Open Access Review Article

Damage Control in Surgery-An Expanding Concept

R. W. Seneviratne, M. M. A. J. Kumara, R. P. Abeywickrama, J. P. M. Kumarasinghe, U. I. Hapuarachchi, P. V. De Silva

Asian Journal of Medicine and Health, Page 1-8
DOI: 10.9734/AJMAH/2016/28588

Patients with multiple injuries suffer severe Physiological insult by single overwhelming hit or secondary hits leading to development of fatal triad namely Coagulopathy, Hypothermia and Acidosis. Without prompt corrective measures the patient will be pushed towards Systemic Inflammatory Response Syndrome, Organ failure and finally Death.

The concept of damage control surgery developed in order to prevent secondary hits due to magnitude of surgery and involves doing the minimal in the shortest possible time followed by stabilization in ITU before definitive surgery. Since then the concept has expanded.

The expansion of the concept of DCIS can be considered in four stages. First Stage involved Establishment of the Damage control Surgery (DCS) in severe abdominal trauma. Stage Two saw establishment of Damage control Resuscitation with DCS as a component. DCR, a systematic approach to exsanguinating trauma, incorporating several strategies to reduce morbidity and mortality is achieved by wide range of efforts to minimize fatal triad. Stage Three the concept encompassed other regions such as thorax, limbs and brain. Stage four extended it beyond Trauma in to critical surgical illnesses across a vast range which includes cholecystitis, bleeding peptic ulcers, intestinal obstructions and pyonephrosis.

DCIS has become a key component in trauma care saving many severely injured. Since origins in Abbreviated laparotomy, DCIS has evolved in to concepts of DCR and branched off to cover other areas and systems and also engulfed care of non-trauma surgical emergencies. More conceptual, technical and technological developments are expected in the future care of injured and ill.


Open Access Original Research Article

Plasmid Profile Analysis and Curing of Multidrug-resistant Bacteria Isolated from Two Hospital Environments in Calabar Metropolis, Nigeria

Elizabeth N. Mbim, Clement I. Mboto, Uwem O. Edet

Asian Journal of Medicine and Health, Page 1-11
DOI: 10.9734/AJMAH/2016/28587

Objective: The objective of this study was to determine the plasmid profile and curing of environmental isolates from General and Infectious Disease hospitals showing multi-drug resistance.

Methods: Isolates were obtained from air and surfaces of two hospitals using standard microbiological techniques. The isolates were then subjected to sensitivity using ofloxacin, reflacine, ciprofloxacin, augmentin, gentamycin, streptomycin, ceporex, nalidixic acid, septrin, amplicin, norfloxacin, amoxyl, erythromycin, chloramphenicol, ampiclox, levofloxacin, ampicillin, cefoxitin, amoxicillin and ceftazidime. Multi-drug resistant isolates were then selected for plasmid DNA analysis, quantification, electrophoresis and curing.

Results: The isolates that showed resistance to more than two antibiotics were S. aureus,             E. aerogenes, C. freundii, K. pneumoniae, P. aeruginosa, Salmonella species, S. marcescens, Proteus species, S. marcescens, E. coli, and coagulase-negative Staphylococcus. The extracted plasmid DNA ranged from 1.2 - 80.5 ng/ml in quantity and showed the presence of SHV, CTX-M and MecA genes in the isolates with sizes of 154, 300 and 600-1000 bp, respectively. All isolates had SHV while a few had CTX-M genes except S. aureus and coagulase-negative S. aureus which had mecA gene in addition. Chi-square and Fisher exact test for SHV gene was significant while CTX-M was not. Treatment with ethidium bromide showed that at a concentration of 0-20 µl, all isolates exhibited very heavy growth (+++), at 50-100 µl, only P. aeruginosa showed very heavy growth (+++) while other organisms showed heavy to moderate growth. However, at 400 to 1,000 µl, no growth was observed.

Conclusion: The presence of plasmid-borne multiple resistant genes is of great public health concern and this highlights the need for antibiogram and molecular typing in the control of nosocomial infections.


Open Access Original Research Article

Seroprevalence and Risk of Primary Maternal HCMV Infection among Pregnant Women in Taiz City, Yemen

Hafez Alsumairy, Talal Alharazi, Samirah Alkhuleedi, Waheed Alswiadi

Asian Journal of Medicine and Health, Page 1-7
DOI: 10.9734/AJMAH/2016/29000

Aims: To determine the risk of primary and previous HCMV infection among antenatal women in Taiz city.

Study Design: A descriptive cross sectional study.

Place and Duration of Study: This study was carried out on 100 pregnant women attending the antenatal clinic and hospitals of Taiz city during April to September 2014.

Methodology: A 100 Serum specimens were collected and screened for the presence of HCMV-specific immunoglobulin (Ig) IgG/IgM antibodies using the enzyme linked immunosorbent assay. The anti-HCMV-IgM antibody positive specimens were further subjected to avidity test. Consenting participants were instructed to fill a semi-structured questionnaire to obtain demographic and other related data. Results analysis was prepared using Pearson’s chi squared test for analytical assessment.

Results: Protective anti-HCMV-IgG antibody was detected in 99% pregnant women and 1% were vulnerable to infection. The 2% of anti-HCMV-IgM seropositive were undergoing a recurrent HCMV infection, according to the high avidity (>60%) test results interpretation. Statistically significant association (P< 0.05) between the anti-HCMV-IgG seropositivity of HCMV antibody and parity and blood transfusion was found.

Conclusion: Despite the very high seroprevalence of anti-HCMV-IgG protective antibody (99%) among pregnant women in Taiz city, there is no primary infection detected. Screening test of pregnant women to detect primary and seronegative susceptible women is necessary. A comprehensive study with a large sample size would be required.


Open Access Original Research Article

Clonal Endemicity of Clinical Isolates of Carbapenem Resistant Klebsiella pneumoniae from a Tertiary Care Hospital in North India

Joel Filgona, Tuhina Banerjee, Shampa Anupurba

Asian Journal of Medicine and Health, Page 1-11
DOI: 10.9734/AJMAH/2016/28785

Background: Dissemination of carbapenem resistant Klebsiella pneumoniae (CRKP) harbouring multiple resistance determinants constitute significant threat to hospital ecology.

Aims: This study analysed susceptibility of carbapenem non-susceptible K. pneumoniae (CNSKP) to tigecycline and colistin and the prevalence of CRPK and clonal diversity among clinical isolates of K. pneumoniae.

Study Design: Investigative.

Place and Duration of Study: The study was performed in the Microbiology Department, Institute of Medical Science, in association with Sir Sunderlal hospital, Banaras Hindu University Varanasi, during January 2012 to May 2015.

Methodology: Multidrug-resistance and non-susceptibility to carbapenem was determined by disk diffusion test. Further susceptibility of the CNSKP to ceftriaxone, cefoperazone, ceftazidime, carbapenems, tigecycline, and colistin was performed by agar dilution test and CRKP screened by standard protocol. Multiplex PCR amplification for blaNDM-1 and blaOXA-48 was performed on the CRKP using primers specific for each gene, while methyltransferase activity was determined on brain-heart infusion agar supplemented with gentamicin and amikacin. PCR amplification for methyltransferase genes (rmtF and rmtG) was determined using specific primers and typing was done by enterobacterial repetitive intergenic consensus (ERIC) PCR.

Results: Of the 238 K. pneumoniae isolates, 173 were MDRKP, 113 CNSKP and 75 CRKP. Susceptibility spectrum of CNSPK to doripenem, tigecycline and colistin was 40.4%, 56.0% and 84.1% respectively, while blaNDM-1, blaOXA-48 and methyltransferase activity among CRKP was 53.3%, 38.7% and 70.7% respectively. rmtF and rmtG occurrence among the methyltransferase positive isolates was 37.7% and 13.2% respectively. Thirty six profiles of single strain each and nine clonal types of CRKP were observed.

Conclusion: Declining efficacy of antibiotic and dissemination of clones harbouring several resistant determinants was observed, hence an urgent need for implementation of workable infection control policy in order to limit spread of MDR K. pneumoniae within the hospital.


Open Access Original Research Article

Seroprevalence of Hepatitis B and Listeriosis Co-Infection among Patients Attending Sickbay Hospital, Ahmadu Bello University, Zaria, Kaduna, Nigeria

M. Umar, A. A. Aliko, S. Idris, O. I. Daniel, A. S. Adam, A. Salisu, I. M. Abdulkarim, D. Danzarami, D. Y. Jobbi

Asian Journal of Medicine and Health, Page 1-12
DOI: 10.9734/AJMAH/2016/28933

Aims: A cross-sectional research study on the seroprevalence of hepatitis B and listeriosis co-infection among patients attending Sickbay Hospital, Ahmadu Bello University, Zaria was carried out, with view to characterize, identify and to determine the antimicrobial sensitivity profile of Listeria monocytogenes isolated from the HBV seropositive patients. 

Place and Duration of Study: The study was conducted at Sickbay Hospital, Ahmadu Bello University, Zaria, between August 2015 and June 2016.

Methodology: A total of 100 venous blood samples were collected from consenting patients presented to the study area suspected with hepatic disorders. The samples were centrifuged and the blood sera were obtained. The sera were qualitatively screened for HBsAg by immunochromatographic technique using rapid diagnostic device kit. Reactive sera for HBsAg were further confirmed by ELISA kits. Listeria monocytogenes was isolated from the HBV seropositive samples by standard methods and identified using biochemical characterizations.

Results: The results showed that the overall seroprevalence of hepatitis B was found to be 11 (11%) in the study area, with females and males accounting for 3 (8.6%) and 8 (12.3%) seroprevalences respectively.  The prevalence of hepatitis B — listeriosis co-infection was found to be 4 (36.4%). A statistical relationship (p= .56) was found between hepatitis B— listeriosis co-infection and the age of the patients. There is no significant difference between the prevalence of Hepatitis B — Listeriosis co-infection and the gender. All sex has equal chance of contacting the disease.

Conclusion: The seroprevalence of 11% HBsAg obtained in this study signifies high endemicity of HBV infection in the study area. There is presence of mixed infections of hepatitis B and listeriosis in the study area. The Listeria monocytogenes isolated from HBV seropositive patients was found to be highly sensitive to Penicillin (100%) and Ampicillin (100%) but resistant to Chloramphenicol (0%), Ofloxacin (0%) and Gentamicin (0%).