Open Access Case Report

Marked Weight Loss, Muscle Wasting and Fatigue on Administration of Empagliflozin in a Subject with Type 2 Diabetes

Udaya M. Kabadi

Journal of Advances in Medicine and Medical Research, Page 1-7
DOI: 10.9734/BJMMR/2017/33253

Background: Weight loss, fatigue and decreased quality of life are frequently reported at the time of initial diagnosis by subjects with Diabetes Mellitus of both types although far more frequently with type 1 and are attributed to fluid and electrolyte losses due to persistent glycosuria as well as decline in adipose tissue secondary to lipolysis. However, muscle wasting and weakness as initial manifestations are noted almost exclusively in subjects with type 1 diabetes.
Case Report: A man with history of type 2 diabetes about 10 years reported onset of general fatigue, polyuria, nocturia, polydipsia as well as profound progressive weight loss, muscle wasting and weakness within 2 weeks after initiation of Empagliflozin. He had been receiving glimepiride 8 mg and metformin 2000 mg daily for about 5.5 years. Resolution of polyuria, nocturia and polydipsia was attained promptly within a week after discontinuation of Empagliflozin and initiation of insulin glargine. Weight gain and improvement in fatigue began by 2 weeks, continued until achieving desirable glycemic control over next 4 months and then stabilized. However, muscle mass and strength have not yet returned to the level prior to initiation of Empagliflozin during the follow up period of 12 months.
Conclusion: Empagliflozin is responsible for induction of transient weight loss as well as persistent muscle weakness and wasting in this subject.

Open Access Case Study

Cementoblastoma in the Maxilla: An Unusual Case Report

Delise Pellizzaro, Guilherme Monteiro Tosoni, Marcelo Gonçalves, Valfrido Antônio Pereira Filho, Oscar Fernando Muñoz Chávez, Andrea Gonçalves

Journal of Advances in Medicine and Medical Research, Page 1-6
DOI: 10.9734/BJMMR/2017/32449

Cementoblastoma is characterized by the formation of cementum-like tissue attached to the root of a tooth. It is a benign neoplasm with odontogenic mesenchymal origin, and is considered the only true neoplasm of cemental origin. Cementoblastomas are usually located in the mandible, the majority of which affect the permanent first molar. There is no distinct gender preference and the mean age of occurrence is approximately 20 years of age. The lesion is usually identified as well defined, radiopaque, delimited by a cortical border, and with a well-defined radiolucent band just inside this cortical border. Root resorption and loss of the root outline are commonly associated with the cementoblastoma. The only treatment is enucleation of the lesion with removal of the associated tooth. Here, we present an unusual cementoblastoma case in a 52-year-old woman with different radiographic findings from those frequently reported in the literature. The patient has been followed for 2 years with no sign of recurrence.

Open Access Minireview Article

A Review of Incidence and Injury Patterns of Equestrian-Related Accidents in Children and Adolescents

Georgios A. Angoules, Nikolaos A. Angoules, Antonios G. Angoules

Journal of Advances in Medicine and Medical Research, Page 1-7
DOI: 10.9734/BJMMR/2017/33193

Horse riding represents a globally popular activity for people of all ages for recreational, sport or professional purposes. Among these individuals an increasing number of young people, children and adolescents has been recorded. This activity is also associated with a significant number of accidents ranging from relatively innocent injuries up to more serious ones which can even endanger the life of the horse rider. In this article review, international literature was thoroughly studied focusing on the analysis of mechanisms leading to these injuries as well as of the risk factors that increase their frequency and the prevention strategies which may reduce their incidence. Horse riding is an activity associated with a significant frequency of accidents mainly due to falls off the horses, accompanied by a large number of accidents, mainly head and upper limbs injuries. These injuries impose considerable socio-economic costs, with unbearable consequences for the life and health of young riders. For these reasons, prevention strategies as well as the appropriate equipment and particularly the use of a special helmet is of particular importance.

Open Access Original Research Article

Prevalence and Pattern of Pigmentary Changes among Primigravidae Attending a Tertiary Health Facility in South-Western Nigeria

Fatai Olatunde Olanrewaju, Olaniyi Onayemi, Olayinka Abimbola Olasode, Adebanjo Babalola Adeyemi, Abimbola Olumayowa Oninla, Mufutau Muphy Oripelaye, Ogochukwu Ifeanyi Ezejiofor, Olaide Olutoyin Oke

Journal of Advances in Medicine and Medical Research, Page 1-9
DOI: 10.9734/BJMMR/2017/33382

Background: Pigmentary skin changes are common presentation among pregnant women. The impact of which is very worrisome. Most of these pigmentary changes were due to increase hormonal influence such as melanocyte stimulating hormone, adrenocorticotrophic hormone, cortisol, progesterone and increased sensitivity of melanocyte at normally pigmented areas.

Objective: The study was aimed at documenting the prevalence and pattern of pigmentary changes as well as providing baseline data among pregnant women in Nigeria.

Materials and Methods: This study was a descriptive cross-sectional study of 240 primigravidae who attended antenatal clinic of Obafemi Awolowo University Teaching Hospitals’ Complex (OAUTHC), Ile-Ife, Nigeria and 240 controls who were never pregnant. The study was carried out between March, 2013 and March, 2014. Data was analyzed using Statistical Package for the Social Sciences (SPSS) version 16.0. Data were presented in tables and statistical significance (measured as P<0.05) were determined using Chi square and Friedman’s tests as appropriate.

Results: The general prevalence of pigmentary changes in pregnancy among the subjects in this study was 77.5% in first trimester, 95.8% in second and 95.4% in third trimesters while it was 17.1% in the controls. Nipple, areola, generalized hyperpimentations and linea nigra were much higher than controls. These pigmentary changes also increased in prevalence as pregnancy advanced. There was statistically significant association between gestational age (trimester) and pigmentary changes (P=0.000). The prevalence of melasma increases as the pregnancy progresses from 5.0% in first trimester to 8.8% in third trimester. The relationship was found to be statistically significant (P=0.000).

Conclusion: The prevalence of pigmentary changes among pregnant women in Nigeria was found to be very high. Healthcare workers involved in obstetric care need to be well informed to enable accurate diagnosis and education of patients. The effects of pigmentary changes on quality of life may further be elucidated with further studies.

Open Access Original Research Article

Association of Ischemic Contracture, Hypercontracture and Post-Ischemic Recovery in Diabetic Rat Heart

Hande O. Altunkaynak, Arif T. Ozcelikay

Journal of Advances in Medicine and Medical Research, Page 1-7
DOI: 10.9734/BJMMR/2017/33421

Objective: Previous studies suggest a relation among ischemic contracture and/or hypercontracture profiles and the functional responses in diseased hearts isolated from hypothyroid and post-infarcted animals. We therefore aimed to find out whether there is a similar relation in the diabetic hearts.

Methods: Experiments were performed on Sprague-Dawley rats divided into control and diabetic groups. Diabetes was induced by streptozotocin (45 mg/kg) in citrate buffer (0.1 M, pH:4.5) into the tail vein of the rat. Isolated hearts from control and diabetic rats were subjected to 40-min ischemia followed by 40-min of reperfusion. The left ventricular end-diastolic pressure and left ventricular developed pressure were measured during the experimental protocol. Furthermore, the increase in minimal value of left ventricular pressure during ischemia and the peak value of left ventricular end-diastolic pressure measured during the first 5 min of reperfusion for each heart were evaluated as a measure of ischemic contracture and hypercontracture, respectively.

Results: Ischemic contracture did not develop and hypercontracture was markedly suppressed in the diabetic hearts compared with control hearts. In addition, post-ischemic recovery was negatively correlated with hypercontracture in both groups.

Conclusion: Both the non-existence of ischemic contracture and the suppressed hypercontracture results in a better post-ischemic recovery of diabetic heart. Furthermore, the relationship between hypercontracture and post-ischemic recovery suggests that the utility of hypercontracture as a predictor of the post-ischemic recovery.

Open Access Original Research Article

Analysis of Undergraduate Students’ Perception of the Educational Environment of a Medical School in Zambia Provided a Framework for Strategic Planning

Christian C. Ezeala, Mary M. Moleki

Journal of Advances in Medicine and Medical Research, Page 1-9
DOI: 10.9734/BJMMR/2017/33545

Aim: To propose a strategy for improvement of undergraduate students’ learning environment based on analysis of their perceptions.

Methods: Medical, Pharmacy, and Physiotherapy undergraduate students participated in the study. The study used a quantitative descriptive design, based on the Dundee Ready Educational Environment Measure (DREEM) inventory. The University of South Africa and University of Zambia Ethics Committees provided ethical approval. Using stratified random sampling, participants were drawn from the Ridgeway Campus of the University. They responded to a demographic section and the 50 DREEM items. Data analysis included descriptive statistics on demographics, total and subscales DEEM scores, and mean scores on individual items. Cronbach’s alpha and confirmatory factor analysis provided reliability and validity indices of the dataset. Specific issues derived from individual items’ scores were used to propose a strategy. 

Results: Total participants were 488 including 239 from Medicine, 135 from Pharmacy, and 74 from Physiotherapy. Response rate was 95.5%. Mean total score was 119.3/200. Scores within subscales of perception of learning, perception of teachers, academic self-perception, perception of atmosphere, and social self-perception were 29.87/48, 26.29/44, 20.96/32, 27.26/48, and 14.86/14, respectively. Four strategic issues emerged from six items with mean scores below 2.0/4.0: lack of adequate social support for stressed students, substandard teaching and mentoring, unpleasant accommodation, and inadequate facilities. Strategic objectives were raised and strategic options recommended from literature.

Conclusion: Strategic planning in medical and health professions education should consider learners’ concerns by analysing their learning environments.

Open Access Review Article

Mother and Child Health Care and Human Development in Turkey: A Review

Nazan Bilgel

Journal of Advances in Medicine and Medical Research, Page 1-11
DOI: 10.9734/BJMMR/2017/33637

Human development and investing in human are major issues of today’s world. In spite of rapid improvements in the near past, Turkey is still behind of the most middle- income and of the countries at a similar level of economic status in terms of human development. As an economic power Turkey is 17th in the global scale but is 71st in the Human Development Index prepared according to social indicators involving health and education.

The demographic profile of Turkey is relatively young and mother and child health care issues concern about 57.0% of the total population. On the other hand Turkey has the poorest indices in terms of mother and child health among European countries. The indicators regarding mother and child health care issues have shown improvements in the last four decades as a result of socio-economic development and priority given to these health services. But still there are discrepancies between rural-urban and eastern-western regions of the country. Some of these discrepancies exist because of the economic disadvantages. But most of them are still alive due to cultural norms. The most effective cultural norm is the diminished value of women and girls. Almost all studies showed a strong correlation between these discrepancies and educational and/or socioeconomic level of women. Turkey’s health expectations are not far to reach but depend on prioritizing and strengthening of women both in educational and economic manner.