Open Access Case Study

Small Cell Lung Carcinoma with Overt Cutaneous Metastasis; Unusual Case

Zehra Yasar, Vildan Tekelıoglu, Guray Can, Yusuf Yuce, Gulzade Ozyalvaclı, Ummugul Uyeturk

Journal of Advances in Medicine and Medical Research, Page 625-629
DOI: 10.9734/BJMMR/2015/13754

Small cell lung carcinoma is a rapidly progressive neuroendocrine tumor having a poor prognosis. It is considered as a systemic disease, because it has diffuse involvement, distant organ metastasis, and regional lymphatic involvement at the time of initial diagnosis. While small cell lung carcinomahas a lot of metastasis to bone, liver, surrenal and other hemithorax in the onset of disease, cutaneous metastasis are rarely seen. Skin metastasis are encountered in lower than 0.5% of the patients with metastatic diseases. In this article, we aimed to present a case of small cell lung carcinoma with cutaneous metastasis which is rarely seen in the literature.

Open Access Original Research Article

Locomotor Behaviour and Anxiety in the Open Field and Light/Dark Box in CD1 Mice Treated with Aspirin, Cataflam and Ethanolic Extract of Cannabis sativa

C. O. Nku, G. O. Oghale, I. O. Ajiwhen

Journal of Advances in Medicine and Medical Research, Page 563-572
DOI: 10.9734/BJMMR/2015/15032

Aims: To study the effects of cataflam, aspirin and the ethanolic extract of Cannabis sativa on nociception in CD1 albino mice of both sexes.
Method: Twenty (20) albino mice were divided into four (4) groups of five (5) each. The control group (group 1) received normal saline orally. Meanwhile groups 2-4 received p.o. cataflam (1.5 mg/kg), aspirin (13.5mg/kg) and Cannabis sativa (10 mg/kg) respectively. All four (4) groups were given access to normal mice chow and water ad libitum. The Open field apparatus and the light/dark box were used to measure locomotor/exploratory behaviour and anxiety.
Result: There was a significant (p=0.05) reduction in the frequencies of rearing, walling and line crossing in the Open field test and a reduction in frequency of transition, rearing and line crossing in the light/dark box. There was no significant difference in the chamber durations in the light/dark box test.
Conclusion: Cataflam, Aspirin and the ethanolic extract of Cannabis sativa all have anxiogenic effect and reduced locomotor behaviour. The ethanolic extract of Cannabis sativa seems to have the greatest anxiogenic effect, followed closely by Cataflam and Aspirin.

Open Access Original Research Article

Anti-cell Proliferative, Anti-inflammatory and Anti-angiogenic Potential of Lupeol in 7,12-dimethylbenz(a) Anthracene Induced Hamster Buccal Pouch Carcinogenesis

Asokan Manimaran, Shanmugam Manoharan, Sekar Karthikeyan, Madavan R. Nirmal

Journal of Advances in Medicine and Medical Research, Page 587-596
DOI: 10.9734/BJMMR/2015/14951

Aim: Diverse pharmacological and biochemical effects of lupeol have been reported earlier. The present study utilized the immune expression pattern of proliferating cellular nuclear antigen (PCNA), cyclin D1, vascular endothelial growth factor (VEGF), cyclooxygenase-2 (COX-2) and nuclear factor kappa B (NFkB) to assess the anticancer potential of lupeol in 7,12-dimethylbenz(a) anthracene (DMBA) induced oral carcinogenesis.

Methods: Well differentiated squamous cell carcinoma was appeared in the buccal mucosa of hamsters painted with DMBA thrice a week for 14 weeks. The expression pattern of the molecular markers was analysed using immunohistochemistry (PCNA, VEGF), Real Time PCR (NFkB, cyclin D1) and ELISA (COX-2).

Results: We noticed oral tumors in all the hamsters treated with DMBA alone and thus the tumor incidence is 100%. The total number of tumors developed in DMBA alone painted hamsters was 23. Upregulation of cell proliferative (PCNA, cyclin D1), inflammatory (NFkB, COX-2) and angiogenic markers (VEGF) was noticed in oral tumor bearing hamsters. Lupeol administration orally to DMBA painted hamsters completely inhibited the tumor formation (0%) and downregulated the immunoexpression pattern of cell proliferative (PCNA, cyclin D1), inflammatory (NFkB, COX-2) and angiogenic markers (VEGF).

Conclusion: The present results suggest that lupeol exhibited antitumor potential through its anti-cell proliferative, anti-inflammatory and anti-angiogenic potential during DMBA induced oral carcinogenesis.

Open Access Original Research Article

Health Services' Profile Introduced to under Five Rural Egyptian Children: A Cross-Sectional Study

Ghada El-Khawaga, Farida Abdel-Wahab

Journal of Advances in Medicine and Medical Research, Page 597-605
DOI: 10.9734/BJMMR/2015/13806

Background: Children under 5 years of age represent 11.1% of total Egyptians with a mortality rate of 22/1000 live births in 2013. Family health centers are the first gates that provide them with health services. This study aimed to evaluate the health care services introduced to under 5 children in one of the rural family health centers in Egypt called Shawa family health center (SFHC) during 2012-2013.
Subjects and Methods: This is a cross sectional descriptive and analytic study, conducted in SFHC, and included two phases. Phase I: Records of births, antenatal care, immunization, well-baby and sick child visits to the clinic for the year 2012 were reviewed. Phase II: Data were collected using a structured pretested questionnaire.
Findings: Antenatal care coverage rate was 57.8% of the visits, while neonatal examination accounted for 98.6%. Thyroid screening rate was 94.5%, while immunization coverage rate was 98.9%. No vitamin A supplementation was provided. The commonest health problems among this age group of children were respiratory tract infection (67.9%) and gastrointestinal problems (15.2%); 11.3% gastroenteritis and 3.9% parasitic infestation. The mean age of participating mothers was 26±2.4 years, 89% of them were < 35 years of age, 97% were currently married, 75% were of secondary or lower educational level and 91% belonged to families that have income < 1200 Egyptian pound / month. Over 80% of the mothers were satisfied with the service they received. Younger mothers, of income <1200 Egyptian pound /month and having greater than a secondary education were significantly more satisfied.
Conclusion: SFHC fulfills most services recommended for children under 5 years of age. However there is shortage in some other services (e.g. low rates of antenatal and natal care, reluctance in application of integrated management of childhood illness (IMCI) program and non documentation of health education activities).

Open Access Original Research Article

The Recognition of Locomotive Syndrome in 2014: A Cross-Sectional Study in the Orthopeadic Outpatients in Tokyo

Midori Ishii, Yongji Kim, Yoshiyuki Suehara, Takayuki Kawasaki, Joe Matsuoka, Keisuke Akaike, Kenta Mukaihara, Daisuke Kubota, Taketo Okubo, Tsuyoshi Saito, Tatsuya Takagi, Kazuo Kaneko

Journal of Advances in Medicine and Medical Research, Page 606-616
DOI: 10.9734/BJMMR/2015/14207

Background: To prevent locomotor dysfunction, the Japanese Orthopaedic Association (JOA) proposed the concept of locomotive syndrome (LS) in 2007, and has carried out numerous campaigns to increase the awareness of LS. We previously surveyed the recognition of LS and reported that 24.6% of outpatients knew about it in 2013. Were surveyed the recognition of LS and the prevalence of LS in 2014 to elucidate the effects and trends of the recognition of LS and the promotion campaigns.
Methods: To investigate the recognition of LS and the prevalence of LS, we conducted a questionnaire survey including both the 25-question Geriatric Locomotive Function Scale (GLFS-25) and the “loco-check” in 1,027 (450 male and 577 female) orthopaedic outpatients. This survey was performed at Juntendo University Hospital (Tokyo, Japan), from March to June 2014.
Results: The concept about LS was known to 26.4% of the patients, which was increased 1.8% in comparison to our survey in 2013. And, the most common media source to obtain information about LS was TV. Newspapers and magazines were also common media sources. In terms of the prevalence of LS in orthopaedic outpatients, 60.5% (734 of 1,027 people who answered the questions) were classified into the LS high-risk group as determined using the GLFS-25. The prevalence of LS was 54.9% in males and 64.3% in females.
Conclusion: We investigated the recognition of LS and the prevalence of LS using an outpatient cohort from the Tokyo area. This study demonstrated that the recognition of LS in 2014 was 26.4%, which increased by 1.8% compared to our survey in 2013. Our outpatient-based survey is therefore considered to positively help obtain a better understanding of the effects and trends of promoting the concept of LS.

Open Access Original Research Article

Procalcitonin, Calcium, and Magnesium in Patients with Febrile Seizure during One-Hour Attack

Hussein Kadhem Al-Hakeim, Zainab Muhammed Al-Hillawi, Mahmood Aziz Al-Kindi

Journal of Advances in Medicine and Medical Research, Page 617-624
DOI: 10.9734/BJMMR/2015/13252

Aims: Procalcitonin (PCT) is a marker used as an indicator of severe bacterial infection, which causes febrile seizure (FS). In this study, the level of PCT in patients with FS during the first hour of attack was investigated. Furthermore, the correlation between PCT and serum Ca and Mg was determined.
Methodology: Sixty children (26 male and 34 female) with hyperthermia-induced seizures participated in the study. Blood sampling was performed when seizure attack elapsed (within the first hour of the attack). Patients were classified according to sex, Ca level, C-reactive protein (CRP, positive >6 mg/L), and PCT level (high PCT>0.5ng/mL). Thirty healthy children were selected as the control group.
Results: PCT level increased in patients compared with that of the control group. Patients with normal or hyperPCT showed no correlation between PCT level with the total and ionized Ca and Mg. The PCT level between the hypocalcaemic and normocalcaemic groups was not significantly different. The PCT level significantly increased (p<0.05) in the group with higher CRP compared with that of the normal CRP group. During the first hour of FS attack, PCT increased with the increase in CRP and no correlation was observed between PCT and the total and ionized serum Ca and Mg levels.
Conclusion: PCT increased and was correlated with CRP in patients with FS during the first hour of attack. The results indicated that PCT elevation is due to the infection and has no evident effect on Ca metabolism in the patients. It can be concluded that the increase in PCT may be due to the FS as a leading cause rather than the bacterial infection.

Open Access Review Article

Changing Epidemiology of West Africa Ebola Outbreaks 1994-2014

J. B. Kangbai, M. Koroma

Journal of Advances in Medicine and Medical Research, Page 538-546
DOI: 10.9734/BJMMR/2015/14257

The severity, epidemic duration and general epidemiology of viral epidemic depends on determinants such as viral strain, ecological, environmental and socioeconomic factors. The West Africa Ebola outbreaks in Guinea, Sierra Leone and Liberia in 2014 and in Ivory Coast, Liberia and Gabon in 1994 were reviewed and compared because of their similarity in terms of their geographic location, proximity to each other, pre-outbreak Preparedness status, mortality, epidemic duration, as well as access to international health aid by the affected countries. Data for this study were obtained from the health ministries of Sierra Leone, Guinea, Gabon and Liberia, the United States Center for Disease Control and Prevention (CDC), the World Health Organisation (WHO) published data on Ebola virus disease outbreaks in Guinea, Liberia, Gabon, and Sierra Leone. Sierra Leone recorded its first confirmed Ebola outbreak in 27th May 2014. Both Guinea and Liberia recorded confirmed Ebola outbreaks in March 2014. The 2014 Ebola outbreak in West Africa has a long epidemic duration compared to the 1994 and 1996 outbreaks in Ivory Coast and Gabon respectively partly because of the misdiagnosis of earlier cases and the poor containment measures of the 2014 Ebola outbreak.

Open Access Review Article

Drug Permeation across the Blood-Brain Barrier: Applications of Nanotechnology

Marc Fakhoury, Ryusuke Takechi, Hani Al-Salami

Journal of Advances in Medicine and Medical Research, Page 547-556
DOI: 10.9734/BJMMR/2015/15493

The blood-brain barrier (BBB) is a neurobiological frontier that isolates brain tissues from the blood vascular system. Its main role is to protect the brain and the central nervous system from external fluctuations in hormones, nutrients and drugs, while allowing the passage of water and small lipophilic molecules. Diffusion across the BBB can occur through several biological mechanisms, but the most common one is simple diffusion, which mainly depends on the size, lipid solubility and concentration gradient of the molecule. Because of the highly dense network of capillary endothelium cells found in the BBB, most of the drugs are not able to cross this physiological barrier. Delivering therapeutic agents to the brain is thus a big challenge, which may prevent treatment of important neurological diseases. In order to overcome this difficulty, researchers have used nanotechnology to help the passage of drugs across the BBB. Nanotechnology has significantly contributed to the field of biotechnology by improving the strategies for drug delivery, and by providing novel carriers for safe and effective brain targeting. The aim of this review is to discuss in more details the anatomical structure and the functions of the BBB, as well as its significance in neurological diseases. A closer look will be given at the transport mechanisms across the BBB. This review finally explores the most recent advances in the field of nanotechnology for drug delivery in the brain, and gives meaningful examples of delivery systems developed including the micelles, liposomes, dendrimers, microcapsules and polymeric nanoparticles.

Open Access Review Article

The Molecular Mechanisms of Magnesium Neuroprotection in Patients with Eclampsia: A Short Review

Amir Mor, Itai Gat, Reshef Tal, Mohamad Irani, Jigal Haas, Rotem Inbar, Hava Golan

Journal of Advances in Medicine and Medical Research, Page 557-562
DOI: 10.9734/BJMMR/2015/14598

Eclampsia has been studied extensively over the last decades. Several pathophysiological mechanisms and animal models have been proposed for the disease. However, to date, none of them can fully explain the neuronal pathophysiology of eclamptic convulsions and the associated deleterious complications. Magnesium is the drug of choice for the prophylaxis and treatment of eclampsia in addition to prompt delivery. There is evidence to suggest that the beneficial effect of magnesium is exerted via modulation of the N-Methyl-D-Aspartate Receptor (NMDAR). The aim of this review is to explore the molecular mechanism by which magnesium exerts its neuroprotective effect and prevents eclamptic convulsions through the NMDAR activation pathway. Future investigations and alternative treatments are discussed.

Open Access Review Article

Ramadan Fasting and Maternal Perspectives in Healthy Pregnant Women: Systematic Review

Intessar E. Sultan, Inass M. Taha, Mohamed M. Hassanein

Journal of Advances in Medicine and Medical Research, Page 573-586
DOI: 10.9734/BJMMR/2015/15022

Background: Practicing fasting during Ramadan by pregnant women might be risky. Controversies still exist about the nature and the magnitude of metabolic changes in healthy pregnant women who practice fasting.
Objectives: To systematically review literature pertaining to the practice of Ramadan fasting and the effect of fasting on maternal health.
Methods: Relevant literature was obtained through searches of PubMed, and Cochran's. Incidence and duration of fasting, reasons for non-fasting, dietary changes, physical activity, weight changes, symptoms with fasting, and metabolic parameters for healthy pregnant women who fasted during Ramadan were extracted. Synthesis of data was performed when appropriate.
Results: Out of 56 English-language studies, 21 addressed maternal perspectives, 85.57% women experienced fasting during pregnancy, 76.26% fasted the whole month or ≥20 days, 80.9% perceived fasting as obligatory, 63.1% perceived no harm in fasting during pregnancy, and 17.6% broke their fast because of harm. The reasons for non- fasting included pregnancy (25%), coexisting medical problems (20.6%), symptoms (16.2%), daily commitments (16.2%), personal, family reasons (13.2%), and belief that fasting is not compulsory (8.8%). Common symptoms were hunger or thirst (16.82%), nausea or vomiting (7.47%), giddiness (6.66%), fatigue (17.01%), and fever or headache (2.72%). Accelerated starvation was reported in many studies; whereas hyperglycemia was reported in only 2 studies. Negative impact of fasting on lipids and hormones was reported in a few studies.
Conclusion: There are large gaps in knowledge, and more large interventional clinical trials are needed. In the light of available research, the majority of pregnant women showed a strong sense of religious obligation and chose to fast, even though some of them did not fully recognize their right to be exempted. There is still no definite evidence that accelerated starvation due to Ramadan fasting during an uncomplicated pregnancy can adversely affect maternal health.