##### A Different from of Sternal Reconstruction: A Case Study

Halil Tozum, Mustafa Akyil, Tahir Sevval Eren, Murat Demiroglu, Bulent Kilic

Journal of Advances in Medicine and Medical Research, Page 1-6
DOI: 10.9734/BJMMR/2016/27458

Currently, almost all sternum defects, with or without tissue loss, can be repaired through various kinds of surgical procedures and grafts. A patient diagnosed with multiple myeloma one and a half years earlier experienced during therapy a pathological fracture of the sternum that healed with a “staircase” like complication. Reconstruction of the sternum using the "nitinol plaque" was performed on the patient, who came to have the deformity corrected. We present our first case of reconstruction using a new material, which had a successful outcome.

##### Normal Cerebral Blood Flow Volume in Healthy Nigerian Adults

Akeem Babatunde Bello, Temitope O. Bello, Ademola Adegoke Aremu, Victor A. Adetiloye

Journal of Advances in Medicine and Medical Research, Page 1-11
DOI: 10.9734/BJMMR/2016/25801

Background: Blood supply to the brain is very vital for its functions. Most of the pathologic processes that affect the acutely injured brain eventually results in impairment of cerebral blood flow (CBF). Early identification of the ischaemic or hyperemic conditions is critical to define the most appropriate therapeutic strategies. However, there is paucity of data on the normal cerebral blood volume in Sub Saharan Africa; we therefore employed the use of a safe, practical, economical, repeatable and readily available Doppler ultrasonography to evaluate CBF.

Aims and Objectives: The main aim of the study was to determine age and sex specific normal cerebral blood flow volume by Doppler ultrasonography of the extracranial carotid and vertebral arteries in healthy Nigerian adults.

Methodology: Three hundred and ninety six (396) subjects that met the inclusion criteria were examined with the aid of Doppler ultrasound machine. All the subjects were scanned by the same radiologist, thereby avoiding inter observer variability and each measurement was taken thrice and an average found. The flowmetry values from the carotid and vertebral arteries were statistically analyzed using SPSS version 16.

Results: The total cerebral blood flow volume was 624.90±115.57 ml/min with the mean blood flow volumes of 226.57±32.03 ml/min and 226.85±31.58 ml/min (right and left internal carotid arteries); 85.59±27.81 ml/min, and 85.59±27.20 ml/min (right and left vertebral arteries). The mean total cerebral blood flow volume was more in the males (625.64±116.38 ml/min) than the females (624.75±115.06 ml/min), decreasing with increasing age in both sexes with associated increase in vessels diameters with age. Although, statistically significant differences (P<0.001) were seen in the Peak.

Systolic velocities (PSV), End diastolic velocities (EDV) and Resistive Indexes (RI) of the internal carotid arteries in Males and Females, the difference in the total cerebral blood volume was not significant. The intra rater reliability showed an almost perfect agreement with an average Kappa coefficient of 0.88.

Conclusion: Our study has provided a safe, economical and repeatable age, sex and side specific extracranial normogram of flowmetries of individual and total cerebral blood vascular supplies to the brain which is essential in successful management of cerebrovascular diseases.

##### Prothrombin Time Prolongation in Patients with Acute Intentional Anti-coagulant Rodenticide Intoxication

Ujala Zubair, Osama Salam, Ahmad Faraz

Journal of Advances in Medicine and Medical Research, Page 1-6
DOI: 10.9734/BJMMR/2016/26578

Aims: Aim of this study is to determine effects of acute intentional ingestion of superwarfarin compounds for suicidal intentions on homeostatic profile of patients.

Study Design: This is a retrospective observational study.

Place and Duration of Study: This study was conducted at Jinnah Postgraduate medical center in Karachi, Pakistan during the period from 15th October 2015 to 27th December 2015.

Methodology: 74 patients with rodenticide intoxication were included in this study. PT was ordered at the time of presentation. aPTT was done only in few patients because of financial constraints. Symptoms at the time of presentation were recorded. Results were analyzed using SPSS v.20.

Results: 52.7% were males while 47.3% were females. Most common symptom was found to be vomiting which was positive in 38.8% of individuals. No bleeding abnormality was recorded in any patient. Mean PT among patients was found to be 10.51 seconds +- 2.38 (control = 11 seconds). PT >14 was found in 5 individuals. Mean INR was found to be 0.94+-0.24. INR greater than 1.5 was found only in 2 individuals.

Conclusion: Majority of studies report no bleeding abnormality in majority of patients associated with rodenticide intoxication while some studies report minor and major symptoms associated with it. However no bleeding abnormality was found in any patient of our study.

##### Assessment of the Performance of Specific Prostate Diagnostic Tools in the Detection of Prostate Cancer among Ghanaian Men

Agyemang-Yeboah Francis, Aboah Kenneth, Gyasi-Sarpong Kofi Christian, Laing Edwin Ferguson, Acheampong Emmanuel, Twumasi Frimpong Benjamin, Odame Anto Enoch, Batu Nsenbah Emmanuella, Amankwaa Bright

Journal of Advances in Medicine and Medical Research, Page 1-13
DOI: 10.9734/BJMMR/2016/27890

Aims: This study evaluated the individual and combined performances of specific prostate diagnostic tools in the detection of prostate cancer among Ghanaian men.

Study Design:  A hospital-based cross-sectional prospective study.

Place and Duration of Study: Department of surgery (urology unit) Komfo Anokye Teaching Hospital (KATH) from December, 2014 to November 2015.

Methodology: A total of 241 patients suspected of having prostate cancer (PCa) due to abnormal digital rectal examination (DRE) and, or elevated prostate specific antigen (PSA) level underwent Trans rectal ultrasonography guided biopsy of the prostate. Evaluation of PSA, Prostate Specific Antigen Density (PSAD), DRE, prostate volume was done using receiver operating characteristics curve analysis These four diagnostic tools were combined into a single score to improve the diagnostic performance.

Conclusion: Combined diagnostic performance of DRE+PSAD+PSA poses a better diagnostic accuracy. Bioscores for the combination of the diagnostic tools were significantly associated with increasing odds of prostate cancer detection upon logistic regression analysis. Further studies are required to evaluate the combine diagnostic performance in larger population.

##### Exploring the Role of Spirituality in Coping Process of Family Caregivers of Patients in Vegetative State

Zahra Imani-Goghary, Esmat Noohi, Hamid Peyrovi, Majid Kazemi

Journal of Advances in Medicine and Medical Research, Page 1-11
DOI: 10.9734/BJMMR/2016/26300

Introduction: The vegetative state (VS) is a condition which can occurs after a severe brain injury. After hospital discharging Responsibility of caring of patients in vs is transferred to their families, which cause high burden for them. Religion and spirituality help people to reinterpret uncontrollable events and cope with difficulties.

Aims and Objectives: This study was carried out to explore the role of spirituality during coping process of family caregivers of patients in VS with caregiving burden.

Place and Duration of Study: The present study was carried out in Kerman province, Iran during 2014- 2015.

Methods: This study is a part of a larger qualitative study with using grounded theory method. Sampling was done by using purposeful sampling and then theoretical sampling according to data analysis and constant comparative method for expanding concepts. 11 family members and 2 nurses participated in the study. Data was gathered using face to face in-depth interviews and were analysed through constant comparison method.

Results: From the analysis of the interview texts two themes were extracted, first: "finding meaning in care" which indicates that there is meaning and purpose in delivering care. The categories "care is something spiritual", "looking toward the horizon" and "a sense of excellence in care" formed this theme. Second: "Internal solace provided by religious beliefs" that shows religious beliefs can be effective in bringing relief to the caregivers’ life. The categories "reliance" and “invocation" formed this theme.

Conclusion: Spirituality and religion help family caregivers to accept care and strongly affected the ability of family caregivers to cope with the hardships of caregiving for patients in vegetative state. In light of spirituality, they maintained hope for a better future and experience inner peace by remembrance and supplicating to God.

##### Thoughtful Tolerance: A Strategy for Managing Moral Dilemmas among the Nurses in Iran

Niloofar Zafarnia, Abbas Ebadi, Abbas Abbaszadeh, Nouzar Nakhaee, Fariba Borhani

Journal of Advances in Medicine and Medical Research, Page 1-8
DOI: 10.9734/BJMMR/2016/27417

Aim: Nurses face plenty of challenges as a result of their workplace interactions pertaining in part to morality and in part to their individual rights. Nevertheless, having effective professional ethics, even when the nurse has faced a challenge, is part of their competency as a nurse.

This study was carried out in order to examine how moral dilemmas and challenges related to individual rights are faced and managed by nurses in Iran.

Research Design and Methodology: This is a qualitative content analysis study. Data were collected through in-depth semi-structured interviews and field notes. The resulting data were analyzed by Graneheim’s method of conventional content analysis.

The study was carried out in the years 2014 and 2015 in Iran. The total population was the clinical nurses from Iran’s universities of medical sciences. Purposive convenient sampling was used to select 12 nurses.

Results: Examining the data led to the emergence of the main theme of thoughtful tolerance. This main theme was categorized into three subthemes namely, mutual forgiveness, forbearance, and chivalry.

Conclusions: Iranian nurses choose to manage their moral dilemmas they face in relation to their rights by taking up thoughtful tolerance based on their individual, religious, and cultural values in the cultural construct, and in this way they make sure that their performance is most professional. They believe that not only their soul softens up through forbearance and forgiving themselves and others, but it also helps improve the quality of care. Therefore, thoughtful tolerance may lead to an enhancement of the nurses’ professional competency.

##### Tranexamic Acid as Prophylactic Therapy for Intra and Post Partum Hemorrhage, Randomized Controlled Trial

Mohamed N. Salem, Magdy A. Mohamed, Ahmed H. Salem, Ahmed Abbas

Journal of Advances in Medicine and Medical Research, Page 1-7
DOI: 10.9734/BJMMR/2016/26288

Objective: To evaluate the role of TXA in minimizing the incidence of postpartum hemorrhage after cesarean delivery.

Methodology: This is a randomized placebo controlled study conducted on 169 patients who subjected to elective CS. Study group include 84 patients who received 2 gm Tranexamic acid before induction of anaesthesia plus 10 u oxytocin. The control group received only 10 U oxytocin. Both group were compared as regard amount of blood loss.

Results: The amount of blood loss was lower in study group than control group (410.33±175.08 ml versus 650.25±180.90 ml). Also the 24 hours post-operative hemoglobin was significantly higher in study group (10.68±0.9 mg/dl) compared to control group (8.2±0.7 mg/dl), as well as, the 24 hours post-operative hematocrit value was significantly higher in study group (37.63±5.4) compared to control (31.19±2.48).

Conclusion: Tranexamic acid could be helpful option in reducing amount of blood loss during elective CS.

##### Is Childhood Ocular Trauma More Often in Families with Low Socio-economic Level?

Ali Kurt, Adem Gul, Irfan Uzun, Cagatay Caglar, Halil Ibrahim Yener

Journal of Advances in Medicine and Medical Research, Page 1-6
DOI: 10.9734/BJMMR/2016/27808

Aim: To examine whether socioeconomic status as determined by the number of siblings, educational level, and monthly household income is associated with childhood eye injuries.

Materials and Methods: Eighty six patients with ocular trauma and 86 subjects without trauma (control group) were enrolled. A questionnaire was completed by the parents. Age, sex, type of trauma, educational status of the mother and father, the number of siblings, working status of the mother, the number of the individuals in the residence, and the monthly household income were recorded.

Results: The average age of the patients was 7.52±3.24 (range 1-13) years in the ocular trauma group and 7.59±2.47 (range 3-12) years in the control group. Ocular trauma was caused by the children themselves in 68.6% and by another person in 31.4%. The educational status of the mothers/fathers was similar in both groups. The average number of siblings was higher in the ocular trauma group (2.24±1.09) than the control group (1.90±1.02). The average monthly income per capita was lower in the ocular trauma group (113.5±47 US$) than the control group (148.1±77 US$). The monthly income per capita was lower than 100 US\$ in 47.7% and 25.6% of the ocular trauma and control group subjects, respectively.

Conclusion: We found that the families of children with ocular trauma were slightly larger and had lower income than the families of the control group subjects.

##### Involvement of Nitrergic and Opioidergic Systems in the Oxidative Stress Induced by BDL Rats

Amir Hossein Doustimotlagh, Ahmad Reza Dehpour, Abolfazl Golestani

Journal of Advances in Medicine and Medical Research, Page 1-10
DOI: 10.9734/BJMMR/2016/27568

Aims: Liver cirrhosis is the irreversible end result of ‎fibrous scarring and associated with prominent morbidity and mortality. We aimed to investigate the involvement of nitrergic and opioidergic systems in the oxidative stress ‎induced by bile duct ligation (BDL) rats by evaluating the oxidative stress markers such as malondialdehyde (MDA), protein carbonyl content and total thiol in the plasma.

Methodology: Rats received injections of 3 mg/kg Nω-Nitro-L-arginine methyl-ester-hydrochloride (L-NAME: a NO-synthase inhibitor), 10 mg/kg opioid-receptors antagonist naltrexone (NTX), L-NAME (3 mg/kg)+NTX (10 mg/kg) or saline once daily for 28 days after BDL or sham surgery. Oxidative stress markers and biochemical indexes were measured in plasma samples.

Results: Results showed that serum levels of total bilirubin (TB) and alkaline phosphatase (ALP) to be significantly increased in BDL rats as compared with the Sham-operated (SO) group (P<0.05). MDA level was significantly increased and plasma total thiol content was insignificantly decreased in the BDL group as compared with relevant SO control. Treatment of NTX in BDL rats could significantly decrease the MDA production (P<0.05) as compared to BDL group. After 4 weeks of intervention, protein carbonyl content was significantly lower in BDL+L-NAME+NTX group as compared to the related SO and BDL groups (P<0.05).

Conclusion: The results of the study showed that nitrergic and opioidergic systems have various impacts in the oxidative stress induced by BDL rats. Blockage of opioid receptors in BDL rats during the study could significantly decrease the MDA production and protein carbonyl content as compared to BDL group, therefore, could moderately prevent the severe liver injury.

##### Quantifying Resistance to Sliding in Orthodontics: A Systematic Review

Hamza Tageldin, Maria Cadenas de Llano-Pérula, Patrick Thevissen, Jean-Pierre Celis, Guy Willems

Journal of Advances in Medicine and Medical Research, Page 1-30
DOI: 10.9734/BJMMR/2016/27208

Objective: The present article aims to review all the in vitro experimental setups available in literature used to evaluate the resistance to sliding (RS) in orthodontics in correlation with other related parameters.

Methods: An electronic search was performed in three different data bases including all articles published until 20th February 2016. Additionally, a manual search through the reference lists of the collected records was performed. Studies that addressed different experimental setups to evaluate RS were selected, reviewed, and grouped per research group. The experimental setups were compared and assessed based on their degree of clinical simulation.

Results: A total of 1380 non-duplicate records were primarily selected in the electronic search. After applying the selection criteria, only 189 studies were considered eligible.

Conclusion: The clinical simulation of each setup varied based on the aim of the performed investigation. None of the included experimental setups could achieve a full clinical simulation by studying several variables synergistically in a scenario as similar as possible to the oral environment.

Clinical Relevance: Unfortunately, in vivo evaluation of RS is not possible so far. Therefore, reviewing the in vitro methods and analyzing them on the light of the clinical situations they represent, would be of a great clinical benefit. Deeper understanding of this multifactorial phenomenon will help improving the current in vitro designs with an obvious clinical impact.