Open Access Case Study

A Rare Cause of Recurrent Dyspnea in Emergency Service: Carotid Body Tumor

Hakan Oguzturk, Esra Karaman, Muhammet Gokhan Turtay, Şükrü Gürbüz, Kasım Turgut, Özge Erdogmus, Inan Beydilli

Journal of Advances in Medicine and Medical Research, Page 1-3
DOI: 10.9734/BJMMR/2016/20194

Carotid Body Tumors (CBT) are rare neoplasms that are represent 0.5% of neoplasms of the head and neck.

In the current report, we present the case of a patient with syncope and recurrent dyspnea attack who, after other causes had been ruled out, was found to have a left-sided CBT as the cause of her problems.

She was monitored in the emergency department for 24 hours. Lastly, she was discharged by arranging symptomatic therapy because she refused the surgical intervention due to fear of death.

Despite the development of therapy techniques, CBT continue to have high incidence of complications like in our case.

Open Access Case Study

Health Risk Assessment of Water Polluted with Fluoride in the Mining Area in Southern Tunisia: The Case of the Region of Berka

Fatma Omrane, Amina Ben Sâad, Younes Hamed, Moncef Khadhraoui, Boubaker Elleuch, Imed Gargouri

Journal of Advances in Medicine and Medical Research, Page 1-6
DOI: 10.9734/BJMMR/2016/20354

Aims: As part of risk assessment, we explored health impacts of consuming polluted water with fluoride in an exposed population in the region of Berka in the mining area of Gafsa. The main objective of this study was to evaluate and prioritize the health risks of polluted water with fluoride by the method of Kinney. The secondary objective is to propose a corrective action plan.

Study Design: Descriptive.

Place and Duration of Study: The study was conducted in the southwest of Tunisia, in the mining area of south Gafsa (Moulares-Redayef basin) between February and June 2012.

Methodology: The approach adopted in the Health Risk Assessment of water polluted with fluoride is one of the Ranking methods named the method of Kinney which classifies risks according to their severity. It consists on (1) Research of the identified hazards in the population concerned, (2) analyze them, (3) Develop a strategy and (4) Set priorities.

Results: Following this process of health risk evaluation of water pollution with fluoride, we have been able to show that over 50% of the population had presented dental fluorosis and 11% of our population had a very high risk score.

Conclusion: Secondary health risks to polluted water with fluoride were important in our study population and a corrective action plan was proposed. This encourages us to promote the dosage of fluoride in water and the updating of Tunisian standards for drinking waters.

Open Access Short Research Article

Pancreas Alone Grafts from Cardiac Death Donors; is Procurement Damage an Issue?

F. G. Afridi, R. Coates, J. French, S. White, D. Talbot

Journal of Advances in Medicine and Medical Research, Page 1-4
DOI: 10.9734/BJMMR/2016/17645

Aims: In order to minimize damage to DCD (deceased cardiac donors) pancreatic grafts the donor surgery has to proceed as quickly as possible. Because of this previous studies have suggested that organs procured (liver and kidney) from DCD donors have higher discard rates. The aim of this study was to establish whether DCD pancreatic grafts were more likely to be damaged and discarded when compared to conventional DBD (deceased brainstem) pancreatic grafts.

Methods: Data was collected retrospectively from pancreatic alone organ offers to our single centre over a 12 month period and analyzed, Simultaneous kidney pancreas (SPK) grafts were excluded.

Results: Of 33 pancreas alone offers 15 were DCD’s and 18 were DBD’s. There was no difference in leading cause of death between DCD or DBD donations of which intracranial hemorrhage was the most frequent and Hypoxic brain injury [joint with cardiovascular accidents (CVA) for DBD donations] the next most frequent cause. There was also no difference in BMI between the two groups. For DCD’s the mean donor age was 45.5 years compared with 42.6 years for DBD organs. 6% of all organs were discarded (n=2) because of procurement damage and all were from DBD donors. Of the remaining 31 organs only 6 were transplanted (DBD n=5 to DCD n=1). The leading cause of decline for the remaining 27 organs was donor history for both groups followed by prolonged cold ischemia for DBD’s and other logistical reasons for DCD’s. Procurement damage was the third most common cause of decline for DBD pancreas alone grafts.

Conclusions: Although there did not appear to be a higher incidence of pancreatic graft damage when the organ was retrieved from a DCD donor in comparison to DBD donors, there are still organs being discarded because of procurement damage. Enhanced training techniques/supervision during the retrieval process still need to be optimised to reduce organ discard rates even further so no organs are ever wasted because of procurement damage.

Open Access Policy Article

Spine Condition Improvement. Health Training Plan for Persons with a Movement Deficit

Małgorzata Kałwa, Tadeusz Stefaniak

Journal of Advances in Medicine and Medical Research, Page 1-15
DOI: 10.9734/BJMMR/2016/20549

Background: Physical activity is the cheapest way the prevention of diseases of civilization, the increase of the utilitarian physical fitness and the improvement of well-being of adults. The participation of people in health training (HT) should be a priority of social policy today, because it contributes to minimizing the cost of the incapacity of the employee to work. In addition, better physical condition of working age group can revive the labor market.

Aim: The objective of this study is to model of design a HT in accordance with modified principles and criteria of sports training design. The presented HT project is aimed at strengthening of the postural muscles and the improvement of mobility of the musculoskeletal system.

Materials: The materials research concerns the literature on the methodology of exercises from different physical activity areas.

Methods: This is a conceptual work. Systems designing were used in line with the concept of Gerard Nadler and adopted by Łasiński to the training planning area.

Results: The result of this work is a comprehensive development of an annual plan HT (macrocycle) for people with passive and active musculoskeletal system dysfunctions.

Conclusions: The health training is a system that requires planning and control.

Incomplete execution of the planned HT may improve the well-being of participants, may reduce absenteeism at work as well as enhance their activity on a labor market and in social life, even if they fail to achieve the training objective.

Open Access Original Research Article

Urogenital Tract Infection with Chlamydia trachomatis among Women Attended at Different Units in a Referral Hospital in Spain

P. Mejuto, J. A. Boga, P. S. Leiva

Journal of Advances in Medicine and Medical Research, Page 1-8
DOI: 10.9734/BJMMR/2016/19542

Aims: The objective of this study was to estimate the prevalence and characteristics of Chlamydia trachomatis infections in a group of women visiting different Units in a referral Hospital from Spain

Study Design: This was a hospital retrospective and descriptive study for the presence of C. trachomatis in endocervical, vaginal and urine swabs obtained from consecutive sexually active women attendees at different Units. Also their medical records were reviewed. Retrospective ethical approval was granted by the Ethical Committee of Clinical Investigation of Principality of Asturias.

Place and Duration of Study: Units of Gynecology, Obstetrics and Infertility of Hospital Universitario Central de Asturias, between January 2007 to December 2011.

Methodology: We included 1997 symptomatic and asymptomatic unselected women (mean age 29.1 range 18 to 45 years) who were evaluated for urogenital chlamydial infection.

Results: The overall prevalence of C. trachomatis was 6.3%. The C. trachomatis infection had the highest prevalence among the age group below 25 years of age (n=30, 7.5%). Genotypes E, G and D constitute 89.4% of the genotyped strains. Infections with genotypes G and F were more often (n=31, 42%) associated with clinical manifestations that suggest cervical infection and genotype E was observed more frequently (n=17, 85%) in asymptomatic women.

Conclusions: In our study, similar prevalence rates between both symptomatic and asymptomatic women, under 25 years, were found. Self-collected vaginal swabs are an appropriate alternative for routine diagnosis of C. trachomatis infection. The findings of this work highlighted the need for a possible Chlamydia screening program, offered especially in younger women. Delays in seeking a diagnosis and treatment among asymptomatic females can result in increased transmission of this bacterium and its serious consequences for women reproductive health. 

Open Access Original Research Article

Pulmonary Function Impairment in Female Workers Exposed to Environments with Varied Ambient Air Pollution in the Central Business Area of Lusaka-Zambia

Lumba Siachingili, Fastone M. Goma

Journal of Advances in Medicine and Medical Research, Page 1-13
DOI: 10.9734/BJMMR/2016/20719

Aims: To determine the lung function of cleaners exposed to particulate matter of aerodynamic diameter less than 2.5 micrometer (PM2.5) in the streets and offices in Lusaka, Zambia.

Study Design: This was a cross sectional study between two groups.

Place and Duration of Study: Lusaka city, central business area, between June and August 2014.

Methodology: The study included women between 18-50 years of age who had been working as street or office cleaners for 6 months or more. Males and individuals in both groups who used to smoke or were currently smokers, as well as those with a history of respiratory related illnesses or had cardiopulmonary conditions were excluded from the study. The cleaners were interviewed to get information on socio-demographic characteristics and other information using a structured interview schedule. The participants’ lung volumes, forced expiratory volume in one second (FEV1), forced vital capacity (FVC) and their ratio (FEV1/FVC) were measured using a MRI spirobank G spirometer. On the day of the interview, PM2.5 in their work environment was sampled using a personal aerosol monitor (SIDEPAK AM510).  

Results: Out of the 90 participants, 45 were street sweepers and 45 were office cleaners. More street sweepers had impaired lung function (FEV1/FVC) 15(75%) than office cleaners 5(25%) p=0.01. FEV1 was also significantly different among street sweepers 12(70.6%) and office cleaners 5(29.4%) p=0.05. PM2.5 measurements revealed significantly high levels of exposure among street sweepers (p=0.001). Participants with impaired lung function (p=.005) and those with reduced FEV1percent predicted were exposed to significantly high concentrations of PM2.5 (p=0.012).

Conclusion: Exposure to high PM2.5 concentration is associated with pulmonary function impairment and reduced FEV1 % predicted among cleaners.

Open Access Original Research Article

Predictors of Diabetic Ketoacidosis among Patients with Type 1 Diabetes Mellitus Seen in the Emergency Unit

Abbas Ali Mansour, Muntader Abdu-Al-Kareem Abdu-Alla

Journal of Advances in Medicine and Medical Research, Page 1-12
DOI: 10.9734/BJMMR/2016/21384

Aims: To identify the factors that can predict the development of diabetic ketoacidosis (DKA) among patients with type 1 diabetes mellitus (T1DM) in Basrah.

Materials and Methods:

Place and Duration of Study: The study was conducted in the emergency units of Al-Faiha General Hospital and Al-Basrah General Hospital for the period from June 2013 to June 2014.

Methodology: This study was cross-sectional enrolled four hundred patients with T1DM seen in the emergency unit were selected; patients and their families were subjected to specific questionnaires prepared for this study.

Results: In this study, 400 patients with T1DM enrolled, 160 patients were having DKA (40%), 240 (60%) were not. Factors that predict DKA include,age, gender, school level of both the patients and their parents, address of the patients, the early initiation of the proper insulin regimen after diagnosis of T1DM, presence of acute recent illness, missing insulin doses and frequency of the dose missing, number of previous DKA attacks, using of syringes or pens as a tool of insulin delivery, however,  the most important two predictors  are the source of insulin supply to patients, presence of glucometer at homes and frequency of its uses.

Conclusion: This result provided evidence that multiple factors interact together to play a vital role in the development of DKA among patients with T1DM in Basrah.

Open Access Original Research Article

Seroprevalence of Hepatitis A and E Virus Infections in Patients with Acute Viral Hepatitis in Hyderabad, India - A One Year Study

Fatima Sarwat, Syyeda Anees, Anjum Ayesha

Journal of Advances in Medicine and Medical Research, Page 1-9
DOI: 10.9734/BJMMR/2016/21879

Introduction: Acute viral hepatitis due to faeco- oral group of hepatitis viruses is endemic in India. Outbreaks of hepatitis E virus infection are more common than the hepatitis A virus.

Aim: The present study aimed at determining the seroprevalence of IgM antibodies to hepatitis A and E virus in clinically diagnosed acute viral hepatitis cases. And to determine its usefulness against the disease prevention.

Study Design: A cross sectional study was carried out on symptomatic patients referred from paediatric and gastro enterology department of Princess Esra hospital.

Place and Duration of Study: Around one hundred and eight subjects were analyzed for anti IgM antibodies to hepatitis A and E virus and liver function test in the department of laboratory medicine for Microbiology and biochemistry at Princess Esra Hospital, Deccan College of Medical Sciences between January 2013 and January 2014.

Methodology: Blood samples were collected under strict aseptic precautions and tested for anti-HAV and Anti-HEV IgM antibodies using capture elisa from diasorin. Biochemical analysis included estimation of serum aminotransferases, alkaline phosphatase and bilirubin levels.

Results: An overall seropositivity of 54% was observed in the present study. More number of the subjects as 46.29% tested positive for anti HAV IgM than for anti HEV IgM as 7.4%. Co-infections were not noticed. Acute viral hepatitis due to hepatitis A virus is more common in children in the age group 6-10 years followed by 11-15 years and lastly 0-5 years indicating the epidemiological shift. Infection with hepatitis E virus was common in adolescent and adults. Males were more susceptible to both the infections than females. Liver function test results correlated well with viral markers indicating damage to the liver parenchyma. The socioeconomic status of the individuals revealed that 95% of the subjects were below poverty line and didn’t have access to proper drinking water and sanitary facilities. None were vaccinated against Hepatitis A virus.

Conclusion: The present data suggest that we need to have a dual pronged approach against prevention of acute viral hepatitis caused by A and E virus. Government authorities should prioritize on bringing a uniform improvement in the living standards of the society and make vaccine available to the high risk group at a subsidized rate.

Open Access Original Research Article

Erythrocyte Transfusion and Alloimmunisation Patterns among Sickle Cell Disease Patients, Benin City, Nigeria

S. Ademola Adewoyin

Journal of Advances in Medicine and Medical Research, Page 1-8
DOI: 10.9734/BJMMR/2016/21755

Introduction: Blood transfusion remains a mainstay therapy in sickle cell disease (SCD).Transfusional therapy may be complicated by allo-immunisation due to exposure to foreign red cell antigens. However, the prevalence and patterns of atypical antibodies in Nigerian SCD has been sparsely reported majorly due to underdeveloped blood banking systems. A prospective study was therefore undertaken to assess patterns of blood transfusion and allo-immunisation among SCD patients in Benin City, Nigeria. 

Methodology: The study was conducted among adult and paediatric SCD subjects seen at a sickle cell centre in Benin City, Nigeria. All subjects (parents in case of children) who gave consent/assent to the study were interviewed using a structured questionnaire to obtain details on bio-data, SCD history and blood transfusion history. Blood specimen obtained from each participant was subjected to antibody screening/identification test using tube agglutination technique. Association of categorical variables was tested using chi-square or fisher exact test as appropriate.

Results: Fifty five SCD patients were studied with a mean (SEM) age of 22.95 (1.66) years. More of the subjects (67.3%) were aged 15 years and above. 74.5% of the subjects have a past history of blood transfusion. Four (7.3%) of the subjects had unexpected erythrocyte allo-antibodies. Antibodies belonging to the Rh and Kell blood group systems were implicated. The risk of alloimmunisation increased with total lifetime transfusions (p = 0.002)

Conclusion: Erythrocyte alloimmunisation is a significant therapy related complication in Nigerian SCD. Hydroxyurea use reduces transfusion requirements and should be maximized. There is need to upgrade local/regional transfusion services to include routine allo-antibody screening/identification as part of precompatibility testing particularly SCD patients who have received more than 10 units of red cell transfusion.

Open Access Original Research Article

Evaluation of Postural Stability in Pregnant Women

Fayiz F. El-Shamy, Anees S. Ghait, Magda Morsy

Journal of Advances in Medicine and Medical Research, Page 1-5
DOI: 10.9734/BJMMR/2016/21551

Aim: The hormonal, physiological and anatomical changes throughout pregnancy affect the musculoskeletal system that lead to postural instability which may impair their lifestyles and increased risk of collapses. This study was aimed to assess postural balance in females during the second and third trimester of pregnancy.

Study Design:  A case control study.

Place and Duration of Study: Biomechanics lab. IN Faculty of Physical Education at Kafrelsheikh University, between February and July 2015.

Methodology: In this study, postural stability throughout the second and third trimester was measured using the Biodex Balance System (BBS) in 14 pregnant females (age range 25-30 years). The overall (OA), anterior-posterior (AP) and medial-lateral (ML) stability index scores were obtained at level 8 and 7.

Results: The mean OA, AP and ML scores were significantly higher in the third trimester compared to second trimester (P <.05). There was no significant difference in the ML between the stability level 8 and 7 (P >.05) during the second or third trimester.

Conclusion: Pregnant females have poor postural stability as well as decreased postural equilibrium in the third trimester compared with the second trimester of pregnancy.