Prevalence and Associated Factors of Depression in Outpatients of Internal Medicine Department of Kigali University Teaching Hospital, Rwanda

Background Depression is more prevalent in medically ill patients than in the general population. More is not known about depression rates in internal medicine outpatients consulting the teaching hospitals in Rwanda. Adults with medical diseases are more likely to develop depression, it is an often-unrecognized co-morbidity in this group, and it has a major impact on their function and disability. In the absence of studies in our region, we did this research in our country with interest in what factors might be associated with depressive symptoms. Methods The descriptive cross-sectional study was used to determine the prevalence of depression and associated factors among internal medicine outpatients of Kigali university teaching hospital (CHUK). The 9 items Patient Health Questionnaire (PHQ-9) instrument was used to screen depression symptoms among outpatients. The validated cut-off score of 10 for diagnosing depression was applied in this study. Patients’ clinical and socio-demographic characteristics were collected and analyzed for their relationship with depression. All patients who scored PHQ-9 above 10 were referred to CHUK mental health department for appropriate management. Results Three hundred patients were recruited, of whom 65.3%) were females and 51% had an age between 45 and 96 years. The overall prevalence of depression among outpatients in the internal medicine department of CHUK was 45.7%. Outpatients had 20.7%, 17%, and 10% for moderate, moderately severe, and severe depression, respectively. Age, educational status, and follow-up visits as current physical complaints were independently associated with depression (P < 0.05). As much as 22.7% of patients were presenting with Suicidal ideas. The study showed that low income was strongly associated with suicide ideation (P < 0.001). Regardless of age and gender, the prevalence of depression was higher among outpatients of internal medicine than the general population. Conclusions A holistic approach in the management of internal medicine outpatients should be implemented to facilitate the early detection and treatment of depression in general tertiary hospitals. Furthermore, intervention programs that address depression and suicide in adults are needed.

The Frequency of Prescribing Nicotine and Varenicline in a Public Hospital

Aim: This study was conducted to demonstrate the prescribing pattern of nicotine and varenicline in a public hospital in Alkharj. Methodology: This is a retrospective study includes evaluating outpatient prescribing of nicotine and varenicline from 1st of January 2018 to 30th of June 2018 in a public hospital in Alkharj. Results: All of the nicotine patch prescriptions were written by internal medicine department and all of the prescriptions were prescribed by residents. The age of more than half of them was between 30 and 39 (53.33%). All of the varenicline tablet prescriptions were written by internal medicine department. The age of about 88.23% of the patients who received varenicline tablet was more than 29 years. Conclusion: Nicotine and varenicline prescribing was infrequent in Al-kharj. More awareness programs are needed for health care workers and for the public. Moreover, the physicians should assess if the treatment is needed or no according to the person condition.

Surveillance of hospital-acquired infections and monitoring of empiric antibiotic therapy in an internal medicine department

Introduction: Hospital-acquired infections (HAIs) are the most serious and frequent complication of healthcare systems. In 2019 the Marche Region has introduced a project to check HAIs and also the use of antibiotics in empirical therapy. The aim of this analysis was to conduct a periodic descriptive prevalence study according to the regional plan. Materials and Methods: In the quarter January-March 2020, the Internal Medicine Department of the Mazzoni Hospital of Ascoli Piceno has been considered, enrolling patients with HAIs to whom has been prescribed at least one antibiotic in empirical therapy. To assess the prevalence of multi-drug resistant organisms (MDRO), microbiological isolates were examined and laboratory response times were measured as a quality indicator. Besides, the incidence of HAIs from medical device, the clinical outcomes and the average length of stay have been analyzed. Results: The results show: high incidence of HAIs and high percentage of MDRO. The response time of the laboratory analysis is on average over 48-72 hours after sampling. The data show a widespread use of broad-spectrum antibiotics and low adherence to the new regional empiric therapy guidelines. Conclusions: The high incidence of HAIs implies the urgent need of an active surveillance of an Antimicrobial Stewardship team. This would represent a strategic solution to prevent and limit antimicrobial resistance and reduce morbidity, mortality and costs.

P047 Musculoskeletal symptoms as first clinical presentation of juvenile-onset systemic lupus erythematosus: Experience from a military internal medicine department

Background Juvenile-onset systemic lupus erythematosus (SLE) is a multisystem autoimmune disorder occurring before the age of sixteen. The clinical manifestations are variable and the management of the disease at this age may be different. The aim of our study was to investigate first clinical presentation of juvenile-onset SLE. Methods We conducted a retrospective study in a military internal medicine department. We accessed medical records of 103 patients with SLE diagnosed according to the revised 1997 American College of Rheumatology (ACR) criteria or the 2012 Systemic Lupus International Collaborating Clinics (SLICC) classification criteria. Only patients with an age of lupus-onset &lt; the age of sixteen were included. Clinical data were collected and analyzed. The statistical analysis was performed using SPSS 23.0 software. Result There were eight juvenile-onsets SLE: two males and six females. The median age at the diagnosis was 13.7 + 1.9 years-old (11–16). First clinical presentations are shown in table 1. Arthritis and hematological involvement tended to be associated (p = 0.07). Hypocomplementemia and positive anti-DNA antibodies were detected in 50% of cases. All patients received Hydroxychloroquine and most of them combined corticosteroids (7cases). Conclusion Our study showed that musculoskeletal manifestations especially arthritis were frequent at the diagnosis of juvenile-onset SLE. According to the aggressive pharmacological treatment, a multidisciplinary approach should be required

Clinical and laboratory factors associated with nosocomial pneumonia in adult patients in the internal medicine department of a national hospital in Peru: A case-control study

Objective To determine how clinical and laboratory factors were associated with nosocomial pneumonia in adult patients hospitalized in an internal medicine department. Methods We conducted a retrospective unmatched case-control study. We recorded clinical and epidemiological data from patients discharged from an internal medicine department of a Peruvian reference hospital, the Hospital Nacional Arzobispo Loayza, between 2016 and 2018. Bivariate and multivariate analyses (using logistic regression models) were performed to obtain crude and adjusted odds ratios with 95% confidence intervals. A P value < 0.05 was considered significant. We calculated the population attributable fraction of the significant variables. Results We analyzed 138 cases and 200 controls, with a mean age of 72.6 ± 17.8 years (21 to 104) for cases and 71.7 ± 15.3 years (19 to 98) for controls. The multivariate analysis indicated that severe anemia (adjusted odds ratio 9.0, confidence interval 95% 1.9 to 43.1, P = 0.01), severe hypoalbuminemia (adjusted odds ratio 4.0, confidence interval 95% 1.2 to 13.8, P = 0.03), altered state of consciousness (adjusted odds ratio 3.6, confidence interval 95% 1.6 to 8.2, P = 0.00), and prior use of antibiotics (adjusted odds ratio 6.3, confidence interval 95% 2.7 to 14.5, P = 0.00) were significantly associated with nosocomial pneumonia. The population attributable fraction found were 41.8% for altered state of consciousness, 33.2% for severe anemia, and 36.3% for severe hypoalbuminemia. Conclusion Clinical and laboratory risk factors associated with nosocomial pneumonia development in adult patients hospitalized in an internal medicine department were severe anemia, severe hypoalbuminemia, altered consciousness, and previous use of antibiotics.

A Comparative Study Evaluating Improvement of Swallowing ability of Elderly Patients who Admitted to the Internal Medicine Department with Dysphagia using Fujishima’s Dysphagia Grading System

This comparative study evaluated the improvement in swallowing ability in elderly patients admitted with dysphagia. Between 2013 and 2018, 961 inpatients with dysphagia, aged ≥65, were admitted to the internal medicine department of our hospital. We divided these patients into two groups based on whether pneumonia was (n=691) or was not (n=270).