Nontuberculous Mycobacteria in Critical Care

                                                      http://austinpublishinggroup.com/tuberculosis/

Recentstudies inpatients, who are hospitalized in Intensive Care Unit (ICU), show that 51% of them have infections, and 71% are given treatment. Bacterial and some fungal infections, as opportunistic microorganism are the primary concern. Hospitalizing in ICU is associated with increasing in mortality rate and excess expenses. Pharmacokinetics, absorption, distribution, metabolism, and excretion of drugs experience many changes in critical illness.

NTM, are a group of mycobacteria which is not a causative organism of tuberculosis or leprosy, so they called as Mycobacteria Other Than Tuberculosis (MOTT). NTM bacteria are a family of small, rod-shaped bacilli which have more than 150 species. Atypical mycobacteria have different favor in choosing their environment and are identified as environmental mycobacteria. NTM are the causative organisms in pulmonary diseases like tuberculosis, lymphadenitis, skin disease, or disseminated disease. Major clinical manifestations of NTM Infections are presented in Table 1. In 1950s, they were accepted as human pathogens. Unlike tuberculosis and leprosy, spreading NTM infections from one person to another person is rare. Environmental exposure is the major way of contagion. The risk of getting infected by a particular species of NTM is dependent on pathogenicity of microorganism, the method of exposure and frequency of exposure. In the last decade, (NTM) infections have worldwide increasing in incidence and mortality. The reasons for this increase are not obvious. But increasing incidence of acquired immune compromised syndrome, cancer, diabetes mellitus, chronic lung injuries, and continues supportive ventilation could be causative.

A retrospective study in medical center of Taiwan from January 1999 to June 2007 was planned to evaluate medical ICU patients whose respiratory specimens were positive for NTM. They defined tree group of patients, one group with NTM pulmonary infection, the other with NTM colonization and a control group who have culture negative samples for mycobacteria. Clinical sign, symptoms and outcomes were compared. Their finally result was that, increment in mortality rate in patients who have NTM pulmonary. Suitable treatment against NTM would followed by better result.

Urban-Rural Disparities in Female Cancer Incidence and Mortality in Trivandrum, South India

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Significant differences in cancer incidence between urban and rural women have been reported and for the same type of cancer, rural women are generally diagnosed at a later stage and have decreased survival rates as opposed to their urban counterparts. This has been shown for cancers such as breast, colo-rectum in both developed and developing countries. Rural women may suffer significant inequalities in terms of access to medical care and health awareness and these women tend to be less educated with lower economic means. Poorer hygienic conditions tend to aggravate physical threats in rural areas. Conversely, mechanized life-style, stress and air pollution are more widespread in urban environment.

Currently, lifestylehomogenization, particularly in developed countries, and the increased opportunities to healthcare access in rural population, has led to a minimal difference in cancer pattern. However, within Asia, large differences in cancer pattern are found between urban and rural population. Incidence rates of cancers such as cervix uteri, esophagus, stomach etc. are generally low in urban than rural population. In contrast to this, cancers such as breast, corpus uteri, ovary, colo-rectum etc. incidence rates are higher in urban than rural.

Cancer incidence particularly breast cancer among women in Kerala, South India, is a growing threat to public health. In urban Trivandrum other cancers such as corpus uteri, colo-rectum and kidney are also reported as the highest in the country (NCRP 2016). In Kerala, urban-rural difference according to education among women is minimal (literacy rate: 84.6% urban vs. 81.6% rural) (Census of India 2011) and the distances by road between the main oncology centers in Trivandrum and the rest of the regions are small. It is therefore possible to hypothesize that urban-rural differences in health care access is minimal. However, the magnitude and pattern of cancer incidence and mortality may differ by type of residence due to the difference in socio-demographic and life-style factors.

Atrial Fibrillation in a Patient with Subacute Thyroiditis

                                           http://austinpublishinggroup.com/thyroid-research/

Thyrotoxicosiscaused by subacute thyroiditis is self-limited and results from the subacute release of preformed thyroid hormone. Our data showed that the hyperthyroid state may last for 1 or 2 months as the stored thyroid hormone is depleted. It may be followed by a hypothyroid phase in approximately 60% of the cases, but 91% of them return to the euthyroid state and the remaining 9% remained hypothyroid, as presented in Figure.

Atrial fibrillation occurs in up to 15% of patients with hyperthyroidism compared to 4% of people in the general population and more common in men. But the case report of subacute thyroiditis with atrial fibrillation is rare. We report the case of a 54-year-old man with subacute thyroiditis who had unexpected atrial fibrillation.

A 54-year-old man presented to our observation in November 2017 with 10 days of neck pain, high fever, chills, fatigue, sweating, dysphagia, odynophagia, palpitation, and an 8kg weight loss. A recent history of upper respiratory tract infection was not evident. Bilateral thyroid pain and tenderness were noted. Past medical history was not significant. Family history was pertinent for his niece with hyperthyroidism. On physical examination, the patient had a temperature of 39.9^oC, blood pressure of 110/70 mmHg, and weight of 55kg. There was no proptosis, lid lag, conjunctiva; redness, periorbital edema, or erythema. His thyroid gland was enlarged to 48g (normal range 15-35g) estimated by ultrasonography without palpable nodules or lymphadenopathy. Both sides of the anterior thyroid gland were tender to palpation.

Review of Lavender Aromatherapy: Past, Present, and Future

                                       http://austinpublishinggroup.com/therapeutics/index.php

Complementary and Alternative Medicine (CAM) is a practice that incorporates unconventional medical therapies such as aromatherapy, acupuncture, and massage in order to alleviate medical problems. CAM practice is a huge undertaking in the United States, in a 1993 report in the NEJM 1 out of 3 Americans used CAM therapies. It was estimated at that time that $13.7 billion dollars per year were spent on CAM therapies and that three quarters were paid out of pocket. In 2007 it was determined that 4 out of 10 adults in the U.S. used CAM therapies, which is a significant increase since the prior study [2], and the National Center for Complementary and Integrative Health reported that $33.9 billion were spent on CAM therapies. It was further determined that when there was concern about the cost of conventional care, individuals were more likely to use CAM therapy. 

Aromatherapy is commonly defined as therapy through the use of aromatic plant extracts and essential oils through various methods (inhalation, oral, massage, baths). The physiologic effects of aromatherapy have been recognized in folk medicine for many years. In particular, lavender oil has been attributed to have mood enhancing and analgesic properties by aromatherapists. As alternative medicine continues to grow, aromatherapy is at the forefront of this growth [6]. Interest in lavender oil in particular has increased, not just in retail but also in the medical community. Lavender oil in vapor form is purported to have multiple beneficial effects in humans including: relief of anxiety, analgesia, sleep improvement, pain relief, and decreased restlessness. Many recent clinical trials have supported these claims and suggest that lavender aromatherapy can be a useful adjunct to standard care.

An Unusual Presentation of Nocardiosis - A Report of Two Cases

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Nocardiosisis an opportunistic infection more common in immune compromised hosts. Disseminated nocardiosis has a poor outcome. We report a case of disseminated nocardiosis with nocardaemia (case-1) which is an extremely rare finding even in immune compromised subjects. In case-2 we found pulmonary abscess caused by nocardia in a patient of sarcoidosis on steroids. Vascular thrombosis complicating nocardiosis is not recognized. We report two cases of nocardiosis with arterial thrombosis.

Nocardiaspecies are saprophytic aerobic actinomycetes and are common worldwide in soil causing decay of organic matter. It is an opportunistic pathogen causing significant morbidity and mortality in human beings. It predominantly affects lung with pre-existing structural defects and also with co-existing mycobacterial infection. Disseminated nocardiosis occurs through haematogenous spread to distant organs including brain (commonest), bone, soft-tissues and kidney; whereas peritoneum and heart valves only rarely affected. Isolating nocardia in blood culture (nocardaemia) is extremely rare. Endovascular foreign body e.g. prosthetic heart valve is a unique risk factor for nocardaemia but our patient (case I) did not posses any such foreign body. Nocardia bacteraemia is also associated with simultaneous infection with other bacterial pathogens, especially Gram negative organisms in 30%. First patient had concomitant Klebsiella infection [Extended-Spectrum Beta-Lactamase (ESBL) producer in lung. Surprisingly in both the cases vascular thrombosis complicated the picture-thrombosis in pulmonary trunk was in case- 1 and lacunar infarcts of brain found in case-2. Nocardiosis and vascular thrombosis may be causally related.

A 52 yr old gentleman presented to our clinic with fever and dry cough for 15 days. He also complained of chest tightness and exertional breathlessness for the same duration. His fever was low grade, intermittent in nature and subsided only on taking antipyretics. It was associated with cough without expectoration, hemoptysis or chest pain.

Registration of Road Traffic Injuries at Emergency Departments in the Netherlands

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In the Netherlands, direct medical costs of road traffic accidents resulting in an ED-visit or hospital admission are high, comprising €400 million. This is 21% of the total direct medical costs in the Netherlands (€1,9 milliard). Understanding causes and risk groups provides important information for improving road safety and reducing high costs of health care. For several authorities, but especially at regional and local level, acquiring road traffic accident data is an important issue. It is known that the Registered Crashes database - containing the Dutch police data - does not provide sufficient data. The Dutch Injury Surveillance System (DISS) of the Consumer Safety Institute registers the number of injury-related ED-visits in the Netherlands due to different causes, such as occupational –and road traffic injuries. The goal of this study was to establish risk groups and risk factors for road traffic accidents.

The Dutch Injury Surveillance System (DISS) registers data of individuals who visit Emergency Departments (EDs) of a selection of 13 hospitals in the Netherlands, injured due to an accident, an act of violence or self-harm. These hospitals form a representative sample of the general and university hospitals in the Netherlands providing a 24 hour accident and emergency service. This enables extrapolation of the recorded injury cases and of subsets of cases to national estimates. The quotient-estimate method is used, for extrapolation, given the auxiliary variable ‘number of ED-visits in the Netherlands.

In DISS a variety of variables is registered, for example demographic characteristics, referral to the ED and circumstances of the accident. In terms of road traffic injuries, the most important variables are ‘mechanism of transport accident’, ‘mode of transport victim’, ‘transport function victim’, ‘injury mechanism’ and ‘type of injury’. In addition to these variables DISS registers a description of accident circumstances and location, if present. In the participating hospitals ED staff registers the data for every injury patient in the Electronic Medical Record (EMR). To minimize the workload of the ED staff, existing data (e.g. gender, age, admission date and referral to the ED) of the EMR are used as much as possible. More specific variables like ‘means of transport’ require an additional registration of the ED staff in the EMR. The ‘injury mechanism’ (e.g. collision with an obstacle) and ‘type of injury’ (e.g. bone fracture) are filtered out from an open-text field by an automatic text processor. In order to obtain the best possible quality and completeness of data, the ED staff is instructed by the Consumer Safety Institute about encryption and how to fill in the open-text fields. In order to ensure the patients privacy an opt-out procedure is part of the data collection procedure.

6 Year Old Boy with a Right Posterior Thoracic Mass

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Bronchogenic cysts result from the abnormal or late budding of the ventral lung bud or the tracheobronchial tree during the process of the development. Primary Bronchogenic cysts of cardiac origin or extension are rare. Bronchogenic cysts can be detected in fetus or in stillbirths and it is well recognized in babies or infants. Bronchogenic cysts are rare lesions which originate from primitive tracheobronchial tree. They are primarily located in the thorax. Extrathoracic locations may be either in the immediate vicinity of the thoracic cage or more remote periscapular location which is extremely rare. The clinical presentations are usually releated to trancheal and tracheobronchial compressions. Typical localization of bronchial cysts has been reported for esophageal, pericardial, dermal cervical, diaphragmatic or intradural spaces, but such localizations are very rare.

A 6-years old male with presented with chest typical chest pain, discomfort, paroxysmalpalpitations continuing, for one month, cough, fever was admitted in our department with bronchogenin cyst extending to the right atrial wall. Physical examination, chest radiography, and blood analysis were found to be normal. The computed tomography (CT) confirmed giant cystic mass with a diameter of 6,5 x 5,5 x 5,5cm. Following standard a right posterolateral thoracotomy, we performed tumor enucleation and managed to resect the cyst from the atrial wall with the use of a side-biting clamp on the right atrial wall, which was repaired with continuous 4-0 polypropylene sutures (Ethicon, Somerville, NJ, USA). The patient was taken to the intensive care unit and weaned off mechanical ventilation in 6 hours. He was taken to the ward next day and discharged from the hospital on the postoperative 5th day. Microbiologic examination ended sterile and Bronchogenic cyst diagnosis was confirmed with detailed histopathologic examination. Grossly, the excised tumor measured 6,5 x 5,5 x 5,5cm and had multi-cystic features with turbid contents. Microscopically the tumor consisted of thin-walled multiple cysts attached to the respected myocardium. The inner cavities were lined with pseudo-stratified ciliated columnar epithelium and cartilages, which are characteristic features similar to those of normal bronchi and confirm a pathologic diagnosis of Bronchogenic cyst.