Open Access Original Research Article

Subjective Global Assessment in Hemodialysis Patients in an Iranian Care Hospital

A. M. Dorri, B. Ebrahimzadeh Koor, M. R. Nakhaie

Journal of Advances in Medicine and Medical Research, Page 1-7
DOI: 10.9734/JAMMR/2017/25317

Background: The nutritional status of end stage renal disease (ESRD) patients is a critical index of effective health care delivery. Nutritional status can be estimated by subjective global assessment (SGA).

Aims: We assessed the nutritional status among hemodialysis patients in a governmental-owned hospital, from Northeast Iran.

Materials and Methods: Forty-eight randomly selected hemodialysis patients participated in a cross -sectional descriptive analytical study. We assessed SGA (dry weight, height, body mass index, triceps skinfold thickness, mid-arm circumference, mid-arm muscle circumference, and arm muscle area), along with several biochemical and anthropometric indices. Data were analyzed with the SPSS statistical package for Window version 11.0, Chicago, USA. A p-value of <0.05 was considered significant.

Results: Of the included patients, three people (6.3%) had “normal” nutritional status; twenty-four people (50%) were mildly malnourished, whereas twenty-one people (43.7%) had fallen into the “moderately” malnourished status. None of the patients had “severe” malnourishment. SGA scores had significant correlation with patients’ age (r=0.335,P=0.035), duration of dialysis (r= 0.332, P=0.031) and education level (r=-0.425 P=0.029). Patient's SGA did no differ by gender. Serum C-reactive protein and creatinine were not significantly associated with SGA score.

Conclusion: In this study, none of patients had severe malnutrition and most of patients had mild or moderate malnourished. Significant correlation were observed between SGA grades and biochemical and anthropometric variables, indicating the value of SGA to assess the nutritional status in hemodialysis patients

Open Access Original Research Article

Immunological Effect of Tramadol, Codeine, Flunitrazepam on Plasma Cortisol (Anti-inflammatory Agent), Cortisol Binding Globulin (Acute Phase Protein) and Total Bile Acid in Rabbits

Mathew Folaranmi Olaniyan, Donatus F. N. Ozuruoke, Joshua Seun Fapohunda, Temitayo Afolabi

Journal of Advances in Medicine and Medical Research, Page 1-8
DOI: 10.9734/JAMMR/2017/35432

Study Background: Flunitrazepam, Tramadol and Codeine are irrationally used as energy booster, psychoactives and as recreational drugs apart from their normal applications to relieve pains (Tramadol and Codeine), cough (Codeine) or as sedative (Flunitrazepam). High doses could induce inflammatory and acute phase responses.

Aim and Objectives: This work was designed to determine the Immunological Effect of low and High Doses of Tramadol, Codeine and Flunitrazepam on fasting Plasma Total Bile Acid, Cortisol(Anti-inflammatory Agent) and Cortisol Binding Globulin (Acute Phase Protein) in rabbits given normal and high doses.

Materials and Methods: The subjects include thirty five (35) male rabbits weighed 0.8 kg-1.3 kg. grouped into control (Group A; 5 rabbits on normal meal and water without drugs), 5 rabbits given 15 mg/kgBW of Tramadol per 24 hrs (Group B1), 100 mg/kgBW of Tramadol per 24 hrs (Group B2), 10 mg/kgBW of Codeine per 24 hrs (Group C1), 100 mg/kgBW of Codeine per 24 hrs (Group C2), 0.5 mg/kgBW of Flunitrazepam (D1) and 5 mg/kgBW of Flunitrazepam (D2). Early morning fasting Plasma Cortisol. Total Bile Acid (TBA) and Cortisol Binding Globulin were determined immunochemically by ELISA and spectrophotometry.

Results: The result obtained from this work showed a significantly lower plasma value of cortisol in rabbits given 100 mg/kgBW of tramadol per 24 hrs for 14 days and also in the rabbits given 100 mg/kgBW of Codeine per 24 hrs for 14 days compared with the control rabbits on normal meal and water without drug administration with p<0.05. There was a significantly lower plasma value of cortisol binding globulin in rabbits given 100 mg/kgBW of tramadol per 24 hrs for 14 days compared with the control rabbits and those given 15 mg/kgBW of tramadol per 24 hrs for 14 days with p<0.05.There was a significantlyhigher plasma value of Total bile acid  in rabbits given 100 mg/kgBW of tramadol per 24 hrs for 14 days than the rabbits administered with 15 mg/kgBW of tramadol per 24 hrs for 14 days and when compared with normal control rabbits with p<0.05. There was significantlyhigher plasma value of Total bile acid  in rabbits given 100 mg/kgBW of codeine per 24 hrs for 14 days than the rabbits administered with 10 mg/kgBW of codeine per 24 hrs for 14 daysand when compared with normal control rabbits with p<0.05.

Conclusion: High Doses of Tramadol (100 mg/kgBW) and Codeine (100 mg/kgBW) could trigger inflammatory responses which could alter the plasma levels of Total Bile Acid (TBA), cortisol (glucocorticoid anti-stress and anti-inflammatory hormone) and cortisol binding globulin (Cortisol storage protein and a negative acute phase protein). Measurement of cortisol and globulin binding globulin in those addicted to the drug will tremendously improve on the management of possible Tramadol and Codeine induced toxicity and inflammation.

Open Access Original Research Article

Prevalence of Nosocomial Infections in Hebron-Palestine Hospitals

Muna Salah, Rawan Zgheir, Razan Qadi, Haya Fakhory, Hiba Al-Aloul, Shorouq Sultan, Manar Jubeh, Orjowan Juneidi, Haniya Jubeh, Nour Sharawi, Yara Taha, Ghaida' Qasrawi, Bayan Abu-Hamdieh, Tarteel Maswadeh, Hana Mohtaseb, Fawzi Al-Razem

Journal of Advances in Medicine and Medical Research, Page 1-7
DOI: 10.9734/JAMMR/2017/35383

Background: Nosocomial infections, especially urinary tract infections, form a serious problem in hospitals, and are associated with increased mortality, morbidity, and prolonged hospital stay. In addition, the most infection rates occur at neonatal intensive care units (NICUs).

Aims: To investigate the prevalence of urinary tract infections in different clinical departments and to screen for the main pathogens that colonize and cause infection in infants in the NICU in order to provide a scientific basis for effective prevention and control systems for nosocomial infections.

Methods: This cross sectional study was conducted in three hospitals in Hebron. 81 urine samples were collected from the different clinical departments at the hospitals, and 79 swab samples from the throat, umbilical cord, nose, and eye were collected from neonates who were admitted to the NICU section in the three studied hospitals. All samples were cultured on Mac Conkey and human blood agar, and positive cultures were identified according to their morphology, gram stain, motility, and biochemical tests. Antibiotic susceptibility testing was performed using Kirby-Bauer’s disk diffusion method and interpreted according to Clinical & Laboratory Standards Institute guidelines 2016.

Results: Results from collected urine samples showed that 20% of patients carried infectious bacteria. Enterobacteriaceae pathogens were the most common in addition to Staphylococcus aureus, with 22% of Enterobacteriaceae isolates being Extended Spectrum β-lactamase (ESBL). Screening in NICU departments showed that infections were reported in 77.2% of samples, of which coagulase negative Staphylococcus formed 50%, Enterobacteriaceae formed 42%, and  S. aureus formed about 8% of the isolated pathogens. Almost 58% of the Enterobacteriaceae were ESBL producing, and all S. aureus isolates were methicillin resistant S. aureus (MRSA).

Conclusions: The data collected point to a high threat of healthcare associated infections in the hospitals studied and to the urgent need to establish effective infection control systems in Palestine based on standardized surveillance.

Open Access Original Research Article

Perception of Self-esteem and Body Image among Women with Breast Cancer of a University Hospital in Tunisia

Hela Ghali, Sirine Fendri, Ines Ayedi, Iheb Bougmiza, Asma Ammar, Imtinene Belaid, Njah Mansour, Nabiha Bouafia

Journal of Advances in Medicine and Medical Research, Page 1-12
DOI: 10.9734/JAMMR/2017/35567

Background: Breast cancer is a major public health problem. It represents the first female cancer which creates physical, psychological and social disorders.

Objectives: This study aimed to describe the perception of the self-esteem and the body image of women reached by breast cancer in the hospital of Habib Bourguiba of Sfax – Tunisia during three months.

Methods: It is a cross-sectional observational study. Two measure scales of beforehand designed and validated were administered to 125 patients treated for breast cancer: a scale estimating the body image according to Hopwood and a scale estimating the self-esteem according to Rosenberg.

Results: 79% of the investigated women had weak self-esteem and 62% had a distress of the body image. Our study also showed that there is a statistically significant correlation between the perception of the body image and the self-esteem. The presence of history of psychiatric pathologies (P=0,007) and alopecia (p=0,006) are statistically correlated to a body image distress. Civil status (p=0,025) and alopecia (p=0,014) statistically impacted the perception of self-esteem.

Conclusion: In order to improve the quality of life of women with breast cancer, healthcare professionals should take into consideration the psychological effect of the consequences of this disease.

Open Access Original Research Article

Prevalance of H63D and C282Y Mutation and Its Association with Iron Overload in Thalassemia Patients in an Eastern Indian Population

Anindya Dasgupta, Suparna Roy, Manali Sinharay

Journal of Advances in Medicine and Medical Research, Page 1-10
DOI: 10.9734/JAMMR/2017/35374

Aims: Iron overload in beta thalassemia is linked to different mutations in diverse population groups. Among them polymorphism of C282Y and H63D in the Hfe gene are particularly important. The present study was undertaken to evaluate the prevalence of the H63D and C282Y mutation and their effects on iron deposition in beta-thalassemia patients in our region having a high prevalence of the disease.

Study Design: Hospital based, observational, case control study in patients of beta thalassemia major.

Place and Duration of the Study: Department of Biochemistry of a medical college and hospital in Kolkata during April 2016 to April 2017.

Methodology: Cases were diagnosed for beta thalassemia major using HPLC. DNA was purified from whole blood in 210 cases and 104 controls and Hfe gene was studied for H63D and C282Y polymorphisms after amplification by PCR followed by restriction digestion using appropriate restriction enzymes. Allelic differences between two groups were assessed by chi square and odd ratio test. Any potential link between the polymorphic variations and iron deposition were assessed by post hoc ANOVA of serum ferritin levels among the three genotypes.

Results: For C282Y polymorphism, all 210 cases were homozygote for the allele. For H63D mutation, 16, 186 and 8 cases were heterozygotes (CG), homozygotes (CC) and of mutant variant (GG) respectively, the difference being insignificant between the case and control group (χ2 = 1.44, P= .486). Allelic difference of Gand C between the two groups were also insignificant (χ2 = 0.09, = .76; OR range of 0.72 to 1.98 at 95% CI). Post hoc ANOVA showed significant difference in the serum ferritin values between the GG and CC genotype and GC and CC genotype (P =.001)  in the case group.

Conclusions: Our study population was not at risk for iron deposition from the C282Y mutation. However, 92 percent of cases showed wild CC alleles for the H63D mutation that showed significantly higher amount of iron deposition. We suggest that this mutation has a higher penetrance in our study population suffering from beta thalassemia.

Open Access Original Research Article

A Pilot Study of Family Stigma in Alzheimer’s Disease: Slovenian Perspective

Jure Bele

Journal of Advances in Medicine and Medical Research, Page 1-14
DOI: 10.9734/JAMMR/2017/35029

Since the population of patients with AD is growing and the disease is affecting more and more people, the main goal of this paper was to investigate the process of stigmatisation of family caregivers, when a family member is facing Alzheimer’s disease (AD). The research consists of two parts. Since only a limited number of research and case study reports can be found in the literature, even though the stigma in the context of AD is widely assumed to exist in societies, first the bibliometric analysis was performed. In the second part the empirical research was conducted. Four hypotheses were tested. A pilot random sample consisting of 22 caregivers of family members – patients with AD, was formed. The standardised questionnaire (Werner et al. [1]) was used. Multidimensional variables of cognitive attributes, emotional reactions, caregivers’ stigma, lay persons’ stigma and structural stigma, were formed using exploratory factor analysis, based on KMO statistics and Bartlett test of Sphericity, with principal component analysis and Varimax rotation. Cronbach’s Alphas were used to test the reliability of measurement scales. To test hypotheses, correlations analysis was used (Pearson correlation), at 5% significance level. Four factors for cognitive attributes, five factors for emotional reactions, two factors for caregivers’ stigma, single factor for lay persons’ stigma and four factors for structural stigma were formed.Statistically significant correlations were identified. Bibliometric analysis showed that the research topic of Alzheimer’s disease and caregivers’ variety of problems is an important topic worth researching. The factor analysis and correlation analysis revealed that there are several statistically significant correlations between the multidimensional factors of cognitive attributes, emotional reactions and the three aspects of stigma (caregiver stigma, lay persons’ stigma, structural stigma). The limitations as well as possible continuation of the research are also presented.

Open Access Original Research Article

Dearth of Haematologists in Nigeria: Unfriendly Specialty among Medical Students in Niger-Delta Region of Nigeria

Nwagu Marcellinus Uchechukwu, Borke Moghene Emona, Ologbo Thompson

Journal of Advances in Medicine and Medical Research, Page 1-6
DOI: 10.9734/JAMMR/2017/35658

Background: There is continuous rise in haematology and haemato-oncology cases in Nigeria. Unfortunately, there is inadequate number of haematologists to care for these rising cases despite the high number of medical doctors being churned out by over twenty medical schools in Nigeria.

Object: The aim of this study is to find out the preference rate of Haematology among medical students in a typical Nigerian medical school.

Methodology: Questionnaires were used to collect data from medical students who met the inclusion criteria. The collected data were analyzed using Statistical Package for the Social Sciences (SPSS) software version 22. Results were presented in Frequency distribution tables and pie charts.

Results: Three hundred and thirty-one students were interviewed. The mean age was 23.47±3.92 years. Male medical students were more than the females: 193(62.1%) versus 118(37.9%), respectively, giving a male to female ratio of 1.63:1. Urhobo, 144(46.3%) and Igbo, 67(21.5%) were the two major tribes of the students. Others were the Isokos 31(10%), the Ukwuanis, 16(5.1%), and the Binis 11(3.5%). One hundred and eighty two students (58.5%) attended private

schools, 116(37.3%) attended public schools while the remaining 13 students (4.2%) attended the mission schools. Two hundred and eighty two students (91%) said they would specialize while the remaining 29(9%) said they will not specialize after graduation. Surgery was the most preferred choice (23.5%), followed by Obstetrics and Gynecology (13.2%), Internal Medicine (11.9%), Family Medicine (10.9%) and Paediatrics (9.0%). Twelve point nine percent of the students have not decided which specialty they would choose. The choice to specialize in Haematology was 1.9%.

Conclusion: This study showed that the preference of haematology as a specialty for specialization was abysmally too low. Haematology should be made to be more interesting and appealing to the students. There is need for re-structuring and re-organization of the medical training to increase the student-patient interaction during the students postings in haematology.