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ORIGINAL ARTICLE
Autologous stem cells therapy, The first baby of idiopathic premature ovarian failure
M Edessy, Hala N Hosni, Y Shady, Y Waf, S Bakr, M Kamel
January-June 2016, 3(1):19-23
DOI:10.5530/ami.2016.1.7  
Introduction: Stem cells (sc) are the foundation cells for every organ, tissue and cell in the body. They are self sustaining and can replicate themselves for long periods of time. Stem cells can differentiate into different types of cells. Women below the age of forty and showing ovarian function loss are defined to have premature ovarian failure (POF). It is associated with sex steroid deficiency, amenorrhea, infertility, and elevated serum gonadotropins. Aim: To evaluate the therapeutic potential of autologous Mesenchymal sc (MSC) transplantation in women suffering from POF. Out of 112 high risk patients for POF(cases with amenorrhoea befor the age of forty), diagnosis was confirmed in10 cases. The ten POF patients were scheduled for MSC transplantation at Al- Azhar University Hospitals. MSC preparation from the bone marrow of the iliac crest was laparoscopically injected into the ovaries. Endometrial fractional biopsy was histopathologicaly (HP) and Immunohistochemically (IH) stained and evaluated according to Edessy stem cells score (ESS). Ovarian reserve was evaluated according to Edessy ovarian reserve score (EORS). Results: Showed that after transplantation two cases (20%) (ESS = 5 and 6) resumed menstruation after 3 months, one of them (10%) (Case no 5) (ESS = 6) got pregnancy after 11 months and delivered a healthy full term baby (Zeinab).Ten months after transplantation EORS of patient who developed pregnancy (case no 6) was found to be 7 after being 0 before therapy. EORS of the other menstruating case (case no 10) was 5 after being 0. The 2 menstruating cases showed focal secretory changes after being atrophic endometrium in case 5 and distorted proliferative endometrium in case 10. Conclusion: Stem cell transplantation is a good procedure and regarded as a real and hope to get healthy pregnancy and baby for cases of POF. It showed good clinical, HP and IH outcome.
  16 3,124 473
ORIGINAL ARTICLES
Association of serum biochemical panel with mineralogical composition of kidney stone in India
Muhammed A P. Manzoor, M Mujeeburahiman, PD Rekha
July-December 2017, 4(2):26-30
DOI:10.4103/ami.ami_24_17  
Purpose: The aim is to study the diversity in the composition of kidney stones and its association with the basic biochemical metabolic panel in patients with kidney stone disease (KSD). Methods: A cross-sectional prospective study enrolling consecutive patients with KSD attending a tertiary care hospital in Mangalore (India) was undertaken. Mineral compositions of kidney stones were analyzed using attenuated total reflection-Fourier transform infrared spectroscopy. Kidney stones were classified into different groups according to the composition. Metabolic status was assessed to analyze possible association with the kidney stone. Results: A total of 369 patients (male 305 and female 64) in the age group of 43.05 ± 14.3 years were included in the study and showed a high diversity of kidney stone types with >50% with mixed compositions. A significant association was found between pure stone type and gender as well with age group (P < 0.001). Serum calcium levels in the calcium oxalate stone formers were significantly higher (P < 0.001) than others. Similarly, uric acid stone formers showed higher random blood sugar, blood urea, uric acid, and serum creatinine levels (P < 0.001). Urine pH was also found to be a contributing factor for the stone formation (P < 0.001). Stone recurrence did not differ significantly concerning stone composition as well as metabolic status. Conclusion: The study reports a high diversity of the kidney stone types among patients. This finding highlights the increased cases of mixed stones that may be because of various lifestyle factors resulting in altered metabolic status. This finding warrants mechanistic studies to understand the etiology of stone formation. This will enable to develop novel noninvasive interventional strategies and proper preventive strategies to reduce the risk of KSDs.
  6 2,073 231
ORIGINAL ARTICLE
The effect of clomiphene citrate versus tamoxifen versus letrozol on endometrial thickness and blood flow in ovulation induction in women with polycystic ovaries
Asem Anwar, Haitham Torky, Osama Dief, Ahmed Abd Elwahed, Hesham Abou Senna
July-December 2016, 3(2):88-92
DOI:10.5530/ami.2016.2.19  
Aim of Work: To compare between the effects of clomiphene citrate, tamoxifen and letrozol as ovulation induction agents on endometrial thickness and blood flow as non-invasive parameters of endometrial receptivity in women with polycystic ovaries. Patients and Methods: One hundred and fifty cases meeting the selection criteria were prospectively randomized into three groups 1st Group took 100 mg clomiphene citrate, 2nd Group took 5 mg letrozol and 3rd group took 40 mg tamoxifen. Transvaginal ultrasound and Doppler were done to measure endometrial thickness and endometrial blood flow both pulsatility index (PI) and resistance index (RI) at the day of the maximum follicular growth or at day 20 in the absence of the dominant follicle in the three groups. Results: Significantly thinner endometrium in the clomiphene citrate group as compared to the other two groups and lower impedance in the spiral arteries in both letrozol and tamoxifen groups (P value less than 0.001). Conclusion: Endometrium was thicker with lower impedance in the spiral arteries in both letrozol and tamoxifen groups as compared to clomiphene citrate group. Ovulation and pregnancy rates were not significantly different. Other studies are needed to measure the cumulative results of six cycles, increasing the dose in non-responders and the incidence of miscarriage.
  5 1,510 157
Insulin-like growth factor binding Protein-1/alpha-fetoprotein versus placental alpha microglobulin-1 for diagnosis of premature fetal membranes rupture
Ibrahim A Abdelazim, Mohammed M Al-Sherbeeny, Mohamed E.M Ibrahim, Ahmed A Fahmy, Noha H Rabei, Amr A. Aziz Khalifa
January-June 2016, 3(1):69-74
DOI:10.5530/ami.2016.1.15  
Objectives: To compare insulin-like growth factor binding protein-1/alpha-fetoprotein (IGFBP-1/AFP) to placental alpha microglobulin-1 (PAMG-1) for diagnosis of premature fetal membranes rupture (PROM). Methods: 220 pregnant women ≥ 37 and <39 weeks gestation studied and classified into two groups; study group (PROM) and control group (no PROM). Examination of the studied women followed by abdominal ultrasound (TAS) and sterile vaginal speculum examination to visualize amniotic fluid leaking and for collection of samples for fern, nitrazine, AmniSure® and AmnioQuick® Duo+ tests on admission. Results: The sensitivity and specificity of AmnioQuick® Duo+ test to detect PROM was 93.6% and 86.4%; respectively compared to 95.5% and 89.1%; respectively for AmniSureR test, 72.7% and 80.9%; respectively for fern test and 76.4% and 83.6%; respectively for nitrazine test. PPV, NPV and accuracy of AmnioQuick® Duo+ test to detect PROM were 87.3%, 93.1% and 90%; respectively compared to 89.7, 95.1% and 92.3%; respectively for AmniSureR test, 79.2%, 74.8% and 76.8%; respectively for fern test and 82.4%, 77.97% and 80%; respectively for nitrazine test. AmnioQuick® Duo+ and AmniSure® tests had higher sensitivity, specificity, predictive values and accuracy to detect PROM compared to conventional diagnostic tests. Conclusion: AmnioQuick® Duo+ test for detection of IGFBP-1/AFP was rapid, accurate bedside test better than the individual conventional diagnostic tests and has same accuracy and performance like AmniSure® test.
  5 1,747 134
CASE REPORTS
Mediastinal mass in a patient with IgG4-related disease
Kesato Iguchi, Osamu Ishibashi, Norio Takayashiki, Hiroaki Satoh
January-June 2016, 3(1):216-218
DOI:10.5530/ami.2016.1.44  
Introduction: IgG4-related disease is now considered to result from an imbalance in the regulatory immune system, and it is diagnosed on the basis of clinical and histopathologic evidence such as the presence of lymphoplasmacytic infiltrates, especially increased IgG4-positive plasma cells and fibrotic sclerosing tissue. Case report: We report herein a 45-year-old male patient with mediastinal mass with IgG4-related disease. IgG4-related disease can involve any organ but the most frequently involved sites include pancreato-hepatobiliary tract, salivary glands, and kidneys, generally manifesting as a mass in one or more sites mimicking a neoplasia. In the thoracic region, IgG4-related disease manifests as interstitial lung disease and fibrosing mediastinitis. Mediastinal lesion in our patient was quite resemble to mediastinal tumor derived from anterior mediastinum. This is the first case with mediastinal mass in a patient with this disease. Conclusion: Although very rare, we should rule out this disease as differential diagnosis in patients with anterior homogeneous density mediastinal mass simulating mediastinal tumor.
  3 1,337 130
ORIGINAL ARTICLE
Cytoplasmic expression, optimization and catalytic activity evaluation of recombinant mature lysostaphin as an anti-staphylococcal therapeutic in escherichia coli
Samaneh Naderi, Mohammad Yousef Alikhani, Jamshid Karimi, Nooshin Shabab, Nejad Mohamadi, Hossein Zarei Jaliani, Massoud Saidijam
July-December 2015, 2(2):72-77
DOI:10.5530/ami.2015.3.5  
Objective: Scientists are to develop novel antibacterial therapeutics in order to eliminate medically significant pathogens resistant to antibiotic. Lysostaphina zinc metalloprotease with the sub-atomic weight of 27kDa and particularly tic action against Staphylococcus aureus degrades the S. aureus by hydrolyzing the pentaglycine cross-links introduce in its cell wall. Because of such potential, lysostaphin will be a decent agent for treatment of antibiotic-resistant staphylococcal infections. Also, due to the broad needs of society to increase localization of sciences, the national production of this drug in research laboratories would be necessary. Materials and Methods: First, with the aid of articles we identified Lysostaphin sequences without signal peptide via Gene Bank data base. In order to achieve the correct protein sequence, we add the entrokinase cutting site to our sequence. To ensure the correct cloning process, the entire process of cloning and protein expression was evaluated in silico. The sequence obtained for the synthesis was sent to the Biomatik Company in Canada (BIOMATIK). After the primer design and synthesis of the DNA fragment of the gene, we amplified the gene using PCR. The mature lysostaphin gene was cloned in plasmidpET28a and expressed in E.coli with the carboxyl terminal hexa-histidine fusion tag under the transcriptional control of T7/lac promoter/operator. Result: The transformed E.coli BL2 (DE3) cells produced catalytically active recombinant lyso staphin after being induced by IPTG. Conclusion: This study shows that the E. coli expression system is suitable for expression of recombinantly so staphin and according to the conducted bioassay in this study, the expressed protein can be considered as an effective therapeutic agent against antibiotic resistant staphylococcus aureus.
  3 1,334 86
Positive and negative symptoms in patients of schizophrenia: A cross sectional study
Atiqul H Mazumder, Md T Alam, Hatsumi Yoshii, Riitta-Liisa Kortesluoma, Mohammad S.I Mullick, Md W.A Chowdhury
January-June 2015, 2(1):48-52
DOI:10.5530/ami.2015.1.7  
Background: Analysis of positive and negative symptoms of schizophrenia has been increasingly needed for a systematic management plan. Unfortunately, this type of study was lacking in Bangladesh. Aims: The study aims were to find out the predominant symptom pattern and associating factors in schizophrenia. Methods: This was a cross sectional, analytical and descriptive study done in a tertiary care hospital with a sample size of 78. The SCID-I and pre designed socio demographic questionnaire was applied. Positive and negative symptoms were assessed by using the Positive and Negative Symptom Scale (PANSS). Statistical analysis was done through SPSS version 17. Results: Among 78 patients, schizophrenics with positive symptoms (57.7%) were predominant over schizophrenics with negative symptoms (42.3%). Delusion (64.1%) and blunted affect (55.1%) were the most frequent positive and negative symptoms respectively. Negative symptoms were significantly associated with poverty, unemployment and lack of education. Limitations: Single centered cross sectional study with small sample size. Conclusions: Schizophrenic patients with positive symptoms visit clinicians more readily than those with negative symptoms.
  3 1,368 140
Heme iron polypeptide (proferrin®-ES) versus iron saccharate complex (ferrosac) for treatment of iron deficiency anemia during pregnancy
Ibrahim A Abdelazim, Mohannad Abu-Faza, Assem A. M Elbiaa, Hossam S Othman, Dareen A Alsharif, Walid Farok Elsawah
January-June 2017, 4(1):56-61
DOI:10.5530/ami.2017.4.11  
Objectives: Anemia is one of the world's leading causes of considerable perinatal morbidity and mortality. This study designed to compare the efficacy and safety of Heme iron polypeptide (Proferrin®-ES) versus iron saccharate complex (Ferrosac) in treatment of iron deficiency anemia during pregnancy. Methods: Two hundred and sixty (260) pregnant women with hemoglobin level below 10 gm/dl due to iron deficiency anemia were included in this study and randomized to receive either; intravenous Iron Saccharate (IV group) or oral Proferrin®-ES (PO group) for correction of iron deficiency anemia during pregnancy. Treatment efficacy checked by comparing pre-treatment values of hemoglobin, serum ferritin, mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH) and reticulocytes count by the 3-months` post-treatment values. Results: The 3-months` post-treatment hemoglobin level increased compared to the pre-treatment level without any significant difference between the two studied groups (from 8.5 ± 3.5 to 11.3 ± 1.3 gm/dl in PO group and from 8.7 ± 2.5 to 11.7 ± 0.9 gm/dl in IV group). In addition; the 3-months` post-treatment ferritin level, increased compared to the pre-treatment level without any significant difference between the two studied groups (from 19.4 ± 4.9 to 118.8 ± 7.1 ug/l in PO group and from 15.3 ± 5.6 to 122.3 ± 6.4 ug/l in IV group). 1.6% (2/124) of the studied women developed gastrointestinal intolerance and upset with oral Proferrin®-ES (insignificant difference and excluded from the study) and no other side effects recorded with oral Proferrin®-ES. Conclusion: HIP (Proferrin®-ES) is an effective, safe, well tolerable oral iron preparation as well as intravenous iron saccharate complex for treatment of iron deficiency during pregnancy; it increases the hemoglobin and replaces the depleted iron store.
  3 3,509 325
ORIGINAL ARTICLES
Medicine promotional literature as a source of updated information in Bangladesh: Do those advertising literature promote continued medical education or deceptive advertising?
Rayhana Sharmin, Zinat Rehana Sharmin, Abu Syed Md. Mosaddek, Md Zakirul Islam, Md Faizur Rahman, Roksana Parvin, Syeda Papia Sultana, Mainul Haque
July-December 2017, 4(2):20-25
DOI:10.4103/ami.ami_58_17  
Background: Drug promotional literature (DPLs) is an integral part of pharmaceutical marketing strategy. This marketing approach influences, a physician to prescribe definite variety of medicine from a particular company. Many physicians bank on exclusively in DPLs. This research was intended to appraise the DPLs available in Bangladesh for accuracy, consistency, and validity of the information in accordance with the WHO rules and regulations. Materials and Methods: This was a cross-sectional study was conducted in Uttara Adhunik Medical College, Dhaka, Bangladesh after collecting DPLs from the different outpatient department. The data was analyzed Microsoft Excel 2016. Results: None of the national and multinational DPLs fulfilled all the WHO criteria. Among the national and multinational DPLs, 94.7% and 100% presented with claims respectively. Out of 284 national and multinational DPLs references citation were presented in 82.04% and 100% respectively. Among the DPLs of national and multinational companies' relevant, irrelevant, and partially relevant pictures were presented in 48.79%, 24.65%, 26.76% and 31.58%, 26.32%, and 42.11%, respectively. Conclusion: DPLs of Bangladesh did not comply with the WHO guidelines while promoting their products. Evidence provided in those DPLs were mostly biased and persuasive since it is focusing mainly on the positive aspect of drug therapy. Accordingly, studied DPLs were principally aiming to maximizes industries' financial benefit rather than fulfill the educational aspects. The Government of Bangladesh should develop very stringent policy and practices regarding DPLs based on science and the WHO guideline as the literature very often act as a primary source of information among medical doctors.
  3 1,870 171
Prevalence of sickle cell disease among children attending plateau specialist hospital, Jos, Nigeria
Nanbur Stephen, Nanyak Nden, Nanle Joseph Gusen, Patience Ringkat Kumzhi, Bonji Gaknung, Dauda Abimiku Auta, Lydia B Bulndi, Champion Mbursa, Vasantha P Kumari, Nannim Nanvyat
January-June 2018, 5(1):20-23
DOI:10.4103/ami.ami_60_17  
Background: An estimate of 250,000 children are born annually with sickle cell disease (SCD) worldwide and 75%–85% of the affected children are born in Africa; where mortality rates for those under age 5 years range from 50% to 80%. Objective: The present study was conducted to estimate the prevalence of SCD among children in Plateau State Specialist Hospital (PSSH), Jos, Nigeria. Methodology: Ethical approval was obtained from the Health Research Ethics Committee of the Hospital. Secondary data on age, gender, and region from the case notes of infants, children and/or adolescents; who received medical care in PSSH from 2012 to 2014 were used. Data were analyzed using frequency tables and Chi-square statistics. Results: The findings revealed that the prevalence of SCD in PSSH, Jos from 2012 to 2014 was 26.9/1000 population of pediatric patients. There was a gradual increase in the prevalence rate from 25.8/1000 in 2012 to 26.8/1000 in 2013 and 28.1/1000 in 2014. However, the case fatality rate of SCD gradually decreased from 15.4% in 2012 to 11.1% in 2013 and 10.3% in 2014. Chi-square test shows that the prevalence of the disease in relation to sex, age, and residence was not statistically significant (P > 0.05). Even though the case fatality rate of the disease decreased, its prevalence increased during the study. Conclusion: Therefore, preventive measure for SCD such as premarital genetic screening and counseling should be emphasized, especially in the southern and central geopolitical zones of Plateau state, where the prevalence was found to be higher.
  3 4,903 500
REVIEW ARTICLE
WHO recommended tools to improve diagnosis of active and drug resistant tuberculosis
Shubhada Shenai
July-December 2015, 2(2):118-129
DOI:10.5530/ami.2015.4.3  
The successful arrest or cure of tuberculosis (TB) depends largely on early case detection and proper treatment. Currently, several promising diagnostic tools with improved sensitivity and speed are available. Old microscopic and culture based technologies have been revisited and new molecular technologies have been developed. In recent years, World Health Organization (WHO) evaluated and endorsed different TB diagnostic tools and published various policy statements. These policy statements address improvements in smear microscopy, use of commercial and non-commercial culture based techniques and rapid molecular assays. This is the first comprehensive review compiling pros and cons of WHO recommended TB diagnostic tools for effective implementation in TB endemic regions.
  3 1,535 122
CASE REPORTS
Nonspecific Low Back Pain (LBP) can occult a serious pathology: Case report of Multiple Sclerosis (MS) in a young patient
Maselli Filippo, Pennella Denis, Cataldi Fabio, Albertoni Bruno Davide, Ciuro Aldo
January-June 2016, 3(1):202-206
DOI:10.5530/ami.2016.1.40  
Low Back Pain (LBP) is one of the main causes of disability in the whole world. In most cases, its presentation is considered benign and usually managed quite easily. However, in a low percentage of cases LBP is secondary to a serious pathology. Patients with Multiple Sclerosis (MS), for instance, are often affected also by LBP, and LBP could also be an initial symptom of MS. Moreover, patients with MS can present with a w ide range of clinical symptoms, as the Restless Legs Syndrome – RLS. In these specific cases, the ability to recognize a serious pathology is a key component of the physical therapist practice. Both conditions, nonspecific LBP and RLS, have been found in a patient that was referred with diagnosis of bilateral sciatica.
  2 1,543 119
The effectiveness of continuous venovenous hemodiafiltration in phenobarbital intoxication
Yasemin Coban, Dinçer Yildizdas, Özden Özgür Horoz, Nagehan Aslan, Didar Arslan
July-December 2018, 5(2):92-94
DOI:10.4103/ami.ami_20_18  
Phenobarbital continues to be widely used in childhood epilepsy. Incorrect drug prescription can sometimes lead to intoxication, particularly in young children. A 40-month-old female infant presented to our emergency department due to failure to awaken. The patient was assessed in terms of etiology of coma, and her history revealed that she had been given a 100 mg phenobarbital pill instead of 15 mg. Her blood phenobarbital level was high (>80 mg/dl). At physical examination, her Glasgow coma score was 6, the pupils were isochoric, pupillary light reflex was bilateral positive, deep tendon reflexes were absent, respiration was superficial, and pulmonary bilateral diffuse secretory rales were present, and the patient was intubated. Continuous venovenous hemodiafiltration (CVVHDF) was performed due to prolonged coma, intubation, and potentially fatal phenobarbital level. Blood phenobarbital levels at 4 and 12 h improved to >80 and 33.4 mg/dl, and the patient was extubated at 14 h. CVVHDF was effective in intoxication despite long-acting barbiturate phenobarbital not binding to protein. We think that this is a useful method capable of use in phenobarbital intoxications.
  2 1,323 158
GUEST EDITORIAL
Pretreatment with myo-inositol in patients undergoing gonadotropins multiple follicular stimulation for IVF
Franco Lisi
January-June 2016, 3(1):8-10
DOI:10.5530/ami.2016.1.4  
  2 1,541 122
ORIGINAL ARTICLE
Adipose-derived stem cells: An optimized protocol for isolation and proliferation
Mahdieh Ghiasi, Reza Tabatabaei Qomi, Naser Kalhor, Mohsen Sheykhhasan
January-June 2016, 3(1):116-121
DOI:10.5530/ami.2016.1.25  
Background and Aims: Current advances in the researches on the stem cells has opened new approaches for their apply in tissue engineering and clinical trials. The most common sources of stem cells are adult and embryonic stem cells. Due to ethical issues, embryonic stem cells use in research has been hotly debated. Unlike embryonic stem cells, adult stem cell have not ethical problem for clinical and research. The purpose of present study was to stem cells isolation and proliferation from the human dipose tissue. Materials and Methods: In this study, stem cells were successfully isolated from human adipose tissue by digestion with type I collagenase enzymes. In summary, adipose tissue were digested by type I collagenase enzyme. Subsequently, the cell solution was centrifuged for mature adipocytes and debris elimination and obtained sedimentation was cultured in culture medium contains Dulbecco's Modified Eagle's Medium (DMEM) via 1% penicillin/streptomycin antibiotics and 10% fetal bovine serum (FBS) at 37°C, 5% CO2 and 95% humidity. Results: in this study, ADSCs were successfully isolated and proliferated. Human ADSCs were able to divide in our culture mediums. Conclusion: The results of the current study were suggesting that this adipose-derived stem cell isolation protocol provides an effective and improved method for isolation and proliferation of these cells in order to tissue engineering application.
  2 1,645 185
Comparative study between the attenuation of cardiac fibrosis by mesenchymal stem cells versus colchicine
ZH El Gammal, LA Rashed, MT Abdel Aziz, Ahmed H.M Elwahy, MF Youakim, AlaaEddeen M Seufi
January-June 2016, 3(1):137-145
DOI:10.5530/ami.2016.1.29  
Introduction: Considered as an end-stage for all cardiovascular diseases, cardiac fibrosis leads to the development of heart failure, thus the ultimate goal is to prevent the progression of fibrosis. Indeed, heart can regenerate itself but to a certain limit based upon the number of resident stem cells which is limited. Thus, stem cells transplantation is considered as a promising therapy. This study aims to examine if MSC transplantation can inhibit the progression of myocardial fibrosis in rat model compared to Colchicine treatment; and if the timing of treatment with MSCs or COL affect the progression of fibrosis. Material & Methods: To induce cardiac fibrosis in 48 female albino rats, Isoproterenol hydrochloride was used. These rats were divided into 2 models: COL-treated group that were treated after 1,2,3 weeks of the last ISO injection by colchicine orally. MSC-treated group that were injected intravenously after 1,2,3 weeks of last ISO injection by MSC. Heart rate and Systolic blood pressure were measured and the levels of Creatine phosphokinase, Lactate dehydrogenase, Matrix Metalloproteinase II and Collagen I were assessed. Moreover, cardiac tissues were examined hitopathologically. Results & Conclusion: MSC were proved to enhance the effect of anti-remodeling of extracellular matrix significantly by modulating the expression of matrix metalloproteinases, which is superior to COL treatment.
  2 1,286 106
Pattern of obstetrical emergencies and fetal outcomes in a tertiary care center
Rehana Najam, Sarika Gupta, Hasnahana Chowdhury
January-June 2015, 2(1):105-110
DOI:10.5530/ami.2015.1.18  
Introduction: There is increasing awareness and facilities provided by various government and non government organizations regarding antenatal care and safe delivery practices but it is still a public health concern due to high maternal and perinatal mortality. The aims of present study is to assess the availability of manpower which provided services to the mothers in the peripheries, role of demographic characteristics, educational status, common pregnancy complications and there maternal and fetal outcome along with the hospital stay. Material and Methods: It was a retrospective study carried out in the Teerthanker Mahaveer Medical College. All the patients who were admitted through casualty were analysed with respect to Age, parity, Socioeconomic status, antenatal check-up, reason for referral from periphery, maternal and fetal condition at the time of admission, mode of delivery, maternal and fetal outcome along with NICU admission & hospital stay. Result: It has been observed that most of the patients with poor obstetrical outcome are multiparous or grand multiparous with low socio economic status not receiving any antenatal care. The common obstetrical emergencies came out were PIH (18%), obstructed labor (10.3%) followed by APH (8.2%), fetal mal-presentation (7.5%) and anemia (7.2%). Conclusion: Illiteracy and ignorance of female regarding healthcare requirements came out to be a major contributor of poor pregnancy outcome. Early diagnosis and management of high risk pregnancies is one of the measures which can reduce poor pregnancy outcomes. It is to be emphasized that majority of the maternal death from pregnancy are preventable by sample priority intervention. Co-ordination between healthcare providers at gross root level to tertiary care centre is the need of time. Health care providers at PHC and CHC levels should have adequate knowledge of antenatal requirements and importance of immunization. There must be referral of high risk cases for their early and timely management. There must be adequate transport facility and systematic referral system as well as provision of immediate management of referred cases at tertiary care centre. So it is high time for urgent strategic planning and investment for upgrading eff ective obstetric and neonatal care.
  2 1,456 121
MTHFR gene (C677t) polymorphism in Ischemic stroke, its subtypes and hemorrhagic stroke in a South Indian population
Satrupa Das, Sitara Roy, Subhash Kaul, Akka Jyothy, Anjana Munshi
July-December 2015, 2(2):28-33
DOI:10.5530/ami.2015.2.7  
Objective: We investigated the association of MTHFR C677T polymorphism with ischemic stroke, its subtypes and hemorrhagic stroke in a South Indian Population from Andhra Pradesh. Methods: Six hundred and twenty ischemic stroke patients, 220 hemorrhagic stroke patients and 620 age and sex matched healthy controls, were included in the present study. The polymorphism was determined using PCR-RFLP technique. Results: The strength of association between genotypes and stroke types was measured by the odds ratio with 95% confidence interval and chi-squared analysis. We found significant association of the CT genotype with ischemic stroke as well as haemorrhagic stroke (p<0.05). Further, evaluating the association of this polymorphism with stroke subtypes, we found significant association with intracranial large artery (p<0.05), lacunar stroke (p<0.05) and undetermined etiology (p<0.05). However, there was no significant difference in genotypic or allelic frequencies between ischemic and hemorrhagic strokes. Conclusion: Our study suggests that MTHFR (C677T) is an important risk factor for ischemic stroke, its subtypes and hemorrhagic stroke in the South Indians from Andhra Pradesh but it cannot help in distinguishing between the two types of stroke.
  2 1,398 121
Serum Fetuin A, hs-CRP and homocysteine as biochemical markers of cardiovascular complications in chronic dialysis patients
Perihan H Tawfik, Sawsan S Hafez, Nermine H Mahmoud, Hesham M El Sayed
January-June 2015, 2(1):57-64
DOI:10.5530/ami.2015.1.9  
Introduction: Chronic kidney disease (CKD) patients are considered a high risk group of cardiovascular disease in which vascular calcification plays central role. A pivotal role in the inhibition of calcification is played by fetuin-A. The measurement of inflammatory markers such as high sensitivity C-reactive protein (hs-CRP) and homocysteine which promotes atherosclerosis is helpful in predicting cardiovascular disease in ESRD patients on regular dialysis. Material and Method: The study included 40 adult CKD patients divided into 30 ESRD patients on conventional hemodialysis, 15 with CVD and 15 without CVD, as well as 10 CKD patients on conservative treatment. Ten healthy subjects served as a control group. Enzyme-linked immunosorbent assays were used for fetuin-A, hs-CRP and homocysteine. Results: ESRD patients showed a significant increase in serum hs-CRP, homocysteine and decrease in fetuin-A compared to control group. In addition, ESRD patients with CVD and without CVD showed a significant increase in hs-CRP, homocysteine and only those with CVD had significantly decreased fetuin-A in relation to CKD patients. The study revealed increased levels of hs-CRP and decrease in fetuin-A in ESRD patients with CVD compared to ESRD patients without CVD. Fetuin-A showed a negative correlation with hs-CRP and homocysteine in ESRD patients with and without CVD. Conclusion: The combined use of hs-CRP at a cutoff of (10 mg/dL) with either fetuin-A at a cutoff value of (0.26 g/L) or alternatively with homocysteine at a cutoff value of (48.23 μmol/L) proved to be effective for discrimination of CVD patients from other ESRD or CKD patients.
  2 1,432 137
A correlative study of oocytes morphology with fertilization, cleavage, embryo quality and implantation rates after intra cytoplasmic sperm injection
Emad Ghanem Qassem, Kani Muhmmed Falah, Ismaeel H.A Aghaways, Tan Azad Salih
January-June 2015, 2(1):7-13
DOI:10.5530/ami.2015.1.3  
Introduction: Non-invasive selection of developmentally human oocytes may increase the overall efficiency of human assisted reproduction. Morphologic abnormalities in the oocyte are relevant for determining its developmental fate. The objective is to evaluate the influence of MII oocyte morphology on intra cytoplasmic sperm injection (ICSI) outcomes. Material and Methods: 132 patients undergoing ICSI cycles and having female factors of infertility and unexplained infertility. Couples having male factors of infertility were excluded. A total of 1200 oocytes were retrieved from 132 ICSI cycles, of which 1056 MII oocytes were evaluated. The criteria for morphological evaluations were: (i) Normal MII oocytes showing clear cytoplasm with uniform texture and homogenous fine granularity, a round or ovoid first polar body with a smooth surface, and perivitelline space of normal size. (ii) MII oocytes with extra cytoplasmic abnormalities (first polar body and perivitelline space abnormalities). (iii) MII oocytes with cytoplasmic abnormalities (dark cytoplasm, granular cytoplasm, inclusion body and presents of vacuoles). (iv) MII oocytes with combined abnormalities. Result: From 1056 MII oocytes, 180 (17.04%) had normal morphology while 876 (82.95%) had at least one demonstrable morphological abnormality. Cytoplasmic abnormalities were observed in 516 (58.9%) of the oocytes. Extra cytoplasmic abnormalities were observed in 104 (11.87%) while combined abnormalities were responsible for the remaining 256 (29.22%). There were no significant differences in fertilization, cleavage, and embryo quality between the groups but there was a highly significant difference in implantation rate which was higher in the group of normal oocytes morphology than abnormal oocytes morphology, oocytes with cytoplasmic, extracytoplasmic and combined abnormality 11.11%, 7.33%, 9.03%, 2.3%, and 4.34% respectively. Conclusion: MII oocyte morphology did not affect fertilization, cleavage, and embryo quality, but affecting implantation rate.
  2 2,388 248
IABP ballooning in chinese patients
Gonzalo Pullas Tapia, Xiahua Zhu, Pan Liang, Gang Su, Hai Liu, Shuiqi Li
January-June 2015, 2(1):79-83
DOI:10.5530/ami.2015.1.12  
Introduction: The ischaemic disorders as a complication of intra-aortic balloon pump counterpulsation (IABP) could be deleterious in critically ill patients with myocardial failure and cardiogenic shock. Tis study is a pilot to predict the length of the descending aorta to select the optimum IABP size for Asian patients. Methods: The somatometric features from 80 Chinese patients were used: gender, age, height, body mass index, body surface area, trans-pyloric plane. Moreover, the aortic length from the origin of left subclavian artery to the orifice of the celiac trunk (LSA-CT) measured from tomographic scan examination. The variables to predict the length from the LSA-CT were studied in four types of predictive statistical analysis: nonlinear regression analysis, tree model, linear regression, and loglinear regression. The model was defined by obtaining the R square. Results: Tere were 59 males (mean age 53.9 years SD 13.2, height 170.8cm SD 4.0) and 21 females (mean age 58.7 years SD 7.8, height 160.2 cm SD 6.8). LSA-CT distance was found to be 279.5 SD 31.34 mm. The length of distance from the jugular notch to trans-pyloric plane was 273.8cm SD 12.5. The body mass index was 25.6 Kg/m2 SD 3.8 and the body surface area 1.8 m2 SD 0.1. The tree model for predicting the distance to the left subclavian artery to the celiac axis was chosen due to obtained an R2 square of 0,829. The comparison between the tomographic values and results of the tree model was realized with a nonparametric test. Wilcoxon signed-rank test showed that the values of computed tomograhy scan did not show a statistically significant difference with the results of the tree model (Z = -0.827 p =0.408). Conclusion: The tree model for predicting the distance from the left subclavian artery to the celiac trunk, could be an accurate guide to choosing an adequate catheter length of intra-aortic balloon pump counterpulsation in Asian patients.
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Structure based virtual screening, docking and molecular dynamic simulation studies to identify potent mdm2-p53 inhibitors: Future implications for cancer therapy
B Vijay Raj, MV Raghavendra Rao, Yogesh Acharya
January-June 2017, 4(1):11-21
DOI:10.5530/ami.2017.4.3  
Objective: To identify the p53 binding pocket as well as active residues in mdm2 protein, and search for similar (or) better compounds to inhibit mdm2-p53 interactions in comparison to FDA approved drug (Nutlin) by ligand and structure based virtual screening methods, docking, and molecular dynamic simulation studies. Methods: A structure and ligand based virtual screening for mdm2 protein; targeting the key residues involved in their active binding of p53 peptide was conducted after obtaining structurally suitable compounds similar to Nutlin from ZINC database. These compounds are virtually screened onto the mdm2 protein targeting its active binding site where p53 binds. The best compound with highest binding affinity was taken up for further analysis using molecular dynamic simulations for further validating the docking studies and to reveal interactions during the conformational changes Results: We discovered several compounds that are potentially able to block the interaction between active residues of mdm2 and p53 complex, suggesting their capability to act as anti-cancer agents. As proven by our structure based virtual screening studies coupled with semi-flexible and flexible docking studies, compound ZINC59256947 was found to be the strongest inhibitors for mdm2 protein amongst all of those isolates from ZINC database. Conclusion: Our results suggest that, a simple, selective and reliable inhibition assay can be performed to search for novel inhibitors of p53-mdm2 interaction. Therefore this study provides a rationalization to the ability of a ZINC59256947, an isolate from ZINC database with strong binding affinity towards mdm2 protein, for future implications as anti-cancer agent.
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ORIGINAL ARTICLES
A study of snakebite envenomation cases admitted to egyptian national poisoning center
Ahmed Salah Gouda, Nagla A Elnabarawy, Sayed M Badawy
July-December 2017, 4(2):34-40
DOI:10.4103/ami.ami_48_17  
Introduction: Snakebite is an Egyptian health problem since ancient Egypt. Meanwhile, there is still no controlled geographical and medical studies on locally prevalent snake family intoxication. Aim and Methods: The present study aimed to investigate local snakebites presentations, management, prognosis, and the effect of the polyvalent antivenom, locally produced by the Holding Company for Biological Products and Vaccines (VACSERA) through the year 2015. Results: A total of 87 snakebites caused by venomous and nonvenomous species were recorded. Most cases were middle-aged males. Most cases presented in summer and in the evening time. Two major groups of venomous Egyptian snakes were identified, Viperidae and Elapidae species, based on history, characteristic symptoms, and laboratory findings. Most snakebites (56 cases) were reported to be nonvenomous bites (64.4%). Twenty-one cases (24.1%) of snakebites were reported to be venomous bites by Elapidae snakes and 10 cases (11.5%) were reported to be venomous bites by Viperidae snakes. Antivenom was administered before referral to 37 (42.5%) of cases, and 19 only of them were victims of venomous snakes. Thirty-six (41.3%) patients received antivenom during admission including all cases of the venomous bites and 8.9% of nonvenomous bites' cases. Conclusion: Patients who had moderate or severe symptoms were effectively treated with VACSERA's polyvalent antivenom, with doses related to the severity grading and snake species identification. Additional antivenom doses were repeated on the bases of the clinical condition. Many snakebite victims referred from primary health centers received inadequate or nonnecessary doses of antivenom. No cases of anaphylaxis were recorded. There were no mortalities with current National Center for Clinical and Environmental Toxicology's protocol of treatment.
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REVIEW ARTICLE
Current scenario on genetic basis of infertility- A review
Vishram Singh, Rohini Pakhiddey
July-December 2015, 2(2):149-154
DOI:10.5530/ami.2015.4.7  
Infertility is an emerging major health issue affecting the physical, psychological and social status of the general population across the globe. There are innumerable causes of infertility, viz., ovarian and testicular disorders, advanced maternal age, obesity, chromosomal abnormalities etc. Most of these causes are linked to the genetic disorders. With recent advances in the field of reproductive biology, it has become imperative to have a concise knowledge of the genetic basis of infertility, for better outcome in Assisted Reproductive Techniques (ART).
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SYSTEMATIC REVIEW
Effect of balance exercises for person with multiple sclerosis using Wii® game: A systematic review of randomized and non-randomized control trials
Hasan Tariq
January-June 2016, 3(1):196-201
DOI:10.5530/ami.2016.1.39  
Background: The recent engagement of Game base console is emerging in rehabilitation practice and its overall effectiveness has not been yetsubstantially manifested. Objective: To evaluate the effectiveness of Wii based balance interventions among Multiple Sclerosis people. Data Sources: A systemic search was conducted in the PubMed and Scopus data bases electronically up to February 2014. Study Selection: Randomized and non-randomized control trials with Wii intervention on balance as an outcome measure among people with Multiple Sclerosis were included in this review. Data Synthesis: After screening 57 studies, 7 were selected for full-text screening and 5 were included in this review. Three out of five were RCTs and rest were quasi experimental and 2-point crossover pilot studies. Total of 205 medically diagnosed mild to moderate MS people were in the selected studies with less than 6 expanded disability status scale (EDSS). Total of 13 different outcome measures were used on assessment of balance in Multiple sclerosis individuals and the most common outcomes were Berg balance scale (BBS), Center of Pressured (COP), Four Square step test (FSST), Time up and Go test (TUG). Three out of five studies report statistical significant improvement in the Four Square step test (FSST), Berg Balance Scale (BBS) and center of Pressure (COP) between intervention and control groups of MS. Conclusion: Review of the selected studies indicates that the inclusion of Wii game in balance exercise on Multiple sclerosis people improve static balance more effectivelyas compare to dynamic balance in mild to moderate level of disability. However evidence on the mode selection in Wii, treatment setting and frequency lacking. Further studies with large sample size and more homogenize outcome measure and control setting is recommended for future.
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* Source: CrossRef