Journal of Advances in Medicine and Medical Research

Wallenburg syndrome occurs due to damage to lateral segment of the medulla. Medial medullary syndrome occurs due to damage to upper portion of the medulla. I report a case of a 30 years old woman diagnosed with medullary syndrome [both medial & lateral features] in absence of CT scan findings sent to the department of Physiology for electrophysiological tests like nerve conduction studies, blink reflex, brainstem auditory evoked potential (BERA) & visual evoked potential (VEP). She had loss of sensations on the ipsilateral half of face (right), hemisensory loss on contralateral trunk & extremities, headache, contralateral hemiparesis (left), ipsilateral lingual paresis with atrophy, fibrillations with contralateral positive Babinski’s sign. The electrophysiological tests showed decrease in conduction velocity of right facial nerve, left tibial & peroneal nerves with decreased amplitude. The nerve conduction studies of median nerve (both motor & sensory) were normal. In blink reflex, latency of R2 ipsilateral & R2 contralateral of supraorbital nerves were increased on right side. There were increased latencies of waves II, III, IV & V of BERA & increased P100 latencies in VEP.

The results of the electrophysiological tests of the patient showed that she had features of both medial & lateral medullary syndrome suggesting a lesion of both upper & middle medulla. The CT scan in this case was normal but conduction of MRI & CT guided angiography of posterior cerebral & vertebral arteries could have further localized the lesion causing this mixed symptomology.

This systematic review (SR) synthesises recent evidence and assesses the methodological quality of published SRs in the Differential diagnosis of temporomandibular disorders (TMD). A systematic literature search was conducted in the PubMed, Cochrane Library, and Bandolier databases for 1987 to September 2019. Three investigators evaluated the methodological quality of each identified SR using two measurement tools: The assessment of multiple systematic reviews (AMSTAR) and level of research design scoring. Thirty-one SRs met inclusion criteria and 28 were analysed: 20 qualitative SRs and eight meta-analysis. The main aim of this article is to Differential diagnose the pain which is not related to any dental disease. Most of dental clinician have problem to diagnose TMD (Temporomandibular Disorders) and Orofacial Muscle pain. The approach of this article is to simplify the differential diagnosis for better and fast treatment of the respective disease by classifying various TMJ related and muscle related problems.

Background: Malnutrition among under-five children have significant interest for the health authorities in Sudan. This is considered by the fact that the prevalence of underweight children in Sudan is among the highest in the world and it is essential to determine its prevalence and causes, as this problem affects the future of the under-five children and the community as general. This review aimed to assess the prevalence and causes of undernutrition among under-five children in Sudan.

Methods: Published data such as peer-reviewed articles, published dissertations and official reports on malnutrition and its causes among under-five Sudanese children during the last twenty years, were collected from Science Direct, Google Scholar, PubMed, and others. The information restored was reviewed and analyzed for inconsistency.

Results: Data shows that the prevalence of under-nutrition among under-five children was high and diverse widely, and the majority of the studies were carried out in Khartoum state, which showed the prevalence of wasting (3.3 to 21.1%) stunting (20.3 to 51.0%), severe stunting (12.9 to 25.2%) and underweight and severe underweight represent 24.4 to 35.0% and 6.6 to 48.0%, respectively. The prevalence rate of malnutrition was reported to be 14.1, 23.6, and 10.7% in South Darfur IDP camps, while in North Darfur it was 14.7, 48.9, and 35.6%, for wasting, stunting, and underweight, respectively. In El Fau, Gadarif state the prevalence of moderate and severe malnutrition of the under-five children were 6% and 3.3%. Many causes were reported for malnutrition among the under-five children including bad feeding practices, childhood diseases, hygiene and sanitation, and low socioeconomic status.

Conclusion: The prevalence rate of undernutrition among the under-five Sudanese children was very high, and stunting is the main shape of malnutrition. Many causes were contributed to under-five malnutrition and improvement in infant feeding and better maternal education are significant to get a high nutritional status of the children.

Introduction: An acute phase response to tissue injury leads to release of pro inflammatory and anti inflammatory cytokines. TNF alpha  is an early pro inflammatory cytokine that released in SIRS and largely responsible for clinical manifestation of sepsis. The release of TNF alpha is influenced by messenger RNA transcription of TNF alpha gene. In patients with severe sepsis genomic polymorphism with in the TNF locus found to be associated with TNF alpha production and outcome.

Objectives: To evaluate genetic polymorphism of TNF alpha gene at c 850 t locus, influence on TNF alpha expression and on outcome.

Materials and Methods: A prospective cohort study conducted at our institute between June 2007 to 2009 in 100 cases. Serum TNF alpha levels measured by using ELISA .TNF alpha polymorphism done at c850t locus in 100 patients and were compared with 70 controls who were normal subjects. By using MEDCALC software mean and standard deviations were calculated, continuous variables were compared using t-test. ROC curves were used to determine the predictive capability of the variables.

Results: The most common polymorphism observed was CT in 51 patients.  The significant different TNF alpha level expression between the three groups were observed. Significant Tallele was observed in cases (100) when compared with controls (70), p= 0.0002.

Conclusion: Genetic polymorphism of TNF alpha gene may play critical role in stress response and outcome of the patient but it needs to be validated in large number of population.

Objective: Describe the epidemiological profile of patients seen in an outpatient clinic in a region of the Amazon.

Methodology: A cross-sectional, exploratory, descriptive survey with a quantitative approach, conducted in an outpatient clinic of health specialties of a Private Higher Education Institution (HEI) of Belém-Pará, from February to March 2019. With a range of 100 participants. From the application of a form on the socio-demographic, health and food profile. The data were analyzed by Bioestat version 5.3.

Results: 65% female, average age 43, 67% up to a minimum wage, 54% single, 51% with complete high school, 86% from the metropolitan region of Belém, 76% own a home, 75% have basic sanitation, 56% have running water, 50% with a family group of 4 to 6 members, 81% are not smokers, 59% are not alcoholics, 93% have no health plan, 42% in medical treatment, 72% report complete immunization, 79% 3 to 4 meals/day, 59% do not consume canned food, 62% consume fried food weekly, 52% consume fruit and vegetables daily, 60% consume red meat weekly, 51% consume white meat weekly, 50% do not consume soft drinks, 37% do not practice physical activities.

Conclusion: Are young adults, with low schooling, low income, inadequate nutrition, who do not engage in physical activities, however most of them have a current vaccination picture, and inadequate basic sanitation. These are determining factors in the quality of life of these individuals, being characteristics of a developing country, and that health interventions and policies should be implemented to promote health.

Introduction: There are varied scrotal findings in subfertile males of which ultrasonography is a readily available, non-ionizing and reproducible imaging modality of choice for proper assessment.

Aim: To identify the patterns of scrotal ultrasonographic findings in suspected subfertile males in Enugu. 

Study Design: A comparative cross sectional prospective study. 

Place and Duration of Study: Department of Radiation Medicine University of Nigeria Teaching Hospital (UNTH) Enugu, between July 2019 and February 2020. 

Methodology: 130 adult males comprising 65 suspected subfertile males and 65 normal adult males were recruited for this study. Ultrasound scanning was done on research participants using 5.0-7.5 MHz linear transducer on a mobile “ALOKA” ultrasound machine. The obtained data were coded, validated, and analyzed using Statistical Package for the Social Sciences SPSS software, version 24, percentage, analysis of variance (ANOVA) and t test. A P-value of less than 0.05 was considered statistically significant. 

Results: A total of 130 subjects were scanned. The mean age was 41.2years. The mean testicular volume was 10.01±4.09 cm^3. There was a wide variety of findings in the assessed subfertile males ranging from normal to inhomogeneous testicular echotexture and varicocoele. Varicocoele was the commonest finding accounting for 50% of other findings, followed by hydrocoele (22%), then 10% had inhomogeneous echotexture while microlithiasis, undescended testis as well as epididymal cyst all had 6%. 

Conclusion: Ultrasonographic evaluation of testis is invaluable in the assessment of patterns of findings in male subfertility. Varicocoele was the commonest sonologic finding among the suspected subfertile males. This is reassuring as varicocoele is readily treatable cause of subfertility compared to complex multifactorial causes of female subfertility.

Background/Purpose: Malaria is an established health challenge and a major cause of mortality and morbidity among under-five children in Nigeria. This community-based study was designed to assess the effect of health education packages on the malaria control practices of mothers of under-five children in Ibeagwa Nike Enugu State.

Methods: The study utilized a quasi-experimental study design with a sample size of 124 mothers that attended the infant welfare clinic at the community health center and those that received treatment of minor childhood illnesses for six months. A multistage random sampling technique was used in choosing the required samples. The instrument for the collection of data was a self-adapted and validated questionnaire. Reliability was assessed and yielded a Cronbach’s correlation coefficient of 0.823. Data generated were summarized using simple descriptive statistics of frequencies and percentages and analyzed using Fishers’ exact test and Chi-square.

Results: Findings of the study showed that: the practice of malaria control practices was very low below 40% before health education intervention; malaria control practices increased significantly above 40% after the health education intervention; hindrances to the practice of malaria control measures reduced after the health education intervention; there is poor awareness of environmental hygiene as a method of malaria control measure before health education.

Conclusion: Periodic health education on the importance of malaria control practices should be conducted in the community regularly, to promote control of malaria.

Introduction: Tracheostomy is one of the most common procedures that done to critical patients such as head injury ones to improve their situation. It is done by creating an anterior stoma in the neck and inserting a short tube to maintain stoma open.

Objective: The objective of this study was to determine if there were benefits of early tracheostomy and the following components: ICU stay, hospital stay, ventilation- associated-pneumonia, weaning from Mechanical Ventilator, Glasgow Coma Scale, and decannulation.

Methods: This study was done retrospectively, and non-random sampling involved 56 head injury patients with a tracheostomy who were admitted to ICU in King Abdulaziz medical city (KAMC). Out of 56 head injury patients who underwent an early tracheostomy (≤12 days) were 25 patients and late tracheotomy (>12 days) were 31 patients. Using data collection form which contains demographic data, intubation duration, tracheostomy, decannulation, MV, Glasgow coma scale, VAP, ICU, and hospital stay.

Results: Total of 56 head injury patients with tracheostomy; their age ranges from 18-80 years with the mean 41.77years, height 168.95cm, and weighs 69.07kg. Head injury patient in this paper was classified according to the day that was done the procedure on after the injury occurred. Which result in 25 patients had early tracheostomy ≤12 days with a mean of (9.8 days) and median (10), whereas 31 patients had late tracheostomy >12 with mean of (17.677 days) and median (16).Patients with early tracheostomy showed significant (P-value <0.05) less length stay in ICU (22.68 days), MV duration (15.16 days), decannulation (27.80 days) compared with late trach ICU stay (33.10 days), MV duration (28.10 days), decannulation (47.03 days). VAP incidence among patients with a late trach was 12.90% and there were no VAP with an early trach. The median in early tracheostomy patients did not show any improvement in GCS (6 before trach,7 after trach) while in the late trach (7 before thrach,8 after trach). The hospital stays showed an insignificant p-value which means there were no differences between the early and late tracheostomy. 

Conclusion: Early tracheostomy for head injury patients associated with less MV time, less VAP, shorter ICU stay, and faster decannulation. However, there was no significant effect on hospital stays period and no improvements on GCS.

Background: Fracture femur is common in elderly. Spinal anesthesia (SA) in elderly patients can be associated with major hemodynamic changes whereas lumbar plexus block (LPB) can provide ideal perioperative analgesia as there is no hemodynamic instability or depression of pulmonary functions. The purpose of this study is to compare the efficacy of SA versus LPB for intraoperative anesthesia and postoperative analgesia in fracture femur surgery.

Materials and Methods: This prospective randomized controlled study was carried out 70 patients of either sex with age >20 years, ASA physical status I - III scheduled for fracture femur surgery. Patients were randomly classified into two equal groups (n = 35); group I (SA) received SA by heavy bupivacaine HCL 0.5% 2.5-3.5 ml and group II (LBP) received posterior LPB by 30-35 ml bupivacaine 0.5%.

Results: The time for performing the block was significantly longer in group LPB than group SA. The onset of sensory and motor block was significantly increased in group LPB than group SA. The intraoperative HR was significantly increased, and intraoperative MAP was significantly decreased in group SA compared to group LPB at 5, 10, 15, 20, 25 and 30 minutes. Postoperative HR and MAP was significantly increased in group SA compared to group LPB at 1 and 6 h. Postoperative VAS was significantly increased in group SA than group LPB at 1 and 6 h. The duration of sensory and motor block was significantly increased in group LPB than group SA. The time of postoperative first analgesic requirement was significantly longer and the total pethidine consumption in the 1^st 24 h was significantly lower in group LPB than group SA. SA was associated with significant increase in hypotension, nausea, vomiting and headache.

Conclusion: LPB is an effective alternative to SA as an anesthetic technique for femur fracture surgeries. LBP offers a more stable intraoperative hemodynamics and provides longer duration of analgesia postoperatively with less side effects. However, SA has shorter time for performing the block with earlier onset of sensory and motor block.

Tuberculosis has re-emerged as a serious health concern as a result of AIDS epidemic, immigration from areas where the disease is endemic and multi drug resistance, with 8.8 million patients affected worldwide in 2010. Infections with mycobacterium tuberculosis (MTb) are globally prevalent in many countries, yet descriptions of placental pathology in tuberculous patients are few. Moreover, the diagnosis of tuberculosis in pregnant patients can be missed or delayed owing to the insidious onset and variability of clinical presentation, often overlapping with non-specific symptoms common in pregnancy such as loss of appetite, malaise and lethargy. The exact incidence of tuberculosis in pregnancy is not readily available in many countries due to confounding factors. However, it is expected that the incidence of tuberculosis in pregnant women is high as in general population, with higher incidence in developing countries. Placental tuberculosis shows predominantly neutrophilic and histiocytic response in the form of villitis and intervillitis which is due to the innate immune response. This innate response contributes more to tissue injury than protection as proved in our case, where it led to intrauterine death of the fetus. We, hereby report a case of placental tuberculosis, diagnosed on histopathological examination of placenta showing caseating epithelioid cell granulomas with langhan’s giant cells and Acid Fast Bacilli on Zeihl Neilson stain.

Background: Breast cancer is the leading cause of death globally in women between 44 – 50 years. As a result of poor awareness, late presentation is often times common amongst women with breast cancer in developing countries of the world as such outcome is poor.

Aim: To determine the awareness and early detection of ante natal clinic attendees towards breast cancer at the Rivers State University Teaching Hospital (RSUTH), Port Harcourt, Nigeria.

Methods: This was a cross-sectional study of ANC attendees at the RSUTH. Simple randomized sampling method was used. A structured pre-test survey questionnaire The information was analyzed using SPSS version 25.

Results: A total of 180 questionnaires were distributed and 176 questionnaires retrieved. The mean gestational age was 32.4 years. The modal parity was 1. With respect to the educational level, tertiary were 129 (73.3%), secondary 43 (24.4%) and primary 4 (2.3%). Those aware of breast cancer were 159 (90.3%). Means of information by the subjects for breast cancer prevention were media 96 (54.6%), hospital 39 (22.0%), religious house 3 (3.8%) and others 38 (19.6%) Antenatal mothers who carried out self breast examination for detection of breast lumps were 95 (54%). Subjects who were aware of mammogram were 42 (23.9%) while those who had mammogram in the past were 2 (1.1%). ANC attendees who had family history of breast cancer were 7 (4%). The relationship between breast cancer awareness and educational status were as follows, tertiary 123 (69.9%), secondary 34 (19.3%), primary 2 (1.1%).

Conclusion: Though the level of breast cancer awareness was high 90.3%. Self breast examination for early detection of breast cancer was above average (54%), while the use of mammogram for early detection of breast cancer was still not encouraging represented by 1.1% of the respondents. The media was the commonest medium of awareness for the prevention of breast cancer represented by 54.6% of the ante natal clinic attendees.

Introduction: Obstructed labour is a major cause of maternal mortality. Admissions into the intensive care unit (ICU) especially for post-delivery monitoring and treatment of patients with obstructed labour entails critical care for favourable outcome for the mother.

Aim: To evaluate the maternal outcome of mothers admitted into the intensive care unit who had obstructed labour at the University of Port Harcourt Teaching Hospital (UPTH).

Methodology: The study was a retrospective study of all the cases of obstructed labour admitted into the ICU of UPTH between 1^st January, 2007 to 31^st December, 2016. Information were retrieved from the patients case note and analyzed using SPSS version 20.

Results: A total of 1549 patients were admitted into the ICU for the period under review, of which 218(14.1%) were obstetric admissions. One hundred and forty were unbooked mothers while 78 were booked. The mean age was 30 ± 2 years and the modal parity was 2. All the 64 cases of obstructed labour were unbooked mothers and comprised 29.4% of the obstetric admissions. The number of maternal deaths from obstructed labour were 23, which comprised of 10.6% of the obstetric admissions.

Conclusion: The study revealed that the maternal deaths following obstructed labour admitted into the ICU was high. The reason is that these patients present late. There is therefore need for patients at risk of obstructed labour to register for antenatal care early and delivery conducted by skilled birth attendant for improved outcome.

Introduction: Female Genital Mutilation (FGM) or Female Circumcision (FC) have been influenced by religion, culture and medicine. The practice of FGM have been associated with myriads of negative health consequences, resulting in its abolishment by the World Health Organization (WHO). This is unlike male circumcision which is well accepted by most religions of the world, culture and medically.

Aim: To ascertain the influence of religion, culture and medicine as regards FGM amongst antenatal clinic (ANC) attendees at the Rivers State University Teaching Hospital (RSUTH).

Methods: It was a cross sectional study of ANC attendees at The RSUTH. The Information was retrieved using a self structured questionnaire which was coded and analyzed using SPSS version 25.

Results: A total number 84 ANC attendees were recruited for the study. The mean age was 30.7 years and the modal parity was 1. The mean gestational age was 15.8 weeks. Twenty (23.8%) respondents had FC, all of whom were Christians. Eighteen (21.4%) of the respondents were of the opinion that FGM was a good practice; while 66 (78.6%) respondents believed that FGM was a wrong practice. The 2 most common reasons for FGM were to prevent promiscuity 7 (8.3%) and cultural reasons 7 (8.3%). The commonest known complication by respondents following FGM was  bleeding  from the genital tract 24 (28.6%).

Conclusion: The prevalence of FGM from the study was 23.8% amongst ANC attendees at the RSUTH. Religion, culture and medicine may play vital roles in the eradication of FGM in our sub-region as recommended by WHO.

Introduction: The importance of contraception amongst adolescents cannot be over-emphasized especially as it concerns reproductive health. Globally, these group of persons are vulnerable and engage in high risk sexual behaviour with little or no access to contraception particularly in the developing countries of the world.

Aim: To determine the access to contraception amongst female adolescents in Rivers State. 

Methods: It was a cross sectional study of female adolescents attending holiday camp in Port Harcourt, Rivers State. Questionnaires were distributed and information coded and analysed using SPSS version 22.

Results: One hundred questionnaires were distributed and 89 retrieved. The mean age was 16 ± 2 years. Fifty seven (64.0%) were in secondary school while 32(36.0%) of the adolescents were undergraduates. Twelve (13.5%) were sexually active compared to 69 (77.5%) who were not sexually active, 8 (9%) were non respondents to this question. One (1.1%) of the adolescents had access to contraception while 85 (95.5%) had no access to contraception, 3 (3.3%) did not give any response as regards to access to contraception or not. The media was the most common means of information 25 (28%) on contraception.

Conclusion: The study revealed that access to contraception amongst female adolescents in Port Harcourt was poor. Enlightenment programme is highly recommended to prevent unwanted pregnancies, sexually transmitted infections and other adverse effects on reproductive health.

Background: There is need to educate the pastors and the church congregation for the need for skilled birth attendants to handle pregnancy and labour related challenges in other to reduce maternal and perinatal mortality.

This is because, in some “maternities” in Nigeria traditional birth attendants (TBAs) attend to pregnancy related cases and in some instances these unconventional practices are extended to the local churches.

Aim: To determine cases of TBAs practicing in churches and help prevent these unconventional obstetrics practices thus preventing maternal and perinatal motality.

Methods: It was a cross-sectional study of TBAs across all 23 local government areas of Rivers State in a lecture to prevent maternal death in the month of June 2019 in Port Harcourt, Rivers State.

Information was coded and analyzed using SPSS version 25.

Results: Forty questionnaires were distributed and 37 retrieved.  The mean age was 44 years.

They were all females.  All of them were Christians.

Their modal age of practice was 1 – 5 years. As regards TBAs educational status, those with no formal education were 4 (10.8%), primary 6(16.2%), secondary 20 (54.1%) and tertiary 7 (18.9%).

Eleven (29.7%) of the TBAs have ante natal care in the church out of which 6 (16.2%) conducts delivery in the church. Perinatal and maternal deaths recorded by the TBAs in the past 1 year were 7 (18.9%) and 1 (2.7%) respectively.

Conclusion: There is need for our Pastors and churches in Nigeria to recognize the place of skilled birth attendants in attending to pregnancy and labour in other to reduce maternal /perinatal mortality and discourage TBAs from practicing in the church.

n addition, the study revealed that majority of the TBAs had secondary level of education (54.1%).

There is need for churches to encourage their members to seek the pre-requisite training by emphasizing acquiring the necessary education to improve their vocation as birth attendants.