Journal of Advances in Medicine and Medical Research

Aims: To report estimates of the reliability and agreement of a new method for measuring the femoral Neck-shaft angle in the Jordanian population. The neck-shaft angle is an important anatomical indicator in orthopedics of the hip. While there are different approaches to measuring the neck-shaft angle in the literature, there is no agreement on the best technique used for measurement. CT scout view was used in this study to provide a promising alternative.

Study Design: Observational reliability and agreement study.

Places and Duration of the Study: Department of physiotherapy, school of rehabilitation science, University of Jordan and University of Jordan Hospital between March 2014 and October 2015.

Methodology: Two independent raters calculated the neck-shaft angle on each hip of 50 pelvic CT scout images of healthy adults to determine inter-rater reliability. One rater performed the measurement twice to determine the intra-rater reliability. Intra-class correlation coefficients were used to examine relative reliability. The standard error of measurement (SEM) and 95% minimal detectable change (MDC) were calculated to examine absolute reliability. 

Results: The mean value of all angle measurements was 131.3. Intra-class correlation coefficients were 0.726 and 0.63 for inter and intra-rater measurements respectively. SEM and MDC for inter-rater measurements were 2.69 and 7.46 respectively. For intra-rater measurements, they were 2.84 and 7.86 respectively.

Conclusion: The new method proposed in this study for measuring the neck-shaft angle showed good reliability and small measurement error.

Background: Papillary thyroid carcinoma is the most common thyroid carcinoma. There is a debate on prophylactic removal of central lymph nodes. Some authors advise it to avoid recurrence while other investigators condemn it due to its higher risk of recurrent laryngeal nerve injury and/or hypoparathyroidism.

Aim of the Work: The aim of this study was to evaluate the safety and morbidity of central lymph nodes dissection during total thyroidectomy in the management of patients with papillary thyroid carcinoma.

Patients and Methods: Twelve patients were confirmed by histopathological evaluation to have papillary thyroid examination. Total thyroidectomy was done through transverse neck incision followed by removal of bilateral central group of lymph nodes. Patients were examined postoperatively for recurrent laryngeal nerve injury or hypoparathyroidism. Follow up was done 6 months later with neck ultrasonography, thyroglobulin and antithyroglobulin antibodies.

Results: Thirty four percent of the studied cases proved to have lymph nodes metastasis. temporary hypocalcemia occurred in only one patient in this study and was temporary. Recurrent laryngeal nerve affection happened in 17% of the studied cases and was reversible by medical treatment. No evidence of recurrence happened in the first 6 months after operation.

Conclusion: The risk of postoperative recurrent laryngeal nerve injury or hypoparathyroidism is minimal after prophylactic CLND. Postoperative hypocalcemia and recurrent laryngeal nerve injury are usually reversible.

Epidemiological literature identifies a variety of factors that can affect the mortality of COVID-19. We use a sample of 42 countries and 46 States of the US, and analyse 19 factors that could affect mortality. The factors that were found significant were the following: Population in nursing homes; pollution; prevalence of lung cancers, hypertension and diabetes; median age of population and percentage of the population above 65 years old; air traffic; population concentration; mean temperature; and UV radiation. Regarding mobility policies, quarantines to passengers arriving and suspending the entry of air passengers were found to reduce mortality; community mobility reduction in public spaces was not found to reduce mortality and the influx of people in the healthcare system in the following weeks to the outbreak.

Background: Magnetic resonance imaging (MRI) is the technique that demonstrated the highest sensitivity and specificity in the early diagnosis of osteonecrosis. It allows detecting initial typical signal intensity alterations of the bone marrow when other examinations showed nonspecific findings or even no alterations at all. The aim of this study is to assess the role of magnetic resonance imaging in detection and monitoring osteonecrotic lesions in pediatric patient with acute lymphoblastic leukemia after chemotherapy.

Materials and Methods: This prospective study was performed on 30 pediatric patients ranged from 4 to 18 years with acute lymphoblastic leukemia on chemotherapy or after 3months from ending chemotherapy with symptoms suspicious for osteonecrosis (i.e., articular pain). All patients were explained about the procedure to be done. MRI study of whole lower limbs was done for all patients.

Results: In the present study all patients were symptomatic. 24\30 patients (80%) had hip pain, 25\30 patients (83.3%) had knee pain and 8\30 patients (26.7%) had limping. We reported that knee pain was the most common complaint representing 83.3% of patients. 11\30 patients (36.7%) had no MRI findings. 19\30 patients (63.3%) had different positive findings; 4 patients (13.3%) had non -articular osteonecrosis (ON) only with no joint involvement (bone infarction), 2 patients (6.7%) had avascular necrosis of femoral head epiphysis without bone infarction and 13 patients (43.3%) had combined bone infarction and avascular necrosis with Joint involvement. Follow up by MRI was done for all patients (30 patients), 27 patients showed no change in MRI findings, one patient progressed from avascular necrosis of the femoral head epiphysis without deformity to avascular necrosis of the femoral head epiphysis with deformity. The other two patient showed regressive course.

Conclusion: We concluded that MRI study is mandatory for early detection and monitoring of lower limb osteonecrosis in pediatric patients with acute lymphoblastic leukemia under or after chemotherapy. The radiologist and clinician must do MRI lower limbs routinely and follow up MRI after 4-6 months to first MRI due to some patients had regressive or progressive findings.

Aims and Objectives: A study to determine the effect of glycemic variability measured by continuous blood glucose monitoring as assessed by standard deviation of each SARS CoV -2 patient's mean glucose level and to correlate with the severity of the disease.

Study Design: Cross-sectional observational study of 13 patients with SARS CoV-2 infection with Acute Respiratory Distress Syndrome (ARDS) with and without diabetes.

Place and Duration of Study: Department of Medicine, Dhiraj Hospital, Smt. Bhikhiben Kanjibhai Shah Medical College and Research Institute; between June 2020 to July 2020.

Results: 13 patients of SARS CoV-2 with ARDS were enrolled in the study. The median age of the enrolled patients was 55±12 years. Out of the 13 patients, 5 patients belonged to mild and severe category of ARDS each respectively and 3 patients belonged to the moderate category of ARDS. There was a gradual rise in inflammatory markers such as serum LDH, Ferritin, CRP from mild to severe ARDS and D-dimer level was more than double in severe category as compared to the mild ARDS. Normal glycemic variability in adults is 0-3 SD, and we found that there was a significant co-relation of glycemic variability with severity of the disease evidenced by the mean standard deviation of severe ARDS patients as 27.44 SD; whereas 19.26 SD and 9.7 SD for moderate and mild ARDS patients respectively. Hypoglycemia was documented in 10 patients. The maximum stay in the hospital was that of the patients with high glycemic variability that is 22 ± 2 days

Conclusion: This preliminary study relates glycemic variability with severity of ARDS in patients of severe SARS CoV-2. Frequent episode of hypoglycemia is not uncommon and should be monitored.

Objective: To investigate the efficacy of the placement of two towels around uterus before delivery of fetes upon the incidence of intraoperative shoulder tip pain (STP) during cesarean section.

Methods: Two hundred and sixty parturient were scheduled to undergo elective cesarean section under spinal anesthesia were randomized to do packing around the uterus before uterine incision or placebo (control group). The primary outcome was the incidence of intraoperative shoulder pain. Secondary outcomes were operative time, amount of intraoperative blood loss, incidence of hypotension, and the Need of post-opertive morphine.

Results: Shoulder tip pain was recorded only in 7 cases (5.4%) in towel placement group compared to 25 cases (19.2%) in placebo group (P value, 0.001). The need of post-operative morphine was statistically significant lower in Towel placement group (33.8%) compared to (47.7%) in control group (P value, 0.023).

Conclusion: Packing around the uterus just before uterine incision decreases the incidence and severity of intraoperative shoulder pain in patients undergoing cesarean section.

Background: Cartilage oligomeric matrix protein (COMP), is an extracellular matrix (ECM) non-collagenous glycoprotein that is mainly localized within the cartilage, and also be found in tendon and synovium.Recent studies in west and Asia Pacific region has shown that COMP, is a prognostic marker in Rheumatoid arthritis(RA).

Objective: To correlate serum COMP levels with disease severity and cartilage destruction in rheumatoid arthritis.

Methods: The study was conducted in Department of Pathology and Rheumatology, Ziauddin University Hospital, Karachi from June 2018 to May 2019. Patients were recruited as per American College of Rheumatology (ACR) 2010 classification criteria. The study population consists of 88 healthy subjects and 88 RA patients. Sandwich ELISA technique was used to assess serum COMP level. Other inflammatory markers such as erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) antibodies like rheumatoid factor, and anti-cyclic citrullinated protein (anti-CCP) were also assessed. Results were analyzed using SPSS-20 and P-value ≤0.05 was considered as significant.

Results: Serum COMP levels were significantly higher in RA patients 51.35 ng/ml than controls 21.454 ng/ml with significant p value=<0.0001. There was strong positive correlation between COMP level and disease severity in RA patients with moderate as well as high disease activity score (DAS) with significant p value. Serum COMP showed 96% sensitivity and 83% specificity at level of 27.01 ng/ml for diagnosis of RA.

Conclusions: COMP has significant positive correlation with severity of RA. Serum COMP can be utilized as a biomarker to quantify cartilage destruction in RA patients.

Background: Sickle cell anaemia, (SCA) the homozygous and most severe of the sickle cell diseases exerts adverse effects on growth and linear body proportions. In Nigeria, these changes in the lower extremity are scarcely documented.

Objectives: To evaluate the differences between the real leg lengths and apparent leg lengths determined by tape measure among children with SCA.

Methods: A clinic-based, cross-sectional, comparative study of 140 age and sex matched “SS” and “AA” children. The real leg lengths, anterior superior iliac spine to medial malleolus and to the heel, the apparent leg length, umbilicus to the medial malleolus were measured with a plastic tape and recorded. 

Leg length discrepancy (LLD), the arithmetric differences between corresponding leg lengths were recorded and classified into nil (0), mild (<2cm), moderate (2-5cm) and severe (>5cm).

Results: At the medial malleolus, the subjects had more mild and moderate Real LLD than controls while more controls than subjects had nil Real LLD (p = .033). Both right and left real leg lengths were significantly shorter in the 6-9 year old subjects especially the males, all female subjects, all 10-13 year olds subjects more so the females than their respective counterparts. (All p values < 0.05) Similarly, the right and left leg lengths at the heel were significantly shorter in subjects of the same age and sex groups as above than all their respective counterparts. (P values < 0.05). However, male subjects had only the right real leg length significantly shorter than those of the controls. Real LLD: ASIS-MM was significantly higher in 10-13 year old female subjects, real LLD: ASIS-HEEL in 14-18 year old subjects than the controls. The right and left apparent leg length were significantly lower in all 10-13 year old subjects as well as 10-13 year old female subjects than the respective matches. All p values were < 0.05. No significant difference existed in the apparent LLD comparisons.

Background: Childhood hypertension is a public health concern because of associated cardio-metabolic morbidities in adulthood. Overweight and obesity are main drivers and predictors of childhood hypertension. There is paucity of studies on waist circumference (WC) and waist-hip ratio (WHR) – measures of central obesity - as predictors of hypertension in children. The study was done to determine if WC and WHR predicts hypertension in children.

Study Design:  The study was a descriptive cross-sectional study.

Place and Duration of Study: Primary schools in Owerri Municipal Local Government Area (LGA), Imo State, Nigeria between September 2017 to April 2018.

Methodology: 809 school children aged 6-12 years were recruited from three public and six private primary schools using multi-staged sampling method. Their blood pressure (BP), weight, height, hip circumference and WC were measured using standard techniques. The BMI and WHR were then calculated. Central obesity was defined as WC ≥90^th percentile. The data were analyzed with IBM-SPSS 21.

Results: The male female ratio was 1:1. The prevalence of pre-hypertension and hypertension were 8.50% and 2.70% respectively. While those of overweight, obesity and central obesity were 5.10%, 5.90% and 10.10% respectively. WC significantly and positively correlated with systolic blood pressure (SBP) [r = 0.57, p = 0.0001] and diastolic blood pressure (DBP) [r = 0.57, p = 0.0001]. WHR had a negative correlation with SBP and DBP [r = -0.33, p = 0.0001 in both cases]. Central obesity increased the odds of developing systolic and diastolic prehypertension/ hypertension by 9 and 8 folds respectively.

Conclusion: Central obesity predicted prehypertension/hypertension in primary school children in this study and therefore can be used as screening tool in programs to prevent childhood obesity and hypertension.        

Introduction: Ethical norms in research promote the aims of research such as knowledge, truth and avoidance of error. Observing ethics in clinical research is very important and this should be well known by all health care practitioners. The aim of this study was to determine the knowledge of doctors working in a tertiary hospital about research ethics and the barriers they encounter in the ethical conduct of research.

Materials and Methods: A questionnaire-based survey was conducted among 215 doctors in a tertiary hospital in Nigeria to determine their knowledge of the concepts of ethics in research, their research practices and perceived barriers to ethical conduct of research. Data obtained was analysed with SPSS v 20 and reported as Tables and charts. Chi square was used to test for differences between categorical variables and a P value < .05 was regarded as significant.

Results: There were 108 consultants, while the rest were medical officers and resident doctors. The consultants were more active in research and 42% had between ten to fourteen published articles. There was fairly adequate knowledge of the 5 concepts of research ethics tested, with 90% who had knowledge of GCP. Common perceived barriers to ethical research conduct were poor funding and cultural beliefs.

Conclusion: There remains a gap between knowledge of ethical research conduct and actual practice. This should be addressed by improved sensitization and oversight by the regulatory agencies and the IEC.

Background: The benefits of Pain relief to parturients in labour cannot be over-emphasized. However, in low middle income countries accessibility, availability and affordability these services are not optimum. This has made it near impossible for women in labour to benefit from epidural analgesia.

Aim: This study was aimed to assess the knowledge of availability and level of acceptance of labour analgesia amongst antenatal clinic attendees at the department of Obstetrics and Gynaecology, Rivers State University Teaching Hospital (RSUTH).

Methods: The present observational study was conducted after informed consent was given by antenatal clinic attendees. Data was collected using a pretested questionnaire and analyzed using SPSS Version 25.

Results: Response from 200 women with mean ± SD age and gestational age of 31.49 ± 4.89 years and 34.25 ± 4.75 weeks respectively. The modal Parity was 1. 56; while 106/200 (53%) were aware of pain relief in labour, 94/200 (47%) had no knowledge of pain relief in labour. Twenty eight (28/106) constituting 26.42% had knowledge of the pharmacological methods while 78 (73.59%) had non-specific ideas about pain relief in labour. Twenty six (26/28) (92.86%) of the respondents will accept epidural analgesia in labour.

Conclusion: Knowledge of availability and acceptance of labour analgesia was poor. Lack of information is a major contributor for non-acceptance of labour analgesia. The inclusion and dissemination of information about labour analgesia by anaesthetists and obstetricians during antenatal classes would increase the knowledge about its availability and wide acceptance to these parturients.

Introduction: Caesarean section (Cs) is a surgical procedure carried out to prevent adverse maternal and fetal outcome.

Aversion to Cs may constitute a major obstacle to safe motherhood.

Some for pregnant women not accepting Cs are socio-cultural, religious, ethnic or economical.

Aim: Determine the attitude of the church in Nigeria and Pastors towards caesarean section, hence profer solution to the aversion to caesarean section.

Methods: It was a prospective study of ANC attendees at the RSUTH.

The information was coded and analyzed using SPSS version 25.

Results: A total of 200 questionnaires were distributed and 193 retrieved.

The mean age was 31 years.  The modal parity was 2.

As regards level of education; respondents with no formal education were 5 (2.6%), primary 6 (3.1%), secondary 88 (45.6%) and tertiary 94 (48.7%). Fifty seven (30%) of the antenatal mothers had aversion for CS.

The reasons given were socio-cultural 25 (13%), religious 8 (4.1%), economic 7 (3.6), ethnic 4 (2.1%), combination of the above 17 (8.8%) and 132 (68.4%) did not respond.

Conclusion: The study revealed that the aversion for CS was 30% amongst antenatal clinic attendees at the RSUTH. Religious in this scenario were all Christians was 4.1 %, non-respondents were 68.4%.

Counselling and advocacy are needed to change the wrong perspective about CS by the Pastors to reduce maternal and perinatal mortality.

Background: The prevalence of diabetes mellitus (DM) have tripled from 1980 till date as a result of many factors of which obesity/excessive weight gain is a closely related factor of DM. There are many adverse challenges of DM in pregnancy with its associated fetal and maternal consequences.

Aim: To determine the prevalence of DM in pregnancy amongst antenatal clinic (ANC) at booking at the Rivers State University Teaching Hospital (RSUTH).

Methods: It was a cross sectional study of ANC attendees at booking at the RSUTH. Simple random sampling method was used. The Information was coded and analyzed using SPSS version 25.

Results: A total of 99 pregnant women were recruited at booking in the ANC of the RSUTH. The mean age was 32.2 years and the modal parity was 1.0.The number of ANC attendees with weight equal to or greater than 90 Kg were 21 (21.2%), number with weight greater than equal to 90 Kg with glucose in urine were 10 (10.1%) Three (3.0%) of the subjects were known diabetic whereas 12 (12.1%) had family history of DM.

Conclusion: The study revealed the prevalence of DM amongst ANC attendees at the RSUTH as 3.0%. There was corresponding glycosuria in 10.1% of the ANC attendees. ANC attendees had family history of DM were 12.1%. Advocacy is needed to educate the populace on the predisposing factors of DM and its adverse effect on maternal and child health.

Introduction: Pastors and religious leaders have a role to play in the prevention of diseases, in this scenario prevention of breast cancer. Breast cancer is the leading cause of death globally in women between 44 – 50 years.

Aim: The role pastors and religious leaders play in the prevention of breast cancer exemplified by the analysis of 176 antenatal clinic (ANC) attendees at the Rivers State University Teaching Hospital (RSUTH).

Methods: It was a prospective study of ANC attendees at the RSUTH. The information was coded and 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.As regards level of education, 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 tertiary 123 (69.9%), secondary 34 (19.3%), primary 2 (1.1%) and no information on educational status 17(9.7%).

Conclusion: Though the level of breast cancer awareness was high 90.3%, religious houses contributed to only 3%. In addition, preventive measures such as self breast examination (54%) and mammogram (1.1%) are still not encouraging.

Decision-Delivery interval when carrying out emergency caesarean section (EmCS) cannot be over-emphasized especially with regards to maternal and fetal outcome.

There are variety of factors that may contribute to these intervals such as logistics, personal delay, delay in obtaining of informed consent, lack of blood, and availability of theatre space.

Aim: To determine the decision-delivery interval and causes of delay in EmCS at the Rivers State University Teaching Hospital (RSUTH).

Methods: It was prospective study conducted at the RSUTH between July 1, 2018 to January 31, 2019. Information was obtained using a self structured questionnaire and analyzed using version SPSS 25.

Results: There were 481 patients admitted into labour ward for the period under review of which 71(14.8 %) had EmCS. The mean age was 31 years. The commonest indication for EmCS was Cephalopelvic disproportion (CPD) represented by 23 (32.4%) of the subjects.

The average time for decision - delivery interval was 1 to 2 hours represented by 29 (40.8%). The shortest decision - delivery interval was less than 30 minutes 1(1.3%).The decision – delivery interval time greater than 5 hours were 9 (12.7%). The 3 commonest reasons for delay with respect to average decision – delivery intervals were personal delay 21 (20.8%), logistics 19 (18.8%) and lack of blood 13 (12.9%).

Conclusion: The study revealed that the average decision - delivery interval was 1 – 2 hours represented by 40.5% of the subjects. This was relatively long when compared to developed countries of the world. The commonest reason for delay in carrying out EmCS was personal delay (20.8%). The commonest indication for EmCS was CPD (32.4%). Addressing the reasons for the decision – delivery interval will help improve our practice and reduce adverse effects to mother and baby.