Open Access Case Study

Acute Lymphoblastic Leukaemia in Pregnancy: A Case Report

C. E. Amiwero, O. O. Izuegbuna, R .O. Olowosulu

Journal of Advances in Medicine and Medical Research, Page 3924-3932
DOI: 10.9734/BJMMR/2014/9531

Background: Acute Lymphoblastic leukaemia (ALL) is a malignant disorder which originates in a single B–or T-lymphocytes progenitor as a result of somatic mutation. ALL represents about 15% of all malignancies in 1-15 year olds, 5% in 15-19 year olds, and <10% of malignancy in >20 year olds. This condition is rare in pregnancy and when it occurs, its management and the use of chemotherapy during pregnancy, poses a significant risk to both the mother and fetus.
Aim: To underscore the difficult dilemma physicians are faced with in the management of ALL in pregnancy.
Study Design: Case study.
Place of Study: Obstetrics & Gynaecology Department of the Federal Medical Centre, Bida, Nigeria.
Methods: A review of the index case was conducted at the Obstetrics & Gynaecology Department of the Federal Medical Centre, Bida-a tertiary health care facility in Nigeria. This review took into cognizance the patient’s demographic bio-data, case history, methods of diagnosis and various supportive measures.
A comprehensive analysis and account of events during this period were also reviewed.
Results: This case identifies a 26-year old gravida 2, para 1+0, a full term housewife and secondary school leaver, a Muslim background from a tribe of the Nupe part of Niger State. She was on a routine antenatal visit to Obstetrics Unit, when patient was noticed to have purpuric lesions. She was subsequently referred to our unit (Haematology Department) at a gestational age of 22 weeks 4 days along with florid features of bleeding diathesis. A complete blood count, cytochemical, Immunophenotyping and molecular analysis done classified patient as having a Ph Negative, pre B acute lymphoblastic leukaemia in pregnancy. Patient was then offered some supportive measures though inadequate due to the absence of aphaeretic machine in the centre. Patient had early uneventful spontaneous vaginal delivery of a live baby (birth weight; 2.6kg) at 30 weeks gestation thereby making administration of chemotherapy much less worrisome. Meanwhile, mother and baby remain clinically stable while being followed up on the aftermath of remission induction of combination chemotherapy.
Conclusion: Supportive management for ALL patients with anaemia and thrombocytopaenia is a necessary pre-induction workup step, and as in this case, would allow room for fetal growth and lung maturity; when the fetus would be mature enough to cope with extra-uterine life but also without endangering the health of the mother. This patient however, had early spontaneous vaginal delivery precluding the anticipated risk of fetal exposure to cytotoxic agents.c

Open Access Original Research Article

Prevalence of Overweight and Obesity among Children in Private Schools in Aracaju

José Aderval Aragão, Mirian Ellen de Jesus Agripino, Elenilde Gomes Santos, Enaldo Vieira Melo, Marina Elizabeth Cavalcanti de Sant’Anna, Francisco Prado Reis

Journal of Advances in Medicine and Medical Research, Page 3834-3843
DOI: 10.9734/BJMMR/2014/10019

Introduction: Childhood obesity is a matter of growing public health concern worldwide and may be associated with risks of illness and premature death in adulthood. In the light of increasing numbers of individuals presenting excessive weight, studies in Brazilian schools have shown that the prevalence of obesity and overweight among children varies according to the region, age group and type of school attended (public or private).
Objective: To determine the prevalence of overweight and obesity among children in private schools in Aracaju, Sergipe, Brazil.
Materials and Methods: Anthropometric examinations (weight, height and calculations of body mass index (BMI) and percentiles) were conducted on 600 children aged 7 years to 12 years and 11 months at five private schools in Aracaju. All of them were asked about their physical exercise practices. To determine overweight and obesity, respectively, the 85th and 97th percentiles of the World Health Organization’s BMI curve were used.
Results: Among the children studied, 21.5% (129) presented obesity (95% CI:18.3%-24.8%) and 22.3% (134) presented overweight (95% CI:18.8-25.3). There was greater prevalence of obesity among male children (p=0.05). Only 10% of the children did not practice physical activities.
Conclusions: High prevalence of childhood overweight and obesity was found in our study, which signals that there is a need to concentrate on preventive, screening and care actions in this population.

Open Access Original Research Article

Interconception Health Services for Women at High Risk for Adverse Pregnancy Outcomes: A Descriptive Study

Dean V. Coonrod, Debra Welborn, Rosie Casillas, Blanca-flor Jimenez, Amber N. Sturgeon, Kathie Records, Colleen Keller

Journal of Advances in Medicine and Medical Research, Page 3844-3855
DOI: 10.9734/BJMMR/2014/8871

Aims: To describe and present results of preconception care services aimed at underserved women who have experienced an adverse birth outcome.
Study Design: Retrospective descriptive study.
Place and Duration of Study: Sample: Maricopa Integrated Health System’s Internatal Clinic, a public safety-net hospital in Phoenix, Arizona USA, between March 2008 and October 2011.
Methodology: 102 women who have experienced a prior preterm birth or stillbirth currently enrolled in an “Internatal Clinic” where interconception and prenatal care is provided. The interventions included education by clinicians and trained support staff, support groups, a walking program to address physical activity, contraception, folic acid intake, dental care, overweight/obesity, mental health and substance use issues prior to a future pregnancy. Chart reviews were performed and a preconception health survey addressing knowledge (pre/post) and patient satisfaction were analyzed using descriptive and univariate statistics.
Results: Of current enrollees (N=102), 79% have been in the program for 12 to 18 months. 100% of those with mental health needs have had them addressed, 93% of those not desiring pregnancy are using contraception, 75% are consuming a folate supplement, 53% are engaging in regular exercise and 37% had oral health needs addressed despite no insurance coverage. Of the 102 patients, only 21% had a normal body mass index (18.5 to 24.9 kg/m2). Improvements in patient knowledge and attitudes were documented.
Conclusion: Women in our program had improved preconception knowledge, attitudes and behaviors.

Open Access Original Research Article

Health Locus of Control, Health Related Behaviors and Demographic Factors: A Study in a Turkish Population

Alis Ozcakir, Fatma Oflu Dogan, Nuran Bayram, Nazan Bilgel

Journal of Advances in Medicine and Medical Research, Page 3856-3869
DOI: 10.9734/BJMMR/2014/9440

Aims: The purpose of this study was to examine the association between socio-demographic variables and the health locus of control (HLC) as well as health locus of control and health-related behaviors.
Study Design: Cross-sectional, descriptive.
Place and Duration of Study: This study was conducted in 2012 in the fourth largest city of Turkey. Data collection lasted about six months.
Methodology: Participation in this study was voluntary and data collection was conducted anonymously. Convenience sampling was used. People on the streets, in parks, in shopping centers, metro stations, and students at the university campus were informed about the study and asked to participate. A total of 1125 people were asked and 885 gave their verbal consent. The participation ratio was 78.7%. The study participants (437 women and 448 men aged 18-84 years) filled out the Multidimensional Health Locus of Control (MHLC) scale, together with a questionnaire about their social, demographic and economic characteristics and a questionnaire regarding their health-related behaviors which was consisted of 10 items.
Results: The Cronbach ï¡ of the MHLC scale was within the range 0.74-0.78. Internal health locus of control was determined in 71.4% of the participants; chance in 10.3% and powerful others in 18.3%. The rate of powerful others health locus of control (HLC) increased with age. There were no HLC differences between males and females. No significant relationship was found between socio-economic characteristics and HLC. Of the evaluated 10 health related behaviors, physical exercise; reading health related printed material; checking food expiry dates, and reading food content labels were found to be significantly related to HLC.
Conclusion: Except for age, no significant associations were found between socio-demographics and health locus of control. The impact of HLC on health related behaviors was small.

Open Access Original Research Article

Evaluating Markers of Oxidative Stress in Managing Gestational Diabetes Mellitus: A Cross Sectional Study in Iraq

Dina Jamil, Hayder Al-Aubaid, Estabraq Al-Wasiti, Mohammed Al Bayati

Journal of Advances in Medicine and Medical Research, Page 3870-3877
DOI: 10.9734/BJMMR/2014/10139

Aims: The objective of the present study was to evaluate the association of oxidative stress markers and antioxidants in gestational diabetes when compared to non-diabetic pregnant women.
Methodology: This is a cross-sectional study, conducted in Al-Husayniya Medical Centre, Baghdad, Iraq and included 73 participants attending the Maternal and Childhood Unit for the period between January 2008 and May 2010.
Results: Serum 8-Hydroxy-2-Deoxyguanosine was significantly greater in the gestational diabetes mellitus group compared to control group (57.2±17.6ng/dl versus 19.8±7.8ng/dl respectively, P<.05). The increase in 8-Hydroxy-2-Deoxyguanosine was associated with a significant elevation in serum total cholesterol and high density lipoprotein cholesterol and a significant reduction in serum superoxide dismutase in the gestational diabetes mellitus group compared to the control group at P<.05. A significant negative correlation was noted between 8-Hydroxy-2-Deoxyguanosine and superoxide dismutase among all the participants included in this study (r=0.66 at P<.05).
Conclusions: The current study proves the importance of measuring markers of oxidative stress (expressed by serum 8-Hydroxy-2-Deoxyguanosine & serum lipids) and antioxidants (expressed by serum superoxide dismutase) in managing cases of gestational diabetes mellitus and provides a useful way of assessing the disease progression and/or remission in response to the treatment.

Open Access Original Research Article

Trace Elements Deficiency in Patients with Homozygous Sickle Cell Disease

John Kennedy Nnodim, Meludu Samuel, C. E. Dioka, Christian Ejike Onah, Augustine Ihim, Chidiadi Atuegbu

Journal of Advances in Medicine and Medical Research, Page 3878-3883
DOI: 10.9734/BJMMR/2014/7489

Aim: The serum trace elements statuses of sickle cell patients attending at General Hospital Owerri, Nigeria were investigated to determine whether or not the serum levels of these elements were normal.
Materials and Methods: One hundred confirmed sickle cell patients (HbSS) age 5–30 years were selected. One hundred normal subjects (HbAA) age 5–30 years were used as control.
Results: The levels of trace elements were significantly decreased in sickle cell anemia (p<0.05), except copper, when compared with the control.
Conclusion: The result suggests, but not conclusively, that supplementation of sickle cell patients with food and drug containing trace elements might be helpful, particularly if diminished mineral levels predispose patients to crises.

Open Access Original Research Article

Unsedated Colonoscopy: Experience from an Endoscopy Centre

Akande Oladimeji Ajayi, Patrick Temi Adegun, Ebenezer Adekunle Ajayi, Olusoji Abidemi Solomon, Ekemini Udo

Journal of Advances in Medicine and Medical Research, Page 3884-3892
DOI: 10.9734/BJMMR/2014/10022

Aim and Objective: Colonoscopy is generally considered a painful procedure requiring sedation. Due to the high cost of sedation colonoscopy, coupled with the attendant morbidity and mortality, there is a general trend towards unsedated colonoscopy. The aim of this study was to determine the effect of unsedated colonoscopy on the success of caecal intubation, factors predictive of painful procedure and to compare with results elsewhere.
Materials and Methods: Forty one consecutive patients who underwent colonoscopy were recruited into this study. The study was carried out at a privately owned low-volume endoscopy centre: Gilead specialist hospital (GSH), Ado-Ekiti, Nigeria from January 2010 to December 2011. Ethical approval for the study was obtained from the centre’s Research and Ethics Committee and all the patients gave their individual written consent. SPSS version 15.0 (SPSS, Inc., Chicago, Illinois, USA) was deployed for statistical analysis using the t-test for quantitative variables and χ2 test for qualitative variables. Differences were considered to be statistically significant if P value was less than 0.05.
Results: The male: female ratio was 1.93:1. The mean age of the studied population was 53.20±9.53 years [age range from 30-71. The indications for colonoscopy were; lower gastrointestinal bleeding (41.5%), abdominal pain or discomfort (19.5%), diarrhea (12.2%), suspected cancer [Patients with history of GI bleeds, weight loss, recurrent diarrhoea and ileus (12.2%), constipation (7.3%) and routine examination (7.3%). Overall, caecal intubation was achieved in 70.7% of cases while in 29.3% caecal intubation was unsuccessful. With on demand analgesia, and exclusion of both cases of obstruction (tumors) and poor bowel preparations, caecal intubation rate rose to 94.3%. Causes of unsuccessful caecal intubation included: abdominal pain or discomfort (33.3%), bowel obstruction (25%), poor bowel preparation (16.7%), anxiety (6.6%) and obesity (8.3%). Colonoscopy findings were haemorrhoids (36.6%), polyps (17.1%), colorectal cancer (14.6%), arteriovenous malformations (7.3%), anal fissure (4.9%), inflammatory bowel disease (2.4%) and normal findings (17.1%). Bowel preparation was adjudged adequate in 80.5% (33/41) of the patients. Female gender and abdominal pain as indication for colonoscopy were found to be predictive for painful colonoscopy (p<0.05).
Conclusion: Unsedated colonoscopy with on demand analgesia is advocated in resource poor countries to minimize the direct and indirect costs of colonoscopy. It is also recommended to minimize patient burden in screening and surveillance colonoscopy. Colonoscopists are advised to use the warm water (37°C) method in this setting as against the traditional air insufflations to achieve a high success rate of caecal intubation.

Open Access Original Research Article

Pregnancy Outcome among Nulliparous Women at the University of Maiduguri Teaching Hospital, North Eastern Nigeria: A Retrospective Cohort Study

A. D. Geidam, S. M. Ibrahim, Z. Oummate, B. M. Audu

Journal of Advances in Medicine and Medical Research, Page 3893-3901
DOI: 10.9734/BJMMR/2014/8399

Aim: To compare the pregnancy outcomes among nulliparae, with multiparae as the control.
Study Design: Retrospective cohort study.
Place and Duration of Study: University of Maiduguri Teaching Hospital over a period of one year (1st January 2007 to 31st December 2007).
Methodology: This retrospective cohort study reviewed the pregnancy outcome of nulliparae over one year, using multiparae as control. The data were analysed using SPSS. The χ2-test was used to compare the sociodemographic characteristics and pregnancy outcomes of the nulliparae and the multiparae. Multivariate logistic regression analysis was used to create a model for the factors that were independently associated with nullipara. A P-value of<0.05 was considered significant.
Results: Nulliparae contributed 259 (13.7%) of the 1,865 babies delivered during the period of study. The age ranged from 15 years to 42 years with mean age of 27.1 years ±5.3 years. Nulliparous women were more likely to be of younger age less than 20 years (P<0.001), educated (P=0.01) and booked early (P=0.001) when compared with multiparae. Also nulliparous women were more likely to have pregnancy induced hypertension (P=0.001) and episiotomy at delivery (P<0.001) but less likely to have anaemia (P=0.002) when compared with multiparae. Multivariate logistic regression showed that Nulliparae were more likely to be of younger age group (OR 7.22, P<0.001) and have malaria (OR 2.22, P=0.02), malpresentation (OR 5.68, P=0.02), abruptio placentae (OR 6.41, P=0.02), preterm delivery (OR 7.04, P=0.01), episiotomy (OR 7.74, P<0.001) and pregnancy induced hypertension (OR 3.53, P=0.01) but less likely to have anaemia at booking and fetal macrosomia.
Conclusion: Nulliparous women are at increased risk of certain adverse pregnancy outcome including malaria, preterm delivery and pregnancy induced hypertension. These adverse factors should be looked out for and excluded in order to improve maternal and fetal health in these women.

Open Access Original Research Article

Study of Magnesium, Copper, Zinc, Iron and Ceruloplasmin in Liver Cirrhosis and Ovarian Cancer Ascitic Patients

Md. Khaleel Pasha, Qamar Ayesha, M. Lakshmi Narasu, K. Pandu Ranga Rao, B. Prabhakar, K. Suseela, M. Srinivasulu, M. Gopal Reddy

Journal of Advances in Medicine and Medical Research, Page 3902-3911
DOI: 10.9734/BJMMR/2014/6774

Introduction: The excess accumulation of free fluid in the peritoneal cavity is due to its multitude causes. Certain cytological and biochemical markers are reported for the differential diagnosis of ascites. In the present study, ascitic patients with liver cirrhosis and ovarian carcinoma are investigated.
Aim: To study the concentrations of certain trace elements and ceruloplasmin levels in ascitic fluid and in serum of patients with liver cirrhosis in comparison to ovarian cancer patients.
Study Design: The study includes 170 patients with liver cirrhosis, 95 patients with ovarian cancer and 100 serum controls.
Place and Duration of Study: The study is performed in the department of Gastroenterology, Osmania General Hospital Hyderabad, A.P, INDIA, between December 2011 to July 2013.
Methodology: The trace elements such as magnesium, copper, zinc, iron and ceruloplasmin were investigated in 170 patients with liver cirrhosis (120 males, 50 females, 22-75 years; mean age 46.2±11.2) and 95 ovarian cancer patients (19-84 years; mean age 50.2±12.2). All the analysts were measured in serum and ascitic fluid by using standard commercial kits. 100 serum samples from healthy controls were also included in the study.
Results: The mean serum concentrations of copper and ceruloplasmin were significantly increased in ovarian cancer patients when compared to that of liver cirrhosis and healthy controls (P<. 001, P<. 001) respectively. The mean zinc levels in serum samples were low in both the groups when compared to controls (P<. 001). The ascitic fluid zinc levels in ovarian cancer were higher when compared to that of liver cirrhosis (P<. 001). Similar results were noted in the serum iron levels in both the groups. The serum magnesium levels in liver cirrhosis are comparable to that of controls but the levels of magnesium in ovarian cancer ascitic patients are high when compared to that of controls.
Conclusion: Our results showed that there are differences in trace elements and ceruloplasmin levels in liver cirrhosis and ovarian cancer patients in both serum and ascitic fluid samples. The cutoff value of copper and ceruloplasmin in serum samples are 134.5 µg/dl and 43.5 mg/dl, while in ascitic fluid were 46.5 µg/dl and 21.0 mg/dl respectively. As the diagnostic efficiency of copper and ceruloplasmin in serum and ascitic fluid samples are 97% to 99% with highest sensitivity and specificity, analysis of trace elements with ceruloplasmin in depth with their ratios may be helpful in differentiating the cirrhotic and neoplastic illness.

Open Access Original Research Article

Is Human Immunodeficiency Virus Still Transmissible Through Blood Transfusion in Children with Sickle Cell Anaemia in Jos, Nigeria?

E. U. Ejeliogu, S. N. Okolo, S. D. Pam, E. S. Okpe, C. C. John, M. O. Ochoga

Journal of Advances in Medicine and Medical Research, Page 3912-3923
DOI: 10.9734/BJMMR/2014/9575

Aims: To compare the prevalence of HIV infection amongst transfused and non-transfused children with sickle cell anaemia (SCA) in Jos, Nigeria and explore the factors affecting it.
Study Design: This was a prospective case control study.
Place and Duration of Study: Department of Paediatrics (Sickle Cell Clinic), Jos University Teaching Hospital, Jos, Nigeria, between January 2008 and March 2009.
Methodology: A total of 200 transfused children with SCA (117 males and 83 females) were recruited consecutively and screened for HIV using rapid test kits. A questionnaire was used to ascertain the details of blood transfusion and other relevant clinical information. Two hundred age and sex matched non-transfused children with SCA attending the same clinic were recruited as controls.
Results: The prevalence of HIV infection amongst transfused children with SCA was 2%, compared to 0% in the control group (P=.04). The four HIV positive cases were transfused in private hospitals with blood of unknown screening status. The number of blood transfusions was not a significant factor in acquiring HIV infection (P=.78); however remunerative blood donation increased the risk of acquiring HIV through blood transfusion (AOR=6.28; 95% CI (1.82-9.92); P=.01).
Conclusion: HIV is still transmissible through blood transfusion and screening of blood before transfusion is still not completely practiced in Jos, Nigeria. Policies on proper screening of blood before transfusion and voluntary blood donation should therefore be enforced at all levels of healthcare.