Journal of Advances in Medicine and Medical Research

Letter to the Editor

Solitary splenic metastasis is extremely rare with few reported cases in literature. Current study reports the case of a 74-year-old, female patient who was diagnosed isolated spleen metastasis after lung adenocarcinoma, in the postoperative course. She presented with the incidental detection of nodular liver and central splenic lesions in a follow-up abdominal computed tomography (CT) scan after 5 years from the left lower lobectomy due to lung adenocarcinoma. By MRI examination, lesion in the liver was characterized as cystic and the central splenic lesion was found having a heterogeneous hypoechoic nodular character. Tru-cutbiopsy of spleen confirmed metastasis of lung adenocarcinoma. The patient underwent splenectomy. Although liver biopsy couldn’t detect any malignant tissue, lung cancer adenocarcinoma metastasis was diagnosed in splenectomy material. Herein, we report a case of incidentally found solitary splenic metastasis, 5 years after left lobectomy for lung adenocarcinoma.

Aims: To study the importance of differential diagnosis of breast cancer using Magnetic resonance mammography.

Study Design:  Cohort Study.

Place and Duration of Study: The study was conducted Republican Specialized Scientific-Practical Medical Center of Oncology and Radiology between 2017 and 2019.

Methodology: The study included a clinical and instrumental examination of 70 women with suspected breast cancer. The age of the patients was 26-75 years (average age - 49.0 ± 2 years). All patients underwent core biopsy. The procedure was performed in a horizontal position of the patient, a needle was brought in and a “shot” was performed, during which a tissue sample was taken from the focus of interest. In 5 (7.1%) cases, the second stage of verification of the diagnosis was carried out through sectoral resection with an urgent histological examination. The resulting material is sent for cytological and histological studies.

Results: The sensitivity of x-ray mammography in detecting breast tumors was 83.4%, specificity 60.0%. The sensitivity of ultrasound in the diagnosis of breast cancer was 86.4%, specificity - 44.8%. In our observations of breast MRI, the sensitivity was 97.5%, specificity 87.2%. Magnetic resonance mammography is considered a more effective method in the early diagnosis of breast cancer.

Conclusion: Breast MRI is highly sensitive, specific and accurate in assessing the prevalence and differential diagnosis between a benign and malignant process.

Aims: To analyze the application of mammography and ultrasound in breast cancer associated with pregnancy.

Study Design:  Cohort Study.

Place and Duration of Study: The study was conducted Republican Specialized Scientific-Practical Medical Center of Oncology and Radiology between 2018 and 2019.

Methodology: A total of 30 consecutive patients with breast cancer pathologically diagnosed during pregnancy were included in this study. The ages of the patients ranged from 26 to 49 years. Both mammography and ultrasound were performed all 30 patients

Results: Mammography revealed positive findings in 24 (80,0%) of 30 patients, even though all 30 patients had dense breasts. Mammographic findings included masses without calcifications, masses with calcifications, calcifications with axillary lymphadenopathy, a mass with axillary lymphadenopathy, calcifications alone, asymmetric density alone and diffuse skin and trabecular thickening alone. Sonographic findings were positive and showed masses in 26 of 30 patients (86,7%). The common sonographic findings of masses were irregular shapes, irregular margins, mixed echo patterns and posterior acoustic enhancement.

Conclusion: Timely diagnosis and adequate therapeutic tactics will significantly improve the results of treatment of breast cancer that has developed against the background of pregnancy.

Some Guidelines on Cardiotocograph (CTG) trace continue to recommend the administration of oxygen and fluids to the mother to correct the abnormalities observed on the cardiotocograph. However, the fetus has a separate autonomic nervous system, blood volume, haemoglobin concentration, oxygen saturation and cardiovascular responses as compared to the mother. Therefore, administration of oxygen and fluids to the mother to correct observed “suspicious” CTG traces should be questioned in contemporary obstetric practice. This commentary examines the scientific principles and current scientific evidence on these historical practices, and all practising midwives and obstetricians should urgently review their individual clinical practice, based on the knowledge of anatomy, physiology and biochemistry as well as a critical review of current scientific evidence to prevent avoidable patient harm. Current evidence suggests that administration of oxygen to the mother, who has a normal oxygen saturation does not correct the observed abnormalities on the CTG trace, and it may in fact lead to harm. Similarly, administration of fluids (oral or intravenous) to a woman during labour who is not dehydrated or hypotensive may not only cause maternal dilutional hyponatremia and resultant complications, but also, it may cause neonatal convulsions. Women and babies expect every healthcare provider to practice evidence-based medicine during the intrapartum period, which is based on logic, common sense and robust scientific principles, irrespective of what is erroneously stated by some CTG guidelines.

Nutritional status is considered as one of the key indicators of the overall wellbeing of a population. Lactating women and children are among the most vulnerable groups due to their higher nutritional needs and detrimental effects of poor nutrition on their health. Lactating women have increased nutritional needs and if not well met, breast milk quality and quantity are negatively affected, which leads to increased risk for child morbidity and mortality. Studies have been done in the different regions of Ethiopia to assess the nutritional status among lactating women and have reported various prevalence and different associated factors. Despite the different efforts to improve nutrition in Ethiopia, the prevalence of underweight is still high, with most regions having a higher prevalence than the documented 5-20% of African women.

We aimed to review the prevalence and associated factors of underweight among lactating women in Ethiopia. We used literature searched from key databases such as Google Scholar, Web of Science, among others, to collect relevant information about the prevalence of underweight among pregnant women in Ethiopia.

The mini-review identified the highest prevalence at 50.6% in the Northern parts and the lowest at 17.4% in the Southern parts of Ethiopia. Several factors were identified to be associated with underweight among lactating women in Ethiopia including; dietary diversity score, household food security, family income, place of delivery, nutritional education programs and antenatal care attendance. This implies the need for targeted programs/policies to promote household food security and family income, community nutritional education, and nutritional counselling during antenatal care attendance. Besides, there is a need to conduct national and regional studies to inform policy further since there were more studies done in the Southern parts of the Country with less information from other regions.

Introduction: Septicemia is an invasive infection where chemical substances released into the bloodstream causes morbidity and mortality in neonates. The developing countries carries major burden of the problem and Nigeria is not exceptional.

Objective: The study was carried out to determine age/sex-related prevalence, causative agents and antimicrobial sensitivity pattern of neonatal septicemia in children at University of Port Harcourt Teaching Hospital, Nigeria.

Methods: This retrospective study was carried out in the pediatric department for a period of twelve months. Blood culture test using thioglycollate broth and tryptone soya broth for isolation of microorganisms was adopted. Antimicrobial sensitivity pattern was done with disc diffusion method. The data was analyzed using descriptive statistics and Chi square for significance.

Results: A total of 598 children were examined, of which 394(67.9%) children showed negative blood cultures, while 204(34.1%) children had positive bacterial cultures and 2 children (0.3%) were positive for Candida albicans. Overall, Klebsiella spp. was the most common pathogen, accounting for (37.8%) of the total isolates, which is followed by Staphylococcus aureus (28.4%), Escherichia coli (11.8%), unclassified Coliforms (8.3%), Pseudomonas spp. (4.9%), Proteus spp. (3.4%), Enterococcus spp. (2.9%) and coagulase-negative Staphylococcus (CONS) (2.5%) respectively. Early onset neonatal sepsis (EONNS) had Klebsiella spp as the most prevalent causative agent while Staphylococcus aureus was prevalent among the late onset neonatal sepsis (LONNS). Klebsiella spp. was susceptible to spafloxacin (87.0%) followed by ofloxacin (82.0%), amoxycillin-clavulanic acid (79.0%) and ceftazidime (65.0%) among the Gram negative organisms. In the category of Gram positive organisms, Staphylococcus aureus was highly sensitive to ofloxacin (81.0%) followed by spafloxacin (79.0%) and amoxicillin-clavulanic acid (71.0%).

Conclusion: The study showed Klebsiella spp. and Staphylococcus aureus were the prevalent bacterial organisms of septicemia in children in University of Port Harcourt Teaching Hospital. Early diagnosis with use of appropriate antimicrobial treatment will effect intervention for management of the children.

Background: Teeth are among the most important parts of our body which help in mastication, phonetic and esthetic. Now a days tooth extraction can be avoided due to availabilities of most advanced treatment. Mostly, extraction is the treatment of choice for extensive caries and severe periodontitis because of late reporting to dentist due to lack of knowledge. Knowledge about post extraction complications and their management can prevent the occurrence of untoward sequalae following extraction. Previous studies have shown that preoperative patient education can help in decreasing postoperative anxiety, pain and complications.

Methodology: This is a questionnaire based cross-sectional descriptive study. The study was conducted during the period of January to March 2018. Total of 250 patients (138 males and 112 females) were included in the study by the convenient method of sampling that visited the dental clinics of college of Dentistry, Taibah University. Validated questionnaire was asked about post extraction preventive knowledge. Categories of answer was good, average and poor according to number of correct answers. The statistical analysis was performed by the Statistical Package for Social Science version 21 (SPSS Inc Chicago, IL, USA). The significant value was obtained by using Chi Square test and p < 0.05 was set to be significant.

Results: Females and 31-45 years age group had better post extraction preventive knowledge and there was significant relation. Nationality and education level had no significant relation with level of post extraction preventive knowledge. The patients who had better knowledge followed the instructions precisely.

Conclusion: It was concluded that female, patients above middle age group and more qualified patients had more post extraction preventive knowledge and they also followed the instructions very strictly. The importance of study came out that dentist or dental assistant should explain and convince them to follow proper post-operative instruction to avoid complications.

Aims: COVID-19 has been a big public health challenge around the world in the past several months. The aim of this study is to describe the epidemic and report the number of confirmed cases of COVID-19 in Mexico until March 23, 2020.

Study Design: Ecological descriptive study.

Place and Duration of Study: Registries of confirmed cases for COVID-19 in Mexican population during February and until 23 March 2020, from National System of Epidemiological Surveillance/ General Direction of Epidemiology/ Secretary of Health, Mexico.

Methodology: Based on the database of confirmed cases of COVID-19 by Secretary of Health in Mexico, we collected data on age, gender, and source of infection (travel to USA, European or Asian countries. As of March 23, 2020, 405 cases have been identified in Mexico. It was included 405 registries.

Results: The first confirmed case in Mexico has been identified on February 20, 2020 and the incidence has been rising from the end of February and throughout March. The early confirmed cases were imported cases resulting from travel to USA, Italy, Germany, Spain, France and Singapore. No one travelled to China. No cases of community transmission have been reported.

Conclusion: The frequency of confirmed cases of COVID-19 in Mexico are concerning and the health authorities in Mexico are waiting for the peak of the epidemiological curve to occur in April.

Aim: Rubella virus is the cause of the communicable viral infection that can affect the foetus causing foetal loss or congenital rubella syndrome. Plasma samples from 180 pregnant women attending tertiary hospitals in River State, Nigeria were examined randomly to evaluate the prevalence of rubella virus (RubV) IgG antibodies.

Study Design:  Cross-sectional study.

Place and Duration of Study: University of Port Harcourt Teaching Hospital (UPTH) and Braithwaite Memorial Specialist Hospital (BMSH) now Rivers State University Teaching Hospital (RSUTH) between September 2015 and August 2017.

Methods: The sample of this study was composed of 180 pregnant women. ELISA was used to detect the RubV IgG antibodies and prevalence was correlated with sociodemographic factors.

Results: The study result revered that 155(86.1%) were positive for RubV IgG while 25(13.9%) were negative for RubV IgG. Of the 90 samples examined from BMSH, 71(78.9%) were IgG-positive. From UPTH, 84(93.3%) were positive for RubV IgG. The highest (100%) seropositivity for RubV IgG was found in age groups 39-43 years.  No RubV IgG was recorded in age groups 44-48 years.  Women in their third trimester had the highest prevalence of RubV IgG antibodies (94.7%). Those with secondary education had the highest prevalence of RubV IgG (93.4%). Vaccinated pregnant women had the highest prevalence (87.4%). Among the variables evaluated, education (p=0.023), occupation (p=0.040), marital status (p=0.001) and vaccination history (p=0.005) were the main correlates in this study.

Conclusions: This study has shown evidence of immunity among expectant mothers in this study (86.1%) with 13.9% being vulnerable to rubella virus infection. Completion of adequate rubella vaccination along intensified surveillance of the vulnerable population remains the keystone for the control of congenital rubella syndrome in Nigeria.

Background: The objectives of the study were to determine prevalence and severity of depression among patients with Parkinson’s diseaseand compare with a control group that has comparable disability with PD and ascertain the correlation of depressive symptoms severity with the severity of motor symptoms in Parkinson’s disease (PD).

Methods: This was a comparative cross-sectional descriptive study conducted at the Neurology clinic of University of Port Harcourt Teaching Hospital (UPTH).The presence and severity of depression in patients with PD measured using Becks Depression Inventory (BDI) and severity of PD using Unified Parkinson’s DiseaseRating Scale (UPDRS)-motor.

Results: A total of 40 PD patients and 40 patients with non-complicated hypertension werestudied. This study showed that the prevalence of depression among subjects with Parkinson’s disease was significantly higher 72.5% as compared with control group, further comparing the mean BDI for PD and Hypertension using independent t-test shows statistical significance (t=-3.306, p-value< 0.001). However, there is no significant difference between the severity of depression among PD patients and control. The study also reported difference in the pattern of depressive symptoms as the PD progresses.

Conclusions: The prevalence of depression in this study was significantly higher (72.5%) among patients with PD, with no significant difference in severity of depression. however, the pattern of depressive symptoms shows significant difference as PD progresses.We recommend the integration of mental health services into the care of Parkinson’s disease to ensure regular assessment of their mental health status and prompt treatment.

In the post-resuscitation period through the I-II-III-IV-V - stages and long - term periods (1 and 3 months) of post – resuscitation disease, the morpho functional activity of β-and d-basophil cells of the adenohypophysis was studied in white male rats with a weight of 180-220 g, who suffered a 10-minute stop of systemic circulation (compression of the vascular bundle of the heart by the method of V. G. Korpachev). False-operated animals served as a control. Morphological, morphometric, histochemical, and cytophotometric studies of the state of both β - and d - basophil cells of the adenohypophysis were performed. We used image analysis using a leys microscope with an electronic micro-nozzle attached to an Intel computer, and the content of the glycoprotein was studied using a cytophotometer. In the postoperative period during the phase I identified in the background of gipergidratace cytoplasmic β - and d - basophilic cells of the anterior pituitary, in the period of II-III stage disease gipergidratace nuclei β - and d - basophilic cells of the anterior pituitary revealed an increase in the excretion of glycoprotein in blood, i.e., the observed compensatory-adaptive reactions. Starting from stage IV and in remote periods of post-resuscitation disease, compensatory and restorative processes were observed against the background of hyperhydration of the nuclei.

The elderly are a growing proportion of the global population. They are more susceptible to non-communicable diseases and respiratory viral diseases like influenza and covid19, which may lead to increased levels of morbidity and mortality than those of a younger generation. It is also reported that co-morbidities, especially diabetes, hypertension and coronary heart disease contribute significantly to the prognosis with these types of infections. That the immune system operates in a less efficient way as an individual ages, is now well understood and likely contributes significantly to this situation. The role of certain micronutrients in maintaining a healthy immune system is well recognised and demonstrated to play an important role both in preventing and controlling infection. However, for a number of reasons many elderly individuals have a less than optimal intake of many of the micronutrients that support the immune system. This review examines the contributory roles an aging immune system, suboptimal intake of micronutrients, comorbidities and the impact of the intake of medications typically used to treat them can play in the outcome of viral respiratory infections. It identifies the need for supplementation, especially in the elderly to support the immune system.

Dyslipidemia is an important cause of atherosclerotic cardiovascular disease (ASCVD) worldwide that leads to increased risk of morbidity and mortality; treating dyslipidemia to goal reduces the risks. This article reviews the pharmacological therapy of dyslipidemia which is often required in addition to life style intervention to achieve target lipid levels. Currently, there are seven types of approved lipid modifying drugs which are effective in treating dyslipidemia when used singly or in combination. Statins are considered as first line drug and have been used extensively in the primary and secondary prevention of ASCVD. Ezetimibe is used as a first line add-on drug for patients already on a statin who have not reached their low density lipoprotein (LDL-C) goals; however, ezetimibe can be used as initial drug in statin intolerant patients. Bile acid sequestrants are a useful alternative to statins or ezetimibe in pregnant women or patients with liver disease. They also lower blood glucose and are useful in diabetes mellitus (DM). The PCSK9 inhibitors are powerful lipid modifying drugs, are expensive, need injection for delivery, and are used when statin in maximum doses with other drugs cannot lower the LDL-C level to targets in patients with very high CV risk. Fibrates have recently shown to slow the progression of microvascular diseases and are found beneficial for DM with hypertriglyceridemia and microvascular complications. Currently, niacin use is markedly decreased due to development of more effective alternative drugs for managing dyslipidemia and because of the adverse effects related to niacin use. Recent trials reveal that, ω-3 fatty acids, when added in pharmacological doses to statin therapy (after controlling LDL-C), are effective in reducing CV events in patients having moderate hypertriglyceridemia with high or very high CV risks.

The severe diarrheal disease Cholera, has gained public health importance because of its life-threatening effect. The detection of the causative agent of this disease (Vibrio cholerae (V.  Cholerae) O1 or O139) from a specimen (stool, vomitus of food sample) remains a major concern in the world today. Phenotypic finger printing (the conventional methods) of the toxigenic V. cholerae strain, remains the gold standard for the laboratory diagnosis of cholera; especially during cholera epidemic outbreaks. Detection around the remote areas which are usually rampaged by these outbreaks is usually difficult due to lack of required diagnostic facilities in small laboratories. However, the use of phenotypic approaches have some major setbacks as they are usually labor-intensive and time consuming. This delays treatment commencement especially in life threatening cases.To alleviate these setbacks, rapid molecular typing techniques involving the Polymerase chain reaction (PCR) amplification, hybridization methods, Pulsed Field Gel Electrophoresis (PFGE), Multilocus Sequence Typing (MLST), Multiple-Locus Variable Number Tandem Repeat Analysis (MVLA), Fluorescent Amplified Fragment Length Polymorphism (FAFLP),  Whole Genome Sequencing (WGS) etc. represent promising tools for early detection of the pathogen V. cholerae O1/O139 even in remote areas where laboratory resources are poor. Immunoassay-based techniques like enzyme-linked immune-sorbent assay (ELISA), coagglutination, immunofluorescence, and quartz crystal microbalance (QCM), are capital/labour intensive and expensive for low resource settings. Rapid diagnostic tests based on immune-chromatography principle have also been developed for simultaneous detection of V. choleraesero groups O1 and O139. These test kits are easy to use, transport, and fast. All these methods enable the subtyping of unrelated bacterial strains and they all operate with different accuracies, discriminatory ability, and reproducibility. This review sought to address some of the methods used in diagnosing the disease cholera, with the objective of identifying the best and easiest of the methods that can help to curb the cholera problem (deaths) often encountered, especially in low resource settings in the developing countries (Nigeria inclusive).