Open Access Case Study

The Uncommon Association between Typhoid Fever and Immune Thrombocytopenic Purpura

Maria Alejandra Pereda-Ginocchio, Rodrigo Zea-Vera, Sergio Vasquez- Kunze, Ray Ticse-Aguirre, Hector Sosa-Valle, Leslie Soto-Arquiñigo

Journal of Advances in Medicine and Medical Research, Page 1-5
DOI: 10.9734/JAMMR/2017/35137

Aims: To report an uncommon and underreported association between immune thrombocytopenic purpura and typhoid fever and review the available literature.

Presentation of Case: We present a 19 year-old female with two weeks of vaginal and gastrointestinal bleeding. At the time of presentation, fever, pallor, petechial lesions, ecchymosis and hepatosplenomegaly were noted. Initial workup for associated secondary viral infections were negative, hematologic studies were undertaken. Immune thrombocytopenic purpura was diagnosed and treatment with prednisone initiated. Nonetheless, after initial improvement, fever recurred and Salmonella typhi was isolated on blood culture, after treatment with ciprofloxacin symptoms disappeared with good evolution after outpatient follow-up.

Discussion: Immune thrombocytopenic purpura is commonly associated to several viral and some bacterial infections, yet Salmonella typhi has not been consistently proved to be associated. A growing body of literature shows that a diverse variety Salmonella sp. presentation can be associated to immune thrombocytopenic purpura. Both diseases reverse after antibiotic treatment.

Conclusion: Typhoid fever should be included in the differential diagnosis when other causes of immune thrombocytopenic purpura have been discarded and clinical presentation is suggestive.

Open Access Original Research Article

Parameters to Guide Rescue Therapy for Intravenous Immunoglobulin-resistant Kawasaki Disease

Toshimasa Nakada

Journal of Advances in Medicine and Medical Research, Page 1-8
DOI: 10.9734/JAMMR/2017/35081

Aims: To identify the most useful parameter to guide rescue therapy among the IVIG-resistant patients who received an initial single IVIG therapy dose with a delayed use of anti-inflammatory drugs (DUA) for Kawasaki disease.

Methods: The parameters of 174 patients who received the initial IVIG therapy at 2 g/kg/dose with DUA were investigated. These patients were divided into 135 IVIG-responders (responder group) and 39 IVIG-resistant patients. The 39 IVIG-resistant patients were further divided into two groups, a rescue group with 15 patients who received rescue therapies for initial IVIG therapy resistance and a non-rescue group with 24 children who did not receive the rescue therapy for resistance. Four parameters, including neutrophil counts, neutrophil %, neutrophil to lymphocyte ratio and C-reactive protein (CRP) value after initial IVIG therapy, were investigated retrospectively, as was the ratio of each parameter, defined as the ratio of the values after/before initial IVIG therapy.

Results: All four parameters and their ratios were significantly different among 3 groups (P < .05). Among these parameters, the ratio of CRP for the rescue group had the highest sensitivity and specificity, at 90.8%. Furthermore, the logistic regression analysis showed that only the ratio of CRP was an independent predictor for rescue group (P < .001, odds ratio: 66.807, 95% confidence interval: 7.468 ~ 597.655).

Conclusion: The ratio of CRP may be the most useful parameter for guiding rescue therapy among the IVIG-resistant patients who received an initial single IVIG therapy dose with DUA for Kawasaki disease.

Open Access Original Research Article

Effect of Curcumin on Spatial Working Memory and Oxidative Stress Biomarkers in Alloxan-induced Diabetic Swiss Albino Mice

Garkuwa Usman Adamu, Tanko Yusuf, Adamu Bello Yakubu, Alhassan Abdulwahab

Journal of Advances in Medicine and Medical Research, Page 1-8
DOI: 10.9734/JAMMR/2017/34411

The study was undertaken to evaluate the effect of curcumin on blood glucose level and neurobehavioral response in Alloxan-induced diabetic Swiss Albino mice. The animals were divided into five groups of four each (n=4). Group I served as control and received distilled water, group II, III, IV and V were diabetic and received olive oil 1 mL/kg, glibenclamide 1 mg/kg, curcumin 50 mg/kg and curcumin 100 mg/kg respectively. Diabetes was induced by injection of alloxan 150 mg/kg intraperitoneally. All administrations were done via oral gavage for duration of 21 days. Oxidative stress biomarkers (catalase, superoxide dismutase and glutathione peroxidase) and lipid peroxidation (MDA) were assayed using standard assay kits and cognitive impairment was determined using spontaneous alternation in the Y-maze. The results of the Y- maze significantly increase the spontaneous alteration percentage in spatial working memory at the dose of 100 mg/kg curcumin when compared to diabetic control. As regards to the oxidative stress biomarkers administration of 50 and 100 mg/kg b.w curcumin significantly increase the level of catalase as compared to diabetic control. Furthermore, there was a significantly increase in the level of superoxide dismutase at the dose of 100 mg/kg as compared to the control. However, there was a significant decrease in the malondialdehyde (MDA) level as compared with the control. Also when compared with the standard drug glibenclamide with the two doses of circumin, there was a significant decrease in the MDA level. This study demonstrated that curcumin at a dose of 100 mg/kg significantly (p < 0.05) attenuated diabetes-induced cognitive impairment in the Y- maze. It may be concluded that oral administration of cucurmin for 21 days increases spontaneous alteration in spatial working memory, and has protective effects against oxidative stress biomarkers in alloxan induces diabetes.

Open Access Original Research Article

Angiogenesis Inhibiting Crosslinked Albumin Hydrogel as a New Approach for Adhesion Prevention

Odermatt Erich, Freytag Christiane

Journal of Advances in Medicine and Medical Research, Page 1-10
DOI: 10.9734/JAMMR/2017/33960

Aims: Two crosslinked albumin hydrogels with angiogenetic inhibition activities were tested in situ for their potential to prevent adhesions in rabbits.

Methodology: The albumin hydrogels – one viscous and another non-viscous - were applied with a 4:1 double chamber syringe onto a traumatized rabbit abdominal wall. This allowed testing anti-adhesion properties and biocompatibility with respect to their wound healing effects. Seprafilm® was used as a negative control; the positive control remained untreated.

Results: The study indicated good biocompatibility properties for both hydrogels and Seprafilm®, such as the absence of cytotoxic effects, missing signs of systemic toxicity as well as undisturbed wound healing. However, while Seprafilm® was near to complete resorption, some remnants of the hydrogels could still be seen after 21 days. Additionally, slight signs of inflammation, especially in the spleen were observed after the intra-abdominal implantation of 1.3 ml hydrogel per kg body weight possibly due to beginning phagocytosis. Nevertheless, both hydrogels as well as Seprafilm® displayed good anti-adhesive effects in the abdominal wall model. The trend for the hydrogels to have lower and less tense adhesions compared to the untreated control and even Seprafilm® is in part explained by the angiogenetic inhibition effect of the hydrogels.

Conclusion: The crosslinked albumin hydrogels and the Seprafilm® showed good anti-adhesive efficacy. These promising results of crosslinked albumin hydrogels may even lead to further application forms such as non-viscous sprays which would increase fast, easy and secure handling of this effective device.

Open Access Original Research Article

Risk Factors Associated with Diabetes Mellitus among Adults in the Hohoe Municipality of Ghana

Joseph Wolorm Kwame Fiagbe, Wisdom Takramah, Wisdom Kudzo Axame, Richard Owusu, Phyllis Atta Parbey, Martin Adjuik, Mohamed Takase, Elvis Tarkang, Margaret Kweku

Journal of Advances in Medicine and Medical Research, Page 1-12
DOI: 10.9734/JAMMR/2017/33846

Background: Diabetes Mellitus (DM), one of the Non-Communicable Diseases (NCDs) is a major cause of morbidity and mortality worldwide and is increasingly becoming an important public health concern. This study examined the prevalence, control and risk factors associated with DM2 among adults in the Hohoe Municipality.

Methods: This was a hospital-based case control study that involved 70 cases and 140 controls. Data was collected using a face-to-face interview with structured questionnaires. Blood pressure, fasting blood glucose and anthropometric indices were measured with appropriate instruments following standard procedures. Differences in means were determined using t-test. The Chi-square test and the conditional logistic regression model were used to determine association and the strength of the association between independent categorical variables and DM2 respectively.

Results: Uncontrolled diabetes among cases was 78.6%. Prevalence of hypertension among cases was higher (64.3%) than in controls (60.0%). Adults with overweight and obesity were 13.03 and 12.81 times more likely to develop diabetes (AOR=13.02, p=0.011) and (AOR=12.81, p=0.015) respectively. Civil servants were 0.15 times less likely to have diabetes (AOR=0.15, 0.048). Adults who recently tested their blood glucose, or current/ex-smokers were 12.03 and 12.88 times more likely to develop diabetes (OR=12.03, p<0.001) and (OR=12.88, p=0.037) respectively.

Conclusion: One out of 5 diabetics could not control their blood glucose levels. Six out of 10 diabetics had hypertension. Recent testing of blood sugar, overweight and obesity, smoking and occupation were factors found to be associated with diabetes in the Hohoe Municipality.

Open Access Original Research Article

Cardiopulmonary Resuscitation Skills of Some Nigerian Primary and Secondary Schools Teachers

Adedamola Olutoyin Onyeaso, Onyedikachi Oluferanmi Onyeaso

Journal of Advances in Medicine and Medical Research, Page 1-8
DOI: 10.9734/JAMMR/2017/34645

Background/Aim of Study: Training of primary and secondary schools teachers on cardiopulmonary resuscitation (CPR) has received the support of the international community for the purposes of increasing potential bystander CPR providers for out-of –hospital cardiac arrests and teaching of the school children the same, but the situation is different in Nigeria. This study aimed at assessing the CPR skills of a group of Nigerian teachers.

Study Design: Cohort experimental study.

Place and Duration of the Study: Department of Human Kinetics and Health Education, Faculty of Education, University of Port Harcourt in September 2016.

Methodology: A group of Nigerian primary and secondary schools teachers who came for further education at the University of Port Harcourt, Port Harcourt, Nigeria had their pre-training and post-training CPR skills assessed by a certified CPR instructor. The training was based on the American Heart Association (AHA) conventional CPR teaching standard and a modified AHA CPR Skills Evaluation Guide was used in the data collation.

Results: Although the pre-training CPR skills of the teachers were very poor, they significantly improved after the training (P < 0.05).

Conclusion: Nigerian primary and secondary schools teachers could serve as potential bystander CPR providers, as well as instructors to the children and the public, if well exposed as in advanced parts of the world.

Open Access Original Research Article

Effect of Lighting on Concentration of Medical Students: A Randomised Controlled Trial

Umar Bin Mohd Ramzan, Yang Yiqin, Suniljeet Singh Sandhu, Aqilah Syafiqah Binti Mahamad Yasri, Nur Syazzwanis Binti Abdul Halim, Nadiahtul Izzati Binti Mohd Dan

Journal of Advances in Medicine and Medical Research, Page 1-10
DOI: 10.9734/JAMMR/2017/35245

Aims: To determine the effect of lighting on concentration in college students.

Study Design: Randomised controlled trial.

Place and Duration of Study: Melaka-Manipal Medical College (MMMC), Muar Campus, Johor, Malaysia in July 2016.

Methodology: 50 students were randomly chosen and then assigned to intervention and control groups equally via randomisation. 41 students participated in this study. Participants of both groups were required to perform d2 Test of Attention and answer a structured questionnaire. The intervention group was placed in room with low luminosity while the control group was in a room with higher luminosity. Data were analysed using SPSS version 18.

Results: The intervention group had a mean score of 526.9 for concentration performance, which was lower than that of the control group at 615.3. The mean for error percentage of the intervention group was 0.10, whereas the control group had a lower mean of 0.03 for the same outcome. In general, the intervention group had significantly weaker concentration and more errors made as compared to the control group.

Conclusion: The results of this study highlight the positive effect of a higher lighting intensity has on concentration. Thus, it is recommended that educational institutes take into consideration the intensity of lighting as an important factor when setting up and designing their classrooms.