Open Access Case Report

HCV Extrahepatic Events: Cryoglobulinemic Syndrome – A Case Report in an Over-70-Year Old Patient

Alfonso Merante, Pietro Gareri, Alberto Castagna, Gaetano Russo, Norma Maria Marigliano, Alfonso Ciaccio, Giovanni Ruotolo

Journal of Advances in Medicine and Medical Research, Page 1-7
DOI: 10.9734/BJMMR/2016/21610

Mixed Cryoglobulinemia (MC) is the most severe among the extrahepatic manifestations of hepatitis C virus. It is a circulating immune disease due to a virus-induced proliferative disorder of B lymphocytes, mainly involving low and medium-sized vessels. Diagnosis of cryoglobulinemia is based upon the presence in the serum of immunoglobulins which may reversibly precipitate at temperature inferior to 37°C.

Presentation of Case: In the present paper we report an interesting case of a 72-year-old man with MC. The two main findings in MC are vasculitis and neuropathic syndrome. Cryoglobulinemic syndrome is characterized by purpura, which is one of the earliest and common clinical manifestations in over 80% of the cases. In this case report the neurological picture is represented by severe sensorimotor polyneuropathy, characterized by burning dysesthesia and lack of sensitivity and strength in the limbs.

Discussion and Conclusion: The therapeutic approach to the patient with cryoglobulinemic syndrome should be tailored to the clinical characteristics of the patient and the degree of disease activity. The present clinical picture occurring with severe neurological impairment may be included among the most severe forms of the disease.

Open Access Case Report

Fatal Superadded Nocardia Infection in a Case of Pulmonary Aspergillosis

R. K. Mahajan, Shweta Sharma, Shukla Das, Arun Wilson, R. S. Tonk

Journal of Advances in Medicine and Medical Research, Page 1-5
DOI: 10.9734/BJMMR/2016/22356

Pulmonary nocardiosis is a severe opportunistic infection in which chronic lung disease along with long term steroid therapy is the most significant predisposing factor. Demonstration of Nocardia in even potentially contaminated sample like sputum, warrant strong warning signal of association of the organism with the clinical condition because Nocardia are rarely encountered as laboratory contaminants. Immediate initiation of appropriate treatment is absolutely essential since any delay in diagnosis or treatment may prove detrimental to the extent of complete fatal outcome.

Open Access Case Study

Combined Spinal-epidural Anesthesia for Hip Fracture Surgery in Two Geriatric Patients with Low Ejection Fractions

Özgür Özmen, Emine Uzlaş Karaman, Duygu Kara, Muhammet Ahmet Karakaya, Zakir Arslan, Fatma Karakoç, Mesut Misirlioğlu

Journal of Advances in Medicine and Medical Research, Page 1-5
DOI: 10.9734/BJMMR/2016/22382

Aims: To present the combined spinal-epidural anesthesia and postoperative analgesia in two geriatric patients, with low Ejection Fractions (EF) that underwent hip fracture surgery.

Presentation of Case: Herein, 90 and 106-years-old geriatric patients respectively, with low ejection fractions were admitted to the orthopaedic ward because of hip fracture. These patients were planned to undergo hip prosthesis surgery. Anesthesia and postoperative analgesia were achieved by Combined Spinal-Epidural (CSE) techniques in both patients. We observed that spinal anesthesia using low dose hyperbaric bupivacaine with fentanyl was an effective and safe method, and post-surgical patient controlled analgesia via an epidural catheter provided sufficient pain control for 48 h.

Discussion: In older patients with hip fracture, comorbidities such as cardiac disease increase the risk of perioperative morbidity and mortality. Individuals that undergo hip prosthesis surgery are usually geriatric patients, and comorbidities can increase their risk of perioperative morbidity and mortality during surgery. Regional anaesthesia techniques are widely utilized for surgical procedures (especially obstetrics, orthopaedics, urology, general surgery) and pain management, and they are known to have favourable effects on the vital signs and endocrine and metabolic responses after the operation compared with those of general anesthesia. In addition, regional anaesthesia is preferable because of its superior results in relation to postoperative pain control.

Conclusion: Combined spinal epidural anaesthesia with low-dose hyperbaric bupivacaine and fentanyl in hip fracture surgery is a safe and efficient method when used in geriatric patients with low EF. In addition, we find that patient controlled epidural analgesia is a considerably effective technique in postoperative pain management.

Open Access Original Research Article

Detection of Hepatitis E Virus RNA in Chicken Droppings and Pig Feces in Ogun and Lagos States, South Western, Nigeria

E. E. Ogbolu, R. K. Obi

Journal of Advances in Medicine and Medical Research, Page 1-8
DOI: 10.9734/BJMMR/2016/15467

Background/Aim: Hepatitis E virus (HEV) is a major cause of sporadic and epidemic cases of enteric non-A non-B hepatitis in humans. It estimated that 14 million symptomatic cases of HEV infection, with 300,000 deaths and 5,200 stillbirths occur annually worldwide, with developing countries in the Indian subcontinent, Southeast and Central Asia, the Middle East, and northern and western parts of Africa being the most affected. This study was carried out to detect the presence of HEV RNA in commercial chicken and pigs in some parts of Ogun and Lagos states, South Western, Nigeria.

Materials and Methods: A total of 550 fecal samples were collected from chicken and pigs in both states. HEV RNA was extracted from the fecal samples and amplified by nested-PCR. Gel electrophoresis was used to evaluate the nested-PCR products.

Results: HEV RNA was detected in 10(1.8%) of the 550 samples. This comprised of 5(6.7%) positive from chicken droppings and 5(1.7%) from pigs feces. The result also showed that 3(4.3%) of chicken droppings collected from Ogun state were positive while there was no positive cases recorded in pig feces. Similarly 2(40%) of chicken droppings collected in Lagos state were positive while 5(1.7%) of pig feces were also positive.

Conclusion: The detection of HEV among commercially available chicken and pigs poses a great economic danger to poultry farmers and a tremendous public health risk to consumers of pork meat in Nigeria.

Open Access Original Research Article

Evaluation of the Diagnostic Value of Serum Cytokeratin-8 as a Marker of Liver Injury in Chronic Hepatitis C Patients

Maaly M. Mabrouk, Medhat A. Ghazy, Mohamed A. Elrashidy

Journal of Advances in Medicine and Medical Research, Page 1-13
DOI: 10.9734/BJMMR/2016/22003

Background: Hepatitis C virus (HCV) is considered the most health problematic in Egypt. Its severity ranges from mild illness to serious complications as cirrhosis and hepatocellular carcinoma. Keratins emerge as markers of liver injury beside significant contributors to liver disease pathogenesis.

Aims: We analyzed the cytokeratin-8 serum levels and blood mRNA expression in chronic hepatitis C patients to evaluate serum CK8 role as a marker of liver injury.

Patients and Methods: This study included 100 Egyptian patients with liver disease. They were 82 patients with chronic hepatitis C and 12 patients with hepatitis C-induced cirrhotic changes. Fifteen healthy controls were also included in the study. All studied subjects underwent a clinical assessment and complete laboratory evaluation. For patients groups a conventional abdominal ultrasonography and guided liver biopsy were performed with histopathological examination to assess the grade of inflammation and stage of fibrosis according to the Metavir scoring. The levels of CK-8 serum and blood mRNA expression were measured.

Results: Serum CK-8 levels and mRNA expression were increased in HCV and cirrhotic patients compared to control group (P <0.001*). Serum CK-8 levels were positively correlated with Metavir score in patients groups (r=0.714, P <0.001) (r=0.447, P <0.001) and in selected patients with inconclusive FIB4 index (values in between 1.45-3.25) (r=0.291, P =0.048) (r= 0.486, P <0.001).

Conclusions: Serum CK 8 levels were positively correlated with Metavir score and FIB4 index. They may be useful for monitoring disease activity in chronic HCV patients especially with inconclusive FIB4 index.

Open Access Original Research Article

Sequential Treatment with Lamivudine and Peg-interferon Therapy in Patients with E-positive Chronic Hepatitis B and High Viral Load

Shou-Wu Lee, Sheng-Shun Yang, Teng-Yu Lee, Hong-Zen Yeh, Chi-Sen Chang

Journal of Advances in Medicine and Medical Research, Page 1-8
DOI: 10.9734/BJMMR/2016/21870

Background: Patients with chronic hepatitis B virus (HBV) who are positive for e antigen (HBeAg) and have a high viral load are considered to be poor therapeutic responders to pegylated interferon (PEG-IFN). The aim of this study was to assess the therapeutic response of sequential therapy, lamivudine (LAM) followed by PEG-IFN, in these cases.  

Methods: Chronic HBV patients who were HBeAg positive, with HBV DNA over 107 IU/ml and ALT 2-10 times the upper normal limit, and who were treatment naive were included in our study. Those with concurrent hepatitis C or HIV infection, liver cirrhosis or decompensated cirrhosis, or pregnancy were excluded. The enrolled cases received therapy with PEG-IFN monotherapy for 48 weeks (PEG-IFN group) or sequential therapy with lamivudine (LAM) for 4 weeks followed by PEG-IFN therapy for 48 weeks (LAM/ PEG-IFN group).

Results: There were 10 patients in each group, and there were no differences in age, gender, HBV genotype, pre-treatment ALT, and HBV DNA levels between the two groups. The biochemical, virological and serologic responses within 24 weeks after treatment were 40%-60%, 30-50%, and 40-50%, respectively, in the PEG-IFN group, compared with 70%, 20-40%, and 20-40%, respectively, in the LAM/PEG-IFN group. The rates of positive EOT were 30% and 10% in the PEG-IFN group and the LAM/PEG-IFN group, respectively, with rates of 40% and 10% in the SVR-12-week subgroup, and 30% and 20%, respectively, in the SVR-24-week subgroup. The therapeutic responses between the two groups showed no differences.

Conclusion: In chronic HBV patients who were positive for HBeAg positive and with a high viral load at baseline, similar therapeutic responses were noted between the sequential LAM/PEG-IFN therapy group and the PEG-IFN monotherapy group. Further research with a higher number of patients and a prolonged LAM course are needed to confirm the efficacy of this approach.

Open Access Original Research Article

Hepatocellular Carcinoma Sub-types in North-Central Nigeria: A Histological Review of Liver Biopsies

R. A. Vhriterhire, J. A. Ngbea, B. A. Ojo, O. O. Jegede, A. N. Manasseh, M. D. Ayuba, B. M. Mandong

Journal of Advances in Medicine and Medical Research, Page 1-8
DOI: 10.9734/BJMMR/2016/21772

Introduction: Hepatocellular carcinoma (HCC) is the 6th most common cancer worldwide and a greater burden of this disease is born by the hepatitis B virus (HBV) endemic and resource deficient sub-Sahara Africa. This investigation was carried out to determine the pattern of hepatocellular carcinoma sub-types in north-central Nigeria.

Materials and Methods: Archival formalin fixed and paraffin embedded 374 liver biopsy specimen blocks were obtained, sectioned, re-stained and examined histologically. Classification of primary liver cancers was done according to standard World Health Organisation criteria. 

Results: Chronic HBV infection was found in 219 (58.6%) and cirrhosis in 29 (7.8%) cases. HCC occurred in 76 (20.3%) cases with background cirrhosis in 18 (23.7%) of the HCC. The HCC subtypes found were the trabecular 54 (71.1%), acinar 10 (13.2%) and mixed trabecular and acinar 6 (7.9%), clear cell 5 (6.6%) and fibrolamellar 1 (1.3%) respectively.

Conclusion: HCC is the most common histologically diagnosed primary liver cell carcinoma with the trabecular subtype as the predominant variant in Nigeria, followed by the pseudoglandular and the mixed types.

Open Access Original Research Article

The Effect of Parkia Leaf Extract on Cadmium-Induced Cerebral Leison in Wistar Rats

V. O. Makanjuola, O. D. Omotoso, O. B. Fadairo, B. J. Dare, O. P. Oluwayinka, S. A. Adelakun

Journal of Advances in Medicine and Medical Research, Page 1-7
DOI: 10.9734/BJMMR/2016/16017

Cadmium is a relatively rare soft metal that occurs in the natural environment typically in association with zinc ores and to a lesser extent, with lead and copper ores. It is highly toxic to both human and animals because it is widely distributed in the environment and is used in various industries. Some of the toxic effects of cadmium exposure are testicular atrophy, renal dysfunction, hepatic damage, hypertension, central nervous system injury and anemia. Parkia biglobosa serves as a remedy for quite number of ailments and has medicinal properties against bronchitis, pneumonia, diarrhea, violent colic, vomiting sores and ulcers. This research work was targeted at investigating the activities of cadmium and Parkia biglobosa leaf extract on the histoarchitecture and histochemistry in prefrontal cortex. Thirty Wistar rats were used for the study. The animals were acclimatized for two weeks and were maintained under standard condition in Bingham University animal house holding they were housed in well ventilated cages and kept under controlled light schedule and were fed with standard laboratory feed and water ad libitum. The rats were randomly grouped into six groups A, B, C, D, E, F each containing five animals. Group A served as control, Groups B, C, D, E and F were injected intra-peritoneally with 3.0 mg/kg of cadmium sulphate. After 72hrs of injecting cadmium, group C, D and E were administered orally with 20 mg/kg, 30 mg/kg and 40 mg/kg of the leaves extract of Parkia biglobosa respectively and group F received oral administration of 100 mg/kg and 30 mg/kg of vitamin C and E respectively for two weeks. Animals were sacrificed after two weeks of the last administration of the Parkia biglobosa leaf extract by cervical dislocation. Cadmium administration caused a significant increase (P< 0.05) of LDH, G6PD and MDA level in cadmium group animal while there was a significant decrease in LDH, G6PD and MDA level upon administration of Parkia biglobosa leaf extract. This study has shown that Parkia biglobosa leaf extract has antioxidant properties that might have enhanced morphological damage caused by cadmium by regenerating pyramidal and neuroglial cells and improving distribution of Nissl bodies in the prefrontal cortex of the treated rats.

Open Access Review Article

Factors Associated with Drug Counterfeit in Nigeria: A Twelve Year Review

Chika F. Ubajaka, Alphonsus C. Obi-Okaro, Obiageli F. Emelumadu, Maureen N. Azumarah, Andrew U. Ukegbu, Samuel O. Ilikannu

Journal of Advances in Medicine and Medical Research, Page 1-8
DOI: 10.9734/BJMMR/2016/21342

Background: Drug counterfeiting poses a great danger to every society. The actual prevalence of counterfeit drugs is difficult to ascertain presently but just like other crimes, drug counterfeiting is an underground business that often comes to light mostly when death occurs. About 10% of drugs circulating worldwide are fake drugs with enormous associated health risk. Preventing the problem is a primary duty of every responsible nation in order to save lives.

Objective: This paper aims at studying the factors associated with drug counterfeiting, its consequences and possible solutions.

Methods: This article reviews relevant literatures published from 2004 to 2015 from medical journals, health survey reports, books, Google search and health-related websites such as World Health Organization.

Results: Several researchers have identified corruption and conflict of interest, poor health seeking behavior of Nigerians, high prices of locally manufactured drugs due to high taxes and tariffs, inadequate legislation, unordered drug distribution system, inadequate cooperation from government agencies and discriminatory regulation by exporting countries as the major factors associated with drug counterfeiting in Nigeria.

Conclusion/ Recommendations: Drug counterfeiting is one of the greatest atrocities of our time and it affects both developing and developed countries. There is an urgent need for the government as well as professional bodies to ensure massive public enlightenment and the effective enforcement of the existing drug laws in Nigeria.

Open Access Review Article

Recent Esthetic Restorations: Reliability and Impact on Antagonists

Elie E. Daou

Journal of Advances in Medicine and Medical Research, Page 1-15
DOI: 10.9734/BJMMR/2016/19671

Dental practitioners have to respond to the patients’ esthetic demands. Newly developed ceramics permit new indications in the oral rehabilitation. Impact on opposing dentition is still to be determined. Peer-reviewed articles published until December 2014 were identified through a Medline (Pubmed and Elsevier). Divers methods are used to measure the wear process of natural or artificial teeth. Stability and reliability of materials are also off concerns.  Technics are not always comparable. Results may also be contradictory. Newly developed prosthetic materials are scrutinized. Emphasis on zirconia restorations’ behavior is made.