Open Access Case Study

Virtual Colonoscopy is Feasible in Geriatric Patients-A Case Series

J. Gossner

Journal of Advances in Medicine and Medical Research, Page 3615-3619
DOI: 10.9734/BJMMR/2014/10052

Virtual colonoscopy (VC) or computed tomographic colonography is now an established imaging test in the detection of colorectal cancer. Like other modern imaging tests VC requires highly compliant patients (rectal air insufflation, breath hold, imaging in supine and prone position). As patients are getting older VC is also requested in the elderly. In a case series of geriatric patients (mean age 83 years) undergoing VC after incomplete optical colonoscopy 92.7% of all colonic segments were adequately visualized. VC seems to be feasible in geriatric patients and has therefore replaced barium enema in this patient group after incomplete optical colonoscopy at our department.Q

Open Access Case Study

Phantom Human Chorionic Gonadotropin in an End Stage Renal Disease Case

Buket Kin Tekce, Hikmet Tekce, Gulali Aktas

Journal of Advances in Medicine and Medical Research, Page 3666-3670
DOI: 10.9734/BJMMR/2014/10237

Aims: Gestation is very difficult in women with end stage renal disease (ESRD). In addition, human chorionic gonadotropin (HCG) may be increased in Non-pregnant women with ESRD. Therefore, elevated HCG levels in ESRD patients may cause diagnostic confusion. Here we present a case with suspicious HCG elevation who desire of pregnancy and without gonadal deficiency. We also discussed the possible reasons of this HCG elevation.
Presentation of Case: A twenty-two year old young woman with ESRD for seven years has been followed up outpatient clinics of our institution. She was receiving hemodialysis treatment for last three years after renal transplant rejection. In gynecological examination, obstetric ultrasound scan revealed no embryonic yolk sac or other radiological images of pregnancy. The case evaluated according to the algorithm of HCG elevation. Advanced clinical differential diagnosis and laboratory analyzes were performed. A diagnosis of HCG elevation due to heterophile antibodies made, which has not been previously described in the literature in ESRD patients.
Discussion and Conclusion: Heterophile antibodies should be kept in mind in evaluation of HCG increase in reproductive women with ESRD patients with transplantation history.

Open Access Original Research Article

An Innovative, Reusable Menstrual Cup that Enhances the Quality of Women’s Lives during Menstruation

Alfred Shihata, Steven Brody

Journal of Advances in Medicine and Medical Research, Page 3581-3590
DOI: 10.9734/BJMMR/2014/9640

Objective: A) To evaluate the acceptability of a unique, Cost-effective, reusable, and environmentally safe device for menstrual blood collection among culturally diverse women. B) To enhance the quality of life for women during menstruation.
Methods: The first author developed a unique, reusable menstrual collection device as an alternative to sanitary pads and tampons. After successful research and development, the United States Food and Drug Administration (USFDA), as well as the European Union and Health Canada, granted their approval for the device.
The first author and five co-investigators recruited 146 women of diverse cultural and national backgrounds to evaluate the FemmyCycle. Women were instructed to use the FemmyCycle for three cycles, report any side effects and compare their experiences using the FemmyCycle with other sanitary products.
Results: Among all participants who used this new device for three cycles, 84% preferred the FemmyCycle over prior methods used for menstrual hygiene. These women rated the device superior to previously-used methods and safer for the environment than pads and tampons.
Conclusions: The majority of women preferred the FemmyCycle over their previous feminine sanitary protection methods. The device can protect the environment and enhance the quality of women’s lives during menstruation, particularly working and athletic women. This is due to the longer duration of protection, prevention of leakage, activity compatibility, as well as elimination of the risk of Toxic Shock Syndrome. This device may fill a major void in menstrual hygiene products and women’s reproductive health worldwide.

Open Access Original Research Article

Distribution and Antibiotic Susceptibility Pattern of Bacterial Pathogens Causing Urinary Tract Infection in Mubi General Hospital, Yola-Nigeria

M. Y. Tula, O. Iyoha

Journal of Advances in Medicine and Medical Research, Page 3591-3602
DOI: 10.9734/BJMMR/2014/9525

Aims: This study was conducted to determine the distribution and antimicrobial susceptibility of uropathogens among patients attending Mubi general hospital as well as to determine the effect of gender on the etiology of bacterial uropathogens.
Study Design: Distributions of urinary isolates and their antibiogram
Place and Duration of Study: Mubi General Hospital, Adamawa State, between April, 2013 and January, 2014
Methodology: Urine samples of 101 patients comprised of 46 males and 55 females were analyzed for bacterial growth, antibiogram and multiple antibiotic resistance index.
Results: Females showed higher prevalence of UTI than males. Gram negative bacteria (61.7%) were found in high prevalence than Gram positive (29.3%). Staphylococcus aureus (58.3%) has the highest prevalence rate among Gram positive organisms, while Citrobacter freundii (25.3%) was the most prevalent Gram negative isolates. Citrobacter freundii (17.9%) was the most prevalent uropathogens closely followed by S. aureus (17.1%). Antimicrobial susceptibility was performed on all isolated bacteria by the disc diffusion method employing multiple antibiotic discs differently for both Gram positive and Gram negative isolates. The results showed that S. aureus and Coagulase Negative Staphylococci (CoNS) were more susceptible to Chloramphenicol (83%), followed by Streptomycin and Amoxicillin (78%). While their resistance profile showed that S. aureus and CoNS are more resistant to Ampiclox, Gentamycin and Rifampicin (31%). Susceptibility to all the antibiotics by Gram positive organisms was significantly higher than their resistance to the same antibiotics (p< 0.05). Gram negative organisms are more susceptible to Streptomycin (62%), followed by Ciprofloxacin (47%) and Ofloxacin (44%), while their resistance profile showed that they are more resistance to Nalixidic acid (79%) followed by Augmentin (76%), Ampicillin (75%) and Reflacine (74%). Resistance to all the antibiotics by Gram negative organisms is significantly higher than their susceptibility to the same antibiotics (p<0.05). Using spearman correlation, the results further showed significant correlation in resistance between P. vulgaris, Escherichia coli and P. agglomerans (p<0.01). Also, there was significant correlation in resistance between E. coli, Klebsiella sp., Citrobacter diversus and P. vulgaris (p<0.05). The multiple antibiotic resistances (MAR) index of each antibiotic was calculated. The MAR index for Gram positive antibiotics was significantly lower than that of Gram negative antibiotics (p<0.05).
Conclusion: In this study, we found multidrug resistance strains which are resistant to most of the antimicrobials agent tested more especially the Gram negative uropathogens. This reflected the fact that Nalixidic acid, Augmentin, Ampicillin, Reflacine, Ceporex and Septrin were the most commonly prescribed antibiotics in the hospital even before the results of urine analyses and also the most easily available in the market without prescription and because they were also very cheap in terms of cost. Consequently, the widespread use or misuse of antimicrobial drugs has led to a general rise in the emergence of resistant bacteria.

Open Access Original Research Article

Electron Beam Irradiation of Resin Luting Agents - a Cytotoxic Evaluation on Dental Pulp Cells

Mithra N. Hegde, S. Shabin, Nidarsh D. Hegde, Shilpa S. Shetty, Suchetha Kumari, Ganesh Sanjeev

Journal of Advances in Medicine and Medical Research, Page 3603-3614
DOI: 10.9734/BJMMR/2014/7762

Aim: The aim of this study was to evaluate the cytotoxicity of three resin luting agents Rely X luting cement, Rely X luting 2 cement and Clearfil SA luting cement before and after electron beam irradiation.
Materials and Methods: Growth and maintenance of cell cultures of human pulp cells was done in Dulbecco’s modified Eagle’s Medium (DMEM). The test samples were divided into two Categories: Irradiated Category and Non-radiated Category. Samples in Irradiated category were exposed to electron beam radiation at 200Gy. Three subgroups of radiated category and non radiated category were made. All the samples were subjected to MTT assay and spectrophotometric analysis and their cytotoxicity was assessed. Statistical analysis was done using t test.
Results: Evaluation of Rely X luting Cement showed that radiated samples of powder, liquid and set cements showed decreased cell viability than non radiated samples. In Case of Rely X luting 2 cement, radiated samples showed increased cell viability for Paste A and Paste B samples. But in set material, irradiated samples showed decreased cell viability as compared to non radiated samples. For Clearfil SA luting Cement, Paste B showed increased cell viability for radiated samples. Paste A and Set cement of radiated samples showed decreased cell viability than non radiated samples.
Conclusion: In the present study , the increased cytotoxicity of irradiated samples may be due to increase in the release of unbound monomers which may be due to chain breakage after irradiation and a reduction in the cytotoxicity which may be due to the cross linking of unbound monomers during irradiation.

Open Access Original Research Article

Comparison of Fentanyl Citrate-midazolam-propofol and Fentanyl Citrate-ketamine Propofol Combinations with Regards to Efficiency and Safety in Sedation Practices for the ERCP

H. Kara, M. Aksun, G. Aran, U. Ozgurbuz, A. Sencan, L. Koroglu, N. Karahan

Journal of Advances in Medicine and Medical Research, Page 3650-3665
DOI: 10.9734/BJMMR/2014/8541

Aims: The objective of our study is to compare the efficiency and safety of fentanyl citrate-midazolam-propofol combination with fentanyl citrate-ketamine-propofol combination used as sedative and analgesic medication in patients undergoing ERCP procedure.
Study Design: Randomized and prospective.
Place and Duration of Study: Department of Anaesthesiology and Reanimation (Gastroenterology Unit) between June 2009 and June 2010.
Methodology: 103 patients undergoing ERCP aged between 20-80 years, ASA I-III, participated in our study. Cases were randomly divided into two groups as group M(n=51) and group K(n=52). Fentanyl citrate 1 µg/kg IV was infused to all patients 5 minutes before the process.
Group M: In addition to fentanyl, midazolam 0.04 mg/kg IV and propofol loading dose of 1mg/kg IV and maintenance dose of 4mg/kg/h IV were also infused.
Group K: In addition to fentanyl, ketamine 0.5mg/kg IV and propofol loading dose of 1mg/kg IV and maintenance dose of 4mg/kg/h IV were infused as well.
At the end of ERCP procedure, propofol infusion was terminated. The time required for the Richmond Alertness-Sedation Scale (RASS) score to reach -1 (recovery period) and its change from -1 to 0 in recovery room (discharge period) and also the development of side effects during the practice were recorded. After recovery period the patients were questioned if they felt pain during the procedure or not. If they felt any, the pain was evaluated according to Visual Analog Scale (VAS) score.
Results: Recovery period, discharge period and satisfaction of the endoscopist were similar between the two groups, however cardiovascular and respiratory system parameters were more stable in patients in Group K.
Conclusion: Our study pointed that fentanyl citrate-ketamine-propofol combination is probably preferable over fentanyl citrate-midazolam-propofol combination in terms of cardiovascular and respiratory stability during sedation in ERCP procedures.

Open Access Original Research Article

Dermatologic Effects and Management of Urine and Feces on Infant and Adult Skin

Miranda A. Farage, Ghebre Tzeghai, Kenneth W. Miller, Bruce Tepper, Rob O’Connor, Wendy Qin, Mauricio Odio

Journal of Advances in Medicine and Medical Research, Page 3671-3688
DOI: 10.9734/BJMMR/2014/10006

The effect of urine and feces on the skin is a contributing factor to the development of incontinent and diaper dermatitis. The objective of this research was to evaluate skin effects of a given urine or fecal sample on the donor child and/or an adult caregiver, both of whom would be exposed to the biological material in course of daily life.
Methods: Urine was evaluated under a variety of experimental skin conditions: normal (N), compromised by tape stripping (C), hydrated by prolonged exposure to water via occlusive patch (H), and hydrated/compromised (H/C). After pre-treatment, sites were patched (3 times of 24-h each) with 0.5 ml infant urine, saline (negative control) or 0.3% sodium lauryl sulfate (SLS, positive control). Fecal material was evaluated using a 4-h patch followed by tape stripping of selected sites.
Results: In the urine study, a single 24-h patch produced a significant elevation of pH compared to both the negative (saline) and positive (sodium lauryl sulfate) controls for all experimental skin conditions. Erythema produced by urine was intermediate between the negative and positive controls, and significantly different from the negative control on the N and C skin test sites. All three materials produced an increase in hydration of the skin. The single 4-h patch of fecal material produced significant erythema, a significant elevation of pH, and a significant increase in TEWL. Recovery to pre-treatment levels was observed by the next day on sites that received no further treatment. However, on sites patched with fecal material, then further compromised by tape stripping, recovery to pre-treatment levels for erythema and TEWL were delayed.
Conclusion: These studies indicate that urine appears to have an inherent low level irritant property when in continuous contact with skin for 24 to 48 hours. With relatively short exposures of 4 hours fecal material causes visible erythema, increases in pH and TEWL, and decreases in stratum corneum resilience to the subsequent insult of tape stripping. Results re-inforce the utility of modern diapers and incontinent products, utilizing superabsorbent materials, to effectively absorb wetness, keeping skin dryer and minimizing adverse skin effects.

Open Access Original Research Article

Prevalence of Placental Malaria and Effects on Birth Weight of Neonate of Mothers Who Had Antenatal Care in Maiduguri Metropolitan City, Nigeria

Baba Usman Ahmadu, Chama Rejoice, Halilu Bala Musa, Fatimah Joy Baba, Apollos Nachanuya Chafi, Adzu Yusuf, Elesa Bitrus Evelyn, Baba Kyari Aisha, Yakubu Emmanuel, Zoba Joseph Francis

Journal of Advances in Medicine and Medical Research, Page 3689-3697
DOI: 10.9734/BJMMR/2014/9023

Background: Low birth weight (LBW) is an important risk factor for infant morbidity and mortality especially in malarial endemic countries. The study focused on the prevalence of placental malaria and neonatal LBW, as well as the relationship between placental malaria and neonatal LBW outcome in Maiduguri metropolitan city, Nigeria.
Methods: A total of 110 mother-neonatal pairs were studied. Neonatal birth weights were measured using the bassinet weighing scale and placental tissues for the diagnosis of placental malaria were collected from mothers of these neonates. Student t test and Chi-square trend (χ2) with Yate’s correction were used to investigate quantitative and categorical variables, whereas, Univariate analytical model was used to estimate the relationship between placental malaria, maternal age, parity and neonatal LBW.
Results: Forty-nine mothers (44.5%) had placental malaria and the association of maternal age group (27-31and32-36) years with placental malaria was significant (p=0.029). Of the 14(100%) neonates with LBW, 10(71.4%) had their mothers diagnosed with placental malaria. The relationship between placental malaria and LBW was however not significant (p=0.207). Also, the relationship between maternal age, parity and neonatal LBW outcome was not significant.
Conclusions: Placental malaria constituted 44.5% and the disease was associated with maternal age bracket (27-31and32-36) years in this work. Although the relationship between placental malaria and neonatal LBW was not significant, most neonates with LBW in present study had their mothers diagnosed with placental malaria.

Open Access Original Research Article

Commercial Drivers’ Participation in the Use of Family Planning Services in Ibadan, Southwest Nigeria

K. O. Osungbade, O. O. Akinyemi, T. D. Ojediran

Journal of Advances in Medicine and Medical Research, Page 3698-3719
DOI: 10.9734/BJMMR/2014/9094

Aims: To determine the participation of male commercial drivers in the choice and use of family planning methods and possible implications for reproductive health policy formulation.
Study Design: A cross-sectional study was conducted.
Place and Duration of Study: The study was conducted in Ibadan, Southwest Nigeria.
Methodology: A cross-sectional study of 402 adult drivers was done. Participants were selected by balloting from the drivers register and all consenting drivers were interviewed by trained research assistants.
Results: Mean age of respondents was 44.5±9.9 years. Slightly more than half (53.0%) of participants were currently using a family planning method. The condom (58.2%) was the most popular family planning method followed by injection (32.9%) and withdrawal (22.1%). Only 43 (10.7%) and 36 (9.0%) of study’s participants have ever visited a family planning clinic for information or ever accompanied their spouses to a family planning clinic respectively. The commonest sources of information about family planning were the mass media (67.2%), health workers (21.1%) and friends (5.2%). Age (P<0.001) and knowledge (P=0.001) of family planning were found to be significantly associated with previous and current use of family planning. Respondents aged 40 years and above were about two times more likely to have good knowledge of family planning compared with younger respondents (OR=1.89; 95% CI=1.17–3.05). Similarly, respondents with good knowledge of family planning were about two times more likely to use a family planning method compared with those with poor knowledge (OR=2.35; 95% CI=2.257.20).
Conclusion: Commercial drivers’ participation in the choice and use of family planning was poor. The policy implication of these findings is the need for programmes targeted at men and designed to further improve their knowledge and attitude about family planning. This will motivate the men and by extension their wives in order to achieve better planned families.

Open Access Review Article

Helicopter EMS Transport Outcomes Literature: Annotated Review of Articles Published 2012-2013

Eric J. Lee, Annette O. Arthur, Stephen H. Thomas

Journal of Advances in Medicine and Medical Research, Page 3620-3649
DOI: 10.9734/BJMMR/2014/9127

Helicopter EMS (HEMS) and its possible association with patient-oriented outcomes improvement continues to be a subject of discussion. As is the case with other scientific discourse, debate over HEMS usefulness should be framed around an evidence-based assessment of the relevant literature. In an effort to facilitate the academic pursuit of assessment of HEMS utility, in late 2000 the National Association of EMS Physicians’ (NAEMSP) Air Medical Task Force prepared annotated bibliographies of the HEMS-related outcomes literature. As a result of that work, review articles covering HEMS outcomes studies from 1980-2000, for both non trauma and trauma, were published in 2002. The project was extended with subsequent reviews covering the literature through 2011. This review continues the series, outlining outcomes-associated HEMS literature for 2012-2013.