Open Access Case Study

Spontaneous Twin Ectopic Pregnancy with Live Embryos: A Case Report

Tayfur Çift, Emin Üstünyurt, Müzeyyen Duran, C. Narter Yeşildağlar

Journal of Advances in Medicine and Medical Research, Page 5248-5252
DOI: 10.9734/BJMMR/2014/11415

Ectopic pregnancy is a challenging medical emergency that can be easily misdiagnosed. Early diagnosis is essential in ectopic pregnancy since it may be a life-threatening clinical entity if it is misdiagnosed and ruptures, resulting in intra-abdominal bleeding. Twin ectopic pregnancy is a rare clinical entity. We present a case of unilateral live spontaneous tubal twin ectopic pregnancy in a woman with a history of counter-lateral salpingectomy.

Open Access Case Study

Acinetobacter Species Associated with Spontaneous Preterm Birth and Histological Chorioamnionitis

Julie A. Quinlivan, Nadeem O. Kaakoush, George L. Mendz

Journal of Advances in Medicine and Medical Research, Page 5293-5297
DOI: 10.9734/BJMMR/2014/12004

Aim: Preterm birth is a complex and unresolved public health problem across the globe. Infection is a factor for which a causal link has been established with preterm birth. A better understanding of its aetiology is required to improve obstetric and neonatal care. The case highlights the limitations of current obstetric hospital microbiology tests, and contributes to the knowledge of bacterial pathogens in the female genital tract associated with preterm birth.
Case Presentation: A woman presented with no signs of infection and spontaneously delivered preterm at 34 weeks gestation. Culture-based microbiological results from blood samples and swabs of mother and child were negative. Postpartum histopathology of the placenta demonstrated chorioamnionitis, and vasculitis of the umbilical cord. Cultivation-independent PCR analyses showed a massive Acinetobacter spp. infection.
Conclusion: Cultivation-independent PCR analyses may detect potentially pathogenic species when standard culture-based techniques are negative. The frequency of Acinetobacter spp. infections during pregnancy and in neonatal units manifests the need to develop appropriate diagnostic methods that can become standard practice in hospitals and clinics.

Open Access Short Research Article

Dexmedetomidine Ameliorates Histological and Neurological Outcomes after Transient Spinal Ischemia in Rats

Toru Goyagi, Yoshitsugu Tobe

Journal of Advances in Medicine and Medical Research, Page 5238-5247
DOI: 10.9734/BJMMR/2014/11623

Aims: Dexmedetomidine, anα2adrenergicagonist, provides neuroprotection in various cerebral ischemia models and against anesthesia-related neurotoxicity. Dexmedetomidine also improves paraplegia induced by intrathecal morphine after short-term spinal ischemia. In this preliminary study, we investigated whether dexmedetomidine provides spinal protection against transient spinal ischemia in rats.
Methodology: Adult male Sprague-Dawley rats were randomly divided into the following 3 groups: 1) intravenous infusion of 0.9% NaCl at a rate of 0.5 mL/h (control), 2) dexmedetomidine 1 µg/kg/h, and 3) intravenous infusion of 0.9% NaCl without spinal ischemia (sham). The rats received saline solution or dexmedetomidine 30 min before spinal cord ischemia and for 24 h. Spinal cord ischemia was induced by intra-aortic balloon occlusion combined with proximal arterial hypotension for 10 min. Ischemic injury was assessed by the neurological deficit score and by the number of viable motor nerve cells in the anterior spinal cord at 24 h of reperfusion.
Results: The neurological deficit score was significantly lower in the dexmedetomidine group compared to the control group (p< 0.05). The number of viable motor nerve cells in the dexmedetomidine group was significantly greater than was that in the control group (p< 0.05), but was lower than was that in the sham group.
Conclusion: Our findings suggest that continuous administration of dexmedetomidine ameliorates short-term neurological and histological outcomes induced by transient spinal cord ischemia and reperfusion in rats; thus, dexmedetomidine appears to protect the spinal as well as the brain.

Open Access Original Research Article

A Study of an Unexplained and Large Increase in Respiratory Deaths in England and Wales: Is the Pattern of Diagnoses Consistent with the Potential Involvement of Cytomegalovirus?

Rodney P. Jones

Journal of Advances in Medicine and Medical Research, Page 5193-5217
DOI: 10.9734/BJMMR/2014/11382

Aims: To determine if the ubiquitous herpes virus, cytomegalovirus (CMV), could be involved in a large and unexplained increase in all-cause mortality in England and Wales in 2012, and more specifically if this involvement was via a respiratory etiology.
Study Design: Analysis of respiratory system cause of death in England and Wales and of respiratory system emergency hospital admissions in England.
Place and Duration of Study: Cause of death statistics with primary respiratory system involvement in England and Wales in 2011 and 2012. Trends in emergency hospital admissions in England where there is a respiratory system primary diagnosis over the period 2000/01 to 2012/13.
Methodology: Respiratory diagnoses which show a statistically significant increase as cause of death in 2012 were identified, as were diagnoses showing a statistically significant increase as the primary cause of an emergency hospital admission in 2012/13. These diagnoses were then compared with medical case studies for hospitalization and death due to CMV.
Results: Deaths in England and Wales showed a sudden and unexplained increase in early 2012 which continued for 18 months before abating. The increase was equivalent to a large influenza epidemic, although higher levels attributable to influenza were absent. The increase was age and gender specific, and highest among those with neurodegenerative diseases (+15%); however, due to the way in which the primary cause of death is coded the role of respiratory diseases as the trigger for decease can be obscured. The next highest increase was for respiratory conditions, the most notable for bronchiectasis (+19%), asthma (female +14%), lung diseases due to external agents (+12%), interstitial pulmonary diseases (female +12%), chronic pulmonary disease (+7%) and a range of other conditions with >4% increases. After adjusting for the way in which deaths in the dementia group are coded the increase due to pneumonia rises to +8% for males and +15% for females. For the whole of the respiratory group augmented with the dementia group the increase in deaths was specific to those aged over 65 (average for 65+ of male +8.3%, female + 8.7%) with a peak at 90-94 (male + 15%, female + 17%). A corresponding large increase in respiratory admissions accompanies the increase in deaths. Given that the increase in admissions and deaths moved across England and Wales in a time-based spread, indicative of an infectious agent, with spurts of rapid local spread compatible with respiratory transmission, the increase in respiratory deaths were examined to see if the nature of any putative infectious agent could be discerned. There was a striking match with the known clinical effects of CMV.
Conclusion: In an aged population lifelong exposure to the immune erosive effects of CMV presents the potential for the emergence of diseases reliant on immune impairment for their modus operandi. The lung is a primary reservoir for permanent CMV infection in humans and conditions/diagnoses showing a large increase in both death and hospital admissions in 2012 are all potentially CMV-mediated. In view of the very large increase in death for particular respiratory diagnoses further research is urgently required.

Open Access Original Research Article

The Pattern of Cervical Cytology in Women Attending Various Clinics at a Tertiary Hospital in Anambra Southeast, Nigeria

S. U. Mbamara, C. O. Ukah, C. I. V. Onyiaorah, Ikpeze Okay, Okonkwo Jen

Journal of Advances in Medicine and Medical Research, Page 5218-5228
DOI: 10.9734/BJMMR/2014/11345

Background: Cervical cancer is one of the most common female reproductive tract malignancies with high morbidity and mortality most especially in the developing countries. Our purpose of this study is to determine the pattern of cervical smear and also to determine the effect of socio-demographic factors on the pattern of cervical cytology among women attending gynaecological clinic in Nnewi, Southeast Nigeria.
Materials and Methods: This cross-sectional prospective study was conducted at Nnamdi Azikwe University Teaching Hospital, (NAUTH), Nnewi, Anambra state, in South East Nigeria from December 2007–July 2008.
Result: Ninety six (68.6%) of the women had normal cervical smear while forty one (29.3%) had abnormal cervical smear. The proportion of unsatisfactory smear was 2.1%. The number and rates of abnormal cervical smear was further sub-classified as LSIL (25 cases, 17.9%), HSIL (12 cases, 8.6%), ASC-US (3 cases, 2.1%) and glandular intraepithelial lesion (1 case, 0.7%). No case of squamous cell carcinoma was detected.
Conclusion: The study shows that various patterns of abnormal cytology were found among our women and the prevalence of this abnormal smear is high. these findings underscore the need for massive and sustained reproductive health education and establishment of cervical cancer screening centres.

Open Access Original Research Article

Impaired Fasting Glucose & 8-Iso-Prostaglandin F2α in Diabetes Disease Progression

Herbert F. Jelinek, Dina A. Jamil, Hayder A. Al-Aubaidy

Journal of Advances in Medicine and Medical Research, Page 5229-5237
DOI: 10.9734/BJMMR/2014/11147

Aims: The objective of the present study was to evaluate the changes of 8-isoprostaglandin F2α and other markers of oxidative stress with impaired fasting glucose when compared to non-diabetic control participants.
Methodology: This is a cross-sectional study, conducted at Charles Sturt University, Albury, NSW, Australia and included 428 participants (female: male, 247:181) participants attending the Diabetes Complications Clinic in the School of Community Health for the period between January 2011 to October 2012.
Results: Urinary 8-isoprostaglandin Fwas significantly greater in the impaired fasting glucose group (1.4±1.3ng/ml) compared to control group (0.68±0.5ng/ml, P= .05). The increase in urinary 8-isoprostaglandin F was associated with a significant elevation in serum total cholesterol (4.7±1.1mol/L, P= .04) and a significant reduction in high density lipoprotein cholesterol (1.4±0.4mmol/L, P= .02) in the impaired fasting glucose group compared to the control group. A significant negative correlation was noted between urinary 8-isoprostaglandin Fand high-density lipoprotein cholesterol among all the participants included in this study (P= .05).
Conclusions: The current study proves the importance of measuring markers of oxidative stress, expressed by urinary 8-isoprostaglandin F and serum lipids in managing cases of impaired fasting glucose and suggests a useful biomarker for assessing disease progression and/or remission, especially in the prediabetic state.

Open Access Original Research Article

Effect of Muscle Energy Technique on Pain Perception and Functional Disability of Women with Postnatal Low Back Pain

Asmaa M. El-Bandrawy, Marwa A. Mohamed, Ahmed M. Mamdouh

Journal of Advances in Medicine and Medical Research, Page 5253-5261
DOI: 10.9734/BJMMR/2014/6999

Aims: To determine the effect of muscle energy technique (MET) on postnatal low back pain.
Place and Duration of Study: Department of obstetrics and gynecology, Ain Shams University Hospital, and Outpatient Clinic of Faculty of Physical Therapy, Cairo University, between January and May 2013.
Methodology: This study was carried out upon forty women diagnosed as postnatal low back pain. They were selected from outpatient clinics of gynecology of Ain Shams University Hospital, Cairo University. Their age ranged from 25-35 years, BMI<30kg/ m², they were all after normal vaginal delivery using local anaesthesia. Patients with radicular pain distal to the knee, previous low back surgery, low back pathology diagnosed by a physician, spondylolisthesis and chronic low back pain were excluded from the study. They were randomly assigned into two equal groups (A& B). Group (A) consisted of twenty subjects, with an average age 29.2±1.9Yrs, and BMI 27.28±2.1kg/m2 who received MET. Group (B) consisted of twenty patients, with an average age 28.58±2.2Yrs, and BMI 28.92±0.7kg/m2 who received sham technique. A hot pack was used for 15 minutes for both groups (A&B) before the treatment. This is to decrease pain, muscle spasm, and provide vasodilatation of the blood vessels supplying the area. The MET was applied three times per week for four weeks for patients in group A, and the sham technique was applied three times per week for four weeks for subjects of group (B).
Assessment of all subjects in both groups (A&B) was carried out before and after the treatment program using Visual Analogue Scale (VAS) and Stratford Back Pain Functional Scale (BPFS).
Results: There was a statistically highly significant decrease (P<0.001) in VAS scores and a statistically highly significant increase (P<0.001) in BPFS, after 4 weeks of the treatment program for group A than group B.
Conclusion: Muscle energy technique is an effective and safe method in alleviating postnatal low back pain.

Open Access Original Research Article

The Prevalence and the Predictors of Complementary and Alternative Medicine among Children on Highly Active Antiretroviral Therapy in Makurdi, Nigeria

Emmanuel Adémólá Anígilájé, Ayodotun Olutola, Othniel Joseph Dabit, Usenobong Morgan Akpan, Augustine Aondohemba Agbedeh, Terkaa Terrumun Bitto

Journal of Advances in Medicine and Medical Research, Page 5262-5383
DOI: 10.9734/BJMMR/2014/10695

Aims: To determine the prevalence, the pattern of usage and the predictors of complementary and alternative medicine (CAM) among children on highly active antiretroviral therapy (HAART).
Study Design: Prospective, Cross-sectional and quantitative.
Place and Duration of Study: Paediatric antiretroviral clinic of the Federal Medical Centre, Makurdi, Benue State, Nigeria, February 2012 to December 2012.
Methodology: Researchers administered structured questionnaire to 409 (102 men and 307 women) consecutively consented caregivers (CGs) whose children had been on HAART for not less than 6 months in order to fulfill the objectives of the study.
Results: 79.2% (324/409) of children used CAM as reported by their CGs. The three most commonly used CAM products were herbal concoctions containing majorly Bitter leaves (317/324, 97.8%), Ugu leaves/roots (282, 87.0%) and Neem tree leaves/bark (270, 83.3%). CGs also largely administered CAM whose contents were unknown (250, 77.2%). The use of Anointed water (255, 78.7%) and Anointed Oil (245, 75.6%) were also common. Animal products including Elephant skin (12, 3.7%), Elephant bone (10, 3.1%) and Snake bone (8, 2.5%) were also acknowledged. Spiritual healing was the most sought-for practice, seen among 252 (77.8%) CGs. 3.7% (12/324) of the CGs had disclosed the use of CAM to their primary physicians. Multivariate logistic regression analyses showed that: the use of CAM by CGs (AOR; 33.79, 95%CI; 8.049-141.856, P=.000); when the child on HAART is of a male gender (AOR; 2.142, 95%CI; 1.230-3.730, P=.007); fathers as CGs compared to mothers (AOR; 1.698, 95%CI;1.180-2.443, P=.004); CGs with no formal education compared to when CG attained a post-secondary level of education (AOR; 1.498, 95%CI; 1.127-1.990, P=.005), remained independently associated with the use of CAM in children.
Conclusions: CAM use is common in Nigerian children on HAART. Concerted efforts should be put in place to encourage disclosure among CGs. Identified harmful CAMs should be discouraged.

Open Access Original Research Article

Effect of Obesity on Hormonal Profile and Semen Parameters of Male Partners of Infertile Couples in Kwara State Nigeria

N. Ugwueke Thaddeus, A. Ibrahim Isa

Journal of Advances in Medicine and Medical Research, Page 5284-5292
DOI: 10.9734/BJMMR/2014/11406

Background: Infertility is a global and a public health concern in many parts of sub-Saharan Africa and obesity is gradually becoming an epidemic disease that is rapidly spreading among Africans. Male obesity has been associated with increased incidence of low sperm concentration and progressively low motile sperm count.
Methods: The study was a multicenter prospective comparative analytical study conducted at the University of Ilorin Teaching Hospital (UITH), Anchor Medical Centre, Royal Medical Centre, Surulere Medical Centre and Mid-land Fertility Centre all in Ilorin, Kwara State, Nigeria over a period of six months (February to July 2011). Our aim was to identify the effect of male obesity on measures of reproductive potentials among male partners of infertile couples. Serum levels of testosterone, luteinizing hormone (LH), follicle-stimulating hormone (FSH) and estrogen of 42 obese and 42 non obese male partners of infertile couples were assayed in addition to seminal fluid analysis.
Results: There was a statistically significant association between obesity, class of obesity with sperm count and sperm motility (All P< 0.05) and low serum levels of FSH and testosterone (All p <0.05) levels. There was however no significant association between LH and estrogen levels in this study. (All P > 0.05).
Conclusion: This study has demonstrated an inverse but significant relationship between male obesity and semen parameters (sperm count and motility), serum testosterone and FSH amongst the study population. This suggests that male obesity has an adverse effect on the quality of semen amongst male partners of infertile couples.

Open Access Review Article

Prognosis of Male Breast Cancer: A Systematic Review of the Literature

Paulo Bender, Anke Bergmann, Celia Regina Costa, Luiz Claudio Santos Thuler

Journal of Advances in Medicine and Medical Research, Page 5179-5192
DOI: 10.9734/BJMMR/2014/10462

Objective: to discuss disease-free survival, overall survival, cancer specific survival, mortality and potential complications of the surgical treatment of breast cancer in men. Methods: a systematic review of studies identified in the databases PubMed and Lilacs, using the keywords "breast cancer in men" in combination with the terms "treatment" and "complications", published from 2006 to 2011. Results: the review included 20 studies sourced from all continents except Latin America and Oceania. The selected studies included 9,634 cases of male breast cancer diagnosed and treated between 1969 and 2009. Several authors have shown that men and women with breast cancer have similar clinical patterns, and that the treatment of male breast cancer persists as an extrapolation of female breast cancer. In primary studies, male survival rates 5 years after surgery ranged from 42% to 100% and, after 10 years, from 43% to 83%. In secondary studies, cancer specific survival at 5 years was 59% and at 10 years was 34%. There was no information regarding complications of surgical treatment. Conclusion: a wide variation in the rates of disease-free survival and overall survival was observed. Further studies should address this specific group, focusing mainly on its biological nature, therapeutic approaches and post-operative complications.