Journal of Advances in Medicine and Medical Research

Temporomandibular joint (TMJ) dislocation is defined as excessive forward movement of the mandibular condyle beyond the articular eminence with complete separation of the articular surfaces and fixation in that position. A 54 years old man attended our Emergency Department (ED) with complaints of slurred speech and inability to close his mouth after upper gastroendoscopic procedures. Lateral craniography was obtained and illustrated bilateral anterior dislocation of the patient's mandibular condyles. To confirm the diagnosis urgent radiographic imaging is required without delay as the risk of complications occurring increases as time elapses.

Hearing loss and visual impairment are not common presentations of Chronic Myeloid Leukemia (CML). We report such a case who presented in the chronic phase with profound hearing loss, visual impairment, progressively enlarging spleen, anaemia, and weight loss.
Laboratory evaluation showed Packed Cell Volume – 10%, Total White Cell Count – 1,343 x 10⁹/ L, Platelets – 589 x 10⁹/ L. Blood chemistry showed Uric Acid level of 530mmol/L. Karyotyping showed the Philadelphia chromosome.
Chemotherapy was instituted and she improved remarkably with minimal improvement in perception of sound.

Aims: Since 2005, cardiopulmonary resuscitation (CPR) guidelines advise immediately resuming CPR after a defibrillation shock to minimize CPR interruption. During resuscitation, the incidence of ventricular fibrillation (VF) recurrence is as high as 79%. The aim of this report is to present a case of VF recurrence induced by chest compressions (CCs) following successful defibrillation of VF and to discuss the possible mechanisms that could be linked to this observation.
Case Presentation: A 57 year-old female suddenly collapsed and upon initiation of CPR, VF was observed. The patient was treated with 6 CPR-defibrillation cycles according to the current guidelines, after which she converted to normal sinus rhythm (NSR), but died following 9 in-hospital days. The monitor rhythms strips throughout resuscitation reveal restoration of NSR after the 4th defibrillation, yet CCs were resumed 1.3 seconds post DC shock and refibrillation closely followed. The first compression was timed exactly on the peak of the first post-shock sinus beat followed by refibrillation.
Discussion: possible mechanisms for the observed phenomenon include: creation of a long-short activation sequence by electric stimulation of the ventricles leading to VF recurrence, sudden stretch during a vulnerable window, which is determined by repolarization inhomogeneity and activation of mechano-sensitive ion channels, reperfusion arrhythmias (commonly ventricular tachycardia and PVCs) during restoration of coronary perfusion in acute myocardial infarction.
Conclusion: further evaluation of whether few second only of post shock pause and rhythm analysis might reduce the risk for such refibrillation and hence outweigh the minimal interruption of CCs is warranted.

Aims: To recognize the importance of considering perforation of viscus in the differential of peritonitis after upper gastrointestinal endoscopy in peritoneal dialysis patients and to address the potential benefit of antibiotic prophylaxis in PD patients undergoing upper GI procedures.
Presentation of Case: We report the case of a 54-year-old African American female with end-stage renal disease on peritoneal dialysis presenting with generalized abdominal pain, along with nausea and vomiting. Peritoneal fluid revealed a WBC count of 1,499/mm³. Two days earlier, she had undergone an esophagogastroduodenoscopy with biopsy. Broad spectrum antibiotics were started to treat possible peritonitis. Surgical exploration revealed no perforation but murky peritoneal fluid was noted and gram stain showed mixed flora (both gram negative and gram positive rods); however, blood and peritoneal fluid culture grew only Streptococcus pneumoniae.
Discussion and Conclusion: An occult perforation, which may not be obvious to the naked eye or signs of contrast extravasation can occur after esophagogastroduodenoscopy with manipulations and can lead to peritonitis, especially in high-risk patients such as those with end-stage renal disease on peritoneal dialysis. To our knowledge, this is the first reported case of mixed peritonitis attributable to suspected micro-perforation after esophagogastroduodenoscopy. Whether pre-procedure antibiotics are warranted to decrease the occurrence of infectious complications in PD patients undergoing upper gastrointestinal procedures remains uncertain and not well studied. The prompt recognition of possible mixed bacterial infection remains essential after these procedures.

Aims: To describe the clinicopathologic features of children with Duodenal eosinophilic infiltrates (DEI).
Study Design: Retrospective.
Place and Duration of Study: Pediatric Gastroenterology Division, Texas Children’s Hospital over 24 months (Jan 1, 1998 –Dec 31, 1999).
Methodology: Children with DEI at Texas Children’s Hospital over 24 months were identified. Clinical symptomatology was analyzed by a retrospective medical record review. Two pediatric pathologists re-evaluated all biopsies. Follow-up was done by contacting the patients 12-36 months after the initial diagnosis.
Results: Total number of GI biopsies that included duodenum over the study period was 1145 biopsies. Out of 1145 cases, 780(68%) cases indicated eosinophilic infiltrates (EI) at some GI site. Out of these, 287(37%) cases had DEI. Mean age was 10.4 years. (F: M .2:1). Race: 197(79%) Caucasians, 37(15%) Latin Americans, 9(4%) African Americans and 6(2%) Arabs. Clinical symptomatology: 249 records were available for evaluation. 69.9% complained of abdominal pain, 55% had vomiting, 34.9% with diarrhea and 32.9% had weight loss. 105 patients were available for follow up; 38% continued to have abdominal pain, 15.2% with vomiting, 10.5% diarrhea and 7.6% had a persistent weight loss. Peripheral eosinophilia was present in 35.2%. Medical treatment included proton pump inhibitors (57.0%), H2-blockers (55.4%), steroids (26.5%), and elemental diet (9.6%). Histopathology: 6% had <10 eosinophils /hpf, 51.8% with 10-20eos/hpf, and 42.2% with >20 eos/hpf. There were no significant differences in the number of eos/hpf between those with or without a specific symptom. Fourteen children (5.6%) subsequently developed IBD; their histopathological data did not differ from the rest.
Conclusion: 1) children with DEI present with variable chronic symptoms 2) symptoms persisted in a significant number of patients despite therapy, 3) Close observation is warranted since a small number of patients may develop IBD.

Aims: To identify the reasons why obese adolescents seek weight loss therapy and what barriers they face in losing weight.
Study Design: Cross-sectional study.
Place and Duration of Study: Department of Physical Education and School Medical Science, University of Pernambuco 2009-11.
Methodology: The study was conducted with 128 obese adolescents (76 girls [BMI=35.46±3.92] and 52 boys [BMI=33.70±2.88]), aged between 12 to 18 years old. Personal reasons for seeking weight loss treatment and barriers to losing weight were obtained by an individual semi-structured interview (8 questions) conducted by a psychologist. All individual interviews lasted approximately 20 min and were performed in a quiet room. Adolescents’ answers were semi-transcribed by the researcher and the content was anonymously analyzed in order to categorize the data.
Results: The main reason for girls to start a weight loss program was to become healthy (39.47%), followed by to fit in clothes (30.26%), personal appearance (30.26%), and bullying (28.95%). Physical fitness (40.38%) was the most important reason to seek weight loss for boys, followed by to become healthy (36.54%), and bullying (25%). For both genders, the main barriers described were lack of self-control (47.37% - 36.54%), lack of social support (27.63% - 30.77%), and self-motivation (22.37% - 21.15%).
Conclusion: Obese adolescents had several reasons for seeing weight loss. Overall, becoming healthy was the main motivation for weight loss and lack of self-control was the main barrier. This information can be used to help develop more effective weight loss strategies for obese adolescents.

Aims: We estimated the number of users of tobacco, particularly narghile (water pipe) among a sample of women working at a higher education institute in Jordan. We also investigated the attitudes of narghile smokers to their habit, together with their willingness to stop NS; and finally their awareness to oral health and their perceptions about the harmful effects of NS.
Study Design: The study was a cross-sectional survey whereby the sample was conveniently selected from all the faculties, institutes and centres of the University.
Place and Duration of Study: University of Jordan, Amman, Jordan during July 2011.
Methodology: Data were collected by allowing the participants to complete a pre-prepared questionnaire privately. Statistical analysis was performed using the SPSS program.
Results: Among the (96) participants, 24 ladies (25%) were smokers mostly (79.2%) of narghile. Demographic and social data of age, marital status, education level and number of children did not seem to affect smoking status. Friends and relatives were the main introducers and companions in narghile smoking (73.7%), and home was the main setting for the habit (68.4%). Whereas the hygienic practices related to narghile smoking were below the required level, narghile smokers reported a satisfactory level of oral health practices and were aware of the health risks associated with this habit.
Conclusion: Narghile smoking is showing popularity among Jordanian educated working women who invariably have children. Social influences seem to be the major player in shaping women's smoking behavior, whereby close family and friends are the introducers and home is the favorable place for practicing the habit. Specific measures are needed to educate women, their husbands and children of the health hazards of narghile especially that children are adversely affected on different levels.

Aims: To describe an adapted Nominal Group Technique which can be applied to mixed populations.
Study Design: Mixed methods Nominal Group Technique (NGT) consensus building exercise.
Place and Duration of Study: Community Pharmacy across South West Wales, United Kingdom (UK) between 2009 and 2010.
Methodology: We describe the research methodology involved in an adapted Nominal Group Technique. We carried out the adapted NGT exercise in homogenous consultation workshops following the traditional approach which resulted in the generation of individual consensus lists of the important issues related to the posed question. In order to ensure that issues highlighted within different consultation workshops were maintained in the outputs we further developed the NGT approach, firstly by bringing common issues together by applying a thematization process and then further applying a second consensus building exercise based on the developed themes with a mixed population group. By supplementing consensus data with qualitative data collected during the research process, we further explored and justified the consensus reached.
Results: We successfully applied the adapted NGT within the community pharmacy setting and were able to gain consensus regarding the positive and challenging aspects of patient- centred professionalism. Using qualitative data collected, we were able to describe in more detail the issues raised and the justification for the consensus reached.
Conclusion: Using an adapted NGT, we describe how consensus was reached regarding the study question and how the basis for the consensus was explored. By applying this adapted NGT we were able to gain consensus regarding the relative importance of the issues under discussion across a mixed population group. The adapted approach allowed us to elaborate upon the consensus reached and justify the relative importance of the choices that were made.

Aim: To assess the effect of hyperlipidemia and atherosclerosis on essential minerals.
Study Design: Animal model was used for this study.
Place and Duration of Study: Department of biochemistry and department of Anatomy, Ladoke Akintola University of Technology, Ogbomoso. January, 2012 to October, 2012.
Methodology: We included 8 white rabbits which were divided into 2 groups, 1 (control i.e. rabbits given normal diet) and 2 (rabbits given standard diet plus 0.2% cholesterol and 0.6% groundnut oil i.e. atherogenic diet). Feeding was for 8 weeks. The minerals were determined using atomic absorption spectrophotometer; lipids and lipoproteins were determined spectrophotometrically while the effects of atherosclerosis on heart and kidneys were determined chemically and histologically.
Results: The results showed elevated serum concentrations of total cholesterol (4.05%), triglyceride (28%), high density lipoproteins (12.17%), very low density lipoprotein (70%) in atherosclerotic group when compared with control. Atherosclerosis caused decreased serum concentrations of copper (13.88%), manganese (23%), iron (26.46%) in atherosclerotic group when compared with control. Atherosclerosis induced elevated serum concentrations of zinc (47.34%), chromium (37.21%), calcium (72.04%) and magnesium (125.13%). Except for chromium, significant positive correlations were observed between serum cholesterol and trace elements. Induction of atherosclerosis resulted in impaired renal function shown by elevated concentrations of urea (34.80%) and creatinine (147.54%). Renal histology showed cellular necrosis of the epithelial squamous cells. In the aorta and brachiocephalis of the atherogenic diet fed rabbits, there were large number of smooth muscle like cells and focal aggregation of foam cells resulting in intima thickness.
Conclusion: This study further emphasized the monitoring of systemic concentrations of essential minerals in cardiovascular disorder as this may prevent occurrence of another pathologic condition.

Aim: To establish clinical chemistry reference intervals for the Rwandan population.
Study Design: A population-based cross-sectional study.
Place and Duration of Study: The study was carried out in three blood transfusion centres: Buhanda, Ruhango and Nyaruteja, between August and December 2011.
Methods: Serum clinical chemistry tests were performed on a Cobas C311 automated chemistry analyzer.
Results: Results of 187 subjects (age range: 17-54 years) presented as median, with 2.5^th-97.5^th percentiles (95% reference interval) in brackets are as follows: For males: alanine aminotransferase: 25 (12-43) U/L; aspartate aminotransferase: 29 (16-47) U/L; gamma-glutamyl transferase: 22 (9-77) U/L; total bilirubin: 0.6 (0.2-1.7) mg/dL; direct bilirubin: 0.2 (0.1-0.4) mg/dL; creatinine: 0.8 (0.5-1.1) mg/dL; uric acid: 5 (3-7) mg/dL. For males and females: alkaline phosphatase: 71 (27-122) U/L; amylase: 144 (50-235) U/L; lactate dehydrogenase: 176 (114-237) U/L; triglycerides: 82 (32-172) mg/dL; high-density lipoprotein: 48 (29-86) mg/dL; glucose: 87 (70-114) mg/dL; total protein: 7.6 (6.5-8.5) g/dL; albumin: 4.4 (3.4-5.4) g/dL; sodium: 142 (137-147) mmol/L; potassium: 4.1 (3.3-5.0) mmol/L; chloride: 106 (100-112) mmol/L; phosphate: 1.16 (0.87-1.49) mmol/L.
Conclusion: The clinical chemistry reference values are in agreement with those reported in other African studies, with variations.

Aims: To determine the effect of cytokines, namely transforming growth factor-beta one (TGF-β1), and interleukin-6 (IL-6) on the expression of 88 cancer-related microRNAs (miRNAs) in TW01 nasopharyngeal carcinoma (NPC) cells with or without the presence of Epstein-Barr virus latent membrane protein 1 (LMP1).
Methodology: TW01 and TW01-LMP1 cells were treated with cytokines. MicroRNAs were isolated from treated and untreated TW01/TW01-LMP1 cells and were subjected to RT-PCR array of 88 cancer-related microRNAs. The threshold cycle (Ct) data were analysed and fold-change in the level of gene expression was calculated based on ΔΔCt using two endogenous controls, SNORD 47 and SNORD 44. Data obtained from each treatment were compared with the data obtained from the respective control group (untreated TW01/ TW01-LMP1).
Results: TGF-β1 down-regulated miR-143 in TW01 NPC cells. In TW01 cells that expressed the EBV LMP1 gene (TW01-LMP1), approximately 97% of the 88 miRNAs were up-regulated by TGF-β1. Among them was miR-181c a well-known repressor of NOTCH2/4 and KRAS and has important role in cell differentiation. IL-6 up-regulated approximately 65% of the miRNAs in TW01 cells but in less than four-fold. In TW0-LMP1 cells, eight miRNAs; namely, miR-15b, miR-155, miR-16, miR-215, miR-23b, miR-25, miR-9 and miR-98 were significantly up-regulated by IL-6. Among these, miR-15b, miR-155 and miR-25 had been reported to be elevated in NPC tissues.
Conclusion: This study provides a preliminary perspective on the effects of cytokines on the expression of miRNAs in TW01 NPC cells.

Aims: This study assessed and compared compliance with preferred infant feeding options among HIV positive booked and un-booked women in Osun State in South western Nigeria.
Study Design: Descriptive cross sectional study.
Place and Duration of Study: This study was carried out in Osun state in South-western Nigeria between January 2007 and June 2009.
Methodology: Descriptive cross sectional comparative study among 210 booked and 105 un-booked HIV positive women, to assess their compliance with pre-delivery infant feeding options preferred up to four months after delivery. Research instruments employed were semi structured, interviewer administered and pre tested questionnaires. Responses were analyzed using the SPSS software version 13.0.
Results: More booked women 153 (72.9%) preferred or selected exclusive replacement feeding as compared with un-booked women 29 (27.6%). Among un-booked women, 43 (40.9%) currently breastfeeds exclusively, while 22 (21.0%) give cow milk. Among booked women, 44 (21.0%) currently breastfeeds exclusively while 152 (72.4%) give cow milk. Compliance rate with preferred breastfeeding option was higher among booked than un-booked women (77.2% vs. 58.1%, p=0.010). Compliance rate with preferred replacement feeding option was also higher among booked than un-booked women, (93.2% vs. 75.9%, p=0.001). Mixed feeding rate was higher among un-booked than booked respondents (27.6% vs. 6.7%, p=0.001). Respondents who preferred breastfeeding and replacement feeding among un-booked women were a half ((O.R of 0.57, 95%C.I of 0.41-0.95, and p=0.013) and one-third ((OR of 0.32, 95%C.I of 0.1-0.8 and p=0.044) fold more likely to practice preferred method respectively when compared with booked women.
Conclusion: Un-booked HIV positive women were less likely to practice selected infant feeding method compared to booked women.

Objectives: This paper is intended to describe 1) the level of diabetes control and 2) related disturbances of the menstrual cycle among diabetic women in Kinshasa.
Study Design: It is a prospective, observational, case control study carried out from 1^st till 31^st July 2012 in a medical centre of Salvation Army, in Kinshasa, DR Congo, mostly giving low cost diabetic healthcare. Post menarche, non pregnant and non lactating diabetic women aged from 15 years up to 35 years attending a routine monthly visit were consecutively recruited after consent. The controls were enrolled consecutively after each case among non diabetic women. Fasting plasma glucose for patients and random plasma glucose values for controls were measured. Gynecologic antecedents including menstrual irregularities were recorded.
Statistical Analysis: Mean values are presented with standard deviations. Chi-square and student’s t-test were used for comparison of characteristics’ proportions and means of patients and controls. Odds ratio was used to seek for influence of diabetes on disturbances. Results are given with 95% confidence interval (CI), and p<0.05 as significant.
Results: During the period of study 35 patients and 35 controls were recruited. The mean glucose blood concentration of patients (232.5±4.8mg/dL vs 82.7±15.6mg/dL) is a marker of overall poor diabetes control. Late menarche was significantly more frequent in cases than in controls (p=0.01; CI=8.5-48). As of menstrual troubles, differences appeared for amenorrhea (p=0.000; CI=23.3-62.5) and spaniomenorrhea (p=0.03; CI=2.4-43.3), more frequent among patients.
Conclusions: Mean blood glucose concentration of diabetic women of the study averages 232.5mg/dL. Amenorrhea and spaniomenorrhea that characterize cycle disturbances in these patients could thus be regarded as need for better control of the illness and good contraception. Such a suboptimal diabetes management is expected to increase the burden of the illness not only in terms of chronic complications but also in reproductive health of the community.

Background: There are conflicting reports regarding the relationship between body mass index (BMI) and intraocular pressure (IOP). There is a need to evaluate these contradicting findings in our environment.
Aim: To examine the relationship between intraocular pressure and body mass index (BMI) in a population screened for glaucoma at the University of Port Harcourt, Nigeria
Materials and Method: This study was part of a one-day screening exercise for glaucoma at the University of Port Harcourt. All subjects participated with willful consent. Demographic data included age, sex, race and occupation. Height was measured with a wall-mounted tape and weight with a bathroom scale. Intraocular pressure was measured with Perkins hand-held applanation tonometer and funduscopy was carried out with a direct ophthalmoscope. BMI was calculated as weight in kilograms divided by the square of height in meters (Weight/Height²).
Results: A total of 491 subjects were screened. There were 230 males (46.8%) and 261 females (53.2%). About 50% (n=246/491) of the participants had normal BMI, 28.7%(n=141) were overweight while 17.7%(n=87) were obese. The mean BMI was 25.39 ± 4.82. Most obese participants were females (n= 63/87; 72.4%) while most males had normal body weight (n=131; 53.2%). The relationship between BMI and gender was statistically significant (P=0.00). The mean intraocular pressure of all participants was 16.21±5.01mmHg. Most overweight (88.6%; n=241/272) and obese persons (n=149; 87.6%) had normal IOP. There was however no statistically significant relationship between BMI and IOP (P=0.473; r² =0.02).
Conclusion: In a population screened for glaucoma at the University of Port Harcourt, Nigeria, we found no statistically significant relationship between BMI and intraocular pressure but there was a statistically significant relationship between BMI and age.

Aims: Validation of the Greek version of Work Ability Index (WAI).
Study Design: A cross sectional survey of 943 workers from a shipyard industry.
Place and Duration of Study: University of Patras, Medical School, Public Health Department, HSY occupational health department, Greece in 2006-07.
Methodology: The translation and cultural adaptation of the questionnaire was performed according to the international standards. The following aspects of the questionnaire were evaluated: construct validity, using factorial analysis, and discriminant capacity, by comparing Work Ability Index scores across variables likely to be related with work ability, like absenteeism; criterion validity, by determining the correlation between self-reported health and Work Ability Index score; and reliability, using Kendall’s tau b coefficient to determine the internal consistency of the questionnaire.
Results: A two-dimensional structure model, interpreted as “subjectively estimated work ability” and “ill-health related ability” of the instrument fits better our study population with some of the subscales load on both dimensions. Good discriminating properties of the tool with sickness absence, education level and high criterion validity using dimensions of health status, were evident. High inter-item Kendall’s tau b coefficients were indicative of satisfactory reliability.
Conclusions: The Greek version of the WAI showed satisfactory psychometric properties thus constituting an appropriate option for evaluating work ability in both individual and population-based settings.

Aims: The aim of this study was to isolate and extensively characterize parathyroid gland stem cells (PT-SCs) from secondary hyperparathyroidism cases. For this purpose, proliferation capacity, phenotypic properties, differentiation characteristics and gene expression profiles were analyzed and compared with mesenchymal stem cells from bone marrow (BM-MSCs) of the human.
Methods: Stem cells isolated from PT and BM were analyzed by flow cytometry, RT-PCR, Real Time-PCR, and immunocytochemistry. Both cell lines were directionally differentiated towards adipogenic, osteogenic and neurogenic cell lineages.
Results: The isolated hPT-SCs share similar characteristics of hBM-MSCs by immunophenotypic, histological and molecular analyses. Both cells were shown to differentiate successfully into adipogenic and osteogenic cell lines. Embryonic stem cell markers Pou5F1, Zpf42, FoxD3, Sox2 and Nanog were also expressed beside 5 fold higher telomerase activity in hPT-SCs that could indicate the regenerative ability of the human parathyroid gland. The osteogenic cell markers were expressed by hPT-SCs, which transformed efficiently into osteogenic cell lines, both at the level of genes (BMP2, BMP4, BGLAP, Coll11a1, Runx2, Sparc) and of proteins (BMP2, BMP4, Osteocalcin, Osteonectin, Osteopontin). Higher alkaline phosphatase (ALP) activity indicating osteogenic differentiation was determined in hPT-SCs from secondary hyperparathyroidism patients.
Conclusion: PT-SCs might responsible for the calcified parathyroid glands and other ectopic calcifications including the vascular ones, observed in the secondary hyperparathyroidism cases, beside parathyroid hormone-dependent hypercalcemia leading diffusion of calcium phosphate precipitation in tissues.

Aims: We aimed at assessing perception and effect of free maternal health services on the utilization of ANC services among women of child bearing age.
Study Design: A cross-sectional study involving 460 women aged 15-49 years who were currently pregnant or had their most recent birth within the previous five years prior the survey was conducted using a two-stage sampling technique.
Place of Study: Rural and semi-urban communities in Ondo State, Nigeria.
Methodology: We administered semi-structured interviewer questionnaire. Knowledge was classified as good if knowledge score is higher or equal to the mean score obtained from this study and poor if otherwise. A 5-point likert scale was used to measure respondents’ perception. Respondents with scores less than the mean perception score from this study were classified as having negative perception and positive if otherwise. Descriptive statistics, Chi-square tests and logistic regression model were used for data analysis and significance level was set at P = .05.
Results: Mean age, knowledge score and perception score of the respondents were 29.8±7.3 years, 6.0±1.2 and 29.6±6.0 respectively. Overall, 95.4% had utilized ANC facilities. Highest proportions (55.0%) of those utilizing ANC were aged 20-30years.About two fifth (40.8%) reported that free ANC services was the main reason for choosing public ANC facilities. Almost two-third (63.0%) of the respondents had good knowledge of ANC, while about 35.9%had positive perception towards free ANC services. Higher utilization of ANC services was observed among married or cohabiting women than the singles and widows (P = .04). Logistic regression showed that Respondents’ knowledge was significantly influenced by respondents’ occupation, previous pregnancies, and religion.
Conclusion: Perception of women on free ANC utilization in the study area was negative although free ANC program instituted by government across the state enhanced ANC utilization. The government should sustain the policy on free maternal health services.

Aims: The aim of our study was to examine the associations of dietary fat intake, serum estrogen level and obesity with the risk of breast cancer in a case-control study among Saudi females including newly diagnosed breast cancer patients.
Study Design: Case-control study.
Place and Duration of Study: King Abdulaziz Medical City, Riyadh, Saudi Arabia, during the period between 1^st February and 30^th May, 2008
Methodology: Dietary histories were collected 40 newly diagnosed female breast cancer cases and 82 randomly selected control subjects matched for age, parity, gravidity, number of children, breast feeding practice and age at marriage. A modified food frequency questionnaire (FFQ).was applied. Anthropometric measurements and blood tests that measured LDL, HDL, triglycerides (TGs) and estrogen levels were performed. Significance was considered at P≤0.05.
Results: Breast cancer was significantly associated with overall obesity based on BMI (OR = 3.10, 95%, CI = 1.17–8.25, P=0.02) and central obesity based on WC (OR = 3.95, 95%, CI = 1.27–12.28, P=0.01). Cases exhibited significantly higher fat mass (39.6 vs. 36.9 kg, p=0.04) and significantly lower Fat intake (46.0±27.5 vs 59.0±38.9 g/day, P=0.034) than did the control group. The mean levels of TGs (2.9±1.1vs.1.8±1.1 mmol/L, P<0.0001) and estradiol (131.0 vs 70.6 pmol/L, P≤0.008) were significantly higher in the study patients compared with the control subjects, whereas the mean level of low density lipoprotein (LDL-C) was significantly higher in the control subjects (3.1±0.8 vs. 1.6±1.0 mmol/L, P≤0.0001) compared with the study patients.
Conclusion: Both overall obesity and central obesity were significantly associated with breast cancer. Higher fat mass and lower fat intake and increased estrogen level were significantly associated with breast cancer cases. Further prospective studies on the Saudi population are recommended to explore the mechanisms of these findings.

Background: Spondylolisthesis is a condition where one vertebra slips over the top of the adjacent vertebra. This is commonest in the lumbar spine.
Objectives: To audit lumbo-sacral spine radiographs for spondylolisthesis with emphasis on localisations, sex distribution, types and grading.
Materials and Methods: A descriptive cross sectional study was carried out from1^st May, 2011 to 21^st June, 2012 in Radiology Department, University of Uyo teaching hospital, Uyo, Nigeria. Recruited patients were referrals for lumbo-sacral radiography irrespective of indications. Anterior-posterior and lateral radiographs of the lumbo-sacral spine were taken under standardized conditions. Radiographs with spondylolisthesis were identified and analysed statistically using computer SSPS 13.
Results: 249 Patients were studied (132 Males and 117 females). 9.24% (n=23) of the studied population had 25 individual vertebral displacements. 82.61% (n=19) of these patients were females and 17.39% (n=4) were males (female to male ratio - 4.75:1). The mean age for males with vertebral displacement was 44.5 (S.D=10) while the mean age for females was 44.5 (S.D=15.81). The commonest level of vertebral involvement was L4 on L5. This was seen in 56.52% (n=13) of patients with positive cases of spondylolisthesis. This was followed by L5 on S1 with 30.43%. 82.61% of patients had grade 1 displacements. Degenerative spondylolisthesis was the commonest type (52.17%), followed by isthmic type (21.74%), uncategorised (17.39%) and traumatic spondylolisthesis (8.70%).
Conclusion: Radiographic pattern of spondylolisthesis in Uyo, Nigeria demonstrates the usual female gender bias, L4/L5 localizations but interestingly show predominance in degenerative spondylolisthesis.

Aims: This study examined the association of socio-cultural and psychological factors with body shape concern, perception and body weight perception among tertiary students of Northern Malaysia.
Study Design: This is a cross-sectional study.
Place and Duration of Study: Universiti and Kolej Tunku Abdul Rahman (UTAR and KTAR), Perak campuses, between August 2011 and January 2012.
Methodology: A total of 1003 students were recruited (M = 431, F = 572; mean age 19.96 ± 1.51) and their body image perception were assessed using Body Shape Concern Questionnaire, Body Weight Perception Questionnaire, Body Shape Perception Questionnaire (Stunkard Silhouette Chart), Multidimensional Body Self Relations Questionnaire (MBSRQ), Rosenberg’s Self-Esteem Scale (RSE) and Quality of Life measurement.
Results: More females than males had problems with their body shape, where more females desired a thinner body size and vice versa for males. There was misperception of opposite sex’s perception of attractive body shape, where males chose a larger figure for attractive body shape of female compared to females themselves, and vice versa. Overweight students had significantly lower parental/peer acceptance, higher body shape satisfaction and hence lower body weight/shape anxiety, and made lesser body shape comparison compared to other counterparts. Quality of life and self-esteem were significantly negatively correlated with body satisfaction.
Conclusion: Male and female Malaysian tertiary students were concerned with their body shape and perceived their body weight/shape differently.

Background: Diabetes mellitus is associated with many cardiovascular dysfunction and impairment of potassium channel function.
Aim: We compared the vascular reactivity in aorta from streptozotocin-induced and Goto-Kakizaki (GK) diabetic rats to potassium channel openers.
Methodology: Diabetes mellitus (DM) was induced in Sprague Dawley rats by intraperitoneal injection of streptozotocin (STZ) at 65 mg/kg body weight. After four weeks of DM, vascular reactivity of the aortic rings from STZ-induced Sprague Dawley and age-matched GK and control rats to phenylephrine, acetylcholine, levcromakalim and naringenin was studied using standard organ bath procedure.
Results: The phenylephrine-induced contraction was significantly (P<0.05) increased in STZ-diabetic aortic rings [2.03 ±0.07 g] when compared with GK rats [1.47±0.14 g] and STZ-control [1.42±0.21 g]. Maximal relaxation and potency to acetylcholine, levcromakalim and (+/-)-naringenin were significantly (P<0.05) decreased in STZ- diabetic aorta when compared with GK-diabetic and control groups.
Conclusion: The phenylephrine-induced contraction, endothelium-dependent relaxation, K_ATP - and (+/-)-naringenin-induced vasorelaxation are not altered in the early stages of Type 2 diabetes whereas there is exaggerated contractile response and a relaxant dysfunction involving the endothelium, K_ATP in Type 1 diabetes mellitus.

Aims: To describe the familial occurrence of paracentric inversion of chromosome 3.
Presentation of Cases: Patient 1: Female, Caucasian, born in Southeast of Brazil, 7 years old. Born at term and asphyxia. Developmental delay; aggressive behavior and tendency toward isolation. Prominent forehead, discrete epicanthal folds, down-slanting palpebral fissures, long philtrum and hypermobility of the four limbs. Karyotype: 46,XX,inv(3)(p13p25). Patient 2: Female, Caucasian, born in Northeast of Brazil, 3 years old. Born prematurely by cesarean section, pelvic presentation and asphyxia. Severe developmental delay. Microcephaly, bilateral convergent strabismus, epicanthal folds, wide nasal bridge, micrognathia, high arched palate and nasolabial hemangioma, low set ears, hypoplastic nipples, nucal café-au-lait spots, deep plantar fold. Dysgenesis of the corpus callosum. Karyotype: 46,XX,inv(3)(p13p25). Patient 3: Male, Caucasian, born in Southeast of Brazil, 5 years. Born at term, by cesarean section, cephalic presentation. Developmental delay and flexor spasms. Dolichocephalic skull, prominent forehead, ocular hypertelorism, epicanthal folds, disproportioned and low set ears, single palmary crease in the right hand, large and elongated thumbs, hypotonia, and recurrent acute otitis. Karyotype: 46,XY,inv(3)(p13p25).
Discussion: Patients presented developmental delay and dysmorphic features, but the relatives that presented the same inversion were asymptomatic. Carriers seem to have a normal reproductive fitness, without differences between males and females.
Conclusion: The chromosomal rearrangements, especially balanced chromosomal alterations provide an opportunity to broaden the understanding of the structure and functional organization of chromosomes and to offer better genetic counseling for the families.

Aims: to evaluate the potential apoptosis inducing effect of Ducrosia flabellifolia extracts against different cancer cell lines.
Methodology: The antiproliferative activity of Ducrosia flabellifolia extracts was tested against three cell lines using MTT assay. The apoptosis induction ability of ethanol extract was determined using TUNEL colorimetric assay while agarose gel electrophoresis was used to detect DNA fragmentation. Morphological changes associated with apoptosis were observed using scanning electron microscopy. LC/MS-MS analysis was used to determine the main flavonoids present in the plant extract.
Results: Ducrosia flabellifolia ethanol extract showed selective antiproliferative activity against different cell lines. The highest activity was against MCF-7 cell line with IC₅₀ value of 25.34 μg/mL, followed by Hep-2 cell line with IC₅₀ value of 98.01 μg/mL. While the lowest activity was against Vero cell line with IC₅₀ value of 98.01 μg/mL. The antiproliferative effect was exerted by inducing apoptosis as indicted by the presence of DNA fragmentation, nuclear condensation, and formation of apoptotic bodies in treated cancer cells. LC/MS-MS analysis revealed the presence of five flavonoids (quercetin, fisetin, kaempferol, luteolin, and apigenin) and their derivatives in the extract.
Conclusion: The apoptosis inducing ability of Ducrosia flabellifolia ethanol extract validate the use of this plant in traditional medicine to treat cancer. The anticancer synergistic effect of Ducrosia flabellifoliacompounds has broad implication for understanding the anticancer potential of plant natural products in vivo, where different compounds may act in concert to reduce tumor burden.

Aims: A substantial part of the genome is transcribed in non-coding RNAs. We review our finding of a long non-coding RNA (designated Heg) in mononuclear cells (MNC) and regulation of TSH receptor autoantibodies (TRAb).
Results: The Heg RNA transcript in MNC is negatively correlated with TRAb in patients with early and untreated Graves’ disease. In treated patients and in controls Heg correlated negatively with CD14 mRNA. Transfection studies with fragments of Heg added to MNC (exogenous Heg) decreased CD14 mRNA in MNC and increased gene expression of RIG-I, TLR7 and IFN-γ. Heg is likely to activate TLR7 receptors. CD14 is a co-receptor of TLR7. Decrease in gene expression of CD14 after Heg is a sign of differentiation of MNC to dendritic cells. This may reduce surface expression of CD14, cytokine responses and the responsiveness to TSH receptor antigens. Thus the relationship between TRAb and lnc Heg RNA is most likely explained by receptor cross-interference. Cdk1 mRNA (an index of cell cycle activity) is positively related with TRAb. Cdk1mRNA and TRAb but not Heg decreased significantly during antithyroid treatment. Cdk1 decreased to values below normal.
Conclusion: Thus both Heg RNA and Cdk1 may regulate the level of TRAb but by two different mechanisms.

Aims: Sleep disturbances are common in patients with breast cancer. The aim of this systematic review was to present the literature on pharmacological interventions against sleep disturbances and use of hypnotics in patients with breast cancer. We wanted to study patients both in the perioperative period as well as when they were receiving oncological (medical) treatment.
Study Design: Systematic review.
Methodology: According to the PRISMA guidelines, a literature search was performed on May 10th 2012 in Pubmed and Embase. Primary outcomes were pharmacological interventions against sleep disturbances. No restriction on publication status was made. Only articles in English were included. Case reports and studies with less than ten patients were excluded.
Results: Five studies met the inclusion criteria and were included in the review. One study investigated pharmacological intervention in the perioperative period and showed that treatment with triazolam significantly improved sleep three consecutive nights after surgery. Two studies investigated patients undergoing endocrine oncological treatment. The studies showed that zolpidem combined with an SSRI/SNRI improved sleep in patients having hot flashes, and that hypnotics were prescribed significantly more often in patients undergoing endocrine treatment compared with healthy patients not receiving endocrine treatment. Two studies investigated patients receiving chemotherapy. The studies showed that hypnotics were prescribed to almost every second patient. Prior users of hypnotics and patients with a psychiatric diagnosis were more likely to take hypnotics during chemotherapy.
Conclusion: Sleep disturbances occur frequently in patients with breast cancer indicated by the high prevalence of hypnotic use. It therefore is of concern that only few clinical trials exist on pharmacological intervention against sleep disturbances in the different treatment time periods. At present, there is insufficient evidence to recommend one single pharmacological intervention in this patient group.

The current review aimed to highlight the update management in patients with ischemic Cardiogenic shock (CS) and its impact on mortality. We reviewed the literature using search engine as MIDLINE, SCOPUS, and EMBASE from January 1982 to October 2012. We used key words: “Cardiogenic Shock”. This traditional narrative review did not expand to explore the mechanical complications or other causes of CS. There were 7193 articles assessed by 3 reviewers. We excluded 4173 irrelevant articles, 1660 non-English articles and 93 case-reports. The current review evaluated 888 articles (880 studies and 8 meta-analyses) that were tackling ischemic CS from different points of view before and after the era of SHOCK trial. Ischemic CS remains the most serious complication of acute MI, being associated with high mortality rate both in the acute and long-term setting, despite the advances in its pathophysiology and management. Further randomized trials and guidelines are needed to save resources and lives in patients sustained ischemic CS.