Open Access Minireview Article

Review of Bone Turn over Biomarkers for Early Diagnose of Osteoporosis

Afshan Iftikhar, Syed Tousif Ahmed, Tayeb Asim

Journal of Advances in Medicine and Medical Research, Page 1-8
DOI: 10.9734/JAMMR/2018/41718

Introduction: Osteoporosis is a worldwide major burden among postmenopausal women. Not only the women, men are also prone to osteoporosis and fragility fractures with increasing age. The underlying pathology of osteoporosis is actually an imbalance among bone turnover cells including osteoblasts and osteoclasts. The rate of bone formation and resorption can be either measured by using urinary excretion of different biochemical markers or their presence in serum as well.

Objective: The aim of this review article was to collate all the osteoporotic biomarkers, their role in assessing risk of fractures, and monitoring of treatment potency.

Methodology: A web-based search was used and online data bases from PUBMED and MEDLINE were searched for osteoporosis. Studies from the year of 2000 up to 2017 were included. A total of 28 studies were included in the review which fulfilled the study parameters.

Results: Bone turnover biomarkers are not only helpful in early identification of the osteoporosis and fracture risk but also for the follow-up purpose after the antiresorptive treatment. These are also helpful in identifying over suppression of bone turn over after taking long term treatment of osteoporosis so beneficial in monitoring of patient taking long term treatment or who are on treatment holiday. The including biomarkers are bone-specific alkaline phosphatase, Procollagen type 1 amino-terminal propeptide, Osteocalcin, Procollagen type 1 carboxy-terminal propeptide, receptor activator of nuclear factor NF-κB ligand, Osteoprotegerin, Carboxy-terminal telopeptide cross-linked type 1 collagen, type 1 collagen amino-terminal telopeptide, deoxypyridinoline, tartrate-resistant acid phosphatase, Cathepsin K and hydroxylysine.

Conclusion: At the end of this mini-review, it can be concluded that the bone biomarkers have enough potential to act as an indicator in early prediction of the risk of osteoporosis and fracture along with the follow up after osteoporosis therapy. Multiple studies are going on to introduce novel biomarkers using genomic and proteomic approaches.

Open Access Original Research Article

Prevalence of Epstein-Barr Virus and Hepatitis B Virus Infections among Chronic HCV Patients Attending Kafer El Shiekh Liver and Heart Institute, Egypt

Hany M. Ibrahim, Faten R. Abdel Ghaffar, Rabie E. El Shaer, Mohamed A. Madian

Journal of Advances in Medicine and Medical Research, Page 1-8
DOI: 10.9734/JAMMR/2018/41753

Background: Viral infections such as hepatitis C (HCV), B (HBV) and Epstein-Barr virus (EBV) infections play a critical role in liver disease and represent a critical public health problem all over the world. Dual infections of these viruses are pos­sible and accompanied by bad clinical consequences.

Aim: In this study, a trail has been made to detect the seroprevalence of HBV and EBV infections among the HCV patients attending Kafer El Shiekh Liver and Heart Institute, Egypt. The current study was extended to assess the clinical changes in HBV or EBV infection in the chronically HCV infected patients.

Methods: One hundred and eighty-four chronically infected patients with HCV were examined for HBV and EBV using ELISA using commercially available kits (Auto Bio Diagnostics Co, China) and (Calbiotech Inc, CA, USA), respectively, and some clinical parameters were demonstrated (compensated cirrhosis using Fibro-scan™, complete blood count, fasting sugar, antinuclear antibody (ANA), alpha-fetoprotein (AFP), thyroid-stimulating hormone (TSH), liver and kidney functions).

Results: Overall prevalence of HBV and EBV infection was 1.63% and 17.39%, respectively. No significant difference (P > 0.05) was detected in the prevalence of HBV or EBV among HCV patients based on area, gender, residence, age and HCV RNA load. Liver cirrhosis at patient with concomitant EBV IgG and chronic HCV infections showed a high percentage compared to those patients with chronic HCV mono-infection. Moreover, a significant increase in the level of ALT, AST and the relative monocyte count was detected in patients with concomitant HBV and chronic HCV infections compared to patients with chronic HCV mono-infection.

Conclusions: HBV and EBV infection are existed in Egypt among HCV patients. Obtained data recommended the importance of screening and treating of HBV and EBV among HCV patients to lessen the clinical outcome of chronic HCV infection.

Open Access Original Research Article

Functional Low Vision Services in a Tertiary Hospital: Our Initial Experience

B. Fiebai, E. A. Awoyesuku, C. O. Chikezie

Journal of Advances in Medicine and Medical Research, Page 1-6
DOI: 10.9734/JAMMR/2018/41509

Aims: To describe our initial experience regarding the low vision services offered in our center, a tertiary eye hospital, pointing out the major causes of low vision, and types of low vision aids available in our setting.

Study Design: Descriptive, retrospective study.

Place and Duration of Study: Department of Ophthalmology, University of Port Harcourt Teaching Hospital, Port Harcourt, Rivers State, Nigeria between January 2013 and December 2017.

Methodology: We included 65 patients (42 men, 23 women; age range 4-81 years) with best corrected visual acuity < 6/18 in the better eye who were referred to the low vision clinic. Demographic data, visual acuity, indications for referral and types of low vision aids prescribed were extracted from their hospital records.

Results: The prevalence of functional low vision was 0.6%. The mean age was 47.04 ± 23.4, with a male to female ratio of 1.8:1. Glaucoma was the commonest cause of low vison followed by oculocutaenous albinism. Posterior segment disorders constituted the majority of cases seen. Telescopes and spectacle magnifiers were the most prescribed low vision aid.

Conclusion: The findings in our study are similar to those reported in other studies however the prevalence is low. There may be poor uptake of these services in our setting possibly due to lack of awareness of the availability of such services. It is hoped that these findings will guide in the planning and implementation of low vision services and the strengthening of the existing ones.

Open Access Original Research Article

Acute Pelvic Inflammatory Disease and Its Long – Term Sequelae: The University of Port Harcourt Experience

Ikobho Ebenezer Howells, Emmanuel Oranu Okwudili

Journal of Advances in Medicine and Medical Research, Page 1-11
DOI: 10.9734/JAMMR/2018/41437

Background: Pelvic inflammatory disease is a very common gynaecological problem among women, especially in sub-Saharan Africa. It is often implicated in the misery suffered by women with subfertility, chronic pelvic pain and ectopic gestation.

Objective: The objective of this study is to determine the pattern of presentation of acute pelvic inflammatory disease, and its long-term complications at the University of Port Harcourt Teaching Hospital in Nigeria. It would also determine the socio-demographic characteristics of the subjects, the probable sources of infection, the radiological manifestation, the pathogenic organisms and sensitivity pattern, and mode of treatment. It would also recommend the most suitable broad-spectrum antibiotics while awaiting culture results.

Methodology and Subjects: A retrospective observational study of 4,909 women diagnosed with gynaecological problems at the University of Port Harcourt Teaching Hospital, from January 2008 to January 2013. Out of these, a total of 280 women who were managed for the acute pelvic inflammatory disease were identified. Their case notes were retrieved from the hospital medical records and data concerning their socio-demographic characteristics, risk factors, clinical features, and mode of treatment was retrieved. Also retrieved were the radiological findings, culture and sensitivity results and complications experienced within the period of study. The date was then analyzed.

Results: The prevalence rate of PID  in UPTH was quite low 5.7%, The mean maternal age was 29.3 ± 6.31 years, significantly more married women has PID, P = 0.002, and nulliparous women were 3 times more likely to have PID than multiparas, Odds Ratio = 3.35[2.37, 4.75]. Majority of the women were unemployed, and the commonest source of infection was STI (74.3%), 89.3 has offensive vaginal discharge and a great majority (95%) had lower abdominal pain, which was severe in 30%. The most consistent finding on ultrasound scan was fluid in the pouch of Douglass (45.7%), and infertility was the commonest long-term complication. The in-patient treatment rate was only 11.8%; the most predominant organism isolated was klebsiella species, and the most sensitive antibiotic was ceftriaxone.

Conclusion: The prevalence of acute PID in UPTH is relatively low, and it affects mostly unemployed, middle age, married, and nulliparous women. The disease is predominantly sexually transmitted, and infertility is the most consistent long-term complication. Though ceftriaxone was the most sensitive broad-spectrum antibiotic, oral cefuroxime is recommended for out-patient treatment.

Open Access Original Research Article

Assessment of Morphological Length and Anatomical Variations of Greater Palatine Canal Observed in CBCT- A Retrospective Study

S. Kailasam, D. K. S. Lakshminrusimhan, R. Sangeetha, B. Niveditha, A. Priyadharshini, C. K. Vishnu Priya

Journal of Advances in Medicine and Medical Research, Page 1-10
DOI: 10.9734/JAMMR/2018/41287

Aim: To determine the morphological variation of greater palatine canal by using data from cone beam computer tomography.

Study Design:  Observational study.

Place and Duration of Study: Department of Oral Medicine and Diagnostic Radiology, Ragas Dental College and Hospital, Uthandi, Chennai, between January 2017 - February 2017.

Methodology: CBCT data obtained from 100 patients were evaluated. Both right and left greater palatine canal (GPC) were viewed in sagittal plane and coronal plane. The pterygopalatine fossa (PPF) was selected as the superior limit, and greater palatine foramen of the hard palate was selected as the inferior limit to assess the length and most common anatomical pathway of greater palatine canal among different age groups and sex.

Results: The average length of the GPC was 32 mm (± 3 mm) with a range from 23 mm to 40 mm. Coronally the most common anatomical pathway consisted of canal travelling lateral inferior for a distance then inferiorly for the rest of the course (86%) of the canal from the PPF to GPC. In the sagittal view, the canal travelled most commonly in the inferior direction to a distance and then travelled Antero - inferiorly for the rest of the course (87%) of the canal from the PPF to GPC.

Conclusion: Our study gives a better understanding to the clinicians about the morphological length anatomical variations of GPC while performing surgical procedures in the maxillofacial region.

Open Access Original Research Article

Quality of Life after Third Molar Removal in Subjects with Pericoronitis

K. V. Ramana Reddy, Gargi Jadaun, Sukhvinder Bindra

Journal of Advances in Medicine and Medical Research, Page 1-9
DOI: 10.9734/JAMMR/2018/39796

Aims: To assess the quality of life outcomes after third molar surgery in patients with symptoms of pericoronitis in Indian population.

Place and Duration of Study: Department of Oral and Maxillofacial Surgery, Army College of Dental Sciences, Secunderabad, between in the time period of May 2016 to April 2017.
Methodology: 200 Patients in the age group of 18-35 years with impacted mandibular teeth as a risk indicator with pericoronitis were included in the study. All the patients were assessed for the Presence of pain, Inter incisal opening, Presence of Swelling, affect on the daily routine activities like going for work/college, difficulty in taking part in social life, difficulty in chewing and sleeping difficulty in participation in recreational activities like sports before surgical removal of third molar removal, on the day of surgery and post operative day 1, 3, 5, 7 and day 21.

Results: This study revealed a statistically significant difference in oral health–related quality of life at 21 days interval after surgical removal of lower third molar when compared with preoperative status with respect to all the parameters.

Conclusion: This study concluded that third molar surgery is associated with an improvement in quality of life in the long term but with a deterioration of life quality in the short term (immediate postoperative). Removal of the third molars positively influenced the quality of life outcomes in patients with symptoms of pericoronitis.

Open Access Original Research Article

Occurrence and Detection of blaKPC Producing Klebsiella pneumoniae in an Indian Tertiary Hospital

Asifa Bhat, Dalip K. Kakru, Mohmmad Suhail, Shazia Benazir, Shaista Nazir, Dekyong Angmo

Journal of Advances in Medicine and Medical Research, Page 1-7
DOI: 10.9734/JAMMR/2018/41632

Background: Klebsiella pneumoniae is one of the most important gram-negative bacterial pathogens which has caused worldwide concern because of its association with life threatening nosocomial infections and its multidrug-resistant (MDR) property. As a result of the increased use of antibiotics; Carbapenemases are widespread in Enterobacteriaceae family and particularly in K. pneumoniae so effective treatment options are decreasing. The aim of this study was to detect blaKPC gene in Klebsiella pneumoniae by conventional PCR and to compare the phenotypic, ie Modified hodge test and genotypic methods ie PCR for detection of KPC carbapenemases of the recovered isolates of Klebsiella pneumoniae.

Study Design: Cross Sectional Prospective.

Place and Duration of Study: This study was conducted in the Department of Microbiology, Sher-i-Kashmir Institute of Medical Sciences, Srinagar; in India over a period of one year and three months (june 2014-september 2015).

Methods: This study included all isolates of Klebsiella pneumoniae recovered from blood culture of the patients. The identification and antimicrobial susceptibility were done on Vitek 2 compact. Isolates that were resistant to meropenem were included for phenotypic (Modified Hodge Test) and genotypic (Conventional Polymerase Chain Reaction) tests.

Results: A total of 70 Klebsiella pneumoniae isolates were recovered. Out of these 55 were meropenem resistant and 15 were sensitive. 76.3% isolates were MHT positive and 23.7% were negative. blaKPC gene  was present in 64.5%  and absent in 34.5% isolates. Out of 42  MHT positive isolates 81% were carrying blaKPC gene.

Conclusion: It was seen that a higher prevalence of blaKPC producing Klebsiella pneumoniae were isolated from patients admitted in ICU (intensive care unit). So formulation of an antimicrobial policy and its strict implementation is needed along with appropriate infection control measures to curtail its emergence and spread.