Open Access Case Study

Unusual Presentation of a Caseating Lymphadenitis Causing Abnormal Lymphadeno-Duodenal Communication

Yamuna Jayasree, Subramanian Ilanchezhian, Ralph Jeffery, Rajoo Ramachandran, Periasamy Varadaraju Prithiviraj

Journal of Advances in Medicine and Medical Research, Page 1-5
DOI: 10.9734/BJMMR/2015/18593

Aim: To describe the imaging features of a case of abnormal lymphadeno-duodenal communication caused by caseating lymphadenitis.

Presentation of Case: The case discussed is of a thirty-five year old Indian woman who presented with abdominal pain, vomiting, fever, loss of appetite and later diagnosed with abnormal lymphadeno-duodenal communication caused by caseating lymphadenitis.

Discussion: Caseating lymphadenitis is a chronic disease process that occurs anywhere in the human body and its prevalence varies from region and country. Here, we report a case of lymph node with caseous necrosis causing abnormal lymphadeno-duodenal communication which was diagnosed by Computed tomography. This poses a great diagnostic challenge for a variety of reasons which include its non-specific symptoms, wide range of causes and the complications in the case of a delayed diagnosis. Abdominal involvement can occur in the peritoneum and the mesentery. Imaging plays a very important role to assess the cause of caseating lymph nodes and identify the complications.

Conclusion: As abnormal lymphadeno-duodenal communication is an unusual condition and rarely reported, it is important to consider the possibility of tuberculosis as one of the underlying etiology. A high index of suspicion needs to be maintained for timely diagnosis and accurate treatment.

Open Access Original Research Article

Benefit and Safety of Dual Antiplatelet Therapy after Coronary Artery Bypass Grafting for Off-pump CABG: A Systematic Review and Meta-analysis

Yin Wang, Si Chen, Jia-Wei Shi, Nian-Guo Dong

Journal of Advances in Medicine and Medical Research, Page 1-15
DOI: 10.9734/BJMMR/2015/19433

Aims: This study aims to evaluate benefit and safety compared dual antiplatelet therapy with single aspirin therapy after coronary artery bypass grafting.

Study Design: A systematic review and Meta-analysis.

Place and Duration of Study: Medline, Embase, ScienceDirect and Cochrane Library databases were searched for randomized controlled trials or observational studies focusing on anticoagulant therapy after coronary artery bypass grafting until December 2014.

Methodology: Endpoints included postoperative mortality, bleeding events, myocardial infraction, stroke, repeat revascularization and graft occlusion. All these endpoints were compared between dual antiplatelet therapy and single aspirin therapy. Newcastle-Ottawa and Jadal scale were used to assess the quality of observational studies and randomized controlled trials respectively. Software R2.15.2 was utilized for Meta-analysis.

Results: 15 studies composed of 31,365 patients were included. Compared with single aspirin therapy, dual antiplatelet therapy resulted in reducing risk of vein graft occlusion (OR=0.53, 95%CI 0.36-0.81, P=0.001), but no significant difference for artery graft occlusion (OR=0.91, 95%CI 0.39-2.12, P=0.882), Risk of postoperative mortality (OR=0.57, 95%CI 0.38-0.85, P=0.006) and repeat revascularization (OR=0.15, 95%CI 0.05-0.45, P=0.001) was also reduced. There were no significant difference for MI (OR=0.77, 95%CI 0.55-1.09, P=0.137), Stroke (OR=0.85, 95%CI 0.60-1.19, P=0.330) and bleeding (OR=0.95, 95%CI 0.82-1.09, P=0.465). In subgroup analysis of off-pump CABG, dual antiplatelet therapy reduced risk of graft occlusion (OR=0.49, 95%CI 0.30-0.82, P=0.006), MI (OR=0.28, 95%CI 0.11-0.72, P=0.009), mortality (OR=0.39, 95%CI 0.25-0.60, P<0.001), and did not increase risk of bleeding (OR=0.75, 95%CI 0.55-1.02, P=0.066).

Conclusions: Dual antiplatelet therapy reduced risk of postoperative graft occlusion and mortality in the early and late postoperative phase after CABG. It appeared to be more beneficial for off-pump CABG.

Open Access Original Research Article

The Significance of Abnormal Urine Stream in the Male Infant: A Survey of Mothers’ Knowledge in a South-East Nigerian City and Implications for Preventive Nephrology

Samuel N. Uwaezuoke, Odutola I. Odetunde, Henrietta U. Okafor

Journal of Advances in Medicine and Medical Research, Page 1-9
DOI: 10.9734/BJMMR/2015/19165

Introduction/Aim:  Chronic kidney disease (CKD) in children is now a global health problem, and obstructive uropathy plays a major causative role. Reports however indicate limited CKD knowledge and awareness among caregivers which may be a draw-back in ‘preventive nephrology’.

The study aims to determine the knowledge of mothers regarding the significance of abnormal urine stream in the male newborn infant.

Study Design: Paediatric Nephrology Clinic, University of Nigeria Teaching Hospital (UNTH), Ituku-Ozalla, Enugu, South-East Nigeria. Period of six months (June to December, 2013).

Place and Duration: Paediatric Nephrology Clinic, University of Nigeria Teaching Hospital (UNTH), Ituku-Ozalla, Enugu, south-east Nigeria. Period of six months (June to December, 2013).

Methodology: A cross-sectional, descriptive study of 204 mothers who met the study criteria was conducted using interviewer-administered, structured questionnaires. Their knowledge on whether abnormal stream suggests disease was measured on a rating scale of 1=never, 2=sometimes to 3=always. Data were analyzed with appropriate descriptive statistics on SPSS (version 13.0). P value <0.05 was chosen as level of statistical significance.

Results: Eighty eight (43.1%) of the mothers had a knowledge scale of 3, while 70 (34.3%) had a scale of 2. There was no statistically significant difference between the social classes of the two groups of mothers (P=.25).

Conclusion: The over-all knowledge of mothers is adjudged as modest and is not influenced by socio-economic status. Preventive intervention strategies should include health education to promote early self-referral and diagnosis.

Open Access Original Research Article

The Potential Therapeutic Benefit of Diclofenac Sodium in Treatment of Patients with Type-2 Diabetes Mellitus

Noor A. Abdullah, Abdullah M. Jawad, Abbas A. Mansour

Journal of Advances in Medicine and Medical Research, Page 1-9
DOI: 10.9734/BJMMR/2015/19458

Background: Type-2 diabetes mellitus, is associated with low-grade chronic inflammation, which could contribute to its pathogenesis. The objective of this study is to evaluate the role of the non-steroidal antinflammatory drug (diclofenac sodium) in type 2 diabetic patients who are not achieving target HbA1c.

Patients and Methods: Fifty four, type-2 diabetic patients consulting Al-Faiha Diabetes, Endocrine and Metabolism Center (FDEMC) in Basrah were included in this study after meeting a set of inclusion criteria. Their HbA1c was more than 7% (53 mmol/mol) despite the optimal use of oral antihyperglycemic drugs. They were overweight with a BMI of 25 or more. They served as the study group and treated with diclofenac sodium. Diclofenac sodium was administered to each patient as 100 mg sustained-release capsule, given once daily for one month (with omeprazole 20 mg daily). Another fifty patients of similar inclusion criteria were also followed for 3 months, but without treatment with diclofenac sodium and served as a control group.

Results: Treatment with diclofenac sodium 100 mg sustained-release capsules (in presence of omeprazole 20 mg daily), resulted in a significant improvement in the glycemic control and inflammation parameters in the form of a reduction in the HbA1c, fasting plasma glucose and postprandial plasma glucose. The mean ± SEM of HbA1c before the start of treatment with diclofenac sodium is 9.26±0.269 percentage which was reduced significantly to 8.25 ± 0.255 percentages after one month of diclofenac treatment (a reduction by 10.9%, p˂0. 001). HbA1c levels continued to decrease even after stopping diclofenac treatment reaching a level of 7.41% (a reduction of 19.9% compared to pre-treatment level, p ˂0. 001). Fasting plasma glucose decreased significantly from a mean ± SEM of 153.87±4.65 mg/dl to 129.98±3.41 mg/dl (a decrease of 16%, p˂0. 001). High-sensitivity C-reactive protein also decreased by 19% one month after diclofenac treatment. Two months after stopping treatment, high-sensitivity C-reactive protein continued to decrease reaching a value of 0.379±0.291 mg/L (a reduction by 45%, p˂0. 001). There was no significant change in insulin level after diclofenac treatment. Insulin resistance, measured by the Homeostasis Model of Assessment - Insulin Resistance (HOMA-IR) equation, decreased two months after diclofenac treatment from 83.3% to 68.5%.

Conclusion: If the results of this study are confirmed by other studies in the future,type-2 diabetic patients who are not achieving target HbA1c after treatment with two oral antihyperglycemic drugs, showed a significantly reduced HbA1c levels compared with pre-treatment levels when treated with diclofenac sodium 100mg SR capsule  for one month, with no side effects. This reduction, increased further even after cessation of diclofenac treatment with reduction in the markers of insulin resistance and inflammation.

Open Access Original Research Article

In vitro Antimicrobial Activity of Various Mouth Rinses against Streptococcus mutans, Lactobacillus casei, L. acidophilus and Candida albicans

Gülbike Demirel, Müjde Eryılmaz, Nurten Altanlar, Gürkan Gür

Journal of Advances in Medicine and Medical Research, Page 1-5
DOI: 10.9734/BJMMR/2015/19112

Aim: The aim of this in vitro study was to determine the antimicrobial activities of commonly used mouth rinses against different oral microorganisms.

Methodology: Six commercially available mouth rinses (Colgate Total, Colgate Plax, Colgate Pro-argin, Oral-B Pro-expert, Listerine and Oderol) were used in this study. The antimicrobial activities of mouth rinses against Streptococcus mutans ATCC 25175, Lactobacillus casei RSKK 900, L. acidophilus ATCC 11975 and Candida albicans ATCC 10231 were evaluated by disc diffusion and minimum inhibitory concentration tests. Klorhex® was used as positive control. Experiments were repeated twice.

Results: Colgate Total, Colgate Plax, Oral B Pro-expert and Oderol showed good antimicrobial activity against test microorganisms in comparison with Colgate Pro-argin and Listerine.

Conclusion: Chlorhexidine and cetylpyridinium chloride containing mouth rinses were found more active than other products tested. Main motive of mouth rinses is removing the microorganisms from the mouth although their effectiveness depends on the formulation, concentration, quantity of ingredients and duration of rinsing.

Open Access Original Research Article

Effectiveness of Tuberculosis Smear Microscopy in Laboratory Diagnosis of Mycobacterium tuberculosis in Resource Constrained Settings

Ameh James, Kingsley Ochei, Nnamdi Emenyonu, Lovett Lawson

Journal of Advances in Medicine and Medical Research, Page 1-8
DOI: 10.9734/BJMMR/2015/6714

Aim: To determine the correlation of accuracy of direct smear microscopy compared with BACTEC MGIT 960.

Design: The study prospectively compare direct smear microscopy with BACTEC MGIT 960 using the reference standard, Lowenstein Jensen culture.

Place and Duration: The study was conducted in Zankli Medical Centre, Abuja, between November 2004 and July 2005.

Methodology: 340 suspected patients for Mycobacterium tuberculosis referred from direct observation therapy clinics located in six different government owned health facilities were referred to our facility. These patients; male (192) and female (148) were between the age of 10 and 64 years old. Three sputa samples were collected over two consecutive days and direct smear microscopy and culture were performed on these samples.

Results: When compared with the reference standard, BACTEC MGIT 960 has a sensitivity and specificity of 100.0% and 56.4% respectively, and a negative predictive value of 100.0%; indicating the proportion of AFB negative participants were actually not infected with M. tuberculosis when tested with BACTEC MGIT 960. The sensitivity of direct microscopy was significantly lower than BACTEC MGIT 960 (84.9% versus 100%, p<0.001) and the specificity was significantly higher (96.6% versus 56.4%, p<0.001).

Conclusions: For the purpose of effectiveness of tuberculosis program in developing countries, direct smear microscopy may still be relevant in the diagnosis of Mycobacterium tuberculosis.

Open Access Original Research Article

Palliative Oncology Treatments and Hopelessness: An Analysis of Associated Clinical and Psychosocial Factors

Daniela Batista Sorato, Flávia L. Osório

Journal of Advances in Medicine and Medical Research, Page 1-11
DOI: 10.9734/BJMMR/2015/18890

One of the psychological symptoms of major concern in palliative care is hopelessness because it is a risk factor for poor treatment adherence, suicidal ideation, suicide, and the desire for a premature death.

Objectives: To identify the psychosocial and clinical factors associated with hopelessness after beginning palliative oncology treatment.

Methods: 66 patients with advanced cancer were evaluated using the following instruments: a) Beck Hopelessness Scale, b) Quality of Life Questionnaire - EORTC-QLQ-C30, c) Hospital Anxiety and Depression Scale, d) Coping Strategies Inventory, at two times: at the first consultation in the palliative care outpatient clinic and at the first medical return visit.

Results: The relative absence of information about palliative care treatment was associated with hopelessness after the beginning the palliative treatment (p=0.043). With regard to coping strategies, the use of social support mechanisms (p=0.033), problem resolution (p=0.033), and positive reevaluation (p=0.037) were associated with decreases in hopelessness, which indicates that these strategies have a protective character. Social support (p=0.007) and constipation (p=0.038) significantly predicted hopelessness at the first medical return visit according to the multiple linear regression analysis. The experiences of hope among the patients at the beginning of the palliative treatment did not decrease. Few correlations were found between the different clinical and psychological variables studied, and few parameters predicted hopelessness.

Conclusion: The offer of information and the promotion of therapeutic interventions favoring use of coping strategies less focused on emotion thereby allowing more active coping with the situation were found to be.

Open Access Original Research Article

Isolation, Cloning and Co-expression of Hepatitis C Virus Envelope Proteins: As Potential HCV Detecting Antigens

Mahshid Mohammadipour, Ghasem Ahangari, Majid Sadeghizadeh

Journal of Advances in Medicine and Medical Research, Page 1-8
DOI: 10.9734/BJMMR/2015/16720

Aim: Approximately 3% of the world population is infected with Hepatitis C virus (HCV) which is the main cause of chronic liver disease. Blood transfusion is thought to be the leading cause of global epidemic of HCV. The envelope proteins E1 and E2 are involved in the early stages of the virus life cycle. These proteins have a major role in binding to receptors on the cell surface, fusion and integration of the virus into the host cell. Considering the potency of E1 and E2 in the development of diagnostic methods, the aim of our present study was co-expression of recombinant envelope proteins in eukaryotic HEK293 (human embryonic kidney) cells.

Methods: The viral genomic RNA was used for cDNA (complementary DNA) synthesis. Isolation of HCV envelope proteins coding fragment was performed using cDNA and specific primers. The target gene was cloned into pcDNA3.1 expression vector, and transfected into HEK293 cells, an expression host. Accuracy of the cloning and expression was confirmed using PCR and Western blot analysis.

Results: The isolation and cloning of the gene fragment encoding the E1 and E2 proteins was successful. Co-expression of these proteins was confirmed using monoclonal antibodies specific for each protein.

Conclusion: This study showed that HEK293 host cell is suitable for the expression of hepatitis C virus E1 and E2 coding gene. These proteins can be used in numerous virological studies and detection of HCV infection.

Open Access Review Article

Advances in the Mechanism of Action of Natriuretic Peptides at a Cellular Level

Gurdeep S. Mannu, Angeline Bhalerao

Journal of Advances in Medicine and Medical Research, Page 1-15
DOI: 10.9734/BJMMR/2015/19325

Background: Natriuretic peptides have a vast array of different actions at numerous sites throughout the human body. There have been rapid advances in understanding their mechanism of action in recent years and this review aimed to collate all available information on this field in order to present the current evidence-base.

Method: A two-step process utilising a Medline/PubMed systematic search was conducted. The initial search was undertaken using elementary phrases. The search produced over 4000 published papers on the topic of the mechanisms of action of natriuretic peptides. The resultant abstracts were analysed and appropriate papers were selected. The secondary search was performed by (1) using the reference lists of the chosen articles and (2) by using PubMed weblink for related articles. The studies were selected if they were in English language published in the past 30 years (1983-2013) and included the appropriate topics. All of the reports regarding the intracellular and pharmacological mechanisms of action of natriuretic peptides were selected.

Conclusions: This review has collected all information on the recent advances in our understanding of the intracellular pathways that allow these peptides to bring about natriuresis, vasodilatation and their many other effects. Although offering significant pharmacological potential, this field remains poorly understood and there is a need for more research using newer research techniques.

Open Access Review Article

Ultrasonography as a Breast Imaging Modality: A Review

P. Agbenorku, V. E. Agbemor Brayn, F. Aitpillah, J. Akpaloo, K. Aboah, E. Agbenorku

Journal of Advances in Medicine and Medical Research, Page 1-8
DOI: 10.9734/BJMMR/2015/19056

Introduction: Ultrasonography and Magnetic Resonance Imaging (MRI) serves as the most prominent adjunct imaging modality to mammography. Ultrasound (US) is cheap, non-invasive and widely available in healthcare centres in Ghana but often used for obstetrics and gynaecological investigations. These including many other factors have stimulated a challenge to further investigate and optimise the use of the ultrasound equipments’ availability in order to facilitate the early diagnosis and treatment of breast diseases.

Aim: The aim of this article is to review the role played by ultrasonography in diagnosing breast masses.

Methods: Google search engine was used to search for ultrasonography related articles. The selected articles were reviewed to prepare this manuscript.

Results: It was established that though mammography is the orthodox and only modality suitable for screening and should not be replaced, ultrasound is a helpful and reliable diagnostic tool for first-line imaging (screening) especially in younger women to diagnose a palpable mass in the breast without having to necessarily perform a mammogram examination and it is also the only modality that can accurately detect a cystic mass without a biopsy. MRI has a higher sensitivity but low specificity and hence not suitable to be used as a screening tool.

Conclusion: Ultrasound is non- invasive, common and cost effective, however it is advisably to do this procedure when clinically necessary or deemed fit.