Open Access Case Study

Trapped after Coming Buttocks: A Consequence of Sacrococcygeal Teratoma: A Case Report

M. Bukar, S. M. Ibrahim, C. Ayuba, H. A. Nggada

Journal of Advances in Medicine and Medical Research, Page 1-4
DOI: 10.9734/BJMMR/2016/23876

Sacrococcygeal teratoma (SCT) is the commonest fetal tumour but a rare cause of obstructed labour. If undiagnosed during antenatal period, high index of suspicion is required during labour to make a diagnosis. In this case report, we present a case of sacrococcygeal teratoma (SCT) which was diagnosed at the time of delivery. The fetus, with a massive ruptured sacrococcygeal mass, was delivered by traction and suprapubic pressure. Histology report revealed malignant sacrococcygeal teratoma. The diagnosis of sacrococcygeal teratoma (SCT) should form part of the differential diagnoses when there is obstructed labour after the delivery of the fetal shoulders so that appropriate management can be instituted.

Open Access Case Study

Gangrenous Purpura Fulminans Associated with Influenza A Infection

Türkay Akbaş, Elif Şenocak Taşçi, Birgül Öneç, Feruze Turan Sönmez, Hakan Turan

Journal of Advances in Medicine and Medical Research, Page 1-5
DOI: 10.9734/BJMMR/2016/24131

Background and Purpose: Purpura fulminans (PF) is a rapidly progressive disease of small-vessel thrombosis and hemorrhagic skin infarctions with high mortality and morbidity. Three forms of disease exist; neonatal, idiopathic and infectious. Infectious one usually appears secondary to gram-negative bacteremia and rarely secondary to viral infections.

Case Description: In this paper, we present a 27-year-old female patient with diagnosis of purpura fulminans secondary to Influenza A septicemia which is the first case reported in the literature.     

Discussion: Several kinds of infection may cause purpura fulminans including rare viral infections so the clinician should be alert to diagnose and to treat purpura fulminans in case of purpuric and hemorrhagic lesions in patients with infectious diseases.

Open Access Short Research Article

Peculiarities of Cognitive Disorders in Adult Patients with Epilepsy

Makhmudova Ziyoda Takhirovna, Gafurov Bakhtiyor Gafurovich

Journal of Advances in Medicine and Medical Research, Page 1-7
DOI: 10.9734/BJMMR/2016/23181

Aim: The basic aim of the article is to study the state of cognitive functions in patients with epilepsy due to clinical characteristics and a pharmacological group of received anticonvulsive medicines using MMSE test and examination of cognitive induced potential P300.

Place and Duration of Study: The Department of Neurology at Tashkent Institute of Postgraduate Medical Education, Tashkent, Uzbekistan, between April 2012 and April 2013.

Methodology and Study Design: The study was conducted on the basis of the neurological department of the city hospital number 7 in Tashkent (Uzbekistan). 75 patients with epilepsy at the age from 21 to 42 being under treatment at hospital were examined. The average age of patients in the debut of the disease was 32±9.3 years. The clinical form of the disease and epileptic seizures were determined based on the International Classification of epileptic seizures and the International Classification of epilepsy and seizures. Clinical assessment of cognitive functions was performed using MMSE (Mini Mental State Examination) test. Besides this method of research of cognitive evoked EEG potential to acoustic stimulation, and the assessment of potential latencies of P300, which reflects the cognitive processes of attention and perception, N200 was used, reflecting the process of initial identification of the stimulus.

Results: The results indicated the presence of more severe cognitive disorders in patients who were sick for more than 5 years, with symptomatic epilepsy, generalized convulsive seizures and taking barbiturates. It was established by assessing cognitive function method, that examination of potential P300 is more sensitive in comparison with MMSE test.

Conclusion: Our results clearly demonstrate the extension of the latent period of the components of P300 complex at all examined patients, shows a decline in the integral functions of the central nervous system and the mechanisms of information processing occurring in epilepsy. While taking AEDs, cognitive deficit increases in the following order valproates – carbamazepine – barbiturates.

Open Access Short Research Article

Development of a Seizure and Epileptogenesis in EL Mouse

Jiro Suzuki

Journal of Advances in Medicine and Medical Research, Page 1-5
DOI: 10.9734/BJMMR/2016/23157

To elucidate the mechnisms of epileptogenesis in the EL mouse which is an excellent animal model of epilepsy. All animals (EL/Suz) were stimulated by our routine tossing-up method once a week through their lives and exibited seizures.

The electric activities of the brain were recorded through implanted electrodes in the freely moving state. The following symptoms of an established seizure are observed: tiny auras, wild running, tonic convulsions, clonic convulsions, and finally, stupor repose lasting approximately 1 to 3 min. These symptoms are accompanied by major changes in paroxysmal discharges in the electro-corticogram and the electric activities of the deep brain parts. Paroxysmal activities start at the parietal cortex and are transmitted to other cortical areas. When the paroxysmal activities reach to the thalamus, hippocampus and striatum, the mouse runs; simultaneously, tonic-clonic convulsions start, for which the hippocampus plays a major role. Finally, paroxysms stop, and the animal stands still. 

Abortive seizures do not occur until the age of 8 weeks and only occur after routine stimulation. At that time, some small paroxysmal activities are observed in the parietal cortex. After the age of 10 weeks, a running fit appears; however, it is not necessarily observed later in life. The most remarkable symptom of epilepsy, tonic convulsion, occurs after 10 weeks of age, and clonic convulsion continues until the death of animal. 

A common course of onset of individual seizures and abnormal plastic formation of seizures during the lifespan of the EL mouse are observed. All individual seizures repeat the developmental process of seizures in order. This paradigm can be demonstrated by longitudinal observations of seizure symptoms and electric activities in the EL mouse brain and by life-long investigations of many animals.

In conclusion one could observe all individual seizures repeat the developmental process of seizures in order by the EL mouse investigation.

Open Access Original Research Article

Combination of Oral Anticoagulant with Antiplatelet and All-cause Mortality in Elderly Patients with Atrial Fibrillation and Ischemic Heart Disease

Shijun Li, Li Zhang, Yangyu Wang, Na Li, Hongjie Li

Journal of Advances in Medicine and Medical Research, Page 1-9
DOI: 10.9734/BJMMR/2016/23637

Aim: Clinicians are often face the dilemma of choosing more appropriate antithrombotic regimen, since there is no evidence regarding the role of combination of Oral Anticoagulant (OAC) and antiplatelet which played in elderly patients with Atrial Fibrillation (AF) and Ischemic Heart Disease (IHD). We therefore aimed to investigate the effect of combination of OAC and antiplatelet on all-cause mortality in elderly patients with AF and IHD.

Study Design: This is a retrospective analytical study.

Place and Duration of the Study: The study was conducted in Chinese PLA General Hospital, Beijing, China. Selected patients' data available for the period between 2008 and 2014 were included in this study.

Methods: A total of 669 elderly patients with AF and IHD between 2008 and 2014 were included (mean age, 80.8 years; 67.5% men). The endpoint was all-cause mortality. Risk of all-cause death was examined with Kaplan-Meier analysis and adjusted Cox regression models.

Results: During a median follow-up of 1.3 years, the mortality rate was 74.3% for patients with antiplatelets, 58.6% for OAC and 42.9% for combination of both, respectively. OAC and /or antiplatelet use were associated with risk of mortality (chi-square=11.03, log rank p = 0.004) using unadjusted Kaplan-Meier analysis. In overall cohort, the adjusted hazard ratios for mortality for combination of OAC and antiplatelet was 0.41 (95% CI 0.19-0.87, p = 0.019) as compared to antiplatelet use, 0.80 (95% CI 0.39-1.64, p = 0.541) as compared to OAC use. In subgroup age ≥ 75 years, the adjusted hazard ratios for mortality were 0.40 (95% CI 0.16-1.02, p = 0.054) for combination of OAC and antiplatelet as compared to antiplatelet use, 0.79 (95% CI 0.31-1.96, p = 0.605) for combination of OAC and antiplatelet as compared to OAC use, and compared to antiplatelet use, the adjusted hazard ratio for mortality were 0.51 (95% CI 0.32-0.81, p = 0.005) for OAC use.

Conclusions: Combination of OAC with antiplatelet is associated with reduced all-cause mortality and OAC is better on outcome as compared to antiplatelet agents, but OAC plus antiplatelet is not superior to OAC in elderly patients with AF and IHD and in subgroup aged ≥ 75 years.

Open Access Original Research Article

Sexual Risk Practices of Undergraduate University Students in the Niger Delta Region of Nigeria: Implications for Planning Interventions

Tobin-West Charles, Akani Yetunde

Journal of Advances in Medicine and Medical Research, Page 1-9
DOI: 10.9734/BJMMR/2016/23587

Aim: To evaluate the sexual practices of undergraduate university students in the Niger Delta region of Nigeria in order to provide evidence for appropriate interventions.  

Study Design: A multi-stage random sampling design and stratified sampling proportionate to size was used to select study participants.

Place and Duration of Study: The study was carried out in four out of the 18 public universities in the region between October and December 2013. 

Methodology: An anonymous questionnaire was administered to 828 students selected from four faculties and eight departments of the universities. Married students and those from departments of medical and health sciences were excluded.  Data was analyzed using Epi Info ver. 6.04d software package. The Chi-square test was performed at 95% confidence level and p-value set at P=.05.

Results: A total of 391(47.2%) males and 437 (52.8%) females participated in the study. The majority of the students 444(53.6%) were in sexual relationships: 150 (33.8%) males and 294 (66.2%) females. Of these, 358 (80.6%) had had an HIV test and knew their HIV status: males 125 (34.9%) and females 233 (65.1%), but only 280(63.1%) had knowledge of the HIV status of their sexual partners: males 93(33.2%) and females 187 (66.8%). More females than males knew their HIV status and those of their sex partners (p=.00). Similarly, only 216(48.6%) used condoms in their last casual sex, while only 145(32.7%) used condoms consistently with a non-regular partner: males 71(49.0%) and females 74(51.0%) respectively. Finally, less than half of the students 216(48.6%) were consistent with safer sex negotiation with their partners.                                

Conclusion: The study highlights the occurrence of high sexual risk behaviours among undergraduate university students. We advocate the inclusion of sexuality education in the General Studies curriculum for students and the provision of accessible Sexually Transmitted Infection services through youth-friendly channels, like Youth Friendly Centres.

Open Access Original Research Article

Assessment of School Health Instruction Implementation in Primary Schools in a Local Community in South-East Nigeria: A Comparative Study between Private and Public Schools

Osuorah DI. Chidiebere, Ulasi O. Thomas, Ebenebe Joy, Ekwochi Uchenna, Onah K. Stanley, Ndu K. Ikenna, Asinobi N. Isaac

Journal of Advances in Medicine and Medical Research, Page 1-6
DOI: 10.9734/BJMMR/2016/23737

Schools have the responsibility to educate their students and encourage them to live healthy and hygienic behavior. This descriptive cross-sectional study aimed to determine the status of the school health instruction in 56 randomly selected schools in Nnewi North Local Government area of Anambra state using the school health program evaluation scale. It also assessed the extent of implementation of provisions of school health instruction in these schools. Forty six (78.6%) of the 56 schools surveyed had adequate implementation of school health instruction. The proportion of school that met the requisite score (16) for adequate implementation of school health instruction was not significantly different between private and public schools [24(73%) vs. 20(87%), P=0.389]. There was also no significant difference in mean scores attained for school health instruction between private and public schools (17.6±4.4 vs. 17.6±3.6; P=0.939). Private school had more non classroom related heath activity compared to public schools (75.8% vs. 21.7%, P=0.000) while public schools, had significantly more qualified health instructors, ten (43.5%) compared to private schools six (18.2%), P=0.040. Training and retraining of primary school teachers coupled with effective school health policies would be essential in ensuring adequate and optimal implementation of school health instructions in primary schools.

Open Access Original Research Article

The Clinical Experience of Atosiban in Preterm Labour

Bhupesh Dewan, Deepashri Shah

Journal of Advances in Medicine and Medical Research, Page 1-9
DOI: 10.9734/BJMMR/2016/23823

Aims: To evaluate the efficacy, safety and tolerability of atosiban in delaying preterm labour.

Study Design: A prospective, open label, non comparative study.

Place of Study: Lokmanya Tilak Municipal Medical College Mumbai, India.

Methodology: Pregnant women (N=110) between the gestational age of 24 to 34 weeks, presenting with signs of preterm labour were enrolled in the study. Efficacy, safety and tolerability of Atosiban were assessed for a period of 72 hrs.

Results: Ninety Eight patients (89.09%) remained undelivered up to 72 hrs after completion of treatment phase and ninety seven patients (88.18%) till the end of their hospital stay (upto 7 days). There were six patients with twin and one with quadruplet pregnancy; atosiban therapy was successful in delaying labour upto discharge from hospital in all the seven patients. The study medication was well tolerated as no adverse events were observed throughout the study duration.

Conclusion: Atosiban, an oxytocin receptor antagonist, has proven to be an effective and well tolerated tocolytic drug and because of its favourable safety profile, it may be the best choice as a tocolytic therapy to delay the preterm labour.

Open Access Original Research Article

The Renal Ultrasound in Patients with Acute Kidney Injury

Mahvesh K. Mahmud, Waseem Mehmood Nizamani, Nida Hussain, Zarak Iqbal Samoo, Wahaaj Ali Khan, Farah Ahmad, Syed Hasan Danish

Journal of Advances in Medicine and Medical Research, Page 1-9
DOI: 10.9734//BJMMR/2016/23827

Aims: Acute Kidney Injury (AKI) is seen in 15% of hospitalized patients and a renal ultrasound (RUS) is often ordered to exclude an obstructive cause in the initial evaluation of AKI. This study was done to evaluate the usefulness of a RUS in patients with AKI in a developing country.

Methods: This was a retrospective study on all patients who were referred to nephrology with AKI and had a RUS, over a one-year period at a tertiary care teaching hospital of Karachi, Pakistan. The patients’ charts were reviewed for clinical characteristics and the RUS findings were documented.

Results: A significant number of patients did not have documented risk factors for obstruction based on the medical history. Hydronephrosis was found in 22.5% (25 out of 111) of patients, and in 14 of these cases, the etiology of the acute kidney injury was found to be obstructive uropathy. The presence of nephrolithiasis and/or benign prostatic hypertrophy was associated with and increased likelihood of finding hydronephrosis on RUS.

Conclusions: We thus recommend doing a renal ultrasound in all cases of AKI due to the fact that most of the time in a developing country, an accurate history is not available, and the prevalence of stone disease and obstructive uropathy is high.

Open Access Original Research Article

Laparoscopic Myomectomy in a Tertiary Care Centre in Douala, Cameroon

Thomas Obinchemti Egbe, George Enonchong Enow-Orock, Gregory Edie Halle Ekane, Charlotte Nguefack Tchente, Eugene Belley-Priso

Journal of Advances in Medicine and Medical Research, Page 1-10
DOI: 10.9734/BJMMR/2016/23499

Objective: To assess the feasibility and outcome of laparoscopic myomectomy with single or double-layer closure of myoma bed for management of myomas at a tertiary care centre in Douala, Cameroon.

Materials and Methods: Thirty patients with large or moderate-size myomas were managed laparoscopically from September 1996 to September 2008. The indications for surgery included subfertility, heavy menstrual bleeding, abdominal mass and lower abdominal pain. Pre‑operative evaluation included history, clinical examination and sonographic mapping. Myomas were enucleated and retrieved laparoscopically by morcellation. Myoma beds were sutured in a single or double layer by endoscopic intra-corporeal suturing depending on the depth of the fibroids.

Results: Among our patients, 14 (46.7%) presented with subfertility, 8 (26.7%) with heavy menstrual flow and 6 (20%) with abdominal mass. Two (6.7%) presented with lower abdominal pain. The average maximum diameter of myoma was about 8.5 cm. The mean duration of surgery was 123.2±90 min and blood loss was minimal. The mean post-operative stay in hospital was averagely 3.03 days. There were no intra-operative complications recorded among our series and hospital stay was uneventful.

Conclusion: With proper single layer closure of the myoma bed, laparoscopic myomectomy is feasible for moderate and even large myomas not more than three fibroids, and has excellent outcomes.