Factors Associated with GOLD Staging and BODE Index in Patients with Chronic Obstructive Lung Disease in Elderly

Background:We aimed to assess the clinical profile of Chronic obstructive pulmonary disease (COPD) occurring in elderly patient according to GOLD criteria/BODE index and to study the association of COPD with various risk factors in an elderly patient. Methods: We designed a hospital based observational study, in which we included patients with COPD who are elderly and admitted at the Lokmanya Tilak Municipal Medical College and Hospital, Mumbai from January 2015 till July 2016. After obtaining approval of the institutional ethics committee, all the eligible patients were interviewed for socio-demographic variables, clinical history and examination and risk factors for COPD. Post- bronchodilator spirometry and imaging studies were performed on the study patients, based on which patients were classified as per the GOLD criteria and BODE index. Associations between various risk factors and severity of pulmonary function impairment and prognosis was analysed. Results: During the study period 50 patients were included in the study. Body mass index and two dimensional echocardiography findings of pulmonary artery hypertension were found to be significantly associated with the staging of pulmonary function according to GOLD staging criteria. Additionally, statistically significant association between BODE index and smoking index, body index and two dimensional echocardiography findings of pulmonary artery hypertension (p value less than 0.01, 0.01 and 0.05 respectively) was found. We found higher creatinine levels, leucocyte count and acute on chronic type 2 respiratory failure to be significantly associated with death. Conclusion: Patient variables have a strong association with severity and prognosis of COPD.

Signaling pathway involved in Rheumatoid Arthritis: target for new therapeutic interventions

Rheumatoid arthritis is categorized as a systematic autoimmune disease which causes chronic disabilities exclusively in bones that are aligned with synovium. RA etiology is still unknown but previous studies have coined that several number of factors play a significant role e.g. environmental and genetic factors. Cellular signaling pathways orchestrate the inflammatory response that regulates various cellular functions like cellular progression, proliferation, death and secretion of signaling molecules [pro and anti inflammatory cytokines] in response to genetic and environmental stimuli. These regulatory pathways are tightly controlled and naturally activated by ligands that attach to their respective receptors on the cell surface. In diseased state, these signaling pathways escape the normal control mechanisms resulting in intensification of cytokines and chemokines, transcription factors and mediatory proteins that disrupt normal cell processes and might bring about auto-destructive consequences such as in the case of rheumatoid arthritis. The review highlights multiple levels of targeting molecules in signaling pathways that may be potential diagnostic markers and also attempts to underline potential therapeutic targets

Sensitive, resistant and multi-drug resistant Acinetobacter baumanii at Saudi Arabia hospital eastern region

Abstract: Since the Physicians start use of antibiotics long ago with un-notice drug resistance. However actual problem was recognized about 85 years ago. Antibiotic resistant and Multi-drug resistant bacterial strains are at rise throughout the world. It is physicians and researchers to take scientific research based appropriate action to overcome this ever-spreading problem.. This study is designed to find out sensitive [S], resistant [R] and multi-drug resistant [MDR] Acinetobacter baumanii strain along with other isolates in the resident patients of Eastern Region of Saudi Arabia. Pseudomonas aeruginosa is excluded from other gram-negative organisms isolated from different sites as it will be dealt separately. This study is based in was retrospective observations designed to collect data of different stains of Acinetobacter baumanii with reference to their Sensitivity [S], Resistance [R], Multi-Drug Resistance [MDR] along with other Gram negative isolated from different sites [from 1st January 2004 to 31st December 2011] at King Abdulaziz Hospital located Eastern Region of Kingdom of Saudi Arabia [KSA]. All necessary techniques were used to culture and perform sensitivity of these isolates. There were 4532 isolates out of which 3018 [67%] were from patients. Out of Acinetobacter baumanii infected were 906 [20%] while other 3626 [80%] isolates were miscellaneous. Numbers of patients or cases were 480 [53%] out of 906 isolates and numbers of patients or cases in other organisms were 2538 [70%] out of 3626 isolates. Acinetobacter baumanii infected patients 221 [46%] were male and 259 [54%] were female and the male and female ratio of 1:1.2. In other organisms this male female ratio was almost same. There was steady rise in number of patients and the hence the isolates from 2004 to 2011. Majority of the bacterial strains were isolated as single organism but some were isolated as double or triple or quadruple or more organisms from different sites. Sensitive, Resistant and Multi-Drug Resistant Acinetobacter baumanii have been isolated from different sites. The other Gram negative isolates included Escherichia coli, Klebsiella pneumoniae, Proteus vulgaris, Klebsiella oxytoca, Serratia marcescens and Stenotrophomonas maltophilia. A significant rise in R and MDR but there is rise in R and MDR Acinetobacter baumanii Strains has been interceded other isolates. It is important to adopt proper and sustainable policies and guideline regarding antibiotics prescription and used. We should also check our infection control practices in our hospital or healthcare settings. We should start antibiotics stewardship in our hospital in order to reducing or overcoming antibiotics Resistant [R] and Multi-Drug Resistant [MDR] strains prevalence.

Screening of renal and urinary tract problems in pre-school children and their relationship with parasitic infection

This cross sectional study was done for pre-school children households of an Egyptian village with evaluation of possible relationship between urinary tract problems detected and parasitic agents especially those causing diarrhea. A systematic random sample of houses was selected. Urine was examined using microscopic examination and dipstick techniques Stool was examined by direct smear and standard Kato-Katz techniques. The history taking included family history of congenital anomalies and relative parents; clinical and ultrasonographic examinations were performed in presence of mothers. Results showed that, a high percentage of children had positive urinary findings [pyuria and haematuria were found in 40% of children while 80% had crystaluria]; females had more problems than males. Microscopic examination was more superior to dipstick testing in detecting urinary problems except protein in urine. Pin worm infection showed positive relationship with urinary findings especially with males [O.R. 1.7 for pynria and 2.1 for haematuria]. Children having parasites causing diarrhea had higher percentage of pyuria than free children. Ultrasonographic examination showed four positive cases including congenital anomalies. Screening programs for preschool children should be adopted for early detection of urinary tract problems as urinary tract infection [UTI] and congenital anomalies especially in villages. Microscopic examination is the technique of choice for screening programs. Selected dipstick testing for proteinuria could be used. Screening for UTI in diarrheic children and those having pin worms or other parasites should be considered by health care personnel

Cardiac myxomas clinical spectrum and outcome

To describe the characteristics and outcome of patients with cardiac myxomas. A case series. The Aga Khan University Hospital [AKUH], from 1999 to 2004. All patients diagnosed and managed as having cardiac myxomas at AKUH, during a period of six years [1999- 2004] were included. Data was collected by reviewing clinical records. Follow-up data was collected from the clinical records and by a telephone interview where required. Out of 15 patients who were diagnosed to have cardiac myxomas, complete information was available in 14 patients. There was a female predominance [64%] with a mean age of 47 years. About two-thirds [71%] had symptom of dyspnoea. Half of the patients [50%] had neurological symptoms at presentation. Constitutional symptoms were present in 36% of patients. About two-third of patients [71%] had positive findings on cardiac auscultation. None of the patients had any rhythm abnormalities on the ECG. Diagnosis was made by transthoracic echocardiography in all patients. All of the tumors were located in the left atrium, and majority [64%] were attached to the interatrial septum. All patients were advised surgical treatment, however, only 8 [57%] were operated upon. Outcome was good in those who were operated upon, with no peri and postoperative mortality. Cardiac myxomas are a rare, but potentially curable form of heart disease. They occur in a wide range of age groups with a female predominance. Dyspnea is the most common clinical feature followed by embolic complications. Left atrium is the most common site of location. Surgical excision is a safe and effective procedure

cross sectional study of hepatitis B, C, some trace elements, heavy metals, aflatoxin B1 and schistosomiasis in a rural population, Egypt

Chronic liver diseases are disastrous to health. Many factors are associated with their prevalence, hence endemicity. These are mainly infectious, parasitic and toxic. A survey was conducted in a village south to Cairo. Large industries concerned with iron and steel industry, metals smelting, cement manufacturing and electric station were located north to the village. A systematic random sample of houses was selected. All individuals inside the houses were invited to share in the study. Sample size was 84 individuals. Hepatitis markers were done [HBsAg and anti-HCV antibodies]. The levels of some heavy metals were assessed; which were lead, mercury, arsenic, aluminum, manganese, nickel, chromium and cadmium. Levels of some trace elements were assessed. These were copper, iron, selenium and zinc. Aflatoxin B1 was assessed in serum. Assessment of schistosomal circulating antigen and antibodies was carried out. Abdominal ultrasonograghy was done to assess liver condition. Univariate logistic regression analysis was done to assess the association between studied variables and HBsAg or anti-HCV sero-positive subjects. The association between studied variables and bilharzial or fatty liver, diagnosed by ultrasonography, were also assessed. The univariate logistic regression analysis revealed odds ratios at the following results. For HBsAg sero positive subjects, aflatoxin B1, lead, chromium and schistosomal antigen and antibodies were higher than negative ones where odds ratios were; 6.2, 1.6, 1.6, 1.6 and 1.7, respectively. None of the variables showed statistically significant difference. For anti-HCV antibodies sero-positive subjects, aflatoxin Bi and chromium had the highest odds ratios among the studied variables, [odds ratios were 2.5 and 2.4, respectively]. Bilharzial liver showed higher significant positivity of anti-HCV antibodies and insignificant decreased level of zinc than negative ones [odds ratios were 7.2 and 4.5, respectively]. Fatty liver cases showed higher statistically significant positivity of anti-HCV antibodies and chromium than negative ones. Odds ratios were 8.0 and 7.1, respectively. Statistically significant lower level of aflatoxin B1 was shown in fatty liver than normal liver subjects. Multivariate logistic regression analysis for fatty liver showed that only anti-HCV antibodies sero-positivity had statistically significant odds ratio in comparison to chromium level and aflatoxin B1. It is concluded that some heavy metals, and Aflatoxin B1 had a definite association with liver diseases in the area under study. Having anti-HCV antibodies had a relation with fatty liver and with bilharzial liver more than having HBsAg. It is recommended that environmental management to factories nearby the village is urgently needed to decrease exposure to heavy metals. Prevention of hepatitis infection and aflatoxin exposure through different means is also recommended, other wise health care authorities would be confronted with unusual cases of HCC in the nearby future

KAP study among staff and student nurses about infection control in Theodor Bilharz Hospital

The aim of this study is to assess the knowledge, attitude and practice of staff and student nurses in Theodore Bilharz Research Institute Hospital towards simple protective measures such as: Hand washing practices, recapping of syringe needles after use, and their awareness of Hepatitis B and C viruses prevention and control. A questionnaire is designed and distributed to all student nurses in the school [4l students out of 45], and to all staff nurses working in the hospital [39 nurses out of 50], with a total of 80 out of 95. Scoring system is used for data analysis. The overall scoring of KAP for the three items studied is below 80%, which means that they really need health education about these items. Thus, it is very important to create public awareness in the hospital community and among nurses about the concept of infection control. This could be done through formal and informal instructions and by organizing regular courses and posters. It is very essential to provide safe disposal of syringe needles in special containers, have facilities for hand washing during work and apply HB vaccine for nurses working in the hospital. Meanwhile, a highly motivated behavior should be enabled and reinforced through realization of the regulatory and organizational factors for better implementation arrangement, which all supplement the educational intervention directed to change rather than just planning