Open Access Original Research Article

Unexpected Failure Events in Surgical Patients: Failure of the System or of the Patient?

Fyntanidou Barbara, Fotiadis Kyriakos, Diamantidou Anna, Stavrou George, Doumaki Eleni, Grosomanidis Vasilios, Kotzampassi Katerina

Asian Journal of Medicine and Health, Page 1-6
DOI: 10.9734/AJMAH/2017/34519

Background: Unexpected failure events are undesired harmful effects, which result in prolonged hospital stay, higher mortality and morbidity rates and increased hospital costs. The aim of our study was to identify and thorough investigate patients hospitalized in our university surgical ward, who had to be transferred to the surgical ICU (SICU) due to such an event.

Methods: This was a retrospective observational study performed in the surgical ward of a large, urban, teaching hospital during a 2.5 year period. All failure events, which resulted in the transport of surgical patients from ward to the SICU, were included and reviewed.

Results: There were 56 failure events recorded in 43 patients. Most patients suffering a failure event were admitted through the Emergency Department as acute cases (55,81%) and in most cases the failure event was identified by a nurse on duty (51,8%). Respiratory failure was the most common final diagnosis after SICU admission (60,71%). Of the total 43 patients suffering one or more failure event, 14 died.

Conclusions: Based on our results, it seems that high risk patients admitted through ED should be admitted into ICUs for safety reasons. Moreover, triggering systems and monitoring of postsurgical patients, especially respiratory monitoring, would be helpful in minimizing failure events.

 

Open Access Original Research Article

Helicobacter pylori Containing More Phosphorylation Sites of the CagA Protein Induces Greater Reduction of Gastric Mucins

Moacir Ferreira Júnior, Sérgio de Assis Batista, Rafael Calvão Barbuto, Adriana Dias Gomes, Dulciene Maria Magalhães Queiroz, Ivana Duval Araújo, Marcelo Vidigal Caliari

Asian Journal of Medicine and Health, Page 1-9
DOI: 10.9734/AJMAH/2017/34618

Aims: H. pylori infection is associated with gastritis, pre cancerous lesions, gastric cancer and changes in the protective layer of mucus. However, to our knowledge, there are no studies in humans or experimental models that relate the infection with H. pylori strains containing one or three phosphorylation sites of the CagA protein with the mucins of the protective layer of mucus. The aim of this study was to research the effects of infection with H. pylori strains containing one or three phosphorylation sites of CagA protein on the MUC1 and MUC5AC mucins of Mongolian gerbils (Meriones unguiculatus) gastric mucosa.

Methods: Mongolian gerbils were inoculated with H. pylori isolates containing one or three EPIYA C phosphorylation sites. The control group consisted of uninfected animals receiving only Brucella broth. Gastric mucosa fragments were assessed by immunohistochemistry using rabbit monoclonal antibodies against MUC1 and MUC5AC. The fragments were then analyzed through a digital morphometric method.

Results: From the control group of non-infected animals (CTRL) to the Cag A positive locci with 1 EPYIA C group (CagA1Ep) and Cag A positive locci with 3 EPYIA C group (CagA3EP) there was a progressive and significant reduction in the expression of both MUC1 (p=0.003) and MUC5AC (p=0.003) after 45 days of infection. This reduction was more prominent in the CagA3Ep group. Similar results were obtained six months post-infection, but the reduction in the MUC5AC (p=0.001) and MUC1 (p=0.001) expression was more intense.

Conclusion: H. pylori strains containing more phosphorylation sites of the CagA protein are able to reduce with greater intensity the expression of MUC1 and MUC5AC.

 

Open Access Original Research Article

Computed Tomography Imaging Features of Chronic Headaches in Abuja, Nigeria

D. Itanyi Ukamaka, A. Okechukwu Adaorah

Asian Journal of Medicine and Health, Page 1-8
DOI: 10.9734/AJMAH/2017/34713

Headache is one of the commonest presenting complaints among patients in the emergency room and in general outpatient clinics. Computed Tomography, CT is a veritable diagnosing tool in the evaluation of both intracranial and extracranial causes of headache.

Aim: To document the features of cranial CT in patients with chronic headache and determine the frequency of significant intracranial lesions.

Methodology: This is a retrospective study of the reports of cranial CT of 126 patients referred to the Radiology department of University of Abuja teaching hospital from January 2014 to February 2017with complaint of chronic headache. Data was statistically analyzed using SAS software version 9.3 and statistical level of significance set at 0.05.

Results: Age range of the studied patients was 5-75 years with a mean of 37.3±15.3 years and slight female preponderance (64% vs 54%) with majority of patients in the 45-55 age range. The CT findings show a near equal number of abnormal (n=62, 49.2%) and normal (n=64, 50.8%) findings with higher incidence of intracranial lesions (n=36, 58.1%).Intracranial tumors were seen in 11(17.7%) all occurring in patients <50 years. Sinusitis involving the maxillary and sphenoid sinuses were the commonest extracranial lesions.

Conclusion: There is a significant yield of remediable positive findings in Computed tomography scan of patients with chronic headaches in Abuja, Nigeria.

 

Open Access Original Research Article

Assessment Patients’ Satisfaction Related on Quality of Care: A Cross-sectional Descriptive Study

Mohammad Reza Heidari, Hossein Asgar Pour, Reza Norouzzadeh, Ezgi Temel, Büşra Şahin

Asian Journal of Medicine and Health, Page 1-8
DOI: 10.9734/AJMAH/2017/34513

Patient satisfaction has become increasingly popular and assessment of patient satisfaction is an important tool for monitoring the quality of care in hospitals. The aim of this study was to assess patients satisfaction related to quality of care and factors affecting this. This cross-sectional descriptive study was conducted at a university hospital in Tehran, Iran. In this study, 500 patients were randomly selected and their satisfaction was measured by a standardized questionnaire. Data collection was done during four months period before the discharge process. The study results showed that there was a directly relatiopship betwwen nurses caring and the patients’ satisfaction. The most satisfaction reported was regular health checks by nurses at day shift (4.69±0.67) and the least satisfaction was related to hospital payment (1.20±0.16), respectively. There was a significant correlation with overall satisfaction between insurance status and marital status (P<0.05). The results indicate that periodic patient satisfaction survey should be institutionalized to provide feedback for continuous quality improvement.

Open Access Case Report

Gangrenous Gut in a Pregnant woman: A Case Report

Verner Orish, Emmanuel Coomson, Seth Fanyi, Onyekachi Onyeabor, Adekunle Sanyaolu, Chuku Okorie, Afolabi Antonio

Asian Journal of Medicine and Health, Page 1-5
DOI: 10.9734/AJMAH/2017/34594

Gangrene of the intestines is a rare complication in pregnancy. Intestinal obstruction and ischemic bowel diseases are common causes of gangrene of the intestines in pregnancy. Adhesion bands can cause intestinal obstruction while arterial occlusion, venous thrombosis and vasculitis are some causes of ischemic bowel disease. We present a case of small intestinal gangrene in a 30 year old woman in her third pregnancy, diagnosed during emergency cesarean section with extensive gangrene of the ileum and jejunum caused by band formation at the illeo-caecal junction. This case, despite the unfortunate catastrophic outcome, highlights the subtle challenges of managing rare obstetric complication in resource limited settings.