International Medical Publisher Journals (iMedPub)
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Disseminated Saprochaete capitata in a patient with Diabetes mellitus and HCV Hepatitis; A Case Report
Get PDFSaprochaete capitata yeast rarely causes human infections; nonetheless the vast majority of infections were reported in patients with hematological malignancy. Here, we report one of the unusually rare presentations of disseminated Saprochaete capitata in a patient without hematological malignancy, but the patient had a prolonged history of chronic active hepatitis C, diabetes mellitus, prolonged ICU stay on mechanical ventilation, and exposure to several antimicrobials. The currently isolated Saprochaete capitata showed resistance to Amphotericin B, triazoles and ecchinocandins, but susceptible to 5-fluocytocine with MIC ≤1 mg/dl
Afferent Loop syndrome with associated perforation 15 years after gastrectomy and Roux-En-Y Reconstruction
Get PDFAn elderly patient presented to our institution with abdominal pain, nausea and vomiting. She had an extensive surgical background including gastrectomy with Roux-en-y reconstruction undertaken 15 years earlier. A CT abdomen demonstrated a small bowel obstruction proximal to the jejunojejunostomy with features suggestive of afferent loop syndrome (ALS), a rare but known complication following Roux-en-y reconstruction. Initial surgery identified a band adhesion and an associated ischemic small bowel segment, which was resected with primary anastomosis. A further operation was required at post-operative day five due to clinical deterioration. A retroperitoneal collection was identified secondary to perforation of the afferent loop
Acellular mucinous lymph nodes in colonic mucinous Adenocarcinoma
Get PDFThis is an interesting case report on a 72 year old female who underwent an elective right hemicolectomy for a mucinous tumour. Histology revealed 15 lymph nodes with two entirely replaced by mucin without evidence of metastatic tumour cells. The rest of the lymph nodes were normal. After discussion at the local colorectal multidisciplinary meeting these were treated as lymph node metastases and the patient received adjuvant chemotherapy. There is little evidence around the management of colonic carcinoma with acellular mucin evident in lymph nodes
La evaluación multidisciplinaria en disforia de género: reporte de caso y revisión de la literatura
Get PDFEl Trastorno de Identidad de Género (TIG), Transexualismo (T) o Disforia de Género (DG), se caracteriza por la experiencia subjetivade pertenecer al sexo opuesto y la presencia de sentimientos de malestar o desacuerdo por el sexo anatómico. Esta discrepancia sueleimplicar cambios fÃsicos y sociales importantes, asà como riesgo de presentar comorbilidad psiquiátrica asociada. Su prevalencia es pocofrecuente y se desconoce su etiopatogenia. Las guÃas internacionales para la atención de estos pacientes recomiendan una evaluacióndesde equipos multidisciplinarios para realizar un diagnóstico correcto y ofrecer un tratamiento con el objetivo principal de lograrun equilibrio perdurable, una comodidad personal con el género con el que se identifica y la realización total del paciente. La intención de este trabajo es presentar nuestra experiencia en un caso de DG/T/TIG evaluado por un equipo de profesionales de la salud
Molecular determinants of ß-lactamase producing Klebsiella pneumoniae in Mansoura University Neonatal Intensive Care Unit
Get PDFBackground: The emergence of ß-lactamase- producing Klebsiella pneumonia (K. pneumoniae), represents a significant diagnostic and therapeutic challenge to the management of infections caused by this organism. This prospective study aimed at studying the frequency of ß-lactamase production by K. pneumoniae in neonatal intensive care unit (NICU) of Mansoura University Children’s Hospital.Methods: This prospective study was conducted over a period of thirty six months from September 2010 to August 2013, where 684 samples were collected from different body sites of neonates in the NICU. Microbial isolation, identification and antimicrobial susceptibility testing were carried out. ß-lactamase production by K. pneumoniae isolates was tested by phenotypic methods and PCR amplification of related genes using a six-gene panel for the amplification of the blaCMY-2, blaDHA, blaACC, blaSHV, blaTEM and blaCTX-M genes. In vitro transformation and conjugation were carried out to test for plasmid mediated AmpC ß- lactamase resistance transmission to E. coli. Results: K. pneumoniae was isolated at a percentage of 12.6% and ß-lactamase production was detected in 62.8% of the isolates. The most commonly detected ß-lactamase gene was blaSHV (51.9%), followed by BlaCMY-2 (16.67), blaDHA (12.96%), blaTEM (9.2%), blaCTX- M(7.4%) and lastly blaACC (1.85%). Additionally, some strains carried combinations of two or three genes. The plasmid carrying blaCMY-2 was 100% successfully transformed into the competent E. coli LE392 while conjugation with the E. coli ATCC 25922 was (77.8%) successful.Conclusion: K. pneumoniae is a common multidrug resistant isolate; the production of ß-lactamases is the mechanism of resistance in a significant number of cases and represents a real risk for failure of many therapeutic options. This problem is highly complicated by the horizontal spread of resistance plasmids among microbial population
Value of phenotyic and genotypic identification of Acinetobacter baumannii isolates from two hospitals in Jordan
Get PDFAcinetobacter baumannii isolates have been recovered from hospitalized patients over the past few years from two hospitals in Jordan. Phenotypic and biochemical characterization in addition to disc susceptibility testing of all clinical isolates indicated that all of them were belonging to A. baumannii. A high degree of conservation of both the ITS length and the ITS sequence was observed, and their identities were further confirmed by amplified ribosomal DNA gene restriction analysis (ARDRA). The application of ARDRA for the identification of Acinetobacter species has several advantages over phenotypic identification. ARDRA considered rapid and reliable and universally applicable method for identification of most of the Acinetobacter genomic species, thus contribute to better understanding of the clinical importance and epidemiology of isolates
Enfermedad de Paget. Actualización en el tratamiento médico
Get PDFLa enfermedad de Paget del hueso (EP) se caracteriza por un aumento del metabolismo óseo localizado en uno o varios focos del esqueleto. El mecanismo fisiopatológico inicial es el aumento de la resorción ósea osteoclástica, y los bifosfonatos son el tratamiento de elección. Las indicaciones aceptadas para el tratamiento de la EP incluyen el dolor óseo y las manifestaciones del sistema nervioso. También se recomienda el tratamiento antes de una cirugÃa ósea para prevenir el sangrado excesivo o la hipercalcemia. Los pacientes con una alta actividad metabólica (nivel de fosfatasa alcalina más de dos veces el lÃmite superior normal) también deben ser tratados. Una indicación controvertida es el tratamiento en pacientes asintomáticos para prevenir las complicaciones evolutivas.Los nuevos bifosfonatos, como el ácido zoledrónico, con una gran potencia y afinidad de unión a la hidroxiapatita, son muy útiles para el control de la actividad de la enfermedad a corto y largo plazo. El ácido zoledrónico está indicado para EP en Europa y América en una sola dosis de 5 mg, administrado por vÃa intravenosa. En 2005, un ensayo controlado con risedronato, demostró una respuesta terapéutica en el 96% de los pacientes tratados con ácido zoledrónico, que es significativamente mayor que los resultados obtuvieron por otros bisfosfonatos. En el estudio de extensión, se demostró que la duración de la respuesta era de al menos 6 años y medio tras la infusión del fármaco.El ácido zoledrónico ha cambiado el manejo de la enfermedad de Paget. Queda pendiente demostrar si el control metabólico eficaz y prolongado que se consigue con los nuevos fármacos, reducirá el riesgo de complicaciones tales como la deformidad, las fracturas, la sordera y la artropatÃa secundaria
Impacto de la formación en el manejo de la patologÃa locomotriz axial atraumática en la actividad asistencial del médico interno residente
Get PDFEl objetivo del presente estudio es el determinar el efecto de la aplicación de un programa formativo para médicos internos residentes sobre manejo de patologÃa atraumática axial en un entorno de medicina de urgencias.El programa formativo consiste en la aplicación de una jornada de charlas magistrales de 4 horas lectivas que se imparten a lo largo del año a residentes que van a empezar su segundo año de programa de especialización y que realizan actividad en el servicio de urgencias.El estudio consistió en valorar la aplicación de los conocimientos impartidos en la labor asistencial durante las jornadas de atención continuada (guardias de puerta) en términos de necesidad de reevaluaciones por urgencias, uso de pruebas complementarias y necesidad de hospitalización por mal control analgésico.La cifra de solicitud de pruebas radiológicas complementarias se redujo significativamente después de la ejecución del curso optativo sin embargo en los siguientes meses la cifra retornó a su valor inicial. El asistir al curso no modificó significativamente el tiempo hasta que los pacientes volvieron a consultar por el mismo motivo aunque se evidenció una tendencia a la prolongación de este en pacientes atendidos por residentes que hicieron el curso. La especialidad de procedencia de los MIRes fue la variable que más influyó en la curva de supervivencia.Concluimos que el impacto de la formación en el manejo de la patologÃa axial depende de los cursos impartidos y del interés que estos generen en los MIRes
Vulnerability Aspects That Hinder Tuberculosis Healing According to the Perspective of Patients and Healthcare Managers.
Get PDFIntroduction: Tuberculosis is a major public health condition worldwide. The partnership between Healthcare Services and the patient is the gold standard for a successful healing outcome and a reduction in the harm the disease causes to patients and society in general. Objective: To analyze the vulnerability aspects that make tuberculosis healing difficult according to the perspective of patients and public healthcare managers. Method: This is a descriptive study conducted in the year 2013 in Cajazeiras, a town located in the state of ParaÃba in the northeastern region of Brazil. The study population was composed of 4 healthcare managers and 29 patients with confirmed tuberculosis diagnosis. In order to gather the sample of tuberculosis patients, a search on the Information System on Diseases of Compulsory Declaration (SINAN, in the Portuguese abbreviation) was run. Results: All patients had fixed addresses. Among these individuals, a total of 12 were of the male sex, 13.6% were smokers, 77.3% were alcohol-free and 13.6% were frequent alcohol consumers. In addition to that, 72.7% of the patients received no public financial support of any sort. As to coping with the disease, 54.5% declared no difficulty at all, 22.7% found it very difficult, 18.2% reported it was somewhat difficult and 4.5% stated it was extremely difficult. Concerning family income, 68.0% lived on up to two minimum wages. Final considerations: The findings in the current study revealed the vulnerability condition upon which tuberculosis patients live, highlighting the social exclusion of this population with their low educational level, their low-income status, their poverty condition and their difficulty in understanding their basic needs, such as the necessity of a well-balanced diet to prevent the adverse effects caused by the drugs during the treatment. Managers identified social stigma, prejudice, denial of the disease with a resultant resistance to treatment, street-dwelling individuals and drinking and smoking habits as major difficulties for tuberculosis control in the city. It is quite clear that the managers approach the universe of vulnerability within its three inseparable dimensions: individual, social and programmatic. A better understanding of the real needs of tuberculosis patients as well as the prioritization of the disease are of utmost importance in the municipal public health agenda, which is based on a higher involvement of managers in the participation, discussion and definition of the application of resources for the disease control and a public health policy that encompasses tuberculosis social issues
Plagiarism as another ethical issue in scientific research
Get PDFThe excessive demand for publications results in high plagiarism and duplicate numbers by scientists who take over existing texts into new publications. In addition to serious ethical problems, this practice hinders the generation of original material. In order to reduce the problem, softwares such as eTBLAST are being used to detect plagiarism and repeated papers. Despite the persistence of fraudsters, these tools have helped to reduce these problems; however, the ideal solution would be the basic ethical establishment principles. Therefore, plagiarism has always been a foible that could lead to fraudulent and dishonorable development of science