Review Article

Sleeplessness and health

Sunitha V, Jeyastri Kurushev, Felicia Chitra and Manjubala Dash*

Sleep influences each intellectual and physical health. It’s essential for a person’s well-being. The reality is when we see at well-rested people, they’re working at an exclusive degree than people making an attempt to get by way of on 1 or 2 hours much less nightly sleep. Loss of sleep impairs your higher tiers of reasoning, problem-solving and interest to detail. Sleep deficit will additionally make people much less productive and put them at higher danger for creating depression. Sleep affects almost each tissue in our bodies. It influences growth and stress hormones, our immune system, appetite, breathing, blood pressure and cardiovascular health. Nurses play a foremost function in teaching and guiding the sleep deprived patients on the importance of sleep and its physiological and psychological effects.

Research Article

Effectiveness of therapeutic ultrasound and kinesio tape in treatment of tennis elbow

Hamza Shaheen, Azzam Alarab* and Muntaser S Ahmad

Objective: To investigate the effect of kinesio tape and therapeutic ultrasound on pain and hand grip strength associated with tennis elbow.

Material and Methods: Twenty male and female patients with age from 20-50 years suffering from lateral epicondylitis were participated in this study. All patients were randomly selected from orthopaedic surgeon. They were dividing into two groups. Group (A) (ultrasound and exercises group). Group (B) (kinesio tape and exercises group). The hand-held dynamometer was used to provide a detailed and objective measurement of wrist joint strength throughout its range of motion, the pressure being registered in kilogram (Kg) and Visual Analogue Scale (VAS) was used to record the degree of pain intensity.

Result: The result shows no significant difference between group A and B in their ages, weights, heights, and BMI where their t and P-values were (0.8, 0.43), (0.03, 0.97), (0.98, 0.33), and (0.9, 0.37) respectively. In Group A the significant differences in hand grip strength between pre and post-test which shows 31.59), compared to the pre-test (27.35), while in group B (33.17) compared to the pre-test (23.88). According the pain scale for group A and group B there are significant differences where the results were (2.50), compared to the pre-test (5.90) and (2.00), compared to the pre-test (7.30), retrospectively.

Conclusions: The treatment was improvement between both groups. However, the kinesio tape is better than therapeutic ultrasound.

Research Article

The PVSG/WHO versus the Rotterdam European clinical, molecular and pathological diagnostic criteria for the classification of myeloproliferative disorders and myeloproliferative neoplasms (MPD/MPN): From Dameshek to Georgii, Vainchenker and Michiels 1950-2018

Jan Jacques Michiels* and Hendrik De Raeve

The present article extends the PVSG-WHO criteria into a simplified set of Rotterdam and European Clinical, Molecular and Pathological (RCP/ECMP) criteria to diagnose and classify the myeloproliferative neoplasms (MPNs). The crude WHO criteria still miss the masked and early stages of ET and PV. Bone marrow histology has a near to 100% sensitivity and specificity to distinguish thrombocythemia in BCR/ABL positive CML and ET, and the myelodysplastic syndromes in RARS-T and 5q-minus syndrome from BCR/ABL negative thrombocythemias in myeloproliferative disorders (MPD). The presence of JAK2V617F mutation with increased erythrocytes above 6x1012/L and hematocrit (>0.51 males and >0.48 females) is diagnostic for PV obviating the need of red cell mass measurement. About half of WHO defined ET and PMF and 95% of PV patients are JAK2V617F positive. The combination of molecular marker screening JAK2V617F, JAK2 exon 12, MPL515 and CALR mutations and bone marrow pathology is 100% sensitive and specific for the diagnosis of latent, early and classical ECMP defined MPNs. The translation of WHO defined ET, PV and PMF into ECMP criteria have include the platelet count above 350 x109/l, mutation screening and bone marrow histology as inclusion criteria for thrombocythemia in various MPNs. According to ECMP criteria, ET comprises three distinct phenotypes of true ET, ET with features of early (“forme fruste” PV), and ET with a hypercellular erythrocythemic, megakaryocytic granulocytic myeloproliferation (EMGM or masked PV). The ECMP criteria clearly differentiate early erythrocythemic, prodromal and classical PV from congenital polycythemia and idiopathic or secondary erythrocytosis. The burden of JAK2V617F mutation in heterozygous ET and in homozygous PV is of major clinical and prognostic significance. JAK2 wild type MPL515 mutated normocellular ET and MF lack PV features in blood and bone marrow. JAK2/MPL wild type hypercellular ET associated with primary megakaryocytic granulocytic myeloproliferation (PMGM) is the third distinct CALR mutated MPN. The translation of WHO into ECMP criteria for the classification of MPNs have a major impact on prognosis assessment and best choice for first line non-leukemogenic approach to postpone potential leukemogenic myelopsuppressive agents as long as possible in ET, PV and PMGM patients..

Research Article

Primary myelofibrosis is not primary anymore since the discovery of MPL515 and CALR mutations as driver causes of mono-linear megakaryocytic and dual megakaryocytic granulocytic myeloproliferation and secondary myelofibrosis

Jan Jacques Michiels* and Hendrik De Raeve

Primary myelofibrosis (PMF) is a distinct clinicopathological myeloproliferatve disease (MPD) not preceded by any other MPD ET, PV, CML,... Combined use of bone marrow histology and increased erythrocyte counts above 5.8x1012/L can replace increased red cell mass at time of presentation as the pathognomonic clue for the correct diagnosis of hetero/homozygous or homozygous mutated PV. Erythrocyte counts are in the normal range below 5.8x1012/L in heterozygous JAK2V617F mutated ET and prodromal PV but above 5.8x1012/L in heterozygous-homozygous or homozygous mutated PV. The bone marrow cellularity and morphology in pre-fibrotic ET, prodromal PV and PV carrying the JAK2V617F mutation are overlapping showing clustered increase of large mature pleomorphic megakaryocytes (M) with no increase of cellularity (<60%) in ET. The bone marrow is hypercellular (60%-80%) due to increased erythropoiesis megakaryopoiesis (EM) in prodromal and classical PV and trilinear hypercellular (80%-100% due increased megakaryopoiesis, erythropoiesis and granulopoiesis (EMG) in advanced PV and masked PV. Bone marrow cellularity ranging from normal (<60%) in ET to increased erythropoiesis (EM) in prodromal PV to hypercellular (80-100%) in advanced PV and masked PV largely depends on increasing JAK2V617F mutation load from low to high on top of other biological MPN variables like constitutional symptoms during long-term follow-up. MPL515 mutated ET is featured by an increase of clustered small and giant megakaryocytes with hyper-lobulated staghorn-like nuclei in a normal cellular bone marrow. The third entity of pronounced JAK2/MPL wild type ET associated with primary megakaryocytic granulocytic myeloproliferation (PMGM) without PV features proved to be caused by calreticulin (CALR) mutation. CALR mutated thrombocythemia is characterized by dual proliferation of megakaryocytic and granulocytic bone marrow proliferation of dense clustered large to giant immature dysmorphic megakaryocytes with bulky (bulbous) hyperchromatic nuclei, which are not seen in MPL515-mutated Thrombocythemia and JAK2V617F-Thrombocythemia, prodromal PV and classical PV. 

Mini Review

Handwashing in healthcare today: Why haven’t we gotten better?

Nicholas S Carte*

In 2010, a study identified that only about 40 percent of doctors and other health care providers comply with proper hand hygiene techniques in hospitals and other healthcare facilities. These statistics are alarming as healthcare professionals are the ones who set the gold standard for hygiene and sterility, but they continue to find it difficult to demonstrate this standard in every practice [1]. Even with The Joint Commission supporting that hand hygiene as the most critical intervention for preventing healthcare-associated infections (HCAIs), the compliance rate for hand hygiene has not drastically improved [2]. The goal of this article brief is to answer the question why hasn’t handwashing improved even with the evidence to support that proper hand hygiene decreases HCAIs?

Case Report

An uncommon cause of isolated ascites: Pseudomyxoma peritonei

Louly Hady*, I Nassar, K Znati and N Kabbaj

Pseudomyxoma peritonei or Gelatinous Peritoneal Disease is a rare disease. We report a case treated in the department of Hepato-Gastroenterology at Ibn Sina Hospital in Rabat, of a 64-year-old male who presented with an abdominal pain and an increased volume of the abdomen corresponding to ascites. Imaging and anatomopathological study made it possible to diagnose the disease. However, given the general state of the patient, he is under palliative care.

Research Article

Determine seroprevalence and associated risk factors of HBV infection among pregnant women and it relationship with blood transfusion at Hargeisa Group Hospital, Hargeisa, Somaliland

Abdullah Al-Mamari*

Background: The measures are being put in place for the management of Hepatitis B virus (HBV) infection in Hargeisa, Somaliland among pregnant women remain the most vulnerable to develop chronic hepatitis. Routine screening in pregnant women is therefore necessary for effective control. However, the performance of the commonly used the HBsAg sero test strips has been available. Also, identifying the risk factors of transmission in pregnant women is importance for the implementation of preventive measures. Hence, the goal of this study was to determining seroprevalence and associated risk factors with HBV infection among pregnant women.

Material & Methods: The study area was carried out at Hargeisa group hospital in Somaliland from May 2018 up to December 2018. The researcher was collected research pregnancy woman data through questionnaire & used diagnostics methods such as Hepatitis B surface antigen (HBsAg) test, antibodies test (HBsAb) by used anti-card test and ELIZA system. In order to find specific full information’s about patients & relationship the associated risk factors with hepatitis B in pregnancy. Data processed and analyzed by used both words and SPSS package. The sample size investigated was 80 patients. Of these, 28 were excluded; among the reasons for exclusion were prior HBV vaccination and known HBsAg sero-positive status.

Aims of Study: The study was designed & aimed to determine seroprevalence and associated factors of HBV infection among pregnant women. To assess and establish if there is significant relationship between blood transfusion and hepatitis B virus at Hargeisa group hospital (HGH). 

Results and Discussion: The results in the current study shown that the pregnancy with hepatitis BV and it relation with appeared some symptoms in our study was 24(46.15%) of patients appeared they have cirrhosis symptom, 12(23.08%) of patients answered they have liver failure, while 9(17.31%) of patients appeared yellowish of eyes & skin and 5(9.62%) showed hepatic cancer.

Overall, HBV prevalence: HBsAg was detected in fifteen 15(31.3%) of the participants while all fifteen (100%) had total HBcAb (both IgM and IgG). Of the HBsAg sero-positive women, 26(42.7%) were positive for HBeAg; eight (13.3%) were positive for HBeAb and four 4(9%) were negative for both HBeAg and HBeAb which was close similar with other previous studies. On the other hand, We found identify statistically significant p-values < 0.05 and high relationship between HBV and some demographic and clinical risk factors such as blood transfusions, levels of knowledge about HBV infection in addition to age and marital status. 

Conclusion: The results of this study showed that the seroprevalence of HBV infections in pregnant women and it relationship with blood transfusion in Hargeisa Group Hospital, Hargeisa, Somaliland is high. However, further studies are needed to assess the role of other demographic and clinical risk. Urgent action is required to improve hepatitis B infection control measures to reduce dependence on blood transfusions and make new policies for treatment of anemia in HGH.

Research Article

Demographic survey and management outcome of Post-Neonatal Tetanus at the Ekiti state university teaching hospital, Ado Ekiti

Ajite AB*, Ogundare EO, Oluwayemi IO, Olatunya OS, Babatola A, Taiwo A, Komolafe A and Fatunla O

Background: Tetanus continues to threaten the survival of children in spite of it being a vaccine preventable disease. The objective of this study was to determine the prevalence of post-neonatal tetanus, review the vaccination of affected children, complications encountered and the outcome among affected children in a tertiary health institution in southwestern Nigeria.

Methods: The study was a retrospective study. Case notes of children outside neonatal life admitted to the Paediatric ward with clinical diagnosis of tetanus between January 2012 and October 2018 were retrieved and evaluated to identify socio-demographic and clinical characteristics. A review of the immunization history and cards was done where the immunization cards were available.

Results: 21children with post-neonatal tetanus were admitted over a period of six years (November 2012 to October 2018) with a prevalence of 0.3%. The M:F was 3.2:1. The mean age in years was 10.14 ±3.44 while the age range of the subjects was 4 to 16years. None of the patients had booster doses of tetanus toxoid (TT) outside the infancy period. Nine (42.9%) subjects had no previous TT vaccination, 2 (9.5%) had 3 doses of TT vaccine in infancy but developed tetanus at age ≥9 years, 1(4.8%) subject had a dose of TT while the remaining 9subjects had no proof of previous TT vaccination. The percentage mortality was 19% (4 out of 21). All the patients that died had no prior record of TT vaccination. Complications identified included laryngeal spasm and autonomic dysfunction.

Conclusion: Post-neonatal tetanus is still common in our locality because booster doses of Tetanus Toxoid are not part of the national immunization schedule. Complete dose of tetanus toxoid vaccination during infancy and booster doses at school entry is necessary and should be part of school health programme to forestall post-neonatal tetanus

Research Article

Head impact exposure comparison between male and female amateur rugby league participants measured with an instrumented patch

King DA*, Hume PA, Cummins C, Clark T, Gissane C and Hecimovich M

Background: Epidemiological studies report that females experience greater rates of concussion when compared with males. Biomechanical factors may result in greater post-impact head velocities and accelerations for a given force for females when compared with males.

Purpose: To quantify the magnitude, frequency, duration and distribution of impacts to the head and body in rugby league match activities for females versus males.

Design: Prospective descriptive epidemiological study.

Methods: 21 female and 35 male amateur rugby league players wore wireless impact measuring devices (X2Biosystems; xPatch) behind their right ear over the mastoid process during match participation across a single season. All impact data were collected and downloaded for further analysis.

Results: Male amateur rugby league players experienced more head impacts than female amateur rugby league players (470 ±208 vs. 184 ±18; t(12)=-3.7; p=0.0028; d=1.94) per-match over the duration of the study. Male amateur rugby league players recorded a higher median resultant Peak Linear Acceleration (PLA(g)) (15.4 vs. 14.6 g; F(824,834)=51.6; p<0.0001; t(1658)=-3.3; p=0.0012; d=0.10) but a lower median resultant Peak Rotational Acceleration (PRA(rad/s2) (2,802.3 vs. 2,886.3 rad/s2; F(831,827)=3.1; p<0.0001; t(1658)=5.7; p<0.0001; d=0.13) when compared with female amateur rugby league players

Conclusion: Females recorded lower median values for PLA(g) and Head Impact Telemetry severity profile (HITSP) for all positional groups but had a higher PRA(rad/s2) for Hit-up Forwards (HUF) and Outside Backs (OSB’s) when compared with male HUF and OSB’s. Females also recorded more impacts to the side of the head (48% vs. 42%) and had a higher 95th percentile resultant PRA(rad/s2) (12,015 vs. 9,523 rad/s2) to the top of the head when compared with male rugby league players.





Research Article

A qualitative method for determining the surfaces between asphalt layers using ABAQUS software

Seyed Masoud Hadian*

The analytical models are mainly combined with numerical equations for the problems of the pavement under the wheel load. Different assumptions can be considered, such as elastic asphalt and viscoelastic as well as static or dynamic load. Mainly on deformation at the bottom of asphalt and tension layers focus on subgrid. The pavement structure was considered as layers with uniform characteristics. Therefore, this analytical model calculates the three-dimensional contact tension between the wheel and the pavement and the shape of the contact area. Basis and subgrid are considered linear and the asphalt layers can be linear or viscoelastic. This model is based on the results of direct shear stress tests at an axial load constant. The curves obtained from this experiment can be defined by three parameters: the maximum shear stress (shear stress curve versus shear displacement), the interaction modulus between the layers (the same curve slope) and the friction coefficient after the failure. Due to the ability of ABACOUS software, this project is done with this software. One of the methods widely used to predict viscoelastic responses of asphalt mixtures is the finite element method. ABAQUS software is one of the tools that can simulate mixed asphalt behavior based on a finite element method, taking into account all the determinant parameters. The use of the Prony series is one of the common techniques for describing the viscoelastic behavior of asphalt mixtures in ABAQUS software. For this purpose, it is necessary to determine the parameters required for this field, including proven constants, moment elastic modulus, and asphalt mixture poison ratio. On the other hand, the determination of these parameters through testing in addition to spending time and costs requires laboratory equipment. Therefore, in this thesis, a three-dimensional finite element model with ABAQUS software was constructed to analyze the persistent pavement using theoretical relations without conducting the experiment. Also, viscoelastic behavior of common asphalt mixtures and time dependence of its responses at different temperatures can be modeled in ABAQUS software. After performing the shear stress test for different axial loads, different temperatures, with or without a single coil, they found that all parameters are temperature dependent and the coefficient of friction does not depend on the applied axial load. This new model improves the accuracy of the finite element model and its important role can be an analytic expression that includes all the variables that are effective in the problem.

Research Article

Study the effect of transient vibration on multi-storey building structure according to equivalent spring-mass system performed by Ansys

Dinesh Sen and Anosh Kujur*

The carried work has based on transient vibration response of multiple degrees of freedom (MDOF) system. By this work study of Time–history analysis and prediction of the displacement for excitation has done. For the MDOF system, we have taken the four-storey building to done transient vibration. We establish the equivalent spring-mass system. Transient analysis has done for both Undamped and Damped of the forced system of multiple degrees of freedom (MDOF) system. In the case of the Damped system, we have done three stages of damping, i.e., (1) Underdamped system, (2) Critically damped system, (3) Overdamped system. The time-history graph obtained for two different time stages i.e. 0.001 sec & 0.01 sec with initial time 0.000001 sec. The natural frequency has determined by both theoretical calculation and ANSYS. The whole study of transient vibration makes it possible to predict the damping values that oppose any kind of sudden impact or force vibration, such as blasts, earthquakes and tsunamis. The ANSYS is the modelling and simulation software is used to perform the transient vibration response. The Mode Superposition method is used by ANSYS to calculate the structure response.

Review Article

Topical Management of chronic rhinosinusitis - A literature review

Aremu Shuaib Kayode* and Tesleem Olayinka Orewole

Chronic rhinosinusitis (CRS) is an inflammatory condition involving nasal passages and the paranasal sinuses for 12 weeks or longer [1]. It can be subdivided into three types: CRS with nasal polyposis (CRS with NP), CRS without nasal polyposis (CRS without NP), and Allergic fungal rhinosinusitis (AFRS).

Research Article

Stability determination of candidate reference genes in cucumber plants subjected to stresses from Phytophthora melonis

Rui Wang, Hu Du, Qingmin Jin, Yu’e Lin, Yujuan Zhong, Chunpeng Yao, Xiaomei Xu and Tingquan Wu*

Stable reference genes are indispensable for ensuring the fidelity of determined gene expression levels. However, the expression levels of reference genes are unable to remain constant under all possible experimental conditions. Therefore, the stability determination of reference genes is necessary in an experimental system set.In the preset study, the stability of nine cucumber candidate reference genes (CsACT, CsUBQ, CsEF1α, CsCYP, CsαTU, CsCACS, CsTIP41, CsYSL8 and CsHEL) subjected to stresses from Phytophthora melonis(P. melonis) were determined using four different analysis methods, including Delta Ct, BestKeeper, NormFinder and GeNorm. The study results revealed that CsUBQ and CsCYP were the most stable genes suitable as internal control in cucumber plants under attack by P. melonis condition.

Letter to the Editor

Do you really want to improve the results of treatment for acute pneumonia?

Klepikov Igor*

The question raised in the title of this letter is a natural consequence of the findings and conclusions that have been growing steadily in recent years regarding the results of treatment for acute pneumonia (АР). If you look at the publications of recent years in this field of medicine, it turns out that one of the main obstacles to progress in improving the results of treatment of this disease is the lack of appropriate methods for determining the pathogen. Thus, the lack of timely diagnostic information about the etiology of the disease excludes the possibility of targeted antibiotic therapy. In recent years, such regrets have become more and more relevant, playing the role of the main explanation for treatment failures .Continuing to narrow the unidirectional view of the problem and to pay attention only to the microbial factor as the main cause of the disease, such views are in fact another illusion, which, even in the case of its hypothetical implementation, will not make significant changes in the overall trend. This statement is easy to verify if you rely on well-known facts, and not use as arguments assumptions and guesses.

Research Article

The pattern of blood pressure and renal function among children with Sickle Cell Anaemia presenting in a tertiary health institution in Nigeria

Adebukola Ajite*, Ezra Ogundare, Oludare Oluwayemi, Oladele Olatunya, Oluwasola Oke, Kayode Tolorunju and Evelyn Omoniyi

Background: In sickle cell anemia (SCA), compromise of the renal vasculature due to sickled red cells has been recognized.

Objectives: To assess the renal function and blood pressure pattern in children with sickle cell anaemia (SCA) presenting in a tertiary institution.

Method: A cross-sectional study of patients with sickle cell anaemia (SCA) over six months involving the use of questionnaires, general physical examination, blood pressure, investigations for haemoglobin genotype, urinalysis, serum creatinine, screening for hepatitis B and HIV.

Results: 51 children with SCA were seen. The prevalence of impaired renal function as defined by reduced eGFR <90mL/min/1.73m2 in this study was 27.5%, previous hospital admission and blood transfusion were associated with reduction in eGFR but blood pressure did not have significant correlation with the eGFR. The overall mean age at diagnosis of SCA was 4.09 ± 3.33 (years).

Conclusion: Impaired renal function is a major comorbid condition in children with SCA. In countries/locations where there is no newborn screening for sickle cell disease, diagnosis is delayed, thus detecting impaired renal function may be delayed, therefore the need for early detection and management is imperative.

Research Article

Can bloodstream infection be predicted by nasal culture in hemodialysis patients?

Behrooz Broumand*, Shahram Boroumandi, Zahra Rahbar, Mehrdad Sheikhvatan and Maryam Shahroukh

The blood and drainage cultures are suggested for early diagnosis of bloodstream infection (BSI), which are time consuming and laborious. Nasal colonization of bacteria is one of the modalities, occasionally can predict BSI. We hypothesized that nasal culture, as an accessible fluid may be helpful to predict future BSI in hemodialysis patients. The present prospective study evaluated 63 patients undergoing maintenance hemodialysis at the Pars hospital dialysis center, Tehran, Iran, from November 2015 until February 2016. Nasal fluid of patients were collected from the 1–cm internal anterior part of both nostrils of patients by a sterile swab and cultured in Trypticase soy agar. All patients were followed for three months for BSI. The results of first nasal fluid sample revealed that 33.3% in first sampling and 27.0% in sampling had positive nasal fluid culture. The type of bacteria in all positive cases was Staphylococcus aureus. The rate of BSI infection in the patients with positive and negative first nasal fluid culture was 9.5% and 2.4% respectively with no significant difference. We found also no significant association between BSI positivity and nasal culture results so that positive BSI was revealed in 5.9% of patients with positive nasal fluid culture and 4.3% in those with negative nasal fluid culture with no meaningful difference. None of the baseline variables including age and gender, underlying risk factor, access, or duration of dialysis was associated with BSI positivity. In hemodialysis patients, BSI may not be predicted by nasal fluid culture positivity.

Research Article

Knowledge, attitude, practice and associated factors towards nursing care documentation among nurses in West Gojjam Zone public hospitals, Amhara Ethiopia, 2018

Atsedemariam Andualem*, Tarekegn Asmamaw, Mezinew Sintayehu, Tiliksew Liknaw, Afework Edmealem, Bekalu Bewuket and Mihretie Gedfew

Background: In health care systems nursing care documentation is a vital and powerful tool that ensures continuity of care and communication between health personnel for better patient outcomes. Knowledge, attitude and practice of nurses’ towards nursing care documentation affect the quality and coordination of patients’ care. Hence, this study aimed to assess knowledge, attitude, practice and associated factors towards nursing care documentation among nurses in West Gojjam Zone public hospitals, Amhara Ethiopia.

Method: Institutional based cross sectional study was conducted among 246 nurses in West Gojjam Zone public hospitals from February to March 8, 2018. The study participants were selected by simple random sampling technique. Data were collected by using pre-tested and validated self-administered structured questionnaire with internal reliability of Cronbach’s Alpha values 0.912, 0.784 and 0.713 for knowledge, attitude and practice questions respectively. Epi data version 3.1 and SPSS version 20 was used for data entry and analysis respectively. Descriptive statistics and binary logistic regression model were used.

Result: The overall response rate was 97.56%. Among 240 respondents 54.6% of them had good knowledge, 50% of study participants had favorable attitude and 47.5% of study participants had good nursing care documentation practice. Sex and monthly salary were found to be statistically significant with knowledge of nurses. Work setting, work experiences and knowledge of nurses had significant association with nurses’ attitude towards nursing care documentation. Availability of operational standards, knowledge and attitude of nurses had significant association with nursing care documentation practice.

Conclusions and Recommendation: Results of this study showed that knowledge, attitude and practice of West Gojjam zone public hospital nurses on nursing care documentation were poor. Therefore; in order to solve this problem each hospital should recruit nurses until hospitals are saturated enough. It is recommended to avail nursing care documentation standards/guidelines in each hospital and to give training about it and also it is recommended to conduct multisite studies especially qualitative type to increase its quality.

Review Article

Hypertension as a persistent public health problem. A position paper from Alliance for a Healthy Heart, Mexico

Luis Alcocer, Humberto Alvarez-Lopez, Gabriela Borrayo-Sanchez, Ernesto German Cardona-Munoz, Adolfo Chavez-Mendozaa, Enrique Diaz y Diaz, Jose Manuel Enciso-Munoz, Hector Galvan-Osegueraα, Enrique Gomez-Alvarez, Pedro Gutierrez-Fajardo, Hector Hernandez y Hernandez, Francisco Javier Leon-Hernandez, Jose Antonio Magana-Serrano, Jose Zacarias Parra-Carrillo and Martin Rosas-Peralta*

Today, Mexico has more than 130 million inhabitants; 85 millions of them are adults of 20 or more years old. The population pyramid is still one of base wider and this base corresponds to adults younger than 54 years old. Despite predictions made 20 years ago, about a transformation of the population pyramid shape to a mushroom shape as a consequence of more life expected and adult population growth; this change has not been occurred. Hypertension has become the biggest challenge of noncommunicable chronic diseases to public health in Mexico. Around 30% of adult Mexican population has hypertension; 75% of them have less than 54 years old (in productive age); 40% of them are unaware but only 50% of aware hypertensive population takes drugs and, 50% of them are controlled (< 140/90 mmHg). Cardiovascular risk factors including hypertension, dyslipidemia, obesity, and diabetes often cohabit in the same person and are magnified one to another in terms of common pathophysiological pathways. Atherosclerosis, arrhythmias, stroke and heart failure are common and are the final pathologic end-points and explains why cardiovascular diseases occupy first place in mortality in Mexico and worldwide. The costs of care for these diseases are billionaires and if we do not generate appropriate strategies, their global impact can become a high threat to social development of the country. The life style like nutrition, sports habits of the Mexicans must be emphasized; there is poor education about this crucial topic. This position paper is focused on the principal controversies and strategies to be developed by all, government, society, physicians, nurses, patients and all people related with healthcare of hypertension, in order to confront this huge public health problem in Mexico.

Case Report

A serious pulmonary infection secondary to disseminated Strongyloidiasis in a patient with Nephrotic syndrome

Mingming Ma, Shuang Cui, Ting Luo, Zhanhua Chen, Xiangnan Dong, Sibo Huang and Lianghong Yin*

We report a case involving infection with Strongyloides stercoralis found in the sputum of a 66-year-old male patient who had a medical history of nephrotic syndrome and was treated with methylprednisolone and monthly intravenous cyclophosphamide therapy 3 months previously. This patient presented with stubborn pulmonary symptoms and signs, which was the mechanical destruction caused by larval migration. We found strongyloides in his sputum that provided diagnostic proof.

Research Article

Peritonitis: Culprit for peritoneal dialysis decline

Kishore Kumar*, Jais Kumar and Chaudhri Naureen

Peritonitis is the main complication of peritoneal dialysis caused the withdrawal of treatment like peritoneal dialysis which was used as primary treatment modality few years back in Pakistan. With this motto to know the exact cause of peritonitis this retrospective study was done and 35 out of 42 pervious peritoneal dialysis patients who had peritonitis were analyzed using old data. A total of 57 bags of all these peritonitis patients were analyzed in department of microbiology during the year 2007-2011. Out of these bags positive culture was obtained from 42 bags (74%). Most of patients with positive culture were undergoing acute peritoneal dialysis 66.67% and rest were on chronic ambulatory peritoneal dialysis. Main concern was the yield of organisms causing culture positive peritonitis. It was found that bacterial peritonitis was positive in 80%, fungal peritonitis was 11% and mycobacterium tuberculosis peritonitis was 09%. Various culture techniques along with Gram Stain, Zeihl Nielsen Stain and Auramine stain were used for knowing the yield.

Limitations: Old and only small available data of peritonitis patients and stop of further peritoneal dialysis.

Case Report

Anti-glomerular basement membrane disease: A case report of an uncommon presentation

Natalia Silva*, Luis Oliveira, Monica Frutuoso and Teresa Morgado

Anti-glomerular basement membrane (anti-GBM) disease is an uncommon autoimmune disease that classically presents as an aggressive necrotizing and crescentic glomerulonephritis (CG), with or without pulmonary hemorrhage, and typically does not relapse. The pathologic hallmark is linear staining of GBM for Immunoglobulin G (IgG) which binds to the alpha-3 chain of type IV collagen. Recent reports have noted the occurrence of anti-GBM disease with atypical clinical presentations. We describe a case of a 22-year-old female presenting an anti-GBM disease with typical histological features with a singular clinical presentation with lower limb edema, elevated serum creatinine and nephrotic range proteinuria. Renal biopsy showed signs of chronicity and direct immunofluorescence microscopy demonstrated diffuse, intense linear positivity for IgG. All serologic tests were negative, including anti-GBM antibodies. Hence, a diagnosis of atypical anti-GBM disease was made. The patient was treated initially with mycophenolate mofetil and corticosteroids. After 3 months she began to aggravate renal function so mycophenolate of mofetil was discontinued and a low dose cyclophosphamide was initiated.


Managing epileptic women in pregnancy

Sarmad Muhammad Soomar* and Saima Rajpali

Epilepsy is commonly seen in women of reproductive age and it is affecting their reproductive and pregnancy outcomes in an adverse manner [1]. It has seen that there are increased numbers of maternal deaths of pregnant women with epilepsy than those who have no any epilepsy symptoms or episodes.

Case Report

Local recurrence after enlarged total nephrectomy

Mahdi Graiouid, Walid Bai*, Messian Gallouo, Dakir Mohammed, Adil Debbagh and Rachid Aboutaieb

Local isolated recurrence of kidney cancer in the renal lodge after radical nephrectomy is rare and has a poor prognosis. Surgical excision, sometimes even extended to neighboring organs, is currently the only effective treatment for local recurrence of kidney cancer. The interest of new medical therapies remains to be defined. We report a case of local recurrence in a patient with radical nephrectomy.

Research Article

Isolation and biochemical characterization of Plant Growth Promoting (PGP) bacteria colonizing the rhizosphere of Tef crop during the seedling stage

Zerihun Tsegaye*, Birhanu Gizaw, Genene Tefera, Adey Feleke, Solomon Chaniyalew, Tesfaye Alemu and Fasil Assefa

The use of novel PGPR as bio inoculant is an alternative sustainable agricultural practice to improve soil health, grain quality, increase crop productivity, and conserve biodiversity. The aim of this study is to isolate, and characterized PGP bacteria colonizing tef rhizosphere during the seedling stage. For this concern, 426 samples of tef (Eragrostis tef) rhizosphere soils and roots were collected from East Shewa zone, Oromia regional state. 200 morphologically different bacterial pure colonies were isolated and screened for their PGP traits and biocontrol properties. Among these 40.5% isolates were positive for phosphate solubilization. 36% were positive for IAA production, 4.5% were positive for ammonia production, 19 % were positive for (EXPS), 15.5% were positive for protease production, 12.5% were positive for HCN productions, 9.5 % were positive for cellulase production, 4% were positive for amylase production, 3.5% were positive for chitinase production. For abiotic stress tolerance test, all of the isolates were grown well at 20oc and 30oc and neutral pH, 27% isolates were grown well at 4oc, 25.5% grew at 40oc, 25.5% were grown well on pH-9 and pH-11, 23.5% were tolerated pH-5, 3.5% grew at 50oc and 60oc, 13.5% were grown well on 5% NaCl (w/v), 3.5% were grown well on 10 and 15% NaCl (w/v), which indicated these isolates can survive in some extreme conditions. Totally 15 bacterial species having PGP traits, biocontrol properties, and abiotic stress tolerance ability were identified using the Biolog bacterial identification system. Among these, the majority of the identified PGPR have utilized carbohydrate, carboxylic acid, and amino acid, which are the main components of plant root exudates. The above results indicated that thus PGPR can be used as biofertilizers as well as biocontrol agents to replace agrochemicals to improve crop productivity. Hence, these species can be further formulated and used for greenhouse and field applications.