Open Access Case Study

Combined Central Retinal Vein and Cilioretinal Artery Occlusion in a Patient Who Underwent Allogeneic Renal Transplantation

Mahmut Kaya, Taylan Ozturk, Nilufer Kocak, Suleyman Kaynak

Journal of Advances in Medicine and Medical Research, Page 861-866
DOI: 10.9734/BJMMR/2015/16731

A high incidence of venous thromboembolism has been reported in patients who have had renal transplantation especially within the early postoperative period. Herein, the management of a 31-year-old renal graft recipient with the diagnosis of combined left central retinal vein occlusion (CRVO) and cilioretinal artery occlusion (CRAO) is presented. Although detailed work-up for inherited as well as acquired thrombophilic disorders was performed in our case, none of the definite prothrombotic and predisposing risk factors for venous thromboembolism was identified. The case under review or the index case had a remarkable visual recovery within 3 weeks after the referral, since anterior chamber paracentesis was immediately scheduled after performing ocular massage in order to achieve acute resolution of venous stasis.

Open Access Case Study

The Use of McGrath® MAC Video Laryngoscope in Difficult Airway

Rohit V. Agrawal, Addy Y. H. Tan

Journal of Advances in Medicine and Medical Research, Page 867-871
DOI: 10.9734/BJMMR/2015/16659

Rigid indirect video laryngoscopes were designed to aid glottis visualisation in difficult airway. The McGrath® MAC video laryngoscope was designed similarly for routine use. The unique design of the blade makes it easy to use in patients with limited mouth opening and facilitates tracheal intubation without use of stylet. It is compact and easy to assemble with preparation time less than one minute making it a reasonable choice in cases of unanticipated difficult intubations. This case series demonstrates its successful use as a rescue device in patients with difficult intubation. One of the patient was intubated awake with the help of McGrath® MAC video laryngoscope thus making it an attractive alternate for fibre optic bronchoscopy assisted tracheal intubation.

Open Access Case Study

Diagnosis of Multifocal Extranodal Rosai Dorfman Disease by Fine Needle Aspiration Cytology

Priyadarshini Biswal, Ipsita Dhal, Asaranti Kar, Manjushree Nayak, Dilleswari Pradhan, Subhasini Naik

Journal of Advances in Medicine and Medical Research, Page 872-876
DOI: 10.9734/BJMMR/2015/15733

Rosai-Dorfman Disease (RDD) or sinus histiocytosis with massive lymhadenopathy is a rare, non- neoplastic proliferative disorder of the cells of macrophage-histiocyte family having a self limiting course. Though it affects lymphnodes commonly, it can also involve many extranodal sites. These cases can often be misdiagnosed as lymphoma. Therefore, one has to be very careful not to interpret it as lymphoma or other causes of histiocytosis because of the difference in treatment protocol. Fine needle aspiration cytology (FNAC) is a simple, fairly accurate diagnostic tool in the evaluation of such lesions.
Although large numbers of RDD cases have been reported, review of the literature has revealed very few cases diagnosed by FNAC. Here, we report a case of RDD presenting with massive bilateral cervical and submandibular lymphadenopathy along with unilateral orbital involvement, diagnosed by FNA cytology, which was subsequently confirmed by excisional biopsy and immunohistochemistry.

Open Access Original Research Article

Anemia in Female Collegiate Athletes: Association with Hematological Variables, Physical Activity and Nutrition

Yuka Yasui, Masaru Kubota, Ayako Nagai, Noriko Matsumoto

Journal of Advances in Medicine and Medical Research, Page 801-808
DOI: 10.9734/BJMMR/2015/17284

Aims: The current study aims to clarify the prevalence of anemia in collegiate athletes in relation to various hematological variables, physical activity and nutrient intake.
Study Design: A cross sectional, retrospective study.
Place and Duration of Study: This study was done at two universities in Nara, Japan, between April and September, 2013.
Methodology: Fifty-eight female athletes and 65 female non-athletes were enrolled. Hematological variables, physical activities based on the definition of the International Physical Activity Questionnaire, and nutrients intake using one week’s dietary records were measured.
Results: The prevalence of anemia (<12 g/dl of hemoglobin) and hypoferritinemia (<12 ng/ml of ferritin) was comparable between athlete and non-athlete groups. Reticulocytes percentages or haptoglobin levels were statistically higher or lower respectively, in the athlete group. There was no statistical difference in the intake of micronutrients related to erythropoiesis between the two groups. Multiple regression analysis revealed that hemoglobin levels were significantly associated with an irregular menstruation status in both groups, and were associated with the physical activity only in the athlete group.
Conclusion: Although the prevalence of anemia in female collegiate athletes is identical to that of non-athletes, they may be at risk for anemia when their strength of physical activity will increase. Since the signs of hemolysis are more common in the athlete group, a measure of minimizing hemolysis such as the introduction of a pad on the sole of the foot may be considered to prevent the occurrence of overt anemia.

Open Access Original Research Article

Age Related Changes in Cerebrovascular Reactivity and Its Relationship to Global Brain Structure

Gordon D. Waiter, George G. Cameron, Trevor S. Ahearn, Christian Schwarzbauer, Alison D. Murray

Journal of Advances in Medicine and Medical Research, Page 809-820
DOI: 10.9734/BJMMR/2015/16889

Introduction: There is growing evidence to suggest that vascular and CSF haemodynamic effects are related to structural changes in the ageing brain. We investigated these effects in a sample of healthy participants by measuring changes in cerebrovascular reactivity induced by hypercapnia and comparing these to global and ROI based cerebral volume measures.
Methods: Forty five participants aged 21 to 58 years (23 female) were recruited. Cerebrovascular reactivity was determined from hypercapnia induced BOLD signal change during two 3-minute intervals of breathing 6% CO2, interleaved with three 2-minute intervals of breathing room air. Parametric maps of reactivity were calculated as the ratio of % BOLD signal change to end-tidal CO2 (mmHg). High resolution 3D T1-weighted images were segmented and lateral ventricle volume and white matter hypointensity volume determined.
Results: Significant negative correlations between both grey matter (p = .042) and white matter (p = .021) reactivity and age were found and significant negative correlations between grey matter (p = .013) and white matter (p = .004) reactivity and lateral ventricle volume were also found while correcting for age and total intracranial volume. A significant negative correlation between white matter reactivity and white matter hypointensity volume was found (p = .049) after correcting for age.
Conclusion: These results support the hypothesis that cerebrovascular haemodynamics influence structural brain changes that occur during normal ageing that are independent of the age of the individual.

Open Access Original Research Article

Antimicrobial Potential of the Leaves of Stachys pseudopinardii on Microorganisms Isolated from Urinary Tract Infections

Gorkem Dulger, Basaran Dulger

Journal of Advances in Medicine and Medical Research, Page 821-826
DOI: 10.9734/BJMMR/2015/17123

Purpose: Urinary tract infections are a serious health problem affecting millions of people each year. Therefore, studies for new alternative remedies are necessary. The aim of this study was to investigate the antimicrobial potential of the leaves of Stachys pseudopinardii R. Bhattarcharjee & Hub.-Mor. (Lamiaceae) against the pathogens causing complicated urine tract infections.
Methods: The ethanolic extracts obtained from the leaves of S. pseudopinardii were investigated for their antimicrobial activities against the pathogens causing complicated urine tract infections (Enterococcus feacalis, Escherichia coli, Klebsiella pneumoniaePseudomonas aeruginosaProteus mirabilis and Candida albicans) by disc diffusion method and microdilution method. Some antibacterial and antifungal antibiotics were used as a positive reference standard to determine the sensitivity of the strains.
Results: The extracts showed antimicrobial activity against Enterococcus faecalisProteus mirabilis and Candida albicans with inhibition zones of 18.2, 17.4 and 16.0 mm, with MIC’s and MBC’s or MFC’s of 32.0 (64.0), 32.0 (64.0) and 64.0 (128.0) µg/mL, respectively. Also the extracts exhibited moderate activity against the other test microorganisms.
Conclusion: Our findings support the use of S. pseudopinardii in traditional medicine for the treatment against the urine tract pathogens. Hence, it is suggested to isolate and identify the active compounds of the plant for novel antimicrobial agents in future.

Open Access Original Research Article

Epidemiology and Pattern of Osteoarthritis at Ogbaku, Imo State University Teaching Hospital Annex, Mbaitoli Local Government Area, Imo State, Southeast, Nigeria

S. N. Ukibe, T. N. Ugorji, L. C. Ikeakor, A. C. Obi-Okaro, N. R. Ukibe, J. Ekezie, C. U. Okeke, E. A. Alagwu

Journal of Advances in Medicine and Medical Research, Page 827-832
DOI: 10.9734/BJMMR/2015/16344

Background: Osteoarthritis is a major cause of disability and incapacitation Worldwide.
Aim: To evaluate the epidemiology and pattern of osteoarthritis at Ogbaku, Imo State University Teaching Hospital annex, Mbaitoli Local Government Area, Imo State, South-east Nigeria.
Study Design: A retrospective epidemiological study.
Methodology: One hundred and six case notes of patients managed for osteoarthritis between January 2009 and October 2010 were studied. Simple statistical methods like percentages were used for data analysis.
Results: Out of 106 cases studied, 72(67.9%) were females while 43(32.1%) were males. The highest percentage of cases (34%) occurred in people aged 65-74 years followed by people aged 55-64 years (24.5%). Younger people (45-54 years) were the least affected. Farmers (24.5%) were the most affected occupational group followed by athletes (18.9%) and then traders (17%). Civil servants were the least affected. The knee (41.5%) was the most frequently affected joint followed by the hip (22.6%). The least affected joints were the wrist (1.9%) and the elbow (1.9%).
Conclusion: The study shows that osteoarthritis occurred most in people aged 65-74 yrs and the knee was the most frequently affected joint in the body.

Open Access Original Research Article

Chronic Suppurative Otitis Media in Nigerian Children: The Port Harcourt Experience

L. O. Onotai, A. E. Osuji

Journal of Advances in Medicine and Medical Research, Page 833-838
DOI: 10.9734/BJMMR/2015/17126

Background: The prevalence of chronic suppurative otitis media in children appears to be on the increase in our society probably due to factors associated with poverty and deteriorating healthcare facilities. This study aimed to determine the prevalence of chronic suppurative otitis media as seen in the University of Port Harcourt Teaching Hospital (UPTH), Port Harcourt with a view to documenting the pattern and highlighting the results of management.
Patients and Methods: A retrospective study of all children that presented to the department of E.N.T surgery of UPTH, Port Harcourt, Nigeria with chronic suppurative otitis media over a ten-year period (January 2003-December 2012). The patient’s data were retrieved from the clinic registers, patients’ case notes and theatre registers. Demographic data, predisposing conditions, aetiological factors, site of tympanic membrane perforation, affected ear, treatment modalities, complications of treatment and outcome of management were recorded and analyzed.
Results: Seven hundred and twenty three patients were found to have CSOM. These accounted for 9.4% of all otorhinolaryngological cases seen within the study period. There were 385 males and 338 females (male: female ratio of 1.1:1.0). Age range was 3 months to 16 years, mean = 8.2 +/- 3.2 years. Age group 1-5 years has the highest (n=344, 47.6%) number of cases. Bilateral CSOM accounted for the highest number (n=350, 48.4%) of cases. Perforation was found more on the antero inferior aspect of the tympanic membrane and the commonest etiological factor was poorly treated acute otitis media (AOM). The commonest mode of treatment was conservative medical treatment.
Conclusion: This study confirmed a prevalence of 9.4% of CSOM in children that attended the ENT clinic in UPTH, Port Harcourt. The commonest type seen was the tubo-tympanic disease with antero-inferior tympanic membrane perforation. However, poorly treated AOM was found to be the commonest etiological factor. The provision of adequate health facilities and eradication of poverty possibly will reduce the prevalence of pediatric CSOM in our environment.

Open Access Original Research Article

Fever of Unknown Origin (FUO) in HIV Infection in the Era of Antiretroviral Treatment (ART) in India: Development of a Simple Diagnostic Algorithm

S. Anuradha, Sandeep Ghosh, Richa Dewan, Ravinder Kaur, K. Rajeshwari

Journal of Advances in Medicine and Medical Research, Page 839-846
DOI: 10.9734/BJMMR/2015/16868

Objective: Fever of unknown origin (FUO) is a challenging problem among people living with HIV (PLHIV).With increasing access to Anti-retroviral treatment (ART), the spectrum of causes of FUO has evolved in the developed world. This study evaluated the etiology of FUO among PLHIV in the era of ART in India.
Methodology: This prospective study was conducted at a tertiary-care institution in New Delhi, India. Sixty four PLHIV with a diagnosis of FUO were assessed by detailed clinical evaluation and immunological assessment. Specific investigations to identify the etiology of fever: microbiological and radiological investigations, bone marrow and histopathological examination of biopsies were performed. A simple diagnostic algorithm for FUO was developed based on the findings.
Results: Sixty five episodes of FUO were studied. Seventy percent of subjects were men, 76% were <40 years of age, and 39% were receiving ART. The mean CD4 count was 156.57±178.43 cells/mm3 (5 to 1144 cells /mm3) and 23% patients had CD4 counts <50 cells/mm3. The mean duration of fever was 11.26±8.54 weeks. Infections were the most common cause for FUO, with Tuberculosis the most common (61.54%), particularly disseminated tuberculosis (41.54%). Cryptococcal meningitis (7.69%), bacterial pneumonia (4.62%), pyogenic abscesses (4.62%), Pneumocystis jirovecii pneumonia (PCP) (3.08%), visceral leishmaniasis (3.08%) were other infections observed. Non-infectious etiologies including lymphoma (4.62%) and progressive multifocal leucoencephalopathy (PMLE) (3.08%) were also seen. The etiology remained undiagnosed in 6.15% episodes. Importantly, two or more concurrent etiologies of fever were seen in 60% of patients.
Conclusion: Infections especially Tuberculosis remain the most common cause of FUO in PLHIV even in the era of ART in developing countries like India. Multiple concurrent infections and a rising trend to non-infectious causes are being observed. A simple diagnostic algorithm will help diagnose majority of FUO even at the peripheral centers.

Open Access Original Research Article

Effects of Rebounding Exercises versus Whole Body Vibration on Functional Capacity, Genu Recurvatum Angle and Bone Mineral Density in Children with Down Syndrome

Rasha A. Mohamed, Abd El Aziz A. Sherief, Shimaa N. Aboelazm

Journal of Advances in Medicine and Medical Research, Page 847-860
DOI: 10.9734/BJMMR/2015/16002

Aim: To compare between the effects of rebounding exercises and whole body vibration on functional capacity, genu recurvatum angles and bone mineral density in children with Down syndrome.
Study Design: Prospective, randomized controlled study.
Place and Duration of Study: National Institute for Neuro-Motor System, Egypt, between June 2014 and September 2014.
Methodology: Thirty children with Down syndrome (16 boys and 14 girls) whose age ranged from 6 to 8 years. They were assigned randomly into two equal study groups (n=15). Study group I received rebounding exercise and study group II received whole body vibration. In addition, both groups received the same designed exercise program. Functional capacity via 6-minute walk test, genu recurvatum angles and bone mineral density were evaluated before and after 3 successive months of treatment.
Results: Significant differences were observed in both groups when comparing their pre and post-treatment mean values of all measuring variables (p<0.05). Six minute walk test was changed from (300±9.258, 294.667±9.904) meters to (350±8.451, 357.333±13.741) meters for study group I and II respectively. Right genu recurvatum angles were changed from (20.330±1.543, 19.730±1.534) degrees to (17.800±1.699, 16.130±1.885) degrees for study groups I and II, respectively while left genu recurvatum angles were changed from (19.930±1.486, 19.870±1.407) degrees to (17.600±1.549, 15.067±1.223) degrees for study groups I and II, respectively. Bone mineral density of femoral neck was changed from (0.576±0.015, 0.580±0.016) g/cm2 to (0.805±0.042, 0.831±0.066) g/cm2; distal tibia changed from (0.335±0.085, 0.339±0.089) g/cm2 to (0.485±0.095, 0.549±0.083) g/cm2; proximal tibia from (0.557±0.017, 0.565±0.017) g/cm2 to (0.781±0.053, 0.827±0.076) g/cm2 for study groups I and II, respectively. No significant differences were recorded between both groups when comparing their post-treatment mean values of six minute walk test and bone mineral density while significant differences were recorded in genu recurvatum angles in favor of the study group II (p < 0.05).
Conclusion: Both rebounding exercises and whole body vibration are effective in correcting genu recurvatum, increasing low bone mineral density and functional capacity for the children with Down syndrome. The whole body vibration in correction of genu recurvatum angle is more effective in comparison to rebounding exercises.