Open Access Original Research Article

Sensitivity and Resistance Patterns of Gram-Negative Uropathogens Isolated from the Urine of Patients with Upper/Lower Urinary Obstruction in Nigeria

John E. Raphael, Victor Abhulimen

Journal of Advances in Medicine and Medical Research, Page 11-19
DOI: 10.9734/jammr/2022/v34i931343

Background: Urinary tract infection is a cause of significant morbidity and potential mortality in patients. Urine microscopy culture and sensitivity enable the isolation of the incriminating microbes. The sensitivity and resistance of the various microorganisms are invaluable in the effective management of UTIs and the associated adverse consequences. Gram-negative organisms are the usual pathogens responsible for most UTIs. The abuse of antibiotics can increase the prevalence of antimicrobial resistance. This leads to an increased cost of treatment, as more expensive higher-end antibiotics may become indicated. There is also the risk of spreading multidrug-resistant infections to the community.

Aims: To evaluate the sensitivity and resistance patterns of commonly available antibiotics to uropathogens in the positive urine culture of patients who presented with upper and lower urinary obstruction.

Methods: This retrospective study was carried out on urine samples of patients with upper/lower urinary obstructive from two specialist urology referral hospitals with a positive culture and sensitivity tests between January 2011 and December 2020. The patients’ case notes were retrieved, and their urine culture, sensitivity results and mode of treatment were analyzed. These data were collated using Microsoft Excel, and they were analysed using SPSS version 20.

Results: 314 urine samples had positive culture and sensitivity tests. All were Gram-negatives: Klebsiella, Escherichia coli, Pseudomonas, Proteus and Citrobacter spp. in decreasing frequency. Among the quinolones, levofloxacin {56.7% (178)} had the highest moderate-high (M-H) sensitivity to the Gram-negative uropathogens; followed by Ciprofloxacin {46.2 % (145)} and Ofloxacin {19.1% (60)}.

The gram-negatives were most sensitive to streptomycin {75.5% (237)} and gentamicin 62.4% (196)} and also least resistant to them. (Streptomycin 11.1%; gentamicin 21.0%) The highest resistance was to Nalidixic acid {90.1%, (225)}, peflacine {76.1% (239)}, Augmentin {73.6% (231)} and Ampicillin{72%(226)}.

Conclusion: Among the commonly available antibiotics in our study, the gram-negative uropathogens are the most sensitive and least resistant to streptomycin, gentamycin and levofloxacin. Levofloxacin had the best sensitivity and lowest quinolones resistance compared to ciprofloxacin and ofloxacin. There is very low sensitivity and high resistance to nalidixic acid, ampicillin, Augmentin, Septrin and Peflacine.

Open Access Original Research Article

Accuracy of Fetal Transcerebellar Diameter in Estimation of Gestational Age in Small for Gestational Age Fetus

Esraa Mohamed Maher Hatata, Mona Khaled Omar, Diaa Moner Aglaan, Ashraf El Mohamdy Ghareb

Journal of Advances in Medicine and Medical Research, Page 20-25
DOI: 10.9734/jammr/2022/v34i931344

Background: Transcerebellar diameter (TCD) is a novel unique measure that is well established in the ultrasound literature as a dependable criterion for estimating gestation length, and it is steadily predominant in predicting GA in singleton and twin gestation, as well as at the fetal growth extremes. The aim of this work was to evaluate the value of use of TCD as a reliable predictor in singleton gestations of GA in SGA pregnancies. Methods: This cross-sectional research enrolled 40 pregnant w

Open Access Original Research Article

Efficacy of Titrating Positive End Expiratory Pressure Recruitment Versus Extended Sigh Recruitment by Volumetric Capnography in Patients with Acute Respiratory Distress Syndrome

Ahmed Kamal Taha, Mohammad Ali Abdallah, Ghada Fouad Elbaradey, Sohair Mostafa Soliman

Journal of Advances in Medicine and Medical Research, Page 26-34
DOI: 10.9734/jammr/2022/v34i931345

Background: The rationale for recruitment maneuvers is to open the atelectatic alveoli, thus increasing end expiratory lung volume, improving gas exchange, and attenuating ventilator induced lung injury. The study aimed to assess the efficacy of titrating positive end expiratory pressure recruitment versus extended sigh recruitment by volumetric capnography in patients with acute respiratory distress syndrome.

Methods: Seventy patients were randomly allocated into two equal groups according to plan for ventilator management of ARDS by protective lung strategy according to ARDS network. Group I (n= 35) titrating PEEP recruitment, and Group II (n= 35) extended sigh recruitment. The primary outcome measure was mortality in the first 28 days wheras the secondary outcome measures were changes in static compliance, dead space to tidal volume ratio, ventilation / perfusion ratio, duration of mechanical ventilation, weaning outcomes, oxygenation and hemodynamic data.

Results: There was no statistically significant difference in 28th day mortality in both groups in group 1, 10 patients were died (28.57%), In group II, 12 patients were died (34.28%) (p value =0.607), wheras there was significant increase regarding static compliance ml/cm H2O, ventilation / perfusion ratio (p value =0.003. 0.001 respectively) and significant decrease regarding dead space to tidal volume ratio in group I compared to group II, 15 minutes after recruitment and significant decrease in duration of mechanical ventilation (days) in group I compared with group II (p value = 0.014, 0.04 respectively). There was a significant difference in weaning categories between both groups with better outcomes in favor of group I (p value = 0.034). The findings of this study presented that there were no significant difference regarding other measurements.

Conclusion: Titrating PEEP recruitment was better than extended sigh recruitment as regard weaning outcomes and duration of mechanical ventilation, which may be due to improvement in aerated lung volume, reflected on decreased dead space to tidal volume ratio, better ventilation perfusion ratio and static compliance.

Open Access Original Research Article

Effect of Hot Fomentation on Plasma HSP70 Levels and Body Temperature

Masayo Nagai, Hidesuke Kaji

Journal of Advances in Medicine and Medical Research, Page 35-40
DOI: 10.9734/jammr/2022/v34i931346

Objective: Our previous study reported that thermal stimulation on thigh muscle in vivo and skeletal muscle-derived cell (SMDC) in vitro favorably changed plasma proteins and several gene expression, respectively, to prevent atherosclerotic cardiovascular disease (ASCVD). In our previous in vitro experiment using transcriptome, hot stimulation caused a slight decrease in SMDC density, associated with higher gene expression of apoptosis-related factors as well as HSP70. In the present study, plasma HSP70 was compared before and after hot fomentation methods as a marker of heat stress. Furthermore, skin temperature was measured to assess whether the hot effect was local or systemic.

Method:  Subjects were volunteers of 3 men and 7 women aged 21.8 ± 1.31 (mean ± SD). Hot fomentation consisted of four types: hot towels, hot packs, red bean bags, and thermal sheets. Plasma HSP70 concentration was determined by ELISA. Skin temperature was measured by an infrared thermometer.

Results: Plasma HSP70 concentration was significantly reduced by thermal loading using hot towels (pre: 18.46 ± 6.55 vs. post: 14.7 ± 6.66 ng / ml, p = 0.011), but not by those using the other 3 types. Thermal stimulated thigh skin temperature in the opposite side of the hot fomentation was significantly increased by hot towels, hot packs and red bean bags. There was no significant change in axillary temperature.

Conclusion: These results suggest that thermal sheets might not cause heat stress at least in this condition. Hot towels, hot packs and red bean bags provide systemic thermal effect. Further evaluation is required for safe and effective application of hot fomentation to ASCVD prevention.

Open Access Original Research Article

First Trimester Placental Volume and Uterine Artery Doppler in Pregestational Diabetic and Non-Diabetic Pregnant Women

Eman Taher Mahmoud, Ahmed Mahmoud Hagras, Hossam Abd El-Hafiz Zaiton, Ahmed Tawfik Morsi Soliman

Journal of Advances in Medicine and Medical Research, Page 41-47
DOI: 10.9734/jammr/2022/v34i931347

Background: Pregestational diabetes is diabetes diagnosed before pregnancy comprises approximately 13 % of all diabetes in pregnancy, while gestational diabetes i.e. diabetes with onset or first recognition in pregnancy comprises the remaining 87%. This work aimed to evaluate the effect of pregestational diabetes mellitus on placental volume and uterine artery Doppler during the late first trimester of pregnancy compared to non-diabetic pregnant women during the same period of gestation.

Methods: This prospective study was conducted on 100 pregnant females from 11 weeks to thirteen 13 weeks gestation. Patients were divided into 2 equal groups: group A included pregnant women with pregestational diabetes mellitus and group B: included non-diabetic pregnant women as a control group. All cases were subjected to clinical examination, laboratory investigations (fasting blood sugar, 2Hrs post-prandial blood sugar, HbA1c and creatinine clearance test) and specific investigations (Mindray DC30 ultrasound and Transabdominal examination).

Results: HbA1c was a positive significant correlation with PI, RI, creatinine clearance and fasting blood sugar, there was a positive significant correlation between fasting blood sugar and PI and RI, there was a positive significant correlation between RI and PI (P<0.05).

Conclusions: Pre-gestational DM does not induce demonstrable alterations in first trimester placental volume, while it induces demonstrable alterations in the first trimester placental development as regards to uterine artery velocimetry Especially PI and RI are significantly increased.

Open Access Original Research Article

Effect of Spinal Anesthesia on Postoperative Cognitive Dysfunction

Hosein Kimiaei-Asadi, Saghi Sanamar, Latif Moradveisi, Ahmad Moradi, Nahid Manouchehrian

Journal of Advances in Medicine and Medical Research, Page 48-55
DOI: 10.9734/jammr/2022/v34i931348

Background: It seems that spinal anesthesia is an appropriate approach for elderly patients and those who are not suitable candidates for general anesthesia. This study aimed to determine the effect of spinal anesthesia on postoperative cognitive decline in elderly patients.

Methods: This cross-sectional study was performed on 81 patients older than 65 years of age with the ASA classes I and II. The cases were candidates for surgery and spinal anesthesia and referred to Besat Hospital, Hamadan, Iran. Moreover, they receive surgical treatment and underwent spinal anesthesia from 2019 to 2020. Wechsler Memory Scale-III (WMS-III) was utilized to compare the cognitive dysfunction in elderly patients before and after spinal anesthesia. Furthermore, the WMS-III scores were compared before and after anesthesia to assess the severity of cognitive dysfunction, short- and long-term memories, as well as concentration rate at discharge.

Results: According to the results, there was no significant difference before and after spinal anesthesia regarding the mean mental control, repetition, visual reproduction, and verbal paired associates (P>0.05). Moreover, the mean values of spatial addition (Z=-2.07; P=0.03) navigation (Z=-2.13; P=0.03), and logical memory (Z=-2.42; P=0.01) increased after spinal anesthesia. In addition, the mean values of the memory coefficient were estimated at 68.28±16.77 and 68.66±16.94, respectively. The comparison of memory coefficient among elderly patients undergoing spinal anesthesia showed no significant difference before and after spinal anesthesia (Z=-1.51; P=0.13). A reverse correlation was reported between age and memory coefficient before (r=-0.46; P<0.005) and after spinal anesthesia (r=-0.405; P<0.005).

Conclusion: Spinal anesthesia had no effects on memory coefficient. However, there was an increase in some memory function domains, including spatial addition, navigation, and logical memory after the operation. The memory scores may have been affected by the patients' conditions before the operation.

Open Access Original Research Article

Correlation between Changes in End-Tidal Carbon Dioxide and Stroke Volume Variation Detected by Electrical Cardiometry as a Predictor of Fluid Volume Responsiveness in Hemodynamically Unstable Patients in the Intensive Care

Ahmed Elbaiomy Abo-Elkhier, Mohamed Samir Abd El Ghaffar, Reda Sobhi Salamh Abd Alrahman, Salama Ibrahim El Hawary

Journal of Advances in Medicine and Medical Research, Page 56-65
DOI: 10.9734/jammr/2022/v34i931349

Background: The requirement for cardiac output (CO) measurements typically restricts the widely used passive leg raising (PLR) test for a set of patients because they need costly or intrusive hemodynamic surveillance equipment. This trial aimed to evaluate the role of end-tidal CO2 pressure (EtCO2) monitoring in the prediction of the fluid responsiveness in connection to                 stroke volume variation (SVV) observed in unstable hemodynamic patients in electrical cardiometry (EC).

Methods: This prospective observational study was carried out on 60 cases aged 18 years or above with hypotension and mechanically ventilated patients in critical care. Patients were classified into two groups according to the SVV:a) Responder group (SVV≥10%) and b) non-responder group. All patients were mechanically ventilated and received sedation and muscle relaxation with no spontaneous respiratory effort.

Results: EtCO2 was significantly increased in responder group than non-responder group at the end (P value = 0.002). SVV was significantly higher in responder group than non-responder group at the baseline (P <0.001). There was a significant negative correlation between SVV and EtCo2 (r = -0.456, P <0.001) and a significant positive correlation between cardiac index and EtCO2 (r = -0.456, P = 0.005). Ä EtCO2 can predict fluid responsiveness significantly (P <0.001) at cut-off > 3 mmHg with 81.4% sensitivity, 88.24% specificity.

Conclusion: EtCO2 existed as a simple, inexpensive, and non-invasive alternative for the CO in the evaluation of various shock conditions. Ä EtCO2 can also predict fluid responsiveness significantly (P <0.001) at cut-off > 3 mmHg with 81.4% sensitivity, 88.24% specificity.

Open Access Review Article

Biological Mode of Action of Phospholipase A and the Signalling and Pro and Anti Inflammatory Cytokines: A Review

Roshan Kumar, Purabi Saha, Ivan Kahwa, Edward Amoah Boateng, Paul Owusu Boateng, Richard Owusu Nyarko

Journal of Advances in Medicine and Medical Research, Page 1-10
DOI: 10.9734/jammr/2022/v34i931342

It is degraded to free triglycerides and fatty acids by the secreted phosphatases of the plant family (sPLA2s). Plants have very few sPLA2s. Plant sPLA2s' molecular, biochemical, and catalytic properties are being studied. Three-dimensional structures are also included when comparing the two groups. Glycine max is used as a benchmark for comparing various organisms, including any herbal plants and small animals. In addition, they can be used as a type of signalling molecular. The functions of SPLa2 enzymes are well understood, however their ligand activities remain a mystery. Since the last review, sPLA2-binding proteins have evolved dramatically. Promiscuous SPLa2 proteins exist in nature for evolutionary reasons that we describe. As sPLA2s have a wide range of roles in the human body, they appear to be suitable therapeutic targets. New diagnostic and therapeutic techniques can be developed by using sPLA2s to interact with other proteins.