Open Access Case Study

A Giant Pure Uterine Lipoma: A Case Report

Issam Msakni, Mohamed Amine Bani, Faten Gargouri, Sarra Ben Rejeb, Nada Mansouri, Ammar Bouziani, Besma Laabidi

Journal of Advances in Medicine and Medical Research, Page 1-6
DOI: 10.9734/BJMMR/2016/26798

Aims: The authors present a case of a giant pure lipoma of the uterus revealed by a postmenoposal metrorrhagia and discuss the clinical, radiological, histological characteristics and the different histogenesis hypothesis of this entity.  

Case Presentation: We report the case of a 73-year-old woman who presented with a pure uterine lipoma in which a preoperative diagnosis of ovarian teratoma was suggested by computed tomography.

Conclusion: Pure uterine lipoma is extremely rare and only a few cases have been reported in the literature. It usually develops in postmenoposal women. Clinical symptoms and physical signs are similar to those found in leiomyomas. Nevertheless, preoperative diagnosis is difficult and requires pathological confirmation.

Open Access Original Research Article

Impact of Sildenafil on Smooth Muscle and Blood Vessels by Using Light and Electron Microscopy

Ehab Abou-eladab, Heba Abdal-razzak Abdel-fattah Mahmoud, Hanaa abdel Kader Ibraheem, Ashraf Mahmoud Kamel, Sameh Fawzy Elsonbaty, Faten Shehata

Journal of Advances in Medicine and Medical Research, Page 1-9
DOI: 10.9734/BJMMR/2016/25678

The present study aimed to examine the histological changes in the smooth muscles of corpus cavernosum and veins of rats as an eventual outcome of the ceaseless use of Sildenafil citrate. The comparison of the histological aftereffects of the veins among the control and experimental groups revealed extended thickness of tunica intima and media, as exhibited by a picture analyzer. The findings indicated that the steady usage of Sildenafil reduced smooth muscles and enabled the growth of collagen fibers in corpus cavernosum of penis and mass of veins.

Open Access Original Research Article

Comparison of the Quality of Life of Vulnerable Children Resident in Household and Those Resident in Institution in Jos Nigeria

Abok Ibrahim Ishaya, Selina Okolo, Zoakah Ayuba

Journal of Advances in Medicine and Medical Research, Page 1-10
DOI: 10.9734/BJMMR/2016/24092

Background: There are over 143 million orphans globally, however, sub-Saharan Africa/Asian regions account for over 80% of the global burden (143 million orphans), Nigeria inclusive with over 10 million orphans. This has caused a crisis of shelter, as more children drift towards institutional care rather than staying in communities that are laden with a high prevalence of poverty (70% in Nigeria). This development is not the best practice in the care of Orphans and vulnerable children (OVC) based on national policy of OVC care which recommends Household rather than institutional care. Since studies have shown that Institutional care has a negative impact on a child, the place of placement is thus crucial to the outcome of vulnerable children (VC) which can easily be assessed by measuring the Quality of life (QOL).

The aim of this study is to compare the QOL of VC living in Household against those living in Institutions.

Methods: A cross-sectional comparative study involving 202 VC (aged 6-18 years) was conducted. VC were sampled using the multistage sampling technique across two orphanages and three communities located in suburban areas in Jos East, Jos North and Jos South Local Government Area.

Outcome Measure: Quality of Life was determined using the WHOQOL BY (brief for youth) tool after validity and reliability test was done. The total score was transformed into a score of 1-100, with higher score implying higher QOL. Data generated were processed and analyzed using the EPI info version 3.5.1 statistical software. A score < -1 standard deviation (SD) from mean was considered poor, ±1 SD to -1 SD was considered fair and > ±1 SD was considered good. The student t-test was used for comparison of means while chi-square test or fisher exact test was used for comparison of categorical variables. In all statistical tests a p values ≤ 0.05 was considered significant.

Results: The QOL score for the study population ranged between 47.2 to 95.2, the mean QOL was 75.2±8.1. The median and mode were both equal (QOL score of 75.2). Comparatively, IVC had higher mean QOL score of 76.9±7.0 compared to HVC 73.3±8.9 (p=0.002). IVC had higher scores compared to HVC in the following domain: psychological (p=0.05), social (p=0.004) and environmental (p=0.002).

Conclusion: The QOL of VC in Institution is better than children in suburban Households in Jos Nigeria. IVC are better psychosocially and environmentally. However, a Qualitative study is needed for more depth.

Open Access Original Research Article

The Role of Fine Needle Aspiration Cytology in the Diagnostic Evaluation of Palpable Breast Lesions Seen in a Low-resource Hospital Setting

O. O. Odujoko, G. O. Omoniyi-Esan, A. O. Komolafe, D. Sabageh, O. O. Olaofe

Journal of Advances in Medicine and Medical Research, Page 1-7
DOI: 10.9734/BJMMR/2016/26199

Background: Preliminary diagnosis of palpable breast lesions often requires the use of fine needle aspiration cytology (FNAC). The aim of this study was, therefore, to determine the diagnostic utility of this procedure in the evaluation of palpable breast masses seen at our institution.

Methods: FNAC was performed on all patients who presented with palpable breast lesions over the period of one year. These were classified according to the United Kingdom National Health Services Breast Screening Programme (UKNHSBSP) and were compared with the corresponding histopathologic diagnosis in each case. The sensitivity, specificity, positive predictive value as well as negative predictive value were subsequently determined.

Results: A total of 164 cytological reports were obtained from 153 patients during the study period. The patients seen during the study period were between the ages of 15-86 years (Mean 42.3±15.8 SD). The peak age range of presentation of benign lesions was 20-29 years while that for malignant was 40-49 years. Fifty (50.6%) were reported as benign (C2) and 31.7% were reported as malignant (C5). About 7.8% and 8.5% were reported as inadequate (C1) and suspicious for malignancy (C4) respectively. Histopathology was performed on 87 (biopsy rate of 53.0%). There was good correlation between the cytological and histological diagnosis with the sensitivity of FNAC for benign lesions being 97.3% while that for malignant lesions was 100%. The correlation between fine needle aspiration cytology of palpable breast lumps and histological diagnosis was found to be statistically significant.

Conclusion: FNAC of palpable breast lesions has a high predictive value for the histologic diagnosis especially when performed by experienced cytopathologists.

Open Access Original Research Article

Evaluation of Thyroid Hormones Changes and CD4+ T-cell Count during Menstrual Cycle in Pulmonary TB Infected Women in Nnewi, Nigeria

R. Ukibe Nkiruka, N. Ukibe Solomon, C. Onyenekwe Charles, E. Ahaneku Joseph, C. Chukwuanukwu Rebecca, Martin Ifeanyichukwu, N. Monago Ifeoma, A. Ilika Linus

Journal of Advances in Medicine and Medical Research, Page 1-8
DOI: 10.9734/BJMMR/2016/27086

Background: Tuberculosis remains a disease of major public health importance worldwide including Nigeria. Endocrine abnormalities have been reported among Tuberculosis patients with the thyroid inclusive.

Aims of Study: The present study was designed to evaluate the thyroid hormones changes and CD4+ T-cell count during menstrual cycle in women infected with Pulmonary Tuberculosis in Nnamdi Azikiwe University Teaching Hospital, Nnewi, south east Nigeria.

Materials and Methods: The study comprised 90 premenopausal females aged 15-45 years randomly recruited at Direct Observed Therapy (DOT) Clinic at NAUTH, Nnewi from 2013-2014. 30 participants were Symptomatic TB infected females who were not yet on drugs at the time of sample collection while 30 were Symptomatic TB infected females on Anti tuberculosis therapy. The remaining 30 were apparently healthy hospital staff with regular menstrual cycle. After due consent, a detailed medical history was obtained and routine investigations of pulmonary tuberculosis and confirmation using Ziehl Neelsen and sputum culture techniques for AFB and chest x-ray were done.  Blood samples were collected at follicular and luteal phases of their menstrual cycle for analysis of Thyroid hormones (T3, T4 and TSH) using Enzyme Linked Immunosorbent Assay (ELISA) method. CD4 T-cell counts was determined using cyflow SL Green Cytometer.

Results: Result showed significantly lower T3 and CD4 T-cells with normal TSH values in Symptomatic TB compared with control females at both phases of menstrual cycle (P=.05 respectively). TSH value was significantly lowered in Symptomatic TB than Symptomatic TB on ATT while T3 and CD4 T-cell count were significantly higher in Symptomatic TB on ATT compared to Symptomatic TB at both phases of menstrual cycle (P=.05).

Conclusion: Euthyroid sick syndrome was observed among Symptomatic TB females which showed some level of improvements with administration of ATT. A new national strategic plan for TB control is advocated to include routine thyroid function check with special attention paid to the reproductive function.

Open Access Original Research Article

Birth Defects and Parental Consanguinity in the North of Iran

Nafiseh Kaviany, Maliheh Sedehi, Elaheh Golalipour, Mohammad Aryaie, Mohammad Jafar Golalipour

Journal of Advances in Medicine and Medical Research, Page 1-7
DOI: 10.9734/BJMMR/2016/26374

Aim: Consanguineous marriages are considered as a risk factor of some congenital anomalies. This study was done to determine the relationship between birth defects and consanguineous marriage in northern Iran.

Methodology and Study Design: This hospital based study with consecutive sampling was performed on 1545 live newborns with birth defects in Golestan province, northern Iran during 2007–2012. Consanguinity of parents of each newborn was recorded.

Results: From 1545 malformed newborn who born during the study period, 480(31.06%) of newborns were born to consanguineous parents. 395(82.3%) of parents were first cousins followed by second cousins 85(17.7%). The number of 557 congenital malformations was detected in 480 malformed newborns were born from consanguineous parents. The percent of congenital anomalies in newborns were born from consanguineous vs. non-consanguineous parents were as following; heart anomalies (45.2% vs. 51.2%), followed by anomalies of central nervous system (17.5% vs. 15.5%), limb anomalies (22.9% vs. 14.8%), urogenital anomalies (7.1% vs. 5%) and gastrointestinal anomalies (23.3% vs. 18.4%). There was a significant association between the percentage of heart, limb and gastrointestinal anomalies with Consanguinity of parents (P<0.05).

Conclusion: This study showed that the congenital anomalies was significantly related with consanguineous marriages in north of Iran.

Open Access Original Research Article

Identifying Modifiable Socio-demographic Risk Factors for Severe Hyperbilirubinaemia in Late Preterm and Term Babies in Abuja, Nigeria

L. I. Audu, A. B. Mairami, A. T. Otuneye, R. Mohammed-Nafi’u, L. J. Mshelia, V. E. Nwatah, Y. Wey

Journal of Advances in Medicine and Medical Research, Page 1-11
DOI: 10.9734/BJMMR/2016/26551

Background: Severe neonatal hyperbilirubinaemia remains an important cause of neonatal admissions in Nigeria, often giving rise to irreversible neurotoxicity. Access to effective phototherapy is restricted to a few centers while salvage therapy with exchange blood transfusion may occur too late to reverse acute bilirubin encephalopathy (ABE).

Aim: We set out to identify modifiable socio-demographic risk factors for severe neonatal jaundice in babies of ≥34 week gestation at the National Hospital Abuja.

Methodology: Late preterm and term babies admitted into Special Care Baby Unit (SCBU) with jaundice from April 2014 to May 2015 were consecutively recruited into the study with parental consent. Socio-demographic information, history of common risk factors for neonatal jaundice and results of laboratory investigations were obtained for statistical analysis. Jaundice was classified as severe (≥ 20 mg/dl) or non-severe (10-19 mgdl). Bivariate and multiple logistic regressions were carried out to determine the significance of associations between risk factors and severity of jaundice.

Results: A total of 123 babies were seen with an Inborn/Out born ratio of 1:2.3. Eighty two percent were term. Severe Jaundice accounted for 43(35%). The mean TSB for babies with severe jaundice was 29.1(9.6) mg/dl while that of controls was 16.9(5.9) mg/dl, (p=0.000). There was no significant difference in the distribution of primary risk factors (ABO/Rh incompatibility, sepsis, G6PD deficiency and concealed haemorrhage) among severe and non-severe groups. Among investigated secondary risk factors, late presentation (P=0.043), being out born (OR=0.164 95% CF=0.054-0.504), vaginal delivery (p=0.012), prematurity (OR=2.233 95% CF=1.051-4.740) and maternal education (p=0.017) were significantly associated with severe jaundice. Over 98% of the mothers had antenatal care while 91% delivered in hospitals/clinics. Thirty two (26%) had signs of acute bilirubin encephalopathy and exchange blood transfusion was done in 50 (40.7%) babies.

Recommendation: There is a need to refocus preventive strategies on modifiable risk factors, increasing awareness about the consequences of neonatal jaundice and the essence of early identification as well as prompt hospital presentation.

Open Access Original Research Article

Ease of Intubation with the McGRATH® MAC, C-MAC® or Macintosh Laryngoscopes by Novice Operators in Simulated Difficult Airways – A Manikin Study

L. Q. Liew, W. W. Teo, B. H. Tan, S. M. Leong, A. Y. Tan

Journal of Advances in Medicine and Medical Research, Page 1-6
DOI: 10.9734/BJMMR/2016/27180

A variety of video laryngoscopes have been introduced to facilitate endotracheal intubations as failed intubations can result in morbidity and mortality. We aimed to compare the use of the conventional Macintosh laryngoscope, McGRATH® MAC and C- MAC® video laryngoscopes among novice operators. 37 medical students were recruited to perform oro-tracheal intubations in a human patient stimulator with simulated ‘difficult airway’ scenario using 3 devices: The Macintosh laryngoscope, McGRATH® MAC and C- MAC® video laryngoscopes.
The success rate of tracheal intubation using the C-MAC® video laryngoscope (84%) was higher than both the McGRATH® MAC (59%) and the Macintosh laryngoscope (57%) (p=0.005). The use of video laryngoscopes were associated with lower incidence of oesophageal intubation (p<0.001) and deemed easier to use (p<0.001). Overall, the C-MAC® yielded a higher rate of successful tracheal intubation, a shorter time to glottic visualisation and was deemed to provide the greatest ease of intubation with novice practitioners.

Open Access Original Research Article

Traditional Medicine and Modern Medicine: Knowledge, Attitude and Practice of Medical Students and Their Mothers in Tabuk City, Saudi Arabia

Ebtihaj Al-Arabi Al-Ghamdi, Naseem Akhtar Qureshi, Lidija Krekman, Ali Magboul Al-Arabi Al-Ghamdi, Abdullah Mohammed Al-Bedah

Journal of Advances in Medicine and Medical Research, Page 1-12
DOI: 10.9734/BJMMR/2016/26915

Background: Traditional remedies are mostly used as auto-medications for the treatment of physical diseases not only in Saudi Arabia but also worldwide. The traditional preparations are also prescribed by practitioners to patients who seek their consultation.

Objective: The objective of this descriptive, cross-sectional study was to assess knowledge, attitude and practice (KAP) of medical students and their mothers towards traditional medicine (TM) and modern medicine (MM) in Tabuk city.

Methods: A cross-sectional survey of purposefully selected University Preparatory Program (UPP) students (n=147) for health specialties and their mothers (n=61) was conducted to examine their KAP of TM and MM at the University of Tabuk and mothers' homes. A self-designed, self-administered questionnaire with 10-item to be answered mostly by "yes" or "no" was used in this research.

Results: There were no significant differences in knowledge between students and their mothers concerning TM safety, efficacy, rapid cure, cost, and use in various mild diseases and cosmetic conditions. However, mothers' practice of TM differed significantly in regards to self-use of herbal medicines for skin diseases. Mother's attitude that TM is a primitive mode of treatment significantly differed from the views of medical students.

Conclusion: The preliminary findings of this survey suggest that the participants differentially preferred the use of both TM and MM in the treatment of various physical conditions as well as for cosmetic purposes. Further research is needed to comparatively explore medical student and mother KAP of TM and MM in Saudi Arabia.

Open Access Original Research Article

A Study of Cardiac Autonomic Neuropathy and Its Correlation with QTc Dispersion in Type-2 Diabetes Mellitus

M. Mahesh, M. A. Sandeep, P. K. Kiran, M. Madhumitha

Journal of Advances in Medicine and Medical Research, Page 1-6
DOI: 10.9734/BJMMR/2016/27201

Aims: To evaluate the presence of cardiac autonomic neuropathy in Type-2 Diabetes and to correlate autonomic dysfunction with QTc dispersion.

Study Design: This was a hospital based cross-sectional study carried out in the department of Medicine JSS Hospital Mysore, India between March 2012 and March 2013.

Methodology: We included 50 Diabetes patients (Cases) and 50 Non Diabetes healthy adults (Controls) of both genders. Five standard cardiovascular response tests were carried out (Valsalva ratio, expiration-inspiration ratio, immediate heart rate response to standing, fall of systolic blood pressure on standing and sustained hand grip test) to determine the severity of cardiac autonomic neuropathy. QTc dispersion was determined by subtracting heart rate-corrected minimum QTc interval (QTc min) from maximum QT interval (QTc max) from standard electrocardiogram.

Results: 17 patients (34%) had evidence of cardiac autonomic neuropathy. Of this 8 (16%) had borderline and 9(18%) had abnormal CAN. In the control group only 1(2%) had CAN. (P value of 0.000) Mean QTc in cases was 41.60+/-18.11) and in controls was 20.80(+/-4.88) QTc dispersion was 32.7(+/-13.0) in those without CAN and 48.75(+/-9.71) in borderline CAN and 67.77(+/-9.71_in abnormal CAN group. (P =0.000).

Conclusion: Prolonged QTc a feature of autonomic dysfunction due to diabetes. QTc dispersion correlates significantly with presence of cardiac autonomic neuropathy and may be a simple and useful measure for detection of cardiac autonomic neuropathy.