Open Access Original Research Article

Cell Elasticity-based Microfluidic Label-free Isolation of Metastatic Tumor Cells

Muhymin Islam, Waseem Asghar, Young-tae Kim, Samir M. Iqbal

Journal of Advances in Medicine and Medical Research, Page 2129-2140
DOI: 10.9734/BJMMR/2014/7392

Aims: Circulating tumor cells (CTCs) have significant diagnostic value for cancer patients. We report a label-free, simple and rapid microchannel filter type device for isolation of known metastatic cancer cells based on their mechano-physical properties like size and deformability.
Study Design: Metastatic renal cancer cells were highly elastic and squeezed through microchannels much smaller than their size. Using a reverse-selectivity approach, the number of microchannels and their dimensions were varied to optimize and reduce the shear stress on tumor cells such that these did not pass through filtering channels.
Place and Duration of Study: Department of Electrical Engineering and Department of Bioengineering, University of Texas at Arlington, USA, between June 2012 and March 2013.
Methodology: A microfluidic filter type device was fabricated using soft lithography in polydimethylsiloxane (PDMS). The device consistedof one inlet and one outlet connected via 400 microchannels. First of all human derived renal cancer cells were suspended in 1X PBS solution and passed through these microchannels and capture efficiency of the device was calculated. The dimensions of microchannels were varied in order to increase efficiency. Eventually cancer cells were spiked in rat blood and isolated from the mixture.
Results: For different dimensions of microchannels capture efficiencies of the devices were calculated. First device consisted of microchannels of 20 µm x 10 µm (Device-1) and the capture efficiency was 31.04±2.5%. Then dimensions were varied to 10 µm x 10 µm (Device-2), 10 µm x 5 µm (Device-3), and 5 µm x 5 µm (Device-4) and capture efficiencies increased to 45.18±1.85%, 70.96±2.39% and 78.36±4.29%, respectively. Rat blood was used as negative control in Device-3 and Device-4 and blood cells were able to pass the microchannels. Finally renal cancer cells were spiked in rat blood and isolated from red blood cells and white blood cells.
Conclusion: A novel microdevice is fabricated to detect metastatic renal cancer cells based on their size and deformability. The efficiency of the device is more than 78%. This microfluidic channel device does not require preprocessing of blood (except dilution) or tagging/modification of cells and can be implemented for primary screening of cancer.

Open Access Original Research Article

The Effect of Long Term Consumption of Powdered Tobacco Diet on Learning and Memory in Swiss White Mice

B. I. Owhorji, S. A. Bisong, I. E. Joshua, A. A. Nwankwo, E. E. Osim

Journal of Advances in Medicine and Medical Research, Page 2141-2155
DOI: 10.9734/BJMMR/2014/7420

Aim: The effects of long term consumption of powdered tobacco (snuff) diet on learning and memory was studied in 30 Swiss white mice.
Design: The mice were randomly assigned into two groups (n = 15 each). Mice in group 1 (test group) were fed 1% tobacco diet while mice in the other group (control) were fed normal rodent chow only. Both groups were fed for 31 days before carrying out behavioural testing. All mice were given free access to clean drinking water.
Methodology: Food and water consumption by the animals were measured daily while their body weight was measured every two days. The Morris water maze was used to assess Learning and Memory in the mice.
Results: The mean daily water and food intake was significantly higher (p<0.01; 0.001 respectively) in the tobacco diet-fed group than in control. The tobacco diet fed group also had a significantly higher (p<0.05) body weight gain than control. The swim latency during the reversal training was shorter in the tobacco diet-fed mice compared to their controls (p<0.01), showing better learning among the tobacco diet-fed group of mice. Southeast (reversal/retention) quadrant duration was also higher in the tobacco diet-fed mice (p<0.01) showing better memory than control.
Conclusion: Long term consumption of 1% tobacco diet increased food and water intake, weight gain and improved learning and Memory in mice.

Open Access Original Research Article

Evaluation of Antioxidant and Acteylcholinesterase-inhibitory Properties of Methanol Extracts of Nauclealatifolia, Cymbopogon citratus and Cocos nucifera: An In vitro Study

Oluwatosin Adekunle Adaramoye, Fausat Adesola Azeez

Journal of Advances in Medicine and Medical Research, Page 2156-2170
DOI: 10.9734/BJMMR/2014/7206

Aims: To evaluate the in vitro antioxidant and acetylcholinesterase (AChE)-inhibitory potentials of methanol extracts of Nauclea latifolia (NL), Cymbopogon citratus (CC) and Cocos nucifera (CN).
Study Design/Methodologies: The antioxidant and AChE- inhibition activities were evaluated using standard in vitro methods viz; DPPH (2,2-diphenyl-1-picrylhydrazine), nitric oxide (NO.), hydroxyl radical (OH.) and hydrogen peroxide (H2O2) radical scavenging assays as well as reducing power, Fe2+/ascorbate-induced lipid peroxidation (LPO) and AChE inhibition assays.
Place and Duration of the Study: The study and analyses were carried out at the Department of Biochemistry, University of Ibadan between March and June 2012.
Results: Extract of NL has the highesttotal phenol and flavonoids contents. The antioxidant activities of the extracts followed the order; CN> NL> CC. Based on DPPH radical scavenging, extract of CN was the most effective. The DPPH scavenging potential of CN, NL and CC were 88%, 82% and 76%, respectively relative to catechin (standard) (91%). The IC50 for the scavenging of hydroxyl radicals by CN, CC and NL were 145.3, 148.8 and 162.3 μg/mL, respectively while catechin is 178.6μg/mL. The reducing powers of CN and NL were statistically similar to catechin. At100 μg/mL, extracts of CN, CC and NL inhibited hepatic LPO by 41%, 22% and 29% respectively. Importantly, extract of CN significantly (p<0.05) inhibited brain LPO and promotes NO. scavenging by 48% and 23%, respectively. Also, CN at 250 and 500 μg/mL significantly (p<0.05) inhibited AChE activities by 33% and 75%, respectively.
Conclusion: CC, NL and CN exhibited strong antioxidant activities but only CN has significant AChE-inhibitory potential.

Open Access Original Research Article

Role of Anxiety on Patient Intolerance during Bronchoscopy

Cuneyt Tetikkurt, Ilknur Yasar, Seza Tetikkurt, Nail Yılmaz, Bilge Yılmaz Kara, Ruhi Yavuz, Rian Disci

Journal of Advances in Medicine and Medical Research, Page 2171-2180
DOI: 10.9734/BJMMR/2014/6907

Aims: There are no current data about the adverse effects of anxiety on patient intolerance during bronchoscopy.The aim of our study was to assess the correlation between anxiety and patient intolerance during bronchoscopy.
Study Design: Retrospective research study
Place and Duration of Study: Department of Pulmonary Diseases, Cerrahpasa Medical Faculty, between January 2010 and 2013 March.
Methodology: Data from 94 patients were analyzed. The mean age of the patients was 59 years. Bronchoscopy was performed for lung cancer in 54, pulmonary nodules in 26 and pulmonary infiltration in 14 patients. Hospital Anxiety Depression scale was used to appraise the anxiety symptoms. Cytologic examination of bronchoalveolar lavage, and sputum samples were performed in each patient when available.
Results: The anxiety or fear profile of the patients before bronchoscopy were as follows: dyspnea (78%), malignant disease (74%), nasal, laryngeal or tracheal irritation (70%), bronchoscopic findings (68%), and hemorrhage (42%). Bronchoscopic examination was intolerable in 14 cases while there was great difficulty to perform the procedure in 18 patients. Cytologic analysis revealed severe in 18, moderate in 22, and mild dysplasia in 25 patients while it was normal in 29 subjects. Hospital Anxiety Depression scale was over eight in 33 patients. The scale was over eight in 13 out of 14 patients who were intolerant to bronchoscopy. Cytology revealed severe in one and moderate dysplasia in another patient intolerant to bronchoscopy.
Conclusions: Anxiety appears to be the predominant factor for patient intolerance during bronchoscopy. Pulmonary function, atypical or dysplastic cytomorphological changes in sputum or bronchoalveolar lavage cytology did not show correlation with patient performance.

Open Access Original Research Article

Patient Satisfaction with Services at a General Outpatient Clinic of a Tertiary Hospital in Nigeria

H. Adamu, M. O. Oche

Journal of Advances in Medicine and Medical Research, Page 2181-2202
DOI: 10.9734/BJMMR/2014/5918

Aims: To determine the factors influencing patient satisfaction with services at the general outpatient clinic of a tertiary hospital in Nigeria.
Study Design: A descriptive cross sectional study.
Place and Duration of Study: We carried out the study between February and July 2011, in the General Outpatient Department of Usmanu Danfodiyo University Teaching Hospital Sokoto, Ni.
Methodology: One hundred respondents were sampled using systematic sampling technique. We developed a structured questionnaire, which sought information on socio-demographic characteristics of patients, registration/wait times and patients’ satisfaction. We analyzed the data using the Statistical Package for Social Sciences (SPSS) version 17.0.
Results: Out of the 100 patients sampled, 4 opted out, thus giving a response rate of 96%. Their ages ranged between 15-70 years with mean of 32±13 years. Students constituted 28.4% of the participants, followed by full term housewives (27%). Those participants having up to tertiary education accounted for 36.1%. Up to 62.5% of participants were females and majority of them were from urban areas (88.5%). Registration time ranged between 1-132 minutes (mean = 76±22.7 minutes) whereas clinic wait time ranged between 10-167minutes (mean = 83.7±38.6 minutes). Sixty five percent of them expressed satisfaction with neatness of the clinic environment, 48.5% expressed satisfaction with communication with the doctors while 65% expressed satisfaction with the explanations offered concerning their ailments. The overall satisfaction with services at the clinic was 52%. Determinants of satisfaction were total clinic wait time (P=.001, r=-0.4), clinic wait time (P=.007, r=-0.25) and age (P=.001, r=0.31).
Conclusion: The overall satisfaction with services at the clinic was above average, patients expressed dissatisfaction with registration time, wait time and condition of consulting room. Health care managers should commence appointment system to reduce the number of patients who turn out at the same time. They should also address provider-related factors that cause dissatisfaction.

Open Access Original Research Article

The Value of Cytology in the Diagnosis of Pleural Effusions

Cuneyt Tetikkurt, Bilge Yılmaz Kara, Seza Tetikkurt, Nail Yılmaz, Ilknur Yasar, Rian Disci

Journal of Advances in Medicine and Medical Research, Page 2203-2211
DOI: 10.9734/BJMMR/2014/7165

The aim of this study is to assess the value of cytology in the diagnosis of pleural effusions. It is a retrospective review of the patients with pleural effusions admitted at our clinic in a 8-year period. We evaluated the cytological and diagnostic results of 470 patients. Male to female ratio was 3:1 with a mean age of 38.6 years (range 18-76 years). Samples were processed and evaluated according to the standard methods. Cytology results were reviewed and the patients were stratified according to the their final diagnosis of the 470 effusions, 40 were transudates. Among 430 exudates, 190 (74.8%) were malignant on pleural fluid analysis alone. Adenocarcinoma was the most common malignancy. Tuberculosis was the second most frequent etiology for the exudative effusions. Cells in benign or malignant effusions were easily recognized without further invasive evaluation, contributing to diagnosis and therapeutic decisions. Diagnostic power of cytology was high and showed a good correlation with the eventual pathologic diagnosis, with an overall 70.6% sensitivity. Cytologic examination of the pleural fluid is a simple minimally invasive procedure as an initial step in the diagnostic work-up of patients with pleural effusions. It does not only provide high diagnostic sensitivity but also leads the clinician in the correct algorithm as the most informative and leading test even when not diagnostic on its own.

Open Access Original Research Article

Willingness of Individuals to Comply with Annual and Long-term Ivermectin Treatment in Abia State, Nigeria

O. R. Ezeigbo, B. E. B. Nwoke, C. N. Ukaga, R. O. Emecheta

Journal of Advances in Medicine and Medical Research, Page 2212-2219
DOI: 10.9734/BJMMR/2014/6435

This study was designed to document individuals’ adherence to annual ivermectin treatment and people’s willingness to continue taking ivermectin as an important predictor of sustained compliance with long-term ivermectin treatment. The study which was conducted between April and September, 2011 adopted a cross-sectional approach in collecting quantitative and qualitative data from the two Local Government Areas of Abia State that were assessed by REMO as hyper-endemic for onchocerciasis. The study population involved both high and low compliers groups. A Structured questionnaire was administered to 558 people to ascertain their compliance rate to annual and long-term ivermectin treatment and their willingness to sustain the treatment. Of these, 195 (34.9%) were males while 363 (65.1%) were females. Among these groups, 53.8% and 57.3% of males and females respectively were treated before. Of the 195 males and 363 females, only 25 (12.8%) males and 45 (12.4%) females were high compliers. On their willingness to continue with the drug, 483 (86.6%) claimed that most people take the drug, 495 (88.7%) affirmed that most people will continue with the drug while 555 (99.5%) indicated that they are personally willing to continue with the drug if made available. This is confirmed by the Chi-square (χ2) analysis at 0.05 level of significance that people are personally willing to continue with the drug if available (χ2cal =163.585, P-value < 0.0001). Suggestions on ways to improve compliance to annual and long-term ivermectin treatment showed that health education/enlightenment ranked very high (78.3%). This is followed by “awareness through church/school” (77.5%). It is imperative that the existing health education materials be reviewed by taking into cognizance such factors that will improve individual’s willingness to comply with annual and long-term ivermectin treatment. Such materials should emphasize compliance among youths and children 5 years and above.

Open Access Original Research Article

Tibiotalar Joint Stabilization by Steinman Pins in Oestern-tscherne Type III Open Fracture Dislocation of the Ankle

P. K. Karampinas, E. Kavroudakis, J. Vlamis, D. Anagnostopoulos, V. Polyzois, Sp. Pneumaticos

Journal of Advances in Medicine and Medical Research, Page 2220-2228
DOI: 10.9734/BJMMR/2014/7776

Aim: Open fracture-dislocation of the ankle is a high-energy limp-threading injury, almost always associated with vary grades of soft tissue damage. Stabilization of the tibiotalar joint by Steinman pins is retrospectively evaluated and seems to favor the management of the soft tissue damage and probably minimize the rate of complications in diabetic patients.
Study Design: Retrospective case series study.
Place and Duration of Study: From 2003 to 2011, Department of Orthopedics and Traumatology, University of Athens Medical School, KAT Hospital Athens, Greece.
Materials and Methods: 17 patients were admitted with a fracture dislocation of the ankle. Twelve were featured as Oestern-Tscherne type III and 5 as type V. There have been used Steinmann pins to provide a rigid stabilization of the ankle in anatomic position, and available enough space to observe, follow and manage the soft tissue damage during the entire period of treatment. Two groups were confronted according to associated co-morbidity of diabetes mellitus.
Results: At their last follow up visit, 14 patients were evaluated and the mean AOFAS score was 86, 5. The mean follow up period was 18, 1 months. Five patients underwent secondary arthrodesis of tibiofibular joint and in 4 patiens were observed non union of the fibula. Intra operatively in 10 patients were observed osteochondral post-traumatic lesions. In 3 patients the talus demonstrated signs of AVN at 7 months after trauma. There was no statistical difference between the two groups studied.
Conclusions: Immediate débridement, irrigation, antibiotic therapy and use of Steinmann pins to stabilize the tibiotalar joint are indicated in a way to reduce the complication rates in diabetic patients. This technique seems to be effective and low cost, evidenced by the unnecessary use of further wound and soft tissue treatment operations.

Open Access Original Research Article

Breastfeeding Indicators in Jazan Region, Saudi Arabia

Mohamed S. Mahfouz, Hala M. Kheir, Amzeenah A. Alnami, Ala'a H. Al-Asfour, Amal R. Awadh, Ebtesam A. Bahlool, Mona A. Al-Ghawi, Suzan A. Al-Hazmi, Ruba M. Qadri, Ahmed A. Ismail

Journal of Advances in Medicine and Medical Research, Page 2229-2237
DOI: 10.9734/BJMMR/2014/7197

Aims: The study aimed at exploring breastfeeding indicators and examining the effect of some demographic and maternity factors on exclusive breastfeeding among mothers of Jazan region, south west Kingdome of Saudi Arabia (KSA).
Study Design: Observational cross-sectional study design.
Place and Duration of Study: The study conducted in Jazan region, south west Kingdome of Saudi Arabia (KSA), during November 2012
Methodology: Community survey covered a random sample of 400 mothers who have at least one child less than 5 years old. Participants were interviewed using structured questionnaire containing background characteristics and breastfeeding information. Descriptive statistics were used for summarizing study variables. Differences in proportions were compared for significance using Chi Square/Fisher exact test. Logistic regression analysis was also used to test some associations with exclusive breastfeeding. All tests were two-sided and p < 0.05 was considered statistically significant
Results: The majority of the women 93% had ever breastfed their infants (95% C.I. (90.0-95.1)). Prevalence of breastfeeding initiation was 44.1% [95% C.I. (39.1-49.2)] as mothers initiated breastfeeding after less than hour after delivery. The prevalence of exclusive breastfeeding was 26.9%, (95% C.I. (22.6-31.6)). Regarding reasons for discontinuing breastfeeding, the main reason led the mothers to wean their infants was diminished milk supply (45.9%).
Conclusion: The study recommends encouragement of exclusive breastfeeding. Promotion of breastfeeding support groups is essential for advocating the great benefits and advantages of breastfeeding for mothers and their babies.

Open Access Original Research Article

Early Intervention in Audiology: Exploring the Current Status from a Developing Country Context

Katijah Khoza-Shangase, Gila Michal

Journal of Advances in Medicine and Medical Research, Page 2238-2249
DOI: 10.9734/BJMMR/2014/7322

Aims: Analysis of the current audio logical management protocols for children with hearing impairment in South Africa’s Gauteng state hospitals was investigated in this study.
Study Design and Methods: A retrospective record review was conducted, with 70 files/medical records of paediatric patients between the ages of birth and three years. These records came from three state hospitals’ audiology clinics where full audio logical and otological services were available.
Results: Findings of this study revealed concerning trends. Firstly, findings indicated that on average children were identified with a hearing loss at 23.65 months. Secondly, they received amplification 7.11 months after diagnosis and were only introduced into aural rehabilitation at the average age of 31.2 months. However, 81% of children received appropriate audio logical tests; with 85.7% of children who were identified with a hearing loss receiving amplification. All children identified with a bilateral hearing loss in the current sample were aided bilaterally. As far as communication development was concerned, 48.57% of the children identified with a hearing loss received the auditory verbal therapy approach, with 18.57% receiving sign language as a means of communication, while 11.43% received a total communication approach. A significant number (14.29%) were not receiving aural rehabilitation therapy.
Conclusion: Findings raise important implications for the success of early hearing detection and intervention (EHDI) initiatives in South Africa. Improved and concerted efforts in the form of systematic planning and implementation of EHDI protocols are required.

Open Access Original Research Article

Effect of Occupational Exposure to Aluminum on Parathyroid Hormone and Calcium Metabolism

Mona Sobhi Siha, Laila Rashed, Dalia Abdel-Hamid Shaker, Mona Ramadan

Journal of Advances in Medicine and Medical Research, Page 2265-2276
DOI: 10.9734/BJMMR/2014/8153

Aims: Aluminum is widely used in industry and it has been associated with several health hazards among exposed workers. To study the effect of aluminum on the parathyroid gland and the disturbance in calcium and phosphorus metabolism among workers exposed to aluminum in aluminum industry.
Methodology: This study was conducted on fifty workers in an aluminum foundry, who were occupationally exposed to aluminum and were compared with fifty non-exposed individuals. Full history was taken, clinical examination and some laboratory investigations were done in the form of: CBC, kidney functions, serum PTH, serum calcium, serum phosphorus and serum aluminum. Plain X-ray was done for workers who were markedly complaining of musculoskeletal symptoms. Environmental measurement of aluminum dusts were carried out in selected workplaces.
Study Design: Case control study of aluminum exposed workers.
Place and Duration of Study: Aluminum industry in Ain-Helwan, Cairo, Egypt, 2012.
Results: Statistically significant differences were found between exposed and control as regards prevalence of parathyroid and musculoskeletal disorders, serum level of the parathyroid hormone (PTH), serum calcium, serum phosphorus, serum aluminum, creatinine, RBCs count and also there was a statistically significant difference between exposed workers with osteopenia and exposed workers without osteopenia as regards serum aluminum level. The environmental measurements in the workplace were within the permissible limits in Egypt.
Conclusion: The elevation of serum aluminum level in workers exposed to environmental level within the permissible limits was associated with disturbance in PTH, calcium and phosphorus metabolism, so these limits should be revised. Periodic medical examination of workers exposed to aluminum is a must; this should include clinical examination, analysis of aluminum in serum, measurement of serum electrolyte (calcium and phosphorus) and bone imaging.

Open Access Original Research Article

Combined Therapy of Moringa oleifera and Ocimum gratissimum Reversed Testicular Damage in Diabetic Rats

Patrick E. Ebong, Esienawan E. Efiong, Bob I. A. Mgbeje, Godwin O. Igile, Edisua H. Itam

Journal of Advances in Medicine and Medical Research, Page 2277-2290
DOI: 10.9734/BJMMR/2014/7078

Introduction: Testis is an important male reproductive and endocrine organ whose structure and function are altered in diabetes complicated disorders.
Aim: This study evaluated the protective effect of Moringa oleifera (MO) and Ocimum gratissimum (OG) on diabetic rat testes.
Methodology: Thirty six rats, weighing between 120-180g, were divided into six groups of 6 rats each. Groups 1 and 2 representing Normal (NC) and Diabetic Control (DC) received 0.5ml of dimethylsulphoxide. Group 3 received 5IU/kg b.w insulin; groups 4, 5 and 6 received 500mg/kg b.w of MO, 500mg/kg b.w of OG and 250mg/kg b.w of each extract respectively. Fasting blood glucose (FBG), serum testosterone, luteinizing hormone (LH), follicle stimulating hormone (FSH) and histology of the testes were analysed after 28 days treatment.
Results: MO, OG and the combination extract normalized the levels of FBG. Only the Moringa extract normalized the levels of testosterone, LH and FSH compared with DC. The OG extract had no effect on the level of the three sex hormones but provided a potentiating effect on the FSH level in the MO + OG group. The results were confirmed by histological studies which showed damage on the testes for the DC and OG and reversal of damage to the testes in MO and MO + OG groups.
Conclusion: The combined extracts more than Moringa extract alone, had ameliorative effects on testicular architecture and spermatogenesis in diabetes and provide a cheap alternative to treating diabetes associated testicular damage and sexual dysfunction.

Open Access Original Research Article

Long-term Outcome and Satisfaction to Surgery after Vaginal Hysterectomy

Ritva Nissi, Kotila Vesa, Silvennoinen Laura, Talvensaari-Mattila Anne

Journal of Advances in Medicine and Medical Research, Page 2291-2295
DOI: 10.9734/BJMMR/2014/5708

Purpose: Pelvic organ prolapse (POP) is a common condition that can severely impact the quality of a woman’s life. POP will generally get worse in time and is likely to become more common, as the population ages in the coming years. Epidemiologic studies point to vaginal childbirth delivery as the strongest risk factor, although the etiology is multifactorial. The annual incidence of posthysterectomy vaginal prolapse that requires surgery has been estimated to be 36 per 10 000 persons globally.
Methodology: This study was a retrospective analysis in which we evaluated long-term anatomical results and quality of life after vaginal hysterectomy. 43 patients out of 98 who underwent vaginal hysterectomy between the years 1990 and 1996 in the Länsi-Pohja Central Hospital in Finland were examined and interviewed for the study.
Results: 33% of examined patients presented cystocele or rectocele at the time of study (on average 17.6 years post operation). Seven of them had already been operated. No vaginal vault prolapse was observed. As for quality of life 72 % of patients reported lower urinary tract symptoms, namely urgency, but only 9% felt sensation of prolapse, while 53 % of sexually active patients complained dyspareunia.
Conclusion: In this article we present unique long-term follow-up after vaginal hysterectomy. This is a first article presenting over 15 year follow-up after vaginal hysterectomy.

Open Access Review Article

A Systematic Review of Management of Otitis Media with Effusion in Children

S. Zulkiflee, A. Asma, R. Philip, M. H. Siti Sabzah, D. Sobani, N. Y. Nik Khairulddin, P. L. Jaclyn Teoh, I. B. Norizzati Bukhary, M. Y. Mazapuspavina, S. Roza, M. Y. Mohd Aminuddin, A. Hafeza, M. Rafidah, A. R. Shahrom, S. Juliana, M. Suhaidie

Journal of Advances in Medicine and Medical Research, Page 2119-2128
DOI: 10.9734/BJMMR/2014/8027

Aim: Otitis media with effusion in children can result in impairment of speech and language development secondary to the effects of conductive hearing loss from the disease. The review was conducted as part of a clinical practice guideline to assist healthcare providers in the management of this condition.
Study Design: Systematic review.
Place and Duration of Study: Development Group on Otitis Media with Effusion in Children Clinical Practice Guidelines, Medical Development Division, Ministry of Health Malaysia, between 17 August 2010 and 21 February 2012
Methodology: Literature search was carried out on multiple electronic databases. In addition, the reference lists of all retrieved articles were searched to identify relevant studies. Experts in the field were also contacted to identify further studies. All searches were officially conducted between 17 August 2010 and 21 February 2012. All literature retrieved was appraised using Critical Appraisal Skills Programme (Oxford) by at least two members and presented in the form of evidence tables and discussed during development group meetings. The articles used in this review were graded using the US/Canadian Preventive Services Task Force Level of Evidence [7].
Results: A total of 356 relevant titles were identified and 147 abstracts were screened Thirty one articles were used in the results. There was good evidence for non surgical intervention as the initial mode of management. It consists of active observation and medical therapy. Short term (less than six weeks) intranasal steroid can be used for otitis media with effusion (OME) with concurrent allergic rhinitis and adenoid hypertrophy (p<0.001). There was good evidence that oral steroids, prolonged intranasal steroids, antibiotics, antihistamines or decongestants, auto inflation, homeopathy and mucolytics are not beneficial. Surgical intervention should be considered after three months of persistent otitis media with effusion with in children with hearing loss >25 dB (at three frequency average). Myringotomy with ventilation tube (VT) insertion is the procedure of choice. Combined adenoidectomy should be considered in children with persistent OME and hypertrophied adenoids (p<0.001).
Conclusion: The initial management of OME in children consists of active observation. Short term (up to 6 weeks) use of intranasal steroids can be used in children with concurrent adenoid hypertrophy or allergic rhinitis. Surgical management is considered after three months of persistent OME. Myringotomy with VT insertion is the procedure of choice.

Open Access Review Article

Stem Cell and Its Banking: Current Trends and Developments

Jia Xi Chong, De Somsubhra

Journal of Advances in Medicine and Medical Research, Page 2250-2264
DOI: 10.9734/BJMMR/2014/7467

Stem cells are immature cells capable of self-renewal and differentiation into mature cells. They are of different types and functionally diverse depending on the site it is produced. A major leap in stem cell culture is seen from using the conventional Mouse Embryo Fibroblast (MEF) with the possibility of problems arising due to xenogenicity to Induced Pluripotent cells (iPS) cells which take the stem cell harvesting to a new level. The usage of stem cells were expanded from human Embryonic stem cell (hESC) to various Mesenchymal Stem cells (MSC), Hematopoietic stem cells (HSC) and human-animal cybrids which showed promise in the treatment of diseases like HIV, Parkinsonism and Alzheimer’s. The stem cell banking made it possible for researchers to further their knowledge and also the patients to utilize the variety of stem cell transplantation obtained from adipose tissue, menstrual blood and dental pulp and thereby not limiting to hESC.
In this review we discuss the developing trends in the stem cell culture and also in its banking mainly public with private, considering the facilities available on the storage and accessibility to the researchers and patients. We also discuss about the prerequisites of such storage and the challenges faced by alternative therapeutic possibilities to stem cell therapies. Stem cell banking looks promising amidst its pitfalls however the future trend of stem cell therapy and banking still appears shrouded with unpredictability in the face of newer developments.