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   2012| January  | Volume 4 | Issue 1  
    Online since February 13, 2012

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Cesarean section in morbidly obese parturients: Practical implications and complications
Lovina SM Machado
January 2012, 4(1):13-18
The prevalence of obesity has reached pandemic proportions across nations. Morbid obesity has a dramatic impact on pregnancy outcome. Cesarean section in these women poses many surgical, anesthetic, and logistical challenges. In view of the increased risk of cesarean delivery in morbidly obese women, the practical implications and complications are reviewed in this article. A Medline search was conducted to review the recent relevant articles in english literature on cesarean section in morbidly obese women. The types of incisions and techniques used during cesarean delivery, intra-operative and postpartum complications, anesthetic and logistical issues, maternal morbidity and mortality were reviewed. Morbidly obese women with a body mass index (BMI >40 kg/m 2 are at increased risk of pregnancy complications and a significantly increased rate of cesarean delivery. Low transverse skin incisions and transverse uterine incisions are definitely superior and must be the first option. Closure of the subcutaneous layer is recommended, but the placement of subcutaneous drains remains controversial. Thromboprophylaxis adjusted to body weight and prophylactic antibiotics help in reducing postpartum morbidity. Morbidly obese women are at increased risk of postpartum infectious morbidity. Weight reduction in the postpartum period and thereafter must be strongly encouraged for optimal future pregnancy outcomes and well-being.
  7,611 1,089 23
Collagen IV in normal skin and in pathological processes
Ana Maria Abreu-Velez, Michael S Howard
January 2012, 4(1):1-8
Context: Type IV collagen is a type of collagen found primarily in the skin within the basement membrane zone. The type IV collagen C4 domain at the C-terminus is not removed in post-translational processing, and the fibers are thus link head-to-head, rather than in a parallel fashion. Also, type IV collagen lacks a glycine in every third amino-acid residue necessary for the tight collagen helix. Thus, the overall collagen-IV conformation is structurally more pliable and kinked, relative to other collagen subtypes. These structural features allow collagen IV to form sheets, which is the primary structural form found in the cutaneous basal lamina. There are six human genes associated with collagen IV, specifically COL4A1, COL4A2, COL4A3, COL4A4, COL4A5 and COL4A6. The aim of this review is to highlight the significance of this protein in normal skin, and in selected diseases. Results: The alpha 3 protein constituent of type IV collagen is thought to be the antigen implicated in Goodpasture's syndrome, wherein the immune system attacks the basement membranes of the renal glomeruli and pulmonary alveoli. In addition, mutations to the genes coding for type IV collagen lead to the Alport syndrome. Furthermore, autoantibodies directed against denatured human type IV collagen have been described in rheumatoid arthritis, scleroderma, and SLE. Structural studies of collagen IV have been utilized to differentiate between subepidermal blistering diseases, including bullous pemphigoid, acquired epidermolysis bullosa, anti-epiligrin cicatricial pemphigoid, and bullous lupus erythematosus. Collagen IV is also of importance in wound healing and in embryogenesis. Conclusions: Pathological studies have demonstrated that minor structural differences in collagen IV can lead to distinct, clinically different diseases.
  6,701 1,464 41
Prevalence of nosocomial wound infection among postoperative patients and antibiotics patterns at teaching hospital in Sudan
Mohamed Issa Ahmed
January 2012, 4(1):29-34
Background: Postoperative nosocomial infections remain a major problem in health care facilities, resulting in extended length of stay, substantial morbidity and mortality, high excess of cost, and less frequent cause of death in the surgical patient. Aims: To determine the prevalence of aerobic nosocomial pathogens among patients with postoperative wound infections at Gadarif state which located in Eastern part of Sudan. Materials and Methods : 109 wound swabs were collected from patients who had developed postoperative wound infection. Conventional technique for isolation of bacteria was applied with analytical profile index (API system) for identification to confirm primary and secondary isolates. Antibiotics susceptibility was applied for all isolated bacteria. Results: Aerobic bacterial isolates were S. aureus (n=55, 55.0%), P. mirabilis (n=35, 35.0%), E. coli (n=5, 5.0%), Ps. aeruginosa (n=3, 3.0%), and Pr. vulgaris (n=2, 2.0%). The prevalence rate of hospital acquired infection were 25.23% Conclusion: The highest prevalence rate of nosocomial postoperative wound infection, in Sudan was due to poor antibiotic selection, for prophylaxis during and after surgery and increased level of contamination in most part of the hospital.
  3,475 659 10
Perforated duodenal ulcer in high risk patients: Is percutaneous drainage justified?
Aly Saber, Mohammad A Gad, Gouda M Ellabban
January 2012, 4(1):35-39
Background: Conservative treatment was recommended as the treatment of choice in perforated acute peptic ulcer. Here, we adjunct percutaneous peritoneal drainage with nonoperative conservative treatment in high risk elderly patients with perforated duodenal ulcer. Aim: The work was to study the efficacy of percutaneous peritoneal drainage under local anesthesia supported by conservative measures in high risk elderly patients, according to the American Society of Anesthesiologists grading, with perforated duodenal ulcer. Patients and Methods: Twenty four high risk patients with age >65 years having associated medical illness with evidence of perforated duodenal ulcer. Results: The overall morbidity and mortality were comparable with those treated by conservative measures alone. Conclusion: In high risk patients with perforated peptic ulcer and established peritonitis, percutaneous peritoneal drainage under local anesthesia seems to be effective with least operative trauma and mortality rate.
  3,020 447 8
Medicine vendors: Self-medication practices and medicine knowledge
Asa Auta, Simeon Omale, Temitope J Folorunsho, Shalkur David, Samuel B Banwat
January 2012, 4(1):24-28
Background: Medicine vendors fill the gap created by inadequate skilled professionals required for medicine procurement, storage, and distribution in developing countries. Aim : To evaluate self-medication practice and medicine knowledge among medicine vendors and to determine if a relationship exists between both. Materials and Methods : A descriptive, cross-sectional study was conducted, using a pretested questionnaire on 236 medicine vendors in Jos, Nigeria, sampled through a two-stage stratified design. Data collected were analyzed using the Statistical Package for Social Sciences version 16, and the chi-square test was used to determine the association between variables. Results : Self-medication was common (75.4%) among respondents and was not associated (P>0.05) with any of the demographic characteristics studied. The classes of medicines commonly used by respondents for self-medication were analgesics (31.4%), anti-malarials (22.6%), multivitamins (17.7%), and antibiotics (11.25%). A knowledge assessment test revealed that only 34.3% of the respondents had adequate knowledge. There was no significant (P>0.05) relationship between self-medication practice and medicine knowledge, among the respondents. However, the medicine knowledge scores were significantly (P<0.05) associated with holding a certificate in health sciences, years of experience, and the place of practice of the medicine vendors. Conclusion : The present study demonstrated that self-medication practice was high and inadequate medicine knowledge existed among respondents.
  2,708 498 11
The reason for regimen change among HIV/AIDS patients initiated on first line highly active antiretroviral therapy in Southern Ethiopia
Beharu Woldemedhin, Nasir Tajure Wabe
January 2012, 4(1):19-23
Background: Highly active antiretroviral therapy (HAART) has markedly decreased the morbidity and mortality due to HIV disease. However, toxicities, comorbidity, pregnancy, and treatment failure, among others, would result in frequent initial HAART regimen change. Aim : The study was designed to assess the causes of initial highly active antiretroviral therapeutic regimen changes among patients on HAART. Materials and Methods: The study was conducted using a retrospective institution-based study, by reviewing the patient information sheet and physician diagnosis cards. Patient cards that showed a change in the initial treatment regimen were assessed and analyzed, to identify the common reason that resulted in a change from the initial treatment regimen. The data was analyzed using SPSS version 16.0. Results: A total of 340 patient cards were assessed. The majority of the patients (69.29%) were females. The most common first regimen, before the first switch, was stavudine / lamivudine / nevirapine (D4T/3TC/NVP) (54.70%) and stavudine / lamivudine / Efavirenz (D4T/3TC/EFV) (20.88%). The main reasons for modification were toxicity, comorbidity, pregnancy, and treatment failure. The main types of toxicities observed were peripheral neuropathy (36.52%), rash (17.83%), and anemia (17.39%). Conclusion : Toxicity was the main reason for the modification of initial HAART among the study population. Efavirenz-based regimens had the lowest hazard for change relatively, except in pregnancy-related cases.
  2,566 481 16
Assessment of causes and patterns of recurrent varicose veins after surgery
Mohammed A Gad, Aly Saber, Emad N Hokkam
January 2012, 4(1):45-48
Background: Varicose vein surgery is characterized by high recurrence rate of 60% after 5 years of follow-up observation, and this is a disappointing finding, both for the patient and surgeon. Aim: To identify the possible causes and patterns of recurrent varicose veins. Materials and Methods: 92 patients with recurrent varicose veins were enrolled in this study. Full detailed history, examination, and investigations were done. Results: 30 patients had recurrence after saphenofemoral disconnection, 22 patients with recurrence after saphenofemoral disconnection and stripping below knee, 28 patients recurrence after saphenofemoral disconnection with stripping above knee and 12 patients recurrence after sapheno-popliteal disconnection with stripping. The double great saphenous veins, neovascularization and deep venous thrombosis before and after surgery were the most observed patterns of recurrence. The anatomical patterns of recurrence were more in leg then both leg and thigh pattern. Conclusion: Saphenofemoral ligation with below knee stripping has the least frequency of recurrence, while Trendlenberg operation alone has the highest.
  2,472 503 10
Demographic factors associated with insecticide treated net use among Nigerian women and children
Asa Auta
January 2012, 4(1):40-44
Background: Malaria constitutes a major health problem, with children and pregnant women being the most vulnerable to its morbidity and mortality. Aim: To determine the demographic factors associated with the use of insecticide-treated nets among children and pregnant women in Nigeria. Materials and Methods: The study was based on data drawn from the Nigeria Demographic and Health Survey 2008 on the use of insecticide-treated nets among women and children. The survey was conducted in 34070 households and a total of 10,724 women aged 15-49 years participated in the survey. Data were entered into Minitab version 15 and the chi-square test for independence was performed to show association between variables. Results: The results revealed that 49.8% of children and 44% of pregnant women present in households that owe insecticide-treated nets slept under them on the night before the survey. Sleeping under an insecticide-treated nets among children was associated with (P<0.05) the age of a child, geopolitical zone, and wealth quintile while the use of insecticide-treated nets among pregnant women was associated with the education level and wealth quintile of households. Conclusion: The study demonstrated that some demographic factors are associated with the use of ITNs among children and pregnant women in Nigeria.
  2,499 355 15
Eight years follow-up of a case with idiopathic pulmonary hemosiderosis after corticosteroid therapy
Hasan Kahraman, Nurhan Köksal, Fuat Özkan
January 2012, 4(1):49-51
Idiopathic pulmonary hemosiderosis is characterized by recurrent episodes of alveolar hemorrhage, hemoptysis, and secondary iron deficiency anemia with unknown etiology. It generally emerges in childhood and adolescence periods but rarely found in adulthood. Definite diagnosis is established by appearing the hemosiderin-laden macrophages at sputum, bronchoalveolar lavage, or open lung biopsy. We reported a male patient who was born in 1975, expectorated blood since 1995, and was diagnosed in 1998. He received many blood replacements. He admitted to our clinic in 2003 with complaints of coughing up blood, shortness of breath, and tiredness. We gave the corticosteroid therapy to patient for 6-month period. After treatment, the patient did not have any complaints. Clinicians should keep in mind that idiopathic pulmonary hemosiderosis may differ in localization on chest X-ray and corticosteroid treatment should be started when diagnosis is established.
  2,376 435 4
Prognostic factors in pancreatic cancer
Ĺke Andrén-Sandberg
January 2012, 4(1):9-12
Prognostic factors in pancreatic cancer have been a hot topic for the clinical pancreatology, and many studies have been involved in the field. The author reviewed the pancreatic abstracts of American Pancreas Club 2011, and sumarized "highlight" of all the abstracts in prognostic factors in pancreatic cancer.
  1,204 238 7