Clinical Medicine Research

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

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Volume 3, Issue 6, November 2014

  • Author: Michael D. Innis

    Abstract: Parents and carers are often falsely accused of injuring a child asserting that unexplained bruises, fractures, retinal and subdural hemorrhages with ischemic encephalopathy, the so called “Triad”, are signs of physical abuse. However these features can be the result of Tissue Scurvy, a disorder of Vitamin C metabolism in which Vitamin C, although abundant in the plasma, is unable to enter the cell because of a lack of Insulin which is necessary to conduct the transfer of the Vitamin C into the cell. The cause is an autoimmune reaction to a viral, bacterial or parasitic infection or a vaccine which destroys the Insulin-producing Beta cells of the Pancreas, as evidenced by Hyperglycaemia and Glycosuria, in some genetically susceptible children. Here it is shown that the evidence of the Prosecution Experts alleging death from the Shaken Baby Syndrome was demonstrably flawed. The diagnosis Shaken Baby Syndrome is false and an innocent man was incarcerated. This irrational diagnosis should beabandoned.

    Received: Sep. 8, 2014 Accepted: Oct. 14, 2014 Published: Oct. 30, 2014

    DOI: 10.11648/j.cmr.20140306.11 View: Downloads:

  • Authors: Turano Salvatore, Biamonte Rosalbino, Conforti Serafino, Mastroianni Candida Maria, Manfredi Caterina, Palazzo Salvatore

    Abstract: Background: Gastric adenocarcinoma is the second most common cause of cancer death worldwide. There is no standard regimen of chemotherapy for metastatic disease, although the regimen of ECF is the most used regimen, with a median survival of 7-9 months. With new regimens of chemotherapy, such as DCF, the median survival has increased, despite a major toxicities and 1-2% of toxic death.Patients And Methods: This is a monocentric experience. In three years (2009-2012) we have treated 36 chemo-naïve patients with histological diagnosis of locally advanced or metastatic gastric cancer with a DCF regimen. All patients were treated with a prophilactic Peg-filgrastim injection at 6th day of therapy. Results: A total of 168 cycles were administered (median 5 per patient, range 3–8). Major responses were observed in 10 patients, with 2 complete (5,5%) and 8 partial remissions (22,2%); 16 additional pts showed disease stabilization (44,4%) and 10 progressed (27,9%). Median OS times were 12 months. Median TTP were 9,5 months. Toxicity was acceptable, worst per patient toxicities were neutropenia (grade 3-4 in 15%), feverish neutropenia (11,1%) diarrhoea (grade 2 in 25% , grade 3 in 25%, grade 4 in 18,8%), asthenia (grade 2 in 8%), neurotoxicity (grade 3 in 4%), anhemia (grade 4 in 10%), four pts received blood transfusion. Conclusion: Time to response and ORR favor DCF over other schedule’s treatment according to literature. A trend towards increased myelosuppression and infectious complications was observed but the management of this and others side-effects is possible and not too difficult if pts is managed by an expert toxicities team. Infact we don’t have no-one toxic death.

    Received: Sep. 26, 2014 Accepted: Oct. 28, 2014 Published: Oct. 30, 2014

    DOI: 10.11648/j.cmr.20140306.12 View: Downloads:

  • Authors: Reza Elahi, Seyed Morteza Tabatabaee, Seyed Alireza Heydariezade, Mitra Ranjbar

    Abstract: Purple urine bag syndrome (PUBS) is purple discoloration of urinary catheter, tubing and bag and it is a rare and uncommon manifestation of urinary tract infection. Female gender, constipation, urinary tract infection, dementia, alkaline urine and high urinary bacterial counts are main risk factors. Here we report a 70 year old woman living in a nursing home presented with diarrhea, decreased oral intake and purple urine. The urine was evaluated and urine analysis showed PH=7 and pyuria. The result of urine culture was growth of more than 10¬0000 colony of Proteus Mirrabilis sensitive to Imipeneme. The patient condition improved after antibiotic therapy. The main reason of this phenomenon is not clearly recognized but some authors believe that Indigo (blue pigment) and Indirubin (red pigment) which are metabolite derivate of tryptophan can cause this uncommon discoloration. This condition is benign without any serious consequences and the treatment of underlying disease should be considered.

    Received: Nov. 3, 2014 Accepted: Nov. 16, 2014 Published: Nov. 20, 2014

    DOI: 10.11648/j.cmr.20140306.13 View: Downloads:

  • Authors: Megbaru Alemu, Asrat Hailu, Gessessew Bugssa

    Abstract: Introduction: Intestinal Schistosomiasis and Soil transmitted helminthic infections (STIs) are among the major public health problems in the world, especially in Subsaharan Africa. Objective: To determine the prevalence of intestinal schistosomiais and soil transmitted helminthic infections and associated factors among Umolante primary school children, South Ethiopia. Methods: A cross sectional study was conducted among Primary School Children in Umolante Destrict, South Ethiopia. A total of 405 school children were selected at random. For each selected subject interview and stool examination was done. Interviews were used to identify the risk factors. Stool specimens were examined using the Kato-Katz technique. Data was entered and analyzed using SPSS version 16.0 statistical packages software. Results: The overall prevalence of intestinal helminthic infection was 26.9%. The predominant parasites were hookworm 59(14.6%) and S.mansoni 51(12.6%). Prevalence of S.mansoni infection was significantly higher in males (p=0.006) whereas hookworm infection was significantly higher in females (P=0.015). Other helminthes found were E.vermicularis (1%), whipworm (1.5%), tapeworm (1.5%) and A.lumbricoides (0.5%). The highest prevalence of S.mansoni was reported in the age group of 10-14 years (17.8%) followed by the age group 15 and above (11.6%) and the difference was statistically significant (P=0.02). Geometric mean intensity was also highest in the same age group (245 eggs per gram). The overall prevalence of infection was 7.7% for girls and 17.1% for boys and the difference was statistically significant (p=0.006). Bathing practice in the nearby stream was significantly associated with S.mansoni infection (OR, 3.4, 95.0% C.I., 1.5-5.3, P=0.03). Conclusion and recommendation: On the basis of these results, it can be concluded that intestinal helminthic infections are important health problems among school children. Hence, integrated control programme including periodic deworming, shoes wearing, improving sanitation, provision of safe water supply are needed to have a lasting impact on transmission these diseases.

    Received: Nov. 10, 2014 Accepted: Nov. 21, 2014 Published: Nov. 24, 2014

    DOI: 10.11648/j.cmr.20140306.14 View: Downloads:

  • Authors: Fang Ning, Yinzhong Duan, Yi Xue, Donghui Yuan

    Abstract: Purpose: The aim of this study was to investigate and evaluate the changes of incisor inclination and arch width in the surgical-orthodontic treatment to correct a Class Ⅲ malocclusion resulting from skeletal mandibular prognathism. Materials and methods: The skeletal mandibular prognathism subjects consisted of 25 males and 20 females (mean age:22.8±4.2years). A lateral cephalogram was taken for each subject before preoperative orthodontic treatment (T1), presurgical (T2), and at completion of the postoperative orthodontic treatment (T3). Skeletal and dental values and arch width measurements at T1, T2 and T3 were obtained. Each cephalogram was traced and digitized twice. For statistical evaluation, all the data were expressed as Mean±Standard deviation and analyzed with SPSS software. Results: At pretreatment, dental compensation was normally found in both dental arches, including anterior and posterior teeth. During presurgical orthodontic treatment, most of the patient’s mandibular incisors were significantly decompensated (P<0.05), while no significant changes were noted in the maxillary incisors (P ≥ 0.05). The increase in maxillary inter-first molar width were statistically significant (P<0.05). With effective dental decompensation, the relationship between teeth and basal bone was improved obviously. It is beneficial for moving bone bulk in surgery. After the surgery, most of the patients (97.8%) finished with proper overjet and overbite, establish stable and harmony occlusion. Conclusion: By effective and proper dental decompensation, desired teeth positions could be achieved before surgery, which could lead to better surgical results.

    Received: Nov. 16, 2014 Accepted: Nov. 28, 2014 Published: Dec. 2, 2014

    DOI: 10.11648/j.cmr.20140306.15 View: Downloads:

  • Authors: Feleke Tilahun, Workalemahu Alemu, Getasew Mulatu

    Abstract: Introduction; Cutaneous leishmaniasis is a neglected tropical disease strongly associated with poverty with an adverse health effects over the poorest populations of the world. The disease is endemic in 88 countries, 72 of them are developing countries including Ethiopia. It has been estimated that 12million people are infected and 350 million people are at risk with the annual incidence of new cases is estimated between 1.5-2million. Ethiopia has seen new outbreaks in areas previously not known to be endemic often with co-infection by the human immunodeficiency virus with rates reaching 5.6% of the cases and other associated risk factors. As best of my knowledge similar study was not conducted specifically in Mekelle even though other study conducted to the whole region, Tigray. Thus, this preliminary study concerns to determine the magnitude and associated factors of cutaneous leishmaniasis in Mekelle city.Objectives; To assess the prevalence and associated factors of cutaneous leishmaniasis on patients who visit dermatology out patient department in Ayder referral hospital, Mekelle, Tigray, Northern Ethiopia. Methods and subjects; Institutional based cross sectional study was conducted on 478 study population from Ayder referral hospital by using systematic random sampling technique. Data entry and analysis was conducted by using SPSS v-20. The association between different variables in relation to the outcome variable was measured by odds ratio with 95% confidence interval. All variables with P<0.05 in the bivariate analysis were included in the multivariate model, accepting P ≤0.05 as the inclusion level for the independent variables. Result; Prevalence of cutaneouse leishmaniasis in this study was nearly six percent (5.6%) with 99% response rate. Sex [AOR 2.1(95% CI); (0.15, 0.79)], income source being farmer [AOR 2.1(95% CI); (], location of the home near to both farm and gorge [AOR 10.1 (95% CI); (0.00, 0.574)] and presence of the hyrax [AOR 1.1(95% CI); (0.00, 0.60)] were statistically significant to the presence of cutaneouse leishmaniasis in Mekelle city. Conclusion The overall prevalence of cutaneouse leishmaniasis in the study area was relatively high (5.6%) having a statistical significant association with sex, income source (farmer), location of the residence near to farm land and gorge and the presence of hyrax. Thus, a continuous health education and awareness creation about the disease, factors and preventive methods of cutaneouse should be sought.

    Received: Nov. 22, 2014 Accepted: Dec. 4, 2014 Published: Dec. 16, 2014

    DOI: 10.11648/j.cmr.20140306.16 View: Downloads:

  • Authors: Andi Koraqi, Denada Lacej, Rezart Xhani, Myzafer Kaci, Gjergj Andrea, Rudin Domi

    Abstract: Pulmonary hypertension presents a great challenge to the anesthesiologist. The number of patients suffering from pulmonary hypertension presenting for surgery is increasing because of increased age and the modern medical and surgical therapy as well. We present a case of a patient suffering from pulmonary hypertension scheduled for left radical nephrectomy due to left kidney tumor. Preoperative optimization and prevention of deterioration of pulmonary hypertension and right side heart failure are the problems the anesthesiologist must deal with. A good collaboration among cardiologist, anesthesiologist, and the surgeon can guarantee the patient’s outcome.

    Received: Dec. 7, 2014 Accepted: Dec. 12, 2014 Published: Dec. 19, 2014

    DOI: 10.11648/j.cmr.20140306.17 View: Downloads:

  • Authors: Feray Koc, Figen Tokucoglu

    Abstract: A 27 year old female presented with symptoms of diplopia, headache, ptosis, ataxia, and macropsia. She was subjected to extensive and repetitive medical evaluations on 3 separate occasions over a 2 year period resulting in a delay in diagnosis, expense of the evaluations and unnecessary treatment. Ophthalmologic consultation uncovered a delayed onset of refractive accommodative esotropia. Signs and symptoms of refractive accommodative esotropia can simulate other neurologic diseases in adults.

    Received: Dec. 6, 2014 Accepted: Dec. 18, 2014 Published: Dec. 23, 2014

    DOI: 10.11648/j.cmr.20140306.18 View: Downloads:

  • Authors: Sacit Nuri Gorgel, Osman Kose, Ozan Horsanalı, Evren Sahin, Ugur Balci, Kutan Ozer, Cengiz Girgin

    Abstract: Objectives: To investigate the relation between age and tumor characteristics and to evaluate oncologic results after radical cystectomy in elderly patients. Materials and Methods: We reviewed 501 patients retrospectively who underwent radical cystectomy because of bladder cancer. Patients were divided into two groups; greater than or equal to 70 (group 1) and less than 70-years-old (group 2). We compared tumor pathological characteristics and oncologic results in both groups. American Society of Anesthesiologists (ASA) score is less than three and there was no risk for major surgery for all patients. None of the patients did not receive neoadjuvant radiotherapy and/or chemotherapy. Results: There were 87 (17.4%) patients in group 1 and 414 (82.6%) patients in group 2. The mean age was 73.3±3.01 (70-85) in group 1, and 58.3±7.47 (34-69) in group 2. There were no significantly difference between gender (0.135), pathological T stage (p=0.483), lymph node involvement (p=0.462), grade (p=0.522), type of diversion (p=0.193), histological type (p=0.656) in both groups. Perioperative mortality were 3.9% in group 1 and 3.4% in group 2 (p=0.218). Perioperative complication rates were 16.6 % in group 1 and 17.4% in group 2 (p=0.469). Five years disease specific survival (DSS) rates were 61% in group 1 and 53% in group 2 (p=0.936). The mean DSS periods were 72.91 ± 5.35 months in group 1 and 76.25±7.45 months in group 2. Five years overall survival rates were 43.9% in group 1, 45.9% in group 2 (p=0.476). Mean overall survival periods were 54.02±8.47 in group 1 and 69.25±4.97 in group 2. In cox regression analyse; tumor stage (p=0.012) and lymph node involvement (p<0.001) were significant factors affected the survival in both groups. Conclusions: We found similar oncological results in patients who underwent radical cystectomy because of bladder cancer between young and elderly patients. We believe that age is not a contraindication factor for radical cystectomy operation. In addition preoperative performance statue of patients is important in terms of perioperative complications and mortality.

    Received: Dec. 11, 2014 Accepted: Dec. 24, 2014 Published: Dec. 31, 2014

    DOI: 10.11648/j.cmr.20140306.19 View: Downloads:

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