Open Access Original Research Article

The Totaled Health Risks in Vascular Events (THRIVE) Score Predicts Ischemic Stroke Outcomes

Hesna Bektas, Sadiye Gumusyayla, Gonul Vural, Asli Bolayir, Orhan Deniz

Journal of Advances in Medicine and Medical Research, Page 1-7
DOI: 10.9734/BJMMR/2016/23887

Objective: Assessment of the outcome after an ischemic stroke is important both to serve as a baseline for the evaluation of therapeutic measures and for rehabilitation and health planning. Our aim was to compare the Total Health Risks in Vascular Events (THRIVE) score with outcome scores and infarct volumes.

Methods: We retrospectively reviewed our stroke registry for the period 12/2012–12/2013 and identified patients diagnosed with ischemic stroke. We included patients who had undergone Diffusion-Weighted Magnetic Resonance Imaging (DW-MRI) within 24 hours of their stroke. One of the investigators reviewed all the DW-MRI images to verify infarct volumes. The periphery of the lesion area in each section was drawn by hand, and the surface area of the section was automatically calculated in mm2 by PACS (Picture Archiving and Communication System software), which was installed on the computer. The areas were summed, and the result was multiplied by the section thickness to calculate infarct volumes. The THRIVE scores were calculated. Infarct volumes and clinical outcomes, as measured by Modified Rankin Scale (mRS) and Barthel Index (BI), were compared to initial THRIVE score subgroups of 0–2 and ≥3.

Results: We included 153 (65 female, 88 male) patients in the study. The mean age was 68.30±12.07 years. The median infarct volume was 4.10 cm3 (Interquartile range (IQR):19.180). An increasing THRIVE score was independently associated with an increasing likelihood of poor outcome (mRS≥3: odds ratio, 2.140; 95% confidence interval, 1.068–4.290; BI<60: odds ratio, 0.335; 95% confidence interval, 0.149–0.751). There was no significant difference in infarct volumes between the THRIVE score subgroups of 0–2 and ≥3 (P=0.43).

Discussion: The THRIVE score is simple to use and predicts long-term neurological outcomes in ischemic stroke patients.

Open Access Original Research Article

Alice-in-Wonderland Syndrome in Patients with Migraine

J. E. Azimova, A. V. Sergeev, K. V. Skorobogatykh, E. A. Klimov, G. R. Tabeeva, A. P. Rachin

Journal of Advances in Medicine and Medical Research, Page 1-11
DOI: 10.9734/BJMMR/2016/23997

Aims: Alice-in-Wonderland syndrome (AIWS) is a rare neuropsychological syndrome that includes paroxysmal distortion of the body schema, depersonalization, derealization, visual hallucinations, distorted sense of time, and deja vu and jamais vu experiences. Alice-in-Wonderland syndrome may be an equivalent of a migraine attack. The objective of this study was to evaluate the clinical particulars of Alice-in-Wonderland syndrome in patients suffering from migraine.

Place and Duration of Study: University Headache Clinic between June 2012 and November 2015.

Methodology: The study sample involved 14 subjects with migraine as defined in the ICHD-III-beta and AIWS (1 male and 13 females) with a mean age of 22.9±12.1 years. 13 patients had migraine with aura, and one subject had migraine without aura. All study subjects were somatically and psychiatric healthy. A specially designed and validated questionnaire was being used to assess symptoms in patients with AIWS.

Results: Alice-in-Wonderland syndrome was characteristically being developed in children and adolescents as part of a migraine aura, combined with a typical impairment of visual perception, or between attacks, and also had episodes of visual hallucinations. Older patients were characterized by only interictal, short (lasting a few seconds) phenomena, which was most commonly teleopsia.

Conclusion: The reported study indicates that Alice-in-Wonderland syndrome is a heterogeneous condition varying with different age subgroups among patients with migraine.

Open Access Original Research Article

Prevalence of Glucose -6- Phosphate Dehydrogenase (G-6-PD) Deficiency in Sokoto: Liver Function and Oxidative Stress Biomarkers in Deficient Individual

Taofeeq Oduola, Ismaila Jelani, Debayo Moshood Bolarin, Mohammed Alhaji Ndakotsu, Muhammad Kabiru Dallatu

Journal of Advances in Medicine and Medical Research, Page 1-6
DOI: 10.9734/BJMMR/2016/24149

Background: Glucose-6-phosphate dehydrogenase (G6PD) is a key enzyme in the pentose phosphate pathway (PPP) and plays an essential role in the oxidative stress response by producing Nicotinamide adenine dinucleotide phosphate (NADPH), the main intracellular reductant. Deficient individuals suffer from mild chronic haemolytic episode which could be exacerbated on exposure to oxidant drugs.

Aim: The aim of the study was to determine the prevalence of G-6-PD deficiency in Sokoto, assess liver function, lipid peroxidation and antioxidants status in G-6-PD deficient individuals.

Place and Duration of Study: The study was undertaken at the Department of Chemical Pathology, Faculty of Medical Laboratory Sciences, Usmanu Danfodiyo University, Sokoto, Nigeria, between February and April 2015.

Methods: G-6-PD screening in 1000 individuals (603 males and 397 females) using Methaemoglobin Reduction Method was carried out, liver function and oxidative stress biomarkers were then evaluated in 60 deficient individuals (30 males and 30 females) and 60 individuals with normal G-6-PD status as controls using standard techniques.

Results: 376 (37.6%) subjects were found to be G-6-PD deficient, 128 (12.8%) of the males and 248 (24.8%) of the females screened were deficient. G-6-PD deficient individuals have significantly low (p<0.05) total protein (TP), aspartate transaminase (AST) and alkaline phosphatase activities when compared to control group but the decreases were within the reference range, while albumin (Alb), total bilirubin (TB) and conjugated bilirubin (CB), alanine transaminase (ALT) and alkaline phosphatase (ALP) values showed no significant difference (p > 0.05). Significantly high (p<0.001) malondialdehyde (MDA) and low total antioxidant potential (TAP) values were obtained in G-6-PD deficient individuals compared to controls.

Conclusion: The prevalence of G-6-PD deficiency in Sokoto is high, hence screening for G-6-PD deficiency before administration of oxidant drugs in G-6-PD deficient subjects may be necessary. G-6-PD deficient individuals may also be at the risk of developing oxidative stress induced diseases.

Open Access Original Research Article

The Incidence of Anemia in Patients with Rheumatoid Arthritis

Aida Eshmurzaeva, Marif Karimov, Iskandar Mavlyanov, Marina Sibirkina, Nigora Tukhtaeva, Bekhzod Abdullaev

Journal of Advances in Medicine and Medical Research, Page 1-7
DOI: 10.9734/BJMMR/2016/23443

Background: Rheumatoid arthritis (RA) is an autoimmune, systemic disease that affects the joints. In RA, the body’s immune system destroy body’s tissue for a foreign invader. This leads immune system to attack the protective cushion of tissue and fluid between the joints. The result is swelling, stiffness, and pain in the joint.

The body’s misfiring immune system also may go after the body’s soft tissues, like cartilage, and organs such as the heart, eyes, and veins. Ultimately, RA can cause permanent damage, disability, and anemia. Evaluation of progress in RA and anemia control at the population level is increasingly important. It is not only a medical but also an economic issue, since the onset of the disease in most common cases is observed in people of working age [1,2].

Methods: Retrospective analysis representing in this article was performed through 1250 case histories of patients with RA who was received inpatient treatment in the Department of Rheumatology 3-clinic Tashkent Medical Academy (TMA) in period from January 2010 to January 2015. Authors analyzed spreading spectrum of anemia in RA patients via verified laboratory data. Authors studied the age and gender characteristics of patients with anemia that occurred after RA and the degree and severity of anemia.

Results: The results of the study showed that 1250 patients were treated with a diagnosis of RA, men were 116 (9.28%), women – 1134 (90.72%). Most patients were at the working age. According to the disease activity, patients separated into 3 degree. 140 (11.2%) of them were in I degree, and 834 (66.72%) in II degree and 276 (22.08%) in III degree. In most cases, the disease duration ranged from 1 to 5 years 418 (33.44%).

The results showed that 874 patients of the 1250 patients have a verified diagnosis of anemia as a comorbidity, which amounted to 69.92%. Almost two-thirds of patients with rheumatic pathology was found anemia varying degrees. Among them, women accounted for 71.7%, men were 28.3%.

Conclusion: Among patients with RA, the prevalence of anemia manifestations is relatively high. Leading cause of anemia in patients with rheumatoid arthritis is iron deficiency anemia. The incidence of anemia is directly depends on the age of patients and duration of disease.

Open Access Original Research Article

Factors Associated with the Time form Myocardial Infarction Onset to Hospital Arrival in Southeastern Iran

Lida Soltani, Ali Ravari, Sakine Sabzevari

Journal of Advances in Medicine and Medical Research, Page 1-7
DOI: 10.9734/BJMMR/2016/23404

Background: Myocardial infarction (MI), is a fatal cardiovascular condition which results in various outcomes, considering time of treatment form symptoms onset. Despite of high importance of first hour after MI onset, a considerable proportion of patients arrive at hospital with delay. To assessing determinants of hospital arrival time in MI patients in southeastern Iran.

Methods: A cross-sectional study was conducted. A validated and reliable questionnaire was designed and used for data collection. Patients with a confirmed diagnosis of acute myocardial infarction were interviewed after informed consent.

Results: A total of 175 patients participated in this study. The most of them were male (76.6%, n=134). Median time to hospital arrival was 130 minutes. Its min and max were 15 and 1500 minutes, respectively. The most common reasons for delayed hospital arrival, were waiting for spontaneous recovery 45.70%, and then the distance to the hospital 35.40%.

Conclusion: Lack of MI patients’ awareness of importance of times to hospital arrival could be the best underling reason for the delayed hospital arrival. Mass education about the symptoms of MI and importance of prompt care seeking may be effective intervention to reduce MI deaths and complications.

Open Access Original Research Article

Lycopene Embedded into Cocoa Butter Micelles of Dark Chocolate Causes Dose-dependent Decrease in Serum Lipids of Hypercholesterolemic Volunteers

Ivan M. Petyaev, Pavel Y. Dovgalevsky, Natalia E. Chalyk, Victor A . Klochkov, Nigel H. Kyle

Journal of Advances in Medicine and Medical Research, Page 1-11
DOI: 10.9734/BJMMR/2016/23623

Aim: To investigate if different amounts of lycopene embedded into cocoa butter micelles of dark chocolate affect serum lipid profile of hypercholesterolemia patients.

Study Design: 32 clinically healthy volunteers with borderline hyperlipidemia were enrolled in a 4 week dietary trial. The study participants ingested daily one 10 g bar of L-tug dark chocolate (DC) which contained 0, 2, 3.5 or 7 mg of lycopene with no other restrictions/modifications to their habitual diet. Serum specimens were collected at the outset and after the second and fourth weeks of the trial. The study was conducted at the Saratov’s Institute of Cardiology (Russian Federation) using dark chocolate specimens provided by Lycotec Ltd (Cambridge, UK) during January-March 2013 under approved and registered protocol.

Results: It was found that even the lowest concentration of lycopene tested (2 mg) caused a statistically significant (p<0.05) decline in the total cholesterol value at the end of the trial [from a median of 230.5 mg/dl (95% CI: 243.6, 204.8) to 210.5 mg/dl (95%CI: 221.7, 200.1)]. Consumption of higher amounts of lycopene embedded into L-tug DC caused an even more significant step-wise decline in total cholesterol values which were observable from the second week of the trial. There was a corresponding decline in LDL-cholesterol and triglyceride values. Consumption of L-tug DC with the highest amount of lycopene (7 mg) caused a small but statistically significant (P<0.05) increase in HDL values at the end of the interventional period [from a median of 40 mg/dl (95% CI: 43.65, 39) to 42 (95%CI: 43.65, 40.35)].

Conclusion: Lycopene-containing L-tug DC can be used for dietary management of abnormalities of lipid homeostasis in mild hyperlipidemia.

Open Access Original Research Article

Knowledge and Behaviour of Physicians and Surgeons Regarding Shisha Smoking

Ashok Kumar, Mahvesh Mahmud, Nida Hussain, Zafar Abdul Nabi, Barun Shah, Nadeem Rizvi

Journal of Advances in Medicine and Medical Research, Page 1-12
DOI: 10.9734/BJMMR/2016/24258

Background: The aim of the study was to determine the prevalence, knowledge, attitude and practices of shisha (waterpipe) smoking among physicians and surgeons in five main cities of Pakistan. Shisha smoking is becoming more popular in Pakistan, and as medical doctors (both physicians and surgeons) serve as role models for healthy behavior, they can greatly influence shisha use in public by the example they set, and by the education that they provide to their patients.

Objective: To investigate and compare the knowledge, attitudes, and practices of shisha smoking among physicians and surgeons in Pakistan.

Materials and Methods: A cross-sectional study was done in five major public medical universities of Pakistan. A self-administered questionnaire was used with some modification.

Results: Out of 1000 distributed questionnaires, 786 doctors responded of which 51.4% were physicians and 48.6% were surgeons. Even though the vast majority (99%) of doctors agreed that shisha smoking is detrimental to health, almost 20% of surgeons and 13% of physicians reported using shisha daily. More physicians than surgeons had never used shisha, and more physicians were willing to quit, with the difference achieving statistical significance. The knowledge about shisha smoking was not uniform amongst the doctors, with physicians demonstrating significantly more knowledge as outlined in three areas (smoking causing increased risk of Sudden Infant Death Syndrome [SIDS], lung and heart disease). More physicians than surgeons agreed that doctors who use shisha are less likely to advise people against it; they also agreed that doctors should get training on cessation techniques. The majority of participants agreed that doctors are role models for patients. More physicians thought that smoking should be banned in public places and that tobacco sale to children and adolescents should also be banned. More surgeons than physicians agreed that shisha use is socially more acceptable than cigarette smoking. It was also noted that for the majority of doctors, there is no workplace policy in place regarding smoking.

Conclusion: Social and recreational use of shisha is widespread among both physicians and surgeons (slightly higher among surgeons), despite being acknowledged by the majority as a health hazard. This is of concern as doctors are role models for patients, and doctors who smoke shisha raise public skepticism. Keeping in mind the health complications of this social practice, appropriate counter measures should be taken.

Open Access Original Research Article

Outcomes of Laparoscopic Cholecystectomy in Patients 65 Years and Older

Cem Tugmen, Ismail Sert, Eyup Kebabci, Bulent Calik, Sait Murat Dogan, Cem Karaali, Mustafa Olmez, Cengiz Aydın, Cezmi Karaca

Journal of Advances in Medicine and Medical Research, Page 1-8
DOI: 10.9734/BJMMR/2016/23958

Aim: Laparoscopic surgery is considered to be the gold standard in gall bladder surgery and to take advantage of its benefits, the number of laparoscopic procedures carried out on elderly patients is increasing daily. The aim of this study was to determine the mortality and morbidity rates of laparoscopic cholecystectomy (LC) in a patient group over 65 years of age and to analyze the predictive factors for conversion to open surgery.

Study Design: A retrospective analysis of patients, 65 years of age and over, who had undergone laparoscopic cholecystectomy operation.

Place and Duration of Study: Tepecik Training and Research Hospital, Department of General Surgery, Izmir, Turkey between January 2012 and June 2014 in our clinic was conducted.

Methodology: A retrospective analysis of 385 patients, 65 years of age and over, who had undergone cholecystectomy operation When excluding the patients who had open cholecystectomy or additional surgical procedures, 240 patients were included in the study. The patients were also divided into two age groups (65-74 years; 75+ years) for further analysis.

Results: The median age of the patients was 70. The rate of conversion from laparoscopy to open surgery was 12.5% (n=30). Multivariate analysis showed the leukocytosis and pathological acute cholecystitis to be independent risk factors for conversion. A longer total hospital stay was seen in patients with inflammatory bile duct diseases (5±4 days - 3±2 days). The surgical morbidity rate was 19.6% (n= 47); the rate of systemic complication was 2.5% (n=6).

Conclusion: Inflammation related to gallstones in the biliary system is a definite risk factor for conversion to open surgery. Laparoscopic cholecystectomy, with its acceptable rates of morbidity, mortality and conversion, is a reliable surgical procedure in the 65 and over age group.

Open Access Original Research Article

Reasons Preventing or Delaying Dental Visits in Taibah University Students

Norah S. Alkhalifa, Dalia H. Zahran

Journal of Advances in Medicine and Medical Research, Page 1-8
DOI: 10.9734/BJMMR/2016/23519

In order to maintain good oral health and prevent dental problems, regular dental visits are highly recommended. Previous studies have reported reasons preventing or delaying dental visits such as fear of dentist, cost and lack of time. The aims of the study were to asses and identify the obstacles that prevent or delay dental visits among the students of Taibah University in Al-Madinah Al-Munawarah, Saudi Arabia.  It is an analytical cross sectional study where an online questionnaire was distributed to the students of Taibah University. A total of completed 416 questionnaires were used in analysis. The frequency of dental visit was less than 1 every two years with no significant gender difference. Lack of time and cost were reported to be the most common causes that prevented visiting the dental clinic in males and females. While males reported no importance to visit the dentist if there is no pain as the second most common reason. The less commonly reported reasons were the lack of transportation to visit the dentist and I am medically compromised/disable. Lack of transportation was recorded only by females as a barrier preventing dental visit.

Open Access Review Article

Role of Adiponectin and Serotonin in Development of Obesity and Therapeutic Implications

Archana Singh Sikarwar, Mohd Nazmi Nizar Bin Mohd Azmi

Journal of Advances in Medicine and Medical Research, Page 1-11
DOI: 10.9734/BJMMR/2016/24181

Obesity is a major health concern worldwide as it provokes other health issues. The rise of obesity cases has started public concern as chronic obesity incidences are closely related to significantly shortened life expectancy. Coronary artery disease, hypertension, liver/biliary disease, osteoarthritis, strokes and type 2 diabetes are the common comorbidities which are closely associated with obesity. Adiponectin is the copious adipokine secreted by the adipose tissue in a human body. It is an anti-inflammatory and vasculoprotective cytokine whereas Serotonin, 5-hydroxytryptamine (5-HT) is a bio amine derived product of the amino acid tryptophan. Adiponectin and serotonin are observed to be the parts of the obesity by indirectly acting on the adipose tissues. The association of adiponectin and serotonin is based on the effect of adiponectin and serotonin on each other activity. Studies showed an elevation of serotonin may down-regulated the expression of adiponectin, which is normally seen in the case of obesity. Also, the factors affecting their activity vary from the molecular to the physical level.