Open Access Clinical Practice Article

Noninvasive Antenatal Diagnosis of Fetal RhD Status

Emilija Velkova, Dijana Plaseska-Karanfilska

Journal of Advances in Medicine and Medical Research, Page 1-10
DOI: 10.9734/JAMMR/2018/43917

Introduction: Fetal cell-free nucleic acids within the blood stream of a pregnant woman come from fetal genetic material which can be acquired by simple venipuncture that reduces any risk to a minimum. Fetal cell-free DNA can be detected in the mother's blood stream in the 5th gestation week at the earliest. That enables fetal genotyping at the earliest possible stage of pregnancy which is best done in the 12th gestation week.

Aim: To determine fetal RhD status at RhD negative pregnant women where the father is a heterozygote, Dd.

Materials and Methods: The research includes 1540 RhD negative pregnant women, out of which at 30 of them the RhD fetal status had been detected by a PCR technique from the mother’s plasma. The RhD fetal status was confirmed after delivery by serologic analysis at 27 newborn babies.

All research patients were submitted to serologic immunohematology testing: blood group typing of red blood cell antigens, screening of irregular anti-red blood cell antibodies. Fetal RhD status was determined by the plasma of RhD negative pregnant women using the real-time PCR technology in the period from the 12th gestation week until the 31 gestation week. The biological fathers of all 30 fetuses were phenotyped as heterozygote to the RhD antigen. The results showed that 30% of the fetuses are RhD negative, and 70% are RhD positive.

Conclusion: The noninvasive fetal RhD genotyping is not only one precious tool in the management of RhD alloimmunised pregnancies, but it also allows antenatal anti-D immunoglobulin prophylaxis exclusiveness for only non-immunized RhD pregnant women carrying RhD positive fetus. Taking into consideration that 30% of the RhD negative pregnant women that carry a RhD negative fetus receive antenatal RhIG prophylaxis with no absolute need for it.

At RhD alloimmunised pregnant women the noninvasive genotyping of the fetal blood group enables an easy and safe method in determination of a fetal risk from a hemolytic disease, and at the same time evading a vast laboratory and clinical monitoring of RhD antigen-negative fetal cases.

Open Access Case Study

A Series of Six Cases of Candida Ciferrii Infection in a Tertiary Care Centre of North India

Shalini Upadhyay, Teena Wadhwa, Smita Sarma

Journal of Advances in Medicine and Medical Research, Page 1-5
DOI: 10.9734/JAMMR/2018/43742

Aim: We aim to understand the role of Candida ciferrii (C. ciferrii) as a pathogen for invasive mycosis.

Presentation of Cases: We report six cases of patients with invasive disease due to C. ciferrii from a tertiary care centre of North India in one year. Among the six cases, two cases are of candidemia, three from lower respiratory samples and one from drainage fluid.

Discussion: Fungal infections especially candidiasis may occur in immunocompromised patients or in patients with associated co-morbidities. Candidiasis increases both the morbidity and mortality. C. ciferriihas been rarely reported as cause of human infection. It may not be the primary pathogen but has the potential to exacerbate the existing pathology.

Conclusion: Rare and unusual pathogens should not be ignored. They should be reviewed in accordance with the patient’s clinical manifestations and treated promptly to improve the prognosis of patient in appropriate clinical conditions.

Open Access Original Research Article

The Role of Hospital Surfaces and Theatre Environment in Transmission of Nosocomial Infections in a Rural District Hospital in Eastern Uganda

Waako Christopher Knox, Kateregga Elvis, Lulenzi Jalia, Nakhokho Ephraim, Oloka Emmanuel, Tebagerwa Annet, Ibilat Gorett, Rebecca Nekaka, Iramiot Jacob Stanley

Journal of Advances in Medicine and Medical Research, Page 1-13
DOI: 10.9734/JAMMR/2018/44101

Background: Healthcare-associated infections (HAIs) are the "most frequent adverse events" in the delivery of healthcare worldwide.  Most of these infections are linked to resistant pathogens harboured by hospital fomites and could persist for a long period of time thereby predisposing patients to HAI. Therefore the aim of this study was to determine the role of hospital surfaces (HS) and theatre environment (TE) in the transmission of drug-resistant pathogens.

Materials and Methods: A descriptive cross-sectional study design was employed using a sample of 42 swabs collected from indoor hospital surfaces and settle plate method for the theatre environment. Isolates were cultured under favourable growth conditions and identified using colonal morphology, microscopic appearance on gram stain and biochemical methods. Anti-microbial susceptibility testing was performed using the Kerby-Bour disc diffusion method. Results were analysed using SPSS version 16.0 software package and findings presented in tables, charts and graphs.

Results: All plates contained growth either bacterial or fungal (bacteria 66% and fungi 34%), majority isolates included Klebsiella (35%) and aspergillus spp. (26.19%) among bacteria and fungi respectively. Other pathogens isolated included Bacillus, Staphylococcus and Pseudomonas among bacteria and Rodothorula and Cladosporium among fungi. All isolates on settle plates displayed varying numbers of colony forming units ranging from 1.6*102 to 4.2*104 CFU/m3. Enterococcus showed the highest resistance to anti-microbial agents, though the general trend of pathogens tested showed the existence of resistance to the commonly used antibiotics. There was rising resistance to the beta-lactam class of antibiotics whereas vancomycin, linezolid, refampin and cefoxitin showed high susceptibility to the antibiotics. There was a 60% MDR and 2.38% ESBL specifically with pseudomonas.

Conclusion and Recommendations: There was a high level of bacterial and fungal colonisation on hospital surfaces and theatre environment with a correspondingly high level of resistance to antimicrobial agents in Ngora Freda Carr Hospital.

Open Access Original Research Article

Rare Rh E/e Negative Antithetical Antigens Found Only among Women with at Least One History of Pregnancy – A Maternal Phenotype (Novel)

I. Z. Isaac, O. Erhabor, T. C. Adias, R. T. John, A. S. Isezuo, O. I. Ajayi, A. Yakubu

Journal of Advances in Medicine and Medical Research, Page 1-9
DOI: 10.9734/JAMMR/2018/40078

Background: Rh blood group antigens are hereditary characters inherited by Mendelian principle, and are useful in the population genetics study, in resolving medico-legal issues, in disease aetiology and more importantly in compatibility issues in transfusion medicine. This study was a descriptive cross-sectional study to determine the prevalence of rare Rh phenotype among patients requiring a red cell transfusion in a specialist hospital Sokoto.

Materials and Methods: Three millilitres of whole blood was collected from each of the patients and the red cells were screened for the presence of Rh antigens by Ortho Biovue system cassettes (AHG/Coombs) technique.

Results: In this study, the percentages of Rh D, C, c, E and e obtained were 97.3%, 24.3%, 92.2% 18.9%, and 93.6% respectively. We found no Rh null and no D deletion, however, rare Rh phenotypes were encountered among which were Rh Cc deletion and Rh E/e deletion. The Rh E/e Negative antithetical antigens encountered was 4.7% (DCc 1.0%, DC, 1.0% and Dc was 2.7%). And Cc deletion was also 4.7% (Dee, 1.3% and De, 3.4%). The Rh E/e negative phenotypes showed a statistically significant relationship with gender (p = 0.007), marital status (p = 0.002), history of pregnancy (p < 0.001) and ethnicity (p = 0.028). There was. However, no statistical significant difference found with Rh C/c negative phenotype. We also encountered no Rh e negative and Rh E/e negative among male patients, unmarried patients, Igbo patients and also Yoruba patients.

Conclusion: We conclude from this study that rare Rh E/e negative antithetical antigens are high in the study area and found only among women with at least one previous pregnancy, possibly caused by low levels of maternal hormones, suggesting a role of maternal hormones on rare Rh Ee negative antithetical phenotype.

Open Access Original Research Article

Assessment of Spectroscopic Interaction of Lamivudine/Metronidazole with Dihydroartemisinin – Piperaquine Antimalarial Tablet

Sunday O. Awofisayo, Francis Alphonsus Ifiok, Nkechinyerem A. Jonathan, Chioma N. Igwe, Peter D. Ojobor

Journal of Advances in Medicine and Medical Research, Page 1-7
DOI: 10.9734/JAMMR/2018/28517

In vitro interactions between dihydroartemisinin (DHA) or piperaquine (PQ) components of antimalarial dihydroartemisinin-piperaquine (DP) with lamivudine/metronidazole were studied using Fourier transform infrared spectroscopy (FTIR). One milligram of either of lamivudine or metronidazole was mixed with 1 mg of crushed and powdered DP tablet and the admixture pelletized with 20 mg potassium bromide (KBr) powder. The pellets were scanned at 2 mm/s over wavenumber region of 4000 to 500 cm-1. The bond vibrations of DHA and PQ were consistent with the reference literature values. Lamivudine shifted (C=O) bond stretching of DHA from 1735 to 1649 cm-1 and (O-H) stretching from 2926 to 2922 cm-1. The endoperoxide bond vibration was shifted from 875 to 866 cm-1. Lamivudine also shifted the characteristic aromatic (C-H) bending of PQ from 775 to 796 cm-1. The aromatic and aliphatic (C-N) stretchings were shifted from 1367 to 1384 cm-1 and 1274 to 1278 cm-1, respectively. Metronidazole shifted the (C=O) stretching of DHA from 1735 to 1643 cm-1 and lactone (C-O-O-C) stretching from 875 to 883 cm-1. The (O-H) stretching was shifted from 2926 to 2935 cm-1. Piperaquine aromatic (C-H) bending was shifted from 775 to 727 cm-1 while aromatic (C-Cl) stretching vibration from 1145 to 1143 cm-1. The vibrational spectra shifts caused by lamivudine and metronidazole on the characteristic spectra vibration of DHA and PQ were adjudged insignificant. There was no in vitro interaction between lamivudine/metronidazole and the actives of DP tablet. The drugs may not pose any biopharmaceutical implications on co-administration with DP tablet.

Open Access Original Research Article

Comparison between 3 Dimentional Conformal Radiotherapy, Sequential Intensity Modulated Radiotherapy and Simultaneous Integrated Boost Intensity Modulated Radiotherapy as a Boost for Pelvic Lymph Nodes for Patients with Cancer Cervix

Mohamed Mahmoud, Sherweif Abdel Fatah, Amr Amin, Shaimaa Abdelgelil, Rasah A. Elawady, Abdullah Osama

Journal of Advances in Medicine and Medical Research, Page 1-7
DOI: 10.9734/JAMMR/2018/44404

Aim: The study aims to Compare 3 Dimentional Conformal Radiotherapy (3DCRT), sequential Intensity Modulated Radiotherapy (sIMRT), Simultaneous Integrated Boost-Intensity Modulated Radiotherapy (SIB-IMRT) for positive pelvic lymph nodes for patients with cancer cervix treated with concurrent chemo-radiotherapy.

Materials and Methods: C-T simulation was done for 10 patients with cervix cancer who had pelvic nodes, the clinical target volume (CTV) included the upper vagina, parametria, uterus, cervix, presacral area, and draining lymph nodes. One cm was added to form the Planning Target Volume (PTV). The organ at risk (OAR) included the bladder, rectum, pelvic bones marrow (PBM). Nodal CTV was expanded 7 mm to form nodal PTV. 3DCRT, sIMRT and SIB-IMRT planes were done. Doses of  3DCRT and sIMRT plans were 50 Gy to pelvic PTV with a nodal boost of 16 Gy in a total of 33 fractions while SIB plan treating the targets to the same doses in 25 fractions (i.e., 2 Gy per fraction to the pelvic PTV and 2.4 Gy per fraction to the boost PTV).

Results: Comparable target volume coverage (V95%) was achieved with the 3 plans, maximum dose was significantly reduced using conformal plan for the boost plans with p= 0.01. Median dose for V45 of the rectum was the lowest with sIMRT (p= 0.015), the median dose for V50 of the bladder was the lowest in sIMRT plan (p= 0.007), the V10 of the bone marrow was low in the sIMRT plan (p= 0.015).

Conclusion: The sIMRT boost for pelvic lymph nodes produce the same coverage as 3DCRT and SIB-IMRT and spares significantly the OAR.

Open Access Original Research Article

Eating Disorder Risk and Extreme Weight-control Behaviours among Young University Students: Is the Desire to Change Eating Habit Correlated?

Olumide Abiodun, John Ogunkoya, David Rabor

Journal of Advances in Medicine and Medical Research, Page 1-14
DOI: 10.9734/JAMMR/2018/44834

Background: The aim of this study was to determine the relationship between the desire to change eating habits and the risk of eating disorders and extreme weight-control behaviours among university students aged 15 to 24 years.

Methods: A cross-sectional study of 1470 randomly selected undergraduate students of four universities. Data were collected using the well-validated Eating Attitude Test (EAT-26) questionnaire. The effects of the desire to change eating habit on the outcome variables were assessed using odds ratio while possible effect modification by gender was assessed using the Mantel-Haenzsel test. Multivariate logistic regression analyses were used to build models to predict the outcome variables.

Results: The prevalence of Eating Disorder Risk and Extreme Weight-control Behaviours were 17.01% (95% CI=15.17-19.02) and 23.33% (95% CI=21.24-25.57) respectively. The desire to change eating habits was associated with greater odds of Eating Disorder Risk (1.43; 95CI=1.08-1.90; p= 0.011). The desire to change eating habits was associated with greater odds of Extreme Weight-control Behaviours among male participants (OR=2.37; 95%CI=1.59-3.53; p<0.001). A similar relationship was not found among female participants (OR= 0.98; 95% CI=0.70-1.37; p=0.8899). The Mantel Haenzsel test of homogeneity of odds ratio showed a p-value of 0.0005.

Conclusions: Eating Disorder Risk and Extreme Weight-control Behaviours are highly prevalent among university students in Nigeria. The desire to change eating habits may be correlated with a potential risk for an eating disorder. It could be a simple and realistic initial tool for predicting eating disorders and extreme weight-control behaviours among university students.