Open Access Case Study

Anti-musk Myasthenic Crisis in the Puerperium: The Management Dilemma

Peter Appiah–Thompson, Yaw Asante Awuku, Paul Masiowski, Benedicta L. Appiah–Thompson, Olukemi Olawaiye Dampson

Journal of Advances in Medicine and Medical Research, Page 1-5
DOI: 10.9734/BJMMR/2015/20381

Myasthenia gravis (MG) is a chronic neuromuscular junction (NMJ) dysfunction with a wide spectrum of neurological manifestations. MG is as a result of autoantibodies directed against NMJ at the postsynaptic level involving nicotinic or other postsynaptic antigens. The newly identified subtype of MG with antibodies against the muscle-specific receptor tyrosine kinase (Anti-MuSK) shows an unpredictable response to current MG treatment. The initial presentation of this disease entity often poses a diagnostic challenge and a treatment dilemma to the clinician. We present a case of life threatening Anti-MuSK-positive myasthenic crisis occurring during puerperium which required a temporary surgical airway and percutaneous endoscopic gastrostomy tube for feeding. She had dysphonia for 7 years but was not diagnosed. The complications and management dilemma of this case report are highlighted.

Open Access Case Study

Focal Caroli’s Disease Presenting as Fusiform Dilatation of Intrahepatic Biliary Radicles

Simmi Aggarwal, Rashmeet Kaur, Sarabjot Kaur, Ravinder Garg

Journal of Advances in Medicine and Medical Research, Page 1-6
DOI: 10.9734/BJMMR/2015/19776

Background Caroli's disease is a rare congenital disorder characterized by segmental, non obstructive, cystic dilatation of intra hepatic bile ducts. It belongs to the spectrum of fibropolycystic liver disease which results from in utero malformation of ductal plate. Two forms of this disorder have been described, the less common 'Pure' form involves only the large intrahepatic bile ducts and the more 'complex' form is associated with congenital hepatic fibrosis (CHF), and is known as Caroli's Syndrome. Case A young female presented with features of cholangitis and in addition to all the routine investigations, non invasive imaging in the form of ultrasonography, computed tomography and magnetic resonance imaging was done. Diagnosis Final diagnosis of focal Caroli's disease with cholangitis was made on clinical and imaging findings. Treatment Conservative treatment was given and patient referred to gastro surgery department for partial hepatectomy. Conclusion An early recognition of Caroli's disease with non invasive imaging can bring down the morbidity.

Open Access Minireview Article

Antioxidant Therapy in Tinnitus

Oguz Kadir Egilmez, M. Tayyar Kalcioglu

Journal of Advances in Medicine and Medical Research, Page 1-7
DOI: 10.9734/BJMMR/2015/20125

Oxidative stress and reactive oxygen species (ROS) have been working in the pathophysiology of various chronic diseases. Under normal circumstances, the human cochlea has some antioxidant molecules which can scavenge the oxidant substances and ROS to avoid the possible damage into the inner ear. In tinnitus therapy, several forms of complementary and alternative medicine (CAM) are increasingly popular but they are generally selected with or without professional guidance. Although several antioxidant agents like vitamin A, C, E and glutathione can be used in the treatment of tinnitus as CAM, melatonin, N-acetyl cysteine (NAC) and coenzyme Q10 (CoQ10) were especially used as alternative for classic antioxidants. According to the literature, it seems antioxidant therapy in patients with idiopathic tinnitus may reduce oxidative stress and damage to the inner ear. And also it can reduce the intensity and discomfort of tinnitus. Further clinical studies are necessary to determine antioxidants’ protective role and to choose the appropriate therapeutic protocol.

Open Access Minireview Article

Infections of Cardiac Implantable Electronic Devices: Diagnosis and Approach

Rose Mary Ferreira Lisboa da Silva, Alessandra de Souza Maciel

Journal of Advances in Medicine and Medical Research, Page 1-8
DOI: 10.9734/BJMMR/2015/20118

With the expansion of the indications for implantation of cardiac electronic devices, there was an increase in these procedures and, consequently, there was an increase of the infection rate. The risk of infection depends on many factors, including device type and the number of implantation procedures. In addition to significant morbidity, one-year mortality is approximately 20%. Knowledge of the factors associated with this unfavorable outcome, clinical manifestations, diagnosis and treatment are very important for proper approach. This review presents all these aspects and strategies for the prevention of infection related to implantable electronic cardiac devices.

Open Access Original Research Article

Short Sleep Duration and Correlates among Sero-positive HIV Patients in Nigeria, West Africa

Rasaq O. Shittu, Louis O. Odeigah, Alabi K. Moradeyo, Musa A. Sanni, A. Aderibigbe, Abdullateef G. Sule, B. S. Okesina, Salamat Isiaka Lawal, Jimoh O. Kamaldeen

Journal of Advances in Medicine and Medical Research, Page 1-10
DOI: 10.9734/BJMMR/2015/19630

Introduction: Short sleep duration is a salient issue because it is a major public health concern and has more wide-reaching problems among HIV/AIDS patients. Short sleep duration was said to be associated with lower CD4 count, higher viral load values, depression, high blood pressure, high body mass index and disease progression. It was also documented that patients receiving efavirenz had shorter duration of deep sleep. Incidentally there is paucity of data in Nigeria to support these claims hence the need to investigate.

Methods: Four hundred HIV zero-positive patients were recruited at the HIV clinic of Kwara State Specialist Hospital, Sobi, Ilorin, after institutional ethical approval and informed consent was obtained. Blood pressure was measured. Classification of hypertension was made according to the seventh report of the Joint National Committee on Prevention, Detection, Evaluation and Treatment of high blood pressure (JNC-7). Body Mass Index was calculated as (kg/m2). The Patient Health Questionnaire (PHQ-9) was administered to the respondents to screen for depressive symptoms. The Pittsburgh Sleep Quality Index (PSQI) was used to assess sleep duration. The respondents were categorized into four groups viz, sleeping more than 7 hours, 6-7 hours, 5-6 hours and less than 5 hours. Subjects with <5hrs are poor sleepers while those with >7hrs were good sleepers.

Results: Four hundred HIV-infected patients were recruited with a mean age of 39yrs (SD 9). Eighty four (21%) were male, while 316 (79%) were female. The mean body mass index was 22.0 (SD 4.6), mean present CD4 count was 339.0 (SD 180.6). One hundred and eighty three respondents (45.8%) slept less than 5 hours, while 58 (14.5%) sleep more than 7hours. Short sleep was commoner in the age group 31-40 73(39.9%), among the female 145(79.2%) and those that were married 103(56.7%), and those with non-formal education 84(45.9%). Traders 80(43.7%) had highest number than other occupation. Short sleepers of less than 5 hours were prone to high blood pressure; higher body mass index and depression. This was statistically significant. The lower the CD4 count, the more the short sleep duration observed among the respondents. Patients receiving HAART containing efavirenz had shorter duration of deep sleep.

Conclusion: Almost half of the respondents were poor sleepers with associated high blood pressure and increased body mass index (BMI). Both effects of the virus and antiretroviral drugs may cause short sleep duration. Health providers managing HIV positive patients, need to take complaints of short sleep duration seriously, because they can indicate an increased risk for low CD4 counts, high viral load, depression, high blood pressure and increase body mass index. There is the need for targeting efforts to improve short sleep duration for the majority of adults living with HIV/AIDS and tailoring appropriate interventions.

Open Access Original Research Article

Management of Oral Leukoplakia Using Diode Laser: A Pilot Study

Kotu Nagavenkata Sai Praveen, Gajendra Veeraraghavan, Reddy Sudhakara Reddy, Pavani Kotha, Jyothirmai Koneru, Kalyan Yelisetty

Journal of Advances in Medicine and Medical Research, Page 1-6
DOI: 10.9734/BJMMR/2015/19178

Aim: To evaluate the effectiveness of 810-nm diode LASER in the management of patients with oral leukoplakia.

Materials and Methods: A total of 10 cases diagnosed clinically and histopathologically as leukoplakia were included in the present study. All the cases were treated using 810-nm diode LASER at a power of 5 watts and followed up for 3 months and assessed for pain and healing post-operatively.

Results: All the lesions healed within duration of 3-4 weeks without scarring. Complications or recurrence has not been noticed in any of the patients except for mild pain during follow up period.

Conclusion: Patient acceptance was found to be high using 810-nm diode LASER without compromising health and function. Thus usage of diode LASER may indeed be the best choice in the management of oral leukoplakia.

Open Access Original Research Article

Beliefs, Practices and Evaluation of Non-prescribed Antibiotics Use among Children in Madinah, Saudi Arabia

Duoaa Abdoh, Maryam Fahmie, Muatasim Noorelahi

Journal of Advances in Medicine and Medical Research, Page 1-9
DOI: 10.9734/BJMMR/2015/20210

Objectives: To assess the current knowledge, beliefs, awareness and practices of the Saudi population attending Maternity and Children Hospital (MCH) in Madinah City, Saudi Arabia  using non-prescribed antibiotics for their children.

Methods: A cross-sectional study was conducted. Socio-demographic, knowledge, beliefs, awareness and behaviour data related antibiotics and patterns of antibiotics usage (PAPA scale) were collected. The knowledge, beliefs, awareness, and behaviours data were compared between subjects using non-prescribed antibiotics for their children and those did not by using appropriate statistical methods.

Results: 170 subjects reported using non-prescribed antibiotics for their children (48.5%). The average score of negative knowledge and beliefs about antibiotics misuse was higher among subjects using non-prescribed antibiotics. It was 4.3±3.1 among subjects using non-prescribed antibiotics for their children compared to 1.7±3.2 among those not using non-prescribed antibiotics.  Also, the average positive score of behaviour and awareness was lower among subjects using non-prescribed antibiotics. The average score of the studied behaviour and awareness was found to vary by the educational level of the studied subjects with the higher average score was among of highly educated subjects.

Conclusion: The study revealed a considerable high proportion of the Saudi population using non-prescribed antibiotics for their children. The average score of negative knowledge and beliefs and positive score of behaviour was found to vary by the usage of non-prescribed antibiotics and by the educational level of the studied cohort. There is a need to conduct more community-based studies and to deliver health education programs about the dangers of antibiotics misuse through mass media.

Open Access Original Research Article

Incidence of Hypoglycaemia in a Paediatric Emergency Ward in Nigeria

C. N. Onyearugha, I. O. George

Journal of Advances in Medicine and Medical Research, Page 1-8
DOI: 10.9734/BJMMR/2015/13339

Objective: The study was conducted to determine the incidence of hypoglycaemia and some associated factors in children presenting as emergency in Aba, Nigeria.

Materials and Methods: This was a hospital based prospective descriptive study conducted in the children’s emergency ward (CHEW) of Abia State University Teaching Hospital (ABSUTH), Aba over a ten month period. Three hundred and eight children aged twenty nine (29) days to sixteen (16) years were enrolled. The patients’ biodata, detailed history and physical examination findings were recorded in a study proforma. Random blood sugar (RBS) was done on all patients at presentation and subsequently on hypoglycaemic patients using glucometer. Hypoglycaemia was defined as RBS < 2.2 mmol/l. Data analysis was done using SPSS version 11.0. P value < 0.05 was taken as statistically significant for all analyses.

Results: The incidence of hypoglycaemia was 7.5%. Hypoglycaemia was significantly associated with age less than 5 years, interval of more than 4 hours between the last meal and presentation, shorter duration of admission, coma and death.

Conclusion: The incidence of hypoglycaemia in this study is high and its contribution to mortality significant. Ill looking children particularly those aged less than five years or in coma presenting in emergency units should be mandatorily investigated for hypoglycaemia and managed aggressively if detected.

Open Access Original Research Article

Evaluation of Spatial Accessibility to Ohio Trauma Centers Using a GIS-Based Gravity Model

Wei Chen, Krista K. Wheeler, Yungui Huang, Simon M. Lin, Daniel Z. Sui, Huiyun Xiang

Journal of Advances in Medicine and Medical Research, Page 1-10
DOI: 10.9734/BJMMR/2015/20378

Aims: Traumatic injury is one of the leading causes of death in all age groups. Ensuring adequate and effective access to trauma centers is key to improving the quality of care for injured patients. This study evaluates the spatial accessibility of Ohio trauma centers and identifies potentially underserved Ohio counties.

Study Design: A gravity based accessibility model using a Geographic Information System (GIS) was implemented.

Place and Duration of Study: The study was conducted in Nationwide Children’s Hospital in 2015.

Methodology: A gravity based accessibility model using a Geographic Information System (GIS) was adapted to incorporate US census data, trauma center location data, and trauma center utilization data to quantify accessibility to trauma centers at both the zip code and county levels. An underserved index was developed to identify the location and clustering pattern of underserved regions within the state.

Results: Most served counties were about 10 times more served than an average county while least served counties were about 4 times less served than an average county.

Conclusion: Findings of this study are potentially useful for evaluating regionalized trauma care and provide evidence for trauma care system improvements.

Open Access Original Research Article

Diet in Patients with Non-Alcoholic Fatty Liver Disease: A Pilot Study

Azita Hekmatdoost

Journal of Advances in Medicine and Medical Research, Page 1-6
DOI: 10.9734/BJMMR/2015/20326

Aim: The aim of this study was evaluating the role of diet in induction and management of NonAlcoholic Fatty Liver Disease (NAFLD).

Place and Duration of Study: The study was performed in Taleghani Hospital, Tehran, Iran for one year.

Methodology: Dietary intakes of 24 patients with biopsy proven NAFLD referring to Taleghani Gastroenterology Clinic (Tehran, Iran) were analyzed by a detailed food frequency questionnaire. Dietary intervention including a proper dietary intake and advice on increasing individual activities was applied for them, and the effect of it was assessed after 6 months.

Results: we did not find any significant differences between patients with NAFLD and healthy control population in the case of blood pressure, blood glucose, total cholesterol, and HDL cholesterol, but weight, height, BMI, waist, waist/hip ratio, and triglycerides, were significantly higher in patients than controls. The carbohydrate intake in patients was significantly more than controls while the protein consumption was significantly lower in patients than controls. We did not find any significant difference in the other dietary intakes. All anthropometric, biochemical, and histopathologic characteristics of the patients decreased after six months dietary intervention, however none of these differences were statistically significant.

Conclusion: Our results indicate that dietary intake in patients with NAFLD is different from normal population, and a 6-month dietary and life-style consultation might result in improvement in clinical and para-clinical features of NAFLD.