International Archives of Medicine - Latest articles

An unusual complication following radiological percutaneous gastrostomy

Tonny Veenith, Manasi Bhagwat and Andrew Bailey — 2008-08-12

IntroductionIntestinal malrotation is a disease which predominantly happens in the childhood. Because of the relative rarity, there is a possibility that it can be missed in routine clinical care of adults. This case highlights the need of high index of suspicion for malrotaion when things go wrong in routine procedures. This can be the reason for catastrophic sepsis in patients who undergo minimally invasive procedures.Case presentationWe present a case of patient who presented with a malignant lesion of the tongue who went for elective placement of feeding tube who went through a series of complications as a result of malrotated caecum. Conclusions: The malrotation of the intestine can make a relatively straight forward procedure fraught with complications. Clinicians should have high index of suspicion about malrotation when performing a procedures like percutaneous gastrostomy and radiologically guided entrostomy. If there is an index of suspicion they should be screened prior to the procedure.

Utilizing video on myocardial infarction as a health educational intervention in patient waiting areas of the developing world: a study at the emergency department of a major tertiary care hospital in India

2008-07-29

ObjectiveTo study the effect of health educational video instruction on increasing patients' knowledge in a hospital waiting area of a developing country. Methods: An educational video on signs, symptoms, and risk factors of myocardial infarction (MI) was played in an Emergency Department (ED) patient waiting area of an urban tertiary care hospital in India. Participants (n= 217) were randomly assigned to two groups: an intervention group that viewed the MI video (n=111) and a control group that did not view the video (n=106). Each group took a standard survey of thirty-seven questions to assess baseline knowledge pertaining to MI (pretest). The intervention group then viewed the video and the initial survey was re-administered to each group (posttest). Results: At baseline (pretest) there was no statistically significant difference between the intervention and control group in the mean number of correct (18.1 vs. 19.0, p = 0.19), incorrect (9.4 vs. 8.6, p = 0.27) and unsure (9.6 vs. 9.3, p = 0.78) responses per participant. After viewing the video on MI, the intervention group had a statistically significant improvement in the mean number of correct responses (27.0 vs. 20.0, p < 0.001), and a significant decline in the mean number of unsure responses (1.8 vs. 9.4, p < 0.001) compared to the posttest responses of the control group. There was no significant change in the number of incorrect responses on the posttest between the intervention and control groups, (8.3 vs. 7.7, p = 0.35), respectively. Conclusion: A health educational video can serve as an effective tool for increasing patients' short-term knowledge and awareness of health conditions in a hospital waiting area of a developing country. Health educational videos serve as a public health low cost intervention that demonstrates clear short term benefits. Health care workers in developing countries can help educate individuals presenting to hospitals by displaying these videos in hospital waiting areas.

Pattern of eye casualty clinic cases

Ehab I Wasfi, Randeep Sharma, Emma Powditch and Alaa A Abd-Elsayed — 2008-07-26

Introduction/ Background The purpose of the eye casualty clinic (ECC) is to manage patients with ocular emergencies, however a large number of patients attended the eye casualty clinic did not have an acute problem and could have been treated by their General Practitioner (GP) or referred to the eye outpatient clinic. Aim: To identify the number of patients attending the ECC every day and their route of referral and to estimate the number of patients who could have be seen and managed by a competent ophthalmic nurse practitioner. Methods: A retrospective analysis was conducted using the notes and history of all patients who attended the eye casualty clinic at the Princess Margaret Hospital in Swindon during two weeks in March 2006. Results: The average daily attendance was 21 patients who were seen between morning and afternoon sessions in the Eye Casualty Clinic.112 (54%) patients were female. The median patient age was 50 years with an age range of 1 to 91 years. 68 (34.2%) patients attended as self referrals without GP letters as our eye casualty clinic is open to the general public from 9.00 a.m. to 5.00 p.m. A & E referred 28 (14.1%) patients of which only 3 had a General Practitioner (GP) letter and only 1 patient had a walk-in centre letter. There was insufficient information to assess whether 14 patients could have been managed by a nurse; of the remaining 195 visits, 50 (25.6%) patients could have been managed by an Ophthalmic Nurse Practitioner and 145 (74.4%) patients could not have been managed by an Ophthalmic Nurse Practitioner. Conclusion: The workload of the eye casualty doctors could be decreased by 38.6% if defined categories of patients were managed by the ophthalmic nurse practitioner, appropriate referrals were directed to the General Clinic and casualty patients were not followed up inappropriately.

Dysphagia secondary to dermatomyositis treated successfully with intravenous immunoglobulin: a case report

Deepak Joshi, Rizwan Mahmood, Peter Williams and Paul Kitchen — 2008-07-23

A 46 year old woman presented with a one month history of rash and mylagia. The history, clinical findings and blood tests all supported a diagnosis of dermatomyositis. The patient later developed dysphagia and was successfully treated with intravenous immunoglobulin. Investigations and treatment of dysphagia in the context of dermatomyositis are discussed.

Plasmatic level of neurosin predicts outcome of mild cognitive impairment

2008-07-11

Background: Mild Cognitive Impairment (MCI) is a disorder considered to be a transitional stage from health to dementia. Diagnosis of dementias at these early stages is always troublesome because the pathophysiologic events leading to dementia precede clinical symptoms. Thus, the development of biomarkers that can be used to support the diagnosis of dementias at early stages is rapidly becoming a high priority. We have recently reported the value of measuring plasmatic levels of neurosin in the diagnosis of Alzheimer's disease (AD). The aim of this study is to determine whether measuring plasmatic concentration of neurosin is a valuable test to predict progression of MCI. Methods: Plasmatic neurosin concentrations were measured in 68 MCI patients and 70 controls subjects. Blood samples were obtained at the beginning of the study. Sixty six patients diagnosed with MCI were observed for 18 months. In 36 patients a second blood sample was obtained at the endpoint. Results: The mean value of plasmatic neurosin concentration differs significantly between MCI patients who converted to Dementia with vascular component, those who converted to AD, or those who remained at MCI stage. The relative risk of developing Dementia with vascular component when neurosin levels are higher than 5.25 ng/ml is 13 while the relative risk of developing mild AD when neurosin levels are lower than 5.25 ng/ml is 2. Increases in the levels of neurosin indicate progression to Dementia with vascular component. Conclusion: The measurement of plasmatic neurosin level in patients diagnosed with MCI may predict conversion from MCI to Dementia with vascular component. A single measurement is also valuable to estimate the risk of developing AD and Dementia with vascular component. Finally, repeated measurement of plasmatic neurosin might be a useful test to predict outcome in patients with MCI.

Second hit in cervical carcinogenesis process: involvement of wnt/beta catenin pathway

Carlos Perez-Plasencia, Alfonso Duenas-Gonzalez and Brenda Alatorre-Tavera — 2008-07-07

The Human papillomavirus plays an important role in the initiation and progression of cervical cancer. However, it is a necessary but not sufficient cause to develop invasive carcinoma; hence, other factors are required in the pathogenesis of this malignancy. In this review we explore the hypothesis of the deregulation of wnt/β-catenin signaling pathway as a "second hit" required to develop cervical cancer.

The variant Creutzfeldt-Jakob Disease: Risk, uncertainty or safety in the use of blood and blood derivatives?

Antonio Liras — 2008-06-23

It has been long since French physician Jean-Baptiste Denys carried out the first successful blood transfusion to a human being. Using bird feathers as canules, sheep blood was transfused to a young man. The patient died soon after Denys' treatment and Denys was accused of murder. In the XXI century, known as the biotechnology century, we face new challenges in Medicine. New emerging and reemerging diseases, such as Creutzfeldt-Jakob disease (CJD) or "mad cow disease" and its human variant (vCJD), challenge the biosafety aspects of a widely extended and extremely useful technique, that is, the perfusion of blood, of its derived components and of other pharmacological products obtained from plasma. To face these new challenges we need innovative prevention strategies.TranslationThis article is translated from Spanish, originally published in Archivos de Medicina. The original work is at doi:10.3823/005

Correlates of cigarette smoking among school-going adolescents in Thailand: findings from the Thai global youth tobacco survey 2005

Emmanuel Rudatsikira, Adamson S Muula, Seter Siziya and Ronald H Mataya — 2008-06-11

Background: Many studies examining the social correlates of tobacco use among adolescents fail to recognise theories of health behaviour and health promotion in their analysis. Using the Socio-Ecologiocal Model (SEM) we assessed the demographic and social factors associated with current cigarette smoking among adolescents in Thailand.MethodA secondary analysis of cross-sectional data from the Thai Global Youth Tobacco Survey (Thai GYTS) 2005 was analysed to obtain prevalence of selected attributes and assess factors associated with current cigarette smoking. Current cigarette smoking was defined as having smoked a cigarette, even a single puff, in the last 30 days. Logistic regression was conducted to estimate the level of association between the explanatory variables and current smoking. Results: Of the 18,368 respondents, 22.0% males and 5.2% females reported being current smokers (p < 0.001). In multivariate logistic regression analysis, current smoking was negatively associated with the perception that smoking is harmful to health (OR = 0.47; 95% CI [0.33, 0.66]) and positively associated with male gender (OR = 3.46; 95% CI [2.72, 4.86]) and having smoking parents (OR = 1.62; 95% CI [1.25, 2.11]) and friends (OR = 5.07; 95% CI [3.54, 7.25]) for some friends smokers and OR = 26.71; 95% CI [18.26, 39.06] for most or all friends smokers. Compared to subjects 11 = 12 year olds, those who were older were less likely to report smoking (OR = 0.49; 95% CI [0.36, 0.66] for 13 years olds, OR = 0.56; 95% CI [0.40, 0.79] for 14 years olds, OR = 0.59; 95% CI [0.41, 0.86] for 15 years olds). Conclusion: Current cigarette smoking was associated with male gender, smoking parents or closest peers. Perception that smoking was harmful to health was associated with less likelihood of being a current smoker.

Fat feeding potentiates the diabetogenic effect of dexamethasone in Wistar rats

Shanmugam Sivabalan, Shanmugam Renuka and Venugopal P Menon — 2008-05-23

Background: The role of cortisol and its increased action/availability is implicated in the pathogenesis of insulin resistance associated with obesity and metabolic syndrome but the mechanism of increased action/availability is not known. Availability of several other lipophilic hormones, drugs and pollutants are also reported to be increased in obesity. Increased lipids in the circulation are reported to alter the fluidity and permeability of membranes. Hyperlipidemia is also reported to alter the pharmacokinetics and pharmacodynamics of lipophilic molecules and also membrane fluidity and permeability. In this context we assumed that the hyperlipidemia associated with human obesity might play a role in the altered action/availability of cortisol and this in turn might have initiated the metabolic complications. To evaluate our assumption we have administered dexamethasone [low [50 μg/kg/day] or high [250 μg/kg/day] dose] to high-fat [coconut oil & vanaspati] fed rats and the results were compared with rats administered with either dexamethasone or high-fat.Results and DiscussionWithin two weeks, the rats co-administered with high-fat and dexamethasone developed severe hyperglycemia, hyperlipidemia and insulin resistance compared to rats treated either of them alone. High-fat fed rats treated with higher dose of dexamethasone were presented with severe hyperglycemia, insulin resistance and also severe glycosuria. The hyperlipidemia caused by high-fat feeding might have altered the transport and distribution of dexamethasone, probably by altering the physical state of membranes and transport proteins. Conclusion: From the results obtained, it can be speculated that the altered lipid and cortisol metabolism could affect one another, forming a vicious cycle.

Eruptive xanthomas and acute pancreatitis in a patient with hypertriglyceridemia

2008-05-12

Acute pancreatitis and eruptive xanthomas are the only recognised direct complications of severe hypertriglyceridaemia. We present the case of a 33-years old male patient in whom the onset of a type 2 diabetes, added to an unknown familial hyperlipidemia, precipitated a dramatic raise of serum triglyceride levels, that cause in turn an acute pancreatitis and the appearance of dermic eruptive xanthomas.TranslationThis article is translated from Spanish, originally published in Archivos de Medicina. The original work is at doi:10.3823/001