Open Access Case Study

Multidisciplinary Management of Impacted Supernumerary Teeth

Wamiq M. Fareed, Hassan Al-Zoubi, Giath Gazal, Muhammad S. Zafar

Journal of Advances in Medicine and Medical Research, Page 1025-1031
DOI: 10.9734/BJMMR/2015/15143

Background: Mesiodens are supernumerary teeth present in the anterior maxillary region that may erupt or remain embedded in the jawbone. The incidence of mesiodens is rare, surgical removal of supernumerary teeth with correction of anterior teeth by orthodontic treatment is performed.
Case Report: This case report represents a very rare incidence of multiple mesiodens in a male patient. Extraction of two mesiodens was indicated, as these impacted supernumerary teeth may cause complications during orthodontic treatment. The third tooth was not operated on the fact that it needs to be extracted by additional extraoral approach involving risk factors. The current case report delineates the fruitful administration of the un-erupted supernumerary teeth situated high in the mid-palatal area not associated with any syndrome. Blends of operating and surgical strategies were utilized to enhance the results with hard and soft tissue conservation, maintenance and support. In the surgical phase, surgical removal of the supernumerary teeth, bone grafting was done using the hydroxyapatite. Radiographic evidence of complete healing was observed following up visit.
Conclusion: Timely diagnosis and suitable management can decrease the potential complications due to the presence of supernumerary teeth. Dental clinicians should be aware of related clinical signs and must look for unexpected findings during the routine clinical as well radiological examinations.

Open Access Original Research Article

A Clinico-Pathological Study of Hemophilia in Rural Set up of Karnataka

Raja Parthiban, Amrit Kaur Kaler, M. Sangeeta, Suresh Hanagavadi, P. Sashikala, Shameem Shariff

Journal of Advances in Medicine and Medical Research, Page 948-955
DOI: 10.9734/BJMMR/2015/12810

Haemophilia is the most common inherited coagulation disorders, with X linked recessive inheritance, affecting the males while females are the carriers of the disease. Haemophilia A and Haemophilia B are the commonest form of Haemophilia encountered and they result from defect in Factor VIII and Factor IX gene respectively. A clinico hematological study with suspected coagulation disorder was conducted over a period of two years, from June 2008 to July 2010. Of the 76 patients visited OPD, based on clinical presentation and family history, 50 cases were categorized as Hemophilia A or B after laboratory investigations. Majority (41) of the cases were categorized as Hemophilia A & only 7 cases were Hemophilia B. The mean age group of the patients was 2.87 years with an age of onset ranged between 3rd day to 5.6 years. All the cases were males and only a very rare case of female Hemophilia patient was noted. Thirty five (52.23%) patients had positive family history of bleeding. In 12 families (18.75%) there had been consanguineous marriage. Spontaneous bleeding was the predominant presenting symptom followed by Hemarthrosis and prolonged post traumatic bleeding. The knee joint was most commonly involved. Coagulation screening tests showed that 60% patients had prolonged activated partial thromboplastin time (APTT) with an average of 88 seconds. Mixing and substitution studies were very useful in distinguishing between Hemophilia A & B. Factor assays in both Hemophilia A & B showed 66% of cases with severe factor deficiency, 26% moderate and 8% with mild deficiency.
In the present study an effort is made to explore, elucidate and document the clinico haematological correlation of Hemophilia in this part of Karnataka.

Open Access Original Research Article

Prevalence and Factors Associated at Presence of Central Nervous System Congenital Malformations

Roseane Porto, Francisco Prado Reis, Cristiane Costa da Cunha Oliveira, Enaldo Vieira de Melo, José Aderval Aragão

Journal of Advances in Medicine and Medical Research, Page 956-964
DOI: 10.9734/BJMMR/2015/14642

Introduction: Congenital malformations are currently an important cause of morbidity and mortality in many countries, though in most cases their etiology is unknown. The central nervous system (CNS) is involved in many of these defects.
Objective: To study the factors associated with CNS congenital malformations and their prevalence in infants born at a high risk maternity hospital in Northeastern Brazil.
Materials and Methods: A case-control study performed from January 2010 to December 2011, with data from The Latin American Collaborative Study of Congenital Malformations.
Results: Among the 8.405 registered births, 187 were malformed newborns (2.2%). Nervous system malformations were diagnosed in 61 patients (32.6% (CI = 95% 27.5 to 38.0)), the most frequent being neural tube defects and congenital hydrocephaly. Previous history of miscarriage and/or stillbirth (p = 0.008), family history of malformations (p < 0.001) and parental consanguinity (p = 0.028) are associated with CNS malformation. Environmental factors such as maternal chronic diseases, smoking, exposure to teratogenic drugs and alcohol presented no statistically significant differences.
Conclusions: The genetic component was an important contributing factor to the etiology of the malformations studied.

Open Access Original Research Article

Is Having Had a Cup of Coffee a Methodological Issue in Routine Sphygmomanometry?

Nyunt Wai, Mohd Ariff Bin Khaled, Archana Singh Sikarwar

Journal of Advances in Medicine and Medical Research, Page 965-977
DOI: 10.9734/BJMMR/2015/15037

Background: In view of the impact of hypertension on public health, the objective of this study was to determine whether having had a cup of coffee in an everyday life setting raises blood pressure significant enough to make it a methodological issue in routine sphygmomanometry.
Methods: Healthy normotensive volunteers from a private university in Malaysia were recruited. After an overnight fast, seated systolic and diastolic blood pressures (SBP and DBP) of habitual coffee drinkers (n=16) were measured (Omron HEM 7080 automated monitor) in the laboratory 15 min. before and every 15 min. up to 90 min. after drinking strong coffee. This was repeated on non-habitual drinkers (n=16) who also underwent a control study (decaffeinated coffee). To see whether the laboratory findings could be extrapolated to everyday life setting, the pre-coffee BP and 30 min.- and 60 min.- post-coffee BPs were measured on habitual coffee drinkers (n=18) who consumed self-prepared coffee and who carried on with routine office work between BP measurements taken in a nearby room.
Results: In the laboratory setting, coffee significantly increased SBP and DBP at all time-points in non-habitual drinkers (e.g.11.38+/- 8.2 and 10.75+/-5.7 mm Hg at 75 min; P<0.01, repeated measures ANOVA and Dunnett's test); in habitual drinkers, SBP only was increased (7.23+/-4.7 at 90 min; P<0.05). In the office setting, smaller but significant DBP elevations (3.72+/-5.1 at 60 min; P<0.05) were observed.
Conclusion: The results indicate that having had a cup of coffee could be a methodological issue in routine sphygmomanometry, particularly with non-habitual coffee drinkers consuming strong coffee. However, caution should be exercised in drawing conclusions because of the small sample size.

Open Access Original Research Article

Accuracy of Combined Maternal Serum Interleukin-8 and Salivary Estriol in Prediction of Preterm Labor

Gihan M. Shehata, Gihane I. Khalil, Hesham Abd Elfatah, Samir Elsayd

Journal of Advances in Medicine and Medical Research, Page 978-986
DOI: 10.9734/BJMMR/2015/15146

Aim: To assess the accuracy of combined maternal serum interleukin and maternal salivary estriol levels in prediction of preterm labor in Egyptian pregnant females.
Study Design: Case control study.
Place and Duration of Study: It was conducted in El-Shatby University Hospital of Gynecology and Obstetrics, Alexandria, Egypt between 1st Jan to 30th September in the year 2012.
Methodology: We included 80 pregnant females of gestational age 28-36 weeks (40 females with preterm labor and 40 pregnant not in labor). Both groups were matched for the women's age and the gestational age. A questionnaire was completed; abdominal and vaginal examinations were done. Maternal serum and saliva were collected for measuring the serum interleukin-8 and salivary estriol levels using ELISA technique.
Results: Using ROC curve analysis, the overall diagnostic accuracy of Salivary Estriol alone at cut off point 200 pg/ml in prediction of preterm labor was 58% (0.46-0.71). Sensitivity and specificity were 82.5% and 32.5% respectively. The diagnostic accuracy of combined Salivary Estriol and serum interleukin-8 in prediction of preterm labor was 68% (0.56-0.79). Sensitivity and specificity were 75%% and 60% respectively. Lastly, the maternal serum interleukin-8 had the following accuracy measures for prediction of preterm labor at cut off point 965 pg/ml. (Overall accuracy: 79% (0.69-0.89), sensitivity 92.5% and specificity 42.5%).
Conclusion: The maternal serum interleukin-8 is an effective and relatively non invasive and more accurate strategy for prediction of preterm labor at cut off point 965 pg/ml than salivary estriol. (Overall accuracy: 79%, sensitivity 92.5% and specificity 42.5%).

Open Access Original Research Article

Child Attention-Deficit Hyperactivity Disorder (ADHD) in Same-Sex Parent Families in the United States: Prevalence and Comorbidities

D. Paul Sullins

Journal of Advances in Medicine and Medical Research, Page 987-998
DOI: 10.9734/BJMMR/2015/15897

Aims: This paper presents the first population data on attention-deficit hyperactivity disorder (ADHD) among children raised by same-sex parents with the aims 1) to test whether residence with same-sex parents is associated with higher ADHD prevalence, and 2) to observe and assess any clinically significant aggravators or comorbidities.
Methodology: Aggregate data for 1997-2013 from the U.S. National Health Interview Survey yielded a representative sample of children from 207,007 households, including 512 with same-sex parents, permitting inferential comparisons.
Results: ADHD was more than twice (OR 2.4, 95% CL 1.6-3.4) as prevalent among children with same-sex parents than in the general population, after controlling for age, sex, ethnicity and parent SES. Comorbidities with general emotional problems and defiance behavior were standard. ADHD risk with same-sex parents was reduced among adopted children (OR 0.54 95% CL .27-1.1), null in the presence of parent psychological distress, and substantially elevated in the presence of stigmatization (OR 7.3 95% CL 1.4-38.1). In same-sex families, children with ADHD were over seven times (OR 7.5 95% CL 1.2-46.8) more likely to suffer stigmatization due to impaired interpersonal coping skills.
Conclusion: Diagnostic intake for ADHD should include parent sexual orientation, and treatment programs should include resources to bolster anti-victimization skills, particularly for children with same-sex parents. Results suggest the presence of shared genetic factors for same-sex attraction and ADHD, though more research is needed to confirm.

Open Access Original Research Article

Levofloxacin Reverses Hydroxyzine Induced Psychomotor Performance Deterioration: A Randomized Crossover Study

Hayder M. Alkuraishy, Ali I. Al-Gareeb

Journal of Advances in Medicine and Medical Research, Page 1008-1015
DOI: 10.9734/BJMMR/2015/15120

Background: Levofloxacin is a third generation fluoroquinolone chemotherapeutic agent used in the treatment of severe and resistant bacterial infections; it exerts antibacterial effects in both blood and inflamed tissues. Levofloxacin leads to central nervous system stimulation via inhibition of GABA-A receptor complex like beta-lactam antibiotics. Hydoxyzineis used for the treatment of insomnia, allergic reactions and for preoperative sedation because of blocking H-1 receptors and so blocking histaminergic signals.
Objectives: The aim of the present study is to elucidate the exciting effect of levofloxacin in hydroxyzine induced psychomotor performance deterioration in normal healthy volunteers.
Methods: Thirty healthy medical student volunteers, aged between 22-25 years were allocating arbitrarily. All participants were habituated with the study measures and skilled on the Leeds psychomotor tester before and after levofloxacin (500 mg/day) alone or with hydroxyzine (10 mg/day).
Results: Hydroxyzine impaired psychomotor performance and cognitive function, it prolongs the total reaction time, movement reaction time, recognition reaction time and distort critical flicker and fusion frequency significantly p<0.05.
While levofloxacin activates psychomotor performance and cognitive function, it shortens the total reaction time, movement reaction time, recognition reaction time and regulate critical flicker and fusion frequency significantly p<0.05.
The combined effect of levofloxacin and hydroxyzine produced insignificant effects on psychomotor performance and cognitive function p>0.05.
Conclusion: Levofloxacin significantly improves psychomotor performance in normal, healthy volunteers and produced CNS stimulation that is able to reverse deteriorations in psychomotor performance and cognitive function induced by hydroxyzine.

Open Access Original Research Article

A Systematic Review of Elective, Urgent and Emergency Cervical Cerclage and Pregnancy Outcomes

Amsavalli Sundaresan, Somsubhra De

Journal of Advances in Medicine and Medical Research, Page 1016-1024
DOI: 10.9734/BJMMR/2015/15574

Introduction: Different cervical cerclage namely elective, urgent and emergency are in practice and they aim to improve the maternal and perinatal outcomes.
Methods: The aim of this systematic review and analysis is to assess the difference in the outcomes of the three different cerclages. Randomized or quasi randomized controlled studies from last 15 years were considered in this study. The relative risk was calculated with 95% confidence interval and the maternal and perinatal outcomes were compared.
Results: A total number of 923 patients were analyzed from the nine studies. Out of these 923 patients, 783 patients had adverse maternal outcome whereas all the patients had some form of adverse perinatal outcome. The urgent cerclage was comparable with the elective cerclage in most of the outcomes except having 3-4 folds higher pregnancy loss but 75% lower neonatal deaths. The emergency cerclage showed poor outcomes when compared to both urgent and elective cerclage with a very high risk of chorioamnionitis and less term births with high risk of neonatal deaths.
Conclusion: Elective cerclage seems to have an overall better outcome when compared to the other two cerclages. The urgent cerclage is comparable to elective cerclage with lesser risk of neonatal death but a threefold higher risk of pregnancy loss. The emergency cerclage has shown poor outcome when compared to the other two types of encerclage. Therefore it can be recommended to evaluate the cervical length after one previous preterm delivery and if would to be less than 25 mm then a cervical cerclage should be considered.

Open Access Original Research Article

Epithelioid Haemangioma – A Diagnostic Dilemma

D. Ayesha Thabusum, N. Rajesh, R. Sudhakara Reddy, T. Ramesh, M. Ravikanth

Journal of Advances in Medicine and Medical Research, Page 1032-1039
DOI: 10.9734/BJMMR/2015/15144

Epithelioid haemangioma (EH), synonymously termed as angiolymphoid hyperplasia with eosinophilia, is a rare lesion whose etiopathogenesis is unclear. Clinically it manifests as solitary or multiple nodules in the skin and subcutaneous tissues of the head and neck region. It can also arise in the deep tissues such as muscle, bone and lymphnode. Intra oral involvement is less common and very few cases have been reported in the literature. Common intra oral sites include lip followed by buccal mucosa and tongue. Epithelioid Haemangioma affecting alveolar mucosa is very rare. We report one such case of epithelioid hemangioma of size 4x4 cm on lower right alveolar mucosa in 38 year old female patient.

Open Access Review Article

Association between Polymorphisms of XRCC1 and TP53 Genes and Endometriosis

Manal A. Safan, Ashraf A. Ghanem

Journal of Advances in Medicine and Medical Research, Page 999-1007
DOI: 10.9734/BJMMR/2015/15811

Endometriosis is a complex disorder of the female reproductive system where endometrial tissue embeds and grows at extrauterine location. Polymorphisms in several genes have been studied as probable risk factors of this debilitating disease.
Aims: To investigate the association between poly¬morphisms in DNA repair pathway genes, namely XRCC1 Arg399Gln and TP53 codon 72 and risk of developing endometriosis.
Study Design: The study was conducted at Medical Biochemistry Department, Menoufia University and Obstetrics and Gynecology Department, Mansoura University between May 2012 and June 2014.
Methodology: Genotyping of XRCC1 Arg399Gln by PCR-CTPP and TP53 codon 72 using allele-specific PCR techniques were conducted on 85 endometriosis patients and 60 healthy controls.
Results: This study found that TP53 Pro/Pro and XRCC1 399 Gln/Gln homozygotes had a 5.11 and 4.19 fold increased risk to develop endometriosis when compared to the arginine homozygotes, respectively. This association between TP53 codon 72 Pro/Pro genotype and the risk of endometriosis was also clearly evident in endometriosis patients with stage III and IV (4.6 fold increased risk to develop endometriosis). However, the association between XRCC1 399 Gln/Gln genotype and endometriosis stage was not statistically significant (P=0.16). Anon significant higher risk of endometriosis was associated with the presence of two risk genotypes, with OR values of 1.6 (95% CI = 0.64-3.8).
Conclusion: It could be concluded that XRCC1 399Gln and TP53 72Pro alleles are significantly associated with an increased risk for endometriosis. More than one gene variant didn't significantly increase the risk of endometriosis. Therefore, further larger population-based studies including other DNA repair pathway genes are needed in order to confirm the possible relationship between DNA repair gene polymorphisms and endometriosis risk.