Open Access Commentary

Role of Rapid Antigen Test in the Diagnosis of COVID-19 in India

Aroop Mohanty, Ankita Kabi, Subodh Kumar, Vivek Hada

Journal of Advances in Medicine and Medical Research, Page 77-80
DOI: 10.9734/jammr/2020/v32i1830657

In the current world scenario where we are seeing of an alarming increase in the number of SARS-CoV-2 infections, it is necessary that in addition to RT-PCR assays, there is development and standardization of other rapid and efficient diagnostic tests. In relation to the total number of confirmed cases, India ranks second only behind the United States and according to forecasts it will not be long before it reaches the first place. As in developing countries, such as India, it is difficult to implement molecular biology facilities in all centres, the creation of rapid antigen tests is increasingly common in the detection and diagnosis of cases of COVID-19 in an early stage limiting the spread of infection.”

Open Access Original Research Article

Intestinal Parasites and Salmonella typhi Infection among Food-handlers in Port Harcourt Metropolis, Nigeria

Adedokun, Ambali Amudatu, Onosakponome Evelyn Orevaoghene, Austin E. Abah

Journal of Advances in Medicine and Medical Research, Page 1-9
DOI: 10.9734/jammr/2020/v32i1830649

Background: Intestinal parasites and Salmonella infections are of main public health concerns in Nigeria and the world, especially in developing countries where access to safe water and hygienic food handling practices by food handlers is a challenge. Consequently, food-handlers play a major role in the transmission of these types of foodborne diseases.

Objective: This study was to determine the preponderance of intestinal parasites and Salmonella typhi among food-handlers in selected areas in Port Harcourt.

Materials and Methods: A total of 480 food-handlers (195 males and 285 females) of various educational levels were sampled. Stool samples were collected and analyses were carried out using direct smear examination and formol-ether concentration technique - adopted for investigation of intestinal parasites and deoxycholate citrate agar and Salmonella-Shigella agar for the cultivation of Salmonella typhi.

Results: Of 480 food-handlers examined, comprises of 195(40.6%) males and 285(59.4%) females, - majority (85.4%) were young adults aged 20-40 years. 47.9% of them - had education above secondary educational level. The preponderance of intestinal parasites was 48(10.0%) and implicated were Ascaris lumbricoides (41.7%), hookworm (33.3%) and Trichuris trichiura (25.0%). No intestinal protozoa were identified. Prevalence of 30(6.3%) was recorded for Salmonella typhi.

Conclusion: Prevalence of Intestinal Parasites and S.typhi infection is relatively low among food handlers in Port Harcourt, but indicates the important role food handlers play in the transmission of the infection. Therefore, awareness should be step-up for the food handlers to avoid escalation of these infections.

Open Access Original Research Article

Factors Associated with Non-adherence to Anti-Retroviral Therapy among Clients in Lodwar County and Referral Hospital, Turkana County, Kenya

Nadio Etabo Clement, Peter Edome Akwee, Josephat Bitok, Peterson Kariuki

Journal of Advances in Medicine and Medical Research, Page 10-26
DOI: 10.9734/jammr/2020/v32i1830651

Patient, Health-facility and Socio-cultural related factors associated with non-adherence have contributed to poor management of ART among HIV/AIDS clients. In Lodwar County and Referral Hospital, Turkana County, a significantly high number of clients on ARV therapy have defaulted treatment. The purpose of this study was to investigate the factors associated with non-adherence to anti-retroviral treatment in Lodwar County and Referral Hospital (LCRH), Turkana, Kenya. The study was guided by cross sectional descriptive study design where qualitative and quantitative data were collected. The research instruments used for data collection consisted of structured questionnaires, interview schedules among clients on ARV therapy and documents analysis. The sample size was obtained using the modified Fishers formula at 95% level of confidence. The Statistical package for Social Sciences (SPSS) and descriptive statistics were used to analyze the data. The findings in the study revealed that there are many patient, health system and socio-cultural related factors associated with non-adherence. From the study document analysis at LCRH there should be 5243 people on ARVs, however, as at January 2018 there were 1551 (30%) who were actively on ARVs this shows that there is 70 % default rate. The study found that, Patients’ related factors that are causing non-adherence include; lack of education, lack of support, the distance to facility, lack of food, the side effects, alcohol use among many others. The study concluded that, health facility should improve their service delivery to the patients, change attitude and conduct adherence counseling. There is need to sensitize the community members to accept the HIV+ people to enable them express their health issues. They should support them and ensure that they are trained on how to use ARVs and not seek the tradition herbs and medicine men.

Open Access Original Research Article

Role of Chymotrypsin in Management of Moderate Parapneumonic Pleural Effusion in Children

Rawan Mohamed Eldeeb, Md Ahmed Abd El Basset Abo El Ezz, Md Mohamed Adel Eltomey, Md Mohamed Basiony Hamza

Journal of Advances in Medicine and Medical Research, Page 27-33
DOI: 10.9734/jammr/2020/v32i1830652

Aims: To show the benefit of chymotrypsin as an adjuvant therapy in cases of moderate parapneumonic pleural effusion in children.

Study Design: Randomized controlled trial.

Place and Duration of Study: Pulmonology Unit, Pediatric Department and Radiology Department, Tanta University Hospital, Egypt between Februray, 2019 to Februray, 2020.

Methodology: Subjects comprised of 60 children randomized into three groups 20 children each (41 males, 19 females; age range 1-14 years) with moderate parapneumonic pleural effusion by chest ultrasound. Clinical as well as complete blood count, C-reactive protein and chest ultrasonography at time of presentation, after one week (first end point) and after two weeks (second end point). Management with antibiotics, analgesics, antipyretics, chest tube insertion and oral chymotrypsin in group 2 and intramuscular chymotrypsin in group 3.

Results: There was statistically significant decrease in fluid thickness by chest u/s (mm) in group 2 (Mean ±SD= 6.400±3.872) and  group 3 (Mean ±SD= 6.150±2.720) after one week and after two weeks group 2 (Mean ±SD= 15.3±4.658) while group 3 (Mean ±SD= 3.3±1.559) in comparsion to group 1 after one week (Mean ±SD= 16.100±10.351) and after two weeks (Mean ±SD= 11.35±7.066) ( P < 0.001), duration of hospitalization (days) and chest tube (days) were statistically significant lower in group 2 (Mean±SD= 15.200±4.112 ), (Mean±SD= 9.100±2.808) respectively and group 3  (Mean±SD= 14.050±3.300), (Mean±SD= 7.400±1.698 ), in relative to group 1 (Mean±SD= 18.65±3.329 ),         (Mean±SD= 9.85±3.265 ), (P  <0.001, P=0.017  respectively) and  percentage  of  decortication  was statistically significant lower in group 2 and 3 in relative to group 1. (P =0.017).

Conclusion: Chymotrypsin has an adjuvant role in management of moderate parapneumonic pleural effusion evidenced by earlier recovery less hospital stay, derease in chest tube insertion and need for decortication and intramuscular  chymotrypsin  injection  has  better effect than oral chymotrypsin in moderate parapneumonic pleural effusion.

Open Access Original Research Article

Cord Blood Bilirubin, Albumin and Bilirubin/Albumin Ratio versus Hydrogen Peroxide as Early Predictors of Significant Neonatal Hyperbilirubinemia

Sohayla Abdel Rahman Deghady, Mohamed Ahmed Rowisha, Ashraf Mohamed Ibrahim, Walaa Arafa Kishk

Journal of Advances in Medicine and Medical Research, Page 34-42
DOI: 10.9734/jammr/2020/v32i1830653

Aims: To evaluate significance of cord blood bilirubin, albumin, bilirubin /albumin ratio and hydrogen peroxide as early predictors of significant neonatal hyperbilirubinemia.

Place and Duration of Study: Egypt, Tanta University Hospital (at delivery room and follow up was done in Neonatal Intensive Care Unit (NICU) over one year from April 2019 to April 2020.

Methodology: We included 80 neonates allocated into two groups (40 each), Group I included neonates with gestational age between 30 to less than 35 weeks, Group II neonates with gestational age ≥35 weeks. They were subjected to history taking, clinical assessment and lab investigations (cord blood albumin, bilirubin, hydrogen peroxide level and blood bilirubin/albumin ratio, 3rd day total and direct serum bilirubin level and others). Follow up done for developing jaundice on 3rd day.

Results: There was statistically significant increase in the incidence of significant hyperbilirubinemia in group I (82.5%) in comparison with group II (27.5%) (P-value <0.001). There was positive significant correlation between cord blood bilirubin (P<0.001), bilirubin/albumin ratio (P <0.001) and hydrogen peroxide (P=0.012 in GI) (P = 0.001 in GII) and 3rd day TSB levels in the studied groups. There was negative significant correlation between cord blood albumin and 3rd day TSB levels in the studied groups (P < 0.001). There was positive significant correlation between cord blood bilirubin (P <0.001 in GI) (P =0.024 in GII), bilirubin/ albumin ratio (P <0.001 in GI) (P =0.002 in GII) and hydrogen peroxide (P <0.001) and the duration of phototherapy in the studied groups. There was negative significant correlation between cord blood albumin and the duration of phototherapy in group I (P =0.001), while there was no significant correlation between cord blood albumin and the duration of phototherapy in group II (P = 0.118).

Conclusion: When comparing the four cord predictors for significant indirect hyperbilirubinemia; bilirubin/albumin ratio was the most accurate predictor with higher sensitivity and specificity, followed by cord blood bilirubin, then albumin, while hydrogen peroxide was the least accurate in all neonates ≥ 30 weeks.

Open Access Original Research Article

Refractive Outcome of Posterior Optic Capture versus Intrabagal Implantation of Intraocular Lenses in Pediatric Cataract Surgery

Hend Mohammed Elshershaby, Waleed Abdelhady Allam, Ahmed Fekry Elmaria, Rabab Mohammed Elseht

Journal of Advances in Medicine and Medical Research, Page 61-68
DOI: 10.9734/jammr/2020/v32i1830655

Purpose: To compare refractive outcome of posterior Optic Capture versus In-the-bag Implantation of Intraocular Lenses in Pediatric Cataract Surgery.

Design: Prospective, randomized and comparative study.

Methods: Forty eyes of 25 children (12 males and 13 females) were included in this study with unilateral or bilateral cataracts in the pediatric age during the period between October 2018 to July 2019. These children were diagnosed to have congenital or developmental cataracts. All children underwent cataract surgery and IOL implantation. In our study, all children were divided into two groups: group (A) included 22 eyes that underwent posterior capsulorhexis and anterior vitrectomy with IOL implantation entirely in the capsular bag and group (B) included 18 eyes that underwent posterior capsulorhexis and posterior optic capture of the IOL. Patient demographics, surgical intervention, presenting symptoms, postoperative refraction and follow up of refractive changes for 6 months were recorded.

Results: Ten cases were unilateral and fifteen cases were bilateral. The mean age was 5.44 ±3.30 in group (A) while the mean age was 4.26±1.45 in group (B). At 1.5 month, the mean spherical error in group (A) was 2.85 ± 1.41 D  with range from 1 to 6.5D, and the mean spherical error in group (B) was 2.50 ± 1.70 D with range from -0.75 to 3.75 D with no statistically significant difference in both groups. The mean cylindrical error in group (A) was -0.96 ± 1.87 D with range from -3.5 to 2.25D and the mean cylindrical error in group (B) was -1.38 ± 1.79 D with range from -3 to 2D with no statistically significant difference in both groups. At 6 months, the mean spherical error in group (A) was 0.73 ±1.89 D  with range from -4.00 to 3.75D and the mean spherical error in group (B) was 0.00 ± 2.27 D with range from -3.50 to 2.7D with no statistically significant difference in both groups. The mean cylindrical error in group (A) was -1.21± 0.90 D with range from -2.75 to 1.25D and the mean cylindrical error in group (B) was -1.68 ±0.93 D with range from -3.00 to -0.75D with no statistically significant difference in both groups.

Conclusion: There was no statistically significant difference between in-the-bag intraocular lens implantation and intraocular lens posterior optic capture in the term of post-operative refraction.  Posterior optic capture helped in preventing posterior capsule opacification (PCO) postoperatively in all cases.

Open Access Original Research Article

Evaluation of Serum Interleukin-6 and C-Reactive Protein Levels among Women During Term Labour

Ubongabasi A. James, John O. Imaralu, Ijeoma Esiaba

Journal of Advances in Medicine and Medical Research, Page 69-76
DOI: 10.9734/jammr/2020/v32i1830656

Aims: To determine the serum concentrations of C-reactive protein (CRP) and interleukin 6 (IL-6) as well as level of leukocytosis, as inflammatory contributory factors in women with uncomplicated term pregnancies before, during and after labour.

Study Design:  This is a cross-sectional study.

Place and Duration of Study: The study was carried out in the Department of Obstetrics and Gynaecology of Babcock University Teaching Hospital (BUTH) and Department of Biochemistry, Babcock University, Ogun State Nigeria between June 2019 and February 2020.

Methodology: 45 venous blood samples were obtained from 34 selected women and grouped into three; prenatal (≥ 32 weeks, n = 18), labour (4 to 6 cm dilation, n = 12) and postnatal (≤ 24 hour postpartum, n = 15). Sixteen blood samples were also obtained from the umbilical cord. Levels of CRP and IL-6 were determined by Enzyme Linked Immunosorbent Assay (ELISA) techniques and the leukocyte count, by hematologic method. Differences in statistical mean were evaluated by one way analysis of variance (ANOVA) with Bonferroni post hoc comparison. The level of significance was set at P < 0.05.

Results: Concentration of serum IL-6 was significantly high during labour (1354.79 ± 189.16 pg/mL) compared to the prenatal (14.94 ± 4.86 pg/mL, P < .001) and postnatal (13.17 ± 3.06 pg/mL, P < .001) periods. The low level of CRP observed during active labour compared to the prenatal and postnatal periods did not reach significant difference. The levels of these inflammatory markers were low in the cord blood. Leukocyte counts (P = .011) as well as neutrophils (P = .014) and MID cell fractions (P = .004) were significantly higher during the postnatal period.

Conclusion: The high levels of serum IL-6 observed in this study supports human term labour as an inflammatory event not associated with increased leukocytosis.

Open Access Original Research Article

Intraperitoneal Versus Ultrasound Guided Transversus Abdominis Plane Block by Bupivacaine-Magnesium Sulphate for Pain Relieafter Laparoscopic Cholecystectomy

Nashwa I. Hamoda, Hesham I. El Tatawy, Nagat S. El Shmaa, Mohammad I. Okab

Journal of Advances in Medicine and Medical Research, Page 81-90
DOI: 10.9734/jammr/2020/v32i1830660

Background and Aim: Intraperitoneal (IP) administration of local anesthetic is considered a method of control of visceral component of pain. This method cannot be used as sole agent for pain relief after laparoscopic cholecystectomy (LC). Transversus Abdominis Plane block (TAP) becomes a useful anesthetic technique in the treatment of postoperative pain after the LC surgery. The aim of the study was to compare between IP bupivacaine –Magnesiu;m Sulfate (MgSO4) and TAP by bupivacaine- MgSO4 for pain relief after LC.

Materials and Methods: This was a randomized double blinded study on sixty patients ASA I &II, age from 18 to 60 years old, undergoing elective LC surgery were randomly classified into two equal groups (30 patients in each group). Group I: IP instillation of 30 ml [15 ml bupivacaine 0.5% (75mg) plus 2.5ml MgSO4 (250 mg) plus 12.5 normal saline].Group II: Ultrasound guided subcostal TAP block was performed by using total volume 20 ml on each side [10 ml bupivacaine %0.5 (50 mg) plus 1.5ml MgSO4 (150 mg) plus 8.5 normal saline]. Heart rate (HR) and Mean Arterial Blood Pressure (MAP) were measured at 5 min before induction and every 15min after induction till the end of operation and then every 5 min for the first 20 mins after administration of study drugs then they recorded at interval of 30mins, 1hr, 2hrs, 4hr and 6hr postoperative. Numeric Rating Scale (NRS) at emergence, 2, 4, 8, 12, 18 and 24hr after recovery, first rescue analgesia time, postoperative analgesic consumption, length of hospital stay(LOS), patients’ satisfaction and post-operative complications were recorded.

Results: There were insignificant differences in HR and MAP between the two groups. There was a significant decrease in NRS at 4hr and 8 hr in group II than group I. There was a significant decrease regarding to time of first rescue analgesia, total postoperative analgesic consumption and LOS in group II compared to group I. There was a significant increase of satisfaction in group II compared to group I. There was an insignificant difference between both groups in nausea, vomiting, hypotension, bradycardia, bradypnea or MgSO4 toxicity.

Conclusion: TAP by bupivacaine-MgSO4 has superior analgesia, longer duration, less postoperative analgesic consumption and more satisfaction in patients undergoing LC than IP block by bupivacaine-MgSO4.

Open Access Original Research Article

Effect of Hair Straightening Treatment on Porosity and Cysteic Acid Content of Hair

Hadeer M. Sedik, Shereen F. Gheida, Wafaa M. Ibrahim, Noha N. Doghaim

Journal of Advances in Medicine and Medical Research, Page 91-97
DOI: 10.9734/jammr/2020/v32i1830661

Background: Chemical straightening has increased in popularity because of its durability over thermal straightening and because it gives the hair a natural smooth, shiny look, more styling options for a longer time. The aim of this study was to evaluate the degree of damage that occur to the hair after chemical straightener treatment by assessing the change in hair porosity and hair cysteic acid content before and after straightener treatment.

Methods: Forty hair samples were collected from female volunteers; each sample was divided into 2 groups; group A (before straightening) and group B (after straightening). Hair samples were washed then blow dried after that hair straightener was applied for 30 min then flat iron was done, hair samples were washed and blow dried. Each group was subjected to test their porosity and Fourier transform infrared spectroscopy examination to assess cysteic acid content.

Results: Hair porosity showed significant increase after straitening. Cysteic acid and disulfide content showed insignificant difference between both groups.

Conclusion: Hair straighteners may cause great damage to hair internal structures. So, proper choice of the material used and assessing the hair characters before straightening is necessary.

Open Access Review Article

COVID-19 Immunopathology, Particle Pollution, and Iron Balance

Mark Whiteside, J. Marvin Herndon

Journal of Advances in Medicine and Medical Research, Page 43-60
DOI: 10.9734/jammr/2020/v32i1830654

The coronavirus (COVID-19) pandemic exploded into a world already reeling from climate change, degradation of natural systems, and pandemics of air pollution and noncommunicable diseases. These pandemics are interrelated; air pollution, the world’s biggest killer, is a major contributor to noncommunicable disease. Air pollution is a probable cofactor in the spread and severity of COVID-19. There are shared mechanisms of injury by the emerging COVID-19 immunopathology, ultrafine air pollutants, and chronic degenerative disease. A key feature of each is oxidative stress, including that caused by iron dysregulation. Exogenous combustion-derived magnetite nanoparticles found in human brains and hearts are strongly implicated in the development of cardiometabolic and neurogenerative disease. Altered iron balance favoring excess reactive or misplaced iron is probably the most important predisposing condition for severe COVID-19 infection. Ultrafine-particle/nanoparticle toxicity and COVID-19 immunopathology on the subcellular level are both characterized by iron dysregulation, mitochondrial dysfunction, and endoplasmic reticulum stress. Primary sources of the most damaging ultrafine pollution particles are fossil fuel combustion, vehicle emissions, and coal fly ash utilized in undisclosed tropospheric aerosol geoengineering. The same ultrafine particles when emitted or placed into the troposphere alter the world’s cloud layers and reduce atmospheric convection, directly contributing to climate change and global warming. Pandemics can only be tackled by international cooperation. Immediate steps that must be taken include monitoring and control of ultrafine particulate air pollution, and prompt cessation of geoengineering operations.

Open Access Review Article

Pathological Markers for Brucellosis, a Bacterial Challenge: A Review

Rashmi Wardhan

Journal of Advances in Medicine and Medical Research, Page 98-106
DOI: 10.9734/jammr/2020/v32i1830667

The Brucellosis, caused by Brucellae species is an infectious disease infecting animals and human population. Unlike other bacteria Brucella does not secrete toxin but is pathogenic because of prolonged stay and replication in host. B. melitensis is most virulent among six classified species. In this paper the proteins responsible for virulence, survival and replication like two-component regulatory system BvrR/BvrS (TCS BvrRS) , type IV secretary system and effectors molecules have been discussed from different perspective to target and inhibit Brucellae inter cellular growth. The various defined effectors may be possible target for inhibitors for future. Genetically the Brucella chromosome II having pathogenic virB operon maybe engineered for regulation and expression .The available vaccines and inhibitors against bacterial infections are highlighted with side effects . There is urgent need to redesign fool proof vaccines and drugs to protect animals and human population before it challenges to be another pandemic like cholera or plague.