Open Access Case Study

Open Neural Tube Defect Following Antenatal Exposure to Carbamazepine: A Case Report

A. B. Mairami, R. Mohammed-Nafi’u, L. J. Mshelia, L. I. Audu

Journal of Advances in Medicine and Medical Research, Page 1-5
DOI: 10.9734/JAMMR/2018/43557

Aim: The aim is to highlight the causal relationship of perinatal exposure to carbamazepine and neural tube defect as well as the implication of missed perinatal diagnosis of this severe neurologic abnormality.

Presentation of Case: We present a term baby with lumbosacral meningomyelocele delivered to a 34-year-old primigravid woman who had been treated with Carbamazepine for generalised epileptic seizures for 1 year prior to conception and which she continued for the 38 weeks duration of her pregnancy. Second and 3rd trimester abdominal ultrasound examinations did not pick the defects. Significant examination findings at presentation included bilateral Talipes Equinovarus deformity; lumbosacral cystic swelling measuring 7cm by 5 cm,anal and urinary sphincter dysfunction.

Discussion/Conclusion: We speculate that severe maternal folate deficiency from the prolonged use of Carbamazepine coupled with the absence of folate supplementation was responsible for spinal defect observed in this baby. The prospect for prevention including antenatal diagnosis is discussed.

Open Access Original Research Article

Evaluation of Male Sex Hormones and Oxidative Stress Markers in Obese Subjects with and without Metabolic Syndrome in Nnewi Nigeria

Onuora Ifeoma Joy, Meludu Samuel Chukwuemeka, Dioka Chudi Emmanuel, Obi-Ezeani Chikaodili Nwando, Usman Saheed Opeyemi, Onyema-Iloh Obiageli Bridget

Journal of Advances in Medicine and Medical Research, Page 1-8
DOI: 10.9734/JAMMR/2018/43013

Background: The incidence of metabolic syndrome is rapidly increasing in Nigeria and it is a cluster of risk factors of abdominal obesity, dyslipidaemia, hyperglycaemia, hypertension which can lead to infertility and oxidative stress. The objective of this study was to verify the influence of metabolic syndrome on male fertility hormones, oxidative stress and antioxidant defense in obese subjects.

Materials and Methods: This is a cross sectional study which involved ninety (90) obese subjects between the ages of 29 – 49 years. They were divided into two groups; group 1 obese with metabolic syndrome (50 subjects) and group 2 obese without metabolic syndrome (40 subjects). The classification of metabolic syndrome was based on the National Cholesterol Education Program ATP III guidelines. Fasting blood samples were collected for biochemical analyses. Serum metabolic profile and oxidative stress markers were analyzed colorimetrically while serum level of male sex hormones and insulin were measured with Enzyme-linked Immunosorbent Assay method. Statistical analyses was done using SPSS version 23.0.

Results: The mean levels of metabolic profile (fasting plasma glucose, fasting blood insulin  homeostatic model assessment – Insulin Resistance index, total cholesterol, low density lipoproteins, very low density lipoprotein and triglyceride) were significantly higher (P<0.05) in groups with metabolic syndrome. Furthermore, there were significant lower level of testosterone and higher level of estradiol in metabolic syndrome group (P<0.05). The mean levels of antioxidants total antioxidant capacity and glutathione peroxidase were not significantly lower in test group (metabolic syndrome) when compared with the control (P>0.05), however, malondialdehyde was significantly higher (P<0.05).

Conclusion: In conclusion, components of metabolic syndrome can cause alterations in male sex hormones thus leading to infertility. It can also cause a redox imbalance characterized by increased plasma oxidation and reduced antioxidant capacity.

Open Access Original Research Article

Oxidative Stress Markers and Selenium Levels of Pulmonary Tuberculosis Patients in Some Dot Centers in Port Harcourt

Brown Holy, Ben-Chioma ., Adline Erima, Idoko Roselin Adiza

Journal of Advances in Medicine and Medical Research, Page 1-11
DOI: 10.9734/JAMMR/2018/43696

Severe oxidative stress has been reported in Tuberculosis (TB) patients, and this is associated with increased production of free radicals due to phagocyte respiratory burst, malnutrition, and poor immunity. This study investigated the levels of Malondialdehyde (MDA), Superoxide dismutase (SOD) and Selenium (SEL) levels in naïve Tuberculosis (TB) patients and TB patients on treatment. The study comprised of a total of 100 TB patients made up of 57 TB patients on treatment with anti-tuberculosis therapy and 43 naïve TB patients not on treatment. MDA and SOD were analyzed using Enzyme linked Immunosorbent assay technique (ELISA). While selenium and tuberculosis were detected by atomic absorption spectrophotometer and Gene Xpert respectively. The MDA level in TB patients on treatment was significantly higher (p<0.0011) than the MDA level of naïve TB patients. Also, the SOD level of TB patients on treatment was significantly lower (p<0.0426) than the SOD level of naïve TB patients. While the levels of Selenium in TB patients on treatment was significantly higher (p< 0.0002) than the selenium level of naïve TB patients. The study showed an increase in oxidative stress due to low levels of antioxidants and high lipid peroxidation due to increased MDA levels in TB patients on drugs. Therefore it might be appropriate to include antioxidant supplementation, either through nutrition or antioxidant therapy in the treatment regimen of TB patients; this may signify an innovative line of management of TB patients to quick recovery.

Open Access Original Research Article

A Study of Scoliosis among Adolescent Female Patients at the National Orthopaedic Hospital, Enugu, Enugu State, Southeast Nigeria

A. C. Obi-Okaro, S. N. Ukibe, C. U. Nwadinigwe, Ekezie Jervas, N. R. Ukibe

Journal of Advances in Medicine and Medical Research, Page 1-5
DOI: 10.9734/JAMMR/2018/43883

Background: Scoliosis is a musculoskeletal disorder characterised by a lateral bending or curvature of the spine.

Aim of Study: To evaluate the prevalence, distribution and age of onset of adolescent scoliosis among female patients at the National Orthopaedic Hospital, Enugu, Southeast, Nigeria.

Study Design:  This was a retrospective epidemiological study of female scoliosis patients treated between 2005 and 2014. Data were obtained from patients medical records after due permission had been sought for and obtained from the hospital management. A total of 16,027 orthopaedic cases were analysed.

Results: The prevalence of female adolescent scoliosis within the 10-year period was 0.27%. The peak age of presentation was 11-12 years, followed by 13-14 years. The prevalence rate varied from one year to the other. Thirty per cent (30%) of the presenting females were children of traders followed closely (20%) by children of teachers.

Conclusion: Female adolescent scoliosis was not common at the National Orthopaedic Hospital, Enugu within the study period. In view of the public health importance of scoliosis in adolescent girls, screening tests should be done periodically to detect cases in time for effective management and orthotic rehabilitation.

Open Access Original Research Article

Prevalence of Foreign Body in the Otolaryngology Service in Ado Ekiti

Waheed Atilade Adegbiji, Stanley Baba Amutta

Journal of Advances in Medicine and Medical Research, Page 1-8
DOI: 10.9734/JAMMR/2018/43889

Aims: To determine the prevalence, sociodemographic features, clinical presentation, patterns of foreign body impaction and management in our center.

Study Design: A cross-sectional descriptive study.

Place and Duration of Study: Department of Otorhinolaryngology, Ekiti State University Teaching Hospital, Ado-Ekiti, Nigeria between October 2015 and September 2017.

Methodology: An Interviewer-assisted questionnaire was used to collect data from 233 consecutive and consented patients with an impacted otorhinolaryngeal foreign body. Analysis of the obtained data done with SPSS version 16.0.

Results: Prevalence of otorhinolaryngeal foreign body impaction was 7.8%. There were 60.9% males and 39.1% of females with a male to female ratio of 2:1. There were 57.9% ear, 31.3% nasal and 10.7% throat foreign body.

Main types of the foreign body were 76.8% organic (living or dead). The most frequent foreign bodies were the cotton bud, seeds, foam, beads, and insects in 22.3%, 13.3%, 11.6%, 10.7%, and 9.9% respectively.

The most prevalent mode of otorhinolaryngology foreign body presentation was foreign body impaction in 93.1%, pain in 54.1%, hearing impairment in 41.6%, bleeding in 35.2%, and discharge in 26.2% and nasal blockage in 25.3%. A single episode of otorhinolaryngology foreign body in 96.1% was commoner than recurrent cases in 3.9% of the patients.

Associated complications of the impacted otorhinolaryngology foreign body were 22.3% injury/bleeding, 13.7% otitis externa and 12.4% hearing impairment.

The most common predisposing factors for otorhinolaryngology foreign body were 22.3% allergy and 20.6% earwax impaction.

All the patients had the foreign body removed. Pre-hospital treatment occurred in 164(70.4%) with unpleasant complications.

Conclusion: There were various foreign body impactions in all the age group. Prehospital attempted removal by unskilled sympathisers leads to avoidable complications. Foreign body retrieval required skilled hands and appropriate instruments.

Open Access Original Research Article

A Comparative Study of Time Dependent Candidal Colonisation in Diabetic and Non-diabetic Complete Denture Patients

Mujtaba Ashraf, Mariyam Ali, Abhishek Gaur, Monika Rajani, A. K. Verma, Pratibha Katiyar, Kaushik Kumar Pandey, Fauzia Tarannum

Journal of Advances in Medicine and Medical Research, Page 1-8
DOI: 10.9734/JAMMR/2018/43719

Introduction: Acrylic dentures are important predisposing factors for oral candidiasis. Duration of wearing dentures in the oral cavity of diabetic and non-diabetic patients can increase Candida colonisation and results in the higher incidence of oral and systemic candidiasis.

Aims and Objective: 1. To compare the changes in Candidal colonisation with time in complete denture prosthesis in diabetics and non-diabetics. 2. To evaluate the change in Candidal growth in diabetics and non-diabetic complete denture wearers. 3. To evaluate the relation of time with Candidal growth in complete denture wearers.

Materials and Methods: Three Salivary samples from each 20 edentulous, non-insulin dependent diabetic and 20 edentulous (Group-1), non-diabetic subjects (Group-2) were collected at 3 different time intervals. First sample was collected on the day of denture insertion, the second sample after one week from the day of insertion and third sample, after one month from the day of denture insertion in sterile containers using oral rinse technique. All samples were cultured directly on Sabouraud agar medium and species identification was done by HiCrome Candida Differential Agar culture methods.

Results: Candidal carriage and colonisation is more in diabetic denture wearer patients than non- diabetic denture wearer patients. Candidal growth in complete denture wearers was significantly increased from Day 1 to last day of 1st week (p=0.006), Day 1 to last day of 1st Month (p=0.005) and last day of 1st Week to last day of 1st Month (p=0.007) in Group 1. There was significant mean change in Group 2 from last day of 1st Week to last day of 1st Month (p=0.001). The common species of Candida isolated in both diabetic and non-diabetic denture wearer patients are: C. albicans, C. glabrata and C. tropicalis.

Open Access Original Research Article

Pharyngocutaneous Fistula Following Total Laryngectomy in Sokoto, Northwestern Nigeria

Stanley Baba Amutta, Mohammed Abdullahi

Journal of Advances in Medicine and Medical Research, Page 1-6
DOI: 10.9734/JAMMR/2018/44127

Aims: This study aims to determine the prevalence of pharyngocutaneous fistula and the risk factors in this environment.

Study Design: Retrospective study.

Place and Duration of Study: Department of Otorhinolaryngology, Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria between January 2006 and December 2017.

Methodology: The case record of all patients who had total laryngectomy were retrieved from the Hospital Record Department and reviewed.   Partial laryngectomy and incomplete/missing case file were excluded. Data obtained were patients' age, gender, co-morbidities (like diabetes mellitus and hypertension), laboratory investigations, tumour site, histology and stage, type of laryngectomy, pre-operative radiotherapy, surgical technique, time of fistula formation, the days before the commencement of oral diet and length of hospital stay. The data analysed with IBM SPSS version 21.0 and the statistical significance calculated with GraphPad Instat 3 Software. A P value ≤ 0.05 was considered statistically significant.

Results: The total number of patients who had total laryngectomy during the study period was 30, comprising 26 (86.7%) males and 4 (13.3%) females with a male to female ratio of 6.5:1. The average age was 58 years (range 29-80). The average duration of hospitalization was 29.5 days (range 19-48). The prevalence of pharyngocutaneous fistula among the patients was 8 (26.7%), and it occurred exclusively in the male. The majority (62.5%) of the pharyngocutaneous fistula occurred before initiation of oral diet and within the first ten postoperative days.

The identified risk factors for the observed pharyngocutaneous fistula were supraglottic and transglottic tumour sites, well differentiated squamous cell carcinoma and T3/T4 tumour stage. However, none of these risk factors was statistically significant. The PCF was successfully managed conservatively, but the patients had prolonged hospitalization and initiation of the oral diet.

Conclusion: The prevalence of pharyngocutaneous fistula in this study was 26.7%, and the identified risk factors were not statically significant. There were prolonged hospitalization and initiation of oral diet with obviously increased morbidity, cost, and delayed rehabilitation.