Open Access Study Pre-Protocol

New Therapy Strategy for Prostate Cancer: Amanita phalloides Treatment Stabilizes Best Without Pre-treatments (Observational Study Pre-protocol)

Isolde Riede

Journal of Advances in Medicine and Medical Research, Page 1-7
DOI: 10.9734/BJMMR/2017/32673

Background: Amanita phalloides (Amanita) contains amanitin, inhibiting RNA polymerase II. Partial inhibition with amanitin influences tumor cell - but not normal cell - activity. Patients treated with Amanita often gain a stable disease state without further tumor growth.

Aim: Several therapies for prostate cancer are in use so far. This study evaluates the implementation of the Amanita therapy into the therapeutic regimen of today.

Methods: 38 Patients with diagnosed prostate cancer were treated with Amanita alone. Prostate specific antigen (PSA) was used as a parameter for tumor cell growth. Data about previous therapies like anti androgen treatment, prostatectomy, chemotherapy or radiation and progression state of the disease were collected, and relationships analyzed.

Results: Some patients could be stabilized with Amanita, evidenced by previously increasing PSA that did not increase for at least six months during Amanita therapy. In some patients PSA levels further increased despite Amanita therapy indicating immediate therapy resistance. Analyses revealed that successful Amanita therapy is strongly associated with beginning therapy early, while progressive disease states are often resistant to Amanita (p-value 0,005). Correlation between tumor specific pre-treatments and Amanita therapy resistance is significant: all patients without pre-treatment could be stabilized with Amanita (p-value 0,007).

Conclusions: Amanita therapy can reduce tumor growth best in patients without previous treatments, and was most effective in patients without tumor progression. Therefore Amanita should be used first as a tumor specific therapy. Anti androgen treatment, chemotherapy, radiation or prostatectomy can be applied at later stages.

Open Access Case Study

Calcifying Cystic Odontogenic Tumor: A Diagnostic Challenge

Anil Kumar Nagarajappa, Ankit Dhimole, Sumit Asrani, Ankit Agarwal, Ankur Kakkad

Journal of Advances in Medicine and Medical Research, Page 1-5
DOI: 10.9734/BJMMR/2017/30384

The calcifying odontogenic cyst was first described by Gorlin et al in 1962 and has been referred to as “Gorlin’s cyst” or “Calcifying ghost cell odontogenic cyst”. The lesion has cystic as well as tumor-like elements and was termed “calcifying cystic odontogenic tumor” (CCOT) by the World Health Organization (WHO) in 2005. The CCOT is b­­enign; ­­more commonly affects the anterior aspect of jaws and is without gender dominance. Knowledge of its clinical, radiographic, and pathological features is necessary to arrive at a proper diagnosis and management because it resembles other forms of pathology. Diagnosis relies mainly on radiographic features and the histologic presence of ghost cells within the epithelium. We report here a classic case of a CCOT in a 28 year old female.

Open Access Case Study

Delirious Mania: Recognition and Successful Treatment with Donepezil

Laurie Jo Moore, Mila Goldner-Vukov, Rachel Huso

Journal of Advances in Medicine and Medical Research, Page 1-5
DOI: 10.9734/BJMMR/2017/33433

Aims: Presentation of a case of severe delirious mania with resolution of delirium after treatment with donepezil.

Presentation of Case: KA was a 44 y/o Australian female with a history of bipolar affective disorder with psychotic manic episodes. Two weeks prior to her psychiatric admission she was admitted to a medical ward after an overdose (OD) of acetaminophen. On review, it appeared that this OD may have been the beginning of an unrecognized delirious mania. The patient was sent home and returned 2 weeks later for a prolonged psychiatric admission with multiple medical comorbidities. Psychiatric management and medical care were provided in intensive settings and despite adequate treatment and improvement in mood symptoms, her delirium did not resolve.  Immediately upon institution of donepezil, her delirium resolved. After a period of stability, donepezil was stopped. Her delirium returned and donepezil was reinstituted with resolution of normal cognitive function.  

Discussion: The DSM 5 criteria for Delirium and some inherent difficulties using these criteria are discussed. A review of the literature of delirious mania is presented which shows unresolved controversies but an evolving recognition of this disorder. A Cochrane Review shows no benefit in the use of acetylcholinesterases in the treatment of delirium. However, the multiple etiologies and pathological processes involved in delirium may require unique and individual recognition and management. 

Conclusion: This case suggests that the use of donepezil is strongly recommended in the treatment of delirious mania.  Further study is required to clarify in this challenging disorder.

Open Access Original Research Article

ASA Physical Status Score as a Predictive Tool of Mortality in Emergency Postoperative Abdominal Injuries in the ICU

M. N. Edubio

Journal of Advances in Medicine and Medical Research, Page 1-7
DOI: 10.9734/BJMMR/2017/32381

Background: The factors affecting the pattern and outcome of management of postoperative abdominal injuries in the intensive care unit of University of Uyo Teaching Hospital has never been investigated. This is especially important against a backdrop of limited resources in our intensive care unit.

Aim: This study seeks to determine the pattern and outcome of ICU management of postoperative abdominal injuries, and whether the American Society of Anesthesiologists physical status (ASA-PS) score is of any prognostic value with regards to outcome in this patient population.

Patients and Methods: This was a retrospective study of all postoperative patients admitted into the ICU on account of abdominal injuries (blunt and penetrating), between April 2006 and November 2014. Data for each patient was obtained from the ward and ICU records. Data collected were Age, Sex, Mechanism of Abdominal injury, ASA-PS score, ICU Length of Stay and Outcome of Management. Prolonged ICU length of stay was taken as >72 hours.

Results: Thirty-six patients with either blunt or penetrating abdominal injuries were studied. Thirty (83.3%) of these patients were males while six (16.7%) were females; giving a male to female ratio of 5:1. A majority of patients (36.1%) were between 25 and 39 years. There were more blunt 22 (61.1%), than penetrating 14 (38.9%), abdominal injuries. Thirteen (36.1%) were ASA IIIE, 19 (52.8%) were ASA IVE and 4 (11.1%) were ASA VE. The ASA-PS score of patients had no significant association with the type of abdominal injury (P = 0.722). There was no significant association between the ASA-PS score of patients, and outcome of management, with the length of patient stay in ICU. Outcome of management was significantly associated with the ASA status of patient (P = 0.001).

Conclusion: The ASA-PS of emergency post laparotomy patients admitted to the ICU is possibly a viable tool for prognostication of outcome of management.

Open Access Original Research Article

Frequency and Awareness of Thalassemia in Families with Cousin Marriages: A Study from Karachi, Pakistan

Muhammad Muizz Uddin, Faizan-Ul-Haq ., Asma Sarfaraz, Muhammad Mannan Ali Khan, Aneeba Nazim, Bushra Maqsood, Sundas Sajid, Namerah Nasir, Ghuncha Kamran, Amna Ahmed, Ifrah Tanweer, Bisma Noor, Fatima Akhlaq, Mahzareen Ishrat

Journal of Advances in Medicine and Medical Research, Page 1-11
DOI: 10.9734/BJMMR/2017/32710

Aim of Study: To assess the frequency of thalassemia in families with cousin marriages.

- To assess the level of awareness of Thalassemia in affected patients.

Introduction: Thalassemia is one of the most common inherited diseases in Pakistan. According to few experts approximately 5000 children are diagnosed with this disease every year and according to some sources there are more than 50,000 Thalassemic patients registered in treatment centers all over the country.

Methodology: This cross-sectional study was conducted at OSF, AMTF and Hussaini Blood Bank, Karachi from January to December 2015. A total of 100 sample size was selected. Only Thalassemic people having consanguineous marriages were included in the study. Informed consent was taken from both the parents and patients. Structured questionnaire was devised to collect data from patients.

Results: When asked 56% (p=0.00) of patients said they had Thalassemia in their families and 28% (p= 0.268) have had deaths in their families due to Thalassemia. 92 %( p=0.00) of parents with cousin marriages had no awareness about Thalassemia before their first Thalassemic child and 63% (p= 0.012) were not aware about the treatment for Thalassemia even after their first Thalassemic child. Regarding screening test for Thalassemia 62% (p= 0.012) were aware of it and 98% (p=0.46) agreed to go through screening.

Conclusion: The study concluded that cousin marriages had high frequency of Thalassemia. Awareness of the patients was inadequate. General public, parents and families of the patients should be educated in this regard.

Open Access Original Research Article

Effectiveness of Exercise Protocols in Treatment of Patellofemoral Pain Syndrome: A Prospective Comparative Study

Abdulmohesn H. Al Ghamdi, Naif Bin Nwihadh. Alshahrani, Faris Q. Alenzi

Journal of Advances in Medicine and Medical Research, Page 1-8
DOI: 10.9734/BJMMR/2017/33482

Background: Patellofemoral pain syndrome (PFPS) refers to anterior or retropatellar pain in knees. It is amongst the widespread and commonly known knee disorders seen in orthopaedic clinics, especially in young adult. The majority of patients who have are initially treated non operatively and many non operative imitative are successful wherein physical exercise remains the basic approach to deal with the ailment. Amongst various physical therapies used; open kinetic chain exercises (OKCE) and closed kinetic chain exercises (CKCE) have gained prominence.

Aim: The purpose of this study was to investigate the efficacy of closed versus open kinetic chain exercises in Saudi patients with PFPS, and to determine whether any of two programs offer any advantages over the other one.

Methodology: Forty male subjects with PFPS, were randomly assigned into two equal groups, each one consisted of 20 subjects, their age ranged between (20-40) years. Group 1; (28.20 ± 5.39) years, performed only closed kinetic chain exercises (CKCE). Group 2; (28.55 ± 8.00) years, performed only open kinetic chain exercises (OKCE). Pain intensity, patellofemoral scoring scale, isometric knee muscle strength, and patellar tendon muscle torque were measured before and after 6-weeks of treatment program.

Results: Statistical analysis showed that both CKCE and OKCE have a significant effect in reduction of pain intensity, increased isometric knee muscle force, and the patellar tendon muscle torque. Results also showed that CKCE has more effective results than OKCE.

Conclusion: This study indicates that both CKCE and OKCE could be used in treatment of patients with PFPS.

Open Access Original Research Article

Self-acceptance and Attitude towards Disability among People with Disability Attending a Nigerian Tertiary Health Facility

Olufemi O. Oyewole, Olatunde Odusan, Olubunmi T. Bodunde, Lateef O. A. Thanni, Bamidele S. Osalusi, Adekunle A. Adebanjo

Journal of Advances in Medicine and Medical Research, Page 1-10
DOI: 10.9734/BJMMR/2017/33268

Acceptance of disability status and positive attitude towards disability may be modulating factors in improving quality of life of individuals with disability. Although many studies have investigated attitudes toward disability, none has evaluated personal attitude towards disability among People With Disability (PWD) in Nigeria. This study was to investigate self-acceptance and attitude towards disability among PWD in Nigeria and to examine factors influencing their attitudes. A cross-sectional design was employed to recruit 260 PWD consecutively from out-patient clinic of a tertiary hospital in Nigeria. Data were collected on participants’ socio-demographic information, disability and attitude towards disability using World Health Organization Disability Assessment Schedule and Attitudes toward Disabled Persons Form A (ATDP-A) questionnaires. Descriptive and inferential statistics were used to analyse the data. Poisson regression was applied to assess factors associated with attitudes. ATDP- A score was 92.7 ± 21.1 (ranged, 34-170) with more participants (54%) having a score ≥90 which indicates a positive attitude and acceptance of their disabilities. Item-by-item analysis of responses to 30 items on ATDP-A Scale showed that negative attitudes were preponderant on items relating to their emotional and competitiveness. PWD largely held positive attitude towards disability and this remained unchanged when stratified by disability severity. Factors such as educational level, mild disability, younger age, type and duration of disability were associated with positive attitude held towards disability. In conclusion, PWDs largely held positive attitude, accepted their disability status irrespective of disability severity though negative attitudes were more on items relating to their emotion and competitiveness.