Diagnostic challenges in critical care management of fluid and electrolyte disturbances in a poor-resource setting: a survey of critical care doctors

Background: To determine the challenges in diagnostic support for adequate fluid and electrolyte (F/E) management in a poor-resource critical care setting.Methods: This cross-sectional survey was conducted between March and May 2017 in one hundred and four (104) doctors practicing in four tertiary hospitals in North-central Nigeria. These doctors were currently working in Accidents and Emergency Units (A/E), Intensive care Units (ICU) and Children Emergency Units and have worked for at least two months prior to the study. They were given a structured questionnaire to fill and return. The questionnaire among other things, addressed laboratory-related factors that affect management of F/E disturbances.Results: Unavailability of some laboratory tests, inaccuracy of laboratory results, incomplete test results and delay in obtaining results, hampered F/E management in critical care according to more than 75% of the surveyed doctors. About sixty percent of the doctors reported a turnaround time (TAT) of ≥3 hours for electrolytes and most emergency biochemical tests (except urine dipstick and Blood gases). Also ≤25% of doctors responded that electrolytes and most emergency biochemical tests (except urine dipstick and Blood gases) were offered in the ICU/Emergency unit laboratories. Ten percent or less of doctors reported that electrolytes and the emergency biochemical test were available by Point of care testing (POCT).Conclusions: There is an urgent need for the managers of healthcare in LMICs to establish functional laboratories in ICUs, explore the use of POCT and build capacity for diagnostic critical care

From the Singular to the Plural: Exploring Diversities in Contemporary Childhoods in sub-Saharan Africa

The challenges that sub-Saharan Africa has faced in the post-colonial period have come to characterise the way the region is perceived. These narratives are especially evident in the various ways children’s lives are discussed, leading to a particular focus on childhoods in difficult circumstances or at the margins. This has eclipsed the mundanities of everyday life for many children whose lives are not characterised by ‘lacks’. This article seeks to move beyond an overwhelming focus on childhoods defined by what they lack by illustrating the multitude of childhoods which exist in the continent

Adolescent self-harm in Ghana: a qualitative interview-based study of first-hand accounts

Background: Recent prevalence studies suggest that self-harm among adolescents in sub-Saharan Africa is as common as it is in high income countries. However, very few qualitative studies exploring first-person accounts of adolescent self-harm are available from sub-Saharan Africa. We sought to explore the experiences and first-person perspectives of Ghanaian adolescents reporting self-harm - for deeper reflections on the interpretive repertoires available in their cultural context for making sense of self-harm in adolescents. Methods: Guided by a semi-structured interview protocol, we interviewed one-to-one 36 adolescents (24 in-school adolescents and 12 street-connected adolescents) on their experiences of self-harm. We applied experiential thematic analysis to the data. Results: Adolescents’ description of the background to their self-harm identified powerlessness in the family context and unwanted adultification in the family as key factors leading up to self-harm among both in-school and street-connected adolescents. Adolescents’ explanatory accounts identified the contradictory role of adultification as a protective factor against self-harm among street-connected adolescents. Self-harm among in-school adolescents was identified as a means of “enactment of tabooed emotions and contestations”, as a “selfish act and social injury”, as “religious transgression”, while it was also seen as improving social relations. Conclusions: The first-person accounts of adolescents in this study implicate familial relational problems and interpersonal difficulties as proximally leading to self-harm in adolescents. Self-harm in adolescents is interpreted as an understandable response, and as a strong communicative signal in response to powerlessness and family relationship difficulties. These findings need to be taken into consideration in the planning of services in Ghana and are likely to be generalisable to many other countries in sub-Saharan Africa

Polysaccharide Complexes in Full-Grown Oocytes of the Newt, Pleurodeles, and Changes in their Distribution During Progesterone-Induced Maturation. (glycogen granules/oocyte maturation/polysaccharide complexes/urodele amphibian)

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