Open Access Case Report

Acute Psychosis as Clinical Manifestation of Tuberculous Meningitis

Durgesh Pushkar, M. L. Patel, Rekha Sachan, Ravi Misra

Journal of Advances in Medicine and Medical Research, Page 1-5
DOI: 10.9734/BJMMR/2017/31747

A young female was admitted with complaint of low grade fever, loss of appetite and fluctuating behaviour from the past two week. There was no history of any seizures, loss of consciousness, tuberculosis or any psychiatric illness. On examination the patient was apathetic, drowsy and her Glasgow Coma Scale was 13/15(E4V3M6). The patient was bed ridden and most of the time she use to sleep with occasional interruptions by episodes of agitation. No bladder bowel involvement was present. Motor system examination revealed grade 4/5 power in all four limbs with normal muscle tone and bilateral plantar flexor response. There was no signs of meningeal irritation (neck rigidity, Kernig’s and Brudzinski’s sign).

All routine investigation including CSF and CT scan was normal. On clinical ground she was diagnosed as a case of acute psychosis and kept on olanzapine. Initially she responded to drug, but again she was admitted due to headache, nausea and instability of gait. Cerebrospinal fluid examination was suggestive of tuberculous meningitis. MRI of brain showed infarct in right cerebellar hemisphere. The patient was treated with anti-tubercular drugs and steroids. On follow-up visit one month later, her psychotic symptoms had fully resolved. She was able to ambulate and care for herself.

Open Access Original Research Article

Diabetes Complications and Burden in a Metropolitan Environment: Correlates and Costs of Diabetic Foot Disorders

Raouf M. Afifi, Ashraf El-Ghali Saad, ‎Yousef Afifi, Same Zaytoun

Journal of Advances in Medicine and Medical Research, Page 1-14
DOI: 10.9734/BJMMR/2017/31547

Background: Diabetes is a chronic disease of complications, and of which diabetic foot ulceration (DFU) and consequences can be devastating.

Aim: Identify and analyze the economic costs related to DFU upon the Saudi diabetic population.

Methods: Direct costs related to treatment of DFU illness episodes in patients enrolled in healthcare plans with major health insurance agencies in Saudi Arabia between 2012 and 2015 were studied. Patient demographic characteristics, treatment and intervention level, and cost of illness (COI) were analyzed.

Results: The enrollees’ age averaged 54.33 ±4.76y (range 41-to-72=31y). Out of 229 diabetic patients surveyed, 158 (68.9%) were male; 162 (71%) were Saudis and 67 (29%) were non-Saudis. Least frequently needed intervention for DFU conditions was conservative treatment alone (12%, n=28), mostly needed was debridement (43.2%, n=99), and in-between was either minor lower extremity amputation (LEA) (26.2%, n=60) - or major LEA (18.3%, n=42). Further, amputation increased by age, 1.7% minor LEA for DFU patients <50 years old and 0.9% LEA for ≥50y old peers (Fisher’s exact=27.5, p<0.0001). Also, amputation was more frequent among Saudi DFU patients compared to non-Saudi peers (23.6% vs. 2.6% minor LEA, and 14.4% vs. 3.9% major LEA, respectively) [Fisher’s exact 17.3, p=0.0015]. The enrollees’ mean COI accounted SR35,934.4±15,065.1 (range 141,204, 11,032 -to- 15,2236) (1SR=USD267) per DFU event, which significantly varied by the level of intervention [F(df 3, 225)=426.9, p<0.001]. Saudi DFU patients significantly incurred higher COI [t(df 214.8)= 9.7, p<0.001].

Conclusions: Among DFU patients, amputation rates and related COI increased both by patients’ age and having Saudi nationality. An ongoing update on the prevalence and costs of DFU disorders should be among the community health research priorities in Saudi Arabia. Prevention and close monitoring save limbs and assure better quality of life of Saudi diabetic patients.

Open Access Original Research Article

Appreciating the Essence of Post Natal Care Services from Mothers’ Perspective in Kiambu, Kenya

Nancy Mugure Njoka, George Ochieng’ Otieno, Peter Mwaniki, Solomon Kemoi Cheboi

Journal of Advances in Medicine and Medical Research, Page 1-13
DOI: 10.9734/BJMMR/2017/32196

Introduction: The first 42 days after delivery is a critical period in the lives of mothers and newborn babies.  Most maternal and infant deaths occur during this time. The   government of Kenya has recommended that all mothers and newborns receive three postnatal (PNC) checkups this period. These are; within 48 hours before discharge from post-natal ward, at 2 weeks and again at 6 weeks. Nonetheless, uptake of postnatal services particularly visit two remains low. For instance 25% of mothers in Kiambaa Sub County access PNC at two weeks.

Study Design: A cross sectional descriptive study design was conducted among 399 mothers to determine the factors that influence utilization of PNC services.

Study Area and duration: This research was undertaken in Kiamba, Kiambu County between August and September, 2013.

Methodology: This was a mixed qualitative and quantitative study. Simple random sampling was used to select participating administrative units and respondents selected systematically. Sample size distribution was by probability proportionate to size. Quantitative data was analyzed using Stata version 13, while qualitative data was analyzed manually based on themes.

Results: Utilization of PNC services was at 45.1%. Over half (53%) of the respondents made their first PNC post-delivery visit after 14 days, 11% and 36% within 7 and 14 days respectively. The health care workers had informed only 15 % of the women, to attend the PNC services. College education (OR=12.292, p<0.001); high household wealth status (OR=3.6211, p<0.001); formal employment (OR=2.705, p=0.008); delivery at a private facility (OR=2.9269, p< 0.000) and high knowledge of PNC services (OR=2.2307, p=0.008) were synonymous with utilization of PNC services. Perceived good quality of care (OR=5.2607, p< 0.000), and a positive attitude (OR=3.6507, <0.000) were other determinants.

Conclusion: Uptake of postnatal care services remains a challenge among mothers and is predicted by several overt and covert constraints. Quality of delivery services and providers respective care practices were key predictors. Nevertheless, close to half of the women sought postnatal care at least twice in the post-natal period. The services were mainly accessed at or after 6 weeks. The timing of first PNC, post- delivery visit varies. Uptake of PNC visit two remains low.

Open Access Original Research Article

Birth Control Pills: Profile of Acceptors at University of Port Harcourt Teaching Hospital, Port Harcourt, Nigeria

Ojule John Dimkpa, Oranu Emmanuel Okwudili

Journal of Advances in Medicine and Medical Research, Page 1-7
DOI: 10.9734/BJMMR/2017/32069

Background: Oral contraceptives are among the earliest, safest, and most common method of fertility control especially in the developed countries. However, there is paucity of data on birth control pills in Sub-Saharan Africa including Nigeria.

Objectives: To determine the uptake rate of oral contraceptive pills and review the profile of the acceptors at the University of Port Harcourt Teaching Hospital, Port Harcourt, (UPTH) Southern Nigeria.

Methods: A retrospective study was conducted of all clients who accepted and used the oral contraceptive pills at the family planning clinic of the University of Port Harcourt Teaching Hospital (UPTH), Port Harcourt, between 1st January, 2006 to 31st December, 2015.

Results: During the study period, 6341 clients accepted modern contraceptive methods in the UPTH, out of which 124 chose the oral contraceptive pills, giving an uptake rate of 1.96%. The majority (64.5%) of the clients were in the age range of 20-29 years, were Christians (93.5%), parous (91.9%) and 66.1% had tertiary education. One hundred and fourteen (91.9%) used the pills for child spacing, while 10 (8.1%) used them for terminal contraception. No unintended pregnancy occurred during the observation period, giving a Pearl pregnancy Index of zero.

Conclusion: Birth control pills are very effective and safe contraceptive method but with very low uptake rate and rapidly diminishing patronage in Port Harcourt, Southern Nigeria. Clients who accept this method in our centre are young, parous, well educated women who want to space their pregnancies.

Open Access Original Research Article

Sealing Ability of Nano Hybrid Bulk Fill Composites and High Strength Posterior Glass Ionomer Cements in Restoring Class V Lesions - A Microleakage Study

Chitharanjan Shetty, Anish Kumar Lagisetti, Anjana Rajan, Mithra N. Hegde, Shishir Shetty, Aditya Shetty

Journal of Advances in Medicine and Medical Research, Page 1-8
DOI: 10.9734/BJMMR/2017/31327

Aim: The aim of the study was to evaluate the microleakage of nano hybrid composite (Tetric N ceram- bulk fill, Ivoclar Vivident, USA) and high strength glass ionomer (GC Fuji IX, GC corporation, Tokyo, Japan) in class V restorations using a dye leakage model.

Study Design: Study design included dye penetration model and observing the samples under Stereomicroscope at 20X magnification.

Place and Duration: The study was conducted in the Department of Conservative Dentistry and Endodontics, A. B. Shetty Memorial institute of Dental Sciences, Nitte University, Deralakatte, Mangaluru, Karnataka, India over a period of 1 month.

Materials and Methods: The study included collection of thirty molars and preparation of class V restorations in each tooth. All the teeth were randomly divided into 3 groups

Group I: Cavities left unrestored (Served as Positive control) Group II: Class V cavities restored with high strength glass ionomer (GC Fuji IX), Group III: Cavities restored with nano hybrid bulk fill composites (Tetric N ceram- bulk fill). After thermocycling, all the samples were placed in 2% methylene blue for 48 hours for cervical dye penetration test. All the samples were cut buccolingually using a diamond disk and dye leakage on cervical margin was measured under stereomicroscope at 20X magnification. All the results were subjected to statistical analysis.

Results: The Kruskal Wallis test showed significant results for microleakage between groups. Fuji IX showed better sealing compared to Tetric N ceram- bulk fill. Control group exhibited highest microleakage. Mann Whitney U test of pair wise comparison between groups showed no significant microleakage between Fuji IX and Tetric N ceram group.

Conclusion: Within the limitations of the present study, none of the materials were free from microleakage. Fuji IX Glass ionomer cements showed less dye penetration than Tetric N ceram.

Open Access Original Research Article

Service Delivery of a Preventive Oral Health Care Model to High Caries Risk Urban Children in Sri Lanka: A Retrospective, Descriptive Study

Irosha Rukmali Perera, Chandra Kumari Herath, Manosha Lakmali Perera, Susira Suranga Dolamulla, Jayasundara Mudiyanselage Weerasena Jayasundara Bandara

Journal of Advances in Medicine and Medical Research, Page 1-10
DOI: 10.9734/BJMMR/2017/27386

Background: Caries in primary teeth poses a global public health challenge as the most common chronic childhood disease in young children. It is compounded by marked social and geographical inequalities demonstrating high risk groups of children who carry the highest burden of the disease. Present study aims to describe an oral health care delivery model catering to both demands and needs for high caries risk, urban children in Sri Lanka with futuristic strategizing for improving its performance.

Methods: Local data were extracted from data sources of the Department of Census and Statistics and Sri Lanka National Dental Hospital (Teaching) Colombo. Accordingly, the Preventive Dental Clinic Performance Data and Preschool Oral Health Programme data  were accessed. Moreover, an extensive literature search was conducted. The data entry and analysis were performed using SPSS 16. Descriptive Statistics were used for presentation of data.

Results: Present oral health care model has catered to a total of 5034 high-risk, urban  children aged 20 months to 12-years from low socio economic backgrounds during the year 2015 with a coverage approximately of 10% of 1-9 year-old-age group in the target area. The oral health care delivery comprised of 8165 total visits to the Preventive Dental Clinic for 22915 of treatment procedures.  100% of children received behavioural management, dietary counseling and brushing advice and 63.4% received clinical preventive dental treatment comprising of fluoride varnish application, fluoride gel application and pit & fissure sealants. The screening coverage for preschool children was 82% comprising of high risk children, with an unmet need of 69.4% predominantly presented as untreated dental caries and met need of 59.2%.

Conclusions: Present study demonstrated that a range of preventive dental treatment options could be offered to  high caries risk, urban children to address their unmet needs and demands in oral health care.

Open Access Original Research Article

Some Altered Trace Elements in Patients with Polycystic Ovary Syndrome

Milal M. Al-Jeborry

Journal of Advances in Medicine and Medical Research, Page 1-10
DOI: 10.9734/BJMMR/2017/31503

Background: Insulin resistance is common in patients with polycystic ovary syndrome (PCOS). Trace elements and its correlation with insulin resistance are well documented.

Aim of Study: The current study aimed to determine possible correlations between insulin resistance and some trace elements (molybdenum, manganese, selenium and chromium) in patients with PCOS.

Study Design: Case-control study.

The study was performed in the infertility clinic at Babylon hospital for children and maternity. The duration of this study was from October 2014 to December 2015.

Methodology: The study involved sixty women (thirty women had PCOS and thirty women were controls).

Aspectrophotometrically procedure was used to analyze trace elements (molybdenum, manganese, selenium and chromium) in the serum. In addition the blood glucose and serum insulin during fasting were measured and insulin resistance (IR) was determined using the homeostasis model assessment (HOMA).

Results: Body mass index (BMI) in patients with PCOS was increased compared to controls. HOMA and fasting serum insulin were significantly higher in women with PCOS in comparison with controls. There was no difference in blood glucose in women with polycystic ovary in comparison with controls.

The cohort was divided into insulin sensitive (NIR) and insulin resistant (IR) patients with PCOS.

Women with PCOS-IR had significantly lower serum chromium, selenium and molybdenum and higher serum manganese than women with PCOS-NIR (p-value <0.05).

Conclusion: There was a correlation between the levels of serum chromium, selenium, molybdenum and manganese and IR in patients with PCOS.