http://www.intarchmed.com The latest research articles published by International Archives of Medicine 2012-02-21T00:00:00Z Background: Hydatidiform mole (HM) is characterized by abnormal proliferation of human trophoblast with producers functioning tissues of human chorionic gonadotropin. It can evolve with ovarian cysts tecaluteinicos, hypertension of pregnancy or hyperthyroidism. The incidence of HM is variable and its etiology poorly known, associated with nutritional factors, environmental, age, parity, history of HM, oral contraceptives, smoking, consanguinity or defects in germ cells. There is no reference in literature on HM resulting from sexual violence, objective of this report.MethodDescription of two cases of HM among 1146 patients with pregnancy resulting from sexual violence treated at Hospital Perola Byington, Sao Paulo, from July 1994 to August 2011. Results: The cases affected young, white, unmarried, low educated and low parity women. Sexual violence was perpetrated by known offenders unrelated to the victims, under death threat. Ultrasound and CT of the pelvis showed bulky uterus compatible with HM without myometrial invasion. One case was associated with theca lutein cysts. The two cases were diagnosed in the second trimester of pregnancy and evolved with hyperthyroidism. There was no hypertension, disease recurrence, metastasis or sexually transmitted infection. Conclusion: The incidence of HM was 1:573 pregnancies resulting from rape, within the range estimated for Latin American countries. Trophoblastic material can be preserved to identify the violence perpetrator, considering only the paternal HM chromosomes. History of sexual violence should be investigated in cases of HM in the first half of adolescence and women in a vulnerable condition. http://www.intarchmed.com/content/5/1/8 Jefferson Drezzet Flavia Kurobe Cecilia Nobumoto Daniela Pedroso Marcia Blake Vitor Valenti Luiz Carlos Vanderlei Fernando Adami Franciele Vanderlei Sandra Moraes Maria Auxiliadora Vertamatti Alberto Reis Renata Rossi Carlos Monteiro Luiz Carlos de Abreu International Archives of Medicine 2012, null:8 2012-02-21T00:00:00Z doi:10.1186/1755-7682-5-8 /content/figures/1755-7682-5-8-toc.gif International Archives of Medicine 1755-7682 ${item.volume} 8 2012-02-21T00:00:00Z PDF We studied 57 patients with SpA who received more than 1 year of anti-TNFalpha therapy (infliximab, adalimumab or etanercept). Patients were analyzed for the development of LLS, in addition to measuring ANA levels [greater than or equal to] 1:160 and Anti-dsDNA (measured by IIF). Results: In total, 7.01% of patients treated with anti-TNFalpha had titers of ANA [greater than or equal to] 1:160, whereas 3.5% of patients had serum levels of dsDNA. However, only one patient (1.75%; n = 1) experienced clinical symptoms of LLS; this was a female patient with a history of psoriatic arthritis. Conclusions: The presence of LLS secondary to anti-TNFalpha therapy in patients with SpA is observed less frequently compared with patients with RA. LLS was only detected in a patient with a history of psoriasis since youth, who developed psoriatic arthritis after 27 years of age and had received anti-TNFalpha therapy for > 2 years. This may be because LLS is an entity clearly associated with innate immunity, with little central role of B and T cells. http://www.intarchmed.com/content/5/1/7 Luis Arturo Gutierrez Gonzalez Miriam Azocar Elaudi Rodriguez International Archives of Medicine 2012, null:7 2012-02-15T00:00:00Z doi:10.1186/1755-7682-5-7 /content/figures/1755-7682-5-7-toc.gif International Archives of Medicine 1755-7682 ${item.volume} 7 2012-02-15T00:00:00Z PDF Hyperplastic changes of the thymus may be found in patients with Graves' disease. However, this rarely presents as an anterior mediastinal mass, particularly among adults. In this report, we describe a 46-year old woman with Graves' disease and thymic hyperplasia. http://www.intarchmed.com/content/5/1/6 Amira Hamzaoui Rim Klii Randa Salem Ines Kochteli Mondher Golli Silvia Mahjoub International Archives of Medicine 2012, null:6 2012-02-09T00:00:00Z doi:10.1186/1755-7682-5-6 /content/figures/1755-7682-5-6-toc.gif International Archives of Medicine 1755-7682 ${item.volume} 6 2012-02-09T00:00:00Z PDF Advancements in rheumatoid arthritis (RA) treatment protocols and introduction of targeted biological therapies have markedly improved patient outcomes, despite this, up to 50% of patients still fail to achieve a significant clinical response. In veterinary medicine, stem cell therapy in the form of autologous stromal vascular fraction (SVF) is an accepted therapeutic modality for degenerative conditions with 80% improvement and no serious treatment associated adverse events reported. Clinical translation of SVF therapy relies on confirmation of veterinary findings in targeted patient populations. Here we describe the rationale and preclinical data supporting the use of autologous SVF in treatment of RA, as well as provide 1, 3, 6, and 13 month safety outcomes in 13 RA patients treated with this approach. http://www.intarchmed.com/content/5/1/5 Jorge Paz Rodriguez Michael Murphy Soonjun Hong Marialaura Madrigal Keith March Boris Minev Robert Harman Chien-Shing Chen Ruben Berrocal Timmons Annette Marleau Neil Riordan International Archives of Medicine 2012, null:5 2012-02-08T00:00:00Z doi:10.1186/1755-7682-5-5 /content/figures/1755-7682-5-5-toc.gif International Archives of Medicine 1755-7682 ${item.volume} 5 2012-02-08T00:00:00Z PDF In this minireview we describe the involvement of the atrial natriuretic peptide (ANP) in cardiovascular pathophysiology and exercise. The ANP has a broad homeostatic role and exerts complex effects on the cardio-circulatory hemodynamics, it is produced by the left atrium and has a key role in regulating sodium and water balance in mammals and humans. The dominant stimulus for its release is atrial wall tension, commonly caused by exercise. The ANP is involved in the process of lipolysis through a cGMP signaling pathway and, as a consequence, reducing blood pressure by decreasing the sensitivity of vascular smooth muscle to the action of vasoconstrictors and regulate fluid balance. The increase of this hormone is associated with better survival in patients with chronic heart failure (CHF). This minireview provides new evidence based on recent studies related to the beneficial effects of exercise in patients with cardiovascular disease, focusing on the ANP. http://www.intarchmed.com/content/5/1/4 Julio de Almeira Clodoaldo Alves Luiz Carlos de Abreu Monica Sato Fernando Fonseca Carlos de Mello Monteiro Luiz Carlos Vanderlei Hugo Macedo Carlos Tavares Dafne Herrero Gisele Giannocco Luciano Rodrigues Vitor Valenti International Archives of Medicine 2012, null:4 2012-02-07T00:00:00Z doi:10.1186/1755-7682-5-4 /content/figures/1755-7682-5-4-toc.gif International Archives of Medicine 1755-7682 ${item.volume} 4 2012-02-07T00:00:00Z PDF Background: To investigate the Cochleo-vestibular clinical and audiometric findings in Multi and Extreme Drug Resistance(MDR and XDR) tuberculosis(TB) patients on treatment and make recommendations. Methods: A cross-sectional study of adult MDR and XDR-TB patients was conducted in a general hospital in Cape-Town-South-Africa. Ethical approval was secured and all consenting patients administered with pretested and validated questionnaire under the guidance of International Classification of Functioning, Disability and Health(ICF) Checklist-version-2.1a. Audiometric evaluation included: Otoscopy, Diagnostic Audiometry and Tympanometry. The data analyses were done with SPSS version 16, Chi-square and StatCalc-7. Results: Fifty-three adults, ages 18-60 (mean-33 years) comprising 26 males and 27 females participated in the study. Hospital stay duration varied from 1-18 months (mean-6 months) and all were on anti-Koch's second line drugs (regimen 2). MDR TB group were 45(85%) and XDR 8(15%). Vertigo was the most common vestibular symptoms, 24(45%) whereas, tinnitus 23(42%) and hearing loss 13(25%) were most frequent auditory complaints. Bilateral sensorineural hearing losses of varying degrees were confirmed in 23(47%).There was no association between gender and age with hearing loss [chi2 (P=0.16, alpha =0.05) and (p=0.13, alpha=0.05)]. Furthermore, MDR and XTR TB groups [20/42 Vs 3/8; Z=0.46 and P=0.64], showed no difference in pattern of the hearing losses. Conclusions: A multi-disciplinary close surveillance of MDR and XDR TB patients on therapy is imperative. Finally researches into therapeutic trials on antidotes and potent safer substitutes for aminoglycosides in the management are recommended. http://www.intarchmed.com/content/5/1/3 Lebogang Ramma Titus Ibekwe International Archives of Medicine 2012, null:3 2012-01-31T00:00:00Z doi:10.1186/1755-7682-5-3 /content/figures/1755-7682-5-3-toc.gif International Archives of Medicine 1755-7682 ${item.volume} 3 2012-01-31T00:00:00Z PDF Background: Preliminary evidence has suggested the role of inflammation in development and prognosis of cardiovascular diseases and cancers. Most of the prognostic studies failed to account for the effects of co-morbid conditions as these might have raised the systemic inflammation. We used neutrophil lymphocyte ratio (NLR) as a measure of systemic inflammation and investigated its association with prevalent chronic conditions. Methods: Present study is a cross sectional study conducted on population of Karachi, Pakistan. A detailed questionnaire about the demographic details of all subjects was filled and an informed consent obtained for blood sampling. Multinomial regression analyses were carried out to investigate the relationship between NLR and prevalent chronic conditions. Results: 1070 apparently healthy individuals participated in the study. Proportion of individuals with hypertension was higher in middle and highest tertile of NLR as compared to the lowest tertile (18.2% & 16.1% compared to 11.8%). Individuals with hypertension were 43% (RRR = 1.43, 95% CI 0.94-2.20) and 66% (RRR = 1.69, 95% CI 1.09-2.54) more likely to be in the middle and highest tertile of NLR respectively compared to the baseline group. Similarly, individuals with diabetes mellitus were 53% (RRR = 1.53, 95% CI 0.93-2.51) and 65% (RRR = 1.65, 95% CI 1.01-2.71) more likely to be in the middle or highest tertile of NLR as compared to the baseline NLR group. Conclusions: Systemic inflammation measured by NLR has a significant association with prevalent chronic conditions. Future research is needed to investigate this relationship with longitudinal data to establish the temporal association between these variables. http://www.intarchmed.com/content/5/1/2 Fauzia Imtiaz Kashif Shafique Saira Mirza Zeenat Ayoob Priya Vart Saddiyah Rao International Archives of Medicine 2012, null:2 2012-01-26T00:00:00Z doi:10.1186/1755-7682-5-2 /content/figures/1755-7682-5-2-toc.gif International Archives of Medicine 1755-7682 ${item.volume} 2 2012-01-26T00:00:00Z XML IntroductionSystemic lupus erythematosus is a disease which may initially present with varying symptoms, most commonly a photosensitive rash and arthritis. Protein losing enteropathy is a recognized but rare presenting manifestation. Diagnosing protein losing enteropathy in resource limited centres is challenging but possible through the exclusion of other possible causes of hypoalbunaemia.Case PresentationWe report a case of protein losing gastroenteropathy secondary to intestinal lymphangiectasia as the initial manifestation of systemic lupus erythematosus in a 57 year old Sri Lankan (South Asian) male patient. The diagnosis was made by the exclusion of other causes of hypoalbuminaemia as the gold standard investigations for protein losing enteropathy were not available at this centre. Conclusions: Protein losing enteropathy is a diagnosis of exclusion in resource limited centres in the world. Systemic lupus erythematosus should be considered in the differential diagnosis of protein losing enteropathy. Intestinal lymphangiectasia should also be recognized as a possible pathophysiological mechanism. http://www.intarchmed.com/content/5/1/1 Eranda Ratnayake Ahamed Riyaaz Bandula Wijesiriwardena International Archives of Medicine 2012, null:1 2012-01-26T00:00:00Z doi:10.1186/1755-7682-5-1 /content/figures/1755-7682-5-1-toc.gif International Archives of Medicine 1755-7682 ${item.volume} 1 2012-01-26T00:00:00Z XML Background: Implementing initiatives to achieve the targets of MDG 5 requires sufficient financial resources that are mobilized and utilized in an equitable, efficient and sustainable manner. Informed decision making to this end requires the availability of reliable health financing information. This is accomplished by means of Reproductive Health (RH) sub-account, which captures and organizes expenditure on RH services in two-dimensional tables from financing sources to end users. The specific objectives of this study are: (i) to quantify total expenditure on reproductive health services; and (ii) to examine the flow of RH funds from sources to end users. Methods: The RH sub-account was part of the general National Health Accounts exercise covering the Financial Years 2007/08 and 2008/09. Primary data were collected from employers, medical aid schemes, donors and government ministries using questionnaire. Secondary data were obtained from various documents of the Namibian Government and the health financing database of the World Health Organization. Data were analyzed using a data screen designed in Microsoft Excel. Results: RH expenditure per woman of reproductive age was US$ 148 and US$ 126 in the 2007/08 and 2008/09 financial years respectively. This is by far higher than what is observed in most African countries. RH expenditure constituted more than 10-12% of the total expenditure on health. Out-of-pocket payment for RH was minimal (less than 4% of the RH spending in both years). Government is the key source of RH spending. Moreover, the public sector is the main financing agent with programmatic control of RH funds and also the main provider of services. Most of the RH expenditure is spent on services of curative care (both in- and out-patient). The proportion allocated for preventive and public health services was not more than 5% in the two financial years. Conclusion: Namibia's expenditure on reproductive health is remarkable by the standards of Africa and other middle-income countries. However, an increasing maternal mortality ratio does not bode well with the level of reproductive health expenditure. It is therefore important to critically examine the state of efficiency in the allocation and use of reproductive health expenditures in order to improve health outcomes. http://www.intarchmed.com/content/4/1/41 Thomas Mbeeli Muine Samahiya Nirmala Ravishankar Eyob Zere Joses Kirigia International Archives of Medicine 2011, null:41 2011-12-24T00:00:00Z doi:10.1186/1755-7682-4-41 /content/figures/1755-7682-4-41-toc.gif International Archives of Medicine 1755-7682 ${item.volume} 41 2011-12-24T00:00:00Z XML Background and ObjectivesThere have been no contemporary studies assessing abstract publication rates and the factors associated with full publication within the field of nephrology. As such, it is unclear whether a publication bias exists for abstracts presented at nephrology meetings, which may hinder the dissemination of potentially important results. Our objective was to review a selection of abstracts presented at 3 major nephrology meetings to determine the proportion that reach full publication and factors associated with full publication. Methods: 300 randomly selected abstracts presented as posters at three annual nephrology meetings in 2006 [American Society of Nephrology (ASN), European Renal Association (ERA), and National Kidney Foundation (NKF)] were reviewed. Accepted methods of literature search were performed to determine subsequent journal publication. Univariate and multivariate analyses were performed to determine the association between abstract characteristics and subsequent full publication. Results: 127 (42%) abstracts were published in peer-reviewed journals at 4.5 years. On multivariable analysis, basic science research (OR 2.84, 95% CI 1.44-5.61 as compared to clinical research) and the scientific meeting [OR 2.87, 95% CI 1.60-5.15 (ASN); OR 1.92, 95% CI 1.07-3.45(ERA) as compared to NKF] were significantly associated with full publication. Conclusions: Almost two-fifths of abstracts presented at three major nephrology meetings are subsequently published in peer-reviewed journals. Basic science content and the meeting at which the abstract was presented are associated with publication. Further research is needed to ascertain the impact of other important factors on abstract publication rates to address publication bias in the renal literature. http://www.intarchmed.com/content/4/1/40 Ziv Harel Ron Wald Ari Juda Chaim Bell International Archives of Medicine 2011, null:40 2011-12-06T00:00:00Z doi:10.1186/1755-7682-4-40 /content/figures/1755-7682-4-40-toc.gif International Archives of Medicine 1755-7682 ${item.volume} 40 2011-12-06T00:00:00Z XML