Open Access Case Report

Coexistence of Sarcoidosis and Tuberculosis Presenting with Severe Pulmonary Artery Hypertension: A Clinical Dilemma

Bhanuja Bhagwat, Vijayashree Thyagaraj

Journal of Advances in Medicine and Medical Research, Page 1-6
DOI: 10.9734/JAMMR/2018/41337

Background: Chronic granulomatous conditions affecting the respiratory system such as tuberculosis and sarcoidosis have similar case presentations suggesting them to be polar ends of the same disease spectrum thus putting physicians into a clinical dilemma. This case report highlights one such unique presentation.

Case Presentation: A young female, presented with respiratory distress and significant weight loss. Investigations showed severe pulmonary artery hypertension (PAH), renal failure and generalized lymphadenopathy suggesting multisystem involvement. The initial diagnosis was sarcoidosis warranting corticosteroids but since Mantoux test suggested tuberculosis we were in a dilemma regarding therapeutic options.

Conclusion: This case highlights a rare presentation of sarcoid tuberculous with severe PAH urging physicians to consider this chronic granulomatous disease spectrum during work up of their patients. The authors would also like to emphasize the importance of starting combined therapy on early recognition to combat a possible disease entity like tuberculous sarcoid patients. These predictors, however, need further work to validate reliability.

Open Access Case Study

Non-neoplastic Pulmonary Hyalinising Granuloma

R. Paluri, N. Paranjape, A. Manne

Journal of Advances in Medicine and Medical Research, Page 1-5
DOI: 10.9734/JAMMR/2018/41728

Pulmonary hyalinising granuloma (PHG) is a rare, benign and non-infectious   pulmonary fibrosing lesion   with unknown etiology. Fewer than 100 cases have been reported thus far. PHG can mimick advanced lung carcinoma and should therefore be a part of differential diagnosis for pulmonary nodule. It is characterized by whorled deposits of collagen and hyaline.  Here we report the case of a 43 years old female who presented with dyspnea and constitutive symptoms. Imaging studies revealed bilateral pulmonary nodue and the histopathology consistent with PHG. 

Open Access Original Research Article

Childhood Urinary Tract Infection: Clinical & Laboratory Profile in a Tertiary Care Hospital of Bangladesh

N. I. Nazme, M. R. Ahsan, F. Jalil, N. N. Fatema

Journal of Advances in Medicine and Medical Research, Page 1-9
DOI: 10.9734/JAMMR/2018/33827

Background: Urinary Tract Infection (UTI) implies presence of actively multiplying organisms in the urinary tract. Although it is infrequently associated with mortality, it is still an important cause of morbidity in the paediatric age group. Prompt diagnosis and early initiation of appropriate antibiotics in children reduce the morbidities associated with UTI.

Objective: This study was undertaken to observe the clinical and laboratory profile of UTI in children attending outpatient department (OPD) of Combined Military Hospital (CMH) Dhaka.

Methods: This observational cross sectional study was carried out in CMH Dhaka within the period of June 2015 to May 2016. A total of 120 children aged 0 months to 12 years attending paediatric OPD with symptoms of suspected UTI were included in this study. All the children were subjected to do urine analysis including microscopy and culture-sensitivity. Other relevant workups were also done. After enrollment, clinical and laboratory profile were obtained and recorded in case record form.

Results: Among 120 patients, 63.3% were females and 36.7% were males. Overall highest number of cases was within the age group of 0 to 5 years (62.5%). The most common clinical presentation was fever (64.2%). Common risk factors were wiping of genital area from back to front (91.7%), irregular antihelminthic intake (70.8%), intake of inadequate drinking water (51.7%), infrequent voiding habit (37.5%) and constipation (32.5%). Patients having previous urethral instrumentation and uncircumcised boys had significantly higher rate of UTI. Among all urine analyses 75% urine samples revealed pyuria. Urine culture was positive in 58 (48.3%) subjects and Escherichia coli (62%) was the commonest isolated organism. The common organisms were highly sensitive to Ciprofloxacin and Levofloxacin. Ultrasonography(USG) of whole abdomen showed abnormal findings in 17.5% cases. High Erythrocyte Sedimentation Rate (ESR) and neutrophilic leukocytosis was evident in 25% cases.

Conclusion: This study revealed that UTI was more common in female & under five children. Fever was the commonest symptom and uncircumcised boys had significantly higher rate of UTI. Escherichia coli were the commonest isolated organism but it was resistant to commonly used antibiotics like Amoxycillin and Cephalosporines. In the outdoor set up of CMH Dhaka, Ciprofloxacin and Levofloxacin can be used empirically for UTI treatment after sending urine culture and sensitivity, as most of the organisms are sensitive to these drugs.

Open Access Original Research Article

Organisms Isolated and Their Antibiotic Sensitivity Pattern from Renal Transplant Recepients in Kidney Transplant Unit

Shaista Nazir, Dekyong Angmo, Bashir Ahmad Fomda, Shazia Benazir, Asifa Bhat, Leenah Bashir, Shadan Akhtar

Journal of Advances in Medicine and Medical Research, Page 1-6
DOI: 10.9734/JAMMR/2018/40944

Aim: Despite improvements on immunosuppressive therapy and surgical techniques, infections remain important complication in renal transplant and have been associated with increased morbidity and graft rejection. Role of   microbiological cultures in isolating bacteria and formulating their antibiogram has potential benefits with regards to targeted therapy for MDR bacteria. No such study has been conducted previously from this region so we designed this study to find out the organisms causing infections in renal transplant patients and their antibiotic susceptibility pattern.

Materials and Methods: This retrospective study was conducted over a period of 1 year from 2016 to 2017. All samples were sent from Kidney Transplant Unit (KTU) for culture and sensitivity irrespective of duration of post renal transplant. Qualitative culture of other infected body fluids was performed on blood agar, MacConkey agar plate (Hi media, India). Positive cultures were processed for antimicrobial susceptibility testing on Mueller-Hinton agar plates, using the Kirby-Bauer disk diffusion method, according to the CLSI guideline.

Results: A total of 81 samples were received from kidney transplant unit for culture, out of which 48 (59.2%) were sterile and 33 (40.8%) were culture positive  samples. Urinary tract infection (UTI) (69.6%) was the most common infection followed by wound infection (21.2%) and respiratory tract infection (9.09%). In our study most common organism isolated from UTI was Escherichia coli (30.3%), followed by K. pneumoniae, (21.2%), MRSA (Methicillin resistant Staphylococcus aureus) (18.2%), Acinetobacter spp. (9.1%), Enterococcus spp. (12.1%), Pseudomonas aeruginosa (6.1%), Streptococcus pyogenes (3%).  Antibiotic susceptibility of different organism isolated during culture showed that all strains of Escherichia coli   identified were sensitive to amikacin and none of the strains was resistant to it.

Conclusions: To conclude, UTI was the most common infection followed by wound infection and respiratory tract infection. The most prevalent organism in UTI patients was Escherichia coli and its in vitro antibiotic susceptibility was highest to amikacin (100%) and resistant to cephalosporin, quinolones. The incidence of MRSA was found to be higher as compared to the other studies and needs to be kept in mind while treating transplant recipients.

Open Access Review Article

Aerosolized Coal Fly Ash: Risk Factor for COPD and Respiratory Disease

Mark Whiteside, J. Marvin Herndon

Journal of Advances in Medicine and Medical Research, Page 1-13
DOI: 10.9734/JAMMR/2018/41627

Aim: Coal fly ash (CFA) is a significant contributor to ambient air pollution in India and China, but regulations require its trapping and sequestering in Western nations. Members of the public chronically exposed to aerosolized CFA are likely to have an increased incidence of respiratory disease, including chronic obstructive pulmonary disease (COPD). Our objective is to review the multiple chemical constituents of aerosolized CFA in connection with their potentiality to cause COPD and respiratory disease.

Methods: We review the interdisciplinary medical, public health, and scientific literature.

Results: Tropospheric geoengineering is and has been undertaken since the beginning of the 21st century, with increasing frequency and duration, without public discussion and without disclosure of the particulate matter composition being placed into the air we breathe, or its effects on biota including humans. Published data is consistent with the primary constituent being CFA, the toxic waste-product of coal-burning. We review and to bring together evidence spread throughout the medical/scientific literature that bears on the health risks posed by particulate matter, and especially CFA, aerosolized in industrial settings and in the troposphere during geoengineering activities and to consider in particular the potential consequences on chronic obstructive pulmonary disease (COPD) and respiratory disease.

Conclusion: Aerosolized CFA is a particularly hazardous form of deliberate air pollution. Ultrafine particles and nanoparticles found in coal fly ash can be inhaled into the lungs and produce many toxic effects including decreased host defenses, tissue inflammation, altered cellular redox balance toward oxidation, and genotoxicity. Oxidative stress and chronic inflammation can predispose to chronic lung disease. Recognition and public disclosure of the adverse health effects of geoengineering projects taking place in our skies, and their concomitant cessation will be necessary to prevent an ever-widening epidemic of COPD and other respiratory illnesses.

Open Access Review Article

Psychosocial Aspects of Diabetes Care and Family-Integrated Diabetes Education

Lucia Yetunde Ojewale, Abimbola Oyenihun Oluwatosin

Journal of Advances in Medicine and Medical Research, Page 1-11
DOI: 10.9734/JAMMR/2018/40800

Diabetes mellitus (DM) is a complex, multifaceted condition, which has to be managed throughout the entire life of an individual diagnosed with it. It is complex and multifaceted because it requires a combination of various behavioural modifications. These modifications include changes in diet, the inclusion of an exercise programme in weekly/daily schedule, learning and practising new skills such as self-administration of insulin injection, drawing blood through finger-prick, among others. These changes, along with fear and anxiety about hypoglycaemia, place a lot of psychological stress on the person living with diabetes, since man is a bio psychosocial being.

Psychosocial support from family members can reduce the burden associated with managing DM. However, the psychosocial aspect of DM care is often overlooked by healthcare workers and family members.

The paper highlights the meaning of psychosocial support, the concept of man as a biopsychosocial being; the social and psychological effects of diabetes mellitus; ways of providing psychological support to the patient, importance of family members’ diabetes-education and theories that are associated with psychosocial care.

Open Access Review Article

An “Abundance” Phenotype Hypothesis for Autism

Amalia S. F. Megremi

Journal of Advances in Medicine and Medical Research, Page 1-14
DOI: 10.9734/JAMMR/2018/41138

Autism spectrum disorder (ASD) is significantly increased in recent decades, all over the world. The enlargement of the disorder’s diagnostic criteria and the increased accessibility of diagnostic and treatment services, are not the only factors that could explain the phenomenon. 

Literature review was made in order to formulate a possible explanation for autism epidemics today. So, different phenotypic characteristics of autism (such as macrocephaly, megalosomy, obesity), laboratory findings (such as increased BDNF, IGF-1, IGF-2, IGFBP-3, GHBP, testosterone and oxytocin), and some autism risk factors (such as maternal metabolic conditions, prenatal and postnatal nutritional supplements, infant milk formula and breastfeeding) are discussed from an ecological and evolutionary neuropathology aspect and it is proposed that autism is the result of increased activation of growth pathways, especially at neural tissue and it may represents an adaptive response to modern urban “environmental abundance”.

It is thus proposed that autism is the result of epigenetic disruption in brain development caused by gestational exposure to these conditions (which interfere with neurogenesis).

So, it is hypothesized that autism is the physiological and ecological cost that is paid for the enhanced growth rate activation, especially in neural tissue, due to increased resource and energy availability during prenatal and postnatal period of increased plasticity (excess numbers of neurons are produced but they are also liable to impairment).

So, an “abundance” phenotype hypothesis for autism may emerge, a holistic approach of childbirth would be possible and well organized preventive programs (about parental health and nutrition before conception, nutrition of pregnant woman and child, optimal breastfeeding, rational use of nutritional supplements, etc) could be carried out.