Open Access Clinical Practice Article

Interventional Management of High-risk Patients with Takayasu’s Arteritis

Sridhar Kasturi, Shiva Kumar Bandimida, Shivani Kothari, Ashok Thakkar

Journal of Advances in Medicine and Medical Research, Page 944-954
DOI: 10.9734/BJMMR/2015/12397

Takayasu’s arteritis is a chronic vasculitis affecting aorta and its branches. We report a case series of Takayasu’s disease. Percutaneous intervention with stent implantation is better choice for stenosis and occlusion of coronary and carotid arteries as well as peripheral lesions, and is increasingly used for the management of Takayasu’s arteritis.

Open Access Case Study

Chordoma of the Cervical Spine: A Case Report and Review of Literature

M. Chihani, Y. Darouassi, M. Touati, H. Ammar, B. Bouaity

Journal of Advances in Medicine and Medical Research, Page 955-961
DOI: 10.9734/BJMMR/2015/13080

Chordomas are rare low to intermediate grade malignant tumours derived from the notochordal remnants. Their location in the cervical spine is exceptional. The clinic radiologic features, anatomopathologic aspects, diagnostic difficulties, therapeutic methods and prognostic factors are discussed through a case report of a cervical spine chordoma with a literature review.

Open Access Case Study

Penile Ectopic Testis: An Uncommon Cause of an Empty ScrotumPenile Ectopic Testis: An Uncommon Cause of an Empty Scrotum

A. A. Appiah, R. Azorliade, G. Amoah, C. K. Gyasi-Sarpong

Journal of Advances in Medicine and Medical Research, Page 962-965
DOI: 10.9734/BJMMR/2015/13805

An ectopic testis is any testis that presents outside the line of its normal descent after exiting the external inguinal ring. Sites for ectopic testes include the superficial inguinal pouch of Denis Browne, femoral, suprapubic, contralateral hemiscrotum, perineum and pubopenile region. This case describes yet another rare site of ectopic testis in an 11 year boy. The diagnosis was essentially clinical complimented by ultrasonography. Scrotal repositioning was successfully achieved.

Open Access Case Study

Distal Interphalangial Joint Gouty Arthritis in a Patient with Nodal Osteoarthritis: A Case Report and Review of Literature

Sinem Bozkurt, Fatma Fidan, Berat Meryem Alkan, Aliye Tosun, Ozge Ardicoglu

Journal of Advances in Medicine and Medical Research, Page 966-970
DOI: 10.9734/BJMMR/2015/13670

Case: Herein 73 year- old female patient with distal interphalangial (DIP) joint gouty arthritis accompanying nodal OA was presented. There was significant redness and swelling in the joint, joint was warm and tender on palpation and range of motion was very painful.
Conclusion: The presentation of acute or subacute arthritis in interphalangial joints of a woman with preexisting nodal OA may obscure the correct diagnosis and coexisting gouty arthritis may be overlooked.

Open Access Original Research Article

Identification of Potential Biomarkers in Acquired Cholesteatoma

Juliana Gusmão de Araujo, Marcela Silvestre Outtes Wanderley, Roberto Afonso da Silva, Mariana de Carvalho Leal Gouveia, Silvio da Silva Caldas Neto

Journal of Advances in Medicine and Medical Research, Page 853-863
DOI: 10.9734/BJMMR/2015/12902

Aims: The acquired cholesteatoma, even with all the knowledge accumulated since its first description, still remains a public health problem, far from being solved. A deeper understanding of its pathogenesis is extremely important since it is a destructive lesion that might cause potentially serious complications. We had the objective, in this study, to identify acquired cholesteatoma biomarkers using proteomics platform.

Study Design: descriptive cross-sectional study.

Methodology: Samples were collected from cholesteatoma and also from the retroauricular skin of twelve patients undergoing surgery for cholesteatoma removal. The samples were studied by proteomic analysis, using the Mascot algorithm and the NCBI and Swiss Prot proteins database.

Results: Of the 393 spots identified in the analysis of protein extracts of acquired cholesteatoma, only 10 were within acceptable statistical parameters by Mascot algorithm. The proteins detected in acquired cholesteatoma were fibrinogen beta chain, extracellular matrix protein 2, actin cytoplasmic 1, heparan sulfate glucosamine 3-O-sulfotransferase 3A1, tumor necrosis factor alpha 8 induced protein-like 1, stanniocalcin-2, eosinophil lysophospholipase and OFUT1.

Conclusion: Proteins involved in cell migration, regulation of apoptosis, signaling pathways, cellular proliferation, wound healing and inflammatory processes were identified. We were able to draw a proteomic profile of acquired cholesteatoma.

Open Access Original Research Article

Plasma Thrombopoietin Level in Thrombocytopenic Patients with or without Liver Cirrhosis Chronically Infected by the Hepatitis C Virus

Aiman Al-Qtaitat, Said Al-Dalaen, Samir Mahgoub, Nedal Alnawaiseh, Jehad Al-Shuneiqat, Sameeh Al-Sarayreh, Yousef Al –Saraireh

Journal of Advances in Medicine and Medical Research, Page 864-871
DOI: 10.9734/BJMMR/2015/9860

Background and Aim: Thrombocytopenia is a frequent problem in patients with post- hepatitis C (HCV) liver cirrhosis and also occurs in chronic HCV-infected patients without liver cirrhosis. The aim of this study was to evaluate the role of plasma thrombopoietin (TPO) in the occurrence of thrombocytopenia in both conditions.

Method: Platelet count and plasma thrombopoietin level and liver function tests were measured in four groups of patients: twenty chronic patients with post-hepatitis C liver cirrhosis and thrombocytopenia (group I), ten chronic HCV-positive patients with liver cirrhosis without thrombocytopenia (group II), ten chronic HCV-positive patients without liver cirrhosis with thrombocytopenia (group III) and chronic ten HCV-positive patients without liver cirrhosis and without thrombocytopenia (group IV). Ten normal healthy individuals were included as a control group.

Results: Plasma levels of albumin, alanine aminotransferase (ALT), aspartate aminotransferase (AST), TPO and platelet counts in the four groups of patients were significantly different from their corresponding levels in the control group (P <0.001). There was a significant positive correlation between plasma TPO levels and platelet counts in group III patients (ρ (Spearman's [rho]) = 0.661, P= 0 .038). There was no significant correlation between TPO levels and platelet counts in the other three groups of patients. The logistic regression analysis in the three designated models, using dependent variables (chronic HCV infection, liver cirrhosis and thrombocytopenia) and an independent variable (TPO plasma level) revealed that liver cirrhotic patient and the thrombocytopenic patient have equally the best prediction model for the low plasma TPO.

Conclusion: Decreased thrombopoietin production has a role in the pathogenesis of thrombocytopenia in liver cirrhosis.

Open Access Original Research Article

Nonalcoholic Fatty Liver Disease (NAFLD) in Saudi Patients with T2DM in Jazan Region: Prevalence and Associated Factors

Erwa Elmakki, Hussein Aqeely, Ibrahim Bani, Husam Omer, Yahya Solan, Asim Taher, Talal Hadi, Musa Mohammed, Saif Elden Abdalla, Mohammed S. Mahfouz

Journal of Advances in Medicine and Medical Research, Page 872-879
DOI: 10.9734/BJMMR/2015/13077

Backgrounds: Non-alcoholic fatty liver disease (NAFLD) has become one of the major health problems world widely, especially among communities with sedentary lifestyle. The main objectives of this study were to know the prevalence of NAFLD among Saudi patients with T2DM in Jazan region and to determine the most important associated factors.
Materials and Methods: A cross sectional study targeted 230 type 2 diabetic patients, who attended Diabetic Center at Jazan General Hospital. All participants were screened for NAFLD using abdominal ultrasonography in addition to clinical and laboratory workup. Descriptive statistics, Chi square/Fisher exact test and logistic regression were utilized for data analysis.
Results: The prevalence of fatty liver in the present study was 47.8% (95% CI 41.1–54.6), with no significant difference between males 49.1% (95% CI 40.0–58.3) and females 46.3% (95% CI 36.6-56.3). The prevalence of NAFLD was found to be 52.9% among patients who their ages range between 40-59 years. Factors associated with NAFLD were found to be age, uric acid, aspartate aminotransferase (AST) and alanine aminotransferase (ALT) (p-value<0.05 for all).
Conclusion: NAFLD is tremendously common among people with type 2 diabetes in Jazan region and the major associated factors were age, obesity, uric acid and elevated liver enzymes. There was no positive correlation between the presence of fatty liver and duration of DM or the degree of glycemic control.

Open Access Original Research Article

Hypertension Prevalence in the US Population Varies with Differences in Alpha-1 Antitrypsin Genotype: A Cross Sectional Study

Suchit Kumbhare, Kelly J. Hunt, Paul J. Nietert, Laura Schwarz, Charlie Strange

Journal of Advances in Medicine and Medical Research, Page 880-888
DOI: 10.9734/BJMMR/2015/13447

Background: The prevalence of hypertension (HTN) associated with alpha-1 antitrypsin deficiency (AATD) has been studied with indeterminate results. The aim of the study was to prospectively compare the prevalence of HTN before testing in 3 groups of individuals with subsequently normal, moderately deficient, and severely deficient genotypes of AATD with adjustment for differences in demographics and clinical variables.
Methods: We performed a cross sectional study using data from the Alpha-1 Coded Testing (ACT) study. The univariate demographic and clinical factors associated with HTN were further analyzed by logistic regression analysis.
Results: The prevalence of HTN was 27.2%, 20.6%, and 27.9% for individuals with normal, moderate and severe AATD, respectively (p<0.02). The prevalence of HTN increased with age and an interaction between age, alpha-1 antitrypsin deficiency genotype and HTN was identified. The relative risk of HTN among young moderately deficient individuals was 0.53 (95% CI 0.37-0.76) the risk of young PiMM and PiMS (normal genotype) individuals. There was no significant difference in the risk in older moderately deficient individuals 1.02 (95% CI 0.76-1.37) and individuals with severe AATD 1.10 (95% CI 0.71-1.68) when compared to normal genotypes.
Conclusion: Moderate deficiency genotypes (PiMZ, PiSS, PiMNull) have less HTN than normal or severe deficiency genotypes, particularly in young individuals. We speculate that protease inhibitor deficiency over a lifetime allows unopposed proteolysis of vascular connective tissue.Measured comorbidities do not explain these findings. Validation of this data should occur in other AATD cohorts.

Open Access Original Research Article

Survey of Medical Officers Attitudes and Knowledge of Eye Conditions in Older Patients

K. F. Monsudi, A. A. Ayanniyi, F. O. Olatunji, A. A. Panti, A. Isa

Journal of Advances in Medicine and Medical Research, Page 889-894
DOI: 10.9734/BJMMR/2015/9205

Aim: To assess medical officers’ attitude and knowledge of eye conditions in the elderly.
Study Design: Convenient sampling technique.
Place and Duration of Study: Department of Ophthalmology, Federal Medical Centre, Birnin Kebbi, Nigeria, November 2012.
Methodology: Thirty four medical officers were shown 10 slides of common external eye conditions in the elderly and were asked to give the diagnosis of each slide and complete a self-administered questionnaire during a hospital clinical presentation. The questionnaire and the answers to the 10 slides were collected immediately after the presentation.
Results: All the medical officers agreed that eye examination is an important part of the general medical examination. However, only 16 (47.1%) routinely examined the eye of the elderly patient as part of the general medical examination. Fourteen medical officers (41.2%) were comfortably examining the eye of the elderly. Though 6 (17.6%) medical officers reported being sufficiently trained in the ocular examination but only 1 (2.9%) admitted being proficient in the ocular examination. The entire medical officers agreed that ageing is a risk factor for some ocular conditions, but only 18 (52.9%) ever inquired from the older patients if they had any specific eye conditions. Many of the medical officers wrongly diagnosed the presented slides. There were associations between duration of the medical practice and attitude with the medical officers of less years of practice not bothering about the eye examination in the elderly during the general medical examination (P<.05).
Conclusion: Most studied medical officers were not routinely examining the eyes of the older patients and many were unable to diagnose common eye conditions in the elderly. Medical training should emphasize the ocular examination and diagnosis. The continuing eye medical education for medical officers can bridge the knowledge gaps in eye care and enhance early detection of the eye conditions.

Open Access Original Research Article

Antioxidant and Anti-malarial Properties of Catechins

Iwan Budiman, Rita Tjokropranoto, Wahyu Widowati, Fanny Rahardja, Maesaroh Maesaroh, Nurul Fauziah

Journal of Advances in Medicine and Medical Research, Page 895-902
DOI: 10.9734/BJMMR/2015/11451

Aims: This research was performed to evaluate the antioxidant and anti malarial activities of various catechins including catechin (C), epicatechin (EC), catechin-gallate (CG), gallocatechin-gallate (GCG), epigallocatechin (EGC), epicatechin-gallate (ECG), epigallocatechin gallate (EGCG).
Study Design: The antioxidant activity was measured by 1,1-diphenyl-2-picryl-hydrazyl (DPPH) scavenging activity and anti-malarial activity was determined by In vitro assay against P. falciparum culture, antioxidant activity was analyzed using linear regression analysis, and was continued by determining Inhibitory Concentration 50 (IC50). The anti-malarial activity was analyzed by probit analysis and IC50 determination.
Place and Duration of Study: Medical Research Center, Faculty of Medicine, Maranatha Christian University, Bandung. Pharmacognicy Laboratory, Airlangga University, Surabaya. Biomolecular and Biomedical Research Center, Aretha Medika Utama, Bandung, Indonesia from March 2013 to October 2013.
Results: The results showed that EC has the highest antioxidant activity with IC50 = 0.41μg/ml while ECG and GCG with IC50 = 0.52 μg/ml. For anti-malarial activity, CG has the highest anti malarial activity (IC50 = 0.37 μM).
Conclusion: Catechins have high antioxidant activity and CG has highest anti-malarial activity.

Open Access Original Research Article

Socioeconomic Profile and Academic Performance of Students on Campus VIII of the State University of Paraíba, Araruna, Brazil, 2013

Maria do Rosário da Silva Flor, Odailma da Silva Lima, Dmitry José de Santana Sarmento, Gustavo Gomes Agripino, Flaviana Dornela Verli, Sérgio Henrique Gonçalves de Carvalho, Pierre Andrade Pereira de Oliveira, Sandra Aparecida Marinho

Journal of Advances in Medicine and Medical Research, Page 903-913
DOI: 10.9734/BJMMR/2015/13060

Aims: The aim of the present study was to analyze the socioeconomic profile and academic performance of students of three courses on Campus VIII of the State University of Paraíba.
Study Design: A quantitative, descriptive, cross-sectional study with an inductive approach was carried out involving students in the courses of dentistry, civil engineering and natural science on Campus VIII of the State University of Paraíba (northeastern Brazil) in 2013.
Methodology: A total of 321 students were enrolled, and the sample was made up of 238 participants who answered a semi-structured questionnaire addressing socioeconomic characteristics and academic performance.
Results: Most students were female and beneficiaries of the quota system, had a family income of more than two times the Brazilian minimum monthly wage and had a academic performance coefficient (APC) greater than 7.0. The best academic performance was found among the students of the dentistry course, in which non-beneficiaries achieved a statistically higher mean APC in comparison to beneficiaries of the quota system (P=.004). Although higher mean coefficients were also found among the non-beneficiaries in the other courses analyzed, the differences did not achieve statistical significance. The students of the civil engineering course had the worst academic performance among the three courses analyzed. A greater frequency of failures was found among the beneficiaries of the quota system in comparison to non-beneficiaries for the campus as a whole (P=.010) as well as for the dentistry course (P=.004).
Conclusion: The present findings suggest flaws in the quota system as a strategy for promoting social inclusion and underscore the importance of strengthening elementary and high school education in Brazil.

Open Access Original Research Article

Preliminary Study: Neurobehavioural Effects of Nauclea latifolia and Emilia sonchifolia in Mice Infected with Plasmodium berghei berghei

Innocent A. Edagha, Koofreh G. Davies, Sunday O. Ita, Aquaisua N. Aquaisua, Blessing E. Anwana

Journal of Advances in Medicine and Medical Research, Page 914-923
DOI: 10.9734/BJMMR/2015/3608

This study was designed to examine the effects of ethanolic leaf extracts of Nauclea latifolia and Emilia sonchifolia on anxiety, fear and locomotion in mice infected with plasmodium berghei berghei. Thirty male Swiss albino mice weighing between 26-30g divided into five groups with six mice in each group. Group 1 served as the Control group and was treated with 0.2ml of normal saline, Group 2 served as the parasitized non-treated, Group 3, was parasitized and treated with Coartem®, Group 4 was parasitized then treated with Emilia sonchifolia, Group 5 was parasitized and treated with Nauclea latifolia and Group 6 was parasitized and treated with a combination of Nauclea latifolia and Emilia sonchifolia respectively. The mice were passaged with the parasite intraperitoneally and then administered extract orally using an orogavage cannula for a duration of 5 days. Behavioural tests were performed pretreatment (day 6 after parasite passage) and post-treatment (day 11). The results obtained showed that grooming frequency and stretch attend frequency were significantly (p<0.001) lower in groups 3-5 compared with the Control group. The combined extract treatment in group 5 was significantly (p<0.001) reduced compared with the parasitized non treated group. Line crossing duration was significantly (p<0.001) lower in groups 2 and 4 but significantly higher in groups 3 and 5 compared with the control group. This preliminary study consolidates the view of herbal practitioners that the extract is effective in reducing anxiety and fear and enhances increases locomotion in plasmodium berghei infected mice.

Open Access Original Research Article

Clinical Strategies for Managing Dental Caries in Egypt: Opinions of General Practitioner Dentists

Abeer Farag, Wil J. M. van der Sanden, Jan Mulder, Nico H. J. Creugers, Jo E. Frencken

Journal of Advances in Medicine and Medical Research, Page 924-932
DOI: 10.9734/BJMMR/2015/12439

Background: To assess the approach of GPDs in Upper Egypt regarding preventive and restorative treatments for various stages of carious lesion development.
Methods: A 42-item questionnaire was constructed for obtaining the GPD’s opinions. Factor analyses (with Varimax rotation) were conducted to identify scales (clusters) of variables. Logistic regression analyses, with continuing professional development as dependent variable, were conducted to test for the effect of single and scaled factors regarding indications to perform preventive or restorative treatments.
Results: All 70 participants returned the questionnaire. Three scale factors, i.e., treatment strategies, were identified as: ‘operative-minded dentists’ (who make >10 amalgam and resin composite restorations per week); ‘problem solvers’ (who have >10 years of experience, see >60 patients and make >10 temporary restorations per week); and ‘thinkers’ (who spend >50 hours / year on continuing professional development but also make >10 restorations per week). Logistic regression analyses found only one statistically significant relationship (p=0.03): ‘operative-minded dentists’ indicated provision of significantly less caries-preventive measures. Most patient visits were pain-induced.
Conclusion: It was concluded that most GPDs in Upper Egypt have an operative-minded treatment philosophy, and spend less time on preventive measures. Amalgam is the most common restorative material used.

Open Access Original Research Article

Craniofacial Dimorphism in Young Jordanian Adults

Wala Amin, Dina Othman

Journal of Advances in Medicine and Medical Research, Page 933-943
DOI: 10.9734/BJMMR/2015/13123

Aims: Was to develop a gender determination technique for young Jordanian adult population.
Study Design: using osteometric data, from Cephalometric images, and discriminate function analysis.
Place and Duration of Study: Section of Clinical Dentistry of the Jordan University Hospital, between October 2013 and July 2014.
Methodology: A total of 146 randomly selected digital lateral cephalometric radiographs of young Jordanian adult patients were employed in the investigation, 47 patients were males and 99 were females. For each lateral cephalometric radiograph, one observer using a customized analysis created in Viewbox 4-Cephalometric Software subroutines digitized 19 craniofacial skeletal landmarks. Utilizing the digitized landmarks, 18 measurements that comprised 14 linear, 3 angular and 1 proportional parameters were carried out.
Results: The results demonstrated that, with the exception of the Menton to Gonion distance, i. e., the length of the mandibular body, the mean values of all other parameters of male subjects were statistically significantly larger (p<0.05) than those for females. Mastoid height was found to be the best single predictor of gender and can provide an accuracy rate of 82.2%. Using Stepwise method revealed four dimensions (mastoid height, mastoid width, glabella to supraglabellare-nasion distance, and the length of skull base)were found to form the best combination of parameters most precisely depict the best possible prediction, raising the classification accuracy up to 87.7%.
Conclusion: A discriminant function equation specific for Jordanian population has also been derived from cranio-mandibular variables. The equation can now be used for a calculable and more precise prediction of gender of Jordanian young adult population.q

Open Access Review Article

Bivalirudin Use in the Elderly for Acute Coronary Syndrome

Obiora Anusionwu, Raef Madanieh, Gary Ledley

Journal of Advances in Medicine and Medical Research, Page 848-852
DOI: 10.9734/BJMMR/2015/13032

Introduction: Bivalirudin has been approved for use in acute coronary syndromes as part of the anticoagulation regimen. Elderly patients are at a higher risk for bleeding because of their co morbidities, decreased body mass and their age. Hence, this article reviews the landmark published papers on bivalirudin therapy in this patient population with the goal of understanding the particular benefits and risks.

Discussion: Several review articles suggest that the use of bivalirudin alone is associated with lower rates of major bleeding when compared with unfractionated heparin plus glycoprotein IIb/IIIa inhibitor in patients with acute coronary syndrome with invasive strategy planned. These beneficial effects span through the age ranges. Therefore, it is a good option for elderly patients. Decreased bleeding complications lead to better clinical outcomes in the elderly after percutaneous coronary intervention. It also leads to decreased length of stay in the hospital.