Open Access Short Research Article

Trephine Colostomy: Minimally Invasive Stoma Technique

Erdinc Kamer, Fevzi Cengiz, Ahmet Er, Turan Acar, Nihan Acar, Yeliz Yilmaz, Mehmet Haciyanli

Journal of Advances in Medicine and Medical Research, Page 1-4
DOI: 10.9734/BJMMR/2016/25187

Aims: Stoma is an important part of surgical management of numerous malignant or benign anorectal diseases and anorectal injuries. This can be performed without recourse to laparatomy. This study was aimed to assess the outcome of trephine to loop sigmoid colostomy creation.

Study Design: The retrospective study included 18 patients who underwent trephine colostomy due to various conditions including Fournier’s gangrene, inoperable anorectal cancer, recto-vaginal fistula, fecal incontinence, and rectal injury.

Place and Duration of Study: Izmir Katip Celebi University Ataturk Training and Research Hospital, Department of Surgery between January 2005 and January 2015.

Methodology: The retrospective study included 18 patients who underwent trephine colostomy. Demographic characteristics, primary pathology for colostomy decision, length of hospital stay, anesthesia technique, and early period surgical complications at 3 months were recorded.

Results: Patients comprised 11 males and 7 women with a mean age of 53±5 years. The indications for stoma formation were Fournier’s gangrene in 8 cases, inoperable anorectal cancer in 3 cases, high recto-vaginal fistula in 2 cases, fecal incontinence in 3 cases and rectal injury in 2 cases. Regional anesthesia was performed in 12 and general anesthesia in 6 cases. Only one patient (5.6%) had stricture of the stoma. There were no other complications and no additional morbidity and mortality related to TS technique.

Conclusion: Trephine stoma is a relatively simple, safe and rapid procedure and an effective alternative to colostomy formation without laparotomy indications.

Open Access Commentary

Broader Transparency on Risk-benefit Assessment of the Bial Trial in France

William Wei Lim Chin

Journal of Advances in Medicine and Medical Research, Page 1-7
DOI: 10.9734/BJMMR/2016/26077

On 11 January 2016, a Phase I trial of an experimental fatty acid amide hydrolase inhibitor for pain developed by Bial-Portela was halted after six healthy volunteers were admitted to the University of Rennes Hospital in France. One volunteer died and four suffered severe neurological injuries. It is a dreadful reminder of the Tenegero trial that also hospitalized six volunteers in 2006. Three major similarities were observed between the Tegenero and Bial trials. The first similarity is related to the dosing interval protocol. There is a lack of information about whether the multiple-dose regimen included adequate time intervals between individuals receiving the drug. The second similarity is on the dosing calculation that was based on the ‘no adverse effect level’ (NOAEL). The third similarity is observed in terms of how there was no prior publication of preclinical findings in the public domain before the start of both trials. There have been calls for the full release of the Investigation Medicinal Product Dossier and the Investigator’s Brochure, as these data are critical to maximize patient safety in the future and should outweigh considerations of commercial confidentiality. Likewise, it is necessary for the Brest Regional Ethics Committee to release its documents, which captured the risk-benefit assessment in approving the Bial trial, for external scrutiny.

Open Access Original Research Article

Association between XRCC3 Thr241Met Polymorphism and the Risk of Cancer in Northern Brazil

Suzane da Silva Cabral, Lorrayne Lacerda Lobato, Rafael Espíndola do Nascimento, Olavo Magalhães Picanço Júnior, Artemis Socorro do Nascimento Rodrigues

Journal of Advances in Medicine and Medical Research, Page 1-6
DOI: 10.9734/BJMMR/2016/24667

Aims: Cancer is a genetic disease characterized by an unbalance between cell growth and regulatory factors. The gene XRCC3 encodes a protein that contributes to the integrity of the genome and XRCC3 Thr241Met variants have their capacity of repair altered.

Study Design: Our goal was to evaluate XRCC3 241Met polymorphism in a sample of cancer patients in the city of Macapá.

Place and Duration of Study: Laboratory of Molecular Biology (Biological Sciences Program of the Federal University of Amapá), Dr. Alberto Lima Clinical Hospital (Hcal) and Institute of Hematology and Hemotherapy of Amapá between June 2009 and July 2010.

Methodology: We analyzed 100 DNA samples of patients (50 cases diagnosed with cancer and 50 controls). DNA samples were amplified and analyzed by PCR-RFLP with the enzyme NLaIII. 

Results: The molecular analysis revealed that 58% of cases and 12% of controls had the Thr/Met genotype, while 82% of controls and 36% of cases had the Thr/Thr genotype.

Conclusion: Non-invasive independent predictors for screening esophageal varices may decrease medical as well as financial burden, hence improving the management of cirrhotic patients. These predictors, however, need further work to validate reliability. The frequency of the Thr/Met genotype was higher among cancer patients when compared to the control group. Our findings suggest that XRCC3 241Met polymorphism may be associated with the risk cancer in the study population.

Open Access Original Research Article

The Driver Behaviour Questionnaire as an Accident Predictor in Cross-cultural Countries in Qatar and Turkey: Global Public Health Problem

Abdulbari Bener, Erol Yildirim, Erkut Bolat, Türker Özkan, Timo Lajunen

Journal of Advances in Medicine and Medical Research, Page 1-9
DOI: 10.9734/BJMMR/2016/25719

Background: The Manchester Driver Behaviour Questionnaire (DBQ) has been extensively used as predictor of self-reported road traffic accidents. The associations between crashes and the violation and error factors of the DBQ however, might be reporting a little bias.

Aim: The current study aiming to explore the driving behaviours of Qatari’s and Turkish ethnic groups and to investigate the relationship between error, violations, and lapses of DBQ and accident involvement.

Materials and Methods: The DBQ instruments has been used to measure the aggressive driving behaviours leading to road accidents.  The study included a representative sample of 2050 drivers and of whom 1,511 drivers agreed to participate (73.7%). A sample of 1,511 drivers from two ethnic groups; Qatar (620), and Turkish (891) completed the driver behaviour questionnaire and background information.

Results: There was a significant difference found between both the countries, Qatar and Turkish, in age group, education, occupation, marital status, car type,  and seat belt use (p<0.001). The Qatari drivers scored higher on almost all items of violations, errors and lapses compared to other ethnic groups, while Turkish drivers were lower on all the items.  Turkish drivers (38.9%) have been involved in more accidents compared to Qatari drivers (32.9%). In terms of cause of accidents, careless driving (31.6%) and excessive speeding (28.5%) were significantly higher among Qatari drivers (p<0.001). More than one third of the studied drivers of two ethnic groups were involved in traffic violations; Qatari (26.6%), and Turkish (33.3%). The use of DBQ permitted the differentiation between deliberate deviations from safe driving practices and errors and violation due to misjudgments or lapses in focus.

Conclusion: The present study revealed driver behaviour is different in two ethnic and cultural groups and scores rated differently. Qatari drivers scored higher on most of the items of violations, errors and lapses of DBQ compared to Turkish drivers in all DBQ items. The results emphasise the importance of social, socio-economic, life-style, cultural factors, general driving style and skills, differ between both countries with the respect of traffic safety.

Open Access Original Research Article

Endarterectomy of the Totally & Subtotally Occluded Carotid Artery Facilitates the Surgery of the Stenosed Contralateral Side

Murat Ugurlucan, Muslum Ercument Filik, Ertugrul Zencirci, Gamze Babur Guler, Ekrem Guler, Metin Onur Beyaz, Didem Melis Oztas, Omer Ali Sayin, Gabriele Piffaretti, Fatma Nihan Turhan Caglar, Mehmet Buget, Ufuk Alpagut, Enver Dayioglu

Journal of Advances in Medicine and Medical Research, Page 1-11
DOI: 10.9734/BJMMR/2016/23901

Purpose: Patients with one side total/subtotal occlusion and contralateral side critical stenosis are high risk candidates for carotid interventions for the stenosed carotid side. We present our experiences with carotid endarterectomy of the stenosed side after revascularization of the occluded side.

Methods: Between March 2010 and September 2013, 85 carotid endarterectomies were performed in seventy-four patients. Among the patients, 6 had one side total/subtotal occlusion and contralateral side ³ 70% carotid stenosis. Patients received revascularization for the occluded side first followed by of the endarterectomy of the contralateral stenosed part.

Results: Four patients had cerebrovascular symptoms ipsilateral to the occluded side. Operations were performed with local anesthesia. Endarterectomy priority was given to the occluded side which was followed by the endarterectomy of the contralateral side after 17.2±4.6 days. No neurologic deficit occured during the surgeries and shunt was not required. Mortality did not occur and patients are followed a mean of 18.4±6.3 months event free.

Conclusion: Endarterectomy of the stenosed carotid artery contralateral to the totally/subtotally occluded side is challenging and carries high risk. The treatment of the occluded side first facilitates the endarterectomy of the contralateral carotid stenosis.

Open Access Original Research Article

The Relationship of eNOS, p22 phox, CETP and ESR1 Gene Polymorphisms Related to Endocrine-Metabolic Parameters and Metabolic Syndrome in Postmenopausal Women - A Sample Population Based Study

Olga Ianas, Dana Manda, Roxana Rosca, Susana Vladoiu, Sabina Oros, Oana Popa, Marcela Covic, Constantina Heltianu, Anca Sima, Lorand Savu, Mihaela Giurcaneanu, Constantin Dumitrache

Journal of Advances in Medicine and Medical Research, Page 1-17
DOI: 10.9734/BJMMR/2016/25399

Aims: To investigate the endocrine-metabolic changes in postmenopausal women with MetS and examine relationship with the polymorphisms of eNOS-G894T, p22(phox)-930 A/G, CETP TaqIB, ESR1 (PvuII and XbaI) genes.

Methods: 280 postmenopausal apparently healthy women aged between 60 and 80 years were classified into non-MetS (212) and MetS (68). Clinical, anthropometric and endocrine-metabolic parameters were measured. The single nucleotide polymorphisms were determined and tested for interacting with these parameters.

Results: The weight, waist circumference, blood pressure, WBC, triglycerides, LDL-C, TG/HDL-C ratio, apolipoprotein (apo)B, apoB/apoA-I ratio, fasting glucose, insulin, HOMA, uric acid,  were higher and HDL-C was lower in MetS group thus  fulfilled the criteria for the MetS. The significant higher levels of E2, T3, GHBP, PTH and lower levels of cortisol, SHBG, FSH, LH, IGFBP1, cortisol/DHEA ratio were also detected.

Genetic association studies showed that presence of A allele p22phoxA/G (OR=1.62; CI=1.08-2.42) and heterozygote AG-XbaI(ESR1) (OR=2.29; CI= 1.19-4.37) indicated a significant risk for MetS. The binary logistic regression (MetS vs Controls) showed an interaction of G894TeNOS polymorphism with MetS (OR>2.5; 95% CI =1.47-4.90) that associated with SBP, TG, apoB, uric acid, ASTGOT (OR>1) and HDL-C (OR<1). CETP TaqIB polymorphism associated with MetS (OR<1) in presence of SBP, GLU, TG with OR>1. ESR1 PvuII (T/C) associated with MetS (OR between 1.59-8.60) in presence of LDL-C, TG/HDL-C ratio, P with OD>1 and HDL-C, androstenedione, SHBG, FAI with OR<1.

In MetS group the carriers of -TT (eNOS-G894T) genotype had higher levels of blood pressure, glucose; -GG (p22phox A/G) had higher levels of BMI, apoB/apoA ratio; -B1B2 (CETP B1/B2) had higher levels of SBP, glucose, cholesterol, HDL-C, CRP, GHBP and lower levels of TSH; -CC (PvuII) and GG (XbaI) ESR1 genotypes showed higher levels of glucose.

Conclusions: These results sustain an interaction between the studied polymorphisms and the endocrine-metabolic changes in MetS pathogenesis.

Open Access Original Research Article

A Simple Sensitive Method for Measuring Borderline Mental Fatigue

Leyla Aydin, Nimet Unay Gundogan, Erhan Kiziltan, Canan Yazici, Beste Ozturk, Burçak Kara, Yağiz Yeşilova, Irmak Erdemir, Cem Bulbul, Esra Oner

Journal of Advances in Medicine and Medical Research, Page 1-8
DOI: 10.9734/BJMMR/2016/25893

Mental fatigue [MF] is a critical condition that can accompany cognitive dysfunction. Various surveys have been used to determine the MF state. However, differences in participants' perception levels' can decrease' survey specificity, which therefore should be supported using objective methods. This study describes a new and simple MF scale based on evaluating results from the Piper Fatigue Scale [PFS], together with the results for reaction times. In the study, 29 healthy, right-handed, male, medical student volunteers were included. Attending a theoretical class for 4 hours was used as the MF model. PFS was applied before and after the MF model to determine their levels of vulnerability to fatigue and perception of fatigue qualitatively. The finger tapping test [FTT] and simple and complex visual reaction time [VRT] tests were used to determine physical fatigue and MF quantitatively. There were no significant differences between pre- and post-fatigue PFS scores or FTT and simple VRT results [p=0.531, p=0.160, p=0.065, respectively]. However, the complex VRT was significantly longer after the MF model [p<0.05]. This study showed that borderline MF, which cannot be determined by the PFS alone, might be accomplished when tested with the complex VRT test that keeps participants in a vigilant state.

Open Access Original Research Article

Factors that Influence Infant Feeding Options of HIV-Positive Mothers in Urban and Rural Communities in South-East, Nigeria

Lawson N. Igbokwe, Elias C. Aniwada, Nwachinemere D. Uleanya, Echendu D. Adinma

Journal of Advances in Medicine and Medical Research, Page 1-10
DOI: 10.9734/BJMMR/2016/26189

Introduction: Infant feeding method decision making is a very vital aspect of child care. This study compares the factors influencing infant feeding options of HIV-positive mothers in urban and rural communities in southeastern Nigeria.

Methods: It was a comparative cross-sectional study involving HIV-positive mothers whose babies were HIV-negative, and below 24 months using systematic sampling method. Questionnaires and Focused Group Discussion (FGD) guide were used.

Results: About 123(54.7%) urban and 142(64.1%) rural dwellers intended exclusively breastfeeding (p = 0.150), however 88(39.1%) urban and 122(54.2%) rural dwellers actually exclusively breastfed (p = 0.001). The commonest reason for breastfeeding was belief that breast feeding was best for their babies (p = 0.003) while for formula feeding was that it protects the baby from HIV infection (p = 0.044). Family income with occupation for rural communities (p = 0.01, and p = 0.03 respectively) and family income for urban (p = 0.01) were significantly associated with infant feeding options.

The FGD identified that disclosure of their HIV status to their husbands or relations helped the mothers in both communities maintain their feeding options.

Conclusions: Infant feeding practices differed significantly between communities. Family incomes and occupation were factors influencing feeding options.

Open Access Review Article

Writing on One’s Own Demise: Suicide Notes in the Age of the Internet

Andrei Novac, Neema Pithia, Bao-Nhan B. Nguyen, Srikanth Krishnan, Robert G. Bota

Journal of Advances in Medicine and Medical Research, Page 1-6
DOI: 10.9734/BJMMR/2016/25825

One to two people out of six who attempt suicide will leave a note behind.  In comparison to notes written on paper, internet suicide notes may differ in a variety of characteristics, as they illustrate different degrees of real-time experiences. Given continuous internet traffic, awareness, likelihood of rapid detection and discovery by potential readers is more likely online. Therefore, internet traffic may change the communication dynamic of suicidal wish and intent. The question posed then is: are internet suicide note writers a different population of suicidal individuals compared to those who leave behind paper suicide notes?

While some strides on suicide prevention on the internet are emerging, we propose that four areas of exploration on cybersuicide could benefit from the development of safeguards and intervention: exploration of suicide sites; Facebook traffic on suicide; Suicide blogs and bloggers, and personal communication via email and social media. While many unanswered questions remain regarding the feasibility of a unified approach, in the long run the development of intervention strategies should become a priority in research. Such strategies would include the development of extended online professional networks. While these networks would create a major privacy challenge for the online community, they may also become a model for addressing healthcare issues online. In order to accomplish such an online community, allocation of significant resources, the development of specialized technology and the worldwide cooperation of mental health professionals would be necessary.

Open Access Review Article

Role of Tumor Markers in Oral Cancer: An Overview

Reddy Lavanya, B. Mamatha, Shefali Waghray, Nallan C. S. K. Chaitanya, M. Padma Reddy, D. B. Gandhi Bau

Journal of Advances in Medicine and Medical Research, Page 1-9
DOI: 10.9734/BJMMR/2016/24998

The oral mucosa represents the first part of the digestive tract and is exposed to various exogenous toxins. Exposure for longer duration can lead to changes that lead to potentially malignant diseases or cancers / Tumors. Eventually these can be diagnosed by routine histopathology, but few of them are difficult to diagnose by this method alone. There arises the role of tumor markers in distinguishing different pathologies is well established. A marker can be described as some inconspicuous object used to distinguish or mark certain things. Mostly tumor markers are proteins and these markers may be detected within exfoliated or distributed cells, or as circulating agents within the peripheral blood or plasma. In the recent years, there is a renewed interest about tumor markers, providing window of opportunity for management of cancer patients by enhancing the efficiency in detection and treatment plan. Recent technological advancement has enabled the examination of many potential markers. This paper focuses on the tumor markers in the head and neck neoplasm.