Open Access Original Research Article

Cytotoxic Analysis of Various Root Canal Irrigants at Cellular Level

Jayalakshmi Pandranki, V. V. Narsimha Rao, Srinivas Kumar Chandrabhatla

Journal of Advances in Medicine and Medical Research, Page 1052-1062
DOI: 10.9734/BJMMR/2015/15507

Aim: To evaluate and compare the cytotoxic effects of commercially available root canal irrigants sodium hypochlorite, chlorhexidine and a herbal extract, Morinda tinctoria.
Study Design: Concerned to the biological perspective, root canal irrigants must aid in the complete disinfection of the root canal and be biocompatible when come in contact with the vital periapical tissues. Hence the study was done to analyse the cytoxicity of different root canal irrigants at cellular level.
Place and Duration of Study: Department of Pedodontics and Preventive dentistry, GITAM dental college and hospital in collaboration with Chaitanya Medical centre, Visakhapatnam and Department of Oral Pathology, GITAM Dental college.
Methodology: Forty nine samples with 2 ml of RBC suspension were randomly assigned to seven groups. 100 µl each of 3% NaOCl, 2% CHX and 60 mg/ml concentration of Morinda tinctoria and their 1:1dilutions were tested on RBC suspension. Normal saline is selected as control. Peripheral smear was made to assess the morphological abnormalities of viable cells. After centrifugation of each test tube, the supernated volume is estimated for haemoglobin concentration representing cytotoxicity. The results obtained were subjected to statistical analysis.
Results: Cytotoxicity varies in the following order: 2% Chlorhexidine> 1:1dil CHX > 3% NaOCl > 1:1 dil. 3% NaOCl= 60 mg/ml M. tinctoria > 1:1 dil of 60 mg/ml M. tinctoria. Results showed that statistically significant difference exists between cytotoxicity of tested irrigating solutions.
Conclusion: Considering the undesirable effects of the conventional root canal irrigants and the global scenario with changing trends in search of non-toxic plant extracts, Morinda tinctoria could be an alternative root canal irrigant with least toxicity.

Open Access Original Research Article

Relationship of Oral Lesions and CD4 Count in Female HIV Patients in South Western Nigeria

O. M. Eweka, M. Okoh, G. A. Agbelusi, B. D. Saheeb, O. Odukoya, F. O. Omoregie

Journal of Advances in Medicine and Medical Research, Page 1063-1068
DOI: 10.9734/BJMMR/2015/12618

Background: Oral lesions have been reported to be early clinical features of HIV infection.
Objective: The purpose of this study was to establish the prevalence of oral lesions in HIV Seropositive female patients and correlate the CD4 count with the appearance of oral lesions in the female patients attending Lagos University Teaching Hospital (LUTH) and University of Benin Teaching Hospital, Benin (UBTH).
Methods: A prospective study was undertaken in 172 newly diagnosed adult HIV infected female patients (not on antiretroviral therapy), who attended the PEPFAR clinic at LUTH and the HIV Clinic of the University of Benin Teaching Hospital, Benin City, Nigeria. They were assessed for oral lesions which were evaluated using EEC/WHO (2003) – Classification on the diagnostic criteria for oral lesions in HIV. Data were collected using an interviewer administered questionnaire. Following Oral examination undertaken, oral lesions were detected, recorded and treated. CD4+ values were evaluated from blood samples of patient at presentation.
Results: A total of 172 HIV infected female patients were enrolled into the study. The age range of the participants was 18-65 years, (mean age: 36 + 9.2 years). The commonest oral lesion observed was pseudomembranous candidiasis (n=42, 35.9%); followed by melanotic hyperpigmentation (n=14, 12%) and Linear gingival erythema (LGE) was 12 (10.3%) cases. A high prevalence of oral lesions was seen in patients with low CD4+ count (<200 cells/mm3). P value = .001.
Conclusion: Oral lesions are common features of HIV and were seen more in patients with low CD4 count.

Open Access Original Research Article

An Acute Therapeutic Evaluation of Three Regimens of Tiotropium and Formoterol in COPD Patients: A Randomized, Double-blind, Placebo-Controlled Clinical Study

Mohammed Imran, Sunil Kumar Chhabra, Anita Kotwani

Journal of Advances in Medicine and Medical Research, Page 1069-1077
DOI: 10.9734/BJMMR/2015/14053

Aims: To evaluate therapeutic rationality of combining long-acting β2-agonists (formoterol) with duration of action of 12 hours and anticholinergics (tiotropium) with 24 hours as fixed dose inhaled combination (FDC) still widely prescribed in developing countries in COPD patients.
Study Design: A randomized, double-blind, placebo-controlled, parallel design study. The three regimens that were used; tiotropium 18 µg once a day in the morning along with the formoterol matched placebo in the evening, the FDC of tiotropium 18 µg plus formoterol 12 µg once a day in the morning and formoterol matched placebo in the evening and the same FDC of the two drugs once a day in the morning and once a day formoterol 12 µg in the evening in patients of COPD without any co-morbidity.
Place and Duration of Study: Tertiary care pulmonary medicine university teaching government hospital of Delhi, India; 1 year.
Methodology: Sixty COPD patients (Male, Avg. age 56±11 years) divided into 3 groups of 20 each without any comorbidity were admitted in the hospital for 24 hours. The spirometry, perception of dyspnea on Borg's scale and vitals such as blood pressure (BP) and pulse rate (PR) were recorded at the following interval 30 minutes, 2 hours, 12 hours after the morning dose and 30 minutes and 12 hours after the evening dose.
Results: Addition of formoterol in the evening along with the FDC in the morning enhanced the peak effects in percentage predicted FEV1 (82.55+/-12.639), FEV1/FVC (0.592±0.097) that remained till the next dose (24 hours) which was statistically (P=.05) superior to the tiotropium alone group (75.55+/-17.981) as well as FDC alone group (74.55+/-12.655).
Conclusion: There is no advantage of FDC once a day over tiotropium alone. However addition of evening dose of formoterol has shown therapeutic superiority over once a day FDC of the two in COPD.

Open Access Original Research Article

Asymmetric Thermal Response of Human Feet to Hopping Detected by Digital Infrared Imaging

Byung Kook Kwak, Eui-Chan Jang, Hyung Jin Shim, Kwang-Sup Song

Journal of Advances in Medicine and Medical Research, Page 1078-1085
DOI: 10.9734/BJMMR/2015/15073

Aims: The purpose of this study was to evaluate the effect of asymmetric exercise, hopping, on skin temperature at the foot and ankle subregions by infrared thermography.
Study Design: Prospective volunteer study.
Place and Duration of Study: Department of Orthopaedic Surgery and Department of Radiology, Chung-Ang University Hospital, between June 2013 and March 2014.
Methodology: Ten healthy male volunteers hopped with their dominant limb 1,000 times or for 15 min. Thermography was taken by using an infrared imaging device at 24°C. Each volunteer had four thermographic images of the dorsum, plantar and calf views of both limbs before hopping, and at 5, 20 and 30 min after hopping. Temperatures were measured at the dorsum of the foot (subregion 1), lower tibialis anterior (subregion 2), medial plantar (subregion 3), lateral plantar (subregion 4), calf (subregion 5) and Achilles tendon (subregion 6).
Results: Hopping changed the temperature with different patterns depending on 12 subregions after hopping. At 5 min, except for subregion 3 and 4 of the hopping limb, the other ten subregions showed decreases in skin temperature. Temperatures of all subregions of the hopped limb were higher than that of non-hopped limb ranging from the lowest, 0.54°C atsubregion 1 at 5 min, to the highest, 1.18°C atsubregion 6 at 5 min. Each subregion of the hopped limb was 0.5°C or higher than that of non-hopped limb from 5 till 30 minutes after exercise (P < 0.05).
Conclusion: Heat changes in the foot and ankle by exercise can be imaged and evaluated. After asymmetric exercise, hopping, the subregions of the foot and ankle respond differently. For proper image interpretation, knowing whether asymmetric exercise occurred in the limb of interest is important before image acquisition.

Open Access Original Research Article

Caregiver Experiences with the Introduction of Pentavalent Vaccines in Two Centers in Port Harcourt, South-South Nigeria

Omosivie Maduka, Adedayo Tella, Alafaka Tobin, Margaret Akpan

Journal of Advances in Medicine and Medical Research, Page 1086-1095
DOI: 10.9734/BJMMR/2015/14995

Background: The Nigerian government, with support from the Global Alliance for Vaccine Initiative (GAVI) in 2012, began a three year phased roll out of the pentavalent vaccine as a replacement for DPT in the routine immunization schedule.
Aim: To assess client experiences with the use of pentavalent vaccines in two centers in Port Harcourt, Nigeria.
Methods: A cross-sectional study was carried out in January 2013. Caregiver-baby pairs who had index child six weeks to two years, who had received at least one dose of the pentavalent vaccine and had at least one other living child who took DPT, were interviewed using a semi-structured questionnaire. Chi squared test of significance was done with p-value set at 0.05.
Results: One hundred and eleven (111) caregivers were interviewed. Their mean age was 31±4.6 years, while mean age for babies was 16±8.6 weeks. Although 71 caregivers (76.3%) had received pentavalent vaccine information only 25 (22.5%) had seen pentavalent-specific Information Education and Communication (IEC) materials. Majority of caregivers 94 (84.7%) affirmed that they did not have to pay for vaccination. Fifty-three (53) caregivers (47.7%) preferred pentavalent vaccines to DPT while 35 (31.55%) were indifferent. Eighty-one (81) (73%) caregivers were satisfied with waiting times for vaccination and 62 (57.4%) experienced adverse events following immunization (AEFI) with pentavalent vaccination.
Conclusion: Pentavalent vaccines seem to have been well received in these centers with experiences of AEFI comparable to that of DPT. There is however need for appropriate vaccine-specific IEC materials to foster optimal uptake of pentavalent vaccines.

Open Access Original Research Article

Association of Posterior Reversible Encephalopathy Syndrome with Renal Failure

Imran Khan, Riyaz Ahmad Bhat, Irfan Khan, Tahir Saleem

Journal of Advances in Medicine and Medical Research, Page 1096-1100
DOI: 10.9734/BJMMR/2015/15501

Background: Posterior reversible encephalopathy syndrome is a clinico-radiological entity that is characterized by variable associations of seizure activity, consciousness impairment, headaches, visual abnormalities, nausea, vomiting and focal neurological signs. No large data exists on the association of posterior reversible encephalopathy syndrome with renal failure.
Materials and Methods: This case series of five patients was collected to examine the association of two conditions and evaluate outcome. All these patients were enrolled in a tertiary care hospital over a period of two years. No informed consent was sought because the study was merely observational and did not demand deviations from standard.
Results: Four patients presented with acute renal failure and one patient had established End-Stage Renal Disease. All the patients had hypertension at presentation besides other risk factors. All the patients had Magnetic Resonance Imaging documented posterior reversible encephalopathy syndrome. Despite intensive management, two patients did not show any improvement of blood pressure control and died. This observation raises the possibility that renal failure increases mortality in patients with posterior reversible encephalopathy syndrome. However, our series is limited by small number of enrollees and hence no definite conclusions can be drawn from this observation.
Conclusion: Posterior reversible encephalopathy syndrome should be considered in all those patients who have renal failure and associated neurological abnormalities. The association needs to be taken urgently and seriously.

Open Access Original Research Article

Association between Intraoperative and Post-Anesthetic Care Unit Respiratory Events among 12,641 Children in Southern Thailand

Maliwan Oofuvong, F. Alan Geater, Virasakdi Chongsuvivatwong, Ngamjit Pattaravit, Kanjana Nuanjun

Journal of Advances in Medicine and Medical Research, Page 1101-1112
DOI: 10.9734/BJMMR/2015/15789

Aims: The association between intraoperative respiratory events (IRE) and post-anesthetic care unit respiratory events (PARE) in children as well as the risk factors for PARE have not been described. The objectives of this study were to describe the association between IRE and PARE and to identify the risk factors of PARE in children at a tertiary care hospital in southern Thailand.
Methodology: A historical cohort study based on the surveillance anesthetic database and chart review of children who received surgery at Songklanagarind Hospital during January 2005 to December 2011 was conducted. Demographic, surgery and anesthesia-related data were collected. The association between IRE and PARE and other potential risk factors were analyzed using cross tabulation. Multivariate logistic regression was employed to identify independent predictors for PARE, indicated by adjusted odds ratios (aOR) and their 95% confidence intervals (CI).
Results: Overall, perioperative respiratory event (PRE) occurred in 531 out of 14153 children (315 IRE, 348 PARE). The association between PARE and IRE was strong, with adjusted odds ratios ranging from 3.1 (laryngospasm) to 18.5 (desaturation). Anesthesia-related risk factors for PARE were ASA classification 3 (aOR=3.1, 95%CI=1.9-5.0), jet ventilation (aOR=3.4, 95%CI=1.6-7.1), intubation with succinylcholine vs non-depolarizing muscle relaxant (aOR=1.9, 95%CI=1.4-2.5), use of intraoperative morphine vs fentanyl (aOR=2.4, 95%CI=1.7-3.3) and duration of anesthesia ≥ 3 hours (aOR=3.2, 95%CI=2.1-4.9).
Conclusion: The magnitude of association between IRE and PARE was high. Increased vigilance and close monitoring by anesthesia personnel in high risk children and high risk surgery may prevent IRE and therefore also PARE, so that overall PRE can be reduced. Preventable risk factors for PARE such as using succinylcholine and morphine can be managed under discretion of the anesthesiologist.

Open Access Original Research Article

Hearing Loss in Patients with Spondyloepiphyseal Dysplasia Congenita and Tarda

Roya Azadarmaki, Bria R. Collins, Allyson D. Bull, Sanjay Prasad

Journal of Advances in Medicine and Medical Research, Page 1113-1120
DOI: 10.9734/BJMMR/2015/15496

Aim: To describe hearing loss in patients with spondyloepiphyseal dysplasia congenita and tarda.
Methodology: A literature review of the National Library of Medicine's online database on hearing loss in patients with spondyloepiphyseal dysplasia congenita and tarda was performed.
Results: Four articles were identified that reported hearing loss in subjects with spondyloepiphyseal dysplasia congenita and tarda. Including this study, a total of fourteen patients with hearing loss are reported. Eight patients with sensorineural loss and two patients with mixed hearing loss were identified. The type of hearing loss is unknown in 4 cases.
Conclusion: Serial audiograms are recommended early in life in individuals with spondyloepiphyseal dysplasia congenita and when clinically indicated in patients with spondyloepiphyseal dysplasia tarda.

Open Access Original Research Article

Accuracy of Blood Loss Determination after Vaginal Delivery: Visual Estimation versus Calibrated Measurement

Cornelius A. Turpin, Derick N. M. Osakunor, William K. B. A. Owiredu

Journal of Advances in Medicine and Medical Research, Page 1121-1127
DOI: 10.9734/BJMMR/2015/15114

Background: The ability to determine accurately, the blood loss during childbirth is of extreme importance in the diagnosis and management of primary postpartum haemorrhage (PPH).
Aims: In this study, we evaluate the effectiveness of visual estimation of blood loss, as a method of diagnosing primary postpartum haemorrhage.
Methodology: A cross-sectional study on 271 participants was conducted between April and October 2012, at the Komfo Anokye Teaching Hospital. Women who went through spontaneous vaginal delivery were monitored and blood loss after delivery was visually estimated and then measured with a graduated receptacle, up to 1 hour post-delivery. The paired t-test and Bland-Altman plot was used to compare outcomes of the two methods. P<0.05 was considered significant.
Results: Mean age of study participants was 27.7±5.7. As per visual estimation, most participants were reported to have lost <200 ml of blood (45.0%) as opposed to that of measured losses where most participants had lost between 200-500 ml of blood (48.7%). The mean measured blood loss was 306.09±218.39 ml against a 250±188.78 ml mean visually estimated blood loss (P < 0.0001). Prevalence of primary PPH as estimated with measured blood losses was 20.3% (55/271). Visual estimation, however gave a prevalence of 15.9% (43/271), an underestimation by 4.4%. A Bland-Altman plot showed a clinical bias large enough to cause significant differences in diagnosis of primary PPH.
Conclusion: This study adds to existing evidence that the visual estimation of blood loss in clinical settings underestimates losses and is not reliable. This can lead to misdiagnosis of primary PPH and thus an underestimation of the condition. Health care workers should therefore base diagnosis on calibrated measurement methods.

Open Access Review Article

Measuring Occupational Stress and HRA Axis Dysregulation among Healthy Workers by Salivary Cortisol Levels

Eleni Moustaka, Malliarou Maria, T. C. Constantinidis

Journal of Advances in Medicine and Medical Research, Page 1040-1051
DOI: 10.9734/BJMMR/2015/15530

Background: Salivary cortisol is a useful biomarker in stress research, as a valid measure for HPA axis activity, whose deregulation is one of the ways that psychosocial risk factors at work, result to the creation of illness.
Aim: The aim of this review was to summarize current literature of salivary cortisol as measures of work stress in healthy workers, so as to investigate the association between work stress and cortisol secretion as well as to identify specific work characteristics, that affect the cortisol secretion.
Methods: We identified articles through PubMed using search terms related to salivary cortisol, HPA axis, work stress.
Results: Many studies have shown that altered level of cortisol, appears to be associated with work related stress factors. Work shift, working hours, the nature of work, organizational characteristic of work (effort reward imbalance, high demand-low control, over-commitment, conflicts between home and work demands, and workload) as well as bulling at work, socio-demographic characteristics, financial strain, physical risk factors and social support at work are found to affect Cortisol levels. Though the relationship between the cortisol secretion and some of the above work stressors was found to be contradictory.
Discussion: From the present study it is obvious that the researches present an inconsistency regarding the impact of work stressors on cortisol levels.
It has been identified that increased cortisol levels in populations reporting increased distress couldn’t replicate this association. Among the reasons identified to be behind these inconsistent findings are the differences in the prevalence of potential confounders, differences in analytical approach and the duration of stressful stimulus.
Conclusion: The detailed knowledge about factors that play pivotal role in measures of the cortisol secretion is very important, as the biomarkers have been demonstrated that can characterize and quantify the biological impact of psychological stress. Targeted prevention policy and evidence based interventions in workplace might include the identification of sources of occupational stress and this is the first that can affect cortisol secretion.