Journal of Advances in Medicine and Medical Research

Aims: Obstructive sleep apnea (OSA) increases the risk of cardiac arrhythmias. We investigated QT interval variability among OSA patients.

Study Design: It is a descriptive-cross-sectional study.

Methodology: Newly diagnosed OSA patients and healthy controls were studied. Inter-heartbeat and QT intervals were extracted from electrocardiography (for 1 hour at 3 AM). QT interval metrics including duration and variability indexes were compared between patients and controls.

Results: 35 patients and 13 controls were studied. There was no difference between patients and controls, neither between mild/moderate OSA versus severe OSA patients, in the measured QT interval variables. No significant correlation was found between apnea severity and the measured QT interval variables.

Conclusion: We found no difference between OSA patients and controls in QT variability. Also, no clear association between OSA severity and QT variability was observed.

Aim and Objective: To evaluate the co-relation between philtral and maxillary combined central incisor width in north Indian population.

Materials and Methods: Measurement of philtral width was done by measuring the width of philtrum with digital vernier calipers (to the fraction of 1/10th of a millimeter). Measurement of width of central incisor was done intraorally with a digital vernier caliper.

Results: There was a mild significant correlation of philtral width with central incisor width (r=0.27, p=0.003).

Conclusion: There is a mild significant coorelation between the philtrum width and central incisor width, so we can use the philtrum width to determine the combined central incisor width in north indian population in cases of no pre- extraction records available. Using this result we can easily provide esthetically pleasant maxillary central incisors with proper tooth width and tooth form according to philtrum width and face form.

Aim: To evaluate the effect of analgesia for chest pain control in multiple rib fractures in adult blunt chest trauma patients in terms of improvement in ventilatory function, reversal of abnormal lung function test parameters at different periods of analgesia.

Methodology: Prospective study of 64 adult patients with blunt chest injury. 

Results: There were 64 adult patients with blunt chest trauma studied with male-female ratio 8.4:1.5; dominated by young adults and middle age (92.2%). Commercial motorcyclists and tricyclists, all males, accounted for 62.5% of the patients (p=0.0001) and motorcycle and tricycle accidents accounted for 78.1% of the causes (p=0.005).

Respiratory function was adversely affected by chest pain and got improved when the pain was controlled as shown by the following respective pre and post analgesic means of percent predicted lung function test parameters with statistical significance: FVC (80.3% vs. 93.3%), FEV1 (79.7% vs. 93.5%), FEV₁/FVC ratio (FEV₁%) (79.9% vs. 90.6%), FEF (84.8% vs. 92.2%), and FEF 25-75 (79.9% vs. 92.0%). Before analgesic, 44 (68.7%) of the patients rated their chest pain as severe, but by one hour after the first dose of analgesic only four (6.3%) patients still had severe  chest pain (p < 0.0001) and at 24 hours the difference in chest pain improvement was also statistically significant (p=0.02).

Conclusion: Analgesic is capable of reversing the abnormal lung function test parameters associated with chest pain of blunt chest injury.

Aims: The current study aims to compare the relationship among uric acid level, fasting blood glucose, 2-hour glucose, HbA1C and diagnostic value of uric acid level with diabetes and Pre-diabetes in healthy people and patients with pre-diabetes and diabetes.

Study design:  It is a descriptive – analytical study.

Methodology: This study composed of a total of 1080 participants classified into three groups (n = 360) including healthy people (HbA1C<5.6 and fasting plasma glucose<100 mg/dl), prediabetic (5.7%≤ HbA1C<6.5% and 100 mg/dl < fasting plasma glucose < 126 mg/dl) and diabetic patients (HbA1C≥6.5 and fasting plasma glucose ≥126 mg/dl) presented at Endocrinology and Metabolism Research Center in Isfahan, during 2008 – 2013. The parameters including gender, BMI, blood pressure, fat level, fasting plasma glucose, 2-hour postload glucose, HbA1C and serum uric acid were recorded and analyzed with SPSS (Ver. 20).

Results: Mean uric acid levels of healthy, prediabetic and diabetic groups were 4.89±1.37 mg/dl , 5.21±1.29 mg/dl and 5.01±1.44 mg/dl respectively, indicating a significantly higher level in prediabetic group (P<0.001). Blood sugar levels had a significant increase in healthy people (P<0.001) compared to other groups. Serum uric acid was positively correlated with fasting plasma glucose and HbA1C in general but weak in prediabetic and healthy subjects versus a negative correlation in the diabetic group. In addition, serum uric acid cut-off (≥4.75 mg/dl) can be a good diagnostic criterion for pre-diabetes prediction compared with normal people (P<0.05).

Conclusion: Although serum uric acid is not a target for the treatment of asymptomatic hyperuricemia and not a risk marker of clinical activities, it may be considered as a new therapeutic target for prevention of diabetes or its progression.

Introduction: Inverting stripping resection is a well-described method of esophageal surgery. Although the indications for this procedure have decreased due to the widespread of endoscopic mucosal resection and the advancement of thoracoscopic surgery, familiarity with this procedure is important for the esophageal surgeon. We herein describe the inverting stripping procedure using simple and reliable methods.

Materials and Methods: Porcine esophagus was used. A model with a detached and non-detached site was made with a sponge, and stripping was performed. In our new technique, air was injected into the esophagus and stripping was performed. Clinically, the esophagus was examined from within the esophageal lumen using an endoscope.

Results: The porcine esophagus was stacked on itself without inverting. By pulling the stripper further, the esophagus was drawn into the sponge and appeared on the caudal side of the sponge inverted. With air supply, the esophagus did not stack up and the stripping was smooth. Endoscopically, esophageal stump is sequentially inverted.

Conclusion: During an inverting stripping resection, the esophagus is ultimately withdrawn into an invaginated state. However, this method can damage the esophagus. With our method, we can perform inverting stripping resection of the esophagus with minimal damage and resistance felt by the surgeon.

The question of national medical exams in Australia has sporadically been debated and both advantages and disadvantages have been discussed. The value and importance of monitoring minimum standards over schools is generally accepted but arguments that national exams may impede flexibility of schools’ curricula and instructional methods are used to oppose such exams.

Different methods which can be used to administer national exams without limiting schools are discussed in this paper. By including questions agreed on by different schools in their assessments or by using different subsets of questions, valid comparisons of performance can be achieved. If enough questions are included, robust results can be obtained.

Background: Renal manifestations of sickle cell anaemia range from functional abnormalities to gross anatomic alterations of the kidneys. As people with sickle cell anaemia (SCA) grow older, the kidneys may progress to end-stage renal disease if proper monitoring of renal function is not done.

Aim: The aim of this study is to determine the serum and urine sialic acid levels in SCA patients and correlate with plasma urea and creatinine.

Methods: Venous blood and fresh urine samples were collected from participants and the standard Ehrlich method was used in the analysis of serum and urine sialic acid. The modified Jaffe method was used in the analysis of plasma and urine creatinine and the Urease Berthelot method for plasma urea.

Results: A total of 98 respondents participated in the study consisting of 68 SCA patients and 30 control subjects. The mean age was 28.35 ± 0.42 years for SCA subjects and 33.12 ± 1.14 years for control subjects and most of the SCA subjects were females (M:F = 1 : 1.6). The  serum sialic acid (SSA) level was 1.88 ± 0.96 mmol/L for SCA subjects and 1.93 ± 0.67 mmol/L for controls and it was found to be non-significantly  (P =0.81) higher in SCA subjects with microalbuminuria (1.89 ± 0.07 mmol/L) than in those with normoalbuminuria (1.86 ± 0.10 mmol/L). However, the mean urine sialic acid creatinine ratio (USACR) was higher in SCA subjects (169.39 ± 13.59 mmol/mol) than in the control subjects (60.52 ± 3.39 mmol/mol) and this was statistically significant (P< 0.05). Also, the mean USACR was significantly (P < 0.05) higher in SCA subjects with microalbuminuria than in those with normoalbuminuria.

Conclusion: Serum sialic acid (SSA) is low while USACR is high in SCA patients. Hence, monitoring of serum and urine sialic acid in patients with sickle cell anaemia will be important in detecting early onset of sickle cell nephropathy.