Clinical Medicine Research

ISSN Online: 2326-9057 ISSN Print: 2326-9049

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Volume 3, Issue 2, March 2014

  • Authors: Alassan K. Mahassadi, Emile Allah-Kouadio, Constant Assi, Fulgence M. Y. Bathaix, Ahmad Coulibaly, Hortense Hovi, Mathieu B. Camara, Thérèse Y. Ndri

    Abstract: Background: The high burden of viral hepatitis B (HBV) remains a challenge in Côte d’Ivoire where patients are mostly seen in hospital at the end stage of the disease. Aim: This cross sectional study is aimed at assessing the usefulness of anamnestic findings, clinical and biological factors in predicting chronic hepatitis B surface antigen (HBsAg) carriers in clinical practice. Patients and methods: The study was conducted in 230 workers (median age: 39 years, female: 20%) of government press enterprise (GPE) in 2010. Socio-demographic, clinical and biological parameters were collected. Chronic HBsAg carrier was defined as serum HBsAg positivity after 2 assessments within 6 months interval. Diagnostic accuracy of predictive factors was determined by multivariate logistic regression. Results: The prevalence of chronic HBsAg was 12.6% [95%CI: 8.61-17.60]. Chronic HBsAg carriers frequently expressed a history of hepatitis (13.8 vs 2.5%, p=0.003), or jaundice (37.9 vs 14.3, p=0.003), had slightly high level of AST (33 vs 25.5 IU/L, p=.004) and ALT (31.5 vs 22, p=<0.0001) compared to non-carriers. In multivariate analysis, age (OR: 0.93, p=0.03), history of hepatitis (OR=8.18, p=0.005), unsafe injection with boiled syringe (OR: 3.41, p=0.03), and ALT (OR=1.03, p=0.002) were predictive factors of chronic HBsAg carriers. The model yielded an AUROC of 0.793±0.06. With a cut-off <0.125, the model allowed predicting chronic HBsAg carrier with a sensitivity and negative predictive value of 78.6 and 96.1% respectively. Among 28 chronic HBsAg carriers 22(78.6%) were correctly predicted and 6(21.4%) were false negative. With a cut-off >0.5, the model showed a specificity, positive and negative predictive values of 99, 66.7 and 88.9% respectively. The model correctly classified 192(99%) workers as non-chronic HBsAg carriers and 2(1%) were misclassified. Conclusion: This study suggests that age, history of hepatitis, unsafe injection with boiled syringe combined with ALT could be used to predict chronic HBsAg carrier in Côte d’Ivoire and other endemic areas in Africa.

    Received: Jan. 4, 2014 Accepted: Published: Feb. 20, 2014

    DOI: 10.11648/j.cmr.20140302.11 View: Downloads:

  • Authors: Sukdeb Biswas, Kaushik Ghosh, Sisir Chakraborty, Rajdip Hazra, Rabindra Nath Biswas, Susmita Ghosh, Kaushik Das, Niladri Sarkar

    Abstract: Introduction: Cervical lymphadenoparthy is a common presentation of many diseases, though it is mostly tubercular in origin in developing countries. This cross sectional study was done to corroborate fine needle aspiration cytology (FNAC) findings with histopathological examinations (HPE) in cervical lymphadenopathy. Materials and methods: 120 patients of both sexes attending the FNAC unit of Nilratan Sircar Medical College and Hospital, Kolkata were enrolled in this study. They were evaluated by thorough clinical examination followed by routine investigations, FNAC and histopathological examination (HPE). Results: There was maximum corroboration of FNAC and HPE reports in tubercular lymphadenitis (76 v/s 76) and Hodgkin’s disease (2 v/s 2) followed by metastatic carcinoma (20 v/s 16) and non specific lymphadenitis (14 v/s 5) respectively. Overall correlation was 88.4% (excluding 8 cases where FNAC results were inconclusive due to unsatisfactory smear). The sensitivity, specificity, positive predictive value and negative predictive value of FNAC to diagnose tubercular lymphadenopathies were 86.36%. 100.0%, 100.0% and 72.73% respectively. In case of metastatic CA, these were 100.0%, 96.15%, 80.0% and 100.0% respectively. Conclusion: FNAC is simple, safe, quick, cheap, acceptable yet accurate method of establishing the etiology in cases of cervical lymphadenopathy.

    Received: Jan. 6, 2014 Accepted: Published: Feb. 20, 2014

    DOI: 10.11648/j.cmr.20140302.12 View: Downloads:

  • Authors: Esat Korgali, Mustafa Gökhan Gözel, Emin Yener Gültekin, Mustafa Zahir Bakici, Semih Ayan, Gökhan Gökçe

    Abstract: Background: Urinary tract infections (UTIs) in men are considered complicated, however few studies support this view. We compared the differences in the causative microorganism and their antimicrobial resistance between male and female patients presenting with an UTI. Methods: We evaluated the all microorganism isolated from the urine samples of patients which were admitted to outpatient clinics of our hospital during 2006 – 2011, which diagnosed with uncomplicated community acquired UTI. Results: Totally 8730 bacterial strains were isolated. Of these strains 5168 (59.2%) were isolated in women, whereas 3562 (40.8%) were isolated in men. Escherichia coli was the most frequently isolated microorganism (64.4%), followed by other enterobacteriaceae (15.1%) and enterococci (17.8%). However, the frequency of E. coli in men was significantly lower than in women, and frequency of other enterobacteriaceae and frequency of enterococci were higher than in women (49.4% versus 74.7%, 21.2% versus 10.8%, 24.7% versus 12.9%, respectively, p=0.001). The distribution of microorganism was evaluated according to age groups, similar results were observed in all age groups. In addition, E. coli, the most common strains for both sex. E. coli strains isolated in men were significantly less sensitive to ampicillin, ampicillin/sulbactam, cefuroxime, ceftriaxone, trimethoprim-sulphamethoxazole, gentamicin, ciprofloxacin, nitrofurantoin and fosfomycin than in women (p<0.05). Conclusion: The distribution of bacterial species isolated from urine culture of UTI is different in men. Even though E. coli is the most common strains in men as in women. In addition E. coli strains isolated in men were more resistant to antibiotics.

    Received: Jan. 22, 2014 Accepted: Published: Mar. 10, 2014

    DOI: 10.11648/j.cmr.20140302.13 View: Downloads:

  • Authors: Sami Küçükşen, Yılmaz Halim, Ali Yavuz Karahan, Sinan Bağçacı

    Abstract: In this study we assessed the prevalence of depression and its relevance to pain intensity, functional status (health related disability) and radiographic severity in older adults with knee osteoarthritis (OA).One hundred and thirty-eight elderly (sixty-five years or older) patients with knee OA and 82 age and sex matched healthy controls were included into the study. Beck depression scale was used to assess depressive disorders in all participants. The pain intensity, functional status and radiographic severity in patients were assessed with a Visual Analogue Scale (VAS), the Western Ontario and Mc-Master Universities Osteoarthritis Index (WOMAC), and the Kellgren-Lawrence grading system,respectively. Depression was detected in 49.3% of patients and 12.3% of controls. In patients group whose BDI scores were ≥17, the scores of VAS, WOMAC, and radiographic severity were found to be statistically significantly higher, compared to the group whose BDI scores were <17. A positive correlation was detected between BDI score and VAS, WOMAC and radiological classification scores in patients with knee OA. In linear regression analysis, the most significant determinant for the level of depression was WOMAC score. The present study shows that depression is a commonly encountered comorbidity in older adults with knee OA. The level of depression was correlated with the severity of the disorder, especially in patients whose WOMAC score was high. Therefore, coexisting depression should be taken into account in the assessment and management of older patients with knee OA.

    Received: Feb. 17, 2014 Accepted: Published: Mar. 10, 2014

    DOI: 10.11648/j.cmr.20140302.14 View: Downloads:

  • Authors: Ramyil, Mamzhi-crown Seljul, Ogundeko, Timothy Olugbenga, Idyu, Iorkyase Isaiah, Ameh, Joshua Momoh

    Abstract: Background: Enteric fever caused by salmonella typhi is an endemic disease in the tropics and sub-tropics; and has become a major public health problem in developing countries of the world. Presently, cultures of Stool and blood are the most diagnostic means of confirming salmonellosis in humans. However, the stool and serum sample of an infected patient against the somatic (O) and flagella (H) antigens of the bacteria requires thorough laboratory analysis. This study was biased on the use of stool culture as a confirmatory analysis of typhoid fever indices in the region of research particularly among adolescents (18 yrs and above). Methods: 60 adults attending Bingham University Teaching Hospital with symptoms clinically suspected to be enteric fever were randomly selected. Informed consent of volunteers was obtained in 48 patients and stool specimens collected and were cultured. Stool specimens were processed using isolation method and biochemical characteristics of susceptibility testing of typhoid fever from the individual patient. A significant mean difference of male and female that were affected by enteric fever was determined. Results: Results obtained from a total number of 48 patients (32 male and 16 female) indicated 12 positive stool cultures among which 10 were males and 2 were females (31.25% and 12.5%) respectively. Salmonella was found to be susceptible to Offloxacin, Ciprofloxacin, Ceffraxole and Cefuroxime respectively; thus constituting the choice drugs in the treatment of enteric fever. Conclusion: Result showed that a significant mean difference between the number of affected patients and those not affected (P.v = 0.0521) authenticates stool culture as confirmatory test for enteric fever as against clinical diagnosis. Salmonella enterica showed more resistance to some commonly used drugs. Therefore, sensitivity testing based on prescription is recommended to prevent continuous drug resistance development. Results further showed that men were more affected than women; however, a suggested area to explore in the study of enteric fever infections.

    Received: Jan. 31, 2014 Accepted: Published: Mar. 20, 2014

    DOI: 10.11648/j.cmr.20140302.15 View: Downloads:

  • Authors: Ibrahim Keles, Cavit Ceylan, Erdogan Aglamis, Hasan Salih Saglam, Mustafa Karalar, Soner Coban, Sait Bicer, Oztug Adsan, Mehmet Ozgur Yucel

    Abstract: Purpose: To research association between Mean Platelet Volume (MPV) and tumor stage and grade in non-metastatic renal cell carcinomas in circumstances of hypoxia, thromboembolism, and ischemia, based on MPV increase. Material and methods: Data of 104 non-metastatic patients, in whom nephrectomy was done and whose pathology resulted in renal cell carcinoma, have been evaluated retrospectively. The patients were clinically classified as T1a, T1b, T2a, T2b according to TNM stage and as Fuhrman Grade 1, 2, 3, 4 according to pathology results. Preoperative mean platelet number and MPV values of the patients were compared with their tumor stage and grade. Results: Sixteen (15%) were in T1a, 41 (39%) were in T1b, 39 (38%) were in T2a, and 8 (7%) of the patients were in T2b clinical stage. According to pathology results, 21 (20%) were assessed as Fuhrman grade I, 59 (57%) were grade II, 22 (21%) were grade III, and 2 (2%) of the patients were grade IV. Mean MPV values were 8.50±1.39, 8.51±1.25, 8.65±1.12, and 8.95±0.07 in Grade I, II, III, IV, respectively. A positive correlation was present between mean MPV and grade (r= 0.052, p=0.599). As long as grade increases, mean MPV values were observed to increase. However, no statistically difference was determined between tumor grade and mean MPV and platelet (p values: 0.935 and 0.963, respectively). No statistically significant difference was detected between tumor stage and mean MPV and platelet (p values: 0.996 and 0.397, respectively). Conclusion: A positive correlation was observed to be between mean MPV values and tumor grade. However, no statistically significant difference was determined. It can be supported with the larger series that MPV for renal tumors, that is rapidly and expansively growing tumor, can be an effective biochemical indicator in early diagnosis, staging, and evaluation of response to treatment.

    Received: Mar. 3, 2014 Accepted: Published: Mar. 30, 2014

    DOI: 10.11648/j.cmr.20140302.16 View: Downloads:

  • Authors: Arzu Ataseven, Aynur Ugur Bilgin, Gulcan Saylam Kurtipek, Perihan Ozturk, Nursel Dilek, Huseyin Ataseven

    Abstract: Objective: The aim of this study is to assess the neutrophil lymphocyte ratio (NLR) as an inflammatory marker in patients with psoriasis and to compare it with healthy subjects and to evaluate the correlation with the severity of the disease. Methods: 104 psoriasis patients and 70 healthy persons were included as the control group. The laboratory results were recorded retrospectively from the patients’ files and controls. NLR was calculated by the division of the neutrophil count to the lymphocyte count in the hemogram test. The dermatologic examinations and psoriatic area severity index (PASI) scoring were performed by the same dermatologist. Results: Leukocyte, neutrophil, NLR levels of the psoriasis patients were significantly elevated compared to those of the control group (p<0.05, p<0.01 and p<0.01 respectively). There were no correlation between NLR and PASI score (p>0.05) in the patient group. Conclusions: NLR, an emerging marker of inflammation, is higher in patients with psoriasis.

    Received: Mar. 2, 2014 Accepted: Published: Mar. 30, 2014

    DOI: 10.11648/j.cmr.20140302.17 View: Downloads:

  • Authors: Amin M. Abdel Baki, Nashwa A. Zaky

    Abstract: Background: The world Health Organization has declared hepatitis C a global health problem, with approximately 3 % of the worldﹶs population. HCV infection was associated with a high risk of CHD. Hs-CRP and fibrinogen was considered as markers of coronary artery disease, their elevation correlated with incidence of CAD, However Apo A deficiency predict future risk of CAD. Aim: To study correlation between HCV infections and marker risk factors of coronary heart disease in different stages of liver disease. Patients & Method: Forty three chronic HCV patients were recruited at specialized hepatology clinic in National Hepatology and Tropical Medicine Research Institute (NHTMRI),Cairo; they were classified into 3 groups according to Child – Pugh score (A, B, C), 42 % were Child class A, 28 % Child B and 30 % Child C, age from 20 to 80 years. 15 healthy subjects served as control group. Detection of the following tests occurred for both groups: Liver function tests: ALT, AST, ALP, total protein, albumin, bilirubin, GGT and AFP. Ultra sensitive CRP, fibrinogen, apoprotein A and Lipid profile: Total Cholesterol, triglyceride, HDL-C, LDL-C, and Total Lipid. Results: the data obtained from results show that :liver enzymes AST, ALT, total bilirubin, albumin, total protein and INR levels were significantly different between groups and control (p< 0.05), Alkaline phosphates, GGT and AFP levels were not differing significantly in study groups and control (p> 0.05). Cardiac enzymes; CK and LDH levels were not significantly different between groups and control (p> 0.05). The APO A levels were not differs significantly in study groups and controls (p> 0.05). The fibrinogen andhs-CRP levels in the patients appeared to be significantly higher than those in the healthy controls (p< 0.05). Conclusion: hs-CRP and fibrinogen may be considered as a CHC progression prognostic factor, Evidence indicates that hepatitis C virus (HCV) have a key role in coronary heart disease.

    Received: Jan. 25, 2014 Accepted: Apr. 8, 2014 Published: Apr. 10, 2014

    DOI: 10.11648/j.cmr.20140302.18 View: Downloads:

  • Authors: Hernandez-Bastida, Antonio, Meixueiro-Montes de Oca, Raúl

    Abstract: Use of biosimilars has allowed the access to biopharmaceuticals to a more patients in the World. Insulin galrgine is an analogue of human insulin to provide consistent level of plasma insulin over a long duration. The aim of this study was compare the safety and efficacy of insulin glargine biosimilar vs reference in individuals with type 2 diabetes. One hundred two type 2 diabetic individuals (64 female and 38 male) were studied in a single center, randomized, comparative study. The patients received during 12 weeks insulin glargine biocomparable or reference at doses of 0.4 to 0.7 IU/kg/day by subcutaneous via. Glycosylated hemoglobin (Hb1Ac), Fasting blood glucose (FBG), and lipid profile were evaluated during the study. Health-related quality of life was evaluated using the 36-item Short Form questionnaire. Hb1Ac, FBG and lipid profile improved significantly from to start to endpoint in both groups. No significant differences were found between both groups. A total of 80.8 and 77.2% of patients had HbA1c < 7.5% and 66,6% and 69.5% achieved the FBG target, for reference and biosimilar insulin glargine, respectively. No significant reductions in body weight were observed between the start and the end of the study. The adverse event more reported was hypoglycemia. There was no apparent association between the levels of cross-reacting antibodies and Hb1Ac, body weight, insulin dose, or hypoglycemic episodes Improvements in both mental and physical health status were found, but no differences significant were found between the groups. We conclude that insulin galrgine biocomparable was similar since the safety and efficacy point of view with insulin glargine of reference in patients with diabetes mellitus 2

    Received: Mar. 14, 2014 Accepted: Apr. 9, 2014 Published: Apr. 20, 2014

    DOI: 10.11648/j.cmr.20140302.19 View: Downloads:

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