Open Access Clinical Practice Article

The Relation between Chronic Aseptic Arthritis and Previous Chlamydia Infection among Middle Aged Iraqi Patients

Asa'ad F. Albayati, Sinan B. Alrifai, Wisal R. Al-Hayali, Dhoha R. Al Taha

Journal of Advances in Medicine and Medical Research, Page 353-361
DOI: 10.9734/BJMMR/2015/17615

Aims: This study was conducted to detect and evaluate the relation between chronic aseptic arthritis and previous Chlamydia trachomatis infection among middle aged Iraqi patients.
Study Design: Cross sectional study
Place and Duration of Study: private clinic in Al-Door city/ Salahaddin Province / Iraq, between October 2012 and May 2013.
Methodology: This study included 33 known patients with chronic arthritis, with negative rheumatoid factor (RF) in their sera, aging from 26 to 61 years. Septic arthritis was excluded by history, clinical examination, and blood investigations. The ESR for these patients was estimated. Other 33 subjects were taken as a control group. Chlamydia trachomatis IgM and IgG were estimated by ELISA test (sandwich method) for both groups' sera, and results were statistically analyzed.
Results: The female: male ratio in current study is (5.6: 1), with mean age of (46) years old. More than half of cases (52%) were having ESR value of 40-60. A highly significant statistical difference (P<0.001) was noticed between study groups in regard to C. trachomatis IgG mean levels in their sera calculated by unpaired T- test.
Conclusion: There is a significant relation between chronic arthritis and previous Chlamydia infection in current study (demonstrated by high titer of anti- Chlamydia trachomatis IgG).

Open Access Case Study

Orbital Myositis with Rapid Successful Treatment with Corticosteroids

Syuichi Tetsuka, Asako Tagawa, Tomoko Ogawa, Mieko Otsuka, Ritsuo Hashimoto, Hiroyuki Kato

Journal of Advances in Medicine and Medical Research, Page 362-366
DOI: 10.9734/BJMMR/2015/17738

A 41-year-old Japanese female was admitted to our hospital with a history of right abducens nerve palsy, right gaze diplopia, right eye pain and double vision. Thyroid function, thyroid autoantibody levels, and tests for other pathologies were normal. Orbital contrast-enhanced short-TI Inversion Recovery-magnetic resonance imaging before treatment showed contrast-enhanced, severe lateral rectus and rectus superior muscle swelling in the right eye. We therefore diagnosed this patient as orbital myositis. Intravenous glucocorticoid pulse therapy with methylprednisolone (mPSL) was initiated. After prescribing a daily dose of 1,000 mg of mPSL three times a week, all symptoms, including physical abnormalities, disappeared. The patient was discharged on day 14 after hospitalization and was prescribed oral PSL (30 mg/day). This report indicates that early and initial adequate treatment with a high dose of mPSL is very effective for orbital myositis treatment. However, the possibility of recurrences must be always considered at subsequent follow-up.

Open Access Short Research Article

Evaluation of ‘Wastage Rate’ of Blood and Components – An Important Quality Indicator in Blood Banks

Asitava Deb Roy, Arijit Pal

Journal of Advances in Medicine and Medical Research, Page 348-352
DOI: 10.9734/BJMMR/2015/16930

Aims: To evaluate the wastage rate of blood and components in a newly established blood bank of a teaching hospital in West Bengal.
Study Design: Retrospective study.
Place and Duration of Study: Department of Transfusion Medicine, IQ City Medical College and Narayana Multispeciality Hospital, Durgapur between April 2014 and October 2014.
Methodology: The study recorded the discarding of whole blood and component units due to various reasons viz. over-collection and under-collection of blood from donors; RBC contamination of plasma and platelets; blood bag leakages; presence of hemolysis, clots, lipemic appearance, greenish and yellowish (icterus) discoloration; expiry date and seroreactivity for infectious diseases. The wastage rate was calculated thereafter using appropriate formula.
Results: Out of total 1241 blood bags which were collected from donors during the study period, 1176 units were separated into components and rest 65 units were kept as whole blood units. Total 93 (7.49%) blood bags were discarded, of which 27 (2.18%) were whole blood bags and 66 were components. The total number of whole blood units issued during this period was 38 and components issued during this period were 693.
Therefore, the wastage rate of whole blood units and components can be calculated as:
Wastage rate of whole blood = 27/38 x100 = 71%
Wastage rate of components = 66/693 x100 = 9.52%
Conclusion: The rate of discarded blood components or “wastage rate” is one of those indicators and has been listed third among the ten quality indicators recommended by National Accreditation Board for Hospitals and Health Care providers. It is important to monitor this parameter for judicious management of blood bank inventory.

Open Access Original Research Article

Contrast-enhanced Ultrasound in the Assessment of the Transitional Zone of Microwave Ablations in an Ex vivo Perfused Liver Model; is It a Useful Tool?

Ahmed Alzaraa, Wen Yuan Chung, Bruno Morgan, Kevin West, David Lloyd

Journal of Advances in Medicine and Medical Research, Page 298-312
DOI: 10.9734/BJMMR/2015/17155

Background and Aims: Microwave ablation (MWA) under different imaging guidance is a new technique for treating liver malignancies. The ablation creates a transitional zone at the periphery of the ablated region. In this zone, few cancer cells might escape heat causing local recurrence. Therefore, a more defined transitional zone is required to avoid residual cancer.
Study Design: Experimental study with a block design.
Place and Duration of Study: Departments of Hepatobiliary and Pancreatic surgery, department of Radiology and department of Histopathology; University hospitals of Leicester, UK. May-July 2011.
Methodology: MWA with different powers (50 W, 70 W, 90 W) were created in five ex vivo perfused porcine livers. The ablations were evaluated on morphology, grey-scale US, CEUS and histology. Statistical analysis of the data was performed using ANOVA test.
Results: CEUS showed better demarcation of the lesion’s border when compared with the grey-scale US. There was a significant difference in the long axis of the ablation among morphology, grey-scale US and CEUS (P < 0.0001), and a significant difference in the lesion size between powers (P = 0.0064). There was no difference in the short-axis, but a significant difference in the lesion size between powers (P = 0.0306). A significant difference in the width of the transitional zone (TZ) was noticed between powers 50W and 90W (P= 0.015).
Conclusion: CEUS shows better demarcation of the ablated zone when compared with the grey-scale-US, a finding that could provide guidance in the assessment of the ablation zone during treatment. CEUS does not show superiority over morphology or grey-scale US in reflecting the actual size of the lesion. Histology remains the only method to provide exact measurements of the transitional zone width when compared with morphology. Further research is required to confirm these results.

Open Access Original Research Article

Safety and Efficacy of Prolonged Hydroxycarbamide Administration in Patients with Sickle Cell Disease in Northwestern Greece

Alexandros Makis, Frideriki Koutsouka, Nikolaos Chaliasos, Eleni Kapsali, Evangelos Briasoulis

Journal of Advances in Medicine and Medical Research, Page 313-316
DOI: 10.9734/BJMMR/2015/17515

Hydroxycarbamide (HC) is a ribonucleotide reductase inhibitor which promotes fetal hemoglobin (HbF) induction and has proven efficacy in sickle cell disease (SCD) patients. Given its mechanism of action and prior reports of genotoxicity in animal models, concern exists regarding long-term safety in relation to its cytotoxic effects. The purpose of this study was to retrospectively analyze the long-term (range 3-20 years, median 11) HC-derived clinical and biological effects, in 30 SCD patients (age range 20-68 years) from one referral center. HC treatment resulted in significant reduction of painful crises and transfusions, increase of HbF and hemoglobin as well as drop of white blood cell count and lactate dehydrogenase values. During the long term follow up time the following disease complications were observed: pulmonary hypertension (2 patients), leg ulcers (1 patient) and renal impairment (1 patient). Seven patients discontinued HC therapy because of scheduled pregnancy (3), severe neutropenia (2) and non-compliance (2). One poor HC compliant patient died of pulmonary embolism. No case of malignancy was observed. This retrospective study of most prolonged administration of HC, provides data supporting the safety and the well-established usefulness of chronic administration of HC in SCD.

Open Access Original Research Article

A Regression Model to Predict Diameter of Mitral Valve Prosthesis Preoperatively: An Aid to Clinical Decision Making

Praveen Sharma, Ankur Joshi, B. S. Yadav, Saket Kale, M. C. Songara

Journal of Advances in Medicine and Medical Research, Page 317-323
DOI: 10.9734/BJMMR/2015/16835

Aim: Accurate estimation of the prosthetic valve size pre-operatively can aid to the efficiency and effectiveness to mitral valve surgery. Traditionally Two dimensional Echocardiography is being used for this purpose but cannot be claimed as optimum tool. This study computes and analyses several linear regression equations in order to obtain a best fit model for predicting mitral prosthesis size well before operation.
Materials and Methods: This hospital based longitudinal study was conducted in a tertiary care Cardio Thoracic Vascular Department from August 2011 to August 2012. A total of 67 participants suffering from Rheumatic Heart Disease (with severe mitral valve disease) were recruited. Short and long axis of the mitral annulus were measured through 2-dimensional transthoracic echocardiography. Further three regression models were plots using short axis, long axis and area of the annulus as independent variables and diameter of prosthetic valve as dependent variable.
Results: Among the three predictors namely the anterio-posterior axis (short axis), commissure-commissural axis (long axis) and area of mitral valve annulus; the regression equation with short axis predicted the diameter of prosthesis more accurately. The optimum regression model for short axis is calculated as -Diameter of prosthetic valve= -0.165 + 0.769X short axis of Ellipse. The coefficient of determination for this equation (R2) is 0.905. This equation offers the explanation for maximum observations in the model (F=609.48).
Conclusion: The size of optimum prosthetic valve may be determined preoperatively as a function of anterio-posterior axis (short axis) of annulus through non invasive 2-D Echocardiography. However this finding is amenable for further multi-centric validation.

Open Access Original Research Article

Sero-prevalence of Hepatitis B Infection and Its Risk Factors among Women Admitted for Delivery in Ucth, Calabar, Nigeria

C. U. Iklaki, C. I. Emechebe, B. U. Ago

Journal of Advances in Medicine and Medical Research, Page 324-333
DOI: 10.9734/BJMMR/2015/16397

Background: Vertical transmission of hepatitis B virus infection during pregnancy and delivery remains the major route of transmission in low resource areas.
The objectives of this study were to determine the sero-prevalence of hepatitis B infection (HBsAg) and the potential risk factors among pregnant women admitted for delivery.
Materials and Methods: This cross-sectional study of 300 women admitted for delivery was conducted at University of Calabar Teaching Hospital, Calabar, Nigeria. A pretested questionnaire was used for the collection of socio-demographic data and possible risk factors. Blood sample was collected from each consented woman and the plasma tested for the presence of HBsAg using rapid ELISA test Kits in the laboratory of the hospital. All the data were analyzed using microsoft SPSS version 17 statistical program.
Results: Out of the 300 women studied, positive HBsAg was detected in 14 women, giving a sero-prevalence rate of 4.7%. The age of the women studied varied from 16 to 43 years with mean age of 27.9±4.6 years and mean parity of 1.1±1.5. Hepatitis B viral infection was significantly higher among pregnant women who did not attend any antenatal care (unbooked women) than pregnant women who attended antenatal care (booked women). There were statistically significant relationships between HBV infection and 2 or more sexual partners and previous history of induced abortion. Previous histories of blood transfusion, previous surgeries/dental manipulations, tribal marks/tattoos, previous contact with somebody with hepatitis B infection were not statistically significant. The data are related to 14 (4.7%) of HBV infected women in the study.
Conclusion: An intermediate prevalence of hepatitis B virus infection was identified which justifies the need for routine screening in pregnancy especially among unbooked women in order to identify and treat the infection.

Open Access Original Research Article

Infant and Young Child Feeding in Children under-5 Years in Ghana: Key Strategy to Childhood Development

Paschal Awingura Apanga

Journal of Advances in Medicine and Medical Research, Page 343-347
DOI: 10.9734/BJMMR/2015/17261

Aim: To explore the challenges mothers encounter during infant and young child feeding in children under-5 years and to make recommendations to overcome these challenges. This is paramount as feeding practices in children under- 5 years is essential for optimal infant and young child development.
Methodology: A literature review of selected papers from PubMed, Google scholar, Embase and Medline were used. Also, relevant hand searched books, policy documents, reports and case studies were used in the analysis.
Results: Traditional practices, family pressure, problems with nipples/breasts, sagging of breast, cost of feeds and lack of knowledge were major factors that hindered the recommended practice of infant and young child feeding in children under-5years in Ghana. However, attending antenatal care services, delivery at a health facility and family support were factors that enhanced its practice.
Conclusion: Educate communities in Ghana especially pregnant women and mothers on the benefits of exclusive breastfeeding and complementary feeding in children under-5 years. Pregnant women should be encouraged to attend antenatal care services and deliver at a health facility. Families should also be encouraged to support pregnant women and mothers.

Open Access Review Article

A Review of Efficacy of Hippotherapy for the Treatment of Musculoskeletal Disorders

Antonios G. Angoules, Dionysios Koukoulas, Konstantinos Balakatounis, Irene Kapari, Eleni Matsouki

Journal of Advances in Medicine and Medical Research, Page 289-297
DOI: 10.9734/BJMMR/2015/17023

Objective: Hippotherapy or Equine Assisted Therapy (EAT) is an alternative therapeutic treatment which is based on the special benefits of horse riding. The purpose of the herein review is to investigate the efficacy of this method for the treatment of several dysfunctions affecting the musculoskeletal system.
Materials and Methods: International literature was thoroughly studied, with special focus on indications and therapeutic effectiveness of this method in injuries and diseases of musculoskeletal interest.
Results: EAT seems to contribute positively to spasticity reduction, following spinal cord injuries (SCIs) and affects the overall patients’ quality life. It also acts positively on the prevention of falls in the elderly. Less evidence exists on the usefulness of this method in scoliotic curvature reduction in children with cerebral palsy (CP) and in treatment of Low back Pain (LBP).
Conclusion: Hippotherapy improves muscle strength, balance and coordination of movement and it also contributes to relaxation and control of posture. Thus, it seems that as a supplementary method, accompanying other individualized therapeutic approaches, it can address a number of problems of the musculoskeletal system. More and well-designed studies are needed to draw firm conclusions about the benefits and the indications of the method.