Journal of Advances in Medicine and Medical Research

Sickle cell disease (SCD) is one of the most common life-threatening monogenic disorders affecting millions of people worldwide. The disease has a high prevalence in malaria-endemic tropics, especially in sub-Saharan Africa. Although sickle-cell trait (SCT) offers protective advantage against malaria, it does not apply to homozygous individuals with sickle cell anemia but instead makes them more susceptible to not only malaria but to also other infections, causing a great deal of under-five mortality. Despite the fatal risks and high incidence rates of SCD, little attention is given, in terms of funding, management and surveillance, especially among East African countries. In addition, few works of literature exist, and less has been documented about the disease. This minireview aimed to report the current situation in terms of prevalence, mortality, diagnosis and management of SCD among East African countries; Uganda, Kenya, Tanzania, Rwanda and Burundi.

SCD is characterised by retarded growth, chronic pain attacks and severe organ damage leading to fatal complications. This, coupled with limited resources in East African countries, reduces the survival of SCD patients and most die before five years. SCD is detected through a blood test usually by Haemoglobin electrophoresis, and Hydroxyurea therapy, antibiotics and blood transfusion are used to prevent complications. Early childhood detection through comprehensive newborn screening programmes has been implemented in some countries and is key in the management of the disease.

Backgrounds: Iron supplementation is most widely used approach of controlling the global problem of iron deficiency anemia especially in pregnant anemic women. Anemia is one of the most frequent complications related to pregnancy. Normal physiological changes in pregnancy affect the hemoglobin (Hb), Epidemiological studies have shown high serum iron concentrations following abnormal levels of blood lipids are risk factors for coronary artery disease and myocardial infarction. Both iron deficiency anemia and dyslipidaemia are widely prevalent public health problems, especially in the Sudanese pregnant women.

Objectives: The aim of present study was to measure the serum level of lipids profile in anemic pregnant women compared to non anemic pregnant women.

Methodology and Study Population: The analytical case control study conducted in obstetrics and gynecology centre, Omdurman city, Khartoum state. One hundred subjects known with 50 pregnant anemic as case groups and 50 non anemic pregnant  women as control groups were enrolled in this study, with  match age and sex,  the age ranged between (20 to 40 years) and their mean (31.7±4.34). The serum lipid profile was analyzed using spectrophotometric method.

Results: The (mean±SD) of Hb, HDL, LDL, TG and TC in anemic pregnant women respectively were (68.15±9.35, 46.06±9.62, 114.14±36.86, 170.38±54.57. 197.16±46.83). While the (mean±SD) of Hb, HDL, LDL, TG and TC in non anemic pregnant women respectively were (79.76±7.22, 47.44±9.65, 140.00±40.76, 189.72±37.89, 224.38±45.09). The concentration of Hb was highly significantly decrease in anemic pregnant compare to non anemic pregnant women with p value (p=0.000). The level serum of LDL, TG and TC were significantly decrease in anemic pregnant compare to non anemic pregnant women with p value (p= 0.001, 0.042, 0.004) respectively.  The age of study population were no correlation with serum LDL(r= -0.155, p= 0.283), HDL(r= -0.019, p=0.898) and TC (r=0.68, p=0.640). And also their positive correlation between age and serum TG (r= 0.286, P=0.044).

Conclusion: The anemic pregnant women had a significantly decreased of Hb and serum LDL, TG and TC and also their positive correlation between age and serum TG.

Concomitant transcranial direct current stimulation (tDCS) is suggested to enhance the functional effects of other physical rehabilitation methods in individuals with motor impairment stemming from a chronic cerebrovascular disease. Thus, the primary aim of the proposed study is to analyze the electrical activity of the tibialis anterior (TA) muscle of the paretic limb in stroke survivors following an intervention involving the combination of tDCS over the motor cortex and peripheral electrical stimulation (PES) administered over the paretic TA. The secondary objective is to analyze the effect on dynamic balance.

Methods: Thirty-six adult stroke survivors will be randomized into three groups: 1) Active tDCS + active PES; 2) Sham tDCS + active PES and 3) Active tDCS + sham PES. TDCS active will be positioned bilateral over the primary motor cortex of the damaged hemisphere (C1 or C2) and the cathode will be positioned over the primary motor cortex of the undamaged hemisphere (C1 or C2) with a current of 2 mA for 20 minutes. For sham tDCS, will follow the same standarts, however, the equipment will be switched on for only 20 seconds. PES will be administered to the paretic TA at 50 Hz for 30 minutes. Evaluations: the median frequency and root mean square (RMS) of the paretic TA will be analyzed using electromyography (EMG) and dynamic balance will be evaluated using the Mini-Balance Evaluation System (Mini-BESTest) at baseline (pre-intervention), after 10 treatment sessions at a frequency of five times a week for two weeks (post-intervention) and 30 days after the end of the interventions (follow up).

Discussion: PES has proven to facilitate the conduction of sensory-motor afferences to the cerebral cortex in stroke survivors. Combining PES with tDCS, which has a direct effect on increasing cortical excitability, could favor motor acquisition and neuronal plasticity in this population.

Background: Formal education, antenatal care, and improved health services still remain the key to a large-scale reduction in maternal mortality in developing countries. Pregnancy and labour complications are most prevalent among unbooked patients compared to booked patients. Prompt and effective treatment will go a long way to reduce these complications.

Objective: To determine the pattern of Obstetric referral cases to the Rivers State University Teaching Hospital (RSUTH) and assess time to response by the hospital.

Methodology: A retrospective review of hospital records of all pregnant women referred to RSUTH for maternal delivery and care in a six months period, 1^st April to 30^th September 2015, was carried out. Data on patients’ age, educational level, marital status, gestational age, parity, booking status, time interval between admission and intervention, obstetric diagnoses and outcome were retrieved using structured pro-forma. Data were analyzed using United States CDC Epi Info Version 7.

Results: There were 460 cases referred to the hospital, which represents 42.6% of all maternal deliveries, with a mean age of 28.7±4.6 years and median age of 27.0 years. A majority, 73.7% had secondary education, 55.4% were Primigravidae, 55.4% had term pregnancies and 77.8% were booked elsewhere. Over 60% of diagnoses comprised of difficult labour, Pre-eclampsia/ Eclampsia and prolonged pregnancy. About 75% of the cases had intervention carried out within 12 hours of arrival to hospital.

Conclusion: The pattern of referral cases to our hospital are mainly young educated primigravidae at term, who have had some form of antenatal care and presenting with common complications associated with this group. The intervention response time is good, but we recommend that high risk pregnancies should ab initio be registered at centers properly equipped to handle such cases to avoid calamity.

Background: Juvenile idiopathic arthritis (JIA) represents a heterogeneous group of autoimmune diseases that arises before the age of 16 years and lasts more than 6 months. During acute inflammation of the disease, serum copper concentration increases and zinc decreases, that could point to the possible pharmacological properties of these trace elements.

Aim: To measure the serum level of zinc and copper in patients with juvenile idiopathic arthritis (JIA) with different subtypes and correlate the levels of zinc and copper with the disease activity.

Methods: This cross-sectional study was done on 40 patients already diagnosed clinically with JIA; patients were followed-up at the Rheumatology Outpatient Clinic, Children's Hospital, Cairo University.

Results: Out of forty patients, 16 were males (40%) and 24 were females (60%) with a male to female ratio (M: F) of 1:1.5. Out of the forty patients 17 were in activity and 23 were without activity. Thirty age and sex matched controls were included for comparison. Serum copper level was significantly higher in patients with JIA than those of the controls (P= 0.017) while there were no significant difference in serum level of zinc between JIA patients and that of the controls.

Conclusion: Alteration of serum copper and zinc probably is a defense response against JIA; increased copper may be due to inflammation associated, these elements could serve as biomarkers for the disease activity.

Objectives: To investigate the trend of wearing personal protective equipment by dentists in Karachi, Pakistan.

Methodology: Study was conducted over a period of three months in Karachi. Study included dentists working in Dental practices. Dental students and dentists not registered with Pakistan Medical and Dental Council were excluded from the study. The total filled questionnaires obtained were 251. Data analysis as done on SPSS version 20.0 and chi square test was used to assess difference amongst dentists.

Results: The trend of wearing personal protective equipment such as gloves, mask and protective eye wear showed statistically significant differences amongst dentists. More over disposal of sharp objects and disinfection of surfaces between patients also significantly varied amongst dentists working in different places.

Conclusions: Dentists working in different work places showed great variation in wearing personal protective equipment during dental procedures.

Aim: Infection control is crucial in any clinical setting. It is vital that all dentists must follow the infection control protocols in their clinics to prevent cross-infection. In a dental clinic, even simple dental procedures including extractions, scaling and root planning, dental crown preparations and root canal treatment, have a high risk of exposure to blood, which may cause transmission blood-borne diseases. Dentist’s compliance with these guidelines and recommendations have been recently studied in different parts of the world.  Hence this study was performed to evaluate the knowledge, attitude, and practice regarding infection control measures among private dental practioners in Karachi, Pakistan.

Study Design:  Cross-sectional study.

Place and Duration of Study: This study was conducted for a period of four months in   Karachi, Pakistan.

Materials and Methods: Present cross–sectional study was performed by interviewing 234 dentists via a questionnaire based upon various questions regarding infection control. Sample were collected using convenience sampling, from private dental clinics in Karachi, Pakistan.

Setting: Questionnaire were sent to 400 general dentist in Karachi, out of which 234 replied.

Results: Mostly (69%) dentists who took part in the study were males. Regarding infection control, most of the individuals had a comprehensive understanding of infection control techniques. Isolation was considered to play a vital role in cross-infection prevention by 97.3% of the dentists. 93.2% used autoclave for sterilization and majority had thorough knowledge of the process involved. Regarding preventive measures, 66.7% of the dentists were vaccinated against major infectious agents in our society and 92.2% took protective measures required to prevent cross-infection.

Conclusion: Knowledge, attitudes and practices regarding infection control of dentists in private clinic of Karachi, Pakistan are satisfactory.

Aims: To identify the prevalence of hypertensions, socio demographic characteristics, risk factor and awareness of the study population about hypertension in Khartoum Locality.

Study Design: A descriptive community-based cross-sectional study.

Place of Study: Khartoum locality, Sudan.

Methodology: A total of 587 adult participants were interviewed using structured close ended questionnaire. Blood pressure was measured considering hypertension as ≥ 140 mmHg and ≥ 90 mmHg for systole and diastole blood pressure respectively. Body Mass Index (BMI) was calculated and the cutoff points were derived from World Health Organization (WHO) reference criteria to classify BMI as normal, overweight and obese. Chi square test was used to assess the association of socio demographic characteristics and risk factors with hypertensive population.

Results: The prevalence of hypertensive accounted to 216 (36.8%).  Thirty seven hypertensive participants (17%) were not aware about having hypertension, 86 (40%) were not aware about at least one complication of HTN and 117(54%) were not aware about the normal measures of blood pressure. The hypertensive participants were significantly high in the age group 25- 64 years of age and above. Females were significantly having hypertension more than males, 155 (72%) versus 61 (28%). Married participants were significantly having hypertension more than non-married, 169(78%) and 47(22%) respectively. Unemployed participants were significantly having hypertension more than employed ones, 168 (77.8%) and 48 (22.2%) respectively.

Risk factors among hypertensive participants were significantly found among overweight 67 (31%) and obese 115 (53%), positive family history of hypertension 139 (65%), increase salt in food149 (69.3%) and physical inactivity 166 (77%).

Conclusion: The prevalence of hypertension among Khartoum locality was high.  Hypertensive population awareness was low. Age, sex, marital status, education and employment were significantly associated with hypertensive population. Obesity and overweight, family history of hypertension, increase salt in food and physical inactivity were risk factors among hypertensive study population.