Open Access Original Research Article

Incidence and Outcomes of Community Acquired Pneumonia in Patients with Chronic Obstructive Pulmonary Disease at King Abdulaziz Medical City, Riyadh

Sreekanth Mohan, Maryam Almutairi, Roaa Alnaimi, Taif Alshehri, Winnie Philip, Yassin Ismaiel, Taha Ismaeil

Journal of Advances in Medicine and Medical Research, Page 1-7
DOI: 10.9734/jammr/2019/v29i1030128

Aims: The aim of the study was to estimate the incidence of Community-acquired pneumonia (CAP) among patients with chronic obstructive pulmonary disease (COPD).

Study Design:  A retrospective cohort study.

Place and Duration of Study: King Abdulaziz Medical City in Riyadh between January 2016 to March 2018.

Methodology: From the medical file, we identified patients with COPD diagnosis who admitted to the hospital. Then we identified the patient who develop CAP after the diagnosis date of the COPD. Other variables such as demographic factors, clinical outcome, comorbidity disease, length of stay in the hospital, and mortality were identified for each patient using their electronic medical file.

Results: Out of 363 COPD patients, 122 (33%) had developed CAP after the date of COPD diagnosis.  Based on patient characteristics, the mean age of them was 75.39 years SD was 9.76 and 65% of the patients were female. The available evidence indicates that the mortality rate was n=22 (18.0%). Among those patient, 33 patients were admitted to ICU (27.0%) the rest of patients either wards n= 59 (48.4%) or both n=28 (23.0%). Among our study population, 97.4% had hypertension, 88.6% of the patients had diabetes, and 28.9% had renal failure.  Majority of the study population have been placed on non-invasive ventilation n=94 (77.0%).

Conclusion: This study has been shown that COPD patients had increased risk of CAP. Patients who have multiple comorbidity diseases and got CAP with COPD have a higher risk of morbidities and mortality rate, especially elderly patients.Mention the design of the study here.

Open Access Original Research Article

Asymptomatic Bacteriuria and Candida Colonization among Pregnant Women in a District Hospital in Eastern Uganda

Bakandonda Fredrick, Muwanguzi Shadrack, Nakate Prossy, Opolot Ismail, Imongit Sam, Nnakanwagi Mariam Mirembe, Nteziyaremye Julius, Rebecca Nekaka, Iramiot Jacob Stanley

Journal of Advances in Medicine and Medical Research, Page 1-10
DOI: 10.9734/jammr/2019/v29i1030130

Background: Urinary tract infection (UTI) is the most common reason for which antimicrobials are prescribed in pregnancy Worldwide. This study aimed to determine the prevalence of asymptomatic bacteriuria, Candida colonization and antimicrobial susceptibility patterns among pregnant women attending antenatal in a District Hospital in Eastern Uganda.

Materials and Methods: A descriptive cross sectional study was conducted in which pregnant mothers who had come for routine antenatal care were counseled and their consents obtained before taking off urine samples for laboratory diagnosis. For those samples found to have pus cells, culture and sensitivity test was done to identify the organisms and determine susceptibility to particular antibiotics and antifungal agents.

Results: Gram negative isolates were more sensitive to meropenem (100%), and ciprofloxacin (93.8%) but less sensitive to trimethoprim/sulphurmethoxazole (20%), Ceftazidime (7%), and Cefepime (6%). Gram positive isolates were more sensitive to vancomycin (100%), meropenem (87%) and linezolid (88.1%) but less sensitive to Cefotaxime (31%) and Trimethoprim / sulphurmethoxazole (14%). All bacteria isolated in this study were multi-drug resistant (MDR). All Candida isolates were susceptible to Econazole and Nystatin whereas all isolates were resistant to Griseofulvin.  

Conclusion: The prevalence of asymptomatic bacteriuria among pregnant women in Butaleja district is high with many of the bacteria isolated exhibiting resistance to the commonly used antibiotics. Antifungal resistance was common in this study.

Open Access Original Research Article

Group B Streptococcus Colonization in Pregnancy: Prevalence, Determinants and Antibacterial Susceptibility Pattern in Sagamu, Nigeria

Adebayo A. Akadri, Bamidele D. Osuolale, Tessie O. Shorunmu, Oluwaseyi I. Odelola

Journal of Advances in Medicine and Medical Research, Page 1-8
DOI: 10.9734/jammr/2019/v29i1030131

Aims: To establish the prevalence, determinants and the antibiotic susceptibility pattern of Group B streptococcus in pregnant women in Sagamu, Ogun State, Nigeria.

Study Design: Prospective cross-sectional study

Place and Duration of Study: The study was carried out at the antenatal clinic at Olabisi Onabanjo University Teaching Hospital, Sagamu, Ogun State, Nigeria, between July 2017 and December 2017.

Methodology: The study involved 184 pregnant women attending antenatal clinic. Lower vaginal and rectal swabs were collected under aseptic condition and immediately sent to the laboratory for processing. The samples were assayed for the presence of group B streptococcus using conventional methods. Information on the socio demographic characteristics and details of delivery were recorded on a data capture sheet.

Results: The prevalence of Group B streptococcus was 27.7%. The odds of Group B streptococcus colonization was significantly higher among women of low parity (≤ 2) and binary logistic regression analysis showed that parity was predictive of Group B streptococcus colonization (OR 3.7; 95% CI = 1.03-13.46; P=.045). Younger women (age ≤ 30 years) and women carrying term pregnancies had a non significant trend towards higher odds of Group B streptococcus colonization [(OR= 1.22, 95% CI: 0.6-2.3, P = .54) and (OR=1.6, CI: 0.8-3.2; P = .15) respectively]. The resistance of group B streptococcus isolates to penicillin and ampicillin was 39.2% and 37.3% respectively.                          

Conclusion: The group B streptococcus colonization rate in this study is high. Factors such as low parity, young maternal age and term pregnancies are associated with increased odds of colonization. The emergence of resistance to the commonly prescribed antibiotics calls for re-evaluation of the current recommendations regarding the antibiotics prophylaxis.

Open Access Original Research Article

Assessment of Knowledge and Practice about Self Expressed Breast Milk among Saudi Mothers in Jazan Region, KSA, 2016

Karimah Mohammad Qutah, Safar A. Alsaleem, Abdullah Ahmed Najmi, Muteb Bawwah Zabbani

Journal of Advances in Medicine and Medical Research, Page 1-11
DOI: 10.9734/jammr/2019/v29i1030132

Aim: To assess mother's knowledge and attitude regarding self-expressed milk in Jazan, Saudi Arabia.

Methodology: Study Area: An observational and cross sectional study done in Obstetric Department (Well Baby and immunization Clinics) in King Fahd Central Hospital (KFCH), Jazan, Saudi Arabia and in six PHCCs in Jazan (randomly selected) from  December 2016 - March 2017.  Pregnant women who delivered babies before and post-partum women in Obstetric departments, Obstetric outpatient clinic, mother’s in well baby, and immunization clinics in mentioned areas were included in the study. Stratified multistage sampling techniques were used.  N = 499 Saudi mothers calculated according to survey system with confidence level % 95.  The questionnaire was self-administering questionnaire (in Arabic language).  All data processed via Statistical Package for the Social Sciences (SPSS) version 19. Shapiro-Wilk test. Kruskal-Wallis test used to see the association between level of knowledge and practice with demographic variables that contains more than 2 variables. Mann-Whitney test and Spearman correlation were used.

Results: Total of 499 mothers was participating aged 30±7 years with mean number of kids 2.98 ± 2. Mothers heard about self-expressed breast milks accounts 73.5% and 236 mothers of them were practice it. Both level of knowledge and practice accuracy were inadequate. Around one third of mothers heard about it from social media. More than third of the women practice it because of work related issues. The higher the educational level was the higher knowledge (p<0.001). Age and number of kids, has no statistically significant effect on the knowledge level (P = 0.417, 0.285).  Working mothers have higher knowledge level than house wife and students (p<0.001), nurses especially who toke breast feeding teaching have higher knowledge level than physicians then teachers (p<0.001). Mothers who toke their knowledge from breast feeding courses have the highest knowledge level followed by medical stuffs other than physicians followed by social media and internet websites then physicians then mothers and last are friends (p<0.001). Mothers with more accurate practice were more knowledgeable than mothers with less accurate practices (p<0.001).

Conclusion: Mothers knowledge and practice regarding self-expressed breast milk needed to be improved in order to give the babies better chance for exclusive breast feeding. Breast feeding courses for mothers give better results in term of accuracy of mother’s knowledge and practice of expressed breast milk.

Open Access Original Research Article

Comparative Evaluation of Golden Proportion, Recurring Esthetic Dental Proportion and Golden Percentage in Himachal Demographic

Vishwas Mahajan, Archana Nagpal, Rajeev Gupta, Sharad Vaidya, Farhat Jabeen, Kusha Thakur

Journal of Advances in Medicine and Medical Research, Page 1-7
DOI: 10.9734/jammr/2019/v29i1030133

Aim: The purpose of this study was to comparatively evaluate the validity of Golden Proportion, Recurring Esthetic Dental (RED) proportion and Golden Percentage in maxillary anterior teeth in population of Himachal Pradesh.

Methods and Materials: Dentulous stone casts of maxillary arch were made of the subjects who met the inclusion criteria. Conditions for inclusion criteria included that the individuals:

1) should be of Himachali origin with agreeable smiles

2) have well aligned anterior dentition

3) should be between age group of 20-40 years

Total of 200 students representing Himachal Pradesh population were included. Measurements were done for the spaces in the grids using the digital caliper.

Results:

  • The Golden Proportion ratio of 1.3 and 1.4 were more commonly observed in 27.5% and 40% respectively than 1.618 which was observed in 5.5% under study of the population.
  • A Paired sample t-test showed there was no significant gender based difference in Lateral/Central incisor Red Proportion. (P-value>0.05) except for the Canine/Lateral Red Proportion. (P-value<0.05).
  • The Golden Percentage for males in central and lateral incisors and canine was 22.48%, 15.96% and 11.08% respectively. The mean value for females in central and lateral incisors and canine was 22.72%, 16.25% and 10.97% respectively.

Conclusions: Golden percentage could be used for aesthetic correction and was found to be more applicable in the population included in this study. Golden percentage could be used for aesthetic correction and are more applicable to natural dentition in the population of Himachal Pradesh.

Open Access Original Research Article

Susceptibility Weighted Imaging in Acute Stroke with Co-morbids: Magnetic Resonance Imaging Protocol Revisited

Fatima Mubarak, Muhammad Danish Barakzai

Journal of Advances in Medicine and Medical Research, Page 1-8
DOI: 10.9734/jammr/2019/v29i1030134

Introduction: We aim to investigate ischemic penumbra using Diffusion weighted imaging- Susceptibility weighted imaging mismatch using DWI Alberta Stroke Program Early Computed tomography Stroke Score scoring in patients with multiple co morbid.

Methods: From January 2011 to December, 2017; 70 consecutive patients (50 men, 20 women; mean age 64.5; range 45-82 years) with acute infarct on Diffusion weighted imaging (DWI) were selected for the study. Stroke protocol performed including DWI and susceptibility weighted imaging (SWI) on first day and repeat within three days. All initial MR images were interpreted by one Neuroradiologist with more than ten years blind to the clinical findings of each patient. The definition of an acute infarct area was high signal intensity on DWI with dark signal intensity on Apparent diffusion weighted imaging (ADC). The infarct extent was scored using the Alberta Stroke Program Early CT Score (ASPECTS) system. Infarct growth was defined as any new or larger lesion on the second DWI.

For correlation with infarct growth, the same topographic system was used to record the extent of the Prominent vessel sign (PVS) on SWI.

Spearman’s rank correlation test was used to examine the correlations between PVS score and infarct growth score. Regression was computed, with P<0.05 considered significant.

Results: The study included 12 women and 10 men, (mean age 67.1 years).

MRI images were initially acquired as stroke protocol (mean 12 hours) in acute stage and the next MRI was done within 3 days after the acute stage.

9 patients had right sided and 13 patients had left sided MCA territory infarct, the mean DWI-ASPECTS score was 4.3 (range 0–9).  PVS was detected in 15 patients (mean score 4.1, range 0–10).

Out of 22 patients 9 patients showed no evolution in infarct however in 13 patients evolution was from (ASPECTS mean score 3.95, range 0–9; mean infarct growth score 7.4, range 0–10).

7 patients devoid of PVS in initial MRI, did not exhibited evolution of infarction. Of 15 patients with PVS on initial MRI, 13 (87%) had infarct growth. Correlation between the evolution in infarct size and PVS score was observed (r = 0.86, P<0.001).

Conclusion: PVS seen in infarcted territory is related to poor prognosis and this can be reliably used as a surrogate marker of oxygen extraction in penumbra.

SWI can predict tissue at risk and can be a replacement for perfusion scan in clinical scenerio of acute ischaemic infarct.

Open Access Original Research Article

Opinions of Pregnant Womens Intended to Male Midwives

Nursen Bolsoy, Selma Sen, Seval Cambaz Ulas, Seçil Köken Durgun

Journal of Advances in Medicine and Medical Research, Page 1-8
DOI: 10.9734/jammr/2019/v29i1030137

Aim: The study was conducted to determine opinion of pregnant women about their gender preferences related with midwife profession.

Methods: The study was conducted in cross-sectional and descriptive type. Whereas the research universe was consisted of 2954 pregnant women,the sampling group was including 384 pregnant women. The study was conducted in three randomly-selected Family Health Centers under the jurisdiction of the Manisa Public Health Directorship. The questionnaire consisted of 42 questions, developed by the researchers was harnessed in data collection process. In analysis process of the collected data, mean, percentage and chi-square methods were utilized.

Results: It was determined that although 52.2% of pregnant women agree with the opinion that both women and men could participate in childbearing operation; 97.9% of women preferred to have service from a midwife; and 98.4% preferred to have assistance from a woman midwife. When descriptive characteristics of pregnant women and their opinions regarding gender preferences in midwifery are compared, it was determined that whereas no any statistically significant difference was determined with age, education status, marital status, longest residential place, social security and family types of pregnant women (p>0.05); a statistically significant difference was determined with their employment status, one of their descriptive characteristic (p<0.05).

Conclusion: Whereas majority of pregnant women agree with the opinion that men could be midwife; when it comes to receiving service from midwife during delivery, almost all of them preferwomen midwives. Therefore, if key role of midwives in enhancement of public health are taken into consideration, childbearing, pre- and post-partum care services are especially required to be provided by women midwives.

Open Access Review Article

Assessment of Blood Donation Safety by People Diagnosed with Diabetes, Hypertension, Malaria and Cancer

Demeke Ashencho Debecho, Alemayehu Hailu

Journal of Advances in Medicine and Medical Research, Page 1-8
DOI: 10.9734/jammr/2019/v29i1030136

The present review aims to assess the blood donation safety by people suffered from diabetes, hypertension, malaria and cancer. Diabetes, hypertension, malaria and cancer have become common health problems in human society. Cases of blood transfusion-transmitted malaria, hypertension, cancer and the safety of blood donation by diabetic people have been described around the world and highlighted in some studies. Diabetes is generally associated with complications and people with diabetes usually take different medications and may already have anaemia secondary to renal impairment, B12 deficiency. As for the recipient safety, a blood from a person with hyperglycaemia but otherwise healthy i.e. satisfy blood donation safety standards (no record of HIV, Hepatitis B or C) would be quite safe to receive as the extra glucose would simply be regulated and utilised by the recipient's body. Hypoglycemia is as bad as hyperglycemia and could be fatal and hence, generally, it is not desired that diabetics give blood donations. Diabetic patients taking bovine or porcine insulin may develop antibodies and it is not recommended that the antibody contaminated blood to be given to any other person. A person with hypertension can donate blood, as long as the blood pressure is normal at the time of blood donation and there’s no fluctuation. Malaria is also readily transmitted by blood transfusion through donations collected from asymptomatic, parasitaemic donors. The parasite is released into the bloodstream during its lifecycle and will, therefore, be present in blood donated by infected individuals. The presence of total anti-Plasmodium spp. antibodies in the bloodstream of individuals many years after exposure, with no history of malaria in the meantime, is important to highlight. Regarding donors with cancer blood donations should not be taken from people with recently active malignancies, except in the case of basal cell carcinoma or cervical carcinoma in situ.