Open Access Short Research Article

The Use of the Prague Classification System in the Reporting of Barrett’s Surveillance Endoscopies

Richard Bodington, Shameen Jaunoo

Journal of Advances in Medicine and Medical Research, Page 1-4
DOI: 10.9734/BJMMR/2016/24283

Aims: The Prague classification for the reporting of Barrett’s oesophagus has been validated in previous studies and is recommended by the British Society of Gastroenterologists (BSG) in their latest guidelines. In this short study we aim to audit the adherence to the use of this system in endoscopy reports produced in a busy teaching hospital in the UK. 

Methods: We retrospectively audited all the reports for endoscopies performed as surveillance for patients with known Barrett’s oesophagus within a six month period. These reports were examined as to whether or not the Prague classification system was employed.

Results: Sixty-seven reports were inspected and six were excluded as Barrett’s was not seen. Twenty-six of the 61 reports studied (43%) used the Prague classification system.  The remainder used descriptions and length measurements felt appropriate by the endoscopist. 

Conclusions: The BSG guidelines emphasise the importance of measuring Barrett’s using a standard methodology. The rationale for this include aiding communication, increasing the level of diagnostic confidence and providing an estimate of the risk of adenocarcinoma development based on segment length. The use of the Prague classification is validated, explicit and consensus driven. However our study demonstrates that only 43% of endoscopy reports use the Prague system. The reason for this lack of adherence is unclear and may benefit from further study.

Open Access Short Research Article

Structure of the Small Intestinal Mucosa after Acute Hemorrhagic Shock and Reperfusion of the Ischemic Limbs

Rakhmatova Mukaddas Kholtaevna, Tarinova Margarita Vladimirovna, Nugmanova Umida Takhirovna, Nishanova Aziza Abdurashidovna

Journal of Advances in Medicine and Medical Research, Page 1-6
DOI: 10.9734/BJMMR/2016/23197

Aims: The purpose of the report is to study Structure of the Small Intestinal Mucosa after Acute Hemorrhagic Shock and Reperfusion of the Ischemic Limbs.

Place and Duration of Study: The Department of Histology and Medical Biology, Tashkent State Institute of Dentistry, between March 2013 and March 2015.

Methodology and Study Design: Acute hemorrhagic shock was developed by using Wigger modified method. 76 Shinshilla rabbits having 2.6 + 0.2 kg of body weight fasted for 15 hours before they were undergone acute hemorrhagic shock. In one hour the clamps were removed and simultaneously with the blood flow restoration the ischemic limbs were injected with physiologic solution (II), Rheopolyglukin (III; 20 mg/kg), Succinasol (IV; 1.2 mg/kg). The functional system of digestion and absorbtion integrated with the immune system of the small intestional mucosa which normally regulates homeostasis of the inner medium of an organism was defected one hour after reperfusion of the ischemic limbs of rabbits.

Results: The basement membrane beneath enterocytes had usual thickness, stroma of villi contained large number of lymphocytes, functionally active eosinophils and mast cells, the plasmatic cells were large in size and contained rough endoplasmic network with dilated profiles. Blood vessels had normal structure.

Conclusion: Structural and functional lesions of the supraepithelial layer of mucus in small intestinal mucosa at the acute hemorrhagic shock and reperfusion have led to direct interactions of microorganisms and microvilli of enterocytes, their translocation into the absorbing cells and stroma of villi, phagocytosis and depletion by macrophages, activation of immunocytes and other cells of the connective tissue.  The results indicated the Succinasol had prevented effectively the structural and functional lesions of the small intestinal mucosa and, as a consequence, the interactions of intestinal microorganisms with glycocalix and microvilli and their translocation into the inner medium.

Open Access Opinion Article

Risk Communication and Generic Preparedness: From Agent-based to Action-based Planning - A Conceptual Framework

P. Dickmann, F. J. Apfel, R. Gottschalk

Journal of Advances in Medicine and Medical Research, Page 1-5
DOI: 10.9734/BJMMR/2016/24033

Responses to recent infectious disease outbreaks, such as to Influenza Pandemic 2009 and the on-going Ebola outbreak in West Africa, reveal the need for new and strengthened approaches to risk communication and governance. The article argues for a fundamental re-conceptualisation of current approaches to risk communication, preparedness planning and response. It calls for a reframing of the way we currently identify and respond to outbreaks around a set of core behaviour-based response patterns. This new model moves away from the current risk communication focus on a plethora of agent-specific threats to five generic response patterns that are based on socially relevant response activities such as 1) controlling vectors, 2) enhancing hygiene, 3) isolation of the sick, 4) protection of the well, and 5) systemic protection of people and their environments. Emphasis is placed on gaining relevant insights into the context specific needs of different communities related to these five patterns. Governance structures are then built and evaluated based on their capacity to collect, communicate, share and prepare the public to take appropriate action related to the five different patterns before, during and after an event. Reframing risk communication and preparedness approaches around a better understanding of the determinants of these general behavioural patterns in infectious control could strengthen infection control literacy, response competence and build resilience of both individuals and health systems to address future epidemics, pandemics and other public health threats.

Open Access Original Research Article

Erythropoietin Improves Effects of Mesenchymal Stem Cells in Experimental Endotoxemia

Alexander V. Averyanov, Anatoly G. Konoplyannikov, Fedor G. Zabozlaev, Anastasia V. Sorokina, Mikhail A. Konoplyannikov, Vladimir P. Baklaushev, Robert I. Khabazov

Journal of Advances in Medicine and Medical Research, Page 1-13
DOI: 10.9734/BJMMR/2016/23761

Aims: Sepsis is a leading cause of mortality in intensive care units. Development of new strategies such as the therapy with mesenchymal stem cells (MSC) appears beneficial for the treatment of sepsis. In this study we evaluated anti-septic effects of rat MSCs and recombinant erythropoietin (EPO) in a rat experimental model of endotoxemia.

Study Design: Controlled in vitro and in vivo studies.

Place and Duration of Study: Federal Research Clinical Center of FMBA of Russia, Moscow, Russia, between June 2014 and May 2015.

Methodology: Endotoxemia was induced by intraperitoneal administration of bacterial lipopolysacharide (LPS). The animals were then treated either with allogeneic MSCs alone, with recombinant EPO alone, or with a combination of EPO and MCS. After 3 days , the animals were euthanized, and a pathology study of their liver, spleen, thymus, lung, and kidney was performed. The serum levels of IL-1β, IL-6, and TNF-α were quantified. A histochemical analysis of splenic and thymic expression of CD3, CD57, p53, and Bcl-2 was performed.

Results: Essential positive effects of the combined MSC-EPO treatment were observed: 1) The animals treated with MSCs and EPO had the lowest serum concentrations of IL-1β in respect to that of the rats treated with LPS alone (58 ± 22 pg/mL vs. 155±90 pg/mL, P = .01); 2) The treatment of endotoxemic rats with a combination of MSCs and EPO also caused production of the anti-apoptotic factor Bcl-2, while its expression was markedly down-regulated in the other groups of animals; 3) In the MSC + EPO group, the degree of interstitial pulmonary edema was the lowest as compared to the other groups, and a minimal renal injury was detected .

Conclusion: These findings suggest that EPO generally improves anti-inflammatory and anti-apoptotic effects of MSCs injected in the acute phase of experimental endotoxemia.

Open Access Original Research Article

A Report on the Incidence of Organophosphate Poisoning among Patients Admitted to King Abdul-Aziz Medical City, Riyadh, Saudi Arabia over a Period of 12 Years

Mohammed Khalaf AlMutairi, Faisal Abdullah Almoaiqel, Abdullah Alanazi, Nawfal Aljerian, Abdullah Alqahtani, Nesrin Al Harthy, Shoeb Qureshi

Journal of Advances in Medicine and Medical Research, Page 1-8
DOI: 10.9734/BJMMR/2016/23704

Background: Organophosphate (OP) is a chemical component, extensively used as a pest control. It is known to block the action of acetylcholinesterase (AChE), causing accumulation of acetylcholine, resulting in symptoms which tantamount to poisoning. Many reports are published on OP poisoning, however; there is a paucity of literature on poisoning due to OP in Saudi Arabia. Hence, the purpose of our study was to look for OP poisoning, in patients admitted to King Abdul-Aziz Medical City (KAMC) over a period of 12 years ranging from January 2002 to June 2014.

Materials and Methods: This is a retrospective study of patients admitted to KAMC with history of acute toxicity.

Results: The study constituted a total of 82 patients. Eighty five percent of admissions were Saudis. The age range was between 6 months and 91 years. Gender ratio was 1.05:1 female to male. Accidental exposure was 62.2%, followed by 30% suicidal attempts. About 55.41% of the patients ingested the poison orally, 31.08% and 13.51% of the incidents were through skin and respiration respectively. Most of the patients (59.8%) arrived to the hospital within 4 hours of exposure. Majority of the patients (79.27%) arrived by private car. Muscarinic effects had been dominant in these patients. Nausea and vomiting were present in 62% of the cases, followed by pupil dilation (54%) and hyper-salivation (35%). Out of 82 patients, 26.83% showed shortness of breath. During the treatment, 24 patients developed both acute and chronic complications. The rate of mortality was 2.4%.

Conclusion: Poisoning is found common as a suicidal attempt among adult females and those who had a history of psychiatric illness, while children below 6 years are at high risk of accidental poisoning.

Open Access Original Research Article

Anxiety Sensitivity and Comorbid Psychiatric Symptoms over the Course of Cognitive Behavioural Therapy for Panic Disorder

Sei Ogawa, Masaki Kondo, Keiko Ino, Toshitaka Ii, Risa Imai, Toshi A. Furukawa, Tatsuo Akechi

Journal of Advances in Medicine and Medical Research, Page 1-7
DOI: 10.9734/BJMMR/2016/23979

Aims: Anxiety sensitivity (AS) might be the core vulnerability in the pathogenesis of AXIS I diagnosis and might be the important transdiagnostic target for the interventions for comorbid psychiatric symptoms in panic disorder (PD). This study aimed to examine the relationship of changes in the three factors of AS and changes in comorbid psychiatric symptoms over the course of cognitive behavioural therapy (CBT) for PD.

Methodology: One hundred eighteen patients with PD were treated with manualized group CBT. Using multiple regression analysis, we examined the associations between the changes in subscales of Symptom Checklist-90 Revised (SCL-90-R) and the changes in factors of the Anxiety Sensitivity Index (ASI) involving Physical Concerns, Mental Incapacitation Concerns, and Social Concerns over the course CBT.

Results: Reductions in Mental Incapacitation Concerns of ASI were related to decreases in 8 SCL-90-R scales, including Obsessive-Compulsive, Interpersonal Sensitivity, Depression, Hostility, Phobic Anxiety, Paranoid Ideation, Psychoticism, and GSI. Reductions in Physical Concerns were related to decreases in 5 SCL-90-R scales, including Somatization, Depression, Anxiety, Phobic Anxiety, and GSI.

Discussion: The present study suggests that reductions in AS, especially mental and physical dimensions, predict comorbid psychiatric symptoms reduction over the course of CBT for PD.

Open Access Original Research Article

Serum Levels of Interleukin-2 and Interleukin-2 Soluble Receptor in Patients with Vitiligo

Emina Kasumagic-Halilovic, Nermina Ovcina-Kurtovic, Samra Soskic, Hana Helppikangas, Ognjen Ridic

Journal of Advances in Medicine and Medical Research, Page 1-7
DOI: 10.9734/BJMMR/2016/23959

Background: Vitiligo is a common skin disorder characterized by macular depigmentation of the skin. Although the etiopathogenesis of the disease is still unclear, several studies have shown that within the cascade of pathogenesis of vitiligo, cytokines play an important role.

Objectives: The aim of our study was to evaluate serum concentrations of interleukin- IL-2 (IL-2) and interleukin-2 soluble receptor (IL-2 sR) in patients with vitiligo and healthy subjects and also to asses a possible association between these cytokines and duration of the disease.

Study Design: Case control study.

Place of the Study: The study was carried out in University Clinical Center Sarajevo, Department of Dermatology and Venereology.

Patients and Methods: Twenty one patients (11 female and 10 male; age range 15-53 years) with vitiligo and 20 healthy controls (10 female and 10 male; age range 17-52) were enrolled in the study. c The duration of vitiligo ranged from 2 to 252 months. Ten patients (47.62%) had generalized, and eleven patients (52.38%) had localized vitiligo Serum concentrations of cytokines were measured using enzyme-linked immunoassay techniques.

Results: Both  IL-2 (median 22.600 pg/ml, range 20.900-76.100) and IL-2sR (median 76.100 pg/ml, range 15.700-183.800) in the patient group were significantly higher when compared with that of the normal controls. When the serum cytokine level in vitiligo group were compared to total disease duration (Spearman correlation ρ), serum IL-2 was negatively (ρ= -0.000573, P= 0.9980) and IL-2 sR was positively (ρ=0.241, P= 0.2797) correlated with total disease duration, but it is of borderline significance.

Conclusions: Our results showed hight serum levels of IL-2 and IL2 sR among vitiligo patients which may highligth a functional role of these cytokines in the pathogenesis of this disease.

Open Access Original Research Article

Comparison of the Effectiveness of Dexamethasone Injection into Two Different Sites in Preventing the Postoperative Complications after Mandibular Third Molar Surgery: A Randomized Clinical Trial

Mohammadjavad Shirani, Mahya Hasanzade, Amirhosein Moadabi, Bijan Movahedian Attar

Journal of Advances in Medicine and Medical Research, Page 1-11
DOI: 10.9734/BJMMR/2016/23638

Aims: Inflammation occurring after the surgical removal of impacted lower third molars can cause complications such as pain and swelling. The aim of this study was to compare the effectiveness of dexamethasone injection into the medial pterygoid and gluteal muscles in preventing postoperative complications after surgical removal of bony impacted mandibular third molars.

Study Design: Parallel randomized clinical trial.

Place and Duration of Study: Oral Surgery Department of the Torabinejad Dental Research Center, between April 2013 and January 2014.  

Methodology: This trial included 77 participants aged between 18 and 35 years [mean age (mean ± standard deviation), 25.04±4.33 years] requiring surgical removal of a single bony impacted mandibular third molar under local anesthesia. Participants were randomly assigned to 3 groups based on systematic random. Postoperative pain, swelling, patients’ general satisfaction, and changes in daily life function were evaluated. These factors were first analyzed by the Kruskal–Wallis and ANOVA tests, followed by the Mann–Whitney test.

Results: The two dexamethasone groups had significantly less postoperative pain, swelling, and change in appearance at 48 h after the surgery compared with the DF group.

Conclusion: With the caution of a small sample size, the results of this study indicate that near the surgical field preoperative injection of dexamethasone in the medial pterygoid muscle can control postoperative pain, swelling, and changes in appearance as efficiently as the same in the gluteus muscle.

Open Access Original Research Article

High MDR and ESBL Producing Escherichia coli and Klesbiella pneumoniae from Urine, Pus and Sputum Samples

Surya Subedi, Mahesh Chaudhary, Bidya Shrestha

Journal of Advances in Medicine and Medical Research, Page 1-10
DOI: 10.9734/BJMMR/2016/23350

Aims: This study was done to assess the prevalence of multidrug resistance and extended spectrum β-lactamase producing E. coli, K. pneumoniae in urine, pus and sputum.

Place and Duration of Study: This study was done to assess the prevalence of MDR and ESBL producing E. coli and Klebsiella in urine, pus and sputum from March 2013 to April 2014 at KIST Medical College, Lalitpur, kathmandu, Nepal.

Methodology: E. coli and K. pneumoniae were isolated from urine, pus and sputum samples in KIST Medical College, Lalitpur, Nepal. Antibiotic susceptibility test was performed by using disk diffusion method. MDR isolates which were suspected as ESBL producers were confirmed by using double disk synergy test and combined disk diffusion test for same isolates.

Results: Out of 580 urine samples, (87/580) 15% showed significant growth of E. coli and K. pneumoniae while in 97 pus and 124 sputum (16/221) 7% showed significant growth of E. coli and K. pneumoniae. From the sputum among 9 isolates, 3 were E. coli and 6 were K. pneumoniae whereas in pus among 7 isolates, 6 were E. coli and one was K. pneumoniae. Out of E. coli (77) isolates from urine, (74/77) 96.10% were MDR and of K. pneumoniae (10) isolates from urine 90% were MDR. Among E. coli (74) MDR isolates 52/74 (70.27%) were ESBL producers whereas all MDR K. pneumoniae isolates from urine were ESBL producers. All the isolates of E. coli and K. pneumoniae from pus and sputum were MDR which were resistant to tested third generation cephalosporins. Among the isolates E. coli (55.55%) and K. pneumoniae (42.85%) isolates were ESBL producers.

Conclusions: The high prevalence of MDR E. coli and K. pneumoniae was observed in urine, pus and sputum. The resistance pattern was alarmingly higher to all the antibiotics used except imipenem and amikacin. The prevalence of ESBL was higher so necessary step should be taken to prevent the spread and emergence of resistance.

Open Access Original Research Article

Neuro-epidemiology of Acute Stroke Syndrome in the Adult Emergency Department of a Tertiary Hospital in a Resource-limited Environment of South-eastern Nigeria

Gabriel Uche Pascal Iloh, Patrick Uchenna Njoku, Chinasa Orie Agwu Amadi, Agwu Nkwa Amadi

Journal of Advances in Medicine and Medical Research, Page 1-11
DOI: 10.9734/BJMMR/2016/24260

Background: Globally, acute stroke is one of the leading causes of preventable emergency hospital admissions. It is emerging as an important cause of disability and mortality among adult Nigerian Africans in the emergency department(ED) of Nigerian hospitals.

Aim: The study was designed at reviewing epidemiology of acute stroke syndrome in the adult ED of a tertiary hospital in South-east Nigeria.

Study Design: This was a retrospective descriptive study.

Place and Duration of Study: The study was carried out on patients with acute stroke syndrome at the ED of Federal Medical Centre, Umuahia, Nigeria over a five year period from January 2008 to December 2012.

Methods: The sources of data were from medical records, patients’ case notes; ED admission registers and nurses report books. Information collected were age, sex, place of the incidence, time of presentation to the ED, duration of symptoms at presentation, month (season) of occurrence, type of stroke, number of episodes and associated clinical conditions. Operationally, time of presentation to the ED was categorized into two: day time was defined inclusively as time period from 6.00 am to 6.00 pm while night time referred exclusively to the time period from 6.00 pm to 6.00 am Nigerian time. Early presentation to the ED meant that the victim arrived the ED of the hospital inclusively within 1 hour of the occurrence of the acute stroke while those that arrived after 1 hour were defined as late presentation to the hospital.

Results: The age ranged from 36 years to 95 years with mean age of 68.2±7.4 years. There were 155 (58.3%) males and 111 (41.7%) females with male to female ratio of 1.4: 1. The incident predominantly occurred at home (77.8%), 239 (89.8%) had duration of symptoms more than 1 hour at presentation, 162 (60.9%) presented during the night time, 158 (59.4%) occurred during dry season, 157 (59.1%) had repeat episode, 199 (74.8%) were ischemic stroke and the most commonly associated clinic-medical condition was hypertension (80.1%).

Conclusion: There was variability in the epidemiology of stroke with ischemic stroke being the pre-eminent type and hypertension the most associated clinical condition. The incident occurred predominantly among male gender, elderly patients, at home, during dry season and most of the patients presented late to the ED and at night time. Interventional strategies aimed at risk reduction, early presentation to dedicated and responsible stroke units and centres are advocated.