Open Access Case Study

Clinical and Imaging Findings of Symptomatic Right Aortic Arch and Double Aortic Arch: Case Report

Hakan Demirtas, Ahmet Orhan Çelik, Harun Tepeli, Ayşe Umul, Aykut Recep Aktaş

Journal of Advances in Medicine and Medical Research, Page 1-7
DOI: 10.9734/BJMMR/2015/19837

Aim: Anomalies of aortic arch are uncommon, accounting for only 1-3% of all congenital cardiac diseases. A vascular ring results from the abnormal development of an aortic arch complex. Generally, it manifests with tracheoesophageal compression symptoms during infancy. We aimed to discuss clinical and imaging findings of two cases of vascular ring based on existing literature.

Cases: This article presents two cases of a 4-year-old child diagnosed with right sided aortic arch and a new-born child diagnosed with double aortic arch in neonatal unit. The first patient presented with complaints of coughing, wheezing and shortness of breath, the second patient suffered from respiratory distress. In the both cases, diagnosis were established using multi-detector computed tomography (MDCT). Both patients were diagnosed with vascular ring, considering their existing findings, and referred for surgery.

Discussion: Apparent airway obstructions lead to critical complaints at early ages. Moderately severe symptoms and the non-existence of anatomic compression may cause resulting diseases to be diagnosed in a later period of life. A vascular ring can be diagnosed using chest radiography, barium oesophagus graphy, transthoracic echocardiography, MDCT, magnetic resonance imaging and angiography. However, pathologies of the studied cases (right aortic arch, double aortic arch, and tracheal compression) are effectively observed with MDCT and using the post-processing images of MDCT.

Conclusion: A vascular ring should be considered in the event of recurrent lung infections, unexplained coughs, wheezing and stridor during childhood as well as in the case of unexplained respiratory distress in new-born children. MDCT is an excellent modality for patients suspected of having a vascular ring.

Open Access Case Study

Idiopathic Necrotizing Scleritis, Anterior Uveitis, and Localized Retinal Detachment

Jelena Paovic, Predrag Paovic, Dejan Rasic, Anka Stanojevic

Journal of Advances in Medicine and Medical Research, Page 1-9
DOI: 10.9734/BJMMR/2015/19161

Aim: To present clinical picture and treatment of anterior idiopathic necrotizing scleritis.

Methods: Clinical and laboratory examination; B-scan ultrasound; tissue biopsy and histological analysis, were performed.

Results: Herewith we depict a case of 74 year old man, with unilateral granulomatous, anterior, necrotizing scleritis. Etiology has, through extensive testing, both laboratorial and clinical, not been proven and thus the patient has been classified as having idiopathic scleritis. Complications on both anterior (anterior uveitis) and posterior (subretinal granulomatous infiltrates with localized retinal detachment) segments of the eye are a consequence of granulomatous necrotizing scleritis. Both tissue biopsy of granulomatous scleral infiltrates and histological analysis showed that this is the case of granulomatous, partially necrotizing scleritis with some elements of vasculitis. Progression of granulomatous scleral infiltrates into the eye has also been shown through clinical examination and B-scan ultrasound, and depicted subretinal lesion of medium reflectivity that is in contact with the epibulbar lesion. Retinal detachment in this area had progressed and required excessive laser photocoagulation barrage and resulted in absorption of subretinal fluid. Positive therapeutic outcome was achieved through the use Methotrexate and corticosteroids.

Conclusion: Granulomatous infiltrates that spread towards the subretinal space and result in localized retinal detachment are a rare complication that may occur during the evolution of necrotizing scleritis and require regular monitoring and followup. Treatment, both pharmaceutical and laser photocoagulation, should be adjusted in order to affect progression and prevent possible complications of the disease.

Open Access Original Research Article

A New Anionic Bovine Tendon as Scaffold for the Repair of Bone Defects: A Morphological, Histomorphometric and Immunohistochemical Study

Rogerio L. Buchaim, Marcelie P. de O. Rosso, Jesus C. Andreo, Daniela V. Buchaim, Roberta Okamoto, Antonio de C. Rodrigues, Andre L. Shinohara, Jose S. Roque, Domingos D. Roque, Geraldo M. Rosa Junior, Gilberto Goissis

Journal of Advances in Medicine and Medical Research, Page 1-11
DOI: 10.9734/BJMMR/2015/19678

Aim: The process of bone repair is of evident importance in both the clinical and functional spheres. For this reason, the field of bioengineering has taken it as an object of study, seeking to perfect the implantation of materials that allow for adequate bone neoformation. This study investigated the process of bone repair after anionic bovine tendon grafting in rat tibias by conducting a morphological, histomorphometric and immunohistochemical study.

Methodology: The experimental model consisted of 36 rats randomly divided into two groups: a control group (CG, n=18), in which a surgical cavity in the tibia was filled with blood clots; and an experimental group (EG, n=18), in which a surgical cavity in the tibia was filled with an anionic bovine tendon graft. In the experimental group, the major axis of the collagen fiber bundle was placed perpendicularly to the long axis of the tibia. Microscopic, morphometric and immunohistochemical evaluations were conducted at 7, 15, and 30 days postoperative.

Results: The analyzes showed an increase in bone neoformation in the experimental group during the assessed periods. There was a significant difference between day 7 and day 30 and evident vascular proliferation was detected by the immunohistochemical analysis.

Conclusion: It can be concluded that the anionic bovine tendon collagen proved to be an adequate and biocompatible material for bone regeneration, with osteogenic capabilities that allow it to be used as a scaffold for bone repair.

Open Access Original Research Article

Regenerated Bisphosphonate Related Osteonecrosis of the Jaws: Clinical Data of Eleven Cases

Müge Çina Aksoy, Gülperi Koçer, Murat Koçer, Timuçin Baykul

Journal of Advances in Medicine and Medical Research, Page 1-8
DOI: 10.9734/BJMMR/2015/20096

Aims: Bisphosphonate-related osteonecrosis of the jaw (BRONJ) is defined as the persistence of exposed necrotic bone in the oral cavity for 8 weeks or more in patients with current or previous history of BP use, despite adequate treatment, and no local evidence of malignancy or prior radiotherapy in the maxillofacial region. Complete resolution of symptoms and partial clinical achievement should be the primary goals in the management of BRONJ. The objective of the present study was to describe the clinical data and treatment of 11 patients with completely regenerated BRONJ.

Methodology: This retrospective study included 11 patients who experienced oral complications after intravenous bisphosphonate therapy. The diagnostic procedure involved clinical and radiological examinations. The patients were treated by irrigation with oral rinses, nonsteroidal anti-inflammatory drugs, long-term antibiotic therapy to resolve the infection, and non-aggressive surgical debridement of soft or hard tissues and sequestrectomy.

Results: Complete healing, defined as the absence of any mucosal breaches and exposed necrotic bone, signs of inflammation and infection, and clinical complaints, was achieved in all patients.

Conclusion: Dental professionals should be aware of this potentially serious complication in oral surgery patients receiving long-term treatment with BPs. Although the management of patients with BRONJ is quite challenging since no ideal treatment protocol has been established thus far, discontinuity of bisphosphonate therapy combined with surgical debridement to obtain clear and bleeding margins along with long-term antibiotic therapy administration is the treatment of choice for osteonecrotic lesions of the jaws.

Open Access Original Research Article

Interleukin 8: Changes in Paroxysmal Atrial Fibrillation

Mariya Negreva, Svetoslav Georgiev, Katerina Vitlianova, Daniela Arabadzhieva

Journal of Advances in Medicine and Medical Research, Page 1-7
DOI: 10.9734/BJMMR/2015/20238

Aims: To study the levels of interleukin-8 (IL-8) in patients with paroxysmal atrial fibrillation (occurred in <48 hours) and track the changes after restoration of sinus rhythm.

Study Design: Prospective.

Place and Duration of Study: The study was conducted in the Intensive Cardiology Department of the First Cardiology Clinic at the University Hospital "St. Marina "- Varna for the period October 2010 – May 2012.

Methodology: We included 51 patients (26 men, 25 women; mean age 59.84±1.60 years) with paroxysmal atrial fibrillation and 52 controls (26 men, 26 women; 59.50±1.46 years) with no history of atrial fibrillation. The two groups matched by age, gender and clinical characteristics. Patients’ plasma concentrations of IL-8 were measured three times: immediately after admission to the ward (baseline values), twenty-four hours and twenty-eight days after rhythm restoration. In the control group the indicator was tested once. IL-8 was measured using an ELISA kit. In all patients the arrhythmia episode was discontinued by the administration of propafenone.

Results: All patients were hospitalized between the second and the twenty-fourth hour after the onset of the arrhythmia, and most frequently in the fifth hour (10 of all 51 patients). Baseline values of IL-8 were increased compared to those of the controls (77.38±3.78 vs 32.18±1.54 pg/mL, p <0.001). Twenty-four hours after restoration of sinus rhythm, IL-8 concentrations were still significantly higher (65.33±3.29 vs 32.18±1.54 pg/mL, p <0.001). On the twenty-eighth day there was no significant difference (28.07±1.68 vs 32.18±1.54 pg/mL, p = 0.07).

Conclusion: Plasma concentrations of IL-8 are significantly elevated in the early hours of the clinical manifestation of paroxysmal atrial fibrillation as well as after the arrhythmia discontinuation. Their restoration occurs slowly over time. The established specific dynamics in IL-8 concentrations suggests a close relationship between paroxysmal atrial fibrillation and inflammation.

Open Access Original Research Article

Clinical and Immunological Evaluation of Application of Ronkoleukin in Nonspecific Vulvovaginitis at Adolescent Girls

Smailova Lazat Kenzhebekovna, Kurmanova Almagul Medeubaevna

Journal of Advances in Medicine and Medical Research, Page 1-12
DOI: 10.9734/BJMMR/2015/18891

Package Insert: According to immunological parameters there was found that during the sub-acute there is the secondary immune deficiency and the immunodeficiency is absent during the acute.

During the acute phagocytic function of the local secret is satisfactory, and during the sub-acute against satisfactory absorption function there is a decrease of bacterial growth-inhibitory activity of vaginal secretions, indicating the necessity of correction of phagocytic component of these patients.

The Purpose of the Research: Clinical and immunological evaluation of ronkoleukin using depending on the routes of entry in the treatment of non-specific vulvovaginitis among adolescent girls in different variants of the disease state.

Design of their Search: Prospective study.

Methodology: From 2006 to 2010 years by the assignment of adolescent therapist and upon periodic screening the adolescent girls with a variety of complains for genitalia were examined in the child and adolescent consulting room in Municipal Polyclinic № 11 and «The City Center of Human Reproduction» in Almaty.

124 menstruate adolescent girls from 11 to 18 years, not sexually active, were selected to accomplish the target objective.

I group -20 healthy (control).

II group - 62 with per-acute nonspecific vulvovaginitis.

III group - 42 with sub-acute nonspecific vulvovaginitis.

In cooperation with the scientific consultant and immunologist, M.D. Prof. A. Kurmanova there was developed a dosage schedule of roncoleukine in the complex therapy, based on the results of the analyses of the immune and cytokine status and phagocytic vaginal system.

II group - 62 patients with per-acute nonspecific vulvovaginitis.

II А– 20 patients with sub-acute nonspecific vulvovaginitis.

(Standard therapy + roncoleukine 250 000 U/ml vaginal irrigation once a day).

II B– 25 adolescent girls with sub-acute.

(Standard therapy + roncoleukine 250 000 U/ml twice subcutaneously, every other day).

II C – 17 adolescent girls with sub-acute (standard therapy).

III group - 42 patients with acute nonspecific vulvovaginitis.

(standard therapy + roncoleukine 250 000 U/ml twice subcutaneously, every other day).

Standard therapy of 7-10 days included  [1,2]:

Efficacy of the drug was assessed by patient complaints, inspection, and data of microbiological studies of vaginal discharge, immune state, cytokine status, and local phagocytic system on the 7th and 14th days of treatment.

Open Access Original Research Article

An Assessment of the Benefit of Surgical Face Masks in Preventing Aerosol Droplet Spread during a Simulated Spinal Anaesthetic-a Blinded in vitro Study

Abhijit Biswas, S. Ó. Riain, J. Saunders, D. Barron, N. O. Connell

Journal of Advances in Medicine and Medical Research, Page 1-7
DOI: 10.9734/BJMMR/2015/20265

Aims: The purpose of this study was to assess the benefit of wearing a surgical face mask in reducing aerosol contamination of agar plates in a simulated spinal anaesthetic. The contamination of plates with virulent organisms, association of growth with recent upper respiratory tract infection and food intake were also studied.

Methods: A poster containing written text was fixed to a wall, with a standard agar plate suspended at its midpoint. Each volunteer (n=30) then read the text from the wall chart to simulate verbal interaction with a patient during a spinal anaesthetic, initially wearing a surgical mask and then once again without a mask.

Results: This study revealed an increased risk (p =0.006) of bacterial growth on agar plates when not wearing a surgical face mask. Results also suggest that eating prior to surgical procedures may increase the risk of contamination of the surgical field in the absence of a barrier mask.

Open Access Original Research Article

Risk Factors and Anthropometric Variables of Young People with Essential Hypertension in Uyo, Akwa Ibom State

Umoh Kufre Albert, Jombo Henry Effiong

Journal of Advances in Medicine and Medical Research, Page 1-8
DOI: 10.9734/BJMMR/2015/20070

Hypertension, a chronic medical condition is commonly seen in young people in my environment. Certain risk factors are associated with the development of this condition. They include a positive family history of hypertension, being overweight /obese, excessive alcohol intake, cigarette smoking and high salt intake. The role of micro-RNA, GRK2, CaMKIV and PIA2 are obvious in the aetio-pathogenesis of hypertension. This study was conducted to find out which of these factors have effect on hypertension on young people.

Methods: One hundred and fifty one young people diagnosed with essential hypertension (new cases) over a one year period January to December 2013 were recruited from patients attending the general outpatient clinic of the University of Uyo Teaching Hospital. Their age, sex, tribe, occupation and marital status were assessed. Risk factors like cigarette smoking, significant alcohol intake, adding salt to meals before eating, family history of hypertension and history of diabetes mellitus, weight, height, body mass index, hip circumference, waist circumference and blood pressure were assessed.

Results: A total of 151 respondents (n=151) were recruited into the study.48 respondents had stage 1 hypertension JNC 7 classification while 103 had stage 2 hypertension JNC 7 classification. More women had hypertension n=84(55.6%). Respondents with secondary level of education had more stage 1 hypertension JNC 7 classification while those respondents with tertiary education had more stage 2 hypertension JNC 7 classification. Married respondents had more of stage 2 hypertension JNC 7 classification n=56(54.4%) than stage 1 hypertension n=22(45.6%). Family history of hypertension was present in n=79(52.3%) respondents. Stage 2 hypertension JNC 7 classification was associated with having a positive family history of hypertension p=0.001. Adding extra salt to serve meals was associated with stage 1 hypertension JNC 7 classification p=0.006. Other risk factors were not significantly associated with any stage of hypertension.

Conclusion: Positive family history of hypertension and adding extra salt to serve meals were significant risk factors for hypertension in young persons in this study. So young people with positive family history of hypertension should begin early screening for detection of hypertension and reduce or refrain from adding extra salt to serve meals to reduce risk of developing hypertension.

Open Access Original Research Article

Activity of Autonomic Nervous System, Energy Expenditure and Assessment of Oxidative Stress in Menopause-women Using Hormone Replacement Therapy

Giovanni Messina, Vincenzo De Luca, Andrea Viggiano, Domenico Tafuri, Antonietta Messina, Fiorenzo Moscatelli, Antonio Ivano Triggiani, Giuseppe Cibelli, Anna Valenzano, Sergio Chieffi, Marcellino Monda

Journal of Advances in Medicine and Medical Research, Page 1-13
DOI: 10.9734/BJMMR/2015/18877

Aims: Menopause is a period of significant physiological change that may be associated with increased body weight and obesity-related diseases. Many studies have been carried out to determine influences of estrogen depletion, resting energy expenditure (REE) decline and aging during menopause-related obesity.

Methodology: In the present experiment, REE, body composition, activity of the autonomic nervous system, oxidative stress and food intake were measured in three groups of women: pre-menopause (n=40), post-menopause with hormone-replacement therapy (HRT) (n=40) and post-menopause without HRT (n=40).

Results: In post-menopause women with HRT a significant increase was found in: 1) the sympathetic activity, measured by the power spectral analysis of the heart rate variability; 2) REE, measured by indirect calorimetry; 3) oxidative stress, measured by Free Radical Analytical System 4 (Fras-4) compared to the value of the other two, while fat mass, measured by Body Impedance Analysis (BIA), was reduced in favor of a recovery of free fat mass.

Conclusion: The study emphasizes the important changes due to HRT on various components influencing body weight in menopause-women.