Sonographic guided hydrostatic saline enema reduction of childhood intussusception: a prospective study

Background

The management of childhood intussusception in our sub-region is still via surgical intervention. Currently, the gold standard of treatment is non-operative reduction. We sought to assess the suitability of hydrostatic (saline) reduction of intussusception in children in our institution.

Materials and methods

A prospective study was conducted between January 2016 and June 2017 in all children with ultrasound confirmed intussusception at a tertiary teaching hospital in Nigeria. All children excluding those with signs of peritonitis, bowel gangrene and intestinal prolapse were selected for ultrasound-guided hydrostatic reduction (USGHR). We allowed a maximum of three attempts at reduction.

Results

The age range was 3 months to 48 months with a mean of 10.8?±?9.1 months. Forty percent (N?=?18) presented after 24 h of onset of symptoms. The success rate of hydrostatic reduction with saline enema was 84.4% (N?=?38). Two (4.4%) perforations occurred during the procedure. Three (7.5%) patients had recurrent intussusception within six months. The duration of symptoms greater than 24 h, age and sex of patients did not influence successful reduction p?>?0.05. The duration of admission between those who had successful non-operative reduction and those who subsequently had operative reduction and or resection attained statistical significant difference, p?=?0.001. There was no mortality. We achieved a 68% decrease in the operative reduction of intussusception using USGHR as the primary modality of treatment.

Conclusion

Our study found out that USGHR is a suitable alternative for the treatment of childhood intussusception.

     

Hospitalizations and Costs Incurred at the Facility Level after Scale-up of Malaria Control: Pre-Post Comparisons from Two Hospitals in Zambia

There is little evidence on the impact of malaria control on the health system, particularly at the facility level. Using retrospective, longitudinal facility-level and patient record data from two hospitals in Zambia, we report a pre-post comparison of hospital admissions and outpatient visits for malaria and estimated costs incurred for malaria admissions before and after malaria control scale-up. The results show a substantial reduction in inpatient admissions and outpatient visits for malaria at both hospitals after the scale-up, and malaria cases accounted for a smaller proportion of total hospital visits over time. Hospital spending on malaria admissions also decreased. In one hospital, malaria accounted for 11% of total hospital spending before large-scale malaria control compared with < 1% after malaria control. The findings demonstrate that facility-level resources are freed up as malaria is controlled, potentially making these resources available for other diseases and conditions.     

Induction of Rabies Virus Infection in Mice Brain may Up and Down Regulate Type II Interferon gamma via epigenetic modifications

Metabolic Brain Disease - As feared and deadly human diseases globally, Rabies virus contrived mechanisms to escape early immune recognition via suppression of the interferon response. This study,...     

Assessing decision-making capacity at end of life

Objective

Patients with terminal illness often face important medical decisions that may carry ethical and legal implications, yet they may be at increased risk for impaired decisional capacity. This study examined the prevalence of impairment on the four domains of decisional capacity relevant to existing legal standards.

Method

Twenty-four adults diagnosed with a terminal illness completed the MacArthur Competence Assessment Tool for Treatment, a semi-structured measure of decision-making capacity and measures of cognitive functioning and psychological distress.

Results

Approximately one third of the sample demonstrated serious impairment on at least one domain of decisional capacity. The greatest proportion of impairment was found on subscales that rely heavily on verbal abilities. Decisional capacity was significantly associated with cognitive functioning and education, but not with symptoms of anxiety or depression.

Conclusions

This study is the first to examine decisional capacity in patients with terminal illness relative to legal standards of competence. Although not universal, decisional impairment was common. Clinicians working with terminally ill patients should frequently assess capacity as these individuals are called on to make important medical decisions. Comprehensive assessment will aid clinicians in their responsibility to balance respect for patient autonomy with their responsibility to protect patients from harm resulting from impaired decisional capacity.     

Predictors of Treatment Outcomes for Substance-Abusing Women: A Retrospective Study

This study examined whether client characteristics at admission predict Retention, Abstinence, and utilization of Required Services and Specialized Services for pregnant women in outpatient and residential substance abuse treatment. Retrospective data were collected with the Psychosocial History (PSH), a structured clinical interview that is an expansion of the Addiction Severity Index, designed specifically to assess substance abusing women. The PSH was administered at intake for 183 pregnant women admitted to outpatient (n = 133) or residential (n = 50) treatment. Factor analysis reduced predictors to five factors with composite scores, and multiple regression procedures determined client characteristics that predict treatment outcomes. The findings suggest the complexity of predicting treatment outcomes for pregnant women. Significant predictors were composites of variables that encompassed all aspects of women's personal and family lives including medical and psychiatric needs, family and parenting issues, housing, victimization, and clients' perceived needs for treatment and assistance in all of these areas. The results suggest the need for a holistic approach to substance abuse treatment and continued exploration of a broad range of psychosocial assessments at intake in order to develop substance abuse treatment programs that effectively address multiple aspects of women's lives.     

Patient-centred outcome measures in oral surgery: validity and sensitivity

The performances of patient-centred outcome measures after oral surgery were evaluated in a prospective cohort study of 100 patients who had third molar extractions. Participants self-completed a questionnaire incorporating a general health (12-item short form health survey: SF-12) and two specific outcome scales to oral health (oral health impact profile: OHIP-14, and The United Kingdom Oral Health related Quality of Life measure: OHQoL-UK) preoperatively, daily during the immediate postoperative period, and at the review appointment (7-days later). Ninety-seven completed the study. History of 'taking time off' work/study because of pericoronitis during the past year was significantly associated with preoperative OHIP-14 and OHQoL-UK scores. There were significant differences in SF-12, OHIP-14, OHQoL-UK scores during the immediate postoperative period compared with preoperatively, when postoperative symptoms were prevalent. At the review appointment, OHIP-14 and OHQoL-UKscores were associated with clinical findings. The measures were valid and sensate in relation to oral surgery. However, those specific to oral health were more discerning than the general scale.     

Community-oriented medical emergency programme: development and evaluation issues

A community-oriented medical emergency programme for multidisciplinary healthcare professionals on the Higher Professional Diploma in International Healthcare Studies, at the United Medical Education College, London is described. The main aim of the course is to introduce students to the clinical skills of dealing with medical emergency problems and situations. Students are also exposed to how medical emergency is practised in the community. The four-week programme consists of 16 sessions of clinical skills teaching where students are attached to various community clinics, 10 sessions of college teaching, consisting of talks, workshops and interactive small-group work and four sessions encouraging students to learn independently in a self-directed learning format. Student and tutor evaluations of the programme demonstrate that its aims are being met. However, further adaptation of the module to increase the range and quantity of clinical cases for student learning is being planned.