Extrapulmonary Tuberculosis Manifests as Middle Ear Tuberculosis: A Rare Case Report from Secondary Health Care Center at Sub-Himalayan Region

Tuberculosis of ear is a rare entity. Early diagnosis and prompt treatment can prevent many serious complications. Here we report a case of 45 year old female with middle ear tuberculosis which was cured with mastoid exploration followed by anti tubercular treatment. Keywords: Tuberculosis, TB, Extrapulmonary Tuberculosis, Middle Ear Tuberculosis, Sub-Himalayan Region

Multiple Chemical Sensitivity in Patients Exposed to Moisture Damage at Work and in General Working-Age Population—The SAMDAW Study

A considerable proportion of patients having respiratory tract or voice symptoms associated with workplace moisture damage (MD) could have multiple chemical sensitivity (MCS). MCS is characterized by symptoms of different organ systems in association with low-level chemical exposure. The objective of this study was to assess the prevalence of MCS among patients referred to secondary health care because of respiratory or voice symptoms associated with workplace MD compared to the general working-age population. Using three subscales of the QEESI© questionnaire, we assessed MCS in the study patients and 1500 controls in the same district randomly selected from the Finnish Population Information System. Study patients had significantly more often high scores in chemical intolerance (39% vs. 23%, p = 0.001), symptom severity (60% vs. 27%, p < 0.001), and life impact subscales (53% vs. 20%, p < 0.001). Asthma, chronic rhinosinusitis, laryngeal problems, and atopy were not associated with the presence of MCS. MCS is common among patients referred to secondary health care with respiratory tract and/or voice symptoms associated with workplace MD, and it considerably affects their everyday life. MCS should be considered as a possible explanatory factor for MD-associated symptoms.

Health care utilisation following childhood acute lymphoblastic leukaemia: a population-based matched cohort study

ObjectivesSurvival among children diagnosed with acute lymphoblastic leukaemia (ALL) has increased considerably. However, morbidity in survivors constitutes a potential increasing burden not limited to secondary health care. Our objectives were to compare health care utilisation, including both primary and secondary health care, between childhood ALL survivors and matched references up to 15 years after curative treatment. Moreover, to increase knowledge on survivors’ health service seeking behaviour as time from treatment elapsed.Design and settingA Danish population-based matched cohort study linking multiple nationwide registries.Participants675 cases, diagnosed with childhood (1.0–17.9 years) ALL between 1994 and 2015, and 6750 matched references sampled randomly from the source population (matched on age, gender and geographical region).Primary outcome measuresRepeated consultations in general practice and hospital (outpatient and inpatient) estimated as yearly rates from 2.5 years after diagnosis and onwards. We compared cases and references with yearly incidence rate ratios (IRRs) from negative binomial regression models.ResultsSurvivors of childhood ALL had a mean number of yearly daytime contacts in general practice of 4.75 (95% CI 4.41 to 5.11) the first year, corresponding to an IRR of 1.85 (95% CI 1.71 to 2.00); decreasing to 1.16 (1.01 to 1.34) after 15 years, and without significant impact of gender (p=0.894) or age (p=0.399). For hospital contacts, ALL survivors had a mean number of yearly contacts of 14.21 (13.38–15.08) the first year, corresponding to an IRR of 31.50 (28.29–35.07); decreasing to 2.42 (1.59–3.68) after 15 years. No differences were found across calendar time.ConclusionsALL survivors used significantly more health care services across sectors than the reference population. Decreasing use over 15 years illustrated the dynamics of health care needs; this knowledge may inform the future organisation of integrated follow-up programmes.Trial registration numberNCT03985826.

Prevalence of Alcoholic Liver Disease in Port Harcourt, Rivers State

Alcoholic liver disease is a severe liver disease that affects substantial number of people in different parts of the world. However, there is low level of awareness regarding the disease and poor knowledge of the risk factors. The present study aimed to determine the prevalence of alcoholic liver disease among the residents of Port Harcourt, Rivers State, Nigeria, as this will both provide a clear picture of the incidence, as well as, aiding the diagnosis and management of the disease and distinguish it from other forms of liver impairment. This cross-sectional, descriptive study was conducted in the University of Port Harcourt Teaching Hospital; a tertiary health facility serving treatment, teaching, health research and referral purposes for primary and secondary health care facilities within Rivers State and its adjoining states. The relationship between gender and age to the assayed parameters were investigated, shows that age (0.793) and sex (0.591) were not statistically significant for the circulating level of aspartate, with age (0.000) significant and sex (0.217) non-significant for alanine amino transaminase, while age (0.830) and sex (1.52) were not statistically significant for gamma T. the prevalence of liver disease is low (8.1%) in the population and this may be attributed to factors such as poor healthcare-seeking attitude among the residents and effective diagnostic tools to detect the anomaly in the liver, especially, at the earliest stages of the disease condition.

Baseline Study for Improving Diagnostic Stewardship at Secondary Health Care Facilities in Nigeria

BackgroundBlood culture diagnostics are a critical tool for sepsis management and antimicrobial resistance (AMR) surveillance. A baseline study was conducted to assess existing sepsis case finding, blood culture diagnostics and antimicrobial susceptibility testing (AST) at secondary health care facilities to inform the development of diagnostic stewardship improvement strategies in Nigeria.MethodsA cross-sectional online survey was conducted among 25 public secondary health care facilities in Abuja, FCT and Lagos State in Nigeria to evaluate the capacity for pathogen identification and AST. Following this, data were prospectively extracted on all patients with suspected sepsis from electronic medical records at two facilities in Abuja from October 2020 to May 2021 to further assess practices concerning sepsis case-finding, clinical examination findings, samples requested, and laboratory test results. Data were descriptively analysed, and a multivariate logistic regression analysis was conducted to determine factors associated with blood culture requests among suspected sepsis patients.ResultsIn the online survey, 32% (8/25) of facilities reported performing routine blood cultures. Only one had access to a clinical microbiologist, and 28% (7/25) and 4% (1/25) used standard bacterial organisms for quality control of media and quality control strains for AST, respectively. At the two facilities where data abstraction was performed, 7.1% (2924/41066) of patients were found to have suspected sepsis. A majority of the suspected sepsis patients came from the paediatrics department and were outpatients, and the median age was two years. Most did not have vital signs and major foci of infection documented. Blood cultures were only requested for 2.7% (80/2924) of patients, of which twelve were positive for bacteria, mainly Staphylococcus aureus. No clinical breakpoints were used for AST. Inpatients (adjusted odds ratio [aOR]:7.5, 95% CI:4.6 – 12.3) and patients from the urban health care facility (aOR:16.9, 95% CI:8.1 – 41.4) were significantly more likely to have a blood culture requested.ConclusionLow blood culture utilisation remains a key challenge in Nigeria. This has implications for patient care. AMR surveillance and antibiotics use. Diagnostic stewardship strategies should focus on improving access to clinical microbiology expertise, practical guidance on sepsis case finding and improving blood culture utilisation and diagnostics.

Hb estimation at point of care using cyanmethaemoglobin method

Background: Accurate estimation of haemoglobin (Hb) is an essential prerequisite for detection of anaemia and for assessing response to treatment. In India the gold standard cyanmethaemoglobin method is used for estimation of Hb in tertiary care institutions but accurate methods for Hb estimation are not being used in primary and secondary healthcare settings. Major national surveys have demonstrated the feasibility and accuracy of Hb estimation by indirect cyanmethaemoglobin method (ICM). However, ICM has not been used for Hb estimation in point of care because of reports that ICM underestimates Hb. A study was taken up to compare the accuracy of Hb estimation by direct (DCM) and indirect cyanmethaemoglobin (ICM) method.Methods: ANMs and laboratory technicians pipetted out duplicate samples of blood for both direct and indirect Hb estimation. Another trained laboratory technician undertook Hb estimation using colorimeter in all samples. Hb values between duplicates were compared.Results: There was excellent concordance between means and frequency distribution of Hb values between duplicates when Hb in both were estimated using DCM or ICM and also when Hb estimation was done by DCM in one and ICM in the other. Bland Altman Plots confirmed that across Hb levels there was excellent concordance between direct and indirect method of Hb estimation.Conclusions: Indirect cyanmethaemoglobin method is accurate. It can be used at point of care for screening for anaemia and assessing improvement in Hb after treatment especially in primary and secondary health care settings.