Open Access Case Study

Tibial Blowout”- A Complication of Arthroscopic Anterior Cruciate Ligament Reconstruction

A. Raviraj, Ashish Anand, Vidyasagar ., Shivareddy ., Azhar Amin

Journal of Advances in Medicine and Medical Research, Page 1-4
DOI: 10.9734/BJMMR/2016/26135

The reconstruction of anterior cruciate ligament (ACL) has become the standard of care for a torn ACL in active, young athletes. Various technical complications during the surgery are documented. Of the complications pertaining to the bony tunnel preparation, the posterior femoral blow out is common. In this report we describe a complication that can occur while preparing the tibial tunnel – “tibial blow out”. This is a complication of anterior placement of the tibial tunnel and this has not been reported in the literature. We describe the identification, the possible mechanism, prevention and management of such an intraoperative complication.

Open Access Case Study

Mucoepidermoid Carcinoma of Hard Palate in a Pediatric Case

Neslihan Yaprak, Havva Serap Toru, Melda Bolukbas, Irem Hicran Ozbudak, Alper Tunga Derin

Journal of Advances in Medicine and Medical Research, Page 1-4
DOI: 10.9734/BJMMR/2016/25755

Salivary gland neoplasms are rare in childhood. Only 1 to5.5% of minor salivary gland tumours occur in children and adolescents. The most common malignant minor salivary gland tumours are mucoepidermoid carcinomas (MECs). Herein, we present a rare case of mucoepidermoid carcinoma occuring in the hard palate.

Presentation of Case: A 12-year-old boy visited our hospital with a swelling and ulceration of the right hard palate. Clinical examination revealed a localized mucosal nodule of the right posterior hard palate, measuring 1*1 cm. Biopsy was performed. The tumour was diagnosed as a low grade MEC. Wide excision was performed. The patient didn’t need another therapy. During 15-month follow-up, the patient showed no evidence of local tumour recurrence or metastasis.

Discussion: Mucoepidermoid carcinoma occurring in the oral cavity is extremly rare. These tumours are usually presenting as a painless, reddish-purple nodüle. Biopsy is necessery for definitive diagnosis. Histologically, MECs are divided into low, intermediate and high grade subtypes. Differantial diagnosis of palatal tumours in children include pleomorphic adenoma, benign or malignant mesenchymal tumours, and less commonly giant cell granuloma. A wide local excision with safe free margins is the operative procedure for low-grade MECs.

Open Access Short Communication

Sympathetic Ophthalmia as a Major Sight-threatening Disorder

Mohammed S. Alkhaibari

Journal of Advances in Medicine and Medical Research, Page 1-5
DOI: 10.9734/BJMMR/2016/26226

SO Iris and eyeball inflammatory condition affecting both eyes that occurs after a penetrating injury as a delayed autoimmune reaction to eye injury. Patients present with pain, photophobia, paresis of accommodation, metamorphopsia and mild to significant visual loss. The granulomatous anterior uveitis is accompanied by posterior segment findings including moderate to severe vitritis, choroiditis, papillitis, perivasculitis, and yellow-white lesions of the retinal pigment epithelium (Dalen-Fuchs nodules). The inflammation can lead to serious retinal detachment and macular edema. Extraocular symptoms include headache, meningitis or cerebrospinal fluid pleocytosis, hearing loss, poliosis and vitiligo.

The inflammation is caused by a cell-mediated immune mechanism and autoimmune inflammatory response directed against ocular self-antigens released after the initial injury. SO may occur after ocular trauma (47 to 65% of patients) or contusions. Wounds involving the ciliary body are associated with the highest risk. Surgical interventions may also trigger SO, with posterior segment surgery carrying a higher risk than anterior segment surgery.

Diagnosis of SO is mainly based on patient history and clinical presentation. Imaging studies (fluorescein or indocyanine green angiography, B-scan ultrasonography and optical coherence tomography) may be useful to confirm the diagnosis.

Open Access Original Research Article

An Appraisal of Awareness and Practice of Modern Contraception among Prenatal Clinic Attendees in Southern, Nigeria

Ikeanyi Eugene, Jeremiah Israel, Ekine Atombosoba

Journal of Advances in Medicine and Medical Research, Page 1-13
DOI: 10.9734/BJMMR/2016/25685

Background: Contraception is a key measure at the primary level of prevention of maternal mortality and morbidity. It is an important tool for pregnancy spacing, limiting and timing for prevention of adverse perinatal and maternal health outcomes.

Objective: contraceptive practice as a means of preventing unintended pregnancy was assessed among Nigerian women attending prenatal care. The findings were to contribute in defining the current contraceptive practices in the country, proffer suggestions for reproductive health planning and services.

Method: This was a cross-sectional study of 701 prenatal clinic attendees at a missionary Hospital in Benin-city, Nigeria. Structured pretested questionnaire was administered to each consenting client. Database was raised on relevant information and analyzed, setting the level of statistical significance at p-value <.05

Results: Approximately 89% of the respondents demonstrated awareness of modern contraception, about 66% ever used a modern contraception and only a minority 24.1% was using it just prior to the index pregnancy. Leading sources of information were mass media, friends/peers, school and hospital in that order. The most used methods were male condom (54.8%) and pill (21.8%). About three fifths (56.2%) of the respondents have had at least a premarital termination of unintended pregnancy. More than 71% of previous users and approximately 42% of nonusers were willing to uptake a method of modern contraception in postpartum. Women empowerment; education, quality employment and social class significantly influenced contraception use (P<.05). Key barriers to use of modern contraception were fear of unpleasant side effects, socio-cultural and religious concerns.

Conclusion: There was a wide gap between contraceptive awareness and utilization, a large unmet need of contraception among the prenatal attendees. A renewed concerted contraceptive campaign is advised.

Open Access Original Research Article

Evaluation of the Crimean-Congo Hemorrhagic Fever Cases Followed and Treated in Our Clinic between 2009-2013

İlhami Çelik, Zehra Beştepe Dursun, Filiz Kürklü Bozkır, Fatma Bahadır, Sibel Gürbüz

Journal of Advances in Medicine and Medical Research, Page 1-5
DOI: 10.9734/BJMMR/2016/25724

Objectives: The Crimean-Congo hemorrhagic fever virus (CCHFV) belongs to the family Bunyaviridae, genus Nairovirus, and causes severe disease in man; the reported case-fatality rate is 3%–30%. The aim of this study was to determine the epidemiological and clinical characteristics of the CCHF cases in our clinic between 2009-2013.

Materials and Methods: Thirty-three patients with the diagnosis of CCHF were followed up in Kayseri Training and Research Hospital between January 2009 and September 2013. Demographic, geographic, climatic, and clinical and laboratory characteristics of all patients were investigated. All of the cases were confirmed by CCHF immunoglobulin M (IgM) and/or PCR RNA positivity.

Results: According to our reports 33 CCHF cases were followed in our clinic. Of the CCHF cases, 63.6% were male. Thirty patients (90.9%) were from rural regions. Seventeen patients (51, 5%) were farmers. The median age was 46.7 years (range18-71 years). On admission, 97% of patients experienced high fever, 100% had weakness, 93.9% had headache. The disease was more usual in May, June, July. Of the CCHF cases, 69.7% had a history of tick bite. On admission, all of the patients had thrombocytopenia, 87.9% had leucopenia, 27.3% had anemia, and 87.9% had elevated AST and ALT. Oral ribavirin treatment was used in 33.3% of the CCHF cases. The case-fatality rate was 12.1% (4/33 patients).

Conclusions: CCHF remains a seasonal problem in the Mid-Eastern Anatolia region of Turkey. The mortality rate in our patients was higher than reported in other studies in our country (12% vs 5%). CCHF should be accompanied with supportive care, especially including early platelet replacement.

Open Access Original Research Article

Prevalence and Management of Gall Stones in Sleeve Gastrectomy

Ahmed M. Makki, Saleh M. Aldaqal

Journal of Advances in Medicine and Medical Research, Page 1-6
DOI: 10.9734/BJMMR/2016/25771

Introduction: Obesity is a public health problem with increased prevalence, recent exciting studies linked cholelithiasis to obesity and reduction of weight. Abdominal Ultrasound is essential preoperative work up to reveal cholelithiasis-related obesity. The objective of this study is to determine the incidence of cholelithiasis in morbidly obese patients, pre-and post Laparoscopic Sleeve Gastrectomy (LSG) and to evaluate the outcome of concomitant cholecystectomy when laparoscopic sleeve gastrectomy is combined with cholecystectomy in the same setting.

Materials and Methods: This retrospective study was applied on 221 cases of laparoscopic sleeve gastrectomies, performed for morbid obesity in King Abdulaziz University Hospital, Jeddah, Saudi Arabia, from January 2013 to December 2015.

Preoperative preparation including trans-abdominal ultrasound to rule out Cholelithiasis was fulfilled. Patients with symptomatic Cholelithiasis were informed about the possibility of performing combined (concomitant) cholecystectomy with the sleeve gastrectomy.

Results: 33 out of 221 (15%) of the morbidly obese patients, who were admitted for LSG had cholelithiasis, 28/221 (12.7%) were diagnosed preoperatively, while 5/221 (2.3%) developed it postoperatively.

The age of the cholelithiasis group ranges between 19-51 years, with a mean of 37.4 year old. 28 females, 5 males were involved in the study which represent 85%, 15% for females and males respectively.

Conclusion: This study illustrated the high incidence of gall stones before sleeve gastrectomy indicates abdominal ultrasound as an essential preoperative work up, while advised to be done selectively for the symptomatic cases during follow-up period based on the low incidence of postoperative cholelithiasis. Our study also highlighted the successful management of concomitant cholecystectomy when laparoscopic sleeve gastrectomy is combined with cholecystectomy in the same setting.

Open Access Original Research Article

Prevalence of Self Reported Sleep Problems among Patients with HIV Infection in Sokoto, Nigeria

Mufutau A. Yunusa, Ayodele Obembe

Journal of Advances in Medicine and Medical Research, Page 1-9
DOI: 10.9734/BJMMR/2016/24049

Background: Sleep disturbance results in physical, mental and emotional disturbances among patients with HIV infection. In spite of these observations, studies of sleep problems among HIV patients from Sub-Saharan Africa are limited.

Aim: To determine prevalence of sleep problems among patients with HIV infection in a north western Nigeria.

Methodology: This is a cross sectional study among patients with HIV infection (n = 159) conducted in VCT (Voluntary Counselling and Testing) center of a teaching hospital in Sokoto, Nigeria. Questionnaire comprising of three sections including sociodemographic, sleep pattern, and psychiatric morbidity were administered to the subjects. Sleep pattern was assessed using clinical assessment variables such as early, middle, and late insomnia, presence of nightmare and non-restorative sleep. Psychiatric morbidity was assessed through the use of Hospital Anxiety and Depression Scale. Statistical analysis was performed with frequency distribution and Pearson’s chi square test to test for associations. A significance level of 5% was established.

Results: The prevalence of sleeping problems among the subjects was 20%. Non-restorative sleep is the most prevalent sleep problem among the patients. Factors associated with sleep problems included being employed and presence of psychiatric morbidity.

Conclusion: This study suggested that the prevalence of sleep problems among the patients with HIV infection is high. Routine screening for sleep problems is suggested.

Open Access Original Research Article

Evaluation of Real Time PCR, ELISA and Direct Strip Tests for Detection of Helicobacter pylori Infection in Patients with Gastrointestinal Illnesses

Asma’a Yahya Erzooki, Falah Salim Manhal

Journal of Advances in Medicine and Medical Research, Page 1-9
DOI: 10.9734/BJMMR/2016/25631

Helicobacter pylori (H. pylori) infection is very common worldwide. The infection causes chronic gastritis which significantly increases the risk of developing gastric or duodenal ulcer, gastric adenocarcinoma, and mucosa-associated lymphoid tissue (MALT) lymphoma. This study was undertaken for the detection of cagA gene in biopsy specimens from patients with gastrointestinal diseases by real time PCR test, in addition to serological detection of anti H. pylori IgG and IgM antibodies by ELISA and direct strip tests. A total of 50 antral biopsy and serum specimens were subjected to real time PCR test conducted together with ELISA test for serological diagnosis. Stomach cancer comprised the lowest frequency by admission diagnosis, 1(2%). PCR test was positive in 45 (90%) of study group. Specimens from patients with gastric ulcer, gastritis & dudenitis, stomach cancer, and multiple polyps recorded 100% positive PCR test. Out of total, ELISA-IgM was positive in 16 (32%) of study group, whereas IgG was positive in 23 (46%) of study group. Direct strip test was positive in 18 (36%) of study group. Our study suggested that stomach cancer is unusually rare in Iraq, despite the high prevalence rate of H. pylori infection in this developing country. ELISA-IgM and IgG and direct strip tests showed a low sensitivity and specificity for the diagnosis of H. pylori infection in a group of Iraqi patients. Polymerase chain reaction is highly specific and may be more sensitive than other biopsy-based diagnostic techniques. Although PCR is a time consuming and expensive procedure with need for highly trained staff performing it, our study demonstrated that using PCR methods for detection of H. pylori have a high diagnostic accuracy rate. Further research is needed to study virulence markers and genetic heterogeneity of H. pylori in patients with gastrointestinal illnesses.

Open Access Original Research Article

Analyze of Risk Factors Affecting the Outcomes of Docetaxel-prednisone Combination in the Treatment of Metastatic Castration-resistant Prostate Cancer

Burak Arslan, Mehmet Fatih Akbulut, Özkan Onuk, Aydın İsmet Hazar, Arif Özkan, Cem Tuğrul Gezmiş, Buğra Çetin, Memduh Aydın

Journal of Advances in Medicine and Medical Research, Page 1-8
DOI: 10.9734/BJMMR/2016/25855

Objective: To analyze potential factors affecting the outcomes of docetaxel and prednisone (DP) combination therapy in patients with castration resistant prostate cancer (CRPC).

Methods: A total of 272 patients were treated with DP chemotherapy for CRPC between April 2006 and January 2014. Patients received docetaxel (75 mg/m2) administered as ≥1-h intravenous infusion on day 1, every 3 weeks plus oral prednisone 5 mg twice daily starting on day 1 and continuing throughout the treatment. Patients were evaluated for prostate specific antigen (PSA) response, toxicity and factors affecting the treatment outcomes.

Results: 132 (48.6%) patients achieved a PSA response (47 complete and 85 partial response). There were no differences between PSA responders and PSA non-responders in terms of age, gleason score, initial PSA value and Eastern Cooperative Oncology Group (ECOG) performance status. Alkaline phosphatase (ALP) level of non-responders was significantly higher compared to PSA responders (p= 0.042), total serum protein levels (p=0.035) and albumin (p=0.012) were significantly lower in non-responder group. Median survival rate of PSA responders was significantly higher compared to PSA non-responders (19 months vs 14 months, p= 0.000). The most common grade 3-4 toxicity of chemotherapy was neutropenia which was observed in 95 (34.7%) patients.

Conclusions: Serum ALP, total protein and albumin levels can be used to predict treatment outcomes following docetaxel and prednisone combination therapy in patients with CRPC.

Open Access Original Research Article

Primary HIV Infection as an Unusual Cause of Neutropenia in Crohn’s Disease: A Case Report

Y. A. Awuku, S. R. Thomson, D. Levin, S. Hlashtwayo, G. Watermeyer

Journal of Advances in Medicine and Medical Research, Page 1-4
DOI: 10.9734/BJMMR/2016/26166

Although primary human immune deficiency virus (HIV) infection is a well described entity, it is frequently misdiagnosed or underdiagnosed. This has been attributed to the non-specific clinical features at presentation, inadequate history taking and a low index of suspicion by practicing clinicians. Haematological abnormalities are a recognised feature of HIV infection and may present in the form of pancytopenia or isolated cytopenias. One of the cardinal features of HIV seroconversion is leucopenia, however primary HIV infection as a cause of neutropenia and lymphopaenia in Crohn’s disease, has to our knowledge, not been described in the medical literature. We present a case of profound neutropenia in Crohn’s disease secondary to acute HIV sero-conversion illness.