Current Trends in Medicine and Medical Research Vol. 5

Enhanced secretion of fluid in starvation has been proposed to worsen any fluid secretion that is already occurring after exposure of the intestine to enterotoxins. The evidence for this is that historical accounts of imposed fasting in civil or military circumstances are associated with fatalities that arise from secretory diarrhoeal disease. In addition, there is also experimental work apparently showing that secretion is enhanced during short term starvation. In experimental animals exposed to fasting and bacterial enterotoxin, the short-circuit current increase on toxin exposure, assumed to represent fluid secretion, is always greater in the animal intestine exposed to E. coli heat stable STa enterotoxin.

Attention is drawn to the fact that human volunteers in a laboratory setting do not develop diarrhoea on fasting. They do develop a reduction in circulating blood volume consistent with lower than usual blood pressure and hypovolaemia. More detailed examination of the well documented historical accounts of sieges and civil forms of enforced starvation confirms the cardiovascular changes but evidence of secretion i.e. diarrhoea, only occurs when contaminated water is exploited or is the sole source of fluid and personal hygiene is problematical. In human situations in which salt is provided, the incidence of diarrhoeal disease is intermittent but with salt deprivation, the incidence increases. Polydipsia is a consistent feature of persistent starvation and it can be assumed that this is a response to the hypovolaemia.

The evidence from short-circuit current studies in fasted experimental animals is reviewed. A close examination of these studies indicates that increases in short-circuit current are unlikely to rep-resent chloride ion section. An alternative explanation is given of enhanced but electrogenic sodium ion uptake in response to the shrinkage in blood volume which cannot be restored by drinking water alone. Evidence from isotope studies has shown that fasting in animals increases sodium ion uptake as well as short-circuit current, making it likely that fasting causes electrogenic sodium ion absorption. Earlier data on the effect of diuretics makes it likely that what has been studied is the involvement of compensatory electrogenic sodium ion absorption and its interruption by certain diuretics. The recent siting of the NKCC2 transporter in the intestinal brush border makes this a viable alternative explanation for the changes in ion currents seen in starvation. There are therefore no compelling reasons for assuming that fasting enhances secretion in man or in animals or that bacterial enterotoxins cause secretion that is exacerbated by starvation.

Background: Albeit not life threatening, symptoms of irritable bowel syndrome (IBS) interfere with routine activities and compromise the quality of life (QOL). With the exception of one survey on the prevalence of IBS among students in Malaysia a decade back, there are no other reports. QOL in IBS is yet to be investigated in this region.

Objective: To determine the prevalence of IBS and its impact on QOL among students at a Malaysian medical university.

Methodology: A cross-sectional, questionnaire based, self- reported study was conducted among 1104 students. The IBS-QOL questionnaire based on Rome III criteria, and a demographic questionnaire were used.

Results: The overall prevalence of IBS was found to be 45.3%, with a female preponderance of 49.8%. It was also found to be predominant among Chinese 55% and physiotherapy students 61.7%. IBS Mixed type (IBS-M) was found to be common among all students (78.6%). The mean score for QOL for all IBS symptom positive students was 74.2±22.3. 

Conclusion: The overall prevalence of IBS has escalated, particularly in Chinese, females and physiotherapy students with IBS-M type being the commonest.  Chinese, IBS-D type and those with low-grade symptom severity enjoy a better QOL than others. Considering the imprint left by IBS on the QOL, educational institutions have to introduce curriculum reforms and encourage physical activity among students.

Inhaled bronchodilators with or without inhaled steroids (IGCs) are the mainstay of pharmacological treatment for stable obstructive airway diseases, including beta₂-agonists and muscarinic antagonists. Long-acting muscarinic antagonist bronchodilators (LAMA) and long-acting β₂-agonists (LABA) are the treatment of choice for moderate to severe chronic obstructive pulmonary disease (COPD). Also some studies have demonstrated the benefit of LAMA in the treatment of difficult-to-control asthma and the potential use in asthma-COPD overlap (ACO). Control of airway tone in health and disease states, cholinergic and adrenergic receptors, signaling, molecular biology of mediators, and airway muscle contraction / relaxation mechanisms are reviewed concisely and as they may be handled pharmacologically. Subsequently, the evidence of the role of the LABA / LAMA combination in the aforementioned entities, their complementary mechanisms of action and other alternative mechanisms of action as well as potential deleterious effects is discussed.

Purpose: Chronic non-specific low back pain (cNSLBP) is quite common as seen every day in clinics. Therefore, we assessed the effectiveness of spinal manipulation (High-Velocity Low-Amplitude Thrust) on segmental instability, pain sensitivity and quality of life among patients with chronic non-specific low back pain.

Subjects and Methods: This study is a randomized clinical trial with 100 patients aged between 18 and 60 years suffering from non-specific low back pain for at least 3 months of duration. 50 subjects were randomly assigned to group a received spinal manipulation and 50 subjects to group B received core stability exercises. After 15 days, scores were measured for segmental instability (centre of foot pressure) by win track platform, pain sensitivity (pain pressure threshold) by digital algometer and health-related quality of life by EuroQol questionnaire.

Results: After treatment, spinal manipulation and core stability exercises had improved segmental instability, increased pressure threshold and enhanced health-related quality of life. However, significantly better improvement noticed in segmental instability, pressure pain threshold, and quality of life by spinal manipulation compared to core stability exercises.

Conclusion: The present study indicates that spinal manipulation is more effective than core stability exercises in chronic non-specific low back pain.

Aim: To propose a strategy for improvement of undergraduate students’ learning environment based on analysis of their perceptions.

Methods: Medical, Pharmacy and Physiotherapy undergraduate students participated in the study. The study used a quantitative descriptive design, based on the Dundee Ready Educational Environment Measure (DREEM) inventory. The University of South Africa and University of Zambia Ethics Committees provided ethical approval. Using stratified random sampling, participants were drawn from the Ridgeway Campus of the University. They responded to a demographic section and the 50 DREEM items. Data analysis included descriptive statistics on demographics, total and subscales DEEM scores and mean scores on individual items. Cronbach’s alpha and confirmatory factor analysis provided reliability and validity indices of the dataset. Specific issues derived from individual items’ scores were used to propose a strategy. 

Results: Total participants were 488 including 239 from Medicine, 135 from Pharmacy and 74 from Physiotherapy. Response rate was 95.5%. Mean total score was 119.3/200. Scores within subscales of perception of learning, perception of teachers, academic self-perception, perception of atmosphere, and social self-perception were 29.87/48, 26.29/44, 20.96/32, 27.26/48 and 14.86/14, respectively. Four strategic issues emerged from six items with mean scores below 2.0/4.0: lack of adequate social support for stressed students, substandard teaching and mentoring, unpleasant accommodation and inadequate facilities. Strategic objectives were raised and strategic options recommended from literature.

Conclusion: Strategic planning in medical and health professions education should consider learners’ concerns by analysing their learning environments.

Mastectomy with axillary lymph node dissection is the surgical procedure of choice necessary for the treatment of breast cancer and women are susceptible to develop upper limb edema known as lymphedema. Therefore, it becomes essential for nursing and given its importance, to provide educational support for prevention of lymphedema, which is the main potential complication with serious repercussions on the quality of life of women.

In clinic practice the reduction of cerebral blood flow in particular zones of the brain as brainstem can cause early cerebral damage then, ischemia and posterior reperfusion induce an inflammatory response leading to further cellular death. Indeed, inflammatory cells may release deleterious compounds or cytokines that exacerbate oxidative damage to metabolically compromised neurons, and similar mechanisms may operate in the pathophysiology of neurodegenerative diseases in which vascular factors, inflammation and oxidative stress are implicated. In the present work, the issue referent to mechanisms of pro-oxidants in inflammatory processes and its relation with common pathogenesis and clinical manifestations are analyzed in detailed and updated form.

This in-vivo study was carried out to investigate alterations in the levels of proteins and enzymes produced by the liver of HIV infected pregnant women and HIV infected non pregnant women under different antiretroviral therapy. Forty six human patients (Pregnant patient, n=21, Non pregnant patient, n=25) were recruited during this study from the PEPFAR (President Bush Emergency Plan for Aids Research) clinic in LUTH (Lagos University teaching Hospital), Lagos. The patients were between the ages of 29 – 34 years. All samples were analyzed for Albumin, Transferrin, Urea, Total protein, Total bilirubin, Creatinine and Cholinesterase. Along with it, liver enzymes – Alkaline phosphate, Alanine aminotransferases and Aspartate aminotransferases were also analyzed to confirm proper liver function for each patient. Result showed that total bilirubin and transferrin were statistically higher in the pregnant group while other liver proteins (Albumin, Urea and Total protein) were statistically lower in the pregnant group. Two liver enzymes, Creatinine and Cholinesterase, were statistically lower in the pregnant group. Though, other liver enzymes; aspartate aminotransferases and alanine aminotransferases were also lower in the pregnant group. No significant difference were noted when statistics were applied. Only alkaline phosphatase showed a non significant increase in the pregnant group. Findings in this study suggest that effective antiretroviral therapy stabilizes proteins and enzymes production in both HIV groups, however, slight alterations which were observed in the pregnant HIV group were due to physiological changes during pregnancy.

Background: Febrile episode remains the common clinical presentation responsible for hospital admission among children aged less than 5 years in sub-Saharan African. The overlapping of clinical signs and symptoms, with diverse aetiological agents implicated in febrile illness, tends to compound effective diagnosis and management approach in a low-resource healthcare setting.

Objective: We retrospectively analysed malaria parasitemia and bacteremia results of febrile patients seen at a tertiary hospital in Nguru, Yobe state, Nigeria.

Study Design: A retrospective study analysed malarial parasitemia and bacteremia of febrile patients aged less than 12 years.

Place and Duration of Study: The study was conducted at the federal Medical center Nguru in the department of Medical Microbiology and Paediatric that spanned between January and December 2014.

Methodology: Thick and thin blood smear examination for asexual malarial parasite, blood culture technique for bacterial pathogens isolation and antibiotic susceptibility testing were employed for the study.

Results: Malarial parasitemia was detected in 44(32.6%) cases, bacterial pathogens isolated in 51(37.8%) and co-infection prevalence of 16.3% respectively. Five different bacterial pathogens were isolated, Staphylococcus aureus accounted for 34(66.9%), Salmonella spp 10(19.6%), Escherichia coli 4(7.8%), Coliforms 2(3.9%) and Streprotococcus pneumoniae 1(2.0%) respectively. The statistical difference was observed between clinical details and microbiological indices, malarial parasite (P<0.001) and bacterial pathogens (P<0.0001). High malarial parasitemia and bacteremia was observed within the age-group of 1-11 months and >60 months. The bacterial pathogens demonstrated high resistance pattern to ampicillin and cotrimoxazole.

Conclusion: These findings presented local epidemiological data of febrile episode that could optimized febrile illness diagnosis and management approach.

Objective: To determine the effect of obesity on pregnancy compared to non-obese pregnant Saudi women.

Methodology: This is a prospective cohort research conducted over seven months in Jeddah Maternity and Children Hospital (MCH), Jeddah, Saudi Arabia. Sample included pregnant women with single fetus and cephalic presentation came to the booking clinic. Participants were classified into 5 groups depending on their BMI according to WHO criteria as underweight, normal weight, overweight, obese & morbidly obese. SPSS was used with p-value of< 0.05 to calculate statistical significance.

Results: The frequency of abortion, postdated pregnancy and Caesarean section were higher in obese women compared to non-obese women.

Conclusion: Obese women pregnancy is a high risk for pregnancy and labor complications. It is advisable to achieve normal BMI before conception.

Bladder rupture is a very morbid injury following blunt or penetrating lower abdominal trauma. Prompt diagnosis is crucial to initiate optimal treatment. Intraperitoneal bladder rupture is associated with haematuria and biochemical features of renal failure. Cystogram is diagnostic. Immediate open surgical repair is the main stay of treatment. A case of intraperitoneal rupture diagnosed preoperatively by the presence of haematuria and pseudorenal failure is presented to highlight the association of posttraumatic haematuria and pseudorenal failure in such injuries.