Journal of Advances in Medicine and Medical Research

Aims: To investigate a case of the mid-ventricular variant of Takotsubo cardiomyopathy (TTC), stress-induced cardiomyopathy, and evaluate if gastrointestinal pain may also contribute to this cardiomyopathy.
Presentation of Case: A 73-year-old female was admitted for severe abdominal pain, found to have positive cardiac biomarkers and ischemic ECG changes and was diagnosed with mid-ventricular TTC after non-invasive and invasive investigation.
Discussion: There are many variants of TTC that was found in a literature review. We demonstrated a unique variant of TTC that occurred of a significant emotional stressor with acute abdominal pain.
Conclusion: Not much detail is known about the variants TTC. Investigators must continue to study TTC so that physicians can more effectively diagnose, treat, and manage patients who present the condition. We suspect that gastrointestinal illness was the physical stressor that contributed to the onset of our patients TTC in a setting of ongoing emotional distress and should be on the differential as an eitology.

Background: Ischaemia-reperfusion injury (IRI) is an underlying condition in cardiovascular disease such as arthrosclerosis and stroke, and occurs during surgery that involves the application of a tourniquet. These clinical conditions are extremely prominent in the United Kingdom. This pilot-study aimed to determine the effects of mild tourniquet induced IRI on specific haematological, haemostatic and inflammatory parameters.
Patients and Methods: An In vivo model of mild tourniquet induced IRI was performed on 15 volunteers (n=15). Tourniquet pressure was set between 20-40 mmHg for 10 minutes and rendered the arm temporarily ischaemic. Baseline venous blood samples were taken prior to ischaemia, then following the release of the tourniquet at 7 minutes and 48 hours reperfusion. The parameters investigated included: full blood count, von Willebrand factor (vWF), sE-selectin, prothrombin time (PT), Interleukin-6 (IL-6), IL-8 and IL-10.
Results: The results demonstrated a significant increase in vWF following reperfusion (p=0.005), and increasing trends of IL-6, IL-8 and sE-selectin concentrations (p=>0.05). Decreasing PT, white blood cell and platelet counts were observed following IRI but were not significant (p=>0.05).
Discussion and Conclusion: The study demonstrated that brief periods of IRI caused changes to haematological, haemostatic and inflammatory parameters. Specifically, a significant increase in vWF concentration was observed following tourniquet induced IRI. This suggests that changes to vascular integrity and that of endothelial activation may be occurring.
The results of this pilot-study provide a basis for further exploration of haematological, haemostatic and inflammatory parameters following IRI, which may increase our knowledge and understanding of a subject area that is not fully understood. Ultimately, further studies may highlight areas of therapeutic intervention for the underlying occurrence of IRI in pathological conditions, such as cardiovascular disease (CVD) and surgeries that involve the application of a tourniquet. These predictors, however, need further work to validate reliability in a clinical setting.

Background: The metabolic syndrome is a common metabolic disorder associated to the increasing prevalence of overweight and obesity.
Aims: To assess the prevalence of metabolic abnormalities and metabolic syndrome (MetS) among 16-21 years Cameroonian adolescents and analyzed the influence of age, gender and weight status.
Study Design: This was a cross sectional study.
Place and Duration of study: Commercial High school of Yaoundé, between January and May 2012.
Methods: MetS was defined according to United States (US) adapted pediatric criteria and International Diabetes Federation (IDF) criteria. A cross sectional study was set to collect data from 1765 adolescents (59.1% girls).
Results: Using the US criteria, the prevalence of MetS was 20.3%, while IDF criteria showed a lower prevalence of 15.3%. Girls were at greater risk for MetS (US 25.0% and IDF 23.4%) compared to boys (US 15.0% and IDF 6.1%). The prevalence of MetS was elevated in elder adolescents (US 22.4% and IDF 18.9%) as compared to youngster (US 14.9% and IDF 5.9%). Overweight adolescents (BMI≥25kg/m2) were more exposed to MetS (US 25.5% and IDF 26.7%) than normal weight (US 17.4% and IDF 9.0%). MetS prevalence itself varied markedly according to criteria used. Both US and IDF criteria, showed highest rate of low HDL (US 55.0% and IDF 49.3%) and elevated blood pressure (US 28.8% and IDF 27.0%).
Conclusions: The prevalence of MetS among our study population was high especially in girls and overweight adolescents. Individual MetS abnormalities are common in adolescents, further studies are needed to draw a more precise picture of the situation in order to better target interventions to improve future cardiovascular health.

Aims: The aim of this study was to investigate the association of MMP9 -1562 C /T single nucleotide polymorphism with lung cancer in south Iranian population. Matrix metalloproteinases (MMPs) are a family of highly conserved metal-dependent proteolytic enzymes that are able to degrade ECM components and regulate various cell behaviors. Among several candidate genes, MMP9 is one of the most important genes known to play a key role in relation to lung cancer initiation and progression. A common -1562(C/T) single nucleotide polymorphism in the promoter region of MMP9 was reported to have an association with lung cancer disease.
Study Design: A case - control study was carried out using 90 lung cancer patients and 100 healthy controls.
Place and Duration of Study: Cellular and Molecular Gerash Research Center, Shiraz University of Medical sciences, shiraz, Iran, between 2010-2012.
Methodology: The association of MMP9 promoter single nucleotide polymorphism and lung cancer was examined in a PCR-RFLP method. Our results suggest an association between MMP9 single nucleotide polymorphism and lung cancer initiation and progression.
Conclusion: According to our results, the frequency of T allele in patient group (OR=4.6111, 95% CI, 1.9005 to 11.1879) and TT genotype in smoker group (OR=1.7726, 95% CI, 0.7947 to 3.9538) is higher compared to other groups.

Aims: To determine the prevalence of non-B HIV-1 subtype specific mutations in the protease gene among antiretroviral drug-naive individuals in Jos, Nigeria.
Study Design: This was a cross-sectional study in which randomly selected blood samples of HIV-1 positive anti-retroviral drug-naïve individuals were used for genotyping assay.
Place and Duration of Study: The study was conducted at the adult HIV clinic of the AIDS Prevention Initiative in Nigeria (APIN) programme, Jos University Teaching Hospital (JUTH), Jos, Nigeria between October 2010 and April 2011.
Methodology: Of the one hundred and five plasma samples, 100 samples were successfully reverse transcribed and amplified by nested PCR. The amplicons were directly sequenced on an automated ABI genetic analyzer using BigDye Terminator Cycle Sequencing Kit. Subtyping and phylogenetic analyses were performed using the REGA subtyping tool version 2.0 and MEGA 5.0 software. Both the Stanford HIV database algorithm and IAS-USA 2013 drug resistance update were used for interpretation of drug sensitivity.
Results: The proportion of the non-B HIV-1 subtypes were as follows: CRF02_AG (48%), G (41%), CRF06_cpx (6%), A (5%). Q58E, a major drug resistance mutation to PI, occurred as a low prevalence mutation in subtype G. The most common mutations observed among the subtypes were I13V, K14R, K20I, M36I, R41K, H69K, V82I and L89M.
Conclusion: A non-uniform distribution of non-B HIV-1 subtypes were observed in Jos, Nigeria, with CRF02_AG and G predominating among the antiretroviral drug-naive individuals. Among the different subtypes in circulation, there was a high prevalence of minor mutations and natural polymorphisms associated with the protease gene. Such mutations define the subtype diversity which may impact on virulence and drug ‘responses’, thus further studies are needed to evaluate the clinical implications of these mutations.

Reproductive tourism is the act of crossing an international border to seek assisted reproductive services, which can include maternal surrogacy. Ethical analyses of this phenomenon may be poorly served by considering the Western liberal framework alone. In previous studies, we identified 16 domains of ethical interest arising from this industry. In this paper, we sought perspectives in the scholarly literature that inform the development of an alternative to the Western liberal framework, incorporating more communalistic values that were then applied to the pre-identified domains. We concluded that a hybrid Western-communalistic framework, appropriate for helping to guide ethical analyses of reproductive tourism, incorporates an encouragement of third-party advocates to overcome power gaps between pertinent actors, and assumes the existence of a universal morality, such that a uniform standard of care can be expected regardless of cultural context.

AIM: The aim of this study was to determine the relationship between excess body weight gain and plasma insulin, lipid profile and anthropometric indices in overweight/obese civil servants urban city dwellers in Nigeria where fast food outlets are fast growing.
Study Design: This study was designed to access anthropometric indices, plasma lipid profile and insulin in non diagnosed disease overweight/obese individuals.
Place and Duration of Study: The study was carried out in the Department of Chemical Pathology University College Hospital Ibadan Nigeria, between February 2010 and June 2011.
Methodology: Ninety (90) male and female subjects consisting of sixty overweight/obese with mean age of 36.38±1.04 years and thirty normal weight with mean age of 35.93±1.73 years served as controls. Anthropometric indices were measured using standard procedures. Plasma total cholesterol (TC), high density lipoprotein cholesterol (HDLC) and triglyceride (TG) were estimated using biochemical procedures. Insulin was measured with the Ultrasensitive Insulin assay on the Access^® immunoassay system. The low density lipoprotein cholesterol (LDLC) was calculated.
Results: The results showed increased plasma insulin (P=.031), TC (P=.004), TG (P=.008) and LDLC (P=.001), BMI (P=.005), weight, waist and hip circumferences (P=.000) were significantly increased compared to the corresponding control values. Insulin was significantly correlated with BMI (r=.403, P=.003) body weight (r=.464, P=.001) and height (r=.380, P=.02) in overweight/obese subjects.
Conclusion: Our results suggest that risk factors for cardio metabolic syndrome exist in overweight /obese civil servants urban city dwellers that have no known diagnosed diseases.

Aim: To determine the factors associated with a low CD4 count among HIV-1 positive patients.
Study Design: Cross-sectional study.
Place and Duration of Study: Adult HIV clinic at the Jos University Teaching Hospital, Jos, between October 2010 and April 2011.
Methodology: Data on demographic, clinical and laboratory variables for 218 HIV-1 infected patients aged 20 years and older were analysed. A low CD4 cell count was defined as CD4 cell count <200 cells/ml based on the WHO criteria for severe immune suppression. A multivariate logistic regression modeling was fitted to determine the variables that were independently associated with a low CD4 count.
Results: Of the 218 HIV-1 infected patients, 119 (54.6%) had a low CD4 count at enrolment. The odds of having a low CD4 count was: 7 times higher in patients with WHO clinical stage 3 or 4 compared to those with stage 1 or 2 (P<.001) and 4 times higher in those with HIV RNA viral load ≥4.6 log10 copies/ml compared to those with less (P<.001); but the odds of having a low CD4 count was reduced by 63% in those patients that were resident in Plateau State compared to those resident outside the state (P=.01).
Conclusion: Our study patients were more likely to have a CD4 count <200 cells/ml which would suggest late presentation/ late HIV diagnosis and thus a delayed opportunity for timely access to HIV care and initiation of antiretroviral therapy. There is the need to intensify efforts in early routine HIV counseling and testing not only in health facilities in the cities but also in smaller towns and rural communities, so as to reduce the frequency of late HIV diagnosis with its potential implications.

Aims: Tuberculosis is an infectious disease caused by the bacillus Mycobacterium tuberculosis and other related species. It typically affects the lungs (pulmonary TB) but can affect other sites (extra-pulmonary TB). A profusion of articles have been published on the accuracy and uses of interferon-gamma releasing assays for detection of this disease.
Experimental Design: A prospective study.
Place and Duration of Study: This study was done in Kirkuk city between November 2012 to February 2013.
Methodology: The present study included 50 individuals (40 suspected tuberculosis patients and 10 healthy controls). The patient were examined for the presence of TB by using QuantiFERON-TB Gold In-Tube(QFT-GIT) assay, polymerase chain reaction (PCR) and compared them with certain new and routine tests like AFB smear, OnSite TB rapid test, erythrocyte sedimentation rate and chest X-ray.
Result: The present study showed a relation between QFT-GIT and OnSite TB rapid test, and they were positive in 25(86%) at the same time; QFT-GIT positive and OnSite TB rapid test were negative in 4(14%) of patients; QFT-GIT negative and OnSite TB rapid test positive were seen in 5(45%); while QFT-GIT and OnSiteTB rapid test were negative in 6(55%) of patients. In the control group only one QFT-GIT positive but it was OnSite TB test negative. 9(100%) of individuals for both tests were negative, 29 were males and 21 were females.
Conclusion: The study highlighted the sensitivity of IGRAs for diagnosis of active TB in combination with the rapid IgM/lgG tests for TB.The QFT assay appeared to be a more specific indicator of latent TB infection than TST. The association with blood groups and vaccination is also significant.

Aim: To evaluate early doxorubicin (DOX) cardiotoxicity in asymptomatic leukemic patients and to explore whether Grape seed extract (GSE) proanthocyanidins would prevent the DOX-induced cardiotoxicity.
Study Design: Prospective randomized double blind study.
Place and Duration of Study: This study was conducted in Mansoura University Hospital, between January 2011 and May 2013. Forty two newly diagnosed acute lymphoblastic leukemia (ALL) patients were enrolled, their ages ranged from 9 to14 years. They were divided into two groups; group I received Doxorubicin-containing chemotherapy while Group II was treated with Doxorubicin-containing chemotherapy plus GSE all over the study period. All patients underwent clinical, echocardiographic and laboratory evaluations at the end of induction (phase I) and at the end of CNS intensification (phase II). Serum malondialdehyde (MDA) level, high sensitive cardiac troponin T (hscTnT), N-terminal pro brain natriuretic peptide (NT-proBNP), creatine kinase (CK) and CK -MB isoenzyme activity were determined
Results: There were significant reduction in mean values of ejection fraction (EF), fractional shortening (FS) and Vitamin C, while there were highly significant increase in mean values of hscTnT, NT- ProBNP and significant increase in mean values of CK and MDA at the end of phase II in both groups. There were also significant negative correlations between each of CK and NT-proBNP and EF at the end of phase I & II. Coadminstration of DOX and GSE (group II) significantly improved echocardiographic findings (EF and FS) as well as vitamin C level. It also significantly reduced the DOX cardiotoxicity as revealed by decrement in the elevated values of biochemical cardiac markers (hscTnT, NT-pro BNP and CK activity) and oxidative injury marker (MDA).
Conclusion: Biochemical cardiac markers have the potential to be used, besides echocardiographic measurements, in the early detection of DOX-induced subclinical cardiotoxicity. GSE is promising as a cardioprotective agent against DOX induced cardiotoxicity in children with ALL.

Aim: To determine the prevalence of refractive errors and spectacle use behavior among medical students in University of Calabar Teaching Hospital, Nigeria.
Study Design: Cross sectional study.
Place and Duration of Study: Department of Ophthalmology, University of Calabar Teaching Hospital, Calabar, Cross River State, Nigeria, between April 2010 and July 2010.
Methodology: The study population consisted of fifth year medical students. Subjects had cycloplegic auto refraction with Topcon auto refractor during their rotation in ophthalmology at the Ophthalmology department of the University of Calabar Teaching Hospital. A spherical equivalents (SE) ≥ +0.50D were determined as hyperopia; SE of >-0.50D myopia and >-0.50D cylinder as astigmatism. Statistical analysis, which included chi-square test was carried out with Statistical Package for Social Sciences (SPSS) version 20.0.
Results: Sixty-six (79.5%) of subjects had a form of refractive error; 63.6%%, 16.7% and 19.7% were myope, hyperope or simple estigmat, respectively. The prevalence of ametropia was 82% in female and 78% in males. The association between refractive errors and gender was not statistically significant (p = 0.35, 95% Confidence Interval [CI], 0.34-0.36).Minus spherical errors ranged from -0.16 to -5.25 diopters (D) and plus spherical errors ranged from +0.25 to +1.00D, spherical equivalent between -0.25D and -2.75D being the most common type (85.5%). Eight students (12.1%) were wearing glasses at the time of the study corresponding with 10 (15.2%) who had eye pains while reading.
Conclusion: The prevalence of refractive errors among fifth year medical students of the University of Calabar was high and eyeglasses were worn by students who were symptomatic.

Radioactivity measurements were carried out in and around Warri Refining and Petrochemical Company in the Niger Delta region of Nigeria for the naturally occurring radionuclides of ⁴⁰K, ²³⁸U and ²³²Th. The values were used to determine the excess lifetime cancer risk (ELCR) and the radiation health hazard indices. Results show that the ELCR value within the company premises is 0.12×10^-3 while the highest value was 0.17×10^-3 from Ugborikoko Community. The internal health hazard index ranged from 0.02 – to 0.64 and the external health hazard index ranged from 0.02 – 0.33. All these values were less than the world permissible standards. It could be concluded that the potential carcinogenic risk from gamma radiation doses to the population in and around the refining and petrochemical company is low.

Aims: To assess patient delay differences between early and late stage breast cancer among women in Uganda.
Study Design: A retrospective analytical study.
Place and Duration of the Study: A study conducted at a tertiary teaching hospital. Selected patients’ data available for the period between 2008 and 2011 were included in this study.
Methodology: We included 201 women with histologically confirmed breast cancer. The variables analysed included age, residence, histological subtype, stage at presentation and time delays. Ethical approval was obtained.
Results: The mean age for the early and late presenters was 49 and 46 years respectively (p=0.065). Rural women were more likely to present late. Triple negative breast cancer (TNBC) and HER2+ were the majority cancer subtypes for the late presenters. On average women waited for 29 months before they presented for specialized cancer treatment (median 12 months; range 1-120 months). The duration of symptoms didn’t differ between the two groups (p=0.295) and 75% of early stage presenters, reported at least 6 months after noticing symptoms. Only 9% of the TNBC patients presented under 3 months in comparison to 14 % for HER2+, 33% for Luminal B and 36% for luminal A. Overall 23% (39/168) presented with early stage disease.
Conclusion: Delay in seeking appropriate breast cancer care in Uganda was excessive, a sign of a neglected disease. Tumor biology factors seem to play a role in late stage presentation. Research in factors that lead to prolonged delay in accessing care in a resource poor context are needed urgently.

Depressed mood, with its accompanying mental and physical stresses, could affect the progression and severity of several diseases e.g. hypertension, myocardial infarction, gastritis, peptic ulcer. The present animal study was done to investigate the potential antioxidant effect of paroxetine, as a selective serotonin reuptake inhibitor, to protect against chronic restraint stress-induced oxidative damage in the liver. Thirty albino rats were divided into 3 equal groups. Group 1 was control, non-stressed non-treated group. Group 2 was exposed to chronic restraint model by placing them in wire mesh cages exactly fit to their size for 6 hours daily for 21 days. Group 3 were also exposed to chronic restraint model for 21 days while they were administered by paroxetine 1 mg/kg/day ip during the restraint period. At the end of the study, liver transaminases were determined by commercial kits. The hepatic levels of glutathione peroxidase, catalase and thiobarbituric acid reactive substance were also determined by spectrophotometric methods. Glutathione repletion ability by hepatic cells with and without paroxetine treatment was also determined in all tested groups. The results showed a significant (p<0.05) increase in serum levels of transaminases and liver anti-oxidant enzymes while levels of thiobarbituric acid reactive substance were significantly (p<0.05) reduced in paroxetine-treated group compared with non-stressed non-treated control rats. Glutathione repletion ability was also significantly (p<0.05) increased in treated group to a level comparable to the control non-stressed non-treated values.

Background: There are many different theories on atherosclerosis pathophysiology. The dominant one is endothelial function disorder resulting from the existence of risk factors such as dyslipidemia, diabetes, smoking, and high blood pressure and hyperhomocysteinemia bacterial and viral infections. The inflammation is an important parameter for CKD appearance and evolution too. In this review we will summarize the most recent evidence that inflammation and endothelial dysfunction are implicated in the enhanced cardiovascular risk experienced by individuals with CKD, we will not discuss the role of dialysis or transplantation in the propagation of cardiovascular risk.
Literature Review: Electronic medical databases were searched using as key - words the terms: “atherosclerosis”, “hemodialysis patient”, “end stage renal disease”, “Chronic Inflammation”, “Endothelial Dysfunction”. The search was conducted in English language. All studies referred to the correlation of the key terms were included and highlight the Inflammation and Endothelial Dysfunction in the Initiation and Propagation of Cardiovascular Disease in patients with Chronic Kidney Disease.
Conclusions: The presence of enhanced CV risk in patients with CKD is well known but the mechanisms by which it occurs are less clear. The endothelium is a complex, multi-functional organ with a variety of vascular homeostatic functions and ED has been shown to result in the initiation and propagation of atherosclerosis. Causes of ED are numerous but inflammation and oxidative stress are clearly highly implicated; albuminuria (even at levels thought to be well below previous definitions of abnormal) may contribute to the inflammatory process, as might dyslipidemia (though a combination of traditional and no-traditional pathways).