Background: Globally, the rate of cesarean delivery is increasing rapidly over the past years. Aim: The study was conducted to investigate the incidence and the predictors for cesarean delivery in nulliparous women at Khartoum Hospital, Sudan. Methods: A prospective cross-sectional hospital-based study was conducted where all parturient nulliparous women delivered in the period between February to April 2012 were included. Socio-demographic characteristics were gathered through structured questionnaires. Maternal anthropometric measures, birth weight, gender and mode of delivery were recorded and compared between those who delivered vaginally and by emergency cesarean delivery. Results: A total of 533 parturient women were enrolled, of these, 147(27.6%) were emergency cesarean delivery. The cesarean delivery rate in nulliparous increased significantly with increased maternal, age Ëƒ 30 years (OR=2.4, 95% CI= 1.1â”€5.2, P= 0.032), decreased maternal height < 150 cm (OR=2.4, 95% CI=1.4â”€4.1, P=0.002), and in increase BMI ≥ 30 Kg/m 2 (OR=2.2, 95% CI=1.1â”€4. 9, P=0.046) and increase in birth weight > 3750g (OR=2.7, 95% CI=1.1â”€6.4, P=0.026). There was no association between cesarean delivery rate, mid-upper arm circumference and fetal gender. Conclusion: There was a high incidence of cesarean delivery among nulliparous women especially among elder, obese women, short statue women and with a fetal birth weight > 3750g.
Aims: To investigate the impact of supplemental vitamin D on pulmonary function in patients with stable chronic obstructive pulmonary disease (COPD). Study Design: Case-control study Place and Duration of Study: Department internal medicine, Rouhani hospital, Babol university of medical sciences, Babol, Iran. Over six months from September 2011 through February 2012 Methodology: Patients with COPD allocated to the treatment or control group intermittently. Thirty patients in the treatment group received 50.000 IU oral cholecalciferol weekly for two months plus routine treatment and 28 patients who served as controls received only their usual medications. The serum 25-hydroxyvitamin D (25-OHD) and FEV1% was measured at baseline and two months later. The primary objective was to determine treatment response defined as 5% or greater increase from baseline in FEV1% and the secondary objective was to determine the association between vitamin D supplementation and treatment response. In statistical analysis Spearman's correlation coefficient was used to determine correlation and logistic regression analysis with calculation of odds ratio (OR) was used to determine association. Results: Mean age of the patients and controls was 67.1±10.5 years and 66.±12.2 years respectively (P=0.83).Thirteen patients (43.3%) versus 3 (10.7%) controls responded to treatment (P=0.009). Treatment response was positively correlated with mean serum 25-OHD changes from baseline (Spearman's correlation coefficient = 0.358, P=0.026). Mean 25-OHD change from baseline in the responders was significantly higher than in no responders (P = 0.031). Mean 25-OHD changes were positively correlated with FEV1% (P = 0.013).Vitamin D supplementation increased the treatment response by OR = 6.37 (95% CI, 1.57-25.8). After adjustment for inhaled bronchodilator, corticosteroid therapy, age, weight, smoking, ESR and CRP the odds of treatment response in vitamin D group increased to 17.1 (95%CI, 2.39-122, P= 0.005). Conclusion: The findings of this study indicate that, two months vitamin D supplement to the drug regimen of COPD confers small pulmonary function improvement as compared with controls and justify serum 25-OHD measurement in COPD. Raising serum 25-OHD to sufficient levels with longer duration of treatment may exert further benefits.
This review briefly summarizes how cell-based therapeutic interventions are being developed and applied to treat endothelial dysfunction (ED) as a critical clinical target. ED directly contributes to the onset and prognosis for all of the major forms of cardiovascular diseases, including atherosclerosis, pulmonary artery hypertension, peripheral hypertension, stroke, myocardial infarction and congestive heart failure. Current pharmacological therapies used to treat ED are discussed and compared with newer strategies employing endothelial progenitor cells (EPCs) and other stem cells for tissue repair/regeneration therapies. Cell-based therapies to treat ED are still largely experimental but they are emerging in the clinic and represent a promising avenue for new interventional options to combat cardiovascular disease and improve patient outcomes.
Aims: This Study aimed to evaluate toxic changes that might occur in rabbit cornea after UVB exposure and possible protective role of Trehalose. Study Design: Eighteen adult white female rabbits were divided into three groups, six rabbits for each one. Group Ι received buffered saline (negative control), Group ΙΙ irradiated by UVB (positive control) and Group ΙΙI irradiated by UVB with concomitant application of Trehalose eye drops. Place and Duration of Study: Department of Pharmacology, and Department of Histopathology, Umm AL Qura University (UQU), KSA, between April 2012 and May 2012. Methodology: Eighteen rabbits were divided into three equal groups. Group Ι received buffered saline (0.9%), Group ΙΙ Only the cornea was irradiated by UVB, and Group ΙΙI were treated (by dropping trehalose three drops in each eye, six times daily) after irradiated with UVB. Two weeks after treatment, the excised corneas were employed for histopathological and immunohistochemical examinations. Results: UVB exposure induced cell death and thinning of the corneal epithelium, while the irradiated epithelium was preserved well morphologically with concomitant application of Trehalose eye drops. The irradiated corneal epithelium was significantly (P =0.026) thicker than eyes treated with Ultraviolet and Trehalose eye drops. Apoptotic cells were significantly (P =0.001) reduced in negative control and Trehalose -treated eyes than positive control eyes. Trehalose was showed to prevent oxidative stress, accelerated corneal healing, restored corneal transparency and prevent corneal neovascularization in irradiated corneas. Caspase-3, was strong significantly expressed (P<0.5) in the corneal epithelium two weeks after irradiation and corneal neovascularization was evident. Conclusion: Trehalose prevents apoptosis after the UVB irradiated cornea, so topical Trehalose administration may be a candidate treatment to prevent the damages by UVB irradiation with wide applications in clinical toxicology.
Aims: Cephalometric norms vary between populations as well as among ethnicities within a known population. This study presents an update on cephalometric findings among Nigerians as well as the prevalent jaw patterns among subjects with malocclusion. Study Design: A cross sectional study design was employed. Place and Duration of Study: Orthodontic unit, University College Hospital, Ibadan, Nigeria between April 2008 and September 2011. Methodology: One hundred and seven subjects were recruited (43 males, 64 females; overall mean age was 20.74±5.78 years). Thirty-six subjects had normal occlusion, 35 had skeletal pattern II and 36 had skeletal pattern III. Socio-demographic data, dental, occlusal and other orthodontic features were recorded on a data extraction form. Lateral cephalometric radiographs were taken for soft and hard tissue tracings. The ANB angle and Wits appraisal were used to assess skeletal pattern. Data was analysed using the Statistical Package for Social Sciences (SPSS) version 19. Frequency tables and measures of central tendency were generated. Variations in angular and linear variables were assessed using ANOVA and LSD post-hoc test. Significance was set at P<.05. Results: A hundred and seven subjects were assessed. Mean age was 20.74±5.78 years. There was significant difference in mean values for SNB, ANB, SNMP, PP-MP, FMA, LI-MP and UI-LI angles between the three groups (P<.05). LSD post-hoc test showed significant reduction in SNB for class II (P <.05) but increase in SNB for class III subjects relative to the standards was not statistically significant (P >.05). Conclusions: Mandibular deficiency appears to be the primary defect in class II malocclusion in this environment. On the other hand many factors are accountable for class III malocclusion.
We present a new mathematical model of colorectal cancer growth and its response to monoclonalantibody (mAb) therapy. Although promising, most mAb drugs are still in trial phases, and the possible variations in the dosing schedules of those currently approved for use have not yet been thoroughly explored. To investigate the effectiveness of current mAb treatment schedules, and to test hypothetical treatment strategies, we have created a system of nonlinear ordinary differential equations (ODEs) to model colorectal cancer growth and treatment. The model includes tumor cells, elements of the host’s immune response, and treatments. Model treatments include the chemotherapy agent irinotecan and one of two monoclonal antibodies - cetuximab, which is FDAapproved for colorectal cancer, and panitumumab, which is still being evaluated in clinical trials. The model incorporates patient-specific parameters to account for individual variations in immune system strength and in medication efficacy against the tumor. We have simulated outcomes for groups of virtual patients on treatment protocols for which clinical trial data are available, using a range of biologically reasonable patient-specific parameter values. Our results closely match clinical trial results for these protocols. We also simulated experimental dosing schedules, and have found new schedules which, in our simulations, reduce tumor size more effectively than current treatment schedules. Additionally, we examined the system’s equilibria and sensitivity to parameter values. In the absence of treatment, tumor evolution is most affected by the intrinsic tumor growth rate and carrying capacity. When treatment is introduced, tumor growth is most affected by drugspecific PK/PD parameters.
Aims: To re-evaluate intrauterine contraceptive use in Port Harcourt, Southern Nigeria and determine the uptake rate, effectiveness, side effects and discontinuation rate of IUCD. Study Design: Descriptive retrospective analysis. Place and Duration of Study: Family planning clinic, University of Port Harcourt Teaching Hospital, Port Harcourt, Nigeria, between 1st January 2007 to 31st December, 2011. Methodology: The case files of all the clients who accepted intrauterine contraceptive device at the UPTH within the study period were retrieved from the record section of the family planning clinic and studied. Data on the client’s socio-demographic characteristics, complications and reasons for contraception and discontinuation were extracted, entered into SPSS for windows 11.0 version and analysed. Results: Of the 1, 434 new acceptors of contraception during this period, 366 accepted intra uterine contraceptive device giving an uptake rate of 25.5%. The mean age of the clients was 33.32±4.2 years and all were parous. The common complications were menorrhagia and vaginal discharge in 29 (26. 6%) each, abdominal pain in 28 (25.7%) and secondary amenorrhea in 10(9.2%) clients. One unintended pregnancy occurred giving a pearl pregnancy rate of 0.27 per 100 woman years. Up to 108 clients discontinued IUCD use, giving a discontinuation rate of 29.5%. Conclusion: IUCD is a highly effective and safe contraceptive method with a prevalence rate of 25.5% and discontinuation rate of 29.5% in Port Harcourt, southern Nigeria.
Aims: To evaluate relationship between patient age, location and their preference toward partnership in clinical decision making Place and Duration: A university-based clinic, Tabriz University of medical sciences, Tabriz, Iran from March to September Methods: In a cross-sectional study, 200 patients were randomly selected for the study. Patients’ demographic indicators and attitude toward partnership with their doctor was assessed by the use of an author-developed questionnaire containing 12 questions. Validity of this questionnaire was previously confirmed. The data was finally collected and analyzed. Results: Fifty three percent (53%) of patients were male and 47% was female. Mean age was 33.88 (SD=11.35). Of the 200 patients, 66% had tendency toward shared decision making (SDM). There was a positive correlation between higher level of education and SDM in Iranian patients. Conclusion: We found a trend toward shared decision making among patients. We conclude that raising literacy could change the culture of patient-physician relationship within the country.
Aims: To determine the effect of oral administration of methanolic seed extract of Mucuna pruriens (M. pruriens) on oestrous cycle, ovulation, reproductive hormones and oxidative stress in the ovary of cyclic Sprague-Dawley rats. Design: Prospective animal study related to M. pruriens in reproductive area. Place and Duration: Animal Facility of the Department of Anatomy, Faculty of Basic Medical Sciences, College of Medicine of the University of Lagos, Nigeria between the months of June 2012 and August, 2012. Methodology: Forty female Sprague-Dawley rats with regular 4 days cycle averagely weighing 145 g were used. Methanolic extract of M. pruriens was given orally at 50, 100 and 200 mg/kg body weight. Oestrous cycle was monitored daily. At the end of the experiment animals were sacrificed by cervical dislocation. Oocytes were counted, blood and ovaries were assayed for hormonal and biochemical studies respectively. Results: Oestrous cycle remained unchanged in the treatment groups. Catalase and superoxide dismutase levels were increased slightly compared to control. A dose dependent increase in FSH and LH (p < 0.05 at 200 mg/kg) levels were observed with an increase in the number of oocytes released at ovulation compared to control. Conclusion: M. pruriens seed extract has the potential to enhance fertility by increasing serum levels of FSH and LH which in turn increases the number of oocytes released at ovulation possibly through its antioxidant properties.
Aims: To examine the effect of single endometrial curettage (EC), performed during the menstrual period in primary clinical care setting, on pregnancy rate (PR) in women with unexplained infertility and subgroup analysis based on age and primary and secondary infertility. Study Design: Randomized controlled clinical study. Place and Duration of Study: Private practice setting, Baghdad, between February 2009 and January 2012. Methodology: A total of 197 couples aged 20-40 years with unexplained infertility were randomly allocated into two groups: group A comprised 110 women who underwent EC during the menstrual period; and group B included 87 women, who represent the control group, with no EC done. Both groups received no further fertility treatment. The main outcome measured was cumulative clinical (PR) during 6 months after the endometrial curettage. Results: PR was higher in control group compared to EC group (48.3% vs. 45.5%), and in secondary infertility in women aged 31-40 years (75% vs. 58.8%), and in primary infertility in women aged 20-30 years (35% vs. 5.4%) and 31-40 years (25% vs. 5.5%). Conclusion: EC may improve PR in couples with primary unexplained infertility independent of the age group, and in secondary infertility age group 31-40 years. Adequately powered studies are suggested to confirm or refute the findings.
Background: Morbidity and mortality resulting from malaria remains a serious obstacle for social and economic development. Accurate diagnosis and prompt treatment are therefore essential components of case management strategy. The aim of this study therefore was to examine the diagnostic procedure of uncomplicated malaria, and patients’ understanding and satisfaction of treatment in Community Health Care Facilities, three years after the deployment of Malaria Rapid Diagnostic Tests in Ghana. Methodology: A prospective and data collation was done randomly, by means of cluster and stratified multistage surveyat three government hospitals and three private pharmacies in Kumasi, Ghana, between July and September, 2013. Patients treated for uncomplicated malaria, while leaving the health facility, upon consent, were selected and requested to answer questionnaires which served as a source of data to address the objective of the study. Bivariate statistics from the SPSS v 19 was employed to predict the relationships between health institutions and mode of diagnosis, patients’ understanding and satisfaction of services. Results: Fifty-three (53) out of 65 patients responded. The study indicated presumptive diagnosis [44 (83.0%)] to be predominantly used over test-based diagnosis [9 (17.0%)]. The mean age of patients was 34.44±14.8 years (Range 17-66). Out of 52 patients who provided information on educational level, those with tertiary education were 24 (46.2%), secondary were 9 (17.3%), primary were 14 (26.9%) and no formal education were 14 (26.9%). Male patients were 25 (47.2%) and female 28 (52.8%). All 53 patients were given Artemisinin-based Combination Therapy at the various health facilities. Of 35 patients at hospitals/clinics, 15 (42.9%) rated “very good value” to explain their understanding and satisfaction of services provided, and of 18 patients from private pharmacies, 10 (55.6%) rated as “very good value”. Patients with tertiary education [14/25 (56.0%)] showed better understanding and satisfaction of services than those with no formal education [1/25 (4.0%)]. Not a single use of Malaria Rapid Diagnostic Tests for diagnosis was recorded. Conclusion: Diagnosis of malaria at the periphery of health systems is still mainly presumptive three years after deployment of the Malaria Rapid Diagnostic Test. Patients’ good rating on the diagnosis of uncomplicated malaria at private pharmacies, should be an advantage to introducing the Malaria Rapid Diagnostic Tests by healthcare practitioners.
Aims: In our study we highlight the importance of noninvasive imaging, stressing the role of CTA over echocardiography in the diagnosis of congenital aortic arch anomalies. Study Design: Prospective design. Place and Duration of Study: Radiology and pediatric department, in Cairo University children’s hospital, over the period of 15 months from February 2011 to April 2012. Methodology: Forty five patients (23 males and 22 females) were examined in this study; they were referred to the pediatric cardiology outpatient clinic in Cairo university children’s hospital, by history or clinical examination suspicious of aortic arch anomalies. For each patient full history and clinical examination were obtained including: age, sex, residence, consanguinity, cardiac manifestations weak or absent femoral pulsations, abnormal gradient in blood pressure between upper and lower limbs (>20 mmhg). Echocardiography was done and if aortic arch anomalies were diagnosed; the patient referred to do CT angiography of the heart after taking clear consent from the patient’s parents. Results: Our study included 45 patients, their age range (5 days -11 years), they were 23 males and 22 females, with the following diagnosis: 15 had hypoplastic aortic arch by echocardiography, 6 of them proved to have multiple levels of narrowing by CT angiography, 11patients had aortic coarctation by echocardiography, 3 of them were proved to have more than one segmental narrowing by CT angiography and one patient had hypoplasia of the whole aorta. Six patients had tetralogy of Fallot with right sided aortic arch, mirror imaging branches or aberrant left subclavian artery and hypoplastic pulmonary trunk. Four patients had interrupted aortic arch. One patient had aneurysmal dilatation of ascending aorta and aortic arch. One patient had aortopulmonary window. Six patients had persistent truncus arteriosus.
Aims: To evaluate single-year-of-age specificity in deaths in England and Wales associated with a large, unexpected and unexplained increase in 2012. To demonstrate that this type of event has occurred previously across the entire UK. To demonstrate that infectious-like spread at a regional level in England may be involved. Study Design: Longitudinal study of annual (calendar year) deaths (all-cause mortality) in the United Kingdom and England and Wales using publically available statistics available from the Office for National Statistics (ONS). Place and Duration of Study: United Kingdom, England & Wales, local authorities within England & Wales covering a variety of time spans designed to illustrate various key points. Methodology: Deaths between 1974 and 2012 in the United Kingdom. Live population and deaths for residents of England and Wales and of English local authorities. Calculation of single-year-of-age death rates in 2011 and 2012 which are the years before and after the large and unexpected increase in deaths. Results: A recurring series of infectious-like events can be demonstrated which prior to 2000 had been largely assumed to be due to influenza epidemics. The event in 2012 shows specificity for the elderly particularly above age 75, which is somewhat expected given increased susceptibility to the environment as we age. The single year of age mortality rate shows saw tooth behavior for deaths in 2011 and even more exaggerated saw tooth behavior is seen in the difference between 2011 and 2012. Similar saw tooth behavior is seen in the difference between single-year-of-age standardized admissions via the emergency department in England between 2008 and 2012. The infectious spread across England behind this phenomenon is illustrated at regional level and probably results in a 40% underestimation of the saw tooth behavior. Conclusion: The saw tooth behavior is known to be associated with what is called ‘original antigenic sin’. Hence the saw tooth behavior appears to indicate that the unexpected high elderly mortality in 2012 was due to an outbreak of an infectious agent which has multiple strains. This behavior confirms the results of other studies investigating simultaneous increase in medical admissions to hospital during the time that the deaths increase. The ubiquitous herpes virus, cytomegalovirus may be involved, although at the moment this virus provides a prototype for the sort of immune modulating agent that may be responsible. The use of five year age bands to age standardize mortality and medical admission rates may be subject to misleading outcomes where the periodicity behind these outbreaks and their cumulative effect on immune mediated responses is out of synchrony with the basic saw tooth behavior seen in both mortality and admission rates. This has major implication to the calculation of hospital standardized mortality rates (HSMR).
Aims: The diameter of the posterior atrium of the lateral cerebral ventricles (PALV) does not vary substantially in size during foetal development and has thus become a stable marker for the identification of foetal ventriculomegaly in developed countries. Currently, the accepted upper limit of PADLV is 10 mm. Ventricular atrial diameters greater than 10mm require more radiological evaluation to rule out ventriculomegaly. The aim of this study was to establish the normal range of values for the posterior atrium [PA] of foetal lateral ventricles in our environment and to determine a cut-off value for prenatal diagnosis of ventriculomegaly. Methods: The mean of two measurements was obtained from the transverse diameter of the atrium of the lateral ventricles of foetuses that met the inclusion criteria, as part of the routine obstetric ultrasound scan at the antenatal clinic or ultrasound suite of radiology department of the University College Hospital (UCH), Ibadan. The SPSS version 15 was used to analyse the data obtained. Results: The mean posterior atrial diameter [PAD] of the lateral ventricl was 6.5mm with standard deviation (SD) 1.3mm and mean ±2SD 3.9–9.1mm. Male foetuses had larger atrial diameters than female. Student’s t-test and Pearson’s correlation coefficient were used to explore association. Conclusion: With the existing resources in our environment, prenatal screening for ventriculomegaly during routine obstetric scan is achievable. Measurement of 10mm is a reasonable upper limit of normal in our environment. Foetuses with larger values need further evaluation to rule out hydrocephalus.
The emergence of Mineral Trioxide Aggregate (MTA) as endodontic repair filling material has generated a lot of interest due to its superior sealing ability and biocompatibility. Although MTA possesses superior sealing ability to traditional endodontic repair filling materials, such as calcium hydroxide, but it has poor handling characteristics. A novel endodontic repair filling materials with similar chemical composition, but improved handling characteristics, was recently developed. Recently, BioAggregate repair filling materials is claimed as biocompatible material and promotes cementogenesis and forms a hermetic seal inside the root canal. More recently, Biodentine and EndoSequence endodontic repair materials introduced to the market. Both materials have recommended for perforation repair, apical surgery, apical plug, and pulp capping. This article focused about physical properties of endodontic repair filling materials.