Open Access Case Report

Case Report of a 10 cm Subdued Abdominal Mass: Diagnosis and Management of a Rare Primitive Mesenteric Leiomyosarcoma

Carine EL-HAJJ, Clemence MATTA, Bachir ELIAS

Journal of Advances in Medicine and Medical Research, Page 98-103
DOI: 10.9734/jammr/2020/v32i1230546

Introduction: Specific management schemes of the exceedingly rare primitive mesenchymal leiomyosarcomas do not exist. Reporting their behavior and management is necessary to be able to construct evidence-based directives.

Case Report: We report a case of a 42-year-old Caucasian woman that presented with a large indolent abdominal mass evolving over 3 months. Two differential diagnosis were looked upon, either GIST or leiomyosarcoma. The abdomino-pelvic ct-scan proved that this tumor could be completely resected, so the patient was successfully operated within 2 weeks of the preliminary diagnosis. A monobloc negative margin resection was performed and the patient recovered on the surgical floor. The anatomopathological studies and immunohistochemistry tests confirmed the presence of a primitive mesenchymal leiomyosarcoma. The patient was recommended a follow up every 4 months with a thoraco-abdomino-pelvic ct-scan due to her economic status.

Conclusion: The management of rare tumors is always challenging due to the lack of knowledge concerning its behavior and response to the various treatment modalities. Reporting this rare case of mesenchymal leiomyosarcoma and similar cases will enable a better understanding of this disease and its treatment.

Open Access Case Study

A Case of Cut Throat and Penis

Peter Appiah- Thompson, Kwadwo Obeng, Patrick Maison, Kofi Quansah, Michael Nortey

Journal of Advances in Medicine and Medical Research, Page 87-91
DOI: 10.9734/jammr/2020/v32i1230544

Aims: The management of cut throat injuries with genital self-mutilation is very challenging due to the complex anatomy of the neck and the need to attain acceptable cosmetic and functional outcomes of penile reconstruction. This report thus seeks to highlight the importance of a multidisciplinary approach to the management of these cases and to raise awareness of the need for early suspicion and diagnosis of mental diseases especially among young people.

Presentation of Case: We present an 18-year old newly diagnosed paranoid schizophrenic man who presented with cut throat and penis after an attempted suicide and was successfully managed at our facility. The family had not suspected any mental disorder. He had repair of the cut throat (involving both trachea and esophagus) after elective tracheostomy, refashioning of the penile stump and psychiatric treatment.

Discussion: Cut throat injuries happen in cases of attempted suicide and among patients with psychiatric problems. Cases of cut throat and genital self-mutilation though rare, have been reported among schizophrenics. Some of such individuals have an impression that destroying their genitals could help them overcome their excessive sexual desires and for others to help them remain righteous. Our patient was diagnosed of schizophrenia after he attempted suicide.

Conclusions: Young people with mental illness must be identified and given appropriate treatment early. Patients presenting with cut throat and penis require a multidisciplinary team approach involving at least an otorhinolaryngologist, a urologist, a general/gastrointestinal surgeon and a psychiatrist for optimum care.


Open Access Short Communication

Hypothesis: Bradykinin Blockers Might Reduce the Need for Ventilators for COVID-19 Patients

Olusayo Louise- Oluwasanmi

Journal of Advances in Medicine and Medical Research, Page 1-4
DOI: 10.9734/jammr/2020/v32i1230537

The symptoms of COVID-19, leading to pulmonary edema and the need for ventilators may be due to the fact that the virus increases bradykinin levels. If true, administering bradykinin blockers can provide a cheap way to reduce the severity of the symptoms and the burden on hospital resources, and, ultimately, the fatality rate.

Open Access Minireview Article

Role of Kisspeptin in Puberty in Humans

Ravi Kant, Mahendra Kumar Meena

Journal of Advances in Medicine and Medical Research, Page 92-97
DOI: 10.9734/jammr/2020/v32i1230545

Kisspeptin or GPR-54 is a product of KISS 1 gene regulating the production of gonadotropin releasing hormone (GnRH), luteinizing (LH) as well follicle stimulating hormone (FSH). Both LH and FSH are important hormones for reproduction in animals as well in humans. The recognition of Kisspeptin has a landmark bearing in reproductive biology. Few recent pilot studies have convincingly proven it to be a promising molecule in treating infertile couples especially those having hypogonadotropic hypogonadism not responding to conventional treatment.

Open Access Original Research Article

Detection and Classification of Brain Tumor in MRI Images Using Wavelet Transform and Convolutional Neural Network

Ahmad M. Sarhan

Journal of Advances in Medicine and Medical Research, Page 15-26
DOI: 10.9734/jammr/2020/v32i1230539

A brain tumor is a mass of abnormal cells in the brain. Brain tumors can be benign or malignant. Conventional diagnosis of a brain tumor by the radiologist, is done by examining a set of images produced by magnetic resonance imaging (MRI). Many computer-aided detection (CAD) systems have been developed in order to help the radiologist reach his goal of correctly classifying the MRI image. Convolutional neural networks (CNNs) have been widely used in the classification of medical images. This paper presents a novel CAD technique for the classification of brain tumors in MRI images The proposed system extracts features from the brain MRI images by utilizing the strong energy compactness property exhibited by the Discrete Wavelet transform (DWT). The Wavelet features are then applied to a CNN to classify the input MRI image. Experimental results indicate that the proposed approach outperforms other commonly used methods and gives an overall accuracy of 98.5%.

Open Access Original Research Article

Clinicopathological Correlate of Papulosquamous Skin Disorder in a Tertiary Health Care

B. A. Ukonu, P. U. Ibekwe, B. A. Abimiku

Journal of Advances in Medicine and Medical Research, Page 54-65
DOI: 10.9734/jammr/2020/v32i1230541

Papulosquamous skin disorder is one of the frequently seen skin dermatoses; but due to clinical and morphological overlap, it is sometimes difficult to make a straight forward clinical diagnosis without histological confirmation. This study seeks to examine the level of correlation between clinical diagnosis and histological confirmation. Medical records of subjects diagnosed at the Dermatology clinic with papulosquamous skin disorder between January 2017 and December 2019 were retrieved. Their bio data, clinical description of their lesions, clinical diagnosis and histopathological report were noted and analyzed with SPSS version 23 of the 88 patients with clinical diagnosis of a papulosquamous skin disease, 62 had record of skin biopsy result; these were included in the data analysis. The mean age was 39.1± 13.8 years (age ranged from 3-64 years). Ratio of male to female was 1.7:1 Thirty-four 34 (54.8%) were clinically diagnosed as lichen planus, 25 (40.3%) as psoriasis, 1(1.6%) each as parapsoriasis, lichen nitidus and lichen simplex chronicus. Histopathological diagnosis was the same in 26 cases of lichen planus, 19 of psoriasis and for the above mentioned disorders. Common histological findings for lichen planus were acanthosis 88.5%, hyperkeratosis (30.8%), parakeratosis (3.8%), papillomatosis (61.5%), hypergranulosis (3.8%) and band-like lymphocytic infiltrate (57.7%). While acanthosis (68.4%), Elongated rete ridges (84.2%); band-like lymphocytic infiltrate (78.9%) and dermal dilated blood vessels (5.3%) were seen in psoriasis. In conclusion: We observed 77.4% accuracy in diagnosis of papulosquamous skin disorder.

Open Access Original Research Article

Neuropsychological Changes in Children with Sickle Cell Disease and Their Correlation to the Imaging Studies

Marwa Yassien, Hazem Fayed, Mohamed El- Shanshory, Hassan Nassar, Mohamed Osman

Journal of Advances in Medicine and Medical Research, Page 76-86
DOI: 10.9734/jammr/2020/v32i1230543

Background: Early detection of neuropsychological changes in children with sickle cell disease (SCD) is essential to improve their quality of life.

Aim of the Work: To assess neurological and psychological disorders in children with sickle cell disease (SCD) using multimodal approach through clinical, laboratory, neuroimaging and neurophysiological studies in a trial to detect etiological risk factors.

Study Design: Cross-sectional study.

Place and Duration of Study: Sample: Department of Pediatric (Hematology Unit) and Department of Neurology, Tanta University Hospital Egypt, between April 2016 and April 2018.

Methodology: This study was conducted on 50 children (27 male and 23 female; age range 2-18 years) with SCD and 25 healthy children matched age and sex. All subjects were subjected to full history taking, neurologic examination using pediatric neurological sheet, laboratory investigations, neuroimaging including: CT and /or MRI, MRA and/or CT angiography, also MR, EEG and  Stanford-Binet Intelligence scales-Fifth Edition.

Results: Most of patients presented with headache 66%, cognitive decline 48%, seizures 28%, and visual affection 24%. Less common presentations were, ischemic and hemorrhagic stroke 6% and 4% respectively. SCD children showed many abnormalities on neurological examination and on different modalities of MR imaging on the brain with positive correlation (X2=7.641, p-value <0.001*, r=0.248) with many risk factors. Prophylactic blood transfusion in SCD patients with abnormal TCD had a role in reducing the incidence of stroke.

Conclusion: Children with SCD were presented with variable neuropsychological disturbance that correlated with the brain imaging.

Open Access Review Article

Prone Position in Non-intubated Patients with COVID-19, a Useful Maneuver to Avoid Mechanical Ventilation: A Literature Review

Juárez-Villa Daniel, Mora-Ruiz Pablo, Sáenz-Luna Carlos, Zavala-Jonguitud Luis, Olascoaga-Lugo Arturo, Flores Guillermo, Zepeda-Quiroz Iván

Journal of Advances in Medicine and Medical Research, Page 5-14
DOI: 10.9734/jammr/2020/v32i1230538

The spectrum of coronavirus disease 2019 (COVID-19) ranges from asymptomatic to acute respiratory distress syndrome (ARDS). Prone position has been widely used in ARDS patients with mechanical ventilation and its benefits have been proven. This maneuver can be extrapolated to non-intubated patients with COVID-19, avoiding mechanical ventilation in some patients. Previous reports have demonstrated the benefits of this intervention.

Open Access Review Article

Cholera Prevention and Control Strategies; A Global Overview

Tarh, Jacqueline Ebob

Journal of Advances in Medicine and Medical Research, Page 27-53
DOI: 10.9734/jammr/2020/v32i1230540

The observed devastating effects of cholera disease, usually instil fear in the population whenever a cholera outbreak is reported in a particular region. Cholera outbreaks have become key indicators of social development and this is a course for concern, considering the stigmatization that accompanies it. The pathogenic V. cholerae O1/O139 (the watery diarrheal causing agent), is shed in feces, survive as free-living bacteria in water and enters a new host system through the fecoral route. There is therefor, every reason to conclude that, water and food (especially raw or undercooked shellfish), that is contaminated with feces, is the most implicated cause of outbreaks and epidemics in the endemic areas of the world. Cholera mortality rate can rise to about 50% if severe cases are left untreated, but rapid fluid replacement therapy and supportive treatment can reduce the mortality to around 1%. Prompt intervention strategies are therefore necessary if cholera deaths must be prevented and controlled. These strategies may include; getting access to good potable and clean Water, Sanitation and Hygiene (WASH) facilities, good surveillance/community education systems, Oral Cholera Vaccine (OCV), Oral Rehydration Therapy (ORS), and prompt Antibiotic treatment. However, it has been noted that most of the regions that are prone to this flesh eating diarrheal disease, are usually, low resource communities with little or no available road networks and infrastructural facilities. These major challenges render most of these cholera prone areas of the world in accessible. To assist these areas (for example the Nigerian population), in the cholera prevention and preparedness, free-of-cost cholera Vaccines have been sent from the stockpile to the affected areas. Thanks to the concerted efforts made by Gavi, WHO, and partners, who with the NCDC and Borno State Ministry of Health, have made the vaccine available (to Nigeria) and other hot spots. Moreover, the basic requirements for effective surveillance systems, (effective targeted prevention and control) and early warning units, (detection of the index cases, initiation of outbreak control measures through an integrated approach, identification of high risk areas/vulnerable populations and immediate dissemination of information with stakeholders for timely action), have now put been established in most vulnerable location/cholera hot spots in the world. Better still, the Solidarités International (SIs) which was established in Nigeria since 2016, has intervened in cholera outbreaks especially that which occurred in the Borno state in 2017. They make available to susceptible areas, multi-sectorial, life-saving humanitarian aid, especially to the internally displaced and host communities, who suffer from disease outbreaks. Combining the efforts to improve on water quality, sanitation, hygiene (WASH) and OCVs (targeting the highest risk groups first), would help overcome resource/logistical limitations and enable higher coverage. In this review, we seek to look at the prevention and control strategies put in place by the Government and other bodies, to reduce cholera burden in Nigeria and other cholera hotspots, and the level of effectiveness towards achieving their goals.

Open Access Review Article

Parental History of Type 2 Diabetes Mellitus: A Lurking Genetic Threat

Sheh Zano, Zil-a- Rubab, Saeeda Baig, Burhanuddin Tahir

Journal of Advances in Medicine and Medical Research, Page 66-75
DOI: 10.9734/jammr/2020/v32i1230542

Type-2 Diabetes Mellitus (T2DM) is presently the fastest growing disease and has been recognized to be caused by a collision between inherited parental genes and the environment. The current prevalence in Pakistan of type-2 diabetes mellitus is 26.3%. Out of them 19.2% had disease two to three decades back while 7.1% are recently diagnosed cases. Worldwide burden of disease was 415 million in 2015 and this number will increase to 642 million by 2040. Parental history of diabetes mellitus is a chief reason for the development of T2DM in children, but whether this association derives from shared genetic or environmental factors is unclear. Persistent high blood glucose levels can result in drastic outcomes like Diabetic Ketoacidosis and Hyperosmolar non ketotic syndrome. Genome-wide association analyses have uncovered multiple genomic regions associated with T2DM, but identification of the causal variants remains a challenge. This review will discuss the approach of diagnosing T2DM by analyzing the association of gene variants and family history.