Admission hyperglycaemia as a prognostic indicator of outcome in major trauma patients at Bugando Medical Centre, Mwanza, Tanzania

Background: Admission hyperglycemia has been reported to be associated with poor outcomes among patients with major trauma. However, most of the available literature on this subject has been conducted in the developed world. This study aimed to determine the association between admission hyperglycemia and the outcome of major trauma patients admitted to Bugando Medical Centre. Methods: This was a prospective cohort study, involving major trauma patients admitted to Bugando Medical Centre (BMC) within 6 months from Sept 2017 to February 2018. The exposure was admission hyperglycemia (>11.1mmol/l) and non-exposure was normoglycemia (≤11.1mmol/l). Results:  A total of 217 patients (M: F ratio = 4.1: 1) were recruited. Their ages ranged from 4 to 97 years with a median age of 31 years. Out of 217 patients, 106 (48.8%) were hyperglycemic and the remaining 111(51.2%) were normoglycemic. The overall median days of length of hospital stay (LOS) was 15 days. There was no statistically significant association between admission hyperglycemia and LOS (p =0.875). In this study, 73 patients died giving a mortality of 33.6%. Patients with admission hyperglycemia (>11.1mmol/l) had significantly higher mortality as compared to normoglycemic patients (≤11.1mmol/l) (p < 0.001). Conclusion: This study found that admission hyperglycemia was statistically significantly associated with increased mortality among major trauma patients at BMC. Therefore, there is a need to institute regular monitoring of blood sugar levels among these patients and give appropriate treatment to those found with elevated blood sugar levels

Improving access to health care for malaria in Africa: a review of literature on what attracts patients

BACKGROUND: Increasing access to health care services is considered central to improving the health of populations. Existing reviews to understand factors affecting access to health care have focused on attributes of patients and their communities that act as 'barriers' to access, such as education level, financial and cultural factors. This review addresses the need to learn about provider characteristics that encourage patients to attend their health services. METHODS: This literature review aims to describe research that has identified characteristics that clients are looking for in the providers they approach for their health care needs, specifically for malaria in Africa. Keywords of 'malaria' and 'treatment seek*' or 'health seek*' and 'Africa' were searched for in the following databases: Web of Science, IBSS and Medline. Reviews of each paper were undertaken by two members of the team. Factors attracting patients according to each paper were listed and the strength of evidence was assessed by evaluating the methods used and the richness of descriptions of findings. RESULTS: A total of 97 papers fulfilled the inclusion criteria and were included in the review. The review of these papers identified several characteristics that were reported to attract patients to providers of all types, including lower cost of services, close proximity to patients, positive manner of providers, medicines that patients believe will cure them, and timeliness of services. Additional categories of factors were noted to attract patients to either higher or lower-level providers. The strength of evidence reviewed varied, with limitations observed in the use of methods utilizing pre-defined questions and the uncritical use of concepts such as 'quality', 'costs' and 'access'. Although most papers (90%) were published since the year 2000, most categories of attributes had been described in earlier papers. CONCLUSION: This paper argues that improving access to services requires attention to factors that will attract patients, and recommends that public services are improved in the specific aspects identified in this review. It also argues that research into access should expand its lens to consider provider characteristics more broadly, especially using methods that enable open responses. Access must be reconceptualized beyond the notion of barriers to consider attributes of attraction if patients are to receive quality care quickly

Validation of molecular markers for new stem rust resistance genes in U.S. hard winter wheat

Citation: Bernardo, A. N., Bowden, R. L., Rouse, M. N., Newcomb, M. S., Marshall, D. S., & Bai, G. (2013). Validation of molecular markers for new stem rust resistance genes in U.S. hard winter wheat. Retrieved from http://krex.ksu.eduStem rust, caused by Puccinia graminis f. sp. tritici (Pgt), is one of the most serious diseases of wheat (Triticum aestivum L.) worldwide. The discovery of new Pgt races in Africa, Ug99 and its variants, brings a new threat to global wheat production. Pyramiding several stem rust resistance genes into adapted varieties as opposed to breeding varieties with a single resistance gene is considered a more effective method to combat new races, but the success of gene pyramiding depends on the availability of molecular markers tightly linked to resistance genes. Markers for Ug99-effective genes, Sr2, Sr22, Sr26, Sr32, Sr35, Sr39, and Sr40, were evaluated for usefulness in marker-assisted selection (MAS) of hard winter wheat (HWW) using 10 resistance gene donor lines, 17 recently released U.S. HWW varieties or breeding lines, and 20 advanced introgression lines. Markers XcsIH81-BM and XcsIH81-AG for Sr22, Xsr26#43 and XBE51879 for Sr26, Xbarc55 for Sr32, Xbarc51 for Sr35, Xrwg27 for Sr39, Xsr39#22r for Sr40, and csSr2-derived single nucleotide polymorphism (SNP) marker for Sr2 are diagnostic for the set of HWW accessions evaluated in this study. These markers should be useful in marker-assisted pyramiding of stem rust resistance genes to develop HWW cultivars with multiple gene resistance against Ug99 races