Journal of Advances in Medicine and Medical Research

Aims: To share our experience in the management of a patient of congenital bladder exstrophy, who conceived spontaneously following Indiana pouch surgery for urinary diversion.
Presentation of Case: 21 year old primigravida, who had undergone urinary diversion surgery for congenital bladder exstrophy, reported for antenatal care. In the first year of her life, an ineffective operation was performed for closure of her abdominal wall defect. At 10 years of age she underwent cystectomy, trygonocuteneostomy, diastasis of pubic bones were fixed and urinary diversion operation was performed by Indiana pouch method. She was followed up at the antenatal clinic of Dicle University until 38th week of pregnancy. Thereafter, an elective caesarean section was performed and a live healthy female baby was delivered.
Discussion and Conclusion: Bladder exstrophy is an extremely rare congenital abnormality. Woman with bladder exstrophy and lower urinary tract reconstruction surgery may conceive spontaneously. However they have a high risk pregnancy and an elective caesarian section is advocated for delivery. Review of literature and our experience is presented.

Aims: Susac’s syndrome is a rare clinical entity characterized by encephalopathy, sensorineural hearing loss and retinopathy caused by immune-mediated arteriole occlusion in the brain, retina and inner ear. No familial cases have been reported. We describe here the cases of two sisters who were seen at our Department for subacute neurological symptoms suggestive of a multifocal central nervous system disorder associated to hearing impairment and clinical or subclinical involvement of visual function.
Presentation of Cases: The first case presented with a two-years history of progressive paraparesis, gait ataxia and cognitive dysfunction started at age 46; she also suffered from epileptic seizures since childhood and bilateral visual loss occurred between age 37 and 38. Her sister, aged 44, had a long-standing history of headache followed by sudden-onset bilateral hearing loss at age 35, which did not recover, and an acute episode of right-sided face paresthesias nine years later. Brain MRI showed multiple T2-hyperintense supratentorial lesions involving the corpus callosum in both sisters, with “snowball” appearance in the older one. Serum anti-endothelial cell antibodies assay was positive in the youngest patient.
Discussion and Conclusion: After exclusion of other possible options, a diagnosis of Susac's syndrome looked probable for both sisters. Further studies investigating the pathogenesis and the genetic background of the disease are needed.

Aims: To prove the effect of S. typhimurium vaccine on inhibiting foam cell formation and arterial wall thickness, and also to decrease body weight and abdominal visceral fat.
Study Design: This experimental research was conducted using rat models.
Place and Duration of Study: Faculty of Medicine, Brawijaya University, Indonesia, between February – May 2011.
Methodology: The vaccine was 10⁸ CFU of heat-killed S. typhimurium/100µl vaccine per rat. The adjuvant was CFA-IFA 100µl per rat. Twenty Wistar rats were divided into five groups: a negative control group (have normal diet), and four treatment groups which were given with atherogenic diet. The four treatment groups were positive control group (atherogenic diet only), vaccine + adjuvant group (added with the vaccine + adjuvants), vaccine group (added with vaccine only), and adjuvant group (added with adjuvant only). The vaccines were injected intraperitoneally, five times in two-week intervals.
Results: There was no significantly difference in the average diet intake every day among the groups (P=0.17). The administration of ‘vaccine + adjuvants’, ‘vaccine only’ and ‘adjuvants only’ could decrease foam cell formation and arterial wall thickness compared to the positive control group (P= .00). The ‘vaccine alone’ treatment returned the foam cell numbers to be a normal value just like negative control (P=.15), but ‘vaccine + adjuvants ‘and ‘adjuvant alone’ did not (P=.01). There was a strong and significantly correlation between the foam cell formation with arterial wall thickness (R=0.842, P=.00). In addition, administration of ‘vaccine only’ decreased the rats’ body weight and abdominal visceral fat accumulation significantly compared to the positive control (P=.04 and P=.00 respectively).
Conclusion: The heat-killed Salmonella typhimurium vaccine without CFA-IFA adjuvant decreases foam cells expression and aortic wall thickness, body weight, and abdominal visceral fat accumulation in rat-induced atherogenic diet. In suggestion, heat-killed S. typhimurium is a potential antigen to be developed as an atherosclerosis vaccine in the future.

Background: Obstructed labour and ruptured uterus contribute a significant proportion to the alarming maternal mortality ratio in sub-Saharan Africa. Proper management of labour by using the partograph, a simple tool that is designed to detect early signs of abnormal progress, can significantly reduce incidence and complications of prolonged labour.
Objective: The objective of this study was to assess the knowledge and utilization of the partograph among non-physician obstetric health care providers in University of Calabar Teaching Hospital (UCTH).
Methods: This was a descriptive cross-sectional survey which employed the use of a semi-structured self-administered questionnaire with purposive sampling conducted among 132 consenting non-physician obstetric health care providers in UCTH.
Results: The mean age of the respondents was 37.84±9.38 years. About 66% of them used partograph but only 13.6% of those who had used partograph were very confident with the tool in monitoring labour. Fifty-six percent of them had received formal training on partograph. Only 34 percent of those surveyed could correctly interpret various sections of the partograph, like the cervicogram. The main reasons for non-utilization of the partograph were inadequate knowledge (73.5%), non-availability (46.2%) and shortage of manpower (34.8%). Knowledge of the partograph (X²=38.1, P=.00) and partograph availability (X²=52.5, P=.00) significantly affected its utilization. Years of experience did not significantly influence partograph use.
Conclusion: The knowledge and utilization of the partograph in our hospital can be enhanced by periodic training and retraining of obstetric care givers, developing protocols, ensuring its availability, as well as increasing the staff strength in the delivery units.

Aims: Currently there is not a single conventional marker to reliably assess liver function recovery after hepatectomy. Our aim was to investigate the potential role of circulating lipid levels as markers of liver function recovery.
The study was conducted in the experimental laboratory of the Aretaieion Hospital.
Methodology: 48 male Wistar rats (240-350g) were assigned in 2 groups; the sham operated group (A=21) and the 70% hepatectomy group (B=27). There were 3 subgroups according to the day the animals were killed (1^st, 3^rd and 7^th postoperative day [PO]). We measured the levels of AST, ALT, albumin, total protein, triglycerides, HDL and cholesterol in plasma and correlated them with the steps of liver regeneration
Results: Significant differences between the groups were observed in the levels of HDL (P=0.001) and cholesterol (P=0.001) on the 1^st PO day, and in triglycerides (P=0.045) on the 7^th PO day.
Conclusion: Cholesterol, and in a lesser degree HDL levels seem to reflect well liver function recovery after hepatectomy. In this experiment they were more sensitive than albumin in assessing the deterioration of liver function as well as the subsequent recovery during regeneration hence they may represent a more accurate marker of liver function. Rise in plasma triglyceride levels reflect the completion of the regenerative process.

Aims: This study was aimed at evaluating the phytochemical and nutrient composition of G. kola seed. Also to examine the effect of G. kola seed on the serum lipid profile of fed rats.
Study Design: Quantitative phytochemical, proximate analysis and in vivo effect on serum lipid profile.
Place and Duration of Study: Department of Biochemistry, College of Natural sciences, Michael Okpara University of Agriculture, Umudike Abia State, between June 2013 and September 2013.
Methodology: The seeds were cut into small pieces, dried and ground into powder. The quantitative phytochemical and proximate nutrient analyses of the powdered sample were determined using standard methods. The lipid lowering effects of the powdered sample of G. kola determined in rats. The rats were fed with feed fortified with graded levels (5, 10, 20 and 50%) of powdered sample of G. kola for 21 consecutive days and the effects on total cholesterol, triglyceride, low density lipoprotein cholesterol (LDL-C), very low density lipoprotein cholesterol (VLDL-C) and high density lipoprotein cholesterol (HDL-C) were compared with a negative control.
Results: The seed sample produced significant (p<0.05) dose-dependent decrease in the total serum cholesterol, triglyceride, LDL-C and VLDL-C levels in fed groups of rats when compared to the control group. The seed sample also, caused significant (p<0.05) dose-dependent increase in serum HDL-C level in fed groups of rats when compared to the control groups. The phytochemical analysis showed that the sample contained tannins (5.08%), flavonoids (0.93%), saponins (2.54%) and alkaloids (5.13%). The proximate analysis of the nutrient composition of powdered G. kola seed showed the presence of moisture, ether extract (EE), crude fibre (CF), crude protein (CP), ash and nitrogen free extracts (NFE) in the following proportion 7.40, 1.48, 2.94, 3.19, 4.39 and 80.58%, respectively.
Conclusion: The sample demonstrated good lipid lowering effects which may suggest that the consumption of G. kola seed may help in the reduction of the incidence of cardiovascular diseases in patients.

Background: Interest in avoidance of antibiotic resistance development through non-antibiotic therapeutics prompts development of topical vaginal preparations that may inhibit vaginal microorganisms. Prior data on boric acid, zinc salts and probiotic microorganisms suggests a potential role in female genital tract infections.
Aims: Determine antimicrobial effects of boric acid, zinc sulfate and metabolites of probiotic lactobacilli alone or in combination on Candida albicans, Gardnerella vaginalis and Streptococcus agalactiae.
Methodology: Absolute counts of test organisms cultivated with or without inhibitory compounds were determined by a flow cytometric method and compromise of microbial cell integrity was demonstrated by propidium iodide staining, also determined by flow cytometry. All microbial count growth experiments were conducted in triplicate and averages were reported.
Results: The three microbial species challenged with boric acid, zinc sulfate or spent medium from probiotic lactobacilli showed varying degrees of susceptibility to these inhibitors, with boric acid showing consistent activity against C. albicans and also showing yeast cell damage demonstrated by propidium iodide uptake. Boric acid showed greater antibacterial activity against S. agalactiae than against G. vaginalis and neither of the bacterial organisms showed propidium iodide staining. Zinc sulfate inhibition was greatest for Candida and least for Gardnerella. Probiotic Lactobacillus spent media was also inhibitory toward the three test organisms with Gardnerella being slightly less susceptible than the other two test organisms. When binary combinations were tested, the combination of boric acid and Lactobacillus spent medium was the most effective in vitro against all three organisms.
Conclusion: Zinc sulfate did not prove any more effective in vitro against the three test organisms than did boric acid or Lactobacillus spent media. The most potent binary combination against the three test microorganisms was boric acid plus spent media from probiotic Lactobacilli.

Objective: To explore the neuroprotective effect of Irvingia gabonensis (IG) against cadmium-induced oxidative damage in rats brain.
Place and Duration of Study: Department of Chemical sciences, (Biochemistry laboratory), Afe Babalola University and Department of Biochemistry, Ekiti State University, Ado Ekiti, Nigeria between February 2014 and May 2014.
Methods: The study was performed on twenty (20) male rats divided into four groups: a control group, cadmium group (4mgkg-1day-1, intraperitoneally [i.p.]) and cadmium toxication groups received 200 and 400mgkg-1 body weight of extract by oral gavage for 28 days. The degree of protection in brain tissue was evaluated by the levels of malondialdehyde (MDA), glutathione (GSH), superoxide dismutase, and catalase. The aminotransferase (ALT), aspartate aminotransferase (AST) activities and histological examination were monitored.
Results: Irvingia gabonensis showed a significant (P>.05) brain-protective effect by decreasing the level of lipid peroxidation and elevate the activities of antioxidative enzymes and level of GSH. Furthermore, histological alterations in brain were observed in cadmium untreated rats and were ameliorated in cadmium-induced treated rats with IG.
Conclusions: Consequently Irvingia gabonensis blocked oxidative brain damage induced by cadmium in rats. These data suggest that Irvingia gabonensis extract may play a very useful role in reduction of the neurotoxicological damage induced by cadmium.

Aim: Typhoid fever is caused by Salmonella enteric serovar Typhi and S. enteric serovar Paratyphi A. B. C. Accurate diagnosis of this illness will greatly reduce the mortality and morbidity associated with it. This study therefore evaluated the available diagnostic methods for typhoid fever among 44 clinical laboratories in Ondo State of Nigeria.
Methods: A simple but well-structured questionnaire filled by the most senior scientist, was administered on forty-four (44) out of the forty seven clinical laboratories registered by government and the monitoring agency to assess the various methods used by individual laboratory.
Results: All respondent laboratories used serological method (Widal’s Agglutination Test) while none used neither bone marrow culture nor molecular technique (PCR). Widal tests were reported by 93.2% of the laboratories without titration. Blood and stool cultures were sparingly and inconsistently used by about 48% of the laboratories, thereby being unable to generate information about species prevalence and susceptibility pattern of the pathogens.
Conclusion: The contribution of the clinical laboratories to the seeming treatment failure of typhoid fever became obvious from this study since no proper treatment or control measures can be effective without proper diagnosis. It is therefore suggested that our clinical laboratories be properly equipped for accurate diagnosis of typhoid fever.

Introduction: Female sexual dysfunction (FSD) is recognized as a widespread health problem. Infertility may result in increased sexual dysfunction. The aim of this study was to evaluate the prevalence of FSD and some demographic characteristic with female sexual function; detect predictors factors of female sexual domains on sexual dysfunction a sample of Iranian infertile women.
Methodology: The cross-sectional study was carried out between August 2013 and January 2014 on 208 women referring to Fatemeh Zahra Infertility & Reproductive Center, Babol, Iran. Each survey contains demographic information and one validated questionnaire, the Female Sexual Function Index (FSFI). A score≤ 26.55 is considered ‘‘at risk’’ for sexual dysfunction. Statistical analyses were performed using Independent sample t test, linear and logistic regression with P<.05 indicating statistical significance. All statistical analyses were performed using SPSS software (Version 17).
Results: The percentage of sexual dysfunction was 46.6. The mean score of total sexual function was 26.18±4.14. The lowest mean of FSFI domains was related to desire and then arousal in infertile women. There was a significant association between all of the domains of sexual function with sexual function. All of the female sexual domains had the positive significant predictors of sexual function in infertile women. Standardized beta values showed that orgasm contributed to the greatest amount of unique variance to the model for infertile women sexual function, and followed by sexual satisfaction, sexual arousal, lubricant, sexual desire, and sexual pain (P<.001). There was a significant correlation between the domains of sexual function except pain and desire. The strongest correlation value was between the domains of sexual satisfaction and orgasm, and then arousal with orgasm. There was a significant association between sexual dysfunction and educational level, husband’s educational level, and infertility cause.
Conclusions: With considering to the high prevalence of sexual dysfunction in selected infertile women, therefore, early screening is needed for detecting predictor's factors o sexual dysfunction.

Aim: To evaluate the antihyperglycaemic and antihyperlipidaemic properties of Pseudocedrela kotschyi in alloxan induced diabetic rats.
Materials and Methods: Fasting blood glucose (FBG) was conducted by first inducing diabetes through intraperitoneal administration of alloxan monohydrate (150 mg/kg body weight) (bwt). The diabetic rats, 5 per group received graded extract doses (100, 250 and 500 mg/kg) or glibenclamide (10 mg/kg) or 0.5mL acacia solution (2 %w/v) for 15 days. Blood was collected on days 0, 3, 5, 7, 9, 11, 13, 15 for glucose estimation. In postprandial test, three extract groups (100, 250 and 500 mg/kg) and the control were arranged, each comprised of 5 rats. Each animal was administered orally with glucose at a dose of 2g/kg bwt followed by extract administration 30min later. Blood glucose was monitored at 30, 60 and 120 min intervals. In hypoglycaemic study, the extract was administered at doses of 100, 250 and 500 mg/kg bwt. Lipid profile was analyzed by modified enzymatic procedure and glycated haemoglobin (HbA_1C) by standard protocol.
Results: The diabetic rats treated with the extract/glibenclamide showed weight gain. They also experienced dose (250 and 500 mg/kg bwt) dependent decrease in glycaemia with maximum decrease of 259.1±3.0 (24.9%) and 266.1±2.9 (25.3%) respectively while glibenclamide, 227.0±3.8 (36.0%). The postprandial test showed that the extract induced lower blood glucose level after 60 min. The extract also showed to have good hypoglycaemic activity at doses of 250 and 500 mg/kg bwt respectively. The pancreatic tissue analysis from the rats treated with the root extract indicated substantial beta cells survivor. An appreciable decrease in HbA_1C level was found in the extract and glibenclamide treated compared to the negative control. In lipid profile study, Pseudocedrela kotschyi extract was observed to have ameliorated dyslipidaemia.
Conclusion: The extract showed efficacy in attenuating hyperglycaemia, inducing hypoglycaemia and ameliorating dyslipidaemia.

The γ radiation exposure due to radioactivity concentration of ⁴⁰K, ²³⁸U and ²³²Th in soil samples from 250 different locations from 40 communities in the oil – producing region of Nigeria was carried out. The radioactivity concentrations of these radionuclides were used to determine the absorbed dose, annual effective dose equivalent, the health hazard indices and cancer risk using standard analytical methods. The range of values for the absorbed dose are 6.97 nGyh^-1 to 33.29 nGyh^-1, annual effective dose equivalent (outdoor) are 8.55 µSvy^-1 to 40.83 µSvy^-1 and (indoor) are 34.19 µSvy^-1 to 163.36 µSvy^-1. The external hazard index ranges from 0.038 to 0.174 while the internal health hazard index is from 0.045 to 0.191. The cancer risk obtained for the communities ranges from 0.030 x 10^-3 to 0.143 x 10^-3. All these values are below the standard limits when compared to the world permissible United Nations Scientific Committee on the Effect of Atomic Radiation (UNSCEAR) values for such environment. This shows that the exploration and exportation of crude oil in Nigeria did not pose a radioactive health hazard to the oil producing communities.

Background and Objective: Chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME) remains a challenge for health care professionals because of its complex pathogenesis. Scales and questionnaires have been developed in order to assess the severity of syndrome. Fibromyalgia share similar clinical features with CFS/ME however have its own diagnostic criteria. Our study was performed to analyze impact of value of fatigue severity in patients with CFS/ME and fibromyalgia (FM).
Materials and Methods: One hundred and three CFS/ME patients and 21 fibromyalgia patients were included in study. CFS/ME patients were diagnosed using the diagnostic criteria of Fukuda et al. 1994. The diagnosis of fibromyalgia was established using the American College of Rheumatology (ACR) 1990 diagnostic criteria. Fatigue Severity scale (FSS) and Fibro Fatigue scale (FFS) were used to assess the severity of fatigue. Factor analysis was performed in order to detect most common combinations of clinical signs in patients with CFS/ME. The data were calculated using SPSS version 16.0.
Results: The most common clinical feature other than fatigue was un-refreshing sleep established in 71(68.9%) patients. The mean score of FSS within CFS/ME patients was 6.65±0.256. The highest mean scores–6.94±0.243 were observed within statements – “Exercise brings on my fatigue”, “Fatigue is among my three most disabling symptoms”. The total score of FSS within CFS/ME patients was 59.94±2.045 and 53.62±8.880 in FM patients, (p=0.008). Fatigue was the most severe indicator according to FFS in CFS/ME patients with means score 5.76±0.664.
Conclusion: Most part of the CFS/ME patients suffered from un-refreshing sleep. CFS/ME patients had higher rates according to FSS than FM patients, which shows that fatigue in patients with CFS/ME is more intense, affecting their daily activities.

Arterial blood pressure (BP) can be reduced below pre-exercise levels after a single bout of exercise. This post-exercise reduction in BP is termed “postexercise hypotension” (PEH). The aim of this review was to present current studies exploring the mechanisms of PEH and discuss potential factors influencing the magnitude and the duration of PEH. The mechanisms underlying PEH point to centrally mediated decreases in sympathetic nerve activity (due to decreased neural afferent input to the nucleus tractus solitarius and baroreceptor resetting to lower BP) and to local vasodilatory mechanisms (histamine binding to H1 and H2 receptor). The exercise characteristics (intensity, duration, and mode) and the participant characteristics (such as fitness status, baseline BP, body adiposity, gender, and hydration status) influence PEH. Earlier studies using aerobic exercise in normotensive and hypertensive individuals, suggested that PEH is a low-threshold event; however, most recent studies seem to agree, that at least in the first few post exercise hours, PEH is exercise intensity dependent. Studies using intermittent aerobic, resistance, and concurrent exercise (combined aerobic and resistance) also showed promising results on PEH. Equivocal results regarding the duration and magnitude of PEH are possibly associated with the muscle mass activated, the weight-load, and/or the number of repetitions and sets used in the different studies. Although most studies suggest that moderate to high intensity exercise induces greater PEH in normotensive and hypertensive individuals, exercise prescription should be individualized and caution should be taken in patients with multiple risk factors and chronic diseases.

Arteriosclerosis is a chronic inflammatory vascular pathology that features a leading cause of coronary artery disease contributing to significant mortality and reduced quality of life. The recent identification of the possible role of infections in the initiation of a serious of inflammatory events represents an interesting development towards the better understanding of immune mediated vascular injury and premature atherosclerosis in patients with chronic HCV infection. A number of factors related to chronic HCV infection have been hypothesized to contribute to arteriosclerosis. The current review displays some of the aspects of interaction between the chronic viral infection, the immune system and cytokine networks and its relation to the increased risk of coronary artery disease.