Open Access Case Report

Post Surgery Treatment with Topical Eye Drops of the Recurrent Conjunctival Melanoma

Belinda Pustina, Naser Salihu

Journal of Advances in Medicine and Medical Research, Page 1-5
DOI: 10.9734/BJMMR/2016/26201

Conjunctival malignant melanoma (CMM) is rare and can be life threatening. Management of CMM is by surgical excision of the tumor. Non-surgical treatment consists of topical eye drops especially in diffuse and multifocal malignant melanoma. Interferon is reported as an effective agent of CMM treatment.

The purpose of this study is to evaluate the effect of Interferon alfa 2a in diffuse recurrent conjunctival melanoma and follow up of primary conjunctival melanoma after treatment with Interferon alfa 2a.

In this paper we are going to present a case of CMM in bulbar conjunctiva and 12 years of follow-up. Once the CMM was suspected, surgical removal of the affected area was performed and the subsequent biopsy resulted positive. Ten years later CMM reappeared in the same place and second surgery was performed. Two years later a second recurrence of the melanoma occurred at the same place as before. In order to avoid another surgery a treatment with topical interferon alpha 2 a 1 MIU/mL, 4 drops/day for 3 months was performed instead. Following 15 months of this treatment no sign of conjunctival melanoma came into sight.

Open Access Minireview Article

Prescribing Hormonal Contraception

M. Najimudeen, K. Sachchithanantham

Journal of Advances in Medicine and Medical Research, Page 1-8
DOI: 10.9734/BJMMR/2016/25257

Millions of women are in the reproductive age group. Their age vary from 15 to 50 years. They differ in life style, culture and body mass index. They may have morbidities like high blood pressure, liver disease and other co-morbidities. They are prone to venous thrombosis, malignancies of the breast and endometrium. Therefore the prescription of contraception should be on individual basis.

Over the past 40 years there had been many improvements in the contraceptive methods. The 50 microgram ethinyl oestradiol of the combined pill was reduced drastically. Many rods of the norplant had become a tiny single rod implanon. The inert Lippi’s loop has transformed into Levonorgestrel-releasing intra uterine system (LNG-IUS).

When there are varieties of contraceptive methods available, it is obvious that no method is perfect and full proof to prevent conception. It is important for the caring practitioner to select the most appropriate method to suit each individual client.

Open Access Original Research Article

Cost Benefit Alternative to Single Access Laparoscopic Cholecystectomy

A. M. Abdelaziz Hassan, M. Mahmoud, S. B. Elsebaie, A. I. Nafeh, M. M. Elsebae

Journal of Advances in Medicine and Medical Research, Page 1-7
DOI: 10.9734/BJMMR/2016/25988

Introduction: Single-incision laparoscopic surgery is an attractive approach for cholecystectomy. However, its widespread application has many limitations. A significant obstacle of application in developing countries is the expensive and non affordable specialized single port systems and roticulating instruments.

Objective: To assess the feasibility and effectiveness of the glove port technique of trans-umbilical single incision laparoscopic cholecystectomy (SILC) performed by a single surgeon using the conventional laparoscopic instruments.

Methodology: 70 patients with symptomatic gall bladder stone disease were selected and underwent glove port laparoscopic cholecystectomy (GPLC). Patient’s demographic data, operative data, early postoperative complications, patient satisfaction score and wound measurement 3 months later, were documented and statistically analyzed.

Results: The mean operative time was 47.75 min. The mean estimated blood loss was 14.5 ml. No conversion of the technique occurred. Overall intra operative complication rate was 5.7%, while post operative complication rate was 4.2%.

Conclusion: On technical basis; we consider GPLC in selected cases; a safe, feasible and convenient, and cost effective method of SILC.

Open Access Original Research Article

Serum Levels of Interleukin-6 (IL-6) Cytokine in Patients with Classic Fever of Unknown Origin, in Maiduguri, Nigeria

B. S. Oderinde, O. O. Agbede, S. S. Baba, D. N. Bukbuk, M. M. Baba, S. K. Amoka, B. B. Ajayi, J. S. Dawurung, B. A. Denue, N. Bukar

Journal of Advances in Medicine and Medical Research, Page 1-6
DOI: 10.9734/BJMMR/2016/25116

Aim: To assess whether a significant correlation exists with serum Interleukin-6 cytokine levels in patients with Classic Fever of Unknown Origin (FUO) compared with healthy controls. The levels of IL-6 cytokine were tested as a proinflammatory cytokine which may belong to microorganisms that cause disease.

Study Design: This is a case control, single center study.

Place and Duration of Study: The study was conducted in the University of Maiduguri Teaching Hospital, Maiduguri, Borno State, Nigeria in patients with classic FUO who were treated between 2009 and 2012 were included in this study.

Methodology: A total of 75 patients with classic FUO within the age range of 15 – 65 years were tested for IL-6 cytokine in comparison with 75 healthy controls. The sample size was calculated using Fisher’s formula.

Results: In patients with FUO, 39% of patients demonstrated elevated levels of IL-6 while  20% of healthy controls demonstrated elevated levels (>200 pg/ml) of serum IL-6, while 12% and 15% respectively were in standard range of 0 - 6.4 pg/ml which is considered low. Gender differences were noted and mean values of IL-6 were higher in males (FUO mean±SD 136.7±161.8; Healthy controls mean±SD 132.3±183.5) than in females (FUO mean±141.6±133.9; Healthy controls mean±SD 97.8±134.2). Healthy male control had a value of 520.5 pg/ml with little difference to the male patients with FUO (575 pg/ml), p=0.91) while IL-6 concentrations in the female group who had FUO (407.5 pg/ml vs 367.5 pg/ml, p=0.16) showed greater difference in value in comparison to the healthy which trended towards statistical significance. We found that most patients (39%) with FUO have higher values of ≥ 200 pg/ml than the healthy controls.

Conclusions: Serum IL-6 cytokine level is generally higher in males than in females and most patients (39%) with FUO have a higher value of ≥ 200 pg/ml than the healthy controls. IL-6 levels trended towards statistical significance and may help to discriminate females with FUO as compared their healthy controls.

Open Access Original Research Article

Prevalence of Iron Deficiency Anemia among Chronic Kidney Disease Patients in Kaveri Delta Region, Tamilnadu, India

Deepika Muniyandi, Nathiya Shanmugam, Kumaresan Ramanathan, Bhooma Vijayaraghavan, Giri Padmanabhan

Journal of Advances in Medicine and Medical Research, Page 1-6
DOI: 10.9734/BJMMR/2016/25711

Background: Iron deficiency anemia (IDA) is the most common type of anemia. But the incidence of iron deficiency anemia in chronic kidney disease (CKD) has not been well established in Kaveri Delta Region, Tamilnadu, India. Hence, the present study has been undertaken to evaluate the prevalence of iron deficiency anemia in chronic kidney disease patients of Kaveri Delta Region, Tamilnadu, India.

Materials and Methods: The present study enrolled 221 chronic kidney disease patients from a private nephrology outpatient clinic, Tiruchirappalli. All biochemical tests were done including serum ferritin. Patients were categorized into two groups based on ferritin levels. Group 1 (N: 87) considered as case and the group 2 (N: 134) patients considered as control. These two groups were compared each other respective with gender and age groups with all parameters.

Results: Out of these patients, 87 belonged to iron deficiency anemia patients. Group 1 patients (Total Number of Patients: 87 Male: 29 Female: 58) showing significantly lower serum ferritin levels (15.04±12.48) than group 2 patients (88.98±47.39) (P<0.0001). Within group 1, females had lower ferritin levels (12.98±8.84) than males (17.11±10.78) in the age group of 31-40 years (P <0.0001).

Conclusion: The prevalence of iron deficiency anemia among chronic kidney disease in Kaveri Delta Region was found to be 39%.

Open Access Original Research Article

Attitudes of Patients to Medical Students in the Gynaecology Clinic: A Nigerian Experience

L. C. Ikeako, A. Adiuku-Brown, H. U. Ezegwui, A. C. Onuh, T. C. Okeke

Journal of Advances in Medicine and Medical Research, Page 1-10
DOI: 10.9734/BJMMR/2016/25623

Background: Out-patient clinics are very important in medical students’ education.

Aim: This study was undertaken to determine the attitudes of patients to the participation of medical students in their consultation in the gynaecology clinic at the University of Nigeria teaching hospital, Ituku-Ozalla Enugu (UNTH), Southeast Nigeria.

Methods: This was a descriptive cross sectional survey. Self-administered questionnaires were given to participants recruited using a non-probability convenience sampling technique. One hundred and ninety five patients participated in the study.

Results: Most of the patients, 147(75.4%) were willing to allow medical students to participate in their consultation. Seven (3.6%) patients refused the participation of medical students in any form. Of the 141(72.3%) patients who had previous consultation with medical students present, only 59(41.8%) gave informed consent. Consent was not sought from 63(44.7%) of these patents (P=0.046). In the absence of a doctor, 58.2% and 46.4% of the patients did not accept giving history to male and female students respectively (P=0.021). Sixty nine (35.6%) and 146(75.3%) agreed to examination by male and female students respectively (P=0.031).

Age (P=0.029) and marital status (P=0.017) were identified as independently significantly associated with the acceptance of medical students’ participation during clinic visits.

Conclusion: In UNTH Nigeria, many patients are willing to allow medical students’ participation in their assessment in the gynaecology clinic although there is a preference for female students. There is need to respect patients autonomy by seeking consent in order to maximize their contribution to medical students’ education. There is also the need to create patient awareness on the role of a teaching health facility.

Open Access Review Article

Effectiveness of HIV Anti-retroviral Agents on the HIV/AIDS Epidemic

Zaheer Faizi, Bushra Rizwan, Jordan Scott, Junaid Ahsan

Journal of Advances in Medicine and Medical Research, Page 1-13
DOI: 10.9734/BJMMR/2016/24788

Aims: The scale up of HAART globally has shifted the mortality time table, decreased viral transmission and improved health related quality of life for patients while emphasizing the importance of adherence to therapy for improved outcomes.

Study Design:  Review Article.

Place and Duration of Study: Department of Medicine SABA University School of Medicine.

Methodology: Using Pubmed and Science Direct, research was executed from January 2015 to March 2015. Articles used were limited to a study completion date of less than five years. The type of studies used were case control, cohort, cross sectional, follow up, and qualitative studies on human subjects. All studies originated within the last 20 years but to keep the issue current and relevant, preference was given to studies published within the last five years.

Results: The scale up of HAART correlated with a decrease in mortality rates and a lengthening of the death time table. Health Related Quality of Life significantly improved with therapy. Both vertical and horizontal transmission rates showed improvements with the increase of available therapy. Stigma is still a limiting factor to adherence, limiting the gains of HAART.

Conclusion: HAART has had an overall positive effect in improving the quality of life of patients suffering from the HIV epidemic while working to combat new infections. Causation can be inferred for some aspects as there is adequate literature while certain topics such as stigma need more research.

Ultramini Abstract: HAART has overall improved quality of life for patients while decreasing the mortality time table. It has shifted the perception of HIV from a death sentence to a treatable and preventable diagnosis. Vertical and horizontal transmission have seen great improvements. However, much work has to be done to combat stigma, increase adherence, and decrease attrition to increase the gains of HAART and its effects on the HIV epidemic.

Open Access Review Article

Genotype Distribution of Human Papillomavirus in Warts

Fauzia Perveen, Saeeda Baig, Mohiuddin Alamgir

Journal of Advances in Medicine and Medical Research, Page 1-10
DOI: 10.9734/BJMMR/2016/25384

HPV warts, non-cancerous, epidermal growths, are caused by the virus by generally entering the skin through areas where the skin is broken, fragile or extremely moist making the top layer of skin to grow rapidly, forming a wart. There are more than 200 genotypes of HPV and about 100 genotypes have been identified in different types of warts. Generally, HPV infection, in most people resolves itself within two years without causing any serious health issue but when HPV becomes active it may invade mucous membrane leading to warts or other serious consequences. Since prevalence of HPV varies significantly and exact genotype distribution of HPV in different warts is still not clearly defined, this review aims to assess the distribution of HPV genotypes in different warts, their clinical presentation, diagnosis and treatment.

Open Access Review Article

Alexithymia and Breast Cancer Surgery: A Systematic Review

Domenico De Berardis, Stefano Marini, Felice Iasevoli, Monica Mazza, Alessandro Valchera, Michele Fornaro, Giampaolo Perna, Laura Orsolini, Alessandro Carano, Gabriella Girinelli, Federica Vellante, Ilaria Matarazzo, Nicola Serroni, Marilde Cavuto, Giovanni Martinotti, Maurizio Brucchi, Massimo Di Giannantonio

Journal of Advances in Medicine and Medical Research, Page 1-11
DOI: 10.9734/BJMMR/2016/25934

The term alexithymia is a complex multidimensional construct that literally means “no words for mood”. There are two kind of alexithymia: primary and secondary or otherwise called trait and state alexithymia. There is still an unresolved debate about the nature of alexithymia as a trait or a state. The etiology of alexithymia has not been completely determined because of the numerous factors influencing its development. Alexithymia has been observed among patients with a variety of psychiatric disorders and medical conditions. The aim of this systematic review was to review studies investigating the correlations between alexithymia, depression and anxiety in breast cancer surgery women. Literature search was conducted in January, 2016. PubMed and Scopus databases were used to find studies for inclusion in the systematic review. Correlations between alexithymia, depression and anxiety evidenced that alexithymia may be considered a stable personality trait and an important factor to the development of anxiety symptoms. However, limitations of these studies must be considered and further investigations are needed.

Open Access Review Article

Modest Systemic Hypothermia: A Promising Therapeutic Tool in the Management of Acute Spinal Cord Injuries

Jordan Scott, Zaheer Faizi, Bushra Rizwan, Junaid Ahsan

Journal of Advances in Medicine and Medical Research, Page 1-17
DOI: 10.9734/BJMMR/2016/24789

Aims: Primary and secondary injury mechanisms contribute to neuronal dysfunction, neuronal cell death, and subsequent loss of function following acute spinal cord injury (SCI). This endogenous response to neuronal injury typically proceeds unabated resulting in progressive loss of anatomical and functional integrity. Modest systemic hypothermia (MSH) is defined as systemic cooling of the core body temperature to a range between 32-34°C; it may have a potential neuroprotective role in patients with acute SCI.

Study Design: Review Article.

Place and Duration of Study: Department of Medicine SABA University School of Medicine.

Methodology: Electronic search of PubMed and Google Scholar databases were conducted from 2014 to 2015. Studies published prior to year 2000 were excluded with preference being given to studies completed in the last five years. Electronic search of PubMed revealed four human studies (published between years 2009-2013) which evaluated functional outcomes and complications of modest systemic hypothermia following SCI. The types of studies included one case report, feasibility study, retrospective comparative case series, and retrospective and prospective case series. Eight randomized controlled studies (published between years 2000-2015) were selected that reported histological and/or function outcomes following treatment with modest systemic hypothermia in animal models of SCI.

Results: Functionally, significantly higher mean Basso, Beattie, and Bresnahan scale locomotor scale scores were reported in hypothermia-treated groups at the endpoint behavioral assessments compared to normothermia groups. Histologically, hypothermia significantly increased total white and gray matter volume compared to normothermic control groups. Significantly reduced immunohistochemical expression of apoptotic and inflammatory factors were reported in hypothermia groups following SCI. Biochemically, hypothermia inhibited free radical induced lipid peroxidation significantly more than methylprednisolone alone. Electrophysiologically, hypothermia enhanced the preservation of ascending sensory electrophysiological signals following SCI. Clinically, the application of modest systemic hypothermia after SCI has been shown to be relatively safe and appears to improve functional outcomes in patients with acute SCI when compared to the natural history of complications and recovery.

Conclusion: The results of several basic science studies have shown that modest systemic hypothermia improves functional, histological, biochemical, and electrophysiological outcomes in animal models of acute SCI when compared to normothermic control groups. Although randomized clinical trials must be completed before a clear conclusion can be made, modest systemic hypothermia seems to have a promising role as a therapeutic tool in the management of acute SCI.