Open Access Case Study

Healing by Secondary Intention in Fresh Sockets Filled with Bio Oss®: A Case Report Study

Pâmela Letícia Santos, Edilson José Ferreira, Marcos M. Kuabara, Théssio Mina Vago, Thiago Calcagnotto, Francielli Delgado Agostini, Jéssica Lemos Gulinelli

Journal of Advances in Medicine and Medical Research, Page 1-7
DOI: 10.9734/BJMMR/2017/31616

After dental extraction, the corresponding alveolar bone suffers remodeling, and the bone volume decreases as time goes by, becoming atrophic. The Bio-Oss® is a biomaterial which presents similar crystallinity and chemical composition to the mineral natural bone, and it acts as a framework due to its osteoconductive properties. The objective of this study is to evaluate, through a literature review and a case report, the efficiency of the biomaterial Bio Oss® regarding the alveolar maintenance for the rehabilitation with osseointegrated implants after dental extraction. The atraumatic extraction of the teeth 11 and 21 was performed in a male patient, and after that, the respective alveoli were filled with the biomaterial Bio Oss®. Two and a half months after the dental extraction and the filling with Bio Oss®, a new surgical procedure for the installation of the osseointegrated implants was performed. It was possible to observe through tomograpic image that the alveoli of the teeth 11 and 21 were completely filled with mineralized tissue. We can conclude that the biomaterial Bio Oss® is efficient for the preservation of the alveolar bone after dental extraction, acting as a framework for the bone neoformation for a later installation of osseointegrated implants.

Open Access Policy Article

Information Asymmetry in Financial Forecasting within Healthcare and Simple Methods to Overcome this Deficiency

Neeraj Beeknoo, Rodney P. Jones

Journal of Advances in Medicine and Medical Research, Page 1-12
DOI: 10.9734/BJMMR/2017/31474

Aims: To explore the interplay between information asymmetry and financial forecasting in the context of the English National Health Service (NHS).

Study Design: Synthesis of the political context of the English NHS and how this impacts on the information flows to assist NHS accountants with financial forecasting.

Place and Duration of Study: Monthly hospital activity data across the whole of England between 2006/07 and 2016/17, and monthly deaths by place of residence within England between 2000 and 2016.

Methodology: Running 12-month totals. Cumulative activity within a financial year (April to March) adjusted for available working days per month, with examples calculated for the 2016/17 financial year.

Results: The NHS in England operates in a tightly constrained policy-directed manner, in which government health agencies may omit to communicate essential information that is contrary to current policy. Long-term trends show anomalous behavior which has been used to ‘blame’ the NHS for failure to constrain health care demand, and as the basis of the need for further ‘corrective’ policies. A running 12-month total is presented as a useful method to detect activity trends subject to non-standard behavior. The role of volatility associated with health care trends is emphasized. Volatility arises from Poisson-based variation due to size, and the effects of the environment on human health, i.e. changes in weather, air quality, noise levels, and outbreaks of infectious agents. Volatility is therefore location specific. After adjusting for the number of available work days per month, cumulative monthly activity data can also be used to calculate year-end outturn from any point in the financial year. Multiple years of historic data can be converted into the current financial year equivalent which enables both the median, minimum and maximum potential outturn to be estimated, i.e. with allowance for location-specific volatility. For example, activity totals for month six of the 2016/17 financial year for emergency admissions across England can be multiplied by anywhere between 2.001 to 2.046 to estimate year end, while costs related to end-of-life can be multiplied by 1.945 to 2.258 in West Berkshire or between 1.890 to 2.304 in Redditch (as examples of the effects of size and location).

Conclusion: Information asymmetry is not unique to the NHS in England. Running 12-month totals are a simple method which can be employed by finance departments to detect unusual long-term trends. The activity multiplier method, based on multiple years of historic data, is simple and can be used to estimate a likely year-end position, along with upper and lower limits.

Open Access Original Research Article

Clinical Characteristics of Vitiligo among Adult Patients at the Obafemi Awolowo University Teaching Hospitals’ Complex (OAUTHC), Ile-Ife, Osun State, Nigeria

Echekwube Patrick Ojojarumi, Olasode Olayinka Abimbola, Onayemi Olaniyi

Journal of Advances in Medicine and Medical Research, Page 1-8
DOI: 10.9734/BJMMR/2017/32026

Background: Vitiligo is a depigmentary skin disorder which occurs worldwide due to the loss of melanocytes in the skin of affected persons and it can affect the skin of any part of the body with varied clinical characteristics.

Aim: The aim of the study was to determine, in adults, the clinical spectrum and clinical characteristics of vitiligo and to also identify any precipitants amongst those affected.

Methods: All consecutive adult vitiligo patients attending the Dermatology clinics of the OAUTHC Ile-Ife who gave consent were recruited. A total of fifty patients were recruited for the study. A detailed history and physical examination was conducted for all the patients using a proforma to elicit socio-demographic and clinical data.

Results: The age of the patients with vitiligo at presentation ranged from 18 years to 72 years with mean age of 35 ± 17 years.Most of the patients (56%) had generalized vitiligo. The face was the predominant part of the body in which the lesions  occurred in most of the patients as forty-one patients (82%) had the lesions on their face and the areas of the face mostly affected were the forehead and cheek. The initial lesions were also located on the face in 52% of the patients.

There was a positive family history in 12% of the patients. A proportion of the patients noticed that their lesions were likely to have been precipitated by various stressful events such as physical trauma, emotional stress, severe sun burn and pregnancy which were not related to the clinical spectrum of vitiligo.

Conclusion: The clinical spectrum and clinical characteristics of vitiligo in this study are mostly similar to the findings documented from previous studies. Vitiligo could also be precipitated by factors such as physical and emotional stress which do not affect the clinical spectrum in affected patients.

Open Access Original Research Article

An Epidemiological Study of 198 Cases of Primary Cicatricial Alopecia in Iran

Farahnaz Fatemi-Naeini, Fatemeh Mokhtari, Mina Saber, Akram Basiri, Marzieh Matin

Journal of Advances in Medicine and Medical Research, Page 1-6
DOI: 10.9734/BJMMR/2017/27476

Background: Cicatricial alopecia or scarring alopecia, is a group of trichologic emergency disorders characterized by hair follicle destruction and permanent loss of hair. The aim of this cross-sectional study is to evaluate epidemiological and clinicopathological characteristics of cicatricial alopecia in Isfahan community.

Materials and Methods: 198 patients with proven diagnosis of cicatricial alopecia by biopsy from 2008 to 2015 included. Data were obtained through filled questionnaires by patients. Descriptive statistical methods were used for analyzing the results.

Results: 198 patients including 126 female (63.6%) and 72 male (36.4%) participated in this study. 69.6% of patients suffered from lichen planopilaris (LPP) (85 female and 53 male), 22.2% discoid lupus erythematosus (DLE) (31 female and 13 male), 6% Folliculitis decalvans (6 female and 6 male), 1% pseudopelade of brocq (2 female and no male) and 1% Follicular mucinosis (2 female and no male).

Conclusion: Cicatricial alopecia in women is more common than men and the most common type of cicatricial alopecia is LPP. Early diagnosis and treatment can reduce the burden of psychosocial problems.

Open Access Original Research Article

Association of Major Depression with Serum Prolidase Activity and Oxidative Stress

Akhilesh Kumar Verma, Ashutosh Bajpai, Anand Kumar Keshari, Mona Srivastava, Shalabh Srivastava, Ragini Srivastava

Journal of Advances in Medicine and Medical Research, Page 1-8
DOI: 10.9734/BJMMR/2017/31446

Aim: Stress is a major causative factor for the progression of major depressive disorder (MDD). The present study aimed to know the association of serum prolidase activity (SPA) and oxidative stress with the progression of MDD.

Place and Duration of Study: The study was carried out at the Department of Biochemistry, Sir Sunder Lal Hospital, Institute of Medical Sciences (IMS), Banaras Hindu University (BHU), Varanasi, Uttar Pradesh, India. The duration of study was September-2011 to August-2016. 

Methodology: 80 patients with MDD and 80 healthy controls of matched age and genders were selected. Serums SPA, total oxidant status (TOS), oxidative stress index (OSI) and total antioxidant status (TAS) were measured spectrophotometrically.

Results: Increased SPA, TOS, and OSI were observed in patients with MDD than healthy controls (all P < 0.001). However, TAS was significantly decreased (P < 0.001). SPA, TOS and OSI were also increased in patients with > 1 years of MDD than patients with ≤ 1 years of MDD. Positive, linear and significant correlations were observed between duration of MDD and SPA, and TOS, and OSI (all P < 0.001). However, negative, linear and significant correlation was observed between duration of MDD and TAS (P < 0.001).

Conclusions: The study concluded that SPA and oxidative stress have been significantly increased in the patients with MDD than healthy individuals. Increased SPA and oxidative stress might be significantly correlated to progression of MDD and may be responsible for its pathogenesis.

Open Access Original Research Article

Comparison of Subciliary, Subtarsal and Transconjunctival Approaches for Management of Zygomaticoorbital Fractures

Abbas Haghighat, Amirhossein Moaddabi, Parisa Soltani

Journal of Advances in Medicine and Medical Research, Page 1-9
DOI: 10.9734/BJMMR/2017/31843

Aims: To compare access of the surgeon and bleeding during surgery, and ectropion and scar following the surgery in subciliary, subtarsal, and transconjunctival incisions for treatment of the zygomaticoorbital region.

Study Design: Descriptive cross-sectional

Place and Duration of the Study: This study was conducted in maxillofacial surgery ward in Alzahra and Kashani hospitals in Isfahan, Iran between March to December 2015.

Patients and Methods: 51 patients with unilateral zygomaticoorbital trauma were included in this study in three groups (17 in each). Subciliary, subtarsal, and transconjunctival incisions were performed and intraoperative access and bleeding, presence of ectropion in two-week follow-up, and visual analogue scale (VAS) score for scar by surgeon and patient in four-week follow-up were recorded. Data was statistically analyzed.

Results: The study sample consisted of 7 (13.71%) females and 44 (86.29%) males aging from 17 to 44 years (mean±SD=26.70±6.52). Although intraoperative bleeding and access during surgery were not significantly different between subciliary, subtarsal, and transconjunctival groups, ectropion was more common in subciliary group and VAS score for scar was higher in subciliary and subtarsal group for both surgeon and patient.

Conclusion: Transconjunctival incision without visible scar and ectropion and with intraoperative access and bleeding comparable to subciliary and subtarsal incisions seems to be an appropriate choice in most cases of zygomaticoorbital fractures.

Open Access Original Research Article

Patients’ Perception and Satisfaction with the Quality of HIV Care Services and Its Associated Socio-demographic Determinants in a Tertiary Care Hospital

Anthony C. Iwu, Chukwuma B. Duru, Kenechi A. Uwakwe, Kevin C. Diwe, Irene A. Merenu, Henry N. Chineke, Ugochukwu C. Madubueze, Chukwuyem Abejegah, Emmanuel U. Ndukwu, Ikechi Ohale

Journal of Advances in Medicine and Medical Research, Page 1-14
DOI: 10.9734/BJMMR/2017/32090

Background: HIV/AIDS is a chronic disease on long term treatment and as such it is important that the quality of care meets the patient’s expectations and satisfaction which will consequently encourage treatment adherence that is associated with better HIV management, care and outcomes. 

Objective: To determine the levels of patients’ perception and satisfaction of the quality of HIV care services and the sociodemographic determinants associated with the level of satisfaction.

Methods: This is a descriptive cross sectional study and respondents were selected using a simple random sampling technique. Data was collected using a pretested semi structured questionnaire. Descriptive analyses were done with frequencies and summary statistics. Chi square statistics were computed to determine significant associations and multiple logistic regression to determine predictors of satisfaction. P value was set at 0.05 significant level.

Results: The results revealed that the majority of the respondents (65.6%) perceived that the quality of service rendered was good and were satisfied overall (79.5%) with the services rendered in the HIV clinic of the hospital. It further revealed that the patients overall satisfaction were significantly associated with the following socio-demographic characteristics; religion (p<0.000), marital status (p<0.000), educational level (p<0.000), occupation (p<0.000), centre of HIV diagnosis and treatment (p<0.000), place of residence (p<0.000), number of children (p<0.000), number of people per household (p<0.000), living-in arrangements (p<0.000), and transport cost per visit (p=0.001).

Conclusion: Certain HIV care service areas need improvement in spite of the good level of patients’ perception and overall satisfaction with the quality of HIV care services offered in the tertiary health institution, as this will further enhance the overall patients’ experience and satisfaction thereby increasing the certainty of better treatment adherence and retention in medical care.