Open Access Case Study

Effective Conservative Treatment of Medial Epicondylitis with Physical Therapy–A Case Study

Timothy Hui

Journal of Advances in Medicine and Medical Research, Page 1-5
DOI: 10.9734/BJMMR/2016/23416

Background and Purpose: Like other common tendinopathies, there is debate as to whether medial epicondylitis and tendinitis treatment should focus on inflammation or degeneration management. This case study demonstrates the effectiveness of physical therapy when both are addressed.

Case Description: A patient with bilateral medial epicondylitis and tendinitis recovered with physical therapy directed at both inflammatory and degenerative elements. Soft tissue manipulation, phonophoresis, and electrical stimulation were utilized at areas detected by microcurrent injury detection. Therapeutic exercise in the clinic and home were also utilized.

Outcomes: In 11 treatments, strength increased from 4/5 to 5/5 or 5-/5.  Pain decreased from 8/10 to 0/10 on Verbal Numerical Rating Scale (VNRS). Patient experienced full return to ADLs, no pain or restrictions.

Discussion: Three aspects were unique to this case. First, soft tissue manipulation was used to palpate and remodel degenerative tissues. Second, microcurrent injury detection mapped out specific areas of injured tissues. Finally, modalities were applied to these specific areas, which changed from the flexor tendon and muscle to the proximal cubital tunnel. Used together, the patient experienced full recovery in a timely manner. This case suggests that tendinitis may be a combination of degenerative and inflammatory elements which should both be addressed in a treatment plan.

Open Access Case Study

A Case of Sub Hepatic Perforated Appendicitis Presented as Multiple Gas Containing Subcapsular Hepatic Abscesses

Waseem Mehmood Nizamani, Muhammad Ali, Muhammad Umer Ahmed, Ali Mahmood Khan, Anwar Ahmed

Journal of Advances in Medicine and Medical Research, Page 1-4
DOI: 10.9734/BJMMR/2016/23583

Appendicitis is the most common acute surgical condition of the abdomen. The diagnosis of acute appendicitis can often be made clinically. When the appendix is situated in an abnormal position, the diagnosis of acute appendicitis becomes difficult. Delayed diagnosis or misdiagnosis of subhepatic appendicitis might lead to perforations of the appendix, which is a clinical emergency. Liver abscess as a complication of appendicitis was first described in 1898 by Dieulafoy. The majority of pyogenic liver abscesses are caused by infection originating in the biliary or intestinal tracts. Pyogenic liver abscess is a rare complication of acute appendicitis. Multiple pyogenic liver abscesses are not frequently reported in the literature, but the overall mortality is high, if left with no treatment or not treated early.

We have reported a case of subhepatic perforated appendix presented with multiple subcapsular liver abscesses.

Open Access Minireview Article

A Review of the Crown Lengthening Surgery; The Basic Concepts

Mohammad Reza Talebi Ardakani, Fatemeh Khalilian, Zahra Nateghi, Azade Esmaeilnejad, Noushin Janbakhsh

Journal of Advances in Medicine and Medical Research, Page 1-7
DOI: 10.9734/BJMMR/2016/22602

Clinical crown of the tooth is the distance from gingival margin to incisal edge or occlusal surface of the tooth. A short clinical crown is defined as any tooth with less than 2 mm of sound, opposing parallel walls remaining after occlusal and axial reduction. Although implants have reasonably high success rate, recent literature showed that keeping patient’s tooth has numerous benefits. Crown lengthening is a surgical procedure designed to increase the extent of the supragingival tooth structure, so that the clinician can restore the tooth. The aim of the current study is to review the implications of CL in routine dental practice. To reach this aim, diagnosis requirements, restorative procedures after crown lengthening, stability of crown lengthening and esthetic crown lengthening are discussed in different sessions.

Open Access Original Research Article

Effect of Different Sugar Free Flavoured Chewing Gums on Salivary pH- a Double Blinded, Parallel Arm Randomized Clinical Trial

Syeda Nikhat Mohammadi, G. M. Prashant, P. G. Naveen Kumar, V. H. Sushanth, Mohamed Imranulla, Rashmi Rai

Journal of Advances in Medicine and Medical Research, Page 1-6
DOI: 10.9734/BJMMR/2016/23388

Aim: To evaluate and compare the effect of four different sugar free chewing-gums on salivary pH at 0, 10, 20, 30 minutes.

Study Design: Double blinded, parallel arm Randomized Clinical Trial.

Place and Duration of the Study: Department of Public Health Dentistry, College Of Dental Sciences, Davangere, India. Jan-Feb 2015.

Methodology: Forty healthy dental students, aged 21 -25 years, mean age- 20.3 years were randomly allocated into 4 different study groups: Licorice group, Ginger group, Cinnamon group, and Xylitol group. Unstimulated saliva was collected from the participants at baseline, following which the participants were given respective gums to chew and the subsequent salivary samples were collected at intervals of 10, 20 & 30 minutes and pH was analyzed using pH meter. Statistical analysis was done using repeated measures ANOVA and One way ANOVA followed by Tukey’s post-hoc test.

Results: Intergroup comparison showed, statistically significant difference between the groups at ten minutes (P=0.025), twenty minutes (P=0.004) and thirty minutes (P=0.001). At the end of thirty minutes, Ginger group showed maximum increase in salivary pH followed by Xylitol. When intragroup analysis was done, there was statistically significant difference in Licorice (P=0.033), Cinnamon (P=0.034) and Xylitol group (P=0.041) at different time intervals.

Conclusion: The above results showed that, Ginger flavoured gum followed by Xylitol gum significantly increases salivary pH, as a means of caries prevention; it can be a good way to promote dental health. Hence, it can be suggested that the ginger flavoured gums can be advised in the subjects who are more susceptible to salivary pH fall and dental caries.

Open Access Original Research Article

Challenges Faced in Accessing Diabetes Drugs in Low and Middle Income Settings in Aba North, Southeast Nigeria

Nwaokoro Joakin Chidozie, Ede Alison Okorie, N. O. Ibe Sally, O. Emerole Chima, C. Nwufo Regina, A. Nwaokoro Amaka, Onwuliri Daniel Chinemerem, Dozie Judith Ijeoma

Journal of Advances in Medicine and Medical Research, Page 1-10
DOI: 10.9734/BJMMR/2016/20764

Diabetes is a costly disease, placing a high financial burden on the patient and the healthcare system in every nation. If poorly managed, it can cause a lot of damage to body parts such as blindness, loss of kidney function. The aim of this study is to determine the challenges faced in accessing drugs for diabetes mellitus management in south-eastern Nigeria. The study was conducted between January and December, 2014 in Aba North which is one of the Local Government Areas in Abia State. The study design was a descriptive cross-sectional survey involving face-to-face interview with patients based on a structured questionnaire format. Stratified random sampling technique was used to obtain the required sample size of 200 from the sampling frame on only those who met the inclusion criteria. The instrument used for data collection was questionnaire. The generated data were presented into table/charts, and also analyzed using descriptive statistics and chi-square statistics. The level of association was accepted at 0.05 significant differences. The results of this study showed that age of the respondents, from 51 years and above were highest 71(35%) compared with other age ranges. The educational level of the respondents was majorly on secondary level of education (46.5%). Access to diabetes drugs, 136(68%) of the respondents said they have access to diabetes drugs. Socioeconomic status influences the access of diabetes drugs (55%) and availability of diabetes drugs (80%).Also cost of diabetes drugs have high influence of (82.5%) on accessing diabetes drugs. Based on the findings of this study, it was concluded that majority of the patients with diabetes have access and knowledge of diabetes drugs but still some are yet to meet up with it due to some factors. Therefore, there is need to strengthen diabetes care centres with special focus on improving drugs availability and integration of health services for diabetes at the community level.

Open Access Original Research Article

Comparing the Effects of One Session of Interval and Continuous Aerobic Exercise on Protein and Purine Catabolism among High School Boys in Gonabad-Iran

Mahmood Reza Mottaghy Shahri, Hossein Abtahi, Mostafa Amiri, Hossein Shahdoost, Zahra Rohani, Mojtaba Kianmehr

Journal of Advances in Medicine and Medical Research, Page 1-8
DOI: 10.9734/BJMMR/2016/22605

Aims: Protein, one of the energetic agents, possesses basic and biologic roles, but when the body faces a severe shortage in nutrients, proteins provides the required energy. This study was conducted to examine the impact of interval and continuous aerobic exercises on urea, uric acid, creatinine of urine, and protein catabolism among 15-18 year old boys at high schools.

Study Design: This was a quasi-experimental crossover study.

Place and Duration of Study: Molla Mozaffar Boarding High School for Boys and Gonabad University of Medical Sciences, Gonabad, Iran. The study took about six months in 2013.

Methodology: Twenty voluntary high school boy students who were ordinary and healthy individuals but not athletes were selected randomly. At the beginning of each training session, they warmed up for 10 minutes. Then, activities were performed with the intensity of 65-75 percent of the maximum heart rate. The interval aerobic training was in 3 cycles of 1000 meters; and the active breaking mode of half to one was used between the repetitions. In the continuous aerobic training 3000 meter, practicing was performed continually without any breaks. Heart rate, the intensity of training, and the running distance were measured by the measuring gadgets on the treadmill. Before and after each exercise, the urine was collected for 24 hours. Urea, uric acid, and creatinine of the first 24-hour urine sample were determined.

Results: The results of the experiments were analyzed using t-test. There were not any significant differences among average levels of urea, uric acid, and creatinine of urine and protein catabolism rate in the first 24-hour urine sample after one session of interval and continuous aerobic exercise (P > 0.05).

Conclusion: It was found that one session of the interval and continuous aerobic exercise has no significant effect on protein catabolism rate among the 15-18 year old high school boy students.

Open Access Original Research Article

Neck Circumference as a Novel Anthropometric Value for Diagnosis of Metabolic Syndrome and Obesity in Patients with Diabetes

Zoleika Moazezi, Hamid Mahdizadeh, Abdollah Pooshani

Journal of Advances in Medicine and Medical Research, Page 1-8
DOI: 10.9734/BJMMR/2016/23423

Background and Objective: Metabolic syndrome and obesity are known as important risk factors for cardiovascular disease which have a high frequency among diabetic patients. Central obesity in metabolic syndrome diagnostic criteria was determined as high waist circumference. But it is not always applicable. So introducing novel anthropometrics is crucial to accurate diagnosis of metabolic syndrome. This study was designed to evaluate diagnostic accuracy of neck circumference in central obesity and metabolic syndrome in a diabetic population of north of Iran.

Materials and Methods: In this diagnostic study adult patients with previous diagnosis of diabetes mellitus was evaluated. Metabolic syndrome was diagnosed based on Iranian National Committee of Obesity. Anthropometrics and lab data was collected during 4 years of study period and data was analyzed by Spearman correlation, Man-Whitney U test, and Chi Square test. Diagnostic accuracy was evaluated by drawing ROC curve.

Results: 2942 patients was included in the study. 794 patients (27%) were diagnosed with metabolic syndrome. Neck circumference was significantly higher in patients with metabolic syndrome and obesity (BMI≥30). It has also a positive correlation with waist circumference (r=0.656 in men and r=0.681 in women) and obesity (r=0.632 in men and r=0.661 in women) in all patients. Area under ROC curve for metabolic syndrome was 0.624 for men (95% CI= 0.576-0.672) and 0.663 for women (95% CI= 0.635-0.691).

Conclusion: Neck circumference can be introduced as a novel anthropometric value for diagnosis of metabolic syndrome.

Open Access Original Research Article

Disease Surveillance and Notification, Knowledge and Practice among Private and Public Primary Health Care Workers in Enugu State, Nigeria: A Comparative Study

Elias Chikee Aniwada, Christopher Ndukife Obionu

Journal of Advances in Medicine and Medical Research, Page 1-10
DOI: 10.9734/BJMMR/2016/23249

Aims: The study was to compare knowledge, practice of Disease Surveillance and notification as well as ascertain factors that influence it among Health care workers in public and private health centres in Enugu state, Nigeria.

Study Design: Comparative cross sectional study.

Place and Duration of Study: Selected public and private health facilities in Enugu state, Nigeria, between January and March 2013.

Methodology: Health Care workers in selected public and private health facilities in southeast Nigeria eligible for voluntary participation were selected and studied. The participants were interviewed using a pretested, interviewer administered, semi-structured questionnaire. Data was analyzed using Statistical Packages for Social Sciences (SPSS) version 18 and level of significance was at p ≤ 0.05.

Results: It was based on 160 HCWs (80 each from public and private). The mean age of HCWs was 41.21±8.54 and 38.68±14.64 for public and private respectively. Females > Males in both groups. Some of the factors associated with type of facility included; correct definition of IDSR (AOR= 2.6, 95% CI: 1.4–5.1), correct knowledge of diseases reported (AOR= 4.1, 95% CI 2.1-8.0), correct place to report to (AOR= 3.7, 95% CI 1.9–7.2), correct form for monthly reporting (AOR= 7.0, 95% CI 3.5–14.0), ever reported occurrence of disease (AOR= 8.5, 95% CI 4.0–18.2), reporting in correct place (AOR= 11.5, 95% CI 1.8–73.6), current availability of forms at facility (AOR= 4.9, 95% CI 2.5–9.5), supervision or data collection visits (AOR= 8.8, 95% CI 4.3–18.1) and regularity of the visits (AOR= 6.4, 95% CI 2.3–17.6).

Conclusion: Disease Surveillance and Notification needs to be improved on especially in areas of manpower training and regular supply of forms for efficient Health Management Information System and containment of most diseases ravaging the nation.

Open Access Original Research Article

Treatment of Mild to Moderate Acne with Conventional versus Two Different Intermittent Doses and Continuous Low-dose of Isotretinoin: A Randomized, Comparative Study

Mohammed Saleh Al-Dhubaibi

Journal of Advances in Medicine and Medical Research, Page 1-7
DOI: 10.9734/BJMMR/2016/23594

Background: Oral isotretinoin is a unique drug that affects all four basic pathogenic mechanisms and the most effective systemic drug currently available for treatment of acne vulgaris. In this study, we aimed to assess the efficacy and tolerability of two different intermittent doses and continuous low-dose and to compare them with the conventional dose of isotretinoin in the treatment of mild to moderate acne vulgaris.

Methods: Eighty patients with mild to moderate acne were enrolled and randomized to receive either isotretinoin at 0.5–0.7 mg/kg daily for six months (group A), isotretinoin at 0.5–0.7 mg/kg daily for 1 month, then daily for 1 week out of every 4 weeks for six months (group B), isotretinoin at 0.5–0.7 mg/kg daily for 1 week out of every 4 weeks for six months (group C) or isotretinoin at 0.25–0.4 mg/kg) daily for six months (group D).

Results: Patient satisfaction was highest among group D, followed by group C, then B, and then A with statistically significant differences between groups A and D (P = 0.003) and groups D and B compared to C (P = 0.019).Side effects were more frequent with conventional dose compared with two intermittent doses and continuous low-dose.

Conclusions: This study suggests that, when considering tolerability, efficacy and patient satisfaction, continuous low-dose treatment is most suitable for patients with mild to moderate acne.

Open Access Original Research Article

An Analysis of Determinants in Antimicrobial Use by Physicians in Ogun State, South West Nigeria

Emmanuel Olushola Shobowale, Charles John Elikwu, Benjamin Adegunle, Adeyinka Davies, Victor U. Nwadike

Journal of Advances in Medicine and Medical Research, Page 1-10
DOI: 10.9734/BJMMR/2016/23310

Introduction: The increasing rates of antimicrobial resistance on the part of pathogens are gradually becoming a pandemic, this has to be curbed to reduce mortality.

Background: The vast majority of antimicrobials currently in use are prescribed by Physicians. The Physicians act as a gateway in the control and use of life saving medications such as antimicrobials, attention must be paid towards antimicrobial stewardship and rational antimicrobial use.

Methods: This was a cross sectional survey of clinicians at 3 tertiary hospitals in Nigeria. A self-administered structured Questionnaire containing 25 questions was given to the respondents to complete to assess the level of knowledge of physicians in antimicrobial use.

Results: The following were found to be statistically significant – Physicians in the Public hospitals were more likely to collect specimens for microbiology analysis before commencing antibiotics – p = 0.02, Odds Ratio (O.R) = 2.61, Risk Ratio (R.R) = 1.47, 95% Confidence Interval (CI) = 1.16 – 5.80, Chi Square (χ2) = 1.47, a slightly higher likelihood of Physicians in the Private Tertiary Hospital having a Clinical Microbiologist in their hospital – p = 0. 00, O.R = 0.08, R.R = 0.25, CI = 0.05 – 0.99, χ2 = 4.55.

Discussion: Targeting rational interventions via educating physicians on antimicrobial use has had an established positive impact in curbing antimicrobial resistance in hospitals.

Conclusion: Training programs on antimicrobial use need to be strengthened.