Open Access Case Report

Cardiac Angiosarcoma of the Right Atrium with Cardiac Tamponade

Hirotaka Sato, Kei Aizawa, Arata Muraoka, Hirohiko Akutsu, Yoshio Misawa

Journal of Advances in Medicine and Medical Research, Page 1-5
DOI: 10.9734/BJMMR/2016/22051

Aims: We report a case of cardiac sarcoma, which showed cardiac tamponade as the first clinical symptom and sign. Accumulation of such cases could lead to better treatment for patients with cardiac angiosarcoma.

Presentation of Case: A 56-year-old man presented with loss of consciousness. An echocardiogram showed cardiac tamponade, requiring an emergent exploration of the pericardium. We confirmed that the tumor originated in the right atrium and advanced to the right ventricle beyond the right coronary artery. A thickened right atrium with a small hole was resected, followed by reconstruction of the right atrium using a large patch of autologous pericardium. Cardiac angiosarcoma was pathologically identified. The patient died of multiple lung metastases 6 months after the operation, despite subsequent radiation therapy.

Discussion and Conclusion: Cardiac angiosarcoma shows extremely aggressive growth, as observed in our case. More clinical reports with cardiac angiosarcoma could aid in improving diagnostic and treatment modalities.

Open Access Original Research Article

Hemorrhagic and Non-hemorrhagic Pituitary Apoplexy: Imaging Cohort Analysis

Esther Dupépé, Joseph H. Miller, Daxa Patel, Don E. McCormick, Soni Srivastav, T. Brooks Vaughan III, Kristen O. Riley

Journal of Advances in Medicine and Medical Research, Page 1-7
DOI: 10.9734/BJMMR/2016/22132

Introduction: Patients suffering from pituitary apoplexy present with variable clinical symptoms and imaging findings. Imaging findings may differ between hemorrhagic and non-hemorrhagic apoplexy. Our study aimed to better define imaging findings in both hemorrhagic and non-hemorrhagic apoplexy and is the first cohort study to report a comparison of imaging findings in these two groups.

Materials and Methods: 311 consecutive patients admitted with pituitary tumors were retrospectively reviewed for clinical and imaging evidence of pituitary apoplexy. 37 operative cases were included in this cohort. A cohort statistical analysis was performed between the two groups using Chi Square, Fisher exact test, logistic regression, ANOVA, and t-test.

Results: Imaging analysis demonstrated a significant difference in the hemorrhagic cohort’s Computed Tomography (CT) finding of hyperdensity within the sella (n = 17, 48.5%, p = 0.02) and sellar Hounsfield units (mean 45 versus 38.1, p=0.05). Sellar HU were higher in the hemorrhagic pituitary apoplexy cohort. Similarly, hyperintensity on magnetic resonance imaging was more indicative of patients with hemorrhagic apoplexy according to T1 (p = 0.004), T2 (p = 0.004), and FLAIR (p = 0.04) imaging sequences. No difference was found in patterns of enhancement (p = 0.69) or restriction based on diffusion-weighted imaging (p = 0.54). Gradient echo (n=4) and susceptibility weighted imaging (n=1), while not performed in all patients, demonstrated hemorrhage within a pituitary adenoma in patients where this technique was used.

Conclusions: Our study did not demonstrate a unifying imaging feature in non-hemorrhagic apoplexy cases. Hemorrhagic apoplexy was more likely associated with hyperdensity on CT and hyperintensity on T1, T2 and FLAIR MRI sequences. Because of the variation of imaging findings in hemorrhagic and especially non-hemorrhagic apoplexy, imaging appearance inconsistent with hemorrhage should not be used to exclude the diagnosis of apoplexy.

Open Access Original Research Article

Intersection of Maternal Age and Parity with Pregnancy Outcomes in a Rural Health Centre in Nigeria: Implications for Training and Practice of Family Physicians

Bock-Oruma A. Andrew, Dienye O. Paul, Ndukwu U. Geraldine, Ajadi A. Michael

Journal of Advances in Medicine and Medical Research, Page 1-9
DOI: 10.9734/BJMMR/2016/21649

Background: The impact of biological factors on pregnancy outcomes is equivocal.

Objective: This study was aimed to examine the effect of maternal age and parity on obstetric and perinatal outcomes in Nigeria.

Materials and Methods: This was a prospective, observational study of pregnant women at the Comprehensive Health Centre, Aluu in southern Nigeria. The WHO classifying form of the new antenatal care model was used in enrolling pregnant women registering for ante natal care at the study centre. Data were entered and analyzed using the statistical package for the social sciences version 16.0. Association between the variables was determined using chi-square test with statistical significance set at P ≤ 0.05.

Results: Out of 410 pregnant women involved in the study, 379 (92.4%) completed it. Considering maternal age and obstetric outcomes, statistically significant association was observed between maternal age and delivery gestational age (p= 0.019), mode of delivery (p=0.02) and birth weight (p=0.047). There were 146 (38.5%) primips and 21(5.5%) grandmultips. Statistical significance was observed in the association of parity and birth weight (p=0.02) and foetal outcome (p=0.03) with a high incidence of low birth weight among primips (n=17; 11.6%) and higher perinatal mortality among grand multips (n=3; 14.3%). There was no maternal mortality. Teenage pregnancy encountered zero operative deliveries.

Conclusion: Maternal age is associated with preterm deliveries, low birth weight babies and operative delivery. Parity is associated with birth weight and foetal outcome.  There was no maternal mortality and teenage pregnancy encountered zero operative deliveries.

Open Access Original Research Article

Measurement of Patient Radiation Doses during Certain Diagnostic Radiography Procedures

Abdelmoneim Sulieman

Journal of Advances in Medicine and Medical Research, Page 1-8
DOI: 10.9734/BJMMR/2016/22386

Aims: The aims of this study were to measure the radiation dose to patients in certain routine x-ray examinations and to estimate organs equivalent and effective doses.

Study Design: This prospective study included 220 adult patients who underwent 9 radiographic X ray imaging procedures.

Place and Duration of Study: This study was conducted Sharg Elneel Model Hospital (A), Fidail Hospital (B), Al-Amal Hospital (C) and Medical Corps Hospital (D), Khartoum state, Sudan, between June, 2013-August, 2015.

Methodology: The entrance surface air kerma (ESAK) was measured for four radiographic examinations using thermo luminescence dosimeters (TLD-GR200A). A total of 220 patients were examined in four hospitals.

Results: The mean ESAK (mGy) for the chest, hand, knee joint, leg, shoulder, foot, arm, ankle and lumbar spine were 0.40±0.04, 0.36±0.03, 0.64±0.07, 0.39±0.04, 0.35±0.02, 0.54±0.02, 0.26±0.02, 0.46±0.03  and 1.98±1.1, respectively. The overall effective dose was 0.16±0.05 mSv.

Conclusions: The results of ESAK were comparable with previous studies. Patient’s doses showed wide variations in the same types of x-ray examination due to the choice of exposure factors, technique, focus-to-film distance, filter, film-screen speed and the output of the x-ray units and processor quality were used.

Open Access Original Research Article

Retracted: Skin Expression of Advanced Glycation End Products (AGEs), Their Receptor (RAGE) and Glyoxalase-I (GLO-I) in Patients with Diabetic Neuropathy

Ahmed T. Alahmar, Ioannis N. Petropoulos, Maryam Ferdousi, Wendy Jones, Hassan Fadavi, Shazli Azmi, Uazman Alam, Omar Asghar, Aisha Meskiri, Ahmad Kheyami, Georgios Ponirakis, Andrew Marshall, Andrew J. M. Boulton, Mitra Tavakoli, Maria Jeziorska, Rayaz A. Malik

Journal of Advances in Medicine and Medical Research, Page 1-13
DOI: 10.9734/BJMMR/2016/22104

Advanced Glycation End Products (AGEs), their receptor (RAGE) and their detoxifying enzyme Glyoxalase-I (GLO-I) have been implicated in the development of experimental diabetic peripheral neuropathy (DPN). However, few studies have assessed their role in the tissues of diabetic patients. We have assessed the relationship between skin expression of AGEs, RAGE, GLO-I and diabetic neuropathy in patients with type 1 diabetes. Sixty-two patients with type 1 diabetes mellitus (16 with and 46 without DPN) and 30 age-matched control subjects underwent detailed assessment of neurologic deficits, quantitative sensory testing, electrophysiology, corneal confocal microscopy (CCM), intraepidermal nerve fibre density (IENFD) and AGEs, RAGE and GLO1-I expression in foot skin biopsies. Skin AGEs and RAGE expression was significantly higher and GLO-I was significantly lower in the 16 epidermis, microvessels  and  reticular extracellular matrix  of  patients  with diabeticneuropathy as compared to diabetic patients without neuropathy and control subjects.  Skin AGEs and RAGE expression was also moderately but significantly increased and GLO-I expression was decreased in some skin structures in patients without diabetic neuropathy as compared to control subjects. Skin AGEs and RAGE expression correlated negatively and GLO-I expression correlated positively with sural nerve amplitude and velocity, IENFD and corneal nerve pathology. These findings suggest that AGEs, RAGE and GLO-I may play an important role in the etiology of human diabetic neuropathy.


Retraction Notice: This paper has been retracted from the journal after receipt of written complains regarding authorship dispute. This journal is determined to promote integrity in research publication. This retraction is in spirit of the same. After formal procedures editor(s) and publisher have retracted this paper on 5th April-2016. Related policy is available here:

Open Access Original Research Article

End-stage Renal Disease Costs for Patients New to Hemodialysis in Italy: The FARO-2 Study

Daniela Paola Roggeri, Alessandro Roggeri, Diego Brancaccio, Sandro Mazzaferro, Piergiorgio Messa, Ernesto Paoletti, Alessandro Possidoni, Anna Maria Costanzo, Umberto di Luzio Paparatti, Mario Cozzolino, On behalf of the FARO-2 Study Group

Journal of Advances in Medicine and Medical Research, Page 1-9
DOI: 10.9734/BJMMR/2016/22222

Background: Increasing incidence and prevalence of end-stage renal disease (ESRD) together with the presence of several comorbidities in chronic kidney disease patients (CKD) could be associated with a relevant economic burden.

Aim: The aim of this analysis was to estimate the direct healthcare costs of ESRD and its major comorbidities in Italian patients who were naïve to hemodialysis (HD) recruited for the FARO-2 study.

Methods: The FARO-2 study was a retrospective observational study conducted in Italy that evaluated the patterns of treatment of secondary hyperparathyroidism (SHPT) and related costs in patients naïve to HD. The observational period was 2006–2008. Costs were measured in Euros (reference year: 2008). Resource use for the first 2 periods of 6 months of HD was monetized, with reimbursement calculated for SHPT drugs, phosphate binders, and erythropoietin-stimulating agents (ESAs); HD sessions; and hospitalizations due to ESRD and its major comorbidities. The analysis was performed by the Italian National Health Service (INHS) perspective.

Results: 567 patients were observed for at least 2 periods of 6 months. During the first 12 months after the initiation of HD, average direct healthcare costs were assessed using the percentage of patients treated and the average daily dosages (for drugs), the percentage of patients hospitalized and the types of hospitalizations (for inpatients), and the average weekly frequency of HD sessions. Total per-patient yearly costs totaled 34,789.9 €: HD accounted for 66.1% of expenditures, with hospitalizations and drugs accounting for 12.9% and 21.0% of expenditures, respectively (including 17.1% for ESAs).

Conclusions: Patients naïve to HD have a significant impact on Italian National Health Service expenditures, although only the costs related to treatment of ESRD and its comorbidities were calculated in the present study. The major cost drivers were HD and ESAs, while SHPT drugs and phosphate binders together accounted for only 3.9% of direct healthcare expenditures.

Open Access Original Research Article

A Cross-sectional Study of the Prevalence of Asymptomatic Bacteriuria among HIV-positive and HIV-negative Expectant Mothers in a Tertiary Health Centre in South Eastern Nigeria

L. C. Ikeako, H. U. Ezegwui, J. O. Enwereji, T. C. Okeke, C. K. Oranusi, J. C. Umeobika

Journal of Advances in Medicine and Medical Research, Page 1-8
DOI: 10.9734/BJMMR/2016/21878

Background: Asymptomatic Bacteriuria (ASB) in pregnancy is associated with potential urinary and obstetric complications. The diagnosis and management of ASB in expectant mothers is in keeping with safe motherhood initiative.

Aim: To determine the prevalence and pattern of ASB among HIV-positive and HIV-negative pregnant women in Enugu State, South Eastern Nigeria.

Methods: This was a comparative analytical study among HIV-positive and HIV-negative pregnant women at the University of Nigeria Teaching Hospital, Enugu State. ‘Clean catch’ urine samples of these women collected and analysed. Statistical analysis was performed using the Chi-square and student’s t tests as appropriate. A P-value of less than 0.05 was considered statistically significant.

Results: Among the two hundred and forty HIV-positive women, (23.3%) had significant ASB while (10.4%) of an equal number of HIV-negative women had significant ASB. The difference was statistically significant (p=0.013). A higher proportion of HIV-positive women, (22.5%) with CD4 cell count of ≤ 500/mm3 had significant ASB (p=0.015). Escherichia coli was the commonest isolate in both groups of women. The isolates were generally sensitive to amoxicillin-clavullanic acid, nitrofurantoin and cefuroxime in the two groups. The sensitivity to sulfametoxazle-trimethoprim was low; HIV positive (21.5%), HIV negative (16.0%).  Among those treated, none had overt UTI in pregnancy.

Conclusion: Screening, treatment and follow up for ASB in pregnancy are necessary especially in HIV positive women with CD4 cell count less than 500/mm3. This should be included during counselling in all antenatal protocols.

Open Access Original Research Article

Strains and Sprains in Dentistry

Mithra N. Hegde, Preethesh Shetty, Shehin Abooty

Journal of Advances in Medicine and Medical Research, Page 1-5
DOI: 10.9734/BJMMR/2016/21340

Dental clinicians are routinely exposed to various occupational hazards; chemical, biological and legal as well as ergonomic, which contribute to musculoskeletal disorders (MSD). The aim of the present study was to evaluate the prevalence of musculoskeletal disorders among dentists in South Kanara population and to determine the specialties associated with the highest risk of developing MSD. A total of 100 clinicians participated in the study which included a self assessed questionnaire to determine the site of pain and symptoms associated with it which was followed by the clinician assessed RULA questionnaire (Rapid Upper Limb Disorder Assessment) to determine the posture during their work, the risks associated and finally the need to improve the condition. According to the questionnaire survey, MSD’s were more prevalent among prosthodontists, endodontists, pedodontists & orthodontists compared to the other departments. According to RULA assessment endodontists and prosthodontists were at the maximum risk of developing MSD’s. Severe pain was due to high level of the RULA score; indicating that dentists with higher RULA scores needed to affirm to appropriate working postures. The study concluded that appropriate measures need to be taken into consideration to reduce the prevalence of musculoskeletal disorders to educate the dentists about the right ergonomic positions, awareness about work related risk factors and taking measures to lead a healthy life.

Open Access Original Research Article

Mitral Regurgitation Severity with Left Atrial Volume Index as a Guide to the Early Myocardial Infarction Prognostic Outcome

Hussein Aziz Naser

Journal of Advances in Medicine and Medical Research, Page 1-9
DOI: 10.9734/BJMMR/2016/19614

Background: Mitral regurgitation and the increase in left atrial volume are seen frequently in severe acute myocardial infarction. They are associated with left ventricular dysfunction and may predict the prognosis and the outcome for long term follow up myocardial infarction.  It is important to understand the effect of both in early admission to intensive care unit especially on the development of shock, heart  failure, dysrhythmia and the mortality.                                                          

Methods: This is a prospective study carried out at Al Sader Teaching Hospital in Najaf City and in Cardiac Care Unit (CCU) from March 2014 to November 2014. 150 Patients with acute myocardial infarction were followed during their admission in CCU. Recording was done to the variables like age, sex, STEMI (ST Elevation Myocardial Infarction) or NSTEMI (Non ST Elevation Myocardial Infarction) types, the site of infarction, presence or absence of shock, pulmonary edema and dysrhythmia. All patients were studied by Echo-Doppler and mitral regurgitation severity was recorded as well as measurement of the left atrial volume index and both were correlated with the variables.

Results: Mean age 66±15, 52.52% females, NSTEMI 65%, 30% atrial arrhythmia, 32% ventricular arrhythmia, left atrial volume index increased in 59%, mitral regurgitation in 56%. Severity grading of mitral regurgitation and the increase in left atrial volume index were significantly associated with shock p value 0.001, pulmonary edema p value 0.001 and arrhythmia P value 0.001. The mortality in acute myocardial infarction patients found to be significantly associated with the increase in Left Atrial Volume Index p value 0.0001 and with the severity of Mitral Regurgitation p value 0.013.

Mortality of acute myocardial infarction was also significantly associated with pulmonary edema 0.001, shock p value 0.03 and site of infarction p value 0.017as well as the type of the infarction p value 0.007.

Conclusion: Both mitral regurgitation severity and left atrial volume can predict the early outcome of Myocardial Infarction in early Cardiac Care Unit admission.

Open Access Original Research Article

Severe Pregnancy Induced Hypertension, a Dreaded Complication in Semi-Urban Area in Fako Division, Cameroon? A Case – Control Study

Gregory E. Halle-Ekane, Martin Che, Julius Atashili, Ndemazie Nkafu Bechem, Dickson S. Nsagha, Thomas Egbe Obinchemti, Peter Fon Nde

Journal of Advances in Medicine and Medical Research, Page 1-9
DOI: 10.9734/BJMMR/2016/22375

Introduction: Severe pregnancy-induced hypertension (severe pre-eclampsia and eclampsia) is a major cause of fetal and maternal morbidity and mortality. Pregnancy induced hypertension occurs in 7.7 – 8.2% of pregnancies and causes 17.5% of maternal deaths in Cameroon. However, few descriptive studies have been published in the last decade to demonstrate the gravity of adverse maternal and perinatal outcomes of these disorders in the Fako Division of the South West Region, Cameroon.

Objectives: This study was aimed at determining the prevalence, risk factors and the maternal and perinatal outcomes associated with severe PIH in the two Regional Hospitals in the South West Region of Cameroon.

Methods: This was a cross-sectional and case-control study conducted at the maternities of the two Regional Hospitals of the South West region. Of the 2112 files of parturients that had childbirth in these hospitals between 16th July 2013 and 16th January 2015, 94 case files were selected. These files were classified according to the National High Blood Pressure Education Program Working Group (2000) as severe preeclampsia (64 files) or eclampsia (30 files). A reference group of 188, age, gravidity and parity-matched parturients files with normal blood pressures (BPs) was also selected. Structured questionnaires were used to obtain demographic data, risk factors, gestational age, symptoms and signs of severity, neonatal and maternal morbidity and mortality. Data was analyzed using Epi InfoTM, odds ratios and their 95% confidence intervals were recorded and p<0.05 was considered statistically significant.

Results: The prevalence of severe PIH was 5.02%. Parturients aged 21 – 25 years 30.9% (29) and primiparous 57.5% (54) were most affected. Severe PIH was associated with family history of chronic HBP [44.7% (42) versus14.9% (28)] and pre-tertiary level of education [62.8% (59) versus 44.2% (83)] both with p<0.001 and p≤0.031 respectively. The maternal mortality ratio in cases was 1887/100,000 live births but no maternal death occurred in the reference population. Severe PIH was associated with certain maternal outcomes, the most frequent being caesarean delivery [68.1% (64) versus 16.5% (31)], p<0.001. Others included visual impairment [11.7% (11) versus 0.0% (0)] and Placenta abruptio [5.3% (5) versus 0.0% (0)]. Similarly, severe PIH was associated with perinatal outcomes; low birth weight [50.0% (47) versus 10.6% (20)], prematurity [46.8% (44) versus 9.6% (19)] and perinatal death [27.7% (26) versus 5.3% (10)] all p≤0.001.

Conclusion: The prevalence of severe PIH was high (5.02%). It was common in age group 21-25, primiparous and women with family history of chronic HBP and low level of Education. Parturients with a severe PIH had significantly more maternal and perinatal complications. These data suggest a gap in maternal health in Cameroon. Hence there is need to do complete evaluation (clinical and laboratory) to better assess patients; encourage early patient referral and prompt management of complications; more mid- wives and creation of adult and neonatal intensive care units in the Buea and Limbe Regional Hospitals.