Open Access Original Research Article

Factors Correlating with Severity of Coronary Artery Disease in Type 2 Diabetic Patients on Treatment for More Than 5 Years

Mukund P. Srinivasan, Padmanabh K. Kamath, Narasimha D. Pai, Poornima A. Manjrekar, Chakrapani Mahabala

Journal of Advances in Medicine and Medical Research, Page 4364-4372
DOI: 10.9734/BJMMR/2014/11169

Aims: To evaluate the correlation between insulin resistance and other conventional risk factors with respect to severity of coronary artery disease (CAD) in patients with more than 5 years of treatment for type 2 diabetes mellitus.
Study Design: Cross-sectional study.
Place and Duration of Study: Department of Medicine and Department of Cardiology, Kasturba Medical College, Hospital Mangalore, between February 2013 and December 2013.
Methodology: 61 people with more than 5 years of type 2 diabetes who underwent coronary angiogram for the evaluation of CAD were recruited in this study. Insulin resistance (HOMA-IR), anthropometric and biochemical parameters were determined, and was correlated with severity of CAD which was assessed by syntax score.
Results: There was significant positive linear correlation between log HOMA-IR and syntax score in people with more than 5 years of type 2 diabetes [r=0.605 (95%CI 0.417–0.744), P<0.001]. The correlation of syntax score with other known risk factors of CAD was not significant. Further multivariate analysis after adjusting for conventional risk factors showed a significant association of Log-IR with severity of CAD in people with type 2 diabetes mellitus of more than 5 years of duration (β=0.667, P<0.001)
Conclusion: In type 2 diabetes mellitus with treatment more than 5 years of duration, high HOMA-IR appears to be a good indicator of severity of CAD in Type 2 diabetes mellitus and might be a marker of severity of disease, thus helping us in identifying high risk type 2 diabetes mellitus subjects.

Open Access Original Research Article

Assessment of a long-acting Reversible Contraceptive Insertion Training Program OMIT: A Questionnaire Survey

Gabor T. Kovacs, Stephen Trumble

Journal of Advances in Medicine and Medical Research, Page 4373-4381
DOI: 10.9734/BJMMR/2014/10988

Introduction: Before launching an etonogestrel subcutaneous implant on the Australian market, a training programme for health care providers (HCPs) was designed, and endorsed by both the Royal Australian New Zealand College of Obstetricians and Gynaecologists and Family Planning Australia.
Methodology: 10,000 HCPs were trained between 2001 and 2003, and these were sent a questionnaire in November 2010. Within the first decade after its launch 633,000 implants were inserted.
Results: Twenty-five percent of the questionnaires were returned and collated. Eighty-four percent of respondents were inserting subcutaneous implants, nearly 4% more than ten a month. One hundred and thirteen were not confident in the insertion technique- the “training failures”, yet most of these said that the training gave them the “skills to insert” and “confidence to insert”. As a group these HCPs were older, and there seemed to be a significant interval between undertaking training and starting to insert implants.
Conclusions: To minimise “training failures” MSD now offers representatives to attend at surgeries with a placebo arm and implants to enable a “refresher” training if the HCP requests.
Funding: The cost of printing and posting of the questionnaires, as well as collating the responses were funded by MSD.

Open Access Original Research Article

Antioxidant Potential of Quercetin: Remarkable Protection Against Hypercholesterolemia in Rats

Hussam H. Baghdadi

Journal of Advances in Medicine and Medical Research, Page 4382-4391
DOI: 10.9734/BJMMR/2014/11126

Aims: To explore protective role of the antioxidant flavonoid quercetin (QE) towards experimentally-induced atherosclerosis in rats.
Study Design and Methodology: This study was carried out during Feb. 2014. Experimental atherosclerosis in rats was induced through oral intake of the coconut oil enriched diet (15%) and cholesterol (2%) for successive 30 days. QE (15 mg kg−1 day) was injected intraperitoneally (i.p.) for three consecutive days before cholesterol intake for 30 days.
Results: The triglycerides, total cholesterol, LDL-C, HDL-C, VLDL-C and LDL/HDL ratio levels in plasma were estimated in hypercholesterolemic (HC) rats. Glutathione-S-transferase enzyme level in plasma and liver homogenate were unchanged in all rats. Superoxide dismutase, glutathione peroxidase and catalase activities, were measured in rat liver homogenate. Serum and liver lipid peroxides were determined. HC induced significant elevation in lipid profiles and lipid peroxides and decreased antioxidant enzymes activities. Serum and liver TBARS were significantly increased. The antioxidant enzymes were decreased significantly in HC rats. QE treatment significantly decreased lipid profiles and elevated the antioxidant enzymes.
Conclusion: QE intake protect against HC, by reducing lipid peroxides and elevating antioxidant enzymes levels. Data revealed that, QE could protect against atherosclerosis by decreasing the oxidative stress state.

Open Access Original Research Article

Leukocyte, Haemostatic and Inflammatory Biomarkers Are Activated in Patients with Cardiovascular Disease (CVD): A Pilot Study

K. L. Dudley, J. P. Smith, S. J. Rides, D. T. Vallance, A. K. Banerjee, S. F. Hughes

Journal of Advances in Medicine and Medical Research, Page 4392-4406
DOI: 10.9734/BJMMR/2014/10424

Background: Cardiovascular disease (CVD) provides a huge economic strain worldwide and is responsible for over 4 million deaths in Europe annually. Atherosclerosis, a key component of CVD, is recognised as an inflammatory process. This clinical pilot-study aimed to compare a range of selective leukocyte, haemostatic and inflammatory biomarkers in patients with CVD to healthy volunteers.
Patients and Methods: Fifty participants were recruited, 21 patients with CVD (due to atherosclerosis) and 29 healthy volunteers (with no history of CVD or diabetes). All participants for the study provided a non-fasting venous blood sample prior to analysis (n=50). The biomarkers measured included the Cluster of Differentiation 11b (CD11b) cell surface expression in monocytes and neutrophils, neutrophil elastase, fibrinogen, von Willebrand Factor (vWF), protein C and C-Reactive Protein (CRP).
Results: vWF levels were significantly raised in CVD patients (186.8±106.6 %vWF:Ag) compared to healthy volunteers (109.9±85.2 %vWF:Ag), (p<0.001). CRP was significantly raised (3mg/dL) in CVD patients compared to healthy volunteers (<3mg/dL), (p=0.036), with the CD11b cell surface expression in monocytes being higher (0.64±0.55 MFI) in CVD patients compared to healthy volunteers (0.37±0.44 MFI), (p<0.005). No differences were observed for protein C, fibrinogen, neutrophil elastase or neutrophil CD11b in CVD patients compared to healthy volunteers (p>0.05).
Discussion and Conclusion: Patients with CVD have elevated levels of vWF, CRP and CD11b cell surface expression (monocytes) compared to healthy volunteers. The results of this study support the premise of leukocyte, haemostatic and inflammatory involvement during CVD, and that measuring biomarkers such as vWF and leukocyte CD11b cell surface expression, may aid in the diagnosis and monitoring of patients with CVD. However, further large-scale prospective studies are required to fully understand the relationship between these markers and CVD.

Open Access Original Research Article

The Epidemiological Use of Hospital Data for Suicide Surveillance in Belgium

Christelle Senterre, Alain Levêque, Michèle Dramaix, Magali Pirson

Journal of Advances in Medicine and Medical Research, Page 4407-4430
DOI: 10.9734/BJMMR/2014/11322

Aims: Investigating the E codes related to suicide and self-inflicted injuries through the prevalence, the patient characteristics, the methods and means employed and the characteristics of the hospital stays; and compare them with the others E codes group.
Study Design: Retrospective hospital-based analytical study.
Place and Duration of Study: This study was based on the 2010 data of 13 Belgian hospitals.
Methodology: Based on 16406 cases of patients with a least an E code (ICD-9-CM); Pearson’s chi-squaretests, simple logistic regressions and Wilcoxon rank sum tests were used to assess the variations between distributions of the investigated factors according to the injury’s groups.
Results: Among all the E codes, prevalence of suicide and self-inflicted injury was equal to 10.6%. The poisoning was the major reported diagnosis. There were significantly more discharges without consent in the suicide group than in the others. The length of stay was lowest in the suicide group compared to the others E codes group. The several median costs were always highest among the men, but, regarding the median percentage of the pharmaceutical products, the value was highest among the women.
Conclusion: The epidemiological use of hospital data is complementary to the use of both the population-based data and the death certificates; each data source participating to a better comprehension and a better surveillance of the complex continuum of suicidality.

Open Access Original Research Article

Surrogates of Poor Prognostic Signs in Adult Patients with Homozygous Sickle Cell Disease: An Echocardiographic Study

Taysir Garadah, Adla B. Hassan, Mohamed Al Alawi, Ahmed Jaradat, Reginald Sequeira, Fathia Qureshi

Journal of Advances in Medicine and Medical Research, Page 4431-4443
DOI: 10.9734/BJMMR/2014/10047

Background: Pulmonary Arterial hypertension (PAH) is a late complication in adult patients with homozygous sickle cell Anaemia (SCA). The early identification of PAH may be of paramount importance.
Aim: This study is aimed at evaluating the usefulness of NT pro BNP in the assessment of diastolic function of RV in adult patients with sickle cell disease. It is also aimed at the assessment of the predictive risk of serum level of NT pro BNP hormone and ferritin with other pulsed and tissue Doppler indices for the development of pulmonary hypertension in patients with SCA. In addition, we measured the usefulness of tissue Doppler velocity of lateral annulus of tricuspid valve in the assessment of diastolic function of RV in adult patients with SCD.
Method: In this cross sectional prospective study, 103 patients with homozygous SCD were studied and compared with age and gender matched healthy control. Every patient had a clinical assessment, pulsed and tissue Doppler evaluation. Blood samples were withdrawn for the level of haemoglobin, ferritin and NT pro BNP hormone. The mean difference between the two groups for echo Doppler and biometric variables were assessed. Multiple regression analysis applied for measuring the odds ratio of different biometric and Doppler variables for risk of PAH in SCD.
Results: The study group consist of 103 patients with SCA, mean age of 28.52±14.11 year, (range 14-42), with 68 male (66.0%) Patients with SCA compared with control had a significantly low diastolic pressure, lower haemoglobin level but high serum level ferritin and pro BNP hormone. Further, there was a significant increment in the left atrium area (LA), higher right ventricle (RV) wall thickness and diameter. The RV tricuspid annular systolic excursion (TAPSE) was high of 1.42±0.21 vs. 1.11±0.23, P<0.05. RV Pulsed Doppler data showed restrictive filling pattern with significant higher E wave velocity, higher early diastolic filling wave (E)/ atria wave velocity (A) ratio and short Deceleration Time (DT). Further, the ratio of upper pulmonary vein for systolic/diastolic Doppler velocity was significantly lower 1.5±0.12 vs.2.4±0.11, p<0.05. The tissue Doppler of lateral annulus of tricuspid valve in SCA patients showed a significantly lower S wave of 6.7±1.7 vs 11.3±1.9, p<0.01, higher pulsed early velocity( E)/ early Tissue velocity (E-) ratio and lower atria wave velocity (A). The incidence of pulmonary hypertension in SCD patients via tricuspid valve velocity defined as ≥2.5 m/s was 28%. There were positive correlation between the serum level of ferritin, NT pro BNP hormone and tricuspid valve velocity of (r= 0.38) and (r=0.43) respectively. The odds ratio for development of PAH was 3.1 for E/E- ratio ≥13, 2.5 for DT of <160msec, 2.2 for Left ventricle mass Index (LVMI)>121 gm/M2, 1.9 for ferritin ≥600μg/l, 1.6cm for left atrial area ≥20cm, 1.3 for pro- BNP ≥150Pmol/L.
Conclusion: Adult patients with SCA have normal Systolic function but increase of LV mass and restrictive diastolic dysfunction. RV has increase wall thickness, systolic and diastolic dysfunction of restrictive pattern. The prevalence of pulmonary hypertension in SCA is 28% with positive correlation between ferritin, pro BNP level and tricuspid valve velocity on echo. The risk of PAH in SCA patients is higher if the patient had on echo DT <160msec, LVMI >121gm/M2, cm, E/E- ratio ≥13 or RV wall thickness >3mm.

Open Access Original Research Article

Ondansetron versus Amitriptyline in the Treatment of Peripheral Neuropathy: A Randomized Double Blind Prospective Clinical Study

Anuj Misra, Himal Sangraula, Gajendra Prasad Rauniar, Vikas Seth, Bishnu Hari Paudel, Dilip Thakur, Sanjib Sharma, Prahlad Karki

Journal of Advances in Medicine and Medical Research, Page 4444-4454
DOI: 10.9734/BJMMR/2014/11176

Background and Objective: Clinical trials have shown the potential use of 5-HT3 receptor antagonists like Ondansetron, Tropisetron and Zacopride in a number of disorders of gastrointestinal tract and the central nervous system such as cancer chemotherapy induced vomiting, anxiety, depression, schizophrenia and migraine. Various experimental and clinical studies also point the usefulness of Ondansetron in neuropathic pain. Therefore, the present study was conducted to find out whether Ondansetron could be used as an alternative to a standard drug, Amitriptyline in the treatment of peripheral neuropathy.
Methodology: A randomized double blind prospective clinical study was conducted on thirty six patients of peripheral neuropathy divided into two groups of equal number of patients. Group 1 received Ondansetron 8 mg per day while Group 2 received Amitriptyline 25 mg per day. Patients were being evaluated on the basis of improvements (decrease) in LANSS (Leeds Assessment of Neuropathic Symptoms and Signs), VAS (Visual Analogue Scale) and NCV (Nerve Conduction Velocity) for six weeks. Student’s t-test and/or repeated measure ANOVA followed by Bonferoni correlation was used to compare sets of paired observations. The Friedman test followed by multiple comparisons was used to compare the data which was not normally distributed.
Results: LANSS and VAS scores showed significant improvements in the 1st and 2nd visit in both the groups. NCV showed improvement in Ondansetron group with less number of adverse effects compared to that of Amitriptyline. NCV in Amitriptyline group demonstrated significant increase in one of the parameters, F-waves, indicating a worsening in left tibial nerve (p=0.036), whereas no such change was found in the group treated with Ondansetron.
Conclusion: Ondansetron has beneficial role in peripheral neuropathy by improving its sensory component as it significantly decreased LANSS and VAS scores. Our results also demonstrated that Ondansetron was at least as efficacious as Amitriptyline in the treatment of peripheral neuropathy with lesser adverse effects.

Open Access Original Research Article

Ethnic Differences in Insulin Resistance, Adiponectin Levels and Abdominal Obesity: Haitian Americans and African Americans, with and without Type 2 Diabetes Mellitus

Amanpreet K. Cheema, Gustavo G. Zarini, Joel Exebio, Sahar Ajabshir, Lemia Shaban, Janet Antwi, Joan A. Vaccaro, Fatma G. Huffman

Journal of Advances in Medicine and Medical Research, Page 4455-4469
DOI: 10.9734/BJMMR/2014/10333

Background: Metabolic outcomes of obesity and its associated disorders may not be equivalent across ethnicity and diabetes status.
Aim: In this paper, we examined the association of abdominal obesity, by ethnicity and diabetes status, for indicators of glucose metabolism in Blacks.
Methods: A cross sectional study was conducted in Haitian Americans (n= 186) and African Americans (n= 148) with and without type 2 diabetes mellitus (T2DM). Student’s t-test and Chi-squared test were used to assess differences in mean and proportion values between ethnicities with and without type 2 diabetes mellitus. Relationship between insulin resistance, ethnicity, diabetes status, abdominal obesity, and adiponectin levels were analyzed by analysis of covariance while controlling for confounding variables.
Results: Haitian American participants were older (P = .032), had higher fasting plasma glucose (P = .036), and A1C (P = .016), but had lower levels of Hs-CRP (P < .001), insulin and HOMA2-IR and lower abdominal obesity (P = .030), than African Americans. Haitian Americans had significantly lower HOMA2-IR (P = .008) than African Americans when comparing both ethnicities with T2DM, high abdominal obesity, and adiponectin levels lower than the median (<14.75 ng/mL).
Conclusion: The clinical significance of observed differences in insulin resistance, abdominal obesity, and adiponectin levels between Haitian Americans and African Americans could assist in forming public health policies that are ethnic specific.

Open Access Original Research Article

Experimental Investigation on Rabbits Following Peritoneal Injection of Bacteria Isolated from Human Keratitis

Yousef H. Aldebasi, Salah M. Aly, Mohammad I. Ahmad, Amjad A. Khan

Journal of Advances in Medicine and Medical Research, Page 4470-4481
DOI: 10.9734/BJMMR/2014/10233

Aim: This work was aimed at studying the pathogenicity of bacteria causing infectious keratitis through experimental infection using different groups of rabbits that were inoculated with clinical isolates and assessed through biochemical and histopathological investigations.
Study Design: This study was carried out on Rabbits.
Place and Duration of the Study: this experiment was carried out at Med. Labs. Dept, Qassim Univ., in April 2013.
Methodology: The isolated bacteria, Pseudomonas aeruginosa and Staphylococcus aureus from clinical corneal scraping swabs of patients suffering from infectious keratitis were experimentally inoculated through intraperitoneal injection in different groups of rabbits (2.0-2.5kg) and were subjected to serum biochemical and histopathological examinations.
Results: The experimental rabbits showed alterations in both liver and kidney function parameters that varied with the type of bacteria injected. The level of urea was non-significantly increased to a higher extent in rabbits within 3 and 7 days of infection. There was no marked change in the levels of uric acid and creatinine in all groups of rabbits. Alanine aminotransferase (ALT) and Aspartate aminotransferase (AST) showed variable increased values but seemed also within limits of reference in all the groups of rabbits injected with either S. aureus or P. aeruginosa.
Histopathologically, the internal organs (liver and kidneys) of the experimental rabbits showed inflammatory reactions with degenerative changes and/or necrosis while the cornea revealed oedema and leukocytic infiltration. The microscopic findings were varied in severity according to the type of the bacteria.
Conclusion: Pseudomonas aeruginosa and Staphylococcus aureus experimentally induced infections revealed histopathologic lesions and disturbances in the functions of liver and kidneys of experimental rabbits together with proliferation of corneal epithelium and polymorphonuclear leukocytes infiltration in the corneal stroma. Therefore, strict measures are recommended to control and treat infectious keratitis to avoid visual complications and systemic disturbances among infected patients.

Open Access Review Article

Detection of Basal Cell Carcinoma–a Guide Line for General Practitioners in Dentistry

Rania E. Elsherbiny, Ayesha Umair, S. N. Azzeghaiby, Ibrahim Alzoghaibi, Said Dabour, Bassel Tarakji

Journal of Advances in Medicine and Medical Research, Page 4352-4363
DOI: 10.9734/BJMMR/2014/10143

Basal cell carcinoma or BCC, is a malignant epithelial tumor of the skin, usually seen in the head and neck. Most BCCs are slowly growing and behave in a relatively benign, nonaggressive fashion, but a few of them grow rapidly and infiltrates the structures beneath the skin. Because dentists routinely evaluate the head and neck region, this review will help and guide the oral health care providers to diagnose basal cell carcinoma at an initial stage and provide early treatment by referring them to oral and maxillofacial surgeons, hence reducing the morbidity rate and treatment cost. A literature search using MEDLINE, accessed through the National Library of Medicine Pub Med interface, for articles relating to Basal cell carcinoma etiological factors, clinical features and its diagnosis written in English language were accessed. This study has a specific focuson early detection of BCC which is mostly located in head and neck region. Theskin tumors which are located in other part of the body were excluded from this study. Studies describing cohort, case series and miscellaneous clinical reports were retrieved and evaluated from 1993 to 2013.