Open Access Case Report

An Unusual Cause of Upper Gastrointestinal Bleeding in Clinical Practice; A Case Report of Locally Invasive Colon Cancer with Superimposed Actinomycosis

Y. A. Awuku, Y. A. Nartey, J. I. Lovi, M. Nortey, T. M. Morna, P. K. Akakpo

Journal of Advances in Medicine and Medical Research, Page 1-4
DOI: 10.9734/BJMMR/2017/32202

Background: Colon cancer commonly presents with lower gastrointestinal bleeding in symptomatic patients. Upper gastrointestinal bleeding as a symptom of colon cancer is unusual. This case highlights the diagnostic and management challenges of colon cancer masquerading as gastric ulcer with a bleeding complication.

Case Presentation: We report the case of a 45-year-old man who presented with passage of melaena stools with associated epigastric pain. Endoscopy revealed gastric ulcer in the greater curvature. Histopathology identified a diffuse adenocarcinoma with superimposed actinomycosis. Intra-operatively the patient was found to have a carcinoma of the transverse colon diffusely infiltrating and ulcerating the stomach in its greater curvature. Patient died from bilateral pulmonary thromboembolism 10 weeks after the surgery.

Conclusion: Although rare, colon cancer can present with upper gastrointestinal bleeding. It must be considered as a differential in the work up for a patient passing melaena stool.

Open Access Original Research Article

Etiopathogenesis and Stem Cell Treatment Outcomes in Avascular Necrosis of the Femoral Head: A Review of 50 Cases

Pradeep V. Mahajan, Swetha Subramanian, Ashwini B. Jadhav, Amit Danke, Siddhesh C. Parab

Journal of Advances in Medicine and Medical Research, Page 1-9
DOI: 10.9734/BJMMR/2017/32227

Background and Aim: Avascular necrosis (AVN) is a progressive condition characterized by a vascular insult to the bone, which can lead to collapse of the bone and subsequent degenerative changes. Vascular impairment that results in AVN may occur due to compression of blood vessels that may be due to trauma, immunosuppressive medications or idiopathic etiology. The aim of this review was to identify the prevalence of AVN based on age, sex and causative factors. This review also aimed to analyze the outcome of autologous mesenchymal stem cell therapy in patients suffering from avascular necrosis of femoral head.

Methods: 50 cases of avascular necrosis who had undergone autologous mesenchymal stem cell therapy were included in the study. Demographic and etiologic categorization was done based on data obtained from case history of patients. Outcome following cell based therapy was done based on Harris Hip Score and radiographic tests (X-ray, MRI).

Results and Conclusion: Based on findings in this review, prolonged steroid medication was found to be the prime causative factor for non-traumatic AVN of femoral head.  Autologous cell based therapy has been shown to be effective in arresting progression of the condition. Analysis showed statistically significant outcomes with respect to parameters of pain, joint function and range of motion following cell based therapy. This minimally invasive procedure is effective in management of all stages of the condition and aids in preservation/regeneration of joint structure.

Open Access Original Research Article

Serum Levels of Vitamin E and β-carotene in Relation to Sex and Medical Status in a Population from North Jordan

Fatima-Azzahra Delmani

Journal of Advances in Medicine and Medical Research, Page 1-10
DOI: 10.9734/BJMMR/2017/32470

Aim: The aim of this study is to assess whether serum vitamin E (α-tocopherol) and β-carotene are affected (or not) by different medical conditions such as hypertension, diabetes, smoking, and pregnancy.

Methodology: Total serum vitamin E and β-carotene concentrations were measured in a group of 946 volunteers (males and females with age range between 18 and 60 years); 432 were healthy and non-smokers (161 men and 271 women), and 514 were having a medical condition (90 men and 75 women with high blood pressure, 40 men and 85 women were diabetes, 98 men and 50 women were smokers, and 76 pregnant women). Total serum vitamin E and β-carotene were measured by HPLC. Sera were extracted from blood samples collected from a population from the north of Jordan.

Results: The total vitamin E serum concentrations in male healthy individuals was found to be 32.3 ± 0.9 µmol/l compared to 17 ± 0.4 µmol/l for smokers, 19.2 ± 0.8 µmol/l with diabetes, and 20.1 ± 0.9 µmol/l with high blood pressure; and 26.6 ± 0.1 µmol/l in healthy women compared to 21.1 ± 0.5 µmol/l for smokers, 20.5 ± 0.6 µmol/l with diabetes, and 21.7 ± 0.4 µmol/l with high blood pressure.

The total β-carotene serum concentrations in male healthy individuals was found to be 1.26 ± 0.03 µmol/l compared to 0.83 ± 0.04 µmol/l for smokers, 0.85 ± 0.06 µmol/l with diabetes, and 0.81 ± 0.053 µmol/l with high blood pressure; and 2.4 ± 0.3 µmol/l in healthy women compared to 1.4 ± 0.2 µmol/l for smokers, 0.97 ± 0.03 µmol/l with diabetes, and 0.78 ± 0.06 µmol/l with high blood pressure. The levels of serum concentrations of both vitamins were significantly lower (p < 0.05) in the tested subjects compared with the values registered in the healthy subjects.  Pregnancy was also found to affect the levels of serum concentrations of both vitamins, our results showed a decrease in the serum concentration levels of the pregnant women who participated in this study versus the healthy subjects.

Conclusion: Vitamin E and β-carotene absorption by the body was found to be influenced by the health status of the individual. This was clearly shown by the differences between healthy individuals from the test group and those in the healthy counter parts.

Open Access Original Research Article

Clinical and Radiographic Features of Knee Osteoarthritis of Elderly Patients

Sahli Hana, Ben Tekaya Aicha, Daas Selim, Mahmoud Ines, Tekaya Rawdha

Journal of Advances in Medicine and Medical Research, Page 1-9
DOI: 10.9734/BJMMR/2017/26919

Background: Knee osteoarthritis is a common pathology, characterized by a prevalence that increases with age. Absence of correlation between anatomy and the clinical features makes medical care complex, particularly in a geriatric setting where study is wanting.

Methods: Cross-sectional study including patients who were monitored for 6 months for knee osteoarthritis. A comparaison was made between of those various characteristics between patients of over 65 years of age (group 1; n=56) and those under 65 (group 2; n=56).

Results: The age bracket of group1 was 71±5 years with a feminine predominance. Gonalgia had been evolving for 8.4±9.2 years, bilateral in 82.6% and mechanical in 94.6%. The patients experienced an average pain scale of 65.2 mm. An axial deviation of lower limbs was observed in 60.7% and a limited mobility of the knees in 48.2%. The mean value of Lequesne index was 11.02±4.8. The walking distance was not limited in 37.5%. Comparative study showed that elderly patients had a smaller waist size (p=0.003), a longer course of gonalgia (p<0.0001), a widespread site of pain (0.004), and a more frequent limitation of walking distance (p<0.0001) as well as more axial deviation (p<0.0001) and joint mobility limitation (p=0.005). Gonalgia manifesting during rest was more frequent in elderly patients (p=0.001). Impaired functioning (p=0.001) and stage of radiographic damage (p=0.02) were more advanced in elderly patients.

Conclusion: This study shows that knee osteoarthritis is more severe in the elderly patients in its various and anatomical aspects as well as its impact on normal functions.

Open Access Original Research Article

Arterial Stiffness in Systemic Lupus Erythematosus and Its Correlation with Disease Severity: A Case Control Study

T. Jayapal, K. V. Vysakha, C. Rajasekharan, Akhilkrishna .

Journal of Advances in Medicine and Medical Research, Page 1-9
DOI: 10.9734/BJMMR/2017/30893

Introduction: Arterial stiffness is an emerging field of interest in atherosclerosis. Patients with systemic lupus erythematosus (SLE) are predisposed to have premature atherosclerosis.

Aims: To compare the arterial stiffness among patients with SLE and non-SLE controls. The study also compared arterial stiffness among SLE patients in relation to disease activity (SLEDAI) and end organ damage (SLICC index).

Study Design: Case control study.

Place and Duration of Study: Patients attending rheumatology clinic and those admitted to medical wards of the Internal Medicine and Nephrology departments of Government Medical College Hospital, Thiruvananthapuram.

Methodology: 53 SLE patients and 53 non-SLE controls were studied. Data was obtained in a structured format. Arterial stiffness indices were obtained by measuring the brachial ankle pulse wave velocity (baPWV). The SLEDAI Score and SLICC Damage index were measured in the SLE group. Age-matched controls were obtained from the general population.

Results: SLE patients had higher brachial ankle pulse wave velocity (baPWV) than the control non-SLE population (1194.9 ± 169.6 cm/s vs 1008.5 ± 62.5 cm/s; p<0.001), Mean arterial stiffness index (ASI) among SLE patients was significantly higher than that of control (26.2 ± 3.9 mm Hg vs. 23.7 ± 3.7 mm Hg, p=.001), mean augmentation index(AI) among SLE patients was significantly higher when compared with the control non-SLE population (13.9± 6.7% vs 6.2 ± 1.7%, p<0.001). Patients with SLE-related end organ damage (SLICC index ≥1) had baPWV elevated over those with SLICC index=0 (1234.5 ± 181.5 cm/s.1 vs 1124.1 ± 121.1 cm/s, p=.021). No significant difference was observed between the mean ASI among the patients with SLICC index ≥1 and those with SLICC=0. (26.9 ± 4.1 mm Hg vs 24.8 ± 3.3 mm Hg, p=.070), and mean AI among SLICC index ≥1 was significantly higher than that of SLICC index ≥1 (15.6 ± 6.7% vs 11.1 ± 5.8%, p= .017). Patients with high disease activity (SLEDAI ≥6) had baPWV of 1278.9 ± 131.0 cm/s (95%CI 1229 cm/s.1-1328.7 cm/s) vs (1093.4 ± 156.5 cm/s; 95% CI 1027.3 cm/s -1159.4 cm/s p<0.001) when compared with those having low activity (SLEDAI<6).

Conclusion: Patients with SLE had increased arterial stiffness. End organ damage and high disease activity among SLE patients correlated to increased arterial stiffness, and is contributory to an increased risk of atherosclerosis.

Open Access Original Research Article

A Cephalometric Evaluation of Airway Space in Skeletal Class II Subjects

Shreya S. Iyengar, B. S. Chandrashekar, P. C. Ramesh Kumar, Vinay P. Reddy, C. M. Mahesh, Balamohan Shetty, Abhishek Sundara

Journal of Advances in Medicine and Medical Research, Page 1-10
DOI: 10.9734/BJMMR/2017/31287

Aims and Objectives: To study the correlation of 1. pharyngeal airway space and skeletal class I and II malocclusions and 2. pharyngeal airway space and growth pattern using lateral cephalograms

Materials and Methods: 60 pre-treatment lateral cephalograms of untreated skeletal class I and class II patients were traced using 0.003 inch matte acetate sheets. The subjects were divided into skeletal class I (ANB 0º-4º) and class II (ANB >4º) based on ANB angles. Each group was further divided into three sub groups based on mandibular plane angle. (SN-GoGn <26º-low angle, SN-GoGn 26º-38º-normal angle and SN-GoGn >38º-high angle).

Results: Nasopharyngeal airway space decreased from low angle to normal to high angle. The upper airway was wider in Class II subjects with low, normal or vertical growth than in Class I subjects with low, normal or vertical growth. The lower pharyngeal airway did not have any correlation with the type of malocclusion or the growth pattern.

Conclusion: Thus, it can be concluded that malocclusion type (skeletal Class I or Class II) as well as growth pattern (normal, horizontal and vertical) influence upper pharyngeal airway width, and both do not influence the lower pharyngeal airway width.

Open Access Original Research Article

No More Live Lectures - Quixotism or Realism-? Association between Learning Preferences and Attendances at Live Lectures

Siaw-Cheok Liew, Jagmohni Sidhu, Ankur Barua

Journal of Advances in Medicine and Medical Research, Page 1-10
DOI: 10.9734/BJMMR/2017/33051

Background: The increasing decline in medical students’ attendances at live lectures left educators with differing views on its acceptability.

Aim: The aim of this study was to look at the association between the medical students’ attendances at live lectures and their learning preferences and outcomes.

Study Design: University based, cross sectional study.

Place and Duration of Study: The study was conducted at International Medical University, Malaysia from April to July 2015.

Methodology: All the pre-clinical medical students (Year 2 and Year 3) were invited to participate in this study. A total of 776 students, Year 2 (397) and Year 3 (379) students participated in this study. The students’ recorded attendances at live lectures were compared to their (i) learning preferences; VARK (Visual/Aural/ReadWrite/Kinesthetic) and ASSIST (Approaches and Study Skills Inventory for Students) and to their (ii) performances at the summative examinations. Data was analysed using Pearson Chi-square test.

Results: A majority of medical students (54.8%) still attend live lectures. The attenders were mostly auditory (p=0.010) learners. Non-attenders at live lectures perform better in the examination compared to the attenders (p=0.003). Those who used online lectures as their aid to studying performed better in the examination (p=0.026).

Conclusions: Medical students still attend live lectures regularly. However, high performances at summative examination was associated with non-attendances at live lectures and the use of online learning/online lectures.