Open Access Case Study

A Case of Sarcoidosis Presenting as Cirrhosis and Portal Hypertension

Halil Yanardag, Cuneyt Tetikkurt, Aslı Sezgin, Nuray Kepil, Muammer Bilir

Journal of Advances in Medicine and Medical Research, Page 4272-4277
DOI: 10.9734/BJMMR/2014/9568

Sarcoidosis is a systemic granulomatous disease of unknown etiology that can involve nearly all organs. Liver is the third most commonly affected organ following the lungs and the lymph nodes. Cases with liver sarcoidosis are usually silent clinically while a few can progress to cirrhosis and portal hypertension in less than 1% of the patients.
A 56 year old female was referred for ecchymosis, protuberant abdomen, bilateral pretibial and ankle edema. Medical history did not reveal any previous disease. Ascites, hepatomegaly, splenomegaly, and facial telengiectasies were present on physical examination. Chest x-ray and CT were normal. Papules and plaques on the knees developed six days after admission. Skin biopsy revealed granulomatous dermatitis. Serum ACE was 250IU/L. Liver biopsy showed non-caseiting granulomas, severe hepatitis and fibrosis. Sarcoidosis was confirmed based on high serum ACE, histopathologic findings of the skin and liver biopsy samples that revealed non-caseiting granulomas.
We report a case of sarcoidosis complicated by cirrhosis as the initial manifestation of the disease without lung involvement. An extensive literature review of sarcoidosis, focusing on case reports, which presented with cirrhosis and portal hypertension without lung involvement, was made.

Open Access Short Research Article

“Toxic Butts”: Key Performance Indicators from a California Statewide Social Media Campaign for Tobacco Control

Joseph Smyser, Thomas Novotny, Shanna Dayan, Timothy Rodwell

Journal of Advances in Medicine and Medical Research, Page 4341-4351
DOI: 10.9734/BJMMR/2014/10650

Background: The “Toxic Butts” campaign was funded by the California Tobacco Control Program as part of a tobacco product waste toolkit. The campaign was to function as a case study, helping to establish best practices for social media use by tobacco control while at the same time serving as a training tool for local lead agencies interested in better leveraging social media. Little information existed on monitoring and evaluation of social media so new metrics were devised and results reported with the intent of publication.
Methods: Campaign staff published English-language content twice a day, seven days a week, for six months. The same content was posted on Facebook and Twitter, with occasional exceptions made for character limits on Twitter. Data were collected using Twitter and Facebook as primary sources, as well as with a third-party social media monitoring program. Interactions of social media users with the campaign’s content in Facebook and Twitter were examined using six key performance indicators. Two indicators offered novel approaches to quantify engagement, representing any action performed by a social media user with campaign content.
Results: The six key performance indicators used to measure campaign performance indicated 1.1 million impressions of “Toxic Butts” campaign content by 340,200 individuals on Facebook, over the six-month period of the study. The largest proportion (42.96 percent) of the campaign’s Twitter followers (n=650) was between the ages of 35 and 44 years, whereas Facebook fans (n=1057) were primarily between the ages of 13 to 17 years (59.1 percent). Twitter followers were nearly evenly split between women and men (51 percent and 49 percent, respectively), whereas Facebook followers were mostly male (60.5 percent compared to 39.50 percent female). Health organizations (34.3 percent) represented the largest share of Twitter followers; Facebook followers were mostly individuals (92.8 percent). Engagement ratios clarified social media users’ interactions with campaign content month-by-month and were considered a valuable point of reference for the overall performance of campaign content.
Discussion: The reported key performance indicatorsprovide a starting point of measures of engagement by social media users with a campaign, and the reach of a campaign’s content. Recommendations for future research are provided.

Open Access Original Research Article

Clinical Evaluation of Macrolide-resistant Mycoplasma pneumoniae Infections in Pediatric Japanese Patients

Yuichirou Tsuji, Chitose Karasawa, Masami Kurokawa, Hiroshi Takahashi

Journal of Advances in Medicine and Medical Research, Page 4231-4237
DOI: 10.9734/BJMMR/2014/10966

Background: In recent years, an increase in Mycoplasma pneumoniae infections among children has become a social issue in Japan.
Methods: During a 2-year collection period (2011-2012), we evaluated trends during the first and second halves of both years. Only patients with positive rapid antigen detection test results (ImmunoCard Mycoplasma: Meridian Bioscience, Inc Cincinnati, OH, USA) were included. The evaluation items included the patient number, sex, radiography findings, white blood cell (WBC) count, C-reactive protein (CRP) level, and clinical macrolide-resistance rate.
Results: The patient number increased significantly during the latter halves of the years. The macrolide-resistance rate also increased during the same periods. A similar trend was observed with respect to radiography findings but not with respect to the WBC count and CRP level.
Conclusions: It is important to monitor the macrolide-resistance trends in case of Mycoplasma pneumoniae infections in children.

Open Access Original Research Article

Correlation between Dental Caries and Salivary Albumin in Adult Indian Population–An In Vivo Study

Mithra N. Hegde, Raksha Bhat, Ashwitha Punja, Chitharanjan Shetty

Journal of Advances in Medicine and Medical Research, Page 4238-4244
DOI: 10.9734/BJMMR/2014/9296

Aim: To analyze the relationship between dental caries, albumin in young adults between the age group of 20 to 30 years from South Canara district, Karnataka with varying caries experience as determined by their caries progression
Methods and Materials: Eighty subjects from the outpatient department ranging between 20 to 30 years of age were screened and evaluated for their caries experience. Based on their level of caries a total of 80 subjects were selected and divided into four groups of 20 subjects each as follows; Group 1: enamel caries, Group 2: dentinal caries, Group 3: pulpal caries, Group 4: control group. The saliva was collected and analyzed for the presence of albumin levels in saliva and correlated to the same levels in serum. The statistical analysis was done using one way ANOVA test.
Results: According to the present study there is an increase in the levels of caries with decrease in the levels of albumin. Serum albumin levels were also found to be decreased in caries prone individuals, hence showing a significant correlation between serum and salivary albumin levels.
Conclusions: In the present study we found an inverse relationship between the levels of albumin in saliva and dental caries confirming the importance of albumin levels in inhibiting caries progression. Besides a correlation was also found between the levels of albumin in saliva and serum. Hence it can be used as a biochemical indicator in evaluating the susceptibility of caries.

Open Access Original Research Article

Impact of a Physical Reconditioning Program on the Quality of Life of Patients Following Coronary Artery Bypass, with or without Led Therapy: Preliminary Results

Rauirys Alencar de Oliveira, Gilderlene Alves Fernandes, Andréa Conceição Gomes Lima, Raimundo de Barros Araújo Jr, Renata Amadei Nicolau

Journal of Advances in Medicine and Medical Research, Page 4245-4258
DOI: 10.9734/BJMMR/2014/9974

Aims: Analyse the impact of a physical recondition program (PRP) on Quality of Life (QOL), associated or not to LED therapy on sternotomy after coronary-artery bypass graft (CABG).
Study Design: Follow-up after a clinical trial.
Place and Duration of Study: Participants were recruited and followed-up from September 2011 to March 2012 in Teresina, Piauí, Brazil.
Methodology: 90 volunteers were electively submitted to CABG. During hospitalization, volunteers were randomly allocated into three different groups of equal size: Light emitting diode (LED: λ of 640±20 nm, SAEF of 1.2 J/cm2), placebo and control. All patients were subjected to a physical therapy program during their hospitalization and then stimulated to join a physical therapist-supervised PRP after discharge. The patients were followed for six months after the surgery. The Short-Form (36) was used to assess QOL.
Results: After six months, patients’ QOL had increased significantly in all aspects when compared to pre-operatory scores, regardless the use of LED (Mann-Whitney test p≤0.05).
Discussion: While the use of LEDs has shown to have analgesic and healing effects during hospitalization, the fotobiomodulator not proved to be important in the QOL perception, six months after discharge. In addition, Short-Form (36) showed to be a useful tool to assess the quality of life after CABG, collaborating with risk estimation and prognosis.
Conclusion: The QOL of the patients who adhered to a physical reconditioning program supervised by a physical therapist increased in the first six months after surgery, while those patients who also were submitted to LED therapy during hospitalization had even better results.

Open Access Original Research Article

Assessment of Renal Function and Predictive Performances of GFR Estimating Equations among Nigerian Diabetic Patients

S. T. Shittu, S. O. Jeje, A. A. Fasanmade

Journal of Advances in Medicine and Medical Research, Page 4259-4271
DOI: 10.9734/BJMMR/2014/10752

Aims: To assess the renal functions in Nigerian diabetic patients and to examine the predictive performances of Glomerular Filtration Rate (GFR) estimating equations.
Study Design: A case-control study.
Place and Duration of Study: Department of Physiology and University College Hospital, University of Ibadan, Ibadan, Nigeria. May-August, 2009.
Methodology: One hundred and nine volunteers comprising 58 diabetic patients receiving treatments and 51 healthy individuals. Measured GFR (mGFR) was by creatinine clearance and the equations includes Cockcroft and Gault, CG; Modification of Diet in Renal Disease, MDRD study equation; Chronic Kidney Disease and Epidemiological study group, CKD-EPI and Mayo Clinic Quadratic, Q equation. Ethnicity factor was administered as appropriate. Performances were determined by mean bias, precision and accuracy.
Results: mGFR was significantly (P=.05) reduced among the diabetic when compared with the non-diabetic though within the recommended range for normal renal function. Among the diabetics, CG equation has the least bias when compared with the mGFR but overestimated the GFR by 2.42ml/min/1.73m2 while Q has the highest bias. When the bias of other equations where compared with that of CG, the CKD/EPI formula significantly underestimated the GFR (P=.05) and the Q significantly overestimated GFR (P=.05). The highest precision was by CG and the least was found in the CKD/EPI though not significantly. The highest accuracy in this group was by CKD/EPI. In the non-diabetics, the least bias was recorded in the MDRD when compared with the mGFR while the highest was recorded in the CKD/EPI, the bias when compared with that of CG, the CKD significantly underestimated GFR by up to 7.54ml/min/1.73m2 (P=.001). Precision was highest in the Q though, not significant while its accuracy was significantly lower (P=.05) when compared with the CG. Adjustment for the ethnicity factor significantly overestimated GFR in our two study groups.
Conclusion: Creatinine-based predictive equations are useful in estimating renal functions but the CG as well as the MDRD equations are more superior in their predictive ability among Nigerians and the use of the ethnicity factor is not recommended in Nigerian African as there is overestimation when used with the relevant equations.

Open Access Original Research Article

The Potentiation of Anti-inflammatory Effect and INOS and COX-2 Gene Expression Inhibition by Rut in When Complexed with Cooper

Carla A. H. V. Miyashiro, Susana N. Diniz, Daniel A. F. de Oliveira, Ivair D. Gonçalves, Regina M. S. Pereira, Renata G. Silva, Niraldo Paulino, Cristina E. Okuyama

Journal of Advances in Medicine and Medical Research, Page 4289-4309
DOI: 10.9734/BJMMR/2014/10228

Aims: The aim of this study was to evaluate both the antioxidant effect and anti-inflammatory activity of a new transition metal coordinated rut in compound, Rutin-Cu2 complex.
Study Design: Flavonoids have proven antioxidant and anti-inflammatory activities. Moreover, recent researches demonstrate that the antioxidant activity of flavonoids is believed to increase when they are coordinated with transition metal ions. Our group has recently synthesized new compounds by the reaction of rut in (a flavonoid) with divalent metal salts (copper acetate, nickel acetate or iron sulfate), rendering new transitional metal coordinated rut in compounds, named R-Fe1 [(FeC27H32O21S)2], R-Cu2 [C31H32O18Cu.2H20] and R-Ni2 (C31H42O23Ni). In order to investigate the ability of these new compounds in modulating biological activity and to compare if metal coordinated rut in could increase anti-inflammatory activity of rut in alone, we used murine experimental model of peritonitis to measured cell migration and In vitro models of antioxidant activity to evaluate radical superoxide scavenging activity and of macrophage cell line culture to quantify nitric oxide production and iNOS and COX-2 gene expression.
Methodology: To characterize physical-chemical the new generated compounds we used elemental analysis, FT-IR and UV/Vis. The antioxidant effect was evaluate by radical superoxide scavenging assay, using NBT methodology. The anti-inflammatory activity of the new compounds were investigated by peritonitis models induced by carrageenan (1%, 4h), bradikynin (10nmol/cavity, 1h), histamine (100µg/cavity, 1h), substance P (20nmol/cavity, 1,5h) and PGE2 (10nmol/cavity, 1h). Total and leucocytes subtypes numbers were evaluated in harvest cells from mice peritoneum after phlogistic agents administration, in controls groups (not treated or treated with dexamethasone or rut in alone) or tested groups (treated with metal coordinated compounds). RAW 264.7 cells were stimulated with LPS on the absence or presence of rut in alone (0.01–90mMr), or Rutin-Cu2 complex (0.01–90mM). The production of NO was measured in culture supernatant after 24h of cell incubation, by Griess assay. And iNOS and COX-2 transcripts were quantified by real time PCR with SYBR GREEN, on cDNAs obtained after 24h of cell incubation, in a step one instrument (Applied bio systems).
Results: Complex formation was also verified by 1H RNM, using DMSO-d6 as solvent. The proton signals from Hydroxyl groups 5-OH, 7-OH, 3’-OH and 4’-OH shifted to lower and broader frequencies in coordinated complex R-Fe1, R-Cu2 and R-Ni2, compared with signals from free rut in. The results showed that R-Cu2 complex presented a higher superoxide scavenging effect when compared with rut in alone (6.95% and 46.42%, at 10µM; and 51.80% and 71.32%, at 100µM, respectively). The results also showed that R-Cu2 inhibited significantly (P<0.05; ANOVA) cell migration (neutrophils, lymphocytes and monocytes) in peritonitis induced by carrageenan, bradikynin and PGE2, in mice, when compared to controls ones (without treatment or Ru alone treatment). Furthermore, rutin and R-Cu2 significantly (P<0.05, paired t test) inhibited iNOS and COX-2 gene expression in LPS-induced macrophage cells.
Conclusions: Taken together, our results show for the first time that the R-Cu2 complex, a metal coordinated rut in compound, produces anti-inflammatory effects in mice, at least in part, by means of increasing the antioxidant activity and inhibition of iNOS and COX-2 gene expression. We suggest that cooper coordinated rut in compound can potentiates some biological properties of this flavonoid and could be more effective for therapeutic treatment of diseases related to oxidative stress.

Open Access Original Research Article

Dietary Diversity is a Predictor of Acute Malnutrition in Rural but Not in Urban Settings: Evidence from Ghana

Dickson A. Amugsi, Maurice B. Mittelmark, Anna Lartey

Journal of Advances in Medicine and Medical Research, Page 4310-4324
DOI: 10.9734/BJMMR/2014/10014

Aims: To document the relationships between child dietary diversity and acute malnutrition (wasting) in urban and rural Ghana, controlling for maternal, child and household socio-demographic characteristics.
Study Design: Cross sectional survey
Place and Duration of Study: Urban and rural Ghana, between September and November 2008.
Methodology: The analysis uses data from the 2008 Ghana Demographic and Health Survey. Data on children aged 6-36 months (n = 1,187) and their mothers who provided reports of child food consumption were analysed. The mother reported the child’s consumption of 16 food types/groups in the 24 hours prior to the survey. A value of 1 was assigned for each food group consumed, and these were summed to create the dietary diversity score (DDS). Logistic regression was used to investigate the relationship between DDS and childhood wasting.
Results: Among rural children, but not urban children, higher DDS was associated with a significantly lower likelihood of wasting after controlling for child, maternal, and household characteristics. A one-point increase in DDS was associated with an 11% reduced odds of being wasted (OR = 0.89, 95%, C.I. 0.80 - 0.99). There was also an interaction effect with a higher likelihood of wasting predicted by lower DDS when maternal BMI was low.
Conclusion: Dietary diversity has a modest but statistically significant association with acute malnutrition in rural but not in urban Ghana. Interventions to combat acute malnutrition in rural settings should include efforts to promote the consumption of a variety of food groups.

Open Access Original Research Article

Gender Related Differences in the Prevalence and Correlates of Modifiable Cardiovascular Disease Risk Factors among Seemingly Healthy Adult Nigerians–A Cross Sectional Study

Segun Johnson Showande, Olubukunola Adewunmi George, Omobolanle Olufunke Adekunle

Journal of Advances in Medicine and Medical Research, Page 4325-4340
DOI: 10.9734/BJMMR/2014/8737

Background: Mortality from cardiovascular diseases (CVD) is on the increase globally and the presence of multiple CVD risk factors is related to poor CVD outcomes. Most studies in Nigeria described the prevalence of CVD risk factors in populations with hypertension, diabetes, metabolic syndrome and the aged.
Aim: We studied gender disparities in the prevalence and correlates of these factors in a seemingly healthy adult population.
Study Design: A cross-sectional study involving 540 participants aged from 18 to 74 years.
Place and Duration of Study: The study was conducted in five centers in Lagos state; Mafoluku/Airport, Ikeja, Lekki, Ikota and Yaba from February to June 2010.
Methods: Blood pressure, body mass index, total serum cholesterol and random blood glucose were measured with standard methods. Smoking status was also ascertained. Gender differences in the presence of multiple risk factors and prevalence of CVD risk factors were determined by Fisher’s Exact Test and Chi-Square test respectively. Pearson and partial correlation were used to determine the correlation between risk factors. Statistical significance were set at P<.01 and P<.05.
Results: The prevalence of hypertension, hypercholesterolemia, obesity, diabetes and smoking was 163(30.2%), 140(25.9%), 106(19.6%), 80(14.8%), and 43(8%) respectively. Females had a higher prevalence of hypercholesterolemia and lower prevalence of smoking than males (P=.001). Only 212 (39.3%) participants had no existing CVD risk factors while 148(27.5%) had multiple risk factors with females been more affected (P=.03). There was no gender difference in the moderately positive correlations between risk factors before and after adjusting for age (P>.05).
Conclusion: The increase prevalence of CVD risk factors and the presence of multiple CVD risk factors call for urgent formulation of policies to address the looming epidemic of cardiovascular diseases through programs targeting prevention, systematic screening, interventions and control.

Open Access Review Article

Malignant Transformation of Radicular Cyst/Residual Cyst: A Review of Literature

Bassel Tarakji, Ayesha Shireen, Ayesha Umair, Saleh Nasser Azzeghaiby, Ibrahim Alzoghaibi, Salah Hanouneh

Journal of Advances in Medicine and Medical Research, Page 4278-4288
DOI: 10.9734/BJMMR/2014/9536

Aim: The aim of this study is to review the literature concerning malignant transformation of radicular cyst.
Material and Method: A literature search using MEDLINE, accessed via the National Library of Medicine PubMed interface (, searching for articles relating to the malignant transformation of radicular/residual cyst written in English from 1960-2013.
Results: Our search identified only fourteen studies available to date in English written literature. No randomized controlled trials to assess the possibility of malignant transformation of radicular/residual cyst were in the literature.
Conclusion: The development of malignancy from radicular /residual cysts is rare, however, it should always be considered as a differential diagnosis. The numbers of studied cases in literature are few but small number of case series & case reports are available. Also it is recommended that further work involving large series of tumors arising from radicular /residual cyst to determine the malignancy potential.