Open Access Case Study

Hyoscyamus niger Intoxication: A Case Report

Zeynep Collak, Duygu Kara, Emine Uzlas Karaman, Fatma Karakoc, Abdulhamit Collak

Journal of Advances in Medicine and Medical Research, Page 1-3
DOI: 10.9734/BJMMR/2016/21777

Aims: To present the clinical findings and intensive care management of Hyoscyamus niger (HN) intoxication in a 7-year-old patient.

Presentation of Case: A seven-year-old girl was admitted to the emergency department who   had eaten a plant in large amounts. She had psychomotor agitation, inability to recognize her family, slurred speech, dry mouth, flushing, over-distended urinary bladder, visual and hearing hallucinations. After a nasogastric tube was inserted, gastric lavage was performed and activated charcoal was administered. Symptomatic treatment including oxygen, fluid-electrolyte balance, and gastric protective drugs was established. Physostigmine infusion (0.02 mg/kg) was given due to tachycardia at the second hour of hospitalization. The plant that was responsible for the clinical picture was confirmed as ‘deli bat bat grass’. The clinical symptoms resolved after 2-hours administration of physostigmine. She was transferred to pediatric ward after 24 hours of monitorization in intensive care unit.

Discussion: HN is commonly known as black henbane or deli bat bat grass in the Eastern Anatolian Region in Turkey. Oral intake of this plant can cause central and peripheral anti-cholinergic effects. This clinical picture described as ‘central anticholinergic syndrome’ is characterized by thought impairment, hallucinations, hyperpyrexia, ataxia, excitement, drowsiness, coma, dry skin and flushing, tachycardia, mydriasis, and reduction of bowel movements. Diagnosis of HN intoxication is made by clinical symptomatology and ingestion history of the parts of HN. Therapy includes stomach lavage, supportive therapy, and physostigmine as a specific antidote in some cases.

Conclusion: Physicians should always keep in mind for plant poisoning in patients with anti-cholinergic symptoms.

Open Access Short Research Article

GLA Nonsense Mutation (c.485G>A) in a Three-Generation Family with Fabry’s Disease

Gabriela Sarca, Cristina Dragomir, Adriana Stan, Emilia Severin

Journal of Advances in Medicine and Medical Research, Page 1-8
DOI: 10.9734/BJMMR/2016/21432

Background: GLA nonsense mutations seem to be associated with more severe clinical phenotype.

Aims: Main aims were to identify the disease-causing mutation, to screen high risk family members and to predict the severity of clinical phenotype and age of onset based on genotype-phenotype analysis.

Methods: Seven family members were clinically assessed and enzyme activity levels were evaluated as well. Genomic DNA was isolated from blood samples and analyzed for GLA gene mutation.

Results: The proband, a 34-year-old man, was misdiagnosed for years. At 25 years of age he was diagnosed with Fabry’s disease. He had a less severe phenotype failing to express cardiac, cerebral or renal symptoms. In addition, the patient presented a ventricular septal defect as an incidental finding which has not been reported previously in Fabry’s disease. His maternal uncle had a severe classic form and, in addition, osteonecrosis of femoral head rarely reported as associated findings. All females were heterozygous; 3 of them were asymptomatic and 2 developed milder symptoms, skin and heart predominantly affected. Fabry’s disease was caused by the presence of GLA nonsense mutation c.485G>A. All close relatives of proband had one copy of the mutation.

Conclusion: The family nonsense mutation c.485G>A  known to predict the classic phenotype showed a wide range of clinical manifestations from severe to asymptomatic forms both in males and females supporting the intrafamilial phenotypic variability for Fabry’s disease.



Open Access Short Research Article

Staphylococcus and Pseudomonas Isolated from Mobile Phones and Cheek and Ear Locales

Weslin Thomas, Anna R. Oller

Journal of Advances in Medicine and Medical Research, Page 1-8
DOI: 10.9734/BJMMR/2016/20616

Background: Mobile phones may harbor pathogenic bacteria, so studying bacterial relationships between cell phones and the face is important.

Aims: To isolate and identify Staphylococcus and Pseudomonas from the cheek, ear, and mobile (cell) phones of college students.

Study Design: A total of 150 samples (three per student) were obtained from 50 random college students who gave informed consent and answered a brief survey. One swab was taken from the cheek, one from the mid-ear, and one from the mobile phone of each student. This study was performed in the microbiology laboratory at the University of Central Missouri, United States from January 2011 until May 2011.

Methodology: Swabs were plated in duplicate onto Mannitol Salt Agar (MSA), Oxacillin Resistance Screening Agar Base (ORSAB) Chromagar containing Oxacillin supplement, and Cetrimide Agar. MSA positive colonies were subcultured onto ORSAB and tryptic soy agar plates, which were incubated for 24 hours, and colonies were subjected to a confirmatory PBP2a assay. Statistical analysis was performed using a one-way Analysis of Variance (ANOVA) with significance set at (P = 0.05).

Results: Twenty-seven (54%) touch screen, 13 (26%) sliders, and 10 (20%) flip phones were swabbed. No Pseudomonas aeruginosa was detected. Touch screen phones harbored more Staphylococcus than other phone types (P = 0.028). Statistical analysis showed significance between the three locations of bacteria cultured from the phone, cheek, and ear (P = 0.03). Two students (4%) tested positive for MRSA, and 10 (20%) students harbored methicillin susceptible Staphylococcus aureus (MSSA). Most MSSA were on flip (10%) and touch screen (8%) phones. More Staphylococcus colonies were recovered from phones belonging to females than males (P = 0.0001).

Conclusion: Staphylococcus aureus was recovered from the cheek and ear more frequently than from phones. No correlation was seen between cell phone, cheek and ear recovery of Staphylococcus aureus or Pseudomonas; however, mobile phones may still serve as a reservoir for Staphylococci that may be transferred between mobile phones and the face.

Open Access Short Communication

Quantitative Behavioral Method for Assessing Pharmacologically-Induced Episodes of Micturition in an Animal Model of Urinary Retention and Detrusor-Sphincter Dyssynergia

Inge Steuer, Magali Grob, Pierre A. Guertin

Journal of Advances in Medicine and Medical Research, Page 1-6
DOI: 10.9734/BJMMR/2016/19011

No cure or acceptable treatment exists against bladder problems and urinary retention in spinal cord-injured (SCI) patients. Although some non-central nervous system (CNS)-acting drugs exist, as symptomatic treatment, most have been associated with significant side effects and deleterious complications. To ease basic research aimed at identifying new drug candidates against bladder control problems, we develop a standardized approach and corresponding assays for assessing quantitatively acute recovery of bladder expression and episodic urination elicited by CNS-acting compounds in paraplegic animals. Following a period of acclimation, a single systemic (s.c.) injection of vehicle (sterile water) was performed in intact animals or in early chronic (7-10 days post-surgery) thoracically (Th9/10)-transected (Tx) mice. Observations were immediately conducted during 30 minutes using a transparent circular Plexiglas arena where timing (post-injection), frequency (number of episodes post-injection), incidences and total volumes (mg) of expulsed urine were assessed. In clear contrast, administration of quipazine, a 5-HT2/3 receptor agonist was shown here to elicit increased urine volume expressed within 30 min post-administration in Tx mice. Using this simple, straightforward and reliable method, it will become possible to conduct large scale drug screening experiments aimed at identifying potent and safe centrally acting-drugs (e.g., upon the Sacral/Spinal Micturition Center) for potent ‘on-demand’ facilitation of urination and voiding in patients with SCI.

Open Access Original Research Article

Clinical Features and Prognostic Significance of Limited and Diffuse Endobronchial Sarcoidosis

Cuneyt Tetikkurt, Halil Yanardag, Muammer Bilir, Sabriye Demirci, Alef Bakır, Mustafa Senocak

Journal of Advances in Medicine and Medical Research, Page 1-7
DOI: 10.9734/BJMMR/2016/20786

Aims: Airway involvement is a common feature of sarcoidosis   and mucosal abnormalities may be evident in the respiratory tract. However, firm data establishing the clinical features and prognosis of sarcoidosis in these patients is lacking although the incidence of   endobronchial disease is high. The purpose of this study was to evaluate   the   clinical   features   of   the   patients   with   limited,   diffuse and no endobronchial involvement. Another aim was to investigate the prognostic differences between these patients.

Methods: We conducted a retrospective study to evaluate the clinical and laboratory findings of 48 patients with endobronchial sarcoidosis and 50 patients without endobronchial involvement seen at our institution. The patients fulfilled the clinical, radiologic or both features of sarcoidosis supported by the histopathologic evidence of noncaseiting granulomas. Six to ten bronchial biopsies were taken from each patient. The sample was considered positive if it demonstrated noncaseiting granulomas with negative fungal and mycobacterial cultures. The patients were classified into three groups according to the histopathologic biopsy results: 1) No endobronchial involvement, 2) Limited endobronchial involvement: One biopsy site positive and 3) Diffuse endobronchial involvement: Two or more biopsy sites positive for noncaseaiting granulomas.

Results: Bronchial biopsy was positive in 82% of the abnormal appearing airways while it was diagnostic in 36% of the normal appearing mucosa.  The most frequent bronchoscopic appearence was miliary infiltration. Nodular, erythematous lesions and edematous mucosal swelling were other bronchoscopic findings. There were no significant differences between the three groups for FEV1, FVC, TLC, DLCO/VA serum and 24 h urinary calcium levels. Serum ACE levels were significantly higher (p<0.001) in patients with limited and diffuse bronchial involvement compared to patients with no endobronchial disease. The extrapulmonary organ involvement (p<0.001) and progressive disease incidence was more frequent (p<0.001) in patients with limited and diffuse endobronchial disease.

Conclusions: Endobronchial involvement in sarcoidosis appears to be a significant predictive risk factor for progressive disease. Patients with limited or diffuse endobronchial disease have more severe extrapulmonary organ involvement and a worse prognosis than patients without endobronchial disease. Bronchoscopy may identify such patients carrying a risk factor for progressive sarcoidosis.

Open Access Original Research Article

Quantitative Analysis of Trace Elements in Sound and Carious Enamel of Primary and Permanent Dentitions

Wala Amin, Farah Almimar, Mahmoud Alawi

Journal of Advances in Medicine and Medical Research, Page 1-10
DOI: 10.9734/BJMMR/2016/21613

Aims: Quantitative assessment of trace elements in enamel of sound and carious permanent and deciduous teeth, and evaluation of correlation between the presence of caries and trace elements

Study Design: Using powdered enamel from extracted primary and permanent human dentitions and graphite furnace atomic absorption spectrophotometry.

Place and Duration of Study: Faculty of Dentistry and clinical Dentistry section of the Jordan University Hospital, between October 2014 and May 2015.

Methodology: Forty extracted human deciduous and permanent dentitions were collected from patients attended the dental surgery and pedodontic departments of the Jordan University Hospital. After proper cleaning and drying, four groups of ten teeth each from which enamel samples were collected in four containers labelled as, sound permanent, carious permanent, sound primary, and carious primary enamel. In each group the corresponding teeth were mechanically ground using a different bur; the grinding was within the enamel layer and without exposing dentine. The powdered enamel samples were acid-digested and transferred to liquid solutions in order to measure their content of heavy metal ions by means of Atomic Absorption Spectrophotometer (GFAAS).

Results: Eight trace elements were detected, namely, Cu, Pb, Sr, Fe, Mn, Zn, Al, and Se and their concentrations were estimated in all four enamel samples. The concentrations of Sr, Cu, and Fe were significantly higher in sound than in carious enamel of primary and permanent teeth. The concentrations of Al, Mn, and Se were significantly higher in carious than in sound enamel of primary and permanent teeth. Zn and Pb demonstrated comparable concentrations in carious and normal enamel of primary and permanent teeth.

Conclusions: In the light of the obtained results, it could be concluded that Sr, Cu, and Fe function as cariostatic elements and there presence enhances caries resistance of primary and permanent teeth, whereas, the presence of Al, Mn, and Se is associated with caries.

Open Access Original Research Article

Intratympanic vs. Oral Steroids for Treatment of Idiopathic Sudden Sensorineural Hearing Loss: A Randomized Controlled Study

Ali Maeed S. Al-Shehri

Journal of Advances in Medicine and Medical Research, Page 1-6
DOI: 10.9734/BJMMR/2016/21732

Objective: To compare the efficacy of oral to intratympanicsteroids for treatment of idiopathic sudden sensorineural hearing loss (ISSHL).

Patients and Methods: A total of 39 ISSHL patients were included in this study. They were consecutively randomized into the “control” group, who received oral prednisone (started with 60 mg/day tapering over 14 days) or the “study” group, who received intratympanic methylprednisolone sodium succinate (four 1- mL doses of 40 mg/mL of methylprednisolone over 2 weeks, with a dose given every 3-4 days by injection through the tympanic membrane into the middle ear). Pure tone audiometry (PTA) was measured for all patients before injection as baseline. Patients were asked to come to the outpatient clinic after two weeks, one month and at the end of the second month to assess hearing, vital signs, otological examination and adverse events.

Results: At the last follow up visit, patients in the study group had significantly lower PTA than those in the control group (39.2±6.0 dB and 43.8±6.4 dB, respectively, p=0.027). Improvement in hearing was significantly higher among patients in the study group than those in the control group (32.1±6.9 dB and 27.5±6.5 dB respectively, p=0.041). Significantly higher proportions of patients in the control group had mood change (p=0.035), sleep change (p=0.044) and mouth dryness (p=0.020) than patients in the study group. On the other hand, a significantly higher proportion of patients in the study group had earache (p=0.030). Patients in both groups did not differ significantly as regard blood glucose problems, increased appetite, pain due to injection or weight gain. Patients’ age correlated negatively with improvement in pure tone average (r= -0.267). However, this correlation was not statistically significant.  

Conclusions: Treatment with intratympanic steroid injection is better than oral steroid treatment of patients with ISSHR. Adverse effects associated with intratympanic injections are less than those associated with systemic steroid therapy.

Open Access Original Research Article

Optic Disc Size in Glaucoma Patients Attending a Tertiary Institution in Nigeria

E. A. Awoyesuku, C. N. Pedro-Egbe

Journal of Advances in Medicine and Medical Research, Page 1-6
DOI: 10.9734/BJMMR/2016/20587

Background: Assessment of optic disc size is an important component of optic nerve head examination which is often overlooked in the diagnostic evaluation for glaucoma. Measured values of optic disc size vary with the measurement technique utilized. The actual disc size varies with race and possibly other demographic characteristics. Disc size is also associated with variation of specific anatomical structures of the optic nerve head and the retinal nerve fiber layer. These disc size-dependent variations are risk factors for glaucoma or affect the likelihood of glaucoma diagnosis [1].

Aim: To report the clinical (measured by biomicroscopy) disc diameters of small, average and large optic discs and produce data on the disc sizes of Nigerian patients who have been diagnosed with glaucoma and are currently undergoing treatment.

Materials and Methods: One hundred eyes of 100 glaucoma subjects were studied. Disc diameter was measured using stereo biomicroscopy (78 D). Discs were classified into small (<1.3 mm2), average (1.3-1.75 mm2) and large (>1.75 mm2) using the European Glaucoma Society Guidelines [2,3]. The relationship between disc size and age, sex and type of Glaucoma was also assessed.

Results: One hundred eyes of 100 individuals were studied comprising 64 (64.0%) males and 36 (36.0%) females. Age range was 20- 80 years with a mean age of 50±13.66.

Mean disc size was 1.99±0.239. Eighty-two percent of discs were large size (>1.75 mm2). Males (61%) had larger discs than females (21%) (p=0.001). There was no correlation between disc size and age (p=0.87) or clinical types of glaucoma (p=0.59).

Conclusion: Majority had large optic discs in our study (82%). Large discs have large cup: Disc ratio. These differences must be considered while evaluating the optic disc to prevent over diagnosis of glaucoma and its attendant economic burden on the patient.

Open Access Review Article

Sports Dentistry and Mouthguards

Suryakant C. Deogade, Gunjan Dube, K. Sumathi, Prashant Dube, Utkarsh Katare, Divya Katare

Journal of Advances in Medicine and Medical Research, Page 1-10
DOI: 10.9734/BJMMR/2016/20413

Dental and orofacial injuries have been reported to be the most commonly occurring form of traumatic injury resulting from sport-related activities. Sports dentistry is the upcoming field in dentistry which is associated with the correct diagnosis, prevention and treatment of orofacial injuries and related oral diseases. This branch also deals with the collection and dissemination of information on dental athletic injuries and the encouragement of research in the prevention of such traumatic injuries. This article discusses an overview of sport-related injuries in orofacial and dental region, incidence, evaluation, treatment and their prevention. It also discusses the several functions and types of mouthguards. It stresses the prime role of dentist in educating the general public, parents/guardians, staffs of emergency department, coaches and athletes regarding health risks and benefits of mouth guards including the importance of emergency care for orofacial injuries.

Open Access Review Article

Use of Recombinant Factor VIIa in Obstetrics

Neena Chuni, Sachchithanantham Kanagasabai

Journal of Advances in Medicine and Medical Research, Page 1-14
DOI: 10.9734/BJMMR/2016/20737

The objective of this review article was to evaluate the current literature on the increasing off-label use of rFVIIa in the management of critical obstetric haemorrhage. Given the lack of high-level evidence, there is a need to review the clinical indications, observed response and adverse events. This review is designed to aid practitioners in deciding when and how to administer rFVIIa; since the current evidence from observational studies shows that benefits outweigh risks in its use as an adjunct to conventional treatment in massive haemorrhage. However, pregnancy is a potentially thrombogenic state, hence a cautious approach is required in patients with risk factors for thromboembolic complications.