Incidence of adverse events after discharge from a secondary hospital in northern Ghana

Background: Adverse events involve unintended injuries or complications resulting in death, disability, harm or prolonged hospital stay that arise from health care management. This paper aims at giving insight into the incidence, types and severity of adverse events after hospital discharge in the context of the management/care patients received from the hospital.Methods: A descriptive cohort study design was used in a secondary hospital in Ghana. The study population involved patients discharged from the medical, surgical and emergency wards of the Hospital. A total of 206 patients were recruited through a consecutive sampling technique.Results: The findings revealed an adverse events rate of 25.7%. The study also identified adverse events related to medications to be the leading type of adverse events recorded after discharge from the hospital. There were 3.9% death rate among participants 21 days after discharge from the hospital. The study revealed that adverse events usually occur after discharge from the hospitals which differ in several forms and in severity.Conclusions: These, therefore offer nurses and other service providers an opportunity to target the areas for improvement of services.

Parasitic Profile of Fresh Vegetables Sold in Selected Markets of the Cape Coast Metropolis in Ghana

Background: Vegetable consumption is a major source of vitamins, minerals and dietary fibre for the body. While fresh vegetables play a key role in the prevention of some chronic diseases, cancers, and alleviation of micronutrient deficiencies, some have been associated with foodborne parasitic infections. Objectives: We investigated the parasitic contamination of fresh vegetables sold in three market places in the Cape Coast Metropolis in Ghana. Materials and Methods: In this study conducted over a period of three (3) months, a total of one hundred and twenty-six (126) vegetable samples were obtained from three (3) selected markets in the Metropolis. Six (6) different species of vegetables namely tomato (Solanum lycopersicum), cabbage (Brassica oleracea var capitata), carrot (Daucus carota), lettuce (Lactuca sativa), spring onion (Allium fistulosum) and green pepper (Capsicum annuum) were subjected to parasitological examination for the detection of parasite forms such as larvae, ova and cysts. Results: The overall prevalence of parasitic contamination of vegetables in this study was 52.4%. Five different parasites were detected namely Strongyloides spp, Hookworm, Trichuris trichiura, Ascaris lumbricoides and Entamoeba coli. The prevalence of parasitic contamination was higher in leafy vegetables such as spring onions (90.5%), lettuce (76.2%) and cabbage (66.7%). Multiple parasitic contaminations were a common feature of leafy vegetables than smoothly surfaced ones such as green pepper and tomatoes. Conclusion: The study revealed that most vegetables purchased from the markets in the metropolis were highly contaminated with intestinal parasites. It is therefore recommended that vegetables should be subjected to thorough disinfection processes before being served for food to reduce the transmission of intestinal parasites.

Access to mental health care in El Salvador: a case study of progress toward decentralization / Acceso a la atención de salud mental en El Salvador: un estudio de caso de progreso hacia la descentralización / Acesso à saúde mental em El Salvador: um estudo de caso sobre o progresso em direção à descentralização

ABSTRACT Objective To assess the need for decentralization of psychiatric services in El Salvador, based on country-specific evidence, and to generate baseline measures the government and researchers could use to monitor and measure future progress toward decentralization. Methods Observations were made and psychiatric outpatients and their families/caregivers (n = 453) surveyed with a cross-sectional instrument at the National Psychiatric Hospital (Hospital Nacional General y de Psiquiatría "Dr. José Molina Martínez") in the capital city of San Salvador. Findings were compared with national census data to determine barriers to psychiatric care in a largely centralized system. The following data were collected: department of origin, travel time to hospital, time in hospital, costs, and qualitative comments about accessing services. Descriptive statistics and regression were used to assess the data. Government reports on all psychiatric outpatient consultations provided nationwide in 2015 (n = 61 010) at 10 regional hospitals were also reviewed and compared to population data to determine the proportion of the population of each hospital service area (department or group of departments) that received a psychiatric outpatient consultation. Results Households from the half of the country (7 out of 14 departments) farthest away from the National Psychiatric Hospital (42% of the general population) spent twice as much time and three times as much money to access the hospital's psychiatric outpatient services, resulting in severe hardship on both patients and families/caregivers. Conclusions This report estimates that 45% of those with mental health needs in the seven departments farthest away from the National Psychiatric Hospital departments are still not accessing services compared to the seven departments nearest the hospital. The results of this study support the World Health Organization's call for governments to fully implement community-based mental health systems. This is the first study to assess progress toward decentralization of psychiatric services in El Salvador.

RESUMEN Objetivo Evaluar la necesidad de la descentralización de los servicios psiquiátricos en El Salvador con base en la evidencia específica del país y generar medidas de referencia que podrían ser utilizadas por el gobierno y los investigadores para monitorear y medir el progreso futuro hacia la descentralización. Métodos Se realizaron observaciones, y se encuestaron pacientes psiquiátricos ambulatorios y sus familiares/cuidadores (n = 453) con un instrumento de corte transversal en el Hospital Nacional Psiquiátrico (Hospital Nacional General y de Psiquiatría "Dr. José Molina Martínez") en la capital, San Salvador. Los hallazgos se compararon con los datos del censo nacional para determinar las barreras en el acceso a la atención psiquiátrica en un sistema en gran medida centralizado. Se recopilaron los siguientes datos: departamento de origen, tiempo de viaje al hospital, tiempo en el hospital, costos y comentarios cualitativos sobre el acceso a los servicios. Se usaron estadísticas descriptivas y regresión para evaluar los datos. También se revisaron informes gubernamentales sobre todas las consultas psiquiátricas ambulatorias proporcionados a nivel nacional en 2015 (n = 61 010) en 10 hospitales regionales, y estos se compararon con datos poblacionales para determinar la proporción de la población de cada área de servicio hospitalario (departamento o grupo de departamentos) que efectuó una consulta psiquiátrica ambulatoria. Resultados Los hogares de la mitad del país (7 de los 14 departamentos) más alejados del Hospital Psiquiátrico Nacional (42% de la población general) gastaron el doble de tiempo y tres veces más dinero para acceder a los servicios psiquiátricos ambulatorios del hospital, lo que resultó en dificultades económicas severas tanto para los pacientes como para sus familias/cuidadores. Conclusiones Este informe estimó que el 45% de las personas con necesidades de salud mental en los 7 departamentos más alejados del Hospital Nacional Psiquiátrico aún no tienen acceso a los servicios en comparación con los 7 departamentos más cercanos al hospital. Los resultados de este estudio respaldan el llamado de la Organización Mundial de la Salud para que los gobiernos implementen por completo sistemas de salud mental basados en la comunidad. Este es el primer estudio en evaluar el progreso hacia la descentralización de los servicios psiquiátricos en El Salvador.

RESUMO Objetivo Avaliar a necessidade de descentralização dos serviços psiquiátricos em El Salvador com base em provas específicas do país e gerar medições de referência que poderiam ser usados pelo governo e pesquisadores para monitorar e medir o progresso futuro no sentido da descentralização. Métodos Observações foram feitas, e foram pesquisados pacientes psiquiátricos ambulatoriais e suas famílias/cuidadores (n = 453) com uma ferramentas de seção transversal no Hospital Psiquiátrico Nacional (National Hospital Geral e Psiquiatria "Dr. Jose Molina Martinez") na capital, São Salvador. Os resultados foram comparados com dados do censo nacional para determinar as barreiras ao acesso à assistência psiquiátrica em um sistema amplamente centralizado. Os seguintes dados foram coletados: departamento de origem, tempo de deslocamento para o hospital, tempo no hospital, custos e comentários qualitativos sobre o acesso aos serviços. Para avaliar os dados foram utilizadas estatística descritiva e regressão. Também foram analisados relatórios do governo sobre todas as consultas psiquiátricas ambulatoriais a nível nacional em 2015 (n = 61 010) em 10 hospitais regionais, e comparados com os dados da população para determinar a proporção da população de cada área de serviço hospitalar (departamento ou grupo de departamentos) que recebeu uma consulta psiquiátrica para pacientes ambulatoriais. Resultados As pessoas da metade do país (7 dos 14 departamentos) mais afastada do Hospital Psiquiátrico Nacional (42% da população geral) gastaram o dobro do tempo e três vezes mais dinheiro para acessar os serviços psiquiátricos ambulatoriais do hospital, o que resultou em privação severa para pacientes e familiares/cuidadores. Conclusões Este relatório estimou que 45% das pessoas com necessidades de saúde mental nos 7 departamentos mais distantes do Hospital Psiquiátrico Nacional ainda não têm acesso aos serviços em comparação com os 7 departamentos mais próximos do hospital. Os resultados deste estudo apoiam o apelo da Organização Mundial de Saúde para que os governos implementem totalmente os sistemas de saúde mental baseados na comunidade. Este é o primeiro estudo a avaliar o progresso em direção à descentralização dos serviços psiquiátricos em El Salvador.

Presentación de un protocolo efectivo para el tratamiento de la miodermonecrólisis por loxoscelismo cutáneo / Presentation of an eff ective protocol for the treatment of miodermonecrolisis by cutaneous loxoscelism

Las lesiones por mordedura de arácnidos del género Loxosceles producen lesiones locales y presentan pérdida de tejidos, con necrosis extensas que requieren cirugía reparadora. En algunos casos se observan lesiones sistémicas graves como hemólisis, coagulación intravascular diseminada e insufi ciencia renal aguda, que pueden desencadenar coma y muerte. Se aplicó un protocolo sistematizado basado en fasciotomías descompresivas, necrosectomías y posteriores coberturas con colgajos e injertos a pacientes que ingresaron con lesiones de aspecto necróticas con antecedente de contacto con arácnidos del género Loxosceles y clínica de miodermonecrólisis. Los casos tratados, evolucionaron favorablemente, con secuelas variables y sin comorbilidades importantes. Se presenta un modelo de protocolo actualizado, que permite efectivizar el tratamiento

The lesions for the arachnid's bite of the genus Loxosceles produce local lesions and present tissue loss whit extensive necrosis and required restorative surgery. In some cases, presents severe systemic lesions such as hemolysis, disseminated intravascular coagulation and acute renal failure can develop coma and death. Patients admitted with necrotic lesions with antecedent of contact with arachnids of the genus Loxosceles and clinic of miodermoncrelisis. A systematized protocol was applied based on decompressive fasciotomies, necrosectomies and posterior fl ap and graft coverage. The treated cases evolved favorably, without major comorbidities. An updated protocol model is presented, which allows eff ective treatment

Helminth parasites of Phyllodactylidae and Gekkonidae lizards in a Caatinga ecological station, northeastern Brazil / Helmintos parasitas de lagartos Phyllodactylidae e Gekkonidae em estação ecológica na Caatinga, nordeste do Brasil

Abstract We investigated the parasites of five lizard species belonging to Phyllodactylidae (Phyllopezus pollicaris and Gymnodactylus geckoides) and Gekkonidae (Hemidactylus agrius, Lygodactylus klugei and Hemidactylus brasilianus) families in a semiarid region of Brazil. Six nematode species were identified: Parapharyngodon alvarengai and Spauligodon oxkutzcabiensis (Pharyngodonidae), Physaloptera lutzi (Physalopteridae), Skrjabinelazia intermedia (Seuratidae), Trichospirura sp. (Rhabdochonidae) and Piratuba sp. (Onchocercidae), and a cestode species, Oochoristica sp. (Linstowiidae). The most prevalent species were Spauligodon oxkutzcabiensis, which infected P. pollicaris (75%), and Parapharyngodon alvarengai, which infected G. geckoides (29%). South American lizards were identified as being new hosts for the Trichospirura genus (a usual parasite of mammals), and there were 16 new occurrences of parasite species in the five lizard species studied herein.

Resumo Nós investigamos os parasitas de cinco espécies de lagartos pertencentes às famílias Phyllodactylidae (Phyllopezus pollicaris e Gymnodactylus geckoides) e Gekkonidae (Hemidactylus agrius, Lygodactylus klugei e Hemidactylus brasilianus) em região semiárida do Brasil. Seis espécies de nematoides foram encontrados: Parapharyngodon alvarengai e Spauligodon oxkutzcabiensis (Pharyngodonidae), Physaloptera lutzi (Physalopteridae), Skrjabinelazia intermedia (Seuratidae), Trichospirura sp. (Rhabdochonidae), Piratuba sp. (Onchocercidae) e uma espécie de cestódeo, Oochoristica sp. (Linstowiidae). As espécies de maiores prevalências foram S. oxkutzcabiensis, a qual infectou P. pollicaris (75%) e P. alvarengai a qual infectou G. geckoides (29.%). Nós documentamos novo registro de hospedeiro para lagartos na América do Sul pertencente ao gênero Trichospirura, o qual é comum em mamíferos, e 16 novas ocorrências de espécies parasitas nas cinco espécies de lagartos aqui estudadas.

Causes of blindness and severe visual impairment among children enrolled in an early intervention and preschool program of a school for the blind in the Philippines

@#<p style="text-align: justify;"><strong>OBJECTIVE:</strong> To identify the avoidable causes of childhood blindness and visual impairment in a school of the blind in the Philippines.</p> <p style="text-align: justify;"><strong>METHODS:</strong> The medical records of students enrolled at the Resources for the Blind early intervention and preschool program from 1999 to 2012 were reviewed. Demographic characteristics and causes of visual disability were abstracted and tabulated.</p> <p style="text-align: justify;"><strong>RESULTS:</strong> A total of 90 records were included in the study. Eighty six (76.7%) had visual acuity classified as blind (<20/400) or severe visual impairment (<20/200 - 20/400, 18.9%). Majority (69.8%) were below 6 years of age and most (44.2%) were below 1 year. Retinopathy of prematurity was the most common cause (47.7%), followed by retinablastoma (11.6%). Perinatal factors accounted for most of the etiologic causes (58.1%) of visual loss.</p> <p style="text-align: justify;"><strong>CONCLUSION:</strong> More than half of the causes of severe visual impairment and blindness were potentially avoidable, with retinopathy of prematurity as the leading etiology.</p>

Seroprevalence of Syphilis Infection in Individuals at Cape Coast Metropolis, Ghana.

Background: Syphilis is a sexually transmitted infection caused by Treponema pallidum. The disease becomes very common among individuals with multiple sexual partners without protection. Aim: This research aimed at assessing the prevalence of syphilis infection in Cape Coast Metropolis and the factors associated with the transmission of the disease Methodology: 200 participants from Cape Coast were sampled and assessed for syphilis infection using Venereal Disease Research Laboratory syphilis test strips (a nontreponemal test) and positive samples were confirmed with Treponema palladium haemagglutination (TPHA) test. Questionnaires, reflecting the participant’s sociodemographic data were also administered. The results were analysed, to assess the relationship between various risk factors and syphilis infection. Results: The prevalence of syphilis infection in Cape Coast was found to be 8.5%, mainly associated with participants having multiple sexual partners and having unprotected and indiscriminate sex. Other factors found to be indirectly affecting the rate of infection were illiteracy, lack of knowledge and information concerning the disease. Conclusion: The seroprevalence of syphilis infection in the Cape Coast Metropolis is an indication that the disease is endemic.

Phototoxic and modulatory effects of natural products from the skin of Rhinella jimi (Stevaux, 2002)

The skin of amphibians possesses a large diversity of biologically active compounds that are associated with the natural defenses of these animals against pathogens. Five different extracts and fractions were obtained from the skin of Rhinella jimi: methanol extract (ME), methanol fractions (MF), chloroform extract of methanol extract (CF), aqueous alkaloid fraction (AAF) and aqueous non-alkaloid fraction (ANAF). All fractions were evaluated with respect to their antibiotic modifying activity in standard bacterial strains and multiresistant clinical isolates. Antagonism was detected with kanamycin and gentamicin when combined with substances obtained from the skin of R. jimi. Phototoxic activity was observed in the methanol and chlorophorm fractions, as well as the aqueous non-alkaloid fraction. The antagonistic action was apparently associated with the protection afforded by the bacterial populations that inhabit the skin of this amphibian, preventing colonization by pathogenic fungi. The phototoxic activity demonstrated by natural products from the skin of R. jimi showed an interruption of the bacterial growth after UV exposure. This could indicate an antibacterial effect activated by the UV light, opening a path for carrying the attack by pathogenic fungi, causing the disease related with the amphibian decline.

Potentiation of aminoglycoside antibiotic activity using the body fat from the snake Boa constrictor

Boa constrictor is widely used in traditional communities in many different folk remedies and products derived from it are sold in public markets throughout northeastern Brazil and as its body fat has many different therapeutic indications as a folk remedy. The present work evaluates the antibacterial activity of the body fat from the snake Boa constrictor when employed either alone or in combination with antibiotics and discusses the ecological implications of the use of this traditional remedy. Oil (OBC) was extracted from body fat located in the ventral region of B. constrictor using hexane as a solvent. The antibacterial activity of OBC was tested against standard as well as multi-resistant lines, either alone and in combination with antibiotics. OBC did not demonstrate any relevant antibacterial activity against standard or multidrug-resistant bacterial strains. OBC showed synergistic activity when combined with the aminoglycoside antibiotics. Our results indicate that the body fat of Boa constrictor does not possess bactericidal activity, from the clinical point of view, but when combined with an antibiotic, the fat demonstrated a significant synergistic activity.

Absence of inferior pancreaticoduodenal artery compensated by dorsal pancreatic artery: a case report.

Consideration of new aspects of vascular anatomy of the pancreaticoduodenal region is required for further improvement of surgical procedures. Awareness of variations in arteries supplying the duodenum and pancreas can help in minimizing the blood loss during surgery. We report the absence of inferior pancreaticoduodenal artery, which was compensated by a large dorsal pancreatic artery arising from proximal part of the splenic artery. This artery replaced inferior pancreaticoduodenal artery and formed a large loop of anastomosis with the gastroduodenal artery.

Resultados atuais da cirurgia coronária em pacientes de alto risco / Current results of coronary surgery in high risk patients

No período e 4 anos (1984 a 1987), 427 pacientes (313 homens e 114 mulheres, idade média 61,83 anos) foram submetidos a cirúrgia coronária de emergência. A indicaçäo para cirurgia foi angina instável, que requeria uso intravenoso de nitroglicerina. Quanto à classe funcional, 369 (86,41%) pacientes estavam em classe IV e 51,95% estavam em grau funcional III ou IV de ventrículo esquerdo, pelo estudo hemodinâmico e 30,44% tinham lesöes de tronco. Foram realizadas 2,99 pontes/pacientes. A mortalidade total foi de 7,72% e 17,09% tiveram síndrome de baixo débito; déficit neurológico ocorreu em 2,85% e infarto do miocárdio, em 16,86% dos casos. Durante o mesmo período, 30 pacientes (16 do sexo masculino e 14 do feminino) com idade média de 64,03 anos, com angina instável e em choque cardiogênico, foram submetidos a revascularizaçäo de emergência. Quanto à classe funcional, 86,66% estavam em classe IV, 13,33% em classe III e 56,66% estavam em grau funcional IV de ventrículo esquerdo e 13,33% em grau III; 40% dos pacientes tinham lesäo de tronco. O número médio de pontes foi de 2,76 pontes/pacientes. A mortalidade foi de 60%; déficit neurológico ocorreu em 16,66% e 43,33% sofreram infarto do miocárido. Em conclusäo, a mortalidade e a morbidade, para pacientes submetidos a cirurgia de revascularizaçäo, permanecem elevadas, principalmente, em pacientes com choque cardiogênico. Portanto, mais estudo futuros säo requeridos em relaçäo à proteçäo miocárdica, para melhores resultados