Open Access Case Study

A Rare Case of Cockayne Syndrome

Satish Sivan, Usha Varadharajan, Soundarya Srinivasan, Mahesh Neerupakam

Journal of Advances in Medicine and Medical Research, Page 1-6
DOI: 10.9734/BJMMR/2016/22404

Background: Cockayne syndrome is a rare autosomal recessive congenital disorder characterized by growth failure, impaired development of the nervous system, abnormal sensitivity to sunlight (photosensitivity), and premature aging.

Case: In this report we present a 24 year old male with decreased height, weight & reduced head circumference measuring 124 cm, 20 kg and 20 cm respectively. Cachectic dwarfism, ataxic gait, mental retardation, sunken eyes, hypoplastic maxilla, and parrot beak shaped nose giving “bird like facies” were other key features observed in our patient. Oral examination revealed congenital missing teeth and multiple dental caries teeth are also seen. Magnetic resonance imaging and computed tomography findings were also contributory to our diagnosis.

Conclusion: This case report aims to rekindle and emphasis the diagnostic features of Cockayne syndrome & highlights the role of various investigations done by both medical & dental professionals to diagnose and manage the patient.

Open Access Original Research Article

Development and Validation of the Emergency Department Geriatric Readmission Assessment at Yale (ED GRAY): Part 1, Fundamental Measurement

Lori A. Post, Thomas L. Conner, James F. Oehmke, Fuad Abujarad, Leo M. Cooney, Cynthia Brandt, Connie Page, Sarah Swierenga, Brian J. Biroscak, Christal Esposito, Jim Dziura

Journal of Advances in Medicine and Medical Research, Page 1-14
DOI: 10.9734/BJMMR/2016/23875

Objective: Our primary objective was to develop a reliable, valid, and efficient screening tool that measures recovery disability among geriatric patients for the Department of Emergency Medicine (ED) Geriatric Readmission Assessments (GRAY).

Methods: We conducted a retrospective medical chart review and prospective data analysis of geriatric patients admitted to hospital from the emergency department that were discharged, admitted, or died at a single academic urban university-affiliated hospital to identify items for ED GRAY. Rasch analysis was then used to reduce items and construct an interval/ratio scale of physical and cognitive disabilities. Patients consisted of a cohort of consenting, non-critically ill, English-speaking adults older than 65 years and receiving care in the ED to reduce the number of items.

Results: Rasch analyses resulted in infit and outfit statistics that eliminated redundant items or items that did not fit a unidimensional disability construct. From the 158 original items, sixteen items comprise the ED GRAY global health questionnaire, representing five sub-constructs: physical disability, cognitive disability, stress, depression, and isolation. All infit and outfit statistics for the global recovery disability score ranging from 1 (least healthy) to 5 (most healthy) were consistent with forming a unidimensional scale.

Conclusions: Our study resulted in an objective measurement tool of physical and cognitive disability using Rasch analyses. This screening tool allows healthcare providers the ability to screen older ED patients on a continuum of risk, with high-risk patients being most likely to benefit from in-depth evaluation—e.g., comprehensive geriatric assessment—followed by intervention (when necessary).

Open Access Original Research Article

Social and Behavioural Factors Associated with Dental Caries Experience among Adolescent School Children in Bengaluru City, India

Sushi Kadanakuppe, S. S. Hiremath

Journal of Advances in Medicine and Medical Research, Page 1-10
DOI: 10.9734/BJMMR/2016/24021

Aim: To assess the influence of social and behavioural factors on dental caries experience among adolescent school children in Bengaluru city, India.

Study Design: Cross sectional study.

Place and Duration of the Study: Primary schools of Bengaluru City, between November 2012 and March 2013.

Methodology: A cross sectional study was conducted on 11 year old 814 adolescents attending upper primary schools of Bengaluru city and their parents. Separate interview for adolescent students and parents was conducted on behavioural and social factors respectively. Dental caries was recorded according to WHO criteria using mouth mirrors and CPI probes under natural light. Statistical analysis included descriptive analysis, bivariate analysis using chi-square tests and t-tests. Later the variables were subjected to logistic regression analysis.

Results: Dental caries experience of the children studied was associated with social factors such as occupation of the mother (OR=1.9; 95% CI=1.3-2.3), presence of social support for mother during adulthood (OR=2.1; 95% CI=1.4-2.0), possession of television (TV)/computer at home (OR= 1.6; 95%=0.9-3.0); and behavioral factors such as adolescents who consume at least one serving of dairy/legumes/eggs/meat or poultry per day (OR=1.8; 95% CI=0.14-1.32), those who consume sweet snacks >1times in a day (OR=1.42; 95% CI=0.82-1.83). Influence of parents and TV on snacking, tooth brushing frequency and fluoridated dentifrice were also shown to be significantly associated with dental caries experience.

Conclusion: Social factors such as occupation of the mother and social support play an important role in shaping the more proximal behavioural habits such as snacking among 11 year old children. These interactions ultimately influenced dental caries experience in this age group.

Open Access Original Research Article

Effect of Methanolic Extract of Passiflora foetida on Glucose Kinetics in Alloxan-induced Diabetic Mice

A. O. Sijuade

Journal of Advances in Medicine and Medical Research, Page 1-7
DOI: 10.9734/BJMMR/2016/23767

Background: This study investigated the hypoglycemic potential of methanolic extract of Passiflora foetida (PF) in alloxan-induced diabetic albino mice. Diabetes is a metabolic disease characterized with high blood sugar levels over a prolonged period. Discovery of a new drug will greatly reduce the mortality and morbidity associated with the disease.

Methods: Diabetes was induced in albino mice by administration of 150 mg/kg body weight (b.w.) alloxan. Different concentrations of the methanolic extract of PF was prepared and administered orally to groups of alloxan-induced diabetic mice. Blood glucose was determine at different time point over 4 hrs.

Results: The extract reduced blood glucose levels in diabetic mice significantly (P<0.001) and the kinetic parameters such as, area under glucose concentration time curve (AUC0-4hG) (P<0.05), glucose mean residence time (MRTG), glucose t1/2G were significantly lower (<0.05) in PF treated groups when compared with the control groups. The rate of glucose clearance (CLG) was high in the group treated with the extract.

Conclusion: The results of this study indicate presence of hypoglycemic constituent in the plant.

Open Access Original Research Article

Adherence of Diabetic Patients to Education Information Provided at Primary Health Care Level in Khartoum State, Sudan

Siham Ahmed Balla, Kamil Mirghani Ali Shaaban, Haiedr Abu Ahmed Mohamed, Mohamed Ali Awadelkareem

Journal of Advances in Medicine and Medical Research, Page 1-6
DOI: 10.9734/BJMMR/2016/24203

Introduction: Diabetes mellitus needs medical care and education. Adherence of the diabetic patients to education information provided at primary care level have been scantly documeneted.

Objective: To measure the adherence of diabetic patients to education information provided at health centers.

Methods: A cross sectional study was carried out in 25 governmental health centers (Gov.HCs) and 15 non-governmental health centers (Non-Gov.HCs). Study population was 419 adult diabetic males /females known beneficiaries of the services in the study centers.

Patients were interviewed by structured questionnaire. Descriptive statistic presented the patients profile, as well as the education information received by the patients and the levels of patients’ adherence. Fisher exact test at 95% confidence level used to test differences in education information services. Adherence of patients to education information was measured by three points Likert scale. Chi square test used to test the difference in adherence. Ethical clearance and written consent were obtained.

Results: The mean age was 55.2±10.2 years. Males and females were 44.6% and 55.4% respectively. Education accounted to 76.4%. Family income above 1000 Sudanese Geneh (SDG) accounted to 64.2%. Doctors provided education information about physical activities to 64.6% and 46.2% patients in Gov.HCs and Non-Gov.HCs respectively, P-value 0.014. Diet plan received by 73.6% and 55.8% of patients in Gov.HCs and Non-Gov.HCs respectively, P-value 0.013. Information on how to measure blood glucose at home received by 48.2% and 25.0% of patients in Gov.HCs and Non-Gov.HCs respectively, P-value 0.002. Very few patients received information from educators, 0.2% and 3.4% of patients in Gov.HCs and Non-Gov.HCs respectively. Foot care education information provided to 25.3% of patients. Adherence of diabetic patients to education information provided was adequate but does not significantly differ between the types of the health centers

Conclusions: Education information services were significantly high in Gov.HCs. Adherence of diabetic education information was adequate.

Open Access Original Research Article

MRI versus CT Machine of the Quality of Brain Image

Haifa Hussein Al-Harbi

Journal of Advances in Medicine and Medical Research, Page 1-7
DOI: 10.9734/BJMMR/2016/23918

The aim of our study was to compare the imaging quality of the two machines in order to find out which of them produces more quality brain images that the other. A qualitative study was employed and data was collected, through observation, from a population that consisted of 80 patients whose age ranged from 2 months to 60 years old and took place at King Fahad Specialist Hospital in Buraidah, Saudi Arabia. These patients were referred in the hospital to undergo brain imaging. The hypothesis guiding the study was that MRI produces quality brain images. The findings of this research underscored the need to use MRI machines during brain imaging. It was concluded that MRI machine was suitable for soft tissues and produces images of higher quality compared to CT machine and it is for this reason that they alternate H1 hypothesis was rejected.

Open Access Original Research Article

Development and Validation of the Emergency Department Geriatric Readmission Assessment at Yale (ED GRAY): Part 2, Prognostic Accuracy

Lori A. Post, Thomas L. Conner, James F. Oehmke, Fuad Abujarad, Leo M. Cooney, Cynthia Brandt, Connie Page, Sarah Swierenga, Brian Biroscak, Christal Esposito, Jim Dziura

Journal of Advances in Medicine and Medical Research, Page 1-8
DOI: 10.9734/BJMMR/2016/23877

Objective: The Emergency Department (ED) Geriatric Readmission Assessment (ED-GRAY) is a 16-item questionnaire we developed that can be used to evaluate the prognostic ability to determine if geriatric patients will recidivate to the ED, be admitted or die within 30 days.

Methods: We conducted an observational prospective cohort study at a single academic urban university-affiliated hospital. Subjects (n=250) were consenting, non-critically ill, English-speaking adults older than 65 years and receiving care in the ED. Multivariable logistic regression and receiver operating characteristic (ROC) curves were used to evaluate the ability to accurately predict the likelihood of a 30-day event: subsequent ED visit, hospitalization, or death.

Results: 56 participants (22%) experienced at least one 30-day return visit or death. Greater disability as measured by the ED GRAY global disability was associated with an increased likelihood of an event (OR=1.7 for each 1-point worsening in severity; 95% CI 1.2, 2.5). In the multivariable model, prior ED visits (OR=2.7, 95% CI=1.4, 5.2), ED GRAY global score (OR=1.4, 95% CI=1.0, 2.1), and age (OR=1.03, 95% CI=0.99, 1.07) were associated with a greater likelihood of a 30-day event. The fit of the multivariable model was good (Hosmer-Lemeshow Goodness of Fit test, p=0.85) and it provided good discrimination between those having and not having a 30-day event (AUROC=0.70). The predicted probability of a return visit ranged from 3–56%.

Conclusions: ED GRAY demonstrated good predictive validity when combined with prior ED visits, poly-pharmacy and age.

Open Access Original Research Article

Retreatment Efficacy of Propoint and Guttapercha - A Cone Beam Computed Tomography Analysis

Chandrasekhar Veeramachaneni, Mohini Ratakonda, Vijetha Badami, S. Anitha Rao

Journal of Advances in Medicine and Medical Research, Page 1-7
DOI: 10.9734/BJMMR/2016/23884

Introduction: The present study aimed to evaluate the amount of residual material after retreatment of propoint (DRFP Ltd. Stamford, UK) and gutta-percha obturated using smart paste bio sealer (DRFP Ltd. Stamford, UK), considering gutta-percha and AH Plus (Dentsply Maillefer, Ballaigues, Switzerland) as the standard for comparison.

Methods: Forty five single rooted teeth were instrumented using rotary files (F3, Protaper, Dentsply Maillefer, Ballaigues, Switzerland). Obturation was done with three different materials (n=15); group 1, Propoint with smart paste bio, group 2, gutta-percha with smart paste bio and group 3, gutta-percha with AH Plus. Teeth were scanned by cone beam computed tomography to measure the volume of obturation material. After three months of storage, retreatment was performed (Protaper universal rotary retreatment files, Dentsply Maillefer, Ballaigues, Switzerland). Second scan of cone beam computed tomography was taken to evaluate the residual filling material. Group comparisons were performed using one way ANOVA and Post-Hoc Tukey test HSD test (P=0.05).

Results: There was no statistically significant difference between the three groups (P<.05), in the residual filling material.

Conclusions: In conclusion, the results of this study indicate that the obturation material could not be removed completely in all the three groups. There was no significant difference in the retreatment efficacy between propoint and gutta-percha.

Open Access Original Research Article

Health-related Microbial Quality of Drinking Water in Kangavar, Western Iran

Nezam Mirzaei, Heshmatollah Nourmoradi, Allahbakhsh Javid, Fazel Mohammadi-Moghadam, Hamid Reza Ghaffari, Mohammad Ahmadpour, Kiomars Sharafi

Journal of Advances in Medicine and Medical Research, Page 1-7
DOI: 10.9734/BJMMR/2016/23212

Evaluation of the microbial quality of drinking water can prevent the water-borne diseases outbreak that is one of the most important challenges in the world. Therefore, the aim of this study was to assess the seasonal variation of water-borne diseases prevalence associated with the microbial quality of drinking water and the comparison between rural and urban areas in Kangavar city, west of Iran. To accomplish this study, the results of the microbial quality of drinking water and cases of simple diarrhea, dysentery, typhoid and hepatitis A were received from all rural and urban health centers of the city during five years (2006-2010). To determine the relationship between diseases and microbial quality of water, Correlation instruction and Pearson correlation coefficient were used. The results showed that except hepatitis A, the incidence of all diseases in different areas (urban or rural) and seasons had significant relationship with microbial contamination of drinking water (P-value<0.05). The stronger relationship was observed in rural areas than in urban areas (except simple diarrhea) and in warm seasons than in cold seasons. With respect to the impact of the microbial quality of water on the incidence of dysentery and typhoid diseases, keeping up the quality of drinking water in places and times with high sensitivity (rural areas and warm seasons) should be considered strongly.

Open Access Original Research Article

Comparative Analysis of Maternal and Perinatal Outcomes of Trial of Vaginal Birth and Planned Repeat Caesarean Section Following a Prior Caesarean

Eugene M. Ikeanyi, Alphonsus N. Onyiriuka

Journal of Advances in Medicine and Medical Research, Page 1-9
DOI: 10.9734/BJMMR/2016/23218

Background: Delivery following a previous caesarean section is associated with the fear of increased maternal and perinatal morbidity and mortality. The optimal mode of such delivery remains critical with increasing rate of caesarean births in the contemporary obstetric care. The intended choice of mode of delivery for the woman and her clinician remains between trial of vaginal birth after caesarean and elective repeat caesarean section. This study was therefore designed to appraise the obstetric outcomes of the two main modes of delivery after a primary caesarean delivery.

Objective: This study assessed the feto-maternal implications of trial of vaginal birth and elective caesarean section after a prior caesarean in order to contribute data to the increasing volume of evidence for expeditious management of increasing caesarean section rates. Specifically the maternal and perinatal outcomes of trial of vaginal birth after caesarean (TVBAC) and elective repeat caesarean delivery (ELRCD) were estimated and compared.

Methodology: This was a comparative analytical observational study of 245 and 57 women who respectively had Trial of vaginal birth after caesarean (TVBAC) and elective repeat caesarean section (ELRCS) in their subsequent delivery following a primary caesarean section. EPI-INFO statistical package was used for data collation and analysis.

Results: Trial of vaginal birth was associated with 1.22% risk of hysterectomy, 0.82% of uterine rupture and 1.6% long hospital stay unlike elective repeat caesarean section that had no recorded incidence of any of these morbidities. The women who had TVBAC were twice at increased risk of blood transfusion and more than 50% increased risk of postpartum hemorrhage compared to those who had ELRCS. The differences were however not statistically significant.

Composite perinatal morbidity was thrice higher among TVBAC  (5.3% vs. 1.8%, OR 3.14 P=0.48) mainly 3.3%, 1.2% and 1.6% of Apgar scores less than7 at 5 minute, fresh stillbirths and perinatal deaths respectively. Again none of the differences was statistically significant. The morbidities associated with TVBAC seemed to increase when it failed and the need for emergency caesarean arose.

Conclusion: There appeared to be subtle but insignificant increased likelihood of both maternal and perinatal adverse outcomes in trial of vaginal birth after caesarean. We recommend TVBAC in well selected cases since the feto-maternal outcome appeared similar in the two modes of delivery.