African Journal of Internal Medicine

African Journal of Internal Medicine ISSN 2326-7283 Vol. 5 (5), pp. 428-432, May, 2017. © International Scholars Journals

Case Report

Vitamin C deficiency and purpuric hyperkeratotic skin lesions in the elderly: What relationship? A clinical case report

Binan Yves^*, Konan N’guessan, Acko Ubrich, Kaba Ibrahima, Bita Darius, Adom Hilaire And Toutou Toussaint

 Department of Internal Medicine and Geriatrics, University Hospital Center (UHC)-Treichville, Abidjan- Cote d’Ivoire.

*Corresponding author Email: [email protected]. Tel/fax : +22507903060//+22549344288  

Accepted 22 March, 2017

Abstract

Gingival bleeding and dental heaving during scurvy are the most reported in the literature. However nonspecific isolated purely cutaneous manifestations due to hypovitaminosis C are not uncommon. Their incidence increases with age related decrease in microcirculation of the skin causing trophic disorders observed in the skin extremities in the elderly. We report the case of an elderly vascular poly 73 years whose examination of the extremities showed purpuric hyperkeratotic lesions. The various complementary examinations for different diagnostic hypotheses have helped to spread a disease of cholesterol emboli, systemic vasculitis and retain low vitamin C after dosing incidentally the serum ascorbic acid. The disappearance of these skin lesions after two weeks of supplementation with vitamin C orally confirms the diagnosis. The appearance of mucocutaneous lesions in geriatric subject to high risk of atherosclerosis and living in unfavorable socio-economic conditions must take the clinician to look for low vitamin C and titrate the serum ascorbic acid.

Keywords: Hypovitaminosis C, Serum ascorbic acid, purpuric hyperkeratotic lesions, elderly atherosclerosis.

African Journal of Internal Medicine ISSN 2326-7283 Vol. 5 (4), pp. 412-421, April, 2017. © International Scholars Journals 

Full Length Research Paper                                    

QRS fragmentation as a prognostic test in acute coronary syndrome

Tarek M Abdelrahman

MD Cardiology Department, Minia University Hospital, Egypt.

*Corresponding author. E-mail:[email protected].

Accepted 30 April, 2013 

Abstract

Among several invasive and non-invasive tests for risk stratification of acute coronary syndromes (ACS), fewer markers can be utilized in clinical practice. Our rationale is to validate the use of QRS-fragmentation as a promising bed-side test for assessment of prognosis in those patients. Collection of two-hundred and twenty patients with ACS was done in two years (from January 2011 till January 2013). Significant organic valve disease and QRS duration ≥120 ms as well as patients with permanent pacemakers were excluded. Patients were subjected to full clinical examination, ECG and Echocardiography in the first day of admission followed by diagnostic coronary angiography before discharge and a nuclear study was done for Randomized sample from each group. 12-leads ECG revealed fragmentation of QRS in 74 patients and 146 patients with no QRS fragmentation. Localization of the infarct site revealed NS difference between percentages in both groups. Echocardiography revealed a significant deterioration of LV functions in group-A than group-B. Also, MR jet area was significantly higher in group-A. Coronary angiography revealed severer lesions in group-A more than group-B. Nuclear study revealed higher percentages of irreversible scars in group-A (30%) and higher reversibility in group-B (80%). In-hospital Occurrence of complications from ACS revealed a significant higher incidence of MACE in group-A. Presence of fragmented QRS in surface ECG during ACS represents myocardial scar or fibrosis and reflects the severity of coronary lesions and a correlation between fQRS and depression of LV function is established. Indeed, occurrence of MACE is suspected.

Key words: Fragmented QRS (fQRS), acute coronary syndrome (ACS),major Adverse Cardiac Events (MACE).

African Journal of Internal Medicine ISSN 2326-7283 Vol. 5 (5), pp. 422-427, May, 2017. © International Scholars Journals

Full Length Research Paper

Intestinal parasitosis in school age children in Lalitpur District of Nepal

Sarmila Tandukar¹, Shamshul Ansari²*, Nabaraj Adhikari³, Anisha Shrestha³, Jyotshana Gautam³, Binita Sharma³, Deepak Rajbhandari⁴ and Jeevan Bahadur Sherchand¹

¹Public Health Research Laboratory, Institute of Medicine, Nepal.

²Department of Microbiology, Chitwan Medical College, Bharatpur, Nepal.

³Kantipur College of Medical Science, Sitapaila, Kathmandu, Nepal.

⁴Kritipur Hospital, Kathmandu, Nepal.

*Corresponding author. E-mail: [email protected].

Accepted 4 December, 2012

Abstract

Enteric parasites are the most common cause of parasitic diseases, and they cause significant morbidity and mortality, particularly in developing countries like Nepal. This study was conducted to estimate the intestinal parasitic infestations among school children in Lalitpur district of Nepal. A total of 1392 stool samples were collected from school children selected from two governments, two private, one community and one slum school from the same district. The stool samples were examined for evidence of parasitic infections by direct microscopic examination and further confirmed by concentration and flotation methods, for the coccidian parasite modified ZN staining was performed. Prevalence of intestinal parasites was 16.7%. The highest prevalence was seen with Giardia lamblia (7.4%) followed by Entamoeba histolytica (3.4%) and Cyclospora cyantenenis (1.7%). Highest number was seen in male child (17.8%) and the highest prevalence of parasites were seen in age between 11 to 15 years that is, 7.3%, whereas highest prevalence was seen in government school (12.2%). The results designated that intestinal parasitic infestation among school children in the study area is mainly water-borne. The burden of parasitic infestations among the school children, coupled with the poor sanitary conditions in the schools, should be regarded as an issue of public health priority.

Key words: Entamoeba histolytica, Giardia lamblia, Intestinal parasite, Nepal, school children.

African Journal of Internal Medicine ISSN 2326-7283 Vol. 5 (4), pp. 406-411, April, 2017. © International Scholars Journals

Full Length Research Paper

In vitro activity of antibacterial drugs upon microorganisms from patients with chronic otitis media

¹Özalkan Özkan*, ²Hakan Uslu, ²Dilek Vural Keleş, ¹Fatih Bingöl, ¹Murat Yaşar, ¹Harun Üçüncü*

¹Ataturk University, Faculty of Medicine, Deparment of Otorhinolaryngology, Erzurum, Turkey, ²Ataturk University, Faculty of Medicine, Deparment of Microbiology, Erzurum, Turkey.

*Corresponding author E-mail: [email protected]

Tel:04425111530, Fax:04422361301

Accepted 12 May, 2014

Abstract

This study was conducted to generate microorganisms isolated from cultures of ears taken from the patients diagnosed to have chronic otitis media and determine and compare the in vitro effects of different antibiotics on these microorganisms. Between June 2009 and October 2010, 127 ear cultures were taken from 100 patients who applied to the Department of Otolaryngology of Ataturk University Faculty of Medicine Hospital diagnosed to have chronic otitis media in the otolaryngological investigation. Antimicrobial susceptibility of isolated strains was determined by the disc diffusion method according to the CLSI criteria. From the cultures investigated, 277 (6 ferment and 16 fungus) microorganisms were generated. Among the isolated pathogen microorganisms, pseudomonas spp. (24,91%), staphylococcus spp (13,00%), proteus spp. (5,05%) were the three most frequently isolated pathogen agents. 4 Peptococcus spp. (1,44%) and 3 Peptostreptecoccus spp. (1,08%) multiplied and it was observed that there was 2,52% anaerobic reproduction among all microorganisms. It was also seen that Pseudomonas spp. strains were more susceptible to gentamicin (97,1%), imipenem (94,2%), amikacin (84,1%) and ciprofloxacine (78,3%). In the study, vancomycine, teicoplanin, telithromycin and linozolidin were found to be the most effective antibiotics for all staphylococcus. It was seen that proteus spp. strains were more susceptible to gentamicin (92, 9%), ciprofloxacin (%92, 9) and piperacillin (92, 9%). In the antimicrobial treatment required to reach effective outcomes in the treatment of patients with chronic otitis media, it is important to monitor the frequency of effective microorganisms and their rates of resistance to antimicrobial agents.

Keywords: Chronic otitis, antibiogram, microorganism, in vitro, antibacterial.

African Journal of Internal Medicine ISSN 2326-7283 Vol. 5 (3), pp. 394-405, March, 2017. © International Scholars Journals

Full Length Research Paper

Addition of clopidogrel versus cilostazol in acute ischemic stroke patients while on aspirin therapy

¹Mira M Salama, ¹Osama A Badary, ¹Manal H ElHammamsy, ²Mohammed A Saleh*, ³Azza A Abdel-Aziz, ⁴Mona M Zaki and ⁴Manal Shams

¹Department of Clinical pharmacy, Faculty of Pharmacy, ²Department of Cardiology, Faculty of Medicine, ³Department of Neurology, Faculty of Medicine, ⁴Department of Clinical Pathology, Faculty of Medicine, Ain Shams University, Cairo, Egypt.

*Corresponding author E-mail: [email protected]

Tel.: 01222124031

Accepted 15 April, 2014

Abstract

Antiplatelet therapy is the cornerstone for the secondary prevention in acute ischemic stroke. Aspirin was considered first-line therapy for secondary prevention in patients with atherothrombotic stroke. However, several studies actually found that aspirin alone did not significantly regulate platelet activation or aggregation in acute ischemic stroke. Thus, a rational approach, to augment this relatively weak inhibitory effects, is to combine it with an anti-platelet agent with a different mechanism of action. This study compared the efficacy and safety of dual antiplatelet therapy of aspirin and clopidogrel versus aspirin and cilostazol in non-cardioembolic stroke patients who were on current aspirin therapy admission. 60 patients with acute ischemic stroke were randomized to receive either aspirin (162 mg/d) plus clopidogrel (75 mg/d) or aspirin (162 mg/d) plus cilostazol (200 mg/d)for six months. The antiplatelet effect of dual therapy was monitored by measuring P-selectin and PAC-1 expression before and after 7days of therapy. The clinical efficacy was assessed using National Institute of Health Stroke Scale and modified Rankin Scale. The composite clinical endpoint (death, recurrent stroke, hemorrhagic complications, hemorrhagic transformation), was used to assess the safety of the two treatment strategies. Both regimens were similarly effective in significantly reducing P-selectin and PAC-1 expressions in the acute phase of ischemic stroke. Patients on both regimens showed a significant improvement in the neurological and functional outcome during the hospitalization period with no significant difference. A non significant higher incidence of hemorrhagic complications and recurrent stroke was encountered among patients on aspirin plus clopidogrel therapy than those on aspirin plus cilostazol therapy. Dual antiplatelet therapy of either aspirin plus clopidogrel or aspirin plus cilostazol was effective in improving the therapeutic outcomes of patients admitted with acute ischemic stroke while on current aspirin therapy.

Keywords: Clopidogrel, cilostazol, ischemic stroke, platelet, P-selectin, aspirin therapy. 

African Journal of Internal Medicine ISSN 2326-7283 Vol. 5 (2), pp. 389-393, February, 2017. © International Scholars Journals

Full Length Research Paper

Current evidence on the association between MMP-7 (-181A>G) polymorphism and digestive system cancer risk

Pan Ke, Zhong De Wu, Hua Song Wen, Miao Xiong Ying, Huo Cheng Long, Liu Guo Qing*

Department of General Surgery, Xiang-Ya 2nd Hospital, Central South University, Chang-Sha, Hunan Province, China.

*Corresponding author E-mail: [email protected]. Tel.: 86-022-23340123-2071

Accepted 12 July, 2013

Abstract

The matrix metalloproteinase (MMPs) can degrade various components of the extracellular matrix and its functional genetic polymorphisms may contribute to genetic susceptibility to many cancers. Up to now, the association between MMP-7 (-181A>G) and digestive system cancer risk remain inconclusive. To better understand the role of MMP-7 (-181A>G) genotype in digestive cancer development, we conducted this comprehensive meta-analysis encompassing 3,518 cases and 4,596 controls. Overall, the MMP-7 (-181A>G) polymorphism was associated with higher digestive system cancer risk in homozygote comparison (GG vs. AA, OR=1.21, 95% CI = 1.12-1.60) and dominant model (GG/GA vs. AA, OR=1.16, 95% CI =1.03-1.46). In subgroup analysis, this polymorphism was significantly linked to higher risks for gastric cancer (GG vs. AA, OR=1.22, 95% CI = 1.02-1.46; GA vs. AA, OR=1.82, 95% CI =1.16-2.87; GG/GA vs. AA, OR=1.13, 95% CI =1.01-1.27; GG vs. GA/AA, OR= 1.25, 95% CI = 1.06-2.39. We also observed increased susceptibility of colorectal cancer and ESCC in homozygote comparison (OR = 1.13, 95% CI = 1.06-1.26) and heterozygote comparison (OR =1.45, 95% CI = 1.11-1.91) respectively. In the stratified analysis by controls, significant effects were only observed in population-based studies (GA vs. AA, OR=1.16, 95% CI=1.08-1.50; GA/AA vs. GG, OR=1.10, 95% CI=1.01-1.72). According to the source of ethnicity, a significant increased risk was found among Asian populations in homozygote model (GG vs. AA, OR=1.40, 95% CI=1.12–1.69), heterozygote model (GA vs. AA, OR=1.26, 95% CI=1.02–1.51), and dominant model (GG/GA vs. AA, OR=1.18, 95% CI=1.08–1.55). Our findings suggest that the MMP-7 (-181A>G) polymorphism may be a risk factor for digestive system cancer, especially among Asian population.

Keywords: MMP-7, polymorphism, digestive cancer, meta-analysis.