Academic literature on the topic 'Ulcers – Risk factors – Benin'

Background: Many physicians continue to fear iatrogenic complications of the total contact cast, and use of this modality has remained restricted to a segment of the orthopaedic and podiatric communities. I examined the actual rate of complications and the factors associated with them in a large consecutive series of total contact casts drawn from the practice of a single surgeon to determine whether this modality is safe for multiple conditions in the neuropathic foot and ankle. Method: A consecutive series of 398 total contact casts spanning a 28-month period from the practice of a single physician were analyzed. All casts were placed by the same team of orthotists. This study comprised 70 patients with severe peripheral neuropathy; an average of 5.69 sequential casts per patient were placed. Three-hundred and sixty-seven casts were placed in diabetic patients, and 31 in patients with idiopathic peripheral neuropathy. By protocol, the initial cast was changed at an interval of no more than 1 week. On occasion, subsequent casts were left on longer, but on average casts were left in place for 7.69 days. Logistic regression analysis was used to analyze the contribution of patient factors to the chance of ulceration. Results: Complications occurred in 22 casts, including six new pretibial ulcers, six new midfoot ulcers, four forefoot or toe ulcers, five hindfoot ulcers, and one malleolar ulcer. In no case was a preexisting ulcer made worse. This corresponds to an overall complication rate of 5.52% per cast. Overall, 30% of patients suffered one complication during the course of their treatment. With one exception, all new ulcers healed with simple modalities within 3 weeks, often with continued total contact casting. A single cast led to a proximal interphalangeal ulceration that exposed the joint and eventually required toe amputation. The rate of permanent sequelae from cast-related injuries was therefore 0.25%. In no case were the resultant odds ratios statistically different from 1.0, but several trends were observed. Charcot arthropathy represented the highest risk (odds ratio 1.46), while the presence of neuropathic ulceration was surprisingly benign (odds ratio 0.69). The presence of diabetes as opposed to other causes of neuropathy was associated with increased risk (odds ratio 1.34). The use of a cast after deformity-correcting surgery in a neuropathic patient was remarkably safe (odds ratio 0.44), as were casts in which the patient was instructed to remain nonweightbearing (odds ratio 0.27). Patient age was not a factor (odds ratio 1.03). The length of time the cast was left on was not statistically important (odds ratio 0.99), although strict protocols for cast changing likely altered this data. Conclusion: A frequently changed total contact cast is a safe modality for the offloading and immobilization of the neuropathic foot, albeit with an expected constant rate of minor, reversible complications. Patients should be informed of these complications and risks before cast application.

INTRODUCTION: Guidelines recommend a policy of endoscopic follow-up of all gastric ulcers until healing. Analysis of data from the Alberta Endoscopy Project indicates that fewer than 50% of patients diagnosed with benign gastric ulcer had undergone a repeat procedure. The practice and attitudes of physician members of the Canadian Association of Gastroenterology (CAG) on the follow-up of such patients were assessed.METHODS: A self-administered questionnaire was mailed to members of CAG. Respondents were asked to indicate their practice setting and to estimate the proportion of gastric ulcer patients in whom they perform follow-up endoscopy. They were also asked to indicate factors influencing this choice, including the role ofHelicobacter pylori.RESULTS: Fifty-seven per cent of 220 respondents indicated that they perform repeat endoscopy in 95% to 100% of individuals with benign gastric ulcer. The most common reasons influencing this choice were to ensure healing (86.3%) and to confirm the benign nature of the lesion (79.5%). Nonsteroidal anti-inflammatory drug (NSAID) use (83.2%) and patient ill health (62.9%) were the most common reasons for not repeating the endoscopy. Twenty per cent of individuals indicated thatH pylorihad influenced a change in their practice.DISCUSSION: Physicians vary widely in their follow-up of benign gastric ulcer. Studies on the occurrence of gastric cancer in this setting are not unanimous in their conclusions. Subgroups of patients with NSAID exposure and successfully eradicatedH pyloriinfection may have a lower risk of malignancy. Studies to confirm this are warranted, and modified guidelines may be appropriate.

Posterior perforation of gastric ulcer is a rare clinical entity and has a propensity for delayed presentation and missed diagnosis. By virtue of their location, posterior gastric perforations may rupture into the retroperitoneum which leads to abscess formation and development of adhesions and consequently, leads to a delay in the onset of symptoms. Alternatively, ulcers located in the fundus or the body of the stomach may perforate into the lesser sac, which results in sealing off the perforation and less dramatic clinical signs and symptoms. This delay in presentation contributes to higher morbidity, higher infection rates and higher mortality. Thus, it is essential to have a high index of suspicion for this condition, particularly in patients with a protracted clinical presentation and classical risk factors so that timely, life-saving intervention is possible. We report a case of giant posterior gastric perforation with benign histopathology in a 40-years-old male. This case is being presented due to the rarity of this clinical entity and the relative paucity of literature on the same.

ObjectiveVaricose veins (VVs) are common and although considered benign may cause morbidity. However, the association between VV severity and cardiovascular and mortality risks remains unknown. The aim of this study was to investigate the factors associated with overall mortality in patients with VV.MethodsA total of 4644 patients with newly diagnosed VV between 1999 and 2013 were identified from Taiwan’s National Health Insurance Database. VV severity was classified from grade 1 to 3 according to the presentation of ulcers or inflammation. Moreover, 9497, 2541 and 5722 age-matched, sex-matched and chronic cardiovascular risk factor-matched controls, as assessed based on propensity score, were separately selected for three grading VV groups. Enrolled patients were analysed using conditional Cox proportional hazards regression analysis to estimate risk of mortality and major adverse cardiovascular events (MACEs) in the VV and control groups.ResultsMost patients with VV were free from systemic disease. However, compared with matched controls, patients with VV showed a 1.37 times increased risk of mortality (95% CI 1.19 to 1.57; p<0.0001). Compared with matched controls, older (age ≧65 years) (adjusted HR: 1.38; 95% CI 1.17 to 1.62; p=0.0001) and male patients with VV (adjusted HR 1.41; 95% CI 1.18 to 1.68; p=0.0001) showed increased risk of mortality. Furthermore, compared with controls, patients with VV showed 2.05 times greater risk of MACE. Compared with matched controls, population at grade 3 increased 1.83 times risk of mortality and 2.04 to 38.42 times risk of heart failure, acute coronary syndrome, ischaemic stroke and venous thromboembolism.ConclusionsThis nationwide cohort study demonstrated that patients with VV are at a risk of cardiovascular events and mortality. Our findings suggest that presence of VV warrants close attention in terms of prognosis and treatment.

Notre travail porte sur tous les cas UB enregistrés entre 1997 et 2003 au Centre Sanitaire Nutritionnel Gbemoten (CSNG) de Zagnanado dans la région du Zou au Bénin. Une base de données a été créée et a permis d’analyser divers aspects de l’UB. Ces analyses ont donné lieu à diverses publications dont les résultats essentiels sont repris ci-dessous.

Une première publication porte sur 1700 cas consécutifs admis au CSNG entre 1997 et 2001. Ces données nous ont permis d’illustrer l’évolution du nombre des cas d’UB au cours des années, par département et par sous-préfecture. Le nombre de patients UB qui se présentent au centre est fonction de différents facteurs comme par exemple l’ouverture d’autres centres de traitement, l’organisation de campagnes d’information sur l’UB mais aussi de changements dans l’environnement. Au niveau des formes de la maladie, nous avons montré que les formes non ulcérées sont aussi fréquentes que les formes ulcérées. La forme de la maladie est liée au délai à consulter le CSNG. Les atteintes osseuses sont fréquentes et sont présentes chez plus de 13% des cas. Au fil des années, le délai à consulter le CSNG ainsi que la durée de l’hospitalisation ont été fortement réduits, passant de 4 mois à 1 mois dans le premier cas et de 9 mois à 1 mois en ce qui concerne l’hospitalisation. Les personnes ressources à cibler lors des campagnes de sensibilisation sur la maladie ont été identifiées. Il s’agit des anciens malades, qui dans 68% des cas, réfèrent les nouveaux malades au CSNG.

Une deuxième publication, portant sur la même période, nous a permis de mettre en évidence pour la première fois des taux d’UB élevés chez les sujets de 60 ans et plus, probablement du fait d’une diminution de leur immunité. Chez les 60 ans et plus, les hommes sont plus à risque de développer un UB que les femmes. Par contre aucune différence dans le risque d’UB en fonction du sexe n’est trouvée chez les moins de 60 ans. Les lésions d’UB prédominent au niveau des membres inférieurs pour tous les groupes d’âge. Du fait de leur petite stature, les enfants ont une répartition des lésions qui touchent tout le corps. Chez les adultes, les femmes présentent plus de lésions que les hommes au niveau de la tête, du cou et du tronc. Les sujets de moins de 15 ans développent souvent des lésions multifocales, associées à des atteintes osseuses. Ces atteintes osseuses constituent les formes graves de la maladie.

Notre troisième publication porte sur le suivi des malades au niveau des villages, entre mars 2000 et février 2001, afin de déterminer les taux de récurrences de l’UB. Le taux de récurrence de la maladie est faible (6.1%) pour un temps de suivi des malades allant jusqu’à 7 ans. La majorité des malades soignés au CSNG étaient en bonne santé. Nous n’avons néanmoins pu retrouver qu’un nombre limité de malades.

Dans notre quatrième publication, nous avons pu mettre en évidence le développement d’un UB sur le site d’une morsure humaine. La surface de la peau du malade a pu être contaminée par M. ulcerans et la morsure (= traumatisme) a occasionné l’entrée de M. ulcerans dans le derme. Une autre explication plausible est que la morsure ait réactivé un foyer latent de M. ulcerans au niveau du site de la morsure.

Notre base de données nous a également permis de contribuer à d’autres études, notamment celles sur l’influence du BCG et de la schistosomiase sur l’UB. Dans les deux cas, nous trouvons une association significative avec les formes graves de l’UB, l’absence de vaccination BCG et la schistosomiase favorisant le développement de formes osseuses. Aucun lien n’a pu être établi entre la présence ou l’absence de l’infection à Schistosoma haematobium et l’UB.

Dans la dernière partie de notre travail, nous nous sommes attachés à l’étude de quelques facteurs de risque de l’UB. Nous avons montré que l’UB est essentiellement associé à l’âge, le lieu de résidence et le type d’eau utilisé. Pour les sujets de 5 ans et plus, le risque d’UB est plus élevé chez les sujets vaccinés à la naissance avec le BCG. L’analyse par strate d’âge des sujets âgés de 5 ans et plus, nous a permis de voir que dans le groupe des 50 ans et plus l’influence du type d’eau utilisé est moindre que dans les autres groupes d’âge, laissant envisager qu’un autre facteur entre en jeu :une réactivation de la maladie à la faveur d’une baisse d’immunité.

Notre étude démontre que la prise en charge de l’UB doit être pluridisciplinaire et doit pouvoir englober diverses interventions telles que :

- les campagnes d’information à la population,

- la formation du personnel sanitaire ainsi qu’une implication de l’état,

- une bonne prise en charge des malades au niveau des centres de traitement de l’UB en collaboration avec les laboratoires régionaux et internationaux,

- la confirmation microbiologique des cas,

- la mise en place d’un suivi des malades en s’appuyant sur les structures déjà mises en place pour d’autres maladies,

- la mise à disposition des populations de sources d’eau potable (puits, pompes) qui par la même occasion permettront de limiter/diminuer d’autres affections liées à la consommation d’eau non potable,

- la poursuite des activités de recherche sur un éventuel vaccin ou une médication appropriée, ainsi que sur le réservoir de M. ulcerans afin de pouvoir mettre en place des stratégies de prévention de la maladie.

Doctorat en Sciences de la santé publique
info:eu-repo/semantics/nonPublished

Le rôle majeur de l’Helicobacter pylori dans l’étiopathogénie des maladies gastroduodénales (gastrite, ulcère gastrique et duodénal, lymphome gastrique) est bien établi aujourd’hui. L’OMS l’a reconnue comme jouant un rôle important dans la survenue des lésions cancéreuses gastriques. La prévalence de l’infection à H. pylori varie selon les pays de 20% à 90% avec des taux supérieurs à 60% dans les pays en développement, dont le Bénin. Les méthodes usuelles de diagnostic sont soit invasives nécessitant une endoscopie gastrique avec biopsies (test rapide à l’urée, histologie, culture et PCR), soit non-invasives (test respiratoire à l’urée marquée au carbone, sérologie, et détection de l’antigène dans les selles). La trithérapie associant un inhibiteur de la pompe à protons (IPP) et deux antibiotiques choisis parmi l’amoxicilline, la clarithromycine et le métronidazole est recommandée pour son traitement. La survenue de résistance des souches H. pylori aux différents antibiotiques devient une cause majeure de l’échec des régimes d’éradication.

Afin d’évaluer l’applicabilité et l’efficacité des régimes thérapeutiques recommandés en pratique courante, et à partir d’une étude de cohorte prospective, nous avons étudié la prévalence de l’infection à H. pylori chez les patients consultant à la clinique de Gastroentérologie de l’hôpital universitaire Erasme à Bruxelles, déterminé son taux de résistance primaire aux antibiotiques, et évalué le taux d’éradication d’H. pylori par la trithérapie. Nous avons aussi évalué la performance du test de détection de l’antigène d’H. pylori dans les selles pour le diagnostic chez l’adulte (avant traitement) comparé avec les méthodes de référence (culture, histologie), également dans le contrôle de l’éradication.

Au Bénin, nous avons évalué à partir d’une étude transversale prospective, la prévalence de l’infection à H. pylori dans une population en milieu urbain et rural. Nous avons déterminé la distribution par famille des sujets infectés, ainsi que l’influence des variables démographiques individuelles, et les caractéristiques socio-économiques familiales sur le risque de l’infection.

La prévalence de résistance primaire à la clarithromycine et au métronidazole fut observée respectivement dans 3% et 31% des souches isolées. Aucune résistance primaire à l’amoxicilline et à la tétracycline n’a été observée.

Les analyses en intention de traiter, ont montré que H. pylori a été éradiqué chez 80% des patients inclus dans l’étude thérapeutique. Le taux d’échec d’éradication fut de 20%. Comparé au 14C-TRU, le test HpSA avait une sensibilité de 100%, une spécificité de 91%, VPP de 69%, VPN de 100%. De même, la sensibilité du test HpSA par rapport aux deux méthodes usuelles (culture et histologie) est de 96.5% pour une spécificité de 91.2%, une VPP de 90.3% et une VPN de 96.8%.

Au Bénin, la prévalence de H. pylori était de 75.4% en ville et de 72.3% dans le village (p = 0.459). Aucune association n’a été observée avec l’âge, le sexe, le niveau d’instruction, la taille du ménage, l’activité économique ou le mode d’approvisionnement en eau potable. Le taux d’infection était plus élevé chez les enfants dont les parents étaient infectés et chez ceux ayant une mère H. pylori positive (p < 0.001). L’analyse multivariée par régression logistique a montré que la densité d’occupation des dortoirs [OR (95%) = 9.82 (4.13-23.31)] p < 0.001), et le statut des mères dans le ménage ([OR (95%) = 3.85 (1.53-9.67)] p < 0.001) étaient les prédicteurs indépendants de l’infection par H. pylori. Le risque de l’infection chez les enfants était 13 fois plus élevé quand les deux parents sont simultanément positifs OR (95% CI) = 13.6 (3.63-51.22), il l’était respectivement de 5.3 (1.52-18.45); 2.7 (0.47-15.44), quand la mère et le père sont positifs p < 0.001. Aussi le risque d’infection à H. pylori comparé aux enfants qui dorment seul dans leur chambre, était élevé pour ceux qui dorment avec un ou deux personnes OR (95% CI) = 5.2 (1.08-25.16), p < 0.05, et plus élevé chez les enfants qui dorment à 4 ou plus OR (95% CI) = 16.6 (2.66-103.44), p < 0.005, comparé à ceux qui dorme seuls. Donc, le contact avec des personnes infectées au sein de la famille et la vie en promiscuité, étaient associés avec un risque d’infection plus élevé indiquant une transmission intrafamiliale de l’infection par H. pylori.

En conclusion, nos résultats montrent une séroprévalence encore élevée de l’infection à H. pylori dans la population béninoise. Une surveillance de l’épidémiologie accompagnée de mesures de prévention ciblées sur les facteurs potentiels de risque de l’infection doit être poursuivie. La validation du test de détection de l’antigène dans les selles avant traitement et dans le contrôle de l’éradication de la bactérie pour le suivi thérapeutique des patients infectés, est une alternative intéressante notamment au Bénin. Le taux de résistance primaire pour le métronidazole est actuellement stable en Belgique, alors que la prévalence de la résistance à la clarithromycine mérite d’être précisée par d’autres études multicentriques. La trithérapie classique à base d’inhibiteur de la pompe à protons–amoxicilline-clarithromycine reste recommandable en première intention. La surveillance épidémiologique de l’infection basée sur la prévalence locale des souches clarithro-résistantes et métronidazole-résistantes devrait être poursuivie.

SUMMARY OF THE THESIS

The major role of H. pylori in the etiopathogeny of various gastroduodenal diseases (gastritis, gastric and duodenal ulcers, gastric lymphoma) is well established today. The World Health Organization concluded that H. pylori plays a causal role in the chain of events leading to cancer of the stomach.

The prevalence of H. pylori infection varies by country from 20% to 90%, with higher prevalence rates over 60% observed in developing countries, including Bénin. The usual methods allowing the diagnosis of the gastric infection by H. pylori are either invasive, requiring a gastric endoscopy and biopsies (fast urease test, anatomopathological examination, culture and PCR), or noninvasive (breath test with 13C or 14C marked urea, serology and stool antigen detection). Triple therapy associating a proton pump inhibitor (PPI) with two antibiotics, chosen between amoxicillin, clarithromycin and metronidazole, is currently recommended. Resistance of H. pylori strains to antibiotics becomes a major determinant in the failure of eradication of regimens.

To evaluate the applicability and efficacy of the therapeutic recommendations in our pratice, based on a prospective study, we studied the prevalence of H. pylori infection in the outpatient population of the Gastroenterology clinic at the Erasme University hospital in Brussels, determined its rate of primary resistance to antimicrobial agents and evaluated the rate of eradication of H. pylori by triple therapy. We also evaluated the performance of a stool antigen detection test for the diagnosis of H. pylori infection in adults (before treatment) compared with reference methods (culture and histology) as well as in control of eradication.

In Benin, we evaluated by a cross-sectional study the prevalence of the infection with H. pylori in the population living in urban and rural environment. We determined the family distribution of infected subjects as well as the influence of individual demographic variables and of the socio-economic family characteristics on the risk of infection.

In Brussels, primary resistance to clarithromycin and metronidazole was observed in 3% and 31% of the isolates, respectively. No primary resistance to amoxicillin and tetracycline was observed. By intention to treat analysis, H. pylori was eradicated in 80% of patients included in the therapeutic study. The rate of eradication failure was 20%. In comparison with 14C-Urea breath test, the H. pylori Stool Antigen test showed a sensitivity of 100%, a specificity of 91 %, PPV of 69%, and NPV of 100%. Compared to the reference methods (culture and histology), the HpSA test had a sensitivity of 96.5% and a specificity of 91.2%. PPV of 90.3% and NPV of 96.8%.

In Benin, the prevalence of H. pylori antibodies was 75.4% in town and 72.3% in the village (P= 0.459). No association was found between infection and age, sex, education level, size of the household, economic activity or source of drinking water. The infection rate was higher in children of parents who were both infected and also in those whose mother was infected (p < 0.001). By logistic regression analysis, the density of occupation of dormitories (more than three persons sharing dormitory, [OR (95%) = 9.82 (4.13-23.31)] p < 0.001), and mother status within the household ( [OR (95%) = 3.85 (1.53-9.67) ] p < 0.001), were independent predictors for H. pylori infection. The risk of H. pylori infection in children was 13 times higher when the two parents were simultaneously positive: OR (95% CI) = 13.6 (3.63-51.22) and it was respectively of 5.3 (1.52-18.45); 2.7 (0.47-15.44), when mother and father were positive p < 0.001. H. pylori infection risk in children was higher for a sharing a dormitory with one or two persons, OR (95% CI) = 5.2 (1.08-25.16), p < 0.05 and was even higher if a dormitory of 4 persons or more, OR (95% CI) = 16.6 (2.66-103.44), p < 0.005 as compared to sleeping alone. Family contact with infected persons and crowded living conditions were associated with increased risk of infection consistent with intrafamilial H. pylori transmission.

In conclusion, our results confirm a still high H. pylori seroprevalence in population in Benin. An epidemiolgic survey with prevention mesures targeted on potential risk predictors should be going on. Validation of antigen detection test in patients stools before treatment and for eradication control could be an interested alternative, notably in Benin. Primary resistance rate on metronidazole is stable today in Belgium, though the resistance prevalence on clarithromycin should be determined by other multicentric studies. Standard triple therapy by (PPI)-amoxicillin-clarithromycin is still recommended in first intention to treat. Epidemiological survey of infection based on local prevalence of claritromycin-resistant and metronidazole-resistant strains should be continued.

Doctorat en Santé Publique
info:eu-repo/semantics/nonPublished

Pressure ulcers (PUs) present intrinsic risk factors that are not consistently identified by clinical assessments. The objective of this project was to develop a clinical practice guideline (CPG) to provide nurses with guidance in identifying and differentiating how intrinsic and extrinsic risk factors are associated with populations at risk for developing avoidable and unavoidable PUs. CPG development followed a systematic method to search the literature, organize findings, and assess the strength of the resulting evidence and its applicability to the CPG. Quality of the CPG was assessed by a panel of 8 health care professionals using the Appraisal of Guidelines for Research & Evaluation II instrument. Findings of the assessment indicated a high overall quality of the CPG; its immediate use was recommended and systematic evaluation was suggested to promote usage in a wider array of health care contexts. The quality domains with the highest scores were scope, purpose, applicability, editorial independence (all 100%), rigor of development (99.7%), and clarity of presentation (99.3%). The stakeholder involvement domain demonstrated the lowest--yet still robust--score (94.4%). The CPG can be used to emphasize appropriate and specific nursing competencies for making informed decisions when identifying and describing patients at risk for developing PUs. Further research and evaluation of the use of this CPG will be useful to demonstrate how CPGs can help to decrease the incidence of avoidable PUs. The potential for positive social change relative to the prevention of PUs is high. Decreased incidence of preventable PUs will eliminate unnecessary health care costs and improve overall health outcomes of patients at all levels of socioeconomic status.

Previous literature showed weak and sometimes contradictory evidence regarding the best interventions to prevent pressure ulcers and the best factors that can serve as predictors for ulceration. The aim of this study was to explore effective interventions and associated risk factors in the area of pressure ulcer. A retrospective approach was used to explore such interventions and risk factors in a more natural clinical environment than found in a prospective study. While retrospective studies have their limitations, one problem of prospective studies, the Hawthorn effect, is not present. In order to meet the aims of the study, a matched case-controlled design was employed. A convenience sampling technique was used to select all patients who matched the study criteria. Two groups of patients were selected. The first group developed pressure ulcer during hospitalization, the other did not. In order to have a sound and robust comparison, each patient from the pressure ulcer groups was matched or at least nearly matched with another patient from the non-pressure ulcer group for a number Waterlow sub-scores. Further criteria for selection included a minimum of three days total length of stay in hospital and being initially free of any pressure ulcer on admission for both of the study groups. Electronic medical records for all patients were revised, and multidimensional data were extracted using a data extraction sheet. Data analyses were carried out using univariate analysis (t-test, Mann-Whitney, Chi-square and Fisher’s exact test) and multivariate analysis (binary logistic regression). In univariate analysis for preventive interventions, the following interventions were significantly associated with pressure ulcer prevention (P≤ 0.05): standard hospital bed, seating cushion, static pressure redistributing mattress, re-positioning every four hours and helping the patient to sit regularly in a chair. When the effect of all interventions was adjusted through the multivariate model, the following interventions were independently associated with prevention: draw sheet, re-positioning every four hours and helping patient to sit regularly in chair (odds ratio = 0.24, 0.06 and 0.13 respectively; P≤ 0.05). In univariate analysis for risk factors related to physical activity and mobility, the following factors were significantly associated with developing pressure ulcer (P≤ 0.05): moving in bed with help, the ability to take a bath only in bed, needing two helpers in performing activities of daily living and moving outside bed only by a hoist. When adjusting the effect of all variables related to physical activity and mobility through the multivariate model, only two factors were independently associated with developing pressure ulcer: moving in bed with help and the ability to take a bath only in bed (odds ratio = 7.69 and 3.67 respectively; P≤ 0.05). In univariate analysis for risk factors related to pressure ulcer intrinsic risk factors, the following factors were significantly associated with developing pressure ulcer (P≤ 0.05): presence of three underlying medical conditions, dehydration, depression, having a blood transfusion, serum albumin <32mg/dl, haemoglobin <130 g/l in males or <115 for females and systolic blood pressure <113 mmHg. When adjusting the effect of all variables related to intrinsic risk factors through the multivariate model, the following risk factors were independently associated with pressure ulcer: presence of two underlying medical conditions, presence of three underlying medical conditions, cognitive impairment, serum albumin <32mg/dl and haemoglobin <130 g/l in males or <115 for females (odds ratio = 13.3, 143, 4.3, 0.10 and 0.14 respectively; P≤ 0.05). Findings from this study suggest a number of interventions to be effective in PUs prevention, and a number of risk factors that can predict risk of PUs. Findings were based on statistical association between acquiring PUs and the independent variables (preventive interventions and risk factors). This cannot constitute a cause and effect relationship due to the retrospective nature of data analyzed; it only supports the association between a number of interventions and risk factors in preventing or predicting PUs. This can guide further research to investigate these interventions and risk factors by employing the same approach used, but in a prospective manner.

Dating violence has been reported globally as a public health and socio-cultural issue affecting millions of female university students in dating relationships. The serious health implications can affect academic performance and the total wellbeing of the individual and the society. Literature on risk and protective factors for dating violence among students at universities is limited in Nigeria. The purpose of this study was to explore and describe the perceptions of risk and protective factors for dating violence among female students at the University of Benin, Nigeria, using a case study methodology. In this study, a sample of 90 participants was recruited to participate in nine focus groups. Data were collected through focus group discussions. Thematic content analysis was employed to analyse the data, which yielded 24 themes. These were grouped according to the four levels of the socio-ecological framework: individual, interpersonal, community and societal level factors regarding risk of and protection from dating violence among female students. Thirteen themes were identified under risk factors for dating violence among female students, while 11 were identified under protective factors. Individual level risk factors included alcohol and substance abuse, poor interpersonal skills, poor control of emotions, possessiveness and risky sexual behavior. Interpersonal level risk factors included negative childhood experiences, influence from others and clash in belief systems between partners. Community level risk factors included patriarchy and violence in the community, and societal level risk factors included the influence of technology on relationships, absence of regulations to protect women from abuse and poverty. Individual level protective factors included maturity and self-knowledge/acceptance before dating, self-protective behaviours and control. Interpersonal level protective factors included having elders as good role models, trusting relationships, mutual respect between partners and an open relationship and transparency between partners. The community level protective factors included cultural norms to reduce violence and the university response, while societal level protective factors included public awareness and laws to protect women from violence. The findings raise the need for the university management and other stakeholders on campus to develop community awareness campaigns around healthy dating relationships among partners, and to improve the practice of dating violence prevention. Policy makers in Nigeria can use the findings to develop policies and regulations to address dating violence and other forms of violence on Nigerian campuses.

L'objectif était d'évaluer l'effet de l'anémie pendant la grossesse et ses facteurs de risque sur le développement cognitif d'enfants à un an.Notre cohorte a inclus 636 couples de mères et d'enfants singletons nés de femmes enceintes incluses dans un essai clinique antipaludiques au Bénin. Les prélèvements sanguins ont été réalisés lors des 1er et 2nd visites prénatales (VP) et à l'accouchement (AC) afin d'évaluer la concentration en hémoglobine (Hb) et la ferritine sérique. Les selles ont été testé la présence d'oeufs d'helminthes par la technique de Kato-Katz. Toutes les femmes ont reçu 600mg de mébendazole lors de la 1er VP. À l'âge d'un an, le développement psycho-moteur des enfants a été évalué par le Mullen Scales of Early Learning.La prévalence de la carence en fer (CF) chez les femmes 1er et 2nd VP et à l'AC était de 30,5%, 34,0% et 28,4%, respectivement. La prévalence des infections helminthiques était de 11,5%, 7,5% et 3,0 % à la 1er, la 2nd VP et à l'AC, respectivement. La prévalence de l'anémie a diminué de 67,1% à la 1er VP à 40,1% à l'AC. L'infection par ankylostomes à la 1er VP était associée avec un score de motricité globale (MG) inférieure -4,9 (IC 95%:-8,6;-1,3). Nous avons observé une relation quadratique négative significative entre la MG de l'enfant et la concentration d'Hb à la première et la 2nd VP.Dans ce contexte de supplémentation en fer des femmes enceintes, la CF maternelle n'était pas associée au développement neurocognitif de l'enfant. De plus, il semble que des concentrations en Hb légèrement en-dessous de la normale (comprises entre 90 et 110 g/L) soient optimales pour la motricité des enfants à un an
The aim was to investigate the impact of anemia during pregnancy and its risk factors on the cognitive development children.Our cohort included 636 mother-singleton child pairs from 828 eligible pregnant women who were enrolled during their first antenatal care (ANC) visit in Allada, Benin, into a clinical trial comparing two malarial drugs. Ferritin and hemoglobin (Hb) level were assessed at the first and second ANC visit of at least one-month interval and at delivery. Stool samples of pregnant women were tested for helminths using the Kato-Katz method. All women were given 600 mg of mebendazole to be taken after the first ANC visit. Cognitive and motor functions of one-year-old children were assessed using Mullen Scales of Early Learning.The prevalence of iron deficiency (ID) at first and second ANC visits, and at delivery was 30.5%, 34.0% and 28.4%, respectively. Prevalence of helminth infection was 11.5%, 7.5% and 3.0% at first, second ANC visits and at delivery, respectively. Prevalence of anemia decreased from 67.1% at first ANC visit to 40.1% at delivery. Hookworm infection at first ANC was associated with lower mean gross motor (GM) scores -4.9 (95% CI:-8.6;-1.3) in the adjusted model. We observed a significant negative quadratic relationship between infant GM function and Hb concentration at first and second ANC visits.Prenatal helminth infection is associated with poor with infant cognitive and motor development. However, in the presence of iron supplementation, ID is not associated with infant neurocognitive development. Further, there appears to be an Hb concentration range (90-110 g/L) that may be optimal for better GM function of one-year-old children

Prostate cancer is the most common cancer in men. One type of treatment is internal radiation therapy, brachytherapy. This treatment requires the patient to lie completely motionless and in lithotomy position. The purpose of this study was to investigate the prevalence of pressure ulcers associated with brachytherapy in prostate cancer at the UniversityHospitalin Uppsala. Furthermore, the purpose was to identify the most common location of pressure ulcer and to examine whether there were any connection between risk factors and possible pressure ulcers. Thirty patients participated in the study. The data collection was carried out partly by the nurse anesthetist and partly by the nurse in the oncology ward in fall 2009 to spring 2010. The study showed that seven of thirty patients (23.3%) developed pressure ulcers after brachytherapy. All of these were stage 1 according to EPUAP's pressure ulcer scale. Only one of the patients (3.3%) had remaining pressure ulcer the day after treatment. The most common location were lower legs/calves (16.7%). No statistically significant relationship was found between risk factors and the development of pressure ulcers. The results of this study showed a relatively high incidence of pressure ulcers (23.3%). All of stage 1 and only one of the pressure ulcers were remaining the day after brachytherapy. This indicates a good pressure-relieving measures and equipment, and that the patients in this study have a relatively good general          condition.Keywords: brachytherapy, pressure ulcers, lithotomy position, risk factors
Prostatacancer är den vanligast förekommande cancersjukdomen hos män. En av behandlingsformerna är intern strålbehandling, brachyterapi. Denna behandling kräver att patienten ligger helt stilla och i gynekologiskt läge. Syftet med studien var att undersöka förekomsten av trycksår i samband med brachyterapi vid prostatacancer på Akademiska sjukhuset i Uppsala. Vidare var syftet med studien att kartlägga de vanligaste lokalisationerna samt att undersöka om de fanns några samband mellan riskfaktorer och eventuella trycksår. Trettio patienter deltog i studien. Datainsamlingen utfördes dels av anestesisjuksköterskan och dels av patientansvarig sjuksköterska på onkologavdelningen under hösten 2009 till våren 2010. Resultatet av studien visade att sju av trettio patienter (23,3 %) utvecklade trycksår efter behandlingen. Alla dessa var av grad 1 enligt EPUAP:s trycksårsskala. Endast en av patienterna (3,3 %) hade kvar trycksåret dagen efter behandlingen. Den vanligaste lokalisationen för trycksår var underben/vader (16,7 %). Inga statistiskt säkra samband kunde ses mellan riskfaktorerna och utvecklandet av trycksår. Studien visade en relativt hög frekvens av trycksår (23,3 %). Dock var samtliga av grad 1 och endast ett trycksår var kvarstående till dagen efter brachybehandlingen. Detta tyder på bra tryckavlastande åtgärder och utrustning samt att patienterna i den aktuella undersökningsgruppen har relativt gott allmäntillstånd.   Nyckelord: brachyterapi, trycksår, gynekologiskt läge, riskfaktorer

A pressure ulcer, defined by the National Pressure Advisory Panel and European Pressure Ulcer Advisory Panels as localized injury to the skin or tissue as the result of pressure or pressure in combination with shear, can be an adverse complication of a hospital stay, especially for acute and critically-ill patients. Factors that can contribute to pressure ulcer development include the intensity and duration of pressure, tissue tolerance, shear, and friction. Common anatomical sites for pressure ulcers development are over bony prominences. The National Pressure Advisory Panel and European Pressure Ulcer Advisory Panels define pressure ulcers in six stages according to the degree of tissue damage present in the wound. A risk assessment should be performed to identify the vulnerability of pressure ulcer development and provide guidance for the implementation of preventative interventions. For the critically-ill patient, several specific measures are advocated for preventing pressure ulcers.

Over time, organs may lose their ability to adapt to the oxidative stressors from internal and external environments. Exercise and other lifestyle factors may slow the effects of aging. This chapter focuses on changes in three organ systems: skin, vision, and hearing. Alternative recommendations are given for preventing or delaying age-related skin conditions, eye diseases, and hearing loss. Topics covered are melanoma, skin cancer, sun exposure, xerosis, pressure ulcers, cataracts, macular degeneration, glaucoma, and presbycusis. Mock case studies are provided to further explain risk factors.

Abstract This chapter describes the risk factors, pathogenesis, clinical signs, diagnosis and treatment of digestive disorders, acidosis, hyperkeratosis, liver abscesses, laminitis, oesophageal and gastric ulcers, urea poisoning and other feed-related diseases in domestic animals.

Pressure ulcers are a problem worldwide with social and cost implications. Patients at special risk are paraplegics, those in intensive care units who are critically sick, and older patients having prolonged bed rest for whatever reason. The important extrinsic factors are pressure, shear, and friction. There are a number of charts, which endeavour to identify patients at risk, and institute appropriate preventative measures thereby avoiding the long-term sequelae and burden of pressure ulcers. In patients with established pressure ulcers, an accurate patient and wound evaluation is vitally important. The long-term success of management of these ulcers is dependent on good patient rehabilitation and optimization of the wound. Reconstructive success is improved by following surgical guidelines. Use of fasciocutaneous flaps, designed in a V–Y configuration, is the preferred method of reconstruction with muscle flaps reserved as a back-up option. Conscientious postoperative care is equally important at ensuring a successful surgical outcome and minimizing complications

The prevalence of pressure ulcers has been reported to range from 4.1 to 32.2% in the older adult population. Pressure ulcers, also known as decubitus ulcers, bedsores, and pressure sores, are defined as localized injury to the skin and/or underlying structures, usually over a bony prominence as result of pressure or pressure in combination with shear. Within the geriatric population, prevalence and incidence rates tend to be high due to multifactorial risk factors such as comorbidities, changes in functional status, nutritional habits, medications affecting the skin, and physiological changes. The impact of pressure ulcers spans physical, emotional, social, and economic dimensions, and is of concern throughout the healthcare continuum. The aim of this chapter is to illustrate the aetiologic complexity of pressure ulcers in the geriatric population and summarize a comprehensive approach to prevention and management of pressure ulcers.

Management of pressure ulcers requires a multifaceted approach for both prevention and treatment. The posterior thigh flap is one option for definitive surgical management. Treatment is initiated optimizing factors for wound healing and minimizing risk factors for recurrence. Obtaining adequate pressure offloading, moisture control, decreased wound contamination, and correction of any malnutrition should be addressed before considering surgery. The arc of rotation allows for potential closure of defects of the upper gluteal region, lower sacrum, greater trochanter, pubis, or perineum. Ischial ulcers treated with the posterior thigh flap can have a high rate of wound healing complications, but total flap loss and other serious complications are relatively rare. Partial loss or recurrence can often be treated with flap readvancement. Patient selection and preparation are keys to success.

This chapter addresses the fundamental role of nurses in the prevention of skin breakdown. Every nurse should possess the knowledge and skills to identify people at risk of skin breakdown, to select and implement strategies to maintain skin integrity, and to review the effectiveness of these to inform any necessary changes in care. Skin breakdown is associated with long-term conditions such as diabetes, cardiovascular disease, and spinal cord injury, and with acute illnesses that cause mobility restriction such as surgery and severe illness. Diabetes is associated with foot ulcers, cardiovascular disease with leg ulcers, and acute or long-term mobility restriction is associated with pressure ulcers. This chapter focuses on these three categories of skin breakdown and illuminates the key responsibilities carried by nurses in each of these areas. The first section of this chapter provides detailed guidance on the nursing management of pressure ulcer prevention. This is followed by a subsidiary section on the prevention of diabetic foot ulcers. The final section provides a short overview of the nursing role in preventing or managing venous ulceration. Pressure ulcers, which are also called pressure sores, bed sores, and decubitus ulcers, have been defined as:…localized injury to the skin and/or underlying tissue usually over a bony prominence, as a result of pressure, or pressure in combination with shear. (European Pressure Ulcer Advisory Panel and National Pressure Ulcer Advisory Panel, 2010)…Pressure ulcers may present as persistent redness (where the skin is damaged, but not yet broken), blisters, shallow sores, or necrotic wounds extending to the muscle and bone. An ‘avoidable pressure ulcer’ is one that developed and the provider of care did not do one of the following:…● evaluate the person’s clinical condition and pressure ulcer risk factors; ● plan and implement interventions consistent with the person’s needs and goals, and recognize standards of practice; ● monitor and evaluate the impact of the interventions; or ● revise the interventions as appropriate….

Chronic venous diseases are frequent pathologies in the general population. The most common chronic venous pathologies are varicose veins and chronic venous insufficiency including post-thrombotic syndrome. In the general adult population, varicose veins are present in up to 25% of people with an increasing prevalence with age. Risk factors include advanced age, genetic predisposition, female sex, and multiparity. The term chronic venous insufficiency summarizes the clinical signs of chronic venous disease with oedema, skin changes, or venous ulcers. More than 15% of the population is affected by chronic venous insufficiency. Risk factors include advanced age, obesity, and prolonged sitting.

This chapter discusses gastrointestinal drugs and includes discussion on H2 blockers and proton pump inhibitors (including discussion on physiology of acid secretion, pharmacology, pathophysiology of stress ulcers, stress ulcer prophylaxis, and treatment of acute bleeding after endoscopy), antiemetics (including discussion on mechanisms of nausea and vomiting, antiemetic drugs, and clinical approach), gut motility agents (indications, erythromycin, erythromycin versus metoclopramide, metoclopramide, domperidone, cisapride, neostigmine, and alternative treatment strategies), antidiarrhoeals (risk factors and causes of diarrhoea, antidiarrhoeal drugs, and enteral supplements), and constipation in critical care. This includes pathophysiology of and risk factors for constipation, treatments including bulk-forming, stimulating, osmotic, and emollient laxatives, as well as suppositories and enemas, motility agents, and opioid antagonists. It also outlines special circumstances, including palliative care, spinal cord injury, and liver failure patients.

Though a preventable risk, the management of pressure ulcers (PUs) in nursing homes is not satisfactory due to inadequate prevention and complex care plans. PUs early detection and wound assessment require to know the patient condition and risk factors and to have a good knowledge of best practices. We built a guideline-based clinical decision support system (CDSS) for the prevention, the assessment, and the management of PUs. Clinical practice guidelines have been modeled as decision trees and formalized as IF-THEN rules to be triggered by electronic health record (EHR) data. From PU assessment yielded by the CDSS, we propose a synthetic visualization of PU current and previous stages as a gauge that illustrates the different stages of PU continuous evolution. This allows to display PU current and previous stages to inform health care professionals of PU updated assessment and support their evaluation of previously delivered care efficiency. The CDSS will be integrated in NETSoins nursing homes EHR where gauges for several health problems constitute a patient dashboard.

Vascular disease is one of the leading causes of morbidity and mortality in the United States and throughout the world. One of the key offending factors in the pathogenesis of vascular disease is atherosclerosis, which involves endothelial damage as a result of generalized inflammation of the vasculature. The clinical sequelae related to atherosclerosis are varied based on the extent and anatomic location involved. Typically, atherosclerotic disease exists in multiple sites, even if it clinically presents in one location. Aortic atherosclerosis results in aneurysms, dissections, penetrating ulcers, intramural hematomas, and occlusive disease. Carotid artery stenosis, which is caused predominantly by atherosclerosis, is associated with an increased risk of stroke. Peripheral arterial disease results in insufficient blood flow to the lower extremities, which manifests as intermittent claudication. The risk of limb loss from poor circulation is often overshadowed by the risk of mortality from coexistent coronary artery and cerebrovascular atherosclerosis.

During the 1990s, most diabetic ulcers were considered neuropathic, but the Eurodiale study showed that more than 50% of these were non-plantar (neuro-ischaemic and ischaemic). According to the International Guidelines, the neuro-ischaemic and ischaemic diabetic foot ulcer (DFU) outcomes are connected to factors related to the wound, leg-associated factors and patients’ comorbidities. We used wound, ischaemia and foot infection (WIfI) classification system; Trans-Atlantic Inter-Society Consensus-II (TASC-II) arterial lesion score; and Kaiser Permanente pyramid (stratification of patients according to their complexity) for assessing these parameters. From February 2011 to June 2012, we collected 124 episodes of neuro-ischaemic and ischaemic active ulcer in 100 patients: 18 required major amputation, 14 of them were in WIfI stage 4 and 4 in WIfI stage 3. Ten patients (over 14 in WIfI stage 4) were classified as TASC-II D. Eight patients (over the same 14) were classified as the higher risk of Kaiser Permanente pyramid. In line with other studies, our data support that the WIfI classification correlates well regarding risk of amputation at 1 year. However, when adding TASC-II and Kaiser Permanente pyramid assessment, the outcome is even more accurate not only for limb salvage but also for patients’ survival.

The article deals with the external and internal factors influencing development of pressure ulcers and the effectiveness of their care. The patients were assessed according to their age, gender and changes in their condition. The modified Norton Scale was used to assess the effectiveness of pressure ulcer care. It has been established that internal factors increase the risk of developing pressure ulcers. The effectiveness of pressure ulcer care is promoted by pressure ulcers preventative measures, medicines and skin hygiene.

Transtibial amputation (TTA) patients face ongoing morphological changes in their residual limb. The residuum volume changes due to weight gain or loss, diurnal edema, and muscle atrophy. Consequently, the TTA prosthetic-user is fitted with a new prosthetic socket approximately every four years. Despite new innovations in socket and liner materials and design, contemporary prosthetics are not yet equipped to confront these changes. The TTA residual limb is therefore subjected to high superficial and internal stresses which may cause injury. Appending the hazardous condition of natural volume change of the residuum is the initial geometrical state of the truncated bones. The primary surgical considerations in TTA are the tibial length, the bevelment of the distal end of the tibia and the location of the surgical scar. These risk factors may significantly affect the well being of the TTA residuum. Previous studies assumed that the criteria for a well-fitted socket were low interface stresses. However, while interface stress measurements may help prevent superficial skin damage, knowledge of the internal stress distribution can prevent the formation of deep tissue injury (DTI) [1]. While superficial pressure ulcers are visually detected, DTI is concealed under the skin and spreads to its surroundings in the soft tissues of the residuum. If this latent wound is ignored, the skin will rupture to reveal a massive injury to skin, fat and muscle tissues, clinically termed as a type IV pressure ulcer. Our purpose was to evaluate the effect of the following risk factors on the internal mechanical condition of the TTA residuum: shorter tibial lengths (thicker muscle flap tissue), milder tibial end bevelments, different mechanical properties of the muscle flap (simulating both variance between patients or flaccid versus contracted muscle) and superficial scarring in inferior and anterior locations on the skin.

Sickled erythocytes appear to be primarily responsible for occlusion of microvasculature in patients with homozygous sickle cell disease (SCD), but it is unknown whether the activation of the coagulation pathway is also contributory to these vaso-occlusive crisis and other complications as leg ulcers, aseptic necrosis of bone, strokes. Thus, we studied coagulation and fibrinolysis parameters in 12 patients (ages 2 to 26 years with SCD, in steady-state, far from thrombotic events which occurred in 3 of them) to determine if it would be possible to detect a high-risk group for thrombosis. We were surprised to observe that all the vitamin K dependent factors levels (II, VII+X, IX, protein C) were found next to the lowest values of the normal range.But in 3 out of 12 patients, protein C was significantly lower and 2 of them have had thrombotic events (stroke, leg ulcers). Factor V level was in the normal range except for 3 patients with low levels. As other authors, we observed normal fibrinogen, plasminogen and a 2 antiplasmin values and always very high factor VIII levels. Antithrombin III activity was normal or even high contrasting with the lower levels of the other factors synthesized in the liver. However all these abnormalities seem to balance since the thrombin generation test performed in the patients plasmas are in the normal range. As a marker of high-risk group for thrombosis, fibrin-D-Dimer levels (using a latex bead agglutination assay) were measured and found to be positive in 4 patients, 3 of them having suffered from thrombosis associated in two cases with a protein C deficiency. Thus, if the hemostatic modifications observed are involved in the mechanism of thrombosis, fibrin-D-Dimer and protein C seem to be the most significant parameters in this study.