American Journal of Clinical Medicine Research

A retrospective study of utero-vaginal prolapse to determine the frequency and determinants of uterovaginal prolapse, degrees and its complications at the University of Nigeria Teaching Hospital (UNTH) between January 1, 2005 and December 31, 2009. The prevalence of uterovaginal prolapse was 3.4%. Thirty three (66%) of them were postmenopausal. Multiparity was a significant determinant as 74% of them were grand-multiparous. The commonest symptom was ‘something coming down the vagina’ in 96% of the study subjects. Second degree prolapse was the commonest type of presentation (48%) and the definitive treatment modality was vaginal hysterectomy with pelvic floor repair (44%). Multiparity, prolonged labour and unsupervised deliveries are significant determinants. Uterovaginal prolapse is primarily a common gynaecological condition of the parous and elderly postmenopausal women associated with a decreased body image and quality of life. Education of women, women empowerment, effective antenatal care, supervised hospital deliveries, and limiting the family size by efficient contraception deserve priority attention to prevent this social malady.

American Journal of Clinical Medicine Research. 2013, 1(1), 23-25. DOI: 10.12691/ajcmr-1-1-6
Pub. Date: February 23, 2013

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HIV/AIDS: The Zimbabwean Situation and Trends

by Duri Kerina, Stray-Pedersen Babill and Muller F

Review Article

Although there are many Zimbabwean published manuscripts reporting on different HIV/AIDS research areas on what has been happening over the years concise national reviews are rare yet such reports are not only important to the respective researchers and policy makers of the native country but are also of great value to potential donors and/or collaborators who may wish to have a quick and deep understanding of disease burden and trends of the nation they may wish to work with. Recent data from general population surveys point to a remarkable decline in the HIV prevalence attributed mainly to changes in sexual behavior and to some extent to effective preventive programmes such as male circumcision, prevention of mother to child transmission of the virus (PMTCT) including improved access to antiretroviral therapy among the infected that has consequently reduced transmission at population level. This review seeks to give a simple and clear Zimbabwean HIV/AIDS perspective detailing the geographical, demographical, social economic status including HIV related legal aspects that could have shaped the observed disease burden and trends. Milestones, impact, and challenges around the control of the HIV/AIDS pandemic will be discussed.

American Journal of Clinical Medicine Research. 2013, 1(1), 15-22. DOI: 10.12691/ajcmr-1-1-5
Pub. Date: February 23, 2013

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The Effect of Femoral Stem Length on Inpatient Rehabilitation Outcomes

by Serkan BAKIRHAN, Bayram UNVER and Vasfi KARATOSUN

Original Research

Thrust plate prosthesis (TPP) has load-transferring characteristics different from those of conventional intramedullary stemmed prostheses (ISP). We investigate whether prosthesis type (intramedullary or extramedullary application) can improve early functional activities in hospital patients with hip arthroplasty. Early postoperative functional activities of 30 patients with TPP were compared with 31 patients treated by ISP. Each group received same rehabilitation programmes: TPP patients with early full weight bearing and ISP patients with early full weight bearing. Patients were evaluated postoperatively (on the second, sixth and discharge days). Their functional activities were assessed with Iowa Level of Assistance Scale (ILAS), walking speed with Iowa Ambulation Velocity Scale (IAVS), hip functions with Harris Hip Scoring System, and hip motions with goniometer. TPP patients achieved higher scores for total functional activities on the second and sixth postoperative days and during discharge than did ISP patients (p<0.05). Comparison of the walking speed of the patients on the second and sixth postoperative days and during discharge showed that TPP patients walked faster than did ISP patients (p<0.05). TPP patients had higher Harris hip scores and a higher hip motion degree than did ISP patients during discharge (p<0.05). We conclude that patients with TPP gain their independence in functional activities earlier than do patients with ISP.

American Journal of Clinical Medicine Research. 2013, 1(1), 9-14. DOI: 10.12691/ajcmr-1-1-4
Pub. Date: February 23, 2013

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Complicated Peptic Ulcer Disease after Ingestion of Single Dose NSAIDs in Children

by Smaranda Diaconescu, Claudia Olaru, Marin Burlea and Nicoleta Gimiga

Case Report

AIMS: In our small case series we would like to highlight some severe clinical consequences of the empirical use of NSAIDs and the necessity of educating parents and caregivers. CASE REPORTS: Throughout a period of two years, four children (two boys and two girls, median age 26±0.9 months) have been hospitalized in our unit for upper digestive hemorrhage after receiving single doses of NSAIDs. Two patients received aspirin (500mg) and the other two received ibuprofen (50-100mg). In three cases, aspirin and ibuprofen were given for fever control, while the 4^th child accidentally ingested two half-tablets of aspirin, which were used as a preservative agent in home-made stewed fruits. Within the first 24-48 hours after receiving NSAIDs, all patients were brought to our unit, with hematemesis (two cases), melena (one case) and both hematemesis and melena (one case). History for gastrointestinal problems, chronic drugs usage or overdosage of NSAIDs was negative. Hemoglobin values ranged from 5.5 to 10.5mg/dl and the coagulation tests were normal. Within 24-48 hours of admission, an upper digestive endoscopy was performed in two children; for the other two cases we could not obtain an informed consent from the parents. In both patients who underwent endoscopy we found double gastric ulcers in the antral region. No evidence of Helicobacter pylori infection was obtained. In one case, lack of early endoscopy due to parental refusal was followed by progressive worsening vomiting and acute dehydration; a barium meal revealed a decompensated pyloric stenosis that imposed an antrectomy. Two children were treated with intravenous PPI and one with H2-blockers. The patients were discharged after 7-10 days with a recommendation for oral PPI/H2-blockers. The endoscopic revaluation after two months showed a complete healing of the gastric lesions in three children. CONCLUSIONS: Improving parental education about the risks of self medication and severe side effects of NSAIDs and using acetaminophen as a first choice medication for fever control in young patients seems to be a reasonable attitude of general practitioners and pediatricians.

American Journal of Clinical Medicine Research. 2013, 1(1), 6-8. DOI: 10.12691/ajcmr-1-1-3
Pub. Date: February 23, 2013

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Institution of Multiple Daily Insulin Regimen Compared with Twice Daily Pre-Mixed Insulin Regimen for Children with Type 1 Diabetes Mellitus

by Christopher Murphy and Sze May Ng

Original Research

Children and young adults with type 1 diabetes mellitus are usually commenced on either a multiple daily insulin (MDI) regimen or twice daily pre-mixed insulin regimen at diagnosis. The MDI regimen is thought to more closely mimic the normal secretory patterns of endogenous insulin production to improve glycaemic control compared to twice daily or thrice-daily insulin regimens. This study aims to look at the effect on glycaemic control and growth over an 18-month period in children with type 1 diabetes mellitus on a twice-daily pre-mixed bis die (BD) insulin therapy compared to MDI regimen. This is a retrospective study comparing glycaemic control (HbA1c) and growth parameters (height SDS, weight SDS and BMI SDS) at intervals over an 18-month period between children with type 1 diabetes mellitus started on a twice-daily pre-mixed insulin regimen compared to those children started on MDI regimen. No significant difference was found between the two groups. Multiple regression analysis examining independent variables (age at diagnosis, insulin regimen, gender) affecting HbA1c values at 3, 6, 12 and 18 months confirmed that there were no independent factors affecting glycaemic control at any time point A twice-daily insulin regimen and an MDI insulin regimen were equivocal in efficacy of HBA1c control and measures of growth parameters within an 18-month period in paediatric diabetic patients with type 1 diabetes mellitus. Future prospective studies are warranted to address the issues described.

American Journal of Clinical Medicine Research. 2013, 1(1), 3-5. DOI: 10.12691/ajcmr-1-1-2
Pub. Date: February 23, 2013

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Multiple Massive Bladder Calculi Following Traumatic Pelvic Fracture

by Ozgu Aydogdu and Caner Alptekin

Case Report

A 25 year old man was hospitalized with the complaints of pain during micturition and macroscopic hematuria. Plain radiography showed 4 properly shaped bladder stone shadows. Cystolithotomy was performed following cystoscopy and bladder neck incision. The stones weighed 500 g totally. Previously we have reported a similar patient with giant bladder calculi . To the best of our knowledge the present patient represents one of the largest bladder stone cases reported to date.

American Journal of Clinical Medicine Research. 2013, 1(1), 1-2. DOI: 10.12691/ajcmr-1-1-1
Pub. Date: February 23, 2013

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