Journal of Medical Science and Technology

108 – 114.

Authors: Moses M, Yassa P, Kapasa M, Hira S, KwanguM, Sijumbila G.

Drugs from the group of xanthines (caffeine and aminophylline) are frequently used to manage premature neonates. This study investigates the effects of aminophylline loading dose administration on serum sodium levels in premature neonates admitted Neonatal Intensive Care Unit (NICU) at the University Teaching Hospital (UTH). We evaluated the effects of aminophylline loading dose on serum sodium ions in premature neonates admitted to NICU at (UTH), Lusaka Zambia. A cross sectional study design was used to answer the question. According to our findings, 165 (51%) of the participants had the serum sodium levels below 135mmol/l and 157 (49%) had their serum sodium levels above 135mmol/l.The findings showed the prevalence rates of hyponatremia to be highest in the weight category of 1-1.5kg and the lowest in the weight category of >1.5kg. We found that weight and gestational age has a significant association with serum sodium levels as evidenced by the P=values (0.041 and 0.009) by multivariate linear regression. In our results the majority of the premature neonates showed a significant decrease in serum sodium levels after taking a loading dose of aminophylline. These results suggest that premature neonates on aminophylline could actually benefit from supplements of sodium ions.

119 - 122.

Authors: Asma Aref Idamat, Najeh Yousef Alomari

Surgical site infection (SSI) in a serious complication requiring prolonged hospitalization, intravenous antibiotics, wound care and dressings resulting in increased cost and resistant bacteria. Despite the new advances in asepsis and surgery, postoperative (SSI), still considered a serious morbidity. Several reports suggest that (SSI) may be prevented by the administration of appropriate antimicrobial regimes. Quality improvement techniques in surgery are in continued practice since long time with the aim to reduce (SSI) rate. Many centers are implementing standardized protocols in using antibiotic prophylaxis for (SSI) to achieve the best outcome. In this study, we present the effectiveness of our hospital protocol for the use of antibiotic prophylaxis for (SSI). After approval of the study from ethical and research committee, the data of all pediatric patients who underwent uncontaminated procedures in general pediatric surgery & urology at Queen Rania Hospital for Children were reviewed prior and after the implementation of the new hospital protocol using the current literature. All patients who had infection, obvious contamination or on antibiotic treatment were excluded from the study. Other exclusion criteria were re operation, diabetic patient, malignancy, steroid treatment, clean inguinoscrotal surgery, circumcision and patients with allergy, blood or metabolic disorders. According to our hospital protocol, antibiotic prophylaxis for (SSI) will continue for 3 doses over 24 hours. The choice of single or combined antibiotic depends on the type of surgery. Cefazolin was the first choice for most procedures. For gastrointestinal surgery Cefoxitin (40mg/kg) and Metronidazole (15mg/kg) were used in combination. Cefazolin (30mg/kg) alone or with Gentamycin (2,5mg/kg) were used for urogenital surgery. Antibiotic should be administered intravenously one hour prior surgery. Procedures and (SSI) were evaluated prior and after protocol implementation. Thirteen pediatric surgeons in the hospital performed 11.000 procedures between March 2010 – March 2014. The minimum follow-up period for (SSI) was 4 weeks, 2000 procedures (group I) met the criteria prior the implementation of the hospital protocol and 2000 procedures (group II) met the criteria after the implementation of the protocol. The (SSI) rate decreased from 8.4 % (group I) to 4.6% (group II). Over all protocol implementation commitment was 86% and improved during the observation interval. The implementation of a standardized protocol for antibiotic prophylaxis in pediatric surgery significantly reduces (SSI). Generally, the protocol compliance was very good and easy to practice. The implementation of the hospital protocol has been considered as baseline in our major medical center and other hospitals for proper assessment of new treatments plans. The identification of factors associated with (SSI) will help in the revision and improvement of protocols in the future resulting in more control and reduction of (SSI) with significant cost effective results, less hospitalization and less bacteria resistance.

130 – 134.

Authors: Gangapatnam Subrahmanyam, Krishnan Ramalingam

Hypertension is an important risk factor in cardiovascular diseases. Microalbuminuria in non diabetic hypertension is an important early marker for cardiovascular risk. Silicon is an important trace element and possesses beneficial effects on cardiovascular events. Mica mines consists of large amount of silicon, hence workers were exposed to huge amounts of silicon dust. Aim of this study is to find out the relation between silicon levels and microalbuminuria in non diabetic hypertensive patients of mica mine workers. We have recruited 61 non diabetic hypertensive subjects from mica mine (group-I), 60 non diabetic hypertensive subjects who were not exposed to mica mines (group-II) and 60 healthy non exposure to mica mines were included as control subjects (group-III). We did biochemical analysis, urine albumin/creatinine ratio and serum silicon for all the study subjects. Among hypertensive groups (group-I&II) we observed serum total cholesterol, and urine albumin/creatinine ratio were decreased in group-I, whereas serum silicon levels were elevated significantly in group-I than group-II. Percentage of microalbuminuria is less in group-I patients (15%) than group-II patients (28%). Among group – I patients, serum silicon shows negative correlation with total cholesterol (r=-0.04, p=<0.05) and urine albumin/creatinine ratio (r=-0.03, p=<0.05) There is a significant inverse relationship observed in group-I towards serum silicon, whereas there was no such relationship found in group-II. Our study concludes Silicon can decrease microalbuminuria which is an endothelial damage marker and hence it has beneficial effect on endothelial functions but exact mechanism of action is not yet clear.

138 – 144.

Authors: N. Jyothirmayi, S.H.R.K.Prasad , N.Mallikarjuna Rao

The present work assesses the antibacterial activity of solvent extracts (aqueous, ethanol, methanol and hexane) of ripe and unripe fruit pulps of Musa x paradisiaca L. cv. Amruthapani against Gram-positive (Bacillus cereus, Micrococcus flavus) and Gram-negative (Escherichia coli, Pseudomonas aeruginosa) pathogenic bacteria by Kirby-Bauer method along with, the minimum inhibitory concentrations (MICs). The phytochemical composition of non-polar solvent extract, hexane, was analyzed, qualitatively, by Gas Chromatography – Mass Spectrometry (GC-MS). The aqueous unripened and ripened pulp extracts of Amruthapani showed minimum inhibition at highest tested concentration against all the test organisms. Ethanolic ripened extracts exhibited good activity against all the test organisms in comparison with unripened pulp extracts and also the methanolic extracts. Hexane extracts showed very little activity against all test organisms even at high concentrations. A wide spectrum of bioactive compounds like phenols, ketones, aldehydes, alkanes, esters and terpenes were found to be present in the hexane extract and may be responsible for antibacterial activity exhibited.

47 –50

Authors: Dr Asma Aref Idamat, Dr Najeh Yousef Alomari

Urinary tract infection (UTI) is known entity and a common problem in pediatric age group. Children at risk for (UTI) such as vesicoureteric reflux (VUR), pelvi-ureteric junction obstruction (PUJO) and other urinary tract anomalies commonly receive prophylactic antibiotics to prevent nephropathy such as renal scaring ,hypertension and renal failure. Prolonged use of prophylactic antibiotics is common for recurrent (UTI), but this has not been assessed in well-controlled prospective studies. Different antibiotics such as nitrofurantoin, trimethoprim/sulfamethoxazole and nalidixcic acid have been used as prophylactic antibiotics to prevent (UTI) in pediatric age group which proved to be safe in long term prophylactic therapy without major complications. Although it is not easy to perform prospective studies in children because both clinical course and prognosis may be affected by many factors. Infant and children with factors need prolonged use of antibiotic prophylaxis, until there is evidence that these patients are not at risk without prophylaxis. We reviewed thoroughly the up to date literatures and practice guidelines to make sure that we are implementing appropriate use of antibiotic prophylaxis in pediatric urology in our institution being the referral pediatric hospital dealing with the vast majority of pediatric urology/ nephrology cases in the kingdom. We focus on the evaluation and actual benefits of prophylactic antibiotics in vesicoureteric reflux (VUR) in pediatric age group to reach consensus and recommendations for in hospital protocol on the basis of current best evidence. Over the past 3 years we selected a group of patients (N=130), 50 males and 80 females , age 4-7 years ,median age 5, 2 years with grad I-III (VUR).All patients with abnormal voiding , neurogenic bladder and urinary tract anomalies were excluded from the study. All patients who had breakthrough (UTI) or deterioration in the renal function were excluded from the study and managed by surgery or endoscopic injection. All patients were treated by prophylactic antibiotics for 18 months (first trial) then stopped and followed up for another 18 months on no prophylaxis (second trial). At the end of both trials, 100 patients met the inclusion criteria and the results were analyzed. There was no significant break though infection in the second trial and no significant drop in the renal function. Multi resistant bacterial growth was encounter in the first trial, while less resistant bacterial growth was encountered in the second trial. In conclusion, routine use of prophylactic antibiotics for low grade I-III (VUR) in normal urinary tract is not indicated after the age of 4 years without any significant health compromise.

57 – 60

Authors: Maher khader, Ahmed AL- Issa, Fatin Al -Awaisha, Sameera Abuzeat RN, Asma Al Nesraween RN, Tagreed AL-kasassbah RN

Our aim is to determine whether the levels of blood electrolytes assessed using blood gas analyzer and central laboratory auto-analyzer are equivalent. This retrospective study was conducted over six month period (October 2012- March 2013). A total number of 60 paired blood samples were drawn from pediatric and adult patients either in the intensive care unit or in the ward with a variety of diagnoses .Analysis of blood sodium and potassium levels was carried out using a point-of-care blood gas analyzer and a central laboratory auto-analyzer. Statistical measures were employed using paired t –tests. The mean level (± standard deviation) of sodium measured by blood gas analyzer was significantly higher than in the auto-analyzer (141.4 ± 7.3 mmol/L and 137.7 ± 5.6 mmol/L respectively; P˂0.001). Regarding the potassium levels, there was also a significant difference between the mean level (± standard deviation) measured by blood gas analyzer and central laboratory auto-analyzer (3.2 ± 0.8 mmol/L and 4.2 ± 0.7 mmol/L respectively; p˂0.001). Our results showed that sodium and potassium levels measured by blood gas analyzer and auto-analyzer were significantly different.

67 –74

Authors: Mwenya Kwangu, Sandra Chileya, Pierre Yassa, Nason Lambwe, Gibson Sijumbila

The main objective was to investigate the role of glucose 6-phosphate dehydrogenase deficiency in aetiology of essential hypertension. An analytical cross-sectional design was applied to 89 essential hypertensive participants and 89 healthy normotensive participants, making a total of 178. All the participants were aged between 35 and 65 years. Blood was collected for G6PD activity and levels of blood nitric oxide, glucose, creatinine, urea and electrolytes. In addition, routine urinalysis was done. A logistic regression was used to investigate the association of age, sex, nitric oxide levels, and G6PD deficiency with essential hypertension as the dependant variable. The G6PD deficiency was found in 14 (16%) participants with essential hypertension and 9 (10%) control participants. The difference however, in the G6PD deficiency prevalence rate was not statistically significant (p= 0.13). Logistic regression analysis revealed that G6PD deficiency was significantly associated with increased risk for essential hypertension. The analysis further showed a significant association of age and essential hypertension with participants in age groups 46-55 and 56-65 being at higher risk of developing essential hypertension than those in age group 35-45. The study also revealed no association between gender and essential hypertension. The study showed that states that there is no difference in G6PD deficiency prevalence between the essential hypertensive and normotensive adults. The findings also demonstrated a possible role of G6PD deficiency in the pathophysiology of essential hypertension.

79 – 81

Authors: D Anil Kumar, V Shanmuga Priya, J Jaiprabhu, Krishnan Ramalingam

Alterations in plasma concentrations of several trace elements have been reported to occur in type 2 diabetes mellitus. These micronutrients are suspected to have a role in pathogenesis and progression of the disease. In a comparative analysis, the plasma concentration of copper and zinc was estimated in 50 patients with type 2 diabetes mellitus and 50 healthy non-diabetic subjects. Trace elements were estimated by using atomic absorption spectrophotometer. When compared to controls, cases (type 2 diabetic patients) showed significantly higher copper and lower zinc levels (P < 0.0001). Serum copper levels are significantly higher in type 2 diabetes mellitus patients, while serum zinc levels are significantly decreased when compared to controls.

87 – 90

Authors: Dr Jameel Ahmad

Medicines can be given to patients by different routes such as oral, topical, inhalation and parenteral. In the parenteral route of drug administration injections are among the most frequently used methods of drug delivery system and usually given for curative purposes and less than 5% cases for immunization. The correct vaccine administration is a very important component of a successful immunization. In India, 96% of all injections given by private practitioners include antibiotics, vitamins and analgesics and 66% of these injections are said to be unsafe. According to the WHO at least 16 billion injections are given every year in developing countries. The intramuscular (IM) and the subcutaneous (SC) injections are often referred as “basic skills”. The unsafe injection practices can give rise to the transmission of many blood borne diseases and complications such as abscess at the injection site, nerve injury and infections (Hepatitis B and C, and HIV etc). The reuse of syringes is another problem in some countries and it is also common in India. The injection practices are not always rational and research-based practices. So there is need to promote the research based injection practices for the safety of patients and the health care providers. The present article focuses on the issues related to the intramuscular and the subcutaneous routes of drug administration. This is particularly important for health care providers involved in the drug prescribing.

105 – 107

Authors: Anoop Sreevalsan, D Kavitha, Vasantha N Subbaiah

Ovarian pregnancy is a rare form of ectopic pregnancy. Although ectopic pregnancies have been reported to implant in the cervix, ovary, interstitial tubal segment, and at various intra-abdominal sites, majority of ectopic pregnancies are identified in the fallopian tube. Data regarding these unusual ectopic pregnancies come largely from case reports and anecdotal information. Management and treatment of these ectopic pregnancies includes various combinations of surgery and/or systemic and local chemotherapy. In this article we present a rare case of ovarian pregnancy which was diagnosed intraoperatively and managed successfully.

1 – 6.

Authors: Jolanta Walasz, Teresa Matthews-Brzozowska, Maja Matthews-Kozanecka, Dorota Cudziło

General muscle hypotonia, including hypotonia of the oro-facial muscle complex, is one of the characteristics of Down syndrome. To eliminate this disorder, oro-facial therapy with the use of a palatal plate is employed. The aim of this study is to assess the influence of the types and positioning of stimulation elements in palatal plates on the tongue position and mimetic muscles in children with Down syndrome. The study was conducted on 50 children with Down syndrome between the ages of 3 months and 2 years (22 boys, 28 girls) who were treated by means of palatal plate therapy in the Department of Maxillofacial Orthopaedics and Orthodontics at the Poznan University of Medical Sciences. The study analysed the responses received from the parents and the orthodontist to the questions included in a questionnaire developed for this study as well as the photographic documentation produced during every appointment over a period of two years. In total, 90 palatal plates were made for the children with stimulation elements in the form of a cylinder with a "roller" or a movable bead. The plates were replaced on average every 6 months in order not to inhibit the growth of the jaw. The study found that in 50 children who underwent palatal plate oro-facial therapy there was an improvement in the visual appearance of the mimetic muscles and tongue retraction, as well as improved lip closure. None of the children experienced deterioration in their condition. The stimulator in the form of a cylinder with a "roller" had a greater influence as regards improvements in the appearance of the mimetic muscles and lip closure, whereas a movable bead threaded on a wire and secured to the plate produced a greater improvement as regards tongue retraction. The positioning of the stimulation element closer to the alveolar ridges rendered better therapeutic results in the youngest children, whereas placing it in a central or posterior position produced better results in the older children.

10 – 12

Authors: Eyad Safadi, Aser Hrout, Zahi Majali, Nisreen Alkurdi, Sana'a Sulieman Al-Ali

Objective is to evaluate our clinical experience in dealing with recurrent respiratory papillomatosis (RRP) at Queen Rania Al-Abdullah Hospital for children. A total number of 9 patients (8 males, one female) were diagnosed by means of history; physical examination and flexible nasopharyngolaryngoscope .Patients age at time of presentation were 2-10 years. The presenting symptom was just hoarseness of voice in 5 patients (group 1). Hoarseness and dyspnoea on exertion in 3 patients (group 2) and respiratory distress in only one patient (group 3). All 9 patients had been treated by microdebrider excision using apnoic technique. In 3 of patients (group 2) we injected MMR vaccine intralesional and we injected sometimes MMR vaccine and sometimes Cidofovir intralesional in only the most severe case (group 3). In group 1 and 2 the post operative symptom free period was 6-8 months. In group 3 the symptom free period was 4-5 weeks when MMR was injected and 10-12 weeks when Cidofovir was injected. Recurrent Respiratory Papillomatosis (RRP) is a benign neoplasm caused by HPV, it affects mainly children, it has high recurrence rate with remissions. Best results are achieved using microdebrider and Cidofovir intralesional injection.

19 – 23.

Authors: Najeh Alomari, Asma Aref Idamat

Gastroesophageal reflux disease (GERD) is common in pediatric age group due to incomplete maturation of the antireflux mechanism. Vomiting and regurgitation are frequent manifestations in pediatric age group and are important for consideration when they adversely affect their nutritional status and recurrent chest infection due to aspiration. Medical treatment may not control (GERD), so surgical treatment is the remaining choice to control GERD and late complications. In this study, we present our experience in laparoscopic Nissen fundoplication for the management of (GERD) in children over 5 year period, acceptability, safety, efficacy and outcome. The data of all patients undergoing fundoplication for (GERD) at Queen Rania Hospital for Children / King Hussein Medical Center were retrospectively reviewed of prospectively collected data from April 2008 to 2013. Ages ranged from 3 months to 15 years. All laparoscopic fundoplications were performed by a single surgeon. Patients were evaluate for the indications for surgery, diagnostic modalities, duration of surgery, peroperative complications, pain management , hospital stay , post operative course, morbidity, mortality and the need for re operation. We used the Enseal vessel sealing device and hook diathermy through 5 and 3 mm ports for dissection and division of short gastric vessels and excision of the hernia sac. Over the last 5 years, 80 laparoscopic Nissen fundoplication for GERD were performed, 12 patients had GERD associated with thoracic stomach, 3 patients had esophageal achalasia underwent cardiomyotomy & fundoplication, 14 patients had neurological impairment. Weight ranged from 3, 5 to 82 kg. Mean age 5 years, range (3 months – 15 years), 50 males and 30 females. The indications for surgery were thoracic stomach and Barret esophagus due to (GERD), other indications were severe esophageal ulceration, stricture, recurrent bleeding, para-esophageal hernia and recurrent aspiration pneumonia. Five patients had previous repair of esophageal atresia. Mean operating time was 120 min (range 45 -240 minutes). The mean hospital stay was 2 days, range from 1 to 4 days. There were no intra-operative and post-operative complications. One conversion to open fundoplication was required due to technical fault of the CO2 insufflator. Six patients had laparoscopic gastrostomy insertion in addition to Nissen fundoplication. Blood transfusion was not required in any case and no mortality. There was no need for re do surgery. The vast majority of patients showed significant respiratory improvement as well as control of emesis and hematemesis. This study shows that laparoscopic Nissen fundoplication for GERD in children is rapidly becoming the procedure of choice for surgical correction because of the advantages of reduced discomfort and decreased hospitalization. It is feasible, effective and safe technique. Laparoscopic Nissen fundoplication operation times in children reduced by experience. The surgical skills are important to improved outcomes include adequate length of intraabdominal esophagus, minimal hiatal dissection and tension-free wrap. The results are superior to the traditional open fundoplication. Laparoscopic Nissen fundoplication should be considered the gold standard for anti reflux procedures. The length of hospital stay and convalescence is short and hence rapid return to normal activity is expected with less analgesia requirements. Follow-up examination verified perfect clinical, radiological and endoscopic findings. The cosmetic, endoscopic and functional results were excellent with very good patients and family satisfaction.

30 – 42

Authors: Anthony Kodzo-Grey Venyo

Primary angiosarcomas of the urinary bladder are very rare in view of this their clinical and pathological features have not been extensively described. Literature on primary angiosarcoma of the urinary bladder was reviewed performing an extensive search using various internet search engines for case reports, case series and review papers on primary angiosarcoma of the urinary bladder excluding metastatic angiosarcomas. Primary angiosarcomas of the bladder are rare tumours which are more commonly found in men and quite often present with haematuria, cystoscopy reveals raised lesions in the trigone / dome. Microscopic examination of the tumour tends to show anastomosing vascular channels lined by plump hyperchromatic cells as well as solid and epitheliod cytology. Typically the tumour is locally invasive invading the muscularis propria. The tumour stains positively with CD31, CD34 and can be focally positive especially in cases of epitheliod tumours. Few cases have so far been reported and on the whole previous reports have indicated poor prognosis. However, recent anecdotal reports have indicated that multi-modality treatment with radical cystectomy and adjuvant combination chemotherapy and radiotherapy may result in long term survival. Primary angiosarcomas of the urinary bladder tend to affect middle-aged and elderly men. Anecdotal reports have indicated longer term survival with multi-dal treatment strategy unlike previous reports which on the whole indicated poor prognosis. There is no consensus opinion regarding their treatment. There is therefore the need for a multi- centre trial to determine the best treatment options that would improve the prognosis for these tumours.