Open Access Case Report

Penetrating Neck Injuries Following a Case Report of a Successfully Healed Penetrating Neck Injuries Inflicted by a Sharp Tool

Ljubica Živić, Slavčo Tončev, Danijela Jovanović, Stevan Stojanović, Jasmina Stojanović

Journal of Advances in Medicine and Medical Research, Page 1-7
DOI: 10.9734/BJMMR/2016/21374

Introduction: The penetrating neck injuries belong to the group of the most urgent conditions in medicine. Large blood vessels and nerves that connect the head with the body are situated in the neck as well as the important parts of respiratory and digestive system. The penetrating neck injuries inflicted by the sharp object cause damage to organs that are placed in the neck which directly treatens life of the injured person. Bleedings that occur in such conditions, as well as other complications, could be the immediate cause of death.

Aim: The aim of our work is to present the case of a female patient with a penetrant and perforant neck injury and the state of the hemorrhagic shock, successfully treated in our institution.

Case Report: Female patient, 37 years old, was injured by the two stabbs into the left side of the neck caused by kitchen knife. As the injury occurred 40 km from our center the first aid was administered at the regional center, so she arrived to our clinic already intubated, with heavy mouth bleeding despite tampooning of the mouth cavity, unconscious, with administered transfusion. Two sutured wounds were present on the  left lateral side of the neck, each about 2 cm long, one along the front SCM edge, localized in its middle third and the other placed laterally to the neck line, at about 2 cm below the left ramus of the lower jaw. She immediately underwent general anesthesia and the team work was organized to explore the above mentioned wounds. Two large injuries were noticed as dominant there: penetration of the internal jugular vein in the length of 3 cm and penetration of the lateral wall of hypopharinx. Primary vein wall plastic and hypopharynx reconstruction provided satisfactory haemostasis. The success of the intervention was checked by directoscopy. The nasogastric tube was immediately placed. In the postoperative period, the patient was extubated the following day, the nasogastric tube was removed after 7 days and there were no complica­tions detected. She was released home fully recovered on the tenth day.

Discussion and Conclusion: The penetrant and perforant neck injuries belong to the group of the most urgent conditions in medicine since they directly threatens patient’s life. In taking care of these injuries, the most important thing is to secure breathing, by intubation or tracheotomy, to stop the bleeding, if not permanently, then at least temporarily, to provide for compensation of fluids by infusion or transfusion, as well as to organaize safe transport to the medical institution where patient can receive final treatment. The approach to such injuries requires team work, while being aware that the size of the entering wound does not implicate the size of the injury.

Open Access Case Study

The Giant Intraabdominal Liposarcoma as a Cause of Chronic Intraabdominal Hypertension and Inferior Vena Cava Syndrome

Natasa Kovac

Journal of Advances in Medicine and Medical Research, Page 1-5
DOI: 10.9734/BJMMR/2016/23445

Aims: We report a case of development of chronic intraabdominal hypertension (IAH) in patient with giant abdominal liposarcoma and finally its presentation as inferior vena cava syndrome.

Presentation of Case: A 77- year old patient presented with history of abdominal enlargement in last three years. The patient had dyspnea, legs edema and poorly tolerated supine position but he was without chest pain and complained on urinary frequency. CT scan of abdominal cavity shows huge tumor formation in front of abdominal cavity, and another one in pelvis, which compressed the bladder and spread into the inguinum. The patient had medical history of hypertension, chronic heart disease and chronic obstructive pulmonary disease (COPD). 

Discussion and Conclusion: This case report indicates complex pathophysiology of gradually increased intraabdominal pressure (IAP), which occurs in conditions like morbid obesity, big intraabdominal tumors, pregnancy and ascites development. Since the IAH increases gradually over months or years, the compensatory mechanisms adjust gradually as well, and thus reduce a possibility of acute IAH complications and ACS (abdominal compartment syndrome) development. In our case, patient was presented with symptoms of inferior vena cava syndrome (IVCS) as a result of external compression by a mass on the IVC. This case highlights the importance of understanding of pathophysiological events in chronic IAH as well as in acute IAH.

Open Access Short Communication

Renal Dysfunction among Arc Welders in Benin City, Nigeria-A Pilot Study

Adekunle Olatayo Adeoti, Sulaiman Dazumi Ahmed, Evelyn Irobere Unuigbe

Journal of Advances in Medicine and Medical Research, Page 1-5
DOI: 10.9734/BJMMR/2016/23398

Objective: Occupational exposure to liberated fumes and gases during welding process could be hazardous to the kidneys. The objective of this study was to screen and identify associated factors for renal dysfunction in arc welders. 

Methods: A cross-sectional study conducted in 36 arc welders selected by simple random sampling from a sampling frame of registered arc welders in Egor local government area in Benin city. Twenty-two consenting age-matched controls were recruited from the maintenance department of University of Benin Teaching Hospital, Benin city. A proforma was used to obtain vital clinical information and participants’ blood and urine samples were collected for biochemical analysis.

Results: There was no significant difference in the mean age, body mass index, blood pressure reading, serum creatinine, eGFR, lipid profile between the arc welders and controls. However, proteinuria was significantly commoner in the arc welders compared to controls (p<.001). Likewise, the fasting blood glucose level was also significantly higher in the arc welders compared to controls (135.93±53.92 mg/dL in welders, 97.67±29.28 mg/dL in controls, p =.01). The majority of the arc welders (66.7%) had chronic kidney diseases (CKD) stage 1 compared to 54.6% of the controls. However, a little below half of the control had CKD stage 2. About 11% of the arc welders had CKD stage 3 while none of the controls had CKD stage 3. 

Conclusion: Proteinuria, a useful indicator of CKD is commoner among the arc welders compared to the apparently healthy controls. Therefore, there is a need to create awareness among arc welders for early CKD screening in view of the occupational exposure to toxic metals.

Open Access Original Research Article

Modified Ashworth Scale and Alpha Motor Neuron Excitability Indicators of F-wave in Spastic Soleus Muscle Early after Stroke

Abhijeet Toshniwal, Abraham M. Joshua, S. Karthikbabu

Journal of Advances in Medicine and Medical Research, Page 1-7
DOI: 10.9734/BJMMR/2016/23432

Aims: Plantar flexor spasticity affects walking ability after stroke. Spasticity is clinically tested by modified Ashworth Scale (MAS) and it is fairly reliable. The aim of this study was to test the correlation between MAS and alpha motor neuron excitability indicators of F-wave in spastic soleus muscles early after stroke.

Place and Duration of Study: Neurophysiology laboratory, Kasturba Medical College, Mangalore, India and between June 2010- August 2012.

Methodology: Twenty three people with post stroke duration of 2.26 (1.18) months and MAS score > 1 on soleus muscle participated in this cross-sectional study. Modified Ashworth Scale and F-wave procedures were administered on spastic soleus muscle and the relationship was tested by Spearman’s rank correlation coefficient.

Results: The correlation of MAS to persistence of F-wave was high (r=0.842; p=<0.0001), but not with latency of F-wave (r= -0.264; p=0.223). A moderate correlation was found for post stoke duration to F-wave persistence (r=0.45; p=0.013) and the relation was nonlinear with latency of F-wave (r=0.016; p=0.950).

Conclusion: Modified Ashworth scale may be a tool to measure the neural aspects of soleus muscle spasticity i.e. alpha motor neuron excitability in people with early stage stroke.

Open Access Original Research Article

Comparative Studies of Therapeutic Effect of Leaves, Stem Bark and Root Bark Extracts of Afzelia africana (Smith) in Mice Challenged with Trypanosoma brucei brucei

M. H. Garba, A. Y. Kabir, Y. Garba, M. A. Yusuf, M. Inuwa, B. J. Lekene, O. A. Ibrahim, L. M. Hafsa

Journal of Advances in Medicine and Medical Research, Page 1-14
DOI: 10.9734/BJMMR/2016/23033

Background: Traditional and complimentary health care is inarguably the system most close to homes, accessible and affordable. It is also culturally acceptable and trusted by large numbers of people. The affordability of most traditional medicines makes them all the more attractive at a time of soaring health-care costs, neglect of orphaned/non profitable diseases and nearly universal austerity.

Aim: Aqueous leaf, stem bark and root bark extracts were evaluated for their anti trypanosomal effect in experimental trypanosomiasis with a view to come up with a phytomedicine that is efficacious, available, accessible and non-toxic to both humans and animals.

Study Design: Complete randomized clinical trial design was used in the experiment.

Methodology: Ninety five (95) mice were grouped into three (I, II, III) of thirty mice each (with sub groups A, B, C, D, E, and F consisting of five mice each) to which the leaf, stem bark and root bark extracts were administered at a dose of 100, 200, 300, 400 mg/Kgbw, while the remaining five mice served as the control for all the groups.

Results: The aqueous leaves extract at doses of 100, 200 and 300 mg/Kg bw portrayed very low activities except for the 400 mg/Kg bw that displayed a sustained Trypanostatic effect. The aqueous stem bark extract, at doses of 100 and 200 mg/Kg bw portrayed trypanostatic effect while doses of 300 and 400 mg/Kg bw effectively cleared the parasites from circulation on the 13th and 17th days into the treatment respectively. Three and two of treated mice survived and remained apparasitaemic for up to 120 days and beyond in the group treated with 300 and 400 mg/kg bw respectively. In the group treated with the root bark extract, the mice on a dose of 100 mg/Kg bw died some few days into the experiment (6th day) while the dose of 200 mg/Kgbw sustained the animals until the 19th day. Doses of 300 and 400 mg/Kg bw were observed to clear the parasites in circulation after sustained administration for 23 and 16 days respectively.

Conclusion: This study has demonstrated the potency of the stem bark and root bark crude extracts of Afzelia africana in treating experimental trypanosomiasis and can thus be further purified and packaged as phytomedicine against this dreaded but neglected disease.

Open Access Original Research Article

Does Patient Position Influence the Results of Three-dimension High Resolution Ano-rectal Manometry?

Alban Benezech, Michel Bouvier, Nathalie Lesavre, Jean-Michel Gonzalez, Karine Baumstarck, Jean-Charles Grimaud, Véronique Vitton

Journal of Advances in Medicine and Medical Research, Page 1-7
DOI: 10.9734/BJMMR/2016/23049

Aims: Anorectal manometry is the current gold standard to explore anorectal functional disorders. Recently, three-dimensional high-resolution anorectal manometry (3DHRAM) was developed. However, although procedures are usually performed in the left lateral decubitus position, anorectal symptoms usually occur in the erect or in the sitting position. Our aim was to prospectively compare the values obtained with 3DHRAM in the left lateral decubitus position versus the erect position.

Study Design and Setting: A monocentric prospective study was conducted at a tertiary referral center, in the Department of Gastroenterology, Hôpital Nord, Marseille, France.

Study Duration: Study was conducted from June 2013 to March 2014.

Methodology: All patients referred to our center for 3DHRAM and endoanal ultrasonography to explore faecal incontinence or constipation were eligible. The 3DHRAM was successively performed by the same operator in the left lateral decubitus and then in the erect position. For each patient, the body mass index, the values of the KESS score or of the Wexner score were systematically rated.

Results: Forty patients were included in this prospective study (20 with constipation, 20 with faecal incontinence). The median anal resting pressure was the only significantly different parameter between the left lateral decubitus and the erect position, both in patients suffering from constipation or from faecal incontinence (p=0.02 and p<0.001 respectively). All pressures values, as well as anismus diagnosis, were well correlated between the two positions, except the high-pressure zone, the sensation threshold and the need to defecate.

Conclusion: In this study, only the median anal resting pressure was significantly different between the two positions. The good correlation between anal pressures values obtained in the two positions allows achieving 3DHRAM in the left lateral decubitus.

Open Access Original Research Article

Superficial Mycoses in Relation to Age and Gender

O. A. Oninla, S. O. Oninla

Journal of Advances in Medicine and Medical Research, Page 1-10
DOI: 10.9734/BJMMR/2016/23455

Aims: To determine the type of superficial fungi infections of the skin affecting different ages and gender at a dermatology clinic in a developing country.

Study Design: A descriptive cross-sectional study.

Place and Duration of Study: Dermatology Clinics of Obafemi Awolowo University Teaching Hospitals’ Complex, (OAUTHC), Ile-Ife, Osun State, Nigeria between October 2009 and September 2012.

Methodology: Demographic information, history and clinical examination of consecutive patients with fungi infections of the skin were documented. The diagnoses were mainly clinical, and necessary laboratory procedures were performed for confirmation. Statistical analysis was done using SPSS 16 and odds ratio with 95% confidence interval obtained using WINPEPI version 11.  

Results: The total number of new cases of dermatoses presenting during the study period were 1454, from few weeks to 90 years of age, and 55% were females. Patients affected constituted 39.5%. Superficial fungi infections found were Dermatophytes (13.1%), Pityriasis versicolor (4.3%), and Candidiasis (2.1%). Children had more infections than adults (P = 0.000; OR = 9.31; 95% C.I. = 6.93; 12.50). The most common type was tinea capitis (children), pityriasis versicolor (adults), tinea unguium (females), and tinea cruris (males). Dermatophytic infections and candidiasis were significantly associated with childhood and female gender respectively.

Conclusion: Superficial fungi diseases are the most common dermatoses presenting to dermatologists in Nigeria and affect different ages and both gender invariably. Tinea capitis occurred predominantly in children, and pityriasis versicolor, tinea unguium and tinea cruris in adults, females and males respectively. Adequate control will lead to drastic fall in the number of skin problems confronting the general populace.

Open Access Original Research Article

Endovascular Reduction of Splenic Blood Flow in the Treatment of Patients with Liver Cirrhosis

Shavkat Karimov, Utkir Matkuliev, Murad Khakimov, Bekhzod Abdullaev, Tuychiboy Nishonov

Journal of Advances in Medicine and Medical Research, Page 1-10
DOI: 10.9734/BJMMR/2016/23484

Purpose: Defining the effectiveness of the embolization of the splenic artery (ESA) in the treatment of patients with liver cirrhosis.

Materials and Methods: We have analyzed the results of treatment 318 patients with cirrhosis who were hospitalized in the 2-clinic of the Tashkent Medical Academy in 2007-2014. Most of the patients (201) were males, mean age was 35.1±17.7 years. For the purpose of monitoring performed comprehensive study, including clinical, laboratory and special instrumental methods of research. To assess the severity of the Hepatic Failure (HF) used classification of Child-Turcotte-Pugh (CTP). Bleeding from the esophagus and stomach varices history was noted in 207 (65.1%) patients, in 151 (47.5%) of them had been made endoscopic ligation varices of esophagus and stomach and 56 (17,6%) patients was successfully performed percutaneous transhepatic embolization coronary vein and short gastric vein using the technique described by Lunderquist et al. Pronounced hemodynamic disorder on the background of anemia accompanied by deteriorated metabolic and functional status of the liver and other organs. Therefore, 32.0% detected HF class-A by CTP, at 45.6% - Class-B and 22.4% -Class C. The indications for ESA are splenomegaly with hypersplenism, and without it, varices of esophagus and stomach, high portal pressure (PP). Contraindications were severe general condition of the patient, the high activity of cirrhotic process, which was estimated at the level of bilirubin and ALT, AST.

Results: The effectiveness of endovascular interventions we evaluated on the following criteria: changes in general clinical and biochemical parameters of blood, portal blood flow dynamics and the state of varices of esophagus and stomach, the incidence of bleeding, the overall mortality rate and life expectancy. Laboratory analysis was carried out after stabilization of the patients in terms from 1 to 3 months, revealed an increase in cellular composition and the level of hemoglobin. The number of leukocytes increased to 6.8±0.24×109/L, platelet – to176.3±15.8×109/L,34 the hemoglobin level was 94.7±12.4 g/l. The increase in arterial blood supply of the liver caused by the redistribution of blood flow after ESA, accompanied by an improvement of the functional state of the liver, which evaluated by a number of clinical and laboratory parameters in 37 the at 1 month, 3 months, 6 months and 12 months. Results of the study of the portal system show that in the period of 3 months after the ESA with a decrease of PP428,7±10,2 to 342,3±12,6 mm of water.

Conclusion: Splenic artery embolization after endoscopic band ligation varices of esophagus and stomach or transhepatic embolization coronary vein and short gastric vein reduces the risk of rebleeding and maybe use as method for improve liver function and decrease of portal hypertension.

Open Access Original Research Article

Metabolic Syndrome in a Sub-population of Geriatric Nigerians in a Primary Care Clinic of a Tertiary Hospital in South-Eastern Nigeria

Gabriel Uche Pascal Iloh, Agwu Nkwa Amadi, Chinasa Orie Agwu Amadi

Journal of Advances in Medicine and Medical Research, Page 1-12
DOI: 10.9734/BJMMR/2016/23672

Background: Research studies have shown that age is an independent risk factor for metabolic syndrome (MetS). However, as eco-demographic structure and function of Nigeria changes, geriatric Nigerians tend to adopt lifestyles that promote the emergence of metabolic syndrome.

Aim: This study was aimed at determining the prevalence of metabolic syndrome and its associated risk factors in a sub-population of geriatric Nigerians in a primary care clinic of a tertiary hospital in South-eastern Nigeria.

Study Design: This was a cross sectional study carried out on a sub-population of 225 geriatric Nigerians.

Place and Duration of Study: The study was done in the primary care clinic of Federal Medical Centre, Umuahia, Nigeria between May 2012 and October 2012.

Methodology: Two hundred and twenty five geriatric patients aged ≥ 60 years were screened for MetS using International Diabetes Federation (IDF) criteria: An Individual was considered to have MetS in the presence of waist circumference ≥94 cm for men and ≥80 cm for women plus  any two or more of the following: systolic and/or diastolic blood pressure ≥130/85 mmHg and/or hypertension on treatment; fasting plasma glucose ≥ 100 mg/dL and/or diabetes mellitus on treatment;  triglyceride level ≥150 mg/dL and/or hypertriglyceridaemia on treatment and high density lipoprotein (HDL-C) cholesterol <40 mg/dL for men or <50 mg/dL for women and/or HDL-C dyslipidaemia on treatment. The data collected included basic demographic and nutri-behavioural variables using structured, pretested and interviewer administered questionnaire. 

Results: The prevalence of MetS was 44.0%. MetS was significantly associated with female sex (P=.036), not engaged in any occupation (P=.043), and physical inactivity (P=.001). The most significant predictor of MetS was physical inactivity (P=.001, OR=2.30 (1.08-5.63). The geriatric patients with MetS were two times more likely to be physically inactive compared to their non-MetS counterparts.

Conclusion: MetS occurs in a sub-population of geriatric Nigerians in primary care and is associated with female sex, not engaged in any occupation, and physical inactivity. Screening for MetS alongside its determinants should be considered for geriatric Nigerians in primary care.

Open Access Review Article

Porous Titanium Granules in Treatment of Intra-bony Defects: A Literature Review

Zahra Nateghi, Fatemeh Khalilian, Noushin Janbakhsh, Mohammadreza Shirian, Amirali Shirian

Journal of Advances in Medicine and Medical Research, Page 1-10
DOI: 10.9734/BJMMR/2016/22482

Background: This study aimed to do a review on the applications of porous titanium granules (PTG) in periodontal and non-periodontal treatments.

Methods: An electronic search was carried out in Google Scholar and PubMed databases using the key words “guided tissue regeneration”, “intrabony defects”, “porous titanium granules” and “moderate to advanced chronic periodontitis”. English articles published from 2006 to 2014 were searched.

Results: Porous titanium granules showed positive results in enhancing the outcome of treatment in medicine. Most of the relevant studies have been conducted using culture media or animal models.

Conclusion: It can be stated that PTGs have many applications in periodontal procedures due to their space maintaining capability, long-term substantivity, not requiring a membrane and biocompatibility.