Open Access Clinical Practice Article

Pearls of Clinical Examination of the Eyes for Family Medicine Practitioners

Sagili Chandrasekhara Reddy, K. Ambigga Devi

Journal of Advances in Medicine and Medical Research, Page 1-10
DOI: 10.9734/JAMMR/2018/42189

Many eye diseases can be diagnosed with penlight and direct ophthalmoscope available in the general practitioner’s clinic. Proficient ocular examination technique and visual recognition skill are essential to diagnose them. Examination of the eyes can help in diagnosing systemic diseases and assessing their progression because ocular involvement is observed in a majority of the systemic diseases. The signs observed on clinical examination are unique in the sense that one eye sign is specific of a particular eye disease. All the signs seen in different structures of the eye are summarized with the diseases in which they are seen in this article. Hence, this article is useful as a quick reference to the family medicine practitioners to interpret the eye signs and assist in the diagnosis of the common eye diseases as they are often the first port of call in the community

Open Access Case Study

Chronic Pulmonary Aspergillosis Misdiagnosed as Smear-Negative Pulmonary Tuberculosis in a TB Clinic in Nigeria

Titilola Gbaja Biamila, Felix Bongomin, Nicholas Irurhe, Augustina O. Nwosu, Rita O. Oladele

Journal of Advances in Medicine and Medical Research, Page 1-5
DOI: 10.9734/JAMMR/2018/41816

The clinical manifestations of chronic pulmonary aspergillosis (CPA) and pulmonary tuberculosis (PTB) are practically indistinguishable. We present a case of CPA in a 35-year-old HIV-negative trader, who had had three unsuccessful treatment courses for smear-negative PTB. He presented with a five-year history of recurrent symptoms suggestive of TB (haemoptysis, weight loss and productive cough). His sputum smear was acid-fast bacilli negative and GeneXpert analysis was negative for Mycobacterium tuberculosis. Chest X-rays revealed bilateral apical cavities and bullae. His Aspergillus-specific IgG tests were positive (>40 mg/L). He was managed with itraconazole 200mg twice daily with marked improvement in his clinical presentation and his quality of life after 4 months of therapy. However, he significantly deteriorated after discontinuing itraconazole for 1 month; he had adherence counselling and was re-commenced on long-term itraconazole therapy

Open Access Original Research Article

Impact of Medical and Neurological Complications on Intra-Hospital Mortality of Stroke in a Reference Hospital in Ouagadougou (Burkina Faso)

Lompo Djingri Labodi, Cisse Kadari, Kabre Nestor Judicael, Napon Christian, Millogo Athanase, Kabore B. Jean

Journal of Advances in Medicine and Medical Research, Page 1-13
DOI: 10.9734/JAMMR/2018/42376

Introduction: Medical and neurological complications occurring at the acute stroke stage are frequent and increase post-stroke mortality. Their prevention, early recognition, or effective management in stroke units, should contribute to a significant reduction in early post-stroke deaths. The purpose of our study was to assess the impact of the medical and neurological complications observed at the acute stroke phase, on intra-hospital mortality of strokes.

Patients and Methods: It was a prospective, transversal, descriptive and analytical, hospital study, from 01/11/2015 to 31/10/2016, at Tingandogo University Hospital Centre, in Ouagadougou, Burkina Faso. The study concerned patients aged > 16 years, consecutively hospitalized for ischemic or hemorrhagic stroke, occurred less than 72 hours of hospitalization, confirmed with the brain scan, after informed consent of patients or members of their families.

Socio-demographic characteristics, vascular risk factors, comorbidities, clinical, neuroradiological and biological data at admission and intra-hospital evolutionary data were analyzed. A univariate, then multivariate, logistic regression analysis was performed between the various medical and neurological complications observed during hospitalization, at acute stroke phase (independent variables), and intrahospital deaths (dependent variable), to investigate the impact of these medical and neurological complications on intra-hospital mortality.

Results: We have consecutively collected 197 patients. The average age of the patients was 61.1 years old. The majority of patients (63.3%) were male.  At the admission, 19 patients (9.6%) were in coma, the average NIHSS was 16.7.There were 129 cases of cerebral infarction (65.5%) and 68 cases of hemorrhagic stroke (34.5%). Fever (56.9%), pulmonary infection (42.6%), cardiac complications (25.9%), malnutrition (22.8%), malaria access to Plasmodium falciparum (17.3%), urinary tract infection (16.2%), were the most common medical complications. Neurological complications were represented by neurological deterioration (36%) and epileptic seizures (15.2%), respectively. The intra-hospital mortality rate was 25.9%. At the end of the multivariate analysis with logistic regression, pulmonary infection (OR 4.41; 95% CI [1,171-16,619]; p = 0,028) and neurological deterioration (OR 29.11; 95% CI [8,009-105,844]; p = 0,000) were the only predictive independant medical and neurological complications of intra-hospital post-stroke death.

Conclusion: Medical and neurological complications remain frequent at the acute stroke phase, causing a high intra-hospital mortality of about 26%. Post stroke pulmonary infection and neurological deterioration are the independent predictive complications of intra-hospital deaths. The use of therapeutics to reduce the size and severity of stroke, including fibrinolysis, control of physiological parameters and homeostasis within SU, would allow a significant reduction in early post stroke mortality.

Open Access Original Research Article

Seroprevalence of Treponema pallidum Antibodies among Blood Donors in a Tertiary Hospital in South-South Nigeria

Kingsley Akaba, Olukayode Oshatuyi, Marcus Inyama, Obinna Iheanacho, Freeman Jabengo, Chisom Ntomchukwu, Essien U. Ekpeyong, Essien U. Ekpeyong, Offiong A. Bassey, Anthony N. Kokelu

Journal of Advances in Medicine and Medical Research, Page 1-6
DOI: 10.9734/JAMMR/2018/41574

Background: Treponema pallidum is well-known for its immune-evasiveness and invasiveness, its spirochaete has a long latent period in which individuals present no signs or symptoms and still could be infectious. In spite of the available effective treatment, the development of suitable diagnostic techniques and implementable preventive strategies, sexually transmitted diseases (STDs) including syphilis, remains major public health problem in Nigeria.

Aim: The aim of this study is to determine the seroprevalence of T. pallidum antibodies among blood donors at the blood bank unit of University of Calabar Teaching Hospital (UCTH), Calabar, Cross River State, Nigeria.

Materials and Methods: Two thousand six hundred and ninety-six blood samples collected from commercial, voluntary and replacement donors were screened for syphilis using the Venereal Disease Research Laboratory (VDRL) particle agglutination test kit. The kits were manufactured by BTNX Inc., Ontario, Canada and onsite Enzyme-Linked Immuno-Sorbent Assay (ELISA) test kit by CTK Biotech (USA) was used in confirming the presence of antibodies of T. pallidum. This study was carried out at the blood bank of University of Calabar Teaching Hospital, Calabar from June 2016 to August 2017.

Results: A total of 2695 unit of blood was screened for T. pallidum antibody during the study period. Sixty-seven (67) units of blood tested positive giving a seroprevalence of 2.50%.

Conclusion: Our report shows a low seroprevalence of syphilis compared to what has obtained from other parts the country notwithstanding. Improved diagnostics, a better test of cure, intensified public health measures and, ultimately, a vaccine is needed to curb the increasing prevalence of STDs, including syphilis.

Open Access Original Research Article

Factors Associated with the Occurrence of Medical Complications in the Acute Phase of Stroke in a Reference Hospital at Ouagadougou (Burkina Faso)

Lompo Djingri Labodi, Cisse Kadari, Savadogo Mahamoudou, Kabre Nestor Judicaël, Napon Cristian, Kabore Jean

Journal of Advances in Medicine and Medical Research, Page 1-14
DOI: 10.9734/JAMMR/2018/41869

Introduction: Medical complications are responsible for almost 50% of the causes of death in the acute phase of stroke. The purpose of this study was to identify the factors associated with the occurrence of acute stroke medical complications at the Tingandogo Teaching Hospital in Ouagadougou, Burkina Faso.

Patients and Methods: This was a prospective, cross-sectional study of patients admitted to hospital for stroke less than 72 hours from March 2015 to February 2016. Initial general, clinical and paraclinical characteristics and medical complications post stroke, were analyzed. A bivariate and then multivariate analysis with logistic regression, made it possible to identify the independent factors associated with the occurrence of medical complications after stroke.

Results: Of the 197 patients enrolled, 63.3% were male; the average age of the patients was 61.1 years; the neurological admission deficit was severe in 30.5%; swallowing disorders were observed in 51.3%. Brain infarctions accounted for 65.5% and haemorrhagic strokes accounted for 34.5%. Broncho-pulmonary infection (42.6%), cardiac complications (25.9%), undernutrition (22.4%), malaria access (17.3%) and urinary tract infection (16.2%). %), were the main medical complications. Neurological deterioration (36%) and epileptic seizures (15.2%) were the observed neurological complications. The independent factors associated with the occurrence of medical complications were: Clinical severity of stroke (NIHSS ≥17) at admission (OR = 3.402, 95% CI 1.27-16.46, p = 0.031); swallowing disorders at admission (OR = 10.19, 95% CI 1.16-89.00, p = 0.000) and co-morbidities (OR = 8.72; 95% CI 1.23- 61.43, p = 0.030).

Conclusion: The screening and appropriate management of patients at high risk of medical complications in the acute phase of stroke, in NVUs, will reduce the incidence of these complications and help reduce mortality and disability post stroke.

Open Access Original Research Article

A Comparative In vivo Study for Evaluation of the Amount of Gingival Displacement

Arun Kumar Tiwari, Kaushik Kumar Pandey; A. K. Verma; Mariyam Ali, Pratibha Katiyar, Abhishek Gaur, Naeem Ahmed, Fauzia Tarannum

Journal of Advances in Medicine and Medical Research, Page 1-8
DOI: 10.9734/JAMMR/2018/42212

Aim and Objective: This study was done for comparative evaluation of the amount of gingival displacement produced by three different gingival retraction systems (Magic Foam Cord, Racegel & Medicated Retraction Cords) based on gingival displacement, haemorrhage control and ease of placement and finally to suggest the best material for gingival displacement.

Materials and Methods: The study involved 30 edentulous patients of 19-25 year age group with healthy periodontium and aligned natural dentition. The custom tray was made on a model from diagnostic alginate impression. The four-time impression was made for each subject on the custom tray. Each impression was taken after interval of one week. First impression was done without gingival displacement; second after gingival displacement with aluminum chloride; third with ‘Magic Foam Cord’ for tissue displacement; Fourth impression after using ‘Racegel’ for tissue displacement. Maxillary right central incisor was used for retraction. Mesiodistal width of right central incisor was measured with help of vernier caliper and the center point of the tooth was marked on the cast for making cut. Cast was positioned and stabilized on platform of die cutter, and primary cut was made on the marked central point of incisal edge in the buccolingual direction through the entire length of the cast. Evaluation of the amount of displacement: For determining the amount of displacement, samples were studied under a stereomicroscope having magnification of ×20.

Results: The displacement observed was found to be significantly (p=0.0001) higher in Retraction Cord (mean 0.73 mm) than Magic foam cord (mean 0.56 mm) and Racegel (mean 0.37mm). Displacement observed was found to be significantly (p=0.0001) higher in Magic foam cord than Racegel. The percentage of no bleeding was higher in Racegel (96.7%) than Magic foam cord (43.3%) and Retraction cord (10%). Among the three retraction systems compared for ease of placement in the present study, the time taken for Racegel retraction technique (mean time 58.53 seconds) was considerably less as compared to the time required for placement of Magic foam cord (65.33 seconds) and Medicated retraction cord technique (119.33 seconds). 

Conclusion: Magic foam cord can be suggested for use in clinical practice as it is more effective among the three retraction systems used in this study, as it has taken less time and easier in placement, attained good amount of displacement and induced minimal bleeding on removal compared to Aluminum chloride soaked retraction cord.

Open Access Review Article

Biomarkers for Carcinoma Meningitis in Solid Tumors

Ashish Manne, Ravi Paluri

Journal of Advances in Medicine and Medical Research, Page 1-13
DOI: 10.9734/JAMMR/2018/41792

Carcinomatous meningitis (CM), also known as neoplastic meningitis or leptomeningeal metastasis, refers to the invasion of meninges protecting the brain and spinal cord by tumor cells. It should be distinguished from brain metastasis where there is an infiltration of brain parenchyma by metastatic cells. Cancer cells from the primary source can migrate to the meninges through various ways: vertebral and paravertebral metastasis (breast and lung cancers), perineural spaces (gastrointestinal cancers), arteries from parenchymal metastasis, and rarely by direct invasion (primary central nervous system tumors). Patients often present with non-specific symptoms, like a headache and altered mental status, or focal neurological signs, depending on the area of the central nervous system involved. Due to poor prognosis and limited success in treating it, early detection is key. Diagnosis in suspected cases by cerebrospinal fluid (CSF) cytology (identifying malignant cells) and/or imaging has limited success. In this review, we discuss the need for using various biomarkers in CSF to increase the probability of a diagnosis of CM in solid tumors. Biomarkers can also help in predicting the disease burden, response to treatment, and in detecting the recurrence. We also discuss utilizing Fluorescence in situ hybridization (FISH), Rare cell capture technology (RCCT) and circulating tumor DNA (CtDNA) in identifying malignant cells in CSF for diagnosing CM