Open Access Case Study

Anterior Maxilla Rehabilitation with Implants, Subepithelial Connective Tissue and Alloplastic Bone Grafts: A Case Report

André Gustavo Paleari, Cristina Dupim Presoto, Gabriela Mayara Oliveira Nascimento, Luiz Antônio Borelli Barros, Ana Carolina Pero, Marco Antonio Compagnoni

Journal of Advances in Medicine and Medical Research, Page 1-6
DOI: 10.9734/BJMMR/2017/30770

The prosthetic rehabilitation of anterior teeth with osseointegrated implants is still a challenge in implantology. To avoid aesthetic complications in areas with bone or mucosal defects, it is often necessary to use bone and soft tissue grafts with the implants. This article describes the surgical and prosthodontic approach to such a patient where removal of the maxillary central incisors was performed and implants were immediately placed. To avoid the loss of bone and mucosal tissues, alloplastic bone graft and subepithelial connective tissue grafts were used. The prosthetic phase of treatment was performed after the period of osseointegration period, allowing for aesthetic harmony between the prosthesis and gingival tissue.

Open Access Original Research Article

Risk Factors of Genital Tract Lacerations at Yaoundé Central Hospital - Cameroon: A Case Control Study

Florent Ymele Fouelifack, Félix Essiben, Lovlyne Tchoutouo Kemadjou, Jeanne Hortence Fouedjio, Jovanny Tsuala Fouogue, Robinson Enow Mbu

Journal of Advances in Medicine and Medical Research, Page 1-8
DOI: 10.9734/BJMMR/2017/31020

Background: Genital tract lacerations are lesions resulting from breakage of continuity of the lower genital tract during birth. This includes precisely the cervix, vagina, vulva and perineum. Genital tract lacerations are common causes of maternal morbidity and mortality. A good knowledge of risk factors can prevent complications.

Aim: Our general objective was to determine the risk factors for genital tract lacerations.

Study Design: Case-control study.

Place and Duration of Study: Five months (from January 2015 to May 2015) at the Obstetrics and Gynecology Unit of Yaoundé Central Hospital.

Methodology: Once identified, women who had suffered genital tract lacerations were interviewed, after which they underwent physical examination aimed at identifying the laceration site and type. We paired these women to those of same age and parity who did not have genital tract laceration (control group). Data were collected using a questionnaire and analyzed with Epi info software version 3.5.1 with a significance level of P< 0.05.

Results: Out of 1250 deliveries, 150 women had genital tract laceration, giving the prevalence of 12%. But we excluded 14 and retained 136 women as cases. Perineal tears accounted for 92.6% of genital tract lacerations, cervical tears 8.8% and vaginal tears 7.4%. Maternal risk factors were: past history of perineal tear (OR=5.05; 95% CI :1.9-13.7; p=0.00), length of the perineum < 4 cm (OR=33.72; 95% CI:17.2-66.02; p=0.00), duration of expulsion < 30 minutes (OR=3.16; 95%CI:1.9-5.2; p=0.00) and duration of active phase of labor < 6 hours (OR=5.01; 95% CI:2.8-8.9; p=0.00). Iatrogenic risk factors were: induction of labor (OR=9.57; 95% CI: 2.1-42.1; p=0.00) and augmentation of labor (OR=3.79; 95%CI: 2.1-6.6; p=0.00). The only fetal risk factor was birth weight >4000 g (OR=7.32; 95% CI:1.8 - 60; p=0.03).

Conclusion: Prior to delivery and in order to prevent trauma to the genital tract, the following risk factors should be sought out for: past history of perineal tears, perineal lengths less than 4 cm, duration of the active phase of labour less than 6 hours, induction and augmentation of labor with newborn birthweights of more than 4000 g and expulsive phases lasting less than 30 minutes.  Also, care providers are advised to perform episiotomies in women presenting these risk factors.

Open Access Original Research Article

Family Risk of Metabolic Disorder; A Parameter for Timely Screening of Vascular Endothelial Health

Preeti Kanawjia, Sunita Tiwari, Manish Bajpai

Journal of Advances in Medicine and Medical Research, Page 1-10
DOI: 10.9734/BJMMR/2017/31004

Aim: To study the correlation of vascular endothelial health with family risk of metabolic disorders, in healthy overweight, obese and non obese subjects.

Study Design: A case-control (pilot) study.

Place and Duration of Study: The study was conducted in Cardiovascular Physiology lab, Department of Physiology, K.G.M.U from January 2009 to February 2010.

Methods: Cases and controls comprised of 30 overweight/obese healthy subjects (BMI >= 25 kg/m2 and/or WHR (female>0.85; male>1) and 30 non-obese healthy subjects respectively (BMI< 25 kg/m2 and/or WHR (female<0.85; male<1) excluding subjects with secondary cause of abnormal blood flow. Vascular endothelial health was assessed via reactive hyperemic response measured via impedance plethysmography in the subject’s forearm. Fasting plasma glucose and serum lipid profile was also done.

Results: On comparison of biochemical variables, lipid derangement was recorded in both the groups.  Significant difference in VLDL (control 21.84±9.68, case 29.01±16.83) (p=0.048) and TG (control 101.22±-43.33; case145.21±84.02) (p=0.013), could be seen. VLDL & TG was deranged in 15 (6 cases + 9 controls) (P=0.371) and 14 (5 cases + 9 controls) (P=0.222) subjects respectively with no inter-group significant statistical difference. Inter-group reactive hyperemia at 1, 2, 3, 5, 7, 9 min post occlusion time showed no significant difference. Peak hyperemic response was seen at 2 minutes in both the groups. Though independent family history in first degree relatives of diabetes, coronary artery disease and/or hypertension showed a significant association with % RH at 2 min. (P=0.049), yet in group wise exploration, no significant association was seen.

Conclusion: Adverse anthropometry is universally not associated with deranged lipid profile and vice versa. Raised RH response associated with positive family risk could be either due to hyperinsulinemia and/or some yet undeciphered cause but not solely as add-on sequelae of deranged anthropometry (BMI & WHR).

Open Access Original Research Article

Staged Treatment for Childhood Obesity in a Medical Home: A Feasibility Study

Linessa Zuniga, Stephanie A. Marton, Heidi Schwarzwald, Angelo P. Giardino, Sarah E. Barlow

Journal of Advances in Medicine and Medical Research, Page 1-8
DOI: 10.9734/BJMMR/2017/31527

Introduction: In 2007, a committee of experts made evidence-informed recommendations for the treatment of childhood obesity that proposed a stepwise approach to treatment of overweight and obese children. The aim of this study is to assess the feasibility and efficacy of a staged intervention for obese and overweight children in a large medical home.

Methods: A staged intervention approach to treating childhood obesity was implemented for patients enrolled in a large Medicaid managed care organization in Houston, Texas. Patients were eligible if they were between the ages of 7 and 13 years and had a BMI greater than the 85th percentile. After one year, patients EMR was reviewed to compare final & initial BMI as well as patient participation.

Results: 51 children were enrolled over a period of 3 months. Participation was low with only 18% of all completed problem-oriented visits focusing on healthy weight counseling (stage 1). Despite a high acceptance rate for enrollment into the Keep Fit classes (stage 2), patients did not continue to attend classes over the course of the year, on average attending only 21% of scheduled classes. The stage 3 group program was not offered. There was no improvement in BMI status and no relationship between the frequency of documented weight counseling and BMI change.

Discussion: Exposure to the planned program was low and thus we were unable to ascertain the efficacy of a staged intervention for childhood obesity. In assessing feasibility, there are several reasons that could explain the high rate of attrition, including scheduling conflicts, lack of transportation, and poor motivation.

Open Access Original Research Article

Prevalence of Rotavirus Infection in Infants and Young Children with Gastroenteritis in Two North-East States, Nigeria

Samuel O. Oyinloye, John Idika, Mahdi Abdullahi, Mohammed A. Lawan, Abdulrazak Dahiru, Aisha Salihu

Journal of Advances in Medicine and Medical Research, Page 1-7
DOI: 10.9734/BJMMR/2017/22773

Introduction: Rotavirus, is an eleven segmented double stranded ribonucleic acid virus in the family of Reoviridae, and is a leading cause of gastroenteritis among infants and young children.

Aims: This study was aimed at conducting a preliminary survey of rotavirus antigen in diarrheic stool of children (< 5 years) in Taraba and Yobe states in Nigeria to determine the prevalence. 

Methodology: One hundred and fifty children, each, in two north east states (Taraba (TR) and Yobe (YB) Nigeria with acute diarrhea were selected by random sampling in a cross-sectional, hospital-based study. Fifty two non-diarrheic and three hundred diarrheic tool samples from children less than five years old were assayed for rotavirus antigen by enzyme linked immunosorbent assay (Cortez Diagnostic Automation, Inc, USA) kit. Demographic data of the children were collected and result analysed using chi-square.

Result: All non-diarrheic stool (n=52) were negative for rotavirus antigen while of the total of 300 children sampled, overall prevalence of 4.0% and 9.3% were obtained in Taraba (mean age = 25.85months) and Yobe (mean age = 25.65months) respectively. Type of toilet used in both states was a factor in infection (TR p=0.007; YB p=0.00004). There was preponderance of infected male over female children in both states but this was not significant (p=0.55; p=0.48). Also, the source of drinking water had no significant effect on the prevalence of infection in both states (TR: p=0.177; YB: p=0.134). Playing with toys was found to serve as a predisposing factor of infection in Yobe state only (p=0.001).

Conclusion: The result of this study shows that rotavirus is a significant aetiologic agent of diarrhea among infants and young children in the study area. Public enlightenment on the predisposing factors to infection should be emphasized in order to mitigate transmission. Also, determination of the circulating genotypes in the study area is recommended.

Open Access Original Research Article

Prevalence, Isolation and Detection of Virulent Gene in Escherichia coli from Duck

Showmitra Majumder, Most. Mousumi Akter, Md. Monowarul Islam, Khalid Hussain, Shobhan Das, Imam Hasan, K. H. M. Nazmul Hussain Nazir, Marzia Rahman

Journal of Advances in Medicine and Medical Research, Page 1-8
DOI: 10.9734/BJMMR/2017/32003

Aims: This study was conducted to determine virulent genes in Escherichia coli prevalent in duck population by multiplex Polymerase Chain Reaction.

Methodology: A total of 60 cloacal swab samples were collected from two duck farms of Bangladesh Agricultural University and Shamvuganj. Initially the samples were screened for the detection of E. coli on the basis of cultural, staining and biochemical properties, followed by molecular detection of E. coli using genus specific primers to amplify 16s RNA.

Results: According to the results, out of 60 samples, 26 (43.33%) were confirmed to be E. coli positive. Among the E. coli positive samples, 12 (46.15%) samples were found positive for Stx-1 and 11 for Stx-2. Among 26, 11 (42.31%) samples possess both Stx-1 and Stx-2 genes, whereas only one isolate had Stx-1 gene. The prevalence of both Stx-1 and Stx-2 in Bangladesh Agricultural University Poultry Farm was 41.66%, and the prevalence of Stx-1 and Stx-2 in Shamvuganj was 50% and 42.86%, respectively.

Conclusion: This is the first report on the detection of virulence genes in E. coli of duck origin in the context of Bangladesh. This study indicates that duck may play role for the transmission of Shiga-like toxin producing E. coli (STEC) to human or its environment through fecal contamination or eggs or meat.

Open Access Review Article

Papillary Thyroid Cancer: A Histopathological Review in Accra, Ghana

E. M. Der, S. B. Naaeder, J. N. Dakubo, R. K. Gyasi

Journal of Advances in Medicine and Medical Research, Page 1-9
DOI: 10.9734/BJMMR/2017/31822

There is paucity of information on papillary thyroid cancer (PTC) in Ghana. The aim of this study was to determine the relative proportions of thyroid malignancies diagnosed in our institution that were PTC, the trend and the clinico-pathological characteristics.

Materials and Methods: A review of all thyroid malignancies diagnosed in our department from January 1994 to December 2013 was conducted. Data was entered and analysed using SPSS software (Version 23 Chicago).

Results: Papillary thyroid cancer was the commonest thyroid malignancy (52.7%). There was a gradual decline in the numbers of cases during the period under review. Approximately 60.3% of the patients were younger than 40 years. The great majority (77.6%) were females with a female to male ratio of 4:1. Four patients (4) presented with symptoms of metastatic disease (headache in 2; pathological fracture of the femur in 1; and dysphagia - 1). Many of the patients (62.9%) presented after 2 years with large anterior neck swelling. PTC was commonly diagnosed in total thyroidectomy specimens (43.1%). Follicular variant of PTC was the commonest histological subtype (75.6%). Lymphovascular invasion was found in approximately 16.4% of the cases. Nine of the cases (7.8%) showed extra-glandular involvement.

Conclusion: The study found papillary thyroid cancer to be the commonest thyroid malignancy. There was a gradual decline in the number of cases over the period of study. Many of the patients were younger than 40 years of age and presented late with large palpable neck swellings. Approximately, 4.3% of patients presented cases with metastatic disease.