waves. Objectives: Study objectives were to determine factors associated with hospital admission during the second wave and to describe factors associated with in-hospital COVID-19 mortality. Method: Data from a national hospital-based surveillance system of COVID-19 hospitalisations were used. Multivariable logistic regression models were conducted to compare patients hospitalised during wave 1 and wave 2, and to determine factors associated with in-hospital mortality.Results: The case fatality ratio was the highest (39.95%) during wave 2. Factors associated with hospitalisation included age groups 40­59 years (adjusted odds ratio [aOR]: 2.14, 95% confidence interval [CI]: 1.08­4.27), 60­79 years (aOR: 2.49, 95% CI: 1.23­5.02) and ≥ 80 years (aOR: 3.39, 95% CI: 1.35­8.49). Factors associated with in­hospital mortality included age groups 60­79 years (aOR: 2.55, 95% CI: 1.11­5.84) and ≥ 80 years (aOR: 5.66, 95% CI: 2.12­15.08); male sex (aOR: 1.56, 95% CI: 1.22­1.99); presence of an underlying comorbidity (aOR: 1.76, 95% CI: 1.37­2.26), as well as being admitted during post­wave 2 (aOR: 2.42, 95% CI: 1.33­4.42). Conclusion: Compared to the recent omicron-driven pandemic waves characterised by lower admission rates and less disease severity among younger patients, COVID-19 in-hospital mortality during the earlier waves was associated with older age, being male and having an underlying comorbidity.

The impact of government- and institution-implemented COVID-19 control measures on tertiary- and regional- level intensive care units in Pietermaritzburg, KwaZulu-Natal Province, South Africa

Background. The COVID-19 pandemic has had a significant impact on healthcare systems globally as most countries were not equipped to deal with the outbreak. To avoid complete collapse of intensive care units (ICUs) and health systems as a whole, containment measures had to be instituted. In South Africa (SA), the biggest intervention was the government-regulated national lockdown instituted in March 2020. Objective. To evaluate the effects of the implemented lockdown and institutional guidelines on the admission rate and profile of non-COVID-19 patients in a regional and tertiary level ICU in Pietermaritzburg, KwaZulu-Natal Province, SA. Methods. A retrospective analysis of all non-COVID-19 admissions to Harry Gwala and Greys hospitals was performed over an 8-month period (1 December 2019 - 31 July 2020), which included 4 months prior to lockdown implementation and 4 months post lockdown. Results. There were a total of 678 non-COVID-19 admissions over the 8-month period. The majority of the admissions were at Greys Hospital (52.4%; n=355) and the rest at Harry Gwala Hospital (47.6%; n=323). A change in spectrum of patients admitted was noted, with a significant decrease in trauma and burns admissions post lockdown implementation (from 34.2 - 24.6%; p=0.006). Conversely, there was a notable increase in non-COVID-19 medical admissions after lockdown regulations were implemented (20.1 - 31.3%; p<0.001). We hypothesized that this was due to the gap left by trauma patients in an already overburdened system. Conclusions. Despite the implementation of a national lockdown and multiple institutional directives, there was no significant decrease in the total number of non-COVID-19 admissions to ICUs. There was, however, a notable change in spectrum of patients admitted, which may reflect a bias towards trauma admissions in the pre COVID-19 era

Diagnosis associated with COVID-19 (U07.1), pneumonia- unspecified (J18. 9) and other types of admissions: A restricted medical scheme case study-South Africa

The primary objective of this study was to assess the characteristics of patients admitted for COVID-19, 'J18.9 Pneumonia, unspecified organism' and other types of diagnoses. The aim was to assess as to what extent do COVID-19 related admissions changed to pneumonia, and as to what extent do 'J18.9 Pneumonia, unspecified organism' related admissions that changed to COVID-19 diagnosis at discharge stage. The secondary objective of the study was to assess' predictors of readmissions in private hospitals. The review period was private hospital claims received by the scheme between January and August 2020. The inclusion criteria for COVID-19 admissions were patients that had a laboratory-confirmed (RT ? PCR assay) COVID-19. Predictors of readmissions were modelled using logistic regression. The study found that restricted scheme patients admitted for a COVID-19 diagnosis changed to a 'J18.9 Pneumonia, unspecified organism' diagnosis. The converse was found to be true in that some patients that were admitted as J18.9 Pneumonia, unspecified organism' diagnosis changed to a COVID-19 diagnosis. This study showed underlying factors associated with hospital admissions and predictors of readmissions in private hospitals.

Profile and outcomes of hospitalized patients with COVID-19 at a tertiary institution hospital in Ghana

Background: In high-income countries, mortality related to hospitalized patients with the Coronavirus disease 2019 (COVID-19) is approximately 4-5%. However, data on COVID-19 admissions from sub-Saharan Africa are scanty. Objective: To describe the clinical profile and determinants of outcomes of patients with confirmed COVID-19 admitted at a hospital in Ghana. Methods: A prospective study involving 25 patients with real time polymerase chain reaction confirmed COVID-19 admitted to the treatment centre of the University Hospital, Kwame Nkrumah University of Science and Technology (KNUST), Kumasi, Ghana from 1st June to 27th July, 2020. They were managed and followed up for outcomes. Data were analysed descriptively, and predictors of mortality assessed using a multivariate logistic regression modelling. Results: The mean age of the patients was 59.3 ± 20.6 years, and 14 (56%) were males. The main symptoms at presentation were breathlessness (68%) followed by fever (56%). The cases were categorized as mild (6), moderate (6), severe (10) and critical (3). Hypertension was the commonest comorbidity present in 72% of patients. Medications used in patient management included dexamethasone (68%), azithromycin (96%), and hydroxychloroquine (4%). Five of 25 cases died (Case fatality ratio 20%). Increasing age and high systolic blood pressure were associated with mortality. Conclusion: Case fatality in this sample of hospitalized COVID-19 patients was high. Thorough clinical assessment, severity stratification, aggressive management of underlying co-morbidities and standardized protocols incountry might improve outcomes

Admission hyperglycemia and associated risk factors among patients with acute stroke in intensive care units in Kinshasa, the Democratic Republic of the Congo

Context and objective. Despite being established as a correlate of unfavorable outcome in acute stroke, little is known about the burden and associated risk factors of admission hyperglycemia in acute stroke in sub-Saharan Africa. The present study aimed to assess its frequency and associated risk factors in Congolese patients admitted in Intensive Care Units (ICUs) in the acute phase of stroke. Methods. A multicenter (6 ICUs) prospective cohort study including consecutive patients with acute stroke was undertaken from July 15th, 2017 to March 15th, 2018.The Glasgow Coma Scale helped to determine the severety of the disease at admission. Stress hyperglycemia was considered for a random blood glucose levels at admission ˃140 mg/dL in patients without type 2 diabetes mellitus (T2DM). Independent factors associated with admission hyperglycemia were assessed using logistic regression analysis. Results. Out of 194 patients (mean age 58.7±13.1 years; 64% males, 74.7% light to moderate stroke severity; 59% hemorrhagic stroke) enrolled, admission hyperglycemia was found in 106 (54.6%) of patients (mean age 60.1 ± 14.3 years; 67% men, 67% hypertension) with 77 (72.6%) and 29 (27.4 %) of them having stress and chronic hyperglycemia, respectively. Independent predictors of admission hyperglycemia were age [aOR 1.98; 95%CI 1.17-3.36), GCS < 8 (aOR 3.83; 95% CI 1.99-7.35) and diabetes (aOR 9.02; 95%CI 3.38-14.05). Conclusion. More than half of critically ill patients exhibit admission hyperglycemia with age, severity of stroke and known diabetes as its main associated risk factors

Coping strategies of mothers with preterm babies admitted in a public hospital in Cape Town

Background: Most pregnancies run a normal course, ending in a healthy mother­infant relationship, but sometimes, it can also be a life-threatening and stressful condition. The stress levels of mothers are more aggravated when they deliver preterm babies.Objectives: To explore the coping strategies of mothers of preterm babies with the stress of preterm delivery and subsequent admission of the preterm neonate to a neonatal care unit.Method: A qualitative research approach applying an exploratory and descriptive design was applied to explore the coping strategies of mothers with preterm babies admitted in a neonatal care unit. The study applied a purposive sampling technique to select mothers with preterm babies. The population for this study included women who delivered preterm babies and whose babies were admitted in the neonatal care unit at a public hospital in Cape Town. Semi-structured interviews were conducted until data saturation was reached, and 11 mothers with preterm babies in the selected public hospital participated in the study. Data were analysed manually using thematic content analysis with an inductive approach. Results: Results were deductively interpreted and supported by the Brief COPE model. The main themes that emerged from data analysis included praying, attachment with baby and acceptance of the situation. Under praying the following subthemes emerged, namely praying for God's strength, God's grace, babies' survival and thanksgiving to God for babies' health and preferred gender. The theme of attachment with the baby emerged with the following subthemes: bonding with the baby and seeing the baby. The last theme that was acceptance of the situation emerged with the following subtheme: perseverance in the situation and mother's awareness of her responsibility. Conclusion: Even though the mothers of preterm babies cope differently after delivery, their coping abilities, which included praying, attachment to baby and acceptance of the situation, were greatly determined by the condition of their babies as well as the support they receive from significant others

Admissions and mortality over a 5-year period in a limited-resource neonatal unit in Ghana

Objective: To review admissions and deaths at the neonatal intensive care unit (NICU) of the Korle Bu Teaching Hospital (KBTH), Ghana from 2011 to 2015, for the purposes of documentation of outcomes and identification of areas for improvement.Design: A retrospective descriptive study of NICU Admissions & Discharges from 2011 to 2015. All data in the NICU Admissions & Discharge books were transferred into a spreadsheet and analysed. Setting ­ The NICU of KBTH provides secondary and tertiary care for premature and critically ill term babies in the southern half of Ghana. Results: Over the 5-year period, 9213 babies were admitted to the NICU. Admission weights ranged from 300 to 6700g with median of 2400g. Overall mortality rate was 19.2%. Mortality rates were progressively and significantly higher in babies with lower admission weights and earlier gestations. Conclusions: We report a high NICU mortality rate of 19.2%, compared to the worldwide range of 3.1% to 29%. This wide range of outcomes is attributable to differences in the severity of illness of patients and to the organisation of resources devoted to obstetric and neonatal care. To substantially improve perinatal and neonatal outcomes, there is a need for wider coverage and better quality of health care; and to consider rationing of care. Complex interventions are necessary to improve outcomes, not just an increase in the allocation of particular resources

Description and early clinical outcome of patients with omphalocele admitted to a tertiary hospital in Kigali, Rwanda over a three-year period ­ a cross-sectional study

BACKGROUND: Studies suggest that patients with omphalocele have poor outcomes which are associated with the high rate of associated congenital abnormalities. A variety of surgical management techniques have been described, with some requiring equipment not available in resource-limited countries. OBJECTIVES: This study aimed to describe associated abnormalities, management and early hospital outcomes of patients with omphalocele.METHODS: A retrospective study of newborns diagnosed with omphalocele hospitalized from January 2014 to December 2016 at a tertiary level facility, the University Hospital of Kigali (CHUK) in Kigali, Rwanda. Case-file review of included newborns and analysis of the data collected was performed with SPSS version 16.0. RESULTS: Thirty-one patients were hospitalized with omphalocele during the three-year study period. A limited number of investigations were done to diagnose possible associated congenital abnormalities. Three patients (9.7%) were found to have cardiac abnormalities, nine (27.0%) had suspected genetic abnormalities including Trisomy 13, 18 and Beckwith Wiedemann Syndrome. In terms of management, ten patients (32.3%) underwent primary closure. Sixteen patients (51.6%) developed sepsis during hospitalization. Of the thirty-one patients hospitalized, nine (27.0%) died in the hospital. The only factor found to be associated with increased mortality was the size of the omphalocele, with small omphaloceles associated with lower mortality than large omphaloceles (OR 0.909, P-value 0.028).CONCLUSION: Mortality of these patients is significant and slightly higher in patients with larger omphalocele. Newborns with omphalocele should receive appropriate investigations to diagnose associated congenital abnormalities and have early recognition and prompt management of complications, especially sepsis. The results are limited by the small sample size and limited investigations performed to detect associated abnormalities

HIV Infection among children aged two years to less than eighteen years admitted to the Emergency Pediatric Unit in a tertiary health facility in Lafia North-Central Nigeria

BACKGROUND: Human Immunodeficiency virus (HIV) is a retrovirus that impairs the immune system by attacking the body's natural defense from infections and diseases. Pediatric HIV continue to be a major public health problem despite the global decline in its seroprevalence rates. The decline in the incidence of new HIV infections is particularly lower in children with a 52% reduction in the last ten years. This is attributed to a wider coverage in the use of antiretroviral therapy (ART) and the prevention of mother to child transmission of HIV (PMTCT) programs. Several programs designed at curtailing mother to child transmission of HIV are yielding positive result. This is not unexpected since most of the HIV infections among children were acquired via maternal to child transmission. With this, the study sets out to determine the prevalence of new HIV infection among patients admitted to the Emergency Pediatrics Unit (EPU) using the provider-initiated testing and counseling approach. METHODS: A prospective cross-sectional descriptive study was conducted at the mini laboratory attached to the EPU of the Dalhatu Araf Specialist Hospital Lafia Nasarawa State between 1st August 2017 to 31st July 2018. Using non-probability sampling, categorical variables were analyzed as frequencies and percentages. The association between categorical variables were analyzed using chi square.RESULTS: A total of 964 children ranging in age from two to less than eighteen years were screened. The total number of males was 550 (57.1%) while females was 414 (42.9%) with a male to female ratio of 1.3:1. Five (0.5%) children were newly diagnosed with HIV of the 964 children tested for the infection. CONCLUSION: The incidence of HIV infection among children admitted into our Emergency Pediatric Unit was 0.5%, comparable to some earlier reports

A profile of adult acute admissions to Lentegeur psychiatric hospital, South Africa

Background: The Western Cape province has the highest documented lifetime prevalence of common mental disorders in South Africa. To ensure the efficient, equitable and effective distribution of current resources, there is a need to determine the profile of patients requiring psychiatric admission.Aim: To describe patients admitted to the acute adult admissions unit at Lentegeur Hospital.Setting: Lentegeur Psychiatric Hospital is situated in Mitchells Plain, Cape Town, and serves about 1 million people from nearby urban and rural areas.Methods: This retrospective study involved an audit of all patients (18­60 years of age) admitted between 01 January 2016 and 30 June 2016. The clinical records of 573 adult patients were examined.Results: The median age of the cohort was 29 years. Most patients (63%) were educated to the secondary level. Only 12% of the patients were employed, and 37% received disability grants. More than 90% of the patients presented with psychotic symptoms. Of these, 28% presented with a first-episode of psychosis. Of all patients, 20% were referred with manic symptoms and 7% with depressive symptoms. Many patients (62%) used substances concurrently in the period leading up to admission. Significantly more males (73%) used substances compared to females (38%). Cannabis was the most widely used substance (51%), followed by methamphetamine (36%). Recent violent behaviour contributed to 37% of the current admissions. A total of 70 patients (13%) tested positive for human immunodeficiency virus (HIV), and 49 (9%) tested positive for syphilis.Conclusion: Substance use and a history of violence contributed to admissions in this population

Chronic lung disease and a history of tuberculosis (post-tuberculosis lung disease): Clinical features and in-hospital outcomes in a resource-limited setting with a high HIV burden

Background. Many patients with previous pulmonary tuberculosis (PTB) continue to experience respiratory symptoms long after completion of tuberculosis (TB) therapy, often resulting in numerous hospital visits and admissions.Objectives. To describe the profile of patients with chronic lung disease (CLD) with or without a history of PTB, and their in-hospital outcomes. Methods. We conducted a retrospective review of patients with CLD admitted with respiratory symptoms to Dora Nginza Hospital, Port Elizabeth, South Africa, from 1 April 2016 to 31 October 2016. These patients were divided into two groups: CLD with a history of PTB (CLD-TB) and CLD without a history of PTB. Patients with current culture-positive TB were excluded. Baseline characteristics and clinical outcomes (duration of hospitalisation and in-hospital mortality) were compared between the two groups.Results. During the study period, a total of 4 884 patients were admitted and 242 patients received a diagnosis of CLD. In the CLD patient group, 173 had CLD-TB and 69 had no history of PTB. Patients with CLD-TB presented with respiratory symptoms a median of 41 months (interquartile range (IQR) 101) after completion of TB therapy. CLD-TB patients were predominantly male (59.5%), and compared with patients with no history of PTB were more likely to be HIV-positive (49.7% v. 8.7%; p=0.001) and had had more frequent hospital admissions before the current admission (median 2.0 (IQR 2.0) v. 0; p=0.001) and longer hospital stays (median 5 days (IQR 7) v. 2 (4); p=0.002). However, there was no statistically significant difference in in-hospital mortality between the two groups (17.3% v. 10.1%; p=0.165).Conclusions. In patients with CLD, a history of PTB is associated with numerous hospital admissions and longer hospital stays but not with increased in-hospital mortality. TB therefore continues to be a public health burden long after cure of active disease

Factors contributing to neonatal admissions and outcomes at Effia Nkwanta regional hospital: January to December 2015

Objectives: To investigate factors contributing to neonatal admission outcomes at Effia Nkwanta Regional Hospital (ENRH) Method: All neonatal admissions to the Neonatal & Intensive Care Unit (NICU) of the hospital that were entered into the DHIMS2 database were extracted and complemented with additional information from patients' folder review. The data from the two sources were merged and analysed using SPSS version 21. Univariate and multivariate regression analysis was performed to identify factors associated with admission outcomes, taking statistical significance as p < 0.05. ARC-GIS version 10.1 was used to describe the geospatial distribution of health facilities referring to ENRH. Setting: Neonatal & Intensive Care Unit of ENRH Participants: All neonates admitted to NICU between January and December 2015. Intervention: None Results: Nine Hundred and Ninety-Three out of the 1150 neonatal admissions were entered into DHIMS2. Fifty-two percent were males, 57.3% were delivered through Caesarean Section, 72% were admitted within 2 days of birth, and 56.8% had normal birth weight. FiftyEight percent of the neonates were delivered at the ENRH, whilst 39.9% were referred from health facilities located within Sekondi-Takoradi Metropolis. At 1 minute, only 14% of the neonates had normal Apgar score (8-10), and this improved to 50% at 5 minutes. The main causes of neonatal admission were birth asphyxia 21.0%, followed by prematurity 17.5%, neonatal jaundice 17.1% and neonatal sepsis 14.5%. The death rate was 18% with more than 80% of the deaths occurring during the early neonatal period. More than 80% of deaths were due to four admission diagnoses: birth asphyxia, prematurity, neonatal jaundice, neonatal sepsis. Factors associated with adverse admission outcome are: low birth weight, delivery by Caesarean Section and low Apgar score at 5 minutes. Conclusions: The institution of appropriate interventions to reduce or manage the four major causes of adverse neonatal admission outcomes will significantly reduce neonatal mortality in the hospital

A quality improvement study of the emergency centre triage in a tertiary teaching hospital in northern Ethiopia

Introduction:An effective emergency triage system should prioritize both trauma and non-trauma patients according to level of acuity, while also addressing local disease burden and resource availability.In March 2012, an adapted version of the South African Triage Scale was introduced in the emergency centre (EC) of Ayder Comprehensive Specialized Hospital in northern Ethiopia. Methods:This quality improvement study was conducted to evaluate the implementation of nurse-led emergency triage in a large Ethiopian teaching hospital using the Donabedian model. A 45% random sample was selected from all adult emergency patients during the study period, May 10th to May 25th 2015. Patient charts were collected and retrospectively reviewed. Presence and proper completion of the triage form were appraised. Triage level was abstracted and compared with patient outcome (dichotomized as ''admitted to hospital or died" and ''discharged alive from emergency centre") to quantify over- and under-triage triage. Results: From 251 randomly selected patients, 107 (42.6%) charts were retrieved. From these, only 45/107(42.1%) contained the triage form filled within the chart. None of the triage forms were filled out completely. From 13 (28.9%) admitted or deceased patients, the under-triage rate was 30.7% and from 32(71.1%) patients discharged alive from the EC the over-triage rate was 21.9%. Discussion:The under-triage rate observed in this study exceeds the recommended threshold of 5% and isa serious patient safety concern. However, under-triage may have been magnified by irregularities in the hospital admission process. Haphazard medical record handling, poor documentation, erroneous triage decisions, and poor rapport between nurses and physicians were the main process-related challenges that must be addressed through intensive training and improved human resource management approaches to enhance the quality of triage in the emergency centre

Admission patterns and outcomes in the medical intensive care unit of St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia

Background: Knowledge of the characteristics and outcomes of critically ill patients admitted to Medical Intensive Care Unit (MICU) helps with identification of priorities and the resources required to improve care. The objective of this study was to examine admission patterns and outcomes in MICU at St. Paul's Hospital Millennium Medical College. Materials: A retrospective review of 1256 patients' case notes who were admitted to the MICU at St. Paul's Hospital Millennium Medical College from 2007 to 2012 was carried out. The data was analyzed by SPSS version 18.0 to obtain descriptive and inferential measurements. P values < 0.05 were considered significant for all tests. Results: Among specific diagnoses, diabetic ketoacidosis; 187 (14.9%), was the leading cause of admission, followed by all Strokes; 103 (8.2%), and Unspecified Diseases of Circulatory System; 81 (6.4%). The overall mortality rate was 39 %. Strokes were the leading causes of death, accounting for 12.2% of total deaths. The deceased were older than the survivors by five mean age years, mean age (±SD) 41.9 (± 18.5) and 36.7 (± 17.4) years, respectively.Conclusions: Non- communicable will continue to be increasing proportion of ICU admissions in the study. The mortality in this study is also substantial, and reasons looks like late admissions and limited care in the facility. Improving the ICU infrastructure and staffing with skilled personnel might improve the quality of care

Actors associated with treatment outcome of pediatric cancer patients admitted with febrile neutropenia in Tikuranbessa specialized teaching hospital, Addis Ababa, Ethiopia

Background: Cancer treatment is associated with variable degrees of myelosupression. Infection is often a life-threatening complication of chemotherapy-induced neutropenia, and it is also considered an oncologic emergency. Febrile neutropenia is a common, costly and potentially fatal complication in oncology.Objective: To assess factors affecting treatment outcome of cancer patients with chemotherapy induced febrile neutropenia.Method: We conducted a review of records of pediatric patients hospitalized and treated for chemotherapy-induced febrile neutropenia from January 1, 2013 to December 31, 2013 and met the selection criteria.Result: A total of 60 patients (36 males and 24 females) fulfilled the selection criteria. Twelve of them died while in hospital. The mean (SD) age of patients who died was 4.78 (±2.48) years and the mean (SD) hospital stay before death was 20.2 (±5.26) days. Ten children had hematologic malignancy and two had a solid tumor. Ten of the 12 patients had an absolute neutrophil count of less than 100/mm3 (p=0.008, OR=20.3) and a platelet count of less than 50,000/mm3. Six of the 10 children (10%) had sepsis. Patients with profound neutropenia, platelet count of less than 50,000 and sepsis were more likely to die (P=0.048, OR=7).Conclusion: The result of this study showed that absolute neutrophil count of less than 100/mm3, platelet count of less than 50,000/mm3 and a diagnosis of sepsis were factors affecting outcome patients with febrile neutropenia. Careful evaluation of these factors and assessing severity of patients' clinical condition at time of admission can be useful for triaging children with febrile neutropenia

Profil des patients admis en unité de soins intensifs dans un service de cardiologie de Dakar

Introduction : L'unité de soins intensifs cardiologiques ou USIC est une unité hospitalière de prise en charge intensive des urgences cardio-vasculaires. Notre objectif était de déterminer les principaux motifs d'admission dans une USIC de Dakar, d'apprécier l'évolution des patients et d'identifier les facteurs pronostiques.Méthodologie :C'est une étude transversale descriptive incluant tous les patients admis en USIC à la clinique cardiologique du centre hospitalier universitaire Aristide Le Dantec de Mars à Octobre 2014.Résultats : Au total, 128 sujets ont été inclus. L'âge moyen était de 59,4 ans avec une prédominance masculine. Les patients étaient souvent adressés de la consultation externe du service (40,60%). Les motifs d'admission étaient dominés par les syndromes coronariens aigus (21,9%), les blocs auriculo-ventriculaires complets (19,5%) et l'insuffisance circulatoire aiguë (13,3%). La durée d'hospitalisation moyenne était de 4±3 jours. L'évolution était favorable chez 75% des patients, émaillée de complications dans 6,2 % des cas. Les complications étaient à type d'insuffisance circulatoire aiguë, de déplacement de sonde et d'infections. La mortalité hospitalière était de 18,8%. Les principaux facteurs pronostiques étaient les dysfonctions systoliques des ventricules droit (p=0,022) et gauche (p=0,019), l'insuffisance circulatoire aiguë septique (p=0,001) ainsi que l'anémie (p=0,034).Conclusion : Les urgences cardio-vasculaires à Dakar sont variées, dominées par les syndromes coronaires aigus et les troubles de la conduction

High prevalence of atrial fibrillation in stroke patients admitted to university of Gondar hospital, northwest Ethiopia

Purpose : Even though atrial fibrillation is a common risk factor of stroke which contributes to poor outcome, data concerning this association is scarce in African countries. This study assessed the prevalence of confirmed atrial fibrillation and its effect on outcome in stroke patients admitted to University of Gondar Hospital.Methods: A Hospital based cross-sectional study by record analysis was done from December 2014 to February 2015. All adult stroke patients with documented head CT scan and ECG results admitted to university of Gondar hospital during June 2010 to May 2013 were included. Relevant data including sociodemographics, type of stroke, and presence of atrial fibrillation was collected from patient charts using a data extraction form.Results: A total of 94 patients with mean age of 67.4±12.4 years and Female to male ratio of 1.13:1 were analyzed. The prevalence of AF was 28.7%. It occurred in 34% and 14% of ischemic and hemorrhagic strokes respectively. The in hospital case fatality of stroke associated with and without atrial fibrillation was 22.2% and 8% respectively while the rate of improvement at discharge was 34% and 68% respectively. Atrial fibrillation was associated with a low rate of improvement at discharge (OR= 0.28 CI: 0.1-0.78).Conclusion: Atrial fibrillation is common in stroke patients in our hospital, especially in the elderly population. It is associated with low rate of improvement at discharge. Appropriate screening and treatment of atrial fibrillation is invaluable for the primary and secondary prevention of stroke