Incidence of Ventilator-associated pneumonia in the critical care unit at Kenyatta National Hospital, a public tertiary care hospital

Background: Ventilator-associated pneumonia (VAP), a severe type of hospitalacquired pneumonia develops 48-72 hours after initiation of mechanical ventilation. Objectives: This study aimed to determine incidence of VAP using the Clinical Pulmonary Infection Score (CPIS) which combines clinical, radiographic, physiologic and microbiological data into a numerical result, ranging from 0 to 12, and to identify risk factors associated with its development. A secondary objective was to assess the diagnostic utility of a positive culture of pathogenic bacteria on tracheal aspirate in predicting a positive culture on a mini-Broncho Alveolar Lavage (Mini-BAL). Design: A hospital-based, prospective cross-sectional study carried between 01st January 2015 to 31st March 2015. Setting: Kenyatta National Hospital, a tertiary care hospitalSubjects: Ninety-two subjects who met the inclusion criteria were included. Results: Of the 92 patients studied, 50 had a CPIS of ≥6, an incidence of 54.4% (C.I. 44.0-64.7%). Factors that appeared to show an association with VAP included documented aspiration (OR 2.0), a high nurse to patient ratio (OR 4.0), postsurgical patients (OR 2.5) and those who were nasally intubated (OR 4.0) and those with oral candidiasis (OR 3.5). Of the 50 patients that showed a CPIS of ≥6, 46 (92%) patients had a positive culture on tracheal aspirate and 31 (62%) patients demonstrated a positive mini-BAL culture. The sensitivity and specificity of a positive tracheal aspirate in predicting a positive min-BAL culture were 100% (C.I 88.7-100.0%) and 21.1% (C.I 6.2-45.6%) respectively. Negative predictive value of 100.0% (C.I 40.2-100.0%) and a positive predictive value of 67.4% (C.I 52.0-80.5%). Conclusion: Our study, the first documented in East Africa, found a high incidence of VAP. Further studies are needed to compare the diagnostic utility of various invasive and non-invasive tests for diagnosis of VAP

The incidence and risk factors for intra-operative hypothermia among paediatric patients undergoing general anaesthesia at the Kenyatta National Hospital

Objective: To determine the incidence and risk factors for intra-operative hypothermia in paediatric patients undergoing general anaesthesia at the Kenyatta National Hospital. Design: A prospective observational study.Setting: The Kenyatta National Hospital main operating theatres and affiliated satellite operating theatres.Subjects: A total of 100 paediatric patients (range; three days to 12 years, mean; 4.1 ± 3.3 years) were enrolled in the study.Results: Thirty out of 100 patients developed hypothermia defined as a core temperature <36ºC recorded at least once during provision of general anaesthesia. Ninety percent of those developing hypothermia were male compared to 63% who remained normothermic (p = 0.006). Proportionally, more than twice as many hypothermic patients had a caudal block (43% versus 20%, p = 0.016) and received 121ml more of fluid (p = 0.002) compared to the normothermic group. The patients who became hypothermic tended to be colder at induction of anaesthesia (36.6 ± 0.5ºC versus 37.0 ± 0.5ºC, p = <0.0001) but there was no significant difference in the waiting time, time of  induction, environmental temperatures or theatre temperatures compared to those not developing hypothermia. There was no significant difference in the BMI between the two groups (14.0 ± 2.9 kg/ m2 versus 15.2 ± 3.5 kg/m2, p = 0.101).Conclusion: The incidence of intra-operative core hypothermia in paediatric patients undergoing general anaesthesia at the Kenyatta National Hospital is 30%. Gender (male), lower body temperature at induction, use of caudal block and the volume of intravenous fluids infused were significant independent predictors of core hypothermia. The most significant predictor was body temperature at the time of induction of general anaesthesia

Ogilvie’s syndrome: case report of spontaneous rupture of the ceacum following caesarean section

In acute colonic pseudo-obstruction (ACPO) there is colonic distension without an organic obstacle (intrinsic or extrinsic to intestinal wall). This becomes a potential site of ceacal rapture which can lead to the demise of the patient. Presented is a case of a mother who had spontaneous caecal rapture five days after Caesarean delivery. At Laparotomy the ceacal rapture was confirmed and a colostomy was done. The patient succumbed in Intensive care unit two days post-operatively

Pheochromocytoma in pregnancy: Case report

This is a case presentation of a 32 year old woman with pheochromocytoma diagnosed at 27 weeks of gestation, she was managed till term, induced and had assisted vaginal delivery. The pheochromocytoma was surgically re-sected successfully at six weeks postpartum

Early childhood obesity: a survey of knowledge and practices of physicians from the Middle East and North Africa

BACKGROUND: Childhood obesity is one of the most serious public health issues of the twenty-first century affecting even low- and middle-income countries. Overweight and obese children are more likely to stay obese into adulthood. Due to the paucity of data on local practices, our study aimed to assess the knowledge and practices of physicians from the Middle East and North Africa region with respect to early-onset obesity. METHODS: A specific questionnaire investigating the perception and knowledge on early-onset obesity was circulated to healthcare providers (general physicians, pediatricians, pediatric gastroenterologist, neonatologists) practicing in 17 Middle East and North African countries. RESULTS: A total of 999/1051 completed forms (95% response) were evaluated. Of all respondents, 28.9% did not consistently use growth charts to monitor growth during every visit and only 25.2% and 46.6% of respondents were aware of the correct cut-off criterion for overweight and obesity, respectively. Of those surveyed, 22.3, 14.0, 36.1, 48.2, and 49.1% of respondents did not consider hypertension, type 2 diabetes, coronary heart disease, fatty liver disease, and decreased life span, respectively, to be a long-term complication of early childhood obesity. Furthermore, only 0.7% of respondents correctly answered all survey questions pertaining to knowledge of early childhood overweight and obesity. CONCLUSION: The survey highlights the low use of growth charts in the evaluation of early childhood growth in Middle East and North Africa region, and demonstrated poor knowledge of healthcare providers on the short- and long-term complications of early-onset obesity. This suggests a need for both continued professional education and development, and implementation of guidelines for the prevention and management of early childhood overweight and obesity

Association of dietary fiber and depression symptom: A systematic review and meta-analysis of observational studies

Background: A potential relationship between depression and the intake of dietary fiber has been hypothesized in several studies. However, no meta-analysis has been conducted so far to explore the association between these two variables. Hence, we designed the present meta-analysis to elucidate the relationship between the intake of dietary fiber and depression. Methods: A comprehensive search was performed using the PubMed/Medline, Scopus, Web of Science and Google Scholar databases to identify any relevant studies published from inception to October 2019. Observational studies (cross-sectional and case-control) were included in the analysis. Results: Pooled analysis from the random-effects model of four case-control studies revealed that the consumption of dietary fiber in patients with depression was significantly lower versus healthy controls (WMD: -1.41 mg/dl, 95 CI: �2.32, �0.51, P = 0.002). No significant heterogeneity was demonstrated among the analyzed studies (I2 = 4.0 , P = 0.37). By pooling 5 effect sizes of cross-sectional studies (with a total of 97,023 subjects), we demonstrated that a higher dietary consumption of fiber was associated with significantly lower odds of depression (OR = 0.76; 95 CI: 0.64, 0.90; P = 0.010), with a low heterogeneity seen among the retrieved studies (I2 = 43.9 ; P = 0.12). Conclusion: An increased intake of total dietary fiber is associated with lower odds of depression. Further studies are needed to evaluate the relationship between the different types of dietary fiber and depression. © 202

The Effectiveness of Non-pyrethroid Insecticide-treated Durable Wall Lining to Control Malaria in Rural Tanzania: Study Protocol for a Two-armed Cluster Randomized Trial.

Despite considerable reductions in malaria achieved by scaling-up long-lasting insecticidal nets (LLINs) and indoor residual spraying (IRS), maintaining sustained community protection remains operationally challenging. Increasing insecticide resistance also threatens to jeopardize the future of both strategies. Non-pyrethroid insecticide-treated wall lining (ITWL) may represent an alternate or complementary control method and a potential tool to manage insecticide resistance. To date no study has demonstrated whether ITWL can reduce malaria transmission nor provide additional protection beyond the current best practice of universal coverage (UC) of LLINs and prompt case management. A two-arm cluster randomized controlled trial will be conducted in rural Tanzania to assess whether non-pyrethroid ITWL and UC of LLINs provide added protection against malaria infection in children, compared to UC of LLINs alone. Stratified randomization based on malaria prevalence will be used to select 22 village clusters per arm. All 44 clusters will receive LLINs and half will also have ITWL installed on interior house walls. Study children, aged 6 months to 11 years old, will be enrolled from each cluster and followed monthly to estimate cumulative incidence of malaria parasitaemia (primary endpoint), time to first malaria episode and prevalence of anaemia before and after intervention. Entomological inoculation rate will be estimated using indoor CDC light traps and outdoor tent traps followed by detection of Anopheles gambiae species, sporozoite infection, insecticide resistance and blood meal source. ITWL bioefficacy and durability will be monitored using WHO cone bioassays and household surveys, respectively. Social and cultural factors influencing community and household ITWL acceptability will be explored through focus-group discussions and in-depth interviews. Cost-effectiveness, compared between study arms, will be estimated per malaria case averted. This protocol describes the large-scale evaluation of a novel vector control product, designed to overcome some of the known limitations of existing methods. If ITWL is proven to be effective and durable under field conditions, it may warrant consideration for programmatic implementation, particularly in areas with long transmission seasons and where pyrethroid-resistant vectors predominate. Trial findings will provide crucial information for policy makers in Tanzania and other malaria-endemic countries to guide resource allocations for future control efforts

Postpartum women’s use of medicines and breastfeeding practices: a systematic review

The objectives of this article are to systematically review i) the extent of medicine use in postpartum women, and ii) the impact of maternal medicine use (excluding contraceptives and galactogogues) on breastfeeding outcomes (initiation and/or duration). PubMed, Medline (Ovid), Scopus (Elsevier), Cinahl (EBSCO), PsycINFO (Ovid), Embase (Ovid) and Web of Science (ISI) databases were searched to find original studies on medicine use in women after the birth. Additional studies were identified by searching Google Scholar, Wiley Online Library, Springer Link, selected journals and from the reference list of retrieved articles. Observational studies with information about postpartum women’s use of any type of medicine either for chronic or acute illnesses with or without breastfeeding information were included. The majority of relevant studies suggest that more than 50 % of postpartum women (breastfeeding or not) required at least one medicine. Due to the lack of uniform medication use reporting system and differences in study designs, settings and samples, the proportion of medicine use by postpartum women varies widely, from 34 to 100 %. Regarding the impact of postpartum women’s medicine use on breastfeeding, a few studies suggest that women’s use of certain medicines (e.g. antiepileptics, propylthiouracil, antibiotics) during lactation can reduce initiation and/ or duration of breastfeeding. These studies are limited by small sample size, and with one exception, all were conducted in Canada more than a decade ago. Large scale studies are required to establish the relationship between maternal medicine use and breastfeeding, considering type of illness, period of use and total duration of medicine use