Nurse-led implementation of ETAT plus is associated with reduced mortality in a children's hospital in Freetown, Sierra Leone

BACKGROUND: In the wake of the Ebola virus disease (EVD) epidemic in Sierra Leone, secondary care facilities faced an increase in admissions with few members of medical staff available to assess and treat patients. This led to long waiting times in hospital outpatient departments. The study was undertaken in the outpatient department of Ola During Children’s Hospital (the tertiary paediatric hospital for Sierra Leone) in the period immediately following the EVD epidemic of 2014–2015. AIMS: This retrospective analysis of operational programme data aimed to assess whether a quality-improvement approach and task-sharing between medical and nursing staff improved the quality of triage and the timeliness of care. METHODS: All staff working in the outpatient department were offered a 4-week training course, followed by on-the-job supervision and support for 6 months. Nurses who successfully completed the course were given responsibility for the initial assessment of sick patients and for prescribing and giving initial treatment. Data were collected at three points: before intervention and at 3 and 6 months after initiation of the intervention. All children presenting to the hospital for medical attention between 0800 and 1400 Monday to Friday were included. Triage assessment by the outpatient nurse was compared to that made by a clinically experienced observer, and the time taken for each child to be triaged, assessed and given initial treatment was recorded. RESULTS:Between months 0 and 6 of the intervention, detection of emergency signs by the triage nurse improved from 30% to 100%, and detection of priority signs improved from 34% to 100%. For children presenting with emergency signs, the median time between triage and full assessment improved from 57 minutes before intervention to 17 minutes at 3 months and 5 minutes at 6 months (p < 0.0005). For the same group, median time between triage and first antibiotic or antimalarial treatment improved from 220 minutes before intervention to 40 minutes at 3 months and 18 minutes at 6 months (p = 0.006). CONCLUSION: The results indicate that, with appropriate training and support, extending the emergency assessment and treatment of sick children to nursing staff in West African hospitals may improve the accuracy of triage and the time to assessment and treatment of children presenting with signs of serious illness

Energy Distribution of a Stringy Charged Black Hole

The energy distribution associated with a stringy charged black hole is studied using M{\o}ller's energy-momentum complex. Our result is reasonable and it differs from that known in literature using Einstein's energy-momentum complex.Comment: Latex, no figure

Stability of compressible boundary layers over a smooth backward-facing step

An investigation is conducted into the determination of the credibility of interacting boundary layers in predicting compressible subsonic flows over smooth surface imperfections. The case of smooth backward-facing steps is considered. The predicted mean flows are compared with those obtained using a Navier-Stokes solver. Moreover, the linear 2-D compressible stability characteristics of both mean flows are compared. The results show that the interacting boundary-layer formulation produces accurate mean flows that yield accurate linear stability characteristics, such as growth rates and amplification factors

Prenatal genotyping of Gaucher disease in Egypt

Objective: To use chorionic villi sampling (CVS) and amniocentesis to determine the genotyping of Gaucher Disease (GD) of fetuses of pregnant mothers who had a previous child affected by GD.Methods: The study was conducted between January 2009 and December 2012. It included 42 pregnant women that gave informed written consent. Thirty mothers presented early so they underwent CVS at 10–12 weeks of pregnancy while 12 mothers presented later and underwent amniocentesis at 14–16 weeks. Strip assay for the identification of Glucocerebrosidase (GBA) gene mutations in the samples of chrorionic villi and amniotic fluid was based on polymerase chain reaction (PCR) and reverse hybridization.Results: The age of the studied pregnant women ranged from 19 to 26 years. Consanguinity was present in 38 cases. Eighteen women were pregnant in affected fetuses. The results of genotyping revealed 15 cases were homozygous L444P/L444P and one case homozygous (N370s/N370s) while two cases were heterogeneous (L444P/D409H). Twenty-four pregnant women had carrier fetuses which were all heterozygous L444P.Conclusion: This study highlights the findings of an extended gene mutation examination for prenatal diagnosis of Guacher Disease. The study found out that the most common mutation was L444P/L444P.Keywords: Gaucher diseases; Prenatal diagnosis; Egypt; Gene; Mutatio

Detection and Identification of Helicobacter pullorum in Poultry Species in Upper Egypt

This work aimed to detect, identify and study the epidemiology of Helicobacter pullorum in avian species in Upper Egypt. A total of 1800 samples, including cloacal swabs, cecal swabs and livers were collected from chickens, turkeys and ducks in five different governorates in Upper Egypt. Using conventional phenotypic methods for isolation and identification, Helicobacter pullorum could be identified only from chickens with percentage 39.33% and no presence of the organism in turkeys and ducks. Sixteen randomly selected phenotypically identified Helicobacter pullorum isolates were confirmed using PCR assay based on 16S rRNA gene. In conclusion, conventional phenotypic methods for detection and differentiation of Helicobacter pullorum are often hampered by many limitations, while molecular methods, and PCR, in particular, have marked an important step forward in bacterial diagnostics and can provide a sensitive and rapid alternative method for detection and identification and highlights the potential of PCR technology in routine detection and identification of pathogens

Interleukin 6 (IL6) as a predictor outcome in patients with compensated cirrhosis and symptomatic gall stones after cholecystectomy

Compensated cirrhosis means that the liver is heavily scarred but can still perform many important functions; many peoples with compensated cirrhosis have gall bladder stones. The advantages of laparoscopic cholecystectomy (LC) for most patients have been extensively published. However its benefits and successful use in patients with cirrhosis are less documented. The study compromised 50 patients with symptomatic gallstone in compensated liver disease and undergone either open cholecystectomy (OC) or laparoscopic cholecystectomy. These patients were randomized into two groups: Group I included 24 patients who underwent OC, and group II included 26 patients who underwent LC. Patient&#8217;s age, sex, clinical presentation and Child-Turcotte-Pugh (CTP) class were documented. No patients in this study had CTP class c cirrhosis. IL-6 was measured by ELISA, postoperative pain (measured by Visual analog scale), hospital stay, blood loss, recovery time (return to work), and liver function tests were documented. IL-6 was significantly lowered at 6th hour and 12th hour post operative in LC group. Mean surgical time was significantly longer in OC than LC group, (mean &#177;SD, 96.6 &#177;32 vs 58.7 &#177; 23.8 min, P = 0.037). No patients in group II required any blood replacement in contrast to 9 patients (37.5%) in group I. Intraoperative bleeding remained significantly higher in group I (P = 0.043). No patients in group II had wound complications compared with 5 patients (29.14%) in group I. Group I had significantly longer hospital stay than group II, mean 9.0+ 1.3 days (median 7) vs 2.3 days + 1.9 (median 2.5); P = 0.001. Our results were demonstrated that laparoscopic cholecystectomy can be performed safely in patients with CTP class A and B cirrhosis. IL-6 was more significantly, increased post operatively in open cholecystectomy than laparoscopic one and it correlated well with intensity of operative trauma.&#160;Keywords: Interleukin 6; Liver cirrhosis; Cholecystectom

Simplicity versus complexity in modelling groundwater recharge in Chalk catchments

Models of varying complexity are available to provide estimates of recharge in headwater Chalk catchments. Some measure of how estimates vary between different models can help guide the choice of model for a particular application. This paper compares recharge estimates derived from four models employing input data at varying spatial resolutions for a Chalk headwater catchment (River Pang, UK) over a four-year period (1992-1995) that includes a range of climatic conditions. One model was validated against river flow data to provide a measure of their relative performance. Each model gave similar total recharge for the crucial winter recharge period when evaporation is low. However, the simple models produced relatively lower estimates of the summer and early autumn recharge due to the way in which processes governing recharge especially evaporation and infiltration are represented. The relative uniformity of land use, soil types and rainfall across headwater, drift-free Chalk catchments suggests that complex, distributed models offer limited benefits for recharge estimates at the catchment scale compared to simple models. Nonetheless, distributed models would be justified for studies where the pattern and amount of recharge need to be known in greater detail and to provide more reliable estimates of recharge during years with low rainfall.</p> <p style='line-height: 20px;'><b>Keywords:</b> Chalk, modelling, groundwater recharge</p