Open Access Original Research Article

Assessment of Relation between Recurrence of Enterocutaneous Fistula and Preoperative C-reactive Protein Level after Complete Surgical Repair

Osama H. Khalil, Zaki A. Allam, Wael S. Mansy, Eman M. Mortada

Journal of Advances in Medicine and Medical Research, Page 1-8
DOI: 10.9734/JAMMR/2017/36874

Background: Recurrence of enterocutaneous fistula after the definite surgical repair has not changed significantly. In postoperative complication of abdominal surgery, serum C-reactive protein level is used for evaluation of severity of the condition. In this study, we aim to find a relation between recurrence of enterocutaneous fistula and preoperative serum level of C-reactive protein.

Methods: A prospective study of 40 patients admitted with the diagnosis of enterocutaneous fistula (ECF) and prepared for definite surgical repair in the form of resection anastomosis of ECF. We used preoperative serum C-reactive protein as predicting factor of recurrence and independent variable for timing of surgery.

Results: Eleven cases showed recurrence with increased level of preoperative serum level of C-reactive protein above (0.75 mg/dl) with high significant (P<0.05). There was significant different between recurrent and non-recurrent cases regarding preoperative serum level albumin and malnutrition (P<0.05).

Conclusion: C-reactive protein can be used as predicting factor for recurrence of ECF after definite surgical treatment as well as helping surgeon to take decision for proper time of operation.

Open Access Original Research Article

Diagnosing Cerebral Venous Sinus Thrombosis on Unenhanced Computed Tomography -Measuring the Hounsfield Unit. Does it Add to the Confirmation of Diagnosis?

Fatima Mubarak, Waseem Mehmood Nizamani

Journal of Advances in Medicine and Medical Research, Page 1-7
DOI: 10.9734/JAMMR/2017/33324

Background: Over past decade, epidemiology of cerebral venous sinus thrombosis (CVST) has significantly changed. CVST is being diagnosed clinically and by non- invasive imaging techniques early in its course and has better prognosis and non-fatal outcomes.

Methods: Institutional ethical review committee approval was obtained prior to start of this retrospective study. All Magnetic resonance venogram (MRV) performed between January 2007 and December, 2016 were reviewed retrospectively. Only positive cases were included which show thrombosis on MRV. We calculated sensitivity, specificity, positive predictive value and negative predictive value on the basis of CT density taking post contrast MRV as gold standard.

Results: Total 554 positive venous sinuses in 350 patients were included. Mean age was 37.46 ± SD 15.4 years, range: 72 years, minimum 4, and maximum 76 years. Only those cases were included who had MRV and non-contrast CT (NCT) within 24 hours of each other. 554 positive venous sinuses were analyzed as well as 2246 negative sinuses were analyzed in the same cohort. The average (Hounsfield unit) HU of vessels containing a thrombus was 60 ± 1.56  which was significantly higher than that of any other normal sinus in same patient  40 ± 0.28 (p < 0.05).

Sensitivity, specificity, positive predictive value and negative predictive value were calculated as 99.6%, 89.05%, 69.17% and 99.9% respectively.

Conclusion: Hounsfield unit is highly sensitive and specific for CVST and can be used as a good screening tool.

Open Access Original Research Article

Spectrum of Adult Digestive Diseases Presenting at a Suburban Tertiary Health Facility in Nigeria

Abiodun Christopher Jemilohun, Olusola Olateju Akanbi, Sebastine Oseghae Oiwoh, Adedapo Adegboyega Adeleke, Olusayo Akinwumi Akanbi

Journal of Advances in Medicine and Medical Research, Page 1-12
DOI: 10.9734/JAMMR/2017/36761

Background: Diseases of the digestive system vary in type and distribution worldwide. There is presently no comprehensive audit of the types of digestive diseases presenting at any particular tertiary health facility in Nigeria. We present an audit of the digestive diseases presenting over a period of four years (2012 to 2015) at the LAUTECH Teaching Hospital, Ogbomoso, Nigeria, a suburban healthcare facility.

Methodology: Outpatient and inpatient digestive disease cases and relevant information were extracted from the medical and surgical gastroenterology clinics’ and wards’ registers. Patients’ case files were retrieved from the medical records department and consulted for clarification when necessary. Diagnoses were categorized according to the International Statistical Classification of Diseases and Related Health Problems 10th Revision, 2016 version (ICD-10) codes for digestive diseases. Data were stratified into outpatient cases, inpatient (admissions) cases, in-hospital mortalities and digestive cancers.

Results: There was a total of 799 gastrointestinal clinic cases. Chronic hepatitis B was the commonest cause of clinic visit (28.8%). Appendicitis was the most frequent cause of admission (16.0%) of the 682 gastrointestinal admissions. There was a total of 86 in-hospital digestive disease mortalities of which hepatocellular carcinoma was the leading cause at 22.1%. Of the 188 cases of digestive cancers identified; hepatocellular carcinoma had the highest frequency (43.4%) and the highest mortality (59.4%).

Conclusion: A very important finding from this study is fact that chronic hepatitis B and its attendant sequelae (liver cirrhosis and hepatocellular carcinoma) constituted a substantial proportion of the digestive diseases among our study population.

Open Access Original Research Article

The Effect of Gum Arabic on Energy Balance Genes in Mouse Liver

Jaafar Suleiman Fedail, Hassan Hussein Musa, Abdelkareem Abdalla Ahmed, Amal Zakria Sifaldin, Taha Hussein Musa

Journal of Advances in Medicine and Medical Research, Page 1-8
DOI: 10.9734/JAMMR/2017/35322

Aims: Energy homeostasis is regulated by a complex neuroendocrine system including appetite regulatory hypothalamus peptides and adipocytes derived peripheral signals. The aim was to study the effects of Gum Arabic on fat mass and obesity-associated gene expression in liver.

Study Design: This case control study was conducted at Key laboratory of Biochemistry, Nanjing Agricultural University, China.

Methodology: Female C57BL/6 J mice at 13 weeks of age were treated with 10% of gum Arabic in drinking water for 12 weeks. Food intake, body weight, visceral adipose tissue (VAT), blood glucose and lipids profiles were measured. The expression of energy balance related genes was measured by Real-time PCR.

Results: Gum Arabic significantly (P<0.05) decreased food intake, body weight, and VAT accumulation. Gum Arabic significantly (P<0.05) decreased blood glucose, total cholesterol, and LDL-c, whereas increased high- density lipoprotein (HDL). Gum Arabic had no significant effect on the expression of neuropeptide Y (NPY), adenosine monophosphate (AMP), agouti (Ago) protein and fat mass and obesity-associated protein (FTO) in the liver.

Conclusion: Gum Arabic had significant effect on food intake, body weight and VAT associated with decreased blood glucose and lipid profiles, without any change in the expression rate of energy homoeostasis genes.

Open Access Original Research Article

Long-term Weight Changes and Subsequent Hypercholesterolemia in Chinese Population

Liancheng Zhao, Long Zhou, Ying Li, Min Guo, Yangfeng Wu

Journal of Advances in Medicine and Medical Research, Page 1-8
DOI: 10.9734/JAMMR/2017/36956

Aims: To explore the relationship between long-term body weight changes and hypercholes-terolemia in middle aged Chinese population.

Study Design: Population based cross-sectional study.

Place and Duration of Study: Department of Epidemiology, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, between August 1998 and December 1998.

Methodology: Data were from China Multicenter Collaborative Study of Cardiovascular Epidemiology which was conducted in 1998, including 15 population samples selected by random cluster sampling. Approximately 1000 men and women in each population were surveyed for CVD risk factors, including to asking participants’ body weight at age 25. Weight change was the difference between the body weight at the age of 25 and at the survey. The association of long-term body weight change with hypercholesterolemia was examined by Logistic Regression models.

Results: A total of 13883 participants including 6603 men and 7280 women were enrolled. After adjusting for age, sex and other potential confounding factors, long-term weight gain since age 25 was positively and weight loss negatively associated with the risk of hypercholesterolemia. In comparison with participants with a weight gain from − 2.5 to 2.5 kg since 25 years old, the ORs (95% CI) of developing hypercholesterolemia for other weight change categories of <− 7.5 kg, − 7.5 to − 2.6 kg, 2.6 to 7.5 kg, 7.6 to 12.5 kg, and >12.5 kg were 0.59(0.49-0.71), 0.90(0.78-1.03), 1.19(1.06-1.35), 1.39(1.23-1.57), and 1.72(1.53-1.93), respectively.

Conclusion: Long-term weight gain was independently associated with the marked increase in risk of hypercholesterolemia in middle-aged Chinese men and women. Weight loss may help to reduce the risk of hypercholesterolemia for people who were overweight or obese in early adulthood.

Open Access Original Research Article

Diagnosis of Vaginal Candidiasis and Trichomonas vaginalis Infection by Antibody Coated Latex Particles

Hossein Yousofi-Darani, Seyedeh Maryam Sharafi, Maryam Heidari, Simin Taghi Poor, Rasool Jafari, Seyed Mohsen Hosseini

Journal of Advances in Medicine and Medical Research, Page 1-5
DOI: 10.9734/JAMMR/2017/36600

Introduction: Candidiasis is a fungal infection caused by Candida spp. Trichomoniasis is also an infection with worldwide distribution. Recurrent vaginitis which may be associated with lack of proper diagnosis is now one of the problems of women visiting Gynecology clinics. Considering this fact that conventional laboratory methods do not possess enough sensitivity or may be time consuming, using a rapid and easy method is important in the differential diagnosis of vaginal infections. The aim of this study was diagnosis of vaginal infections using latex agglutination method.

Methods: In this descriptive analytical investigation, vaginal swabs were collected from 186 women suspected to vaginal infection referred to the Gynecology clinics in Shahrekord, Iran. All samples were tested using wet smear, culture and latex agglutination methods. To estimate sensitivity and specificity of the latex agglutination method, culture method considered as gold standard.

Results: Sensitivity and specificity of the latex method for Trichomonas vaginalis infection was 70% and 96% and for Candida infection was 80% and 90% respectively. Also, the positive and negative predictive values for Trichomonas vaginalis were 50% and 98% and for Candida infection were 87% and 84%, respectively.

Conclusion: Latex agglutination method has an appropriate sensitivity and specificity for detection of Trichomonas vaginalis and Candida Spp. in human samples. So, with further modifications this method can be used for diagnosis of vaginal infections in medical laboratories.

Open Access Original Research Article

Analysis of Regulatory Compliance on Radiation Safety Parameters with Chain of Diagnostic Centers in Tamil Nadu, India

R. Rajan, Paul Rajan Raj Kumar

Journal of Advances in Medicine and Medical Research, Page 1-16
DOI: 10.9734/JAMMR/2017/37075

Aims: To evaluate compliance against Atomic Energy Regulatory Body guidelines in India with chain of diagnostic centers, aimed at protecting the health of people while using human made ionizing radiation. To assess whether revenue, patient queue size and Quality System accreditation influence the Regulatory compliance.

Study Design:  Descriptive Research Design was used to study the existing practices.

Place and Duration of Study: 107 chain of diagnostic centers, which houses the diagnostic imaging equipments that emanates radiation, which needs regulatory compliance were studied. This study was conducted in 25 identified cities across Tamil Nadu, in India between April 2016 and June 2017.

Methodology: We included 65 chains of diagnostic centers accredited by National Accreditation Board for Testing and Calibration Laboratories (NABL) and 42 Non-NABL diagnostic centers. The Radiologists and Technicians were the point of contacts for primary data collection through a structured questionnaire. The compliance to regulatory guidelines was assessed using a 7 point scale, based on the existing practices followed. There were 70 questions covering Regulatory, Layout Engineering, Technician Competency, Human Safety, Operations Know-How, Radiation Exposure Monitoring and Top Management Commitment included in this study. Non-Parametric statistics was used to perform the analysis.

Results: The probability distribution was estimated using ”mode” as a measure of compliance. The compliance on 7 parameters studied has shown, Regulatory (3, Significant compliance), Layout Engineering (3, Significant compliance), Technician Competency (4, High Compliance), Human Safety (4, High Compliance), Operations Know-How (3, Significant Compliance), Monitoring Radiation Exposure (4, High Compliance) and Top Management Commitment (4, High Compliance). Wilcoxon Rank Sum test has shown a ‘P’ value of .083 @ 95 percent confidence interval established no difference in compliance between NABL and Non-NABL diagnostic centers. Spearman correlation co-efficient (Rho +0.12 and ‘P’ value, .43) has established a positive weak and insignificant relationship between Revenue and Compliance and negative weak and insignificant relationship (Rho -.093, ‘P’, 0.52) between patient queue size and compliance.

Conclusion: The chain of diagnostic centers did not pose any risk of radiation leakage supported by significant and high compliance scores across all parameters studied. The NABL accreditation did not influence the compliance. Revenue and Patient queue size did not establish significant relationship on compliance. Similar studies can be initiated with Government Hospitals, Corporate Hospitals and Private Diagnostic centers in other states of India.