Journal of Advances in Medicine and Medical Research

Introduction: Minimal change disease is a histopathological lesion of the kidneys most commonly associated with nephrotic syndrome. Three pathophysiological mechanisms have been proposed to explain this syndrome: Nephrosarca (severe edema of the kidney), presence of acute tubular necrosis and decreased of glomerular filtration rate.
Presentation of Case: We present a 69years old patient with minimal change disease presented with severe renal dysfunction, dyspnoea, oedema of the lower extremities and weight gain of 10kg the month prior to admission. Renal function did not improve despite excess fluid removal with hemodialysis. Renal biopsy did not show significant interstitial Oedema but showed signs of tubular damage and mild atherosclerosis. Renal function returned with remission of proteinuria following administration of corticosteroid therapy.
Conclusion: Our case does not support the nephrosarca hypothesis but the presence of acute tubular necrosis and decreased of glomerular filtration rate theories cannot be excluded.

The clinical features of idiopathic normal pressure hydrocephalus (iNPH) are characterized by cognitive impairments, gait disturbances, and/or urinary incontinence. These symptoms can also include seizures following a shunt placement but there is a lack of data regarding seizures as a presenting symptom in patients with iNPH. Thus, the present report describes a case of iNPH accompanied by seizures which resolved after the placement of a shunt.

Aims: To evaluate the efficacy and safety of intravitreal bevacizumab injections on macular edema secondary to retinal vein occlusion.
Study Design: Retrospective case series.
Place and Duration of Study: Department of Retina, Beyoglu Eye Training and Research Hospital, between July 2012 and July 2013.
Methodology: Forty two eyes (22 CRVO and 20 BRVO) were included in this study. Follow up time was a year for all patients. All patients were newly diagnosed and 3 intravitreal bevacizumab injections are used monthly and additional injection is used as needed. Scatter laser photocoagulation is used after macular edema disappears in all patients. Macular thickness was measured via spectral-domain OCT at baseline, at month 6 and at month 12.
Results: The mean age of the patients was 52.4±16.2 years (range 22 – 74 years). The central macular thickness improved from 684±196 μm at baseline to 220 ± 102 μm at month 6 (p<0.001) and to 214±112 μm (p<0.001) at month 12. Best-corrected visual acuity (BCVA) at baseline improved from 1.0±0.4 logMAR to 0.6±0.4 logMAR (p<0.001) at month 12.
Conclusion: Intravitreal bevacizumab injection is effective to treatment of macular edema secondary to retinal vein occlusion. 3 monthly injections and as needed regimen is effective in one year follow up time.

Background: Neonatal Jaundice is a common disorder worldwide. Early identification and proper management is needed to prevent the serious neurological complications associated with it.
Objective: The aim of this study is to assess the predictive ability of a pre-discharge serum bilirubin measurement to screen for subsequent significant hyperbilirubinemia in the term and near-term newborn.
Materials and Methods: This is a historic cohort study conducted at Makassed General Hospital during two periods of time: January 2011 till December 2011, versus January 2013 till December 2013. A bilirubin screening program, instituted in February 2012, called for a total serum bilirubin to be performed on every neonate before discharge regardless of whether clinical jaundice was observed. For non-jaundiced neonates, the nursery staff was encouraged to obtain the screening total serum bilirubin at the sametime they obtained the hospital-mandated newborn screen for inborn errors of metabolism. Bilirubin values were plotted on an hour-speciï¬c nomogram. This study compared mean total serum bilirubin and hospital readmission data for two different periods before and after implementing the program.
Results: The study involved 1200 neonates: 601 in period one and 599 in period two. After initiating the program, the mean peak of total serum bilirubin fell from 14.76 mg/dl to 11.03 mg/dl. Also the rate of hospital readmission with a primary diagnosis of jaundice fell from 10% in period one to 1.8% in period two.
Conclusion: A pre-discharge total serum bilirubin applied as a policy in hospitals would facilitate targeted intervention and follow-up for indirect hyperbilirubinemiaina safe, cost-effective manner.

Background: Few studies have examined cancer patients with acute kidney injury (AKI) who require continuous renal replacement therapy (CRRT). The aim of this study was to compare the characteristics and outcomes of patients with and without cancer requiring CRRT for AKI in general intensive care units (ICUs).
Methods: We studied a retrospective cohort study in an ICU. A total of 200 patients (without cancer 79%; with cancer 21%) were included over a 24 month period. Predictors of all-cause death were examined using Kaplan-Meier and Cox proportional hazards analyses in both treatment groups for statistical analysis.
Results: The 1st contributing factors of AKI was cardiac dysfunction (40%) and 2nd factors was sepsis (38%). The cause of AKI was multifactorial in 78% of cancer patients and in 71% of patients without cancer. Hospital mortality rates were higher in patients with cancer (69%) than in patients without cancer (49.4 %) (P = 0.023). In multivariate analyses, older age, medical admission, poor chronic health status, comorbidities, ICU days until RRT start, number of associated organ dysfunctions, and diagnosis of cancer were associated with hospital mortality. The diagnosis of cancer was independently associated with mortality [odds ratio = 1.68 (95% confidence interval, 1.10–2.59), P = 0.017].
Conclusions: The presence of cancer may be independently associated with mortality in our study.

Background: Delivery by caesarean section has been reported as the single most important risk factor for maternal wound infection. Wound infection is not only a leading cause of prolonged hospital stay but a major cause of widespread aversion to caesarean delivery in developing countries. Despite all these, the determinants of post-caesarean wound infection in Nnewi have remained largely uninvestigated.
Objective: This study was to determine the factors that predispose to post- caesarean wound infection at a tertiary institution in a developing country.
Design: This was a cross sectional study.
Place and Duration of Study: Labour ward, Theatre and Post natal ward of NAUTH Nnewi between April to November 2012.
Methodology: All women who had caesarean section, met the inclusion criteria and gave consent were included in the study. They were divided into two groups (Group A and Group B) each comprising 60 women. Group A comprised women who had emergency caesarean section, while those in group B had elective caesarean section. The outcome of their post-caesarean wound was assessed. Statistical analysis (Logistic regression) of identified risk factors in patients who developed wound infection was performed at a 95% confidence interval.
Results: The incidence of post caesarean wound infection was 12.5%. While the infection rate was twelve (20.0%) among women who had emergency caesarean section, it was 3 (5.0%) among those who had elective caesarean section. The identified independent risk factors for wound infections were the duration of membrane rupture more than 24 hours (OR=0.11: 95% CI 0.03-0.47: P =0.003), labour duration more than 12 hours (OR =0.07: 95% CI 0.01-0.32: P =0.001) and the use of subumbilical, midline incision (OR=0.21: 95% CI 0.05-0.91).
Conclusion: The post caesarean wound infection rate in NAUTH was high. Efforts should be geared towards the prevention of prolonged labour by health education, early intervention and use of partograph. Timely intervention for prolonged rupture of membranes would drastically reduce the incidence of wound infection in our area.

Aim: Sources for health information are continually growing and become easily accessible to the public. The aim of the study was to investigate the sources of health information and the satisfaction level with the sources among patients attending otolaryngology (ENT) outpatient clinics in Israel.
Study Design: A structured questionnaire was given to patients attending ENT clinics at a tertiary medical center.
Place and Duration of Study: Department of Otolaryngology, Soroka university medical center during the years 2011-2012.
Methodology: We included adult patients attending the otolaryngology clinic at our medical center that agree to fulfill the questionnaire.
Results: 186 questionnaires were completed. 74% of the patients thought that prior information would have helped them in their visit, 54% actually obtained information. Internet access was not age or education-dependent. 71 patients consulted their family physician, 94% were satisfied. The percentage of satisfaction from friends, medical leaflets, Internet, books and newspapers were 91%, 83%, 80%, 78% and 66%, respectively. 71% wanted to know more about their disease, 17% to reduce anxiety, 7% to accept their disease and 5% to treat themselves. Among patients who did not obtain information; 50% expected to get enough information at the visit, 17% did not think it was important, 27% did not have time and 6% did not have information access.
Conclusions: Obtaining information prior to medical consultation is important to patients. The main and best source is family physicians. The patient - doctor encounter is expected by patients to provide information on their diseases.

Background and Purpose: Immobility during hospitalization can lead to deleterious consequences and substantial decline in functional capacity, and even a rise in mortality rate has been reported. Determining and understanding varying levels of mobility, barriers to mobility, and associated factors during hospitalization will help in the development of successful health care interventions.
Study Design: An institution-based cross sectional study design was used to determine various levels of mobility (LOM) and to identify their associated factors and barriers in a single academic center in Ethiopia.
Methods: A 400 bed university teaching hospital and referral center for different health centers in and around Gondar was the study set-up. Four hundred twenty three adult patients of various wards admitted for different conditions were recruited by stratified sampling and assessed for in-hospital LOM using a previously validated scale.
Results: Four hundred twenty three subjects were included in this study (n=423, mean age 37±14, 45.2% male). One hundred fifty three (36.17%) of the patients were identified as having low LOM with median Modified Clinical Mobility Score (MCMS) of 12 (inter quartile range [IQR]: 6-15). Low in-hospital LOM was associated with multiple variables. Risk of low LOM was three-fold higher in male patients (p 0.001).Old age groups were associated with 4.7 times lower LOM, and symptoms like weakness, dyspnea or dizziness increase the risk of having low LOM compared to not having these symptoms (AOR=2.7, 95% CI = 1.39- 5.43). Other perceived barriers to mobility during hospitalization were pain (60.3%), followed by environmental factors (19.4%), and personal factors (14.7%). Symptoms, age, sex, length of stay at the hospital and presence of invasive medical lines, catheters, etc. are found to have significant association with low LOM at 95% CI.
Conclusion: More than one third of hospitalized patients were identified as having low LOM. Old age, presence of pain symptom, duration of stay at the hospital and invasive medical lines are significantly associated with a low level of mobility during hospitalization. We recommend early and effective management of contributing symptoms, and adjustment of the hospital environment for a better level of mobility. We posit early detection and classification of influential factors of mobility level is an important step towards developing successful intervention programs.

Background: One of the biggest challenges in blood donation particularly in Nigeria is the recruitment and retention of voluntary non-remunerated, low cost blood donors.
Aims: The aim of this study is to determine the effect of repeated blood donations on iron stores and the prevalence of iron deficiency anaemia among the male blood donors in the Enugu State, Nigeria.
Study Design: In this case-control study, two hundred and twenty three randomly selected male blood donors, were grouped into six categories according to the number of units of blood donated in one year, two years, three years and the last group were on their 4^th year.
Place and Duration of Study: Haematology and blood bank laboratory unit, Enugu State University of Science and Technology Teaching Hospital, Enugu, Enugu State, Nigeria: April 2012 to December 2012.
Methodology: Prior to blood donation, blood samples of 202 directed/regular male blood donors and twenty one apparently healthy men with no previous history of blood donation (aged 18-40years) were collected. Donors were grouped into 0, ≤ 3, 4-6, 7-9, 10-12 and > 13 categories based on the number of units of blood donated.
Results: Iron depletion was seen in 1.3% in group 2 (1-3 times) and also in 13.3% of group 4 (7-9 times), iron deficiency was present in 4.4% of group 3 (4-6 times) and in 20% of group 6 (13-15 times) and iron deficiency anaemia was discovered in 4.4% of group 3 (4-6 times). Blood donors with more than seven times instances of blood donation (P<0.05) showed a significant relationship between iron depletion and iron deficiency.
Conclusion: This study showed that iron deficiency anaemia in blood donors can occur as a result of increase in number of units of blood donated and also based on iron status of individual at time of donation. Based on findings of this study ferritin test should be done on all male blood donors in Enugu before donating any unit of blood to find out the appropriate time to start iron supplement.

Aims: This study examined the psychosocial characteristics of subjects who hoped to receive psychotherapy, but were not receiving psychiatric medication as part of a research study using quantitative methods to measure psychometric properties in Japan.
Methods: Subjects were examined using the Structured Clinical Interview for DSM-IV Axis I disorders, Global Assessment of Functioning, a questionnaire (including the resilience scale, social desirability scale, and the State Trait Anger Expression Inventory (STAXI)) and psychological assessments.
Results: Of the 67 people who initially volunteered, 22 came to the clinical centre at Tokyo International University. Of these, 16 completed a psychiatric diagnostic interview. They all had a fair IQ and were highly resilient and functioning well. Nine subjects had an Axis I disorder that could be classified as a life-long prevalence or 12-month prevalence. The subjects were diagnosed as follows: depressive episode group (N=7), manic episode group (N=1), anxiety disorder group (N=7), and eating disorder group (N =2). There were no significant differences between the subjects with (N=9) and without (N=6) a psychiatric diagnosis except for GAF. The results of a Mann-Whitney test between subjects with or without a desire to seek psychotherapy revealed that the former (N=7) had significantly lower GAF scores as well as lower Perceptual Organization scores than the latter (N=7).
Conclusion: Regardless of whether or not they had a psychiatric diagnosis and were motivated to receive psychotherapy, the subjects intended to participate in a study on the psychotherapeutic process. The results suggested that the subjects in this study were a mix of people who had mistaken opinions about their psychological problems and those who truly hoped to receive psychotherapy. Since little is known about reluctant subjects, further larger studies using diagnostic, quantitative, and qualitative methods will be needed.

Background: The study evaluates the prevalence and incidence of thyroid cancer in Libya, and describes demographic and clincopathological features.
Patients and Methods: The study was conducted on 64 patients with thyroid carcinoma, admitted to the Misurata hospitals, Libya during the years 2000-2012. The clincopathological features were collected from pathology reports and hospital files of the patients.
Results: The mean age of thyroid cancer patients in Libya was 46 years, which is much higher than in benign lesions (36.5 years). Libyan thyroid cancer prevalence and incidence wasevaluated as 12.4 and 2.9 per 100,000 females, respectively. The histological types of the thyroid cancer in Libyan populations showed that the papillary carcinoma was the predominant type followed by follicular carcinoma. On other hand, the medullary carcinoma was less common than anaplastic carcinoma.
Among Libyan patient the systemic involvement, LN involvement, non-papillary histological type of tumor, and tumor size larger than 4cms were strongly associated with poor survival. Although, the men patients had shorter life span than women did, this survival difference was not statistically significant.
The histological types andhistopathological risk features show similar importance in respect to survival as the data from European thyroid cancer.
Conclusion: In Libya, the thyroid cancer incidence is low andmore common in female than in male.Libyan thyroid cancer is dominantly seen in young adult and displays unfavorable features such as high histological grade and stage, large size, frequent lymph node involvement and systemic metastases.

Background: Amblyopia is a common cause of visual impairment in children with uncorrected refractive errors, so screening and treatment should be carried out as early as possible to prevent permanent visual loss.
Objective: To determine the prevalence of amblyopia among individuals less than 18years with refractive errors presenting to the Ophthalmology clinic of the University of Port Harcourt Teaching Hospital (UPTH).
Methods: Children with refractive errors presenting at UPTH over a period of 2 years were studied. Their bio-data and relevant medical and ocular history were obtained. Their visual acuity was measured and standard ophthalmic examination was done for the anterior segment with a pen torch and slit lamp bio-microscope. The posterior segment was examined with Welch Allen direct ophthalmoscope. All the children in the study were refracted using the appropriate techniques.
Result: A total of 306 children with refractive errors were studied, out of which 110 (36%) were males and 196 (64%) were females. Of these children, 204 (66.7%) had astigmatism, 68 (22.2%) had Myopia, 23(7.5%) had hypermetropia and 11(3.6%) had inconclusive refraction. Two hundred and seventy eight (90.8%) of these children with refractive errors had optimal correction by refraction while 17(5.6%) had developed amblyopia. All the children who had amblyopia were between 13 and 18years; five (29.5%) were males while twelve (70.5%) were females which is statistically significant (p=0.00001).
Conclusion: The prevalence of amblyopia among children with refractive error is high and therefore early screening and intervention is important to prevent permanent visual loss.

Background: Diabetes mellitus (DM) is an important health problem which necessitates long term follow up and control.
Aim: This study is designed to determine the level of glycemic control among diabetic patients in Al-Madina and to explore which type of DM shows better glycemic control. In addition, we aim to define barriers of good compliance in diabetic patients who have a HbA1c test of 7% or more.
Subjects and Methods: A cross sectional analytic study was conducted and included diabetic patients participated in the campaign (Your Health is Your Life II) held in Al-Madina. Data collected by administering a questionnaire and measuring glycosylated hemoglobin (HbA1c), blood pressure, weight and height for all participants.
Results: Among 164 participants, only 24.4% achieved the recommended goal of HbA1c level (<7%). Higher percentage of achieving this goal is observed among type 2 diabetics (26.2%) than type 1(10.5%). Higher educational level, being on diet prescribed by a physician or a dietitian, duration of DM less than 5 years and visits of diabetic clinic within the past 3 months were associated with better HbA1c level while age above 50 and treatment with both (insulin+pills) or insulin alone were associated with lower level of control. Forgetfulness was the barrier in more than the half of patients with HbA1c of 7% or more while fear of insulin injection is the only factor which showed statistically significant difference between males and females.
Conclusion: High percentage of patients did not attain the recommended target of HbA1c level which is nearly comparable to results reported from many countries. This may indicate the presence of a gap between recommendations of the international guidelines and the actual practices. Regular clinic visits and higher educational level of the patients may contribute to better glycemic control.

GnRH agonists have been shown to intervene in the mechanism of adhesion formation in a variety of ways. Influence on the hormonal state, the inflammatory and coagulation processes contribute to the reduction of adhesion formation postoperatively. Most studies on this topic have been conducted in animal models and have indicated the possible clinical use of GnRH agonists for this purpose. The aim of this study is to investigate the literature review of the mechanisms and the possible advantages of GnRH agonists therapy in the prevention of postoperative adhesions.

This review briefly summarises the literature concerning our current understanding of the aetiology and immunopathogenesis of sarcoidosis, and the identification of novel markers of this disease. Although the immune paradox is a key part of sarcoid immunology, the mechanisms underlying this remarkable phenomenon are not well understood. Biomarkers may further the current understanding of the granulomatous inflammation seen in sarcoidosis. Exhaled breath condensate (EBC) is a novel, minimally invasive tool to sample the fluid lining the respiratory tract. EBC can be used to identify sarcoid specific biomarkers, which may shed light on the sarcoid immune paradox.