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The prevalence of pre-eclampsia among pregnant women in the University of Calabar Teaching Hospital, Calabar
Mary Esien Kooffreh, Mabel Ekott, Dorcas O Ekpoudom
September-December 2014, 3(3):133-136
Background: Pre-eclampsia is a pregnancy-specific disorder recognized clinically by the onset of hypertension and proteinuria. It complicates about 2%-10% of pregnancies worldwide and contributes to maternal and foetal morbidity and mortality. However there is paucity of information on its prevalence in Calabar. Aims: To determine the prevalence of pre-eclampsia in the University of Calabar Teaching Hospital, Calabar, Nigeria over a period of 3 years for the purpose of further genetic studies. Settings and Design: A descriptive epidemiologic study that consisted of all documented cases of Pre-eclampsia in a tertiary referral center from 2009 to 2011. Materials and Methods: Data on pre-eclamptic patients were obtained from the Records Department of the hospital. Statistical Analysis: The results were anaylzed using SPSS version 17, percentages, mean and standard deviations were used to describe data. Results and Conclusions: A total of 8,524 deliveries and 104 cases of pre-eclampsia were documented giving an overall prevalence of 1.2%. The prevalence in 2009, 2010, and 2011 was 0.7%, 1.2%, and 1.5%, respectively. Fifty-nine case notes were available for analysis (56.7% retrieval). The mean age of the patients was 27 ± 4.9 and majority; 25 (42.4%) were in the age group 25-29 years. The mean parity was 1.1 ± 1.4 and 26 (44.1%) were nulliparous. 11 (18.6%) had family history of hypertension, 2 (3.4%) had personal history of hypertension, and 2 (3.4%) had a personal history of pre-eclampsia. The slight increase in the prevalence rate over the years underscores the need for close surveillance.
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Unusual presentations of sacrococcygeal teratomas in pediatric patients
Iftikhar A Jan, Hazratullah , Nazia Ishaque, Anwar-ul Haq, Mudassar Gondal, Ahmad Sharif, Sofia Ahmad
January-April 2012, 1(1):30-34
The present study aims to review the unusual modes of presentation of sacrococcygeal teratomas (SCT) in pediatric patients. In this study we managed 23 cases of SCT, at NICH Karachi and Children's Hospital Islamabad from Jan 2004 to June 2008. Their mode of presentation and previous management issues were studied. All patients had U/S, Alpha Fetoprotein levels, CT or MRI scan beside the routine investigation. Patients were labeled as having unusual presentation, if they had either a erroneous diagnosis at referral, had complication of previous surgeries or presented late due to erroneous or missed diagnosis. Patients were managed on standard protocol with preoperative staging. Of the 23 patients been registered, there were 17 Female and 6 male suggesting a 3:1 preponderance of female. Nearly half of the patients had atypical presentation. Five patients were referred with the diagnosis of meningocele. Hematuria, inguinal lymphadenopathy, suspected abscess, ruptured SCT, fecal fistula, simultaneous abdominal and sacrococcygeal teratoma, laminectomy for lower limb weakness and fetus in fetu were presentations in one patient each. Outcome was most favorable in external SCT which was presented early. Of the 11 patients with type-I and Type-II teratomas, only one died and he had ruptured teratoma. All other survived inspite of the large external tumor masses. Of the seven patients with type-III teratomas, five survived, one died and one lost to follow-up. Of the six babies with type-IV SCT, three survived, one died and two lost to follow-up. It could be concluded that, there were many cases of unusual presentation of SCT. In some cases, it caused significant delay in diagnosis and poor outcome. The reasons were hidden tumors, ignorance of the families, lack of awareness and inadequate evaluation by the treating physicians in peripheral hospitals. In some cases, the unusual presentation was due to the natural process. A high index of suspicion, awareness of treating physicians and parents, can help in early diagnosis and better outcome. Above all, pediatric tumors like SCT need a team approach and all patients with such lesions must be referred early to tertiary care pediatric surgical facilities for optimal care and management.
  13,006 325 -
Role of transvaginal ultrasound in detection of retained products of conception after abortion
Ahmed Maged, Hassan Gaffar, Walaa Mostafa
September-December 2012, 1(3):151-155
Objectives: To evaluate risk factors for retained products of conception (RPOC) after surgical evacuation (SE) using transvaginal sonography (TVS) and success of medical and surgical management. Study Design: Retrospective open-label study included 270 women after SE done for abortion; 204 were completely evacuated and 66 had RPOC randomly equally subjected to medical or surgical treatment. Results: There was a significant difference between the two study groups regarding GA at SE (lower in the complete evacuation group) 7.32 ± 1.352 vs. 10.23 ± 1.572, experience of the obstetrician (higher in complete evacuation group) and adverse effects as vaginal bleeding, abdominal pain, and fever (lower in the complete evacuation group). Success of both medical and surgical treatment of retained products showed a statistically nonsignificant difference. Nausea and headache showed nonsignificant difference between the two groups while most side effects reported were more in the medical group as diarrhea (12 vs. 1), fever (9 vs. 0), hot flushes (10 vs. 0), abdominal pain (9 vs. 2), and vaginal bleeding (9 vs. 2). Few side effects were reported more in the surgical group such as vomiting (13 vs. 2) and tiredness (12 vs. 2). Conclusion: TVS is recommended following D and E in patients at high risk for RPOC for whom medical and surgical treatment are effective.
  10,771 371 -
Anal transposition (trans-sphincteric ano-rectoplasty) for recto-vestibular fistula
Jamal S Kamal
May-August 2012, 1(2):89-91
Background: Imperforate anus with recto-vestibular fistula is the most common form of imperforate anus in females and is an intermediate type of this disease, which is treated surgically. The current study aimed to compare three techniques used for the treatment of imperforate anus with recto-vestibular fistula. Materials and Methods: Fifty-four cases of imperforate anus with recto-vestibular fistula were managed using three main approaches: posterior sagittal ano-rectoplasty, anterior sagittal ano-rectoplasty, and the anal transposition or trans-sphincteric ano-rectoplasty (TSARP). The functional results and cosmetic appearance for each case after treatment were evaluated in patients above 3 years of age (43 cases). Results: The functional outcomes were good in all treatment groups; however, the better cosmetic results were evident in the group treated using TSARP, a technique, which preserves the skin bridge between the new anus and the posterior fourchette, does not disturb the perineal body, and avoids division of the levator muscles. In this group, a continence rate of 100% but a higher constipation rate (41%) than in the other groups was recorded. Conclusion: TSARP is recommended for imperforate anus with recto-vestibular fistula.
  9,220 331 2
Intermittent testicular torsion in an adult: A case report and review of the literature
Suryapratap Singh, Saranjeet Singh Bedi
January-April 2013, 2(1):61-63
Testicular torsion is an acute vascular event in which the spermatic cord becomes twisted on its axis, such that the blood flowings to and/or from the testicle becomes impeded. This results in ischemic injury and infarction. Testicular torsion in adulthood is relatively unusual and has a higher morbidity rate. Any delay in the diagnosis can lead to the loss of the spermatogenic function of the testis and an increased risk of orchidectomy. Closed reduction is the initial treatment of choice. Open surgical reduction is recommended for possible testicular torsion or rupture.
  8,317 300 -
Mayer-Rokitansky-Kuster-Hauser syndrome presenting as rectovaginal fistula
Mohamed Daffalla A Gismalla, Awad Ali Mohamed Ahmed Alawad
September-December 2014, 3(3):168-170
Mayer-Rokitansky-Küster-Hauser (MRKH) Syndrome is a Müllerian abnormality, characterized by the absence of the vagina, associated with abnormal or absent uterus and the presence of apparently normal tubes and ovaries. Physical growth development and secondary sexual characters as well as the external genitalia are also normal. These patients usually present with primary amenorrhea. Here we report a case of 20-year-old woman with primary amenorrhea due to Müllerian agenesis presented with rectovaginal fistula following coital injury. To the best of our knowledge, this is the first case reported in the literature with this rare presentation.
  8,243 170 -
Chronic obstructive pulmonary disease: An evidence-based update
Abdullah Alshimemeri
May-August 2013, 2(2):75-80
The use of bronchodilators represents the cornerstone drug management of chronic obstructive pulmonary disease (COPD), and the employed bronchodilating agents include β2 -adrenergic agonists, anticholinergic agents, and the methylxanthines. Combination therapy combining bronchodilating agents with differing durations of action and from different classes provides greater symptomatic improvement and reduced risk of adverse drug effects. As a result of the observed tendency to precipitate steroid myopathy, oral glucocorticosteroids are not recommended for long-term use in COPD management, but the adjunctive use of inhaled forms in cases of COPD stages III and IV reduces the frequency of exacerbations and improves the patient's quality of life. The absence of medications modifying the lung function decline, a major hallmark describing the course of COPD, necessarily implies that drug management involves an amelioration of COPD symptoms. Preventive approach to COPD management involves measures aimed at reducing individuals' exposure to tobacco smoke and other airborne pollutants; measures geared towards smoking cessation is the most efficacious way of halting the progression of COPD.
  7,726 429 -
Effects of cactus pear (Opuntia ficus indica) juice on oxidative stress in diabetic cataract rats
Fatma H Abd El-Razek, Eman M El-Metwally, Gaber M.G. Shehab, Amal A Hassan, Anhar M Gomaa
January-April 2012, 1(1):23-29
Diabetes mellitus is a heterogeneous metabolic disorder characterized by hyperglycemia. It is often associated with complications, such as cataracts. The purpose of this study was to investigate the effects of cactus pear juice on oxidative stress and cataract formation in alloxan-induced diabetic rats. Rats were divided into six groups, Group 1 untreated as negative control, Group 2 injected with alloxan only to induce diabetes as diabetic cataract positive control, Groups 3,4,5 and 6 injected with alloxan and given orally 1, 2, 3 and 4 ml concentrated cactus juice/rat/day, respectively. After 8 weeks, the animals treated with cactus juice showed a significant decrease in the level of blood glucose and lipid peroxidation in blood and lens, and a significant decrease in the concentration of lens Fas ligand, compared with negative control (group 1). Also, the treated groups showed significant increase in the level of reduced glutathione and the activity of superoxide dismutase and significant decrease in the levels of nitric oxide concentration. Slit lamp examination revealed that supplementation with cactus juice delayed the progression and maturation of cataract in the treated groups compared with positive control (group 2), which developed subcapsular cataract. The best result observed in Group 5, which was given orally 3 ml juice/rat/day. The data in the present study indicate that cactus juice is a rich source of natural antioxidants such as total phenolics, total flavonoids, vitamin C, vitamin E, β-carotene and total carotenoids. It can be concluded that regular consumption of cactus pear juice can protect the body from the oxidative stress and can attenuate the development of cataract as a complication of diabetes by reducing the level of blood sugar.
  6,394 529 -
Isoniazid and rifampicin induced fever in a patient with tuberculous pleural effusion
Sibes Kumar Das, Pulak Kumar Jana, Tapan Das Bairagya, Anirban Das
January-April 2014, 3(1):47-49
A 52-year-old male patient of right sided tuberculous pleural effusion developed fever with chill and rigor 12 days following therapy with antituberculous drugs. After careful clinical evaluation and investigations, it was proved to be a case of drug-induced fever. Isoniazid (H) and rifampicin (R) were found to be the offending drugs in re-challenge test. He was subsequently put on a modified regimen excluding these drugs and he made an uneventful recovery. We are reporting this case because of very rare occurrence of drug-induced fever with both R and H and presence of few atypical manifestations of drug fever in this case. Drug induced fever should be considered in a patient of tuberculosis developing fever during chemotherapy. Drug fever may sometimes be produced by more than one drug simultaneously.
  6,324 264 -
Elucidating the molecular mechanisms that govern β-Amyloid protein-induced neuritic dysfunction in Alzheimer's disease
Steven Petratos, Michael F Azari, David Cram
January-April 2012, 1(1):35-37
  6,066 293 1
Operating theaters as a source of nosocomial infection: A systematic review
Tewelde Tesfaye Gebremariam, Maria Fe Fontecha Declaro
January-April 2014, 3(1):5-8
Introduction: Microbial contamination of operating theaters (OTs) is a major cause of nosocomial infections (NIs). Purpose: Thus, the purpose of this systematic review was to determine the degree of contamination present on OTs and to evaluate the methodological quality of this evidence. Materials and Methods: Published studies from December 2000 to December 2012 were identified in nine major databases. Methodological quality was evaluated using a quantitative critical appraisal tool. Data were extracted and analyzed using four major outcome measures. Results and Conclusion: A total of 45 studies were identified investigating the levels of microbial contamination on OTs; of which 26 were included in the review. The included studies reported that 51.3% of all sampled air/articles/surfaces of OTs were contaminated. However, the majority of microbial contamination and hence any risk of acquiring a NIs can be reduced substantially by implementing the infection control measures. Further research is also required on the role of OTs in NIs.
  5,617 608 1
Sudanese parents' knowledge, attitudes and practice about self-medication to their children: Qualitative study
Ahmed S Eldalo, Tarig M. H. El-Hadiyah, MA Yousif
May-August 2013, 2(2):103-107
Aim: This study was designed to test the Sudanese parents' knowledge, attitudes and practice (KAP) toward self medicating their children. Design and Methods: A cross-sectional study was carried out by using a pretested questionnaire. Non probability convenient sampling method was used to select the participants. The total sample size was 1000 parents from different health settings in Khartoum State, Sudan in the period from January to June 2011. Results: The obtained response rate was 94.9%. The majority of Sudanese parents in this study 84% used to recommend western medicines to their children. More than one-third of children had received parental self medication in the month preceding this study. The results revealed that parents in 95.7% cases, self medicated their children from minor illnesses. The most frequently used medicines are antibiotics 36.6% followed by paracetamol 31.5%, even though the most common symptom reported was fever 39.7%. In case of self-treatment failure; 64.0% of responded parents used to consult physicians in public settings, while 8.0% seek advice from the community pharmacists. The main reasons of parental self medication were the expensive consultation fees and the long waiting time in the clinics. Conclusion: The study revealed that parents' knowledge was inadequate, and their parental self medication practice showed to be inappropriate. The study outcomes urge instant move toward educating parents on risk of liberal use of medicines in children.
  5,545 659 3
Growth hormone and its receptor: A molecular insight
Yahia A Kaabi
May-August 2012, 1(2):61-68
Growth hormone (GH) is a peptide hormone necessary for normal postnatal growth as well as human metabolism. It works via its widely expressed receptor (GHR), which is a dimer of transmembrane glycoproteins, belonging to cytokines type I receptor family. Signaling via GHR is initiated by conformational changes triggered upon GH association. GHR is recognized as an important therapeutic target for treatment of many pathologic conditions, including growth disorders and cancer by designing highly specific and efficient GHR agonists or antagonists. However, engineering of such molecules requires deep understanding of the structure and function of both GH and GHR protein molecules. This work reviews the current status of knowledge covering the molecular structure of both GH and GHR and their molecular interactions, in addition to different GH agonists or antagonists developed to regulate GH action.
  5,347 663 3
Congenital giant melanocytic nevus with ambiguous genitalia in an 8-year-old child: A rare combination
Aliyu Ibrahim, Abdullah Ramatu
September-December 2013, 2(3):214-216
Congenital melanocytic nevi may be common, quite extensive and even benign, but a giant congenital nevus is rare and has potential for malignant transformation. Giant nevus could occur in any part of the body; though, it is most common on the trunk and may be associated with other congenital malformations such as spina bifida, meningocele. However, there is a dearth of information on its combination with ambiguous genitalia. We therefore report a case of an 8-year-old child with a giant melanocytic nevus on the face and neck with widespread satellite nevi and ambiguous genitalia.
  5,823 162 -
A longitudinal study of maternal and socioeconomic factors influencing neonatal birth weight in pregnant women attending an urban health center
Saurabh R Shrivastava, Prateek S Shrivastava
May-August 2013, 2(2):87-92
Background: Having a low birth weight (LBW) baby can cause emotional, social and financial stress for the family. Settings and Design: A longitudinal study of 1 year duration (June 2009-May 2010) was conducted in an urban slum of Mumbai. Universal sampling method was employed and every antenatal women registered at the urban health center from June 2009 to August 2009 were included as study participants. Materials and Methods: Of the 231 pregnant women that registered, 21 were excluded from analysis as - 5 home deliveries, 3 still births, 3 spontaneous abortions, and 10 that could not be traced. Thus for final analysis, sample size was 210. Inclusion and Exclusion criteria were: All antenatal care (ANC) subjects registered at the urban health center within 20 weeks of their gestational age were included as the study subjects. Subjects with only live hospital/institution birth were included. These registered women were then followed-up for next 9 months for monitoring maternal weight gain and neonatal birth weight. Statistical Analysis: Statistical analysis was done using SPSS version 17. Chi-square test was used for testing significance of association at P value of 0.05 and 0.001. Results: Proportion of LBW in the present study is 27.1% with mean birth weight 2.2285 kg with S.D. 0.2281 kg. Factors like maternal age, education, tobacco addiction, hemoglobin levels, gestational age, and interval between pregnancies were significantly associated with birth weight. Conclusions: LBW continues to be a significant public health problem and as multiple factors are associated with it, it requires a more holistic and multipronged approach for its reduction.
  5,222 721 1
Antibiogram of candida species isolated from mono and multi-species oral candidal carriage using disk diffusion method
Apurva K Pathak, Navin R Jain, Ruchi Joshi
September-December 2012, 1(3):132-138
Context: Oral candidiasis is the most common oral opportunistic infection has seen in the immunocompromised patients. Apart from C. albicans the non-Candida albicans Candida species, which are less susceptible to the commonly used antifungal drugs are major etiological agent for candidiasis. Thus, the treatment strategy for candidiasis should be different in case of multiple species infection. Aims: The aim of this present study is to compare the antifungal susceptibility patterns of Candida species isolated from mono species and multiple species oral Candidal carriage. Materials and Methods: The species of Candida, isolated from mono and multiple species oral Candidal carriage of the healthy and immunocompromised patients were used for the experiment. Antifungal susceptibility test was performed by using disk diffusion susceptibility method on Methylene blue Glucose- Mueller-Hinton agar. Statistical Analysis Used: Paired student's t-test. Results: In this, present study, variability in antibiogram of Candida species isolated from mono species and the corresponding species isolated from multiple species combinations were reported. The susceptibility ranking for antifungal drugs for the strain isolated from mono species OPC (C. albicans > C.tropicalis > C. glabrata > C.krusei) and for the strains isolated from multiple species combination (C. albicans > C. glabrata > C.krusei > C.tropicalis) for mean of the five antifungal drugs combined were reported. Species of C. albicans and C. tropicalis were reported more resistant towards anti fungal agents when these present in mono-species condition, whereas; C. krusei and C. glabrata were more susceptible when these present in mono-species condition. Polyenes (amphotericin-B and nystatin) compounds were found to be most effective than azoles against Candida spp. isolated from multi-species lesions as none of the strain were shown resistant towards these drugs, conversely; a significant fraction of C. tropicalis and C. albicans isolated from mono-species lesion were shown resistant toward polyenes compound tested. Conclusions: The findings of this study shows statistically insignificant diverse antifungal susceptibility pattern of Candida species isolated from mono and multiple species Oropharyngeal Candidiasis combinations.
  5,377 502 2
Prevalence of tuberculosis in Calabar, Nigeria: A case study of patients attending the outpatients Department of Dr. Lawrence Henshaw Memorial Hospital, Calabar
Mary Esien Kooffreh, Jonah Bassey Offor, Ekerette Emmanuel Ekerette, Udeme Ita Udom
September-December 2016, 5(3):130-133
Background: Tuberculosis (TB), though a curable infectious disease, remains one of the leading causes of death in adults. It is also a major public health concern in Nigeria. This study was aimed to determine the prevalence rate of tuberculosis among patients attending the out-patient Department of Dr. Lawrence Henshaw Memorial Hospital Calabar. Materials and Methods: A retrospective study was carried out consisting of all documented cases of tuberculosis from January 2005 to April 2015. Results: Out of 20185 patients tested, a total of 5,004 cases of tuberculosis was recorded within the period of this study with a prevalence rate of 24.8%. The prevalence for each year during this study were as follows: 2005 (37.5%), 2006 (30.9%), 2007 (26.2%), 2008 (23.1%), 2009 (23.0%), 2010 (20.5%), 2011 (16.6%), 2012 (20.5%), 2013 (22.9%), 2014 (21.8%) and 2015 (44.6%). HIV co-infection was more prevalence in males than females, while majority of the disease site was pulmonary tuberculosis (PTB). The highest mortality was recorded in 2012 (18.2%). Within the ethnic groups assessed, the prevalence was higher among the Efiks. Conclusion: The prevalence of TB/ HIV co-infection and subsequent mortality within the years under study is traumatizing and thus requires prompt measures in combating the situation.
  5,369 433 -
Blood group O protects against complicated Plasmodium falciparum malaria by the mechanism of inducing high levels of anti-malarial IgG antibodies
Amre Nasr, Muna Eltoum, Anhar Yassin, Gehad ElGhazali
January-April 2012, 1(1):16-22
In a prospective clinical study in North Kordofan (Western Sudan), the possible association between blood groups and anti-malarial antibody responses with clinical outcome of Plasmodium falciparum malaria among Sudanese patients was investigated. A total of 184 individuals were consecutively enrolled from an outpatient clinic. Sixty six (35.9%) patients were classified as complicated malaria (CM), 53 (28.8%) with uncomplicated malaria (UM) and 65 (35.3%) were malaria free controls (MFC). Phenotypes of ABO blood groups were typed using commercial anti-sera. The antibody responses to MSP2 malaria antigens were assessed by an enzyme-linked immunosorbent assay (ELISA). The frequency of O blood group was significantly lower in those with CM when compared with MFC and UM patients (P value < 0.001 and 0.002 respectively). The levels of IgG1, IgG2 and IgG3 antibodies were statistically significantly higher in UM and MFC compared with CM patients. Statistical analysis indicated that higher levels of total IgG, IgG1, IgG2, and IgG3 specific to the MSP2 (both antigen forms, 3D7 and FC27) were associated with a reduced risk of complicated CM in O blood type carriers than in non-O blood type carriers, P value <0.001. Taken together, the current study indicates that blood group O is associated with a reduction in the risk of developing complicated malaria in western Sudan. Our results also revealed that the natural acquisition of immunity against clinical malaria appeared to be more associated with IgG1 and IgG3 antibodies, signifying their roles in parasite-neutralizing immune mechanisms.
  5,065 586 2
Reporting of randomized controlled trials: A systematic review and bibliometric analysis of quality and quantity of publications in palliative care journals
Senthil P Kumar, Vaishali Sisodia
May-August 2013, 2(2):93-102
Background: This study aimed to perform a bibliometric analysis of Randomized Controlled trials (RCTs) published in palliative care journals. Settings and Design: Systematic review of palliative care journals. Materials and Methods: MEDLINE database was searched for journals with name 'palliative' in their title, and articles published from January 2007 - December 2011 were then searched in individual journals with search limits activated for 'randomized controlled trials.' The reporting rates of all journals were compared. The selected articles were categorized into practice, education, research, and administration (PERA). The articles were also grouped under participants, interventions, comparisons, and outcomes (PICO) format for analysis. Quality scoring of RCTs was done using Jadad scale. Statistical Analysis: Quality scores were compared between journals and article categories (PERA, PICO) using one-way ANOVA with Bonferonni test, Chi-square test were done at 95% confidence interval using SPSS for Windows version 16.0. Results: The overall reporting rate of RCTs in palliative care journals was 1.04%, and the overall RCTs' quality score was 2.8.99 out of a total score of 5 on Jadad scale. PSC had the highest reporting rate of 3.27% (8/244) followed by JPC at 1.53% (3/196) and PM at 1.353% (8/591). The RCTs in IJPN had the highest quality score at 3, followed by AJHPC (3 ± 1) and JPPCP (3 ± 2.82). Significant association was found between cancer patients as study population and practice as RCT category. Comparison between PERA and PICO categories for quality of RCTs was not significant (P > 0.05). Conclusions: The 12 palliative care journals analyzed in this study published few RCTs at a five-year reporting rate of 1.04%, with Palliat Support Care having the highest reporting rate. Overall quality of the RCTs was moderate-low category.
  5,031 211 -
Crisponi syndrome: A new mutation in a Saudi family
Osama S El-Assy, Adnan A Al-Sulaimani, Abdelfattah A Mujahed
May-August 2012, 1(2):103-106
Crisponi syndrome is a rare autosomal recessive disorder caused by mutation in the Cytokine Receptor-Like Factor1 (CRLF1) gene. The cardinal features of this syndrome, which are always evident at birth, consist of muscular contractions of the facial muscles in response to tactile stimuli with trismus simulating tetanic spasm, abundant salivation, major feeding and respiratory difficulties, characteristics dysmorphic features, camptodactyly and hyperthermia. In infancy and childhood they develop progressing kyphoscoliosis and developmental delay. Molecular analysis performed on DNA of our patient (and both parents) showed evidence of a new pathogenetic homozygous mutation never described before in the literature. Our case is one of 9 new mutations found in addition to 29 already described mutations, thus expanding the mutational spectrum of CRLF1 in Crisponi syndrome.
  4,937 279 -
Prevalence of non-fermenting gram negative bacilli and their in vitro susceptibility pattern in a tertiary care hospital of Uttarakhand: A study from foothills of Himalayas
Deepak Juyal, Rajat Prakash, Shamanth A Shanakarnarayan, Munesh Sharma, Vikrant Negi, Neelam Sharma
May-August 2013, 2(2):108-112
Introduction: Non-fermenting gram negative bacilli (NFGNB) are taxonomically diverse group of pathogens that has emerged as a major cause of health care associated infections especially in immunocompromised hosts. Identification of NFGNB and monitoring their susceptibility pattern are important for proper management of infections caused by them. Prevalence and antibiogram of NFGNB has not yet been reported from this part of India. Aim of the present study was to characterize the prevalence of NFGNB along with their antimicrobial sensitivity pattern among the patients coming to our hospital a tertiary care center. Materials and Methods: A total of 2585 various clinical specimens were received in laboratory and were processed. Non fermenters were identified using a standard protocol. Antimicrobial susceptibility testing was performed by Kirby Bauer disc diffusion method. Results: Among 2585 clinical samples 241 yielded NFGNB accounting for an isolation rate of 9.32% and a total of 246 non fermenters were grown as five samples yielded two types of NFGNB. Pseudomonas species (49.59%) and Acinetobacter species (43.09%) were the most commonly isolated NFGNB. A high level of antibiotic resistance was recorded for most of the first and second line drugs. Imipenem and amikacin were the drugs with maximum activity. Overall imipenem resistance was found to be 30.54%. Conclusion: Identification of NFGNB and monitoring their susceptibility patterns will help in proper management of infections caused by them. Improved antibiotic stewardship and infection-control measures will be needed to prevent or slow the emergence and spread of multidrug-resistant NFGNB in the healthcare setting.
  4,508 512 2
Alternatives to surgical tracheostomy: A critical review
Sami A Al Kindy
May-August 2014, 3(2):66-70
Surgical tracheostomy (ST) is the oldest life-saving procedure in records, usually done by otolaryngologists and occasionally by general surgeons, thoracic surgeons, and neurosurgeons. It has been an important surgical skill for any given otolaryngology training program. On the contrary, retromolar, submental, submandibular endotracheal intubations, and their modifications are carried out by oral surgeons, maxillofacial surgeons, skull base surgeons, and plastic surgeons and are considered alternative to ST. Despite none are done in an emergency situation, it is suggested to be less invasive, simple, safe, with less surgical time, nearly unknown complications, has unsightly scar and cheaper in comparison to ST. It is thought that these techniques provide free surgical access in cases where oral and nasal intubations are often not suitable and require intermittent intraoperative dental occlusion to check alignment of fractured fragments. In the current report, PubMed has been reviewed for the reasons, indications, complications, techniques, and modifications of the above mentioned ST alternatives. The article critically discusses the surgical part of these innovative procedures and concludes that ST, in spite of its risks, remains the procedure of choice for surgical airway access when long-term intubation is not anticipated, especially in emergencies and difficult airways. A regular workshop of this highly in demand surgical skill is suggested.
  4,706 276 1
Asthma control and self-management: The role of asthma education
Ghazi Abdulrahman Alotaibi
January-April 2015, 4(1):16-22
Asthma is a common chronic airway disease that afflicts both adults and children. Worldwide, about 300 million people suffer from asthma. There has been a great interest in developing treatment guidelines for asthma in many countries. The focus in all asthma treatment guidelines is to control asthma symptoms by involving patients in their treatment planning and execution. Therefore, asthma education has become the main component of the treatment plan. Studies have shown that simple educational sessions for asthmatics could have positive impacts on patients' adherence to treatment and control of symptoms. We searched most common medical and health databases for related research studies that were published since 2001. The retrieved articles were carefully scrutinized for inclusion in this review. This review focuses on level of asthma control as reported in the literature and provides an overview of effectiveness of asthma education programmes on controlling asthma symptoms. With all available knowledge and technology, it seems that the goal of controlling asthma is yet to be achieved. Asthma education should be integrated in treatment plan and conducted at all points of patients' care.
  4,531 451 1
Various treatment options for benign prostatic hyperplasia: A current update
Alankar Shrivastava, Vipin Bihari Gupta
May-August 2012, 1(2):53-60
In benign prostatic hyperplasia (BPH), there will be a sudden impact on overall quality of life of the patient. This disease occurs normally at the age of 40 and above and is also associated with sexual dysfunction. Thus, there is a need to update our knowledge on the current medications for this disease. The presented review provides information on medications available for BPH. Phytotherapies with some improvements in BPH are also included. Relevant articles were identified through a search of the English language literature indexed on MEDLINE, PUBMED, ScienceDirect, and the proceedings of scientific meetings. The search terms were benign prostatic hyperplasia, BPH, medications for BPH, drugs for BPH, combination therapies for BPH, and phytotherapies for BPH. Medications including watchful waitings, β1 -adrenoreceptor blockers, 5β-reductase inhibitors, and combination therapies including tamsulosin-dutasteride, doxazosin-finasteride, terazosin-finasteride, tolterodine-tamsulosin, and rofecoxib-finasteride were found. Herbal remedies such as Cernilton, Saxifraga stolonifera, Zi-Shen Pill (ZSPE), Orbignya speciosa, Phellodendron amurense, Ganoderma lucidum, Serenoa repens, pumpkin extract, and Lepidium meyenii (Red Maca) showing some improvement on BPH are included. Other than these, discussions on transurethral resection of prostate (TURP) and minimally invasive therapies (MITs) are also included. Recent advancements in terms of newly synthesized molecules are also discussed. Specific β1 -adrenoreceptor blockers such as tamsulosin and alfuzosin will remain the preferred choice of urologists for symptom relief. Medications with combination therapies still need more investigation to establish their preference in the initial stage for fast symptom relief, reduced prostate growth, and obviously for reducing the need for BPH-related surgery. Due to lack of proper evidence, phytotherapies are not gaining much advantage. MITs and TURP are expensive and are rarely supported by healthcare systems.
  4,332 445 -
Eco-dentistry: The environment-friendly dentistry
Amandeep Chopra, Nidhi Gupta, Nanak Chand Rao, Shelja Vashisth
May-August 2014, 3(2):61-65
Green dentistry is a high-tech approach that reduces the environmental impact of dental practices and encompasses a service model for dentistry that supports and maintains wellness. It is based on waste reduction, energy conservation, and pollution prevention. Increasing consumption of diminishing natural resources, air and water pollution, ever-growing landfills, and the effects of global warming, makes saving our environment imperative. The aim of this article was to provide a series of "green" recommendations that dentists around the world can implement to become leading stewards of the environment. By conserving water, using digital imaging and recycling the many recyclable items that pass through the office of a green dentist, a great impact is made. So, going green is the need of the hour.
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