Open Access Case Study

Inflammatory Pseudotumor of Maxilla: Masquerading as Aggressive Malignancy

Iram Khan, Satinder Singh, Shalabh Sharma, Vrushali Mahajan

Journal of Advances in Medicine and Medical Research, Page 1-5
DOI: 10.9734/BJMMR/2016/26330

Inflammatory pseudotumor is a chronic inflammatory lesion of unknown origin with highly aggressive course. The disease even being benign in nature spreads aggressively, giving a false clinical impression of malignancy. A knowledge of the clinical entity is essential when considering a diagnosis of malignancy.

Open Access Case Study

Neonatal Gastric Perforation: A Report of Three Cases

Abdolhamid Amouei, Fatemeh Ehsani, Mojtaba Babaei Zarch, Seyed Mostafa Tabatabaei, Mostafa Babai

Journal of Advances in Medicine and Medical Research, Page 1-5
DOI: 10.9734/BJMMR/2016/26106

Gastric perforation in neonates is an unusual, serious and catastrophic condition. Although ischemic, traumatic and spontaneous mechanisms have been proposed for gastric perforation, the exact etiology is not clear. Both early diagnosis and treatment is very important to improve survival. We hereby report three cases of neonatal gastric perforation managed successfully by early resuscitation efforts and prompt laparotomy.

Open Access Original Research Article

A Study of Frequency of Glomerular Diseases (Biopsy Proven) from a Tertiary Care Center of North West Rajasthan

Surendra Kumar, Jitendra Phalodia, Zahid Khan, Vinod Kumar Aswal, Akhil Gupta

Journal of Advances in Medicine and Medical Research, Page 1-8
DOI: 10.9734/BJMMR/2016/24158

Aims and Objective: Glomerular disease (GD) is one of the most common forms of renal diseases and can have many different clinical presentations and there is a variation in the prevalence of the type of GD according to geographical location and race of the study population, so our aim is to report the frequency of biopsy-proven glomerular disease (GD) in a single center in North-west Rajasthan.

Materials and Methods: Medical records of 48 patients with biopsy-proven GD over a period of 1 year from October 2013 to October 2014 were prospectively analyzed. The clinical, laboratory, and histological data were recorded. All biopsy specimens were examined by the same pathologist with light and immunofluorescence microscopy. Electron microscopic analysis was performed only in selected cases.

Results: According to renal biopsies, chronic thrombotic microangiopathy was present in 1 patient and it belonged to secondary glomerular disease, 2 patients had diffuse lupus nephritis class IV and they also had secondary glomerular disease, 17 patients had FSGS and out of them 16 belonged to primary glomerular disease, 9 patients had IgA Nephropathy. We identified 5 patients each had MPGN and MGN and they all belonged to primary glomerular disease. Three patients had mesangioproliferative glomerulonephritis. Minimal change disease was present in 3 patients while 1 patient had renal amyloidosis. Out of total 48 patients, 31 had nephrotic syndrome while 17 patients had nephritic syndrome out of them 28 and 15 patients had primary glomerular disease respectively.

Conclusion: Our study showed that FSGS as most common cause of primary glomerular disease {the most common variant is not otherwise specified (NOS)}, followed by IgA nephropathy in North West Rajasthan. Lupus nephritis was more common in patients who had secondary glomerular disease in our study. The spectrum of GD varies according to the area of study and changes over time.

Open Access Original Research Article

Possible Effects of Moringa oleifera versus Ginger (Zingiber officinalis) on Experimental Colitis in Mice

Ahlam Elmasry, Mohamed-Hesham Daba, Amro A. El-Karef

Journal of Advances in Medicine and Medical Research, Page 1-19
DOI: 10.9734/BJMMR/2016/26312

Aims: We evaluated effects of extracts of both Moringa oleifera (MOR) leaves and ginger (GIN) root on dextran sodium sulphate (DSS) induced colitis mice.

Study Design:  experimental study

Place and Duration of Study: Clinical Pharmacology dep., Mansoura Faculty of Medicine. To weeks study.

Methodology: Forty BALB/c mice were used throughout this study. Mice were divided into 5 groups (n=8). Group (1) received plain filtered water. Group (2) received DSS. Group (3) received DSS and MOR. Group (4) received DSS and GIN. Group (5) received DSS plus MOR & GIN. All mice were sacrificed after 14 days of colitis induction and colon was removed. Length of the colon was detected and examined microscopically and immunohistochemistery for detection of NFKβ. Biochemical assessment of TNFα was done in serum, while, MDA and GSH were done in colonic tissue homogenate.

Results: Both MOR and/ or GIN showed significant reduction in DAI, microscopic lesion score, NFKβ expression as well as significant improvement in TNFα, MDA, and GSH levels as compared to group (2).

Conclusion: The ethanolic extract of leaves of MOR and/ or extract of GIN root showed significant improvement of experimentally induced colitis, which may be attributed to its anti-inflammatory and antioxidant properties. Combination therapy of GIN and MOR showed non additive benefit than GIN alone. These natural plants could be used as additive to drug therapy of IBD.

Open Access Original Research Article

Dentinal Tubules of Attrited, Abraded and Eroded Teeth- A Comparative Evaluation of Scanning Electron and Light Microscope

Mudita Chaturvedi, Balasundari Shreedhar, Mala Kamboj, Saurabh Chaturvedi

Journal of Advances in Medicine and Medical Research, Page 1-9
DOI: 10.9734/BJMMR/2016/25812

Aim: The aim was to study the ultrastructure of dentin exposed by attrition, abrasion and erosion separately and in combination and to visualize the lesions using scanning electron microscope and thereby establish a superior basis for evaluating dentinal changes at the ultra-structural level and to correlate the findings with changes seen at the light microscopic level.

Study Design: Tooth wear is often multifactorial. Loss and excessive wear of hard dental tissues is a permanent problem of the dentition, especially in present era, encompassing almost all age groups. In this study 40 extracted teeth were used.

Four groups were made and comparison was made between light microscope and scanning electron microscopic findings.

Place and Duration of Study: Department of oral and maxillofacial pathology, career post graduate institute of dental sciences, lucknow, (U.P.), India.

Methodology: Forty extracted permanent teeth (10 attrited, 10 abraded, 10 eroded and 10 normal premolars and molars) were sampled divided into four groups. After debridement and fixation in 10% formalin for 24-48 hours, the teeth were fractured along their longitudinal axes. Two halves of the teeth were studied under scanning electron and light microscope. The dentinal changes secondary to attrition, abrasion and erosion such as dead tracts, dentinal sclerosis and reparative dentin formation seen under light microscopy, were correlated with the ultra-structural findings. The data so obtained were tabulated and statistically analyzed.

Results: The light microscopic finding of 4 randomly selected teeth, showed frequency of tertiary dentin significantly more than dead tracts and dentinal sclerosis was absent, from each group. 10 samples scanned with electron microscope  showed the tubular surface/margins smooth, tubular surface/margins rough and presence of crystals was highly significant (p<0.001) whereas peritubular dentin and intertubular dentin, was not significant (p>0.05) in each group. Similarly, mean density of dentinal tubules of normal group was the highest followed by abraded, attrited and eroded the least. The percentage of affected dentinal tubules was most in eroded & least in attrited teeth.

Conclusion: The scanning electron microscope is a powerful magnification tool which offers extremely high resolution. In the present study, scanning electron microscopic image complements the information available from the light microscope about the dentinal changes in abraded, attrited and eroded teeth.

Open Access Original Research Article

Pulse-induced Continuous Cardiac Output Monitor versus Trans-esophageal Doppler Monitor for Optimization of Fluid Management in Patients Undergoing Major Abdominal Surgery. A Comparative Study

Hend F. Hassan, Mohamed Z. Ali, Ahmed I. Refaat, Reeham S. Ebied, Mohamed M. Abdelhak, Abla S. El-Hadidi, Nadia G. El-Sharkawy

Journal of Advances in Medicine and Medical Research, Page 1-15
DOI: 10.9734/BJMMR/2016/26063

Background: Perioperative fluid management is essential to the practice of anaesthesia. Outcomes may be improved if fluid therapy is individualized according to the patient's fluid responsiveness. Pulse-induced continuous cardiac output (PiCCO) monitor is an invasive device that quantifies several parameters, including cardiac output (CO), stroke volume variation (SVV) and extravascular lung water (EVLW). Trans-oesophageal Doppler monitoring (TED) is another minimally invasive form and has the benefit of providing beat to beat analysis.                                                    

Aim of Work: We designed this prospective, randomized comparative study to evaluate the use of PiCCO monitor from the fluid and haemodynamic point of view in comparison to TED monitor in order to maintain an adequate circulatory volume ensuring end-organ perfusion and oxygen delivery.

Patients and Methods: This study was performed on 72 patients of either sex (ASA I-II), undergoing major abdominal surgery. Patients were randomly allocated into two groups; PiCCO group (n=36); where fluid management was guided by SVV & colloid boluses were given to maintain SVV below 10% and TED group (n=36); where fluid management was guided by (systolic flow time corrected for heart rate) (FTc) & colloid was infused when the (FTc) ˂ 0.35 second, the fluid challenge would be repeated until FTc raised ˃ 0.40 second with no change in SV. Laboratory parameters of organ hypoperfusion in perioperative period were recorded as well as the number of postoperative complications, mortality and length of ICU stay.

Results: PiCCO group received more intraoperative colloids (P=0.001) and had lower incidence of hypotensive events (P=0.001). Postoperative lactate levels were lower in PiCCO group (P=0.04). PiCCO group showed fewer numbers of patients developed complications & overall number of postoperative complications (P=0.01). It also showed shorter duration of ICU length of stay (P=0.01). No mortality was recorded in both groups.

Conclusions: During major abdominal surgery; intraoperative fluid optimization using PiCCO monitor showed more haemodynamic stability and was associated with a lower incidence of postoperative complications, organ dysfunction and infectious complications with a tendency to decrease the ICU length of stay in comparison to TED monitor.

Open Access Original Research Article

Glucose-lowering Potential of Cocoa Powder Intake - An Avenue for Positive Management of Diabetes Mellitus

T. M. Olasope, G. T. Fadupin, O. O. Olubamiwa, C. O. Jayeola

Journal of Advances in Medicine and Medical Research, Page 1-7
DOI: 10.9734/BJMMR/2016/24534

Diabetes mellitus (DM) is a public health problem which is increasing all over the world and various contributions to its prevention and management is crucial. Cocoa powder as a food ingredient has been discovered to have medicinal purposes most especially in the treatment of cardiovascular diseases. This study was conducted to determine the efficacy of cocoa powder on the blood glucose level, body weight, feed and water in-take of experimental normal and albino rats with DM.

Sixty matured male and female albino rats with an average weight of 200 g were randomly divided into 10 groups of 6 rats which include the normal and diabetic control and 8 treatment groups. DM was induced intravenously by giving the rats a single dose of Alloxan Monohydrate (100 mg/kg body weight) and the treatments include 1-4% natural cocoa powder mixed-feed.

The results showed that cocoa powder could normalize increase fasting blood glucose and water in-take as well as body weight loss caused by alloxan. The group with DM fed with 4% cocoa powder feed showed the lowest water intake (29.6±8.41 ml) as well as the lowest final fasting blood glucose level (101±3.26 mg/dl) when compared to the diabetic control group while the normal group fed with 4% cocoa powder had the lowest body weight (204±11.6 g) when compared to the normal control group. There was a significant decrease in the final feed intake of both the diabetic and normal treatment groups when compared to the normal control group.

This study suggests that cocoa powder contains glucose-lowering potentials that could yield a positive result in the management of DM.

Open Access Original Research Article

Masimo® Plethysmograph Variability Index as a Tool for Assessment of Fluid Responsiveness in Elective Major Abdominal Surgeries

Ahmed M. Essam, Mohamed Z. Ali, Mohamed A. Maher, Ali M. Mokhtar, Sohila H. Omar, Hossam H. El-Sabae, Mohamed H. Hafez

Journal of Advances in Medicine and Medical Research, Page 1-11
DOI: 10.9734/BJMMR/2016/26030

Background: Maximizing the stroke volume (SV) as measured by Trans-oesophageal Doppler (TED) optimizes preload, & is a goal-directed fluid therapy technique that has been used in a variety of clinical settings. Masimo® Plethysmograph variability Index (PVI) is a reliable, safe & noninvasive tool to guide fluid management. PVI is an automated measure of the dynamic change in the perfusion index (PI) that occurs during a respiratory cycle.

This study was designed to determine whether PVI, measured using finger co-oximetry is an efficient predictor of fluid responsiveness in low-risk patients undergoing elective major abdominal surgery.

Subjects and Methods: 60 ASA I-II patients of either sex, 25-60 years old, undergoing major abdominal surgery were enrolled in this study. A Masimo® Radical-7 Pulse Co-Oximeter probe & a Cardio Q TED probe were applied to each patient. In all patients, a fluid bolus of 500 ml of 130/0.4 tetrastarch colloid solution was administered rapidly via pressurized IV infusion. Maintenance & deficits were calculated routinely. If the SV decreased by 10%, a 250-mL bolus of colloid was given via fast infusion. Patients’ demography, TED-derived measurements: (SV & Flow Time corrected (FTc)), Masimo®-derived measurements: (PVI & PI), HR and MAP were all collected and statistically analyzed. Measurements were done at five minutes post-induction T1, Ten minutes after volume expansion (500 ml colloid) T2, If the SV decreased by 10%, (guided by TED) T3, Then 250 ml colloid is given. Ten minutes after a 250-ml colloid bolus T4.

Results: A significant difference was found in FTc, SV, PI & PVI in T1 vs. T2 & T3 vs. T4 (P=0.001). There was a significant difference in PI & PVI between responders & non-responders for the 1st bolus (P<0.05) and in SV & PVI in subsequent boluses (P<0.01). There was no significant difference between percent changes of SV and PVI at T3 & T4.

Conclusions: Plethysmograph Variability Index (PVI) measured by Masimo® Co-Oximeter is an efficient predictor of fluid responsiveness as SV measured by TED in low risk patients undergoing elective major surgery.

Open Access Review Article

Advances in Devices for Insulin Delivery and Glucose Monitoring

Mariyam Sakha Abdul Hakeem, Archana Singh Sikarwar

Journal of Advances in Medicine and Medical Research, Page 1-13
DOI: 10.9734/BJMMR/2016/24987

Diabetes mellitus is a metabolic disease which poses a major challenge to healthcare and is characterized by elevated blood glucose levels resulting from either an underproduction or underutilization of the insulin hormone. The actual cause of Type 1 diabetes is unknown, but it most likely results from an autoimmune mediated destruction of the insulin producing pancreatic beta cells that reduces or terminates insulin production. On the other hand, type 2 diabetes is often caused by obesity and induces a gradual desensitization of the body’s cells to insulin. Recent advances in diagnostic methods have heralded in a new era of diabetes management with improved glucose control, reduced fear of complications and better compliance with intensive therapies. Additional efforts are being made to refine these methods to allow their implementation into clinical practice and gain universal acceptance. Advances in diagnostic methods for insulin delivery and glucose monitoring are an important step forward in greatly improving the lives of diabetic patients.

Open Access Review Article

Chronic Recurrent Hematogenous Osteomyelitis (Literature Review)

S. S. Zayniev

Journal of Advances in Medicine and Medical Research, Page 1-6
DOI: 10.9734/BJMMR/2016/25477

The analyses of the existed literature devoted to chronic recurrent hematogenous osteomyelitis have been performed in this study. Pathogenesis and morphologic picture of the disease have been studied in detail. It has been presented modern imaginations about clinical manifestation and diagnostic of chronic recurrent hematogenous osteomyelitis. The principal basics of the complex therapy and surgical methods of treatment of chronic recurrent hematogenous osteomyelitis have been described.