International Research Journal of Medicine and Medical Sciences

111-117

Authors: Kaiomakx Renato Assunção Ribeiro, André Rodrigues dos Santos, Rachel Iglesias Teodoro dos Santos, Lorena Suquyama Lelis, Thales Antônio Martins Soares, Widney de Castro Baião, Daniella Valença Daher, Edivalda Pereira de Abreu and Fernanda Alves Ferreira Gonçalves

The objective of this study is to analyze the difference between the male and female genders regarding the number of cases of acute coronary syndrome (ACS)/acute myocardial infarction (AMI). This is an integrative literature review study, in which articles were searched in the following databases: MEDLINE, LILACS, SCIELO, BDENF. The articles were published between the years 2006 and 2018. Initially, 502 studies were found, 17 of which were selected to compose this research. Studies in general have pointed to a high incidence of ACS/AMI in males, however, a linear increase in the incidence of cardiovascular diseases in females has been observed in recent years. And that the factors associated with the appearance are hypertension, smoking, alcoholism, sedentary lifestyle and obesity, among others. In conclusion, the incidence of patients with ACS/AMI every year has been a major challenge for health institutions and health professionals. The gender most affected by these diseases is the male gender; however, the increase in new cases in women has increased linearly in recent years.

68-74

Authors: L. A. Lar, O. G. Ogbeyi and Z. W. Wudiri

Absenteeism occurs when an employee (individual) does not come to work for one or more days (or shifts) when assigned. It is a common global occurrence having negative effects on work productivity. This study aimed to determine the level of absenteeism and contributory factors among staff of Plateau State Specialist Hospital, Jos, Plateau State. This was a facility based, cross sectional study, involving 181 hospital staff, consecutively selected. A structured, pre tested, self-administered questionnaire was used to assess absenteeism within the previous one year. Data was collected and analysed using Epi info statistical software (and a p value of ≤ 0.05 was considered statistically significant). Annual prevalence of absenteeism was 38.7%, crude absence rate; 1.6% and sickness absenteeism; 28.7%. Other factors included attending burials, weddings, study, examinations, family responsibilities, inadequate salary, working additional jobs, lack of promotion, and transportation problems. There was a statistically significant relationship (p = 0.0026) between poor remuneration and absenteeism. In conclusion, majority of the workers at the hospital had not been absent in the preceding year. It is therefore recommended that hospital management should improve staff remuneration.

84-90

Authors: Mahmoud S. Babiker, Rana A. Eisa, Fahad B. Albadr, Abdullah H. Abujamea, Awatef M. Omer, Mohammed Gamaleldin Mohammed, Arwa M. Asiri, Zeena H. Abdulhamid and Rawan Saif

The clinical significance of knowing the status of thyroid nodules is the need to exclude thyroid cancer. The purpose of this study is to evaluate ultrasound (U/S) features of thyroid nodules and correlate them with fine-needle aspiration cytology (FNAC). A descriptive prospective study was conducted at the Radiology Department, King Khalid University Hospital, King Saud University (KSU), Riyadh, KSA. The inclusion criteria were adult patients with neck swelling, palpable neck lesion, and/or abnormal thyroid-stimulating hormone (TSH) laboratory test result. Philips IU22, epic, sonosite, and Toshiba-Xerio ultrasound (U/S) systems with 7-MHz transducers were used in this study. All participants underwent a thyroid U/S scan according to standard protocol. FNAC-U/S was conducted for 159 nodules (according to suspicious U/S features) using a 10-ml plastic syringe with conventional (23 to 25) gauge needle. There were 246 participants included in this study (165 females [67%] and 61 males [33%], age range 13 to 88 years). There were 303 types of thyroid nodules noted, as follows: 47.8% were solid nodules, 42.5% were complex, and 9.6% were cystic nodules. Among 159 FNAC samples, 8.2% (n = 13) were positive results for malignancy. Females predominantly had malignant results (P = 0.001). U/S showed a sensitivity of 89.1 and 78.0% and a specificity of 43.0 and 57% for the right and left lobes, respectively. FNAC showed a sensitivity of 10.0% and 21% and a specificity of 56.9% and 42% for the right and left lobes, respectively. In conclusion, nodule malignancy and gender were significantly associated. Mixed and hypoechoic nodules were common features of malignancy. Both U/S and FNAC confirmation were important in thyroid nodule evaluation.

99-104

Authors: Solyom Árpád, Gilyén Botond, Fodor Pál, Zuh Sándor and Bățagă Tiberiu

Elbow arthroplasty is very successful in terms of pain relief, motion and function. Indications include posttraumatic osteoarthritis, acute distal humerus or proximal forearm fractures, and many others. With the present article, the authors would like to present the case of a patient who underwent total elbow arthroplasty following a car crash which resulted in the following conditions: IIIC type distal humerus open fracture, IIIC type proximal forearm open fracture, and multiple other lesions. Immediate surgical care consisted of primary wound correction and external fixation of the bones and secondary wound correction was practiced. A few months later the patient underwent total elbow arthroplasty. One year after the accident, following rigorous physical therapy, the patient has regained 45% of nerve function, 70% of muscle function and now can lead a relatively normal life. He can drive a car and use his elbow in daily activity. Although replacement arthroplasty was initially used mainly in patients with inflammatory arthritis, its indications were expanded to other conditions, which place higher demands on the implants and seem to lead to higher failure rates, but an elbow arthroplasty is a good option in complicated open fractures if we have a multidisciplinary team and the time of surgery is opportune despite the high failure risk.

34-39

Authors: Joshi B. and Chaudhary R.

Meniscus extrusion can be considered as a serious and relatively frequent clinical problem and can be also considered as a risk factor for osteoarthritis progression and knee pain symptom. Previous studies have shown a strong association between degenerative radial meniscal tears and extrusion. The aim of this study was to correlate the shape of lateral meniscus and the risk of its extrusion based on MRI examination of the knee joint. A prospective study was done in 75 patients of age group between 18 years and 50 years of age who were referred for MRI of knee joint in a tertiary hospital. The MRI was performed on a Magnetom Amira 1.5 Tesla MRI scanner following TUTH MRI routine protocol of Knee joint. All the cases who met the inclusion criteria were included in the study. After the procedure, images were evaluated. The measurements for the parameters used for this study were done in T1 Coronal image at the level of inter-condylar eminence and Proton density(PD) fat saturated sagittal image at the mid bow tie level where the morphology of the lateral meniscus were clearly delineated. Then the recorded data for each patient was correlated with the extrusion of the lateral meniscus along with body mass index (BMI) of the patient. The study showed a strong positive linear correlation of BMI and lateral meniscus-bone angle [LMBA] with meniscus extrusion, where (r=0.94; p=0.000) and (r=0.857; p=0.000) respectively. However, lateral meniscus-cartilage angle [LMCA] and lateral meniscus-cartilage height [LMCH] showed a moderate positive linear correlation with meniscus extrusion (r=0.564; p=0.000) and (r=0.305; p=0.26) respectively. The height of the anterior and posterior horns of the lateral meniscus showed the mean dimension of about 6.13(SD±0.62) mm and 6.30 (SD±0.58) mm respectively in our study. Similarly, the mean antero-posterior diameter of the anterior and posterior horns of the lateral meniscus were found to be 11.3(SD±1.06) mm and 11.4(SD±1.02) mm, respectively. Finally, the mean meniscus extrusion of the lateral meniscus observed beyond the tibial margin were about 2.57 (SD±0.93) mm whereas, the maximum meniscus extrusion was found to be 4.7 mm. In conclusion, increased BMI and LMBA showed significant increased risk of lateral meniscus extrusion beyond the tibial margin. However, LMCA and LMCH showed statistically moderate relation with the risk of lateral meniscus extrusion.

48-52

Authors: Beatriz Cepeda De Romero, Diana Carolina Cañon Guarnizo, Lina Marcela Orozco Herrera, Sofìa Cepeda Tarazona and Maria Alexandra Polo Pacheco

The ratio Deoxypyridinoline / Creatinine measured in urine (DPD/Cr) is the most sensitive and specific marker of early metabolic breakdown of collagen I, and therefore, of osteopenia and bone resorption. The normal values change with age and gender; in male adults the normal range is 2.3 to 5.4 nmol/mmol and in women is 3.0 to 7.4 nmol/mmol. It has been shown that osteopenia can lead to osteoporosis and to failure of implant osseointegration. The objective of this study was to associate levels of DPD/Cr in urine with bone height measured by tomography before surgery and three months after oral implant surgery in menopausal women. 20 healthy or systemically controlled postmenopausal women who underwent surgery implants, were selected by convenience for the study. All implants were: Titanium SIS® Implants (CIEO Foundation, Colombia) customized according to the patient requirements indicated in the CBCT. The implant length varied in the range 5 to 15 mm, internal diameter: 3 to 5 mm, internal hexagon: 2.4 mm, and screw: 1.85 × 0.35 mm. DPD values in urine were measured by a Chemical Luminescence Immune test and bone height in mm was measured in a tomography on implant zone before the surgery and 3 months after implant surgery. The average age of the patients was 61.2 ± 17.31 years and the number of implants 1-4/patient. The ratio DPD/ Cr showed a high average of 9.594 ± 0.475 nmol/mmol. Average pre-surgery bone height was 15.23 ± 1.41 mm and post-surgery decreased to 13.78 ± 1.16 mm. This difference was significant (t paired, p = 0.001). The Pearson correlation test showed a high association (p = 1) between the elevation of DPD/Cr and the decrease in bone height. There is a significant association between the change in concentrations of urinary creatinine-corrected deoxypyridinoline and bone resorption in menopausal women, three months after oral implant surgery.

60-67

Authors: R. S. Omotayo, O. Akadiri, A. L. Akintan and S. E. Omotayo

The health sector occupies an enormously important position in ensuring sustainable overall socio-economic advancement in developing countries. Healthy people make a healthy nation and also contribute to economic growth. Satisfaction is the contentment one feels when one has fulfilled a desire, need, or expectation. Poor quality is costly - to clients, to programmes and to the society overall. People's perception about quality of care often determines whether they seek and continue to use services. This study evaluated the level of patient’s satisfaction in gynaecological practice at the state specialist hospital Akure. This study is a descriptive cross-sectional study. Questionnaires of the Likert-like form was used to obtain information from consenting patients on various factors that determines or have effect on their level of satisfaction while accessing gynaecological care services at the gynaecology clinic of State Specialist Hospital, Akure. Systematic sampling method was used to recruit patients by selecting every second patient serially as they present . Three hundred and eight consenting gynaecological patients were recruited into the study. Data was analysed with the Statistical Package for Social sciences (SPSS) 20.0. Majority of the respondents 295 (95.7%) were satisfied with the morning time clinic schedule. More percentage of respondents were very satisfied with attending doctor being male (52.9%) than if the attending doctor was female (26.3%). Most patients (53.3%) were not satisfied with having to go outside the hospital to get some of their investigations done. Most patients (44.6%) were not satisfied with the level of availability of drugs in the hospital as they still go out to buy drugs. Vast majority of the respondents (89.2%) were either satisfied or very satisfied with the behavior and competence of the attending doctors and nurses. In conclusion, client's satisfaction is reflected by their happy expression about the care they receive, where and how they access the care. There is need for health care givers to continue and improve on aspects of care that gives patients satisfaction and discourage those that make the patients dissatisfied.

1-8

Authors: Taha Inass

The objective of this study is to assess the metabolic control of diabetes during Ramadan fasting among different risk groups. This cohort study included 203 diabetic patients attending Prince Abdulaziz Bin Majid Diabetic Center in Madinah, who intended to fast during Ramadan 2014. They were divided into high-risk group (68.47%), low-risk group (23.65%) and very high-risk group (7.88%). Weight, waist circumference (WC), blood pressure (BP), glycosylated hemoglobin (Hb A1c), creatinine and lipid profile were all measured 2 weeks before Ramadan, 4 weeks during the period of the fast and on the week that followed the end of the month. Hypoglycemia was highest in the very high-risk group (42.9%) which consisted of type 1 diabetics. Hb A1c significantly decreased in the high (9.13 ± 1.46% vs 8.75 ± 1.46%), (p=0.014) and very high-risk (9.88 ± 2.00 Vs 8.64 ± 1.67), (p = 0.005) groups but increased in the low-risk group (7.0548 ± .93% vs 7.49 ± .99%), (p=0.002). Weight, WC, BP, creatinine, and lipid profile were similar in low- and high-risk patients. The very high-risk group showed significantly increased systolic BP and total cholesterol levels (P= 0.018 and 0.001). In conclusion, fasting Ramadan has different impacts on glycemic control among different risk groups. Hypoglycemia and other unfavorable effects observed among the very high-risk group mandate close monitoring during fasting.

16-20

Authors: Ozen Dedeoglu, Guzin Fidan-Yaylali, Duygu Herek, Suleyman Demir, Hande Senol and Senay Topsakal

Pentraxin 3 (PTX3) is an acute-phase protein that shares structural homology with C-reactive protein (CRP). Because obesity and metabolic syndrome (MetS) are considered chronic inflammatory states, PTX3 might be involved in the pathogenesis of obesity and MetS as well as CRP. In this study, we aimed to investigate the relationships between PTX3, CRP, body fat distribution and carotid intima media thickness (CIMT). 73 obese premenopousal women and 53 women with normal body mass index (BMI) took part in this study. Body fat distribution was evaluated by ulrasonography and by Bioelectrical Impedance Analysis (BIA). PTX3 was similar in both groups. PTX3 was also similar in obese patients with and without insulin resistance. CRP is significantly higher in obese patients (p < 0.01). It was also significantly higher in insulin resistance obese patients (p < 0.01). There was no correlation between BMI and any of the inflamatory markers. Multiple regression analysis showed that PTX3 is positively correlated with waist circumference (WC) (p = 0.036, beta = +0.436) and negatively correlated with subcutaneous fat (SCF) (p = 0.011, beta = -0.310). In conclusion, although PTX3 levels were not higher in obese patients and have no correlation with visceral fat, PTX3 levels were correlated with WC. In premenoposal obese women PTX3 levels were not related to subclinical atherosclerosis measured by CIMT.

28-33

Authors: Daniel J. A., Nwaogu E. I., Okoli S. C. and Nzeribe E. A.

Exercise has been shown to reduce blood pressure (BP) in hypertensive patients. However, studies reporting reduced BP from chronic exercises might disregard an acute effect exercise could have on BP. Aerobic dance is one of the commonly recommended exercises for pregnant women without complications. The study aims to determine the acute effect of aerobic dance exercise of moderate intensity, on the BP of normotensive pregnant women. Pre-test/post-test research design involving 24 pregnant women of not less than 12 weeks gestation who volunteered from among women attending antenatal clinic at the Federal Medical Centre, Owerri, Nigeria. The women were screened and met the inclusion criteria, had their Systolic and Diastolic blood pressures (SBP and DBP) measured before participating in an exercise. The SBP and DBP were measured again at the end of the exercise and finally after 30 min rest. Data was analysed using Repeated ANOVA. SBP changed significantly between pre-exercise and 30 min post exercise rest but not between Pre-exercise and after 30 min exercise. DBP decreased significantly from pre-exercise to 30 min post exercise rest but not between after 30 min exercise and 30 min post exercise rest. In conclusion, moderate intensity aerobic dance exercise did not precipitate adverse acute cardiovascular response. Aerobic dance may be effective in management of hypertension in pregnancy.