Journal of Advances in Medicine and Medical Research

Aim: To describe a rare case of pelvic desmoid tumour simulating as a huge uterine leiomyoma causing a diagnostic dilemma in a premenopausal woman.

Case Presentation:  This was a 44-year-old, para 2 (2 alive) who was referred to our gynaecology clinic from a secondary health facility on account of slowly increasing abdominal swelling of 2 years duration. There was no nausea, vomiting or diarrhoea. There was associated mild to moderate dull lower abdominal pain that did not radiate to any other part of the body. There was no change in her monthly menstrual flow. Physical examination revealed a pelvic mass about 32 weeks pregnancy size and firm. Computed Topography scan showed a huge pedunculated sub-serous uterine fibroid. A huge mass adherent to the anterior surface of the body of the uterus was completely surgically excised at exploratory laparotomy. Histology of the excised tumour revealed a definitive histological diagnosis of pelvic desmoid tumour. The patient was clinically stable and discharged home 10 days post operation and was followed-up on out-patient gynaecology clinic basis.

Discussion: Pelvic desmoid is a rare mesenchymal tumour caused by abnormal proliferation of fibroblasts.  It is three times more common in women and occurs mostly between 25 and 35 years of age which correspond to the same age peak incidence for uterine fibroids. The tumour can easily be misdiagnosed as uterine leiomyoma and imaging cannot reliably distinguish the two conditions.

Conclusion: Pelvic desmoid tumour should be considered as a differential diagnosis in premenopausal women who present with abdominal swelling. Relevant clinical history, Radiological imaging and Histopathological assessment are essential in making prompt accurate diagnosis.

The authors report a rare case of bilateral elbow dislocation with associated radial head fractures in a 33 year male who presented to our hospital following a road traffic accident. The elbow dislocations were reduced in the emergency room, the left radial head fracture was treated conservatively in an above elbow slab for four weeks and the right radial head and neck fracture was treated operatively with Herbert screw fixation for the radial head fracture and buttress plating for the radial neck fracture. At six months follow-up, the patient was pain free and had functional range of flexion and extension of both elbows with pronation and supination of the right elbow up to 50° and 40° and that of the left elbow up to 60° and 45° respectively.

Background: Policies and programs aimed at giving access to healthcare free of charge for some segments of the population are increasingly being put in place by low and middle-income countries. The impact of such policies has so far been rather mixed.

Objective: This study sought to determine the pattern of obstetrics clinic attendance, deliveries and neonatal outcome during and after a Free Medical Care (FMC) Programme. Was there any significant difference during and after the FMC programme? 

Methodology: This was a retrospective population-based study involving the three years of a free medical care programme (2012-2014) and the three years after the programme (2015-2017). Data on antenatal/postnatal clinic attendance, method of deliveries and neonatal outcome were retrieved from the hospital records. The Epi-Info 7 statistical software was used for analysis and statistical significance was set at p<0.05.

Results: Mean antenatal attendance was 20763.67±6085.71 and 14269.00±1932.71 during and after the programme respectively, but this difference was not significant (P = 0.143). The mean postnatal attendance of 1457.7±447.69 during and 1025.7±193.52 after was not significant (P=0.200). There was more total number of deliveries during (8596) than after (5989) but this was not significant (P=0.171). There were more operative deliveries during (51.9%) than after (39.3%) and this was significant (P=0.0001). The CS rate was 43.1% with previous CS and CPD both responsible for over 40%. Livebirths were 8,272 (58.8%) during and 5,796 (41.2%) after, which was significant (P=0.0001). There was significant difference (P=0.006) in the macerated stillborn (MSB) rate during (44.2%) and after (55.8%). The stillborn rate was 66.9 during and 98.2 after the programme.

Conclusion: There were more clinic attendance and deliveries during the programme, but it was not statistically significant. There was however statistically significant increase in operative delivery, total births and livebirths, and reduced MSB rate during the programme.

Aims: This study was carried out to determine the rate of co-infection of Malaria/typhoid fever among patients attending the hospital.

Study Design: The study was a hospital based cross-sectional.

Place and Duration of Study: The study was carried out at the Centre Medical Camrail, de Bassa (CMCD), Douala, Littoral Region, Cameroon, from April to May 2015.

Methods: One hundred and sixty (160) blood and stool Samples were collected. Blood samples were subjected to microscopic examination used for the malaria parasite. Widal agglutination slide and tube test were performed for the identification of antibodies to Salmonella typhi and stool culture used for isolation of Salmonella species.

Results: Overall malaria prevalence was 19.4% (31/160) with a geometric mean parasite density (GMPD) of 788.62±1945.763 parasites/µL of blood. The overall prevalence of typhoid fever by stool culture was 32.5% (52/160) while malaria/typhoid fever and malaria/non-typhoidal salmonella co-infection rates were 29% (9) and 7% (3) respectively. Of the positive malaria samples, 03 (4%) were identified as Salmonella typhi, 4 (5.3%) as S. typhimirium, 02 (2.6%) as S. paratyphi A and 03 (4%) as S. paratyphi B. They were no significant relationship between malaria and typhoid fever (χ2=.609; p= .738). Typhoid fever was grossly under diagnosed by Widal test 1.25% (2/160) compared to stool culture 34.4% (55/160).

Conclusion: The study showed the rate of co-infections of malaria and typhoid fever is relatively high. Malaria was the most prevalent disease among febrile patients in the study area. There was a substantial result discrepancy between Widal test and stool culture for the diagnosis of typhoid fever.

Aims: The aim of this study is to determine association between lymph node metastasis and various clinico-pathological parameters in order to predict their future prognosis of cancer patients.

Study Design: Cross sectional study design.

Place and Duration of Study: Ziauddin Hospital, North Nazimabad campus, Karachi.

Methodology: November 2018 to September 2019.

Results: The present study enrolled 140 OSCC patients visiting Ziauddin University of which 30 (21.4%) were females and 110 (78.6%) were male patients. The mean age of patients was 46.99 ± 12.26. The buccal mucosa was the most common site observed 93 (66.4%). The mean size of tumour was 4.05 ± 2.261 mm, mean thickness was 1.70 ±1.32 mm. It was found that lymph node metastasis was not present in 66 (47.1%) of OSCC cases, 22 (15.7%) cases were found N1, 9(6.4%) N2a, 27(19.3%) N2b, 3 (2.1%) and 13(9.3%) N3.

Significant association was found between age and lymph node metastasis: (P 0.02); however, gender showed no significant association. (P 0.149). Thickness of tumor, site of tumor, peri-neural invasion, lympho-vascular invasion and bone penetration showed significant association with lymph node metastasis with (P 0.040, 0.021, 0.016, 0.00 and 0.001) respectively.

Conclusion: Our study showed significant association of lymph node involvement with tumour staging, tumour thickness, lymphovascular involvement, perineural invasion and bone penetration. Our suggestion is to incorporate these clinic-pathological variables while determining the treatment and prognosis of Oral squamous cell Carcinoma (OSCC). Given the very high incidence and prevalence of Oral Cancer in our country and the region further multi-centered researches should be carried out and with larger sample sizes. Early diagnosis and restrictions on smokeless tobacco products can limit the occurrence and progression of OSCC.

Background: Normal-pressure hydrocephalus (NPH) affects the older people and the presentations are gait disturbance, incontinence and dementia. The reason is still unknown and there is increased CSF volume causing pressure to the periventricular brain causing the symptoms where there is no evidence of absorption failure or obstruction of the CSF pathway.

Aims: The main objective of this study is to compare the surgical outcome of endoscopic third ventriculostomy (ETV) and VP shunt (VPS) in NPH.

Methodology: A total of 24 patients were included in the study where 12 patients underwent ETV and 12 patients VPS. Patients having a definite cause of hydrocephalus and multiple co-morbid diseases were excluded from the study. Various Scoring systems were studied to see the efficiency of ETV.

Results: About 60% of patients were successfully recovered. 40% needed to revision surgery either VP shunt or LP shunt. Some scales showed higher effieciency of ETV.

Conclusion: ETV in NPH is a safe and effective procedure. Whether the CSF absorption is hampered at arachnoid granulation is doubtful for failure cases. ETV is a short procedure with a good success rate in selected patients.

Background: Oral squamous cell carcinoma is prevalent in South Asian countries with rising cases of its incidence and mortality. Despite advancements in treatment, survival and recurrence rates are poor. Immunotherapy is a novel therapeutic modality in immunooncology. Immune checkpoint proteins are under investigation for clinical implications amongst which Programmed Death Ligand-1 has shown valuable results in certain malignancies.

Aims: To determine the immunohistochemical expression of Programmed Death Ligand-1(PD-L1) in oral squamous cell carcinoma and to find an association of Programmed Death Ligand-1 with stage and clinicopathological parameters of oral squamous cell carcinoma.

Study Design: Cross-sectional study.

Place and Duration of Study: Ziauddin Medical University, Karachi, 1 Year duration during 2018-2019.

Methods: A total number of 140 biopsy confirmed cases of oral squamous cell carcinoma were recruited in the study. Immunohistochemical expression of Programmed Death Ligand-1 was evaluated and associated with the clinicopathological parameters of oral squamous cell carcinoma (OSCC). The data was statistically analyzed through Descriptive statistics and Chi square test by using SPSS v.20.

Results: Out of 140 participants, 74% were males (n=103) and 26% were females (n=37). Programmed Death Ligand-1 positivity was observed in 62.1% of cases (n=87). The Mean age of the participants was 48.91 ± 11.7 years.  The most common site of cancer involvement was buccal mucosa and majority of participants were habitual of consuming chewable products i.e. Pan, Gutka and betel nut (89; 64%). Stage III and IV tumours comprised a major portion of cases in our study. (52; 37%), (56; 40%). A statistically significant p-value was noted for the association of Programmed Death Ligand-1 with stage II and IV tumours. (P-values: 0.029, 0.001)The association of Programmed Death Ligand-1 with other variables such as age, gender, ethnicity, sites or habits was not statistically significant.

Conclusion: This study concludes that the statistical significance of Programmed Death Ligand-1 expression with tumour stage is suggestive of worsening prognosis and might have detrimental effects as tumour progresses in advanced stage. Programmed Death Ligand-1 positivity in patients having oral squamous cell carcinoma could be useful in future research in the light of cancer immunotherapy which has shown success in oncology.

Objectives: Destruction of blood cells and damage to hepatocytes are the hallmark of hepatitis B viral infection. This cross-sectional study was undertaken to evaluate some hematological parameters and biomarkers of liver injury in healthy blood donors infected with the occult and overt hepatitis B attending the University of Abuja Teaching Hospital (UATH) and Nnamdi Azikiwe University Teaching Hospital (NAUTH) Nnewi, Nigeria. 

Materials and Methods: A total of 20 overt and 14 occult hepatitis B virus-infected blood donors were confirmed and enrolled using Roche ® COBAS q-PCR from 212 consented pooled subjects. Hematological parameters and absolute CD4⁺ T-cell count were determined using the Sysmex hematology analyzer and Partec cyflow counter, respectively. Determination of serum Alanine Aminotransferase (ALT) and Alpha Feto-protein (AFP) levels were done spectrophotometrically and ELISA, respectively. 

Results: The mean red blood cells, hematocrit, hemoglobin, white blood cells, CD4 and platelet count in the overt group were not statistically significantly different from the occult group p>0.05. However, of the 34 infected subjects, 7 (20.6%), 6 (17.7%), 2 (5.9%), 13 (38.2%), 2 (5.9%) and 4 (11.8%) had abnormally low blood values for red blood cells, white blood cells, hematocrit, hemoglobin, CD4 and platelets respectively. The mean ALT and ALP values from the occult and overt groups were not also significantly different (p>0.05). 

Conclusion: This study found a decrease in the values of some blood cells. However, no significant changes in the liver enzymes were found. These infected individuals should be managed to prevent transmission of HBV infection to other people and subsequent destruction of blood cells and damage to liver cells. Future studies could focus on patients with chronic liver diseases/Hepatocellular carcinoma caused by HBV to determine the effects on the liver biomarkers and hematological parameters.

Background: Road Traffic Accidents (RTAs) are an important cause of mortality and morbidity worldwide and are highly on rise. Its socioeconomic repercussions are a matter of great concern. In order to control the losses created due to RTA, it is important to study its causative factors.

Aim and Objectives: To study the various epidemiological factors related to road traffic accident cases.

Methodology: It was a Cross-sectional study that was conducted in two tertiary care hospitals of Kashmir (Government Hospital for Bone and Joint surgery, Barzulla and SMHS Hospital, Srinagar) from Oct 2018 to Nov 2018. Study participants were RTA patients coming to the Emergency of these two hospitals. A pretested semi-structured interview schedule was used to collect necessary information regarding the accident.

Results: RTAs affected mainly the people of productive age group (20-40 years) which were predominantly male. Approximately 1/6^th of the victims were illiterate and 2/5th of the victims were unemployed. Most of the accidents occurred on Saturdays (26%) and Sundays (22.5%) while less number of accidents was reported on Tuesdays (5.0%) and Wednesdays (5.0%). Most of the accidents (39%) occurred between 16:01 to 20:00 hours. Use of Safety measures (helmet/seatbelt) was reported by only 24% of the cases. Two wheeler drivers were more (61.5%) involved in accidents (61.5%). Weather condition at the time of accident in majority of the cases (53.5%) was found to be sunny.

Conclusion: Most of the factors that are responsible for RTA and its multiple consequences are preventable. A comprehensive programme can reduce the prevalence of RTA to a great degree.

Previous research, defining spatial control of inositol phosphate biosynthesis in the developing brain of CBA (normal) and CT [curly tail (ct-CT) and straight tail (st-CT)] mutant mice implicated a role for 1l-myo-inositol 1-phosphate synthase (MIP) in normal functioning of the central nervous system. Biochemical research indicated that MIP enzymatic activity, conversion of glucose 6-phosphate into inositol phosphate, is highest in the cerebellum of ct-CT and lowest in st-CT, when compared to that of CBA mice.

Here, we utilized microscopic and biochemical investigations to analyze and extend previous findings of MIP expression in the cerebellum. Results of this research indicated that MIP expression correlates, well, with its enzymatic activity in the cerebellum of CBA and CT mutant mice. Statistical analyses of fluorescent micrographs detected a significant difference in fluorescence intensity between MIP from ct-CT, st-CT, and CBA mice.

These data support vital links between inositol phosphate biosynthesis, MIP expression, and normal functioning of the cerebellum. Moreover, published data, identifying significant behavioral differences in the CT mutant, as well as data linking motor and non-motor cerebellar functions to abnormal levels of inositol, support the conclusion that aspects of normal cerebellar functions require temporal and spatial control of inositol phosphate biosynthesis, MIP expression.

Aim: Several challenges have been hampering the DOTS strategy ranging from a paucity of staff, laboratory consumables and drugs among others. This study, therefore, assessed the challenges facing TB-DOTS implementation in Anambra State, Nigeria.

Study Design: A cross-sectional analytic study was carried out.

Place and Duration of Study: TB-DOTS accredited facilities in Anambra State, South-East Nigeria, September 2017 - March 2018.

Methodology: Using questionnaires on 354 respondents, a checklist on 32 DOTS accredited facilities, and Key In-depth Interview (KII) guide which was administered on 14 focal persons in rural and urban facilities, including the State TBL coordinator, was employed. Data were analysed using Chi-square and Fisher`s exact test with level of significance set at p<0.05, while key themes from KII were thematically analysed.

Results: Both urban and rural respondents took nearly the same time to reach a DOTS centre, however, urban respondents spent more money to reach a TB centre and this was statistically significant p≤0.002. Patients stated that the DOTS strategy could be improved by attending to them early, home visiting, having more staff, providing pocket money among others in urban compared to rural areas and these were statistically significant p≤0.003. Checklist revealed that most patients in rural facilities 16/19(84.2%) compared to urban 11/13(84.6%) were not observed taking their medications while 11/19(57.9%) rural compared to 5/13(38.5%) urban had no functional microscope. Both rural and urban facilities specifically had challenges of Genexpert machines, needed more staff and laboratories as well as adequate funds and retraining.

Conclusion: Challenges of DOTS may be myriad, however, Focal persons and Health workers should ensure direct observation of patients while the STBL coordinator informs government and policymakers on the need to employ more workers in TB management to help reduce waiting time. Regular training and retraining of health workers are also recommended.

Objective: To evaluate the influence of Medical Residency Program Health in Family and Community (MRPHFC) on the quality of care and prevention of type II diabetes mellitus (DM II) provided by basic health units (BHU) in Gurupi-TO.

Methodology: Descriptive, cross-sectional and retrospective research carried out in 12 BHU in the urban area of Gurupi-TO, to compare the primary care provided in the BHU that have the medical residency program, with those who do not have the program, through of the QualiAB 2016 tool that evaluates the conduct of the servers, 107 medical health professionals, nurses, nursing technicians and community health agents were surveyed, 61 in BHU with MRPFCH and 46 without. The data were tested by the chi-square test to verify if there is a difference in the service considering p≤5% or 0.05.

Results: The BHU with MRPFCH performance presented more significant results in most of the items studied.

Conclusion: The presence of MRPFCH programs contributes significantly to quality improvement in preventive care that is extremely important in the prevention and management of chronic comorbidities in patients with DM II.

Introduction: Resistin, (Retn) a pro - inflammatory cytokine, accumulates at the site of inflammation. It is found to be elevated in chronic inflammation. The aim of this present study is to evaluate the levels of salivary resistin in healthy individuals and in patients with Oral pre-malignant lesion.

Materials and Methods: This case control study comprises of total 90 patients which includes 45 healthy controls and 45 cases diagnosed with oral pre-malignant lesions. Salivary levels of resistin and clinical parameters were evaluated in all of them. Socio - demographic data (age, gender and residence) was collected from all participants through a questionnaire. In addition,  we also recorded the total duration of tobacco usage (in years), daily frequency, and intra-oral examination and oral hygiene practices. This was followed by evaluation of clinical parameters of oral premalignant lesions and investigation of salivary levels of resistin through ELISA.

Results: The saliva of all the patients showed presence of resistin. On analyzing the samples present study shows no significant difference and variation in the salivary levels of resistin in healthy and OPML patients.

Conclusion: With the results of this study, it can be concluded that there is no significant difference in the salivary levels of resistin in healthy individuals and individuals diagnosed with oral pre-malignant lesion.

Background: Gynaecological disorders are a particularly common cause of morbidity and mortality among women of reproductive age and a common cause of hospital presentation/admission and surgery.

Objective: This study sought to review gynaecological diagnoses and surgeries performed in a tertiary health facility from 2012 to 2017 and its implication for healthcare planning and budgeting.

Methodology: This was a retrospective review of all gynaecological diagnoses and surgeries seen in the Rivers State University Teaching Hospital (RSUTH) from 2012 to 2017. Data were retrieved using a proforma comprising of year, gynaecological diagnosis and gynaecological surgeries. Data obtained was entered into Microsoft Excel for descriptive analysis.

Results: The proportion of clinic attendees declined from an average of 23% in the first three years (2012-2014) to about 10% in the last three years (2015-2017). The most common gynaecological diagnosis were uterine fibroid (33.3%), infertility 28.1% (primary 5.7%, secondary 22.4%), PID (5.9%), ovarian tumour (4.2%), secondary amenorrhea (3.4%) and pelvic malignancies (3.4%). The commonest major surgeries were myomectomy 441(33.7%), salpingectomy 345(26.4%), hysterectomy 168(12.8%) and cervical cerclage 122(9.3%). The commonest minor surgeries were manual vacuum aspiration 314(41.0%), examination under anaesthesia and biopsy 110(14.3%) and adhesiolysis for synechiae 97(12.6%). The duo of uterine fibroid and infertility made up 50%-70% of all gynaecological diagnoses.

Conclusion: This study showed that there has been a steady decline in gynaecological consultations over the years. However, the duo of uterine fibroid and infertility made up half to three-quarter of all gynaecological diagnoses over the 6 years. Infertility and uterine fibroids have a long cause and effect association. Healthcare policies and budgeting should be increased towards tackling these conditions, especially the setting up of a fertility center to provide assisted reproductive technologies and laparoscopy to improve practice and patient outcome.

Blood lipids are essential for life; at the same time, elevated or reduced levels of some of the components of lipid are related to risk of atherosclerotic cardiovascular disease (ASCVD). This article provides a review on dietary and blood lipids with their impact on cardiovascular health. The role of apolipoprotein B (ApoB), Lipoprotein(a) ((Lp(a)) and other lipoprotein particles in the development of ASCVD has been reviewed. There are new evidences that ApoB the structural protein of most of the lipoprotein particles (carrier of blood lipids), in addition to low density lipoprotein-cholesterol (LDL-C), plays a central role in the pathogenesis of atherosclerosis with increased risk for ASCVD. Elevated levels of Lp(a) concentrations are associated with an increased risk of ASCVD, but it appears to be a weaker risk factor than ApoB or LDL-C.