Journal of Advances in Medicine and Medical Research

Aims: The objective of the Study on Transitions in Employment, Ability and Motivation (STREAM) is to acquire knowledge on determinants of transitions in employment and work productivity among persons aged 45-64 years.
Research Framework: A research framework was developed, in which transitions in employment (e.g. leaving the workforce, entering the workforce, job change) and work productivity are influenced by the following determinants: health, job characteristics, skills and knowledge, social factors, and financial factors. Central explanatory variables in the framework are the ability to work, the motivation to work, and the opportunity to work.
Study Design: STREAM is a prospective cohort study among 12,055 employees, 1,029 self-employed persons, and 2,034 non-working persons, all aged 45 to 64 years at baseline. The study sample was stratified by age and employment status (employed, self-employed, non-working), and was drawn from an existing internet panel. The baseline measurement was carried out in 2010 (response: 70%), and with yearly follow-up measurements in 2011 (response: 82%), 2012 (response: 80%), and 2013. At each wave, participants fill out an online questionnaire covering all aspects of the research framework.
Place and Duration of Study: The Netherlands, between October 2010 and December 2013.
Methodology: Quantitative data on all aspects of the research framework were assessed with an online questionnaire, qualitative data were assessed with interview studies, and the questionnaire data can be linked to register data at Statistics Netherlands for 89% of the participants.
Results: Transitions in employment between the first three waves of data among the participants are described.
Conclusion: STREAM will provide insight in the determinants of healthy and productive labour participation among persons aged 45 years and older, which will support the development of interventions prolonging working life in good health, while maintaining good work productivity.

Background: Various factors contribute to the discrepancies observed between the bromocresol green (BCG) and bromocresol purple (BCP) assays of serum concentration. Either a BCG or a modified BCP assay is a routine laboratory for albumin measurement in Japan. High-dose of penicillin G underestimates serum albumin level using a modified BCP method in vitro. Therefore, we examined the serum albumin level in the patients treated with high-dose of penicillin G and also performed the experiments on co-incubation with plasma, or albumin product and penicillin G solution in vitro.
Methods: The medical records of 71 patients treated with high-dose of Penicillin G collected between 2009 and 2012 were reviewed for age, gender, biochemistry (total protein, albumin and potassium), underlying diseases and usage of albumin product. Patients were divided into 2 groups: BCG group (N = 38) and a modified BCP group (N = 33). We compared serum albumin levels between two groups. We performed the experiments on co-incubation with albumin product or human plasma and penicillin G solution in vitro.
Results: Serum albumin levels using a modified BCP assay decreased during the treatment with high dose penicillin G (-0.4 ± 0.1 g/dL), while serum albumin levels by a BCG method did not decrease (0.06 ± 0.05 g/dL). Although only one patient revealed hypoalbuminemia (<2.0 g/dL) by a BCG method (2.6%), ten patients revealed hypoalbuminemia by a modified BCP method (33%). Penicillin G underestimated plasma albumin levels using a modified BCP methods (% underestimation: 42.9 ± 0.0%) more than those using a BCG method (% underestimation: 10.6 ± 0.0%) in co-incubation experiments in vitro.
Conclusion: High-dose of penicillin G might cause the underestimation of serum albumin levels using bromocresol dye-binding methods.

Aims: To conduct a hormonal and biochemical studies on 10 patients with diagnosis of probable Nodding Syndrome (NS).
Study Design: A cross-sectional study
Place and Duration of Study: Atanga Health Center III in Pader District in Northern Uganda in September 2012.
Methodology: We recruited consecutively 10 children with probable Nodding Syndrome who had been admitted for symptomatic management of seizures, injuries resulting from falls and nutritional rehabilitation. History, physical examinations, biophysical measurements (anthropometry) and blood investigations including serum electrolytes, liver function tests, thyroid hormones and vitamin D assays. Ethical approval was obtained from Gulu University Institutional Review Committee.
Results: All children had severely low serum calcium and bicarbonate levels and a high Anion Gap. Thyroid hormones and vitamin D assays were largely normal.
Conclusion: Children with Nodding Syndrome undergoing treatment for seizure control and nutritional rehabilitation have high Anion Gap metabolic acidosis.

Background: Protein energy malnutrition is a significant cause of morbidity and mortality in children between the ages of 12 and 59 months and diarrhoea has been shown to have a bi-directional relationship with malnutrition. Mid upper arm circumference (MUAC) has been shown to be a useful indicator of malnutrition in children aged 12 to 59 months.
Objective: To determine the nutritional status of children aged 12 to 59 months with diarrhoea using mid upper arm circumference (MUAC).
Method: Over a 6 month period, all children aged 12 to 59 months who presented to the Niger Delta University Teaching Hospital (NDUTH) with diarrhoea were consecutively recruited into the study. Information on their ages, diarrhoeal type, duration and frequency as well as parental educational level and occupation were obtained and recorded into a proforma. MUACs were measured and recorded to the nearest 0.1cm.
Results: There were 144 children with a male to female ratio of 1.3:1. The mean MUAC was 14.25 ± 2.46cm with a steady increase with age from13.45 ± 1.99cm at 12 to 23 months to 16.50 ± 0.58cm at 48 to 59 months. Using MUAC measurements, 19 (13.2%) of the children were malnourished, with 7 (4.9%) having severe acute malnutrition and 12 (8.3%) having moderate acute malnutrition (MAM). Seventeen (11.8%) of the children were at risk of malnutrition. Children with chronic diarrhoea and ages ranging from 12 to 23 months had significantly lower MUACs with χ² and p values of 19.58 (0.000) and 7.99 (0.005) respectively.
Conclusion: Under nutrition is an important problem in children aged 12 to 59 months with diarrhoea. There is need to pay extra attention to nutritional status of this age group especially during episodes of diarrhoea.

Aims: To compare the mean levels of plasma total Homocysteine (tHct), Methylmalonic acid (MMA), vitamin B₁₂, folate and haematological parameters(PCV, WBC, Platelet counts, MCV, MCH, MCHC) among adult SCA patients in steady state (SS), SCA in (VOC) and age and sex matched controls in order to determine significant differences.
Study Design: Case-control study.
Place and Duration of Study: Department of Haematology and Department of Chemical Pathology, University College Hospital, Ibadan, Nigeria between March 2012 and July 2012.
Methodology: We included 60 SCA patients (30 in VOC, 30 in Steady State; and 30 age and sex matched controls. Plasma tHct, MMA, folate and vitamin B₁₂ were assessed using HPLC and haematological parameters were determined using haematological autoanalyzer (Syxmex Kx21).
Results: The mean plasma tHct, MMA, vitamin B₁₂ of SCA patients (VOC and SS) were significantly lower (p=0.000) compared to control population but the mean folate levels were comparable (p=0.085). The SCA (in VOC) had significantly lower (p=0.000) MMA and folate levels compared to SS group but the SS group had significantly lower (p=0.001) tHct level compared to VOC group. While the PCV, Hgb, MCV, and MCH were significantly lower; the WBC, platelet count and the MCH were significantly elevated in SCA patients compared to controls.
Conclusion: A larger, better controlled, multicenter study is required to confirm lower tHct and MMA found in SCA groups compared to control group and higher tHct in SCA (VOC) but higher MMA level in SCA (SS) when VOC and SS groups were compared. The haematological parameters in SCA groups were not in keeping with macrocytic anaemia but were indicative of chronic haemolytic and inflammatory process.

The effect of Masfon-Aloe vera drink on intestinal transit and motility was investigated in this study. Thirty (30) albino Wistar rats were divided into 2 batches of 15 rats each, batch 1 for intestinal motility, and batch 2 for intestinal transit experiments. Each batch was further divided into three groups of 5 rats each (control, low dose and high dose). All groups were fed with normal rat chow and water for 21 days. In addition, the control received 0.3 ml of normal saline (0.9% NaCl solution) while the low dose (LD) and high dose (HD) experimental groups received Masfon Aloe vera drink (1 ml and 3 ml/kg body weight orally, once daily respectively). The study was carried out at the Department of Physiology, University of Calabar, Nigeria. At the end of the study duration, intestinal motility and transit studies were conducted. Result for intestinal motility showed the extract (Masfon-Aloe vera drink), at either low or high dose did not significantly change the frequency and amplitude of the spontaneous contraction (basal contraction) of the rat ileum when compared with the control. Graded concentrations of Acetylcholine (10^-8 to 10^-4) was observed to produce a dose dependent increase in contraction of the rat ileum which was significantly (p<0.001) greater in the LD and HD groups at lower concentrations of 10^-8 and 10^-7M. The mean percentage intestinal transit which was not significantly different (p = 0.226, p=0.892) among the groups was 42.16 ± 2.63 in the low dose, 37.75 ± 5.15 in the high dose groups compared to 36.91 ± 3.01 in the control. Administration of atropine produced significantly higher (p<0.01) relaxations in the LD (5.00 ± 0.41 mm) and HD groups compared with control [relaxation in mm, mean ± SEM (2.25 ± 0.25) in control vs (5.00 ± 0.41) and (10.75 ± 0.25) in LD and HD respectively]. Masfon-Aloe vera drink administered at these concentrations “did” not significantly alter the basal motility and transit of the rat ileum, but was observed to potentiate Ach induced contraction of the rat ileum, and also “augmented” the relaxant effect of atropine.

Aims: The purposes of this study were to clarify the changes in smoothness of each phase by making use of the angular jerk cost for the smoothness of the knee joint motion at the stance phase in patients with osteoarthritis, to verify the relationship between the kinetics variables and the smoothness, and to clarify the dynamics in osteoarthritis by comparison with healthy subjects using the angular jerk cost of knee flexion or extension.
Methods: The osteoarthritis group comprised 19 knees of 12 subjects with a Kellgren–Lawrence grade of 1 in at least one knee. The control group comprised 10 healthy adults. The subjects walked barefoot along a 10-m walkway at their self-selected habitual speeds. The stance phase of gait was defined as four periods To calculate the smoothness of the knee joint movement, the angular jerk cost of the knee joint angle during the stance phase was calculated by differentiation three times using the knee joint angle data.
Results: The angular jerk cost was increased in the early stance phase in both groups. Only the osteoarthritis group showed a large angular jerk cost in the late stance phase. The ground reaction force in the osteoarthritis group showed a small value in the stance phase compared with the control group.
Conclusion: The movement of the knee joint at the initial stance phase had a strategy to ensure the smoothness of the movement by decreasing the change in the angular acceleration in accordance with the impairment disorder. In addition, the smoothness of the knee joint movement was decreased at the late stance phase compared from the loading response to mid-stance period in the osteoarthritis group, and the propulsion for forward movement of the body was exerted by a change involving a large angular acceleration with a large force.

Aims: To assess sensory ocular dominance of children by means of a novel psychophysical technique (Domitest-S).
Study Design: population study.
Place and Duration of Study: Department of Ophthalmology, The Gradenigo Hospital, Turin, between June 2012 and June 2013.
Methodology: Thirty sequences of stimuli (15 for the left eye and 15 for the right eye) were administered in dichoptic conditions to 152 pupils (mean age: 9 ± .8 years). The task was to detect the target (a checkerboard-like pattern arranged so as to form an “X”) embedded in a series of null stimuli (checkerboard-like patterns randomly arranged). Left and right proportion correct responses were computed and an index of dominance laterality, the Balance Value (BV), expressed as the right minus left proportion correct responses was introduced. A second index based on the total amount of percent correct responses, the Interocular Inhibitory Index (III) was computed to provide a measure of reciprocal binocular suppression.
Results: The frequency distribution of sensory dominance was not normal, but skewed on the left (KS=.17, P<.001). The median was .20 (range .00-.80) with 77% of the subjects showing a BV between .00 and .27. A substantial equivalence was found between the proportion of right and left dominants (46%). Balance values ranging from –.20 to +.27 accounted for 79% of the variance. The distribution of the reciprocal interocular suppression measured as III was bimodal, showing two peaks, one on the right (lower inter-inhibitory effect) and the other on the left (stronger inter-inhibitory effect). Test-retest reliability was acceptable (correlation between the left and right correct responses at first and second examination: Spearman r= .54, P< .001). The duration of the examination was about 5 minutes.
Conclusion: Domitest-S proves to be a fast and reliable technique to assess sensory dominance in children within the clinical setting

Objective: To study the effect of heavy consumption of sugar sweetened beverages on serum 25-hydroxy vitamin D (25OHD) level and bone mineral density (BMD) in preadolescents.
Study Design: Case-control.
Place and Duration of Study: Outpatient clinic in Children`s hospital, Ain Shams University, between September, 2009 and July, 2010.
Methods: A questionnaire to define the frequency of beverage consumption was filled by one thousand children within the age range of 8-12 years. Fifty children were selected from the heavy sugar sweetened beverages consumers and were compared to 50 clinically healthy age and sex matched children who gave no history of more than average sugar sweetened beverages intake. Each enrolled case filled a questionnaire that assesses duration of beverage intake, frequency and type as well as milk consumption. Questions concerning symptoms of pain, limitation of movement and fractures were also included. Anthropometric measurements were taken. Serum calcium and phosphorus were measured as well as the circulating 25OHD and dual-emission x-ray absorptiometry scan assessed their BMD Z-score.
Results: Children who heavily consumed the sugar sweetened beverages had significantly lower 25 (OH) vitamin D, and BMD Z-score as compared to the controls (t= 4.05, P<0.001 and t= 3.73, P<0.001, respectively). There was significant negative correlations between duration of beverage intake and both BMD Z-score and 25OHD among heavy sugar sweetened beverage consumers(r=0.38, P=0.01 and r=0.4, P<0.001, respectively). A significant negative correlation was detected between duration of beverage intake and serum calcium among heavy sugar sweetened beverage consumers (r = -0.46 and P<0.001) and significant positive correlation between BMD Z-score and 25OHD among them (r = 0.69 and P<0.001).
Conclusion: Sugar sweetened beverages intake is associated with a decrease in 25OHD which contributes to low bone mineralization in preadolescents and the duration of intake is the most determinant factor for this association. Consumption of carbonated beverages had more hazardous effect on 25OHD and BMD than packed fruit juice while milk intake showed an opposite effect. We recommend more awareness programs for preadolescents and their parents whether at school or as a part of national campaigns to boost healthy trends in beverage consumption.

Aims: In single-nucleotide polymorphism (SNP) scans, SNP-phenotype association hypotheses are tested, however there is biological interpretation only for genes that span multiple SNPs. We demonstrate and validate a method of combining gene-wide evidence using data for high-density lipoprotein cholesterol (HDLC).
Methodology: In a family based study (N=1782 from 482 families), we used 1000 phenotype-permuted datasets to determine the correlation of z-test statistics for 592 SNP-HDLC association tests comprising 14 genes previously reported to be associated with HDLC. We generated gene-wide p-values using the distribution of the sum of correlated z-statistics.
Results: Of the 14 genes, CETP was significant (p=4.0×10^-5 <0.05/14), while PLTP was significant at the borderline (p=6.7×10^-3 <0.1/14). These p-values were confirmed using empirical distributions of the sum of χ² association statistics as a gold standard (2.9×10^-6 and 1.8×10^-3, respectively). Genewide p-values were more significant than Bonferroni-corrected p-value for the most significant SNP in 11 of 14 genes (p=0.023). Genewide p-values calculated from SNP correlations derived for 20 simulated normally distributed phenotypes reproduced those derived from the 1000 phenotype-permuted datasets were correlated with the empirical distributions (Spearman correlation = 0.92 for both).
Conclusion: We have validated a simple scalable method to combine polymorphism-level evidence into gene-wide statistical evidence. High-throughput gene-wide hypothesis tests may be used in biologically interpretable genomewide association scans. Genewide association tests may be used to meaningfully replicate findings in populations with different linkage disequilibrium structure, when SNP-level replication is not expected.

Aims: Interest in the distribution of birth weight arises because of the association between birth weight and the future health of the child. A common statistical result is that the birth weight distribution differs slightly from the Gaussian distribution.
Methods: A standard attempt has been done to split the distribution into two components, a predominant Gaussian distribution and an unspecified “residual” distribution.
Results: We considered birth weight data among triplets born in Finland in 1905-1959 and compare the birth weight among stillborn and live-born triplets. The stillbirth rates are 119.1 per 1000 births for males, 124.6 for females and 121.8 for all. The sex differences are not significant. The still birth rate for the period 1905-1930 was 119.5 and for the period 1931-1959, 124.2. We identified a strong association between birth weight of the triplets and their survival. The weight distribution for male triplets is described well by the Gaussian curve, while for females a slight deviation from the Gaussian distribution is discernible.

Aims: To assess the semen characteristics of primary and secondary male infertile couples in the Kumasi metropolis.
Study Design: A cross-sectional study.
Place and Duration of Study: Department of Obstetrics and Gynaecology, Komfo Anokye Teaching Hospital, Kumasi; between February 2012 and May 2013.
Methodology: The study involved 150 men whose female partners reported to the Obstetrics and Gynaecology Department of Komfo Teaching Hospital (KATH) in Ashanti Region of Ghana for infertility treatment. Semen of the respondents were examined for various characteristics (viscosity, pH, volume, presence of RBC and bacteria, motility, etc).
Results: Eighty-eight partners involved in the study representing 59% of total respondents were partners of primary infertile couples whereas 41% were partners of secondary infertile couples. Semen abnormalities were reported in terms of sperm motility, sperm concentration, pH and presence of bacteria and these were significantly different among primary and secondary infertile couples.
Conclusion: Sperm abnormalities influence infertility among males of infertile couples. There is the urgent need to include male partners in the screening, detection and treatment of infertility among couples.

A general knowledge among youths is that alcohol enhances sexual desire and sexual performance. In contrast to this, studies have reported various adverse effects of alcohol on reproductive and sexual functions in both male and female. Male alcoholics frequently suffer from erectile dysfunction, intermittent delay in or absence of orgasm, and premature or delayed ejaculation. Alcohol is a toxin that can damage sperm-producing cells in the testicles, decrease testicular size, increase number of abnormally-shaped sperm and lower sperm count. Studies found that heavy alcohol consumption results in reduced testosterone and elevated estrogen levels in the blood and it can decrease the production, release and/or activity of luteinizing hormone and follicle-stimulating hormone. Female alcoholics have problems in producing enough natural lubrication for pain-free sex. Alcohol has a disruptive effect on menstrual cycle which can result in amenorrhea and anovulation. It affects estrogen and progesterone levels and also leads to hyperprolactinemia. It has been observed that when a man stops drinking alcohol, the negative effects on fertility and sexual abilities reverse quickly. Long term excessive intake of alcohol can lead to damage to the central nervous system and the peripheral nervous system resulting in loss of sexual desire and infertility in men and women.

Buruli ulcer (BU) is a tropical disease caused by Mycobacterium ulcerans (M. ulcerans) but with “unknown” means of transmission. In order to help reduce this disease, many preventive and treatment measures have been recommended and used in the past years around the globe. This aims to review BU disability problems, prevention and treatment procedures used in Ghana. The review was done by soliciting information from literatures, published articles, news reports and presentations on Buruli ulcer disability prevention and treatment in Ghana. BU disease results in disabilities such as contractures, amputation of the arms and legs, loss of eyes and eyelids and loss of nose among others. Antimicrobial therapies, prevention of deformities and surgical interventions have been the main treatment options for BU in Ghana. Prevention of disabilities caused by BU can be achieved by early detection, treatment of the disease supported by intensive health education programs within the prone areas and empowerment of patients through small-scale welfare grants.

Background: Spinal Schwannomas are benign nerve sheet tumors and the most common intradural extramedullary tumors of the spine, mainly occurring in the cervical and lumbar region.
Case Description: Here we illustrate the case of a 34-year-old woman with a paraspinal lesion presenting with severe lumbar pain. There were no focal sensory or motor deficits. Magnetic resonance imaging (MRI) disclosed a nodular lesion embedded in the paraspinal lumbar musculature, suspicious of tumorous growth. Complete surgical excision of the lesion was performed with clear margins and neuropathological analysis revealed a Schwannoma. Postoperative imaging confirmed a gross total resection with no recurrence after 6 months.
Conclusion: Although Schwannomas are frequently encountered in the lumbar spine, a location distinct from the spinal canal is very rare. To be adequately treated, it needs to be considered in the differential diagnosis of any spinal or paraspinal mass. As with other accessible and symptomatic lesions, the treatment of choice is complete excision with clean margins to avoid local recurrence.