Open Access Case Study

Mutations in HLA DRB1*0101 Exon 2 in a Sub-population of Latvia

Diana Kasjko, Vladislavs Jasinskis, Elena Eglite, Lilija Kovalchuka, Elina Dobele, Gunta Sture, Artur Sochnev, Ludmila Viksna

Journal of Advances in Medicine and Medical Research, Page 981-989
DOI: 10.9734/BJMMR/2014/5660

Aims: To find out whether ongoing missense mutations in the exon 2 of DRB1*01:01 affect the operation of this protective allele in HIV patients.
Place and Duration of Study: the Clinical Immunology and Immunogenetics Laboratory of Riga Stradiņš University, Riga Eastern Clinical University Hospital, “Infectology Center of Latvia”, between May 2006 and December 2011.
Methodology: The study includes 200 HIV-infected patients. DNA was isolated from venous blood samples using the Qiagen QIAamp DNA kit reagents and the exon 2 nucleotide sequence of HLA was determined by the automatic sequencing – “Big Dye Terminator mix” (Applied Biosystems, USA). Statistical analysis was performed using Microsoft Excel, DOS StatCalc programs. The significance of the differences in indicators was evaluated according to reliability p<0.05. The odds ratio was calculated according to Wolf’s method.
Results: We found missense: at codon 47– in 80% of cases; at codon 67– in 20% of cases; at codon 75 – in 11% of cases; at codon 82– in 10% of cases; at codon 86– in 10% of cases (p<0.05) (See Table 3). One of the HIV patients had a STOP-codon (codon 13). Besides, a balance between nucleotide transversion and transition has been observed, suggesting mutations in the exon 2 (transversion in a human genome is rare) (OR 0.05, 95% CI 0.00-0.053).
Conclusion: The results of the study are not complete in order to be able to say conclusively that the existing mutations in the exon 2 of HLA-DRB1 *01:01 gene cause wrong immune response, thus the protective functions of this allele are not fulfilled. For a fuller understanding of the importance of ongoing mutations in the exon 2 in the development of HIV/AIDS, it is necessary to increase the study group.

Open Access Case Study

Simultaneous Occurrence of Spontaneous Coronary Artery Dissection and Embolic Stroke

Ghulam Akbar, Ronald Pachon, Hasan Al Azzawi, Naureen Jessani, Kebir Bedran, Naeem Abbas, Katherine Abella, Mohammed A. Islam, Ravindra Patel, Mark Niemiera

Journal of Advances in Medicine and Medical Research, Page 990-1001
DOI: 10.9734/BJMMR/2014/6516

Acute coronary syndrome (ACS) due to spontaneous coronary artery dissection (SCAD) is rare. Further, concurrent ACS with a cerebrovascular accident is improbable, but possible. We report a case of a young man, with a history of Hodgkin’s lymphoma treated with a combination of chemotherapy and radiotherapy ten years ago, presented with acute coronary syndrome caused by an extensive dissection of the right coronary artery, together with acute ischemic stroke. Survivors of Hodgkin’s lymphoma are at increased risk for cardiovascular complications due to radiation, which can expedite atherosclerosis and can, eventually, give rise to dissection and cerebrovascular disease, as exemplified in our case. This case report and review outlines the incidence, epidemiology, causes, pathophysiology, diagnosis and treatment of spontaneous coronary artery dissection. Our case report is a remainder to clinicians to be mindful of concomitant occurrence of these two conditions and highlights the significant impact the treatment of each has on the other, especially when the literature does not have clear recommendations about simultaneous management. Spontaneous coronary artery dissection with concomitant ischemic cerebrovascular stroke poses a therapeutic dilemma and requires a multi-disciplinary team to appropriately manage the patient. q

Open Access Case Study

Decitabine Induced Localized Maculopapular Eruption

Ilhami Berber, Mehmet Ali Erkurt, Mustafa Koroglu, Recep Bentli, Ilknur Nizam, Emin Kaya, Irfan Kuku, Sevgi Sezgin

Journal of Advances in Medicine and Medical Research, Page 1002-1007
DOI: 10.9734/BJMMR/2014/6347

Aims: Decitabine is a drug for the treatment of myelodysplastic syndromes and acute myeloid leukemia. It has a side-effect profile affecting many systems, including dermatologic side effects. Herein, we report a case with a maculopapular-type drug eruption due to decitabine.
Presentation of Case: A 51-year-old previously healthy woman was diagnosed with myelodysplastic syndrome RAEB-1, and decitabine [20mg/m2/day/i.v (5 days with cycles repeated every 28 days)] chemotherapy was given. On the seventh day of the second treatment cycle, we diagnosed a maculopapular eruption on the front of the left arm. The patient presented with skin that was itchy, puffy, maculopapular and erythematous. The rash faded when pressed and tended to coalesce with each other, indicating a drug eruption due to decitabine. Maculopapular type drug reaction depending on decitabine was considered. The eruption improved remarkably within 10 days, and the patient's rash had disappeared by the 17th day of treatment.
Discussion: Drugs occasionally induce cutaneous side effects. Ecchymosis, rash, erythema, petechiae skin lesion and pruritus have been described in decitabine’s prospectus. Maculopapular eruptions can affect all age groups. This type of eruption is common with certain drugs as well as with several diseases and medical conditions including scarlet fever, measles, rubella, secondary syphilis, parvovirus B19 and heat rash. A number of drugs may cause the appearance of maculopapular eruptions.
Conclusion: Practitioners should be aware of this rare, but potentially serious, adverse event, especially as decitabine is commonly used for myelodysplastic syndromes and acute myeloid leukemia.

Open Access Case Study

Myopic Shift Following Selective Laser Trabeculoplasty: A Case Report

Julia Song, Alice Song, Trisa Palmares, Michael Song

Journal of Advances in Medicine and Medical Research, Page 1008-1013
DOI: 10.9734/BJMMR/2014/6391

Introduction: Selective laser trabeculoplasty (SLT) (Lumenis, Santa Clara, CA) was developed in 1999 as a means to lower IOP in patients with glaucoma. It is a relatively safe procedure. We report a rare side effect of anterior chamber shallowing with myopic following SLT.
Case Presentation: A 48 year-old white female who underwent SLT OD developed a 4-diopter myopic shift and anterior chamber shallowing 1 week following SLT. Both the anterior chamber shallowing and the myopic shift resolved within 5 weeks.
Conclusion: Anterior chamber shallowing and myopic shift following SLT is a rare side effect but is reversible. Physicians and patients should be aware of this potential side effect of SLT.

Open Access Case Study

Open Access Original Research Article

Measuring Cranial Soft Tissue Thickness with MRI or Force-Compensated Tracked Ultrasound

Floris Ernst, Ralf Bruder, Tobias Wissel, Patrick Stüber, Achim Schweikard

Journal of Advances in Medicine and Medical Research, Page 937-948
DOI: 10.9734/BJMMR/2014/6822

Aims: A new approach to patient tracking in cranial stereotactic radiosurgery relies on contact-free localisation of the cranial bone. It requires accurate information about the soft tissue thickness on the patient's forehead, which in this work is measured using two independent modalities: magnetic resonance imaging (MRI) and force-compensated tracked ultrasound.
Methodology: High resolution MRI scans and ultrasound data of the forehead were recorded and the soft tissue thickness was extracted. The datasets were registered using the iterative closest point algorithm with high accuracy (RMS error < 0.5 mm after artefacts from data acquisition were removed). Tissue deformation was analysed using a robotic setup with force control where the ultrasound transducer was pressed against the skin.
Results: The force compensation setup showed that a tissue compression factor of 0.75 can be assumed for typically applied forces of 7-10N. This factor was confirmed by comparing histograms of soft tissue thickness. Comparing soft tissue thickness as measured by MRI and ultrasound showed a mean error of 0.14mm and a standard deviation of 0.87mm.
Conclusion: We could show that, using MRI as a ground truth, data from 2D ultrasound can be compensated for pressure and can also be used to generate realistic values of soft tissue thickness.

Open Access Original Research Article

Effect of Dimethoate and Chlorpyrifos in Hepatic and Renal Function of People Belonging to Risk Groups in Iraklia Serres (N. Greece)

George Andreadis, Triantafyllos Albanis, Eleni Andreadou, Styliani Mitka, Faedra Eleftheriou, Dimitra Lampropoulou, Nikolaos Avramidis, Dimitrios Patoucheas

Journal of Advances in Medicine and Medical Research, Page 949-956
DOI: 10.9734/BJMMR/2014/5828

Aims: There is little evidence concerning the effects of organophosphates in the liver of healthy individuals, and the existing researches come to contradictive results. In this study, we evaluated the influence of organophosphates (Dimethoate, Chlorpyrifos) in liver and renal function of healthy exposed workers, not experiencing symptoms of serious intoxication.
Study Design: Measure serum activity of the liver function monitoring enzymes SGPT, SGOT, γ-GT and ALP and serum concentration of the renal function indicative biomarkers urea and creatinine.
Place and Duration of Study: Sample were collected in Health Care Greece of Iraklia Serres and analyzed in Department of Medical Laboratory Studies Alexander Technological Educational Institute of Thessaloniki.
Methodology: Blood samples were collected from 112 individuals, randomly selected from villagers of N. Greece. 42 of them were organophosphates (OP) applicators aged less than 50 years old (mean age 37 years old) and 42 were OP applicators older than 50 years old (mean age 58 years old); while 28 individuals (13 of them were less than 50 years old and 15 older than 50 years) were not OP applicators and used as control groups.
Results: A remarkable and statistically significant increase (P < 0.05) in the main liver-function monitoring enzymes (SGOT, SGPT, γ-GT) was observed in exposed people compared to the control group. Increase in ALP values compared to not exposed individuals was not observed. Concerning the kidneys, data analysis shows that there is not any significant effect on their operation by the use of OP.
Conclusion: The age of OP applicators and the time past between the application and the measure of blood serum seems to play an important role in the values of hepatic enzymes. While the renal indicators seemed not so much affected, as organophosphates are rapidly metabolized in human organism.

Open Access Original Research Article

Neonatal Overfeeding Induced by Reducing the Litter Size Leads to an Obese Phenotype and Increases Preference for Sweet Food in Adult Male Rats

Cristie Noschang, André Krumel Portella, Sheila Cardoso, Verônica Bittencourt, Carla Dalmaz, Marcelo Zubaran Goldani, Patrícia Pelufo Silveira

Journal of Advances in Medicine and Medical Research, Page 957-968
DOI: 10.9734/BJMMR/2014/5161

Aim: the aim of this study was to induce obesity in rats using the neonatal overfeeding protocol and evaluate in adult male animals standard chow intake, sweet food intake, the preference between sweet food and standard chow, locomotor activity and anxiety-like behavior.
Methodology: The neonatal overfeeding protocol consisted of reducing the litter size to 4 animals (small litters = SL) compared to 8 animals in normal litters (NL). In these experiments we used 55 offspring from 18 litters.
Results: obesity was successfully induced as observed by increased body weight and depots of abdominal fat in SL animals compared to NL; [F(1, 53)=15.018; P<.001] for body weight and [t(48.06)=2.186 P=.03] for abdominal fat.No difference between groups was found in standard chow [t (16)=1.843 P=.08] and sweet food intake [t(53)=0.453 P=.65], however in the test that evaluated the preference between both foods SL animals consumed more sweet food than NL [t(48) =2.481 P=.02]. Additionally, there was no difference between groups regarding locomotor activity [t(52)=0.073 P=.94] but SL animals showed reduced anxiety-like behavior compared to NL [t(39.36)=2.205 P=.03].
Conclusion: this study supports the use of neonatal overfeeding protocol as a model of early obesity and showed for the first time the increased preference for sweet food in adult neonatal overfed animals.

Open Access Original Research Article

Vitamin D Levels in Men with Metabolic Syndrome with or Without Hypogonadism

P. Angelova, Z. Kamenov

Journal of Advances in Medicine and Medical Research, Page 969-980
DOI: 10.9734/BJMMR/2014/5843

Aims: To clarify the relation of metabolic syndrome (MS) with or without late-onset hypogonadism (LOH) and vitamin D deficiency in men.
Study Design: Consecutive male patients with MS were additionally evaluated for LOH and vitamin D status.
Place and Duration of Study: Department of Endocrinology, Alexandrovska University hospital, Sofia; between March 2010 and February 2011.
Methodology: 99 men were included in the study. Of them 65 had MS and they were divided according to their morning total testosterone (TT) level (cutoff 10.4 nmol/l) into two groups: MS-LOH (N=21) and MS-noLOH (N=44). The control group consisted of 34 men without MS and LOH. Vitamin D levels were measured using electrochemiluminiscence immunoassay.
Results: MS men were at mean age (±SD) = 50.4±9.6 years and had TT = 13.6±5.4 nmol/l. The control group was at age = 51.5±6.4 years (compared to MS: NS) and had TT = 17.9±5.6 nmol/l (compared to MS: P< .001). MS-LOH sub-group had age 47.9±10.5 years and TT = 8.1±1.5 nmol/l; MS-NoLOH sub-group – age 51.6±9.1 years, TT = 16.3±4.5 nmol/l. The levels of vitamin D were higher in the controls – 27.9±12.0 ng/ml compared to the MS – 16.2±9.1 ng/ml (P< .001). There was no difference in 25(OH)D between MS-LOH – 17.4±10.9 ng/ml and MS-NoLOH – 15.6±8.2 ng/ml sub-groups. They both differed from the control group (P< .001). There was a negative relationship between 25(OH)D and BMI in all patients (rho= -0,344, P< .001) and in the MS-LOH group (rho= -0,439, P< .05). Similar relationship was found between vitamin D and waist circumference (respectively: rho= -0,459, P< .001; rho= -0,553, P= .011). Much smaller in strength but significant correlation was the one between vitamin D levels and Aging Male Score in all patients (rho= -0,254, P< .05).
Conclusion: There are no differences in vitamin-D levels when comparing metabolic syndrome patients with and without late onset hypogonadism.

Open Access Original Research Article

Exploring the Opinions of Parents and Teachers about Young People Receiving Puberty and Sex Education in Rural Kenya: A Qualitative Study

C. L. James, N. F. Fowler, L. M. Roberts

Journal of Advances in Medicine and Medical Research, Page 1014-1033
DOI: 10.9734/BJMMR/2014/6878

In Kenya, one of the most significant public health concerns is the spread of HIV. Additionally, 13,000 girls drop out of school every year due to pregnancy. Although the Kenyan Ministry of Education and other independent organisations have tried to implement various means of developing puberty and sexual health education for young people, the situation is not improving.
Aims: To explore the opinions of teachers and parents in rural Kenya about delivering puberty and sex education and to identify their perceptions of barriers to young people accessing this education.
Study Design: Qualitative study.
Place and Duration of Study: Rural Nyanza Province, Western Kenya between January and March 2013.
Methodology: semi-structured interviews with 19 teachers and 30 parents following a topic guide to explore their opinions about what young people need to learn about sex education and perceived barriers to accessing that education. The interviews were transcribed and subjected to Framework analysis.
Results: Analysis revealed a lack of continuity in teacher training for sex education and discrepancies in what is being taught in schools. It also highlighted internal contradictions in teachers’ and parents’ views about some aspects of sex education, particularly the emphasis on abstinence and negative attitudes towards contraception.
Conclusion: Strategies for improvement may include a full evaluation of the formal sex education curriculum and retraining where necessary to ensure consistency in the sexual health messages that are delivered to young people. Additionally, parents and wider rural communities may need to be better supported in their ways of discussing puberty and sexual health with their children.

Open Access Original Research Article

The Epidemiology of Deliberate Self-Poisoning Presenting at a Tertiary Care Hospital in Hyderabad Sindh, Pakistan

Faizan Qaisar, Mohsin Shafi, Ayesha Majeed, Dileep Kumar, Awais Memon, Umer Memon

Journal of Advances in Medicine and Medical Research, Page 1041-1048
DOI: 10.9734/BJMMR/2014/6416

Objective: To observe the demographic characteristics of the patients, substance abused, intention and precipitating factors for self-poisoning presenting to Accident& Emergency department of Liaquat University Hospital Hyderabad, Sindh, Pakistan.
Patients and Methodology: A prospective observational study was carried out for a period of 6 months from (March 2013 to August 2013).100 patients more than >12years with a definite history of self-poisoning were included. Details regarding patients demographic characteristics e.g. age, sex, maritalstatus, academic status, socioeconomic standing etc. and substance abused for self-poisoning were recorded on a specifically designed proforma.
Results: During the study period 100 patients of DSP were included. Of 100 patients 40% (n=40) were male age ranges from (15-50) and 60% (n=60) were female age ranges from (17-50). Mean age of the patients was 23.63±8.370 (mean±SD). Out of hundred patients 57% (F=31, M=26) were uneducated, 56% (F=34, M=22) were unmarried, those who were unmarried had statistically significant relationship with the use of organophosphorous compounds/Rat killer for self-poisoning (p= 0.0281). 85% of the total patients belonged to lower socioeconomic class. Occupation wise mostly female were household/house wife and male were farmer/labour. (49%) of the studied group used organo-phosphorous containing compound insecticide/pesticides, 29% used Rat killer. 11% of the patients consumed benzodiazepine for self-poisoning.60% of the total patients had suicidal intention, use of organophosphorous compound/Rat killer is significantly associated with the intention to suicide (p=0.0001), 33%of the patients wanted to draw attention and 7% committed DSP to show anger, or to punish themselves because of guilt Table 4. (46%) committed the act of DSP after having conflict with parents other had interpersonal conflicts with husband/wife, girlfriend/boyfriend and close relatives.

Conclusion: Use of organophosphorous containing compound/Rat killer are associated with an intention to suicide (p=0.0001) and these are preferred substances used for self-poisoning among unmarried population (p=0.0281).Demographic characteristics of patients do not vary greatly with relation to their orientation to urban or rural areas as well as choice of substance for self-poisoning were also independent to location (p=1.0000).

Open Access Original Research Article

Birth Weight and Placental Weight Correlation of Fulani Ethnic Group Parturients in Nigeria

I. Y. Anas, M. S. Saleh

Journal of Advances in Medicine and Medical Research, Page 1049-1055
DOI: 10.9734/BJMMR/2014/4110

Aims: We aim to establish the relationship of birth weight to the placental weight of Fulani ethnic community which is an important population politically and economically not only in Nigeria but to West Africa in general.
Study Design: This was a prospective study on Fulani ethnic group parturients living in Kano State of Nigeria.
Place and Duration of Study: The study was conducted in Murtala Mohammed Specialist Hospital Kano, Nigeria, from November 2007 to September 2008.
Methodology: The study involved 390 healthy placentas (delivered at term) of Fulani ethnic group parturient in Nigeria. Each placenta was cleansed of blood clots and trimmed of umbilical cord near its attachment and its weight determined using the triple beam balance. The weight of new born was determined using Birth weight weighing Balance. The data were recorded and analyzed using Minitab 16 software and Pearson’ Correlation Coefficient was used to determine the relationship between the weights. Regression equation was also developed.
Results: The mean birth weight was 2867.4 g (SD: 447.7 g), and for the placental weight, the mean found to be 477.6 g (SD: 74.8 g). The results showed a statistically significant correlation between the placenta and the birth weight using the Pearson correlation (r = 0.963, P < 0.001). Birth weight-Placenta ratio was 6.0 (SD: 0.3). The scatterplot (birth weight vs. placenta) shows the linear relationship of birth weight to placental weight (Fig. 1).
Conclusion: The birth weight of Fulani ethnic group parturients correlates positively with the placental weight (P < 0.001) and this is in keeping with what was reported in the literature.

Open Access Original Research Article

Epidemiology and Outcomes of Pediatric Burn Injuries in Cairo University Hospital- Egypt

John Rene Labib, Silvia Farouk Shalaby

Journal of Advances in Medicine and Medical Research, Page 1056-1068
DOI: 10.9734/BJMMR/2014/5844

Aim: To identify the epidemiology and outcome of pediatric burn injuries.
Study Design: Retrospective hospital -based analytical study.
Place and Duration of Duration: Burn unit at Cairo university hospital, in the period between the first of January 2007 till December 2011.
Methodology: The study retrospectively evaluated 564 children with different burn injuries, who were admitted to Cairo University Hospital during the period of the study. Data about age, sex, burn size, etiology of burn, and outcome of admission to the intensive care unit were retrieved from the medical records and the burn treatment registry. In addition, average length of hospital stay (ALOS) and bed occupancy rate (BOR) were calculated. Further analysis was done in the last year of the study (2011), by interviewing mothers of the patients and residents in charge.
Results: The average age of the children was 5.9 years (SD: ± 4.1).Under five children were found to be the most susceptible to burn injuries accounting for about 70% of the affected population There was no significant difference in the number of patients between genders (P= 0.3). While scald type of burn was the most prevalent etiology of burn injuries representing more than 60% of all causes. Total burn surface area. (TBSA)% was greater among females, patients from rural residencies and flame type of burn. The non- survivors represented 2.5% of the studied sample. Intensive care unit (ICU) admission was mainly due to renal impairment, sepsis and respiratory stress due to inhalation injury. LOS and decreasing in the BOR reflects better advances in care.
Conclusion: Under five children are the most susceptible age group to burn injuries, this could be prevented by raising awareness of patients. More attention should be paid to reduce complications that necessitate ICU admission.

Open Access Original Research Article

Influence of Vitamin K Epoxide Reductase Complex 1 Gene Polymorphisms on Anticoagulation with Acenocoumarol in Patients with Cerebral Venous Thrombosis

Tanima De, Rita Christopher, Dindagur Nagaraja

Journal of Advances in Medicine and Medical Research, Page 1069-1080
DOI: 10.9734/BJMMR/2014/7067

Aims: Acenocoumarol, a commonly prescribed oral anticoagulant drug, exhibits wideinter-individual variability in response. This study aimed at evaluating the contribution of genetic variations in Vitamin K epoxide reductase complex, subunit 1 (VKORC1), to variability in the response to acenocoumarol, in patients with cerebral venous thrombosis (CVT).
Place and Duration of Study: National Institute of Mental Health and Neuro Sciences, Bangalore, India, between September 2009 and January 2013.
Methodology: 476 acenocoumarol-treated aseptic CVT patients (153 males, 323 females) were genotyped for VKORC1 -1639G>A and 1173C>T polymorphisms. Mean daily acenocoumarol dose for achieving and maintaining the optimum international normalized ratio (INR) was calculated for different genotypes.
Results: Genotype distribution of VKORC1-1639G>A was as follows: 69.7% were wild, 25.6% heterozygous and 4.6%, mutant. Mean acenocoumarol dose required to achieve the optimum INR was lower in heterozygous (1.82±0.71mg/day) and homozygous mutants (1.75±0.69mg/day) when compared to wild type patients (2.31±0.89mg/day). Bearing the VKORC1 -1639A allele independently increased the odds of requiring a low dose (Adjusted OR 3.9; 95% CI 1.97-7.73; p<0.0001). Significant differences in dose requirement during maintenance phase were observed in patients of different genotypes. VKORC1-1639G>A and 1173C>T were observed to be tightly linked (r2=0.98) and no difference in the genotype distributions was observed between the two polymorphisms. Factors such as age and co-medication with phenytoin were also found to influence the drug dosage.
Conclusion: Our findings support the use of VKORC1 genotyping during anticoagulation with acenocoumarol in patients with CVT.

Open Access Original Research Article

Contrast Induced Nephropathy Risk Prediction Assessment: Usefulness among Africans Undergoing Intravenous Contrast Procedures

Ogochukwu Okoye, Louis Ojogwu, Evelyn Unuigbe, Efosa Oviasu

Journal of Advances in Medicine and Medical Research, Page 1081-1093
DOI: 10.9734/BJMMR/2014/6132

Aims: To validate the CIN predictive risk score developed by Mehran et al in the study population.
Study Design: This is a hospital-based prospective observational study.
Place and Duration of Study: Department of Medicine and Department of Radiology, University of Benin Teaching Hospital, Edo State, Nigeria. September 2009 to March 2010.
Methodology: One hundred and forty-two (142) out of 180 patients undergoing intravenous contrast procedures completed the study. They were recruited consecutively over a 6-month period. Data on their sociodemographic characteristics and health status were collated. A modified version of Mehran’s CIN risk prediction chart was included in the questionnaire. Venous blood and urine were collected for serum creatinine and biochemical estimations before contrast exposure and up to 72 hours post-exposure.
Results: The frequency of CIN was 35.9%. Majority of the patients studied had low risk scores. Although CIN (+) patients had higher total risk scores when compared to CIN (-) patients, it did not reach statistical significance (P=.600). Baseline renal insufficiency, anaemia and age >55 years were significant risk factors for CIN and predictive of CIN in univariate but not multivariate analysis.
Conclusion: The CIN predictive score by Mehran et al. did not sufficiently identify patients at risk for CIN in the population studied.