Open Access Case Study

The "Fisherman`s Waders" Sign on Bone Scan: A Case Report

Abdulkareem Alkahtani, Ahmad Subahi, Nouf Alaqla, Hussein Algahtani

Journal of Advances in Medicine and Medical Research, Page 1-6
DOI: 10.9734/BJMMR/2016/22085

Fisherman`s Waders sign is caused by several medical conditions including venous thrombosis, portal hypertension and lymphoma. It is characterized by increased uptake of radiotracer in soft tissues below the mid-thorax level with normal tracer clearance above that level in bone scan. This case reports the Fisherman`s Waders sign in a patient with lymphoma complicated by Inferior Vena Cava (IVC) obstruction by the aid of CT scan and bone scan. Also, literature review of this rare sign is performed in this report. This sign can be found incidentally on bone scan and high level of awareness by the nuclear medicine physicians may alert the treating team for the underlying diagnosis.

Open Access Case Study

A Female Case of Goldenhar Syndrome with Mandibular Hypoplasia and Aural Involvement

F. Ferrari, F. D’Orazio, L. Patriarca, A. Piccorossi, S. Di Fabio, A. Barile, E. Di Cesare, A. Splendiani

Journal of Advances in Medicine and Medical Research, Page 1-5
DOI: 10.9734/BJMMR/2016/21666

Goldenhar syndrome (GS) is a poly-malformation syndrome, also defined as oculo-auricolo-vertebral dysplasia with hemifacial microsomia. It is a rare congenital defect involving first and second branchial arches. The aetiology is not known. The most supported hypothesis is based on the abnormal embryonic vascular supply after mesodermal migration. Autosomal dominant, autosomal recessive and multifactorial modes of inheritance have been reported. We report the case of a female neonate affected by hemifacial microsomia and presence of pre-auricular tragi. Patients were subjected to computed tomography scan and MRI that revealed a mandibular unilateral hypoplasia without association of skeleton, brain and ocular alteration. The purpose of our study was to define the important role of the CT and MRI in the diagnosis of this poly-marformation syndrome. 

Open Access Case Study

Gastric Metastatis of Renal Cell Carcinoma Presenting as Polyps

Gulhan Kanat Unler, Gulsum Teke Ozgur, Huseyin Savas Gokturk, Ozgur Hilal Erinanc, Oznur Kal

Journal of Advances in Medicine and Medical Research, Page 1-5
DOI: 10.9734/BJMMR/2016/20203

Metastatic tumors of the stomach are very rare, with an incidence of 0, 2%- 0, 7% in the autopsy series. Malignant melanoma, carcinomas of breast, esophagus and lung are the most frequent primary tumor sites. The present case describes a 57-year-old woman who presented to the gastroenterology department with epigastric pain, nausea and vomiting for two months. Examinations revealed gastric metastasis of Renal Cell Carcinoma.

Open Access Opinion Article

Deconstructing Medicine: The Alternative Cellular Energy Pathway

W. John Martin

Journal of Advances in Medicine and Medical Research, Page 1-6
DOI: 10.9734/BJMMR/2016/21484

The pharmaceutical model for treating chronic illnesses has largely dominated the practice of medicine since the Flexner report of 1910. It essentially entails biochemical based endeavors to correct detectable or discerned metabolic imbalances in diseased cells. These manipulations almost invariably alter the metabolism of normal cells leading to predictable adverse side effects. Enhancing cellular energy can potentially help overcome cellular impairments in diseased cells without necessarily affecting normal cells. The identification of the alternative cellular energy (ACE) pathway, expressed as a dynamic (kinetic) quality of biological fluids, is providing a useful new paradigm for universally applicable therapeutic endeavors. This article reviews the current understanding of the fluid activation process. It appears to be mediated by a repulsive environmental force termed KELEA (kinetic energy limiting electrostatic attraction), which reduces the strength of intermolecular hydrogen bonding. Various means of imparting KELEA to drinking water are discussed. The article is intended to encourage widespread clinical evaluation of KELEA activated “ACE Water” as a waterceuticalÔ in the prevention and therapy of many clinical illnesses.

Open Access Original Research Article

Diagnostic Accuracy of Griess Test for Asymptomatic Bacteriuria in Pregnancy

R. Manjula, H. Kavya, S. V. Kashinakunti, Shivakumar Solabannavar, A. S. Dorle, D. H. Lalitha

Journal of Advances in Medicine and Medical Research, Page 1-7
DOI: 10.9734/BJMMR/2016/20754

Introduction: Asymptomatic bacteriuria (ASB) is a microbiological diagnosis based on the isolation of a specified quantitative count of bacteria in a properly collected specimen of urine from pregnant women without signs and symptoms, which are referable to urinary tract infection. Global prevalence of ASB in pregnancy is 1.9-9.5%.

Objectives: 1. To evaluate the accuracy of Griess test as a tool for screening of ASB in pregnancy. 2. To measure the validity (sensitivity and specificity) of Griess test in comparison with urine culture (Gold standard) and its diagnostic ability by ROC curve.

Methodology: A Cross sectional study was done during June and July 2012. Predesigned, pretested questionnaire was used for collection of data regarding demographic profile. Midstream urine sample was collected in sterile container, Griess test was done and urine sample sent for culture.

Results: In the present study, the prevalence of asymptomatic bacteriuria was 18% among the pregnant women. The sensitivity of Griess test was 92.3% and specificity was 99%. Area under the curve is 0.96. Hence Griess test has good diagnostic value when compared to urine culture for detecting bacteriuria, it is statistically highly significant with p=0.000001.

Conclusion: ASB is not uncommon among antenatal mothers in the population studied. Hence routine urine examination and Griess test for detecting ASB should be included in the ANC on routine basis.

Open Access Original Research Article

Correlation of Multidrug Resistance and Plasmid Profile in Extended Spectrum Beta Lactamase Producing Escherichia coli Isolated from Patients Suspected of Urinary Tract Infection

Vivek Kumar Singh, Mahesh Kumar Chaudhary, Reshma Tuladhar

Journal of Advances in Medicine and Medical Research, Page 1-9
DOI: 10.9734/BJMMR/2016/21451

Aims: To determine the prevalence of extended spectrum beta lactamase producing Escherichia coli (ESBL E. coli) strains among the total isolates and study the association between the antibiotic resistance and plasmid profiles of the isolates.

Methodology: A total of 1258 urine samples were collected. Identification of Bacterial isolates was done using standard biochemical tests, antibiotic susceptibility pattern was determined using the Kirby - Bauer’s disk diffusion method and confirmation of the ESBL E. coli was done following CLSI guidelines. Isolation of Plasmid DNA of ESBL positive strains was done by alkaline lysis method.

Results: Out of 303 isolates, 198 were E. coli. The isolates were tested for antibiotic sensitivity, MDR, ESBL and plasmid profiles. 59.09% of the E. coli isolates exhibited multi-drug resistance. 41(58.57%) out of 76 ESBL E. coli isolates possessed plasmids. Few isolates possessed single plasmid while other had multiple plasmids with different size ranged from 1 kb to 10 kb.

Conclusions: High prevalence of ESBL E. coli was found with good association between the antibiotic resistance and plasmid profiles of the isolates.

Open Access Original Research Article

Thymectomy in Children with Juvenile Myasthenia Gravis: Is It Recommended?

Chahed Jamila, Mekki Mongi, Kechiche Nahla, Hidouri Saida, Ksia Amine, Sahnoun Lassaad, Hemmadi Faten, Sfar Mohamed Tahar, Belghith Mohsen, Nouri Abdellatif

Journal of Advances in Medicine and Medical Research, Page 1-9
DOI: 10.9734/BJMMR/2016/19760

Objective: Juvenile myasthenia gravis (JMG) is a rare disease with possible severe forms. Thymectomy is supported by many authors particularly in generalised forms with positive AcetylCholine Receptor Antibody (AChR- Ab). The aim of our study was to discuss the indication and the outcome of thymectomy in five children with JMG.

Methods: We performed a retrospective study of the medical files of patients with JMG, who were hospitalised in our pediatric surgery department for thymectomy. For all the children we performed Acetylcholine Receptor Autoantibody (ACHRAB) test-system producer, a chest x-ray, a chest Computed Tomography Scan (CT-scan) and a Magnetic Resonance Imaging (MRI).

Thymectomy was indicated on the presence of anomalies on CT-Scan or MRI and realised via either thoracotomy or video-assisted thoracoscopy.

The study was conducted with the approval of the ethics committee at our institution.

Results: Based on our findings, thymectomy in JMG with imaging anomalies seems to be associated with clinical improvement. In our patients complete remission after surgery was seen in one case, a clinical improvement with a decrease of the medical therapeutic dosage was noted in three other cases. One patient could not be evaluated because of non adherence to medical treatment.

Surgery by thoracotomy or video assisted thoracoscopy (VAT) was also well tolerated by all the patients.

Conclusion: The benefits of thymectomy in children with JMG are still controversial. However, many researchers have reported a sustained improvement of symptoms in the majority of patients after thymectomy. Our findings seem to encourage thymectomy in cases of JMG and particularly when imaging anomalies are found. VAT thymectomy was well tolerated and it is considered by many researchers to be the standard method for thymectomy in children.

Open Access Original Research Article

Determinants of Out-of-Pocket and Catastrophic Health Expenditure: A Cross-sectional Study

Rajesh Kumar Sinha, Keya Chatterjee, Nirmala Nair, Prasanta Kishore Tripathy

Journal of Advances in Medicine and Medical Research, Page 1-11
DOI: 10.9734/BJMMR/2016/21470

Background: In India, Out of Pocket Health Expenditures (OOPHE) is as high as 70-80% of total health expenditures, borne by the families of ailing persons. In most cases such high OOPHE is catastrophic in nature, in the backdrop of high poverty level in the country. High OOPHE and Catastrophic Health Expenditures (CHE) have a potential to impoverish people. It is therefore important to identify the predictors of OOPHE and CHE, to formulate an equitable and efficient financial protection measure from health expenditure.

Methods: The study tried to understand the factors of out-of-pocket health expenditure and catastrophic health expenditure using the cross-sectional data from 986 sampled households in Koderma district of the state of Jharkhand in India. A multi-staged sampling method was followed to select households with incidences of in-patient care in the last one and child birth in the last two years and of out-patient care in the last one month. Alongside health expenditure data of the sampled households, their socio-demographic and socio-economic information were also collected using survey questionnaire.

Findings: Male headed households, families with more than five members, household head who were unemployed or were engaged in agriculture or labour works as compared to those in service; household head aged above 60 years, households from higher expenditure quintiles, households with any member suffering from chronic illness, households reporting any episode of hospitalisation, in-patient or delivery services availed from private providers in the reference periods, families living closer to service providers especially private providers were significant predictors of high OOPHE.

Residence in rural area (aOR: 1.65, 95% CI 1.10 - 2.49), families living in ‘kutcha’ (mud house) houses (aOR: 1.46, 95% CI 1.06 - 2.0), families with lower social status like Schedule Tribe (aOR: 1.76, 95% CI 1.0 – 3.13), Scheduled Caste (aOR: 1.73, 95% CI 1.02 - 2.92) and Other Backward Classes (aOR: 1.42, 95% CI 1.02 - 2.01) compared to General castes, families where any member suffering from chronic illness (aOR: 2.33, 99% CI 1.48 – 3.67), families where any member had received in-patient care in the last one year irrespective of type of providers (aOR: 2.18, 99% CI 1.60 - 2.97), longer distance from health service providers, had higher likelihood of CHE.

Conclusion: The study tried to identify different predictors of Out of Pocket Health Expenditure (OOPHE) and Catastrophic Health Expenditure (CHE), incurred by families seeking medical care for various ailments. OOPHE was found higher among families from higher expenditure quintile; however, people from disadvantaged socio economic profile had higher likelihood of CHE. Apparently, even smaller OOPHE is proving to be catastrophic for families from lower socio-economic segments. Families with any member suffering from chronic illness were at a higher risk of CHE. OOPHE was considerably higher when services have been sought from private providers compared to public health providers, however, for in-patient care, expenditure incurred in both situations were found to be catastrophic.

Urgent action is needed for designing healthcare finance policies that is more equitable and efficient and has a potential to reduce OOPHE and incidences of CHE.

Open Access Original Research Article

Prevalence and Risk Factors of Low Back Pain among Workers in a Health Facility in South–South Nigeria

Ofonime E. Johnson, Emmanuel Edward

Journal of Advances in Medicine and Medical Research, Page 1-8
DOI: 10.9734/BJMMR/2016/20785

Background: Low back pain (LBP) has been documented to be a common occupational health problem among health care workers. A cross sectional study was carried out in a health facility in South – South Nigeria to determine the prevalence and risk factors of low back pain among the workers.

Materials and Methods: Data was collected using a self designed, interviewer assisted, semi-structured questionnaire. Information obtained included socio-demographic characteristics, work history of respondents, prevalence and factors predisposing to low back pain. The tool was administered during the different shifts of the health workers. Frequencies were calculated and Fishers exact test was used to test the significance of association between different variables. Level of significance was set at 0.05.

Results: A total of 50 out of 53 workers participated in the study. The mean age of the respondents was 36.59±8.6 years with a male to female ratio of 2:3. The overall prevalence of LBP over the preceding 12 months was 28%, while the prevalence among males was 35% and females, 23.3%, respectively. The proportion of those with LBP among the doctors, pharmacists and nurses was 33.3% each. No history of back pain was recorded among the administrative staff. Prolonged standing/sitting (25.0%), age above 35 years (38.9%), being overweight or obese (50.0%), lifting of heavy objects (35.7%) and frequent stooping (33.3%) were common risk factors associated with LBP. The associations were however not statistically significant (p>0.05). Up to 42.8% of those with LBP had sleep disturbance and 21.4% needed to obtain sick leave as a result of the pain.

Conclusion: LBP was a common problem among staff in the health facility. Also, prolonged standing/ sitting, being overweight or obese, and lifting of heavy objects were among risk factors reported by those with LBP. Use of ergonomically designed chairs and equipments in the workplace, better lifting techniques and encouragement of mobility among the workers may help reduce the risk of LBP and thus improve workers’ productivity and wellbeing.

Open Access Review Article

Stem Cell Therapy for Stroke, Recent Advances, Controversies and Literature Review

Paula Eboli, Lindsey Ross, Michael Alexander

Journal of Advances in Medicine and Medical Research, Page 1-9
DOI: 10.9734/BJMMR/2016/21478

Stem cells based therapy has shown to improve stroke recovery in multiple animal models. Translating these findings into clinical research can result in a potential therapeutic option for stroke. At this moment multiple animal models, different stem cells type and administration route have been used for research purposes. So far ideal timing, type of stem cells and administration routes has not yet been determined. This review summarizes current approaches and progresses in stroke stem cell therapy.