CSF lactate level: a useful diagnostic tool to differentiate acute bacterial and viral meningitis.

OBJECTIVES: To evaluate the potential role of CSF lactate level in the diagnosis of acute bacterial meningitis and in the differentiation between viral and bacterial meningitis. METHODS: This was a hospital based observational study, conducted at Infectious Diseases Unit, Rashid Hospital Dubai, United Arab Emirates, from July 2004 to June 2007. The patients with clinical diagnosis of acute bacterial meningitis and who had CSF Gram stain/culture positive, CSF analysis suggestive of bacterial meningitis with negative Gram stain and culture but blood culture positive for bacteria and patients with clinical diagnosis suggestive of viral meningitis supported by CSF chemical analysis with negative Gram stain and culture as well as negative blood culture for bacteria were included in the study. CT scan brain was done for all patients before lumber puncture and CSF and blood samples were collected immediately after admission. CSF chemical analysis including lactate level was done on first spinal tap. The CSF lactate level was tested by Enzymatic Colorimetric method. RESULTS: A total 95 adult patients of acute meningitis (53 bacterial and 42 viral) fulfilled the inclusion criteria. Among 53 bacterial meningitis patients, Neisseria meningitides were isolated in 29 (54.7%), Strept. Pneumoniae in 18 (33.96%), Staph. Aureus in 2 (3.77%), Klebsiell Pneumoniae in 2 (3.77%), Strept. Agalactiae in 1 (1.8%) and E. Coli in 1 (1.8%). All the patients with bacterial meningitis had CSF lactate > 3.8 mmol/l except one, whereas none of the patients with viral meningitis had lactate level > 3.8 mmol/l. The mean CSF lactate level in bacterial meningitis cases amounted to 16.51 +/- 6.14 mmol/l, whereas it was significantly lower in viral group 2.36 +/- 0.6 mmol/l, p < .0001. CONCLUSION: CSF lactate level was significantly high in bacterial than viral meningitis and it can provide pertinent, rapid and reliable diagnostic information. Furthermore, CSF lactate level can also differentiate bacterial meningitis from viral one in a quick and better way.

Healthcare quality and moderators of patient satisfaction: testing for causality.

PURPOSE: The purpose of this article is to present a comprehensive structural equation based service quality and patient satisfaction model taking into account the patient's condition before and after discharge. The authors aim to test for causality in a sample of patients from United Arab Emirates public hospitals. DESIGN/METHODOLOGY/APPROACH: Data were collected using questionnaires completed by adults discharged (n = 244) from UAE public hospitals. The proposed model consists of five main constructs. Three represent service quality: quality of care (four variables); process and administration (four variables) and information (four variables). There is also one construct that represents patient's status (two variables--health status before admission and after discharge). Finally, there is one construct that represents patient's satisfaction with care (two variables--general and relative satisfaction). Structural equation modeling and LISREL using maximum likelihood estimation was used to test hypothesized model(s)/parameters(s) derived deductively from the literature. FINDINGS: The structural equation modeling representation provides a comprehensive picture that allows healthcare constructs and patient satisfaction causality to be tested. The goodness-of-fit statistics supported the healthcare quality-patient status-satisfaction model. ORIGINALITY/VALUE: The model has been found to capture attributes that characterize healthcare quality in a developing country and could represent other modern healthcare systems. Also, it can be used to evaluate other healthcare practices from patients' viewpoints. The study highlights the importance of healthcare quality as patient satisfaction predictors by capturing other effects such as patient status.

Hepatitis E: a common cause of acute viral hepatitis.

OBJECTIVE: To investigate the etiology of acute hepatitis in adult patients admitted in a hospital. METHODS: The study included all acute hepatitis patients admitted in the Infectious Diseases Unit of Rashid Hospital Dubai (JCI accredited), UAE, from January 2006 to December 2007. Various viral markers were used to establish the diagnosis of acute hepatitis which included anti HAV IgM, HBsAg, Anti HBc IgM), anti HCV IgG and anti HEV IgM by ELISA. In hepatitis C positive cases HCV RNA was also done to confirm acute HCV. Liver function test weres done by Hitachi 912 machine. RESULTS: A total of 165 cases with acute hepatitis were admitted in the hospital during the study period. The specific etiologic diagnosis could be made in 122 (74%) patients and of these acute hepatitis E was found in 40%, HAV in 18.7%, HBV in 11.5%, HCV 1.2%, and combined infection 4.2%. Overall, HEV accounted for 54% of acute viral hepatitis. Majority (95.4%) of HEV patients were from developing countries which included 69.5% patients from Nepal, 52.7% from Bangladesh, 48.8% from India and 30.7% from Pakistan. The mean age of the patients with HAV infection was significantly younger than patients with HEV and HBV, p value < .0001 and < .0002 respectively. Prothrombin time was longer in HAV infection than HBV and HEV, (p < .01 and < .02) respectively. However, there were no significant differences in serum bilirubin and transaminases concentration among different groups. CONCLUSION: The present study showed that about 60% of the acute viral hepatitis is water borne and can be easily controlled with improving sewage and water distribution and personal hygiene.

Testing not-so-obvious models of healthcare quality.

PURPOSE: The purpose of this paper is to show that, although there has been some research to identify the dimensions on which healthcare quality and in-patient satisfaction should be measured, the confirmation of constructs and indicators that constitute an overall care quality and satisfaction remains unclear. The objective is to present several models of service quality and satisfaction in healthcare for discharged patients; and to test those models in a sample of discharged patients in public hospitals in the United Arab Emirates. DESIGN/METHODOLOGY/APPROACH: A detailed in-patient survey (using interviews) was used. Data were collected with questionnaires from adult discharges (n = 244) in public hospitals in the UAE. Several structures are proposed and tested. Confirmatory Factor Analysis (CFA) and LISREL SIMPLIS using maximum likelihood estimation were used to estimate and test the parameters of the hypothesized models derived deductively from the previous literature. FINDINGS: Several models (with one, two, three and four constructs) with different structures were tested using CFA. The final recommended model is based on three constructs--quality of care, process and administration, and information. The goodness-of-fit statistics supported the basic solution of the healthcare quality-satisfaction model. ORIGINALITY/VALUE: The model has been found to capture attributes that characterize healthcare quality in a developing country such as the UAE and could represent other modern healthcare systems. It can be used as a basis for evaluation in healthcare practices from discharges (in-patients) point of view. The study highlights the importance of patients' satisfaction with care as predictors of quality of care. The results also confirm the construct validity of the previously discussed healthcare quality scales.