Open Access Original Research Article

Prevalence of Hashimoto’s Thyroiditis and Its Association with Vitamin D Deficiency in West Bengal, India

Tirna Halder, Rinini Dastidar, Sujit Bhattacharya, Debasish Maji

Journal of Advances in Medicine and Medical Research, Page 1-10
DOI: 10.9734/BJMMR/2016/21714

Objective: The aim of our study is to screen the prevalence of Hashimoto’s Thyroiditis and to evaluate a correlation between 25(OH)Vitamin D deficiency and AITD in hypothyroid patients of West Bengal.

Study Design: Ethical clearance was received for the study. 130 patients from the Medicine OPD of Ramakrishna Mission Seva Pratishthan (RKMSP) and 100 healthy individuals were included in the study from March to July 2015.

Methodology: Brief clinical history was taken from all the subjects and  serum 25(OH)Vitamin D, Thyroid Stimulating Hormone (TSH), Thyroid peroxidise antibody (TPOab), Parathyroid hormone (PTH)  were estimated by Cobas e 601 Immuno assay auto-analyzer.

Results: 48.4% (63/130) of the screened patients were found to have AITD with elevated level of anti-TPO in their serum. The prevalence of vitamin D deficiency was significantly higher in patients with AITD compared to controls (Group I: 14.67±4.51; Group II: 11.26±2.8 vs Control: 28.66±8.3 respectively, p<0.0001). There was a significant inverse association between serum 25(OH)D and Hashimoto’s Thyroiditis established by the negative r values (Group I: r = -0.2 , p=0.03; Group II: r = -0.5, p=0.013 vs Control: r=0.07, p=0.48).

Conclusion: It has been demonstrated from this study that all the patients with Hashimoto’s Thyroid disorder had significantly low serum 25(OH)vitamin D suggesting its involvement in the pathogenesis of AITD.

Open Access Original Research Article

Modal and Vibration Analysis of Functionally Graded Dental Implant

Saeed Asiri

Journal of Advances in Medicine and Medical Research, Page 1-14
DOI: 10.9734/BJMMR/2016/22139

Dental implant is considered to be the best treatment when dealing with the loss of teeth. It gives beautiful results and can last longer than most of other treatments. Since the Osseo-integration period is a critical period for implant stability, so the used material for dental implant is one of the most factors affecting the stability and Functionally Graded Material (FGM) is one of the opportunities to improve it. The aim of this research is to carry out modal analysis and vibration analysis analytically for functionally graded Dental Implant. In this study several models for dental implant was analyzed by ANSYS15.0 APDL. The functionally graded material was considered in three models. The same materials, Ti-HA, where used in all of them but with different ratio in each. The natural frequency and mode shapes were extracted for all models. The frequency responses of functionally graded Dental Implant after performing a static analysis for each modal have been studied. It was noticed using modal analysis that all of the extracted results for FGM are vary between the two basic materials and it is affected by the concentration of each. It is firmly believed that FGM is the future of dental implant due to the ability of designing a specific material property to be more stable. A comparison of the materials that utilized in FGM when the ration of each 100% was performed as well as an evaluation for the classical dental implant. It is firmly believed that FGM is the future of dental implant due to the ability of designing a specific material property to be more stable.

Open Access Original Research Article

Neonatal Septicaemia in a Rural Nigerian Hospital: Aetiology, Presentation and Antibiotic Sensitivity Pattern

Ogundare Ezra Olatunde, Akintayo Akinyemi Akinsoji, Dedeke Iyabode Olabisi Florence, Okeniyi John Akintunde, Adeyemi Lateef Ademola, Ogunlesi Tinuade Adetutu, Oyelami Oyeku Akibu

Journal of Advances in Medicine and Medical Research, Page 1-11
DOI: 10.9734/BJMMR/2016/22325

Background: Neonatal Septicaemia (NNS) remains a major cause of morbidity and mortality in neonates despite advances in antimicrobial therapy, life support measures and the early detection of risk factors. This study aimed at determining the risk factors, aetiologic agents and antibiotic sensitivity pattern of NNS in Wesley Guild Hospital, Ilesa.

Methods: This was a prospective study involving 360 neonates admitted into Wesley Guild hospital, Ilesa over a period of seven months. Socio-demographic data and clinical characteristics of the neonates were collected using a standard proforma. Blood culture was done on admission and bacterial isolates were identified using standard procedures. Antibiotic susceptibility testing was done using disc diffusion method.

Results: The prevalence of neonatal septicaemia (NNS) was 16.0% in this study. Multivariate regression model of significant risk factors revealed prolonged labour (AOR 2.2(1.036 - 4.912) p=0.041) as the only independent risk factor for NNS. Staphylococcus aureus was the predominant isolate (70%). The case fatality rate from the study was 25%. Ciprofloxacin (86.7%), Cefuroxime (82.7%) and Ceftriaxone (81.3%) were the antibiotics with the highest sensitivity, while the infective organisms were most resistant to Cloxacillin (80%) and Ampicillin (77.3%).

Conclusion: Neonatal septicaemia remains a significant cause of neonatal mortality. S. aureus was the predominant bacterial isolate in this study. Cephalosporins should be considered as first-line antibiotics in its management. Prevention of preterm deliveries and encouraging good antenatal care and supervised deliveries will help in reducing the high incidence.

Open Access Original Research Article

The Evaluation of Laparoscopic Orchiopexy on the Treatment of Non-palpable Undescended Testes

Mamochehr Ghorbanpoor, Mohamad Ali Amirzargar, Amir Derakhshanfar, Amin Niayesh

Journal of Advances in Medicine and Medical Research, Page 1-5
DOI: 10.9734/BJMMR/2016/19375

Objectives: Cryptorchidism is the most frequent birth anomaly in boys with 2-5% prevalence in full term infants. This anomaly is associated with an increased risk of testicular cancer and infertility as well as hernia, testicular torsion, and psychological distress. Surgery is the main treatment for this anomaly. This study aimed to evaluate the therapeutic efficacy of laparoscopic orchiopexy in the treatment of non-palpable undescended testis.

Methods: Forty patients with a non-palpable testis were evaluated by laparoscopic orchiopexy in a hospital in Hamedan city, Iran, during 2006 to 2009. The average age of patients was 19±12.16 months old. The patients were followed up after the surgery and three months later to assess the response to treatment and the testicular atrophy.

Results: Thirteen patients did not have a testis in the laparoscopic investigation and six patients had testis located in the inguinal canal. So they were excluded from the analysis. Seventeen patients were treated by one-staged laparoscopic orchiopexy while four patients were treated by two-staged Fowler-Stephens laparoscopic orchiopexy. The success rate for the treatment was 100%.

Conclusion: Laparoscopic orchiopexy is a safe and effective method for the treatment of non-palpable undescended testis.

Open Access Original Research Article

Perception of Women about Implanon as a Contraceptive Method in Akure Western Nigeria

Theresa Azonima Irinyenikan

Journal of Advances in Medicine and Medical Research, Page 1-6
DOI: 10.9734/BJMMR/2016/22374

Background: Implanon is a single rod implant contraceptive with increasing popularity; however, different views have been expressed by women concerning its use.

Aim and Objective: The aim of the study was to evaluate family planning client’s perception and acceptance of implanon as a contraceptive method and the factors affecting its uptake.

Study Design/ Methodology: The study used a cross-sectional design consisting of 200 women who visited the family planning clinic of State Specialist Hospital, Akure in Ondo State, Western Nigeria between October and December 2014. Data were collected using self administered questionnaires after obtaining ethical clearance and the clients informed consents. The main outcome measured were awareness of implanon as a method of contraception, source of information about implanon, previous use of implanon and their willingness to accept implanon.

Results: The study showed that 54.5% were in the age bracket of 30-39 years and 96% were married. The majority of the women were educated with only 3.5% having no formal education. About 55% had less than 4 children while 45% had 4 or more children. In addition 60% of the women were Christians, 39% practiced Islam while 1% was of other religion. About 69% of the women were already aware of implanon as a contraceptive method with their health care providers being their major source of information. There was a significant association between awareness of implanon with its usage and the health care providers being the source of their information (X2=6.763, P=0.009 and X2 =17.672, P=0.000 respectively). Only 7% of the women had used implanon previously while 24.5% would consider implanon if offered but 75.5% would not. The reasons for this were that insertion and removal could be painful, that it involves a surgical operation and that their husbands may not approve of it.

Conclusion: The study showed increased awareness of implanon among our women but this may not translate into its use due to some misconceptions. The findings therefore suggest that additional strategies may be adopted such as the male partner involvement during counselling in order to enhance its use.

Open Access Original Research Article

Prevalence of ACS and Causal Relation of Hypomagnesaemia

Bina Nasim, Ahmed Sajjad, Zafar Khan, Zulfiqar Ali, Anis Sheikh, Tanvir Yadgir, Wajahat Khan, Omer Sakaf, Ghulam Yasin Naroo

Journal of Advances in Medicine and Medical Research, Page 1-5
DOI: 10.9734/BJMMR/2016/19850

Magnesium is an important intracellular cation [1], actually the second most abundant cation after Potassium, which has gained an essential role in normal human homeostasis. Low serum magnesium has been detected commonly in around 12% hospitalized patients and even more commonly in Intensive Care Patients as high as 60 to 65%.

The link of low serum magnesium with acute coronary syndrome is being discussed widely and its actual role is being scrutinized [2,3].

Recently, Hypomagnesaemia has also been found to play an important role in the pathogenesis of a variety of clinical disorders including Hypertension, Diabetes Mellitus, Atherosclerosis and Acute Coronary Syndromes [4-8].

Acute coronary syndrome (ACS) has been defined as a group of conditions due to decreased blood flow in the coronary arteries. Acute coronary syndrome includes a vast spectrum like: ST elevation myocardial infarction (STEMI / 30%), non ST elevation myocardial infarction (NSTEMI  / 25%), or unstable angina (U.A. / 38%).These are described according to ECGs  and Cardiac Biomarkers  of myocardial necrosis (troponin T, troponin I, and CK MB), in patients presenting with acute cardiac chest pain (Medscape).

Aim: To look for any association between Hypomagnesaemia and Acute Coronary Syndrome.

Materials and Methods: It’s a retrospective study involving 1198 patients who presented to the Accident and Emergency department (A & E), Trauma Center, Rashid Hospital, Dubai, with Acute Coronary Syndrome (ACS) between April 2010 and May 2013.

We reviewed the records of all patients including their clinical history and presentation.

The Magnesium levels of all the patients in the ACS pathway were checked along with, Cardiac biomarkers - Troponin, CPK and CK MB and Lipid profiles were also analyzed.

A Chi-Square test was performed at 5% level of significance to test the null hypothesis of no association between cardiac markers, lipid profile and magnesium level.

Inclusion Criteria: All new patients presenting to A & E Department at Rashid Hospital with an acute coronary syndrome (both NSTEMI & STEMI).

All new patients presenting with non-specific chest pain who test positive for cardiac markers.

All the age groups presenting to A & E Department at Rashid Hospital from 11/04/2010- 30/05/2013 were included. Both the genders were included.

Exclusion Criteria: Patients diagnosed initially with acute coronary syndrome that eventually had negative cardiac markers.

Results: Out of 1198, 1087(91%) patients were male. 49% were between 50 and 75 years of age group whereas 46% were between 25 years and 50 years of age. 77% patients were Asians and 17% belonged to Arabic peninsula. The Magnesium level was normal in 1097(92%), low in 63(5.3%). Troponin was negative in 431(36%) and positive in 767(64%) patients with low, medium and high levels in 338(28.2%), 426(35.5%) and 03(0.3%) respectively.

These results indicate that there is no statistically significant association between Magnesium levels and Troponin groups (positive and negative) (chi-square with two degree of freedom = 3.30, p = 0.192). 

Conclusion: Our study proves that there is no significant association between Hypomagnesaemia and Acute Coronary Syndrome.

Open Access Original Research Article

Comparison of Two Methods in Surgical Treatment of Varicocele: Laparascopic and Open Surgery

M. Ghorbanpoor, A. Derakhshanfar, A. Niayesh

Journal of Advances in Medicine and Medical Research, Page 1-7
DOI: 10.9734/BJMMR/2016/17338

Introduction and Objective: Varicocele is the loosening of testicular veins and the pump form venous channel within the spermatic cord. There are different treatments for varicocele, as open surgery, microsurgery, laparoscopy, sclerotherapy and other techniques. The purpose of this study was to compare the outcomes of laparoscopic and open techniques in the surgical treatment of varicocele.

Materials and Methods: In a randomized interventional study, 96 patients referring to the private or public hospitals of Hamedan were diagnosed to have Varicocele, and after filling the informed consent they were included in the study.  Patients with a confirmed diagnosis of Varicocele, were studied after filling the testimonial. Testicles size was measured by using vernie calipers in width and height and the patients underwent the analyzing of their semen fluid. The patients were randomly assigned into 2 groups (n = 48 per group).

Following-up the patients in order to assess any effects related to the treatment, such as wound infection, hydrocele, hematoma, and etc. lasted up to 1 month. Examining with regard to the recurrence or lack of examination of the form obvious clinical Varicocele was conducted, despite the treatment and related examines with infertility factors after 6 months. The assessment of the size of the testis and analysis of semen was done after 3 and 6 months. At the end of 6 months, the results were compared between the two groups. The collected data was analyzed using the indicators of frequency, mean, SD and in necessary cases were analyzed using t-test and paired t-test, and in cases of comparing qualitative data it was analyzed by using Chi-square test. The significance of the results were considered P ≤ 0.05.

Results: The semen analysis after 6 months, in all patients, indicated a significant difference in favor of the improvement of these factors after the surgery, in comparison with to the state before the surgery. These evaluations were performed separately in each group and in both laparoscopic and open groups a statistically significant difference was observed in favor of improving semen analysis factors. Changes in these factors before and after the surgery were compared in both groups and no significant statistical difference was observed. This means that both groups had no differences regarding the effect on fertility factors. No varicocele recurrence was reported within 6 months. Hospital stay was had no significant differences between the two groups. Also, no significant difference was observed between the two groups, regarding the effects associated with surgery.

Conclusions: Open and laparoscopic varicocelectomy surgeries have approximately equal post-surgery consequences, regarding improved parameters of semen liquid and post-surgery effects. However, further research with larger sample size and longer follow-up period is required so that with greater certainty, we could judge about the advantages and disadvantages of the two methods.

Open Access Original Research Article

Hemorrhagic and Non-hemorrhagic Pituitary Apoplexy: Clinical Analysis

Daxa M. Patel, Joseph H. Miller, Nidal B. Omar, Don E. McCormick, Esther Dupépé, Soni Srivastav, T. Brooks Vaughan III, Kristen O. Riley

Journal of Advances in Medicine and Medical Research, Page 1-9
DOI: 10.9734/BJMMR/2016/22130

Objective: The diagnosis of hemorrhagic versus non-hemorrhagic pituitary apoplexy can be difficult as both the clinical presentation and radiographic appearance can be variable. Early identification and treatment of these patients is essential to prevent poor outcomes. This study identifies clinical characteristics of hemorrhagic and non-hemorrhagic pituitary apoplexy.

Methods: 311 consecutive patients admitted with pituitary tumors were reviewed for clinical and radiographic evidence of pituitary apoplexy. Patient demographics, comorbidities, clinical presentation, tumor characteristics, surgical therapy, complications, and outcomes were analyzed for both groups. A cohort statistical analysis was performed using Chi square, Fisher exact test, and t-test.

Results: Patients with hemorrhagic (n = 23, 57.5%) and non-hemorrhagic (n=17, 42.5%) pituitary apoplexy were similar except the hemorrhagic cohort was older (mean age 51.5 versus 40.6, p=0.03) and more hypertensive (n=16, p=0.03). Thirty-seven patients underwent surgical decompression for their pituitary apoplexy symptoms either through transcranial or endoscopic approach. There was no statistically significant difference between hemorrhagic (n=16, 43.2% endoscopic; n=4, 10.8% transcranial) and non-hemorrhagic (n=16, 43.2%, endoscopic; n=1, 2.7%, transcranial; p=0.22) apoplexy cohorts. Risks of post-operative complications were similar in both hemorrhagic (n=5: RR 1.13, 95% CI 0.59-2.1) and non-hemorrhagic cohorts (n=3: RR 0.84, 95% CI 0.31-2.3). Achievement of a good functional outcome as measured by modified Rankin scale better than 4 at last follow-up was not statistically different among cohorts (p = 0.74).

Conclusions: Hemorrhagic and non-hemorrhagic pituitary apoplexy are similar clinical entities that require prompt surgical decompression of the optic apparatus and medical therapy aimed at treating acute adrenal insufficiency.

Open Access Original Research Article

Prevalence and Antibiotic Susceptibility Pattern of Pathogens Isolated from Post-Operative Wounds of Diabetes Mellitus Patients in Uyo, Nigeria

Sunday O. Awofisayo, Ekaete D. Nkanang, Nkechinyerem A. Jonathan

Journal of Advances in Medicine and Medical Research, Page 1-8
DOI: 10.9734/BJMMR/2016/21585

This study was aimed at investigating the prevalence and antibiotic susceptibility of isolates from wounds of diabetic and non diabetic patients in University of Uyo metropolis. Eighty five wound swab samples were collected from the culture bench of University of Uyo Health Center and three neighboring hospitals. The isolates were characterized and identified using standard microbiological methods. The antibiotic susceptibility pattern was determined using the disc diffusion method. Oral interview was conducted on patients to ascertain their medical history and samples taken to conduct HbA1c test at the time of wound swab collection. Out of the samples collected, 62.5% were infected with bacteria (80% Gram negative and 20% Gram positive) featuring frequency of occurrence percent of Staphylococcus aureus (28.8%), Pseudomonas spp. (33.1%), Escherichia coli (25.0%), Proteus spp. (8.3%) and Klebsiella spp. (2.6%). There was significant difference in the antibiotic sensitivity of S. aureus to ciprofloxacin and ofloxacin comparing the two groups. Similarly, there was significantly lower sensitivity to ofloxacin shown by E. coli and Klebsiella spp. in the DM group compared with the control. There were no significant differences in the antibiotic sensitivities of the isolated organisms for the cephalosporin and aminoglycoside antibiotics. The study showed that isolates from SWI demonstrated significant differences in susceptibility to fluoroquinolones but no differences to the aminoglycoside and cephalosporin antibiotics based on the glycaemic levels.

Open Access Review Article

Biologics and Biosimilars: Differences and Clinical Implications

Canna Jagdish Ghia, Gautam Rambhad, U. R. K. Rao

Journal of Advances in Medicine and Medical Research, Page 1-7
DOI: 10.9734/BJMMR/2016/21588

Biologics or biopharmaceuticals are drugs derived from living organisms by recombinant technology. Biologics have made a significant contribution to the management of certain chronic diseases such as cancer, rheumatoid, arthritis, ankylosing spondylitis, psoriasis and other immune mediated disorders. Biologics are produced by genetically modifying cells and, are highly complex and expensive to manufacture. Many of them are now facing patent expiry which has paved the way for the development of biosimilars. Biosimilars are biologic medicine that is similar in terms of quality, safety and efficacy but not the same as a registered innovator biologic. The manufacturing of biosimilars has many complexities, such as consistency of manufacturing process, conformation of manufacturing standards and demonstration of product consistency Also, powered clinical trials have to be executed to demonstrate similarity to the innovator biologic. Registration of biosimilars requires a more stringent evaluation than that is required for conventional generics. Biosimilars have the potential to be the molecules of the future as long as they are developed strictly in accordance with comparative procedures mandated by regulatory authorities such as EMA and USFDA. It is believed that the advent of biosimilars will improve patient access to expensive biologics for chronic illnesses. However, it is important that clinicians distinguish between innovator biologics and biosimilars. Physicians should avoid substituting biosimilars for innovators as well as avoid interchangeability as biosimilars are not generics. In addition, pharmacovigilance will be the need of the hour to track down any safety and efficacy problems arising from the use of biosimilars.