Open Access Case Study

Acute de Garengeot Hernia Masquerading as a Recurrent Inguinal Hernia – A Diagnostic Dilemma

K. Shah, R. D’ Souza, A. Khan

Journal of Advances in Medicine and Medical Research, Page 1-4
DOI: 10.9734/BJMMR/2016/19167

A de Garengeot hernia is a femoral hernia in which the sac contains the vermiform appendix. herein, we report an interesting case of a de Garengeot hernia with secondary appendicitis presenting acutely in a male patient with previous history of inguinal hernia repair. We discuss the diagnostic dilemmas involved and present a review of current literature.

Open Access Case Study

Delayed Dual-Time Point Imaging Protocol Improving Myocardial Uptake of 18-Fluorine Flouro Deoxyglucose (18F-FDG) During Viability Screening of Diabetes Mellitus Type 2 Patients Using Integrated Positron Emission Tomography/Computed Tomography (PET/CT) Im

Mohd Nazmi Nordin, Abdul Jalil Nordin, Fathinul Fikri Ahmad Saad, Hairil Rashmizal Abdul Razak

Journal of Advances in Medicine and Medical Research, Page 1-7
DOI: 10.9734/BJMMR/2016/22398

Aims: To investigate the effect of delayed imaging protocol and hypoglycemic agent on quantitative values obtained during myocardial viability 18F-FDG PET/CT assessment.

Presentation of Case: Mr. A, a 72 year-old man, Madam B, a 73 year-old woman and Madam C, a 64 year-old woman, presented to the Centre for Diagnostic Nuclear Imaging, Universiti Putra Malaysia for myocardial viability assessment. All were diagnosed Diabetes Mellitus type II on oral hypoglycemic agent.    

Discussion: Our study showed an increased 18F-FDG uptake in the wall of LV after the delayed protocol was applied to the patients. One hour time elapsed before 18F-FDG injection is to allow optimal level of niacin in the blood for its action to lower the plasma FFA levels and encourage myocardial preference towards glucose metabolism. Oral glucose loading is given to stimulate insulin secretion and increase glucose utilization as the metabolic substrate. The approach of premedicating nicotinic acid like niacin can be a reliable hypolipidemic agent in shifting myocardial metabolism to glucose oxidative pathway in 18F-FDG PET/CT myocardial viability assessment. Delayed enhancement imaging has been shown to be effective, in both animals and humans, in identifying the presence, location, and extent of acute and chronic myocardial infarction in patients with ischemic cardiomyopathy. Furthermore, this technique may also be useful in assessing myocardial injury in patients with non-ischaemic heart disease.

Conclusion: Delayed imaging is superior to early imaging. The improvement of the image quality leads to accurate assessment of the viable or non-viable myocardium.

Open Access Original Research Article

Experiences of Parents of Children with Burn Injuries in a Tanzanian Referral Hospital: A Qualitative Consideration

E. S. Kashega, M. A. Vastani, S. Bayongo, P. M. Petrucka

Journal of Advances in Medicine and Medical Research, Page 1-15
DOI: 10.9734/BJMMR/2016/23614

Aims: Burns injuries are the most common causes of physical and psychological trauma in both children and parents globally. It is characterized by prolonged hospitalization, as well as reduced productivity of parents due to family conflicts and economic implications. This study aimed to reveal the experiences of parents of children with burn injuries in a developing context to inform future care directions and improvements to care.

Study Design: A qualitative exploratory study design was used.

Place and Duration of Study: The study was conducted at Muhimbili National Hospital, Tanzania in early 2014 over a 4 month time period.

Methodology: Four female participants were recruited via purposive sampling method. They participated in in-depth interviews as well as semi-structured questionnaires. All interviews were audio-recorded and transcribed verbatim later. Data analysis was done using a modified version of Colaizzi’s (1978) seven step approach, whereby themes and sub-themes were identified.

Results: Based on a thematic analysis of the transcripts of interviews, it was revealed that parents of children with burn injuries experienced a mix of positive and negative feelings and challenges associated with the medical procedures, nursing care, hospital environment, coping mechanisms, and impacts of hospitalization. The participants spoke of the balance of parents (i.e., skills, coping, assets), people (i.e., others for support, comfort); professionals (skills, compassion, resources) and place (i.e., hospital network and resources).

Conclusion: Parents of children with burn injuries experience a range of challenges immediately after the burn injury and during the hospitalization period. Thus, psychological support from a range of sources (personal, external, professional, social) is necessary to address, identify, and minimize these challenges, thereby improving the health care experience and overall well-being of the child and their parents.

Open Access Original Research Article

Congenital Anomalies of the Alimentary Tract in Children: Experience in a Tertiary Health Facility in Enugu, Nigeria

Christopher Bismarck Eke, Uchechukwu Obiora Ezomike, Bartholomew Friday Chukwu, Nnamdi Benson Onyire

Journal of Advances in Medicine and Medical Research, Page 1-8
DOI: 10.9734/BJMMR/2016/23306

Background: Congenital anomalies including those of the alimentary tract are among the leading causes of childhood morbidity and mortality. A variety of these anomalies could affect the alimentary tract with various medical as well as economic costs. The aim of the current study was to determine the prevalence of the different forms, maternal as well as birth characteristics and outcomes of the congenital anomalies of the alimentary tract in hospitalized children in Enugu.

Methods: A 3 year retrospective audit of all hospitalized cases of alimentary tract anomalies was carried out. Case definitions of the different forms of alimentary tract anomalies studied were based on International Classification of Diseases and Related Problems, Tenth Edition (ICD-10). Data was analyzed using SPSS version  21.0 while level of statistical significance was set at p<0.05. 

Results: A total of 59 children (37 males and 22 females) with alimentary tract anomalies were admitted during the period under review. Anorectal malformations 26(44.1%), Hirschsprung’s disease 14(23.7%) and Ompalocoele 5(8.5%) were the most common anomalies observed. Congenital talipes equinovarus deformity of the lower limbs was the most predominant associated congenital  anomaly. Maternal periconceptional use of herbal medications was reported in 7 (11.9) cases.

The case fatality rate was 5.1%.

Conclusion: A variety of alimentary tract anomalies do occur in children in our setting with some mothers having taken various forms of herbal medications in pregnancy. Efforts should be made to educate mothers on the need to avoid use of herbal concoctions during periconceptional period and in pregnancy as it could lead to a possible congenital anomaly.

Open Access Original Research Article

The Clinical, Diagnostic, and Therapeutic Characteristics of 22 Male Patients with Breast Cancer

Serdar Gökay Terzioğlu, Murat Özgür Kiliç, Gül Dağlar

Journal of Advances in Medicine and Medical Research, Page 1-6
DOI: 10.9734/BJMMR/2016/24607

Aim: The aim of this study is to evaluate the clinicopathological, diagnostic, and therapeutic features of male breast cancer.

Study Design: This is a retrospective clinical study.

Methodology: Twenty-two male patients who underwent surgery for breast cancer in a tertiary reference hospital in Ankara between 2010 and 2015 were included in this retrospective study. Patient characteristics, clinical findings, diagnostic and therapeutic features were recorded.

Results: Among the 22 patients with a mean age of 59.6 years, 3 (13.6%) had a family history of BC. Painless breast mass was the most common (95.5%) presenting symptom. Hypoechoic breast mass with irregulary margins was the most frequent sonographic finding (90.9%) while mammography revealed asymmetric density or poorly defined mass in the majority of cases (75%). Modified radical mastectomy was the most performed surgical type (n= 21, 95.5%). In one patient, simple mastectomy was performed for a diagnosis of ductal carcinoma in situ. Twelve (54.5%) patients received adjuvant chemotherapy while 3 (13.6%) cases had radiation therapy. Hormonal therapy was given to 17 (77.2%) patients with receptor positivity. Median follow-up time of the patients was 31.2 months, and 3 recurrences was observed.

Conclusion: The incidence of male breast cancer has been increased in the recent years. Since the management of male breast cancer is still based on the rules of female breast cancer, large scale clinical studies are urgently needed to develop an international guideline for of this rare cancer.

Open Access Original Research Article

Common Musculoskeletal Injuries in Athletes and Its Relation with Body Mass Index (BMI) in Jeddah Society

D. Nagadi, B. Z. Shakhreet, S. Jastaniah, K. Khashoggi, A. Elkhedr

Journal of Advances in Medicine and Medical Research, Page 1-6
DOI: 10.9734/BJMMR/2016/24500

Aims: To study the types of sports injuries in different age groups and its prevalence in the Saudi society, especially in the city of Jeddah, thus comparing them with the BMI of the different age groups.

Study Design:  A prospective study with a special questionnaire to collect data.

Place and Duration of Study: Subjects: Department of Radiology (X-ray unit), King Abdulaziz University Hospital, Jeddah, Saudi Arabia, for 3 months.

Methodology: A questionnaire developed by the authors was used to collect data. The questionnaire had two parts. The first part was used to collect demographic data, and the second part was used to determine the incidences and regions (knee, upper and other lower limb regions) of sports injuries. The subjects of the survey were athletes competing in football, basketball, handball, volleyball and daily athletics. Then, SPSS 15.0 for Windows was used for statistical analyses. Data are presented using descriptive statistics and were analyzed using the chi-squared test.

Results: The majority of injured subjects were youth. The upper limb region had the highest incidence of injury (38%) as well as the knee (36%), while the lower limb region had the lowest (26%) injury. The injuries in a knee were the highest (50%) in the adult subjects compared with the other age categories. The highest percentage of the upper limb and other regions of lower limb injuries were concentrated in the pediatric (47%) and youth (67.5%) age groups. There is a highly significant relationship (p<0.05) between the BMI and athletic injuries for the studied age groups. The most common type of injuries that have presented a highly statistical significance were the upper limb (p=3.44×10-6) as well as the other type of injuries for the degree of freedom (df=6).

Conclusion: It is confirmed that there is a lack of awareness in nutrition habits in this culture and society, which leads to obesity and overweightness, thus causing injuries when practicing sports.

Open Access Original Research Article

Evaluation of Incidence and Risk Factors of Severe Preeclampsia in a Tertiary Hospital Centre

Eriseida Ndoni, Redi Hoxhallari, Astrit Bimbashi, Erjola Pupi

Journal of Advances in Medicine and Medical Research, Page 1-7
DOI: 10.9734/BJMMR/2016/24143

Aims: To evaluate the incidence of severe preeclampsia, eclampsia and HELLP syndrome in a tertiary Hospital Centre of Obstetrics and Gynaecology and to identify the impact of risk factors associated with severe preeclampsia.

Study Design: Retrospective cross-sectional study.

Place and Duration of Study: University Hospital of Obstetrics and Gynaecology “Koço Gliozheni”, Tirana, Albania between January 2009 and December 2013.

Methodology: To collect the data for this study we used the medical records of births of a period of five years. The standard inclusion criteria in the study were pregnant women diagnosed with preeclampsia that had delivered in this hospital after 24 weeks’ gestation despite the number of the babies, fetal presentation and mode of delivery. The exclusion criteria in this study were: pregnancies with confirmed fetal anomalies non-viable, pregnancies with missing data, and pregnancies with unknown gestational age. The maternal variables collected from the medical records were: maternal age, parity, gestational age at delivery, multiple pregnancy, pre-existing (chronic) hypertension, pre-existing diabetes mellitus, renal diseases and preeclampsia in previous pregnancy. The data collected for the variables were compared with the statistical data for all the deliveries during the study period. Fisher’s exact test, Chi-squared test and SPSS program were used as statistical methods.

Results: The study found differences between the severe preeclampsia group and the general population for the maternal risk factors: severe preeclampsia was evaluated 16.8% vs. 3.5% (P< 0.01), pre-existing hypertension 7.8% vs. 2.3% (P = 0.02), renal diseases 1.9% vs. 1.1%, diabetes mellitus 5.8% vs. 4.6% and multiple pregnancies 7.1% vs. 2.7% respectively.

Conclusion: Identification of these risk factors is very important for the calculation of risk for preeclampsia in early pregnancy and early treatment to prevent the maternal and perinatal morbidity and mortality from this disease.

Open Access Original Research Article

Association of Tumor Necrosis Factor-α (TNFα) Gene Polymorphisms with HLA Class II Alleles in HIV/AIDS Patients

Jelena Eglite, Jelena Golushko, Evalds Urtans, Inga Januskevica, Baiba Rozentale

Journal of Advances in Medicine and Medical Research, Page 1-10
DOI: 10.9734/BJMMR/2016/23065

Aim of Study: To identify the factors of molecular genetic risks during the development of infection in HIV, based on the TNFα cytokine gene polymorphism in combination with HLA DRB1/DQA1/DQB1 genes, as well as to analyse their possible association with the progress of the disease. 185 HIV infected patients and 173 individuals control group have been analysed. The DNA was extracted from peripheral blood, by using QiagenQIAamp DNA kit reagents. The quality and quantity of DNA was checked by using Qubit ® fluorometer HLA typing for HLA DRB1/DQB1/DQA1* was performed by RT-PCR with sequence-specific primers (SSO). TNFα gene G–238A and G–308A polymorphic variant incidence was determined by RT-PCR analysis.

Results: We have detected TNFα gene allele 308A in 11% HIV infected patients, whereas in control group this allele have been detected only in 4% patients. Although the incidence of the TNFα gene –238A allele was twice as high in the control group (6%) as in the HIV infected patients (3%), it did not prove to be statistically valid (p = 0.253). The incidence analysis of three-locus haplotypes DRB1-DQB1-DQA1 – in TNFα position-238A/G -308A/G showed that haplotypes 01:01/05:01/01:01-TNFα-238(GA)/308(GG) and 01:01/03:02/03:01 - TNFα-238(AA)/308(GG) are more frequent in the control group in comparison to the groups of infected patients. This means that these haplotypes have a protective function, which significantly affects the progress of infection. The association of 15:01/05:01/01:01 -TNFα-238(GG)/308(GG) and 03:01/05:01/01:01- TNFα-238(GG)/308(GА) genotypes indicates a high risk of developing a fulminant infection. The genetic factors of AIDS-related complex of syndromes development are associated not only with the HLA complex class II alleles, but also with the SNP polymorphism in the promoter region of cytokine genes.

Open Access Original Research Article

Blood Parameters and Spleen Histology Following Chronic Consumption of Ethanolic Extract of Costus afer Stem and Juice on Albino Wistar Rats

Amabe Otoabasi Akpantah, Ubon Akpan, Mokutima Amarachiz Eluwa, Theresa Ekpenyong Isamoh, Mfoniso Udonkang, Theresa Bassey Ekanem

Journal of Advances in Medicine and Medical Research, Page 1-10
DOI: 10.9734/BJMMR/2016/23414

Aim: Costus afer is a medicinal plant used as a therapy for diabetes and hypertension. This study investigated the effect of crude ethanolic extract of Costus afer (Monkey sugar cane) stem and its juice on the histology of the spleen and some blood parameters of albino wistar rats.

Place and Duration of Study: This study was carried out in the Department of Human Anatomy, University of Calabar, Nigeria for four weeks.

Methodology: Twenty four (24) rats were divided into four groups of six (6) animals each. Group one (I) served as control, Group two (II) served as experimental group and received 200 mg /kg body weight (low dose) of the crude ethanolic extract. Group three (III) also served as experimental group, tested with 500 mg/kg body weight (high dose) of the crude ethanolic extract and Group four (IV) was tested with 5 mls /kg body weight of Costus afer stem juice. Treatment was orally using orogastric tube for twenty eight (28) days after which the animals were sacrificed within twenty four hours after the last dose.

Results and Conclusion: Results showed no morphological changes. Histological sections of the spleen from experimental animals in the control group showed normal histology of the spleen with well distinct lymphatic tissue. Sections of the spleen from animals tested with 200 mg /kg ethanolic extract showed no pathological changes compared with the control group. Sections of the spleen from animals tested with 500 mg/kg body weight of the crude ethanolic stem extract were observed to have more red pulp than the white pulp. Animals tested with 5mls /kg body weight of Costus afer stem juice showed no pathological observations. Hematological observations showed decreased Packed Cell Volume (PCV) and increased Platelet count (P =.05), but had no significant effect on total white blood cell count and differential count. In conclusion, Costus afer at the administered dose had no pathological effect on the spleen histology, but increased platelet count and decreased packed cell volume.

Open Access Original Research Article

Y Chromosome Microdeletions and Partial AZFc Deletions in Infertile Men from South India

Jaganathan Suganya, Smita B. Kujur, Kamala Selvaraj, Muthiah S. Suruli, Geetha Haripriya, Chandra R. Samuel

Journal of Advances in Medicine and Medical Research, Page 1-10
DOI: 10.9734/BJMMR/2016/24208

Aim: Yq microdeletions involving the azoospermia factor (AZF) region are the second most frequent genetic cause of spermatogenic failure next to Klinefelter syndrome. These deletions occur in about 10-15 percent of men with azoospermia and severe oligozoospermia. Molecular screening for AZF deletions has become mandatory in the work-up of infertile men. Further, partial AZFc deletions categorized as gr/gr, b2/b3, b1/b3 and b2/b4 deletions have also been known to affect spermatogenesis. This study aimed to screen for both classical AZF deletions in 250 karyotypically normal infertile men from south India and partial AZFc deletions as a case-control analysis involving 108 fertile men.

Methods: PCR amplification involving two multiplex reactions was carried out using primers for six STSs sY84, sY86 (AZFa), sY127, sY134 (AZFb), and sY254, sY255 (AZFc) with two internal controls (SRY, ZFY). Further, those men who showed deletions with one or both STSs sY1291 and sY1191 were subsequently tested with sY1189 and sY1192 to detect partial AZFc deletions. 

Results: One individual showed deletion of all the three AZF regions while two men had only AZFc deletion. Deletion of partial AZFb (sY127) was seen besides complete AZFc region in the fourth patient. The gr/gr, b2/b3 and b1/b3 deletions were detected in 24 (9.6%), one (0.4%) and nine (3.6%) infertile men in comparison with five, one and two fertile men respectively. The b2/b4 deletion was observed in a single azoospermic individual.

Conclusion: Screening for AZF deletions would help in not only determining the cause for male infertility but also in its management and accurate genetic counselling.