Australasian Medical Journal
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Demographic features, Challenges, and Treatment Outcome of Rheumatoid Arthritis patients in Private Healthcare System in a Low-income Country
Get PDFA b s t r a c t Objectives: In a low-income country like Bangladesh; the study was taken place in a private rheumatology center between 1st January 2016 to 31st December of 2016 includes 85 Rheumatoid Arthritis (RA). The aim of the study was to observe and statistically analyze the response to treatment with different types of disease-modifying antirheumatic drugs (DMARDs). Initially the patients were treated with conventional synthetic disease-modifying antirheumatic drugs (csDMARDs) like Methotrexate (MTX), Leflunomide (LEF), Sulfasalazine (SSZ) and Hydroxychloroquine (HCQ). Since the biological disease-modifying antirheumatic drugs were expensive and not affordable by most of the refractory to csDMARDs patients, these patients were treated with a single Janus kinase (JAK) inhibitor; a targeted synthetic (tsDMARD) Tofacitinib (TOFA) when the drug available in Bangladesh in July 2016. Treatment response was assessed by use of disease activity score of 28 joints (DAS28) using Erythrocyte Sedimentation Rate (ESR) and C-Reactive Protein (CRP). The adverse effects of different DMARDs, patients’ residence (urban or village) with their monthly income; lastly attendance rate of the patients for timely follow-up were assessed. Methods: An observational, prospective cohort study was performed. After obtaining the informed consent of individual patient; history taking, direct clinical examination, interview of the patients and clinical disease activity, adverse effects etc. were recorded and statistically analyzed. Results: The mean age at diagnosis was 40.68±13.56 years; mostly females (n=69, 81.18%). Majority of the patients had obtained post-primary education (n=67, 78.82%). Two-third patients (n=66, 77.65%) were house wives; funded by their husbands. Majority of the patients (n=73, 85.88%) had moderate to severe impairment of activities of daily living (ADL) at the time of enrollment with moderate to high disease activity. Most of the patients (n=77, 90.59%) had a positive rheumatoid factor test at recruitment and considerable number of patients (n=53, 62.35%) had a positive anti-cyclic citrullinated peptide (ACPA) test. Eighteen patients (21.18%) were in remission with DAS28 scor
Analysis of the distribution and antifungal susceptibility of Candida albicans and non-albicans Candida isolated from human blood culture
Get PDFBackgroundCandidaemia is a growing concern worldwide, and its species distribution has shifted toward non-albicans Candida in recent decades, especially in patients with malignancy. The population continues to age worldwide, especially in developing countries and among groups with high socioeconomic status.AimsThis study aimed to analyse the Candida species and associated antifungal susceptibility in one region of Korea.MethodsFrom December 2014 to June 2018, 126 specimens of Candida species from blood cultures were analysed using various methods. We used VITEK 2 to perform the blood culture and the R statistical program for analysis. In addition, an antifungal susceptibility test was performed.ResultsC. albicans was detected in 51 (40.5 per cent), C. glabrata and C. tropicalis in 24 (19.0 per cent), and C. parapsilosis in 16 (12.7 per cent) specimens. The mean age of patients with C. albicans was 63.8 years and that of patients with non-albicans Candida was 65.6 years. We performed an antifungal susceptibility test using six agents, and eight (6.3 per cent) specimens exhibited antifungal resistance. The data showed that C. albicans was the most commonly detected species. Moreover, a large proportion of the elderly subjects were infected with C. albicans, and the rate of antifungal agent resistance was as high as 6.3 per cent.ConclusionOur study indicates that C. albicans was the most commonly detected species and the infection rate was high among elderly patients. Therefore, clinics should remain vigilant, and preparedness levels must be increased in regions with a high percentage of elderly people
Metal ion levels post primary unilateral total knee arthroplasty
Get PDFBackgroundMetal ion release from metal implants through the processes of mechanical wear and corrosion has been one of the main concerns post total joint arthroplasty. However, there have been very few studies to show metal ion exposure post total knee implants.AimsThe aim of this study was to investigate whether blood metal ion levels are raised in patients with well-functioning unilateral primary total knee arthroplasty in the short and the long term after surgery.Methods Whole blood Chromium and serum Cobalt levels were measured in 22 patients following primary total knee arthroplasty at a minimum of 12 months after surgery and then repeated at a mean of four years. Eleven patients had the cemented triathlon knee system and 11 patients had an uncemented ACS knee system with multilayer coatings.Results Cobalt levels in our study are low one year after TKR and stayed within normal limits with no significant rise at four years (p=0.300). Chromium levels raised significantly by four years (p=0.007), but remained within normal range with no evidence of toxic systemic effects. Our data showed no statistically significant difference for cobalt and chromium levels between ACS and Triathlon groups (p=0.62; p=0.54 respectively).ConclusionAt an average of 50-months post well-functioning total knee arthroplasty, whole blood Chromium levels and serum Cobalt levels are within the normal range. The use of cement is unlikely to influence metal ion release and titanium nitride coating did not influence metal ion release from TKR implants
Female health college students’ knowledge and attitude towards breast cancer
Get PDFBackgroundBreast cancer is the most common cancer in women in Saudi Arabia and worldwide. It occurs at an earlier age in comparison with Western countries and account for 25.1 per cent of all newly diagnosed female cancers.AimsAim was to assess knowledge level of breast cancer risk factors, the symptoms, the signs and screening methods of early detection among female students at the health colleges. Additionally, to determine the attitude of students towards the breast cancer.Methods A cross-sectional study was carried out on a representative sample of female students at the health colleges in King Abdulaziz University, through stratified sampling with proportional allocation.Results More than 78 per cent of the students had good knowledge about the symptoms and signs of breast cancer, and 76.8 per cent of them had positive attitude towards believing and treatment of breast cancer. About 75.5 per cent of students mentioned mammography is an early screening method. However, the total score of insufficient knowledge about breast cancer risk factors was 57.5 per cent. Logistic regression analysis revealed that lower grades were the predictors of insufficient knowledge about breast cancer risk factors.ConclusionAlthough the students had a good knowledge about the symptoms and signs of breast cancer and they had positive attitude towards believing and treatment of breast cancer, for example, most of them will consult a doctor if they develop breast cancer and they will agree to perform mastectomy if she needed, they will see a doctor within one week if they have breast lump and they thought that the breast cancer is a curable disease. However, they had insufficient knowledge of some risk factors. So, we should focus on increasing the knowledge of risk factors among the students either through regular update teaching courses and methods or through health education workshop or campaigns
Rehabilitation of an atrophic jaw with three short implants and a customized milled bar overdenture
Get PDFEdentulism is frequently observed in older individuals, and edentulous patients with conventional prostheses have reported lack of retention, support, stability, and chewing and phonation failures. Overdentures are a good option for rehabilitation of edentulous patients. Two or more implants supporting a milled bar with attachments may be used for rehabilitation of these patients, since this arrangement allows very limited rotation and vertical movement, thereby increasing patient satisfaction. This report describes a clinical case involving oral rehabilitation of an atrophic jaw with three short implants and a customized milled bar overdenture
Sickle cell disease and systematic lupus erythematous association in a 14-year-old adolescent female
Get PDFSCD develops when haemoglobin (HbS) is produced in the body as a result of a mutation occurring in haemoglobin beta chain. SLE is defined as a rare, chronic autoimmune multi-organ manifestation. SCD and SLE rarely coincide in literature due to the limited number of cases and the overlapping of symptoms of both diseases. Majority affecting child bearing age, with a mean of 23-year-old. Articular manifestations like joint pain are common in both diseases. We report a case of female adolescent with sickle cell disease associated with systemic lupus erythematous
Zero % long term biliary stricture in microscopic reconstruction (MBR) of Hepatico-Jejunal Biliary Roux en Y choice of biliary drainage of adult liver transplant
Get PDFBackgroundRoutine use of (MBR) by Roux en Y in adult Orthotopic Liver Transplantation (OLT) has not been elucidated. The usual choice of enteric drainage got expected morbidities of biliary enteric anastomosis. Patients of liver transplant clinical differences are compared. Choices, current status, efficacy, application, short and long term outcome of biliary reconstruction by (MBR) roux en Y anastomosis in adult liver transplant was compared to Conventional roux en y.AimThe primary aim of the study is to clarify the influence to the diseased liver recipient duct to the future graft biliary drainage.MethodsStudy of consecutive liver transplant patients was retrieved. Total Number of 1234 OLT, By the End of July 2014. Group A 16 patients of Conventional Period up to 22 March, 2006. Group B 50 patients of (MBR) up to 31 JULY 2014.ResultsIn group A 8/16 got short and long term complication. However, in group B only 4/50 got short term problems, with no death.ConclusionIn Spite of the drawback of adult OLT roux en Y hepatico-jejunal anastomosis including anatomical challenges and graft position, we developed graft survival in adults liver transplant with widened application of (MBR).There is accessible and durable intact biliary drainage choice by (MBR) hepatica enteric anastomosis for adults OLT patients that can be encouraged and advised by microscopic surgery
Prevalence of white coat hypertension in adult primary care attenders
Get PDFBackgroundWhite coat hypertension (WCH) is common but such data is lacking in Malaysia. AimsTo determine the prevalence of WCH and its associated factors among healthy adults in the Malaysian primary care setting. Methods This was a cross-sectional study conducted from January to June 2014 in 5 primary care clinics in Negeri Sembilan, Malaysia. Previously healthy adult who found to have persistently elevated BP fulfilling all the inclusion and exclusion criteria of our study at clinic were recruited. The validated BP set Omron HEM7200 was used for home BP monitoring in making the diagnosis of WCH. Patients were guided to do home BP monitoring. Results A total of 105 subjects completed the study, with a response rate of 92.1 per cent. The prevalence of WCH among Malaysian primary care attenders was 52.4 per cent. There was no correlation found between WCH and socio-demographic variables. ConclusionMore WCH studies using ambulatory blood pressure monitoring with larger sample size are needed for Malaysian primary care setting. Accurate diagnosis of hypertension could have saved money on the unnecessary anti-hypertensive agents