Open Access Case Study

Uremic Encephalopathy with Basal Ganglia Lesions in a Diabetic Predialysis Patient

Ye Na Kim, Ho Sik Shin, Hark Rim

Journal of Advances in Medicine and Medical Research, Page 249-254
DOI: 10.9734/BJMMR/2013/2068

Syndromes associated with acute bilateral lesions of the basal ganglia in diabetic uremic patients are uncommon, and usually have reversible clinical and imaging findings. Such syndromes are seen almost exclusively in patients with diabetes mellitus and renal failure. Previously reported cases have described diabetic men with uremia on dialysis.
Here, we report a case of uremic encephalopathy with lesions of the basal ganglia in a diabetic predialysis patient. A 44-year-old man with uremic encephalopathy presented with dysarthria, chorea, and right upper extremity paresthesia. Magnetic resonance imaging of the brain showed classic findings of hyper intensity in the bilateral basal ganglia. The patient had no family history of psychiatric or neurological disease. Laboratory findings revealed elevated levels of blood urea nitrogen, creatinine, and glucose. Haloperidol and ropinirole therapy was continued, resulting in significant improvement without dialysis. The patient recovered from his episode without apparent sequelae. 

Open Access Case Study

Severe Hyponatraemia under Carbamazepine for Secondary Prophylaxis of Post-Traumatic Epilepsy

Josef Finsterer, Claudia Stöllberger, Christine Steger, Christine Steger, Elisabeth Stöphasius

Journal of Advances in Medicine and Medical Research, Page 255-261
DOI: 10.9734/BJMMR/2013/2306

Aims: Among the antiepileptic drugs (AEDs) applied for secondary prophylaxis of post-traumatic epilepsy (PTE), carbamazepine (CBZ) may cause severe side effects and worsen traumatic brain injury (TBI).
Presentation of Case: Two days after a bicycle accident causing severe TBI, a 23yo female developed a questionable seizure and received CBZ. Since then she required substitution of sodium. Six days after the accident she was extubated. Serum sodium was 123mmol/l. One day after transfer to the general ward, she was found comatose with a serum sodium of 114mmol/l. Cerebral CT showed diffuse cerebral edema. Electroencephalography did not record paroxysmal activity. After replacement of CBZ by levetiracetam, her condition markedly improved with a favourable outcome.
Discussion and Conclusion: CBZ was made responsible for severe hyponatraemia in the presented case after exclusion of all other possible causes. Hyponatraemia may trigger the recurrence of cerebral edema after TBI. Hyponatraemia from CBZ may favourably respond to slow substitution of sodium with physiologic saline. CBZ for secondary prophylaxis of PTE may cause hyponatraemia, cerebral edema, and deterioration of pre-existing TBI. Replacement of CBZ by levetiracetame may resolve the condition. CBZ should be used with caution for secondary prophylaxis of PTE in TBI.

Open Access Case Study

Psychotic Symptoms in a Patient with Hashimoto’s Thyroditis

K. Kontoangelos, M. Economou, A. Kandaraki, V. Mylona, I. Makrygiannis, G. N. Papadimitriou

Journal of Advances in Medicine and Medical Research, Page 262-266
DOI: 10.9734/BJMMR/2013/1675

Objective: Psychopathological symptoms, depression, apathy, memory and sleep disorders, have been reported in patients with Hashimoto’s thyroiditis, but psychotic symptoms without psychiatric background are extremely rare.
Method: A 74 year male patient without previous psychiatric history was presented with acute psychotic symptoms to the emergency department and was hospitalized for three days.
Results: The laboratory profile showed the presence of high titer of serum thyroid antibodies (ANTI-TG>4000IU/ml, n.r.=0.0-115.0 IU/ml), high titer (corrected) of serum Anti-thyroid peroxidase antibodies (Α-TPO: 386.7 IU/ml, n.r.:0.34 IU/ml) and high Thyroidstimulating hormone TSH: 45.6μΙU/ml,n.r.:2.03-4.01μIU/ml, T4(Thyroxine =6.98μg/dL, (n.r.:5.10-14.10μg/dL), T3triiodothyronine=0.84ng/mL (n.r.:0.80-2.00ng/mL). The diagnosis of primary hypothyroidism was made due to Hashimoto’s thyroiditis.
Conclusion: Since psychiatric symptoms may be one of the earliest manifestations of hypothyroidism, they are often misdiagnosed as functional psychiatric disorders. This confusion can lead to delayed treatment.

Open Access Case Study

Isolated Pancreas Fracture after a Go-Kart Accident

Engin Deniz Arslan, Elif Çelikel, Bige Sayin, Cemil Kavalci, Fevzi Yilmaz, M. Serkan Yilmaz, Tamer Durdu

Journal of Advances in Medicine and Medical Research, Page 288-293
DOI: 10.9734/BJMMR/2013/2487

Isolated pancreatic trauma is extremely rare because of pancreas’ anatomic localization. Also, diagnosis of pancreatic injury may be difficult due to lack of sensitivity of initial clinical findings, laboratory and imaging examinations in emergency department. Morbidity and mortality is much higher in delayed presentation or if the trauma is unrecognized. In this paper we report a 20-year-old female with isolated pancreas fracture after a blunt abdominal trauma due to a go-kart accident. Repeated evaluation of patient by taking into account of mechanism of trauma and suspicion of pancreatic injury is essential for early diagnosis.

Open Access Case Study

The Use of Iodine as First Line Therapy in Graves' Disease Complicated with Neutropenia at First Presentation in a Paediatric Patient

Arundoss Gangadharan, Harsha Hanumanthaiah, Sze May Ng

Journal of Advances in Medicine and Medical Research, Page 324-328
DOI: 10.9734/BJMMR/2013/2517

Aims: Graves' disease is a common cause of hyperthyroidism in the paediatric population. An association between neutropenia and untreated Graves' disease has been described although the aetiology is unknown.
Presentation of Case: A 13 year old boy presented with a 3 month history of weight loss, insomnia, fatigue, palpitations and anxiety. On examination, he had tachycardia of 140 beats/minute, sweating, tremors and brisk deep tendon reflexes. The clinical and laboratory results were consistent with Graves' hyperthyroidism. He was treated with Lugol`s iodine and Propanolol in view of his low neutropenia count at diagnosis.
Discussion: Thionamide drugs remain the initial treatment of choice in children and adolescents presenting with Graves' disease, however adverse effects such as agranulocytosis remains a concern.
Conclusion: In cases where anti-thyroid thionamides are contraindicated due to the risk of side effects such as agranulocytosis or neutropenia, Lugol's iodine may be an alternative temporary form of first line therapy.

Open Access Case Study

Impact of D-bifunctional Protein Deficiency on Telomere Length and Gene Expression in a Child

Marta Elena Hernández-Caballero, Diego Julio Arenas-Aranda, Raquel Chávez-Torres, José Alfredo Sierra-Ramírez, Calzada-Mendoza Claudia Camelia

Journal of Advances in Medicine and Medical Research, Page 351-360
DOI: 10.9734/BJMMR/2013/2614

Aim: To explore, in one patient, the possibility that D-bifunctional protein (D-BP) deficiency affects telomere length, and to determine the profile of genetic expression.
Presentation of Case: Due to the symptoms of a newborn and his family background, a peroxisomal panel was performed. There were high levels of very long chain fatty acids and abnormal peroxisomes. At 8 months the patient exhibited other complications, including progressive multi systemic deterioration, and at 15 months died of pneumonia.
Discussion: Analysis of the patient’s fibroblasts provided evidence of a defect in the peroxisomes and in the oxidation of fatty acids, leading to a diagnosis of D-BP deficiency. Significant alterations were found in the genetic expression profile, with the greatest number of affected genes involved in neuronal functions, two implicated in peroxisomal biogenesis, and some others related to telomere protection and DNA repair. The child had a mixture of very short and normal length telomeres, a condition commonly observed in the elderly and in individuals with chronic degenerative diseases.
Conclusion: The abnormal function of peroxisomes and altered gene expression found in the patient under study could explain the affected telomere length. Further studies are needed to explore this possibility.

Open Access Case Study

Catastrophic Wear of Tibial Component of Total Knee Replacement Due to Neglected Dislocation of Polyethylene Insert: A Case Report

Kasim Kilicarslan, Mahmut Nedim Aytekin, Aydan Kilicarslan, Ismail Demirkale, Hakan Cicek, Nadir Yalcin

Journal of Advances in Medicine and Medical Research, Page 420-427
DOI: 10.9734/BJMMR/2013/2528

We report a case of 69-year-old female patient who presented with a dislocated insert causing tibial component failure and catastrophic metallosis after 4 years of prosthesis implantation. In case of a trauma history, surgeons must suspect friction noise and motion loss as clinical symptoms indicating dislocation of the insert at the initial postoperative period. Timely diagnosis can prevent catastrophic consequences.

Open Access Original Research Article

Renewal versus Retention: Isotopic Composition of Intestinal Epithelium and Eye Lens

Yuri K. Doronin, Daria Yu. Bednik, Andrei A. Ivanov, Elena N. Kalistratova

Journal of Advances in Medicine and Medical Research, Page 210-215
DOI: 10.9734/BJMMR/2013/1591

Aims: To compare isotopic signatures of contrasting (due to the structure and metabolism) organs in mice of two contrasting ages.
Study Design: Cross-sectional study.
Place and Duration of Study: Biology Department of Moscow State University; Institute of Geochemistry and Analytical Chemistry, Russian Academy of Sciences; 2007–2011.
Methodology: Mass spectrometric measurements of carbon and nitrogen isotopic ratios of jejunal epithelium and lens in 1- and 22-mo mice fed a monotonous diet.
Results: The lenses are enriched in carbon and nitrogen as compared with intestinal epithelium (by 5.5% and 4.5% in 1-mo mice and 8.3% and 6% in 22-mo mice, respectively). The 15N content is also higher in lenses than in intestinal epithelium (8.97‰ vs. 7.62‰ in 1-mo mice, and 7.40‰ vs. 6.58‰ in 22-mo mice). The 13C content of lenses exceeds that of intestinal epithelium in 1-mo mice (-20.27‰ vs. -21.69‰), although 13C content is equal in 22-mo mice (-22.56‰ vs. -22.67‰). 15N content is depleted in the intestinal epithelium of 22-mo mice (-1.04‰), whereas 13C depletion (-0.98‰) is non-significant. 13C and 15N content in lenses is also significantly decreased in 22-mo mice (-2.29‰ and -1.57‰).
Conclusion: The intestinal epithelium represents a structure with short-term isotopic memory lasting a few days, whereas the events of the organism’s entire lifetime are retained in lens isotopic memory. The difference of the parameters measured is evidently determined by structural contrast, metabolic rate, and rejuvenation modes of the tissues. The 15N depletion in both the intestinal epithelium and lenses, as well as 13C depletion in lenses of 22-mo mice might be considered as a sign of ageing. In contrast, the depletion of 15N in lenses of 22-mo mice should be considered primarily as a result of dilution of breastmilk isotopic signature that probably obscures age-related alterations of the organ. Comparison of isotopic compositions of these contrasting organs may be useful for physiological and ecological determinations.

Open Access Original Research Article

Evaluation of Anti-inflammatory and Antinociceptive Potentials of Khaya senegalensis A. Juss (Meliaceae) Stem Bark Aqueous Extract

O. T. Kolawole, M. O. Akiibinu, A. A. Ayankunle, E. O. Awe

Journal of Advances in Medicine and Medical Research, Page 216-229
DOI: 10.9734/BJMMR/2013/1931

Aim: To investigate anti-inflammatory and antinociceptive potentials of aqueous stem bark extract of Khaya senegalensis A. Juss (Meliaceae) in rodents.
Methodology: Anti-inflammatory activity of aqueous stem bark extract of K. senegalensis (AKS) was studied in different models. Effect of the extract in acute inflammation was tested in carrageenan-induced rat paw edema and its effect in chronic inflammation was evaluated using cotton pellet-induced granuloma test. Croton oil-induced ear edema in mice was used to investigate the effect of the extract on topical inflammation. Antinociceptive property of AKS was evaluated using three models of nociception: hot-plate test, acetic acid-induced writhing in mice and formalin-induced paw licking in rats. Membrane stabilizing effect of AKS was tested in heat and hypotonicity-induced hemolysis. The mechanism of antinociceptive effect of the extract was evaluated by pre-treating rats with metoclopramide, a dopamine (D2) antagonist (1.5 mg/kg body wt.) and naloxone, an opioid receptor antagonist (5 mg/kg body wt.). One hour after these treatments, the rats were given AKS (150 mg/kg p.o) and their reaction time in hot-plate was assessed. Free-radical scavenging activity of the extract was measured by decrease in the absorbance of 1, 1-Diphenyl-2-picrylhydrazyl (DPPH) methanol solution.
Results: The extract produced significant (P<0.05) and dose-dependent inhibition of ear edema in mice. It also caused a significant (P<0.05) reduction in granuloma formation and paw edema in rats. At concentration range of 125 - 500 µg/ml, AKS significantly (P<0.05) protects the erythrocyte membrane against lysis induced by heat and hypotonic medium. It also significantly (P<0.05) reduced the licking/biting time of the formalin-injected rat paw in the early (19 - 51 % reduction) and late (13 - 57 % reduction) phases. The extract demonstrated significant (P<0.05) antinociceptive activity in the hot-plate and writhing tests and exhibited good scavenging effect on DPPH free radical.
Conclusion: The study demonstrated that Khaya senegalensis stem bark aqueous extract possesses anti-inflammatory activity and antinociceptive effect mediated via central and peripheral mechanisms. Further studies on the plant may produce lead molecules for the development of new anti-inflammatory drugs.

Open Access Original Research Article

Hemodynamic Treatment Aimed to Reduce Catecholamine Toxicity in Patients Suffering from Septic Shock: An Observational Single Center Study

Andreas Hartjes, Bettina Wurzinger, Gabriele Neubauer, Sieglinde Wieczorek-Waltenberger, Martin Dünser, Walter Hasibeder

Journal of Advances in Medicine and Medical Research, Page 230-248
DOI: 10.9734/BJMMR/2013/2072

Aims: Catecholamines represent a cornerstone in the hemodynamic management of septic shock (SS). However, development of toxicity may adversely affect patient outcome. We describe the outcome of 460 consecutive SS patients who were treated with an institutional hemodynamic protocol aimed at decreasing catecholamine toxicity.
Study Design: Retrospective observational analysis.
Place and Duration of Study: Multidisciplinary intensive care unit in a 460 bed hospital between January 1, 2004 to July 31, 2010.
Methodology: Demographic data, premorbidities, admission Simplified Acute Physiology Score (SAPS) II, most aberrant laboratory data, highest dosages of norepinephrine (NE), dobutamine, milrinone, use of ß-adrenoreceptor blocking agents, hydrocortisone and arginine vasopressin (AVP), development of new-onset tachyarrhythmia and myocardial ischemia were analyzed from an electronic database. The institutional hemodynamic treatment protocol includes early administration of hydrocortisol and arginine vasopressin in addition to norepinephrine and aggressive treatment of hyperthermia (T>38.5º). New onset tachyarrhythmia’s/tachycardia were treated using amiodarone and ß-adrenoreceptor blockers to decrease heart rate below 95bpm, respectively. Observed and SAPS-predicted mortality were analyzed for all patients and SAPS-quartiles (QI-QIV) of increasing disease severity.
Results: Age, incidence of preexisting heart, renal disease, arterial hypertension, and MODS increased while body mass index significantly declined from QI to QIV. With increasing disease severity, patients received higher dosages of NE, steroids, AVP and milrinone. The incidence of tachycardic atrial fibrillation and myocardial ischemia increased from QI to QIV. Overall, there was no significant difference between the observed and SAPS II predicted mortality (p=0.2, Chi2-test). However, we observed a trend (-12, 2%) towards decreased mortality in QIII (p=0.07) and a significant decrease in hospital mortality (-19%) in QIV (p<0.0001; Chi2-test).
Conclusions: Our data suggest that a treatment protocol aimed at decreasing catecholamine toxicity including early administration of hydrocortisone, AVP, aggressive body temperature and heart rate control may decrease SS mortality, particularly in elderly, premorbid patients suffering from advanced SS.

Open Access Original Research Article

Depression, LUTS and ED Relation in Elderly Men

C. Ceylan, O. G. Doluoglu, M. Yigman, I. Keles, E. Benli, G. E. Dagistanli, O. Odabas

Journal of Advances in Medicine and Medical Research, Page 267-274
DOI: 10.9734/BJMMR/2013/1700

Objectives: Depression unfortunately, remains an under-recognized and misdiagnosed condition, especially in the aging population. We aimed to research the relation of depression, LUTS and ED in elderly men.
Methods: In this prospective study, 364 elder male patients were evaluated. For depression research in patients, Beck's Depression Index (BDI) was used. Lower urinary tract symptoms of patients were evaluated by International prostatic symptoms score (IPSS) examination form and Erection quality was evaluated with International Index of Erectile Function (IIEF 5-15) examination form. According to evaluation results, patients were assigned as Group 0: Mild LUTS and no ED (IPSS<7 - IIEF>26), Group 1: Patients describing only moderate and severe LUTS, Group 2: Patients describing only ED (IIEF<26), Group 3: Patients describing both LUTS and ED (IPSS>7 - IIEF<26).
Results: A significant difference was observed between depression states of patients and their LUTS and IIEFs. Depression risk for the Group 3 was monitored to increase by 5.4 fold (p=0.012) according to the Group 0.
Conclusions: ED, LUTS and depression are all common conditions that accompany aging and significantly negatively impact quality of life. So this patient group can be treated more successful by a multidisciplinary approach.

Open Access Original Research Article

Occupational Exposure, Risk Perception and Access to Prophylaxis for HIV/AIDS Infection among Health Care Workers in Northern Nigeria

O. E. Amoran

Journal of Advances in Medicine and Medical Research, Page 275-287
DOI: 10.9734/BJMMR/2013/1770

Introduction: This study was designed to describe occupational exposure, risk perception and access to prophylaxis for HIV/AIDS among the health care workers in Northern Nigeria.
Methods: This study is an analytical cross-sectional study. Multistage sampling technique was used to obtain a representative sample and a structured self-administered questionnaire was used to collect relevant information.
Results: A total of 421 health care workers were interviewed, 5.2% reported per-cutaneous exposure to HIV infected blood or body fluids in the workplace in the last 6 months. Predictors of risk perception were working in public facilities [OR=2.28, C.I=1.26-4.15], male gender [OR=3.42, C.I=1.59-7.36] and training on infection control [OR=1.94, C.I=1.13-3.34]. Significantly more males [OR=2.33, C.I=1.12-4.94], those in public facilities [OR=5.85, C.I=1.97-19.48], urban facilities [OR=24.99, C.I=3.67-491.82] and those in tertiary facilities [[OR=17.96, C.I=6.04-59.99] reported a greater access to prophylaxis medication.
Conclusion: The study concludes that male health care workers that are young, working in public facilities and have insufficient knowledge about HIV/AIDS have a high risk perception for HIV/AIDS while those in urban and public facilities especially tertiary facilities reported a ready access to prophylaxis medication. Uneven distribution of medication and other health care resources in Northern Nigeria and similar populations may contribute to increased casualty among the health care workers.

Open Access Original Research Article

A Histological Study of the Hepatic and Renal Effects of Subchronic Low Dose Oral Monosodium Glutamate in Swiss Albino Mice

Adejoke Yetunde Onaolapo, Olakunle James Onaolapo, Tolulope Josiah Mosaku, Onigbinde Oluwanisola Akanji, Onigbinde Oluwanisola Akanji, Onigbinde Oluwanisola Akanji, Oyeleke Abiodun, Onigbinde Oluwanisola Akanji, Oyeleke Abiodun

Journal of Advances in Medicine and Medical Research, Page 294-306
DOI: 10.9734/BJMMR/2013/2065

Aim: Earlier studies have shown that exposure to monosodium glutamate (MSG) in large doses during the neonatal period may result in steatohepatitis and evidence of pre-neoplastic changes in the liver. However, the effect of low dose, chronic oral MSG intake on the histology of the liver and kidneys have not been addressed to date, this study was designed to ascertain if MSG consumption at these doses is associated with histological evidence of hepatic or renal injuries.
Study Design: Experimental study.
Place and Duration of Study: Department of Anatomy and Department of Pharmacology Ladoke Akintola University of Technology Ogbomosho Oyo State Nigeria between October and November 2011.
Methodology: Forty adult male Swiss albino mice weighing between 20-25 mg were assigned into 4 groups A, B, C and D of ten mice each (n=10). Group A served as control and received normal saline while groups B, C and D received MSG daily at 0.5, 1.0 and 1.5 mg MSG /kg body weight (BW) dissolved in normal saline respectively for 28 days. On day 29 of the study animals were sacrificed, and the liver and kidneys were removed, weighed and processed for histological examination. Statistical analysis was by one way ANOVA followed by a posthoc test, and results were expressed as mean ±S.E.M.
Results: MSG consumption resulted in a significant increase in the relative liver weight at 1.0 and 1.5 mg MSG /Kg BW and a relative increase in kidney weight occurring at 1.5 mg/Kg BW (P<0.05). This was accompanied by a dose- dependent increase in body weight compared to control which failed to reach statistical significance. Liver and kidney histology indicated a loss of normal liver architecture with varying degrees of disorganization and apoptotic cell death compared to controls. The kidneys of MSG-exposed mice exhibited contraction of the renal glomerulus and thickening of the walls of the renal tubules.
Conclusion: The study provides evidence that oral consumption of MSG at doses within the Acceptable Daily Intake (ADI) may promote hepatic and renal injuries.

Open Access Original Research Article

Oxidative Stress Markers in Children with Autism Spectrum Disorders

María Elena González-Fraguela, Mei-Li Diaz Hung, Hector Vera, Carlos Maragoto, Elena Noris, Lisette Blanco, Reynaldo Galvizu, Maria Robinson

Journal of Advances in Medicine and Medical Research, Page 307-317
DOI: 10.9734/BJMMR/2013/2335

Aims: The etiology of autism spectrum disorders (ASD) remains elusive, but oxidative stress has been suggested to play a pathological role. The understanding of the potential role of oxidative stress in the etiopathogenesis of autism would be very useful for earlier clinical, therapeutic or preventive strategies.
Sample: To evaluate the redox status, we quantified the activity of the antioxidant enzyme catalase (CAT), glutathione concentration (GSH) and markers of damage to biomolecules, malonyldialdehyde (MDA) and 8–hydroxy-2deoxyguanosine (8OHdG) in peripheral blood samples.
Place and Duration of Study: Sample: Department of Neuropediatrics and Technology Science Division. International Center for Neurological Restoration (CIREN), Havana, Cuba. May 2011- June 2012.
Methodology: We included 45 children with autism (36 males and 9 females, age-range from 3 to 11 years). 42 children of the same age were selected as a control group. The diagnosis of autism was made based on the criteria of autistic disorders as defined in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM IV) (American Psychiatric Association, 1994).
Results: The total GSH content in autistic patients was significantly lower compared with the control group (0.24 ± 0.162 vs. 0.94 ± 0.115, respectively, p ≤ 0.001). Higher serum CAT, MDA and 8OHdG levels were found in children with autism compared with controls (CAT, 2.836 ± 0.479 vs. 0.689 ± 0.157, p ≤ 0.001; MDA 8.6 ± 0.5 vs. 1.76 ± 0.33 p ≤ 0.001, and 8OHdG 13.134 ± 1.33 vs.1.46 ± 0.326, p ≤ 0.001).
Conclusion: The present study supports the notion that oxidative stress is associated with autism, but additional researches are needed to investigate how it may contribute to autistic pathophysiology and these studies are currently in progress.

Open Access Original Research Article

SNPs on ABC Transporters and in vivo Malaria Parasite Non Clearance after Chloroquine Treatment in Malian Children

Mamadou Wélé, Abdoul Habib Beavogui, Mamadou Tekete, Antoine Dara, Seydou Z Maiga, Abdoulaye Djimdé

Journal of Advances in Medicine and Medical Research, Page 318-323
DOI: 10.9734/BJMMR/2013/2434

Background: pfcrt K76T mutation was demonstrated to play a central role in the P. falciparum resistance to chloroquine.
Aim: To find any association between mutant alleles of pfcrt K76T, pfmdr1 N86Y, pfG30 and pfG47 and the in vivo parasite non clearance after chloroquine treatment in Mali.
Methodology: We carried out a chloroquine efficacy study in 196 children suffering from uncomplicated malaria in a rural village of Kollé, Mali, using WHO protocol. Subjects were treated with standard dose of chloroquine and followed for 14 days. Parasite DNA was extracted from finger prick blood blotted onto filter paper and genotypes were analyzed by different PCR methods.
Results: The mutant alleles pfcrt 76T and pfmdr1 86Y were associated with parasite non clearance withp=0.00001 and 0.03 respectively.
However, the association of SNPs on pfG30 and pfG47 genes with parasite non clearance was not statistically significant, p =0.43 and 0.57 respectively. The logistic regression analysis showed that the mutant allele pfmdr186Y contributed positively to the pfcrt 76T parasites non clearance (p=0.02).
Conclusion: These findings have shown that pfcrt76T and pfmdr1 86Y alleles are associated with the in vivoparasite non clearance, but not SNPs on the new putative transporters genes.

Open Access Original Research Article

Presence of Helicobacter pylori Detected by PCR in Saliva of Male Smokers and Non Smokers with Chronic Periodontitis

Rajiv Kishor Saxena, Abdul Samad Aziz, Madhav Govind Kalekar, J. P. Milsee Mol, Adinath Narayan Suryakar, Benjamin Tabita, Ravi Vasudev Shirahatti, Raghavendra Shrishail Medikeri

Journal of Advances in Medicine and Medical Research, Page 329-340
DOI: 10.9734/BJMMR/2013/2251

Aims: To assess the comparative presence of Helicobacter pylori (H. pylori) in saliva of smokers and nonsmokers with chronic periodontitis.
Study Design: Male individuals diagnosed with chronic periodontitis with and without smoking habits were enrolled in the study. The unstimulated whole saliva was subjected to H. pylori DNA detection using real time PCR. The percent presence of H. pylori DNA among the groups, were statistically compared.
Place and Duration of the Study: Department of Biochemistry and Department of Dentistry, Grant Medical College and Sir JJ group of Hospitals, Mumbai and Department of Microbiology, Sinhgad Dental College, Pune, between January 2010 and June 2010.
Materials and Methods: A total of 48 males with severe chronic periodontitis (CAL≥5mm) were divided into two groups, Group I (n=30, mean age=44.2±5.88 yrs) with smoking habit, Group II (n=18, mean age 41.72±4.36yrs) without any smoking habit. Nonsmokers with slight chronic periodontitis (CAL<3mm) were enrolled as controls, Group III (n=16, mean age 39.64±5.04 yrs). Periodontal status was evaluated by measuring gingival index (GI), plaque index (PI), probing depth (PD) and clinical attachment loss (CAL). Salivary samples were subjected to real time PCR for detection of H. pylori DNA.
Result: Periodontal parameters were significantly different between Group I and II compared to Group III (P=.001). Overall, H. pylori was not detected in Group III (100% negative), whereas 5.5% of Group II and 13.3% in Group I patients showed presence of H. pylori. Chi-square test showed a significant difference (P=.003) between Group I and Group III however it was seen that there was an insignificant difference between Group I and Group II (P=.312) and between Group II and Group III (P=.186).
Conclusion: The smokers with chronic periodontitis may be at a relatively higher risk of H. pylori presence in the oral cavity, than non smokers. The study needs validation on a larger sample size.

Open Access Original Research Article

Efficacy and Tolerability of MlC601 in Patients with Mild to Moderate Alzheimer Disease who were Unable to Tolerate or Failed to Benefit from Treatment with Rivastigmine

Ali Amini Harandi, Farzad Ashrafi, Mojgan Tabatabaei, Askar Ghorbani, HamidReza Hatamian, Hossein Pakdaman, Manochehr Ilkhani, Koroush Gharagozli, Maziar Shojae, Marjan Asadollahi, Farshid Alaeddini, Seyed Kazem Hosseini

Journal of Advances in Medicine and Medical Research, Page 341-350
DOI: 10.9734/BJMMR/2013/2537

Aim: To evaluate the efficacy and tolerability of MLC601 in patients with mild to moderate Alzheimer disease (AD).
Study Design: This is an open-label pilot study.
Place and Duration of Study: It was conducted at three university referral centres in Iran from September 2009 until November 2011.
Methodology: One-hundred and twenty four outpatients with mild to moderate AD who had previously failed to tolerate or benefit from treatment with Rivastigmine for 6 months at a dose of 2 to 12 mg per day were switched to a MLC601 regimen of one capsule three times per day for up to 18 months. Outcome measures included adverse events (AEs), withdrawal rate, and changes in the Mini-Mental State Examination (MMSE) and the cognitive subscale of the AD Assessment Scale (ADAS-cog) relative to baseline measurements.
Results: Two patients were lost to follow up, and 122 patients completed the 18-month trial. The mean age of the participants was 65.3±6.4 years (range 54-82), and 77 (63.1%) of the participants were female. Improved cognitive function was observed in the first 6 months of the regimen (ADAS-cog=-3.1±10.1; MMSE=1.2±3.0), and the stabilisation of cognitive decline was observed over the remaining 12 months (ADAS-cog=-1.6±7.6; MMSE=0.8±4.2). AEs were predominantly gastrointestinal and occurred in 7.3% of patients.
Conclusions: MLC601 showed good tolerability and promising effects on cognitive function in AD patients during 18 months of treatment.

Open Access Original Research Article

Avena sativa: An Effective Natural Ingredient in Herbal Shampoos for the Treatment of Hair Greasiness

Effat Sadat Farboud, Gholamreza Amin, Leyla Akbari

Journal of Advances in Medicine and Medical Research, Page 361-371
DOI: 10.9734/BJMMR/2013/1828

Aims: Evaluation of anti-greasiness properties of oat extract and oil in shampoos.
Methodology: Seborrhea can cause greasiness in scalp and hair. There are few compounds currently in use to reduce sebaceous gland secretions. Avena sativa or oat is a plant containing saponins as active ingredients with cleansing activity. In a double blinded, randomized, placebo clinical study, we investigated anti-grease and cleansing effects of oat by comparing shampoos formulated from oat extract and oil with control shampoo. Sixty male and female volunteers aged 19 to 30 years old randomly received either oat oil/extract or placebo to the scalp for 5 minutes, twice per week for four weeks. Signs and symptoms such as scaling, greasiness and itching were assessed every week.
Results: In vitro detergency test revealed better detergency power in extract and oil of oat shampoos compared with control shampoo. Clinical studies showed a significant reduction of greasiness scores in extract shampoo compared to the oil and control shampoos.
Conclusion: shampoos containing oat extract could be considered as an appropriate alternative therapy for the management of greasiness in seborrheic patients.

Open Access Original Research Article

Genetic Susceptibility to Normal Tension Glaucoma (NTG)

Barkur S. Shastry

Journal of Advances in Medicine and Medical Research, Page 372-382
DOI: 10.9734/BJMMR/2013/2655

Aims: The Purpose of this short article is to summarize the recent developments in the genetics of normal tension glaucoma (NTG).
Background: Glaucoma is one of the leading causes of irreversible blindness. Primary open-angle glaucoma (POAG) is the most common type of glaucoma in most populations and is frequently associated with elevated intraocular pressure (IOP). However, patients with POAG can also have IOP within the normal range and they are classified as having normal tension glaucoma (NTG) – most likely an independent entity. In NTG, the optic nerve head is just susceptible to normal IOP. Therefore, factors other than elevated IOP are likely to play a role in the pathogenesis of glaucoma. Although factors such as myopia, older age, vasospasm, ischemia and vascular insufficiency are indicated to be associated with the development of NTG, substantial percentage of NTG patients (21%) have a family history of glaucoma suggesting that these patients may have a genetic predisposition for developing NTG.
Methodology: Using the keywords or phrases such as glaucoma, genetics, normal tension glaucoma, open-angle glaucoma and retinal ganglion cell, the literature search was carried out.
Results: NTG is a genetically complex disorder and many genes have been reported to be associated with the development of glaucoma. However, none of them account for a substantial portion of patient population. A complex glaucoma pathogenesis may include interplay among several factors such as genetic, epigenetic and environmental factors. Therefore, an understanding of IOP independent mechanisms of development of NTG is important.
Conclusion: NTG is relatively a less explored avenue of research. There has been paucity of research into the genetic basis of NTG.

Open Access Original Research Article

Prevalence of Congenital Malaria in Port Harcourt, Nigeria

I. O. George, I. Jeremiah, T. Kasso

Journal of Advances in Medicine and Medical Research, Page 398-406
DOI: 10.9734/BJMMR/2013/1436

Aim: To determine the prevalence of congenital malaria among newborn babies delivered at University of Port Harcourt Teaching Hospital, Nigeria.
Study Design: Cross-sectional study.
Place and Duration of Study: Antenatal clinic and labour ward of the University of Port Harcourt Teaching Hospital, Nigeria between January and September 2010.
Methodology: This study was conducted among 281 pregnant women attending antenatal services at the hospital. Socio-demographic and obstetric information of the mothers was collected. Samples of cord blood smears of babies were stained with Giemsa and examined for malaria parasites.
Results: Plasmodium falciparum was the only malaria parasite species. The prevalence of congenital malaria among newly born was 9.6%. This was more prevalent in women of Para 0 (5.3%) compared to other parities (4.3%) (P = 0.048). Malaria parasite was found in 4(16.7%) of preterm and 23(8.9%) of term deliveries (P>0.05).
Conclusion: Congenital malaria is still common in Port Harcourt, Nigeria. It is important that blood smear from neonates are taken and examined for malaria parasite soon after birth. Malaria prevention measures such as intermittent preventive treatment, prompt management of all malaria cases and use of insecticide treated bed nets should be emphasized for all pregnant women.

Open Access Original Research Article

Gene Expression Profiling Identified High-mobility Group AT-hook 2 (HMGA2) as Being Frequently Upregulated in Esophageal Squamous Cell Carcinoma

Leo C. M. Cheung, Leo C. M. Cheung, Kenneth K. Y. Lai, Alfred K. Y. Lam, Johnny C. O. Tang, John M. Luk, Nikki P. Lee, Yvonne Chung, Daniel K. H. Tong, Simon Law

Journal of Advances in Medicine and Medical Research, Page 407-419
DOI: 10.9734/BJMMR/2013/2644

Background: Esophageal cancer is one of the most deadly malignancies worldwide and esophageal squamous cell carcinoma (ESCC) is the most frequent type.
Methods: We identified up-regulated genes from gene expression profiles of HKESC-4 cell line, its parental tumor tissues, non-tumoral esophageal epithelia and lymph nodes with metastatic carcinoma using Human Genome U133 Plus 2.0 microarray.
Results: Four genes [High-mobility group AT-hook 2 (HMGA2), paternally expressed 10 (PEG10), SH3 and multiple ankyrin repeat domains 2 (SHANK2) and WNT1 inducible signaling pathway protein 3 (WISP3)] were selected for further validation with real-time quantitative polymerase chain reaction (qPCR) in a panel of ESCC cell lines and clinical specimens. HMGA2 was found to be overexpressed in the panel of ESCC cell lines tested. By using immunohistochemistry, HMGA2 was found to be up-regulated in 70% of ESCC tissues (21 out of 30 cases).
Conclusion: This study demonstrates successful use of gene microarray to identify and reveal HMGA2 as a novel and consistently overexpressed gene in ESCC cell lines and clinical samples.

Open Access Original Research Article

Serum and Urine Electrolyte Profiles during Amlodipine and Hydrochlorothiazide Combination Therapy in Nigerian Patients with Essential Hypertension

Godfrey B. S. Iyalomhe, Eric K. I. Omogbai, Osigbemhe O. B. Iyalomhe, Sarah I. Iyalomhe

Journal of Advances in Medicine and Medical Research, Page 428-441
DOI: 10.9734/BJMMR/2013/2485

Aims: To evaluate changes in electrolyte profiles during combination treatment with amlodipine (AML) and hydrochlorothiazide (HCZ) in hypertensive Nigerians.
Study Design: Randomized, open-label, prospective, two-centre, outpatient, 48-week study.
Methodology: We enrolled 90 male and female Nigerians aged 31-86 years with uncomplicated essential hypertension (blood pressure [BP] > 160/90 ≤ 180/120mmHg). Patients, who were 30 each (15males [M] and 15females [F]) in AML, HCZ and AML-HCZ groups, were treated, respectively, with 5mg AML for 6 weeks (wks) and the dose increased to 10mg till wk 12 (monotherapy) after which HCZ 25mg was added; HCZ 25mg till wk 6 (monotherapy) after which AML 5-10mg was added; and AML 5-10mg + HCZ 25mg. Body mass index (BMI), BP, 24h urine volume, serum and urine electrolytes (Na+, K+, Cl-) were assessed at baseline and at the end of wks 1, 3, 6, 12, 24, 36 and 48 during treatment.
Results: The 3 regimens comparably significantly (P= .05) reduced BP. Diuresis was greatest and significant (P= .05) in HCZ group. A time dependent significant (P< .0001) hyponatraemic changes were observed in all subgroups except AML M subgroup such that the mean maximum M/F decrease in AML, HCZ and AML-HCZ groups, respectively, were 5.07/14.74, 17.40/16.40 and 10.93/16.86 mmol/L. A parallel significant (P< .01) increase in urine Na+ was observed in all groups with maximum mean M/F increase in AML, HCZ and AML-HCZ groups being, respectively, 26.00/24.40, 28.07/40.94 and 30.47/27.67 mmol/L. A baseline hypokalaemia was observed in all groups except in the AML M subgroup. Significant (P< .0001) M/F hypokalaemic changes were 0.23/0.35, 0.76/0.53 and 0.18/0.19 mmol/L for AML, HCZ and AML-HCZ groups, respectively. Corresponding significant (P< .0001) M/F increase in urine K+ were 4.60/5.71, 10.67/18.60 and 8.2/9.3 mmol/L for AML, HCZ and AML-HCZ groups, respectively. Significant (P= .05) disproportionate chloraemia was observed at baseline in all groups. The observed significant (P< .0001) M/F hypochloraemic changes in AML, HCZ and AML-HCZ groups were, respectively, 10.60/11.46, 25.60/26.94 and 22.93/17.67. A significant (P < .0001) parallel hyperchloriuria was evident in all groups and M/F values in AML, HCZ and AML-HCZ groups were, respectively, 8.09/6.46, 26.00/39.86 and 24.53/18.00 mmol/L.
Conclusion: Long-term AML and HCZ combination therapy, though effective, is associated with biochemical changes – Na+, K+ and Cl- depletion, thus making serum electrolytes monitoring and K+ supplementation or concomitant use of a K+-sparing diuretic clinically imperative.

Open Access Original Research Article

Global Responses to HIV/AIDS and Noncommunicable Diseases: Analysis of Similarities and Differences

Tilahun Nigatu Haregu, Brian Oldenburg, Julian Elliott, Geoffrey Setswe

Journal of Advances in Medicine and Medical Research, Page 442-465
DOI: 10.9734/BJMMR/2013/2835

Introduction: Recent evidence suggests that HIV/AIDS and Noncommunicable diseases (NCDs) share essential commonalities in their risk factors, progression and management. However, the interrelatedness between the global responses to HIV/AIDS and NCDs hasn’t been systematically analyzed.
Objective: To examine the similarities and differences between global responses to HIV/AIDS and NCDs.
Methods: Using preliminary review of literature, we identified four major themes of the global response: Strategies, Systems, Intervention and Monitoring and Evaluation. Detailed review of purposively selected documents was then conducted under these four themes. Similarities and differences between the global response to HIV/AIDS and NCDs were then examined for each major theme using qualitative content analysis and interpretive synthesis. The findings were presented using narrative summaries, tables and boxes.
Findings: HIV/AIDS and NCD strategies are similar in their general approach. However, HIV strategies are geared towards improving effectiveness and efficiency of programs while NCD ones focus on increasing access to and coverage of services and enhancing the priority accorded to NCDs. The organizational systems involved in the global response to both HIV/AIDS and NCDs involve multi-sectoral, multi-stakeholder and multi-level approaches that require global coordination mechanisms. The presence of many diseases in the NCD group means more complex coordination of the NCD response. HIV/AIDS and NCD interventions use similar models and approaches despite their differences in the technical content of the interventions and the demographic characteristics of the target population groups. The indicators and the target populations for monitoring and evaluation of HIV/AIDS and NCD programs differ in their timeframe, level of specificity, and relative magnitude. Besides, the current NCD targets are voluntary. However, the Monitoring and Evaluation frameworks share important similarities in the methods used to generate and manage information.
Conclusion: The similarities between the global responses to HIV and NCDs indicate that there are many processes that could be coordinated and/or integrated to improve synergy and efficiency. The differences, on the other hand, warrant the need for maintaining the integrity of the responses to each disease condition.

Open Access Original Research Article

Medical Student Experiences in Clinical Reproductive Medicine: Dual-Cohort Assessment of a New Learning Module at the Royal College of Surgeons in Ireland

Anthony PH Walsh, Gary S Collins, David J Walsh, Lyuda V Shkrobot, Fergal D Malone, E Scott Sills

Journal of Advances in Medicine and Medical Research, Page 466-473
DOI: 10.9734/BJMMR/2013/2659

Aims: Exposure to a structured curriculum in reproductive medicine during medical school is helpful given the high frequency of fertility and pregnancy-related issues that future physicians will encounter. This study sought to evaluate a new reproductive medicine module for medical students.
Study Design: Prospective cohort study.
Place and Duration of Study: Dublin, Ireland; 2008-2010.
Methodology: A new educational module in reproductive medicine for upper-level medical students was initiated in 2008 at the Royal College of Surgeons in Ireland (RCSI). The module included reproductive endocrinology lectures, laboratory sessions, and direct observation of clinical consultations as a required component of an obstetrics and gynaecology rotation. Students were assigned to this module on the basis of random allocation by departmental administration. The current investigation used an anonymous questionnaire and a MCQ exam to measure academic performance and student acceptance of this module, at launch and again two years later. The first sampling was from the pilot class in 2008 and a second group was evaluated in 2010. No student was in both groups.
Results: 42 of 66 students completed the evaluation in 2008, and 71 of 98 did so in 2010. Mean±SD medical student age and average examination scores were comparable for the two groups. In both samples, most students (95.5%) had no prior lectures on reproductive endocrinology, and most indicated improvement in their level of understanding after the module. Both laboratory and clinical features were scored highly by students.
Conclusion: At present, there is no standardised medical student curriculum for reproductive medicine in Ireland. This report is the first to describe a structured learning experience in this subspecialty area for medical students in Ireland. Additional studies are planned to track knowledge acquisition and career impact specific to reproductive medicine based on this module.

Open Access Review Article

A Review of Low Angle Fibre Diffraction in the Diagnosis of Disease

Veronica J. James

Journal of Advances in Medicine and Medical Research, Page 383-397
DOI: 10.9734/BJMMR/2013/2432

More than ever, unlocking the secrets of cancer in the 21st century is a collaborative exercise between medical science and a greater use of all available forms of technology. Peeling away the layers that surround cancer diagnoses reveals a deeper understanding about the nature of cancer conditions. The use of technology thus may aid the process of early diagnosis. The information gained by each successful step in turn adds to our existing understanding and helps to direct the course of improved treatment protocols. Treatment protocols resulting from our greater understanding of the cancers bring us one step closer to our ultimate goal of better interventions for all patients suffering from a range of cancer conditions. One such method of investigation has been the use of low angle fibre diffraction techniques in the analysis of body tissues, including skin, hair and nails. The results obtained produce characteristic diffraction patterns which are distinctive and reproducible for a number of cancers including breast cancer, prostate cancer and melanoma. These patterns may be used as a means of early detection of some of the most commonly occurring cancers, or, alternatively, as an indicator that cancers which have previously been diagnosed for particular patients have been cured and no trace of the disease remains in the patient’s body.