Clinical Medicine And Health Research Journal

Urinary Tract Infection and Antibiotic-Resistant Patterns of Isolated Bacteria in Geriatric Patients.

Akinbobola Ayokunle Adeniyi — 2024-03-11

Age-related risk factors influence the prevalence of urinary tract infections (UTIs) in older people. Therefore, early detection is important to prevent adverse consequences. A retrospective study was conducted on 206 geriatric patients (65 years old and above) who were seen in various clinics at University College Hospital, Ibadan. There were 138 men (67%) and 68 women (33%) in total. A significant growth of >10⁵ cfu/ml of bacteria was found in a total of 44 (21.4%) samples. Escherichia coli was the most common pathogen isolated (40.9%), and it was followed in order by Klebsiella pneumonia (29.5%), Pseudomonas aeruginosa (13.6%), Klebsiella oxytoca (9.1%), and Proteus mirabilis (6.8%). The distribution of UTI by gender was statistically significant (P = 0.009), with men (33%) having a higher prevalence than women (11%). Most of the isolated bacteria were resistant to the first line of antibiotics, with Escherichia coli showing the highest level of resistance to the commonly prescribed antibiotics. There is a need to step up the campaign against the indiscriminate use of antibiotics to prevent a rise in antibiotic resistance.

Prevalence of Thalassemia in Nigeria: Pathophysiology and Clinical Manifestations

Audu Isaiah — 2024-03-15

There is evidence linking genes for thalassaemia, sickle cell diseases, and glucose-6-phosphate dehydrogenase (G6PD) deficiency to a high prevalence of malaria infection. Haemoglobinopathies are hereditary conditions that mostly results in thalassaemia and sickle-cell anaemia. The current global haemoglobin gene carrier population (i.e., healthy individuals who have acquired only one mutant gene from one parent) is between 1 and 5%. Some haemoglobinopathy genes (alpha-thal, beta-thal and HbS) cause alpha-thalassaemia, beta-thalassaemia and sickle-cell anaemia, respectively. Nigerians have a prevalence of 25–30% for sickle cell anaemia (SCA), G6PD, but both alpha thalassaemia and beta thalassaemia are at the lower limit. Thalassaemia and SCA have comparable clinical manifestations. which is quite prevalent in Nigeria? This could lead to underdiagnosis of thalassaemia, which accompany hypochromia and microcytosis, that could be mistaken for iron deficiency anaemia. Depending on the levels of foetal haemoglobin and haemoglobin A₂, thalassemia, iron deficiency anaemia, and sickle cell disease continue to be the most common chronic types of anaemia. This review provides details information on the prevalence of thalassaemia in Nigeria and molecular mechanisms in the expression of thalassaemia genes. The authors also suggest various possible way to minimize the occurrences of thalassaemia in Nigeria

Hand Function and Hand-Eye Coordination in Cervical Conditions – A Cross Sectional Study

Senthil Kumar B — 2024-03-15

Background of the study: Cervical Conditions are most common orthopaedic condition that may affect a large number of people. It compresses the nerve roots and may cause muscle weakness, numbness and loss of fine movements of the upper limbs. Hand Functions are movements of the hand and Hand eye coordination is the coordination of motor and visual inputs to produce a movement. This study helps to find out whether the hand function and hand eye coordination are affected in Cervical Conditions.

Aim: Aim of this study is to find whether the hand function and hand eye coordination are affected in Cervical Conditions.

Method: A total number of 212 subjects with cervical pain were screened for the study inclusion criteria and 132 subjects were selected for the study. The assessment of hand function, hand-eye coordination skills and shoulder disability were carried out for all the Subjects. NDI scale was used to evaluate the subject’s severity of pain and the associated disability among the samples. Hand function we evaluated using Purdue pegboard. Ball Tossing Task and Wall Ball Bounce Task were done to assess the Hand eye coordination.

Results: On assessing the correlation between NDI and PURDUE, the results obtained on analysis is -0.108, which shows a negative relationship between the variables. The non-parametric correlation analysis using the spearman’s rho between the Neck disability index (NDI) with the PURDUE is -0.053, which shows a negative relationship between the variables. On assessing the correlation between NDI and Hand-Eye Task-1, the results obtained on analysis is -0.0081, which shows a negative relationship between the variables and the non-parametric correlation analysis is -0.162, which shows a negative relationship between the variables. On assessing the correlation between NDI and Hand-Eye Task-2, the results obtained on analysis is -0.023, which shows a negative relationship between the variables and the non-parametric correlation analysis is -0.092, which shows a negative relationship between the variables.

Discussion: The purpose of the study is to find whether the hand function and hand eye coordination are affected in Cervical Conditions.

Conclusion: This study concludes that the hand function and hand eye coordination are not affected in Cervical Conditions.

Healthcare Workers and Infectious Disease Outbreaks: A Review.

José Antunes — 2024-03-17

In last two decades the world assisted to an increase in the frequency of infectious disease outbreaks which are a challenge for health services and healthcare workers (HCWs). Infectious disease outbreaks cause an unexpected increase in morbidity and mortality, which in turn cause an increased demand on healthcare facilities and consequently an increase in Healthcare workers workload. A search was performed in PubMed selecting meta-analysis, reviews and systematic reviews published before July 2023. The search carried out resulted in abundant information on various aspects of HealthCare Workers’s mental health during and after infectious disease outbreaks. A substantial number of HealthCare Workers suffer greatly from a variety of psychological and psychosomatic problems. The enormous psychological burden of working under such stressful circumstances can severely affect their wellbeing and, consequently, work performance. Health policies and interventions specifically aimed at these professionals should be taken in future infectious disease outbreaks.

Short Overview of The Burden of Tuberculosis

Ahmad Khan MD MS — 2024-03-25

Tuberculosis has been a common infectious disease among humans since ancient times. Mycobacterium tuberculosis can affect different parts of the human body – commonly, human lungs. Tuberculosis is one of the significant public health issues in most countries. According the World Health Organization (WHO) globally, tuberculosis kills approximately 2 million people every year, and 10 million new cases were diagnosed in 2019 (WHO, 2020). The primary source of infection in the community is people who have smear-positive Mycobacterium tuberculosis and their sputum. Among people infected with Mycobacterium tuberculosis, 5 to 10% of people might develop clinical manifestations of the disease. The emergence of clinical manifestation is significantly increased in HIV-positive people (Harries & Dye, 2006).

Accelerated Idioventricular Rhythm in Acute Coronary Syndrome with ST Segment Elevation: Clinical Significance

Hanane ZOUZOU — 2024-03-30

Background: Accelerated Idioventricular rhythm in acute coronary syndrome with ST segment elevation is common after thrombolysis and it is relatively benign; its occurrence is considered as a sign of reperfusion of the occluded coronary artery.

Aims: The main objective of our study is the determination of the frequency of Accelerated Idioventricular rhythm in acute coronary syndrome with ST segment elevation after thrombolysis, the secondary objective is checking with coronary angiography if this rhythm really means the success of thrombolysis and reperfusion of the occluded coronary artery.

Methods and materials: In this prospective study, conducted in the cardiology department of Hussein Dey hospital (Algiers-Algeria), 467 patients with acute coronary syndrome with elevated ST segment (87 women and 380 men) were enrolled between 28 February 2014 and 16 July 2015. The average age is 60 ± 13 years; at admission, a Holter recorder was attached in 448 patients, for continuous ECG monitoring during 48 hours, coronary angiography was performed in 329 patients.

Kruskal’s ANNOVA or H tests were used for comparison of quantitative variables, χ2 test or Fisher’s exact test, were used for qualitative variables, all tests were performed with 1^st species risk of 5%.

Results: The frequency of Accelerated idioventricular rhythm recorded by the Holter ECG is 17.2 % (77 patients), CI 95%: [13.7%-20.7%], this frequency is 18.71 % (73 patients) CI 95%: [14.8 %-22.6%] in patients undergoing thrombolytic treatment.

There is no significant difference between the frequencies of persistence of chest pain in the groups of patients with or without accelerated idioventricular rhythm after thrombolysis: 5.47 % (4 patients) versus 5.99 % (19 patients) respectively, p = 0.979; also for the frequencies of persistence of ST segment elevation after thrombolysis: 4.10 % (3 patients) versus 6.94 % (22 patients) respectively, p = 0.476).

The frequency of occluded coronary artery (TIMI 0) is low in group of patients with accelerated idioventricular rhythm 14.51 %, (9 patients) compared to group of patients without this rhythm 21.39 % (52 patients), but the difference isn’t significant (p= 0.227).

Conclusion: Accelerated idioventricular rhythm is common in acute coronary syndrome with elevated ST segment and generally considered as a sign of reperfusion; in our study, this rhythm may occur even in the absence of reperfusion of the occluded coronary artery and does not necessarily mean reperfusion or success of thrombolysis.

Possible Interaction Between Drugs for COVID19 And Cancer Therapy

Gabriella Marfe — 2024-04-01

At the end of 2019, a new disease was reported in Wuhan China and described such as severe acute respiratory syndrome (SARS). This new virus named SARSCoV-2 S is characterized by high infectivity among humans. Such disease can have no symptoms in some individuals, while in others can provoke flu like symptoms or acute respiratory distress syndrome, pneumonia, and death. At the end of January 2020, the World Health Organization and Public Health Emergency of International Concern declared a pandemic status. Many studies showed a high mortality rate in cancer patient infected by SARS-CoV-2 infection. In this context, the decision of a safe and effective treatment against COVID19 plays a crucial role crucial in these patients Therefore, important questions arose: Can the COVID19 therapies protect everyone and above all cancer patients? and which drug interactions can occur between cancer therapy and COVID19 treatment? In this regard, Covid-19 is a new disease and for this reason it will be necessary to modify constantly pharmacological treatment. In this scenario, the potential drug–drug interactions (DDI) in the cancer patients should be considered to evaluate the risks and benefits of drug combinations.

Introduction to Different Diagrams Commonly Used in Literature

Ahmad Khan, MD, MSHs, LSSBB — 2024-04-03

Diagrams help researchers and authors communicate and visualize complex concepts, data, and relationships effectively to a broader audience, including scientists, students, and the general public (Garcia-Retamero & Cokely, 2017). Visual representations can convey information more clearly and succinctly than paragraphs of text (Divecha et al., 2023; Duquia et al., 2014; Nguyen et al., 2021). Diagrams can take various forms, such as flowcharts, organizational charts, network diagrams, Venn diagrams, and others, and they are commonly used in various fields like business, engineering, science, education, and software development to illustrate processes, systems, relationships, and concepts. They help organize information, clarify relationships, identify patterns, and display data in an organized and visually attractive manner (Divecha et al., 2023; Duquia et al., 2014; Nguyen et al., 2021).

Spinal Manifestation of Sickle Cell Disease. A Report On 35 Patients with Literature Review

Furat Hassan Shalal — 2024-04-15

Background: Sickle cell disease is a hereditary hemoglobinopathy affecting the spine in a wide range of pathology. Despite the several pathological involvements, some patients remain asymptomatic even with positive imaging findings.

Objectives: Theme of this study is to report the various pathological disorders involving the spine of patients with sickle cell disease in Basra “south of Iraq”

Patients and method: 35 Homozygous and heterozygous sickle cell patients were included in this study. 22 Males and 13 females, their age range from 6 to 69 years they were evaluated clinically, and also by laboratory imaging studies like plain radiography, computerized tomography, magnetic resonance imaging and mineral bone density “DEXA scan “

Results: 54% of the patients were homozygous, and the remaining were heterozygous, 66% of them were asymptomatic, back pain was the complaint in 60% while spine tenderness was reported in 40%, 31% had tenderness in the sacroiliac region and only 6% had neurological claudication and focal neurological deficit. Biconcave vertebra was confirmed in 72% of the patients and mainly localized in the lumbar Spine, MRI findings of vertebral infarction were observed in 58% of the studied patients while sacroiliac joint changes appeared in 60%, 60% of those who had DEXA scan showed low mineral bone density in the lumbar spine

Conclusion: Sickle cell disease involve the whole Spine in a wide range of pathological process, some show clinical symptoms, and some remain asymptomatic in spite of changes. The structural changes are more obvious in the homozygous group (55) the lumber spine is dominantly involved, disc prolapse, and neurological deficit is rare while the low mineral changes is common. We did not report a case of spondylodiscitis in this series, though it is very much expected, so routine screening of the spine in sticklers is mandatory

Incidence and Predictive Factors of Heart Rhythm Disorders in Acute Coronary Syndrome with ST Segment Elevation

Hanane ZOUZOU — 2024-04-17

Background: Heart rhythm disorders in acute coronary syndrome with ST segment elevation are common and may induce hemodynamic instability and sudden death.

Their predictive factors have been the subject of several international studies, as well as their related mortality but their epidemiological data are lacking in Algeria.

Aims: The main objective of our study is the determination of the frequency of heart rhythm disorders in acute coronary syndrome with ST segment elevation; we included conduction disorders, ventricular and supra ventricular arrhythmias; the secondary objective was the analysis of their predictive factors, and related mortality.

Results: The frequency of Heart rhythm disorders is 48.6 % (227 patients), CI 95%: [44.1%-53.1%], multivariate analysis identified the following independent predictors: high ST segment elevation above or equal 6 mm, excessive reciprocal ST segment depression above or equal 2 mm, low diastolic blood pressure less than 60 mm Hg, and cardiac troponin elevation above or equal 5 ng/ml.

The risk of mortality expressed by Hazard Ration (HR) is 71, CI95%: [1.1-3572], p = 0.032; low diastolic blood pressure and Blood creatinine above or equal 17 mg/l are the two predictive factors of mortality, identified in our study.

Conclusion: Heart rhythm disorders are frequent in acute coronary syndrome with elevated ST segment, their predictive factors according to our study are: high ST segment elevation, excessive reciprocal ST segment depression, low diastolic blood pressure, and cardiac troponin elevation.

Their occurrence increases the risk of in-hospital mortality, and the predictors of this latter are hemodynamic instability and high creatinine level.

Wellens Syndrome the Previous Room to A Large Previous Myocardial Infarction. Report of A Case.

Dr. Sierra Barrales José Antonio — 2024-04-24

Wellens syndrome or also called anterior descending T wave syndrome, described for the first time in 1982 by Wellens and Zwaan, as a subtype of high-risk unstable angina that progresses to myocardial infarction in the anterior face, which can be massive and fatal; Documentation of this pattern on the ECG would be essential to initiate pharmacological treatment and priority referral to the hemodynamics room; A case of a 74-year-old male patient is described who begins symptoms in the early morning with typical chest pain and adrenergic discharge that progressively disappears. The patient is sent to a High Specialty Medical Center for Catheterization, which correlates injury in a rare anatomical site of the middle segment of the anterior descending artery. Knowledge of Wellens Syndrome in the emergency room is of utmost importance to reduce morbidity in patients and avoid its consequences, as well as the importance of primary referral for cardiac catheterization.

Ischemic Stroke Following Sclerotherapy of Varicose Veins

M. ABDELBAKI — 2024-04-28

Sclerotherapy consists of an injection of a sclerosing foam or liquid to occlude the varicose vein. This therapeutic method is recognized for its immediate effectiveness and its low complication rate. Certain neurological complications have been reported, notably ischemic stroke (CVA), which remains a very rare complication. We report the case of Mrs. FK aged 35, without any particular personal history, who presented to vascular surgery for sclerotherapy of her varicose veins. During the procedure, the patient presented a sudden onset of impaired consciousness associated with left hemiplegia with aphasia.

She was immediately transferred to medical intensive care. Brain computed tomography (CT) confirmed the diagnosis of stroke. As part of the etiological assessment, we performed a transesophageal echocardiography (TEE) on the 7th day of his hospitalization, which was in favor of a patent foramen ovale (PFO). In the literature, this complication has been reported by certain authors but it remains rare. CiVA is secondary to the presence of a PFO. It may be a gas embolism (related to the product used) in which case the stroke is early, or a cruoric embolism, in which case it occurs late. Is echocardiography systematic before sclerotherapy? Through this case and referring to the literature, we will review this entity of stroke of rare etiology.

Operative Morbidity and Mortality of Aortic Stenosis with Left Ventricular Dysfunction

M. Abdelbaki — 2024-04-28

Objectives: Study of the operative morbidity and mortality of aortic stenosis with left ventricular systolic dysfunction (LVEF < or = 35%).

Method: 73 patients with a mean age of 55+/-8 years, 59 of whom were men, underwent surgery between January 2014 and december 2019; 14% (10/73) of these patients had a pre-operative low trans-valvular aortic gradient (<30mmHg).

We determined the factors predictive of operative mortality using univariate and multivariate analyses, analysed changes in functional status and left ventricular ejection fraction, and compared operative mortality and late survival in these 73 patients with those in a control group with no left ventricular dysfunction.

Results: The mean NYHA stage, before and after aortic valve replacement, fell from 3.8 to 1.7, and the mean improvement in LVEF was 28+/-13.

In univariate analysis, the parameters significantly associated with operative mortality were arterial hypertension (p=0.039), congestive heart failure (p=0.030), a smaller indexed left ventricular mass (p=0.039), a mean gradient of less than 30mmHg (at the limit of significance (p=0.053)), a low cardiac index (p=0.0045), and mono-truncular coronary involvement (p=0.042).

In multivariate analysis, no variable was identified as an independent predictor of operative mortality.

Conclusion: Operative mortality was significantly higher 11.7%vs 2.9% (p=0.048) in the group with left ventricular dysfunction, although late survival rates were similar in the 2 groups (86.8% vs 93%).

Given the spontaneous prognosis and the increased operative risk, these patients should be operated on.

The Correlation Study Between Lipid Profile Parameters and Hba1c In Type 2 Diabetic Patients Compare with Healthy Persons in Babylon Province

Shaimaa H. Ali — 2024-04-28

This study was aimed to evaluate the connection between lipid profile and glycated hemoglobin (Hba1c) parameters (LDL, HDL VLDL, cholesterol and triglyceride) in the patients of type 2 diabetes mellitus compare with healthy person, also determine the significant differences between these parameters among healthy and diabetic patients, after assumed whole blood and serum specimens from laboratory of Diabetes and Endocrinology Center in Marjan hospital and private in the Babylon City between the period from October 2022 to February 2023.

The results revealed significant differences (P ˂ 0.05) between study groups in the levels of Hba1c, also it was revealed significant increase (P ˂ 0.05) in all lipid profile include: cholesterol, LDL, HDL, VLDL levels in diabetic group of study compare with control, the results showed significant positive correlation between VLDL and Hba1c in diabetic group, also it was revealed positive correlation between cholesterol and Hba1c in control and diabetic groups, and the results showed negative correlation between triglycerides and Hba1c in both control and diabetic groups, and the results revealed significant positive correlation between body mass index and glycated glucose (Hba1c) in diabetic group.

The research was concluded that the lipid profile level in diabetic patients is correlated with the HbA1c value and the significant positive correlation was conducted between HDL and Hba1c in diabetic group, also the study was concluded significant differences (P ˂ 0.05) between diabetic and healthy group in the levels of Hba1c and other lipid profile parameters.