Open Access Review Article

Inhaled Nitric Oxide in Treatment of Persistent Pulmonary Hypertension of Neonate: An Insight into Biochemical Pathways

Abbas M. Hassan, Surekha Bhat, V. N. Prasad

Asian Journal of Medicine and Health, Page 1-7
DOI: 10.9734/AJMAH/2017/38892

Persistent pulmonary hypertension of neonate (PPHN) is a syndrome of failed circulatory adaptation in the neonatal period and is defined by sustained elevation of PVR and is often associated with hypoxemia, severe cyanosis, and cardiac dysfunction and normal or low systemic vascular resistance. Stability of pulmonary vessels is achieved through the formation of vascular complexes and Nitric oxide (NO). The decline in the secretion of endothelial diastolic factors in the pulmonary vasculature aggravates the injury of endothelial cells, which induces shrinkage of the vasculature. Currently available agents in the treatment of PPHN include oxygen, inhaled nitric oxide (iNO), prostanoids, sildenafil, milrinone, and bosentan. NO the smallest signaling molecule known is synthesized from L-arginine in the presence of nicotinamide adenine dinucleotide phosphate (NADPH) and oxygen by four major isoforms of NO synthase (NOS). The most important physiological signaling pathway stimulated by NO is the activation of soluble guanylyl cyclase and the generation of cyclic GMP. NO can also bind to the ferrous heme forming iron nitrosyl Hb, FeIINO Hb and to ferric heme, but with a substantially lower affinity. Both of these reactions end up inactivating NO. There are several diffusional factors that contribute to the negative modulation of the reaction of NO with ferrous hemoglobin and include the erythrocyte membrane, or sub-membrane network of protein, an unstirred layer surrounding the erythrocyte and an erythrocyte-free zone within the lumen nearest to the endothelial layer that results from dynamic, flow-mediated, axial concentration of the red cells. Such an effect is believed to be the cause of pulmonary and systemic hypertension and many other diseases. Inhaled NO can disperse to vascular smooth muscle cells, and soluble guanylate cyclase can increase the levels of NO, which causes specific expansion of the pulmonary vasculature. NO has allosteric effects on hemoglobin, which increases the exchange of oxygen and carbon dioxide, and causes blood flow distribution from oxygenation tissue to hypoxic tissue, which improves systemic and pulmonary circulation. iNO has been approved by the U.S. Food and Drug Administration (FDA) for the treatment of PPHN.

Open Access Original Research Article

Methodological Horizon for Understanding the Health-disease Process

Arturo G. Rillo

Asian Journal of Medicine and Health, Page 1-21
DOI: 10.9734/AJMAH/2017/38430

Aims: Constructing a methodological horizon that makes possible the analytic of the health-disease process from the perspective of the philosophical hermeneutics.

Study Design: Qualitative research with interpretive hermeneutic approach.

Place and Duration of Study: Faculty of Medicine, Autonomous University of the State of Mexico, between August 2016 and July 2017.

Methodology: The theme of the study was themed to rehabilitate the methodological strategy to approach the understanding of the health-disease process. Through Foucault’s archeological method was confronted methodological work of Heidegger and Gadamer for the analytics following categories: hermeneutic situation, phenomenological reduction, phenomenological destruction and phenomenological construction; rehabilitating the medical tradition influenced by Claude Bernard, Karl Jaspers, Georges Canguilhem, Jacques Lacan, and Maurice Merleau-Ponty and Hans Jonas.

Results: The results show the structure of the methodological horizon that begins with a starting point to clarify the hermeneutical situation with the following structure: having previous, previous way of seeing and previous way of understanding. Continues with the elaboration of the horizon of meaning product of the phenomenological reduction and delimits the point of view, the direction of the gaze and the horizon of the gaze. Subsequently the destructive moment that includes two phases is developed: analytical and comprehensive. The hermeneutical task is concluded with the constructive moment in which the knowledge, explanations and understandings are incorporated, through the fusion of horizons; It includes two phases: reconstructive and critical.

Conclusion: The epistemic complexity of the health-disease process requires articulating multiple methods to understand it. Based on the methodological indications analyzed, the horizon is integrated by a point of departure and three moments: phenomenological reduction, constructive moment and deconstructive moment. This methodological approach opens horizons to the understanding of the health-disease process circumscribed to the world of life.

Open Access Original Research Article

Musculoskeletal Complications of Sickle Cell Anaemia and Their Management Approaches in Makurdi, Nigeria

Williams T. Yongu, Itodo C. Elachi, Daniel D. Mue, Joseph N. Kortor, Joseph Orkuma, M. Ochoga

Asian Journal of Medicine and Health, Page 1-8
DOI: 10.9734/AJMAH/2017/38798

Background: Musculoskeletal complications are responsible for up to 80% of indications for presentation to the hospital by sicklers during their life time. It is important to know when to expect the complications and the treatment options available.

Methods: A retrospective study was conducted involving all sickle cell anaemia patients treated between June 2012 and May 2017 at Benue State University Teaching Hospital (BSUTH), Makurdi, Nigeria. The data collected included age, sex, complications, anatomic site, stage of disease and treatment. Data obtained were analyzed using the software Statistical Package for Social Sciences for Windows version 15.0 (SPSS, Inc; Chicago, Illinois) and presented as frequencies (%) and mean values (SD) as appropriate, P < 0.05 was taken as statistically significant.

Results: Thirty one out of 85 sicklers presented with 53 musculoskeletal complications giving a prevalence rate of 36.4%.There were 18 males and 13 females with mean age of 14.2±1.03 years. Those ≤ 20 years had more complications than those 21 years and above, P=0.0001. The femur was involved in 20(37.7%) and avascular necrosis 17(20.1%) was the most common complication followed by septic arthritis 13(15.3%) and chronic osteomyelitis 8(9.4%). The mean Haemoglobin concentration 7.5±0.5 mg/dl of the patients with AVN was higher than those without it, P=0.02. Conservative treatment was employed in treatment of 40(75.7%) of the complications while others had arthrotomies and arthroplasties.

Conclusion: Avascular necrosis, osteomyelitis and septic arthritis are the most common orthopaedic complication among sicklers in Makurdi. They occur predominantly in the younger age group and many are amenable to conservative treatment.

Open Access Original Research Article

Gender Specific Predictive Performance and Optimal Threshold of Anthropometric Indices for the Prediction of Hypertension among a Ghanaian Population in Kumasi

William K. B. A. Owiredu, James Osei-Yeboah, Christiana Aryee, Ellis Owusu-Dabo, Edwin F. Laing, Isaac K. Owusu

Asian Journal of Medicine and Health, Page 1-10
DOI: 10.9734/AJMAH/2017/37772

Despite the extensive use of anthropometric indices in the risk prediction of hypertension, there is lack of consensus on the type and the optimal threshold to be used. This current work evaluates the optimal threshold points, discriminative power and comparative performance as discriminators of hypertension for ten (10) anthropometric indices. Standard methods were used to measure weight, height, waist circumference, hip circumference for calculating BMI, PI, WHR, WhtR, CI, AVI, and BAI. Gender specific predictive performance of anthropometric indices were assessed using the area under the curve (AUC) of the receiver operator characteristic curves (ROC). In this Ghanaian cohort, body mass index, waist-to-hip ratio and ponderal index were poor predictors of hypertension. Among the commonly used anthropometric measures, waist circumference at a lower threshold (>75 cm and 80 cm for females and males respectively) than the currently recommended cutoffs was the index of choice for the prediction of hypertension, however significant improvement in prediction was achieved with the use of conicity index (>1.08 female, >1.05 male).

Open Access Original Research Article

Effect of Aqueous Extract of Persea americana Seed on Blood Glucose in Alloxan-induced Diabetic Wistar Rats

A. A. Aigbiremolen, R. N. Ativie, M. E. Aisuodionoe, O. M. Odigie, J. C. Igweh, M. Egwaoje

Asian Journal of Medicine and Health, Page 1-10
DOI: 10.9734/AJMAH/2017/37955

Alternatively known as grape sugar, Glucose, a monosaccharide (C6H12O6) is often found in honey and the juices of many fruits. It is the sugar most often produced by hydrolysis of complex compounds from plants (natural glycosides) and forms a major constituent of the blood of animals. One of the major implications of increased blood glucose is Diabetes Mellitus. In spite of its life-threatening complications, the issue of cost, and appropriate dosage administration (with synthetic drugs) remain an issue. This study was undertaken to determine the hypoglycemic (glucose lowering) activity of Persea americana seed extract in the blood of alloxan-induced, diabetic (hyperglycemic) wistar rats. To achieve this, Thirty-Five (35) Wistar rats (140 – 200 g) were assigned into seven groups of 5 rats each with group A serving as normal control. While Groups B through E were respectively treated with 250 mg/kg and 500mg/kg of Persea seed extract (Non-diabetic rats), Alloxan (diabetic control), and Alloxan (diabetic, then treated with 50 mg/kg of metformin), Groups F and G were diabetic rats which respectively received 250 mg/kg and 500mg/kg of Persea seed extract. After 28 days of administration, rats were sacrificed with blood samples collected for analysis of glucose levels. Pancreatic tissues were also harvested for histopathological extermination. Results show an increase in body weight (20.39 – 26.32%) of diabetic treated rats (group E) as compared to diabetic control (Group D). Though blood glucose levels for group E reduced significantly (at p<0.05) in a dose-dependent manner as compared to elevated levels in diabetic control, no significant changes were observed in normal treated rats (group D) as against normal control (Group A). Histopathology of the pancreas revealed a degeneration in the islet cells of diabetic untreated groups F and G compared to non-diabetic group A.