Urinary tract infection (UTI) is one of the most common infections affecting the elderly. However, UTI is overdiagnosed and overtreated in this group. This project aimed to look into strategies for improving the management of UTI in elderly medical inpatients. A retrospective audit was performed on the case notes of medical inpatients in a district general hospital from December 2012 to April 2013. The target measures for improvement include increasing adherence to SIGN guidelines in the diagnosis of UTI, increasing the frequency and timeliness of urinary culture collection in suspected UTI, and increasing use of urine culture sensitivities to tailor antimicrobial treatments.Initial baseline measurement revealed 16 patients treated for UTI. 31.3% of these fulfilled SIGN criteria for UTI. 68.5% had urine cultures performed. 60% of patients with positive urine cultures had correct antibiotic therapy after sensitivity results. The mean time from the diagnosis of UTI to urine collection for culture was 4 days.Three further cycles were performed. Following each cycle, improvement measures were implemented to raise the awareness of medical staff about the management of UTI in the elderly. These comprised presentations to junior doctors at local teaching sessions; emails to ward managers with results of the previous audit cycle broken down by ward; and prominent display of guidelines on medical wards and ensuring availability of ‘Newcastle pads’ for taking sterile urine cultures from incontinent patients.In the final cycle, 19 patients were diagnosed with UTI. 42.1% of these fulfilled SIGN criteria for diagnosis of UTI. 89.5% had urine cultures sent. 86.7% of patients with a positive urine culture were treated with appropriate antibiotics after sensitivities became available. Mean time from UTI diagnosis to culture collection improved to zero days.In conclusion, continuous educational measures, performance feedback, and increased availability of specialist equipment are imperative for improving management of UTIs in the elderly.

Background Aneurysmal dilation of the right ventricular outflow tract complicates assessment of right ventricular function in patients with repaired tetralogy of Fallot. Tricuspid annular plane systolic excursion is commonly used to estimate ejection fraction. We hypothesized that tricuspid annular plane systolic excursion measured by cardiac magnetic resonance imaging approximates global and segmental right ventricular function, specifically right ventricular sinus ejection fraction, in pediatric patients with repaired tetralogy of Fallot. Methods Tricuspid annular plane systolic excursion was measured retrospectively on cardiac magnetic resonance images in 54 patients with repaired tetralogy of Fallot. Values were compared with right ventricular global, sinus, and infundibular ejection fractions. Tricuspid annular plane systolic excursion was: 1) indexed to body surface area, 2) converted into a fractional value, and 3) converted into published pediatric Z-scores. Results Tricuspid annular plane systolic excursion measurements had good agreement between observers. Right ventricular ejection fraction did not correlate with the absolute or indexed tricuspid annular plane systolic excursion and correlated weakly with fractional tricuspid annular plane systolic excursion (r=0.41 and p=0.002). Segmental right ventricular function did not appreciably improve correlation with any of the tricuspid annular plane systolic excursion measures. Pediatric Z-scores were unable to differentiate patients with normal and abnormal right ventricular function. Conclusions Tricuspid annular plane systolic excursion measured on cardiac magnetic resonance imaging correlates poorly with global and segmental right ventricular ejection fraction in pediatric patients with repaired tetralogy of Fallot. Tricuspid annular plane systolic excursion is an unreliable approximation of right ventricular function in this patient population.

Usoro et al.: Tricuspid annular plane systolic excursion by cardiac MRI has poor correlation with RVEF in pediatric patients.

An estimated 50,000 Nigerian women die each year from complications of pregnancy and childbirth, accounting for 10% of global estimates of pregnancy maternal death with about 2% resulting from drug induction. This cross-sectional study sets out to evaluate the Prothrombin time test (PT), activated partial thromboplastin time test (aPTT) Erythrocyte sedimentation rate (ESR), and Platelet count (PC) of pregnant women attending antenatal clinics at Oredo Health Centre in Benin City, Edo State. A total number of 130 subjects comprising 100 pregnant women and 30 non-pregnant women were recruited for the study. Prothrombin time (PT), Activated Partial Thromboplastin Time (APTT), Platelet count and Erythrocyte Sedimentation Rate (ESR) were studied using standard manual methods. The prothrombin time (sec) of the pregnant women 1st trimester (19.12±0.77b), 2nd trimester (19.90±1.02 b) and 3rd trimester (19.66±0.56 b), activated partial thromboplastin time (sec) 1st trimester (44.02±1.17 b), 2nd trimester (47.72±1.47 b) and 3rd trimester (45.88±1.10b), Erythrocyte sedimentation rate (mm/hr) 1st trimester (24.37±3.04 a), 2nd trimester (37.83±4.53 a) and 3rd trimester (43.25±5.24 a) and platelet count (X109/L) 1st trimester (248.29±23.18a), 2nd trimester (236.33±13.84 b) and 3rd trimester (239.10±16.07 a) were significantly higher than the prothrombin time (sec) 16.48±0.81 a, activated partial thromboplastin time (sec) 36.53±1.42 a, ESR (mm/hr) 29.83±4.14 a and platelet count (X109/L) 201±9.54 an of the non-pregnant women (p<0.05). The ESR (mm/hr) of the 3rd trimester (43.25±5.24) was observed to be significantly higher than that of the 1st trimester (24.37±3.04) and 2nd trimester (37.83±4.53) (p<0.05). Our investigation showed that antibiotics in pregnancy have a deleterious effect on PT, ESR, APTT and PC studied. We recommend that pregnant women should be given due attention throughout the course and events of pregnancy to prevent or reduce the risk of thrombotic episodes and possible disseminated intravascular coagulation (DIC) with resultant better maternity/child safety and health outcome and educated on the effects of antibiotics to pregnancy.