Clinical Medicine Research

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

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Volume 4, Issue 5, September 2015

  • Author: Toshimasa Nakada

    Abstract: Appropriate therapy during the acute phase of Kawasaki disease to prevent large coronary artery lesions (CAL) has not been established. The aim of this retrospective study was to investigate the usefulness of an initial single intravenous immunoglobulin (IVIG) therapy. In this study, I included a total of 200 pediatric patients who had received 2g/kg/day IVIG therapy for Kawasaki disease between 1999 and 2015 at the Department of Pediatrics, Aomori Prefectural Central Hospital. An initial IVIG therapy starting on day 5 was used as first-line therapy when possible. The second-line therapy was additional IVIG therapy, and the third-line therapy was an urinastatin infusion or plasma exchange. All patients received an initial single IVIG therapy with delayed or with concomitant administration of aspirin or flurbiprofen. Initial IVIG therapy resistance occurred in 48 of 200 patients (24%), and 17 patients (9%) received additional IVIG therapy. Four patients received urinastatin and one patient received plasma exchange as the third-line therapy. Before the 30th day, the prevalence of CAL was 5% (10/200); after 30 days, it was 2% (4/200). The maximal internal CAL diameter was 4.8 mm (Z score = 6.3) among all patients. Variable factors including IVIG resistance, responsiveness, and relapse of disease were associated with CAL complications. An initial single IVIG therapy may be useful for the prevention of large CAL caused by different factors of Kawasaki disease.

    Received: Jul. 1, 2015 Accepted: Jul. 23, 2015 Published: Aug. 1, 2015

    DOI: 10.11648/j.cmr.20150405.11 View: Downloads:

  • Authors: Abraha Gebrelibanos Kahsay, Frehiwot Daba, Abraham Getachew Kelbore, Sefonias Getachew

    Abstract: Background: Sexually transmitted Infections represent a large burden of disease worldwide with an annual incidence of about 333 million cases. In Ethiopia, studies on Sexually Transmitted Infections (STIs) among HIV patients are very few; therefore, conducting research on STIs in general and among HIV patients in particular is an important input to design policy and strategy aimed at preventing and controlling the infections. Objective: To determine the prevalence and associated factors of sexually transmitted infections among HIV patients in ART clinic; Ayder referral hospital, Tigray, Ethiopia. Methods: Institution based cross sectional study design was conducted among 353 HIV patients in Ayder hospital, ART clinic from July to September 2014. A systematic random sampling technique was used to identify study subjects. Data were collected using structured questionnaire and entered into and analyzed using SPSS 20 for windows. Descriptive analyses were used to estimate the prevalence of STIs and selected characteristics of patients. The effects of predictors on having STIs were analyzed using logistic regression and their effects were depicted using OR adjusted for confounding. P-value less than 0.05 were considered as statistical significant for all tests. Result;: Among total respondents; 150 (42.5%) were male and 203 (57.5%) female HIV patients .The prevalence of sexually transmitted infections based on the syndromic approach was 8.5% with specific prevalence of (4.6%) urethral discharge syndrome,(2.8%) genital ulcer syndrome, none of them scrotal swelling syndrome, (2.5%) lower abdominal pain syndrome,(0.3%)inguinal bubo and (5.5%) had vaginal discharge syndrome. 8 patients (26.7%) had recurrent disease and 28 patients (93.3%) treated without their partners. After multivariable logistic regression analysis, age (AOR=11.3 (95%CI: 1.1-116.5), marital status (AOR=0.031 (95%CI: 0.001-0.93) and having new sexual partner within the last three months (AOR=152.7 (95%CI: 3.7-6274) were significantly associated with STI syndromes p-value<0.05. Conclusion and recommendations: The prevalence of sexually transmitted infections based on the syndromic approach among HIV patients was 8.5% and the factors associated with STIs among HIV patients were: age, marital status and having new sexual partner within the last three months. Moreover, further studies to explore the predictor variables are highly recommended.

    Received: May 19, 2015 Accepted: Jun. 10, 2015 Published: Aug. 3, 2015

    DOI: 10.11648/j.cmr.20150405.12 View: Downloads:

  • Authors: Pushpalatha Manjunatha, Satish Kumar Amarnath, P. K. Menon, Arun Kumar H. R., Bala Satish M., S. J. Sabarish Babu

    Abstract: Analysis of the HCV genome has demonstrated extremely high heterogeneity in both structural and nonstructural coding regions and there are at least six different genotypes that have generally been divided into several subtypes. Of the 6 different Hepatitis genotypes, genotypes 1-3 is common worldwide, type 1a and 1b are the most common, accounting for about 60% of global infections. They predominate in Northern Europe, Southern and Eastern Europe, North America, and Japan respectively. Type 2 is less frequently represented than type 1. Type 3 is endemic in south-east Asia and is variably distributed in different countries. The determination of the infecting genotype is important for the prediction of response to antiviral treatment; genotype 1 is generally associated with a poor response to interferon alone, unlike genotypes 2 and 3 which are associated with better responses. A total of 238 plasma samples were received from patients attending gastroenterology department across India for treatment from March 2008 – Aug 2010. The samples were analyzed for viral load by real time PCR by Taqman principle. HCV genotyping was carried out on the samples whose viral load was more than 300IU/ml (limit of detection as per the kit). Qiagen RNA columns were used for RNA extraction, followed by reverse transcription (Promega) and genotyping was performed by conventional PCR. Out of 238 samples, 117 were positive for 3a, 44 samples were load negative, 43 samples were non- typable due to less viral load i.e. less than 1000 IU/ml. 26 were type 1a, 107 were 3a, and 11 were 2a.

    Received: Jul. 12, 2015 Accepted: Jul. 27, 2015 Published: Aug. 3, 2015

    DOI: 10.11648/j.cmr.20150405.13 View: Downloads:

  • Author: Ilker Ilhanli

    Abstract: Objectives: To evaluate the differences between Conventional, Acupuncture-like and Brief-intense TENS in chronic low back pain with lumbar disc herniation. Methods: 160 patients who were diagnosed as lumbar disc herniation were randomized into 4 groups: Group1= Conventional TENS, Group2= Acupuncture-like TENS, Group3= Brief-intense TENS, Group4= Sham TENS. Hotpack, ultrasound and exercise were applied all groups (5 days/week for 3 weeks). Patients were evaluated before treatment, a week after baseline, at the end of treatment and a month after the end of treatment. Ostwestry Low Back Pain Disability Questionnaire (OLBP) and Short-Form 36 physical component (SF-36PCS), mental component (SF-36MCS) scores, Modified Lumbar Schober test (MLS), Straight Leg Raising test (SLR) and Femoral Stretching test (FS) results and Visual Analog Scale for pain (VAS) at activity and at rest were recorded. After the exclusion, statistical analysis was administered to 135 participants (44 males and 91 females). Results: There were no differences according to demographic data (p>0,05). For each evaluation step, we compared the means of MLS, SLR, VASactivity, VASrest, OLBP, SF-36PCS and SF-36MCS and found no significant difference (p>0,05). At the end of first week, all groups showed significant improvement according to SLR (p=0,046, p=0,035, p=0,035, p=0,045, respectively) and VASrest (p=0,038, p=0,048, p=0,045, p=0,048, respectively); only group 1 (p=0,034) and group 3 (p=0,045) showed significant improvement for VASactivity. At the end of treatment, all groups showed significant improvement for MLS, SLR, VASactivity, VASrest, OLBP and SF-36PCS (p<0,05). Conclusions: Pain relief is seem to be starting earlier in treatment regimens including conventional and brief-intense TENS. Probably, final outcomes of the treatment regimens for pain and functional capacity, with or without TENS don’t differ.

    Received: Jul. 21, 2015 Accepted: Jul. 28, 2015 Published: Aug. 5, 2015

    DOI: 10.11648/j.cmr.20150405.14 View: Downloads:

  • Author: Samira T. Abdulghani Alaani

    Abstract: Introduction. Twin reversed arterial perfusion (TRAP) sequence is a rare complication of multiple pregnancy caused by defects in early embryogenesis. The pump twin supplies the acardiac recipient twin with blood, and although the pump twin is usually structurally normal, congenital anomalies have sometimes been reported. We report a case of twin reversed arterial perfusion sequence with feet polydactly in the surviving pump twin. This was the 1st case reported in Fallujah city, Iraq. Case report. A 22 years old. gravida 2, para 0. abortion 1, full term lady presented to the delivery room with labour pain with no history of any prenatal care. She gave no history of any familial congenital anomaly and there was no history of consanguinity with her hasbund. She has been referred for cesearian section delivery as an emergency as there was no progress in labour. Ultrasound examination at the delivery room revealed the diagnosis of monozygotic twin, one was normal & the 2nd was diagnosed as (abnormal) with difficulty in visualization of the fetal parts and gender. Conclusion. Twin-Reversed Arterial Perfusion (TRAP) sequence is a rare complication of monozygotic multiple gestation. Accurate antenatal diagnosis is essential to improve the prognosis of this rare entity.

    Received: Jul. 21, 2015 Accepted: Jul. 31, 2015 Published: Aug. 10, 2015

    DOI: 10.11648/j.cmr.20150405.15 View: Downloads:

  • Authors: Nega Desalegn, Merga Haile

    Abstract: Background: Preeclampsia is a multisystem hypertensive disorder of pregnancy with new onset after 20 weeks gestation which is a leading cause of worldwide maternal and fetal morbidity-mortality. Objective: To assess causes of ICU admission and outcomes among pre-eclampsia and eclampsia mothers admitted to Jimma University Specialized Hospital. Methods: A retrospective cross sectional study was conducted at JUSH from May 3 to 8, 2015, all ICU admitted preeclampsia and eclampsia mother’s records from January 1, 2010 to December 31, 2014 were included by consecutive sampling with inclusion and exclusion criteria. Causes of admission, complications and outcomes were obtained from patient records and analyzed by SPSS version 16.0, finally the results presented using simple frequency tables and figures. Chi square (x2) test calculated to analyze the statistical association between patients outcome and other variables, p-value less than 0.05 was considered statistically significant. Result: A total of 1981 patients admitted to Jimma University specialized hospital ICU over the last five years (January 1, 2010 to December 31, 2014) from this 326 of them were preeclampsia and eclampsia mothers and this gives admission rate of 16.5%. For this study only total of 314 preeclampsia and eclampsia mothers records were used and 12mothers cards were excluded by exclusion criteria. The main causes of admission to ICU were eclampsia 106 (33.8%), General condition need close observation 77(24.5%), pulmonary edema 63 (20.1%), postoperative bleeding 31(9.9%) While the main complications were pulmonary edema 82(26.1%), acute renal injury 76(24.2), HELLP syndrome 57(18.2%) and mortality rate of 7.3%.There is association level of blood pressure with maternal outcomes. Conclusion: Rate of maternal admission, complications and mortality is found to be high at JUSH ICU, Jimma University with other stakeholders has to work in improving high quality of cares provided to reduce maternal complications and mortality

    Received: Jul. 21, 2015 Accepted: Aug. 5, 2015 Published: Aug. 19, 2015

    DOI: 10.11648/j.cmr.20150405.16 View: Downloads:

  • Authors: Bolla G., Sercia F., Longo R.

    Abstract: The clinical experience tends towards a possible sharing between enuresis and encopresis in pediatric age. This pattern goes back again to a maturative delay in the neurofunctional competence. The differentiation of therapies for nocturnal enuresis and for encopresis responds to the peculiarities of children and their families

    Received: Feb. 18, 2015 Accepted: Mar. 1, 2015 Published: Aug. 21, 2015

    DOI: 10.11648/j.cmr.20150405.17 View: Downloads:

  • Authors: Yanchun Hu, Yanxia Hu, Shenju Song

    Abstract: The goal of this study was to establish whether changes in microvascular perfusion play an important role in the development of hypertension. To achieve this goal, we measured the photoplethysmographic waveforms recorded from the fingertips of patients with untreated hypertension. The photoplethysmographic waveforms were obtained from 60 healthy, normotensive male controls (NTs) and 30 untreated hypertensive male patients (HTs). The NTs were divided into two groups: a younger NT group (age 20 to 40 years, 30 individuals) and an older NT group (age 40 to 60 years, 30 individuals). The PPG waveform displayed a steep rise and a notch on the falling slope in the younger NT group. And for younger subjects, there were two positive waves (P1 and P2) and one negative wave (V).In the older NT group, a more gradual rise and fall was observed. For the HT group, no pronounced dicrotic notch was observed. A program was used to calculate the P2/P1 and P2/V ratios. The P2/P1 and P2/V ratios can indicate the perfusion to the fingertips during cardiac diastole. There were no significant differences in P2/P1 between the older NT group and HTs (0.37±0.07 versus 0.33±0.05, p>0.05).The P2/V ratios were significantly different between the older NT group and HTs (0.93±0.11 versus 0.59±0.08, p<0.05). These results indicate that there is a decrease in perfusion to the fingertips in hypertensive subjects during cardiac diastole.

    Received: Aug. 13, 2015 Accepted: Aug. 22, 2015 Published: Sep. 2, 2015

    DOI: 10.11648/j.cmr.20150405.18 View: Downloads:

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