International Research Journal of Medicine and Medical Sciences

24-30

Authors: Shahida Maqsood, Hasan Baber, Maqsood Ahmed Soomro, Fauzia Quadir, Quratul Ain Maqsood, Masood Anwar Qureshi and Sadiqa Syed

Dental clinicians often come across patients having chronic systemic conditions, like diabetes, which has a direct influence on the onset, duration, and management of periodontal disease. Type II diabetes mellitus is considered as a contributing factor instead of being a primary etiologic factor, acting as an initiator of periodontitis. Type II is characterized by loss of ielts cells of Langerhans and survival is possible by external application of insulin. Prevalence of periodontal disease and diabetes is known to increase with an increasing age. Identification and characterization of diabetic patients with high risk of periodontal disease are needed and this is what the study focuses on. This research was an interventional study aiming to narrow the gap by acquiring possible relationship between type II diabetes and periodontal disease group of patients after surgical/non-surgical periodontal therapy in local Pakistani Population. This interventional study was conducted on 104 males and female patient suffering from T2DM (aged 25 to 65 years). Periodontal parameters were calculated by using the community periodontal index need, comprising bleeding on probing, tooth mobility and furcation involvement. Non-surgical periodontal treatment was performed and systemic Doxycycline treatment was prescribed for two weeks. The glycated hemoglobin, fasting and random blood glucose levels were determined, at the baseline before non-surgical periodontal therapy and after three months of treatment using commercially available kits. The periodontal parameters significantly improved after the treatment, along with the reduction in the results levels of glycemic parameters. In conclusion, poor glycemic control is an important risk factor for developing periodontal disease and once established, periodontal inflammation negatively affects glycemic control. In the current study, non-surgical periodontal treatment improved glycemic control in T2DM subjects affected with periodontitis. Keywords: T2DM, glycated hemoglobin, fasting and random blood glucose levels, periodontitis, periodontal pocket depth, bleeding on probing.

7-16

Authors: Fatma Ibrahim Abd El Latif, Hassan Ali Abd El Wahid, Amina Ahmed Mohamed and Hanaa Kassem Farg

Quality of life is an important aspect in diabetes because the poor quality of life leads to diminished self-care, which in turn leads to worsened glycemic control, increased risks for complications, and exacerbation of diabetes overwhelming in both the short run and the long run. The aim of the study was to assess physical and psychological health domains of the quality of life in type 2 diabetic patients in relation to clinical factors of diabetes mellitus in Egypt. A cross-sectional analytic study design was utilized in this study. This study was conducted at the Family Medicine Outpatient Clinic of Suez Canal University Hospitals in Ismailia city, Egypt. 143 type 2 diabetic patients were included who agreed to participate in this study and were selected using probability systematic sampling technique. Two tools were used to collect data; structured interviewing and World Health Organization Quality of Life Questionnaire abbreviated version were used to collect data. Revealed that the mean age of the study group was 54.74 (SD = 7.32) years and the majority of them were females. Factors related to lower quality of life in the present study were obesity, cigarette smoking, physical inactivity, and poor glycemic control. In conclusion, type 2 DM has negatively affected all domains of quality of life of the study group. Keywords: Type 2 diabetes mellitus, quality of life, clinical factors.

103-112

Authors: Mohamed O. Nour, Ahmed O. Babilghith, Hatim A. Natto, Fowzi O. Al-Amin and Sallahaldeen M. Alawneh

Middle East Respiratory Syndrome-coronavirus (MERS-CoV) infection is becoming a global health problem that is primarily detected in KSA with progressive increase in cases and deaths. Mass gathering and cross country mixture during season of Hajj and Umrah, the associated hygienic conditions and limited community knowledge about the infection are possible causes. Although many researchers have analyzed epidemiology of the infection, there are few reports of knowledge, attitude and practice (KAP) of healthcare providers towards the infection in KAS. A cross-sectional study was conducted in Makkah public hospitals from September 2014 to April 2015. A total of 281 participants representing healthcare providers were included in this study. Data representing knowledge, attitude and practices were collected using structured self-administered questionnaires. The mean age of the participants was 30.8 ± 6.3, years ranged from 21 to 57. More than half of them were females (57.7%) and 46.3% were nurses. In general, our findings showed that only one third of them (32.4%) acquired good knowledge about the infection with mean knowledge score 18.3 ± 3.9 (out of 28) and most of them (91.8%) showed negative attitude towards the infection with mean attitude score 5.4 ± 1.6 (out of 11). However, 87.9% reported good practices with mean practice score 7.2 ± 1.5 (out of 8). There are significant positive associations between knowledge and both attitude and practices scores. The mean knowledge score was significantly higher among those with age ≥ 30 years, physicians and those with > 10 years of experience and the mean practice score was significantly more among females. In conclusion, our study showed that there are knowledge gap and negative attitude among healthcare providers at Makkah hospitals towards MERS-CoV infection although they reported good practices. Continued and strengthened educational programs are needed to improve their knowledge and change their attitudes towards MERS-CoV infection that will be in the interest of global public health. Keywords: Knowledge, attitude, practice, healthcare providers, MERS-CoV.

116-121

Authors: Dhaher JS Alhabbo

Pulmonary embolism (PE) is commonly presented with non-specific symptoms and clinical signs which are very easily missed or misdiagnosed. Massive PE may lead to death during the first few hours of the event. Therefore, early diagnosis and treatment is vital and very important because repeated embolization and death can be prevented with immediate treatment. Ken Moser explain the morbidity and mortality from these events as “substantial and unacceptable” as PE is not a disease by itself but it is rather a complication of deep vein thrombosis. Upper extremity deep venous thrombosis is not insignificant risk factor for PE. The objective of this study is to report pulmonary embolism secondary to external jugular vein thrombosis. The case report is a 45-year old male presented with history of dyspnea and right sided chest pain accompanied by tender right supraclavicular mass lesion. The patient was admitted to the intensive care unit in the teaching hospital. The diagnosis of external jugular vein thrombosis with secondary pulmonary embolism was made by C. T. angiography. In conclusion, external jugular vein thrombosis with secondary pulmonary embolism is rare but should be put in mind. Keywords: Embolization, clinical signs, misdiagnosed, morbidity, mortality.

60-63

Authors: Sahel Hammouri and Ala al Omari

The aim of this study is to evaluate post-operative pain relief on patients who had hemorrhoidectomy. 300 patients who had hemorrhoidectomy were divided in to three groups, according to anesthesia type, group 1 (local anesthesia and sedation), while spinal anesthesia was group 2 and general anesthesia was considered to be group 3, pain relief, post-operative complications, total cost, hospital staying, operating time and post-operative period of time to start ambulation were measured and compared among the three groups. The study was performed during 2010 to 2014 in Jordanian Prince Rashid military hospital. The study showed that patients who had local anesthesia infiltration and sedation had significant influence decrease of post-operative total pain scores at 6/12/18/24 h more than 50%, (200/240/300/320) out of 1000 points compared to (420/500/540/580), (700/680/660/660) in the other 2 groups, the total post-operative analgesia doses in the 3 groups were (120, 140, 180) vials. The total hospital staying time for patients in each group were (130, 210, 260) days, while the total anesthesia and surgical and procedure time were (1500, 3000, 3500) min, total cost (25000, 30000, 35000) JD, post-operative lack of early ambulation time was (100/600/300) h, intra-operative doctor–patients interaction were(100/100/0) patients, headache (0, 8, 1) patients, urine retention (0.6.1) patients, nausea and vomiting (0, 1, 5) patients were reduced by 30%, (P-value < 0.05). In conclusion, post-operative pain, analgesia, total cost, hospital staying and operation time, intra-operative doctor–patients interaction, nausea and vomiting have been significantly reduced by local anesthesia infiltration compared to non-infiltrated groups while spinal anesthesia had a higher rate in post-operative urine retention, headache and hypotension compared to local anesthesia with sedation and general anesthesia. Keywords: Pain, local anesthesia, analgesia, complications, hemorrhoidectomy.

70-77

Authors: Sherifa A. Hamed, Ahmad H. Youssef, Amal M. Tohamy, Refaat F. Abd Elaal, Mahmoud M. Hassan and Eman Nasr Eldin

The adverse outcome after cerebrovascular stroke (CVS) is determined not only by the neurological deficits but also by medical comorbidities including kidney dysfunction. We studied the frequency of acute kidney injury (AKI) with CVS and its relationship to short-term mortality. This study included 80 patients with stroke (mean age: 62.5 ± 6.2 years). Stroke severity was determined using Scandinavian Stroke Scale (SSS). Serum creatinine (SCr), creatinine clearance (CrCl) and kidney injury molecule-1 (KIM-1) concentrations were the measured markers of AKI. Follow-up was done for 3-months or till death. Cox proportional hazards model was used to evaluate contributors to mortality. Compared to reference group, patients had higher SCr (p < 0.05) and KIM-1 (p < 0.001) and lower CrCl (p < 0.01). The majority of patients (86.25%) had normal SCr, while 57.5% had lower CrCl (<70 ml/min) and 92.5% had higher KIM-1 (>0.75 ng/ml). Mortality rate was 35%. Compared to survivors, patients who died had lower SSS, higher SCr and KIM-1 and lower CrCl (all p < 0.001). Higher SCr [Hazard ratio (HR), 1.65; 95% CI, 1.41 to 1.93], KIM-1 [HR, 1.63; 95%CI, 1.21 to 2.19] and lower CrCl [HR, 1.34; 95% CI, 1.09 to 1.65] significantly predicted worse short-term survival. We conclude that AKI is a common complication of CVS. Increase in SCr, KIM-1 and decrease in CrCl concentrations are associated with worse short-term outcome with stroke. Keywords: Cerebrovascular stroke, acute kidney injury, kidney injury molecule-1, mortality.

88-93

Authors: Mohammed J. Ashour and Fadel A. Sharif

This retrospective case-control study was carried out in order to investigate the association between Factor II (G20210A), Factor V (G1691A, H1299R, Y1702C) and Factor XI (rs3756008 A>T) gene polymorphisms and recurrent pregnancy loss (RPL) in a group of Palestinian women residing in Gaza strip. A total of 400 females, 200 RPL patients and 200 women without previous history of RPL, aged 20 to 35 years were included in the study. Factor V (G1691A) and Factor II (G20210A) polymorphisms were analyzed by allele-specific PCR whereas, Factor V (H1299R, Y1702C) and Factor XI (rs3756008 A>T) gene polymorphisms were screened by PCR-RFLP. No statistically significant difference existed between RPL cases and controls in terms of the allelic and genotypic distribution of Factor II (G20210A), Factor V (Y1702C) or Factor XI (rs3756008 A>T). On the other hand, the minor allele of the two Factor V gene polymorphisms (G1691A and H1299R) independently showed statistically significant association with RPL. Factor V G1691 and H1299R polymorphisms may increase the risk for RPL in Gaza strip women, and should be screened for in cases suspected to have inherited thrombophilia. Keywords: Factor V, Factor II, Factor XI, gene polymorphism, recurrent pregnancy loss.