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   Table of Contents - Current issue
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May-August 2018
Volume 5 | Issue 2
Page Nos. 57-110

Online since Monday, August 13, 2018

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ORIGINAL ARTICLES  

Epidemiology of hypoglycemia among ambulatory Type 2 diabetic patients in a primary care clinic of a tertiary hospital in Southeastern Nigeria p. 57
Gabriel Uche Pascal Iloh, Agwu Nkwa Amadi
DOI:10.4103/jhrr.jhrr_37_17  
Aim: The study was aimed at describing the epidemiology of hypoglycemia among ambulatory type 2 diabetic patients in a primary care clinic in Eastern Nigeria. Materials and Methods: A cross-sectional descriptive study was carried out on 145 type 2 diabetic patients in a primary care clinic in Nigeria. Data were collected using pretested, structured, and interviewer-administered questionnaire containing information on relevant epidemiological variables. Experience of hypoglycemia was defined as self-reported symptoms of hypoglycemia in the previous 1 year. Results: The age of type 2 diabetic patients ranged from 32 to 78 years with mean age of 44 ± 10.2 years. There were 59 (40.7%) males and 86 (59.3%) females. The prevalence of hypoglycemia was 35.2%. Hypoglycemia occurred predominantly among the elderly (72.5%), male gender (54.9%), outside home environment (72.5%), during the daytime (82.4%), duration of diabetes ≤1 year (58.8%), and patients on insulin secretagogues alone (46.2%). The most common symptom was dizziness (76.5%). Experience of hypoglycemia was significantly associated with elderly age (P = 0.025), duration of diabetes ≤1 year (P = 0.021), and use of insulin secretagogues alone (P = 0.043). The most significant predictor of hypoglycemic events was use of insulin and insulin secretagogues (odds ratio = 3.15 [1.74–5.66]; P = 0.002). Type 2 diabetic patients on insulin and insulin secretagogues were three times more likely to experience hypoglycemic events compared to their counterparts who were on insulin sensitizers. Conclusion: The study has shown variable epidemiology of hypoglycemia. The incident occurred predominantly among the elderly, male gender, during daytime, outside home environment, duration of diabetes ≤1 year, and patients on insulin and insulin secretagogues. Interventional measures for hypoglycemia should consider relevant epidemiological factors that predispose to hypoglycemia.
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Does the frequency of temporomandibular myofascial dysfunction differ in patients treated for different mandibular and zygomatic fractures? p. 66
Charles E Anyanechi
DOI:10.4103/jhrr.jhrr_98_17  
Aim: To determine whether the frequency of Temporomandibular myofascial dysfunction (TMD) differs in patients treated for different mandibular and zygomatic fractures. Materials and Methods: This was a 9-year prospective study. The diagnosis of TMD was based on standard diagnostic criteria and was made during follow-up reviews of patients after the treatment of the fractures. Additional information obtained from the patients and their case files were age, gender, site of fracture (s), and treatment methods. One-way analysis of variance was used to compare the presence of TMD among the study groups. Results: Overall, 42/587 (7.2%) patients were diagnosed with TMD between 2.3 and 4.7 years after treatment commenced. Patients who presented with TMD were those treated for isolated zygomatic (n = 5/42, 11.9%), isolated condylar (n = 7/63, 10.0%), and multiple mandibular (n = 30/475, 6.3%) fractures, which was significant (P = 0.01) in favor of those treated for isolated zygomatic and isolated condylar fractures. Patients who were treated for unilateral zygomatic complex/arch(P == 0.001), unilateral intracapsular condyle (P = 0.001), and parasymphyseal/body/angle/condyle (P = 0.01) fractures also had higher frequencies of TMD. Conclusions: Patients who were treated for isolated zygomatic or condylar fractures had higher frequencies of TMD than those with multiple mandibular fractures. Future research work needs to be directed toward the description of the pathogenesis of the different types of TMD symptoms so that more information can be gathered on the natural course of the disorders and identify the risk factors for pain persistence and chronicity.
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Family support, medication adherence andglycaemic control among ambulatory type 2 diabetic Nigerians in a primary care clinic in Eastern Nigeria p. 71
Gabriel Uche Pascal Iloh, Agwu Nkwa Amadi
DOI:10.4103/jhrr.jhrr_121_16  
Aim: The study was aimed at determining the role of family support in medication adherence and glycemic control among ambulatory Type 2 diabetic patients in a primary care clinic in Nigeria. Materials and Methods: A clinic-based descriptive study was done on 120 Type 2 diabetic Nigerians who were on treatment for at least 3 months at the primary care clinic in Nigeria. Family support and medication adherence were assessed in the previous 3 months and 1 month preceding the study using multi-dimensional Scale of Perceived Social Support and interviewer-administered questionnaire on self-administered and reported therapy (SAT), respectively. Glycemic control was assessed in the previous 1 month. Results: The age of the participants ranged from 27 to 81 years, and there were 37.5% males and 62.5% females with sex ratio of 1:1.7. Family support, medication adherence, and glycemic control rates were 77.5%, 72.5%, and 61.7%, respectively. Family support was significantly associated with elderly age (0.041), medication adherence (P = 0.038), and glycemic control (P = 0.027). The most significant demographic predictor of family support was elderly age (odds ratio = 4.30 [2.06–5.15]; P = 0.015). The elderly patients with Type 2 diabetes were four times more likely to have family support compared to their counterparts who were <60 years. Conclusion: This study has shown the level of family support, medication adherence, and glycemic control among patients with Type 2 diabetes. Family support was significantly associated with elderly age, medication adherence, and glycemic control. Interventions to improve medication adherence and glycemic control should consider measures to enhance family support and this could be used to plan diabetes-oriented management decisions.
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Prevalence of enteric parasitic diseases among patients referred at a teaching hospital in Kenya p. 78
Rose Jepkosgei Kimosop, Chrispinus Siteti Mulambalah, Moses Mwajar Ngeiywa
DOI:10.4103/jhrr.jhrr_7_18  
Aim: Enteric parasitic diseases pose a serious public health problem worldwide and yet are neglected. To refocus attention on these diseases, a cross-sectional study was conducted to assess the prevalence of enteric infections in patients referred to referral hospital in Kenya. Materials and Methods: This study was conducted from April to December 2015 and involved a randomly selected sample of 185 patients. Fecal specimens were collected and delivered to laboratory for analysis. Preliminary macroscopic assessment of specimens for segments, larvae, and adult stages was done. To confirm the presence of ova, trophozoites, cysts, and oocysts, direct wet smear, formol–ether concentration, and modified Ziehl–Neelsen techniques were used. Results: Overall prevalence of 46.5% of enteric parasitic diseases was confirmed. Highest and lowest prevalence was due to protozoans and helminthes, respectively. Protozoan parasite prevalence was Entamoeba histolytica (23.9%), Cryptosporidium parvum (13%), Entamoeba coli (6.5%), Giardia lamblia (6.5%), and Iodamoeba butschlii (6.5%). Helminth prevalence was Ascaris lumbricoides (1.6%), Hymenolepis nana, Trichuris trichiura, and Ancylostoma duodenale each (0.5%). There was no significant difference in prevalence in age groups and gender (P = 0.05). Females were at the highest risk of C. parvum infection. Polyparasitism was prevalent among protozoans than helminthes. Conclusion: High prevalence of protozoan infections was observed among referred patients in comparison to helminthiasis. Based on reported multiple infections, deworming programs targeting helminthiasis should be restructured to incorporate diagnosis and treatment of enteric protozoan infections to reduce prevalence of enteric parasitic infections.
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Comparison of efficacy, safety, and cost-effectiveness of topical salicylic acid 6% versus clobetasol propionate 0.05% in the treatment of limited chronic plaque psoriasis p. 86
Narayana Goruntla, Govardhan Kumar Arakala, Gowthami Priyanka Nelluri, K Naga Mounika, Srinivas Pujari, Manoj Kumar Byalla
DOI:10.4103/jhrr.jhrr_3_18  
Aims: The aims of this study were to: (1) Comparison of Psoriasis Area Severity Index (PASI), Physician Global Assessment (PGA) Scores, and adverse effect profile on the use of topical salicylic acid 6% versus clobetasol propionate 0.05% in the chronic-limited plaque psoriasis.(2) Selection of the cost-effectiveness option using average cost-effective ratios of the two individual regimens. Materials and Methods: This was a randomized, open-labeled, parallel group design which was conducted at dermatology department of a tertiary care hospital located in resource-limited settings of South India. A total of 75 patients were recruited and randomized into two groups: Group A received 6% of topical salicylic acid and Group B received 0.05% of clobetasol propionate for 3 months with a three follow-up visits. Efficacy was assessed based on the reduction of PASI and PGA scores at each visit. The safety profile of two drugs was assessed by a screening of adverse drug reactions. Cost-effectiveness of treatment groups was calculated by considering inputs of direct medical costs required to reduce one unit on PGA scale. Results: Demographic and clinical profiles of participants were matched between two groups. The mean PASI score of Group A and Group B were reduced from baseline (4.36, 4.67) to final follow-up (1.97, 2.03). There was a statistically significant difference exist in mean PASI score difference of Group A and Group B from baseline to 1st follow-up and baseline to 2nd follow-up (P < 0.00001) visits. Whereas, at final follow-up, mean PASI score difference of two groups was almost equal (P < 0.21). Conclusion: Initially, clobetasol propionate shows more effective compared to salicylic acid in the reduction of PASI score. But at end of the treatment, both drugs were equal in the reduction of PASI score where only matters the cost. Salicylic acid was a cost-effectiveness option in limited chronic plaque psoriasis.
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RAPMYCO: Mitigating conventional broth microdilution woes p. 93
Gurpreet Singh Bhalla, Naveen Grover, Lavan Singh, Manbeer S Sarao, Dinesh Kalra, Chetna Pandey
DOI:10.4103/jhrr.jhrr_106_17  
Aim: Nontuberculous mycobacteria (NTM) are proven pathogens causing a plethora of diseases in humans. Various methods are available for their identification and susceptibility testing. Since their susceptibility varies with species, it becomes imperative to perform drug susceptibility testing. Various methods are available, of which broth microdilution is recommended by the Clinical and Laboratory Standards Institute (CLSI). We report our results after using RAPMYCO, commercially available, predosed, ready-to-use broth-microdilution plate. Materials and Methods: A total of 33 isolates of NTM were tested using the RAPMYCO panel for susceptibility against amikacin, cefoxitin, ciprofloxacin, clarithromycin, doxycycline, imipenem, linezolid, trimethoprim + sulfamethoxazole, tobramycin, and tigecycline, and the results were interpreted as per the CLSI guidelines. Results and Conclusion: Minimum inhibitory concentration results of conventional broth microdilution correlated well with those of RAPMYCO. All Mycobacterium fortuitum and Mycobacterium chelonae isolates were susceptible to amikacin and tobramycin.Good susceptibility was observed towards clarithromycin for all isolates; some degree of susceptibility was observed for quinolones and linezolid. High degree of resistance was seen for cefoxitin, doxycycline, and trimethoprim + sulfamethoxazole. Mycobacterium abscessus was the most resistant. RAPMYCO was simple, easy, and saved precious person-hours as compared to conventional broth microdilution.
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Baseline characterization and annual trends of body mass index for a mega-biobank cohort of US veterans 2011–2017 p. 98
Xuan-Mai T Nguyen, Rachel M Quaden, Rebecca J Song, Yuk-Lam Ho, Jacqueline Honerlaw, Stacey Whitbourne, Scott L DuVall, Jennifer Deen, Saiju Pyarajan, Jennifer Moser, Grant D Huang, Sumitra Muralidhar, John Concato, Philip S Tsao, Christopher J O'Donnell, Peter W. F. Wilson, Luc Djousse, David R Gagnon, J Michael Gaziano, Kelly Cho, On Behalf of the VA Million Veteran Program
DOI:10.4103/jhrr.jhrr_10_18  
Aim: Million Veteran Program (MVP) is the largest ongoing mega-cohort biobank program in the US with 570,131 enrollees as of May 2017. The primary aim is to describe demographics, military service, and major diseases and comorbidities of the MVP cohort. Our secondary aim is to examine body mass index (BMI), a proxy for general health, among enrollees. Materials and Method: The study population consists of Veterans who actively use the Veterans Health Administration in the US. Data evaluated in this paper combine health information from multiple sources to provide the most comprehensive demographic profile and information on height and weight of MVP enrollees. A standardized cleaning algorithm was used to curate the demographic variables for each participant in MVP. For height and weight, we derived a final data point for each participant to evaluate BMI. Statistical Analysis Used: Multivariable logistic regression was used to compare the differences in BMI categories across enrollment years adjusting for gender, race, and age. P < 0.05 was considered statistically significant. All analyses were conducted using Statistical Analysis System 9.2. Results: The MVP cohort consists of 90.4% of males with an average age of 61.9 years (standard deviation [SD] = 13.9). MVP is the largest multiethnic biobank cohort within the Veteran population with 73.9% White, 19.0% Black, and 6.5% Hispanic. The most common self-reported disease was hypertension (62.6%) for males and depression (47.5%) for females. Mean BMI was 29.7 kg/m2 (SD = 5.8) with 38.2% obese and 42.3% overweight. Conclusions: Our findings suggest that demographic representation in MVP is similar to the Veterans Health Administration population and contrasts with the overall National Health and Nutrition Examination Survey US population. The prevalence of overweight and obese is high among US Veterans, and future studies will examine the role of BMI and disease risk in the Veteran population.
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CASE REPORT Top

Sublingual hematoma following viper envenoming p. 108
Godpower Chinedu Michael, Ibrahim Aliyu, Bukar Alhaji Grema
DOI:10.4103/jhrr.jhrr_20_18  
Snakebite envenoming causes considerable morbidity and mortality in rural, agrarian, and poor-resourced communities of Sub-Saharan Africa and Asia. Echis ocellatus (carpet viper) is responsible for most injuries and deaths in Northern Nigeria. Tissue necrosis and hemorrhage are the key features of this snake species. While bleeding can occur into virtually any tissue of the body following snakebite envenoming, sublingual hematoma (SLH) has been scarcely reported. The index patient was an adult female farmer with delayed presentation of SLH following venomous snakebite in a rural Nigerian community. Diagnostic and management challenges were encountered.
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