by Otike-Odibi Bolaji and Ujile Ichechiek
Original Research
Background: Erythroderma is a rare, life threatening dermatological emergency with multiple underlying aetiologies. Methods: We reviewed the clinical, laboratory and histologic findings of 22 patients diagnosed with erythroderma, who were managed in the dermatology unit over six years (from 2016 to 2021). Results: Symptoms were scaly lesions, generalized rash, itching, fever, pustules, and on examination there was lichenification. The Male to Female ratio was 1.75:1 with a mean age at diagnosis of 41.6+17.3 years. The causative factors were commonly idiopathic (59 %) and drug-induced (9%). Others were psoriasis, lichen planus, and onchodermatitis. The comorbidities identified were HIV and Chronic kidney disease. Test of agreement between clinical and pathological diagnosis was 62.5%. Conclusion: Erythroderma is more common in men, aetiology was mostly idiopathic Test of agreement between clinical and pathological diagnosis was 62.5, showing biopsies are an important aid in making a definitive diagnosis.
American Journal of Clinical Medicine Research. 2022, 10(1), 27-31. DOI: 10.12691/ajcmr-10-1-6
Pub. Date: April 25, 2022
1658 Views
by Haneen Khalid Albeeshi, Abdullah Mariea Alqahtani, Maher Atyatallah Alhazmi, Sami Yahya Saad and Yasemin Yusuf Demiroz
Original Research
Background: Living a pandemic disaster is associated with mental health consequences including post-traumatic disorder (PTSD). The primary objective of this study is to determine the prevalence of PTSD among tertiary hospital staff working in King Abdullah Medical City (KAMC) in Saudi Arabia and the secondary objective is to determine the factors associated with the risk of developing post-traumatic stress disorder. Methods: A descriptive cross-sectional design were used through an electronic survey questionnaire that sent to all KAMC staff who are working during early COVID-19 from June 2020 till June 2021. 118 from 235 were responded and included in the study. The Posttraumatic Diagnostic Scale (PDS-5) was used. It is a reliable and valid tool in measuring the PTSD symptoms and severity. Results: The prevalence of PTSD among KAMC staff were found 50.2 % (Moderate 35.6%, Moderate to severe 38.1%, and Severe 26.3%). The gender found near significant P value in the avoidance domain and Arousal and reactivity domain (0.066), (0.073) respectively. In regards to nationality, the Arousal and reactivity domain showed a significant P value (0.03) among Saudi and non-Saudi while the other domain showed no significant value. Conclusion: Our study highlights the importance of the psychological stress and traumatic events in staff working during a disaster such as COVID-19 pandemics and the results should be taken in consideration to focus on the importance of mental health condition of working staff in a tertiary hospital.
American Journal of Clinical Medicine Research. 2022, 10(1), 21-26. DOI: 10.12691/ajcmr-10-1-5
Pub. Date: April 25, 2022
1744 Views7 Downloads
by Fiekabo Ogan and John E. Raphael
Original Research
Background: There are many options for managing benign prostatic hyperplasia (BPH). They include medical treatment with alpha-blockers, 5-alpha reductase inhibitors, minimally invasive therapy, endoscopic and open surgical surgery. Transurethral resection of the prostate (TURP) is the gold standard for treating patients with BPH. Monopolar resection is the most available method of endoscopic treatment of prostate enlargement. Successful outcome requires a good understanding of the prostate gland and the peculiarities of the procedure. TURP syndrome is one of the most significant and limiting complications of monopolar TURP. We aim to highlight the pertinent anaesthesia considerations during monopolar TURP and the aetiology, presentation and management of TURP syndrome. Methods: We reviewed the anaesthesiology aspects of monopolar TURP at the University of Port Harcourt Teaching Hospital, Port Harcourt Rivers, Nigeria and considered pre-anaesthetic clinical concerns, along with the preoperative preparation and approach. The equipment and accessories for the procedure were identified, along with the intraoperative techniques for performing monopolar TURP, emphasizing the anaesthetic considerations. We then performed a literature review using Medline, PubMed, Google Scholars search engines; and discussed the primary concerns during monopolar TURP and the perioperative management of TURP syndrome. Conclusion: Administration of anaesthesia for patients undergoing monopolar TURP involves applying relevant anaesthetic principles and understanding the nuances of the procedure. Proactive measures, adequate perioperative evaluation and monitoring, and prompt diagnosis and treatment are pertinent to avoid potentially fatal TURP syndrome.
American Journal of Clinical Medicine Research. 2022, 10(1), 17-20. DOI: 10.12691/ajcmr-10-1-4
Pub. Date: March 27, 2022
1706 Views2 Downloads
by John Edoka Raphael and Chizurum Ezenta
Original Research
Background: Medical advancement has led to endoscopic treatment becoming the first-line option in stone management. Holmium laser lithotripsy is the gold standard for stone fragmentation during retrograde intrarenal surgery (RIRS), as it can be applied with a flexible ureterorenoscope (fURS) to access the entire collecting system. Percutaneous nephrolithotomy (PCNL) is effective for large and multiple renal stones. Bladder stones can be crushed and evacuated using lithotrite, pneumatic and laser energy. While endourology is well established in the developed western countries, it remained budding in most of sub-Saharan Africa. This study aims to present our experience in percutaneous nephrolithotomy, RIRS and ureteroscopy with lithotripsy using holmium laser and pneumatic lithotripter for urinary calculi. Methods and Methodology: The study was a 4year retrospective study on patients presenting with urinary tract who had endoscopic management; including litholapaxy, pneumatic and holmium laser lithotripsy and PCNL. The case records of the patients were obtained. Their clinical records such as age, sex, CT urography, operative and post-operative notes and complications were extracted. This was coded into Excel format and then analyzed using SPSS Version 20. Results: There were 61 patients with an age range from 29 -80years and a mean age of 51.39± 14.40years with a male: female ratio of 3.5:1. The 40-49year age group had the highest prevalence {17(27.9%)}. Flank pain was the most frequent presenting complaint {49(80.3%)}. The mean size of the calculi was 19.28mm with a range from 3mm to a 120mm bladder stone. Renal stone was the most frequent, {40(65.6%)} followed by ureteric stones 12(19.7%). The mean Hounsfield of the stones was 738.60HU. There was an association between age and stone location, (p=0.039) but none between the sex of the patients, the development of stones, type of symptoms and the location of stones. RIRS with laser lithotripsy was the most frequently performed procedure. {31(50.8%)} followed by ureteroscopy with laser lithotripsy. Stone dusting was the most preferred setting used during RIRS. All but one was calcium oxalate stones. Majority were complication-free {28(70.5%)}, and fever {11(18.0%)} was the commonest. There was no mortality. Conclusion: RIRS and ureteroscopy with laser lithotripsy are the commonest procedures we now perform for upper urinary stones. The capacity to perform RIRS, ureteroscopy and laser lithotripsy and PCNL, and other forms of endoscopic stone management is a welcome development that will mitigate the morbidity associated with stone diseases in Nigeria and sub-Saharan Africa.
American Journal of Clinical Medicine Research. 2022, 10(1), 10-16. DOI: 10.12691/ajcmr-10-1-3
Pub. Date: March 27, 2022
1966 Views3 Downloads
by Dicky Adi Putra, Ivan Riyanto Widjaja, Anugrah Sitta Latumahina, Marsha Zaneta, Angelina Armine Susanto Putri and Sudung O. Pardede
Original Research
Background: Accurate diagnosis of urinary tract infection (UTI) in children is crucial, nevertheless it is an intricate process. Combination parameters such as leukocyte esterase (LE) and leukocyte count in urinalysis as initial laboratory exam for a suspected UTI reported to have a high sensitivity and specificity. Urine culture as the gold standard may take some time, while prompt treatment is imperative. Methods: From July 2016 to June 2018 paired urinalysis and urine culture data from in-patient in Koja General Hospital age 6 months to 18 years old were retrieved. Diagnostic study was done for each individual component i.e. LE, nitrite, bacteria, and leukocytes. Urinary pathogen and antibiotic susceptibility patterns were descriptively analyzed. Results: One-hundred-seventeen data were eligible for analysis. Median age of subjects was 2 years old (6 month-18 years), of which 51.3% were boy. Nitrite had the best specificity (98.8%) and accuracy (77.4%) while bacteriuria had the best sensitivity (34.5%). Pyuria and LE had the lowest sensitivity (31% and 17.2% respectively). Bacteria isolated from the culture were all gram negative. Escherichia coli was the most prevalent bacteria, represented 44.8% of the positive cases. Amikacin had the best sensitivity among the antibiotics tested. Conclusion: While in theory pyuria and LE might be used in diagnosing UTI, several factors may distort its value. This should be taken into consideration when a child is suspected of having a UTI.
American Journal of Clinical Medicine Research. 2022, 10(1), 6-9. DOI: 10.12691/ajcmr-10-1-2
Pub. Date: March 25, 2022
2057 Views8 Downloads
by Chu Chu and Hong-Mei Ding
Original Research
Background: Analyzed pathogenic bacteria isolated from bile samples of patients with biliary tract infection and their drug resistance in the first Affiliated Hospital of Nanjing Medical University from 2017 to 2020, so as to provide evidence for the treatment of biliary tract infection. Methods: Clinical strains isolated from bile specimens of patients suspected of biliary infection in the First Affiliated Hospital of Nanjing Medical University from 2017 to 2020 were collected, The drug susceptibility criteria are based on the standards published by the National Standardization Committee of the US Clinical Laboratories. WHONET 5.6 software was used to analyze the distribution of pathogens and drug resistance. Results: From January 2017 to December 2020, a total of 2006 strains of bile pathogenic bacteria were cultured and identified. There were 1253 cases of gram-negative bacilli, 638 cases of gram-positive cocci, 98 cases of fungi, and 17 cases of Gram-positive bacilli. The top five pathogens of Gram negative bacilli were Escherichia coli, Klebsiella pneumoniae, Enterobacter cloacae, Pseudomonas aeruginosa, Acinetobacter baumannii. The top five pathogens of gram positive cocci were Enterococcus faecium, Enterococcus faecalis, Enterococcus gallinarum, Enterococcus faecalis and Staphylococcus epidermidis. the resistance rate of Escherichia coli to ampicillin, ampicillin / sulbactam, cefotetan, ceftazidime, ceftriaxone,cefepime, itronam, compound trimethoprim decreased, the resistance rate of Klebsiella pneumoniae to gentamicin, levofloxacin decreased, the resistance rate of Enterobacter cloacae to ciprofloxacin, levofloxacin decreased. the resistance rate of Pseudomonas aeruginosa to ceftazidime, cefepime, gentamicin decreased. the resistance rate of Acinetobacter baumannii to ceftazidime, ciprofloxacin decreased. the resistance rate of Enterococcus faecium to penicillin G, high concentration streptomycin, erythromycin decreased. Conclusions: Enterogenic pathogens were the main pathogens in China. Such as Escherichia coli, Klebsiella pneumoniae, Enterococcus faecalis and Enterococcus faecalis; Nosocomial infection pathogens. For example, Pseudomonas aeruginosa and Acinetobacter also need to be paid attention to. Clinicians should improve their awareness of microbiological examination and provide more reliable pathogenic evidence for the selection of clinical antibiotic.
American Journal of Clinical Medicine Research. 2022, 10(1), 1-5. DOI: 10.12691/ajcmr-10-1-1
Pub. Date: December 22, 2021
1878 Views3 Downloads