International Medical Publisher Journals (iMedPub)
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Haemodialysis access: clinical and epidemiological profile of patients and their vascular access in interior of Brazil.
Get PDFBackground: The analysis of vascular access for hemodialysis is relevant for the quality of life of patient. In this study we investigated the profile of vascular access used for hemodialysis patients in a poor place, interior of Brazil.Objectives: To identify the percentage of vascular access for hemodialysis in this unit conforms to international standards.Methods: We evaluated the reference hemodialysis service in a specific poor place in Brazil. There are 120 patients of both genders who have undergone implant or manufacture of vascular hemodialysis access; there aren´t patients on renal replacement therapy by peritoneal dialysis.Results: Associated diseases were unknown cause, diabetes mellitus and hypertension. 93(77.5) had arteriovenous fistula, with 89 held by the same dialysis and four of them were still maturing. 27 patients on dialysis used central venous catheter. 91 were indigenous and two were made using polytetrafluoroethylene prosthesis (PTFE). Among the 27 patients with central venous catheters, twenty were short-term catheter and 7 were long-term catheter. Among the fistulas for dialysis patients, the highest prevalence was radiocephalic fistula in 60 patients (50%).Among all the fistulas, the left radiocephalic was the most found, in 37 patients (39.8) and right, in 23 patients (24.7). The number of patients that they had only one fistula manufactured corresponded 60 patients (50%). and mean duration of use was 1,74 ±1,64 years, ranging from two months to 9 years.Conclusion: Our Unit of hemodialysis is above the limits established by international norms.Â
Village Health Workers: Considering their Potential Role in the Current Ebola Virus Disease (EVD) Outbreak
Get PDFAn overview of the Ebola virus disease (EVD) in the current outbreak was discussed. The void created by the loss of health care workers and the increased need for village health workers (VHWs) was highlighted. The clinical manifestations of EVD in past and current outbreaks were also examined. The implementation of VHWs in various countries before the 1978 Declaration of Alma, Ata was reviewed. Village health workers are also called community health workers (CHW). They are called by different names around the world and they have different levels of training. Some are trained in only one area like the traditional birth attendants. The village health care worker was identified as part of Primary Health Care and their roles in different countries were explored. The positive impact in the health status of the communities after the introduction of VHW was also highlighted. In this present outbreak, there has been antagonism towards health care workers which has sometimes ended fatally. As part of community participation, VHWs are selected by the community they serve and this would reduce the antagonism sometimes directed at health care workers that are not from the community. The potential role of VHW as contact tracers, counselors, health educators, temperature monitors and first contact with the health system in the control of EVD was also highlighted. The governments of the three most affected countries should collaborate with countries that have employed the use of VHWs in EVD outbreaks
Epidemiological and clinical factors impact on survival in ALS/ MND: a cohort study
Get PDFBackground Motor neuron diseases (MND) are rare yet severe neurodegenerative disorders with peculiar characteristics of unknown etiologies that cannot be prevented. They are irreversible and incurable, but treatable diseases. Treatment can improve the quality of life and increase survival. This study aimed to investigate the impact of epidemiological and clinical factors in individuals with motor neuron diseases, particularly amyotrophic lateral sclerosis (ALS). This study aimed to analyse the survival of patients with ALS in relation to clinical and epidemiological aspects. Methods Data were collected from charts in the Division of Clinical Investigation on Neuromuscular Diseases (DCINM), (from 1999 to 2011). Kaplan-Meier curves illustrated the survival time. Results A total of 1146 records of patients with MND were investigated and 578 records, in accordance with the inclusion criteria, were included. For analyzing epidemiological and clinical aspects 231 records were included and survival curves were plotted. Conclusion The survival of patients with MND was not influenced by sex. Younger patients live longer. Too much time passes between initial symptoms and 1st appointment. Patients who survive longest are those who were not diagnosed on the 1st appointment, or did not show any clinical and electromyographic findings, and presented with initial symptoms in the lower limb
The HLA-DRB1 Alleles Effects on Multiple Sclerosis:a Systematic Review
Get PDFBackground: Multiple sclerosis (MS) is an autoimmune disease of the central nervous system that affects sensitive and motor functions. Many population studies were made with the intent of knowing better the most affected groups and the disease manifestations. These review analyses some of those studies, evaluating risk factors, especially genetic relations of Human Leukocyte Antigen DRB1 (HLADRB1) gens, for developing clinical disease.Method: We have analyzed 57 articles, published between 2009 and 2014, with the key words “multiple sclerosisâ€, “genetic association studies†and “HLA-DRB1 chainsâ€, through the Scopus database. Only 18 articles were eligible for our study; they were read entirely and included in the fial analysis.Results: Most studies imply genetic and environmental factors for the incidence of MS, its age of starting and prognosis. Previous studies have shown that many gens are related in MS pathogenesis and that interactions between them are important in determining clinicalmanifestations.Limitations: Different results were observed when different populations were targeted in the studies.Conclusion: There is an important relation between HLA-DRB1 and MS in diverse population groups. Complementary studies are needed to know better the importance of environmental factors and its interaction with gens in the development of MS
Hemorrhoidectomy in Patients with Grade III or IV Disease: Harmonic Scalpel Compared With Conventional Closed Technique.
Get PDFAbstractBackground: Harmonic scalpel (Ultracision) is a device that simultaneously cuts and coagulates soft tissues through ultrasonic vibration. In this study we aimed to determine the operative and postoperative characteristics of hemorrhoidectomy using the harmonic scalpel compared with the conventional closed technique.Methods and Findings: Patients with grade III or IV hemorrhoids, operated between 2010 and 2013, using the harmonic scalpel (n=21) or the conventional closed technique (n=42) were included in the study. Exclusion criteria were thrombosed or strangulated hemorrhoids, concomitant perianal disease, history of recurrent perianal surgery and known tendency for bleeding. Patient characteristics, duration of operation, complications, postoperative pain measured on a visual analog scale (VAS), hospital stay, and return to regular activity were compared between the two groups retrospectively.Patient characteristics (female:male ratio, mean age, hemorrhoid grade, and symptom duration) were similar between the two groups. Harmonic scalpel and conventional hemorrhoidectomy patients did not differ significantly in terms of VAS score of pain, complications, hospital stay or return to regular activity. However, duration of operation was significantly shorter with harmonic scalpel (24.2 vs. 36.2 min, p<0.05).Conclusion: There is no clear evidence to support the routine use of harmonic scalpel system in hemorrhoid surgery
Espacios 100% libres de humo de tabaco en la UAZ, como prevención de la Epidemia del Tabaquismo
Get PDFIntroducción: La epidemia mundial del tabaquismo mata cada año a casi 6 millones de personas, de las cuales más de 600 000 son no fumadores que mueren por respirar humo ajeno. Si no actuamos, la epidemia matará a más de 8 millones de personas al año de aquà a 2030. Más del 80% de esas muertes evitables se producirán entre las poblaciones de los paÃses de ingresos bajos y medianos (Organización Mundial de la Salud 2014). De ahà la importancia de promover espacios 100% libres de humo detabaco, esta acción entre los jóvenes que son la población susceptible. En la UAZ con la implementación del Modelo académico UAZ Siglo XXI, contempla la formación integral de nuestros alumnos que conlleva a un desarrollo sostenible que sea para toda la vida.Objetivo: Implementar en todos los espacios Universitarios, espacios 100 % libres de humo de tabaco.Material y Métodos: El proceso se llevó en 2 etapas: (2007-2010), (2011-2013). Participando todos los sectores que conforman la UAZ, alumnos, docentes, trabajadores, autoridades administrativas. Procedimiento: 1.-Solicitud a la SecretarÃa de Salud, 2.- Que realizó cinco visitas, 3.-Que la Comunidad estuviera enterada del proceso, 4.-Colocación de ceniceros a la entrada del edificio, 5.-Señalamientos de espacio 100% libre de Humo de Tabaco, 6.-Señalamiento del Reglamento de la UAZ como espacio 100% libre de Humo de Tabaco.Resultados: La primera Etapa, se certificó el área de Ciencias de la Salud y CECIUAZ. En la segunda etapa se certificó 45 espacios de la UAZ.Conclusiones: Con este reconocimiento inicia el trabajo de retroalimentación y forma parte de la formación integral de nuestros alumnos, y del personal docente, trabajadores y administración central. Se programa una evaluación del programa en dos años
Deformidad vertebral en el SÃndrome de Noonan: revisión de la literatura. A propósito de dos casos
Get PDFEl sÃndrome de Noonan es un trastorno autosómico dominante, caracterizado por talla baja, cardiopatÃa congénita (la alteración congénita más frecuente), dimorfimo facial y alteraciones esqueléticas [1,2].Entre las anomalÃas vertebrales descritas en la literatura la escoliosis es la más frecuentemente descrita con prevalencias que oscilan entre el 10 y 15% de los casos [4-8]. El diagnóstico es clÃnico. Actualmente no tiene tratamiento especÃfio. Presentamos dos casos de escoliosis asociadas al sÃndrome de Noonan atendidos en nuestro servicio
The antimicrobial potential of Lactobacillus acidophilus on pathogenic bacteria causing diarrhea
Get PDFObject: Lactobacillus acidophilus is a nonpathogenic member of gastrointestinal tract and it is widely used in fermented dairy products. This study aimed to assess the antimicrobial potential of two strains of L. acidophilus on some pathogenic bacteria frequently causing diarrhea or gastroenteritis.Methods: The antibacterial activity cell free supernatant (CFS) of two control standard strains of L. acidophilus (L. acidophilus-la5 and L. acidophilus against fie control standard strains of bacteria causing diarrhea; Enterotoxogenic Escherichia coli (ETEC), Enterohaemorrhagic E. coli O 157:H7(EHEC) Salmonella typhimurium Shigella flxeneri and Staphylococcus aureus were determined using agar well diffusion method. The sensitivity of the pathogenic bacteria to the CFS of each L. acidophilus in relation to time was determined by standard plate count .The antibiotic susceptibility tests of 20 antibiotics against tested organisms with and without CFS were assessed by disc diffusion method. The minimum inhibitory concentration (MIC) of ciproflxacin with and without CFS was determined by tube dilution method.Results: Both Lactobacilli strains decrease the colony count of tested strains by more than 90% after 60 min contact time. Both Lactobacilli strains signifiantly improve the antibacterial effect of tested antibiotics against ETEC, S. typhimurium and S. aureus, and S. flxeneri (P< 0.05). The MIC of ciproflxacin alone against all tested strains was 15.625 μg/ml, while when combined with both Lactobacilli CFSs, the MIC decreased signifiantly to 0.488 μg/ml for ETEC, S. typhimurium, and S. flxeneri and to 0.977 μg/ml for EHEC and S. aureus (P= 0.000).Conclusion: living L. acidophilus strains could be used in prevention and treatment of diarrhea caused by certain bacterial pathogens, either in fermented milk/ yoghurt or as mediations
Low incidence of hypervirulent clinical klebsiella pneumoniae producing carbapenemases among Jordanian hospitalized patients
Get PDFBackground: Klebsiella species are widely present in the environment and colonize mucosal surfaces of humans. The organism is responsible for various community and hospital-acquired infections. Increased incidence of isolates producing K .pneumoniae carbapenemases (KPCs)  in infected patients has become a significant problem in many countries, especially those new hypervirulent clinical variant (hvKP).  This prospective study was intended to detect the incidence, virulence factors and carbapenems resistant gene (blakpc2) in K. pneumoniae isolates among Jordanian patients.Methods:  A total of 104 klebsiella species isolates were collected randomly from three major hospitals in Amman, Jordan, over the period from September 2012 to October 2013. These isolates were investigated for incidence of K.pneumoniae , antimicrobial susceptibility and detection of virulence factors and kpc gene using PCR .Results: A total of 75 (72%) of the collected isolates were confirmed as K. pneumoniae using PCR, and 74% of these were MDR to at least 3 antibiotic classes. The percentage of the virulence factors K1, K2, K5, rmpA and aerobactin were 0%, 4%, 0%, 5.3% and 10.7%, respectively. Resistant to cabapenems was detected in 18/75 (24% ) of K . pneumoniae isolates, and 10 (13.3%) of these have the kpc genes .Conclusion: This study confirms the high incidence rate of MDR K. pneumoniae and low incidence of (KPCs) isolates in Jordanian patients.  There were few isolates associated with virulence factor genes causing hvKP, and no significant correlation demonstrated between the presence of virulence factors and kpc gene in these isolates
Planimetry of the medial temporal lobe: a feasible method for supporting the diagnosis of Alzheimer’s disease in clinical practice
No full textAlbeit a disproportionate rate of atrophy in the medial temporal lobe (MTA) represents a reliable marker of Alzheimer’s disease (AD) pathology, the measurement of MTA is not being widely used in daily clinical practice. This is mainly because the methods available to date are sophisticated and diffiult to implement (volumetric methods) or lack objectivity (visual rating scales). Here, we aimed to assess the reproducibility of computing the 2D-yrA-MTL and the efforts needed to start the usage of 2D-yrA-MTL. A series of 290 1.5T-MRI studies on 230 subjects in the age range of 65–85 years, including patients with AD (n = 100), MCI (n = 100) and matched controls (n = 90) were examined by experienced tracers (ET) and inexperienced tracers (IT). The IT got suffiiently trained by attending to a minimum of 3 cases before being able to perform the 2D-yrA-MTL on their own and without mistakes according to the corrections made by the ET. After training, the IT needed 5 minutes to perform the 2D-yrA-MTL on a new case. The intrarater and interrater reproducibility of 2D-yrAMTL was good. In conclusion, the 2D-yrA-MTL is a simple, objective and reproducible method that could be easily implemented in clinical practice