Open Access Case Study

A Successful Resuscitation of a Young Patient with Persistent Life Threatening Ventricular Fibrillation during a Minor Surgical Procedure

Jing Song, Josue Rivera, Vilma Joseph, Shamantha Reddy

Journal of Advances in Medicine and Medical Research, Page 948-952
DOI: 10.9734/BJMMR/2015/15822

Aims: A discussion about the treatment options for cardiac arrest due to cocaine toxicity.
Presentation of Case: This is a case report of a young man who underwent general anesthesia for a urologic procedure. He suffered a ventricular fibrillation arrest and required over an hour of Advanced Cardiac Life Support (ACLS). Team Strategies & Tools to Enhance Performance and Patient Safety (TeamSTEPPS) techniques were utilized. Within one hour from the initiation of the dysrhythmia he received femoral vessel cannulation in preparation for extracorporeal membrane oxygenation (ECMO). The hypothermia protocol was instituted early for brain protection. The patient completely recovered with no neurological or cardiovascular sequelae from this life threatening cardiac arrest. Upon further investigation, it was discovered that cocaine was consumed one day prior to surgery.
Discussion: The use of cocaine is associated with multiple cardiovascular complications including ventricular fibrillation which was the probable etiology of this patient’s dysrhythmia. Recent studies elicited that there are underlying anatomic substrate alterations and changes in the molecular structure when cocaine is used. Cocaine stabilizes membranes in the nervous and myocardial tissue by antagonizing sodium and potassium channels. Multiple interventions were utilized which resulted in a successful resuscitation.
Conclusion: The implementation of ACLS, ECMO, hypothermic brain protection and team training all aided in the complete neurologic recovery in this patient.

Open Access Case Study

Anterior Chest Wall Tuberculosis Involving Lungs, Pleura and Lymph Nodes in an Immunocompetent Patient: A Case Report

Ashok K. Gupta, Pradeep Sharma, Neeru Mittal

Journal of Advances in Medicine and Medical Research, Page 953-956
DOI: 10.9734/BJMMR/2015/16832

Aims: The chest wall tuberculosis accounts for 1-5% of all cases of musculoskeletal tuberculosis. Here we are presenting a rare case of anterior chest wall tuberculosis in an immunocompetent patient.
Presentation of Case: A 20-year-old male came for routine medical check-up, which was prerequisite for his job. He had no respiratory complaints with no history of fever and weight loss. Local examination revealed a swelling over the right chest in the infraclavicular region.
Discussion: Tubercular anterior chest wall abscess is a rare form of extra pulmonary TB. Simultaneous involvement of lung, pleura and lymph nodes of mediastinum, neck and axilla has rarely been reported in an immunocompetent individual.
Conclusion: Cold abscess of chest wall is not common. Anti-tubercular therapy should be recommended as initial treatment.

Open Access Short Research Article

Identification and Susceptibility Testing on Samples of Mycobacterium spp

R. A. O. Calsolari, M. L. Shikama, M. A. M. B. Ribeiro, M. P. Okoshi, A. L. Mondelli

Journal of Advances in Medicine and Medical Research, Page 942-947
DOI: 10.9734/BJMMR/2015/14797

Background: Tuberculosis is still a major global health problem. Human tuberculosis is caused by species of bacteria belonging to the Mycobacterium genus. In this study we determined mycobacterial species affecting patients from Botucatu, Brazil, and tested M. tuberculosis sensitivity to different drugs.
Methods: Data were obtained from Clinical Laboratory Analysis records at Botucatu Medical School University Hospital, UNESP. All samples were processed according to standard isolation procedures from the 2008 Brazil Ministry of Health Mycobacteria Manual, which consist of staining smears by the Ziehl-Neelsen technique and seeding cultures in the Löwenstein-Jensen medium.
Results: Samples were isolated from sputum (80.5%), bronchoalveolar lavage (13.8%), pleural fluid (4.6%), and cerebrospinal liquor (1.1%). Smears were evaluated in 87 cases and a total of 59 patients showed positive smears; 55 from 70 sputum samples and 4 from 12 bronchoalveolar lavage samples. No pleural fluid (4) or cerebrospinal liquor (1) samples showed positive smears. The most commonly identified strain was M. tuberculosis (61 cases); followed by M. avium and M. gordonae 2 cases each, and M. peregrinumand M. abscessus 1 case each. Mycobacteria were not identified in 20 patients. Only two strains of M. tuberculosis were multidrug resistant; one was resistant to isoniazid, rifampicin, and pyrazinamide. These two patients evolved to cure.
Conclusion: This study highlights a small but troubling percentage of multidrug resistant samples and reveals the occurrence of nontuberculous mycobacteria, emphasizing the importance of correctly identifying species and testing sensitivity to antibacilar drugs to assure an adequate therapy.

Open Access Original Research Article

Assessment of Pupil Diameters in Pseudoexfoliation Syndrome under Scotopic, Mesopic, Photopic and Dynamic Conditions Using Infrared Pupillometer (Assessment of Pupil Diameters in Pseudoexfoliation Syndrome)

Ulviye YiÄŸit, Ismail Umut Onur, Ali Kutlay Tufan, Mehmet Fatih AÅŸula

Journal of Advances in Medicine and Medical Research, Page 877-883
DOI: 10.9734/BJMMR/2015/16423

Aim: Our study aims to assess the mean pupil size under scotopic, mesopic, photopic and dynamic conditions in patients with PXS.
Methodology: This study was performed in Ophthalmology Clinic at Ä°stanbul Bakırköy Dr.Sadi Konuk Training and Research Hospital. Fourty-six patients with PXS and 46 age and sex matched controls were included in the prospective study. The subjects were allowed at least 3 minute to adapt to the lighting condition in the room. Pupil diameters were measured with infrared (IR) pupillometer integrated within CSO Sirius Corneal Topographer (Costruzione Strumenti Oftalmici S.r.l,Italy ) by the same examiner. The measurements were taken in scotopic, mesopic, photopic and dynamic conditions. Statistical analyses were evaluated.
Results: Mean pupil diameter were significantly lower in the PXS group than control group for all measurements. Scotopic and mesopic pupil size were significantly lower in the PXS group than control group (p=0.0001). Also photopic and dynamic pupil size were significantly lower in the PXS group than control group (p=0.014, p=0.013).
Conclusion: The results suggest that pupillary light response in patients with PXS significantly was affected not only in scotopic and mesopic conditions but also in photopic and dynamic conditions.

Open Access Original Research Article

Survey of Knowledge and Source of Information Relating to Reproduction and Sexually Transmitted Infections among Senior Secondary Schools Students in a Military Barracks in Nigeria

Uzoh. C. Chimah, Taiwo. O. Lawoyin, Chinomnso. C. Nnebue, Amobi. L. Ilika

Journal of Advances in Medicine and Medical Research, Page 884-894
DOI: 10.9734/BJMMR/2015/16555

Context: Adolescents seek health information from diverse sources. When such information is appropriately sought, correct and complete, it ensures an understanding of their reproductive health needs and encourages healthy sexual decision making and behaviors.
Objective: To determine the level of knowledge and source of information about reproduction and sexually transmitted infections among senior secondary schools students in Ojo military barracks, Lagos.
Materials and Methods: A cross-sectional study of 400 senior secondary schools students in Ojo military barracks, Lagos, selected using multistage sampling technique was done. Data collection employed pretested, self- administered structured questionnaires. Data was analysed using statistical package for social sciences version 17. Tests of statistical significance were carried out using chi square and t tests. A p value of <.05 was considered significant.
Results: Majority of them 391(97.8%), were in the age group (10-19 years) while the mean age was 152.4 for males and 152.2 for females respectively. Information on sexual and reproductive health was sought from the electronic media by 238(59.5%), 115 (52.0%) males and 123 (68.7%) females; peer group 231(57.8%), 120 (54.3%) males and 111 (62.0%) females as well as print media and other sources with a statistically significant difference in this practice between the males and females (P=.01). Only 38 (9.5%) had very good knowledge. The sexually experienced were less knowledgeable than the non-experienced (3.71.3 and 3.91.3 respectively; P<.05). Knowledge was found to increase with age (P<.05). Females had more knowledge than males (P<.05).
Conclusions: Overall knowledge was assessed as fairly good, while key sources of information were the electronic media and peer groups. Interventions including peer education are recommended to ensure that these sources provide veritable information on reproductive health.

Open Access Original Research Article

Evidence Based Medicine: Assessing Knowledge, Attitudes and Barriers in Post-graduate Training

Shuvankar Mukherjee, Biswanath Sharma Sarkar, Soma Mukhopadhyay, Soma Chakrabarti

Journal of Advances in Medicine and Medical Research, Page 895-903
DOI: 10.9734/BJMMR/2015/16398

Aims: To assess the knowledge and attitude of post- graduate medical students regarding evidence based medicine (EBM) and to find out the barriers against its implementation, if any.
Study Design: Medical college based cross-sectional survey.
Place and Duration of Study: The study was carried out between October 2013 to March 2014, at a medical college in Kolkata, West Bengal, India.
Methodology: Altogether 145 post-graduate medical students of clinical disciplines filled up a pre-designed, pre-tested, structured questionnaire and data were analyzed by standard statistical procedures.
Results: The mean knowledge score was found to be 13.46±3.10. The score was arbitrary, ranged from 0 to 20 and higher score corresponded to higher knowledge. The distribution of the mean knowledge score among <30 years (13.34±3.28) and ≥30 years (13.67±2.62) was the same across these two categories (P=.62). Large proportions of the respondents were not familiar with reputed EBM resources such as Cochrane data base (66.9%) and Best Evidence (67.6%). Use of Medline was also quite poor (35.9%). Nearly half of them did not think that EBM was focused on patient’s values and preferences and many believed that EBM would place another demand on the already overburdened residents and doctors. Quite a large proportion thought that EBM would be of limited value in clinical practice. However the mean attitude score (21.23±4.06) showed an overall favorable attitude towards EBM. There was a positive correlation between the mean knowledge and attitude scores (P =.008). The common barriers against the implementation of evidence-based medicine were “no ready access to resources” (68.3) and “never taught on the subject” (56.6%).
Conclusion: Although many of the respondents were not adequately knowledgeable about evidence-based medicine and also quite a few had a negative attitude towards its practicality, the positive correlation between knowledge attitude scores suggested that imparting proper knowledge could bring about a positive change in this attitude.

Open Access Original Research Article

Epidemiology of Coccidian Parasites in HIV Patients of Northern Uganda

Isaac Echoru, Lule Herman, Lisa Micheni, Mulkah O. Ajagun-Ogunleye, Muhamudu Kalange, Keneth Iceland Kasozi

Journal of Advances in Medicine and Medical Research, Page 904-913
DOI: 10.9734/BJMMR/2015/15959

Aim: The epidemiology of coccidian parasites in HIV patients of sub-sahara Africa is poorly understood. This study aimed at determining the epidemiology of coccidian parasites and their associated risk factors. This was a cross sectional study carried out in Arua district in West Nile region of Northern Uganda for a period of five months.
Materials and Methods: Participants in the study included HIV positive patients presenting with diarrhea. A total of 111 patients were included and classified into children, middle aged and adults. A structured questionnaire was administered, stool samples were obtained using sterile stool containers and laboratory analysis carried out using modified Ziehl-Neelsen technique (ZN). Ethical clearance was acquired and the consent of the patients was sought.
Results and Discussion: Prevalence of Coccidian parasites among HIV patients was found to be 5.4% and Cryptosporidium parvum showed more prevalence than Isospora belli and Cyclospora cayatenensis i.e. (3.6%), (1.8%) and (0.0%) respectively. Most Cryptosporidium parvum infections occurred in children (13.6%) compared to adults (3.3%); with a significant relationship of (p = 0.02). The infection was higher in females (7.1%) than males (2.4%) (p = 0.19). The major risk factors associated with the disease were mainly consumption of contaminated and un-boiled water from taps and boreholes.
HIV patients who took co-trimoxazole and drunk boiled water were shown to have a low prevalence of coccidian parasites of 1.9% and 2.6% respectively (p<0.05). This is because co-trimoxazole is a prophylactic drug for opportunistic infections and proper boiling of drinking water kills coccidian parasites.
Conclusion and Recommendations: The study highlighted the importance and need to screen for coccidian parasites and emphasis on regular taking of prophylactic treatment as a way of controlling opportunistic infections in HIV patients. Future prevalence studies of Coccidia amongst healthy, HIV sero-negative children and adults of similar age groups in similar settings are recommended to ratify the relationship.

Open Access Original Research Article

Chronic Low-dose Step-up Protocol in Treating Women with Unexplained Infertility: (37.5 Units Versus 75 Units of Follitropin Alpha as the Initial Dose)

Ibrahim Polat, Gonca Yetkin Yildirim, Eser S. Ozyurek, Vuslat Lale Bakir, Ali Ekiz, Deniz Acar, Merve Aldıkactioglu Talmac

Journal of Advances in Medicine and Medical Research, Page 914-920
DOI: 10.9734/BJMMR/2015/17266

Aims: To compare the treatment outcome of the 37.5 Units/day follitropin-alpha (Study Group) with 75 Units/day (Control Group) as the initial dose for chronic low-dose step-up ovulation induction for unexplained infertile, non-PCOS (polycystic ovarian syndrome) women.
Methodology: Retrospective study and comparison of the patient characteristics and treatment outcome of 2 patient groups of 100 patient-cycles (Study and Control groups: Low-dose step-up cycles with initial doses of 37.5 Units/day and 75 Units/day, respectively). 95 (Study group) and 98(Control group) ovulatory cycles were included in the final analysis.
Results: Cycle cancellations were less common in the Study Group (6.3% vs 15.3%; P=0.02); those in the control group being mostly due to excessive response. The conception rates were similar: 11.5% and 11.2% in the study and the control groups, respectively. Total and mean daily gonadotropin used were lower in the study group (P=0.02 and P=0.04). 1 mild OHSS (Ovarian hyperstimulation syndrome) was observed in each group. There were no multiple pregnancies in either group.
Conclusion: The initial daily dose of 37.5 Unit/day is more effective in achieving a unifollicular cycle while being as safe and effective as 75 Units/day; requiring a lower amount of gonadotropin for the conventional treatment of unexplained infertility in non-PCOS women.

Open Access Original Research Article

Clinico-Demographic Indicators of Depression among Infertile Women in a Tertiary Health Institution in Awka, South East Nigeria

L. C. Ikeako, O. Iteke, H. U. Ezegwui, T. C. Okeke

Journal of Advances in Medicine and Medical Research, Page 921-931
DOI: 10.9734/BJMMR/2015/16302

Background: Infertility is a phenomenon which influences all lifestyle aspects of a couple and has cultural, social, legal and especially psychological consequences. Depression is a common consequence of infertility and its impact can be devastating to the infertile persons and to their partners.
Aim: To determine the prevalence of depression and its indicators among infertile women in Awka, Southeast Nigeria.
Methods: This was a cross-sectional survey on consecutive attendees at the Fertility Clinic of Anambra State University Teaching Hospital, Awka, southeast, Nigeria, over a three month period. Data on socio-demographic variables were extracted using a pretested semi-structured questionnaire. Depression was assessed using the Beck’s Depression Inventory (BDI). Statistical Package for Social Sciences SPSS 10 (SPSS Inc, Chicago IL) was used for analysis. A value of P<0.05 was considered significant.
Results: Of the 96(100%) respondents, 37(38.5%) had depressive disorder while 59(61.5%) were normal (P=0.001). Thirty (21.3%) respondents had primary infertility while 66(68.7%) had secondary infertility. Of those with primary infertility 22(77.3%) had depression compared to 15(22.7%) with secondary infertility (P=0.001). Depression was also significantly associated with duration of infertility (P=0.001), verbal abuse (P=0.001), willingness to adopt (p=0.009) and increasing maternal age (p=0.001).
The associations between husband being supportive (P=0.140), social status (P=0.652), family setting (P=0.106), place of residence (P=0.134), employment (0.652), educational level (P=0.444) and depression were not statistically significant.
Conclusion: The prevalence of depression among infertile women in Awka is significant. This should be taken into account in the treatment of infertile women in view of the adverse effects of depression in the aetiology and outcome of management of the infertile women.

Open Access Original Research Article

Adverse Drug Reaction Reporting by Different Categories of Healthcare Workers in Nnewi, Nigeria: Awareness, Knowledge and Attitudes

Amaka Y. Ezeuko, Uzo E. Ebenebe, Chinomnso C. Nnebue, Okechukwu O. Ndu

Journal of Advances in Medicine and Medical Research, Page 932-941
DOI: 10.9734/BJMMR/2015/17183

Aim: To determine the level of awareness, knowledge and attitudes among health workers in different settings of health care in Nnewi, Nigeria towards the reporting of adverse drug reactions (ADRs).
Methods: A descriptive cross-sectional study of 372 health workers in different health facilities in Nnewi North LGA of Anambra state, Nigeria was done. The participants were doctors, pharmacists and nurses, selected using multistage sampling technique. Data collection employed pretested, self-administered structured questionnaires. Data was analysed using statistical package for social sciences version 17. Chi-square test for proportions was used to document statistical significance among variables. A p value of < 0.05 was considered significant.
Results: Two hundred and fifty five (68.5%) were females and 117 (31.5%) were males. This comprises 241 (64.8%) nurses/related cadres, 109 (29.3%) doctors and 22 (5.9%) pharmacists. Majority of them, 221 (59.4%) were not aware of the existence of the national ADR reporting scheme/guideline. The Pharmacists were more aware compared to other health professionals (P=.000). Respondents from tertiary health facility showed greatest awareness (43.2%). A total of 131 (35.2%) respondents have knowledge of the criteria for reporting ADR though it does not have a relationship with profession (P=.71) and does not depend on the level of the health facility where one worked (P=.30).
Conclusion: This study showed poor awareness, knowledge gaps and poor attitude to ADR reporting across the professional groups. There is need for regular sensitization, training and retraining as well as attitudinal changes of health care providers to ADR reporting.