Open Access Case Study

Severe Alopecia Complicating Systemic Sclerosis

Dilia Giuggioli, Michele Colaci, Giulia Cassone, Clodoveo Ferri

Journal of Advances in Medicine and Medical Research, Page 1-4
DOI: 10.9734/BJMMR/2015/19589

Aims: To describe a case of systemic sclerosis (SSc) associated with severe alopecia areata (AA) responsive to topical and systemic treatments, including vasoactive and immunosuppressive drugs (mycophenolate mofetil).

Presentation of the Case: A 56 year old woman, affected by SSc as from 5 years back, developed a rapid hair loss that progressively involved a large area of the scalp. AA was diagnosed, after the exclusion of an overlapping systemic lupus erythematosus or fungal infection. Treatment with topical steroids and minoxidil, plus mycophenolate mofetil that was introduced for interstitial lung disease, led to progressive improvement of alopecia up to a complete resolution within 4 months.

Discussion: This is an interesting observation of SSc complicated by severe AA, which is often observed in patients affected by various autoimmune disorders. A possible common pathogenesis of AA and SSc is also discussed.

Open Access Case Study

The Effect of Buprenorphine and Bupropion in the Treatment of Methamphetamine Dependency and Craving

Jamshid Ahmadi

Journal of Advances in Medicine and Medical Research, Page 1-4
DOI: 10.9734/BJMMR/2015/19334

Background: Methamphetamine dependency and abuse is a growing problem in the world.

Objective: To compare efficacy of buprenorphine and bupropion in the treatment of methamphetamine craving in a single case.

Results: Buprenorphine is more effective than bupropion in the treatment of methamphetamine craving.

Discussion: This case indicates although both buprenorphine and bupropion could be beneficial in treating methamphetamine dependency and withdrawal craving, however, buprenorphine is much more effective than bupropion.

Conclusion: To our knowledge there is not any report on buprenorphine use in the treatment of methamphetamine craving in Iran and other countries as well, therefore this case-study of an Iranian patient could represent the most innovative information.

Open Access Case Study

A Case of Age Related Macular Degeneration Responding to a Statin – Perspective for a New Treatment

Helmut Gohlke, Lutz L. Hansen

Journal of Advances in Medicine and Medical Research, Page 1-6
DOI: 10.9734/BJMMR/2015/19135

The newly started use of atorvastatin eliminated the need for further intravitreal injections of ranibizumab for 37 months in a case of wet form of age related macular degeneration(AMD). Repeated optical coherence tomographic examinations documented the absence of intra- or subretinal fluid. The known effects of statins on endothelial function might also improve retinal capillary endothelial function and reduce or eliminate fluid leakage into the intra- or subretinal space. This would intervene earlier in one important disease mechanism of AMD than the injection of anti-VEGF therapies. A randomized study is necessary to prove this hypothesis.

Open Access Case Study

Diode Laser – A Boon in the Treatment of Mucocele – A Case Report

Shakti Agarwal, Shailesh Kumar, Haider Iqbal, Kamini Kiran, Abhishek Sinha, Rameshwar Singh

Journal of Advances in Medicine and Medical Research, Page 1-5
DOI: 10.9734/BJMMR/2015/15245

A mucous cyst (mucous extravasation cyst, mucocele, ranula, mucous retention cyst) is a thin sac on the inner surface of the lips. They are painless swellings but can be bothersome. The cysts are thought to be caused because of trauma by sucking of the lip membranes between the teeth, if left untreated; they can organize and form a permanent bump on the inner surface of the lip. They are known as ranula when on the floor of the mouth, and epulis when present on the gums. This article highlights the advantages and evaluates the efficacy of treatment of mucocele with the help of diode lasers.

Open Access Original Research Article

Studying the Rate of Physical and Emotional Abuse among Elementary School Students of Isfahan in 2014 and Its Relation with Some of the Cognitive Demographic Characteristics for Better Health Care

Heidar Ali Abedi, Abbas Abbaszadeh, Minoo Motaghi

Journal of Advances in Medicine and Medical Research, Page 1-11
DOI: 10.9734/BJMMR/2015/19645

Aim: Determining the rate of physical and emotional abuse among elementary school students of Isfahan and its relation with demographic characteristics

Place and Duration of the Study: The study was conducted in 12 elementary school of Isfahan in central Iran from November to January of 2014.

Methods: In this analytic descriptive study 500 elementary students from 12 elementary schools under supervision of The Education Department of Isfahan, central Iran, were participated. Samples were selected through multi-step random sampling. Data was gathered using a researcher made questionnaire about some individual and family characteristics and physical and emotional abuse from January to November 2014. Data was analyzed using SPSS software and by appropriate analytic descriptive statistics.

Results: Results showed that “you were forced to stand in the corner of the class” among choices for physical abuse (mean = +1.87, -0.96) and “you were shout at” among choices for emotional abuse (mean = +1.80, -0.98) gained the highest mean scores. There was a significant relation between the age and sex of student and their fathers’ job with the rate of physical and emotional abuse. But mothers’ education only had a statistically significant relation with emotional abuse. There was no significant relation between fathers’ education and mothers’ job with the rate of physical and emotional abuse.

Conclusions: Since physical and emotional abuse does exist among elementary school students, and it is more in boys rather than girls and in older students rather than younger students, careful planning, supervisory actions and necessary educations regarding this field are essential.

Open Access Original Research Article

A 66 Patient Multi-Institution Phase IV Post-Authorization Surveillance of ProThelial™ (High Potency Polymerized Cross-linked Sucralfate) -Single Agent Efficacy for the Prevention and Rapid Reversal of Chemo-radiation Induced Oral, Esophageal and Intestinal Mucositis

R. W. McCullough

Journal of Advances in Medicine and Medical Research, Page 1-17
DOI: 10.9734/BJMMR/2015/19755

Background: Standard potency sucralfate is not recommended by most clinical guidelines for prevention or treatment of oral and intestinal mucositis. However, its polymerized cross-linked (thereby high potency) formulation (HPPCLS) was cleared by the FDA for management of oral mucositis and has been associated with complete prevention and rapid reversal of oral, esophageal and intestinal mucositis. Statistically significant high quality evidence from a 66 patient multi-institution phase IV non-controlled observation study is reported here.

Patients and Methods: In February 2014, as part of the Phase IV post-approval surveillance of HPPCLS, a non-interventional mucositis registry was established. The primary aim of the registry was the surveillance of patients’ tolerance of HPPCLS. A secondary aim was the observation of the prescribing pattern of oncologists using HPPCLS to manage chemo-radiation induced mucositis.  

Inclusion Criteria: Any cancer treatment patient who developed or was anticipated to develop oral mucositis and was prescribed HPPCLS. 

Exclusion Criteria: Allergies or prior adverse reactions to sucralfate.

Conduct of Study: Patients identified by oncology clinical staff with mucositis or anticipated to develop mucositis, were prescribed a 75 ml single week-supply of HPPCLS as needed. 

Results: Thirty-nine oncologists from 32 institutions prescribed HPPCLS to 66 patients. No adverse reactions were reported. Five patients were lost to follow-up and 61 patients reported outcomes. Eight patients experienced successful prevention of mucositis averting placement of gastrostomy tube and the remaining 53 patients with WHO-Grade 1-3 mucositis involving the mouth, esophagus, small bowel & colon experienced reversal in 2-3 days. Though cleared for oral use only, 48 of 61 patients were instructed by oncologists to swallow HPPCLS following swish-and-gargle.

Statistical Analysis: Quantitative Glasziou rate-ratio treatment effect beyond 10 (37-82 for HPPCLS) supported efficacy (p≤0.05).

Conclusion: HPPCLS paste may offer oncologists a single-agent approach to manage chemo-radiation induced mucositis. To wit a protocol is offered for practical use.

Open Access Original Research Article

Review of Genotoxic Effects for Pesticides Exposure among Rural Community in a Farming Village

Vivien How, Zailina Hashim, Patimah Ismail, Dzolkhifli Omar, Shamsul Bahri Mohd Tamrin, Salmiah Md Said

Journal of Advances in Medicine and Medical Research, Page 1-7
DOI: 10.9734/BJMMR/2015/19402

Background: Past studies have suggested that early exposure of farm children to chronic pesticides were likely to establish genotoxic risk that might lead to cancerous cell development later during their adulthood (if not repaired properly).

Objective: This review aims to fill the knowledge gap concerning the genotoxic effect on the rural community in a farming village from exposure to a mixture of pesticides.

Results: This review paper shows substantial evidence that farmers were vulnerable to pesticide exposure, however, limited evidence shows that children are at an increased or equivalent risk in terms of the genotoxic effect when considering their exposure to the contaminated environment.

Conclusion: This paper summarizes the existing state of knowledge concerning the genotoxic effects from pesticide exposure among farmers and their children, and highlights the genotoxic effect of pesticides as a health risk for future studies.

Open Access Original Research Article

Effect of Symptom Graduation on Oncologic Outcomes in Patients with Renal Cell Carcinoma and Hematuria

Eder N. Ilário, Eduardo P. Miranda, Marcos F. Dall’Oglio, Jose R. Jr. Colombo, Giuliano B. Guglielmeti, William C. Nahas, Miguel Srougi

Journal of Advances in Medicine and Medical Research, Page 1-8
DOI: 10.9734/BJMMR/2015/19243

Aims: Symptoms associated with renal cell carcinoma characterize high-risk disease. Hematuria is the most common symptom and usually occurs as a result of urothelial invasion.  The objective of this study was to evaluate the prognostic value of progressive symptomatic disease in patients with kidney cancer.

Place and Duration of Study: Sao Paulo Cancer Institute at University of Sao Paulo School of Medicine between 2005 and 2009.

Methodology: Data was prospectively recorded at our database and retrospectively reviewed. Sixty-six individuals who presented with macroscopic hematuria were included in our analysis. Patients were divided into three groups: (1) Exclusive hematuria (27 patients), (2) Hematuria associated with another symptom (23 patients), and (3) Hematuria associated with two or more symptoms.  We evaluated these groups for histopathology, kidney function, recurrence, and survival characteristics.

Results: Mean tumor diameter was 8.5 cm, 11 cm and 13.4 cm for groups (1), (2) and (3). Recurrence-free survival was 89%, 91%, and 69% and overall survival was 96%, 79%, and 56% for groups (1), (2) and (3), respectively.  The mean follow-up time was 97.6 months and the disease-free survival rate was 84.8%. Cox regression analysis showed a death risk 10.5 times higher in group (3) when compared to Group (1). 

Conclusion: Association of two or more symptoms with hematuria impairs prognosis of patients surgically treated for kidney cancer.

Open Access Original Research Article

The Role of Antigravity Treadmill in Haemophilic Children Aged 8 to 11 Years with Unilateral Knee Haemarthrosis without Radiological Involvement

Hatem Abd Al-Mohsen Emara

Journal of Advances in Medicine and Medical Research, Page 1-10
DOI: 10.9734/BJMMR/2015/19132

Background: Recurrent joint bleeding in children with hemophilia leads to joint damage with pain, loss of range of motion and function. Antigravity treadmill (AGT) allows unloading of the lower extremities during exercise in a pressurized treadmill chamber.

Aim: To investigate the effect of AGT on muscle strength and functional balance in children with hemophilic knee arthritis.

Study Design: Prospective, randomized controlled study.

Place and Duration of Study: The outpatient clinic, Medical rehabilitation hospital, and King Fahd  Hospital, Almadinah Almonawarah, Kingdom of Saudi Arabia, between January 2015 and Mars 2015.

Methods: Thirty hemophilic male children with unilateral knee heamarthrosis in the age ranged from 8 to 11 years old were randomly allocated into two equal groups. The control group (group A) received traditional exercise program, while the study group (group B) received AGT gait training added to the same exercise program of group A. Training was applied three times per week for twelve consecutive weeks. All children were assessed at baseline and after 36-session. Assessment included peak torque of quadriceps and hamstring muscles using  Biodex Isokinetic Dynamometer and functional balance using Pediatric Berg balance scale (PBBS).

Results: Significant differences were observed in both groups when comparing their pre and post treatment mean values of all measuring variables (p<0.05). Peak torque of the quadriceps  changed from (32.60±1.183, 32.933±1.533) to (38.40±1.681, 40.466±1.060) and peak torque of the hamstring changed from (25.00±1.81265, 25.933±2.0517) to (32.533±2.474, 35.933±2.631) for the control and study group respectively, indicating more improvement  in favor of the study group. Both groups demonstrated a significant increase in functional balance, with more improvement in favor of group B.

Conclusion: It can be concluded that gait training using AGT may be used as a therapeutic intervention for improving muscle performance and functional balance in children with hemophilic knee arthritis. Although our sample was not large, the effect size was moderate to large (0.85 and 0.83) for the knee extensors and flexors respectively and 0.553 for PBBS.

Open Access Review Article

Brucellosis of Testis and Epididymis: A Review of the Literature

Anthony Kodzo-Grey Venyo

Journal of Advances in Medicine and Medical Research, Page 1-19
DOI: 10.9734/BJMMR/2015/17310

Background: Brucellosis is a zoonotic disease which can afflict a number of organs and tissues. Brucellosis epididymo-orchitis (BEO), a complication of human brucellosis, can lead to other complications. In brucellosis non-endemic areas, some clinicians may be unfamiliar regarding the disease entity which may lead to delay in the diagnosis.

Aims: To review the literature on BEO, in order to document its presentation, diagnosis, management and outcome following treatment.

Methods: Various internet data bases were used to obtain literature on BEO.

Results/Literature Review: BEO (epididymitis plus or minus orchitis) is a complication of brucella species which can be transmitted by direct contact through the respiratory tract, skin, or conjunctiva, and through the gastrointestinal tract after ingestion of unpasteurized milk/milk products or raw infected meat. BEO may in endemic areas affect 2 to 20% of patients with brucellosis but the disease can also be encountered sporadically globally in non-endemic areas. BEO may at times be bilateral. The presentation of BEO is non-specific and it may be mistaken for non-specific epididymo-orchitis or epididymitis or testicular tumour or abscess. Ultrasound and MRI scan findings are not specific to BEO. Diagnosis of BEO may be established by (a) history of contact, (b) cultures from blood/epididymal aspirations, (c) various types of laboratory studies including (I) Culture, (II) Polymerase chain reaction (PCR), and (III) serology. Laboratory criteria for the diagnosis of Brucellosis is divided into (I) those for presumptive diagnosis and (II) those for confirmatory diagnosis: BEO can be effectively treated by means of combination chemotherapy for about six weeks but at times ochidectomy or drainage of testicular collection  may be required for persistence of symptoms or suspicion of a tumour/testicular abscess. Relapses can occur therefore careful follow-up is required.

Conclusions: BEO can occur anywhere globally. A high index of suspicion is required from clinicians in order to establish early diagnosis. Most cases of BEO can be effectively treated with combination chemotherapy for about 6 weeks and triple antibiotic therapy would appear to be most effective and associated with absence or reduction of relapse.