International Invention Journal of Medicine and Medical Sciences

173-178

Authors: Omnia Awad Ibrahim1, Mahmoud Mohamed Zakaria2*, Mahmoud Gamil Elsebaei3, Khaled Khilo4

To evaluate the use of TERT and CK20 gene expression as a diagnosis of HCC in animal model. Thirty adult albino male rats were divided into 3 groups of 10 animals each. Animals in group A underwent a sham experiment, group B was injected by CCL4 for 4 weeks (early) and group C was injected by CCL4 for 8 weeks (late). At end of experiments, specimens from liver were all stained by H and E dye. TERT and CK20 gene expression were done by Real-Time PCR in blood and tissue samples. The relative quantification of target genes and statistical analysis were done. A histopathological study of the rat liver of early group showed mild fibrosis and the late group showed formation of cirrhotic nodule with dysplasia of hepatocytes. TERT mRNA was increased significantly in early and late tissue by about 17 and 23 folds and in blood samples, the expression was increased about 3 and 11 folds, respectively. The gene expression of CK20 was not observed in blood stream but was expressed significantly in tissues with about 4 and 44 folds. P value was <0.001 between control and early or late HCC. Human TERT gene expression was observed to increase according to HCC in both tissue and blood samples but CK20 was regulated in tissue samples.

72-78

Authors: Ahmed Yehia MD

Atrial fibrillation (AF) is the most common cardiac arrhythmia and it may be symptomatic (manifest), or asymptomatic (silent). Silent AF is much more common than manifest AF. Both paroxysmal (PAF) and persistent AF confer a risk of embolic stroke. Increased left atrial (LA) size is associated with an increased prevalence of non-valvular AF and could be a predictor of stroke. Relationship between LA size and asymptomatic attacks of PAF in hypertensive patients. Sixty hypertensive patients following at the cardiac outpatient clinic having controlled hypertension (HTN) underwent ambulatory Holter monitoring (HM) for detection of silent PAF and measurement of left atrium antero-posterior diameter (LAAPd) using M-mode echocardiogram. Patients were classified into two groups according the LAAPd: group I; twenty-six patients and having increased LAAPd and group II; thiry-four having normal LAAPd. Patients in both groups have comparable demographic variables, cardiovascular (CV) risk factors, controlled BP; antihypertensive drugs used to control BP, and left ventricular size and function. Upon HM, 11 (18%) patients found to silent PAF, 8 (30.7%) in group I and 3 in group II (8.8%). Thus hypertensive patients having increased LAAPd have significantly more attacks of silent PAF than hypertensive patients with normal LAAPd (P = 0.043). Increased LAAPd can be used in selecting hypertensive patients for HM to identify patients having silent PAF and thus at risk for embolic stroke.

84-88

Authors: Andi Indahwaty Sidin

Informed consent refers to the process of giving information, discussing and obtaining permission of patients or participants in terms of medical treatment and human research. Informed consent is the most important right for the patient. However making standardization of valid informed consent is likely to be difficult due to a number of obstacles. On the other hand, courts may require valid informed consent to hold litigation. For this reason, this paper intends to discuss the difficulties in obtaining valid informed consent which is divided into five main elements: disclosure of information, understanding, voluntariness, competence, and consent. This paper will focus on particular situations: emergency cases, critically ill, psychiatric patients, child patients, and human research. This literature review is developed from examining in depth some references such as journal and text book. Chosen references reviewed are study of informed consent particularly in emergency cases, critically ill, psychiatric patients, child patients and human research. The main theory is from Beauchamp, the author of Principle Bioethics. After reviewing this literature it is found that, employing the four aspects of informed consent is likely to be complicated. This may be caused by the condition of patients and participants. People have to deal with some ambiguities of the four aspects of informed consent. There is likely to be conflict between promoting autonomy and the principle of beneficence. Furthermore, the valid informed consent may not be obtained. Therefore, courts have to consider informed consent as a part of legal doctrine for those circumstances. Nonetheless, physicians and researchers have to be aware of the importance of informed consent to grant patients and participants’ autonomy and to respect human rights. Informed consent may be seen as part of ethical issues rather than law.

62-67

Authors: Kaladada I. Korubo, MB.BS, FMCPath

Thrombotic thrombocytopenic purpura is a rare congenital or acquired disorder either due to mutations in the ADAMTS13 gene or development of antibodies to the ADAMTS13 protein. TTP causes a life-threatening form of thrombotic microangiopathy that is characterized by thrombocytopenia, microangioapathic haemolytic anaemia, fever, neurological symptoms and renal impairment. ADAMTS13 functions to cleave large von Willebrand factor multimers and in its absence there is unregulated VWF-dependent platelet thrombosis. A nineteen year old female presented with a history of menorrhagia, petechiae and purpural haemorrhages, painful right jaw, anaemia of 8.1g/dL and thrombocytopenia of 31 X 109/L. Her blood film showed numerous schistocytes with thrombocytopenia on film. Bone marrow aspirate revealed increased megakaryocytic and erythroid activity. The uric acid and lactate dehydrogenase parameters were elevated but her renal functions and other investigations were essentially normal. At presentation she was initially commenced on high dose prednisolone, however on review of the peripheral blood schistocytes and thrombocytopenia a provisional diagnosis of thrombotic thrombocytopenia was made and ADAMTS13 was done which revealed low ADAMTS13 levels. This is a case report to document this rare disorder for the first time in our environment which was successfully treated without the use of plasma exchange, plasma infusion or blood transfusion but rather with high dose prednisolone.