Open Access Case Study

Diabetic Ketoacidosis in Two Nigerian Adolescents with Homozygous Sickle Cell Anaemia

Alphonsus N. Onyiriuka, Magdalene E. Odunvbun, Izehiuwa G. Enato

Journal of Advances in Medicine and Medical Research, Page 4004-4010
DOI: 10.9734/BJMMR/2014/9858

In the tropics where the prevalence of sickle cell anaemia (SCA) is high, reports of concurrence of sickle cell anaemia and diabetes mellitus are rare with diabetic ketoacidosis (DKA), being rarer. In this case report, we present the cases of two Nigerian adolescents (one male and one female) with homozygous SCA who presented in DKA. Sickle cell anaemia was diagnosed eight and nine months respectively prior to their presentation with DKA. There was no history of previous multiple blood transfusions. Neither of the two cases had positive family history of diabetes mellitus. The diagnosis of DKA in each case was based on the presence of hyperglycaemia, ketonuria and acidosis. The families of these two patients were of low socio-economic status.
Conclusion: Although concurrent homozygous sickle cell anaemia and diabetic ketoacidosis is rare, it does occur in Nigerian children and adolescents.

Open Access Case Study

Late Gadolinium Enhancement on Cardiac Magnetic Resonance Imaging in Acute Myocardial Infarction Due to Myocardial Bridging: A Clinical Dilemma

Michelle L. Zielinski, Homayoun R. Ahmadian, Travis C. Batts, Ahmad M. Slim, Dustin M. Thomas

Journal of Advances in Medicine and Medical Research, Page 4011-4017
DOI: 10.9734/BJMMR/2014/10208

A 51-year-old male with a family history of premature coronary artery disease (CAD) presented with acute myocardial infarction (AMI) with coronary angiography demonstrating no angiographic disease and a mid-left anterior descending (LAD) myocardial bridging (MB) segment with 71% mean lumen diameter (MLD) compression. Due to continually rising biomarkers and recurrent angina, cardiac magnetic resonance imaging(CMR) was obtained demonstrating late gadolinium enhancement (LGE) involving the mid-distal LAD territory. Patient subsequently underwent successful percutaneous coronary intervention (PCI) with drug-eluting stent (DES) to the MB segment with resolution of symptoms, which persisted over a year. MBis defined as an intramuscular segment resulting in overlying bands of myocardium, also called “tunneled” artery. Once thought benign, MB has been reported to cause unstable angina, AMI, life-threatening arrhythmias, and sudden cardiac death. PCI has been reported to relieve symptoms balanced against rates of in-stent restenosis and target lesion revascularization as high as 19% with DES. This case illustrates the utility of CMR in the setting of AMI to guide decision to purse PCI in symptomatic MB.

Open Access Case Study

Small Bowel Obstruction from a Displaced Penile Prosthesis Reservoir: Case Report and Review of the Literature

Michael H. Johnson, Frank E. Johnson

Journal of Advances in Medicine and Medical Research, Page 4025-4029
DOI: 10.9734/BJMMR/2014/10316

Aims: To alert practitioners to complications regarding inflatable penile prostheses.
Presentation of Case: A 56 year-old male with a history of an inflatable penile prosthesis and multiple revisions was found to have a small bowel obstruction. Computed tomography scan and subsequent surgery demonstrated a disconnected, displaced penile prosthesis reservoir as the cause of his bowel obstruction.
Discussion: The inflatable penile prosthesis is a commonly used device for the treatment of erectile dysfunction. While patient satisfaction is high, this is device is prone to complications that arise with prosthetic, mechanical implants.
Conclusion: Inflatable penile prostheses are common devices that can have immediate and delayed complications. Practitioners should be aware of the device and its complications when evaluating patients.

Open Access Original Research Article

Interrelation of Argyrophilic Proteins of Nucleolar Organizer Regions and Ki-67 with Clinical and Morphological Parameters and Survival in Patients with Non-small Cell Lung Cancer

D. S. Kobyakov, E. Yu. Bychkova, A. M. Avdalyan, I. P. Bobrov, A. F. Lazarev, S. A. Lazarev, N. M. Kruglova, E. L. Lushnikova, L. M. Nepomnyaschikh

Journal of Advances in Medicine and Medical Research, Page 3941-3953
DOI: 10.9734/BJMMR/2014/10319

Argyrophilic proteins associated with nucleolar organizer regions (AgNOR) and Ki-67 were studied at non-small cell lung cancer (NSCLC). Tumors with low and high area index (AI) of AgNOR and label index (LI) Ki-67 were defined. AI AgNOR was related to the key clinical and morphological parameters in accordance with TNM system: values Т, N, greatest tumor dimension up to 3 cm and more, disease stage, histogenesis, and tumor differentiation. LI Ki-67 is related to the greatest tumor dimension up to 3 cm and more, disease stage, and tumor differentiation. NSCLC patients survival is longer in low AI AgNOR or LI Ki-67 tumors versus high AI AgNOR or LI Ki-67 tumors. NSCLC patients survival is longer in low AI AgNOR and LI Ki-67, shorter in high AI AgNOR and LI Ki-67, and intermediate in opposite AI AgNOR and LI Ki-67. Value N, greatest tumor dimension, histogenesis, AgNOR are independent predictors in NSCLC. NSCLC patients survival without metastases to lymph nodes is related to the greatest tumor dimension and in case of metastases it is related to AI AgNOR and greatest tumor dimension. Combined determination of AgNOR and Ki-67 has prognostic value at NSCLC.

Open Access Original Research Article

Utility of Per Vessel Coronary Artery Calcium (CAC) Score in Symptomatic Patients Undergoing Coronary Computed Tomography in Predicting Major Adverse Cardiovascular Events: Single Center Experience and Literature Review

Ryan L. Prentice, Megan L. Barnwell, Dustin M. Thomas, Homayoun R. Ahmadian, Ronald L. Jones, Charles K. Lin, Ryan J. McDonough, Bernard J. Rubal, Ahmad M. Slim

Journal of Advances in Medicine and Medical Research, Page 3933-3940
DOI: 10.9734/BJMMR/2014/10207

Background: Atherosclerotic vascular disease remains a significant etiology of morbidity and mortality in the United States. Coronary artery calcium (CAC) is associated with increased stroke incidence and coronary atherosclerotic burden. Uncertainty remains regarding how best to interpret non-zero CAC scores, particularly in symptomatic patients.
Methods: A review of the first 1122 patients who underwent coronary CT angiography (CCTA) with CAC scoring from January 2005 until July 2012 was performed. Patients were dichotomized into 2 groups, zero CAC score and non-zero CAC score. Non-zero CAC patients were further subdivided based on the specific coronary artery containing calcium. Rates of major adverse cardiovascular events (MACE) defined as all-cause mortality, non-fatal myocardial infarction (MI), ischemic stroke, and late revascularization (>90 days following CCTA) were evaluated in each group.
Results: 505 patients (63% male, mean age 60 ± 11) with non-zero CAC scores were analyzed over a six year period with resultant median follow up period of 22 months (IQR25,75 13-34 months). Major adverse cardiovascular events were observed in 11 patients. Receiver-operator curve (ROC) analysis on each coronary segment showed significance with the presence of left main (LM) CAC (AUC 0.752, p=0.004).
Conclusions: The presence of CAC at any value in the LM in this case series appears to predispose patients to increased rates of MACE.

Open Access Original Research Article

Comparative Effects of Sevoflurane and Desflurane on Erythrocyte Deformability in Streptozotocin-induced Diabetic Rats

Faruk Metin Çomu, Volkan Şıvgın, Zerrin Özköse, Mustafa Arslan

Journal of Advances in Medicine and Medical Research, Page 3954-3962
DOI: 10.9734/BJMMR/2014/8749

Aim: It is known that blood viscosity and erythrocyte aggregation are increased and erythrocyte deformability is decreased in diabetic patients. Blood rheology is known to be affected by numerous factor including anaesthetic drugs. Accordingly, we aimed to investigate the effects of sevoflurane and desflurane on erythrocyte deformability in diabetic rats.
Place and Duration of Study: The study was performed upon the approval of Gazi University Experimental Animals Ethics Committee in Gazi University Experimental and Clinical Research Center (GUDAM).
Methodology: In this study, 24 male albino Wistar rats were used.Diabetes was induced by a single IP injection of streptozotocin, at a dose of 55 body weight in 18 Wistar Albino rats.72 hours following this injection rats were classified as diabetic if their fasting blood glucose (FBG) levels exceeded 250 mg.dl-1and only animals with FBGs of > 250 mg.dl-1 were included in the diabetic groups. After the effects of chronic diabetes encountered diabetic rats were randomly assigned into diabetic control (group DC), diabetic desflurane (group DD) and diabetic sevoflurane (group DS) groups. Another 6 rats without diabetes were assigned as control group (group C). 4 weeks after the injection of streptozotocin diabetic rats were anaesthetized by desflurane 6% or sevoflurane 2% at a dose by which minimal alveolar concentration (MAC) for rats would be one. The drugs were given for 2 hours within 100% oxygen at a rate of 4 L.min1. After the anesthesia all rats were given ketamine (100 intraperitoneally and blood samples were withdrawn from the abdominal aorta and then rats were sacrificed. Erythrocyte samples were obtained from heparinized whole blood samples. Measurements for deformability were conducted on erythrocyte suspensions within serum physiologic tamponized with phosphate.
Results: Diabetes led to increased relative resistance compared to group C however desflurane and sevoflurane did not alter erythrocyte deformability significantly in diabetic rats.
Conclusion: Neither sevoflurane nor desflurane caused a negative effect on erythrocyte deformability in diabetic rats. However these findings should be further investigated in larger and more detailed studies.

Open Access Original Research Article

Effect of HIV Infection and Antiretroviral Therapy on Some Red Cell Enzyme Activities and Coagulation Parameters

G. I. Amilo, C. O. Okeke, M. O. Ifeanyichukwu, A. C. Okeke, S. I. Ogenyi Ogenyi, J. O. Okoye

Journal of Advances in Medicine and Medical Research, Page 3963-3974
DOI: 10.9734/BJMMR/2014/10211

Aim: To assess G-6-PD, Pyruvate kinase enzyme activity and some coagulation parameters in HIV positive patients on antiretroviral treatment (ART) and those not on antiretroviral treatments with varying durations of infection and Antiretroviral treatments.
Study Design: Case-control study
Place and Duration of Study: Nnamdi Azikiwe University Teaching Hospital Nnewi, Nigeria from March to August 2013.
Methodology: We included 181 subjects; Sixty HIV patients on ART with infection and ART duration of <1 – 5, >5 – 8 and >8 – 17 years; Sixty HIV patients not on ART with an infection duration of <1 – 3, >3 – 6 and >6 – 11 years; and Sixty-one apparently healthy individuals control. Glucose-6-Phosphate Dehydrogenase (G-6-PD) activity, Pyruvate kinase (PK) activity, Activated Partial Thromboplastin time (APTT), Prothrombin time (PT), Platelet count (PLT)and Human Immunodeficiency virus (HIV) status were determined.
Results: G-6-PD, APTT and PT, for ART and non-ART were significantly higher (P< 0.05) compared with those of control. G-6-PD and PT were significantly higher in ART subjects when compared with non-ART (P<0.05). There was no significant difference in Pyruvate kinase activity and platelet count (P>0.05). G-6-PD activity was significantly higher in ART subjects with HIV duration of >8 – 17 years than<1 – 5 years and >5 – 8 years (P< 0.05), and also in non-ART subjects with HIV duration of>3 -6 years and>6 – 11 years compared with<1 – 3 years (P< 0.05). G-6-PD activity was significantly higher in ART duration of>8 – 17 years compared to ART durations of >5 – 8 years and <1 – 5 years (P< 0.05).
Conclusion: This study identified a significant increase in G-6-PD activity in HIV patients in proportion to the duration of infection and therapy while APTT and PT were significantly prolonged in HIV patients implying a derangement in the intrinsic and extrinsic coagulation pathways.

Open Access Original Research Article

One-time Exposure to General Anesthetics Alters Nociceptive Response and Nucleotide Hydrolysis in Infant Rats

Liciane F. Medeiros, Ana Maria O. Battastini, Andressa de Souza, Joanna R. Rozisky, Vinicius S. dos Santos, Wolnei Caumo, Iraci L.S. Torres

Journal of Advances in Medicine and Medical Research, Page 3975-3989
DOI: 10.9734/BJMMR/2014/6571

Aims: The objective was to evaluate the single exposure of general anesthetics with or without a surgical procedure at postnatal day 14 (P14) on nociceptive behavioral responses. Furthermore, we evaluated ectonucleotidase activities at P14 and P30.
Place of Study: All experiments were performed at the Animal Experimentation Unit of Hospital de Clínicas de Porto Alegre. The Institutional Committee approved the experimental protocol f (GPPG-HCPA protocol No: 08149).
Methodology: Fourteen-day-old male Wistar rats were divided into two experimental designs (ED): the 1stED – control (C), isoflurane (ISO), isoflurane/surgery (ISO-SUR) and the 2nd ED – control (C), fentanyl/S(+)-ketamine (FK) and fentanyl/S(+)-ketamine/surgery (FK-SUR). Nociceptive responses were evaluated using the formalin and tail-flick tests, and the ectonucleotidase activities were evaluated by spinal cord synaptosome. All assessments were performed at P14 and P30.
Results: The FK and FK-SUR groups displayed an increased latency at P30. For the ectonucleotidase activity analysis, the following results were observed: (a) in the 1st ED, the ISO group displayed a reduction in ATPase and ADPase, and both ISO and ISO-SUR displayed a reduction in AMPase activity at P14; (b) in the 2nd ED, the FK group displayed an increase in AMPase activity at P14 and increased ATPase activity at P30, and both FK and FK-SUR exhibited an increase in AMPase activity at P30.
Conclusion: Our results indicate that single administration of general anesthetics at P14 is able to promote changes in the nociceptive response in the intermediate-term, and in the ectonucleotidase activities in the short- and medium-terms.

Open Access Original Research Article

Reported Experiences of Stalking Behavior from Patients towards Psychiatrists from the Atlantic Provinces of Canada

Amin A. Muhammad Gadit, Gerry Mugford, Terrence Callanan, Rana Aslanov

Journal of Advances in Medicine and Medical Research, Page 3990-4003
DOI: 10.9734/BJMMR/2014/9856

Aim: A study was conducted to assess the magnitude of stalking experienced by psychiatrists, its’ effects and actions taken to ameliorate the problem.
Methods: A cross sectional study to assess the magnitude of stalking the consequent effects on the psychological, social and occupational life of psychiatrists; and any preventative measure taken was conducted from July 2009-April 2010. A questionnaire was sent to 301 psychiatrists practicing in Atlantic Canada. Local Ethics approval was obtained.
Results: Of the 308 psychiatrists sent surveys, 116 responded (37.6%; 67 males and 47 females). One questionnaire was invalid. (Twenty-nine (15 males and 14 females) reported experiences of stalking. Fifty-eight (50.4%) were above age 50, 49(42.6%) were between ages 35-50 and (8) 7% were younger than 35. In the study cohort, 39(33.6%) psychiatrists were in pure clinical practice, 4(3.4%) were in academic practice and 71(61.2%) had combined clinical and academic practice. Among the subspecialties, 73(62.9%) psychiatrists were practicing general adult psychiatry, 19(16.4%) were child and adolescent psychiatrists, 6(5.2%) in geriatric psychiatry, 4(3.4%) in consultation-liaison, 5(4.3%) in forensic, 1(0.9%) in developmental disability and 7(6.0%) were in other psychiatric specialties. Of 115 psychiatrists, 53(46.1%) were in practice for more than 15 years, 16 (13.9%) were from 11–15 years, 29 (25.2%)-from 5 to 10 years and 17(14.8%) were in practice for less than 5 years. There was no significant differences [OR (Odds Ratio values), p-values>0.05) in reported stalked for age or length of psychiatric practice.
However, there was strong association of stalking with the distress experienced by the psychiatrists (p=0.00).
Conclusion: The problem of stalking does exist in the Atlantic Provinces of Canada and causes immense psychological, professional and social distress among psychiatrists who fall victim to stalking behavior. The majority of mental health professionals are unaware of any laws against stalking in Canada. There is a need for more effective education, support services and redress if we are to ameliorate the burden associated with stalking behaviours.

Open Access Original Research Article

High Prevalence of Hepatitis-B Surface Antigen in Pregnant Women Observed in Southwest Nigeria: A Potential Risk for Vertical Hbsag Transmission

Samson A. Olofinsae, Bartholomew Okechukwu Ibeh, Adesina A. Olufisayo

Journal of Advances in Medicine and Medical Research, Page 4018-4024
DOI: 10.9734/BJMMR/2014/10498

Aim: Nigeria has been classified among the nations highly endemic for viral Hepatitis with a seroprevalence of 2.7-13.3% in normal population. The study determines the seroprevalent rates of hepatitis B virus based on trimester stages in a population of pregnant women.
Study Type: Case control.
Place of Study: Department of Microbiology, Obafemi Awolowo University, Ile Ife.
Materials and Methods: In this case-control study, a total of 300 pregnant women sampled in the population were attending ante-natal clinic at the Obafemi Awolowo University Teaching Hospital, Ile-Ife, Southwest Nigeria. A rapid one-step diagnostic strip method was used for Hepatitis B surface antigen (HBsAg) detection and Smart check HBsAg Immunoassay used for confirmation. The study had a structured questionnaire to generate baseline information. One-way analysis of variance (ANOVA) using statistical Package for Social Sciences (SPSS) version 18.
Results: High prevalence of HBsAg was observed in pregnant women that are married (6.67%), have multiple sexual partners (7.76%) and indulge in transactional sexual behaviour (7%). Awareness of HbsAg transmission to the fetus by the pregnant mothers (0.95%) and previous HbsAg testing were low (3%). Differentials in the 1st, 2nd and 3rd pregnancy trimesters showed 42.9%, 10.9%, and 18.4% prevalent rates respectively.
Conclusion: The result expresses high potential and possible risk associated with HbsAg vertical transmission during the 1st and 2nd trimester of pregnancy. Therefore, proactive approach targeted at this population should be designed to reduce HbsAg transmission to the fetus.