Advances in Medicine https://www.hindawi.com The latest articles from Hindawi © 2017 , Hindawi Limited . All rights reserved. A Systems Medicine Approach: Translating Emerging Science into Individualized Wellness Sun, 15 Oct 2017 00:00:00 +0000 http://www.hindawi.com/journals/amed/2017/1718957/ In today’s aging society, more people are living with lifestyle-related noncommunicable diseases (NCDs) such as cardiovascular disease, type 2 diabetes, obesity, and cancer. Numerous opinion-leader organizations recommend lifestyle medicine as the first-line approach in NCD prevention and treatment. However, there is a strong need for a personalized approach as “one-size-fits-all” public health recommendations have been insufficient in addressing the interindividual differences in the diverse populations. Advancement in systems biology and the “omics” technologies has allowed comprehensive analysis of how complex biological systems are impacted upon external perturbations (e.g., nutrition and exercise), and therefore is gradually pushing personalized lifestyle medicine toward reality. Clinicians and healthcare practitioners have a unique opportunity in advocating lifestyle medicine because patients see them as a reliable source of advice. However, there are still numerous technical and logistic challenges to overcome before personal “big data” can be translated into actionable and clinically relevant solutions. Clinicians are also facing various issues prior to bringing personalized lifestyle medicine to their practice. Nevertheless, emerging ground-breaking research projects have given us a glimpse of how systems thinking and computational methods may lead to personalized health advice. It is important that all stakeholders work together to create the needed paradigm shift in healthcare before the rising epidemic of NCDs overwhelm the society, the economy, and the dated health system. J. S. Bland, D. M. Minich, and B. M. Eck Copyright © 2017 J. S. Bland et al. All rights reserved. Methylene Blue Effectiveness as Local Analgesic after Anorectal Surgery: A Literature Review Tue, 15 Aug 2017 07:05:52 +0000 http://www.hindawi.com/journals/amed/2017/3968278/ Background. Methylene blue (MB) has been found to have unique analgesic property through temporary disruption of sensory nerve conduction. In anorectal surgery, MB is widely used as a biologic stain but the analgesic effect has never been studied. Thus, a literature review completed with critical appraisal is required to find out its efficacy. Methods. A review has been run to find out its efficacy. Literature search proceeded in database sites, namely, PubMed, EBSCO, Cochrane, Wiley, and ProQuest using the following keywords: “anorectal” OR “hemorrhoid” OR “anal fistula” OR “anal fissure” OR “anal abscess” OR “anal pruritus” AND “methylene blue” AND “analgesic”; then the critical appraisal and its implication were discussed. Result. There were 491 articles in full text found, and four studies met the inclusion criteria. Two studies were focused on the evaluation of VAS in hemorrhoid surgery whereas the rest were focused on the evaluation of symptom score in anal pruritus. Conclusions. A study with level of evidence 2 on VAS showed the efficacy. The rest showed insufficient evidence due to variations of anorectal surgery and the methods and techniques of MB application. A further prospective clinical study is required. Dewi Fransiska, Wifanto Saditya Jeo, Yefta Moenadjat, and Dewi Friska Copyright © 2017 Dewi Fransiska et al. All rights reserved. Reducing 30-Day Rehospitalization Rates Using a Transition of Care Clinic Model in a Single Medical Center Wed, 02 Aug 2017 07:33:28 +0000 http://www.hindawi.com/journals/amed/2017/5132536/ Background. Rehospitalization for medical patients is common. Multiple interventions of varying complexity have been shown to be effective in achieving that goal with variable results in the literature. For medical patients discharged home, no single intervention implemented alone has been shown to have a sustainable effect in preventing rehospitalization. Objective. To study the effect of a transition of care clinic model on the 30-day rehospitalization rate in a single medical center. Methods. Retrospective observational analysis of adult patients discharged home from Memorial Medical Center from September 1, 2014, through December 31, 2014. The primary outcome was to compare hospital readmission rates between patients who followed up with a transition of care (TOC) clinic and those who did not. Results. The study population included 378 patient discharges. A total of 40 patients (10.6%) were readmitted to the hospital within 30 days of discharge. Patients who attended the TOC clinic had a significantly lower 30-day readmission rates (3.8% versus 11.7%). A Cox regression analysis showed that the TOC clinic attendance had a significant negative predication for readmission (HR 0.186, 95% CI 0.038–0.898, ). Conclusion. Adopting a TOC model after discharging medical patients has reduced the readmission rates in our study. Tamer Hudali, Robert Robinson, and Mukul Bhattarai Copyright © 2017 Tamer Hudali et al. All rights reserved. Cigarette Smoking and Its Hazards in Kidney Transplantation Thu, 27 Jul 2017 00:00:00 +0000 http://www.hindawi.com/journals/amed/2017/6213814/ Cigarette smoking affects many organs. It causes vasoconstriction through activation of sympathetic nervous system which leads to elevation of blood pressure and reduction in glomerular filtration rate and filtration pressure. It also causes thickening of renal arterioles. Cigarette smoking increases the risk of microalbuminuria and accelerates progression of microalbuminuria to macroalbuminuria. Furthermore, it causes rapid loss of glomerular filtration rate in chronic kidney disease patients. After kidney donation, these factors may be injurious to the solitary kidney. Kidney donors with history of cigarette smoking are prone to develop perioperative complications, pneumonia, and wound infection. Postkidney transplantation various stressors including warm and cold ischemia time, delayed graft function, and exposure to calcineurin inhibitors may result in poor graft function. Continuation of cigarette smoking in kidney transplant recipients will add further risk. In this review, we will specifically discuss the effects of cigarette smoking on normal kidneys, live kidney donors, and kidney transplant recipients. This will include adverse effects of cigarette smoking on graft and patient survival, cardiovascular events, rejection, infections, and cancers in kidney transplant recipients. Lastly, the impact of kidney transplantation on behavior and smoking cessation will also be discussed. Muhammad Abdul Mabood Khalil, Jackson Tan, Said Khamis, Muhammad AshhadUllah Khalil, Rabeea Azmat, and Arslan Rahat Ullah Copyright © 2017 Muhammad Abdul Mabood Khalil et al. All rights reserved. The Relation of Diabetes Type 2 with Sexual Function among Reproductive Age Women in Iran, a Case-Control Study Thu, 06 Apr 2017 08:01:34 +0000 http://www.hindawi.com/journals/amed/2017/4838923/ Background. Diabetic patients are at the greater risk of retinopathy, nephropathy, neuropathy, and sexual dysfunction compared to the general population. Objective. The aim of this study was to evaluate the sexual dysfunction in type 2 diabetes reproductive age women in Iran. Method. This was a case-control study carried out on 130 women with type 2 diabetes and 130 healthy women. The type 2 diabetes diagnosis was confirmed with abnormal fasting blood sugar, abnormal random blood sugar test, and abnormal level of HbA1C. Eligible women were requested to complete a demographic questionnaire and female sexual function index (FSFI). The chi-square test, independent -test, and Multivariate Analysis of Covariance (MANCOVA) were used for analyzing data. Results. Results of this study showed that diabetic women had significantly lower sexual desire, arousal, lubrication, and orgasm and more pain compared to the healthy women (). Also diabetic women had lower sexual satisfaction compared to the healthy women (). The total score of sexual function was significantly lower in the diabetic women compared to the healthy women ( versus , ). Conclusion. Results of this study showed that the score of all dimensions of sexual function in diabetic patients was lower than that in healthy women. Education and counseling about controlling diabetes and sexual function among diabetic women in reproductive age are recommended. Poorandokht Afshari, Shiva Yazdizadeh, Parvin Abedi, and Homayra Rashidi Copyright © 2017 Poorandokht Afshari et al. All rights reserved. Knowledge and Attitude toward Epilepsy of Close Family Members of People with Epilepsy in North of Iran Mon, 26 Dec 2016 08:38:13 +0000 http://www.hindawi.com/journals/amed/2016/8672853/ Background. Knowledge and attitudes are required for relatives of people with epilepsy to allow them to better understand and cope with this condition. This study evaluated the knowledge and attitudes of family members of people with epilepsy about the disease. Methods. This cross-sectional survey was conducted using a self-administered questionnaire completed by close family members of people with epilepsy at the outpatient clinic of a medical university. The questionnaire included 25 items that determined the demographics and information on the level of knowledge and attitudes about epilepsy. Results. The 124 participants had an average age of years. The mean knowledge score was (range: 4 to 15). 87.1% of respondents answered that epilepsy is a brain disorder, 39 (31.5%) said epilepsy is inherited. As a whole, 62 (50%) had good knowledge about the disease. The mean score of attitude was (range: 2 to 10). 83.9% of respondents believed that a person with epilepsy can get married and get pregnant (76.6%). Overall, 15 (12.1%) had negative attitudes and 109 (87.9%) had positive attitudes. Conclusion. The main findings of this study indicated good knowledge and a positive attitude about epilepsy among family members of people with epilepsy. Narges Karimi and Seyyed Ali Akbarian Copyright © 2016 Narges Karimi and Seyyed Ali Akbarian. All rights reserved. Efficacy of Synbiotics for Treatment of Bacillary Dysentery in Children: A Double-Blind, Randomized, Placebo-Controlled Study Wed, 30 Nov 2016 10:13:47 +0000 http://www.hindawi.com/journals/amed/2016/3194010/ Bacillary dysentery is a major cause of children’s admission to hospitals. To assess the probiotic and prebiotic (synbiotics) effects in children with dysentery in a randomized clinical trial, 200 children with dysentery were studied in 2 groups: the synbiotic group received 1 tablet/day of synbiotic for 3–5 days and the placebo group received placebo tablets (identical tablet form like probiotics). The standard treatment was administered for all patients. Duration of hospitalization, dysentery, fever, and the weight loss were assessed in each group. It was concluded that there was no significant difference in both groups in the baseline characteristics. The mean duration of dysentery reduced (). The mean duration of fever has been significantly reduced in the synbiotic group ( days) in comparison to the placebo group ( days) (). Average amount of weight loss was significantly lower in the synbiotic group in comparison to that in the placebo group ( grams and grams, resp.; ). There was no significant difference in the mean duration of hospitalization in both groups (). The use of synbiotics as an adjuvant therapy to the standard treatment of dysentery significantly reduces the duration of dysentery, fever, and rate of weight losses. The trial is registered with IRCT201109267647N1. Manijeh Kahbazi, Marzieh Ebrahimi, Nader Zarinfar, Mohammad Arjomandzadegan, Taha Fereydouni, Fatemeh Karimi, and Amir Reza Najmi Copyright © 2016 Manijeh Kahbazi et al. All rights reserved. The Biological Metallic versus Metallic Solution in Treating Periprosthetic Femoral Fractures: Outcome Assessment Sun, 20 Nov 2016 10:48:55 +0000 http://www.hindawi.com/journals/amed/2016/2918735/ Introduction. The periprosthetic fracture of the femur is, in order of frequency, the fourth leading cause (5.9%) of surgical revision. Our study aims to demonstrate how the grafting of bone splint betters the outcomes. Materials. We treated 15 periprosthetic femoral fractures divided into two groups: PS composed of 8 patients treated with plates and splints and PSS involving 7 patients treated only with plates. The evaluation criteria for the two groups during the clinical and radiological follow-up were the quality of life measured by the Short Form (36) Health Survey (SF-36), Harris Hip Score (HHS), Modified Cincinnati Rating System Questionnaire (MCRSQ), bone healing measured by the Radiographic Union Score (RUS), postoperative complications, and mortality. The evaluation endpoint was set at 24 months for both groups (). Results. The surgery lasted an average of 124.5 minutes for the PS group and 112.6 minutes for the PSS. At 24 months all clinical and radiographic scores were for the PS group. During follow-up 4 patients (2 in each group) died of causes not related to surgery. Conclusions. The use of the metal plate as opposed to cortical allogenic splint should be taken into consideration as a noteworthy point for periprosthetic femoral fractures. Serafino Carta, Mattia Fortina, Alberto Riva, Luigi Meccariello, Enrico Manzi, Antonio Di Giovanni, and Paolo Ferrata Copyright © 2016 Serafino Carta et al. All rights reserved. Comparison of Clinical and Radiologic Outcome of Adolescent Idiopathic Scoliosis Treated with Hybrid Hook-Screw Instrumentation versus Universal Clamp System Sun, 30 Oct 2016 14:04:50 +0000 http://www.hindawi.com/journals/amed/2016/7639727/ Background. In surgical treatment of adolescent idiopathic scoliosis (AIS), hybrid universal clamp system has been used by some authors. We aimed to compare the clinical and radiologic outcome of hybrid universal clamp with hybrid thoracic hook lumbar screw. Methods. A prospective study was performed on 56 consecutive patients with AIS, who had alternatively undergone a posterior spinal fusion and instrumentation with hybrid thoracic hook lumbar screw system (28 patients: group A) and hybrid universal clamp system (28 patients: group B) between June 2006 and January 2014 at Imam Reza University Hospital and had been followed up for more than two years. The comparison was according to radiographic changes, operative time, intraoperative blood loss, complications, and Scoliosis Research Society (SRS-22) outcome scores. Results. The preoperative mean curve Cobb angle was (42°–74°) in group A and (46°–75°) in group B. The mean final coronal curve correction was 60.4% and 75.5% in groups A and B, respectively (). Postoperative SRS outcome scores were also comparable. Conclusion. Universal clamp instrumentation had a significantly better curve correction and lower complication rate compared with hybrid thoracic hook lumbar screw. Both instrumentation methods had similar operative time, intraoperative blood loss, and postoperative SRS outcome scores. Ebrahim Ghayem Hassankhani, Farzad Omidi-Kashani, Shahram Moradkhani, Golnaz Ghayem Hassankhani, and Mohammad Taghi Shakeri Copyright © 2016 Ebrahim Ghayem Hassankhani et al. All rights reserved. Morphology of Anterolateral Ligament of the Knee: A Cadaveric Observation with Clinical Insight Tue, 25 Oct 2016 05:50:48 +0000 http://www.hindawi.com/journals/amed/2016/9182863/ Background. The morphology and function of anterolateral ligament (ALL) of the knee are not clearly understood even today with all the sophisticated techniques available. There have been differing descriptions of the ALL of the knee in literature, and not all of them have been named or described clearly. Aim. The present study was undertaken to provide a clear structure/relationship description on ALL. Materials and Methods. We used 24 formalin-fixed cadaveric limbs. Knee regions of the all the limbs were neatly dissected and the ALL was exposed. Its proximal and distal attachments were traced carefully. Middle portion of ALL was removed and processed for histological analysis. Results. ALL was found in one right knee (4.16%). It extended distally from the lateral femoral condyle to the lateral tibial plateau margin. Its attachment on the tibial plateau was located between head of the fibula and Gerdy’s tubercle. A strong connection was identified between the ALL and the periphery of the middle third of the lateral meniscus. Histological analysis of ALL confirmed the presence of true ligamentous structure in it with dense connective tissue and plenty of fibroblasts. Conclusion. The prevalence of ALL in different populations along with its clinical significance has been discussed in detail in this paper. Bhagath Kumar Potu, Abdel Halim Salem, and Marwan F. Abu-Hijleh Copyright © 2016 Bhagath Kumar Potu et al. All rights reserved. External Validation of the Cancer of the Prostate Risk Assessment Postsurgical Score for Prediction of Disease Recurrence after Radical Prostatectomy Wed, 19 Oct 2016 12:45:46 +0000 http://www.hindawi.com/journals/amed/2016/8639041/ Objective. The cancer of the prostate risk assessment (CAPRA-S) postsurgical score predicts recurrence, metastasis, and cancer-specific survival after radical prostatectomy (RP). We evaluated the relation between CAPRA-S score and biochemical recurrence (BCR) in prostate cancer after RP in our clinic. Materials and Methods. This study was performed on 203 patients with prostate carcinoma who underwent open RP and regional lymph node dissection in our clinic between 2008 and 2013. We calculated the CAPRA-S scores including prostate-specific antigen (PSA) at diagnosis, pathology Gleason score, surgical margin, seminal vesicle invasion, extracapsular extension, and lymph node involvement. The patients were divided into 3 risk groups (low, intermediate, and high risk) according to risk scores. Results. Recurrence occurred in 17.8% of the patients (36 patients out of 203 patients) with a median of 11.7-month follow-up. The average recurrence-free survival time is 44.6 months. Surgical margin invasion and seminal vesicle invasion significantly correlated with BCR especially in high risk group (11 and 13 of 15 patients, , resp.). Conclusion. CAPRA-S score can be easily calculated and it is useful in clinical practice in order to timely propose adjuvant therapies after surgery. Taha Numan Yıkılmaz, Erdem Öztürk, Eşref Oğuz Güven, and Halil Başar Copyright © 2016 Taha Numan Yıkılmaz et al. All rights reserved. Lipopolysaccharide-Induced Spatial Memory and Synaptic Plasticity Impairment Is Preventable by Captopril Tue, 18 Oct 2016 14:14:29 +0000 http://www.hindawi.com/journals/amed/2016/7676512/ Introduction. Renin-angiotensin system has a role in inflammation and also is involved in many brain functions such as learning, memory, and emotion. Neuroimmune factors have been proposed as the contributors to the pathogenesis of memory impairments. In the present study, the effect of captopril on spatial memory and synaptic plasticity impairments induced by lipopolysaccharide (LPS) was investigated. Methods. The rats were divided and treated into control (saline), LPS (1 mg/kg), LPS-captopril (LPS-Capto; 50 mg/kg captopril before LPS), and captopril groups (50 mg/kg) before saline. Morris water maze was done. Long-term potentiation (LTP) from CA1 area of hippocampus was assessed by 100 Hz stimulation in the ipsilateral Schaffer collateral pathway. Results. In the LPS group, the spent time and traveled path to reach the platform were longer than those in the control, while, in the LPS-Capto group, they were shorter than those in the LPS group. Moreover, the slope and amplitude of field excitatory postsynaptic potential (fEPSP) decreased in the LPS group, as compared to the control group, whereas, in the LPS-Capto group, they increased compared to the LPS group. Conclusion. The results of the present study showed that captopril improved the LPS-induced memory and LTP impairments induced by LPS in rats. Further investigations are required in order to better understand the exact responsible mechanism(s). Azam Abareshi, Akbar Anaeigoudari, Fatemeh Norouzi, Mohammad Naser Shafei, Mohammad Hossein Boskabady, Majid Khazaei, and Mahmoud Hosseini Copyright © 2016 Azam Abareshi et al. All rights reserved. Changes of Nitric Oxide and Peroxynitrite Serum Levels during Drug Therapy in Patients with Obsessive-Compulsive Disorder Sun, 16 Oct 2016 08:58:31 +0000 http://www.hindawi.com/journals/amed/2016/9131680/ Objectives. Some studies have shown that increased nitric oxide (NO) concentrations may be associated with obsessive-compulsive disorder (OCD). In a few animal researches, enhanced synthesis of NO had reversed the effect of selective serotonin reuptake inhibitors (SSRIs). The present study tries to find the effect of treatment with SSRIs on NO serum levels and its product peroxynitrite. Patients and Methods. Patients diagnosed with OCD who are candidates of receiving SSRIs entered this study. Two blood samples were taken from subjects, prior to drug therapy and after the patients had shown some improvements due to their regimen. Serum NO and peroxynitrite levels were measured and their correlation with SSRI use was assessed. Results. 31 patients completed this study. Mean concentrations of NO and peroxynitrite prior to drug therapy were and  μmol/L, respectively. These values were 18. and  μmol/L at the second blood test. With values < 0.05, these differences were considered significant. Conclusion. Patients, who showed improvement of OCD symptoms after a mean duration of SSRI monotherapy of months, had lower values of NO and peroxynitrite in their sera compared to their levels prior to therapy. Such results can be helpful in finding a predictive factor of response to therapy and augmentation therapy with future drugs that target NO synthesis. Leila Kouti, Mehdi Sayyah, Parisa Mosallanezhad, Sara Kooti, Maryam Aghakoochakzadeh, and Kaveh Eslami Copyright © 2016 Leila Kouti et al. All rights reserved. Dietary Energy Density, Renal Function, and Progression of Chronic Kidney Disease Thu, 13 Oct 2016 09:24:23 +0000 http://www.hindawi.com/journals/amed/2016/2675345/ Background. There is evidence of the association between dietary energy density and chronic diseases. However, no report exists regarding the relation between DED and chronic kidney disease (CKD). Objective. To examine the association between dietary energy density (DED), renal function, and progression of chronic kidney disease (CKD). Design. Cross-sectional. Setting. Three nephrology clinics. Subjects. Two hundred twenty-one subjects with diagnosed CKD. Main Outcome Measure. Dietary intake of patients was assessed by a validated food frequency questionnaire. DED (in kcal/g) was calculated with the use of energy content and weight of solid foods and energy yielding beverages. Renal function was measured by blood urea nitrogen (BUN), serum creatinine (Cr), and estimated glomerular filtration rate (eGFR). Results. Patients in the first tertile of DED consumed more amounts of carbohydrate, dietary fiber, potassium, phosphorus, zinc, magnesium, calcium, folate, vitamin C, and vitamin B2. After adjusting for confounders, we could not find any significant trend for BUN and Cr across tertiles of DED. In multivariate model, an increased risk of being in the higher stage of CKD was found among those in the last tertile of DED (OR: 3.15; 95% CI: 1.30, 7.63; ). Conclusion. We observed that lower DED was associated with better nutrient intake and lower risk of CKD progression. Mohammad Hossein Rouhani, Mojgan Mortazavi Najafabadi, Ahmad Esmaillzadeh, Awat Feizi, and Leila Azadbakht Copyright © 2016 Mohammad Hossein Rouhani et al. All rights reserved. Nonrecurrent Laryngeal Nerve in the Era of Intraoperative Nerve Monitoring Thu, 13 Oct 2016 05:53:05 +0000 http://www.hindawi.com/journals/amed/2016/1606029/ Nonrecurrent laryngeal nerve (non-RLN) is an anatomical variation increasing the risk of vocal cord palsy. Prediction and early identification of non-RLN may minimize such a risk of injury. This study assessed the effect of intraoperative neuromonitoring (IONM) on the detection of non-RLN. A total of 462 (236 right) nerves in 272 patients were identified and totally exposed, and all intraoperative steps of IONM were sequentially applied on the vagus nerve (VN) and RLN. Right predissection VN stimulation at a distal point did not create a sound signal in three cases (3/236; 1.27%). Proximal dissection of the right VN under IONM guidance established a proximal point, creating a positive signal. The separation point of non-RLN from VN was discovered in all three patients. Non-RLNs were exposed from separation to laryngeal entry. Positive IONM signals were obtained after resection of thyroid lobes, and postoperative period was uneventful in patients with non-RLN. Absence of distal VN signal is a precise predictor of the non-RLN. IONM-guided proximal dissection of the right VN leads to identification of the non-RLN. The prediction of non-RLN by the absence of the VN signal at an early stage of surgery may prevent or minimize the risk of nerve injury. Emin Gurleyik and Gunay Gurleyik Copyright © 2016 Emin Gurleyik and Gunay Gurleyik. All rights reserved. Prevalence and Correlates of Peripheral Arterial Disease in Nigerians with Type 2 Diabetes Wed, 05 Oct 2016 13:48:15 +0000 http://www.hindawi.com/journals/amed/2016/3529419/ Background. Peripheral arterial disease (PAD) is a major risk factor for nonhealing foot ulcers in people with diabetes. A number of traditional risk factors have been reported to be associated with PAD; however, there may be a need to consider nontraditional risk factors especially in some vulnerable populations. This study determined the prevalence and risk factors associated with PAD in diabetics. Methods. One hundred and fifty type 2 diabetics and an equal number of age- and sex-matched apparently healthy controls were studied. Assessment of PAD was made using history, palpation of lower limb vessels, and measurement of ankle-brachial index (ABI). Statistically significant differences between categorical and continuous variables were determined using Chi square (χ2) and Student t-tests, respectively. Regression analysis was done to determine the associated risk factors for PAD. Results. Prevalence of PAD using ABI was 22.0% and 8.0% among diabetic and nondiabetic populations, respectively. Peripheral arterial disease was associated with age, male gender, waist circumference, and high-sensitivity C-reactive protein. Conclusion. This study highlights the high prevalence of PAD in people with type 2 diabetes mellitus and in apparently healthy controls; age, male gender, abdominal obesity, and high hs-CRP values were the associated risk factors. D. O. Soyoye, R. T. Ikem, B. A. Kolawole, K. S. Oluwadiya, R. A. Bolarinwa, and O. J. Adebayo Copyright © 2016 D. O. Soyoye et al. All rights reserved. A Study to Analyze Different Patterns of Quid Usage among Subjects with Oral Submucous Fibrosis in Mangalore Population Thu, 29 Sep 2016 16:16:56 +0000 http://www.hindawi.com/journals/amed/2016/6124059/ Aim and Objectives. Oral submucous fibrosis (OSF) is a potentially malignant disorder associated with the usage of areca nut. Usage of processed forms of areca nut is popular among the youth and its carcinogenic effects are not well known. Due to large immigrant population, various patterns of areca nut usage are seen. The aim of this study is to assess the various quid chewing patterns and their association with severity of OSF. Materials and Methods. A cross-sectional study was carried out with 250 cases clinically and histologically diagnosed as having OSF lesion that were selected and subjected to a detailed habit history which was recorded through preformed questionnaire. The data obtained was statistically analyzed. Results. Among the 250 subjects, males were seen to be affected more than females within the age group of 26–35 years and were having clinical stage I OSF. A combination of processed areca nut and processed tobacco was used by the majority of the subjects with duration of 1 to 5 years, at a frequency of 3 to 5 quids per day. Conclusion. The present study confirms the association between oral submucous fibrosis and the quid containing processed areca nut and processed tobacco and also highlights the increasing youth population using the processed forms of areca nut. Vidya A. Holla, L. K. Chatra, Prashanth Shenai, Devika Shetty, and Ashwini Baliga Copyright © 2016 Vidya A. Holla et al. All rights reserved. Reactive Oxygen Species: A Key Hallmark of Cardiovascular Disease Wed, 28 Sep 2016 14:06:48 +0000 http://www.hindawi.com/journals/amed/2016/9152732/ Cardiovascular diseases (CVDs) have been the prime cause of mortality worldwide for decades. However, the underlying mechanism of their pathogenesis is not fully clear yet. It has been already established that reactive oxygen species (ROS) play a vital role in the progression of CVDs. ROS are chemically unstable reactive free radicals containing oxygen, normally produced by xanthine oxidase, nicotinamide adenine dinucleotide phosphate oxidase, lipoxygenases, or mitochondria or due to the uncoupling of nitric oxide synthase in vascular cells. When the equilibrium between production of free radicals and antioxidant capacity of human physiology gets altered due to several pathophysiological conditions, oxidative stress is induced, which in turn leads to tissue injury. This review focuses on pathways behind the production of ROS, its involvement in various intracellular signaling cascades leading to several cardiovascular disorders (endothelial dysfunction, ischemia-reperfusion, and atherosclerosis), methods for its detection, and therapeutic strategies for treatment of CVDs targeting the sources of ROS. The information generated by this review aims to provide updated insights into the understanding of the mechanisms behind cardiovascular complications mediated by ROS. Nisha Panth, Keshav Raj Paudel, and Kalpana Parajuli Copyright © 2016 Nisha Panth et al. All rights reserved. The Protocol of Choice for Treatment of Snake Bite Wed, 21 Sep 2016 09:46:08 +0000 http://www.hindawi.com/journals/amed/2016/7579069/ The aim of the current study is to compare three different methods of treatment of snake bite to determine the most efficient one. To unify the protocol of snake bite treatment in our center, we retrospectively reviewed files of the snake-bitten patients who had been referred to us between 2010 and 2014. They were contacted for follow-up using phone calls. Demographic and on-arrival characteristics, protocol used for treatment (WHO/Haddad/GF), and outcome/complications were evaluated. Patients were entered into one of the protocol groups and compared. Of a total of 63 patients, 56 (89%) were males. Five, 19, and 28 patients were managed by Haddad, WHO, or GF protocols, respectively. Eleven patients had fallen into both GF and WHO protocols and were excluded. Serum sickness was significantly more common when WHO protocol was used while 100% of the compartment syndromes and 71% of deformities had been reported after GF protocol. The most important complications were considered to be deformity, compartment syndrome, and amputation and were more frequent after the use of WHO and GF protocols (23.1% versus 76.9%; none in Haddad; = NS). Haddad protocol seems to be the best for treatment of snake-bitten patients in our region. However, this cannot be strictly concluded because of the limited sample size and nonsignificant values. Afshin Mohammad Alizadeh, Hossein Hassanian-Moghaddam, Nasim Zamani, Mitra Rahimi, Mohammad Mashayekhian, Behrooz Hashemi Domeneh, Peyman Erfantalab, and Ali Ostadi Copyright © 2016 Afshin Mohammad Alizadeh et al. All rights reserved. Control of Pedicle Screw Placement with an Electrical Conductivity Measurement Device: Initial Evaluation in the Thoracic and Lumbar Spine Tue, 06 Sep 2016 15:44:56 +0000 http://www.hindawi.com/journals/amed/2016/4296294/ Aim. Transpedicular screw fixation is widely used in spinal surgery. But the insertion of pedicle screws can sometimes be challenging because of the variability in pedicle size and the proximity of nerve roots. Methods. We detected intraoperatively the sensitivity for iatrogenic pedicel perforation with a hand-held electronic conductivity measurement device (ECD) that measures electrical conductivity of tissue-medium surrounding the instrument tip. ECD was used to guide the placement of 84 pedicle screws in 15 patients undergoing surgery for tumor or degenerative spinal disease at various spinal levels from T8 to L5. Additionally a CT-scan controlled screw positioning postoperatively. Results. The placement was “correct” (no mediocaudal pedicle wall penetration) for 78 of 84 (92,8%) screws, “suboptimal but acceptable” (0–2 mm penetration) for 4 of 84 (4,8%) screws, and “misplaced” (penetration > 2 mm) for 2 of 84 (2,4%) screws. Conclusion. Although this study was not designed to compare electronic conductivity technique to other guidance methods, such as fluoroscopy or navigation, a convincing “proof of concept” for ECD use in spinal instrumentation could be demonstrated. Advantages include easy handling without time-consuming setup and reduced X-ray exposure. However, further investigations are necessary to evaluate i.a. the economic aspects for this single-use developed instrument. Olaf Suess and Markus Schomacher Copyright © 2016 Olaf Suess and Markus Schomacher. All rights reserved. Topical Colchicine Gel versus Diclofenac Sodium Gel for the Treatment of Actinic Keratoses: A Randomized, Double-Blind Study Mon, 05 Sep 2016 14:23:22 +0000 http://www.hindawi.com/journals/amed/2016/5918393/ Introduction. Actinic keratoses (AKs), a premalignant skin lesion, are a common lesion in fair skin. Although destructive treatment remains the gold standard for AKs, medical therapies may be preferable due to the comfort and reliability .This study aims to compare the effects of topical 1% colchicine gel and 3% diclofenac sodium gel in AKs. Materials and Methods. In this randomized double-blind study, 70 lesions were selected. Patients were randomized before receiving either 1% colchicine gel or 3% diclofenac sodium cream twice a day for 6 weeks. Patients were evaluated in terms of their lesion size, treatment complications, and recurrence at 7, 30, 60, and 120 days after treatment. Results. The mean of changes in the size was significant in both groups both before and after treatment (<0.001). The mean lesion size before treatment and at 30, 60, and 120 days was not different between the two groups ( > 0.05). No case of erythema was seen in the colchicine group, while erythema was seen in 22.9% (eight cases) of patients in the diclofenac sodium group ( = 0.005). Conclusions. 1% colchicine gel was a safe and effective medication with fewer side effects and lack of recurrence of the lesion. Gita Faghihi, Azam Elahipoor, Fariba Iraji, Shadi Behfar, and Bahareh Abtahi-Naeini Copyright © 2016 Gita Faghihi et al. All rights reserved. The Relationship between Body Mass Index and Depression among High School Girls in Ahvaz Thu, 01 Sep 2016 11:07:49 +0000 http://www.hindawi.com/journals/amed/2016/3645493/ Objective. Today, obesity and depression are two major illnesses that are on the rise all over the world and threaten human health. This research was done to determine the relationship between Body Mass Index (BMI) and depression among Ahvaz high school female students. Method. In a descriptive-analytical study using stratified random sampling, 400 female high school students in academic year of 2013-2014 were picked and their height and weight were measured. BMI was classified based on World Health Organization classification. To assess the severity of depression, Beck depression questionnaire was used. In order to analyze the data, descriptive statistics and Pearson correlation test were used. Results. In terms of BMI 9% of students were slim, 77% were at an acceptable level, and 14% were overweight. Also, the prevalence of depression was 86.20% major depression and 13.79% moderate depression for obese persons, 10.41% major depression and 70.83% moderate depression for overweight persons, 8.78% major depression and 12.97% moderate depression for normal weight persons, and 9% moderate depression for slim persons. The relationship between BMI and depression among high school students is positive and significant (). Conclusion. There is a positive and significant relationship between BMI and the severity of depression among Ahvaz high school female students. Ashraf Tashakori, Forough Riahi, and Amin Mohammadpour Copyright © 2016 Ashraf Tashakori et al. All rights reserved. CYP4F2 (rs2108622) Gene Polymorphism Association with Age-Related Macular Degeneration Mon, 29 Aug 2016 14:24:52 +0000 http://www.hindawi.com/journals/amed/2016/3917916/ Background. Age-related macular degeneration is the leading cause of blindness in elderly individuals where aetiology and pathophysiology of age-related macular degeneration are not absolutely clear. Purpose. To determine the frequency of the genotype of rs2108622 in patients with early and exudative age-related macular degeneration. Methods. The study enrolled 190 patients with early age-related macular degeneration, 181 patients with exudative age-related macular degeneration (eAMD), and a random sample of 210 subjects from the general population (control group). The genotyping of rs2108622 was carried out using the real-time polymerase chain reaction method. Results. The analysis of rs2108622 gene polymorphism did not reveal any differences in the distribution of C/C, C/T, and T/T genotypes between the early AMD group, the eAMD group, and the control group. The CYP4F2 (1347C>T) T/T genotype was more frequent in males with eAMD compared to females (10.2% versus 0.8%; ); also T/T genotype was less frequently present in eAMD females compared to healthy control females (0.8% versus 6.2%; ). Conclusion. Rs2108622 gene polymorphism had no predominant effect on the development of early AMD and eAMD. The T/T genotype was more frequent in males with eAMD compared to females and less frequently present in eAMD females compared to healthy females. Ruta Sakiene, Alvita Vilkeviciute, Loresa Kriauciuniene, Vilma Jurate Balciuniene, Dovile Buteikiene, Goda Miniauskiene, and Rasa Liutkeviciene Copyright © 2016 Ruta Sakiene et al. All rights reserved. Blatchford Score Is Superior to AIMS65 Score in Predicting the Need for Clinical Interventions in Elderly Patients with Nonvariceal Upper Gastrointestinal Bleed Sun, 28 Aug 2016 16:51:56 +0000 http://www.hindawi.com/journals/amed/2016/6850754/ Background. Blatchford and AIMS65 scores were developed to risk stratify patients with upper gastrointestinal bleed (UGIB). We sought to assess the performance of Blatchford and AIMS65 scores in predicting outcomes in elderly patients with nonvariceal UGIB. Methods. A retrospective cohort study of elderly patients (over 65 years of age) with nonvariceal UGIB admitted to a tertiary care center. Primary outcome was a combined outcome of in-hospital mortality, need for any therapeutic endoscopic, radiologic, or surgical intervention, rebleeding within 30 days, or blood transfusion. Secondary outcome was a combined outcome of in-hospital mortality or need for an intervention to control the bleed. Results. 164 patients were included. The primary outcome occurred in 119 (72.5%) patients. The secondary outcome occurred in 12 patients (7.2%). Blatchford score was superior to AIMS65 score in predicting the primary outcome (area under the receiver-operator curve (AUROC) 0.84 versus 0.68, resp., ). Both scores performed poorly in predicting the secondary outcome (AUROC 0.56 versus 0.52, resp., ). Conclusions. Blatchford score could be useful in predicting the need for hospital based interventions in elderly patients with nonvariceal UGIB. Blatchford and AIMS65 scores are poor predictors of the need for a therapeutic intervention to control bleeding. Khalid Abusaada, Fnu Asad-ur-Rahman, Vladimir Pech, Umair Majeed, Shengchuan Dai, Xiang Zhu, and Sally A. Litherland Copyright © 2016 Khalid Abusaada et al. All rights reserved. Antifungal Susceptibility Patterns of Candida Species Recovered from Endotracheal Tube in an Intensive Care Unit Tue, 23 Aug 2016 17:03:22 +0000 http://www.hindawi.com/journals/amed/2016/9242031/ Aims. Biofilms formed by Candida species which associated with drastically enhanced resistance against most antimicrobial agents. The aim of this study was to identify and determine the antifungal susceptibility pattern of Candida species isolated from endotracheal tubes from ICU patients. Methods. One hundred forty ICU patients with tracheal tubes who were intubated and mechanically ventilated were surveyed for endotracheal tube biofilms. Samples were processed for quantitative microbial culture. Yeast isolates were identified to the species level based on morphological characteristics and their identity was confirmed by PCR-RFLP. Antifungal susceptibility testing was determined according to CLSI document (M27-A3). Results. Ninety-five strains of Candida were obtained from endotracheal tubes of which C. albicans (; 35.7%) was the most frequently isolated species followed by other species which included C. glabrata (; 25.2%), C. parapsilosis (; 16.8%), C. tropicalis (; 12.6%), and C. krusei (; 9.4%). The resulting MIC90 for all Candida species were in increasing order as follows: caspofungin (0.5 μg/mL); amphotericin B (2 μg/mL); voriconazole (8.8 μg/mL); itraconazole (16 μg/mL); and fluconazole (64 μg/mL). Conclusion. Candida species recovered from endotracheal tube are the most susceptible to caspofungin. Elham Baghdadi, Sadegh Khodavaisy, Sassan Rezaie, Sara Abolghasem, Neda Kiasat, Zahra Salehi, Somayeh Sharifynia, and Farzad Aala Copyright © 2016 Elham Baghdadi et al. All rights reserved. Evaluation of HLA-G 14 bp Ins/Del and +3142G>C Polymorphism with Susceptibility and Early Disease Activity in Rheumatoid Arthritis Tue, 16 Aug 2016 10:37:10 +0000 http://www.hindawi.com/journals/amed/2016/4985745/ Purpose/Background. Mounting evidence designates that HLA-G plays a role in the regulation of inflammatory processes and autoimmune diseases. There are controversial reports concerning the impact of HLA-G gene polymorphism on rheumatoid arthritis (RA). This study was aimed at examining the impact of 14 bp ins/del and +3142G>C polymorphism with susceptibility and early disease activity in RA patients in a sample of the Iranian population. Methods. This case-control study was done on 194 patients with RA and 158 healthy subjects. The HLA-G rs1063320 (+3142G>C) and rs66554220 (14 bp ins/del) variants were genotype by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFP) and PCR method, respectively. Results. The HLA-G +3142G>C polymorphism significantly decreased the risk of RA in codominant (OR = 0.61, 95% CI = 0.38–0.97, , GC versus GG; OR = 0.36, 95% CI = 0.14–0.92, , CC versus GG), dominant (OR = 0.56, 95% CI = 0.36–0.87, , GC + CC versus GG), and allele (OR = 0.58, 95% CI = 0.41–0.84, , C versus G) inheritance models tested. Our finding did not support an association between HLA-G 14 bp ins/del variant and risk/protection of RA. In addition, no significant association was found between the polymorphism and early disease activity. Conclusion. In summary, our results showed that HLA-G +3142G>C gene polymorphism significantly decreased the risk of RA in a sample of the Iranian population. Mohammad Hashemi, Mahnaz Sandoughi, Seyed Amirhossein Fazeli, Gholamreza Bahari, Maryam Rezaei, and Zahra Zakeri Copyright © 2016 Mohammad Hashemi et al. All rights reserved. The Protective Effects of Alpha-Lipoic Acid and Coenzyme Q10 Combination on Ovarian Ischemia-Reperfusion Injury: An Experimental Study Mon, 15 Aug 2016 14:58:32 +0000 http://www.hindawi.com/journals/amed/2016/3415046/ Objective. This study aims to evaluate whether alpha-lipoic acid and/or coenzyme Q10 can protect the prepubertal ovarian tissue from ischemia-reperfusion injury in an experimental rat model of ovarian torsion. Materials and Methods. Forty-two female preadolescent Wistar-Albino rats were divided into 6 equal groups randomly. The sham group had laparotomy without torsion; the other groups had torsion/detorsion procedure. After undergoing torsion, group 2 received saline, group 3 received olive oil, group 4 received alpha-lipoic acid, group 5 received coenzyme Q10, and group 6 received both alpha-lipoic acid and coenzyme Q10 orally. The oxidant-antioxidant statuses of these groups were compared using biochemical measurement of oxidized/reduced glutathione, glutathione peroxidase and malondialdehyde, pathological evaluation of damage and apoptosis within the ovarian tissue, and immunohistochemical assessment of nitric oxide synthase. Results. The left ovaries of the alpha-lipoic acid + coenzyme Q10 group had significantly lower apoptosis scores and significantly higher nitric oxide synthase content than the left ovaries of the control groups. The alpha-lipoic acid + coenzyme Q10 group had significantly higher glutathione peroxidase levels and serum malondialdehyde concentrations than the sham group. Conclusions. The combination of alpha-lipoic acid and coenzyme Q10 has beneficial effects on oxidative stress induced by ischemia-reperfusion injury related to ovarian torsion. Ahmet Ali Tuncer, Mehmet Fatih Bozkurt, Tulay Koken, Nurhan Dogan, Mine Kanat Pektaş, and Didem Baskin Embleton Copyright © 2016 Ahmet Ali Tuncer et al. All rights reserved. Prevalence of Schistosoma mansoni Infection in Four Health Areas of Kisantu Health Zone, Democratic Republic of the Congo Sun, 07 Aug 2016 08:16:38 +0000 http://www.hindawi.com/journals/amed/2016/6596095/ Background. Schistosomiasis is a public health problem in Democratic Republic of the Congo but estimates of its prevalence vary widely. The aim of this study was to determine prevalence of Schistosoma mansoni infection and associated risk factors among children in 4 health areas of Kisantu health zone. Methods. A cross-sectional study was carried out in 4 health areas of Kisantu health zone. 388 children randomly selected were screened for S. mansoni using Kato Katz technique and the sociodemographic data was collected. Data were entered and encoded using software EpiData version 3.1. Analysis was performed using SPSS version 21 software. Results. The prevalence of S. mansoni was 26.5% (103); almost two-thirds (63) (61.2%) had light infection intensity. A significant association was found between S. mansoni infection and age (), educational level (), and practices of swimming/bathing () and using water from river/lake/stream for domestic use (). Kipasa health area had high prevalence of schistosomiasis (64.6%) (64/99; 95% CI 54.4–74.0) compared to other health areas. Conclusion. Schistosoma mansoni infection still remains a public health problem in these areas. There is a need to promote health education and promote behavioral changes in children towards schistosomiasis. R. Khonde Kumbu, K. Mbanzulu Makola, and Lu Bin Copyright © 2016 R. Khonde Kumbu et al. All rights reserved. Surgical Management of Massive Pericardial Effusion and Predictors for Development of Constrictive Pericarditis in a Resource Limited Setting Tue, 19 Jul 2016 13:55:33 +0000 http://www.hindawi.com/journals/amed/2016/8917954/ Background. The diagnosis and treatment of massive pericardial effusion and cardiac tamponade have evolved over the years with a tendency towards a more comprehensive diagnostic workup and less traumatic intervention. Method. We reviewed and analysed the data of 32 consecutive patients who underwent surgery on account of massive pericardial effusion and cardiac tamponade in a semiurban university hospital in Nigeria from February 2010 to February 2016. Results. The majority of patients (34.4%) were between 31 and 40 years. Fourteen patients (43.8%) presented with clinical and echocardiographic feature of cardiac tamponade. The majority of patients (59.4%) presented with haemorrhagic pericardial effusion and the average volume of fluid drained intraoperatively was 846 mL  ± 67 mL. Pericardium was thickened in 50% of cases. Subxiphoid pericardiostomy was performed under local anaesthesia in 28 cases. No postoperative recurrence was observed; however 5 patients developed features of constrictive pericarditis. The relationship between pericardial thickness and development of pericardial constriction was statistically significant (). Conclusion. Subxiphoid pericardiostomy is a very effective way of treating massive pericardial effusion. Removing tube after adequate drainage (50 mL/day) and treatment of primary pathology are key to preventing recurrence. There is also a need to follow up patients to detect pericardial constriction especially those with thickened pericardium. Emeka B. Kesieme, Peter O. Okokhere, Christopher Ojemiega Iruolagbe, Angela Odike, Clifford Owobu, and Theophilus Akhigbe Copyright © 2016 Emeka B. Kesieme et al. All rights reserved. Intestinal Parasite Profile in the Stool of HIV Positive Patients in relation to Immune Status and Comparison of Various Diagnostic Techniques with Special Reference to Cryptosporidium at a Tertiary Care Hospital in South India Sun, 17 Jul 2016 12:23:13 +0000 http://www.hindawi.com/journals/amed/2016/3564359/ Acquired immunodeficiency syndrome and related opportunistic infections are a significant cause of morbidity and mortality in susceptible population. This study aims to negate the paucity of data regarding the relation between CD4 levels, prevalence of enteric parasites, and the outcome of treatment with HAART (highly active antiretroviral therapy) and Cotrimoxazole in Kerala, India. Multiple stool samples from 200 patients in a cross-sectional study were subjected to microscopy and Cryptosporidium stool antigen ELISA. Parasites were identified in 18 samples (9%). Cystoisospora and Cryptosporidium spp. were seen in 9 cases (4.5%) and 5 cases (2.5%), respectively. Microsporidium spores and Chilomastix mesnili cysts were identified in 1 case each (0.5% each). Seven cases of Cystoisospora diarrhoea recovered after treatment with Cotrimoxazole. Diarrhoea due to Cryptosporidium spp. in all 5 cases subsided after immune reconstitution with HAART. This study concludes that a positive association was seen between low CD4 count (<200 cells/μL) and overall parasite positivity ( value < 0.01). ELISA is a more sensitive modality for the diagnosis of Cryptosporidium diarrhoea. Chilomastix mesnili, generally considered a nonpathogen, may be a cause of diarrhoeal disease in AIDS. Immune reconstitution and Cotrimoxazole prophylaxis remain to be the best therapeutic approach in AIDS-related diarrhoea. Vishnu Kaniyarakkal, Nizamuddin Mundangalam, Anitha Puduvail Moorkoth, and Sheela Mathew Copyright © 2016 Vishnu Kaniyarakkal et al. All rights reserved.