Open Access Case Study

Concomitant Onset of Thymoma and Primary Infection with Toxoplasma gondii: A Case Report

Capodanno Isabella, Valli Riccardo, Zanelli Magda, Ragazzi Moria, Merli Francesco

Journal of Advances in Medicine and Medical Research, Page 425-431
DOI: 10.9734/BJMMR/2015/8667

Aims: This case reports is about a patient with diagnosis of thymoma with intercurrent infection with Toxoplasma gondii. The state of immunosuppression caused by thymoma had probably facilitaded the development of an infection with Toxoplasma gondii, that determined lymph nodes involvement and symptoms, appearing like lymphoproliferative disease.
Presentation of the Case: A 57-year-old woman presented with intense night sweats, fatigue, dyspnea on moderate effort, multiple superficial enlarged lymph nodes, and fever with shivering. Blood tests showed marked leukocytosis with lymphocytosis and eosinophilia, normal hemoglobin and platelet counts, increased ESR (40 mm) and LDH (606 U/L). The search for anti-Toxoplasma IgM antibodies was positive and the serum protein electrophoresis showed increased acute phase proteins.
Suspicion of lymphoproliferative disease became stronger after the execution of CT and PET. In agreement with the thoracic surgeon, we decided to perform biopsy of the mediastinal mass in order to confirm diagnosis. The histological examination showed the presence of a thymoma.
Discussion: When the patient first came to our department, given the physical examination and the reported symptoms, the case seemed easy to solve. Suspicion of lymphoproliferative disease became stronger after the execution of CT and PET. Nevertheless, the diagnostic process was complicated and required two surgical procedures over a short period time, before the thymectomy itself.
Conclusion: This patient was affected by two rare medical conditions involving the lymph node system. The collaboration between the various specialists allowed us to exclude the hypothesis of lymphoproliferative disorder and to reach the correct diagnostic conclusions. The correct diagnosis has allowed appropriate treatment for resolution of thymoma.

Open Access Case Study

Bronchial Cytokine Changes Following Bronchial Resection and Reconstruction for Carcinoid Tumor

Nilgün KanlıoÄŸlu Kuman, Salih Çokpınar, Aslıhan Karul, Fisun KaradaÄŸ

Journal of Advances in Medicine and Medical Research, Page 432-437
DOI: 10.9734/BJMMR/2015/16006

As bronchial carcinoids are known to be notably rare, adequate histochemical investigations couldn’t have been carried out on these types of tumors hitherto. In this study, we investigated bronchial cytokines in a carcinoid tumor localized in the left main bronchus. Bronchial resection and reconstruction was performed without the lung resection. Bronchial lavage samples were obtained from both sides of main bronchial system preoperatively and postoperatively. TNF-α, IL-8 and IL6 levels were measured by ELÄ°SA. Preoperative TNF-α and IL-8 levels were found to be 2-folds and 5-folds higher on the tumor side respectively (TNF-α; 14.184 pg/ml and IL-8; 3359.86 pg/ml) compared to tumor-free bronchial system (TNF-α; 6.886 pg/ml, IL-8; 615.072 pg/ml). Interestingly, both cytokine levels were found to be equal and within normal ranges on both sides subsequent to bronchial resection and reconstruction. There were no significant difference in IL-6 levels between two bronchial systems preoperatively (IL-6 levels of right bronchus, 16.44 pg/ml; levels of left bronchus, 19.11 pg/ml). However, there was more than four-fold increase in postoperative levels (IL-6 level; 89.41 pg/ml).
In our study, we found that preoperative TNF-α and IL-8 levels were higher compared to the postoperative ones; whereas IL-6 levels showed a significant increase, postoperatively. These findings led us through the idea that carcinoid tumors might be activating the inflammatory process among TNF-α and IL-8 and the surgical bronchoplastic procedure could be the cause of enhanced IL-6 response.

Open Access Short Research Article

Combined Laparoscopic Cholecystectomy (LC) and Laparoscopic Assisted Vaginal Hysterectomy (LAVH) is Feasible and Safe in Selected Cases

S. Dalmia, R. Dalmia

Journal of Advances in Medicine and Medical Research, Page 405-409
DOI: 10.9734/BJMMR/2015/16616

Aims: Laparoscopy has been practised for many years by both surgeons and gynaecologists and has made significant advances in last three decades. Laparoscopic Cholecystectomy (LC) has been the mainstay of treatment for gallstones for a long time. In recent years laparoscopy has been used more widely in gynaecology, where Laparoscopy Assisted Vaginal Hysterectomy (LAVH) has been performed with good results. The objective of this study was to evaluate the feasibility and outcome of performing both LC and LAVH in the same sitting.
Methods: Between May 2006 and May 2012, 42 women underwent LC and LAVH in the same sitting. Patients were jointly seen by surgeon and gynaecologist and selected following certain strict criteria. We retrospectively recorded postoperative complications, duration of operation and hospital stay. They were followed up in outpatient clinic at four and twelve weeks after discharge.
Results: Forty two women underwent both LC and LAVH in the same sitting. Mean duration of surgery was 160 minutes (range 140 - 245).Mean duration of hospitalisation was 64 hours (range 48 – 124 hrs). The pain experienced in the postoperative period measured on the visual analogue scale ranged from 2 to 7 with a mean of 3.8. Two (4.7%) patients had umbilical port site infection.
Conclusion: Both LC and LAVH can be performed together safely with minimum pain and morbidity. Appropriate selection of patients, preoperative planning and good communication between the surgical and gynaecological team is the key for success.

Open Access Original Research Article

Factors Influencing Maternal Acceptance of Human Papillomavirus Vaccination for Their School-Aged Daughters in Fukuoka Prefecture, Japan

Yukiko Hamada, Miyuki Nagamatsu, Takeshi Sato

Journal of Advances in Medicine and Medical Research, Page 341-354
DOI: 10.9734/BJMMR/2015/15917

Aims: The aim of this study was to elucidate the factors that influence maternal acceptance of human papillomavirus (HPV) vaccination for their school-aged daughters.
Study Design: The survey was cross-sectional and conducted using an anonymous self-administered questionnaire.
Place and Duration of Study: Two middle schools and 10 high schools in Fukuoka prefecture, between November 2012 and April 2013.
Methodology: The cross-sectional survey was conducted on mothers (n=1,407) with daughters aged 13-16 years, and an anonymous self-administered questionnaire was used. The items were HPV vaccination status of daughter, knowledge of the HPV vaccine and cervical cancer, attitude toward the HPV vaccine and general vaccinations, and communication with daughters about cervical cancer. The questionnaire was distributed and collected through the junior high school students and the high school students. Variables were extracted related to the daughters’ state of vaccination, and subsequently multivariate logistic regression analysis was performed.
Results: Eight factors of mothers were extracted related to daughters’ HPV vaccination in order of strong influential: attitude placing importance on cost-free vaccination (OR, 9.26; 95% CI,3.42-25.0), sense of parental obligation (OR, 4.65; 95% CI, 2.30-9.43), trust in the effectiveness of vaccine (OR, 3.91; 95% CI,2.41-6.34), trust in the government’s handling of vaccination (OR, 2.40; 95% CI,1.49-3.86), communication with daughters (OR, 2.04; 95%CI, 1.28-3.22), trust in the safety of vaccine (OR, 1.81; 95% CI,1.04-3.15), threat of cervical cancer (OR, 1.80; 95% CI,1.14-2.86), and knowledge of the HPV vaccine (OR,1.23; 95%CI, 1.06-1.43).
Conclusion: HPV vaccination of school-aged girls was promoted by passive factors of mothers: attitude toward free vaccination through a public subsidy and a sense of parental obligation. Further enhancement of education for HPV prevention is urgently needed.

Open Access Original Research Article

A Haemodynamic Analysis to Assess the Safe Dose of Carvedilol across Different Child Class of Liver Disease

Zeeshan Ahmad Wani, Riyaz Ahmad Bhat, Ajeet Singh Bhadoria, Showkat Ali Zargar, Altaf Hussain Shah, Rakhi Maiwall, Iqra Hameed, Syed Basit

Journal of Advances in Medicine and Medical Research, Page 355-368
DOI: 10.9734/BJMMR/2015/15398

Background: Literature regarding safe dose of carvedilol is limited and also safe dose across different child classes of chronic liver disease is not very clear.
Aim: We aimed primarily to study, the effect of reasonably safe dose (12.5 mg) of carvedilol in acute reduction of portal pressure and compared it with chronic reduction of portal pressure, after proper optimization of dose of carvedilol. Second aim of our study was to define predictors of response for acute and chronic reduction of portal pressure and to assess difference in dose tolerated and response across different child class on chronic basis.
Methods: One hundred two consecutive patients of cirrhosis of liver with significant portal hypertension were included and hepatic venous pressure gradient was measured at the base line and after 90 minutes of administration of 12.5 mg carvedilol. After proper dose optimization of carvedilol, hepatic venous pressure gradient was again measured after 3 months to assess the chronic response.
Results: The mean age of study population was 58.3±6.6 years. A total of 42.2%, 31.9% and 26.6% patients had child class A, child class B and Child class C cirrhosis, respectively.
Mean pre-drug hepatic venous pressure gradient was 16.75±2.12 mmHg which dropped to 13.07±2.32 mmHg after 90 minutes of administration of 12.5 mg of carvedilol. The mean drop of hepatic venous pressure gradient was 4.5±2.2 mmHg and 2.4±1.9 mmHg among responders and non-responders, respectively. Overall, 51% showed acute response while 49% were non-responders. Low cardiac output and high mean arterial pressure were significantly predicting the acute response, while, low baseline cardiac output was found as an independent predictor.
After dose optimization, number of responders increased from 52 to 62. Mean dose of carvedilol was higher in non–responders as compared to responders, though statistically insignificant (p>0.05). Mean reduction of hepatic venous pressure gradient from baseline and after 3 months was 5.5±1.7 mmHg and 2.8±1.6 mmHg among responders and non responders on chronic basis, respectively (p<0.001).
Absence of any adverse events (OR 11.3, 95% CI; 1.9-67.8), and more than 2.5 mmHg fall in hepatic venous pressure gradient during acute response (OR 8.7, 95% CI; 3.1-25.3) were found as independent predictors of chronic response (p<0.05). Univariate analysis found that no adverse events, no ascites, low baseline cardiac output, more than 2.5 mmHg fall in hepatic venous pressure gradient during acute response, as predictors of chronic response. However, etiology, child class, variceal size (large vs small) and gender were not significantly associated with chronic response
Conclusion: At safe dose and with proper optimization of dose, carvedilol may achieve greater response with minimum side effects among different child classes of liver disease.

Open Access Original Research Article

The Prevalence and the Characteristics of Supernumerary Teeth of Children and Young Adolescents from North-Western Region of Turkey

Levent Demiriz, Ahmet Ferhat Mısır, Mustafa Cenk Durmuşlar

Journal of Advances in Medicine and Medical Research, Page 369-377
DOI: 10.9734/BJMMR/2015/16422

Aim: The objective of the following research is to study the prevalence by evaluating a large group of children and young adolescent patients from the north-western region of Turkey and investigate the characteristics of supernumerary teeth.
Methodology: This descriptive and retrospective study was performed on 6535 non-syndromic children and adolescent patients (4077 females and 2458 males) ranging in age from 5 to 18 years old. The characteristics of supernumerary teeth were noted and diagnosed during the clinical and radiographic examination. For each patient we recorded the demographic variables including age and gender. During statistical analysis Chi-squared test was used to determine potential differences in the distribution of supernumerary teeth when stratified by gender. p value of less than .05 was considered statistically significant.
Results: 177 supernumerary teeth were detected in 141 patients (2.2%). 58 patients were females and 83 patients were males with a 1.4:1 male/female ratio (p<.001) among them. In 78.0% (n=110) of patients, one supernumerary tooth was observed. A total of 177 supernumerary teeth were observed, of which 84.2% (n=149) were located in the maxillary arch, while 15.8% (n=28) were determined in the mandible. 78 teeth (44.1%) of all supernumerary teeth were found in the maxilla midline (mesiodens). Regarding their status within the arch, 65 supernumerary teeth (36.7%) had erupted. 100(56.5%) supernumerary teeth did not cause any complications whereas 77(43.5%) teeth caused a complication. 119 supernumerary teeth (67.2%) were extracted and most of them were the complication source, however periodical observation was chosen as a treatment option for 58 teeth (32.8%).
Conclusion: The frequency of supernumerary teeth was 2.2% in the following research and we found out that supernumerary teeth are not a very rare case among children and young adolescents and clinicians should take measures and examine all patients carefully even at early ages.

Open Access Original Research Article

Analysis of Atherogenic and Anthropometric Profiles of Normotensive and Hypertensive Ghanaians in the Kumasi Metropolis

Isaac K. Owusu, Christiana Aryee, William K. B. A. Owiredu, James Osei-Yeboah, Ellis Owusu-Dabo, Edwin F. Laing

Journal of Advances in Medicine and Medical Research, Page 378-397
DOI: 10.9734/BJMMR/2015/14308

Ghana is undergoing a rapid epidemiological transition from solely communicable to a double burden of infectious and chronic disease such as hypertension.
Aims: We aimed to compare the association between different lifestyle practices, adiposity indices, atherogenic dyslipidaemic parameters and hypertension as well as the prognostic implications for the levels of these parameters on target cardiac organ damage among hypertensives. We also determined the optimal threshold points and the discriminative power of these parameters on this urban Ghanaian hypertensive population.
Study Design: A hospital-based case–control study was conducted.
Methodology: The study purposively recruited 241 Ghanaian indigenes in the Kumasi metropolis, with 180 hypertensives as cases and 61 normotensives as controls. In addition to socio-demographic data captured, all participants underwent standard haemodynamic, anthropometric, atherogenic lipid and cardiac organ damage assessment.
Results: In general, the case group presented with a significantly poorer atherogenic lipid profile compared to their counterparts in the control group. Participants presenting with significantly higher multiple atherogenic scores were found to cluster at the upper quartiles of systolic blood pressure, diastolic blood pressure and pulse rate. Population-specific threshold for waist circumference of >75 cm for females and >80 cm for male were the best adiposity indices for discriminating hypertension. Increasing atherogenic dyslipidaemia was more prevalent with the presence of cardiac target organ damage.
Conclusion: In this urban population, higher altered lipid scores and abdominal obesity aggravated by lifestyle choices including alcohol consumption, smoking and physical inactivity may constitute significant risk for cardiovascular complications among hypertensives.

Open Access Original Research Article

Diet-Induced Fatty Hepatic Steatosis in Male Spontaneously Diabetic Torii (SDT) Fatty Rats, A Genetic Model for Obese Type 2 Diabetes

T. Ohta, Y. Motohashi, K. Miyajima, Y. Kemmochi, Y. Ishii, M. Shinohara, T. Yamada

Journal of Advances in Medicine and Medical Research, Page 398-404
DOI: 10.9734/BJMMR/2015/15922

Aim: The Spontaneously Diabetic Torii (SDT) fatty rat is a metabolic syndrome model, showing obesity, hyperglycemia, dyslipidemia, and hypertension. Moreover, female SDT fatty rats exhibit hepatic steatosis. In this study, metabolic abnormalities, particularly in the liver, were assessed in male SDT fatty rats fed a diet containing 40% fat and 2% cholesterol (HFC-diet).
Location and Duration of Study: Niigata University, CLEA Japan and JT Central Pharmaceutical Research Institute, between January and December 2014.
Methodology: Male SDT fatty rats in control and HFC groups were fed a standard or HFC-diet (40% fat and 2% cholesterol, based on percentage of total calories) from 5 to 17 weeks of age, respectively. Body weight and blood chemistry parameters were periodically measured and a pathological analysis of the liver was performed at 17 weeks of age.
Results: In biological analyses, the HFC group showed increases in body weight, blood insulin, and total cholesterol during the experimental period and an increase in aspartate aminotransferase (AST) at 13 weeks of age. Blood glucose levels in HFC group decreased after 13 weeks of age. In pathological examinations, an increase in liver weight and hepatic steatosis, fatty change and hypertrophy in hepatocyte, were observed in the HFC group. Hepatic steatosis was not observed in the standard-diet group.
Conclusion: Male SDT fatty rats fed an HFC-diet may serve as a new nonalcoholic fatty liver disease (NAFLD) model.

Open Access Original Research Article

Genetic Diagnosis and Prevalence of Urinary Tract Fungal Pathogen with Antifungal Susceptibility Pattern in Iraq

Zaidan Khlaif Imran, Suha Hamid Abuad

Journal of Advances in Medicine and Medical Research, Page 410-418
DOI: 10.9734/BJMMR/2015/12559

Background: Urinary tract infection (UTI) is considered as one of the frequent diseases affecting humans. Usually, emphasis has been on bacteriological etiologies but this study focuses on fungal etiologies.
Aims: The aim of this study is isolation and characterisation of fungal spp. from urine of patients diagnosed of urinary tract infections genetically and phenotypically. Secondly, to evaluate antifungal sensitivity of isolated fungi against 5 antifungals in Iraq.
Methods: A total of 150 urine specimens were collected from 150 UTI suspects patients attending Marrjan hospital in Babylon province from October 2012 to October 2013. Fungal organisms were isolated, virulence of Candida was detected and both genetic analysis of isolates and antifungal susceptibility test, using 5 antifungals were performed on the most frequent isolate.
Results: Candida albicans (32.7%) and Aspergillus fumigatus (10.9%) were the most frequent fungal isolates. Other isolated fungi from the urinary tract of patients include: Acremonium polychromium, Penicillium digitatum, A. fumigatus, A. niger and some other Candida species including C. albicans, Geotrichum capitatum, C. glabrata, C. guilliermondii and C. famata. Most Candida spp. produced proteinase and lipase. Candida spp. has the ability to ferment most of sugar types under interest except lactose. Clotrimazole, Fluconazole, Ketoconazole, and Amphotercin B showed high activity while Miconazole showed low activity to the most frequent isolate of C. albicans, C. guilliermondii, C. famata. The range of antifungal activity concentration for Amphotericin B was 10-100 mg while for Fluconazole, Miconazole and Ketoconazole was 100-1000 mg. Females (39 cases) aged 18-30 years showed frequency of 26% while males (21cases) aged 30-40 years showed frequency of 14%. Eighteen isolates were genetically analyzed and identified as Candida genus with PCR product size of 210 bp.
Conclusion: Fungal organisms are common etiological agents of UTI patients. Candida spp. and Aspergillus spp. showing highest frequency in our study. All isolates of yeast were genetically diagnosed as Candida except Geotrichum isolates. The common antifungals like Clotrimazole, Fluconazole, Ketoconazole and Amphotericin B are still effective in eradicating these pathogens in Iraq.

Open Access Original Research Article

A Rare Intradural Extramedullary Calcifying Pseudoneoplasm of the Spine Presenting with Radiculopathy

Kevin Reinard, Donald Seyfried, Jorge Gutierrez, Jack Rock

Journal of Advances in Medicine and Medical Research, Page 419-424
DOI: 10.9734/BJMMR/2015/16543

Aims: Calcifying pseudoneoplasms of the neuroaxis (CPN) are rare, poorly understood lesions of the central nervous system that pose a diagnostic challenge because they mimic the more common calcified lesions of the neuroaxis. We highlight the relevant clinical presentation as well as radiological and histopathological features unique to intraspinal CPNs.
Presentation of Case: We present the case of a 44-year-old Hispanic male with lumbar radiculopathy, radiological features of an indolent, intradural extramedullary mass, and a histopathological evaluation consistent with CPN. The patient underwent successful surgical resection and remained neurologically intact at long-term follow-up.
Discussion: Epidural CPNs have been described in the literature. However, intradural CPNs are exceedingly rare lesions, and as a result, are not routinely included in the differential diagnosis of calcified, intraspinal lesions. Although there are currently no consensus guidelines for the diagnosis and management of intraspinal CPNs, understanding the clinical presentation and radiological features of these lesions is crucial for spine surgeons and neurosurgeons because surgical resection may offer a cure.
Conclusion: Calcifying pseudoneoplasms may present as intradural abnormalities that mimic more prevalent lesions such as meningiomas. Surgical resection should be considered as first-line treatment because it is associated with low morbidity and may be potentially curative.