Open Access Case Report

An Unusual Case of Cerebral Nocardiosis Masquerading as Tuberculosis

Gupta Priyanka, Sarma Smita, Sengupta Sharmila, Gupta Neha

Journal of Advances in Medicine and Medical Research, Page 1-4
DOI: 10.9734/BJMMR/2016/28824

This is a report of a unique case of cerebral nocardiosis in an immunocompetent host who was initially diagnosed with extra pulmonary tuberculosis not responding to 1st line anti tubercular treatment (ATT). The deteriorating abscess required multiple drainage procedures before the correct diagnosis was clinched by microbiological analysis. Cerebral nocardiosis is a rare entity, typically occurs in immunocompromised host and is associated with poor prognosis. As it can be easily confused with tuberculosis, a high index of clinical suspicion and supporting microbiological evidence is essential for the correct diagnosis. 

Open Access Case Report

Bilateral Optic Atrophy Following Methanol Poisoning: A Case Report

A. A. Onua, I. C. Nwadiuto, C. N. Pedro-Egbe

Journal of Advances in Medicine and Medical Research, Page 1-6
DOI: 10.9734/BJMMR/2016/26645

Background: Methanol is an industrial chemical found in many products including antifreeze solutions, solvents and fuels. Most cases of methanol poisoning among humans occur following accidental ingestion, inhalation or dermal exposure. Humans may sometimes ingest methanol as an ethanol substitute or to inflict injuries on themselves. Multiple victim methanol poisonings can occur with illicit distillation or occult substitution of methanol for ethanol. The clinical diagnosis is made in the presence of toxic alcohol ingestion, early visual symptoms and unexplained metabolic acidosis. 

Case Report: We report a case of methanol poisoning with bilateral optic atrophy in a 53-year old carpenter who presented to the ophthalmology clinic, University of Port Harcourt Teaching Hospital on 9th June 2015 on account of eight days history of sudden loss of vision in both eyes, following ingestion of alcohol with colleagues. Prior to presentation, he had good vision in both eyes. 

Clinical examination revealed visual acuity of hand motion in both eyes, widely dilated pupils with no reaction to light. Fundoscopy showed bilateral chronic optic atrophy. Based on the clinical and fundus photographic findings and the epidemiological report of methanol poisoning outbreak in Rivers State at this particular time from 30th May 2015 to 15th June 2015), a diagnosis of methanol poisoning was entertained. Patient was treated with folic acid, prednisolone and multivitamins.

Conclusion: Early recognition and treatment of methyl alcohol poisoning could prevent hazardous outcome. Late Presentation of our client worsened by poverty and ignorance led to optic neurotoxicity, with bilateral blindness. Practising ophthalmologist should have a high index of suspicion of alcohol related chronic optic neuropathy with blindness among chronic alcoholics.

Open Access Case Study

Adult Sigmoid Colo-colic Intussesception Due to Polypoidal Lipoma: A Rare Case Report

Rahul Jain, Dharmender Aggarwal, Vidhya Gunasekaran, Sushanto Neogi, Ruchi Jain

Journal of Advances in Medicine and Medical Research, Page 1-4
DOI: 10.9734/BJMMR/2016/29810

Aim: Intussusception is defined as invagination or telescoping of proximal bowel loop (intussusceptum) into distal loop (intussuscepiens). More than 90% of adult colonic intussusceptions are associated with a mass acting as lead point. It is required for all treating surgeons to know about presentation and management of adult intussusception.

Case Report: A 40 year old man presented with pain in left iliac fossa and obstipation. Ultrasonography reveals target sign in left iliac fossa and CT scan showed sigmoid colo-colic intussusception with polypoidal submucosal lipoma as lead point. Patient was managed with en bloc resection and anastomosis in continuity.

Discussion: Intussusceptions are very rare in adult population and less than 50 cases has been reported till now of colo-colonic intussusception with lipoma as lead point. About 60% of adult colonic intussusception are caused by malignant growth. CT scan is able to diagnose correctly in about 95% cases and role of colonoscopy is debatable for reduction of intussusception.

Conclusion: Although rare, pathophysiology of adult intussusception should be understood clearly for proper management. Early CT scan should be used in doubtful cases to diagnose intussusception.

Open Access Opinion Article

The Intricate Relationship between Insulin Resistance and Adipokines in Non-obese Patients with Polycystic Ovarian Syndrome

Suparna Roy, Anindya Dasgupta, Rituparna Maji, Nibedita Chattopadhyay, Arati Biswas

Journal of Advances in Medicine and Medical Research, Page 1-9
DOI: 10.9734/BJMMR/2016/29265

Background: Dyslipidemia and metabolic complications related to Insulin resistance are closely linked to patients suffering from polycystic ovarian syndrome (PCOS).

Aims: To find out the changes in serum testosterone, leptin and adiponectin levels and explore their relative importance in alterations of insulin resistance (IR) in non obese PCOS patients.

Study Design: Hospital based, case control, non interventional study. Both cases and control subjects were selected following the method of convenience according to prefixed inclusion and exclusion criteria.

Methodology: In 33 non obese PCOS patients and 35 controls Leptin, insulin, testosterone, leutinizing hormone (LH), follicular stimulating hormone (FSH) and adiponectin were measured by enzyme linked immunoassay (ELISA). Fasting plasma glucose (FPG) was measured by spectrophotometric method. Insulin resistance (IR) was calculated through homeostatic model for assessment of insulin resistance (HOMA-IR) technique. Waist hip ratio (WHR) and body mass index (BMI) were calculated as anthropometric parameters to assess distribution of body fat.

Results: Mean +/- Standard error of mean values for the HOMA-IR (1.98 +/- 0.19 vs 1.04 +/ - 0.04), FBG (4.98 +/- 0.27 vs 4.52 +/- 0.07) serum leptin (12.55 +/- 1.00 vs 8.23 +/- 1.03), serum testosterone (1.19 +/- 0.07 vs 0.41 +/- 0.04), serum LH (30.74 +/- 1.73 vs 5.69  +/- 0.44), serum FSH (10.93 +/- 0.38 vs 6.29 +/- 0.46) and WHR (0.82 +/- 0.01 vs 0.74 +/- 0.01) were significantly elevated in the PCOS patients compared to the control group. On the other hand, serum adiponectin was significantly decreased in PCOS group (11.41 +/- 1.21 vs 23.55 +/- 2.94) while BMI showed no significant difference. Although, individual bivariate correlation analysis suggested IR to be significantly associated with serum leptin, adiponectin, testosterone and WHR, but multivariate linear regression analysis revealed significant predictive values for serum leptin (β = .467,), adiponectin (β = -.324,) and testosterone (β = .266,) only on the HOMA-IR.

Conclusion: Increased androgen and leptin along with decreased adiponectin levels have crucial determining effects on increased IR that might play a major role in mediating the pathogenesis and metabolic abnormalities in non obese PCOS.

Open Access Original Research Article

Complex Changes in Blood Biochemistry Revealed by a Composite Score Derived from Principal Component Analysis: Effects of Age, Patient Acuity, End of Life, Day-of Week, and Potential Insights into the Issues Surrounding the ‘Weekend’ Effect in Hospital Mo

Rodney P. Jones, Graham Sleat, Oliver Pearce, Martin Wetherill

Journal of Advances in Medicine and Medical Research, Page 1-28
DOI: 10.9734/BJMMR/2016/29355

Aims: To determine if a score (PCA score derived from Principal Component Analysis), a validated score of frailty and mortality, based on 12 blood biochemistry parameters can shed light on the issue of patient acuity, end of life and weekend mortality in hospitals.

Study Design: The PCA score was calculated from over 280,000 blood tests. Average PCA score was calculated for different patient groups on different days of the week. An accompanying literature review of day-of-week variation in human mental and physical performance, and of studies investigating hospital mortality.

Place and Duration of Study: Retrospective analysis of 280,000 blood test results from 80,000 patients attending the Milton Keynes University Hospital in the interval January 2012 to July 2015.

Participants: Patients at outpatient clinics, the emergency department or as an inpatient who had one or more blood samples comprising the 12 biochemical tests.

Methodology: Average PCA score was calculated for patients in different hospital departments, on different days of the week, in different age groups, and at different times prior to death.

Results: The PCA score for individual’s ranges from -6 to +6, with scores above zero generally associated with higher morbidity and mortality. The average PCA score is lowest in outpatient and A+E settings, varies across wards dedicated to different types of inpatient care, and is highest in ICU. The average PCA score reaches a minimum around age 18, and shows a modest increase with age in those who are not an inpatient. There is a day-of-week variance in the PCA score which is higher at the weekends, and dips to a minimum around Wednesday. The strength of the day-of-week effect varies by age and condition, and occurs in locations where staffing levels remain constant throughout the week.

Conclusions: Variation in human blood biochemistry follows day-of-week patterns and responds to different conditions, age, and the acuity of the condition. These add further weight to the argument that weekend staffing levels, and proposed 7 day working patterns, do not take account of all the factors that contribute to a day-of-week variation in hospital mortality and morbidity.


Open Access Original Research Article

Therapeutic of Controlled Exposure to Selected Allergens - A Non-drug Measure

Nwachukwu Francis Chukwuedozie, O. Mbakwe, Onwuegbule Martina Chinyere

Journal of Advances in Medicine and Medical Research, Page 1-7
DOI: 10.9734/BJMMR/2016/27799

Allergies exemplify the cases in which normally unnecessary immune responses give rise to diseases. The research was aimed to explain some of the background on biochemical adaptation, in non drug treatment of allergic reactions through well-thought-out exposure on allergens. Allergic reactions viz: Insect sting allergy, allergic rhinitis, food allergy, drug allergy and allergic asthma were delved into and result presented in percentage reliability. The results of the six-year showed insect sting allergy, allergic asthma, and allergic rhinitis were 60, 33 and 39% respectively, while drug and food allergy were 30 and 38% respectively. The allergies follow similar pattern in all, involving inflammation, immunoglobulin E, histamine among others. The results depicted that controlled repetitive exposures caused desensitization and tolerance to the respective allergens. This method might have reduced the production of allergic participatory cells hence a new form of vaccination. This study described the outcome of the association between allergen exposure, sensitization and allergic diseases. This work is considered paramount when allergy symptoms are moderate to severe, occurs throughout the year, do not respond adequately to medications, and are triggered by an allergen not easily avoided.

Open Access Original Research Article

Comparison of Shear Bond Strength of Different Orthodontic Metal Bracket-bases Bonded on Enamel Surface – an In vitro Study

Nirav Dholakiya, Hina Desai, Mohammed Shahid Dal, Nikunj Patel, Rahul Aghera, Nishil Agrawal

Journal of Advances in Medicine and Medical Research, Page 1-9
DOI: 10.9734/BJMMR/2016/29260

Aim: To compare the shear bond strength of different metal bracket bases bonded on enamel surface and further to evaluate the Adhesive Remnant Index score to localize the sites of adhesive fracture.

Materials and Methods: Four types of premolar metal brackets were selected according to their different mesh designs: (G1, Gemini Series,3M Unitek; G2,Micro Sprint, Forestadent; G3,Equilibrium 2,Dentaurum and G4,Mini-Master Series, American Orthodontics). One hundred brackets for each type were used and bonded on enamel surfaces of extracted human premolars (Transbond XT, 3M Unitek) and were tested to evaluate shear bond strength with an Instron Universal Testing Machine (Star Testing Systems, India). All data were analysed with ANOVA, Tukey’s HSD Post hoc test, and with descriptive statistics. The adhesive fracture site was also evaluated and classified with ARI score.

Results: G2 showed greater shear bond strength when compared with other samples (P < 0.001). G2 and G3 showed statistically significant differences in comparison with other groups with respect to shear bond strength. There was no statistically significant difference between G1 and G4. The ARI index demonstrated a large variability. G2 showed 70% of the adhesive fracture at cement-enamel interface.

Conclusion: G2 showed the highest shear bond strength in comparison with other groups. ARI score showed that G2 resulted in 70% adhesive fractures at the cement-enamel interface. An increased size of the bracket-base enhances adhesion but affects the adaptability to surface morphology of the enamel, increasing the risk of fracture at the interface with the bracket.

Open Access Original Research Article

Biochemical Evaluation of Selected Renal Indices in Women with Metabolic Syndrome in Ilesa Metropolis South Western Nigeria

Stephen Olajide Awofadeju

Journal of Advances in Medicine and Medical Research, Page 1-9
DOI: 10.9734/BJMMR/2016/26851

Aim: The aim of this study was to see the effects of metabolic syndrome on some selected renal indices for kidney biological functions.

Study Design:  One-factor, one control - one test group quasi - experimental design.

Place and Duration of Study: Department of Chemical Pathology, Obafemi Awolowo University Teaching Hospitals Complex, Wesley Guild Hospital Unit, Ilesa, Osun State, Nigeria, between July 2015 and March 2016.

Methodology: A total of eighty (80) subjects were recruited for the study, and were grouped into normotensive women (n=40), and women with metabolic syndrome (n=40). Blood samples (10 mL venous blood) and 24 hour timed urine were collected, centrifuged and stored as plasma and aliquoted urine respectively before subjection to biochemical analysis. Blood plasma and urine samples were analyzed for renal indices using standard flame photometry and Spectrophotometric methods.

Results: Renal indices results revealed that Plasma (creatinine, urea, sodium and potassium) were significantly raised in women with metabolic syndrome when compared to normotensive women while significant decreases were observed in Urine (creatinine, potassium and urea) and creatinine clearance rates respectively in same comparison. However, a non-significant increase in Urine (volume and protein), as well as a non-significant decrease in urea clearance rates and urine sodium were seen in women with metabolic syndrome when compared to normotensive women.

Conclusion: This work revealed that metabolic syndrome has negative effects on the renal indices investigated which were attributed to the characterizing high blood pressure and vessel dysregulation to possibly result in kidney dysfunction in its sufferer. This work thus showed that renal indices can be employed with other investigations to diagnose metabolic syndrome, prevents its medical complications and monitor treatment progress.

Open Access Original Research Article

Patient Factors that Predict Complicated Hernia Presentation Using the National Hospital Ambulatory Medical Care Survey (NHAMCS)

Deborah Green, Emaad Iqbal, Aziz M. Merchant

Journal of Advances in Medicine and Medical Research, Page 1-10
DOI: 10.9734/BJMMR/2016/29338

Aims: Patient age and insurance status can lead to presentation with complicated hernias. Surgery for complicated hernias results in greater morbidity, mortality, and healthcare costs compared to elective repair of uncomplicated hernias. This study explores the association between insurance status and age with presentation of complicated inguinal hernia.

Methodology: Data from Center for Disease Control (CDC) National Hospital Ambulatory Medical Care Survey (NHAMCS) for 1992-2010 of inguinal hernia encounters from emergency department and outpatient visits were selected and combined. This cross-sectional study compared presentation of complicated inguinal hernia with explanatory variables of insurance status and age through chi-square and logistic regression analysis. Ethnicity and sex were potential confounders.

Results: Of the 1452 inguinal hernia encounters, 4.1% were complicated. Lack of insurance did not predict presentation with a complicated hernia (OR=0.11, 95%CI [0.04-0.35]), even after adjusting for age, sex, and ethnicity. Age 65 years and older was a strong predictor of complicated hernia presentation (P<.0001). The reduced odds of presenting with a complicated hernia for those without insurance persisted across different age groups.

Conclusion: Our results suggest that age is a strong predictor of complicated hernia presentation; however, lack of insurance is not. Elderly patients, regardless of insurance status, should be considered for early elective hernia repair.

Open Access Original Research Article

Evaluation of Optical Coherence Tomography Findings in Idiopathic Parafoveal Telangiectasia Type 2

Yesim Altay, Fatih Kocamaz, Yasemin Topalak, Pınar Altıaylık Ozer, Sertac Ozturk, Ahmet Sengun

Journal of Advances in Medicine and Medical Research, Page 1-7
DOI: 10.9734/BJMMR/2016/29197

Background and Objectıves: To evaluate changes in eyes with idiopathic parafoveal telangiectasia  type 2 (IPFT) using  spectral domain optical coherence tomography (SD-OCT).

Materıals and Methods: SD-OCT images of cases  were analyzed for the presence or absence of foveal contour asymmetry, inner and outer retinal cavities, hyperreflective spots, photoreceptor disruption and outer limiting membrane (OLM) integrity.

Results: Twelve eyes of 7 patients with IPFT type 2 were examined by SD-OCT. Foveal contour asymmetry was found in 41.6% of the eyes. Hyporeflective retinal cavities were found in 25% involving only inner layer, 8.3% involving only outer layer and 66.6%  involving both inner and outer layers of the eyes. In 50% of the eyes, hyperreflective spots were present. Photoreceptor loss was observed in 66.6% of the eyes and appeared as hyporeflective areas at inner and outer photoreceptor segments (IS-OS) junction. Of the 8 eyes with photoreceptor disruption, the OLM was disrupted in 7 eyes (87.5%). OLM was intact in all 3 eyes with only inner retinal layer  cavitation. The all eyes with both inner and outer retinal cavities had photoreceptor disruption.

Conclusıon: This study desribed characteristic changes in IPFT type 2 based on SD-OCT. The pathogenesis of IPFT type 2 is not entirely understood and SD-OCT is a powerful tool for evaluating this disorder. According to our findings, the integrity of both OLM and photoreceptors seem to be closely associated with IPFT type 2 and  the primary pathology in these eyes is the Müller cells.