Open Access Commentary

Insufficiency of Currently used Dental Indices in Epidemiology

Markku Larmas, Kauko K Mäkinen

Journal of Advances in Medicine and Medical Research, Page 2058-2064
DOI: 10.9734/BJMMR/2014/7139

The World Health Organization (WHO) classifies oral diseases in two different ways: officially dental caries (K02) and gingivitis as well periodontal diseases (K.05) are diseases in the digestive system. In epidemiological surveys the so-called DMF-index values (D= decayed or M= missing or F= filled tooth/surface) are used in determining past and present caries experience and the Community Periodontal Index (CPI) of WHO is used for the region around the teeth. Prevalence may be defined as the proportion of a population that has a disease at a specific point in time. In epidemiology, a subject-specific approach is the only accepted practice which means that a patient has one or multiple diseases, the rest of the population being healthy. A certain “cut-off” value normally differentiates the healthy subjects from diseased ones. In oral epidemiology the index values are used to determine the “seriousness” of the oral diseases. Calibrated dentists/examiners may be educated in recording dental caries and attachment loss exactly at a high level of precision but unless these scientific recordings are “diagnoses”, the observations represent disease detections and assessments only without providing any prevalence or incidence values of oral diseases. The reason for that is hidden in the fact that the tools for oral health determinations are different from those for the diagnosis of oral diseases by WHO.

Open Access Original Research Article

Evaluation of Oral Clonidine Premedication on Intraoperative Blood Loss and Bleeding Severity Score in Functional Endoscopic Sinus Surgery – A Prospective Placebo Controlled Study

Masrat Jan, Fayaz A. Reshi, Shiwalika Gupta, Shaugfta Aara, Iftikhar H. Wani, Basharat Saleem

Journal of Advances in Medicine and Medical Research, Page 1970-1979
DOI: 10.9734/BJMMR/2014/4168

Background: Bleeding during functional endoscopic sinus surgery (FESS) remains a challenge for both surgeons and anaesthesiologists despite several modalities available for improving the surgical field. This study was conducted to evaluate the effect of oral clonidine premedication on blood loss and the quality of the surgical field in FESS.
Methods: This prospective placebo controlled trial was performed on 120 patients (ASA I, ASA II). Patients undergoing endoscopic sinus surgery for chronic sinusitis and nasal polyposis were randomly allocated to receive either oral clonidine 0.005mg/kg or identical-looking placebo tablets 90 min before arrival at the operating room. During general anaesthesia, the hemodynamic endpoint of the anaesthetic management was maintenance of hypotension (Mean Arterial Presure) at ≤ 65 mmHg for producing a bloodless surgical field. The control of MAP was attained with inspired concentration increments of halothane up to maximum of 1.5 vol % as needed. Intraoperative bleeding was assessed on a six – point scale from 0 (= no bleeding) to 5 (= severe bleeding). Data were compared with chisquare test, fisher's exact test and Student t-test.
Results: There was less bleeding volume in the clonidine group (mean±SD) than in the placebo group (140.7±65.4 Vs 199.2±104.4, P<0.05). Frequency of bleeding severity scores 3 and 4 (troublesome with repeated suction) were lower in the clonidine group than in the placebo group (13.3 Vs 33.3%, P< 0.05). ). Accordingly, the surgeon was more satisfied with the surgical field in the clonidine group than with that in the placebo group.
Conclusion: In conclusion, premedication with oral clonidine can effectively reduce bleeding during endoscopic sinus surgery.

Open Access Original Research Article

Comparison of DNA Extraction Methods for Human Oral Microbiome Research

Jing Wu, I-Hsin Lin, Richard B. Hayes, Jiyoung Ahn

Journal of Advances in Medicine and Medical Research, Page 1980-1991
DOI: 10.9734/BJMMR/2014/5333

The oral micro biome is highly diverse and its composition is associated with oral disease and potentially diseases at other sites. Our objective is to evaluate DNA extraction methods potentially suitable for population-based investigations on the oral human microbiome and disease risk. Six commonly used microbial DNA extraction kits, employing either enzymatic methods or mechanical bead beating for cell lysis, were evaluated for the following aspects total DNA yield and quality and 16s rRNA DNA product and representation of microbial diversity. All analyses were carried out using a pooled and homogenized sample from one study subject. 16s rRNA gene sequence data were processed using the QIIME pipeline. One way ANOVA and Kruskal-Wallis tests were used to compare the different DNA extraction methods. We found that enzymatic extraction kits produced higher human genomic DNA, compared with mechanical extraction kits, however, phylogenic diversity in oral microbiome community structure from 16s rRNA gene sequence reads revealed no important differences between kit types. Enzymatic and mechanical bead beating kits provide alternative approaches for DNA extraction of oral microbiome DNA from oral wash samples. Greater total DNA yields are found in enzymatic approaches but microbial diversity can be similarly well characterized by either enzymatic or mechanical bead beating approaches.

Open Access Original Research Article

Length of Stay of Surgical Inpatients at University College Hospital, Ibadan, Nigeria

Olayinka Stephen Ilesanmi, Akinola Ayoola Fatiregun

Journal of Advances in Medicine and Medical Research, Page 1992-2001
DOI: 10.9734/BJMMR/2014/5944

Aims: This study was conducted to assess the Length of Stay (LOS) of surgical inpatients and compared factors associated.
Study Design: Retrospective review of records.
Place and Duration of Study: The study was carried out at the University College Hospital (UCH), Ibadan. Review of records of 404 inpatients who had surgery from January to December, 2010 was conducted.
Methodology: Information was collected on socio-demographic, LOS and other variables related to the surgical procedure with the aid of a semi-structured pro-forma. Cost of care was estimated using hospital billing documents. LOS was summarized using median with 25th-75th percentile. LOS was categorized into ≤ 7 and >7 days. Chi square test was used to compare factors associated with LOS. Level of statistical significance was set at 5%.
Results: The median age of patients was 30 years with inter-quartile range of 13-42 years. Males were 257(63.6%). Overall median LOS was 11 days with an inter-quartile range of 5-20 days. In all, 254(63%) stayed longer than 7 days. Longer stay was statistically significant in 141(75%) of patients who had emergency surgery (p<.001), 35(87.5%) Neurological Surgery (p=.01), 188 (66.9%) General anaesthesia (p=.02), and 64(81.0%) of those who had blood transfusion (p<.001).
Conclusion: Prolonged LOS was experienced by a high proportion of surgical inpatient at University College Hospital, Ibadan. Types of surgery, emergency surgery, higher American Society of Anaesthesiologists (ASA) grade and blood transfusion were the factors identified to have led to longer LOS. These factors are non-modifiable. There is therefore a need for a prospective research to identify modifiable and hospital related factors responsible for prolonged LOS of surgical inpatients.

Open Access Original Research Article

Health Professionals in the 21st Century: Results from an Inter Professional and Multi-institutional Global Health Competencies Survey (A Pilot Study)

Mirella Veras, Kevin Pottie, Raywat Deonandan, Vivian Welch, Tim Ramsay, Peter Tugwell

Journal of Advances in Medicine and Medical Research, Page 2002-2013
DOI: 10.9734/BJMMR/2014/7483

Introduction: In the new century, worldwide health professionals face new pressures for changes towards more cost-effective and sustainable health care for all populations. Globalization creates daunting challenges as well as new opportunities for institutions and health professionals being more connected and rethink their strategies toward an inter professional practice. Although Health professionals are paying increased attention to issues of global health, there are no current assessment tools appropriate for evaluating their competency in global health. This study aimed to assess global health competencies of family medicine residents, nursing, physiotherapy and occupational therapy students.
Methodology: A cross-sectional study was conducted in five universities across Ontario, Canada. The online survey drew from 429 participants, including students and residents between May to October 2011. The surveys were previously evaluated for face and content validity and reliability. Descriptive statistics and chi-square tests were used to evaluate the quantitative data. The level of significance was set at 5%.
Results: Self-reported knowledge and confidence in global health issues and global health skills were low for family medicine residents, nursing, physiotherapy and occupational therapy students. The percentage of residents and students who self-reported as confident was less than 60% for all global health issues.
Conclusion: This study also highlights a need for the development of interdisciplinary education in global health. The new century requires professionals competent in global health. Institutions must offer interprofessional approaches and a curriculum that exposes them to varied learning methods and opportunities to improve their knowledge and skills in global health.

Open Access Original Research Article

Applying Ethical Guidelines in Clinical Researches among Academic Medical Staff: An Experience from South Egypt

Ekram El Shabrawy, Tamer Hifnawy, Heba Reda

Journal of Advances in Medicine and Medical Research, Page 2014-2024
DOI: 10.9734/BJMMR/2014/7071

Background: There is an increased need to conduct medical research in developing countries. Meanwhile, research ethics is needed to achieve the balance between advancement in science and protection of human subjects’ rights.
Our aim was to assess the knowledge and attitude of researchers in the Faculty of Medicine, Beni Suef University, towards applying ethical guidelines in medical research.
Methodology: This was a descriptive analytical cross sectional study using a self-administered questionnaire.
Results: Around 90% of the study subjects reported previous exposure to bioethics. Only 57.7% of respondents agreed to participate in the study. More than two thirds (67.8%) of participating researchers explained possible risks & potential benefits of their research to the participants. Less than a quarter (22.3%) had published their articles in international publications and among them, only 31% were asked to submit ethical approval. Only 10% of researchers had submitted their research to the Research Ethical Committee (REC) for ethical review.
More than half of investigators did not agree on the role of REC in the protection of human subjects (58.5%).
Only 14.6% (19/130) and 14.7% (11/75) had an acceptable level of knowledge regarding the different codes of ethics and items of the consent form respectively.
Conclusion: The knowledge of our researchers about research ethics was remarkably low and more emphasis on research ethics training is urgently needed.

Open Access Original Research Article

Association between Perceived Social Support and Postpartum Depression in Turkey

Dilek Ozmen, Aynur Cakmakci Cetinkaya, Seval Cambaz Ulas, Erol Ozmen

Journal of Advances in Medicine and Medical Research, Page 2025-2036
DOI: 10.9734/BJMMR/2014/6109

Aims: The purpose of this study was to find out the association between perceived social support and postpartum depression.
Study Design: This study was a cross-sectional study.
Place and Duration of Study: The cross-sectional study was carried out in Manisa, a city in western part of Turkey.
Methodology: Two hundred eighty seven postpartum women were included in the study using stratified sampling from the records of 11 primary health care centers in Manisa city centre. Depression and social support were measured using, Edinburgh Postnatal Depression Scale and Multidimensional Scale of Perceived Social Support.
Results: It was found that the point prevalence of post partum depression (Edinburgh Postnatal Depression Scale total score >12) was 13.5%. Smoking, pregnancy number, social support from family and from a significant other predicted postpartum depression, but baby’s gender, family type, perceived family income, educational level, occupation, having a health insurance, antenatal care, unwanted pregnancy and social support from friends did not.
Conclusion: Postpartum depression is a public health problem in Turkey and social support from family and from a significant other is associated with postpartum depression. This finding highlights that there is a need to address this unmet need in planning interventions. But prevalence rate of postpartum depression and differential effects of risk factors on postpartum depression vary substantially among countries and regions, this should be taken into consideration when planning interventions for postpartum depression.

Open Access Original Research Article

Effect of Pentoxifylline on Experimental-dextran Sulphate Sodium-induced Colitis in Rats

Marwa A. Al-Gholam, Fouad K. Mansour, Nariman A. Abdel-Fattah, Hanaa Z. Nooh

Journal of Advances in Medicine and Medical Research, Page 2037-2057
DOI: 10.9734/BJMMR/2014/5108

Aims: Ulcerative colitis (UC) is considered as an idiopathic, chronic inflammatory bowel disease (IBD) with multifactorial agents. Tumor necrosis factor-alpha (TNF-α) has been suggested to be one of them. The study was designed to evaluate whether pentoxifylline (PTX), as TNF-α suppressor, has a beneficial effect in rats with dextran sulfate sodium (DSS) induced-colitis.
Study Design: Original research papers.
Place and Duration of Study: In both Anatomy Department, Faculty of Medicine, Menoufia University and Animal medicine & Infectious Diseases Department, Faculty of Veterinary Medicine Sadat City Branch , Menoufia University, Egypt , between April 2009 and August 2010.
Methodology: Fifty adult male rats were divided randomly and equally into: control group, model control group, colitis model group, PTX treated group and recovery group. Induction of colitis was made in colitis model by adding DSS to the drinking water; for three weeks (5% for one week followed by 3% of for two weeks). Rats in both PTX treated and model control groups received pentoxifylline for two weeks after the induction of colitis; by intraperitoneal injection (100 mg/kg/day; 1ml /rat). Colon mucosal inflammation and damage were assessed through; clinical, macroscopic, microscopic, morphometric and molecular assessments.
Results: Rats treated with oral administration of DSS for three weeks developed clinical and macroscopic signs of colitis. Treatment with PTX for two weeks, in the treated group or cessation of DSS for two weeks, in the recovery group relieved the colitis symptoms including: diarrhea, reduction in body weight, shortening and ulceration of the colon and extensive colonic damage. All of these were associated with a significant increase in TNF-α m RNA expression. However, an improvement was more significant among treated animals than that in the recovery one.
Conclusion: Pentoxyfylline seems to be an effective in the treatment of ulcerative colitis for further investigation. Also, the unclear dual role of mast cell in both induction and treatment of the disease should be considered in a further investigation.

Open Access Original Research Article

Prevalence of Obesity, Diabetes Type 2 and Hypertension among a Sampled Population from Sokoto Metropolis-Nigeria

H. Adamu, A. M. Makusidi, H. M. Liman, M. D. Isah, M. R. Jega, A. Chijioke

Journal of Advances in Medicine and Medical Research, Page 2065-2080
DOI: 10.9734/BJMMR/2014/7540

Aims: To determine the prevalence of obesity and its relationship with hypertension and diabetes among dwellers of Sokoto metropolis.
Study Design: A descriptive cross sectional study.
Place and Duration of Study: We conducted the study in March 2012, within Sokoto metropolis to mark the world kidney day.
Methodology: We enrolled 300 participants using a convenience sampling technique. An interviewer administered questionnaire was used to obtain the biodata and past medical history. Blood pressure and anthropometric parameters were measured while blood and urine samples were taken for RBS estimation and urine analysis respectively. We analyzed the data obtained using the Statistical Package for Social Sciences (SPSS) version 17.
Results: Out of the 300 participants that came for screening, two opted out, thus leaving 298 participants. There were 50.3% males and 49.7% females. Their mean age was 42±31 years. The BMI ranged between 14-48 kg/m2 with mean of 24.24 kg/2 ±5. Mean SBP and RBS were 130mmhg (±25) and 7.34±4 mmol-1 respectively. About 13.9% of the participants were found to be obese. Obesity was significantly associated with SBP (p<0.001) and RBS level (p=0.002).
Conclusion: Obesity is quite common in our environment and it contributes to the occurrence of hypertension and elevated blood sugar. Screening for obesity markers should be encouraged at every contact with healthcare provider. Physical activity for at least 30 minutes/day should be encouraged in order to reduce the risk of obesity, hypertension and diabetes mellitus.

Open Access Original Research Article

Genetic Polymorphisms of CYP2C8 in A Healthy Iranian Population

Ali Ramazani, Mahsa Ghaffari, Amir Fakhri

Journal of Advances in Medicine and Medical Research, Page 2081-2088
DOI: 10.9734/BJMMR/2014/7517

Aim: The aims of this study were to genotype CYP2C8 in an Iranian population and compare their allelic frequencies with other ethnic groups.
Study Site and Duration: Biotechnology Department, School of Pharmacy, Zanjan University of Medical Sciences, Zanjan, Iran from June 2012 through May 2013.
Methodology: CYP2C8 (*1/*2/*3) allelic variants were determined in 200 unrelated healthy Iranian volunteers by real time-polymerase chain reaction (PCR).
Results: A total 156 subjects (78%) were homozygous for CYP2C8*1, six subjects (3%) were homozygous for CYP2C8*2 and 38 subjects (19%) were heterozygous CYP2C8*1/*2. CYP2C8*3 was not detected.
Discussion and Conclusion: Genotyping indicated no significant (P>0.05) difference between CYP2C8 allelic variant frequencies in an Iranian compared with Burkina Faso population. The Iranian population’s CYP2C8allelic variation was significantly (P<0.05) different when compared with populations in Portugal, African-American race to Malaysia, Ghana, Zanzibar, Spain, Czech Republic and Sweden.

Open Access Original Research Article

Exercise-based Rehabilitation Improves Hemodynamic Responses after Lower Limb Arterial Blood Flow Surgery

E. Jakubseviciene, D. Vasiliauskas, R. Kubilius, L. Velicka, J. Vencloviene, E. Milinaviciene, L. Leimoniene

Journal of Advances in Medicine and Medical Research, Page 2089-2099
DOI: 10.9734/BJMMR/2014/7964

Aim: The aim of this study was to evaluate the effectiveness of exercise rehabilitation programmed (ERP) on hemodynamic responses and functional status in patients after lower limb bypass surgery.
Place and Duration of the Study: The study included 70 patients, who were treated in the Hospital Lithuanian University of Health Sciences between the period of May 2012 and June 2013.
Methodology: Forty seven patients were selected for this study. They were allocated to two groups. While the rehabilitation group (n=25, mean age: 68.6±1.6 years) completed ERP for six months, the control group (n=22, mean age: 68.8±2.4 years) did not have any supervised physical activity during this period. Patients were assessed at baseline and 6 months after intervention. Walking distances were evaluated by a 6-minute walking test (6 MWT), hemodynamic response was measured by ankle-brachial indices (ABI).
Results: As a result of ERP, a significant improvement was observed in the total distance walked in the rehabilitation group after 6 months (P=.01) compared to the control group. Also a significant progression was observed in pain-free walking (PFW) distance in the rehabilitation group (P=.02) compared to the control group after 6 months. Furthermore, ERP significant improved hemodynamic responses such as heart rate (P=.00), systolic (P=.008) and diastolic blood pressure (P=.007).
Conclusion: ERP is an effective therapy to significantly improve functional capacity and hemodynamic response in patients after lower limb bypass surgery.

Open Access Original Research Article

Normal Thickness of the Tendo Calcaneus (TCT) in an Adult Nigerian Population: An Imaging Based Normographic Study

Egwu, Ogugua A, Ogbonna Chukwudi O, Salami Elizabeth, Eni Ogbonnia E, Besong Elizabeth, Onwe, Curtis C.

Journal of Advances in Medicine and Medical Research, Page 2100-2111
DOI: 10.9734/BJMMR/2014/5678

The tendo calcaneus is a vital structure in the bipedalic system of human propulsion. Its thickness (TCT) was assessed in an apparently healthy young adult population of Southeast Nigeria using ultrasound. The relationship between TCT and other anthropometric parameters was also evaluated. 120 young adults with age ranging between 19 and 30 years volunteered for the study and their TCT was assessed using B-mode ultrasound. Height, weight, foot length and midcalf circumference were measured while Body Mass Index (BMI) and Body Surface Area (BSA) were calculated for the sample population. Results show that the mean values of TCT were 6.26±0.56mm and 6.32±0.58mm for the right and left sides respectively. TCT correlated positively with all the anthropometric variables assessed except age and BMI. TCT also showed significant sexual dimorphism (P=0.000), laterality and bilateral asymmetry with the left being thicker (P=0.000). These findings will further emphasize the biomechanical relationships of the large tendon. The study is the first to report lateralization and significant sexual dimorphism in a young adult population.

Open Access Original Research Article

The Analgesic and Adverse Effects of Intrathecal Opioids for Cesarean Section: 11 Years’ Experience in 10,061 Cases

MD. Sasikaan Nimmaanrat, MMed. Frcat, RN. Qistina YunusWanjsa

Journal of Advances in Medicine and Medical Research, Page 2112-2118
DOI: 10.9734/BJMMR/2014/5316

Purposes: To evaluate analgesic effect and adverse effects of intrathecal morphine and fentanyl in parturients undergoing cesarean section.
Methods: This is a retrospective, descriptive study from anesthetic and recovery room records from January 2001 to August 2011.
Results: From this 11-year retrospective, descriptive analysis in 10,061 patients undergoing cesarean section who received intrathecal opioids, it had been found that their pain scores both at rest and with movement were mild and moderate, respectively. Nausea / vomiting and pruritus were common complications but no patient experienced respiratory depression.
Conclusions: Intrathecal morphine is effective for controlling postcesarean pain with minor adverse effects.

Open Access Review Article

Uncommon Sites for Body Stuffing: A Literature Review

R. Philip, D. Aidayanti

Journal of Advances in Medicine and Medical Research, Page 1943-1949
DOI: 10.9734/BJMMR/2014/7683

Introduction: ‘‘Body stuffing’ refers to concealment of illegal drugs within the human body to avoid arrest. Emergency physicians and law enforcement authorities should be aware of uncommon sites of concealment used to avoid detection.
Methods: A literature search of Medline (Pubmed), Science Direct and the Cochrane databases was done, for articles relating to body packing or body stuffing of illegal drugs and sites of concealment.
Results: A total of 55 full text articles and one abstract were reviewed after removing duplicates and non relevant titles. Seventeen articles were included in the results. Cocaine was the most common drug. Body stuffing is more common among males in the 3rd to 4th decade of life. The majority of cases, 99% (1144 cases), involved concealment in the oral cavity or ingestion. Unusual sites for body stuffing reported were the external auditory canal (5 cases), the rectum (3 cases), the superior oropharynx and glans penis (one case each). Complications reported are fatal toxicity, aspiration and oesophageal obstruction.
Conclusion: Although uncommon, ear, nose and throat orifices have been used in body stuffing. Authorities and attending physicians should be aware that these orifices can be used to conceal drugs and proceed to a full otorhinolaryngologic examination if warranted.

Open Access Review Article

Immune Responses and Vaccine Development for Cytomegalovirus Infections

Masha Fridkis-Hareli

Journal of Advances in Medicine and Medical Research, Page 1950-1969
DOI: 10.9734/BJMMR/2014/8128

Aims: (1) To review the published literature on immune biology of host-Cytomegavovirus (CMV) interactions and to discuss the host immune responses against viral infection, providing insights into the complex interplay between the host and the virus that facilitates viral persistence. (2) To report on the status of CMV vaccines that are currently in preclinical and clinical development, outlining important questions about the nature of protective immune responses that will be required of potential CMV immunization strategies.
Methodology: A Pub Med search of original articles and reviews in English language only between the years 1974-2013 was conducted using “CMV infection”, “CMV vaccines”, “CMV immune responses” and “CMV clinical trials” as keywords. Inclusion criteria were a description of the CMV disease in immune compromised patients and in individuals affected by the virus through congenital transmission, clinical observations in the course of CMV infection, the overview of the host immune responses and CMV factors in the outcome of CMV infection, the current status of therapeutic strategies and vaccine development.
Results: CMV is found throughout the world in all geographic and socioeconomic groups, but, in general, it is more widespread in developing countries and in areas of lower socioeconomic conditions. CMV still remains a major human pathogen causing significant morbidity and mortality in immune suppressed or immune compromised individuals. Between 50% and 80% of adults in the United States are infected with CMV by 40 years of age. CMV is the most common congenitally transmitted virus, resulting in approximately 1 in 150 children born with congenital CMV infection, and in about 1 in 750 children developing permanent disabilities due to CMV. Thus, development of vaccines against CMV infections has been a major biomedical research priority.
Conclusion: There is a need for an effective CMV vaccine that will protect immune compromised transplant patients as well as newborns, although the key requirements for protection of these two populations (and the optimal vaccine strategy to provide this protection) may differ. To date, only the Towne vaccine – a live, attenuated CMV vaccine – has undergone efficacy evaluation. Application of molecular biological techniques, coupled with an improved understanding of the CMV genome, should allow design of safer, more immunogenic, live, attenuated vaccines.