Open Access Case Report

Globotriaosylceramide (GL-3) Accumulation in the Renal Biopsy of a 1-year-old Patient with Fabry Disease and Ureteropelvic Junction Obstruction

D. Ripeau, F. Masllorens, N. Lago, H. Amartino, J. I. Bortagaray, H. A. Repetto

Journal of Advances in Medicine and Medical Research, Page 1-6
DOI: 10.9734/BJMMR/2016/25294

Introduction: Fabry disease is a x-chromosome hereditary disease with an incidence of 1/40000 newborns. Nowadays it presents as much in males as in females and its first clinical symptoms are seen in pediatric patients. Patients have reduced or no activity of alpha-galactosidase which leads to progressive accumulation of GL-3 in lysosomes of all types of cells. This early deposition disrupts lysosomal function, leading to cell death, metabolic problems, vascular lesions, endothelial dysfunction, oxidative stress, alterations in autophagy tissue ischemia, and finally producing fibrosis in different tissues. On the other hand, ureteropelvic junction obstruction (UPJO) is the most frequent congenital anomaly of the urinary tract; with an incidence of 1 in 1000-2000 newborns.

A patient with antenatal diagnosis of Fabry disease and pre-natal diagnosis of UPJ is described. GL-3 deposits were found in all progeny of renal cells in the surgical biopsy.

Patient Report: Prenatal diagnosis of FD and severe left hydronephrosis (left renal pelvis 23 mm) He was born at term with adequate weight. Enzymatic activity of Alpha-Gal A was low and the molecular analysis confirmed the family’s mutation. Pyeloplasty was performed when he was 17 months old and, having obtained informed consent, a small piece of kidney was studied, showing evidence of characteristic GL-3 deposits in all cell types and showed podocyte “effacement”, a marker of injury and stress.

Conclusion: We demonstrate in this report that the deposits that lead to the sequence of a series of inflammation and fibrosis are present at a very early age. Based upon this finding, one can speculate about the prevention of late lesions with an early start of enzyme replacement therapy (ERT). Long term follow-up studies will be necessary to confirm this hypothesis.

Open Access Short Research Article

Effect of Depressive Mood on NK Cells in Patients with Pancreatic Tumor – Pilot Study

Jindřich Kopecký, Ladislav Slováček, Birgita Slováčková, Zuzana Šinkorová, Jiří Knížek, Stanislav Filip, Petronela Trojanová, Ondřej Kubeček, Otakar Kopecký

Journal of Advances in Medicine and Medical Research, Page 1-8
DOI: 10.9734/BJMMR/2016/25200

Aims: In up to 50% of cases is pancreatic cancer accompanied with depressive symptoms or already developed depression. There is well described connection between pancreatic cancer and qualitative changes in immune system. The purpose of this pilot study was to observe the quantitative changes in levels of NK cells and the state of expression of activation and inhibitory receptors on the surface of NK cells in the peripheral blood of patients with pancreatic tumor.

Study Design: This is prospective analytical study.

Place and Duration of Study: The study was carried out between December 2010 and April 2011 at the University Hospital Hradec Králové, Czech Republic.

Methodology: Twenty-one patients with locally advanced or metastatic adenocarcinoma of the pancreas were divided into two groups based on the presence of depressive symptoms. The control group consisted of healthy volunteers. The presence of depressive symptoms was assessed by the Zung self-rating depression and psychiatric examination. Measurement and analysis of peripheral venous blood was performed by flow cytometry to estimate quantitative changes in NK cells. The statistical significance was considered as p < .05.

Results: There was reduced number of CD56brightCD16- subset (P = .01), decreased levels of NKp46 positive NK cells in patients with pancreatic cancer and depressive symptoms (P = .03), but without statistical significant for patient without depression (P = .054). We found decreased number of NKG2A-positive circulating NK cells in patients without depressive symptoms in comparison to control group (P = .05). No differences in NK cells, its subsets and receptors were observed when comparing each group of patients with each other.

Conclusion: The main immunomodulating factor in the case of NK cells in pancreatic cancer is the tumor itself. This is valid particularly for reduced levels of NK cell activation receptors. The presence of chronic stress or depression plays its role in affecting the number and distribution of NK cells and might play an important role in tumor escape mechanism.

Open Access Original Research Article

Beneficial Effects of Ascorbic Acid and Alpha-tocopherol on the Locomotor Functional Recovery of Spinal Cord Injured Rats

A. Alwin Robert, S. Sheik Abdullah

Journal of Advances in Medicine and Medical Research, Page 1-10
DOI: 10.9734/BJMMR/2016/24533

Aim: To examine the effects of ascorbic acid and alpha-tocopherol on the locomotor functional recovery of rats with incomplete spinal cord injury.

Methods: A total of 80 male Sprague-Dawley rats (180–200 g) were used. Seventy of them were subjected to spinal cord injury (SCI) and given various doses of ascorbic acid and alpha-tocopherol as treatment for 84 days (12 weeks). The remaining 10 rats were used as a control (without SCI, untreated). Basso, Beattie, and Bresnahan (BBB) and Tarlov scores were used to assess the locomotor recovery.

Results: Compared with the baseline value, all the rat groups tested (i.e. 3, 4, 5, 6, 7 and 8) showed gradual improvements in the BBB and Tarlov scores at the end of the first week. These improvements were sustained at all-time points until the completion of the trial period. Besides, when compared with disease control, positive improvements were observed in all the groups tested with respect to their BBB and Tarlov scores throughout the trial period. When the low-dose ascorbic acid and alpha-tocopherol groups were compared with the high-dose ascorbic acid and alpha-tocopherol groups, positive differences were observed in the BBB and Tarlov scores. When compared with the ascorbic acid treatment group significant additional improvements were observed in the alpha-tocopherol groups, especially in the high-dose alpha-tocopherol group.

Conclusion: Administration of high-dose alpha-tocopherol enhances the SCI-induced locomotor functional recovery as it is more effective than the ascorbic acid.

Open Access Original Research Article

Medicinal Plants for Treatment of Neonatal Jaundice by Community of Attars (Traditional Healers) of Several Urban Areas in Mazandaran Province, Northern of Iran

Moloud Fakhri, Mohammad Azadbakht, Seyede Seddigheh Yousefi, Seyyed Nuraldin Mousavinasab, Roya Farhadi, Masoud Azadbakht

Journal of Advances in Medicine and Medical Research, Page 1-13
DOI: 10.9734/BJMMR/2016/24795

Aims: This study aimed to determine the use of specific medicinal plants based on traditional medicine from community of Attars (Traditional healers) in the province of Mazandaran (North Iran).

Place and Duration of Study: The province of Mazandaran in north Iran, between March until July 2015.

Methodology: Eighty-eight Traditional healers consisting of 62 men (70.5%) and 26 women (29.5%) from among the community of Attars (i.e. The Owners of shops, selling medicinal plants, providing traditional medications and some time act as traditional healer) of the province of Mazandaran in north Iran were randomly selected using questionnaires from March until July 2015.

Results: In this study, 50 plant species belonging to 29 plant families were recommended for treating neonatal jaundice. Asteraceae, Fabaceae and Rosaceae were the most commonly used plant families. The five main plants with the highest reported use included: Contoneaster discolor, Descurainia sophia, Cichorium intybus, Alhagi camelorum, and Fumaria parviflora. The most important reason for prescribing medicinal herbs was to help detoxify the body, and the most important reason that people visit Attaries (i.e., shops selling medicinal plants, providing traditional medications) to receive remedies was stated as the lower side effects of these traditional remedies.

Conclusion: This study shows that numerous medicinal plants are recommended for treating neonatal jaundice in Mazandaran province by Attars (Traditional healers). To the best of our knowledge, the wide range of herbs used for the treatment of neonatal jaundice has not been previously reported in any other study as extensively as shown here. Naturally, it is necessary to perform comprehensive studies on the above-mentioned medicinal plants to make use of these herbal remedies.

Open Access Original Research Article

Oxidative Stress in Ghanaians Presenting with Prostate Cancer

C. K. Gyasi-Sarpong, Idriss Ali, W. K. B. A. Owiredu

Journal of Advances in Medicine and Medical Research, Page 1-8
DOI: 10.9734/BJMMR/2016/25093

Introduction: The latest estimates of global cancer incidence show that prostate cancer has become the second most common cancer among men in the world. A number of reports have linked oxidative stress to prostate cancer. Although oxidative stress has been found to be much prevalent among the Ghanaian population, no data exist on its prevalence among prostate cancer patients in Ghana. This study therefore sought to investigate oxidative stress in Ghanaians presenting with prostate cancer.

Methods: This cross-sectional study was conducted at the out-patient department of the department of surgery, Komfo Anokye Teaching Hospital, Kumasi, between the period of November, 2010 and April, 2012. In all, one hundred and twenty four (124) adult males (87 case subjects and 37 control subjects) aged at least forty two years were enrolled.

Results: Malondialdehyde, an oxidative stress marker, and uric acid were significantly raised whereas the measured antioxidant (vitamin C) was significantly reduced among the prostate cancer patients compared to the controls. The indication is that oxidative stress with reduced antioxidant levels is common in prostate cancer patients.  

Conclusion: Oxidative stress may have a significant role in prostate cancer. Based on the findings, it may seem reasonable to propose that therapeutic regimens aimed at beefing up the antioxidant defences could help offer some degree of protection for prostate cancer patients against oxidative stress.

Open Access Original Research Article

Comparison of the Immediate Effect between Functional Electrical Stimulation and Ankle Foot Orthoses on Gait Parameters in Cerebral Palsy

Waleed Salah El-Din Mahmoud, Ragab Kamal Elnaggar

Journal of Advances in Medicine and Medical Research, Page 1-10
DOI: 10.9734/BJMMR/2016/25353

Aim: To compare the immediate effect of functional electrical stimulation (FES) to solid ankle foot orthosis (SAFO) concerning spatiotemporal parameters and ankle kinematics during gait in hemiplegic cerebral palsy (CP).

Methodology: Thirty spastic hemiplegic cerebral palsied children were randomly distributed into two equal groups; group A, who used the functional electrical stimulation (FES) and group B, who worn the solid ankle foot orthosis (SAFO).  Vicon 3D motion analysis system was used to measure the spatiotemporal parameters of gait and ankle dorsiflexion angle at initial contact and mid-swing before intervention and with application of either FES or SAFO. Spasticity was ranged between 2 and 1+ and determined by Modified Ashworth Scale score.

Results: Following the application of  solid AFO, stride length and walking speed significantly increased than next to FES (p=0.0001, p=0.001) respectively. Whereas, number of steps/minute significantly decreased (p=0.001). Further, Solid AFO increased ankle dorsiflexion at initial contact (6.2±4.7º) and mid-swing (3.4±0.6º) more than FES at initial contact (1.86±3.9º) and mid-swing (-4.6± 5º).

Conclusion: FES, unlikely found to evoke an immediate effect of spatiotemporal parameters while solid AFO improved the gait efficiency by enhancing spatiotemporal parameters. Both treatment interventions increased ankle dorsiflexion at initial contact and mid-swing but solid AFO was more effective immediately than FES.

Open Access Original Research Article

Transviginal Ultrasound Assessment of Normal Ovarian Volume among Women of Reproductive Age in Jos, Nigeria

S. M. Danjem, P. O. Ibinaiye, A. J. Salaam

Journal of Advances in Medicine and Medical Research, Page 1-6
DOI: 10.9734/BJMMR/2016/24679

Objective: This study was to evaluate the normal ovarian volume among women of reproductive age using transvaginal ultrasound and correlating it with different age groups, parity and BMI.

Methodology: A hospital-based cross-sectional descriptive study. The data were obtained from 347 selected clinically and sonographically healthy non pregnant women. Sonographic examination was done using LOGIC 5 machine fitted with a 7.5 MHz transvaginal transducer. The right and left ovarian volume of each patient was measured. The mean ovarian volume was classified into five different age groups, four categories of BMI as well as different parities and the results were analyzed.

Results: The mean ovarian volume was 7.9±2.1 cm3. The average volumes of the left and right ovaries were 8.0±2.0 cm3 and 7.7±2.2 cm3 respectively. Statistical significant difference between the left and the right mean ovarian volume was noted (p=0.00). Ovarian volume showed a trend of decline after reaching its peak at the second decade of life. Negative correlation was shown between ovarian volume and parity (p=0.02). There was no statistical significant difference in ovarian volume related to BMI (p=0.74).

Conclusion: These values represent the normal average ovarian volume for the local population.

Open Access Original Research Article

Association of Sclerostin with Bone Metabolism and Bone Mineral Density in Adults with Type 1 Diabetes Mellitus

Neslihan Soysal-Atile, Bülent Bilir, Betül Uğur-Altun, Betül Ekiz-Bilir, Hüseyin Çelik

Journal of Advances in Medicine and Medical Research, Page 1-7
DOI: 10.9734/BJMMR/2016/25400

Aims: Type 1 DM (T1DM) patients are shown having lower bone mineral density (BMD). Wnt signaling pathway is important in bone homestasis. Sclerostin is a major inhibitor of this pathway. The objectives of our study are to evaluate sclerostin levels of T1DM patients and to analyse its relationships with bone turnover markers.

Place and Duration of Study: Department of Endocrinology, Tekirdağ State Hospital, between January to December 2013.

Methodology: 48 T1DM patients and age, sex and BMI-matched 40 healthy control cases were included in this study. BMD measurements of T1DM patients were done by dual energy x ray absorptiometry. Serum samples were used to measure albumin, calcium, phosphorus, alkaline phosphatase, intact parathyroid hormone, osteocalcin, pyrilinks-D, 25(OH) Vitamin D and sclerostin levels of all cases.

Results: Sclerostin levels of T1DM patients (803,9±92,01 pg/ml) were significantly higher than control cases (522,9±76,23 pg/ml) (P=0.000). Sclerostin has no correlation with age or gender. Sclerostin level was negatively correlated with lumbar vertebrae and femur neck BMD; however, positively correlated with alkaline phosphatase, intact parathyroid hormone, osteocalcin, pyrilinks-D. Lumbar vertebrae and femur neck BMD has negative correlation with HbA1c and duration of T1DM.

Conclusions: Sclerostin is increased in T1DM patients and this increment is associated with degradation of lumbar vertebrae and femur neck BMD.

Open Access Original Research Article

Non-clinical Expectations of Patients in an Oral Healthcare Setup: A Qualitative Research

Mina Pakkhesal, Arezoo Ebn Ahmady, A. Hamid Zafarmand, Maryam Sadeghipour, Nona Attaran

Journal of Advances in Medicine and Medical Research, Page 1-8
DOI: 10.9734/BJMMR/2016/25020

Aims: Patients’ expectations are essential part of healthcare delivery system. This would definitely relate to patient satisfaction and consequently would provide a guideline for promotion of community health level. This study illustrates the non-clinical expectations of patients referred to a dental school clinic.

Study Design: This is a Qualitative study.

Place and Duration of Study: This study was performed in dental school of Shahid Beheshti University of Medical Sciences, for a period of three months from May to July 2015.

Methodology: In this qualitative study, seventeen patients aged 18 years and older were interviewed. These patients were selected by convenient sampling method from a dental school in Tehran, Iran. The data was gathered based upon semi-structured, face-to-face, and an in-depth interview. The transcribed interview texts were analyzed according to the principals of qualitative content analysis.

Results: The responses were interpreted into two main themes: “met” and “unmet” expectations.  “Met expectations” included four subthemes consisting “students and staff behaviors”, “infection control”, “fees”, and “trust” in dental school clinics. “Unmet expectations” included seven subthemes consisting “length of reception process”, “waiting time”, “accessibility”, “explanation about treatment procedures”, “facilities and equipment”, “working hours of the clinic” and “insurance coverage”.

Conclusion: The results highlight that there are many concerns to the eyes of healthcare receivers which should be regarded by healthcare providers and administrators. Meeting these expectations would consequently improve the oral health level of a related community.

Open Access Review Article

Behavioral Anatomy of the Celiac Trunk Based on Human Embryology

Mohammed H. Karrar Alsharif, Khalid M. Taha, Abubaker Y. Elamin, Khalid H. Al-Dosari

Journal of Advances in Medicine and Medical Research, Page 1-7
DOI: 10.9734/BJMMR/2016/23879

Anatomical knowledge of the coeliac trunk and its branches is indispensable for surgeons in order to avoid post-surgery complications and malpractice and that’s what inspired us to review this important topic.

The coeliac trunk is the first ventral branch of arising from the abdominal aorta below the aortic opening of diaphragm.

It is responsible for the blood supply of the not only the foregut but also for accessory organs of gastrointestinal tract (GIT) which include liver, pancreas and biliary apparatus [1]. Anatomic variations are often responsible for a variety of clinical conditions and it’s often occurring in the coeliac trunk branches.