Open Access Case Study

Determination of the Localization by Intra-arterial Calcium Stimulation in Insulinoma: A Case Report

Mehtap Evran, Murat Sert, Tamer Tetiker, Erol Aksungur, Ömer Alabaz

Journal of Advances in Medicine and Medical Research, Page 1-5
DOI: 10.9734/BJMMR/2015/19978

Aims: Insulinoma, though a very rare disease, is the most common endocrine tumors of the pancreas. High serum insulin levels during hypoglycemic episodes are specific for the diagnosis. Where ultrasonography, tomography and other imaging modalities are not adequate for determination of the adenoma and its localization, hepatic venous sampling method with selective intra-arterial calcium stimulation becomes important in terms of determination of preoperative localization of adenoma and shortening surgery time.

Presentation of Case: A 38-year-old female patient investigated for weakness and low blood glucose was examined with a prediagnosis of insulinoma. Although clinical and laboratory results suggested insulinoma, no focus could be found by routine imaging methods. Hepatic venous sampling with selective intra-arterial calcium stimulation of the patient, who had pancreatic angiography, was performed. As a result of calcium stimulation performed from proximal splenic, mid splenic and gastroduodenal arteries, insulin and C-peptide levels in blood samples collected from hepatic vein were found to be high. The patient underwent an operation with intraoperative ultrasonography in which mass excision of the pancreas tail was performed. Pathologic examination revealed a neuroendocrine tumor showing synaptophysin, chromogranin and NSE (+) staining.

Discussion and Conclusion: Hepatic venous sampling with selective intra-arterial calcium stimulation in insulinomas is an extremely accurate and reliable method for the preoperative localization.

Open Access Case Study

Majewski Syndrome, Short Rib Polydactyly Syndrome (SRPS) Type II - A Rare Case Report, with Review of Literature

Sainath K. Andola, Rajashree J. Ingin, Dimple Mehrotra, Radhamohan Rana

Journal of Advances in Medicine and Medical Research, Page 1-8
DOI: 10.9734/BJMMR/2015/18367

Short Rib Polydactyly Syndrome (SRPS) type II also known as Majewski syndrome, is the rarest of the four subtypes of SRPS which is a rare inherited skeletal dysplasia. We report a case of Majewski syndrome in a neonate with brief review of literature.

A 24 years old primigravida, with history of second degree consanguineous marriage underwent a Prenatal USG which revealed anhydramnios, bilateral enlarged kidneys, extremely narrow thorax and bilateral short limbs with polydactyly. Based on these findings a probable diagnosis of lethal skeletal dysplasia was made and termination of pregnancy advised. Refusing termination the mother delivered a male foetus at 30 weeks with severe respiratory distress and gross anomalies. The foetus succumbed to respiratory failure inspite of resuscitation. Gross findings were a male foetus with enlarged head, hydropic face, hypertelorism, short nose, depressed nasal bridge, pseudo cleft lip, cleft palate, low set posterior rotated ears, cystic hygroma, micrognathia, short and narrow chest, all the limbs showed mesomelic limb shortening, postaxial polydactyly, syndactyly and brachydactyly. Postnatal X-ray, CT scan and USG confirmed the above mentioned features and additional findings were extremely short horizontal ribs and disproportionately shortened ovoid tibia.

Autopsy revealed a bell shaped thorax, small hypoplastic lungs, bilateral enlarged kidneys, atrial septal defect, hypoplastic epiglottis and larynx and short small intestine. Microscopic findings of pulmonary hypoplasia, renal cystic dysplasia, hepatic fibrosis and markedly retarded endochondral ossification correlate with the clinical, radiological and pathological findings of Short Rib Polydactyly Syndrome Type II -Majewski Syndrome.

Open Access Original Research Article

Epidemiology of the Postoperative Bacteriuria and Urinary Tract Infections Following Transurethral Resection of the Prostate

Beatriz Lemos da Silva Mandim, Claudia Lemos da Silva, Hugo Cogo-Moreira, Fabíola Prado Moraes, Augusto Diogo-Filho

Journal of Advances in Medicine and Medical Research, Page 1-8
DOI: 10.9734/BJMMR/2015/19726

Aims: Despite guidelines and recommendations, a pragmatic approach, i.e., that treatment will improve patient-centered outcomes when performed by typical clinicians in typical patients, is necessary to evaluate the effectiveness of antibiotic prophylaxis in urological surgery.

Study Design: Prospective, randomized, double-blinded, pragmatic trial.

Place and Duration: The study was performed in a tertiary hospital at Federal University of Uberlandia, Brazil, from January 2012 to December 2013.

Methods: One hundred and thirty patients were randomly assigned to receive a single dose of 2 g intravenous (IV) ceftriaxone (66 subjects) or 2 g IV cefazolin (64 subjects) thirty minutes before transurethral resection of the prostate (TURP). We evaluated their physical status, preoperative urinary catheter use, urological risk factors, prostate size, and the duration of surgery.

Results: Ceftriaxone showed a non-significant trend towards superiority to cefazolin (OR = 0.567, 95% CI [0.234-1.414], p = 0.228) for the prevention of infections among TURP patients.

Conclusion: No significant difference in the effectiveness of a single dose of ceftriaxone compared with cefazolin for the prevention of postoperative infections was found in patients undergoing TURP following the early postoperative removal of an indwelling catheter. Due to the pragmatic assumptions of this trial, this result might not represent a negative finding; instead, it may indicate the importance of risk factors influencing the patients’ susceptibility to infection.

Open Access Original Research Article

Health Care Strategies for Elementary Schools

Abbas Abbaszadeh, Heidar Ali Abedi, Minoo Motaghei

Journal of Advances in Medicine and Medical Research, Page 1-9
DOI: 10.9734/BJMMR/2015/19638

Aim: Every society uses a kind of strategy to provide health care for schools, so the aim of this study was to determine health care strategies for elementary schools.

Study Design: This is a qualitative study that conducted content analysis.

Place and Duration of the Study: This study was conducted in Isfahan, Iran, during 2014.

Methodology: This study was conducted on health care providers of elementary schools. By targeted sampling 17 healths care providers from 22 elementary schools were selected. 20 semi-structured interviews were performed. Data was analyzed using qualitative content analysis.

Results: Three concepts of social contribution (with two sub-categories of responsibility toward peers and cooperation), family-oriented (with three sub-categories of school and family interaction, parents’ desperateness and transparency of information between teachers and parents) and holism (with four sub-categories of students’ health problems, multidimensionality of health, social skills and promoting spirituality).

Conclusions: Using these approaches to provide health care for students could help to enhance the health of this group.

Open Access Original Research Article

Unappreciated Cognitive Dysfunction is Common among Patients Hospitalized with Cardiovascular Disease

James V. Cireddu, Mary A. Dolansky, Denise Lin- DeShetler, Joel Hughes, John Gunstad, Richard Josephson

Journal of Advances in Medicine and Medical Research, Page 1-9
DOI: 10.9734/BJMMR/2015/18618

Background: Better understanding of the prevalence of unappreciated cognitive dysfunction among patients with cardiovascular disease during hospitalization is integral to patient-centered care. We tested the hypothesis that there is a substantial prevalence of debilitating cognitive dysfunction in cardiac patients which health care providers do not appreciate. 

Methods: This observational prospective study evaluated 51 patients on admission to a cardiac intensive care unit (CICU) who did not have a history of conditions known to adversely affect cognition and appeared cognitively intact to treating physicians and nursing staff. Patients underwent neuropsychological testing to assess the domains of global cognition, attention, memory, and executive function at important points during hospitalization.

Results: Twenty-six percent of participants were impaired globally based upon the Modified Mini Mental Status Examination. Of the study’s participants, 46% were impaired in memory on short recall and 40% were impaired on long recall based upon Rey Auditory Verbal Learning, while 49% were impaired based upon Digit Span. Further, 38% of participants were impaired in attention based upon Trail Making Test Part A. Twenty-five percent of participants were impaired in executive function based upon Trail Making Test Part B, and 18% were impaired based upon Frontal Assessment Battery. 

Conclusions: In patients hospitalized with cardiovascular disease, unappreciated cognitive dysfunction is common. The dysfunction involves multiple domains and likely impedes patient participation in longitudinal care and their comprehension of health education which ultimately hinders the transition from hospital to home care. This process creates a setting of poor self-management with significantly increased potential for rehospitalizations.

Open Access Original Research Article

Postoperative Nausea and Vomiting Following General Anaesthesia: A Prospective Study on Surgical Patients in the University of Calabar Teaching Hospital, Calabar, Nigeria

Queeneth N. Kalu, Atim I. Eshiet, Sylvia G. Akpan, Emmanuel Monjok

Journal of Advances in Medicine and Medical Research, Page 1-12
DOI: 10.9734/BJMMR/2015/18030

Introduction: Postoperative nausea and vomiting remains a significant problem in our clinical setting. This study at the University of Calabar Teaching Hospital, Calabar in Nigeria aims to investigate the incidence of postoperative nausea and vomiting among gynaecological and non-gynaecological patients undergoing surgery under general anaesthesia, compare the incidence as it affects males and females, identify predisposing factors and recommend preventive measures.

Methodology: One hundred and sixty six(166) adult patients aged 18 years and above were recruited prospectively excluding cases of full stomach, patients with nasogastric tubes and those who could not be followed up for 24 hours. The past history of motion sickness and postoperative nausea and vomiting was obtained and documented. General anaesthesia was induced with either sodium thiopentone or ketamine hydrochloride. Maintenance was inhalational with or without a relaxant technique. Intravenous pentazocine and subanaesthetic doses of ketamine were used for intraoperative analgesia. The patients were observed postoperatively and questioned at two hourly intervals for nausea or vomiting and pain was scored using the categorical rating scale. A data sheet was completed at the end of 2 and 24 hours. The data was entered on a microcomputer for analysis with aid of EPI INFO version 6 software. The level of significance was set at 95% confidence interval with P value less than 0.05.

Results: The overall incidence of nausea was 11.45% and vomiting 13.35% in the 166 patients studied. There was no significant difference in incidence between the gynaecological and non gynaecological patients. Female patients experienced more postoperative nausea and vomiting than male patients with 11.4% and 18.42% nausea and vomiting. Sodium thiopentone induction, muscle relaxant use and reversal as well as moderate to severe postoperative pain increased the incidence of PONV

Conclusion: The use of prophylactic “balanced antiemesis” in high risk patients, avoidance of muscle relaxant reversal and adequate postoperative analgesia are recommended as preventive measures.

Open Access Original Research Article

Evaluation the Anxiety Status of Pregnant Women in the Third Trimester of Pregnancy and Fear of Childbirth and Related Factors

Tayebeh Nekoee, Mohammad Zarei

Journal of Advances in Medicine and Medical Research, Page 1-8
DOI: 10.9734/BJMMR/2015/19784

Aims: The present study has been conducted with the aim of evaluating the anxiety status of pregnant women in the third trimester of pregnancy and fear of childbirth and related factors.

Methodology: This longitudinal study was conducted in 2014 on 186 pregnant women attending health centers of Quchan city for receiving routine prenatal care. Demographic questionnaire, Glomberk questionnaire for the fear of birth and marital satisfaction-right (Grimes) and Spielberg State and Trait questionnaire were used on 3 occasions in the third quarter for data collection. Data were analyzed using the statistical package SPSS (version 20), analysis of variance test, T-test and one -way analysis of variance (ANOVA). P value of less than 0.05 was considered significant.

Results: According to the results, 47.2% of mothers suffered from moderate and severe anxiety and 43.5% suffered from covert moderate and severe anxiety. Average anxiety in pregnant women in the third round was more than the first and second round and this difference was statistically significant (F=10.33, P<0.002). In addition, there was a statistically significant correlation between age, educating level, employment status, abortion record, marital satisfaction and fear of childbirth (P<0.05), but there was no statistically significant correlation between factors such as number and type of delivery (P<0.05).

Conclusion: The results further indicated that maternal anxiety and trait increases with pregnancy age. Therefore, health care providers’ awareness of changes to mental health status of pregnant women is very important for the formulation of appropriate policies and measures to promote mental health during pregnancy.

Open Access Review Article

Ectopic Prostate in the Uterine Cervix / Female Genital Tract Including Vagina and Vulva: A Review of the Literature

Anthony Kodzo-Grey Venyo

Journal of Advances in Medicine and Medical Research, Page 1-14
DOI: 10.9734/BJMMR/2015/18101

Background: Men are known to have prostate glands but not women. The thought of prostate gland occurring in the female genital tract in women would be petrifying to all clinicians and people who are not aware of its biological behavior. Ectopic prostate in the uterine cervix (EPIUC) and the female genital tract (FGT) is very rare.

Aim: To review the literature on EPIUC/FGT and to document its biological behavior.

Methods: Information obtained from 17 references, was used for the literature review on EPIUC/FGT.

Results: Few cases of EPIUC/FGT have been reported at ages ranging between 21 and 82 years EPIUCs/FGTs may be diagnosed incidentally in biopsies of the cervix/vagina/vulva, or in hysterectomy specimens or they may mimic leiomyomas. Histological examination of cervical biopsies or of the cervix in hysterectomy specimens reveals ducts and acini some papillary or cribriform, with prominent squamous metaplasia EPIUCs/FGTs show positive Immunohisto-chemical staining for prostate specific antigen (PSA), prostatic-specific acid phosphatase (PSAP [PAP]), high molecular weight keratin (for basal cells). EPIUCs reported so far have exhibited benign behavior.

Conclusions: Information obtained from the literature would indicate that EPIUCs / FGTs are rare and so far have exhibited benign behavior. Clinicians should report cases of EPIUC/FGT in order to establish whether or not EPIUCs/FGTs may or may not develop into carcinomas in the future.

Open Access Review Article

Pathogenesis and Mutations of Myeloproliferative Neoplasms: An Overview

Yonal-Hindilerden Ipek, Hindilerden Fehmi, Sargin Deniz

Journal of Advances in Medicine and Medical Research, Page 1-24
DOI: 10.9734/BJMMR/2015/17689

Chronic myeloproliferative neoplasms (MPNs), clonal disorders of hematopoietic system resulting in abnormal proliferation of one or more hematopoietic cell lineages, express different clinical, hematologic and biological features. The majority of classical MPNs -95% of polycythemia vera (PV) and half of essential thrombocythemia (ET) and myelofibrosis (MF) patients- display alterations in the JAK2 gene.  JAK2 wild-type ET, and MF patients lack features of PV. Driver mutations in pathogenesis of Philadelpiha-negative MPNs - JAK2, MPL and calreticulin (CALR)- all play pivotal roles in cytokine signaling in hematopoiesis. Negative regulators of signaling pathways, LNK and CBL are infrequently targeted genes in MPNs. Mutated or deleted transcription factors such as IKZF1, EZH2, Tp53 and RUNX1, are present in a low proportion of patients with MPN. Some of these factors, such as IKZF1 and Tp53, were associated with transformation to acute myeloid leukemia (AML), yet their prognostic impact needs to be elucidated. Mutations of CHEK2, the tumor suppressor gene against uncontrolled cell growth, were associated with susceptibility to ET. Mutations of NRAS gene, a member of  MAPK signaling pathway frequently mutated in MPNs, seem to affect expression of JAK2 target genes and  are primarily associated with transformation to AML. Mutations in epigenetic regulators including TET2, DNMT3A, ASXL1, EZH2, and IDH1/2 were described in MPNs and other myeloid malignancies at variable frequencies. The somatic mutation of SRSF2, one of the RNA splicing machinery genes, was associated with worse survival and increased leukemic transformation in PMF. Alterations in DNMT3A, ASXL1, EZH2, and IDH1/2 are more frequent in PMF than PV and ET. Recent studies suggest that for Ph-negative MPNs, mutations affecting epigenetic regulation might be prognostically more relevant than mutations affecting JAK-STAT signaling. Mutations in CALR were newly discovered in a majority of JAK2V617F- and MPL-negative ET and MF patients. In MPNs,
genetic abnormalities affecting epigenetic regulation are often expressed in patients carrying JAK2, MPL, or CALR mutations, indicating a cooperation between these two classes of mutations in MPN pathogenesis. This review summarizes pathogenesis and molecular events of MPNs.

Open Access Review Article

Non-Helicobacter pylori, Non-NSAID Peptic Ulcer Disease: An Important Consideration in the Evaluation of Patients with Gastric or Duodenal Ulcers

Julian P. Yaxley

Journal of Advances in Medicine and Medical Research, Page 1-8
DOI: 10.9734/BJMMR/2015/19580

Peptic ulcers are common although the pattern of aetiology is changing. The traditionally most frequent causes of Helicobacter pylori infection and non-steroidal anti-inflammatory toxicity are likely to assume less relative importance as the proportion of cases attributed to other causes rises. Primary care physicians should be aware the pathogenesis of peptic ulceration in non-H. pylori non-NSAID induced disease. This article considers the various less prevalent causes of peptic ulcers and outlines their evaluation and management. Greater awareness of such conditions will improve patient care when traditional causes and remedies are absent.