Open Access Case Study

Effective Physical Therapy Treatment of Post-Cesarean Section Low Back Pain – Case Report

Timothy Hui

Journal of Advances in Medicine and Medical Research, Page 1-5
DOI: 10.9734/JAMMR/2017/34897

Introduction: Treatment of low back pain after cesarean section has been studied with exercise programs, but there has been little with a full physical therapy treatment plan involving manual therapy and therapeutic exercise.

Case: 38 year old female 2.5 years after cesarean section. Presenting with a previous history of low back pain treated by laminectomy. Patient reported marked difficulty lifting her child due to low back pain.

Interventions: Manual therapy was performed, involving soft tissue manipulation, to abdominal muscles, gluteal muscles, and SI joints. Therapeutic exercise involved strengthening the abdominals and gluteus medius muscles. Patient was treated 7 times over 5 weeks.

Outcomes: Pain on Verbal Numeric rating scale (VNRS) decreased from 6-7/10 to 0/10.  Objective measure by Focus on Therapeutic Outcomes (FOTO) lumbar scale showed improvement from 59 to 82, with an increase of 8 points being a clinically significant improvement.  Patient was able to lift her child pain-free.

Conclusions: A physical therapy treatment plan combining manual therapy and therapeutic exercise was very effective in treating a patient with low back pain after a cesarean section.

Open Access Case Study

Streptococcus Toxic Shock Syndrome Due to Non Haemolytic Streptococcus pyogenes

Jorge Soria, Jorge Mosqueira, Alfredo Guillen, Leslie Soto

Journal of Advances in Medicine and Medical Research, Page 1-5
DOI: 10.9734/JAMMR/2017/35171

Aim: Describe the detection of an unusual pathogen associated with a common clinical presentation with abrupt worsening.       

Case Presentation: We present the case of a 36-year-old Peruvian male who presented to the Emergency Department with a 24-hour history of fever, nausea, vomits and diarrhea. He received intravenous hydration and antibiotics. In the next eight hours he became toxic and developed septic shock. Despite intensive vasopressor therapy and broad-spectrum antibiotics, patient died of multiorganic failure within the first 48 hours. The first blood culture was positive for Streptococcus pluranimalium, but subsequent molecular testing of the strain showed non-beta-haemolytic Streptococcus pyogenes.

Discussion: Streptococcus pluranimalium is a gram positive cocci isolated from organ samples of different animals. It has been described few cases of this bacteria causing human infection. We discuss the similarities and differences between the reported cases and our findings. Surprisingly, after using more advanced tests, the isolated strain was identify as a non-beta-haemolytic Streptococcus pyogenes.

Conclusion: The detection of uncommon human pathogens in challenging clinical scenarios requires an early and accurate typification.

Open Access Original Research Article

Sex-selective Abortion in Rural Pakistan

Kanwal Qayyum, N. Rehan

Journal of Advances in Medicine and Medical Research, Page 1-7
DOI: 10.9734/JAMMR/2017/33824

Aims: The existence of sex-selective abortions has been documented in Asian countries including Pakistan. However, most of these studies have used indirect methods of estimation based on sex ratio at birth, which is known to give accurate estimates only in countries where complete registration of births is available, which is not the case in Pakistan. In the absence of birth registration, only direct estimation can provide the evidence and estimates of sex-selective abortion. Therefore, when a large survey on Gender-based violence was being planned, it was decided to add a component on sex-selective abortion also. 

Study Design:  Non- interventional Cross-sectional Study.

Place and Duration of Study: Six Districts of Pakistan: 2011- 2014.

Methodology: This study, was undertaken during 2011-14 in six rural districts; two from three provinces; Balochistan, Punjab and Sindh as part of a survey on domestic violence among 4,885 married women aged between 18-49 years. The fourth province, Khyber Pakhtunkhwa was not included because of political turbulence at that time. 

The sample of 4,885 women was selected through multistage random sampling. Out of these 4,885 women, four thousands, six hundred and twenty (4620) were parous and the present analysis is based on responses of these 4,620 women. 

Results: Out of 4,620 ever-pregnant women, 968 women (20.9%) reported ever having induced abortion. According to discussion with these 968 women, the reason for abortion in 338 women (34.9%) was presence of a female fetus. Some of them reported to have got ten the sex of the foetus confirmed by ultrasonography. The highest rate of sex-selective abortion was in Balochistan (62.5%). The corresponding figures were 19.6% for Sindh and 18.8% for Punjab. The prevalence of sex-selective abortion in Balochistan was significantly higher (P<0.0001) than the other two provinces.

Conclusion: Although the present study reveals a high prevalence of sex-selective abortions in Pakistan, yet larger studies based on both rural as well as urban areas encompassing quantitative as well as qualitative data are needed to further explore the phenomenon.

Open Access Original Research Article

The Continued Burden of Renal Cell Carcinoma in a Developing Country. Lessons Learnt or Not Learnt?

F. O. Ugwumba, O. C. Okafor, I. I. Nnabugwu, K. N. Echetabu, A. D. Okoh, E. F. Nnakenyi, E. I. Udeh

Journal of Advances in Medicine and Medical Research, Page 1-8
DOI: 10.9734/JAMMR/2017/34941

Aims: To determine the incidence, gender distribution, presentation, management, histopathological features and outcome of renal cell carcinoma (RCC).

Study Design: Retrospective study.

Place and Duration of Study: University of Nigeria Teaching Hospital, Saint Mary’s Hospital, Royal Hospital, Mother of Christ Specialist Hospital and Eastside Hospital between January 2002 and December 2015.

Methodology: We included 54 patients (29 men, 25 women; age range 19–67 years). Information abstracted included age, gender, presenting symptoms, imaging modality used, clinical stage of the disease and other relevant laboratory results. Histopathology results, duration of follow up, clinical outcome, use of targeted therapies and their duration.

Results: The mean age was 37.61 ± 15.1 years Tumours were most frequent in the 4th decade of life, the male: female ratio was 1.16: 1. Smoking and obesity as risk factors were present in 7 patients (all male) and 2 patients respectively; familial-related RCC, as well as VHL-related RCC or long term dialysis-related RCC were absent. Loin mass in 54 patients (100%) and loin pain in 50 patients (92.5%) were the more common presentations. Right-sided tumours were slightly more common (28 patients, 51%).

Late presentation was the bane, with onset-presentation interval being 3–34 months (mean 10). Commonest imaging modality was ultrasound (54 patients, 100%); intravenous urography (30 patients, 55.5%), and CT urography/ abdomen (24 patients, 44.4%). 8 patients were managed non-operatively, while 46 patients (85.2%) had radical nephrectomy. Clear cell and papillary carcinoma were the histologic patterns seen in 43/46 patients (93.4%) and 3/46 patients (6.5%) respectively. Follow up was short, mean 7 months (range 4-46 months).

Conclusion: Late presentation, paucity of radiotherapy services, short duration of follow-up and prohibitive costs of targeted therapies were challenging.

We recommend enlightenment and strengthening of the health system aimed at earlier detection.

Open Access Original Research Article

Antibiogram of Vulvovaginal Candidiasis amongst Pharmacy Undergraduates in a Nigerian University

Angus N. Oli, Chiamaka B. Ugwu, Eunice O. Osuala, Charlotte Blanche Oguejiofor, George Uchenna Eleje, Felix N. Osuala, Malachy C. Ugwu

Journal of Advances in Medicine and Medical Research, Page 1-10
DOI: 10.9734/JAMMR/2017/33340

Objectives: To assess the knowledge, perception, incidence and the antibiogram of vulvovaginal candidiasis (VVC).  

Methods: Validated questionnaires were used to collect demographic information of consenting study participants and to test the participants’ level of knowledge and perception of VVC among pharmacy undergraduates. High-vaginal swab specimens were also collected for isolation of Candida species and speciation using standard yeast identification protocol and CHROMagar respectively.

Results: Among the 160 participants, yeasts were detected in 43.75% and 27.50% by culture and direct microscopy respectively. Having multiple sexual partners (at least two), poor vaginal hygiene and antibiotic usage were shown to significantly increase the incidence of VVC (p<0.05). Yeasts other than Candida albicans were predominant (66.67%), especially Candida tropicalis (40.00%). Although participants’ knowledge about VVC was good (80.49%), their perception was only average (54.10%). Susceptibility test showed that the isolates were susceptible to voriconazole (84.37 ± 5.70%), fluconazole (71.54 ± 7.66%) and nystatin (65.70 ± 12.33%). The commonest isolate (Candida tropicalis) was farely susceptible to voriconazole (77.00%) and fluconazole (63.00%) but resistant to nystatin (36.00%).

Conclusion: There is high prevalence of VVC despite good knowledge and average perception. Candida tropicalis was predominant in the study. Based on antibiogram, Voriconazole was the most effective drug/antibiotic and drug of choice for therapy.

Open Access Original Research Article

Abnormalities in Liver Function Tests in HIV Positive Children on Highly Anti-retroviral Therapy in a Tertiary Hospital in Abuja, Nigeria

A. A. Okechukwu, M. S. Dalili, U. D. Itanyi, J. O. Lawson

Journal of Advances in Medicine and Medical Research, Page 1-11
DOI: 10.9734/JAMMR/2017/34659

Background: Liver related deaths are becoming common amongst HIV-infected individual with longer survival on antiretroviral therapy. This study was undertaken to document derangement in liver function tests with associated risk factors in HIV infected children and adolescents on highly active antiretroviral therapy overtime in our health facility, for guide for intervention, and baseline information. 

Methods: A cross sectional hospital based study was conducted among HIV-infected children and adolescents aged 6 months-18 years on antiretroviral therapy in our health institution from February to May 2016 for the above objectives.

Results: Of the total of 161 patients studied with a mean age of 10.13±4.5 years, 103(64.0%) were males, and 137 (85.1%) on 1st line HAART. Hepatotoxicity was seen in 37(22.9%) of patients, with grade 3 and 4 toxicity (alanine aminotransaminase of 5.0 - >10.0 x ULN) being recorded in 3.4% of those on antiretroviral therapy for <10 years and 13.3% of those >10 years. Grade 3 and 4 hepatotoxicity was also found to be commoner in patients on zidovudine + lamivudine + nevirapine (5.7%), zidovudine + lamivudine + lopinavir-ritonavir (18.2%), and tenofovir + emtricitabine + lopinavir-ritonavir (100%). Risk factors for hepatotoxicity were 2nd line medication [OR of 0.26 (CI 0.81-0.97), p value = 0.013, and co-administration with trimethoprim/sulfamethoxazole [OR 0.18, (CI 0.55-9.59), p value =0.026)].

Conclusion:  HAART was well tolerated by most children and adolescents in this study, however, those on 2nd line medication and co-administration with trimethoprim/sulfamethoxazole need more regular monitoring for hepatotoxicity.

Open Access Original Research Article

Comparison of Diastolic Function of Homozygous Sickle Cell Anaemia with Haemoglobin AA Children Using Basic Mitral Inflow Doppler Echocardiography

Bamigboye-Taiwo Olukemi, Okeniyi John Akintunde, Omokhodion Samuel, Adeodu Oluwagbemiga, Elusiyan Jerome Boluwaji

Journal of Advances in Medicine and Medical Research, Page 1-9
DOI: 10.9734/JAMMR/2017/34717

Aims: Sickle cell anaemia (SCA) remains the most prevalent and arduous inherited disease in Nigeria. Various adverse cardiovascular consequences have been documented including cardiac chamber enlargement and left ventricular (LV) hypertrophy. Diastolic dysfunction, a recognized risk factor for death, has been reported in adults however the time of onset remains unknown. A dearth of literature persists about the impact of SCA on diastolic function among children. This study aimed to determine LV diastolic function in children with SCA in steady state and compare with apparently healthy haemoglobin type AA controls.

Study Design: Observational, case-controlled, cross-sectional study.

Place and Duration of Study: Department of Paediatrics, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife and the Bethesda Heart Centre, Ibadan, Nigeria, six months.

Methodology: Fifty subjects aged ≤ 15 years and 50 age- and sex-matched controls to determine and compare basic mitral inflow indices of diastolic function using 2-D guided Doppler echocardiography.

Results: Subjects had significantly higher left atrial and LV dimensions, mean E-wave velocity (1.08 versus 0.94 m/ s, p = .001) and A-wave velocity (0.58 versus 0.52 m/ s, p < .001) than controls. Slightly higher E/ A ratio and longer deceleration time were observed in subjects but without statistical significance [p = .48 and p = .33 respectively]. E- and the A-wave velocities in subjects did not correlate with age or BSA unlike in controls which showed negative correlations. There was however significant negative correlation between haematocrit and the A-wave velocity and the E/ A ratio of subjects.

Conclusion: Even in steady state, children with SCA have relatively abnormal early and also late LV diastolic filling. These did not correlate with age or BSA. Haematocrit showed significant correlation with late diastolic LV filling. Evaluation of left ventricular diastolic function should be routinely used in cardiac assessment of children with SCA.