Open Access Case Report

“Black Ink” Sonographic Pattern as a Predictor for Invasive Papillary Thyroid Micro Carcinoma: A Case Report

Ersilio Trapanese, Basilio Angrisani, Alberto Angrisani, Ermanno D’Arco, Mariano Agrusta, Carmine De Bartolomeis, Stefano Laudati, Giulio Tarro

Journal of Advances in Medicine and Medical Research, Page 1-13
DOI: 10.9734/jammr/2019/v30i130162

Background: This study investigated the utility of the Sonographic pattern "Black Ink" with BRAF mutation testing of thyroid fine-needle aspiration cytology specimens for the risk papillary thyroid microcarcinoma (PTMC).

Case Presentation: We describe a case of a 41-year-old Caucasian woman affected by a ultrasonography “Black Ink” papillary thyroid microcarcinoma (PTMC) of the left lobe of the thyroid gland with very tiny size (Ø 0.4 cm). The characteristics, with the Diagnostic Imaging using Ultrasonography (US), Superb Micro-Vascular Imaging (SMI), fine-needle-aspiration cytology (FNAC) and mutation analysis are here discussed. There are more rare subtypes of thyroid cancer as papillary microcarcinoma "Black Ink" that even if small, are invasive and there is why the need to early diagnosis to avoid their aggressive behavior is needed. Nowadays, focusing on the size, the cut-off for non-occult tiny tumors has dropped to 0.3 cm. This value is of great relevance.

Conclusion: Ultrasonography, FNAC and BRAF molecular study have proven to be the most sensitive diagnostic combination for the early detection of thyroid cancer. Despite the size of this micro-lesion, the Black Ink ultrasonographic pattern associated with malignant cytology at FNAC represents an important biological risk factor and could still be a predictor of the PTMC and risk for neck lymph node metastases.

Open Access Original Research Article

Sonographic Assessment of Normal Fetal Cerebral Lateral Ventricular Diameter at Different Gestational Ages

Benjamin Effiong Udoh, Ogbu Sylvanus, Wilson Imo Uduak, Ulu Okoro Ulu

Journal of Advances in Medicine and Medical Research, Page 1-5
DOI: 10.9734/jammr/2019/v30i130156

Abnormal dilatation of ventricles has been shown to be the most common abnormality of the brain & fetus in most of the geographical zones, but the normal dimension of the fetal lateral ventricle in south-south geopolitical zones of Nigeria has not been evaluated.

The aim of this study was to determine the normal feto-lateral ventricular diameter using ultrasound at different gestational ages.

Measurement of the fetal-lateral ventricular diameter was obtained from 685 fetuses of pregnant mothers that met the inclusion criteria during routine ultrasound scan in Calabar metropolis. Measurement of the ventricular diameter was taken at the level of the atria, measured according to Australian society for ultrasound in medicine guidelines.

The result shows that the mean lateral ventricular diameter of fetuses in the studied region is 6.62 ± 2.51 mm with a range of 4.12-9.54 mm. The lateral ventricular diameter and the fetal head circumferences, as well as the gestational age, do not show any significant correlation throughout gestation.

Conclusion: Fetuses in Calabar Metropolis have a lateral ventricular diameter that ranges from 4.12 - 9.54 mm. Ventricular diameter above this normal range in this region and could be considered as an abnormal and may demand further investigations.

Open Access Original Research Article

Isolation of Candida albicans among HIV Patients Presenting with Oral Thrush in Abuja, Nigeria

Yunusa, Thairu, Ukonu, Agwu Bob, Aisha Mashood Adeoye

Journal of Advances in Medicine and Medical Research, Page 1-8
DOI: 10.9734/jammr/2019/v30i130157

Background: Candida infections are known contributors to the high morbidity and mortality rates seen in HIV positive patients.

Methodology: This was a descriptive cross-sectional study.  The study was carried out at the Microbiology research laboratory, department of Medical Microbiology, University of Abuja Teaching Hospital, Gwagwalada. The population is made up of two hundred and ten (210) patients who presented with oral thrush between fifteen years and seventy years which comprises of 160 HIV seropositive and 50 non age and sex matched HIV seronegative patients. Culture, Microscopy and ELISA methods were used for isolation of Candida albicans. An interviewer-administered, structured questionnaire was used as the study tool.

Results: The mean age for the isolation of Candida albicans was 30 ± 18.7 years, with the highest proportion of isolates within the age range of 21-30 years accounting for 27.1% of the study population recruited and the lowest proportion of isolates being 41-50 years accounting for 8.0%. From the 210 subjects with Candida albicans in the study, one hundred and sixty (160) representing 76.2 were isolated from HIV seropositive clients and Candida albicans isolation rate among HIV seronegative population was 23.8%.

Conclusion: The sensitivity, specificity and positive predictive value of using Grams reaction methods in the diagnosis of Candida albicans was 22.9%, 95.2% and 82.6%. The sensitivity, specificity and positive predictive value of using ELISA methods was 25.7%, 86.7% and 65.9%. In this study, there was preponderance of Candida albicans isolate among the young and the old in HIV seropositive patients but largely isolated from older patients among HIV seronegative  patients.

Open Access Original Research Article

Preoperative Diagnosis of Upper Gastrointestinal Leiomyoma by Endoscopic Ultrasound-guided Fine Needle Aspiration

V. O. Shaprynskyi, Zaki Nageeb Nasr, Y. V. Babii, Abdulhakeem Alkamali

Journal of Advances in Medicine and Medical Research, Page 1-10
DOI: 10.9734/jammr/2019/v30i130158

Aims: To evaluate the role of endoscopic ultrasonography-guided fine needle aspiration (EUS-FNA) with using immunohistochemical analysis in the preoperative diagnosis of upper gastrointestinal leiomyoma.

Study Design:  This was ’prospective’ observational study.

Place and Duration of Study: Department of surgery №1, Vinnytsia National Pirogov Medical University, Vinnytsia, Ukraine; between September 2016 and February 2019.

Methodology: Sixteen prospectively studies have been performed using endoscopic ultrasonography-guided fine needle aspiration (EUS-FNA) in patients with submucosal hypoechoic tumors (according to the results of previous gastroduodenoscopy) with continuity to proper muscle layer suspected as leiomyoma of upper gastrointestinal tract. All cases for the final diagnosis underwent surgery (n = 16). Additionally, immunophenotyping of specimens obtained by EUS-FNA and surgical resection specimens have been compared.

Results: The puncture has been performed in all patients without any anatomical problems. The collection rate of adequate specimens from the GI tract subepithelial hypoechoic tumor with continuity to proper muscle layer was 87, 5%. The diagnostic rate for the tumor less than 2 cm, 2 to 4 cm, and 4 cm or more were 77, 8%, 100% and 100% respectively. In 16 surgically resected cases, the sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy of EUS-FNA using immunohistochemical analysis of leiomyoma were 100%; 83,3%; 90,9%; 100% and 93,75% respectively. No major complications were encountered.

Conclusion: EUS-FNA with immunohistochemical analysis is a safe and accurate method in the preoperative diagnosis of gastrointestinal leiomyoma. It should be taken into consideration in decision making, especially in early diagnosis following minimal invasive surgery for gastrointestinal leiomyoma.

Open Access Original Research Article

Hyperemesis Gravidarum, Wernicke Encephalopathy and Korsakoff Syndrome: A Critical Appraisal of the Relevant Literature

Nasreen Khawer Salahuddin, Arindam Dutta, Naseem Akhtar Qureshi

Journal of Advances in Medicine and Medical Research, Page 1-18
DOI: 10.9734/jammr/2019/v30i130159

Background: Hyperemesis gravidarum tends to rapidly progress into Wernicke encephalopathy and Korsakoff syndrome and, therefore, needs to be recognized early and managed promptly with targeted multimodal therapies.

Objective: This study critically reviewed the relevant literature on clinical perspectives of hyperemesis gravidarum, Wernicke encephalopathy and Korsakoff syndrome. The secondary objective of this study was to improve the awareness, emphasis on early diagnosis and immediate intervention concerning these sequential syndromes in pregnant women across the board.

Methods: Electronic searches (since inception-2019) of PubMed/MEDLINE, Google Scholar, OvidSP, Dove Medical Press, ScienceDomain International (SDI) and Hindawi.com were conducted using keywords and Boolean Operators. Hundreds of thousands articles were retrieved which were reviewed independently by two authors and finally 144 articles retained that addressed clinical components of these sequential syndromes along with relevance of thiamine deficiency.

Results: Evidently, vulnerable women in early stage of gestation tend to develop hyperemesis gravidarum characterized by persistent severe pernicious nausea and vomiting that causes Wernicke encephalopathy defined by variable oculomotor disturbances, ataxia, confusion, metabolic disturbances and Korsakoff syndrome linked with gross memory impairment, confabulation and constipation. The women with these conditions need diagnostic evaluation by means of clinical history, relevant laboratory tests, abdominal ultrasound and brain computerized tomography and magnetic resonance imaging. Most patients need emergency admission, prompt treatment with optimal doses of antiemetics, vitamin B1, and followed by fluid replenishment and electrolyte balance with follow up till the end of pregnancy. Successful maternal and fetal outcome of pregnancy depends on multiple determinants including associated systemic diseases.

Conclusion: Evidently, a variety of etiological and risk factors in pregnant women determine the initiation of hyperemesis gravidarum that subsequently causes Wernicke encephalopathy and Korsakoff syndrome, and each of which needs prompt multimodal treatment in order to reduce maternal morbidity and increase successful outcome of pregnancy. Although clinical literature concerning these sequential syndromes is huge, further studies are needed to understand their underlying pathophysiological pathways across the world.

Open Access Original Research Article

Evaluation of Nephroprotective Properties of Aqueous and Hydroethanolic Extracts of Crinum scillifolium against Gentamicin Induced Renal Dysfunction in the Albino Rats

Koffi Francis Bienvenu, Droucoula Guillaume Cyril, Yessoh Bogui Florian, Yapi Houphouët Felix, Okpekon Aboua Timothée

Journal of Advances in Medicine and Medical Research, Page 1-10
DOI: 10.9734/jammr/2019/v30i130160

Aims: Gentamicin, a widely used aminoglycoside antibiotic, is recognized as possessing significant nephrotoxic potential in human beings. The aim of this study was to determine the protective effect of aqueous and hydroethanolic extracts of Crinum scillifolium on gentamicin induced nephrotoxicity using biochemical approaches and determined the most active extract in rat.

Study Design: The leaves of Crinum scillifolium were collected in the district of Me (Côte d’Ivoire). The plant was identified and authenticated by the Department of Botany, Felix Houphouet Boigny University of Abidjan (Côte d’Ivoire).

Place and Duration of Study: Analysis of the plant samples was done in pharmacodynamics Biochemistry Laboratory, Felix Houphouet Boigny University and the Laboratory of Organic Chemistry and Natural Substances, Felix Houphouet Boigny University between July and August 2018.

Methodology: The extractions were execcuted by macerating 100 g of plant dry powder in 1 liter of distilled water (aqueous extraction) or in 2 liters of water / ethanol mixture (30/70 V / (ethanol extraction). The animals were divided according to weight in seven groups each of six rats. The nephroprotective effects were estimated by comparing the effects of the extracts (100 and 200 mg / kg) to that of vitamin E (250 mg / kg) against gentamicin-induced renal failure by (80 mg / kg). Gentamicin is administered to the animals one hour after treatment with the extracts for seven days.

Results: The administration of gentamicin through intraperitoneal route to rats for seven days, resulted in an increase in urea and creatinine concentrations as well as decrease of total protein concentration in the serum. The level of total protein and albumin increased in urine after administration of gentamicin. The treatment of animals suffering from nephrotoxicity with Hydroethanolic and aqueous extracts of Crinum scillifolium would have significantly reduced (P < 0.001 and P < 0.01) biochemical parameters considered as markers of nephrotoxicity.

Conclusion: This study proved that the aqueous extract of Crinum scillifolium possesses a nephroprotective activity against gentamicin-induced kidney failure in rats. So aqueous extract can be useful for preventives applications.

Open Access Original Research Article

Malaria in Pregnancy: Prevalence and Risk Factors in the Mamfe Health District, Cameroon

Felix Amate Elime, N. Rene Nkenyi, Luis Ako-Egbe, Ann Njunda, Dickson Nsagha

Journal of Advances in Medicine and Medical Research, Page 1-11
DOI: 10.9734/jammr/2019/v30i130161

Background and Aim: Malaria remains a major public health problem and a global threat to humanity especially in sub-Saharan Africa. In a bit to combat malaria in Cameroon, about 8million Cameroonian received the insecticide treating nets (ITNs) in 2011. However, hospital based reported prevalence of malaria still remains high. Our objective was to determine the community based prevalence and possible risk factors of malaria in pregnancy in the Mamfe health district, south west region-Cameroon.

Methods: This was a community-based cross-sectional study involving 269 pregnant women in the Mamfe health district of Cameroon. Three out of the 5 health areas were randomly selected and pregnant women were later sampled by convenience and an interviewer administered questionnaire was done. Also rapid diagnostic test (RDT) for malaria was done for all the participants. Data was analysed using Epi info version 3.5.4 at a level of error of 5%.

Results: Of the 269 pregnant women who took part in the study, 106 (39.6%) were positive for malaria. Risk factors associated with developing malaria among them were: presence of mosquito breeding sites (OR=0.001, 95%CI; 0.02-0.27, p-value=0.001), not sleeping under Insecticide treated nets(ITNs) (OR=0.01, 95%CI; 0.01-0.03, p-value=0.001), bushes around houses (OR=0.24, 95%CI; 0.07-0.79, p-value=0.02) and not taking intermittent preventive treatment (IPT) (OR=0.08, 95%CI; 0.01-0.49 p-value=0.01). Majority of participant knew malaria can be prevented by sleeping under ITNs 75% (95%CI; 69.9-80.5) and uptake of IPT 23.8% (95%CI; 18.8-29.2).

Conclusion: Prevalence of malaria in pregnancy in the Mamfe health district is higher than reported by the regional delegation of public health for the south west. Risk factors include: mosquito breeding sites, bushes around compound, not taking IPT and none use bed nets are known to pregnant women. Interventions to fight against malaria in pregnancy should target intensification of health education on environmental hygiene and use of ITNs.

Open Access Original Research Article

Cancer in Cross River State

G. A. Ebughe, T. I. Ugbem, D. E. Ushie, S. Effewongbe

Journal of Advances in Medicine and Medical Research, Page 1-8
DOI: 10.9734/jammr/2019/v30i130163

Aims: To determine the prevalence of cancer in the rest of Cross River State not covered by the population-based cancer registry which is limited to the capital city of Calabar.

Study Design: Descriptive retrospective study involving a trend analysis of cancers from the rest of Cross River State not covered by the Calabar cancer registry. Cancers incident in the Pathology and Haematology departments of the University of Calabar Teaching hospital are included in the study.

Place and Duration of Study: Pathology and Haematology departments of the University of Calabar Teaching hospital. Data was assessed between April to May 2019.

Methodology: An institution-based trend analysis of cancers originating from the rest of Cross River State, out of population-based cancer registry’s coverage was carried out. Such cases incident in the Pathology and Hematology Departments of the University of Calabar Teaching Hospital were included. Cancer data from 1st January 2004 to 31st December 2013 was accessed from the archives of both departments. Data extraction was carried out though filling of a check list and these were fed into IBM statistical package for social sciences SPSS version 21 for analysis.

Results: Nine hundred and fourty one (941), cancer cases were diagnosed during this period. The mean age of diagnosis was 49.18 ± 18.9.Four hundred and seventy seven (477 or 50.69%) females and 464 or 49.31% males had cancer, representing a female to male ratio 0.97: 1. Overall, the commonest age group was 40 to 64 years (46.3%), followed by 18 to 39 years (25.5%), and 65 years or greater (23.0%).Breast cancer followed by prostate cancer were the commonest cancers in adults, while cancers in the lymphohaematopoietic tissue, soft tissue and eye were the commonest in children.

Conclusion: Cancer occurs at an earlier age in the rest of Cross River State, with breast and prostatic cancer dominating. Efforts should be doubled to institute effective screening programmes.

Open Access Original Research Article

The Impact of Stigma and Discrimination on Adherence to Medication amongst People Living with HIV in Tiv Land, North Central Nigeria

Godwin Aondohemba Timiun, Timothy J. Scrase

Journal of Advances in Medicine and Medical Research, Page 1-9
DOI: 10.9734/jammr/2019/v30i130165

In spite the identification of stigma as a factor impeding public utilisation of HIV counselling, testing, and treatment services in Nigeria, gaps still exist in knowledge on the impact of stigma, and discrimination on adherence to medication amongst people living with HIV (PLWH). This study adopted mixed methods to examine the impact of stigma and discrimination on adherence to medication amongst PLWH in Nigeria.  A sample of 1,621 respondents was collected using multi-stage and purposive sampling methods. Structured interviews using questionnaires and in-depth interviews (using a guide) were utilised for data collection. SPSS (version 21) was used for quantitative data analysis while the qualitative data was analysed thematically. There are 46.3% men and 53.7% women respondents. Generally, their income is low, 70.7% are earning less than N25, 000 (approximately $125 USD) per month. Some of the HIV patients are stigmatised. In reaction, they avoid public places, travel long distances away from their immediate community to collect drugs and to avoid been noticed around the centers. They sometimes miss taking drugs regularly as prescribed, suffer depression and die. Stigma and discrimination impede adherence to medication amongst PLHW in Nigeria. More efforts should be made to create awareness to reduce stigma and discrimination of HIV patients, while augmenting their income to meet up with the challenges of adherence to medication. The overall benefits would be enhanced mechanism of HIV prevention, treatment and control in the study area.