Open Access Case Report

Distal Humeral Shear Fracture - A Modified Technique for Exposure

A. Raviraj, Vidyasagar Mallepati, K. Abhishek Sugumar, Vivek Kumar N. Savsani, Ajith N. Prabhu, Ashish Anand

Journal of Advances in Medicine and Medical Research, Page 1-5
DOI: 10.9734/jammr/2019/v30i1130249

Coronal shear fractures of the distal humerus are rare, complex fractures that can be technically challenging even in the best of hands. Their peak incidence is seen in elderly females and is usually the result of low energy fall. The injury is usually part of complex elbow injury and in rare instances can be isolated entity. Complex injury pattern is characterized by shear fracture combined with fracture of radial head and collateral ligament injury. The preferred treatment for this complex fracture is Open reduction and internal fixation. The usual recommendation is a two-incision approach.

We report a rare case in which fracture could not be classified using the traditional classification systems and in which entire fracture was managed via a single approach.

Open Access Minireview Article

Epidemiology of Measles in Sudan

Taha Hussein Musa, Hassan Hussein Musa, Layla Ahmed Mohammed, Abdelkareem Abdallah Ahmed, Rehab Ibrahim Kambo, Idriss Hussein Musa, Tauseef Ahmad, Joseph Kawuki, Upama Ghimire, Nathan Obore, Shireen Salome Papabathini, Alieu Tommy, Lovel Fornah

Journal of Advances in Medicine and Medical Research, Page 1-9
DOI: 10.9734/jammr/2019/v30i1130273

Few epidemiological studies have been undertaken of measles disease among Sudanese, although measles is the third leading cause of death since 1995 among childhood diseases that can be prevented by immunization. The measles vaccine was introduced into the EPI program in 1985. In the run-up to the introduction of the vaccine, the country suffered from measles epidemics periodically and extensively, ranging from 50,000 to 75,000 cases and from 15,000 to 30,000 deaths per year. Simple actions can save a million lives of children through immunization coverage, eye care programs, maternal and child health education, maintaining and improving the general nutritional status of Sudanese children. Continuous surveillance and monitoring systems and evaluation are essential tasks at all levels to improve performance, identify and address problems throughout establishing and increasing the surveillance system. This review highlights a brief overview of measles epidemiology in Sudan and determinants of a measles outbreak, clinical symptoms, complications, and surveillance sites and the ways for prevention and control of measles disease. The review established that it is crucial to enforce coordination between governmental and non-governmental agencies for an effective disease surveillance system in the area, especially in those affected by civil wars.

Open Access Original Research Article

Rheumatic Fever and Rheumatic Heart Disease: A Physicians Perspective

Nsirimobu Ichendu Paul, Chika O. Duru

Journal of Advances in Medicine and Medical Research, Page 1-12
DOI: 10.9734/jammr/2019/v30i1130247

Background: Acute rheumatic fever (ARF) and rheumatic heart disease (RHD) are non-suppurative cardiovascular sequlae of group A Streptococcus pharyngitis affecting children and young adults. Despite concerted efforts aimed at prevention, they still remain diseases of public health concern globally.

Objectives: The aim of this study was to assess the knowledge and practice of acute rheumatic fever and rheumatic heart disease among physicians practicing in public and private hospitals in two states of the Niger delta region of Nigeria.

Materials and Methods: Using a structured self administered questionnaire with 9 questions, 123 physicians from all the medical and surgical specialties were interviewed. Data was analyzed using SPSS 20.

Results: Majority (95.93%) of the doctors were working in Government hospitals and nearly half (49.59%) of them were Paediatricians. Over half (50.41%) had more than 5 years’ experience in medical practice. Among the cadre of the doctors, house officers represented 44.72% while Consultants constituted 17.07% of the study participants. The study showed that 70 (56.91%) of the study participants selected at least seven correct answers out of the nine questions that assessed their knowledge and practice and so showed a good knowledge and practice of ARF and RHD.

Conclusion: Though a good level of knowledge and practice was gotten from our study, there are still some gaps in the knowledge and practice that can be improved by health education through training and retraining our healthcare professionals. We therefore recommend the inclusion of ARF and RHD in CME and other training programs.

Open Access Original Research Article

Impact of Age and Life-expectancy on Treatment Receipt in High-risk Prostate Cancer

Kezhen Fei, Jenny J. Lin, Stephen Supoyo, Rebeca Franco, Sarah Abramson, Gerald Hoke, William Oh, Richard Stock, Nina A. Bickell

Journal of Advances in Medicine and Medical Research, Page 1-9
DOI: 10.9734/jammr/2019/v30i1130248

Background/Objectives:  The incidence of Prostate cancer is increasing with age and active treatment of high-risk prostate cancer improves survival. However, it is uncertain how the age as contrasted with life expectancy impact treatment decision-making for men with clinically significant prostate cancer. The aim of this study was to determine whether age or life expectancy affected the treatment receipt.

Participants: 541 men with high-risk localized prostate cancer (Gleason ≥ 8 or PSA > 20) diagnosed between 2007 and 2013 were recruited to the study.

Measurements: Outcome variables included treatment underuse and type of definitive therapies such as radical prostatectomy, radiotherapy, androgen deprivation therapy and cryotherapy. Life expectancy was assessed according to Schonberg Prognostic Index.

Results: Among the 541 high-risk prostate cancer patients, older men (≥65 years) received definitive therapy at similar rates as younger men (97% vs 98%; p=0.2), while younger men were more likely to accept surgery compared with older men (95% vs. 72%, p<0.001). Age affected treatment choice depending on the patient's life expectancy. Among men with higher life expectancy, age did not affect surgery receipt (OR=0.62; 95%CI: 0.18-2.20). But among men with lower life expectancy, older age (OR=0.15; 95%CI: 0.06-0.38), black race (OR=0.27; 95%CI: 0.10-0.77), comorbidity (OR=0.31; 95%CI: 0.13-0.76) and non-commercial insurance (OR=0.12, 95%CI: 0.05-0.28) were associated with lower rate of surgical receipt.

Conclusion: Although most high-risk prostate cancer patients undergo definitive therapy, both age and life expectancy affected the type of treatment. Clinical decisions appear to be based on patients’ medical condition and long-term outlook, rather than simply age. Non-clinical factors such as race and insurance play a role in treatment decision-making.

Open Access Original Research Article

Spinal Accessory Dysfunction Following Neck Dissection with Harmonic Scalpel V/S Electrocautery – A Single Centre Experience

Mitesh Chandra Kaushik, Sucheta ., Chanchal Malhotra, Richa Pawar

Journal of Advances in Medicine and Medical Research, Page 1-11
DOI: 10.9734/jammr/2019/v30i1130272

Aims: This study is an effort towards comparing the efficacy of the Harmonic Focus and Electrosurgical technique with regard to nerve injury especially spinal accessory nerve and its morbidity postoperatively after neck dissection.

Sample: Ninety patients of oral carcinoma who required neck dissection were included in the study.

Study Design: This is a prospective study.

Place and Duration of Study: Bhagwan Mahaveer Cancer Hospital & Research Centre, Jaipur, Rajasthan, India for a period of 17 months from November 2016 to March 2018.

Methodology: Patients’ post-operative recovery was studied prospectively by using parameters pertaining to shoulder function and shoulder pain.

Results: There were significant differences in the pain and abduction deformity at various time periods after surgery. However differences in the quality of life did not show significant difference at the end of 3 months. For up to one month pain scores were lower for Harmonic Focus and shoulder function was better through 3 months.

Conclusion: Though the technique of neck dissection (harmonic v/s electro cautery) has significant impact on shoulder dysfunction, despite that in postoperative period shoulder function measured by way of shoulder pain and shoulder abduction recover almost fully during follow-up period without causing significant morbidity and with minimal effect on quality of life. There are few recommendations we would like to suggest that if incorporated, they might significantly affect the outcome and better results.

Open Access Original Research Article

Adherence to Isoniazid Preventive Therapy (IPT) among Children in Close Contact with Adult Pulmonary Tuberculosis (PTB) Patients

Nsirimobu Ichendu Paul, Nneka Gabriel-Job

Journal of Advances in Medicine and Medical Research, Page 1-8
DOI: 10.9734/jammr/2019/v30i1130274

Introduction: Tuberculosis (TB) is among the top ten leading cause of morbidity and mortality globally, and studies have shown that adherence to a six Month course of Isoniazid Preventive Therapy (IPT) reduces the incidence of TB disease in HIV-negative/positive populations at risk of developing active TB disease.

Objective: This study was carried out to identify active TB cases among children aged 0-5 years who are in close contact with adult cases of pulmonary TB (PTB), to determine the adherence rate to IPT among these close contacts that do not have active TB and to identify factors associated with non adherence if any.

Methodology: This study was a prospective descriptive study carried out in Rivers state, Nigeria in two health facilities that offers services for TB diagnosis and treatment. Ethical approval for the study was obtained from the Rivers State Ministry of Health while verbal consent was obtained from the parents/caregivers of the children. Children aged 0-5 years who were in close contact with newly diagnosed PTB cases were recruited for the study. They were screened for HIV and evaluated for TB using clinical features and standard laboratory investigations. Those without active TB disease were commenced on isoniazid preventive therapy (IPT) for six months at a daily dose of 5mg/kg after adherence counselling and followed up at the health centres. Obtained data was analysed using Epi Info Version 7.2.3.1 statistical software. Descriptive statistics was used while the test for association between variables was done with chi-square test at p ≤ 0.05 level of significance. Frequency tables were used for presentation of results.

Results: A total of Sixty three children were recruited for the study 37 (58.7%) were males while 26 (41.3%) were females. Thirty two (50.8%) were children of index PTB patients while 29 (46.1%) belonged to lower socio-economic class. Their age ranged from 4 months to 4 years with a mean age of 2.84years ±1.27years. Six (16.2%) out of the 37 males and 2 (7.7%) out of the 26 females were confirmed to have active TB, giving a TB prevalence of 12.7%. The gender difference was not statistically significant (p= 0.32). Of the fifty five children that commenced INH in the first Month, only twenty four of them completed the six Month course of INH, giving an IPT adherence rate of 49.6%. Identified reasons for non adherence includes ‘My child is not sick’, ‘No transport Money’, ‘My child is writing exams”. “My child is tired of the drugs”, “the Health workers are not friendly’ and ‘long waiting time before collecting medications”.

Conclusion: Early contact tracing is important for early detection of TB cases in children. Adherence to IPT in this study is low and strategies like community tracing of defaulters using trained social workers and community nurses as well as use of well-supervised and convenient ambulatory treatment centres that are manned by trained lower cadre health staff can improve adherence.

Open Access Original Research Article

Protective Effect of Terminalia chebula Extract in Doxorubicin Induced Hyperlipidemic Rats

Aamina Muneer, S. I. Rabbani

Journal of Advances in Medicine and Medical Research, Page 1-9
DOI: 10.9734/jammr/2019/v30i1130275

Aim: To study the anti-hyperlipidemic activity of Terminalia chebula in rats.

Study Design: Hyperlipidemia was induced by administering doxorubicin and the effect of Terminalia chebula was studied in male and female rats.

Methodology: Three doses of hydroalcoholic extract of Terminalia chebula (0.25, 0.5 and 1.0 gm/kg, body weight, per orally for 28 days) was tested against the doxorubicin (0.25 mg/kg, intra-peritoneal, 6 doses for 12 days) in male and female rats. Serum levels of total cholesterol, triglycerides, low-density lipoprotein (LDL-cholesterol) and high-density lipoprotein (HDL-cholesterol) were estimated. The antioxidant effect was determined by estimating the serum peroxidation levels. The result of the data was analyzed statistically by One-way Anova followed by Bonferroni comparison test. p<0.05 was considered to indicate the significance of the results.

Results and Discussion: The data indicated that a dose-dependent significant (p<0.05) reversal was observed in the doxorubicin-induced elevated total cholesterol, triglycerides, LDL-cholesterol and diminished HDL-cholesterol upon treatment with Terminalia chebula in male rats. In the female rats, only the highest tested dose of Terminalia chebula (1 gm/kg) produced the inhibitory effect in the elevated lipid levels without affecting significantly the HDL-cholesterol activity. Further, when Terminalia chebula was tested separately at 0.5 g before and after the administration of doxorubicin, a significant inhibition was observed in the post treatment in both sexes. Serum lipid peroxidation was found to be significantly (p<0.05) reduced by the extract compared to the doxorubicin group.

Conclusion: The results suggest that Terminalia chebula extract might have the potential to reduce doxorubicin-induced hyperlipidemic complications if administered together or after the doxorubicin therapy.

Open Access Review Article

Zika Virus in Africa: Epidemiology and Determinants

Nathan Obore, Shireen Salome Papabathini, Upama Ghimire, Joseph Kawuki, Taha Hussein Musa

Journal of Advances in Medicine and Medical Research, Page 1-13
DOI: 10.9734/jammr/2019/v30i1130271

Zika virus (ZIKV) that was less known for decades suddenly became a global health emergency at the beginning of 2016. The virus was first discovered in the Zika forest of Uganda in 1947, and the first confirmed human infection was reported in Uganda between1962-1963. From its origin in East Africa, ZIKV then spread to West and Central Africa with a limited occurrence in North Africa. ZIKV has been circulating in Africa for over 60 years, but less attention had been given, not until its recent outbreaks outside Africa and its discovered association with adverse congenital disabilities. ZIKV is known to cause several debilitating neurological complications, including microcephaly in newborns and Guillain-Barré Syndrome (GBS) in adults.

This review thus aims to highlight the epidemiological evidence and distribution of ZIKV in Africa with a focus on determinants, complications as well as management. We used literature searched from key databases such as Google Scholar, Web of Science, among others, to collect relevant current information about ZIKV in Africa.

Climate, sociodemographic factors, and increasing human density impact the spread of ZIKV in Africa, as in other areas. Furthermore, ZIKV transmission is affected by several unique factors, including the potential risk of sexual transmission, as well as vast numbers of refugees and other travellers from ZIKA endemic areas across Africa, and all over the world.

The review identifies the need to improve surveillance mechanisms and focusing on vector control as critical steps to enable prompt detection and avert potential outbreaks of the disease in the continent.