Clinical Medicine Research

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

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Volume 4, Issue 6, November 2015

  • Authors: Hu Kangxin, Pan Jie, Yao Wenliang

    Abstract: Brugada syndrome is an inherited arrhythmogenic disorder that exhibits ECG ST-segment elevation with a negetive T-wave in the right precordial leads (V1-V2), with normal heart structure,predisposing to VF and SCD. Its symptoms include syncope, nocturnal agonal respiration and cardiac arrest. Recently, reserches on Brugada syndrome had archived some advances, for examples, regarding to exposuring concealed Brugada 1 type ECG, besides pharmacological provocation, there are two orter methods: putting right precordial lead on the second intercostal space or Holter monitoring; early repolarization(J-wave) has important value in prognostic judgment of Brugada syndrome; radiofrequency catheter ablation was generally applied only in epicardium of RVOT in the past, while it has been applied in endocardium of RVOT today. Therefore, the endocardium of RVOT can be considered as an alternative site in the treatment of recurrent VF in Brugada syndrome.

    Received: Jul. 3, 2015 Accepted: Sep. 25, 2015 Published: Oct. 12, 2015

    DOI: 10.11648/j.cmr.20150406.11 View: Downloads:

  • Author: Salvatore Musumeci

    Abstract: Chitin is abundant in the structural coatings of fungi, insects, and parasitic nematodes, but it is not produced in mammals. The host defense against chitin-containing pathogens include production of chitinases. An acidic mammalian chitinase (AMCase) is produced in human epithelial cells of lower airways and conjunctiva via a Th2-specific, IL-13-dependent pathway and seems to be associated to asthma and allergic ocular pathologies. The role of AMCase in allergic disease is only at beginning and many issues open new possibilities for its control using specific inhibitors of AMCase activity or modulating its expression. In patients with vernal keratoconjunctivitis (VKC) and with season allergic conjunctivitis (SAC) the level of AMCase activity in the tears was found significantly elevated when compare to healthy controls and the highest levels were found in VKC. When RNA was extracted by conjunctival epithelial cells of these patients, the Real Time PCR measurement confirmed that the mRNA expression correlates with tear AMCase activity and the expression was significantly higher in VKC and SAC respectively. Also Receiver Operating Characteristic (ROC) analysis demonstrated that the sensitivity and specificity of AMCase measurement were 100% respectively, addressing the use of AMCase assay in the biochemical diagnosis of VKC and SAC. Recent studies in rabbit, where a reactive uveitis was induced by LPS injection in eye’s anterior chamber, confirmed that increased AMCAse activity was measurable in tears and that epithelial cells of conjunctiva express specific mRNA. A well as it was previously demonstrated in experimental model of mouse asthma, the inflammatory reaction induced by LPS was controlled by the chitinase inhibitor and steroid, instilled at 3 hr interval in conjunctival sacs. In dry eye, another pathologies where the role of innate immunity is sustained by AMCase secretion, an increased AMCase activity was documented and the specific mRNA expressed by epithelial conjunctival cells. In this pathology the eye inflammation can be ascribed to a common mechanism mediated by AMCase, via a Th 2 specific, IL-13 dependent way. In synthesis AMCase may be considered an important mediator in the pathogenesis of Th2 inflammation eye’s diseases, suggesting its potential diagnostic and therapeutic utility.

    Received: May 29, 2015 Accepted: Aug. 28, 2015 Published: Oct. 14, 2015

    DOI: 10.11648/j.cmr.20150406.12 View: Downloads:

  • Authors: Ermias Shenkutie Greffie, Tadesse Mitiku, Seid Getahun

    Abstract: Stroke is one of the commonest causes of morbidity and mortality among non-communicable diseases. Its occurrence has been significantly increasing in Sub Saharan Africa in the last couple of decades. Mortality has been shown to be higher in this area compared to developed countries. Yet, there is a big information gap about stroke in Ethiopia. This study aimed at describing the clinical pattern, risk factors and outcome of adult stroke patients admitted to university of Gondar hospital. Retrospective chart record analysis of adult patients with stroke who had Computerized tomography(CT) scan of the brain admitted to University of Gondar hospital medical wards from June 2010 to May 2013 was done. Relevant data including sociodemographics, risk factors, type of stroke and outcome were collected using a data extraction form. Data was entered and analyzed using Epi info7. Results: A total of 98 patients with a median age of 68 years (IQR: 60-76) and F:M ratio of 1.13:1 were analyzed. Ischemic stroke accounted for 69.4% of the cases. The median ages of patients with hemorrhagic and ischemic stroke were 60 and 70 years respectively (P=0.0027). Hypertension (55.9%), any type of structural heart disease (44.6%) and atrial fibrillation (28.7%) were the most commonly identified risk factors. Atrial fibrillation was more prevalent in ischemic stroke patients (34.3%) compared to hemorrhagic stroke (14.8%) (P= 0.049). In hospital mortality rate was 13% with median duration of hospital stay before death of 6 days. Respiratory failure secondary to aspiration pneumonia and increased intracranial pressure were the most common immediate causes of death. Conclusion: Even though ischemic stroke was the most common stroke subtype, the proportion of hemorrhagic stroke was higher compared to studies from the developed world. Appropriate screening and treatment of hypertension, structural heart disease and atrial fibrillation should be give due attention as they are the most commonly identified risk factors. Most deaths occurred early after admission due to stroke related acute complications with respiratory failure; as such an emergency stroke care unit capable of managing these complications can partially decrease the death rate.

    Received: Oct. 9, 2015 Accepted: Oct. 21, 2015 Published: Oct. 30, 2015

    DOI: 10.11648/j.cmr.20150406.13 View: Downloads:

  • Authors: Esam-eddin Bakheit Mohammed Ahmed, Faroug Bakheit Mohammed Ahmed

    Abstract: This is a prospective hospital based study conducted in Omdurman Military Hospital (OMH) from January to December 2009 comparing the conventional dissection tonsillectomy (CDT) versus bipolar diathermy tonsillectomy (BDT). The study was conducted to determine the incidence of post-tonsillectomy haemorrhage and it's relation to technique used. Also to detect the efficacy of bipolar diathermy in intra-operative haemostasis in tonsillectomy procedures. 165 patients who had tonsillectomy during the study period were randomly collected and grouped into two according to the technique used. Questionnaire and SPSS program were used for data collection and analysis respectively. The primary haemorrhage was reported in 3.6% and the secondary one in 1.8% of study sample. The intra-operative bleeding found to be correlated (p < 0.005) to the technique. Insignificant secondary haemorrhage occurred in three cases from the bipolar diathermy group but had no correlation (p > 0.005) with the technique used for tonsillectomy. The primary haemorrhage was found to be correlated to the technique used. The bipolar diathermy is highly efficacious in intra-operative haemostasis during tonsillectomy. The difference was insignificant between bipolar diathermy and conventional dissection methods regarding the secondary haemorrhage.

    Received: Oct. 10, 2015 Accepted: Oct. 21, 2015 Published: Nov. 24, 2015

    DOI: 10.11648/j.cmr.20150406.14 View: Downloads:

  • Authors: Sadije Halimi, Mybera Ferizi, Antigona Gerqari, Nita Krasniqi, Mergita Ferizi

    Abstract: Background: Vitiligo is a common skin condition resulting from loss of normal melanin pigments in the skin which produces white patches. It mainly affects a younger population and can cause serious cosmetic and social problems. At least three theories about the underlying mechanism of vitiligo have been proposed. Release of a chemical that is toxic to melanocytes is one theory, while another theory says that the melanocytes simply self-destruct. According to the third theory, vitiligo is a type of autoimmune disease. Methods: We performed a prospective study to evaluate the efficacy of the 0.05% clobetasol propionate and 1% pimecrolimus in the treatment of vitiligo. In our study is 25 patients with virtually lesions of vitiligo. Results: Results from this pilot study indicate that topical 1% pimecrolimus is as effective as clobetasol propionate in restoring skin disfiguring due to vitiligo. Discussion: Further studies investigating the safety and efficacy of topical 1% pimecrolimus ointment either as monotherapy or in combination with other therapeutic measures are warranted.

    Received: Aug. 31, 2015 Accepted: Nov. 9, 2015 Published: Dec. 3, 2015

    DOI: 10.11648/j.cmr.20150406.15 View: Downloads:

  • Authors: Mohamed Abdulkadir Mohamed, Nebiyu Bekele, Ermias Diro, Ermias Shenkutie Greffie, Timothy Landers, Habtewold Shibiru, Helen Gebremedhin, Murad Muhammed, Omer Abdu, Tesfaye Yesuf

    Abstract: Coma represents a serious, life-threatening medical condition which should be treated effectively. It is important to recognize the underlying causes of coma in order to provide timely medical treatment. There is dearth of data on causes of medical coma in adults in Africa. This research aimed at determining the cause and outcome of coma in University of Gondar Hospital. Methods: A prospective observational descriptive study was conducted from 01/01/2014 to 31/06/2014 G.C in University of Gondar Hospital. All consecutive non trauma patients admitted to the medical wards with a Glasgow Coma Scale of 8 or less were included. An interview administered questionnaire to patient attendants and neurologic examination were employed to collect data like sociodemographics and clinical features. All important laboratory tests and outcome data were documented at patient discharge. Verbal consent from attendants was taken. Data was entered to and analyzed using Epiinfo7. Result: A total of 53 patients constituting approximately 3.4% of the medical emergencies seen during the study period were included in the study. The most common cause of coma were diseases that cause no focal neurologic deficit (FND), occurring in 31 (58.5%) patients. Among the causes with non-localizing signs, the most common causes were intoxications, uremic and hepatic encephalopathies, occurring in 11 (20.8%), 7 (13.2%), and 5 (9.4%) of the patients, respectively. Organophosphate (malathion) poisoning was the most common agent of intoxication responsible for 9 patients out of 11. These were followed by diseases with FND and meningitis syndromes, occurring in 14 (26.4%) and 8 (15.1%) patients, respectively. Among the patients admitted with coma without FND, 17 (54.8%) of the patients died, 6 (19.3%) had disability and 8 (25.8%) patients were discharged with improvement. In contrast, among patients admitted with coma with FND, no patient was discharged with improvement, 7 (50%) died and 7 (50%) were disabled. Among patients admitted with meningitis syndrome, 4 (50%) died, 2 (25%) were disabled and 2 (25%) were discharged with improvement. Conclusion: Diseases presenting without focal neurologic deficit, including toxic and metabolic causes, are the most common causes of coma. Among these, the most common was malathion poisoning which is reversible with appropriate care. Meningitis syndrome was not found to be a prominent cause of coma. Medical coma, regardless of the etiology, was associated with high mortality rate.

    Received: Nov. 8, 2015 Accepted: Nov. 17, 2015 Published: Dec. 10, 2015

    DOI: 10.11648/j.cmr.20150406.16 View: Downloads:

  • Author: Bitsoev Vladimir Dodtievich

    Abstract: In this work, we study the effect of water structure on absorption spectra of water that is subject to electromagnetic radiation of the following types: 1. polychromatic visible and infrared polarized (PVIP) light emitted by a "Bioptron" device with a wavelength of 480 to 3,400 nm and frequency of 625 to 88 THz under water via a fiber optic cable and with an exposure of 2, 4, 6, 10, 15, and 30 minutes; 2. electromagnetic waves belonging to a 5.6 mm range with a frequency of 50-52 GHz and an exposure of 2, 4, 6, 10, 15, and 30 minutes via a radiation source with dimensions over 5 cm immersed into water; 3. one-time effect of PVIP light and CO2 at a temperature of 0°C and with an exposure of 4 minutes; 4. one-time effect of electromagnetic waves belonging to a 5.6 mm range and CO2 at a temperature of 0°C and with an exposure of 4 minutes; 5. effect of PVIP light on water from a 10 cm height above the water surface. The conducted studies have shown that the best changes occur in water irradiated with PVIP light during 4 and 15 minutes as compared to the absorption spectra of a control specimen of tap water. Significant changes in the water structure occurred if water was irradiated with PVIP light from a 10-cm height above the water surface during 15 minutes. The studies showed as well that after the end of 4- and 15-minute exposure of water to electromagnetic waves (26 and 15 minutes later, respectively) the water structure significantly improved owing to its unique ability to store and transmit information.

    Received: Nov. 26, 2015 Accepted: Dec. 6, 2015 Published: Dec. 22, 2015

    DOI: 10.11648/j.cmr.20150406.17 View: Downloads:

  • Author: Noha Fathy Ahmed Osman El-Tahtawi

    Abstract: Corneal blindness is a major health problem worldwide and infectious keratitis is one of the predominant causes. The incidence of fungal keratitis has increased over the last few years. Keeping this in mind, this study was conducted to evaluate the frequency of positive fungal cultures in infectious keratitis and of the various fungal species identified as etiologic agents in patients with corneal ulcer attending the ophthalmic departments of 3 hospitals in Riyadh. Corneal scrapings from 100 patients of corneal ulcer with suspected fungal etiology were subjected to direct examination by 10% KOH and lacto-phenol cotton blue mount. Also swabs of diseased eyes were taken with sterilized swabs. The specimens were also inoculated directly on to Sabouraud’s dextrose agar in C-shaped streaks. From 100 patients of corneal ulcer investigated, only 52% of patients were positive. Males were more commonly affected than females (69.23% and 30.76%), respectively. The age of patients was ranged from 28-55 years. 18 (34.61%) patients with fungal keratitis were laborers, 15 (28.84%) teachers, 7 (13.46%) housewives, 6 (11.53%) shepherds and 6 (11.53%) were civil engineers. Corneal trauma with stone chips and metal splinters appeared to be the most common predisposing factors of fungal keratitis (30.76%) followed by ocular surgery and corneal disease (26.92%). Of 52 positive patients with corneal ulcer surveyed the most important causative agents of fungal keratitis were Aspergillus spp. (44.23%), followed by Candida spp. (17.30%) and Fusarium spp. (17.30%). Because of serious consequences of infectious keratitis, it is important to know the exact etiology of fungal keratitis to institute appropriate therapy in time. Laboratory confirmation should be before pre scribing corticosteroids and antifungal.

    Received: Nov. 20, 2015 Accepted: Dec. 6, 2015 Published: Dec. 25, 2015

    DOI: 10.11648/j.cmr.20150406.18 View: Downloads:

  • Authors: Basant Hamdy El-Refay, Rehab Farrag Gwada, Bassem S. Ibrahim

    Abstract: This study was to compare the efficacy of continuous, bi-level positive airway pressure (CPAP, Bi-PAP) and oxygen therapy on detailed observation of time-course change in blood gases, physiological parameters and rate of endotracheal intubation in patient with acute cardiogenic pulmonary edema (ACPE). Sixty-six patients with ACPE were randomly assigned to receive standard oxygen (O2) therapy (n=23), CPAP (n=21), and Bi-PAP (n=22). Blood gases (PaCO2, PaO2, SaO2, pH, and HCO3), and physiological parameters (HR, RR, SBP, and DBP) were collected at baseline (T0), immediately after 60 minutes (T60), and after 30 minutes of discontinuation (T90). A significant improvements (p<0.05) in PaCO2, PaO2, SaO2 and vital signs were observed immediately after CPAP and Bi-PAP when compared to O2 therapy. After 30 minutes of disconnection, Bi-PAP revealed significant improvement (p<0.05) in PaO2, SaO2, and respiratory rate. No differences on intubation and death rate detected among treatment groups. Both methods of noninvasive ventilations are effective treatment for ACPE. However, Bi-PAP should be considered as first line of treatment due to faster and continuous improvement in oxygenation and respiratory rate.

    Received: Dec. 12, 2015 Accepted: Dec. 27, 2015 Published: Jan. 8, 2016

    DOI: 10.11648/j.cmr.20150406.19 View: Downloads:

  • Authors: Xianhua Ren, Yi Wang, Ruilian Ma

    Abstract: A clinical pharmacy management system (CPMS) software developed by our hospital has been described and utilized to provide drug information services, promote the rational drug use, improve the efficiency of clinical pharmacists, and carry out investigations on the counting of large sample cases taking the example of the urology department. The efficiency, normalization and accuracy of the prescription evaluations by the clinical pharmacists were improved, the quality and passing rates of the evaluation results were ensured, and the rational drug use and drug information services in the urology department of our hospital were also improved. The system could eventually promote the clinical drug information services in the whole hospital onto a new level.

    Received: Feb. 4, 2016 Accepted: Published: Feb. 4, 2016

    DOI: 10.11648/j.cmr.20150406.20 View: Downloads:

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