American Journal of Clinical Medicine Research

Background: Increased intra-abdominal pressure (IAP) is a complication related to physio pathological changes with high rates of mortality and morbidity. Abdominal surgery is consider one of the risk factors that can increased IAP. Measurement can be done by direct or indirect methods, being the most used the transurethral (TM). However this method continues to generate some controversy. This study tries to clarify the doubts of the effect of body position when we use different methods to measure IAP. Methodology: Study realized an anatomical model in order to eliminate the described variables that influence IAP: abdominal and gastric contraction, micturition reflex and breathing. IAP was measured, directly, via microsensor and, indirectly, by TM and intragastric manometry, in five different body positions. The study population consists in a population of 29 anatomical model, 14 males and 15 females, with an average weight of 12.04 ± 5.67 kilograms (Kg). The inclusion criteria consisted in the absence of abdominal disease that would. Principal Findings: IAP determination by direct method showed no differences in the five body positions (P=0.765). The indirect method with better correlation with the direct was TM (cc0.87). Indirect methods revealed statistically significant differences with the direct, only in the Trendelenburg and reverse Trendelenburg. Conclusions: The clinical impact of this study is to decrease the doubts in the measurements of IAP. This study improves the knowledge of the application of the direct and indirect methods to accesses IAP. IAP is not affected by body position and the direct pressure value measured in all positions is constant. Only if the indirect methods are used, in Trendelenburg and reverse Trendelenburg positions, they may underestimate or overestimate IAP value. For the first time it was explained why this phenomenon occurs.

American Journal of Clinical Medicine Research. 2016, 4(1), 11-18. DOI: 10.12691/ajcmr-4-1-3
Pub. Date: March 25, 2016

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Budesonide in Severe Alcoholic Hepatitis: Results of the Original Research

by Komkova I.I., Tkachenko P.E., Maevskaya M.V. and Ivashkin V.T.

Original Research

Background and aim: Severe alcoholic hepatitis (AH) is a life-threatening alcoholic liver disease with a potential of 30-40% mortality at 1 month. While steroids remain to be a first line therapy, there is a need in alternative treatment. The aim of the study is to compare efficacy and safety of budesonide and prednisolone in treatment of severe AH and to determine predictors of none-response, predictors of short-term mortality. Methods: 37 patients with severe AH were randomized in 2 groups and enrolled in the prospective trial. Group 1 (n=17) patients received budesonide 9 mg/daily per os, group 2 (n=20) patients were managed with prednisolone 40 mg/daily per os. Treatment duration was 28 days. Response criteria – Lille model. Results: There were no significant differences in short-term survival (р = 0,857). In group 2 adverse events were statistically more frequently than in group 1 (70% vs. 26,7%, р = 0,011). Hepatorenal syndrome occurred more frequently in group 2 (р = 0,033). Predictors of non-response were MELD score (р = 0,009), ABIC score (р = 0,011), hepatic encephalopathy (p=0,035), total bilirubin (p=0,016). Predictors of mortality were Lille score (p=0,018), serum glucose (p=0,017), total bilirubin level at the 7th day of the therapy (p=0,030). Conclusions: Budesonide therapy for patients with severe alcoholic hepatitis showed same efficacy as prednisolone treatment with significantly less adverse events. Budesonide appears to be effective in prevention of hepatorenal syndrome.

American Journal of Clinical Medicine Research. 2016, 4(1), 7-10. DOI: 10.12691/ajcmr-4-1-2
Pub. Date: February 25, 2016

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Effect of Multiple Micronutrient Supplementation on CD4 T Cell levels of Clinically Stable HIV Patients on Highly Active Antiretroviral Therapy; A Randomized Controlled Crossover Trial

by Anthony C. Iwu, Chukwuma B. Duru, Kenechi A. Uwakwe, Christopher N. Obionu, Kevin C. Diwe, Abah O. Steve, Prosper O. Adogu, Irene A. Merenu, Nathan C. Nwaimo, Uche R. Oluoha, Ikechi Ohanle and Emmanuel U. Ndukwu

Original Research

Background: Human Immunodeficiency Virus (HIV) infection produces a chronic and potentially fatal disease of the immune system. In the pre HAART (Highly Active Antiretroviral Therapy) era, micronutrient supplementation was associated with improvement in the immune status of HIV infected individuals but in the post HAART era, this association has been unclear with conflicting results. Objective: To determine the effect of multiple micronutrient supplementation on the CD4 T cell levels of clinically stable HIV patients on HAART for at least one year. Methods: A randomized cross over intervention trial was used to determine the CD4 T cell effect of a 12 week daily consumption of multiple micronutrient supplement on 50 clinically stable HIV infected participants receiving treatment from the Imo State University Teaching Hospital. The participants were purposively selected based on certain inclusion criteria and were randomized into two groups to receive the supplement at different periods after a washout period. CD4 T cell measurements were taken at baseline, 12, 20 and 32 weeks. Results: The mean age of the participants studied was 43.8±10.8 years with an average duration on HAART of 3.2±1.5 years. At baseline, 55.3% of the participants were severely immunodeficient, 51.1% were either overweight or obese and 45% were hypertensive. The intervention results, revealed that there was no statistically significant difference in CD4 T cell count levels with micronutrient supplementation compared to no supplementation [t=0.78, p=0.438]. Conclusion: Micronutrient supplementation in the post HAART era especially in patients on long term HAART appear not to have any significant effect on the CD4 T cell counts.

American Journal of Clinical Medicine Research. 2016, 4(1), 1-6. DOI: 10.12691/ajcmr-4-1-1
Pub. Date: January 25, 2016

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