Clinical Medicine Research

ISSN Online: 2326-9057 ISSN Print: 2326-9049

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Volume 2, Issue 6, November 2013

  • Authors: Solomon Asnakew Feleke, Chalachew Misganaw Alemayehu, Hawult Taye Adane

    Abstract: Introduction: Diabetes mellitus was perceived as the problem of the developed world but currently developing countries like Ethiopia are suffering chronic diseases of which diabetes is the major one.Objective: The aim of this study wasto assess of the level and associated factors with knowledge and practice of diabetes mellitus among diabetic patients attending at FelegeHiwot hospital. Methods: Institution based cross sectional study was conducted using interviewer administered questionnaire among 410 diabetic patients. Systematic sampling technique was used to select study subjects. Data was entered to EPI info 3.5.1 and then transferred to SPSS for analysis. Descriptive and analytical statistics including bivariate and multivariate analysis were applied. Result: Among 410 respondents, Half (49.8%) of them had good knowledge and one hundred fifty four (36.8%) participants had good practice on diabetes. Lower age was significantly associated with good knowledge and practice. Age group 18-32 yrs, 33-41 yrs and 42-50 yrs were 6.2 times, 3.3 times and 3.1 times respectively more likely to had good knowledge compared to individuals who were at the age of 50 yrsand above. Similarly, age group between 18-32 yrs was 6 times more likely to have good practice. Higher educational status was also associated with good knowledge and practice. Participants in grade 1-8, grade 9-12 and higher education and above were 3.4 times, 4.7 times and 7.2 timesrespectively more likely to had good knowledge compared to those who were unable to read and write.Likewise, those in grade 1-8, grade 9-12 and higher education and above were 3.5, 4.3 and5.4 times respectivelyto have good practice.Increased duration of diabetic therapy was positively associated with good knowledge and practice. Increased level of income was positively associated with good practice.Conclusion: This study demonstrated low level of knowledge and practice among DM patients. Age, educational status and duration of DM therapy were associated with good knowledge and practice of participants. Monthly income was also associated with good practice. Improving knowledge and practice of diabetic patient through active education is advisable. Involvement of both governmental and non-governmental organizations is also crucial to help patients receive maximum benefit from the health care service.

    Received: Aug. 11, 2013 Accepted: Published: Sep. 30, 2013

    DOI: 10.11648/j.cmr.20130206.11 View: Downloads:

  • Authors: Ayodele Teslim Onigbinde, Oyebukola Akindoyi, Funmilola Adenike Faremi, Adaobi Okonji, Oniyangi Shuaib, Olaitan Olukunmi Lanre

    Abstract: Most often, attention is focused on management of pains, restricted joint motions and decreased muscle strength in subjects with knee osteoarthritis, with little attention on hamstring flexibility training. The objectives of this study were to assess and compare hamstring flexibility of subjects with knee osteoarthritis with their age matched healthy control. Forty-four subjects with grade III knee osteoarthritis and 58 apparently healthy individuals participated in the study. Hamstring flexibility, pain and knee flexion range of motion of both groups were measured. The data was analyzed using descriptive statistic and parametric inferential statistics [student t-test and Pearson’s product moment correlation]. The result showed that the mean flexibility of apparently healthy individual was significantly higher than that of subjects with knee osteoarthritis [t = 2.84, p<0.001]. Also, there was significant correlation between age, BMI, height and flexibility of the subjects with knee OA [r = -0.453, p = 0.002; r = -0.568 p = 0.034, r = 0.328, p = 0.030] respectively. This study concluded that the mean hamstring flexibility of subjects with knee osteoarthritis was significantly lower than that of apparently healthy individual.

    Received: Aug. 4, 2013 Accepted: Published: Sep. 30, 2013

    DOI: 10.11648/j.cmr.20130206.12 View: Downloads:

  • Authors: Zelalem Alamrew, Worku Awoke, Getachew Fikadie, Bizuayhu Shimekaw

    Abstract: Background: Transactional sex is the practice of exchanging sex for financial or life style rewords; which has been associated with increased risk of HIV and others STD’s. The aim of this study was to assess the prevalence and correlates of exchanging sex for money (gifts) among college students in Bahir Dar city. Methods: A cross sectional study was conducted in July 2012 among 790 students in eight private colleges in Bahir Dar city using multistage sampling technique. A pre-tested self-administered questionnaire was used. The data were analyzed in bivariate and multivariate logistic regression analysis with SPSS version 16 soft ware package. Results: About 27.8% of sexually active respondents of the study were reported to have exchanged sex for money (gift). Respondents reported unprotected sex were about 2 times more likely to exchange sex compared to those never did unprotected sex (AOR= 1.85, 95%CI: 1.07-8.78).The odds of exchanged sex was higher for students living in rented house with no family compared to those living with family (AOR= 1.78, 95%CI: 1.03 -3.06), and for the students who used khat and shisha compared to those never took these substances (AOR= 1.92, 95%CI: 1.10-3.33 and AOR= 3.14, 95%CI: 1.32-7.44) respectively. Moreover, the students visited night clubs more than two times a week were more than threefold risk of exchanging sex compared to those students never visited night clubs(AOR= 3.87, 95%CI: 1.71- 8.78). Conclusion: This study revealed that 27.8% of sexually active respondents were ever exchanged sex and unprotected sex was associated with it, implying that receiving/paying money (gift) might interfere to negotiate condom use. Besides, several variables were associated with it, therefore, HIV/AIDS prevention programs need to give attention to exchanged sex.

    Received: Aug. 30, 2013 Accepted: Published: Oct. 20, 2013

    DOI: 10.11648/j.cmr.20130206.13 View: Downloads:

  • Authors: Basri Cakiroglu, Ramazan Gozukucuk, Orhun Sinanoglu, Suleyman Hilmi Aksoy, Tuncay Tas, Seyit Erkan Eyyupoglu, Bekir Sami Uyanik

    Abstract: Purpose: To evaluate the correlation between international prostate symptom score (IPSS) and objective measures of lower urinary tract symptoms to estimate the grade of infravesical obstruction in benign prostatic hyperplasia (BPH). Methods: The data of 152 male patients examined in urology outpatient clinic with lower urinary tract symptoms (LUTS) were retrospectively rewieved between January 2010 and December 2011. Prostate volume, detrusor wall thickness (DWT) and post voiding residue (PVR) were evaluated with suprapubic ultrasound. The patients were distributed in three groups according to IPSS values; 1st, lower IPSS group (n=39), 2nd, moderate IPSS group (n=80) and 3rd, .higher IPSS group (n=33). IPSS, BWT, prostate volume, postvoiding residue (PVR), and maximum urine flow (Qmax) values were compared. Results: The mean age was 52.9 ±9.0 years. There were significant differences between the three groups for total PSA, in terms of prostate volume, DWT, PVR, Qmax, Qave values. There was a significant correlation between IPSS questionnaire results and PVR, Qmax and Qave (P< 0.05). PVR, Qmax and PVR values revealed especially strong positive correlations with symptoms severity or IPSS (Pearson /Spearman’s correlation coefficients were 0.441; p < 0.000 and 0.446; p < 0.000 respectively; Table 3). Conclusions: There are significant correlations between symptoms severity (IPSS) and objective BPH-related parameters, such as age, PSA, prostate volume, DWT, PVR, Qmax, Qave and QoL. The measurements of especially DWT, PVR and Qmax are promising noninvasive tools to predict the grade of LUTS in men and is reflected in IPSS severity.

    Received: Sep. 11, 2013 Accepted: Published: Oct. 20, 2013

    DOI: 10.11648/j.cmr.20130206.14 View: Downloads:

  • Authors: Wondemagegn Mulu, Gebre Kibru, Getenet Beyene, Meku Damtie

    Abstract: Background: Nosocomial infections are the most challenging problem in all health care systems. In developing countries many people are dying daily due to inadequate health care services of which postoperative infections constitute a large proportion of this burden. Objective: The aim of this study was to identify risk factors associated for post operative nosocomial infections among operated patients at Felege Hiwot Referral Hospital. Methods: A cross-sectional study was conducted on patients who under gone operations from October 2010 to January 2011. A structured questionnaire was used for collection of data on socio-demographic characteristics and associated risk factors. The clinical diagnosis was made by respective surgeons and gynaecologists. Bacterial culture confirmation was done for all patients who developed clinical signs and symptoms of surgical site (SSI) and/or bloodstream infection (BSI) starting from the second day of admission until the time of discharge using standard bacteriological techniques. Bivariate analysis was made to generate to identify associated risk factors. P.value < 0.05 was considered as stastically significant. Results: A total of 294 patients were included in the study. The rate of postoperative culture confirmed nosocomial infection was 10.9%. The infection rate was higher in females (11.6%) than males (9.4%) (OR=1.27, CI=0.564- 2.863). Patients age of >51 years old were likely to develop post operative nosocomial infection (OR=6.38, CI=1.156-35.14). Patient with underlying diseases (OR=2.725, CI=1.269-5.853) and patients who undergone appendectomy ( OR=3.1, CI=1.1-8.3) were more likely developed post operative nosocomial infections. Operation duration of 91-150 minutes (OR=11.00, CI=1.989-60.83), and postoperative hospital stay of greater than 15 days (OR=82.00, CI=5.738-1.172) were also likely to be risk factor for infection. Conclusion: This study confirmed that advanced age, underlying disease, extended preoperative and postoperative hospital stay, longer duration of surgery and appendectomy were the most likely risk factors for post operative infections. Hence, more attention is required in management of such cases through prior identification of underlying disease, use of effective antibiotics as a prophylaxis and adherence of strict aseptic operating procedures.

    Received: Sep. 7, 2013 Accepted: Published: Oct. 30, 2013

    DOI: 10.11648/j.cmr.20130206.15 View: Downloads:

  • Authors: Melissa Laus, Domenico Crescenzi, Alessandro De Stefano, Adelchi Croce

    Abstract: Larynx and trachea invasion by thyroid cancer is an uncommon but difficult problem. There is no consensus on indication for the extent of surgery, particularly when there is a requirement for airway reconstruction. In general, the surgeon must decide between a complete ablation of the tumor at the cost of large-mutilation and a less radical dissection that leaves residual tumor to be treated with radiation therapy and additional radio-iodine.

    Received: Sep. 21, 2013 Accepted: Published: Oct. 30, 2013

    DOI: 10.11648/j.cmr.20130206.16 View: Downloads:

  • Author: Michael D Innis

    Abstract: Requests from distressed parents and relatives seeking help after having been falsely accused by doctors of injuring their children are not uncommon. Viraland parasitic infections andvaccinescause an autoimmune disorder, Tissue Scurvy, misdiagnosed as child abuse. This report presents the evidence. Method. Relevant hospital and laboratory reports of three children were examined for evidence of Tissue Scurvy as the cause of the neurological lesions, fractures, bruises and hemorrhages found on them. Results. In all the cases in which appropriate histories and tests were done there was evidence that the doctors either misinterpreted the laboratory evidence or they were unaware of the significance of abnormal tests suggesting Tissue Scurvy as the cause. Conclusion. Some doctors are unaware of the pathophysiological processes of autoimmunity, haemostasis and osteogenesis and are misdiagnosing vaccine induced Tissue Scurvy, absence of Vitamin C within the cell, as Non-accidental Injury.

    Received: Oct. 2, 2013 Accepted: Published: Nov. 10, 2013

    DOI: 10.11648/j.cmr.20130206.17 View: Downloads:

  • Authors: Aybala Agac Ay, Abdullah Çetin

    Abstract: Aim: Thyroid fine-needle aspiration biopsy (TFNAB) is the gold standard methodology for the evaluation of thyroid nodule. Nevertheless, diagnosis of TFNAB specimens is sometimes interpreted as “follicular lesion of undetermined significance”: This indeterminate diagnosis is given upon TFNAB despite the presence of sufficient cellular material available for cytopathological analysis. Furthermore, this indeterminate diagnosis constitutes a grey zone between benign lesion and malignancy. As a result, it becomes difficult to determine the type of surgical intervention that needs to be performed on the patient and the technique that will be used. In this study, we aim to correlate the diagnosis of “follicular lesion of undetermined significance” with clinical and postoperative evaluations. Methods: A total of 147 patients, who were diagnosed as “follicular lesion of undetermined significance” following initial TFNAB, were included in this retrospective study. These patients were evaluated according to whether they underwent a second TFNAB or thyroidectomy pathology following initial diagnosis of “follicular lesion of undetermined significance”. Results: Results were generated by evaluating the reports of the second TFNAB and 15 of 147 patients were followed. Histopathological examination of specimens derived from 132 patients following surgery revealed the following diagnosis: (i) hyperplasia in 67 patients, (ii) nodular lesion belonging to Hashimoto’s thyroiditis in 34 patients, (iii) papillary carcinoma in 28 patients, (iv) follicular carcinoma in two patients, and (v) anaplastic carcinoma in one patient. Conclusion: Based on this retrospective study and on examination of the available literature concerning the treatment options and follow-up of patients initially diagnosed as “follicular lesion of undetermined significance” (FLUS or Atypia of undetermined significance) upon TFNAB, we conclude that it is important to keep in mind the elevated rates of malignancy that potentially develop from these undetermined lesions. is electronic document is a “live” template. The various components of your paper [title, text, heads, etc.] are already defined on the style sheet, as illustrated by the portions given in this document.

    Received: Nov. 20, 2013 Accepted: Published: Dec. 20, 2013

    DOI: 10.11648/j.cmr.20130206.18 View: Downloads:

  • Authors: Mahmoud Hassan El-Bidawy, Nabil Mohamed Elbahey, Mohamed Mahmoud Shaaban

    Abstract: Chronically excessive numbers of glucocorticoids are known to induce insulin resistance, which is possibly involved in impairing the insulin signaling in liver, muscle, and adipose tissues. Excessive levels of cortisol are characterized by the symptoms of abdominal obesity, hypertension, glucose intolerance or diabetes and dyslipidemia ,all of these features are shared by the condition of insulin resistance .Consumption of high levels of dietary fat is thought to be a major factor in the promotion of obesity and insulin resistance [7]. Fatty acid composition in the diet is another mechanism implicated in the development of insulin resistance [6]. Several environmental factors, including high-fat diet, are reported to activate the functioning of the hypothalamus-pituitary-adrenal axis [HPA]. Frequently evoked HPA-axis secretes excessive amount of cortisol [21] and elevated cortisol level is implicated in the development of entire spectrum of the metabolic syndrome, including insulin resistance, visceral obesity and dyslipidemia as well as the kinds of [21]. Cinnamon contains biologically active substances that have demonstrated insulin-mimetic properties. In vitro [3] and in vivo [1, 20] studies have shown that cinnamon enhances glucose uptake by activating insulin receptor kinase activity, autophosphorylation of the insulin receptor, and glycogen synthase activity. Other recent studies have demonstrated the ability of cinnamon to reduce lipid levels in fructose-fed rats, potentially via inhibiting hepatic 3-hydroxy-3-methylglutaryl CoA reductase activity [2]. Adiponectin is the most abundant plasma protein synthesized for the most part in adipose tissue, and it is an insulin-sensitive hormone,playing a central role in glucose and lipid metabolism [7] Furthermore, adiponectin levels are inversely associated with visceral adiposity [15]. Moreover, adiponectin has been reported to exhibit anti-atherosclerotic and anti-inflammatory effects [17,16].

    Received: Dec. 1, 2013 Accepted: Published: Dec. 20, 2013

    DOI: 10.11648/j.cmr.20130206.19 View: Downloads:

  • Authors: Gaude Gajanan, Hattiholi Jyothi, Chaudhury Alisha

    Abstract: Background: Acute exacerbations of COPD (AECOPD) are known to be associated with increased morbidity and mortality and have a significant socioeconomic impact. The factors that determine frequent hospital readmissions for AECOPD are poorly understood. The aim of this study was to EVALUATE the factors responsible for the repeated admissions for AECOPD. Methodology: We conducted a prospective study of 235 patients with COPD with one or more admissions for acute exacerbations in a tertiary care hospital. Frequency of previous readmissions for AECOPD in the past year, and clinical characteristics, including spirometry were ascertained in the stable state both before discharge and at 6-month post discharge. All the patients were followed up for a period of two years after discharge to evaluate the readmissions for the acute exacerbations. Results: Among 149 COPD patients who were admitted and assessed for AECOPD, there were 278 readmissions for AECOPD over a follow-up period of 24 months. Of these, 27% had one readmission, while rest 78% had two or more readmissions during this period. There was a high prevalence of current or ex-heavy smokers, associated co-morbidity, underweight patients and low prevalence of vaccination and use of domiciliary oxygen therapy among COPD patients. A total of 15.4% mortality was observed in the present study. The multivariate logistic regression analysis for repeated admissions revealed that disease duration >10 years (OR =0.50; 95% CI: 0.27 -0.93), non-use of inhaled corticosteroids (ICS +LABA) (OR = 2.31; 95% CI: 2.26–4.88), lower serum albumin level (<2gm/dl) (OR = 0.48; 95% CI: 0.26–0.88), MRC dyspnea grade > 3 (OR = 1.15; 95% CI: 2.56–4.89), body mass index (BMI) <20 (OR =0.62, 95% CI: 0.31-1.23) and non-use of Tiotropium (OR = 1.21, 95% CI: 0.67-2.19) were independently associated with frequent readmissions for AECOPD. Conclusion: The repeated exacerbations in COPD were common with major burden to the society. The major factors influencing frequency of repeated COPD exacerbations were disease duration, non-prescription of inhaled corticosteroids (ICS +LABA) and Tiotropium, lower serum albumin level (<2gm/dl), lower BMI and MRC dyspnea grade > 3.

    Received: Nov. 24, 2013 Accepted: Published: Dec. 20, 2013

    DOI: 10.11648/j.cmr.20130206.20 View: Downloads:

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