Journal of Advances in Medicine and Medical Research <p style="text-align: justify;"><strong>Journal of Advances in Medicine and Medical Research (ISSN:&nbsp;2456-8899)</strong> aims to publish research papers, reviews and short communications in the areas of medicine and medical research.&nbsp; JAMMR will not only publish traditional full research reports, including short communications, but also this journal will publish reports/articles on all stages of the research process like study protocols, pilot studies and pre-protocols. JAMMR is novelty attracting, open minded, peer-reviewed medical periodical, designed to serve as a perfectly new platform for both mainstream and new ground shaking works as long as they are technically correct and scientifically motivated.&nbsp;The journal also encourages the submission of useful reports of negative results. This is a quality controlled,&nbsp;OPEN&nbsp;peer reviewed, open access INTERNATIONAL journal.</p> SCIENCEDOMAIN international en-US Journal of Advances in Medicine and Medical Research 2456-8899 Hepatopulmonary Syndrome in a Nigerian Man with Decompensated Alcoholic Liver Cirrhosis <p>Hepatopulmonary syndrome is a rare complication of liver disease and portal hypertension. It has not been previously described in medical literature in Nigeria. We report this case of a 64-year-old man who presented with a 3 months’ history of recurrent breathlessness, platypnoea and leg swelling. He had been diagnosed with liver cirrhosis and had variceal band ligation in 2018, and had been managed for 2 episodes of hepatic encephalopathy prior to referral. Physical examination showed he was in respiratory distress, centrally cyanosed, had grade 4 digital clubbing, tachypnoea, platypnoea, orthodeoxia and bibasal coarse crepitations He also had a non-tender hepatomegaly, splenomegaly and ascites with no leg edema. Investigations showed negative screening for hepatitis B and C, elevated AST and GGT, conjugated hyperbilirubinemia, hypoalbuminemia, negative COVID-19 test, polycythemia, thrombocytopenia, prolonged INR and coarse enlarged liver with irregular margins on ultrasound. Gastroscopy revealed Grade 3 oesophageal varices, Forrest 3 pre-pyloric ulcer and portal hypertensive gastropathy. Spirometry demonstrated a restrictive pattern of airflow limitation.&nbsp; Contrast echocardiography demonstrated intrapulmonary shunt. Alpha-1- anti-trypsin was not deficient. The peripheral cyanosis resolved with oxygen therapy. He was initially commenced on pentoxyfylline but terminated therapy due to side effects.</p> <p>The relevant literature was reviewed. Liver transplantation is the only effective therapy for HPS and prompt recognition and referral for transplant is key.</p> <p>We therefore present the first documented and published case of hepatopulmonary syndrome in Nigeria and the West African sub-region.</p> Chinwe Philomena Onyia Olive Obienu Promise Asogwa Winifred Adiri Ugochukwu Nwoko Uchenna Nkemdilim Ijoma Sylvester Chuks Nwokediuko ##submission.copyrightStatement## 2022-10-27 2022-10-27 85 92 10.9734/jammr/2022/v34i234842 Cryptococcus laurentii Fungaemia in a Neonate from Nigeria: A Case Report <p><strong>Aim:</strong> Increasing cases of <em>Cryptococcus laurentii </em>infection are being reported globally possibly due to advances in medicine, the use of immunosuppressants and invasive therapies such as endotracheal intubation, parenteral nutrition, central vascular catheters and exposure to broad-spectrum antimicrobial agents. <em>Cryptococcus</em> species are ubiquitously distributed in the environment, abundant in contaminated soil and bird droppings. Four cases of <em>Cryptococcus laurentii </em>fungemia have been described in neonates, all were premature low/very low-birth-weight. Our case is likely the 5<sup>th</sup> reported globally and the 1<sup>st</sup> from Nigeria and Africa across all age groups.</p> <p><strong>Case Presentation:</strong> The patient presented at 34 hours of life with complaints of fever and multiple convulsions after delivery in a traditional birth attendant facility. Mother drained liquor for 5 days with poor cord care. A diagnosis of severe birth asphyxia with sepsis was made and baby received antibiotics (ceftriaxone and genticin) in addition to the management of severe birth asphyxia but showed no improvement. Blood culture yielded cream-colored smooth colonies, identified by Vitek 2 (bioMerieux, France) as <em>Cryptococcus laurentii. </em>Baby was treated with fluconazole, had good recovery and was discharged home.</p> <p><strong>Conclusion:</strong> Our case report emphasizes the need for high index of suspicion for non-bacterial organisms (fungi) as possible causes of sepsis in newborns. Improved fungal diagnosis and timely commencement of antifungal medications will improve clinical outcomes.</p> Bassey E. Ekeng Emmanuel B. Adams Ubong A. Udoh Okokon Ita Ita Linda N. Okorafor Bernard E. Monjol Ochigbo S. Oteikwu Offiong E. Ikpeme Rita O. Oladele ##submission.copyrightStatement## 2022-11-28 2022-11-28 379 383 10.9734/jammr/2022/v34i234873 Digitalis purpurea Improve Obesity Inducing Alternation of Cardiac Infarction: A Meta Analysis <p>Patients with Heart Failure (HF) and Atrial Fibrillation (AF) who have systolic dysfunction or no systolic dysfunction are ideal candidates for first therapeutic choices that involve regulating either heart rate or rhythm. Patients with Heart Failure (HF) without systolic dysfunction are not ideal candidates for these first therapeutic choices. If one want to attain rate control, the consumption of a beta-blocker is virtually essential. It is conceivable to have a resting ventricular rate that is even lower than 100, which is the standard for what is considered a normal resting ventricular rate. However, this is not always the case. It is not standard practise to give nondihydropyridine calcium channel blockers in the presence of systolic dysfunction, heart failure, and atrial fibrillation all at the same time (AF). Recent arguments have centred on the possibility of a lowered efficacy of beta-blockers and the safety dangers connected with the use of digoxin in the treatment of heart failure patients who develop AF. The extremely high prevalence of overweight and obesity in today's culture represents a significant threat to the health of the population. Another health issue that has been shown to have a direct correlation to obesity and the medical conditions that are typically connected with it is heart disease (hypertension, diabetes, insulin resistance, and sleep apnoea syndrome). When a person carries excess fat around their middle, they put themselves at a greater risk of developing coronary artery disease and atherosclerosis. Obesity is linked to a number of changes in the structure and function of the heart, some of which can lead to heart failure. As a consequence of the aberrant structure of the heart, a person has a greater risk of developing atrial fibrillation as well as sudden cardiac death. However, there is a phenomenon that is known as the "obesity paradox," which asserts that a person who already has cardiovascular disease may potentially benefit from being overweight and having a higher body mass index. Because of advancements in cardiac imaging, it is now possible to detect structural and functional alterations in the hearts of obese persons earlier than was previously possible. In the following paragraphs, we will make an attempt to provide a high-level overview of the data that links obesity and cardiovascular disease, as well as the factors that contribute to this relationship.</p> E. Keshamma Shaheena Sohi . Harshita Vijender Kumar Ayano Shanko Ajay Prakash Pasupulla Ajay Kumar ##submission.copyrightStatement## 2022-10-27 2022-10-27 93 110 10.9734/jammr/2022/v34i234843 A Review of Covid-19’s Impact on Pregnancy <p><strong>Background and Aim:</strong> Since the new Coronavirus started spreading in December 2019, the virus has had enormous consequences on people’s health and way of life in every nation on earth has been touched. A pregnant lady is more susceptible to infection than a healthy one because she is immunocompromised throughout pregnancy. The purpose of this present paper is to review relevant published literature to determine the impact of covid-19 on pregnant women.</p> <p><strong>Methods:</strong> In this narrative review all publications published in the databases PubMed, Scopus, Embase, Science Direct, and Web of Science from December 2019 to August 2022 by conducting a complete search with the required keywords, including covid-19, coronavirus illness 2019, SARS-CoV-2, and miscarriage, abortion, or pregnancy outcomes. After applying inclusion/exclusion criteria and following the PRISMA guidelines, total 25 papers were identified and thoroughly examined. There are few accessible data on the effects of covid-19 on pregnancy. Every day, new information emerges on the management of pregnancy during the covid-19 era.</p> <p><strong>Results:</strong> Pregnant women with covid-19 experienced fever, cough, dyspnea, myalgia, and exhaustion in the early stages, while headache, chest discomfort, and diarrhea were less common. Results shows that covid-19 can cause fetal distress, miscarriage, respiratory distress, and preterm delivery in pregnant women, according to the reviewed literature.</p> <p><strong>Conclusion:</strong> There is a higher risk in women who have a positive SARS-CoV-2 test result. covid-19 infection during pregnancy may cause pregnancy problems such as preterm birth, fetal distress and miscarriages. Due to the absence of adequate data regarding the effects of covid-19 on pregnancy, it is required to monitor suspected pregnant women to prevent miscarriage, fetal distress, respiratory distress and preterm delivery.</p> Mehedi Mala Mitu Md. Iqbal Hossain Nayan Tirtha Nandi ##submission.copyrightStatement## 2022-11-26 2022-11-26 350 360 10.9734/jammr/2022/v34i234871 An Unusual Detected Cause of Abnormal Liver Enzymes in an Aircrew Member Periodical Visit: Case Report <p><strong>Background</strong><strong>:</strong> Hepatic tuberculosis (TB) is a rare entity, poorly described in the literature. It presents with nonspecific clinical manifestation and imaging findings mimicking other liver disease making diagnosis challenge. We report a case of isolated hepatic tuberculosis in asymptomatic cabin crew member diagnosed accidentally by investigating a liver chemistry test disorder.</p> <p><strong>Case Report</strong><strong>:</strong> A 28 year-old Moroccan cabin crew attendant came to the aeromedical expertise center to perform her periodical medical assessment. She had no medical history. Physical examination was unremarkable. Liver chemistry test values were elevated. Imaging studies of the liver suggested malignant disease. Histological examination showed isolated hepatic tuberculosis.</p> <p><strong>Discussion</strong><strong>:</strong> Isolated hepatic TB is very uncommon, lacks typical clinical manifestation and radiological features, but remains an important differential diagnosis of hepatic nodules especially in endemic areas. This observation highlights the benefit of liver chemistry test evaluation realized systematically for periodical aeromedical fitness to diagnose some pathology in asymptomatic stage avoiding complications. Hepatic TB is a cause of temporarily unfitness because it’s not compatible with flight safety conditions. Aircrew with hepatic TB will need to be assessed for both complete disease control and full resolution of any iatrogenic side effect of anti-tubercular drugs before returning to fly under some restrictions.</p> Meryem Zerrik Houda Echchachoui Zakaria Iloughmane Mouna El Ghazi Fahd Bennani Smires Mohamed El khalifa Choukri El’mhadi Laila Benaissa Mohamed Chemsi ##submission.copyrightStatement## 2022-10-31 2022-10-31 140 145 10.9734/jammr/2022/v34i234847 Mature Cystic Teratoma of Adrenal Gland Masquerading as Myelolipoma <p><strong>Introduction: </strong>Extragonadal teratomas are uncommon tumors and are less common in adults than children. They are mostly retroperitoneal. Primary adrenal teratomas are even rarer.</p> <p><strong>Objective: </strong>We report an unusual case of primary adrenal teratoma in a young adult.</p> <p><strong>Case Summary:</strong> A 29 year old male presented with complains of intermittent right sided flank pain for 6 months, dull aching, radiating to groin. On CT Abdomen a large heterogenous mass was seen having predominantly fat component and punctuate calcification in right suprarenal region. Histopathology confirmed a diagnosis of adrenal teratoma.</p> <p><strong>Conclusions:</strong> Adrenal teratomas are difficult to diagnose clinically or on imaging as these mimic other lipomatous lesions. Although rare this should be considered as a differential diagnosis for adrenal tumors.</p> Kumar Anmol Reecha Singh Umakant Prasad M. Vivek Nayak ##submission.copyrightStatement## 2022-11-12 2022-11-12 225 229 10.9734/jammr/2022/v34i234857 Prevalence and Risk Factors Associated with Preterm Birth at Irene-Neto Lubango Provincial Maternity- Huila /Angola <p>According to WHO (2018), almost 15 million babies are born every year before 37 weeks of pregnancy, the majority taking place in Sub Saharan Africa and in south Asia. Preterm birth is a common complication of pregnancy and usually bore heavy short- and long-term medical, socio-economic and financial burden to the affected children, the family, the heath system and the community as all. Angola with one of the highest fertility rates in the world, 6.2 according to the DHS 2015-2016, coupled with the fact that preterm birth is regarded as a traumatic social even for the parent and a quite expensive condition to the health system will need to stablish the main risk factors for preterm birth in order to inform strategies to prevent its occurrence.</p> <p>We conducted an hospital based cross sectional study to determine the prevalence and the risk factors of preterm birth at Irene Neto Maternity Hospital- Lubango-Angola.</p> <p>Three trained research assistants were recruited from the post labour wards and the new born unit and trained to collect data. Gestational age was calculated using a standard obstetric wheel based on menstrual dates or first trimester ultrasound (when available).&nbsp; A Newborn clinical assessment using the Finnstrom Score aided by a printed pictorial scoring chart was then conducted within 24 hours of birth, by a trained medical Doctor for confirmation.</p> <p>17.7% of women giving birth at Lubango maternity hospital had a preterm new-born.</p> <p>Among the socio- demographics factors, only maternal age (p :0.021), family income(p:0.032), use of alcohol (p: 0.013) and lack ANC (p: &lt;0.001) were associated with premature birth. Clinical factors found to increase the risk of premature birth included Antecedent of hypertension (p: 0.021), Preeclampsia (p: 0.026), Malaria (p:0.001) and multiple gestation (p: 0.01).</p> <p>Only antecedent of premature birth (p:0.0049), lack of antenatal care (p&lt;0.001), malaria (p:0.009) and multiple gestation (p: 0.001) remained significant after controlling for confounders.</p> <p>Premature birth is still a public health problem in Angola, principally among pregnant women who do not attend ANC clinic and those with multiple gestation. Malaria infection during pregnancy as well as preeclampsia are also serious predictors of premature birth.</p> <p>With a prevalence of 17.7%, premature birth is a still a serious problem at lubangopediatric hospital and deserve a multisectoral well-coordinated action.</p> <p>ANC clinic should be actively promoted, improved and expended.</p> <p>Pregnant women with antecedent of premature birth should be closely monitored</p> <p>Preeclampsia and malaria should be prevented, searched and serious treated when present during pregnancy.</p> <p>We the recommend a Multicentre and large sample size, longitudinal observational analytic study for better understanding of the principal predictors at a country level.</p> Ketha Francisco Belo Ussanje Joana Chitungu Lorenzo luggatti ##submission.copyrightStatement## 2022-10-21 2022-10-21 1 12 10.9734/jammr/2022/v34i234834 Spectrum of Chest CT Findings in Covid-19 Patients: Relationship to the Patient’s Age Group and Duration of Infection in Al-Dhafra Hospitals, Abu Dhabi <p><strong>Purpose:</strong> This study aims to identify chest CT findings among asymptomatic and symptomatic COVID-19-positive patients in Al Dhafra Hospitals and review the common CT findings in relation to the different age groups of the patients and the duration of their symptoms.</p> <p><strong>Methods:</strong> Data from 301 consecutive patients whose COVID-19 infection was confirmed using an RT-PCR test, and who subsequently underwent a chest CT and presented to our hospital, were collected from April, 1 to May 31, 2020. They were further classified according to the time after the onset of the initial symptoms, namely stage-1 (0–4 days); stage-2 (5–8 days); stage-3 (9–14 days), and stage-4 (14+ days), and according to the age of the patient in four groups (Group A- &lt;18 years, Group B- 18–44 years, Group C- 45–59 years, and Group D- ≥60 years). We analyzed the prevalence, distribution, type of abnormal lung findings, and extent of the involvement of affected lobes through Ground-Glass Opacities (GGO), crazy-paving pattern, and consolidation in five categories of percentual severity by semi-quantitative CT score (maximum CT score, 25).</p> <p><strong>Results:</strong> Multiple small patchy, rounded, pure Ground-Glass Opacities (GGO) and mixed GGO with consolidations were the main HRCT signs in 231 patients with confirmed COVID-19 infections. Both of these were predominant patterns in the young, middle, and elderly groups (&lt;18 to &gt;60 years). However, crazy paving patterns were more common in groups ages 45 to &lt;60. The peripheral disease distribution was seen in 100% of cases, and both peripheral and central types of distribution of opacities were most common in the elderly group (&gt;60 years old), at 73.3%. Bilateral involvements were common in all groups, but unilateral involvement was fairly common in groups ages &lt;18 to 44 years old. Both the mean number of lesions and CT score were higher in 44 to &lt;69 years and &gt;69 years aged groups than in &lt;18 to 44 years old, and lower lobes showed relatively higher numbers of lesions and CT score than other lobes in all age groups.</p> <p>Normal CT findings among symptomatic patients were seen in the early stage (0–4 days) and progressive stage (5-8 days) of the disease, at 36.3% and 6.6%, respectively. Peripheral mixed GGO with consolidation and pure GGO were the most important imaging manifestations in the early and progressive stages of the disease. CT features of the lesions were variable in the peak (9-13 days) and late stages (14+ days), showing a mixture of GGO, crazy-paving pattern, consolidation, and linear opacities. Both the “Reverse Halo sign” and “Halo sign” were seen, predominately in the early stage of the disease (0 to 8 days) in 52 patients (22.5%) and 16 patients (6.9%), respectively. The number of lesions per capita, meaning the number of lesions in different lobes of both lungs and the CT score, were higher in the progressive and peak stages of the disease than in the early stage, and then gradually decreased in the late stage of the disease. We also observed a relatively greater number of lesions in both lower lobes compared to the upper lobes and a smaller number of lesions in the right middle lobe at all stages.</p> <p><strong>Conclusion:</strong> The most common HRCT findings in patients with COVID-19 pneumonia were peripheral, bilateral, rounded pure ground glass opacities, and mixed GGO with consolidation. The early stages of the disease may present with normal CT chest findings. Chest HRCT manifestations in patients with COVID-19 are related to the patient’s age and the duration of the symptoms, and HRCT signs are relatively milder in younger patients and in the early stage of the disease. CT could be a useful tool for evaluating the changes in pulmonary abnormalities in patients at different stages and in different age groups (especially elderly groups) for optimal management.</p> Nehar Ranjan Chakraborty Ahmed Saeed Al Hurmuzi Ashraf Alakkad Feras Youssef Al Zoabi ##submission.copyrightStatement## 2022-10-21 2022-10-21 20 34 10.9734/jammr/2022/v34i234836 Evaluation of the Effect of Low Level Laser Therapy in the Treatment of Stable Vitiligo <p><strong>Background:</strong> Vitiligo is a chronic cutaneous disease characterized by hypo- or depigmented patches that leave psychological impact on the patients. New treatment modalities have been developed to shorten the duration of treatment of vitiligo with fewer side effects.</p> <p><strong>Objective:</strong> To evaluate the effect of low-level laser therapy (LLLT) in the treatment of stable vitiligo.</p> <p><strong>Patients and Methods:</strong> The study included 20 stable vitiligo patients with overall symmetrical lesions. For each patient, one site was treated with LLLT &amp; NB-UVB twice weekly for 3 month.</p> <p><strong>Results:</strong> There was statistically significant improvement in the re-pigmentation, 25% of patients showed excellent improvement, 40% of patients showed good improvement, 20% of patients showed moderate improvement, 10% of patients showed poor improvement and 5% of patients showed no improvement after 3 months therapy. Side effects were minimal and transient in both sides.</p> <p><strong>Conclusion:</strong> LLLT in combination with NB-UVB therapy could be considered as safe and tolerable technique for treatment of vitiligo. Longer follow up is needed.</p> Hadeer M. Mostafa Esraa E. El Hawary Shereen F. Gheida Elham M. Kassem ##submission.copyrightStatement## 2022-10-22 2022-10-22 35 43 10.9734/jammr/2022/v34i234837 Proximal Fibular Osteotomy in Treatment of Medial Unicompartmental Knee Osteoarthritis in Elderly Patients <p><strong>Background:</strong> Osteoarthritis (OA) involves mainly the medial tibiofemoral joint of the knee as the stresses of weight bearing mainly involve the medial condyle of the tibia: thus, this is the primary site for knee OA. The work aimed to evaluating the results of proximal fibular osteotomy alone or conducted with arthroscopic lavage and debridement for treatment of medial unicompartmental knee osteoarthritis in elderly patients.</p> <p><strong>Methods</strong><strong>:</strong> This study was carried out on 37 cases with knee pain with medial compartment knee osteoarthritis with varying degrees of genu varum. Patients grouped randomly into two matched groups regarding age, sex, BMI and degree of osteoarthritis. Group 1 (n=18) had undergone proximal fibular osteotomy alone and group 2 (n=19) had undergone proximal fibular osteotomy conducted with arthroscopic debridement and lavage.</p> <p><strong>Results: </strong>The mean VAS and mean knee sub scores improved in group (A) and (B) postoperatively than preoperatively (p-value &lt;0.0001). Comparing the two groups according to mean (VAS) and mean knee sub scores, it was found that p-value was &lt;0.001 which was statistically significant. The mean ratio of knee joint space it was found that p-value was &lt;0.001 which was statistically significant.</p> <p><strong>Conclusions: </strong>PFO is a convenient surgical option in most developing countries like Egypt with low medical and financial resources. PFO may delay or even negate the need for total knee arthroplasty. PFO may be A viable alternative procedure for medial compartment knee osteoarthritis, especially for patients who cannot undergo TKA because of certain medical co morbidities. Care must be taken to avoid common peroneal nerve injuries. Knee arthroscopic lavage helps in decreasing knee pain and knee improving joint function by washing of crystals and debris that may induce inflammation and pain.</p> Mohab Osama Hemeda Elsayed Mohammed Alforse Abd Alhafiz Abd Alhafiz Mogahed Osama Ahmed Amin ##submission.copyrightStatement## 2022-10-25 2022-10-25 44 53 10.9734/jammr/2022/v34i234838 Clients` Satisfaction and Barriers towards Childhood Immunization Service in Primary Health Care Facilities in Tanta, Egypt <p><strong>Aims: </strong>To assess the clients` satisfaction towards childhood immunization service ‎among parents having children aged less than 2 year in primary health ‎care settings, and to highlight barriers affecting client satisfaction with immunization ‎services in primary health care facilities‎.</p> <p><strong>Study Design:</strong> Cross-sectional study.</p> <p><strong>Place and Duration of Study:</strong> Three primary health care facilities in Tanta Egypt; Said Health Care Center, Elragdia Health Care Unit, and Mahalet Rouh Health Care Unit<strong>,</strong> between March 2021 and April 2022.</p> <p><strong>Methodology:</strong> We included 400 clients coming to the primary health care facilities during the vaccination sessions of their children less than 2 years of age. Participants’ data were collected using a pre-designed interviewing validated questionnaire sheet through interview that assessed the sociodemographic data, knowledge, satisfaction, and barriers toward the childhood vaccination.</p> <p><strong>Results:</strong> In this study, the majority (87.8%) were recruited from Said Health Care Center. The clients<sup>,</sup> ages ranged from 19 to 70 years, with the highest percentage in the age group of 20 – &lt;40 (78.3%). The clients’ knowledge score ranged from 1 to 9, with a median of 7 denoting an overall good knowledge. The highest percentage of clients in Said Health Care Center dissatisfied (78.9%) while the highest portion of clients in Elragdia Health Care Unit and Mahalet Rouh Health Care Unit satisfied (75% and 60%, respectively). The relation to child, level of education, health care facility, followed by marital status, income, residence, child sex, total knowledge score, and child age were found to be statistically significant predictors for the satisfaction, with <em>P</em> values of 0.002, 0.004, &lt;0.001, 0.006, &lt;0.001, &lt;0.001, 0.01, &lt;0.001, and &lt;0.001, respectively.</p> <p><strong>Conclusion:</strong> An overall good knowledge as shown among caregivers attending for children vaccination. The least satisfaction rates were noted in the Urban Health Care Center. Clients’ knowledge beside some sociodemographic data significantly affected clients’ satisfaction.</p> Hanaa Gad Atia Eltalawy Khalil Mohamed Abbas Ayad Salwa Abdel-mageed Atlam Shimaa M. Saied ##submission.copyrightStatement## 2022-10-25 2022-10-25 54 64 10.9734/jammr/2022/v34i234839 Psychological and Radiological Study of Cognitive Impairment among Diabetic Patients (A Comparative Cross-Sectional Study) <p><strong>Objective of the study: </strong>To assess the cognitive impairment among diabetic patients and explore the potential alterations in various areas of the brain in a sample of diabetic patients in comparison to normal control subjects.</p> <p><strong>Study Design: </strong>Cross-sectional study.</p> <p><strong>Place and Duration of Study: </strong>Neuropsychiatry Department, Tanta University and Centre of Psychiatry, Neurology and Neurosurgery-Tanta University, at the Diabetes&amp; endocrinology unit in the department of internal Medicine, Tanta University Hospitals and at the radiology department, Tanta University Hospitals during the interval from September 2018 to September 2019.</p> <p>This study was conducted on two groups <strong>Group A </strong>(60) diabetic patients compared to <strong>Group B </strong>(20) normal healthy individuals free from any cognitive impairment matched age and sex using psychometric scales e.g. Structured Clinical Interview (SCID) (American psychiatric association, 1994), Stanford-Binet Intelligence quotient (I.Q) fourth edition, Mini mental state examination (MMSE) or Folstein test, The Montreal Cognitive Assessment (MOCA) test, Trail making test (Part A&amp; part B)&amp; Stroop color_word test (Computerized version).and diffusion tensor imaging. All subjects aged from (18-65) years old.</p> <p><strong>Results: </strong>patients with cognitive impairment represented 53.3% of the diabetic patients. Most of them presented with MCI (45%), while (8.3%) of them presented with dementia. The most affected executive functions in diabetic patients with impaired cognitive functions are delayed recall, attention, naming and language as assessed by MMSE&amp; MOCA scales. There was negative correlation between HBA1C levels and fractional anisotropy in most of areas of interest of statistically significant value.</p> <p><strong>Conclusion: </strong>The higher HBA1C levels (uncontrolled diabetes mellitus), the more cognitive deficits recorded through psychometric tests&amp; DTI.</p> Dalia Hannora Mohammad Seleem Rasha El Shafaey Mai Issa Gamal Shama ##submission.copyrightStatement## 2022-10-25 2022-10-25 65 77 10.9734/jammr/2022/v34i234840 Profile of Blood Donors and Deferral Reasons in a Tertiary Care Centre in South India <p><strong>Aim:</strong> To assess the demographic profile of blood donors and determine the frequency and causes for deferral.</p> <p><strong>Study Design:</strong> Retrospective cross-sectional study.</p> <p><strong>Place and Duration of Study:</strong> Department of Pathology, Blood Centre at Dr. SMCSI medical college, Karakonam, Trivandrum. January 2018 to September 2022.</p> <p><strong>Methodology: </strong>This study was done to analyze the various causes of deferral and the profile of donors. 8064 donors from the study period were analyzed and their demographic profile was recorded. The deferred donors were analyzed according to their age, sex, type of donor, type of deferral and reasons for deferral.</p> <p><strong>Results: </strong>8064 donors came to our center for donation of which 7682 (95.3%) were males and 382 (4.7%) were females. Majority of blood donors belonged to age group 18-25 years (50.6%). Replacement donors accounted for 6596 donors (81.8%). Voluntary donors were only 940 (11.7%). 1541 (19.1%) donors were deferred from donating. Out of these, 1186(77%) were replacement donors, 198(12.8%) were voluntary donors and 160(10.2%) were family donors. The most frequent causes of temporary deferrals: Hypertension 314(20.2%), Hypotension 82(5.3%), low hemoglobin 110(7.1%), On medication 104(6.7%), Tattoo/ ear piercing/smoking/pan chewing 154(10%), previous recent illness/surgery 190(12.3%) and alcoholism 46(3%). Permanent deferrals were done for only 68 donors (0.7%). They included 21 high risk donors and 47 donors who were serology positive.</p> <p><strong>Conclusion: </strong>Deferral pattern analysis can help the medical personnel in knowing the common causes of deferral and be more focused in screening. Determination of cause and rate donor deferral can help in preventing loss of precious blood and components.</p> Reeba Mary Rajan J. Anu Apuca Susan Mathew ##submission.copyrightStatement## 2022-10-25 2022-10-25 78 84 10.9734/jammr/2022/v34i234841 Postpartum Arterial Hypertension Management in Patients with Severe Preeclampsia. The Experience of a High Specialty Hospital of Mexico City <p><strong>Background:</strong> The management of postpartum hypertension is a priority in severe preeclampsia (SP) to reduce short and long term complications. This study aimed to analyze the results of the management of postpartum arterial hypertension in patients with SP of a high specialty hospital of Mexico City.</p> <p><strong>Methods:</strong> An observational, longitudinal, retrospective and analytical study was carried out in a series of 91 pregnant women with SP admitted to the Intensive Care Unit (ICU) from May 1 to September 30, 2019 with termination of pregnancy and postpartum stay in the same hospital. Systolic blood pressure (SBP), diastolic blood pressure (DBP) and antihypertensive management were compared on admission (prepartum, baseline measurement) and on days 1, 3 and 7 postpartum. Statistical analysis: descriptive statistics, Student t test and two-way ANOVA test with the statistical program SPSS version 20.</p> <p><strong>Results:</strong> Age 30.91±6.69 years, parity 2 and pregnancy of 32.48±4.21 weeks. SBP gradually decreased, at the end of the study the changes had statistical significance (baseline measurement 163.08±16.52, vs day 1 133.78±22.11 P=.150, vs day 3 131.56±21.07 P=0.051, vs day 7 125.02±17.79 P=0.007). DBP also decreased, but at the end of the study the changes were not significant (baseline measurement 100.29±13.06, vs day 1 82.02±13.88 P=.61, vs day 3 80.87±11.98 P=.11, day 7 78.02±10.78 P=.14. At the beginning, the combination of two to five oral drugs was necessary, but in the end the number of drugs was reduced. Blood pressure was controlled (&lt;140/90 mmHg) in 87.92% (n=80), and 12.08% (n=11) continued with uncontrolled hypertension (≥140/90 mmHg). Stay in the ICU was 2.33±2.12 days, hospital stay 7.23±3.69 days and mortality 0%.</p> <p><strong>Conclusion:</strong> SBP was significantly improved, but not DBP. Polypharmacy was necessary in most cases. A significant number of patients did not have adequate blood pressure control.</p> Juan Gustavo Vázquez-Rodríguez Claudia Isabel Sánchez-Pardo ##submission.copyrightStatement## 2022-10-28 2022-10-28 111 121 10.9734/jammr/2022/v34i234844 Gingival Inflammatory Profile of Intensive Care Unit Patients with COVID-19: A Pilot Study <p>There is minimal evidence to provide robust conclusions on how periodontal disease may be associated with COVID-19 infection. The objective of this research was to evaluate the gingival inflammatory profile of patients with COVID-19 in the ICU of the Western Paraná State University Hospital (HUOP) in Cascavel/PR, through a pilot clinical study. Data such as age, sex, exams and health history were performed by searching the information system - Tasy®. Patients were divided into two groups: Patients without COVID-19 (control group) and patients with COVID-19 (case group) and were evaluated: Plaque Index (IP), Probing Depth (PS), clinical attachment level (NI) and bleeding on probing (SS) and 3 sites were selected to collect the amount of Gingival Crevicular fluid (GCF). It was observed that in both groups the majority of patients were male, with no differences between them for sex and age. Patients in the COVID-19 group had statistically higher values ​​of IP and FCG and lower values ​​of PS and NI. In addition, patients with COVID-19 had an increase in Hemoglobin and a decrease in Lymphocytes and Platelets compared to the control group. As for Hospital Medication, only the variable Corticosteroids was administered with greater statistical frequency in patients with COVID-19 and each NI unit increases the chance of the patient dying by 10.59 times. It is concluded that there was an increase in the periodontal inflammatory profile of patients with COVID-19, however dexamethasone therapy may have led to an inhibition in the development of periodontitis in these patients.</p> Gustavo Henrique Gomes Silva Isabela Mangue Popiolek Péricles Almeida Delfino Duarte Alex Sandro Jorge Íris Sawazaki Calone Carlos Augusto Nassar Patricia Oehlmeyer Nassar ##submission.copyrightStatement## 2022-10-31 2022-10-31 129 139 10.9734/jammr/2022/v34i234846 Magnetic Resonance Imaging in Trigeminal Neuralgia <p><strong>Background: </strong>Trigeminal neuralgia (TN) is still a serious neurologic condition that causes significant facial pain that is unilateral and is distributed across the trigeminal nerve. Magnetic resonance imaging (MRI) is an excellent imaging technique for determining the aetiology of TN, despite the fact that there are no particular clinical tests for its diagnosis. 3D FIESTA MRI helps to improve diagnostic precision and identify neurovascular compression when used in conjunction with conventional MRI. MRI is used to rule out alternative causes of TN, such as cerebellopontine angle lesions, demyelinating diseases, and inflammatory conditions, in addition to neurovascular compression.</p> <p><strong>Aim of the Work: </strong>The objective of this study was to assess the utility of MRI in the diagnosis of TN and its various causes.</p> <p><strong>Patients and Methods: </strong>In this prospective study, 30 patients (14 men and 16 women), with an average age of 49.6 years, were referred to Tanta University Hospital's Radiodiagnosis and Medical Imaging Department from outpatient neurosurgery and/or dental clinics.</p> <p><strong>Results: </strong>The commonest affected side was the left side (46.7%) followed by the right one (40%), while bilateral affection was seen in (13.3%) of cases. According to aetiological factor, TN was secondary to underlying pathology in 24 cases (80%), while idiopathic TN with no underlying pathology was found in 6 cases (20%). Neurovascular compression and neoplastic lesions had the higher incidence. The most affected segment of the trigeminal nerve was the cisternal segment that was involved in 15 cases out of 24 cases with abnormal MRI findings.</p> <p><strong>Conclusion:</strong> Many CPA lesions may cause TN such as schwannomas and meningiomas. Demyelinating disease as multiple sclerosis were reported in our study to cause also TN. MRI showed that it has significant diagnostic role denoting brain lesions in patients with TN as it has a diagnostic accuracy 62.5%, sensitivity 60% and specificity 100% (P &lt; 0.001).</p> Eman Awad Bedir Elakhder Atef Hammad Teima Ehab Shawky Mohamed Heba Mohamed Atef Sawahel ##submission.copyrightStatement## 2022-10-31 2022-10-31 146 156 10.9734/jammr/2022/v34i234848 Gastric Insufflation and Ventilatory Mode during Induction of Anesthesia: A Prospective Randomized Study <p>Mechanical ventilation is a fundamental tool in daily anesthetic practice.</p> <p>Several ventilation modes are used for the ventilation of patients during the induction of general anesthesia; the controlled volume mode is most commonly used by anesthesiologists.</p> <p>Ventilation often causes gastric insufflation, which may be responsible for gastric fluid inhalation, with serious consequences.</p> <p>The aim of our study was to compare the incidence of gastric insufflation according to the ventilatory mode used during anesthesia induction.</p> <p><strong>Methods:</strong> This was a randomized prospective study carried out in the central operating complex of the Mohamed V Military Teaching Hospital in Rabat for a period of 06 months between January and June 2021.</p> <p>The patients included in our study were candidates for laparoscopic cholecystectomy.</p> <p>Gastric insufflation was assessed using epigastric auscultation. Finally, it is evaluated using the camera.</p> <p><strong>Results:</strong> During the study period, 120 patients were enrolled and divided into three groups of 40 patients according to the ventilation mode used: Group VM (Manual Mode), Group VV (Controlled Volume Mode) and Group VP (controlled pressure Mode).</p> <p>There were no statistically significant differences between the three groups in terms of hemodynamic and respiratory parameters.</p> <p>Gastric insufflation rate was lower in the VP group (14%).</p> <p>The pressure-controlled ventilation mode causes less gastric insufflation without additional hemodynamic or respiratory cost and gives the surgeon greater comfort without the need for a stomach probe.</p> Abdellatif Chlouchi Aziz Benakrout Mohamed Rabi Andaloussi Mustapha Bensghir Abdelouahed Baite ##submission.copyrightStatement## 2022-11-01 2022-11-01 157 163 10.9734/jammr/2022/v34i234849 Foreign Body Ingestion: Report of Two Cases <p>Foreign body ingestion are commonly seen in children and mentally handicapped adults. Most foreign bodies pass through G.I tract without any problem. Metallic objects except aluminium, most animal bones except fish bones and glass foreign bodies are opaque on radiographs, whereas plastic and wooden foreign bodies are not opaque. Foreign body can simulate the appearance of medical device. It is important that all ultrasound, CT, nuclear medicine and MR images be interpreted in light of radiographs of the same region.</p> <p>Oesophageal foreign bodies require prompt diagnosis and treatment. Patients who have symptoms of complete oesophageal occlusion and those who have ingested button batteries need urgent treatment. Main symptoms due to oesophageal foreign body are dysphagia, acute onset of pain, excessive salivation and choking. In case of suspected foreign body ingestion in children, symptoms are more notable during swallowing. Younger children may drool, vomit, refuse food or gag. Hematemesis and Cough are other symptoms.</p> <p>Children most commonly ingest metal coins throughout the world. Hand Held Metal Detector (HHMD) has been found to be radiation free, cost effective and an accurate method in diagnosing and localizing coins ingested by children.</p> <p>Besides history and physical examination, radiology is a very important diagnostic tool in diagnosing and localizing ingested foreign body. Plain radiographs of cervical and chest region done in posteroanterior and lateral views help to identify foreign body and its location. Barium swallow examination is done in case of negative radiographs.</p> <p>Two cases of foreign body ingestion has been reported in this article.</p> <p>Case 1 is an adult male and case 2 a six year old female child. Both of them developed sudden chest pain, dysphagia, excessive salivation and choking after eating fruits. Diagnosis of foreign body oesophagus was made on barium studies and fruit seed was removed on endoscopy in both of them.</p> <p><strong>Aims of this article are to:- </strong></p> <ol> <li>Outline the evaluation of a patient who has ingested a foreign body.</li> <li>Highlights various modalities for diagnosis of ingested foreign body.</li> </ol> Abhimanyu Airon Neha Airon Dhruv Airon Swasti Jain Roopal Malik ##submission.copyrightStatement## 2022-11-01 2022-11-01 164 170 10.9734/jammr/2022/v34i234850 Clinical Comparison of Two Surgical Techniques in the Treatment of Cairo RT2 Gingival Recessions Associated to Subepithelial Connective Tissue Graft: Randomized Clinical Trial <p><strong>Purpose:</strong> The treatment of advanced gingival recessions represents a clinical challenge due to lack of appropriate interdental support. The objective of this study was to compare the outcomes of root coverage in surgical techniques employed for Tunnel root coverage and Coronally Positioned Flap (CPF), both associated to Subepithelial Connective Tissue Graft (SCTG), in patients with Cairo RT2 gingival recession. &nbsp;</p> <p><strong>Methods:</strong> Forty-one Cairo RT2 recessions were selected in 18 patients divided in groups to undergo root coverage surgery. The patients were evaluated at 0, 90, and 180 post-operative days for verification of the recession height and width, probing depth, bleeding on probing, clinical attachment level, gingival thickness, and zone of keratinized tissue (P&lt;0.05%).</p> <p><strong>Results:</strong> There was 1.84 ± 1.03 mm gain in gingival height in the Tunnel + SCTG group, and 2.33 ± 0.90 mm in CPF + SCTG group, without statistically significant differences between groups, and the coverage average was 62%. Full coverage was obtained in 17% of recessions.</p> <p><strong>Conclusion:</strong> The two techniques presented significant improvement in the periodontal parameters evaluated. Only the keratinized gingiva presented better outcomes in the CPF group.&nbsp;</p> Simone Karine Rothen Edson Oliveira Silva Luiza Roberta Bin Patrícia Oehlmeyer Nassar Carlos Augusto Nassar ##submission.copyrightStatement## 2022-11-02 2022-11-02 171 181 10.9734/jammr/2022/v34i234851 Trends of Demographic and Clinical Features of Alopecia Areata in Benghazi-Libya <p>Alopecica areata (AA) is thought to be a T-cell mediated autoimmune disease directed against an unknown hair follicle autoantigen. The aim of this study was to determine demographic and clinical features of alopecia areata in Benghazi-Libya.</p> <p><strong>Patients and Methods: </strong>In a cross-sectional observational study of one hundred seventy-one patients with clinically diagnosed alopecia areata who attended the hair clinic and dermatology outpatient department at Jomhoria hospital, Benghazi-Libya over a period of 2 years, all patients were subjected to a detailed disease history and a complete dermatological examination by dermatologists. To confirm the clinical diagnosis, determine the sites and clinical type, and ascertain the severity of the disease. Statistical analysis was performed using SPSS (version 18.0), and descriptive statistics were calculated using a chi-square test.</p> <p><strong>Results: </strong>In a study of 171 patients of AA, 63.2% were females, with a male to female ratio of 1:1.7. The patients' mean age was 25.5 years, and the mean age at onset was 22.6 years. The majority of patients were aged ≤30 years (66.4%) and showed limited AA.</p> <p>A positive family history of AA was elicited in 20.5%. The duration of the disease &lt; 1 year was recorded in 52.6% of patients.</p> <p>The commonest clinical type was patchy AA with a single patch (52%). Limited (mild) AA (less than 50% involvement) was seen more in males (39.4%) and the severe type was seen more in females (73%). Precipitating factors were reported in 50.3% of patients, and stress constituted 49.1% A personal history of atopy was recorded in 24.6% and vitiligo was seen in 4.1% of patients. Out of total patients, 42.1% had nail changes, 38% of 137 mild AA had nail changes, and 58.8% of severe AA had nail involvement, indicating a significant correlation between nail changes and severity (P=0.027).</p> <p><strong>Conclusion:</strong> Alopecia areata is considered an important health problem in our community.&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; &nbsp;Stress is a common precipitating factor, and family history and nail changes are significantly reported.</p> Majda Salem Ghait Alsdae Tarik Enaairi Gamal Duweb ##submission.copyrightStatement## 2022-11-02 2022-11-02 182 189 10.9734/jammr/2022/v34i234852 Added Value of Multi-slice CT Scan (320 Slice) in Evaluation of Cardiac Complications Post COVID-19 Infection <p><strong>Background: </strong>The COVID-19 pandemic had affected population health throughout the world. Few studies had focused on post-COVID19 complications detection using multi-slice CT scans. Our trial aimed to assess the value of cardiac CT utility during the COVID-19 pandemic for the detection of cardiac complications and correlation with the severity scoring system for chest manifestations. Since the beginning of COVID-19 outbreak, cardiac computed tomography (CT) had a sudden increased value and use with a huge reduction in face-to-face patient care and elective diagnostic testing. This study started from May 2021 to April 2022 in a single cardiac CT centre. This prospective cohort trial was conducted on 40 patients proved to have COVID-19 infection by positive RT-PCR test for COVID-19 and/or CT chest manifestations. CT results were reviewed and compared to echocardiography and/or catheterization data.</p> <p><strong>Results: </strong>In the CT severity score, the more severe score for COVID-19 infection was noted in cases with coronary artery occlusion and pulmonary embolic diseases. Meanwhile, the mild and moderate severity score groups developed myocarditis, pericarditis, and dilated cardiomyopathy, respectively, with statically significant differences with p-value= 0.007 for coronary artery disease (CAD) and 0.026 for pulmonary embolism. The significance of echocardiography examination was noted in cases with pericarditis and dilated cardiomyopathy, with p-value= 0.018 for pericarditis and 0.01 for dilated cardiomyopathy.</p> <p><strong>Conclusions: </strong>MSCT is a very useful technique to for patients presenting with suspected post-COVID cardiac complications, in addition to severity scoring of chest involvement, also providing its correlation with the occurrence of cardiac complications.</p> Somia Tarak Ragaie Sameh Ahmed Khodair Hatem Mohamed El-Sokkary Amr Ahmed Mubarak Alaa Mohamed Reda ##submission.copyrightStatement## 2022-11-02 2022-11-02 190 201 10.9734/jammr/2022/v34i234853 Routine Use of Pressure Wire as an Adjunct to Diagnostic Angiography; Comparison of Resources Utilization in the Catheterization Laboratory: A Sub-Study of RIPCORD 2 <p><strong>Background: </strong>The RIPCORD 2 trial randomized patients undergoing coronary angiography to strategy of routine measurement of fractional flow reserve (FFR) in all vessels or to angiography alone.</p> <p><strong>Objectives: </strong>We compared, for the randomized groups, the catheter laboratory procedure costs to diagnosis.</p> <p><strong>Methods: </strong>This is a sub-study of the RIPCORD2 trial. We excluded patients with follow-on PCI to better reflect procedural costs of the diagnostic phase.&nbsp; We compared resource utilization and, from this, derived an estimated procedure cost for UK practice.&nbsp; We examined the association between cost and the number of vessels examined with pressure wire (PW) technology.</p> <p><strong>Results: </strong>We included 249/552 (45%) patients randomized to angiography and 261/548 (48%) patients to systematic FFR measurement.&nbsp; The median (IQR) procedure cost was higher in the FFR group £1392 (1126 – 1686) versus £411 (308 – 586); P &lt; 0.001. In the FFR group, 86.6% of procedures were completed with a single pressure wire; two and three PWs were used in 10.7% and 1.5% of cases respectively. The procedure duration (median, IQR; mins) was longer in the FFR group; 52 (39 – 66) versus 20 (15 – 30) as was the use of radiographic contrast (median, IQR; mls); 140 (110 – 189) versus 70 (60 – 94). In the FFR group, it seems that the additional cost was associated with the cost of the PW and laboratory set up for the performance of FFR measurement; the incremental cost of examining additional vessels, beyond the first, was modest.</p> <p><strong>Conclusion: </strong>The procedural cost associated with a strategy of systematic measurement of FFR in all vessels is higher than that of angiography alone.</p> Yousra Aboul-Enien Nick Curzen Magdy Elmasry Hanan Kassem Ehab Hamdy Mahmoud El-Amrousy Liam Mullen Mostafa Elguindy Ian Kemp Zoe Nicholas Rod Stables ##submission.copyrightStatement## 2022-11-08 2022-11-08 202 209 10.9734/jammr/2022/v34i234855 Anxiety and Depression among Breast Cancer Patients: A Prospective Study in a Tertiary Care Hospital <p><strong>Background:</strong> Breast cancer is the most common cancer in women. Course of disease and its treatment impacts self-image, and the sexual relationship of patient. Most patients experience Psychological reactions. Patients develop psychiatric morbidities, mainly anxiety and depressive disorders. Anxiety and depressive disorders although being common in breast cancer are ignored and left untreated. These psychiatric disorders worsen course of the disease and outcomes of treatment. Having a better understanding of common psychiatric disorders can help in planning treatment and may lead to better treatment success.</p> <p><strong>Methods:</strong> A prospective study was carried out in the Department of General Surgery at Sri Guru Ram Das Institute of Medical Sciences And Research, Sri Amritsar. We enrolled 50 patients of carcinoma breast. Depression and Anxiety were assessed using validated scales as advised by psychiatrist- Hamilton depression rating Scale (HDRS) and Hamilton Anxiety Rating Scale (HAM-A), respectively. The data was collected and assessed using appropriate statistical tool.</p> <p><strong>Results:</strong> In our research the average age of women was 49.25 years. Of the 50 patients, 72% had depression. 24% of patients with depression had moderately severe to severe depression.90% of patients had anxiety disorder and 24% had moderately severe to severe anxiety disorder.</p> <p><strong>Conclusion:</strong> Depression and anxiety disorders are quiet common among the patients of breast cancer. A public health initiative compromising of social, financial and environmental support that can help in providing better quality of life for breast cancer survivors is required.</p> H. Singh D. Bansal M. Singh B. Mahajan A. Rattan ##submission.copyrightStatement## 2022-11-15 2022-11-15 230 236 10.9734/jammr/2022/v34i234858 Molecular Classification of Breast Carcinoma Based on the Prognostic Marker: A Clinico-pathological Correlation <p><strong>Background:</strong> Breast cancer (BC) has now surpassed lung cancer as the leading cause of global cancer incidence in 2020, with an estimated 2.3 million new cases, representing 11.7% of all cancer cases. It is a highly heterogeneous disease with a variety of morphologic and clinical manifestations which results in a range of responses to treatment. Recently, targeted therapies based on the genetic, hormonal, or immunohistochemical (IHC) subtypes of breast cancer have been used.</p> <p><strong>Objective:</strong> The study was a prospective hospital-based observational study with a sample size of 150 cases. The study aimed to determine the distribution of various molecular subtypes of breast carcinoma and also correlate the expression status of ER, PR, Her2neu, and Ki 67 with the patient's age, tumor size, tumor type, histological grade, lymph node status, and TNM staging.</p> <p><strong>Results:</strong> 96.7% of cases were invasive ductal carcinoma (NOS). Most of the grade 1 tumors (68.8%) were both ER and PR positive. Grade 2 tumors had almost equal distribution with 39.4% of patients being ER &amp; PR positive and 43.7% being both ER &amp; PR negative. Almost all grade 3 tumors (88.9%) were both ER and PR -negative.</p> <p><strong>Conclusion:</strong> IHC markers are cost-effective and easily available worldwide even in resource-poor countries like India. A greater understanding of the molecular classification of breast carcinoma based on triple markers will help in the development of targeted therapies that will lead to increased efficacy, decreased toxicity, increased disease-free survival, and better selection of patients who will benefit from treatment.</p> Umesh Kumar Anju Singh Kalpana Chandra Kshiti Atreya Reecha Singh Manish Kumar ##submission.copyrightStatement## 2022-11-19 2022-11-19 237 247 10.9734/jammr/2022/v34i234859 Evaluation of Predictive Factors Associated with Resolution of Acute Central Serous Chorioretinopathy <p><strong>Background:</strong> Central serous Chorioretinopathy (CSC) is characterized by serous subretinal fluid (SRF)leakage and accumulation with subsequent serous retinal detachment We conducted this study to study the predictive factors associated with resolution of the non-treated, first episode of acute CSC including systemic factors and ocular factors using different imaging modalities.</p> <p><strong>Methods:</strong> This prospective, observational study of 30 affected eyes and 30 fellow eyes of 30 consecutive patients with non-treated, first episode of acute CSC and age and sex matched control group of 30 eyes were also studied. Detailed history taking including: name, age, residence, previous and present ocular or systemic diseases, previous ocular trauma, previous ocular surgery, assessment of systemic factors including, smoking, hypertension, Helicobacter pylori infection, pregnancy, sleeping disturbance, autoimmune diseases and psychological factors, history of intake of ocular or systemic medications especially corticosteroid and psychopharmacological medications, best corrected visual acuity (BCVA).</p> <p><strong>Results:</strong> The baseline BCVA of the "Improvement" group was lower than that of "No Improvement" group and the difference was statistically significant (p. value 0.014*). On the other hand, the final BCVA of the "Improvement" group was higher than that of "No Improvement" group and the difference was also statistically significant (p. value 0.005*). There was a statistically significant decrease of the mean automated central retinal thickness (ACRT) (P-value 0.004*), mean vertical SRF dimension (VD) (P-value 0.012*), mean horizontal SRF dimension (HD) (P-value 0.022*) and mean SRF height (P-value 0.002*).</p> <p>There was a statistically significant negative correlation between age (years) and the mean baseline SFCT (um) in both affected and fellow eyes (P-value 0.013* and 0.014* respectively). In other words, the older the patient was, the thinner the baseline SFCT in both eyes (affected and fellow) will be measured.</p> <p><strong>Conclusions: </strong>Proper assessment of systemic factors associated with CSC and ocular factors using multimodal ocular imaging help us in predicting the course and visual prognosis of CSC cases. We depended on evaluating the difference of all variables between the "improvement group, n=22 cases" (decreased SRF height after 3 months) and "no improvement group, n=8 cases" (persistent/increased SRF height after 3 months).</p> Ahmed Yousef Amin Mohamed Hosny El-Bradey Yasser Ragab Serag Magdy Salah Moussa ##submission.copyrightStatement## 2022-11-22 2022-11-22 248 266 10.9734/jammr/2022/v34i234860 A Study of Cancer Antigen-125 as a Diagnostic Marker in Tuberculous and Malignant Pleural Effusion <p><strong>Background:</strong> Cancer Antigen-125 (CA-125) was first identified as an ovary-specific tumor indicator but&nbsp;subsequently shown that inflammation exists even in the absence of polymorphism leads to this marker to rise. Multiple locations of tuberculosis (TB) produce an increase in serum antigen levels. This research objects to estimate the diagnostic value of CA-125 and to establish the cut-off value, distinguishing tuberculous from malignant pleural effusion.</p> <p><strong>Methods:</strong> This prospective analytic case control study involved 90 subjects above 18 years old and with a confirmed diagnosis of tuberculous pleural effusion (TPE), malignant pleural effusion (MPE) and parapneumonic effusion (PPE). Subjects were equally allocated into 3 groups: group I "Tuberculous": subjects with a confirmed diagnosis of TPE, group II "Malignant": subjects with a confirmed diagnosis of MPE and group III "Control": subjects with a confirmed diagnosis of PPE.</p> <p><strong>Results: </strong>There was positive significant correlation among CA-125 in serum and pleural fluid in tuberculous effusion group (group I) and in malignant effusion group (group II).</p> <p><strong>Conclusions: </strong>For reliable detection of pleural effusion cause, serum and pleural fluid CA-125 might be included to the pleural fluid diagnostic workup.</p> Abeer Gamal Gab Allah Ahmed Shawky Mohamed Sahar Mohey El-Din Hazzaa Wafaa Saleh El-Shimy ##submission.copyrightStatement## 2022-11-22 2022-11-22 267 273 10.9734/jammr/2022/v34i234861 The Maximum Standardized FDG Uptake on PET/CT in Evaluation of Patients with Non-small Cell Lung Cancer: A Prospective Study <p><strong>Background: </strong>Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography (FDG-PET/CT) functional imaging has shown to be an invaluable non-invasive, diagnostic method, enhancing the accuracy in the presenting of Non-Small Cell Lung Cancer (NSCLC). The purpose of this research was to evaluate the role of the maximum standardized uptake value (SUV max) in PET-CT in staging and follow-up of operable and non-operable patients with NSCLC.</p> <p><strong>Methods: </strong>This prospective research carried on 50 cases with histopathological diagnosis of NSCLC were mentioned to do PET/CT scanning for initial staging of the disease (17 patients died, 28 survived, and five were lost to follow-up so 28 patients out of 50 came for follow-up after treatment with surgery, radiotherapy, or chemotherapy). All cases underwent intravenous contrast media, 18F-FDG Dosage Administration, CT Technique, PET Technique, PET-CT Fusion, and PET/CT Interpretation.</p> <p><strong>Results:</strong> SUV max is a semi-quantitative technique of determining 18F-FDG uptake by tumor cells. Adenocarcinomas have lower 18F-FDG uptake and lower SUV max measurements compared to the squamous cell carcinoma. The average SUVs of tumours ≥ 4 were significant increased compared to those &lt; 4, and additional analysis showed that SUV max was significantly correlated with tumor size. SUV max is a prognostic factor of T and N stages as T1 lesions had a decrease average SUV max compared to T2 and a lower mean SUV max than T3/T4 lesions, also we found that the mean SUV max of N0 is lower compared to that of NI, NII, and lower than NIII. There was a strong association among ΔSUV and Δ size.</p> <p><strong>Conclusion:</strong> FDG-PET/CT was a valuable, efficient, and reliable method of analysis in the initial staging and follow-up of lung cancer cases, and lately became a portion of the international standards in the diagnosis and the follow-up of cases with bronchogenic carcinoma.</p> Rania Abdalrahman Albahnasy Manal Fathey Hamisa Fatma Gharib Khirallah Hwaida M. Mokhtar ##submission.copyrightStatement## 2022-11-22 2022-11-22 274 286 10.9734/jammr/2022/v34i234862 Molecular Detection of Bacillus anthracis from Soil in Niger Delta University and Environs, Bayelsa, Nigeria <p><em>Bacillus anthracis</em> is an aerobic or facultative anaerobic, Gram-positive Bacilli which is naturally found in soil. <em>Bacillus anthracis</em> is known as the most dangerous bacterium which is used as a biological weapon causing cosmopolitan disease condition called anthrax infection. The study aimed at detecting <em>Bacillus anthracis</em> from Niger Delta University (NDU) Amassoma and her environs soil sample. Twenty soil specimens were collected randomly and processed, characterized by Microbiological and Polymerase Chain reaction technique. Disk diffusion method was used for Antimicrobial susceptibility testing. Findings from this study revealed that out of the 20 samples collected, 8(40%) were <em>Staphylococcus</em> species, 5(25%) were <em>Mucor </em>species while 7(35%) were <em>Bacillus</em> species, of the 7 positive for <em>Bacillus</em> 4(20%) had Mannitol fermentation while 3(15%) showed no fermentation, 3(15%) of the 7 also showed gamma hemolysis while 4(20%) showed complete (beta) hemolysis and 4(57.1%) showed turbidity while 3(15%) did not show turbidity. Antibiotic Susceptibility testing showed that Septrin, Ampicillin, Ceporex, Nalidixic acid and Gentamicin had total resistance to <em>Bacillus anthracis</em>, <em>Bacillus cereus</em> and other species. From the sequencing, other species of <em>Bacillus </em>were observed apart from <em>Bacillus anthracis</em>. This showed an advantage of genotypic identification over the phenotypic features. Hence proper identification of <em>Bacillus anthracis</em> from NDU and her environs soil sample must be put in place to create awareness for the students, staff, farmers, children and others who constantly have contact with the soil. Anthrax infection can also be controlled by improved personal hygiene.</p> Tolulope Olukemi Alade Lawani-Luwaji Ebidor Ekemejiro Godbless ##submission.copyrightStatement## 2022-11-23 2022-11-23 287 292 10.9734/jammr/2022/v34i234863 Molecular Detection of blaTEM, blaCTX-M and blaSHV Genes in Extended Spectrum β-Lactamase (ESBL) Escherichia coli from Clinical Samples <p><strong>Introduction:</strong> Extended spectrum β-lactamases are the group of β-lactamase enzymes which confer resistance to the oxyimino-cephalosporins and monobactams.</p> <p><strong>Study Design:</strong> Cross-sectional prospective study.</p> <p><strong>Place and Duration of Study: </strong>This study was conducted over a period of 2 years (September 2018 to April 2020) at microbiology laboratory of Nepal Mediciti Hospital.</p> <p><strong>Methodology: </strong>Clinical samples were processed in microbiology laboratory and culture isolates were characterized by standard microbiological techniques following standard procedures<strong>. </strong>Antibiotic susceptibility testing was performed by modified Kirby-Bauer disc diffusion method as recommended by Clinical and Laboratory Standard Institute. Extended spectrum βlactamases were phenotypically confirmed by combined disc method. ESBL producing genes i.e. blaTEM, blaCTX-M and blaSHV were confirmed by PCR.</p> <p><strong>Results:</strong> Of the 1449 total <em>Escherichia coli</em> isolates, 323/1449(22.29%) isolates were multidrug resistance. Among total MDR <em>E. coli</em> isolates, 215/323(66.56%) isolates were ESBL producers. The maximum number of ESBL <em>E. coli </em>was isolated from urine 194(90.23%), followed by sputum 12(5.58%), swab 5 (2.32%), pus 2 (0.93%) and blood 2 (0.93%). Antibiotic susceptibility pattern of ESBL <em>E. coli</em> producers showed highest sensitivity towards tigecycline (100%) followed by polymyxin B, colistin and meropenem. Out of 215 phenotypically confirmed ESBL <em>E. coli</em>, only 186(86.51%) isolates were found to positive by PCR. The last 29(13.49%) were negative for any of the resistant genes. Among the ESBL genotypes, most common was blaTEM 118(63.4%) followed by blaCTX-M 68(36.6%).</p> <p><strong>Conclusion:</strong> The emergence of ESBL producing <em>E. coli</em> isolates with high antibiotic resistant rates to commonly used antibiotics and increased predominance of major gene types <em>bla</em>TEM is a serious concern to the clinicians as well as microbiologist. This study forwarded a real massage to all the clinicians for the emergence of XDR and PDR resistant bacteria and preservation of antibiotics for their proper use in near future, if past experience with MDR and ESBLs is any indicator.</p> <p><strong>Aims: </strong>This study was focused to find out the ESBL producing <em>Escherichia coli </em>and detection of TEM, SHV and CTXM genes by Polymerase Chain Reaction (PCR).</p> Mahesh Kumar Chaudhary Indrani Jadhav Megha Raj Banjara ##submission.copyrightStatement## 2022-11-24 2022-11-24 293 301 10.9734/jammr/2022/v34i234864 Examining the Impact of Perinatal Deaths on the Mothers in the Tamale Metropolis, Northern Ghana <p>Perinatal loss has serious implications on the lives of the affected women and sometimes on the family. However, not much is known in the empirical literature, especially in the Tamale Metropolitan area. This paper sets out to examine the impact of neonatal deaths on women. The study was conducted in three major hospitals in Tamale and involved 384 women and 10 medical officers. The study employed mainly interviews, questionnaires and a review of secondary data including hospital records. The study found that, apart from the emotional trauma, affected women sometimes suffer stigma and are subjected to traditional rituals in order to ‘cleans’ them. The women also entertained the fear of getting a miscarriage or suffering from perinatal death in the future, the study recommends counseling and sensitization for pregnant women to avoid future perinatal deaths.</p> Abdulai Abubakari Bridget Daborikuu ##submission.copyrightStatement## 2022-11-25 2022-11-25 306 317 10.9734/jammr/2022/v34i234866 Managing Retinoblastoma at a Tertiary Eye Hospital in Kaduna, Nigeria - A Five Year Retrospective Cohort Review <p><strong>Purpose:</strong> To review the outcome of retinoblastoma management at a tertiary eye hospital in Nigeria over a five - year period since chemotherapy became available at our institution.</p> <p><strong>Methods: </strong>A retrospective review of hospital records of patients managed for retinoblastoma between January 2014 and December 2018 was done. Information on age, gender, clinical findings, treatment, duration of follow up and survival as at June 2021. The International Retinoblastoma Classification and Staging Systems were used.</p> <p><strong>Results:</strong> 120 eyes of 94 patients with RB were reviewed. Mean age at presentation was 24.1 ± 11.4 months (range 25 days - 9 years). There were 55 (58.5%) males, 68 (72.3%) had unilateral disease while 17 (18.1%) presented within the first year of life. Leucocoria and proptosis were the most common presenting signs in 53.2% and 40.4% respectively. International Retinoblastoma Stages III and IV disease were seen in 40.4% and 5.3% of patients respectively. Thirty-four patients (36.2%) received a combination of systemic chemotherapy and enucleation while 27 (28.7%) did not receive any treatment. Overall patient survival was 20% while 41% were lost to follow up as at June 2021.</p> <p><strong>Conclusion:</strong> the major challenges encountered in RB management are advanced disease at presentation, difficulties in out-of-pocket financing of treatment, poor follow up and survival. There is an urgent need for a national public screening and treatment programme for this life-threatening condition.</p> Aminatu Abdulrahman Amina Hassan Musa Danjuma Mahmoud Alhassan ##submission.copyrightStatement## 2022-11-25 2022-11-25 318 324 10.9734/jammr/2022/v34i234867 Antioxidants and Biomarkers of Inflammation as Risk Factors of Vascular Cognitive Impairment in Adult Hypertensives <p><strong>Background: </strong>Impairment in cognition and attention involving memory loss characterize Vascular Cognitive Impairment (VCI), a complication of hypertension. The involvement of antioxidants and inflammatory biomarkers in the progression of hypertension to VCI is controversial and is investigated in this study.</p> <p><strong>Methods: </strong>A total of 216 normoglycaemic individuals (aged 40-75 years) were enrolled into this case control study by systematic sampling method. They consisted of 81 Newly Diagnosed Hypertensives (NDH) without cognitive impairment, 69 Newly Diagnosed Hypertensives with Cognitive Impairment (NDHCI) attending Medical Outpatient Clinic and 66 apparently healthy individuals without hypertension or cognitive impairment (Controls), who were members of staff of University College Hospital, Ibadan.&nbsp; Socio-demographic indices and lifestyle were obtained through a semi-structured questionnaire while Systolic and Diastolic tg6bn Blood Pressure (SBP and DBP, respectively) were obtained using standard methods. Neuropsychological assessment based on Cognitive Score (CS) was performed using Community Screening Instrument for Dementia. Antioxidants [Glutathione (GSH), Catalase (CAT) and Superoxide Dismutase (SOD)] and inflammatory biomarkers [Interleukin-6 (IL-6), High sensitivity C - reactive protein (hs-CRP)] in serum were estimated by ELISA. Data were analysed using Statistical Package for Social Sciences (SPSS) software 17.0 version. Analysis of variance (ANOVA) and Post Hoc test were used for comparison of variables while Chi square test was used to find associations between variables. Data analysed were significant at p&lt;0.05.&nbsp;&nbsp;</p> <p><strong>Results: </strong>The inflammatory biomarkers hs-CRP (0.14±0.01; 0.12±0.01 versus 0.11±0.01 mg/L; p&lt;0.001) and IL-6 (301.62±17.61; 115.60±16.01 versus 51.41±1.60 ng/mL; p&lt;0.001) were significantly higher in NDHCI and NDH relative to control, respectively. Significant decreases in mean activities of catalase (81.71±1.01; 285.10±5.51 versus 403.00±17.31 ng/mL; p&lt;0.001), SOD (5.04±0.97; 9.67±0.70 versus 12.02±0.53 ng/mL; p&lt;0.007), GSH (7.02±0.89, 8.91±0.90; 20.5±1.31μg/mL; p&lt;0.001) and cognitive scores (3.51±0.41; 18.81±0.50 against 28.71±0.20; p&lt;0.001) were found in NDHCI compared with NDH and control, respectively.</p> <p><strong>Conclusion: </strong>Increased oxidative stress and inflammatory processes may underlie the progression of hypertension to cognitive impairment.</p> Oluyinka Bamidele Aborisade Mabel Ayebatonyo Charles-Davies Mayowa Ojo Owolabi Emmanuel Oluyemi Agbedana ##submission.copyrightStatement## 2022-11-25 2022-11-25 325 333 10.9734/jammr/2022/v34i234868 Obesity and Dyslipidemia as Risk Factors of Vascular Cognitive Impairment in Adult Hypertensive Nigerian <p>Hypertension impairs the cerebral vasculature resulting in vascular cognitive impairment [VCI]. The role of obesity and plasma lipids shown as risk factors in development of VCI in adults with hypertension is unclear and is investigated in this study.</p> <p>Normoglycemic individuals [n=216] aged 40-75 years were enrolled into this study between January and December 2019. They included Newly Diagnosed Hypertensives with [NDHCI, n-69] and without Cognitive Impairment [NDH, n-81], age-matched with 66 apparently healthy individuals [Controls]. Anthropometric measures [height, weight, waist circumference [WC], Hip circumference [HC], waist hip rratio [WHR] and body mass index [BMI] and socio-demographic indices, lifestyle and blood pressure were obtained using standard methods. Plasma lipids [Total cholesterol [TC], high density lipoprotein cholesterol [HDL-C], Triglyceride [TG] were determined spectrophotometrically, while low density lipoprotein cholesterol [LDL-C] was calculated using Friedewald formula. Neuropsychological assessment based on cognitive score [CS] was done using community screening instrument for dementia [CSID]. Data were analyzed using statistical package for social sciences [SPSS] software 17.0 version. Analysis of variance [ANOVA] and Post Hoc test were used for comparison of variables while Chi square test was used to find associations between variables. These were considered significant at p&lt;0.05.</p> <p>The obesity indicators [WHR, WC and BMI] and dyslipidemia indicators [TC, LDL-C and triglyceride] levels were significantly higher in NDHCI [WHR=76.97±0.89, WC=37.67±0.61, BMI=28.09±0.49; TC=206.89±3.91, LDL-C=135.76±3.81, triglyceride=135.38±1.63] and NDH [WHR=70.71 ± 0.10] WC=34.74 ± 0.04,BMI= 28.30 ± 0.49 and TC=192.83 ± 4.28,LDLC= 120.35 ± 3.22,Triglyceride=127.00 ± 2.69] relative to control [WHR=51.99 ± 0.83, WC=32.94 ± 0.22, BMI=23.89 ± 0.30 and TC=104.70 ± 7.19,LDLC= 94.80 ± 1.90,Triglyceride=72.77 ± 3.70], p&lt;0.01. Significantly low cognitive scores were found in NDHCI[3.48±0.38] compared with NDH [18.77±0.50] and control [28.76±0.16], p&lt;0.001. WHR and LDL-C had inverse relationships with cognitive score in NDH [β= -14.627, p= 0.306] and NDHCI [β= -0.031, p=0.005] respectively. Moreover, WC [β=12.315, p=0.049], HC [β=12.241, p=0.036] and WHR [β=496.374, p=0.043] in NDH group, had a significantly positive relationship with DBP.</p> <p>Obesity and atherogenic dyslipidaemia may be associated with the progression of hypertension to cognitive impairment in Nigerian hypertensive adults.</p> Oluyinka Bamidele Aborisade Mabel Ayebatonyo Charles–Davies Mayowa Ojo Owolabi Emmanuel Oluyemi Agbedana ##submission.copyrightStatement## 2022-11-25 2022-11-25 334 342 10.9734/jammr/2022/v34i234869 A Study on the Bangladeshi Mothers' Experiences with Intrauterine Fetal Death (IUFD) <p><strong>Background:</strong> IUFD (intrauterine fetal death/demise) is a devastating experience for moms. IUFD mothers run the danger of going through life feeling depressed, anxious, unhappy, and sorrowful. Therefore, it is essential to do research on how moms cope with such a terrible event.</p> <p><strong>Purpose:</strong> This study aimed to learn more about how mothers in Bangladesh dealt with intrauterine fetal death/demise (IUFD).</p> <p><strong>Methods:</strong> Using a phenomenological perspective, a purposive sample strategy was used to choose the seven informants for descriptive qualitative research. In-depth interviews were used to gather the data, which was then evaluated utilizing Colaizzi's approach.</p> <p><strong>Results:</strong> The findings revealed four key themes, including the mothers' reactions to a loss-such as painful and traumatic experiences—moral support received by the mother, unfavourable behaviour on the part of others, such as stigma and lack of support, and physical and psychological changes that interfere with the mothers' roles as wife and mother.</p> <p><strong>Conclusion:</strong> IUFD's past was very distressing for mothers, who were left with a heavy emotional weight. Support and therapeutic communication must thus be included in practice.</p> Deep Chowdhury Sazin Islam Ripon Biswas Agro Bhowmik Jyoti Sonia Afroz Mukta Md. Shariful Islam ##submission.copyrightStatement## 2022-11-26 2022-11-26 343 349 10.9734/jammr/2022/v34i234870 Serum Matrix Metalloproteinase 2 (MMP-2) Levels in Children with Pulmonary Hypertension Associated with Congenital Heart Disease <p><strong>Background: </strong>Pulmonary arterial hypertension (PAH) is a frequent consequence of untreated congenital heart disease (CHD). Elevated pulmonary pressure induces vascular remodeling and RV dysfunction through several mechanisms, culminating in a gradual elevation in pulmonary vascular resistance (PVR) and ultimately reversal of shunt with the progression of Eisenmenger syndrome.</p> <p><strong>Objectives: </strong>To analyze the role of matrix metalloproteinase 2 (MMP-2) in pulmonary hypertension (PH) due to CHD and also to investigate if this marker has a diagnostic or prognostic value.</p> <p><strong>Subjects and Methods:</strong> 25 subjects with PAH associated with CHD, 25 subjects with CHD without PH, and 25 healthy children as controls were included. Heart electrocardiography, Doppler and Two-dimensional, M-mode echocardiographic evaluation of CHD and pulmonary pressure were done. Blood specimens were collected from all subjects to assess serum MMP-2 levels by ELISA.</p> <p><strong>Results:</strong> The mean MMP-2 values significantly enhanced in PAH-CHD children as compared to CHD without PAH patients and controls (P&lt;0.05). A significant correlation was found among MMP-2 and mean pulmonary artery pressure (mPAP) and echocardiographic parameters of RV diameter and function. Sensitivity of MMP-2 as a diagnostic marker was 52% and specificity was 96%.</p> <p><strong>Conclusion:</strong> Serum MMP-2 were significantly enhanced in PAH-CHD children and were correlated to severity of PH and to the echocardiographic measures of its assessment. MMP-2 could be used as an excellent diagnostic and predictive biomarker in PAH-CHD children, which could be beneficial in treatment of PH in children and prediction of their outcome.</p> Alaa Ebraheem Mohammed Shimaa Basyoni Elnemr Hesham Ahmed El-Serogy Amr Mohamed Zoair ##submission.copyrightStatement## 2022-11-29 2022-11-29 384 392 10.9734/jammr/2022/v34i234874 Laboratory Predictors for Morbidity and Mortality after Thermal Burns in Pediatrics <p><strong>Background:</strong> The utility of laboratory values to predict complications in pediatric burn patients is poorly understood. This study assessed the laboratory investigations’ role in morbidities and mortalities prediction after moderate and severe thermal burn in pediatrics.</p> <p><strong>Methods:</strong> This prospective cohort study was carried out on 40 children with moderate and major thermal burn. All patients were subjected to clinical evaluation and laboratory investigations such as CBC, c-reactive protein (CRP), serum albumin, serum creatinine and urea.</p> <p><strong>Results: </strong>Patients were subdivided into two groups: uncomplicated group (n=25) and complicated group (n=15). CRP, serum albumin, platelet count, serum creatinine and urea can significantly predict sepsis incidence with AUC of 0.922, 0.912, 0.911, 0.807, 0.810, at cut off &gt;12, ≤2, ≤194, &gt;0.7, &gt;23, with sensitivity of 100%, 90.91%, 100 %,100 %, 85.71%, specificity of 86.21 %, 86.21%, 79.31%, 24.24%, 39.39%, PPV of 73.3 %, 71.4%, 64.7%, 21.9% , 23.1% and NPV of 100 %, 96.2 %, 100 %, 100 % , 92.9% respectively. Serum creatinine and urea can significantly predict incidence of acute kidney injury (AKI) with AUC of 0.807, 0.810 At cut off &gt;0.7, &gt;23, with sensitivity of 100.00 %, 85.71%, specificity of 24.24%, 39.39%, PPV of 21.9%, 23.1% and NPV of 100.0%, 92.9% respectively. Percent of burn, total ABSI, CRP, platelet, inhalation injury, albumin, creatinine and urea were dependent predictors for mortality. Sex, inhalation injury, percent of burn, total ABSI, hemoglobin, CRP, platelet, albumin, and creatinine were dependent predictors for sepsis. Sex, inhalation injury, percent of burn, total ABSI, CRP, hemoglobin, platelet, albumin and creatinine were dependent predictors for complication of acute kidney disease.</p> <p><strong>Conclusions: </strong>CRP, serum albumin, platelet count, serum creatinine and urea are good predictors of sepsis, AKI and mortalities after moderate to severe burn in pediatrics.</p> Mohamed Ebrahim Matar Ahmed Elsayed Elsharkawy Wael Hussein Mahmoud Mohamed A. Elheniedy ##submission.copyrightStatement## 2022-11-29 2022-11-29 393 401 10.9734/jammr/2022/v34i234875 Intra Articular Corticosteroid Injection in Rheumatoid Arthritis Patients <p><strong>Objectives:</strong> This study was done to assess the effect of intra-articular injection of corticosteroid in persistent synovitis in rheumatoid arthritis (RA) patients.</p> <p><strong>Methods:</strong> Thirty RA patients with persistent synovitis in one joint were subjected to intra-articular injection of corticosteroid. All patients were examined for disease activity by disease activity score 28 (DAS28), functional assessment using the Modified Health Assessment Questionnaire (MHAQ), and laboratory investigations (erythrocyte sedimentation rate and C-reactive protein). Affected joints were evaluated for pain by visual analog scale (VAS) and tenderness score. Follow-up of the patients was done at 2 months after injection by clinical, functional and laboratory.</p> <p><strong>Results:</strong> There was a significant improvement in VAS, tenderness score, DAS 28, MHAQ after 2 months of injection.</p> <p><strong>Conclusion:</strong> Intra-articular injection of corticosteroid is a safe and effective treatment option in persistent synovitis in rheumatoid arthritis patients.</p> Esraa Abdelhamid Elshentenawy Mervat Elsergany Hanan Elsaadany Mananl Eid ##submission.copyrightStatement## 2022-11-29 2022-11-29 402 407 10.9734/jammr/2022/v34i234876 The Value of Tumor Size as a Prognostic Factor in Rectal Adenocarcinoma <p><strong>Background: </strong>Colorectal cancer (CRC) is the third frequent diagnosed cancer and third cause of cancer death. Curative intent surgery followed by chemoradiotherapy are the standard of care for patients with CRC to reduce local recurrence and enhance overall survival (OS). This study aimed to evaluate tumor size as a prognostic factor for rectal adenocarcinoma local recurrence.</p> <p><strong>Patients and Methods: </strong>This retrospective phase II study reviewed 100 rectal adenocarcinoma patients who were treated and followed up for 5 years after treatment. The medical records were reviewed for all cases including demographic data, medical history, personal habits, uncontrolled chronic medical condition, presenting symptoms and signs, pathological data, laboratory investigations, diagnosis, radiological examination, treatment details and treatment outcome assessed by OS and disease-free survival (DFS).</p> <p><strong>Results: </strong>During 5 years of follow up in our study, 12 patients (12%) had local recurrence. Patients with tumor size &gt; 5 cm has a significantly shorter DFS. DFS within 2-yrs for tumours ≤5 cm 96%, while 5-years DFS was 90%. While for tumours &gt;5cm, 2-years DFS was 70% and 55% for 5-years and more. In tumours size &gt;5cm, 2-years OS was 75%, 3-years OS was 72% and 5-years was 70% While In tumours ≤ 5cm, overall survival was 84%. Patients who had neoadjuvant chemoradiation also had a significant low local recurrent rate with (p=.042) in multivariate analysis.</p> <p><strong>Conclusions: </strong>Tumor size has a prognostic value in rectal adenocarcinoma. Tumor size &gt;5 cm is associated with higher rate of local recurrence and worse DFS.</p> Sarrah Mohamed Talayea Bahaa Saied Ibrahim Hamdy Abd-Allah Sedky Hesham Ahmed Tawfik ##submission.copyrightStatement## 2022-11-30 2022-11-30 408 417 10.9734/jammr/2022/v34i234877 Diffusion MRI of the Brain and Susceptibility Weighted Imaging (SWI) in Evaluation of Patients with Acute Stroke <p><strong>Background:</strong> Magnetic resonance imaging (MRI) is useful not only in identifying ischemic lesions. Susceptibility-weighted imaging (SWI) is a new magnetic resonance procedure that utilizes the magnetic susceptibility variances of various tissues, such as iron, blood and calcification. The aim of this work was to highlight the role of addition of susceptibility weighted MR images to diffusion weighted images of the brain in diagnosis of cases with acute stroke. &nbsp;</p> <p><strong>Methods</strong><strong>:</strong> This prospective study included 30 subjects with clinical manifestations of acute stroke. All the subjects underwent history taking, routine laboratory tests, cardiologic assessment by echocardiogram and imaging modalities including non-contrast CT study and MRI of the brain.</p> <p><strong>Results: </strong>PVS on SWI was found in 23 (76.7%) cases, 6 (20%) cases had macro-hemorrhage (low signals) on SWI, and 1 (3.3%) patient had no SWI findings. DWI showed a sensitivity of (100%) and SWI showed a sensitivity of (96.7%) for detection of infarct All of the 30 (100 %) cases showed hyperintense signals on T2WIs, FLAIR sequences and on DWI and hypointense signals on ADC map.</p> <p><strong>Conclusions: </strong>SWI is a potential adjunct in those patients for detecting an asymmetric prominent hypointense vessels, positive DWI-SWI mismatch is considered as a marker of infarct expansion and an indicator of the ischemic penumbra.</p> Mahmoud Nabil Mohamed Rahma Rania Sobhi Mohamed Abokhadra Ashraf Ali Abo El-Safa Hanan Mohamed Saleh El-Ahwal ##submission.copyrightStatement## 2022-11-30 2022-11-30 418 426 10.9734/jammr/2022/v34i234878 HANDLINK: A Dexterous Robotic Hand Exoskeleton controlled by Motor Imagery (MI) <p><strong>Introduction:</strong> Over 5.6 million stroke survivors in the United States experience hemiparesis of the upper limb. Assistive devices are used to help regain upper limb functionality for affected individuals; however, existing devices are bulky, costly, and lack adaptability. The objective of this pilot study was to test the performance of a newly developed hand exoskeleton on a sample of individuals with hand impairment.</p> <p><strong>Methods:</strong> A hand exoskeleton was developed comprising of a novel linkage system with three four-bar linkages structures set up in a series and a novel algorithm that finds optimal Electroencephalogram (EEG) channels, through Common Spatial Pattern (CSP) Recognition, and classifies them with a stacked Linear Discriminant Analysis-Support Vector Machine (LDA-SVM) classifier. The functionality of the novel hand exoskeleton was tested by examining performance across a battery of hand mobility assessments among individuals in the experimental group with hand impairment (n=10) compared to controls (n=10).</p> <p><strong>Results:</strong> A paired-t test was used to show better performance for the experimental group with the exoskeleton compared to those without the exoskeleton across function, grip force, and range of motion measures. An unpaired-t test was used to show that there was no statistical difference in the mean performance of the experimental group with the exoskeleton compared to the control group for most measures, indicating that functionality with the exoskeleton is comparable to a healthy hand.&nbsp; The LDA-SVM classifier resulted in an 88% accuracy in classifying which finger the user intends to move with minimal latency as a result of its computational efficiency.</p> <p><strong>Conclusions:</strong> Findings suggest HANDLINK was effective in improving function, grip force, and range of motion among hand-impaired individuals. The HANDLINK, and its complementary stacked SVM-LDA classification algorithm, work as a viable solution for a fully adaptable and cost-effective assistive hand aide for individuals with paraplegia.</p> Ashvin Arora Robert Malkin ##submission.copyrightStatement## 2022-12-01 2022-12-01 427 436 10.9734/jammr/2022/v34i234879 Role of Multi Slice Computed Tomography in Assessment of Transposition of Great Arteries <p><strong>Background:</strong> Transposition of the great arteries (TGA) is a congenital conotruncal malformation. Imaging has an essential role in evaluating TGA, both prior and post-surgery, aiding in defining the anatomy, quantifying hemodynamics, and assessing complications. This research evaluated the multi-slice computed tomography (MSCT) role in TGA assessment in correlation with echocardiogram and correction either by catheterization or surgically.</p> <p><strong>Methods:</strong> This prospective trial was carried out on 20 cases with suspected or diagnosed cases of TGA and underwent MSCT heart angiography and great vessels for diagnosis confirmation, had limited or incomplete visualization of transposition of great arteries during echocardiography (echo) examination or underwent TGA operations and post-operative follow up. All patients were subjected to history taking from the parents, echo and MSCT.</p> <p><strong>Results:</strong> ECHO can significantly predict TGA (AUC= 0.856, P value &lt;0.001) at cut off ≤6.6 with 79.95% sensitivity, 84.62% specificity, 88.2% PPV and 73.3% NPV. MSCT can significantly predict TGA (AUC= 0.877, P value &lt;0.001) at cut off ≤0.16 with 89.47% sensitivity, 76.92% specificity, 85% PPV and 83.3% NPV. By comparing between ECHO and MSCT as predictors at the same time.</p> <p><strong>Conclusions:</strong> MSCT and transthoracic echocardiogram combination can provide effective and safe imaging for preoperative evaluation, but for post-operative assessment of surgically operated/ catheterized TGA cases, MSCT angiography is the method of choice.</p> Hebatallah Shalaby Elghoul Hossam Mohammed Zaitoun Raghda Ghonimy Elsheihk Neveen Seif Al Islam Shaker ##submission.copyrightStatement## 2022-12-02 2022-12-02 437 445 10.9734/jammr/2022/v34i234880 A Two-Stage Color Correction Algorithm for Facial Image <p><strong>Aims: </strong>Facial image analysis is the main direction of facial diagnosis objectification, where realistic colors in medical facial images are essential clues for disease diagnosis. However, the same person's facial color information will have different display information under different light sources and display devices, which may lead to different diagnostic results.</p> <p><strong>Methodology:</strong> Firstly, we conducted group experiments on the selection of color patches and selected 12 face-related color patches for color correction of facial images. Next, to adapt to this task under different lighting conditions, we utilize an adaptive white balance algorithm to adjust brightness as the first step. We selected the D65 illuminate environment as the standard lighting condition. Finally, we employed a polynomial-regression algorithm based on ridge regression for color correction.</p> <p><strong>Results:</strong> The experimental results demonstrate that the average values of the chromatic distance of our method under all five lighting conditions are less than 3.0. We also compare the ablation experiments of adjusting brightness.</p> <p><strong>Conclusion:</strong> The results indicate that the proposed method has good consistency in color correction of facial images under different lighting conditions, which is more suitable for clinical medical diagnosis.</p> Huilin Liu Lijuan Wang Peng Qian Ying Xu Zhumei Sun Chunrong Guo Fufeng Li ##submission.copyrightStatement## 2022-12-03 2022-12-03 454 469 10.9734/jammr/2022/v34i234883 Lipid Abnormalities among Libyan HIV-Infected Patients Receiving Antiretroviral (ARV) Drugs and ARV Naïve Patients <p><strong>Introduction:</strong> Majority of untreated or Anti-Retroviral (ARV) treated HIV subjects may experience a lot of metabolic alterations including dyslipidemia, lipodystrophy and insulin resistance.</p> <p><strong>Aim:</strong> Due to the shortage of research data related to HIV infection. We conducted this study to assess the lipid profile in HIV infected subjects and to find a correlation between liver function enzymes and other biomarkers and serum lipid alterations among Libyan HIV subjects.</p> <p><strong>Materials and Methods:</strong> Case control study included 121 Libyan HIV-1 positive subjects (101 subjects were on First-line ARV treatment regimens and 21 untreated "Naïve") from Benghazi Medical Center (BMC) and Benghazi center for infectious diseases and immunology (BCIDI) during 2018-2019 to evaluate lipid profile and other biochemical parameters. Control group included 70 age-matched HIV negative individuals. The age range of the study participants was 20-45 years.</p> <p><strong>Results:</strong> The means of CD4 count in the ARV treated HIV subjects were significantly (P &lt;0.014) lower compared CD4 count of untreated HIV group. The mean total cholesterol (TC) level of ARV treated HIV subjects (174 ± 42 mg/dl) was significantly (P&lt;0.012) increased compared to untreated HIV subjects (149 ± 31mg/dl). In accordance, LDL-C levels showed a significant (P &lt;0.014) increase in the ARV treated HIV subjects compared to the untreated HIV subjects. On the other hand, mean HDL-C showed no significant alteration in the ARV treated HIV subjects compared to untreated HIV subjects.</p> <p><strong>Conclusion:</strong> In ARV-treated HIV patients showed higher TC and LDL-C suggesting a role of these drugs upon lipid metabolism.</p> <p>The mechanism by which HIV drugs affect lipid profile need to be fully understood by further research.</p> <p>Unaltered HDL-C and LDL/HDL atherogenic risk ratio indicate reduced risk for developing cardiovascular disease among HIV subjects.</p> M. Y. G. Younis Mona El-Sherif Ahmed B. Alhaddad ##submission.copyrightStatement## 2022-12-05 2022-12-05 470 481 10.9734/jammr/2022/v34i234884 The Efficacy of Bio-synthesized Silver Nanoparticles with Carica papaya Extract against Plasmodium berghei Infected Mice <p><strong>Background: </strong>The evolution of antimalarial drug resistance increases malaria's burden and is a recurring concern in the global fight against malaria. Medicinal herbs have played an important role in the treatment of malaria and have been advised in reducing Plasmodium parasite resistance to standard antimalarial medications. Papaya contains antimalarial bioactive chemicals. Medicinal plants have been found to have some limitations such as poor dosage regimens, determination of active phytochemical components and specific delivery issues at the right time without causing serious damage to the concerned tissue and organs in the body system. Using nanotechnology and nanomedicine for malaria treatment can overcome these limitations.</p> <p><strong>Objective: </strong>This study was aimed to assess the potential of <em>Carica papaya </em>leaf extract with silver nanoparticles against <em>Plasmodium berghei</em>-infected mice.</p> <p><strong>Materials and Methods:</strong> Fresh <em>Carica papaya </em>leaves were collected in Oke-Arade, Ogbomoso, active contents of leaves were extracted and biosynthesized silver nanoparticles were passed into the infected experimental mice. For the investigation, 40 mice were utilized, and their parasitemia level, haematological and histological parameters determined to assess safety effect of the nanoparticle as well as efficacy of the extract.&nbsp; Kidney and liver samples were analyzed for haematological, parasitological, and histological parameters.</p> <p><strong>Results:</strong> On days 3 and 5, Ag-NPs at 25mg/Kg and 50mg/Kg cleared malaria parasitemia better than plant extracts at 100mg/Kg and 200mg/Kg (<em>p</em>&lt;0.05). The mice's weight loss improved on day 5 (<em>p</em>&gt;0.05), as did PCV (<em>p</em>&lt;0.05).</p> <p><strong>Conclusion:</strong> The Ag-NPs synthesized with <em>C. papaya</em> showed antimalarial activity against <em>Plasmodium berghei</em> as more of the infected red blood cells were cleared indicating a decrease in parasitemia coupled with the reduction of the malaria parasite density across the experimental periods. This process of synthesizing Ag-NPs with the extract is simple and cost effective, thereby it's a promising antimalarial alternative.</p> Adebayo Nassar Amudatu Ambali Adedokun Evelyn Orevaoghene Onosakponome Oluwafemi Joseph Adegun Sodiq Adedolapo Bakare Emmanuel Adebayo Ayodele ##submission.copyrightStatement## 2022-12-05 2022-12-05 482 495 10.9734/jammr/2022/v34i234885 Hypertensive Disorders of Pregnancy – A Review <p>High blood pressure is a common medical problem faced during pregnancy. Hypertensive diseases in pregnancy are one of the major causes of maternal morbidity and mortality worldwide. The compendious update of the various literature related to hypertension in pregnancy is presented in this review. The classification of hypertensive disorders of pregnancy, their definitions, the current treatment guidelines, objectives of treatment and the potential risks of various hypertensive diseases of pregnancy has been reviewed. The recent advance in this field has been summarized. There are some changes in the diagnostic criteria and measurement of the severity of preeclampsia which has also been summarized. The short and long-term consequences of preeclampsia have been highlighted. We hope that this comprehensive discussion will stimulate the flourishing research in the field and facilitate clinicians to identify women at risk and thereby undertake more effective treatment of those affected individuals.</p> Tarafdar Runa Laila Sheikh Salahuddin Ahmed ##submission.copyrightStatement## 2022-10-21 2022-10-21 13 19 10.9734/jammr/2022/v34i234835 Congenital Diaphragmatic Hernia: A Review of Its Management <p>Congenital Diaphragmatic Hernia (CDH) is considered a defect in diaphragm development which occurs congenitally, its incidence is about 1 in 2500 newborns. Major components of CDH are increased pul­monary pressure with fetal circulation persistence, with significant reduction in lung compliance and its tidal volume. Preoperative stabilization and optimization should preceed the surgical repair which is done usually via laparotomy which is considered to be the standard approach. Minimally invasive procedures for CDH repair provides the patient with the benefit of less pain and avoidance of the consequences of thoracotomy or laparotomy compared with the open repair strategy, inspite of prescence of disadvantages mainly from insufflation and CO<sub>2</sub> absorption, but this can be controlled with lower CO<sub>2 </sub>pressure, better insufflation instruments and continuous monitoring of blood gases.</p> Rami M. Salama Hisham A. Almetaher Ashraf A. Elattar Hisham F. Fayad Sherif M. Shehata ##submission.copyrightStatement## 2022-10-31 2022-10-31 122 128 10.9734/jammr/2022/v34i234845 Reporting and Interpreting Renal Biopsies – A Review Article <p>Medical renal biopsy is an important tool in patient care in nephrology department. Systematic reporting of a renal biopsy eases the communication between the pathologist and the clinician, thereby improving patient care. H &amp; E (Hematoxylin and eosin) sections alone cannot help to arrive at a diagnosis, immunofluorescence (IF), special stains and EM (electron microscopy) play&nbsp; important roles too. To arrive at an accurate diagnosis, an expert renal pathologist, who has a thorough knowledge of renal pathology as well as renal medicine is required to correlate tissue with clinical data. Although a lot of review articles regarding renal biopsies have been published, review of literature covering all aspects of renal biopsy are a few especially from India. In children the common cause of nephrotic syndrome is minimal change disease, which can only be confirmed with EM (diffuse effacement of foot processes). While the commonest cause of nephrotic syndrome in adults is membranous nephropathy which needs a combination of H &amp; E (Thickened capillary loops), Silver stains (Spikes), IF (Fine granular staining of IgG &amp; C3 in capillary walls) and EM (Subepithelial deposits). In terms of nephritic syndrome, the most common cause in children is post-streptococcal glomerulonephritis, which is diagnosed with H &amp; E (Hypercellularity), IF (Coarse granular staining of IgG &amp; C3 in capillary walls) and EM (Large subepithelial deposit). In adults, one of the most common causes of nephritic syndrome is rapidly progressive glomerulonephritis, which shows characteristic crescents in both H &amp; E and special stains.</p> Anusha Anish Hari S. Pillai P. T. Annamalai ##submission.copyrightStatement## 2022-11-11 2022-11-11 210 224 10.9734/jammr/2022/v34i234856 An Overview of Medical Management of Acute Decompensated Heart Failure <p>ADHF is a heterogeneous clinical syndrome that usually leads to hospitalization due to a combination of interconnected renal dysfunction, cardiac dysfunction, and vascular compliance. Hospitalizations from ADHF are linked to increased morbidity and mortality, with about half of the patients on readmission within six months and short-term cardiac mortality. Importantly, the overall long-term outcome is still poor, combining rates of cardiovascular death, hospitalization for heart failure, myocardial infarction, and stroke. Managing these patients remain a challenge, with an emphasis on end-organ perfusion (coronary and renal), primarily volume control and reduction of vascular resistance.</p> Chukwuka Elendu Abasi-Okot A. Udoyen Precious A. Ante Emmanuel S. Meribole Oseremen V. Okpujie Mohamed Abdirahman Ibukunoluwa V. Ishola Chidinma M. Ogah Chiagozie P. Ayabazu Akinbayo A. Akintunde Ifeanyichukwu C. Ogbuiyi-Chima Richard C. Ikpegbu Fiyinfoluwa E. Ayodele Toluwanimi S. Oseni Emmanuel O. Egbunu Augustina O. Torubiri Karen C. Olumba Clinton A. Olawuni Faeren C. Atsehe Geraldine C. Okafor ##submission.copyrightStatement## 2022-11-24 2022-11-24 302 305 10.9734/jammr/2022/v34i234865 Impact of Oral Microbiome on Head and Neck Cancer Development: A Critical Review <p>A significant contributor to cancer-related morbidity and mortality worldwide is head and neck cancer (HNC). Depending on the affected site, its etiology may include risk factors like geographic differences, genetic predisposition, gender, age, type of diet, smoking and/or alcohol consumption habits, and sexual preferences. Dysbiosis, or disruption of the oral microbiota balance, is another proposed causative factor for HNC. The oral microbiota is home to over 1,000 microbial species, including pathogenic and commensal strains. Disruption of the healthy balance of the oral cavity microbiota triggers the carcinogenic mechanisms by inducing chronic inflammation in the affected site, which acts as a pro-carcinogenic factor by inducing an immune-suppressed microenvironment that induces cell proliferation and inhibits apoptosis. Recent studies have also found that members of the human microbiome are strongly linked to a wide range of cancer types, with well-established associations between the oral microbiota and chronic inflammation and cell proliferation. Aside from chronic inflammation, the bacterial genome, toxins, and metabolites have been proposed as additional factors that induce or facilitate carcinogenesis and its progression in the head and neck region. However, the precise mechanisms remain largely unknown. However, a greater understanding of the underlying mechanisms may lead to the development of novel preventive or customized treatments that can be used in routine clinical practice. The link between oral dysbiosis and the development of HNC is a relatively new and well-received topic in the oncological and dental communities. Therefore, this review intends to provide a comprehensive summary of the currently available information on the potential mechanistic relationships between changes in the oral microbiota and the development of HNC, which is still in the research phase.</p> Efsun Somay Busra Yilmaz Ahmet Kucuk Erkan Topkan ##submission.copyrightStatement## 2022-11-26 2022-11-26 361 378 10.9734/jammr/2022/v34i234872 Cardiac Myosin-Binding Protein C as a New Biomarker in the Diagnosis of Myocardial Infarction <p>Myocardial infarction is an emergency situation, and its early diagnosis is vital for patients and for the treatment which will be followed. Till now the diagnosis of myocardial infarction is based on the increased cardiac troponins I and T in the patient's serum, these biomarkers are the gold standard for the diagnosis of myocardial infarction but there are some limitations due to their slow release from the damaged myocytes. For this reason, new biomarkers are needed to be used for a faster diagnosis. New biomarkers should increase rapidly after acute myocardial infarction and should have cardiac selectivity. Myosin-binding protein C is a newly described candidate biomarker of cardiac injury and in small studies, it appears that its serum concentration decreases and increases faster than that of the troponin T and I.</p> <p>Cardiac troponins are released and cleared slowly after myocardial injury, complicating the diagnosis of an early and recurrent, acute myocardial infarction. Cardiac myosin-binding protein C is a similar cardiac protein that may have different release/clearance kinetics.</p> Charalampos Panotopoulos Emmanouil Magiorkinis Alexandros Spyrantis Ioanna Kotsiri ##submission.copyrightStatement## 2022-12-03 2022-12-03 446 453 10.9734/jammr/2022/v34i234881