Open Access Case Study

Not to be Missed Entity: Dieulafoy's Lesion!

Parag Deepak Dabir, Jens Johannes Christiansen

Journal of Advances in Medicine and Medical Research, Page 5509-5512
DOI: 10.9734/BJMMR/2014/11356

Clinically missed Dieulafoy's lesion is a significant cause of gastro-intestinal bleeding with a poor prognosis. We hereby compare an autopsy case of a similar nature; thereby highlighting the importance of autopsy. 69 years old male living in a retirement home was being managed for anemia. He was admitted with a preliminary diagnosis of septicemia with deteriorating renal function. He was found dead and referred for autopsy to our institute. At autopsy, 3 small defects at the gastroesophageal junction measuring about 5-7 mm were seen, which on microscopy revealed a relatively large artery at the submocosal level with rupture. There was about 2 liters of blood in the stomach. This was a Dieulafoy's lesion, the cause of sudden massive gastrointestinal bleeding and subsequent shock. This signifies that autopsy still holds its value in this modern era of diagnostics.

Open Access Case Study

A Case of Chronic Cough with Progressive Breathlessness in a 32 Year-old Male Health Worker – Tuberculosis?, Allergic Bronchitis?, Asthma?

Gauri Billa, Karan Thakkar

Journal of Advances in Medicine and Medical Research, Page 5513-5518
DOI: 10.9734/BJMMR/2014/11883

Introduction: Although tuberculosis is hyper-endemic in India and is responsible for a huge proportion of respiratory morbidity, adequate workup should be conducted to rule out other differential diagnosis wherever applicable.
Case Report: A 32 year old male health worker was suffering from productive cough and gradually increasing breathlessness since three months. The investigations conducted were a sputum analysis and a chest x-ray, both of which were normal and hence he was treated as a case of allergic bronchitis. Subject presented to us after three months with no relief. We further investigated him and found severe eosinophilia in the peripheral blood, a positive anti-filarial antibody and a negative triple stool test for ova and parasites. He was treated with diethylcarbamazine and albendazole+ivermectin combination. The patient responded well and had no complaints at the end of the 4 week treatment.
Discussion and Conclusion: The subject should have been evaluated by conducting a basic investigation like a complete blood count. Delay in treatment of cases of tropical pulmonary eosinophilia can lead to permanent respiratory morbidity.

Open Access Case Study

Cardiac Arrest Following Inadvertent Intravenous Administration of an Oral Antiacid: Hydrotalcite

Süleyman Ersoy, Fevzi Yilmaz, Bedriye Müge Sönmez, Murat Ongar, Miray Özlem, Ebru Can

Journal of Advances in Medicine and Medical Research, Page 5519-5523
DOI: 10.9734/BJMMR/2014/12509

Emergency department overcrowding combined with shortage of experienced and knowledgeable healthcare staff may lead to fatal, albeit rare, malpractice cases in developing countries. We report herein a patient with cardiac arrest as a result of inadvertent intravenous injection of hydrotalcite, an orally administered anti-acid medication. Our literature search revealed no previous cases of cardiac arrest as a result of intravenous (IV) administration of hydrotalcite.

Open Access Case Study

Bloody Nipple Discharge in Infants: Case Series

E. Scurati-Manzoni, D. Campra, R. Guarino, G. Ballardini, L. Boscardini, A. Guala

Journal of Advances in Medicine and Medical Research, Page 5612-5619
DOI: 10.9734/BJMMR/2014/12333

Bloody nipple discharge very rarely occurs in infants and often is associated with benign mammary duct ectasia.
Just because it is a rare symptom and frequently associated with adults’ mammary cancer, it is inadequately managed: inappropriate diagnostic tools are used, consequently inappropriate treatments are given.
We here describe four cases of bloody nipple discharge, which resolved spontaneously within a few weeks of diagnosis and we present a review of the literature.
In conclusion, a “wait and see” approach is enough and avoids unnecessary invasive diagnostic procedures.

Open Access Case Study

Inflammatory Bowel Disease, a Rare or Under Diagnosed Disease in Nigeria

Mobolaji Oludara, Rachael Akinola, Abiodun Popoola, Samira Makanjuola

Journal of Advances in Medicine and Medical Research, Page 5620-5628
DOI: 10.9734/BJMMR/2014/10863

Six Nigerians, consisting of 5 females and 1 male with confirmed inflammatory bowel disease (IBD) were recruited from a tertiary institution and two private hospitals in Lagos into this study from January 2001 to January 2014. Their ages at the time of first visit ranged from 27 to 65 years. They all had repeated bouts of bloody mucoid stools and abdominal pain plus or minus tenesmus requiring admission and fluid replacement. One of the cases even showed a total reversal of barium enema findings after the follow up treatment of oral sulphasalazine and prednisolone given. The four females and the male have remained relatively symptom free up to the time of their last visit in the follow up clinic, while one of the females was lost to follow up.
This is a prospective case series that highlights the need for a high index of suspicion to make a diagnosis of inflammatory bowel disease in an environment where the reported incidence is low. Its diagnosis requires a team approach between the gastroenterological surgeon, radiologist, gastroenterologist Physician and a sub-specialized pathologist.

Open Access Case Study

A Case of Perianal Abscess Due to Prostatic Abscess

Mustafa Sit, Uğur Uyeturk, Eray Kemahli, Ozgur Ikiz, Ertugrul Kargi

Journal of Advances in Medicine and Medical Research, Page 5629-5634
DOI: 10.9734/BJMMR/2014/12475

Abscess, is a condition that often occurs in the anorectal region. Anorectal abscesses are more frequently seen in men than women (2:1 or 3:1) and often seen in 3th-5th decades. Prostatic abscess, which is a rare condition today, has been thought that originated from prostatitis. A 50 year old male patient, was admitted to our urology clinic with the complaints of urinary frequency and dysuria for last two months. There is no prominent feature other than diabetes in the patient's history and asymmetric growth found on the left lobe in rectal examination of the prostate. The patients presenting with clinically anorectal abscess should be assessed properly with history, physical examination, laboratory, and imaging findings and also rarely underlying causes of inflammation of adjacent organs such as the prostate abscess should be kept in mind.

Open Access Case Study

A Case of Drastic Improvement in a 43 Year Old Male with Severe Refractory Incapacitating Vertigo

Gauri Billa, Karan Thakkar

Journal of Advances in Medicine and Medical Research, Page 5635-5641
DOI: 10.9734/BJMMR/2014/12550

Introduction: Vertigo is a common and distressing complaint seen in primary care. It can be due to central or peripheral causes, which should be determined right at the outset. In some cases, the vertigo is transient and easily manageable while in others it can be more troublesome and difficult to treat.
Case: A 43 year old male presented with episodes of severe vertigo and vomiting progressively increasing since six months. Despite multiple consultations, complete work up and treatment with the standard therapy for suppressing vertigo, his symptoms persisted. On history and examination, it seemed to be a case of Ménière’s Disease and we started him on specific therapy. The patient showed marked improvement within a week and continued to do so at the end of three months despite stopping all treatment.
Conclusion: Identification of the cause of vertigo, multidisciplinary management and specific treatment, rather than just vestibular suppressants, are paramount in managing a case of vertigo.

Open Access Minireview Article

History of Medical Laboratory Diagnostics in Poland

Katarzyna Klimasz, Przemysław Tomasik

Journal of Advances in Medicine and Medical Research, Page 5541-5547
DOI: 10.9734/BJMMR/2014/12514

Background: Medical laboratory diagnostics in Poland has a long history, however there is lack of studies in this field.
Main Findings: The first clinical laboratories on ethnic Polish territory were founded in the mid. 19th Century. After the World War I, rapid development of laboratories in Poland, similar to pan-European trends, occurred.
During the World War II many laboratory professionals were killed and laboratory infrastructures were destroyed or severely damaged. In the post-WW II period, during the communist era, the development of laboratory diagnostics in Poland was not significant due to the lack of access to the latest western technologies. However, some unique solutions to some problems were developed. For example, special M.Sc. studies for laboratory staff were introduced. Towards the end of the 20th Century, in the post-communist era, significant development of private laboratories was observed with subsequent integration into several companies. In Poland, laboratory diagnostician is a profession of public trust and over 14,000 professionals are registered in The Polish Chamber of Laboratory Diagnosticians.
Conclusions: The history of medical laboratories in Poland reflects the development of this key element of healthcare. The recent history has several unique and valuable solutions as teaching laboratory staff in specific medical colleges and organizing them in associations of professionals.

Open Access Minireview Article

Public Health Informatics: A Brief Review of the Field

Maria E. Compton, David M. Compton

Journal of Advances in Medicine and Medical Research, Page 5558-5567
DOI: 10.9734/BJMMR/2014/12063

In the global community of today, the importance of accessing timely and relevant information has increased in value. However, with the exponential increase in data and data sources, innovations to monitor, control, and effectively manipulate data are required, especially to resolve current mysteries. In addition, with the sophistication of informatics systems, consumers are becoming curious to learn about the technology for their own benefit. In learning information technology, tools become available that gives the consumers ideas and knowledge in conducting research about their health and other health information data. For clinicians it is highly useful to become knowledgeable about health information system as well as larger public health issues. PHI is highly utilized in many global health organizations, government agencies, and medical organizations across the United States as well as in the world.

Open Access Original Research Article

Urinary Abnormalities in Asymptomatic Children of Ho Chi Minh City: A Population-Based Study

Le Nhu Nguyet Dang, Thi Le Binh Doan, Thi Kim Anh Pham, Thi Hong Phan, Mong Hiep Tran Thi, Françoise Janssen, Annie Robert

Journal of Advances in Medicine and Medical Research, Page 5451-5461
DOI: 10.9734/BJMMR/2014/11975

Aims: To estimate the prevalence of urinary abnormalities in asymptomatic children aged 3 to 5 and to estimate the prevalence of urological anomalies detected by renal ultrasound among children with abnormal urine findings in an urban district of Ho Chi Minh City.
Study Design: cross-sectional population-based study.
Place and Duration of Study: Twelve kindergartens in Binh Thanh district, Ho Chi Minh City, Vietnam from March to June 2012.
Methodology: There were 11,093 children aged 3 to 5 attending 25 public and 17 private kindergartens including 2,657 in wealthy wards and 8,436 in non-wealthy wards. A total sample size of 2,402 children was required. Using a probability proportional-to size method, 8 kindergartens in public area and 4 kindergartens in private area were randomly selected. Overall, 2,433 children were enrolled including 1,244 boys. The children were screened by dipstick. Those with abnormal results were confirmed by a second dipstick. Children with two positive dipsticks were retested 3 months later and underwent renal ultrasound for urological anomalies.
Results: Abnormalities were detected in 7.8% of the subjects. Prevalence of proteinuria, hematuria, nitrituria, leucocyturia, and combined nitrituria and leucocyturia were 0%, 0.3%, 0%, 5.6%, and 0.2%, respectively. Girls had more abnormal results than boys (14.1% vs 1.8%, p<0.001). After a three-month period, the number of children with persistent abnormalities was 37. The renal ultrasound detected 5 (13.5%) hydronephrosis cases. No significant difference was found when comparing public to private kindergartens and wealthy to non-wealthy region.
Conclusion: In such a region with high population density, the high prevalence of nitrituria and/or leucocyturia in girls calls for a good education for parents and caregivers in order to prevent urinary tract infection, and the low prevalence of proteinuria and hematuria suggests that the appropriate age for urinary screening in Vietnam might be over 6 years.

Open Access Original Research Article

The Attitudes to Ageing and the Influence of Social Support on It

Abdul Rashid, M. Azizah, S. Rohana

Journal of Advances in Medicine and Medical Research, Page 5462-5473
DOI: 10.9734/BJMMR/2014/10023

Because no study has been conducted on the attitude to ageing among the community dwelling elderly in Malaysia, the objective of this study was to determine the attitudes to ageing among the elderly and the influence of social support on it. This cross sectional study was conducted among randomly sampled 2005 elderly in Penang, Malaysia. Attitude to Ageing Questionnaire (AAQ) and the Oslo-3 Social Support Scale (OSS-3) was used. Majority considered those in the age group 60-69 and health status, appearance and level of fitness as the criteria to consider some one aged. The attitude to ageing score ranged from 39 to 109 with a mean score of 78.9. The mean score for the psychosocial gain, physical change and psychological growth domains were 27.2, 24.6 and 27.2 respectively. The differences in the mean scores among the age groups, races, marital status, level of education, employment status, socially active, mobility and living arrangement was statistically significant. As the social support category increased from poor to strong the mean scores also significantly increased. After controlling for all other demographic factors, strong social support was significantly associated with increased AAQ score. The total AAQ score and the score of all the three domains was above average suggesting a positive attitude to ageing and social support is a significant predictor for the AAQ score. Change in the family dynamics in Malaysia may have a negative influence on the attitudes to ageing among the elderly in the future.

Open Access Original Research Article

Chest Radiographic Patterns of Smear Positive Tuberculosis in Relation to HIV: A Cross-Sectional Study in a Population with a High Burden of HIV and Tuberculosis

Assefa Getachew, Jonna Idh, Samuel G/Sillasie, Thomas Schön

Journal of Advances in Medicine and Medical Research, Page 5474-5483
DOI: 10.9734/BJMMR/2014/7308

Aim: The purpose of this study was to investigate the chest radiographic patterns of smear positive pulmonary tuberculosis patients in relation to HIV co-infection.
Study Deign: Cross-sectional descriptive study
Place and Duration of the Study: The study was conducted at Gondar University hospital between May 2004–December 2007.
Methodology: We studied chest radiographs of 207 (128 HIV negative and 79 HIV positive) consecutive sputum smear positive pulmonary tuberculosis patients according to the standard classification. Mean and percentages/ proportions were used for descriptive analysis. Chi square test was used to measure association.
Results: The prevalence of HIV in patients with smear positive pulmonary tuberculosis was 38.2%. The most common chest radiographic patterns were fibronodular (83.1%), cavity (60.4%), lobar consolidation (49.8%), and brochopnemonic consolidation (9.2%). Lymphadenopthy and pleural effusion were more common in HIV co infected patients (p<0.01). Cavities, upper lobe disease and increased mean number of lung lobes involved were more prominent in HIV negative patients (P<0.05). Despite a higher rate of patients with far advanced CXR patterns in HIV negative TBC patients compared to HIV positive (p<0.026), there was no significant difference in the radiographic, sputum smear conversion or clinical response in terms of increased body mass index after 8 weeks of anti TBC treatment between HIV negative and HIV positive patients.
Conclusion: Post primary pulmonary tuberculosis was the commonest chest radiographic pattern at presentation in both HIV positive and HIV negative patients, but atypical chest radiographic presentations were associated with co-infection. It was more common for HIV negative tuberculosis patients to have a radiologically far advanced pattern which did not correspond to the clinical and radiological response. This may prompt a need for revision of the current radiological classification.

Open Access Original Research Article

Treatment for Gynaecomastia in Men. Experience with the Inferior Periareolar Incision in a Single Third Level Medical Facility

Álvaro Montiel-Jarquín, Ángel Espitia-Ayala, Mario García-Carrasco, Claudia Mendoza-Pinto, Rodolfo G. Barragán-Hervella, Arturo Árcega-Domínguez, Arturo García-Galicia, Eugenio García-Cano

Journal of Advances in Medicine and Medical Research, Page 5484-5493
DOI: 10.9734/BJMMR/2014/11251

Background: Gynaecomastia is defined as an enlargement of the mammary gland in men.
Objective: To evaluate Aesthetic Results of Subdermal Mastectomy by means of Inferior Periareolar Incision.
Materials and Methods: Descriptive, cross sectional and prospective study. We evaluate aesthetic results of Subdermal Mastectomy by means of Inferior Periareolar Incision using Analog visual Scale applied by an another Surgeon) and a Questionnaire (Auto Evaluation). Variables: Age, Clinical Symptoms, Evolution time, Complications and Aesthetic Results. Descriptive and Inferencial Statistic was used (Wilcoxon test).
Results: Twelve patients, median age 27.5 (18-58) year-old. Nine (75%) patients presented pain, 4 (33.3%) bilateral gynaecomastia, 4 (33.3%) left and 4 (33.3%) right sided gynaecomastia. According to Simon Classification, 3 (25%) patients grade I; 2 (16.6%) IIa; 2 (16.6%) IIb and 5 (41.6%) III. No patient presented concomitant disease, 12 (100%) had normal secondary sexual characteristics. Six (50%) had hyperesthesia. The Aesthetic Evaluation made by a distinct Surgeon was as it follows, 10 (83.3%) had a ≤ 6 punctuation and 2 (16.6%) had ≥ seven (0 - 10, Analogue Visual Scale). Ranks for Aesthetic Aspect Evaluation made by the patients, before and after surgery were 2.54 (average after surgery) and 0.00 (average before surgery), Z -1.857, p=0.0063 (p<0.05, Wilcoxon).
Conclusion: Subdermal Mastectomy should be in lower case by Inferior Periareolar Incision, it does not present severe complications however aesthetic results are undesirable.

Open Access Original Research Article

Phyllantus amarus (Schum. and Thonn): An Antiplasmodial Plant

R. N. Nwaoguikpe, C. O. Ujowundu, W. Braide, J. Obi

Journal of Advances in Medicine and Medical Research, Page 5494-5508
DOI: 10.9734/BJMMR/2014/7463

The incidence of malaria infestation has assumed epidemic status and treatment procedures have failed to yield required results due to resistance of most Plasmodial species to conventional antimalarial drugs especially in sub-Saharan Africa. Phyllantus amarus (Schum and Thonn) was screened for in vivo antiplasmodial activity in albino mice. Ethanol and aqueous extracts (ETOHE and AE) were used for the assays. Phytochemical screening of the ethanol and aqueous extracts of the aerial parts of the plant was carried out to ascertain the secondary metabolites present. Chloroquine resistant Plasmodium berghei (NK65) was injected into the mice by passaging. Forty-eight hours after inducing malaria infestation, the plant extracts were administered intraperitoneally for 4 days at a dose of 10mg/kg,same with the reference antimalarials. It was observed that the ethanol extract (ETOHE) showed the highest antiplasmodial activity comparable to that of Artemether (Group C) treated mice. There was no significant difference in antimalaria activity between the Artemether treated (Group C) and the ethanol treated (Group A) mice at p=0.01. The antiplasmodial activities of the extracts may be attributed to the presence of phytochemicals/secondary metabolites present in the aerial parts of the plant which include: alkaloids, saponins, flavonods and other secondary metabolites. The plant extracts were equally screened for their mineral contents, some of which were found to be abundant, such as Ca, Fe, Mn, K, Na, Cu and Zn. The plant extracts can be used for the treatment of malaria infestation as well the supplementation of mineral nutrients in health and disease.

Open Access Original Research Article

Home Management of Diarrhoea by Caregivers Presenting at the Diarrhoea Training Unit of a Tertiary Hospital in Southern Nigeria

Boma A. N. Okoh, Balafama A. Alex–Hart

Journal of Advances in Medicine and Medical Research, Page 5524-5540
DOI: 10.9734/BJMMR/2014/11340

Background: Diarrhoea is a leading cause of under – five morbidity and mortality. Diarrhoea deaths can be prevented by adequate case management of diarrhoeal episodes in children. With majority of cases being treated initially or completely in the home and community, the level of awareness of diarrhoea and simple home management practices among caregivers are key determining factors to reducing diarrhoea morbidity and mortality in children.
Aim: To determine caregivers’ perception, knowledge and practice of home management of diarrhoea of children under five years of age presenting to the Diarrhoea Training Unit of a tertiary hospital in Southern Nigeria.
Study Design: A clinic – based descriptive cross sectional study.
Place and Duration of Study: The study was carried out in the Diarrhoea Training Unit of the University of Port Harcourt Teaching Hospital, Rivers State, Nigeria from July to December 2013.
Methodology: A structured pre–tested questionnaire was used to collect data from caregivers on demographic characteristics, knowledge and practice of diarrhoea home treatment. There were 8 knowledge and 10 practice questions; each was scored a point if correctly answered. The caregivers were grouped into those having good, moderate and poor knowledge or practice according to scores obtained.
Results: Of the 157 caregivers, 29.3% had a good level of knowledge, while 33.8% had good level of practice of the home management of diarrhoea. A higher knowledge score was significantly associated with the Social class (P=.002) and mother’s educational level (P=.002). A higher practice score was also significantly associated with the Social class (P<.001) and mother’s educational level (P<.001). After adjusting for other factors, mother’s educational level was significantly associated with both level of knowledge (P=0.022) and practice (P=0.012) of the home management of diarrhea.
Conclusion: The study has shown a low level of knowledge and practice among the caregivers as regarding the home management of diarrhoea. A higher level of education in mothers was significantly associated with a higher level of knowledge and practice.

Open Access Original Research Article

Practices, Scope and Determinants of School Health Services in Osun State, Nigeria

O. L. Abodunrin, O. A. Adeoye, A. A. Adeomi, F. F. Osundina, O. R. Ilori

Journal of Advances in Medicine and Medical Research, Page 5548-5557
DOI: 10.9734/BJMMR/2014/11931

Introduction: A healthful school environment is that which embraces the health and safety of learners and other members of the school community. Undergoing pre-school medical examination (PSME) is not only necessary to screen for previously undiagnosed health conditions and subsequent recognition of those with special care but it is also imperative to have base-line health information about the pupils. This study seeks to elucidate the practices and determinants of school health services (SHS) in Osun state.
Methodology: In the cross-sectional descriptive study, a total of 229 heads of schools (102 primary and 127 secondary) in Osun state were interviewed using a self-administered questionnaire. Data were analyzed with SPSS version 16. Level of significance was set at p-value of 0.05.
Results: All the respondents were aware of SHS with 114(50.7%) having good knowledge. Although up to 209 (91.3%) are aware of PSME and 188 (83.6) agreed that it was necessary, only 46 (20.1%) have their pupils undergo PSME. Most schools (76.8%) provide toilet facilities mainly of the pit type. Overall knowledge of SHS was good in 114 (50.7%) of the respondents. Medical services are provided through First Aid box 221(96.5%) and School clinic 43(19.5%) most (92.7%) of which are free. Overall practice of SHS was good in 42 (18.7%) of the respondents. Respondents from secondary and private schools had better knowledge and practice of SHS.
Conclusion: The practice of SHS is below expectation. There is a need to improve knowledge of heads of schools concerning SHS emphasizing the importance of SHS.

Open Access Original Research Article

Effect of an Empowerment Educational Program on Quality of Life of Patients with Asthma

Asra Nassehi, Hossein Rafiei, Mojtaba Jafari, Majid Dastras, Jamileh Mahdavinia

Journal of Advances in Medicine and Medical Research, Page 5568-5576
DOI: 10.9734/BJMMR/2014/12621

Aim: One of the main goals of caring of asthmatics patients is QOL improvement. The present study was conducted to examine the effect of empowerment education on QoL in patients’ whit asthma.
Methods: In this quasi experimental study, we examined 70 patients with asthma who had referred to Be'sat clinic in Kerman in Southeast of Iran. Patients randomly were assigned in intervention or control groups. Based on empowerment education model patients were trained for four two-hour sessions in the experimental group, while the control group did not receive any training. QoL in patients before and eight weeks after the intervention was measured using Asthma Quality of Life Questionnaire (AQLQ).
Results: The mean overall AQLQ score was 32.85±12.31 and 37.40±15.6 in intervention and the control groups before training respectively. This difference was not statistically significant (P>0.05). After training program, the mean score of QoL in the intervention group decreased to 20.37±10.18 and in the control group it was increased to 37.37±15.38. This difference was statistically significant (p<0.05).
Conclusions: Results of present study showed that empowerment education program will considerably improve the QoL of patients with asthma.

Open Access Original Research Article

Treatment Delay Attitude of Caregivers in Management of Childhood Malaria in Rural Communities in Nigeria

Emmanuel N. Ezedinachi, Friday A. Odey, Ekpereonne B. Esu, Olabisi A. Oduwole, Nuria S. Nwachuku, Martin M. Meremikwu

Journal of Advances in Medicine and Medical Research, Page 5577-5586
DOI: 10.9734/BJMMR/2014/7473

Aims: The aim of this paper was to assess the promptness of caregiver’s action at the onset of malaria symptoms to giving recommended effective anti-malaria drugs from public health facility.
Study Design: It was a cross sectional study.
Study Setting: The study was conducted in Akpabuyo, a rural community in Cross River State, south eastern Nigeria, March to May 2011.
Methods: Announcements were made in the community inviting mothers/caregivers to bring their sick-children/wards to the public primary health facilities for free laboratory malaria test and treatment. Caregivers treatment seeking behaviour were assessed using an interviewer administered questionnaire. Data was collected from each of the ten electoral wards that make up Akpabuyo local government area (LGA) in Cross River State, Nigeria. Wherever necessary native language or broken-English was used.
Results: Eight hundred and sixty children between the ages of 6 months to 14 years participated in the study. Majority of them (68%) were under-five years of age. There were slightly more males (52%) than females, mean age of the children was 47 months. The mean time-lag between onset of symptom and presentation in the public health-care was about 168 hours. The mothers either bought their drugs from patent medicine vendors and/or used herbal-medicines, before eventually going to the public health facility, where there are both free drugs and skilled manpower. Twenty-seven (27%) of the caregivers did not give any known treatment.
Conclusion: Mothers/caregivers in this community treat their malaria sick children within 168hours, after lots of delay, trying other remedies, before presenting in public health facilities. There is need to improve their treatment seeking behaviour, using health education intervention and behavioural change communication.

Open Access Original Research Article

Differential and Combined Effects of Simvastatin and Vildagliptin on Angiogenic Markers and Oxidative Stress in Hind Limb Model of Ischemia in Diabetic Rats

Amany Shalaby, Heba Kamal

Journal of Advances in Medicine and Medical Research, Page 5587-5603
DOI: 10.9734/BJMMR/2014/10804

Background: This study investigated the potential therapeutic effect of simvastatin and vildagliptin and their combination on angiogenesis in diabetic hind-limb ischemia.
Methods: 60 Sprague-dawely rats were divided into 5 groups, group A (normal control), group B (diabetic ischemic control), group C (simvastatin treated diabetic ischemic group), group D (vildagliptin treated diabetic ischemic group) and group E (combined sim. + vild. diabetic ischemic group). Parameters of angiogenesis as well as oxidative stress markers were evaluated.
Results: Increased capillary density in ischemic gastrocnemius tissue of diabetic rats treated with either simvastatin or vildagliptin with marked increase in its combination. This effect was accompanied by up-regulated plasma levels of HO-1, nitric oxide, vascular endothelial growth factor (VEGF) and expression of HIF-1 alpha levels. Tissue SOD and Catalase enzymes activities were normalized in groups treated with simvastatin or their combination with vildagliptin with concomitant decrease of lipid peroxidation.
Conclusion: Both vildagliptin and simvastatin has antioxidant and angiogenic effects and their combination could be a promising strategy in the management of diabetes associated peripheral arterial disease.

Open Access Original Research Article

Comparative Study of the Prevalence of Occlusal Anomalies in Down Syndrome Children and Their Siblings

Viviana Macho, David Andrade, Cristina Areias, Ana Coelho, Paulo Melo

Journal of Advances in Medicine and Medical Research, Page 5604-5611
DOI: 10.9734/BJMMR/2014/12688

Aims: The aim of this study was to characterize occlusal anomalies in a Portuguese population with Down Syndrome (DS) and to compare its distribution with that of their siblings.
Study Design: A sibling-matched, population-based and cross-sectional survey was performed.
Methodology: This study involved 132 children with DS and 84 of their siblings, aged 2 to 26 years. Data were gathered through the use of a complete questionnaire and clinical observation. Data analysis was performed by using SPSS® v.20.0 and any p-value <.05 was considered significant.
Results: Seventy six percent of the DS children and 72% of their siblings showed class I of Angle. There were no statistically significant differences between both groups regarding class I (P=.60). Only 4% of the DS children presented class II versus 22% of the siblings (P=.001). Twenty percent of the DS children and 6% of the siblings presented class III (P=.008). The DS group presented occlusal anomalies more frequently, especially posterior crossbite (P<.001), anterior open bite (P=.005) and anterior crossbite (P=.001). Deep overbite was only found in the siblings group (P=.001).
Conclusions: The results of this study suggest that children with Down syndrome have more occlusal anomalies than general population.

Open Access Original Research Article

Differential Impact of Parental BMI and Diet on Overweight and Obesity in Young School Children in Southern Brazil

Emil Kupek, Maria Alice Altenburg de Assis, Filipe Ferreira Costa, Danielle Biazzi Leal, Raquel Engel, Wolney Lisboa Conde

Journal of Advances in Medicine and Medical Research, Page 5642-5656
DOI: 10.9734/BJMMR/2014/12185

Aims: To analyze simultaneous impact of biological, socioeconomic and behavioral determinants of excess weight in schoolchildren.
Study Design: Cross-sectional study based on a representative sample of schoolchildren from 2nd to 5th grades of elementary school.
Place and Duration of Study: City of Florianopolis, Brazil, 2007.
Methodology: A representative sample of 1232 schoolchildren aged 7-10 years had their weight and height measured. Their diet and physical activity, as well as parental height, weight and income were all self-reported. Multinomial regression analysis was used to allow for differential impact of child diet on overweight without obesity versus obesity.
Results: Different food groups were associated with overweight without obesity compared to obesity and some of these were gender-specific. Maternal BMI modified these associations to some extent and exerted highly significant influence on child nutritional status both for overweight and obesity, whereas paternal BMI was significant only for the latter. Physical activity and family socioeconomic status had a limited impact once parental BMI was taken into account.
Conclusion: Some markers of unhealthy diet are specific to gender and to the level of excess weight in young schoolchildren. Maternal BMI is one of the key determinants of excess weight in schoolchildren.

Open Access Original Research Article

Comparison of Health Students’ Perceptions and Expectations of Their Educational Environment

Mandana Shirazi, Teamur Aghamolaei, Ideh Dadgaran, Amin Ghanbarnejad

Journal of Advances in Medicine and Medical Research, Page 5657-5666
DOI: 10.9734/BJMMR/2014/8078

Aims: Understanding the strengths and weaknesses of educational environment can help managers to improve the educational system. The aim of this study was determining the gap between students’ perceptions and expectations of the educational environment at Health School of Hormozgan University of Medical Sciences in Iran.
Methodology: In this cross-sectional study a total of 250 health students were studied. To determine the students’ perceptions and expectations they filled out a questionnaire included 56 pairs of five point likert scaled items with six domains including school atmosphere, teaching and learning, teachers, students’ self perception, educational facilities and equipments and the physical environment. Descriptive statistics and paired t-test were used to evaluate and analyze the data by SPSS ver.19.
Results: In all of the domains of educational environment, the students’ expectations of the educational environment were significantly higher than their perceptions (p<0.001). The gaps between the students’ perceptions and their expectations in school atmosphere, teaching and learning, teachers, students’ self-perception, educational facilities and equipments and physical environment domains were -1.42, -1.00, -1.03, -.49, -1.53, and -1.16 respectively.
Conclusion: Students’ expectations have not been fulfilled and to achieve the ideal level, proper planning and effective efforts with emphasis on facilities and equipment and school atmosphere domains should be implemented.

Open Access Original Research Article

Dietary Patterns and Weight Loss in New-onset Type 2 Diabetes Mellitus: A Sub-analysis of the St Carlos Study: A 3-year, Randomized, Clinic-based, Interventional Study

N. García de la Torre, L. del Valle, A. Durán, M. A. Rubio, M. Fuentes, M. Galindo, R. Abad, F. Sanz, I. Runkle, I. Barca, A. L. Calle-Pascual

Journal of Advances in Medicine and Medical Research, Page 5667-5677
DOI: 10.9734/BJMMR/2014/12800

Objective: To assess lifestyle patterns associated with weight loss in newly-diagnosed type 2 diabetic patients (T2DM) in the St Carlos Study.
Design: A 3-year, randomized, interventional study with three parallel groups.
Setting: A single-center, outpatient clinic-based study.
Participants: 195 newly-diagnosed T2DM were randomized to either the intervention group (self monitoring of blood glucose with-or-without an exercise program), or to the HbA1c control group. The same lifestyle-intervention protocol was applied in all patients. A questionnaire was applied to evaluate adherence to recommended lifestyle changes.
Main outcome measures: Patients were grouped by quartiles of body-weight loss at the end of follow-up.
Analysis: Multivariate linear-regression analyses were conducted to identify the independent effect of lifestyle patterns on three-year weight loss.
Results: Following a 3-year follow-up, median body weight loss was 2kg (IQR: -6/2.3). A higher level and an increase on physical activity, both leisure-time activity and sport exercise, and an increase in the nutrition score, mainly due to a higher consumption of nuts in substitution of cured sausages as snacks, and to a higher consumption of vegetables, legumes, whole grain cereals and fruits instead of juices, potatoes and white cereals, were associated to a greater weight loss (p<0.05). There was no association between low-fat diet and reduced body weight.
Conclusions and Implications: The application of simple recommendations (enhanced vegetable consumption, nuts for snacks, fruit instead of juices, wholegrain instead of processed cereals, legumes instead of potatoes, increased daily walking and stair-climbing) can achieve long-term, sustained weight loss in T2DM.

Open Access Original Research Article

Putative Risk Factors among Ghanaian Women Presenting with Leiomyoma

H. S. Opare-Addo, W. K. B. A. Owiredu, T. Dapilah, A. Alhassan

Journal of Advances in Medicine and Medical Research, Page 5678-5688
DOI: 10.9734/BJMMR/2014/11823

Aims: The objective of the current study was to investigate potential demographic, lifestyle, and medical history risk factors for leiomyoma in a sample of Ghanaian women.
Study Design: A case-control study was conducted among women who attended the Gynecology department of Komfo Anokye Teaching Hospital (KATH), Kumasi, Ghana.
Place and Duration of Study: The study took place between May 2005 and March 2009 at the Obstetrics and Gynecology Department of the Komfo Anokye Teaching Hospital (KATH), Kumasi.
Methodology: Premenopausal Ghanaian women aged 20-40 years were studied for the role of putative socio-demographic, lifestyle, and medical history risk factors in the development of leiomyoma. Two hundred women with confirmed uterine fibroids and two hundred women with no observable fibroids were recruited as controls for the study.
Results: Family history (OR 2.21, 95% CI:2.21-5.9) and obesity (OR 3.60, 95% CI:1.74-7.47), nulliparity (OR6.5, 95%CI:4.18-10.0), age at first birth (OR 2.82, 95%CI:1.60-4.98), induced abortion (OR 3.33, 95%CI:1.11-9.99), and history of sexually transmitted infections (OR 2.27, 95%CI:1.21-4.28), all greatly increased the risk of fibroids, not married (OR1.62, 95%CI:1.07-2.44), alcohol intake (OR1.69, 95%CI:1.13-2.53), and contraceptive use (OR1.66, 95%CI:1.11-2.46) also significantly increased the risk of fibroids.
Conclusion: The results of this study describe the association of fibroids with specific lifestyle and medical history risk factors. The present study also revealed that past induced abortions is a significant risk factors for the development of leiomyoma among Ghanaian women.

Open Access Original Research Article

Patterns of Alcohol Use among Patients Who Visited Community Emergency Care Services in Southwestern Brazil

Margarita Villar Luis, Luciana Barizon Luchesi, Sara Pinto Barbosa, Karla Selene Lopez, Jair Lício Ferreira Santos

Journal of Advances in Medicine and Medical Research, Page 5689-5698
DOI: 10.9734/BJMMR/2014/9406

Alcohol is among the most frequently consumed drugs worldwide. However, identification and intervention measures for alcohol abuse have not yet been established. This article reports the results of applying the Alcohol Use Disorders Identification Test (AUDIT) in 463 patients from five centers for emergency care community in a large city in the interior of São Paulo. The relationship between the AUDIT risk-levels of alcohol use and the socio-demographic variables of individuals seeking treatment between August and November 2010 was also examined. The instrument was administered by seven nurses and six students nurses. Individuals with AUDIT scores ≥07 received brief counseling (BC). The main reasons for seeking emergency care were “headache”, “pain”, and “ill-being”. Among the individuals in the study, 95.9% lived in the municipality where the data was collected, 40.7% had an incomplete elementary school education, and the percentage of alcohol dependence was lower among employed individuals (11.9%). The sample was composed of 61.1% men and 38.6% women. Among the men, 18.7% had scores suggesting dependence, and 48% exhibited hazardous drinking levels; the corresponding proportions among women were 3.3% and 16.7%, respectively. The mean age of the participants was 42 years, and 16.2% of the alcohol-dependent users were aged 30 to 49 years. Alcohol use was recorded as the cause of treatment for 3.4% of the individuals. The administration of the AUDIT in a community emergency care setting proved to be a useful for the early identification of high-risk drinkers.