Current Issue : April - June Volume : 2021 Issue Number : 2 Articles : 5 Articles
Background: The WHO recommended DOTS has been proven to be very effective in the treatment of tuberculosis (TB) patients. However, despite its effectiveness, non-adherence to the treatment regimen remains a major concern in TB management. This has great consequences which include persistent infectiousness, higher rates of treatment failure, continued transmission, drug resistance, and untimely death. The aim of this study is to examine the factors and behavioural patterns that contribute to treatment adherence among TB patients in Kano State, Nigeria. Methods: A qualitative study design which included two focus group discussions (FGDs) and four key informant interviews (KIIs) were adopted for this study. In total, 20 participants were interviewed comprising 16 focus group discussion participants (8 patients on treatment and 8 individuals who have been cured) divided into two groups and four key informant interviews with 4 health workers in the selected treatment facilities. Data analysis was done by translating and transcribing the responses from the FGDs and KIIs. The transcribed data was analysed using a thematic framework procedure. Results: It was observed that having a good treatment supporter who was effective and very supportive was the most important factor contributing to treatment adherence. Other identified factors that contributed to treatment adherence included: good communication by health personnel, social support from relatives and communities, little or no side effects from drug usage, low cost of transportation to the health facilities, a positive mind set towards drug usage and treatment, support and motivation from health workers, feelings of wellness during treatment, and a balanced diet. All the respondents agreed that treatment adherence had far reaching effects on positive treatment outcomes. Conclusion: For better treatment adherence, a competent treatment supporter should be available for TB patients. Health care workers should ensure that effective communication and a cordial relationship do exist with TB patients. Also, TB patients should be properly counselled before the commencement of their treatment regimen to help them maintain a positive mind-set towards treatment. Finally, TB interventions should provide adequate social support for patients....
Purpose. Thyroid hormones play an important role in growth, development, and physiology of the kidney. The kidney plays a key role in the metabolism, degradation, and excretion of thyroid hormones and its metabolites. The aim of this study is to investigate the prevalence of disease states of thyroid-kidney organs and detecting the correlation between thyroid and kidney function abnormalities. Materials and Methods. In this retrospective study, a total of forty-five patients with thyroid and kidney dysfunction were investigated. Clinical features, laboratory data at initial presentation, management, and outcomes were collected. The paper has been written based on searching PubMed and Google Scholar to identify potentially relevant articles or abstracts. Median, percentage, mean ± standard deviation (SD), and the two-tailed t-test were used for statistical analyses. The correlation between variables was assessed by Pearson’s, Spearman’s correlation tests and regression analyses. Results. The mean ± SD of age of study patients was 48.2 ± 22.93 years (ranging from 1 to 90 years). There was no correlation between serum thyroid-stimulating hormone, free thyroxine levels with estimated glomerular filtration rate, and proteinuria. No association between antimicrosomal antibodies with estimated glomerular filtration rate was seen. Cardiovascular disease was the most common complication of overt hypothyroidism in kidney dysfunction patients. Conclusion. The present study showed more prevalence of primary hypothyroidism in comparison with other thyroid dysfunctions in patients with kidney dysfunction. Reduced mean values of thyroid function profiles after treatment suggest that this thyroid disease should be considered and ameliorated with thyroid hormone replacement therapy in patients with kidney disease....
Background: Elderly patients have a high risk of acute Kidney Injury (AKI) due to aging, decreased renal function and the presence of comorbidities. There is limited data on AKI in elderly patients in low income regions, especially in Sub-Saharan Africa. We therefore sought to describe the clinical profile and outcome of AKI in elderly in a tertiary hospital in Cameroon. Methods and Materials: We reviewed the medical records of all patients admitted with the diagnosis of AKI in the internal medicine unit of the Yaounde University Teaching Hospital, from January 2015 to February 2018. Records of elderly patients (≥65 years) were retrieved and analysed. AKI was diagnosed and classified using the KDIGO (Kidney Disease Improving Global Outcomes) 2012 classification. The diagnosis, aetiologies and mechanisms of AKI were clinical. Renal outcomes were evaluated on day 7, 14, 28, 60 and 90 of hospital stay. Results: We included 76 elderly (66% males) patients with a median [interquartile rate—IQR] age of 69 [65 - 75] years. Hypertension (60.5%), diabetes mellitus (36.8%) and heart failure (26.3%) were the most common comorbidities. The median [IQR] Charlson index was 4 [3 - 5]. Infections (47.4%) and hypovolemia (69.7%) were the most frequent risk factors for AKI. AKI was mainly community acquired (89.5%) and most of the patients were in stage 2 (34.2%) or 3 (29%). Pre-renal AKI (58%) was the leading mechanism involved. Hypovolemia and sepsis were the most common aetiologies. Of the 14.5% with indication for dialysis, only 2.6% had access to it. The overall prognosis was good with a mortality rate of 2.6%, complete and partial renal recovery at 3 months of 70%, and 26.3% respectively. Conclusion: AKI in the elderly, in our setting was community-acquired and affected mainly those with comorbidities. Pre-renal AKI was the main mechanism; hypovolemia and sepsis were the major aetiologies. Most participants had complete renal recovery at 3 months....
Peripheral artery disease (PAD) is highly prevalent among patients with chronic kidney disease (CKD) and portends a very poor prognosis. Indoxyl sulfate has been shown to induce atherothrombosis and impaired neovascularization in uremic mice. However, there is no clinical evidence regarding the role of indoxyl sulfate in PAD associated with CKD. We examined associations between indoxyl sulfate and incident symptomatic lower extremity PAD events as well as major adverse cardiovascular events (MACE) and all-cause mortality using Cox proportional hazards models in a prospective cohort of 200 hemodialysis patients free of PAD at baseline. Patients were considered as having PAD if they developed PAD symptoms confirmed by an ankle-brachial index with waveforms, duplex ultrasound or angiography, and/or major adverse limb events including revascularization and amputation. During a median follow-up of 6.5 years, 37 patients (18.5%) experienced incident symptomatic PAD. MACE occurred in 52 patients, and a total of 85 patients died. After adjusting for traditional risk factors for PAD, including age, current smoking, diabetes, and cardiovascular disease, indoxyl sulfate was significantly associated with the risk of PAD (hazard ratio (HR), 1.19 for every 10-μg/mL increase in indoxyl sulfate; 95% confidence interval (CI), 1.05–1.35). However, indoxyl sulfate was not associated with risk of MACE (HR, 1.00; 95% CI, 0.90–1.12) or death from any cause (HR, 0.98; 95% CI, 0.90–1.07). Indoxyl sulfate was associated with incident symptomatic PAD but not with MACE or all-cause mortality, suggesting that indoxyl sulfate toxicity may be unique to PAD among hemodialysis patients....
Background: Palatine tonsils are part of the immune system located within the Waldeyer’s ring, they are prone to infections, hypertrophy or both. These conditions are known as tonsil diseases that usually require surgical removal through tonsillectomy. Tonsillectomy is one of the most common procedures done for children but it is challenged by the occurrence of complications, especially post tonsillectomy bleeding (PTB). In the current study, the incidence of post tonsillectomy bleeding in children younger than 14 years undergoing tonsillectomy in Salmaniya Medical Complex is evaluated and their demographic data and risk factors are assessed. Method: Pediatric patients who are younger than 14 years with postoperative tonsillectomy bleeding that were treated in Salmaniya Medical Complex between the period of January 2018 and December 2019 were retrospectively studied for risk factors. Results: A total of 1161 patients within the age range of 2 - 13 years old underwent tonsillectomy in Salmaniya Medical Complex from the period of January 2018 to December 2019. Twenty-eight pediatric patients had post-tonsillectomy bleeding (PTB) during the study period with an incidence of 2.4% of the total number of pediatric tonsillectomies done in our institute. The majority were male patients and the mean age was 6.2 years. The main indication of tonsillectomy for those with bleeding was recurrent tonsillitis. A second surgery was needed in 64.5% to control the bleeding. The size of the tonsil, the level of the surgeon and the season at which the tonsillectomy was done did not seem to have any effect on the incidence of post-tonsillectomy bleeding (PTB). Conclusion: The incidence of post tonsillectomy bleeding (PTB) in Salmaniya Medical Complex is 2.4%, which makes it a common complication for a common surgery irrelevant to any patient, surgeon or climate related factors....
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