Journal of Advances in Medicine and Medical Research

Background: Mitochondrial dysfunction leading to insulin resistance may contribute to metabolic and cardiovascular abnormalities and subsequent increase in coronary artery disease. Since mitochondria are involved in generation of ROS, we aimed to investigate the association of mtDNA mutations with T2DM and CAD in our population.

Methods: We analyzed the complete mtDNA of South Indian subjects which included patients with angiographically documented CAD [n = 120], subjects with Type 2 Diabetes Mellitus and CAD [n = 150] and healthy control subjects without clinical manifestations of atherosclerotic disease and Type 2 Diabetes [n = 100]. We detected the association of common variants of the mitochondrial genes with both T2DM and CAD, which raises the possibility of a shared mitochondrial genetic background of these metabolic disorders in our population.

Results: The complete mitochondrial analysis of the control group revealed several sequence variations but did not show any novel mutations. Mitochondrial analysis of individuals with CAD and T2DM revealed a total of 36 novel variations. Mutations were more prevalent in NADH Dehydrogenase [ND] genes that encode mitochondrial enzyme Complex I. Among the 20 novel mutations in the ND genes, 17 were missense, 2 synonymous and 1 frame shift variant were observed. In Cytochrome b [Cytb] gene, 7 variations observed were novel that included 5 missense mutations in cytochrome c oxidase [CO2] were novel mutations including 1 missense mutation and 1 synonymous mutation. In rRNA genes, we identified 1 novel variant in 12s RNA and 3 in 16s rRNA. Among the CAD patient group without T2DM, 3 novel variants in ND region were identified of which 2 were synonymous and one was missense. The variants observed are not reported to have any disease association so far by any studies.

Conclusions: Presence of pathogenic known and novel mutations suggests mtDNA variations have a role in the pathophysiology of CAD associated with T2DM in our population.

Open oesophagectomy may be associated with significant morbidity and mortality. With the increa-sing experiences in laparoscopic and thoracoscopic techniques, minimal invasive approaches to oesophagectomy are being explored to determine the feasibility, results, and potential advantages.

Pyloroplasty is performed during oesophagectomy to avoid delayed gastric emptying and hence reduces the risk of aspiration pneumonia. By contrast, it has been argued that pyloroplasty is unnecessary as gastric outlet obstruction is a rare occurrence following oesophagectomy and that the procedure itself is associated with a number of complications.

Aim: The aim of this study is to assess the safety of minimally invasive oesophagectomy without pyloroplasty.

Methods: Retrospective cohort study was carried out of 90 consecutive surgically fit oesophagogastric cancer patients irrespective to the age and gender having undergone minimally invasive oesophagectomy without pyloroplasty. The outcomes were measured in terms of developing postoperative gastric outlet obstruction or evidence of pyloric stenosis in endoscopy, operative time, intraoperative complications, in hospital and 30 days mortality rate.

Results: 8/90 of minimally invasive oesophagectomy without pyloroplasty developed postoperative gastric outlet obstruction with endoscopic evidence of pyloric stenosis (8.9%). 7/8 with postoperative delayed gastric empyting had been managed conservatively with repeated endoscopic dilatation (87.5%) while one out of eight patient necessitated laparoscopic pyloroplasty (12.5%). Only one among 90 necessitated laparoscopic pyloroplasty .The mean operative time was 366 minutes. 11/90 had postoperative leak (12.2%) which was managed conservatively. The postoperative in hospital mortality was 4/90 (4.4%) and the 30 days mortality is 2/90 (2.2%).

Conclusion: Routine pyrloroplasty is not advocated as the incidence of post operative complication delayed gastric empting, leak,  aspiration pneumonia are comparable with pyroloplasty more over pyloroplasty is associated with increased operative time ,so not doing is  a safe and a wise decision.

Background: Odontogenesis begins from the sixth week of fetal life; meanwhile, the subsequent evolution is very complex and takes a long time. As a part of odontogenesis, amelogenesis can be altered by local and systemic factors. Systemic factors include the change of and reduction in tissue oxygenation, metabolic disorders, gamma ray, fever, infections, as well as vitamin A&D deficiency. There are few investigations demonstrating the effect of gestational diabetes on enamel defects. The current study aims to compare enamel hypoplasia and DMFT (Decayed, Missing, and Filled Teeth) index of children born to diabetic mothers with gestational diabetes with those of healthy mothers.

Methods: In this retrospective study, 50 children born to diabetic mothers aged between 3 and 12 were selected as the study group and 50 age- matched children with healthy mothers as the control one. The presence of enamel hypoplasia, the involved surfaces and DMFT index were recorded.

The data were collected and analyzed using SPSS software version 15, NPar, Mann-Whitney and Chi-Square tests.

Results: The results obtained from the current study revealed that the prevalence of enamel hypoplasia and mean DMFT index in children of diabetic mothers was significantly higher than in the control group p=0.03.

Conclusion: In this study, the prevalence of enamel hypoplasia and mean DMFT in children of gestational diabetic mothers were significantly higher than that of the controls.

Aims: Ethnic differences and factors associated with high glycated haemoglobin A1c (HbA1c) levels in families of East Indian and West African descents with early onset type 2 diabetes mellitus (T2DM) were compared. Glycaemic control is affected by genetics and is strongly influenced by adherence to medication and cultural adaptations to instructions.

Study Design: A 12 months study.

Place and Duration of Study: Diabetes Mellitus Clinic, University of the West Indies Hospital, Mona, Jamaica, between September 2000 to October 2003.

Methodology: A 12 months analysis was done on 54 members of families of East Indian descent and 48 members of families of West African descent with early onset T2DM enrolled in the Maturity Onset Diabetes of the Young (MODY) study. HbA1c levels were measured at baseline, 6 and 12 months.

Results: The families of West African descent started at baseline with significantly higher HbA1c (11.0±1.5% versus 10.0±1.5% [97±17 mmol/mol versus 86±16 mmol/mol], P=0.05) than families of East Indian descent. Nevertheless their mean HbA1c level was significantly lower at 12 months (7.0±0.7% versus 7.9±0.5% [53±7 mmol/l versus 63±5 mmol/mol], P=0.05). Variables such as access to healthcare, social status and education, age, body mass index (BMI), duration of diabetes and insulin and lipid therapies were similar in the ethnic groups. Lipid function was abnormal over 12 months in families of East Indian descent. Families of East Indian descent adhere less to medication guidelines and instructions.

Conclusion: Families of East Indian descent had poorer glycaemic control than those of West African descent. The poor control may be linked to genetics as seen in triglyceride and high density lipoprotein cholesterol profile over 12 months and may have been influenced by ethnic differences in adherence to medication and instruction following.

Aims: To determine the prevalence of anaemia among pregnant women in Jazan in the Southern region of Saudi Arabia, and identify some food habits of pregnant women. The association between having anaemia and some maternal factors like age and obstetric history are also studied.

Study Design:  A descriptive cross sectional study.

Place and Duration of Study: Five different health care centres and Jazan general hospital in Jazan, Southern region of Saudi Arabia during November 2014. 

Methodology: A sample of 389 pregnant women in the reproductive age (15-49 years) was studied. Cluster sampling was used to choose the different health facilities and systemic random sampling technique was used to select the women within these institutes. 

Data was collected using a pre-structured interview questionnaire and review of files of pregnant women in these facilities.

Results: The prevalence of anaemia among the pregnant women was found 58.9%. The percentage of pregnant women who experienced cravings was 35.5%, 56.1 % had aversions and 67.3 % had pica. The study also found that two thirds of women who got pregnant more than 5 times were anaemic with a P value (0.005). However, no significant relation was found between anaemia and maternal age, number of deliveries or number of abortions.

Conclusion: Anaemia among pregnant women in Jazan region is high. Many pregnant women experience cravings and aversions which affect their nutrition. These findings signal the need for proper interventions to address female’s nutritional habits in this area. Nutritional advice during ante-natal care visits for pregnant women are advised.

Aim: To provide the normal range of retinal nerve fiber layer (RNFL) thickness in a subset of Karachi population by Spectralis OCT and to evaluate the effects of age and gender on it.

Methodology: 300 eyes from 150 healthy subjects aged 40 years and above with no ocular pathologies were examined using standard protocols by a single examiner. Subjects with high myopia, history of diabetic or hypertensive retinopathy, raised intraocular pressure (> 21 mmHg) and previous intraocular or laser surgery were excluded from the study. The mean retinal nerve fiber layer thickness was calculated and was correlated with age and gender difference.

Results: The mean global retinal nerve fiber layer thickness was found to be 99.02±9.08 μm in our set of population. Out of four quadrants the maximum RNFL thickness was found in inferior quadrant (126.45±16.23 μm) followed by the thickness of 121.50±15.03 μm in superior quadrant,  78.99±13.99 μm in nasal quadrant and 68.90±13.10 μm in temporal quadrant. We found strong negative correlation of RNFL thickness with age (P= 0.001) and not significant relation with gender (P= 0.8).

Conclusions: Keeping in mind the variations in RNFL thickness with ethnic differences, this study provides the normal values of RNFL thickness according to our set of population. It is concluded that RNFL thickness decreases significantly with increasing age but gender had no significant effect on it.

Background: Sickling test and haemoglobin solubility test are screening techniques used to detect the presence of haemoglobin S, but can't identify exact phenotype or genotype. Haemoglobin electrophoresis can determine the phenotype of sickle cell disease but it cannot be performed on infants aged less than 6 months because of the presence of hemoglobin F as the predominant hemoglobin before this age and thus it is not suitable for prenatal and neonatal screening.

This study aimed to compare PCR-based single tube genotyping of sickle cell disease with routine alkaline haemoglobin electrophoresis. 

Materials and Methods: This is a cross sectional-analytic study conducted at Khartoum state, Sudan in the period from November 2014 to March 2015.

The total number of study subjects was 70, 35 of them with sickle cell anaemia (Hb S/S), 15 sickle cell trait (Hb A/S), and 20 healthy volunteers (Hb A/A).

Blood samples were collected in EDTA blood tubes and genomic DNA was extracted from leucocytes by salting out method. Allele specific polymerase chain reaction (PCR) was used for genotyping of all samples. Alkaline haemoglobin electrophoresis was also performed on all subjects to confirm the phenotypes and the findings were compared with genotyping results.

Results: Using alkaline Hb electrophoresis, 33(94.3%) out of 35 patients with provisional diagnosis of sickle cell anaemia were found to be S/S and 2(5.7%) were A/S; using PCR all the 35 patients were found to be S/S; the two patients who their phenotype was A/S while by PCR their genotype was S/S were found to have a history of recent allogenic blood transfusion.

The results of Hb electrophoresis and PCR were in full agreement for both sickle cell trait individuals (A/S), and the healthy controls (A/A).

Conclusion: Diagnostic accuracy of PCR based single tube genotyping of SCD is superior to routine alkaline haemoglobin electrophoresis particularly in situations of recent allogeneic blood transfusion and prenatal and neonatal screening.

Aim: To describe an outbreak which occurred in a neonatal ward and the role of active surveillance in the control of further outbreaks.

Study Design: Cross Sectional Observational Study.

Place and Duration of Study: Lady Hardinge Medical College and Associated Hospitals, between May 2013 and June 2014.

Methodology: The Infection Control Team (ICT) conducts active surveillance in the neonatal ward (NNW) routinely every year. The data regarding the above mentioned period were analysed and infection rates were calculated on monthly basis and compared. Attack rate was calculated as number of patients who acquired hospital acquired infections/ total number of admissions during that month.

Results: A sudden increase in bloodstream infection (BSI) from 2 cases to 16 cases were observed over a period of 2 months (November 2013, and December 2013). Therefore an outbreak was suspected. Sixteen cases of primary blood stream infections caused by ceftazidime/ amoxicillin – clavulanic acid -resistant Klebsiella pneumoniae were observed over a two month period. Case definition was made. Recommendations for Infection control practices with immediate effect were sent. The ICT visited NNW and main labour room. Relevant samples were collected and Klebsiella species was isolated from suction tubing, baby cot, feeding katori, fingertip of health care worker (HCW) and soap sludge. Bacterial identification and antimicrobial susceptibility testing was performed by using the automated Vitek 2 instrument. The antibiogram of Klebsiella species from the samples and cases was found to be similar. It was found that NNW staff was changed recently without any training in Infection control practices. There was breach in Infection control practices.

Conclusion: Active surveillance plays a very important role in detection of early onset of outbreak. All the HCWs including resident doctors, nursing and subsidiary staff and others must be trained in Infection control practices before they are posted to high risk areas.

Skull base surgery has experienced dramatic advances in the last decade. Recently, various surgical disciplines have conducted reviews of quality of randomised controlled trials (RCTs). This is the first review to our knowledge regarding RCT quality within skull base surgery.

Systematic review of skull base surgery RCTs published between 2000 and 2014 were conducted. Literature search provided 96 papers. Duplicates and trials which did not meet our inclusion criteria were excluded. This left 28 papers for analysis. A total of 1785 patients participated across trials.

Consolidated Standards of Reporting Trials statement (CONSORT) and Jadad scale were used assess to the quality of reporting. These were our main outcome measures.

The mean CONSORT score prior to 2011 was 16.9 (n = 17, range; 13 – 22), and post 2011 was 17.5 (n = 11, range; 12 – 22). The mean Jadad score was 3.1 (n = 28, range 2 – 5). CONSORT were found to increase significantly with both increasing sample size (rho=0.467, p=0.012) and Jadad scores (rho=0.540, p=0.003). Linear regression showed CONSORT increase by 0.36 (95% CI: 0.02 – 0.70, p=0.041) for each additional 10 patients included, and by 1.50 (95% CI: 0.58 – 0.24, p=0.002) for each increase of one in the JADAD score.

There are common omissions related to randomization, sample size calculations and availability of protocols. RCTs in skull base surgery are comparable to other surgical disciplines. We recommend utilisation of the CONSORT statement during protocol formation of RCTs to improve reporting of trials.