Medical mortality in an emergency department in Nigeria: the transition is obvious!

Introduction: The emergency department (ED), a major entry point into the hospital, provides an insight to the type of cases seen, the quality of care and mortality spectrum in a health institution. We aim to identify the spectrum of medical causes of mortality in our ED, the demographic pattern and duration of stay before death. Method: This is a retrospective study that looked at medical mortality in the ED from January 2004 to December 2009. We obtained data on the demographics and causes of death from the medical records and case notes of the deceased. Results: A total of 16587 patients were admitted during the period under review, of these 1262 (7.61%) died in the ED. The male to female ratio was 1.58:1.0 [772 males (61.2%), and 489 females (38.8%)]. Mortality was highest among the 20-45years age range, followed by 46-65 years, >65years and < 20 years in decreasing frequency [589(46.7%), 421(33.4%), 186 (14.8%) and 66(5.2%) respectively]. The three most common causes of death were stroke 315(25%), HIV related illness- es 126(10.0%), and heart failure 123(9.7%). Most deaths occurred less than 24hours of admission, 550(43.6%), followed by one day (36.0%) and two days (10.8%) post admissions respectively. Conclusion: The commonest cause of death in the ED was stroke. The burden of death was highest in the younger age group, with most occurring less than 24 hours of admission. Keywords: Emergency department; duration; mortality.

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Quality of life of tinnitus patients with and without hearing loss

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20205616 ◽

2020 ◽

Vol 7 (1) ◽

pp. 11

Author(s):

Oluyomi S. Ayodele ◽

Segun Segun-Busari Segun-Busari ◽

Kayodele H. Omokanye ◽

David A. Dunmade ◽

Emmanuel F. Ologe

Keyword(s):

Quality Of Life ◽

Hearing Loss ◽

Pure Tone Audiometry ◽

Female Ratio ◽

Age Range ◽

The Relationship ◽

Male To Female ◽

Significant Health ◽

Moderate Hearing Loss

Background: Tinnitus is a common, irritating and often disturbing symptom. It poses big challenge to the patients’ management and affects their quality of life (QoL). Tinnitus is one of the most common otological symptoms associated with hearing loss. The aim of the study was to determine the quality of life of adult tinnitus patients and the effect presence of hearing loss has on the quality of life.Methods: All consenting adults presenting with tinnitus with or without associated hearing loss were recruited. Sociodemographic information, clinical assessment, pure tone audiometry (PTA) and QoL assessment with Tinnitus Functional Index (TFI) were carried out. The data collected were analysed and results were presented in tables and simple chart. Results: The age range of participants was between 18 and 80 years with a mean age of 51.94 years±17.41. Male to female ratio was 1:1.4. The relationship between tinnitus and associated hearing loss was statistically significant with moderate hearing loss found as commonest. Sensorineural hearing loss was the commonest type found. Tinnitus was mostly described as a big problem. The relationship between the TFI scores and presence of hearing loss as well as degree of hearing loss was statistically significant.Conclusions: Tinnitus has a significant health burden which tends to increase with co-existing hearing loss. PTA assessment and measurement of QoL should be advocated as routine for tinnitus patients no matter the cause of tinnitus and also especially among those with self-professed normal hearing.

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GALLBLADDER STONES SPECTRUM IN SAUDI POPULATION BY USING ULTRASONOGRAPHY

International Journal of Advanced Research ◽

10.21474/ijar01/12423 ◽

2021 ◽

Vol 9 (02) ◽

pp. 97-103

Author(s):

Abdullah Hamdan ◽

◽

NasraldeenAlnaeem M. Alkhidir ◽

Abdelmoneim Saeed ◽

◽

...

Keyword(s):

Spinal Cord ◽

Microsoft Excel ◽

Female Ratio ◽

Gallbladder Stones ◽

The Social ◽

Common Causes ◽

Upper Abdominal ◽

Age Range ◽

Male To Female ◽

Spinal Cord Injured

Objective:This study was designed with an aim to determine the incidence of gallbladder stonesandto evaluate the accuracy of ultrasonography in the diagnosis of calculus, occur in Saudi patients whom presents at the Radiology and Ultrasound Department. Materials and method: Retrospective study in the period 22 August 2020 to 22 December 2020, a total of 108 patientsunderwentultrasound. When the gallbladder is investigated using ultrasound imaging (US) modality. Ultrasound instrument used was spatial digital U22 Philips Convex probe 3.5 Data analysis performed using the tables and computerized systems,ultrasound using different types of ultrasound units with 3.5 MHz and 5 MHz curve linear probes.Statistical analysis was performed using Microsoft Excel Software and the Standard Statistical Package for the Social Sciences version 15 for windows. Result: Out of 108 examined samples [mean age of 29 years male to female ratio of .9:1].Gallstones in this study were more common in the age range from 2 to 39, (58.3%).The most common causes of gallbladder stones are, 0ral contraceptives44(40.7%),Cholesterol28 (25.9%),Biliary dyskinesia 17 (15.7%),Diabetes 12 (11.1%),and Spinal cord injury7 (6.5%)one of the commonest complaints is upper abdominal pain,52(48.1%) and in majority of the cases the etiology is treatable,Nausea30 (27.8%) andVomiting 26(24.1%).Confirmation is done by CT scan 20 (18.5%) for the cases of small gall stones (<2mm) and impacted stones in cystic duct and operations, Cholecystectomy 14(13%) were done for stones large than (>2 cm), who have a nonfunctional or calcified (porcelain) gallbladder and patients for spinal cord injured. Conclusion: Ultrasound (US) is the preferred method for evaluating gallstones with 96% accuracy. The number, size and calcification can be evaluated by virtue of US inversion and attenuation. If there are more than five stones, the accuracy decreases.

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COMPARISON OF CLINICO-SOCIAL PROFILE OF PULMONARY AND EXTRA PULMONARY TUBERCULOSIS IN TERTIARY CARE HOSPITAL IN A RURALAREA: A RETROSPECTIVE STUDY

10.36106/ijsr/4605295 ◽

2021 ◽

pp. 70-72

Author(s):

Gaurav Santosh Nemade ◽

Sumit Nitin Dhus ◽

Arushi Ramesh Shetty ◽

Neha Dhananjay Firake

Keyword(s):

Tertiary Care ◽

Care Hospital ◽

Female Ratio ◽

Extra Pulmonary Tuberculosis ◽

Younger Age ◽

Tobacco Addiction ◽

History Of ◽

Early Case ◽

Male To Female ◽

Clinical Characteristic

BACKGROUND AND OBJECTIVES: The burden of tuberculosis (TB) in India is the highest accounting for 26% of the global incidence. A total of 1.4 million people died from TB in 2019 (including 208 000 people with HIV). India accounts for a fourth of the global burden of TB and 29% of global mortality. Therefore, we carried out this study to compare demographic, lifestyle and clinical characteristic between pulmonary TB (PTB) and extrapulmonary TB (EPTB). MATERIALS AND METHODOLOGY:Aretrospective analysis was carried of 348 patients diagnosed in DOTS centre, Pravara Rural Hospital, Loni. Characteristics of demographic and clinical characteristics were obtained from medical case records. RESULTS:Among the 348 cases, 71.3% were PTB and 28.7% were EPTB including, pleural (36%), meningeal (27%) and lymphatic (20%) cases. The male to female ratio in PTB and EPTB are 1.99 and 1.22 respectively. EPTB was more common at younger age (<25 years). Tobacco addiction (10.9%), diabetes mellitus (4.03%), HIV positivity (12.1%) and history of contact with Tb patients (17.7%) were more likely to be associated with PTB. CONCLUSION:Increased awareness of the risk factors may facilitate early case nding and better management outcomes for these patients.

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Improving Nursing Care Documentation in Emergency Department: A Participatory Action Research Study in Iran

Open Access Macedonian Journal of Medical Sciences ◽

10.3889/oamjms.2018.303 ◽

2018 ◽

Vol 6 (8) ◽

pp. 1527-1532 ◽

Cited By ~ 3

Author(s):

Seyed Majid Vafaei ◽

Zahra Sadat Manzari ◽

Abbas Heydari ◽

Razieh Froutan ◽

Leila Amiri Farahani

Keyword(s):

Emergency Department ◽

Action Research ◽

Nursing Care ◽

Medical Records ◽

Research Study ◽

Collaborative Action Research ◽

Second Phase ◽

Monitoring And Control ◽

Action Research Study

BACKGROUND: Standardization of documentation has enabled the use of medical records as a primary tool for evaluating health care functions and obtaining appropriate credit points for medical centres. However, previous studies have shown that the quality of medical records in emergency departments is unsatisfactory.AIM: The aim of this study was improving the nursing care documentation in an emergency department, in Iran.MATERIAL AND METHODS: This collaborative action research study was carried out in two phases to improve nursing care documentation in cooperation with individuals involved in the process, from February 2015 to December 2017 in an affiliated academic hospital in Iran. The first phase featured virtual training, an educational workshop, and improvements to the hospital information system. The second phase involved the recruitment of human resources, the implementation of continuous codified training, the establishment of an appropriate reward and penalty system, and the review of patient education forms.RESULTS: The interventions improved nursing documentation quality score of 73.20%, which was the highest accreditation ranking provided by Iran’s Ministry of Health and Medical Education in 2017. In other words, this study caused a 32% improvement in the quality of nursing care documentation in the hospital.CONCLUSION: The appropriate practices for improving nursing care documentation are employee participation, managerial accountability, nurses’ adherence to documentation standards, improved leadership style, and continuous monitoring and control.

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Frequency of Patients Passing an Impacted Esophageal Meat Bolus by Conservative Method Alone

Esculapio ◽

10.51273/esc20.2516311 ◽

2020 ◽

Vol 16 (03, july 2020-Septmber 2020) ◽

Author(s):

Ghulam Murtaza ◽

sarwat Hassan Syed ◽

Mohammad Qamar Nasir ◽

Damish Arsalan ◽

Muhammad Awais Amin ◽

...

Keyword(s):

Conservative Management ◽

High Frequency ◽

Clinical Suspicion ◽

Barium Swallow ◽

Single Intravenous Dose ◽

Demographic Information ◽

Food Bolus ◽

Female Ratio ◽

Age Range ◽

Male To Female

Objectives: To determine the frequency of patients passing the impacted esophageal meat bolus by conservative management Methods: After obtaining permission from ethical committee of Hospital,a total of 62 patients meeting the study criteria were recruited in the study which was conducted in Department of Otorhinolaryn-gology, Services Hospital, Lahore. Demographic information (name, age, gender, contact) was also obtained. Patients with clinical suspicion of impacted esophageal food bolus of age 20-50 years of either gender were included. Patients with known esophageal abnormalities like stricture, web or growth on either barium swallow or esophagogastroduodenoscopy, peptic ulcer and GERD were excluded. After taking informed written consent from each patient, single intravenous dose of buscopan 20mg was given to each patient. Each patient was followed by the researcher himself for 24 hours to assess the passage of food bolus. Results: 20-50 years was the age range in our study, with mean age being 34.10± .63 years. Majority of the patients 32 (51.61%) were between 20 to 35 years of age. Out of 62 subjects, 37 (59.68%) were male, 25 (40.32%) were females with male to female ratio 1.5:1. In our study, Frequency of patients passing the impacted esophageal meat bolus by conservative management was found in 51 (82.26%) patients. Conclusion: This study concluded that there is a high frequency of patients passing the impacted esophageal meat bolus by conservative management. Keywords: Esophagus, foreign body, conservative management.

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Management of Adult Renal Tumours: Review of Nine (9) Years Experience

European Journal of Medical and Health Sciences ◽

10.24018/ejmed.2020.2.5.515 ◽

2020 ◽

Vol 2 (5) ◽

Author(s):

Ngwobia Peter Agwu ◽

Abdullahi Khalid ◽

Uzodimma Ejike Onwuasoanya ◽

Abdullahi Abdulwahab-Ahmed ◽

Abubakar Sadiq Muhammad ◽

...

Keyword(s):

Late Presentation ◽

Molecular Therapy ◽

Female Ratio ◽

Review Period ◽

Urological Malignancies ◽

Clinical Presentations ◽

Renal Tumours ◽

Male To Female ◽

Management Challenge

Background: Renal tumours appear to be relatively uncommon in our routine urological practice compared to other urological malignancies of bladder and prostate origins. Their presentations are often late despite increasing availability and affordability of routine imaging modalities for early detection. This therefore poses management challenge in our environment. This study aims to review our 9-year experience with the management of renal tumours at the Urology Unit of a tertiary health facility in North-western Nigeria Methodology: A retrospective review of 20 patients managed for renal tumour at our facility from September 2009 to August 2017. Data of all adult patients managed for renal tumours was retrieved and analyzed using SPSS 20.0 version for windows. The results were presented in percentages and mean ± SD as well as charts. Results: Twenty (20) patients were managed for renal tumours during the review period. The mean age of patients was 39.94 ± 12.19 years with median of 35 years and male to female ratio of 1:2. Nineteen (19) patient (95%) and 1(5%) had malignant and benign renal tumours respectively. Clinical presentations were flank mass seen in 18 patients (90%), flank pain 16 (80%), haematuria 10(50%), cough 2(10%), and pleural effusion 2(10%). Only clinical stages III and IV tumour were seen. 70% were clear cell variety while 5% was angiomyolipoma. Sixteen (80%) of patients had radical nephrectomy and two (10%) with inoperable tumour benefited from targeted molecular therapy preoperatively using Sorafenib. Conclusion: Late presentation of patients with renal tumours to our facility despite the availability of imaging facilities such as ultrasound scanning is still the norm. This makes surgery which offers best chance of survival and quality of life difficult and challenging. Targeted therapy using sorafenib, if available and affordable in our environment will be useful in management of patients with inoperable tumours.

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OUTCOME OF DACRYOCYSTORHINOSTOMY WITH OR WITHOUT SILICON INTUBATION IN PRIMARY NASOLACRIMAL DUCT OBSTRUCTION

Journal of Saidu Medical College, Swat ◽

10.52206/jsmc.2011.1.2.55-59 ◽

1969 ◽

Vol 1 (2) ◽

pp. 55-59

Author(s):

Haroon Rashid ◽

Faizur Rahman ◽

Abid Naseem ◽

Arshad Iqbal.

Keyword(s):

Nasolacrimal Duct ◽

Nasolacrimal Duct Obstruction ◽

Interventional Study ◽

Female Ratio ◽

Duct Obstruction ◽

Number Of Patients ◽

Silicon Tube ◽

Complications Rate ◽

Age Range ◽

Male To Female

Objectives: The objective of the study was to compare the outcome of Classical Dacrocystorhinostomy(DCR) alone or with Slicon intubation in patients of primary nasolacrimal duct obstruction.Study design: This is a randomized prospective interventional study performed at Saidu Teaching Hospitalform from 1st January'2006 to 31st December 2006.Material and methods: Diagnosis of nasolacrimal duct obstruction was made on basis of history, clinicalexamination, regurgitation test and syringing of the nasolacrimal passage. Patients were selected byconvenient sampling and were randomized to two groups, for DCR with and without Silicon tube. Silicontube was removed after 4 months of surgery. Patients were followed up to 6 months.Results: Total number of patients was one hundred. Fifty (50%) patients were operated with siliconintubation and 50 (50%) without silicon intubation. Male to female ratio was 1:1.27.Age range was 15 yearsto 80 years. Mean, median and mode ages were 42.54, 47 and 30 years respectively. Eleven patients werelost from the study at various stages and were not included in the results of the study. The complicationsnoted were silicon tube loss in 2 cases, silicon tube displacement in 3 cases and DCR failure in 4 cases.Among the failure, 2 cases belonged to each group with and without silicon intubation.Conclusions: We conclude that the complications rate with and without silicon intubation is the same inprimary nasolacrimal duct obstruction. It is therefore, recommended that silicon intubation may not benecessary in such cases.Key words: DCR, Intubation, NLD Obstruction.

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Diagnostic Accuracy of Rapid Diagnostic Kits Test for Diagnosis of Malaria

10.53350/pjmhs2115102826 ◽

2021 ◽

Vol 15 (10) ◽

pp. 2826-2828

Author(s):

Muhammad Ahsan Zafar ◽

Sidra Khalid ◽

Talha Munir

Keyword(s):

Diagnostic Accuracy ◽

Gold Standard ◽

Female Ratio ◽

Diagnostic Kits ◽

Negative Results ◽

Malaria Antigen ◽

The Mean ◽

Sensitivity Specificity ◽

Age Range ◽

Male To Female

Objective: To assess the diagnostic accuracy of rapid diagnostic kits test for diagnosis of malaria taking microscopy as gold standard Methodology: A total of 375 cases with age range 18-65 years of either gender as suspected for malaria were included in the study. We excluded all those cases already taking anti-malarial drugs. The study was conducted at Chughtais Lahore Lab, Lahore. Required blood sample were obtained following aseptic measures. Malaria RDT SD Bioline Malaria Antigen Pf/Pan (Catalogue No. 05FK60, Standard Diagnostics Inc, Hagal-Dong, Korea, from now on referred as “SD RDT”) was used. Patients were labeled as positive or negative on the basis of reports from hematology department assessed by microscopy and patients were labeled as positive or negative Results: The mean age of the patients was 41.84±13.44 years, male to female ratio of the patients was 1.01:1. The sensitivity, specificity, and diagnostic accuracy of the RDT for diagnosing malaria was 96.79%, 96.28% and 96.53% respectively taking microscopy as gold standard Conclusion: Rapid diagnostic kits is very useful reliable test with high diagnostic accuracy for diagnosis of malaria taking microscopy as gold standard Keywords: Microscopy, Rapid Diagnostic kits, Malaria,

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Drug Abuse Deaths in Glasgow in 1992 — A Retrospective Study

Medicine Science and the Law ◽

10.1177/002580249503500306 ◽

1995 ◽

Vol 35 (3) ◽

pp. 207-212 ◽

Cited By ~ 16

Author(s):

Marie T Cassidy ◽

Michael Curtis ◽

Gillian Muir ◽

John S Oliver

Keyword(s):

Retrospective Study ◽

Drug Abuse ◽

Place Of Residence ◽

Female Ratio ◽

Drug Deaths ◽

The Family ◽

Family Home ◽

Age Range ◽

High Degree ◽

Male To Female

A survey of 62 drug deaths in Glasgow showed a wider age range than expected (16–49), a high male to female ratio (44:18) and, where mode of employment had been recorded, a high degree of unemployment (91%). The majority of deaths occurred near centres of known supply. Although a number occurred in the family home, a large proportion were not at the place of residence. In only two cases was morphine detected alone. The majority of the deaths were from combinations of drugs, primarily with benzodiazepines.

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Tracheostomal Stenosis after Laryngectomy: Incidence and Predisposing Factors

Otolaryngology ◽

10.1016/s0194-5998(95)70112-5 ◽

1995 ◽

Vol 113 (3) ◽

pp. 242-247 ◽

Cited By ~ 26

Author(s):

Mark K. Wax ◽

B. Joseph Touma ◽

Hassan H. Ramadan

Keyword(s):

Suture Line ◽

University Hospitals ◽

West Virginia University ◽

Female Ratio ◽

Stenosis Rate ◽

Plastic Type ◽

Minimal Rate ◽

Good Technique ◽

Age Range ◽

Male To Female

Laryngectomy for carcinoma of the larynx has been performed since it was first described in 1880. Since that time the complication of tracheostomal stenosis has plagued both surgeons and patients. The reported incidence of tracheostomal stenosis ranges from 4% to 42%. At West Virginia University Hospitals from 1976 to 1994, 106 patients undergoing laryngectomies on the head and neck oncology service were analyzed. The charts of patients treated before 1991 were reviewed retrospectively; a prospective analysis was initiated in 1991. Only patients with a minimum of 6 months of follow-up were included in this study. The male-to-female ratio was 3:1, with an age range of 28 to 86 years (mean, 58 years). The overall rate of stenosis was 28.4%. The incidence of tracheostomal stenosis was higher in women (46.4%) than in men (21.6%) ( p < 0.05). Since 1991 a plastic type of closure was used in 25 patients. The stenosis rate was 0% in these patients. Before 1991 a bevel or circle technique was used, with stenosis rates of 33% and 75%, respectively ( p < 0.05). Infection at the site of the stoma, fistula, steroid use, neck dissection, pectoralis major myocutaneous flap usage, primary tracheoesophageal puncture, and radiotherapy did not correlate with an increased incidence of stenosis. The most important factor in prevention of stomal stenosis after laryngectomy is attention to detail while forming the stoma. With good technique and a plastic-type closure to break up the suture line, a minimal rate of stenosis should be encountered.

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