Open Access Case Study

Menorrhagia, Tranexamic Acid and False Negative D-Dimer in Patients with Venous Thromboembolism Case Report and Systematic Literature Review

Gianni Lorenzini, Luca Masotti, Euro Ubaldi, Annalisa Mannucci, Annamaria Bellizzi, Chiara Bini, Sandra Gori, Patrizia Fenu, Daniela Cannistraro, Alessandro Pampana

Journal of Advances in Medicine and Medical Research, Page 5116-5124
DOI: 10.9734/BJMMR/2014/12072

A 56 years-old woman came to our attention for abrupt onset of shortness of breath. Pulmonary embolism was firstly ruled out due to negative D-Dimer and unlikely probability. On second day, the patient presented with heavy menorrhagia and treated with tranexamic acid (TA). She informed that similar episode happened some months ago, so she had been treated with cycles of TA, discontinued the last time few days before the hospital admission. After three days from oral intake of TA, the patient suffered from abrupt painful left calf without any cardiac or respiratory sign. Urgent legs ultrasonography showed distal deep vein thrombosis and this time a new D-Dimer assay showed a mild positivity. The patient underwent to computer tomography pulmonary angiography which revealed bilateral segmental pulmonary embolism. Other three case reports referred to patients with acute venous thromboembolism after taking TA for menorrhagia emerged from systematic review of literature. Two of them presented with false negative D-Dimer. In another one D-Dimer assay was positive but performed after cardiopulmonary resuscitation.
TA could link with venous thromboembolism both influencing D-Dimer value, proving false negativity, and increasing the thrombotic risk in young-adult females suffering from menorrhagia. These possibilities should be taken into account in this population.

Open Access Case Study

Thinking beyond Gauze Count at Surgery: A Reminder to Surgeons on Textilomas

I. O. Awowole, O. N. Makinde, A. M. Tijani, O. Olasehinde, O. O. Badejoko

Journal of Advances in Medicine and Medical Research, Page 5167-5173
DOI: 10.9734/BJMMR/2014/12208

Introduction: Inadvertently leaving surgical sponges in operation site has been described by various terms, including textiloma and gossypiboma. In recognition of the morbidity and economic implications that are associated with this error, surgeons exercise utmost caution to avoid retention of surgical instruments in body cavities.
Presentation of Case: A 29 year old Para1 presented at our facility with incapacitating abdominal pain and swelling of twelve months duration. She had an emergency Caesarean section at another hospital one month before the onset her symptoms. She had several hospital admissions, during which she was managed conservatively for adhesive intestinal obstruction without sustained relief. She was resuscitated, and she had exploratory laparotomy at our centre. A surgical linen that measured 110x150cm was retrieved from an abscess cavity. The procedure was complicated by entero-cutaneous fistula, which was satisfactorily managed surgically.
Discussion and Conclusion: Despite the large size of the retained material, the diagnosis was not entertained for twelve months, thereby conferring untold hardship on the patient. The possibility of retained foreign bodies should be considered early as a differential diagnosis of chronic post-operative pain, abscess or fistula. Furthermore, teamwork and seamless communication between surgeons and other theatre staff is essential to prevent such mistakes.

Open Access Case Study

Barotraumatic Subcutaneous Orbital Emphysema after Nose Blowing: Case Report

Yasin Metiner, Tuba Cimilli Ozturk, Ozge Ecmel Onur, Serdar Ozdemir

Journal of Advances in Medicine and Medical Research, Page 5174-5178
DOI: 10.9734/BJMMR/2014/11832

Orbital subcutaneous emphysema is defined as the abnormal presence of air within the periorbital soft tissue. It occurs generally as a result of blunt or penetrating facial trauma. Spontaneous barotraumatic emphysema is a very rare entity that generally results due to a sudden increase in the intraorbital pressure. If there is not an obvious visual acuity loss even with high ocular pressure, it is generally managed conservatively. However prolonged elevation of intraorbital pressure may cause an irreversible, ischemic visual loss secondary to an ischemic optic neuropathy or an acute central retinal artery occlusion. Emergency decompression may be required. Here we are presenting a patient with barotraumatic orbital subcutaneous emphysema, occurring after forceful nose blowing who was managed conservatively without any complications.

Open Access Short Research Article

Low and Zero Prevalence Rates of Anti-measles Virus Immunoglobulin G in Mothers and Their Infants Respectively in Health Centers in Osogbo, Nigeria

Oluwatoyin Adebusola Adegboye, Adetayo Abosede Adegboye, Moses Olubusuyi Adewumi, Waidi Folorunso Sule

Journal of Advances in Medicine and Medical Research, Page 5107-5115
DOI: 10.9734/BJMMR/2014/9738

Aim: We undertook this study to determine the susceptibility of mother-infant pair participants to measles virus infection in two health centers in Osogbo, Osun State, Nigeria.
Study Design: This is a descriptive, cross-sectional hospital-based study.
Place and Duration of the Study: The study was carried out in Osogbo, southwestern, Nigeria between November, 2012 and February, 2013.
Methodology: With ethical approval and participants’ consents, 83 mothers and their 84 infants were consecutively recruited; blood samples were aseptically collected from them by thumb puncture onto Whatman filter paper. The papers were appropriately labeled; air-dried and kept in brown envelopes which we kept in clean polythene bags and stored at 4ºC until assayed. Freshly prepared PBS was used to elute serum from 5 to 6 punched-out disks from each Whatman filter paper. The supernatant from the spun eluate of each sample was assayed for anti-measles virus IgG using ELISA.
Results: Overall, 2.41% and zero percent seroprevalence rates were recorded from the nursing mothers and their infants respectively.
Conclusion: We concluded that the seropositivity of anti-measles virus IgG antibody in the nursing mothers from the two health facilities was very low, and that all the infants and most (97.59%) of the nursing mothers were apparently susceptible to measles virus infection.

Open Access Original Research Article

The Effects of Supervised Exercise Program on Health-Related Physical Fitness in Kuwait

Fahad Al-Ghimlas, Kalaivane Subbramaniam, Osama Al-Owaish, Ma. Theresa Bilas, Kazem Behbehani

Journal of Advances in Medicine and Medical Research, Page 5083-5097
DOI: 10.9734/BJMMR/2014/11416

Aims: Physical activity improves health in terms of cardiovascular fitness, musculo-skeletal fitness, body composition, and metabolism. The study aims to examine the effects of supervised exercise training on metabolic profile and health-related physical fitness parameters in Kuwait.
Study Design: A prospective observational study.
Place and Duration of Study: Fitness and Rehabilitation Center (Dasman Diabetes Institute, Kuwait) between January 2012 and December 2013.
Methodology: We included 90 participants (44 women), mean age 48.6 (±14.4) years with adherence exceeding 50%. Outcome measures health-related physical fitness (measured by cardiopulmonary exercise testing) and other secondary outcome measures including anthropometric data, vital signs, and glycemic profile values.
Results: Paired t-test was used to evaluate the effects of exercise training. Both diabetic and non-diabetic participants showed significant increase in peak oxygen consumption (3.0 ml∙min-1∙kg-1; 95% CI: 2.3 to 3.7; p <0.001). There was significant reduction in BMI (-0.6 kg/m2; 95% CI: -0.9 to -0.3; p<0.001), waist circumference (-2.2cm; 95% CI: -3.4 to -1.0; p = 0.002) and body fat percentage (-0.9%; 95% CI: -1.4 to -0.3; p = 0.002). The glycated hemoglobin significantly decreased (p=0.001). Fasting blood glucose and lipid profile improved but were not statistically significant. The exercise intervention reduced the systolic blood pressure (BP) and diastolic BP by a mean of 0.6 (95% CI: -3.2 to 1.9; p = 0.63) and 2.6 mmHg (95% CI: -4.9 to -0.3; p=0.03) respectively, with the latter being statistically significant. Significant changes were also noted in variables of total handgrip (4.2 kg; 95% CI: 1.4 to 7.0; p=0.04) and push-up (4.2 repetition; 95% CI: 1.9 to 6.4; p < 0.001).
Conclusion: The 12-week supervised exercise intervention used seems to improve cardiorespiratory fitness, glycemic control, diastolic BP and anthropometric measurements. This improvement can indicate that exercise decrease cardiovascular events and mortality.

Open Access Original Research Article

Evaluation of Polymorphisms rs762624 and rs3176336 of CDKN1A Gene and Risk of Colorectal Cancer

Neda Zali, Mehrdad Hashemi, Vahid Chaleshi, Mahdi Montazer Haghighi, Sanaz Savabkar, Hamid Asadzadeh Aghdaei, Mohsen Vahedi, Ehsan Nazemalhosseini Mojarad, Mohammad Reza Zali

Journal of Advances in Medicine and Medical Research, Page 5098-5106
DOI: 10.9734/BJMMR/2014/8762

Aims: Progressive loss of cell cycle control is an important feature on the colorectal cancer. CDKN1A gene encoded p21 protein that’s one of the cyclin-dependent kinase inhibitors, plays a key role in regulating the cell cycle. The aim of this study was to investigate associations of the CDKN1A gene polymorphism rs762624 and rs3176336 with risk of colorectal cancer in an Iranian population.
Methods: A case-controls study was conducted to investigate the association of polymorphism rs3176336 and rs762624, with colorectal cancer risk in Iranian population. In this study 150 cases of sporadic CRC and 150 healthy controls were recruited, genomic DNA were extracted from peripheral blood, the genotypes were determined using the polymerase chain reaction and restriction fragment length polymorphism (PCR-RFLP) method and the result was validated by direct sequencing.
Results: The rs762624 frequencies of the AA, AC, and CC genotypes among cases were 9.3%, 74.7%, and 16%, respectively, while in controls genotype frequencies were 10%, 74%, and 16%, respectively. The rs3176336 frequencies of the AA, AC, and CC genotypes among cases were 29.3%, 18% and 52.7%, respectively, while in controls genotype frequencies were18%, 20%, and 62%, respectively. No association was found for the CDKN1A rs3176336 AT/AA genotype (Adjusted odds ratio (OR), 0.726, 95% confidence interval (CI), 0.365–1.443 for AT genotype; OR, 1.67, 95% CI, 0.754–3.702 for AA genotype) with risk of colorectal cancer, compared with the TT genotype. In our research, we could not found significant relation between stage of colorectal cancer and genotypes of rs762624 and rs3176336 polymorphisms (p=0.081, p=0.988).
Conclusion: Present data do not confirm association of rs3176336 and rs762624 polymorphisms with susceptibility of Iranian to colorectal cancer.

Open Access Original Research Article

Demographic Profile of Travellers Seeking Reproductive Tourism Services

Raywat Deonandan, Samantha DiRaimo

Journal of Advances in Medicine and Medical Research, Page 5125-5132
DOI: 10.9734/BJMMR/2014/11751

Reproductive medical tourism is by some accounts a multibillion dollar industry globally. Transnationally, it involves the travel between nations of individuals seeking assisted reproductive technologies in foreign countries. Through a structured literature review, we identified the demographic characteristics of those seeking these services. Data from 14 peer-reviewed studies were synthesized. Most studies described travel within Europe, with Belgium being the destination most often cited. Key findings include that those travelling for reproductive purposes are typically over 35 years of age, likely to self-identify as homosexual, bisexual or transgendered. The most frequently mentioned reason for travel was the lack of appropriate services in the home country.

Open Access Original Research Article

Sex Determination Potential from Canine Tooth Dimensions

Ayesha Shireen, Syeda Arshiya Ara, S. N. Azzeghaiby, Ibrahim Alzoghaibi, Bassel Tarakji, Ayesha Umair

Journal of Advances in Medicine and Medical Research, Page 5133-5143
DOI: 10.9734/BJMMR/2014/11005

• This study was conducted to know sex determination potential from mesiodistal dimensions of permanent canines.
• To find out the average size of canines in males and females of south Indian population.
• To compare the findings with National and International Studies.
Study Design: The subjects were selected based on the inclusion and exclusion criteria set forth for the study. Measurements of mesiodistal widths of the four canines were made on the dental casts of each of the 600 subjects with Digital caliper with 0.01 resolution and subjected to statistical analysis. Statistical methods used were statistical mean, standard deviation, Student’s t-test (p< 0.05), step-wise discriminant analysis and cross validated discriminant analysis using SPSS version 11.00.
Place and Duration of Study: Department of Oral Medicine and Radiology ,Al-Badar Rural Dental College and Hospital, Gulbarga , Karnataka, India , between May 2008 and May 2011.
Methodology: We included 600 patients (300 men, 300 women; age range 17-25 years).

• The mesiodistal width of canines of both the jaws is significantly greater in males than females.
• The mean maxillary canine width in males and females is 7.73 mm. The mean mandibular canine width in males and females is 6.825 mm.
• The mean (male and female), maxillary and mandibular canine width is found to be less in South Indian Population as compared to Central Indian population.
• The mean (male and female), maxillary and mandibular canine width is found to be less in South India Population as compared to values given by Wheelers and similar to the study done in the Saudi population.
Conclusion: The present study measured only linear dimensions because of simplicity, reliability, inexpensibility and in a setup where latest technology utilizing DNA methods are not available and gender estimation has to be managed based on jaw fragments.

Open Access Original Research Article

Prescription Pattern Study in Type 2 Diabetes Mellitus in Diabetic out Patients in Private Clinics in Kerman, Iran

Gholamreza Yusefzadeh, Gholamreza Sepehri, Hamid Goodarzi, Mostafa Shokoohi

Journal of Advances in Medicine and Medical Research, Page 5144-5153
DOI: 10.9734/BJMMR/2014/11721

Aims: Diabetes mellitus (DM) is a chronic disease associated with significant morbidity and mortality. The present study was carried out to assess prescribing practice for oral antidiabetic drugs in type 2 diabetes mellitus patients seen in diabetic outpatients in private clinics in Kerman, Iran.
Study Design: Retrospective analysis of prescription pattern for type 2 diabetic outpatients.
Place and Duration of Study: Diabetic clinics in Kerman city, Iran, (from 1st September 2012 to 31st August 2013.
Methodology: Prescription pattern of 1118 diabetic outpatients were analyzed for age, percentage of male and female patients, antidiabetic drug category, name of prescribed drug, most frequently prescribed antidiabetic drug and percentage of one/two drug combination.
Results: Out of the 1118 prescriptions of antidiabetic drugs studied, 424 (37.9%) were for women and 694(62.1%) were for men with mean age of 56.2±11 years. Oral antidiabetic drugs were prescribed for 777(69.5%) and 30.5% of patients received insulin. Biguanides were the most frequently prescribed drugs (61.7%) followed by sulfonylurea (59.9%), alpha-glucosidase inhibitors (4.5%), repaglinide (NovoNorm®) (2.7%) and thiazolidinediones (1.7%). Metformin 690 (61.7%) and glibenclamide 670 (59.9%) were the most frequently prescribed antidiabetic drugs. About 46.9% of patients received monotherapy and a total of 594 (53.1%) patients were on combination therapy of 2 or more antidiabetic drugs. The Combination of glibenclamide plus metformin (41.5%) was the most commonly prescribed antidiabetic drug combination in diabetic outpatients. Most common prescribed drugs associated with DM were found to be antihypertensive/antianginal (65%) and lipid lowering drugs (33.3%).
Conclusions: Oral hypoglycemic agents were the main form of antidiabetic therapy in type 2 DM patients. Metformin was the most frequently prescribed biguanides and combination of metformin with glibenclamide has been most widely used. This suggests the need for development of evidence-based guidelines for oral antidiabetic prescription by health professionals.

Open Access Original Research Article

Aging, Diabetic Nephropathy and Multiple Macrovascular Involvement are Associated with Atrial Fibrillation in Type 2 Diabetes Mellitus

G. Papa, M. P. Iurato, C. Licciardello, R. Maiorana, C. Finocchiaro, V. Pezzino

Journal of Advances in Medicine and Medical Research, Page 5154-5166
DOI: 10.9734/BJMMR/2014/11918

Background: Atrial fibrillation (AF) is the most common arrhythmia in the world and a recognized risk factor for stroke and death.
Aims: To establish the association between atrial fibrillation and markers of glucose homeostasis as well as anthropometric, laboratory and clinical variables in type 2 diabetes.
Study Design: Cross-sectional retrospective study.
Place and Duration of Study: Unit of Metabolic and Endocrine Diseases, “Centro Catanese di Medicina e Chirurgia” Clinic, Catania, Italy, between January 1, 2008, and January 1, 2014
Methods: We included 6,920 type 2 diabetic (T2D) patients (mean age 66.4±11.4 years, 50.4% men) treated in specialist diabetes center. Persistent AF was assessed by clinical history and confirmed (by a single cardiologist) by a resting 12-lead electrocardiogram. Demographic, clinical and laboratory parameters were included in the analyses, as well as vascular laboratory studies. Standardized procedures were used to assess microvascular complications and Metabolic Syndrome (MetS).
Results: In total, 6,455 (93.3%) patients had no evidence of atrial arrhythmia and the remaining 465 (6.7%) had AF. The prevalence of AF increased with age (peak of prevalence after 75 years in both sexes) and it was significantly greater in men (p=0.02). AF was significantly associated with hypercreatininemia, eGFR (and more advanced stage of Chronic Kidney Disease, CKD) and albuminuria (p<0.0001) as well as the diagnosis of cardio-vascular disease (CVD, p<0.0001). In a multivariate logistic regression analysis, age (OR 1.08, 95% CI 1.05-1.11, p<0.0001), male sex (OR 2.46, 95% CI 1.5-3.9, p=0.0002), estimated Glomerular Filtration Rate (eGFR) (OR 0.99, 95% CI 0.98-0.99, p=0.02) and the presence of CVD (OR 1.65, 95% CI 1.01-2.75, p=0.04) were all independent factors related to AF. When we subgrouped patients according to cardiovascular patterns, an adjusted analysis revealed a significant difference only in the poly-vascular subgroup (OR 2.24, 95% CI 1.26-3.99, p=0.006).
Conclusion: Aging, CKD and cardiovascular disease (particularly poly-vascular involvement) were the most significant AF-related factors. In T2D patients, the identification of factors predisposing individuals to AF may facilitate an early diagnosis and stroke prevention therapy.