Volume 4 Number 5 May 2018

A Review on Iron Homeostasis and Anaemia in Pulmonary Tuberculosis

Authors: Obeagu Emmanuel Ifeanyi
Pages: 84-89
The paper discussed iron homeostasis and anaemia in pulmonary tuberculosis. Iron (Fe) is one of the most abundant elements in the earth’s crust and an essential nutrient for almost all known organisms. It is able to receive and release electrons during conversion from Fe (II) to Fe (III) and plays a major role in DNA production and in energy generation. A system of highly regulated mechanisms is in place to control iron homeostasis. Regulation occurs at both the systemic and cellular levels and influences a number of iron-associated proteins. The iron regulatory protein, hepcidin, plays an important role in the mechanisms responsible for AI and the inflammation-mediated alteration of iron homeostasis. Specifically, hepcidin binds to and degrades the iron export protein ferroportin and down-regulates expression of the iron importer DMT1.Since hepcidin transcription is induced by the pro-inflammatory cytokine, interleukin-6 (IL-6), inflammation leads to a reduction in iron absorption and causes iron to be sequestered in macrophages and enterocytes.The inflammatory cytokines that are released upon innate recognition of a pathogen induce changes in plasma concentrations of other proteins. This phenomenon is referred to as the acute phase response (APR) and the affected proteins are considered acute phase proteins (APPs). The iron homeostasis proteins ferritin, transferrin and hepcidin are considered APPs, as are C-reactive protein (CRP) and alpha-1-antichymotrypsin (ACT), both of which are often utilized in studies as markers of inflammation. In the context of infection, iron’s limited availability within the human body and its physiological importance to both hosts and microbes make it a valuable commodity. Many microbes depend on host-acquired iron and, in response; hosts use their complex system of iron regulation to modify their iron metabolism and restrict iron availability. Evidence links iron with PTB pathogenesis both from the perspective of the pathogen and the host. Upon infection, host immune recognition of Mtb induces a pro-inflammatory reaction that restricts iron access. Most strikingly, a pattern of altered host iron status characterized by high ferritin, low transferrin, and low hemoglobin has been identified as a risk factor for progression to PTB. Decreasing iron availability (regardless of the mechanism) reduces Mtb growth, and addition of iron to Mtb almost always enhances growth.

Psychological Interventions in Inpatient Medical Settings: A Brief Review

Authors: Lekeisha A. Sumner ; Waguih William IsHak ; Jonathan Dang, MD ; Brigitte Vanle ; Naina Mahtani ; Itai Danovitch
Pages: 73-83
Background: Behavioral health conditions are prevalent among patients in inpatient medical settings and when not adequately treated contribute to diminished treatment outcomes and quality of life. Substantial evidence has demonstrated the effectiveness of psychological interventions in addressing behavioral health conditions in a range of settings but, to a lesser extent with psychologically-based interventions delivered in inpatient medical settings. Purpose: The purpose of this paper is to increase attention on psychological interventions being delivered to patients across a broad spectrum of medical specialties in inpatient medical settings to support the implementation of interventions to address increasing patient needs. Methods: This selected, brief review of the literature sought to describe published psychologically-based interventions delivered in inpatient medical settings. A search for studies catalogued on PubMed from 2007 to 2016 was examined and studies were included in the review if they were delivered within inpatient medical settings. Two reviewers independently assessed relevant studies for criteria. Results: A total of ten articles met the inclusion criteria with interventions targeting outcomes across four primary domains: 1) pain and fatigue; 2) cognition; 3) affective/emotional and; 4) self-harm.  Several articles support interventions grounded in Cognitive-Behavioral Therapy and brief psychological interventions. Most studies reported favorable outcomes for the interventions relative to controls. Conclusions: Psychologically-based interventions, especially those that integrate components of cognitive-behavioral therapy and a multidisciplinary approach, can be implemented in inpatient medical settings and may promote improved patient outcomes. However, the quality of this evidence requires formal assessment, requiring more comprehensive reviews are needed to replicate findings and clarify effectiveness of interventions.

Epidemiological Aspects of Prostate Cancer at the Medical Oncology Service of the Yaounde General Hospital -Cameroon

Authors: Tchinda Fossi Cedric ; Nguendo Yongsi H. Blaise ; Atenguena Etienne ; Ndom Paul ; Mankollo Bassong Olga
Pages: 66-72
Background: The incidence of cancers is increasing worldwide, particularly in the developing countries as shown by recent cancer stastics from the WHO. It is even anticipated that with the increase in life expentancy, consequent upon inproved standard of living and globalization, the burden of cancers will increase within this millenium. With respective to cancer of the prostate, it is the most common type of cancer in urology. In developing countries, diagnostic is done at a late stage of evolution. In Cameroon, data on prostate cancer are scanty whereas the incidence of this disease is increasing. Objective: This article is designed to describe the epidemiological features of prostate cancer at the General Hospital of Yaoundé. Patients and methods: A 4-year retrospective study of patients seen with the diagnosis of cancer at the Medical Oncology unit of the Yaoundé General Hospital between January 2012 and December 2015. The demographic pattern (age of patients, socio professional activity, marital status), clinical features (cancer diagnosis), treatment modalities and outcome were studied. Main results: Of the 7 775 patients enrolled in the Medical Oncology Service over the study period, 1.4% (n = 108) cases of prostate cancer were seen. The prevalence over the study period was 1.38% and a relatively large annual growth of cases with an annual average of 27 cases was noted. The average age of patients was 67.82 years with a range of 34-83 years. The commonest presenting symptoms were the urinary frequency (54.63%) whereas the least common were fatigue (05.5%) and straining (03.70%). PSA was obtained in 49 patients, representing about 45.4% of all patients. Only 14 (01.26%) had biopsy reports. Conclusion: Prostate cancer is a major problem facing the aging male, and inadequate facilities make early detection difficult. Therefore, treatment is mainly palliative because of late diagnosis.

Molecular Detection of Beta-Lactam Resistance Genes in Staphylococcus Aureus Isolated From Women in Nasarawa State, Nigeria

Authors: Joseph WG ; Oti BV ; Tsaku AP ; Ajegena SA ; Ajegena BK
Pages: 60-65
Resistance to antimicrobials by pathogenic microorganisms has raised serious global clinical concerns in recent times. The present study aimed at detection of β-lactam resistance genes in S. aureus isolates from women with symptomatic and asymptomatic cases of urinary tract infections in Nasarawa state, Nigeria. A total of 200 non-repetitive midstream urinal samples were analysed and 50 (29%) bacterial isolates were identified as S. aureus. The susceptibility profile of the bacterial isolates to tested antibiotics was Nitrofurantoin (74.1%), Gentamicin (72.4%), Ciprofloxacin (65.5%), Ofloxacin (56.9), Augmentin (36.2%), Cotrimozazole (29.3%), Ampicillin (27.6%), Erythromycin (25.8%), Ceftazidine (20.7%) and Cefurozime (10.3%). Thirteen bacterial isolates were found to be resistant to all β-lactam antibiotics tested, out of which 7 were confirmed β-lactamase producers using the acidometric and iodometric methods. The detection of β-lactamase genes (blaZ, blaI and blaR1) was carried out and only five of the isolates were found to be expressing the blaI genes. This research finding suggests that β-lactam resistance by S. aureus may not be dependent only on the blaZ, blaI and blaR1 genes.

An Empirical Study of the Co-Creation of Values of Healthcare Consumers – The Perspective of Service Dominant Logic

Authors: Yu-Hua Yan ; Chih-Ming Kung
Pages: 54-59
Background: The major goal of this research is to fill in the gap of articles with insufficient theoretical support regarding the SDL and strategy of co-creation of values provided by medical and healthcare organizations. Approaching from the perspective of healthcare consumers, it examines relationships among interaction, willingness, competence, and value co-creation. Methods: The research is a cross-sectional study, with people seeking healthcare services in major hospitals in Taiwan as objects, Questionnaires were used as method for investigation and data collection. Results: The affecting factors of the co-creation of healthcare are education, occupation, with or without commercial insurance, willingness, competence, and interaction, reaching significant statistic standard (p <0.05). Conclusion: The co-creation of values cannot only rely on the efforts of the medical professionals, it also requires the cooperation and efforts of patients and their families.