Open Access Case Report

Immediate Effect of Transcranial Direct Current Stimulation Combined with Functional Electrical Stimulation on Plantar Distribution and Body Sway Frequency in a Patient with Hemiparesis from Stroke: A Case Report

Aline Marina Alves Fruhauf, Glaucio Carneiro Costa, João Carlos Ferrari Corrêa, Fernanda Ishida Corrêa

Journal of Advances in Medicine and Medical Research, Page 1-9
DOI: 10.9734/jammr/2019/v31i1230340

Objectives: The present study aimed to evaluate the immediate effect of a single session of anodal transcranial direct current stimulation (tDCS) over the primary motor cortex (M1) combined with functional electrical stimulation (FES) of the tibialis anterior (TA) muscle on plantar distribution and body sway frequency in an individual with hemiparesis stemming from a stroke. A further aim was to determine whether the effects of the combination of stimulation techniques would lead to greater improvement than the techniques administered separately.

Methods: The therapy was conducted with one 60-year-old male with right-side stroke and complete, but disproportional hemiparesis with brachial predominance on the left side, 42 months elapsed since the event and severe Fugl-Meyer score. The patient was submitted to four different randomly performed intervention protocols with a 48-hour intervention between sessions: 1) anodal tDCS + sham FES + active TA contraction; 2) sham tDCS + active FES + active TA contraction; 3) anodal tDCS + active FES + active TA contraction; 4) sham tDCS + sham FES + active TA contraction). TDCS was administered for 20 minutes with the anode over C4 and the cathode over the supraorbital region on the contralateral side and FES was administered over the left TA. The evaluation of plantar distribution was performed with a foot-pressure platform and body sway frequency was evaluated using a force plate before and after each protocol.

Results: Beneficial changes occurred in the area of contact of the left hindfoot and right forefoot following intervention protocols 1, 2 and 3 and a reduction in body sway frequency occurred under all data acquisition conditions after protocols 1 and 2.

Conclusion: The use of tDCS (combined and alone) and the use of FES contributed to improvements in plantar distribution and body sway frequency in a stroke survivor with hemiparesis. The use of tDCS either alone or combined with FES achieved better results than the use of FES alone.

Open Access Minireview Article

Undesirable Outcomes of Starvation Therapy of Cancer Require Special Attention

Fawwaz Shakir Al Joudi

Journal of Advances in Medicine and Medical Research, Page 1-10
DOI: 10.9734/jammr/2019/v31i1230339

Nutritional starvation is a growing area of research into development of cancer therapy. Within the vast amount of positive research findings in starvation trials, there have been weaknesses in some of the systems utilized. Because such weaknesses are taken as adverse points that must be well-thought-out and avoided, such negative effects have been sought from the literature and presented in this work. This mini-review can then be a suitable guide for researchers and clinicians to either avoid situations where the growth of certain cancer cells is enhanced by certain forms or modes of starvation, or their metastatic abilities are boosted. The intra- and extra-cellular mechanisms associated with these cellular enhancements have been demonstrated. Some negative interactions of starvation with chemotherapy have also been included. The understanding of these mechanisms can help avoid them for better future experimental and clinical results and may, at the same time, open new avenues for research workers to find ways of dismantling them.

Open Access Original Research Article

Geriatric Research in Saudi Arabia: A Bibliometric Analysis

Sultan H. Alamri

Journal of Advances in Medicine and Medical Research, Page 1-9
DOI: 10.9734/jammr/2019/v31i1230336

Background: This bibliometric analysis was performed to assess the research trends and productivity from Saudi Arabia in the field of geriatrics.

Methods: In this descriptive study, we collected bibliometric data for manuscripts published from Saudi Arabia between the year 1980 to June 2018. Data were retrieved from PubMed; Embase; MEDLINE; CINAHL and Google Scholar using the Medical Subject Headings (MeSH) terms: “Saudi”, “Elder”, “Older”, “Gerontology”, “Seniors”, “Senility” “Geriatric” and “Ageing”. The number of published papers overall and citations per paper were also collected.

Results: From the publications analyzed between the year 1980 to June 2018, 91% of the articles were published between the years 2000 -2018, indicating the major contribution from Saudi Arabia in the field of geriatric research has been in the recent 20 years. In total, 34 publications were retrieved, of which, 85% were cross-sectional studies, with 66% of the studies carried out in hospitals or primary health care centers. The sub-topics with maximum number of publications included mental health, musculoskeletal health, and socio-gerontology. The most cited publications were related to the topics of depression, psychosocial health and osteoporosis.

Conclusions: Despite the recent increase in geriatric research in Saudi Arabia, the research output and quality of publications were low and did not address commonly seen geriatrics health conditions such as dementia, delirium and polypharmacy. More high quality research directed to address common geriatrics conditions is needed to better inform decision making. Building research capacities, enhancement of infrastructure, and provision of adequate support from funding bodies are required interventions to enable geriatric research in Saudi Arabia to operate at a maximum efficiency.

Open Access Original Research Article

Assessment of Serum Anti-mullerian Hormone Level, Antral Follicle Count and Age as Indicators of Ovarian Reserve Response in Women Diagnosed with Infertility in Abia State, South Eastern Nigeria

Ebirien-Agana S. Bartimaeus, Chukwuma E. J. Obi, Felix O. Igwe, Edna O. Nwachuku

Journal of Advances in Medicine and Medical Research, Page 1-11
DOI: 10.9734/jammr/2019/v31i1230338

Aim: This study aimed at assessing serum anti-mullerian hormone level, antral follicle count and age as indicators of ovarian reserve response in women diagnosed with infertilility.

Methodology: Subjects comprised of 200 females: 150 subjects and 50 controls, aged < 20  and up to 49 years, stratified into age < 20 years (control), age 20-29 years  (group 1), age 30-39 years (group 2) and age 40-49 years (group 3). About 5 ml of blood sample for AMH determination was collected on day 2-3 of spontaneous menstrual cycle from all groups and control and serum anti-mullerian hormone analyzed using enzyme linked immunosorbent assay. Baseline transvaginal ultrasound scanning was carried out on the subjects in experimental groups and control on day 2-3 of un-stimulated menstrual cycle for the measurement of antral follicle count, using the 2-dimensional plane.

Results: The means±SEM of serum anti-mullerian hormone by experimental groups was 1602.44 ± 54.42 pg/ml for control, 848.06±23.04 pg/ml for group 1, 26.74±1.28 pg/ml for group 2, while group 3 is 10.37±1.26 pg/ml. The means were significantly different (P<0.0001). The mean±SEM of AFC by experimental groups was control; 7.82±0.14, group 1; 5.46±0.18, 1.78±0.10 for group 2, and 0.70±0.08 for group 3. The means of antral follicle count by experimental groups showed significant difference (p<0.0001). Results showed that anti-mullerian hormone level and antral follicle count decreased significantly (p<0.05) as the age of the subjects increases. Subjects in the control and experimental group 1 showed 100% high anti-mullerian hormone level indicating 100% potential of good ovarian response. The antral follicle count result also indicate that 100% and 75% of the control group and experimental group 1 respectively show good ovarian reserve. The ovarian response and reserve in the subjects decreased substantially as the age of the subjects increased. Positive correlations were also observed between the AMH and AFC across the ages of the population studied.

Conclusion: The study reveals that good ovarian response and reserve in the population is related to the age of the subjects.

Open Access Original Research Article

Determinants of Quality of Life among Menopausal Market Women Traders in a South-Western Town, Nigeria

Abosede Adekunbi Farotimi, Musiliat Olufunke Akinbade, Grace Ogba Okueso

Journal of Advances in Medicine and Medical Research, Page 1-9
DOI: 10.9734/jammr/2019/v31i1230342

Menopause marks the end of a woman’s reproductive life with associated physical, social, mental and cultural changes. Menopausal symptoms are known to impair the quality of life (QoL) of women. This study assessed the determinants of quality of life among menopausal women traders in a South-Western Town, Nigeria.

Methodology:   This study adopted descriptive research design. 421 respondents were purposively selected based on inclusion and exclusion criteria.  Standardized Structured Questionnaire that was pretested and validated was used to collect data. The data obtained were analyzed using the statistical package for the social sciences (SPSS) version 23 and P-value were set as 0.05.

Results: Socio-demographic characteristics distribution of respondents showed that 286 respondents (67.9%) were married; 205 respondents (48.7%) were secondary school holders and the menopausal mean age was 48.45±3.78 years. On determinants of QoL, 328 respondents (78.0%) reported good sleep; 301 respondents (71.5%) reported good memory; 138 respondents (32.8%) reported enjoyment of love life; and 215 respondents (51.0%) claimed to work actively. On the overall QoL 223 respondents (53.0%) experienced fair QoL; there is no significant relationship between QoL and selected demographic variables, their P value were, age = 0.48, number of children = 0.13, educational qualification = 0.70, occupation = 0.20 and monthly income = 0.53.

Conclusion: The study concluded that respondents’ love life has the least reported response among the determinants, and little above half has fair QoL. Therefore public health practitioners need to pay special attention to comprehensive sexuality education for menopausal women to improve their QoL.

Open Access Original Research Article

Improving Diagnostic Approaches to Predicting Stroke Complications

E. M. Toshkenov, G. S. Rakhimboeva, U. T. Abdukodirov

Journal of Advances in Medicine and Medical Research, Page 1-7
DOI: 10.9734/jammr/2019/v31i1230343

Introduction: This article provides a brief description of the possibility of using reversible cerebral vasoconstriction syndrome as a possible predictor of stroke development. As you know, the main subtypes of ischemic stroke are: atherothrombotic. Cardiogenic embolic, lacunar, hemodynamic, hemorheological. To date, the pathophysiological mechanisms of the development of stroke have not been fully studied, so the search for new diagnostic criteria that expand the clinical diagnosis of acute circulatory disorders remains an urgent issue in clinical neurology.

 Materials and Methods: 36 patients aged 30 to 77 years (mean age 53.5 ± 11.4 years) were examined at the Department of Neurology of the ASMI. The diagnosis was made based on anamnestic information, the results of the clinical and neurological examination and MRI data in the T-1, T-2, T2-FLAIR, MPA modes.

Results: According to the results of the study, a mild stroke (NIHSS less than 7 points, Bartel index more than 75 points, mRS less than 2 points) was observed in 36% of subjects, moderate severity (NIHSS 7-14 points, Bartel index 70-60 points, mRS 2-3 points) in 52% of patients with severe severity (NIHSS more than 14 points, Barthel index less than 50 points, mRS - 4 points) in 12% of patients. In neurological status, in all patients, motor (contralateral hemiparesis or monoparesis and sensory disturbances in combination with impaired innervation of the facial and sublingual nerve were determined to vary degrees. Speech disorders in the form of aphasia and dysarthria, slightly expressed disorders of gnosis and praxis were also detected.

Conclusion: The most significant factors affecting the course and outcome of the disease in patients with stroke can be considered the presence of cerebral angiospasm.

Open Access Review Article

Efficacy of Oil-pulling Versus Chlorhexidine Mouthwash in Reducing Oral Streptococcus Mutans Count: A Systemic Review and Meta-analysis

Zaeem Arif Abbasi, Fizza Saher, Jabbar Ahmed Qureshi, Ayesha Tariq Niaz, Saima Akram Butt, Shafaq Saeed Roghay

Journal of Advances in Medicine and Medical Research, Page 1-9
DOI: 10.9734/jammr/2019/v31i1230341

Purpose: To determine whether oil-pulling with sesame or coconut oil yields a better result in reducing Streptococcus mutans count compared to conventional chlorhexidine mouthwashes.

Methods: Multiple databases were used to search for articles up to and including August 2019. Studies which reported use of oil-pulling and chlorhexidine mouthwashes to reduce Streptococcus mutans bacterial count were analyzed procedurally. Studies that fulfilled the inclusion criteria were then undertaken for qualitative and quantitative analysis.

Results: Five studies were included in this analysis, which used oil-pulling (test group) and chlorhexidine mouthwash (control group). The follow-up period ranged from 14 to 30 days. The oil used in oil-pulling group were either sesame or coconut oil. Quantitative analysis showed a significant reduction in oral Streptococcus mutans count with oil-pulling as compared to chlorhexidine mouthwash at follow-up (Q value = 6.61, DF = 4, I2 = 39.50%).

Conclusion: Use of oil-pulling showed better result in reducing cariogenic bacterial count as compared to the gold standard chlorhexidine mouthwashes. More clinical trials, evaluating additional oral hygiene parameters, would further validate the effects of oil-pulling on the oral cavity. Clinicians may advise their patients to use oil-pulling instead of chlorhexidine mouthwashes, as it is safe, cost-effective, and easily available.