Schizophrenia relapse in a community mental health setting

ABSTRACT AIM: The aim of this study was to determine, if any, the factors associated with relapse with a view to provide guidelines for prevention, early identification and management of relapse in a community setting. METHOD: The study is a retrospective record review of the patients attending seven randomly selected Community Mental Health Clinics in Southern Gauteng during the period January 1995 to June 2005. Two hundred and seventeen (217) patients aged 18 years with a diagnosis of schizophrenia were included in the study. Patients were excluded if the diagnosis of schizophrenia was made in the preceding six months of the study. Demographic and clinical variables including age, gender, marital status, source of income, highest level of education, non compliance, presence of substance abuse, co-morbid psychiatric condition, the presence and number of relapses and stressful life events were recorded on a data schedule. RESULTS: Two hundred and seventeen patients records were analysed: 61.8% have had at least one relapse. The only factors that provided a significant predictive factor for relapse included non compliance due side-effects, non compliance due to lack of insight, and the presence of depressive symptoms. 64.2% of the study population were non compliers and 27.1% have had depressive features. Demographic variables were not associated with relapse. CONCLUSION: These findings imply that interventions aimed at reducing relapse in schizophrenia should include improving medication compliance and early detection and treatment of depression

Aspects épidémiologiques et cliniques des manifestations rhumatismales au cours de l’infection à VIH en milieu hospitalier de Kinshasa: Epidemiological and clinical aspects of rheumatic manifestations in HIV patients in Kinshasa. A hospital- based study

Context and objective. Data on articular manifestations of HIV infection in sub-Saharan Africa are scarce. The present study aimed to describe clinical features of rheumatic manifestations in Congolese HIV patients. Methods. A cross-sectional study including HIV patients was conducted from June 1st to September 30th, 2015 in two hospitals of Salvation Army in Kinshasa, DRC. The parameters of interest included musculoskeletal signs, radiographic and laboratory data of each patient. Rheumatic diseases were defined according to classical criteria or physician opinion if criteria were not applicable. Results. Three hundred twenty one HIV patients were recruited, of whom 254 women (79.1%). Their average age was 45.1 ± 9.56 years. The median duration of HIV infection and antiretroviral therapy was 38 months (ranged between 3 and 155 months) and 34 months respectively (ranged between 2 to 137 months). The prevalence of rheumatic complaints in HIV was 27.7%. The following diseases were encountered: osteoarthritis (49.4%), spondyloarthitis (33.7%), soft tissue rheumatisms (25.8%), rheumatoid arthritis (1.1%) and miscellaneous (16.9%). HIV patients with rheumatic symptoms showed no difference to those without rheumatic symptoms concerning the WHO classification system for HIV infection, the number of T-CD4 lymphocytes and the duration of HIV infection. A disease or a treatment duration between 12 and 60 months was associated to a high frequency of spondylarthritis and soft tissue rheumatisms. The risk of soft tissue rheumatisms occurrence was fourfold highest in patients with low T-CD4 lymphocytes. Conclusion. Roughly, one third of HIV patients exhibits various rheumatic diseases, mainly osteoarthritis, spondylarthritis and soft tissue rheumatism. Contexte et objectif. Les données sur l’atteinte articulaire dans l’infection à VIH en Afrique subsaharienne l’épicentre sont fragmentaires. La présente étude a décrit les aspects épidémiologiques des manifestations rhumatismales, au cours de l’infection à VIH/SIDA ; en milieu hospitalier de Kinshasa. Méthodes. Etude transversale descriptive et analytique incluant les personnes vivant avec VIH menée du 1er juin au 30 septembre 2015 dans deux formations médicales de l’Armée du Salut. Les paramètres d’intérêt étaient : démographiques, cliniques (symptômes musculosquelettiques), radiographiques et biologiques. Le diagnostic des pathologies rhumatismales a été posé sur base des critères classiques ou le cas échéant, l’opinion du rhumatologue pour les maladies sans critères diagnostiques consensuels. Résultats. Trois cent vingt et un PVV ont été examinés, dont 254 femmes (79,1%). L’âge moyen des patients était de 45,1 ± 9,6 ans. La durée médiane de l’infection à VIH et du traitement antirétroviral étaient respectivement de 38 mois [extrêmes 3 et 155 mois) et 34 mois (extrêmes 2 et 137 mois). La fréquence des manifestations rhumatismales était 27,7%. Les pathologies rhumatismales rencontrées comprenaient: l’arthrose (49,4%), les spondylarthrites (33,7%), les pathologies abarticulaires (25,8%), la polyarthrite rhumatoïde (1,1%) et les autres rhumatismes (16,9%). Les caractéristiques de l’infection à VIH (stade de l’OMS, taux des LT CD4, durée de la maladie, durée du traitement) étaient similaires entre les rhumatisants et les non rhumatisants. Une maladie ou un traitement d’une durée de 12 à 60 mois était indépendamment associé aux maladies abarticulaires. Le risque d’atteinte abarticulaire était également majoré par 4 pour un taux bas de LTCD4. Enfin, seul l’âge > 40 ans était associé risque d’arthrose. Conclusions. Près d’un tiers des PVV présentent des manifestations rhumatismales variées, en particulier ; les spondylarthrites, l’arthrose et les pathologies abarticulaires

CHOIX ET PLACE DE L’ANTIBIOTHERAPIE SUR LES INFECTIONS ORL AUX CLINIQUES UNIVERSITAIRES DE KINSHASA, RD CONGO

Les infections des voies aériennes supérieures et de la sphère oto rhino laryngologie constituent une des premières causes de consultation en médecine générale. Malgré leur faible taux de complications, elles sont source d’une forte demande thérapeutique de la part des patients. Cette demande peut être considérée comme étant l’une des causes de l’importante consommation d’antibiotiques. Cette étude a pour objectif de Contribuer à l’utilisation judicieuse d’antibiotique chez les patients souffrants d’infections oto rhino laryngologie. Une étude descriptive. Sur les 251 cas d’infections oto rhino laryngologie répertoriées, 137 ou 55% ont bénéficié d’une antibiothérapie. L’âge médian était de 25 ans avec des extrêmes allant de 1 à 60 ans, Les motifs de consultation otologique, rhinologique et pharyngo-laryngologique les plus observés étaient : otorrhée, rhinorrhée et toux.   Quant aux infections oto rhino laryngologie, la Rhinite et la Rhino sinusite revenaient en tête avec 21 et 17% des cas respectivement, suivi du Syndrome obstructive des VRS (Végétations adénoïdes) avec 10%. L’antibiothérapie faite de l’association Amoxicilline Acide clavulanique était la plus utilisée, suivie d’Amoxicilline seul puis les Céphalosporines de 3ième génération.Les infections des voies aériennes supérieures et de la sphère oto rhino laryngologie constituent une des premières causes de consultation en médecine générale. Malgré leur faible taux de complications, elles sont source d’une forte demande thérapeutique de la part des patients. Cette demande peut être considérée comme étant l’une des causes de l’importante consommation d’antibiotiques. Cette étude a pour objectif de Contribuer à l’utilisation judicieuse d’antibiotique chez les patients souffrants d’infections oto rhino laryngologie. Une étude descriptive. Sur les 251 cas d’infections oto rhino laryngologie répertoriées, 137 ou 55% ont bénéficié d’une antibiothérapie. L’âge médian était de 25 ans avec des extrêmes allant de 1 à 60 ans, Les motifs de consultation otologique, rhinologique et pharyngo-laryngologique les plus observés étaient : otorrhée, rhinorrhée et toux.   Quant aux infections oto rhino laryngologie, la Rhinite et la Rhino sinusite revenaient en tête avec 21 et 17% des cas respectivement, suivi du Syndrome obstructive des VRS (Végétations adénoïdes) avec 10%. L’antibiothérapie faite de l’association Amoxicilline Acide clavulanique était la plus utilisée, suivie d’Amoxicilline seul puis les Céphalosporines de 3ième génération

GERMES INCRIMINES DANS LES OTITES MOYENNES SUPPUREES AUX CLINIQUES UNIVERSITAIRES DE KINSHASA, RD CONGO

L'otite moyenne suppurée est une infection de l'oreille moyenne caractérisée par un écoulement purulent à travers une perforation de la membrane tympanique. C'est une cause importante de perte de l'audition évitable. La prédominance des germes pathogènes de l'otite moyenne suppurée étant variable d'un pays a un autre, voir même d'une région a une autre d'où la connaissance des germes pathogènes de cette maladie dans un milieu donné se révèle très importante pour mener un traitement adéquat. Nous identifions  par cette étude le profil bactériologique de l'otite moyenne suppurée des patients qui ont consulté le service d'ORL des Cliniques Universitaires de Kinshasa et la sensibilité de ces germes au regard des antibiotiques utilisés. L'étude de la sensibilité a été faite par la méthode de diffusion en milieu gélose.  Il s'agissait de 7 femmes et 5 hommes avec 4 de plus de 44 ans soit 34%, 3 de 0 à 10 ans soit 25%, 3 de 33 à 43 ans soit 25%, 1 de 11 à 21 ans soit 8% et enfin 1 de 22 à 32 ans soit 8%. Le profil bactériologique était dominé par les entérobactéries (Klebsiella pneumonie, Citrobacter freundii et Shewanella putrefaciens), le Pseudomonas aeruginosa et le Staphylocoques aureus. Ces germes se sont montres tous sensibles aux fluoroquinolones (ciprofloxacine) et aux aminosides (amikacine).L'otite moyenne suppurée est une infection de l'oreille moyenne caractérisée par un écoulement purulent à travers une perforation de la membrane tympanique. C'est une cause importante de perte de l'audition évitable. La prédominance des germes pathogènes de l'otite moyenne suppurée étant variable d'un pays a un autre, voir même d'une région a une autre d'où la connaissance des germes pathogènes de cette maladie dans un milieu donné se révèle très importante pour mener un traitement adéquat. Nous identifions  par cette étude le profil bactériologique de l'otite moyenne suppurée des patients qui ont consulté le service d'ORL des Cliniques Universitaires de Kinshasa et la sensibilité de ces germes au regard des antibiotiques utilisés. L'étude de la sensibilité a été faite par la méthode de diffusion en milieu gélose.  Il s'agissait de 7 femmes et 5 hommes avec 4 de plus de 44 ans soit 34%, 3 de 0 à 10 ans soit 25%, 3 de 33 à 43 ans soit 25%, 1 de 11 à 21 ans soit 8% et enfin 1 de 22 à 32 ans soit 8%. Le profil bactériologique était dominé par les entérobactéries (Klebsiella pneumonie, Citrobacter freundii et Shewanella putrefaciens), le Pseudomonas aeruginosa et le Staphylocoques aureus. Ces germes se sont montres tous sensibles aux fluoroquinolones (ciprofloxacine) et aux aminosides (amikacine)

Allergic Rhinitis and its Associated Co-Morbidities at Bugando Medical Centre in Northwestern Tanzania; A Prospective Review of 190 Cases.

Allergic rhinitis is one of the commonest atopic diseases which contribute to significant morbidity world wide while its epidemiology in Tanzania remains sparse. There was paucity of information regarding allergic rhinitis in our setting; therefore it was important to conduct this study to describe our experience on allergic rhinitis, associated co-morbidities and treatment outcome in patients attending Bugando Medical Centre. This was descriptive cross-sectional study involving all patients with a clinical diagnosis of allergic rhinitis at Bugando Medical Centre over a three-month period between June 2011 and August 2011. Data was collected using a pre-tested coded questionnaire and analyzed using SPSS statistical computer software version 17.0. A total of 190 patients were studied giving the prevalence of allergic rhinitis 14.7%. The median age of the patients was 8.5 years. The male to female ratio was 1:1. Adenoid hypertrophy, tonsillitis, hypertrophy of inferior turbinate, nasal polyps, otitis media and sinusitis were the most common co-morbidities affecting 92.6% of cases and were the major reason for attending hospital services. Sleep disturbance was common in children with adenoids hypertrophy (χ2 = 28.691, P = 0.000). Allergic conjunctivitis was found in 51.9%. The most common identified triggers were dust, strong perfume odors and cold weather (P < 0.05). Strong perfume odors affect female than males (χ2 = 4.583, P = 0.032). In this study family history of allergic rhinitis was not a significant risk factor (P =0.423). The majority of patients (68.8%) were treated surgically for allergic rhinitis co morbidities. Post operative complication and mortality rates were 2.9% and 1.6% respectively. The overall median duration of hospital stay of in-patients was 3 days (2 - 28 days). Most patients (98.4%) had satisfactory results at discharge. The study shows that allergic rhinitis is common in our settings representing 14.7% of all otorhinolaryngology and commonly affecting children and adolescent. Sufferers seek medical services due to co-morbidities of which combination of surgical and medical treatment was needed. High index of suspicions in diagnosing allergic rhinitis and early treatment is recommended

An international survey on the pragmatic management of epistaxis

Epistaxis is one of the most common ear, nose and throat emergencies. The management of epistaxis has evolved significantly in recent years, including the use of nasal cautery and packs. However, a correct treatment requires the knowledge of nasal anatomy, potential risks, and complications of treatment. Epistaxis is often a simple and readily treatable condition, even though a significant bleed may have potentially severe consequences. At present, there are very few guidelines concerning this topic. The current Survey explored the pragmatic approach in managing epistaxis. A questionnaire, including 7 practical questions has been used. The current International Survey on epistaxis management reported a relevant prevalence (21.7%), mainly during childhood and senescence, an important hospitalization rate (11.8%), the common use of anterior packing and electrocoagulation, and the popular prescription of a vitamin supplement and intranasal creams

Scaling up strategies of the chronic respiratory disease programme of the European Innovation Partnership on Active and Healthy Ageing (Action Plan B3: Area 5)

Abstract Action Plan B3 of the European Innovation Partnership on Active and Healthy Ageing (EIP on AHA) focuses on the integrated care of chronic diseases. Area 5 (Care Pathways) was initiated using chronic respiratory diseases as a model. The chronic respiratory disease action plan includes (1) AIRWAYS integrated care pathways (ICPs), (2) the joint initiative between the Reference site MACVIA-LR (Contre les MAladies Chroniques pour un VIeillissement Actif) and ARIA (Allergic Rhinitis and its Impact on Asthma), (3) Commitments for Action to the European Innovation Partnership on Active and Healthy Ageing and the AIRWAYS ICPs network. It is deployed in collaboration with the World Health Organization Global Alliance against Chronic Respiratory Diseases (GARD). The European Innovation Partnership on Active and Healthy Ageing has proposed a 5-step framework for developing an individual scaling up strategy: (1) what to scale up: (1-a) databases of good practices, (1-b) assessment of viability of the scaling up of good practices, (1-c) classification of good practices for local replication and (2) how to scale up: (2-a) facilitating partnerships for scaling up, (2-b) implementation of key success factors and lessons learnt, including emerging technologies for individualised and predictive medicine. This strategy has already been applied to the chronic respiratory disease action plan of the European Innovation Partnership on Active and Healthy Ageing

ARIA 2016: Care pathways implementing emerging technologies for predictive medicine in rhinitis and asthma across the life cycle

Abstract The Allergic Rhinitis and its Impact on Asthma (ARIA) initiative commenced during a World Health Organization workshop in 1999. The initial goals were (1) to propose a new allergic rhinitis classification, (2) to promote the concept of multi-morbidity in asthma and rhinitis and (3) to develop guidelines with all stakeholders that could be used globally for all countries and populations. ARIA—disseminated and implemented in over 70 countries globally—is now focusing on the implementation of emerging technologies for individualized and predictive medicine. MASK [MACVIA (Contre les Maladies Chroniques pour un Vieillissement Actif)-ARIA Sentinel NetworK] uses mobile technology to develop care pathways for the management of rhinitis and asthma by a multi-disciplinary group and by patients themselves. An app (Android and iOS) is available in 20 countries and 15 languages. It uses a visual analogue scale to assess symptom control and work productivity as well as a clinical decision support system. It is associated with an inter-operable tablet for physicians and other health care professionals. The scaling up strategy uses the recommendations of the European Innovation Partnership on Active and Healthy Ageing. The aim of the novel ARIA approach is to provide an active and healthy life to rhinitis sufferers, whatever their age, sex or socio-economic status, in order to reduce health and social inequalities incurred by the disease

Risk factors for asthma among schoolchildren who participated in a case-control study in urban Uganda.

Data on asthma aetiology in Africa are scarce. We investigated the risk factors for asthma among schoolchildren (5-17 years) in urban Uganda. We conducted a case-control study, among 555 cases and 1115 controls. Asthma was diagnosed by study clinicians. The main risk factors for asthma were tertiary education for fathers (adjusted OR (95% CI); 2.32 (1.71-3.16)) and mothers (1.85 (1.38-2.48)); area of residence at birth, with children born in a small town or in the city having an increased asthma risk compared to schoolchildren born in rural areas (2.16 (1.60-2.92)) and (2.79 (1.79-4.35)), respectively; father's and mother's history of asthma; children's own allergic conditions; atopy; and cooking on gas/electricity. In conclusion, asthma was associated with a strong rural-town-city risk gradient, higher parental socio-economic status and urbanicity. This work provides the basis for future studies to identify specific environmental/lifestyle factors responsible for increasing asthma risk among children in urban areas in LMICs

ARIA 2016 : Care pathways implementing emerging technologies for predictive medicine in rhinitis and asthma across the life cycle

The Allergic Rhinitis and its Impact on Asthma (ARIA) initiative commenced during a World Health Organization workshop in 1999. The initial goals were (1) to propose a new allergic rhinitis classification, (2) to promote the concept of multi-morbidity in asthma and rhinitis and (3) to develop guidelines with all stakeholders that could be used globally for all countries and populations. ARIA-disseminated and implemented in over 70 countries globally-is now focusing on the implementation of emerging technologies for individualized and predictive medicine. MASK [MACVIA (Contre les Maladies Chroniques pour un Vieillissement Actif)-ARIA Sentinel NetworK] uses mobile technology to develop care pathways for the management of rhinitis and asthma by a multi-disciplinary group and by patients themselves. An app (Android and iOS) is available in 20 countries and 15 languages. It uses a visual analogue scale to assess symptom control and work productivity as well as a clinical decision support system. It is associated with an inter-operable tablet for physicians and other health care professionals. The scaling up strategy uses the recommendations of the European Innovation Partnership on Active and Healthy Ageing. The aim of the novel ARIA approach is to provide an active and healthy life to rhinitis sufferers, whatever their age, sex or socio-economic status, in order to reduce health and social inequalities incurred by the disease.Peer reviewe