Open Access Case Study

Bilateral Renal Infarction in a Teenage Patient: A Case of “Transient” Antiphospholipid Syndrome?

Shadwa Hassan, Diniece Barran, Eleny Romanos-Sirakis, Richard Sidlow

Journal of Advances in Medicine and Medical Research, Page 1-5
DOI: 10.9734/JAMMR/2017/33611

We present a case of abdominal pain in an 18-year-old-female which was ultimately diagnosed to be due to bilateral renal infarction. The etiology of this finding was determined to be a transient antiphospholipid syndrome, a rare but known cause of renal infarction in the pediatric age group, with seropositivity for lupus anticoagulant waning after three months in this patient. We review, in addition, the literature on antiphospholipid syndrome-induced renal infarction and its varied serological presentations.

Open Access Short Research Article

Polymorphism of pfk13-propeller in Niger: Detection of Novel Mutations

Ibrahim Maman Laminou, Mahaman Moustapha Lamine, Boubacar Mahamadou, Oumou Maïga Ascofaré, Alioune Dieye

Journal of Advances in Medicine and Medical Research, Page 1-5
DOI: 10.9734/JAMMR/2017/34192

Aim: Artemisinin resistance was confirmed in Southeast Asia in 2009, and a molecular marker of resistance to artemisinin as point mutations in the region of the kelch13 gene (k13) coding for the C-terminal propeller domain of Kelch13 (K13-propeller) gene, was discovered in Cambodia in 2013.

Methods: In this context, we examined the polymorphism of k13-propeller by sequencing 602 Plasmodium falciparum isolates collected from patients with uncomplicated malaria in Niamey, Niger, during the rainy season of 2013.

Results: We observed thirteen single-nucleotide polymorphisms (SNPs) including eight specific to Niger at a low frequency from 0.02% to 2.7%. The key mutations associated with delayed parasite clearance time in Southeast Asia (SEA) and with decrease of the ring-stage sensitivity to artemisinin in vitro (C580Y, R539T, Y493H, I543T and N458Y) were not observed. However, five particular non-synonymous mutations were found in our study area: M472I, Y558C, K563R, P570L and P615S and were not reported elsewhere.

Conclusion: These results suggest a genetic variability of P. falciparum k13-propeller domain in Niamey, Niger.

Open Access Original Research Article

Hearing Impairment among Children and Adolescents of Consanguineous Parents: A Study with Practical Challenges Encountered in Malakand, Northern Pakistan

Aftab Alam Sthanadar, Muhammad Zahid, Abdulbari Bener

Journal of Advances in Medicine and Medical Research, Page 1-10
DOI: 10.9734/JAMMR/2017/33713

Aim: The aim of the present study is to determine the prevalence of HI and its association with parental consanguinity in urban and rural areas of Malakand District, Khyber Pakhtunkhwa Province, Pakistan.

Methods: In this community-based study, data was collected by random sampling method. Families with children were recruited in the study sample. Families without children were excluded from the study sample. Information was collected by questionnaire from 1,506 families in their homes from January 2011 to February 2013 and from September 2013 to April 2014. Data collection was interrupted several times due to security concerns in the study area. In the first phase, data collection was not enough. After a while, sampling was resumed to achieve a reasonable sample size. Otoscope, Tympanometry, Tuning fork testing (Rinne Test) and Audiometry were used in this study. Audiometry was for air conduction (AC) and bone conduction (BC). Subjective testing was performed including pure tone audiometry, free field speech tests, evoked response audiometry, visual reinforcement audiometry (VRA), play audiometry (PA), speech testing and tuning fork tests. Objective testing was performed including tympanometry. Pure Tone Audiometry (PTA) was used to record the degree and types of HI in children and adolescents.

Results: A total of 7,888 out of 8,227 children born to consanguineous parents were recruited in this study. 339 children were excluded from the study sample due to incomplete data. Couples were recorded as first (F ≥ 0.125), second (F ≥ 0.0156), or third degree cousins (F ≥ 0.0039), and unrelated (F = 0.00). The HI testing, principally by free field speech testing, otoscopy, tuning fork tests, evoke response, visual reinforcement audiometry (VRA), play audiometry (PA) were initially performed at homes with pure tone audiometry (0.5-2kHs2) and tympanometry used to confirm and record the severity of HI in the HI examination centre at Seena Medical Centre at Dargai.

Conclusion: We found a strong positive association between parental consanguinity and HI. There is a need of several efforts, including awareness and genetic counselling programs for Hearing Impairment. Prevention is becoming highly essential to reduce the risk incidence of genetic hearing loss. Meanwhile, consanguinity should be discouraged through health education of the public concerning the adverse effect of interrelated marriage. Genetic counselling, Pre-marital and antenatal screening are to be applied whenever possible, at least for those at risk of developing genetic diseases including hearing impairment.

Open Access Original Research Article

Outcomes of Older Children with Kawasaki Disease Who Received Intravenous Immunoglobulin Therapy with Delayed Use of Anti-inflammatory Drugs

Toshimasa Nakada

Journal of Advances in Medicine and Medical Research, Page 1-7
DOI: 10.9734/JAMMR/2017/34047

Background: The prevalence of coronary artery lesions (CAL) is higher in older children compared with younger children. Anti-inflammatory drugs including aspirin appeared to have a negative impact on the suppressive effects of initial intravenous immunoglobulin (IVIG) therapy for CAL development during the acute phase of Kawasaki disease and an initial single IVIG therapy with the delayed use of anti-inflammatory drugs (DUA) might be effective for CAL suppression. The outcomes regarding CAL and non-cardiac complications after single IVIG therapy with DUA remain unclear.

Aims: To ascertain the outcomes of the older children with Kawasaki disease who received single IVIG therapy with DUA.

Methods: The retrospective data of 25 children who were ≧ 60 months old and received this therapy between 2004 and 2017 in our department were collected and outcomes were investigated. Anti-inflammatory drugs were initiated within 24 hours after the end of initial IVIG infusion.

Results: No patients were associated with CAL. However, three patients were associated with non-cardiac complications including transient blindness, intractable arthritis, and prolonged restriction of cervical movement caused by atlantoaxial rotatory fixation. All three children were IVIG therapy-resistant and had statistically higher C-reactive protein values (median: 9.64 interquartile range: 7.82-18.29 vs. 1.905: 0.76-4.77 mg/dL, P = 0.007), neutrophil counts (9545: 9312-9660 vs. 2766.5: 1936-3812 /mm3, P = 0.006), and neutrophil to lymphocyte ratios (10.38: 4.85-11.29 vs. 1.44: 0.92-2.69, P = 0.006) after IVIG therapy compared to those without complications.

Conclusion: Initial IVIG therapy-resistant three patients with high values of inflammatory biomarkers after initial therapy with DUA were associated with non-cardiac complications.

Open Access Original Research Article

The Effect of Fluid-structure Interaction in Finite-element Analysis of Skull Bone on Relieving Cerebral Injury in a Porcine Model

Xian Fang Yue, Duncan E. T. Shepherd, Daniel M. Espino, Li Wang, Hongwu Meng

Journal of Advances in Medicine and Medical Research, Page 1-24
DOI: 10.9734/JAMMR/2017/30457

Introduction: Bone tissue is non-homogeneous, porous and anisotropic. Compact bone contains a hierarchical structure of interconnected channels, and cancellous bone is the spongy construction with the biphasic of viscous fluid and elastic solid materials. Fluid flow in and out has also been suggested to play a role in the mechanosensory system of bone.

Objective: To investigate the influence of interstitial fluid on the microstructural skeleton of compact and cancellous skull bone by finite-element simulation with the changing intracranial pressure.

Methods: Scanning Electron Microscopy (SEM) was adopted to determine the microstructural parameters of fresh porcine skull bone, which used to create a microscopic model of skull bone subjected to a fluid-solid interaction analysis.

Results: Simulations were performed with and without Fluid-Structure Interaction (FSI). The strain and stress rate of the skull-bone microstructure increased with the tissue fluid by 38.5% and 21.5%, respectively. Especially for compact skull bones, the microstructure strain and stress rate were greater by 1.42 to 2.49 times and 1.39 to 2.42 times, respectively, when the tissue fluid flow was included.

Conclusion: In conclusion, the deformation of skull bone tissue is enhanced with the increase of interstitial fluid under the same pressure, which would absorb more impact on cerebral injury caused by intracranial hypertension. Conversely, the load-bearing of bone tissue is enhanced with the increase of solid bone skeleton under the same pressure. During the analysis on mechanical properties of skull bone with FSI, the compact and cancellous bones are not regarded as a single phase solid structure and the porous material characteristics must be considered.

Open Access Original Research Article

The Relationship between Neutrophil to Lymphocyte Ratio and Left Ventricular Function in Drug-naïve Asymptomatic Hypertensive Adults in Port Harcourt, Nigeria

Norbert Ndubuisi Unamba, Akpa Maclean Romokere, Odia Osaretin James

Journal of Advances in Medicine and Medical Research, Page 1-12
DOI: 10.9734/JAMMR/2017/32894

Background: Systemic hypertension is the commonest cardiovascular disease, affecting over a billion people all over the world and causing deaths due to target organs damage. Left ventricular dysfunction could be the result of hypertension causing a mechanical alteration of cardiac performance. More importantly it can be the main cause of congestive heart failure.  Lastly, left ventricular dysfunction can be either systolic or diastolic. Left ventricular dysfunction is thought to be related to endothelial dysfunction and several substrates have been identified as surrogate markers of this target organ damage including neutrophil to lymphocyte ratio (NLR).

We aim to study the relationship of NLR to left ventricular function in treatment-naive African black hypertensive patients in Port Harcourt, Southern Nigeria.

Methods: A descriptive cross-sectional study of newly diagnosed, treatment-naive hypertensive patients, consecutively recruited over a six months’ period. All underwent routine investigations for hypertension including a full blood count and a transthoracic echocardiography. The NLR was calculated using the total absolute neutrophil and lymphocyte count and correlated to the echocardiographically-determined left ventricular systolic and diastolic function.

Results: One hundred and forty-four patients and seventy-two controls were evaluated. The mean ages in subjects and controls were 51.4±12.9 years (Range 25–86 years) and 48.8±12.6 years (\Range 24 – 78 years) respectively. The mean body mass indices were 29.5±4.9 kg/m2 and 27.2±5.0 kg/m2 (P=0.001) in subjects and control respectively. Mean systolic blood pressure were 149.0±22.5 and 115.0±11.3 mmHg in subjects and controls respectively (P<0.001) while mean diastolic pressures were 93.0±13.6 mmHg and 70.6±9.1 mmHg respectively (P <0.001). Mean NLR in the subjects and controls were 1.35±0.8 and 1.23±0.6 respectively (P= 0.272). Mean NLR in subjects with normal left ventricular function was significantly lower compared with those with different grades of systolic dysfunction, (1.35 ±0.66 Vs 1.43. ±0.78 Vs 1.34± 0.56 Vs 2.43 ±1.11   (P = 0.009). The left ventricular ejection fraction and fractional wall shortening decreased with increasing NLR tertiles and the difference between tertiles was statistically significant (p=0.004 and 0.009). 

Conclusion: NLR was highest in the subjects with LV systolic dysfunction and in those with severe LV systolic dysfunction. NLR is related to LV systolic dysfunction in patients with hypertension even in the absence of overt features of heart failure.

Open Access Original Research Article

Factors Influencing Mortality and Outcome of Burns from a Trauma Registry in Nigeria: A Retrospective Study

Sydney E. Ibeanusi, P. N. Wichendu

Journal of Advances in Medicine and Medical Research, Page 1-8
DOI: 10.9734/JAMMR/2017/34268

Background: Burns injury has a global distribution and contributes to trauma mortality and morbidity. Whereas mortality from burns is reducing in most developed countries, the picture in developing countries such as Nigeria still remains gloomy. Better understandings of the pathophysiology of burns and improvement in burns care are reasons for the improved outcome of burns in developed countries. This study aims to identify the factors that influenced mortality and outcome of burns in Port Harcourt Nigeria.

Methods: Retrospective evaluation of data of patients with burns from January 1, 2007 to December 31, 2009 from a regional trauma registry in Port Harcourt Nigeria was undertaken and analysed. Factors observed to be associated with mortality and influenced outcome were determined and presented.

Results: The result of this study showed that of the 301 cases of burns were recorded during the period under observation. Flame burns arising from misadventure with petroleum products (n=188 {62.5%}) had the highest fatality especially when associated with inhalational injury (P <0.0001).  The total burnt surface area was the greatest determinant of mortality from burns (R = 0.86, P<0.0001) and all the patients with burnt surface area above 50% died. The observed median lethal surface area of body burnt (LA50) from this study was 32%. Most of the deaths occurred during the first week of burns. The common complications which contributed to death observed during the early phase of burns was fluid and electrolyte derangement from inadequate and or over resuscitation (n=140).

Conclusion: The commonest determinant of fatality from burns was the total surface area burnt. Flame burns contributed to a sizable number of deaths especially when there is an associated inhalational injury. Most of the deaths occurred in the first week of admission from fluid and electrolyte derangements.