##### Lymphangioma of Nasopharynx in an Adult: A Rare Case

Kartik Parelkar, Keya Shah, Smita Nagle, Reshma Hanwate

Journal of Advances in Medicine and Medical Research, Page 1-5
DOI: 10.9734/BJMMR/2016/29476

Lymphangiomas are rare benign congenital malformations of the lymphatics, most often encountered during childhood. Generally they are found in the head and neck region, isolated involvement of the nasopharynx is very rare. Our patient had a nasopharyngeal lymphangioma which aggravated his chronic otitis media. The surgical excision of mass was performed by a combined transoral and transnasal endoscopic approach. Histopathological evaluation revealed the diagnosis as lymphangioma. After a follow-up of 1 year the patient is free of recurrence.

##### Proper Medical Prescriptions and Cord Blood Harvesting Improvement at a Children’s Hospital of North Eastern Italy

Sergio Parco, Fulvia Vascotto

Journal of Advances in Medicine and Medical Research, Page 1-9
DOI: 10.9734/BJMMR/2016/29751

A systematic harvesting of hematopoietic progenitor cells for transplant purpose in oncology begun in Friuli Venetia Giulia (FVG), a region of north east Italy, at the end of 2000. The actual economic crisis in Italy and in all Europe slows down number births and the cord blood related collection, because tests’ ticket during pregnancy and medical visits are many expensive; nevertheless some specific medical prescriptions and test during pregnancy are exempt from tickets in public health, but not all doctors and patients know rules and modalities of exemption in obstetric-gynecology. Moreover there are formal errors due to the bad quality of external quality control (EQC) of some tests useful to the validation of the cord blood collection. The aim of this work is to study the impact of formal errors in prescriptions and tests validation at a Children’s Hospital of Trieste (main town of FVG region). To this aim had been performed a monitoring, during 2013-14s, to improve appropriateness of prescriptions related to stem cells collection and to make more suitable and safe transplants and related medical cares.3300 medical prescriptions were monitored for 24 months (from 2013 January to 2015 December), and studied with a χ2 test before and after analysis not in compliance with activities and was introduced a management protocol of improvement: the external quality assessment (EQA) of the tests was performed by Biodev (Milan, Italy). Results. The comparison of prescriptions and external tests during 2014-15s has highlighted a significant decreasing of not appropriate requests, mistakes of prescriptions about obstetric exemptions (p<0.05), with a improvement of cord blood harvesting and a re-entry of EQA in the first or second SD. These data stress the continuous use of the sanitary activities monitoring, with updated protocols and severe controls, as key points to improve cares and to avoid improper costs in public health.

##### The Metabolic Syndrome in Adolescents Age 11-18 Years with Familial History of Early Onset Type 2 Diabetes (T2DM)

Rachael Irving

Journal of Advances in Medicine and Medical Research, Page 1-8
DOI: 10.9734/BJMMR/2016/26276

Background: Some studies have noted an association between family history of diabetes and the Metabolic Syndrome (MS) in childhood.

Aim: To determine the prevalence rate of the metabolic syndrome in adolescents with familial history of early onset (T2DM) and BMI < 95th percentile for age.

Study Design: A cross-sectional analysis.

Place and Duration of Study: Department of Basic Medical Sciences University of the West Indies, Jamaica, 2012.

Methodology: Anthropometric and biochemical measurements were evaluated for 25 adolescents 11-18 years of BMI < 95th for age and family history of early onset T2DM. Thirty two (32) adolescents of similar age and BMI without familial history of diabetes served as controls. Measurements included: Total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol (LDL-C), triglyceride (TG), fasting glucose, glycosylated hemoglobin (HbA1c), insulin, BMI, waist circumference and insulin resistance (HOMA-IR). The prevalence rate of MS was determined in the childhood/adolescence criteria as recommended by the National Cholesterol Education Program Adult Treatment Panel Third (NCEP-ATP III) modified standard.

Results: Sixteen percent (16%), 16% and 20% of adolescents with familial history of early onset T2DM had glucose intolerance, dyslipidemia and abdominal obesity respectively. Twenty percent of these adolescents were insulin resistant and 8% were diagnosed with diabetes mellitus.  Approximately 3.1%, 9.4% and 6.3% of adolescents without familial history of diabetes had dyslipidemia, abdominal obesity and insulin resistance respectively. No adolescent presented with hypertension. The prevalence rate of MS in adolescents with familial history of early onset T2DM and BMI < 95th percentile for age was 19.1%. MS was not present in adolescents without familial history of diabetes.

Conclusion: Adolescents of BMI < 95th percentile and family history of early onset T2DM are more likely to develop MS than adolescents of similar BMI without family history of diabetes.

##### Histomorphological and Biochemical Effects of Ethanolic Extract of Monodora myristica Seed (African Nutmeg) on Some Liver Function Parameters Using Albino Wistar Rats

P. Akpojotor, H. D. Kagbo

Journal of Advances in Medicine and Medical Research, Page 1-9
DOI: 10.9734/BJMMR/2016/27521

Aim: This study was carried out to investigate the effects of Monodora myristica on the physiological status of the liver using albino Wistar rats as a model.

Study Design: This research was conducted at the Department of Human Physiology, Faculty of Basic Medical Sciences, University of Port Harcourt, Nigeria; between May and October, 2014.

Methodology: Thirty six (36) albino Wistar rats weighing between 180 – 220 g were used in the study. They were grouped into 3 groups of 12 rats each (2 test groups and a control group). The animals were fed with standard feed and clean water. In addition, those of test groups 2 and 3 also received 400 mg/kg and 200 mg/kg of ethanolic extract of M. myristica seed respectively on daily basis for twenty eight days (four weeks). After each week of administration, three rats from each group were sacrificed, blood samples collected by cardiac puncture for biochemical analysis of some liver function parameters (alkaline phosphatase (ALP), alanine transaminase (ALT), aspartate aminotransferase (AST), serum total protein and serum albumin). The liver of the animals were also examined for histological study.

Results: The results from the biochemical assay were subjected to statistical analysis and it showed a significant (p<0.05) increase in ALT values, non significant increase in AST and ALP values, and a non significant effect on total serum protein and serum albumin. The histological study of the liver showed hepatocytes and periportal inflammations as well as cytoplasmic swelling, which are indications of alteration on the normal physiological status of the liver.

Conclusion: Findings from this study showed that the extract produced an adverse alteration in the normal histomorphology and biochemical make-up of the liver. Therefore, the plant should be used with caution, especially when used for medicinal purposes.

##### Measuring Intra-abdominal Pressure during Spontaneous Breathing Trial: Does It Help?

Mohamed Omar Elghonemi, Mohamed Hamdi Saleh

Journal of Advances in Medicine and Medical Research, Page 1-7
DOI: 10.9734/BJMMR/2016/28953

Background: Respiratory system impairment may be caused by an increase of the intra-abdominal pressure (IAP).

Aim of Work: To assess the role of measuring intra-abdominal pressure in predicting successful weaning from mechanical ventilation.

Methods: 124 patients with acute respiratory failure ARF fulfilling the criteria for weaning were included. Each underwent a 1-hour spontaneous breathing trial (SBT). All clinical, respiratory parameters and mechanics were recorded. IAP was measured using Krons technique at the beginning and every 15 minutes till the end of SBT. The mean of IAP during SBT was calculated.

Results: Of 124 patients included in the study, 94 patients achieved successful SBT and extubation, while 31 patients needed re-intubation within 48 hours. Mean IAP was lower in patients that achieved successful SBT compared to patients who didnt, 7.25 ± 2.28 vs 9.96 ± 2.6, p value < 0.001. Moreover, patients who needed re-intubation within 48 hours had higher mean IAP compared to patients who didn`t, 9.96 ± 1.4 vs 5.92 ± 1.17, P value < 0.001. The cut-off value of  mean IAP that predict the need for re-intubation was 8.9 cm H2O with sensitivity and specificity measuring 80% and 52% respectively. The Area Under the Curve (AUC) was 0.97. With multivariate regression analysis, mean IAP was an independent predictor of SBT failure (odds ratio (OR) 1.46, 95% confidence interval (CI) 1.62 to 1.839, p value 0.001). Using Spearman's rank correlation coefficient, it was found that mean IAP was positively correlated with auto ,positive end expiratory pressure, PEEP that measured at the beginning and at the end of SBT, and admission APACHE II score, with correlation coefficient measuring 0.515, 0.595, and 0.4 respectively.

##### Gender Satisfaction among Type 2 Diabetes Patients: A Comparison between Intensive Diets, Lifestyle Intervention with Medication Controlled Management

Abdulbari Bener, Abdulla O. A. A. Al-Hamaq, Funda Çatan, Kaleem U. Rajput, Mustafa Guzel

Journal of Advances in Medicine and Medical Research, Page 1-13
DOI: 10.9734/BJMMR/2016/29418

Background: Exactly when to initiate insulin in recent onset Type 2 Diabetes Mellitus (T2DM) remains unclear. Emerging evidence suggests that increased physical activity and weight loss can delay or prevent the onset of T2DM, and in some cases normalise blood glucose levels.

Aim: The aim of the study is to investigate gender satisfaction of health quality of life at achieving better glycaemic - HbA1c level in patients with T2DM in comparison to intensive dietary and lifestyle interventions with medication controlled management.

Subjects and Methods: A cross-sectional comparison study was designed based on 1,386 available participants with diagnosed T2DM at the Primary Health Care (PHC) and Hamad General Hospital in Qatar during the period from November 2012 to June 2014. 1,386 participants were evaluated to get either conventional therapy (dietary restriction) or intensive therapy (metformin, sulfonylurea, sitagliptin) for glucose control. The changes in serum lipid profiles (cholesterol, LDL, HDL), uric acid, blood pressure and glycated hemoglobin (HbA1c) were analysed at baseline and after twelve months. In addition, socio-demographic data was collected and univariate and multivariate statistical analysis was performed.

Results: There were statistically significant differences between female and male patients in terms of age (p<0.001), ethnicity (p=0.012), occupation (p<0.001), monthly income (p<0.001), physical exercise (p<0.001), sport activity (p=0.018), cigarette smoking (p<0.001), shisha smoking (p=0.036) and consanguinity (p=0.012). Significantly greater improvements in mean values of blood glucose (-2.50 vs. -2.46; p=0.001), HbA1c (-1.22 vs. -1.21; p=0.001), and cholesterol (-1.51 vs. -0.59; p=0.001) were found in female patients. Reductions in blood glucose, HbA1c, total cholesterol, HDL, albumin, urea triglyceride, and blood pressure systolic and diastolic were found in both genders. Male patients had higher changes in systolic blood pressure (-4.4 vs. -3.9; p<0.001) urea (1.04 vs. -0.83; p<0.001), LDL (-0.13 vs. +0.16; p<0.001) and albumin (-3.56 vs. -3.61; p<0.001) in comparison to females.

Conclusion: Current study indicates that intensive lifestyle changes, physical exercise and metformin treatment have favourable effects on patients at high risk for T2DM. Lifestyle modifications based on physical, dietary interventions and medication are associated with improvements in the blood glucose and HbA1c levels in patients with T2DM. Even those with gross glycaemic abnormalities, more than 60% can achieve target glycaemic control using diet, lifestyle and metformin.

##### Accuracy of Dynamic Contrast Enhanced Magnetic Resonance Imaging (DCE-MRI) in Detecting Breast Tumors

Asma Elamin, Ahmed Abukonna, Bushra A. Elmalik, Mona Ali, Mohamed Yousef, Ekhlas Abdelaziz, Mustafa Z. Mahmoud

Journal of Advances in Medicine and Medical Research, Page 1-10
DOI: 10.9734/BJMMR/2016/28835

Aims: To evaluate the accuracy of dynamic contrast enhanced magnetic resonance imaging (DCE-MRI) in characterizing breast tumors.

Study Design: This prospective study included 254 patients (4 males and 250 females; ages range between 15-78 years) underwent breast MRI examination.

Place and Duration of Study: This study was conducted in different MRI medical centers in Khartoum, Sudan between June 2014 and July 2016.

Methodology: Patients were examined using two sequences of MRI; routine-MRI and DCE-MRI. Signal intensities were evaluated from different MRI sequences in different tumors; the histopathology result was used as a reference for each case.

Results: The sensitivity and specificity of DCE-MRI were (82.6%) and (73.2%) respectively. In addition, breast cancer was more enhanced with fat suppression images. Image subtraction technique showed that breast cancer has heterogeneous features (89.9%), and ring enhancement was clearly seen on (8.7%).

Conclusion: The accuracy of MRI in this study was more than other imaging modalities in characterizing breast tumors. Therefore, it offers a new method to detect breast cancer in its early stage, and help improve the survival rate.

##### Public’s Attitude toward Organ Donation in Egypt: A Social and Conceptual Approach

Raouf M. Afifi, Sameh Sh. Zaytoun, Ejaz Ah. Khan, Yousef Afifi

Journal of Advances in Medicine and Medical Research, Page 1-15
DOI: 10.9734/BJMMR/2016/29797

It is now well established that organ donation (OD) in Egypt gains utmost official support both from Islamic and Christian authorities. Yet, some social and behavioral obstacles may often obviate the full benefit of cadaver donors.

Aim: To identify and analyze determinants influencing the public’s awareness and attitude toward organ donation (OD) in Egyptian population.

Methods: At an outpatient setting of Qena University hospital (QUH), Qena, Egypt, care seekers were interviewed.

Results: Participants mean age was 42.9±8.17y years. More than half (56%) of participants are aware of the presence of OD programs in Egypt. However such awareness was not significant as to improve OD knowledge score. Otherwise, the same score significantly increased by educational level [F(df 3, 812= 3.61, p=0.0002]. Importantly too, the participants’ OD attitude score significantly improved by education [F(df 3, 805) = 4.52, p=0.038]. Media was most accessible as an individual source of information about OD (16.5%), and the knowledge score varied by source of OD information (14.6% with Internet source, 13.3±3 healthcare source, 5.6±1.9 friends source, 38% more than one source) [F(df 6, 809)= 3.10, p=0.0016]. Only 43.6% of participants were willing to donate an organ after death. Conceptualizing OD as an anti-religious behavior was reported by 16.9% of participants.

Conclusions: The current knowledge fabric toward OD among Egyptian bears a mix of negative and positive potentials. Improving OD knowledge standard assures propagating positive attitude toward OD and hence enhanced survival opportunities for organ failure victims.

##### Determinants of Male Partner Involvement in Antenatal Care in Wakiso District, Uganda

Kinuthia Francis Kariuki, Gloria K. Seruwagi

Journal of Advances in Medicine and Medical Research, Page 1-15
DOI: 10.9734/BJMMR/2016/28056

Aims: In spite of its associated positive outcomes for maternal and child health, male partner involvement continues to be low in Uganda. This study sought to assess determinants of male involvement (MI) in antenatal care (ANC) in a Ugandan sub-urban context as well as the proportion of male partners who are consistently involved in ANC.

Place and Duration of Study: This was a descriptive cross-sectional community-based survey with both quantitative and qualitative approaches conducted in Makindye sub-county, a peri-urban area in central Uganda, between August and October 2015.

Materials and Methods: Participants were selected using simple random sampling. Data were collected from 384 males aged 18 - 49 years whose wife had given birth to at least one child and below two years of age. In addition 21 key informants were also purposively selected for the qualitative strand.

Results: Male involvement in ANC was found to be very low (6%) and attributed to socio-demographic factors such as education (p=0.000), marriage (p=0.001) and age (p=0.044) which were found to increase ANC involvement while lower income earnings (p =0.023) decreased MI levels. Inconsistent participation in ANC is increased by: not living together with their spouses during pregnancy (OR-3.474, p-0.012); family members living with male partners and their spouses (OR-4.122, p-0.001); family members influencing male partners’ decision to get involved in ANC (OR-5.421, p-0.001); unplanned pregnancies (OR-8.935, p-0.001); peer influence (OR-3.614, p-0.036); and limited male involvement in deciding where spouses attend ANC (4.245, p-0.009). Health worker attitude (p=0.001), waiting time (p=0.001) and cost of antenatal services (P=0.003) were significantly associated with male involvement in ANC.

Conclusion: Study findings confirmed low MI in ANC with explanatory factors being social, economic and system related. Interventions need to focus on continued sensitization and dialogue especially with and among men; support income generating initiatives and address health system barriers to male involvement.

##### Imaging Techniques for Dental Implants: Review Article

Kaushik Kumar Pandey, Abhishek Gaur, Pratibha Katiyar, Taseer Bashir, Pallavi Srivastava, Monika Srivastava, Amrit Rai

Journal of Advances in Medicine and Medical Research, Page 1-8
DOI: 10.9734/BJMMR/2016/28115

In modern era, dental implant supported prosthesis is first choice of the many patients and clinicians. Before going to opt the dental implant for patient, assessment of bone is prime requisite of clinician. It requires extensive radiographic examinations. In these days, many imaging techniques are popular like periapical, panoramic, lateral cephalometric, tomographic radiography, interactive computed tomography, magnetic resonance imaging. In this review paper, various imaging techniques used for preoperative, operative and postoperative assessment of dental implant are discussed.