Journal of Advances in Medicine and Medical Research

Cervical spondylosis is a very common and painful condition affecting many people. The mainstay of treatment of this painful condition has been analgesics which have not proved effective in addition to their untoward complications. Biomechanical studies have shown the potential of neck distraction by traction to be very promising in pain relief and an assessment of high weight cervical traction was done to evaluate its efficacy. Fifty patients including thirty (30) males and twenty (20) females (mean age: 50.46±8.31 years, mean weight: 87.17±14.30 kg, mean height: 1.66±0.12 meters) were available for study on the usefulness of infrared radiation only and a combination of infrared radiation and cervical traction in a cross-over research design at the National Orthopaedic Hospital Enugu. Infrared radiation were applied three times a week for six weeks before a washout period of seven days and then application of cervical traction combined with infrared radiation were done three times a week for six weeks. Pain rating scores were used to evaluate pain relief before, during and after treatment sessions and finally after six weeks. The results of the study showed that cervical traction in combination with infrared radiation was superior (p < 0.05) to infrared radiation alone in the management of cervical spondylosis as there was prolonged relief of pain in those that had cervical traction. It is recommended that high weight cervical traction should always be used in the management of cervical spondylosis.

Aim: The study was to investigate the relationship of phenytoin-associated hyperuricaemia with the hyperglycaemia and dyslipidaemia caused by phenytoin administration.

Methods: Forty-two albino Wistar rats were randomly divided into six (6) groups of 7 rats each. Group 1 animals served as the control (receiving normal saline 0.50 ml). Groups 2,3,4,5 and 6 received phenytoin, phenytoin + vitamin C, phenytoin + vitamin E, phenytoin +vitamin E +vitamin C and phenytoin + allopurinol respectively. The drugs were administered once daily for four weeks by oral intubation as follows: Phenytoin: 5 mg/kg body weight of rat, vitamin C: 1.4 mg/kg body weight of rat, Vitamin E: 10 IU/kg body weight of rat and allopurinol 5mg/kg body weight of rats. Appropriate immunoassay or spectrophotometric methods were used for analysis of fasting plasma glucose, insulin, cholesterol, triglyceride and catalase activities.

Results: Showed a significant elevation of serum uric acid following phenytoin administration (p= 0.000) that were not reversed by co-administration of antioxidant vitamins but were reduced by allopurinol administration. Serum catalase activities which were significantly depressed by phenytoin treatment were reversed by antioxidant Vitamins C, E or allopurinol. The concentration of fasting plasma glucose, insulin resistance index, total cholesterol and triglyceride were significantly increase [(59.5%: p=0.001), (87.9%: p=0.005), (35.7%: p=0.000), (34.5% p=0.027)] respectively by phenytoin administration compared to control. However, the values of these parameters were not significantly lowered by antioxidant Vitamins, but significant reduction (p=0.017) to values similar to those of normal control group were observed in the group receiving both phenytoin and allopurinol. Fasting plasma insulin levels were not significantly (16.8%: p=0.137) affected by these drug treatments. Pearson bivariate correlation analysis of data of the experimental groups and control showed significant positive correlation between uric acid and fasting plasma glucose (r=0.598, P=0.000), fasting plasma insulin (r=0.394, P=0.010), insulin resistance index (HOMAIR: r=0.551, P=0.000), total cholesterol (r=0.677, P=0.000) and triglyceride (r=0.490, P.0.001).

Conclusion: We conclude that the metabolic toxicities of phenytoin associated with impaired glucose metabolism, insulin resistance and dyslipidaemia, are related to phenytoin induced hyperuricaemia.

Background: Anticancer effect of hydatid has been shown in previous investigations. However the mechanism of anticancer effects of hydatid cyst has not been clarified. So in this work the effect of spleen cell transfer immunized by the hydatid cyst antigens on melanoma cancer growth in animal model has been investigated.

Methods: Spleen cells of mice immunized with hydatid cyst fluid, cyst wall and protoscoleces were transferred to different group of mice and subsequently challenged with melanoma cells. Then the tumor size, tumor growth rate and survival time of mice were compared with those of control groups.

Results: Tumor size, tumor growth rate and mice survival time were significantly lower than what observed in control mice.

Conclusion: Immune response to hydatid cyst antigens may be involved in Anti-cancer effect of this parasite.

Background: The risk factors of many non-communicable diseases including hypertension are similar and include increasing age, a high salt intake, sedentary lifestyle, obesity and tobacco addiction. Due to the epidemiological transition in countries like India, many of these risk factors are on the rise. For the control and treatment of hypertension, these factors must be managed and prevented.

Aim: The aim of this study is to determine the prevalence of risk factors of hypertension, and to evaluate the association between these factors and prevalence of hypertension.

Materials and Methods: This was a cross sectional study, conducted in the month of December, 2015 at Mirzapur, a village in Aligarh District, Uttar Pradesh. The study population comprised of all the residents of the village ≥ 40 years of age, on the day of survey after prior consent. The data entry and other statistical calculations were done through SPSS version 20 and MS- Excel.

Results: The study included 160 people above 40 years of age. The prevalence of sedentary lifestyle was 36.3%, obesity- 23.1% and average salt intake- 7.23 (2.60) grams. The tobacco addiction level, including both smoked and smokeless forms were found to be very high-45.6% in this study. Increasing age and obesity were significantly associated with hypertension.

Conclusion: There is a substantial prevalence of risk factors of hypertension in India that may be the reason behind the increase in non-communicable diseases.

Adnexal torsion is a gynaecologic surgical emergency. Misdiagnosis or delay may lead to loss of the adnexa and may compromise fertility.

Aim: To determine the most relevant findings for the diagnosis of adnexal torsion and the results of laparoscopic surgery.

Methodology: A retrospective cohort study of 266 patients who underwent surgical treatment for adnexal torsion in our department from January 1994 to January 2014. Clinical, biological, ultasonographic, therapeutic and histological findings were analysed as well as risk factors and prognosis.

Results: The mean age of patients was 33.1 years. Adnexal torsion occurred during pregnancy in 21 patients (7.8%). Abdominal pain was present in 91.7%, vomiting in 63.9% and fever in 19.1% of the cases. Ultrasonographic findings were: ovarian cysts (54.1%), complex mixed echogenicity masses (40.2%) and ovarian enlargement (5.6%). The pain-to-surgery interval varied from 4 hours to 26 hours. At surgery, the mean number of spiral turns was 2. Treatment was carried out by laparotomy in 87 patients (32.7%). The mean size of the adnexa treated by laparotomy was 10.7 cm. Laparoscopic surgery was performed in 137 patients (51.5%). The mean size of the adnexa treated by laparoscopy was 6.9 cm. Laparoscopic treatment was conservative in 77.3% of the cases.

Conclusion: Adnexal torsion is a common gynaecologic emergency. Prompt diagnosis of adnexal torsion requires a combination of clinical, biological and sonographic investigation. The prognosis of adnexal torsion was potentially increased by the interval period before surgery. Laparoscopic treatment is the gold standard if possible.

Aims: The aim of this study was to find out the involvement of renal dysfunction in people living with human immunodeficiency virus/acquired immune deficiency syndrome (PLHA) in India.

Study Design: Observational study.

Place and Duration of Study: Total (n=150) consecutive HIV positive patients between November 2012 - April 2014, who were attending the ART Clinic or were admitted in Department of Medicine at University College of Medical Sciences and Guru TegBahadur Hospital, Delhi, India were recruited for the study.

Methodology: Estimated glomerular filtration rate (eGFR) was calculated by using Modification of Diet in Renal Disease (MDRD) and Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation. Morning spot urine samples were collected for urine albumin and urine creatinine test. Albumin/creatinine ratio (ACR) was calculated by using urine albumin and urine creatinine and were expressed in mg/g creatinine.

Results: The mean eGFR (MDRD) of the study subjects was found 106.8±20.72 mL/min/1.73 m² and a statistically significant difference was observed between male and female subjects (p = 0.039). The mean eGFR (CKD-EPI) of the study subjects was found 107.53±18.50 mL/min/1.73 m², however, no significant difference was observed between male and female subjects (p = 0.745). The micro/macro-albuminuria (urinary ACR ≥ 30 mg/g creatinine) was found in 18 (12%) patients and leucocyturia and hematuria was found in 12.7% and 5% patients respectively. The median CD4 counts of the study subjects was 341 (222-467) cells/ mm³ and 141 (94%) were taking highly active anti-retroviral therapy (HAART). The most common HAART regimens were zidovudin/ lamivudine/nevirapine (ZLN) and tenofovir/ lamivudine/ nevirapine (TLN); 60.7% & 26.0% respectively. Hepatitis B and C co-infection rate found among subjects was 4% and 3.3% respectively.

Conclusions: In conclusion, the prevalence of deranged renal functions as indicated by eGFR and urinary ACR is common in PLHA in North India. All HIV infected patients must undergo renal function tests including urinary ACR to detect the renal involvement at early stage.

Aims: End-of-life care is a significant part of nursing practice. The role of organizations at the end of life care cannot be ignored. Organization can act as a facilitator to improve the quality of care and provide a peaceful death at the end of life. The aim of this study was to illuminate oncology nurses’ organizational challenges of caring for dying patients in Iran.

Study Design: Qualitative method with conventional content analysis approach, Data collected by interviewing nurses which worked in oncology units in hospitals supervised by Zahedan Medical University in Iran and were conducted during the late summer 2014 to spring 2015. 

Methodology: Was used to analyze the experiences of 18 oncology nurses in relation to caring for dying patients. The mean age of participants was 32 years old, and had a minimum of 9 months and up to 12 years (mean = 6 years) of working experience in the oncology sector. 75% of nurses were married; all of them had a bachelor's degree in nursing.

Findings: Three themes emerged from the text including: 1) environment structural challenges, 2) cultural and structural challenges of the organization, and 3) educational challenges of end of life care.

Conclusion: Considering the vital role of hospitals in providing holistic care for end of life patients, new technologies and methods of care can have a great impact on education, treatment and nursing practice, therefore, necessary organizational and cultural changes need to take place to improve nursing care which is fit to new condition.

Perthes is a self-limiting disorder of paediatric hip. The outcome of this disorder is variable. Every aspect of it including, etiology, pathogenesis, pathology, classification, natural course, management and outcome is controversial. There is still no clear guideline for the management of Perthes disease. The aim of treatment is to prevent the head deformity and subsequent secondary osteoarthritis of hip. To maximize the results of containment procedures, measures to unstiffen the hip should be taken. Evidences are there that only a section of involved hips need intervention. Most untreated hips do not require intervention until the age of forty.

Osteoporosis is a common bone disorder found predominantly in women in every corner of the globe both in the living and in skeletons of the last seven millennia found in global archaeological excavations, except Polynesia.

The Pacific Islands, or South Sea Islands, Polynesian people have an instantly recognisable phenotype characterised by a large bone and muscle mass frequently found in the front row of the rugby union scrum, or as security ‘bouncers’ on the door of night clubs. They are rarely seen in the orthopaedic wards of Australasia in spite of increasing migrant numbers and their passion for the two rugby football codes. This poses the questions of are their bones stronger and if that is the case, why is that?

Information directly from the islands is restricted by limited life expectancy, greater health priorities such as diabetes, limited diagnostic facilities and the lack of sophisticated computerised health information collection. However; this paper finds supportive data for the first question and identifies genetic and lifestyle factors as the possible answer to the second question.

Cataract, the leading cause of blindness in the world, is treated with surgery, and is the most common eye surgery performed. A PubMed search was done to review the spectrum of practice of cataract surgeries in Asian countries. Coverage for surgeries varied in different countries which depends mainly on the surgical facilities available in the region or country. Outreach programs, free surgeries and reimbursement of transport influence this. The cost of cataract surgery depends on type of cataract operation, government/private hospital, and facilities provided in the hospital, day care/in patient surgery, and economic status of people in the region/country.

Phaco surgery was more expensive than extracapsular cataract extraction (ECCE) and manual small incision cataract surgery (SICS). Intracapsular cataract extraction (ICCE) was cheaper than ECCE in India. Local anaesthesia (retrobulbar, peribulbar, subtenon and topical) is used compared to general anaesthesia. Pain was more in topical compared to regional anaesthesia though no pain was reported for phacoemulsification under topical.

Several manouveres have been utilised in difficult cases to optimise the outcomes. These include invention and modification of instruments, phacodynamic settings and surgical techniques. Specific regimes for pupillary dilatation have been recommended. In Diabetics, trenching was difficult. Elimination of cotton balls reduced fibres in the anterior chamber. Innovations in intraocular lenses (IOL) are glued IOL, Artisan iris fixated IOL, intrascleral fixation of IOL with Y sutures. Visual outcomes varied based on techniques of surgeries and types of IOLs used. The advancement of techniques and instrumentation has benefited patients with cataracts by improving outcomes.