Journal of Advances in Medicine and Medical Research

Introduction: Sickle Cell Disease (SCD) is an inherited haemolytic disorder that affects virtually all body systems including the eye. Ocular complications of SCD could have dire consequences if not detected early.

Objectives: We aimed at determining the prevalence of ocular complications of SCD in our patients.

Methods: This study was carried out on patients attending both the adult and Paediatric Sickle cell disease clinic at Chukwuemeka Odumegwu Ojukwu Teaching Hospital, Akwa, Anambra State, Nigeria, over an 8 month period. A structured questionnaire was administered to consenting patients to determine their sociodemographic variables and other characteristics. Visual acuity was determined with multiple optotype Snellen’s chart at 6 metres in natural daylight. Using pen-torch, the face, external eye examination, anterior segment examination and pupillary reaction to light were assessed. Magnified anterior segment examination was performed with slit-lamp biomicroscope.  All subjects underwent dilated fundoscopy (after instillation of tropicamide 0.5% eye drop) using Welch Allyn indirect ophthalmoscope. Results were analysed using SPSS version 22.0 Inc Chicago Illinois and represented in tables. Statistically significant P value was set at < 0.05.

Results: A total of 28 patients with age range of 6-42 years were seen. 17 (60.7%) were males, while 11 (39.3%) were females.  8 (28.6%) had at least one ocular anomaly comprising of refractory errors 3 (10.8%), sickle cell retinopathy 4 (14.3%) and glaucoma 2 (7.1%). Only 2 (7.1%) routinely visit eye clinic. SCD retinopathy was found to increase with age (P value= 0.005).

Conclusion: SCD retinopathy was found more in the older age group despite the small sample size at a prevalence rate of 14.3%. Early initiation of routine ocular examination for SCD patients will be beneficial to avert these complications. More efforts should be made at educating the patients. Larger studies will be required to determine the actual prevalence of ocular anomaly in SCD patients in Anambra State.

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Background: Any criteria (clinical, pathologic, microbiological or histo-pathologic) attributing a case of Paediatric gastrointestinal perforation to Typhoid would be of help in reaching a proper diagnosis to guide appropriate management.

Aims and Objectives: To review all cases of Typhoid perforation for their clinical, pathologic and intra-operative findings.

Materials and Methods: A retrospective study was conducted on all cases of typhoid perforation (gastrointestinal perforation with positive Widal test) operated at a tertiary care centre from September 2015 to September 2018. Data regarding their clinical findings, investigation results, intraoperative findings, nature of the surgical intervention, postoperative results and histopathological findings were collected from their records and analysed.

Results: A total of 13 patients were operated during this period with positive Widal’s test at presentation. 6/13 had single ileal perforation; two patients had multiple ileal perforations; perforation at atypical sites were found in four patients (one each at gastric, duodenal, caecal and rectal); one patient presented with Meckel’s band obstruction with multiple ulcers – this patient was sick and died despite a diverting ileostomy in the postoperative period. While 8/13 patients had primary closure of the perforation site, diversion through ileostomy was performed in five patients. All patients did well in the post-operative period except one patient of multiple ulcers and obstructing Meckel’s band who died in the post-operative period.

Conclusion:  On encountering a gastrointestinal perforation, no definite symptomatology or its pattern, no clinical examination findings, no intraoperative characteristics of the perforation and no biopsy can definitively point towards Typhoid as the cause. Therefore, we still have to depend on serological tests in correlation with clinical features to reach a conclusive diagnosis. Cultures and PCR, although sensitive are either time-taking or expensive to guide management. Typhoid perforation can have vivid and atypical presentation depending on the number and site of perforation.

Introduction: Memory is a cognitive function essential to everyday life. Alcohol causes damage to the hippocampus. Music (especially Mozart music) has been reported to enhance memory function.

Aim: This study investigated the possible role of different genres of Nigerian music (Afro-Hiphop and Fuji) on alcohol-induced hippocampal toxicity.

Methodology: Thirty-six (36) Adult Wistar rats (105 g-160 g) were randomly distributed into 6 groups. Group A were administered 5 ml/kg b.wt. of distilled water everyday for 28 days. Group B rats were administered 5 ml/kg b.wt. of alcohol (20%) for 2 weeks. However for the first 2 weeks, the rats in Groups C and D were administered 5 ml/kg b.wt. of alcohol (20%) and the rats in Groups E and F were exposed to Nigerian Fuji and hip hop music at 75dB-83dB respectively for 4 hours daily. For the last 2 weeks, the rats in C and D were exposed to Nigerian hip hop and fuji music respectively 75dB-83dB, for 4 hours daily and the rats in Group E and F were administered 5 ml/kg b.wt of alcohol.

Results: Higher memory capacity, oxidative status and normal histo-architecture of the hippocampus in group A rats were recorded. However, Group B rats showed a non-significant (p≥0.05) increase in body weight, higher and lower memory capacity as shown by Morris water maze test and Y-Maze respectively, significant decrease (p≤0.05) in oxidative stress markers (SOD, CAT, GSH) and a significant (p≤0.05) increase in MDA and Acetylcholinesterase, structural distortion and neuronal degeneration as evident by a significant (p≤0.05) decrease in number of pyramidal cells when compared to the rats in groups A, C-F. The rats in group C-F had changes in their memory capacity at the 14th and 28th day.

Conclusion: Music (AfroHip-Hop and Fuji) improved the histo-architecture of alcohol-distorted hippocampus in rats. However they do not have a definite effect on spatial memory.

Aim: To determine the reasons why women deliver outside institutions where they register for antenatal care.

Study Design: Qualitative study.

Place and Duration of Study: Antenatal clinic of the University of Port Harcourt Teaching Hospital in February 2018.

Methodology: A qualitative study using in-depth interviews (IDIs) was conducted in Port Harcourt, Nigeria to collect information on various reasons why women do not deliver where they received antenatal care (ANC) or with skilled birth attendants (SBAs). This was done using structured interview guides. Specifically, we asked 30 pregnant women to elucidate the circumstances that lead women to deliver in places other than where they had received antenatal care, and recommendations to enhance the number of women delivering with skilled birth attendants. All in-depth interviews were audio-taped, transcribed and content-analyzed.

Results: Thirty IDIs were carried out. The women were all pregnant; aged 20 to 43 years old with mean age of 32.9 ± 5.5 years. The broad themes that emerged from their responses: Cost/financial reasons relating to inability to afford the cost of care in the hospitals, personal reasons such as fear of Caesarean section, and hospital-related reasons such as health workers’ strike action.

Conclusion:  Evidence from our study indicates that pregnant women’s non-use of skilled birth attendants during childbirth even when they received antenatal care in the hospital is mainly due to financial, personal and hospital-related reasons. These factors are modifiable and should be targeted to increase delivery with skilled attendants, a key strategy for the reduction of maternal and neonatal mortality and morbidity.

Aim: Granulocyte differentiation factor 15 (GDF15) is a growth factor and biomarker for many disorders where Ischaemia Reperfusion Injury (IRI) is pathophysiologically relevant. Hence the need to evaluate GDF-15 as a biomarker in Sickle Cell Disease (SCD).

Study Design: This is a cross sectional study.

Place and Duration of Study: Department of Haematology, Nnamdi University Teaching Hospital, Nnewi, Anambra state, Nigeria, between January and December 2018.

Methods: Ninety subjects were randomly recruited with haemoglobin (Hb) phenotypes SS (test), AS and AA (controls); numbering 30, 28 and 32 respectively. Disease severity was determined by calculating an objective score. 5 mls of blood was collected and used to determine Full Blood Count (FBC), haemoglobin Phenotype and GDF-15 levels (by Enzyme Linked Immunosorbent assay).  Data collected was analysed using Statistical Package for Social Sciences software version 20 (SPSS Inc., IL, Chicago, USA). P< 0.05 was considered as significant.

Results: GDF-15 level was found to be significantly different in the different HB phenotypes p= 0.005 and correlated negatively with sickle cell disease severity (r= -0.307, p= 0.098). The difference between median GDF-15 levels of HBSS subjects with mild and moderate disease was statistically significant at p= 0.01.

Conclusion: We hypothesize that GDF-15 may be a potential therapeutic target for intervention against ischaemia/reperfusion induced micro- vascular injury.  Natural GDF-15 mimetics may be useful in taking advantage of this potential therapeutic target.

Aim: This study aimed at assessing P-wave and QT interval dispersion in children with β-thalassemia and to correlate them with various laboratory and echocardiographic data.

Methodology: Subjects comprised of 30   children with β-thalassemia major as the patient group. 30 healthy children matched for age and sex served as the control group. All patients were evaluated clinically as well as by echocardiography and 12 leads ECG. The type of study is prospective case control study.

Results: There was a statistically significant increase of Interventricular Septal end diastole (IVSd), Interventricular Septal end systole (IVSs), Left Ventricular Internal Diameter end diastole (LVIDd), Left Ventricular Internal Diameter end systole (LVIDs) and Left Ventricular Posterior Wall end diastole (LVPWd) in patients as compared to controls (Mean ±SD = 0.950±0.166, 0.863±0.103, 3.983±0.456, 2.947±0.535a nd 0.797±0.165 respectively) (P < 0.05). Moreover, there were a significant increase of LV mass (Mean ±SD = 107.267±26.736, P= 0.002) and LV mass index of the studied patients (Mean ±SD = 106.900±22.651, P = 0.005) compared to the controls. There were significant decrease of ejection fraction (EF%)( Mean ±SD = 60.373 ± 8.088,  P = 0.032)and fractional shortening (FS%) (Mean ±SD = 29.495 ± 4.171, P = 0.026) of the studied patients compared to control group.  Both P wave dispersion (PWd) (Mean ±SD = 33.667 ± 13.767, P =     0.029) and QT dispersion (QTd) (Mean ±SD = 53.000 ± 18.411, P = 0.001) were significantly higher in patients compared to controls.  There was a significant positive correlation between PWd and serum ferritin (r =0.551, P-value= 0.002), LVIDd (r =0.406, P-value= 0.026), LVPWd (r =0.461, P-value= 0.010), LV mass (r =0.412, P-value= 0.024), and LV mass index(r = 0.379, P-value= 0.039). While, there were a significant positive correlations between QTd and serum ferritin (r =0.654, P-value <0.001), LVIDd (r = 0.388, P-value = 0.034), LV mass (r = 0.454, P-value = 0.012) and LV mass index (r = 0.456, P-value = 0.011).

Conclusion: P wave dispersion and QT dispersion were prolonged in children with β-thalassemia major denoting cardiac autonomic dysfunction with homogeneity disorders of atrial conduction and ventricular repolarization in these patients. 

Introduction: CAD is the most common cause of mortality in India. It is a common multifarious public health crisis today and a leading cause of morbidity and mortality in both developing and developed countries. Hence, understanding the predominant risk factors among the Indian population is important.

Materials and Methods: This was a hospital based age and sex matched case control study, carried out at Government Medical College and Rajindra Hospital Patiala. A total of 100 patients of Acute coronary syndrome were studied. Patients and controls were enquired about  the presence of cardiometabolic risk factors and the significance of association of these risk factors with the occurrence of Acute coronary syndrome was given by p value of  <0.05.

Results: Majority of the cases were in the age group 61-70 years (32%) with male to female ratio  of 1.25:1. Significant association was found between ACS and risk factors like smoking, positive family history of IHD, hypertension, diabetes, dyslipidemia, waist hip ratio and body mass index. Overall, most common outcome of ACS in the present study was NSTEMI (45%) followed by STEMI (35%) followed by Unstable angina (20%).

Conclusion: Significant association was found between smoking and occurrence of STEMI and significant association was found between Hypertension and occurrence of NSTEMI.

Aims: This study was to analyze the association among ES, VEGF, Microvessel Density (MVD), clinicopathologic characteristics, angiogenesis and prognosis of OSCC.

Methods: Eight normal samples of oral epithelia and 52 Oral Squamous Cell Carcinoma (OSCC) samples were analyzed by immunohistochemical evaluation to study the expression and significance of Endostatin (ES) and Vascular Endothelial Growth Factor (VEGF) during the development of OSCC.

Results: Statistically significant differences were found as p<0.05 between VEGF expressions and clinicopathologic stages of OSCC and as p<0.01 between VEGF expressions and lymph node metastases of OSCC. And Statistically significant discrepancy was also found as p<0.05 between MVD and differentiation degrees and lymphnode metastases of OSCC, as well as p<0.01 between VEGF expressions and MVD. Additionally MVD increased gradually in accordance with the progression of the Cancer. While there was no obvious correlation between ES and VEGF, ES and MVD, as well as between ES and the development of OSCC.

Conclusion: By MVD et al evaluation, VEGF is one of the major angiogenesis factors for angiogenesis and lymphonode metastasis of oral carcinomas, as an important indicator for the development and malignancy of OSCC, while ES is of significance for anti-angiogenesis in tumor therapy.

Neuro-endocrine disorders are a frequent complication of head trauma. The exploration of these disturbances is important because it can contribute to the understanding of some symptoms presented by the patients for better management in the acute phase or during the evolution.

Aim: The objective of this study was to identify the anterior pituitary dysfunction of severe traumatic brain injury and to analyze the correlations between these disorders, brain lesions and clinical signs.

Materials and Methods: This is a prospective and descriptive study, conducted in collaboration between the pediatric intensive care unit and the clinical biochemistry laboratory of the Mohammed VI University Hospital of Marrakech. This study was spread over 9 months. It Included children admitted for severe head trauma and with a clinical, hormonal and CT scan. And the interest was in 28 severely traumatized skulls in the acute phase. All patients received TSH, T3, T4, Prolactin and cortisol levels 8 hours after admission.

Results: There were twenty eight patients included in the study. Sex ratio m / f of 1.54, whose age varies between 9 months and 14 years, with an average age of 6.5 years. Half of the patients had an initial Glasgow score of 8/15. This was cerebral oedema in (46.42%) cases. In this study, the rate of endocrine disorders was 85.71%, the exploration of the thyrotropic axis proved normal in all of these patients. Low cortisol levels were observed in 11% of cases, 67.84% of children had hyperprolactinemia. One-third of the patient included in the study had 2-axis involvement, namely cortisol and prolactin. Half, on the other hand, showed only one axis.

Conclusion: In the aftermath of head trauma, pituitary disturbances are frequent and should be included in their management.

Background: Maternal mortality ratios (MMR) are still unacceptably high in many low- and middle-income countries especially in sub-Saharan Africa. Background Data for the causes of maternal deaths are needed to inform policies to improve maternal healthcare and reduce maternal mortality.

Objective: This study sought to determine the magnitude and trend in maternal mortality and the causes at a tertiary hospital over a seven-year study period.

Methodology: This was a retrospective review of maternal mortality and causes from 2012 to 2018. Data on number of maternal deaths, deliveries and causes of death were retrieved from the departmental annual reports and hospital records and entered into Microsoft Excel 2013. Data were presented as line graphs, charts and frequency tables.

Results: One hundred and ten (110) maternal deaths occurred out of 17,080 total births during the study period giving an overall MMR of 644. The MMR increased progressively from 580 in 2012 to 785 in 2018 with a sharp rise to the highest and subsequent decline to the lowest, values at the midpoint. The commonest causes of maternal deaths were Pre-eclampsia (PET) and Eclampsia 44(40%), Postpartum Haemorrhage (PPH) 25(22.7%) and Ruptured Uterus 13(11.8%).

Conclusion: The maternal mortality ratio is high and the trend is worsening. The leading causes of maternal deaths were PET/Eclampsia and Postpartum haemorrhage accounting for about two-thirds of all deaths. Efforts must be geared towards improvements in the management of these cases, if this trend is to be reversed.

Objectives: Assessment of plasma level of connective tissue growth factor in congestive heart failure children, assessment of its diagnostic and prognostic role and correlate its level with clinical and echocardiographic assessment of congestive heart failure.

Methods: Connective tissue growth factor level in the plasma was measured in 40 children; 20 of them have congestive heart failure, and 20 are healthy then, correlated with clinical parameters.

Results: The diagnostic and prognostic value of it was evaluated. We compared its levels in both patients and healthy children. We found that connective tissue growth factor level was significantly increased in diseased children. Fractional shortening and ejection fraction correlated negatively with the plasma level of connective tissue growth factor. Heart rate, respiratory rate and calibrated integrated backscatter correlated positively with connective tissue growth factor. Connective tissue growth factor was significantly correlated with the class of heart failure according to Ross classification.

Conclusions: Plasma connective tissue growth factor has a promising diagnostic and prognostic value as a biomarker for congestive heart failure in children with high sensitivity and specificity.

The study assessed households’ direct cost of Onchocerciasis illness and the perceived benefits of community-directed treatment with ivermectin in Benue State, Nigeria. A survey method was used and primary data were collected using structured questionnaires. The survey covered a period of six (6) months between June, 2019 and December, 2019. The population of the study consisted of households affected with Onchocerciasis in Benue State, Nigeria. Random sampling technique was used in selecting a sample size of 200 respondents from three Local Government Areas of Benue State. Descriptive statistics, Cost of illness approach, household expenditure model and multiple regression models were used to analyze the data. The descriptive statistics showed that majority (63.7%) of the respondents were males and married (66.7%) with average age of 48.8 years and average household size of 10 persons. The average farm size was 4.0 hectares with an annual farm income of N167, 266.16. The most perceived symptoms of onchocerciasis by the respondents were severe itching (29%), skin rashes (25.5%) and swelling (17.3%). Ivermectin was cited as the most effective treatment for onchocerciasis as 57.0% of the respondents attested to its effectiveness. The average cost of onchocerciasis illness was N77, 923.84. The direct cost of illness was estimated at N34, 503.20 per household which is high enough to stretch the already tight expenditure budgets of the poor rural households. The household expenditure model revealed negative and statistically significant relationship between onchocerciasis (health shock) and food expenditure (P<0.05), education expenditure (P<0.01) and housing expenditure (P<0.1). The study revealed a positive relationship between health consumption of affected households and household income, borrowing, sale of assets, de-saving and sale of food reserves. The study identified social and health benefits of community-directed treatment with ivermectin (CDTI). The social benefits include: Ability to work better (70.7%), acceptance by peers (52.3%) and respect in the community (47.7%) while the health benefits to the respondents were improved vision (69.4%), reduced itching (65.1%) and deworming (61.1%).The factors associated with perceived benefits of CDTI in the study area are age (P=0.029), marital status (p<0.012), length of stay in the onchocerciasis endemic community (p<0.001) and individual susceptibility to onchocerciasis infection (p<0.0001). The study recommends continuing sensitization of members of the public on the consequences of Onchocerciasis and the importance of Mectizan as curative drug. This will improve the overall health status, enhance the social interactions and increase the economic productivity of the households of North-Central Nigeria, as well as ensure food security and the development of the nation at large.

Aim: To evaluate the antiamnesic and antidepressant effect of Foeniculum vulgare whole crushed seeds.

Study Design: Laboratory based randomized control study.

Place and Duration of Study: Department of Pharmacology, University of Karachi between January 2018 to August 2018. 

Methodology: Thirty swiss albino mice and wistar rats were divided equally in three groups. Control group was fed on standard rodent diet, group 2 was fed on 2% Foeniculum vulgare diet and group 3 was given 4% Foeniculum vulgare diet. Antidepressant activity was assessed using forced swimming test. Memory enhancement effect was evaluated by stationary rod test, passive avoidance test and water maze test.

Results: Increased duration of struggling time was noted in both group 2 and group 3 as compared to control in forced swimming test. Decrease in time to reach platform in both water maze and stationary rod test was recorded in both the study group (group 2 & 3). Increase in step through latency was also seen in group 2 and group 3 as compared to control group.

Conclusion: The results showed the memory enhancing and antidepressant actions of Foeniculum.

Background: Suicide is an intentional fatal act of self-destruction and largely preventable phenomenon. Early Identification of suicide risk factors, proactive preventive steps and therapeutic interventions tend to reduce robustly its epidemiological trends including associated high mortality around the world.

Objective: This review study aimed to critically describe the identified potential risk factors underlying suicide together with a specific focus on its relevant preventive and management strategies.

Methods: A selective e-searches of Google Scholar, PubMed/MEDLINE and Science Direct of relevant English literature (2000-2019) was conducted by using keywords and Boolean operators, and following exclusion and inclusion criteria included 115 most influential articles for this critical review.

Results: Suicide is a global preventable phenomenon determined by multiple interconnected risk factors and mechanisms embedded in several levels; population (indigenous people and social media), individual (distal predisposing factors), developmental (mediating factors) and proximal (precipitating factors). Evidently suicide needs multimodal intervention approach in terms of universal, selective and indicated prevention.

Conclusion: Suicide is a global heterogeneous phenomenon and needs continuing concerted efforts of multidisciplinary health team and multi-sector stakeholders because its risk pathways and protective factors dynamically changes overtime across the world.