Open Access Case Report

A Case of Tacotsubo Cardiomyopathy - How We Uncovered the Diagnosis

V. Andova, M. Otljanska, H. Taravari, A. Jovkovski, N. Kostova, E. Caparoska, B. Zafirovska

Journal of Advances in Medicine and Medical Research, Page 1-6
DOI: 10.9734/jammr/2020/v32i1330547

Introduction: Tacotsubo cardiomyopathu (TTC) is a stress-induced condition characterized by transient appical hypokinesia and is usually caused by stress-induced catecholamine release with toxic action that leads to stunning myocardium.

Methods and Results: The patient was a 62 year old woman without any history of heart disease and she admitted with chest pain and electrocardiography (ECG) with ST segment elevation in the precordial leads and troponins suggesting acute anterior myocardial infarction (MI). Emergency coronary angiography which is performed showed no significant coronary artery disease. Echocardiography showed reduced LV ejection fraction with left ventricular apical ballooning and (LV) thrombus. Cardiac magnetic resonance imaging showed localized hypokinesia of the mid septal segments and akinesis of all segments of the apex of the left ventricle and T2 hyperintesity consistent with myocardial transmural oedema in the same area with diffuse involvement. During the hospitalizasion patient was treated with single antiplatelet, anticoagulation therapy, diuretics, angiotensin-converting-enzyme inhibitors (ACE inhibitors) and beta blockers for treatment of heart failure reduced Ejection fraction (HFrEF). At 3 months follow up ECG was normal with reversal of symptoms and regression of wall motion abnormalities at echocardiography. According to investigation results, a diagnosis of tako­tsubo syndrome (TTS) was established.

Conclusion: Tako-tsubo cardiomyopathy often presents as an acute coronary syndrome with ST segment changes, as ST-segment elevation and/or T-wave inversion. Clinical presentation is characterized by acute coronary artery disease, in the absence of obstruction, verified by coronarography.Diagnostic methods are very important to make true decision of Tacotsubo cardiomyopathy.

Open Access Case Report

The Esophageal Diverticulum: About Two Cases

Yasser El Brahmi, Youssef Achour, Mohammed Rebbani, Abdelkader Ehirchiou, Abdelmounaim Ait Ali

Journal of Advances in Medicine and Medical Research, Page 59-64
DOI: 10.9734/jammr/2020/v32i1330553

The hypopharyngeal diverticulum of the cervical esophagus, also knows as Zenker's diverticulum, is the most common esophageal diverticulum. It develops at the junction of the hypopharynx and the esophagus. The most present symptom is dysphagia. Between the period of 01/01/2018 to 31/12/2018, we accessed two patients with esophageal diverticulum.both underwent surgical treatment - diverticulectomy at department of the visceral surgery II of the Military Hospital Mohamed V of Rabat.Morocco.

The aim of this report is to evaluate the diagnostic methods and the surgical outcomes by comparing them to others technics used in the treatment of the esophageal diverticulum.

Open Access Original Research Article

Uterine Artery Doppler Screening in 2nd Trimester of Pregnancy for Prediction of Pre-eclampsia and Fetal Growth Restriction

Nafisa Anwar Mariana, Tanzina Iveen Chowdhury, Tasrina Rabia Choudhury

Journal of Advances in Medicine and Medical Research, Page 7-22
DOI: 10.9734/jammr/2020/v32i1330548

Background: Pre-eclampsia is a pregnancy specific disorder characterized by hypertension and proteinuria after 20 weeks of gestation. Uterine artery Doppler velocimetry analysis has been extensively studied in the second trimester of pregnancy as a predictive investigation for the future development of pre-eclampsia and Fetal Growth Restriction.

Aims: To predict the probability of developing pre-eclampsia of pregnant women and Fetal Growth Restriction in relation with normal and abnormal Doppler velocimetry of uterine artery at 2nd trimester of pregnancy.

Methods: A total of 97 pregnant women of 2nd trimester of pregnancy were included in this study. After taking informed written consent of the participants, all they underwent uterine artery Doppler velocimetry at 22nd and 24th week of pregnancy. They again examined clinically during delivery at different gestational age. Pre-eclampsia (PE) was diagnosed on the basis of measurement of blood pressure as well as urine routine and microscopic examination. Fetal Growth Restriction (FGR) was determined by measuring birth weight and gestational age at the time of delivery. Development of PE and FGR was observed in relation to severity of Uterine Artery Doppler Velocimetry findings. A pre-structured data collection sheet was used as a research tool for data collection. Statistical analyses of the results were obtained by using windows-based computer software devised with Statistical Packages for Social Sciences (SPSS-23).

Results: More than half (52.6%) of the subjects belonged to age 21-25 years and 52(53.6%) subjects were nulliparous. More than half (56.7%) of the subjects came from low income group family. Pre-eclampsia developed 11(11.3%) of the patients, 15(15.5%) had FGR and 12(12.4%) had notching in 2nd UADV at 24th week. Presence of Pre-diastolic notch in 2nd UADV study at 24th week to predict pre-eclampsia has sensitivity 72.7%, specificity 95.4%, accuracy 92.8% and positive predictive values 66.7% and negative predictive value 96.5%. Presence of Pre-diastolic notch in 2nd UADV study at 24th week to predict FGR has sensitivity 20.0%, specificity 89.0%, accuracy 78.4% and positive predictive values 25.0% and negative predictive value 85.9%. The mean age was 28.69±7.81 years who had per-diastolic notch in 2nd UADV at 24th week and 24.13±6.11 years who had normal UADV and the p value is 0.022 which is significant. The mean para was 1.29±0.33 who had per-diastolic notch in 2nd UADV at 24th week and 1.77±0.29 who had normal UADV together with remarkable p value which is 0.001. The mean BMI was 23.59±1.09 Kg/m2 who had per-diastolic notch in 2nd UADV at 24th week and 21.57±0.47 Kg/m2 who had normal UADV with notable p value 0.001 in this study.

Conclusion: Uterine artery Doppler velocimetry in early pregnancy can be a good investigating tool for prediction of subsequent development of pre-eclampsia and Fetal Growth Restriction.

Open Access Original Research Article

Application of Call Centre as COVID 19 Alert and Surveillance System in Pastoralist Communities of Somali Region of Ethiopia

Olusola Oladeji, Bibilola Oladeji, Abibakar Sheikaden Ismail, Ahmed Abdi

Journal of Advances in Medicine and Medical Research, Page 23-28
DOI: 10.9734/jammr/2020/v32i1330549

Aims: Ethiopia recorded the first confirmed case of COVID 19 pandemic on 13th March 2020 and the surveillance and alert systems were immediately activated. In Somali Region, the toll-free call center was used as alert and surveillance system in addition to the routine health facility surveillance system because of poor coverage of health facilities and pastoral lifestyle in the region.

Study Design: This was a retrospective chart review of COVID 19 alerts and surveillance database. 

Place and Duration of Study: Somali Region between 13th March and 30th June 2020.

Methodology: A retrospective chart review of alert database from the two COVID 19 alert and surveillance systems. The sensitivity for each system was calculated as the proportion of confirmed cases and test of association was done using chi-square test at significant level of 5%.

Results: 414 alerts were reported during the study period, 259( 62.5%) alerts  from the  toll-free call centre,(49.3%) of which  met the criteria as  suspected cases and  22(8.5%) confirmed positive for COVID compared to 155( 37.5%) alerts from the health facilities,145(50.7%)  of which  met the criteria as suspected cases and  43(27.7%) confirmed positive. The positivity rate was statistically significant, p=0.045. However, alerts were received from all the 11 zones in the region through the call centre compared to six zones through the health facilities.

Conclusion: The call centre is an effective system with wide coverage for monitoring alerts and can be explored as a long-term  surveillance  system  during disease outbreaks and other public health interventions post COVID pandemic.

Open Access Original Research Article

Second Hand Smoke Exposure among Pregnant Women in Nigeria

Obinna Francis Onunkwor, Sami Abdo Radman Al- Dubai, Hassana Ojounba Shuaibu

Journal of Advances in Medicine and Medical Research, Page 29-36
DOI: 10.9734/jammr/2020/v32i1330550

Background: Despite the ban on smoking in public places in Nigeria, second-hand smoke exposure is common across the country. It is increasingly being viewed as a severe women’s issue because of the high prevalence among women, and its harmful effects on pregnant women. However, second-hand smoke exposure among pregnant women in Nigeria is hugely under-researched.

Aim: This study aims to determine the prevalence of second-hand smoke exposure among pregnant women in Nigeria, and determine their knowledge and avoidance behavior towards second-hand smoke.

Methodology: This cross-sectional study was conducted among 314 pregnant women in ten health facilities in Sokoto state, Nigeria. The health facilities were selected through simple random sampling.

Results: The prevalence of second-hand smoke exposure was 72.9%. The majority of the respondents (61.1%) were exposed to second-hand smoke in homes of others, 20.4% in school, 18.5% in restaurants, 43.3% in their own homes, 49.7% in public transport, 20.4% at work, and 15% in health facilities. Factors significantly associated with second-hand smoke exposure included knowing it causes miscarriage (OR=0.39, 95% CI=0.23 – 0.64, P= <.001), and being able to keep a distance from smokers (OR=0.5, 95% CI= 0.28 – 0.76, P=.002).

Conclusion: This study revealed a high prevalence of exposure to second-hand smoke. Knowledge about the harmful effects of second-hand smoke was one of the significant factors associated with exposure. These findings indicate the need for appropriate education of all pregnant women about the harmful effects of second-hand smoke and adequate enforcement of the ban on smoking in public places.

Open Access Original Research Article

Utilization of an Instructional Package on Patient Safety Culture to Enhance Knowledge of Nursing Students in Two Selected Universities in South-West, Nigeria

Emeghara, Obiageli Christiana, Emeghara Okechukwu, Asonye Christian C. C., Oladapo Rasheed Olawale, Akinlawon Adekemi Quamariyat

Journal of Advances in Medicine and Medical Research, Page 37-45
DOI: 10.9734/jammr/2020/v32i1330551

Aims: The culture of keeping patients safe is a global issue which should be emphasized within the nursing profession. Despite exposure of nursing students to patient safety teachings, its knowledge among nursing students has been low. Re-emphasizing a positive culture of patient safety in classroom is essential in the training of nurses that will provide high quality care. This study was developed to assess the outcome of an instructional package on the knowledge of baccalaureate nursing trainees concerning patient safety culture in two chosen Universities in Southwest, Nigeria.

Study Design: The researchers adopted a two groups nonequivalent pre-test, and post-test quasi-experimental design.

Place and Duration of Study: Babcock University, Ogun State and Afe Babalola University, Ekiti State between March and April 2018.

Methodology: The study participants comprised 143 nursing students from Babcock University (experimental group) and Afe Babalola University (control group). A self-developed questionnaire was employed to obtain data on the knowledge of patient safety culture pre-intervention and two weeks post intervention. Data was examined using Statistical package for the social science (SPSS) and t-test was done at a significance level of P<0.05.

Results: Findings revealed experimental mean knowledge gain of 2.425, while control group mean knowledge gain was 0.110. Significant differences were found in the participants knowledge of patient safety culture between the experimental group and control group (P<0.001) and between knowledge of error reporting in the experimental group (P<0.001). 

Conclusion: Teaching sessions on patient safety culture can improve nursing students’ knowledge about patient safety. The findings of the study recommends that patient safety education should be reinforced in the curriculum of nursing schools, and that supplementary boosting sessions be executed periodically to ensure the  retention of learned materials.

Open Access Original Research Article

ACTH Dependent Cushing’s Syndrome: A 72-Hour Trial of Octreotide will Identify Patients with Pituitary Dependent and Ectopic ACTH Overproduction

Omayma Elshafie, Nicholas Woodhouse

Journal of Advances in Medicine and Medical Research, Page 65-70
DOI: 10.9734/jammr/2020/v32i1330554

Aims: To determine whether the use of an octreotide suppression test will reliably distinguish pituitary from ectopic ACTH overproduction.  Somatostatin receptors are expressed in NETs, but are downgraded in the pituitary as the result of hypercortisolaemia. Octreotide should therefore lower ACTH and cortisol levels in patients with NETs but not in patients with Cushing’s disease and pituitary tumors.

Methodology: A cross sectional study was performed in 13 patents with ACTH dependent Cushing’s (8 women, 5 men) with ages ranging between 21 to 40 years were studied. Serum cortisol concentrations were measured at 0800 hrs before and during the administration of. Octreotide at a dosage of 100 mcg subcutaneously every 8 hours for 72 hours.

Results: The serum cortisol concentrations returned to normal in 4 patients who were later documented to have ectopic disease, two with typical bronchial carcinoids and two with pancreatic NETs and metastatic disease. The other 9 patients had no suppression in serum cortisol concentrations and were documented later to have pituitary tumours.

Conclusion: These results indicate that a short trial of octreotide will identify patients with ectopic disease as evidenced by a fall in serum cortisol levels whereas in those with Cushing’s disease and pituitary tumours serum cortisol levels remains unchanged. 

Recommendation: We recommend all patients with ACTH dependent Cushing’s syndrome have an octreotide suppression test, even if the MRI shows an adenoma, so as to exclude the possibility of a pituitary incidentaloma in a patient with ectopic disease, or false localization from IPSS to the pituitary gland due to ectopic CRH secretion.

Open Access Original Research Article

The Effects of Triazine Herbicides on Critical Peroxide Metabolism Gene Expression in MCF-7 and MCF-10A Cells

Stephen J. DeMartini, Nicole B. DeHart, Jennifer R. Schroeder

Journal of Advances in Medicine and Medical Research, Page 71-82
DOI: 10.9734/jammr/2020/v32i1330555

Aim: To identify the oxidative stress impacts of chloro-s-triazine herbicides on human mammary epithelial cell lines.

Study Design: MCF-7 mammary epithelial carcinoma and MCF-10A mammary epithelial cells were treated with levels of three triazine herbicides in concentrations flanking the US FDA safe levels.

Place and Duration of Study: Department of Biology, Millikin University, in January 2015 through December 2015 and January 2019 through May 2020.

Methodology: We examined the oxidative effects of two triazine herbicides, atrazine and simazine, on estrogen-dependent MCF-7 mammary epithelial carcinoma cells using three different bioluminescent assay techniques. We then utilized real time PCR to analyze gene expression through RT-PCR analysis, in both MCF-7 cells and a non-cancerous cell line, MCF-10A, for both of these triazine herbicides plus the related cyanazine.

Results: At all concentrations of atrazine and simazine, no statistical differences were found in the levels of oxidized glutathione or total oxidized and reduced nicotinamide adenine dinucleotides phosphates. In stark contrast, levels of hydrogen peroxide were found to be statistically different from the control at all concentrations of atrazine and simazine tested. Using an Analysis of Variance (ANOVA) we determined that within the enzymatic portion of the hydrogen peroxide pathway there were statistically significant differences in the expression of Peroxiredoxin 1 (PRDX1), Sulfiredoxin (SRXN1), and Thioredoxin (TXN).

Conclusion: Exposure to triazines alters the hydrogen peroxide pathway, which in turn can greatly affect the stability of the cell milieu.

Open Access Review Article

Clinical Outcome of Intravascular Ultrasound Guided Left Main Coronary Intervention

Mohamed Ezzelregal, Luca Testa, Medhat Alashmawy, Ayman Elsaid, Hanan Kassem

Journal of Advances in Medicine and Medical Research, Page 46-58
DOI: 10.9734/jammr/2020/v32i1330552

Introduction: Intravascular ultrasound is a new imaging modality that facilitate the process of coronary intervention. The angiographic evaluation of left main lesions significance is always questionable, IVUS detect the significance, guide the procedure and some studies proves a benefit in mortality.

Objectives: To investigate whether intravascular ultrasound IVUS guided Left Main coronary intervention could improve clinical outcomes compared with angiographic-guided Left main coronary PCI.

Patients and Methods: This controlled study was carried out between June 2017 and June 2019, in Tanta university Hospital and San Donato Hospital, Milan, 83 patients eligible to Left Main coronary intervention divided into two groups, IVUS-guided group (n=19) and angiographic-guided group(n=64). The occurrence of major adverse cardiac events (MACE): death, non-fatal myocardial infarction, or target lesion revascularizations) were recorded 6 and18 Months of follow-up.

Results: The IVUS-guided group had a lower rate of 18-months MACE than the control group. The incidence of target lesion revascularization was lower in the IVUS-guided group than in the control group. The incidence of TLR after 6 months was not different between both groups (1 cases in IVUS group (5.3%), 6 cases in angiography group (9.4%) (P value 0.686) while the incidence of TLR after 18 months was significantly different between both groups (1 cases in IVUS group (5.3%), 17 cases in angiography group (26.6%) (P value 0.048), However, there were no differences in death, myocardial infarction, stent thrombosis and number of patients treated with CABG in the 2 groups.

Conclusion: The present study demonstrates that IVUS-guided LM angioplasty can improve 18 -months MACE events especially the incidence of target lesion revascularization.

Open Access Review Article

Galen Vein Aneurysm: Problem of Management in an Under-Equipped Neurosurgical Environment about a Case and Review of the Literature

Faye Mohameth, Thioub Mbaye, Mhaks Malangu, Célèbre Mualaba, Mounia Bouih, Lounceny Fatoumata Barry, Ba Momar Code, Badiane Seydou Boubakar

Journal of Advances in Medicine and Medical Research, Page 83-87
DOI: 10.9734/jammr/2020/v32i1330556

Vein of GALEN aneurysmal malformation (VGAM) is a rare congenital disease caused by arteriovenous shunts between the choroidal arteries and the porencephalic ectatic vein. The diagnosis is often made in utero or during infancy, endovascular treatment remains the most suitable therapeutic means in a well-equipped environment. Here we report here the case of a patient complaining of headache for 1 year, and whose brain CT imaging showed the presence of Galen vein aneurysm with associated non-communicating hydrocephalus. In the absence of the appropriate technical platform, the placement of a ventriculoperitoneal shunt relieved our patient’s symptoms.