Open Access Original Research Article

Prevalence of Clinically Concealed Prostatic Diseases at Post Mortem; a Teaching Hospital Experience in South-South, Nigeria

E. Imasogie Dele, T. Azeke Akhator

Journal of Advances in Medicine and Medical Research, Page 1-13
DOI: 10.9734/JAMMR/2018/40271

Background: Most post-mortem studies on prostate gland are limited to malignant prostatic tumours. The possibilities of finding other histological types of prostatic diseases were worth exploring bearing in mind that Nodular hyperplasia and cancer are of epidemiological importance.

Aim: This study aims to determine the pattern of prostatic diseases at post-mortem among individuals not previously diagnosed with prostate disease and who died from other causes.

Materials and Methods: Prostate glands at post-mortem were obtained from individuals who died from non-prostate related causes, weighed, fixed in 10% neutral buffered formalin, processed and histologically analysed. Biodata and clinical diagnoses were obtained using clinical case notes and post-mortem register.

Results: The population under study were 86 adult males whose ages ranged from 30 to 85 years with a mean age of 52.71 ± 13.10 years. Ninety-three percent (93% / 80 cases) of the study population were afflicted with prostatic diseases at post-mortem. The most common lesion was nodular hyperplasia. Latent or occult adenocarcinoma followed this, prostatic intraepithelial neoplasia and Schistosomiasis in decreasing order of frequency. The frequency of occult adenocarcinoma, prostatic intraepithelial neoplasia (PIN) and nodular hyperplasia increased significantly with age (P ≤ 0.05).  The peak age for the development of occult adenocarcinoma, PIN and nodular hyperplasia was in the 6th, 8th and 6th decades respectively.

Conclusion: Clinically concealed prostatic diseases are common findings at post-mortem. There is a significant increase (P ≤ 0.05) in the frequency of covert prostatic diseases (nodular hyperplasia, PIN and adenocarcinoma) with advancing age. Convert prostatic diseases especially nodular hyperplasia and prostatic carcinoma have the potentials of contributing significantly to the burden of health care and the cost of receiving treatment if the life expectancy improves in our environment in particular and Nigeria in general.

Open Access Original Research Article

Congenital Anomalies at Benue State University Teaching Hospital, Makurdi, Benue State: A Three-year Review

M. O. Ochoga, G. I. Tolough, A. Michael, I. Ikuren, A. O. Shogo, R. O. Abah

Journal of Advances in Medicine and Medical Research, Page 1-7
DOI: 10.9734/JAMMR/2018/40055

Aim: To describe the pattern of congenital anomalies as seen in Makurdi, Benue State.

Study Design: Retrospective descriptive study.

Place and Duration of Study: Special Care Baby Unit(SCBU) of Benue State University Teaching Hospital from June 2013 to July 2016.

Methodology: This was data analysis through data review of three years from the past records. Data on an antenatal visit, maternal age and parity of mother, sex, gestational age, weight on admission, age at admission, a birth position of the baby, type of congenital anomaly, and outcome were extracted.

Results: A total of eight hundred and forty-three babies were admitted into the SCBU of the hospital over a three-year period from June 2013 to July 2016. Seventy-two of them were found with congenital anomalies giving a prevalence rate of 8.5%.43 (59.7%) were males, and 29(40.3%) were females.22(30.6%) of the babies had a birth weight <2500g while 50(69.4%) had a birth weight >2500g.The mean birth weight in (kg) was 2.73 SD  0.67, 95% CI (2.57, 2.88). Sixty-seven (93.0%) of the babies were delivered at a gestational age between 37-40 weeks. 52 (72.2%) mothers attended ANC while 20 (27.8%) of them did not.The most affected systems were the central nervous system(CNS)28(38.9%),musculoskeletal system (MSS) 21(29.2%), gastrointestinal tract (GIT) 21(29.2%),genitourinary system(GUS)5(6.9%) and cardiovascular system(CVS)2(2. 8%).The highest occurring anomaly among the top three systems was, myelomeningocele 21 (29.7%) for CNS, anorectal malformation 14 (19.4) for GIT and gastroschisis 8 (11.1%) for MSS. The outcome showed that 39 (54.2%) of the cases were discharged, 6 (8.3%) were referred, 12 (16.7%) discharged against medical advice, and 15 (20.8%) died.

Conclusion: The study showed that CNS anomalies were the most common congenital malformations noted in the study. Therefore, adequate antenatal care and fortification of staple foods are advocated.

Open Access Original Research Article

Prevalence of Burnout in Medical and Non-medical Undergraduate Malaysian Students in Various International Universities - A Cross-Sectional Study

Tan Wing, Yee Cia Pey, Vithiya Subramaniam, Nur Athirah Ab Raof, Ooi Wan Ting, Muhd Haziq Hannan Ahmad

Journal of Advances in Medicine and Medical Research, Page 1-13
DOI: 10.9734/JAMMR/2018/40212

Aims: To determine the prevalence as well as potential risk factors of burnout among Malaysian undergraduates who were studying in Malaysia and overseas.

Study Design: Cross-sectional.

Place and Duration of Study: Melaka Manipal Medical College (MMMC), Melaka, between May and June 2016.

Methodology: We circulated the Copenhagen Burnout Inventory-Student Survey (CBI-SS) online to assess personal, studies-related, colleagues-related and teachers-related burnout levels among the students. A total of 538 responses were collected, of which 249 were medical students and 289 non-medical.

Results: The prevalence of burnout in medical and non-medical students were 27.3% and 20.1% respectively. Only the type of course (medical/ non-medical) showed a significant difference in burnout prevalence (odds ratio = 1.50, confidence interval: 1.00 - 2.23). The same was true when the type of course was adjusted towards age and gender in logistic regression analysis. No other demographic, socioeconomic and course-related factors showed significant associations with burnout prevalence.

Conclusion: The prevalence of burnout in both medical and non-medical students is high; the former being significantly higher than the latter. Therefore, appropriate measures should be taken to minimise the possibility of future quitting of professions, which will otherwise adversely affect the national economy and development.

Open Access Original Research Article

High Resolution Gray Scale and Color Doppler Ultrasound Evaluation of the Scrotum at the University of Port Harcourt Teaching Hospital, Rivers State, Nigeria

R. C. Onwuchekwa, D. O. Umelo

Journal of Advances in Medicine and Medical Research, Page 1-9
DOI: 10.9734/JAMMR/2018/40147

Objectives: The scrotum and its contents can be affected by a wide variety of pathologic processes which include: congenital, inflammatory and neoplastic pathologies. Scrotal lesions may be grouped into painful and non-painful lesions, while scrotal masses are grouped into testicular and extratesticular masses. Ultrasonography performed with the high-frequency transducer, using pulse and colour Doppler modes is the imaging modality of choice for evaluating acute and non-acute scrotal diseases.

Methodology: This was a retrospective study carried out over a period of 18 months (from June 2016 to November 2017), at the Department of Radiology of the University of Port Harcourt Teaching Hospital (UPTH), Rivers State, Nigeria. The study population was patients who presented to the department for scrotal evaluation. The inclusion criteria were patients scanned during the 18 months period, whose request forms and written reports where intact. Exclusion criteria were for patients not scanned during the period and those whose document was not complete.

Results: 74 cases of scrotal scan which met the inclusion criteria were retrieved and analysed for this study. The age range was 6years to 75years, while the mean age was 38.89± 1.531 years. Infertility 17(22.97%), scrotal swelling 11(14.86%) and scrotal pain 11(14.86%) were the most common clinical indications for the scan. Twenty-one (28.38%) of the scans were standard. Hydrocele was the most frequent abnormality detected on ultrasonography constituting 27(36.49%). This was closely followed by varicocele which constituted 16(21.62%) cases.

Open Access Original Research Article

Significant Inhibition of Protein Binding of Phenytoin

Sheril Alexander, Jesse Flores, Henrietta Ofuluozor, Mariana Babayeva

Journal of Advances in Medicine and Medical Research, Page 1-7
DOI: 10.9734/JAMMR/2018/40729

Aim: This research was aimed to assess the potential for inhibition of protein binding of phenytoin by tizoxanide in human plasma. Phenytoin was used because studies have proven to be a highly plasma protein-bound drug with a narrow therapeutic index and non-linear pharmacokinetics. Tizoxanide is another highly protein-bound active metabolite of an anti-infective prodrug nitazoxanide. Both drugs are expected to be administered together due to their therapeutic indications.

Study Design: The study was divided into two phases. Phase 1 produced a reference line of phenytoin protein binding values. Phase 2 was conducted to reveal the effect of the interactant tizoxanide on the protein binding of phenytoin. The results obtained from phase 1 were compared with those of phase 2.

Methodology: Protein binding of phenytoin was studied using a centrifugal ultrafiltration method. Protein binding of three phenytoin concentrations was studied: 25, 50, and 100 µg/mL. The concentrations of phenytoin were analyzed by validated HPLC method. Each experiment was performed in triplicate.

Results: Co-administration of tizoxanide significantly inhibited protein binding of phenytoin for all concentrations tested. Tizoxanide increased unbound fraction (fu) of phenytoin by 4.4, 3.7, and 2.8-fold for concentration of 25, 50, and 100 µg/ml, respectively. Phenytoin was displaced from protein binding sites what resulted in amplified unbound plasma levels of the antiepileptic drug.

Conclusion: Tizoxanide significantly inhibited protein binding of phenytoin in human plasma. The interaction could potentially result in altered elimination and increased toxicity of phenytoin leading to neuronal side effects and hypersensitivity reactions. Caution also should be taken when administering nitazoxanide concurrently with other highly plasma protein-bound drugs, especially drugs with narrow therapeutic indices, as competition for binding sites may occur.

Open Access Original Research Article

Missclassification of HIV Disease Stages with Continuous Time Hidden Markov Models

Tatek Getachew Habtemichael, Ayele Taye Goshu, Gemeda Bedaso Buta

Journal of Advances in Medicine and Medical Research, Page 1-15
DOI: 10.9734/JAMMR/2018/39428

The purpose of this study is to explore the simple Markov and Hidden Markov models with continuous time to investigate disease progression of HIV/AIDS patients under ART follow-up at Shashemene Referral Hospital, Ethiopia. The msm R package is used for the analysis. Results from the simple Markov model reveals that the disease progression of the HIV/AIDS patients considered tend to move towards the healthier than the worse state. The mean waiting time for the healthiest state is significantly higher than the other transient states. The total length of time stay in a state declines with severity of the disease stages. Analysis of the misclassification model provides transition rates of the true states. Estimation of the transition rates of the true states are found to be relatively smaller compared to those obtained by the simple Markov model. For the true states compared to observed ones, the conditional probability of moving to the healthiest state from the next worse state grows higher dramatically, while that of moving to next worst state grows slightly lower. The ART based patient care might have positive impacts on the overall progression of the disease. For covariate effects, male patient is more likely to move to worse state than the female does. But age of patient is not significant. The progression of the underlying states of the HIV/AIDS disease behaves similar to that of the generated markers observations except the turning points of the conditional probabilities. The turning points so interesting for be studied further.

Open Access Review Article

Recent Advances in the Understanding of Adiponectin and Its Role in the Aetiology and Pathogenesis of Childhood Obesity

Margarita Theodorakidou, Olti-Alexandra Nikola, George I. Lambrou

Journal of Advances in Medicine and Medical Research, Page 1-19
DOI: 10.9734/JAMMR/2018/38438

Obesity is a contemporary disease of epidemic proportions according to national and international reports, considered as the consequence of consumerism and life style modifications, which is both true for developed as well as developing countries. Several reports have shown that 30-35% of the population in developed countries is obese or overweight. Numerous studies have reported the etiology and pathogenesis of obesity, under the possible molecular mechanisms of this condition. One of the main molecules studied is adiponectin, considered as a key adipokine. The present work attempts to review the current knowledge on adiponectin and its participation in the etiology and pathogenesis of childhood obesity.