Open Access Short Research Article

The Incidence of Hypersplenism in Decompensated Liver Cirrhosis of Alcoholic Etiology

Goran Bokan, Zoran Mavija

Journal of Advances in Medicine and Medical Research, Page 1-4
DOI: 10.9734/BJMMR/2016/27460

Introduction: Liver cirrhosis is a terminal, morpho-functional entity of hepatic dysfunction, which is characterized by the replacement of the hepatic lobule connective tissue nodules. Splenomegaly is a common finding in patients with liver cirrhosis and portal hypertension can cause hypersplenism. Hypersplenism is the leading cause of thrombocytopenia.

Objective: The aim of this study was to investigate the association between platelet count and spleen size in patients with decompensated liver cirrhosis.

Materials and Methods: Retrospective study included 50 male patients with liver cirrhosis, alcoholic etiology, hospitalized in the University Clinical Center of Republic of Srpska, at the Department of Gastroenterology and hepatology. The degree of liver function we determined by using Child-Pugh score. Craniocaudal diameter of the spleen was determined by ultrasound, a criterion for splenomegaly has a diameter greater than 11 cm. Presence of thrombocytopenia is platelet count below 150,000 / ml.

Results: The average age of patients was 62 years. Splenomegaly was present in 62% of patients. The mean diameter of the spleen was 14.6 cm. The mean platelet count was 87,500 / ml. In this study, no significant correlation was observed between spleen size and platelet count (p = 0.587).

Conclusion: In this study, liver cirrhosis and thrombocytopenia may be present even in the absence of enlarged spleen, indicating the possible presence of other mechanisms that reduce the number of platelets.

Open Access Original Research Article

Positive Correlation of Thyroid Gland Volume with Isthmus Dimensions and with Anthropometric Parameters through a Cross Sectional Study on Karachi Population

Mahrukh Kamran, Iffat Raza, Sahrish Mukhtair, Sanabor Bughio, Hira Waseem

Journal of Advances in Medicine and Medical Research, Page 1-8
DOI: 10.9734/BJMMR/2016/29710

Objective:  Diverse variation in normal thyroid gland volume (TGV) among populations is mainly due to age, gender, anthropometric parameters and genetic factors. This study was carried out to determine the correlation between TGV with isthmus dimensions and with anthropometric parameters in a subset of Karachi population.

Place of the Study: It was a cross-sectional study.

Place and Duration of Study: Department of Radiology Ziauddin University Hospital Clifton Karachi, between April 2013 to March 2014.

Methodology: TGV of 208 euthyroid subjects was evaluated by 2 dimensional ultrasonography. Serum TSH was the screening test used to recruit euthyroid subjects for the study. Non parametric tests were applied to determine the correlation of TGV with anthropometric parameters and with isthmus dimensions.

Results: TGV was significantly and positively correlated with, height, weight, body surface area (BSA) and lean body mass (LBM) but not with body mass index (BMI). Similarly, significant and positive correlation was observed between TGV and Isthmus transverse dimension but not with isthmus antero-posterior (A-P dimension.

Conclusion: Among all the studied anthropometric parameters diverse variation in TGV are mainly due to variation in height, weight, BSA and LBM. LBM was found to be the most crucial determinant influencing TGV in this studied population. TGV has also correlated significantly and positively with isthmus transverse dimension.

Open Access Original Research Article

Influence of Culturally-based Abdominal Massage and Antenatal Care Uptake among Pregnant Women in a Tertiary Hospital in Southern Nigeria

Ekine Atombosoba Adokiye, Adhuze Judit Isioma, West Obaabo Levi

Journal of Advances in Medicine and Medical Research, Page 1-9
DOI: 10.9734/BJMMR/2016/27109

Background: Abdominal massage in pregnancy has been reported for thousands of years in many societies and cultures all over the globe. They have been mostly culturally based and benefits to the pregnant women have been claimed, however this is a subject for scientific evaluation.

Objectives: The purpose of this study is to evaluate the incidence and influence of abdominal massage among pregnant women, despite the accessibility of antenatal care.

Methods: This is a cross-sectional study using a structured questionnaire administered on pregnant women attending antenatal clinic at the Niger Delta University Teaching Hospital, Okolobiri, Bayelsa State.

Results: A total of 150 pregnant women were interviewed at booking. The mean age of the women was 29.9±5.1 years, 34% had tertiary education. The mean gestational age at booking was 28.8±7.4 weeks and the median parity was 2.0000. Among the respondents 78% had abdominal massage in the index pregnancy; 32.5% and 35% weekly and monthly respectively. Abdominal massage was not free, fees were paid. Majority 64.1% had complaints after the massage. Among the respondents 48.7% had abdominal massage by TBAs (traditional birth attendants). Meanwhile, 22.2% had abdominal massage because it was the usual cultural practice of pregnant women, others 18.8% had massages because they sought relief for abdominal pain.

Conclusion: Majority, ¾ of the respondents preferred and had regular abdominal massage in concurrent with antenatal. It’s therefore evident, that abdominal massage has tremendously influenced our expecting women’s attitude towards antenatal uptake; in spite of its associated implications on feto-maternal performance reported in an earlier studies in the Niger Delta Hence adequate education and advocacy is necessary in respect to singular and consistent uptake of modern antenatal care.

Open Access Original Research Article

The Role of Bacterial Translocation in Development of Acute Intestinal Obstruction

Shavkat Karimov, Sayfiddin Baymakov, Asqar Asrarov

Journal of Advances in Medicine and Medical Research, Page 1-8
DOI: 10.9734/BJMMR/2016/28653

Aim: Studying of quantity and quality content of intestinal microflora and abdominal cavity exudate in complex treatment of acute intestinal obstruction with addition of enterosorption.

Materials and Methods: It was investigated the results of treatment of 63 patients with acute intestinal nontumoral obstruction at the age from 16 up to 83 years old. The patients were divided into 2 groups according to the treatment measures: the group without enterosorption and the group with the using of domestic enterosorbent “Zerotox”. The gut microflora and abdominal cavity exudate were investigated.

Results of Investigation: The addition enterosorption to the complex of enteral measures permitted of significant improvement of quality and quantity content of intestinal microflora, as well as early stopped of exudation in abdominal cavity and because of it the frequency of postoperative complications decreased from 20% down to 7,9%, and mortality from 8% down to 2,6%.

Conclusion: The using of enterosorption in complex of enteral measures permits to significant improves the results of treatment of acute intestinal obstruction.

Open Access Original Research Article

Assessment of the Deleterious Effects of Therapeutic Antitussives on Enamel. Mapping the Chemical Profile of Over the Counter Cough Lozenges Using Analytical HPLC

Roshni Sharma, Mamta Kaushik, Ritu Rana, Pallavi Reddy, Neha Mehra, Mona Yadav, Vallari Jain

Journal of Advances in Medicine and Medical Research, Page 1-8
DOI: 10.9734/BJMMR/2016/29168

Aim: 1) To evaluate and compare changes in the micro hardness of enamel after exposure to different cough lozenges.

2) To assess the pH of dissolved lozenge solutions, and

3) To analyze the number of components in cough lozenges using Analytical HPLC (High-performance liquid chromatography).

Study Design and Methods: Experimental Confirmatory Study.

Forty extracted human molars were selected for the study. The teeth were embedded in self-cured acrylic resin except a small rectangular area of 3.0 mm × 2.0 mm on the buccal surface. Micro hardness tests were carried out with a Vickers Diamond Indenter with a 50 gm load for 15 seconds. Based on the lozenges used, the samples were randomly divided into 4 groups (n=10);

Group 1: Control - No treatment

Group 2: Lozenge - A

Group 3: Lozenge - B

Group 4: Lozenge - C

Lozenges were dissolved in 20 ml of artificial saliva for 30 minutes. After complete dissolution, the samples were immersed in lozenges solution for 30 minutes at room temperature, four times a day for one week. After each exposure specimens were washed in deionized water for 20 seconds and immersed in artificial saliva until the next experimental step. At the end of 7 days, again the micro hardness of the enamel surfaces was measured with the Vickers Indenter at the same specifications.

Change in the pH of artificial saliva following dissolution of lozenges was assessed using Microprocessor pH meter.

Components of cough lozenges were separated and analyzed using Analytical HPLC.

Results: Paired t- test and ANOVA were used for statistical analysis. All experimental groups showed a significant decrease in micro hardness of tooth enamel. Analytical HPLC revealed the complex composition of these lozenges.

Conclusion: Increased consumption of cough lozenges reduces the micro hardness of teeth which may lead to erosion, sensitivity and caries susceptibility.

Open Access Original Research Article

Long Term Clinical Course of Hemodynamic Stable Pulmonary Embolism

Babak Tamizifar, Arash Beiki, Elham Raoofi

Journal of Advances in Medicine and Medical Research, Page 1-8
DOI: 10.9734/BJMMR/2016/28236

This study aimed to review the mortality rate of pulmonary embolism (PTE) during one year follow up, incidence of hemorrhagic complications and other causes of death.

This prospective cohort study was conducted on 245 patients with confirmed diagnosis of pulmonary embolism divided in two groups of survived and died in a tertiary center hospital in Isfahan from Jan 2011 to March 2015.

In addition to the use of the patients’ records for evaluating some clinical variables, parameters and radiologic findings, interviews with patients were recorded in a check list. Patients were followed for at least one year after the occurrence of pulmonary embolism if death did not occur. Data were analyzed using SPSS software version 13.

After at least one year follow-up, 145 cases (59.2%) were alive and 100 (40.8%) had died. Age older than 67 years, congestive heart failure, ،malignancy, ،trauma, anemia and the evidence of involvement of the pulmonary artery branches in CT angiography were independently associated to mortality (P<0.05). Also, the most common cause of death was cancer in 35% of the patients, while only in 3% it was PTE.

Open Access Original Research Article

Effect of Age and Gender Variation in Normal Pituitary Gland Height Using Magnetic Resonance Imaging

Abubaker E. Mohieldin, Duha A. Mohamed, Mustafa Z. Mahmoud, Maram A. Fagiri, Ahmed Abukonna

Journal of Advances in Medicine and Medical Research, Page 1-8
DOI: 10.9734/BJMMR/2016/29162

Aims: The aim of this study was to analyze the age and sex related changes in pituitary gland height in a selected population from Sudan, and also to compare findings with those of other authors.

Study Design: This prospective study included 50 participants (25 males and 25 females; ages range between 2-65 years) underwent brain magnetic resonance imaging (MRI) examination.

Place and Duration of Study: This study was conducted in different MRI centers in Khartoum, Sudan between March 2016 and August 2016.

Methodology: In order to measure pituitary gland height, MRI T1 weighted sagittal images were obtained using General Electric (GE) Signa HDe 1.5 T MRI system. The unpaired t-test was used for the statistical significance, P-value ≤ 0.0001 considered significant. Statistical analysis was performed using the standard Statistical Package for the Social Sciences (SPSS Inc., Chicago, IL, USA) version 20 for windows.

Results: The mean value of pituitary gland height in the sample was (5.4±1 mm). Mean pituitary gland height of females (5.65±1.21 mm) was greater than that of males (5.13±0.69 mm). A significant correlation was noted between pituitary gland height in both sexes during age ranges 11-21 years, 22-32 years, 33-43 years, and 44-54 years respectively. A gradual decrease in the height was noted to start in the mid of the fifth decade of life in both sexes.

Conclusion: A reference value of normal pituitary gland height was obtained in Sudanese population. The height of the gland was greater in females. There was a gradual increase in height of the gland with age.

Open Access Original Research Article

Using Social Groups to Locate Areas with High Emergency Department Attendance, Subsequent Inpatient Admission and Need for Critical Care

Neeraj Beeknoo, Rodney P. Jones

Journal of Advances in Medicine and Medical Research, Page 1-23
DOI: 10.9734/BJMMR/2016/29208

Aims: To study the role of social group and deprivation on the proportion of patients admitted via the emergency department who then progress to the critical care unit.

Study Design:  Two large data bases were compared using the output area code of the patient’s home address.

Place and Duration of Study: Patients attending the emergency department (ED) and admitted into the general surgical and medical critical care unit (CCU) at the King’s College University Hospital, London, during a three-year period (2013/14 to 2015/16).

Methodology: The output area of the patient’s home address was used to link ED attendances with CCU admissions. Each output area has an associated social group and deprivation score. Various ratios were calculated such as the proportion admitted in each social group, and a method based on Poisson statistics was used to measure statistical significance. Each output area contains around 300 persons of roughly similar social and demographic characteristics. The Cartesian co-ordinates (distance east and north of the UK reference point as the X- and Y-axis respectively) for each output area have been used to map ED attendances without resort to GIS software.

Results: Output area social grouping, via the London Output Area Classification (LOAC) and deprivation (Index of Multiple Deprivation) are shown to affect the attendance rates at the ED, the proportion admitted from the ED, and conversion rates for patients admitted via the ED into an adult general surgical and medical CCU. The overall conversion rate from an admitted inpatient to the CCU was 6.6%, however, higher than average conversion rates of 14.3% were associated with the ‘Settled Asians’ Super Group, while lower conversion rates of 3.3% were associated the with the ‘Ageing City Fringe’ Super Group and other ‘Affluent Suburbs’ Super Groups. Social group rather than deprivation per se appeared to delineate high and low conversion rates.

Conclusion: Small areas characterised by particular social groups (and relative deprivation) were identified having either high/low rates of attendance at the ED, high/low conversion to an inpatient from an ED attendance, and high/low conversion into CCU admission. This will enable Primary Care Organisations to target admission avoidance and/or appropriate end-of-life care to those social groups yielding the greatest benefit.


Open Access Original Research Article

Tricuspid Atresia: A Rare Cause of Cyanosis among Nigerian Children

Barakat Adeola Animasahun, Akpoembele Deborah Madise-Wobo, Henry Olusegun Gbelee, Fidelia Bode- Thomas

Journal of Advances in Medicine and Medical Research, Page 1-8
DOI: 10.9734/BJMMR/2016/28998

Background and Objective: There is a dearth of literature on tricuspid atresia among African people. The current study aims to document the clinical profile and prevalence of tricuspid atresia amongst children in a tertiary hospital in South Western Nigeria.

Methods: A prospective review of all consecutive cases of tricuspid atresia diagnosed by echocardiography at the Lagos State University Teaching Hospital (LASUTH) between January 2007 and December 2015. The hospital is located in South Western Nigeria. The subjects were all children with an echocardiographic diagnosis of tricuspid atresia made at the study center. Data were analyzed using Statistical Package for Social Sciences (SPSS) version 20. Level of significance set at p< 0.05.

Results: The prevalence of tricuspid atresia in the study population was 4.6 per 100,000 population of children who presented at the study center during the study period. The prevalence of tricuspid atresia amongst the children with congenital heart disease was 1.3% while its prevalence among children with cyanotic congenital heart disease was 4.3%. Male to female ratio of 1.5:1. The most common class of tricuspid atresia found in this study was class 1C. All but one presented with cyanosis. Surgical intervention was not available in the local environment.

Conclusion: Tricuspid atresia is a rare cause of cyanosis among Nigerian Children; the prevalence of tricuspid atresia in the present hospital based study was lower than the population prevalence in developed countries. There was a male predominance and cyanosis was the most common mode of presentation. The most common class and subtype was 1C. In the sub-region, non-operated cases up to 12 years of age are also reported.

Open Access Original Research Article

Effect of Lycopene and Genistein on Hepatic Inflammation and Fibrosis in Thioacetamide Induced Liver Injury in Rats

Bilal Akdemir, Ibrahim Halil Bahcecioglu, Mehmet Tuzcu, Cemal Orhan, Murat Ispiroglu, Ibrahim H. Ozercan, Necip Ilhan, Nese Cabuk Celik, Kazim Sahin

Journal of Advances in Medicine and Medical Research, Page 1-11
DOI: 10.9734/BJMMR/2016/27654

Lycopene, a red crystalline carotenoid, and genistein, a phytoestrogen, have shown considerable promise as effective agents for chronic diseases prevention by reducing oxidative stress. The objective of this experiment was to elucidate the protective effect of lycopene, genistein and their combination against thioacetamide-induced chronic liver injury. Thirty-five rats were randomized into five groups: one untreated group (Control) and four groups treated with the hepatotoxicant thioacetamide (TAA) 200 mg/kg b.w. i.p., for 8 weeks. Concomitantly, the rats received a standard diet (control and TAA), lycopene 6 mg/kg, p.o. (TAA+L), genistein 1 mg/kg, p.o. (TAA+G) or lycopene and genistein (TAA+L+G). After 8 weeks of treatment, the rats were killed and blood and liver samples were collected. TAA administration elevated liver malondialdehyde (MDA), collagen type 1, tumor necrosis factor-α (TNF-α), transforming growth factor β-1 (TGF-β1), nuclear factor kappa B (NF-kB); depleted heme oxygenase-1 (HO-1), nuclear factor-E2-related factor-2 (Nrf2) and glutathione peroxidase (GPx) activity. Lycopene and genistein supplementation reduced liver MDA concentration, fibrosis/inflammation scores (P <0.001), alpha-smooth muscle actin (α-SMA) scores, TGF-β1, TNF-α, NF-kB (P <0.001) and collagen type 1 (P<0.01) levels in TAA-treated rats. Lycopene and genistein intake increased HO-1 (P <0.01), Nrf2 (<0.001) and GPx activity (P<0.05) in the liver of TAA-treated groups. Lycopene combined with genistein significantly reduced fibrosis/inflammation, α-SMA scores (P <0.001), compared to the lycopene treated group. In conclusion, our results demonstrated that lycopene and genistein supplementation  protected the rat liver from TAA-caused fibrogenesis by suppressing hepatic inflammation and inhibiting HSC activation, possibly through downregulation of NF-kB and activation of Nrf2 pathways. Lycopene combined with genistein intake presented greater beneficial effects than lycopene against liver injury induced by TAA in rats.