Open Access Original Research Article

Comparing Diagnostic Performance of Pronto Dry Rapid Urease® and Culture to Histopathology among Endoscopy Patients at the Aga Khan University Hospital, Nairobi-Kenya

Stephen Njoroge, Catherine Mwangi, Kimang’a Nyerere, Gunturu Revathi, Smita Devani, Allan Rajula, Rose Kamenwa, Nyamongo Onkoba, Fredrick Odhiambo

Journal of Advances in Medicine and Medical Research, Page 1-7
DOI: 10.9734/jammr/2019/v29i1230147

Aim: This study sought to evaluate Pronto dry rapid urease® diagnostic test and compare its performance with culture.

Study Design: Cross-sectional study.

Place and Duration: From September 2017 to July 2018, across-sectional study was conducted at the Aga Khan University Hospital.

Methodology: Patients attending endoscopy unit at the hospital were randomly sampled to provide gastric biopsy specimen. One specimen was tested for presence or absence of H. pylori using Pronto dry rapid urease® test and another specimen subjected to in vitro culture test which were then compared with histology reference results. Test validity and reliability was determined using Graph Pad Prism v5.01.

Results: Of 274 study specimens, 121(44%) were positive for histology. Ninety-one (33%) of the study specimen were positive for culture compared to 147(54%) for Pronto dry rapid urease®. Pronto dry rapid urease® test had sensitivity of 100% (97.5%-100%) against 73.6% (64.8%-81.3%) for culture. Specificity was 96.1% (91.1%-98.7%) for Pronto dry rapid urease® compared to 35.3% (95% CI 24.1%-47.8%) for culture. Positive predictive value was 96.7% (92.5-98.9%) for Pronto dry rapid urease® compared to 97.8% (92.3%-99.7%) for culture. Negative predictive value was 100% (97%-100%) for Pronto dry rapid urease® against 82.5% (76.2%-87.7%) for culture. There was significant difference between both Pronto dry rapid urease® and culture test performance with histology in all validity measures, P< 0.001. On the other hand, there was no significant difference between Pronto dry rapid urease® and culture in all validity measures due to overlapping confidence intervals.

Conclusion: Pronto dry rapid urease® out-performed culture in sensitivity and NPV. It would be the method of choice in H. pylori detection where histology is untenable and antimicrobial profiling which require culturing the bacterium is needless.

Open Access Original Research Article

Assessment of Factors Influencing Adherence to Malaria Microscopy Diagnosis in the Treatment of Out-patients at Kisumu County Referral Hospital in Kenya

Fredrick Odhiambo, Harrysone Atieli, Stephen Njoroge, David Sang

Journal of Advances in Medicine and Medical Research, Page 1-10
DOI: 10.9734/jammr/2019/v29i1230148

Aim: This study sought to assess factors that influence adherence to malaria microscopy diagnosis in the treatment of out-patients in the hospital.

Methods: From April to June 2018, a cross-sectional study was conducted. Semi-structured questionnaires were administered on clinicians and microscopists, while prescription practices of pharmacy personnel and clinicians were observed. To determine microscopy performance, systematically sampled thick blood smears, which had been used to diagnose malaria in out-patients were re-examined for presence or absence of malaria parasites by independent expert microscopists. Each thick blood smear was re-examined by two independent expert microscopists, and in case of discordant results a tie-breaker expert provided reference results for performance measures. Test validity and reliability were determined using Graph Pad Prism v5.01.

Results: Three (30%) clinicians strictly (100%) adhered to malaria microscopy diagnosis during treatment of out-patients, had refresher training on malaria case management and were aware that the laboratory participates in national quality assurance (QA) scheme. At the pharmacy-level adherence to microscopy results during treatment was generally 100% and >98% for clinicians. However, 13 (11%) malaria false-positive participants still received Artemether-Lumefantrine. Of 375 selected blood slides, 118(31.5%) were read as positive at the health facility, while 105 (28%) were read as positive by the experts, (P <0.01). Overall, 96% of test results were concordant with expert reference. The overall inter-reader agreement between hospital diagnosis and experts microscopists was κ=0.91 (95% CI: 0.87-0.96). Sensitivity was; 99.1% (95% CI: 94.9-100), specificity; 95.2% (95% CI: 91.9-97.4), Positive Predictive Value; 89% (95% CI: 81.9-94) and Negative Predictive Value; 99.6 (95% CI: 97.9-100).

Conclusion: Our results show commendable adherence to malaria microscopy during treatment of out-patients in Kisumu County Referral Hospital. Refresher training on malaria case management for clinician and awareness by clinicians that the hospital laboratory participates in national QA scheme had positive influence on the adherence to malaria microscopy during treatment of out-patients. Malaria microscopy test validity and reliability were commendable

Open Access Original Research Article

Malignant Thyroid Lesions: A Histopathological Perspective

Innocent Emmanuel, Mansur Aliyu Ramalan, Adam Ochigbo, Philip Akpa, Daniel Yakubu, Jagshak Barnabas Mandong, Barnabas Mafala Mandong

Journal of Advances in Medicine and Medical Research, Page 1-10
DOI: 10.9734/jammr/2019/v29i1230149

Introduction: Thyroid cancer incidence is increasing globally. This increase has been attributed to improvement in diagnostic methods. This study has as its aim the analysis of the pattern of thyroid gland malignancies seen at the Jos University Teaching Hospital, Jos, Nigeria, between January 2008 and December 2018.

Methodology: A descriptive retrospective study of consecutive cases of thyroid specimens analyzed at our center was done. Data was obtained from the Histopathology Department Records. The diagnosis of each case was confirmed by reviewing archival slides.

Results: There were 70 cases of thyroid carcinomas during the period of the study. The histological types of thyroid cancers seen were: follicular carcinoma, papillary carcinoma, medullary carcinoma and anaplastic carcinoma, respectively accounting for 36(51.4%), 23(32.9%), 4(5.7%) and 7(8.6%) cases. There was only 1 case of follicular carcinoma in 2012, and non between 2013 and 2018. The male to female ratio was 1: 3.1. The mean age of thyroid carcinoma was 42.7 years, with an age range of 13-80 years.

Conclusion: The histological pattern of thyroid cancers has changed over the last two decades in our environment with the erstwhile predominant follicular carcinoma receding to near disappearance. The papillary carcinoma histotype is currently overwhelmingly the commonest type diagnosed. The former is relatively commonly seen in the older age group, in a sharp contrast with the later. The female gender remains the most afflicted group.

Open Access Original Research Article

Geoengineering: The Deadly New Global “Miasma”

J. Marvin Herndon, Mark Whiteside

Journal of Advances in Medicine and Medical Research, Page 1-8
DOI: 10.9734/jammr/2019/v29i1230151

Near-total adherence to false scientific theories is the striking parallel between 19th century miasma theory associated with cholera, dispelled by Dr. John Snow, and 21st century “miasmas”, namely, the anthropogenic-carbon-dioxide-cause of global warming theory, and its presumed “cure” by geoengineering, undisclosed jet-spraying particulate pollution into the troposphere. An image published in the New York Times in 2017 began a series of discoveries that pointed to particulate pollution, not carbon dioxide, as the principal cause of global warming. Both industrial and deliberate jet-sprayed particulate pollution heat the atmosphere and thus reduces atmospheric convection-efficiency, which retards heat loss from earth’s surface and causes global warming, concomitantly wreaking havoc on human and environmental health. Today’s “bad air,” rather than spreading contagion, is causing a pandemic of non-communicable diseases (NCD’s) and decimating our natural environment. Covert tropospheric aerosol geoengineering, especially utilizing coal fly ash, is a primary catalyst for both of these modern disasters, and it must be recognized and halted. Air pollution is the leading environmental cause of disease and death in the world. Combustion products of fossil fuels are major contributors to both global warming and air pollution. The causes of air pollution and associated runaway global warming are modifiable in a short time-frame by reducing industrial and geo-engineering particulate pollution. However, corrective actions hinge on a scientific paradigm-shift and international cooperation at all levels of authority. The modern “miasmas” of complacency encompassing the universal dangers of air pollution and the deadly code of silence on the subject of undisclosed geo-engineering must be dispelled if we are to have a “fighting chance” to confront these global public health emergencies. Despite Snow’s ground-breaking work, the stubborn belief in “miasma” as the cause of infectious disease persisted well beyond his death into the 20th Century; our time is much too short now to delay changing course.

Open Access Original Research Article

Musculo-skeletal Symptoms and Its Severity among Radiographers and Sonographers in Southern Nigeria

Benjamin Effiong Udoh, Ulu Okoro Ulu, Joseph Chukwuemeka Eze, Hyacienth Uche Chiegwu

Journal of Advances in Medicine and Medical Research, Page 1-7
DOI: 10.9734/jammr/2019/v29i1230152

Background: A lot of activities have been found to contribute to musculoskeletal symptoms (MSS) among different professionals such as lifting of heavy objects, prolonged sitting or standing, long schedule of duties equipment manipulation and others. The aims of this study were to assess the prevalence and severity as well as risk factors of musculoskeletal symptoms among practicing radiographers and sonographers in the southern part of Nigeria.

Methods: This study involved distribution of questionnaire to radiographers and sonographers within the southern part of Nigeria. A total of 48 radiographers and 45 sonographers were involved in this study. Information collected from the participants included categories of work performed, schedule/ duration of duty, types of equipment used, work organizational factors, prevalence and severity of musculoskeletal symptoms to mention a few.

Results: Out of the 48 Radiographers and 45 sonographers that participated in the study, 76.3% complained of at least one episode of symptom. Low back pain was the most frequent complaint (52.6%), followed by neck pain, shoulder pain and hand/wrist pain. Reports showed that some of the respondents were prevented from performing their duties as a result of the symptoms experienced. The major risk factors were prolonged standing/sitting during prolonged duration of duty, lifting of patients and heavy equipment, overstretching of the neck following heavy work schedules. 

Conclusion: There is a high prevalence of musculoskeletal symptoms among radiographers and sonographers in Southern Nigeria. Work schedule/duration of duty and lifting of heavy loads are important factors to be controlled in order to reduce the prevalence and severity of musculoskeletal symptoms among radiographers and sonographers in Southern Nigeria.

Open Access Original Research Article

XRCC1 A910G Polymorphism and Gastric Cancer Risk in an Brazilian Population in the Amazon Region

Gabriel Neto Oliveira, Olavo Magalhães Picanço Jr, Artemis Socorro do N. Rodrigues

Journal of Advances in Medicine and Medical Research, Page 1-5
DOI: 10.9734/jammr/2019/v29i1230153

The objective of this study was to examine the association between the XRCC1 A910G polymorphism in gastric cancer patients in the city of Macapá, State of Amapá, Amazonia, Brazil.  DNA samples were obtained from 102 individuals, of which 40 were cancer patients and 62 controls. Polymerase Chain Reaction (PCR) was carried out to detect polymorphism, followed by PCR-RFLP analysis with the restriction enzyme HhaI. Of the 40 patients analysed, 22.5% had the Thr910Thr (A/A) genotype, while Ala910Ala (G/G) and Thr910Ala (A/G) genotypes accounted for 25% and 52.5% of samples, respectively. In the control group, of the 62 samples analysed, 74.1% had the Thr910Thr (A/A) genotype, while Ala910Ala (G/G) and Thr910Ala (A/G) represented 9.6% and 16.1% of samples, respectively. Our findings demonstrate that A910G polymorphism was found in most of the patients with gastric cancer in the study population. The G allele was frequently found in the analysed samples, as also observed in the genotype frequency, where AG and GG genotypes were present in cancer patients. This is the first study in Brazil to report the association between A910G polymorphism and gastric cancer.

Open Access Original Research Article

A Survey of Contraceptive Use and Associated Factors among Street Beggar Women in South Ethiopia

Shambel Alemu, Berihun Megabiaw, Abate Lette, Tilahun Ermeko

Journal of Advances in Medicine and Medical Research, Page 1-11
DOI: 10.9734/jammr/2019/v29i1230154

Background: According to Ethiopian demographic and health survey 2011, contraceptive acceptance was 29%. But no evidence that shows how much it is in absolutely poorest people and what factors affect their utilization.

Objectives: This study aimed to assess prevalence of contraceptive acceptance, and associated factors among street beggar women in Hawassa town, southern Ethiopia.

Methods: A community based cross- sectional study was carried out among street beggar women from February to March 2013. An interview based pre-tested and structured questionnaire was used to collect data. Data collection sites were demarcated into churches, mosques, market areas and women begging on roads. EPI info 3.5.3, and SPSS version 20 were used to enter and analyze the data respectively and descriptive statistic and odds ratio were used to present the data. Binary and multivariate logistic regulations were performed.

Results: Three hundred forty five women participated in the study yielding response rate of 91%. The contraceptive acceptance rate prevalence was 37.4% (95% CI: 20.5, 27.3). Nearly 60% were used injectable contraceptive. Religion (AOR = 11.6, 95%CI: 2.12, 63.62), husband approved utilization (AOR = 7.68, 95%CI: 1.37, 43.15), women who have children after joining street begging (AOR = 10.18, 95%CI: 3.84, 17.26) were significantly associated with contraceptive utilization; but those who sleep at the night on the street use contraceptive less likely (AOR = 0.21, 95%CI: 0.05, 0.92).

Conclusion: This study found high prevalence of the contraceptive acceptance among beggar women in south Ethiopia. Furthermore, the study revealed that the contraceptive acceptance among beggar women is strongly associated with husband approved utilization, women who have children after joining street begging, and women who sleep the night on the street. Therefore, concerned bodies should intervene on these factors.

Open Access Review Article

‘Different Branches from the Same Root’: Similarity and Specificity of Five Saponins from Panax Notoginseng in Cardiovascular-Related Therapeutic Effects and Mechanisms

Jiangquan Liao, Zhe Wang, Kangkang Wei, Jiangmeng Chang, Xianlun Li, Jinhang Du

Journal of Advances in Medicine and Medical Research, Page 1-11
DOI: 10.9734/jammr/2019/v29i1230150

Saponins are the major extracts of Panax notoginseng, which is one of the most commonly used herbal medicine in East Asia. Increasing evidences suggest that Panax notoginseng saponins (PNS) have various therapeutic effects on cardiovascular diseases. The therapeutic effects of PNS is through the complex combination of saponins. Notoginsenoside R1, ginsenosides Rb1, Rg1, Rd and Re are the major components of PNS, which have been studied thoroughly in recent years. In this review the authors summarize and compare the cardiovascular-related effects and mechanisms of these five saponins respectively. Anti-atherosclerosis, anti-inflammatory, anti-apoptosis are the most shared functions. But some of the functions are contradictory, such as GRb1 inhibit the endothelial tube formation and angiogenesis, while GRg1 promote the VEGF synthesis and angiogenic tube formation. Even GRg1 itself functions contradictory in angiogenesis. The comprehensive summary of the effects and mechanisms of saponins shed lights on the understanding of the diverse functions PNS exert, and lay groundwork for the development and utilization of saponins in cardiovascular diseases.