Journal of Advances in Medicine and Medical Research https://journaljammr.com/index.php/JAMMR <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> en-US contact@journaljammr.com (Journal of Advances in Medicine and Medical Research) contact@journaljammr.com (Journal of Advances in Medicine and Medical Research) Fri, 19 Jun 2020 12:28:52 +0000 OJS 3.1.1.4 http://blogs.law.harvard.edu/tech/rss 60 Penetrating Scrotal Injury: Two Unusual Case Reports in Children and Brief Review of Literature https://journaljammr.com/index.php/JAMMR/article/view/30480 <p><strong>Introduction:</strong> Scrotal trauma is a rare surgical emergency that accounts for less than 1% of all traumatic injuries. They are more prevalent in 15-40 years age group. Blunt scrotal trauma contributes to about 80% of all scrotal injuries whilst penetrating scrotal injuries constitute the remaining 20%. Penetrating scrotal injuries are however, more rare in children but can result from bicycle handlebars, falls with impalement, and animal bites.</p> <p><strong>Case Reports: </strong>We did a retrospective review of our records over a 7-year period for penetrating scrotal injuries and report two (2) cases involving 13-year old and 14-year old males who sustained injuries from a tree branch and an iron rod respectively after falling from heights.</p> <p><strong>Discussion:</strong> Penetrating scrotal trauma can present with complex injury patterns involving the testes and other surrounding structures, and all invariably need urgent scrotal exploration. Consequently, both of our cases had immediate surgical exploration with conservative debridement of non-viable tissue and surprisingly both were spared any testicular injury.</p> <p><strong>Conclusion:</strong> Penetrating scrotal trauma may spare the testis and the scrotal contents despite the gravity of the injury.</p> Emmanuel Owusu Ofori, Baba Alhaji Bin Alhassan, Samuel Essoun, Alvin Asante-Asamani, Patrick Maison ##submission.copyrightStatement## https://journaljammr.com/index.php/JAMMR/article/view/30480 Mon, 22 Jun 2020 00:00:00 +0000 Mucinous Adenocarcinoma of the Colon in Uganda: A Case Report and Literature Review https://journaljammr.com/index.php/JAMMR/article/view/30475 <p><strong>Introduction: </strong>In Uganda, the Kampala Cancer Registry has reported a steady increase in the incidence of colorectal carcinoma(CRC) over the last few decades. The author reports a case of a 25 year old gentleman presenting with bowel obstruction and found to have mucinous adenocarcinoma of the colon. This is followed by a literature review of the clinical and pathological characteristics of young age sporadic colorectal carcinoma (YSCC) and hereditary nonpolyposis colorectal carcinoma (HNPCC).</p> <p><strong>Presentation of Case:</strong> This patient presented with a family history of colorectal carcinoma (CRC) and with bowel obstruction. An emergency laparotomy involving a right hemicolectomy was carried out. The postoperative course of this patient was uneventful.</p> <p><strong>Discussion: </strong>The typical histological features of mucinous adenocarcinoma of the colon were seen on the resected colon specimen. In addition this study reviews the literature regarding the clinical presentation, pathological characteristics, histology and prognosis of mucinous and medullary carcinoma of the colon.</p> <p><strong>Conclusions:</strong> Mucinous adenocarcinoma happens to be the most common histological type of colorectal carcinoma in young adults. In Uganda, low risk young patients with symptoms should be screened for colorectal lesions. A high index of suspicion should therefore be taken in the diagnosis of colorectal malignancy in these patients.</p> Richard Wismayer ##submission.copyrightStatement## https://journaljammr.com/index.php/JAMMR/article/view/30475 Fri, 19 Jun 2020 00:00:00 +0000 Presentation of a Case Report and Literature Review on Granular Cell Tumour of the Breast https://journaljammr.com/index.php/JAMMR/article/view/30478 <p>A 21 years old woman presented with a breast swelling of 4 years duration and with an associated pain of a more recent onset. On clinical examination, the mass was found to be firm, mobile and without attachment to the skin or surrounding structures. An excisional biopsy was performed based on a provisional clinical diagnosis of fibroadenoma. However, histological evaluation showed the tumour to be a granular cell tumour. The clinical features of this rare tumour may mimic a variety of conditions and cause a diagnostic dilemma.</p> Raymond Akpobome Vhriterhire, Joseph Aondowase Ngbea, David Gyenger, B. A. Eke ##submission.copyrightStatement## https://journaljammr.com/index.php/JAMMR/article/view/30478 Mon, 22 Jun 2020 00:00:00 +0000 A Prospective Comparative Study: Stapler Hemorrhoidopexy vs Laser Hemorrhoidoplasty in the Treatment of Hemorrhoids https://journaljammr.com/index.php/JAMMR/article/view/30477 <p><strong>Aims:</strong> Stapler hemorrhoidopexy (SH) has evolved over time as a procedure of choice over conventional surgery due to less postoperative pain. Laser hemorrhoidoplasty (LH) is a novel procedure aimed at shrinking the terminal branches of hemorrhoidal arteries with fewer complications. The present study is aimed to compare these procedures (SH and LH).</p> <p><strong>Study Design:</strong> Prospective comparative study.</p> <p><strong>Place and Duration of Study:</strong> Patients operated for hemorrhoids at the Department of General, MI &amp; Bariatric Surgery, Artemis Hospitals, Gurgaon from April 2018 to March 2019.</p> <p><strong>Methodology:</strong> 50 patients with grade II-III hemorrhoids were allocated to two groups: Stapler hemorrhoidopexy (SH) and Laser hemorrhoidoplasty (LH) with 25 patients in each group. Results were compared and patients were followed up for minimum period of 3 months.</p> <p><strong>Results:</strong> The mean operative time was 24.6 min (LH) and 28.6 min (SH) (P =.122). The average blood loss was 8.32 ml (LH) and 11.64 ml (SH) (P &lt;.05). The mean hospital stay 21.44 hours (LH) and 32.64 hours (SH) (P &lt;.05). Mean postoperative pain score (VAS) at 12 hours was 2.64 (LH) and 4.76 (SH) (P &lt;.05), at 24 hours was 1.88 (LH) and 3.6 (SH) (P &lt;.05), at 1 week was 0.36 (LH) and 0.88 (SH) (P =.054) and at 3 months 0.04 (LH) and 0.12 (SH) (P =.53). One patient in LH (4%) had postoperative bleeding on 4th postoperative day. In SH group, 2 (8%) had severe postoperative pain with VAS &gt; 8, requiring longer hospital stay, 2 (8%) had bleeding on the same day, 1 (4%) had bleeding on follow up and 1 (4%) had recurrence.</p> <p><strong>Conclusion:</strong> In terms of early postoperative pain and complications, LH offers better results as compared to SH. It was associated with a shorter hospital stay and early return to work. No significant complications were noted in LH compared to SH. LH is an extremely viable alternative to the popular SH for grade II-III hemorrhoids.</p> Anshuman Kaushal, Aakanksha Aggarwal, Amanpriya Khanna, Rajesh Agarwal, Dhruv N. Kundra, T. K. Thusoo ##submission.copyrightStatement## https://journaljammr.com/index.php/JAMMR/article/view/30477 Sat, 20 Jun 2020 00:00:00 +0000 Misconceptions about Insulin and Barriers to Insulin Initiation in Type 2 Diabetes among General Physicians in Southeast Nigeria https://journaljammr.com/index.php/JAMMR/article/view/30479 <p><strong>Aims: </strong>The aim of this study was to evaluate the perceptions of general physicians (GPs) regarding insulin and determine the barriers to its initiation in patients with type 2 diabetes mellitus (T2DM).</p> <p><strong>Study Design:</strong> A cross-sectional, quantitative research.</p> <p><strong>Place and Duration:</strong> Enugu metropolis, Southeast Nigeria, between March and November 2018.</p> <p><strong>Methodology:</strong> We used structured self administered questionnaire to evaluate the perceptions of 64 GPs (45 males and 19 females) regarding insulin, and to elicit barriers to insulin initiation in subjects with T2DM.</p> <p><strong>Results:</strong> The mean (SD) age of the participants was 45.5 (11.7) years and their duration of general practice ranged from 3 – 38 years. Majority were private practitioners predominantly in the rural areas. Only 15 (23.4%) respondents had ever initiated insulin for outpatient with T2DM.</p> <p>Fear of hypoglycemia, anticipated patients’ refusal of insulin, physician’s lack of confidence, and concerns about needle pains were among the commonly reported barriers to insulin initiation. Others were socio-economic factors including concerns about affordability of insulin and frequent glycemic monitoring, and availability of insulin storage facilities.</p> <p>There was a general consensus among the GPs on a number of misconceptions including that patients’ adherence to oral glucose lowering drugs eliminates the need for insulin; that insulin should be reserved as a last resort; and that once initiated, insulin therapy is lifelong.</p> <p><strong>Conclusion:</strong> This study revealed that there are several physician-related barriers and misconceptions regarding insulin therapy for T2DM among GPs in Southeast Nigeria. Periodic training to improve GPs’ attitude to insulin and optimize insulin utilization in T2DM is required.</p> Ejiofor Ugwu, Joseph Ojobi, Edmund Ndibuagu ##submission.copyrightStatement## https://journaljammr.com/index.php/JAMMR/article/view/30479 Mon, 22 Jun 2020 00:00:00 +0000 Prevalence of Using Aromatic and Medicinal Plants in the Treatment of Gastrointestinal Tract Diseases in Al-Taif City, Kingdom of Saudi Arabia https://journaljammr.com/index.php/JAMMR/article/view/30482 <p><strong>Background:</strong> In recent years, there has been growing interest in the use of herbal drugs to treat Gastrointestinal Tract Diseases (GIT) diseases which widely spread in Saudi Arabia due to their efficacy and minimal side effect. Therefore, it is reasonable and timely to assess the validity of phytotherapeutics products as an adjuvant treatment for GIT problems.</p> <p><strong>Objectives: </strong>The current study aims to estimate the frequency of using aromatic and medicinal plants and identify the commonly used plants in the treatment of some GIT diseases in Al-Taif city, Kingdom of Saudi Arabia(KSA).</p> <p><strong>Methods: </strong>A cross-sectional study carried out among 655 citizens and residents of people who live in Al-Taif city from different age groups and educational levels. The data will be collected using the self-questionnaire paper and analyzed using SPSS software.</p> <p><strong>Results: </strong>The study included 655 participants, (48.7%) of them aged from 20-29, (54.6%) were female and (92.8%) were Saudi. Most of the participants (74.6%) used aromatic and medicinal plants. Plants were effective in treating gastrointestinal diseases (97.3%) of the participants by consulting their friends and family or through social media. Diarrhea, constipation, vomiting, nausea, abdominal bloating and irritable bowel syndrome were the most common gastrointestinal diseases among the population of Al-Taif city. Cinnamon, fennel, senna, and turmeric were the most used plants and had positive results in treatment and minor side effects.</p> <p><strong>Conclusion:</strong> This study showed that the use of aromatic and medicinal plants in the treatment of gastrointestinal diseases is widespread in Al-Taif city and had a positive effect on the treatment of GIT diseases. The source of information is gained from friends, kindred and social media. Therefore, the media should have a great role in the interest and dissemination of correct and accurate information about medicinal plants.</p> Fatimah S. Al- wuthaynani, Ahlam O. Al- salmi, Amjaad K. Al- shehri, Eman H. Al- talhi, Salwa F. Farag ##submission.copyrightStatement## https://journaljammr.com/index.php/JAMMR/article/view/30482 Wed, 24 Jun 2020 00:00:00 +0000 Personality Disorder in a Nigerian Prison Community https://journaljammr.com/index.php/JAMMR/article/view/30484 <p><strong>Background:</strong> Personality disorders have since the 19<sup>th</sup> century been known and established as psychiatric diagnosis, yet very few epidemiological studies have been done. Absence of information about this disorder in the prisons led to the assessment of its prevalence in Agodi prisons in Nigeria.</p> <p><strong>Objective:</strong> To determine the prevalence of personality disorder in a prison community.</p> <p><strong>Methods:</strong> A total of 213 inmates who met the study criteria were interviewed, using (IPDE) International Personality Disorder Examination, a semi structured questionnaire modified to conform to DSM 111-R (Diagnostic and Statistical Manual) and ICD-10 (International Classification of Diseases) classifications. Using the Statistical Package for Social Sciences (SPSS/PC+), cross tabulation of the variables was obtained using chi-square and t- test.</p> <p><strong>Results:</strong> The results showed that at least 31% of prison inmates have personality disorders with antisocial personality disorder being most prevalent. A strong association between criminality and personality disorder was established.</p> Enyidah Nonyenim Solomon ##submission.copyrightStatement## https://journaljammr.com/index.php/JAMMR/article/view/30484 Mon, 29 Jun 2020 00:00:00 +0000 Perceived Morbidity Patterns among Workers in the Oil Industry of Nigeria https://journaljammr.com/index.php/JAMMR/article/view/30485 <p><strong>Background:</strong> Globally, the oil industry is replete with several high-risk activities as seen in seismic exploration, construction, drilling, production, and maintenance. Generated hazards could impact exposed workers. Exposure to associated hazards and rigour of activities usually puts workers in oil and gas installations at risk of developing several occupational illnesses. Environmental problems have also been reportedly associated with these activities as well. This study was thus aimed at determining the perceived environmental effects and morbidity patterns among staff of an oil and gas installation in the Niger Delta Region of Nigeria.</p> <p><strong>Methods:</strong> A descriptive, cross-sectional study design was used in conducting this study in an onshore oil and gas hub in Nigeria. Study group comprised engineers and technicians of various oil and gas specialties. A random sampling method was used to select 256 personnel from the study population. A self-administered questionnaire was administered to the personnel of the facility. Data was analysed using the Statistical Package for Scientific Solutions (SPSS) version 17.0 (statistical software package) for analyses. Ethical considerations were adhered to during this study.</p> <p><strong>Results:</strong> Common complaints include transient tinnitus (97.3%), joint pain of varying degrees (83.6%), occasional prickling sensation in the skin (78.1%) and the lowest frequency of health effects was claims of stressful feeling (56.6%). Environmental problems including the destruction of aquatic biodiversity as well as water contamination were reported in this study.</p> <p><strong>Conclusion:</strong> This study found experience of several morbidities by the respondents. They also reported observation of certain environmental problems related with oil exploratory activities at the oil and gas installation.&nbsp; It is recommended that a regular review of measures be put in place to prevent these health and environmental problems from occurring in or around oil and gas installation located in Nigeria.</p> Kennedy A. Osakwe ##submission.copyrightStatement## https://journaljammr.com/index.php/JAMMR/article/view/30485 Mon, 29 Jun 2020 00:00:00 +0000 The Effect of Restraint Stress on the Reactivation of Colitis in Acetic Acid-Induced Ulcerative Colitis Rat https://journaljammr.com/index.php/JAMMR/article/view/30486 <p><strong>Aim:</strong> To evaluate the effect of restraint stress on the reactivation of ulcerative colitis in rats that have been chemically-induced with ulcerative colitis after allowing progression of natural healing to take place.</p> <p><strong>Study Design:</strong> 36 animals were used for this study, and were divided into three groups; control (group 1), colitis alone (group 2) and colitis + restraint stress (group 3).</p> <p><strong>Methodology:</strong> 36 healthy female wistar rats of weight of 170±20 were used. Colitis was induced by intra-rectal administration of 1 mL/100 g body weight of 7% acetic acid. Fourteen days post colitis induction, colitis + restraint stress group animals were exposed to restraint stress for six consecutive days while animals in colitis alone group were not. Colon levels of Malondialdehyde (MDA), Glutathione (GSH) concentration, Superoxide dismutase (SOD), Catalase (CAT) and Myeloperoxidase (MPO) activities were measured spectrophometrically. Histological assessment was also done on the colon tissues.</p> <p><strong>Place and Duration of Study:</strong> Department of Physiology, Ladoke Akintola University of Technology, Ogbomoso, Oyo State, Nigeria, between April 2019 and August 2019.</p> <p><strong>Results:</strong> Colitis caused significant increase in the levels of GSH, SOD, CAT and MPO on the 3<sup>rd</sup> day. On the 14<sup>th</sup> day, group 2 showed lowered level of antioxidant activities (SOD and CAT) when compared with the 3<sup>rd</sup> day, while on the 20<sup>th</sup> day, group 3 animals exhibited increased levels of antioxidant activities (as well as increase in&nbsp; MDA and MPO) when compared to group 2 and group 1. Histological examination revealed cyst in the mucosal layer, infiltration of inflammatory cells and dilation of vessels in the colitis + restraint stress on the 20<sup>th</sup> day post colitis induction. Results are considered significant when p≤0.05.</p> <p><strong>Conclusion:</strong> The results of this study showed that restraint stress is capable of reactivating and inhibiting colitis healing in acetic acid-induced ulcerative colitis rats.</p> S. F. Ige, O. T. Adio ##submission.copyrightStatement## https://journaljammr.com/index.php/JAMMR/article/view/30486 Mon, 29 Jun 2020 00:00:00 +0000 A Short Term Clinical Outcome of Provisional versus Routine Kissing Balloon Technique after Main Vessel Crossover Stenting for Coronary Bifurcation Lesions https://journaljammr.com/index.php/JAMMR/article/view/30488 <p><strong>Background: </strong>Kissing Balloon Inflation (KBI) technique was the first technique for percutaneous intervention in bifurcation lesions. It's the standard strategy in the two-stent procedure. Its benefit in one-stent approach remains uncertain. Several trials comparing KBI strategy with the No-KBI strategy in one-stent technique did not show any advantages in the clinical outcome. Clinical outcome and the follow up of ischemic symptoms is a useful method to compare the effectiveness of both strategies.</p> <p><strong>Aims: </strong>To study the short-term clinical outcome (3and 6 months) of provisional versus routine kissing‑balloon technique after main vessel stenting for coronary bifurcation lesions.</p> <p><strong>Patients and Methods: </strong>The study included sixty consecutive patients. They were randomized to receive different side branch (SB) intervention strategies: group I (provisional final kissing balloon inflation group - PFKBI) (FKBI only when SB Flow less than TIMI 3) and group II (routine final kissing balloon inflation group – RFKBI).</p> <p><strong>Results: </strong>1- Dissection of side branch and conversion to two stent strategy was significantly higher in PFKBI group (14,3%) than in RFKBI group (0) 2-The amount of dye, total procedure time and time of admission was significantly higher in RFKBI group. 3-Chest pain immediately after the procedure was significantly higher in PFKBI group while at 3 and 6 months follow up no significant difference between both groups was noticed. 4- MACE, target lesion revascularization (TLR) and stent thrombosis were similar between both groups at 3 and 6 months.</p> <p><strong>Conclusions: </strong>Main vessel stenting with and without final kissing balloon dilatation was associated with favorable and similar 3 and 6-month clinical outcomes.</p> Mohamed Ahmed Khalil, Fatehia Ahmed Elsheshtawy, Medhat Mohamed Ashmawy, Samiah Mahmoud Sharaf El-Din, Ayman Mohamed Elsaeed ##submission.copyrightStatement## https://journaljammr.com/index.php/JAMMR/article/view/30488 Tue, 30 Jun 2020 00:00:00 +0000 Sex Hormone Disruption and Histological Changes in Testes on Chronic Dichlorvos Exposure in Animal Model https://journaljammr.com/index.php/JAMMR/article/view/30489 <p><strong>Background:</strong> Dichlorvos is an organophosphate used indiscriminately as a pesticide in homes and for agricultural purposes. This study evaluated the effects of its low dose sub-lethal chronic exposure on male reproductive function using an animal (<em>Rattus norvegicus</em>) model.</p> <p><strong>Methodology:</strong> Three groups of rats were given dichlorvos at the dosages of 0.28 mg/kg, 0.56 mg/kg and 1.68 mg/kg respectively on alternate days. The control group was given only plain drinking water. The experiment lasted for 50 weeks.</p> <p><strong>Results: </strong>Dichlorvos induced a dosage variation effect on blood levels of follicle stimulating hormone but this was insignificant on levels of luteinizing hormone, oestrogen, progesterone and dihydrotestosterone. Prolonged treatment with dichlorvos had no overall influence on luteinizing hormone levels. The major histological findings in descending order of frequency included tubular atrophy and degeneration, germ cell depletion, germ cell exfoliation, tubular necrosis, spermatid retention and Leydig cell hyperplasia, each scored on a semi-quantitative scale. After 50 weeks of dichlorvos treatment, progesterone and oestrogen blood levels both had strong positive correlations with the frequency of germ cell exfoliation and residual bodies in the testes. In contrast, there was no statistically significant correlation between blood levels of follicle stimulating hormone, luteinizing hormone and dihydrotestosterone and the histological findings.</p> <p><strong>Conclusion: </strong>This research evaluated the chronic effect of low dichlorvos exposure on reproductive function using an animal model. There was a strong positive correlation between progesterone and germ cell exfoliation and residual bodies. Oestrogen also correlated with germ cell exfoliation, depletion and presence of residual bodies. Furthermore, the correlation between the blood hormone levels and histological changes in the testes was largely unpredictable.</p> Raymond A. Vhriterhire, Samuel O. Odeh, Gideon U. Egesie ##submission.copyrightStatement## https://journaljammr.com/index.php/JAMMR/article/view/30489 Tue, 30 Jun 2020 00:00:00 +0000 Evaluation of Drug Utilization Pattern in Cardiovascular Diseases Using WHO/ INRUD Prescribing Indicators at Cardiology OPD of Tertiary Care Hospitals in South India: A Multicenter Cross-Sectional Study https://journaljammr.com/index.php/JAMMR/article/view/30490 <p><strong>Objective:</strong> Aim of this study is to assess the drug utilization pattern of cardiovascular drugs in cardiology outpatient department (OPD).</p> <p><strong>Methodology:</strong> This prospective, multicenter, cross-sectional observational study was conducted at three selected tertiary care hospitals from different regions in South India. A total of 1026 prescriptions of the patients attending cardiology OPD of these selected hospitals 342 each over a period of 12 months was randomly identified and included in this study then critically analysed for WHO/INRUD core prescribing indicators.</p> <p><strong>Results:</strong> Medicines prescribed from NLEM were 89.27%, average drugs prescribed was 5, medicines prescribed by its generic name were 2.33% and encounters with an injection prescribed were 14.52%. Commonly prescribed different class of drugs for CVDs patients were Anti-platelets (67.73%) followed by Statins (62.57%), Beta blockers (49.51%), ACE-inhibitors (40.93%), Angiotensin receptor blockers (30.40%), Calcium channel blockers (30.11%), Nitrates (25.34%), Diuretics (20.56%), Anticoagulants (20.27%), Vasodilators (9.94%) rest of the cardiovascular drugs were prescribed within 0.5-5% only, other class of drugs also prescribed for patients with different comorbidities are Anti-ulcers (69.10%), Opioid analgesics (4.09%), Antacids (3.80%), Anti-emetics and Pro-kinetics (1.85%), a pattern of poly-pharmacy was clearly evident, majority of drugs were prescribed as single drug (86.78%) whereas 13.21% as FDCs. The most commonly prescribed single drug was Aspirin (59.93%) and FDCs were Aspirin + Clopidogrel (40.24%). Anti-thrombotic agents’ particularly antiplatelet drugs expected to overtake anti-cholesterol drugs as the sales leader in the market. Maximum drugs were prescribed from the recent NLEM of India by most of practitioners its shows its acceptance and implementation by the prescribers.</p> <p><strong>Conclusion: </strong>Deprescribing PPIs for the non-required patients is suggested to lower the risk of adverse drug interactions and economic burden to patients, also pharmacists needs to encourage the prescriptions with drugs in generic name if it’s deviated from the standards recommended by WHO/INRUD.</p> Vinoth Prabhu Veeramani ##submission.copyrightStatement## https://journaljammr.com/index.php/JAMMR/article/view/30490 Tue, 30 Jun 2020 00:00:00 +0000 Recurrence of Ventral Hernia Post Open Ventral Hernia Repair with Mesh and the Mechanism of Its Failure https://journaljammr.com/index.php/JAMMR/article/view/30506 <p><strong>Aims: </strong>A ventral hernia is a protrusion of viscera through an abdominal wall defect. Ventral hernias are mostly treated by a surgical procedure called open ventral hernia repair (OVHR). However, complications arising from the OVHR procedure may result in the recurrence of a hernia. This study was aimed to measure the recurrence rate of ventral hernia after OVHR with mesh and the reasons for failure.</p> <p><strong>Study Design: </strong>It was a cross-sectional retrospective study conducted on all patients who underwent an OVHR with mesh, between 2010 and 2017, at King Abdulaziz University Hospital (KAUH) in Jeddah, Saudi Arabia. Data were extracted from KAUH medical records. A total of 241 patients were included in the study, divided into two groups; group 1- patients with recurrence (37 patients) and group 2- patients with no recurrence (204 patients). Consent was taken from patients and preoperative assessment of procedures were performed under general anesthesia. The variables in the study are parameters like age, sex, parity, and history of chronic liver disease and their correlation with recurrence of the hernia. Different variables Data were analyzed by SPSS v 21. Association between the variables was determined using the t-test and Pearson’s Chi-squared tests.</p> <p><strong>Results: </strong>The relationship between recurrence and age was statistically significant (P=0.019). The recurrence of hernia was more frequent in females than males. Patients with a history of multiparity (P=0.00) and liver diseases (P=0.041) showed significant differences in terms of recurrence. The umbilical hernia was more prevalent (133 cases; 55.2%) than other types of hernia. The most frequent site of hernia in the recurrence group was supraumbilical (38.46%; P=0.039).</p> <p><strong>Conclusion: </strong>OVHR is a commonly performed surgical procedure at KAUH. Because of multiparity, ventral hernia recurrence was more common in women than men. To reduce recurrences, we recommend doing exercises to strengthen the abdominal muscles. Patients with chronic liver diseases in the form of portal hypertension should avoid surgical repair. For the surgeons, the type of mesh does not have a significant impact on recurrence.</p> Fatma Al-Thoubaity, Amjaad Bin Ghanem, Elaf Alharthi, Lujain Almairfi, Malak Bajunaid, Nada Fallata ##submission.copyrightStatement## https://journaljammr.com/index.php/JAMMR/article/view/30506 Tue, 30 Jun 2020 00:00:00 +0000 Pupillary Response to Light is Preserved in Patients without Brain Insult Undergoing Rapid Sequence Intubation https://journaljammr.com/index.php/JAMMR/article/view/30507 <p><strong>Objective of the Study: </strong>This paper has been aimed to determine whether the pharmacological neuromuscular blockade with rocuronium during emergency Rapid Sequence Intubation (RSI) affected pupillary response to light (PLR) in patients with brain insult as compared to patients who had non- neurological illness. Previous studies elucidated that RSI with pharmacological neuromuscular blockade does not affect PLR, except in patients with significant neurological lesion. Our objective is to examine the validity of existing but scarce literature on this subject, with further stratification of patients involved in this study into neurological and non-neurological disease groups.</p> <p><strong>Methods:</strong> This was a prospective case-reference study of case group with brain insult patients compared with reference group of patients without neurological diseases undergoing RSI in emergency settings. It is single centered study, conducted from October 2019 till May 2020. A pair of a neurosurgeon and a medical officer assessed pupillary light response after administration of neuromuscular blockade and intubation, each blinded to other’s assessment of PLR. Cases without pupillary response before RSI intubation were excluded. The primary outcome measure was clinically observable Pupillary Light Response (PLR) following neuromuscular blockade with Rocuronium in each group.</p> <p><strong>Results:</strong> We examined 50 patients undergoing RSI with Rocuronium, either in emergency department or Intensive Care Unit (ICU), 25 each in index and reference group respectively. All patients in the reference group showed PLR after RSI. Of case group patients receiving RSI, only15 of 25 (60%) demonstrated PLR after RSI. This was statistically significant (p value&lt;0.05) when compared to number of patients with intact PLR after RSI in reference group. Cohen’s Kappa Coefficient (k) for inter-observer agreement was 0.70.</p> <p><strong>Conclusion: </strong>Rocuronium does not appear to affect PLR after emergent RSI in patients without brain injury. Only in patients with known brain insult showed impaired PLR, suggesting impaired pupillary light reflex mechanism may be the culprit for this aberration, rather than pharmacological neuromuscular blockade.</p> Abhishek Chaturbedi, Jitendra Thakur, Aashik Jha, Milan Niraula ##submission.copyrightStatement## https://journaljammr.com/index.php/JAMMR/article/view/30507 Tue, 30 Jun 2020 00:00:00 +0000