Open Access Case Report

Scalp Metastasis from Thyroid Carcinoma 12 Years Post-thyroidectomy: Clinical and Ethical Lessons

M. O. Udoh, D. F. Mekoma, C. Osime, U. O. Igbokwe

Journal of Advances in Medicine and Medical Research, Page 1-6
DOI: 10.9734/BJMMR/2016/29983

Aim: We describe a rare presentation of thyroid carcinoma, to highlight thyroid carcinoma in the differential diagnosis of skin lesions; and emphasize the importance of efficient record keeping in patient management.

Presentation of Case: A 73 year old man who presented with an occipital scalp nodule. This solitary skin lesion was the presenting symptom of the recurrence of a thyroid tumor surgically treated 12 years earlier. All records of the initial presentation and treatment could not be retrieved.  Immunohistochemistry of the scalp lesion confirmed a thyroid carcinoma. Further examination revealed nodules in the thyroid bed, liver and lung metastases. He was referred for radio iodine therapy.

Discussion: Recurrences of thyroid carcinoma are common and can occur several years after initial diagnosis. Our patient presented with a scalp metastasis 12 years post thyroidectomy. The non-availability of the patient’s medical records makes it difficult to evaluate the management of the patient at initial presentation, and the follow up period.

Conclusion: Thyroid lesions in elderly males are more likely to be cancerous, and can recur several years after initial treatment. Proper investigation, efficient record keeping and, long term follow-up is advocated.

Open Access Case Study

Ochrobactrum anthropi - An Unusual Cause of Line Related Sepsis. Current Knowledge of the Epidemiology and Clinical Features of This Pathogen

Guillermo Jimenez, Suresh Antony

Journal of Advances in Medicine and Medical Research, Page 1-7
DOI: 10.9734/BJMMR/2016/29365

Onchrobactrum anthropi is a rare gram negative pathogen that is not usually associated with human infection. When it does occur, it tends to cause severe sepsis related to central venous devices. The susceptibility patterns vary and removal of the device and treatment using a suitable antimicrobial usually results in a cure. We present such a case in an immunocompetent patient and review the available.

Open Access Minireview Article

Why Endometriosis Causes Infertility?

Swati Agrawal, Kumar Jayant

Journal of Advances in Medicine and Medical Research, Page 1-7
DOI: 10.9734/BJMMR/2016/29919

Endometriosis is a common disorder of reproductive age group, defined as the presence of endometrial glands and stroma outside the lining of the uterus. The disease carries enormous medical and economic burden on the society mainly due to the its symptoms and prolonged course. There is no promising non-invasive test to diagnose it and can only be diagnosed invasively by laparoscopy. The symptoms include chronic pelvic pain and infertility. The estimated prevalence of the disease is 10% which rises to 35 to 50% in women with infertility. Here we give a brief overview about the factors leading to infertility in patients with endometriosis.

Open Access Original Research Article

Evaluation of the Selected Root-to-Crown Ratio of Crowned Teeth in a Hospital Setting: A Cross-sectional Study

Amanda Kung, Andrew Kelvin Lam, Ni Fung Lay, Jennifer Leung, Yung-Ming Lim, Jaafar Abduo

Journal of Advances in Medicine and Medical Research, Page 1-8
DOI: 10.9734/BJMMR/2016/30711

Aims: The root-to-crown (R/C) ratio is envisaged to influence the longevity of crowned teeth. The purpose of this study is to measure the selected R/C ratio of crowned teeth at the Royal Dental Hospital of Melbourne, and to evaluate the effect of tooth category and location on the R/C ratio.

Study Design:  Retrospective study.

Place and Duration of Study: Melbourne Dental School and the Royal Dental Hospital of Melbourne, between February 2014 and July 2015.

Methodology: Peri-apical radiographs of patients treated with single tooth crowns were retrieved. The radiographs were confirmed to be of diagnostic quality and covered the entire crowned tooth. All the selected radiographs were scanned and converted to digital radiographs. With the aid of image manipulation software, the crown and root lengths were measured along the long axis of the tooth. The bone crest level separated the crown and the root. Subsequently, the R/C ratio was established. In addition, the mean R/C ratio was calculated for all the teeth and for every single tooth category. The impact of tooth type and location within the arch on the R/C ratio was statistically evaluated.

Results: A total of 257 crowned teeth were included. The mean R/C ratio was 1.43. Canines had the lowest R/C ratio followed by molars, incisors and premolars respectively. The significant difference existed between incisors and premolars (P = .04), and between premolars and molars (P = .01). In general, the maxillary anterior region exhibited a greater R/C ratio than the mandibular anterior region. However, for the posterior region, the mandibular teeth had a slightly greater R/C ratio than the maxillary teeth.

Conclusion: The implemented R/C ratio of the crowned teeth in this study was close to the recommended ratio of 1.5. Although differences exist between the different tooth categories, the actual difference is minimal. Thus it is difficult to set the R/C ratio recommendation for each tooth category.

Open Access Original Research Article

Hepatitis B Virus Total Core Antibodies among HIV-1 Infected Hepatitis B Surface Antigen Negative Patients Attending a Tertiary Health Facility in North-central Nigeria

A. J. Anejo-Okopi, T. M. Akindigh, N. Markus, D. S. Adeniyi, O. J. Abba, A. O. Ebonyi, E. Ejeliogu, O. Audu, P. Lar, H. J. Zumbes, E. S. Isa, S. Oguche

Journal of Advances in Medicine and Medical Research, Page 1-7
DOI: 10.9734/BJMMR/2016/28184

Aims: The aim of this study was to determine the prevalence of total Hepatitis B core antibodies (anti-HBc) among HIV-1 infected adults without Hepatitis-B surface antigen (HBsAg).

Study Design: Observational cross-sectional study.

Place and Duration of Study: This study was carried out at the AIDS Prevention Initiative in Nigeria (APIN) adult HIV clinic at Jos University Teaching Hospital (JUTH), Jos, North-Central Nigeria, between August and December, 2014.

Methodology: We determined the presence of total anti-HBc for 120 HIV-1 infected patients (32 males and 88 females, with a mean age of 40.4±10.6 years). We performed serological screening for total anti-HBc and for other serological markers for each patient, then performed CD4+ cell enumeration, biochemical analysis of serum for Alanine aminotransferase levels and HIV viral load assays.

Results: A total of 105, HIV-1 positive patients who were HBsAg negative were studied. Of these patients, 59 (56.2%) showed no HBV serological markers, 23 (21.9%) had total anti-HBc, and 15 (14.3%) had HB surface antibodies. Only one patient (1%) showed HBeAg while anti-HBe was detected in 20 (19.0%). The mean age of patients with anti-HBc was 41.4 ± 10.8 years which was similar to the mean age of patients who were negative for anti-HBc (P =.81). While no significant associations were observed between ALT levels, CD4 counts, marital or educational status and total anti-HBc of the patients (P =.91, P =.39, P =.78 and P =.44, respectively), there was a significant association between having a history of tooth extraction and total anti-HBc (P =.03).

Conclusion: There may be a need to assess occult HBV infection in HIV-infected individuals with isolated anti-HBc for active replication of HBV by detecting HBV DNA. Dental care practitioners must take great care to prevent possible transmission through surgical equipment used in procedures for tooth extraction.

Open Access Original Research Article

Assessment of Oral Health Knowledge, Attitude and Practices among Medical Students of Taibah University in Madinah, KSA

Raghdah O. Mulla, Ola M. Omar

Journal of Advances in Medicine and Medical Research, Page 1-10
DOI: 10.9734/BJMMR/2016/29778

Introduction: Oral health is as important as any part of the body and can greatly influence the human beings' normal life and well-being. Better oral health can be achieved with increased awareness and proper oral health practices.

Aim: The aim of this study was to evaluate oral health knowledge, attitude and practices among medical students of Taibah University in Al-Madinah, KSA.

Materials and Methods: An observational, cross-sectional study was applied among 119 medical students of Taibah University. A self-administrated close-ended questionnaire containing 27 multiple choice questions and one open ended question was distributed electronically, to assess oral health knowledge, attitude and practices toward oral health. According to the responses that were achieved through questionnaires, the data obtained were analyzed by using statistical software package SPSS version 16.0 and statistical significance was set at P < 0.05.

Results: A total of 119 medical students studying in fourth and fifth grades participated in this study. 79.8% of students recognized dental caries as black spots. The difference between males and females regarding dental caries knowledge was statistically significant (P = 0.012). According to 97.5% of students, oral health is important for overall body health. Most of students do not smoke (80.7%), there was gender difference regarding smoking (P = 0.00). The most common reason for not visiting the dentist among the study sample was absence of pain (46.2%).

Conclusion: Oral health knowledge among medical students was fair, attitude towards oral health stands good, while oral health practices were moderate.

Open Access Original Research Article

Non-traditional Relationship between Carotid Intima-media Thickness and Mean Platelet Volume, Serum Magnesium and 25-OH-Vitamin D3 Level in Chronic Kidney Disease

Refika Karaer, Saime Paydaş, Kairgeldy Aikimbaev, Damla Karacor, Mustafa Balal, Nurten Dikmen

Journal of Advances in Medicine and Medical Research, Page 1-5
DOI: 10.9734/BJMMR/2016/28231

Aım: Cardiovascular diseases are the most important causes of mortality and morbidity in chronic renal disease. The purpose of this study is to determine the relationship between glomerular filtration rate, serum levels of calcium, phosphorus, magnesium parathormone, vitamin D, lipids and hematological parameters and carotid intima-media thickness (CIMT) in chronic renal patients and healthy indiviuals.

Methods: Twenty-seven healthy individuals  [(control group (CG)] and 53 patients with chronic renal failure (CRF) (GFR 15-59 ml/min) [study group (SG)] were included in this case control study. All participants’ characteristics, physical examination and laboratory tests results were recorded. Same radiologist measured bilateral CIMT by color Doppler ultrasonography.

Results: CG and SG were similar for age, gender. Besides CIMT was higher in patients with chronic renal failure, CIMT were correlated with systolic blood pressure (SBP), platelet, magnesium, alkaline phosphatase (ALP), parathormone (PTH) positively, 25-OH vitamin D3, high density lipoprotein (HDL) negatively. In CG CIMT was positively correlated with SBP, body mass index (BMI), serum levels of albumin, glucose, ALP, and mean platelet volume (MPV).

Conclusion: CIMT was higher in patients with CRF compared to healthy controls. Besides the serum levels of glucose, albumin, HDL, and BMI, CIMT were correlated with non-traditional factors such as higher serum magnesium and PTH level, 25-OH vitamin D3 deficiency in patients with chronic renal failure.

Open Access Original Research Article

Factors Associated with Preference for Caesarean Section among Women in the Ante-Natal Clinic of a Tertiary Hospital in the Niger Delta, Nigeria. A Pilot Study

Eme Olukemi Asuquo, Ngozi Clare Orazulike, Emmanuel Chimatara Onyekwere, Jennifer Nyerhovwo Odjegba, Agbonose Ikeoghene Ojo, Joseph Amarachi Ogbansiegbe

Journal of Advances in Medicine and Medical Research, Page 1-9
DOI: 10.9734/BJMMR/2016/28713

Aims: Preference for caesarean section for childbirth that could otherwise have been natural has led to a significant increase in the rate of caesarean sections in the world. This pilot study therefore, sought to determine the factors associated with preference for caesarean section among women receiving antenatal care in the University of Port Harcourt Teaching Hospital, Rivers State, Nigeria.

Study Design: A descriptive cross-sectional study.

Place and Duration of Study: Department of Obstetrics and Gynaecology, University of Port Harcourt Teaching Hospital, between January and February 2014.

Methodology: The pilot study was conducted among 256 pregnant women in the University of Port Harcourt Teaching Hospital. A pretested well-structured self-administered questionnaire was administered to all pregnant women in their third trimester that attended the antenatal clinic on the different days of the week and consented to be part of the study. Data was entered into an excel sheet and analysed using the Statistical Package for Social Sciences (SPSS) version 20.0.

Results: Respondents were aged between 18 and 44years. Two hundred and forty one (94.1%) of them were married, with 87(34%) and 75 (29.3%) of them being Business women (traders) and civil servants respectively. Of the respondents, 180 (70.3%) preferred vaginal delivery, 44(17.2%) did not mind if they had vaginal delivery or caesarean section while 32 (12.5%) would prefer a caesarean section. The major factors that influenced preference for caesarean section in this study were doctors’ advice 13(40.6%), previous caesarean section 8(25%), safety for both mother and child 3(9.4%), fear of labour pains 3(9.4%) and previous bad birth experience 3(9.4%). In addition, those who had had a previous vaginal delivery wanted a repeat vaginal delivery (77.5%) and those who had had a previous CS wanted it again (54.2%) (P <0.05).

Conclusion: Our pilot study has shown that women's preferences are unlikely to be the most significant factor driving the high caesarean section rates in the Niger Delta region, Nigeria.

Open Access Original Research Article

Neuropsychological and Related Clinical Features Associated with Complex Regional Pain Syndrome: A Latent Class Analysis

David J. Libon, Joel Eppig, Deborah A. G. Drabick, Kirsten Erwin, Christine Annibali, Lynn Durmala, Aaron Bloch, Jacqueline Donohue, Rodney Swenson, Guillermo M. Alexander, Enrique Aradillas, B. Lee Peterlin, Robert J. Schwartzman

Journal of Advances in Medicine and Medical Research, Page 1-12
DOI: 10.9734/BJMMR/2016/29713

Aim: The current research examined neuropsychological and key features related to Geschwind-Behan-Galaburda (GBG) model (i.e., non-right handedness, learning problems, autoimmune disease) in patients with Chronic Regional Pain Syndrome (CRPS). 

Methods: A large sample of patients with CRPS (n=509) were evaluated with a neuropsychological protocol that assessed executive control, language/ lexical retrieval, and declarative memory. A portion of our sample was assessed with the modified Oldfield-Edinburgh questionnaire (n= 262) surveyed handedness, learning problems, and autoimmune disease was obtained on a portion of patients. 

Results: Latent Class Analysis identified four neuropsychological classes: patients with moderate cognitive impairment (n= 44), patients with elements of an amnestic syndrome (n= 93), patients with intact but low average/ average neuropsychological test performance (n= 191), and patients with average/ high average neuropsychological test performance (n= 181). Elements of dysexecutive impairment were obtained in some groups. A minority, but statistically significant number of patients presented with mixed/ non-right handedness (26.30%); learning disabilities/ related problems (18.40%); and autoimmune disease (23.50; P< .001, all analyses). While intact neuropsychological performance was generally found in this large sample of patients with CRPS patients, elements of mild dysexecutive and amnestic impairment were observed in a portion of patients. 

Conclusion: Neuropsychological impairment is present in a minority number of patients. The statistically significant incidence of non-right handedness, learning problems, and autoimmune medical disorders among a subset of patients is consistent with elements of the GBG model.

Summary: These data suggest the presence of mild neuropsychological deficits in some patients along with the possibility for anomalous brain development, suggesting a possible predisposition for CRPS in some patients.

Open Access Review Article

High-throughput Sequencing and Profiling of Antibody Repertoire and the Promises for Diagnostic and Therapeutic Applications

Anteneh Getachew, Malaiyarasa Pandian

Journal of Advances in Medicine and Medical Research, Page 1-11
DOI: 10.9734/BJMMR/2016/27765

High-throughput DNA sequencing technologies are advancing at rapid state and transforming our indulgent about humoral immune modulation. The antibody repertoire encoded by B cells in the blood or lymphoid organs and the information obtained from high-throughput DNA sequencing of immunoglobulin genes (Ig-seq) can be applied for various disciplines. These are basically used to detect B-cell malignancies with high sensitivity and discovering specific antibodies for specific antigens. In advance, it plays significant roles in vaccine development process and it increases our understanding about autoimmunity. The broader applications of Ig-seq in clinical sets highly necessitate the development of a consistent experimental design framework that will enable the sharing and meta-analysis of sequencing data generated by many scientists. The present review attempts to give backgrounds about high-throughput antibody repertoires gene sequencing as well as the ways in which Ig-seq might be applied to characterize immune responses and identify antibodies of therapeutic, diagnostic or mechanistic relevance to autoimmune diseases.