Open Access Case Study

Ramsay Hunt Syndrome in HIV Positive Individual

Nidhi Jain, Anil Kumar Nagarajappa, Rohit Mishra, Meenakshi Bhasin

Journal of Advances in Medicine and Medical Research, Page 1-4
DOI: 10.9734/BJMMR/2017/30148

Ramsay-Hunt syndrome (RHS) is caused by varicella zoster virus (VZV) infection in the geniculate ganglion of the facial nerve. It is characterized by facial palsy, otic pain, herpetic vesicles around the auricle and external auditory canal. We report here rare case of a RHS affecting a middle-aged individual, in human immunodeficiency virus (HIV) positive patient. The patient presented with severe herpes zoster infection of the maxillary and mandibular divisions of the trigeminal nerve. Unilateral vesicles involved lower and middle 1/3rd of trigeminal nerve distributed area on the left side of the face. Intraoral involvement included buccal, labial and palatal mucosae of the affected side. Patient also suffered with lower motor neuron facial palsy of facial muscles on the affected side.

Open Access Case Study

A Rare Case Report of Parotid Cavernous Hemangioma in an Adult

Suwal Rubina, Guan Jian, Wang Xin Yu, Khatri Kalu Singh, Nyimi Bushabu Fidele

Journal of Advances in Medicine and Medical Research, Page 1-5
DOI: 10.9734/BJMMR/2017/30899

Hemangioma is a common soft tissue lesion in oral and maxillofacial region. However, hemangioma in the parotid gland is a rare presentation in adult population with only few reports of cavernous hemangioma within the parotid gland. Hemangiomas are classified as benign vascular tumours which are further categorized into infantile and congenital types. A 40-year old male presented with the mass on the left parotid region to the Oral and Maxillofacial Surgery Unit of second Affiliated Hospital of Jiamusi University. Magnetic Resonance Imaging (MRI) revealed the presence of vascular malformations. The mass was removed with total parotidectomy via standard lazy S incision. Histopathological examination confirmed the diagnosis of cavernous hemangioma. It is often challenging for clinicians to reach a definitive diagnosis based on clinical and/or radiographic findings as it is a rare pathology in adults.

Open Access Minireview Article

Gaucher’s Disease: Prenatal and Post Natal Diagnostic Dilemma and Biochemical Aid - Case Series and Review of Literature

Mohammed Ismail Khan, Swathi Emmadisetty, Asna Yasmeen, Shahzeb Zaman

Journal of Advances in Medicine and Medical Research, Page 1-11
DOI: 10.9734/BJMMR/2017/29680

Background: Gaucher’s Disease (GD) is a rare genetically inherited, autosomal recessive disorder. It is classified as a lysosomal storage disorder and is characterized by the accumulation of glycolipids. This is due to the deficiency of lysosomal hydrolase β – glucocerebrosidase. The gene responsible for synthesizing this enzyme is encoded by GBA1 on chromosome 1q21.

Case Series: We present a case series of a Gravida-5 Para-3 Live-1 Death-2 Abortion-1 (G5P3L1D2A1) patient, with 19 weeks amenorrhea with prenatal diagnosis suggestive of GD clinically being planned for termination. The past obstetrics history is as follow; First pregnancy – full-term normal vaginal delivery (FTNVD) with male baby diagnosed as type 2 GD at 8 months after birth and died at 9 months 14 days;  Second pregnancy – FTNVD with female baby presently 3 years 6 months and healthy and enzymatic assay and mutational analysis for GD negative; Third pregnancy – full-term lower segment cesarean section (FTLSCS) with male baby diagnosed as type 2 GD at 7 months after birth and died at 1 year 8 days;  Fourth pregnancy – chorionic villus sampling (CVS) done at 12 weeks and enzymatic assay positive for GD and terminated  at 17 weeks.

Conclusions: We report a case of a lady presenting with two children diagnosed with type 2 GD after birth who died within a year of birth. Another two pregnancies diagnosed prenatally with GD and terminated and one healthy live child. Case series and Literature Review is presented together with an objective to emphasize that a rare disease like GD can have bad infant prognosis and that prenatal diagnostics can help in the diagnosis of the disease in intrauterine life, to facilitate making a timely decision. It also highlights the importance of genetic counseling to avoid dismal outcomes.

Open Access Original Research Article

Correlation of Anthropometric Indices and Age with Fasting Plasma Glucose among Inhabitants of Ogun State, South-West Nigeria

Taiwo Hussean Raimi, Adesina Olalekan Odewabi, Olatunde Odusan, Olufemi Fasanmade

Journal of Advances in Medicine and Medical Research, Page 1-11
DOI: 10.9734/BJMMR/2017/29730

Background: Type 2 diabetes has assumed epidemic proportion. Several reports have linked both general and central obesity with diabetes mellitus but there are ethnic differences between adiposity, visceral adipose tissue and type 2 diabetes. This study aims to determine the correlation of anthropometric indices and age with fasting plasma glucose (FPG) in south-west Nigeria. 

Methods: This is a cross-sectional survey involving 521 adult participants comprising of 134 (25.7%) males and 387 (74.3%) females. Body mass index (BMI), waist circumference (WC), waist-to-hip ratio (WHR), and waist-to-height ratio (WHtR) were determined by standard protocols. Fasting plasma glucose (FPG) was determined by glucose oxidase method. Student’s t-test was employed to compare the means of FPG of the obese and non-obese participants. 

Results: The mean FPG of obese men was significantly higher than those of non-obese men (94.62±25.86 mg/dL vs 81.14±13.29 mg/dL, P=.029 with WC; 86.56±20.09 mg/dL vs 80.04±11.42 mg/dL, P=.024 with WHR; 89.23±20.34 mg/dL vs 79.92±12.92 mg/dL, p=.006 with WHtR; 91.4±23.4 mg/dL vs 80.5±12.4 mg/dL, P= .013 with BMI). Among the women, FPG was significantly greater in those with general obesity compared to the non-obese in the fifth decade (81.93±11.59 mg/dL vs 75.3±88.18 mg/dL, P=.025). Similarly women with central obesity had greater FPG compared with the non-obese between the fifth to sixth decades: WC,94.34±40.89 mg/dL vs 77.28±8.04 mg/dL, P=.009; WHR,81.73±12.13 mg/dL vs 75.76±6.84 mg/dL, P=.016; WHtR,95.00±40.16 mg/dL vs 74.41±6.51 mg/dL, P=.001)

Conclusions: Plasma glucose correlated with obesity. Participants with obesity had higher mean fasting plasma glucose compared with those who were not obese. The difference was apparent among women between the fifth to sixth decades only. Among the men, the difference was observed with only WHR between the seventh to eight decades. Preventive strategies may need to be directed at certain age groups.

Open Access Original Research Article

Search for Escherichia coli O157:H7 and Other Enterohaemorrhagic Escherichia coli in Diarrhoeal Cases in Abuja, Nigeria

C. C. Asamole-Osuocha, O. O. Nwankiti, C. I. Nwosuh, A. A. Chukwuedo, E. I. Ikeh

Journal of Advances in Medicine and Medical Research, Page 1-12
DOI: 10.9734/BJMMR/2017/30184

Aims: To detect the sporadic involvement of shiga toxin producing Escherichia coli (STEC) O157:H7 or any other enterohaemorrhagic E. coli in gastro-intestinal (diarrhoeal) infections.

Study Design: The study is a cross sectional survey for bacterial causes of diarrhoea in the study area.

Place and Duration of Study: The study was conducted over a six months period (January to July) within Abuja, Nigeria.

Methodology: One hundred and six faecal samples were collected and analyzed. Direct inoculation of diarrhoeal stool samples on Sorbitol MacConkey agar and Cefixime-Tellurite Sorbitol MacConkey agar for the isolation of E. coli O157: H7 alongside Enrichment culture in modified peptone water followed by immunomagnetic separation (IMS) with magnetic beads coated with an antibody against Escherichia coli O157 was used. For the identification of non-O157 STEC among the Non-sorbitol fermenting E. coli isolated, PCR for virulence markers was carried out. Verocytotoxicity Assay was used to detect free faecal toxin in the stool samples for the identification of other Enterohaemorrhagic E. coli (EHEC) infections. Routine methods were used for the isolation and identification of bacterial isolates in the specimens.

Results: Enteric bacterial pathogens detected in the study include V. cholerae (1.9% of subjects), S. typhi (1.9%), S. paratyphi B (0.95%), S. paratyphi C (0.95%), unidentified Shigella species (0.95%), Shigella dysenteriae A1 (1.9%), Shigella flexneri (4.7%). No E. coli O157:H7 was isolated. Eleven NSF E. coli isolated and screened for shiga toxin/verocytotoxin (st/vt) genes via PCR and latex agglutination tests were negative. However, free faecal toxin was demonstrated in 16 (15.09%) of the 106 faecal samples analyzed indicating the possible involvement of non-O157 VTEC in diarrhoeal diseases. None of the non-sorbitol fermenting E. coli was found to be STEC.

Conclusion: Findings mean that none of the sorbitol-negative E. coli isolated from this study is VTEC/STEC. Results point to the presence of non-O157 VTEC in the study area. This pathogen should be considered as a routinely sought after agent in diarrhoeal illnesses especially among children.

Open Access Original Research Article

The Validity of Poisoning Severity Score in Acute Carbon Monoxide Intoxicated Patients

Samia S. Barghash, Hala Nasser El Sherif, Rawya Mohammed Salah El-Din, Azza Mohammed Hassan

Journal of Advances in Medicine and Medical Research, Page 1-17
DOI: 10.9734/BJMMR/2017/25943

Background and Objective: The poisoning severity score is a standardized and generally applicable scheme for grading the severity of poisoning. It allows a qualitative evaluation of morbidity and facilitates comparability of data. The aim of this study was to evaluate the validity of the poisoning severity score in patients with acute carbon monoxide poisoning as a result of their descriptive, laboratory, clinical data and outcome.

Subjects and Methods: An observational prospective study design was used in the data collection process for eighty Co poisoned patients who presented to Poison Control Center (PCC), Ain Shams University Hospital, Egypt over six months. Patients with coronary artery disease or other known heart disease, patients with renal failure as well as smoker subjects were excluded. The patients were divided into 3 grades according to the poisoning severity score (PSS) which was applied to all patients in the present study at the emergency department. Also a group consisted of twenty apparently healthy nonsmoker volunteers (of matched age and sex) were served as a control group. Arterial blood gases (ABG), carboxyhemoglobin level (COHb), random blood sugar, serum of sodium (Na), potassium (K), alanine aminotransferase (ALT), serum creatine phosphokinase (CPK), serum urea and creatinine, hematological parameters (red blood cells, white blood cells and hemoglobin), serial cardiac markers (serum of aspartate aminotransferase (AST), creatine kinase-MB, lactate dehydrogenase (LDH), and cardiac troponin-I (cTnI) quantitative determination and ECG however brain CT scan was done only for cases who admitted to ICU.

Results: Higher mean delay time, tachycardia, bradypnea, respiratory distress, pulmonary edema, lowest mean GCS, hypernatremia, leukocytosis, acidosis, hyperglycemia, high levels of CPK- MB, AST and cTnI, ECG changes, abnormal CT (infarction and brain edema) at presentation and the need of mechanical ventilation with hyperbaric oxygen showed significant  relation with higher PSS and adverse outcome.

Conclusion: Age, delay time, PSS grade, Glucose, AST, CPK-MB and Cardiac Troponin I are significant predictors of outcome. These results indicated that those variables are the most important factors for determining the outcome within the limitations of our study. So the results of the present study revealed that PSS is reliable severity score for diagnosis, management and prognosis of COP cases especially with the added modifications in the form of laboratory, ECG and brain CT scan.

Open Access Original Research Article

Salivary Biomarkers to Monitor Osteopenia and Stress Levels in Breast Cancer Survivors

Xun Xiao, Michael C. W. Yip, Wings T. Y. Loo, Liang Hao, Louis W. C. Chow, Erich F. Lie, Christopher Y. C. Chow, Min Wang

Journal of Advances in Medicine and Medical Research, Page 1-8
DOI: 10.9734/BJMMR/2017/30663

Aims: The aim of this study is to assess salivary biomarkers, i.e. cortisol, calcium, phosphate, osteocalcin, vitamin D and estradiol levels, to monitor osteopenia and stress levels in post-treatment breast cancer patients.

Methods: The salivary biomarkers of forty-five female breast cancer survivors aged between 30 to 48 years were compared against twenty-eight disease-free, healthy female subjects, which act as the reference values in our study.  Saliva collection was done by resting/drooling collection method (minimal oral movements). The independent unpaired t-test was used to compare the differences between the parameters of control group and patient group.

Results: The salivary flow rate and the amount of saliva were not significantly different between both groups. The concentration of salivary cortisol in breast cancer survivors was significantly higher compared to healthy controls (P<0.01). The mean concentrations of salivary calcium (P<0.01), phosphate (P<0.05), osteocalcin (P<0.001), vitamin D (P<0.001) and estradiol (P<0.05) in the breast cancer survivor group were significantly lower than those in the control group.

Conclusion: Our findings suggest that the measurement of salivary biomarkers can be considered as a useful method to monitor osteopenia and stress levels in breast cancer survivors.

Open Access Original Research Article

Prevalence and Pattern of Non-communicable Diseases in Children in Jos, Nigeria

Esther S. Yiltok, Helen O. Akhiwu, Idris A. Adedeji, Akinyemi O. D. Ofakunrin, Emeka U. Ejeliogu, Edache S. Okpe

Journal of Advances in Medicine and Medical Research, Page 1-7
DOI: 10.9734/BJMMR/2017/30410

Aims: In most developing countries there is limited information on the burden of Non Communicable Diseases (NCD); even though recent findings in the developed world are predicting rapid transitions in these NCDs. This study was carried out to determine the prevalence and patterns of NCDs in children in Jos, Nigeria.

Study Design: This is a retrospective review of children admitted with NCDs. 

Place and Duration of Study: Emergency Pediatric Unit (EPU) of Jos University Teaching Hospital (JUTH), Jos Nigeria between January 2012 and December 2012.

Methodology: The study included 258 (150 males; 108 females; age ranged 1 month – 17 years) that were admitted with NCD (out of a total of 655 patients admitted from January to December 2012). Neonates and patients with inconclusive diagnoses were excluded. The bio-data and diagnosis of each patient was obtained and entered into Epi Info version 7.2. The categorical data were analyzed using student t-test while continuous variables were analyzed with the chi-square test. P value of < 0.05 was regarded as statistically significant.

Results: Two hundred and fifty eight children of the 655 patients admitted during the period under review had NCDs giving a ratio of 0.7:1 compared to Communicable Diseases (CDs). The age group most affected was the 1 month - 5 years with the commonest NCDs being sickle cell disease (37%), severe protein energy malnutrition (8.5%), seizure disorders (7.8%), congenital heart diseases (6.6%) and malignancies (6.6%).

Conclusion: The burden of NCDs is great and on the rise even in the developing world and urgent measures need to be put in place if these trends are to be averted and children are to grow into healthy and productive adults.

Open Access Original Research Article

The Performance of the Finnish Diabetes Risk Score (FINDRISC) Questionaire for Screening Individuals with Undiagnosed Type 2 Diabetes and Dysglycaemia in Nigeria

Olamoyegun A. Michael, Oluyombo Rotimi, Iwuala O. Sandra

Journal of Advances in Medicine and Medical Research, Page 1-8
DOI: 10.9734/BJMMR/2017/31022

Introduction: The Finnish Diabetes Risk Score (FINDRISC) questionnaire is a non-invasive, cheap, and easy to use screening tool to estimate future risk of diabetes development and detection of asymptomatic type 2 diabetes mellitus (T2DM) in other populations. This study aimed to evaluate usefulness of the FINDRISC to assessed future development of T2DM among a high-risk population.

Methods: 750 participants recruited from semi-urban communities aged 18 years and older participated in this cross-sectional study. Data on the FINDRISC and fasting plasma glucose variables were available for each participant. SPSS version 16 was used for analysis and p<0.05 was taken as statistically significant.

Results: The mean age of participants was 61.7±18.5years, 70.6% females and 8.8% were adjudged to have diabetes based on FPG. 103 (13.73%) participants had high-risk score of 15-20, which estimates that 1 in 3 participants would develop diabetes within 10 years. 4 of the participants had very high risk (>20) and all of them were adjudged to have diabetes. There was significant association between diabetes risk score and FPG (p=0.001), SBP (p=0.034) and age (p<0.001).

Conclusion: The FINDRISC seem a useful non-invasive, easy to use, self-administered and practical tool to screen for undetected diabetes and future development of diabetes among high-risk groups in this semi-urban community.

Open Access Original Research Article

Evaluation of Evidence Based Medicine Knowledge and Skills among a Sample of Medical Students in King Abdul Aziz University: A Follow up Study

Hussam Albugami, Qusay Mandoorah, Ayman Zaky Elsamanoudy, Mohammed Ahmed Hassanien

Journal of Advances in Medicine and Medical Research, Page 1-9
DOI: 10.9734/BJMMR/2017/30248

Background: Evidence-based medicine (EBM) is an essential method of teaching that represents the integration of clinical expertise, patient values, and high-quality evidence in the process of decision making concerning healthcare. The current study aims to evaluate the EBM skills of medical students four years after having taken this course. In order to evaluate the effectiveness of this course, students who took the course are compared with students who did not take the course.

Materials and Methods: The current study was conducted at the Faculty of Medicine of King Abdulaziz University in Saudi Arabia between 2009 and 2013. Fifteen students out of 165 in the fourth year selected this course as one of their student-selected components (SSC), and this was their first experience in learning about EBM. Immediately after the end of the course, faculty members asked the first student cohort to evaluate the effectiveness of the course and rate the EBM project, the material taught, and the instructional handouts using a five-point Likert scale questionnaire. Out of the 15 who enrolled in the course, 14 were surveyed four years after taking the EBM course, in addition to another 14 medical students who did not take the EBM course. The students self-assessed their confidence with EBM skills in the following areas: formulation of clinical questions in the “PICO” format (patient population, intervention [or exposure], comparison, outcomes), literature searches, evaluation of articles, and ability to apply this process to other clinical situations. In addition, student performance was evaluated with regard to the five steps applied in their learning experiences during the course. A five-point Likert-type scale was used in the questionnaires, with “strongly disagree” coded as 1 and “strongly agree” coded as 5. The collected data were analyzed in terms of descriptive statistics using SPSS.

Results: The results indicate that the overall scores from the four-year prospective study were lower than those collected immediately after the EBM course. Students who took the course (EBM group) has better skills in critiquing articles and linking EBM with clinical skills than those who did not (non-EBM group). Moreover, subjects from the EBM group had more interest in medical updates and research and were more familiar with the medical database library.

Conclusion: EBM teaching should be integrated as an initial course and applied early, followed by continuous EBM-based practice with clinical activities throughout the clinical years. Moreover, smartphone based E-learning has become an efficient way to handle medical knowledge and deliberation among medical students and healthcare providers.