Open Access Case Report

Questionable Nasolabial Lump: A Case Report

Kanika Rai, Cassandra Carvalho, Bhagyashree Sagane, Haritosh K. Velankar, Shilpi Agrawal, Gabriela Hawkes

Journal of Advances in Medicine and Medical Research, Page 38-44
DOI: 10.9734/jammr/2020/v32i1030517

As an otorhinolaryngologist it is not an everyday occurrence to find a swelling in the nasolabial fold area. The challenge however lies in the diagnosis, proper and timed treatment of the existing pathology, especially in a non – infective case. There are various pathologies that can lead to a swelling in the nasolabial area. We here report a rare case of a female patient who presented to our outpatient department with a slowly progressive nasolabial swelling which radiologically pointed towards a Nasolabial cyst. However, the final diagnosis was an entity on the other end of spectrum, an Ameloblastoma, an odontogenic tumor.

Open Access Case Study

Perineal Rectosigmoidectomy Associated with Low Colorectal Anastomosis for Complete Rectal Prolapse Correction – Altemeier’s Procedure

Marcel Gutierrez, Anne Martinez, Sandra Di Felice Boratto

Journal of Advances in Medicine and Medical Research, Page 45-49
DOI: 10.9734/jammr/2020/v32i1030518

Introduction: Rectal prolapse constitutes in rectal protrusion through anal orifice. It’s more frequent in elderly women and the correction is exclusively surgical and fundamental, given the condition’s social relevance. We intend to describe a perineal rectosigmoidectomy (Altemeier) for correction of prolapse in multi-morbidity elder patient.

Case Report: Female patient, 78 years old, evaluated by proctology ward of CHSBC. She Came in with complaint of anal region bulge for past 2 years. Proctological examination showed 15 cm rectal procidentia Rectal prolapse’s diagnosis came from colonoscopy. A perineal rectosigmoidectomy associated with colorectal anastomosis was done (Altemeier’s Procedure). There was appropriate postoperative evolution, discharge with good wound healing and ambulatorial follow up with good general healing.

Discussion: Rectal prolapse is a result of anatomical alterations due to factors such as age and multiparity. Clinical presentation: abdominal discomfort, constipation, feces and gases release. It leads to life quality loss, thus surgical interventions become essential. Corrective surgeries seek to give back fecal continence. Currently, procedures branch out into abdominal and perineal. Altemeier consists in complete rectal removal via perineum. It’s appropriate for high surgical risk elders, since it has the lowest complications rate.

Open Access Original Research Article

Prevalence and Determinants of Toxoplasma Seropositivity among Women Who had Spontaneous Abortion in Gombe, North-Eastern Nigeria

H. U. Farouk, M. M. Manga, U. R. Yahaya, C. H. Laima, A. I. Lawan, F. M. Ballah, A. U. El-Nafaty

Journal of Advances in Medicine and Medical Research, Page 1-10
DOI: 10.9734/jammr/2020/v32i1030509

Aim: To determine the seroprevalence and determinants of Toxoplasma IgG and IgM seropositivity among women with spontaneous abortion in Gombe.

Materials and Methods: This was a cross-sectional study of 302 pregnant women with spontaneous abortion, presenting at the gynaecological emergency units of Federal Teaching Hospital Gombe and State Specialist Hospital Gombe. An interviewer-administered questionnaire was used to collect data, and a venous blood sample was drawn from each participant and tested for Toxoplasma IgG and IgM by ELISA technique.

Results: Toxoplasma seroprevalence was 62(20.5%) and was higher in women that owned cats (24% vs 20.1%, OR 1.3, 0.5-3.1) and ate grilled meat (suya) (21.0% vs 11.8%, OR 2.0, 0.4-9.0), but lower in those that washed fruits and vegetables before consumption (OR 0.6, 0.2-1.4).

Conclusion: Seroprevalence of Toxoplasmosis in Gombe is high and may be influenced by cat ownership cooking and eating habit.

Open Access Original Research Article

Subjective versus Objective Assessment of Short Term Occupational Stress: Bias and Analysis of Self-Assessment of High Stress Levels

Philippe Fauquet- Alekhine, Laetitia Rouillac, Jean-Claude Granry

Journal of Advances in Medicine and Medical Research, Page 50-64
DOI: 10.9734/jammr/2020/v32i1030519

Aims: Experiments undertaken with two professions (engineers and anesthesiologists) have shown the possible overestimation of perceived stress by subjects when self-assessing stress through questionnaires for high levels of acute stress. Previous analyses having demonstrated that the overestimation was effective, the present study aimed at analyzing a possible effect due to professional traits.

Study Design: Data were compared with models of professional personality: Myers-Briggs Type Indicator approach, Holland’s theory of careers and vocational choice and the Five-Factor model of personality.

Place and Duration of Study: Data from previous studies were used: A sample of engineers working at the nuclear power plant of Chinon in France (published in 2014) and a sample of anesthesiologists working at the University Hospital of Angers, France (published in 2015).

Methodology: Anesthesiologists (N=11, 50% male, 25 to 35 years old) experienced a stress episode in an operating theater simulator. Engineers (N=8, 38% male, 25 to 35 years old) underwent a stress-test in their office. Heart rate was measured for each subject. Comparison was examined between the stress perceived by the subjects through the Post-traumatic Disorder Inventory and the expected levels of stress estimated using the heart rate data. Characterization of the difference was undertaken using models of professional personality.

Results: While a Myers-Briggs Type Indicator approach did not provide any relevant information, an approach based on Holland’s theory of careers and vocational choice and on the Five-Factor model of personality showed that overestimation of stress was linked with occupational preoccupations specific to the professions. Limitations, perspectives and scientific implications are discussed.

Conclusion: As a major recommendation for researchers, during experiments inducing high levels of acute stress, it is worth to consider the possibility to compare self-assessment of stress with physiological measurements in order to detect a possible overestimation of perceived stress.

Open Access Original Research Article

Prenatal Diagnosis in Sickle Cell Disease: In the Eyes of the Couple at Risk

Okechukwu Chioma

Journal of Advances in Medicine and Medical Research, Page 65-71
DOI: 10.9734/jammr/2020/v32i1030520

Background: Prenatal diagnosis of sickle cell disorders provides a couple at risk the opportunity to make informed decisions whether or not to birth a child with Sickle Cell Disease (SCD).

Aim: To explore the knowledge of prenatal diagnosis and its acceptability among parents at risk of having another child with SCD

Methods: A self-administered structured questionnaire was used to obtain information on socio-demographics, knowledge and attitude towards prenatal diagnosis. The respondents were parents of SCD patients seen at the haematology consultant paediatric clinic of the University of Port Harcourt Teaching hospital. Data were analysed using SPSS version 20.0.

Results: Forty-six parents were interviewed and they were all Christians. Thirty-two (69.6%) were females and fourteen (30.4%) were males. All the respondents were from the south-south region of Nigeria. Four (8.7%) had lost children from complications of SCD. Twenty-four (52.2%), had heard about prenatal diagnosis of sickle cell disease while twelve (50%) of them heard about it from health care professionals. Four (8.7%) had done prenatal diagnosis in previous pregnancies while 32 (69.6%) were willing to do it in their next pregnancy. The most common reasons given for not doing prenatal diagnosis were religious beliefs, personal beliefs and fear of the procedure.

Conclusion: There is still a gap in knowledge and utilization of prenatal diagnosis by at risk couples. Appropriate information and regular counselling should be given to at risk parents as a key method of preventing SCD.

Open Access Original Research Article

Barriers to Diabetes Care in a Developing Country: Exploratory Evidence from Diabetes Healthcare Providers

Ejiofor Ugwu, Samuel Onung, Ignatius Ezeani, Michael Olamoyegun, Olufunmilayo Adeleye, Andrew Uloko

Journal of Advances in Medicine and Medical Research, Page 72-83
DOI: 10.9734/jammr/2020/v32i1030522

Aims: The morbidities and mortalities associated with diabetes are disproportionately high in low and middle income countries. This study aimed to explore important barriers and facilitators to diabetes care in Nigeria from the perspectives of diabetes healthcare providers (DHPs).

Study Design: A nationwide descriptive survey.

Place and Duration: Onsite (Calabar, Nigeria) and online surveys conducted between September 2016 and March 2017. 

Methodology: A validated self-administered questionnaire was used to assess barriers to diabetes care and strategies to improve care among DHPs in Nigeria.

Results: A total of 129 subjects with mean ± SD age and mean ± SD duration of practice of 42.4 ± 7.6 years and 8.5 ± 5.4 years respectively were surveyed. About 84.5% of the respondents perceived diabetes care in Nigeria as being remarkably challenging. The most common barriers identified include: poverty, low diabetes awareness, shortage of trained diabetes care specialists, poor diabetes care knowledge among primary care doctors, and poor knowledge of diabetes self care among patients and other institutional, cultural and religious barriers.

To improve care, respondents recommended, among other strategies, increasing healthcare funding, expansion of national health insurance coverage, introduction of government subsidy on diabetes medications, encouraging local production of diabetes medicines and supplies, increasing public diabetes awareness, periodic training of general practitioners and strict regulation of alternative medicine practitioners and faith healing centers.

Conclusion: This survey identified several barriers to diabetes care in Nigeria and proffered some useful and implementable strategies to improve care. In order to reduce the burden of diabetes in Nigeria and perhaps other countries in SSA, these expert opinions should form the basis for a blue print by major diabetes stakeholders and health policy makers.

Open Access Original Research Article

Changes of Cardiac Rhythm after Closure of Secundum Atrial Septal Defect in Children

Esraa A. Sorour, Elatafy E. Elatafy, Wael N. Lotfy, Amr M. Zoair

Journal of Advances in Medicine and Medical Research, Page 84-96
DOI: 10.9734/jammr/2020/v32i1030523

Background: Arrhythmias may complicate congenital heart diseases, such as secundum atrial septal defects. We aimed at following up the rhythm changes in children after closure of ostiumsecundum atrial septal defects.

Methods: The current study was conducted in the Pediatric Cardiology Unit, Tanta University, on 60 pediatric patients who had undergone either trans-catheter or surgical closure of secundum atrial septal defects. Complete history taking and full clinical assessment were done. Echocardiographic assessment was performed to detect any residual defects, and assess chamber dimensions, and cardiac functions. Electrocardiographic assessment including Holter monitoring was performed within two months after the procedure, after six months, and after one year. Arrhythmias were classified into major and minor types. All results were statistically analyzed and tabulated.

Results: There were no significant differences between the pre-closure rhythm and the rhythm after closure of the defects throughout the follow-up. The percentage of patients with major arrhythmias has increased from 6.7% of the total sample to 13.3%, 11.6%, and 11.6% in the early, midterm and late follow up respectively. The significant risk factors for postoperative arrhythmias were; pre-closure arrhythmia, right atrial dilatation, and serious hemodynamic instability in the early follow up.

Conclusions: We concluded that arrhythmias were common before and after atrial septal defect closure, without significant differences. Pre-closure arrhythmia, right atrial dilatation, and serious hemodynamic instability are considered important risk factors of arrhythmias after secundum atrial septal defect’s closure in pediatric patients.

Open Access Review Article

Dimensions of Pathophysiology of COVID 19 on the Body Systems and Its Implication for Investigations, Treatment and Further Studies

Albert Opoku, Joseph Sarfo Antwi, Joana Owusu Danso, Olivia Nyarko Mensah, Kofi Baffoe - Sarpong, Abdul Karim Boakye Yiadom, Nicholas Amoah Owusu, Prince Twene, Ransford Sarfo Mensah

Journal of Advances in Medicine and Medical Research, Page 11-21
DOI: 10.9734/jammr/2020/v32i1030510

Introduction: The 2019–20 coronavirus pandemic is a continuing pandemic of coronavirus disease 2019 (COVID-19), result in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). By May 27th, 2020, over 5.61 million people have been infected with COVID 19 across the globe in over 200 countries with more than 350,000 deaths. So far more than 2.3 million people have recovered from the COVID 19 pandemic.

Objective: To review literatures associated with various pathophysiology on the body systems identified and published so as to guide effective management of patient with COVID 19. To highlight some pathological dimensions of the systems significantly affected by COVID 19 to identify gaps for the enhancement of further studies.

Methodology: The LILACS-BIREME, SCIELO, PUBMED, ACADEMIA, SCIENCE DOMAIN databases and some textbooks were accessed for the study. Scientific papers published in English between January and May, 2020 on the pathophysiology of COVID 19 were reviewed. A total of 89 reports published between 1st January 2020 to 29th May 2020 were identified and reviewed. Sixty-seven publications meeting the inclusion criterion on COVID 19 pathophysiology were selected for this review. Finally, an analysis was conducted and the papers were assessed in agreement with the study objectives.

Results and Discussion: The review has discovered different pathophysiological changes on about seven body systems namely respiratory, cardiovascular, hematological, nervous, urinary, digestive and reproductive systems.

Conclusion: There are a lot of pathophysiological dimensions that have devastating effect on the body systems which may need immediate investigations, treatment and further studies.

Open Access Review Article

Child Development Leading to the Pursuit of Virtues and the Avoidance of Vices

Gerald Katzman

Journal of Advances in Medicine and Medical Research, Page 22-29
DOI: 10.9734/jammr/2020/v32i1030511

Optimizing the social, emotional, moral and cognitive development of children will support prosocial behavior and peaceful societies. To accomplish these goals, efforts need to start from birth with authoritative parenting to achieve secure attuned attachment between caregiver and child. Such parenting should eliminate the toxic stress associated with the authoritarian approach and the lack of direction seen with permissive or uninvolved parenting. Early literacy is the key to building character using the vehicles of modeled behaviors, reading stories with a moral and that teach a lesson and Human Relations Programs for Children. Benevolent mindfulness characterized by emotional empathy, compassion and helping behaviors will result from proper parenting and successful character education. The resultant ability to think in a complex fashion where virtues are pursued and vices avoided should facilitate resistance to false narratives and non-violent conflict resolution. Avoiding Adverse Child Experiences has been shown to minimize depression, violence perpetration and other problem behaviors and disorders. When there are educational and professional resources in play to support the development of children in communities, a responsible, caring citizenry can be anticipated.

Open Access Review Article

A Wonder Drug in the Arsenal against COVID - 19: Medication Evidence from Ivermectin

B. Suresh Kumar, Madhan Jeyaraman, Rashmi Jain, Talagavadi Channaiah Anudeep

Journal of Advances in Medicine and Medical Research, Page 30-37
DOI: 10.9734/jammr/2020/v32i1030512

Ivermectin, an FDA approved broad-spectrum anti-parasitic agent has been recently reported to show an inhibitory activity against SARS-CoV-2 in an in-vitro study. This antiviral response has rendered it as a potential drug to be repurposed for COVID-19. Previously, ivermectin had showed inhibitory activity against RNA viruses in-vitro and DNA viruses in-vitro and in-vivo respectively. Much of its characterization has been related to SARS-CoV wherein viral proteins interacting with IMPα/β1 (Importins) were proposed to enhance the viral infectivity. These documentations serve as a ray of hope for considering ivermectin in treating COVID-19 due to its suggested nuclear transport inhibitory mechanism. Importantly, these recent findings warrant detailed investigations for understanding its benefit in terms of efficacy and safety in COVID-19 patients. This review article throws light on the current consensus in this regard.