American Journal of Clinical Medicine Research

Objective: Investigate the influence of permeability of low-flux versus high-flux dialysis membranes on intact PTH during hemodialysis. Background: Hyperparathyroidism is a common finding in patients with renal insufficiency and parathyroid hormone (PTH) is considered a uremic toxin responsible for many of the abnormalities of the uremic state and bone disease. Materials and Methods: Forty adult patients on regular hemodialysis were enrolled in a prospective study. Low-flux polysulfone membranes were used for at least 6 months and then the patients were switched to use high-flux polysulfone membranes for 1 month. Serum electrolytes and intact PTH before and after dialysis were compared before and after changes in dialysis membrane. Results: At the end of the 1-month use of high-flux filters, predialysis intact PTH level (415.96 ± 226.72 ng/dL) showed a significant decline (P < 0.05) compared to the predialysis intact PTH (312.28 ± 191.98 ng/dL) with low-flux membranes. Intact PTH level correlated negatively with serum calcium and positively with serum phosphorus levels only in the predialysis samples with the use of low-flux but not high-flux filters. Conclusion: High-flux dialysis membranes are more efficient in removal of intact PTH, one of the middle-sized uremic toxins, than low-flux membranes.

American Journal of Clinical Medicine Research. 2014, 2(1), 36-42. DOI: 10.12691/ajcmr-2-1-9
Pub. Date: February 23, 2014

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Donor Selection in Allogeneic Stem Cell Transplantation

by Mehmet Ali ERKURT, Ilhami BERBER, Irfan KUKU, Emin KAYA and Ilknur NIZAM

Review Article

Allogeneic hematopoietic stem cell transplant is safe and curative treatment modality for many hematologic diseases. Expanding alternative donor options such as haploidentical hematopoietic stem cell transplantation and umbilical cord blood, taken together with enhanced outcomes of matched unrelated donors, has resulted in a advisable donor for most patients with an hematopoietic stem cell transplantation indication. This review article provides improved patient selection, offers hope for decreasing relapse and improving outcomes for in patients applied allogeneic hematopoietic stem cell transplant.

American Journal of Clinical Medicine Research. 2014, 2(1), 32-35. DOI: 10.12691/ajcmr-2-1-8
Pub. Date: February 16, 2014

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Predictors and Typical Clinical Findings of Refractory Epilepsy

by E. Viteva

Original Research

Purpose: Our purpose was to identify the predictors of refractory epilepsy (RE) and the typical clinical findings in Bulgarian patients with RE. Patients and Methods: We studied 70 adult patients with refractory epilepsy and 70 patients with pharmaco sensitive epilepsy. The Liverpool Seizure Severity Scale was completed by 84.29% of the patients with RE. Results: The typical clinical findings and significant predictors of RE on univariate analysis were: high initial seizure frequency (OR = 2.45), heredity for epilepsy (OR = 8.90), febrile seizures (OR = 4.50), partial epilepsy (OR = 5.98), low or lacking seizure reduction with the first AED (OR = 44.0), clusters of seizures and/or epileptic status in the disease course (OR = 16.5), childhood onset (OR = 8.0), great number of ineffective antiepileptic drugs (AED) – OR = 232.88, poly therapy (OR = 61.0). On multivariate analysis significant predictors of RE were poly therapy (B = 4.86), childhood onset (B = 2.79), and great number (> 4) of ineffective AED (B = 5.44). Frequent clinical findings were: moderate seizure severity, high seizure frequency despite the prescribed treatment, polymorphic seizures. Conclusion: The most significant predictors of RE are: great number of ineffective AED, treatment with poly therapy, and early disease onset. This conclusion may be useful for a timely identification of patients with epilepsy who are likely to be refractory to medical therapy.

American Journal of Clinical Medicine Research. 2014, 2(1), 26-31. DOI: 10.12691/ajcmr-2-1-7
Pub. Date: February 14, 2014

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Underexposure of Residents in Training in the Art of Vaginal Hysterectomy in Nigeria

by Okeke TC, Ikeako LC and Ezenyeaku CCT

Review Article

Worldwide, vaginal route is the gynaecologist’s route of surgery. However, abdominal route is the favoured route of hysterectomy in Nigeria inspite of the advantages of vaginal route. This descriptive review is to awaken interest in the teaching and surgical exposure of residents in obstetrics and gynaecology in the field of vaginal surgeries. The ratio of vaginal hysterectomy to abdominal hysterectomy in Nigeria ranges from 1:4 to 1:9. The frequency of vaginal hysterectomy in centres in Nigeria ranges from 10-23%. These rates are lower than the figures quoted from the United States (25%), France (50%), Australia (40-50%) and Saudi Arabia (28%). Vaginal hysterectomy is under-utilized in Nigeria. Most centres hardly do up to five vaginal hysterectomies in a year. Residents in training hardly perform vaginal hysterectomy and may not have watched or assisted in up to ten vaginal hysterectomies before the residency programme is completed. This is completely inadequate for acquisition of proficiency. There is inadequacy and under exposure of residents in the art of vaginal surgeries in Nigeria. There is need for workshops, training and retraining of residents in the field of vaginal surgeries to meet these challenges. This would ensure production of quality gynaecologists with skills and proficiency in vaginal surgery.

American Journal of Clinical Medicine Research. 2014, 2(1), 22-25. DOI: 10.12691/ajcmr-2-1-6
Pub. Date: January 23, 2014

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The Efficacy of Electroconvulsive Therapy in Major Depressive Disorder Relapsed or Unresponsive to Transcranial Magnetic Stimulation in Pregnancy: Three Case Studies

by Eylem Ozten, Gokben Hızlı Sayar, Işıl Gögcegöz Gül, Ali Evren Tufan, Cem Cerit and Nesrin Dilbaz

Case Study

About 5-10% of women experience depression during pregnancy. The potentially adverse effects of pharmacological treatment (e.g. teratogenicity, toxicity, foetal developmental abnormalities and withdrawal symptoms) on both the mother and the foetus mean that psychopharmacological treatments have limited application for pregnant women. In these cases treatment needs to be tailored to the individual patient and non-pharmacological options may be appropriate. Transcranial Magnetic Stimulation (TMS) and Electroconvulsive treatment (ECT) may be viable alternatives for these patients. We report on three patients in their first trimester of pregnancy suffering from major depressive disorder (MDD). All three were initially treated with TMS and psychotherapy because of the reduced risk of side effects. Two patients failed to respond adequately to treatment and were switched to ECT. The third patient displayed an adequate response to TMS but failed to maintain the improvement. This patient had to receive ECT in the post-partum period due to on-going depressive symptoms. Subsequently this patient responded adequately to ECT. Further studies of novel, non-pharmacological treatment methods for MDD during pregnancy (such as TMS and ECT) and detailed investigations of the factors associated with treatment responses in such patients are needed. Our cases demonstrate the need to evaluate the effectiveness of TMS in larger samples of pregnant patients diagnosed with MDD.

American Journal of Clinical Medicine Research. 2014, 2(1), 18-21. DOI: 10.12691/ajcmr-2-1-5
Pub. Date: January 23, 2014

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The Incidence and Management Outcome of Preterm Premature Rupture of Membranes (PPROM) in a Tertiary Hospital in Nigeria

by Okeke TC, Enwereji JO, Okoro OS, Adiri CO, Ezugwu EC and Agu PU

Original Research

Preterm premature rupture of membranes (PPROM) complicates 3-8 percent of pregnancies and leads to one third of preterm deliveries. It results in increased risk of prematurity and leads to perinatal and neonatal complications with risk of fetal death. This article aims to determine the incidence and management outcome of PPROM in Enugu, Nigeria over a ten year period. This was a retrospective review of management outcome of PPROM at the UNTH Enugu from January 1^st 1999 to December 31^st, 2008. The frequency of 3.3% for PPROM and 7% perinatal death were recorded over the period. Preterm PROM is a major complication of pregnancies. Currently, there is no effective way of preventing spontaneous rupture of fetal membranes due to ignorance of its aetiology, with consequent inability to control its incidence. However, it is important that women be well informed regarding maternal, fetal and neonatal complications regardless of controversies of its management.

American Journal of Clinical Medicine Research. 2014, 2(1), 14-17. DOI: 10.12691/ajcmr-2-1-4
Pub. Date: January 23, 2014

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Molecular Diagnostic Methods and Their Application to Patient Care: Clinical Microbiologist’s Perspective

by K V Ramana

Review Article

In the era of Human Immunodeficiency virus, emerging and re-emerging of various microbial infections, the status of a clinical microbiology laboratory performance is different in the developed and developing nations. On the one side application of rapid, accurate and advanced molecular laboratory techniques have contributed to better diagnosis, patient care and management in developed nations, the developing and economically weak countries are still plagued by ill equipped and undertrained laboratory personnel unable to afford the cost associated with acquiring infrastructure and man power. Clinical microbiology laboratories in the developing nations should be revolutionized so as to improve patient care and to contribute effectively in the control of infectious disease epidemics and pandemics that are of public health importance.

American Journal of Clinical Medicine Research. 2014, 2(1), 8-13. DOI: 10.12691/ajcmr-2-1-3
Pub. Date: January 23, 2014

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Pancreatic Schwannoma Presenting as Gastric Outlet Obstruction- A Rare Presentation

by Kumar Jayant, Swati Agrawal and Rajendra Agarwal

Case Report

Introduction: Schwannoma is a very uncommon pancreatic neoplasms. Because of their varing size, cystic nature they mimic pancreatic cystic neoplasms. Mostly definitive diagnosis is confirmed with histological assessment post resection. The mainstay of treatment is surgical resection based on the nature of tumour. Case presentation: Here we are reporting a very rare case of pancreatic schwannoma in 45 year old female presenting with pain upper abdomen with projectile vomiting. Pre-operative diagnosis of heterogenous tumor arising from head of pancreas was made on CECT abdomen following which Whipple's procedure was performed. Post operative histological analysis showed spindle cells arranged in palisading pattern with S-100 positivity, confirms the diagnosis of pancreatic schwannoma. Conclusion: We conclude that pancreatic schwannoma must be considered as an important differential diagnosis of pancreatic neoplasms. Though they have non specific symptoms but can present in unusual way as gastric outlet obstruction. Pre-operative diagnosis is difficult though computed tomographic and magnetic resonance imaging may be of value. For benign tumors, simple enucleation is enough, while malignant tumors requires complete oncological resection.

American Journal of Clinical Medicine Research. 2014, 2(1), 4-7. DOI: 10.12691/ajcmr-2-1-2
Pub. Date: January 23, 2014

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A Case Report of Primary Mucinous Adenocarcinoma of Urinary Bladder with Review of Literature

by Umesh Das, Vishwanath Sathyanarayanan, Lakshmaiah K.C., Champaka G, Lokanatha D, Suresh TM, Linu Jacob, Suresh Babu and Govind Babu K

Case Report

The primary mucinous adenocarcinoma of the bladder is an extremely rare urologic entity, which is less than 2% of all urinary bladder tumours and often presents in advanced stage. A 68-year old gentleman was diagnosed with a primary mucinous adenocarcinoma of the bladder from biopsy of anterior abdominal wall ulcer. Immunohistochemistry was done to rule out metastasis from colon and prostate and it confirmed the nature of the tumour. As the patient presented in advanced (stage IV), palliative intent chemotherapy with gemcitabine and cisplatin was administered, however he succumbed to the illness after one cycle of chemotherapy. The primary adenocarcinoma of urinary bladder creates a diagnostic dilemma, as it is difficult to differentiate metastatic adenocarcinoma of the colon and prostate. The immunohistochemistry has a leading role, aiding in diagnosis.

American Journal of Clinical Medicine Research. 2014, 2(1), 1-3. DOI: 10.12691/ajcmr-2-1-1
Pub. Date: January 17, 2014

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