Open Access Case Study

Increasing Role of Magnetic Resonance in Diagnosis and Prognosis of Arrhythmogenic Right Ventricle Dysplasia/Cardiomyopathy

Sílvia Aguiar Rosa, Susana Castela, Pedro Matos, Manuel Nogueira da Silva, Nuno Jalles Tavares

Journal of Advances in Medicine and Medical Research, Page 1-8
DOI: 10.9734/BJMMR/2016/28394

A 33-year-old woman with previous diagnosis of asymptomatic frequent premature ventricular complexes (PVC), without documented structural disease in echocardiography. She presented recently with palpitations and dizziness. Another echocardiogram was performed suggesting for the first time right ventricle (RV) dilation and possible hypokinesia of RV apex. Electrocardiogram showed T-wave inversion in V1-V2 and Epsilon wave in V1. Holter documented 2869 polymorphic isolated PVC. Cardiovascular magnetic resonance (CMR) showed moderate RV dilation (end-diastolic volume of 125 ml/m2), RV systolic dysfunction (RV ejection fraction 33%) with RV free wall hypokinesia, a focal area of dyskinesia (“buldging”) in RV outflow tract and trabecular disarray. There was no evidence of intra-myocardial fat. Positive Late gadolinium enhancement was evident in RV free wall and RV outflow tract.

Genetic test showed heterozygous desmoglein-2 (DSG2) mutation.

The patient fulfilled criteria for Arrhythmogenic Right Ventricular Dysplasia / Cardiomyopathy (ARVD/C).

Diagnosis of ARVD/C can be challenging, requiring closer follow up and evaluation of multiple parameters. CMR is the imaging method of choice for diagnostic, structural evaluation and risk stratification.

Open Access Case Study

Urinary Bladder a Storeroom: Electric Wire This Time – A Case Report

Rahul Jain, Vidhya Gunasekaran, Dharmender Aggarwal, Sushanto Neogi, Ruchi Jain

Journal of Advances in Medicine and Medical Research, Page 1-4
DOI: 10.9734/BJMMR/2016/29640

Aim: Foreign bodies of lower urinary tract are not uncommon, caused by accidental events, deliberate insertion for auto eroticism or migration from adjacent organs, [1] which is one of the causes of urological emergency. Removal may be as simple as just pulling the foreign body manually or endoscopically to surgical procedures as in this case.

Presentation of Case: We present a young male with an electric wire in the urinary bladder inserted via urethral orifice. Failed attempt of cystoscopic removal lead to open surgery. 

Discussion: Foreign body in the lower urinary tract is most often self inflicted but can be accident or migration from adjacent organs or iatrogenic occurrence. Most of the cases have been associated with self-exploration and for sexual pleasure, the urge to derive some pleasurable sensation is driven by a psychological predisposition for sexual gratification. Or it can be an impulsive behaviour, self punishing in nature and may progress to suicidal tendency.

Conclusion: Patients with chronic lower urinary tract infections should be suspected for Urinary tract foreign bodies, which could be removed by the least invasive methods based on the location, nature and number of foreign body. Open surgical interventions are reserved for those in whom endoscopic therapy has failed or unsuitable.

Open Access Original Research Article

A Study of High Sensitivity C - reactive Protein in Cerebrovascular Accident

C. Jayabhaskar, M. Ramadevi, N. Sreelalitha

Journal of Advances in Medicine and Medical Research, Page 1-6
DOI: 10.9734/BJMMR/2016/27012

Background: Inflammation plays an important role in the pathogenesis of stroke. C-reactive protein (CRP) is the most reliable marker of inflammation. Cerebrovascular accident is the second most common cause of death in the world causing about 5 million deaths in a year. High sensitivity CRP (hsCRP) refers to lower detection limits of assay procedure being used (1 mg/L). High levels of hsCRP in stroke indicates poor prognosis.

Objectives: The objectives of the study are to observe the levels of hsCRP in cerebrovascular accident, the role of hsCRP in differentiating ischemic and hemorrhagic stroke, the relation between the levels of hsCRP and the size of the lesion and the outcome of patients with stroke in relation to hsCRP.

Methodology: Fifty patients with first episode of stroke as evidenced by CT scan, presenting to the Department of General Medicine, SVRRGG Hospital, Tirupati from August 2013 to August 2014 are studied and the levels of hsCRP are measured and analyzed.

Results: In the study, majority of the patients (58%) are in the age group of 56-70 years with a male preponderance. Hypertension (62%) is the commonest risk factor observed followed by smoking (40%) and diabetes (36%). Most of the study population (96%) has raised hsCRP levels. Mean hsCRP (in mg/L) is high in patients with large (>3 cm) infarcts (53.51±18.13) compared to those with small (<3 cm) infarcts (8.71±6.27). In hemorrhagic stroke, mean hsCRP is high in patients with large (32.11±28.11) bleeds than those with small bleeds (12.90±11.14). In both ischemic and hemorrhagic stroke non survivors have hsCRP levels higher than survivors and the levels correlate with GCS score.

Conclusion: hsCRP is raised in both ischemic and hemorrhagic stroke. The rise in hsCRP is less in small lesions compared to that of large lesions and the levels are high in diseased than in survivor group.

Open Access Original Research Article

Effect on Mechanical Properties of Orthodontic Elastomeric Ligatures on Immersion in Disinfecting Solutions - an in vitro Study

Manvi Singh

Journal of Advances in Medicine and Medical Research, Page 1-9
DOI: 10.9734/BJMMR/2016/28630

Background and Objectives: Cold water disinfection can damage the elastomeric material, cross contamination in handling elastomeric ligatures is a serious concern in the orthodontic office. In addition, elastomeric strips with enough ligatures for both arches of a single patient are produced by most manufacturers. Thus, cross -contamination can occur in remaining ligatures if an entire strip is not used at once.

In this investigation effect on tensile strength on short to medium exposure of elastomeric ligatures to disinfection solution and in turn its effect on force delivery is studied.

Aims and Objectives: Effect of extended exposure to disinfection solutions on tensile load at failure of different orthodontic elastomeric ligatures is assessed.

Materials and Methods: Orthodontic elastomeric ligatures were obtained from 5 manufacturers;

3M Unitek, Ormco, Ortho organizer, GAC, T P Orthodontics.

3 Disinfectant solutions used were

Glutarex-3M Unitek, Cidex-Johnson and Johnson and Cidex OPA- Johnson and Johnson.

From each manufacturer, ten orthodontic elastomeric ligatures will be exposed to each disinfectant solution with exposure times of 30 minutes, 1 hour, 12 hour and 24 hours. Ten unexposed elastomeric ligatures from each manufacturer will also be tested which will act as control group.

Ligatures were stretched in custom made jig of a universal testing machine (INSTRON) until they fractured to determine the tensile load failure. Maximum tensile load were recorded. The tensile load at failure was used as an analog to the clinical situation of the ligature breakage during tie-in.

Results and Conclusions: Three-way ANOVA showed significant differences (P < .0001) not only within manufacturer and time of exposure but also between disinfectants (P < .001). Significant interactions (P < .0001) were observed between manufacturer and time and between disinfectant and time. Greater significant changes were seen in tensile load at failure for all 5 manufactures ligatures in Cidex solution whereas changes were less significant in Glutarex and Cidex OPA solution. The ligatures from all companies showed significantly different failure loads from each other, with the ligatures from 3M exhibiting the greatest tensile load at failure and those from Ortho Organizer, the least.

Elastomeric Ligatures Tensile Load at Failure Followed the Pattern: 3M Unitek _ GAC _ Ormco _ T P Orthodontics _ Ortho organizer. Tensile load to failure of elastomeric ligatures, compared to unexposed specimens changed when exposed to disinfectant solution for as little as 30 minutes.

Open Access Original Research Article

Histological and Aminotransferase Implications of Administration of Extracts of Acalypha wilkesiana Leaves in Normal Rabbits

Omage Kingsley, Azeke A. Marshall, Orhue N. E. Jerry, Iseghohi O. Sylvia

Journal of Advances in Medicine and Medical Research, Page 1-7
DOI: 10.9734/BJMMR/2016/28142

Background and Aim: Traditionally, Acalypha wilkesiana leaves are used in the management of hypertension, diarrhoea and dysentery. Thus, this study was carried out to evaluate the effects of oral administration of extracts of Acalypha wilkesiana leaves on serum aminotransferases activities and tissues of normal experimental rabbits.

Methods and Design: Eighteen adult rabbits of the New Zealand strain, were randomized into three groups (groups A, B and C) of six rabbits each and treated as follows; Group A (Treated with Aqueous Extract), Group B (Treated with Ethanol Extract), Group C (Non treated-Control), and used for the study.

Statistical Analysis: Data are represented as Mean ± S.E.M (n = 6). Significance of difference was tested by ANOVA at P < 0.05.

Results and Conclusion: Administration of the extracts of Acalypha wilkesiana leaves at a dose of 300 mg/kg body weight to normal experimental rabbits resulted in significantly lower levels of serum ALT and AST activities. Histological studies revealed that administration of the aqueous extract of Acalypha wilkesiana leaves to normal rabbits resulted in moderate congestion of blood vessels in the heart, mild lymphocytosis of the glomerular of the kidney, and no effect on the liver. While administration of the ethanol extract resulted in moderate congestion in blood vessels of the heart, moderate congestion of the central portal vein of the liver, and marked lymphocytosis in the kidney.

Open Access Original Research Article

A Simple Method to Forecast Future Bed Requirements: A Pragmatic Alternative to Queuing Theory

Neeraj Beeknoo, Rodney P. Jones

Journal of Advances in Medicine and Medical Research, Page 1-20
DOI: 10.9734/BJMMR/2016/29518

Aims: To review the current state of hospital bed planning, and to develop a simple tool to estimate short-term future bed requirements using historical bed occupancy data.

Study Design: Analysis of daily bed occupancy between January 2008 and October 2015. Synthesis of trends into a method for forecasting bed numbers for each day of the year.

Place and Duration of Study: Daily occupied bed statistics for King’s College University Hospital, a large London Teaching Hospital having 1,600 beds.

Methodology: An eight-year time-series of daily midnight bed occupancy covering elective, emergency and transfer admissions has been used to estimate the number of beds required to deliver a delay-free hospital.

Results: In this large 1,600 bed hospital it is estimated that 100 extra beds (a 6.3% increase) are required to deliver delay free admissions, i.e. no delays to admission from the emergency department or delays due to cancelled elective operations.

Conclusion: The analysis reveals that far higher flexibility is required in staffing levels than is currently available. Potential strategies are discussed to address this issue.

Open Access Original Research Article

Comparing Subcuticular Sutures versus Percutaneous Staples for Skin Closure after Caesarean Delivery: A Randomized Controlled Study

L. C. Ikeako, E. I. Iloghalu, C. C. Dim, A. C. Adiuku-Brown, H. U. Ezegwui, C. K. Oranusi

Journal of Advances in Medicine and Medical Research, Page 1-9
DOI: 10.9734/BJMMR/2016/29450

Background: Wound complications following caesarean delivery are significant causes of morbidity and financial strain especially in low resource countries. Use of appropriate technique in skin closure could reduce the emotional burden of an already difficult period of adjustment.

Objective: To compare the outcome of surgical metallic staples versus absorbable subcuticular suture for skin closure at caesarean delivery.

Methods: This was a randomised interventional study of pregnant woman booked for caesarean delivery in two hospitals in Enugu, south east Nigeria. Data was analysed using SPSS computer software version 20.0 for windows (Chicago IL, USA). Proportions were compared using Pearson’s Chi Square or Fisher’s test as appropriate. P value of ≤0.05 was considered statistically significant.

Results: Two hundred and twenty women booked for elective and emergency caesarean section were randomised into surgical metallic staples and absorbable subcuticular sutures groups. Outcome in the staples and sutures groups are; composite wound complications, (11.9%) vs (3.8%) p=0.041, mean operation time (minutes), (50.7±6.88) vs (69.5±5.71) p<0.001, mean post operation pain, (1.8±1.18) vs (1.1±0.99) p<0.001 and maternal satisfaction (8.05±0.54) vs (9.5±0.75) p=0.011.

Conclusion: Women in Enugu, Nigeria are more satisfied with subcuticular absorbable suture for skin closure following caesarean delivery.

Open Access Original Research Article

Correlation of Platelet Distribution Width [PDW], Mean Platelet Volume [MPV] and Red Cell Distribution Width [RDW] with Serum Blood Sugar Levels: A Case- control Study in the West Luck Now Population

Neema Tiwari, Seema Singh, Ritu Karoli, Sunita Tiwari, Faraz Ahmad, Harshit Jain, Nitin Ranjan Gupta, Arvind Kumar

Journal of Advances in Medicine and Medical Research, Page 1-9
DOI: 10.9734/BJMMR/2016/29448

Background: Diabetes itself is known to have long standing complications of both micro-vascular as well as macro vascular type. One of the life threatening complications that diabetes gives rise to is stroke and Ischemic heart disease Altered thrombocyte morphology and function have been reported in patients with diabetes mellitus. Few researches have been conducted on complete blood count parameters like Platelet-Crit [Pct], Platelet distribution width [PDW], Mean Platelet Volume [MPV] and Red Cell Distribution width [RDW-SD, CV].

Aim: The aim of the present study was to determine the associations between platelet morphology markers like PDW, MPV and RDW with Fasting glucose (FBG), Post- prandial blood glucose [PPBG] and Random blood sugar[RBS] in long standing diabetics.

Materials and Methods: Analyses were performed in 2 groups, one for cases and another for controls. A total of 240 patients, with 150 cases and 90 controls were analyzed over a period of 6 months. The data was collected from the hospital registry. Patient’s blood had been collected in Fluoride vials for sugar estimation [FBG, RBS, PPBS] and CBC for platelet parameters and RDW of the same patients was done. The identity of the patient was not disclosed and ethical approval was taken.

Results: No significant correlation could be achieved between the tested parameters and the increased blood sugar level [p-value>0.05]. RDW-SD was seen to be an important diagnostic tool for interpretation if the sample size would have been adequate [ROC curve analysis]. Also in blood sugar level estimation, FBS, PPBS &RBS were found to be significantly increased.

Conclusion: The FBS, RBS, PPBS were seen to be significantly increased in the case group as compared to the control group. There was no significant correlation seen between the platelet parameters, the RDW and Blood sugar parameters [p-value>0.05] .RDW was seen to be a good tool for investigation when ROC cure for RDW-SD was analyzed.

Open Access Original Research Article

Risk Factors Associated with Hypertension among Adults in the Hohoe Municipality, Ghana

Sedoafia Amelor, Margaret Kweku, Eric Agboli, Isaac Agbemafle, Wisdom Takramah, Elvis Tarkang, Wisdom Kudzo Axame, Prince Kubi Appiah, Fred Newton Binka

Journal of Advances in Medicine and Medical Research, Page 1-12
DOI: 10.9734/BJMMR/2016/29463

Background: Hypertension (HPT) is a major cause of morbidity and mortality worldwide and is increasingly becoming an important medical and public health issue. Identification of major risk factors, their prevention and control form the basis of the prevention of the disease. We set out to determine risk factors associated with HPT among adults in the Hohoe Municipality, Ghana.

Methods: A matched case control study was conducted in February 2016 using 65 cases of HPT recruited from the municipal hospital HPT clinic and 130 controls from communities of the cases to trace various exposures to hypertension. Information on the background characteristics, family history and lifestyle practices were collected using the WHO STEPWISE questionnaire. Blood pressure (ABP) and glucose levels were measured using a digital sphygmomanometer (Omron M3, HEM-7131-E) and glucometer (ONETOUCH UltraEasy). Weight, height, waist and hip circumference were measured with a digital weighing scale, Stadiometer and an inextensible tape measure respectively. Chi-square test and Odds Ratios were used to determine the relationships and associations between the dependent and independent variables at the 0.05 level.

Results: About 84% of the respondents were females, majority (72.3%) were between the ages of 45-74 years, 61% were married, 37.9% had no formal education and most (43.6%) were traders. There was no significant difference in background characteristics between the cases and controls. The odds of those with Diabetes developing HPT is 3.80 times higher compared to those without Diabetes [OR=3.80 (95% CI: 1.07-3.45); p=0.039]. The odds of developing HPT among those with Family history of HPT/Diabetes was 5 times more compared to those with no family history of HPT/Diabetes [OR=5.45 (95% CI: 0.28-1.02; p<0.001]. The odds of current consumers of alcohol developing HPT was 2 times higher compared to those who never consumed alcohol [OR=2.24 (95% CI: 0.99-5.06; p=0.052]. Palm oil consumption was 4.9 times higher among those with hypertension compared to vegetable oil [OR=4.90 (95% CI: 2.58-9.0; p<0.001], and those with hypertension were 1.5 times more likely to consume low salt, 2 times more likely to consume fruits 2 to 3 days a week and 3 times more likely to consume vegetables 2 to 3 days a week.

Conclusion: Alcohol consumption, diabetes and family history of hypertension were risk factors associated with hypertension. Those with hypertension were more likely to consume palm oil, take in less salt, eat more fruits and vegetables as a control measure based on dietary counselling at the hypertension clinic. Dietary counselling should not only be used as a tool for controlling hypertension but be extended to the general population as a preventive measure.

Open Access Original Research Article

Association of Serum Soluble Endoglin Levels with Adverse Foetomaternal Outcome in Preeclampsia and Eclampsia

Rekha Sachan, Munna Lal Patel, Pratima Verma, Soniya Dheeman, Pooja Gupta

Journal of Advances in Medicine and Medical Research, Page 1-9
DOI: 10.9734/BJMMR/2016/28862

Background: Serum Endoglin has also previously shown to be elevated in woman with established preeclampsia especially in those presenting with preterm labour and foetal growth retardation.

Objectives: To evaluate association of serum soluble Endoglin with adverse foeto-maternal outcome in woman with hypertensive disorders of pregnancy.

Materials and Methods: A prospective case control study carried out from 2013 to 2014 at department of Obstetrics and Gynaecology. Ethical clearance was obtained from institutional ethics committee No.ECR/262/Inst/UP/2013 from King Georges Medical University, Lucknow. After informed consent, total 90 pregnant women from gestational age 20-40 weeks were enrolled after randomization. 30 women of preeclampsia and 30 of antepartum eclampsia served as cases where as 30 normotensive pregnant women served as controls. Preeclampsia was defined as per NHBPEP2000 working group. Estimation of serum soluble Endoglin level was done by Enzyme linked immunosorbent assay using ELISA kit.

Results: Serum Endoglin levels were found higher in preeclampsia and eclampsia group (p<0.001) in comparison to controls. The women who had complication in terms of postpartum haemorrhage, cerebrovascular accident during the study had maternal serum Endoglin levels 12.48 ng/ml, and 16.08 ng/ml, respectively in preeclampsia group and 15.88 ng/ml, 16.76 ng/ml respectively in eclampsia group. 4 women expired, all were from eclampsia group mean serum Endoglin level of these women was 14.18±2.4. Serum Endoglin levels increased with low birth weight in preeclampsia and eclampsia. 12 neonates in preeclampsia and 17 neonates in eclampsia, required admission to NICU, in whom the maternal serum Endoglin level was 14.67±1.77, 15.68±1.48 respectively, which was higher than those neonates who did not required admission & difference was statistically significant (p<0.001). Neonates who died had high maternal S. Endoglin level (15.77±0.44 and 16.23±1.30) as compared to alive foetuses (12.35±2.49, 14.30±1.86 respectively).

Conclusion: Serum soluble Endoglin level might predict adverse foetomaternal outcome, but larger studies should be carried out to confirm this association.