Clinical Medicine Research

ISSN Online: 2326-9057 ISSN Print: 2326-9049

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Volume 3, Issue 4, July 2014

  • Authors: Rameez Shah, Md. Shahriar Islam, Md. Rafiqul Islam, Anika Arfin

    Abstract: Nasal polyps are one of the most frequent clinical entities encountered by otolaryngologists. However, nasal polyps should be regarded as “signs” and not “diagnosis”, unless subject to histopathology-especially when the case is of unilateral nasal polyps, as histopathological evaluation is mandatory to reach a confirmed diagnosis. This study was thus aimed to establish the importance of histopathology in diagnosis of unilateral nasal polyps (as many otolaryngologists still do not agree with the need to do so). A prospective study done in the Dept of Otolaryngology, Dhaka Medical College Hospital, Dhaka, Bangladesh from January’2012 to June’2013 on 69 patients clinically diagnosed as unilateral nasal polyps and surgically treated with subsequent histopathological evaluation. It was found that histopathology was very important and conclusive in the diagnosis of nasal polyps.

    Received: Mar. 6, 2014 Accepted: Jun. 19, 2014 Published: Jun. 30, 2014

    DOI: 10.11648/j.cmr.20140304.11 View: Downloads:

  • Authors: Abdellah Babahabib, Mohamed Elmarjany, Hicham Bakkali, Mehdi Elhassani, Jaouad Kouach, Rhali Driss Moussaoui, Mohamed Dehayni

    Abstract: The carcinosarcoma is a mixed tumour composed of epithelial and mesenchymatous malignant tissus. It can occur on the level of all the female genital tract, most frequently the uterus. The ovarian localization is rare. The purpose of our work is to discuss the problems of differential diagnosis raised by this rare entity. We report the case of a 60 years old patient, who consulted for an abdominal mass of 20 cm. Tomodensitometry of the abdomen and the pelvic had objectified the right ovarian origin. The patient was treated by total colpohysterectomy with bilateral annexectomy. Through this case with review of the literature we shall discuss the histogenetic assumptions of this entity which are the object of controversies as well as the prognosis and therapeutic implications.

    Received: Apr. 15, 2014 Accepted: Jul. 5, 2014 Published: Jul. 20, 2014

    DOI: 10.11648/j.cmr.20140304.12 View: Downloads:

  • Author: Michael D. Innis

    Abstract: The Triad, characterized by bilateral retinal haemorrhages, diffuse cerebral haemorrhage and hypoxic ischaemic encephalopathy is conventionally thought to result from trauma caused by violently shaking a child by a parent or carer. The shaking is said to cause a to and fro movement of the brain in the skull leading to injury to the neurons, disruption of the cerebral veins and trauma to the retinal vessels. Vigorous shaking of a child has never been observed and an alternative explanation for these changes was sought. Here it is shown that Tissue Scurvy, an autoimmune disorder which has specific and consistent biochemical features of Hyperglycaemia and Liver Dysfunction as shown by abnormal Liver Function Tests, is the cause of the lesions. A child diagnosed as being the victim of the Shaken Baby Syndrome was tested for evidence of Tissue Scurvy and both Hyperglycaemia and Abnormal Liver Function were demonstrated. It is concluded that these results provide conclusive evidence that the Shaken Baby Syndrome is a form of Tissue Scurvy in which encephalopathy is caused by damage to neurons in the cervical spinal column causing hypoxia, which leads to ischaemic encephalopathy and the other features of the triad.

    Received: Jul. 4, 2014 Accepted: Jul. 16, 2014 Published: Jul. 30, 2014

    DOI: 10.11648/j.cmr.20140304.13 View: Downloads:

  • Authors: Arafat A. Kassem, Amir A. Fikry, Doaa Shahin, Hosam Aldeen Salah Shabana, Sadek Mostafa

    Abstract: Aims: to evaluate the correlation between endoscopic disease activity, and fecal calprotectin, transforming growth factor-B1, Clinical Activity Index, C- reactive protein, and blood leucocytes. Methods: Ninety two patients with ulcerative colitis were enrolled and scored according to the endoscopic part of the Rachmilewitz Index. Patients and controls provided fecal and blood samples for measuring calprotectin, TGF-B1, CRP, and leucocytes. Results: The values in ulcerative colitis patients (n = 92) compared to controls (n = 20): calprotectin: 728.9 ± 388.4 versus 22.9 ± 12.9 µg / g, TGF-B1: 350.1 ± 214.7 versus 4.3 ± 2.01 pg /Ml, CRP: 36.9 ± 20.3 versus 3.5 ± 1.9m g/L, blood leucocytes: 13.8 ± 4.5 versus 7.3 ± 1.8 g/ L (all P< 0.001). Endoscopic disease activity correlated significantly with calprotectin (Spearman’s rank correlation coefficient r = 0.545), TGF-B1 (r = 0.531), Clinical Activity Index (r = 0. 520), CRP (r = 0.481), and blood leucocytes (r = 436). Calprotectin and TGF-B1 levels were significantly lower in ulcerative colitis patients with inactive disease ( endoscopic score 0 -3, calprotectin 60.5 ± 47.8 µg / g, TGF-B1 39.9 ± 35.4 pg/Ml , P < 0.001), compared to patients with mild ( score 4 – 6, calprotectin 460.2 ±240 µg/g, TGF-B1 172.4 ± 88.2 pg/ Ml, P < 0.001 ), moderate ( score 7 – 9, calprotectin 797.9 ± 239.2 µg/g, TGF-B1 352.6 ± 89.9 pg/Ml, P < 0.001 ), and high disease ( score 10 – 12 , calprotectin 969.2 ±268.9 µg/g, TGF-B1 486.8 ± 211.2 Pg/ Ml, P < 0.001). The overall accuracy for detection of histopathological active disease was 96.7 % for fecal calprotectin, 94.5 % for TGF-B1, 90 % for Endoscopic Activity Index, 87 % for Clinical Activity Index, and 65 % for both blood leucocytes and CRP. Conclusion: Both fecal calprotectin and TGF-B1 correlated significantly with endoscopic disease activity, clinical activity index, CRP, and blood leucocytes. Furthermore, both calprotectin and TGF-B1 were suitable markers that can differentiate endoscopically and histopathologically inactive from active disease, thus, these two biomarkers may be used for monitoring ulcerative colitis activity.

    Received: Jul. 16, 2014 Accepted: Jul. 23, 2014 Published: Jul. 30, 2014

    DOI: 10.11648/j.cmr.20140304.14 View: Downloads:

  • Authors: Okwy-Nweke C. P., Anyanwu J. O., Maduforo A. N.

    Abstract: Objective: The research was designed to ascertain information on the mothers’ beliefs and obstacles as limitations in promoting exclusive breastfeeding among the working class mothers aimed to: (1) to determine the rate of promotion of the awareness on the benefits of exclusive breastfeeding, (2) to determine the obstacles or barriers to the practice of exclusive breastfeeding, (3) to determine the percentage level of working class who practice exclusive breastfeeding, (4) to assess the nutritional knowledge and beliefs of working class mothers about exclusive breastfeeding and (5) to find out the level to which the practice of exclusive breast feeding influences the working class. Methodology: This survey study was carried out on 60 respondents which compromised of registered working class mothers attending the Infant Welfare Clinic at the Institute of Child Health, UNTH, Enugu. Structured and validated questionnaire were used to obtain information from the subjects on their socio-economic background, baby’s information, promotion of exclusive breastfeeding and obstacles to exclusive breastfeeding. Data obtained from the subjects were analyzed using SPSS version 16 to determine their frequency and percentages. Result: Result showed that 91.7% of the mothers had knowledge of exclusive breastfeeding which they individually came across at different times in their lives. A small number of the mothers 38.3% practiced exclusive breastfeeding which was found to be influenced by their level of education, antenatal clinic attendance and personal conviction. 35% of them initiated breastfeeding within 30 minutes of delivery. It was observed that majority of the mothers, 80% of them do not express their breast milk. Apparently 85% of the mothers are agreed to the numerous benefits of exclusive breastfeeding. 81.7% of the mothers are of the opinion that the presence and availability of hygienic crèche in their offices will reduce the obstacles to exclusive breast feeding. The main obstacle to exclusive breastfeeding identified was absence and unavailability of hygienic crèche in office environments, followed by breast and nipple problems, perceived milk insufficiency, pressure from family and sometimes the effect of drugs taken while breastfeeding. Conclusion: Educational programme on exclusive and optimal breastfeeding should be strengthened and mothers enlightened on its importance. Therefore more behavioural changes and communication should be made to promote, protect and support exclusive breast feeding.

    Received: Jul. 17, 2014 Accepted: Jul. 29, 2014 Published: Aug. 10, 2014

    DOI: 10.11648/j.cmr.20140304.15 View: Downloads:

  • Authors: Tarimo Nesto, Ina Diener

    Abstract: Low back pain (LBP) is a musculoskeletal disorder, affecting humans from adolescent to adult age. It is a health and socio-economic problem worldwide. The cause and contributing factors to LBP are multifactorial resulting in different approaches for its management. The attitudes and beliefs of patient with LBP, play an important role in the whole process of pain management. Negative attitudes and beliefs may lead to fear -avoidance behaviour, resulting into pain chronicity and disability. Thus, this study aimed to identify the attitudes and beliefs among patients with LBP, attending physiotherapy treatment in Malawi. Queen Elizabeth and Kamuzu Central hospitals were selected as study settings. A quantitative cross-sectional survey was done, using a self-administered questionnaire, employing a convenience sampling method. Twelve statements about attitudes and beliefs on LBP were adopted from the Back Beliefs Questionnaire (BBQ) and from the Survey of Pain Attitudes (SOPA). The SPSS (version 19.0) was used for data capturing and analysis. Descriptive and inferential statistics were used to summarize data. The Chi-square test was used to determine any association between variables and the Alpha level of significance was set at 0.05. All ethical issues were sought and adhered to throughout the study period. The results showed that out of 205 participants, with mean age of 47.74 years, (SD=13.29), female constituted 53.2% of the sample. More than half (67%) of all participants portrayed negative attitudes and beliefs about their LBP. We concluded that, majority of patients with LBP in Malawi hold negative attitudes and beliefs about their pain. Therefore, patient health education is needed to change these attitudes and beliefs if recovery and treatment goal are to be achieved.

    Received: Jul. 25, 2014 Accepted: Aug. 6, 2014 Published: Aug. 20, 2014

    DOI: 10.11648/j.cmr.20140304.16 View: Downloads:

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