Open Access Case Study

Hyperglycemic Crisis in a 37 Year Old Man with Multiple Substance Use and Depression

Ikenna Desmond Ebuenyi, Peter Ogie Ikuabe, Uzoechi Eze Chikezie, Ifeoma N. Onyeka

Journal of Advances in Medicine and Medical Research, Page 1-4
DOI: 10.9734/BJMMR/2016/24424

Uncontrolled hyperglycemia termed hyperglycemic hyperosmolar syndrome (HHS) is a serious but relatively common presentation of new-onset diabetes mellitus. The diagnosis of the disorder itself is fairly straight forward, but the search for trigger factors can be challenging. Infections are the usual precipitating factor, but a variety of other stressors can be involved such as the abuse of substances like alcohol, cocaine, and cannabis. Available evidence suggests that depression is common among diabetic patients. When such patients are also dependent on substances, it becomes challenging to distinguish between diabetes-related depression and substance-related depression. Clinicians managing diabetic patients need to be aware of comorbid conditions that may negatively impact patient care. We report herein a patient presenting with hyperglycemic hyperosmolar state with two possible precipitating factors; infection and substance abuse.

Open Access Original Research Article

ASpirin and Plavix Following Coronary Artery Bypass Grafting (ASAP-CABG): A Randomized, Double-Blind, Placebo-Controlled Pilot Trial

Ahmad M. Slim, Emilio Fentanes, Dustin M. Thomas, Jennifer N. Slim, Taylor Triana, Homayoun R. Ahmadian, Ryan J. McDonough, Jason Saucedo, Norma J. Suarez, Dorette Pearce-Moore, H. Lester Kirchner, Edward Hulten, Ricardo C. Cury, Kelley Branch

Journal of Advances in Medicine and Medical Research, Page 1-10
DOI: 10.9734/BJMMR/2016/24386

Background: Vein graft thrombosis is the leading cause of acute graft failure within the first post-operative month. Several studies have shown the benefit of post-operative dual anti-platelet therapy (DAPT) in preventing acute graft thrombosis. The purpose of this study was to determine whether peri-operative initiation of DAPT will improve short and intermediate term graft patency.

Methods: This was a randomized, double-blind, placebo controlled trial of 20 patients undergoing CABG to compare DAPT versus aspirin monotherapy. The primary outcome was post-operative graft patency at 2 and 52 weeks determined by <50% bypass graft stenosis by cardiac computed tomography angiography (CCTA). The secondary outcomes were (1) major adverse cardiovascular events (MACE), defined as myocardial infarction, thrombotic events, and angina, and (2) safety end-points defined as TIMI major and minor bleeding events.

Results: The study population consisted predominately of men (19/20 patients). At 2 weeks, all LIMA grafts were patent although vein graft patency for the DAPT group was only 83.3% (20/24) compared to 89.5% (17/19) for placebo (p=0.597). At 52 weeks, the patency rate in the placebo group was 52.6% (10/19) as compared to a patency of 71.4% (15/24) in the dual anti-platelet therapy arm (p=0.244). 

Conclusion: The addition of clopidogrel to aspirin post-bypass surgery did not significantly improve venous graft patency at 2 weeks but trended toward higher graft patency at 52 weeks.

Open Access Original Research Article

Blood Profil of Dogs Experimentally Infected with Single Trypanosoma brucei, Ancylostoma caninum and Conjunct Trypanosoma brucei and Ancylostoma caninum and Treatment with Diminazene Aceturate and Mebendazole

R. I. O. Nwoha, B. M. Anene

Journal of Advances in Medicine and Medical Research, Page 1-13
DOI: 10.9734/BJMMR/2016/24062

The present study was designed to ascertain the level of haematological alterations in single Trypanosoma brucei (T. brucei), Ancylostoma caninum (A. caninum) and conjunct infections of both parasites in dogs and effect of treatment with diminazene aceturate and mebendazole on haematology. Sixteen dogs grouped into 4 of 4 members each were used in the study. Group 1 (GPI) was uninfected (control), GPII was infected with A. caninum, GPIII was infected with T. brucei and GPIV was infected with conjunct infections of T. brucei / A. caninum. Post acclimatization, GPII and GPIV were infected with A. caninum, 2 weeks after GPIII and GPIV were infected with T. brucei. By week 6 post infection, GPII and GPIV were treated with 100 mg of mebendazole given twice daily for 3 days and a repeat given 2 weeks later. GPIII and GPIV were also treated with diminazene aceturate at 7 mg/kg once. Treatment was repeated at week 8 and 9 of the experiment. There was a significant (p < 0.05) decreases in pack cell volume (PCV), haemoglobin concentration (Hb), red blood cell count (RBC) in all the experimental groups (GPII, GPIII and GPIV). The decreases were more in the conjunct group (GPIV) compared to the others. A significant (p < 0.05) decrease in white blood cell (WBC) count was recorded in all the experimental groups (GPII, GPIII and GPIV). It was reflected in significant (p <0.05) decreases in lymphocytes, neutrophil, monocyte, basophil counts in T. brucei infected group. Conversely there were significant (p <0.05) increases in neutrophil, eosinophil, monocyte and basophil count but a decrease in lymphocyte count in A. caninum group. The haematological alterations were more in T. brucie group compared to the A. caninum group. Similarly the effect was more in the conjunct   T. brucei /A. caninum group compared to the single T. brucei. Treatment with 7 mg/kg diminazene aceturate and 100 mg mebendazole given once daily for 3 days caused some improvement in haematology. These findings would enhance clinicians’ knowledge of the effect of single and mixed infections of T. brucei and A. caninum in dogs.

Open Access Original Research Article

Comparison of Menarche Age between Two Generations

Nazanin Hazhir Karzar, Robabeh Ghergherehchi, Mahnaz Sadeghi Shabestari

Journal of Advances in Medicine and Medical Research, Page 1-5
DOI: 10.9734/BJMMR/2016/24244

Background: During the past century, the mean age at menarche among the North West Iranian girls has decreased. The aim of this study was to compare the age of menarche between two generations and to determine the effect of BMI on the menarche age.

Materials and Methods: This cross –sectional study was carried out on 2029 girls of 9-17 years of age during September 2012 to May 2014 in North-West of Iran. Participants were selected by multistage random cluster sampling from school students in urban and rural areas. After measuring their height and weight, relevant data were collected through a questionnaire. Data were analyzed by chi-square, independent-t test and Pearson bivariate correlation Coefficients, using SPSS 16.

Results: Out of 2029 girls’ age 9-17 years, the 1600 who were menstruating included in the study. The mean age of menarche in daughters and their mothers were 12.58±1.3 and 13.22±1.22 years, respectively. There was a significant positive correlation between mothers’ and daughters’ menarche age (r = 0.33, P= 0.001). However, a negative significant relation was observed between menarche age and BMI (r= 0.24 P< 0.001).

Conclusion: We found that the mean age of menarche was different in comparison with the previous generations. The age at menarche of obese girls is significantly earlier normal weight.

Open Access Original Research Article

Acute Effects of Air Stacking Versus Glossopharyngeal Breathing in Patients with Neuromuscular Disease

Rodrigo Torres-Castro, Jordi Vilaró, Roberto Vera-Uribe, Luis Vasconcello, Homero Puppo

Journal of Advances in Medicine and Medical Research, Page 1-8
DOI: 10.9734/BJMMR/2016/23192

Objective: To compare the effects of Air Stacking (AS) and Glossopharyngeal Breathing (GPB) on the Maximum Insufflation Capacity (MIC) in patients with Neuromuscular Disease (NMD).

Methods: We design a randomized cross-over study. Children and adolescents with NMD who were users of non-invasive mechanical ventilation were recruited. Vital capacity (VC) and MIC were measured before and after the intervention with AS and GPB. Values were compared pre- and post-intervention and were considered statistically significant if p <0.05.

Results: We selected 14 patients with a median age of 12.5 years (range 9-18) with the following diagnoses: Duchenne Muscular Dystrophy (7), Spinal Muscular Atrophy Type II (3), Spinal Cord Injury (1) and Congenital Myopathies (3). The median baseline VC was 1325 ml (CI 1084-1594 ml). AS improved the VC to 1930 mL (CI 1630-2434 mL, p<0.001), and GPB increased the VC to 1600 mL (CI 1370-1960 mL, p=0.001). There was a significant difference of 290 mL (CI 168-567 mL, p<0.002) between both techniques.

Conclusion: The air stacking and glossopharyngeal breathing were both effective in increasing the maximum insufflation capacity, but air stacking resulted in a greater increase in MIC.

Open Access Original Research Article

Antioxidant Trace Metals among Roadside Petrol Dispensers in Gombe State, Nigeria

S. Adamu, O. M. Akinosun, F. M. Abbiyesuku, M. A. O. Kuti, Jibril M. El-Bashir, J. D. Abubakar

Journal of Advances in Medicine and Medical Research, Page 1-7
DOI: 10.9734/BJMMR/2016/24251

Background: The number of people found to be exposed to gasoline is of public health concern. In developed countries, unlike developing countries, measures are taken to dispense gasoline quickly and safely to reduce exposure. In Nigeria, roadside dispensers are a common sight, often with no any form of protection. This leads to high levels of exposure with the consequences including oxidative injuries. As cofactors in antioxidant reactions, antioxidant trace metals are consumed in the process of converting the free radicals generated by petrol.

Methods: Antioxidant trace metals (zinc, manganese, copper, and selenium) were compared between 90 road side dispensers of gasoline and 90 matched controls. Plasma zinc, selenium, manganese and copper ware analyzed using Atomic Absorption Spectrophotometer (AAS).

Results: The mean age of the exposed and control groups are 29.03±3.7 and 29.24±3.5 years respectively. Antioxidant trace metals zinc (64.7±6.09 µg/dl), manganese (7.93±1.32 µg/dl) and copper (77.8±7.38 µg/dl) of the exposed were significantly (p< 0.001) lower than the controls (100.2±9.58 µg/dl, 9.22±1.19 µg/dl and 103.8±20.09 µg/dl respectively). Selenium (0.03±0.008 µg/dl) was significantly (p< 0.001) higher in the exposed group compared to the controls (0.01±0.0023 µg/dl).

Conclusion: This study has demonstrated lower level of antioxidant trace metals in roadside dispensers of gasoline compared to the controls. This indicates that those exposed are probably at greater risk of developing chronic diseases associated with increase oxidative stress. Enforcing legislation on roadside gasoline dispensing may reduce the risk.

Open Access Original Research Article

Is Salbutamol and Adrenalin Inhalation Effective in Management of Transient Tachypnia of Newborn?

Fathy Nawar, Hisham Ahmad Aly, Sheref Helmy, Mohamed Abd El Monaem

Journal of Advances in Medicine and Medical Research, Page 1-8
DOI: 10.9734/BJMMR/2016/23922

Background: In the neonatal period, transient tachypnea of the newborn (TTN) is the most frequent cause of early respiratory distress because of delayed resorption of lung fluid, which fills the fetal airways. The inability of the lung to switch from fluid secretion to fluid absorption and immaturity in the expression of epithelial Na+- channels (ENaC) may play an important role in the development of transient tachypnea of the newborn.

Aims: Evaluation of inhalation therapy by BETA-2 agonist salbutamol and epinephrine for the management of transient tachypnea of newborn.

Methods: The study was a prospective randomized control study. It included 60 neonates diagnosed clinically and radiologicaly as TTN. Inhaled salbutamol, epinephrine or saline 0.45% solution was administered. 

Results: Comparing studied groups after intervention, highly significant lower respiratory rate, TTN scores, respiratory support and duration of hospital stay was detected in group II (salbutamol group) while no significant difference between groups regarding heart rate after 4 hours from intervention.

Conclusion: Inhaled Salbutamol resulted in better outcome in decreasing the respiratory rate, TTN clinical score, lower FIO2, higher O2 saturation, decreasing the duration of respiratory support along with the total duration of hospitalization.

Open Access Original Research Article

Haemoassessment of Dogs Experimentally Infected with Single and Conjunct Trypanosoma congolense and Ancylostoma caninum and Treatment with Diminazene Aceturate and Mebendazole

R. I. O. Nwoha, B. M. Anene

Journal of Advances in Medicine and Medical Research, Page 1-11
DOI: 10.9734/BJMMR/2016/24067

The haemoassessment of dogs with single Trypanosoma congolense (T. congolense) and conjunct T. congolense /A. caninum was determined in this study. Twelve mongrels of both sexes weighing between 4 to 8 kg were grouped into 3 of 4 members each. The group i (GPI) was the uninfected (control), group ii (GPII) was infected with T. congolense and group iii (GPIII) was conjunct infection of T. congolense/A. caninum. Post acclimatization GPIII was infected with 200 infective L3 of A. caninum, 2 weeks later both GPII and GPIII were given 2.5x106 trypanosomes intraperitoneally. Three weeks post trypanosome infection, treatment was done with 100 mg of mebendazole twice daily for 3 days and 7 mg/kg of diminazene aceturate. Result showed a significant decrease (p<0.05) in PCV, Hb and Rbc of both GPII and GPIII. The decrease in GPIII was more compared to that in GPII. There was significant decrease (p<0.05) in neutrophil, monocyte, lymphocyte and eosinophil counts of both GPII and GPIII except in basophil count which showed no significant difference (p<0.05) from GPI (control) throughout the experiment. Treatment with both diminazene aceturate and mebendazole cause significant haematological improvement.

Open Access Original Research Article

Prevalence of Positive Tuberculin Skin Test (TST) Results among Pre-clinical and Clinical Medical Students during their Educational Course in Mashhad, Iran

Fatemeh Habibi, Atefeh Hajipour

Journal of Advances in Medicine and Medical Research, Page 1-5
DOI: 10.9734/BJMMR/2016/22940

Background: Tuberculosis is an endemic and critical public health issue in Iran and many developing countries. Healthcare workers, including medical students are at a great risk of exposure. This study is conducted in order to determine the prevalence of latent tuberculosis infection in medical student in different stages.

Materials and Methods: This is a cross sectional study, conducted between August and December 2013. 195 medical students from different stages (preclinical, externship and internship) enrolled in this study. Tuberculin skin testing (TST) was used to determine the prevalence of infection with TB and the induration was measured. A standardized questionnaire was collected for risk-assessment analysis.

Results: Among the 195 participant, 118 (60.5%) had indurations lower than 10 mm and 77 (39.5%) had indurations more than 10 mm. Induration ≥10 mm was taken as positive (P-value<0.0001).

Conclusion: TST positive results increase among medical students as they advance in their training program. The screening programs of healthcare student before clinical training can be useful for early identification and treatment of the sporadic cases of latent tuberculosis.

Open Access Original Research Article

Estimation of Sex Using Antero-posterior Dimension of Talus in North Eastern Nigerians

Eduitem S. Otong, Aminu A. Rufai, Danladi S. Amaza, Zainab Mustapha, Tamunotonye W. Jacks, Martha Attah

Journal of Advances in Medicine and Medical Research, Page 1-8
DOI: 10.9734/BJMMR/2016/22847

Aim: To evaluate sexual differences using demarking point and index of sexual dimorphism from the length of talus in relation to age among male and female north-eastern Nigerians.

Study Design: Retrospective Study.

Place and Duration of Study: Departments of Human Anatomy and Radiology, University of Maiduguri and University of Maiduguri Teaching Hospital (UMTH) respectively, Borno State, Nigeria between October 2010 to March 2012.

Methodology: Three hundred and twelve (312) radiographs of adult north-eastern Nigerians (156 males and 156 females) with ages ranged from 20 to 69 years were measured. Radiographs used for this study were obtained from the collection of records unit of Radiology Department of UMTH in Borno State, Nigeria. Radiographic viewing box, erasable maker, meter rule were used for the measurements. Both female and male samples were grouped into two separate subsamples (right and left talus). Samples were classified into five (5) age groups which spanned ten years interval. The lateral views of the plain radiographs of the ankle were mounted on viewing box connected to a light source which gave good illumination. Antero-posterior length (APL) of the talus was measured as a linear distance between the most anterior point on the head of talus and the most posterior point on the body of the talus) using a calibrated meter rule.

Results: The means of APL for males are all significantly greater than their female counterparts of the same age group. The results also show statistically significant (p<0.001) differences between the lengths of talus in males and females. The values of demarking points (DP) in males were higher than in females. The Index of sexual dimorphisms (ISDs) are greater than 100 which suggest that males have higher value over female counterparts. The result also show age related variation with male APL range from 5.82 cm at 60-69 years age group to 6.21 cm at 30-39 years age group; while female APL range from 5.27 cm at 60-69 years age group to 5.56 cm at 30-39 years age group.

Conclusion: It was observed that the APLs of talus are sexually dimorphic; the DPs of male are all higher than those of female Counterparts. ISD also shows that, male APLs are greater than those of the female counterparts: because the ISDs were all greater than 100 at all age groups. However more studies are required in other part of Nigeria, so as to capture the racial variation of Nigeria.