Journal of Advances in Medicine and Medical Research

Aim: To assess a case of Fournier’s gangrene and treatment of this problem.

Case Report: A 70-year-old male presented to the emergency ward with a complaint of scrotal and perineal pain and swelling. He had a past medical history for poorly non-controlled diabetes mellitus. Based on the history, physical examination and these findings, a diagnosis of Fournier’s gangrene was made. An emergent surgery consultation was obtained and after evaluation, the patient was transferred to the operating room for debridement of the scrotal and perineal skin and soft tissues. He was treated with surgical debridement thrice beside broad spectrum antibiotics.

Conclusion: This case describes a sample of successful treatment with surgical and antibiotic therapy in Fournier’s gangrene.

Introduction: Periapical lesions generally develop as a sequel to pulpal infection. When there is a large periapical tendency visible on the radiograph, clinicians tend to have a surgical approach towards treatment. However a non- surgical approach with appropriate use of intracanal medicaments should be attempted to salvage teeth. This paper demonstrates healing of large periapical lesions in two cases by non – surgical Endodontic treatment

Case Presentation: This report describes Endodontic treatment of a mandibular first molar and maxillary incisors. Calcium hydroxide in an aqueous vehicle was placed as intracanal medicament, the dressing changed every fifteen days for a period of three months. Continued follow ups demonstrated radiographic healing and the patients were asymptomatic.

Conclusion: The case reports presented in this article showed healing of large periapical lesions following endodontic treatment. Isolation with rubber dam, thorough chemo mechanical debridement of the root canal space with use of calcium hydroxide as intracanal medicament is emphasized.

Background: Hepatitis C is increasingly found to be a significant etiological agent causing liver disease in India. Prevention is the best safeguard against this silent killer but a major obstacle has been the low awareness. Attitudes and awareness of general population can play a key role in prevention of spread of infection.

Aims: The objectives of the present survey were to assess the knowledge and attitudes of general population vis a vis risk factors, route of transmission, vaccination and treatment of Hepatitis-C virus (HCV).

Study Design: Cross-sectional questionnaire based study.

Place and Duration of Study: South west border region of Northern Indian State of Punjab from 2012-2014.

Methodology: This random survey was conducted in south west border region population of northern Indian state of Punjab.

Results: Overall, 24.2%, 29.2% and 46.6% respondents had good, fair and poor awareness levels respectively.

Conclusion: The study highlights and calls for a targeted and effective HCV awareness, by innovative means and on an emergency basis, to control the spread of this silent killer.

Sickle cell anaemia is an inherited disorder of haemoglobin characterized by sickled red blood cells and increased destruction of these cells. Antioxidants protect cells from the damaging effects of free radicals. The aim of this study was to determine antioxidant vitamin A in steady state sickle cell anaemia patients and that of controls in Maiduguri, Borno state North-Eastern Nigeria. The study was carried out at UMTH Maiduguri. Sixty sickle cell anaemia patients were compared with sixty controls, aged ranged 1 year 3 months to 33 years of age, using HPLC for vitamin A status. The mean vitamin A in sickle cell patients according to age ranged between 0.047±0.002 to 0.053±0.002 mg/ml, while that of controls is 0.053± 0.001 to 0.091±0.001 mg/ml. The maximum mean serum vitamin A (0.053±0.001 mg/ml), in SCA was found in the business and children groups while the minimum vitamin A (0.039±0.001 mg/ml) was recorded in the un-employed SCA patients. The study showed the antioxidant vitamin A was found to be lower in the SCA subjects than in normal control in all age groups. Level of education also plays a role in the level of antioxidant vitamins in the blood.

Aims: To assess the concordance between conflicts of interest reported by physicians in three major scientific journals and industry-reported payments available through the Open Payments Program (OPP) database.

Study Design: Comparative cross-sectional surveys.

Place and Duration of Study: United States allopathic and osteopathic physicians with publications in American Journal of Ophthalmology, JAMA Ophthalmology, and Ophthalmology accepted after January 1, 2014 and published from May 2014 through October 2014.

Methodology: We compared physicians’ self-reported conflicts of interest in their academic publications to industry-reported payments in the Centers for Medicare & Medicaid Services OPP database. Authors were categorized based on concordance between self-reported disclosures and payments listed in the database. Payments were designated as disclosed or undisclosed.

Results: Of the 670 authors surveyed, 367 (54.8%) were in perfect concordance with the OPP database; 68 (10.1%) authors made disclosures beyond those in the database but had no undisclosed ties; 235 (35.1%) authors had one or more undisclosed payments.  Disclosed and undisclosed payments totaled $1.46 million and $1.81 million, respectively.

Conclusion: In three major ophthalmology journals, a significant discrepancy exists between conflicts of interest reported by physician authors and payments found in the OPP database.  This lack of concordance raises concerns about incomplete physician disclosure, inaccurate reporting, inadequate vetting, and ambiguity over financial relevance, all of which undermine confidence in the disclosure process.

Aims: In this study, patient safety culture was assessed in four educational hospitals in Ilam city, Iran.

Study Design and Setting: A cross-sectional study was carried out in four educational hospitals (Imam Khomeini, Mustafa Khomeini, Taleghani and Kowsar hospitals) in Ilam city (Iran).

Study Duration: The study was conducted over 2014.

Methods: The data collection was conducted via the Iranian version of Hospital Survey on Patient Safety Culture (HSOPSC) questionnaire. The questionnaire contains 42 items that evaluates 12 dimensions of patient safety culture.

Results: The results showed that 47% of the participants had 1- 5 years of work experience and 71.1% of them worked more than 40 hours per week in hospital. The mean positive answers score of the safety culture in this study was obtained 40% that was much lower than the benchmark (64%). The highest and lowest percentages of the positive answer were attributed to teamwork within units (70%) and non-punitive response to error (11%), respectively.

Conclusion: In order to increase the patient safety culture in the hospitals, the number of professional staff should be increased and a practical plan about the patient safety culture should be provided. Moreover, the hospitals management should support the staff to report errors without fear of the punishment.

Introduction: Tuberculosis (TB) is an Infectious disease existing pandemically in our world.In parallel, the prevalence of multidrug-resistant tuberculosis (MDR-TB) is also increasing. The TB control programs were not successful due to the emergence of multidrug resistance in M. tuberculosis strains. Objective of the present study was to detect the rate of MDR-MTB in the central state of India.

Materials and Methods: The study included all new & old cases of pulmonary & extra pulmonary tuberculosis enrolled between January 2013 and December 2014 carried out in our Indore, lab, India. All the patients’ samples found to be TB positive in our lab were tested by Mycobacterium culture and MTB isolated strains were put for first-line drug-susceptibility testing (DST). MDR-TB was defined as TB caused by bacilli showing resistance to at least isoniazid and rifampicin.

Results: A total of 60 MTB isolated strains; fourteen were MDRs (23.3%). Resistance to INH, RIF, PYRA, ETHAM,streptomycin (STREPTO) was found to be 41%, 36.6%, 23.3%, 30%, 25% respectively.

Conclusions: MDR-TB prevalence was found to be high among both new & old cases of pulmonary & extra pulmonary tuberculosis cases. Nation-wide and State-wide representative data on prevalence of MDR-TB are lacking in the state of Madhya Pradesh, in India. Efforts needs to be directed towards further continuous surveillance for MDR-TB among newly diagnosed TB cases and old diagnosed cases.

Aim: This work was aimed at determining the influence of nutritional status on physical aptitudes and cardiovascular profiles of children in rural and urban areas of North Cameroon.

Experimental Design: The study was a cross-sectional survey.

Place and Duration of Study: The study was carried out in Cameroon from February to March 2014.

Methodology: Overall, 633 children aged 6-17 years were enrolled into the study. Demographic information was recorded. Weight, height, cardiovascular profiles [heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP)] and physical aptitudes [six minutes walk (6MWT), broad jump (BJ), 30 m dash] were evaluated.

Results: Prevalence values of malnutrition and hypertension were 3.3% and 0.31% respectively. HR was significantly higher in males (P<0.001), children aged 6-10 years (P=0.001) and those from urban areas (P<0.001) when compared with their respective counterparts. DBP was significantly higher in children aged >10years (P=0.01) and normonourished children (P=0.014) than their respective counterparts. SBP was higher in children aged >10 years than those aged 6-10 years and the difference was significant (P<0.001). The mean 6MWT and mean BJ were significantly higher (P<0.001) in children aged >10 years and those from rural areas (P<0.001) than their respective counterparts. The mean time taken to do the 30 m dash was significantly higher (P = 0.001) in children from rural areas (6.15±0.06 sec), than those from urban areas (5.86±0.22 sec). There was a negative correlation between the HR and mean BJ (P<0.001), HR and mean 6MWT (P <0.001), SBP and mean time for 30 m dash (P <0.001), DBP and 30 m dash (P<0.001) in the normonourished children. There was a positive correlation between HR and 30 m dash (P<0.001), SBP and BJ (P<0.001) as well as DBP and BJ (P<0.001) in normonourished children.

Conclusion: A weak correlation was registered between the nutritional status, physical and cardiovascular parameters of the school children.

Background: Hyperhomocysteinemia has been identified as a risk factor for stroke and other vascular diseases in the general population, its role in sickle cell disease (SCD) has not been investigated in children with SCD in Nigeria.

Aim: This study was designed to evaluate plasma homocysteine, B-vitamins, folate and lipid profile in sickle cell disease (SCD) HbSS children in Nigeria.

Methods: Fifty (50) SCD children (12.04±4.17 years) consisting of 30 females and 20 males were selected from Sickle club center Abeokuta. Fifty non SCD (HbAA) children (12.62±4.28 years) consisting of 25 males and 25 females were included as controls. Anthropometric indices and plasma homocysteine, B₁₂, B₆, folic acid, lipids and lipoproteins were determined using standard procedures.

Results: The results showed significant decreases in body weight (29.84±10.68 kg) and height (1.37±0.16 m), (p<0.045) in all SCD patients. Plasma total homocysteine (tHcy) (6.40±3.37 µmol/L) was significantly increased (p< 0.05), whereas plasma vitamins B₆ (28.81±12.44 nmol/), B₁₂ (184.16±35.13 pmol/L), folic acid (46.73±9.93 µmol/L), total cholesterol (102.42±28.62 mg/dl), low density lipoprotein cholesterol (24.45±5.25mg/dl) (p< 0.01) and triglyceride (71.98±22.61 mg/dl) (p<0.04) were markedly decreased compared with the control values. Plasma high density lipoprotein cholesterol was however not significantly different from the control value. Plasma tHcy) did not correlate with any of the measured parameters.

Conclusion: Increased plasma total homocysteine level and reduced B vitamins as well as lipids profile obtained in this study are prominent features of sickle cell disease in this environment.

Benign prostatic hyperplasia is the most common prostatic pathology and its incidence has accelerated recently [1]. Benign prostatic hyperplasia (BPH) is diagnosed histologically as enlargement of mucosal and sub mucosal glands with the proliferation of prostatic stroma occurring within the prostatic transition zone [2]. BPH compresses the urethra resulting in anatomic benign prostatic obstruction and may present as lower urinary tract symptoms (LUTS). The prevalence of LUTS  can be progressive in the aging male [3]. LUTS associated with BPH usually affects 45% of males in their 50s, and 80% of males are affected by LUTS in their 70s [4]. Benign Prostatic Hyperplasia is not a life threatening condition, but has negative impact on a patient’s quality of life as evidenced in community and clinical studies [5]. Obstruction related LUTS that develops in BPH occurs as a result of dynamic and static components [6]. In order to evaluate the BPH\LUTS American Urology Association devised a scoring system called AUASI (American Urological Association Symptom Index) which consists of six questions and International Prostate Symptom Score (IPSS) is based on seven questions and their answers concerning urinary symptoms [7].

Data Selection: Literature published during 2008-2014 were selected for review from cross-sectional and cohort studies.

Data Extraction: Data was collected and assembled from NCBI, Google Scholar, journals of Radiology and Urology.

Conclusion: The accurate assessment of LUTS plays a pivotal role in the interpretation of benign prostatic hyperplasia therefore, the authenticity of symptom scores is crucially important. International prostatic symptom score is the paradigm questionnaire for subjective evaluation of symptoms of the lower urinary tract [8]. The IPSS and IPSS quality of life (QoL) questionnaire can be an important tool for the diagnosis of BPH.