Journal of Advances in Medicine and Medical Research

The “Type of Article” of this paper is “Letter to the Editor”. This paper discuses about: “Relationship between the Characteristics of Staplers and Malformation of Staples”. No formal abstract is available. Readers are requested to read the full article.

Cemento-ossifying fibroma is a slow growing benign tumor of mesenchymal origin. It is typically found in craniofacial bones, frequently involving the mandible and it tends to occur in third and fourth decade of life with predilection for women. Occurrence of this lesion in maxilla is a rare entity. We report one such case of cemento-ossifying fibroma of size 5x4 cm on upper left maxilla in 38 year old female patient which is an unusual presentation.

Introduction: In Latin America the introduction of GMO (Genetically Modified Organisms) involves a risk of harm to human health, to the environment and a violation of human rights in exposed populations.

Objective: To investigate risk conditions of pesticide exposure in a population devoted to subsistence farming and surrounded by GMO crops, through the analysis of the fulfillment of State obligations to guarantee basic human rights.

Methods: A survey was conducted among local farmers in San Juan, in the Canindeyú Department (Py) in January, 2016 concerning farming practices. The compliance with state obligations was performed by analyzing the National Constitution and the Law of Phytosanitary Control.

Results: 43 Settlers were interviewed, out of which, a hundred percent (100%) are dedicated to farming, of which 53,5% (23/43) are dedicated to subsistence farming and 46,5% (20/43) are dedicated to income and subsistence. Their median level of education is 4,9 years. The population is surrounded by monocultures that are close to a 100% of the families, climate conditions are not taken into account, nor are they informed, also they were not trained in agrochemical handling and knowledge. An irregular handling of the proper preservation of recipients was described, also a lack of suitable spray equipment, washing of clothes, and child safety inside their home during massive spraying.

Conclusion: There is a risk of permanent exposure to pesticides in a context of a repeated violation of human rights of that population.

A great amount of research has focused on nutritional genomics in order to personalize dietary interventions based upon genetic premises. The aim of nutritional genomics research is to use this information as a preventive tool in primary care, through personalized dietary advice to populations or to individuals. Increasing the understanding of genetic traits on the part of dieticians and other healthcare professionals can complement the data that is required to create personalized recommendations for dietary intervention. A literature review was conducted by the author using PubMed journals from 2000 to the present day with regard to nutritional genomics studies in order to address the factors affecting dieticians in the provision of advice related to personalized nutrition. Inclusion criteria included research limited to human studies, in the English language and published after 2000. This review concludes that there is a huge demand for an increase in the knowledge and skills of dieticians in order to transform the genetic results and nutrigenomics message into common language as part of their clinical practice. This could be achieved by participation in specific training courses on diet and gene interaction, and by attending conferences and seminars to exchange their perspectives on nutritional genomics. In addition, there is a need to establish a healthcare system that supports and rewards these approaches and promotes their application.

Introduction: Acute appendicitis is the inflammation of the vermiform appendix and it is the most common intra-abdominal surgical emergency. Therefore, perforated appendicitis is rarely accompanied by pneumoperitoneum and that apparent rarity of association of pneumoperitoneum and acute appendicitis prompted us to discuss this condition.

Materials and Methods: This retrospective study reviewed all cases of acute abdomen with pneumoperitoneum admitted in King Abdulaziz University Hospital from January 2011 to December 2015. Only cases with acute appendicitis were selected to be in the study, Leucocytic count and C-reactive protein, as well as plain X-ray abdomen in erect position and C.T.scan were reviewed preoperatively.

All demographic data (age, gender), as well as the clinical details which included relevant  investigations results, in addition to the perioperative data (the type of the performed operative procedure, operative time and the hospital stay with reference to the postoperative complications for each patient), all were collected and analyzed by IBM-SPSS version 22.

Results: Pneumoperitoneum due to perforated appendix was found in 7 out of 131 cases in this study (5.3%), with male predominance 6/7, with a mean age of 29.7 years. The documented postoperative complications were pulmonary complications; intra-abdominal pus collection (pelvic and subphrenic) as well as wound dehiscence, all were found post conventional exploratory laparotomy cases.

Conclusion: The study documented the rarity of pneumoperitoneum due to perforated appendix. Therefore, it should be considered as a cause of acute abdomen with pneumoperitoneum, imaging studies were very essential to visualize these cases, Laparoscopic approach provided better outcome than the conventional laparotomy approach.

Background: Single dose caudal block application is preferred among children since it is a safe and easy method. Caudal morphine has an important advantage with its long half-life. However, caudal morphine application has some side effects such as nausea-vomiting, urinary retention, pruritus, sedation and respiratory stiffness and many of those are dose-dependent. The aim of this study was to determine the minimum morphine doses that will provide adequate analgesia and by this way to diminish the life threatening side effects such as respiratory depression as well as comfort-threatening side effects such as nausea-vomiting.

Methods: This double blind, randomized, prospective study, was performed in Gaziantep University among 60 pediatric patients aged between 1-9 years, who were planned to have Salter operation for congenital hip dislocation, with ASA classification of I-II. Premedication was not applied in any of the cases. Patients were sub-grouped randomly and for 15, 20 or 25 μg.kg^-1 caudal morphine administration: G15, G20 and G25. Caudal injections were performed under general anesthesia just before the operations. Having total volumes of 0.75 ml.kg^-1, caudal injections were performed with 15, 20 or 25 μg.kg^-1 morphine together with 0.25% bupivacaine according to the groups. The first time of analgesic requirement was recorded.

Results: The number of cases required analgesia in first 24 hours was determined as 4 (20%), 3 (15%) and 2 (10%) in Group 15, Group 20 and Group 25, respectively. There was not statistically significant difference between groups (P>0.05). In none of the patients, the pain level was as high as causing restlessness (score 2). With single dose Paracetamol, pain cured in all of these patients. Postoperative nausea and vomiting in first 24 hours was reported in 1 (5%), 2 (10%) and 8 (40%) cases in 15, 20 and 25 µg.kg^-1 groups, respectively. Although the difference between Groups 15 and 20 was not statistically significant (p=0.548), the number of patients with nausea and vomiting in Group 25 was statistically significantly higher than that of Group 15 and Group 20 (p=0.009 and p=0.025, respectively). In first 24 hours in postoperative period, respiratory depression was not observed in any of the cases.

Conclusions: We determined that decreasing the caudal morphine dose to 15 µg.kg^-1 in Salter osteotomy does not decrease analgesia in 24 hours but minimizes nausea-vomiting incidence.

Aims: The aim of current study to examine percentage inhibition of α-glucosidase by synthesized metal complexes.

Study Design: The α-glucosidase inhibitory activity assay was performed by Tripathi et al. method  with minor modification

Place and Duration of Study: Faculty of Science and Environment and Department of Physical Sciences, between June 2009 and July 2010.

Methodology: In the present work we have synthesized metal [Cu(II), Co(II), Ni(II), Zn(II)] complexes with N - methylethylenediamine. We synthesized total twelve metal complexes by various salts i.e. nitrate, sulphate and chloride of copper, cobalt, nickel and zinc. Synthesized metal complexes characterized via IR spectroscopy and cyclovoltametry. We examined percentage inhibition of α-glucosidase by synthesized metal complexes. IC₅₀ value of metal complexes was also calculated.  

Results: All twelve complexes possess α-glucosidase inhibition activity, among them [Co (men)₃]2NO₃ have the highest α-glucosidase inhibition, having IC₅₀ value 900 µg/ml and [Ni (men)₃]2Cl have the lowest  α-glucosidase inhibition, having IC₅₀ value 2533.21 µg/ml.

Conclusion: Diabetes is a proven and inherited type of disorder transition metal ions are essential nutrients to all forms of life. Iron, copper, zinc, manganese, cobalt and nickel all have unique chemical and physical properties that make them useful metals for biological systems so this type of approach may be useful. We have done in-vitro study; however, need further work to validate reliability.

This study compared the levels of calories and macronutrients ingested by patients with type 1 diabetes and their relatives. This is a cross-sectional study that evaluated dietary intake (24-hour Food Record), nutritional status (Body Mass Index), as well as socioeconomic status of patients and their families. Glycemic control was assessed by glycated hemoglobin (HbA1c). There were positive correlations between dietary intake of patients and family members/accompanying persons regarding carbohydrates, proteins and lipids consumption. Dietary intake of patients and their family members was similar, but inadequate and discordant in relation to current recommendations. Longer time since diagnosis and in service as well as higher number of capillary blood tests was related to better HbA1c levels. Kinship relationship to HbA1c requires further study focusing on parental influence on the treatment of adult patients with type 1 diabetes.

Background: Lymphadenopathy is one of the commonest manifestations of a variety of diseases of diverse etiology. Tuberculosis, metastasis, acute suppurations and lymphomas are some of the entities. Fine needle aspiration cytology is a precise diagnostic technique for evaluation of different causations of lymphadenopathy and is comparable to the gold standard test excision biopsy and histopathological examination.

Aims and Objectives: The study was designed to evaluate the clinicopathological profile of patients presenting with peripheral lymphadenopathy, establishing the role of fine needle aspiration cytology in the etiological diagnosis and to assess its sensitivity and specificity to correlate the findings with histopathological examination.

Materials and Methods: One year single centered hospital based prospective analytical study was conducted in a tertiary care teaching hospital in north eastern India among 100 adult patients aged above 15 years presenting with accessible peripheral lymphadenopathy.

Results and Observation: A male preponderance with maximum occurrence in the age group 15-40 years with features of neck swelling, fever, night sweats, unilateral cervical lymphnode involvement, anemia and raised ESR were common. Fine needle aspiration cytology was successfully done in 98% cases whereas excision biopsy in 90% cases. Diagnosis arrived on the basis of aspiration cytology and histopathology were tubercular in 52.04% vs 52.22%, metastasis in 25.51% vs 28.88%, nonspecific reactive lymphadenitis in 17.34% vs 13.33%. Hodgkin’s and Non-Hodgkin’s lymphoma in 2.04% vs 2.22% and 3.06% vs 3.33% cases respectively. The respective sensitivity and specificity of aspiration cytology vis-a-vis histopathology obtained in various groups are statistically significant (p< 0.0001) in each of tuberculosis 95.65% vs 100%, metastasis 96% vs 100%, nonspecific reactive lymphadenitis 100% vs 96%, Hodgkin’s lymphoma and Non-Hodgkin’s lymphoma 100% vs 100%.

Conclusion: Peripheral lymphadenopathy is a manifestation of a variety of diseases and fine needle aspiration cytology is a convenient and accurate diagnostic tool in evaluation of lymphadenopathies.

Aims: To evaluate the value of therapeutic drug monitoring (TDM) of vancomycin in clinical practice.

Methods: To review retrospectively on 292 hospital cases (111 females, 181 males) treated with vancomycin, July to October 2014, at ChoRay Hospital. The main evaluating parameters were TDM criteria for vancomycin (dose, dosing interval, times of monitoring), trough level, dose adjustment, renal function follow-up, minimum inhibitory concentration of infectious agents, clinical response.

Results: Two hundred seventy-five patients (94.2%) received routine dose of 1 g vancomycin per IV infusion time. Dosing interval was given correctly to estimated glomerular filtration rate (eGFR) level 80.8% (235/291). The 1^st monitoring after 9^th dose was in 139 cases (47.6%). Trough level was lower than 10 mg/L in 86 patients (29.5%), higher than 20 mg/L in 96 (32.9%), and 110 in optimal range 10-20 mg/L (37.7%). Age and eGFR were 2 independent predictors for trough level. Dose adjustment were done in 6.9% (6/86) patients ≤ 10 mg/L, 20.8% (20/96) ones >20 mg/L, and 11.8% (13/110) ones 10-20 mg/L. Vancomycin concentrations in young patients were lower than those in elderly ones with OR = 5.9 [95%CI: 2.6 – 14.0], p = 0.0001. Response sensitivity was 69.3% (13/19) for dose reduction, and 83.3% (5/6) for dose increase. Dose adjustment did not make change in trough level compared to unadjusted ones. Nephrotoxicity rate was found as 8.4%. Treatment failure was 50% in patients with trough concentration/minimum inhibition concentration ratio ≤ 10 compared to 15% in ones with higher ratio > 10, p = 0.034. The failure rate was highest in patients received vancomycin ≤ 7 days (22/70: 31.4%), OR: 4 (2.0-7.7) p=0.002. The clinical AUC/MIC ratio cut-off, 190 mg/L/day, had 75.9% and 66.7%, respectively for sensitivity and specificity to predict the success result in treatment.

Conclusion: The criteria of TDM on vancomycin were not applied strictly, especially for dosing intervals, dosing adjustment and follow-up thereafter. The clinical pharmacodynamics of vancomycin is dependent on both concentration and duration of treatment.