Assessment of laboratory test request forms for completeness

Background: Laboratory test request forms usually accompany patient’s samples to the laboratory, providing biodata and clinical details of the patient. This information is for purposes of identification and guiding pathologists to accurately interpret patient’s result. Clinicians however do not usually provide all the required information, thus making interpretation difficult. The frequency of such incompleteness is assessed in this study.Methods: Laboratory request forms received at the Chemical Pathology laboratory between July and September 2020 were assessed for completeness of all the required parameters. Parameters analyzed in this study included age, gender, hospital number, location, clinical information, name of requesting physician and the date of request. Frequency of missing parameters were expressed as proportions (%) of the total omissions.Results: There were 1906 request forms received during the course of this study and 789 (41.4%) of them had at least one missing parameter. Apart from patients’ names, nature of sample and the requested investigation, all other parameters were omitted at one time or the other making a total of 1117 omissions. Age (287; 25.7%) hospital number (264; 23.6%) and clinical information (246; 22%) were the most commonly omitted parameters. Majority of the omissions (69%) were from the outpatient clinics, 20% were from the wards while 10% of the forms had no ward or clinic indicated.Conclusion: Incomplete filling of laboratory test request forms is a regular occurrence among clinicians. Effort must be made to continually sensitize them of the importance of each of the required parameters to ensure a visible improvement.

The level of matrix metalloproteinase-9 in the serum as a prognostic sign in extrasphincteric fistulas of the rectum

Background. Acute or chronic rectal fistulas make up to 30% of proctologic pathology and are accompanied by significant impairment of patients` lives. In recent years, the role of matrix metalloproteinases in the pathogenesis of many diseases has grown rapidly. The most widely expressed protease in inflamed tissues is matrix metalloproteinase-9 (MMP-9).Objectives. To identify and analyze changes in the level of MMP-9 in the serum of patients with extrasphincteric fistulas of the rectum, depending on the method of surgery.Methods. The study involved 28 patients with extrasphincteric rectal fistulas, who undergone surgery in the proctology department of Poltava Regional Clinical Hospital and the surgical department of the 3rd city clinical hospital in Poltava from 2010 to 2018. The patients were divided into 2 groups according to the method of surgical treatment. Quantitative determination of MMP-9 in blood serum was performed.Results. In the main group, the average value of MMP-9 before surgery was 14.90 ± 0.15 ng/ml, a month later it decreased to 7.73 ± 0.37 ng/ml (p˂0.0001), and after three months, the average value of MMP-9 was determined at 2.41 ± 0.13 ng/ml (p˂0.0001). In the comparison group, the initial average value was 15.00 ± 0.08 ng/ml, which decreased to 11.89 ± 0.26 ng/ml (p˂0.0001), and three months after surgery it decreased to 4.14 ± 0.17 ng/ml (p˂0.0001).Conclusion. The use of MMP-9 levels in blood serum before and after surgery has determined that the method of treatment of extrasphincteric fistulas using the drug Tachocomb is less traumatic and reduces the healing time of postoperative wounds compared to the ligature method.

Patient autonomy

Patient autonomy is one of the most important ethical values in the health care practice. Patients’ autonomy means the right of patients to make decisions about their medical care without their health care provider trying to influence the decision. Patients’ autonomy allows health care providers to educate the patients but do not allow them to make the decision for the patients.

A Case of Abdominal Cocoon Syndrome: A Rare Cause of Small Bowel Obstruction At Aber Hospital in Northern Uganda

Abdominal cocoon syndrome (ACS) is a rare cause of small bowel obstruction characterized by partial or complete encasement of small bowel loops in a thick fibro-collagenous sac. It poses diagnostic difficulties due to the non-specific nature of its presentation and thus in most cases, diagnosed incidentally at laparotomy.The researchers present a case of a 27-year old female Ugandan who presented to a rural hospital in Northern Uganda with complaints of central abdominal pain, failure to pass stool and bilious vomiting for three days. She also had feelings of a peri-umbilical mass. She had several episodes of related obstructive symptoms that would be self-limiting for a year. She had unremarkable past surgical, past medical and past gynecological history. Laboratory investigations were unremarkable.Preoperative diagnosis of small bowel intussusception was made basing on examination and ultrasonography report and the patient was managed operatively. At laparotomy, almost all the small bowel loops were found encased in a thick, whitish, fibrous membrane. There was also marked inter-loop adhesions. The membranous sac was incised and completely removed using both sharp and blunt dissection. Inter-loop adhesions were released solely by blunt dissection.The patient recovered postoperatively and was discharged on the seventh postoperative day.

Hepatitis E viral infection in pregnant ladies, a challenge for obstetricians and physicians

Background: Hepatitis E Virus (HEV) is the major cause of morbidity and mortality in pregnancy. The virus was detected about three decades ago. The incidence and severity during pregnancy vary widely around the world.Material & Methods: This observational retrospective study was conducted from March 2019 to February 2020 in Obstetrics & Gynecology Department of Lady Aitchison Hospital, Lahore. 70 pregnant women with hepatitis E were subjected to detailed history taking. The diagnosis was based on positive Hepatitis E IgM (Anti HEV IgM) antibody on laboratory test in current pregnancy in antenatal period up to 42 days post partum were included.Results: Out of 70 pregnant women with Hep E IgM+ve, 3 (4.3%) women had Obstetrical hysterectomy as complications, with mean age of 26.0 ± 4.69 years. The mean gestational age when infection occurred was 31.12 ± 5.18 weeks. Among all females 9 (13%) patients expired due to fulminant hepatic failure, 12 (17.14%) females gave birth via spontaneous vaginal delivery (SVD),17(24.2%) females gave birth via C-Section. 30 (42.8%) females were manage conservatively.Conclusion: Hepatitis E viral infection in pregnant females is a life threatening condition. The study showed that pregnant women with jaundice and hepatitis E virus infection had a high mortality rate during third trimester. Early diagnosis and management will help in the control of the disease and prevents its complications.

Loneliness and Cardiovascular Disease

Loneliness is a silent social epidemic that affects more than one third of the US population. Cardiovascular diseases impart a huge morbidity, mortality, and financial burden on our society. The detrimental role of loneliness in cardiovascular diseases is being increasingly recognized. Besides having a direct molecular effect on cardiovascular diseases, loneliness also encourages poor compliance with healthy lifestyles, that play a significant role in preventing and improving cardiovascular diseases. This brief review highlights the ominous effects of loneliness on cardiovascular diseases.

Factors Influencing Utilization of Maternal Health Services by Adolescent Young Mothers Aged 15-19 Years in Kiryandongo General Hospital

Background: In Uganda, 25 % of adolescents age 15-19 have already begun childbearing, 19 % have already given birth and another 5 % pregnant with their first child. Utilization of maternal health services is, therefore, an effective approach to reducing the risk of maternal morbidity and mortality. Low utilization of Maternal Health Services (MHS) has been registered in many parts of Uganda.Objective: To identify the key factors that influenced the utilization of MHS by adolescent young mothers aged 15-19years in Kiryandongo general HospitalMethods: A Cross Sectional analytical design, both quantitative and qualitative was used. A total of 98 adolescent young mothers were randomly selected. Data was collected using semi-structure questionnaires and analyzed using SPSS version 19.Results: Level of utilization of MHS was 44.9%. The socio-demographic (personal) factors that significantly influenced MHS utilization were; maternal age (COR= 0.29; 95% CI: 0.13-0.67, p = 0.003), husband’s education level (COR= 0.19; 95% CI: 0.08-0.47, p =0.000) and husband’s monthly income (COR= 0.35; 95% CI: 0.15-0.80, p = 0.012). Health System factors that influenced MHS utilization included; Time for travelling to reach health facility (COR=2.39; 95% CI: 1.03-5.52, p = 0.040) and Cost of the health services (COR= 2.68; 95% CI: 1.17-6.15, p =0.019).Conclusion: Strategies in addressing decision-making norms, engaging in massive community dialogue and designing appropriate communication strategies may help improve MHS utilization.

Antibiotic susceptibility of bacterial strains isolated from urinary tract infections inPakistan

Background: Urinary track infection (UTI) is a common infection in Pakistan. Poor knowledge about personal hygiene and lack of awareness are major reasons of this infection. All over the world and in Pakistan E. coli and K. pneumonia are main causative agents of UTI.Objectives:To analyze Antibiotic susceptibility pattern of bacterial strains isolated from urinary tract infections.Methods: In present study total 227 samples from Genomic Research Lab and Diagnostic Center Rawalpindi, Pakistan were tested for presence of different microbial infectious agents and their antibiotic resistance and susceptibility pattern. Biochemical test such as Gram staining, Lactose fermentation test, Motility test, Catalase test and Colony formation on MacConkey agar, Indole test, and Citrate utilization test were applied. The antibiotic susceptibility and resistance pattern was evaluated by using fourteen different antibiotics on MullarHigton agar. Top ten antibiotics were selected at a cut off value of 100 samples for E. coli and 20 samples for Klebsiella.Results: Against E. coli and K. species the most susceptible antibiotic was Imipenam with 97.5% and Amikacin with 94.9% susceptibility respectively. Moreover, against E. coli and K. species the most resistance antibiotic was Ciprofloxacin 81.7% and Tobramycin with 76.1% resistance respectively. The comparison of present study with pervious studies had shown an increase in resistance against various antibiotics.Conclusion: It is concluded from the present study that antibiotic resistance is on raise in Pakistan and the effect of each antibiotic was different with respect to type of infectious agent so it is recommended that the doctor should determine the dominant type of infectious agent and its susceptibility response before prescription of any antibiotic.

Qualitative study of roles of religious leaders in promoting adolescent sexual reproductive health and rights in Iganga municipality Uganda

Introduction: Young people in adolescent stage are very vulnerable. Sexual and reproductive health choices they make as they transition from childhood to adulthood determine a lot about their well-being.Objective: To assess the role of religious leaders in promoting adolescent sexual and reproductive health rights in Iganga Municipality.Methodology: Qualitative phenomenological design was used. Sample of 30 participants (25religious leaders and 5adolescents) were interviewed. Data was collected using in-depth interviews, transcribed, coded and analyzed using thematic content analysis.Results: Information shared by religious leaders to adolescents helped them to live responsible lives. Results also indicated that; religious leaders perceived promotion of ASRHR to imply elevation of sexual immorality. Religious leaders had both protective and preventive influences on promotion of ASRHR.Conclusion: Religious leaders greatly contribute to promotion of ASRHR by enhancing information sharing. Dialogues, therefore, enhances their awareness about ASRHR and gives them confidence to address the matter with adolescents.

Safety and efficacy of double vs. triple antithrombotic therapy in patients with atrial fibrillation with or without acute coronary syndrome undergoing percutaneous coronary intervention： a systematic review and meta-analysis of vitamin k antagonist a

Objective: To compare the safety and efficacy of double therapy (DT) (no aspirin) versus triple therapy (TT) (with aspirin) antithrombotic drugs in patients with atrial fibrillation and acute coronary syndrome or underwent percutaneous coronary intervention (PCI).Methods: We searched PubMed, Cochrane, Scopus, and Web of Science for relevant articles from inception to December 2020. We conducted the analysis of dichotomous outcomes using risk ratio (RR) and relative 95% confidence interval (CI), while the continuous outcomes were analyzed using mean difference (MD) and relative 95% CI. Heterogeneous outcomes were analyzed with random-effects model, and homogeneous data were analyzed with fixed-effects model. We assessed the risk of bias among the included studies by using Cochrane’s risk of bias tool.Results: A total of five studies were included. Regarding Major or Minor Bleeding, the overall risk ratio was significantly lower with DT group compared with TT group (RR=0.60 [0.45, 0.81], (P = 0.07)). For the safety endpoint (TIMI major or minor bleeding, TIMI major bleeding) favored DT group over TT group, respectively (RR=0.60 [0.45, 0.81], (P = 0.07)); (RR= 0.55 [0.43, 0.70], (P < 0.01)). Intracranial hemorrhage did not differ between both groups (RR=0.62 [0.37, 1.05], (P = 0.07)). The efficacy endpoint, all-cause death showed no significant difference between both groups (RR=1.08 [0.89, 1.31], (P = 0.42)). There were no significant differences between two groups in cardiovascular death, stent thrombosis, myocardial infarction and stroke, respectively (RR=1.10 [0.86, 1.41], (P = 0.43); (RR=1.40 [0.92, 2.12], (P = 0.11); (RR=1.20 [0.98, 1.49], (P = 0.08); (RR=0.95 [0.66, 1.37], (P = 0.79).; respectively).Conclusion: Compared with triple antithrombotic therapy, double antithrombotic therapy is associated with lower bleeding risks, including minor and major bleeding, but the incidence of efficacy endpoints was similar between both groups.