Open Access Case Series

A Brief Review of Mucormycosis: Report of Five Cases

Esmaeil Faraji, Mohammad Reza Jafari Nakhjavani, Omid Mashrabi, Shiva Farajpour Maleki, Ramin Farajpour Maleki

Journal of Advances in Medicine and Medical Research, Page 1-5
DOI: 10.9734/BJMMR/2016/19714

Mucormycosis is an emerging and slowly rising fatal infectious disease in most countries. It is the third most common invasive mycosis after candidiasis and aspergillosis. Hematologic malignancies notably acute myeloblastic leukemia (AML) and diabetes mellitus (DM) especially when uncontrolled or there is ketoacidosis are the most common predisposing conditions. Clinical manifestations vary according to the organ involved. Based on anatomic localization, mucormycosis can be classified as one of 6 forms: Rhinocerebral, Pulmonary, Cutaneous, Gastrointestinal, Disseminated and Uncommon presentations.

The mortality rate is often very high. Early diagnosis and aggressive treatment are the cornerstone of management. Here we report 5 cases of mucormycosis in patients admitted to Imam Reza hospital, the tertiary referral center in Northwest of Iran. We will also have a brief review of this fungal infection.

Open Access Minireview Article

A Novel Approach for Innovative Pharmaceutical, Nutraceutical and Biocosmeceutical Products: Different Types of Combination Products and Co-activation of Natural Synergistically Acting Target-Receptors (CanSATs)

Pierre A. Guertin

Journal of Advances in Medicine and Medical Research, Page 1-8
DOI: 10.9734/BJMMR/2016/18997

Traditionally, the main model of the pharmaceutical industry for developing new drugs has been based on monotherapies, new molecular entities (NMEs), and their underlying one-target-one-disease dogma. It is no surprise that closely related fields such as the cosmeceutical and nutraceutical areas, largely inspired by Big Pharma, have also mainly used that model. However, compelling evidence suggests that the time has come for these sectors of R&D activities to further explore more efficient, cost-effective and reliable approaches for innovative products. Among a few approaches proposed in recent years, there is one that is of particular interest – the ‘combination drug’ often referred to as the fixed-dose combination (FDC) products approach. It has been generally defined as two or more active ingredients that are combined in a single dosage form for either new effects or superior synergistic-like efficacy with less adverse effects. Both the World Health Organization (WHO) and the U.S. Food and Drug Administration (FDA) have recognized the great potential of FDCs for the future of innovation in those sectors. In fact, the development of FDCs has recently received substantial support for commercialization of new products – that is between three and five years of additional protection and exclusivity. Next-generation FDCs have already been identified. Indeed, FDCs that may be referred to as ‘variable-dose combinations’ (VDCs) products and, more specifically, ‘Co-Activation of Natural Synergistically-Acting Target-Receptors’ (CanSATs) products when applied to natural products if synergistic-like actions are found among active ingredients. Although VDCs and CanSATs have emerged mainly from the nutraceutical and cosmeceutical sectors, these approaches may perhaps also promote the development of promising new pharmaceutical products.

Open Access Original Research Article

Evaluation of Protein C in Nigerian Patients with Sickle Cell Anaemia in Steady State

A. A. Ibijola, O. T. Ojo, W. A. Shokunbi

Journal of Advances in Medicine and Medical Research, Page 1-5
DOI: 10.9734/BJMMR/2016/21539

Background: Sickle cell disease which is considered to be a hypercoagulable state has a worldwide distribution. Protein C is a naturally occurring anticoagulant with anti inflammatory and fibrinolytic properties.

Objective: To evaluate the level of Protein C in Nigerian Patients with sickle cell anaemia (SCA) in steady state.

Methods: This is a comparative cross sectional study carried out in Ibadan on 40 HbSS patients in steady state attending Haematology clinic at University College Hospital, Ibadan and 40 age and sex matched healthy normal HbAA control. Protein C was assayed with Amax Destiny Coagulometer using clot based method. Liver function test (LFT) was done with Hitachi 912.

Results: A significant decrease in Protein C was found in HbSS patients in steady state (median value 62.8%) compared with HbAA control Subjects (74.6%) (p = 0.00).

There was no significant difference in the LFT of the HbSS patients and the control HbAA subjects, P > 0.05 in all the parameters measured. (Alanine Transaminase (ALT), P = 0.82; Albumin, P = 0.12; Total Protein, P =0.37).

Conclusion: The low Protein C level observed in HbSS patients in steady state may not be due to hepatic dysfunction as LFT in the subjects were found to be normal.

Open Access Original Research Article

Results of Radioactive Iodine (131I) Therapy in Well Differentiated Thyroid Carcinoma: A Retrospective Study from the Tygerberg Hospital

D. Acullu, A. E. Fourie, K. Baatjes, E. J. Opakas

Journal of Advances in Medicine and Medical Research, Page 1-13
DOI: 10.9734/BJMMR/2016/20375

Introduction: Well Differentiated thyroid carcinoma (WDTC) represents 80% of all thyroid malignant tumours, with good prognosis and a survival rate higher than 90% at 20 yrs. Total or subtotal thyroidectomy is the treatment of choice, with radioactive iodine (RAI) therapy reserved for adjuvant setting/ablation and/or as a curative treatment modality in patients with local recurrence and/or distant metastases. This retrospective study aimed to investigate the treatment outcome, survival rate and prognostic factors in our institution over the past half-decade.

Methods: A retrospective study was conducted of 33 patients with WDTC. Data were collected from 1stJanuary 2007 to 31st December 2012 and included: Age at diagnosis, sex, histology, TNM stage, treatment received, indication for 131I therapy, doses of 131I, complication of treatment, follow-up diagnostic scan 123I / Thyroglobulin, time of recurrence since surgery and cause of death. Prognostic factors were analysed using chi-square test and crude mortality rate was used.

Results: Papillary subtype is the most common type of WDTC (63.6%); mean age at diagnosis is 50 years and female to male ratio is cosmopolitan at 3.1:1 with female preponderance. RAI therapy after thyroidectomy (total or subtotal) offers complete remission in 26/33 (78.8%) and the overall mortality rate was 3/33 (9.1%) p=0.023.

Conclusion: RAI therapy is safe and effective in management of patients with WDTC. The initial surgical approach is the cornerstone in the subsequent outcome of RAI therapy with very poor outcome registered in unresectable thyroid tumour and in patients with multiple organ metastases.

Open Access Original Research Article

A Cross-Sectional Study of the Relationship among Energy Drinks Consumption, Smoking and Academic Performance among Male Health Science Students

Sameer Al-Ghamdi, Khaled Aldossari, Jamaan Al-Zahrani, Saad Al-Qasem, Ali Al-Gonaim, Ibrahim Al-Tamimi, Saad Al-Juhaim, Abdulrahman Al-Ghamdi, Hussain Al-Ghamdi

Journal of Advances in Medicine and Medical Research, Page 1-9
DOI: 10.9734/BJMMR/2016/19808

Aims: To estimate the prevalence, attitude and magnitude of consumption of energy drinks among health science students. To establish the relationship between consumption of energy drinks and smoking. To determine the relationship between energy drinks consumption and the students perceptions about their academic performance.

Methodology: A cross-sectional study has been conducted including 521 male health
sciences colleges students in Prince Sattam Bin Abdulaziz University throughout the period of
September 20 – December 20, 2014. A validated, confidential, self – administered questionnaire including questions designed to estimate the prevalence, attitude and magnitude of consumption of energy drinks was used for data collection.

Results: Among 521 male students who participated in this study, 199 students were consuming energy drinks (38.2%). Students consumed energy drinks for many reasons, mostly they like the taste (59.8%). (50.3%) and (39.2%) perceive energy drinks to increase their alertness and academic performance, respectively. More than half of participants not manifest any side effect after consumption, and digestive tract upset were reported as the most frequent side effects.      

Conclusion: Energy drinks consumption is common behavior among male health science students. Heavy consumption of energy drinks can have some adverse effects including digestive tract upsets. Participants perceive energy drinks to increase their alertness and academic performance. However, people who consume these drinks are more likely to be alert compared to those who do not.

Open Access Original Research Article

Liver Protein and Enzymes in HIV Infected Pregnant and Non-pregnant Women on Antiretroviral Therapy

P. I. K. Onyeka, U. O. Emmanuel, E. U. O. G. Udujih, Nwabueze ., H. I. Udujih

Journal of Advances in Medicine and Medical Research, Page 1-5
DOI: 10.9734/BJMMR/2016/19651

This in vivo study was carried out to investigate alterations in the levels of proteins and enzymes produced by the liver of HIV infected pregnant women and HIV infected non pregnant women under different antiretroviral therapy. Forty six human patients (Pregnant patient, n=21, Non pregnant patient, n=25) were recruited during this study from the PEPFAR (President Bush Emergency Plan for Aids Research) clinic in LUTH (Lagos University teaching Hospital), Lagos. The patients were between the ages of 29 – 34 years. All samples were analyzed for Albumin, Transferrin, Urea, Total protein, Total bilirubin, Creatinine and Cholinesterase. Along with it, liver enzymes – Alkaline phosphate, Alanine aminotransferases and Aspartate aminotransferases were also analyzed to confirm proper liver function for each patient. Result showed that total bilirubin and transferrin were statistically higher in the pregnant group while other liver proteins (Albumin, Urea and Total protein) were statistically lower in the pregnant group. Two liver enzymes, Creatinine and Cholinesterase, were statistically lower in the pregnant group. Though, other liver enzymes; aspartate aminotransferases and alanine aminotransferases were also lower in the pregnant group. No significant difference were noted when statistics were applied. Only alkaline phosphatase showed a non significant increase in the pregnant group. Findings in this study suggest that effective antiretroviral therapy stabilizes proteins and enzymes production in both HIV groups, however, slight alterations which were observed in the pregnant HIV group were due to physiological changes during pregnancy.

Open Access Original Research Article

Countertransference Triggered Activity in Treatment. Good, Bad or Useful?

F. Datz, K. Parth, U. Said, H. Löffler-Stastka

Journal of Advances in Medicine and Medical Research, Page 1-11
DOI: 10.9734/BJMMR/2016/21985

The aim of the “Dismantling Psychotherapy Research Study” was to evaluate whether the psychotherapist is more or less active in connection to his or her countertransference, the therapist-patient-interaction and the patient’s level of object relationship quality.

We worked with 234 tape- recorded therapy sessions with depressed patients from the Munich Psychotherapy Study (Huber, 2012), a comparative quasi-experimental study of psychoanalysis (PA), psychodynamic therapy (PD) and Cognitive behavioral therapy (CBT). The study aimed to maximize external validity by examining non-manualized and representative psychotherapies under the conditions of day-to-day practice.

The tape recordings were rated and analyzed using the Psychotherapy Process Q-Set (PQS), the Countertransference Questionnaire/Therapist response questionnaire (CTQ/TRQ), the Shedler-Westen-Assessment Procedure-200 (SWAP) and the Quality of Object Relations Scale (QORS).   90 patients with a definite diagnosis of depressive disorder and 12 clinical psychologists/psychotherapists with at least 5 years of professional experience took part in the study.

Findings show a clear correlation between the therapist’s activity and the ongoing countertransference. Further, the therapist’s activity is linked to the patient’s emotional and psychological state. This implies a more active therapeutic work as well as a better therapy outcome treating healthier patients. However, therapy outcome is not necessarily related to the patient’s object relation quality. Nevertheless, it has become clear that a therapist responding with negative countertransference and acting it out impairs not only the patient-therapist-interaction but also the therapeutic process itself. The findings illustrate that there are specific countertransference feelings related to the patients’ respective unconscious transference. We conclude to encourage therapists to use their own countertransference reactions as a diagnostic and therapeutic asset.

Open Access Original Research Article

Determination of Prostate Gland Volume by Ultrasonography and Its Correlation with Anthropometric Measurements in a Subset of Karachi Population

Iffat Raza, Nuzhat Hassan, Pashmina Gul, Anis Jafri, Nosheen Zehra, Naila Younas

Journal of Advances in Medicine and Medical Research, Page 1-12
DOI: 10.9734/BJMMR/2016/20530

Objectives: To establish the local reference range of prostate volume according to our subset of population. To correlate prostate volume (PV) with age, body mass index (BMI) and waist circumference (WC).

Methods: A cross-sectional study with 119 healthy adults aged 40-79 years without any prostatic pathology were recruited .The study population was categorized into 4 age groups (40 - <50 yrs, 50 -<60 yrs, 60-<70 yrs, 70-<80 yrs), 3 BMI groups (healthy, obese and overweight) and 2 WC groups (<90 cm and >90 cm). A p-value of <0.05 was considered significant.

Results: The mean prostate volume was 21.7±2.2 mls, mean body mass index was 28±6 kg/m², whereas mean waist circumference was 95 cm. PV was found to be higher in obese and >90 cm waist circumference group. After applying multiple regression analysis, waist circumference correlated positively and significantly with prostate volume.

Conclusion: Mean prostate volume in our studied population was smaller than that of many western populations. Our study has proved that central obesity is the most important factor influencing prostate volume.

Open Access Original Research Article

Clinical Effects of Mixed Infection of Trypanosomes and Ancylostoma caninum in Dogs and Treatment with Diminazene and Mebendazole (Nigeria)

R. I. O. Nwoha, B. M. Anene

Journal of Advances in Medicine and Medical Research, Page 1-10
DOI: 10.9734/BJMMR/2016/21363

The socio-economic importance of trypanosomosis and ancylostomosis in both humans and animal necessitated the investigation of the clinical signs of single and conjunct infection of both parasites in dogs. Sixteen dogs grouped into 4 of 4 members each were used in the study. GROUP I was uninfected dogs (control), GROUP II was infected with Ancylostoma caninum GROUP III was infected with Trypanosoma brucei (T. brucei), GROUP IV was mixed infections of Trypanosoma brucei and Ancylostoma caninum (T. brucei/A. caninum). Post acclimatization, Ancylostoma caninum infection was done on GPII and GPIV. Two weeks later Trypanosoma brucei infections was done on GPIII and superimposed on GPIV. Three weeks post trypanosome infection; GPIII and GPIV were treated with 7 mg/kg diminazene aceturate (Veribin®, CEVA Sante Animale- La Ballasteiére 33501 Libourne Cedex, France) x intramuscularly x once. Mebendazole (Vermin®, Janssen-Cilag Ltd 50 - 100 Holmers Farm Way, High Wycombe, Bucks, HP12 4EG UK)  at 100 mg x per os twice daily for 3 days was used only on GPII and GPIV and a repeat treatment given 2 weeks later. Prepatent period of T. brucei infection was 5.00±1.30 days in single infection and 3.00±1.40 days in conjunct infection of T. brucei and A. caninum. Persistent parasitaemia resulted in repeated treatment with diminazene aceturate at 7 mg/kg and mebendazole at 100 mg twice daily for 3 days. The predominant signs revealed include; fluctuation in weight, lethargy, vomition, enlargement of popliteal lymphnodes, pyrexia, oedema of lower jaw and ocular discharges, enlarged abdomen, anaemia, cornea opacity and slight emaciation. The clinical signs were most severe in GPIV compared to GPIII. The egg per gram of faeces (EPG) in GPII was significantly higher than the mixed infection (GPIV). Treatment only slightly improved clinical manifestations.

In conclusion, most signs shown were consistent with trypanosomosis in dogs except abdominal enlargement which is a complication of A. caninum. Clinical signs therefore could serve as a diagnostic tool in the treatment of both conditions in dogs.

Open Access Review Article

Cancer Therapy by Nutritional Restrictions: Current Knowledge and Future Guidelines

Fawwaz Shakir Al Joudi

Journal of Advances in Medicine and Medical Research, Page 1-19
DOI: 10.9734/BJMMR/2016/21795

Cancer therapy has been a major scientific and medical focus for decades, treatment of which has proven to be a challenging task, especially in the light of its escalating incidence all over the globe. The material and moral costs of understanding the nature of the disease and finding successful ways of treatment have been extremely high. One major experimental addition to the methods of dealing with the various types of cancer has been the use of starvation protocols that may halt or delay the progression of malignant cells. In this review, a comprehensive and a pioneering account of the literature on starvation therapy is being demonstrated with an emphasis on the experimental and clinical evidence that exist, in addition to the molecular mechanisms and cellular alterations that accompany the starvation. The major objectives were to open ways for further research into understanding the topic and developing suitable and effective methods based on nutritional manipulations, for combating malignancies. The starvation includes precursors of growth such as energy precursors and others such as amino acids, nucleic acids, in addition to environmental manipulations such as abnormal oxygenation. Additional emphasis has highlighted the synergistic effects of combining conventional chemotherapy and radiotherapy with various modes of the artificial starvation. Methods of manipulating nutritional precursors have also been compiled. Additionally, negative effects of starvation were also briefly explained in an attempt to comprehend future guidelines for antagonizing such negative effects.