Illness and Treatment Perceptions of Patients with Epilepsy Attending Treatment at a Tertiary Hospital in Addis Ababa - A Qualitative Exploration.

BACKGROUND: Epilepsy can be a large economic burden in countries where appropriate treatment is not taken due to religious and psychosocial beliefs. The objective of this study was to explore the perceptions and experiences of patients with epilepsy attending their treatment at Tikur Anbessa Specialized Hospital about their illness and treatment. METHODS: A qualitative exploratory design with an in-depth interview was followed. Fourteen purposively selected patients were used until saturation of key emerging themes was achieved. RESULTS: The finding showed that study participants expressed perceptions towards their illness including about its cause, timeline, severity and psychosocial consequences which at times may be considered different from the biomedical version. They also expressed concerns about their treatment, reported about social and psychological issues and in certain cases dissatisfaction with their healthcare providers. Such issues may have led to delays in treatment-seeking and non-adherence to recommended treatment regimens and as well use of traditional medicine and spiritual healing. On the other hand, reasons that were reported to positively influence their treatment experiences include necessity perceptions about their medications, family support and use of spiritual healing alongside their biomedical treatment. CONCLUSION: The healthcare provision should improve to cater to these groups of patients including instituting chronic care management and appropriate health education provision.

[Emergency management of regular supraventricular tachycardias]. / Notfallmanagement supraventrikulärer regelmäßiger Tachykardien.

With an estimated incidence of approximated 36 per 100,000 persons per year, paroxysmal supraventricular tachycardias form a relevant clinical set of problems. They occur based on different substrates with varied symptoms and electrocardiographic items. The 12-channel ECG depicts the background to determine the underlying pathomechanism. The sinus node and all components of the conduction system such as atrial myocardium can be involved. Vagal maneuvers, several pharmacological strategies and various ablation technology are available for acute therapy.

Barriers and facilitators to adherence to anti-diabetic medications: Ethiopian patients' perspectives.

BACKGROUND: Little is known about the experiences of Ethiopian patients with type 2 diabetes related to adherence to their anti-diabetic medications. This may limit attempts to develop and implement patient-centred approaches that consider Ethiopian contexts. OBJECTIVES: To conduct an exploratory study with a focus on identifying barriers and facilitators to anti-diabetic medications adherence in Ethiopian patients with type 2 diabetes. METHODS: Qualitative methods were used to conduct semi-structured interviews with 39 purposively selected participants attending clinic in three public hospitals in central Ethiopia. Open coding was used to analyse the data to identify key themes. RESULTS: A number of factors were identified as barriers and facilitators to participants' adherence to their anti-diabetic medications. The most common factors were perceptions related to their illness including symptoms, consequences and curability; perceptions of medications including safety concerns, convenience and their necessity; religious healing practices and beliefs; perceptions about and experiences with their healthcare providers and the healthcare system including the availability of medications and diabetes education; and finally perceived self-efficacy and social support. CONCLUSIONS: The findings of this study provide guidance to strengthen diabetes education programmes so that they reflect local patient contexts focusing among other things on the illness itself and the anti-diabetic medications.

Explanatory models of adult patients with type 2 diabetes mellitus from urban centers of central Ethiopia.

BACKGROUND: Type 2 diabetes, which is increasing as a public health problem in the low resource settings of Africa has been associated with the high prevalence of micro-vascular complications and increasing levels of macro-vascular complications. There is evidence from the developed world that understanding patient perceptions of chronic illness is important to design effective strategies for helping patients manage these conditions. This study utilized Kleinman's model to explore the illness perceptions of type 2 diabetes patients attending treatment in Addis Ababa and Butajira (Ethiopia) and better understand how they manage their illness. DESIGN: Qualitative interviews were conducted to elicit the explanatory models of purposively sampled type 2 diabetes patients attending treatment in three hospitals in central Ethiopia until saturation of key emerging themes was achieved. Analysis of interview transcripts was guided by Kleinman's model. RESULTS: A total of 39 participants, 24 from Addis Ababa and the rest from Butajira took part in the study. This study revealed that patients' explanatory models were informed by both the traditional and biomedical models with emotional distress evident in some of the participants. The traditional model seemed to reflect the strong religious and cultural influences for the majority of study participants. The findings also revealed that symptoms played significant roles in how patients viewed their illness including assessment of its severity. Most were uncertain about the cause of their illness, with those expressing certainty citing factors over which they believed they had little or no control. This may have contributed to the perceptions about the use of religious healing and traditional medicines in a complementary or alternative manner to the biomedical regimen which could affect their adherence to recommended regimens and their health outcomes. CONCLUSION: This study suggests the need for a strong diabetes care program that is sensitive to patients' experiences of their illness including emotional distress. Individuals providing the diabetes care should consider local and individual contexts and strive to make their approach patient-centered and engage active participation of patients. There appears to be a need for better training of health providers in different areas including health communications and the fundamentals of mental healthcare.

Percutaneous endovascular thrombosuction for acute lower limb ischemia: a 5-year single center experience.

AIM: The aim of this paper was to report a 5-year single center experience with the use of percutaneous endovascular thrombosuction (PET) for acute lower limb ischemia (ALLI). METHODS: All patients that underwent PET for ALLI within the period January 2009-December 2013 in our institution were included. Data were collected retrospectively. RESULTS: A total of 262 patients (132 female, mean age 74.5±11 years) were treated. Level of severity of ALLI preoperatively was stratified as class I (viable) in 76% (199/262) of patients, class IIa (threatened marginally) in 19.4% (51/262), and class IIb (threatened immediately) in 4.6% (12/262). Initial technical success was 91% (237/262). Additional PTA was performed in 29.8% (78/262) of patients, and PTA with stenting in 27.5% (72/262). Open surgery due to technical failure of PET was required in 4.2% (11/262) of patients. Thirty-day mortality was 4.6% (12/262). Perioperative complications occurred in 9.2% (24/262). Thirty-day amputation rate was 3.8% (10/262). The mean duration of follow-up was 26.2±16 months. Estimated cumulative survival was 84.2±2.5% at 1 year, and 73.7±3.6% at 3 years. Estimated freedom from amputation during follow-up was 92.4±1.8% at 1 year, and 91.2±2% at 3 years. Estimated freedom from reintervention was 90.4±2% at 1 year, and 80±3.7% at 3 years. CONCLUSION: PET in selected patients with ALLI provides high initial technical success, low mortality and morbidity rates, and favorable early and mid-term limb salvage rates.

IABP before cardiac surgery: clinical benefit compared to intraoperative implantation.

BACKGROUND: The aim of this study was to determine whether preoperative compared to intraoperative intra-aortic balloon counterpulsation (IABP) is advantageous regarding 30-day and 2-year survival in high-risk patients (acute myocardial infarction, severely impaired left ventricular ejection fraction (LVEF), low output syndrome) undergoing coronary surgery. METHODS: In the years 2004 to 2008, 156 consecutive patients undergoing coronary surgery with IABP support (119 preoperative, 37 intraoperative IABP) were observed. Applying Fisher's exact test, as well as Wilcoxon and median tests, possible group differences were evaluated. After univariate analysis, models of logistic regression and Cox-regression were built. RESULTS: Preoperative hemodynamic state and risk profile of the two patient groups were comparable: patients with preoperative IABP showed a similar level of urgency (21.9% vs. 18.9% emergencies), cardiogenic shock (8.4% vs. 10.8%), inotropes (8.4% vs. 8.1%), impaired LVEF (30.3% vs. 29.7%) and ventilation (5.9% vs. 5.4%) compared to patients with intraoperative IABP. Nevertheless, patients with intraoperative IABP demonstrated a significantly higher 30-day mortality rate (37.8% vs. 5.9%) and 2-year mortality rate (54.0% vs. 18.1%) compared to patients with preoperative IABP. Logistic regression revealed that patients with intraoperative IABP have a 16-times higher 30-day mortality rate after coronary surgery (OR: 16.386, 95% CI: 4.858-55.266) than patients with preoperative IABP. Two-year mortality (OR: 9.317, 95% CI: 3.430 to 25.311) and survival time were significantly better in patients with preoperative IABP therapy. CONCLUSION: Considering the significant benefit for patients with preoperative compared to intraoperative IABP and the absence of vascular problems after IABP insertion, the results of this study indicate a more liberal indication for IABP in high-risk patients before coronary bypass surgery.

Do induced tachycardias within the scope of electrophysiological studies lead to elevated plasma troponin I levels?

AIMS: Troponin I (TNI) is an established marker for the diagnosis of acute coronary syndrome (ACS). The study evaluated if (induced) tachycardiac arrhyhthmias within the scope of the electrophysiological studies (EPS) led to elevation of TNI serum levels. METHOD: TNI was measured in the serum of 28 patients before and after the EPS. The left ventricular ejection fraction (LV-EF) was investigated by two-dimensional echocardiography. Left ventricle hypertrophy (LVH) was measured according to the recommendations of the American Society of Echocardiography. All patients underwent coronary angiography prior to the EPS, and significant coronary heart disease was defined as stenosis > 50%. The EPS revealed supraventricular and ventricular tachycardias using the 18-step protocol with one, two, and three extrastimuli. RESULTS: Indications for the EPS were syncope (n = 15), atrioventricular tachycardia (n = 4), non-sustained VT (n = 6), and sustained VT (n = 3). Coronary heart disease (CHD) was detected in 8 patients (1-vessel: n = 3; 2-vessel: n = 4; 3-vessel: n = 1), and 2 patients underwent percutaneous coronary intervention before EPS. Echocardiography revealed normal LV-EF in 18 patients and a reduction in the others (low n = 3, middle n = 5, high n = 2). Thirteen patients suffered from LVH. In 2 patients, external cardioversion was required during the EPS. TNI was elevated over 0.1 ng/ml (risk stratification cut-off for ACS) in 4 patients before and in 12 patients after EPS. There was no relationship between LV-EF, CHD, and the elevation of TNI after the EPS. CONCLUSION: TNI can be elevated by (induced) tachycardias within the scope of electrophysiological studies without a relationship to LV-EF, LVH, and CHD.

Do endoscopy capsules interfere with implantable cardioverter-defibrillators?

BACKGROUND AND STUDY AIMS: Capsule endoscopy is already an established diagnostic tool, and the newly introduced capsule PillCam COLON is now entering clinical studies. Because of the very limited clinical experience in patients with implantable cardioverter-defibrillators (ICDs), it is generally recommended that capsule endoscopy should not be used in these patients. Therefore, we investigated, in vitro, the possible interference between three different endoscopy capsules (Given Imaging and Olympus) and ICDs. MATERIALS AND METHODS: A total of 45 ICD devices were separately placed in a tank filled with a 0.9 % saline solution. With the help of pin jacks, the pacing pulses of ICDs were recorded and inhibiting signals could be coupled in. The capsules were placed in different positions near to the lead and the ICD device, and finally placed on the case of the device for 1 minute each. The function of each device was observed continuously. RESULTS: Even when the capsules were in closest proximity to the ICDs, no interference was observed. CONCLUSION: The clinical use of the three tested capsule devices is safe in patients with ICDs.

Capsule endoscopy and cardiac pacemakers: investigation for possible interference.

BACKGROUND AND STUDY AIMS: The diagnostic benefit of capsule endoscopy in suspected small-bowel disease is high and seems to be superior to that with conventional methods and scintigraphy. Because of the limited clinical experience in patients with cardiac pacemakers and other implanted electrical devices, it is recommended that capsule endoscopy should not be used in such cases. We investigated the potential for capsule endoscopy to interfere with cardiac pacemakers in vitro. MATERIAL AND METHODS: 21 different pacemakers and leads were positioned in a 0.9 % saline solution in a tank. Pin jacks were placed that were in contact with the solution. The pacemaker impulse was recorded and an inhibiting signal could be coupled in. The capsules (Given Imaging and Olympus) were placed in different positions relative to the cardiac pacemaker and finally placed on the case of the pacemaker, for 1 minute in each site. The functioning of the pacemaker was observed continuously. The effect on the pacemaker was noted particularly as inhibition, synchronization, or no effect. The pacemaker was then inhibited using a standard test signal. RESULTS: There was no interference between the video capsule and the cardiac pacemakers in our experiment in spite of the close proximity of the two devices. CONCLUSION: The clinical use of capsule endoscopy is unproblematic in patients with cardiac pacemakers.

Staphylococcus aureus induces caspase-independent cell death in human peritoneal mesothelial cells.

Bacterial peritonitis remains a serious complication of peritoneal dialysis. Although Staphylococcus epidermidis is the most common pathogen involved, infections with Staphylococcus aureus lead to severe peritoneal damage and are often associated with a dramatic loss of mesothelial cells. Induction of cell death appears to be involved in peritoneal damage and mesothelial cell loss during bacterial infections. Using cultured human peritoneal mesothelial cells (HMCs), we investigated the ability of different S. epidermidis and S. aureus strains to damage the HMC monolayer and to trigger cell death. We show that only a subgroup of live S. aureus isolates, characterized by an invasive and alpha-hemolysin-producing phenotype, induces cell death. None of the tested S. epidermidis strains, which were not invasive or hemolytic, had a cytotoxic effect. After host cell invasion, S. aureus resided within phagocytic vacuoles, and HMCs were apparently able to degrade staphylococci. However, even after prolonged infection, a high percentage of S. aureus remained alive within HMCs and might be released after host cell death. Cell death induced by S. aureus was accompanied by apoptotic alterations, such as DNA fragmentation, but was independent of endogenous FasL and tumor necrosis factor-alpha death ligand expression. Moreover, caspases were not involved in S. aureus-induced mesothelial cell death. In conclusion, our data indicate that mesothelial cell death might represent a major mechanism of S. aureus-induced damage of the peritoneum during bacterial peritonitis.

Generation of 14.8-fs pulses in a spatially dispersed amplifier.

We demonstrate amplification and compression of 110-nm broad spectra in a spatially dispersed amplifier for what is believed to be the first time and generate 14.8-fs pulses with 450 microJ of energy at a repetition rate of 1 kHz. The amplifier concept is scalable in energy and allows for spectral shaping, which was demonstrated and compared with numerical simulations and showed excellent agreement.

Initial experience with the Endicor X-sizer thrombectomy device in patients with ST segment elevation myocardial infarction.

We investigated 16 patients with ST segment elevation myocardial infarction who had an occluded coronary artery (TIMI 0) at initial angiogram. Instead of balloon angioplasty and stenting, patients were subjected to thrombectomy (Endicor X-sizer) and stenting. In 15/16 patients the occlusion could be crossed by the thrombectomy device resulting in TIMI flow 3 in all of them. Thereafter, stenting was performed. At final angiogram all 15 patients continued to show TIMI flow grade 3. Twelve-lead ECG was performed prior to and post-intervention. ST elevation was measured as the sum of eight leads for anterior infarction and of five leads for inferior infarction. In 13/15 patients, ECG analysis was possible (2 developed bundle branch block post-intervention). In all 13 patients, a > 50% ST decrease of the initial amount of ST elevation was observed reaching a > 70% reduction in 11 patients. Procedural complications were low (one coronary dissection after thrombectomy) and 30 days follow-up was uneventful. Thrombectomy using the Endicor X-Sizer device may become an attractive mechanical reperfusion strategy for patients with acute myocardial infarction.

[Role of glycoprotein IIb/IIIa inhibitors in the treatment of degenerated aortocoronary saphenous vein grafts]. / Stellenwert der Glykoprotein IIb/IIIa-Rezeptorantagonisten in der interventionellen Therapie degenerierter aortokoronarer Venenbypässe.

Treatment of degenerated vein grafts is a large, growing portion of interventional procedures. Because the operative risk of repeat bypass surgery is substantially increased, percutaneous transluminal coronary angioplasty has been accepted as a less invasive treatment in symptomatic patients with significant stenoses of vein grafts. Stent placement has been established in the randomized SAVED trial as a safe and efficient treatment strategy of degenerated saphenous vein grafts, enhancing acute success, reducing the incidence of subsequent angiographic restenosis, and improving event-free survival. Despite coronary stents and new technological innovations like directional and transluminal extraction atherectomy distal embolization is still a frequent occurrence, with a reported incidence of 10-15% associated with an increased in-hospital mortality. Blockade of the platelet surface glycoprotein IIb/IIIa receptors has been convincingly demonstrated to reduce the ischemic complications of angioplasty in native coronary arteries. In degenerated vein grafts the efficacy of glycoprotein IIb/IIIa inhibitors in reducing distal embolization is uncertain. Major clinical events could not be reduced by glycoprotein IIb/IIIa antagonists administered periprocedurally. But prospective randomized trials are lacking. Protection devices could reduce the incidence of distal embolization during interventions in degenerated saphenous vein grafts. The relative role of these devices compared to pharmacologic interventions will require careful assessment in future clinical trials.

Enterotoxigenic potential of Staphylococcus intermedius.

Staphylococcal food poisoning (SFP) caused by enterotoxigenic staphylococci is one of the main food-borne diseases. In contrast to Staphylococcus aureus, a systematic screening for the enterotoxins has not yet been performed on the genomic level for the coagulase-positive species S. intermedius. Therefore, the enterotoxigenic potential of 281 different veterinary (canine, n = 247; equine, n = 23; feline, n = 9; other, n = 2) and 11 human isolates of S. intermedius was tested by using a multiplex PCR DNA-enzyme immunoassay system targeting the staphylococcal enterotoxin genes sea, seb, sec, sed, and see. Molecular results were compared by in vitro testing of enterotoxin production by two immunoassays. A total of 33 (11.3%) S. intermedius isolates, including 31 (12.6%) canine isolates, 1 equine isolate, and 1 human isolate, tested positive for the sec gene. In vitro production of the respective enterotoxins was detected in 30 (90.9%) of these isolates by using immunological tests. In contrast, none of 65 veterinary specimen-derived isolates additionally tested and comprising 13 (sub)species of coagulase-negative staphylococci were found to be enterotoxigenic. This study shows on both molecular and immunological levels that a substantial number of S. intermedius isolates harbor the potential for enterotoxin production. Since evidence for noninvasive zoonotic transmission of S. intermedius from animal hosts to humans has been documented, an enterotoxigenic role of this microorganism in SFP via contamination of food products may be assumed.

The benefits of powered liposuction versus traditional liposuction: a paired comparison analysis.

BACKGROUND: There is much debate about the safety of liposuction as well as the efficacy and risk:benefit ratio of newer devices used in this procedure. OBJECTIVE: To determine if there are any benefits in terms of safety and efficacy of power reciprocating cannulas compared to traditional manual liposuction cannulas. METHODS: Patients served as their own controls in a paired comparison analysis of power liposuction cannulas and traditional liposuction cannulas. RESULTS: Power cannulas significantly reduced procedure times, intraoperative pain, and surgeon fatigue, and increased the amount of fat aspirated per minute. Power cannulas also decreased postoperative pain, ecchymoses, and edema, as well as resulting in higher patient satisfaction scores. CONCLUSION: Power liposuction cannulas produce significantly faster recovery times for patients, allow faster procedure times, and reduce surgeon fatigue, resulting in safer and more precise surgery. A lower incidence of touch-up procedures is likely due to these benefits.

The efficacy of powered liposuction.

BACKGROUND: Powered liposuction is a relatively new innovation for more efficient removal of adipose tissue. OBJECTIVE: To evaluate the effectiveness of powered liposuction in removing adipose tissue when compared to traditional liposuction. METHODS: Four powered liposuction devices were evaluated in the power on mode vs. the power off. The fat extracted in each of these modes was measured in a mucous specimen trap. RESULTS: There was increased fat extraction in the powered mode for all instruments. The increased rate of fat extraction varied from 20 to 45% between instruments. the overall increased extraction in powered vs. nonpowered mode was 30%. CONCLUSION: The powered liposuction devices tested significantly increase the efficacy of subcutaneous fat removal during liposuction.

Draw It again Sam: the effect of drawing on children's suggestibility and source monitoring ability.

Preschool children (aged 3 to 6 years) participated in a magic show. Later, the children were given repeated true and false reminders about the show. Half the children were asked to draw these true and false reminders (drawing condition) and half the children were asked questions about the reminders but not to draw them (question condition). Later, children in the drawing condition had better recall of true reminders than children in the question group; however, children in the drawing group also recalled more false reminders than children in the question group. Finally, although children in the drawing group had better memory of the source of the reminders than children in the question group, both groups equally reported that the false reminders actually happened.

Children's use of anatomically detailed dolls to report genital touching in a medical examination: developmental and gender comparisons.

The influence of anatomically detailed dolls on 3- and 4-year-old children's reports of a routine medical exam was examined. During the exam, half the children received a genital examination and half the children did not. Immediately after the exam, all children were asked to demonstrate various events on an anatomically detailed doll and on their own bodies. Although there were age differences in the number of accurate demonstrations of how the doctor used different instruments, there were no age differences on measures that assessed reports of genital touching. Among girls, commission errors were more frequent when dolls were used because some children falsely showed insertions into the anal or genital cavity. The authors conclude that dolls should not be used in interviews with children below the age of 5 years.