Open Access Case Study

Laparoscopic Cholecystectomy Performed Immediately after Cesarean Section without Additional Incisions: A New Method

Onder Surgit, Ilknur Inegol Gumus, Murat Ozgur Kilic

Journal of Advances in Medicine and Medical Research, Page 1-5
DOI: 10.9734/BJMMR/2016/23906

Aim: To describe a new technique in which laparoscopic cholecystectomy can be performed through trocar cannulas inserted directly through the same incision used for the cesarean section, without the need for additional incisions elsewhere.

Presentation of Case: A 30-year-old pregnant woman presented with symptomatic cholelithiasis. Laboratory and radiological investigations revealed no signs of cholecystitis or pancreatitis. She had previously undergone cesarean section, so this was planned for the current birth as well, to be followed immediately by laparoscopic cholecystectomy. In week 38 of gestation, under general anesthesia and with a standard Pfannenstiel incision, a cesarean section was successfully performed. Thereafter, a laparoscopic cholecystectomy was performed through the same incision. The patient was discharged without any problem.

Discussion: For patients with symptomatic gallbladder stones who undergo cesarean section, treatment options include laparoscopic cholecystectomy performed immediately after cesarean section during the same operative session, either with the standard technique or with the use of the cesarean incision in addition to other incisions. Technical difficulties of laparoscopic cholecystectomy performed through Pfannenstiel incision is the main concern of this method; however, the laxity of the abdominal wall due to enlarged uterus and hormonal changes during pregnancy facilitate laparoscopic maneuvers.

Conclusion: Our technique, by making use of the cesarean incision alone, provides for easy gallbladder removal while also minimizing the risk of port related injury, reducing postoperative pain and providing better cosmetic results due to the absence of additional incisions; therefore can be considered in selected patients.

Open Access Case Study

Poor Cardiovascular Risk Profile Following a Vegan Diet: A Case Report

Olivia Hanna Koury, Andreas Bergdahl

Journal of Advances in Medicine and Medical Research, Page 1-4
DOI: 10.9734/BJMMR/2016/23762

Introduction: Vegetarianism and veganism are becoming increasingly popular in North America due to reasons ranging from environmental motives to animal rights. While the vegetarian lifestyle allows some egg and dairy items, vegans completely abstain from all animal products in favour of plant-based diets. Of additional interest to vegans, are the health benefits associated with cardiovascular disease, type 2 diabetes, weight loss and some particular forms of cancer.

Case Presentation: Numerous studies have demonstrated drastic improvements in lipid markers such as low-density lipoprotein and total cholesterol that follows vegan dieting when compared to vegetarians or omnivores. This case report discusses a female patient who revealed abnormal lipid markers following blood analysis, despite observing a strict vegan diet for two years.

Conclusion: It is questioned whether a vegan diet and its associated macronutrients are indeed beneficial for cholesterol levels or if adhering to this diet require more thorough investigation for an overall reduced risk of cardiovascular disease.

Open Access Case Study

Surgical Management of Haemangiolymphangioma - An Infrequent Tumor in Oral Cavity: A Case Report and a Review

Nikhil Srivastava, Akshay Shetty, Rahul Dev Goswami, Vijay Apparaju

Journal of Advances in Medicine and Medical Research, Page 1-5
DOI: 10.9734/BJMMR/2016/23753

Hemangiomas are group of vascular anomalies which are not present at birth. They generally manifest within 3-4 weeks of life, consists of a rapid proliferative phase, stable plateau phase and slow involuting phase. Hemangiomas of the oral cavity are not commonly observed though head and neck are common sites. Histologically it may be evident in some cases that lymphatic channels are present in hemangiomas, and then it is be categorized according to the predominant component either Haemangiolymphangioma or lymphangiohemangiomas. All most all hemangiomas involute with time, but 10-20% of true hemangiomas don’t involute and require post- adolescent surgical treatment. In this article a case of Haemangiolymphangioma of right buccal mucosa in a 22-year-old male patient is reported. Various treatment modalities and their clinical implication have also been reviewed.

Open Access Original Research Article

Transmissible Spongiform Encephalopathy and Cattle in Enugu State of Nigeria

F. O. Ugwuene, C. N. Soronnadi, R. C. Duru

Journal of Advances in Medicine and Medical Research, Page 1-6
DOI: 10.9734/BJMMR/2016/21721

Bovine spongiform encephalopathy (BSE) is the Transmissible spongiform encephalopathy (TSE) found in cattle. The disease can be transmitted by ingestion of prion infected beef. The aim of this study is to determine whether the beef consumed in Enugu area of Nigeria can transmit TSE to humans and animals. Apparently healthy cattle from abattoir of Enugu State Main Market, numbering eighty, were used in this research work. The cattle were slaughtered and their brain tissues collected and stored in 10% phosphate buffered saline respectively for tissue preservation, shortly before assay. Part of each cattle’s brain tissue was homogenized and subjected to prion protein (PrP) extraction procedure. Aliquots of the PrP extract and commercial positive PrPc control were treated with proteinase K solution to eliminate proteinase K labile proteins, especially cellular prion protein (PrPc). An aliquot of the proteinase K treated extract was further treated with 26.8% Sodium sulfate solution and ethyl ether to remove any immunoglobulin protein which may be present thereby leaving the remnant solution with abnormal prion protein (PrPres) if present. Aliquots of the protein extract and control without proteinase K treatment, the ones that were treated with proteinase K, the other that was treated with 26.8% Sodium sulfate solution and ethyl ether were assayed respectively for proteins using biuret method. The results showed the presence of prion protein in the aliquots without proteinase K treatment, trace of protein in the aliquot of protein extract treated with proteinase K and no prion protein in the PrPc control treated with proteinase K. The aliquot that was treated with both proteinase K and 26.8% Sodium sulfate solution / ethyl ether showed zero protein. The results suggest that there was no abnormal PrP in the eighty samples of brain tissues of cattle used for this work and they did not have BSE.

Open Access Original Research Article

Screening for Glucokinase (GCK) Gene Mutation in Gestational Diabetes Women in Western Region of Saudi Arabia

Sabah M. Hassan, Archana P. Iyer, Fahad A. Al-Abbasi

Journal of Advances in Medicine and Medical Research, Page 1-10
DOI: 10.9734/BJMMR/2016/23928

Aim: The study involved screening of three exons of glucokinase gene (7, 8 and 9) to detect mutations at posi­tions 682A>G, p.T228A, 895G>C, p.G299R and 1148C>A, p.S383X, respectively in Saudi pregnant women with or without gestational diabetes.

Study Design: Retrospective study.

Place and Duration of Study: The Obstetrics and Gynecology clinic of King Abdul-Aziz Hospital in South Jeddah between May and October 2013.

Methodology: A sample of 100 Saudi pregnant women classified as healthy (control, N = 50 (pregnant women without diabetes)) or with gestational diabetes (N = 50) was analyzed for mutations in the GCK gene. Blood samples were taken and DNA was extracted from whole blood. The target part of GCK gene was amplified by the polymerase chain reaction (PCR). The specific amplified regions were digested by restriction enzymes: BstUI for exon 7, HhaI for exon 8 and BfaI for exon 9, and electrophoresed on agarose gel. Mutations were screened by restriction fragment length polymorphism.

Results: Fasting glucose levels were statistically higher in gestational diabetes women than controls (P-value = 0.00). The difference in Glucose Challenge Test (GCT) values between two groups shows significante p-value = 0.00. However, We observed that there was no significant correlation between any of the GCK mutations and gestational diabetes in Saudi population.

Conclusion: The glucokinase gene mutations do not affect glucose metabolism in pregnant Saudi women.

Open Access Original Research Article

Elevated Body Mass Index and Waist Circumference Induced Hypertension is not Significantly Reversed by Oral Administration of Antihypertensive Agent

Akinwumi T. Ogundajo, Modupe F. Asaolu, Ridwan T. Oladipo

Journal of Advances in Medicine and Medical Research, Page 1-6
DOI: 10.9734/BJMMR/2016/23731

Aims: This study investigated the effects of elevated body mass index and waist circumference on blood pressure control in hypertensive subjects under a specific antihypertensive agent in comparison with normotensive subjects.

Study Design: One factor quasi-experimental design.

Place and Duration of Study: Department of Biochemistry, Ekiti State University, Ado- Ekiti, Ekiti State, Nigeria. December, 2014-November, 2015.

Methodology: The research subjects and control subjects between ages 31-60 years both male and female subjects were selected. Systolic and diastolic blood pressures were measured using mercury sphygmanometer. The body mass index was calculated as weight in kilograms divided by the square of the height in metres. While the waist circumference was measured at the level of the iliac crests using a flexible tape and passing along the umbilical level of the unclothed abdomen.

Results: Comparing the body mass index and waist circumference of both untreated and treated hypertensive subjects with the normotensive subjects showed a significant increase  (P=0.0001).

Conclusion: Elevated body mass index and waist circumference may be a predisposing factor to high blood pressure and resistant to antihypertensive agents.  Reducing body mass index and waist circumference may be a way of enhancing effectiveness of antihypertensive agents.

Open Access Original Research Article

Imaging and Pathologic Features of the Common Hepatic Focal Lesions

Lamiaa Mobarak, Mohammed M. Nabeel, Waleed El Agawy, Zeinab Zakaria

Journal of Advances in Medicine and Medical Research, Page 1-7
DOI: 10.9734/BJMMR/2016/23665

Background and Study Aims: Focal liver lesions are considerably detected in every day practice. Radiological imaging has a significant role in the detection and follow up of hepatic focal lesions. At times, the pathological study is absolutely necessary to confirm a definite diagnosis. The aim of this study was to estimate the probability that radiological scans to diagnose different types of focal liver lesions as primary imaging modalities are inconclusive.

Methods: This study was carried out at National Hepatology and Tropical Medicine Research Institute, Egypt. Abdominal ultrasonography, triphasic computed tomography +/- magnetic resonant imaging and ultrasound guided percutaneos core biopsy of 42 patients with suspected hepatic focal lesions were carried out.

Results: Out of 42 patients with liver focal lesions detected by transabdominal ultrasound and with inconclusive criteria by triphasic computed tomography +/- magnetic resonant imaging then confirmed by pathological examination, 8 were regeneration nodules, 18 hepatocellular carcinoma (HCC), 6 adenomas, 5 haemangiomas, 1 undifferentiated carcinoma,1 sarcoma., 2 abscesses and 1 dysplastic nodule.

Conclusions: Ultrasound is a safe and rapid method of detecting hepatic focal lesions, also allowed ultrasound guided interventions. High proportions of inconclusive criteria by additional scans were observed in this study. In this case histopathology is recommended to confirm the diagnosis.

Open Access Original Research Article

Assessment of Occupational Health Safety and Hazard among Government Health Workers in Ondo City, Southwest Nigeria

B. W. Osungbemiro, O. A. Adejumo, A. A. Akinbodewa, A. A. Adelosoye

Journal of Advances in Medicine and Medical Research, Page 1-8
DOI: 10.9734/BJMMR/2016/23620

Aim: To assess the level of awareness of occupational health safety (OHS), to identify common occupational hazards and to determine the association between profession, year of experience and level of awareness of occupational health hazards among government Health Care Workers (HCWs) in Ondo city, Southwest Nigeria.

Study Design: A descriptive cross-sectional study carried out over a 6 week period between September to October 2015.

Place and Duration of Study: The Two Government Hospitals in Ondo (University of Medical Science Teaching Hospital and State Specialist Hospital Ondo).

Methodology: A Standard questionnaire that has both risk assessment and safety practices sections was administered to HCWs in the hospitals which were categorised into clinical and non-clinical professionals. Data obtained were analysed using SPSS version 17.

Results: A total of 345 respondents participated in the study comprising of 136 (39.4%) males and 209 (60.4%) females. About 85% of the respondents were aware of OHS and undergraduate training was the major source of awareness in 177 (51.3%). The common hazards identified among the respondents were sharp related injuries in 280(75.4%), infections from patients in 244(70.7%), cuts and wounds in 207(60%), air borne disease in 207(60%) and stress in 268(77.7%), physical/verbal abuses in 184(53.3%). One hundred and thirty one (38%) respondents had high level of occupational risk while only 21(6.1%) had good level of safety measures. Non-clinical HCWs had significantly better safety practices (P <0 .001). Clinical HCWs were significantly more aware of OHS (P < 0.001). Also, HCWs with > 10 years of practice had better awareness of OHS (P =0 .01).

Conclusion: Majority of the government HCWs in Ondo had high occupational hazard risk, poor compliance to occupational safety measures despite high awareness of OHS.

Open Access Original Research Article

Relation between Job Stressors and Nursing Satisfaction

Hadi Khoshab, Hassan Alinejad, Ali Khodadadizadeh, Fatemeh Ghorbani, Zeinab Hajaliakbari, Seyed Hamid Seyed Bagheri

Journal of Advances in Medicine and Medical Research, Page 1-7
DOI: 10.9734/BJMMR/2016/22371

Background: Nursing is one of the most stressful jobs that many factors involved in this stress. Stress reduction may improve the job satisfaction of nurses. The purpose of this study was to assess the relationship between job stressors and job satisfaction among nurses.

Materials and Methods: A descriptive-correlational study was conducted to investigate the relationship between job stressors and job satisfaction. One hundred and sixty-nine nurses were selected by stratified sampling. Nursing stress scale and Herzberg occupational satisfaction were used to collect data. Pearson correlation coefficient, T-test and ANOVA were conducted to analyze data.

Results: There was no significant relation between job stressors and job satisfaction among nurses (P > 0.05). The mean job stressors was 79.11±14.85 and mean job satisfaction scores was 71.74±14.28. Majority of nurses had average job satisfaction and average job stressors. Most of the nurses were unsatisfied about lack of work place welfare and most of them were satisfied about colleague interaction among nurses, and the most of stressors were reported by the nurses was watching the death and suffering of patients.

Conclusion: In this study Nurses experienced average job stressors and average job satisfaction. Therefore, paying more attention to nursing work environment for the decision-makers and managers is necessary. Further exploration is required to find them to take practical steps to resolve them.

Open Access Original Research Article

Socio-Demographic Characteristics and Predictors of Childhood Primary Nocturnal Enuresis in Benin City, Nigeria

Damian U. Nwaneri, Nosakhare J. Iduoriyekemwen

Journal of Advances in Medicine and Medical Research, Page 1-9
DOI: 10.9734/BJMMR/2016/22965

Aim: To document the socio-demographic characteristics and predictors of primary nocturnal enuresis in children.

Study Design: A descriptive cross sectional study.

Place and Duration of Study: The study was carried out in public primary and secondary schools in Egor Local Government Area, Edo State, Nigeria from April to August 2014.

Participants and Methods: A semi-structured self-administered questionnaire was used to obtained information about nocturnal enuresis from 1221 mothers/child pair who gave consent to participate in the study.

Results: Prevalence of primary nocturnal enuresis in the children was 18.8% (primary monosymptomatic nocturnal enuresis 73.7% and primary non- monosymptomatic nocturnal enuresis 26.3%). Children ages 5 – 7 years (OR = 5.0, p = 0.00) and those from the large household (20.3%) (p = 0.02) significantly had primary nocturnal enuresis. Predictors of primary nocturnal enuresis in this study included difficulty to awaken child from sleep (β = 0.90, OR = 2.5, p = 0.00), history of soiling under-wear (β = 1.56, OR = 5.0, p = 0.00), urgency (β = 1.0, OR = 2.7, p = 0.00), and family history of enuresis (β = 1.95, OR = 7.0, p = 0.00).

Conclusion: This study showed that about one out of every five school children had primary nocturnal enuresis. Difficulty to awaken child from sleep, soiling of under-wears, history of urgency and family history independently predicted primary nocturnal enuresis.