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Jun 2026 DOI 10.14302/issn.2766-8681.jcsr-26-6296
Background Acute diarrhea is the major cause of health public problem among paediatric patients in Tanzania. And in Low income countries (LICs), studies have shown, Acute watery Diarrhea (AWD) is the cause of morbidity and mortality which can be prevented by immediate identification and treatment of complications. Methods A prospective cohort study was done between December 2021 and April 2022 to determine the risks, complications, management strategies and predictors of mortality among paediatric patients ≤12 years of age with severe diarrhea. We excluded those who arrived in cardiac arrest at the Emergency Medicine Department (EMD) of Muhimbili National Hospital (MNH). Proportion was used to summarize the counts and frequency of participants who were at risk of complications and management strategies given and for predictors of outcomes. A Modified Poisson log linear model with a robust estimation test was used to test for significant associations between predictors and outcomes. Multivariate logistic regression was used to adjust for confounders. Results A total 6,570 paediatric patients presented to EMD during study period, and we recruited 144 (2.2%). The median age was 1 (IQR 0.7-2.0) years and most were male 86 (59.7%). Among the study participants with diarrhea, 120 (83.3%) had dehydration, acidosis 60 (42.3%), hypoglycemia 8 (5.6%), hypokalemia 76 (53.1%), and Acute renal failure 11 (7.6%). Those patients with complications received appropriate management, including IV crystalloid solution given to 131 (90.97%), and correction of acidosis 60 (42.3%), hypoglycemia correction with IV dextrose 10% 6 (4.2%), and hypokalemia and infections were corrected with IV potassium chloride 52 (36.1%) and IV antibiotic treatment 84 (58.3%) respectively. Conclusion Pediatric patients under 2 years of age are at high risk of severe diarrhea with dehydration as compared to other ages. Early referral and availability of point care tests are essential in early recognition of accompanied complications.
Apr 2024 DOI 10.14302/issn.2329-9487.jhc-24-5040
Objective Hypertensive crisis is an increasingly frequent medical condition in our context. Its management in medical emergencies is a real challenge for physicians. Few data on hypertensive crisis are available in Chad. The aim of this study was to investigate the epidemiological, clinical and prognostic characteristics of hypertensive crisis in the medical emergency department of Reference National Teaching Hospital in N'Djamena. Patient and methods This was a prospective cohort study running from 1er March 2020 to October 31 2020. Patients presenting with a sudden and severe rise in blood pressure (systolic ≥ 180 mmHg and/or diastolic ≥ 110 mmHg) with or without acute target-organs damage, had been consecutively included and followed up over a period of one (01) month. Epidemic and clinical characteristics on admission, and morbidity and mortality parameters during the course of the disease were collected. The Kaplan-Meier method and the Cox model were used to analyze survival and factors associated with death, with a significance level of p<0.05. Results Of the 3978 hypertensive patients admitted to medical emergencies, 252 had a hypertensive crisis, i.e. a prevalence of 6.3%. Two hundred and seventeen (217) patients were included in the study, divided into 149 cases (69%) of hypertensive emergency and 67 cases (31%) of hypertensive hypertensive urgencies. The mean age of the patients was 55.2 ± 14 years (20 and 80 years) and 67% were male. Hypertension was known in 138 patients (64%). At least one complication was present on admission in 69% of patients. Complications were classified as cardiac (50.7%), neurological (38.2%), kidney impairment (46.5%) and ocular (46.1%). The average number of antihypertensive drugs used was 2 ± 0.83 14. Calcium antagonists (86.5%), diuretics (35.5%), converting enzyme inhibitors or angiotensin II receptor antagonists (33.3%) and betablockers (18%) were the pharmacological classes prescribed. Good compliance during follow-up was observed in 124 patients. One-month survival was 84% for all patients, with a 16% mortality rate. Factors associated with death were the duration of hypertension, and the occurrence of cardiovascular, renal dysfunction and ocular disease (p < 0.05). Conclusion Hypertensive crisis is a frequent pathology in sub-Saharan Africa, with high morbidity and mortality. Prevention requires early detection and effective management of hypertension.
Dec 2020 DOI 10.14302/issn.2692-1537.ijcv-20-3652
Background The use of hydroxychloroquine in coronavirus disease (COVID-19) pandemic raised significant concerns as regards safety and efficacy in hospitalized patients. The objective was to examine the effect of hydroxychloroquine on clinical improvement and mortality among hospitalized patients with COVID-19. Methods A prospective cohort study was conducted at four general hospitals in the Western region, Saudi Arabia. Patients who had absolute or relative contraindication for using hydroxychloroquine were excluded. Patients concomitantly receiving other medications including azithromycin, antivirals, and supportive treatment were not excluded. Results A total 267 patients were included in the current analysis; 185 (69.3%) on hydroxychloroquine and 82 (30.7%) on non-hydroxychloroquine treatments. The average age was 46.0±13.3 years and 78.3% of the patients were males. Approximately 95.9% of the patients were symptomatic with mild (50.6%), moderate (32.6%), severe (8.2%), or ARDS symptoms (4.5%). Compared with no hydroxychloroquine, those on hydroxychloroquine had significantly longer length of stay (11.5±7.1 versus 7.8±4.3 days, p<0.001), more ICU admission (22.7% versus 9.8%, p=0.012), and more intubation (12.4% versus 3.7%, p=0.026). Improvement of symptoms (84.3% versus 81.7%, p=0.595) and hospitalization death (7.0% versus 1.2%, p=0.071) were not significantly different between groups. With exception of length of stay, the association of hydroxychloroquine with the above negative outcomes disappeared after adjustment for several factors including disease severity and concomitant use of azithromycin. Conclusions Hydroxychloroquine is not associated with better improvement of symptoms compared with other treatments. Moreover, it is associated with longer length of stay but not mortality or ICU admission in adjusted analysis.
Nov 2018 DOI 10.14302/issn.2474-9273.jbtm-18-2348
The transition to university can be a stressful time in a student’s life. Recent evidence demonstrates declining mental and physical health in college and university students compared to the general public. A prospective cohort study investigating mental and physical wellness over the course of a semester in a sample of first-year undergraduate students (N=74; 65%F) from nine faculties was completed at a large university in Canada. Sixty-eight (92%) students with a mean (SD, ±) age 18.2 ± 1.1 yrs., weight 67.9 ± 15.5 kg, height, 168.5 ± 11.6 cm and waist circumference 81.3 ± 9.8 cm completed the SF-36V2 quality of life questionnaire at the beginning and end of the semester in Fall 2014. A decrease in vitality (p=0.003), social functioning (p=0.004), emotional state (p=0.014), and mental health (p=0.019) outcomes as measured by the SF-36v2 occurred during the semester. In addition, aggregate mental health significantly declined from the beginning to the end of the semester (p <0.001), while physical health did not change (p=0.242). The importance of promoting and increasing awareness of campus wide mental health strategies should be considered a priority for first year undergrad students. Particularly, because students in their first year may take longer than one semester to adjust to the increased work load and although difficult to speculate it is possible that both mental and physical health would decline over the next (second) semester. Future research should aim for longer study duration.
Nov 2016 DOI 10.14302/issn.2474-7785.jarh-16-1275
Bone quality is difficult to assess but the skeletal bone condition is reflected in mandibular trabecular bone, which is well imaged in periapical dental radiographs. The aim of this 12-year prospective cohort study was to test if marginal mandibular bone loss differs in women with varying trabecular bone structure. The sample consisted of 460 women (aged 38, 46, and 54 years) from the prospective population study of women in Gothenburg, Sweden. Marginal bone loss was assessed according to a five-graded scale in two surveys 12 years apart, and the mandibular bone structure was evaluated visually as sparse, mixed, and dense. The results showed that marginal bone loss was significantly correlated to mandibular bone structure (r= 0.20; p<0.001 at baseline, and r= 0.17; p<0.001 after 12 years). Significant differences in marginal bone loss between trabeculation groups were found, with the largest loss in the group with dense trabeculation. Age, smoking, number of missing teeth and trabecular bone structure explained 20-28% of the variation in marginal bone loss. The conclusion was that women with dense trabecular bone in the mandible suffered a stronger periodontal bone destruction when negative events occur, than the women with sparser trabeculation.
Jun 2016 DOI 10.14302/issn.2471-2175.jdrt-15-836
Cellulitis is an acute, spreading pyogenic inflammation of the dermis and subcutaneous tissue, usually complicating a wound, ulcer, or dermatosis. Inappropriate diagnosis of cellulitis is a problem and would need prospective rather than retrospective studies to quantify the extent. There is one national guideline for the management of patients with cellulitis. The aim of this study is to determine the validity of Crest guideline in the patients with non-facial cellulitis. This prospective cohort study was conducted on all Adult patients with cellulites who were admitted at Resole-Akram and Sina emergency department between November 2013 and January 2014. Based on admission duration, the patients were randomly divided into two groups including primary and secondary outcome, <24-hours or >24-hours admission, respectively. Out of 89 admitted patients, 55% were hospitalized over 24 hours and 20% of them had significant systemic symptoms. The most patients (n= 42) had either systemically ill or systemically well or class II followed by classes I (n=28), III (n=18), and IV (n=1). There was significant relevancy between age, fever, PR, infected organ, leukocytosis, diabetes mellitus, IUDA, human bite, and primary outcome. In conclusion, factors associated with admission were age, presence of multiple comorbid conditions, diabetes mellitus, human bite, IUDA, infected organ, leukocytosis and fever. These results showed that the decision in the emergency department was mostly the same as Crest guideline and the prospection of admission and discharge of these patients was almost according to the educations of Crest guideline.
Apr 2016 DOI 10.14302/issn.2474-7785.jarh-15-699
Purpose Hospital readmission of patients with pluripathologies is frequent and costly. This study describes the impact of patients’ pluripathologies, functional capacity and social complexity on readmissions during a 12-month period following hospital discharge. Methods A prospective cohort study. Monthly monitoring of 111 patients over 12 months in Hospital of Riotinto. The primary endpoint was readmission rate. Predictive variables: age, gender, hospitalizations the year before, illnesses that define the pluripathology, medication prescribed on discharge, social situation (Gijón Scale), functional state (Barthel) and cognitive impairment (Pfeiffer). Results Readmissions accounted for 21.6% of the patients surveyed. Of those readmitted, the mean age was lower than those who did not return to hospital (75.4 vs.79.6) (p=0.031), the average amount of medication prescribed greater (10.5 vs.8.7) (p=0.014), the Barthel score higher (52.5 vs.50.6) and the Gijón value lower (13.8 vs.14.6), but no results was significant. The mean survival time (without readmission) was 310.9 days (95% CI, 289.4-332.5). Category B (chronic renal disease and vasculitis) and F (diabetes with microangiopathy and artery disease) had a lower average survival time (X2=7.02; p=0.008) (X2=7.07; p=0.008). The readmission risk was hazard ratio (HR) = 3.13 (95% CI, 1.37-7.14) for category B, and HR = 3.38 (95% CI, 1.37-8.36) for category F. Conclusions There is a high proportion of readmissions among patients with pluripathologies in the year following discharge from hospital. The greater risk occurs in patients with chronic renal insufficiency and diabetes with microvascular complications. Factors that can be modified are polymedication and the proper control of patients’ diabetes.