Open Access Original Research Article

Expression of TLRs and CD14 Does Not Necessarily Correlate with the Type of Pathogenic Bacteria in the Tonsils of Tonsillectomy Patients

Fatah Satya Wibawa, Eryati Darwin, Irza Wahid, Netti Suharti

Asian Journal of Medicine and Health, Page 1-8
DOI: 10.9734/AJMAH/2018/41289

Aims: It has been revealed that in patients with chronic tonsillitis there is an increase in the expression of various types of toll-like receptors (TLRs) in the tonsils. The TLRs in question, especially TLR2 and 4, require Cluster of Differentiation 14 (CD14) in recognising the cellular component of the pathogenic agents. This study aimed to evaluate whether the expression of TLRs and CD14 are associated with the types of bacteria of tonsillar surface swabs of tonsillectomy patients.

Study Design:  Cross-sectional.

Place and Duration of Study: Dustira Hospital, Cimahi, West Java, Indonesia, between May and September 2017.

Methodology: Children aged 4-15 years (n = 34) with chronic tonsillitis showing indications for tonsillectomy in Dustira Hospital, Cimahi, West Java, Indonesia were included in the study. Tonsilar surface swabs were taken by rotating a sterile-cotton tip fine needle on the surface of the tonsils and inoculated into sheep blood and MacConkey agar plates. After tonsillar swabbing then tonsillectomy performed, tonsil specimens were transported to the laboratory in an hour or less for TLRs expression examination using immunohistochemical techniques. To assess CD14+ leukocytes, the venous blood sample (1 ml) of each subject was collected and analyzed using the whole-blood flow cytometry-based method.

Results: Tonsillar surface swabs culture resulted in 18 (52,9%) cultures that were not overgrown with pathogenic bacteria and 16 (47,1%) cultures were overgrown with Staphylococcus aureus (n = 12) and Klebsiella pneumoniae+Streptococcus non-group A (N = 4). All statistical analysis performed regarding the role of bacterial types in TLRs and CD14 expression, as well as the association between variables, showed no significant results.

Conclusion: The present study suggests that in chronic tonsillitis, the expression of TLR2 and TLR4, as well as their CD14-coreceptors, do not necessarily correlate with the type of pathogenic bacteria on the surface of the tonsils.

Open Access Original Research Article

Maternal Age and Congenital Anomalies among Newborns in a Tertiary Health Facility in Benue State, North Central Nigeria

Martha Omoo Ochoga, Geoffrey Ingyoroko Tolough, Aondoaseer Michael, Rose Okwunu Abah, Othniel Dabit, Iyornenge Ikuren, Onyilo Ogbu

Asian Journal of Medicine and Health, Page 1-7
DOI: 10.9734/AJMAH/2018/41868

Background: Congenital anomalies occur due to structural or functional anomalies of the body that present at birth.

Aim and Objective: To determine the relationship between maternal age and congenital anomalies amongst newborns in a tertiary hospital in North Central Nigeria.

Materials and Methods: This descriptive retrospective study was carried out at the neonatal unit of the Benue State University Teaching Hospital over a three-year period. Data was collected from the medical records of patients with congenital anomalies and analyzed using the Chi-square test (c2), significance level of 5%(p<0.05).

Results: A total of 843 neonates were admitted and 72 were documented to have congenital anomalies giving a prevalence of 8.5%. Of the 72,43(59.7%) were males while 29(40.3%) females. The newborns with birth weight above 2500 g, 50(69.4%) presented more with congenital anomalies. Greater percentages 67(93.1%) were term. The mean maternal age of the mothers was 26.5 years, 95% CI 25.3, 27.7. Fifty-two (72.2%) of the mothers attended Antenatal care. Most of the congenital anomalies occurred amongst the primiparous. The major systems involved were the Central Nervous System, Gastrointestinal Tract and Musculoskeletal System. Among the systems involved the Central Nervous System (CNS) had the highest prevalence of 3.3% and occurred in the maternal age group 25-29 years giving a prevalence rate of 1.3%. Myelomeningocele was the leading cause of CNS manifestation with a prevalence rate of 2.5%. Anorectal malformation was the commonest GIT disorder with a prevalence rate of 1.7% and Gastroschisis (MSS) with a prevalence of 0.9%.

Conclusion: Neonates from mothers above 25 years are not more at risk of developing congenital anomalies than mothers below 24 years. The major systems involved were the CNS, GIT and MSS.

Open Access Case Study

Hemophagocytic Lymphohistiocytosis – Unusual Presentation as Cholangitis- Cholestatic Jaundice

Arun Agarwal, Aakanksha Agarwal, Abu Saad Khan

Asian Journal of Medicine and Health, Page 1-10
DOI: 10.9734/AJMAH/2018/41435

Hemophagocytic lymphohistiocytosis (HLH) is a rare, under diagnosed, fatal and devastating hyper-inflammatory syndrome that has gained increasing recognition over the past decade. HLH can be familial (F-HLH) or acquired; infections, autoimmune diseases, malignancy or immune suppression being the most common triggers of the acquired form. Patients with HLH present with clinical and laboratory evidence of uncontrolled inflammation. They may present with fever, cytopenias, jaundice, and hepatosplenomegaly. Laboratory features may show hyperferritinemia, transaminitis, and low fibrinogen, albumin and natural killer (NK) cells. Delay in diagnosis and management inevitably leads to a rapidly progressive and fatal course. We present a case in which the patient had daily fever, gradually rising bilirubinemia, cytopenias, transaminitis and was initially managed as sepsis, and later as cholangitis and obstructive jaundice before being diagnosed as acquired HLH secondary to Epstein Barr virus associated hepatitis. He succumbed to his illness despite starting therapy for HLH after initial recovery .Delayed diagnosis, refractory progressive HLH and secondary bacterial sepsis were the factors contributing to fatality.

Open Access Case Study

Unusual Oesophageal Foreign Bodies in a Young Man with Mental Retardation: A Case Study

Stanley B. Amutta, Mohammed Abdullahi, Daniel J. Aliyu, Lawal Shuaibu, Kareem Mukaila

Asian Journal of Medicine and Health, Page 1-5
DOI: 10.9734/AJMAH/2018/41442

Background: Oesophageal foreign bodies are common in the ear, nose and throat practice. Unlike children, the occurrence in adults is due to accidental or deliberate self-harm. Delay in oesophageal foreign body retrieval could lead to unpleasant complications.

Aims: To highlight the occurrence of multiple and diverse oesophageal foreign bodies in a man with mental retardation.

Case Report: An 18-year-old man with background history of congenital mental retardation, deaf and dumb was brought to the out-patient clinic of the ENT Department, Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria. The presenting complaints were 7-days history of inability to take both fluid and solid diets, excessive salivation and progressive body weakness. The presence of the oesophageal foreign body was confirmed by chest x-ray. Had emergency rigid oesophagoscopy and foreign body removal of the impacted multiple stones and grasses.             The patient was discharged home after seven days on admission and follow-up visits were uneventful.

Conclusion: A case of multiple, unusual and diverse oesophageal foreign body in a young man with background mental retardation. He had a satisfactory outcome with rigid therapeutic oesophagoscopy under general anaesthesia, despite, the delayed presentation.

Open Access Case Report

Odontogenic Keratocyst: A Case Series

R. Kirthika, Ch. Uma Reddy, Br. Sathvikalakshmi, L. Chandrashekar, R. Sudarshan, A. Feroz Khan

Asian Journal of Medicine and Health, Page 1--5
DOI: 10.9734/AJMAH/2018/39788

The maxillofacial region is affected by a more significant number of cysts than any other parts of the body. Odontogenic cysts are rare entities that appear in tooth-bearing areas.  In this study, three cases of odontogenic keratocyst were collected over a period of 3 months in the year 2016. Clinical picture of these cases with regarding age, sex, anatomical distribution, radiological features, clinical and histological features were highlighted.