Journal of Advances in Medicine and Medical Research

This paper presents modeling of the COVID-19 pandemic deaths to understand behavior of it, predict the peak point of the deaths and cases and produces a short-term forecast using the growth models for the reported data of Turkey. The data which is used in this study are gathered of daily announced by Minister of Health. Von Bertalanffy model has outperformed to the other models considered in this study. However, exponential model has predicted the total deaths and total cases better than the others. And, exponential model has given the best prediction errors among them regarding to the death and positive case figures for last months. Observed data have tended to increase since the last days of August. This could mean that the COVİD-19 threat has reached to a critical stage to crack down on prevention of pandemics spread. Or it could sign the beginning of a second wave of epidemics. More studies must be realized to learn more about the pandemic when the new data are available.

Introduction: Children with Down syndrome are predisposed to having congenital heart defect.

Objectives: This study is aimed to describe the clinical correlates, nutritional status and pulmonary hypertension in children with Down syndrome who presented with congenital heart disease.

Patients and Methods: A retrospective study of children with Down syndrome who presented with congenital heart disease from 2016 to 2020 was carried out. Nutritional status was assessed with WHO Anthro software while pulmonary hypertension was assessed with standard procedures.

Results: Out of 758 echocardiography done over the period of 5 years for children suspected of having cardiac disease, three hundred and eight one had confirmed congenital heart disease of which twenty-eight of them had Down syndrome 7.34% (28/381).  Ten 10/28 (35.7%) of them had pulmonary hypertension. This is commonly noted among infants than older ages.

Among 28 children with Down syndrome, twenty-three had complete information for weight and height which was used to assess their nutritional status, 47.8% (11/28) presented with wasting and stunted, 8.7% (2/28) of those with Down syndrome were wasted and 8.7% (2/28) with stunting. Down syndrome is commoner in children with AV canal defect 50% (14/28) followed by PDA 21.4% (6/14). Fast breathing 86.7% (13/15) as the most common symptom followed by cough 64.3% (9/14)

Conclusion: Children with Down syndrome who had congenital heart disease are at increased risk of malnutrition and pulmonary hypertension.

Vitamin D Receptor (VDR) is a member of the nuclear hormone receptor family. 1,25(OH)2D, a form of metabolically active vitamin D3 form, is the ligand of VDR. When VDR and 1,25(OH)2D are connected, many genes start to molecular interaction reactions that will modulate the transcription. VDR has been shown to be a negative regulator of the transforming growth factor beta-1 / Smad (TGF-β1 / Smad) signalling pathway. TGF-β1 / Smad signalling is important in the pathogenesis of scleroderma (SSc). Vitamin D has pleiotropic effects including immunomodulatory and antifibrotic properties in scleroderma pathogenesis. The aim of this study was to investigate the expression of VDR and the levels of vitamin D in scleroderma subtypes and study the possible correlation between the two parameters. 28 SSc patients and 30 healthy controls were included in the study and they were classified according to the 2013 ACR / EULAR criteria and Rodnan Scores were calculated. 14 were of the limited type and 14 were of the diffuse type of scleroderma. Vitamin D levels were determined in serum. Vitamin D level was measured by chemiluminescence immunometric assay. VDR gene expression was determined by quantitative PCR in isolated RNAs from the blood. Changes in mRNA levels were analysed and beta-actin was used as the housekeeping gene. Also, TGF-β1 gene expressions were determined. VDR gene expressions in diffuse type scleroderma patients were significantly decreased compared to the control. TGF-β1 gene expressions were increased in diffuse type scleroderma. It was found that VDR gene expression in limited type scleroderma patients did not show any significant difference when compared to control. Vitamin D levels and VDR gene expressions showed no correlation in scleroderma subtypes. VDR gene expression decreased in patients with diffuse type scleroderma and showed negative correlation with the Rodnan score and TGF-β1 gene expressions. There was no significant difference between vitamin D and VDR levels.

Background: Intrauterine contraceptive devices (IUCDs) are long term, effective and reversible methods of contraception used worldwide by millions of women. The users discontinue its use despite the effectiveness due to various reasons.

Objective: To determine the prevalence rate, side effects, discontinuation rate and indications for discontinuation of Cu T380A at Rivers State University Teaching Hospital (RSUTH), Port Harcourt.

Methods: A retrospective study of 874 clients attending family planning clinic at the RSUTH from 1^st January, 2015 – 31^st December, 2019. Their records were retrieved from the clinic and reviewed. Data was extracted, coded and analyzed using the statistical package for social sciences (SPSS) IBM version 25.0 (Armonk, NY).

Results: Of the 874 acceptors of contraceptives, 221 accepted and used Cu T380A within the study period giving a prevalence rate of 25.3%. The mean age was 37.87+ 5.01 years. The modal age group was 35-39 years accounting for 81 (36.7%). Age range was 23-51 years and most (63.8%) were multiparous. Majority of the clients had formal education 217 (98.2%) and were married, 219 (99.1%). Discontinuation rate was 29.4%and the common reasons for discontinuation were menorrhagia, 14 (21.6%); desire for pregnancy, 13 (20%); irregular vaginal bleeding and menopause each contributing 8 (12.3%). Others were missing string, 6 (9.2%), vaginal discharge, sexual problems, lower abdominal and waist pains each accounting for 5 (7.7%) respectively. There was one unintended pregnancy. 

Conclusion: Copper T380A is safe and effective. Menorrhagia and irregular vaginal bleeding were the commonest side effects. Pregnancy desire and side effects were the reasons for its discontinuation.

Aims: Both obesity and sleep disorders represent an important public health problem. In this study, the prevalence and consequences of obesity and associated sleep disorders were investigated in the Turkish adult population.

Methodology: Data were analyzed in 5019 subjects who had available body mass index (BMI) data from a population-based study interviewer-administered questionnaire (Turkish Adult Population Epidemiology of Sleep Disorders study: TAPES, original sample: 5521). Obesity was defined and classified by BMI into four groups as underweight (BMI<18 kg/m²), normal (18≤BMI<25 kg/m²), overweight (25≤BMI<30 kg/m²), and obese (BMI >30 kg/m²). Insomnia was defined according to the DSM-IV criteria, habitual snoring and risk for sleep-related breathing disorders (SDB) using the Berlin questionnaire, excessive daytime sleepiness with the Epworth sleepiness scale score, and restless legs syndrome (RLS) according to symptoms as per the International Restless Legs Syndrome Study Group criteria.

Results: The underweight, normal, overweight, and obesity rates were 2.9%, 40.5%, 34.3%, and 22.3%, respectively. Obesity was more common in women, and in the middle age, divorced/widow, lower education status, ex-smoker, low-income, and no regular exercise groups After the adjustment for age, gender, smoking status, educational status and income levels obesity was associated  with the increased risk of SDB (OR: 13.03, 95%CI: 9.91-17.14), RLS (OR: 1.43, 95%CI: 1.01-2.02). The risk of heart disease, hypertension, diabetes mellitus, and hospitalization in the last year was higher in the obese population even after adjusting for age, sex, smoking status, educational status, and income levels [OR=2.06 (1.50-2.82), OR=3.45 (2.64-4.51), OR=2.93 (2.05-4.16), and OR=1.55 (1.22-1.98) respectively]. The risk of heart disease increased in subjects who were overweight and obese who had a high risk of SDB, and subjects with obesity who had RLS. The diabetes mellitus risk increased in subjects with obese who had a high risk of SDB or RLS.

Conclusion: Obesity was associated with a high risk of systemic diseases and obesity together with sleep disorders was associated with a higher risk of systemic diseases such as heart disease and diabetes. If confirmed with prospective longitudinal studies with objective measurements, screening for sleep-related symptoms could help to identify adults with obesity at high risk for heart disease and diabetes, and implementation of preventive measures and the proper management of these populations.

The goal of this study is to evaluate the antistaphylococcal potential of ophthalmic ointment obtained from the leaves of Ocimum gratissimum. Cutaneous and ocular tolerances of methanolic extract of O. gratissimum leaves were evaluated according to the Organisation for Economic Co-operation and Development (OECD) 404 and 405 Guidelines. Gentamicin ophthalmic ointment 0.3 % was used as antibiotic reference. In vivo antibacterial activity evaluation of the phytomedicine was carried out in rabbits infected by S. aureus CIP 4.83. During 15 days, three groups of 6 animals were treated as follows: the excipient (vaseline + liquid paraffin), gentamicin ointment and Ocimum gratissimum ophthalmic ointment (OGO). 0, 5% Good cutaneous and ocular tolerances of methanolic extract were observed. The microbial contamination control carried out on the 5th and 240th days showed that the prepared formulation is consistent with the preparation of cleanliness standards for topical application to the European Pharmacopoeia. The subconjunctival injection of S. aureus suspension caused mucopurulent acute keratoconjunctivitis with edema, and sometimes eyelid erythema. It is therefore on these ocular observations that therapeutic efficacy of the phytomedicine was evaluated. The treated rabbits without anti-infective agent have developed leucoma, eyelids swelling and conjunctiva hyperemia. Only one panophthalmitis case was observed. From the 1st to 5th days, we observed significant and gradual regression on ocular damages in animals treated with gentamicin. On the 15th day, the eye became normal; the rabbits showed no lesion on cornea. The batch treated with OGO is experiencing a similar trend. The in vivo therapeutic activity of the OGO was similar to that of gentamicin.

Background: Improper and uncoordinated healthcare waste management (HCWM) practice exposes the healthcare worker, patients and surrounding communities to several morbidities and mortality from nosocomial infections.

Objectives: This study aims at assessing waste management services in public and private healthcare facilities at the three levels of healthcare delivery in Enugu State.

Methods: A cross-sectional study using quantitative and qualitative data collection methods involving healthcare workers and healthcare facilities (public and private) at the three levels of care in Enugu state. The study comprised of a total of 23 health facilities and 362 health workers drawn from the three levels of healthcare for private and public facilities.

Data were analyzed using Statistical Package for Social Sciences (SPSS) version 16.0. Chi-square test was used to compare the proportion of healthcare workers with adequate knowledge of HCWM. A significance level of p < 0.05 was used for statistical calculations. Results: One hundred and eighty (47.5%) of the respondents knew the correct steps for HCWM. Most respondents 355(93.7%) admitted that there is associated risk in handling waste. About 147 (38.8%) sustained injury while they had contact with waste out of which 57(38.8%) have had this injury more than three times. The presence of written strategy was higher in public facilities compared to private facilities (x² = 1.446; p = 0.485), The access to it was highest in the unit (x² = 1.027; p = 0.311). The frequency of waste collection was highest on a daily basis in both private and public facilities. Waste measurement and segregation were also observed to be higher in public than private facilities (x² = 1.434; p = 0.488 and x² = 1.644; p = 0.440 respectively). More public facilities segregated their waste at source compared to private facilities and this was statistically significant (x² = 13.875; p = 0.008).

Conclusion: The frequency of waste collection was highest on a daily basis in both private and public facilities. However, waste measurement and segregation were observed to be higher in public than private facilities. More public facilities segregated their waste at source compared to private facilities. There seems to be a gap in communication among those involve in health management waste. The health personnel despite level of education and cadre, have poor knowledge of the risk associated with healthcare waste.

Aims: to assess and compare the significance of C-reactive protein Albumin ratio (CAR) versus coronary artery ectasia (CAE) as predictors of no-reflow phenomenon.

Methods: This study was conducted on 90 ST segment elevation myocardial infarction patients treated with primary percutaneous coronary intervention (PPCI) within 24 hours of presentation at cardiovascular medicine department Tanta university hospitals in Gharbia Governorate, Egypt. This is a prospective study and data collection was done within 12 months started from June 2018. Patients were divided into two groups according to the post primary PCI thrombolysis in myocardial infarction (TIMI) flow score. Group I (Case group), patients with no-reflow phenomenon TIMI 0-1 flow post primary PCI. Group II (Control group) with TIMI flow ≥ 2 after primary PCI. They                   were subjected to full clinical examination, laboratory investigation including CRP and serum albumin, 12 leads surface ECG, echocardiography and primary percutaneous coronary intervention (PCI).

Results: There was significant statistical difference between both groups as regard age <) 60 years, 96.7% vs 20%, P < 0.001), gender (male, 93.3% vs 63.3%, P = 0.002), ischemia time ) < 6 hours, 100% vs 33.3%, P > 0.001), CRP level (64 ± 32.6 mg/L vs 26.27 ± 21.5 mg/L, P > 0.001), serum albumin (3.22 ± 0.23 g/dL vs 3.55 ± 0.20 g/dL, P > 0.001), CRP albumin ratio (CAR) (0.0204 ± 0.011 vs 0.0076 ± 0.0064, P > 0.001), coronary artery ectasia (30% vs 6.7%, P = 0.003), thrombus grade score )≥ 4, 100% vs 10%, P > 0.001). However, there was no significant  statistical difference between both groups as regard smoking, dyslipidemia and revascularization method.

Conclusion: Compared to CAE, CAR is more significant and more reliable to predict no reflow in acute STEMI patients managed by primary PCI within 24 hours of presentation.

Introduction: The anterior communicating artery complex consists of two anterior cerebral arteries (ACA), the anterior communicating artery (AComA) and the recurrent arteries of Heubner. ACA is divided into the three segments; A1 originating from the internal carotid artery, A2 extending from AComA and A3 also known as the pericallosal artery. The anatomical variations of the ACoA complex are not adequately discussed. The aim of this study is to detect the anatomical variations in the ACoA complex in patients that don’t have any intracranial vascular pathology.

Aims: The present study determines the anatomical Variations of the anterior communicating artery complex.

Patients and Methods: The study group consists of 70 subjects, using Digital Subtraction Angiography and Computed Tomography Angiography to visualize the vascular anatomy.

Results: About 14.29% (10 patients) Aplastic ACoA, 7.14% (5 patients) have unilateral A1 ACA segment hypoplasia, 2.86% (2 patients) have unilateral A1 ACA segment aplasia.

Conclusion: The most common anatomical variant is Aplastic ACoA.

Introduction: About 65% of deliveries in Nigeria (including HIV infected women) take place in settings like traditional birth attendants (TBAs). Though TBA involvement in PMTCT has some challenges, their success stories of increased HIV counseling and testing (HCT) uptake among pregnant women remains a reason for training, supervising and successfully integrating them into formal health centres and to reach the PMTCT target population. This is a brief review of roles and challenges of traditional birth attendants in Prevention of Mother to Child Transmission of HIV in Nigeria.

Methods: Keywords from objectives of review are MTCT, PMTCT and TBA which were used to search for related literatures through online libraries like national and international journals example medline and pubmed including google. About 62 related literatures/studies were initially generated and then narrowed down to 21 literatures which were selected because they met the inclusion criteria of less than 10 years and related to objective of review.

Findings: Because 65% of deliveries take place at non-formal settings like TBAs, they are being trained/engaged mainly by NGOs to be involved in PMTCT. Major success stories include; improved PMTCT knowledge and practices after training (p = 0.01) and increased HCT uptake at the TBAs (p = 0.001). Major challenges include low education level, reluctance to refer HIV positive patients in absence of incentives, poor reporting mechanism and poor-quality assessment/supervisions. National plans on accelerated PMTCT and elimination of MTCT currently advices that TBAs be integrated into formal health centres to further reach target population and cover the PMTCT gap in Nigeria.

Conclusion: TBAs have the potential of bridging the gap between formal PMTCT delivery points and the cultural communities where majority of the target population-pregnant women- live. Though challenges of TBA involvement are visible, support for training/retaining and quality assessment/supervision among TBAs could be the answer to the challenges of reaching the PMTCT target group and reaching the PMTCT target in Nigeria.