Journal of Advances in Medicine and Medical Research

IgA nephropathy (IgAN) is the commonest form of glomerulonephritis worldwide and 15–30% of patients will ultimately develop end-stage renal failure. IgAN can be primary (in most cases) or secondary (associated with seronegative arthritis, cirrhosis, coeliac disease, vasculitis, HIV), but is rarely associated with Crohn’s disease (CD). We describe a case of 22 year-old man with CD associated with IgAN. After the patient underwent surgical resection of right colon due to suspected colon tumor, CD was diagnosed. 5 years after right hemicolectomy, microscopic hematuria was developed and a renal biopsy had revealed IgAN (type III). Patients with CD who present with hematuria more commonly have urological complications, but the possibility of renal parenchymal disease should also be considered.

Aim: The present study was undertaken with the purpose to assess the correlation between the presence of lymph node metastases and the size of tumor and the thickness of the tumor mass.
Methods: The study included 80 consecutive cases of oral squamous cell carcinoma, who underwent radical neck dissection. The various level of lymph nodes in these cases were checked for metastases, which was then correlated with the size of tumor and the thickness of the tumor.
Results: In this study it was revealed that there is a statistically non-significant (p = 0.3204) correlation between size of the tumor and regional cervical lymph node metastases, but a significant correlation (p = 0.0148) between thickness of the tumor and regional cervical lymph node metastases was observed.
Conclusion: Thus we conclude that the tumor thickness was more in cases with skip metastasis than in cases without skip metastasis and tumors greater than 10mm in thickness have more chances of regional metastases.

Aim: This study is aimed to investigate the success rate and clinical outcome of placed implants in reconstructed alveolar ridges using iliac cortico-cancellus bone graft compared to normal non-augmented alveolar ridge.
Materials and Methods: In this clinical trial study, 30 patients who were selected and assigned in case and control groups. The case group included patients with severe alveolar bone loss, who needed bone grafting. The control group included patients with sufficient alveolar ridge and no need for bone grafting. The prosthesis was placed on implants after 3 to 8 months. Plaque index, bleeding, pocket depth, mobility, pain, pus secretion and bone loss were evaluated after 24 month. Data were analyzed by SPSS 13. P-value less than 0.05 was considered as significant.
Results: Out of 30 patients, two were excluded due to their requirements. Totally 97 implants were placed in patients, which included 52 implants in control group and 45 implants in case group. All of the implants were successfully osseointegrated and loaded. There was no significant difference between the success of inserted implants between both groups (P=0.05). The mesial and distal bone losses were significantly more in patients without iliac bone graft (P=0.05). There was no statistically significant difference between measured outcomes including plaque, bleeding, pocket depth, mobility, pain, and pus secretion (P=0.05).
Conclusion: Inserted implant in free non-vascularized iliac bone graft has high rate of success comapred to non-augmented alveolar ridges and has shown to be a reliable method for reconstruction of severe atrophic jaws.

Aims: To explore experiences of elderly people on reproductive decisions made by couples living with HIV in rural southern Malawi.
Study Design: This was a qualitative exploratory descriptive research.
Place and Duration of Study: The informants were recruited from two districts in southern Malawi, patrilineal Chikhwawa - Ngabu area and matrilineal Chiradzulu - Ndunde area between July and December, 2010.
Methodology: Four focus group discussions, with thirty elderly men and women, 15 from each district, where division by gender was the criteria employed in attempts to create well-functioning and articulate groups were selected purposively. Data was analyzed concurrently with data collection using content method. The interviews, which, were transcribed verbatim were uploaded into Nvivo qualitative management software enabling a systematization and easier retrieval of data.
Results: Emerging themes were generation gap, defeated/ignored, lack of information and blame situation. First there was generation gap which led to the elderly people feel that their role in the community was defeated, which they indicated by being ignored in reproductive decision making. They further indicated that they lack information about current issues related to HIV, AIDS and reproductive decisions in couples living with HIV. All these led to a blame situation where the elderly people blamed either the couples living with HIV or health workers for the current situation.
Conclusion: Older people need to be recognized, supported and educated in the fight against HIV and AIDS. The different needs, roles and responsibilities of older men and women need to be acknowledged and included in programs and policies addressing this global epidemic.

Aim: To evaluate the methodology of MTT tube assay and compare it with standard proportion method for detection of drug susceptibility of M. tuberculosis to rifampicin (RIF) and isoniazid (INH).
Study Design: Prospective.
Place and Duration of Study: Sher-i-Kashmir Institute of Medical Sciences, Kashmir, India. One year study.
Methodology: MTT [3-(4, 5-dimethylthiazol-2-yl)-2, 5-diphenyl tetrazolium bromide] assay was performed on 60 clinical isolates of M. tuberculosis. An inoculum of 10⁷CFU/ml prepared in Middlebrook 7H9 with OADC (Oleic acid, albumin, dextrose and catalase) was chosen as standard. For each drug three tubes were used, one drug containing (INH 0.2 µg/ml or RIF 1 µg/ml), second inoculum control and third blank control. The method was performed after incubating the tubes at 37°C for 4 days for RIF and 7 days for INH. Results were read visually and by spectrophotometer at 570 nm. Relative optical density units of 0.2, was taken as cutoff. Results of drug susceptibility were compared with those obtained by Lowenstein Jensen proportion method.
Results: For RIF, sensitivity was 88.9% and 94.4%; specificity was 100% and 97.6% for visual MTT and MTT by RODU respectively. For INH similar sensitivity of 95.1% was seen while specificity was 97.0% and 95.0% by visual MTT and MTT by RODU respectively. There was almost perfect agreement between proportion and MTT method for both drugs. Turn-around time for MTT assay was 7 days.
Conclusion: The MTT tube assay can be used for rapid drug susceptibility testing of M. tuberculosis to RIF and INH.

Aim: Respect for human dignity right has been accepted as a fundamental human need in the world, but its meaning is complex. The present research aimed to understand the meaning of patient dignity in Iran.
Study Design: The study was a qualitative study using content analysis.
Place and Duration of Study: The study was performed in Kerman, Iran in 2014.
Methodology: The study was conducted among patients with Heart diseases. The purposive sampling technique was used to select the participants. Participants were 16 heart patients admitted from two hospitals affiliated with the Kerman University of Medical Sciences. Twenty semi-structured interviews were constructed. Data were analyzed using qualitative content analysis
Results: The analyzed data were made into two main themes and ten sub-themes. The two main themes that emerged were 1- Basic dignity with subthemes (Human security, Comprehensive care, Education and awareness, Respect, Effective communication and Privacy), 2- Transcendent dignity with subthemes (Trust, Gratitude, Satisfaction, Spiritual growth). In the basic dignity, the focus was on physical and psychological needs and in the transcendent dignity; the focus was on spiritual dimension. The results of this study may help health care professionals in understanding patient dignity in Iran.

Background: Diabetes mellitus (DM) and its complications are on the increase especially in the developing countries with significant negative economic consequences on individuals, families and health systems.
Objective: We, therefore compared albumin/creatinine ratio, microalbuminuria, and HbA1c among subjects of varying degree of complications with controls to ascertain if they can serve as markers of diabetic chronic complications to enhance early detection of chronic complications amongst diabetes mellitus patients in developing countries.
Methods: 109 type 2 DM subjects (47 males and 62 females) and 100 non-DM controls of the same age range (40-80 yrs) were recruited for this study. The chronic complications found were: nephropathy, retinopathy, coronary artery disease, cerebrovascular disease, peripheral vascular disease and diabetic foot. These were further classified into micro vascular complications (nephropathy and retinopathy) and macrovascular complications (Coronary Artery Disease, Cerebrovascular Disease, Peripheral Vascular Disease and diabetic foot).Out of these 109 DM subjects, 36 were without chronic complications, 37 have microvascular complications only and 36 have a combination of microvascular and macrovascular complications. HbA1c, Urine microalbumin and creatinine were analysed using standard methods.
Results: The mean levels of HbA1c, Microalbuminuria and albumin-creatinine ratio were significantly higher in DM subjects when compared to the control (p<0.05). Microalbumin, albumin-creatinine ratio, and HbA1c were significantly higher in DM subjects with chronic complications than those without complications (p<0.05). However, DM subjects with both macro and micro complications had significant higher level of urine microalbumin, albumin-creatinine ratio, and HbA1c than those with microvascular complications only (p<0.05). Subjects aged 40-45 years had significant (p<0.01) albumin/creatinine ratio than subjects aged 51-55yrs as well as those >60 years. The male subjects had a significant (p<0.01) albumin/creatinine ratio and microalbumin respectively on comparing to their female counterpart
Conclusion: Albumin-creatinine ratio is a simple, and less cumbersome tool which could serve as a predictor of complications in type 2 diabetes mellitus.

Context: Left ventricular structure and mass is related to body composition. Fat mass as well as fat free mass are known to affect the left ventricular architecture.
Aims: Our goal was to evaluate the relationship between body composition and left ventricular morphology in young healthy non-obese males and females.
Settings and Design: This was the cross sectional study done on 100 (51 male & 49 female) physical education college students.
Methods and Materials: Left ventricular structure was analyzed by 2-D and M-mode echocardiography. Body composition was analyzed using bioelectrical impedance analysis.
Statistical Analysis Used: Pearson correlation analysis and stepwise multiple regression analysis between body composition parameters and left ventricular structure was done using SPSS16 software.
Results: In males, end systolic left ventricular posterior wall thickness (LVPWs) showed significant correlation with weight (r=0.348, p<0.05), BMI (r=0.293, p<0.05), BSA (r=0.314, p<0.05) and fat free mass (r=0.284, p<0.05). BMI showed significant correlation with end systolic left ventricular Internal diameter (LVIDs) (r=0.309, p<0.05), end diastolic Inter ventricular septal thickness (IVSd) (r=0.299, p<0.05) and left ventricular mass (r=0.370, p<0.01). End diastolic Inter ventricular septal thickness (IVSd) also showed significant correlation with weight. (r=0.296, p<0.05) No significant correlation was seen in female subjects.
Conclusion: This study showed that the body composition influences some cardiac structural parameters in adult male subjects. However no significant influence was seen in female subjects. Body mass index was shown to have prominent influence on left ventricular structure in males.

Objective: Evaluate the functional status of critically ill patients after hospital discharge and assess the effect of age and Acute Physiology and Chronic Health Evaluation II on the questionnaire scores.
Study Design: An observational longitudinal study.
Place and Duration of Study: The study was carried out between May 2010 and January 2011, at the Clinical Hospital of the University of São Paulo, Brazil.
Methodology: 147 patients, admitted to the Intensive Care Unit, ≥18 years old, underwent at least 24 hours of Invasive Mechanical Ventilation (IMV), were eligible after hospital discharge for this study. The functional status was assessed by using the Barthel Index, Katz Index and Health Assessment Questionnaire – Disability Index (HAQ-DI), at one, three, and six months after hospital discharge.
Results: Out of 147 eligible patients, 75 and 68 responded to the initial and final evaluations, respectively. Functional status improved significantly over time in all questionnaires. The analysis with two factors (age and severity of illness) in each of the three evaluations revealed significant interaction for Katz Index in the third evaluation (p=.001), and no interaction for the Barthel Index and HAQ-DI in each of the three evaluations.
Conclusion: The functional status of critically ill patients after hospital discharge was not related to age or severity of illness or length of stay in IMV, ICU or hospital. When divided into groups of age and severity of illness, patients with less severe illness presented a higher Katz score if they were older. Yet older patients tended to present higher Katz score with more severe illness.

Aims: To investigate the effect of variations of plasma levels of thyroid and growth hormones on the physical growth indexes, the variation of these hormones with age, correlation of thyroid and growth hormones at varying concentrations of growth hormone in children aged 6-10 years.
Study Designed: Department of Medical Laboratory Science, University of Calabar, conducted between March 2014 and February 2015.
Methodology: Anthropometric uniqueness were described and Body Mass Index calculated for 180 (male 81 and female 99) participants of the study. Thyroid and growth hormones were determined by Enzyme-Linked Immunosorbent Assay (ELISA) specific for the various hormones, using STAT FAX 303 microtitre plate reader.
Results: Nineteen percent (n=34) had GH values (≤0.6 ng/ml), lower than the expected normal, 64% (n=115) had values between (0.6-10.0ng/ml) while 17% (n=31) had values ≥10.0 ng/ml. Ninety two percent (n=166) of the children had thyroid stimulating hormone (TSH) values between 0.35-8.44 µIu/ml; 6.1% (n=11) had values >8.44 µIu/ml which are above normal while1.7% (n=3) had values <0.35 µIu/ml lower than normal. Triiodothyronine appears to increase from birth recording a peak within the first year of postnatal life, and then progressively declining to adult values while GH increases from birth attaining a peak about the age of nine then falling progressively to adult values. Children with apparent GH deficiency had significantly higher T3 and T4 levels and lower TSH, those with high GH values had correspondingly low T3 and T4 values and high TSH. The correlation coefficients of TSH and growth hormones in those with high and low GH (r=-0.05 and r=-0.130) respectively were both negative while that of TSH and GH in those with normal GH was positive (r=0.093), however, physical growth indexes are preserved across board.
Conclusion: It was concluded from the study that growth failure may be due to failure of both hormones and may likely not occur when an unbroken synergy exist between thyroid and growth hormones during childhood.