Open Access Review Article

Imaging Appearances, Diagnosis and Treatment of Atypical Brain Abscesses: Review of the Literature

K. Agyen-Mensah, H. Akoto

Asian Journal of Medicine and Health, Page 1-17
DOI: 10.9734/AJMAH/2017/31739

Introduction: Atypical brain abscesses mostly occur in immuno-compromised patients especially in various endemic regions of the world. The atypical imaging appearances as well as other diagnostic difficulties cause delays in making diagnoses and hence prognosis is generally very poor. Outcomes can be improved if the clinician has a high index of suspicion in a patient with positive risk factors and suggestive radiological appearances. This will enable early institution of appropriate therapy to improve outcomes.

Methods: A review of existing English literature was done by performing a PubMed search. The various imaging appearances of atypical brain abscesses are described and recommendations made to aid early diagnosis and treatment of atypical brain abscesses.

Results and Discussion: The clinical features of atypical brain abscesses are mostly insidious and non- specific and occur frequently with a medical background of obvious or latent immunodeficiency. The imaging appearances of atypical brain abscesses including Brain CT and MRI scans can be very atypical and non-specific but with the application of modalities like Diffusion Weighted Imaging (DWI) and MR Spectroscopy, atypical brain abscesses can be differentiated from pyogenic bacterial brain abscesses, granulomas and brain tumours.

Microbiological identification has also progressed with advances in molecular microbiology, nuclear medicine and immunology, making differentiation of the various causative organisms of atypical brain abscesses possible and more readily.

Clinical management relies upon early surgical drainage or excision and early use of intravenous antimicrobial agents adapted to the strains identified. Most fungal species are susceptible to Amphotericin B, Voriconazole, Caspofungin, Itraconazole and to a lesser extent Fluconazole. Nocardia species are treated with Cotrimoxazole, Amikacin and Linezolid whilst Toxoplasmosis can be successfully treated with Pyrimethamine and Sulphadiazine or Clindamycin. Actinomyces abscess can be treated with Penicillins and Mycobacterium abscesses are treated with antituberculous agents- Isoniazid, Pyrizinamide, Rifampicin and Ethambutol. Adjuncts to therapy include CSF diversion, corticosteroid and antiseizure medications.

Conclusion: A high index of suspicion, careful reviews of radiological images, early pus/abscess wall samples obtained by drainage, biopsy or surgical resection are needed to establish a definitive microbiological diagnosis and prompt administration of appropriate antimicrobial agents will improve outcomes of atypical brain abscesses.


Open Access Review Article

Development or Adaptation of Clinical Guidelines in the Health System of Developing Countries: A Review Article

Fatemeh Bahramnezhad, Parvaneh Asgari, Neda Sanaie

Asian Journal of Medicine and Health, Page 1-7
DOI: 10.9734/AJMAH/2017/31134

Clinical guideline is one of the best approaches to improve clinical care. The content of this study is part of a database review which has been developed by reviewing and studying the world’s most renowned organizations’ approaches in guideline development. This study attempts to point out the importance of development or adaptation of clinical guidelines in developing countries such as Iran. This study will look at: benefits and characteristics of clinical guidelines, identification and refinement of subjects in a guideline, the world’s wide approaches to the use of clinical guidelines and preparation and adaptation of clinical guidelines in Iran.

In developing countries such as Iran adaptation of clinical guidelines is very important and is considered as a top priority. Because in the development of original guideline, in addition to a deep knowledge base about the desired subject the developer should have in-depth and comprehensive knowledge and metrological sciences expertise.

Open Access Original Research Article

Antimicrobial Assessment of Annona muricata Fruits and Its Chemical Compositions

Rosemary I. Uchegbu, Jacinta N. Akalazu, Kalu U. Ukpai, Irenus C. Iwu

Asian Journal of Medicine and Health, Page 1-7
DOI: 10.9734/AJMAH/2017/31927

Aim: To determine the antibacterial activity of Annona muricata fruits against some human pathogens, the fungi associated with deterioration of Annona muricata fruits and the chemical compositions of the fruits.

Study Design: The study was designed to test the inhibitory ability of the plant extract on human pathogens, to identify the fungi associated with deterioration of Annona muricata fruits and determine its chemical compositions by GC-MS.

Place and Duration of Study: Department of Chemistry, Alvan Ikoku Federal College of Education, Owerri and Department of Plant Science and Biotechnology, Imo State University, Owerri, Nigeria, between June to November 2016.

Methodology: The antibacterial activity of Annona muricata fruits was performed by filter paper disc diffusion technique. Pieces of the sour sop sections were plated on potato dextrose agar (PDA) plates each and incubated at 27ºC and the plates examined daily for the development of fungal growth. The chemicals from Annona muricata fruits were extracted with ethanol and subjected to GC/MS analysis and the identification of compounds was done by comparing spectrum of the unknown component with the spectrum of the known components stored in the NIST library.

Results: The results of the bacterial analysis showed that the ethanol extract inhibited all the tested organisms S. aureus, P. mirabilis, K. pneumoniae, Salmonella and E. coli. which justified the use of the  plant in the treatment of diarrhea and other infections by Herbalists. The fungal pathogens found to be associated with the rotting of A. muricata fruit included Aspergillus niger (Tiegh), Aspergillus flavus (Link), Rhizopus stolonifer (Ehrenb.), Fusarium oxysporium (Schlech), and Botryodiplodia theobromae (Pat.). The most pathogenic fungi was B. theobromae which caused rot of 11.48 mm2, followed by R. stolonifer that caused rot of 4.03 mm2. The least pathogenic fungus was A. niger causing rot area of 2.51 mm2. The GC-MS analysis revealed that ethanolic extract of Annona muricata fruits contains seven compounds with 5-Hydroxymethylfurfurole constituting the bulk of the oil (29.95%), followed by 3,5-Dihydroxy-6-methyl-2,3-dihydro-4-H-pyran-4-one (28.57%). The oil contains an ester, Butanoic acid,2-methyl-3-oxo-ethyl ester (5.35%) which may be responsible for the sweet aroma of the fruit. Other compounds present were Furfural (6.25%), 4- Hydroxy-2,5-dimethyl-3-hexanone (13.84%), 2,5-Dimethyl-4-hydroxy-3(2H)-furanone (3.13%) and Oleic acid (12.95%). These compounds possessing a wide spectrum of pharmacological activities justified the use of this plant for the treatment of ailments traditionally.


Open Access Original Research Article

Awareness and Perception as Factors in the Consumption of Homemade Alcoholic Beverage among Irele Community Members, Ondo State, Nigeria

Dayo Adeyanju, Akinola Ayoola Fatiregun, Elizabeth Adedire, Adewale Moses Adejugbagbe, Adefisoye Adewole, Oluwapemi Fadahunsi, Michael Oguntoye, Kayode Ojo, Akinyode Akinfemi, Maureen Anyanwu, Elvis Isere

Asian Journal of Medicine and Health, Page 1-11
DOI: 10.9734/AJMAH/2017/30746

Aim: We assessed the perception and pattern of consumption of homemade alcoholic beverages among community members in Irele Local Government Area (LGA), Ondo State, Nigeria following an outbreak of acute methanol poisoning in the LGA in April, 2015.

Study Design: This is a descriptive cross-sectional study.

Place and Duration of Study: This study was conducted in two communities affected by an incident of acute methanol poisoning in Irele LGA in May, 2015.

Methodology: A multistage sampling technique was employed to select 197 community members who were interviewed using a semi-structured questionnaire. Data were obtained on the socio-demographic characteristics, knowledge, perception and consumption of homemade alcohol. The perception of respondents was determined by assigning a point each to 13-item statements indicating right views about alcohol consumption. Respondents with scores above 7 points were considered as those with favorable perception.

Results: Two hundred participants were approached, out of whom 197 responded. In general, 45.7% had favorable perception and 66.0% reported to be currently taking homemade alcoholic beverages. Although, 70.1% of the respondents were aware of the long-term health effects of consumption of the beverages, only few among those that were aware knew major health effects such as liver cirrhosis (11.5%) and cancer (0.7%). Significantly, having secondary education and above (OR=2.9, 95% CI=1.2-6.9), not taking of homemade alcoholic beverages (OR=3.3, 95% CI=1.8- 6.2) and being aware of the health effects of their consumption (OR=2.9, 95% CI=1.5-5.8) were predictors of favorable perception.

Conclusion: The level of consumption of the homemade alcoholic beverages was high among the community members, although, few had good knowledge and favorable perceptions about their intake. Education interventions on the health consequences of taking the locally made alcohol should target those with low level of education and currently taking the substances.


Open Access Original Research Article

Some Haematological and Haemostatic Indexes in Young Semi-vegetarians in Sub-Sahara Africa

A. A. Adeyemi, Y. O. Makinde, O. A. Omolade, O. I. Ajayi, O. A. Awodu, A. A. Famodu

Asian Journal of Medicine and Health, Page 1-5
DOI: 10.9734/AJMAH/2017/31634

Background: The protective power of vegetarian diet against diseases is not a hype but there is a scarcity of information concerning the impact of semi-vegetarian meals on wellbeing, especially, in young adults living in Africa.

Study Design: This study investigates the impact of semi-vegetarian diets on some haematological and haemostatic indexes in young semi-vegetarians in a Seventh day Adventist cohort in Nigeria.

Results: Packed Cell Volume (PCV), and Hemoglobin concentration (HB) Platelet count (PLT), Prothrombin Time (PT), and Partial Thromboplastin Time (PTT)  of the subjects are significantly higher than that of the controls (P<0.05), Erythrocyte Sedimentation Rate (ESR) is not significant in both groups, and Plasma Fibrinogen Concentration (PFC) is significantly lower in the subjects than in controls (P<0.05).

Conclusion: Semi-vegetarian diets may have a positive impact on cardiovascular and hemostatic risk factors in young semi-vegetarians in Nigeria, and likely to be superior to omnivorous diets.