Open Access Case Study

Obtaining Dental Aesthetics for Lower Incisor Agenesis

Nathalia Blanco Ferreiro dos Santos, Danielle Toledo Baliano Lopes, Anderson Jaña Rosa, Oswaldo de Vasconcellos Vilella

Journal of Advances in Medicine and Medical Research, Page 1-6
DOI: 10.9734/JAMMR/2017/35480

Tooth agenesis is a congenital disorder, which is extremely rare in lateral mandibular incisors. This article presents the case of a female patient with the absence of right lower lateral incisor and significant Bolton discrepancy. She was treated with the aid of a fixed orthodontic appliance and transpalatal bar to avoid the loss of anchorage of the posterior superior dental segment. To correct the Bolton discrepancy, stripping of 4.07 mm on the proximal faces of the anterior superior teeth was also performed. These procedures solved the occlusal disorders presented by the patient, conferring appropriate function, aesthetics and quality of life.

Open Access Original Research Article

Health Infrastructural Correlates and Data Quality in Primary Health Care-Health Management Information System in Edo State, Nigeria

H. A. Esene, A. I. Obi, P. W. Okojie, V. O. Omuemu, O. H. Okojie

Journal of Advances in Medicine and Medical Research, Page 1-10
DOI: 10.9734/JAMMR/2017/34967

Aims: Data management in health systems in developing countries remains very challenging despite its immense potential benefits to health system strengthening and development. This study aims to assess data quality of primary health care- health management information systems (PHC-NHMIS) and health infrastructure available at the PHC facilities in Edo State to aid PHC-NHMIS Data management and improve performance, effectiveness and efficiency.

Study Design: descriptive cross sectional analytical.

Place and Duration of Study: The study was carried out in selected Primary Health Care facilities in Edo State, Nigeria between September 2013 and December 2014.

Methodology: A qualitative assessment of selected health facilities was conducted using appropriate tools to assess quality of data and facility readiness for PHC-NHMIS in Edo State.Focus group discussion guide and observational checklist were utilized for this assessment in line with study objective. The notes and recordings were transcribed using thematic analysis to identify recurrent themes of barriers to the quality of data collected.
Results: Twelve and thirty-five PHC facilities were selected by simple random sampling and audited for data quality and functionality of available health infrastructure respectively. Focus group sessions revealed inadequate training, poor supervision and inadequate funding of the HMIS. The overall verification factor (data accuracy) was 58.9% (Major data quality issues) for pentavalent vaccination, 76.1% (minor data quality issues) for antenatal care and 63.8% (Major data quality issues) for institutional birth. In terms of health facility readiness, none of the facilities had internet connectivity and budget specific for NHMIS, 80% of the health facilities assessed were not operationally ready for NHMIS activities.
Conclusion: Majority of the health facilities studied had poor operational readiness for NHMIS pentavalent vaccination activities with major data quality issues for and institutional births. There is need for relevant stakeholders especially Government to strengthen operational readiness for PHC-HMIS through appropriate resource mobilization and training for better and effective data quality management and response.

Open Access Original Research Article

Plasma N-terminal Pro Brain Natriuretic Peptide as a Prognostic Biomarker in Children with Pulmonary Hypertension

Fatma Abd-Rabo, Doaa El-Amrousy, Hesham El-Serogy, Amr Zoair

Journal of Advances in Medicine and Medical Research, Page 1-7
DOI: 10.9734/JAMMR/2017/35937

Aim: To evaluate plasma level of N-terminal pro brain natriuretic peptide (NT pro-BNP) as a prognostic biomarker in children with pulmonary hypertension (PH) due to congenital heart disease (CHD).

Study Design: Prospective case controlled study.

Place and Duration of the Study: Pediatric cardiology department, Tanta University hospital, Egypt during the period from February 2016 to February 2017.

Methodology: Thirty children with PH due to CHD were enrolled as patients group. Thirty healthy children of matched age and sex were taken as control group. All children were evaluated by echocardiography and plasma level of NT pro-BNP at admission. We followed up patients for 6 months after discharge for adverse effects, mortality or readmission.

Results: Plasma level of NT pro-BNP was significantly elevated in patient group than control group (P=0.001). Both systolic and diastolic functions of left ventricle and right ventricle were impaired in patient group compared to control group. Moreover, both left ventricular and right ventricular dimensions were increased in patient group than control group. Plasma NT pro-BNP was significantly elevated in patient with unfavorable prognosis compared to patients with favorable prognosis (P<0.001). Plasma NT pro-BNP level was positively correlated with heart rate, estimated systolic pulmonary artery pressure and left ventricular end systolic dimension. While, it was significantly inversely correlated with left ventricular fraction shortening, left ventricular E’/A’ ratio, right ventricular outlet fraction shortening and right ventricular E’/A’ ratio. Receiving operating characteristics curve showed that sensitivity of NT pro BNP as a prognostic biomarker in PH patients was 100% and specificity was 92% at cutoff value of more than 103 pg/ml.

Conclusion: NT pro-BNP may serve as a reliable biomarker for predicting adverse outcome in children with PH due to CHD.

Open Access Original Research Article

Five Year Retrospective Study on Keloid Management

P. Denen Akaa, N. C. Ahachi, A. R. Vhriterhire, E. Agada, A. A. Jenrola, D. Dzuachii

Journal of Advances in Medicine and Medical Research, Page 1-8
DOI: 10.9734/JAMMR/2017/34824

Aim: Keloid morbidity is mostly associated with the psychosocial effects of the cosmetically unsightly scars. The study was carried out to highlight the availability of different treatment modalities and the effectiveness of our treatment strategies.

Materials and Methods: A 5 year retrospective study of all patients treated with keloid from March 2012 to February 2017. In this study all patients with keloids attending the plastic surgery clinic at Federal Medical Centre Makurdi and Benue State University Teaching Hospital Makurdi and receiving any form of treatment were included.

Results: Thirty one patients were included in our study. Keloids represented 7.2% of benign skin lesions. Keloids were twice more common in females than males. Young patients particularly belonging to the 21 – 30 year old group were mostly affected. Head and neck area was the predominantly affected anatomic site. All patients received some form of treatment and most (90.3%) were treated with the combination of surgery and intralesional triamcinolone acetonide with excellent results. Recurrence was noted in 25.8% of patients.    

Conclusion: Our study highlights the excellent results of the combination of surgery. With intralesional triamcinolone acetonide, even in patients with difficult keloids like patients from African descent.

Open Access Original Research Article

Biochemical Assessment of Malnutrition in Sudanese Patients with Chronic Renal Failure on Hemodialysis Maintenance Therapy

Mohammed Siddig Mulah, Omer Fadul Idres, Salah Awad, Abd Elkarim A. Abdrabo

Journal of Advances in Medicine and Medical Research, Page 1-10
DOI: 10.9734/JAMMR/2017/34866

Background: Malnutrition in Chronic Kidney Disease Patients on Hemodialysis remains one of the major causes of morbidity and mortality characterized by changes in circulating levels of plasma albumin, pre-albumin and transferrin.

Purpose: The aim of this study was to determine the serum levels of albumin, pre-albumin, transferrin, highly sensitive C-reactive protein (hs-CRP) and BMI as markers for malnutrition.

Materials and Methods: A total of one hundred patients with Chronic Kidney Disease on hemodialysis maintenance therapy and one hundred sex and age-matched healthy control subjects were enrolled in this study; After informed consent six milliliters of venous blood Were collected from each patient of the study group and the control group after dialysis session in the morning, after an overnight fasting in a plain container from which serum is separated and then stored in Eppendorf tubes at -80°C.

Results: In our study: significant decrease in the mean level of serum albumin (3.12±0.39) (P. value >0.001), pre-albumin (24.76±6.46) (P. value >0.001), transferrin (278.66±59.47) (P. value 0. 04), hs-CRP (20.13±5.70) (P. value >0.001) and BMI (20.3±5.5) (P. value >0.001) among the Chronic Kidney Disease patients on maintenance hemodialysis therapy when compared to the control group.

Furthermore, the results showed that there was a negative correlation between serum highly sensitive C-reactive protein with plasma albumin (rho= -.812, p<0.02), pre-albumin (rho= -0.752, p<0.02) and no correlation between serum hs-CRP with transferrin level (rho= -0.062, p=0.385).

Conclusion: In conclusion, a significant decreased in the mean level of serum albumin, pre-albumin, transferrin and BMI among Sudanese Patients with Chronic Kidney Disease on hemodialysis maintenance therapy place them at risk of developing Malnutrition.

The significant negative correlation between albumin and pre-albumin with hs-CRP proofed that Albumin and pre-albumin were negative acute phase reactants that tended to decreased during inflammation and these negative correlations linked between chronic systemic inflammation and malnutrition in chronic kidney disease patients on hemodialysis maintenance therapy.

Open Access Original Research Article

Biochemical Assessment of Atherosclerosis in Sudanese Patients with Chronic Renal Failure on Hemodialysis Maintenance Therapy

Mohammed Siddig Mulah, Omer Fadul Idres, Salah Awad, Abd Elkarim A. Abdrabo

Journal of Advances in Medicine and Medical Research, Page 1-9
DOI: 10.9734/JAMMR/2017/34903

Background: Renal manifestations are becoming a very important health problem in the developing world. In Sudan, the new cases account for about 70-140 thousand of inhabitants per year. Leading to reduced quality of life, these manifestations have negative social and economic impact on the population.

Atherosclerosis is a very frequent complication in uremia due to the coexistence of hypertension, hyperhomocysteinemia, inflammation, malnutrition, increased oxidative stress and hyperlipidemia.

Alteration in structural and functional ability of high-density lipoprotein cholesterol (HDL), Low-density lipoprotein cholesterol (LDL), apolipoprotein (A), apolipoprotein (B), and Lipoprotein (a) were also associated with atherosclerosis.

Purpose: The aim of this study was to determine serum level of total cholesterol, triglyceride, HDL-cholesterol, LDL-cholesterol, lipoprotein (a), fibrinogen and homocysteine as markers for atherosclerosis and to measure plasma homocysteine to assess endothelial Cell Dysfunction and vascular disease.

Materials and Methods: A total of one hundred patients with Chronic Kidney Disease on Dialysis and one hundred sex and age-matched healthy control subjects were enrolled in this study; after informed consent six milliliters of venous blood were collected after hemodialysis session from each patient and healthy subjects after an overnight fasting in a plain container from which serum is separated and then stored in Eppendorf tubes at -80C°. Before analysis, frozen specimens were thawed and allowed to reach room temperature for various measurements.

Results: The results showed that there was increased in the mean level of serum triglycerides (277.45±59.47) (P. value >0.001), Lp(a) (60.29±20.66) (P. value >0.001), Homocysteine (24.30±6.37) (P. value >0.001)and Fibrinogen (498.66±56.48) (P. value >0.001) among the Chronic Kidney Disease patients on maintenance hemodialysis therapy when compared to the control group.

The results also showed that there was a reduced level of HDL-cholesterol (24.76±6.46) (P. value >0.001) among the Chronic Kidney Disease stage on dialysis when compared to the control group.

Furthermore, the results showed that there was positive correlation between serum Lipoprotein (a) with plasma fibrinogen level and homocysteine

Conclusion: In conclusion, the significant increase in Plasma triglyceride concentration, Lp (a), Homocysteine and Fibrinogen level, as well as decreased HDL-Cholesterol level among CKD patients on regular hemodialysis maintenance therapy place them at risk of developing cardiovascular disease. 

This risk is also evident in the positive correlation between serum Lipoprotein (a) with plasma fibrinogen level and homocysteine and these findings showed that homocysteine enhanced the binding of Lipoprotein (a) to Fibrin and this interaction linked between Thrombosis and Atherosclerosis.

Open Access Original Research Article

Audit of Otologic Foreign Bodies Seen at Abubakar Tafawa Balewa University Teaching Hospital (ATBUTH), Bauchi, North-East, Nigeria

Amali Adekwu, Francis A. Ibiam, Johnbosco Ugwuadu, Agida S. Adoga, Michael Efu, Jika Mandabs

Journal of Advances in Medicine and Medical Research, Page 1-7
DOI: 10.9734/JAMMR/2017/34840

Background: Foreign bodies (FBs) in the ear are common emergency presentation in ear, nose and throat clinics. They occur in all age groups but are commoner in children and the mentally retarded. Whereas children tend to explore their orifices out of curiosity, adults experience it accidentally. The aim of this study was to audit the Otologic FBs, treatment protocol and complications at the ATBUTH, Bauchi, where most of these cases were managed by ear, nose and throat nurses.

Materials and Methods: Three year retrospective data comprising biodata, presenting complaint, duration of presentation, type of foreign body, ear(s) involved, mode of extraction, attending medical personnel and complication were obtained from the medical records of the patients. These data were analyzed in simple descriptive form using Excel 2010.

Results: There were 257 patients with FBs in their ears comprising 146 males and 111 females, aged 1 year to 70 years. 160(62.3%) were 10 years and below. The complaint of FB lodgment by individuals/caregivers was 49%, pain 23%, impaired hearing 18% and ear discharge 10%. 143 cases presented within 24hours, 79 within 48 hours and 35 beyond 48 hours. Seed grains accounted for 69 (26.9%), insects/cockroaches 52(20.2%), beads 46(17.9%), stones/pebbles 39(15.2%), and cotton buds 35(13.6%), plastic materials 10(3.9%) and papers 6(2.3%). Treatment using water irrigation accounted for 65% while manual instrumentation was 35%. Complications were seen in 61(23.7%) cases.

Conclusion: Otologic FBs still remain a significant presentation in ENT Units. Knowledge and skill to their proper management are keys to minimizing complications. Due to the limitations of other health care givers in these regard, it is recommended that every Centre with high volume of patients should engage the services of otolaryngologist to avoid complications.