Injection practices at primary healthcare units in bangladesh: experience at six upazilla health complexes.

BACKGROUND: Indiscriminate usage of injections and lack of safe practices during injection administration have been reported worldwide. Unnecessary and unsafe injection usage not only increases the financial burden but are also responsible for spreading blood borne diseases including HIV, HBV and HCV. To attain a better understanding of the situation of injection usage in Bangladesh, a study was conducted at six Upazilla Health Complexes (UHCs), which are primary healthcare units in Bangladesh. METHOD: The study involved the retrospective collection of treatment sheets of 1048 in-patients at six UHCs from January 2009 to June 2009. The data was then analyzed using statistical tests. RESULTS: Among the patients investigated, 60.11% of the patients received injections and among them the male population received more injection than the female population (males vs. females = 62.50% vs. 55.85%). Patients below 12 years of age received the highest proportion of injections and highest usage of injections was observed in the month of March. The average number of injection(s) prescribed to a patient was 2.44 incurring a prescription cost of 280.22 Taka (USD 3.92 approx.). Injections were mostly prescribed in patients who were diagnosed with physical assault and acute watery diarrhea where intravenous fluids and antibiotics were most widely prescribed. Non-compliance to recapping of used injections was very common which accounted for 22.22% needle stick injuries. CONCLUSION: The data suggest that indiscriminate and unsafe injection practices were occurring in all UHCs. Such practices resulted in financial losses as well as compromising safety for healthcare providers and patients.

The watermelon rectum.

This is the first reported case of rectal vascular ectasia in association with gastric antral vascular ectasia (watermelon stomach). The patient, a 39-year-old woman with systemic sclerosis, reported chronic gastrointestinal blood loss and iron deficiency anemia. She had aperistalsis of the distal esophagus, decreased lower esophageal sphincter pressure leading to severe gastroesophageal reflux, and dysmotility of the small intestine. Diagnosis was made by endoscopic appearance of visible linear watermelon-like vascular stripes in the gastric antrum and rectum. Histology confirmed the vascular nature of this disorder, showing dilated and thrombosed capillaries in the lamina propria. Gastric biopsy showed associated fibromuscular hyperplasia in the lamina propria. However, the colonic biopsy showed only focal hyalinization in the lamina propria. The patient was successfully treated using endoscopic bipolar electrocautery. Watermelon stomach has previously been described in association with systemic sclerosis. Based on the histopathologic similarity between rectal vascular ectasia, gastric antral vascular ectasia, and systemic sclerosis, we suggest that the rectal vascular lesion may represent a component of the gastrointestinal manifestations of systemic sclerosis.

Necrolytic acral erythema associated with hepatitis C: effective treatment with interferon alfa and zinc.

BACKGROUND: Necrolytic acral erythema is a recently described necrolytic erythema that is unique in its exclusive acral location and strong association with hepatitis C. OBSERVATION: We report the first case of necrolytic acral erythema in the United States. The patient is a 43-year-old black woman who presented with a 4-year history of tender, flaccid blisters localized to the dorsal aspect of her feet. Serum zinc and glucagon levels were normal. Serum antibodies were positive for hepatitis C, and a liver biopsy specimen showed chronic hepatitis. She was successfully treated with interferon alfa-2b and zinc. We review all previously reported cases. CONCLUSIONS: Necrolytic acral erythema is a distinct entity. In a review of the literature, most patients were between 35 and 55 years of age, although 1 patient was 12 years old. Five of 8 patients were female. Four of 7 patients described previously were treated with variable success using oral zinc sulfate and amino acids, whereas 2 were successfully treated with interferon alfa. All patients were infected with hepatitis C. Necrolytic acral erythema appears to be a skin disorder linked to infection with hepatitis C virus that responds to treatment with interferon alfa and oral zinc.

The Budd-Chiari syndrome revisited.

Major advances in diagnosis and treatment of the Budd-Chiari syndrome over the past decade have made it worthwhile to revisit this intriguing condition. During this time it has become evident that an underlying predisposing cause, in particular a hematological, thrombogenic disorder, is present in up to 70% of patients presenting with hepatic venous outflow obstruction. Doppler ultrasound has proven extremely valuable as the initial imaging modality to establish the presence or absence of normal hepatic veins and phasic flow. Angiography with vena caval pressure measurements and liver biopsy remain essential in decision making with regard to surgical and nonsurgical management. Nonsurgical management has expanded to include angioplasty of stenoses and webs, although the placement of transjugular intrahepatic portosystemic shunts offers a useful alternative to operative shunts in selected circumstances. In many situations, however, decompressive side-to-side type shunts have a definitive role in patients with preserved liver function and structure. Other patients with severe necrosis, fibrosis, or cirrhosis may be offered a life-saving alternative only by orthotopic liver transplantation.

Validity of the Rorschach Mutuality of Autonomy Scale: a replication using excerpted responses.

This study examines the use of excerpted Rorschach responses for rating object relations. This assessment of object relations focuses on a dimension defined as Mutuality of Autonomy. A Rorschach Scale for Mutuality of autonomy is presented. Its application to excerpted Rorschach data is described. Raters did not apply the Mutuality of Autonomy Scale to the entire protocol as had been done previously (Urist, 1977). Instead, in an attempt to argue that Rorschach ratings in fact reflected Mutuality of Autonomy and not extraneous factors, ratings were based exclusively on excerpted responses. Reliability for the excerpting was at a high level of agreement, and the Rorschach Mutuality of Autonomy Scores based on these excerpts correlated significantly with independent clinical ratings of Mutuality of Autonomy.

Castration fantasies and assertiveness in father-absent males.

In a previous report (Shill 1981), father-absence was linked to insecurity in core male gender identity in a nonclinical sample of college males. The present paper describes further aspects of the experimental use of projective techniques, based on psychoanalytic theory and clinical discussions, to assess the effect of father-absence on male personality development. Castration fantasies and sense of competence in the mastery of external reality as an index of masculine self-representation were coded from the projective test responses of 103 father-present and 28 father-absent college males. When given a choice of castrating figure at the human or animal level, all subjects identified the human mother rather than the father as the more frightening castrating figure. Father-absent subjects, however, identified the animal mother as the more frightening castrating figure, compared to the animal father, more frequently than the father-present subjects, suggesting a denial and displacement of castration fear toward the human mother onto the animal substitute. The father-absent subjects also evidence significantly less sense of mastery, suggesting less self-assertiveness and sense of competence than the father-present controls. The importance of identification with the father as the basis for a masculine ego style and of father absence as a developmental interference affecting the appropriate management of aggression in males is discussed.

TAT measures of gender identity (castration anxiety) in father-absent males.

DAT stories of 28 father-absent (FA) and 103 father-present (FP) college males were coded for castration anxiety. Relying on Stoller's (1974) use of castration anxiety (CA) as an index of core male gender identity, it was predicted that FA males would have less secure gender identity and higher CA than FP males. The FP subjects were grouped into three subgroups according to ratings of the quality of father-son interaction (positive, neutral and negative). Social class, age, SAT scores and story-length did not discriminate between FAs and FPs. FAs were significantly higher in CA, but there were no significant differences between the three FP subgroups. Age at father-loss did not affect CA, although father-absence through death rather than divorce, separation or desertion was associated with higher CA. Presence of a stepfather, other significant older male, sibling sex or birth-order did not affect CA level of FAs.

Motivational factors in aphasia therapy: research suggestions.

Following Wepman (1953), the process of recovery from aphasia is seen as involving stimulation, motivation, and facilitation. The most adequate studies of aphasia therapy outcome focus on facilitation to the virtual exclusion of stimulation and motivation, although clinical experience suggests their importance. Motivation includes both the subjective and experiential aspects of the patient's response to aphasic disablement (anxiety, feelings of inadequacy) and the quality of the speech-therapist/patient alliance during the treatment. Retrospective studies utilizing sufficiently improved aphasics and ratings of the patient-therapist alliance are suggested as preliminary means of defining "motivation" in this context more accurately. Research approaches are also outlined which would assess the importance of and interaction between the three factors implicated in recovery for therapeutic outcome.