Open Access Case Study

Bronchial Sleeve Resection for Lung Cancer Preoperative Empyema

Nilgün Kanlıoğlu Kuman, Salih Çokpınar, Ertan Yaman

Journal of Advances in Medicine and Medical Research, Page 82-85
DOI: 10.9734/BJMMR/2015/16007

Surgical management of the cancer with empyema has rarely been reported in the literature because few of such cases are operable. Many patients might be misevaluated because of the incorrect staging associated with an acute or sub-acute infection. Even in the presence of an operable tumor mass; surgeons behave timid to these patients because of the possibility of infective postoperative complications. The balance between expected benefits and possible risk of surgical intervention is also important. If it is indicated, by the time pleural empyema is restored, procedures such as resection and even bronchoplasty should be performed.
59-years old patient with squamous cell carcinoma that completely obstructed left basal segments and caused to empyema. A thoracic catheter was inserted. Multiple pleural irrigations were done and proper antibiotherapy. Pathologic diagnosis of pleural fluid and pleural biopsy were benign. Pleural cultures were negative and amount of empyema fluid volume has decreased within two months. Positron emission tomography (PET) revealed a 2.5 cm sized left infrahilar tumor, right paratracheal, prevascular and subcarinal lymph nodes and non-homogeneous increased pleural activity. Mediastinal lymph nodes were evaluated as reactive with mediastinoscopy. Left lower lobectomy and lingulectomy were performed with bronchial resection and pathologic stage was 2A (T1bN1MO).

Open Access Original Research Article

Geographic Variation in Fertility Measures in Sweden in (1749-1870)

Johan Fellman, Aldur W. Eriksson

Journal of Advances in Medicine and Medical Research, Page 1-10
DOI: 10.9734/BJMMR/2015/15182

We analysed geographic variation in the number of males per 100 females at birth also called the secondary sex ratio (SR), the crude birth rate (CBR), the total fertility rate (TFR) and the twinning rate (TWR). Earlier studies have noted geographic variations in the TWR and racial differences in the SR. Statistical analyses have shown that comparisons between SRs demand large data sets because random fluctuations in moderate data are marked. Consequently, reliable results presuppose national birth data. In this study, we analysed historical demographic data and investigated the geographic variations between the counties in Sweden for the SR among the live born (1749-1869), the CBR in 1751-1870, the TFR in 1860 and the TWR in 1751-1860. We built spatial models and as regressors we used geographic co-ordinates for the residences of the counties in Sweden. The influence of the CBR and TFR on the SR and TWR was examined. For all variables, we obtained spatial variations, albeit of different patterns and power. Hence, no common spatial pattern for the demographic variables SR, TFR, CBR and TWR was detected, but a better fit was noted for TFR, CBR and TWR than for SR.

Open Access Original Research Article

Association between Helicobacter pylori Infection, ABO Blood Groups and Rhesus Factor in Peptic Ulcer Disease Patients, in Gezira, Central Sudan

Moawia Elbalal Mohammed, Omer Hasheim Suliman, Osman Khalfalla

Journal of Advances in Medicine and Medical Research, Page 11-16
DOI: 10.9734/BJMMR/2015/14044

Blood group antigens were associated with peptic ulcer disease, which is potentially caused by Helicobacter pylori. It was recently demonstrated that the receptor for H. pylori is the blood group antigen lewisb, which is exposed only in blood group O.
Objectives: To report the possible correlation among H. Pylori Infection, ABO and Rhesus (Rh) blood groups in patients with peptic ulcer disease.
Methods: This cross-sectional, prospective study was carried out between Jan 2010 and Dec 2010 among patients suffering from dyspeptic symptoms attending to Wad Medani Teaching Hospital-Endoscopy Unit. All patients had their blood group phenotype and Rhesus determined by the slide hemagglutination test. All patients underwent oesophagogastrodudenoscopy to diagnose peptic ulcer disease. Gastric biopsies were obtained and examined for H. pylori by urease test.
Results: 40 patients were enrolled in this study, 29 were males and 11 were females with a mean age of 50.75 ± 18.18 years. 28 patients were both H. pylori biopsy-urease and Rhesus factor positive (93.3%), while 2 patients were H. pylori positive and Rhesus negative (6.7%). Among patients who were H. Pylori urease positive; 3 were blood group A (10%), 9 were B (30%) and 18 were O (60%).Most patients 31(77.5%) had duodenal ulcers, while 9(22.5%) had gastric ulcers at oesophagogastrodudenoscopy. Out of those who had D.U at oesophagogastrodudenoscopy; 3 were Blood group A (9.7%), 10 were B (32.3%) and 18 were O (58.1%).while among those with G.U; 3 were Blood group B (33.3%) and 6 were O (66.7%). Rhesus factor was positive in 28 patients (93.3%) and negative in 2 patients (6.7%) among those who were urease positive. Patients with DU; 29(93.5%) were Rhesus positive and 2(6.5%) were negative. All patients with GU (9 patients) were Rhesus positive (100%). This implies that there was statistically significant correlation between the O blood group, positive Rhesus factor and H. Pylori infection in peptic ulcer disease patients. γ=0.023 and 0.024 respectively.
Conclusion: This study suggests that can be a significant association between Rhesus positive group O and H. pylori infection.

Open Access Original Research Article

Prevalence of Escherichia coli Pathotypes among Children with Diarrhoea in Zaria, Nigeria

A. Sani, J. A. Onaolapo, Y. K. E. Ibrahim, H. W. Idris, J. C. Igwe, A. Nworie

Journal of Advances in Medicine and Medical Research, Page 17-24
DOI: 10.9734/BJMMR/2015/15623

Diarrhoea is one of the foremost public health problems worldwide especially among Children under five years in developing countries. Only few studies have investigated the epidemiology and virulence of Escherichia coli pathotypes in South-Eastern and South-Western Nigeria leaving the Northern part of the country unstudied. In this study, a total of 100 isolates of E. coli (45%) were obtained from the stool of 222 diarrhoea patients who were children below five (5) years attending Ahmadu Bello University Teaching Hospital, Shika, and Institute of Child Health, Banzazzau; an annex of Ahmadu Bello University Teaching Hospital, Shika-Zaria, Nigeria. The isolation and biochemical identification of the E. coli isolates were performed using standard microbiological procedures. A multiplex polymerase chain reaction (PCR) technique was used to differentiate the five (5) major diarrhoeagenic Escherichia coli pathotypes (EHEC, ETEC, EPEC, EIEC and EAEC) in one reaction condition, by using different diarrhoeagenic E. coli primers for different virulent genes found in E. coli. From the result obtained, only one (1) percent of the isolates was found to harbor the virulence gene out of the 100 E. coli isolated from the diarrhoea stools of children employed in this study.

Open Access Original Research Article

Functional Characteristics of Lactobacillus Strains Isolated from Camel's Milk

Muna M. Abbas, Adel M. Mahasneh

Journal of Advances in Medicine and Medical Research, Page 25-39
DOI: 10.9734/BJMMR/2015/15287

This study aimed at isolation, identification and evaluation of probiotic potential of Lactobacillus isolates from camel's milk. Thirty four Lactobacillus isolates coded M 1 to M 34 were Gram positive, rods, catalase and oxidase negative and nonspore-forming bacteria. These isolates were identified by biochemical tests and API 50 CH kits. From these, 14 different Lactobacillus isolates (M 1, M 2, M 4, M 5, M 9, M 10, M 12, M 14, M 15, M 18, M 20, M 27, M 29 and M 31) which were tolerant to gastric and intestinal juices in a previous study were now tested for antipathogenic activity which varied according to the Lactobacillus species and the challenged pathogen. All 14 isolates demonstrated significant inhibitory effect against methicillin resistant Staphylococcus aureus (MRSA), Bacillus cereus and moderate to low activity against Salmonella typhimurium and Escherichia coli. When tested for bile tolerance at the concentration of 0.3 to 2.0%, the growth rate of 8 isolates M 2, M 5, M 9, M 10, M 12, M 14, M 18 and M 20 exceeded 60 % in 0.3 and 0.5 % bile. M 2 (L. fermentum) and M 12 (L. plantarum) and M 20 (L. paracasei ssp. paracasei) exhibited the highest growth rates of 82, 79.4 and 78.8 % respectively. At higher levels of 1 and 2% bile, significant reduction (p < 0.05) was observed for all tested isolates except M 9 (L. plantarum) with growth rate of 66.5% at 2% bile. As for cholesterol reduction, M 10 (L. plantarum) and M 15 (L. paracasei ssp. paracasei) had the highest reduction rate of 58.0 and 53.2% respectively, which is comparable to the reference strain L. reuteri DSMZ 20056. Testing adhesion to intestinal epithelial cells and ileal tissues of BALB/c mouse; M 20 (L. paracasei ssp. paracasei) and M 2 (L. fermentum) exhibited highest attachment rate of more than 15 bacterial cells/epithelial cell. SEM images showed variable degrees of bacterial attachment to ileal tissues. These results suggest that camel milk is a rich source for potential probiotic lactobacilli which may be suitable for food and nutraceuticals industries; however, further in vivo investigations are needed.

Open Access Original Research Article

Sickle Cell Disease in Pregnancy: Maternal and Fetal Outcome in Port Harcourt, Nigeria

H. A. A Ugboma, I. O. George

Journal of Advances in Medicine and Medical Research, Page 40-44
DOI: 10.9734/BJMMR/2015/11602

Background: Medical experts for many years have daunted the occurrence of pregnancy in homozygote sickle cell patients. This is because of associated high risk for mother and fetus.
The aim of this study is to determine the prevalence and maternal and fetal outcome of pregnant mothers with sickle cell disease at the University of Port Harcourt Teaching Hospital, Nigeria.
Materials and Methods: This was a retrospective descriptive study of medical case files of all booked pregnant mothers who attended the antenatal clinic of the University of Port Harcourt Teaching Hospital, Nigeria from January 2007 to December 2011. The parameters extracted from the folders included: age, level of education, hemoglobin genotype, full blood count, malaria parasite, urine analysis and culture, complications of pregnancy, Apgar scores and birth weight.
Results: A total of 4,650 mothers were booked for antenatal care. Eight hundred and forty (18.1%) of them were HbAS, five (0.1%) were HbAC, nine (0.2%) were HbSS and 1(0.02%) HbSC. Age and gestation at booking were 18–42 years (mean 28.6± 2.1) and 9–34 weeks gestation (mean 16.6±3.3), respectively. Malaria and vaso-occlusive crisis were the commonest complications encountered in pregnancy. Twenty percent of women had induction of labour and 60% were delivered by emergency caesarean section. Twenty percent had postpartum haemorrhage. Forty four percent of women delivered before 37 completed weeks. Birth weight below 2500 g occurred in 50% of singleton pregnancies. Two neonates developed transient complications related to maternal opiate exposure postnatally. There were 2(20%) maternal and fetal losses from toxaemia of pregnancy.
Conclusion: Pregnancy is uncommon among females with sickle cell disease in Port Harcourt, Nigeria. Sickle cell disease remains a severe complicating factor to pregnancy and associated with increased fetal and maternal losses.

Open Access Original Research Article

Neglecting the Parent in Neonatal Intensive Care Unit: The Communicational Factors that Increases the Iranian Parents’ Stress

Haydeh Heidari, Marzieh Hasanpour, Marjaneh M. Fooladi

Journal of Advances in Medicine and Medical Research, Page 45-51
DOI: 10.9734/BJMMR/2015/15804

Many parents confront the NICU environment as medical staffs are busy with the physical aspects of care by ignoring other important needs and omitting physicians’ view.
Aim: Identify essential factors in communication process that tend to increase stress among the NICU parents.
The Study Design: Eighteen NICU parents from different hospitals in the city of Isfahan were selected for in-depth interviews. Qualitative content analysis included open coding, categorization and abstraction of data.
Results: Data analysis identified stress provoking factors for NICU parents in four categories as confusion in nurse-parent, nurse-physician communication, negligence in physician-parent communication, inappropriate nurse-physician communication, and the medical diagnosis communication process.
Conclusion: Our findings indicated that NICU parent presence was very low. It is necessary for the hospital management and NICU staff to develop communication skills training sessions for less stressful parent experiences in NICU. Moreover, the Ministry of Health should authorize policy development and guidelines to improve relationship between medical staff, physicians, nurses and NICU families aimed at better neonatal outcomes.

Open Access Original Research Article

Hematological and Immunological Effect of Cannabis sativa on Albino Wistar Rats

A. O. Obembe, G. C. Omini, U. A. Okon, A. I. Okpo-ene, D. E. Ikpi

Journal of Advances in Medicine and Medical Research, Page 52-60
DOI: 10.9734/BJMMR/2015/15201

The present study is aimed at ascertaining the effect of oral feeding of Cannabis sativa on blood parameters and immunity in rats. Administration of Cannabis sativa was done by orogastric feeding. All the groups had free access to water and food. The experiment lasted for 28 days. At the end of the 28 days of feeding, we observed that the mean red blood cell count was 5.68±0.09 x 106/mm3, 5.90±0.04 x 106 mm3 and 6.38 ±0.22 x 106 mm3 for control, low dose (LD) and high dose (HD) respectively. The red blood cells count in high dose was significantly higher (P<0.05) than low dose and control (P<0.01) respectively. However there was no significant difference between control and low dose. The total white blood cell count for control, LD and HD groups was 2.26±0.13 x 103/mm3, 1.69±0.04 x 103 mm3 and 1.58±0.09 x 103mm3 respectively. There was however no significant difference between the LD and HD even though both test groups were each significantly (P<0.001) lower than control. There was no significant difference in the pack cell volume (PCV) among the groups. The haemoglobin concentration (Hb) did not show any significant difference between LD and HD, but between the control and HD there was significantly higher (P<0.05) Hb concentration in HD. The mean platelet count for control, LD and HD were 252±14.94 x 103/mm3, 364±7.47 x 103/mm3 and 424±7.47 x 103/mm3 respectively. Both experimental group were each significantly higher (P<0.001) than control group. Platelet in the high dose was significantly higher (P<0.01) than in the low dose. In the differential count, the lymphocytes, monocytes and neutrophils were significantly (P<0.001) reduced in high and low dose groups when compared with control. Eosinophils and basophils increased significantly (P<0.001) in both high and low dose groups when compared with control. Mean corpuscular haemoglobin concentration (MCHC) showed a significant increase (P<0.05) in the high dose when compared with control but mean corpuscular Hb was unaffected.

Open Access Original Research Article

Prognostic Implications of Expression of the Wilms Tumor 1 (WT1) Gene in Acute Leukemia (Experience from South Egypt)

Abeer Ibrahim, Hosny Badrawy, Heba Sayed

Journal of Advances in Medicine and Medical Research, Page 61-71
DOI: 10.9734/BJMMR/2015/15834

Background: Wilms’ tumor (WT1) gene expression has been reported in the majority of acute leukemia patients at diagnosis and has been evaluated as a prognostic and minimal residual disease (MRD) marker but its role is still controversial.
Methods: Real-time quantitative polymerase chain reaction was used on bone marrow samples from 100 newly diagnosed adults and pediatrics acute leukemia patients (50 AML and 50 ALL patients). WT1 expression were examined at diagnosis and at the end of induction.
Results: WT1 was expressed in (14%) ALL and in (36%) AML patients. We found no statistically significant impact of WT1 expression at diagnosis on response p= 0.054, 0.057, DFS (P = 0.591, 0.858), or OS (p= 0.339, p= 0.331) in ALL and AML patients respectively. Persistence of WT1 expressions at the end of induction didn't show any effect on relapse rate in AML however, it showed significant results in ALL p=0.045.
Conclusion: Our results suggest that WT1 expression in patients with acute leukemia doesn't have any implication on response or survival however, significant association was found in predicting ALL relapse but the small sample size should be considered.

Open Access Original Research Article

Calcium and Total Bilirubin Levels in Patients Co-Infected with HIV and Hepatitis C Viruses in Lautech Teaching Hospital, Osogbo, South West Nigeria

V. O. Mabayoje, M. A. Muhibi, C. A. Akinleye, R. A. Akindele

Journal of Advances in Medicine and Medical Research, Page 72-81
DOI: 10.9734/BJMMR/2015/15205

Aim: One third of HIV patients are co- infected with HCV. As HIV patients live longer this co-infection and its complications such as liver cirrhosis, hepatic carcinoma, metabolic syndrome are emerging as major manifestations of the disease that need to be dealt with promptly in order to avoid a reduction of the positive effects of highly active antiretroviral therapy (HAART) on HIV/AIDS introduced in 1996. Another system that could be affected by co-infection is the skeletal system. It has been shown that HIV itself and in combination with HCV could lead to a reduction in bone mineral density (BMD) predisposing to pathological fractures. It is thus important to determine the state of calcium metabolism among our HIV/HCV patients in order to forestall negative impacts on our patients who have been stable on HAART for several years. The majority of our patients are on combination therapy of Zidovudine, Lamivudine and Nevirapine. The hepatic complications of HIV/HCV co-infection have been well established. In our previous studies signs of hepatic inflammation have been demonstrated by raised aspartate transaminase (AST) and alanine transaminase (ALT) levels. However in this study we wish to also demonstrate liver damage through estimation of bilirubin levels.
Methodology: Antibodies to HIV were determines using Unigold and determine. immunochromatographic device was used to detect anti-HCV. Total bilirubin and calcium were analyzed using vitros DT-60 card reader.
Results: The majority of our patients were female. In group I up to %80. There was a statistically significant elevation of total bilirubin levels in HIV/HCV co-infected patients when compared to HIV mono-infected patients. There were statistically significant changes in calcium levels between the groups
Conclusion: Information on HIV/HCV co-infection and its effects on calcium metabolism in this clinical instance appears to be scarce. Intensification of research is required to firmly establish the role of HIV/HCV co-infection on calcium metabolism in our clinical instance.