Open Access Case Study

Brachial Plexus Middle Trunk Schwannoma: A Case Report with Uncommon Localization and Literature Review

N. Irawati, R. Walukow, D. Hari Susilo, E. H. Kusumastuti, S. Reksoprawiro

Journal of Advances in Medical and Pharmaceutical Sciences, Page 1-5
DOI: 10.9734/JAMPS/2016/24527

Aim: We report a case of schwannoma arising from the middle trunk of the right brachial plexus and presented with radiating pain down to lower arm. The patient developed temporary neurological deficit after surgery.

Presentation of Case: A 30- year old patient presented with history of lump on right lower neck in last nine months. The patient did not have a significant complaint, but occasionally felt sharp pain which was radiating down to right lower arm. USG of the neck showed a hypoechoic soft tissue mass with posterior acoustic enhancement and FNAC suggested of schwannoma.

Discussion and Conclusion: This case report indicates uncommon location of schwannoma in the neck related to symptoms that may occur as the mass increases in size. In our case, we report a case with involvement of the middle trunk of the brachial plexus, which is relatively rare for schwannoma to appear. Surgical excision is the treatment of choice, with recurrence being rare. Excision of the tumor without injuring the parent nerve demands detailed preoperative planning and meticulous dissection. This case highlights the importance of understanding anatomy of surrounding structures to prevent serious complications post operatively. 


Open Access Original Research Article

Preliminary Investigation of the Subchronic Hypolipidemic Actions of Hibiscus sabdariffa in Rats

Patrick Emeka Aba, Amarachi Ossai, Ernest Chukwuamachago Nweze

Journal of Advances in Medical and Pharmaceutical Sciences, Page 1-7
DOI: 10.9734/JAMPS/2016/23186

Hibiscus sabdariffa is a popular medicinal plant that is claimed to have hypotensive and hypocholesterolemic actions in animals. The present preliminary study was conducted to assess the subchronic hypolipidemic actions of H. sabdariffa calyx in normal rats when administered as an aqueous extract. Twenty (20) Wistar albino rats were used for this study and were assigned into 4 groups. Group 1 rats were normal control and received distilled water (10 ml/kg) while Groups 2-4 rats received 200, 400 and 600 mg/kg body weight of the extract respectively. All treatments were through the oral route for 21 days. On the 21st day, blood samples for Lipid panel analyses were collected. The results disclosed  statistically significant (p < 0.05), dose-dependent decreases in Low density lipoprotein (LDL), very low density lipoprotein (VLDL) and triacylglycerol (TAG) levels in all doses of  the extract-treated groups (Groups 2-4) when compared to that of the normal control rats. No statistically significant change (p > 0.05) was observed in the total cholesterol level of groups 2, 3 & 4 given 200, 400 and 600 mg/kg of the extract, respectively compared to the normal control (Group 1). However, there was a significant increase (p < 0.05) in high density lipoprotein (HDL) levels of the extract-treated group when compared to that of the normal control rats. It was concluded that aqueous extract of H. sabdariffa, administered subchronically, exhibited beneficial hypolipidemic effects in healthy rats and warrants further laboratory and clinical investigations to define its potential benefits and risk for the treatment of lipid disorders.


Open Access Original Research Article

Antihyperglycemic Effect of an Important Phytocompound - Phloretin on Streptozotocin Induced Diabetes: An Experimental Study

Tamilarasan Nithiya, Rajangam Udayakumar

Journal of Advances in Medical and Pharmaceutical Sciences, Page 1-10
DOI: 10.9734/JAMPS/2016/24114

Aim: To investigate the antihyperglycemic effect of phloretin on streptozotocin induced diabetic rats.

Materials and Methods: Diabetes mellitus was induced in adult male albino rats of Wistar strain weight ranges between 180-200 g by intraperitoneal administration of streptozotocin (STZ) (60 mg/kg b.w). Phloretin was administered orally to diabetic rats at two different doses like 25 and 50mg/kg b.w. The antidiabetic potential of phloretin was evaluated by analyzing the changes in body weight, blood glucose, total hemoglobin, glycosylated hemoglobin, insulin, liver glycogen and carbohydrate metabolizing enzymes like hexokinase, glucose-6-phosphate dehydrogenase, glucose-6-phosphatase and fructose-1, 6-bisphosphatase in the experimental rats.

Results: Diabetic rats showed increased level of glucose and glycosylated hemoglobin and decreased level of body weight, serum insulin, hemoglobin and liver glycogen.  Increased activities of gluconeogenic enzymes such as glucose-6-phosphatase and fructose-1, 6-bisphosphatase and decreased activities of hexokinase and glucose-6-phosphate dehydrogenase were observed in diabetic rats. The phloretin treated diabetic rats showed significantly reduced level of blood glucose and glycosylated hemoglobin and significantly increased level of body weight, serum insulin and liver glycogen. The altered activities of key enzymes of carbohydrate metabolism were significantly reverted to near normal in phloretin administered diabetic rats.

Conclusion: The present findings suggest that phloretin may be useful in the treatment of diabetes mellitus and confirmed its antihyperglycemic effect mediated through the regulation of carbohydrate metabolic enzyme activities. 


Open Access Original Research Article

The Role of Intraoperative Pain Assessment Tool in Improving the Management of Postoperative Pain

Thomas W. Anabah, Sylvanus Kampo, Yidana W. Yakubu, Peter Paul Bamaalabong, Alexis D. B. Buunaaim

Journal of Advances in Medical and Pharmaceutical Sciences, Page 1-9
DOI: 10.9734/JAMPS/2016/25018

Background: Several studies have proven that despite the availability of quite a number of novel pain management techniques and medications, optimal perioperative pain control still remains a great challenge. Therefore, this suggests that no effort should be spared towards finding the right antidote to address the nagging challenge of inadequate perioperative pain management. The purpose of this study was to evaluate the effects of perioperative pain assessment with standardised pain assessment tools, as well as the role of preventive analgesia on postoperative pain outcomes.

Methods: This study was carried out at the Tamale Teaching Hospital, Tamale, Ghana, West Africa. To achieve the objective of this study, 60 participants were recruited. They were randomly selected into two groups of 30 respondents for each group. Members of the study group (A) were assessed pre-operatively with a Numerical Pain Rating scale before they were given preventive analgesia and afterwards were then re-assessed with the same scale. Members of the study group were also assessed periodically during surgery with an Anaesthetized Patient Pain Scale and interventional pain therapy administered depending on their pain scores after each assessment. Respondents in the control group (B) were also assessed pre-operatively with the Numerical Pain Rating Scale, but afterwards they received the routine anaesthesia care as standard practice of the institution. Both groups had their immediate postoperative pain intensity levels assessed within the postoperative period of 1-12 hours with a Numerical Pain Rating Scale.

Results: Group A had a mean postoperative pain score of 4.57 which was lower, compared to a mean postoperative pain score of 6.47 for group B and the P-value for the comparison of the immediate postoperative pain scores of the two groups was less than 0.001.

Conclusions: The results of this study have adequately demonstrated that the use of standard pain rating tools for perioperative pain assessment, as well as implementing the concept of preventive analgesia, will contribute towards enhancing perioperative pain control and minimising postoperative complications related to pain.


Open Access Review Article

The Healthcare Safety Environment: Egyptian Health Practitioners’ Attitude to Medical Errors

Raouf M. Afifi, Amani Qulali, Ahmed A. El Raggal

Journal of Advances in Medical and Pharmaceutical Sciences, Page 1-14
DOI: 10.9734/JAMPS/2016/24848

Medical errors overwhelm the healthcare environment worldwide.

Aim: Identify correlates of the healthcare workers’ attitude toward medical errors prevention within the health facility environment.

Methods: Healthcare providers from selected private health organizations in greater Cairo, Egypt were surveyed; their work load, burnout, leader-member exchange quality; their influences upon health workers’ attitude toward medical errors prevention were analyzed.

Results: Among 5,725 health professionals surveyed, 2,260 (39.5%) returned valid responses. Participants’ mean age was 33.4 years (±7.76SD); male-female ratio was 1.26:1. Nursing predominate other occupations, e.g., 35.4% vs. 21.6% physicians. Both leadership member exchange quality and health workers’ attitude toward medical errors prevention scores were significantly higher in male workers [t(df=2258)=0.106, p<0.05; t(df=2258)=1.22, p<0.05, respectively]. Leader-member exchange and attitude toward medical errors prevention scores varied by occupation [F(df=4, 2,255)=2.48, p=0.045]; physicians score higher than technicians, nurse, and pharmacists, [F(df=4, 2,255)=6.65, p=0.02]. Participants’ leader-member exchange score increased by age [F(df=3, 2,237)=3.52, p=0.016]. Burnout score decreased by decreasing age [F(df=3, 2,237)=3.37, p=0.042]. Leader-member exchange and health workers’ attitude toward medical errors prevention are correlated (r= 0.16, p=0.015). Workload positively correlated with burnout (r= 0.351, p<0.001), and inversely correlated with attitude toward medical errors prevention (r= ‒0.161, p<0.016). Otherwise, health workers’ attitude toward medical errors prevention and burnout inversely correlated (r=-0.473, p<0.001). Burnout could predict changes in the health workers’ attitude toward medical errors prevention (β= ‒0.032, p<0.001); work experience was a predictor for burnout (β = ‒0.122, p=0.008).

Conclusions: Work stressors impact health workers’ health workers’ attitude toward medical errors prevention, including private health workers, who are often under a financial target pressure. Given their favorable health workers’ attitude toward medical errors prevention and leader-member exchange profile, older health workers can play a role in combating medical errors risk in the healthcare institutions arena.