early presentation
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2022 ◽  
Author(s):  
Muhaba Batebo ◽  
Bereket Loriso ◽  
Tilahun Beyene ◽  
Yosef Haile ◽  
Samuel Hailegebreal

Abstract Background: Procedures to treat intestinal obstruction range from minimally invasive laparoscopic surgery to more complicated open surgical procedures. It may end with high morbidity and mortality because of different reasons. It is very important to know about the determinants of favorable outcome of surgical management for intestinal obstruction however, little is known about this problem at public hospitals of Southern Ethiopia. Methods: Facility based cross sectional study was conducted. A total of 230 medical records which fulfill the inclusion criteria were used for this study. Variables with p value of less than 0.25 in the bivariate analysis were entered in multivariable logistic regression to control confounding. Finally, odds ratio with 95% confidence interval was used to identify variables which were significantly associated with dependent variable. Results: According to this study the magnitude of favorable surgical management outcome of intestinal obstruction was 177(77.0%) [95% CI, 71.4, 82.4]. Having small bowel obstruction (AOR=2.49) [95% CI 1.91, 5.12], having simple bowel obstruction (AOR=4.32) [95% CI, 2.00, 9.35], early presentation of patients (AOR=4.44) [95% CI, 1.99, 9.92] and intraoperative procedure other than resection and anastomosis was performed (AOR=0.45) [95% CI, .21, .96] were significantly associated with favorable outcome among surgically treated patients.Conclusion: The overall magnitude of favorable surgical management outcome of intestinal obstruction was moderate compared to other study. Having small bowel obstruction, having simple bowel obstruction, other procedure other than resection and anastomosis done, and early presentation of patients were significant predictors. Physicians should diagnose intestinal obstruction early and appropriate interventions should be taken on time before the complication happened. On time consultation and decision at the hospital setting is also recommended.


PLoS ONE ◽  
2021 ◽  
Vol 16 (12) ◽  
pp. e0261308
Author(s):  
Sheeladevi Sethu ◽  
John G. Lawrenson ◽  
Ramesh Kekunnaya ◽  
Rahul Ali ◽  
Rishi R. Borah ◽  
...  

Early presentation for childhood cataract surgery is an important first step in preventing related visual impairment and blindness. In the absence of neonatal eye screening programmes in developing countries, the early identification of childhood cataract remains a major challenge. The primary aim of this study was to identify potential barriers to accessing childhood cataract services from the perspective of parents and carers, as a critical step towards increasing the timely uptake of cataract surgery. In-depth interviews were conducted using a pre-designed topic guide developed for this study to seek the views of parents and carers in nine geographic locations across eight states in India regarding their perceived barriers and enablers to accessing childhood cataract services. A total of 35 in-depth interviews were conducted including 30 at the hospital premises and 5 in the participants’ homes. All interviews were conducted in the local language and audio taped for further transcription and analysis. Data were organised using NVivo 11 and a thematic analysis was conducted utilising the Theoretical Domains Framework (TDF), an integrative framework of behavioural theories. The themes identified from interviews related to 11 out of 12 TDF domains. TDF domains associated with barriers included: ‘Environmental context and resources’, ‘Beliefs about consequences’ and ‘Social influences’. Reported enablers were identified in three theoretical domains: ‘Social influences’, ‘Beliefs about consequences’ and ‘Motivations and goals’. This comprehensive TDF approach enabled us to understand parents’ perceived barriers and enablers to accessing childhood cataract services, which could be targeted in future interventions to improve timely uptake.


2021 ◽  
pp. 004947552110646
Author(s):  
Temitope O Okunola ◽  
Babatunde A Olofinbiyi ◽  
Olusola P Aduloju ◽  
Tolulope Aduloju ◽  
Abiodun Obadeji ◽  
...  

There has been a surge in the incidence and severity of sexual assaults globally with the insurgence of COVID-19 owing to lockdown restrictions. Ekiti Sexual Assault Referral Centre, Ado-Ekiti also known as Moremi Clinic was established in June 2020 as a multisectoral response centre to this surge. Seventy-four survivors accessed medical services from June 2020 to May 2021. Adolescents made up 54.1% while the median age was 14.5 years. Only seven survivors were seen within 24 h of the event and around a quarter had follow-up visits. A quarter of survivors reported repeat episodes of sexual assault. Complications documented were sexually transmitted infections (13.5%), depression (4.1%) and posttraumatic stress disorder (5.4%). There was a failure of contraception in 4.5% of survivors who had taken emergency contraceptive pills. For improvements in quality of care, strategies to ensure early presentation and encourage follow-up visits must be introduced.


2021 ◽  
Vol 108 (Supplement_9) ◽  
Author(s):  
Siobhan Chien ◽  
Khurram Khan ◽  
Lewis Gall ◽  
Colin MacKay ◽  
Andrew Macdonald ◽  
...  

Abstract Background Oesophageal cancer carries a poor prognosis.  Despite the availability of urgent Upper GI endoscopy in the United Kingdom, a substantial proportion of patients with newly diagnosed oesophageal cancer present late with near total dysphagia and an obstructing tumour at the index endoscopy.  There is little data analysing the effect of obstructing oesophageal cancer at presentation on overall prognosis.  The aim of the study was to analyse if patients presenting with obstructing oesophageal cancer have a worse outcome. Methods A retrospective cohort study of all newly diagnosed oesophageal cancers (adenocarcinoma and squamous cell carcinoma) and high grade dysplasia registered in a single UK Regional Upper GI MDT between October 2019 and September 2020 was performed.  Electronic records were interrogated and patients dichotomised into two groups based on if they were obstructed endoscopically or not on the index endoscopy and the results were compared.  Median follow up was 7 months. Results 243 patients (68 (28.0%) obstructed and 175 (72.0%) non-obstructed) with median age of 70 were identified.  There were more females in the obstructed group (44.1% vs 25.7%, p = 0.005).  ECOG performance status was worse in the obstructed group: ECOG-0 (30.9% vs 50.3%, p = 0.006).   Adenocarcinoma was more common in non-obstructed group (69.1% vs 54.4%, p = 0.031).  More patients in the obstructed group had a T4 tumour (38.2% vs 18.9%, p = 0.002), however, nodal and metastatic status were similar.  Rates of curative intent treatment were similar.  At median follow-up of 7 months (IQR 3-13), more patients in obstructed group were deceased (72.1% vs 49.7%, p = 0.002). Conclusions Obstructing oesophageal cancer at presentation is a marker of advanced disease and despite curative treatment intent, overall survival is worse compared to passable tumours. New screening techniques such as Cytosponge combined with public health interventions to encourage early presentation may enable earlier diagnosis and improved survival.


Author(s):  
Rose Sitonma Iwo-Amah ◽  
Felix Chikaike Clement Wekere ◽  
Simeon Chijioke Amadi ◽  
Joseph Ngozi Kwosah

Background: Caesarean section (CS) is one of the most common surgical procedure in obstetrics. It involves a surgical incision made through the abdominal and uterine walls to deliver the foetus and placenta after the period of foetal viability.Methods: This was a cross-sectional study aimed at reviewing emergency caesarean section in Rivers State University Teaching Hospital (RSUTH) over a 5-year period, to determine the prevalence and sequelae. Data were analysed using IBM Statistical Product and Service Solution (SPSS) version 25.0 (Armonk, NY).Results: During the review period, there were 13516 deliveries and 3699 cases of emergency CS, giving the prevalence of emergency CS as 27.4% or 274 per 1000 deliveries. Majority (90%) of the parturient were unbooked. The most common complication in women that had emergency caesarean section was fever (56.4%), followed by endometritis (14.7%), absconding from hospital (8.8%), urinary tract infection (7.1%) and wound infection (6.1%). There was a statistically significant association between types of CS and their sequelae, χ2=1153.9, p<0.001, (95% CI: 0.000, 0.000). Women that had emergency CS were 101 times more likely to have a complication compared to those that had planned CS.Conclusions: The rate of emergency caesarean section is high in RSUTH and with more complications compared to planned caesarean section. Booking for antenatal care, early presentation for delivery, birth preparedness and complication readiness will enhance improved maternal and perinatal outcome. 


2021 ◽  
pp. 174749302110562
Author(s):  
Gabriel M Rodrigues ◽  
Mahmoud H Mohammaden ◽  
Diogo C Haussen ◽  
Mehdi Bouslama ◽  
Krishnan Ravindran ◽  
...  

Background Computed tomography perfusion (CTP) has been increasingly used for patient selection in mechanical thrombectomy for stroke. However, previous studies suggested that CTP might overestimate the infarct size. The term ghost infarct core (GIC) has been used to describe an overestimation of the final infarct volumes by pre-treatment CTP of >10 ml. Aim We sought to study the frequency and predictors of GIC. Methods A prospectively collected mechanical thrombectomy database at a comprehensive stroke center between September 2010 and August 2020 was reviewed. Patients were included if they had a successful reperfusion (mTICI2b-3), a pre-procedure CTP, and final infarct volume measured on follow-up magnetic resonance imaging. Uni- and multivariable analyses were performed to identify predictors of GIC. Results Among 923 eligible patients (median [IQR] age, 64 [55–75] years; NIHSS, 16 [11–21]; onset to reperfusion time, 436.5 [286–744.5] min), GIC was identified in 77 (8.3%) of the overall patients and in 14% (47/335) of those reperfused within 6 h of symptom onset. The median overestimation volume was 23.2 [16.4–38.3] mL. GIC was associated with higher NIHSS score, larger areas of infarct core and tissue at risk on CTP, unfavorable collateral scores, and shorter times from onset to image acquisition and to reperfusion as compared to non-GIC. Patients with GIC had smaller median final infarct volumes (10.7 vs. 27.1 ml, p < 0.001), higher chances of functional independence (76.2% vs. 55.5%, adjusted odds ratio (aOR) 3.829, 95% CI [1.505–9.737], p = 0.005), lower disability (one-point-mRS improvement, aOR 1.761, 95% CI [1.044–2.981], p = 0.03), and lower mortality (6.3% vs. 15%, aOR 0.119, 95% CI [0.014–0.984], p = 0.048) at 90 days. On multivariable analysis, time from onset to reperfusion ≤6 h (OR 3.184, 95% CI [1.743–5.815], p < 0.001), poor collaterals (OR 2.688, 95% CI [1.466–4.931], p = 0.001), and higher NIHSS score (OR 1.060, 95% CI [1.010–1.113], p = 0.018) were independent predictors of GIC. Conclusion GIC is a relatively common entity, particularly in patients with poor collateral status, higher baseline NIHSS score, and early presentation, and is associated with more favorable outcomes. Patients should not be excluded from reperfusion therapies on the sole basis of CTP findings, especially in the early window.


2021 ◽  
Author(s):  
Yohannes Tewolde Kidane ◽  
Addisu Worku Teshome

Abstract Background: Epidemiological studies to determine the pattern of eye disorders among children are important for proper health care planning and management. This study aimed to document the spectrum and frequency of eye diseases of children who attended the pediatric ophthalmology clinic of a tertiary teaching hospital Addis Ababa, Ethiopia. Methods: A cross sectional and convenient sample of 1237, male and female children (16 years and below) with ocular disorders presenting for the first time and those children with settled diagnosis coming for follow up visit between June 1, 2018 to May 31, 2019 were included in the study. Data on age at presentation, sex and diagnosis were collected and analyzed. Eye disorders were classified into various categories. Children were grouped into four age groups. Ratios, percentages and chi square associations were calculated. P< 0.05 was considered statistically significant.Results: Of the children 60% were male. The mean age (standard deviation) of the children was 4.26 (+4.1) years. Patients aged 0–5 years old were the largest group constituting 70.5%. Ocular motility imbalances were the most common ocular disorders seen (32.8 %), followed by childhood cataract (18.4%) and infection and inflammation of eye and adnexa (8.3%). Ocular motility imbalances were recorded more frequently and statistically significant (p < 0.001) among 1­ 5 years age group. Within the childhood cataract category, congenital cataract was more prominent (7.1%). Within the infection and inflammation category, cornea/ sclera infections were more common (3.7%). Conclusions: The study highlights common eye disorders seen in children in a specialized hospital ophthalmic clinic. Ocular motility imbalance, childhood cataract, and infection and inflammation of the eye and adnexa, were the most common occurring disorders. Early presentation was common, and males were more affected than females.


2021 ◽  
Author(s):  
Alphonce N Simbila ◽  
Said S. Kilindimo ◽  
Hendry R. Sawe ◽  
Zawadi E. Kalezi ◽  
Amne O. Yussuf ◽  
...  

Abstract Background: Mortality among under-five children in Tanzania remains high. While early presentation for treatment increases likelihood of survival, delays to care are common and factors causing delay to presentation among critically ill children are unknown. Methodology: This was a prospective cohort study of critically ill children aged 28days to 14 years attending emergency department (ED) at Muhimbili National Hospital in Tanzania from September 2019 to January 2020. We documented demographics, time to ED presentation, ED interventions and 30-day outcome. The primary outcome was delay (>48 hours) from the onset of illness to ED presentation. Logistic regression and relative risk were calculated to measure the strength of the predictor and relationship between delay and mortality respectively. Results: We enrolled 440 (59.1%) critically ill children, their median age was 12 [IQR =9-60] months and 63.9% were males. The median time to ED arrival was 3 days [IQR=1-5] and more than half (56.6%) of critically ill children presented to ED in > 48 hours where by being an infant, self-referral and belonging to poor family were independent predictors of delay. Infants and those referred from other facilities had 2.2 (95% CI 1.3-3.8) and 1.7 (95% CI 1.1-2.7) times increased odds of presenting late to the ED respectively. The overall 30-day in-hospital mortality was 26.5% in which those who presented late were 1.3 more likely to die than those who presented early (RR=1.3, CI: 0.9-1.9). Majority died >24 hours of ED arrival (P-value=0.021).Conclusion: Delayed ED presentation of more than 48 hours from onset of illness was associated with in-hospital mortality. A larger study is needed to evaluate the care pathway of critically ill paediatric patients to identify preventable course of delay to tertiary care facility.


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