Aims and Background: Aggressive angiomyxoma is rare tumor of pelvic and perineal organs, occurring usually in women of reproductive age, and carrying a high tendency to local infiltration and relapse. Most literature about Aggressive angiomyxomaconsists of isolated case reports. Presentation of Case: We reported a case of 41-year-old Libyan woman complaining of a slow and progressive growth of a right vulvar labia major a pedunculated tumor with long a stalk was detected, measuring of 12.0x8.0 cm. Wide surgical resection of the tumor were performed. Histopathology diagnosed a large aggressive angiomyxoma with uninvolved resection margins. Patient remains without recurrence at 8.0-months follow-up. Discussion and Conclusion: Non Aggressive angiomyxomais rare but should be excluded in any large vulval mass. We expect that awareness accompanied with wide free safe margin excision has important role to prevent the recurrence of tumor.
Aim: Our aim is to present a case of hypernatremia which has led on to a flaccid quadriparesis due to brain stem demyelination. Rapid correction of hypernatremia as a cause for pyramidal tract demyelination is not documented in the literature. Presentation of Case: A 53 year old male was brought to the emergency services with suspected stroke. He was treated with intravenous mannitol and oral glycerine from the primary health centre. We detected hypoglycemia (blood sugarwas 50mg/dl-Ref range: ≤70mg%) and dextrose was given intravenously. Subsequently the patient went into a hypernatremic state with serum sodium 170milli equivalents /liter which was corrected rapidly. This was corrected over 48 hours to 140milli equalents/litre. The rate of correction exceeded 0.62millimols/liter/hour (Ideal: 0.5 mmol/L/h). On the 6th day the patient developed acute quadriparesis. Magnetic resonance imaging (MRI) of brain revealed bilateral symmetric demyelination of the corticospinal tracts. Over six months the neurological deficit improved with complete resolution of the changes in previous MRI. Discussion: Osmotic Demyelination Syndrome (ODS) has been a recognized complication of rapid correction of hyponatremia. Experiments in animals and clinical experience suggest that correction of chronic hyponatremia should be kept at a slow rate to combat this complication. The characteristic sites include pons and basal ganglia. Such a complication has not been described due to rapid correction of hypernatremia.This is probably the first case report in the literature where acute onset of quadriparesis resulted from demyelination of the pyramidal tract consequent to a rapid correction of hypernatremia. We had to wait about 6 months for the patient to obtain a complete functional recovery and the neuro imaging was repeated after 6 months to confirm the disappearance of the initial findings thus implicating rapid correction of hypernatremia as the cause of his morbidity. Conclusion: This is the first time extrapontine reversible myelinolysis due to rapid correction of hypernatremia has been documented. To prevent this potentially fatal complication it will be prudent if hypernatremia is corrected slowly.
Uterine didelphys or duplication of uterus is a rare congenital anomaly, which constitutes approximately 5% of mullerian duct anomalies. There is failure of the fusion of mullerian ducts resulting in the duplication of uterus and cervix. We report a case of uterine didelphys, which was incidentally detected in a 23 years old G2P1 patient who came for ultrasound with complaints of bleeding per vaginum. MRI was done and uterine didelphys was confirmed. Six months later that patient came again with 6 weeks pregnancy in the right uterine body. We did all antenatal follow up scans in this patient till 36 weeks. Lower segment cesarean section (LSCS) was done at 38 weeks and patient delivered a normal baby of 2.9-kilogram weight.
Aims and Background: Central pontine myelinolysis (CPM) and extrapontine myelinolysis (EPM) are recognized as osmotic demyelination syndrome (ODS). ODS is pathologically characterized by non-inflammatory demyelination of several brain structures with sparing of axons. This condition is usually associated with overzealous correction of hyponatraemia. Acute psychosis as the sole clinical manifestation is extremely rare. Presentation of Case: Hence, we report an interesting case of a middle-aged man who was diagnosed with EPM, following rapid correction of hyponatraemia and subsequently developed acute psychosis. He made a good recovery with supportive treatment alone. Discussion and Conclusion: The possibility of psychosis as a manifestation of ODS, particularly in patients with recent correction of hyponatraemia. The rate of correction of plasma sodium level is the key point for preventing ODS and its complications.
Aims: The aim of this manuscript is to present innovative applications of the BTK model that can potentially contribute additional aspects of safety evaluations for a broader range of products and materials intended for prolonged skin contact. Study Design and Methodology: The basic BTK protocol is one 6-h exposure per day for 4 days. Modification to the basic protocol were made for individual studies, as needed. Results: Studies using fabrics, tissues and films indicate the BTK may be well suited to evaluating these materials for skin compatibility. The BTK test discriminated between; different fabrics, drying methods of the same fabric, similar toilet tissue products, and two similar topsheet films used as coverings on the surface of a range of absorbent consumer products. The method was used successfully to measure the transfer of lotion, and lotion skin benefits from lotioned absorbent products. Conclusion: Studies demonstrate that the utility of the BTK goes beyond the original intent of evaluating the potential skin effects of feminine protection products. The ability to compare fabrics, tissues and films indicate the test model may be useful in the development broad range of absorbent consumer products and in textile development. The utility of the model in measuring the transfer of lotion and other materials from products to the skin surface has the potential to fill an important gap in the development of quantitative exposure assessments. Added endpoint measures, such as enhanced visual scoring and sensory effects further increase the ability to differentiate between very similar products without requiring other protocol modifications.
Aims: Osteoarthritis is the most common disabling disorder affecting particularly knees. A recent systematic review demonstrated the efficacy of walking programs for improving pain, functional status, endurance, and quality of life, in the management of knee osteoarthritis. Even though evidence suggests that walking provides numerous clinical benefits, older people diagnosed with osteoarthritis avoid physical activity. General objective is to evaluate the effect of participants’ exercise preference. We expect to encourage osteoarthritis participants to adhere successfully to a proven effective walking program. Study Design: This is a 9-month supervised walking program with a 3-month follow-up period using a preference trial design which consists of three single blind randomized clinical trials, based on a participant exercise preference model, to elicit preferences independently of randomization. Place and Duration: Indoor Walking Club in the City of Ottawa, Billings Bridge Shopping Centre, next door to The Arthritis Society Ottawa office. Methodology: A total of 69 participants with a confirmed diagnosis of osteoarthritis of the knee will be recruited from the general public from the Ottawa area. We are implementing a knowledge translation strategy, in order to improve adherence and consequently ensure the maintenance of pain relief, functional status and quality of life, among older individuals diagnosed with mild to moderate osteoarthritis. This article summarizes the study protocol of the walking study, by explaining the methods and interventions selected and discussing on the need for this trial. Conclusion: This proposed pilot randomized controlled trial will address a new knowledge gap by concentring on questions of clinical and scientific importance to improve the understanding related to the efficacy of strategies to promote the adoption and long-term adherence of community-based walking programs.
K. Anvari, G. Bahadorkhan, H. Etemad-Rezaie, M. Silanian-Toussi, S. Nekooei, F. Samini, M. Ehsaie, F. Motlagh Pirooz, A. Safaie Yazdi, A. Taghizadeh Kermani, R. Salek, G. Nowferesti, S. Zahed Anaraki, F. Varshoee Tabrizi, M. Mirsadraee, A. Rafati, H. Alipour Tabrizi, H. Baharvahdat, M. Gholamin, M. Dayani, F. Bidouei, M. Fazl Ersi, M. Sadeghi-Ivari, L. Nafarieh, M. Afarid, M. Torabi-Nami
Management of the central nervous system malignancies are among the evolving areas of research and clinical practice requiring a well-coordinated interdisciplinary approach. The neuro-oncology scientific club (NOSC) has tried to cross the links between various disciplines’ experts involved in brain tumor care in Iran since 2011. The NOSC’s structured collaborative brain tumor registry (BTCR) and the support received from its steering committee and provincial boards have been the key elements for its success and growth so far. This scientific community not only has helped to optimize brain tumor care but provided interdisciplinary research opportunities to its members across Iran. Mashhad’s NOSC has been the pioneer in the above. During the 3rd Mashhad’s NOSC meeting held in November 21st 2013, the interim results from some important local neuro-oncology studies were presented. Some potential opportunities to improve the coordinated interdisciplinary brain tumor care within the province were discussed by neurosurgery, neuroradiology and radiation oncology faculty at this provincial NOSC meeting. Clinical outcome, survival data and prognostic factors in adult and pediatric gliomas over the past several years in Mashhad, the association between methyl guanine methyl transferase (MGMT) methylation status (determined by MSQP or methylation specific quantitative polymerase chain reaction) where among the main studies outlined during this event. We realize that optimized brain tumor management and productive research in neuro-oncology can only be achieved through an integrated approach and strong team work. This is what the NOSC pursues.
Aims: The aim of this retrospective study was to analyze the rate and characteristics of intoxications who were admitted to our intensive care unit (ICU). Study Design: This is a retrospective study. Place and Duration of Study: Department of Medical ICU, Karabük Training and Research Hospital, between January 1 st and December 31 th, in 2013. Method: The study was conducted on 166 intoxicated patients who admitted to the Medical ICU in study time. Data were collected from the patients medical records. The demographic features, causes of intoxications, clinical symptoms, the mean stay in the ICU,and outcomes were evaluated. Results: The total number of patients followed in our ICU during this period were 2180, and 166 (7.61%) of them were acute intoxications. The female-to-male ratio was 1.6:1. Mean ages of female and male patients were 33.94±14.49 years and 38.13±17.31 years, respectively. The mean stay in the ICU was 2.43±0.89 days. Drugs were found to be the primary cause (49.40%) of intoxications, and analgesics (24.39%) were the most frequent causative agents.Suicidal attempts were present in 85 patients (49 female, 36 male), and most of them were between 17-34 years (68.23%). The other common causes of intoxications were carbonmonoxide (24.70%) and mushroom (19.28%). Conclusion: Intoxications were more frequent in female and drugs were the most common cause. Suicidal attempts were 51.20% of all intoxications. The intoxications of carbonmonoxide and mushroom were more common in our province than in other parts of Turkey.
Aims: (1) To isolate bacteriocin samples produced from Lactobacillus using natural fermented foods which include: palm-wine, milk, locust beans, fufu (white solid food made from cassava), ogi (known as pap) and dairy fermented product (Yogurt); (2) extraction and purification of these bacteriocin samples using centrifugation and ammonium sulphate respectively and removal of impurities using dialysis. (3) to confirm the production of bacteriocin by performing antimicrobial assay against some selected pathogenic microorganisms. (4) to examine the effects of pH, heat and storage stability as well as biopreservative efficiency of the bacteriocin samples in pap, kunu (made from millet) and fresh orange juice; (5) to investigate the effect of viable antibiotics on the growth of isolates. Study Design: Data were analyzed using the statistical software package SPSS version 16.0 and standard errors of mean (SEM) for all the graphs plotted were represented with error bars while their characterization was designed using reciprocal of the highest dilution (2n) that resulted in the inhibition of the indicator lawn. Thus, the arbitrary units (AU) of the bacteriocin activity per milliliter (AU/ml) were defined as 2n× 1000/ 10µl. Place and Duration of Study: Microbiology Laboratory, Sacred heart Hospital, Abeokuta and Department of Microbiology, Federal University of Agriculture, Abeokuta, Ogun State, Nigeria, between March 2010 and November 2012. Methodology: Bacteriocins, otherwise known as the antimicrobial compounds were produced from the Lactobacillus strains and then isolated from Nigerian fermented foods which include: palm wine, milk, yoghurt, locust beans, ogi and fufu. These foods were isolated using de Mann Rogosa and Sharpe medium. The isolated microorganisms (L. fermentum and L.casei) were identified phenotypically after isolation. Bacteriocins were extracted and purified from the Lactobacillus strains by centrifugation, followed by ammonium sulphate precipitation and dialysis. The antimicrobial activities of the crude bacteriocins were tested against nine selected pathogenic clinical isolates collected from the University College Hospital, Ibadan. The tested isolates were Shigella dysenteriae, Shigella flexneri, Enteropathogenic Escherichia coli type 1, Enteropathogenic Escherichia coli type 2, Enterohaemorrhagic E. coli type 3, Salmonella typhi, Streptococcus pneumoniae, Staphylococcus aureus and Klebsiella pneumoniae. Results: The bacteriocins of Lactobacillus fermentum and Lactobacillus casei showed a broad range of activities and had higher significant effect (P< 0.05) on the selected pathogenic microorganisms. The effects of pH on the bacteriocins were active in range of 2 to 6. Bacteriocins produced by Lactobacillus casei were stable at 800C for 15 minutes while bacteriocins produced by Lactobacillus fermentum were stable at 1000C for 15 minutes. It was observed that these bacteriocins can be stored between -200C and 40C and they had significant difference on the selected pathogenic microorganisms (P<0.05). The preservative activities of the bacteriocins tested on different foods showed that the bacteriocin of Lactobacillus fermentum had maximum reduction on bacterial population. Lactobacillus fermentum and Lactobacillus casei isolates were resistant to erythromycin of 70% and 100% for cotrimoxazole, ciprofloxacin, augmentin and amoxicillin. Conclusion: This study showed that bacteriocins from fermented foods could be used as an effective control for pathogenic microorganisms as they were able to exhibit antimicrobial activity against the test organisms when investigated for bacteriocin production and when characterized.
Aims: To evaluate Iranian physicians’ perspectives on shared decision making by validating and translating the physician version of a shared decision making questionnaire (SDM-Q-DOC). Place and Duration: Iranian Evidence-Based Medicine Center of Excellence, Tabriz University of Medical Sciences, Tabriz, Iran, from June 2012 to July 2013. Methods: The physician version of a shared decision making questionnaire (SDM-Q-DOC) was translated and validated through a pilot study among urologists in one of the hospitals of Tabriz University of Medical Sciences. A validated questionnaire was handed out among Iranian physicians in three main hospitals of Urmia. The results were analyzed using factorial analysis SPSS 16 software. To assess reliability, Cronbach’s alpha coefficient was calculated. Pearson correlation coefficient was used to assess test-retest value. Results: The Persian version of the questionnaire showed an acceptable level of reliability (Cronbach alpha=0.901). In the implementation phase, Iranian physicians were generally in favor of the SDM process ( mean score=74.4%) but their perspective on different phases of SDM were different, with 93% answering questions evaluating physicians’ clinical explanations to their patients and only 68% agreeing with questions evaluating physicians’ attitudes regarding involving patients in the last treatment option. Conclusion: The physician version of SDM-Q-DOC is a valid and reliable questionnaire assessing physicians’ attitudes toward the SDM process. In this study, Iranian physicians showed a positive view to SDM.
Aim: The aim of this study was to determine the potential toxicologic effects of the methanol root extract of Cissampelos mucronata (A. Rich) on liver and kidney tissues. Methodology: A total of 30 rats were used for the study consisting of 5 female rats for the acute toxicity study and 25 rats for the 28 day repeated toxicity studies, the 25 rats were divided into five groups of 5 rats per group. Group I served as the control, while rats in groups II-IV where administered 100, 200 and 300 mgkg-1 body weight of the extract respectively for 28 days. Rats in group V were administered 300 mgkg-1 of the extract for 28 days and allowed to stay for 14 days post treatment. At the end of the experimental period the rats were sacrificed, kidney and liver weight taken and fixed for routine histological examinations while blood was obtained for biochemical analysis. Results: Acute toxicity studies revealed an LD50 of >2000mgkg-1 following oral administration of the extract while 28 days administration of 100, 200 and 300mgkg-1 of the extract caused a significant decrease in body weight (p<0.01) and significant increases in the serum levels of alanine aminotransferase, alkaline phosphatase, total protein and albumin(P<0.05-0.001). Histopathological assessment of the liver and kidney tissues revealed moderate lymphocytic infiltration and thrombus formation within the central veins in the liver, moderate epithelial sloughing of the proximal convulated tubules in renal tissues with no remarkable recovery following withdrawal of the extract. Conclusion: This study suggests that prolonged and constant use of the extract is both hepatotoxic and nephrotoxic.
Background: Lifestyle modifications (LSMs) are indispensable in blood pressure control among hypertensive patients. However, the extent to which patients lifestyles (LS) coincide with clinical prescriptions has become an important management challenge in primary care. Aim: To describe adherence to LSMs among adult hypertensive Nigerians with essential hypertension in a primary care clinic of a tertiary hospital in resource-poor environment of Eastern Nigeria. Study Design: A primary care clinic-based descriptive cross-sectional study carried out on 140 adult patients with essential hypertension who were on treatment for at least 6 months at the primary care clinic. Place and Duration of Study: The study was carried out at the primary care clinic of Federal Medical Centre, Umuahia, Nigeria between April 2011 and November 2011. Methodology: Data was collected using pretested, structured and interviewer-administered questionnaire. Each item of LS was scored on a five points Likert scale ordinal responses of always, most times, sometimes, rarely and none. Adherence to LSMs was assessed in the 30 days preceding the study and measured from the following domains: physical activity, alcohol and tobacco use, dietary fruits, vegetables, salt and fat consumptions. Each of the domains of LS was given a score of one point for healthy LS and zero point for unhealthy LS. Operationally, patients who scored 7 points in all the assessed domains were considered adherent. Specific adherence to LS factors was also determined. Results: The overall adherence rate was 16.4%. Specifically, adherence was highest with the uses of tobacco (100.0%) followed by dietary salt (94.3%) and alcohol (90.7%). Other adherence rates were consumptions of dietary vegetables (75.7%), dietary fruits (66.2%), dietary fat and oils (64.2%) and physical activity (16.4%). Adherence was significantly associated with the female gender (p=.036). Conclusion: This study has shown that adherence to LSMs was 16.4% with no smoking rated highest and physical activity the lowest. Female gender was significantly associated with adherence. There is need to sustain the current level of adherence on smoking while efforts should be made to improve on identified domains of inadequate adherence.
Background: Prostate specific antigen (PSA) is useful in the diagnosis of prostate adenocarcinoma. Aims: Our study sought to establish possible effect of age and BMI on serum PSA levels in Ghanaian men with genitourinary complaints. Methods: In this non-randomized, cross-sectional study, we recruited 202 men from the Genitourology and pathology departments of the Korle-Bu Teaching Hospital (KBTH) and MDS-Lancet Laboratories Ghana, between July 2011 and February 2012. Height and weight were measured and body mass index (BMI) calculated for each participant. Serum PSA levels were measured and prostate biopsies from each of the participants were examined histologically for diagnosis. Results: The mean PSA level was 200 ng/ml, mean age of 66.33±8.90 years, and a BMI of 23 kg/m2. The mean Gleason score of all participants was 3.38±3.58 years. There was a positive correlation between age and PSA levels (r=0.020; P=.78). A negative correlation was established between BMI and PSA (r=-0.068; P=.33). There was however a significant positive correlation (r=0.237; P=.001) between PSA levels and Gleason score. Linear regression analysis revealed no relationship between PSA and age (r=0.002; P=.98) and, PSA and BMI (r=-0.068, P=.36). Conclusion: Serum PSA levels correlate with age and BMI, however these factors do not have an effect on the levels of serum PSA at measurement. We suggest that PSA values be used in the context of the clinical scenario and other PSA altering factors.
Background: The negative effects of iron deficiency anemia (IDA) on cognition are well documented in previous studies; however, distinct mechanisms of these effects are still a matter of debate. Brain derived neurotrophic factor (BDNF) has an important role in brain functions specially memory and learning and was reported to be low in IDA in animal studies. Objective: This study was thus designed to estimate BDNF serum level in patients suffering from IDA and correlate its level to their cognitive function. Study Design: Cross sectional case-control study. Place and Duration of the Study: The Outpatient Clinic in the Children`s Hospital, Ain Shams University, between May, 2009 and March, 2010. Methods: The study was conducted on 27 child suffering from IDA (hemoglobin <11gm/dl and serum ferritin<12ng/ml) with a mean age of 7.96±3.06 years. Full history taking and thorough clinical examination were done. Complete blood count, serum ferritin and BDNF were measured. Cognitive assessment using Wechsler intelligence test was performed for enrolled children. Fifty healthy age and sex matched children were enrolled as controls. Results: Wechsler intelligence test showed significantly lower verbal, performance and total IQ values among IDA patients compared to controls. Total IQ score showed significant positive correlation with hemoglobin level and significant negative correlation with red cell width (RDW). Although BDNF level was not significantly lower in IDA patients, it showed a significant positive correlation with object assembly. Multiple regression analysis using total IQ as a dependent variable showed that RDW was the most determinant factor that affected IQ scores. Conclusion: Wechsler IQ test results were adversely affected in IDA patients. BDNF level was not significantly lower in IDA children but it showed a significant positive correlation with one of Wechsler IQ test items in such patients. Larger scale studies are recommended to further investigate BDNF as a possible mediator that disturb cognitive functions in IDA and explore other mediators.
Aims: The aim of this experiment is to study the effect of flaxseed on lipid profile, antioxidant activity and ATP-cassette binding proteins G5 and G8 (ABCG5 and G8) levels in the liver of diabetic rat. Place and Duration of Study: Department of Biochemistry and Physiology Research Centre, Afzalipour School of Medicine, Kerman University of Medical Sciences(Kerman, Iran), between 2008 and 2011. Methodology: rats randomly were divided into three groups: diabetic rat + flaxseed (treatment group), diabetic rat (control group I), healthy rat (control group II). Afterward one month Serum lipid parameters and also Super oxide dismutase (SOD) activity, reduced glutathione (GSH) and malondialdehyde (MDA) levels were measured. ABCG5 and ABCG8 levels were determined by RT-PCR. Results: Flaxseed markedly reduced malondialdehyde (MDA), total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), triglycerides (TG), very low density lipoprotein cholesterol (VLDL-C) (all of them P<0.05). GSH, SOD (P<0.05) as well as liver ABCG5 and ABCG8 were significantly increased (P<0.01) in flaxseed treated-animals compared with diabetic group. Conclusion: The results of this experiment showed that flaxseed has antioxidant and ani-atherogenic effect. This plant reduced cholesterol levels may be via ABCG5 and ABCG8 transporters in diabetic rats.