Open Access Case Report

Open Access Original Research Article

Impact of Monitoring Endotracheal Cuff Pressure on Endoscopic Laryngo-Tracheal Injury: A Randomized Pilot Study

Tilouche Nejla, Ben Sik Ali Habiba, Jaoued Oussema, Gharbi Rim, Driss Nabil, Fekih Hassen Mohamed, Elatrous Souheil

Journal of Advances in Medicine and Medical Research, Page 1-10
DOI: 10.9734/JAMMR/2017/37186

Aims: Underinflation (<20 cmH2O) and overinflation (>30 cmH2O) of tracheal cuff are independent factors of microaspiration and tracheal ischemic lesions respectively. The aim of this study was to evaluate the impact of discontinuous monitoring of endotracheal cuff pressure on the incidence of endoscopic laryngotracheal injury and to analyze factors associated with the development of these lesions.

Study Design: Prospective and randomized study.

Place and Duration of Study: Medical Intensive care unit at Taher Sfar Hospital in Mahdia, between December 2010 and April 2012.

Methodology: All patients admitted to our intensive care unit (ICU) and requiring invasive mechanical ventilation for more than 48 hours were randomly assigned to have or not a discontinuous cuff pressure monitoring. The primary outcome was the incidence of endoscopic laryngotracheal injury during ICU stay. Secondary outcomes were the incidence of endoscopic laryngotracheal injury at day-90, ventilator-associated pneumonia, the length of stay, the duration of mechanical ventilation and mortality.

Results: Ninety-five patients (49 in the monitored group and 46 in the control group) aged 59 ± 20 years, were included in the study. The incidence of endoscopic laryngotracheal injury was 42% with no significant difference between study groups. The proportion of patients with tracheal granulation was significantly lower in the monitored group: 4% vs 24% (p= 0.0049). Secondary outcomes were similar between the two groups. ICU admission for intoxication was the only independent factor associated with the occurrence of endoscopic laryngotracheal injury (OR 6.779, CI 95% (1.121- 41,008); p= 0.037).

Conclusions: Discontinuous monitoring of cuff pressure did not reduce the overall incidence of endoscopic laryngotracheal injury but only the incidence of tracheal granuloma. These results recommend the routine survey of cuff pressure in ICU.

Open Access Original Research Article

Association of Age and Gender with Simulated Cardiopulmonary Resuscitation Skills Performance in Some Nigerian Student Teachers

Adedamola Olutoyin Onyeaso, Onyedikachi Oluferanmi Onyeaso

Journal of Advances in Medicine and Medical Research, Page 1-9
DOI: 10.9734/JAMMR/2017/37228

Background: The importance of teachers in bystander cardiopulmonary resuscitation (CPR) and the varying influences of demographics such as age and gender in its effectiveness have been documented. Contributions from Nigerian researchers on bystander CPR are very limited. This study aimed at assessing the association between CPR skills and age and gender of future Nigeria teachers.

Methods: A quasi-experimental cohort study involving 41 males and 41 females aged 17 -28 years was carried out in June 2017.The post-training CPR skills of the participants were assessed by one American Heart Association-trained instructor using a modified AHA Evaluation Guide involving four components: Scene Safety & Call for Help (SS); Chest Compressions (CC); Airway & Rescue Breaths (RB); and Cycle / min & Placement of victim in the correct Recovery Position (CR). The data was analysed using descriptive and parametric statistics with p-value < 0.05.

Results: Male participants generally had better chest compressions skills which were not statistically significant (p > 0.05). No statistically significant association was found between CPR skills and gender (p > 0.05), as well as for age except for the scene safety / call for help domain which had significant association with age (p = 0.003).

Conclusion: No age and gender associations were found with the different CPR skills except the significant association found between age and the scene safety / call for help domain.

Open Access Original Research Article

Effect of Nurse-led Training on Self-management of Diabetes among Diabetic Patients Attending Medical Outpatient Clinic in General Hospital Odan, Lagos State, Nigeria

Olajide, Tayo Emmanuel, Nwaokocha Chinonye, Aina, Folasade, Ogunfowokan, Oluwatosin, Awoniyi Adeola Mary

Journal of Advances in Medicine and Medical Research, Page 1-8
DOI: 10.9734/JAMMR/2017/37694

Aims: Diabetes mellitus is a common metabolic disease associated with poor quality of life and great financial burden. Despite training on self-management of diabetes mellitus, its knowledge and practice among diabetic patients has been low. The study assessed the effect of nurse-led training on self-management of diabetes mellitus among diabetic patients attending the medical out-patient’s clinic of General Hospital Odan, Lagos, Nigeria.

Study Design: One group pre-test, post-test quasi-experimental study was adopted.

Methodology: Researchers included 20 diabetic patients (12 men, 8 women; age range 25-65 years) attending medical outpatient clinic of the hospital using purposive sampling. Participants completed a developed questionnaire to assess knowledge and practice regarding diabetes self-management pre-intervention and two weeks post-intervention. Data were analysed using descriptive and inferential statistics at 0.05 level of significance.

Results: There was 70% increase in knowledge regarding diabetes self-management among participants post-intervention. There was 45% increase in practice regarding diabetes self-management among participants post-intervention. Result showed significant difference in the effect of a nurse-led training on knowledge regarding self-management among diabetic patients pre and post-intervention with a mean difference in knowledge score of 14.2 (P=.000). Result also showed significant difference in effect of nurse-led training on practice regarding self-management among diabetic patients pre and post-intervention with a mean difference in practice score of 1.05 (P= .000).

Conclusion: Training program on self-management of diabetes can improve diabetic out-patients knowledge and practice regarding diabetes self-management. The study recommended that hospitals should regularly expose patients to training programmes on diabetes self-management to improve patients’ quality of life.

Open Access Original Research Article

CARBA NP a Rapid and Reliable Test for Detection of Carbapenemases in Gram Negative Bacteria

Saba Choudhary, Bashir Ahmad Fomda, Munazah Manzoor, Gulnaz Bashir, Asiya Khan, Mir Yawar

Journal of Advances in Medicine and Medical Research, Page 1-11
DOI: 10.9734/JAMMR/2017/36876

Both molecular and non-molecular tests currently employed for the detection of carbapenemases are costly, time-consuming and are poorly adapted to the clinical need for isolating patients rapidly to prevent health care associated outbreaks. The present study was thus conducted for rapid detection of carbapenemases in clinical isolates of Gram negative bacteria by Carba NP test. A total of 270 Gram-negative bacilli included were divided into three groups Group I (n=100): Gram negative bacteria isolated from routine samples. Group II (n=130): Imipenem resistant Gram negative bacteria. Group III (n=40): Twenty PCR confirmed for bla VIM and bla NDM1 and twenty PCR negative for bla VIM and bla NDM1 isolates. These isolates were subjected to Carba NP test. Antimicrobial susceptibility was performed by Kirby Bauer disk diffusion method. Out of 100 isolate (Group I), 32 were positive and out of 130 imipenem resistant (Group II), 112 isolates were positive for carbapenemase production by carba NP test. The sensitivity and specificity was 100% for Carba NP test. This test is rapid, user-friendly and does not require costly equipment hence is suitable for resource poor settings. Rapid detection of carbapenemase by this test and timely institution of infection control measures will help in preventing spread of infection.

Open Access Original Research Article

Half of Three Oral Antidiabetic Drugs as a Regimen for Treatment of Type 2 Diabetes Mellitus Patients in Low-income Populations

Mohamed A. Mashahit, Eman M. Ezzat, Ahmed A. Hammad

Journal of Advances in Medicine and Medical Research, Page 1-7
DOI: 10.9734/JAMMR/2017/37656

There is a progressive increase in the number of patients developing type 2 diabetes mellitus (T2DM), worldwide. Several classes of antidiabetic drugs are available. Metformin is a biguanide with many pleiotropic effects in addition to decreasing hyperglycemia. Dipeptidyl-peptidase 4 (DPP4) inhibitors are a group of medications used as glucose-lowering agents in T2DM.The combination of metformin plus DPP4 inhibitors have an additive effect on improving HbA1c level but of high cost, especially in low-income countries like Egypt. So, the aim of this study is to assess the efficacy and safety of adding sulphonylureas (e.g, glimepiride or gliclazide) to half the dose of a DPP4 inhibitor /metformin combinations compared to using the full dose of this DPP4 inhibitor /metformin combination in T2DM.

Materials and Methods: This prospective study was conducted on186 patients with type 2 diabetes mellitus (T2DM), who achieved glycemic targets on DPP4 inhibitor (sitagliptin or vildagliptin) 50 m /metformin 1000 mg, twice daily fixed-dose combination. The enrolled subjects were then divided into 2 groups. Group1 were 92 patients continued on the same regimen. Group 2 (patient who could not afford the high cost of the DPP4 inhibitors) shifted to half the dose of the DPP4 inhibitor / metformin plus a dose of sulphonylureas (SU) either Glimepiride (4 mg) or Gliclazide (60 mg slow release form) once daily. For both groups: weight, fasting blood glucose (FBG), 2 hours postprandial glucose (2 hrs PPG), and glycated hemoglobin (HbA1c), were measured at the start and after 12 weeks of the study.

Results: There were a decrease in FBG, 2hs PPG, and HA1c with an increase in weight and in the mean number of hypoglycemic episodes per patient among participants shifted to half the dose of DPP4 inhibitor /metformin with an added dose of SU compared to the other group of patients continued on the full dose of the same DPP4 inhibitor /metformin combination.

Conclusion: Adding sulphonylureas (either glimepiride or gliclazide) to half the dose of a DPP4 inhibitor/metformin combination is non-inferior to using the full dose of this DDP 4 inhibitor/metformin combination twice daily in T2DM patients with low risk of hypoglycemia. This regimen may be effective and safe for low-income populations like Egypt.

Open Access Original Research Article

Complications Following Prostate Biopsy in a Tertiary Hospital in Trinidad and Tobago

Kirk Gooden, Nastassia Rambarran, Lester Goetz, Satyendra Persaud

Journal of Advances in Medicine and Medical Research, Page 1-5
DOI: 10.9734/JAMMR/2017/38275

Objective: To prospectively evaluate the complications of prostate biopsy at the San Fernando General Hospital.

Methods: All patients, who underwent prostate biopsy between June, 2013 and September, 2014 were prospectively evaluated at the San Fernando General Hospital. A pre biopsy questionnaire was obtained to provide demographic information. Immediate complications were recorded at the time of the procedure. Patients were contacted by telephone every week for four weeks following biopsies and complications recorded. Clinical information included race, PSA, prostate volume, hypertension, diabetes, previous hospital admission and recent antibiotic usage.

Results: From June 2013 to September 2014, approximately 233 men underwent prostate biopsy at the San Fernando General Hospital. The mean age of the patient was 68.2 years. PSA elevation was the commonest indication for prostate biopsy (66.6%). Most patients tolerated the procedure with minimal discomfort.  The most common complication was haematuria and was noted in 57.7% of patients with mean duration of 2.95 days. 8.6% complained of hematospermia with a mean number of ejaculates of 2.6. Rectal bleeding was reported in 19.2% with a mean duration of 1.95 days. 15% complained of new onset or worsening of voiding symptoms and 1.4% experienced acute urinary retention. Of the 7.7% who experienced infective complications of which 3 (1.4%) required hospital admission.

Conclusion: Transrectal ultrasound guided needle prostate biopsy is associated with frequent minor complications and few major complications. Infective complications still remain a concern and further study is still required to identify possible contributing risk factors.