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Factors influencing of professional nurse resignation from Mankwneg Academic Hospital, Limpopo, South Africa
Get PDFProfessional nurses are registered nurses who provide comprehensive nursing treatment and care to patients at various levels of health care. Intentions to quit a job are frequently associated with employee motivation and job satisfaction factors. It has been observed that some of the health professional nurses are quitting Mankweng academic hospital more frequently and which is affecting the service delivery. There is no research done regarding the turnover of the Professional nurse from this institution.
The aim: The main objective of the study is to figure out what factors concern Professional nurses to quit Mankweng Hospital.
Material & methods: The study was a retrospective cross-sectional descriptive quantitative design to analyze the profile of all Professional nurses who quit Mankweng Academic Hospital for 5 years from January 2018 to December 2022.
Result: A total of 47 professional nurses resigned over 5 years from different departments. Lack of promotions (34 %) was the key reason which made professional nurses quit their job at Mankweng Hospital. Poor working conditions (12.8 %) and work-related stress (12.8 %) are other important reasons for resigning.
Conclusions: Lacks of promotions, poor working conditions, and work-related stress are important factors responsible for quitting jobs. Increased staffing, employee support, and enhanced promotion are vital to address to retain the employe
The role of ghrelin and leptin in the formation of morphological changes esophagus of patients with gastro-esophageal reflux disease against type 2 diabetes
Get PDFType 2 diabetes mellitus (T2DM) is associated today with a non-infectious epidemic. Every year, the number of people suffering from this disease only increases. The comorbidity of pathology, namely gastroesophageal reflux disease (GERD) against the background of type 2 diabetes mellitus, is increasingly observed. Pathogenetic mechanisms of the progression of the latter in the combined course with type 2 DM are not sufficiently studied today, and data on the effect of adipokines on the morphological pattern of the esophagus in patients with type 2 DM are emerging.
The aim of this study is to study changes in the esophageal mucosa depending on the concentration of ghrelin and leptin in patients with comorbid GERD on the background of type 2 diabetes.
Materials and methods of the research. 120 patients were recruited for the study and divided into 3 groups and a control group. The 1st group – 60 patients with a combined course of GERD and type 2 DM, the 2nd group – 20 patients with GERD, and the 3rd group – 20 patients with isolated type 2 DM. The control group - 20 practically healthy people of the appropriate age.
The levels of ghrelin and leptin were determined by enzyme-linked immunosorbent assay (ELISA) on a Labline-90 analyzer (Austria).
Endoscopic examination of the upper parts of the gastrointestinal tract (GI) with targeted biopsy was performed with an esophagogastroduodenoscope with end optics "Olympus GIF Q 150-03" (manufactured by Olympus Europa SE & CO. KG, Japan).
The degree of complexity and the presence of reflux esophagitis were determined according to the Los Angeles classification and grading system of esophagitis of the Japanese Society of Esophagitis (JSDE), modified in 1999 [1].
Results. Correlation analysis of the relationship between ghrelin and leptin indicators showed a reliable, inverse, medium strength dependence (r = -0.5531; p<0.05). Reliable maximum values of ghrelin were found in patients with non-erosive form of GERD, and minimum values of ghrelin were recorded in patients with reflux esophagitis stage C. When studying leptin indicators depending on the degree of esophagitis, the following data were obtained: the maximum values of leptin were found in patients with reflux - stage B esophagitis, and minimal - in patients with a non-erosive form of GERD. Regarding the reliability of the obtained data on leptin concentration, we did not find statistically significant differences in the studied groups (p>0.05).
Conclusions. According to the results of the conducted research, we can say that changes in the concentration of ghrelin have an important diagnostic value in the focus of GERD against the background of type 2 diabetes. Decreased ghrelin levels have been associated with erosive forms of GERD in the setting of type 2 diabetes, which can lead to a significant deterioration in the patient's lifestyle. According to the data obtained during the study on the influence of leptin levels on changes in the mucous membrane of the esophagus, it was found that morphological changes in the esophagus did not depend on the concentration of leptin in the studied group
A comparative study of unilateral vs bilateral spinal anaesthesia using hyperbaric bupivacaine with buprenorphine in unilateral inguinal hernia surgery
Get PDFUnilateral spinal anaesthesia can be used for inguinal hernia surgery. The advantage is that it provides a stronger block on the side of surgery and accelerated recovery of the nerve block, with better maintenance of cardiovascular stability. Hence it can be a valuable technique for high-risk patients.
The aim: This randomized controlled trial was designed to evaluate the onset and duration of Sensory and motor block in both unilateral and bilateral spinal anaesthesia and the adverse effects of buprenorphine given intrathecally with 0.5 % bupivacaine for Spinal anaesthesia in patients scheduled for unilateral inguinal hernia surgery.
Materials and methods: it is a сomparative two group randomized clinical study with 60 patients with 30 patients in Group U (UNILATERAL) and 30 patients in Group B (BILATERAL) is undertaken to study the changes in haemodynamics and side effects. Whereas, within the group (for the unilateral group) comparison of the time taken to reach L1, T12, T10 and the Bromage time between the surgical side and non-surgical side sides of surgery was done.
Results: T10 -T12 spinal anaesthesia was achieved in both groups; the average time to anaesthetic onset in the unilateral group was 5.27±1.2 min, and in the bilateral, it was 5.90±1.02 min (p-value=0.32). Sensory and motor block lasted longer in the bilateral group when compared to the unilateral group; the incidence of side effects was limited to the occurrence of hypotension and bradycardia in the unilateral group than in the bilateral group. The success rate of unilateral spinal anaesthesia in our study was 100 %.
Conclusion: Because of haemodynamic stability and faster recovery characteristics of unilateral spinal block, it can be used as a suitable technique in patients with a limited cardiovascular reserve and for outpatient anaesthesia
Comparison of hemodynamic stability of propofol ketamine versus etomidate ketamine during induction in peritonitis cases posted for emergency surgery
Get PDFThe aim: The aim of the present study is to evaluate the hemodynamic stability of propofol ketamine versus etomidate ketamine during induction of anaesthesia in peritonitis cases posted for emergency surgery.
Methods: Sixty patients with peritonitis, posted for emergency surgery under general anaesthesia, were randomly allocated to two groups. Group propofol ketamine (P + K) comprised of 30 patients (n=30) were induced with propofol 1 mg/kg and ketamine 0.75 mg/kg IV. Group etomidate ketamine (E + K) comprised 30 patients induced with etomidate 0.3 mg/kg and ketamine 0.75 mg/kg. The hemodynamic effects of the combination of the drugs in both groups were compared before and after induction.
Results: The change in saturation (SPO2) and Heartrate between the groups P+K & group E+K before induction and after intubation was similar in both groups. There was a statistically insignificant fall in systolic blood pressure (SBP) and diastolic blood pressure (DBP), and mean arterial pressure (MAP) in group P+K before and after induction when compared to group E+K.
Conclusions: The propofol ketamine and etomidate ketamine combinations have a similar haemodynamic profile and are equally effective in maintaining haemodynamic stability during induction and intubation
A clinicoepidemiological study of geriatric dermatoses
Get PDFSkin diseases are a common and inevitable consequence of ageing. Moreover, the clinical presentation is not as classical as they do in the younger population. A lifetime of solar exposure, along with intrinsic changes in the dermal structures, predisposes to a variety of skin diseases.
The aim: to study the spectrum of various geriatric dermatoses among our patient population at the Department of Dermatology, Venereology, and Leprosy at Kamineni Academy of Medical Sciences and Research Centre.
Materials and methods: in this study, a total of 200 patients aged 60 years and above attending the DVL OPD of Kamineni Academy of Medical Sciences and Research Centre were included.
Results: maximum number of patients in this study belonged to 60-65 years (60 %), Male to female ratio was 1.86:1. Most of the males had agriculture work, and most of the females were housewives. Diabetes mellitus was the commonest associated systemic disease seen in 68 cases (34 %), and generalised pruritus was the commonest symptom seen in 64 (32 %) cases, of which 42 cases (65.6 %) were associated with xerosis. Pathological skin disorders and eczematous conditions were seen in 56 out of 200 cases. Of this, asteatotic eczema was the common finding among the eczematous conditions seen in 14 cases (7 %). Psoriasis was seen in 32 (16 %) and lichen planus in 10 cases (5 %). Infectious diseases were seen in 78 cases (39 %). Of these, fungal infections were common, seen in 28 cases (14 %). The benign tumour was seborrheic keratosis in this study, seen in 61 cases (30.5 %); among the malignant tumours, 4 cases (2 %) of basal cell carcinoma and 2 cases (1 %) of squamous cell carcinoma were seen. Among 16 cases of bullous disorders, bullous pemphigoid was seen in 12 (6 %) cases. Among 22 cases of psychocutaneous disorders, delusional parasitosis was seen in 10 cases (5 %), and perforating folliculitis in 15 cases (7.5 %). Loss of luster was the commonest nail change seen in 182 cases (91 %), followed by nail plate thickening in 54 cases (27 %). Greying of the hair was seen in all cases. Out of 70 females, diffuse hair loss was seen in 58 cases (82.9 %), and out of 130 males, androgenetic alopecia was seen in 72 cases (55.4 %).
Conclusion: skin diseases cause considerable morbidity in the elderly, particularly if associated with other comorbid conditions. Health education on proper skin care, avoidance of irritants and self-medication etc., would help to reduce the incidence of common dermatoses
Evaluate the importance of giving antenatal corticosteroids in respiratory distress syndrome in preterm neonates
Get PDFRespiratory distress syndrome (RDS) is one of the leading causes of early neonatal morbidity and mortality in late preterm infants (LPIs) worldwide.
The aim: The study is intended to evaluate the importance of giving antenatal corticosteroids in decreasing respiratory distress syndrome in preterm neonates.
Materials and methods: Prospective cohort study done in all preterms delivered in the hospital attached to those admitted in our neonatal intensive care unit during the study duration are taken as the source. All preterm babies are admitted to the neonatal intensive care unit.
Results: The overall incidence of RDS in this study was 30 (15 %), among which 7 (7 %) were exposed to steroids, and 23 (23 %) were not exposed to steroids. Antenatal corticosteroids were significantly associated with reduced incidence of RDS in preterms (neonates born between 28–37 weeks of gestational age). The overall incidence of TTN (transient tachypnea) was found to be 46 (28 %) in this study, among which 14 (14 %) were exposed to steroids, and 32 (32 %) were not exposed to steroids. Antenatal corticosteroids were significantly associated with reduced incidence of TTN in preterms. Antenatal corticosteroids significantly reduce the need for supplemental oxygen, NICU admission, need for CPAP and mortality rate. The dose of antenatal corticosteroids was significantly associated with the incidence of RDS and TTN. 2 doses of steroids reduced RDS and TTN significantly compared to the single dose, which was just significantly associated. This study found no significance between RDS and TTN with gestational age, mode of delivery, birth weight and RDS among steroid-exposed babies.
Conclusion: The use of antenatal corticosteroids should be promoted because they successfully lowered morbidity and mortality among premature newborns in the population studied. In order to optimise proper and timely prenatal corticosteroid treatment, this study underlines the necessity for quality improvement initiatives
Prospective study on the effect of topical honey on radiation-induced mucositis induced by concurrent chemotherapy and radiation or radiation alone given as radical or adjuvant treatment in head and neck squamous cell malignancies
Get PDFPain imparts additional morbidity and economic burden to patients by requiring parenteral analgesia, interruption of radiation therapy (RT) and/or hospitalization, and parenteral or tube feeding, all of which negatively impact patients' quality of life. There are various drugs tried to relieve pain associated with radiation-induced mucositis.
The aim: The aim of the study is to evaluate the effect of the topical application of pure natural honey on radiation-induced mucositis in patients undergoing concurrent chemo-radiation or radiation alone for radical or adjuvant treatment for head and neck squamous cell malignancies.
Materials and methods: It is a hospital-based prospective study enrolling patients with histopathologically proven head and neck cancers. All histopathologically proven patients of squamous cell carcinoma of Head & Neck cancer (carcinoma of the oral cavity, oropharynx) receiving chemotherapy and radiotherapy or radiotherapy alone in the definitive or adjuvant setting and who meet our inclusion and exclusion criteria will be taken up as study group.
Results: Mean age of patients was 49 years, most males 87 %. The oral cavity was the most common primary site (84 %), followed by the oropharynx (16 %). Most cases were locally advanced cancer stage IV (60 %). The set of mucositis is after 5 fractions in both study and control groups, but 89 % in the control group, compared to 33 % in the study group. On grade 3, mucositis is delayed in the study group compared to the control group, and no patients in the study group had grade 4 mucositis.
Conclusions: All patients in the study developed mucositis. On the set of grade 3, mucositis is delayed in the study group compared to the control group, and no patients in the study group had grade 4 mucositis. Honey is effective in preventing grade 3 and 4 mucositis. Honey showed no effect on weight loss and oral infections in this study
A clinical study of perinatal and maternal morbidity and mortality in gestational hypertension, preeclampsia and eclampsia
Get PDFIn India, hypertensive disorders complicating pregnancy are common and continue to be responsible for the largest proportion of perinatal deaths resulting from prematurity and IUGR and are major contributors to perinatal and maternal morbidity and mortality.
The aim: The present study is undertaken to analyse the cases of preeclampsia and eclampsia, including consequences concerning preterm delivery, IUGR, IUD and stillbirth and for the evaluation of a safe motherhood program at the population level.
Materials and methods: The present study was conducted on 105 selected cases from the census (sample of 12,589 patients) of pregnancy-induced hypertension (gestational hypertension, preeclampsia and eclampsia).
Results: Hypertensive cases complicating pregnancy of the foetal deliveries conducted during the study period, out of which Gestational hypertension (GTN) cases reported were 44. Preeclampsia (PE) cases were 39, severe preeclampsia (SPE) were 1 and Eclampsia cases were 21. Labetalol alone was used in 62 cases, and 44 babies were born without any complications. As an anticonvulsant magnesium sulphate (MgSO4, 7H2O) was used in all cases of imminent eclampsia and eclampsia (MgSO4 PRITCHARD Regime) in a total number of 38 cases. Preterm / prematurity was the most common cause of perinatal death. The total number of NICU admissions was 42 (40 %).
Conclusions: The early use of anti-hypertensive drugs, the optimum timing of delivery, strict fluid balance, and anticonvulsants in cases of eclampsia will help to achieve a successful outcome. Early transfer to a specialist centre is important, and the referral centres should be well-equipped to treat critically ill patients
Series of rare cases of breast tumour: 8-year review at mankweng Breast Oncology clinic, Limpopo, South Africa
Get PDFBreast cancer remains the most common cancer in many parts of the world, particularly for women. In March 2015, a Breast Oncology clinic for breast cancer patients was established at Mankweng Hospital. Invasive ductal carcinoma is the most common (87 %) tumour found in Limpopo, and occasionally, another rare tumour of the breast is presented in the Breast Oncology clinic.
The aim: The main objective is to share the experience of a rare tumour of the breast came across over the past 8 years since the establishment of the Breast Oncology clinic.
Material and Method: Series of rare case reports of Breast tumours and literature review from the Mankweng Breast Oncology Clinic.
Result: Rare tumour encountered in Breast Oncology clinic: adenomyoepithelioma, micro-papillary carcinoma of the breast, primary malignant melanoma of the breast, primary non-Hodgkin's lymphoma of the bilateral breast, advanced breast cancer in a case of Down's syndrome, primary neuroendocrine invasive breast carcinoma, sarcoma of the breast.
Conclusions: Most of these rare cases are presented to the Breast Oncology clinic in the advanced stage. Breast cancer awareness campaign is highly important for women in Limpopo, particularly when attending primary health care for any other conditions
Synchronous metastatic colon carcinoma presenting as ovarian metastasis: a case report
Get PDFThe aim of the study was to discuss a rare case of synchronously metastatic colon cancer, which clinically manifested as intestinal obstruction due to the presence of ovarian metastasis.
Materials and methods. The clinical case of a 47-year-old patient with synchronously metastatic colorectal cancer with an affected disease, peritoneal carcinomatosis and metastatic ovarian lesions was analyzed.
Case presentation. In July 2021, patient R., 47 years old, developed a clinic of sub-compensated intestinal obstruction. According to CT and MRI data, a volume formation of the small pelvis with a diameter of about 15 cm with compression of the surrounding soft tissues and metastases of the 6th and 4a segments of the liver were determined. According to a colonoscopy, a neoplasm of the sigmoid colon was verified as adenocarcinoma. The presence of peritoneal carcinomatosis was determined intraoperatively; the operation was performed in the following scope: SS-0 (complete cytoreduction) – right-sided ovariectomy with a tumour, resection of the sigmoid colon with a tumour, resection of the rectum with TME, extirpation of the cervical stump with the left ovary and pelvic peritonectomy en block resection and diathermocoagulation of foci of peritoneal carcinomatosis on the visceral peritoneum of the small intestine, omentectomy, radiofrequency ablation of a liver tumour under ultrasound guidance. According to histopathological examination: adenocarcinoma (G2) with foci of mucus production in the sigmoid colon, metastatic lesion of the right ovary, cervix, peritoneum, and liver.
Subsequently, from September 2021 to July 2022, the patient underwent 8 courses of adjuvant polychemotherapy according to the FOLFOX scheme and 2 courses according to the FOLFOX scheme and bevacizumab. In August 2022, due to signs of disease progression, the patient underwent SS-0 cytoreductive surgery: removal of tumour nodes of the parietal and visceral peritoneum, partial peritonectomy of the anterior abdominal wall, argon plasma coagulation of foci of peritoneal carcinomatosis of the parietal and visceral peritoneum, resection of the round ligament of the liver, NIRES. According to the results of the histological examination, metastases of mucinous adenocarcinoma of the intestinal type with the II-III degree of medical pathomorphosis were determined.
From September 2022, the patient received 2 courses according to the IRINOX + bevacizumab regimen and 6 courses according to the FOLFIRI + bevacizumab regimen.
According to the control MRI of the abdominal organs with intravenous contrast, metastases of the 7th and 8th segments of the liver were determined.
Performed percutaneous radiofrequency ablation of liver metastases under ultrasound control
Results. According to the results of the MRI of the OCP with intravenous contrast, there are currently no data on the progression of the disease. The patient's quality of life is satisfactory; the ESOG score is 0. It has been 22 months since the onset of the disease.
Conclusions. Cytoreductive surgical interventions for synchronously metastatic colorectal cancer can significantly improve patients' quality of life and their oncological outcomes rather than only symptomatic treatment