scholarly journals Etiology of major limb amputations at a tertiary care centre in Malawi

2019 ◽  
Vol 31 (4) ◽  
pp. 244-248
Author(s):  
Joanna Grudziak
Keyword(s):  
Tertiary Care ◽  
Care Hospital ◽  
Tertiary Care Centre ◽  
Middle Income ◽  
Middle Income Countries ◽  
Below The Knee ◽  
Study Results ◽  
Productive Time ◽  
Kamuzu Central Hospital ◽  
Baseline Demographic

IntroductionAmputations in low- and middle-income countries (LMICs) represent an important cause of disability and economic hardship. LMIC patients are young and suffer from preventable causes, such as trauma and trauma-related infections. We herein studied the etiology in amputations in a Malawian tertiary care hospital over a 9-year period.Methods Operative and anaesthesia logs at Kamuzu Central Hospital (KCH) in Lilongwe, Malawi, were reviewed for 2008–2016. Baseline demographic and clinical variables and type of amputation performed were collected. Only major limb amputations, defined as above or below the knee, above or below the elbow, and above the wrist, were included in this study. Results A total of 610 patients underwent 630 major amputations during the study period. Of these, 170 (27%) patients were female, and the median age of the cohort was 39 (interquartile range [IQR] 25–55). Of these patients, 345 (54.8%) had infection or gangrene recorded among the indications for amputation, 203 (32.2%) had trauma, 94 (14.9%) had cancer and 67 (10.6%) had documented diabetes. Women underwent diabetes-related amputations more often than men (37 out of 67, or 56.1%), and were significantly younger when their amputations were due to diabetes (median age 48 vs 53 years old, P=0.004) or trauma (median age 21 vs 30 years old, P=0.02). The commonest operative procedures were below the knee amputations, at 271 (43%), and above the knee amputations, at 213 (33.8%). ConclusionAmputations in Malawi affect primarily the young, in the most economically productive time of their lives, in contrast to amputees in high-income countries. Preventable causes, such as infection and trauma, lead to the majority of amputations. These etiologies represent an important primary prevention target for public health efforts in LMICs. 

scholarly journals Development of immunohistochemistry services for cancer care in western Kenya: Implications for low- and middle-income countries

2016 ◽  
Vol 5 (1) ◽  
Author(s):  
Kirtika Patel ◽  
R. Matthew Strother ◽  
Francis Ndiangui ◽  
David Chumba ◽  
William Jacobson ◽  
...  
Keyword(s):  
Cancer Care ◽  
Cost Model ◽  
Tertiary Care ◽  
Care Hospital ◽  
Middle Income ◽  
Western Kenya ◽  
Middle Income Countries ◽  
Resource Limited ◽  
Limited Setting ◽  
Low And Middle Income

Background: Cancer is becoming a major cause of mortality in low- and middle-income countries. Unlike infectious disease, malignancy and other chronic conditions require significant supportive infrastructure for diagnostics, staging and treatment. In addition to morphologic diagnosis, diagnostic pathways in oncology frequently require immunohistochemistry (IHC) for confirmation. We present the experience of a tertiary-care hospital serving rural western Kenya, which developed and validated an IHC laboratory in support of a growing cancer care service.Objectives, methods and outcomes: Over the past decade, in an academic North-South collaboration, cancer services were developed for the catchment area of Moi Teaching and Referral Hospital in western Kenya. A major hurdle to treatment of cancer in a resource-limited setting has been the lack of adequate diagnostic services. Building upon the foundations of a histology laboratory, strategic investment and training were used to develop IHC services. Key elements of success in this endeavour included: translation of resource-rich practices to are source-limited setting, such as using manual, small-batch IHC instead of disposable- and maintenance-intensive automated machinery, engagement of outside expertise to develop reagent-efficient protocols and supporting all levels of staff to meet the requirements of an external quality assurance programme.Conclusion: Development of low- and middle-income country models of services, such as the IHC laboratory presented in this paper, is critical for the infrastructure in resource-limited settings to address the growing cancer burden. We provide a low-cost model that effectively develops these necessary services in a challenging laboratory environment.

Trend in the use of neo-adjuvant chemotherapy for the management of muscle invasive bladder cancer at a major tertiary care hospital in Pakistan.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e16033-e16033
Author(s):  
Adnan Abdul Jabbar ◽  
Muhammad Asad Maqbool ◽  
Muhammad Bilal Mirza
Keyword(s):  
Bladder Cancer ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Standard Of Care ◽  
Invasive Bladder Cancer ◽  
Care Hospital ◽  
Muscle Invasive Bladder Cancer ◽  
Middle Income ◽  
Middle Income Countries ◽  
Muscle Invasive

e16033 Background: Although the use of Neoadjuvant Chemotherapy (NAC) has now become the standard of care for Muscle Invasive Bladder Cancer (MIBC) in the world, most patients in lower- middle-income countries (LMIC), like Pakistan, are still undergoing upfront surgery despite being ideal candidates for chemotherapy. Multi-disciplinary tumor boards have been critical in the change of this trend in the developed world. We aimed to assess the trends in the use of NAC for patients with muscle invasive bladder cancer before undergoing definitive surgery. Methods: We included patients who underwent surgery for ≥ cT2 MIBC without distant metastasis between 2011 and 2015 at a tertiary care hospital in Karachi, Pakistan. We retrospectively assessed the trends in NAC compared to upfront surgery in these patients. Results: Among the 171 patients included in our study, only 4 (2.34%) received NAC, whereas the other 167 (97.67%) underwent upfront surgery without NAC. Out of the 90 patients who underwent surgery for MIBC between 2011 and 2013, none of them received NAC and underwent upfront surgery. Among the 81 patients with MIBC in 2014 and 2015, 4 patients received NAC before surgery whereas the other 77 underwent upfront surgery. Conclusions: The adoption of NAC for MIBC remains a challenge in lower- middle-income countries such as Pakistan. Introduction of a multidisciplinary tumor board in our hospital since 2014 has shown a slight change in this trend. Better communication between different departments remains the key in significantly changing the trend of a much desired standard of care.

scholarly journals Study on nutritional status among children up to five years at tertiary care hospital, HIMS, Sitapur, Uttar Pradesh

2021 ◽  
Vol 8 (3) ◽  
pp. 1151
Author(s):  
Ravi Pachori ◽  
Jiratithigan Sillapasuwan
Keyword(s):  
Sample Size ◽  
Tertiary Care ◽  
Uttar Pradesh ◽  
Cross Sectional Study ◽  
Care Hospital ◽  
Normal Children ◽  
Cross Sectional ◽  
Middle Income ◽  
Middle Income Countries ◽  
Sociodemographic Profile

Background: Undernutrition makes children in particular much more vulnerable to disease and death; around 45% of deaths among children up to 5 years of age are linked to undernutrition and these mostly occur in low and middle-income countries. Malnutrition increases health care costs, reduces productivity, and slows economic growth, which can perpetuate a cycle of poverty and ill-health. Objective of the study was to assess the prevalence of underweight (weight-for-age), sociodemographic profile and to determination of differences exist by gender.Methods: The present study was hospital based descriptive cross-sectional study conducted from June 2019 to December 2019. The sample size calculated was 410, and accounting for 10% nonresponsive, the sample size calculated was 451. The data obtained were compiled and entered in MS-excel 2010 and analysed by using institutional SPSS (22.0).Results: Male children 230 (51.0%) was observed higher proportion as compared to female children 221 (49.0%) and same preponderance difference was found among underweight children. Literate fathers belong to 332 (73.6%) children and illiterate fathers belong to 96 (53.0%) underweight children. literate mother belongs to highly significant 283 (62.8%) children and illiterate mothers belong to highly significant 105 (58.0%) underweight children. Majority of father occupation belongs to other type job 294 (65.2) whereas labour occupation mostly belongs to underweight children 109 (60.2%) highly significant and most of the housewives belong to normal children 361 (80.1%) and underweight children 119 (65.8%) highly significant.Conclusions: Health education on nutrition to parents would be beneficiary for underweight children.

scholarly journals The prevalence and clinical characteristics of pertussis-associated pneumonia among infants in Botswana

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Bahaa Abu-Raya ◽  
David M. Goldfarb ◽  
Marek Smieja ◽  
Kathy Luinstra ◽  
Melissa Richard-Greenblatt ◽  
...  
Keyword(s):  
Clinical Course ◽  
Tertiary Care ◽  
Nasopharyngeal Swab ◽  
Care Hospital ◽  
Middle Income ◽  
Middle Income Countries ◽  
Immunodeficiency Virus ◽  
Hiv Exposed ◽  
Exposed Uninfected ◽  
Infants And Young Children

Abstract Background There are scant data on the prevalence and clinical course of pertussis disease among infants with pneumonia in low- and middle-income countries. While pertussis vaccination coverage is high (≥90%) among infants in Botswana, human immunodeficiency virus (HIV) infection affects nearly one-third of pregnancies. We aimed to evaluate the prevalence and clinical course of pertussis disease in a cohort of HIV-unexposed uninfected (HUU), HIV-exposed uninfected (HEU), and HIV-infected infants with pneumonia in Botswana. Methods We recruited children 1–23 months of age with clinical pneumonia at a tertiary care hospital in Gaborone, Botswana between April 2012 and June 2016. We obtained nasopharyngeal swab specimens at enrollment and tested these samples using a previously validated in-house real-time PCR assay that detects a unique sequence of the porin gene of Bordetella pertussis. Results B. pertussis was identified in 1/248 (0.4%) HUU, 3/110 (2.7%) HEU, and 0/33 (0.0%) HIV-infected children. All pertussis-associated pneumonia cases occurred in infants 1–5 months of age (prevalence, 1.0% [1/103] in HUU and 4.8% [3/62] in HEU infants). No HEU infants with pertussis-associated pneumonia were taking cotrimoxazole prophylaxis at the time of hospital presentation. One HUU infant with pertussis-associated pneumonia required intensive care unit admission for mechanical ventilation, but there were no deaths. Conclusions The prevalence of pertussis was low among infants and young children with pneumonia in Botswana. Although vaccination against pertussis in pregnancy is designed to prevent classical pertussis disease, reduction of pertussis-associated pneumonia might be an important additional benefit.

scholarly journals 2029. Prevalence of Antibiotic Use and Administration among Hospitalized Adult Patients at a Tertiary Care Hospital in Kilimanjaro, Tanzania

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S681-S682
Author(s):  
Furaha Lyamuya ◽  
Florida Muro ◽  
Tianchen Sheng ◽  
Rose Mallya ◽  
Tabitha S Uronu ◽  
...  
Keyword(s):  
Median Duration ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Antibiotic Use ◽  
Antimicrobial Use ◽  
Care Hospital ◽  
Middle Income ◽  
Middle Income Countries ◽  
Duration Of Hospitalization ◽  
Kilimanjaro Christian Medical Centre

Abstract Background Antimicrobial stewardship programs (ASPs) have been shown to improve the appropriate use of antimicrobials, especially in high-income countries. However, ASPs are relatively less well implemented in low-or-middle income countries. To improve the effectiveness of ASPs in these settings, it is important to determine the core actions and targets for improving antimicrobial use. We sought to describe the prevalence and patterns of antibiotic use at a tertiary care hospital in Tanzania. Methods Consecutive patients admitted to an adult medical ward at a tertiary care hospital, Kilimanjaro Christian Medical Centre, in Moshi, Tanzania were enrolled from June 2018 to March 2019. The medical record was reviewed for data regarding the type of antibiotics prescribed, indications for use, and microbiologic testing ordered. Results A total of 1103 patients were enrolled during the study period. The majority of patients were males (663, 60.1%), with the median age being 54 years (IQR 39–70). About one-third (390, 35.4%) of the admitted patients received antimicrobials during hospitalization, with pneumonia being the leading indication for antimicrobial use (158, 40.5%). The most commonly used antibiotics included ceftriaxone in 285 (73.1%), metronidazole in 155 (39.7%), and amoxicillin/ ampicillin in 46 (11.8%) patients. The median duration of antimicrobial use was 5 days (IQR 3–7). Few patients on antimicrobials (27, 6.9%) had culture results, of which half (15, 55.6%) were positive for an organism and a minority (8, 29.6%) were susceptible to the antibiotics being used. Overall, mortality in the cohort was 22.7% and the median duration of hospitalization was 5 days (IQR 3–8). Conclusion Antibiotics were used in a substantial proportion of admitted patients. However, in most cases, treatment was empirical with limited use of culture results. Future ASP efforts can target the improved use of microbiologic cultures to target antimicrobial use. Disclosures All authors: No reported disclosures.

CLINICOPATHOLOGICAL PROFILE OF BREAST LESIONS AT TERTIARY CARE CENTRE.

2021 ◽  
pp. 64-66
Author(s):  
S.K. Nema ◽  
Ritika Bharti
Keyword(s):  
Tertiary Care ◽  
Malignant Lesion ◽  
Research Centre ◽  
Breast Lesions ◽  
Care Hospital ◽  
Tertiary Care Centre ◽  
College Hospital ◽  
Duct Carcinoma ◽  
Molecular Features ◽  
Study Results

Background: Breast tissue is a modied sweat gland. Breast lesions present with variety of pathological lesions, ranging from inammatory, non- inammatory, non- neoplastic and neoplastic lesions. Breast carcinoma is multifaceted disease comprised of distinct biological subtypes spectrum of clinicopathological, molecular features and different therapeutic and prognostic implications. The present study was designed to evaluate the frequency, age, gender and histopathological features of breast lesions in a tertiary care hospital. Material and Method: The study was conducted in department of pathology, Index medical college hospital & Research centre,Indore. We retrieved breast specimen received in histopathology department over a period of 24 months from June 2018 to June 2020. A total of 106 cases of breast lesions were included in the study. Results: Out of a total of 106 cases of breast lesions, most common lesions were benign 56 (52.83%) with mean age 30.15 years, followed by malignant 50(47.16%) with mean age 48.16 years . The overall mean age of patients was 40.46 years, with a wide age of 11–88 years. Overall the most commonly reported lesion was broadenoma 35 (33.01%) cases, followed by inltrating duct carcinoma 50 (47.16%) cases, mastitis 3(2.8%) cases, Galactocele 3(2.8%) cases. The maximum cases of malignancy were seen in age group more than 40 years of age of life. Most common malignant lesion was inltrating duct carcinoma. Conclusion: The breast lesions pattern revealed by the present study provides valuable information regarding clinicopathological prole of breast lesions.

scholarly journals Mapping the Implementation of a Clinical Pharmacist-Driven Antimicrobial Stewardship Programme at a Tertiary Care Centre in South India

Antibiotics ◽  
2021 ◽  
Vol 10 (2) ◽  
pp. 220
Author(s):  
Vrinda Nampoothiri ◽  
Akkulath Sangita Sudhir ◽  
Mariam Varsha Joseph ◽  
Zubair Mohamed ◽  
Vidya Menon ◽  
...  
Keyword(s):  
Antimicrobial Stewardship ◽  
Tertiary Care ◽  
Audit And Feedback ◽  
First Year ◽  
Tertiary Care Centre ◽  
Middle Income ◽  
Clinical Pharmacists ◽  
Middle Income Countries ◽  
Major Impediment

In many parts of the world, including in India, pharmacist roles in antimicrobial stewardship (AMS) programmes remain unexplored. We describe the evolution and effect of the role of adding clinical pharmacists to a multidisciplinary AMS at a tertiary care teaching hospital in Kerala, India. Through effective leadership, multidisciplinary AMS (February 2016) and antitubercular therapy (ATT) stewardship programmes (June 2017) were established. Clinical pharmacists were introduced as core members of the programmes, responsible for the operational delivery of key stewardship interventions. Pharmacy-led audit and feedback monitored the appropriateness of antimicrobial prescriptions and compliance to AMS/ATT recommendations. Between February 2016 and January 2017, 56% (742/1326) of antimicrobial prescriptions were appropriate, and 54% (318/584) of recommendations showed compliance. By the third year of the AMS, appropriateness increased to 80% (1752/2190), and compliance to the AMS recommendations to 70% (227/325). The appropriateness of ATT prescriptions increased from a baseline of 61% (95/157) in the first year, to 72% (62/86, June 2018–February 2019). The compliance to ATT recommendations increased from 42% (25/60) to 58% (14/24). Such a model can be effective in implementing sustainable change in low- and middle-income countries (LMICs) such as India, where the shortage of infectious disease physicians is a major impediment to the implementation and sustainability of AMS programmes.

scholarly journals Opportunities and barriers to implementing antibiotic stewardship in low and middle-income countries: Lessons from a mixed-methods study in a tertiary care hospital in Ethiopia

PLoS ONE ◽  
2018 ◽  
Vol 13 (12) ◽  
pp. e0208447 ◽  
Author(s):  
Gebremedhin Beedemariam Gebretekle ◽  
Damen Haile Mariam ◽  
Workeabeba Abebe ◽  
Wondwossen Amogne ◽  
Admasu Tenna ◽  
...  
Keyword(s):  
Mixed Methods ◽  
Antibiotic Stewardship ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Mixed Methods Study ◽  
Care Hospital ◽  
Middle Income ◽  
Middle Income Countries ◽  
Low And Middle Income

scholarly journals Relationship between trajectories of post-stroke disability and self-rated health (NeuroAdapt): protocol for a prospective observational study

BMJ Open ◽  
2021 ◽  
Vol 11 (6) ◽  
pp. e049944
Author(s):  
Sarah K Schäfer ◽  
Robert Fleischmann ◽  
Bettina von Sarnowski ◽  
Dominic Bläsing ◽  
Agnes Flöel ◽  
...  
Keyword(s):  
Observational Study ◽  
Prospective Observational Study ◽  
Tertiary Care ◽  
Functional Health ◽  
Care Hospital ◽  
Duration Of Symptoms ◽  
Post Stroke ◽  
Self Rated Health ◽  
Modifying Factors ◽  
Study Results

IntroductionStroke is the leading neurological cause of adult long-term disability in Europe. Even though functional consequences directly related to neurological impairment are well studied, post-stroke trajectories of functional health according to the International Classification of Functioning, Disability and Health are poorly understood. Particularly, no study investigated the relationship between post-stroke trajectories of activities of daily living (ADL) and self-rated health (SRH). However, such knowledge is of major importance to identify patients at risk of unfavourable courses. This prospective observational study aims to investigate trajectories of ADL and SRH, and their modifying factors in the course of the first year after stroke.Methods and analysisThe study will consecutively enrol 300 patients admitted to a tertiary care hospital with acute ischaemic stroke or transient ischaemic attack (TIA; Age, Blood Pressure, Clinical Features, Duration of symptoms, Diabetes score ≥3). Patient inclusion is planned from May 2021 to September 2022. All participants will complete an interview assessing ADL, SRH, mental health, views on ageing and resilience-related concepts. Participants will be interviewed face-to-face 1–5 days post-stroke/TIA in the hospital; and will be followed up after 6 weeks, 3 months, 6 months and 12 months via telephone. The 12-month follow-up will also include a neurological assessment. Primary endpoints are ADL operationalised by modified Rankin Scale scores and SRH. Secondary outcomes are further measures of ADL, functional health, physical activity, falls and fatigue. Views on ageing, social support, resilience-related concepts, affect, frailty, illness perceptions and loneliness will be examined as modifying factors. Analyses will investigate the bidirectional relationship between SRH and ADL using bivariate latent change score models.Ethics and disseminationThe study has been approved by the institutional review board of the University Medicine Greifswald (Ref. BB 237/20). The results will be disseminated through scientific publications, conferences and media. Moreover, study results and potential implications will be discussed with patient representatives.Trial registration numberNCT04704635.

scholarly journals Effective Utilization of Limited Isolation Rooms to Provide Safe Patient Care and Staff Safety in a Low- and Middle-Income Country

2020 ◽  
Vol 41 (S1) ◽  
pp. s203-s204
Author(s):  
Rozina Roshanali
Keyword(s):  
Emergency Department ◽  
Tertiary Care ◽  
Limited Resource ◽  
Multidrug Resistant ◽  
Communicable Diseases ◽  
Care Hospital ◽  
Middle Income ◽  
Safe Patient Care ◽  
Bed Management ◽  
Resource Setting

Background: My tertiary-care hospital is a 750-bed hospital with only 17 airborne infection isolation room (AIIR) and negative-pressure rooms to isolate patients who have been diagnosed or are suspected with prevalent diseases like tuberculosis, measles, and chickenpox. On the other hand, only 14 single-patient isolation rooms are available to isolate patients with multidrug-resistant organisms (MDROs) such as CRE (carbapenum-resistant Enterobacter) or colistin-resistant MDROs. Due to the limited number of isolation rooms, the average number of hours to isolate infected patients was ~20 hours, which ultimately directly placed healthcare workers (HCWs) at risk of exposure to infected patients. Methods: Plan-Do-Study-Act (PDSA) quality improvement methodology was utilized to decrease the average number of hours to isolate infected patients and to reduce the exposure of HCWs to communicable diseases. A detailed analysis were performed to identify root causes and their effects at multiple levels. A multidisciplinary team implemented several strategies: coordination with information and technology team to place isolation alerts in the charting system; screening flyers and questions at emergency department triage; close coordination with admission and bed management office; daily morning and evening rounds by infection preventionists in the emergency department; daily morning meeting with microbiology and bed management office to intervene immediately to isolate patients in a timely way; infection preventionist on-call system (24 hours per day, 7 days per week) to provide recommendations for patient placement and cohorting of infected patients wherever possible. Results: In 1 year, a significant reduction was achieved in the number of hours to isolate infected patients, from 20 hours to 4 hours. As a result, HCW exposures to communicable diseases also decreased from 6.7 to 1.5; HCW exposures to TB decreased from 6.0 to 1.9; exposures measles decreased from 4.75 to 1.5; and exposures chickenpox decreased from 7.3 to 1.0. Significant reductions in cost incurred by the organization for the employees who were exposed to these diseases for postexposure prophylaxis also decreased, from ~Rs. 290,000 (~US$3,000) to ~Rs. 59,520 (~US$600). Conclusions: This multidisciplinary approach achieved infection prevention improvements and enhanced patient and HCW safety in a limited-resource setting.Funding: NoneDisclosures: None

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