Treatment outcome and associated factors of bacterial meningitis at pediatric wards of southwestern Ethiopian hospital: a prospective observational study

Background Meningitis is a common infectious cause of morbidity and mortality in pediatric age-groups. Acute bacterial meningitis is considered a medical emergency, because it is a life-threatening infection that requires immediate treatment. Therefore the study was aimed to assess the magnitude and predictors of poor treatment outcome among pediatric patients admitted to Bedele General Hospital. Methods A prospective observational study was conducted at pediatric wards of Bedele General Hospital from February 12, 2020 to August 11, 2020. Lumbar puncture, in the absence of contraindications, was performed under aseptic conditions for all patients with suspected bacterial meningitis to collect cerebrospinal fluid specimen. Multivariable logistic regression was used to determine the predictors of poor treatment outcome. Result Of the 196 pediatric patients involved, 112(57.1%) were male and the mean and standard deviation of their age was 6.09 ± 4.46. Regarding to their clinical profile, a total of 101(51.5%) were completely immunized and 115(58.7%) were given corticosteroid during their treatment. In our study the most frequently occurred clinical manifestation of meningitis was fever 164(83.67%), neck rigidity149 (76.02%), and irritability 122(62.24%). Regarding to their pharmacotherapy, the most commonly prescribed antibiotics were Ampicillin 104(24.82%), and Gentamycin 102(24.34%). The magnitude of good treatment outcome was 132(67.35%) whereas 64(32.65%) were poorly controlled. The presence of comorbidity (AOR = 3.64, 95CI%:1.83–7.23,P = < 0.001),corticosteroid use (AOR = 2.37, 95CI%:1.17–4.81,P = 0.017) and oxygen administration (AOR = 3.12, 95CI%: 1.34–7.25, P = 0.008) was a predictor of meningitis treatment outcome. Conclusion The treatment outcome of meningitis was good in of two-third of the patients. It was found that the presence of comorbidity, the administration of oxygen and use of corticosteroid was predictors of the treatment outcomes of bacterial meningitis in children. Therefore, in patients with these factors, appropriate meningitis treatment should be encouraged and locally applicable treatment guidelines should be prepared to improve patient outcome. Finally, the meningitis patients should be given corticosteroid and oxygen as treatment and special attention should be given for patients having co-morbidities.

Treatment outcome and its predictors among diabetic patients attending at selected hospitals of southern ethiopia.

Background: Diabetes is one of the largest health emergencies of the 21st century. The World Health Organization (WHO) estimates that globally, hyperglycaemia is the third highest risk factor for premature mortality, after high blood pressure and tobacco use. It is an important cause of blindness, kidney failure, lower limb amputation and other long-term consequences that impact significantly on quality of life. It result peoples in a disease, death and increase a health care expenditure.Objectives: To determine treatment outcome of Diabetes mellitus and its predictors among patients attending diabetes treatments at selected hospitals of southern Ethiopia, 2021.Methods: All diabetic patients who attended selected hospitals of southern Ethiopia were a source population. Institution based cross-sectional study design was conducted at selected hospitals of southern Ethiopia. Patient’s data was collected using pretested questionnaire. After cleaning and checking for errors, the data was entered in to Epi-data to minimize error then exported to SPSS for analysis. Descriptive findings were presented by tables and charts. The outcome variable was analyzed by using logistic regression model to identify predictors after assumptions of regression analysis had checked. All the independent variables with p<0.25 was used as a candidate for multivariate analysis. Then the level of significance will be set at p<0.05 and AOR with 95% CL was done as the final model.Result: From the total sample; 277 (65.6%) were found to be good treatment outcome. The number of medication taken AOR 95%CI; 0.924 (0.869, 0.983), presence of complication AOR 95%CI; 0.425 (0.217, .832), increased fasting blood glucose AOR 95%CI; 0.080 (0.034, 0.188) were found to be independent predictors. Since the magnitude of treatment outcome found to be low, provision of health information about the adhering to prescribed medication and monitoring fasting blood glucose level will bring good clinical outcome.

Treatment Outcome and its Predictors Among Diabetic Patients Attending at Selected Hospitals of Southern Ethiopia.

Background: Diabetes is one of the largest health emergencies of the 21st century. The World Health Organization (WHO) estimates that globally, hyperglycaemia is the third highest risk factor for premature mortality, after high blood pressure and tobacco use. It is an important cause of blindness, kidney failure, lower limb amputation and other long-term consequences that impact significantly on quality of life. It result peoples in a disease, death and increase a health care expenditure.Objectives: To determine treatment outcome of Diabetes mellitus and its predictors among patients attending diabetes treatments at selected hospitals of southern Ethiopia, 2021.Methods: All diabetic patients who attended selected hospitals of southern Ethiopia were a source population. Institution based cross-sectional study design was conducted at selected hospitals of southern Ethiopia. Patient’s data was collected using pretested questionnaire. After cleaning and checking for errors, the data was entered in to Epi-data to minimize error then exported to SPSS for analysis. Descriptive findings were presented by tables and charts. The outcome variable was analyzed by using logistic regression model to identify predictors after assumptions of regression analysis had checked. All the independent variables with p<0.25 was used as a candidate for multivariate analysis. Then the level of significance will be set at p<0.05 and AOR with 95% CL was done as the final model.Result: From the total sample; 277 (65.6%) were found to be good treatment outcome. The number of medication taken AOR 95%CI; 0.924 (0.869, 0.983), presence of complication AOR 95%CI; 0.425 (0.217, .832), increased fasting blood glucose AOR 95%CI; 0.080 (0.034, 0.188) were found to be independent predictors. Since the magnitude of treatment outcome found to be low, provision of health information about the adhering to prescribed medication and monitoring fasting blood glucose level will bring good clinical outcome.

What contributes to good outcomes? The perspective of young people on short-term psychoanalytic psychotherapy for depressed adolescents

Depression is the fourth leading cause of adolescent illness and disability worldwide. A growing evidence base demonstrates that Short Term Psychoanalytic Psychotherapy [STPP] is an efficacious treatment for moderate to severe adolescent depression. However, with research in its infancy, key factors contributing to efficacy are unknown. Service users’ lived experiences provide valuable insight in this area. This study aimed to elucidate what adolescents value in treatment by inductively exploring lived experiences of STPP. Five adolescents with the largest reduction in depressive symptoms scores between baseline and end of treatment, who had taken part in a large-scale randomized controlled trial, were sampled. In-depth interviews carried out soon after the end of therapy were analysed using Interpretative Phenomenological Analysis. Three superordinate themes were identified: “Therapy as a Transformational Process”, “Explorative and Exposing: The Therapeutic Space” and “Being Heard and Working Together: The Therapeutic Relationship”. Adolescents valued a process of collaborative exploration with the therapist which when it was achieved was felt to facilitate a deep-rooted transformation in self-perception. Additionally, they described how an adjustment was needed to the particular frame of a psychoanalytic therapy. However, not all participants with a good treatment outcome experienced therapy in this way, suggesting a potential gap between the quantitative assessment of outcomes, and the way young people experience and understand the change process. Clinical implications and directions for research are discussed.

Exploring the Question: “Does Empathy Work in the Same Way in Online and In-Person Therapeutic Settings?”

Providing remote psychotherapy using technology is a growing practice, especially since the outbreak of the COVID-19 pandemic. Even if in numerous studies video conferencing psychotherapy (VCP) was found to be clinically effective, some doubts continue to exist about how the psychotherapeutic alliance works in the online setting, and the characteristics of the empathic process are still poorly understood. This is an exploratory study aimed at analyzing the degree of empathy between the psychotherapist and client pair, and the degree of support perceived by the client who shall be referred to as the patient interchangeably in this study, comparing the sessions in person with those online, during the current pandemic, in order to discriminate the impact of empathy in the digital setting. The sample analyzed was composed of 23 patients with different severity of pathology engaged in online and in-person therapeutic sessions with five psychotherapists of different theoretical leanings. The scores of the support and empathy scale, obtained by both members of the psychotherapeutic couple in the two settings, were analyzed and compared. The test used belongs to an Italian adaptation of the Empathic Understanding (EU) of the Relationship Inventory. What emerged from comparing the scores was interesting: Unlike the psychotherapists, the patients perceived their therapists as significantly more empathic and supportive in the remote setting. These are rather important data, because the literature documents that client empathic perception measures represent a more accurate measure of the empathic relationship and, in general, can predict a good treatment outcome. Although these results need further investigation, they represent an important contribution in filling the scientific gap in the understanding of digital empathy. Also, this study provides new insights for future research on the characteristics and impact empathy has on the practice of remote psychotherapy.

BashTheBug: a crowd of volunteers reproducibly and accurately measure the minimum inhibitory concentrations of 13 antitubercular drugs from photographs of 96-well broth microdilution plates.

Tuberculosis is a respiratory disease that is treatable with antibiotics. An increasing prevalence of resistance means that to ensure a good treatment outcome it is desirable to test the susceptibility of each infection to different antibiotics. Conventionally this is done by culturing a clinical sample and then exposing aliquots to a panel of antibiotics, thereby determining the minimum inhibitory concentration (MIC) of each drug. Using 96-well broth micro dilution plates with each well containing a lyophilised pre-determined amount of an antibiotic is a convenient and cost-effective way to measure the MICs of several drugs at once for a clinical sample. Although accurate, this is an expensive and slow process that requires highly-skilled and experienced laboratory scientists. Here we show that, through the BashTheBug project hosted on the Zooniverse citizen science platform, a crowd of volunteers can reproducibly and accurately determine the MICs for 13 drugs and that simply taking the median or mode of 11-17 independent classifications is sufficient. There is therefore a potential role for crowds to support (but not supplant) the role of experts in antibiotic susceptibility testing.

Infective endocarditis (MRSA)with COVID-19 concomitant：a case report

Introduction Since 2019,the COVID-19（a1） epidemic has rapidly spread across China,and the global spread trendappeared,which not only endangered people’s health, but also had a huge impact on the social economy.Infective endocarditis (IE(a2)) is aninflammation of the inner wall of the cardiac valves or ventricle caused by direct infection of bacteria,fungi and other pathogenic microorganisms. It is related to several and the main etiological agents are the Gram-positive cocci. At present,there is limited evidence in the literature for both conditions. Case presentation Here，we report a case of Infective endocarditis concomitant with COVID-19. A blood culture results and toe secretions culture indicated MRSA（a3） strain infection.Because it has no special past history,we consider that is communityassociated (CA-MRSA )strain. TTE（a4） did not identify endocardial vegetations. TEE（a5） was then performed and outlined IE of anterior mitral valve leaflet. CT scan of the patient revealed multiple diffuse abscesses. We tried high-flow nasal cannula(HFNC（a6）) for COVID-19,and we used a combined anti-infection approach(daptomycin, Fosfomycin, linezolid). Conclusion With aggressive anti-infective therapy,our case has achieved a good treatment outcome.

Primary surgery effect on dental arch relationships of patients born with unilateral cleft lip and palate using the GOSLON yardstick index

To score dental arch development using the Great Ormond Street, London, and Oslo (GOSLON) yardstick index, following primary surgery in patients with a complete unilateral cleft lip and palate (UCLP), and to compare the outcome score with the GOSLON score of Cleft Care UK (CCUK) as well as with the Clinical Standards Advisory Group (CSAG), United Kingdom.Study models of patients (average age 12 years) with a non-syndromic complete UCLP, who had been surgically treated at the University of Pretoria Facial Cleft Deformity (UPFCD) clinic. They were assessed using the GOSLON yardstick index by certified raters from the Dental School in Dundee, Scotland. The mean outcome ratings were calculated from the scoring of 27 sets of plaster models. The other scoring rounds were used to calculate intraand inter-observer agreement using Cohen's weighted kappa and Fleiss's multi-rater kappa. There were strong intra- and inter-observer agreement, with a weighted kappa of 0.92. The Facial Cleft Deformity (FCD) clinic data showed a good treatment outcome with a mean GOSLON rating of 2.85 compared to a rating of 3.2 for the CSAG and 2.62 for the CCUK cohort studies. The UPFCD clinic primary surgical protocol displayed a good treatment outcome rating, in line with that of the CCUK cohort and better than the CSAG results.

Self-stigma in Patients with Schizophrenia in a Psychiatry Hospital in Lagos, Nigeria

Aims: Schizophrenia is a devastating and disabling disorder associated with long term negative consequences and may require lifelong treatment. It is often complicated with self-stigma which makes treatment difficult and may be a source of complications. Ensuring good outcome will therefore, involve taking cognizance of self-stigma in the treatment plan. Studies examining self-stigma in patients with schizophrenia is scanty in Nigeria. The aim of the study was to determine the prevalence of self-stigma in patients with schizophrenia as well as identifying some of the correlates of self-stigma in the patients. Study Design: Cross-sectional survey Place and Duration of Study: Outpatient clinic of a Neuropsychiatry hospital in Lagos state, Nigeria. Methodology: 320 adult patients with schizophrenia were recruited using a consecutive sampling technique. MINI international Neuropsychiatric interview (Psychotic disorder module) was used to confirm the diagnosis, after which socio-demographic questionnaire and the Internalized Stigma of Mental illness Inventory (ISMI), were administered to the patients. The data was analyzed with SPSS version 16 and the result presented in frequency tables, percentages, mean and standard deviation where necessary. Results: Majority of the participants (83.4%) were less than 50 years old, they were mostly females (57.2%), of Yoruba ethnic group (59.7%), Christians (75.6%), and were low-income earners, earning either no income or less than ₦18,000 monthly (72.2%). Also, over four-fifth (86.2%) had good social support. Over a third (38.1%), were married, with about 80 percent of these living with their spouses while 46.5% were never married. The prevalence of self-stigma was 25.3%. Educational attainment below secondary school and multiple illness episodes were found to predict self-stigma in the study. Conclusion: Self-stigma is common in schizophrenia and its consideration in management is necessary for a good treatment outcome.

Predictors of Treatment Outcomes among Pediatric Patients Hospitalized with Pneumonia in Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia

Background. Pneumonia remains the leading cause of hospitalization and mortality in young children in low- and middle-income countries. This study is aimed to assess predictors of treatment outcomes among pediatric patients hospitalized with pneumonia in Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia. Methods. A facility-based retrospective cross-sectional study was conducted among pediatric patients admitted with pneumonia, considering patient medical charts recorded for a 1-year period from February 2017 to February 2018. The sample size was computed based on a single population proportion formula and giving a total sample size of 207. The systematic random sampling method was employed to select patient cards from the sampling frame. The data extraction format was used to extract any relevant information from patient chart. The processed data were analyzed by using Statistical Package for Social Sciences (SPSS, version 21). Descriptive statistics were used to summarize the patients’ baseline characteristics and related information. The logistic regression model was fitted to determine factors associated with treatment outcomes. To identify predictors of poor treatment outcome, the level of significance was set at P < 0.05 . Results. From a total of 207 patient charts reviewed, more than half (55.6%) of the study participants were males. Majority of patients, 130 (62.8%), were in the age range of 1 month–11 months. Furthermore, 191 (92.3%) patients had good treatment outcome. Patients who treated with ceftriaxone + azithromycin were less likely to have poor treatment outcome compared with patients who were placed on crystalline penicillin (AOR = 0.86, 95% CI 0.01–0.83). On the contrary, patients who stayed ≥ 8 days were about 14.3 times more likely to have poor treatment outcome compared with patients who stayed ≤ 3 days (AOR = 14.3, 95% CI 1.35–151.1). Conclusion. Even though the study revealed good treatment outcome among the pediatric patients, particular consideration should be given to children in need of other interventions.