Journal of Advances in Medicine and Medical Research

Background: Acquired Methemoglobinemia(MetHb) is a rare, but potentially serious and unfamiliarity with this complication may delay diagnosis and appropriate therapy.

Presentation: A case  of methemoglobinemia occurring in male teenage  demonstrator as a complication of re-current  exposure  to ortho-chlorobenzylidenemalononitrile (CS)  in public protests , the patient became cyanotic with a decrease in his level of consciousness, by the effect of hydrogen cyanide as by-product of (CS),  resulting in a  toxic methemoglobinemia level in his blood.  Methemoglobin is incapable of carrying oxygen and is formed when the ferrous iron in the heme molecule is oxidized to the ferric state. The diagnosis should be entertained when cyanosis, unresponsive to 100% oxygen therapy, appears suddenly, especially when exposure to an oxidant agent is established.

Treatment: The patient received a 1 mg/kg dose of methylene blue intravenously. A cooximetry done 1 hour later showed a methemoglobin level of 43%. A second 1 mg/kg dose of methylene blue was given and another hour later the methemoglobin level had dropped to 13%. The patient also showed clinical improvement with resolution of the cyanosis and return of his mental status to baseline.

Conclusion: Methylene blue is the specific antidote, but should be reserved for more severe cases or if co-morbid conditions make mild hypoxia un advisable.

Bilateral olecranon fractures are a rare occurrence. Direct trauma usually results in comminuted fractures and indirect trauma in transverse fractures. We describe a case of bilateral olecranon fracture with a radial head comminuted fracture with coronoid fracture without the involvement of collaterals.  Olecranon fractures are usually a result of direct trauma (fall from height/motor vehicle accidents) or indirect trauma. A 22year old male patient presented to the emergency department with complaints of pain and swelling around both elbows following a motor vehicle accident. The patient also sustained trauma to the head and had a history of transient loss of consciousness. CT brain at the time of presentation was normal and the patient was conscious. The Olecranon Fracture was fixed with a pre-contoured olecranon locking compression plate (Synthes, USA).  In our case, the collaterals were intact and as the radial head was comminuted, we excised the radial head. The radial head being secondary stabilizer of the elbow in injuries to the medial collateral ligament complex. The excision of the radial head would not cause any instability. Bilateral olecranon fractures need to be fixed anatomically, the comminuted radial head was excised and the anterior capsule was repaired.

As a part of global health care system we are now facing an unprecedented increase in the number of COVID positive patients. While the SARS-CoV2 continues to expand its reach, newer information gets reported every day. The phenomenon of acro-ischemia in patients testing positive for SARS-CoV2 has started gathering attention within the medical community. Also, with increased need for tracheostomy HCWs (health care workers) are constantly at a high risk of aerosol exposure. We report a case of a critically ill, late detected, COVID positive male, with dermatological signs who landed in a tracheostomy. We aim to highlight the importance of high index of suspicion and early detection that would make a significant difference.

COVID-19 was first reported in Wuhan, Hubei Province of China a few months ago (December 2019) and had since become a major challenging public health problem for not only China but also many countries around the world. It was on March 11, 2020, characterized by WHO as a pandemic. The pandemic so far has killed more than 526,465 people and infected more than 11,046,917 people around the world as of 05 July 2020. Nigeria currently has 28,167 confirmed COVID-19 cases with 11,462 (40%) discharged, 16,071 (57%) currently receiving treatment at designated facilities across the country and unfortunately 634 (3%) deaths as at the time of writing this manuscript. As far as the authors are aware, there are little or no work carried out on the implications of COVID-19 on dental practices in Nigeria. Recently, COVID-19 was identified in saliva of infected patients and so transmission via aerosols and splatter generated during dental procedures is sure. To limit exposure, there was a need to avoid scheduling patients except for emergency dental care during this outbreak. This limitation on activities of the dental sector has a very huge impact on the economy of the sector as it has already resulted in serious monetary implications for dental practices worldwide. While dental practices in the high-income countries are getting help from their respective Government, those in the middle and low-income countries like Nigeria have been left to wallow in bankruptcy without support. The authors highly recommend that the Government of these neglected countries, step up and support dental practices that are on the brink of closing down due to the low turnout of patients to their practice during this outbreak.

Background: Early recognition and appropriate treatment of shock have been shown to decrease mortality. Incorporation of bedside ultrasound in patients with undifferentiated shock allows for rapid evaluation of reversible causes of shock and improves accurate diagnosis in undifferentiated hypotension. The aim of the present study was to evaluate efficacy of fluid administration followed by lung sonography in hemodynamic assessment in acute circulatory failure in critically ill patients.

Materials and Methods: This prospective cohort controlled randomized study was carried out on 50 Critically ill Patients who had acute circulatory failure in intensive care unit Tanta university hospital Critically ill patients of either sex aged 21-60 years when mean blood pressure was below 65 mmHg were included. Patients have been uniformly distributed in 2 categories, The patients assigned either to the Control Group (group I) or to the FALLS (fluid administration limited by lung sonography) protocol group (group II).

Results: Comparison between two groups revealed that, the heart rate showed that heart  rate  is  lower  in  group  II  in  comparison  to  group  I  .Comparison between two groups revealed that, the mean arterial blood pressure changes showed that it is higher in group II in comparison to group I .Comparison between two groups revealed that, the Central venous pressure showed that no significant difference in the base line .Intensive care unit stay in group I ranged between 5 – 11 days while in group II ranged between 3 – 8 days .Survival analysis (Kaplan Mier curve), Mortality at 28 days found in group I mean 21.28 days with SE 1.898 and in group II mean 24 days with SE 1.64 with no significant difference in time but there was significant difference in number of mortalities as discussed before.

Conclusion: We conclude from this study that bedside Lung Ultrasound has a good accuracy and superiority in assessment over other traditionally used methods for detecting early signs of pulmonary congestion and thus guides the fluid administration in shock management to decrease complications, mortality and intensive care stay.

Background: Triple-negative breast cancer (TNBC) is a hostile sub-type consisting of nearly 10-20 % of breast cancer patients. TNBC has been known to have a poor prognosis and overall survival (OS) compared to many other breast cancer tumors categories. These tumors are highly aggressive and have a higher risk of early recurrence. Nevertheless, no evidence exists to date and this is also the situation in Saudi Arabia. Recently, it was found to be a heterogeneous disease.

Objective: To subtype breast cancer (BC) following the recent advance molecular classification, and to ascertain the correlation of those sub-types with pathological parameters and to study triple-negative breast cancer and its correlation with other subtypes and its association with recurrence and poor prognosis.

Methods: The study was performed on 740 breast cancer patients at the Department of Pathology, King Abdulaziz University Hospital (KAUH), Jeddah, Kingdom of Saudi Arabia diagnosed between 2005 to 2018. The parameters like Estrogen receptor (ER), Progesterone receptor (PR), and human epidermal growth factor receptor immunostaining were analyzed semi-quantitatively to establish the HER-2, triple-negative, molecular subtypes of luminal A and B in paraffin-embedded sections of BC. We review the histopathology report, tumor invasion, grade, margin, type of surgery, recurrence, metastases, and survival rate.

Results: The most common sub-types were luminal B (19.7%), followed by triple-negative breast cancer (10.9%) and HER2-positive (9.5%), whereas luminal A was the least common subtype (8.1 %). In luminal A majority of their age less than or equal to 50 years, most of these subtypes have tumor invasion, 59.2% of triple-negative breast cancer had positive axillary lymph node involvement. 63.4 % of triple-negative breast cancer had grade 3 tumors most of the recurrence in luminal B.

Conclusion: The biological behaviors of each molecular subtype is likely to be with characteristic pathological features. In addition to molecular sub-typing and further prognostic indicators, might be useful in investigating the prognosis and management of BC patients. The early diagnosis and screening of BC are recommended in our population.

Introduction: Created from Brazilian social and sanitary movements, the Unified Health System (SUS) has changed the concept of health, its management, and how society should actively participate in this process. Portrait n. 154, dated January 24, 2008, created the Family Health Support Centers (NASF), and with it emerged the need to organize the professional practices of Physical Therapy in all actions of its responsibility, through the Health Strategy of the family. Physical Therapy in Basic Health Care is a process under construction that faces challenges since the physiotherapist is trained for rehabilitation.

Objective: To demonstrate significantly the importance of the physiotherapist in the Family Health Support Center.

Materials and Methods: This is a qualitative bibliographic review with an exploratory design, carried out through a bibliographical survey related to the theme The Importance of Physical Therapist Performance in the Family Health Support Center, published since 2006, in the Portuguese language. The descriptors were: Physiotherapist; Family Health; Primary Health Care; Public health for search. The exclusion attributes were: publications inferior to the year 2006 and that flee from the selected theme. The surveys will be carried out in the following databases, Medline, VBS, Lilacs, Scielo, Google Scholar, and Official Sites of the Government of Brazil.

Conclusion: The physiotherapist when inserted within the NASF (Family Health Support Nucleus) team is a fundamental piece, fulfilling its role in primary care investing in the promotion and prevention of diseases and their diseases, recovery, rehabilitation and quality improvement of life of the population, with an integral practice that per passes by the education in health, reception, individual attendance. The literary shortage when the subject is Basic Attention mainly in what concerns the NASF, making difficult the understanding of the importance and the role of preventive Physiotherapy in this context. For physiotherapy to be increasingly recognized, the training of professionals capable of acting in this area should be encouraged.

Introduction: Coronary artery disease (CAD), stroke and peripheral artery disease (PAD) are commonly referred to as cardiovascular disorders (CVD) due to a common underlying pathophysiology of atherosclerosis and are more common in diabetic patients. This study was carried out to determine the pattern and associated factors of CAD and PAD in asymptomatic patients with  type 2 diabetes mellitus in South east Nigeria.

Materials and Methods: One hundred and twenty stable adults with type 2 diabetes mellitus  were recruited consecutively from two out-patient clinics in two tertiary hospitals in South east Nigeria at Nnewi and Enugu. They were assessed for risk factors for CVD including hypertension, obesity and dyslipidaemia. Their ankle-brachial index (ABI) was measured using a hand-held doppler and they also had a 12 lead ECG. Results were analyzed using SPSS V23; p value of < 0.05 considered significant.

Results: There were 60 males and 60 females, with a mean age of 61.7(11.2) years and mean diabetes duration of 127.7(99.9) months. Dyslipidaemia was present in 73.3%, 70% had hypertension, PAD was present in 55.8%, while 16.5% had CAD. PAD was more common in those with higher BMI (p = 0.04), higher diastolic BP (p = 0.03) and higher mean arterial pressure (p = 0.03). On further multivariate stepwise regression analysis, there was no significant predictor of PAD. None of the clinical factors were associated with CAD.

Conclusion: PAD and CAD are common in patients with type2 DM even in the absence of symptoms. Obesity, high diastolic and high mean arterial pressure are more common in patients with PAD.

Introduction: It is generally believed that Cyperus esculentus (tiger nut) has some fertility boosting effects. However, scientific validation of some of the fertility boosting potentials as well as the ameliorative effect of tiger nut on Benign Prostate Hyperplasia (BPH) is lacking.

Objective: The aim of the project is to determine the effect of tiger nuts in reproductive function in rats induced with Benign Prostate Hyperplasia (BPH).

Methods: A total of sixty (60) male rats weighing between 160 – 200 g were used in this study. They were divided into six groups of ten rats per group. Benign prostate hyperplasia was induced in three groups of the rats (as stated in methodology) with 30 mg/kg sub-cutaneous injections of hormones containing dihydrotestosterone (DHT) and estradiol valerate dissolved in olive oil in the ratio of 10:1 (three times in a week, one day interval). Administration of tiger nut meal commenced immediately and lasted for two months. At the end of administration, assay of reproductive hormones (FSH, LH and Testosterone) was done. Comprehensive semen analysis was also done including (count, motility & morphology).

Results: The study showed that the induction of BPH resulted in a very significant reduction of FSH while the administration of the tiger nut meal did not show any significant effect on FSH (P 0.05). The same trend was also observed on the effect of the tiger nut meal on LH level. For testosterone, it was observed that after the initial decrease as a result of the induction of infertility, 20% tiger nut meal administration significantly increased the testosterone level to 2.10±0.06 ng/ml from 0.30±0.01 ng/ml in the infertility-induced group. The effect of tiger nut meal on semen analyses namely, normal sperm cells and sperm motility showed a significant increase (P<0.05) following the induction of infertility. The effect of the tiger nut meal on sperm morphological toxicities were also examined. Sperm abnormalities like sperm cells with twisted tails were examined.

Conclusion: The administration of tiger nut significantly ameliorated the abnormalities and thus, restored the morphology of the sperm cells such that it can enhance fertility.

COVID-19, a disease caused by SARS-CoV-2 has become a public health emergency affecting more than 215 countries worldwide. It originated from Wuhan district of China and in a very short span of time, it has spread rapidly causing millions of deaths worldwide. India reported its first case on 30^th January 2020 and since then the numbers have been increasing exponentially every day. As of 9^th August 2020, India had recorded 21, 09,631 confirmed cases and 43,379 deaths. Because of the complex dynamics involved in its infection and immunity, proper diagnosis is imperative in order to unravel this ongoing mystery. It has clearly told us the importance of establishing and strengthening a strong network of molecular virology laboratories in the country enabling us to strengthen the diagnostic arm which is the first step in disease control. The addition of serological tests has helped in surveillance and also to estimate the overall burden of disease.