Open Access Case Study

Multıple Myeloma wıth Homogenous Secretıon of Lambda Lıght Chaın Immunoglobulın: A Case Report

J. A. Olaniyi, P. S. Ogundeji

Journal of Advances in Medicine and Medical Research, Page 1-7
DOI: 10.9734/BJMMR/2016/25188

About 20% of people with multiple myeloma (MM) produce only light kappa chains which is produced in 80% of cases. This population of MM patients may be missed where the laboratory could not effectively detect free light chains of immunoglobulins as it is the case in most developing countries. Many reports showed that individuals with lambda light chain disease have a three times worse prognosis than kappa light chain disease. It is therefore important to improve awareness on the need to look out for light chain disease and emphasize the usefulness of a well-equipped laboratory that will fully analyze immunoglobulins of  suspected multiple myeloma cases. 

After reviewing the patient, main findings included  paraplegia, constipation and incessant vomiting suggestive of amyloidosis, a positive urinary bence jones proteins (BJP), normal biochemical parameters, elevated lambda light chain level and reversed kappa/lambda ratio of <0.01, magnetic resonance immaging (MRI) proven osteolytic lesions restricted to the spine and histology of bone marrow sample from laminectomy, as well as bone marrow aspiration cytology showed abnormal plasmacytosis.

This is an unusual and rare presentation of MM in this environment. Free light chain (FLC) identification and quantitation should be carried out in all cases of suspected MM; especially in those with no monoclonal bands on serum protein electrophoresis and or immunofixation.

Open Access Case Study

A Case of Antley-Bixler Syndrome with New Genetic Study Result

Zohreh Karamizadeh, Hamdollah Karamifar, Gholamhossein Amirhakimi, Hossein Moravej, Ladan Nasermoaddeli

Journal of Advances in Medicine and Medical Research, Page 1-4
DOI: 10.9734/BJMMR/2016/24651

Aims: Antley-Bixler syndrome (ABS) is a rare disease which is a complex of skeletal, visceral, extremity and genital anomalies and occasionally is associated with adrenal insufficiency due to P450-oxidoreductase deficiency.

In this article we report a patient, a suspicious case of ABS with different phenotypic and genotypic characteristics.

Presentation of Case: The patient is a male infant with facial dysmorphism, syndactyly, multiple joint contractures, and ambiguous genitalia.

He had hyponatremia, hyperkalemia and elevated 17.OH.progestrone level of serum. In genetic analysis, no mutation was found in POR gene.

Discussion: This patient has clinical and paraclinilical manifestations of ABS. Although different mutations have been reported as the cause of this syndrome, all reported patients who suffered from adrenal insufficiencies, had mutations in POR gene.

Conclusion: According to our search in literature, this is the first case of ABS associated with adrenal insufficiency who does not have any mutation in POR gene.

More genetic studies are needed to determine new mutations in such patients.

Open Access Case Study

Tuberculosis in an HIV-infected Child in a Developing Country: A Case Report of Diagnosis Challenges

Samuel O. Oninla, Olusola A. Oyedeji, Olumayowa A. Oninla, Olamide V. Kayode

Journal of Advances in Medicine and Medical Research, Page 1-6
DOI: 10.9734/BJMMR/2016/24733

Aims: To highlight the challenges and the diagnostic dilemmas in resource restricted settings to diagnose and treat Tuberculosis (TB), especially when it co-exists with Human immunodeficiency virus (HIV) infection.

Presentation of Case: A 7-year-old HIV-infected male child admitted to our hospital with clinical features suggestive of Tuberculosis - non-productive cough of 6 months, associated excessive sweating and weight loss despite a good appetite. He did not receive Bacillus Calmette-Guerin (BCG) vaccine and no history of contact with Tuberculosis patient. He was wasted, small for age and, dyspnoeic, with features of consolidation in both lungs. All investigations initially carried out, including chest x-ray examination failed to confirm the diagnosis of TB. However, twenty-three (23) weeks after admission and commencement of antiretroviral drugs, was a radiologic diagnosis of TB made from a repeat chest x-ray examination. He subsequently commenced on anti-TB drugs with remarkable improvement, gaining 4Kg within two months.

Discussion: Diagnosing Tuberculosis in developing countries can be very challenging, especially when there is a co-infection with HIV. The use of appropriate radiological, immunological and bacteriological tests and a good clinical acumen often defy the ability to make a timely diagnosis and institute appropriate treatment. These delays may eventually lead to increase morbidity and mortality. In this reported case of co-infections, it took twenty-three (23) weeks to establish a diagnosis of TB in the HIV-infected child. Provision of inexpensive, sensitive, specific, rapid point-of-care diagnostic tests for tuberculosis will reduce diagnosis delay and facilitate prompt and accurate treatment.

Conclusion: Delay diagnosis and treatment of TB still occur in resource-poor countries, especially when it coexists with HIV infection. With the advent of new tests, such as GeneXpert MTB/RIF assay, the diagnosis of TB in HIV patients would be rapid and precise. Although this premise on its availability and maintenance in various clinics or hospitals where TB cases are managed.

Open Access Short Research Article

A Novel Decrease of Mrp3 Protein in Liver of β-Thalassemic Mouse

Mohammed Qaisiya, Lucia de Franceschi, Achille Iolascon, Claudio Tiribelli, Cristina Bellarosa

Journal of Advances in Medicine and Medical Research, Page 1-6
DOI: 10.9734/BJMMR/2016/25139

Background: Hepatocytes have a fundamental system of efflux proteins that protect cells from toxic insults. Unconjugated bilirubin at higher concentration is toxic to cells and its intracellular accumulation is limited by the induction of efflux proteins such as Mrp3. In vivo studies showed an induction of hepatic Mrp3 expression in response to non-hemolytic hyperbilirubinemia as a compensatory mechanism to reduce UCB toxicity.

Study Design: In the present study, we analyzed the hepatic Mrp3 expression profile during hemolytic hyperbilirubinemia. We used β-thalassemic mouse and WT rodents treated with phenylhydrazine as an animal model of chronic and acute hemolysis, respectively.

Results: Unexpectedly, Mrp3 protein was 75% down-regulated in β-thalassemic mouse although Mrp3 mRNA was normal. Mrp3 mRNA was significantly induced in PHZ treated animals while again; Mrp3 protein was 60% down-regulated.

Conclusion: For the first time we observed a clear down-regulation for hepatic Mrp3 protein that linked to hemolysis, not to bilirubin. We hypothesize that a similar decrease for hepatic Mrp3 proteins is occur in hemolytic patients such as β-thalassemia.

Open Access Original Research Article

Evaluation of Anemia Management in Hemodialysis Patients in Gezira Hospital, in Sudan

Tahani Ibrahim

Journal of Advances in Medicine and Medical Research, Page 1-6
DOI: 10.9734/BJMMR/2016/23878

Anemia of kidney disease is a common but under recognized co-morbid condition that is known to place patients at greater risk of hospitalization, cognitive impairment, cardiovascular diseases and even death.

Aims: The aims of this work to investigate current practice of anemia management in hemodialysis patients and to assess the appropriateness of anemia management.

Study Design: The study was conducted in Gezira Hospital for Renal Diseases and Surgery. Data on anemia parameters, comorbidities, ESAs dosing and iron supplementation were collected. The data were collected for 6 months retrospectively from December 2005 to July 2006. Patients with ESRD undergoing hemodialysis were included. Patients were excluded if they have cancer or receiving chemotherapy or radiotherapy.

Results: Data were collected from 83 patients under hemodialysis. The base line hemoglobin levels in December 2005 revealed that of the 97% of the patients were anemic, because they had hemoglobin levels below the recommended target level (11.0 g/d1). The patients started treatment with erythropoietin (4000IU/wk) for six months, and we found that 6% of patients received regular EPO, 56.6% received it irregularly and 37.3% not received EPO, regarding intravenous iron (100 mg/wk or 100 mg/2wk), 7.2% of patients received regular intravenous iron, 48.2% received it irregularly and 44.6% of patients did not received it, Hemoglobin levels were measured in July 2006 to evaluate the effect of treatment in hemoglobin level, we found that 95% of patients were still anemic. This indicates that current treatment strategies were ineffective because the majority of patient failed to reach the recommended hemoglobin level after six months of treatment.

This study demonstrate that there is no regular periodical laboratory tests, follow up and treatment for renal anemia.

Open Access Original Research Article

The Relationship between TV Viewing and Food Intake and BMI in Preschool Children

Naser Kalantari, Saeid Doaei, Hanieh Malmir, Atefeh Aminifard, Maryam Gholamalizadeh

Journal of Advances in Medicine and Medical Research, Page 1-9
DOI: 10.9734/BJMMR/2016/24970

Background: Considerable attention is currently being paid to childhood nutrition. Mass media, particularly television (TV), is believed to largely contribute to eating habits and Body mass index (BMI). This study was carried out to identify the relation between tendency towards TV viewing and its influence on children with food intake and BMI in pre-school kids.

Methodology: The survey was conducted using a cross-sectional design, in which 114 children aged 2-6 yrs from 11 selected nursery schools were included. Regarding data collection related to TV viewing rate and influence rate of TV viewing from parents' viewpoint, a valid and reliable questionnaire was used. To collect data about children's diets intake, a food frequency questionnaire (FFQ) was applied. Face-to-face meetings and interviews with the parents were held. Height and weights of children were measured using a measuring tape and a digital weight scale. Data were analyzed using Pearson correlation coefficient and analysis of variance (ANOVA) statistical tests by SPSS software.

Results: It turned out that consumption rate of some food groups including meats & alternatives (p=0.008), sugars (p=0.013) and snacks & desserts (p=0.011) were higher in children who spend more time watching TV. In addition, Intake of cereals and breads appeared to be higher in children with strong desire for TV food ads (p=0.019). It was also revealed that influence rate of TV viewing and fats intake were positively correlated (p=0.017). No significant relationship was revealed between TV viewing rate and BMI in children

Conclusion: It can be concluded that tendency of preschool children to TV is positively related with some food groups intake and consumption of low nutritional-value foods.

Open Access Original Research Article

Microalbuminuria in Patients with Recent Ischaemic Cerebrovascular Stroke: A Cross Sectional Study

Shivnarayan Pattanaik, Purna Chandra Dash

Journal of Advances in Medicine and Medical Research, Page 1-9
DOI: 10.9734/BJMMR/2016/21351

Objectives: Microalbuminuria is an integrated marker of both kidney disease and endothelial dysfunction may be associated with global vascular risk. The purpose of the study was to assess the association of microalbuminuria with risk of nondiabetic nonhypertensive ischaemic stroke.

Materials and Methods: 60 cases of recent ischaemic strokes clinically diagnosed by WHO criteria and confirmed by CT scan of brain admitted to SCB Medical College and Hospital were studied. Diabetes mellitus, family history of DM, hypertension, nephropathy, atrial fibrillation, chronic liver disease, systemic infection, neoplasm, recent myocardial infection, females during menstruation and pregnancy were excluded from the study.

Results: Total number of 60 patients were studied, out of which male (35)58.3% and female (25)41.6%. Most of patients were in age group between 50-70 years. Mean age of presentation with microalbuminuria was 60.71 years. Microalbuminuria present in (29)48.33% of cases as compared to (3) 10% of controls. Severity of stroke was assessed by Scandinavian Stroke scale, was lower in presence of microalbuminuria (16±9.04) than without microalbumunuria (22±12.5).

Conclusion: The above study shows that there is increased incidence of microalbuminuria in recent ischaemic stroke and the microalbuminuria increases with severity of stroke.

Open Access Original Research Article

Serum Creatinine, Urea and Their CD4+ T-lymphocyte Count among HIV Positive Patients before and after Initiation of HAART at St. Paul’s General Specialized Hospital In Addis Ababa, Ethiopia

Mohammed Mehdi, Fisseha Bonja, Meron Yohannes, Mistire Wolde, Fatuma Hassen, Biniam Taye

Journal of Advances in Medicine and Medical Research, Page 1-9
DOI: 10.9734/BJMMR/2016/19358

Objective: To describe the serum level of urea and creatinine, and as well as CD4+ T cell count of blood among HIV positive patients before and after initiation of HAART in St. Paulo’s general specialized hospital.

Methods: A retrospective follow up study was conducted among HIV infected individuals who take HAART drug combination regimens such as (TDF/3TC/EFV), (TDF/3TC/NVP), (AZT/3TC/NVP), (D4T/3TC/EFV) and (D4T/3TC/NVP) and visit St. Paulo’s generalized hospital laboratory for renal function testing from 2007-2009G.C.

Results: A total of 2026 HIV positive patients started HAART between 2007-2009G.C in St. Paulo’s ART clinic. Among them 380 HIV patients, with two and three visits for CD4+ and renal function test (creatinine & urea), were recruited to the study. Of whom 240 (63.2%) were female and 140(36.8%) male. Out of 380 patients, 104(27.4%) were taking 1b30, 94(24.7%) were using 1a30, 77(20.3%) were taking 1d, 57(15%) 1c, 14(3.7%) tdf/3tc/efv, 12(3.2%) use tdf/3tc/nvp and 22(5.7%) were taking other drug types. The statuses of CD4+ T cell count of patients become improved as they are using HAART drug through visit. These were 115, 266 and 298 out of 380 have greater than 200 CD4+ T cell count on 6th, 12th, 18th months time difference respectively. But the numbers of patients who have renal dysfunction were increased as they were using HAART drug as treatment through visits. These might indicate that, use of HAART drug combination may improve the immune status HIV positive patients even though some renal side effects are there. Therefore, patients (HAART drug user) should have a follow up on renal function to monitor side effects of drug. 

Conclusion: HAART resulted in improved Immune status of HIV patients with remarkable increase in CD4 T lymphocyte count but at the same time there was an increase in Azotemia after the introduction part of HAART which suggests the impact of drug in renal function. This is especially true for TDF containing drug regimens (TDF/3TC/NVP) which dramatically improve CD4 T lymphocyte count and show significant Azotemia over times.

Open Access Original Research Article

The Impact of Body Mass Index on the Surgical Outcomes in Open Rectal Cancer Surgery

Ali Solmaz, Osman Bilgin Gülçiçek, Elif Binboğa, Aytaç Biricik, Candaş Erçetin, Hakan Yiğitbaş, Erkan Yavuz, Atilla Çelik, Fatih Çelebi

Journal of Advances in Medicine and Medical Research, Page 1-5
DOI: 10.9734/BJMMR/2016/25148

Technical difficulties which affect the outcomes of abdominal operations are common in obese patients, especially in rectal and gastric cancer cases. In several studies, it has been shown that increased body mass index (BMI) is associated with increased morbidity, reduced lymph node retrieval and prolonged hospital stay after colorectal surgery. The aim of this study was to assess the influence of obesity on the surgical outcomes (surgical margin, number of lymph nodes excised) of rectal cancer patients who were operated by open surgery. One hundred rectal cancer patients who underwent open surgery in a single center between January 2011 and August 2014 were included in this study. Patients were divided into two groups according to their BMI values. According to their preoperative BMI values, patients with a BMI of ≥30 kg/m2 (n=29) were defined as ‘obese’. Patients with a BMI of <30 kg/m2 (n=71) were placed in the normal (non-obese) group. Demographic data, surgical margins, the number of lymph nodes retrieved and surveillance of both groups were compared. Obese and normal groups were statistically indifferent in terms of age, sex and stage of the disease. Comparison of the obese and normal groups showed no statistically significant difference in terms of surgical margins and the number of lymph nodes retrieved. This study showed that obesity does not affect the surgical outcomes in rectal cancer. However, prospective studies with larger patient series are needed.

Open Access Original Research Article

The Effect of Epidural Labour Analgesia on Neonatal Outcomes: A Prospective Randomised Study

Sylvanus Kampo, Thomas W. Anabah, Thomas Bavo Azongo, Bright E. Anyizah, Peter Paul Bamaalabong, David Z. Kolbila, Juventus B. Ziem

Journal of Advances in Medicine and Medical Research, Page 1-8
DOI: 10.9734/BJMMR/2016/24182

Introduction: Epidural analgesia is said to have depressive effects on neonates. There seems to be sufficient instances in the literature that have compared maternal outcomes in relation to epidural analgesia. However, there is lack of instances in the literature on neonatal outcomes occurring with respect to epidural labour analgesia. This study therefore aims at unravelling neonatal outcomes following epidural labour analgesia.

Methods: This randomised controlled trial study compared the outcomes of babies of mothers who received epidural labour analgesia with those who did not receive any form of labour analgesia. One hundred and two (102) parturient women were recruited into the study and 51 of them assigned to the epidural group and the other 51 were assigned to the control group. Measures were taken with respect to: APGAR scores at first, fifth and tenth minutes; level of neonatal resuscitation; temperature; and neonatal complications.

Results: It was reveal that there was no statistical difference in the APGAR scores at first, fifth and tenth minutes (P = 0.55, P = 0.33, P = 0.58, respectively). The mean temperatures were 36.13°C for the control group and 35.61°C for epidural group (P = 0.40), indicating no statistical significance between the two groups.

Conclusion: Complications noted in epidural group were not statistically different from those in the control group and therefore with proper monitoring, epidural labour analgesia is safe for the foetus and the neonate.