Open Access Minireview Article

Micronutrient Consequences of Long Term Proton Pump Inhibitor Therapy

N. Inayet, A. Poullis, J. Hayat

Journal of Advances in Medicine and Medical Research, Page 1-7
DOI: 10.9734/JAMMR/2017/34805

Proton pump inhibitors (PPIs) are currently the mainstay of treatment for gastro-oesophageal reflux disease, peptic ulcer disease and dyspepsia. In this area, they have enjoyed remarkable success and there are many patients worldwide who use PPIs on a long-term basis. In recent years concerns regarding adverse effects of PPIs have emerged frequently in the medical literature with several small and large scale studies conducted to look into this. The main areas of interest have been increased risk of neuroendocrine tumours, increased risk of dementia, increased risk of infections (enteric, pneumonia, Clostridium difficle), cardiovascular, renal and lower gastrointestinal side effects and effects on mineral and vitamin metabolism. In this review article, we focus mainly on the metabolic consequences of long term PPI therapy.

Open Access Original Research Article

Diabetic Foot Ulcers: Epidemiology, Management Modalities and Outcome at Benue State University Teaching Hospital Makurdi

P. Denen Akaa, N. C. Ahachi, N. J. Kortor, D. D. Mue, C. I. Elachi, M. Ogiator, M. P. Utoo, J. I. Osuji

Journal of Advances in Medicine and Medical Research, Page 1-12
DOI: 10.9734/JAMMR/2017/34131

Aim: To determine the epidemiology of diabetic foot ulcers (DFU), types, and the risk factors associated with their development at Benue State University Teaching Hospital, Makurdi Nigeria. To assess outcome of various modalities of treatment and mortality.

Study Design: This was a four year retrospective study of consecutive patients admitted at Benue State University Teaching Hospital Makurdi with diabetic foot ulcers. Data was collected using a proforma form in November and December, 2016.

Methodology: Data collected from 46 patients files included socio-demographic parameters of age, sex, type of diabetes mellitus, Meggitt-Wagner’s grading of the ulcers, fasting blood glucose on the second day of admission, glycaemic control and type of drugs used, duration of ulcers before presentation to hospital, types of ulcers and risk factors for their development, length of hospital stay, surgical modalities of treatment and ulcer defect cover, patients who had amputations and mortality.

Results: Forty six patients files showed that patients with DFU were males in 43.5% of cases and females in 56.5%, with a male: female ratio of 1:1.3. The age range of patients was 25 – 75 years with mean age of 51.6 (± 10.4) years. The commonest aetiology for diabetic foot ulceration was peripheral neuropathy seen in 47.8% of cases. Most patients presented with Meggitt-Wagner grade IV ulcers. Vast majority of patients (91.3%) had type 2 diabetes. Honey was the main dressing agent used for the ulcers. Sepsis was the major complication seen. Twelve patients underwent amputations at various levels.  Outcome of treatment was healed ulcers in 34.8% of patients, amputations in 26.1% and mortality in 23.9%.

Conclusion: The study showed peripheral neuropathy as the commonest aetiology of diabetic foot ulceration. Health education on proper care of the foot and compliance with anti-diabetic drugs will help in preventing diabetic foot ulceration with its consequences.

Open Access Original Research Article

Prevalence and Antibiotic Susceptibility Patterns of Escherichia coli O157:H7 in Children 0 – 24 Months in Calabar South L. G. A. of Cross River State, Nigeria

Kingsley Hovana Enyi-Idoh, Okort Agbor Akwa, Ini Ubi Bassey, Veronica David Idim, Stephen Ugoeze Egeonu

Journal of Advances in Medicine and Medical Research, Page 1-10
DOI: 10.9734/JAMMR/2017/31023

Diarrhea continues to be the scourge of children across the world especially in developing countries like Nigeria. Despite efforts by World Health Organization and other agencies, much work still remain to be done in combating diarrheal diseases caused by Escherichia coli O157:H7 in the developing world including  Nigeria. One hundred and fifty (150) children attending five nursery schools including Native nursery/primary school (Anantiga), Bank-dee nursery/primary school (Musaha), Golden nursery/primary school (Ekpo-Abasi), JOESAM nursery/primary school (Yellow Duke) and Ideal nursery/primary school (Palm street) in five major localities in Calabar South LGA between July 2014 and June 2015, were recruited in this study. Socio-demograhpic factors such as age, sex, weaning practices and parents’ occupation/educational level were obtained using structured questionnaires. Stool samples were examined macroscopically and microscopically, and stool culture was done using MacConkey agar and Sobitol MacConkey agar. Antibiotics sensitivity and serology tests were carried out.  E. coli O157:H7 was identified in 14(9.33%) out of the 150 stool samples examined. The highest number of isolates was recovered from the 6 – 12 months age group having 9 (64.29%) in total. No isolates were recovered from the age group 0 – 5 months or from exclusively breastfeed infants. However, 5 (7.35%) isolates were recovered from infants that received mixed feeding while 9 (27.27%) from infants who received no breastfeeding (P > 0.05). Of the isolates, 12 (85.71%) were sensitive to amoxicillin, 10 (71.43%) to pefloxacin, 8 (57.14%) to gentamicin, 17 (73.91%) to sporfloxacin, 16 (69.57%) to ciprofloxacin and 7 (50.00%) to ampiclox, 4 (28.57%) were sensitive to zinacef and rocephin while only 2 (14.29%) were sensitive to streptomycin and septrin. No isolates were sensitive to erythromycin. E. coli O157:H7 is an important bacterial agent in infantile diarrhea. Improvement in nutritional status, weaning practices, socioeconomic status and personal hygiene will lead to a reduction in the spread and incidence of diarrhea due to bacterial agents (pathogens), especially E. coli O157:H7.

Open Access Original Research Article

Testosterone Deficiency Associated with Periodontal Disease Increases Alveolar Bone Resorption and Changes the Thickness of the Gingival Epithelium

Claudio Girelli Junior, João Paulo de Arruda Amorim, Romário Willian Welter, Michael Aparecido Machado, Luiz Gustavo de Almeida Chuffa, Elaine Manoela Porto Amorim

Journal of Advances in Medicine and Medical Research, Page 1-9
DOI: 10.9734/JAMMR/2017/34818

Aim: The relationship between steroid sex hormones and periodontal disease has been extensively investigated in females; however, studies with males are still scarce. The aim of the present study was to analyze the influence of testosterone deficiency on alveolar bone loss and on the histological structure of the periodontal tissues of castrated rats with experimental periodontitis.

Materials and Methods: To test the hypothesis, we used 28 male Wistar rats obtained from the Unioeste’s Central Bioterium. When the animals reached 80 days of age, they were separated into four groups (N =7 animals/group): Control without ligature (CON), Control with ligature (CON+LIG), Castrated without ligature (CAST), and Castrated with ligature (CAST+LIG). At 90 days of age, the orchiectomy was performed in the appropriate groups. Sixty days after castration, the periodontal disease was induced by a ligation technique. At the end of the trials (90 days after castration), the animals were weighed and sacrificed using a CO2 chamber. Their jaws were removed, dissected, separated into the right and left counterparts, fixed in 10% (v/v) buffered formalin for 24 h, decalcified and processed for histological and radiological techniques.

Results: The results of this study showed that the ligature model was effective in inducing periodontitis in animals. The animals of the CAST and CAST+LIG groups showed significant reduction in body weight at the end of the trial period when compared to the CON and CON+LIG groups. Castration led to a significant bone loss in the animals, which was aggravated by the induction of periodontal disease. Animals with periodontal disease showed increased gingival epithelium area and connective tissue area when compared to the animals free of periodontitis.

Conclusion: We conclude that testosterone is an important physiological regulator of alveolar bone metabolism. Testosterone deficiency associated with periodontal disease increases alveolar bone resorption and changes the thickness of the gingival epithelium.

Open Access Original Research Article

Assessment of Total Serum Immunoglobulin Levels and CD4+ T-Lymphocyte Counts in Pulmonary Tuberculosis Patients Co-Infected With HIV in Uyo, Nigeria

Anietie E. Moses, David M. Ibokette, Veronica G. Bassey

Journal of Advances in Medicine and Medical Research, Page 1-9
DOI: 10.9734/JAMMR/2017/33286

Background: Poor disease diagnosis and monitoring, could aid in the progression of Tuberculosis especially in Tuberculosis/HIV co-infected patients.

Aim: This study aimed to evaluate the levels of cellular (CD4+ T-Cell) and humoral (immunoglobulin classes IgA, IgG, IgM) markers associated with PTB and HIV infection in sputum producing patients in Uyo, Southsouth, Nigeria.

Study Design: This was a cross sectional study of patients suspected with PTB and HIV.

Study Location and Duration: The study was conducted at the Tuberculosis and HIV clinics of University of Uyo Teaching Hospital and St. Luke's Hospital all in Uyo, Akwa Ibom State, Nigeria, from October, 2013 to September, 2014.

Methodology: Sputum producing adult patients, 105 (male 48, female 57; age range 18 - >60 years), who were referred to the laboratory for investigation, were recruited for the study. On the spot and overnight sputum samples were collected and analysed using Ziehl Neelsen's technique and fluorescence microscopy. Blood samples were collected by veni-puncture and assayed for HIV status using rapid test kits while CD4+ T-cell counts and total serum immunoglobulin levels were determined by flow cytometry and ELISA techniques, respectively. Subjects were classified into PTB, HIV and PTB/HIV-infected groups.

Results: Mean CD4+ T-cell counts (cells/ul) in the order of PTB/HIV (175.12±85.8)<HIV (311.06±228.6)<PTB (576.31±326.7) were significantly lower than apparently healthy control subjects (1294±334.9) (p<0.05). Mean IgA values (mg/dl) in the order of HIV (208.85±104.9)>PTB/HIV (206.0±71.7) were significantly higher than the control group (126.81±35.5). Mean IgG values (mg/dl) of PTB/HIV (1498.54±35.5) was significantly higher than other patient and control groups (p<0.001). The mean IgM values (mg/dl) of patient groups was significantly higher than those of control (50.00±32.3) (p<0.001). There was a significant moderate negative correlation (r=-0.56) between categorized CD4+ T-cell counts (≤200 cells/µl and >200 cells/µl) and total serum IgG levels in PTB/HIV group. PTB/HIV cases with severe cellular immune suppression had very high IgG levels.

Conclusion: CD4+ T-cell counts and levels of immunoglobulin classes, particularly IgG, were significantly affected in PTB/HIV co-infection. Therefore, these immune markers could be useful in predicting and monitoring disease progression in PTB/HIV coinfected patients.

Open Access Original Research Article

Delayed Presentation of Bone and Soft Tissue Sarcoma of the Extremity in Makurdi: Do Traditional Bone Setters Play a Role?

W. T. Yongu, I. C. Elachi, D. D. Mue, J. N. Kortor, C. T. Soo, C. N. Ahachi, B. A. Ojo, J.A. Ngbea

Journal of Advances in Medicine and Medical Research, Page 1-8
DOI: 10.9734/JAMMR/2017/33753

Background: Soft tissue and bone sarcomas are rare but are associated with high mortality rate when they occur. This is partly due to delay in presentation to a specialist center .Some guidelines have been introduced to aid early diagnosis of these tumours, however, these guidelines are not always observed as required. This study is aimed at highlighting the emerging role traditional bone setters may be playing in delaying presentation of patients with sarcomas of the extremity.

Methods: A 5 year retrospective review of histologically confirmed soft tissue and bone sarcoma patients was conducted at our hospital. Data obtained included socio-demographic characteristics, date symptoms were first noticed, date of first consultation with a specialist, date of first specific treatment and history of traditional intervention. Tumour size, location on the limb, fungation/ ulceration at presentation as well as type of treatment were noted. Descriptive statistics was done to display frequency and measures of central tendency.

Results: There were 16 patients between ages 3 and 65 years. Fifteen had soft tissue sarcoma while one was an osteosarcoma. There were 10 males and 6 females giving a male to female ratio of 1.6:1.Mean Patient Delay was 56.4 weeks and Mean tumour size was 25.3 cm. There were 12(75%) rhabdomyosarcomas and 2(12.5%) Kaposi sarcomas. Seven of the tumours were located in the thigh (43.7%), 2(12.5%) each in the gluteal region, knee and leg. Out of the 6 that ulcerated, 5(83.3%) had traditional bone setters intervention with incisions made. Seven had Wide local excision and 2 had amputation after biopsy. Four patients had adjuvant chemotherapy with one year survival in one. 

Conclusion: Delay in presentation of sarcoma is noticed more commonly among patients with  small size tumours and those  who have had traditional bone setters treatment.

Open Access Original Research Article

Possible Impact of Thyroid Dysfunction on Menstrual Cycle in HIV/TB Co-infected Females in NAUTH, Nnewi, Nigeria

R. Ukibe Nkiruka, N. Ukibe Solomon, N. Monago Ifeoma, C. Onyenekwe Charles, E. Ahaneku Joseph, A. Ilika Linus

Journal of Advances in Medicine and Medical Research, Page 1-13
DOI: 10.9734/JAMMR/2017/34123

Background: Thyroid dysfunction is among the commonest endocrinopathies in HIV as well as Tuberculosis infection and can pose unique consequences on women’s reproductive health.

Aim of Study: The present study aimed to evaluate the impact of thyroid dysfunction on menstrual cycle of HIV/TB Co-infected females in Nnamdi Azikiwe University Teaching Hospital Nnewi, Nigeria.

Materials and Methods: A total of 210 reproductive aged women (15-45 years) were randomly recruited for the study and grouped into: (i) Symptomatic HIV females (n=30); (ii) Symptomatic HIV females on ART (n=30); (iii) Symptomatic TB females (n=30); (iv) Symptomatic TB females on ATT (n=30); (v) Symptomatic HIV/TB females (n=30), (vi) Symptomatic HIV/TB females on therapy (n=30); and (vii) Control females (n=30). After due consent, blood samples were collected at the follicular (Fp) and luteal phases (Lp) of their menstrual cycle for determination of thyroid indices (FT3 (ng/ml), FT4 (µg/dl, TSH (µIU/ml) using enzyme-linked immunosorbent assay (ELISA) method, CD4+ T-cells (/µl) using Cyflow SL Green Cytometer.

Results: There was significantly lower FT3 but significantly higher TSH values in Symptomatic HIV and Symptomatic HIV/TB females and significantly lower FT3 with normal TSH values in Symptomatic TB compared respectively with Control females at both phases of menstrual cycle (P=.05). CD4 T-cells counts was significantly lower in all test groups compared to Control females at both phases of menstrual cycle (P=.05) and  significantly higher in Symptomatic HIV on ART, TB on ATT and HIV/TB females on treatment compared to their counterparts not on therapy (P=.05 respectively). The thyroid indices showed hypothyroidism in Symptomatic HIV females and Symptomatic HIV/TB females while euthyroid sick syndrome was observed in Symptomatic TB females with significant drop in CD4 T-cells.

Conclusions: The study showed significant derangement in thyroid indices and CD4 T-cells in all the study subjects. Early diagnosis and treatment of thyroid dysfunction is beneficial.