Open Access Case Study

Fatal Necrotising Soft Tissue Infection Following Human Bite; a Case Report and Review of Literature

Bashir Mohammad Ibrahim, Sani Ali Aji

Journal of Advances in Medicine and Medical Research, Page 3828-3833
DOI: 10.9734/BJMMR/2014/9813

Human bite injuries are one of the commonest bite injuries seen in the emergency room in a developing country. This bite injury can occasionally lead to devastating complications but yet, one of the most neglected injuries by both the victims and inexperienced attending Clinician. We present a case of fatal and extensive necrotising fasciitis by Eschcerecia coli following human bite by a schizophrenic patient.

Open Access Original Research Article

Improving Crowding in Dyslexic Children by Visual Training: Conflicting Results from a Single-masked Crossover Pilot Study

Carlo Aleci, Riccardo Cafasso, Lorenzo Canavese

Journal of Advances in Medicine and Medical Research, Page 3720-3733
DOI: 10.9734/BJMMR/2014/9835

Aims: To evaluate the effectiveness of visual training aimed at reducing crowding in dyslexic children.
Study Design: Single-masked crossover pilot study.
Place and Duration of Study: University of Turin and the Gradenigo Hospital, Department of Ophthalmology, Turin, between January and November 2013.
Methodology: 15 dyslexic children underwent a visual training devised to reduce crowding. Patients were asked to recognize trigrams of letters with different spacing displayed at different eccentricities on both sides of the fixation point. As a placebo half of the sample was administered a contrast sensitivity test. Average reading rate for words and non-words with different interletter spacing was measured before and after the visual training and the placebo. The sample was divided into two subgroup: G1, who was first administered the training, and G2, who underwent first the placebo trial.
Results: After the training in G1 reading rate for words increased from 1.54 syl/sec (±0.60) to 1.74 syl/sec (± 0.64) (P= .001). Reading rate for non-words improved from 0.94 (0.68-1.55) syl/sec to 1.03 (0.85-1.63) syl/sec. No significant improvement was found after the administration of the placebo (T2) when testing words and non-words. Analysis of variance showed a significant placebo x treatment effect for words (P= .001) and a barely significant effect for non-words (P= .05). In G2 no significant improvement was found after the placebo both at words and non-words (from 1.69 syl/sec [±0.83] to 2.01 syl/sec [±0.94] for words, from 1.07 syl/sec [±0.51] to 1.08 syl/sec [±0.50] for non-words). In this group the training increased the reading rate for words and non-words (from 2.01 syl/sec to 2.12 syl/sec [±1.13]; non-words: from 1.08 syl/sec to 1.22 syl/sec [±0.59]). However, analysis of variance did not show a significant effect of the treatment (words: P= .70; non-words: P= .85).
Conclusion: Factors other than visuoperceptive, in particular the phonological impairment, could help to account for the controversial results obtained in the small group of dyslexic children recruited in this study. In future investigations, performed on a larger sample, a classification aimed at ruling out patients mainly affected by phonological defects should be considered, in order to select the appropriate target suitable for such kind of approach.

Open Access Original Research Article

Cefepime-resistance in Clinical Isolates of Pseudomonas aeruginosa and Klebsiella spp in Ogbomoso

E. K. Oladipo, A. A. Ayandele, J. A. Amao, A. Lateef

Journal of Advances in Medicine and Medical Research, Page 3734-3742
DOI: 10.9734/BJMMR/2014/7452

Aims: Our goal was to identify resistance rate of Cefepime-resistant Pseudomonas aeruginosa and Klebsiella spp infections in the hospital setting within Ogbomoso.
Study Design: The study includes clinical isolates of Klebsiella spp and Pseudomonas aeruginosa obtained by screening samples of blood (for blood culture), urine, aspirate, wound, throat, sputum etc.
Place and Duration of Study: Clinical isolates were obtained from Medical Microbiology and Parasitology Laboratory of the Ladoke Akintola University of Technology Teaching Hospital, Ogbomoso, between March and August 2013.
Methodology: Sixty-six clinical isolates of Pseudomonas aeruginosa and Klebsiella spp obtained from different clinical sites were analyzed using standard bacteriological methods. The sensitivity of clinical isolates of Pseudomonas aeruginosa and Klebsiella spp to Cefepime (30µg) was determined using disk diffusion method. The isolates were divided into three groups sensitive, intermediate and resistance.
Results: The results shows that Pseudomonas aeruginosa had 34.38% sensitivity, 6.25% intermediate and 59.37% resistance while Klebsiella spp had 41.18% sensitivity, 5.88% intermediate and 52.94% resistance. Overall susceptibility pattern of the clinical isolates to Cefepime is 37.87% sensitivity, 6.06% intermediate and 56.06% resistance.
Conclusion: There was a great Cefepime–resistance among the clinical isolates analyzed. The resistance pattern of Pseudomonas aeruginosa and Klebsiella spp calls for continuous surveillance for Cefepime resistance control.

Open Access Original Research Article

Cataract Surgical Services in Kwara State, Nigeria

F. G. Adepoju, Daksha Patel, A. A. Ayanniyi, B. J. Adekoya, C. O. Omolase, K. F. Monsudi

Journal of Advances in Medicine and Medical Research, Page 3743-3754
DOI: 10.9734/BJMMR/2014/9228

Introduction: Service provision for tackling cataract blindness is a key priority and remains a challenge for eye care programs in Nigeria. At the moment, paucity of data on these services makes evaluation and effective planning difficult.
Objective: To evaluate the infrastructure, equipment, and human resources for cataract surgical services, and determine the cataract surgical output in Kwara State, Nigeria.
Materials and Method: A descriptive cross-sectional study of all cataract service institutions in Kwara state was conducted in May-July 2008 using pre-tested questionnaire and on-site review. Output data for 2003-2007 was collected and channels of yearly reporting of cataract surgical output for 2008-2009 established. Descriptive and analytical statistics were performed. For all comparisons, statistical significance was indicated by p<0.05.
Results: There were 14 cataract surgical centres (9 Base Hospitals and 5 Surgical Outreach Centres); all the Base Hospitals were located in the urban centres with over two third cited in Ilorin, the state capital. The state had adequate equipment and infrastructures; however they are mal-distributed in favour of urban areas.
A total of 157 eye care workers comprising 12(7.6%) ophthalmologists (consultants=8, Diplomates=4), 16(10.2%) trainee ophthalmologists, 94(59.9%) mid-level ophthalmic personnel and 35(22.3%) support staff serve the state’s 2.37million people. Eighty per cent of the eye care workers reside in the state capital where less than 30% of the population lives. Cataract surgical output increased from 218 in 2,003 to 1020 in 2009.
Conclusion: There is adequacy of infrastructure, equipment and human resources with improving cataract surgical output. To attain vision 2020 target, mal-distribution of infrastructures, equipment and human resources and poor staff mix need to be addressed. There is urgent need for establishing state- and nation-wide systems for reporting cataract surgical output.

Open Access Original Research Article

Integrated Quiz Competition: A Innovative Method of Teaching and Learning in Undergraduate First Year Medical Course at RAKMHSU, UAE

B. K. Manjunatha Goud, Gulam Saidunnisa Begum

Journal of Advances in Medicine and Medical Research, Page 3755-3766
DOI: 10.9734/BJMMR/2014/9480

Objectives: The main objective of this innovative active learning approach was to increase student’s interest in basic science subjects and to enhance student participation in acquiring the knowledge in the core and applied aspects of anatomy, physiology and biochemistry.
Study Design: Comparative cross sectional study.
Place and Duration of Study: Ras Al Khaimah medical and health Sciences University, 6months
Methodology: It was a comparative cross sectional study to find out whether Quiz competitions are effective teaching learning methodologies. There were 96 students in the class and students were asked to make their groups for the competition. Level of the questions asked in the integrated quiz varied from simple recall, comprehension, to application type from all three specialties.
Results: A total ninety six students were involved in the study and results of the study showed a statistically significant improvement in the performance of students who have participated in the competition.
The study also compared the performance of students who participated in the competition with non-quiz participants and we found that there was a statistically significant improvement in the performance of students who participated in the quiz competition with non-quiz participants P<0.001 both in theory (RRE) as well as in MCQ s section.
Conclusion: The results in this study suggest that the integrated quizzes stimulate self and collaborative learning. They enhance the cognitive level of medical students and also help them to retain academic content.

Open Access Original Research Article

Characteristics of Open-globe Eye Injuries with Respect to Zone of Injury

Yufei Tu, Nishant G. Soni, Alain M. Bauza, Marco A. Zarbin, Neelakshi Bhagat

Journal of Advances in Medicine and Medical Research, Page 3767-3776
DOI: 10.9734/BJMMR/2014/7332

Aims: To describe the demographics, characteristics and outcomes of open-globe injuries (OGI) with respect to zone of injury.
Methods: Medical records of all patients presenting with OGIs to University Hospital, Newark, NJ between January 2001 and December 2008 with a follow-up of at least 3 months were reviewed. Demographics, characteristics of the trauma and outcomes were compared with respect to the zone of injury; location of injury is confined to the cornea and limbus in zone 1 (Z1), <5 mm posterior to the limbus in zone 2 (Z2)and >5mm posterior to the limbus in zone 3 (Z3).
Results: Of the 309 patients (310 eyes) identified, 228 (74%) were male. The mean ageat presentation was 35.3years (1-96). Mean follow-up was 22.8 months (3-108 months). Most of the eyes presented with Z1 injury: 141 eyes (46%) Z1 injury, 83 (27%) Z2 and 86 (28%) Z3. Rupture was the most common type of injury in Z2 and Z3 injuries. Nineteen (86%) of 22 eyes with an intraocular foreign body (IOFB) had a Z1 injury. 32 (42%) of 77 eyes with Z3 injury had no light perception (NLP) at presentation, compared with 9 (8%) of 119 Z1 and 13 (17%) of 78 Z2-injured eyes. Four percent of Z1, 11% of Z2 and 18% of Z3-injured eyes had a final vision (VA) of NLP. Primary enucleation was undertaken in 10 eyes (9 were Z2 injured eyes). Secondary enucleation was performed in 12 (9%) of 141 Z1, 7 of 82 (9%) of Z2 and 22 (26%) of 78 Z3 eyes. Thirty (36%) of 86 Z3 injuries resulted in primary or secondary enucleation. The final Snellen VA was 1.05, 1.41, and 2.19 respectively in Z1, Z2 and Z3-injured eyes. Posterior segment surgery was performed in 30% Z1, 39% Z2 and 49% Z3-injured eyes. Retinal detachment (RD) was diagnosed in 11% Z1, 27% Z2 and 40% Z3 injuries.
Conclusion: Z1 injury may be associated with a better visual prognosis than Z2 andZ3injuries. The visual prognosis of Z3 injured eyes is poor with one-third of these eyes being enucleated.

Open Access Original Research Article

Perception of Smile Attractiveness by Laypeople–influence of Profession and Treatment Experience

Serene A. Badran, Mariam Mustafa

Journal of Advances in Medicine and Medical Research, Page 3777-3786
DOI: 10.9734/BJMMR/2014/5545

Aims: To assess the influence of profession, treatment experience, age and gender on the perception of smile aesthetics with different buccal corridors and smile arcs, and to identify the threshold where buccal corridor space becomes aesthetically displeasing.
Study Design: A questionnaire-based descriptive study on the assessment of attractiveness ratings by laypeople.
Place and Duration of Study: Amman/Jordan, University of Jordan Hospital; Faculty of Dentistry, Division of Orthodontics, from 2010-2011.
Methodology: A coloured photograph of a female smile was digitally modified to produce six smile images with buccal corridor spaces (BCSs) ranging from 0% to 25% and three smile images with altered smile arcs (consonant, flat and reverse). These images were shown to 104 laypeople who were asked to rate the attractiveness of each smile on a scale of one to ten. Analysis of variance was used to study the effect of age, gender, profession and treatment experience on smile attractiveness rating. A one-way ANOVA post hoc Duncan test was used to establish the threshold where BCS was considered unattractive.
Results: The most attractive smile was the broadest and consonant smile (7.42 +/- 1.87). The image with a reverse smile arc was rated as the least attractive (2.65 +/- 1.85). Duncan’s test revealed that the threshold at which BCS was considered significantly unattractive was when it reached 25%. Analysis of variance showed that young adults perceived the broadest smile as significantly more attractive than older adults (P = .03). Profession had a significant influence on smile attractiveness ratings while gender and treatment experience did not.
Conclusion: Flattening the smile arc was found to have more of an unattractive bearing than small variations in BCS. Thus, it is advisable to take into consideration the smile arc during any treatment that involves the anterior maxillary area, especially prosthodontic and restorative treatments, orthognathic surgery and orthodontics.

Open Access Original Research Article

Humoral Response against Native Plasmodium berghei Hemozoin and Synthetic Hemozoin in BALB/c Mice

Lilian M. Spencer, Anaely Agola, Eduardo Roa, Neira Gamboa de Dominguez, Jaime Charris, Andreina Gómez

Journal of Advances in Medicine and Medical Research, Page 3787-3799
DOI: 10.9734/BJMMR/2014/5561

Aims: Malaria is a disease caused by protozoan parasites of the genus Plasmodium. One of the malaria mechanisms of adaptation to the host is the digestion of hemoglobin by the trophozoite stage. This mechanism provides the amino acids needed by the parasite and is carried out during the erythrocytics schozogony phase, which results in the formation of in soluble pigment crystals named hemozoin (Hz). Hz is responsible for many of the immune pathological complications of malaria, given that this pigment accumulates in various organs in severe cases of the disease.
Here, we evaluated the humoral response in BALB/c mice against native Plasmodium berghei Hz (PbHz) and synthetic Hz (SHz).
Place and Duration of Study: Laboratory of Immunology of Infection Diseases. Department of Cell Biology, Simón Bolívar University, Caracas, Venezuela. This study was performed between January 2012 and June 2012.
Methodology: We determined the humoral response of SHz and PbHz by an enzyme linked immunosorbent assay (ELISA), using hyper-immune sera from mice experimentally infected with P. berghei or Plasmodium yoelii. In addition, SHz was evaluated as antigen by Western Blot and dot-ELISA.
Results: When SHz was employed as antigen, we showed by indirect ELISA that the sera from mice immunized with SHz generated higher titers than sera obtained from mice infected with either Plasmodium species. Moreover, the sera from human infections also recognized SHz as antigen, but showed a better recognition by dot- ELISA or Western Blot than by indirect ELISA.
Conclusion: In summary, our results indicated that SHz can be used as a rapid and successful diagnostic antigen for natural malaria infections by indirect ELISA, dot-ELISA and Western Blot techniques.

Open Access Original Research Article

Emergency and Inpatient Treatment of Migraine: An American Headache Society Survey

Carrie O. Dougherty, Michael J. Marmura, Zuhal Ergonul, Larry Charleston I. V., Christina L. Szperka

Journal of Advances in Medicine and Medical Research, Page 3800-3813
DOI: 10.9734/BJMMR/2014/9111

Objective: To determine the medication and management preferences of headache specialists in treating migraine in the ED and during inpatient hospitalization.
Background: Despite the frequency of migraine as a presenting complaint and the cost of acute treatment, there is no clear consensus on the standard of care for acute migraine management in the ED or during hospitalization.
Methods: The American Headache Society (AHS) Special Interest Group for Inpatient and Emergency Care developed an online survey that was distributed to AHS members.
Results: There were 106 survey respondents, 87 of whom completed all 13 questions. The most frequent choices for first-line ED migraine treatment in an otherwise healthy adult were dopamine antagonists (58.7%), non-steroidal anti-inflammatory drugs (NSAID) (49.0%), and IV hydration (48.1%). The most frequently selected second-line treatments were valproic acid, dihydroergotamine (DHE), and NSAIDs. Opioids were chosen by 1% for first line and 4.8% for second line. No respondents selected barbiturate containing medications for either treatment. The most frequently selected medications for initial treatment during inpatient hospitalization for migraine were DHE (64.5%), dopamine antagonists (61.3), and NSAID (37.6%). The most frequent adjunctive treatments were valproic acid and corticosteroids. Vomiting, medication overuse with opioids or barbiturates, and ED recidivism were the most frequently selected indications for inpatient treatment. The majority of respondents (71%) indicated they would taper or stop opioid medication as a part of migraine treatment in patients admitted for intractable migraine who were taking opioids for an unrelated indication such as low back pain. Commonly selected ancillary services included psychology (80.6%), physical therapy (64.5%), nutrition (50.5%), and psychiatry (46.2%). The majority of respondents (79.3%) indicated that outpatient follow-up should occur within 4 weeks of discharge from the hospital.
Conclusions: Headache specialists indicated neuroleptics, NSAID and migraine-specific agents should be considered before opioids or barbiturates for both adults and children with migraine. There was consensus that worsening or refractory migraine treatment should not include the escalation of chronic opioids. Opinion suggested that opioid or barbiturate overuse is more likely to warrant inpatient treatment than triptan or NSAID overuse. Multidisciplinary care and close follow-up are important components of inpatient migraine treatment.

Open Access Original Research Article

Socio-demographic and Environmental Factors Influencing asymptomatic Malaria and Anaemia Incidence among School Children in Fako Division, South West Cameroon

Judith Lum Ndamukong-Nyanga, Helen K. Kimbi, Irene Ule Ngole Sumbele, Lum Emmaculate, Malaika Nain Nweboh, Yanick Nana, J. N. Kenneth Ndamukong

Journal of Advances in Medicine and Medical Research, Page 3814-3827
DOI: 10.9734/BJMMR/2014/9712

Aim: This work was aimed to assess the influence of socio-demographic and environmental factors on the incidence of asymptomatic malaria and anaemia among pupils in Fako Division, southwest Cameroon.
Experimental Design: The study was a cross-sectional survey.
Place and Duration of Study: The study was carried out in Fako Division, southwest Cameroon -Bolifamba, Dibanda and Mutengene from February to March, 2013.
Methodology: A total of 316 pupils aged 4–15 years were studied. Data on socio-demographic and environmental factors was obtained from a semi-structured questionnaire. Blood samples were collected. Malaria parasite incidence and density were determined from Giemsa-stained thin and thick blood smears respectively. Haemoglobin (Hb) levels were determined using a haemoglobinometer.
Results: The overall incidence of asymptomatic malaria was 43.4% (CI=38-48.9). Malaria incidence was significantly highest (χ2=7,P=0.03) in pupils of 6-10 years age group (49.0%, CI=42.1-59.9) when compared with their counterparts. Although not significant, malaria parasite incidence was higher in males, pupils with fever, highest in pupils of Bolifamba and poor social status than their respective counterparts. Geometric mean parasite density (GMPD) was significantly highest (Kruskal Wallis test, *χ2=6.4, P=0.04) in Dibandathan other sites. Anaemia incidence was higher among inhabitants of Dibanda (56.7%) than other sites. Anaemia incidence was statistically higher (χ2=5.6, P=0.02) in malaria positive pupils, highest in Dibanda (χ2=27.244, P<0.001) and the middle class when compared with their respective counterparts. Mean HB was significantly higher in malaria negative (t=1-8, P=0.02), highest in the poor class (χ2=13.4, P=0.001) and Mutengene (F=21.2, P=0.0001) when compared with their respective counterparts.
Conclusion: Sensitization on effective malaria control strategies needs to be emphasized so that a reduction in malaria burden can be achieved.