Open Access Case Study

Primary Small B-cell Lymphoma (MALT Lymphoma) at Lingual Tonsil: A Case Report

Gaffar Aslan, Tulay Tecimer, Sadik Server, Fikret Cinar, Sefik Igdem, Ipek Coban, Coskun Tecimer

Journal of Advances in Medicine and Medical Research, Page 4956-4964
DOI: 10.9734/BJMMR/2014/10789

Aims: Primary non-Hodgkin’s lymphomas of the oropharyngeal region are rare. We report a case of a small B-cell lymphoma (MALT lymphoma) involving base of tongue. The patient was successfully treated with wide excision of the lesion followed by radiotherapy.
Presentation of Case: A 75-year-old female Caucasian patient was referred to our clinic with complaints of foreign body sensation in the throat and progressively worsening snoring over 4 months. Oropharyngeal examination revealed a 3x3-cm smooth mass originating from the left side of the base of tongue and moving with protrusion of the tongue. Excisional biopsy revealed a low-grade small B-cell lymphoma with lambda monoclonal plasmacytic differentiation [extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue (MALT) with lambda monoclonal plasmacytic differentiation]. The neoplastic population was consisted of small lymphoid B-cells and lambda monoclonal plasma cells. Lymphoid cells showed CD20(+), CD5(-), CD23(-), CD10(-), BCL-6(-), IgD(-), BCL-2(+). In the neoplasm were seen few mitoses, and cellular proliferation marker Ki-67 was approximately 15%. Magnetic resonance imaging of the head and neck showed a well-circumscribed solid mass originating from the base of left side tongue. Bone marrow aspiration biopsy showed no evidence of disease. Computerized tomographic scans of the thorax and magnetic resonance imaging of the abdomen showed no adenopathy. Tumor was determined to be at Stage I.
Discussion and Conclusion: Primary non-Hodgkin’s lymphomas involving oropharyngeal region should be considered in differential diagnosis of all lesions located in this region. To our knowledge, a case of small B-cell lymphoma of the base of the tongue is rarely reported. An appropriate evaluation of the clinical presentation along with histopathologic and immunohistochemical evaluation of biopsy specimen may aid in the diagnosis and effective treatment.

Open Access Minireview Article

Genetics to Genomics in Clinical Medicine

Vinit Sawhney, Richard Schilling, Benjamin O. Brien

Journal of Advances in Medicine and Medical Research, Page 4926-4938
DOI: 10.9734/BJMMR/2014/11175

Biomedical research and knowledge has grown exponentially since the completion of the Human Genome Project in the year 2000. There has been a gradual shift from ‘genetics’ (study of genes) to ‘genomics’ (study of the whole genome) in medicine. Advances such as sequencing of the human genome, genome enrichment, epigenetics and bioinformatics have transformed the face of translational research and are beginning to have a major impact on clinical practice. In order to take advantage of the full potential of genomic research in clinical practice, clinicians will need to understand and embrace a significant conceptual shift from ‘Mendelian genetics’ to ‘Post Mendelian genomics’.
A relative lack of genetics to genomics knowledge has been reported amongst senior physicians in major health plans in the United States. This is also true of physicians practicing in the United Kingdom as reflected in the reports by the British Royal Society (BRS), Wellcome Trust and UK department of Health. While large sections of the academic medical community is driving this conceptual shift, a significant proportion of practicing clinicians are not actively involved in these developments. Here we describe the continuum from genetics to genomics in medicine by giving a brief overview of the shift from single gene disorders and chromosomal aberrations to functional genomics and our current understanding of the more dynamic relationship between genotype and phenotype.

Open Access Original Research Article

Hosting the Unwanted: Stethoscope Contamination Threat

Gabriele Messina, Emma Ceriale, Sandra Burgassi, Carmela Russo, Nicola Nante, Lorenzo Mariani, Lucilla Taddei, Daniele Lenzi, Pietro Manzi

Journal of Advances in Medicine and Medical Research, Page 4868-4878
DOI: 10.9734/BJMMR/2014/11337

Aims: Stethoscopes represent a vehicle of bacteria and other microorganisms and may play a role in the spread of health-care associated infections (HAIs). We aimed to evaluate the contamination levels of stethoscopes before and after use of a disinfecting technique (DT).
Study Design: Matched cross-over study.
Place and Duration of Study: The study was conducted in July 2012 and involved three hospitals in Siena Province (Italy). Two were public hospitals with about 750 and 140 beds, and the other was private with 40 beds.
Methodology: We evaluated: i) contamination on 74 shared and non shared stethoscopes; ii) bacterial load before and after use of a DT. Total bacterial count (TBC) at 36ºC and 22ºC, Staphylococcus spp., molds, Enterococcus spp., Pseudomonas spp., Escherichia coli and total coliforms bacteria were evaluated. Mann Whitney and Wilcoxon tests were used for comparisons (p<0.05).
Results: Before DT, 49 stethoscopes were positive for TBC at 36ºC, 48 for TBC at 22ºC, 40 for Staphylococcus spp., 18 for methicillin-resistant Staphylococcus aureus, 33 for coliforms (9 for Escherichia coli), 5 for Enterococcus spp. and 2 for molds. After cleaning, the percentage reduction in CFUs was close at 100% in most comparisons. Shared stethoscopes proved to be less contaminated than non shared ones (p<0.05).
Conclusion: Our results suggest that stethoscopes may be potential vehicles of HAIs. The DT was effective in reducing bacterial contamination.

Open Access Original Research Article

Salivary α-amylase Activity and s-IgA Levels Could be Taken as a Measure of Physiological Stress in Wheelchair-dependent Persons with Physical Disabilities and Without Disability Middle-aged Persons

Yoshimasa Matsuura, Shinichi Demura, Yoshiharu Tanaka

Journal of Advances in Medicine and Medical Research, Page 4879-4891
DOI: 10.9734/BJMMR/2014/10929

Aims: The s-IgA/total protein ratio and α-amylase activity in saliva have been used as indexes of stress because they change according to the physiological stress. Using both indexes, this study aimed to compare the circadian rhythm of stress levels in wheelchair-dependent persons with congenital physical disabilities with those in without disability middle-aged persons.
Study Design: Physiological stress was measured by biochemical analysis of the saliva.
Place and Duration of Study: Collection of saliva was performed at participant’s house by own self and with the care worker. Biochemical analysis was carried out at Osaka Prefecture University, Osaka, Japan, from September 2012 to March 2013.
Methodology: Subjects were 12 wheelchair-dependent persons with congenital physical disabilities and 12 without disability persons of the same generation. Saliva was collected in the morning (on awakening, after breakfast and before lunch), in the afternoon (after lunch, at 15:00 and before dinner) and at night (after dinner and at bedtime). The s-IgA in saliva supernatant was determined by ELISA method. A difference among mean values of the s-IgA/total protein ratio and α-amylase activity was examined by two-way analysis of variance (ANOVA) (disability presence × collection period), with only one-way pairing (collection period).
Results: The s-IgA/protein ratio was significantly affected by the period factor; results of the post hoc test revealed that the ratio was higher in the morning than in the afternoon and at night in the both groups. A significant interaction was observed with regard to α-amylase activity; results of the post hoc test revealed that α-amylase activity in the afternoon and at night was higher in the disability group than in the without disability group, and in the disability group, the activity was lower in the morning than in the afternoon and at night.
Conclusion: Wheelchair-dependent persons with congenital physical disabilities have higher physiological stresses and greater circadian rhythm fluctuation than without disability middle-aged persons.

Open Access Original Research Article

Sero-negative Antibody Status in HIV-Infected Children Initiated on Early Anti-Retroviral Therapy in Jos, Nigeria

E. U. Ejeliogu, S. Oguche, A. O. Ebonyi, E. S. Okpe, E. S. Yiltok, C. C. John, M. O. Ochoga, O. O. Agbaji, P. Okonkwo

Journal of Advances in Medicine and Medical Research, Page 4892-4900
DOI: 10.9734/BJMMR/2014/10951

Aim: To determine the association between the age at initiation of anti-retroviral therapy (ART) and the 18 month antibody status of human immunodeficiency virus (HIV)-infected children in Jos, Nigeria.
Study Design: This was a retrospective cohort study.
Place and Duration of Study: AIDS Prevention Initiative in Nigeria (APIN)-supported HIV clinic at Jos University Teaching Hospital, Jos, Nigeria between July 2008 and June 2012.
Methods: We reviewed the clinical records of all children confirmed to be HIV-infected with 2 positive HIV deoxyribonucleic acid polymerase chain reaction (DNA PCR) results who were initiated on ART before 12months of age. We studied the association between the age at initiation of ART and their antibody status at 18 months of age. We also studied the association between the viral load and the antibody status.
Result: Seventy-three HIV-infected children were initiated on ART at <12 months of age, 66 of these had antibody tests at 18-21 months of age. Nineteen (29%) of the 66 children were negative for rapid antibody test. Those that were initiated on ART at <6 months of age had 5 times the odds ratio of being rapid antibody test negative compared to those who were initiated at ≥6 months of age (AOR=5.23 (1.82-19.66), P=0.002). All the children with negative rapid antibody tests were virally suppressed while all those with detectable viral load were positive for rapid antibody tests.
Conclusion: Antibody tests alone cannot be used to determine whether ART should be stopped in children where a definitive diagnosis does not exist. Improved access to affordable, technically simple DNA PCR testing is essential for the appropriate management of HIV-exposed infants in resource limited settings.

Open Access Original Research Article

Mandatory Child Restraints: A KAP Study among Parents and Nursery Instructors

Elaheh Ainy, Hamid Soori

Journal of Advances in Medicine and Medical Research, Page 4901-4907
DOI: 10.9734/BJMMR/2014/8380

Aims: New road traffic injury (RTI) laws in Iran still neglects the importance of child restraint in automobiles. The objective of this study is to determine the Knowledge, Attitude and Practice (KAP) on the mandatory use of child restraint among parents and nursery instructors.
Study Design: An observational KAP study
Place and Duration of the Study: City of Tehran capital of Iran, between June 2013 and November 2013.
Methodology: An observational KAP study was carried out (using a self-administered questionnaire and a Likert scale) on 403 parents, which children were less than 13 years old and nursery instructors both residing in Tehran by a stratified randomized sampling. Twelve elementary schools and six nurseries were selected randomly. Validity and reliability of questionnaires were determined using the content validity and test re-tests. Subjects were selected randomly and data was collected by trained interviewers, after obtaining consent forms from the subjects.
Results: The majority (71%) of parents was female, aged 36.7±5.6 (range: 25-59). Half of the parents did not have any knowledge about child restraint laws and its implementation in the country. The knowledge among subjects about different kinds of child restraints, according to the child’s age and weight, was 22.6%. Only 28% of subjects use child restraints for their children. A significant difference was observed between subjects' use of child restraints and their region of residency. Low use of child restraints was observed among 30-40 years old age group (p=0.05). Willingness to a pay extra cost to buy a better quality of child restrain was 56%. Willingness to participate in a national child restraint educational program was of 70%. The rate of community agreement to a mandatory use of child restraint in the country was 85%.
Conclusion: Knowledge and practice related to usage and kind of child restraint adjusted with child weight were low among the parents and nursery instructors. The rate of a community agreement to set a mandatory use of child restraint in the country was high.

Open Access Original Research Article

Prevalence and Clinical Pattern of Acute and Chronic Complications in African Diabetic Patients

U. S. Jasper, M. C. Opara, E. B. Pyiki

Journal of Advances in Medicine and Medical Research, Page 4908-4917
DOI: 10.9734/BJMMR/2014/9384

Aims: The aim of this study was to describe the proportion, pro¬file and clinical pattern of acute and chronic complications associated with diabetes and its potential risk factors.
Study Design: This was a retrospective study.
Place and Duration of Study: We conducted this study at an Accident and Emergency unit of a tertiary hospital between February 2012 and January 2013.
Methodology: Type 1 and Type 2 diabetes patients (18 years and older) that presented with diabetes-related complications within the study duration were studied. The emergency case record of patients who were brought in on account of diabetes complications was identified and information relevant to this research was extracted. De¬scriptive statistics was used to summarize data, while Chi-Square test was used for the categorical variables. Regression analysis was done to ascertain the risk factors associated with various complications.
Results: Two hundred and sixty-two cases of diabetes complication were reported. Males (159, 60.7%) and those in 1-5 years group (89, 34%) were the majority. The mean age was 55.2±13.2 (SD) years, while the mean diabetes duration was 9.9±7.8 (SD) years. A slight majority were hypertensive (138, 52.7%), with mortality reported in five patients (1.9%). Acute complications accounted for 47.3% of the reported cases, with hyperglycaemia being the most common (71, 27.1%). Microvascular complications were more common than macrovascular complications (47.8% vs. 19.6%).
Conclusions: More efforts focused on education programmes and early diagnosis through mass population screening, good glycaemic control, proper lifestyle modification through dieting and engaging in physical activity can forestall or reduce complications. Furthermore, government should seek ways to subsidize diabetes medication and make it affordable to the less privileged.

Open Access Original Research Article

The Role of Graduated Drivers' Licensing on Incidence and Severity of Road Traffic Injuries in Iran

Hamid Soori, Ali Nasermoadeli, Elaheh Ainy

Journal of Advances in Medicine and Medical Research, Page 4918-4925
DOI: 10.9734/BJMMR/2014/8379

Aims: This study investigated the role of graduated drivers licensing, implemented by the Traffic Police of Iran, on reducing the severity and incidence of road traffic injuries.
Study Design: It was an evaluation of the effectiveness of intervention by looking at the data before and after intervention.
Place and Duration of Study: Data on road traffic crashes and injuries from one year before, one year after and two years after the implementation of educated drivers licensing were obtained from Iran Traffic Police database in 2010.
Methodology: In this study the effectiveness of provisional license intervention by looking at the data before and after intervention was evaluated.
After data cleaning and stratification of traffic injuries and mortalities, the post-education records of drivers, in their early years of driving experience, were compared against their pre-education driving experience.
Results: Drivers under 23 years of age were involved in 22.8% of total road traffic injuries (RTIs) in the year prior to the implementation of graduated drivers licensing. This measure fell to 15.5% and 16.1% in the first and second years following the intervention among the holders of provisional B1 type driving license (p<0.001).
Conclusion: Intervention is an effective way of reducing the number and severity of traffic injuries, particularly among the young and novice drivers are at a greater risk of RTIs. Such drivers can particularly benefit from graduated drivers licensing program which is proven to reduce the incidence and severity of road traffic injuries.

Open Access Original Research Article

Admission Patterns and Outcome in a Pediatric Intensive Care Unit in Nepal

Gauri S. Shah, Basant K. Shah, Anil Thapa, Lokraj Shah, O. P. Mishra

Journal of Advances in Medicine and Medical Research, Page 4939-4945
DOI: 10.9734/BJMMR/2014/10318

Aims: To study the admission patterns and outcome of children in a Pediatric Intensive Care Unit (PICU) in Nepal.
Methods: Demographic profile, diagnosis, treatment, supportive measures and outcome of children admitted to the PICU of B P Koirala Institute of Health Sciences from April 2011 to March 2012 were reviewed.
Results: 230 children were admitted to the PICU with male to female ratio of 1.7:1. Diagnoses included respiratory diseases (n=76, 33%), central nervous system diseases (n=43, 18.6%), infectious diseases (n=26, 11.3%), surgical problems (n=18, 7.8%), gastrointestinal diseases (n=17, 7.4%), cardiovascular diseases (n=15, 6.5%), poisonings (n=11, 4.8%), renal (n=9, 3.9%), hematological (n=3, 1.3%) and others (n=12, 5.4%). Out of 230 admitted children, 29 (12.6%) died, 19 (8.2%) left against medical advice and 5 (2%) were referred to other centers. Forty-one (17.8%) children received mechanical ventilation, among which 23 (56%) improved, 14 (34.1%) died and 4 (9.7%) children were taken away by caretakers against medical advice.
Conclusion: Respiratory, central nervous system and infectious disease were the common reasons for admission. Children with infectious diseases and need for mechanical ventilation had higher mortality. Therefore, these patients require early referral and timely institution of therapy for better outcome; and intensive care facilities should be expanded to decrease child mortality.

Open Access Original Research Article

Injection Snoreplasty-a Simple Way to Treat Habitual Snoring

Bakshi Jaimanti, Gupta K. Ashok, Dash K. Anil, Khandelwal Gaurav

Journal of Advances in Medicine and Medical Research, Page 4946-4955
DOI: 10.9734/BJMMR/2014/7928

Aims: Injection snoreplasty was recently introduced as a safe, effective, and minimally invasive treatment for primary snoring. We assess the effectiveness of the treatment in our patients.
Study Design: It was a prospective, non-randomised study on 54 patients with primary snoring.
Place and Duration of Study: Study was done in the department of otolaryngology &head neck surgery at PGIMER, Chandigarh, India over 7 years between January 2004 and December 2010.
Methodology: Patients were questioned about their symptoms; a detailed clinical and radiological examination was done in all patients. All the causes of snoring were ruled out. 1-3% sodium tetradecyl sulphate (STS) injection was administered in all patients in 1-3 sittings. Patients were assessed after 1, 3 and 6 months and their improvement was noted
Results: There were 47 males and 7 females enrolled in our study with mean age as 47.6 years. The mean duration of snoring was 76.1 months. The average BMI of patients was 28.11. All the patients except 4 were initially injected 1% STS injection; the others were injected 3%. 11 patients were re-injected at 1 month and 4 had 2nd re-injection at 3 month follow up. The mean improvement in symptoms was 57.24%. The only side effect was pain which in majority of patients was mild. There was no correlation between BMI and percentage of improvement.
Conclusion: Injection snoreplasty is a safe and cost effective treatment for primary snoring.