Journal of Advances in Medicine and Medical Research

It is retrospective and hospital based case control study which was conducted in the federal city of Islamabad in Pakistan in order to assess the risk factors of the urinary bladder cancer. This study was based on the 100 controls and 50 cases comprising 150 subjects which were selected for interview from the two hospitals and required information like gender, age, smoking habits, family history of cancer, etc., was achieved. Both the descriptive and analytical approaches were used to find out the dominating risk factors of the disease. Odds ratios and 95 % Confidence Intervals were obtained for analytical purpose by using the binary logistic regression model. Three factors including cigarette smoking, source of drinking water and fried items were found to be significant having odds ratios and 95% confidence intervals of (17.158, 6.244- 47.147), (0.192, 0.061- 0.603) and (12.206, 3.291- 45.275), respectively. The study revealed that cigarette smoking, consumption of tap water and high use of fried items increases the risk of developing bladder cancer. On the other hand, the use of government provided for drinking purpose is a protection against the urinary bladder cancer as compared to tap water.

Dermatitis herpetiformis (DH) is an autoimmune blistering disorder associated with a gluten-sensitive enteropathy (GSE), and is generally accepted as a cutaneous manifestation of celiac disease and is characterized by grouped excoriations; erythematous, urticarial plaques; and papules with vesicles. We reported an interesting case of adult DH occurred in a 30 year old Sudanese young adult with chronic inflammatory bowel disease, presented with typical string of pearls in the face, trunk and extremities for 2 months duration. The case is diagnosed and confirmed as DH where histopathologically shows a sub-epidermal bulla with microabscess formation, sigmoidoscopy and H. pylori ELISA test were positive IgA.
Our case had an adult onset of presentation. Clinical features and histopathology are typical. It is associated of H. Pylori, although poorly responding to triple therapy (Doxycyclin 100 mg bid for 8 days, Cefixime 400 mg for 5 days and Rabeprazole as proton pump inhibitor (PPI) 20 mg for 28 days), but focusing as possible antigen was of paramount concern as possible causative antigen; as in this case all serological specific tests for Coeliac disease were negative.
The case was considered to be the second case of DH with CIBD due to H. Pylori been reported in Sudan.

Aim: This study was designed to enhance the scope of sputum analysis by using it as a clinical tool in gene/protein expression, by making the paraffin embedded blocks.
Methodology: The specimens were prepared as smear and cell blocks for cytopathologic examination. The preparation of paraffin-embedded block from sputum samples employs fixation and dehydration of the cell specimens. The sputum specimen is first exposed to a suitable fixating agent, Formalin, and graded acetone was employed to dehydrate the samples and saved as pellet. Paraffin blocks containing embedded pellet were taken out gently from the tube. The solidified paraffin-embedded tissue blocks through this novel approach were found to be easy to process for immunohistochemistry and molecular analysis.
Results: Immunohistochemistry staining was performed on paraffin section of sputum block for Cytokeratin (CK) and was found to be easy to process for immunohistochemistry.
Conclusion: The sputum block preparation is feasible and non-invasive, can be useful to identify new biomarkers of exposure or susceptibility in patients with lung pathology to enhance the understanding of airways changes due to different etiological factors and may be useful to find new biomarkers in order to assess and monitor early lung damage.

Mesenchymal stem cells (MSC) have been widely used in different areas of medicine because of their immunosupressive properties and influence on regeneration of the damaged tissues. The objective of this study was to examine the kinetics of growth (MSC from 4-3 passages had significantly higher proliferative activity compared with cultures of 10-12 passages), changes in immunophenotypic characteristics of human MSC in early (3-4) and late (10-12) passages when cultured in vitro as well as study of genetic stability. In the analyzed cultures of MSC was found normal karyotype (46, XY or 46, XX). In most of cultures studied MSC karyotype and the level of aneuploidy remained unchanged even after prolonged culturing.
The author's experience of ex vivo expansion of MSC using both standard medium DMEM with the supplementation of fetal bovine serum (FBS) and serum-free medium MesenCult MSC Basal Medium (Human) (StemCell technologies Inc.) with addition of Mesenchymal Stem Cell Stimulatory Supplements (Human) is presented. The influence of the type of medium on the growth and immunophenotype of MSC is analyzed. The study found that when cultured in serum-free medium proliferative potential of MSCs was lower.

Objective: To determine the significantly associated factors with the relapse rate in chronic hepatitis C patients treated with conventional interferon and their predictive strength through the regression model.
Material & Methods: In a retrospective analysis of 244 patients, result of PCR, gender, fatty liver, diabetes, abnormal ALT at start and end of treatment were the qualitative variables. Age, weight, ALT at start and end of treatment, hemoglobin, platelets and WBC at start of treatment were quantitative variables. Bivariate, multivariate analysis and odds ratio were computed to verify statistically significant association with relapse rate by running binary logistic regression model.
Results: Out of total 244 patients there were 54.1% male and 45.9% female. Eighty two (33.6%) patients had weight > 70 Kg, 30 (12.3%) had fatty liver, 18 were (7.4%) diabetic, 12 (4.9%) had normal ALT at start of therapy and 140 (57.4%) had abnormal ALT at the end. Eighty four (34.4%) patients relapsed while 160 (65.6%) maintained SVR after 6 month to 2 years of completion. In bivariate analysis, age, weight, fatty liver, high fever, decrease and increase in Hb were found significant. The binary logistic regression revealed the significant association of weight (OR=84.813; p=0.000), high fever (OR=4.478; p= 0.038) and Hb increase at 1st month (OR=0.037; p=0.013) with relapse rate. Nagelkerke R Square and Cox & Snell R Square statistics explained 71.1% and 51.1% variation in the model respectively and 93.1% area under the curve gave it very good prediction strength.
Conclusion: The relapse rate to conventional interferon and ribavirin treatment is high in Pakistan. The assessment of predictors of response, like body weight may help in individualizing the treatment, patient selection and to decrease an ever expanding pool of non-responders and re-lapsers. Hence, our prediction model can help us to predict the chances of being relapse in advance

Objective: Postmenopausal women usually experience symptoms related to vasomotor instability due to a decline in estradiol levels. Certain plants have been found to have components that are same in structure and function to female estrogen and progesterone. This study conducted to compare the efficacy of Vitex agnus-castus (Vitex) with placebo in postmenopausal women with hot flashes.
Design: Sixty postmenopausal teachers with 45-60 years old participated in a clinical trial conducted in an academic center in Gorgan-Iran. The participants divided in two equal groups randomly and treated with Vitex or placebo, 40 drops per day for 8 weeks. Data collected by using interview, individual characteristics questionnaire and evaluated by Blatt-kapperman’s index at four follow-up visits. Statistical analysis was carried out by using descriptive statistics and multivariable analysis.
Results: The difference in frequency of hot flushes between groups was significant at 2nd, 4th, 6th and 8th weeks of intervention (P=0.015, p=0.000, p=0.000 and p=0.000, respectively) and also the decline in the severity of hot flashes in women who received Vitex was more evident on 2nd, 4th, 6th and 8th weeks (p=0.015, p=0.12, p=0.000 and p=0.000, respectively). Furthermore, comparing both study groups the result showed that the difference in Blatt-Kupperman index was not significant on the 2nd week of treatment (p=0.198); however, it was statistically significant between the two groups on the 4th, 6th, and 8th week of treatment (p=0.008, p=0.00 and p=0.00, respectively). Some adverse events recoded between groups were statistically significant (p=0.012).
Conclusion: Despite some unimportant adverse events, this study showed that Vitex as a natural therapeutic agent is an effective treatment for the early vasomotor symptoms of postmenopausal women especially in women who have a contraindication to use of female hormones but this recommendation requires to more studies with larger samples.

Objective: To study toxicity, anti-diabetic and cardiovascular effects of hydro-ethanolic extracts of Parinari curatellifolia seed extract and Aristolochia vogelii roots extract and (1:1) mixture of the above two extracts.
Materials and Methods: Twenty Wister strain albino rats were randomly assigned to four groups; A, B, C and D with each consisting of five animals received extracts as follows: Group I, P. curatellifolia and A. vogelli mixture (1:1) (500 mg/kg bwt); Group II, A. vogelli (500 mg/kg bwt); Group III, P. curatellifolia seed extract (500 mg/kg bwt); Group IV, 0.5 ml (2% w/v) acacia solution and served as control. After 30 min, the animals were each administered orally with 40% (w/v) glucose at a dose of 1ml /100 g bwt. Blood glucose levels were then monitored at 30, 60, and 120 min. intervals and reported as the average glucose level of each group. Another set of twenty five rats (diabetic rats) were randomly distributed into five groups of five animals each while the additional sixth group was the positive control consisting of five normal rats. Treatments were as follows: Group I, diabetic treated with A. vogelli at a dose of 500 mg/kg bwt; Group II, diabetic treated with P. curatellifolia at a dose of 500 mg/kg bwt; Group III, diabetic treated with glibenclamide 600µg /kg bwt; Group IV, diabetic treated with mixture of Parinari curatellifolia and A. vogelli (1:1) (500 mg/kg bwt); Group V, diabetic untreated (control negative) while group VI was the positive control.
Results: A significant reduction in postprandial sugar level was observed after 30 min in all treatments. The extracts individually and in combined form also showed effective decrease in plasma glucose levels on the diabetic rats. There were significant reductions (p<0.05) in low density lipoprotein (LDL)-cholesterol levels and significant increase (p<0.05) in high density lipoprotein (HDL)–cholesterol in the treated diabetic group compared to the negative control. Furthermore, significant reductions in aspartate aminotransferases (AST) and alanine aminotransferases (ALT) levels were observed in the treated diabetic animals compared to the untreated. Also significant reduction in the creatinine and increase in the protein levels respectively were observed in the treated diabetic groups.
Conclusion: The results showed that the respective extracts and the extract mixture had both good hypoglycaemic activity and beneficial effects on cardiovascular risk factors.

Background: Down Syndrome (DS) is the most frequent chromosomal abnormality in live births with an incidence of 1 to 1.7 per 1,000 births and a variable physical expression. Down syndrome screening has been an integral part of routine prenatal care in recent decades. Currently, there is no established DS screening program in the Kingdom of Saudi Arabia.
Objective: The total number of DS pregnancies is increasing, probably due mainly to the increasing proportion of older mothers. Live birth with DS increased also so, there is an expected increase in long term survivors. There is a need for a well structured system for prenatal diagnosis and follow up program and an extra health care resource.
Design: A systematic literature search for various prenatal screening tests for DS were explored regarding the time of screening during pregnancy, detection rate, false positive rate, advantages and disadvantages. Various search engines like Pub med, Medline, Index Medicus were used to review the published literature using the key words "Down syndrome", "antenatal screening", and “Chromosomal abnormalities".
Results: Different screening strategies for DS are applied worldwide. In the United Kingdom, the combined test, the integrated test or the serum integrated test is offered for women who present in the first trimester, and the quadruple test for those who present in the second trimester. In the United States, Canada, and Australia the combined test is recommended for the first trimester and the quadruple test for the second trimester.
Conclusion: The Quadruple test should be offered to all pregnant women in the second trimester, in addition all women should be offered a second –trimester ultrasound scan to identify major and minor fetal abnormalities. Extensive research is needed to establish accurate incidence of DS in the Kingdom of Saudi Arabia and its relation to maternal age and parity.