Open Access Original Research Article

AIDS: An Epidemiological Study on Correlation between HIV- Related Oral Lesions and Plasma Levels of CD4, CD8 T Lymphocytes Counts and Ratio among 50 Patients

Antoine Berberi, Ziad Noujeim

Journal of Advances in Medicine and Medical Research, Page 859-866
DOI: 10.9734/BJMMR/2015/15394

Aim: The aim of the study was to evaluate oral manifestations of HIV /AIDS patients and to correlate their occurrence with plasma levels of CD4+, CD8+ counts and CD4/CD8 ratio.
Study Design: A descriptive cross-sectional study.
Place and Duration: Odontology Unit, St-Antoine Hospital, a two- year study.
Methodology: In a descriptive cross-sectional study, 50 patients infected with human immunodeficiency virus (HIV) were assessed. The relationships between oral lesions and CD4+, CD8+ cell counts and CD4/CD8 ratio were evaluated.
Results: The mean CD4+ counts and CD8+ counts were 167.12 cells/mm3 and 979.66 cells/mm3 and the mean CD4/CD8 ratio were 0.25. All patients displayed at least one oral manifestation. The most common identified oral lesion was pseudo- membranous candidiasis, accounting for 76% (38/50) followed by periodontal disease 34% (17/50), herpetic lesions, and hairy leukoplakia 10% for each (5/50), gingivitis 8% (4/50), oral ulceration 8% (4/50), Kaposi’s sarcoma 6% (3/50), and Non-Hodgkin lymphoma 2% (1/50).
Conclusion: The CD4+ count was decreasing and the presence of oral lesions were increasing in this study. No relation was found between the presence of oral lesions and CD4/CD8 ratio. Progression to AIDS was characterized by increased prevalence of some oral lesions such as candidiasis, hairy leukoplakia and Kaposi’s sarcoma. The clinical appearance of oral lesions was more pronounced when CD4+ count was low.

Open Access Original Research Article

Assessment of the Adminstration of Low Molecular Weight Heparin for Hemodialysis Anticoagulation in Comparison to Standard Unfractionated Heparin

Emad Abdallah, Osama Mosbah, Ghada Khalifa

Journal of Advances in Medicine and Medical Research, Page 867-874
DOI: 10.9734/BJMMR/2015/15365

Background and Aim of Study: The use of Low-molecular-weight heparin (LMWH) for hemodialysis anticoagulation has been proposed as effective and safe for hemodialysis (HD) anticoagulation as standard unfractionated heparin (UFH). The aim of our study was to assess the use of LMWH for hemodialysis anticoagulation in comparison to UFH, including hemorrhagic events and clotting of the extracorporeal dialysis circuit and their effect on lipids profile.
Methods: This prospective, randomized study conducted on 44 patients (31 males, 13 females; mean age 53.7.9±14.2 years) with end-stage renal disease on regular hemodialysis. The hemodialysis patients were subjected to UFH and followed prospectively for 16 weeks (48 dialyses sessions) and the same patients were subjected to LMWH (enoxaparin sodium; 40 mg) for a further 16 weeks, clotting of the extracorporeal dialysis circuit and hemorrhagic events were evaluated by visual inspection of the air trap, blood lines and dialyzers and the time required for arterio-venous fistula compression. Kt/V was calculated to determine whether UFH or LMWH had any effect on the adequacy of dialysis and lipid profile were measured at the end of each arm of the study to determine whether UFH or LMWH had any effect on the lipid profile levels.
Results: The present study showed that, compared with UFH, the effect of LMWH (enoxaparin sodium) on the number of hemorrhagic events (relative risk, 1.3; 95% CI: 0.317 - 5.613; P=1.000) or clotting of the extracorporeal dialysis circuit (relative risk, 0.75; 95% CI: 0.284 - 1.984; P=1.000) was not significant. There was no significant difference in Kt/V between the UFH arm (1.4±0.4) and LMWH (enoxaparin sodium) arm (1.5±1.2; p=0.6). Also there was no significant differences in serum total Cholesterol, LDL, HDL and TGs between the UFH arm and LMWH (enoxaparin sodium arm).
Conclusion: LMWH (Enoxaparin sodium) should be considered as effective and safe as unfractionated heparin in hemodialysis anticoagulation. But currently direct costs are about 26% more. So we recommend, the use of UFH for its low cost.

Open Access Original Research Article

The White Coat and the Physician; a Snapshot of the Physicians’ Perspective

Herbert A. Obu, Josephat M. Chinawa, Pius Manyike, Ikechukwu Obi, Ikenna K. Ndu, P. O. Nkwo, Awoere Tamunosiki Chinawa

Journal of Advances in Medicine and Medical Research, Page 875-881
DOI: 10.9734/BJMMR/2015/15150

Background: The white coat is synonymous with medical profession and helps for easy identification by patients and colleagues.
Objectives: The objective of this study is to determine doctors’ perception on mode of dressing of their colleagues, especially wearing of white coats and its influence on the well being of their patients.
Methods: A structured self administered questionnaire was used to collect information from the doctors of all carder in the hospital during the study period. Three photographs, a man with corporate attire and tie without ward coat and the same man with corporate attire and tie with a white coat and same man with casual dressing, were shown to the doctors, and were asked which of the three pictures they would like a doctor to dress.
Results: Majority 200 (72.5%) of the respondents had a white coat on as at the time they were filling the questionnaire while only 76 (27.5%) were not putting on lab coat. Also 202 (75.9%) of the respondents are of the opinion that a doctor should always put on shirt, tie and trouser with a white covering lab coat. Most 76 (35.68%) of those who supported the opinion suggested that the white coat protects the doctors/or their families as their reason.
Conclusion: White coats were seen as the most appropriate dress code for doctors, regardless of gender. Low ranked doctors however wear the white coat more than high ranked ones. Furthermore the type of clothing and accessories used by physicians (physician dressed on shirt, tie and trousers with a white covering lab coat) has a positive influence on physician-patient relationship.

Open Access Original Research Article

CT Scan Patterns of Stroke at the University of Gondar Hospital, North West Ethiopia

Zerubabel T. Desita, Wossen M. Zewdu

Journal of Advances in Medicine and Medical Research, Page 882-888
DOI: 10.9734/BJMMR/2015/14849

Background: In places like rural Ethiopia where there is no CT or MRI, the diagnosis of stroke remains by clinical signs and symptoms. Knowing the actual proportion of the types of stroke seen locally is helpful in the prevention, diagnosis and thereby treatment of this illness.
Objectives: The aim of the study was to determine CT scan pattern of stroke at the University of Gondar hospital so that the local proportion of stroke subtypes will be known.
Methods: This is a descriptive cross-sectional study which included all patients with a CT scan diagnosis of recent onset stroke in the time period of August 2011 to July 2012 at the University of Gondar Hospital; Northwestern Ethiopia.
Results of the Study: A total of 111 patients, 59(53.2%) male and 52 (46.8%) female were included in the study. The age range was from 16 to 88 years. The mean age for stroke is 49 years. Ischemic stroke was diagnosed in 64(57.7%) patients while the remaining 47 (42.3%) had hemorrhagic type. The hemorrhagic stroke had 30 (63.8%) parenchymal, 8(17%) ventricular, 4 (8.5%) subarachnoid and the remaining 5(10.6%) multifocal sites.
Conclusion: The rate of hemorrhagic type of stroke in this study is 42% which is about three times higher than stated by most authors for the largely Caucasian populations in Europe and America and is similar to studies done in Addis Ababa and in different parts of Africa on black patients. Although the percentage of stroke types differs, other studied features of stroke agree with universally accepted patterns.

Open Access Original Research Article

HIV Knowledge and Risk Behaviours of Junior Staff of the University of Ibadan, Nigeria

Abayomi O. Oluwasanu, Eme T. Owoaje, Mojisola M. Oluwasanu

Journal of Advances in Medicine and Medical Research, Page 889-898
DOI: 10.9734/BJMMR/2015/14562

Human Immunodeficiency Virus (HIV) infection remains a public health challenge and Nigerian universities are not immune to the effect of the epidemic. Despite the fact that non academic junior staff constitute a significant proportion of the workforce and are at risk due to their lower level of education and socio-economic status, few studies have focused on them. The broad aim of this study is to assess the HIV knowledge, risk perception and behaviours of junior staff of the University of Ibadan, Nigeria.
A cross-sectional study was conducted among 700 junior staff of the University of Ibadan. Respondents were selected using multistage sampling technique and completed structured interviewer-administered questionnaires. The quantitative data was analyzed using the Statistical Package for the Social Sciences (version 17) to generate frequencies and cross tabulations of variables.
The mean age of the respondents was 38.8 9.9 years, 74.6% were males, 76.4% were married and 51.6% had post secondary education. Majority identified blood transfusion 94.4% and sexual intercourse 97.3% as the main routes of transmission. The commonest methods of prevention known were condom use 79.6% and mutual fidelity 89.7%. Respondents aged 20-29 years, the single and those with post-secondary education (P=0.000) had higher HIV related knowledge. Only 10% of the respondents perceived that they were at risk of contracting the disease; 30.3% did not think People Living with HIV and AIDS (PLWHAs) should continue to work. Fifteen percent reported sexual intercourse with a non-regular partner in the previous 12 months and 30.8% of this group did not use a condom.
Workplace health education programmes to reduce HIV risk behaviours and stigmatizing attitudes are recommended.

Open Access Original Research Article

Role of Hepatitis C Virus Infection on Lymphoproliferative Disorders after Non-liver Transplantation

Hossein Khedmat, Mohsen Amini, Mohammad Ebrahim Ghamar-Chehreh, Aghdas Aghaei, Shahram Agah

Journal of Advances in Medicine and Medical Research, Page 899-907
DOI: 10.9734/BJMMR/2015/4093

Aims: The number of reports on HCV positive PTLD patients in non-liver transplantation setting as well as our knowledge on the issue is extremely limited. In this study, we aimed to investigate the impact of HCV infection on non-liver transplant recipients regarding PTLD development.
Study Design: The study is designed as a comprehensive review of the literature.
Place and Duration of Study: The review of the literature was performed at the Department of Internal Medicine, Baqiyatallah University of Medical Sciences, Tehran, Iran.
Methodology: A comprehensive search was performed for finding the available data by Pubmed and Google scholar search engines for reports of lymphoproliferative disorders occurring in non liver organ transplant patients with regard to their HCV test results. P value of 0.05 was considered significant.
Results: Data of overall 61 patients was entered into analysis. 9 PTLD patients were HCV positive and the remaining were HCV negative. HCV positive patients were significantly younger at the time of transplantation (p=0.04). The same patient group had relatively shorter time from transplantation to PTLD development, but significant level has not been achieved (74±57 vs. 46±38, respectively; p=0.06). No other difference was found.
Conclusion: HCV positivity can reduce the time interval between transplantation and PTLD development which can be interpreted as HCV can enhance the rate of PTLD in non-liver transplant recipients. Our study presents a significant evidence for HCV relationship with PTLD in non-liver transplantation setting. Further studies with prospective designations are needed to confirm our results.

Open Access Original Research Article

Predicting Recurrence in Cervical Cancer Patients Using Clinical Feature Analysis

Ravinder Bahl, S. K. Spolia, Chandra Mauli Sharma

Journal of Advances in Medicine and Medical Research, Page 908-917
DOI: 10.9734/BJMMR/2015/12069

The paper demonstrates an analytic approach for prediction of recurrence in the cervical cancer patients using a probabilistic model. The techniques used for classification and prediction are based on recognizing typical and diagnostically most important test features relating to cervical cancer. The main contributions of the research involve predicting the probability of recurrences in no recurrence (First time detection) cases. The conventional statistical and machine learning tools are applied for the analysis. The experimental study demonstrates the feasibility and promising the proposed approach for the said cause with real data.

Open Access Original Research Article

A Comparison of the Essex-Lopresti Technique and Conservative Treatment for Displaced Tongue-Type Calcaneus Fractures

Cetin Isik, Mesut Tahta, Nurdan Cay, Ramazan Akmese, Safa Gursoy, Murat Bozkurt

Journal of Advances in Medicine and Medical Research, Page 918-925
DOI: 10.9734/BJMMR/2015/15522

Aims: This study aimed to evaluate the mid-term clinical and radiological results of conservative treatment and surgical treatment made with the Essex-Lopresti technique in tongue-type calcaneus fractures.
Study Design: A comparison of two treatment options (the Essex-Lopresti Technique and conservatively). Radiological comparison, Functional comparison and isokinetic dynamometer were used to evaluate.
Place and Duration of Study: 3 separate centers between November 2005 and April 2013 were examined.
Methodology: A retrospective evaluation was made of 19 patients (Group 1) who were operated on with the Essex-Lopresti Technique and 27 patients (Group 2) who were treated conservatively. Radiological comparison was based on correction in Bohler’s angle. Functional comparison was made using the Maryland Foot Score (MFS). In the comparison of the gastrosoleus muscle complex strength, an isokinetic dynamometer was used. To determine the distribution of all the variables in the comparisons of the groups, the Kolmogorov-Smirnov test was used. For variables showing normal distribution, Student’s t-test (Independent Sample T Test) was applied.
Results: The Maryland Foot Score was determined as 96.2 in Group 1 and 85.6 in Group 2 (p=0.002). While findings of subtalar arthrosis were determined in 2 (10.5%) patients of Group1, subtalar arthrosis was seen to have developed in 7 (25.9%) patients of Group 2 (p=0.014). In the isokinetic muscle strength measurements, the mean plantar flexion muscle strength was 106.2 (85-122.4) Nm in Group 1 and 96.4 (73.3-124) Nm in Group 2 and this difference was statistically significant (p=0.034).
Conclusion: The Essex-Lopresti Technique is an effective method in the treatment of tongue-type calcaneus fractures.

Open Access Original Research Article

Use of Nigerian Medicinal Plants Protected Liver from Injury in Plasmodium berghei Infected Mice

A. J. Uraku, A. N. C. Okaka, U. A. Ibiam, K. N. Agbafor, N. A. Obasi, C. J. Okoye, M. E. Ogbanshi

Journal of Advances in Medicine and Medical Research, Page 926-934
DOI: 10.9734/BJMMR/2015/14525

The effects of ethanol leaf extracts of Spilanthes uliginosa, Ocimum basilicum, Hyptis spicigera and Cymbopogon citratus on mice infected with malaria parasite was investigated. Eighty four (84) swiss mice of both sexes were used for the study. All the mice were passaged intraperitoneally with 0.2 ml parasitized blood suspension and parasitemia assessed by Geimsa stain thin blood films after seventy two hours. The mice were divided into 6 groups namely; A, B, C, D, E and F. Groups B, C, D and E were subdivided into three (3): B1, B2, B3, C1, C2, C3, D1, D2, D3, E1, E2 and E3. Both groups and subgroups contained 6 mice each. The subgroups were treated with the extracts of Spilanthes uliginosa (Sw), Ocimum basilicum, Hyptis spiligera and Cymbopogon citratus each for five (5) consecutive days with 200, 400 and 800 mg/kg body weight via oral intubation daily respectively. The results indicated a general significant (P<0.05) decrease in the average body weight of the parasitized untreated mice while the histological photomicrographs showed alterations in the liver architecture of parasitized untreated mice and restorative effects of all the plant extracts and standard drug on the liver architecture of the parasitized treated mice. 

Open Access Original Research Article

Infant Feeding Practices and Growth Pattern in the First Six Months of Life: A Cross-Sectional Study of Babies Attending the Infant Welfare Clinic of the Nnamdi Azikiwe University Teaching Hospital

Onah Stanley Kenechi, Osuorah Donatus Ignatius Chidiebere, Ebenebe Joy, Ezechukwu Clement, Ekwochi Uchenna, Ndukwu Ifeyinwa

Journal of Advances in Medicine and Medical Research, Page 935-947
DOI: 10.9734/BJMMR/2015/14689

Background: Malnutrition which mostly is a consequence of improper feeding practices has been shown to contribute to over 50% of under-5 mortality. This means that appropriate age-specific nutritional prescription is the surest way of significantly shrinking childhood mortality especially in sub-Saharan Africa.
Aim: This cross-sectional descriptive and analytical study aims to determine the relationship between different infant feeding practices and the nutritional status of apparently healthy infants below six months of age attending the infant welfare clinic of Nnamdi Azikiwe University Teaching Hospital, Nnewi.
Methods: Mother infant pairs attending the infant welfare clinic that meets the inclusion criteria were consecutively enrolled over a six months period.
Results: Four hundred infants were enrolled for this study. Educational level (P=0.003), socioeconomic class (P=0.010), occupation (P=0.025) and infants age (P=0.001) significantly determined exclusive breast feeding (EBF) practice. Exclusively breast feed infants showed higher weight and length indices for age and sex compared to infants in other feeding group (P=0.001). Significantly lower proportion of infants in the EBF group (1.9%) compared to infants in the predominant breast feeding (PBF) 5.2% and complementary breast feeding (CBF) 9.7% feeding group showed evidence of under-weight (P=0.015). Binary logistic regression analysis showed that EBF infants were 0.12 and 0.51 times less likely to be under-weight (OR 0.12; CI 0.02-0.93) and stunted (OR 0.51; CI 0.27-0.96) respectively.
Conclusion: Since malnutrition is a major contributor to neonatal and infant’s mortality in Africa, the campaign for EBF practice should not only be sustained but further strengthened as a way of halting and possibly reversing the gloomy trend.