Prevalence of β-lactamase-negative ampicillin-resistant haemophilus influenzae isolated from patients of a teaching hospital in Thailand

The aim of this study was to investigate the prevalence of β-lactamase-negative ampicillin-resistant (BLNAR) Haemophilus influenzae isolated from patients of a teaching hospital in Thailand. Eighty-eight isolates of H. influenzae were collected between September 2005 and March 2008. All isolates were identified and characterized for biotypes and capsular types. The β-lactamase production of these isolates was examined, and their susceptibility to the following 12 antimicrobial agents was determined: ampicillin (AMP), amoxicillin-clavulanate (AMC), cefotaxime (CTX), cefuroxime (CXM), meropenem (MEM), clarithromycin (CLR), telithromycin (TEL), tetracycline (TET), ciprofloxacin (CIP), levofloxacin (LEV), trimethoprim-sulfamethoxazole (SXT), and chloramphenicol (CHL). Of the 88 H. influenzae isolates, 69 (78.4%), 13 (14.8%), 4 (4.5%), and 2 (2.3%) were from the respiratory tract, pus, the genital tract, and blood, respectively. Half of the isolates were biotype II (44 isolates, 50%). The other half comprised biotypes I (23 isolates, 26.1%), III (15 isolates, 17.1%), and IV (6 isolates, 6.8%). All isolates were capsular non-typeable, except for 2 isolates that were type f. Antimicrobial susceptibility showed that all isolates were susceptible to AMC, CTX, MEM, TEL, CIP, and LEV (100%), whereas 96.6%, 94.3%, 80.7%, 68.2%, 50.0%, and 44.3% were susceptible to CXM, CLR, CHL, TET, AMP, and SXT, respectively. The β-lactamase-production rate of H. influenzae isolates was 40.9%, and the prevalence of BLNAR was 18.2%.     

What is the place of the new WHO antenatal care model in a teaching hospital setting?

The basic component of the new World Health Organization (WHO) antenatal care model prescribes reduced number of clinic visits and limited investigations for low-risk pregnant women. The objectives of this study were to determine the proportion of pregnant women seeking antenatal care in a Nigerian teaching hospital who qualify for the basic component and to document difficulties that may arise with the classifying form. In December 2004, 234 pregnant women who had initiated antenatal care were enrolled for the study. Using the classifying form, 157 (67%) were eligible for the basic component, 41 (18%) for special care, but 36 (15%) women could not be classified. Those that did not know the birth weight of their last babies accounted for most (89%) of the unclassified group. The WHO antenatal care model was the most appropriate and relevant method for our hospital where a large percentage (67%) of prenatal women were eligible for the basic component. However, we consider that the classifying form should be adapted to accommodate all pregnant women.     

Epidemiology and outcome of Crohn's disease in a teaching hospital in Riyadh

AIM:To know the epidemiology and outcome of Crohn'sdisease at King Khalid University Hospital,Riyadh,Saudi Arabiaand to compare the results from other world institutions.METHODS:A retrospective analysis of patients seen for20 years (between 1983 and 2002).Individual case recordswere reviewed with regard to history,clinical,findings fromcolonoscopy,biopsies,small bowel enema,computerizedtomography scan,treatment and outcome.RESULTS:Seventy-seven patients with Crohn's diseasewere revisited,13% presented the disease in the first 10 yearsand 87% over the last 10 years.Thirty-three patients (42.9%)were males and 44 (57.1%) were females.Age rangedfrom 11-70 years (mean of 25.3±11.3 years).Ninety-two(92%) were Saudi.The mean duration of symptoms was26±34.7 mo.The mean annual incidence of the diseaseover the first 10 years was 0.32∶100000 and 1.66∶100000over the last 10 years with a total mean annual incidenceof 0.94∶100 000 over the last 20 years.The chief clinicalfeatures included abdominal pain,diarrhea,weight loss,anorexia,rectal bleeding and palpable mass.Colonoscopicfindings were abnormal in 58 patients (76%) showing mostlyulcerations and inflammation of the colon.Eighty ninepercent of patients showed nonspecific inflammation withchronic inflammatory cells and half of these patientsrevealed the presence of granulomas and granulations onbowel biopsies.Similarly,69 (89%) of small bowel enemaresults revealed ulcerations (49%),narrowing of the bowellumen (42%),mucosal thickening (35%) and cobblestoneappearance (35%).CT scan showed abnormality in 68(88%) of patients with features of thickened loops (66%)and lymphadenopathy (37%).Seventy-eight percent ofpatients had small and large bowel disease,16% had smallbowel involvement and only 6% had colitis alone.Of thetotal 55 (71%) patients treated with steroids at some pointin their disease history,a satisfactory response to therapywas seen in 28 patients (51%) while 27 (49%) showedrecurrences of the condition with mild to moderatesymptoms of abdominal pain and diarrhea most of whichwere due to poor compliance to medication.Seven patients(33%) remained with active Crohn's disease.Nine (12%) patients underwent surgery with resections of some partsof bowel,2 (2.5%) had steroid side effects,6 (8%) withperianal Crohn's disease and five (6.5%) with fistulae.CONCLUSION:The epidemiological characteristics ofCrohn's disease among Saudi patients are comparable tothose reported from other parts of the world.However theincidence of Crohn's disease in our hospital increased overthe last 10 years.The anatomic distribution of the diseaseis different from other world institutions with less isolatedcolonic affection.     

Epidemiology and outcome of Crohn＇s disease in a teaching hospital in Riyadh

AIM: To know the epidemiology and outcome of Crohn‘s disease at King Khalid University Hospital, Riyadh, Saudi Arabia and to compare the results from other world institutions.METHODS: A retrospective analysis of patients seen for 20 years (between 1983 and 2002). Individual case records were reviewed with regard to history, clinical, findings from colonoscopy, biopsies, small bowel enema, computerized tomography scan, treatment and outcome.RESULTS: Seventy-seven patients with Crohn‘s disease were revisited, 13% presented the disease in the first 10 years and 87% over the last 10 years. Thirty-three patients (42.9%) were males and 44 (57.1%) were females. Age ranged from 11-70 years (mean of 25.3+11.3 years). Ninety-two (92%) were Saudi. The mean duration of symptoms was 26+34.7 mo. The mean annual incidence of the disease over the first 10 years was 0.32:100 000 and 1.66:100 000 over the last 10 years with a total mean annual incidence of 0.94:100 000 over the last 20 years. The chief clinical features included abdominal pain, diarrhea, weight loss,anorexia, rectal bleeding and palpable mass. Colonoscopic findings were abnormal in 58 patients (76%) showing mostly ulcerations and inflammation of the colon. Eighty nine percent of patients showed nonspecific inflammation with chronic inflammatory cells and half of these patients revealed the presence of granulomas and granulations on bowel biopsies. Similarly, 69 (89%) of small bowel enema results revealed ulcerations (49%), narrowing of the bowel lumen (42%), mucosal thickening (35%) and cobblestone appearance (35%). CT scan showed abnormality in 68 (88%) of patients with features of thickened loops (66%) and lymphadenopathy (37%). Seventy-eight percent of patients had small and large bowel disease, 16% had small bowel involvement and only 6% had colitis alone. Of the total 55 (71%) patients treated with steroids at some point in their disease history, a satisfactory response to therapy was seen in 28 patients (51%) while 27 (49%) showed recurrences of the condition with mild to moderate symptoms of abdominal pain and diarrhea most of which were due to poor compliance to medication. Seven patients (33%) remained with active Crohn‘s disease. Nine (12%) patients underwent surgery with resections of some parts of bowel, 2 (2.5%) had steroid side effects, 6 (8%) with perianal Crohn‘s disease and five (6.5%) with fistulae.CONCLUSION: The epidemiological characteristics of Crohn‘s disease among Saudi patients are comparable to those reported from other parts of the world. However the incidence of Crohn‘s disease in our hospital increased over the last 10 years. The anatomic distribution of the disease is different from other world institutions with less isolated colonic affection.     

HIV/AIDS related mortality among adult medical patients in a tertiary health institution in South–South,Nigeria

ObjectiveTo determine the causes of death among human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) patients as a step to planning strategies to improve mortality from this condition.MethodsThis study retrospectively analyzed the mortality pattern of adult HIV/AIDS patients in the University of Calabar Teaching Hospital from January 2005 to December 2007. The data were obtained from sexually transmitted infection/acquired immunodeficiency syndrome (STI/AIDS) clinic register, admissions and discharge/death registers as well as the patients' case records and the hospitals monthly mortality reviews. Information obtained included age, sex, diagnosis and cause(s) of death. The causes of death considered were the direct causes of death, since the originating antecedent cause of death is the same in all the patients, in this case, HIV/AIDS. Data was analysed using Epi Info 2002.ResultsThe total number of mortalities during the study period was 350,100 were HIV positive representing 28.6% of all deaths. While advanced HIV/AIDS disease was the leading cause of death in our study representing 27.0%, tuberculosis was the single leading cause of deaths in HIV/AIDS patients constituting about 24.0% of deaths. This was followed by sepsis and septicaemia (13.0%), meningitis and encephalitis, and anaemia accounting for 11.0%, while respiratory diseases constituted 5.0% of the mortality burden. The highest number of deaths occurred in those aged between 21–50 years (82.0%).ConclusionsThe study has shown that HIV/AIDS is a major cause of morbidity and mortality in our hospital. The causes of death reflect the varied spectrum of infection and other forms of organ involvement that affect HIV/AIDS patients. The present dismal situation of adult patients living with HIV/AIDS calls for enhanced strategies to decrease the mortality trend observed in Nigeria and sub-Saharan Africa.     

Infective arthritis in adults – experience at a teaching hospital in Kuwait

Infective arthritis (InfectA) has a variable geographical pattern. A `Medline' search did not yield any earlier series on epidemiological pattern of InfectA from Kuwait or the Gulf region. Therefore, an observational prospective study of sequential cases seen over a period of 4 years was carried out. Of a total of 2021 patients seen during this period, 36 (1.8%) were diagnosed to have InfectA. There were 6 (16.7%) cases of neisserial and 30 (83.3%) of non-neisserial InfectA. Predisposing factors were seen in 17 (47.2%), all with non-neisserial InfectA. Microbiological diagnosis was proven in 15 (41.7%) cases, and included Neisseria gonorrhoeae in 5, Brucella spp. in 4, Staphylococcus aureus in 3, and Neisseria meningitidis, Salmonella spp. and Mycobacterium tuberculosis in 1 each. In the remaining 21 (58.3%) cases the diagnosis was made on clinical grounds and confirmed on therapeutic response. The most common presentation of neisserial InfectA was acute polyarthritis while that of non-neisserial InfectA was acute monoarthritis. All patients recovered with little disability and no mortality. Received: 11 December 1998 / Accepted: 12 April 1999     

Will there be room for the teaching of internal medicine in a university hospital?

To answer the question addressed, two working groups, one made of the staff of a University clinic, the other one composed of practising general internists, have discussed the assets and weaknesses of a University service of Internal Medicine for postgraduate training. The groups agreed on a number of points: patients' characteristics (complexity and co-morbidities), quality of teaching, method acquisition for clinical reasoning, as well as absence of exposure to ambulatory patients and of follow-up. The groups differed in their views related to the lack of training in psychiatry and psychosocial problems or to hospital dysfunctions. Opening of internal medicine to primary care appears to be necessary at the same time as individual qualities among the senior staff are to be developed, such as critical analysis and self-questioning.     

Outcome of patients with seronegative spondyloarthritis continuing sulphasalazine and methotrexate after a short course of infliximab therapy—experience from a tertiary care teaching hospital in South India

The objective of the study is to evaluate the outcome of patients with seronegative spondyloarthritis continuing on sulphasalazine (SSZ) and methotrexate (MTX) after a short course of infliximab. Patients with seronegative spondyloarthritis on MTX and SSZ were given short course of infliximab therapy at 0, 2, 6 and 14 weeks. Outcome of these patients while continuing on MTX and SSZ was assessed. Clinical features, Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Bath Ankylosing Spondylitis Functional Index (BASFI), C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) were noted at baseline (pre-infliximab), 1 month, 3 months and last follow-up after last dose of infliximab infusion. Twenty-four patients were included in this study. The mean duration of follow-up was 9.1 months. Statistically significant reduction in tender and swollen joint count was noted at all the three visits as compared to baseline. Fall in ESR and CRP was statistically significant at 1 and 3 months, but not at last follow-up. Mean reduction in BASDAI at 1 month ,3 month and last follow-up after last infliximab dose were 3.907 (95% CI 2.98–4.83; p < 0.001), 4.53 (95% CI 3.56–5.49; p < 0.001) and 2.48 (95% CI 1.12–3.84; p = 0.002), respectively. Mean reduction in BASFI at 1 month, 3 months and last follow-up after last infliximab dose were 4.13 (95% CI 3.23–5.04; p < 0.001), 4.34 (95% CI 2.8–5.88; p < 0.001) and 2.38 (95% CI 0.86–3.90; p = 0.005), respectively. Continuing SSZ and MTX after short course of infliximab results in sustained improvement in our patients with seronegative spondyloarthritis in India.     

Predictors of parent–child communication among a nationally representative sample in Nigeria

This study explores what constructs are associated with parent–adolescent communication about AIDS/sexually transmitted infections (STIs) and sexual relationships in Nigeria. The analyses use data from the 2007 National HIV/AIDS and Reproductive Health Survey on 2593 men and women who had at least one child over the age of 12 years. The respondents were classified as low, medium, or high communicators. Low communicators were parents who did not talk to their child about either AIDS/STIs or sexual relationships. Medium communicators were parents who discussed only one topic with at least one child. High communicators were parents who discussed both topics with at least one child. Logistic regression was used to compare high communicators with low/medium communicators. There are commonalities and differences among men and women in the factors associated with parent–adolescent communication. Age, religion, and knowing where to obtain information about HIV/AIDS were associated with the extent of communication, regardless of the parent's gender. Perceived social support was an important correlate for fathers, while knowledge of female STI symptoms showed a significant association only for mothers. Programmatic and communication implications of the findings include addressing men and women differently, developing strategies to specifically reach younger parents and Muslims, and increasing general awareness of HIV/AIDS information resources. Further research is needed to understand the context, content, and timing of parent–adolescent conversations about AIDS/STIs and sexual relationships and how these factors affect the sexual behaviors of adolescents.     

Is methicillin-resistant Staphylococcus aureus a common pathogen in ventilation-associated pneumonia?: The experience of a tertiary teaching hospital in Jordan

Ventilator-associated pneumonia is a life threatening device related infection in intensive care units. Methicillin-resistant Staphylococcus aureus is considered a common contagious pathogen causing pneumonia and sepsis.To assess the prevalence of S aureus in comparison to other pathogens, and their antibacterial sensitivity profile in ventilator-associated pneumonia.Data regarding ventilator-associated pneumonia of adults admitted to the intensive care unit, at the Jordan University of Science and Technology Hospital, between 2012 and 2018 were extracted from the computerized system. Microorganisms and their susceptibility profiles were identified according to the Clinical and Laboratory Standards Institute.There were 547 isolates, of which 35 (6.4%) were Gram positive, 59% were methicillin resistant. Gram-negative isolates were present in 507 (92.6%) isolates, of which 82% were multidrug resistant, and 1% were Candida species.Gram-negative bacterial infections were significantly associated with ventilation usage. S aureus was not the predominant pathogen.     

The Prevalence and Spectrum of α-Thalassemia in Guizhou Province of South China

Abstract

α-Thalassemia (α-thal) is one of the most prevalent genetic diseases in the world and is especially frequent in tropical and subtropical regions, including South China. The aim of this study was to investigate the prevalence and spectrum of α-thal in Guizhou Province as this information was unknown. A total of 40 α-thal carriers were determined in 1219 newborn umbilical cord blood samples by hemoglobin (Hb) electrophoresis combined with DNA analysis, which revealed that the carrier rate of α-thal in Guizhou Province was 3.28%. One thousand and forty-five individuals referred to our hospital were tested for α-thal mutations. Two hundred and twenty-four cases were determined as α-thal carriers or patients. A total of 11 genotypes and five different α-thal mutations were identified in these 224 cases. Of these mutations, more than 96.0% were deletions, including – –^SEA (65.89%), –α^3.7 (rightward) (22.87%) and –α^4.2 (leftward) (7.74%). The other two nondeletional mutations, Hb Constant Spring (Hb CS, α^CSα, HBA2: c.427T?>?C) and Hb Quong Sze [Hb QS, α^QSα, HBA2: c.377T?>?C (or HBA1)] account for 2.71% and 0.78%, respectively. The results of this study will be useful in genetic counseling and prenatal diagnosis (PND) of α-thal in Guizhou Province.     

Treatment of obstructive sleep apnea syndrome in patients from a teaching hospital in Brazil: is it possible?

Objective  The aim of this study was to evaluate the efficacy of a cost-effective intra-oral appliance for obstructive sleep apnea syndrome built into a large teaching hospital. Materials and methods  Out of 20 evaluated and treated patients, 14 concluded the study: eight men and six women, with a mean age of 42–46 (mean + SD) years and mean body mass index of 27.66. Inclusion criteria were mild or moderate apnea–hypopnea index (AHI) according to a polysomnographic study. All patients were treated with the monobloco intra-oral appliance. They were then submitted to a follow-up polysomnographic study after 60 days using the appliance. An orofacial clinical evaluation was carried out with the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) questionnaire and with clinical evaluation questionnaire devised by the Orofacial Pain Team before and 60 days after fitting the intra-oral appliance. Results  The AHI showed a statistically meaningful (p = 0.002) reduction from 15.53 to 7.82 events per hour, a non-statistically significant oxygen saturation increase from 83.36 to 84.86 (p = 0.09), and Epworth’s sleepiness scale reduction from 9.14 to 6.36 (p = 0.001). Three patients did not show any improvement. The most common side effect during the use of the appliance/device was pain and facial discomfort (28.57%), without myofascial or temporomandibular joint pain as evaluated by the RDC/TMD questionnaire. Conclusions  The intra-oral device produced a significant reduction of the apnea–hypopnea index during the study period with the use of the monobloco intra-oral appliance. Patients did not show prior myofascial pain or 60 days after use of the intra-oral appliance. Support FAPESP, process number 2007/06792-5.     

Prevalence of a newly identified SEN virus in China

AIM:To establish nested-PCR methods for the detectionof SENV-D and SENV-H and to investigate the epidemiologyof SEN virus in China.METHODS:According to published gene sequences,primers from the conserved region were designed.Then,135 samples from healthy voluntary blood donors and 242samples from patients with various forms of liver diseasewere detected by nested-PCR of SENV-D/H.Some PCRproducts were cloned and sequenced.RESULTS:By sequencing,the specificity of genotype-specific PCR was confirmed.SENV-D/H DNA was detectedin 31% of the blood donors,which was higher than thosein America and Italy (2%),and in Japan and Taiwan (15-20%).The prevalence of SENV-D/H viremia was significantlyhigher in patients with hepatitis B and hepatitis C than inblood donors (59-85% vs31%,P<0.05).The prevalenceamong patients with non-A-E hepatitis was significantlyhigher than among blood donors (68% vs 31%,P<0.01),and equivalent to that among patients with hepatitis B and C.CONCLUSION:Nested-PCR with genotype-specific primerscould serve as a useful SENV screening assay.SENV hasthe same transmission modes as HBV and HCV.The highprevalence in patients with non-A-E hepatitis may attributeto the transmission modes,and SENV may not serve asthe causative agents.     

Correlation of serum paraoxonase activities in known cases of 130 elderly hypertensive South Asian aged 56–64 years – a hospital based study

ObjectiveTo evaluate paraoxonase activity, antioxidant status and lipid peroxidation in hypertensive participants and to address the hypothesis that oxidative modifications of lipids due to hypertension can cause changes in serum paraoxonase activities.MethodsThe serum paraoxonase activities, antioxidants and lipid peroxidation were determined in 130 hypertensive participants and 130 age-sexes matched normotensive healthy volunteers served as control. Serum paraoxonase activities were measured by enzymatic kit. The glutathione peroxidase, superoxide dismutase and catalase activity were determined by standard methods. Malondialdehyde was measured by thiobarbituric acid reaction. Conjugated diene level was measured by Recknagel and Glende method. Serum uric acid, total bilirubin, serum albumin, serum ascorbic acid and lipid profile were analyzed by standard methods.ResultsTotal cholesterol, triglycerides, low-density lipoprotein cholesterol were significantly higher and high-density lipoprotein cholesterol were significantly lower in hypertensive patients when compared to normotensive healthy controls. The superoxide dismutase, glutathione peroxidase and catalase were significantly lower in hypertensive when compared with normotensive. Similar findings were observed in the levels of albumin, uric acid, bilirubin and ascorbic acid when hypertensives were compared with normotensive. The oxidative stress indicators namely malondialdehyde and conjugated diene were significantly higher and paraoxonase activity were significantly lower in hypertensive.ConclusionsOur study concludes that paraoxonase activities are bound to alter in hypertension which is caused due to interplay of several confounding factors namely oxidative stress, increased oxidized low-density lipoprotein and depletion of antioxidants.