Open Access Case Study

Hemorrhagic Pericardial Effusion as a First Clinical Manifestation of Systemic Lupus Erythematosus: A Case Report

Majid Alameri, Shaista Urooj, Mohamed Almarzooqi

Journal of Advances in Medicine and Medical Research, Page 1-5
DOI: 10.9734/BJMMR/2016/21490

Pericarditis is the most common cardiac manifestation of Systemic lupus erythematosus (SLE), but pericardial effusion infrequently happens as the first clinical sign of SLE. We report the case of a previously healthy 19 years old male patient whose initial manifestation of lupus was a large pericardial effusion impending tamponade. In this case report we will describe the clinical course, echocardiographic and laboratory features of a large pericardial effusion secondary to systemic lupus erythematosus (SLE) with brief medical literature review.

Open Access Commentary

A New Theoretical Medical Model: The Four Dimensional Model

Zuoguang Wang, Xiaoyun Peng, Yongxiang Wei

Journal of Advances in Medicine and Medical Research, Page 1-6
DOI: 10.9734/BJMMR/2016/21532

Under the guide of the medical models, we clearly know the nature of many diseases. However, a lot of complicated diseases, the polygenic and multi-factorial diseases for example, are remained unexplained. Here, we proposed a new medical model, namely the Environment - Genetic - Homeostasis maintenance system (HMS) - Time medical model, which integrated four essential factors (environmental factor, genetic factor, HMS and time factor) of diseases together that can clearly clarify any diseases in form. Here, HMS is referred to the system involved in the maintaining of human homeostasis which is essential to the survival of a person and acts at the level of cell, tissue, organ and human body as a whole. Time factor mainly concerns age of people and duration of diseases. The integrative effects of the three factors decide the health status (disease, pre-disease, or health) of human body. As time goes, the possibility of catching a disease (determined by environments, genetics, and HMS) also dynamically changed. The model can fully explain pathogenesis of all diseases and health, and can be widely used in early diagnosis, treatment, prevention, and many aspects of any diseases. Therefore, it may change the modern medicine at many aspects.

Open Access Minireview Article

The Use and Abuse of Antimicrobial Agents in Dental Practice

Pankaj Gupta, Heeresh Shetty, Sneha Gada, Hiral Gandhi

Journal of Advances in Medicine and Medical Research, Page 1-6
DOI: 10.9734/BJMMR/2016/19817

It’s been over 60 years since the wide spread use of penicillin saved millions of lives from infection. Today there is a rapid emergence of antimicrobial resistance and it’s on the increase with each passing day. The dentists are responsible for a large number of antimicrobials prescribed and thus have a part to play in the antimicrobial resistance also. The present article discusses how are the dental professionals prescribing habits differ from other medical professionals, how are they contributing towards antimicrobial resistance and what are the steps which can be taken to curb the overuse of antimicrobials by dentists.

Open Access Original Research Article

Relapse of Cutaneous Fungal Infection in Healthy Individuals - A Rising Concern

Sheikh Manzoor Ahmed, Shazia Jeelani, Audil Mohmad Lanker, Seema Qayoom, Farah Sameem

Journal of Advances in Medicine and Medical Research, Page 1-8
DOI: 10.9734/BJMMR/2016/21634

Background: Superficial  fungal  infections  are  among    the  most  common  skin  diseases,  affecting  millions  of  people  throughout  the  world.  These  infections,  which  occur  in  both  healthy  and  immunocompromised  persons,  are  caused  by  dermatophytes,  yeasts  and  nondermatophyte  molds.  Effective  treatment  can  reduce  the  duration  of  symptoms  in  patients  with  superficial  fungal  infections.  Unfortunately,  there  is  a  strong  tendency  for  fungal  infections  to  recur  in  many  people  even  after  effective  clearing  with  medication.

Aims  and  Objectives:  To  study  the  relapse  of  cutaneous  fungal  infection  in  healthy  people. 

Materials  and  Methods:  160  patients  with  a  history  of  relapse  of  fungal  infections  who  came  to  the  out-patient  department  of  this  tertiary  care  hospital  within  6  months  period  were  studied  in  detail  regarding  patient  characteristics,  demographic  details  and  line  of  management.

Results: Relapse of cutaneous fungal infection occurs most commonly in adults greater than 30 years (75%). There was a definite family history of fungal infections (15.6%) in patients coming with history of relapse. Tinea cruris (34.38%) was  the  most  common  site  to  come  with  history  of  relapse  followed  by  onychomycosis (15.6%). Relapse  occurred  in  38.75%  of  the  cases  treated    with  terbinafine  as  this  was  the  most  common  drug  used.

Conclusion: Regardless  of  the  drug  taken  there  were  cases  of  relapse  in  cases  of  cutaneous  fungal  infection  even  in  healthy  individuals.

Open Access Original Research Article

The Knowledge of and Attitude to Hospital-acquired Infections among Public and Private Healthcare Workers in South-East, Nigeria

Angus Nnamdi Oli, Callistus Chibuike Ekejindu, Obiora Shedrack Ejiofor, Adaobi Helen Oli, Ifeanyi Ezeobi, Christian Chibuzo Ibeh

Journal of Advances in Medicine and Medical Research, Page 1-10
DOI: 10.9734/BJMMR/2016/18272

Aims: To ascertained and compared the knowledge and attitude of public and private health-care workers in South-East, Nigeria on hospital-acquired infections. 

Study Design: A cross sectional surveillance report.

Place and Duration of Study: Randomly selected hospital workers in private and public hospital in South-east Nigeria were administered questionnaire between April and July 2013.

Methodology: Proportional sampling technique was used to obtain a representative sample of the health-care workers. Structured and validated questionnaires (n=660) were self-administered to randomly selected healthcare workers present on the days of visit and consenting to participate in the study. Data were analyzed using Chi square statistical tool.

Results: The workers have good knowledge of HAIs but their attitude to preventive measures is poor and significantly different (p = 0.0002: Chi-square (X2) test). Hospital-acquired infections occurred more in public than private hospitals. The prevalence of nosocomial infections in the hospitals surveyed (as reported by the respondents) is urinary tract infection (34.9%), Gastroenteritis (27.1%), Hospital acquired pneumonia (20.3%), yeast infections (10.8%), Tuberculosis (9.0%), ventilator associated pneumonia (3.6%) and methicillin and/or vancomycin resistant infections (1.5%). The prevalence of the etiological agents of the nosocomial infections are the Staphylococcus aureus (31.0%), Candida albicans/ Aspergillus species (10.8%), Pseudomonas aeruginosa (10.5%), Mycobacterium tuberculosis (9.0%) and Clostridium difficile (3.9%). The workers know well about hospital-acquired infections, 322 (97.58%) and 297 (90%) in public and private hospitals respectively. About 11 (3.6%) and 19 (6.2%) workers in private and public hospitals respectively process their equipment as well as practice hand hygiene and use of personal protective equipment.

Conclusions/Recommendation: The burden of HAI is very high. UTI is the most prevalent HAI. The most common causative agent in both hospital setting is Staphylococcus aureus. The knowledge of the workers concerning hospital acquired infections is adequate but their attitude to the infections’ prevention is poor and significantly different. Standardized surveillance of nosocomial infections has to be urgently addressed in Nigeria.

Open Access Original Research Article

Antibiotic Resistance Patterns and Virulence Factors of Coagulase Negative Staphylococcus Associated with Urinary Tract Infections in Bulawayo Province, Zimbabwe

Joshua Mbanga, Sithabile Masuku, Silence Luphahla

Journal of Advances in Medicine and Medical Research, Page 1-9
DOI: 10.9734/BJMMR/2016/19912

Aims: To determine the antibiotic resistance patterns and virulence factors of coagulase negative Staphylococcus (CoNS) associated with urinary tract infections (UTIs). The virulence factors assayed for were the atl E and ica AB genes. The prevalence of the antibiotic resistance gene, mec A, was also determined.

Place and Duration of Study: Southern Pathology Clinical Laboratories and the National University of Science and Technology microbiology department, between December 2012 and March 2015.

Methods: A total of 754 urine samples were analyzed for bacteria by standard procedures. From these, 126 isolates were positively identified as CoNS. Antimicrobial susceptibility testing of the isolated CoNS was done using the disc diffusion method.The polymerase chain reaction (PCR) was also carried out to detect the presence of the mec A, ica AB and atl E genes.

Results: Antibiogram profiles showed that CoNS had high prevalences of resistance to nalidixic acid (88.1%), cotrimoxazole (72.2%) and oxacillin (69.8%).There were however high prevalences of sensitivity to nitrofurantoin (79.4%) and gentamycin (68.3%). A total of 106 (84%) isolates were resistant to three or more antibiotics and 12 multi-drug resistance patterns were observed. The most common pattern (resistance to nalidixic acid, ampicillin, oxacillin, tetracycline and cotrimoxazole) was exhibited by 33 isolates. A total of 40 CoNS isolates were then used to determine the prevalence of the mec A, ica AB and atl E genes. PCR results showed that most isolates 25/40 (62.5%) were positive for the mec A gene. The ica AB and atl E were detected in 32.5% and 25% of the isolates respectively. All isolates which were positive for both the mec A and ica AB genes showed resistance to multiple antibiotics.

Conclusion: There is emerging antibiotic resistance in CoNS that cause UTI’s. The occurrence of both the mec A and ica AB genes in CoNS isolates may lead to an increase in antibiotic resistance.

Open Access Original Research Article

The Knowledge, Attitude and Perception towards Epilepsy amongst Health Workers in a Tertiary Hospital in Uyo, Southern Nigeria

B. C. Ekeh, E. E. Akpan, U. E. Ekrikpo

Journal of Advances in Medicine and Medical Research, Page 1-10
DOI: 10.9734/BJMMR/2016/19812

Background: Epilepsy is usually stigmatized in the developing world because of the poor knowledge. The health workers in Nigeria are generally regarded as the custodians of medical information irrespective of their designation in the health care institution. Their opinion in health issues is generally coveted hence they majorly influence the attitude and health seeking behaviour of their respective communities.

Aim: The aim of the study was to study the Knowledge attitude and perception towards epilepsy amongst health workers in a tertiary hospital. We compared the knowledge and perception of doctors to that of other health service providers. We also made a comparison of the health service providers (HSP) with that of the health management and support workers (HMSW).

Study Design: The study is a prospective cross sectional survey.

Place and Duration of the Study: The study was carried out in University of Uyo Teaching Hospital. The data was collected within six months (September 2014 to March 2015).

Methodology: The participants were health workers in University of Uyo Teaching Hospital. The study is a questionnaire based study. We distributed 600 questionnaires to the participants. The questions explored the knowledge of etiology (perceived and medically proven). Their attitudes and perception to persons with epilepsy was also explored.

Results: There were 477 respondents in this study. The HMSW were more likely to believe that epilepsy was due to evil spirits, witches and excessive consumption of palm oil than the HSP (p<0.001). Five (2.45%) of the HSP believed epilepsy should not be treated in the hospital compared to the HMSW. The HSPs were more likely to relate with a PWE than the HMSWs.

Conclusion: There is still a huge gap in the level of knowledge, attitude and perception of health workers towards especially the HMSW.

Open Access Original Research Article

Resting Salivary Flow Rate and pH Decreases in Chewable Tobacco Users

Areeba Qamar, Saeeda Baig, Asghar Ali, Nousheen Zehra, Muhammad Asif Memon

Journal of Advances in Medicine and Medical Research, Page 1-9
DOI: 10.9734/BJMMR/2016/19273

Background: Salivary flow rate and pH may be altered by chewable tobacco, the habit which is becoming a threat for oral cancer epidemic. The objective of the study was to find out the relationship between alterations in resting salivary flow rate (RSFR) and pH, which are early signs of oral health deterioration, with different forms of chewing tobacco products.

Methods: A total of 354 healthy male subjects, consuming any form of chewable tobacco, belonging to low socioeconomic areas of Karachi were selected for this cross sectional study. A questionnaire was used to collect demographic data and details of chewing habits (using since, pack/day, duration of exposure etc.). Resting saliva of every subject was collected for 5min and RSFR was expressed in ml/min. Salivary pH was determined by using pH strips (pH 0-14). Data was analyzed on SPSS version 20.

Results: Of 354 subjects, 27.4% were gutka, 24.3% niswar, 24.3% paan and 24% multiple users with mean RSFR as 0.40±0.30, 0.65±0.32, 0.64±0.39 and 0.41±0.25 respectively. Mean resting salivary pH was 6.58±0.78 with the lowest pH; 6.16±0.65 in multiple users. RSFR and pH significantly decreased with increase in packs consumed/day, duration of exposure and duration of usage.

Conclusion: A significant negative correlation was found between RSFR and pH with tobacco chewing.

Open Access Original Research Article

Potential Risk of Respiratory Secretions in the Transmission of HBV Infection: A Review of the Literature

Numan Kokten, M. Tayyar Kalcioglu, Emine Timurlenk, Yasar Bayindir

Journal of Advances in Medicine and Medical Research, Page 1-7
DOI: 10.9734/BJMMR/2016/20195

Hepatitis B virus (HBV) infection is a significant health problem around the world and may cause serious morbidity and mortality. The most common transmission routes are parenteral, sexual, perinatal and horizontal way. Identification of the risk factors for viral hepatitis transmission is the main rule to reduce the spread of this infection. The aim of this study was to review the possible occupational risk factors for nanparenteral transmission of Hepatitis B virus for health care workers, especially for otorhinolaryngologists. The Medline / PubMed, Google Scholar, and Cochrane databases were searched by using different combinations of MeSH terms for HBV, transmission routes, and risk factors. The results were collected from articles published between January 2000 and July 2015. There were no language restriction during searching the data, whether the abstracts of the studies contain sufficient data were analysed. All searchable relevant data was evaluated and reviewed. The presence of viral particles, including HBsAg and / or HBV DNA in body secretions such as saliva, tears and cerumen may suggest the possibility of horizontal transmission of HBV infection. Therefore, the healthcare workers, particularly otorhinolaryngologists, ophthalmologists or other surgeons, audiologists, dentists, pulmonologists, intensive care specialists and nurses should pay special attention while applying the standard infection control precautions in order to prevent HBV infection in themselves and their patients.

Open Access Review Article

Asymptomatic Bacteriuria with Escherichia coli in Type 2 Diabetic Patients: An Unresolved Riddle

Archana Deraje, Shalini Shenoy, B. Dhanshree, Prabha Adhikari

Journal of Advances in Medicine and Medical Research, Page 1-9
DOI: 10.9734/BJMMR/2016/20800

Asymptomatic bacteriuria (ASB) is a common finding, but there is a considerable controversy about the appropriate management of bacteriuria. ASB was found to be three times higher in patients with diabetes, especially in women when compared to non-diabetic counterpart. Asymptomatic bacteriuria is the presence of bacteria in the urine presenting without any clinical symptoms of UTI. The objective of this review is to highlight the studies done on ASB in diabetes patients with special reference to Escherichia coli (E. coli), risk factors and its management. The review showed that increasing age, females, post-menopausal status, poor glycaemic control, long duration of diabetes, microalbuminuria, leukocyturia ,poor hygiene were associated with ASB. Available literature does not support the use of antibiotics, however short term trials have shown benefit with topical esteriol. Further clinical trials are needed.