Open Access Short Research Article

Prevalence of Smokeless Tobacco Use and Number of Users in 121 Countries

Dhirendra N. Sinha, Naveen Agarwal, P. C. Gupta

Journal of Advances in Medicine and Medical Research, Page 1-20
DOI: 10.9734/BJMMR/2015/16285

Background: In 2010, a study estimated the number of smokeless tobacco (SLT) users in 70 countries at 302.4 million. These countries represented 70% of the global population. We aimed to update this information and widen the scope to estimate the global prevalence of SLT use by including a larger number of countries.

Methods: Data on the prevalence of current SLT use in 121 countries were obtained from various sources. Country-wise and gender-wise breakdown of the adult population in these countries was derived from the UN World Population for 2015. To translate prevalence rates into an estimate of the number of adult SLT users, we multiplied the adult male and female SLT prevalence rates by the corresponding male and female adult population in the respective countries. We then added the estimated number of male and female SLT users to get an overall estimate of SLT use.

Results: There were 352 million SLT users (351.9 million) in 121 countries. Of these, 67% were men (232.7 million) and 33% were women (119.2 million). Nearly 95% (333.1 million) of global SLT users lived in developing countries and only 5% (918.8 million) lived in developed countries; 82.7% of global SLT users lived in the World Health Organization (WHO) South-East Asia Region.

Globally, 90.4% of SLT users live in 11 countries of the world:  India (237.4 million, 67.5%), Bangladesh (30.9 million), Myanmar (12.6 million), Pakistan (10.1 million), USA (9.6 million), China (4.1 million), Indonesia (3.2 million), Nepal (2.7 million), Madagascar (2.6 million), Germany and Uzbekistan (2.4 million each).

Conclusion: Smokeless tobacco use is a global epidemic affecting 121 countries. All 180 countries that have ratified the WHO Framework Convention on Tobacco Control (WHO FCTC) are obliged to monitor SLT use. Parties to the Convention should collect information periodically using standard protocols for national and international comparability. To prevent health and economic losses attributable to SLT use, countries, especially developing countries, should formulate strategies specific to SLT control.

Open Access Original Research Article

Perioperative Care Related Events are Different Following Elective and Emergency Right Hemicolectomy

Arkadiusz Peter Wysocki, Jennifer Allen, Therese Rey-Conde, John B. North

Journal of Advances in Medicine and Medical Research, Page 1-6
DOI: 10.9734/BJMMR/2015/19247

Introduction: Right hemicolectomy is frequently performed for malignancy but emergency surgery is associated with double the mortality rate of elective colonic resection. The study was designed to compare perioperative clinical incidents patients who died following elective and emergency right hemicolectomy.

Methods: Adult patients who died under the care of a surgeon following elective and emergency right hemicolectomy in Queensland, Australia were identified from the Australian and New Zealand Audit of Surgical Mortality (ANZASM) database. Demographic data, free text entries and surgeon reviewer conclusions were analysed.

Results: The two groups had different indications for surgery but were of similar age and gender. Surgeon reviewers (first and second line) identified similar rates of untoward perioperative events in both groups however post operative events tended towards being more frequent after elective surgery while pre operative events were more frequent in the emergency group. Almost half of the incidents occurred post operatively and often related to delayed diagnosis and management of anastomotic leak.

Conclusion: This analysis suggests more thorough pre operative medical work up may be required prior to right hemicolectomy and that greater attention should be focused on recognizing intra-abdominal sepsis - predominantly following emergency surgery.

Open Access Original Research Article

Pathophysiological Changes by Short-term Food Restriction in Obese Diabetic Rats

K. Miyajima, Y. Toriniwa, Y. Motohashi, Y. Ishii, M. Shinohara, H. Yamashiro, T. Yamada, T. Ohta

Journal of Advances in Medicine and Medical Research, Page 1-7
DOI: 10.9734/BJMMR/2015/18712

Aim: Reduced calorie intake by food restriction leads to extension of life span by exerting beneficial effects on metabolism. Zucker diabetic fatty (ZDF) rat is a type 2 diabetic model with obesity, showing the incidence of diabetes after 7 weeks of age. The present study investigated effects of 2-week food restriction on the pancreas in ZDF rats.

Methods: ZDF rats were pair-fed with Zucker lean (ZL) rats from 7 to 9 weeks of age (The amount of food in ZDF rats was calculated based on the daily food consumption in ZL rats). Body weight and biochemical parameters such as serum glucose, triglyceride, total cholesterol, non-esterified fatty acid and insulin levels, were evaluated. After necropsy, islet size and insulin content in pancreas were measured.

Results: The ZDF rats showed increased blood glucose, insulin and lipid levels at 7 weeks as compared with those in ZL rats. After food restriction for 2 weeks, the blood glucose, insulin, and triglyceride levels in pair-fed ZDF rats were decreased. The islet size in pair-fed ZDF rats decreased as compared with that in ad lib-fed ZDF rats, but the insulin content in pancreas of pair-fed ZDF rats increased remarkably.

Conclusion: ZDF rats showed improvement of pancreatic disorders by food restriction. Caloric restriction applied at an insulin resistant pre-diabetic stage is an effective means for preventing the pancreatic disorder in diabetes with obesity.

Open Access Original Research Article

CDKAL1, KCNQ1, and IGF2BP2 are Identified as Type 2 Diabetes Susceptibility Genes in a Regional Chinese Population

Qiaoping Wu, Hailian Yang, Pingdong Li, Yuxin Liu, Ruiwei Jing, Justin Michael Karush, Guipeng Ding, Xuelian He, Ningsheng Liu, Jiangfang Lian

Journal of Advances in Medicine and Medical Research, Page 1-8
DOI: 10.9734/BJMMR/2015/18554

Aims: Diabetes has become a major public health problem in China. Recent advances in genetic studies have identified numerous susceptibility loci for type 2 diabetes (T2D). Current models to detect risk of T2D are largely based on studies from European populations; this study aims to replicate those efforts in a Chinese population from the Ningbo region in order to diversify and fortify risk models.

Methodology: We successfully genotyped 11 single nucleotide polymorphisms (SNPs) in 222 subjects with T2D and 140 subjects with normal glucose regulation in a population from the Ningbo region of China. Additive and dominant models were used to analyze the associations between SNPs and T2D.

Results: Adjusting for age, triglycerides, total cholesterol, low density lipoprotein, and BMI in the dominant model, we identified three SNPs which were associated T2D: CDKAL1 (OR=2.29 [95%CI=1.25-4.19]), KCNQ1 (4.22 [1.79-9.99]), and IGF2BP2 (1.76 [1.06-2.94]). No significant association was found between T2D and SNPs from KCNJ11, PPARG, TCF7L2, SALC30A8, CDKN2B, HHEX, HNF1β, and WFS1.

Conclusion: Our data indicates that in this population, CDKAL1, KCNQ1, and IGF2BP2 are T2D susceptibility genes.

Open Access Original Research Article

Enhancing Efficacy of Antimicrobials with the Medicinal Synthetic Aluminum-Magnesium Silicate, for Prevention and Treatment of Resistant Infections

Maduike C. O. Ezeibe, Ijeoma J. Ogbonna

Journal of Advances in Medicine and Medical Research, Page 1-8
DOI: 10.9734/BJMMR/2015/17768

Aim: To achieve, at least, 95% clearance of loads of treated infections so that pathogens do not develop resistance against drugs used for treatment.

Materials and Methodology: Lower doses of Aluminum-magnesium silicate (AMS)-stabilized antimicrobials (Piparazine, Ampicillin, Chloroquine and Sulphadimidine), supported with immune stimulants, were used to treat respective sensitive and resistant infections.

Results: Recommended doses of Piparazine, Ampicillin and Chloroquine cleared only 82.94%, 80.68% and 20% of Helignosomoides bakeri, Salmonella gallinarum and Plasmodium berghei infections, respectively. Lower doses (75%) of the AMS-stabilized Piparazine and Ampicillin cleared 96.82% and 97.84% of the treated infections. Supporting the lower doses of AMS-stabilized Chloroquine and AMS-stabilized Ampicillin with immune stimulants led to 100% clearance of P. berghei infection and 95.80% clearance of Ampicillin-resistant Escherichia coli infection, respectively.

Conclusion: Prolonging bioavailability of drugs with AMS, minimizing side effects of drugs by using their lower doses for treatment, and enhancing immune responses of treated patients, help treatments to prevent and cure resistant infections.

Open Access Original Research Article

Contraceptive Choices amongst Antenatal Care Patients in a Tertiary Health Centre in Nigeria

A. O. Addah, T. J. Obilahi-Abhulimen, I. J. Abasi

Journal of Advances in Medicine and Medical Research, Page 1-10
DOI: 10.9734/BJMMR/2015/18276

Background to Study: Maternal mortality and morbidity are very high in sub-Saharan Africa as in most developing countries, Nigeria inclusive. There have been concerted efforts by Governments of these countries, Non-Governmental Organisations, International and World bodies on how to solve this problem. One of the worth able strategies employed to solve the issue of maternal mortality is to prevent unintended pregnancies, unsafe abortions, space births, plan family sizes through the use of modern contraceptive methods for women in their reproductive age. However, maternal mortality remains high in Nigeria because of the low prevalence of contraceptive patronage. We, the authors of this study decided to test the prevalence of contraceptive patronage amongst our antenatal patients and compare our results nationally and globally.

Objective: To determine the pattern of contraceptive  choices among antenatal patients attending the Niger Delta University Teaching Hospital, Okolobiri, Bayelsa State, South-South Nigeria.

Methodology: This was a descriptive cross sectional study conducted at the Niger Delta University Teaching Hospital, Okolobiri, Bayelsa state, South-South Nigeria, between October 2014 to January 2015. It consisted of a set of structured, pretested questionnaires that were administered to consecutive antenatal attendees.

Results: Fifty-one (57.3%) of subjects in the study have used contraceptives in the past. The most commonly used modern contraceptive method among the study population was the male condom – 25 (28.1%). Injectables were used by 12 (13.5%) of those who have used contraceptives before the advent of present pregnancy. Information on contraception- Seventy three (82%) of respondents learnt of family planning services in the hospital through Doctors and Nurses.

Conclusion: Previous contraceptive usage before the pregnancy by the study group was encouraging. However more advocacies by contraceptive providers are needed in the areas of emergency contraception and long term contraceptive methods for increase uptake.

Open Access Original Research Article

Asymptomatic Bacteriuria amongst Geriatrics in Calabar, Cross River State, Nigeria

P. C. Inyang-Etoh, U. E. Chibuzor-Eke

Journal of Advances in Medicine and Medical Research, Page 1-7
DOI: 10.9734/BJMMR/2015/18942

Aims: To investigate the prevalence of asymptomatic bacteriuria among Geriatric patients in Calabar, the predisposing factors associated with this infection, the incriminating bacterial pathogens and their antibiotic susceptibility pattern.

Study Design: Ethical approval, consent from the patients, questionnaire administration, collection and processing of clean catch mid-stream urine specimens.

Place and Duration of Study: Calabar, the capital city of Cross River State, Nigeria between May, 2014 and February, 2015.

Methodology: Urine samples from randomly selected 200 subjects (92 men and 108 women) between the ages of 60 to 90 years were cultured by Leigh and Williams’s method. Questionnaires were also administered.

Results: 92 (46%) subjects had asymptomatic bacteriuria. Subjects between the age group 71 – 75 years had the highest level of infection but the difference was not statistically significant (P=0.165). Females 52 (48.1%) were more infected than the males 40 (43.4%) but this was not statistically significant (p=0.641). Among the diabetics only 22 (47.8%) had infection while 20 (41.6%) hypertensive subjects had infection. There was a negative correlation between diabetic subjects and the presence of infection (r=-0.2) and also a negative correlation between the hypertensive subjects and the presence of infection (r=-0.3). Escherichia coli 24 (26.1%) and Proteus spp 24 (26.1%) were the most commonly isolated bacteria.  

Conclusion: This work revealed a high prevalence rate of asymptomatic bacteriuria among geriatric subjects in Calabar but no association between infection and diabetes or hypertention was observed.

Open Access Original Research Article

Metastases of Hepatocellular Carcinoma to Unusual Sites: A 10 Year Case Study

Beena Umar, Nasir Ud Din, Zubair Ahmad

Journal of Advances in Medicine and Medical Research, Page 1-10
DOI: 10.9734/BJMMR/2015/16942

Introduction: Hepatocellular carcinoma is the most common primary tumor of the liver, usually arising in a background of chronic hepatitis and cirrhosis. It is the fifth most common cancer worldwide comprising almost 6% of all newly diagnosed cancers.

Aim: The aim of our study is to report unusual metastasis of HCC seen in our practice.

Methods and Results: Data of 10 years were collected. A total of 30 cases diagnosed as metastatic hepatocellular carcinoma during the period 2004-2013 were retrieved and reviewed from files of the Section of Histopathology, Aga Khan University Hospital. Cases presenting with metastases to the lungs were excluded from the data. Age range of the patients was 31-84 years with mean age of 59.1 years. There were 28 males and 2 females. The most frequent unusual site of extrahepatic metastases was bone (n= 23), followed by soft tissue of the gluteal region (n=2), posterior triangle of neck (n=1), inguinal region (n=1), iliopsoas muscle (n=1), parotid region (n=1) and the eyeball region presenting as retrobulbar mass (n=1).

Conclusion: Lung and bone metastases are frequently seen in patients with HCC. However, HCC sometimes metastasizes to unusual sites/organs. An early diagnosis of these metastases by appropriate diagnostic modalities is essential and can improve the quality of the patient’s life.

Open Access Original Research Article

Investigation of Gender Difference of Physiological Response in Gonadectomy in Sprague-Dawley (SD) Rats

K. Miyajima, Y. Toriniwa, Y. Motohashi, Y. Ishii, S. Kimura, M. Shinohara, H. Yamashiro, T. Yamada, T. Ohta

Journal of Advances in Medicine and Medical Research, Page 1-8
DOI: 10.9734/BJMMR/2015/19115

Aim: Sex hormones, including testosterone and estrogen, result in various pathophysiological changes in the body. To evaluate the pathophysiological changes following gonadectomy in male and female rats, we performed gonadectomy at the same age in male and female Sprague-Dawley (SD) rats.

Methods: Male and female Sprague-Dawley rats castrated by bilaternal orchidectomy and ovariectomy at 6 weeks of age (six animals of each sex per group). Food intake, body weight, and clinical chemical parameters such as glucose, insulin, triglyceride and total cholesterol levels, were examined every 4 weeks from 8 to 40 weeks of age. Statistical analysis of differences between control and gonadectomized rats was performed using the F-test, followed by the Student’s t-test or Aspin-Welch’s t-test.

Results: In orchidectomized (ORX) rats, food intakes and body weights were decreased, whereas in ovariectomized (OVX) rats, the body weights were significantly elevated without an obvious change in food intake. In clinical chemical analysis, hypercholesterolemia was observed in both ORX and OVX rats, but the triglyceride level was obviously decreased only in ORX rats during the observational period. In OVX rats, decrease of insulin sensitivity and significant increase of adipose tissue weights were observed. In bone metabolic analysis, bone mineral content in ORX rats and bone mineral density in OVX rats were decreased, respectively.

Conclusion: Both orchidectomy and ovariectomy in rats affect glucose/lipid and bone metabolism, and especially, the glucose metabolism was deteriorated in OVX rats. Both male and female sex hormones play a key role in metabolic disease, such as diabetes, hyperlipidemia and osteoporosis.

Open Access Original Research Article

Can We Use Osteopontin as a Reliable Marker for Diagnosis of Early HCC in Chronic HBV Monoinfected Saudi Patients

Ahmad El Askary, Laila Dorgham, Basem Elesawy, Tarek Ali

Journal of Advances in Medicine and Medical Research, Page 1-6
DOI: 10.9734/BJMMR/2015/18302

Background: Chronic hepatitis is a worldwide disease with a catastrophing end as hepatocellular carcinoma (HCC). The objective of the current study was to assess performance of biomarkers for early detection of HCC among Chronic Monoinfected HBV Saudi patients. We selected alpha feto protein (AFP) and serum Osteopontin (OPN) as biomarkers to investigate their performance as early diagnostic biomarkers. Subjects and methods: 250 Saudi subjects were included in this study and classified into three groups. First group included 50 healthy subjects serving as control group. Second group consisted of 100 patients suffering from liver cirrhosis. The third group included 100 patients suffering from Early HCC. The condition of liver pathology (in early HCC patients) was confirmed by liver biopsy or spiral CT scan. Demographic and biochemical investigations were recorded and both alpha-feto protein (AFP) and osteopontin (OPN) were measured. Results: Performance of markers included in diagnosis of early HCC AUC was 0.78 for AFP and 0.87 for osteopontin; the best cutoff value for AFP was ≥25 ng/ml; while for OPN it was ≥135 ng/m. At the best cutoff value OPN had sensitivity of 100%, specificity 65%, PPV 66.7% , NPV 84.6% and overall accuracy 93% (CI: 0.621-0.931 and P value: 0.003), AFP showed 90% sensitivity, 55% specificity, PPV 74%, NPV 89% and overall accuracy 80% (CI: 0.765-0.980 and P value: 0.001).

Conclusion: OPN showed better sensitivity in diagnosis of early HCC than AFP and plasma OPN estimation can be considered as a reliable marker for diagnosis of early HCC.