Browsing by Subject "Outcomes"

Now showing 1 - 6 of 6
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    Conflict and tuberculosis in Sudan: a 10-year review of the National Tuberculosis Programme, 2004-2014
    (BioMed Central, 2018-05-16) Hassanain, Sara A; Edwards, Jeffrey K; Venables, Emilie; Ali, Engy; Adam, Khadiga; Hussien, Hafiz; Elsony, Asma
    Background Sudan is a fragile developing country, with a low expenditure on health. It has been subjected to ongoing conflicts ever since 1956, with the Darfur crisis peaking in 2004. The conflict, in combination with the weak infrastructure, can lead to poor access to healthcare. Hence, this can cause an increased risk of infection, greater morbidity and mortality from tuberculosis (TB), especially amongst the poor, displaced and refugee populations. This study will be the first to describe TB case notifications, characteristics and outcomes over a ten-year period in Darfur in comparison with the non-conflict Eastern zones within Sudan. Methods A cross-sectional review of the National Tuberculosis Programme (NTP) data from 2004 to 2014 comparing the Darfur conflict zone with the non-conflict eastern zone. Results New case notifications were 52% lower in the conflict zone (21,131) compared to the non-conflict zone (43,826). Smear-positive pulmonary TB (PTB) in the conflict zone constituted 63% of all notified cases, compared to the non-conflict zone of 32% (p < 0.001). Extrapulmonary TB (EPTB) predominated the TB notified cases in the non-conflict zone, comprising 35% of the new cases versus 9% in the conflict zone (p < 0.001). The loss to follow up (LTFU) was high in both zones (7% conflict vs 10% non-conflict, p < 0.001) with a higher rate among re-treatment cases (12%) in the conflict zone. Average treatment success rates of smear-positive pulmonary TB (PTB), over ten years, were low (65-66%) in both zones. TB mortality among re-treatment cases was higher in the conflict zone (8%) compared to the non-conflict zone (6%) (p < 0.001). Conclusion A low TB case notification was found in the conflict zone from 2004 to 2014. High loss to follow up and falling treatment success rates were found in both conflict and non-conflict zones, which represents a significant public health risk. Further analysis of the TB response and surveillance system in both zones is needed to confirm the factors associated with the poor outcomes. Using context-sensitive measures and simplified pathways with an emphasis on displaced persons may increase access and case notification in conflict zones, which can help avoid a loss to follow up in both zones.
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    HIV testing, HIV status and outcomes of treatment for tuberculosis in a major diagnosis and treatment centre in Yaounde, Cameroon: a retrospective cohort study
    (BioMed Central Ltd, 2012) Pefura Yone, Eric; Kuaban, Christopher; Kengne, Andre
    BACKGROUND:Human immuno-deficiency virus (HIV) infection and tuberculosis are common and often co-occurring conditions in sub-Saharan Africa (SSA). We investigated the effects of HIV testing and HIV status on the outcomes of tuberculosis treatment in a major diagnosis and treatment centre in Yaounde, Cameroon. METHODS: Participants were 1647 adults with tuberculosis registered at the Yaounde Jamot's Hospital between January and December 2009. Multinomial logistic regression models were used to relate HIV testing and HIV status to the outcomes of tuberculosis treatment during follow-up, with adjustment for potential covariates. RESULTS: Mean age of participants was 35.5 years (standard deviation: 13.2) and 938 (57%) were men. Clinical forms of tuberculosis were: smear-positive (73.8%), smear-negative (9.4%) and extra-pulmonary (16.8%). Outcomes of tuberculosis treatment were: cure/completion (68.1%), failure (0.4%), default (20.1%), death (5.2%) and transfer (6.3%). Using cure/completion as reference, not testing for HIV was associated with adjusted odds ratio of 2.30 (95% confidence interval: 1.65-3.21), 2.26 (1.29-3.97) and 2.69 (1.62-4.46) for the risk of failure/default, death and transfer respectively. The equivalents for a positive test among those tested (1419 participants) were 1.19 (0.88-1.59), 6.35 (3.53-11.45) and 1.14 (0.69-1.86). CONCLUSIONS: Non-consent for HIV testing in this setting is associated with all unfavourable outcomes of tuberculosis treatment. However been tested positive was the strongest predictor of fatal outcome. Efforts are needed both to improve acceptance of HIV testing among patients with tuberculosis and optimise the care of those tested positive.
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    Influence of HIV infection on the clinical presentation and outcome of adults with acute community-acquired pneumonia in Yaounde, Cameroon: a retrospective hospital-based study
    (BioMed Central Ltd, 2012) Yone, Eric Walter; Balkissou, Adamou; Kengne, Andre; Kuaban, Christopher
    BACKGROUND: The impact of HIV infection on the evolution of acute community-acquired pneumonia (CAP) is still controversial. The aim of this study was to investigate possible differences in the clinical presentation and in-hospital outcomes of patients with CAP with and without HIV infection in a specialised service in Yaounde. METHODS: Medical files of 106 patients (51 men) aged 15years and above, admitted to the Pneumology service of the Yaounde Jamot Hospital between January 2008 and May 2012, were retrospectively studied. RESULTS: Sixty-two (58.5%) patients were HIV infected. The median age of all patients was 40years (interquartile range: 31.75-53) and there was no difference in the clinical and radiological profile of patients with and without HIV infection. The median leukocyte count (interquartile range) was 14,600/mm3 (10,900-20,600) and 10,450/mm3 (6,400-16,850) respectively in HIV negative and HIV positive patients (p=0.002). Median haemoglobin level (interquartile range) was 10.8g/dl (8.9-12) in HIV negative and 9.7g/dl (8-11.6) in HIV positive patients (p=0.025). In-hospital treatment failure on third day (39.5% vs. 25.5.1%, p=0.137) and mortality rates (9% vs. 14.5%, p=0.401) were similar between HIV negative and HIV positive patients. CONCLUSION: Clinical and radiological features as well as response to treatment and in hospital fatal outcomes are similar in adult patients hospitalised with acute community-acquired pneumonia in Yaounde. In contrast, HIV infected patients tend to be more anaemic and have lower white cell counts than HIV negative patients. Larger prospective studies are needed to consolidate these findings.
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    The LIFE TRIAD of emergency general surgery
    (2022-07-25) Coccolini, Federico; Sartelli, Massimo; Kluger, Yoram; Osipov, Aleksei; Cui, Yunfeng; Beka, Solomon G; Kirkpatrick, Andrew; Sall, Ibrahima; Moore, Ernest E; Biffl, Walter L; Litvin, Andrey; Pisano, Michele; Magnone, Stefano; Picetti, Edoardo; de Angelis, Nicola; Stahel, Philip; Ansaloni, Luca; Tan, Edward; Abu-Zidan, Fikri; Ceresoli, Marco; Hecker, Andreas; Chiara, Osvaldo; Sganga, Gabriele; Khokha, Vladimir; di Saverio, Salomone; Sakakushev, Boris; Campanelli, Giampiero; Fraga, Gustavo; Wani, Imtiaz; Broek, Richard t.; Cicuttin, Enrico; Cremonini, Camilla; Tartaglia, Dario; Soreide, Kjetil; Galante, Joseph; de Moya, Marc; Koike, Kaoru; De Simone, Belinda; Balogh, Zsolt; Amico, Francesco; Shelat, Vishal; Pikoulis, Emmanouil; Di Carlo, Isidoro; Bonavina, Luigi; Leppaniemi, Ari; Marzi, Ingo; Ivatury, Rao; Khan, Jim; Maier, Ronald V.; Hardcastle, Timothy C.; Isik, Arda; Podda, Mauro; Tolonen, Matti; Rasa, Kemal; Navsaria, Pradeep H.; Demetrashvili, Zaza; Tarasconi, Antonio; Carcoforo, Paolo; Sibilla, Maria G.; Baiocchi, Gian L.; Pararas, Nikolaos; Weber, Dieter; Chiarugi, Massimo; Catena, Fausto
    Emergency General Surgery (EGS) was identified as multidisciplinary surgery performed for traumatic and non-traumatic acute conditions during the same admission in the hospital by general emergency surgeons and other specialists. It is the most diffused surgical discipline in the world. To live and grow strong EGS necessitates three fundamental parts: emergency and elective continuous surgical practice, evidence generation through clinical registries and data accrual, and indications and guidelines production: the LIFE TRIAD.
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    Outcomes following admission to paediatric intensive care: A systematic review
    (2020) Procter, Claire; Argent, Andrew; Morrow, Brenda
    Introduction Paediatric Intensive Care has developed rapidly in recent years with a dramatic increase in survival rates. However, there are increasing concerns regarding the impact that admission to a Paediatric Intensive Care Unit (PICU) has on both the child and their family. Following discharge from PICU, children may be living with complex medical problems as well as dealing with the psychosocial impact that their illness has had on them and their family. Objectives To describe the long-term health outcomes of children admitted to a paediatric intensive care unit (PICU). Methods A full literature search was conducted including the databases; MEDLINE via PubMed, Cochrane Central Register of Controlled Trials, (CENTRAL), Scopus, Web of Science, CINAHL, ERIC, Health Source Nursing/Academic, APA PsycInfo. All studies including children under 18 admitted to a PICU were included. Primary outcome was short- and longerterm mortality. Secondary outcomes were neurodevelopment/cognition/school performance; physical function, psychological function/behaviour impact, quality of life outcomes and social/family implications. Studies focused on Neonatal Intensive Care Admission and articles with no English translation were excluded. Results One hundred and five articles were included in the analysis. Mortality in PICU ranged from 1.3% to 50%. Mortality in high income countries reduced over time but the data did not show the same trend for low- and middle-income countries. Higher income countries were found to have lower Standardised Mortality Rates (SMRs) than low- and middle-income countries. Children had an ongoing risk of death for up to 10 years following PICU admission. Children admitted to PICU also have more ongoing morbidity than their healthy counterparts with more cognitive/developmental problems, more functional health issues, poorer quality of life as well as increased psychological problems. Their parents also have an increased risk of Post Traumatic Stress Disorder (PTSD). Discussion Most of the studies identified are from high income countries and only include short-term follow up. More data is needed from low- and middle-income countries and over longer terms. The studies were markedly heterogenous and were all observational. Agreement is needed regarding which outcomes are most important to measure as well as standardised methods of assessing them. Further research is needed to identify the risk factors which cause children to have poorer outcomes as well as to identify predictive and modifiable factors which could be targeted in practice improvement initiatives.
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    The changing landscape of infective endocarditis in South Africa
    (2019) de Villiers, Marthinus Coenraad; Ntsekhe, Mpiko; Viljoen, Charle André
    Background. Little is known about the current clinical profile and outcomes of patients with infective endocarditis (IE) in South Africa. Methods. We conducted a retrospective review of the records of patients admitted to Groote Schuur Hospital between 2009 and 2016 fulfilling universal criteria for definite or possible IE, in search of demographic, clinical, microbiological, echocardiographic, treatment and outcome information. Results. 105 patients fulfilled the modified Duke criteria for IE. The median age of the cohort was 39 years (IQR 29-51), with a male preponderance (61.9%). The majority of patients (72.4%) had left-sided native valve endocarditis, 14% had right-sided disease, and 13.3% had prosthetic valve endocarditis. A third of the cohort had rheumatic heart disease. Although 41.1% of patients with left-sided disease had negative blood cultures, the three most common organisms cultured in this subgroup were Staphylococcus aureus (18.9%), Streptococcus spp. (16.7%) and Enterococcus spp. (6.7%). Participants with right-sided endocarditis were younger (29 years (IQR 27-37)), were predominantly intravenous drug users (IVDU; 73.3%) and the majority cultured positive for S. aureus (73.3%) with frequent septic pulmonary complications (40.0%). The overall in-hospital mortality was 16.2%, with no deaths in the group with right-sided endocarditis. Predictors of death in our patients were heart failure (OR 8.16, CI 1.77-37.70; p=0.007) and an age > 45 years (OR 4.73, CI 1.11- 20.14; p=0.036). Valve surgery was associated with a reduction in mortality (OR 0.09, CI 0.02-0.43; p=0.003). Conclusions. Infective endocarditis in a typical teaching tertiary care centre in South Africa remains an important clinical problem. In this setting, it continues to affect mainly young people with post-inflammatory valve disease and congenital heart disease. IE is associated with an in-hospital mortality that remains high. Intravenous drug-associated endocarditis caused by S. aureus is an important IE subset, comprising approximately 10% of all cases, a fact which was not reported 15 years ago, and culture-negative endocarditis remains highly prevalent. Heart failure in IE carries significant risk of death and needs a more intensive level of care in hospital. Finally, cardiac surgery was associated with reduced mortality, with the largest impact in those patients with heart failure.