Critical Illness-Related Corticosteroid Insufficiency (CIRCI) among patients with refractory shock at a tertiary hospital: A look into clinical practices and patient outcomes

@#<p style="text-align: justify;"><strong>Introduction.</strong> A significant number of critically ill patients, as high as 60% among patients with septic shock, suffer from critical illness-related corticosteroid insufficiency (CIRCI), which refers to an inadequate corticosteroid response to the level of stress.</p><p style="text-align: justify;"><strong>Objectives.</strong> This study aimed to determine the strategies employed in managing patients with critical illness-related corticosteroid insufficiency and the outcomes of these patients at a tertiary hospital.</p><p style="text-align: justify;"><strong>Methods.</strong> This was a single-center, mixed-methods study which consisted of a review of charts of patients 19 years old and above admitted for shock or developed refractory hypotension from January 2017-December 2019, and key informant interviews and focus group discussion among clinicians who have experience in managing CIRCI.</p><p style="text-align: justify;"><strong>Results.</strong> A total number of 362 patient charts reviewed showed a relatively low rate of initiation of corticosteroids for patients with refractory shock, at just 28.57% of the entire population. After corticosteroids were initiated, patients were in shock for a median of just one day and the median blood pressure improved to 100/60 mm Hg. In this cohort, patients who were started on steroids had more severe illness, as measured by the Mortality Probability Model (MPM) score, which had a median of 43.65% for the group on steroids and just 25.0% for the non-steroid group (p ? 0.0001). Patients who were started on steroids had a statistically significant longer median days on a ventilator, 5 days vs. 3 days for the non-steroid group (p = 0.0297); longer median length of intensive care unit (ICU) stay, 8 days vs. 5 days for the non-steroid group (p = 0.0410), and a higher morbidity and mortality rate. The need for steroids, the presence of septic shock, and a higher MPM score were significant predictors of mortality.</p><p style="text-align: justify;">Discussions among clinicians revealed significant variability in practices in the management of CIRCI.</p><p style="text-align: justify;"><strong>Conclusion.</strong> The presence of clinical features of CIRCI is a poor prognostic factor. Timely recognition, work-up, and interventions to address CIRCI are paramount in critical care.</p>

Human bites as a weapon of violence: how common are they and do they constitute a significant medical evidence?

Objective: To document the pattern of HBM seen in police clinic Benin City Nigeria.Methods: This is a review of all the human bite mark (HBM) seen at the police clinic.Results: HBM were seen in 68 cases of assault and included 90 separate bites. The youngest victim was 10 years old while the oldest was 59 years with a mean age of 31.9±9.68. Age group 30-39 years accounted for most cases. Female victims were more in number both as victims and as assailants. About 94.1% of theassailants were known. The major events that lead to the use of human bite (HB) were quarrel and fights which accounted for 98.5% of cases. HB was mainly used in conjunction with other weapons. About 77.9%of the HB had single bite marks while complete tissue avulsion were seen in 1.5% of cases. The arm was the commonest site (17.8%), closely followed by the fingers (15.6%).Conclusion: This will serve as a baseline data in Nigeria, while we strongly advocate the development of a proforma for HBM examination following ABFO guideline and HIV PEP for victims with grade 4 HBM andabove

Prevention of contrast-induced nephropathy by Cordyceps among patients undergoing percutaneous coronary procedures using intravenous contrast

@#<p style="text-align: justify;"><strong>OBJECTIVES:</strong> This study aimed to determine the efficacy and safety of Cordyceps in preventing occurrence of contrast-induced nephropathy (CIN) among patients undergoing CA / PCI using IV contrast compared to standard therapy.</p><p style="text-align: justify;"><strong>METHODS:</strong> We searched Medline, Embase, Cochrane database, and Google Scholars for RCTs involving the use of Cordyceps in contrast-induced nephropathy. We used the search keywords "Cordyceps" and "contrast-induced nephropathy" with the Boolean operator "AND" and filtering search results to include only randomized controlled trials and clinical trials. Three trials were found which satisfied all the inclusion criteria and none of the exclusion criteria.</p><p style="text-align: justify;"><strong>RESULTS:</strong> No patient developed clinical renal failure, adverse reactions, or side effects with the Cordyceps arm. CIN occurred in 26 out of 285 patients. The incidence of CIN was less in the Cordyceps group compared to the standard therapy group (p < 0.05, CI 0.20, 1.00).</p><p style="text-align: justify;"><strong>CONCLUSION:</strong> Cordyceps shows a trend towards prevention of CIN and a decrease in biomarkers for acute kidney injury. More studies with larger populations need to be performed to further clarify its preventive effects.</p>

A qualitative study of causes of prescribing errors among junior medical doctors in a Nigeria in-patient setting

Aims: The aims of this study were to identify and understand the factors underlying prescribing errors in order to determine how to prevent them. Materials and Methods: A prospective qualitative study that involved face-to-face interviews and human factor analysis in a Tertiary Referral Hospital in Central Nigeria; from July 2011 to December 2011. Pharmacists in the study hospital prospectively reviewed prescription orders generated by doctors in selected wards (male and female medical; pediatric and the private wing wards) and identified prescribing errors. The 22 prescribers involved in the errors were interviewed; and given questionnaires to discover factors causing the errors. A model of human error theory was used to analyze the responses. Results: Responses from the doctors suggest that most errors were made because of slips in attention. Lack of drug knowledge was not the single causative factor in any incident. Risk factors identified included individual; team; environment; and task factors. Junior doctors were affected by the prescribing habits of their seniors. Organizational factors identified included inadequate training/experience; absence of reference materials and absence of self-awareness of errors. Defenses against error such as other clinicians and guidelines were absent or deficient; and supervision was inadequate. Conclusions: To reduce the risk of prescribing errors; a number of strategies addressing individual; task; team; and environmental factors such as training of junior doctors; enforcing good practice in prescription writing; supervision; and reviewing the workload of junior doctors must be established. Aims: The aims of this study were to identify and understand the factors underlying prescribing errors in order to determine how to prevent them. Materials and Methods: A prospective qualitative study that involved face-to-face interviews and human factor analysis in a Tertiary Referral Hospital in Central Nigeria; from July 2011 to December 2011. Pharmacists in the study hospital prospectively reviewed prescription orders generated by doctors in selected wards (male and female medical; pediatric and the private wing wards) and identified prescribing errors. The 22 prescribers involved in the errors were interviewed; and given questionnaires to discover factors causing the errors. A model of human error theory was used to analyze the responses. Results: Responses from the doctors suggest that most errors were made because of slips in attention. Lack of drug knowledge was not the single causative factor in any incident. Risk factors identified included individual; team; environment; and task factors. Junior doctors were affected by the prescribing habits of their seniors. Organizational factors identified included inadequate training/experience; absence of reference materials and absence of self-awareness of errors. Defenses against error such as other clinicians and guidelines were absent or deficient; and supervision was inadequate. Conclusions: To reduce the risk of prescribing errors; a number of strategies addressing individual; task; team; and environmental factors such as training of junior doctors; enforcing good practice in prescription writing; supervision; and reviewing the workload of junior doctors must be established

Peak expiratory flow rate variability in apparently healthy school children aged 10-15 years in Oredo, Nigeria

To study the peak expiratory flow rate variability [PEFRVar] in apparently healthy school children in Oredo, Nigeria. We carried out a cross-sectional study of 438 subjects [10-15 years], attending the public junior secondary schools, between March and November 2005. The study took place in the Oredo Local Government Area. The age and anthropometry were taken and PEFRVar was determined using values obtained at 6 AM, 2 PM, and 10 PM over a 14-day period, using a mini-Wright peak expiratory flow meter. Peak expiratory flow rate variability [mean +/- SD] was 4.5 +/- 1.3% for all subjects [4.4 +/- 1.0% for males, and 4.6 +/- 1.6% for females]. Females had higher PEFRVar. The upper limits of 95% CI were 7.1% for all subjects [6.4% for males, and 7.8% for females]. The PEFRVar showed an inverse relationship with height, age, and weight. Regression equations for PEFR and PEFRVar were derived for age, height, and weight. Based on upper limit of 95% CI for all subjects, a PEFRVar cut-off of 7.1% is recommended for diagnosis of significant airway obstruction as in asthma in the age bracket under review in Oredo and perhaps other areas, sharing similar geo-physical and social characteristics

Patients' response to waiting time in an out-patient pharmacy in Nigeria

PURPOSE : To identify the dispensing procedure at a pharmacy; investigate the possible operational problems that may lead to excessive patient waiting times as prescriptions are filled and to examine patient disposition to perceived delays at the pharmacy. METHODS : The study was carried out in a 574-bed university teaching hospital in Ile - Ife; Nigeria. The subjects were out-patients who gave their consent to participate in the study. Data were collected using the techniques of workflow analysis and time study in observing the dispensing process. A validated questionnaire was administered on the out-patients to measure their responses to waiting in the pharmacy as well as their level of satisfaction with pharmaceutical services rendered. RESULTS: The workflow analysis revealed considerable delay in the dispensing procedure as a result of extended process components. The total waiting time for a dispensing process averaged 17.09 min; and 89.5 percent of this was due to delay components. Specifically; the major delay components included patient queues for billing prescription sheets and subsequent payment to the cashier. Operational problems identified included patients' indirect access to dispensing pharmacist and the tortuous procedure for prescription billing and payments. Generally; patients were not satisfied with undue delay caused by the dispensing procedure at the pharmacy. CONCLUSION: Most of the patient waiting time in the hospital studied can be accounted for by delay components of the dispensing procedure. Attempts should therefore be made to reduce the time on these components of the dispensing process so that more time could be devoted to counseling while reducing the total time spent by the patient in having their prescriptions sheets filled

Diagnóstico microbiológico de las uretritis en el hombre y evaluación de tres esquemas de tratamiento de la uretritis por U. urealyticum / Microbiological diagnosis of urethritis in male and evaluation of 3 treatment schemes of urthritis due to U. urealyticum

Se realizó estudio microbiológico de raspado uretral de 142 pacientes de sexo masculino que consultaron al policlínico de Venéreas del Hospital Base de Valdivia durante 1989, los cuales fueron enviados al Instituto de Microbiología Clínica de la Universidad Austral de Chile con diagnóstico clínico de uretritis. La prevalencia de Uretritis Gonocócicas (UG) y Uretritis no Gonocócica (UNG) fue de un 50 por ciento para ambos tipos. U. urealyticum fue aislado en el 38 por ciento de los casos de UG y en el 59.2 por ciento de las UNG. Además se evaluó la efectividad del tratamiento de las uretritis por U. urealyticum con tetraciclina en base a tres esquemas: 2g/día durante 7 días, 2 g/día durante 14 días y 2 g/dia durante 21 días. Por este motivo, se seleccionaron 59 pacientes con uretritis por U. urealyticum, obteniéndose un 57,6 por ciento de éxito en el total de los pacientes estudiados. La mayor efectividad en el tratamiento fue para el esquema de 21 días (77.8 por ciento) además a medida que aumentó la edad de los pacientes la efectividad fue disminuyendo y cuando U. urealyticum se encontró asociado a otros microorganismos se obtuvo un mayor éxito en los tratamientos