Advances in Medicine最新文献

Objective: To report association between the serum transferrin level and postoperative wound drainage in closed long bone fractures.

Summary of background data: There is an old association between the serum transferrin level and wound drainage leading to peri-implant infection. There is no literature available on the ideal treatment for wound drainage. In the majority of the cases, wound drainage usually stops in 3-5 days postoperatively. However, very few cases have been described in the literature about wound drainage following closed long bone fractures.

Methods: A prospective review of the patient's serum transferrin levels and postoperative wound drainage is done.

Results: We reviewed records of 100 patients in whom levels of serum transferrin were checked preoperatively and correlated with postoperative wound discharge. Out of the 100 patients whose serum transferrin levels were checked, 23 patients had low serum transferrin levels and 19 patients had postoperative wound discharge. Out of these 19 patients, 16 patients had low serum transferrin levels. Thus, sensitivity of the test was 84.2% and specificity was 91.3%. In addition, the positive predictive value was 70% and negative predictive value was 96%.

Conclusion: We report that preoperative serum transferrin levels can be used as a good marker to judge postoperative wound drainage in closed long bone fractures.

Introduction: Recognizing the predictors of mortality among HIV-infected children will allow for concerted management that can reduce HIV-mortality in Nigeria.

Methodology: A retrospective cohort study in children aged 0-15 years, between October 2010 and December 2013, at the Federal Medical Centre, Makurdi, Nigeria. Kaplan-Meier method analysed the cumulative probability of early mortality (EM) occurring at or before 6 months and after 6 months of follow-up (late mortality-LM) on a 12-month antiretroviral therapy (ART). Multivariate Cox proportional regression models were used to test for hazard ratios (HR).

Results: 368 children were included in the analysis contributing 81 children per 100 child-years to the 12-month ART follow-up. A significant reduction in EM rates was noted at 17.3 deaths per 100 child-years (30 deaths) to LM rates of 3.0 deaths per 100 child-years (10 deaths), p < 0.01. At multivariate analysis, children with a high pretreatment viral load (≥10,000 copies/ml) were found to be at risk of EM (aHR; 18. 089, 95% CI; 2.428-134.77, p=0.005). Having severe immunosuppression at/or before 6 months of ART was the predictor of LM (aHR; 17.28, 95% CI; 3.844-77.700, p ≤ 0.001).

Conclusions: Although a lower mortality rate is seen at 12 months of ART in our setting, predictors of HIV mortality are having high pretreatment HIV viral load and severe immunosuppression. While primary prevention of HIV infection is paramount, early identification of these predictors among our HIV-infected children for an early ART initiation can reduce further the mortality in our setting. In addition, measures to ensure a good standard of care and retention in care for a sustained virologic suppression cannot be ignored and are hereby underscored.

Introduction: Basal insulin (BI) infusion in pump therapy of type 1 diabetes (T1DM) mimics physiological secretion during the night and between meals. The recommended percentage of the total BI to daily insulin dose (termed the %BI) ranges between 30 and 50%. We analyzed whether this recommendation was followed in adults with T1DM from a university center, and whether BI doses were linked with glycemic control.

Materials and methods: We included 260 consecutive patients with T1DM (159 women and 101 men) treated with continuous subcutaneous insulin infusion at the Department of Metabolic Diseases, Krakow, Poland. Data were downloaded from patients' pumps and collected from medical records. We analyzed the settings of BI and the association of %BI with HbA1c level. Linear regression was performed.

Results: The mean age of T1DM individuals was 26.6 ± 8.2 years, BMI was 23.1 ± 3.0 kg/m², T1DM duration was 13.3 ± 6.4 years, and HbA1c level was 7.4%. There were 69.6% (n=181) of T1DM patients with %BI in the recommended range. The T1DM duration and HbA1c level of patients with a %BI <30% (n=23) was 9.5 years and 6.4%, respectively; for a %BI of 30-50%, it was 13.2 years and 7.4%; and for a %BI >50% (n=56), it was 15.8 years and 7.8% (p < 0.001 for both three-group comparisons). Multiple regression identified %BI among independent predictors of the HbA1c level.

Conclusion: In this real-life analysis, the recommendations concerning %BI dosing were not followed by almost one-third of adult T1DM patients. Low %BI was associated with better glycemic control; however, this requires further confirmation.

Background: Majority of acute diarrhoeal diseases are self-limiting and do not require routine treatment. Treatment with empirical antimicrobials is recommended only for dysenteric and invasive bacterial diarrhoea. Irrational use of antibiotics in treatment of acute diarrhoea is common in clinical practice worldwide. This study was carried out to assess the pattern of antibiotic use for acute diarrhoeal diseases in Bishoftu General Hospital, East Shewa Ethiopia.

Methods and materials: Institution based cross-sectional study was conducted from April 1 to April 30, 2016. Data were collected retrospectively from patients treated for diarrhoeal diseases from January 2015 to December 2015 using structured questionnaires and entered into SPSS (IBM 20) and descriptive statistics was carried out.

Results: Among the 303 patients, 51.2% were males and 48.8% were females. Of them, 62% were children under five years. Two hundred sixty three (86.8%) patients received eight different types of antibiotics and cotrimoxazole (178 patients, 58.7%) was the most prescribed antibiotics, followed by ciprofloxacin (33, 10.9%) and amoxicillin (14, 4.6%). Based on the presence of blood in stools, 14.5% of cases were of invasive bacterial type. According to the recommendations of WHO, the rate of overuse of antibiotics was 72.3%.

Conclusion: This study revealed that there was high overuse of antibiotics for both adults and children under five with acute diarrhoea in Bishoftu General Hospital. And Cotrimoxazole was the most prescribed antibiotic.

Background: Skin health has become a worldwide concern. Most of the studies investigated the effect of mobile phone radiation on DNA and animals, but a few studies were carried out about skin diseases in mobile phone and tablet users. Few systematic studies have examined the relationship between mobile phone exposure and skin diseases.

Methods: We evaluated the association between mobile phones and tablets and skin diseases. We checked databases including PubMed, Scopus, Springer, Cochrane, and Google Scholar from 1995 to 2013. The eligibility criteria were descriptive, and observational studies were in English and Persian language, and the subjects were of all ages and reported skin disease.

Results: Most of the studies focused on signs and less on skin cancer. In total, 6 studies were included with 392119 participants with age over 25 years. In a nationwide cohort study in Denmark for BCC, the IRR (incidence rate ratios) estimates remained near unity among men and women. In the other studies, they reported an increase in temperature, hypersensitivity of warmth, facial dermatitis, angiosarcoma of the scalp, and burning sensations in the facial skin after mobile phone use on the exposed side and more within the auricle and behind/around the ear.

Conclusions: Overall evaluations showed that the level of evidence associated with the effects of radiation from the mobile phone and tablet on the skin is poor. This review shows a necessity for more studies in this area.

Background: Tuberculosis has been declared to be a global epidemic. Despite all the effort, only less than half the annual estimated cases are reported by health authorities to the WHO. This could be due to poor reporting from the private sector. In Ethiopia, tuberculosis has also been a major public health problem. The aim of this study was to assess the role of the private health sector in tuberculosis control in Debre Markos.

Methods: An institution based cross-sectional descriptive study was carried out in private health facilities. A total of 260 tuberculosis suspects attending the private clinics were interviewed. Focus group discussion, checklist, and structured questionnaire were used.

Results: Majority of the private clinics were less equipped, poorly regulated, and owned by health workers who were self-employed on a part-time basis. Provider delay of 4 and more months was significantly associated higher likelihood of turning to a private provider (OR = 2.70, 95% CI = (1.20, 6.08)).

Conclusions and recommendations: There is significant delay among tuberculosis patients. Moreover, there is poor regulation of the private health sector by public health authorities. The involvement of the private sector in tuberculosis control should be limited to identification and refer to tuberculosis cases and suspects.

Introduction: A "virtual patient" is defined as a computer program which simulates real patients' cases. The aim of this study was to determine whether the inclusion of virtual patients affects the level of factual knowledge of family medicine students at the undergraduate level.

Methods: This was a case-controlled prospective study. The students were randomly divided into experimental (EG: N = 51) and control (CG: N = 48) groups. The students in the EG were asked to practice diagnosis using virtual patients instead of the paper-based clinical cases which were solved by the students in the CG. The main observed variable in the study was knowledge of family medicine, determined by 50 multiple choice questions (MCQs) about knowledge of family medicine.

Results: There were no statistically significant differences in the groups' initial knowledge. At the final assessment of knowledge, there were no statistically significant differences between the groups, but there was a statistically significant difference between their initial and final knowledge.

Conclusions: The study showed that adding virtual patient cases to the curriculum, instead of paper clinical cases, did not affect the level of factual knowledge about family medicine. Virtual patients can be used, but a significant educational outcome is not expected.

Background: Rehospitalization for medical patients is common. Multiple interventions of varying complexity have been shown to be effective in achieving that goal with variable results in the literature. For medical patients discharged home, no single intervention implemented alone has been shown to have a sustainable effect in preventing rehospitalization.

Objective: To study the effect of a transition of care clinic model on the 30-day rehospitalization rate in a single medical center.

Methods: Retrospective observational analysis of adult patients discharged home from Memorial Medical Center from September 1, 2014, through December 31, 2014. The primary outcome was to compare hospital readmission rates between patients who followed up with a transition of care (TOC) clinic and those who did not.

Results: The study population included 378 patient discharges. A total of 40 patients (10.6%) were readmitted to the hospital within 30 days of discharge. Patients who attended the TOC clinic had a significantly lower 30-day readmission rates (3.8% versus 11.7%). A Cox regression analysis showed that the TOC clinic attendance had a significant negative predication for readmission (HR 0.186, 95% CI 0.038-0.898, P = 0.038).

Conclusion: Adopting a TOC model after discharging medical patients has reduced the readmission rates in our study.

Many postgraduate family medicine training programmes have been developed to meet the worldwide dire need for practicing family physicians. This study was conducted in Gezira state of Sudan in a "before-and-after" design in the period of 2010-2012 with the aim to assess improvements in candidates' confidence in performing certain clinical skills. A self-evaluation questionnaire was used with a five-grade scale (1-5) to assess candidates' confidence in performing 46 clinical skills. A group of 108 participants responded for both the "before" and the "after" questionnaire: the response rate was 91% (before) and 90% (after). In general, a positive progress trend was detected. The mean skill value for all skills was 3.23 (before) and 3.93 (after) with a mean increase of 21.7% (P < 0.001). Male students scored constantly higher than females both before and after completing the master's programme, while females showed a higher percentage in progress. Scores in certain medical disciplines were higher than others. However, disciplines with low scores in the beginning, such as psychiatry and ophthalmology, showed the highest progress percentage. The results show a significant increase in confidence in performing procedural skills designed in the curriculum of the GFMP master's programme.

Cigarette smoking affects many organs. It causes vasoconstriction through activation of sympathetic nervous system which leads to elevation of blood pressure and reduction in glomerular filtration rate and filtration pressure. It also causes thickening of renal arterioles. Cigarette smoking increases the risk of microalbuminuria and accelerates progression of microalbuminuria to macroalbuminuria. Furthermore, it causes rapid loss of glomerular filtration rate in chronic kidney disease patients. After kidney donation, these factors may be injurious to the solitary kidney. Kidney donors with history of cigarette smoking are prone to develop perioperative complications, pneumonia, and wound infection. Postkidney transplantation various stressors including warm and cold ischemia time, delayed graft function, and exposure to calcineurin inhibitors may result in poor graft function. Continuation of cigarette smoking in kidney transplant recipients will add further risk. In this review, we will specifically discuss the effects of cigarette smoking on normal kidneys, live kidney donors, and kidney transplant recipients. This will include adverse effects of cigarette smoking on graft and patient survival, cardiovascular events, rejection, infections, and cancers in kidney transplant recipients. Lastly, the impact of kidney transplantation on behavior and smoking cessation will also be discussed.