60 research outputs found
Is Quantitative Radiographic Measurement of Acetabular Version Reliable in Anteverted and Retroverted Hips?
No full textThe Yeditepe University Open Access System is a compendium of indexed publications. Copyright and usage rights may be held by publishers and/or authors. The collection was established for the scientific publications prepared by Yeditepe University academicians and is to be found in the institutional archive.Methods: We searched our image archives for patients who had received both radiographs and CT scans between January 2020 and June 2022 and found 84 patients who met the criteria. From these patients, we selected those who presented with hip pain of different causes and who had no previous elective and/or hip trauma surgery, no hip dysplasia, and results from adequate radiographic examinations. Accordingly, 73 (61 of 84) of the patients were included in this study, and angle measurements were performed on both hips of these patients (122 hips). Standardized positioning was meticulously verified for all plain radiographs and CT scans utilized in the measurement process. We measured quantitative angles and assessed qualitative signs of retroversion, including crossover, posterior wall, and ischial spine findings. We considered a hip with at least one of these findings a retroverted hip, and the hips without these findings were included in the anteverted hip group. Three clinicians took measurements independently. Measurement reliability and agreement were examined using intraobserver and interobserver intraclass correlation coefficients (ICCs), with statistical analyses including paired and independent t-tests. To investigate the reliability of quantitative radiographic and CT methods, we assessed both intraobserver and interobserver agreements. To explore the reliability disparities in measuring the acetabular version via radiography and CT in anteverted and retroverted hips, we analyzed the agreement between measurements from both modalities in the hip groups. Furthermore, to evaluate the degree of variation in acetabular version measurements when comparing quantitative radiographic and CT methods in anteverted and retroverted hips, we utilized paired and independent t-tests to examine the measurement differences within these hip categories. The difference between radiographic and CT measurements was also evaluated by Bland-Altman analysis.Background: The acetabular version is crucial for hip function, and its accurate assessment is necessary for treating patients with hip disorders. Current studies reveal discrepancies in the precision of quantitative radiographic measurements versus CT measurements, but there is a lack of focused analysis on anteverted versus retroverted hips. This study aims to fill this gap by directly comparing the reliability of these two methods in assessing varied hip configurations. Questions/purposes (1) How reliable are quantitative radiographic and CT methods in measuring the acetabular version angle? (2) Is there any difference in the reliability of acetabular version angle measurements using radiography compared with CT in anteverted and retroverted hips? (3) What is the extent of variation in acetabular version measurements when quantitative radiographic and CT methods are compared in anteverted and retroverted hips? Methods We searched our image archives for patients who had received both radiographs and CT scans between January 2020 and June 2022 and found 84 patients who met the criteria. From these patients, we selected those who presented with hip pain of different causes and who had no previous elective and/or hip trauma surgery, no hip dysplasia, and results from adequate radiographic examinations. Accordingly, 73 (61 of 84) of the patients were included in this study, and angle measurements were performed on both hips of these patients (122 hips). Standardized positioning was meticulously verified for all plain radiographs and CT scans utilized in the measurement process. We measured quantitative angles and assessed qualitative signs of retroversion, including crossover, posterior wall, and ischial spine findings. We considered a hip with at least one of these findings a retroverted hip, and the hips without these findings were included in the anteverted hip group. Three clinicians took measurements independently. Measurement reliability and agreement were examined using intraobserver and interobserver intraclass correlation coefficients (ICCs), with statistical analyses including paired and independent t-tests. To investigate the reliability of quantitative radiographic and CT methods, we assessed both intraobserver and interobserver agreements. To explore the reliability disparities in measuring the acetabular version via radiography and CT in anteverted and retroverted hips, we analyzed the agreement between measurements from both modalities in the hip groups. Furthermore, to evaluate the degree of variation in acetabular version measurements when comparing quantitative radiographic and CT methods in anteverted and retroverted hips, we utilized paired and independent t-tests to examine the measurement differences within these hip categories. The difference between radiographic and CT measurements was also evaluated by Bland-Altman analysis. Results Quantitative radiographic measurements showed intraobserver and interobserver reliabilities with ICCs of 0.87 (95 CI 0.84 to 0.91) and 0.78 (95 CI 0.75 to 0.82), respectively, and CT measurements demonstrated higher reliabilities with ICCs of 0.92 (95 CI 0.90 to 0.93) and 0.91 (95 CI 0.89 to 0.92), respectively. The reliability of measuring the acetabular version in anteverted hips was moderate, with an ICC of 0.59 (95 CI 0.49 to 0.68). In contrast, retroverted hips showed an ICC of -0.41 (95 CI -1.17 to 0.08), indicating a lack of consistency between quantitative radiographic and CT measurements. Variation in measurement on plain radiographs in anteverted hips was less than that of retroverted hips (mean 6 SD absolute difference between anteverted hips and retroverted hips 3° 6 3° versus 6° 6 4°; p 0.0001), indicating greater variability in the radiographic measurement of retroverted hips. According to Bland-Altman analysis, we observed that the difference between radiographic and CT measurements was well outside the CI, especially in retroverted hips. Conclusion Although quantitative radiographic measurement demonstrates acceptable intraobserver and interobserver reliabilities, its precision is lower than that of CT-based measurements. Specifically, quantitative radiographic methods are prone to a larger margin of error in retroverted hips. For more precise assessments of acetabular version, especially in retroverted hips, we recommend using CT measurement instead of the radiographic method. Copyright © 2024 The Author(s)
The effect of a preanaesthesia clinic consultation on adult patient anxiety at a tertiary hospital in Kenya: a cohort study
No full textBackground: Preoperative anxiety is a common perioperative complication seen in approximately 11-80% of adults undergoing surgery. One of the goals of the preanaesthesia clinic is to allay anxiety. A preanaesthesia clinic evaluation has been shown to reduce anxiety however current studies on anxiety and the preanaesthesia clinic have not quantified this reduction.
Objective: To determine the reduction in anxiety in patients evaluated in the clinic versus those evaluated in the ward.
Methods: Fifty one adult patients with 28 patients in anaesthesia clinic (AC) group and 23 in the ward (W) group were sequentially recruited from both the surgical, gynaecology and antenatal outpatient clinics and the wards. The patient’s State Trait Anxiety Index (STAI) was taken once the patient was booked for theatre. The patients then had a preanaesthesia evaluation either in the preanaesthesia outpatient clinic (PAC) or in the wards. Another STAI score was taken in the preoperative area in theatre on the day of surgery. The difference in the change of STAI scores in both groups was then analysed.
Results: Fifty one adult patients were recruited with 28 in the AC group and 23 in the W group. The majority of patients were female (n=38). Statistically significant difference was seen in the reduction of the anxiety scores between the clinic group 2.143 (C.I=1.384-2.902) and ward group 0.74(C.I=0.17-1.31) with a p value=0.0051.There was also significant difference in reduction in anxiety scores within ward group in the patients with no prior anaesthetic experience having a greater reduction than those with prior anaesthetic experience. There were no other significant differences between the two groups.
Conclusion: Patients evaluated in the anaesthesia clinic had a greater reduction in their anxiety but it was not as much as hypothesised which may be due to the multi-factorial nature of preoperative anxiety. A larger multicenter study is recommended to increase generalizability to the population
Non-Communicable Disease Epidemics Approaches to Prevention and Control in Sub-Saharan Africa
No full textBookNon-communicable diseases (NCDs) and their risk factors are on the increase globally. It is estimated that NCDs accounted for 72 per cent of mortality globally in 2016, with 80 per cent of these NCD deaths occurring in low- and middle-income countries (LMICs) (WHO, 2013; Forouzanfar et al., 2015). Four out of a large range of NCDs – cardiovascular diseases, diabetes, cancers, and chronic respiratory illnesses – have been identified as being responsible for the greatest share of the burden (WHO, 2013). These four diseases (or disease groups) also share a set of four risk factors, namely tobacco use, unhealthy diet, harmful alcohol consumption, and physical inactivity
HIV-Associated pulmonary hypertension: case report
No full textWith the advent of highly active antiretroviral therapy, there has been a significant change in the epidemiology of pulmonary disease in HIV/AIDS. The relative prevalence of non-infectious manifestations is likely to rise. HIV associated pulmonary hypertension (HIV-PH), albeit low prevalence, is associated with significant morbidity and mortality. Presently, despite having scanty evidence on the management modalities of HIV-PH, evidence extrapolated from idiopathic pulmonary hypertension is being utilised to effectively manage some of these patients. Efforts should therefore be made to screen, diagnose and treat these patients. A case of a thirty year old female with HIV disease and severe pulmonary hypertension is presented
The association between asymptomatic and mild neurocognitive impairment and adherence to antiretroviral therapy among people living with human immunodeficiency virus
No full textBackground: Asymptomatic cognitive impairment in human immunodeficiency virus (HIV)-infected patients has recently been recognised as part of HIV-associated neurocognitive disorders. This has been implicated as one of the causes of poor adherence to antiretroviral therapy (ART).
Objective: To assess the association between neurocognitive impairment (asymptomatic and mild forms) and adherence to ART.
Methods: This was a cross-sectional survey involving 218 participants consecutively sampled from those attending the HIV treatment clinic at Aga Khan University Hospital in Nairobi. Data collected included quantitative primary data on pre-defined baseline characteristics, neurocognitive assessment by Montreal Cognitive Assessment (MoCA) tool (Appendix 1), instrumental activities of daily living by Lawton score and objective and subjective adherence measures by medication possession ratio (MPR) and simplified medication adherence questionnaire (SMAQ) (see Appendix 2). Univariate and bivariate analyses were conducted to determine the strengths of association between predictor and the outcome variables.
Results: Among the 218 participants in the study, a total of 69% had asymptomatic to mild neurocognitive impairment as assessed by the MoCA tool, while a total of 66% were determined as being adherent to ART by objective measures (by MPR) compared to subjective rates of 77% as assessed by SMAQ. However, no statistically significant association was observed between the presence of asymptomatic or mild neurocognitive impairment and likelihood of adherence to ART (p > 0.05).
Conclusion: Even though asymptomatic and mild forms of cognitive impairment are prevalent in the population studied, there was no significant association between cognitive impairment and adherence to treatment
A prospective review of acute coronary syndromes in an urban hospital in sub-Saharan Africa
No full textObjectives: To determine the epidemiology of acute coronary syndromes (ACS) in sub-Saharan Africa.
Methods: A prospective survey was carried out of all patients with a diagnosis of ACS who were admitted to the critical care unit of a tertiary teaching hospital over a 25-month period. Demographics, presentation, management and outcomes were subsequently recorded.
Results: A total of 111 (5.1% of all hospitalisations) patients were recruited, with 56% presenting with ST-elevation myocardial infarction (STEMI) and the rest non-ST-elevation myocardial infarction (NSTEMI) or unstable angina (UA). Chest pain was the most common presenting symptom, and up to one-third of all STEMI patients did not receive any form of reperfusion therapy, primarily due to late presentation. As in the developed world, diabetes, hypertension and cigarette smoking still account for the most common predisposing risk-factor profile, and the mortality associated with ACS is about six to 10% in our unit.
Conclusions: ACS, contrary to common belief, is increasingly more prevalent in sub-Saharan Africa, with similar risk profiles to that in the developed world. Late presentation to hospital is common and accounts for the increased mortality associated with this condition
Initial Rhythm and Outcomes for Inhospital Cardiac Arrest in Kenya
No full textBackground: Health care resource allocation remains challenging in lower middle income countries (LMIC) like Kenya with the co-existence of both communicable and non-communicable diseases in hospitals. In-hospital cardiac arrest and resuscitation remains poorly elucidated. Methods: This was a prospective study of cardiac arrest in 6 hospitals in Kenya from 2014 to 2016. Existing resuscitation teams were utilized to collect data during resuscitation using a standardized protocol. Patients with do-not-resuscitate (DNR) orders, trauma, post-surgical and pregnancy related complications were excluded. The Modified Early Warning Score (MEWS - SBP, HR, respiration rate, temperature, responsiveness) was determined based on worst parameters at least 4 hours prior to the arrest and divided in to low (\u3c3), intermediate (3-4) or high risk (\u3e4). Results: 353 patients with cardiac arrest were included over 19 months. The mean age was 58.6 years, 53.5% were male, and admission diagnoses included cardiovascular disease (26%), sepsis 28.9%, and cancer 14.5%. The median MEWS was 5 (IQR 3-7) and low, intermediate and high MEWS was found in 21.2%, 21.5% and 57.2% respectively. The mean time to CPR was 0.83 minutes (IQR 0-26 minutes). The initial rhythm was asystole in 47.6%, PEA in 38.2%, VT/VF in 5.4% and unknown in 8.8%. Return of spontaneous circulation (ROSC) occurred in 29.2% of patients with the median time to ROSC being 28 minutes (IQR 7.5-16.5). ROSC was 17.3% in asystole, 40.7% in PEA, 57.9% in VT/VF and 25.8% in patients with an unknown rhythm. Of all patients, 16 (4.2%) were discharged alive. Conclusion: Non-shockable rhythms account for the majority of the cardiac arrests in hospitals in a LMIC, and are associated with unfavourable outcomes. Future work should be directed to training healthcare personnel in recognizing early warning signs and implementing appropriate measures in a resource-scare environment
Factors that influence advance directives completion amongst terminally ill patients at a tertiary hospital in Kenya
No full textBackground: An advance directive (AD) is a written or verbal document that legally stipulates a person’s health care preference while they are competent to make decisions for themselves and is used to guide decisions on lifesustaining treatment in the event that they become incapacitated. AD can take the form of a living will, a limitation of care document, a do-not-resuscitate order, or an appointment of a surrogate by durable power of attorney. The completion rate of AD varies from region to region, and it is influenced by multiple factors. The objectives of this study were to determine the proportion of terminally ill patients with AD and to identify the factors that influence the completion of AD amongst terminally ill patients at a tertiary hospital in Kenya.
Methods: The study was a retrospective survey. All available records of terminally ill patients seen at Aga Khan University Hospital, Nairobi, between July 2010 and December 2015, and that met the inclusion criteria were included in the study.
Results: In total, 216 records of terminally ill patients were analyzed: 89 records were of patients that had AD and 127 records were of patients that did not have AD. The proportion of terminally ill patients that had completed AD was 41.2%. The factors that were associated with the completion of AD on bivariate analysis were history of ICU admission, history of endotracheal intubation, functional status of the patient, the medical specialty taking care of the patient, patient’s caregiver discussing the AD with the patient, and a palliative specialist review. On multivariate regression analysis, discussion of AD with a caregiver and patient’s functional impairment were the factors with statistically significant association with completion of AD.
Conclusions: The proportion of terminally ill patients that had AD in their medical records was significant. However, most terminally ill patients did not have AD. Our data, perhaps the first on the subject in East Africa, suggest that most of the factors associated with AD completion mirrored those seen in other regions of the world. Discussion between patient and their physician and patient’s functional impairment were the factors independently associated with completion of AD. Therefore, physicians need to be aware of the importance of discussions of AD with their patients
Helicobacter pylori eradication: A randomised comparative trial of 7-day versus 14-day triple therapy
No full textBackground. Helicobacter pylori is associated with several upper gastrointestinal conditions including chronic gastritis, peptic ulcer disease, and gastric malignancy. Proton pump inhibitor-based triple therapies are considered the standard regimens for H. pylori eradication, but the optimal duration of therapy is controversial. To prevent infection and complications, local studies should be undertaken to evaluate H. pylori eradication rates in a country.Objectives. We compared 7-day and 14-day regimens to determine the optimum duration of triple therapy for H. pylori eradication.Methods. We undertook a prospective randomised comparative trial of 7-day and 14-day triple therapy regimen for H. pylori eradication at the Aga Khan University Hospital, Nairobi; 120 patients with dyspepsia and H. pylori infection were randomised to receive esomeprazole, amoxicillin and clarithromycin for either 7 days (EAC 7) or 14 days (EAC 14). Compliance and side-effects were assessed 2 weeks after the start of therapy and H. pylori eradication was assessed by stool antigen tests 4 weeks after treatment.Results. Both the intention-to-treat (ITT; N=120) and per protocol (PP; N=97) analyses showed no significant differences between the eradication rates of EAC 7 (ITT 76.7%; PP 92%) and EAC 14 (ITT 73.3%; PP 93.6%) (ITT p=0.67; PP p=0.76). Poor compliance was reported in one patient in the EAC 14 group. The incidence of adverse events was comparable in the two groups.Conclusion. One-week and 2-week triple treatments for H. pylori eradication are similar in terms of efficacy, safety and patient compliance.S Afr Med J 2012;102(6):368-371
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