Journal of Advances in Medicine and Medical Research

Aim: This study reviews the ontogeny, phylogeny and clinical importance of horseshoe kidney. In addition, the classifications in relation to variations in blood supply of horseshoe kidney have also been discussed.

Presentation: During routine dissection for undergraduate students, the gross anomaly of horseshoe kidney was found. The kidneys were fused at their lower pole by an isthmus. The isthmus was supplied by a separate artery emanating from the front of aorta and entering on its posterior surface. The pelvis was bifid on both sides.

Discussion: Horseshoe kidney is explainable owing to its ontogeny and phylogeny. Its detection is incidental during intravenous pyelography, routine ultrasound or CT scan performed for other reasons.

Conclusion: Variations in the blood supply of horseshoe kidney should be considered in any of the operative procedures related with the kidneys and preoperative digital substraction angiography should be performed.

Osteosarcoma is a malignant neoplasm of mesenchymal cells which produces defective osteoid or immature bone. Osteosarcoma of the jaw is very rare and represents only 6-8% of all osteosarcomas in the body. It exhibits diverse clinical, radiological and histopathological manifestations resulting in misdiagnosis and diagnostic delay. This case reports emphasizes the veiled behavior of osteosarcoma of maxilla, initially presented as a periapical lesion which later transformed in to an aggressive neoplasm after local curettage and resection followed, by recurrence of the lesion even after surgery, creating a challenge for its diagnosis and management.

Diabetes mellitus is a chronic metabolic disease that is common in nearly all countries. Patients with type 2 diabetes have a two- four fold increased risk of developing cardiovascular disease (CVD) relative to nondiabetic individuals. Herein, in this systematic review we briefly explored the pathophysiology of lipids, lipoproteins, and apolipoproteins patterns in type 2 diabetics and its association to macrovascular disease mainly CVD. Data from clinical and experimental studies reported abnormalities in concentrations of lipids, lipoproteins, and apolipoproteins in type 2 diabetics and that correlated with the progression of CVD. The disturbance in concentrations of lipid profile contributes in the atherogenesis in patients with type 2 diabetes though multiple mechanisms. Therefore, targeting and management of circulating lipids in type 2 diabetics can provide opportunity to reduce CVD morbidity and mortality.

Background: Pirani scoring system is one of the classification systems and is simple, easy to use in the management of clubfoot; however, there is paucity of studies using Pirani system to determine the severity and monitor progress in the treatment of clubfoot. We therefore set out with the aim of assessing severity and monitoring the progress of treatment using the Pirani scoring system. The study was conducted at the Department of Orthopaedics and Traumatology of Obafemi Awolowo University Teaching Hospitals Complex, Ile Ife between January 2011 and June 2015.

Methodology: It was a prospective study of 102 clubfeet in 61 patients less than 3 years of age, and born with idiopathic congenital talipes equinovarus. Corrective serial casts were applied after initial manipulations using Ponseti method. Variables of interest such as the biodata, midfoot score, hindfoot score, Pirani score, need for tenotomy and the number of casts to achieve correction were measured. The data obtained were subjected to statistical analysis using SPSS version 22. Significant statistical inferences were drawn at p<0.05.

Results: The correlation between the midfoot score, hindfoot score, Pirani score and the number of casts to achieve correction was significant (p<0.001). Also, there was correlation between the Pirani score and the need for tenotomy (p<0.001),;between the number of casts to achieve correction and the need for tenotomy (p<0.001). Moreover, the progress of treatment can be monitored with the Pirani score (p<0.001).

Conclusion: Pirani scoring system is a simple and reliable system to determine severity and monitor progress in the treatment of clubfoot.

Introduction: Musculoskeletal pain is one of the most common complaints amongst dental healthcare professionals by virtue of the precision of work demanded from them, which leads to unnatural, static postures and repetitive precise movements.

Objective: The current study was designed to determine the prevalence of musculoskeletal pain and the level of physical activity in dentists and current dental students in the city of Mumbai, India and if any correlation exists between the two.

Materials and Methods: In the current cross-sectional study, a questionnaire containing twelve questions was circulated to 600 dentists and current dental students across Mumbai city by the means of WhatsApp® messages, Facebook® messages and email.

Results: The current study showed that, 82.10% dentists and dental students had suffered musculoskeletal pain in the last 24 months with 20.79% of respondents reporting the pain to be severe enough for them to stop the practice of dentistry at least temporarily. 78.82% of the respondents took a break during their work. The level of physical activity was 26.21% and the prevalence of musculoskeletal pain was significantly less in dentists and dental students who indulged in physical activity.

Conclusion: There is a high prevalence of musculoskeletal pain in the dentists and dental students in Mumbai city and a low prevalence of physical activity in them. There is a direct correlation in the level of physical activity and the prevalence of musculoskeletal pain.

Aims: The aim of this study was to determine the dermatoses associated with gender in this geographical area.

Study Design: A descriptive cross-sectional survey.

Place and Duration of Study: Dermatology Clinics of OAU Teaching Hospitals’ Complex (OAUTHC), Ile-Ife, Osun State, Nigeria between October 2009 and September 2012.

Methodology: Recruitment of consecutive patients presenting with skin diseases was done on two days in a week during the study period. Demographic data on age, gender and symptoms were taken, and the diagnosis of presenting skin conditions documented. The results were analyzed using Statistical Package for Social sciences (SPSS Inc. Released 2007. SPSS for Windows, Version 16.0. Chicago, SPSS Inc). The Odds ratio of dermatological diseases for both genders was obtained using WINPEPI 11.0 with 95% confidence interval and p value of 0.5 signifying a significant relationship between the dermatosis and gender type.

Results: Patients studied were 1013, aged 18-90 years, and 55% females. The male gender was significantly associated with acne keloidalis nuchae, folliculitis/carbunculosis, seborrhoeic eczema, lichen simplex chronicus, and Hansen’s disease. Drug reactions, seborrhoeic keratosis, miliaria rubra, and papular urticaria were, however, the only significant diseases in females.

Conclusion: Certain skin diseases are indeed significantly associated with gender. For some of these diseases, differences in the biophysical profile of the male and female have been found responsible. Other factors such as occupation predisposing to gender predilection will need to be further elucidated.

Background: Adverse drug reactions (ADRs) are the main cause of significant morbidity and mortality worldwide. The identification of barriers, facilitators, strategies, and predictors for reporting ADRs helps in the prevention of ADRs and their potentially harmful consequences.

Objective: This study explored general hospital physicians' opinion to identify the barriers, facilitators, improving strategies, and the most powerful predictors for detecting and reporting of ADRs in three general hospitals of Jeddah city.

Methods: Using stratified sampling technique, 337 physicians were selected from three general hospitals and they were asked to complete a 7-part self-administered questionnaire concerning reporting of ADRs. The research variables of physicians’ demographics and their knowledge, awareness, attitude, and practice (KAAP) towards reporting of ADRs encountered were entered into the best fitting logistic regression model for finding out the best predictors of detection and reporting of ADRs.

Results: Lack of knowledge of ADRs (86.4%) and ADRs reporting process (71.8%), uncertain relationship between ADRs and drug (67.7%), busy schedules and time constraints (53.7%) were the key barriers against reporting ADRs. The important motivators for reporting ADRs were adequate awareness (92.9%), hospital support (89.3%), patient safety concerns (88.1%) and professional responsibility/role (82.5%) of reporting ADRs. Majority of physicians (77.4%) suggested no strategies for improving ADR reporting, and only 16.3% of physicians emphasized on increasing physicians’ awareness and knowledge of reporting ADRs through continued training programs. Consultant job and adequate knowledge of ADRs were the most powerful predictors of recognizing ADRs in practice while consultant job, adequate awareness, ample knowledge of ADRs, and training in ADR reporting were the significant predictors of ADR reporting.

Conclusion: Besides identifying some motivators and improvement strategies for and barriers against ADR reporting, this study found some independent significant predictors of detecting and reporting of ADR in general hospitals. Continuous training of healthcare professionals in adverse drug reactions is considered the best improvement strategy for identifying and reporting of ADRs. Further research is needed in all the general hospitals of Saudi Arabia to capture other predictors, motivators, and improvement strategies for and barriers against ADRs encountering and reporting.

Aim: To explore the association between knee osteoarthritis (OA) and morphological changes in the Achilles tendon.

Study Design: Pilot cross-sectional study.

Place and Duration of the Study: Rheumatology Unit, Barzilai Medical Center, Ashkelon, Israel. Study took place during 2014.

Methodology: A sample of 56 knee OA patients was recruited. Demographic data, sonographic evaluation of the femoral cartilage thickness, Achilles tendon thickness and Western Ontario and McMaster Osteoarthritis (WOMAC) scores, were collected. The associations between the femoral cartilage thickness, WOMAC parameters, and Achilles tendon thickness were tested by Pearson’s correlation and linear regression analyses.

Results: The Achilles tendon thickness of the non-(or less)-symptomatic side, significantly negatively correlated with the cartilage thickness of the symptomatic (r=-0.292, P=0.029) or non-(or less)-symptomatic (r=-0.319, P =0.017) side. These associations remained significant after adjustment for age and BMI in the linear regression analyses (β=-0.284, P =0.049 and β=-0.309, P =0.026, correspondingly). The WOMAC total score showed a significant positive correlation with the Achilles tendon thickness of the symptomatic side (r=0.389, P =0.003), remaining significant after adjustment for age, BMI and cartilage thickness (β=0.400, P =0.007).

Conclusions: Previous studies have shown that soleus and gastrocnemius muscles contribute to knee stabilization. Stress on the muscles used to stabilize the osteoarthritic knee may cause structural changes in the Achilles tendon. Further studies are needed to corroborate the association between the Achilles tendon thickness and knee OA. We suggest considering an assessment of the Achilles tendon as part of the knee OA evaluation.

Background: The objective we evaluated the reliability of some haematological and biochemical parameters performed by a non-invasive auto-analyser (ANESA) with those obtained by the standard method of venipuncture (reference method) in patients who went to the clinical analysis laboratory (Municipal-Hospital of Badalona, Spain).

Methods: A transversal, comparative and parallel (paired) study was carried out. Two methods of study were practiced for the same subject: a) the reference method of venipuncture (conventional clinical analysis) and b) placement of sensors (comparison method: ANESA device). Consecutive patients older than 18 years, who met certain criteria for inclusion were included in the study during an 8 week period in 2014. The parameters studied were: haemogram (7), glucose, lipids (4), transaminases (2), bilirubin, creatinine and urea. Statistical analysis compared averages for paired groups and reliability of the obtained observations (method: intraclass-correlation coefficient (ICC); individual differences: Bland–Altman method), p<0.05.

Results: A total of 195 patients were involved, with an average age of 50.8 years; 65.2% were women. In paired comparisons, cholesterol (185.4 vs. 179.8; difference: 5.6 mg/dL; p=0.005), cLDL (95.9 vs. 100.5; difference: −4.6 mg/dL; p=0.002) and bilirubin (0.6 vs. 0.5; difference: 0.1 mg/dL; p<0.001) obtained more modest results. Erythrocytes, haemoglobin, haematocrit, platelets, leukocytes, glucose, cHDL, triglycerides, ALT, AST, creatinine and urea reached an ICC>0.90. Lipid parameters (cholesterol: ICC=0.728; cLDL: ICC=0.817) obtained a moderate correlation, whereas lymphocytes (ICC=0.551) and monocytes (ICC=0.546) reached discrete results.

Conclusions: Despite of the study limitations, the automatic non-invasive analyser (ANESA) is shown as a reliable and promising screening method in usual clinical practice for most of the analyzed parameters as an alternative to standard blood extraction. However, more studies are required to strengthen the consistency of the results.

Aims: The purpose of the study was to observe if hormonal contraceptive use increases CV risk in women from Ghana through increasing CV RF.

Study Design: The study was longitudinal and purposive random sampling was done.

Place and Duration of Study: A community in the Upper West region of Ghana was selected. The Reproductive Healthcare Clinic which administers contraceptives was used for the study from January 2013 to January 2014.

Methodology: Seventy- one (71) cases were recruited (20-40 years). Twenty-three (23) were on an injectable contraceptive (IC), 43 on an oral contraceptive (OC), 5 on a sub-dermal implant contraceptive (IMP) and 4 switched methods from OC to IC or to IMP. After 12 months, a total of 42 remained in the study. Twenty-three (23) remained on IC, 11 on OC and 4 on IMP. Anthropometry [Body mass Index (BMI), Diastolic and Systolic Blood Pressure (DBP,SBP)], Lipid profile [Total Cholesterol (TC), High Density Lipoprotein Cholesterol (HDL), Low Density Lipoprotein (LDL), Triglycerides (TG), Very Low Density Lipoprotein (VLDL), Apolipoprotein A-1(ApoA-1), Apolipoprotein B(Apo B) and cardiovascular risk indices [Castelli index I = TC/HDL; Castelli index II = LDL/HDL; Atherosclerotic risk = (TC-HDL)/HDL; Atherogenic index of plasma = Log TG/HDL] were determined and statistically analyzed.

Results: Comparison of the studied groups showed that OC users had significantly increased DBP, BMI, TC, LDL, TG and Apo B (p<0.001, all cases). IC user also had significantly increased BP, BMI, TC, LDL, TG and Apo B (p<0.001), whilst HDL and Apo A-1 reduced significantly (p<0.001). IMP users had significantly increased BP, TC and Apo B (p<0.05). Castelli index I, atherosclerotic risk, atherogenic index of plasma, Apo B/Apo A-1 (a better predictor of coronary risk) increased significantly (p<0.001, respectively), for the OC and IC groups.

Conclusion: Chronic use of hormonal contraceptives amongst women has the tendency to cause weight gain, increase BP and dyslipidaemia. IC had the greatest cardiovascular risk.