Alterations of Bronchial Cytokines in Bronchial Carcinoid Tumor Perioperatively | Chapter 06 | New Insights into Disease and Pathogen Research Vol. 2

As bronchial carcinoids are known to be notably rare, adequate histochemical investigations couldn’t have been carried out on these types of tumors hitherto. In this study, we investigated bronchial cytokines in a carcinoid tumor localized in the left main bronchus. Bronchial resection and reconstruction was performed without the lung resection. Bronchial lavage samples were obtained from both sides of main bronchial system preoperatively and postoperatively. TNF- α, IL- 8 and IL- 6 levels were measured by ELİSA. Preoperative TNF- α and IL- 8 levels were found to be 2-folds and 5-folds higher on the tumor side respectively (TNF- α; 14.184 pg/ml and IL- 8; 3359.86 pg/ml) compared to tumor-free bronchial system (TNF- α; 6.886 pg/ml, IL- 8; 615.072 pg/ml). Interestingly, both cytokine levels were found to be equal and within normal ranges on both sides subsequent to bronchial resection and reconstruction. There were no significant difference in IL- 6 levels between two bronchial systems preoperatively (IL- 6 levels of right bronchus, 16.44 pg/ml; levels of left bronchus, 19.11 pg/ml). However, there was more than four-fold increase in postoperative levels (IL- 6 level; 89.41 pg/ml). In this chapter, we found that preoperative TNF- α and IL- 8 levels were higher compared to the postoperative ones; whereas IL- 6 levels showed a significant increase, postoperatively. These findings led us through the idea that carcinoid tumors might be activating the inflammatory process among TNF- α and IL- 8 and the surgical bronchoplastic procedure could be the cause of enhanced IL-6 response.

Author(s) Details

Nilgün Kanlıoğlu Kuman
Department of Thoracic Surgery, Faculty of Medicine, Adnan Menderes University, Turkey.

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Prevalence of Hypertension Stages and the Main Risk Factors in Khartoum Locality, Sudan, 2014 | Chapter 05 | New Insights into Disease and Pathogen Research Vol. 2

Background Information: Cardiovascular diseases (CVDs) are number one killer in the world among non-communicable diseases (NCDs). The principal underlying risk factor for CVDs is hypertension (HTN).

Objectives: To identify the prevalence of hypertension, the stages of HTN and the related risk factors such as age, sex, smoking and body mass index (BMI) among the population in Khartoum locality, Sudan, 2014

Methods: A community based cross-sectional study was carried out in Khartoum locality during March- April 2014. A total of 948 adult individual were interviewed using structured questionnaire that was filled by medical officers, house officers and semi-final medical students. Blood pressure (BP) was measured twice with 5-6 minutes in-between. Hypertension was considered as ≥ 140 mmHg and ≥ 90 mmHg for systole and diastole BP respectively. The international classification of BMI was used for underweight, normal, overweight and obesity.

Analysis: Prevalence of HTN and the stages was measured by descriptive statistics. Multiple logistic regressions was used to test relationships of age, sex, smoking and BMI with stages of hypertension, pre-HTN, stage one HTN, stage two HTN, isolated systolic hypertension (ISHTN) and isolated diastolic hypertension (IDHTN).

Results: More than half of the population (51.3%) was in the age group 18-36 years. Males and females account to 44.7% and 55.3% respectively. Overweight and obesity was detected in 59.1% of the study population. Most of the study populations were non-smokers (88.8%). Pre-HTN, HTN (stage one and two), ISHTN and IDHTN were 7.7%, 10.7%, 9.4% and 7.9 respectively.

Smoking contributed to occurrence of pre-HTN by 5.7%. It has no contribution to other stages of HTN. Male sex is the contributing factor for occurrence of pre-HTN, stage one HTN and stage two HTN, Odd Ratios: 4.555, 8.355 and 6.588 respectively. Overweight contributes to all stages of  HTN by various degrees. Age is also a contributory factor for stage one HTN, stage two HTN and ISHTN.

Conclusion: Prevalence of different stages of HTN in Khartoum locality was high. Overweight contributes to all stages of HTN. Age and male sex were not contributing to pre-HTN and ISHTN respectively.

Author(s) Details

Dr. Asma Abdelaal Abdalla
Faculty of Medicine, University of Khartoum, Sudan.

Dr. Siham Ahmed Balla
Faculty of Medicine, University of Khartoum, Sudan.

Dr. Mohamed Salah Ahmed Mohamed
Faculty of Medicine, Alneelain University, Sudan.

Dr. Hind Mamoun Behairy
Faculty of Medicine, International University of Africa, Sudan.

Dr. Naiema Abdalla Waqialla Fahal
Khartoum State Ministry of Health, Sudan.

Dr. Dina Ahmed Hassan Ibrahim
Ministry of Higher Education and Scientific Research, Sudan.

Dr. Maha Ismail Mohamed
Faculty of Medicine, Almughtaribeen University, Sudan.

Prof. Ibtisam Ahmed Ali
Faculty of Medicine, International University of Africa, Sudan.

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Evaluation of Outcome of a Rare Presentation of Appendicitis | Chapter 04 | New Insights into Disease and Pathogen Research Vol. 2

Introduction: Acute appendicitis is the inflammation of the vermiform appendix and it is the most common intra-abdominal surgical emergency. Therefore, perforated appendicitis is rarely accompanied by pneumoperitoneum and that apparent rarity of association of pneumoperitoneum and acute appendicitis prompted us to discuss this condition.

Materials and Methods: This retrospective study reviewed all cases of acute abdomen with pneumoperitoneum admitted in King Abdulaziz University Hospital from January 2011 to December 2015. Only cases with acute appendicitis were selected to be in the study, Leucocytic count and C-reactive protein, as well as plain X-ray abdomen in erect position and C.T.scan were reviewed preoperatively.

All demographic data (age, gender), as well as the clinical details which included relevant  investigations results, in addition to the perioperative data (the type of the performed operative procedure, operative time and the hospital stay with reference to the postoperative complications for each patient), all were collected and analyzed by IBM-SPSS version 22.

Results: Pneumoperitoneum due to perforated appendix was found in 7 out of 131 cases in this study (5.3%), with male predominance 6/7, with a mean age of 29.7 years. The documented postoperative complications were pulmonary complications; intra-abdominal pus collection (pelvic and subphrenic) as well as wound dehiscence, all were found post conventional exploratory laparotomy cases.

Conclusion: The study documented the rarity of pneumoperitoneum due to perforated appendix. Therefore, it should be considered as a cause of acute abdomen with pneumoperitoneum, imaging studies were very essential to visualize these cases, Laparoscopic approach provided better outcome than the conventional laparotomy approach.

Author(s) Details

Dr. Ahmed Makki
Department of Surgery, King Abdulaziz University, Saudi Arabia.

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Medication Errors Identification: A Major Source of Evaluating Prescribing Errors in Liver Disease Patients | Chapter 03 | New Insights into Disease and Pathogen Research Vol. 2

Aim: The aim of this study was to retrospectively review the patient profiles with liver diseases in order to determine the frequency of medication errors among patients with liver diseases.

Study Designed: Retrospective study was performed.

Place and Duration of Study: Abbasi Shaheed Hospital (ASH), Civil Hospital (CIVIL) and Dow University Hospital (DUH) Karachi Pakistan, conducted from April 2014 to June 2014.

Methodology: The retrospective study was conducted by evaluating 61 patient profiles. These patients were admitted in three different hospitals of Karachi city mentioned above. Toxic hepatitis or drug-induced liver injury comprises a spectrum of clinical diseases that initiates with mild biochemical abnormalities and extends to acute liver failure. In this study 61patient’s profiles were collected and evaluated. The patients were aged 25 years and above. A quantitative analysis and investigation of clinically significant drug-drug interactions, drug-disease interactions, inappropriate medication, over dose and sub therapeutic dose has been studied. Moreover these patients were suffering from either hepatitis B, hepatitis C, hepatitis E, ascites, jaundice, liver abscess, hepatoma, chronic liver disease (CLD), cirrhosis, hepatic encephalopathy or acute hepatitis.

Results: A total 257 medication errors were observed, out of which 40% (n=102) were drug-drug interactions, 14.5% (n=37) were drug-disease interactions, 37.7% (n=97) were inappropriate medications, 7.05% (n=18) were related to over-dose and 1.17% (n=3) were identified as sub-therapeutic dose errors. The occurrence of different types of medication errors was significantly different among the named hospitals.

Conclusion: It can be concluded that a large number of medication errors in a minimal patient’s profiles were observed. This shows a high percentage of irrational prescribing practice among liver disease patients. Furthermore, there is a need to revise the proper structure of hospital and clinical pharmacies. Additionally, the proper prescribing patterns should be followed via employing computerized physician order entry system (CPOE). The result of our study shows high number of medication errors. The rate of medication errors can be minimized by inclusion of clinical pharmacists in hospitals because pharmacist can play a vital role in the identification and prevention of medication errors and can educate all health care professionals with up-to-date information related to drugs. Implementation of electronic based system like COPE system can be beneficial to minimize the chances of errors and it is also essential to educate the patients about their medications along with Staff orientation/development in order to reduce the possibility of these errors.

Author(s) Details

Prof. Dr. Sumbul Shamim
Department of Pharmacology, Faculty of Pharmaceutical Sciences, Dow College of Pharmacy, Dow University of Health Sciences, Karachi, Sindh, Pakistan.

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Risk Factors for Developmental Dysplasia of The Hip | Chapter 02 | New Insights into Disease and Pathogen Research Vol. 2

Aims: To identify the association between potential risk factors with developmental dysplasia of the hip in neonates.

Study Design: A cross-sectional study.

Place and Duration of the Study: Laboratory of Lifestyle, Division of Health Sciences and Engineering, Campus Celaya Salvatierra, University of Guanajuato Mexico, between June 2014 and February 2015.

Methodology: We include 100 newborns, 36 male and 64 females with age between 4 and 28 days old. Data on birth weight, family history of hip dysplasia, obstetric presentation, mode of delivery, swaddling was obtained. The diagnosis of hip dysplasia hip ultrasonography with Graf technique was confirmed. For association Chi squared and p value, for the effect was calculated Odds Ratio and confidence intervals at 95%.

Results: It was found that obstetric presentation and swaddling were associated with developmental dysplasia of the hip (p <0.05) with OR of 5.32 and 4.91 respectively, and the association was confounded by area of residence with OR adjusted 2.94.

Conclusion: It was conclude that the most important risk factors for developmental dysplasia of the hip in this population were obstetric presentation and excessive swaddling.

Author(s) Details

Dr. Nicolas Padilla- Raygoza
School of Medicine, University of Celaya, Celaya,Mexico.

Silvia del Carmen Delgado-Sandoval
Department of Nursing and Obstetrics, Division of Health Sciences and Engineering, Campus Celaya-Salvatierra, University of Guanajuato, Celaya, Mexico.

María de Lourdes García-Campos
Department of Clinical Nursing, Division of Health Sciences and Engineering, Campus Celaya-Salvatierra, University of Guanajuato, Celaya, Mexico.

Carolina Mendoza-Lara
Division of Health Sciences and Engineering, Campus Celaya-Salvatierra, University of Guanajuato, Celaya, Mexico.

Georgina Olvera-Villanueva
Department of Nursing and Obstetrics, Division of Health Sciences and Engineering, Campus Celaya-Salvatierra, University of Guanajuato, Celaya, Mexico.

Verónica Benítez-Guerrero
Academic Unit of Nursing, Institute of Health Sciences, University Autonomous of Nayarit, Tepic, Celaya, Mexico.

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Extrapulmonary Tuberculosis- A Diagnostic Conundrum! | Chapter 01 | New Insights into Disease and Pathogen Research Vol. 2

Introduction: Tuberculosis continues to be the ninth leading cause of death worldwide. Pulmonary tuberculosis [PTB] being an infectious form of the disease receives greater attention & significance; while, the silent forms of disease like latent tuberculosis infection [LTBI] or extrapulmonary [EPTB] form of disease remains as the most neglected ones for reasons well known. Exact data on the disease burden from developing countries is missing due to the existing poor reporting system by both the patient and health care services.

Aim: To know the burden of the disease in a tertiary care hospital of India. To study the clinical trends in the disease, and the utility of various diagnostic modalities in diagnosis of the same. To identify the Mycobacterial species and perform drug susceptibility test.

Materials and Methods: A cross sectional study was carried out for a period of two years. A total of 147 samples were received and tested for extrapulmonary tuberculosis using a combination of bacteriological, cytological, histological and biochemical techniques to achieve proper diagnosis of EPTB.

Results: Bacteriologically, 26% of the specimens were positive for EPTB. Mycobacterial culture positivity was noted in 18%. Smear by Ziehl Nielsen stain was positive in 9%. Young adults and females predominated the study group and positive cases. A combination of culture media both solid and liquid maximized the yield of Mycobacteria. Lymph node tuberculosis was found to be the predominant type followed by others. Fifteen percent of the strains were found to be resistant to the first line drugs used in treatment of tuberculosis. Cytology and biochemical findings were found to be less specific in diagnosis of extrapulmonary tuberculosis. Rapid immuno chromatographic test called MPT64 Antigen test was very useful for presumptive identification of M.tb complex with reported sensitivity and specificity of 99% and 100%.

Conclusion: Extra pulmonary tuberculosis is seen in a substantial number of the symptomatic patients. Hence, attention should be paid towards its proper and early diagnosis followed by rational management, as if neglected may lead to associated complications and sequalae. Use of combination of media and methods enhances the diagnostic sensitivity. Further research is needed to evaluate specific reasons for why the disease is more common in young adults and females. It is wiser to read cytology and biochemical findings in light of bacteriological results as alone they are less specific. Resistance is emerging to anti tuberculosis drugs even in extra pulmonary form of disease. Hence the use of anti-tuberculosis drugs has to be justified as per the laboratory results for drug susceptibility test.

Author(s) Details

Dr. Sarwat Fatima
Department of Microbiology, Ayaan institute of Medical Sciences & Research Center, Moinabad, Telangana, India.

N. M. Aleemuddin
Department of Pulmonology, Deccan College of Medical Sciences, Hyderabad, India.

F. Fakeha
Department of Pathology, Osmania Medical College, Hyderabad, India.

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