Effect of implementation of electronic file system and the completeness of clinical evaluation in chronic non-communicable diseases clinic

Objective: To evaluate the effect of implementation of the Electronic File System [EFS] on the completeness of clinical evaluation in the Chronic Non-Communicable Diseases [NCD] Clinic

Design: A Cross-Sectional, Comparative Study

Setting: Health Center, Bahrain

Method: All patients attending NCD clinic before implementation of Electronic File System [EFS] from 15 February to 31 March 2015 were reviewed and considered the first group [156]. All patients attending NCD clinic after the implementation of EFS from 15 May to 30 June 2015 were reviewed and considered the second group [168]. The clinical item evaluations to be completed by the physician were 9 items and by the nurse 30 items for each patient. The total number of clinical evaluation items before EFS multiplied by the number of cases [39 x 156] was 6,084. The total number of clinical evaluation items after EFS multiplied by the number of cases [39 x 168] was 6,552

Results: Three hundred twenty-four patients were included in the study. The patients were divided into two groups, 156 [48.1%] before EFS and 168 [51.9%] after EFS. The completeness of clinical items evaluation improved after the implementation of the EFS from 3,684 [60.5%] to 4,224 [64.5%]. The completeness by the nurse improved significantly after the implementation, from 2,988 [49.1%] to 3,653 [55.8%] and deteriorated by the physician from 696 [11.4%] to 571 [8.7%]

Conclusion: The average completeness of clinical evaluation remains low after the implementation of the EFS. There are several possible causes and further studies are needed to identify the main underlying causes for such low figures in order to plan and implement improvement

Extended-spectrum β-lactamase and AmpC β-lactamase Production among Gram-negative Bacilli Isolates Obtained from Urinary Tract Infections and Wound Infections.

Extended-spectrum β-lactamases (ESBLs) and AmpC β-lactamases continue to be a major problem in healthcare settings. Due to the scarcity of information regarding the antibiotic susceptibility patterns particularly from urinary tract infections (UTIs) and wound infections, the current study was carried out to assist the clinicians to prescribe appropriate antibiotics against gram-negative clinical isolates. In the current study, urine (n = 620) and pus (n = 228) samples were collected from different sites (at various clinical departments) and subjected to direct microscopic examination, culture and antibiotic susceptibility testing (AST). In the AST testings, the isolates that exhibited reduced zone of inhibition to one or more of the antibiotics such as cefotaxime (≤27 mm), ceftriaxone (≤25 mm), ceftazidime (≤22 mm), cefpodoxime (≤17 mm) and aztreonam (≤27 mm) were considered as potential ESBL producers and the ESBL production was confirmed using phenotypic screening test (doubledisk synergy test) and phenotypic confirmatory test (combined-disk test). However, isolates showing resistance or decreased sensitivity to cefoxitin, cefotaxime, ceftriaxone, ceftazidime, cefpodoxime or aztreonam and sensitive to cefepime were considered as a screen positive AmpC producer and subjected to AmpC disk tests. The current study concluded that 72.41% and 21.76% of ESBL and AmpC producers were detected, respectively in our hospital. It was also observed that the double-disk synergy and combined-disk tests were equally effective for ESBL detection. Further, AmpC disk test is simple, easy to perform and interpret, requiring less expertise for the rapid detection of AmpC isolates.

Rhomboid flap in the treatment of pilonidal sinus disease

The aim of our study was to present our experience with the Rhomboid flap technique in the management of pilonidal sinus disease and to evaluate the morbidity and recurrence. Cross-sectional, observational study. This study was conducted in the surgical department of Nishtar Hospital Multan Ward 4 surgical unit 1, October 2011 to March 2012. Eleven patients were included, eight had previous surgical drainage of multiple natal cleft abscesses, and three had acute disease at the time of surgery. Nine patients had complex, recurrent pilonidal sinus. By using the Rhomboid transposition flap, we were able to excise the diseased area and close the defect. Operative time, hospital stay, healing time, wound infection, wound breakdown, return to normal activity and recurrence were assessed. There were 10 males and one female with a median age of 23 years [range 17-32 years]. Mean follow-up was 6 months [range 5-6 months]. Mean operative time was 63.2 minutes [range 55-75 minutes]. Hospital stay was 3.4 days [range 2-5]. Postoperative morbidity involved superficial wound infection in two patients, superficial gangrene of wound edges in one patient and partial wound breakdown in one patient that settled with dressing in the out-patient clinic. All wounds healed and the median healing time was 15 days. There was no recurrence in our series. Median time to return to normal activity was 17.8 [range 10-27] days. Rhomboid flap is a useful technique in the treatment of advanced, difficult cases of pilonidal sinus disease. It has relatively low morbidity, allows early return to full activity and does not necessitate prolonged postoperative care. A larger series and longer follow up time is needed to assess the recurrence rate more adequately

Serious complications among children during shigella dysenteriae serotype 1 [shiga] outbreak

This is a report of the first documented Shigella dysenteriae type 1 outbreak in Aden city, Republic of Yemen. The aim of the study was to examine the clinical manifestations and the outcome of this infection among children admitted to Al-Sadaqa Teaching Hospital, Aden. 368 patients presented with bloody diarrhoea in the period between January and June 1993, compared to 9 patients with similar complaints in the same period of the preceeding year. The outbreak was attributed to the above mentioned microorganism based on the results of stool cultures, the clinical picture and the outcome. Almost half of the patients had moderate to severe dehydration, and 7.3% of the patients developed acute renal failure. Six of these children fulfilled the criteria for haemolytic Uremic Syndrome. Severe malnutrition, rectal prolapse and protracted colitis were found to be persisting complications in about 5% of the patients. The case fatality rate was 12% which may mean that Shigella shiga is fatal in children in places where lack of facilities and malnutrition continue to be common community problems