Neonate with intractable seizures and metabolic acidosis: an unusual case of type-1 herpes simplex encephalitis-diagnostic and management challenges

Neonatal Herpes simplex virus [HSV] infection is usually caused by type 2 virus following maternal peripartum genital HSV infection. Type 1 HSV usually affects infants after 3 months of age. Neonatal HSV infection present as skin, eye and mouth disease [SEM disease]; affect the central nervous system [CNS disease] or involve multiple organs [Disseminated disease]. Illustrative case: A full term male baby; birth weight of 3.25 kg, born to a primiparous mother with uneventful intrapartum and postpartum period and normal physical examination. At 20 days of life, the neonate presented with lethargy, poor feeding and later developed generalized tonic-clonic seizures. Initial workup showed metabolic acidosis; neuro-sonogram showed diffuse cerebral edema. Seizures were not controlled initially with intravenous phenobarbitone, phenytoin and pyridoxine. On starting intravenous midazolam baby developed poor respiratory efforts and was intubated. Serum ammonia and lactate levels were mildly elevated. Lumbar puncture attempted after seizure control showed 93 WBCs, 90% lymphocytes, normal glucose and mildly elevated proteins. With possibility of viral encephalitis; intravenous acyclovir was started. EEG showed PLEDS and CSF HSV-PCR detected Type 1 HSV. This case illustrates the nonspecific presentation of HSV infection in the neonatal period without history of HSV in the mother and challenges faced during the management. Early initiation of acyclovir reduces HSV associated morbidity and mortality in neonates

Effects of tobacco use and attitude towards anti-tobacco activities: a cross-sectional study among school students in Ajman, United Arab Emirates

Use of tobacco begins early in childhood and builds up to lifelong habit. The present study determined the knowledge of school students regarding the effects of tobacco and attitude towards anti-tobacco activities. This cross-sectional study was carried out at four schools [Grades IX to XII] in Ajman. A self-administered questionnaire was used focusing on the knowledge regarding tobacco use among adolescents, reasons for initiation, associated health risk, and social problems; previous participation and willingness to participate in anti-tobacco activities. Descriptive and inferential analysis was performed using SPSS 19. 229 male and 182 female students [mean age: 15.6+1.1 years] participated. Grade XII, XI, X, IX students constituted 31.4%, 29.4%, 29.7%, and 9.5% respectively. 328 [79.8%] were aware of the use of cigarettes, shisha, midwakh, chewing and sniffing tobacco among adolescents. About 75% indicated the possible reasons for initiation: to blend with friends, elevate mood, and to deal with family problems [Females more than males p<0.05]. More than 80% were aware of associated health risk and social problems [Females more than males p<0.05]. The social problems stated were problems with family, peer and teachers. As regards the level of health risk, 66.9%, 52.8%, 48.7%, felt that severe risk is associated with cigarette smoking, chewing tobacco, and smoking midwakh respectively. The source of their knowledge included television, internet and newspaper. About 66.2% had advised individuals to quit tobacco; 21.2% participated in anti-tobacco activities. Suggested measures to increase awareness were through media, seminars, workshops and student groups in schools. More than 75% were willing to participate in anti-tobacco activities, and 63.5% interested to give talks on the effects of tobacco. The students possessed positive attitude towards anti-tobacco activities and had knowledge of the health and social effects of tobacco. Active participation of adolescents in anti-tobacco activities can help to root out the problem of tobacco use among adolescents

Rare case of hemophagocytic lymphohistiocytosis: a case report

A two-month old infant was admitted to our hospital with history of fever and cough. He was active and playful with normal systemic examination. He was started on antibiotics because the C-reactive protein [CRP] was high. Over the next few days he deteriorated with persisting fever, altered sensorium and hepatomegaly. Inspite of using third line antibiotics, the CRP kept increasing and the child showed no signs of improvement. A possibility of Hemophagocytic Lymphohistiocytosis [HLH] was considered. Ferritin was high and so the child was referred to a tertiary centre for further treatment. Bone marrow biopsy confirmed the diagnosis of HLH. HLH is a clinical syndrome of hyper inflammation, and uncontrolled and ineffective immune response. It could be primary where genetic mutations have been demonstrated or secondary to infection, malignancy or metabolic condition. Criteria have been laid done for the diagnosis of HLH. This condition should be considered when there is continued deterioration in spite of maximal supportive care

rare case of tyrosinemia presenting with abdominal distension with shock

Tyrosinemia type I is the most severe disease of the tyrosine catabolic pathway resulting from deficiency in fumaryl acetoacetate hydrolase [FAH] leading to elevation of tyrosine in liver, kidney and peripheral nerves. It is characterized by hepatic failure, cirrhosis, renal dysfunction, hepatocarcinoma, and neurologic crisis. The estimated prevalence of type I tyrosinemia worldwide is <1 in 100,000. We present a rare case of tyrosinemia presenting with abdominal distension and shock. A two-month old male child of 2[nd] degree consanguineous marriage was born prematurely and was small for gestation [SGA baby]. She was noted to have neonatal hyperbilirubinemia in the immediate neonatal period. Weight gain remained poor in spite of adequate feeding and supplementation. Persistent abdominal distension was noted, and anti-flatulence drugs were administered for the same, with no improvement noted. X-ray showed gaseous distension of abdomen. Tests for hypothyroidism and Hirschisprung disease were normal. The baby had persistent vomiting; ultrasonography was normal. After one month she developed cold clammy extremities with thread pulse, poor urine output persistent vomiting with significantly distended abdomen. Investigations revealed E-coli positive UTI for which appropriate antibiotics were started. However, the condition of the baby deteriorated and baby developed metabolic acidosis which was initially attributed to resistant E-coli sepsis. On investigating further, an elevated level of alpha fetoprotein [AFP] was noted. The other reports revealed significant coagulopathy and the algorithmic work up revealed tyrosinemia. Tyrosinemia type 1 should be differentiated from other causes of hepatitis and hepatic failure in infants

Knowledge of effects of drinking alcohol and attitude towards anti-substance use campaign among school students in Ajman, UAE

Alcohol consumption is an important epidemiological problem affecting health and is on a rise among the adolescents. Knowledge about effects of alcohol consumption and attitude towards anti-substance use campaign among school students in Ajman, UAE was assessed. A population-based cross-sectional study was conducted among students in four schools in Ajman, grades IX-XII. A pre-tested, close-ended questionnaire relating to knowledge of health and social effects of alcohol and attitude towards anti-substanceuse campaign was administered to the students. Chi-square test was applied to determine association between variables using SPSS.19. 411 students between 15-17 years of age participated [Male students constituted 55.7%, mean age: 15.65 +/- 1.1 years], 375 [91.2%] students indicated alcohol consumption was harmful that. 288 [70.1%] were aware of the use alcohol among school students. Severe health-associated risk was attributed to drinking alcohol by 63%. About 334 [81.3%] responded that social problems were associated with alcohol consumption. Common social problems mentioned were problems with parents, friends, and teachers, and the other effects included poor academic performance. Female students were more aware of the reasons for initiation and health and social problems than the males [p<0.05]. Television, internet and newspaper constituted the most common source of their knowledge. About 66% had advised individuals to quit the habit; about 21.2% students had participated in anti-substance use campaigns. Media. Seminars and workshops in schools were the possible ways suggested for increasing awareness. 81% were willing to organize and participate in anti-substance use campaign in their school. High proportions of students were aware of the harmful effects of alcohol and had positive attitude towards anti-substance use campaigns that are necessary to reduce unhealthy behaviors among adolescents

dilemma of polypharmacy: nurses perceptions of health care professionals' contribution in polypharmacy in Ajman, UAE

Health care professionals do not pay sufficient attention to polypharmacy which is a slowly growing phenomenon. Physician-related factors which contribute to polypharmacy include the use of multiple medications in management of co-morbid illnesses, symptomatic treatment, and the treatment of the adverse effects of drugs. The present study aimed to identify nurses' perceptions of health care professionals' role in polypharmacy. This cross sectional study was conducted among nurses in Gulf Medical College Hospital and Research Centre, Ajman, United Arab Emirates from March to May 2011. A structured self-administered close-ended pilot-tested questionnaire was used as a study instrument. Association between socio-demographic characteristics and items were analyzed using Chi-square test and p<0.05 was considered statistically significant. A total of 92 female and 13 male nurses were included. The most common physician factors identified by nurses were prescribing medications for every symptom [78 [74%]], not conducting medication review [74 [70.5%]], not simplifying medication regimens [62 [59%]] and the influence of pharmaceutical companies 58 [55.2%]. Regarding the pharmacist related factors, nurses opined that inadequate pharmacist-doctor communication [71 [67.6%]] and lack of effective patient counseling [65 [61.9%]] influence polypharmacy. On comparing physician related factors between nurses of different years of experience and also between the genders, prescribing medications for every symptom, and not conducting a medication review with the patient scored the highest in all the groups. A higher number of male nurses [statistically significant at p<0.05] in comparison to female nurses opined that inadequate knowledge of clinical pharmacology [7 [53.8%]], and lack of time to review medications [6 [46%]] contributed to polypharmacy. Healthcare professionals need to be aware of the increase in polypharmacy. Regular assessment of prescribed medications should be carried out to avoid the administration of inappropriate drugs

Qualitative insights into the nurses' knowledge and experience of polypharmacy in Ajman, UAE

The specter of polypharmacy is an ever increasing problem. Nurses play a functional role in assisting patients to understand the dangers of polypharmacy. Nurses' knowledge and their experience of polypharmacy in their nursing practice are determined in the study. Nurses working in Gulf Medical College Hospital and Research Centre, Ajman, United Arab Emirates participated in this cross-sectional study during March to May 2011. A self-administered structured questionnaire was used to obtain data. Chi-square test was performed to find the association between sociodemographic characteristics and the variables under study using PSAW software. A total of 105 nurses [92 female; 13 male] participated. The definition of polypharmacy was correctly identified by only 45.7% nurses. Elderly was identified as the most common age group in whom polypharmacy is practiced. 66.7% of the nurses acknowledge their non-awareness of rational and irrational polypharmacy. Non-awareness of rationality of polypharmacy was similar between genders and all three groups of clinical experience. The common reasons given for practice of polypharmacy included use of multiple drugs to manage multiple disease conditions. 66% identified the elderly population as the common age group exposed to polypharmacy, while 22.9% nurses opined that it is common in all age groups. Working knowledge of rational polypharmacy is essential among the nursing community to reduce the practice of polypharmacy

Nurses' views on patient factors associated with polypharmacy in Ajman, UAE

The specter of polypharmacy is an ever-increasing problem faced by the healthcare professionals. Nurses need to be aware of the several patient related factors that contribute to polypharmacy. This study evaluated the views of nurses regarding patient-related factors associated with polypharmacy. Nurses working in Gulf Medical College Hospital and Research Centre in Ajman, United Arab Emirates participated in the study during March to May 2011. The fourteen item questionnaire regarding patient factors was used as the research tool. Association between socio-demographic characteristics and items were analysed using Chi-square test [p<0.05 considered statistically significant]. Of 105 nurses included, 92 were females and 13 males. The most commonly identified patient factors were lack of awareness of polypharmacy [94.3%], seeing multiple physicians [82.9%], use of self medications [79%], ordering of refills without follow up [78%], and not reporting all the medications they are currently on [78%]. On comparing male and female nurses, the lack of awareness of polypharmacy was the most commonly stated patient factors by both groups. Male nurses gave a higher ranking for increased awareness of treatment options among patients in comparison to female nurses. Nurses with 5-10 years of experience had given a high score for ineffective doctor-patient communication and increased awareness of treatment options among patients in comparison to other groups. Nurses are aware of the patient factors contributing to polypharmacy. They should be trained to implement this knowledge in reducing polypharmacy especially while counseling patient regarding medications

Reducing the burden of multiple medications: nurses' views on strategies to prevent polypharmacy in Ajman, UAE

Polypharmacy is often used to imply a negative situation involving unnecessary or inappropriate use of medications. Nurse can contribute significantly in reducing the number of medications prescribed. The study was planned to identify the nurses' opinions on different strategies that could be used to prevent polypharmacy. This cross section study was conducted during March to May 2011 among nurses who are working in a tertiary care hospital in Ajman, UAE. In addition to socio-demographic characteristics the pilot-tested self-administered, questionnaire contained 20 items to collect information. Chi-square test was used to compare percentages by socio-demographic characteristics using PSAW software. The significance level for all analyses was p

Nurses opinion on the negative attributes of polypharmacy in patient safety, in Ajman, UAE

The negative attributes of polypharmacy should be known by nurses while reviewing and administering medications. We studied the nurses' opinion on the negative attributes of polypharmacy. Nurses working in a tertiary care teaching hospital participated in this cross-sectional study, conducted over 3 months, by responding to a self-administered questionnaire. Chi-square test was used to analyze association between socio-demographic characteristics and items in the study. A value of p<0.05 was considered statistically significant. Increased drug interactions scored the highest [98.1%], followed by increased adverse drug effects [81.9%] among the negative effects of polypharmacy. No difference was observed in the opinions between male and female nurses or among nurses of varying duration of nursing experience. Nurses with 5-10 years of experience opined increase in non-compliance to prescribed medication regimen and increase in financial burden also as negative attributes. There is a lacuna in the knowledge about ill effects of polypharmacy among nurses, which can be filled in by Continuing educational programs and workshops