Open Access Case Study

Nigerian HIV Positive Mother Tested Negative after Fifty-Four Months on HAART

Prosper O. U. Adogu, Kenechukwu C. Okonkwo, Obiageli F. Emelumadu, Chioma A. Ofunnu, Amobi L. Ilika

Journal of Advances in Medicine and Medical Research, Page 1181-1187
DOI: 10.9734/BJMMR/2015/13116

Background: There is currently no cure for HIV/AIDS infection. Antiretroviral treatment can suppress and delay AIDS-related illness for many years but cannot clear the virus completely. This case review includes an attempt to find explanation for the conversion of an HIV positive grand-multiparous woman to a negative status.
Findings: The source of data was the patient’s case file and review of relevant literature. A 38 year old HIV positive grand-multiparous female trader was diagnosed on 12/08/2010. She was placed on HAART for four years but was found to have tested HIV negative when the routine retroviral test was performed on 08/04/2014. Her last delivery was on 12/04/12 and she was placed on PMTCT regimen for that pregnancy. The baby’s status was not documented. From 16/08/2010 to 06/03/2014, the patient’s weight ranged between 52kg to 66kg. She was not screened for tuberculosis and viral load was not done. Initial CD4 count on 30/08/2014 was 357 cells / micro-liter while the value was 887 cells / micro-liter on the 24/02/2014. Other test results were essentially normal.
Conclusions: Though a functional cure is a possibility here yet in resource limited settings, the lack of routine confirmatory testing, compounded by incorrect interpretation of weak positive test lines and use of tie breaker algorithms can leave a false-positive result undetected for a long time. Beyond HIV screening, mandatory confirmatory tests are imperative before reporting HIV positive results. Weak positive results should not be recognized as valid except in the screening of blood donors.

Open Access Case Study

Gonadotropin-Releasing Hormone (GnRH) Agonist Trigger in a GnRH Antagonist Protocol and Severe Ovarian Hyperstimulation Syndrome

Matheus Roque, Marcello Valle, Marcos Sampaio, Selmo Geber

Journal of Advances in Medicine and Medical Research, Page 1188-1192
DOI: 10.9734/BJMMR/2015/14034

Aims: Ovarian hyperstimulation syndrome (OHSS) is an iatrogenic and potentially life-threatening complication of ovarian stimulation. The best strategy to prevent it is to use a gonadotropin-releasing hormone (GnRH) agonist (GnRHa) to trigger final oocyte maturation in a GnRH antagonist protocol, followed by cryopreservation of all oocytes/embryos (freeze-all strategy). The objective of this study is to describe two cases of a rare occurrence of severe OHSS following GnRHa trigger in a GnRH antagonist protocol and freeze-all strategy.
Presentation of Case: Two patients (a 33-year-old patient, and a 31-year old patient) were submitted to in vitro fertilization (IVF). The ovarian stimulation started on day 2 of her menstrual cycle in a step-down GnRH antagonist protocol. The final oocyte maturation was induced with a bolus of 0.2 mg triptorelin in both cases. Due tothe risk of OHSS, all the embryos were cryopreserved and no embryo transfer was performed. In the case 1, two days after oocyte retrieval, the patient was seen at the emergency and was diagnosed with severe OHSS with bilateral pleural effusion. In the case 2, three days after oocyte retrieval, the patient was seen at the emergency unit and was diagnosed with severe OHSS. Both patients were managed in an intensive care unit.
Conclusions: Unless the substitution of human chorionic gonadotropin (hCG) by GnRHa triggering in antagonist cycles is done in combination with no embryo transfer (which is the best form of OHSS prevention), and unless it virtually completely eliminates the onset of OHSS, this complication may still occur in certain groups of patients.

Open Access Case Study

Stromal Tumor of the Jejunum Complicated by Hemorrhagic Shock-A Case Report

Y. Fahmi, A. El Bakouri, D. Khaiz, F. Z. Bensardi, K. Hattabi, S. Berrada, R. Lefriyekh, N. Benissa, A. Fadil, N. Zerouali

Journal of Advances in Medicine and Medical Research, Page 1193-1197
DOI: 10.9734/BJMMR/2015/11991

Stromal tumors of the small bowel, commonly known as GIST (Gastrointestinal Stromal Tumors) are mesenchymal tumors of uncertain prognosis. They develop in the wall of the digestive tract. They are usually asymptomatic, incidentally discovered during endoscopy or during surgery. Identifying gastrointestinal stromal tumor is facilitated by a relatively specific marker, c-kit. Diagnosis is confirmed by histological examination of the surgical specimen. They pose two problems first is to confirm the diagnosis and second problem is to assess their evolutionary potential and customize the therapeutic management.
We report the case of a patient aged 34 years with no history of prior illness. He was admitted a year ago in the emergency room in a state of hemorrhagic shock due to lower gastro intestinal (GI) bleeding for three days. The patient underwent conservative therapy with I.V fluids and blood transfusions. An endoscopic assessment consisting of upper and lower GI(UGIE and colonoscopy) was done but that did not reveal any abnormalities.
Surgical exploration revealed a tumor 1 meter distal to the ligament of Treitz. Rest of the exploration was unremarkable. The tumor along with small bowel was resected and end to end anastomosis was performed. The postoperative course was uneventful.
Histological study of the surgical specimen confirmed that this was a stromal tumor with low potential of malignancy. The staging did not reveal any secondary lesions. Stromal tumors are often asymptomatic, lower GI bleeding is an exceptional way of presentation. Complete resection of the tumor is the treatment of choice. The recent development of targeted therapies and molecular biology is a new hope in the treatment of these tumors. The aim of this case study is to review the diagnostic and therapeutic aspects of this disease, and explain that hemorrhagic shock can be due to jejunal stromal tumor.

Open Access Method Article

A Novel Solution to Securing Nasogastric Feeding Tubes in Pediatric Burn Patients

Alyssa Brzenski, Bruce Potenza, Jeanne Lee, Mark Greenberg

Journal of Advances in Medicine and Medical Research, Page 1177-1180
DOI: 10.9734/BJMMR/2015/13729

Aims: To present a novel method of securing nasogastric (NGT) feeding tubes in pediatric burn patients.
Presentation of Case: We have developed an arrangement of tube, twill tie and suture, to secure a feeding tube in position, in which a twill tie is secured around the patient’s head and interwoven into the burn dressing. The NGT is secured to the twill tie via a locking suture.
Discussion: Nasogastric feeding tubes are important in pediatric burn patients to facilitate the healing process by meeting their increased metabolic demand for protein and calories. These tubes are typically secured via tape to the face, but in patients with facial burns tape may not adequately anchor the feeding tube, allowing for unintended dislodgement of the NGT. Inadvertent removal of nasogastric tubes places patients at risk for complications including prolonged healing time and aspiration, as well as the need for replacement of the NGT.
Conclusion: We present a novel method of securing nasogastric feeding tubes in pediatric burn patients, which has decreased the inadvertent dislodgement of NGTs in the pediatric burn patients.

Open Access Study Protocol

Impact of Health Centre Nurses on the Reduction of Early Childhood Caries in Lima, Peru

Eraldo Pesaressi, Rita S. Villena, Wil J. M. van der Sanden, Jo E. Frencken

Journal of Advances in Medicine and Medical Research, Page 1169-1176
DOI: 10.9734/BJMMR/2015/13331

Background: The prevalence of early childhood caries (ECC) among 36-47 months-old children in Lima, Peru, is 65.5%. Dentists have no easy access to see infants but nurses do. If nurses will be trained on oral health behaviours and early recognition of signs of ECC in infants, they could assist parents in keeping infant teeth healthy, during their regular well-child visits, using an oral health advisory and control cards and by referring infants to the health centre dentist earlier.
Aims: The primary aim of the study is to reduce the prevalence of ECC. Nurses will be trained in educating mothers on oral health behaviour and in detecting signs of ECC in infants. They will assist parents in keeping infant teeth healthy with assistance of an oral health advisory card during regular well-child controls and referring infants with ECC risk to the health centre dentist.
Study Design: The study is a three-arm randomized clinical trial. (A) Active intervention group: nurses will receive training in oral health education and in detecting carious lesions, supported by validated oral health advisory and control cards. (B) Passive intervention group: nurses will receive the oral health advisory and control cards together with written instructions, while nurses in the (C) control group will be lectured once on good oral health behaviours. In the three groups, knowledge of nurses will be evaluated, using a validated questionnaire, pre- and post-training. The pattern of referrals and treatments will be obtained from records available in the office of the health centre dentist. The ECC status among three year olds will be assessed at baseline and after three years, as will the quality of life of the infants.
Place and Duration of the Study: The study will be carried out in three districts in Lima, Peru between September 2014 and September 2017.

Open Access Opinion Article

Pediatric Research Ethics: Islamic Perspectives

Ghiath Alahmad, Kris Dierickx

Journal of Advances in Medicine and Medical Research, Page 1158-1168
DOI: 10.9734/BJMMR/2015/13693

Background: Children’s participation is crucial in research on childhood diseases and cases associated with childhood health. Despite the existence of many publications that address ethical issues related to the participation of children in clinical research around the world, very little has been written about these ethical issues from an Islamic perspective.
Methods: In this study, we analyzed medical research on children from three Islamic resources: plural fatwas by juristic institutions, the opinions of Islamic medical organizations and individual writings.
Results: Seven plural fatwas from three juristic councils could be found. Only four of them raise ethical concerns about research on children. Two documents from medical organizations were identified.
Conclusion: Three different positions could be concluded from these fatwas: a total prohibition, prohibition unless and permission. Prevention any harm is a major concern in all fatwas. Guardian's consent is necessary, but more details are needed. The guidelines of Islamic Organization of Medical Sciences IOMS reflect the best available Islamic perspective about research on children.q

Open Access Commentary

Suicide Research: Problems with Interpreting Results

Said Shahtahmasebi

Journal of Advances in Medicine and Medical Research, Page 1147-1157
DOI: 10.9734/BJMMR/2015/12802

There is a great deal of misinformation about suicide and the causes of suicide which has helped to establish mindsets and myths about suicide and how to prevent it. Within the suicide literature including policy documents both prevention and intervention have become confused and often used interchangeably. In this paper, the evidence for two of the most common mindsets, namely depression and suicide, and media reporting and suicide, are examined. The uncritical assessment of evidence and misinformation are responsible for the politicisation of suicide prevention policy development. Politicisation of suicide prevention, in turn, has made all the actors involved part of the problem, rather than the solution.

Open Access Original Research Article

Real-World Observations with Dronedarone Compared to Other Anti-Arrhythmic Drugs in Recurrent Atrial Fibrillation

D. Demarie, F. Orlando, M. Imazio, E. Cerrato, E. Richiardi, R. Belli

Journal of Advances in Medicine and Medical Research, Page 1088-1095
DOI: 10.9734/BJMMR/2015/12626

Background: Many clinical trials have shown that dronedarone which is a potent ion channels blocker is effective in the prevention of atrial fibrillation (AF) relapses.
Objective: The aim of this report is to evaluate the recurrence of AF and safety during therapy with dronedarone.
Methods: From September 2010 to February 2013, 95 patients with recurrent AF were followed by our department. The mean age was 71. Fifty-two were male (55%). All patients were in class NHYA I-II with paroxysmal or persistent AF. Hepatic enzymes were controlled after 1, 3, and 6 months of therapy.
Results: Structural heart diseases were present in 90.5% of patients; 9.5% of patients had lone AF. We observed recurrences of AF in 37.9% of patients treated with dronedarone compared with 39% of patients treated with propafenone or flecainide, 35% of patients treated with sotalol and 25% of patients treated with amiodarone. Using log-rank Mantel-Cox test there are no statistical significant differences between dronedarone and IC anti-arrhythmic drugs and sotalol (p 0.743; p 0.868).
Conclusion: According to guidelines, dronedarone resulted as effective as other anti-arrhythmic drugs (except amiodarone) in the prevention of AF with the advantage that it may be safely used in a greater number of patients (including elderly patients with structural heart diseases).

Open Access Original Research Article

BisGMA and TEGDMA Elution from Two Flowable Nanohybrid Resin Composites: An In vitro Study

Mithra N. Hegde, Ankita Wali

Journal of Advances in Medicine and Medical Research, Page 1096-1104
DOI: 10.9734/BJMMR/2015/12951

Aim: The aim of our study was to evaluate the amount of release of BisGMA and TEGDMA from two commercially available enamel replacement composites; Tetric N-Flow™ and G-aenial Universal Flo™ over a period of 24 hours after polymerization with a standard LED Curing Unit.
Methods and Materials: Two flowable nanohybrid composite materials; Tetric N-Flow™ (Ivoclar Vivadent AG, Liechtenstein) and G-aenial Universal Flo™ (GC, India) were investigated and grouped into two groups. Ten samples from each group were prepared by inserting the material into a standardized Teflon mould of size 2x2x2 mm. Each sample was cured with a LED curing unit for 20 seconds and was stored in 2 ml of Ethanol at room temperature. After 24 hours, the samples were removed from the storage medium (ethanol) and prepared for measurements. A reverse phase HPLC unit was used to detect the release of BisGMA and TEGDMA monomers from the prepared samples. The acquired measurements were obtained after testing them in a High Liquid Performance Chromatography Unit. The data obtained was statistically analyzed and the results revealed significant amount of release of TEGDMA as well as BisGMA.
Results: G-aenial Universal Flo™ showed significant release of both TEGDMA as well as BisGMA as compared to Tetric N- Flow™. The increase was by 0.5 units.
Conclusion: Significant amount of release of TEGDMA as well as BisGMA was seen in both the composite materials after HPLC Unit analysis. This can help in the evaluation of cytoxicity to the soft tissues in the oral environment.

Open Access Original Research Article

Dengue Infection in Rondônia-Brazil: Epidemiological and Environmental Aspects during 2001-2010 Occurrence

Ana Flávia Costa da Silveira Oliveira, André Silva de Oliveira, Edjon Gonçaves dos Santos, Celso Aparecido da Silva Filho, Eduardo Honda, Andréia Patricia Gomes, Rodrigo Siqueira-Batista, Cynthia Canedo da Silva, Sérgio Oliveira De Paula

Journal of Advances in Medicine and Medical Research, Page 1105-1113
DOI: 10.9734/BJMMR/2015/13220

Aims: The state of Rondônia is located in the western area of the Brazilian Amazon, and presents a strategic location for the spread of dengue virus. This study aims to characterize the epidemiology of dengue in Rondônia from 2001-2010.
Study Design: This is a descriptive work that aims to study time series of dengue epidemics from the resident population in the municipalities of the state of Rondonia (Brazil) in the period 2001-2010.
Place and Duration of Study: This study used secondary data. Data was obtained from the Notifiable Diseases Information System (SINAN) using only confirmed cases of dengue during the period from 2001-2010 in the Rondônia state (Brazil). Population statistics were obtained from the Brazilian Institute of Geography and Statistics (IBGE -
Methodology: The epidemiological profile of the disease was traced from the following variables: year of reporting; age; gender, education; final classification; and confirmation criterion. Rainfall and migratory pathways were compared with the disease incidence rate of the cities.
Results: 71,541 cases of dengue were reported in this period. Although Rondônia is not one of the states with the highest incidence rates of dengue in Brazil, it presents some cities with over 4,000 cases/100,000 inhabitants. We found that waterways, roads, ports, airports and borders tend to be associated with regions with the highest number of cases.
Conclusion: Cities where many people from various localities circulate require special epidemiological attention. This analysis points to the need to improve the monitoring/control of vectors, patients and possibly sick people.

Open Access Original Research Article

Radiologic Study of Ischiopubic Index of Urhobos and Itsekiris of Nigeria

G. Sunday Oladipo, K. C. Anugweje, Emoefe Oghenekevwe Rosemary, C. Uzomba Godwin

Journal of Advances in Medicine and Medical Research, Page 1114-1120
DOI: 10.9734/BJMMR/2015/11673

The study was designed to determine and compare the pubic length, ischial length and ischiopubic indices amongst Urhobos and Itsekiris. The parameters were measured from radiographs obtained from the Radiology department of Delta State University Teaching Hospital (DELSUTH), Oghara and Capitol Hill Clinic, Warri both in Delta State, Nigeria. Anteroposterior radiographs of 93 adult pelvis (age range, 18 years and above) were evaluated. 66 of the radiographs were those of Urhobos (36 males and 30 females), while 27 were those of Itsekiris (13 males and 14 females). The morphological measurements were the pubic length, ischial length and ischiopubic index. The mean values for pubic length, ischial length and ischiopubic index for Urhobo males were 78.51±12.4mm, 85.58±11.6mm and 91.66±5.86 respectively while those of their females was 92.39±7.08mm, 81.97±12.00mm and 114.93±18.14 respectively. The mean values for pubic length, ischial length and ischiopubic index for Itsekiri males were 82.20±10.62mm, 83.84±10.82mm and 98.40±9.37 respectively while those of their females was 92.05±6.36mm, 85.03±14.59mm and 111.03±18.37 respectively. There were significant data for male and female pubic length and ischiopubic indices both in Urhobos and Itsekiris. The demarking point of ischiopubic index was more useful in sex determination assigning sex to 78.6% Itsekiri females (p<0, 05). The accurate determination of sex and race are important tools to forensic scientists and physical and clinical anthropologists. Thus, this study is important as it has provided the necessary data for Nigerian population under investigation. The data is recommended to obstetricians, physical and clinical anthropologist and forensic scientists.

Open Access Original Research Article

Gender Differences in Obesity Indices in a 10-Year Risk for Cardiovascular Disease

Tsan Yang, Chien-An Sun, Yu-Ching Chou, Chia-Hsin Lai, Chun-Chieh Chao, Chao-Hsien Lee, Chi Chang, Ling-Mei Yang

Journal of Advances in Medicine and Medical Research, Page 1121-1130
DOI: 10.9734/BJMMR/2015/14015

Objective: To explore the relationship between gender-specific of obesity indices and the 10-year risk for cardiovascular disease (CVD) among elderly population in southern Taiwan.
Methods: Data were collected from Pingtung County in southern Taiwan through a health screening program, carried out from March 2007 to May 2008.The following obesity indices were included: (1) body mass index (BMI); (2) waist circumference (WC); (3) waist-to-hip ratio (WHR); (4) waist-height ratio (WHtR). The present study used the risk assessment tool of the Framingham Heart Study and adopted ≦10% as low risk, 11~20% as moderate risk, and >20% as high risk for CVD. Multiple logistic regression was used to predict the risk indices of obesity causing 10-year risk for CVD.
Results: A total of 831 participants were recruited in the screen program. The prevalence of the obesity indices was as follow: BMI 21.3%; WC 14.6%; WHR 47.1%; and WHtR 65.2%. A total of 118participants were found to have 10-year CVD risk groupings>20%, a prevalence rate of 14.2%. The 10-year risk for CVD is higher in men; subjects≧65 years old in both genders have a higher prevalence of moderate and high risk for CVD. After using multiple logistic regression, the results showed that men who are abnormal in WHR, WHtR, have higher moderate and high 10-year risk for CVD; In this study, men didn't find this risk in BMI and WC. Women on all four obesity indices are not the predictive factors of 10-year risk for CVD.
Conclusions: The predictive factors of 10-year risk for CVD were found in WHR and WHtR of men.

Open Access Original Research Article

Bacteremia in Febrile Children: Its Correlation with Birth Weight, Feeding Practices, Vaccination and Malnutrition

Shammi Kumar Jain, Neeraj Gour, Jayashre Nadkarni, Sneha Bhatia

Journal of Advances in Medicine and Medical Research, Page 1131-1139
DOI: 10.9734/BJMMR/2015/13001

Background: In children under 3 years old, fever is a common presenting symptom to the physician. Fever may be an indication of a mild infectious process such as a viral upper respiratory infection or a more serious infectious process such as bacteremia, bone and joint infections, urinary tract infection, pneumonia, soft tissue infection, bacterial enteritis, meningitis, sepsis and possibly death. The evaluation of fever in this age group has great clinical importance, as any of the serious bacterial infections whose presence it may signal may have grave morbidity if not treated. However, there exists scanty data on risk of bacteraemia among febrile children of developing countries and what clinical predictors, if any, could identify those febrile infants with bacteraemia. Present study aims to determine the prevalence of bacteremia in febrile children and the effect of low birth weight, poor feeding practices & coverage of vaccination and malnutrition which are more prevalent in developing countries like india.
Objective: 1. To assess prevalence of bacteremia among hospitalized febrile children aged 3 months to 36 month.
2. To study effect of birth weight, feeding practices, vaccination and malnutrition on bacteremia in febrile children.
3. To find out different bacterial isolates.
Methods: 84 consecutive febrile children attending children emergency ward of Kamla Nehru Hospital, Bhopal, aged 3 months to 36 months with rectal temperature 38 C( 100.4F) with negative H/o of antimicrobial use and who requiring hospitalization were included in the study. Exclusion criteria were current use of antimicrobial use. Children meeting eligibility criteria were studied to identify clinical predictors of bacteremia. Study subjects underwent full clinical evaluation and had blood culture done for aerobic organisms by standard method. Variable examined were age, sex, temperature, birth weight, vaccination, feeding practices, physical indices & blood culture results.
Results: 50%(42) subjects were bacteremic. Klebsiella (38%), Staph aureous (28.5%) and E. coli (23.80%) of positive cultures were commonly associated.9 variables were found to be significant independent predictor of bacteremia. These were duration of fever >3 days (p=.015), birth weight <2.5 kg, no vaccination (p=.000458), low weight for age (p=.022), stunting (p=.014), presence of edema (p=.04).
Conclusion: above mentioned factors are associated with increased risk of bacteremia in febrile children. Prevention of these factors can greatly reduce the chances of bacteremia in febrile children. Clinician practicing in such a setting needs to be aware of the increased risk of bacteremia in children with these clinical features.

Open Access Original Research Article

Investigating of Mothers' Behavior Based on the Health Belief Model about Using Iron Supplementation in 6 to 24- Month Old Children in Shahrekord City, Iran

Marziye Reisi, Masoome Alidosti, Elahe Tavassoli, Mehdi Kargar, Ziba Raeesi Dehkordi, Asghar Ashrafi Hafez

Journal of Advances in Medicine and Medical Research, Page 1140-1146
DOI: 10.9734/BJMMR/2015/12717

Background: Anemiais one of the most important problems in children's public health. Iron Deficiency Anemia is the most common type of anemia among this group. This study was conducted to determine mothers' behavior based on Health Belief Model about using iron complementation in 6 to 24 month old children in Shahrekord city.
Methods: This cross-sectional study was performed in 2013.Eighty three Mothers, with their children (6- 24 months) participated in the research and completed the questionnaire designed based on Health Belief Model. Validity and reliability of the questionnaire were confirmed in a pilot study (a=0.79). The data were analyzed by software SPSS16, Spearman and Pearson correlation tests.
Results: The mean age of mothers was 28.95±4.05 and most of them (44/6%) graduated from university. Awareness, sensitivity and perceived severity and also perceived benefits of most studied cases (59%) were evaluated acceptable. But the attitude of a considerable number of the cases (41%) towards removing the barriers (perceived barriers) was poor. A lot of studied cases (34/9%) had poor performance as well. There were significant relationships between awareness, education, number of children, and performance (p<0.001). There was also a significant inverse relationship between performance and perceived barriers. (p<0.001, r =- 0.49)
Conclusions: The results showed mothers' poor attitude about removing the barriers which were existed against giving iron to their children. Since perceived barriers have a significant role in performance, it can be concluded that this is the cause of mothers' behavior. So, it is necessary to develop educational programs in this field.

Open Access Review Article

Dermatoglyphic Patterns of Congenital Lame Adults in a Southern Nigerian Population

E. A. Osunwoke, E. J. Olotu, N. K. Micah

Journal of Advances in Medicine and Medical Research, Page 1083-1087
DOI: 10.9734/BJMMR/2015/9573

Aim: This study is aimed at determining the dermatoglyphic patterns of the congenital lame subjects in a southern Nigerian population.
Study Design: This is designed to identify the congenital lame subjects through their palmar and digital prints.
Place and Duration of Study: The subjects were recruited from special schools in Owerri and Borikiri in Southern part of Nigeria. The study was conducted between the month of April to July, 2010.
Materials and Method: A total number of 150 congenital lame subjects (comprising 100 males and 50 females) were recruited for this study. The parameters studied include the digital pattern, A-B ridge counts, ATD and DAT angles. Digital and palmar print patterns were obtained by using the ink method.
Results: Results of this study showed that ulnar loops were the most predominant in both sexes. This was followed by whorls and arches. There was a significant difference (P=.05) in the A-B ridge counts and ATD angles in both hands in males and females while the DAT angles showed no significant difference (P=.05) in the left hand but significant in the right hand.
Conclusion: The results of this study could be useful to anthropologists, clinicians and forensic scientists.