Open Access Case Study

Acute Psychosis Following Hydrocortisone Replacement in a Patient with Secondary Adrenal Insufficiency Due to Recurrent Postoperative Pituitary Macroadenoma

Amarta Shankar Chowdhury, Dipti Sarma, Uma Kaimal Saikia, Bipul Kumar Choudhury, Utpal Bora

Journal of Advances in Medicine and Medical Research, Page 1-7
DOI: 10.9734/BJMMR/2016/21557

Acute psychosis in patients receiving physiological corticosteroid replacement is rare. The exact mechanism of this disorder is not clear. We report a case of a 50 year old female with recurrent post operative pituitary macroadenoma who had presented to us with features of adrenocortical insufficiency. The patient was started on intravenous (iv) hydrocortisone and after receiving six doses, she developed features of acute psychosis. She was put on anti-psychotics and hydrocortisone was withheld for 24 hrs. The patient recovered in a couple of days and oral hydrocortisone was re-started at 5 mg per/day and increased to 15 mg/day without recurrence of symptoms of psychosis.

Open Access Original Research Article

May Obesity and Nutritional Knowledge Influence the Assessing Energy Intake Underreporting in Adults?

Karina Quesada, Bianca Costa Bordin, Elis Vânia de Melo, Luciana Mara Gonçalves do Nascimento, Naylla Pereira de Mazzi, Cláudia Rucco Penteado Detregiachi, Sandra Maria Barbalho

Journal of Advances in Medicine and Medical Research, Page 1-8
DOI: 10.9734/BJMMR/2016/22248

Aims: Investigate the influence of the nutrition knowledge and nutritional status in the assessing energy intake underreporting.

Methodology: It’s a cross-sectional study in 52 adults treated in an ambulatory. The nutritional knowledge was measured through the Nutritional Knowledge Scale. The anthropometric data analyzed were: waist circumference, height and weight. The food consumption was checked by three recalls of 24 hours. The resting metabolic rate was calculated by the Mifflin’s formula, and the assessing energy intake underreporting was calculated after Goldberg’s formula. Statistical analysis was performed by the “Bioestat 5.0” program and the Chi Square test for trend was used to evaluate the association between variables (p≤0,05).

Results: The studied group showed an average age of 38,90±9,52. The assessing energy intake underreporting was noted in 92,3% of the sample. It was observed that the average energy intake related (1583,27±575,29 Kcal) was less than the average of the resting metabolic rate (1802,71±227,02 Kcal). Higher values of IMC (A = 0,153; p = 0,85) and in waist circumference (A = 2,769; p = 0,05) were associated with the increase of the assessing energy intake underreporting. In the other hand, there was a decreasing tendency (A = - 0,384; p = 0,750) in the association between energetic underreporting and nutritional knowledge.

Conclusion: It was observed a higher tendency of assessing energy intake underreporting between individuals with higher IMC and waist circumference and lower nutritional knowledge.

Open Access Original Research Article

Prevalence and Predictors of Depression among Postpartum Mothers in the Limbe Health District, Cameroon: A Cross-Sectional Study

Gladys Ghogomu, Gregory E. Halle-Ekane, Peter F. Nde, John Ngunde Palle, Julius Atashili, Fulbert N. Mangala, Dickson Shey Nsagha

Journal of Advances in Medicine and Medical Research, Page 1-11
DOI: 10.9734/BJMMR/2016/21446

Depression is a debilitating mood and mental disorder affecting approximately 13% of postpartum mothers worldwide with a prevalence of 25%-60% in low and middle income countries. The prevalence is yet to be published in Cameroon.

Aim: This study was carried out to determine the prevalence, severity and risk factors of depression among postpartum mothers in Limbe Health District (LHD), Cameroon.

Study Design: It was a cross-sectional, analytic community-based survey. A non- probability convenient sampling method was used to recruit four hundred participants in eight communities in the LHD. Postpartum mothers with infants aged 1-12 months constituted the study population. Data collected using the Patient Health Questionnaire-9 (PHQ-9) and a structured questionnaire was analyzed using Epi-Info version 3.5.4. A p-value of less than 0.05 was considered statistically significant for variables.

Results: The prevalence of depression among participants was 61.8% based on PHQ-9 depression scale. The severity of depression varied from mild 54.7%, moderate 43.3% to severe2.0%. Socio-demographic factors associated with depression were: unemployment [OR=2.02;95% CI:(1.35-3.86), p=0.002], unsatisfactory support or assistance for care of baby [OR = 4.89; 95% CI: 2.25-10.612), p = < 0.001], marital conflict [OR = 0.44; 95%CI: (0.23-0.82), p = 0.009] and serious financial problems [OR = 0.31; 95% CI: (0.18-0.54), p =0.002]. Unplanned pregnancy was the only obstetric factor associated with depression [OR=2.02; 95% CI: (1.24-3.29), p= 0.004].

Conclusion: The prevalence of depression among postpartum mothers in the LHD was high. Unemployment, unsatisfactory assistance for child care, marital conflicts, financial difficulties and unplanned pregnancy were risk factors for postpartum depression.

Open Access Original Research Article

Unmet Communication and Information Needs for Patients with IBD: Implications for Mobile Health Technology

Sameer Khan, Florence Dasrath, Sara Farghaly, Emamuzo Otobo, Muhammad Safwan Riaz, Jason Rogers, Anabella Castillo, Ashish Atreja, Health PROMISE Consortium Group

Journal of Advances in Medicine and Medical Research, Page 1-11
DOI: 10.9734/BJMMR/2016/21884

Aims: In order to develop an application that addresses the most significant challenges facing IBD patients, this qualitative study explored the major hurdles of living with IBD, the information needs of IBD patients, and how application technology may be used to improve quality of life.

Methods: 15 IBD patients participated in two focus groups of 120 minutes each. Data collection was achieved by combining focus groups with surveys and direct observation of patients looking at a patient-engaged app (HealthPROMISE) screenshots. The survey elicited information on demographics, health literacy and quality of life through the Short IBD Questionnaire (SIBDQ).

Results: The needs of IBD patients center around communication as it relates to both patient information needs and navigating the social impacts of IBD on patients’ lives:

a) Communication Challenges regarding Information Needs: Patients cited a doctor-patient communication divide where there is a continued lack of goal setting when discussing treatments and a lack of objectivity in disease control. When objectively compared with the SIBDQ, nearly half of the patients in the focus groups wrongly estimated their IBD control.

b) Communication Challenges regarding Social Impacts of IBD: Patients strongly felt that while IBD disrupts routines, adds significant stress, and contributes to a sense of isolation, the impact of these issues would be significantly alleviated through more conversation and better support.

c) Implication for Mobile Health Solutions: Patients want a tool that improves tracking of symptoms, medication adherence and provides education. Physician feedback to patient input on an application is required for long-term sustainability.

Conclusions: IBD patients need mobile health technologies that evaluate disease control and the goals of care. Patients feel an objective assessment of their disease control, goal setting and physician feedback will greatly enhance utilization of all mobile health applications.

Open Access Original Research Article

Comparative Study of the Effect of Mometasone Fuorate and Levocetrizine in Alleviating the Symptom Triad of Rhinorrhoea, Nasal Obstruction and Sneezing in Patients of Allergic Rhinitis

Namit Kant Singh, P. S. Nagpure

Journal of Advances in Medicine and Medical Research, Page 1-7
DOI: 10.9734/BJMMR/2016/22061

Aims: The aim of the study is to compare the effect of Mometasone Fuorate and Levocetrizine in alleviating the symptom triad of Rhinorrhoea, Nasal obstruction and Sneezing in patients of Allergic Rhinitis.

Study Design: Prospective cohort study.

Place and Duration of Study: Department of Otolaryngology, Mahatma Gandhi Institute of Medical Sciences (MGIMS), Sevagram, between 1st April 2012 to 31st March 2014.

Methodology: In this study 50 patients were assessed. The diagnosis was made on the basis of 1) Careful detailed history, 2) Clinical examinations, 3) ARIA Classification was used to classify the patients. Patients received, Group A: Mometasone furoate nasal spray 50 µg in each nostril twice daily for the first 7 days followed by once daily upto 8 weeks, Group B: Levocetrizine 5 mg in the night for 8 weeks. In followup period of 12 weeks Patients receivedGroup A: Mometasone furoate nasal spray 50 µg in each nostril once daily for 12 weeks. Group B: Levocetrizine 5 mg in the night for 12 weeks.

Results: In patients with Intermittent Symptoms, 76% of the participants in the group A were found to be relieved of the nasal discharge as compared to 24% in the group B. This difference was found to be statistically significant (P = .0007). 83% of the participants in the group A were found to be relieved of the nasal obstruction as compared to 17% in the group B. This difference was found to be statistically significant (P = .0022). 61.5% of the participants in the group A were found to be relieved of the sneezing as compared to 48.5% in the group B. This difference was not found to be statistically significant (P=0.8017). In patients with Persistent Symptoms, 84.6% of the participants in the group A were found to be relieved of the nasal discharge as compared to 15.4% in the group B. This difference was found to be statistically significant (P = .0124). 100% of the participants in the group A were found to be relieved of the nasal obstruction as compared to 0% in the group B. This difference was found to be statistically significant (P = .0006). 75% of the participants in the group A were found to be relieved of the sneezing as compared to 25% in the group B. This difference was not found to be statistically significant (P = .5647).

Conclusion: In this study we conclude that both Mometasone Fuorate and Levocetrizine are potent drugs for the management of allergic rhinitis but because of the local action and a high lipophilicity, longer retainability and induction of apoptosis of eosinophills in the nasal mucosa, patients taking Mometasone Fuorate as medication appreciate better relief in symptoms as compared to Levocetrizine.

Open Access Original Research Article

Antibiotic Use, Cost, and Consumption in Tertiary Hospitals in Lebanon: A Comparative Study Before and After an Implementation of Antibiotic-Restriction Program (ARP)

Alia Allouch, Hala Sabbah, Samara Hassan, Sanaa Sabbah, Nabil Droubi, Ibtissam Sabbah

Journal of Advances in Medicine and Medical Research, Page 1-15
DOI: 10.9734/BJMMR/2016/22025

Aims: To compare the antibiotic use, cost, and consumption before and after an implementation of an antibiotic-restriction program (ARP) in governmental hospitals setting in Lebanon.

Study Design: A retrospective cohort study on hospitalized patients who were prescribed antibiotics prior to, and after the application of the ARP, was conducted over a three month period, between March 2013 and June 2013.

Methodology: The studied population included patients on antibiotic therapy. The sample size that was enrolled was equal to 612 patients prior to ARP and 606 patients after ARP.

Results: The average age of the patients was 34.6±23.5 years, 55.6% of whom were females, and 79.2% had no comorbidity. Respiratory diseases, and gynecological surgeries motivated the antibiotics prescriptions. The physicians prescribed combinations of intravenous antibiotics in 91% of the cases. The most frequently ordered antibiotics were second, third- generation cephalosporins, and penicillin derivatives. After ARP, the rate of restricted antibiotic use decreased by 11% (P<.0001), while the use of gentamicin increased with a potential for increased rates of nephrotoxicity and ototoxicity; Prior to and after the ARP, a microbiological exam was done in 12.6% of cases, and 67.3% of the cases of prescribed antibiotics were sensitive. The expenditure of all, and restricted antibiotics decreased by 22.3% and 9% respectively. The cost savings were US$ 8099 per month. The compliance with the ARP by prescribers was very high (>90%).

Conclusion: The ARP reduces the amount of antibiotic usage, cuts down the healthcare expenditure, and may prevent a higher prevalence of some resistant bacterial strains; it is, therefore, in the interest of policymakers to propose an antimicrobial stewardship program based on mHealth system that allows patients, and healthcare providers an on-line and mobile consultation.

Open Access Original Research Article

Laparoscopic Treatment of Hepatic Cysts: A 10-Years Single Institution Experience

Nicola Tartaglia, Alessandra Di Lascia, Pasquale Cianci, Alberto Fersini, Vincenzo Lizzi, Antonio Ambrosi, Vincenzo Neri

Journal of Advances in Medicine and Medical Research, Page 1-10
DOI: 10.9734/BJMMR/2016/22140

Aims: This study presents our experience in the laparoscopic management of simple hepatic cysts (SHCs) and the polycystic liver disease (PCLD).

Study Design: Retrospective institutional study.

Place and Duration: Department of Medical and surgical Science, University of Foggia, Foggia, from January 2004 to December 2014.

Methodology: Laparoscopic deroofing was performed in 20 consecutive patients. There were 15 cases with SHCs and only 5 cases with PCLD (Gigot’s type I). In SHCs group, cyst was single in 10 cases and multiple in 5. Cysts were located in both hepatic lobes in 4 cases. The two groups were homogeneous for age, sex and ASA score. Preoperative investigations include routine laboratory tests, ultrasonography and the use of computed tomography in order to make diagnosis ad to rule out parasitic and neoplastic liver cysts. CT scan was performed in all cases to assess the characteristics, dimensions, and exact position of the lesion. Surgery was planned for all patients because of evident and persistent symptomatology, characterized of the presence from no less of 6 months of typical symptoms such as nausea, vomiting and epigastric pain. In our series, 6 cases of cholelithiasis were associated.

Results: The analyzed outcome variables included surgical procedure, operative time, blood loss, length of hospital stay, complications, and medium follow-up period. All the patients underwent laparoscopic deroofing of the larger cysts and puncturing of the smaller cysts. There were no conversions. The mean operative time was estimated twice in the group PCLD than SHCs (110 min vs 60 min). The histological examinations revealed the typical pattern of the simple liver cysts in any case, without evidence of malignancy. No significant blood loss was found.

The total morbidity recorded was 25% (5/20), 2 cases in the group of SHCs (13,3%) and 3 cases in the PCLD one (60%) and was characterized of 2 cases of ascites through trocar insertion sites after removal of drainage tube and 3 case of pleural effusion. There were no significant group differences in term of length of hospital stay. The follow-up period (a mean of 22 months) confirmed that all the patients remained free of symptoms and relapse of the disease.

Conclusion: The technical feasibility and the good short- and medium-term results made the laparoscopic approach the procedure of choice for the management of symptomatic liver cysts.

Open Access Original Research Article

Facial Tissues Donation and Facial Transplantation: Knowledge Evaluation of the Population about this New Procedure

D. C. M. D. Rossetto, A. Bakonyi Neto

Journal of Advances in Medicine and Medical Research, Page 1-7
DOI: 10.9734/BJMMR/2016/21638

Background: Face transplantation is a complex procedure on a medical, moral and psychological point of view. Therefore, provides many benefits in improving aesthetic function and social integration. We evaluate the knowledge of the population about the donation and transplantation of facial tissues.

Methods: A questionnaire was administered to 430 people, randomly selected, with twenty-one years of age or older, collected in all regions of the city of Botucatu. The evaluation of the objective responses in the different issues was accomplished by establishing a frequency distribution data. The descriptive questions were analyzed by reading them.

Results: Between participants, 65.8% did not have knowledge about the possibility of facial tissue donation, however, 90.1% of them knows that face transplantation is indicated in cases of facial deformities, 51.7% are able to donate tissues of the face, 67.7% are not aware how their families would react against its manifestation in life to donate face tissues, 84% have no knowledge about the implications on the funeral ceremonies. Of participants, 359 would accept to live with another face if necessary and 375 would support any family members in being a donor.

Conclusion: The population showed a limited knowledge about the donation and transplantation of face tissues, but would accept to live with it if necessary and support family members in being donors. They considered the donation an important act and required more information on the subject.

Open Access Original Research Article

Assessment of Implant Stability: Methods and Recent Advances

Aman Sachdeva, Pankaj Dhawan, Suruch Sindwani

Journal of Advances in Medicine and Medical Research, Page 1-10
DOI: 10.9734/BJMMR/2016/21877

Achieving primary stability is of greatest importance, at the time of implant placement. A rigid fixation of implant within the host bone, in absence of micromotion is the most critical factor for successful osseointegration. Over the years, several authors have reported various methods in literature to monitor implant stability, which include, tapping the abutment with a metallic instrument, histomorphometry test, removal torque test, cutting torque test, radiography, periotest, and resonance frequency analysis. Resonance frequency analysis (RFA) offers a clinical, objective way to measure stability and presumed osseointegration of implants. The review focuses on different methods used to assess implant stability and recent advances in this field.

Open Access Review Article

Botulinum Toxin: Dentistry Insight

Sakshi Madhok, Gaurav Singh, Abhinav Gupta

Journal of Advances in Medicine and Medical Research, Page 1-13
DOI: 10.9734/BJMMR/2016/21582

Botulinum toxin is the first biologic toxin to be used in the treatment of human diseases. It is a minimally invasive, revolutionary and a novel approach to treat several orofacial disorders. It is produced by autolysis of gram positive anaerobic bacterium called Clostridium botulinum. Botulinum toxin is lethal and is well known for its lingering threat of bioterrorism which is associated with it. On the other hand it has a therapeutic potential when injected in minute quantities in hyperactive muscles. Over the past two decades the cosmetic and non - cosmetic uses of botulinum toxin in the orofacial region has gained wide popularity. The purpose of this article is to overview the tortuous course of botulinum toxin from its discovery as a lethal toxin to its cosmetic and non- cosmetic enhancement roles in the perioral region and to determine its usefulness and   effectiveness in wide range of orofacial disorders.