ABSTRACT
Introduction: Non-tunneled central venous catheter remains the preferred vascular access at hemodialysis initiation in developing countries despite a high burden of infection complications. The goal of this study was to determine the burden, risk factors, and microbiological spectrum of catheter-related bloodstream infections at a tertiary care center in Ethiopia. Methods: A retrospective cross-sectional study design was applied among patients who underwent central venous catheter insertion for hemodialysis between January 2016 and June 2022 with no native arteriovenous fistula and stayed more than 48 hours. Data were collected from the patient's registration book, patient charts, and microbiology registry and analyzed using SPSS 21. Binary logistic regression was applied to assess the relationship between the independent and outcome variables. P-values less than 0.05 with AOR and 95% CI were used as statistically significant variables. Results: In this study, 353 patients were included. The mean age was 39±17.9 years and the average duration of catheter stay was 58 ±95 days. A hundred thirty-five (38.2%) CRBSIs were documented with an incidence rate of 7.74 episodes per 1000 catheter days. The causative microorganism was predominantly gram-negatives (57.6%). Duration of a catheter (AOR: 0.3; P < 0.001), previous CVC infection (AOR: 11.9; P < 0.001), high white blood cell count (AOR: 0.31; P<0.001), urban residence (AOR: 1.92; P<0.05), and low hemoglobin levels (AOR: 2.78; P < 0.05) were independently associated with catheter-related bloodstream infections. Conclusion: In conclusion, the incidence of catheter-related bloodstream infection among patients on hemodialysis was high with gram-negative predominance. Early fistula must be planned to reduce the duration of temporary vascular access.
ABSTRACT
BACKGROUND: An umbilical granuloma is one of the common umbilical masses in young children which appears after the cords fall off, mainly due to an inflammatory reaction to subclinical infections. Though there are different recommendations of treatment modalities, which management modality is the best is not clear yet. OBJECTIVE: This systematic review aimed to assess the effectiveness of salt treatment in terms of complete resolution of the granuloma, any adverse effect, and any recurrence risk in those patients treated as inpatient or outpatient care. METHODOLOGY: The literature search was done using search engines including Google scholar, PubMed, and Medlin. Articles published since 1990 and written in the English language with a target population of young children (less than 24 months) were included. To retrieve the articles, umbilical granuloma, treatment of umbilical granuloma, salt treatment, and neonatal umbilical disorder were used as keywords. RESULTS: This systematic review indicated that the majority of the studies done on salt treatment for umbilical granuloma show excellent response (complete resolution of the granuloma/discharge) with no adverse effect and no recurrence in the subsequent follow-up of the patients in almost all cases of the treatment group. Salt inside the occluded hyperosmolar chamber causes shrinkage of granuloma by a desiccant effect. CONCLUSION: Cooking salt treatment for umbilical granuloma is effective, cheap, available, and easy to apply by non-health professionals. No side effects have been reported yet and a recurrence of the granuloma after treatment seems to be null.
ABSTRACT
AIM: Atypical diabetes is commonly reported in Africa. The objective of this case report is to highlight an unusual case of thin, severely hyperglycemic and ketone resistant teenager with history and signs of chronic under-nutrition to raise the awareness of clinicians on the existence of atypical phenotype of diabetes not fitting the current classification of diabetes. CASE PRESENTATION: A 17-year-old male patient, known diabetic, was diagnosed in the health center as type1 diabetes for 8 months. He was on insulin for 3 months and discontinued for 5 months. He presented with polydipsia, polyuria, and weight loss since he discontinued the drug. On examination, he was severely wasted and underweight with unexplained bilateral parotid enlargement. On investigations;, he had hyperglycemic, glucosuria but no ketonuria. The patient was admitted with the diagnosis of type 1 diabetes and severe acute malnutrition. He started insulin (1IU/Kg/day) subcutaneously and nutritional management. On follow-up, RBS and FBS remained high and insulin was escalated to 3.32 IU/kg/day. Subsequently, serial RBS and FBS, the measurements were in the acceptable range and the patient was gaining weight. As the weight increases, his demand for insulin was decreased and the dose of insulin was de-escalated to 1.2 IU/Kg/day over 3 months. Finally, the patient was discharged with 1.2 IU/Kg/day with a weight of 44 kg over 4 months of hospital course with the diagnosis of malnutrition-modulated diabetes. Now, the patient is in diabetic clinic follow-up with good glycemic control. CONCLUSION: Though there are unclear and uncertainties in malnutrition-modulated diabetes mellitus, clinicians need a high index of suspicion to reach the diagnosis especially in those countries where malnutrition is common. Early diagnosis and appropriate management of the patients demand are important in patient care and outcome.
