International Medical Publisher Journals (iMedPub)
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Conquering Methicillin Resistant Staphylococcus aureus: Perpectives and Treatment Options
Get PDFExploring optimal cure of Methicillin Resistant Staphylococcus aureus (MRSA), has been consistently challenged by clinical physicians and microbiologist. The fatal bacterial infection, Methicillin Resistant Staphylococcus aureus (MRSA), shows unique resistance; when selected drugs are tested on human patients. If holistic approach is overlooked, less possibilities are left for medication to curtail this lethal toxicity. If single range of drug treatment is exercised only, the associated complications and consequences of infections may proliferate beyond threshold levels. The research article is an outcome from primary microbial data collection (from urine and blood) in hospital. The focus of experiment is to scrutinize the highest risk vulnerable hospital area including sampled fluid. The preventive and therapeutic measures are discussed along with multiple substitutes of medication with prudent selection to achieve targeted and optimum outcome
Results of abdominoplasty by electrodissection and short- term complications
Get PDFObjective: To describe abdominoplasty by electrodissection technique for improving short-term complications.Design: A prospective controlled study consisting of 100 consecutive female candidates for abdominoplasty by electrodissection employing spray-coagulation was conducted . The technique and electrical current used are described in detail.Results: Intraoperative bleeding ranged from 25 to 160 ml, (median 85 ml). The short-term specific and general complication rates were very low, not exceeding the rates observed using cold scalpel. The frequency of seroma was 24% and the occurrence of seroma, total seroma volume, and total suction tube discharge were correlated to the area of dissection or depth of electrical tissue injury. Conclusion: Despite the relatively high frequency of seroma, we recommend the use of spray-coagulation for abdominoplasty because bleeding is minimized, visibility during dissection is highly increased and the rate of short-term complications is very low
Acetazolamide responsive episodic ataxia treated with methazolamide: a case report
Get PDFAcetazolamide-responsive ataxia is a rare episodic ataxia (EA) disorder characterized by paroxysmal cerebellar ataxia. Many of the symptoms with EA can be treated with the carbonic anhydrase inhibitor acetazolamide. EA is a family of channelopathies each with its own unique mutation. We report a case of EA treated with methlazolamide in a 37 year old man who experienced dysguesia with acetazolamide. Methazolamide has higher rates of diffusion into the tissue and a longer half-life compared with acetazolamide. It should be considered for episodic ataxia
Knowledge of Malaysian university students towards swine-origin influenza A (H1N1) virus: A qualitative study
Get PDFIntroduction: The study was aimed to explore the knowledge towards swine flu among university students.Methods: An in-depth interview was conducted among 40 Students chosen randomly and asked to participate. The interviewers followed a standardized protocol to ensure that all the participants’ interviews were conducted in a similar manner and that an identical set of questions were discussed. Due to the small sample size, the data was analyzed manually.Results: The majority of the participants were aware that H1N1 is a disease caused by Influenza A virus subtype H1N1. In terms of transmission, the majority of participants believed that the H1N1 might be transmitted from an infected person to a susceptible person; 12 out of 40 students thought that people might be infected by eating pork meat. Few students reported that the pig farmers and those in close contact with pigs were at high risk of the infection. Regarding preventions, half of the participants reported that H1N1 infection might be prevented by wearing face-masks, washing hands and avoiding close contact with infected patients.Conclusion: Despite majority of the participants had the basic knowledge regarding H1N1 and its preventions measures such as wearing face-masks, washing hands and avoiding close contact with infected patients, some of them had some misconceptions about the infection, such as the infection might be transmitted by eating pork meat.Â
Prognostic factors of patients admitted in a medical intermediate care unit: a prospective observational study
Get PDFBackgroundMedical Intermediate Care Units (IntCU’s) are high-dependency units intended for treatment of patients who do not meet criteria for admission to intensive care units (ICU’s) but require a higher level of care than can be provided in general ward. IntCU’s operate as a transitional unit, improving patients outcome. In addition, IntCU’s permit better resource utilization, reducing the length of stay in ICU and therefore increasing availability of critical care. Regardless of admission of unstable patients in IntCU’s, studies on prognostic factors are scarce. Our purpose was to identify prognostic factors of patients admitted in IntCU.MethodsA prospective observational study was performed during 32 months in a IntCU of a central hospital. Main objective was evaluation of mortality and analysis of acute illness severity, nurse workload, comorbidity and previous functional status as prognostic factors. Assessment of these variables was performed using several standardized scores: Acute Physiology and Chronic Health Evaluation II (APACHE II), Simplified Acute Physiology Score II (SAPS II), Sequential Organ Failure Assessment (SOFA), Therapeutic Intervention Scoring System-28 (TISS-28), Nursing Activities Score (NAS), Charlson comorbidity index and Barthel index of basic activities of daily living. Bivariate and multiple logistic regression with forwards stepwise selection were used to identify prognostic factors of IntCU and in-hospital mortality.ResultsTwo hundred and eighty-eight patients were included, mean age 65,67 ± 20,38 years-old. IntCU and in-hospital mortality was 9,38 and 17,71%, respectively. All the scores applied, concerning comorbidity, functional status, acute illness severity and nurse workload were good predictors of mortality. SAPS II was the better predictor of mortality followed by NAS.ConclusionsAcute illness severity and nursing workload scores validated in ICU are useful and reliable in IntCU setting, being SAPS II and NAS the strongest predictors of mortality. Comorbidity, functional status and age were also prognostic factors. Consequently, a comprehensive assessment of patients admitted in IntCU is mandatory to reliably predict outcome. Several scores might be used to help clinical judgment, concerning admission criteria and clinical decisions. Â
Psychosocial Stress in High Risk Pregnancy
Get PDFObjective: A high risk pregnancy may introduce additional psychological stress on a pregnant woman. The aim of this study was to review systematically the available evidence of the psychologicalconsequences, in terms of anxiety and depression, of high-risk pregnancy.Methods: A systematic search of the electronic databases was performed. This review considered only quantitative, primary studies in the English language, published during the period 2000-2015 andrelevant to the objective. The population of interest was previously high-risk pregnant women. Outcome variables were general anxiety, depressive symptoms and pregnancy-specifi anxiety. Seven studiesmet the inclusion and methodological criteria and were included in the review.Results: The review revealed that high-risk pregnant women had high levels of depression ranging from 18% to 58% and these rates decrease throughout the course of hospitalization and are similarbetween women hospitalized in a hospital/health centre and women bed-rested in home. The review identifis additionally the main psychosocial variables that were related to antenatal anxiety and depression in high-risk pregnancy.Discussion: Future studies should overcome specifi limitations. Health care professionals should enhance the implementation of psychological screening and counselling to populations of high-risk pregnant women hospitalized in a hospital/health centre or bed-rested in home
Clinicians and The Modern EHR: Statistician, Scribe or Storyteller?
Get PDFThe Health Information Technology for Economic and Clinical Health (HITECH) Act spearheaded the rapid adoption of electronic health records (EHR) in the United States. Although HITECH's mission is to implement data storage, order management, evidence-based decision support, electronic communication and connectivity, and administrative processes and reporting (i.e. billing and coding), the main purpose of the EHR for the practicing clinicians should remain the same -- to convey the story, facts, and plan for the patient’s health care to the reader. We define three categories of EHR notes: the statistical, the scribe, and the storyteller styles, the pros and cons of each, and how the strengths of each may be used for more effective written communication
VEGF, D-dimer and Coagulation Activation Markers in Indonesian Patients with Polycythemia Vera and Essential Thrombocythemia and Their Relation with Recurrence of Thrombosis
Get PDFBackground. PV and ET have high predisposition to thrombosis and recurrence of thrombosis. We determined VEGF, D-dimer and coagulation activation markers in clinically stable patients and recurrence of thrombosis.Methods. Thirty-five Indonesian patients diagnosed with PV and ET and under treatment for the disease were recruited. The following assays were performed: VEGF, D-dimer, fibrinogen, TAT-complex, vWF, β-TG and JAK2 V617F mutation. Data between patients who were clinically stable(n=20) and those with recurrent thrombosis (n=15) at the time of study was analysed.Results. The mean age for PV/ET was 51.7 ± 14.9 years. Thrombosis episode was recorded for 94.3% (33/35) patients. Twenty (57.1%) clinically stable and 15 (42.9%) patients had recurrence of thrombosis. D-dimer (P=<0.001), fibrinogen (P=0.005) were statistically significant and VEGF (P=0.06) were seen in recurrence of thrombosis compared to clinically stable patients who had normal D-dimer. Elevated D-dimer seen in recurrence thrombosis was significantly correlated with VEGF (P=0.002) levels. Elevated VEGF were seen in 45% of clinically stable patients and 73.3% in recurrence of thrombosis.Conclusions. Elevated D-dimer and fibrinogen with higher mean VEGF levels were seen in recurrence of thrombosis. VEGF and D-dimer measurements have clinical use in determining the risk of patients with vascular complications.Â
Monitoring the Suspension of Surgical Procedures
Get PDFIntroduction: A surgical suspension generates a series of hassles and dissatisfaction of the patient and his family. Preparations for surgery involve an entire remodeling of the professional, social and family schedule, as well as other factors such as expectations regarding the results and the fear of the unknown. Objective: A quantification and identification of the reasons for surgical cancellations was realized for a better understanding and guidance to the leadership team's actions on this issue. Thus, their monitoring is important in the search for actions to make the surgery center´s processes more effective, favoring possibilities for improvement in the quality of hospital services. This way, the objective of this research was to identify the main causes for the cancellations of surgical procedures. Method: Study of documentary and retrospective type, quantitative, performed in the surgical center of a hospital in the city of Juazeiro do Norte, CE, Brazil. Data collection was performed through digital files of the 'syshosp' system used to record performed and suspended surgical procedures. Data were collected from January to December 2014 and analyzed using simplified statistics and presentation through a table. Results: The justifications for cancellation of procedures related to the organizational aspects of the institution were highlighted as main reasons for surgical suspension:  the priority for urgency, lack of material resources / equipment required for the surgical procedure and no hospitalization of surgical patients. There were also those related to the lack of staff, being most of them because of the surgeon's inability to attend and absence of anesthesiologist causing the impossibility of building the surgical team. Finally, the suspensions regarding priority for emergencies are highlighted. It was observed that the main determinants for surgical suspensions were those related to the organization of the hospital, with a total of 267 (51.1%), standing out among these: technical problems (16.1%), no admission (42, 3%), lack of material (13.5%) and the priority for urgency (21%). Discussion: The Brazilian Ministry of Health (Ministério da Saúde) defines the surgery suspension rate by the number of suspended surgeries divided by the total of scheduled surgeries in a given period and multiplied by 1003. During the studied period, there were 6591 scheduled surgeries 6069 surgeries were performed and there were 522 suspensions. Thus, the overall average rate of suspension obtained was 7.9%. Compared to other studies and the goals of the institution (5%), it is clear that this is a high rate, but manageable. Conclusion: It was observed that the suspensions of surgeries must be carefully monitored and analyzed by the entire team involved in order to disseminate this indicator and its possible consequences to all. The process of identification of consequences is still weak and needs to be strengthened to an effective action plan. It was revealed that the main cause of surgical cancellations during the surveyed year was related to the organization of the hospital, emphasizing the importance of updating the interaction of processes with the sectors that influence this indicator and preparation of strategic planning with everybody´s involvement so you can minimize the data, as it directly affect the patient, professionals and the hospital, resulting from the patient´s dissatisfaction to the longer permanency of the patient in hospital
Aneurysmal Bone Cyst of the Zygomatic Arch Causing Limited Mouth Opening
Get PDFThe Aneurysmal Bone Cyst (ABC) is an expansive osteolytic, radiolucent, multilocular, excentric, origin-dismissed lesion consisting of spaces filled with blood in any segment of the skeleton, being most frequently encountered in the diaphysis of the long bones or spinal cord. It may occur as distinct clinic-pathologic entity or as pathophysiologic alteration of a preexisting lesion, like giant-cells lesion, fibrous dysplasia, ossifying fibroma, osteoblastoma, epiphysary chondroblastoma and even malignant lesions as osteossarcoma. This paper reports a rare case of ABC in the zygomatic arch of a young female patient who presented facial asymmetry and progressive limitant mouth opening, treated by ressective surgical procedure and discusses the clinical, imaginological, histological and treatment features of this pathology.Â