Journal of Advances in Medicine and Medical Research

Aims: Here we present early experience using HEED and SEED along with a description of these procedures in more detail. There is also a new look at the endometrial cavity and the placement of embryo transfer or implantation while under direct visualization.
Study Design: Retrospective non-randomized and uncontrolled case series.
Place and Duration of Study: West Coast IVF Clinic, Inc. and LA IVF Lab, LLC, Beverly Hills, CA, USA, between June, 2002 and June, 2011.
Methodology: Embryo transfer was done using a mini flexible hysteroscope with an articulating tip. This was accomplished by either placing the embryo gently on the surface of the endometrium (HEED) in 35 patients undergoing IVF, or embedding the embryo just beneath the endometrial surface (SEED) in 24 patient starts using egg donation. Once pregnancy was confirmed with a positive serum hCG, they were followed up with transvaginal ultrasounds and serial serum hCG’s in the first trimester. They were then referred to their local obstetricians and final outcomes were recorded after deliveries.
Results: There were a total of 35 patients in the early (days 2 or 3) embryo transfer group (HEED) which resulted in 16(46%) total pregnancies, which included 2 biochemical pregnancies, 2 ectopics, 5 spontaneous miscarriages, and 3 multiple pregnancies. There were 7 (20%) live births. In the second group of patients with day 5 or 6 embryo implantations (SEED), there were a total of 24 patient starts, with 16(67%), 4, 0, 5, and 4 total, biochemical, ectopic and multiple pregnancies respectively. There were 7(29%) live births.
Conclusion: Hysteroscopic embryo transfer or implantation may increase successful pregnancies and decrease risks and side effects from IVF procedures. Further prospective, controlled and randomized studies are needed to determine effectiveness of these procedures.

We present a case series of three patients who were admitted in the ENT department with the complaints of nasal congestion, nasal bleeding and vertigo. Evaluation of these patients revealed juvenile nasopharyngeal angiofibroma. Patients were advised to undergo excision surgery. We performed preoperative gelfoam embolization in each of these patients to reduce the complications of intraoperative bleeding. All surgeries went well and the blood supply to the area was found to be reinitiated within 5–6 days postoperatively. Here, we highlight the importance of preoperative gelfoam embolization for uneventful surgical excision of juvenile nasopharyngeal angiofibroma.

Aim: To investigate whether standard general osteopathic treatment can influence the static configuration of the vertebral column or pelvis.
Material and Methods: One hundred thirteen persons, 72 females and 41 males, either symptom-free volunteers or patients with mild idiopathic back pain, were investigated using the DIERS formetric® system, before and immediately after a single session of general osteopathic treatment. Variables of static assessment of the thoraco-lumbar vertebral column and of the pelvis were compared before and after treatment, using paired statistics.
Results: There was no difference between observations in the healthy controls and the symptomatic patients. The sagittal imbalance decreased significantly (two sided student’s t-test: P=0.034), apical deviation diminished (one sided student’s t-test: P= 0.047) after treatment and lordotic apex position increased (one sided student’s t-test: P=0.028). Since such changes have not been observed in a previous trial of repeat measurements without treatment, the observations in the present study suggest an effect of treatment. This effect was, however, limited to persons with sagittal imbalance not exceeding the 62^nd percentile.
Conclusion: General osteopathic treatment is associated with reduced sagittal imbalance and apical deviation and increased lordotic apex position, but this effect is demonstrable only in persons whose sagittal imbalance ranks in the lower or median tertile.

Aims: To determine the prevalence and evaluate the specific characteristics of depressive symptoms in medical, law and pre-university students, as well as to perform an exploratory analysis to survey the relationships of depression with several risk factors.
Study Design: An analytical cross sectional study was conducted on medical, law and pre-university students of two private institutions in Melaka, Malaysia.
Place and Duration of Study: Melaka, Malaysia, between September and October 2014.
Methodology: A total of 376 students participated in this study (MBBS= 142, Law= 129, Pre-U=105). They completed self-administered questionnaires which included socio-demographic questions and the Beck Depression Inventory (BDI) survey. Each item in the BDI can be further divided into 3 clusters: Affective, cognitive and somatic. Statistical analysis was performed using post-hoc test for multiple comparisons and multiple logistic regression.
Results: There were 162 (43.1%) students with depressive symptoms (BDI>9). Law students were found to be more depressed with the highest mean BDI score (11.7±8.7) compared to MBBS (8.4±8.1) and pre-university students (8.9±6.8). Affective, cognitive and somatic clusters were significantly higher among law students. For exploratory analysis of risk factors, law students and those staying in hostel were significantly more likely to develop depressive symptoms.
Conclusion: There is high prevalence of depressive symptoms among law, medical and pre-university students. If detected early, students with depressive symptoms may be successfully managed with behavioral therapy, emotional support and interpersonal psychotherapy.

Aims: Garcinia kola is used in West African countries for the treatment of various ailments such as cough, tooth decay, asthma and menstrual cramps. The inhibitory effect of Garcinia kola seed extract (GKE) on drug-induced contractions was studied on iliac smooth muscle preparations of guinea pig to ascertain the validity of the use of Garcinia kola in traditional medicine and to elucidate its possible mechanism of action.
Place and Duration of Study: The study was done in Post Graduate Laboratory, Department of Pharmacology, College of Medical Sciences, University of Calabar, Calabar-Nigeria, between November 2013 and April 2014.
Methodology: The antispasmodic influence of GKE (0.02 – 1 mg/ml) on acetylcholine, histamine and potassium chloride -induced contractions were carried out. The effect of GKE in a Ca²⁺-free Tyrode medium and in the presence of adrenergic antagonists was also investigated.
Results: The results revealed that GKE inhibited or attenuated the spasmogenic effects of histamine and potassium chloride in a dose-dependent manner and shifted their log. dose-response curves to the right, with pA2 values of 2.09±0.06 and 3.25±0.07 respectively. Pre-administration of propranolol, prazosin or labetalol had no attenuating influence on the antispasmodic effect of GKE. Iliac smooth muscle responses to cumulative increased [Ca²⁺] in a depolarizing bathing medium and in a Ca²⁺- free Tyrode solution were also blocked. Comparative antispasmodic potencies indicated that papaverine and aminophylline were more potent than the extract.
Conclusion: These findings suggest that Garcinia kola seed extract acts neither via cholinergic nor adrenergic receptor mediation, but may involve interference with Ca²⁺ mobilization, thus sharing with papaverine and/or aminophylline similar mechanism(s) of action.

Rheumatic fever (RF) and Rheumatic heart disease (RHD), despite a documented decrease in their incidence, remain as problems in both industrialized and industrializing countries even at the beginning of the 21^st century. The most devastating effects are on children and young adults in their most productive years.
To determine the clinical profiles of RF/RHD patients at Pediatric Department of Tarlac Provincial Hospital, Tarlac city, Philippines and the factors related to their compliance with Benzathine Penicillin G Prophylaxis treatment, the ex post-facto research was done using the charts of patients. Out patients and ward patients diagnosed with RF/RHD patients were identified using the Jones Criteria. They served as the subjects of the study.
The onset of the RF/RHD was seen in age ranging from 6 years to 17 years old with most of them occurring at 7-15 age range. The male to female ratio was 1.3:1. The RF/RHD patients came from different towns of Tarlac, the most number of which came from the city of Tarlac. The patients, being clientele of a provincial and non- paying hospital, came from poor family with low educational attainment, and low monthly income from skilled or unskilled work. Carditis (55% of the 58 cases) and polyarthritis (43%) were the most frequent manifestations seen among patients. In the minor manifestations of RF, majority had episodes of acute tonsillopharyngitis (82%) and fever (82%). Laboratory results, showed abnormal ESR (55 or 95% of the 58 cases), ASO titers (47 or 81%), PR intervals (18 or 31%), and leukocytosis (30 or 67%). Of the 26 cases who had valvular involvement cases, 7 mitral regurgitation; 2 (7%) had mitral stenosis; and 1 had aortic regurgitation. The rest had combination or triple combinations of valvular involvement. Compliance with Benzathine Penicillin G treatment was 46.6%. Compliance to treatment is related to the occupation of father (x²= 6.643, significant at .0361 level) and family income (x²= 8.088, significant at .0175 levels.
Poor families who have low paying jobs are less likely to complete the treatment of their sick children. The Department of Health must find ways to provide the secondary chemoprophylaxis to RF/RHD patients for free to improve the compliance rate, thus, provide bigger chance for the RF/RHD patients to survive their disease.

Aim: To determine the prevalence of disseminated cryptococcosis among symptomatic HIV-infected patients, attending the Antiretroviral Treatment Clinic at the University of Benin Teaching Hospital, Benin City, Nigeria.
Study Design: Cross-sectional study.
Place and Duration of Study: Department of Internal Medicine and Department of Medical Microbiology, University of Benin Teaching Hospital, Edo State, Nigeria, between September 2010 and August 2011.
Methodology: Five hundred consecutive symptomatic HIV-infected patients, on ART were enrolled into this cross-sectional study (266 males, 234 females, age range 18-81 years, mean age, 40.08 years). A blood sample collected from each participant was screened for serum cryptococcal antigen (CRAG) using the cryptococcal Latex agglutination test. The viral load and CD4+ T -cell count were also determined in parallel. A structured questionnaire was used to gather Information on socio demographic characteristics, medical and treatment history of participants. Data collected and the results of laboratory tests were analyzed using the SPSS software, version 22.0.
Results: The prevalence of serum cryptococcal antigen was 9.8%. Majority (66.8%) of the participants had a CD4+ T-cell count of less than 100 cells/µl. The association between serum CRAG and CD4+ T-cell was found to be significant (P < .001). Viral load done for only 90 of the participants was high in 51.1%. The association between serum CRAG and viral load was found to be significant (P < .001).
Conclusion: The prevalence of serum CRAG was high among symptomatic HIV- infected patients on ART, in Benin city, Nigeria, despite ART implementation. There is need therefore for a routine cryptococcal antigen test for all symptomatic HIV-infected patients on ART, while further microbiological investigations for those with positive result are recommended for appropriate medical intervention.

Takotsubo cardiomyopathy is reported at an increasing frequency. Though it is considered a diagnosis of exclusion it remains a pathology requiring focused investigation and tailored management. Despite its prevalence most clinicians do not seem to have a good grasp on the diagnosis and the management of this condition. There have been a large number of published reports on the various aspects of this condition. Though a noxious emotional event seems to be the most commonly associated trigger, there are a large number of others that have been described. There are widely accepted diagnostic criteria based on clinical and investigational findings. Different investigational modalities have different yields in supporting or excluding the diagnosis. The clinical course and the prognosis too can have significant variety. As far as the management strategy is concerned there is no widely accepted pathways published as yet. Clinicians are guided by the clinical condition and the circumstances of the event to decide on the optimal management strategy. We have attempted in this detailed review to collate as much published material as possible to give the clinician reader a sound global insight into this important cardiac condition.

Spinal Muscular Atrophy (SMA) is a group of inherited disorders that involve mainly bulbar and spinal motor neurons; causing muscle weakness and atrophy of proximal and symmetrical predominantly in lower extremities, without affecting the facial muscles and the intellectual ability. It is also unclear if SMA is a developmental or a neurodegenerative disease and occurs predominantly in childhood. The continuous clinical spectrum of SMA has been divided into 3 types based on the age at onset and highest motor milestones achieved. SMA type I was described by Hoffman in 1894 and in 1900 was reported as a disease characterized by hypotonia during the first 3 months of life, as well, is considered as the leading cause of death in children under two years of age among genetic diseases worldwide. SMA type II patients can achieve sitting but not walking. While SMA type III patients achieve full milestones with a progressive loss of walking ability. Deterioration in muscle strength and motor function eventually occurs in SMA type II and III. SMA occurs due to depletion of SMN, a ubiquitously expressed protein, which in all cells regulates RNA biogenesis and splicing through its role in the assembly of small nuclear ribonucleoprotein (snRNP) complexes.

A review on the applications of low energy megavoltage (MV) X-ray beams (1-4 MV) in cancer radiotherapy is presented. Firstly, the physical characteristics of low energy megavoltage X-ray beams are reviewed in terms of penumbra, dose fall-off, exit dose, dose to bone, penetration power, skin dose and image quality. Secondly, the therapeutic applications of low energy megavoltage X-rays in cancer radiotherapy are further stratified and discussed based on X-ray energy levels. Thirdly, a systematic review of imaging applications of low energy megavoltage X-ray beams in image-guided radiation therapy (IGRT) and megavoltage fan beam computed tomography (MVFBCT) is provided. Finally, we summarize the latest development of low energy megavoltage X-ray beams in cancer radiotherapy and cancer imaging during the past twenty years. With their intrinsic physical characteristics, it is feasible to achieve personalized radiotherapy and personalized imaging protocols for individual patient. However, further technological developments and more clinical data would be needed to fully exploit the potentials of low energy megavoltage X-ray beams in the personalized radiotherapeutic management of cancers.