Public Health and Nursing

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Adenocarcinoma of the Appendix
(Scientific Research, 2018-03) Sylla, Moussa; Ossibi, Pierlesky Elion; Tenkorang, Somuah; Dandakoye, Ismael; Majdoub, KarimIbn; Toughrai, Imane; Laalim, Said Ait; Mazaz, Khalid
Objective: To report the experience of our department on adenocarcinoma of the appendix through a series of six (6) cases. Materials and Methods: This is a retrospective study carried out from January 2010 to June 2015 collating all cases of adenocarcinoma of the appendix diagnosed at the department of visceral surgery B in Hassan II University Hospital in Fez. Results: Six cases of adenocarcinoma of the appendix were recorded during the determined period of study. The mean age was 54.67 ± 16.99 years with the extreme ages ranging from 28 to 78 years. There was a female predominance with a sex ratio of 2. All patients had no specific medical history. The revealing symptoms were the following: appendicitis syndrome (1 case), bowel obstruction (1 case), psoas abscess (1 case) and fortuitous discovery during laparotomy for another problem (3 cases). The following histological types found were: colloid adenocarcinoma (3 cases), mucinous adenocarcinoma (2 case), mucinous cystadenocarcinoma associated with a moderately differentiated adenocarcinoma of the appendix (1 case). The surgical procedure consisted of a right hemicolectomy in 3 patients. Appendectomy followed by a right hemicolectomy and drainage of psoas abscess was performed in two patients. Palliative ileocecal resection and Bouilly-Volkmann ileocolostomy was performed in one patent who had carcinosis. All patients received adjuvant chemotherapy. The following occurred during follow-up: carcinosis (2 patients), a locoregional recurrence (2 patients). Two patients never returned for follow-up. Conclusion: Tumor of the appendix is a rare and exceptional pathology. These tumors are generally discovered fortuitously or during histology of appendectomy specimens. The treatment is usually surgical.
Adenocarcinoma of the Appendix in Young Men with Acute Appendicitis
(Scientific Research, 2014-05) Alexiou, K.; Ioannidis, Argyrios; Drikos, I.; Karanikas, I.; Fotopoulos, A.; Chorti, M.; Economou, N.
Intoduction: The adenocarcinomas of the appendix are rare tumors of the gastrointestinal truct that often reveal no clear clinical symptoms and are not diagnosed in time. In this study, we analyze a rare case of an incidentally discovered adenocarcinoma of the appendix after appendicectomy. Case presentation: A Greek male patient of 37 years old patient presented to our hospital with signs of acute appendicitis and peritonitis. He underwent appendicectomy as therapeutic treatment. Post operational histological examination revealed in situ carcinoma of the appendix without high hematological tumor markers or visible metastasis in CT scan analysis. We decided to proceed to right hemicolectomy. The patient was discharged without complications and without displaying other symptoms in a monitoring interval of two months after surgery. Conclusion: Adenocarcinomas of the appendix are generally difficult to detect in the early stage leading to significant morbidity and mortality rates. Therefore, it is necessary to execute a very careful histopathological examination and perform a detailed intraperitoneal cleaning during operation, so that any indications of appendix adenocarcinomas in cases of appendectomy won’t be missed or misjudged.
Adult Cardiac-Related Deaths: A Reflection of Epidemiologic Transition of Diseases in the Developing World?
(Scientific Research, 2012-12) Thomas, Martins O.; Awolola, Nicholas A.; Olusoji, Olugbenga O.
Background: Epidemiologic transition of diseases is taking place globally. Therefore, it is necessary that more work is done to unravel the situation in respect to cardiac diseases in the developing world. Aim: The research was conducted to ascertain the cardiac causes of death in adults and by extension to further unravel the epidemiologic transition in relation to cardiac diseases in the developing world. Materials and Methods: This is an autopsy study of adult cardiac related causes of death in the year 2010 at the Lagos University Teaching Hospital in Nigeria, West Africa. It was conducted based in a 700-bedded hospital that has a catchment area of about 15 million people. Patients’ data (including bio-data, causes of death, etc.) were extracted from autopsy records for the year 2010. The data were entered and analysed with SPSS software. Results: There were 789 autopsies in the year and 99 of deaths were cardiac-related. There was male preponderance with a mean age of 54.2 ± 1.568 years. Hypertensive heart disease was the primary disease in 97.0% of cases in the studied sample. One 76 year old adult had myocardial infarction. There was no case of adult congenital heart disease. Intracerebral haemorrhage was the commonest cause of death. Discussion and Conclusion: Cardiovascular diseases constitute a growing threat to health among Africans. The developing countries are in stages II and III of Omran epidemiologic transition of diseases. This presents a major challenge to a large proportion of the world population with additional problem of poverty and ignorance. A 4-point agenda is suggested to reduce incidence of cardiovascular diseases (and deaths) in the developing world.
Anaesthetic Challenges in Cardiac Interventional Procedures
(Scientific Research, 2014-11) Thangavel, Periyasamy; Muthukumar, Siva; Karthekeyan, Baskar R.; Vakamudi, Mahesh; Nayagam, Hemananand
The increasing scope of interventions in the cardiac catheterization laboratory (CCL) and electrophysiological laboratory (EPL) has resulted in new challenges for the anaesthesia teams where they deal with different patient categories, complications and safety issues. Collaboration and planning between cardiologist and anaesthesiologist are required for both patient safety and procedural success. This review aims to discuss procedures performed in interventional cardiology and the importance of anaesthesiologists in managing such patients. Percutaneous interventions are being increasingly performed in adult as well as in pediatric patients. Procedures are usually done under mild to moderate sedation. General anaesthesia is required in certain conditions and also in pediatric patients. Knowledge of echocardiography, individual disease condition and fluoroscopy is important. Anaesthesiologists are assuming an increasingly important role in the multidisciplinary management of complex patients and interventions. A comprehensive understanding of procedures is essential to provide a high level of anaesthetic care and maintain patient safety
Anesthesia Alert—A Preoperative Safety Concept for the Surgeon
(Scientific Research, 2015-04) Protyniak, Bogdan; Pearce, Paul; Giambarberi, Luciana; Kumar, Atul; Goldfarb, Michael A.
Background: Advances in modern medicine and surgical technique have allowed patients with multiple comorbidities to undergo invasive surgery electively. This places additional stress on hospital resources to anticipate and deal with potential complications. We have introduced a preoperative safety concept called “Anesthesia Alert”. The surgeon or preoperative interviewing anesthesiologist assigns an Anesthesia Alert when booking to denote possible difficulty with anesthesia induction or intubation. As a result, two anesthesiologists and fiber optic equipment are made available on the day of surgery. Methods: A retrospective study of patients from all surgical specialties who were assigned Anesthesia Alerts between January 2012 and November 2012. Records were analyzed for reasons requiring Anesthesia Alerts. Patient demographics, comorbidities, and perioperative complications were reviewed. Results: A total of 112 patients formed this study group. Difficult airway comprised the majority of Anesthesia Alerts (n = 75, 67.0%). Hypertension was the most prevalent comorbidity among patients. There were only 7 patients (6.3%) admitted to the ICU postoperatively and no mortalities. Conclusion: Perioperative patient safety is an evolving concept that requires a team approach amongst the surgeon, anesthesiologist, and operating room staff. An Anesthesia Alert raises awareness for possible complications during anesthesia induction as well as allocates resources to increase patient safety and avoid preoperative delays. Most importantly, this concept places the onus on the surgeon to alert the anesthesiologist for possible complications during induction and extubation.
Antibioprophylaxy by the Surgery Staff in the Teaching Hospital Gabriel Touré in Mali
(Scientific Research, 2015-03) Dembélé, Bakary Tientigui; Traoré, Alhassane; Togo, Adégné; Kanté, Lassana; Diakité, Ibrahim; Traoré, Amadou; Cissoko, Bourama Emmanuel; Konaté, Madiassa; Karembé, Boubacar; Coulibaly, Yacaria; Keita, Soumeila; Keita, Mamby; Diallo, Souleymane; Diallo, Gangaly
This prospective survey was conducted from February to December 2014 about the use ceftriaxone (ceftriaz) for antibioprophylaxy concerning 300 patients by the surgery staff in the Gabriel Touré Teaching Hospital in Mali. The quantity of drug used was based on the weight of the patient. One dose was administrated in intravenous at the anesthesiology induction time. For more than 2 hours of intervention time, 4 (1.3%) patients received a second dose. The majority of cases (189, 63%) were out of emergency (emergency cases—111, 37%). The mean age was 41.6 years (range: 3 - 95 years). The patients were classed Altmeir II 203 (67.7%) and Altmeir I 97 (32.3%). The NNISS score 0 concerned 101 (33.6%) and NNISS 1 in 180 (60%) patients. The factors of risky were anemia (38; 12.7%), diabetes (6; 2%), and HIV (3; 1%). The mean of intervention duration was 56.8 ± 27.5 minutes. Four cases of intervention site infection were encountered caused by Pseudomonas aeruginosa in 2 patients; Escherichia coli (1 case), and Staphylococcus aureus (1 case). Conclusion: Antibioprohylaxy is not the only way to prevent infections but it stays necessary. The respect of hygien and aseptic measures should be used to reduce the rate of intervention site infection.
Assessment of Relationship between Pain and Anxiety Following Dental Extraction—A Prospective Study
(Scientific Research, 2015-07) Sharma, Shalender; Majumder, Kaberi; Rao, J. K. Dayashankara; Arya, Varun; Siwach, Vijay; Gulia, Sunil
Objective—Anxiety and expected dental pain are the main reasons for avoiding any dental treatment by general population. In this study, we aimed to evaluate the various factors which can increase the anxiety and its association with pain perception of patients following dental extraction. Material and Methods—We had included 100 patients in our study who were undergoing orthodontic treatment and required extraction of either 34 or 44. Pain and anxiety levels after extraction were assessed with a visual analog scale (VAS) and an anxiety questionnaire consisting of eleven questions. Results—The mean VAS score for the entire study group was 16.23 ± 1.28 with statistically significant differences between genders, and was high in females and no statistically significant differences between different age groups. The mean anxiety score was 10.64 ± 3.12. This was significantly higher in women (P = 0.005), but there was no statistically significant differences between different age groups. There was a statistically significant correlation between VAS and total anxiety score (P < 0.001) as well as each question, except for question number 4, 8 and 9 in men. Conclusion—Although most patients had experienced limited pain, there was a significant gender difference in pain and anxiety level. They were anxious because they expected pain, women being more anxious than men. The most provoking factor for anxiety and pain while going for extraction in females was “being seated in dental chair”, while in men the most provoking factor was “uncertainty about proper numbness before extraction”.
Assessment of the Left Ventricle Wall Motion Using Tagged Magnetic Resonance Imaging Data (tMRI)
(Scientific Research, 2015-11) Alenezy, Mohammed D.
In this paper, the Radial Strain (RS) and Strain Rate (SR) was calculated using tagged MRI (tMRI) data. Using tagged magnetic resonance imaging (tMRI), the left ventricle short axis of five healthy adults (three men and two women) and four healthy male rats was imaged during diastolic and systolic phases on the mid-ventricle level. The RS and radial SR of the left ventricle were calculated at the mid-ventricular level of the cardiac cycle. The peak RS for rat and human heart was found to be 46.8 ± 0.68 and 40.7 ± 1.44, respectively, and it occurred at 40% of the cardiac cycle for both human and rat hearts. The peak systolic and diastolic radial SR for human heart was 1.10 ± 0.08 s−1 and −1.78 ± 0.02 s−1, respectively, while it was 4.25 ± 0.02 s−1 and −5.16 ± 0.23 s−1, respectively for rat heart. The results show that tMRI data can be used to characterize the cardiac function during systolic and diastolic phases of the cardiac cycle, and as a result, it can be used to evaluate the cardiac motion by calculating its RS and radial SR at different locations of the cardiac wall during both diastolic and systolic phases. This study also approves the validity of the tagged MRI data to accurately describe the radial cardiac motion
Atherosclerotic Descending Aortic Aneurysms. Pros and Cons of Surgery
(Scientific Research, 2015-09) Krylov, Vladimir P.; Titov, Leonid P.; Gaiduk, Valentina N.; Reut, Leonid I.; Smaliakou, Аleksey L.; Mankevich, Nadezhda V.
Within the last few years, there has been a strong trend to rethink the issue of management of atherosclerotic descending thoracic and abdominal aortic aneurysms (AAAs). When etiopathogenetic associations among changes observed during the progression of the disease were not fully described, surgeons had successfully applied, although traumatic, but a rather radical method to rescue from the rupture threat. As we gained experience and knowledge about long-term outcomes, mostly concerned mortality, we realized that surgery could not be the main tactical approach to AAAs treatment due to its frequent inefficiency and failure to guarantee that the disease would be suppressed including co-morbidities, polymorphic processes and clinical manifestations. It all required more sparing treatment strategies. The situation gave rise to a more argumentative and sparing medical-and-surgical approach to treatment based on a more in-depth understanding of the etiopathogenesis of the disease whereas surgery would remain of prime importance when appropriate. The following has been developed to improve treatment outcomes for AAA: 1) Multifactorial determination of indications for surgical correction with outlining the area of relative and absolute risk of aneurysm rupture; 2) Method of conservative treatment aimed to attain and maintain optimal blood pressure, target levels of cholesterol and low-density lipoproteins, as well as reduce oxidative and inflammatory processes in aorta, strengthen its wall, stabilize the disease and control co-morbidities. A four-year follow-up of patients using this developed technology has yielded more preferred results suggesting the need for narrowing indications for surgery to treat AAAs. Another advantage of the sparing approach to treat AAA is economic, due to fewer operations and implantations of stent-grafts, considering the fact that medical treatment should be used in operated subjects, too.
Bradyarrythmias: A Study of Anthropometric, Demographic and Comorbidity Profiles in an African Population
(Scientific Research, 2013-11) Thomas, Martins O.; Ogunleye, Ezekiel O.; Olusoji, Olugbenga O.; Olugbemi, Augustin; Ojo, O. O.
Background: Bradyarrhythmias are a group of cardiac rhythm disorders that are characterized by bradycardia and they are cosmopolitan in distribution. Their demographic, anthropometric and comorbidity attributes are yet to be clearly established in Africa. Aims and Objectives: This study was conducted to determine the anthropometric, demographic and comorbidity factors in an African population. Methods: We got data from two groups of patients—Group A were bradyarrhythmia patients who already had permanent pacemaker insertion (PPI). Group B were non-cardiac non-debilitated patients of similar age bracket. The sample population consisted of referrals received via clinics, admission through the emergency centres and wards. Their bio-data, hospital identification numbers, ages and gender and other relevant parameters were carefully documented. The ensuing data was analyzed with SPSS 21 statistical software. Results: There were 31 patients in group A (17 male and 14 female patients) and 36 in group B (22 male and 14 female patients). They were all above 20 years of age. Group A had a mean age of 65.8 ± 4.76 years while group B had a mean age of 62.2 ± 4.47 years. Body Mass Index (BMI ≥ 25 Kg·m−2 ), elevated BP, and diabetes mellitus were important clinical attributes of bradyarrhythmias in the studied group. Discussion and Conclusion: Our study showed that the stated anthropometric, demographic and comorbidity parameters are important attributes for bradyarrhythmias in African population.
Cardiac Immobilization in Beating Heart Surgery Using Pericardial Bands
(Scientific Research, 2012-06) Sirivella, Srikrishna; Gielchinsky, Isaac
A novel technique of stabilization of the coronary targets with autogenous pericardial bands is described in off pump coronary revascularizations. Pericardial bands are placed across the coronary targets and snared to the pericardial well for local cardiac immobilization. This technique can be used as an alternate to mechanical stabilizers for immobilization of the coronary targets.
Cardiac Surgery during Pregnancy-Our Experience
(Scientific Research, 2017-08) Kanhere, Vivek M.; Kanhere, Anjali V.; Chakravarty, Devashish; Pendse, Nikhil; Pendse, Milan; Khan, Munir A.; Shrivastava, Anita; Narkhede, Vinod
Background: Rheumatic heart disease (RHD) continues to be endemic in developing countries like India, thus a number of female patient present with valvular heart disease complicating pregnancy. Surgery is lifesaving in patients who are symptomatic on medical management. Objective: To study maternal and fetal outcome in patient’s refractory to medical treatment undergoing cardiac surgery during pregnancy. Methodology: Analysis of 8 pregnant patients who underwent cardiac surgery during 5 years from Jan 2012 to Dec 2016 in a Medical college setup in Central India. Results: Maternal age ranged between 20 - 35 mean of 23.75, NYHA class IV, refractory to medical treatment. The underlying cardiac lesion was rheumatic heart disease 7 (87.5%) cases, 6 (85.7%) had mitral valve lesion. 7 primigravida (87.5%) patients were taken as elective procedure in second trimester (18 - 26 weeks), one multipara patient as emergency after failed Balloon mitral valvuloplasty (BMV) in third trimester of pregnancy (32 weeks) was the only maternal death. 5 (62.5%) patients progressed to term pregnancy and delivered vaginally. The cardiopulmonary bypass variables studied were Median bypass time 51.25 minutes (range 37 - 78), median cross-clamp time 25.62 minutes (range 16 - 48), Median flow rate 2.4 l/min/m2 (range 2.2 - 2.6) mean perfusion pressure during CPB 65 - 89 (range 55 - 120) and median perfusate temperature 37˚C (range 32 - 38). 2 (29%) patients had a long term follow-up and have delivered at term in their next pregnancies at the institute. Conclusion: Cardiac Surgery can be performed during pregnancy in patients’ refractory to medical management. The outcome is better with mother than fetus. Multidisciplinary team approach is the strategy for care.
Cardiomyopathies in Tropical Countries: Causes and Nosological Perspective
(Scientific Research, 2013-11) Touze, Jean-Etienne; Fourcade, Laurent
Background: Cardiomyopathy is the main cause of heart failure in developing countries, mainly in Africa. In those areas the concept of “tropical cardiomyopathy” is still used to design all unexplained cardiomyopathy. The primary aim of this review is first to review the main etiologies of cardiomyopathies observed in tropical countries and second to gain a better understanding of the nosological place of the so-called “tropical cardiomyopathies” in the current framework of cardiomyopathies. Methods and Results: We reviewed relevant references over the last forty years (June, 1976 to May 2012). Given literature data, endomyocardial fibrosis (EMF) is mainly diagnosed in sub-Saharan countries, as well as Brazil and India. Peripartum cardiomyopathy (PPCM) is observed with a higher prevalence than in temperate countries. Sickle cell anemia does not induce specific cardiomyopathy in all echocardiographic studies. Malnutrition and chronic anemia can induce reversible cardiac dysfunction. Myocardial involvement in parasitic infections is restricted to Chagas disease and probably to human African trypanosomiasis. Helminthiasis is not involved in the pathogenesis of cardiomyopathy except for the deleterious effect of high eosinophilia induced by some endemic diseases (filariasis, schistosomiasis). Primary cardiomyopathies (dilated, hypertrophic, and restrictive cardiomyopathy) have no specificity. Arrhythmogenic right ventricular dysplasia and left ventricular noncompaction are also reported and do not differ from elsewhere. Conclusions: The concept of tropical cardiomyopathy is no longer relevant as most of the cardiomyopathies observed in tropical countries have no specificity, with few exceptions (PPCM, EMF, Chagas disease). In this context, the European Society of Cardiology classification offers a simpler clinical approach and allows the inclusion of the rare tropical specificities
Child Abdominal Trauma Due to Attack of Cattles While Working on Farms in Burkina Faso
(Scientific Research, 2017-11) Ouedraogo, Souleymane; Zaré, Cyprien; Zida, Maurice; Savadogo, Julien T.; Windsouri, Mamadou; Ouangre, Edgar; Bandre, Emile; Traore, Simon S.
Introduction: Cattle are strong animals very often used in agriculture in rural Africa. Unpredictable in their behavior, they regularly inflict injuries to farmers, some of whom are children in rural Africa. Objective: The purpose of this study was to describe the clinical, therapeutic and evolutionary aspects of abdominal trauma caused by bovidae to children on farms in Burkina Faso. Patients and Method: This is a descriptive study covering the period from January 2014 through December 2016 and was conducted in the General Surgery Unit of the Tenkodogo Regional Hospital in Burkina Faso. It included all patients under the age of 17, victims of abdominal trauma by cattle on farms. Result: A total of 68 patients were identified, which is 3% of all patients under 17 admitted to the service during the same period. The average age of patients was 10.5 years, with a standard variation of 3.6 years. The majority (73.5%) of the patients were boys. The main lesional mechanisms found were horn strokes (88.2%). We noted 35 eviscerations without visceral perforation, 15 intestinal perforations, 6 hepatic wounds and 5 splenic wounds. In 7 cases, there were non-penetrating wounds. All patients underwent surgical intervention under anesthesia. The average length of hospital was 6 days. Two deaths were recorded, making a mortality rate of 3%. Conclusion: Abdominal traumas of the child by attack of cattle are frequent during farm works in rural Burkina Faso. The injuries are sometimes serious. Wearing protective equipment for children should be considered during farm work.
Combined Antero-Posterior Inverted-U Metaphyseal and Open-Wedge Medial-Epiphyseal Osteotomy for Advanced Blount Disease
(Scientific Research, 2015-04) Ogbemudia, Alfred O.; Bafor, Anirejuoritse; Ogbemudia, Ehimwenma J.; Edomwonyi, Edwin
Background: Blount disease is frequently associated with deformities that may not be adequately corrected by a single metaphyseal osteotomy. This study evaluated the outcome of a combined metaphyseal and epiphyseal osteotomy in severe cases. Methods: We prospectively evaluated the outcome of combining the antero-posterior inverted-U metaphyseal osteotomy with a medial open-wedge hemi-epiphyseal osteotomy in eighteen patients (27 tibiae) with Stage IV to VI Blount disease. Results: The average age of patients was 9 years (ranging from 5 to 17). The tibio-femoral angle improved from 43˚ varus (Range: 34˚ - 78˚) to 2˚ varus (Range: 5˚ valgus to 8˚ varus). The metaphyseal-diaphyseal angle improved from 36˚ to 8˚ varus. Internal tibial torsion improved from 39˚ to 2˚. All the patients were able to achieve 110˚ of knee flexion in a year. Conclusion: In conclusion, the combined metaphyseal and epiphyseal osteotomy satisfactorily corrected tibiofemoral and metaphyseal-diaphyseal varus and internal tibial torsion without recurrence in patients with severe Blount disease. Level of Evidence: IV.
Comparison of Double-Incision Laparoscopic Cholecystectomy and Needlescopic Cholecystectomy
(Scientific Research, 2013-12) Ko, Kenju; Yamada, Shigetoshi; Hayashi, Ken; Tsunoda, Akira; Kusanagi, Hiroshi; Kano, Nobuyasu
Purpose: Recently, reduced port surgery is becoming popular for laparoscopic surgery. “Reduced” means reducing the size or number of ports, but it is controversial as to which procedure is better. We evaluated double-incision laparoscopic cholecystectomy (DILC) and needlescopic cholecystectomy (NC) as reducing number or size of ports, respectively. Method: Patient records for 51 patients undergoing DILC and 22 patients undergoing NC were retrospectively evaluated. The patient and operation related variables of DILC and NC were compared by age, gender, body mass index (BMI), operative time, blood loss, length of postoperative hospital stay, numerical rating scale (NRS) pain score, and frequency to administer NSAIDs postoperatively for three days. Results: The operative times of both groups were similar (DILC 106 ± 31 min, NC 103 ± 35 min). Blood loss did not show any difference and each of them was small in amount (DILC 14 ± 29 ml, NC 22 ± 31 ml). Length of postoperative hospital stay of DILC (3.2 ± 0.4 days) was significantly shorter than that of NC (3.5 ± 0.7 days). Regarding postoperative pain, frequency to administer NSAIDs and pain score for three days postoperatively showed no significant difference. Conclusion: It is thought that DILC and NC have the same operative difficulty. As far as early postoperative pain was concerned, both procedures did not have any difference.
A Comparison of Perioperative Blood Transfusions and Other Complications Following Transverse Rectus Abdominis Myocutaneous Flaps versus Deep Inferior Epigastric Perforator Flaps
(Scientific Research, 2017-03) Amaratunga, Rajith A.; Soliman, Bishoy; Lam, Thomas C.
Objective: Abdominal based free flaps such as the Transverse Rectus Abdominis Myocutaneous (TRAM) flap and Deep Inferior Epigastric Perforator (DIEP) flap are essential tools in the reconstructive armamentarium post mastectomy. These reconstructions are often prolonged, complex and associated with complications. This study aims to compare the complication rate, particularly focusing on perioperative transfusions, between TRAM and DIEP flaps performed by the senior author in our tertiary referral centre. Methods: A retrospective review was conducted of one hundred and seven consecutive TRAM and DIEP flaps from 2000 to 2014. The two groups were analysed for demographics, preoperative risk factors and post-operative complications including blood transfusions, haematomas, flap losses, redo-anastomoses, flap infections, abdominal wound sequelae and non-surgical complications. Results: Sixty-three patients underwent 67 free/muscle sparing TRAM flaps and 35 patients underwent 40 DIEP flaps. There were no statistically significant differences in patient demographics or preoperative risk factors between the two groups. Five TRAM flap cases (7.9%) required transfusion whilst no DIEP flap cases required transfusion. This difference was not found to be statistically significant (p = 0.16). However, free/muscle-sparing TRAM flaps were found to have a significantly higher overall complication rate compared to DIEP flaps (23.8% vs. 5.7%, p = 0.02). Conclusion: The current study demonstrated no difference in perioperative transfusion requirement between TRAM and DIEP cases. There was however a significantly higher rate of overall complications associated with TRAM flaps warranting the authors to conclude that care be taken when opting for this reconstructive method.
Consistent Condom Use among HIV Positive Women Attending Comprehensive Care Centre of Thika Level 5 Hospital, Kenya
(Scientific Research, 2015-09) Macharia, Anne G.; Kombe, Yeri; Mwaniki, Peter
Background: Condoms offer protection against human immunodeficiency virus (HIV) transmission when used correctly and consistently. Many HIV infected people do not use condom regularly, thus leading to new HIV infections and re-infections. In Kenya, condom use is considered to be low and HIV prevalence is high among women aged 15 - 49 years where utilization of condoms among HIV positive women has not been studied. Objectives: The study aimed at determining the prevalence of consistent condom use among HIV positive women aged 18 - 49 years and to investigate the variables associated with it. Methods: A mixed method of study design (qualitative and quantitative approaches) was employed. A total of 422 participants were selected randomly and interviewed using a pre-tested structured questionnaire. Three (3) focus group discussions with 8 participants in each group were conducted. Chi-square test (p < 0.05) and odds ratio with corresponding 95% confidence interval were computed to establish the association between consistent condom use and independent variables. Binary logistic regression model was used to identify variables independently associated with consistent condom use. Qualitative data were transcribed and coded and then analysed thematically. Results: Consistent condom use among sexually active HIV positive women was found to be 57.4% (95%CI: 52.7% - 62.1%). The stepwise logistic regression revealed that attending tertiary education [aOR = 2.54; 95%CI = 1.30 - 4.95; P = 0.006], disclosing HIV status [aOR = 2.27; 95%CI = 1.27 - 4.06; P = 0.005], having an HIV negative partner [aOR = 4.23; 95%CI = 1.99 - 8.98; P < 0.001], not taking alcohol [aOR = 1.72; 95%CI = 1.10 - 2.69; P = 0.017], never encountered resistance to use condom by partners [aOR = 1.87; 95%CI = 1.15 - 3.03; P = 0.011] and perceived risk of contracting STIs [aOR = 2.11; 95%CI = 1.12 - 3.97; P = 0.021] as factors independently associated with consistent condom use. Conclusion: This study shows that there is still low prevalence of consistent condom use among HIV positive women. More education campaigning and sensitization should be tailored among HIV positive women during counseling so as to avoid re-infection and transmission of infections.
Dengue Vaccines: Challenge and Confrontation
(Scientific Research, 2011-11) Perng, Guey C.; Lei, Huan-Yao; Lin, Yee-Shin; Chokephaibulkit, Kulkanya
Dengue has been recognized as one of the most important vector-borne human diseases. The disease is induced by dengue virus infection resulting from the bite of an infected Aedes spp. mosquito after imbibing the tainted blood from animals or patients. Dynamic clinical spectrums ranging from asymptomatic, undifferentiated fever, typical dengue fever (DF), dengue hemorrhagic fever (DHF) and dengue shock syndrome (DSS) have been well documented. Initially, the disease was mainly restricted in tropical and subtropical zones. However, with factors such as ineffective vector control, frequency of human migration, unplanned urbanization, and changing climate temperature, the disease has been spotted at almost every territory of the earth. Dengue has been associated with human disease for more than two centuries. Although classic DF is viewed as a self-limited illness, subjects normally resolve within two weeks and recover without any noticeable complications or sequelae, some of these infected individuals may progress to lifethreatening DHF/DSS, characterized with plasma leakage due to an increase in capillary permeability. The significantly increased public health threat and the burden of morbidity and mortality of dengue globally has caught the attention of public officials and prompted an action to find a way to contain and prevent the disease. The lack of specific dengue therapeutics has led to an emphasis on vaccine development, one of the best and effective strategies to reduce and prevent the illness. Making a dengue vaccine has been attempted more than six decades; although some of these products are in clinical trials, vaccine development for the prevention of dengue disease is still at its infancy. So far no dengue vaccine is available for the public. Dengue vaccine development may be hindered by the complexity of the clinical presentations, which implicates that multiple pathogenic mechanisms are involved in dengue disease. Some of these elements will be discussed in the current review. Opening up discussion on these pros and cons and engaging in more research to understand these features would not only improve the understanding of the pathogenesis of the dengue virus infection but also pave a new tactic to develop a safer and effective dengue vaccine
Determination of Accuracy of Nursing Diagnoses Used by Nursing Students in their Nursing Care Plans
(2013) Aydin, Nursel; Akansel, Neriman
Aim: The aim of this study was to determine and evaluate appropriateness of nursing diagnoses with NANDA taxonomy used by second year nursing students in their nursing care plans. Methods: Retrospective design. Findings: While care plans included 42 nursing diagnoses appropriate to NANDA II taxonomy, some phrases (n=30)were used as nursing diagnoses. Risks for infection, pain, activity intolerance, anxiety were the most frequently used diagnoses while nursing diagnoses in domains of cognitive-perceptive, self perception and role relations are very few. Conclusio: Performing case studies in clinical settings by using NANDA diagnoses, specifying difficulties experienced by nursing students’ and determining levels of discomfort while assessing the patients and determining the perceptions of nursing students by doing qualitative studies are recommended.

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