Open Access Case Report

Osteoid Osteoma of the Sacrum - Case Report and Review of Literature

Vidyasagar Maalepati, A. Raviraj, Ashish Anand

Journal of Advances in Medicine and Medical Research, Page 1-6
DOI: 10.9734/jammr/2019/v30i930235

Sacrum is an extremely rare site for osteoid osteoma. We present a 25 year-old male, a computer operator who presented with chronic back pain of 4 years duration. He was initially investigated with routine x-rays and lab investigations and was treated for chronic back pain at another facility. Extensive work up at our clinic revealed a diagnosis of Osteoid Osteoma of Right 2nd Sacral vertebral arch Interlesional resection of the tumor was done and this was verified on histopathology. The patient had complete relief of pain following surgery. Repeat CT scan done at one year follow up. It showed complete removal of the Nidus. To the best of our knowledge there have not been many case reports in English Literature from the Indian subcontinent. There are many studies in which tumor of lumbar region is one of the causes of radiating pain in lower extremities but to the best of our knowledge this finding is unique and can also be an important cause of radicular pain.

Open Access Original Research Article

Administration of Combined Methanolic Leaf Extracts of Vernonia amygdalina and Gongronema latifolium Enhanced Glut 2 Expression in the Pancreas and Downregulates Serum Caspase 3 Activity of Streptozotocin-Induced Diabetic Wistar Rats

M. I. Akpaso, N. N. Orie, P. E. Ebong

Journal of Advances in Medicine and Medical Research, Page 1-10
DOI: 10.9734/jammr/2019/v30i930230

Aim: The study evaluated the effects of the combined extracts of Vernonia amygdalina (VA) and Gongronema latifolium (GL) on pancreatic GLUT 2 expression and caspase 3 activity in streptozotocin (STZ, 45 mg/Kg)-induced diabetic rats.

Study Design: Fifteen Albino rats were used for the study and were placed in 3 groups of 5 rats each: A - normal control, B – Diabetic control and C – experimental group.

Place and Duration of Study: The study was carried out in the department of Anatomy, University of Calabar.

Duration:  6 months.

Methodology:  Half of the diabetic rats were treated with VA+GL (400mg/kg, ratio 1:1, DE group) for 28 days, while the other half was untreated and served as diabetic control (DC). Normal control (NC) rats were untreated. After 28 days, the rats were sacrificed and their blood glucose, serum GLUT 2 and caspase 3 activity were measured.  Histochemical evaluation of the pancreas was also carried out.

Results: Blood glucose concentrations for the 3 groups were 60.31±7.28, 257.00±4.43, and 116.60±10.11 mg/dl for NC, DC and DE respectively. This represented a 4-fold increase in the DC compared with NC and a significant amelioration in the extract-treated DE group compared with DC group. Serum GLUT 2 concentrations were 70 ng/ml in NC, dropped to 8 ng/ml (p<0.05) in the DC and recovered to 20 ng/ml in DE (p<0.05). Serum caspase was 3.2 ng/ml for NC, increased to 8.5 ng/ml in DC (p<0.05) and reduced to 1.8 ng/ml in DE (p<0.05). The histology of the pancreas showed distorted, degenerated and shrunken β-cells mass in DC compared with NC and DE groups. The DE group showed clear signs of regeneration of the islet cells which was corroborated by positive Feulgen’s reaction compared with the DC group.

Conclusion: The data suggests that the combined VA+GL extract has the potential to effectively reverse pancreatic damage in diabetes.

Open Access Original Research Article

Pregnancy Outcome of ART-experienced and ART-naïve HIV-infected Mothers at the University of Port Harcourt Teaching Hospital, Port Harcourt, Nigeria

R. O. Ugwu, N. I. Paul, A. U. Eneh

Journal of Advances in Medicine and Medical Research, Page 1-10
DOI: 10.9734/jammr/2019/v30i930231

Background: Untreated maternal Human Immunodeficiency Virus (HIV) infection is associated with adverse pregnancy outcome including preterm birth, low birth weight, and mother-to-child transmission of the virus. This study aimed to compare the pregnancy outcome between HIV infected mothers who received ART in pregnancy and those who were ART-naïve.

Methods: A cross-sectional study of HIV-infected mothers who brought their infants for follow up between November 2007 and May 2017 at the University of Port Harcourt Teaching Hospital, Port Harcourt, Nigeria. Relevant information obtained include: time of diagnosis, antiretroviral therapy (ART) regimen and when it was commenced, gestational age at delivery and birthweight of child, mode of delivery, infant feeding option and ARV prophylaxis. Infection status of the infant was determined by DNA PCR at 6weeks of age. Based on when ART was commenced, mothers were grouped into three [(HAART experienced (HE) if ART was started before pregnancy, HAART in pregnancy (HIP) and HAART naive (NH) if no HAART was taken in pregnancy]. Main outcome measures were rates of prematurity, low birth weight, mean birth weight, birth defects and mother-to-child transmission.

Result: A total of 1,640 HIV-exposed infants were seen (716(43.6%) in HE, 360(22.0%) in HIP and 564(34.4%) in NH groups). There were 825(50.3%) males and 815(49.7%) females. Zidovudine/Lamivudine and Nevirapine/Efavirenz was the most frequently used combined ART in 724 (67.3%) mothers. The mean birthweight was 3.12±0.38Kg; range 1.2 – 5.7Kg (3.11±0.58Kg in HE; 3.13±0.53Kg in HIP; 3.18±0.74Kg in NH) Table 3. A hundred and eighty (11.0%) babies were preterm [76(42.2%) in HE; 26(14.4%) in HIP; 78(43.3%) in NH](p=0.007), while 159(9.7%) were LBW [74(46.5%) in HE; 22(13.8%) in HIP; 63(39.6%) in NH](p=0.03). Fourteen (0.9%) babies had birth defects [5(35.7%) in HE; 9(64.3%) in HIP] (p=0.01). The commonest birth defects were neural tube defect 7(50%) and congenital heart defect 4(28.8%). Overall transmission rate was 21.4% [8% in the HE, 4.5% in HIP and 87.5% in NH groups] (p=0.001). The mean birth weights of uninfected babies were higher than their infected counterparts but was not significant (p>0.05).

Conclusion: The benefits of early HAART in reducing mother-to-child transmission must be weighed against the risks of lower birthweight and potential teratogenic effects of drug exposure on the foetus.

Open Access Original Research Article

Effect of Hypertensive Disorders of Pregnancy on Maternal Health Outcomes at Primary Health Care Centers in Gaza Strip – Palestine

Khalil Jamil Elqatrawi, Ashraf Yaqoub Eljedi

Journal of Advances in Medicine and Medical Research, Page 1-11
DOI: 10.9734/jammr/2019/v30i930232

Aims: To identify the possible effects of hypertensive disorders of pregnancy (HDP) on maternal health outcomes of women attended primary health care centers (PHCCs) in Gaza Strip – Palestine.

Study Design:  A cross-sectional comparative design.

Place and Duration of Study: The study was conducted at 6 PHCCs from August 2016 to May 2017.

Methodology: Two groups of 215 hypertensive mothers and 215 normotensive mothers in the last pregnancy were recruited by 3-stage stratified random sampling technique. A detailed questionnaire filled through face to face interviews in addition to medical records revision in 2017. Pearson's Chi-square and t-tests were used to compare the outcomes between the two groups.

Results: HDP in 215 women were classified as pregnancy-induced hypertension (n = 153, 71.2%) and chronic hypertension (n = 62, 27.8%). The mean age of HDP women was 28.8 ± 6.8 years. About 40.9% live in refugee camps; 23.7% had gravida ≥ 7; 54.6% had BMI > 30 and 21.9% had a history of twice or more abortions. Only 20% of HDP women received preconception care. Cesarean section and assisted delivery were significantly higher among hypertensive mothers (37.2% and 26.9%) compared with non-hypertensive (16.3% and 8.4%) respectively (P = 0.001). Incidence of preeclampsia/eclampsia, antepartum hemorrhage and postpartum hemorrhage, were significantly higher among HDP women (29.3%, P = 0.001; 14%, p=0.001; 7%, P = 0.003 respectively) while no significant differences in abrupio placenta (0.9%; P = 0.25), placenta previa (0.5%, P = 0.75) HELLP syndrome (0.9%, P = 0.24) were found between the two groups. 20.9% mothers with pregnancy-induced hypertension were not recovered and developed chronic hypertension.

Conclusion: Women with HDP are at higher risk to have adverse maternal outcomes compared to normotensive women in GS. Preconception care, early diagnosis and prenatal follow-up would improve maternal and fetal prognosis.

Open Access Original Research Article

Risk Assessment of Occupational Exposure of Workers Engaged in Radiation Practice without Monitoring Devices

Akinlade Bidemi I., Akisanya Daniel F., Badmus Biodun S.

Journal of Advances in Medicine and Medical Research, Page 1-6
DOI: 10.9734/jammr/2019/v30i930233

Objective: This study was carried out to evaluate occupational dose of personnel, engaged in radiation work without wearing monitoring device, at five diagnostic centres in Abeokuta, Ogun State metropolis, namely, Rainbow, New image, Bethel, Akinolugbade and Abiolad. 

Materials and Methods: Thermoluminescent dosimeters (TLDs) obtained from Radiation Protection Services, Lagos State University (LASU), Ojo were used for dose measurements. LASU is accredited by the Nigerian Nuclear Regulatory Authority (NNRA) to provide radiation monitoring services. The TLDs were distributed to each of the centre for personnel and area (control and supervised) monitoring. The period of exposure of the TLDs was three months. The exposed TLDs were returned to LASU for processing. The effective dose received by personnel per quarter was extrapolated to annual effective dose to make comparison with the International Commission on Radiation Protection (ICRP) recommended dose limit. The stochastic effect of the measured dose was also estimated. 

Results: Annual effective dose received by all personnel ranged from 1.16 - 2.54 mSv. While the highest value was obtained by personnel at Bethel diagnostic centre, the lowest value was obtained at Akinolugbade. The risk of cancer associated with these values, estimated for a million population, was 112 and 61 at Bethel and Akinolugbade respectively.

Conclusion: This study showed that the annual effective doses to personnel at these centres were below the ICRP recommended dose of 20 mSv per annum. However, the Managements of these diagnostic centres should provide monitoring devices for their radiation workers in line with NNRA authorization requirements.

Open Access Original Research Article

Utilization of Chronic Obstructive Pulmonary Disease Assessment Test (CAT) in Patients with COPD in Low Resource Countries

Akor, Alexander Agada, Obaseki Daniel, Bamidele Adeniyi, Gregory Efosa Erhabor

Journal of Advances in Medicine and Medical Research, Page 1-7
DOI: 10.9734/jammr/2019/v30i930236

Background: Chronic obstructive pulmonary disease (COPD) is a chronic respiratory disorder commonly assessed by spirometry and health related quality of life (HRQoL) questionnaires. COPD assessment test (CAT) is a new questionnaire used for HRQoL evaluation especially in a clinic setting.

Aims: To assess HRQoL using the CAT, and to determine the relationship of CAT to other measures of COPD such as pulmonary function test (PFT), dyspnea and six minutes walking distance test (6MDWT) among patients with COPD in Nigeria.

Settings and Design: Cross-sectional study.                 

Methods: Sixty stable patients with a clinical and spirometric diagnosis of COPD according to the GOLD criteria were recruited into the study. Spirometry was performed according to ATS/ERS guidelines. Health status, dyspnea and functional capacity of the patients were assessed using the CAT questionnaire, modified medical research council (MMRC) dyspnea scale and six-minute walking distance (6MDWT) respectively.

Results: The mean age was 68.8 years ± 10.3. Sixty percent of the study participants were male. The mean BMI was 21.6 ± 4.8 kg/m2, 37(61.7%) of the patients were ex-smokers, 3.3% were current smokers and 35% were never smokers. In terms of frequency of exacerbations 18.3% had ≤ 1 per year and 5.0% had ≥ 2 per year. The CAT was strongly associated with 6MWDT (r = 0.85P < 0.001), FEV1% predicted (r= 0.67, P< 0.001) and with MMRC (r=0.64, p<0.01).

Conclusions: CAT scores correlated well with percent FEV1, dyspnea and exercise tolerance which measures various aspect of COPD. It may serve as an easy to administer sensitive tool in assessing stable COPD in outpatient clinics especially in low resource countries.

Open Access Original Research Article

Cytotoxic Effects of Xanthohumol and Its Combination with Cisplatin on Human Metastatic Lung Cancer H1299 Cells

B. Long, E. Parks, P. Pacurari, A. Rieland, M. Pacurari

Journal of Advances in Medicine and Medical Research, Page 1-15
DOI: 10.9734/jammr/2019/v30i930237

Aims: Non-small cell lung cancer (NSCLC) accounts for high lung cancer death that is mostly associated with advanced disease stage at diagnosis and resistance to chemotherapy. In the present study, we investigated whether xanthohumol, a prenylated flavonoid of hop plant, induces metastatic lung cancer H1299 cell death, and whether in combination with cisplatin there are additive effects.

Methodology: H1299 cells were grown and treated with xanthohumol (6.25, 12.5, or 25 µM), cisplatin (12.5, 25, or 50 µM) and the combination of cisplatin and xanthohumol for 24 h. Cell viability, cell morphology, chromatin condensation, ɣH2AX, cPARP-1, capsase-3, p21WAF1/CIP1 and p14ARF genes were analyzed.

Results: Xanthohumol, cisplatin, and the combination of cisplatin and xanthohumol inhibited H1299 cells viability.  Cisplatin growth inhibitory effects were potentiated by xanthohumol.  Xanthohumol induced chromatin condensation and apoptosis and potentiated cisplatin’s effect vs cisplatin alone. Further investigation of growth inhibitory effects, xanthohumol alone induced γH2AX foci formation and the combination potentiated γH2AX foci formation. Cisplatin, xanthohumol at 25 μM, and the combination of cisplatin and xanthohumol at 6.25 and 12.5 μM increased cPARP-1 level.  Active caspase-3 was increased by cisplatin, 12.5 μM of xanthohumol, and the combination of xanthohumol and cisplatin. Xanthohumol at 6.25 or 12.5 μM potentiated cisplatin effect on active caspase-3 and cPARP-1, respectively.  Xanthohumol at 25 µM significtly induced the expression cell cycle control genes p21WAF1/CIP1 and p14ARF.  These results indicate that xanthohumol inhibits proliferation of H1299 cells and induces cell death through cleavage of PARP-1 and activation of caspase-3. The combination of cisplatin and xanthohumol potentiated cytotoxic effects of each other compound.

Conclusion: The present study suggests that xanthohumol poses apoptotic effects and potentiates cisplatin’s growth inhibitory effects on metastatic lung cancer cells.

Open Access Original Research Article

Comparative Study of Two Different Rapid Diagnostic Tests with Microscopy Method for Malaria Parasite Detection

Stella U. Ken-Ezihuo, Sigmund S. Itatat, Ebirien-Agana S. Bartimaeus

Journal of Advances in Medicine and Medical Research, Page 1-8
DOI: 10.9734/jammr/2019/v30i930238

Introduction: Accurate rapid diagnosis is one of the most important steps in the effort to reduce morbidity and mortality of malaria. Blood-specific malaria rapid diagnostic tests (RDTs) are currently in use but reports on their sensitivity and specificity and comparison with the established blood film microscopy methods are dearth. The aim of the present study was to evaluate the performance characteristics of Nova and SD bioline RTDs and compare with microscopic method as a reference standard to detect the presence of malaria parasites in the blood.

Methods: A total of 100 subjects were conveniently selected from consented subjects attending out-patient Department of Rivers State University Teaching Hospital, Port Harcourt, and the samples were analyzed using blood film examined with Giemsa staining technique and Nova and SD bioline kits.

Results: Of the 100 samples examined, 57(57%) were positive for malaria parasite by light microscopy, 37(37%) were positive by Nova and 22 (22%) were positive by SD bioline. The sensitivity of the two RDTs used were found to be 54% for Nova and 30% for SD bioline, the specificity were 86% for Nova and 88% for SD bioline, the PPV for Nova was 83% and 77% for SD bioline while the NPV for Nova was 59% and 49% for SD bioline. Percentage positivity of 50.9% and 49.1% for males and females respectively means that both sexes are equally susceptible to malaria parasites. There was a slight increase in parasitaemia in females (1931±2801) than males (1139±2415) but these results were not statistically significant (P >.27).

Conclusion: The SD bioline showed a very poor sensitivity in contrast to Nova and light microscopy. Inspite of the relative advantages of RDTs, microscopy remains the best method of detecting malaria parasite and Nova should be preferred to other RDTs.