Willingness to Patronize Traditional Bone Setters Among Patients Attending General Out-Patient Department of Federal Teaching Hospital Abakaliki, Nigeria

                                         http://austinpublishinggroup.com/austin-orthopedics/

The practice of traditional bone setting has been of old and it is found in almost all communities of the world. For instance, an approximate 10-40% of patients with fractures and dislocations globally are managed by unorthodox practitioners. Also, there is evidence that bone setters were in practice in England in the 16th and 17th centuries. Incidentally as it is stillobtainable in Africa today, the methods of that practice was handed over by oral tradition from father to son and in most cases continued within the same family. In-fact, one of the founding fathers of orthopaedics in the United Kingdom was the son of a traditional bone setter.

Asexpected, the practice of traditional medicine has been in Africa long before the introduction of orthodox medicine. Its vastness necessitated the emergence of several specialized areas including traditional bone setting, traditional birth attendant and herbal healing. In Nigeria, it has been ascertained that traditional bone setters enjoy more trust and patronage than the other groups of traditional care givers. The popularity of traditional bone setters in Africa is enhanced by the claim by its practitioners that they have supernatural influences. The result is that in Nigeria, majority of the people rank the bone setters far ahead of orthopedic surgeons in the treatment of musculoskeletal injuries. For example, in Eastern Nigeria, it was reported that 85% of patients who presented with femoral fractures in an orthopaedic hospital visited the traditional bone setters first before presenting at the hospital. Perhaps spurred by this high level of societal recognition, the bone setters have ventured into other areas like treatment of congenital anomalies and management of patients with bone infections and tumors.

Role of Proximal Fibular Osteotomy in Medial Joint Osteoarthritis of Knee

                                  http://austinpublishinggroup.com/orthopedics-rheumatology/

Osteoarthritis(OA) of knee joint is a common disease that causes significant disability. Most patients can be managed conservatively in the outpatient setting. The global prevalence of radio graphically confirmed symptomatic knee OA in 2010 was estimated to be 3.8%. It was higher in females (4.8%) than in males. In the USA, 33.6% people aged more than 65 years were found to have osteoarthritis of knees. [3] In south Asian region the prevalence of OA of knees is 1.8% in males and 3.1% in females. With the aging of the world’s population, especially in Low & Middle Income Countries (LMIC), the number of people living with knee OA is anticipated to increase substantially over coming decades. Osteoarthritismanagement in the developed countries is focused on developing patient-specific surgical instrumentation for knee arthroplasty, post-operative supervised exercise programs, and other potentially expensive healthcare modality. In the LMIC, lacking of appropriate healthcare infrastructure or inability to fund expensive treatment of arthroplasty for osteoarthritis can hardly afford to  benefit from such advanced method. In the high income country (HIC) treatment modalities often include arthroplasty techniques. Patient specific instruments are unproven and not widely used.

Computerguided knee replacement is used in some centres but the benefit is not really proven. Unfortunately, ongoing registered trials, largely, are not being conducted to address the research gaps that could have a worldwide influence. However, this issue may not be the fault of individual orthopedic investigators. The researchers in orthopaedics and related fields should heighten efforts to increase awareness and promote better screening of osteoarthritis, in the attempt to initiate treatment sooner and delay the progression of the debilitating effects of the disease.

Is Long-Term Dienogest Treatment Tolerable in Korea?

                                 http://austinpublishinggroup.com/obstetrics-gynecology/

Endometriosis is defined as the presence of endometrial glands and stroma outside the uterine cavity. The prevalence rate of endometriosis is approximately 5-10% of all women of reproductive age, it reduces the patient’s quality of life through the occurrence of pain, including dysmenorrhea, dyspareunia, and lower back pain.

It is known that the primary treatment of endometriosis is surgery. The European Society of Human Reproduction and Embryology (ESHRE) guidelines state that surgical treatment is warranted for an ovarian endometrioma of larger than 3 cm, and that laparoscopic stripping of the cyst wall is considered the gold standard for treatment. Because the surgical excision of lesions has shown to improve the level of pain and enhance fertility, ovarian cystectomy is preferable to oophorectomy, and most women who undergo endometriosis are of childbearing age. However, a pooled analysis of 23 studies estimated the recurrence rates as 40% to 50% 5 years after the primary surgery. Medical treatment for the relief of symptoms and the prevention of recurrence after surgery include Gonadotropin-Releasing Hormone (GnRH) analogs, progestin, danazol, and estrogen/progestin combinations. However, these treatments have adverse.

effects including impaired hepatic function associated with danazol, as well as a decrease in bone mineral density, which may be caused by GnRH analogs. Thus, their long-term use is limited. Dienogest (Visanne, Bayer HealthCare, Berlin, Germany) is a selective progestin that has been approved for treating endometriosis at a low oral dose of 2 mg/day. Dienogest has many beneficial pharmacological uses, such as a potential progestogenic effect, moderate suppression of estrogen, and low concern for increased androgen and corticoid levels. Progestogenic effects lead to an effective reduction in endometrial lesions, and no significant androgenic, mineralocorticoid, or glucocorticoid activity. 

Obesity and Cancer Progression

                                   http://austinpublishinggroup.com/obesity-metabolic-syndrome/

Obesityis defined as increased adipose mass arising from energy imbalance. Currently all over the world, obesity is an epidemic associated with altered whole-body physiology and hormonal balance that promote risk of developing number of cancers with poor survival outcome. Adipose tissue is a dynamic endocrine organ that maintains energy homeostasis. Obesity has been identified as a significant risk factor for the development of various cancers. Obesity, which is a stateof excess of nutrients, chronically activates cellular growth factor and metabolic signalling pathways and stimulates neoplastic transformation. Pathophysiological effects of hyperadiposity have been found to be associated with development and progression of tumor predominantly in metabolically and hormonally driven cancers. Obesity at the time of diagnosis of the cancer is associated with advanced state of the disease affecting progression of the disease, response to the therapeutic agents and disease-free survival. Researchers also observed strong association between increased body mass index and cancer-related mortality, but no exact consensus linking obesity with the pathogenesis of cancer. Among breast cancer women with BMI more than 40Kg/m², mortality rate is three times more than lean women suggesting obesity as a poor prognostic factor.

Goodwin et al observed significant association of higher BMI with increased risk of early and late distant recurrences and death in breast cancer women. Excess of adiposity has been identified as a risk factor for recurrence, reduced effectiveness and complications of the treatment, development of second primary tumor and mortality.

Acquired Sturge Weber Syndrome due to Methotrexate Induced Folic Acid Deficiency in an Adult Patient

                                            http://austinpublishinggroup.com/austin-neurology/

  

The64 years old female patient presented to the emergency room with blurred vision, impaired visual field and episodes of migraine aura like fortification illusions, and persistent headaches with decreasing intensity over the past days. Three years ago, patient admitted to hospital with headache and suspected brain infarction. A cerebral CT showed a small, wedge-shaped hypo density with superficial cortical calcifications in the right occipital lobe. The contra lateral occipital lobe showed slight hypo dense areas within the sub cortical white matter. The patient’s history, additionally, included rheumatoid arthritis since 2007, which was treated with methotrexate (MTX, 15mg weekly) subcutaneous. The patient, however, revealed, that she was not utterly adherent to her intake of folic acid after MTX application.

Atcurrent admittance, neurological examination showed visual extinction phenomenon to the lower left and mild optic ataxia to the left. There were no nevi on the patient’s face or in her eyes. An intellectual disability or hemi paresis could not be observed. Family history showed no neurological diseases. The blood tests on admission showed low levels of folic acid (3.9μg/ml). Levels offolic acid were not measured prior to presentation at hospital. Blood samples from the past years showed continuously increased values for Mean Corpuscular Volume (MCV) and Mean Corpuscular Hemoglobin (MCH) up to 103fl and 35pg, respectively. Anti-gliadin antibodies were negative. EEG showed abnormal slow brain activity with delta waves over the right parieto-occipital lobe.

Potential Susceptibility to Liver Dysfunction Induced by a Therapeutic Dose of Acetaminophen in Rats Submitted to Gestational and Lactational Protein Malnutrition

                                         http://austinpublishinggroup.com/nutritional-sciences/

Acetaminophen,also known as paracetamol, is widely used as analgesic and antipyretic medication in the world and is considered to be safe at therapeutic dosages. It is widely accepted that an overdose of acetaminophen can induce severe liver damage in humans and in experimental animals; it is important to note that hepatic injury induced by therapeutic dose has been reported however there are few studies in order to identify potential triggers for this condition. There are several evidences suggesting that hepatotoxicity of compounds might be related to protein malnutrition condition, for example, Kwashiorkor seems to be associated with exposure to aflatoxins.

Proteinmalnutrition can affect the pathways of acetaminophen metabolism. Acetaminophen is metabolized by different pathways such as sulfation, glucuronidation, and some isoforms of hepatic microsomal cytochrome P450s, such as CYP1A2 and CYP3A. The P450 system can generate the reactive metabolite, N-Acetyl-P-Benzoquinone Imine (NAPQI), which is subsequently detoxified through conjugation with Glutathione (GSH) by Glutathione S-Transferase (GST). However, at higher doses, saturation of conjugation pathways and the consequent depletion of GSH can increase NAPQI levels NAPQI is able to bind to several hepatic proteins, and this binding is associated with development of centrilobular necrosis. Moreover, administration of hepatotoxic doses of acetaminophen can reduce GSH levels in liver and kidney. It is important to note that malnutrition per se induced a reduction in the GSH content.

Review of Avitaminosis Fever and Its Clinical Significance

                                     http://austinpublishinggroup.com/nutritional-disorders/

Feveris a common clinical sign in many kinds of diseases. The most common cause is malnutrition related infections, such as tuberculosis, pneumonia, or gastrointestinal disorders. Their treatments invariably depend on antibiotics. However, fever could be resulted directly from severe deficiency of some nutrients themselves, such as berlberi fever, ariboflavosis fever, or pellagra fever. They were observed in a population with terribly hard labor and hunger, such as in a labor camp 1958-1962 before and during Nationwide Hunger. This paper introduces the follows: 1. Avitaminosis fevers due to deficiency of thiamin, riboflavin, or niacin themselves might be found in cases with prolonged severe labor and hunger 2. Thiamin deficiency fever was very violent and often involved multiple organs and endocrine glands from different systems and often leading to death. Its diagnosis was very complicated and confused, which could be collectively termed as dysautonomia 3. High dose of parenteral thiamin could surely bring down high fever in avitaminosis fever, however unexpectedly, high fever due to different microbial infections including virus and bacteria or even lymphoma could be normalized with it. Therefore, high dose thiamin injection may be a physiologic anti-microbial agent comparable or superior to the current best antibiotics.

Mr. GONG KM was a 26-year-old laborer who suffered from frequent cramps and persisting numbness of the extremities for 3 years. After arduous labor for several days, he experienced sudden onset of high fever and severe headache as if hit on the head with a hammer on a day of Feb 1959. He complained also tightening of the chest. The temperature rose to 41˚C even under penicillin from the beginning and followed by herbal medicine.