Open Access Case Study

An Uncommon Presentation of Klippel-Trenaunay Syndrome Presenting with Acute Hip Pain

Hana Sahli, Asma Bachali, Selim Daas, Zied Ezzeddine, Khaled Bouzaidi, Rawdha Tekaya

Journal of Advances in Medicine and Medical Research, Page 1-4
DOI: 10.9734/JAMMR/2017/36204

Introduction: Klippel-Trenaunay syndrome (KTS) is a syndrome that affects the development of blood vessels, soft tissues and bones. We report a rare case of KTS presenting with spontaneous acute hip pain.

Case Presentation: A 38-year-old male patient presented to the emergency department with a complaint of right hip pain and elevated temperature of one moth duration. These symptoms disappeared spontaneously after two days of hospitalization. Computerized tomography (CT) scan revealed a common iliac vein hypoplasia and collateral circulation associated with asymmetric psoas muscles. A diagnosis of KTS was made based on the vascular abnormalities and associated soft tissue changes.

Conclusion: Our case illustrates a new case of KTS presenting with spontaneous acute hip pain.

Open Access Original Research Article

Prevalence of Musculoskeletal Pain and Body-Chair Mismatch among Junior High School Students in Ghana: A Risk Factor for the Young

Ackah Martin, Oppong Yeboah Bertha, Boakye Hosea, Boakye Acheampong, Ababio Edward, Osei Yeboah Cynthia

Journal of Advances in Medicine and Medical Research, Page 1-9
DOI: 10.9734/JAMMR/2017/36393

Aim: To determine the prevalence of musculoskeletal pain and body-chair mismatch among Junior High School (JHS) students in Ghana.

Study Design: This was a cross sectional study.

Place and Duration of Study: The study was conducted at the Ministry of Health Basic School (MoH), Korle-Bu, Accra Ghana, in May 2016.

Methodology: Two hundred and fifty-five (255) students were recruited for this study. The modified Nordic questionnaire was used to obtain the prevalence of musculoskeletal (MSK) pain information from the participants; a retractable tape measure was also used to measure the body and chair dimensions. All measurements were taken with the participants in T-shirt and shorts and in an erect -sitting position with feet (only socks) flat on the floor. The match-mismatch decisions were taken based on existing rules. SPSS version 22.0 and Microsoft excel 2010 were employed to analyze all the study variables.

Results: Two hundred and fifty-five (255) participants were recruited for this study, out of which 133 (52.6%) were males. The mean age of the participants was 13.11±0.98 years. The study comprised of 103 (40.4%) Junior High School one (JHS 1). The prevalence of musculoskeletal pain was 57.5%. There was a significant association between the students’ body-dimension and classroom furniture mismatch (p=0.001). Pain intensity level and the forms/level of the students were significantly associated. There was no significant difference between the prevalence of musculoskeletal complaints and the sexes (p=0.522) and forms (p=0.895).

Conclusion: The result of this present study suggests that, there is a high prevalence of musculoskeletal pain among JHS students in Ghana. The high mismatch of the school chairs implies that, they were acquired without ergonomic considerations which could be a risk factor for development of musculoskeletal pain in the young.

Open Access Original Research Article

Survey Report on Parents and Patients Related to the Use of Cannabidiol Symptomatic Epilepsy Secondary to Tuberous Sclerosis Complex (TSC) in Mexico

Carlos G. Aguirre-Velázquez, Mario Peral-Ríos, Evelyn López-Guevara, Kenny Lemus-Roldán

Journal of Advances in Medicine and Medical Research, Page 1-8
DOI: 10.9734/JAMMR/2017/36585

A descriptive observational study using a structured survey was circulated through Facebook networks that comprised of parents of children and patients with tuberous sclerosis complex and epilepsy on conventional or medicinal cannabis/cannabidiol (CBD) treatment. Of 105 surveys, 58 were obtained by self-selection and 10 from patients treated with CBD. Forty-seven children and 11 adults, 52% male, 48% female, were included. Epileptic syndromes were present in 70.6% of the cases of which Lennox-Gastaut Syndrome (LGS) was in 20, West syndrome (WS) in 20, and epilepsy with myoclonic-astatic crises (MAE) in 6. Refractory epilepsy (RE) was present in 22 (38%) cases. Ten patients (17.2%) underwent CBD treatment; seizures decreased for 7 patients, with significant decreases in 6 and minor decreases in 1. No effect was seen in 3 patients and there were no seizure-free cases or cases where the seizure worsened. Improvement in quality of life parameters were observed. Mild adverse events were observed in 4 cases (40%). Monthly treatment costs ranged from $300 pesos with CBD to $35,000 pesos with everolimus. Average monthly costs with CBD were $4,039 ± 2,530 pesos. Patient and parent reports suggest medicinal cannabis is a therapeutic option offering improvement in seizures and quality of life at a moderate cost.

Open Access Original Research Article

Dyslipidaemia and Cytokine Profile in Patients with Gout: The Role of IL-6, IL-18 and Hyperuricemia in the Development of Metabolic Disorders

D. A. Nabieva

Journal of Advances in Medicine and Medical Research, Page 1-10
DOI: 10.9734/JAMMR/2017/36242

Evaluation of the correlation of immunological and biochemical values with clinical manifestations of gout, as well as the role of hyperuricemia in comorbid states is an important for the search of therapeutic targets.

Objective: Investigation of the relationship between features of dyslipidaemia and immunological changes in patients with tophaceous gout and asymptomatic hyperuricemia.

Patients and Methods: The study has included 85 male patients: 1st (main) group – 49 patients with primary chronic gout according to criteria of Wallace S.L., 2nd (control) group – 36 patients with asymptomatic hyperuricemia. The levels of uric acid (UA), C-reactive protein (CRP), fasting glycaemia, lipid profile – total cholesterol (TC), triglycerides (TG), high-density (HDL), low density (LDL), very low density (VLDL) lipoproteins, atherogenic ratio (AR); concentrations of cytokine: interleukin-1β (IL-1β), tumour necrosis factor-α (TNF-α), IL-4, IL-6, IL-8, IL-10 and IL-18 in the blood serum by enzyme-linked immunosorbent analysis.

Results: Values of UA have positively correlated with the number of affected joints (r=0.64, p=0.058), presence of tophi (r=0.73, p=0.042), glycaemic level (r=0.74; p=0.038). An increase of TC to 11.85%, LDL to 22.51%, VLDL to 21.43% and a decrease of HDL to 20.9% in patients with gout was observed. AR was higher in the group of patients with gout to 25.8% (p=0.0088). An increase of the production of cytokines IL-6 (p=0.0012) and IL-18 (p=0.0008) was observed in patients with gout whose level of UA was above 0.420 mmol/l. There was no significant increase of IL-1β (+0.36, p=0.0154), TNF-α (+0.21, p=0.0944), IL-4 (+0.02, p=0.0028). There was no relationship between IL-6 and CRP (r=0.26, p=0.0122). Strong correlation was shown in the 1st group between IL-6 and AR (r=0.762, p=0.0018), IL-18 and AR (r=0.766; p=0.0052). Correlation between IL-6 and AR was weaker (r=0.292, p=0.0127), as well as a weak negative correlation was observed in the 2nd group between IL-18 and AR (r=-0.366, p=0.0049).

Conclusion: The exceptional role of hyperuricemia in the development of dyslipidaemia in patients with gout has not been confirmed. TC, LDL, VLDL and AR are significantly elevated, while HDL is significantly lower in patients during the intercritical period of gout. The increase of IL-6 and IL-18 is accompanied by more prominent features of dyslipidaemia and clinical manifestations of gouty arthritis.

Open Access Original Research Article

Pattern and Rate of Occupational and Non- Occupational Exposures: The Experience of a Major HIV Treatment Centre in Nigeria

S. O. Ekama, T. A. Gbajabiamila, E. C. Herbertson, A. Z. Musa, D. A. Oladele, A. N. David, N. N. Odunukwe, O. C. Ezechi

Journal of Advances in Medicine and Medical Research, Page 1-7
DOI: 10.9734/JAMMR/2017/36549

Aims: This study sought to evaluate the nature of exposure, treatment outcome, time of presentation for treatment, assess adherence to follow up visits as well as identify gaps in post exposure prophylaxis treatment practice in the clinic.

Study Design: A retrospective cohort study.

Place and duration of Study: The HIV treatment centre domiciled at the Clinical Sciences Department of the Nigerian Institute of Medical Research Yaba, Lagos Nigeria from January 2006 to October 2015.

Methodology: A database retrospective review was conducted for adult patients who received post exposure prophylaxis for HIV during the study period. A total of 348 patients received treatment for post exposure prophylaxis but only 314 had complete data and were analyzed. Patient information was extracted from the electronic database and patient case files. Data were analyzed and presented using descriptive statistics.

Results: Majority of the patients were females (73.6%), aged 31-45years (47.8%), single (62.1%) had a tertiary education (67.2%) and employed (70.7%).

More than half (65.6%) had non-occupational exposures and overall, 98% presented for treatment within 72hours of exposure but only 2% completed the follow up visits.

Conclusion: Treatment outcome appears good among patients that presented for follow up visits and no sero-conversion was reported or recorded. The completion rate for post exposure prophylaxis was abysmally low. Strategies should be devised to encourage completion of follow up visits.

Open Access Original Research Article

Prevalence and Predictors of Intimate Partner Violence among Antenatal Clinic Attendees in a Tertiary Health Institution in Nigeria

L. C. Ikeako, J. E. Nnagbo, H. U. Ezegwui, C. Chigbu, T. Enebe, U. A. Umeh, L. Ajah

Journal of Advances in Medicine and Medical Research, Page 1-8
DOI: 10.9734/JAMMR/2017/36725

Background: Intimate partner violence (IPV) against women during pregnancy is a special and peculiar sub-class of violence against women. Anecdotal evidence suggest that such practices are still prevalent in Nigeria. Efforts to eliminate this scourge against women would certainly require good baseline information on the experience and attitude of women towards this social vice.

Aim: The study was undertaken to determine the experience, distribution and attitude of women towards intimate partner violence in Enugu, Southeast Nigeria.

Methods: This was a questionnaire-based cross-sectional study. Data was collected using structured questionnaire and analyzed by means of descriptive and inferential statistics including means, frequencies and X2-tests at the 95% confidence (CL) level.

Results: The prevalence of intimate partner violence during pregnancy is 36.1%. Verbal abuse, 14.4% ranked highest in this study and 23.8% of the respondents affirmed they would seek legal redress in cases of physical violence. There was no report of sexual violence. The main perpetrators of IPV were current husbands, 67.1%. Maternal age and employment status of the respondents’ husbands were 4.2 and 6.7 times independently associated with IPV.

Conclusion: The prevalence of IPV during pregnancy is still high among antenatal women in Enugu. The condition could be ameliorated by provision of employment opportunities for their husbands. Despite the high rates of occurrence of both verbal and physical violence during pregnancy, there is still lack of motivation to seek legal redress. Efforts should be made to convince the policy makers and judicial systems to create legal sanctions for perpetrators of IPV during pregnancy.

Open Access Original Research Article

Knowledge and Beliefs Regarding Contraception among Married Women in Gwagwalada, Abuja, Nigeria

A. Onuorah Whitney, M. Jamda Abubakar

Journal of Advances in Medicine and Medical Research, Page 1-12
DOI: 10.9734/JAMMR/2017/36450

Inadequate knowledge and misconceptions on contraception has sustained the low prevalence of contraceptive use in Nigeria over the years.

Aim: This study aims to assess the knowledge and beliefs regarding contraception among married women in Gwagwalada, Abuja, FCT.

Methodology: This was a descriptive survey that employed a cross sectional study design, and was carried out in Gwagwalada community, FCT, Abuja, Nigeria, between July– August 2017. A semi-structured questionnaire was administered to 290 married women, aged 15–49 years, sampled by multi-stage sampling technique.

Results: Most of the participants were aged 25 – 29 years, with a mean age of 31.3 years (SD ; 7.3 years). Although 93% of the participants were aware of contraception, 46% of them had poor knowledge of its methods, side effects, and use. Age (= 0.03), family setting (< 0.000), education (< 0.000), and religion (p = 0.007), were seen to be significantly associated to the level of knowledge. The participants were mostly aware of and willing to use male condoms, contraceptive injections, and implants. Eighty percent of the participants harbored misconceptions on effects of contraceptive use, with 23% believing it could lead to maternal death. Women that sought information through outreach programs from health care workers had fewer misconceptions than other participants, (p = 0.01). Fifty-nine percent of the participants were favorably disposed to contraceptive use, and reported their spouse to be the most important consideration when deciding on contraception.

Conclusion: Awareness does not always translate to good knowledge of contraception. There is need for broader pervasive outreaches to spread awareness, and promote health education interventions. These would increase understanding of contraception, and correct misconceptions. Furthermore, more intervention programs with adequate male involvement should be implemented to increase contraceptive uptake.