Public Health and Nursing

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Jail Incarceration and Birth Outcomes
(2004) Bell, Janice F.; Zimmerman, Frederick J.; Cawthon, Mary L.; Huebner, Colleen E.; Ward, Deborah H.; Schroeder, Carole A.
This study examined the relationships between jail incarceration during pregnancy and infant birth weight, preterm birth, and fetal growth restriction. We used multivariate regression analyses to compare outcomes for 496 births to women who were in jail for part of pregnancy with 4,960 Medicaid-funded births as matched community controls. After adjusting for potential confounding variables, the relationship between jail incarceration and birth outcomes was modified by maternal age. Relative to controls, women incarcerated during pregnancy had progressively higher odds of low birth weight and preterm birth through age 39 years; conversely, jail detainees older than 39 years were less likely than controls to experience low birth weight or preterm birth. For women in jail at all ages, postrelease maternity case management was associated with decreased odds of low birth weight, whereas prenatal care was associated with decreased odds of preterm birth. Local jails are important sites for public health intervention. Efforts to ensure that all pregnant women released from jail have access to enhanced prenatal health services may improve perinatal outcomes for this group of particularly vulnerable women and infants.
Perinatal Outcome of Inadvertent Immunization with the Measles-Rubella Vaccine in Pregnant Mexican Women during the Campaign for the Eradication of Congenital Rubella in 2008
(Scientific Research, 2011-02) Jesus, Reyna; Ilse, Herbas; Misael, Gómez; Patricia, Vidal; Vesta, Richardson; Edith, Cruz
Objective: To investigate maternal and neonatal complications resulting from inadvertent immunization against rubella-measles during the first trimester of pregnancy. Methods: A prospective and descriptive study was carried out, including a total of 1,924 pregnant women, 175 (9.1%) of which were classified as non responding to infection by the rubella virus. They underwent clinical and ultrasonographic follow-up to dismiss maternal or fetal complications and complications at the time of delivery. The infant was checked to determine demographic, anthropometric, serological and clinical features at the time of birth. Results: No women had complications during the pregnancy, including exanthematic symptoms. 174/175 newborns were studied; one pregnancy was interrupted based on non-medical arguments. The findings in terms of the analyzed patients suggest a benign evolution after inadvertently immunizing the pregnant women, which support studies with similar results. No complications during the course of the pregnancy or phenotypic alterations of the infant at the time of birth are suggested.
Dengue Vaccines: Challenge and Confrontation
(Scientific Research, 2011-11) Perng, Guey C.; Lei, Huan-Yao; Lin, Yee-Shin; Chokephaibulkit, Kulkanya
Dengue has been recognized as one of the most important vector-borne human diseases. The disease is induced by dengue virus infection resulting from the bite of an infected Aedes spp. mosquito after imbibing the tainted blood from animals or patients. Dynamic clinical spectrums ranging from asymptomatic, undifferentiated fever, typical dengue fever (DF), dengue hemorrhagic fever (DHF) and dengue shock syndrome (DSS) have been well documented. Initially, the disease was mainly restricted in tropical and subtropical zones. However, with factors such as ineffective vector control, frequency of human migration, unplanned urbanization, and changing climate temperature, the disease has been spotted at almost every territory of the earth. Dengue has been associated with human disease for more than two centuries. Although classic DF is viewed as a self-limited illness, subjects normally resolve within two weeks and recover without any noticeable complications or sequelae, some of these infected individuals may progress to lifethreatening DHF/DSS, characterized with plasma leakage due to an increase in capillary permeability. The significantly increased public health threat and the burden of morbidity and mortality of dengue globally has caught the attention of public officials and prompted an action to find a way to contain and prevent the disease. The lack of specific dengue therapeutics has led to an emphasis on vaccine development, one of the best and effective strategies to reduce and prevent the illness. Making a dengue vaccine has been attempted more than six decades; although some of these products are in clinical trials, vaccine development for the prevention of dengue disease is still at its infancy. So far no dengue vaccine is available for the public. Dengue vaccine development may be hindered by the complexity of the clinical presentations, which implicates that multiple pathogenic mechanisms are involved in dengue disease. Some of these elements will be discussed in the current review. Opening up discussion on these pros and cons and engaging in more research to understand these features would not only improve the understanding of the pathogenesis of the dengue virus infection but also pave a new tactic to develop a safer and effective dengue vaccine
How to Identify Latent Systolic Dysfunction and Post Operative Risk in Patients with Mitral Incompetence and Normal Ejection Fraction?
(Scientific Research, 2011-12) Elkilany, Galal E. N.; Groef., Maryam; Kabbash, Ibrahim
Purpose: To study the significance of impaired positive peak rate of left ventricular (LV) pressure development (MR + dp/dt) and global systolic strain (GLPSS) values in patients presented with significant mitral incompetence (MR) in coronary artery disease (CAD) and early dilated cardiomyopathy (DCM) with normal ejection fraction (EF). Methods: A description of LV contractile behavior requires measurement of the ability of the ventricle to develop force (pressure) and to shorten. Hence, performance of the ventricle as a pump assessed in the present study by measuring the pressure developed by the ventricle (Left ventricular +dP/dt is estimated from MR jet as the rate of pressure rise from 1 to 3 m/sec) and shortening assessed by GLPSS (this Doppler technology allowed measurement of LV systolic strain for the entire length of LV myocardium). GLPSS and MR + dp/dt were calculated in 30 consecutive patients (mean age was 55 ± 12 years) characterized by echocardiographic evidence of moderate or severe MR (in CAD and DCM patients) and normal EF (mean LV Ejection Fraction of 50.9% ± 5.9%) and compared with those obtained in 35 consecutive controls (age 54.7 ± 11.4 years) with normal echocardiographic study of the heart. Results: The mean values of MR +dp/dt and GLPSS averaged from the 3 apical views, differed significantly in DCM and CAD patients (characterized by significant MR with normal EF) compared with control group, (MR + dp/dt = 733 ± 170 mmhg/s and GLPSS –13% ± 1.3%) versus (1420 ± 210 mmhg/s and −19.5% ± 3.3%) for patients versus control, respectively, p < 0.001. A depressed values of MR + dp/dt were highly correlated with GLPSS values in patients with CAD and DCM, r = 0.78. The combined use of 2D Strain (<−13%) and MR dp/dt (<900 mmhg/s) in the presence of MR (grade II or more) had 89% sensitivity and 92% specificity for detection of patients at risk of post-operative major cardiac events after MR and coronary artery bypass surgery. Conclusions: Latent LV systolic dysfunction could be defined noninvasively by depressed peak MR + dp/dt and GLPSS in the echocardiography laboratories.
Cardiac Immobilization in Beating Heart Surgery Using Pericardial Bands
(Scientific Research, 2012-06) Sirivella, Srikrishna; Gielchinsky, Isaac
A novel technique of stabilization of the coronary targets with autogenous pericardial bands is described in off pump coronary revascularizations. Pericardial bands are placed across the coronary targets and snared to the pericardial well for local cardiac immobilization. This technique can be used as an alternate to mechanical stabilizers for immobilization of the coronary targets.
Purification of Dengue Virus Particles by One-Step Ceramic Hydroxyapatite Chromatography
(Scientific Research, 2012-08) Kurosawa, Yae; Saito, Maiko; Kobayashi, Shintaro; Okuyama, Tsuneo
Dengue virus type 2 ThNH7/93 retained infectious activity after purification by ceramic hydroxyapatite chromatography. Dengue virus type 2 culture fluid was loaded onto the ceramic hydroxyapatite column and eluted with a linear gradient of sodium phosphate buffer. Culture fluid and protein contaminants derived from host cells were eluted initially, followed by elutions of dsDNA, and then dengue virus type 2. The recoveries of dengue virus type 2 were 64 ± 14% (n = 11) in the hemagglutination (HA) test and 60% (n = 2) determined by focus assay for viral infectivity. This protocol was highly reproducible, simple, rapid, and appears applicable to other virus species such as influenza virus, Japanese encephalitis virus and adenovirus
HeartSmartTM: A New Method of Assessing Hydration in Neurosurgical Patients
(Scientific Research, 2012-11) Warring-Davies, Kenneth J.; Bland, John M.
Background: Maintenance of normal fluid homeostasis is challenging in neurosurgical patients. Consequently, we studied hydration assessment in neurosurgical intensive care patients. Methods: Pulmonary artery catheter thermodilution (PACTD) is the conventional method for measuring cardiac index (CI) and mean pulmonary artery occlusion (MPAOP) or wedge pressure (MPWP). We compared values from this technique with those derived from continuous cardiac dynamic monitoring (CCDM)-HeartSmart®, a new, less invasive, software-based technique. Over 4 years, we undertook an audit of 101 paired sets of data from 21 patients with sub-arachnoid hemorrhage who had pulmonary artery flotation catheters inserted as part of their treatment. Measured values of CI and MPWP were obtained retrospectively from patients’ charts and compared with values calculated using CCDM-HeartSmart® software. Results: Using the Bland-Altman method for comparing two measurement techniques, there was good agreement between measured and calculated MPWP (mean of differences –1.81, SD 3.97, SE 0.39, 95% CI –2.59 to 2.04 l/min/m2 ; two-sided p < 0.0001). The measured and calculated values of CI were also in good agreement (mean of differences 0.36, SD 1.30, SE 0.13, 95% CI 0.109 - 0.619; two-sided p = 0.0055, 95% limits of agreement –2.1 to 2.91 l/min/m2 ). This indicates that, when estimating CI and MPWP in critically ill neurosurgical patients, CCDM-HeartSmart® provides values close to those generated using PACTD. Conclusions: The CCDM-HeartSmart® could prove invaluable for optimizing response to fluid replacement and for guiding cardiovascular support in neurosurgical patients. This new, simple technology may help to facilitate routine adoption of perioperative optimization of blood flow using early goal-directed therapy.
Long Term Results of Valve Operations in Patients with Diabetes
(Scientific Research, 2012-12) Huddleston, Stephen J.; Goheen, Erin; Opoku-Asare, Isaac; Kokkinos, Peter; Greenberg, Michael D.; Trachiotis, Gregory D.
Diabetes Mellitus (DM) adversely affects survival in patients with Coronary Artery Disease (CAD) undergoing Coronary Artery Bypass Grafting (CABG) surgery. The influence of diabetes on events after valve operations is less defined. We analyzed the effect of diabetes on short and long term outcomes in patients undergoing valvular operations. A total of 2200 patients had cardiac surgery at a single VA Medical Center between 1991 and 2008. 355 patients had undergone valve replacement or repair. Data documenting the presence of diabetes was collected prospectively and captured into the Veterans Affairs electronic medical record. Of the 355 patients who had a valvular operation, 259 (79%) had an Aortic Valve Replacement (AVR), 69 (20%) had a Mitral Valve Repair/Replacement (MVR), and 4 (1%) had a Tricsupid Valve Repair/Replacement (TVR), and 19% (n = 69) of all patients had diabetes. 44% of patients with DM and 38% of patients without DM had a combined valve and CABG procedure. During a total follow up of 18 yrs, 42 (60%) of patients with diabetes and 186 (65%) of patients without diabetes were alive (p = 0.118). At 1, 5, 10, 15 yrs survival in patients with versus without diabetes were 91% v 87%; 71% v 74%; 40% v 56%; 23% v 48% (p = NS). The presence of diabetes does not appear to adversely effect long-term survival in patients undergoing valve operations
Adult Cardiac-Related Deaths: A Reflection of Epidemiologic Transition of Diseases in the Developing World?
(Scientific Research, 2012-12) Thomas, Martins O.; Awolola, Nicholas A.; Olusoji, Olugbenga O.
Background: Epidemiologic transition of diseases is taking place globally. Therefore, it is necessary that more work is done to unravel the situation in respect to cardiac diseases in the developing world. Aim: The research was conducted to ascertain the cardiac causes of death in adults and by extension to further unravel the epidemiologic transition in relation to cardiac diseases in the developing world. Materials and Methods: This is an autopsy study of adult cardiac related causes of death in the year 2010 at the Lagos University Teaching Hospital in Nigeria, West Africa. It was conducted based in a 700-bedded hospital that has a catchment area of about 15 million people. Patients’ data (including bio-data, causes of death, etc.) were extracted from autopsy records for the year 2010. The data were entered and analysed with SPSS software. Results: There were 789 autopsies in the year and 99 of deaths were cardiac-related. There was male preponderance with a mean age of 54.2 ± 1.568 years. Hypertensive heart disease was the primary disease in 97.0% of cases in the studied sample. One 76 year old adult had myocardial infarction. There was no case of adult congenital heart disease. Intracerebral haemorrhage was the commonest cause of death. Discussion and Conclusion: Cardiovascular diseases constitute a growing threat to health among Africans. The developing countries are in stages II and III of Omran epidemiologic transition of diseases. This presents a major challenge to a large proportion of the world population with additional problem of poverty and ignorance. A 4-point agenda is suggested to reduce incidence of cardiovascular diseases (and deaths) in the developing world.
Value of Orthostatic Hypotension as a Prognostic Bed-Side Test in Heart Failure
(Scientific Research, 2012-12) Rahman, Tarek M. A.
Background: Neurohumoral compensatory mechanisms play an important role in stabilizing the functional activity of patients with heart failure using the arms of autonomic nervous system. Orthostatic Hypotension (OH) is one of the most incapacitating symptoms of Cardiac Autonomic Dysfunction (CAD). OH can include sympathetic withdrawal which in turn leads to marked disability and deterioration of heart failure symptoms. Progressive Autonomic Dysfunction (AD) associated with progressive deterioration and impact on mortality of many diseases as hypertension, diabetes and other chronic diseases. The idea of using (OH) as a bed-side simple test expecting the risk of deterioration of cardiac function and furthermore on mortality open a gateway for preventive medicine and care to these group of patients. For more confidential prove, studying subjective and objective factors in heart failure patients became necessary to support these idea. Methods and Results: Sixty-Four patients with known history of heart failure were collected. All patients taking the fixed regiment of 4 drugs (diuretic, ACE inhibitor, Digitalis and B-blocker) in appropriate tolerated doses for two weeks prior to the study. History taking and all routine investigations were done for all patients. Grouping is based upon wither they have (OH) or not. Group-A found to have normal BP response to standing; they were 24 patients (18 male and 6 female) of mean Age (45 ± 8 years). Group-B discovered to have significant (OH) and was 22 patients (16 males and 6 females) of mean Age (43 ± 4 years). The first Clinical and Echocardiographic examination was done and considered as a base-line characteristic. Then, a Call-back after 6 months for follow-up and second visit examination is recorded. Furthermore, every patient was advised to report changes in his clinical symptoms in a note-book describing five main items to answer a questionnaire at the end of the study involves [times of admission to hospital, need for treatment modification, numbers of paroxysmal nocturnal dysnea, numbers of arrhythmic episodes and manifest lower limb edema]. At the end of the study, statistical methods are used to clarify the changes in their data and detect deterioration of cardiac functions by Echocardiographic results and their answers to the questionnaire. In the first visit, comparison of demographic, clinical and Echocardiographic data revealed no significant variations—odd values are excluded and the remaining 46 patients are then tested for their Bp response to standing and classified into two groups. Group-A (normal Bp response) and Group-B (having orthostatic hypotension). Group-A were 24 patients (18 male and 6 female) of mean Age (45 ± 8 years). Group-B were 22 patients (16 males and 6 females) of mean Age (43 ± 4 years). In the second visit (6-month later), divergence of data is observed and was statistically significant. Group-B was found to have a lower EF% and FS% (p = 0.01), a lower Dp/Dt (p = 0.01) and a higher Tie-Index and MR-jet area (p = 0.01). This means that, patients having orthostatic hypotension underwent significant deterioration of cardiac functions after a period of six-months. Indeed, the questionnaire proved frequent times of hospital admissions, paroxysmal nocturnal dysnea, need for treatment modification, arrhythmias and lower limb edema in group-B. Discussion: The present study conclude that, heart failure-patients having orthostatic hypotension experienced a significant deterioration of clinical condition and cardiac functions along a period of six-months which represent failure in their autonomic compensatory mechanisms and possible impact on their mortality. However, extended trials on mortality are needed to confirm this idea. Otherwise, we might use (OH) as a simple, rapid, bed-side tool to determine their prognosis and directing the physician attention to close care towards these subset of patients.
The Risk Factors of Intensive Care Unit Admittance during First Attack of Acute Pancreatitis
(Scientific Research, 2012-12) Dale, Jonas; Omdal, Thomas; Lie, Stein A.; Iversen, Knut; Flaaten, Hans; Ovrebo, Kjell K.
Background: A proportion of patients with acute pancreatitis develop severe organ dysfunction requiring admittance in an intensive care unit. Patient characteristics associated with ICU admittance were evaluated in this consecutive series of patients. Methods: The clinical course of patients with first attack of acute pancreatitis in urban Norway between 01.01.1996 and 31.12.2006 was reviewed. Patient characteristics, comorbidity, pre hospital delay and likely aetiology of acute pancreatitis were analysed as risk factors for ICU admittance. Results: This study includes 565 patients, 299 women and 266 men (p = 0.089), with a median age of 60 years (range: 17 - 98). 50 (9%) of the patients were admitted to the ICU. Men were more at risk than women for ICU admittance (OR 2.34; 95% CI: 1.27 - 4.32). Patients with alcohol associated pancreatitis (OR 5.94; 95%, CI: 2.61 - 13.53), miscellaneous aetiologies (OR: 2.81, 95% CI: 1.02 - 7.73) and non-assessed aetiology (OR 2.71, 95%, CI: 1.26 - 5.82) were more at risk of ICU admittance than patients with bile stones associated pancreatitis. Pre hospital delay increased the risk of ICU admittance amongst patients with alcohol associated pancreatitis (OR 4.23; 95%, CI: 1.11 - 16.18). Two comorbid conditions conveyed increased risk (OR 8.78; 95%, CI: 1.87 - 41.22). The case fatality rate was 24% in the ICU and 1.6% in the ward (OR 20.01, 95% CI: 7.71 - 51.93). Conclusions: Aetiology of acute pancreatitis, especially alcohol, pre-hospital delay and male gender are associated with increased of risk of ICU admittance and increased fatality rate during first attack of AP.
Determination of Accuracy of Nursing Diagnoses Used by Nursing Students in their Nursing Care Plans
(2013) Aydin, Nursel; Akansel, Neriman
Aim: The aim of this study was to determine and evaluate appropriateness of nursing diagnoses with NANDA taxonomy used by second year nursing students in their nursing care plans. Methods: Retrospective design. Findings: While care plans included 42 nursing diagnoses appropriate to NANDA II taxonomy, some phrases (n=30)were used as nursing diagnoses. Risks for infection, pain, activity intolerance, anxiety were the most frequently used diagnoses while nursing diagnoses in domains of cognitive-perceptive, self perception and role relations are very few. Conclusio: Performing case studies in clinical settings by using NANDA diagnoses, specifying difficulties experienced by nursing students’ and determining levels of discomfort while assessing the patients and determining the perceptions of nursing students by doing qualitative studies are recommended.
Quality Assurance in Wound Management in a Developing Country: How Satisfied Are Our Patients?
(Scientific Research, 2013-01) Agbenorku, Pius
Background: Quality is important in every setting especially in the health service where the needs of patients should be an utmost priority. However, this is sometimes not the situation in most health care centres due to increasing stress because of inadequate resources and increasing demands for services. This present study seeks to assess quality assurance in the management of wounds. Method: A descriptive survey involving 280 participants; data was collected using structured questionnaire. The questionnaires included some quality indicators which were used to assess the quality of care patients received from the health facility. Results: Out of the 280 participants, females were 57.1% (n = 160) and males, 42.9% (n = 120). Ages of the participants ranged from 15 - 70+ years with a mean age of 35.8 ± 1.5; 28.6% (n = 80) of staff had an excellent attitude while 5.7% (n = 16) had a fair attitude. The condition of 112 did not require surgery (40.0%), however, out of the 168 who underwent surgery, 32 (19.0%) were not satisfied while 136 (81.0%) were satisfied. Also, 97.1% (n = 272) were accorded privacy, 51.4% (n = 144) were assured of confidentiality, 48.6% (n = 136) were educated on diagnoses and treatment, 91.4% (n = 256) understood pharmacy instruction, 57.1% (n = 160) were satisfied with time spent in the facility, 97.1% (n = 272) were not shun by nurses because of their wounds. Conclusion: Patient satisfaction should be the priority of all persons working in the health facility. In accessing quality service, patient satisfaction can be met if quality assurance measures are put in place. This quality assurance measures should include all units of the health delivery system since it would help to ensure judicious use of resources in order to meet the health needs of patients.
Hybrid External Fixation for Open Severe Comminuted Fractures of the Distal Femur
(Scientific Research, 2013-02) Hassankhani, Ebrahim G.; Birjandinejad, Ali; Kashani, Farzad O.; Hassankhani, Golnaz G.
Background: The treatment of distal femoral open comminuted fractures is a major problem for orthopedic surgeon. The basic and important aim in treatment of these fractures is to assemble the condylar fragments and then fix the condyles to the femoral shaft by minimum handling of the bone and soft tissues. Objectives: To evaluate the treatment of distal femoral open comminuted fractures (type C2 and C3) with hybrid external fixator. Methods: Thirty-four patients with distal femur open comminuted fracture (type C2 and C3) were treated by hybrid external fixator between January 2005 and December 2008. All of the fractures were opened with extension to joint surface. 30 patients were male and 4 were female. Their average age was 30.5 years (17 to 72 years). Average follow up period was 36 months. 12 patients had isolated fracture and 22 patients had multiple fractures. The bony and functional results were evaluated by the association for the study and application of the method of Ilizarov (ASAMI) protocol and knee society score. Results: 29 out of 34 fractures (85%) had union without bone grafts. Average time of union was 6.1 months (4 - 19 ms). The average knee range of motion was 87.5 degrees (30 - 115 degrees). The bony results were excellent in 24 patients (70.5%), good in 6 (17.7%), fair in 2 (5.9%), and poor in 2 (5.9%), and the functional results were excellent in 10 (29.4%) patients, good in 14 (41.2%), fair in 6 (17.6%), and poor in 4 (11.8%), and the functional results were excellent in 10 (29.4%) patients, good in 14 (41.2%), fair in 6 (17.6%), and poor in 4 (11.8%) according to ASAMI protocol. According to the knee society score the functional results were excellent in 9 (26.44%) patients, good in 13 (38.26%), fair in 7 (20.6%), and poor in 5 (14.7%). Conclusion: Hybrid external fixator is an effective method for treatment of distal femoral open comminuted fractures (type C2 and C3) and may be considered as an alternative surgical methods in the management of these fractures.
Therapeutic Process of Gynecological Pelvic Abscess— Retrospective Review of 20 Cases
(Scientific Research, 2013-03) Oride, Aki; Kanasaki, Haruhiko; Miyazaki, Kohji
Background: Conservative therapies of pelvic abscess are not highly effective and surgical treatment is usually required. This study reviewed cases of pelvic abscess treated at our hospital over a 3-year period to evaluate treatment efficacy. The medical records of 20 patients diagnosed with pelvic abscess and admitted to our hospital for treatment between November 2006 and December 2009 were retrospectively examined. Results: Mean age of the patients was 50 ± 16.6 years. Pelvic abscess occurred spontaneously in 13 patients and secondary to surgical manipulation in 7 patients. In the 13 patients with spontaneous abscess, 7 had undergone pelvic surgery and 2 had undergone insertion of an intrauterine contraceptive device. Concomitant endometriosis was present in 5 of the 13 (38.5%) patients. A positive bacterial culture from the abscess was obtained in 16 of 19 (84.2%) patients tested. Causative bacteria included 4 aerobic bacterial species detected in 7 patients and 11 anaerobic bacterial species detected in 10 patients. Although multiple antibiotics were administered in all cases, 19 of the 20 (95%) patients eventually required surgical intervention, which included total hysterectomy plus adnexectomy, drainage under laparotomy or drainage alone. Anaerobic bacteria were frequently detected as the causative bacteria. Conclusion: As treatment with antibiotics alone was ineffective in almost all cases, surgical treatment was required. Drainage might be the first-choice treatment for pelvic abscess to avoid invasive surgery.
The Treatment of Partial-Thickness Burns with a Hydroconductive Wound Dressing: Clinical and Mechanistic Effects
(Scientific Research, 2013-05) Smith, David J.; Karlnoski, Rachel A.; Patel, Ami; Cruse, C. Wayne; Brown, Kimberly S.; Robson, Martin C.
Objectives: Edema in partial-thickness burn wounds can decrease tissue perfusion, increase tissue ischemia, and deepen the burn injury. We report the results of a clinical trial comparing the effectiveness of a hydro-conductive dressing to our standard burn dressing at removing edema fluid from partial-thickness burns and present the proposed mechanisms of action of the hydroconductive dressing. Methods: An internally controlled comparison of two wound dressings was performed on 10 patients with non-contiguous partial-thickness burns. Each patient served as his/her own control. One burn was treated with our standard burn dressing and the other with hydroconductive dressing. Dressings were weighed prior to application, removed at 24 and 48 hours, weighed, and new pre-weighed dressings applied. Weight gain of each dressing at 24 and 48 hours was determined. Statistics were applied using the Student’s paired T-test. The VAS pain scale was measured prior to, during, and after each dressing change. Results: At 24 hours, the hydroconductive dressing had increased 85.6% ± 29.3% in weight compared with 61.3% ± 32.7% for the control (P = 0.053). For the second 24 hour period, the respective numbers were statistically significantly different at 59.7% ± 23.4% vs. 34.2% ± 19.1% (P = 0.038). Averaging the weight gain over the two dressing periods demonstrated that the differences were highly statistically significant as the hydroconductive dressing increased in weight by 71.0% ± 20.3% compared with 44.5% ± 17.4% for the gauze dressing (P = 0.005). VAS scores revealed no statistical differences. Mechanisms of action included capillary, hydroconductive, and electrostatic actions. Conclusions: A hydroconductive dressing designed to draw off excessive wound fluid removes more wound edema fluid than standard burn gauze dressings.
Survival of HIV Infected Children Born to Mothers Enrolled in a PMTCT Program in a Resource Poor Setting
(Scientific Research, 2013-06) Gumbo, F. Z.; Kandawasvika, G. Q.; Kurewa, E. N.; Duri, K.; Chandiwana, P.; Mapingure, M. P.; Chirenje, M. Z.; Stray-Pedersen, B.
Background: Pediatric HIV is a leading cause of morbidity and mortality worldwide. The substantial expansion in PMTCT has generated information on rates of transmission and associated factors, but there are limited studies on disease progression and mortality in vertically infected children, especially from resource poor settings. Methods: A birth cohort study was initiated in 2002 to focus on the role of a single dose of nevirapine in HIV transmission before Highly Active Antiretroviral Therapy (HAART) was readily available. The enrolment of women and subsequent follow up of the children occurred at 3 peri urban clinics around Harare. Findings: 479 women were HIV infected. From these, 93 (19%) children became HIV infected, 182 (38.0%) uninfected and 204 (43%) lost to follow up before HIV diagnosis. Of the HIV infected children, 40 (43%) died before the fifth birthday, 26 (28%) were lost to follow up and 27 (29%) were alive five years after maternal enrolment prior to availability of cART. Conclusion: In this setting, there was unacceptable high mortality from HIV infected children and loss to follow up prior to availability of HAART. A small proportion of HIV vertically infected children is surviving in resource poor settings without antiretroviral therapy.
Early Results of Mitral Valve Replacement in Severe Pulmonary Artery Hypertension—An Institutional Prospective Study
(Scientific Research, 2013-06) Kumar, Nirmal; Sevta, Prashant; Satyarthy, Subodh; Agarwal, Saket; Betigeri, Vithal K.; Satsangi, Deepak K.
Introduction: In patients undergoing surgery for mitral valve replacement (MVR) for valvular heart disease, pulmonary artery hypertension (PAH) has been considered a major risk factor. In this prospective study, we have studied the early hemodynamic changes and post-operative outcomes of MVR among patients with severe PAH. Methods: 68 consecutive patients who underwent mitral valve replacement for severe rheumatic mitral valve disease with severe PAH (pulmonary artery pressure (PAP) > 50 mmHg) were studied prospectively for immediate postoperative hemodynamics and outcomes. The mean age of the patients was 32.1 years. 32 (47.05%) patients had mitral stenosis, 13 (19.11%) had mitral regurgitation and 23 (33.82%) had mixed lesions. Patients were divided into two groups based on preoperative pulmonary artery pressures. In 56 patients (82.35%, group I) PAP was sub-systemic or systemic, with a mean of 58.4 mmHg. Twelve patients (17.65%, group II) had supra-systemic PAP with a mean of 82.4 mmHg. Results: After mitral valve replacement, the PAP and pulmonary vascular resistance (PVR) decreased significantly in group I to near normal levels. In group II also the PAP and PVR decreased significantly but significant residual PAH remained. Operative mortality was 3.5% in group I and 16.6% in group II. Conclusions: MVR is safe and effective at the presence of severe PAH as long as the PAP is below or equal to systemic pressures. With suprasystemic PAP, MVR carries a high risk of mortality and the patient continues to have severe PAH in the postoperative period
RNA Wave for the HIV Therapy: Foods, Stem Cells and the RNA Information Gene
(Scientific Research, 2013-06) Fujii, Yoichi R.
The microRNA (miRNA) gene is small RNA molecule, approximate 20 nucleotides (nts) in length, and also the miRNA is information in a cell as well as the mobile genetic information; therefore, when only one kind of tumor suppressor RNA information gene (Rig) was intravenously administrated, tumorigenic cells can be retuned to the normal cells in vivo. Although the processes of oncogenic have multiple ways, Rig can control its complex system, such as cell cycle with tuning to translation and transcription processing systems. In quite recent experiments, human breast milk and bovine milk have contained Rigs into their microvesicular components. Both also contain the infant nutrient elements. Further, the siRNA genes in artificial nanoparticles were delivered via oral and could restore mouse intestinal inflamemation. In general, Rigs in the diet were found stable to orally affect the digested animals, therefore, the xenotropic Rigs in Rig transgenic plants could also protect from HIV-1 infection by the edible vaccine via intestinal cells. Because orally delivered miRNA as information could be incorporated into intestinal cells and transmitted into intra- and inter-cells and between individuals to wave the system of translation and transcription. Given these mobile characters of Rigs, even though there is the xenotropic miRNA issue, edible Rig agents in plants as a vaccine would be applicable for the Rig diseases (RigDs) by the information technology-based therapy (iTBT) cooperated with system-based therapies such as stem cell therapy and chemotherapy
New-Onset Seizures in HIV Patients on Antiretroviral Therapy at a Tertiary Centre in South-West, Nigeria
(Scientific Research, 2013-06) Olajumoke, Oshinaike; Akinsegun, Akinbami; Njideka, Okubadejo; Oluwadamilola, Ojo; Olaitan, Ojelabi; Adedoyin, Dosunmu; Adewumi, Adediran; Akinola, Dada; Sarah, Ajibola
Background: Seizures are associated with neurological manifestations of HIV. They may be the presenting symptom and can occur at any disease stage. Aim: To determine the frequency and clinical aspects of new-onset seizures in patients with human immunodeficiency virus (HIV) infection. Methods: A study of an HIV-infected patient cohort on highly active anti-retroviral therapy (HAART) in the out-patients clinic of the Lagos state university teaching hospital, Nigeria. In a cross-sectional design, 308 HIV infected patients were recruited over a period of 1 year. Cases with a first seizure during this period were further examined. Details of demographic data, the first seizure date, seizure characteristics, neurologic complications and CD4 count at the time of the seizure were documented. Results: A total of 20 (6.5%) had new-onset seizures during the study period. 6/20 (30%) were males and 14/20 (70%), females. Their ages ranged between 22 - 51 years with a mean of 34.2 ± 8.7 years. The seizure was focal in 2/20 (10%) of cases and generalised in 90% (18/20) of cases. A total of 13/20 (65%) had recurrence of their seizures. None of the cases had focal neurological deficit at the time of the first seizure. The mean CD4 count was 165.3 ± 145.7. The mean duration on HAART was 19.5 ± 12.7 months. Cases with CD4 counts ≤200 cells/mm3 constituted 70% (14/20) whilst those with CD4 counts >200 made up 30% (6/20) [p = 0.666]. Conclusions: Seizures remain a significant neurological manifestation of HIV infection and has a high recurrence rate. It occurs more commonly in the advanced stage with severe immune suppression and may be attributable to HIV encephalopathy. Early treatment would reduce the burden and improve patient’s quality of life.

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