Design of a Low Voltage DC Mini-grid for Isolated Healthcare Centres

Primary healthcare centres are essential to any inhabited place in the world. A lack of electrical power from the grid should not be a reason for people in remote rural areas to miss out on basic healthcare. In developing countries like India, rural healthcare centres usually have intermittent or no grid supply and run on diesel generator-based electricity or other conventional sources, if at all there are such centres established. This, however, contributes to environmental degradation and is also expensive to maintain, considering fluctuating fuel prices. To turn the dependence on renewable energy sources like photovoltaics would pave the way to sustainable energy production and utilization, which costs less in the long run. This research work aims at designing an islanded low voltage DC solar mini-grid that will provide enough power to sustain a primary healthcare centre that has less to no access to the national grid. Previous works in this context tend to rely on varying extents of intermittent supply from the national grid, which may not be the reality in most Indian rural areas. Additionally, an unreliable source of power from the grid which is also difficult to predict would make sensitive and important loads less accessible.

Intra-diploic epidermoid cyst: An iceberg lesion

Introduction: Intraosseous epithelial inclusion cysts of the skull, presenting as lytic defects, constitute a very small percentage of the primary intracranial tumours. The case is presented by virtue of not only the rarity of the variant but also to highlight the importance of timely intervention by a neurosurgeon after adequate investigation and in a tertiary care setting. Case Report: A 45 year old female patient presented to the local Primary Healthcare Centre(PHC) with a small scalp swelling in the occipital region. . Intraoperative identification of intracranial extension was made by the surgeon as inferior margin of the swelling couldn’t be reached and also by palpation of the huge bone defect following which the procedure was abandoned midway and patient was referred to our centre for further management. Imaging: Contrast Enhanced Computerised Tomograhy(CECT) revealed a well defined, mixed density lesion with hypodense and an isodense component in right occipital region. Lesion was measuring 4.2(Cranio caudal) x 3.3(Antero posterior) x 3.6( transverse) cm. A sharp marginated bone defect was noted involving both the outer and inner tables of the occipital bone. Operative management: Lesion was approached through a right occipital craniotomy wherein the margins of bone defect were nibbled away to gain a wide access to the lesion. Pearly white, flaky contents of the lesion along with capsule were identified and excised completely. Discussuion: Intradiploic epidermoid cysts are very rare, accounting for <3% of all intracranial epidermoid cysts.(5) These cysts grow very slowly and usually present as painless bony swelling under the scalp. Conclusion: Cranial epidermoid is a fairly common entity and intradiploic variant of the same isnot uncommonly seen in neurosurgical practise. These lesions may present as a small scalp lesion which should not be judged based on its apparent size as these lesions are not infrequently known to have a bigger intracranial extension

Frequency Occurrence and Percentage Distribution of Rh C, Rh c, Rh E and Rh e Blood Group Amongst Pregnant Women Attending Antenatal Clinic in Port Harcourt, Nigeria

Background: The Rhesus (Rh) blood group is one of the most complex blood groups in humans comprising mainly of Rh D, C, c, E and e. However, only Rh D is routinely screened for in Nigeria despite the fact that other Rh antigens are clinically significant and can cause haemolytic disease of the newborn and delayed haemolytic transfusion reactions. Aim: The aim was to determine the frequency distribution of Rh C, c, E and e blood groups among pregnant women attending antenatal clinic in Port Harcourt, Nigeria. Study Design: The study consisted of 147 apparently healthy pregnant women within the age range of 18-45 years, attending a selected Primary Healthcare Centre (Obio Cottage Hospital) in Port Harcourt. The study was carried out from January 20, 2020 to March 27, 2020. The presence of Rh C, c, E and e blood groups were investigated using Anti-C, c, E and e monoclonal antibody in the same order. Results: Rh C, c, E and e were observed in 38.09%, 100%, 17.68% and 100% in the same order. Conclusion: The study indicated dominance of Rh c and Rh e over Rh C and Rh E among the studied pregnant women. It is necessary to take into cognizance the fact that the presence of Rh C, c, E and e antigens may be the cause of some delayed transfusion reactions and haemolytic disease of the foetus and newborn. Therefore, routine antigen typing for Rh antigens may help in decreasing red blood cell allo-immunization and delayed haemolytic transfusion reaction during pregnancy.

Lag Time between Onset of First Symptom and Treatment of Retinoblastoma: An International Collaborative Study of 692 Patients from 10 Countries

Background: The relationship between lag time and outcomes in retinoblastoma (RB) is unclear. In this study, we aimed to study the effect of lag time between onset of symptoms and diagnosis of retinoblastoma (RB) in countries based on their national-income and analyse its effect on the outcomes. Methods: We performed a prospective study of 692 patients from 11 RB centres in 10 countries from 1 January 2019 to 31 December 2019. Results: The following factors were significantly different among different countries based on national-income level: age at diagnosis of RB (p = 0.001), distance from home to nearest primary healthcare centre (p = 0.03) and mean lag time between detection of first symptom to visit to RB treatment centre (p = 0.0007). After adjusting for country income, increased lag time between onset of symptoms and diagnosis of RB was associated with higher chances of an advanced tumour at presentation (p < 0.001), higher chances of high-risk histopathology features (p = 0.003), regional lymph node metastasis (p < 0.001), systemic metastasis (p < 0.001) and death (p < 0.001). Conclusions: There is a significant difference in the lag time between onset of signs and symptoms and referral to an RB treatment centre among countries based on national income resulting in significant differences in the presenting features and clinical outcomes.

A huge haemorrhagic suprarenal pseudocyst: an unusual presentation of a rare condition

Haemorrhagic suprarenal pseudocysts are very rare and are often incidental findings at surgery or autopsy, though they can sometimes present with predominantly gastrointestinal or endocrine symptoms, including intraperitoneal bleeding or sepsis. Our case report is of a 48-year-old man who presented at our primary healthcare centre with 2-month history of predominantly respiratory symptoms of cough and shortness of breath. CT scan revealed a suprarenal cyst measuring 14.2×13.5×13.1 cm for which he was operated and made a full recovery. A detailed literature review reveals that there has never been a case of a haemorrhagic suprarenal pseudocyst presenting with predominantly respiratory symptoms, which is why we decided to document this case report.

Analisis Cost of Illness Pada Pasien Hipertensi Peserta BPJS Rawat Jalan di Puskesmas Banyuanyar

Hypertension is a chronic disease that requires regular therapy to control blood pressure. The cost of treating hypertension can be measured by using a cost-of-illness analysis. The purpose of this study was to find out the total cost of treating hypertensive outpatients participating in BPJS (universal coverage). Who treated with Captopril for one year at the Banyuanyar primary healthcare centre in Sampang Regency. In a study by Baroroh and Sari (2017), hypertension treatment requires a large cost because it is carried out in a long time. Method this study used a non-random sampling technique with a purposive sampling method with criteria that have been determined by the researcher. This research conducted at Banyuanyar Health Center with total sample 40 people. The instrument used was a structured interview which was previously tested for content validity. The data were analyze by using Microsoft® Excel. The result of this study showed that the cost-of-illness for hypertensive patients for one year was Rp 36.140 to Rp 2.528.000. The total range of direct medical costs was Rp 36.140 to Rp 368.000 per patient, the range of direct non-medical costs was Rp 0 to Rp 360.000 per patient, and the range of indirect costs is Rp. 0 to Rp. 1.800.000 per patient. The difference in cost value range was influenced by the frequency of patient visits. Cheaper costs indicated lower frequency of patient visits and disorderly patient compliance, therefore the therapeutic effects achieved were less good. However, more expensive cost indicated higher frequency of patient visits and orderly patient compliance, and be able to achieved better the therapeutic effects. The effect of less maximum therapy is known with often patients buying drugs outside the primary healthcare centre caused by uncontrolled hypertension disease so that it can trigger very high blood pressure at any time, this is related to the nonroutine of patients in carrying out treatment in the primary healthcare centre.

Investigation of the Possible Effects of Injectable and Skin Patch Contraceptives on Selected Haemostatic and Haematologic Parameters in Women Attending Primary Healthcare Centre in Eleme, Rivers State

The was a case control and comparative study aimed at investigating the possible effects of injectable and skin patch contraceptives on selected haematologic and haemostatic parameters in women attending primary healthcare centre at Eleme, Rivers State The study population consists of seventy-five (75) apparently healthy, non-pregnant, non- smoking women, aged between 25 and 45years; (31 women on DEPO-PROVERA contraceptive, 14 women on Implanon, and 30 apparently healthy non-contraceptive users as control group). Fibrinogen, antithrombin, tissue plasminogen activator was analysed with reagents prepared by Elabscience, Wuhan, China, using an ELISA machine (STAT FAX-2100). Prothrombin time and activated partial thromboplastin time was done manually with reagents prepared by Quimica Clinica Aplicada S.A, Spain. Haematologic parameters were analysed using SYSMEX KX-21-N auto analyser. Graph-pad Prism 5.0 was used in analysing all data, p < 0.05 was considered statistically significant. For haemostatic parameters, results showed that there was statistically significant increase in mean values of antithrombin (38.48 ± 17.48/ml versus 21.02 ± 15.54ng/ml, p=0.0011) and tissue plasminogen activator (1.34 ± 1.35ng/ml versus 0.28 ± 0.46ng/ml, p=0.0047) in women using the two types of contraceptive, while activated partial thromboplastin time (28.11± 2.37s versus 29.87 ± 2.77s, p=0.0205) was statistically decreased in women on the investigated contraceptives, other haemostatic parameters were not statistically significant. For haematological parameters, the results showed that there was statistically significant increase in mean values of packed cell volume 38.13 ± 2.28% versus 36.21 ± 3.07% (p=0.0126), haemoglobin 12.35 ± 0.79g/dL versus 11.56 ± 0.99g/dL (p=0.0028), white blood cells 6.17 ± 1.22 x109/L versus 5.26 ± 1.18 x109/L (p=0.0143) in women using injectable (DEPO-PROVERA) and skin patch (IMPLANON) contraceptive, other parameters showed no statistically significance. Based on duration of use of contraceptive, there was no statistically significant difference (p>0.05) in women using skin patch; while for injectable, platelet count was high in those who had used it for more than a year. Comparing values obtained from using injectable and skin patch, there was no statistical significant difference in all the parameters. Using analysis of variance to compare values based on parity, there was no statistical significant difference. Conclusively, increase in antithrombin and tissue plasminogen activator, and a decrease in activated partial thromboplastin time in women using IMPLANON (skin patch) and DEPO-PROVERA (injectable) are the haemostatic changes that occurs while using contraceptives and these changes may likely predispose them to bleeding, therefore adequate monitoring of the blood haemostatic processes while taking these contraceptives is critical in order not to expose users to haemorrhage.

Multiprofessional assessment of patients with chronic pain in primary healthcare

Background and aimsChronic pain is a common reason to seek health care. Multimodal rehabilitation is frequently used to rehabilitate patients with complex pain conditions. The multiprofessional assessment that patients go through before entering multimodal rehabilitation may, in itself, have a positive impact on patient outcome but little is known regarding patients own view. Therefore, the purpose of this study was to discover how patients experienced this multiprofessional assessment project.MethodsTen patients participating in a multiprofessional assessment at a primary healthcare centre in Western Finland were interviewed using a semi-structured interview. Qualitative content analysis was used to analyse the interviews.ResultsThe analysis resulted in six categories of participant description of their multiprofessional assessment experiences and the rehabilitation plan they received. Feeling chosen or not quite fitting in was a category describing participant feelings upon starting the assessment. They expressed their thoughts on the examinations in the category more than just an examination. Being affirmed described participant desire to be taken seriously and treated well. Receiving support described the perceived roles of the team members. Participant negative experiences of the assessment were described in confusion and disappointment. Finally, in taking and receiving responsibilities, participants described their own role in the team.ConclusionsExperiences of patients in a multiprofessional assessment were mostly positive. This highlights the value of a team assessment that takes several aspects of chronic pain into account when assessing complex patients.

¿Qué sabemos sobre el duelo y el final de la vida las enfermeras? A propósito de un estudio mediante grupo focal en Santa Cruz de Tenerife

Introduction and purpose of the research: the authors, members of the End-of-Life Care group at the University of La Laguna (CUFINVIDA), seek to identify areas of improvement concerning end-of-life care, loss and grief in the professional context, from the premise that there is not enough training around this topic. Methodology: phenomenological hermeneutic research through a focus group of fifteen nurses from Ofra Delicias-Miramar primary healthcare centre in Santa Cruz de Tenerife (Spain), carried out in November 2019. Results: Four main categories are identified when delving into what mourning is: the physical space of mourning and death; meaning and context; mourning for deceased children and proposals for improvement. Conclusions: Nurses report not feeling prepared regarding grief and the process of dying. Training is scarce, and it is necessary to consider and reflect on how nurses carry out diagnoses and establish objectives and interventions for people at the end of life or in the mourning process.