Sapporo Medical Journal

Abstract : This case series investigated the outcomes of children who received the maximum tolerated dose of hydroxyurea for sickle cell patients with avascular necrosis of the femoral head (AVNFH) at Maternity and Children Hospital, Makkah, Kingdom of Saudi Arabia (KSA) over one year. This retrospective case series report describes four pediatric patients under the age of 14 with sickle cell disease complicated by AVNFH. We excluded all patients who were non-compliant to medication, missed follow-up, started on another modality of treatment, or did not complete laboratory work-up or imaging. Patients were started on the maximum tolerated dose of hydroxyurea, and the assessment was conducted according to clinical manifestations and radiological findings. Our study found significant clinical and radiological improvement in sickle cell patients with AVNFH who took the maximum tolerated dose of hydroxyurea.

Abstract : Measuring chest expansion is considered to perform in COVID-19 patient to assess the pulmonary function impairment as its usage to other interstitial lung diseases. The decrease of pulmonary function will affect the cardiorespiratory functional capacity. These problems demand an appropriate pulmonary rehabilitation programme aimed to returning the decent quality of life. Among 43 subjects we prescribed two types of breathing exercise: incentive spirometry and diaphragm breathing exercise. The chest expansion at three levels (axillary, nipple, and xiphisternum) was measured before and after breathing exercise; then average of its improvement was recorded. The assessment of functional capacity using 4-meter gait time test (4MGT) was also performed after sequence of breathing exercises. This study showed improvement of chest expansion on majority of subjects. Based on bivariate analysis using Spearman correlation, the p value was 0,012 (p <0,05) and coefficient correlation was 0,381. We can conclude that there was correlation between chest expansion improvement and functional capacity measured by 4MGT after breathing exercise in COVID-19 patient.

Abstract : Hemorrhagic stroke is a highly debilitating condition with several rehabilitation problems.This study aimed to discern the effects of intensive TENS therapy for 2 weeks, on a motor-impaired haemorrhagic stroke patient’s recovery, with 6 weeks of conventional physiotherapy, to elucidate the effect of TENS and conventional physiotherapy on serum Creatine Kinase and serum Troponin T. Our outcome measures were serum Creatine Kinase, serum Troponin T, and modified Barthel Index scores. This was a pre-post convenient sampling controlled interventional study, conducted in Hospital Universiti Sains Malaysia, with 10 control subjects and 10 TENS-therapy subjects. The intervention group underwent intensive TENS therapy and conventional physiotherapy for 2 weeks, then 4 weeks of conventional physiotherapy. The control group underwent 6 weeks of conventional physiotherapy. All three outcome measures were measured before and after 2 weeks of intensive TENS therapy and 6 weeks of conventional therapy. Results indicated Creatine Kinase and Troponin T were unaffected by 2 weeks of intensive TENS therapy and 6 weeks of conventional physiotherapy (Creatine Kinase p=0.521) (Troponin T p=0.632). The same also applied to 6 weeks of conventional physiotherapy alone (Creatine Kinase p=0.572) (Troponin T p=0.921). Conversely, modified Barthel Index score comparisons show significant increases in intervention group (p=0.040) compared to control group. This study is a pilot study for future research.

Abstract : Intelligence is defined as a general mental ability for reasoning, problem solving, and learning. To assess the intelligence quotient (IQ) of a child, many factors play a role such as genetics, family, social, cultural and environmental. Blood lead levels (BLLs) in 5 micrograms per deciliter (µg/dL) or more are associated with decreased intelligence, behavioral disorders and learning problems. This study aimed to determine the prevalence of low IQ and its associated factors. A cross-sectional study design was conducted in West Bangka. Data on 190 children aged 2-9 years and their mothers were collected. The subjects were divided into two categories on the results of intelligence assessment (IQ test) by Startford-Binet intelligence scale. Descriptive and binary logistic regression analyses were applied to determine the prevalence and associated factors with low IQ. The total prevalence of BLL > 5µg/dL and low IQ in children were 57.9% and 62.3%, respectively. However, after adjustment for head circumference for age, height for age, maternal and paternal education level, BLL was not associated with low IQ in children. Children with microcephaly were more likely to be low IQ (adjusted OR : 4.304 95% CI : 1.602 – 11.563, p = 0.004) than children with normocephaly. Children whose mothers had low education level were at a higher risk for low IQ (adjusted OR : 3.785, 95% CI : 1.976 – 7.248, p = 0.000) compared to children whose mothers had high level education.

Abstract : For a proper activity of the drug, researchers study all factors that could impact the pharmacological action of the drug, including interactions between drug and juices which are the most important factor that alters the effect of a medicine. HPLC/MS technique helps analyze the concentration of drugs in plasma to identify the impact of co-administrated substances on it. In our review article, we concentrated on citrus fruit juices (Grapefruit, Seville orange, and Pomelo), Cranberry juice, and pomegranate and their effect on the pharmacokinetics of studied drugs (Cyclosporine, Warfarin, and Colchicine). In this review, it found that some of the interactions showed several changes in pharmacokinetics parameters Like T max, C max, AUC, and modification in Half-life. While others remained without any interference. In conclusion, the complexity of the fruit juice's composition makes it difficult to study, but healthcare providers should be aware of any possible side effects or unusual interactions that may occur while taking medication with juices. Keywords — Interactions, Juice(s), Drug(s), Pharmacokinetics, HPLC-MS technique, Cyclosporine, Warfarin, Colchicine, Pomelo, Seville orange, Grapefruit, Cranberry, Pomegranate.