Advances in Medicine

Background. Pneumonia is still a major global problem with high morbidity and mortality. The increasing number of pneumonia cases caused by bacteria, especially multidrug-resistant pathogens, increasing age of the population, patients with chronic disease (comorbid), and inappropriate antimicrobial therapy at initial administration make the treatment become less effective. These issues finally contribute to higher morbidity and mortality in cases of hospitalized pneumonia patients. Therefore, it is crucial to know the microbial pattern and select the therapy according to local antimicrobial sensitivity patterns. Method. A cross-sectional study was conducted for hospitalized pneumonia patients between January 2015 and December 2016 in Indonesia National Referral Infectious Disease Hospital. Data were collected from medical records to show patient characteristics, antimicrobial treatment data, culture examination, and bacterial sensitivity. Results. A total of 99 pneumonia patients required hospitalization and underwent sputum culture examination. The patients were mostly above 65 years old (32.3%) and male (57.6%). The most common comorbidities were pulmonary tuberculosis (21%), and the others were heart failure, chronic obstructive pulmonary disease (COPD), and HIV/AIDS. Based on the sputum culture, fungi were identified in most specimens (56%), while the bacteria identified were Klebsiella pneumoniae (14%), Acinetobacter sp. (12%), and Pseudomonas sp. (8%). Third-generation cephalosporin, such as ceftriaxone (50%), was commonly used as an antibiotic for pneumonia treatment. Conclusion. Most common bacteria isolated from sputum culture were Klebsiella pneumoniae which were more sensitive to the beta-lactam and aminoglycoside groups. The higher risk factors were age above 65 years old, being male, and having tuberculosis.

Background. Uncontrolled hypertension (HTN) is a challenge for public health professionals all over the world. It is the leading and most important modifiable risk factor for coronary artery disease, congestive heart failure, stroke, renal diseases, and retinopathy. The aim of the present study was to estimate the prevalence of uncontrolled HTN among Palestinian hypertensive patients on treatment. In addition, the study aimed to explore the relationship between socio-demographic and clinical factors with HTN control as well as establish a comprehensive literature review for similar studies. Methods. A cross-sectional study was conducted. 218 hypertensive patients who met the inclusion criteria were included in the study. Results. HTN is not adequately controlled in over 60% of treated patients. Factors that were linked to uncontrolled HTN and were statistically significant as per this study were diabetes (), high BMI (), smoking (), lower educational level (), and monotherapy (). Conclusion. The results suggest that effective efforts on improving HTN control are strongly needed. The efforts need to target hypertensive patients who are also smokers, diabetics, having a low education level, and have a higher-than-normal BMI.

In this study, we evaluated the diagnostic value of carpal dimensions in wrist plain radiography for the screening of carpal tunnel syndrome (CTS). This is a case-control diagnostic probe in which patients with severe CTS documented by electrodiagnostic study and healthy subjects as controls were enrolled. In the posteroanterior view of the wrist plain radiography in both groups, we defined and measured the carpal ratio, and the results were analyzed deploying statistical software. In this study, 119 participants, including 50 patients and 69 healthy subjects, were recruited. According to the ROC chart, the cutoff points, positive and negative predictive values, and the diagnostic accuracy for the cutoff points were calculated.

Background and Objectives. SARS-CoV-2 virus has caused a global pandemic as declared by the World Health Organisation (WHO) in March 2020. In India, the first case was reported in Kerala on the 30th of January, and since then, many states are active but some are showing flattening. Following the seroprevalence testing in healthy blood donors, we can monitor the spread of the virus among healthy people, thus eventually leading to implementing strategies to reduce the spread. Thus, a need was felt to conduct a study to assess the IgG antibody status in healthcare workers differentiating those who were in COVID-19 and others in non-COVID-19 emergency duties during this pandemic. Materials and Methods. 2085 blood donors were allowed to donate blood only after fulfilling all the criteria laid down by the FDA of India with additional history of excluding COVID-19 suspects. IgG antibody testing was performed by chemiluminescence, and results were noted along with their reactive status. Their reactive status was analyzed with donor information to get an idea of the risk parameters for COVID-19. Medical healthcare workers in whom the study was carried out were 560, out of which 114 had worked in COVID-19 duties and 446 had worked in non-COVID-19 emergencies areas. COVID-19 area duties were further subdivided into triage, holding area, isolation, and COVID-19-related duties. The samples were run on architect i2000 and evaluated for their plasma immunoglobulin G. Results. Amongst the asymptomatic blood donors, 1.9% was found to be COVID-19 IgG antibody positive. It was observed that maximum COVID-19 IgG positivity (57.1%) was seen in the age group 18–29 years followed by 26.2% in the age group 30–39 years. Donors in the age group 40–49 years showed antibody positivity of 16.7%, and no antibody-positive donors were found above 50 years of age. COVID-19 IgG positivity was maximum in replacement donors (61.9%) followed by family donors (28.6%) and least involuntary donors (0.6%) Blood donors who showed high IgG positivity were mainly of labor class. Antibody IgG testing on medical healthcare workers showed 2.3% positivity. The healthcare workers who were posted in COVID-19 duties showed 4.8% positivity in the holding area (waiting area with the treatment of patients till their RT PCR report comes) and 5.7% in other COVID-19 areas related to laboratory work. Healthcare workers doing duties in COVID-19 areas showed 2.7% positivity, while those doing duties in non-COVID-19 emergency areas showed a positivity of 2.2%. Conclusion. Our study shows that the prevalence of detectable antibodies was low in the general population in India and many patients were asymptomatic as seen in the blood donors, especially the labor class. Maximum exposure was present in young healthy males of labor class who remained asymptomatic. The healthcare workers were more exposed to COVID-19 as compared to the general population probably due to lack of precaution and awareness. Those doing non-COVID-19 duties were also exposed appreciably and needed to take all the precautions required for COVID-19 duties.

Constipation is a condition that is very prevalent and is reported in up to 40 percent of individuals with intellectual and developmental disabilities (IDD). Constipation in this patient population is most commonly secondary to neuromuscular abnormalities, immobility, suboptimal diet, and medication side effects. History taking is frequently limited in adults with IDD due to communication barriers, often leading to a missed diagnosis of constipation. Inadequately treated constipation may lead to adverse effects including behavioral disturbances, fecal impaction, intestinal obstruction, and even death from intestinal perforation and sepsis. As a result, a high index of suspicion must exist for this patient population. Treatment in these patients requires an individualized approach, to reduce the constipation and its associated health complications.

Background. Biopsy is an important tool for accurate diagnosis of disease in histopathology which can be examined at multiple levels during microscopic examination. The initial sections may not be representative of the entire biopsy, which leads to frequent request for deeper sections. This study assessed the frequency and diagnostic utility of deeper sections in noncutaneous small biopsy specimens at a tertiary hospital. Material and Methods. All the formalin fixed noncutaneous small biopsy specimens received were processed for grossing followed by tissue processing and embedding. The paraffin-embedded blocks were cut into 3–5 µm sections, fixed in a glass slide, deparaffinised, and then stained with hematoxylin and eosin (H&E) stain as per the standard protocol. Deeper sections were instructed based on microscopic findings of initial slides. The overall frequency of deeper section, its levels of cutting, tissue survival, and outcome were assessed and interpreted for the final diagnosis. Results. A total of 125 cases (26.9%) from 464 samples received were requested for deeper sections. The most frequent deeper sections were from cervix (72 cases) followed by stomach (18 cases) and endometrium (17 cases). The deeper sections were performed most frequently at 4 levels (17.8%) followed by 5 levels (14.8%) and 6 levels (13.3%). Deeper sections revealed nondiagnostic additional features in 28.2%, while 2.2% showed additional diagnostic features. Likewise, 2.2% had tissue segment loss. The overall mean level showing additional features was 6 levels. Tissue survival increased in 13% cases and 1.5% had decreased survival. The most common reason for requesting deeper section was to enhance sensitivity and diagnostic accuracy of disease. Conclusions. Deeper sections often contribute to final diagnosis. Therefore, deeper sections on biopsies that cannot readily be diagnosed on routine levels are recommended regardless of size of the lesion and there should be uniformity in the practice of deeper sections across the globe.