Open Access Case Study

Bone Necrosis in a Rheumatoid Arthritis Patient Secondary to Palatal Rotational Flap: A Practical Surgical Approach

Sertac Aktop, Guhan Dergin, Bedrettin Cem Sener, Kamil Goker

Journal of Advances in Medicine and Medical Research, Page 1-5
DOI: 10.9734/BJMMR/2016/24976

Aims: To present failed rotational palatal flap of a severe rheumatoid arthritis patient with a chronic oroantral fistula and a practical surgical method to deal with the systemic outcomes.

Presentation of Case: Bone necrosis at donor site in closure of oroantral fistulas with palatal rotational flap is known to be very rare. We present a 57 years old female, rheumatoid arthritis patient under Methotrexate medication, with a chronic oroantral fistula in the left first molar region. Bone necrosis has been shown at the donor site after full thickness palatal rotational flap procedure. The treatment approach and alternative methods are discussed. Bone necrosis on the donor site has been treated with the re-rotation of the palatal rotational flap tissues, but this time with partial thickness to its original position. Successful healing has been achieved.

Discussion and Conclusion: The result of this approach could help practitioners challenging with rheumatoid arthritis caused healing problems and oroantral fistulas.

Open Access Data Article

Trends in Pseudomonas aeruginosa Antibiotic Resistance: Case Study from a Portuguese Central Hospital

Sónia Gonçalves Pereira, Margarida Marques, João Pereira, Olga Cardoso

Journal of Advances in Medicine and Medical Research, Page 1-17
DOI: 10.9734/BJMMR/2016/23085

Aims: P. aeruginosa antibiotic resistance is increasing worldwide, greatly limiting therapeutic options, and is mainly associated to nosocomial infections, relating to high morbidity and mortality outcomes. Frequently updated regional guidelines, supported in statistically valid longitudinal information, are mandatory.

Methodology: Resistance to 11 antibiotics used to treat P. aeruginosa infections were surveyed in clinical isolates from a Portuguese central during 10 years (n=3778) using the MicroScan WalkAway system. Statistical analysis (Mann-Whitney tests and regression modeling) were used to determine its time evolution according to origin, specimen samples and hospital wards.

Results: Total resistance rates fluctuated between 77.9% (ciprofloxacin), and 28.6% (amikacin and piperacillin with tazobactam). Statistical analysis revealed an increase over time for the majority of the resistance rates according to origin, specimen samples and wards of collection. Several trends were best fitted to positive power or quadratic regression models, predicting even higher overall resistance rates in the near future. Few resistance trends were best fitted to negative models, indicative of a possible decrease in the future, which is positive but reflects the discrepant success of empirical antibiotic prescription regimens in different wards from the same hospital.

Conclusion: These results, apart from indicating that the studied hospital can significantly improve its prescription policy, prove the importance of specific and local longitudinal studies of resistance trends over time to further drug prescription strategies. Similar biostatistic analysis should be performed in other hospitals and regarding other pathogens to broaden this awareness, necessary for the improvement of empirical antibiotherapy regimens.

Open Access Short Research Article

The Prevalence of Eyelid Myokymia in Medical Students

Sanela Hadžić, Ismir Kukić, Jasmin Zvorničanin

Journal of Advances in Medicine and Medical Research, Page 1-6
DOI: 10.9734/BJMMR/2016/24910

Aims: To determine the prevalence and factors associated with eyelid myokymia (EM) in students attending Medical faculty.

Study Design:  Cross sectional survey.

Place and Duration of Study: Medical faculty University of Tuzla and Department of Ophthalmology University Clinical Centre Tuzla, between December 2015. and January 2016.

Methodology: We included 100 medical students, randomly selected by staff employed in student service of Medical faculty, from the list of students registered for different exams in December 2015. Before the survey all participants were informed about the signs and presentations of eyelid twitching and its possible significance. The survey was performed before and after the exams with students of third, fourth and fifth study year. It consisted of 18 questions regarding the presence of eyelid twitch, and influence of various factors on its frequency and intensity.

Results: Forty four percent of students had signs of eyelid myokimia (EM) during short period of 7 days before the exams. Female students were more likely to have EM than male students (OR 2.46:1). Students of fifth study year were at more risk for development of EM than students of fourth and third year respectively (OR 1:1.5:2.67). Energy drinks consuming was a significant predictor for EM occurrence (P=.046). Students who reported to have reduced sleep during exam preparation have significantly more often symptoms of EM (P=.014) as well as individuals who claim to have been exposed to a greater amount of stress (P=.042).

Conclusion: Eyelid myokymia is relatively common phenomenon among students of Medical faculty. It has higher incidence before exams, during the period of intense studying.

Open Access Original Research Article

Correlation of Human Fasting Blood Sugar with Grip Muscle Strength and Reflex Response Time

O. M. Odigie, A. O. Naiho, E. K. Nwangwa, E. M. Aisuodione, J. C. Igweh

Journal of Advances in Medicine and Medical Research, Page 1-10
DOI: 10.9734/BJMMR/2016/22696

In humans, one of the major complications of chronic Diabetes Mellitus (DM) is Peripheral Neuropathy. Apparently linked to ischemic Nerve damage, a ravaging puzzle on its pathophysiology, onset prediction, and prognosis is yet to be fully uncovered. Today, what seems to be a major “breakthrough” is the discovery that chronic DM damages signal transduction across Nerve and Muscle tissues, leading to a bad and/or poorly coordinated reflex. The goal of this study was to find in humans, the relationship that binds fasting blood sugar (FBS) with grip muscle strengths and reflex response time. To achieve this, 387 humans were ethically sourced from Ethiope East Local government area of Delta State, Nigeria. Based on their glucometer readings, subjects were then gender-sorted and classified into 3 groups; A (hypoglycaemic), B (normoglycaemic or control), and C (hyperglycaemic). Using the hand-grip dynamometer (HGD) and Meter rule, subjects’ Grip Muscle strengths (GMS) and Reflex Response times (RRT) were respectively obtained and mapped against their corresponding glucometer reading (FBS). Using the Pearson Product moment correlation coefficient, Statistical measure of association (correlation) was conducted on obtained variables, and ANOVA was used to analyse the differences between means of each groups. Though no actual difference(s) was/were found between GMS and RRT, apparently, there was a weak Auditory-FBS relationship in hypoglycaemic females, and a weak GMS-FBS, plus Tactile-FBS correlations in hypoglycaemic males and females respectively.

Open Access Original Research Article

Evaluation of Osteopontin in Combination with Bone Turnover Markers for the Assessment of Osteoporosis in Postmenopausal Women

Sara Reza, Asma Shaukat, Maria Mahmud, Tariq M. Arain, Umama Reza, Faryal Waheed

Journal of Advances in Medicine and Medical Research, Page 1-11
DOI: 10.9734/BJMMR/2016/24738

Aims: Osteoporosis, a disease characterized by low bone mass and microarchitectural deterioration of bone tissue, has an important impact on the lives of postmenopausal women, owing to the increased risk of fractures. Although bone mineral density (BMD) is the standard criteria used for the diagnosis of osteoporosis, but BMD provides a slow and static picture of skeleton whereas, the biochemical markers of bone turnover (BTM) can provide dynamic status of bone remodeling and rapid measurement of skeletal metabolism. Osteopontin (OPN), a glycoprotein has been implicated in bone remodeling by activating the resorption process. Combination of osteopontin with classical bone turnover markers can enhance the confidence of detecting osteoporosis and predicting fracture risk.

Study Design: Cross-sectional study.

Place and Duration of Study: Department of Pathology, Quaid-e-Azam Medical College, Pakistan from 1st July 2015 to 15th September 2015.

Methodology: We included 120 females (60 postmenopausal, age >45 years and 60 from childbearing age 25-45 years) and excluded all conditions affecting bone metabolism. Enzyme-linked immunosorbent assay technique was used to measure levels of bone markers in serum.

Results: Bone markers were significantly higher in postmenopausal group of patients. Osteopontin was found to be positively correlated with osteocalcin (r=0.82), bALP (r=0.76), CTX (r=0.62) and DPD (r=0.49) and it was negatively correlated with BMD lumbar spine (r= -0.71) indicating a significant correlation (p<0.0001). The osteopontin and osteocalcin combination showed highest sensitivity (94%) and specificity (88%), closely followed by that of osteopontin and bone alkaline phosphatase combination.

Conclusion: High levels of osteopontin in postmenopausal women are associated with low BMD, raised levels of bone turnover markers and fractures. When used in combination with other bone turnover markers, it can provide an accurate assessment of osteoporosis and fracture risk.

Open Access Original Research Article

The Effects of Enamel Matrix Proteins and Dentin Collagen on the Attachment of Periodontal Ligament Cells

Sema Becerik, Şule Sönmez, Bilge Hakan Şen, Evren Evrenosoğlu, Ismet Deliloğlu Gürhan

Journal of Advances in Medicine and Medical Research, Page 1-8
DOI: 10.9734/BJMMR/2016/24584

Background: The aim of this study was to evaluate the effect of enamel matrix proteins (EMP) and dentin collagen on the attachment of periodontal ligament cells to the root surfaces.

Methods: Eighty-four root slices were obtained from forty-two lower anterior teeth that had been extracted due to the periodontal disease. The root slices were subjected to one of the following treatments: 1) control group 2) EDTA demineralization + EMP, 3) dentin collagen, 4) EDTA demineralization + dentin collagen. Periodontal ligament (PDL) cells (105/ml) were seeded and incubated for two hours on surfaces of the roots in each group. Following the incubation the numbers of the attached cells were calculated by colorimetric assay and the morphologies of the cells were evaluated by scanning electron microscopy (SEM). One-way ANOVA was used for statistical analysis (p=0.05).

Results: No significant difference was found among the groups regarding the number of attached cells (p>0.05). However, the mean number of the attached cells was highest in the 2nd Group (EDTA demineralization + EMP), while it was lowest in Group 3 (dentin collagen). SEM evaluation of the dentin specimens revealed that the EMPs treated specimens exhibited elongated fibroblasts with filopodial extensions while the cells in the control and dentin collagen treated groups were round with thin and short filopodia.

Conclusion: In this study, the EMPs were found effective in the attachment of cells on the root surface when compared to dentin collagen.

Open Access Original Research Article

Study on Self-medication Practices among University Students of Bangladesh

Taniya Idris, Sayema Khanum, Md. Sahab Uddin, Md. Asaduzzaman, Muhammad Ashiqul Islam, Fatema Nasrin, Syed Shabbir Haider

Journal of Advances in Medicine and Medical Research, Page 1-8
DOI: 10.9734/BJMMR/2016/24364

Aims: To know how much knowledge and awareness university students of Bangladesh have about commonly used medicines.

Study Design: The study was conducted on 1200 students randomly selected from 9 university of Bangladesh, in which 87.5% were master’s student and remaining 12.5% were honor’s students. Each willing participant shared their opinion.

Place and Duration of Study: Dhaka University (DU), Jahangirnagar University (JU), Eastern University (EU), East West University (EWU), Daffodil International University (DIU), North South University (NSU), International Islamic University Chittagong (IIUC), University of Information Technology & Science (UITS) and University of Science & Technology (USTC), Bangladesh, from May to July 2012.

Methodology: Questionnaires were distributed among the students, information about students and knowledge about self-medication practices of medicine was determined.

Results: The present study revealed that most frequently used medicine was analgesic/antipyretic (58.75%), followed by antiulcerants (40.17%), antibiotics (18.17%), antihistamines (10.58%) and antitussive (9.33%). 54.5% students took analgesic/antipyretic based on self-decision, followed by 49.83% antibiotics, 43.5% antiulcerants, 46.83% antitussives and 31.08% antihistamines respectively. Based on retailer advice 25% students took antimicrobials. 47.83% students said that they took antibiotics because of fever, 27% said the reason was infection, 13.58% took antibiotics because of GI disease and 12.5% mentioned others. 67.67% had no idea about side effect of antibiotics, followed by 53.17% for analgesic/antipyretic, 53.2% for antihistamine, 47.75% for antitussives and 28% for antiulcerants.

Conclusion: Self-medication was practiced with a range of drugs from the analgesic/antipyretic to antibiotics. Most of the students didn’t know about the side-effects of these medicines as well as the antibiotics resistance. Although the practice of self-medication is unavoidable; drug authorities and health professionals need to educate students about the health hazards of self-medication.

Open Access Original Research Article

In silico Studies on Plant Derived Rutin as Potent Agonist of Peroxisome Proliferator-activated Receptor Gamma (PPARγ)

Olusola Olalekan Elekofehinti

Journal of Advances in Medicine and Medical Research, Page 1-8
DOI: 10.9734/BJMMR/2016/23813

Aims: Peroxisome proliferator-activated receptor gamma (PPARγ) agonists are beneficial in the management of diabetes by increasing insulin sensitivity and inhibiting hepatic gluconeogenesis. The aim of the present study was to investigate PPAR-γ agonist property of rutin, a flavonoid found in many plant species compared to thiazolidenediones (TZDs) using in silico approach.

Methodology: Molecular docking of rutin on human PPAR-γ protein was determined by Vina plugin in PYMOL 1.3 and compared with thiazolidinediones, a known agonist of PPARγ.

Results: Rutin acts as a potential agonist with binding energy of - 7.8 kcal/mol compared to thiazolidinediones with binding energy of - 4.1 kcal/mol. The molecular interaction of rutin was at residues of GLU 319, ILE 369, LEU 368, MET 362, PHE 321, PHE 310, LEU 497, ALA 320, LYS 289, ILE 354.

Conclusion: We conclude that rutin is a better PPARγ agonist than TZDs confirming the capability of rutin for binding at the active site of the PPARγ.

Open Access Original Research Article

Evaluation of Total Phenolic Content and Antioxidant Activity of Three Leaf Extracts of Ziziphus spina-christi (Sedr) Grown in Jordan

Sabah M. J. Khaleel, Adnan S. Jaran, Malik S. Y. Haddadin

Journal of Advances in Medicine and Medical Research, Page 1-8
DOI: 10.9734/BJMMR/2016/24935

Aims: The primary aims of this study were to evaluate the total phenolic content and In vitro antioxidant activity of three different leaves extracts (methanolic, ethanolic and aqueous) of Ziziphus spins-christi grown in Jordan.

Methods: Total phenolic content of the methanolic, ethanolic and aqueous extracts of the leaves of Ziziphus spins-christi was determined spectrometrically according to the Folin-Ciocalteu procedure. The antioxidant activities of the leaves extracts of this plant at different concentrations were determined by 1,1-diphenyl-2-picryl-hydrazyl (DPPH) scavenging activity and reducing power methods. All the analyzes was made with the use of UV-Visible spectrophotometer, and ascorbic acid was used as a standard antioxidant.

Place and Duration of Study: Department of Biological Science, Al-Bayt University, Al Mafraq, Jordan. Department of Nutrition and Food Technology, University of Jordan, Amman, Jordan, from April 2015 to December 2015.

Results: The total phenolic content was ranged between 11.8 to 52.5 mg/g expressed in terms of Gallic acid equivalent (mg of GAE/g extract). In vitro antioxidant activity of the plant extracts revealed that all the extracts showed good antioxidant power with IC50 values of 21.4, 24.2 and  54.3 μg/mL for methanolic, aqueous and ethanolic extracts, respectively. The reducing power of the extracts was found to be concentration dependent. The results of this study revealed that, the methanolic extract of leaves showed the highest phenolic concentration and largest antioxidant activity.

Conclusion: From this study it may be concluded that Z. spina-christi leaves could have potential source of antioxidants for pharmaceutical drug preparations.

Open Access Review Article

Role of Genes in Odontogenesis

Rahul Doshi, Urvi Kulkarni, Siddhart Shinde, Anand Sabane, Amol Patil

Journal of Advances in Medicine and Medical Research, Page 1-9
DOI: 10.9734/BJMMR/2016/24323

With the discovery of the homeobox genes in craniofacial biology researchers across the globe have studied in depth the genetic patterning of the craniofacial region. With respect to craniofacial development –, Barx, Dlx, Gsc, Lim, Msx, Otx, Prx; part of the Hox cluster are important. Barx gene are strongly expressed only in the mesenchyme of the developing molars. Dlx gene expression is noted in the mandibular and maxillary arch ectomesenchyme. Msx genes are expressed in the area of epithelial mesenchymal interactions in the brachial arches in the area of future dentition and also expressed in the formation of skull, facial primordial and sense organs. Msx-1 is seen to be expressed in various stages of tooth formation i.e bud and cap stage of organogenesis. Lim genes which control morphogenesis of the first brachial arch, are expressed in the maxillo-mandibular ectomesenchyme. Prx gene expression is seen in the proximal portion of the mandibular arch. The role of hox genes in the morphogenesis of the jaws and the dentition is immense. Thus it has been proved beyond doubt that the genes have a major role in organogenesis than what human beings have ever envisaged. This review will give the scientific community an overview of all the genes affecting odontogenesis.