International Journal of Medical Advances and Discoveries

International Journal of Medical Advances and Discovery ISSN 2756-3812 Vol. 3 (2), pp. 001-007, February, 2012. © International Scholars Journals

Full Length Research Paper

Obesity, metabolic syndrome and BMI-metabolic-risk sub-phenotypes: A study of an adult Nigerian population

Ifeoma I Ijeh, Uchechukwu Okorie and Chukwunonso ECC Ejike

Department of Biochemistry, College of Natural and Applied Sciences, Michael Okpara University of Agriculture, Umudike, PMB 7267 Umuahia, Abia State – Nigeria

Accepted 06 November, 2011

Abstract

Obesity and the metabolic syndrome are health care challenges of not only the industrialized nations but also of the developing countries. BMI-metabolic- risk sub-phenotypes separate obesity from its metabolic consequences. These indices have not been duly studied in Nigeria. One hundred and ninety nine adult Nigerians (52.3% females) were studied. Obesity and metabolic syndrome were defined using World Health Organization and US National Cholesterol Education Program Adult Treatment Panel III criteria, respectively. The presence or absence of the metabolic syndrome within the 3 BMI groups (normal, overweight and obese) was used to define 6 BMI-metabolic-risk sub-phenotypes. The results show that 12.1% (13.7% for males and 10.6% for females) of the population were obese. Metabolic syndrome was found in 30.8% (males 34.7%; females 26.9%) of the population. In the obese and overweight subjects, 33.3% and 40.9% respectively were metabolically healthy while 37.6% of the normal weight subjects were metabolically obese. BMI-metabolic-risk sub- phenotypes were found at the rates of 4%-34.2% in the entire population. The results are compared to figures from other studies, and discussed in the light of their implications for a country like Nigeria that is still battling with communicable diseases. Lifestyle modifications that encourage physical exertion and appropriate nutrition are advocated.

Key words: BMI-metabolic-risk sub-phenotypes, metabolic syndrome, obesity

International Journal of Medical Advances and Discovery ISSN 2756-3812 Vol. 3 (1), pp. 001-006, January, 2012. © International Scholars Journals

Full Length Research Paper

Comparative effect of chlorpropamide and combined leaf extracts of Azadirachta indica and Vernonia amygdalina on blood glucose and biochemical parameters of alloxanized rats

Item Justin Atangwho¹, Ime Franklin Ani², Margaret Akpana Agiang¹, Grace Sylvester Effiong³ and Patrick Ekong Ebong¹

¹Departments of Biochemistry and ²Public Health, College of Medical Sciences, University of Calabar, P. M. B. 1115, Calabar, Nigeria.

³Department of Clinical Pharmacy and Biopharmacy, Faculty of Pharmaceutical Sciences, University of Uyo, P. M. B. 1017, Uyo, Nigeria.

Accepted 06 October, 2011

Abstract

The comparative anti-hyperglycemic efficacy along with the impact on some biochemical parameters of alloxan-induced diabetic rats, following treatment with chlorpropamide and combined leaf extracts from Vernonia amygdalina (VA) and Azadirachta indica (AI) was evaluated in this study. Twenty four rats, 18 diabetic and 6 non-diabetic were assigned into four groups of 6 rats each, and respectively treated with one of the following combinations: saline (non-diabetic and diabetic controls), extracts of AI and VA combined (200 mg/kg b. w. in 1:1 ratio), and chlorpropamide (14.286 mg/kg b. w.), for a 21-day period. Measured blood glucose reductions relative to their initial values at the end of treatment were 71.05% and 75.83% for combined extracts and chlorpropamide respectively. Similarly the serum glucose respectively decreased by 58.74% and 59.97% relative to the diabetic control value of 264.27 ± 4.36 mg/dl. The extents of decrease of both blood and serum glucose in the combined extracts-treated group, compared well (p > 0.01) with the chlorpropamide test group. The 21-day treatment with chlorpropamide and the combined plant extracts significantly (p < 0.05) reduced serum triglyceride and total cholesterol concentrations as well as aminotransferase activities to a similar extent, and the levels were both comparable to those of the normal control. Result of serum electrolytes and urea concentrations also showed comparable ameliorative effect on associated renal complications of diabetes. Therefore combined extracts of AI and VA has the potentials to replace sulfonylureas such as chlorpropamide in the management of diabetes.

Keywords: Polyherbal therapy, chlorpropamide, diabetes mellitus, blood and serum glucose, biochemical parameters.

International Journal of Medical Advances and Discovery ISSN 2756-3812 Vol. 3 (1), pp. 001-006, January, 2012. © International Scholars Journals

Full Length Research Paper

Safety of daily sedation interruptions in mechanically ventilated inner city patients – an alternative approach

Sindhaghatta Venkatram¹, Jay Nayak², Balavenkatesh Kanna³

¹Director, Critical Care Units, Bronx Lebanon Hospital Center, 1650, Grand Concourse, Bronx. NY. 10457

²Fellow, hematology and oncology, Montefiore Medical Center, 3400 Bainbridge Avenue, Bronx, NY 10467-2404

³Department Internal Medicine, Lincoln Medical and Health Center, 234, E 149 Street, Bronx, NY.10456, Bronx, NY

Accepted 06 June, 2011

Abstract

Mechanically ventilated patients remain at risk for ventilator-associated pneumonia (VAP). While ventilator bundle implementation, with "sedation vacations" and assessing weaning readiness, has been shown to decrease VAP rates, inadequate sedation is a risk factor for unplanned extubation (UPE). We conducted a before-after observational study after institution of the ventilator bundle with sedation vacations in mechanically ventilated Medical Intensive Care Unit (MICU) patients from January 2006 to December 2007. Patients over 18 years old without contraindications to weaning were included. The primary outcome was UPE rate, and secondary outcomes included days on mechanical ventilation, re-intubation, and 28-day mortality. In 2005, 549 of 1196 MICU patients were mechanically ventilated compared to 1179 of 2553 in the study period. UPE rate remained unchanged (5.3% vs. 4.2%; AR -0.010; 95% CI - 0.032 to 0.012). There were non-significant decreases in UPE per 100 ventilator days (1.26 vs. 1.04; RR 0.82; 95% CI 0.51 to 1.35; P = 0.40) and duration of mechanical ventilation for patients who had scheduled extubations (3.7 vs. 3.3 days; 95% CI -0.02 – 082; P = 0.06). This study suggests that sedation interruptions and assessment for weaning are safe in our unique inner city population and do not result in increased UPE rates.

Keywords: Unplanned extubation, sedation vacation, safety, mechanical ventilation

International Journal of Medical Advances and Discovery ISSN 2756-3812 Vol. 2 (12), pp. 001-004, December, 2011. © International Scholars Journals

Full Length Research Paper

Dyspnea scoring in patients with COPD

Gulfidan Cakmak¹, Zuhal Aydan Saglam², Tayyibe Saler³, Mustafa Yenıgun⁴, Esra Ataoglu³, Levent Umit Temiz³, Tuncalp Demır⁵

¹Specialist of Chest Diseases, 4th Clinic of Internal Medicine, Haseki Training and Research Hospital, Haseki Millet Caddesi, Aksaray-Istanbul,Turkey

²Family Practitioner, 4th Clinic of Internal Medicine, Haseki Training and Research Hospital, Haseki Millet Caddesi, Aksaray-Istanbul,Turkey

³Internist, 4th Clinic of Internal Medicine, Haseki Training and Research Hospital, Haseki Millet Caddesi, Aksaray-Istanbul, Turkey

⁴Department of Internal Medicine, 4th Clinic of Internal Medicine, Haseki Training and Research Hospital, Haseki Millet Caddesi, Aksaray-Istanbul, Turkey

⁵Chest Diseases Specialist, Istanbul University Medical Faculty of Cerrahpasa, Department of Respiratory Medicine. Cerrrahpasa-Istanbul, Turkey

Accepted 26 May, 2011

Abstract

COPD is a progressive disorder diagnosed with recognition of the symptoms and spirometry. The parameters of spirometry are well defined in several guidelines. According to GOLD rearranged at 2004, a post bronchodilator FEV₁/FVC rate smaller than 70% is accepted as a diagnostic criterion for COPD. Symptoms are also important as well as spirometric evaluation. Indeed, these symptoms are the clinical representation of the present inflammation. Among symptoms, dyspnea is the most important one alarming the patient. So, classification of dyspne in a simple and objective way has a great value. In this study, we emphasized the presence of dyspnea in outpatients of our Chest Disease Department who smoked more than 10 pack/yr. Patients are classified into two groups as COPD and non-COPD group according to symptoms and spirometric evaluations. Each individual was expected to carry out a self-administered questionnaire for symptom scoring following spirometry. Presence of a rustling sound (A), preexisting pulmonary disease (B), and short of breath (C) were questioned and scored one by one. A, B, C and total ABC scores were significantly different in groups with and without COPD (p<0.001). Symptom scoring according to staging/stages in COPD group revealed that as COPD worsened A, B, C and total ABC scores increased. There was a significant difference regarding symptom scoring especially among patients without COPD and COPD patients at stage 2B and 3. As the patients reached higher scores, all of the spirometric parameters significantly decreased (p<0.001). It is important to explore and express dyspnea in the best possible way in order to avoid misdiagnosing and maltreatment.Examination of dyspne should not require administration of very complex questionnaires, moreover, with simple questionnaires it is possible to achieve reliable scoring.

Keywords: COPD, dyspnea, dyspnea scoring, symptom scoring, spirometry

International Journal of Medical Advances and Discovery ISSN 2756-3812 Vol. 2 (12), pp. 001-008, December, 2011. © International Scholars Journals

Full Length Research Paper

Detection and characterization of human rotavirus in tap water by multiplex RT-PCR

Julius Tieroyaare Dongdem¹*, Jonathan Adjimani² and George Armah³

¹Department of Medical Biochemistry, School of Medicine and Health Sciences. University for Development Studies, Tamale. Ghana

²Department of Biochemistry, University of Ghana, Legon, Ghana

³Department of Electron Microscopy and Histopathology, Noguchi Memorial Institute for Medical Research, Legon, Ghana

Accepted 28 June, 2011

Abstract

More than a billion diarrheal cases occur each year among children below five years resulting in high morbidity and mortality. Rotaviruses, the single leading cause of diarrhea in children below five years, cause more than 130 million episodes of severe diarrhea throughout the world. While treated water has been identified as a route of transmission, rotavirus in treated water has not been investigated in Ghana. Since the presence of rotaviruses in drinking water is unacceptable, a virological survey to detect and characterize rotavirus was conducted on tap water in the western part of Accra. Treated water samples were collected from five zones within the distribution network of Weija Water Works. Two litres of each sample were concentrated 4,000 fold and the viral particles extracted. Viral RNA was extracted from all concentrates using phenol/chloroform, purified with the RNaid^®kit and reverse transcribed. The cDNA was amplified by semi-nested PCR using P and G genotype- specific primers and analyzed an agarose gel. Rotavirus was detected in 48.1% of samples. Nine rotavirus P-types and 12 G-types were detected. The detection pattern showed increased viral pollution with distance from the treatment plant and in areas with high human activity.

Keywords: Characterization, detection; Ghana; rotavirus diarrhea; RT-PCR; tap water.

International Journal of Medical Advances and Discovery ISSN 2756-3812 Vol. 2 (11), pp. 001-003, November, 2011. © International Scholars Journals

Case Report

Benign multicystic mesothelioma of peritoneum presenting as a tubo-ovarian mass – A case report

Madhusmita Jena, M.D. (Pathology)

M.V.J. Medical College and Research Hospital, Bangalore, India. Email: [email protected]

Accepted 25 June, 2011

Abstract

Multicystic mesothelioma is a rare benign neoplasm of the peritoneum occurring in women of reproductive age. A 45 year old woman presented with a mass per abdomen measuring 20 x 18 cms² with on and off pain since 5 months. She had a history of five abdominal surgeries in the past. USG and CT scan of the pelvis showed a multicystic mass of 20 x20 cms² arising from right adenexal region and a provisional diagnosis of ovarian cystadenocarcinoma was suggested. A total abdominal hysterectomy and bilateral salpingo-oophorectomy was done. The specimen showed a multilocular cystic mass of 20 x 15 cms² adherent to the uterus and cervix in the right adenexal area. Histology showed cystic spaces lined by cuboidal cells with hobnail appearance. This case is presented for its rarity and its relationship with history of previous surgical interventions in abdominal region.

Keywords: Multicystic mesothelioma, benign mesothelioma of peritoneum, benign multicystic mesothelioma