Open Access Case Report

Missed Clavicular Fracture in an Adult without Head Injury or Polytrauma Review of Literature and a Rare Case

A. Raviraj, Ashish Anand

Journal of Advances in Medicine and Medical Research, Page 1-5
DOI: 10.9734/JAMMR/2017/36360

We present a case of missed clavicular fracture in a patient with an associated wrist fracture but without head injury. This is the first case of missed clavicular fracture in an adult, despite adequate imaging, and without head injury presenting two days after the patient was discharged after fixation of the distal radius fracture.

Open Access Case Study

Laparoscopic Resection of Ileal Gastro Intestinal Stromal Tumor Presenting as Gastro Intestinal Bleed; a Case Report

Mushtaq Chalkoo, Mumtaz Din Wani, Zahid Mohd Rather, Mohammad Younis, Peer Hilal Ahmad Makhdoomi, Awhad Mueed Yousuf, Wasim Raja, Syed Shakeeb Arsalan, Zubair Gul Lone, Aabid Rasool Bhat

Journal of Advances in Medicine and Medical Research, Page 1-5
DOI: 10.9734/JAMMR/2017/36398

Gastrointestinal stromal tumors are the rare tumors of GI tract and account for 2% of all the tumors of digestive tract. They are usually found in stomach and are also located in the small intestine. They usually present with mucosal ulceration and gastro intestinal bleeding. The bleeding from the small intestine is difficult to diagnose however angiography is a useful tool. We present a case of a GIST located in the ileum presenting with a lower gastrointestinal bleeding. A patient presenting with lower G.I bleeding was admitted in our hospital The colonoscopy was performed which showed blood coming through the ileal opening into the caecum. Patient was asked to undergo CT enterography, which showed an ileal GIST. The patient was subjected to diagnostic laparoscopy which revealed an ileal Gist 25 cms from ileocaecal junction compressing the ileal lumen. Laparoscopic resection of the diseased segment of bowel with GIST was performed and ileo-ileal side to side anastomosis was done with V-loc sutures.

Open Access Original Research Article

Socio Demographic Determinants of Metabolic Syndrome and Its Components in South-West Nigeria

Esther Ngozi Adejumo, Omobolanle Abioye Ogundahunsi, Olusola Adedeji Adejumo, Omodele Jagun, John Sotunsa

Journal of Advances in Medicine and Medical Research, Page 1-11
DOI: 10.9734/JAMMR/2017/35098

The occurrence of hypertension, obesity, dysglycaemia and dyslipidaemia together has been shown to result in increased risk of development of cardiovascular disease and diabetes. This present study assessed prevalence of components and the socio-demographic determinants of metabolic syndrome.

Methods: A cross- sectional descriptive study was conducted. Lagos and Ogun States were purposively selected. Selection of an urban and a rural community in Lagos and Ogun state respectively was done using multi stage sampling methods. Consecutive sampling was used to select apparently healthy subjects 18 years and above. Metabolic syndrome was defined based on the Joint Interim Statement (JIS) criteria. Regression analysis was used to assess the determinants of metabolic syndrome and its components.

Results: Five hundred and thirty-five subjects were recruited with the mean age of 47.1±14.7 years. About 14% of subjects had no MetS components. More of the females than males had two (37.5% vs 24.7%, p =0.005) and three (17.2% vs 6.8%, p = 0.002) components of MetS. Generally, the most prevalent component of MetS were central obesity (49.5%), hypertension (42.1%) and reduced HDL cholesterol (41.5%). The proportion of subjects with two, three and four components of MetS increased with age. The prevalence of MetS based on the JIS criteria was 23%. Gender (OR 3.05, 95% CI 1.72 – 5.44, p < 0.001), urban setting (OR 4.2 95%CI 2.6 – 6.8, p <0.001) and alcohol intake (OR 2.407, 95% CI 1.37 – 4.2, p = 0.002) were the determinants of MetS in this study.

Conclusion: The prevalence of MetS and its components were high in this study especially among females. The need of life style modification to reduce the prevalence of MetS and its components cannot be overemphasized.

Open Access Original Research Article

Simple Interrupted vs. Continuous Suturing in Abdominal Fascia Closure – A Thermographic Analysis in Rabbits

Odermatt Erich, Blender Bernd, Freytag Christiane

Journal of Advances in Medicine and Medical Research, Page 1-11
DOI: 10.9734/JAMMR/2017/36096

Aims: Thermography is an accepted method in different medical fields to detect and to visualize differences in the blood supply of tissue while following their temperature distribution. In this study, we compare the temperature profile of the simple interrupted vs. the continuous suture technique used for the closure of six rabbit abdominal fascia.

Methodology: The closure of rabbit fascia with a simple interrupted (n=3) or a continuous suture technique (n=3) was implemented, in particular under tension and tensionless conditions simulating possible strain situations for the fascia. The temperature profile of the wound healing process was compared during different operation stages for different tissue layers from the preoperative up to the postoperative period of 21 days followed by histology.

Results: The simple interrupted sutured fascia under 4 N tension experienced a significant temperature drop of 2ºC (P=0,01) for each single suture site as well as for the total suture line and did not achieve the same temperature level as before the application of the strain. On the contrary, the continuous sutured fascia experienced no significant temperature changes under 4 N tensions as well as after releasing the tension.

Conclusion: The thermographic analysis of the two compared suture techniques favored the continuous suture technique for the closure of fascia due to better vascularization and wound healing effects related to a more even distribution of tension across the entire length of the sutured fascia.

Open Access Original Research Article

Effect of Submaximal Isometric Exercise on the Relationship between Body Mass Index (BMI) and Blood Pressure (BP)

A. A. Aigbiremolen, O. M. Odigie, A. O. Naiho, J. C. Igweh, C. P. Aloamaka

Journal of Advances in Medicine and Medical Research, Page 1-9
DOI: 10.9734/JAMMR/2017/24077

One of the major determinants of desirable body weights is the body mass index (BMI). In humans, BMI is the ratio of body weight (in kg) to height (in meters square). Helpful to clinicians in estimating average healthy weight and nutritional status of their clients, findings have reported BMI to be dependent on several factors as; genetics, exercise, blood pressure (BP), peripheral arterial blood flow, dietetics, basal metabolic rates (BMR), etc. The goal of this study was to find in men, the effect that sub-maximal isometric exercise has on the relationship between BMI and peripheral arterial blood flow. To achieve this, 400 humans were ethically recruited from Irrua Specialist Teaching hospital, Irrua, Edo State of Nigeria. By means of bidirectional Doppler, Velocity of arterial blood flow (in their upper extremities-brachial arteries) was determined and recorded against values obtained for measured BMI. Subjects were then sorted by age and grouped based on values from arterial flow as; 120 normotensive normal BMI (120-NTNBMI), 120 normotensive high BMI (120-NTHBMI), 80 hypertensive normal BMI (80-HTNBMI), and 80 hypertensive high BMI (80-HTHBMI). Using ANOVA and student t-test, statistical measures of deviation/central tendencies were conducted on obtained data, p-values less than 0.05 were takes as statistically significant. Study found upon analysis, no significant relationship between arterial blood flow of normotensives with normal or high BMI after exercise. Pearson Product moment correlation returned positive correlation between normortensive normal BMI and peripheral arterial blood flow.

Open Access Original Research Article

Weight Change during Hospitalization: Recognition of Risk Factors. Prospective Study at Benghazi Medical Center

Mariam Omar, Faiza Nouh, Manal Younis, Ali Elmabsout

Journal of Advances in Medicine and Medical Research, Page 1-13
DOI: 10.9734/JAMMR/2017/35892

Under nutrition and weight loss associated with prolonged hospitalization is a cause of significant morbidity and mortality. It is also associated with impaired recovery from illness, surgery, and increased hospital length of stay. Despite the growing awareness of the hazards of both over- and under nutrition, nutritional care is often neglected in clinical practice, and nutritional concerns are overlooked or considered of low importance.

The aim of this research was to assess changes in weight status during the course of hospitalization, evaluate nutrition risk factors in Benghazi Medical Center and evaluate the factors independently associated with weight change. A total of 30 patients in total were enrolled, (11 females, and 19 males). Anthropometric measurements were taken by professionally trained researchers. End points were preadmission and post admission. BMI, mid- arm circumference, laboratory investigations were all collected from patients. Interview based questionnaire was used to collect data on nutritional risk factors and patient files were checked for documentation and nutritional referrals. A statistically significant differences was found between preadmission and post-admission BMI and mid arm circumference. The mean of weight loss among patients was (1.076 kg), and mean arm circumference loss was 6.69 cm. Patients charts lacked information on poor appetite, dentures, teeth or swallowing problems, information on food provided. No referrals to dietitians were found in all patient files or in discharge summary. Only one patient reported been visited by a dietitian but was not documented in file.

Female gender, admission to surgical ward and being single as a marital status were associated with losing more weight. Physiological and food related problems correlated with the nutritional status of the subjects. The study finding reveals that despite patient undergoing anthropometric changes during hospital stay, there were no information of nutritional status in patient files, very little, if any, nutritional intervention, little documentation of risk factors, and nutritional consultation was almost lacking.

Open Access Original Research Article

An Early Experience with Totally Extra-Peritoneal Inguinal Hernia Repair from a Teaching Institute from Kashmir Valley

Mushtaq Chalkoo, Mumtaz Din Wani, Zahid Mohd Rather, Awhad Mueed Yousuf, Wasim Raja, Syed Shakeeb Arsalan, Zubair Gul Lone

Journal of Advances in Medicine and Medical Research, Page 1-7
DOI: 10.9734/JAMMR/2017/36616

Objective: To present the observations from an early experience with the TEP hernia repair with regard to feasibility, technical difficulties, operating time, conversion rate and early recurrence.

Methods: The study was conducted in the Post Graduate Department of General and Minimal and Access Surgery from   June 2012 to June 2016. 70 patients, all men having inguinal hernias were operated using Totally Extra peritoneal mesh hernioplasty and various Aims and Objectives of the study observed. The outcome of 70 patients operated by TEP technique was collected 1 year after last patient was operated in the study group.

Results: All patients were men with a median age of 52 years ranging from 20 -80 years. The maximum operating was 90 minutes while minimum was 30 minutes. The conversion rate was 2.8% and recurrence rate was 2.8%. Complication noted was seroma formation

Conclusion: Since all the patients were operated by a single surgeon, skilled in laparoscopic surgery, the study revealed relatively reduced level of complications. We also feel that TEP is relatively a difficult procedure for the beginners and requires a steep learning curve.