Open Access Case Report

Lateral Incisor: Overtaking Others from behind

Jakati Sanjeev, Patil Sayam

Journal of Advances in Medicine and Medical Research, Page 1-7
DOI: 10.9734/JAMMR/2017/34756

In order to preserve the integrity of the dental arch, repositioning of the displaced lateral incisors to their normal position next to the central incisors should be considered. The conventional method for aligning ectopic lateral incisor is to tie the ectopic teeth with the help of a ligature wire to the initial aligning round-NiTi wire, which is the base wire or by engaging open coil spring. This would take more time to align the ectopic tooth. Hence we are presenting here 3 cases (Figs. 1-3) of lingually placed lateral incisor & will evaluate the best technique to align them properly.

Open Access Case Study

Gouty Tophi in Lumbar Region that Mimicked Chondrosarcoma, a Case Report

Nicasio Arriada, Juan Pablo González-Mosqueda, Katiuzka Casares-Cruz, Jose Luis Soto-Hernandez, Martha Lilia Tena-Suck

Journal of Advances in Medicine and Medical Research, Page 1-6
DOI: 10.9734/JAMMR/2017/32813

Aims: To report a case of tophaceous gout in the lumbar spine with atypical imaging presentation, mimicking a chondrosarcoma and to discuss the differential diagnosis, illustrate the pathological aspects and surgical management.

Presentation of Case: A 40 years old hypertensive man presented with a two year history of progressive back pain, swelling on lumbar region and inability to walk by severe pain upon standing. Image studies showed a lumbar lesion with spongy calcifications and L4 pedicles destruction, We found consistent with the diagnosis of a chondrosarcoma. The patient had hyperuricemia. He underwent excision of the lesion. A trans-operative pathological study showed crystals, hemosiderophages and multinucleated giant cells, suggestive of a granulomatous lesion. On immunohistochemistry, the giant cells had positive immunoreaction to osteconectin, vimentin, CD68, fascin, IL1a, IL6, IL18 and TNFα. Gouty tophi was diagnosed. The patient improved after decompression, resection and instrumentation with transpedicular screws at L3, L5 and S1.

Discussion: Due to the variability of clinical presentation and radiological appearance, some authors have designated gout as a great mimicker it may simulate soft tissue tumors, intra articular and bone tumors or metastatic disease. In the spine it has been misdiagnosed with tumors, tuberculosis or pyogenic discitis.

Conclusion: Most cases of tophaceous gout of the spine have required surgical treatment for diagnosis, spinal cord and nerve roots decompression or correction of spinal instability when bone destruction is present.

Open Access Original Research Article

Patients with Abdominal Aortic Aneurysm Demonstrate Higher Levels of Non-cholesterol Sterol Markers of Endogenous Cholesterol Synthesis

Miroslav Prucha, Petr Sedivy, Petr Stadler, Ladislava Dubská, Frantisek Pehal, Josef Hyanek

Journal of Advances in Medicine and Medical Research, Page 1-6
DOI: 10.9734/JAMMR/2017/33956

Aims: To establish the levels of selected non-cholesterol sterols in patients with abdominal aortic aneurysm (AAA) and to compare them with levels in non-AAA patients treated for lipid metabolism disorder. To compare the levels of high-sensitivity C-reactive protein (hs-CRP) and Lp-PLA 2 – inflammation markers in the same group of patients.

Study Design: A total of 58 AAA patients indicated for elective surgical procedure and 20 non-AAA patients in the control group treated for lipid metabolism disorder were examined.

Methodology: Lathosterol (Lat), desmosterol (Des), lanosterol (Lan), campesterol (Cam) and sitosterol (Sit) were analysed with the use of GC/MS in fasting plasma of patients with AAA and outpatients suffering from lipid metabolism disorder. hs-CRP and lipoprotein-associated phospholipase A2 were analysed in both groups.

Results: hs-CRP levels were significantly increased in patients with AAA compared to the control group (med. 3.6 mg/L, IQR 1.83 to 6.0 mg/L vs. 2.05 mg/L, IQR 0.99 to 3.0 mg/L, P = .007). Levels of non-cholesterol precursors of cholesterol synthesis – Lan, Des and Lat – were statistically significantly higher in the group of AAA patients compared to non-AAA patients (Lan: med. 0.28 µmol/L, IQR 0.24 to 0.32 µmol/L vs. 0.23 µmol/L, IQR 0.20 to 0.25 µmol/L, P = .004; Des: med. 3.69 µmol/L, IQR 3.12 to 4.66 µmol/L vs. 3.03 µmol/L, IQR 2.68 to 3.33 µmol/L, P = .0005; Lat: 5.95 µmol/L, IQR 5.18 to 6.9 µmol/L vs. 4.72 µmol/L, IQR 4.32 to 5.22 µmol/L, P = .0002) while there were no statistically significant differences in the absorption parameters of Sit or Cam in either group (Sit: med 6.29 µmol/L, IQR 5.02 to 9.37 µmol/L vs. 6.12 µmol/L, IQR 4.99 to 7.01 µmol/L, P = .65; Cam: med 8.6 µmol/L, IQR 7.31 to 10.71 µmol/L vs. 8.46 µmol/L, IQR 7.24 to 10.86 µmol/L, P = .96).

Conclusion: The markers of endogenous cholesterol synthesis in AAA patients are higher compared with those in non-AAA patients treated for lipid metabolism disorder. Higher hs-CRP levels in AAA patients show increased inflammatory activity compared with the control group.

Open Access Original Research Article

Motivation, Career Aspirations and Reasons for Choice of Medical School among First Year Medical Students in Ogun State, Nigeria

T. Ashipa, M. R. Akinyinka, W. Alakija

Journal of Advances in Medicine and Medical Research, Page 1-14
DOI: 10.9734/JAMMR/2017/33750

Introduction: The current challenges facing the Nigerian health sector make it imperative to examine the long term goals of students training to become medical doctors. Such information is vital for policy makers and administrators of medical schools charged with forecasting the future manpower needs of the nation’s health sector.

Aim: The aim of the study was to ascertain the factors that influenced the choice of medical school among first year students of the Benjamin Carson Sr. School of Medicine, Babcock University, Ogun State, Nigeria. The study also examined the career aspirations of the medical students and their reasons for choosing medicine as a discipline.

Methods: The study design was a descriptive cross-sectional survey. Data was collected on the students’ career aspirations and the factors influencing their choice of a medical school using a structured self-administered questionnaire.

Results: After completing medical school, 70.6% of the students desired to set up their own medical practice and 88.2% of them desired to pursue specialty training. Surgery (43.1%), Obstetrics & Gynaecology (13.7%) and Paediatrics (11.8%) were the preferred choice of specialty among the students. Only 13.7% of the medical students planned to undertake further training in basic medical sciences. The students’ choice of medical school was influenced by their preference for the religious and moral discipline of the institution and the ability of their sponsors to afford a private medical school. Most students (90.2%) opted to study medicine because of their interest in the course.

Conclusion: Majority of the students (86.3%) desired to undergo specialty training after graduating from medical school. Less than 20% of the students desired to practice in Nigeria or pursue further training in basic medical sciences upon completing their medical education. Further research is required to identify factors that will encourage the students to pursue careers in these areas.

Open Access Original Research Article

Relationship between Diabetes Education and Glycaemic Indicators of Patients in Diabetes Care Units at Three Hospitals, Khartoum State - Sudan

Siham Ahmed Balla, Sulaf Ibrahim Abdelaziz, Khitma Abdelgadir Mohamed Ali, Nazik Mahmoud Abdelaal Abdeldafia, Kamil Mirghani Ali Shaaban

Journal of Advances in Medicine and Medical Research, Page 1-6
DOI: 10.9734/JAMMR/2017/34473

Background: Diabetes education could contribute to the control of glycaemic status of the patients. Objective: It was to identify the education received by the diabetic patients and its relationship to their glycaemic indicators in diabetic care units at three hospitals in Khartoum State.

Methods: A descriptive cross section study was carried out. A sample of 251 diabetic patients who attended for follow up was determined.  An exit interview was carried out using a structured questionnaire. The patients` cards were reviewed for the most recent glycaemic indicators. Ethical clearance was obtained. Chi square test was used to test the association of the provided diabetic education with the glycaemic indicators of the patients.

Results: The females and males accounted to 67.7% and 32.3% respectively. Patients in the age group 35-65 years were 78.8% (141) and 77.3% (194) were literate. One hundred and ninety seven (78.5%) were either pensioners or housewives. Education on physical activity, diet control, blood glucose monitoring and foot care was received by77.7%, 86.9%, 12.4% and 45.8% of the patients respectively. Fasting blood sugar <=110 mg/dl, post prandial blood sugar <=180mg/dl and HBA1c < 7% were not significantly associated with receiving education, P-value > 0.05.

Conclusion: The association between receiving diabetes education and normal glycaemic indicators was insignificant.

Open Access Original Research Article

Clinical and Demographical Characteristics of Turkish Patients with Lichen Planus Pigmentosus

Ayşe Akbaş, Fadime Kilinç, Sertaç Şener, Huban Sibel Orhun, Akin Aktaş

Journal of Advances in Medicine and Medical Research, Page 1-12
DOI: 10.9734/JAMMR/2017/34341

Lichen Planus Pigmentosus (LPP) is a disease that is mostly seen in India, Latin America and Far East. It is rarely seen and its etiopathogenesis has not been completely clarified yet. In this study, we aimed to investigate the clinical and demographic characteristics of Turkish paitents diagnosed with LPP.

We retrospectively reviewed medical records of patients with LPP, who had been admitted our outpatient clinic between 2009 and 2015. The following clinical and demographic data were obtained from the records: age of onset, clinical findings, lesion site, laboratory findings, etiological factors, concomitant diseases and drug history. There were 47 LPP patients who were diagnosed clinically and histopathologically. The age average of patients was 51.7. 73% were women and 27% were men. Average age  was 52.2 in women  and 50.6 in men.

When evaluated in terms of localization, 47% was inverse, 45% was localized and 6% was generalized. One patient was in zosteriform pattern. (2%). Area of involvement was as follows:  10.6% face, 23.4% trunk, 4%  legs. 36.7% of patients had more than one body part involved. Axilla was the most common localization site with a ratio of 17%.

Open Access Original Research Article

A Cardiac Mouse Model for Nongenomic Mineralocorticoid Receptor Effects

Sabrina Winter, Barbara Schreier, Ulrich Gergs, Claudia Grossmann, Sindy Rabe, Igor B. Buchwalow, Michael Gekle, Joachim Neumann

Journal of Advances in Medicine and Medical Research, Page 1-13
DOI: 10.9734/JAMMR/2017/34389

Aim: As a ligand-dependent transcription factor the mineralocorticoid receptor (MR) regulates water and electrolyte homeostasis in epithelial tissues but also plays a crucial role in the pathogenesis of cardiovascular diseases. In addition to its genomic effects, via the glucocorticoid response elements, rapid interactions with cytosolic signaling cascades have been described, but the physiological or pathophysiological role of this nongenomic MR pathway is still hardly known.

Study Design: Transgenic and wild type mice (FVB/N background) of random sex were used in this study. Experimental groups (n = 8-10 for each subgroup) were: A) Cardiac function and gene expression at six months of age; B) Cardiac function and gene expression at twelve months of age; C) Cardiac function at six months of age after 4 weeks aldosterone/NaCl treatment.

Place and Duration of Study: Institute for Pharmacology and Toxicology, Medical Faculty of the Martin Luther University Halle-Wittenberg, between June 2008 and November 2011.

Methodology: To investigate the cardiac nongenomic MR effects in vivo, we generated a transgenic (TG) mouse model with cardiomyocyte-specific overexpression of a truncated variation of the human MR (hMRDEF). Characterization of six and twelve months old mice focused on cardiac function, electrical activity, and gene transcription under baseline and stimulation conditions by either isoproterenol or aldosterone/NaCl treatment.

Results: Whereas overexpression of a full-length MR in the heart was lethal, the phenotype of the hMRDEF-TG mouse seemed inconspicuously. Noteworthy, the nongenomic MR effect modulated the cardiac transcription of the α-subunit of the voltage-gated potassium channel ERG, which resulted in prolonged intraventricular electrical activity. Therefore, nongenomic MR signaling pathways may be responsible for MR-associated cardiac arrhythmias.

Conclusion: Our findings demonstrate that nongenomic MR effects can modulate cardiac electrophysiology in vivo and therefore indicate an involvement of nongenomic MR signaling pathways in the pathogenesis of cardiac dysfunction.