Open Access Case Report

Immediate Adverse Reactions and Anaphylaxis Associated with Gadolinium-based Contrast Agents in a Patient with Meningioma: Case Report and Literature Review

Sima Sayyahmelli, Oguz Baran, Taner Tanriverdi, Naci Kocer, Ak Halil

Journal of Advances in Medicine and Medical Research, Page 1-5
DOI: 10.9734/BJMMR/2015/17582

Object: Gadolinium chelates are relatively safe contrast media used in MRI. Immediate severe adverse effects are exceptionally rare.The incidence of immediate hypersensitivity reactions to MR contrast media was 0.079%, and the recurrence rate of hypersensitivity reactions was 30% in patients with previous reactions. The risk factors for immediate hypersensitivity reactions to MR contrast media were the female sex, allergies and asthma.

Case: We report a case of anaphylactic shock due to Gadobenate dimeglumine. While undergoing a magnetic resonance imaging examination, 36 year-old female patient became severely hypotensive, lost consciousness, and had generalized erythema immediately after the intravenous injection of this product. She recovered rapidly after injection of epinephrine and her blood volume was restored with intravenous fluids. 

Conclusions: Although gadolinium is a safe contrast medium, anaphylactoid reactions do occur. Some are severe. Reactions to MR imaging contrast media are uncommon enough that radiologists may not be as familiar with their management as they are with the treatment of complications associated with iodinated radiographic contrast media. Gadobenate dimeglumine is comparable to gadodiamide in terms of safety and efficacy for imaging of CNS lesions.

Open Access Short Research Article

Effectiveness of Lumbar Puncture in the Diagnosis of Central Nervous System Infection for the Elderly Patients Presenting with Acute Confusional State

Adil Adnan Al-Naemee, Akram Al-Mahdawi

Journal of Advances in Medicine and Medical Research, Page 1-7
DOI: 10.9734/BJMMR/2015/13344

Objective: To evaluate the effectiveness of lumbar puncture (LP) as a diagnostic procedure for central nervous system infection in cases of acute confusional states in elderly patients.

Patients and Methods: This is an observational prospective study as a short research article that enrolled 50 elderly patients with acute confusional state to assess lumbar puncture results as a diagnostic procedure for central nervous system infections in Al-Fallujah Teaching Hospital in Al-Anbar, Iraq, between January 2011 and January 2013. All of the patients have been subjected to lumbar puncture (LP), as well as laboratory investigations.

Results: This study reveals slight female predominance (54%) in cases of acute confusional state. The mean age was 68 years. Acute confusional state in 92% of our cases was due to systemic disease, and central nervous system infection (meningitis and encephalitis) represented only 8% of cases. Most LPs were negative (normal). Fifty per cent of CNS infections were in pre-LP cases presenting systemic diseases. Central nervous system infections were mostly bacterial meningitis.

Conclusions: This study reveals that positive LP results were low in elderly patients presenting with acute confusional state. This gives an idea about the LP effectiveness that should be suspected. Since the causes of such presentation are life threatening diseases, so LP remain the best useful procedure in spite of its low positive results.

Open Access Original Research Article

A Simple System to Predict Mortality in Medical Intensive Care Unit

Bruna P. M. Rafacho, Bertha F. Polegato, Roberto M. T. Inoue, Luciano N. Santos, Kurt Schnitz, Polyanne C. Garcia, Leonardo A. M. Zornoff, Marina P. Okoshi, Paula S. Azevedo, Daniella R. Duarte, Sergio A. R. Paiva, Marcos F. Minicucci

Journal of Advances in Medicine and Medical Research, Page 1-8
DOI: 10.9734/BJMMR/2015/19176

Background: Advances in critical care have increased survival chances and the demand for a scientific approach to outcome prediction. The present study aimed to investigate the associations of clinical information, demographic and laboratory data with mortality; and to elaborate and validate a regression equation for mortality prediction in a medical intensive care unit (ICU).

Methods: This study included 202 patients and took place in a medical ICU at the Botucatu Medical School Hospital, Brazil. In Phase 1, 123 patients admitted to ICU between September 2003 and October 2004 was retrospectively analyzed and allowed equation elaboration. In Phase 2, the mortality equation was prospectively applied in 79 patients consecutively admitted to ICU between August and December 2006.

Results: Among Phase 1 patients, 55% were males and mean age was 58±19 years. Mortality rate was 29%. Multivariate analysis revealed that shock (p=0.002) and hypoalbuminemia (p=0.024) were associated with higher mortality rate. When regression equation was applied in Phase 2 patients, higher equation values were shown for nonsurvivors (0.512; -1.008 -0.512) than for survivors (-1.008; -1.290 -1.008) (p=0.03). The equation also had good precision, 1.8% (IC95%; 1.1-4.7), and low bias, -3.1% (IC95%; -27.1 -20.8). Areas under the receiver operating characteristic (ROC) curve showed no statistical differences between APACHE II (0.75±0.06) and the equation (0.66±0.07) (p=0.27).

Conclusions: Our data suggest that a simple and accurate prognostic equation can be used to predict ICU mortality.

Open Access Original Research Article

Biomechanics and Clinical Interactions in Podiatry Assessment

João Martiniano, Ivo Roupa, Guillermo Lafuente, João Abrantes

Journal of Advances in Medicine and Medical Research, Page 1-20
DOI: 10.9734/BJMMR/2015/19153

Background: Most foot joints have three degrees of freedom. Kinematics is important to understand gait cycle feet joint interactions. Daily clinical practice doesn’t allow immediate access to specialized laboratories where specific developments contribute to progress of podiatry knowledge. The aim of this study is to contribute to the knowledge of the interactions between biomechanical and clinical assessments.

Methods: Five healthy subjects underwent two types of assessment. Clinical: Anamnesis; passive joint by goniometry; plantar pressure features and Centre of Pressure (COP) displacement (RsScan®). Biomechanical: In the Laboratory, subjects walked 7 metres (3 trials); the data/percentage stance phase graphics were displayed. Ankle and Forefoot/Hallux dorsi/plantarflexion; Hindfoot/Tibia and Hindfoot/Forefoot eversion/inversion, angles were measured. Ground reaction force (Fz) (AMTI® at 1250 Hz) was used to determine 5 stance phase events (initial contact, loading response, Midstance, Terminal stance, Preswing) collected with 10 Mx1.3 Vicon® (250Hz) and 3D Oxford Foot Model.

Results: Clinical assessments have shown that joint angles are in accordance with literature. The data/percentage stance phase graphics show similar patterns to the literature. Every 5 subject’s angle data show the personalized quantification demonstrated in the text tables.

Conclusion: Despite the absence of statistical reasoning due to the reduced sample size, the obtained data are consistent with the literature’s references. The clinical and biomechanical assessments show different information, although they complement each other. The biomechanical information knowledge gathered is an added value to the clinician and to the evidence-based practice.

Open Access Original Research Article

Assessing the Influence of Clinic-based Health Education on Pregnant Women's Utilization of Primary Health Care Services in Ogun State

C. O. Agbede

Journal of Advances in Medicine and Medical Research, Page 1-9
DOI: 10.9734/BJMMR/2015/19475

Aims: The paper assessed the influence of clinic-based health education (C-BHE) on pregnant women’s attitude in relation to birth preparedness, complication and readiness (BP/CR) and utilization of Primary Health Care (PHC) services in Ogun State.

Study Design: Quasi-experimental design was used. Primary data was collected from surveyed participants.

Place and Duration of Study: Study was conducted between February and May 2013 in Ikenne, Ogun state, Nigeria. 

Methodology: Stratified sampling method was used to allocate 48 pregnant women, attending ante-natal care, each to experimental and control groups, making a total of 96 respondents. Structured questionnaire was used to collect data from the respondents. The women in the experimental group were exposed to two hours of health education discussion addressing pertinent maternal health issues weekly for five weeks. Data were analyzed using descriptive statistics and independent t-test. All tests were measured at p≤0.05 level of significance.

Results: Results showed that the women were between 19 and 24 years, had up to secondary education, recorded parity of 1-2 while timing of first visit was between 20 and 24 weeks of gestation and number of Ante-natal visits were ≥ 4. At baseline, there were no significant difference in the attitudes and desires for utilization of PHC facility for delivery for the experimental and control groups. However, after intervention, the mean scores for variables measuring attitudes to BP/CR and desire to utilize PHC facility for the experimental group increased and were significantly higher than the control group. Follow-up evaluation confirmed that the C-BHE increased actual utilization of PHC centre for delivery among the respondents in the experimental group (75%) as compared to the control group (42%).

Conclusion: Corroborative intervention programme initiatives, directed at creating more awareness about benefits of professional attendants during delivery, stimulating attitudinal change towards BP/CR and fostering necessary confidence in the PHC services for pregnant women should be encouraged.

Open Access Original Research Article

Patient Experience Following Kyphoplasty: Safety, Efficacy, and Patient Satisfaction

Kimberly P. Kicielinski, Patrick R. Pritchard, Henry Ruiz, Daxa M. Patel, Frank J. Crisona, R. Shane Tubbs, M. R. Chambers

Journal of Advances in Medicine and Medical Research, Page 1-11
DOI: 10.9734/BJMMR/2015/19370

Aims: Kyphoplasty is a minimally invasive treatment used to reduce pain, restore vertebral height and improve mobility in patients with painful spinal VCF. Pain from vertebral compression fractures (VCF) comprises an important health issue with significant social and economic impact, particularly in elderly patients with osteoporosis where treatment options are limited. We assessed outcomes in patients with VCF who failed conservative management and underwent kyphoplasty.

Study Design: Prospective and retrospective case series.

Place and Duration of Study: At a single neurosurgical practice February 2003 and September 2012.

Methodology: A total of 203 patients with 288 treated vertebral body fractures treated with kyphoplasty were enrolled. The Visual Analog Scale (VAS) was used to prospectively measure back pain before and after surgery. Pre and post operative disability and quality of life were retrospectively measured with the Roland Morris Disability Index (RMDI) and EuroQol 5-Domain scale (EQ5D), respectively, via patient survey. Pre and post-operative narcotic analgesic usage and incidence of subsequent fractures were recorded. 

Results: There was a statistically significant improvement (P < .001) in each of the assessed measures following surgery. The post-operative rate of narcotic use was reduced from 63% to 17%. Eight patients (4.2%) developed and underwent repair of an adjacent fracture with a mean time between surgeries of 461 days.

Conclusion: Following kyphoplasty, patients experienced significant, rapid, and sustained reduction of back pain, improved quality of life, and reduced disability with a low complication rate. Timely repair of VCF is indicated, not only to prevent complications associated with prolonged inactivity but also for effective treatment of severe pain in the acute setting.

Open Access Original Research Article

A Field Study on Malaria Prevalence along the Myanmar Thailand Border by Rapid Diagnostic Test (RDT) and Polymerase Chain Reaction Assay (PCR)

Salakchit Chutipongvivate, Youngyut Prompunjai, Wanvisa Neadruengsang

Journal of Advances in Medicine and Medical Research, Page 1-6
DOI: 10.9734/BJMMR/2015/18999

Background: Thailand has a national goal to eliminate malaria from 80 percent of the country by 2020. An accurate detection and prevalence are critical to effective management of malaria. Rapid diagnostic tests (RDTs) detecting parasite lactate dehydrogenase (pLDH) antigen are used to identify individuals with Plasmodium falciparum infection even in low transmission settings seeking to achieve elimination.

Aims: The aim of this study was to evaluate the exact prevalence of malaria in the Thai border area where malaria is endemic by RDT compared with PCR.

Methodology: One thousand one hundred thirty blood samples were obtained from study subjects who live along the Myanmar Thailand Border. RTD was performed with the parasite lactate dehydrogenase (pLDH) antigen-based lateral flow test and the primer set used for PCR was designed on the species-specific nucleotide sequence of 18S rRNA plasmodium gene.

Results: Malaria infection was demonstrated in 70 (6.2%) subjects and 97 (8.6%) subjects by RDT and PCR respectively. PCR detected a significantly higher number of malaria infection than RDT (P<0.05). Comparison of RDT negative and PCR positive samples suggested that RDT negatives resulted from low parasitaemia. Moreover, PCR was able to identify the species of Plasmodium parasite. Three species, Plasmodium falciparumPlasmodium vivax and Plasmodium malariae were detected. No Plasmodium ovalae was detected from any of the study location. P. falciparum was predominant along border with a percentage of 31.9 of positive suspected patients. Mixed infections with two or three malaria species were detected in 54 specimens (55.7%).

Conclusion: The result demonstrates that PCR should be undertaken to assess the prevalence of malaria in border areas to progress towards malaria elimination in Thailand.

Open Access Original Research Article

Evaluating Muco-suppressant, Anti-tussive and Safety Profile of Polyscias fruticosa (L.) Harms (Araliaceae) in Asthma Management

George Asumeng Koffuor, Alex Boye, Jones Ofori-Amoah, Samuel Kyei, Cyrille Kablan Nouoma, Agyemang Prempeh Debrah

Journal of Advances in Medicine and Medical Research, Page 1-11
DOI: 10.9734/BJMMR/2015/19403

Background: Polyscias fruticosa is been used in Ghanaian folkloric medicine for the management of asthma and its related complications.

Aim: This study evaluated the muco-suppressant, anti-tussive, and safety profile of an ethanolic leaf extract of Polyscias fruticosa in its use as an anti-asthmatic.

Place and Duration of Study: Department of Pharmacology, Faculty of Pharmacy and Pharmaceutical Sciences, KNUST, Kumasi, Ghana and the School of Physical Sciences, University of Cape-Coast, Cape-Coast, Ghana; between December, 2013 and May, 2014.

Methodology: Preliminary phytochemical screening was carried out on the extract. Ammonium chloride-induced tracheal mucus phenol red secretion in ICR mice and the suppression of citric acid-induced cough in Dunkin-Hartley guinea pigs were determined after treatment of experimental animals with 100 mg/kg sodium cromoglycate, or 20 mg/kg dihydrocodeine respectively, as well as with 100, 250, or 500 mg/kg of the extract.  A 100, 250, and 500 mg/kg dose of the extract was administered daily for 28 days to groups of guinea pigs to establish a safety profile in a sub-chronic toxicity study.

Results: Phytochemical screening revealed the presence of saponins and cyanogenetic glycosides, alkaloids, and sterols. The extract significantly inhibited (P ≤ .01 - 0.001) tracheal mucus phenol red secretion, and suppression of citric acid-induced cough. There were no significant changes in body weight, haematological profile, as well as liver and kidney functions in the sub-chronic toxicity study.

Conclusion: The findings indicate that the ethanolic leaf extract of Polyscias fruticosa has muco-suppressant and anti-tussive properties, and is safe to use; hence a suitable adjunct/remedy for the management of asthma.

Open Access Original Research Article

Iran’s Postgraduate Medical Education Achievements over Last 35 Years

Shima Tabatabai, Nasser Simforoosh, S. Amir Mohsen Ziaee

Journal of Advances in Medicine and Medical Research, Page 1-6
DOI: 10.9734/BJMMR/2015/19256

Aims: This article provides important information on Iran clinical postgraduate education progresses over the last 35 years. This historical study focus is on post graduate education quantitative achievements and growth of admitted residents and graduated specialist and subspecialists and fellowships by gender since 1979 after the revolution in Iran.

Study Design:  This is a comprehensive national historical study.

Place and Duration of Study: This national study was performed in Iranian Academy of medical science, between Apr. 2011 and may 2014.

Methodology: The first hand data gathered from Iran health ministry of and also from Medical Council of IR Iran.

Results:  There are 28 specialty and 24 subspecialties disciplines in Iran’s postgraduate medical education programs. The numbers of resident’s admission in specialties increased from 385 in 1979 to 2500 in 2014, and respectively from zero to 269 in subspecialty fields. 55 percent of admitted residents in specialty programs and 30 percent of admitted specialists in subspecialty programs were female in last year. During the period of 1979-2013, number of Iranians medical specialists’ has more than 300 percentage increases, and the ratio of specialist per 100,000 Iranian Population has more than 110 percentage increases. Research is another important field in our medical education system. Iran has published more than 20,000 medical and health research articles last year and 0.44% of its studies are considered as the 1% best articles of the world. The country has also gained the first place in the Middle East regarding science production.

Conclusion: Along with expansion Iran’s P.G.M.E. over the last 35 years, the number of Iranian female physicians significantly increased. Iran’s medical education system with great achievement in specialty/subspecialty training and related research is comparable with those of the most progressed countries in the world.

Open Access Review Article

Molecular Biology of Chronic Obstructive Pulmonary Disease from the Bases to the Therapeutic Decision: A Review

Alcibey Alvarado-González, Isabel Arce-Jiménez

Journal of Advances in Medicine and Medical Research, Page 1-14
DOI: 10.9734/BJMMR/2015/19607

Chronic obstructive pulmonary disease (COPD) is a global public health problem. It has an overwhelming prevalence, yet accepted therapies are ineffective in reducing disease progression. Bronchodilators, the mainstay of COPD treatment, only provide symptomatic relief. Therefore, in order to provide a superior approach, it is important to better understand the rationale behind therapy and the underlying mechanisms by which the inflammatory process, through various pathogenic pathways, leads to deterioration. Cigarette smoke and other pollutants/biomass fuels affect the lungs ability to counterbalance proteases and neutralize different types of stress. Even if the initial noxa is discontinued, inflammation, infection and autoimmunity promote a chronic lung inflammatory response; leading to the development of emphysema and small airway disease. This is due to continuous endogenous production of reactive oxygen species, nitrative and carbonyl stress. The process then continues into a harmful spiral and systemic disease. The objective of this paper is to offer an updated review of COPD, simplifying the integration of basic science research and introducing the concepts and evidence of therapeutic alternatives. This review discusses why some drugs have failed and which alternatives are emerging. Probably there is no unique effective therapy, but several combinations of drugs might be required to impact the different subcellular compartments and obtain a more effective therapy in COPD.