Journal of Advances in Medicine and Medical Research

We describe a case of malaria vivax in a 31 year old Afghan male complicated by spontaneous splenic rupture one month after returning from Pakistan. The ruptured and enlarged spleen displaying multiple subcapsular hemorrhages was surgically resected. Malaria was diagnosed by peripheral blood smear. The patient underwent antimalarial therapy with chloroquine and primaquine. While numerous diseases can result in splenic complications, such as splenic rupture malarial infection is known as the most common cause. Consequently, It is recommended that malaria be always considered in all cases of suspected splenic rupture in the differential diagnosis of all acute fevers, especially among those with a history of travel to an endemic area.

Introduction: Pre surgical nasoalveolar molding (PNAM) is a viable option in reducing the severity of the cleft resulting in easier surgical repair and the lip and the nose heal under minimal tension and this leads to less scar formation.
Presentation of Case: A case report with UCLP treated by PNAM appliance is described here.
Discussion: Orthopedic molding reduces the deformity and thus reduces the number of surgeries to achieve superior post-surgical esthetics.
Conclusion: PNAM resulted in well aligned alveolar segments, approximated lip, improved columella-philtrum region and nose.

Aging is associated with a decline in maximal aerobic capacity (VO_2max) that may be attenuated by chronic endurance exercise. This case study chronicles the changes in marathon times in a 91 year old man who completed 627 marathons and 117 ultramarathons over 42 years. He began running marathons at age 48. His yearly best times remained fairly constant at ~240 minutes from age 50 - 64 years and then gradually rose to about 260 minutes in his early seventies followed by a curvilinear deterioration as he approached his ninth decade. His times plateaued at ~ 600 minutes in his late eighties. Between ages 68 and 89 his VO_2max declined from 43 to 20 ml/kg/min. His marathon times were highly correlated with his VO_2max (r²=0.87). The decline in marathons times and VO_2max may reflect the contributions of biological aging, changes in exercise training volume and intensity, injuries, and comorbid disease.

Objective: To compare two intra-arterial catheter-directed thrombolysis (CDT) techniques (bolus vs infusion) with respect to clinical outcomes and resource utilization in the management of peripheral arterial thrombosis.
Methods: In a retrospective single-center study, 20 consecutive patients with acute or sub-acute thrombosis received tissue plasminogen activator (tPA) treatment administered either as a bolus via an irrigating balloon catheter (CDT-CLEARWAY group; n=10) or as a bolus followed by a continuous infusion using a traditional infusion catheter (CDT-INFUSION; n=10). Adjunctive therapies were administered at the discretion of the operator. Patients were followed for 30 days post-intervention for complications and major adverse clinical events.
Results: All 20 patients (12 men; median age 71) had Rutherford clinical stages 4-6 at presentation. Procedural success was achieved in all cases. The mean tPA amount required was reduced in the CDT-CLEARWAY group (8.9 mg vs 32.9 mg), as was the mean time to patency (2.2 hrs vs 16 hrs, P<.001). There were no bleeding complications in the CDT-CLEARWAY group while one patient in the CDT-INFUSION developed intracranial and gastrointestinal hemorrhage. The CDT-CLEARWAY procedure was associated with a significant reduction in mean length of hospital stay (2.2 vs. 5.6 days, P<.001) and mean total cost, which were mostly due to the lack of ICU requirement for the CDT-CLEARWAY group. More patients in the CDT-CLEARWAY group (7/10 patients vs. 1/10 patients) underwent adjunctive thrombectomy procedures following disruption of the thrombus in the target vessel.
Conclusion: Significant reductions in total cost, amount of tPA used, and hospital stay were accomplished using a bolus dose of thrombolytic therapy through an irrigating balloon catheter versus a maintenance infusion dose through a standard infusion catheter, while maintaining the efficacy in restoring flow in target vessels.

Aim: Mosquito borne diseases especially malaria is a serious public health problem in the tropical and sub-tropical regions of the world especially the developing countries including India. Besides available key interventions to control the spread of vectors and vector borne diseases, there is a felt need for involving a suitable community approach based on knowledge, attitude, awareness, behaviour and protective practices to get the best results. Hence, the present study is an attempt to provide some inputs in this direction.
Methodology: A community based cross-sectional survey was carried out in a highly malaria endemic cluster of six selected villages of Rohtak and Mewat region of Haryana to know the respondent knowledge about malaria and other mosquito-borne diseases, as much as their attitude, awareness and practices regarding the malaria and its control. The results obtained were processed and analyzed statistically by using STATA version 10 software.
Results: The study revealed that about 52% of the respondents in Rohtak region and 42.68% in Mewat region committed that malaria is transmitted by mosquito bite which was directly correlated with the level of education. It was observed that high fever, chills and body pain were considered as the major signs/symptoms of malaria. Television followed by friends and relatives and health care provider’s acts as the major source of information about malaria and other mosquito borne diseases. Overall (76.2%) individuals from both study areas mentioned that malaria is a serious problem in their area but only 46.3% knew about various Government measures for the protection and treatment of malaria. Mosquito nets, mosquito coil and repellents were commonly used as protective practices by the respondents but the difference was not found significant except for mosquito net (P <0.05) in both the study areas.
Conclusion: Promoting active community participation by improving current intervention strategies through information, education and communication regarding malaria and other mosquito-borne diseases may yield better results.

Background/Aim: Gastric cancer causes the second highest number of cancer related deaths. The purpose of this study is to evaluate the survival of patients who are T3, T4, lymph node positive postoperatively and have undergone adjuvant chemoradiotherapy (CRT). We also examined the toxicities of CRT.
Materials and Methods: Included in this retrospective study were one hundred six, stage IIA, IIB, IIIA, IIIB and IIIC gastric cancer patients undergoing adjuvant chemoradiotherapy after four weeks of surgery presenting at our hospital between 2009 and 2013. Statistical analysis was done with the SPSS (version 19) programme and survival analysis was done by using the Kaplan-Meier method.
Results: The median follow-up of patients was 25 months (range; 7-38). There were local recurrences in 25.9% (n=22) of patients and liver metastasis in 20% (n=17), lung metastasis in 16.5% (n=14) and peritoneal metastasis in 5.9% (n=5). There were no recurrences in 31.8% (n=27) of patients. The median disease free survival (DFS) of the patients was 11 months (8.4-13.5) and overall surival (OS) was 29 months (24.3-33.6).
Conclusion: Survival rates were found to be lower than expected, this could be due to ongoing dietary habits and the low socioeconomic status of the patients. Toxicities were manageable.

Background: The high cost of intensive care unit (ICU) services and limitations in health resources can prompt managers to use predictive scoring systems.
Objective: To evaluate the role of APACHE II as a scoring system to predict outcomes and to compare actual and expected mortality rates.
Methods: This prospective study was conducted in a10-bed, mixed ICU at Namazi University Hospital, a teaching hospital in Shiraz, Iran. All patients were included consecutively and data were collected during the first 24 h of admission. Statistical analyses were done with SPSS v.16 software. The differences were considered statistically significant at a P value of <0.05.
Results: From June to November of 2013, data were available for 110 (61.4%) ICU admission. The patients’ mean (SD) age was 55.1 (17.7) years. Mean APACHE II score was 17.85±7.4. The total standardized mortality ratio (SMR) was 0.92, and the ratio ranged from 0.48 in medical patients to 1.22 in post-elective surgery patients. With the sensitivity 18.5% and specificity 92.8%, the highest correct classification was obtained at predicted death risk 0.6 (74.5%).
Conclusion: We recommend the use of this outcome prediction score for decision-making and classifying patients based on the degree of severity of their diseases in our setting. Further work is needed with larger sample sizes to more precisely determine the generalisability of our results and evaluate validity of this outcome prediction score.

Aims: To highlight the observed features including socio-demographic, economic and biochemical characteristics seen among uncontrolled diabetic adults that should be areas of concern or focus by healthcare providers during the management of diabetes in the country. Also to perform molecular characterization of bacterial organisms prevalent among a cross section of diabetic patients with asymptomatic bacteriauria.
Study Design: This was a cross sectional prospective and descriptive study.
Place and Duration of Study: Study was carried out among patients attending two non-communicable chronic diseases health centers in Trinidad & Tobago over a 6 months period in 2012.
Methodology: Following informed consent, diabetic volunteers were recruited to participate in the study. Participants fulfilled study criteria that included absence of urinary symptoms, not catheterized, no history of UTI or any form of uropathy. Blood samples were screened for Hb1Ac, serum electrolytes and urea values; urine for microscopy, culture and sensitivity. Enterobacteriaceae isolates from urine culture were subjected to screening for CTX-M, TEM, and SHV by amplification of gene fragments by conventional PCR and for KPC, and NDM and OXA48 targets by real-time PCR using Sybergreen melting curve analysis.
Results: Four hundred and fourteen diabetics were surveyed. Significant (15.7%; 65/414) bacteriauria was noted in sixty five subjects. Majority, 81.5% (53/65) with positive urine cultures had high HBA1c values. Escherichia coli 48.57% (34/70) and Klebsiella pneumonia 25.7% (18/70) were the most recovered organisms, with 87.1% (61/70) from urine samples and 75.4% (49/65) from female subjects. Urine samples from males 24.6% (16/65) yielded mostly Staphylococcus epidermidis 14.3% (10/7) and Staphylococcus aureus 5.7% (4/70) respectively. All Enterobacteriaceae isolates were negative for KPC, NDM and OXA-48. Although the blaTEM and bla SHV were detected in both the E. coli and K. pneumoniae isolates as expected.
Conclusion: Escherichia coli was the prevalent Enterobacteriaceae among the patients with asymptomatic bacteriauria. Poor diabetic control is significantly and strongly associated with bacteriauria that was more prevalent among female diabetics. Although none of the antimicrobial resistant targets were encountered among the Enterobacteriaceae, there is still the need to keep an eye on these targets and diabetic subjects in the country.

Introduction: Implant-supported extra-oral prostheses often require a retentive matrix to hold gold alloy clips and magnets, which act as retentive means. Silicone elastomers have a different structure to acrylic resins. Hence, primers are used to increase the bonding between silicone and acrylic resin.
Aim of Study: To investigate the effect of new platinum primers on the peel bond strength of silicone elastomer to acrylic resins.
Materials and Methods: Peel bond strength of Cosmesil 2004 to two acrylic resins was assessed using two primers (MED6-161 and MED160) and no primer (control group). Sixty samples were prepared and divided into six groups according to the combination of acrylic resin, silicone, primer and no primer. All samples were then exposed to load in a universal testing machine with a cross head speed of 25 mm/min until failure. Data was analysed using STATA 12.1 software. Values of mean peel force between light and auto-polymerising acrylic resins were compared using two-way ANOVA and tukey HSD test.
Results: The interaction between primers and acrylic resins had a significant effect on peel bond strength between Cosmesil 2004 and acrylic resins. MED6-161 primer significantly improved peel bond strength of Cosmesil 2004 to light-polymerising acrylic resin. However, MED-160 primer enhanced peel bond strength between Cosmesil 2004 and auto-polymerising acrylic resin.
Conclusion: The combination of primer and acrylic is important in improving the bond strength. However, further investigation of different primers, silicones and different surface treatments to achieve the optimum bonding is need.

Aims: Ventilator-associated pneumonia (VAP) due to mechanical ventilation is an important issue that increases mortality and cost of treatment. In this study, we aimed to compare the effectiveness of three scoring models for estimation of mortality and morbidity in patients with ventilator associated pneumonia.
Study Design: Prospective research.
Place and Duration of Study: Patients with VAP who were admitted into intensive care unit Pamukkale University Hospital prospectively included in the study between January 2012 and June 2012.
Methodology: Demographical data, diagnosis on admission, departments from where admitted, APACHE II, Mortality Probability Model II₀ (MPMII₀) and Mortality Probability Model II₂₄ (MPMII₂₄) scores on admission, length of stay in intensive care and hospital, duration of mechanical ventilation, microbiological data for pneumonia, outcome and Clinical Pulmonary Infection Score values on day 1, 3, 5 and 7 were recorded.
Results: Eighty patients (F/M: 37/43) were included study. Mortality was 67.5%. MPM II₀, MPMII₂₄ values were significantly high in patients who has died but ROC curves were not significant for any of the scoring systems. In addition, relationship between scoring models and mortality, duration of mechanical ventilation, length of stay in intensive care and hospital was not statistically significant (P=.05).
Conclusion: We concluded that each of the three scoring systems for the prediction of mortality in VAP was not superior to each other.