Open Access Systematic Review Article

Effectiveness and Safety of PDE5 Inhibitors for Men with Erectile Dysfunction Caused by Spinal Cord Injury

Yang Teng, Yu Dai, Zhongyun Ning, Ling Yao, Hui Ding, Baoyue Cao

Journal of Advances in Medicine and Medical Research, Page 1-10
DOI: 10.9734/BJMMR/2016/24870

Aims: The objective of this review was to assess the effectiveness of phosphodiesterase type 5 (PDE5) inhibitors in men with erectile dysfunction (ED) and spinal cord injury (SCI).

Methodology: The following databases were sought up to May 2015: PubMed, Google scholar, EMBASE and Cochrane Library. We performed a meta-analysis of all available randomised controlled trials. We used odds ratios (ORs) to assess the strength of the association, and 95% confidence intervals (CIs) gave a sense of the precision of the estimate. Statistical analyses were performed by Review Manager, version 5.0.

Results: After searching and screening the relevant articles, ten studies were included and assessed the effectiveness of PDE5 inhibitors in men with erectile dysfunction and spinal cord injury. The pooled results showed that sildenafil significantly improved erection compared with placebo in ED patients with SCI (OR = 5.96, 95% CI [3.36–10.55], P < 0.00001) and there was no statistical difference compared incomplete injury group with complete injury group (OR = 0.73, 95% CI [0.38–1.43], P=0.36). It is evident that compared upper motor neuron with lower motor neuron, there were better responsive rates in sildenafil(OR = 11.56, 95% CI [2.88–46.36], P=0.0006). Because of lacking studies and data, we could not perform meta-analysis for other PDE5 inhibitors. The commonly reported adverse effects (AEs) were headache, flushing, dizziness and urinary tract infection in these studies. No severe adverse events were found.

Conclusion: Current evidence suggests that sildenafil is effective treatment for ED patients with SCI. In future, we need more high quality randomized controlled trials (RCTs) to confirm these findings and evaluate the effectiveness of other PDE5 inhibitors.

Open Access Short Research Article

Plantar Pressure Asymmetry in Patients Six Months after Surgical Treatment of Calcaneal Fractures in Adults

Soňa Jandová, Martina Černeková, Jan Pazour

Journal of Advances in Medicine and Medical Research, Page 1-8
DOI: 10.9734/BJMMR/2016/25189

Aim: To compare plantar pressure distribution and contact time in patients in month 6 following operative treatment of calcaneal fractures.

Study Design: Walking on the tensometric platform.

Place and Duration of Study: Regional Hospital, Trauma Centrum, between September 2014 and October 2015.

Methodology: Gait analysis was carried out on seven patients (38±9 years; 1.79±0.05 m; 83±8 kg). Measurements were made using a pedobarography platform. The factors observed comprised: total contact time (CT), peak pressure (PP), maximum vertical force (Fz), heel contact time (CT-heel), peak pressure under the heel (PP-heel), and the force-time integral (FTI). The analysis was based on the data from both the healthy and the affected lower limb; values for symmetry index (SI) were computed.

Results: Out of 7 patients, all patients with a longer contact time on the healthy feet were documented. The healthy limbs demonstrated peak pressure values that were predominantly higher beneath the heel, and under the first metatarsus head and under the big toe. On the affected limbs centre of pressure line shifted laterally. Foot contact was applied more often on the outer side of the foot. Not a clear trend was found in the contact time beneath the heel with the ground when 4 patients shortened the duration of the heel contact on the affected limb.

Conclusion: The observed patients still show significant lateral changes in dynamic parameters, which is also reflected in the duration of the individual phases of the gait cycle. The calculation of the index of symmetry for the tracked variables showed significant differences between healthy and affected limbs, although all the patients had returned to their working environments at the time of the measurement. This pilot study is a starting point for future work and co-operation between the University and the Trauma Centrum.

Open Access Original Research Article

Exogenous Testosterone and Vitamin E Ameliorates Diabetes-induced Necrosis of the Pancreas, Lipid and Testicular Disorders in Male Wistar Rats

Elsie Olufunke Adewoye, Adebayo Oluwole Opabunmi

Journal of Advances in Medicine and Medical Research, Page 1-14
DOI: 10.9734/BJMMR/2016/25329

Aims: To investigate the effect of combined administration of testosterone and vitamin E on diabetes-induced testicular dysfunctions and dyslipidemia in male Wistar rats.

Place and Duration of Study: Applied and Environmental Physiology Unit, Physiology Department, University of Ibadan, Nigeria, September, 2013 to January, 2014.

Study Design and Methodology: Fifty male Wistar rats (150-200 g) were randomly divided into ten groups of 5 animals: normal control (NC), normal-vit.E treated (NVE), normal-testosterone treated (NT), normal-vit.E+testosterone treated (NVET), diabetic-untreated (DU), diabetic-vit.E treated (DVE), diabetic-testosterone treated (DT), diabetic-vit.E + testosterone treated (DVET), diabetic-insulin treated (DI), and diabetic-glibenclamide treated (DG). Diabetes was induced with a single intraperitoneal injection of 120 mg/kg alloxan monohydrate. Rats with sustained blood glucose of ≥ 250 mg/dl were selected as diabetic. Blood glucose was measured using glucose/oxidase principle. Animals were treated for 14 days and by day 15, blood was collected from the retro-orbital plexus for serum lipid analysis. Testes, epididymis and pancreas were excised and caudal epididymal fluid was analyzed for spermatogenic indices while testes and pancreas were processed for histological evaluation. Data were expressed as mean±SEM and statistical analysis performed using Student's unpaired test, one-way analysis of variance (ANOVA). Level of significance is P = .05.

Results: The DVET showed significant reduction in serum TC (103.27±12.76), TG (76.25±9.79), VLDLc (15.25±1.96) and LDLc (69.70±14.74) compared with DU (188.67±9.97), (166.75±5.16), (33.55±1.12) and (141.16±11.06) respectively while significant increase was observed in DVET sperm count (59.60±10.31), sperm motility (74.00±2.19) and HDLc (18.31±2.22) compared with DU (25.20±3.99), (66.00±2.19) and (9.70±1.49) respectively.

Conclusion: Combined administration of vit. E and testosterone ameliorates diabetes–induced dyslipidaemia, beta cells necrosis, reduced sperm count and motility in male Wistar rats.

Open Access Original Research Article

Fertility Desire and Reproductive Health Education Needs of Women Living with HIV Receiving Care at Regional Hospital Limbe HIV Treatment Centre

Leku R. Tekoh, Abe H. Tesoh, Nembo S. Tanjoh, N. F. Fonkeng, Mbah J. Njei, Roland N. Ndip, Jane Francis T. K. Akoachere

Journal of Advances in Medicine and Medical Research, Page 1-13
DOI: 10.9734/BJMMR/2016/25879

Aims: Fertility desires among persons living with HIV (PLHIV) could have important HIV prevention and demographic implications particularly in high prevalence settings such as Cameroon. There is a paucity of data on fertility desires and associated factors among PLHIV in Cameroon. The aim of the study was to determine whether HIV positive women desire having children so as to improve on the sexual and reproductive health messages and services provided to them.

Study Design: This was a facility based cross-sectional study.

Place and Duration of Study: Regional Hospital Limbe (RHL) HIV treatment centre between May and June 2014.

Methodology: Systematic sampling was used to select 250 women between the ages of 15–49 years as they consulted at the clinic. Participants were recruited and data collected using an interviewer administered questionnaire.

Results: Mean age was 32 years and 75.9% were sexually active. In this study, 51.4% were not married while 48.6% were married. Fertility desires was high (83.3%) and child bearing after HIV diagnosis was common (48%) with 71.2% of them not going in for preconception counseling. In multivariate analysis, older age (OR: 20.895, 95%CI: 5.3-83.5), not using condom (OR: 30.021, 95% CI: 3.4-262.6) and not being married (OR: 4.87, 95%CI: 1.4-17.6) were having a significantly higher chance of desiring children in future. Majority of WLWHIV (86.9%) indicated a need for RH education. Fertility desire (OR: 11.013, P=.001), previous RH discussions (OR: 7.49, P=.001) and knowledge of PMTCT (OR: 3.647, P=0.021) were the best predictors of RHE need.

Conclusion: A substantial number of WLWHIV attending RHL HIV treatment centre desire having children and there is unmet Reproductive Health Education needs for these women. There is need to sought new strategies to address reproductive health care services so as to satisfy reproductive health care needs of HIV positive woman in Cameroon.

Open Access Original Research Article

Risks of Intravenous Fluid Therapy by First Year Residents – A Prospective Study

Nicola Scott, Jonathan Squibbs, Andrew Lake, Arpan Guha

Journal of Advances in Medicine and Medical Research, Page 1-13
DOI: 10.9734/BJMMR/2016/25456

Aims: Intravenous fluid prescriptions are common in hospitals and most are written by junior doctors. Despite the frequency in which clinicians prescribe IV fluids, the burden from mortality and morbidity related to IV fluids is huge with an estimate that 1 in 5 patients are harmed by inappropriately prescribed fluids. We wished to identify the deficiencies in foundation year 1 doctors’ (FY1s, first year of clinical practice after graduation) knowledge and practice of IV fluid prescribing and to identify barriers to good prescribing practice that they had encountered on the wards. FY1s are in their first year of internship after graduating from medical school and this UK experience may be mirrored across the world.

Study Design: A prospective, mixed methods study was carried out, using questionnaires, educational interventions and post-interventional evaluation.

Place and Duration of Study: Royal Liverpool & Broadgreen University Hospitals NHS Trust, Prescott Street, Liverpool, UK. The study took place over 2015.

Methodology: A 53 point questionnaire was designed and used to sample data. An educational intervention was designed after a gap analysis and post-intervention sampling to assess the efficacy of the interventions was also carried out.

Results: Significant deficiencies were revealed in the ability to prescribe maintenance fluids. 33% of doctors (n = 8) had not read any guidance about IV fluid prescribing. 42% (n = 10) of participants adhered to fluid prescribing guidance. 17% (n=4) doctors stated that they did not know the contents of fluid bags they prescribed. Only 25% (n = 6) of first year residents indicated that they adhered to weight based prescribing and 4% and 16% felt they at times prescribed too much sodium or water, or too little potassium, for maintenance. Most residents (92%, n=22) reported checking patient’s latest urea and electrolyte values prior to prescribing IV fluids and 54% (n=13) indicated that they reviewed the patient clinically prior to prescribing fluids, However, 67% (n = 16) reported not documenting IV fluid therapy and fluid status in the case notes. The analysis of the narrative data showed system barriers, such as nurses not weighing patent weight, as contributing to the deficiencies in prescribing correctly. The intervention was successful in reversing the deficiencies to a large extent. However cultural and system barriers were also identified.

Conclusion: Cultural and system barriers are significant in any learning and need to be taken into account when designing healthcare improvements.

Open Access Original Research Article

Microbiota Evaluation and Extracellular Cytokine Profile in Patients Affected with Intraabdominal Infection

João Fernando Gonçalves Ferreira, João Baptista Rezende-Neto, Rogério Augusto Pinto-Silva, Jaqueline Gontijo de Souza, Luiz de Macêdo Farias, Maria Auxiliadora Roque de Carvalho, Helton Santiago, José Carlos Serufo, Simone Gonçalves dos Santos

Journal of Advances in Medicine and Medical Research, Page 1-14
DOI: 10.9734/BJMMR/2016/25281

Failures in the control of infectious focus may be associated with Intra-abdominal infections (IAI)-driven sepsis. We evaluated the bacterial antimicrobial profile and the cytokine production in patients with IAI in Belo Horizonte, Brazil. To the analyses, Vitek 2 bioMérieux and BD-CBA Human Inflammatory Cytokines were used. Escherichia coli, Enterococcus faecalis and Bacteroides fragilis were predominant in this cohort. Enterobacteriaceae was resistant to at least 4 different antimicrobial classes and 80.0% of Acintobacter baumannii strains to imipenem. 81.8% of Staphylococcus spp. were methicillin-resistant. Penicillin and clindamycin resistance were found in 80.0% and 26.7% of anaerobes, respectively. IL-8 was found in all IAI secretions and in 93.5% of analyzed sera; while IL-6 was identified in 93.5% of patient’s serum and in 51.6% analyzed secretions. IL-10 was detected in 53.3% of patient’s serum. Our data indicates the relevance of further cytokine profile studies to better understanding the evolution of these processes.

Open Access Original Research Article

A New Fixed Dose Combination of Ceftriaxone + Sulbactam + Disodium Edetate for Definitive Treatment of Infections Due to Piperacillin/ Tazobactam Resistant Bacteria: A Retrospective Efficacy and Pharmacoeconomic Study

Prashant Bhatia, Mohd Amin Mir

Journal of Advances in Medicine and Medical Research, Page 1-14
DOI: 10.9734/BJMMR/2016/25102

Objective: Present retrospective study was aimed to analyze comparative efficacy of fixed dose combination (FDC) (ceftriaxone + sulbactam + disodium edetate) and meropenem used alone or in combinations with other antibiotics for management of intensive care unit (ICU) patients suffering with infections from piperacillin-tazobactam (pip-taz) resistant bacteria and to assess the costs associated with respective therapies.

Methodology: Patients records were collected and their demographic characteristics, infection types, co-morbidities, antibiotic therapy, dosage, treatment duration microbial and clinical success rates were evaluated. Effectiveness and costs analysis between antibiotic regimens were estimated in Indian rupees (INR). A total of 136 patients data treated at a tertiary-care hospital was analyzed. These 136 patients included 28, 18, 19, 17, 31 and 23 patients of urinary tract infection (UTI), blood stream infection (BSI), community acquired infection (CAI), skin structure infection (SSI), intra-abdominal infection (IAI) and ventilator associated pneumonia (VAP), respectively. Out of 136 patients, 56 patients received FDC and another 80 patients were administered with meropenem empirically.

Results: Clinical cure observed was 71.42% and 67.50% in FDC and meropenem groups, respectively. The patients in whom meropenem and FDC treatment regime failed to show improvement, colistin was given as an additional cover, which resulted in clinical cure of 86.95% and 85.71% patients respectively. Comparative cost expenditure analysis of these two drug treatment regimens revealed that, the overall treatment cost for patients cured with antibiotic regimen containing meropenem was 107.39% more than that of FDC. The strongest contributors of the increase in treatment costs were cost of antibiotic, number of dosages, average treatment duration and clinical failure rates.

Conclusion: Infections with pip-taz resistant bacteria are frequent in ICU patients and the present study demonstrates that FDC has comparatively similar efficacy as that of meropenem which is considered as an appropriate option to treat pip-taz resistant cases. Pharmacoeconomic analysis clearly advocates in favor of FDC as a cheaper and safer alternative to meropenem to treat ICU patients with infections caused due to pip-taz resistant bacteria.

Open Access Original Research Article

Pattern of Head Injury in the Emergency Department of the Delta State University Teaching Hospital, Oghara, Nigeria

A. A. Bock-Oruma, D. O. Odatuwa-Omagbemi, J. E. Ikubor

Journal of Advances in Medicine and Medical Research, Page 1-6
DOI: 10.9734/BJMMR/2016/25409

Background: Head injury (HI) is a common condition presenting to Emergency Departments (EDs), accounting for a significant proportion of morbidity and mortality of the productive age of the world’s population.

Aim: This study aims to highlight head injured patients’ epidemiological pattern as seen in the Emergency Department of the Delta State University Teaching Hospital (DELSUTH), Oghara, Nigeria.

Methodology: This was a prospective study of all consecutive head injured adult patients seen in the ED of DELSUTH from January to December, 2014. The variables assessed included age, gender, aetiology, severity of injury and mortality. Glasgow Coma Scale (GCS) was used to assess the severity of head injury.

Results: Eighty-eight head injured patients were seen in the ED in the period under review. The mean age was 32.80±12.50 years. Age range was 17-85 years. The most affected persons were from 25-34 years of age (31.8%). The male: Female ratio was 9 to 1. On aetiology, 4.4% of the patients had a fall, 13.6% were assaults and 81.9% had Road Traffic Accident (RTA). In terms of severity of injury, 49 (55.7%) of the patients had mild HI, 20.4% had moderate head injury and 23.8% had severe HI. RTA was the sole aetiology of head trauma for those 45 years and above (22.7%). Six (6.8%) of the patients died while receiving treatment at the ED before transfer for further specialised care.

Conclusion: Head injury is a major contributor to trauma admissions in the ED. The economically most productive age groups and the male sex are mostly affected. RTA is still a major cause of head injury in our society. There is therefore the need for the education of road users on road safety measures and for the government to improve on the state of the roads. Increased funding for pre-hospital and specialist neurosurgical facilities and personnel will also ensure that head injured patients get the best care possible.

Open Access Original Research Article

High Flow Nasal Cannula in the Treatment of Respiratory Distress Syndrome in One Day-old Neonate

Ramin Iranpour, Alireza Sadeghnia, Shima Salehi Abari

Journal of Advances in Medicine and Medical Research, Page 1-7
DOI: 10.9734/BJMMR/2016/25316

Background: This study was carried out to compare high flow nasal cannula (HFNC) and nasal intermittent mandatory ventilation (NIMV) in respiratory support of one day-old neonates with respiratory distress syndrome (RDS).

Methods: This was a clinical trial conducted in neonatology wards of two university affiliated hospitals from Sep 2013 to Dec 2014. Inclusion criteria were gestational age of 30 to 35 weeks, appropriate weight for gestational age, clinical signs and symptoms of RDS, and RDS suggestive chest-X ray. All patients with RDS were treated with NIMV for one day. Those requiring NIMV respiratory support more than one day and showed the signs of respiratory distress were randomized into two groups of NIMV and HFNC. Each group consisted of 30 patients. Outcome measures included chronic lung disease, mechanical ventilation, failure to treatment, the time to establish full enteral feeding and the mortality rate. In addition, all complications were recorded. Characteristics of the two groups were compared at baseline and after the intervention.

Results: Mean gestational age of patients in NIMV and HFNC groups was 31.81 (1.83) and 31.83 (1.39) weeks, respectively. Distributions of sex, gestational age, height, head circumference, and Apgar scores at the first and fifth minute after the birth were not significantly different between the two groups. Mean (SD) duration of respiratory support after the 1st day was 16.48 (7.80) hours in NIMV group and 18.46 (6.95) in HFNC group (P=0.3). Mean (SD) duration of hospitalization in NICU was 3.24 (0.68) days in NIMV group and 3.2 (0.06) in HFNC group (P=0.8). Mean (SD) age when oral feeding was started, was 23.37 (5.78) hours in NIMV group and 20.13 (5.38) hours in HFNC group (P=0.03). Eleven patients (36.7%) in NIMV group vs. 2 patients in HFNC group required free oxygen therapy (P=0.005). No treatment failure, chronic lung disease, mechanical ventilation or endotracheal intubation was observed in any group. 100% vs. 10% in NIMV and HFNC groups, respectively, experienced grade 3 and 4 nasal mucosal damage (P<0.01).

Conclusion: HFNC was more tolerable than NIMV in the treatment of RDS in premature neonates' ≥30 week-old when applied after the first day of life.

Open Access Original Research Article

Analysis of Work-related Injuries among Health Care Workers in Armed Forces Hospital Southern Region, Kingdom of Saudi Arabia

Maryam Ahmed Awaji, Khalid Alahmary

Journal of Advances in Medicine and Medical Research, Page 1-10
DOI: 10.9734/BJMMR/2016/25056

Introduction: Safety of healthcare workers (HCWs)  is essential for patients safety. Despite of this fact, HCWs are at high risk of work-related injuries (WRI). Those injuries include falls, musculoskeletal disorders, needle stick  injuries (NSIs) and workplace violence. These injuries have a negative impact on HCWs and reduces the quality of care. It is, therefore, important to analyze the occurrence of WRIs aiming the design of better targeted interventions to improve safety environment and work conditions in hospitals, which in turn, can improve the quality and outcomes of patient care.

Methods: A retrospective study collected data about WRI reports available in the Armed Forces Hospital Southern Region (AFHSR). Injuries were NSIs that occurred during  the period from January 2010 to June 2015 and workplace violence during the period from March 2014 to June 2015.

Results: Total NSIs were 338 with a peak incidence of 85 (4.39%) during 2010, while the lowest incidence occurred during 2015 (n= 31, 1.12%). Regarding to workplace violence, 211 incidents were reported over the period of two years, and there was decreasing from 125 cases (4.73%) in 2014 to 86 cases (3.11%) in 2015.

Discussion: The analysis showed that nurses had the highest rate of NSIs and workplace violence as compared to other HCWs. The highest rate of NSIs took place in dental, family and community medicine clinics which are usually crowded and had more activities, but emergency room and other clinics had the highest frequency of workplace violence.

Conclusion: Needle stick injuries and workplace violence represent a major occupational challenge to HCWs in the hospital. To prevent those types of WRIs, there is a need for a system of environmental safety, continuous education, skills development, and infection control surveillance that is based on best available evidence of quality and safety best practices.