Knowledge, attitude, practice of hand hygiene among nursing staff in medicine ICU in a tertiary health care centre in Western India

Background: Hospital infection is one of the leading cause of public health related issue throughout the world. Hand hygiene is one of the leading measure used to prevent cross-transmission and thus to reduce health care associated infections.Aims & Objectives: To assess knowledge, attitude and practice about hand hygiene in nursing staff in medicine ICU in a tertiary health care centre.Methodology: Total 48 medicine ICU nursing staff were given open ended questionnaire on knowledge, attitude and practice of hand hygiene. Score were given for correct option and data was filled and analyzed in MS Excel softwareResults: Compliance in knowledge (62 %) and attitude (81 %) for hand hygiene was good. Performance in practice of hand hygiene was 54 % which was comparatively lower.Conclusion: Compliance of hand hygiene practice was lower compared to knowledge and attitude and needs to be addressed in the form of continued medical education.

Yellow fever outbreak in Plateau state, Nigeria: A re-emerging disease or a case of misdiagnosis over the years?

Background: The first reported Yellow fever outbreak in Nigeria occurred in 1931.The latest outbreak in Nigeria, commenced in September 2017. It is active in seven states and suspected cases have been reported in sixteen states, inclusive of Plateau state. The last reported outbreak in Plateau state occurred in Jos in 1969 with an estimated 100,000 cases.Materials and Methods: The cases and health workers involved in management were interviewed. Hospital records, laboratory and surveillance data were reviewed.Results: Case 1: A 6-year-old girl from Tudun-Wada, Jos Plateau state presented with fever (38.6oC), abdominal pain, sore throat and jaundice. Liver function test (AST: 398U/L, ALT: 96U/L). Treatment included ribavirin, ceftriaxone, anti-oxidants, intravenous fluids, blood transfusion. ELISA-IgM was positive for YF, but negative on PNRT.Case 2: A 10-year-old boy from the same family with case 1 presented with fever (39.0oC), abdominal pain, diarrhoea and jaundice. Liver function test (AST: 315 U/L, ALT: 126U/L). Treatment is same as case 1 plus metronidazole. ELISA-IgM was positive for YF, but negative on PNRT, while PCR was positive for Lassa fever.Twenty-three contacts (17 healthcare workers, 6 family members) were traced and daily monitoring instituted.Conclusion: The potential for a major urban outbreak of Yellow Fever in Plateau state and Nigeria is already present. Advocacy, health education and enforcement of vector control measures need to be intensified by the State Ministry of Health. Surveillance for rapid case finding and proactive vaccination also need to be intensified to forestall a disaster.

P210 and P190 BCR-ABL fusion transcripts variants frequencies among Philadelphia chromosome-positive chronic myeloid leukemia in Sudan

Breakpoint cluster region-abelson (BCR-ABL) leukemic fusion gene types in chronic myeloid leukemia (CML) correlate with the disease clinical course and outcome. There are variations in the reports of previous studies about the frequencies and distribution of BCR-ABL transcripts in chronic myelogenous leukaemia among Sudanese patients. This research aims to determine the frequencies of BCR-ABL fusion transcript variants in Sudan. One hundred (informed consent) Philadelphia positive chronic myeloid leukaemia patients, in chronic phase, were enrolled in this study. EDTA anticoagulated peripheral blood samples were collected from each participant, RNA was extracted from mononuclear cells by (TRIzol) reagent. BCR-ABL transcripts were detected by qRT-PCR technique with specific primers forP190 and P210 BCR-ABL transcript variants. The typical p210 BCR-ABL transcripts (b3a2 or b2a2) were detected in all patients (100%) the b3a2 transcript was detected in 96/100 (96%) and the b2a2 transcript was detected in 4/100 (4%).co-expression of p210/p190 (b2a3/e1a2) was detected in 6/100 (6%). p190 variant was not detected independently.

Gender based normative values of pattern-reversal visual evoked potentials in school age children

Background: Male and female brain develops differently. Gender is one of biological variables that influence visual evoked potentials (VEP). Some previous studies support the existence of sex related VEP difference while others not. This study is an attempt to explore if any difference exists in VEP responses between genders of children age seven to 10 years with an additional aim of documenting preliminary normative VEP data.Methods: This cross-sectional study was done on consenting children taken from parents (n=76; girls, n=41, age = 8.39±1.11years; boys, n=35, age =8.40±1.09 years). Pattern reversal VEP of these children was recorded as per standard method. Latencies of N75, P100, and N145 (ms); amplitude of P100 (μV) and ratio; interocular asymmetry (ms) of both eyes were calculated. Unpaired t-test was applied for statistical analysis. Ethical clearance was obtained prior to the study. Result: Girls had decreased VEP latency of P100 than boys in left eye (108.15±8.42 vs. 112.71±11.17ms, p = 0.046), in right eye (107.71±8.52 vs. 114.46±10.98 ms, p = 0.004), and in combination of both eyes (107.92±8.07 vs. 113.58±10.36 ms, p = 0.009). Likewise, girls had decreased VEP latency of N75 than boys in right eye (67.44±6.77 vs. 71.29±8.07 ms, p = 0.027) and in combined eyes (67.23±5.19 vs. 70.14±7.31 ms, p = 0.047). A gender difference in P100 amplitude was not detected.Conclusion: Visual evoked potential differs with gender in prepubertal children aged seven to 10 years.

“Bouquet technique” for displaced boxers fracture: Surgical technique and outcomes in143 consecutive cases

Background: Fifth metacarpal neck fractures, also known as Boxer’s fractures, commonly occur as a result of axial impact on a clenched fist. There is no agreement over the optimum management of undisplaced boxers fracture. We present the results of treatment by a Bouquet technique, described by Foucher in 143 consecutive cases of displaced fifth metacarpal neck fractures.Methods: We retrospectively reviewed our records for 143 consecutive cases of fifth metacarpal neck fractures treated with Bouquet technique. Clinical and radiological evaluation was done at 6 weeks, 12 weeks and 6 months. Total active motion of the fifth digit, radiography and complications if any were noted.Results: Of 143 cases, there were 113 cases with closed reduction and 30 with open reduction. Radiological union was achieved in 140 cases. Remaining 3 were lost to follow up. Good to excellent result was achieved in 95% cases. Seven cases developed bursitis at the K-wire entry site which required k-wire removal.Conclusion: The technique of flexible antegrade intramedulary nailing of fifth metacarpal neck fractures is simple, safe, soft tissue sparing, minimally invasive technique giving excellent functional and cosmetic results with minimal complications.

Evaluation of Serum Creatine Phosphokinase as a Marker of Severity in Organophosphorus Poisoning

Background & Objectives: Organophosphorus (OP) poisoning is an important global health problem. Estimation of erythrocyte cholinesterase (EChE) and butyrylcholinesterase (BChE) as an evidence of OP poisoning is costly and not regularly performed. There are emerging options for new cheaper biochemical markers in relation to OP poisoning like creatine phosphokinase (CPK). The objectives of this study were to measure serum CPK level and correlate it with severity of poisoning, to evaluate clinical and prognostic significance of CPK in OP poisoning, to assess if serum CPK level can be used as an alternative of BChE level to stratify OP poisoning severity.Method: Total 100 patients of OP poisoning without any prior treatment, presenting within 12 hours, were selected and their clinical severity was categorized according to Peradeniya Organophosphorus Poisoning (POP) scale. Level of serum CPK, blood BChE and pH were measured and total dose of atropine required (mg) until final clinical outcome was calculated.Results: Out of 100, 43% patients had mild, 36% moderate and 21% severe clinical picture. There was a significant positive correlation between serum CPK value and requirement of atropine dose in patient with severe POP scale category and negative correlation with pH and serum cholinesterase levels, indicating that more severe the poisoning more will be serum CPK and requirement of atropine doses while less will be pH and serum cholinesterase, (p<0.0001).Conclusions: This study suggests role of serum creatine kinase as surrogate, relatively cheap and easily quantifiable markers of severe OPC exposure and their association.

Impact of sensitization workshop on knowledge regarding tuberculosis among graduate students of rural area of Bareilly District

Background: Tuberculosis (TB) is a major public health concern worldwide. It has been seen that TB control efforts worldwide are although impressive, but not sufficient. Information, Education, and Communication (IEC) are an integral and important strategy of the program to create awareness among general public. Objective: The study was conducted to assess the impact of sensitization workshop regarding tuberculosis among graduate students of rural area of Bareilly district.Material & Methods: A cross-sectional study was conducted from March 2017 to July 2017 by interviewing 146 students in a college in rural area of Bareilly district, U.P after multistage sampling. A pre-designed and pre-tested questionnaire was used to collect the pre-workshop and post-workshop data. The data obtained was compiled and statistical analysis was done using SPSS version 23.Results: A paired-samples t-test was conducted to analyse the impact of sensitization workshop among the students. The mean scores for knowledge regarding TB symptoms pre-workshop was 3.20 ± 1.90 and post-workshop was 5.68 ± 1.58.Conclusion: Knowledge about various aspects of TB was significantly improved after students attended a training workshop. Efforts should be geared towards education in terms of training and retraining regarding TB, as it is known that IEC activities can create awareness among students, thus eradicating the stigma and fear associated with it.

Study of urinary protein creatinine index in hypertensive patient

Objectives: Proteinuria is a hallmark of glomerular diseases. Uncontrolled high blood pressure increases the risk of glomerular disease leading to proteinuria and high urinary creatinine. So an attempt was made to validate the PCI of a random urine sample as a reliable and a convenient test.Methods: Total of 42 hypertensive patients and 80 controls were selected. Their urinary protein was estimated by urinary dipstick method and colorimetric sulfosalicylic acid method. Urinary creatinine was estimated by modified Jaffe’s method. Protein creatinine index was measured for each patients and controls.Results: It was found that the amount of creatinine in urine in hypertensive patients (0.91 ± 0.29 mmol/dl) was comparable to that in the control subjects (0.86 ± 0.38 mmol/dl).The mean of urinary protein concentration in the hypertensive patients was 13.66 ± 5.77 mg/dl, and in the controls was 8.13 ± 2.82 mg/dl respectively. Highly significant value of PCI were observed in hypertensive patients (153 ±59.08) as compared to the controls where PCI was 114.64 ±47.96 (p<0.001). Conclusion: PCI of a random urine sample can serve as a reliable and convenient test to replace 24 hr urine protein estimation. It can serve as baseline predictor of progression of renal diseases.

Lassa fever: A recurring decimal in Plateau state, Nigeria

Background: Since the first reported case of Lassa fever (LF) in Jos, Plateau state Nigeria in the early 70’s, the state has been plagued with increasing number of cases. This could be due to poor environmental practices, food and personal hygiene. By the end of August 2017 there were 42 reported cases with 15 confirmed cases. Sadly, over the years there have been challenges with reporting and investigation of cases. This could be due to weak health systems commonly seen in developing countries.Methods and Materials: We reviewed 2012-2016 surveillance data from the State Ministry of Health (SMoH) using Microsoft Excel. Descriptive analysis was conducted on the reported LF cases in the state.Results: Between the years 2012 – 2016 there were 109 reported LF cases, with 57 (52.3%) males and 52 (47.7%) females. The mean age of the reported cases was 27.9± 13.6 years. Out of these, 23 (21.1%) were confirmed cases: 1 (4.5%) in 2012, none in 2013, 2014 and 2015, and 21 (91.3%) in 2016.The male: female ratio was10 (43.5%): 13 (56.5%). Six (26.1%) of the confirmed cases were health workers. The case fatality rate of the confirmed cases was 52.2%. Even though there is significant association between LF and death (P-value = 0.003) the odds ratio, 0.215 (95% CI) is low. The reporting years show consistent increasing trend from 2012 to 2016, except for 2015 where there was a decline in the number of reported cases. In 2016 there were 74 (67.9%) cases, 5 (4.6%) in 2015, 15 (13.7%) in 2014, 12 (11.0%) in 2013 and 3 (2.6%) in 2012.Conclusion: Even though reported cases are increasing, there are still gaps observed in the surveillance system of the SMoH. The annual recurrence of LF outbreak in the state without reciprocal preventive efforts on ground to combating it has exposed the populace and health workers to ill-health and death.

Kidney manifestations of diabetes mellitus – A Review

The prevalence of diabetes mellitus, especially T2DM is on the increase worldwide and in a developing country like india, as of date approximately 30 – 40% of population are identified as having DM. Sedentary life style, obesity, increased BMI, insulin resistance, hyperlipidemia, delayed diagnosis and metabolic syndrome are some of the factors that lead to the development of DM. Extensive research have been conducted in this field and still more studies are being undertaken. The first organ affected in all uncontrolled DM patients is the kidney, followed by liver and cardiac. Kidney disease predominantly account for increased mortality among T2DM and is the main cause of CKD as well as DN. Treatment of CKD due to uncontrolled T2DM is still controversial because of the scarcity of evidence available. MA plays a significant role in screening pre and established DM. Increased levels of urate is identified as one of the metabolic disturbances in T2DM. This review article summaries the research findings during the last two decades on the manifestations of kidney disease in T2DM.