Open Access Original Research Article

Adherence to Antihypertensive Medications in Type 2 Diabetes: Prevalence and Determinants

Y. P. M. Van Camp, B. Vrijens, I. Abraham, B. Van Rompaey, M. M. Elseviers

Journal of Advances in Medicine and Medical Research, Page 4627-4641
DOI: 10.9734/BJMMR/2014/10585

Aim: To estimate the extent of non-adherence to antihypertensive drugs in type 2 diabetes.
Study Design: Observational.
Place and Duration of Study: The study was conducted at three Belgian specialised diabetes centres during two months.
Methodology: Included were adult type 2 diabetes patients, treated with insulin and either ACE-inhibitors or sartans. Adherence was assessed electronically with the Medication Event Monitoring System. A standardised blood pressure measurement was taken at the study start and end.
Results: Mean age of the 130 included patients was 65 and 51% was male. Mean HbA1c was 7.5mg% (59mmol/mol), mean BMI 32kg/m2 and mean daily oral pill burden 8. Half of the patients showed perfect adherence and another fourth missed the prescribed dose on only 1 of 56 days. Mean baseline blood pressure was 143/77mmHg and 25% had controlled blood pressure (<130/<80mmHg). Higher hypertension knowledge was associated with adherence and higher daily doses of insulin with non-adherence. Adherence correlated positively to diastolic, but not systolic blood pressure. Of patients never missing a dose 78% reached controlled diastolic blood pressure compared to 68% of patients missing doses on ≥3 days.
Conclusion: Adherence to antihypertensive medications was high in this cohort followed up at specialised diabetes centres. Still, about 15-20% had suboptimal adherence and should receive adherence enhancing support, especially since high adherence seems necessary to obtain blood pressure control.

Open Access Original Research Article

Self-perception of Venous Symptoms and Quality of Life Analysis in Wheelchair Athletes and Non-athletes: A Pilot Study

Raquel Caroline Andrade Paiva, Eduardo José Rodrigues Garbeloti, Milton Faria Junior, Carolina Baraldi Araujo Restini

Journal of Advances in Medicine and Medical Research, Page 4642-4653
DOI: 10.9734/BJMMR/2014/10864

Aims: Evaluate the impact of the physical activity in individuals with muscular atrophy on the inferior members (wheelchair users) considering two main aspects: the quality of life and the self-perception of the venous return symptoms.
Place and Duration of Study: Data of handicapped non athletes were collected from a universitary physiotherapy clinic at the University of Ribeirão Preto, Ribeirão Preto, São Paulo, Brazil. Data of the athletes’ sample (basketball players) were obtained from Cava do Bosque, Ribeirão Preto, São Paulo, Brazil, between September 2013 and December 2013.
Methodology: This is a cross-sectional study, with a convenience sampling of wheelchair users: non athletes (n=12) and athletes (n=13). A socio-demographic questionnaire was applied. Self-perception of functional performance and of venous symptoms was evaluated by the VEINES-QOL/Sym, and the quality of life was evaluated by the WHOQOL-Bref. The statistical analysis was performed by the Chi-square test for VEINES-QOL/Sym, Student’s t-test for WHOQOL-Bref and Student’s t-test, proportion test and G-test for the socio-demographic questionnaire.
Results: Twenty-three subjects were men (92%). Data of physical conditions, environmental and psychological domains from WHOQOL-bref questionnaire demonstrated no significant differences between the groups. On the other hand, social relations domain had higher values in athletes compared to non athletes (P<.05). Results from VEINES-QOL/Sym questionnaire (the questions 1, 2, 3, 4(a, b, c), 5(b, c), 6, 7 and 8 showed no statistically significance between the groups. Analyzing the 4d (leisure activity) and 5a (time spent for daily activities) questions, higher values were observed for the athletes (P<.05).
Conclusion: Considering the data obtained by WHOQOL/Bref survey, physical exercise improves the quality of life of wheelchair individuals. However, it has not been possible to establish the relationship between physical exercise and the improvement of self-perception on venous symptoms in wheelchair individuals.

Open Access Original Research Article

Effect of Electron Beam Irradiation on Flexural Strength of Two Nanocomposites-an In vitro Study

Mithra N. Hegde, Shilpa S. Shetty, Nidarsh D. Hegde, Suchetha Kumari, Ganesh Sanjeev, Amit Patodiya

Journal of Advances in Medicine and Medical Research, Page 4654-4664
DOI: 10.9734/BJMMR/2014/10417

Aim: The aim of this study is to investigate whether dental nanocomposite Filtek Z350 XT and Ceram X-duo can benefit from electron beam irradiation in order to achieve increased flexural strength
Place and Duration of Study: Department of Conservative Dentistry and Endodontics,
A. B. Shetty Memorial Institute of Dental Sciences, Nitte University, Deralakatte, Mangalore, India and Microtron Centre; Department of Physics Mangalore University; Mangalore, India between May 2011 to March 2014.
Materials and Methods: Materials were prepared on rectangular bar shaped specimens of 25-×2-×2-mm according to ISO standard -4049. Electron beam irradiation dose selected for the study were 1KGy, 3KGy and 5KGy. In total, 48 specimens were fabricated and divided into 4 groups based on radiation dose group I (non-radiated), group II (1KGy), group III (3KGy), group IV (5KGy) with 12 specimens in each. After 24 hours, specimens were subjected to 3-point bend test on a universal uniaxial servo mechanical testing machine.
Statistical Analysis: Performed using one way ANOVA and inter group comparisons were done using tukeys multiple comparision. ‘P’ value<0.05 was considered statistically significant.
Results: Flexural strength of Filtex Z350 XT before radiation was170.89±9.07.Flexural strength of Filtex Z350 XT after irradiation with 1KGy, 3KGy and 5KGy was found to be 269.06±94.91, 326.53±54.74 and 377.64±74.5 respectively. P value statistically significant (P<0.0001). Flexural strength of Ceram X duo before radiation was120.14±7.12.Flexural strength of Ceram X duo after irradiation with 1KGy, 3KGy and 5KGy was found to be 206.27±76.38, 177.31±67.35 and 229.33±59.15 respectively. P value statistically significant (P<0.0001).
Conclusion: It can be concluded that electron beam irradiation can be used as a tool to modify the present day dental materials for enhancing their mechanical properties.

Open Access Original Research Article

Antidiabetic Activity of Hydroalcoholic Extracts of Nardostachys jatamansi in Alloxan-induced Diabetic Rats

M. A. Aleem, B. Syed Asad, Tasneem Mohammed, Riyaz Ahmed Khan, M. Farooq Ahmed, A. Anjum, M. Ibrahim

Journal of Advances in Medicine and Medical Research, Page 4665-4673
DOI: 10.9734/BJMMR/2014/11282

A review of literature indicates that diabetes mellitus was fairly well known and well conceived as an entity in India with complications like angiopathy, retinopathy, nephropathy, and causing neurological disorders. The antidiabetic study was carried out to estimate the anti hyperglycemic potential of Nardostachys Jatamansi rhizome’s hydro alcoholic extracts in alloxan induced diabetic rats over a period of two weeks. The hydroalcoholic extract HAE1 at a dose (500mg/kg) exhibited significant antihyperglycemic activity than extract HAE2 at a dose (500mg/kg) in diabetic rats. The hydroalcoholic extracts showed improvement in different parameters associated with diabetes, like body weight, lipid profile and biochemical parameters. Extracts also showed improvement in regeneration of β-cells of pancreas in diabetic rats. Histopathological studies strengthen the healing of pancreas by hydro alcoholic extracts (HAE1& HAE2) of Nardostachys Jatamansi, as a probable mechanism of their ant diabetic activity.

Open Access Original Research Article

Hepatitis B Virus Seropositivity among Schistosomiasis and Diabetes Mellitus Patients in Sana'a City, Yemen

Ebtesam M. Al-Zabedi, Mahmoud A. Ogaili, Mohamed T. Al-Maktari, Mohamed S. Noman

Journal of Advances in Medicine and Medical Research, Page 4674-4694
DOI: 10.9734/BJMMR/2014/11303

Hepatitis B virus (HBV) infection is a major public health problem worldwide, often coexisting with other illnesses like parasitic infections and other chronic diseases. Data on the association of HBV infection with schistosomiasis and diabetes mellitus (DM) is limited. This case-control study was conducted to investigate the seropositivity rate and potential risk factors of HBV, and to examine the association between HBV and schistosomiasis with or without super added DM.
Three hundred patients presented themselves to internal medical departments and diabetes centres at different public and private hospitals in Sana’a city, Yemen. Those recruited were then split in to six groups, those being type 1 DM, type 2 DM, schistosomal hepatic fibrosis (SHF), type 1 DM+SHF, type 2 DM+SHF and the control group. Overall, 20% (60/300) of the participants were positive when tested for hepatitis B core total antibody (HBcAb) by ELISA test. There were no significant differences in the positivity rate in terms of group, age or gender of the participants.
Univariate and multivariate analyses showed significant associations between HBV seropositivity and a history of jaundice, familial history of SHF, familial history of liver cirrhosis, personal history of schistosomiasisa and a history of using parenteral antischistosomal drugs. On the other hand, no significant association was reported between HBV seropositivity and any DM-related variables. It was also reported that no additional risk was added to the association between HBV seropositivity and SHF when the analysis stratified for DM.
In conclusion, HBV is still a highly prevalent infection and support is urgently needed in order to implement effective and integrated preventive measures among the people most likely to be affected. Further studies are required in order to investigate the epidemiology of HBV infection among various communities, and to evaluate its relationship with other diseases.

Open Access Original Research Article

Cymbopogon citratus Stapf (DC) Extract Ameliorates Atherogenic Cardiovascular Risk in Diabetes-Induced Dyslipidemia in Rats

Christopher E. Ekpenyong, Koofreh Davies, Ekaette Etim Antai

Journal of Advances in Medicine and Medical Research, Page 4695-4709
DOI: 10.9734/BJMMR/2014/11262

Aims: Diabetic dyslipidemia is a recognized risk factor for coronary heart disease (CHD). Plant medicinal agents such as Cymbopogon citratus (C. citratus) have shown potential as alternative therapies for reducing cardiovascular risk factors. The aim of this study was to investigate the effect of C. citratus leaf extract on the atherogenic index of plasma (AIP) in diabetic dyslipidemic rats (n=35).
Materials and Methods: A C. citratus extract was prepared by ethanol extraction of leaf material. Rats were divided into seven groups (n=5) as follows: (a) Normal diet control, (b) Hyperlipidemic diet (HLD) control, (c) HLD + 65mg/kg streptozotocin (STZ) control (d) HLD + STZ + 250mg/kg C. citratus extract (CCE), (e) HLD + STZ + 500mg/kg CCE, (f) HLD + STZ + 1000mg/kg CCE, and (g) HLD + STZ + 5mg/kg atorvastatin + 600µg/g glibenclamide. Animals were treated with HLD for 14 days and then injected intraperitoneally with 65mg/kg STZ. Confirmed diabetic dyslipidemic animals were treated intragastrically with CCE at doses of 250, 500, and 1000mg/kg, with 5mg/kg atorvastatin, and with 600µg/g glibenclamide for 30 days.
Results: The extract, which tested positive for tannins, saponins, alkaloids, flavonoids, etc. lowered fasting blood glucose and glycosylated hemoglobin levels, and dose-dependently decreased the serum levels of T-chol, LDL, VLDL, and β-HMG-CoA reductase, while simultaneously increasing HDL levels. The AIP was lowered in a dose-dependent manner by 33, 43.7, and 52.4% in groups treated with 250, 500, and 1000 mg/kg of CCE respectively.
Conclusion: The results indicate that the C. citratus extract had an ameliorative effect on hyperglycemia, hyperlipidemia, obesity, and atherogenic index of plasma.

Open Access Original Research Article

Study of Correlation of Pulmonary Function Test with the Markers of Oxidative Stress and Non-enzymatic Antioxidants in Chronic Obstructive Pulmonary Disease (COPD) Patients

Rupali S. Pawar, Subhodhini A. Abhang, P. Borale, Rahul Lokhande

Journal of Advances in Medicine and Medical Research, Page 4710-472
DOI: 10.9734/BJMMR/2014/10552

Aims: Chronic Obstructive Pulmonary Disease (COPD) represents a major health problem. Its prevalence is increasing worldwide. The aim of our study was to assess the relationship between markers of oxidative stress (malondialdehyde (MDA) and protein carbonyl) and the non-enzymatic antioxidants (vitamin E, vitamin C and reduced glutathione (GSH) with the marker of airflow obstruction (FEV1% predicted) in COPD patients.
Study Design: Case-control study.
Place and Duration of Study: Department of Biochemistry, B.J. Govt. Medical College and Sassoon General Hospital, Pune. [Maharashtra]. The study period was in between Feb 2012 to Aug 2013.
Methodology: Study comprised of 120 stable COPD patients of different stages were selected as per (GOLD) guidelines, each group consisting 30 patients, of age 40-75 yrs and 30 healthy controls. Pulmonary function test was done by using spirometer. Serum levels of MDA, protein carbonyl, vitamin E, vitamin C and GSH were estimated by spectrophotometric method. Statistical analysis was performed by using SPSS 17 software.
Results: Lung function tests namely FEV1/FVC% ratio and FEV1 % predicted showed significant reduction in stage I: (65.28±2.78; 90.23±11.36), stage II: (59.76±6.56; 63.13±7.85), stage III: (49.16±6.17; 39.76±6.34) and stage IV: (37.44±4.78; 22.43±5.55) COPD patients as compared to healthy controls (100.33±7.471;105.03±13.08 P<0.001) respectively. The level of serum MDA and protein carbonyl was increased significantly in [stage I: (6.23±0.81nmol/ml, 5.64±2.94nmol/mg) stage II: (7.94±1.26nmol/ml, 8.1±2.33 nmol/mg), stage III: (9.42±1.51nmol/ml, 9.66±3.12nmol/mgs) and stage IV: (11.53±1.23nmol/ml, 11.13±2.17nmol/mg] COPD patients as compared to controls (4.19±1.79nmol/ml, 3.50±1.87nmol /mg) respectively. Where as a significant concomitant decreased was observed in vitamin E, vitamin C and reduced glutathione in [stage I: (1.09±0.37mg/dl; 0.98±0.34mg/dl; 28.24±6.12mg/dl), stage II: (0.806±0.27mg/dl, 0.69±0.28mg/dl, 22.42±4.50mg/dl), stage III: (0.608±0.15mg/dl, 0.53±0.09mg/dl, 17.67±4.45mg/dl) and stage IV: (0.48±0.11mg/dl, 0.43± 0.10mg/dl, 13.73±2.76mg/dl) COPD patients as compared to controls (1.51±0.40mg/dl, 1.41±0.59 mg/dl, 34.26±4.96mg/dl) respectively. We found a significant negative correlation between the MDA and protein carbonyl with the FEV1% predicted and positive correlation between the vitamin C, vitamin E and GSH with the marker of airflow obstruction (FEV1% predicted) in COPD patients.
Conclusion: From this study we conclude that as the severity of disease increases FEV1% predicted decreases. These changes are associated with an increase in oxidative stress and a concomitant decrease in non-enzymatic antioxidants studied.

Open Access Original Research Article

Infectious-like Spread of an Agent Leading to Increased Medical Admissions and Deaths in Wigan (England), during 2011 and 2012

Rodney P. Jones

Journal of Advances in Medicine and Medical Research, Page 4723-4741
DOI: 10.9734/BJMMR/2014/10807

Aims: To demonstrate infectious-like spread of an agent leading to a period of higher death and medical admissions in the Wigan local authority, part of the greater Manchester area of England, during 2011 and 2012.
Study Design: Longitudinal study of deaths and hospital admissions.
Place and Duration of Study: Deaths (all-cause mortality) for the resident population of Wigan from January 2006 to February 2014. Patients admitted to the Wigan Infirmary, a large acute hospital on the outskirts of Manchester, England, between 2008 and 2013.
Methodology: Running twelve month totals for deaths and medical admissions were used to detect step-like increases in these factors. Additional analysis by age, length of stay and for clusters of persons living in over 40 small areas (called mid super output areas) containing approximately 5,000 population within Wigan and surrounds.
Results: A step-like increase in total deaths can be seen for all-cause mortality in Wigan commencing around February of 2012. Medical admissions to the hospital also show a step-like increase at this point. Deaths and medical admissions remain high for around 15 months before beginning to abate. Infectious-like spread of medical admissions can be observed within 40 small area population groups in Wigan during the period January 2011 to April 2012. Certain medical conditions appear to be affected earlier than others, and the pattern of increased admissions show evidence of saw-tooth behavior with age, which is indicative of ‘antigenic original sin’ and which has also been demonstrated for deaths in England and Wales during 2012.
Conclusion: The spread of a previously unidentified infectious agent is implicated in the synchronous increases in death (both in- and out-of-hospital) and in medical admissions (some of which result in death). This is not the first occurrence of an outbreak of this agent and urgent research is required to identify both the agent and clarify its mode of action which appears to be via immune modulation. The ubiquitous herpes virus, cytomegalovirus, which is known to have powerful immune modulating properties, may be involved.

Open Access Original Research Article

Dyslipidaemia in Hypertensives in South-South Nigeria

J. O. Idemudia

Journal of Advances in Medicine and Medical Research, Page 4742-4750
DOI: 10.9734/BJMMR/2014/10678

Background: There is a strong relationship between hypertension and dyslipidaemia, and both can increase the risk of developing coronary heart disease.
Methods: A total of One hundred and eighty (180) participants were recruited for this study; out of which, there was one hundred and fifty (150) hypertensive patients and thirty (30) control subjects that were age- and socio-economically matched with the hypertensive patients. Lipid profile test was carried out for them using standard laboratory techniques.
Results: Fifty-four percent (n=69) of the hypertensive patients were females; majority of the female hypertensive patients were within the age bracket of 50-59years (45.7%) while majority of the male hypertensive patients were within the age bracket of 40-49 years (53.6%). With the exception of HDL-cholesterol values which were comparable with the Normotensive controls, the hypertensive patients had significantly higher lipid profiles (triglyceride, total cholesterol and LDL-cholesterol). There was positive correlation between total cholesterol, triglycerides (0.399, p<0.05), LDL-cholesterol (r=0.609, p<0.05) and HDL-cholesterol (r=0.866, p<0.05) among the hypertensive patients, also, HDL-cholesterol positively correlated with LDL-cholesterol (r=0.218, p<0.05) but in the normotensive patients, LDL-cholesterol negatively correlated with triglyceride (r=-0.409, p<0.05) and positively correlated with total cholesterol (r=0.876, p<0.05).
Conclusion: Hypertensive Nigerians have significantly higher lipid profile except the HDL-cholesterol which is comparable in both hypertensive and Normotensive Nigerians. This shows that the dyslipidaemia in hypertensive Nigerians majorly involve plasma total cholesterol, triglyceride and LDL-cholesterol.

Open Access Review Article

Handwritten to Electronic Prescriptions: Emerging Views and Practices, Saudi Arabia

Naseem Akhtar Qureshi, Abdullah Mohammed Al-Bedah, Harold G. Koenig

Journal of Advances in Medicine and Medical Research, Page 4607-4626
DOI: 10.9734/BJMMR/2014/10962

Background: There has been little research on electronic prescribing (EP) in Middle Eastern countries. This is in part due to the slow implementation of electronic health records [EHR] integrated with EP. Electronic prescribing is associated with a considerable reduction in medication errors compared to handwritten prescriptions.
Objective: This paper reviews the relevant literature on handwritten and EP in the Kingdom of Saudi Arabia, as well as focusing on global issues including problems related to handwritten prescribing, the role of EP in mitigating these problems, the functions of the EHR system with EP, ways of implementing EP, and identifying potential barriers and challenges in the Middle Eastern region.
Search Strategy: Computer searches of PubMed and Google Scholar were conducted using the keywords “handwritten prescription,” “pen and pencil prescription,” “medication prescribing,” “medication errors,” “electronic prescribing,” and “electronic medical records.” These keywords were combined with ‘mechanisms’, ‘standards’, ‘advantages’, ‘disadvantages’, ‘challenges’, ‘plan’, and ‘opportunities’ with the objective of comprehensively retrieving the peer-reviewed articles published in English language journals on this subject. A total of 101 studies were included in this work. Methods: Two of the authors of this work retrieved and reviewed 101 papers that met our inclusion criteria. Any disagreements were resolved by a consensus of all three authors.
Results: There were more articles on handwritten prescriptions that involved illegible writing that resulted in medication errors than articles on EP due to a lack of research and slow implementation of EHR system in the Middle East. At global level, e-prescribing that was supported by well-defined standards and careful implementation was associated with a reduction in serious medication errors, morbidity, mortality, and service cost, as well as an increase in work flow efficiency, a higher quality of healthcare service delivery, and greater satisfaction of both healthcare providers and consumers. Electronic prescribing is now being practiced in many major medical centers and specialist hospitals not only in KSA but also in other countries of the region. However, there remains a need to implement EP systems in hospitals, primary care outpatient settings, and throughout the private health sector where it is missing.
Conclusion: It is time for the widespread adoption of EP, EHR, and health informatics systems across Middle Eastern countries including KSA, as well as for systematic research to evaluate their effectiveness.