Open Access Case Study

Rare Case of Multifocal Cutaneous Tuberculosis Verrucosa Cutis: Posing Clinical and Histopathological Diagnostic Dilemma

R. Sudarshan, Kashinath Nayak, Pramod Kumar, Urmila Kadilkar

Journal of Advances in Medicine and Medical Research, Page 1-5
DOI: 10.9734/BJMMR/2016/26186

Introduction: Tuberculosis is an ancient universal health problem, with cutaneous tuberculosis being a rare extra pulmonary form that accounts for only 0.15-2%. Here we report a case of elderly female diagnosed with multifocal, multicentric Tuberculosis verrucosa cutis.

Presentation of Case: Sixty nine year old female presented to the skin out-patient department (OPD) at a tertiary care center, with chief complaints of multiple, multifocal asymptomatic raised verrucous lesions initially over the right upper limb and face, which insidiously progressed to involve lower limbs and nape of the neck, noticed from past 14 years. Based on histopathological features and clinical examinations, diagnosis of tuberculosis verrucosa cutis was made and patient was started on category 1 anti-tubercular treatment.

Discussion and Conclusion: Tuberculosis verrucosa cutis occupies a pre-eminent position across the spectrum of cutaneous tuberculosis. Tuberculosis verrucosa cutis is positioned between lupus vulgaris and scrofuloderma. Tuberculosis verrucosa cutis is no longer the most frequent type of skin tuberculosis. Present rare case of multifocal tuberculosis verrucosa cutis, display histopathologic features in favor of tuberculosis verrucosa cutis. Partial remission in spite of long term anti-tubercular therapy and other modalities of treatment, as in this case report, tuberculosis verrucosa cutis remains a diagnostic dilemma difficult to be solved.

Open Access Method Article

Conquest of the Weak Point of the Side-to-side Anastomosis: The Novel Technique that Can Reinforce a Weak Point with Stapling

Masahiro Kimura, Takehiro Wakasugi

Journal of Advances in Medicine and Medical Research, Page 1-5
DOI: 10.9734/BJMMR/2016/26589

Introduction: The improvement of stapling devices has been remarkable. As the stapler evolved from two lines to three lines of staples, the lateral strength of the anastomosis increased. However, the strength of the crotch did not change and the crotch remains the weak point of the side-to-side anastomosis. We previously reported the weakness of the crotch and the reinforcement method with animal model [1,2].

Technique: We describe our novel technique to reinforce the crotch using a physician-modified stapling device. A stapler with three rows of staples per side is arranged on a 6 cm segment using an EndoGIA Reinforce. Polymer felt is attached to both the cartridge fork and anvil fork of the stapler. The felt is then trimmed, as a length of 2 cm is sufficient for reinforcement of the crotch.

Results: With this method, we can reinforce the weak point of the side-to-side anastomosis at the same time as the anastomosis.

Conclusions: This method is a simple and novel technique to reinforce the crotch of a side-to-side anastomosis.

Open Access Study Protocol

Paraquat Poisoning Management in Iran (Isfahan): Devising a Protocol

Mahrang Hedaiaty, Ali Mohammad Sabzghabaee, Farzad Gheshlaghi, Nastaran Eizadi Mood

Journal of Advances in Medicine and Medical Research, Page 1-10
DOI: 10.9734/BJMMR/2016/23987

Background: Paraquat poisoning has been a health concern in many developing countries. Management of it is not standardized and varies from center to center. This study is aimed at devising an available evidence-based comprehensive protocol for parquat poisoning management in Isfahan, Iran, to reduce unnecessary variations in practice.

Materials and Methods: A narrative search in electronic databases was performed. Several peer-reviewed articles, guidelines, and textbooks were reviewed and practical details were extracted from 1967 till now.

The simple, available and wide-ranged descriptive protocol was developed.

Then, it was finally discussed with expert physicians specialized to be optimized for the diagnostic tools and treatments used in this setting by supplementing other specific considerations.

Results: The final version of the protocol was designed in six steps. The algorithm consists of a planned are based on the severity of the toxicity. It comprised of supportive treatments based on Resuscitation, Gastrointestinal decontamination, Elimination enhancement, and other treatment options for PQ lung in­jury.

Conclusion: Paraquat poisoning is a clinical toxicologic emergency, which needs to be diagnosed and treated in an organized manner, although its mortality rate is great.

Open Access Original Research Article

ABO and Rh Blood Group System and Periodontal Disease - A Prevalence Study

Patil Anup, Varma Siddhartha, Suragimath Girish, Abbayya Keshava, Zope Sameer, Kale Vishwajeet

Journal of Advances in Medicine and Medical Research, Page 1-6
DOI: 10.9734/BJMMR/2016/24055

Background: Varied literature is documented exploring the relationship between ABO blood group and prevalence of oral and dental diseases. The aim of this study was to investigate the correlation of periodontal disease with “ABO” blood groups and Rhesus factor.

Materials and Methods: A total of 684 systemically healthy subjects who were non smokers were selected by chance. Subjects with known blood group who had at least 20 teeth, were included in the study and the blood groups were confirmed from their medical records. Based on the periodontal parameters like clinical attachment loss (CAL) and bleeding on probing (BOP) the subjects were divided into three groups: healthy, gingivitis and periodontitis. The percentage distribution of ABO blood groups and Rhesus factor among the groups was tabulated.

Results: There was an increased prevalence of gingivitis in subjects with blood group ‘A’ and periodontitis in subjects with blood group ‘O’, while subjects with blood group ‘B’ had healthy periodontium. There was higher prevalence of gingivitis in Rh positive group.

Conclusion: A significant relationship between blood typing and periodontal disease was determined in this study. Further research into this is indicated.

Open Access Original Research Article

Malnutrition among Children with Non-syndromic Cleft Lip and Palate: A Case – Control Study in Ile – Ife, Nigeria

O. F. Babalola, J. K. Olabanji, A. O. Oladele, O. S. Olatunya, Fadeyibi Idowu

Journal of Advances in Medicine and Medical Research, Page 1-7
DOI: 10.9734/BJMMR/2016/26168

Background: Children with cleft lip and palate (CLP) face lots of difficulties in the society. They tend to suffer malnutrition due to lack of standard care especially from their parents and society at-large. The potential risk of malnutrition is particularly high during early childhood. There is paucity of indigenous data on the prevalence of malnutrition in children with CLP. The aim of the study was to assess the influence of non sydromic CLP on the nutritional status of children.

Methods: Anthropometric parameters weight for age z score (WAZ), height for age z score (HAZ), weight for height z score (WHZ) of children with CLP were compared with age matched controls.

Results: Prevalence of underweight, wasting and stunting for cleft group were 26%, 18% and 14% respectively compared to 18%, 14% and 10% for the control. Differences in the underweight, wasting and stunting between the two groups were not statistically significant (p value = 0.334, 0.585, and 0.538 respectively). There was significant difference in the bottlefeeding and breastfeeding rates of the two groups. (p= 0.000 and 0.000 respectively).

Conclusion: There is no statistically significant difference in the occurrence of malnutrition in children with non- syndromic Cleft lip and Palate compared with control.

Open Access Original Research Article

Self-assessment of Dental Anxiety and Fear among Dental Students in a Saudi Arabian College

Hakeem ., Bhayat ., Abou Al Shaar, Al Qobaly

Journal of Advances in Medicine and Medical Research, Page 1-7
DOI: 10.9734/BJMMR/2016/26721

Introduction: The objective was to determine the levels of anxiety and fear of dental students in relation to dental treatment.

Materials and Methods: This was a cross-sectional study and included all dental students registered at a Saudi dental college in 2013/2014. Dental fear and anxiety were evaluated using the Modified Dental Anxiety Scale (MDAS) and Dental Fear survey (DFS). All data was anonymous and confidential.

Results: A total 143 students completed the questionnaire (response rate of 88%) of which 67% were female. Females were significantly more anxious compared to males (p<0.01) and there was a positive correlation between dental anxiety and dental fear, patients with dental anxiety were more likely to have dental fear as well. Pre-clinical students reported significantly higher levels of dental fear (p=0.014) and anxiety scores (p=0.008) compared to clinical students. In addition, between 10% and 20% of students reported high levels of dental anxiety and fear respectively and females’ demonstrated higher dental anxiety and fear scores than males. The administration of an anaesthetic injection was the highest cause for both dental fear and anxiety.

Conclusion: Female demonstrated higher dental anxiety and dental fear scores than males. In addition pre-clinical students demonstrated higher dental anxiety and dental fear scores than clinical students. The most anxious and fearful item was the anaesthetic injection.

Open Access Original Research Article

Health Care Financing and Budgetary Allocation in Ondo State

Umar Jimoh, Bolanle Wahab

Journal of Advances in Medicine and Medical Research, Page 1-9
DOI: 10.9734/BJMMR/2016/25417

Funding of the health care sector in Nigeria is faced with enormous challenges that must be overcome if quality and effective health care service is to be made available to the people. While health care research has focused largely on the provision, access, and quality of the facilities, this study investigated the mechanism of public health care financing in Ondo State, Nigeria. The data used for the study were from both primary and secondary sources. A multi-stage sampling technique was adopted to select and elicit information from the respondents. The 18 local government areas (LGAs) in Ondo state were segregated into three senatorial districts; three LGAs were randomly selected from each senatorial district. With the aid of an interview guide, in-depth interview were held with the chairmen of the three LGAs. Information sought included the various sources of finance and health care financial challenges. Descriptive statistics as well as trend analysis were used for data analysis. The major challenges of health care financing were inadequate funding by government, high out-of pocket-payment, inadequate implementation of health care financing policy and corruption. This study concluded that health care financing was inadequate in the study area and recommended an increase in government budgetary allocation and prompt release of funds for public health care, adequate implementation of health care policies as well as proper monitoring and evaluation of fund utilization to discourage corruption and mismanagement.

Open Access Original Research Article

Association of the Lipoprotein Lipase S447X and Neuropeptide Y Leu7Pro Genetic Polymorphisms with the Lipid Profiles of Individuals with and without Evidence of Coronary Artery Disease

W. O. Pinheiro, C. R. Marques, F. Rios-Santos, M. D. B. Fernandes, D. B. Santos, S. O. T. Klein, F. S. Oliveira, A. Gonzales, D. C. Freitas, J. Y. Park, G. Di Pietro

Journal of Advances in Medicine and Medical Research, Page 1-10
DOI: 10.9734/BJMMR/2016/24670

Background: Coronary artery disease (CAD) is a multifactorial disease whose etiogenesis involves a number of environmental, genetic and lifestyle-related factors. Genetic polymorphisms are noteworthy among these factors because they alter gene expression and, thus, the functions of the respective products.

Methods: A case-control study was conducted in the Cardiology Institute, with 79 subjects classified as cases with CAD, and 96 subjects as controls without CAD or other disease. In this study, we evaluated the association between the single-nucleotide polymorphisms (SNPs) of S447X and Leu7Pro of the lipoprotein lipase (LPL) and neuropeptide Y (NPY) genes, respectively.

Results: No differences were found in the frequencies of LPL SNP between the cases and controls. However, the LPL 447X allele carriers exhibited a near-significant difference in the triglycerides (p=0.086) and higher mean in the HDL-c (p=0.018). NPY polymorphisms proved to be infrequent in this study population, and no significant difference was observed between the groups.

Conclusions: Our findings provide further support of the genetic polymorphisms effect on the lipid metabolism control. So, further studies are needed to assess the functional effect of this and other polymorphisms, on LPL and in the NPY activity, and their impact on CAD risk.

Open Access Original Research Article

Climacteric Women’s Life Quality with Urinary Incontinence in Aracaju City

Pollyanna Dórea Gonzaga, José Aderval Aragão, Vera Lúcia Correa Feitosa, Francisco Prado Reis

Journal of Advances in Medicine and Medical Research, Page 1-9
DOI: 10.9734/BJMMR/2016/25786

Introduction: Climacteric is the biological cycle period in women characterized by loss of ovarian follicular activity, causing innumerous emotional, physical and endocrinal changes. In this period, which starts at the age of 40 and finishes at 60, some women undergo profound existential experience in their interpersonal relations, in their conjugal, professional, spiritual, social and cultural life.

Objective: Assess the impact of urinary incontinence in women's quality of life into climacteric period, registered at health units in the city of Aracaju, Sergipe/ Brazil.

Materials and Methods: A retrospective observational study was conducted on 476 women from 41 health care units in the national family health strategy program. A specific questionnaire, King’s Health Questionnaire (KHQ), validated in Brazil by Tamamani et al. (2006), was used to collect data. The data collected was  divided into categories. Frequency distribution  and cross tabulation, with determination of confidence intervals for each frequency, were applied. The descriptive analysis was carried out through the measure of dispersion and measures of central tendency by the software Microsoft Excel 2007. Data were described by simple and proportions.

Results: 476 climacteric women were interviewed, aged 40 to 59 years old. Among those, 32% reported complaint of urinary incontinence, at least once a week, for at least three months in the last year. The most affected domains of KHQ were: Impact of urinary incontinence, followed by general perception of health and measurements of gravity with average above 50%. The sample was calculated from the formula proposed by Barbeta (2001).

Conclusions: Although other domains had average below 50, the influence of urinary incontinence in the life quality of climacteric women in Aracaju/SE was not discarded, as the presented data pointed that most women interviewed showed  at least minor discomfort in the everyday activities, physical and social limitations, compromising personal relations like relationship with their partners and sexual life, emotions, sleep, disposition and measurements of gravity.

Open Access Original Research Article

Ventricular Septal Defects among Children in Lagos

B. Adeola Animasahun, A. D. Madise-Wobo, Olusegun Gbelee

Journal of Advances in Medicine and Medical Research, Page 1-10
DOI: 10.9734/BJMMR/2016/25984

Background: Although the incidence of Ventricular Septal Defects (VSD) has been reported in other reports on Congenital Heart Disease (CHD) in the region. None has considered VSD as a separate entity. Other previous studies on Congenital Heart Disease in the region had also been for a short period of time (at best two years) with fewer sample sizes hence the need for this study which aims to document the prevalence and clinical profile of children with VSD in a busy tertiary hospital in Sub-Saharan Africa using data collected over nine years.

Methods: Prospective and cross sectional involving consecutive patients diagnosed with ventricular septal defect using clinical evaluation and echocardiography at the Paediatric Department of Lagos State University Teaching Hospital, Lagos Nigeria as part of a large study between January 2007 and December 2015.

Results: Ventricular septal defect was diagnosed in 352 patients, out of which 157 had isolated VSD while 195 had VSD associated with other heart defects (excluding Tetralogy of Fallot). Male to female ratio was 1.1:1. The children were aged 4 days to 13 years, with a mean of 25.18±37.41 months and the median age of eight (8) months. The prevalence of all VSDs in the study population was 10.7 per 10,000 children, and isolated VSD was 4.7 per 10,000 children. The prevalence of VSD amongst other congenital heart diseases was 31.1 and 13.9% for all VSDs and isolated VSDs respectively. Atrial Septal Defects (ASD) were the most common associated acyanotic congenital heart defects followed by Patent Ductus Arteriosus (PDA). Double Outlet Right Ventricle (DORV) was the most common associated cyanotic congenital heart disease. Perimembranous VSD was the most common followed by the sub-aortic type.

Conclusion: Ventricular Septal Defects is as common in Nigeria as in the other parts of the world. The most common associated defect was Atrial septal defects and the most common type is perimembranous.