Open Access Minireview Article

Ineffective Erythropoiesis: Associated Factors and Their Potential as Therapeutic Targets in Beta-Thalassaemia Major

Heba Alsaleh, Sarina Sulong, Bin Alwi Zilfalil, Rosline Hassan

Journal of Advances in Medicine and Medical Research, Page 1-9
DOI: 10.9734/BJMMR/2017/31489

Beta-thalassaemia (β-thal.) is single-gene disorder that exhibits much clinical variability. β-thal. major is a major health problem, and the only method of curing is allogenic bone-marrow transplantation, which is not available to everyone and not without risk.

The underlying pathogenesis of β-thal. major is due to ineffective erythropoiesis (IE), which is characterized by increased proliferative activity that fails to produce sufficient functional red blood cells. In β-thal. patients, the severity of the IE is mainly responsible for the hallmarks of the disease’s presentation, sequalae and complications.

This review discusses the mechanisms of IE, the factors that contribute to it and the potential therapies for targeting these factors to improve patients’ clinical phenotypes.

Open Access Original Research Article

Awareness and Utilization of Guidelines in the Management of Hypertension among Medical Practitioners in a Tertiary Hospital in Nigeria

C. A. Alikor, C. E. Nwafor, N. N. Unamba

Journal of Advances in Medicine and Medical Research, Page 1-7
DOI: 10.9734/BJMMR/2017/32487

Background: Hypertension is a public health problem in Sub-Saharan Africa, as it is responsible for increased cardiovascular morbidity and mortality. The need to improve the global control of high blood pressure and mitigate its complications has necessitated the stipulation of various treatment guidelines. In recent times, it includes those of European Society of Hypertension (ESH), the Seventh report of the Joint National Committee on the Prevention, Detection, Evaluation and Treatment of Hypertension (JNC VII), and the National Institute for Health and Care Excellence (NICE) guidelines. The aim of this study is to determine the level of awareness and utilization of management guidelines in the treatment of hypertension among medical practitioners in a tertiary hospital.

Methodology: A cross sectional descriptive study design was chosen and a structured questionnaire was developed and administered. A total of seventy medical practitioners had analyzable data.

Results: Most of the respondents (87.0%) were aware of the existence of treatment guidelines in the management of hypertension, but only 68.1% routinely use any of the available guidelines in their practice. The most frequently used guideline was the JNC VII treatment guideline (64.7%) followed by NICE guideline (25%), and ESH guideline (17.6%). Among the medical practitioners, the utilization of guidelines was mostly for the management of hypertensive-diabetics (63.8%), followed by their use in the management of hypertensive-chronic kidney disease patients (34.8%), and then in essential hypertensive patients (39.1%). Most of the practitioners however, combined the use of therapeutics and life style modification (75.4%).

It was observed that with increase in level of education, awareness also increased, with the senior registrars been most aware (94.1%), and the least aware been the interns (78.1%). The interns however, routinely utilized the guidelines more than the registrars (65.6% versus 64.3%) although this was not statistically significant (p=0.231). Although most of the participants considered the guidelines appropriate for the management of hypertension in our environment (73.1%) they however feel the training they have received in the course of their training was not adequate (81.2%).

Conclusion: Medical practitioners in this hospital fairly complied with stated guidelines especially when there is co-morbidity, but feel they may require more formal training in the use of these guidelines in order to better manage their hypertensive patients. The findings should serve as a starting point to design new teaching paradigms to increase physician awareness of hypertension treatment guidelines in Nigeria in particular, and in Africa and the developing world, in general.

Open Access Original Research Article

Assessment of Anti-inflammatory and Anti-nociceptive Properties of Aqueous Seed Extract of Carica papaya in Albino Wistar Rats

Uchefuna Roy Chinwuba, Egwurugwu Jude Nnabuife, Ohamaeme Moses Chukwuemeka, Oha Kingsley, Anyasodor Prince, Akunne-Wariso Chris Chinedum, Egwurugwu Ugonne Frances, Azudialu Bede Chinedu

Journal of Advances in Medicine and Medical Research, Page 1-8
DOI: 10.9734/BJMMR/2017/32602

This study was undertaken to assess analgesic and anti-inflammatory properties of seed extract of Carica papaya. Aqueous extracts of the plant at doses of 100, 200, and 300 mg/kg body weight were used for the study on fifty adult white albino wistar rats weighing between 150 to 200 g. The extracts were evaluated for analgesic activity through tail immersion test using 25 rats while anti-inflammatory assay was performed by fresh egg albumin-induced paw oedema using 25 rats. For each model, the rats were divided into five groups of 5 rats each. Group 1 served as the negative control group, group 2 served as the positive control group while groups 3, 4 and 5 received 100, 200 and 300 mg/kg body weight of the plant extract respectively. Pethidine and aspirin were employed as a standard (positive control) for analgesic and anti-inflammatory studies respectively. Normal saline was used as negative control. Results showed statistically significant analgesic and anti-inflammatory properties in a dose and time dependent manner (p<0.05). The results thus validate the ethnomedicinal usage of Carica papaya seed extracts in the management of pain and inflammation.

Open Access Original Research Article

Screening for Fabry Disease among Dialysis Patients in Brazil: Findings from the First 18 months of a Nationwide Study

Marcelo P. Coutinho, Oswaldo M. V. Neto, Júlio C. B. Araújo, Túlio M. Santos, Jorge E. P. Lopez, Luisa R. Baptista, Márcia G. Ribeiro

Journal of Advances in Medicine and Medical Research, Page 1-16
DOI: 10.9734/BJMMR/2017/32156

Aims: To estimate the frequency of Fabry disease (FD) among kidney failure patients on dialysis in Brazil using an algorithm designed to track FD-suspected patients.

Study Design: Cross-sectional study.

Place and Duration of Study: Dialysis Centers in Brazil, from July, 2013 to December, 2014.

Methodology: A total of 25,223 dialysis patients from 188 dialysis centers spread all over the country were analyzed. All collected data were entered in a database created and maintained by DataGenno Interactive Research®. An algorithm was created to sort dialysis patients into three main groups: FD-suspected patients, FD-non suspected patients, and patients for medical analysis. Further up, FD-suspected patients were submitted to GLA gene sequencing.

Results: Out of 25,223 patients, 2,956 (11.72%) were considered FD-suspected. From FD-suspected patients, 89 (3.0%; 2.0% female, 1.0% male) were diagnosed with FD. FD-positive patients represented 0.3% (0.2% female, 0.1% male) of all analyzed patients. Average age of FD-positive patients: 37.7 years (±16.6) and of FD-negative patients: 45.1 years (±11.5). Seventeen different mutations were found in FD-positive patients. Missense mutations c.352C>T(R118C), c.1102G>A(A368T) and c.870G>C(M290I) were the most frequent (60.7% of the patients). A368T and R118C were more frequent among 30 patients with depression. Six female patients had cerebrovascular disease and A368T mutation was more frequent. A368T, R118C and M290I were more frequent in patients with heart disease. Angiokeratoma frequency (14.6%) was higher than in previous findings in the Brazilian population.

Conclusion: The natural history and frequency of FD among Brazilian dialysis patients were found, in general, according to literature. Three missense mutations were highly frequent among FD-positive patients; none of them were directly related to end-stage renal disease caused by FD. The algorithm used could be a helpful tool to identify FD.

Open Access Original Research Article

Hepatitis B Virus Serological Markers in a Rural Community in Southeastern Nigeria

A. S. Bakarey, I. M. Ifeorah, T. O. C. Faleye, M. O. Adewumi, A. Akere, C. E. Omoruyi, A. O. Ogunwale, V. F. Olaleye, R. F. Awokunle, D. E. Sekoni, J. A. Adeniji

Journal of Advances in Medicine and Medical Research, Page 1-9
DOI: 10.9734/BJMMR/2017/32248

Aim: Due to the current blood safety algorithm in Nigeria which excludes only Hepatitis B surface Antigenaemia (HBsAg) positive individuals from blood donation, this study was therefore designed to investigate HBV markers of infection in a rural population in southeastern Nigeria.

Study Design: It is a cross sectional community-based study.

Place and Duration of the Study: This study was carried out in Awuda village in Nnobi town of southeastern Nigeria in August 2013.

Methodology: A total of 92 consenting participants were enrolled for the study. The participants were screened for HBsAg, HBeAg, Anti-HBc IgM, Anti-HBc, Anti-HBe and Anti-HBs using ELISA technique and classified into different serological profiles indicative of infection stages.

Results: Respondents’ mean age was 26.3(SD +­11.5) years and 58 of them were females while 34 were males. An overall prevalence for HBsAg was 1.1% (1/92). The same HBsAg positive individual also had detectable anti-HBe and anti- HBc IgM. Analysis of the results showed 3 (3.3%) of the study participants were positive for both Anti-HBe and Anti-HBc. Also, 12 (13.0%) participants were positive for only Anti-HBc and Anti-HBs antibody. Another 9 (9.8%) participants were positive for only Anti-HBs while 51 (55.0%) had no serological marker for previous exposure to either HBV or HBV vaccine. Altogether, 31(33.7%), 1(1.1%) and 21(22.8%) participants were positive for HBc, HbcIgM and HBs antibodies respectively.

Conclusion: This study has demonstrated that at least 1 out of every 3 people in the studied community might have serological evidence of present or past HBV infection. The current dependence of blood safety algorithms which excludes only HBsAg positive individuals is not enough to guarantee safety of blood and/or blood products. More studies are needed to further investigate the theoretical basis of the algorithm.

Open Access Original Research Article

The Pattern and Outcome of Severe Trauma Using the Trauma and Injury Severity Score (TRISS) Methodology in a Dedicated Trauma Centre in Nigeria

S. E. B. Ibeanusi, S. L. Harcourt

Journal of Advances in Medicine and Medical Research, Page 1-9
DOI: 10.9734/BJMMR/2017/33392

Background: Trauma is a leading cause of mortality and a major contributor of disability as measured by Disability Adjusted Life years lost to inury in various parts of the world. Pattern of injuries and quality of care given to trauma patients differ in various parts of the world. The quality of care given in a particular centre can be assessed and compared with that from other centres by utilising an established standard method of assessment such as the Trauma Research and Injury Severity Score (TRISS). In this observational study, the pattern of presentation of severe trauma and quality of care given to severely injured patients at a trauma centre in Nigeria is evaluated using the TRISS methodology. The findings are compared with those reported from other countries.

Methods: Data required for trauma demographics and TRISS calculation was extracted from the trauma registry of Teme Hospital, Port Harcourt Nigeria and analysed. Trauma demographics, type of care and the probability of survival of included patients were evaluated using the TRISS methodology.

Results: Seven hundred and sixty two patients were seen with severe trauma but 746 patients had enough information required for analysis. Most of the trauma patients seen at the centre were males with a mean age ± standard deviation of 28.5 ± 11.3 years. Road traffic collision was the commonest cause of injury (41.2%) but gunshot injuries contributed a sizable number of the injuries (36.7%). The median Injury Severity Score (ISS) was 20 (range = 16 – 75) while the mean Revised Trauma Score (RTS) ± SD was 7.1 ± 1.3. The median probability of survival was 0.98 with a range between 0.00 and 0.99. The M, Z, and W statistics were 0.87, - 8.5, and -7.0 respectively. From TRISS analysis, 38 patients (5.1%) were expected to die but the observed mortality was 12.4%. Most mortality was related to severe head injuries.

Conclusion: Trauma burden is an identified problem at Teme Hospital Nigeria. Severe trauma constitutes only 12% of trauma cases seen at the centre but it is the main contributor to trauma deaths. The observed mortality is higher than the expected as calculated using TRISS methodology and this call for improvement in the quality of care at the centre.

Open Access Review Article

Geriatric Poly-Pharmacy: A Growing Epidemic. How to Prevent It?

Sonali Sarkar

Journal of Advances in Medicine and Medical Research, Page 1-11
DOI: 10.9734/BJMMR/2017/32944

Introduction: Geriatric poly-pharmacy is defined as the use of more drugs in older adults than are medically necessary. It is widely prevalent in clinical practice. The rationale for poly-pharmacy in the elderly is not clear.

Objective: 1) Review the epidemiology, etiologic factors and potential consequences of geriatric poly-pharmacy; 2) Provide recommendations for prevention and reduction of geriatric poly-pharmacy.

Methods: A review of literature for published articles in English language from online databases (Medline, EBSCO, Psychinfo, Google scholar) was conducted from 2000-2017.

Results: With minor geographical variation, the prevalence of geriatric poly-pharmacy ranges from 15-80%. The trend is rising globally. Etiology is not clear. Associated factors include demographic factors (advanced age, education, geographic variation, socio-economic status, insurance), comorbidities, health status, severity of disease, treatment- refractoriness, healthcare setting (inpatient, out-patient or nursing home), cultural beliefs, physician prescribing pattern, etc. The concurrent administration and use of multiple medications increase the risk of drug interactions, potential adverse consequences, falls, fractures including morbidity and mortality in the elderly. Geriatric poly-pharmacy is also associated with cumulative toxicity, poor medication adherence and treatment non-compliance. Recommendations provided are targeted at preventing and reducing unnecessary geriatric poly-pharmacy in clinical practice.

Conclusion: The growing epidemic of geriatric poly-pharmacy poses a significant public health problem. This article highlights on the strategies for preventing and reducing unnecessary prescribing of drugs in the elderly. A better understanding of physicians’ rationale for geriatric poly-pharmacy, patient tolerability and effectiveness of this strategy is needed to guide clinicians and to inform the development of evidence based treatment guidelines.

Open Access Review Article

Colorectal Carcinogenesis from Gut-associated Lymphoid Tissue Clinical and Experimental Documentation

Carlos A. Rubio

Journal of Advances in Medicine and Medical Research, Page 1-12
DOI: 10.9734/BJMMR/2017/31621

Aims: The conventional (tubular or villous) adenoma-carcinoma pathway and the serrated adenoma-carcinoma pathway evolve in the vast colorectal mucosa built with crypts lined with mucus producing goblet cells and columnar cells. In contrast, few carcinomas developing in the tiny, spotty gut-associated-lymphoid-tissue (GALT) mucosal domain have been reported.

Place and Duration of Study: Department of Pathology, Karolinska Institute and University Hospital, Stockholm, Sweden. The experiments in rats were carried out during four years. 

Methodology: All publications on human colorectal GALT-carcinomas were reviewed. Archival sections from previous experiments in carcinogen-treated rats exhibiting colonic GALT follicles, were re-evaluated.

Results: Only 21 GALT-carcinomas found in 18 patients are in record. Four had ulcerative colitis, two were members of a Lynch syndrome family, two of a CRC family, one of a FAP family, two abdominal pain, two rectal bleedings, one diverticular disease, one a submucosal rectal tumor, one protracted constipation, and two had no symptoms or ground diseases. Conversely, 53% of 276 carcinogen-treated rats had developed GALT-carcinomas.

Conclusions: It is generally recognized that the vast majority of the CRCs in humans evolve via the conventional adenoma-carcinoma pathway or the serrated adenoma-carcinoma pathway in the GALT-free colorectal mucosal domain. Less frequently CRCs in humans develop in the tiny, spotty GALT mucosal domain. Whereas natural exposures to dietary/environmental factors, genome differences, obesity, type 2 diabetes, and the colonic microbiome are important for the development of CRC in the GALT-free colorectal mucosa in humans, no factors have been advanced to explain the development of carcinomas in colorectal GALT domains in humans. On the other hand, more than 50% of the SD rats injected with DMH developed colonic GALT-carcinomas. Although the cause(s) for the difference in frequency of GALT carcinomas in the two species remains mute, the results strongly suggest that the carcinogen DMH was the most important single factor for the induction of colonic GALT carcinoma in SD male rats. More research is necessary to unveil the factor(s) responsible for the development of GALT carcinomas in the human colorectal mucosa.