Open Access Case Study

Recurrent Eccrine Porocarcinoma: A Case Report

Oktay Karaköse, Hüseyin Pülat, Hüseyin Eken, İsmail Zihni, Kazım Çağlar Özçelik, Kemal Kürşat Bozkurt, Hasan Erol Eroğlu

Journal of Advances in Medicine and Medical Research, Page 1-5
DOI: 10.9734/BJMMR/2016/23848

Eccrine porocarcinoma is a very rarely seen malignant skin tumour which originates from the intra-epithelial section of the eccrine sweat glands. They are generally seen in the elderly and are most often located in the lower extremities. This tumour which has a poor prognosis and displays different biological behaviour, often has a tendency to recurrence and metastasis is seen in the skin and lymph nodes. The basis of treatment is surgical excision and if there is lymph node involvement, regional lymph node dissection must be  applied. The case is here presented of  a 67-year old patient with eccrine porocarcinoma which developed in the inguinal region and showed recurrence.

Open Access Case Study

Papillon - Lefèvere Syndrome: A Case Report

Mohammed S. Al-Dhubaibi, Hamdy Metwaly, Amr Elkarargy

Journal of Advances in Medicine and Medical Research, Page 1-5
DOI: 10.9734/BJMMR/2016/23796

Papillon-Lefèvere Syndrome (PLS) is one of the rare autosomal recessive disorders of keratinization (1-4 cases per million). It is inherited as an autosomal-recessive condition with one-third of the patients showing consanguinity of the parents and diagnosed in both sexes. Lesions are characterized by palmo-plantar hyperkeratosis and severe destructive periodontal disease affecting the primary and permanent teeth. This paper reports a case of a 13 -year-old African boy presented to the outpatient clinic of Qassim University with diffuse keratotic plaques of his soles extending to the dorsal surface, localized keratotic plaques of his palm and severe inflammation of the gingiva with premature teeth loss and looseness of remaining teeth.

Open Access Data Article

Microorganisms Causing Severe Sepsis and Septic Shock in Patients Admitted to Alkhor Hospital Intensive Care Unit during 2010-2012

Mohamed Abuhmaira, Hassan Abuzaid, Abdo Lutf, Godwin Wilson, Wissam Ghadban

Journal of Advances in Medicine and Medical Research, Page 1-7
DOI: 10.9734/BJMMR/2016/23460

Objective: To find out specifically the community acquired microorganisms that cause severe sepsis and septic shock in patients admitted to Alkhor hospital intensive care unit and it is susceptibility to antimicrobial agents.

Methods: A Retrospective file review was performed on all adult patients who were admitted to intensive care unit with primary presenting diagnosis of severe sepsis or septic shock between 1st of January 2010 and 31st of December 2012. The primary outcome variable was inpatient mortality.

Results: The top three organisms found were: Streptococcus pneumonia, Klebsiella pneumonie, and E. coli. 59% of patients did not have any organisms growing in the culture.

Conclusions: This study concluded that 41% of blood cultures for patients with severe sepsis and septic shock had shown growth of micro-organism. The top three micro-organisms were Streptococcus pneumonia, Klebsiella pneumonie, and E. coli. Resistance to empiric antibiotic therapy was reported to be 35.7%. Patient age, antibiotic resistance and negative cultures were found to be the major risk factors for mortality in patients with severe sepsis and septic shock.

Open Access Original Research Article

Pattern and Prevalence of Thyroid Dysfunction in Nigerian Pregnant Females

Alfred Azenabor, Joseph Paulinus Omumene, Ayodele Oloruntoba Ekun

Journal of Advances in Medicine and Medical Research, Page 1-8
DOI: 10.9734/BJMMR/2016/23754

Introduction: Thyroid associated endocrinopathies are the second most common endocrine disorders, after diabetes mellitus in women and are more prevalent in women during their reproductive ages. Diagnosing thyroid disease in pregnancy can be difficult as the clinical signs and symptoms mimic those of pregnancy. This study was done to document the pattern and prevalence of thyroid dysfunction in Nigerian pregnant women.

Materials and Methods: This was a cross sectional analytical study carried out on 264 Nigerian pregnant females and 75 aged matched healthy controls. Thyroid hormones, blood glucose, urinalysis and blood pressure were determined. Pregnant females were categorized into normal pregnancy, gestational hypertensive and gestational trimesters.

Results: The mean age (SD) of participants with normal pregnancy was 29.82 (4.39 years). This was comparable with those with gestational hypertensive 31.78 (4.46 years) (p = 0.062). The mean ± SD of plasma levels of free T4 (0.37±0.16 ng/dl) in participants with normal pregnancy was significantly higher than those with gestational hypertensive (0.28±0.33 ng/dl), (p = 0.034). Intra trimester comparison of the participants with thyroid dysfunction showed subclinical hypothyroidism was present in 11.11%, 3.85% and 20.35% in first, second and third trimester respectively.

Conclusion: Subclinical hypothyroidism is the most commonly documented of the thyroid dysfunctional status in Nigerian pregnant females.

Open Access Original Research Article

The Association of Eating Attitudes between Metabolic Control and Quality of Life in Patients with Type 1 and Type 2 Diabetes Mellitus

Merve Yilmaz, Sevki Cetinkalp

Journal of Advances in Medicine and Medical Research, Page 1-8
DOI: 10.9734/BJMMR/2016/17598

Aims: The combination of an eating disorder and diabetes mellitus (DM) puts patients at high risk of mortality and morbidity. The purpose of this study was to determine the association of eating attitudes between metabolic control and quality of life in patients with type 1 DM (T1DM) and type 2 DM (T2DM) and with regard to different type of medical treatments.

Study Design: A descriptive cross-sectional study.

Place and Duration of the Study: Ege University Hospital Endocrine Polyclinic, December, 2013 – April, 2014.İzmir, Turkey.

Methodology: One hundred and fifty adults with T1DM (n=52) and T2DM (n=98) were evaluated using general information questionnaire, Eating Attitude Test (EAT-40 Turkish version), SF-36 quality of life questionnaire. Biochemical data were collected from the hospital records retrospectively. Data were analyzed with SPSS version 15.0 programme.

Results: The prevalence of disorders of eating attitudes in patients was found to be 39.3%. Metabolic control and quality of life were not related with eating attitudes in patients with DM. No significant correlation was found between the types of DM in terms of eating attitudes and medical treatments.

Conclusion: DM is considered to be a risk factor for the development of eating disorders. In this area further studies are needed to develop diabetes specific eating behavior rating scales.

Open Access Original Research Article

Correlation of Nitrite, Leucocyte Esterase and Protein Detection to Diagnosis of Urinary Tract Infections

K. T. Wariso, I. L. Oboro

Journal of Advances in Medicine and Medical Research, Page 1-6
DOI: 10.9734/BJMMR/2016/23444

Aim: To determine the relationship between detection of nitrite, Leucocyte esterase (LE) and protein in urine and significant bacteriuria.

Study Design: Cross-sectional descriptive study.

Place and Duration of Study: Department of Medical Microbiology and Parasitology, University of Port Harcourt Teaching Hospital, between March and September 2015.

Methodology: 240 urine samples were analyzed. Dipstick analysis using Combi-UriScreen 10SL reagent strips (Axiom Medical limited, UK) and culture for significant bacteriuria were performed according to manufacturer’s instruction/ using standard protocols. Data was coded, entered into Microsoft Excel ® version 2010 and analysed using Epi-Info version 7.02. Categorical data were presented as frequencies and percentages using tables. Univariate analysis using logistic regression (Odds Ratio) was used to determine the association between the presence of nitrite, LE and protein and significant bacterial yield in urine. A P-value of ≤ 0.05 was considered statistically significant. Likelihood ratios were calculated.

Results: 23 (23.2%) out of 99 samples with significant bacteriuria were nitrite positive, while 42 (42.4%) and 45 (45.5%) were positive for leucocyte esterase and protein respectively. Nitrite (P = 0.001, OR = 5.03, 95% CI = 2.02-12.93) and leucocyte esterase positivity (P = 0.001, OR = 3.59, 95% CI = 1.91-6.80) were significantly associated with significant bacteriuria while proteinuria was not (P = 0.989, OR = 1.03, 95% CI = 0.60-1.79). Nitrite positivity alone had the best positive likelihood ratio (4.09, 95% CI: 1.91, 8.78) followed by the combination of nitrite and LE positivity (3.65, 95% CI: 1.90, 7.03).

Conclusion: The use of dipstick analysis of urine as a screening tool for samples to be cultured may be a very effective way of reducing laboratory costs and wastage of man hours, which both ultimately improve the effectiveness of clinical laboratories especially in resource-poor settings.

Open Access Original Research Article

Activation of Epidermal Growth Factor Receptor (pEGFR) and Expression of Argentophilic Nucleolus Organizer Regions (AgNOR) in Seminomas

Fernando Guerra, Adriana E. Rocher, Anabela Angeleri, María A. Avagnina, Lilí B. Díaz, Laura Jufé, Gabriela Mendeluk, Luis A. Palaoro

Journal of Advances in Medicine and Medical Research, Page 1-9
DOI: 10.9734/BJMMR/2016/23933

Activation of epidermal growth factor receptor (p-EGFR) is one of the triggers in the development of many malignant tumors, and the measurement of Argentophilic Nucleolus Organizer Regions (AgNOR) area is used as a marker of tumor proliferation. Alpha actin smooth muscle (αASM) of peritubular cells (PT) and Vimentin expression are modified during the expansion of the CIS /intratubular germ cell neoplasia (ITGCN) to solid seminoma. We evaluated the expression pEGFR, the AgNOR areas, the expression of αASM in PT and the Vimentin in neoplastic cells from CIS/ ITGCN to solid seminoma.

28 formalin-fixed paraffin-embedded archival tissue blocks of Seminomas from the Departments of Pathology of Clinical Hospital and Ramos Mejía Hospital (CABA, Argentina) were used in this study. pEGFR was expressed in CIS/ ITGCN with membranous pattern (8/9), switching to a cytoplasmic pattern in the solid seminoma (15/19). AgNOR areas of atypical gonocytes were increasing from CIS (3.5±0.3 µ2) to intratubular seminoma (3.8±0.4µ2) (p<.5), until solid seminoma (5.3±0.7 µ2) (p<.01). Increase of AgNOR areas is proportional to the expression of pEGFR.

Conclusions: pEGFR was expressed in CIS/ ITGCN with membranous pattern, switching to a cytoplasmic pattern in the solid seminoma. The activation of this receptor could be the first step in the mitogenic signal transduction.

AgNOR areas complement diagnosis of testicular CIS, but not differentiate between CIS and intratubular seminoma. The value of AgNOR areas is maximum in the invasive seminoma, and statistically different from intratubular seminoma. The intensity of αASM in PT decreased as the tumor progressed and Vimentin was negative in neoplastic cells.

Open Access Original Research Article

Is There a Significant Renal Sonographic Difference between HIV/AIDs Positives and Negatives? A Developing Country Perspective

Chukwudi E. Okeke, Samuel O. Mgbor, Emmanuel N. Obikili, Olalekan A. Aderibigbe, Emmanuel O. Modebe, Chinwe J. Chukwuka, Godwin C. Mbata

Journal of Advances in Medicine and Medical Research, Page 1-9
DOI: 10.9734/BJMMR/2016/23138

Background/Objectives: HIV/AIDS is a major health problem in the developing countries. It is a known cause of kidney failure especially in patients with HIV-Associated Nephropathy (HIVAN). Ultrasonography is a cheap and readily available imaging modality that is invaluable in evaluating the kidneys. Its value in pathological inference of HIV-associated renal diseases in developing countries is well known. Renal diseases in HIV/AIDS patients in developing countries are often underdiagnosed and often identified only at its end stage. In this study, we aim to identify, document and correlate the pre-intervention sonographic features of diseased kidneys of adult HIV/AIDS patients between the ages of 18 and 65 years.

Methods: This study was conducted as a prospective & descriptive study to assess the sonographic features in kidneys of 219 HIV-seropositive adults aged between the ages of 18 and 65 years; matched (age & sex), with 219 controls. A 3.5-5.0 MHz curvilinear transducer on a mobile ‘ALOKA’ ultrasound machine was used in the study. Comparison of the findings between HIV-seropositive adults and the controls was done using the chi-square and student T-test analysis to determine any statistical significant difference.

Results: Of 219 HIV+ patients studied, 149(68%) were females with an overall mean age of 38.36 years. The modal age group was the 30 – 39 years with a frequency of 94(42.9%). Observed significant features of HIVAN include nephromegaly, increased parenchymal echogenicity and decreased corticomedullary differentiation.  

Conclusion: The renal sonographic findings in HIV-seropositive research participants are similar to those from other studies within and outside Nigeria. Ultrasound can be a useful tool in the management and care of HIV/AIDS patients.

Open Access Original Research Article

Dietary Intake Adequacy and Evaluation of Nutritional Value in Diabetic Patients

Behrooz Ebrahimzadeh Koor, Mahmoud R. Nakhaie, Saied Babaie, Mehdi Ranjbaran

Journal of Advances in Medicine and Medical Research, Page 1-8
DOI: 10.9734/BJMMR/2016/22982

Aims: Diabetes as a health problem, leads to many pathological effects. Many studies showed that micronutrients found in these patients are not in accordance with the recommendations of RDA*. The aim of this study was to assess the adequacy of nutrient intake in diabetic patients attending diabetes clinics in Markazi Province of Iran, there by basic information on the nutritional status of this group of patients was obtained and early survey started.

Study Design: Cross - sectional study.

Place and Duration of Study: Clinical Research Unit, Markazi Province, Arak, Iran, between April 2012 and July 2013.

Methodology: In a random sample procedure 250 diabetic patients referring to diabetic clinics in Markazi Province was assessed. A questionnaire was completed for each patient. This form included some demographic data and laboratory food frequency questionnaire (FFQ -168) and a 24-hour dietary recall. After completing the questionnaire the amount of energy and nutrients in each food and beverage ingredients were calculated by using food composition table USDA designed in a food processing software. The standard amounts of Recommended Daily Allowances (RDA 1989) were used to evaluate the adequacy of the diet. Data was analyzed using Pearson correlation coefficient, chi-square and Independent Samples T-test, Paired Samples T-test the SPSS16 statistical software were used.

Results: In this study, about 32% of patients had normal weight and 68% of them were overweight or obese. The mean of fasting blood glucose was 212.5 mg /dl. Percentage of energy derived from carbohydrate, protein and fat, was 58.8 and 13.6 and 27.6% respectively. Percentage of energy from saturated fat was around 17%. Among male patients, energy intake, fiber, unsaturated saturated fat energy percentage, calcium, phosphorus, iron, potassium, zinc, vitamin A, selenium, vitamin K, vitamin C and vitamin E intake values are significantly different from RDA values​​, the amounts of iron, percent of energy from saturated fatty acids, and vitamin E intakes were significantly higher than RDA values and other nutrient intakes were lesser than the RDA. Among female patients, fiber intake, percentage of energy  from unsaturated and saturated fat, calcium, phosphorus, potassium, zinc, vitamin B1, folic acid and vitamin E values are significantly different from  RDA values, among of these amounts, energy from saturated fat, zinc, vitamin B1 and vitamin E ​​were significantly higher than RDA values and other nutrient intakes were lesser than the RDA.

Conclusion: Our findings indicate that the nutritional adequacy of food intake in diabetic patients, is not desirable. The amount of energy from carbohydrate was higher than RDA recommendations. Percent of energy from saturated fatty acids was higher than standard. Percent of energy from saturated fatty acids was higher than standard. Despite the apparent over-weight and obesity of patients, there was nutrient deficiency in them.  In overall, in this area choice of balance diet and training are necessary.

Open Access Review Article

Local Anesthetic Used for Dental Treatment in Children- Systematic Review

Neeraja Ramadurai, Deepa Gurunathan, E. M. G. Subramanian, A. Victor Samuel

Journal of Advances in Medicine and Medical Research, Page 1-9
DOI: 10.9734/BJMMR/2016/23941

Aims: To analyse the existing literature on the effectiveness of various injectable amide local anaesthetic agents for children undergoing routine dental treatment.

Design: A systematic search was carried out for the databases of PubMed, Central, LILACS, Science direct, Metapress and SIGLE to identify clinical trials published on the effectiveness of injectable amide local anaesthetic agents in dental journals from the inception of the databases up to July 2015.

Results: The systematic search gave nine studies. Four of out seven studies found articaine to more effective. No significant difference in anaesthetic effectiveness of the agents were found in seven studies. One study reported significant difference in the anaesthetic effectiveness in favour to articaine. Two studies reported articaine to have longer duration of action.

Conclusion: With the available evidence, this review may suggest that articaine is an effective amide anesthetic agent. Lignocaine is most effective at 2% concentration. Prilocaine and mepivacaine show comparable effectiveness. As eight of the studies have high risk of bias, there is a greater need for well-designed randomized controlled studies to be conducted to assess effectiveness of various injectable amide local anaesthetics to be used in children for routine dental treatment.