Review of current concept in the management of pressure ulcers

Pressure ulcers are quite distressing, and they cut across all age groups. Aside from increasingmortality, it results in protracted hospital stay and an upsurge in the consumption of healthcare resourcesPressure ulcers are considered to be essentially preventable, but in order to prevent them it is important to identify the people most at risk and deliver timely preventative care. In case of severe acute respiratory distress syndrome (ARDS), as in coronavirus dis­ease 2019 (COVID-19) affected patients, prone position and invasive ventilation improve the clinical status of this group of patients. This form of therapy is associated with an increased risk of facial pressure ulcers. When pressure ulcer occurs, appropriate documentation of each ulcer and staging of the ulcer are essential for good wound assessment.Treatment involves, assessing the nutritional needs of the patient, management of infections, removal of necrotic tissue, maintenance of a moist environment for wound healing, and possibly surgery

Quality of sleep and psychological distress in glaucoma

Background: People living with glaucoma are psychologically burdened because of the threat of visual loss. Therefore, understanding the psychosocial issues and quality of sleep holds important implications for the recognition, prevention, and treatment of emotional problems among people with glaucoma. This study investigated the quality of sleep and psychological distress among people with glaucoma.Methods: This was a cross-sectional study of adults recruited over a period of 12 weeks from a glaucoma clinic of a Teaching Hospital in south-west Nigeria. The quality of sleep and psychological distress were evaluated using the Pittsburgh Sleep Quality Index and General Health Questionnaire respectively.Results: Ninety-three adults with glaucoma participated in the study. The mean age was 62.33 ± 15.25 years. Fifty-seven (61.3%) of the subjects were poor sleepers while 27 (29.0%) were psychologically distressed. Psychological distress correlated with global sleep score (r = 0.399, p = 0.000), subjective sleep quality (r = 0.341, p = 0.001), sleep latency (r = 0.245, p = 0.018) and sleep disturbance (r = 0.279, p = 0.007).Conclusion: Psychological distress and sleep disturbances were common among patients with glaucoma. Concerns about these issues should be incorporated into routine clinical evaluations of patients with glaucoma

Abdominal pregnancy: a cause of failed induction of labour.

BACKGROUND: Induction of labour is a common mode of management of intrauterine fetal deaths, and the process usually involves ripening of the cervix by traditional methods of intracervical Foley's catheter insertion or the use of prostaglandin preparations intravaginally. Such methods are usually very effective independently. The objective of this case report is to call the attention of practising obstetricians to the possibility of an abdominal pregnancy as a cause of failure to ripen the cervix and that careful re-evaluation and use of ultrasound scan can improve diagnostic acumen with favorable outcome of management in such cases METHODS: The case file of the patient was thoroughly reviewed. A literature search on the subject of abdominal pregnancy using local and international journals and relevant textbooks was done to document the current status of the management of such cases. RESULTS: A 29-year-old Gravida 4 para 3+0 (2 alive) presented at an estimated gestational age of 32 weeks with loss of fetal movement, which was suggestive of fetal death and was referred as such from a private hospital. A process of induction of labour was commenced; to ripen the cervix with intracervical Foleys catheter and misoprostol tablet and stimulate uterine contraction, but this was not successful due to failure of the cervix to ripen. This prompted further review of the patient with the aim of excluding the possibility of an abdominal ectopic pregnancy. A repeat ultrasound scan was done and this confirmed a diagnosis of abdominal pregnancy. The patient had laparotomy done to deliver a dead fetus and the placenta was removed with the right tube and ovary as they were deeply embedded in the placental mass. The definitive diagnosis was that of a secondary abdominal pregnancy. She made a satisfactory postoperative recovery and was discharged home. CONCLUSION: A high index of suspicion is needed to make a first time diagnosis of abdominal pregnancy. With timely diagnosis and appropriate management, the prognosis in most cases is favourable.