Open Access Original Research Article

The Effectiveness of the Heated Humidified High Flow Nasal Cannula as an Initial Noninvasive Respiratory Support for Preterm Infants Suffering from Respiratory Distress

Sarah Mohamed Nofal, May Rabie El- Sheikh, Heba Saed El- Mahdy, Mostafa Mohamed Awny

Journal of Advances in Medicine and Medical Research, Page 1-13
DOI: 10.9734/jammr/2020/v32i2130690

Aims: to compare the efficacy and safety of the heated humidified high-flow nasal cannula as a noninvasive respiratory support for the initial management of respiratory distress in preterm infants ≥ 30 weeks gestation with birth weight ≥ 1300 g at different flow rates (3 L/min and 6 L/min) on admission.

Study Design: A Randomized controlled trial.

Place and Duration of Study: Neonatal Intensive Care Unit, Pediatrics department, Tanta University Hospitals, over one-year period, from December 2018 to December 2019.

Methodology: 30 preterm neonates, with gestational ages ranged between 30 to 36 weeks and birth weight ≥ 1300 g, were randomized to receive HHHFNC at either flow rate 3 or 6 L\min as an initial respiratory support. Primary outcomes included: the incidence of treatment failure of the HHHFNC at flow 3 L/min and 6 L/min, which will require n CPAP or NIMV, or will require intubation. Secondary outcomes included: rate of deaths at any time after randomization, the total duration of all types of oxygen support and incidence of neonatal morbidities such as nasal trauma, symptomatic patent ductus arteriosus (PDA), intraventricular hemorrhage (IVH ≥ grade II), pneumothorax, pulmonary hemorrhage, retinopathy of prematurity (ROP), apnea, sepsis and necrotizing enterocolitis (NEC ≥ stage II).

Results: the incidence of the need for higher flow rate of HHHFNC (n=11, 36.6%) , the need for n CPAP or NIMV after failure of higher flow rate of HHHFNC (n=11, 36.6%), the need for intubation & MV (n=1, 3.3%), the incidence of nasal trauma (n=7, 23.3%), BPD (n=0) , IVH ≥ II (n=0), NEC ≥II (n=0), pneumothorax (n=0) , the median duration of hospitalization =10 days (7-15), the median duration of all oxygen support = 6.5 days (6-7). The failure rate was 11 out of 30 infants (36.6%), no deaths or pulmonary haemorrhage.

Conclusion: HHHFNC use shows similar rates of efficacy to other forms of noninvasive respiratory support in preterm infants with respiratory distress for initial respiratory support with lesser complications. There were better outcomes with higher gestational age and birth weight at either flow rates 3 or 6 L/min.

Open Access Original Research Article

Hypothyroidism and Platelet Parameter Evaluation

Fatma S. Shehata, Yasser M. Abd Elraouf, Hisham A. El Serogy, Wael F. Mohamed

Journal of Advances in Medicine and Medical Research, Page 25-34
DOI: 10.9734/jammr/2020/v32i2130692

Aims: To evaluate the effect of subclinical and overt hypothyroidism on mean platelet volume (MPV) and platelet distribution width (PDW).

Study Design: Cross sectional study.

Place and Duration of Study: Outpatient Clinic of Diabetes, Metabolism and Endocrinology Unit in internal medicine department and clinical pathology, Tanta University, Egypt in a period between June 2018 to June 2019.

Methodology: We tested 250 subjects; 50 healthy control and 200 hypothyroid patients (all were female; age ≥18 years old age) without any medical history, then patients were subdivided into newly diagnosed group and another group on l-thyroxin treatment. Platelet parameters (MPV, PDW) were assessed in all of them.

Results: MPV & PDW is increasing in hypothyroid patients than control group (8.93 ± 0.62), more in overt group (10.88 ± 0.57) than subclinical group (10.02 ± 0.55). No significant reduction in MPV and PDW in patients on l-thyroxin treatment which suggest that l-thyroxin treatment couldn’t produce difference till patients reaching their target level being euthyroid.

Conclusion: We recommend the usefulness of MPV and PDW as inexpensive markers of platelet activation in diagnostic work-up of athero-thrombotic complications risk in patients with subclinical and overt hypothyroidism.

Open Access Original Research Article

Comparative Evaluation of Sealing Ability and Marginal Adaptation of Furcation Repair Materials: An in vitro Study

Sonam Yangchen Bhutia, Munish Goel, Vijay Kumar, Shweta Verma

Journal of Advances in Medicine and Medical Research, Page 35-43
DOI: 10.9734/jammr/2020/v32i2130693

The present study was undertaken for evaluating the sealing ability of furcation repair materials GC Fuji VII, MTA Plus and Biodentine. Diagnosis of iatrogenic perforation requires a combination of symptomatic findings in clinical observations. Perforations can be defined as mechanical or pathological communications between the root canal system and the external tooth surface. Study was conducted in the Department of Conservative Dentistry and Endodontics, Himachal Dental College, Sundernagar, Himachal Pradesh, India. Fifty five sound mandibular molars with non fused and well developed roots were used for the study. The specimens were examined using SEM which is maintained approximately 15Kv and 10-6 Torr under high vacuum condition. Specimen imaging were done by secondary electrons using a secondary electron detector. Scanning Electron Microscope (SEM) pictures, MTA plus shows the minimum marginal gap of 2.17 micrometers, followed by Biodentine 5.55 micrometers and GC FUJI VII 8.00 micrometers. The most important factors determining the success of a perforation repair procedure are the location of the perforation; time elapsed between the occurrence of the perforation and repair, the ability of the material to seal the perforation and the biocompatibility of the repair material. In our study, MTA Plus showed minimum leakage compared to GC FUJI VII and Biodentine. The minimum microleakage as observed in MTA Plus group might be attributed to its superior marginal sealing ability resulting from its hydrophilic properties and formations of an inter facial layer. Biodentine also provides a good seal almost similar to that of MTA Plus when used as a furcation repair material. GC Fuji VII showed significantly more leakage and gap formation than Biodentine and MTA Plus.

Open Access Original Research Article

Paediatric Osteomyelitis in a Tertiary Hospital in South-South Nigeria; Clinical Experience at Federal Medical Centre Asaba

N. K. Emeagui, G. O. Obu, H. I. O. Opara, O. D. Emeagui, O. C. Ajaegbu, S. E. Esievoadje, A. Urhi

Journal of Advances in Medicine and Medical Research, Page 57-64
DOI: 10.9734/jammr/2020/v32i2130694

Background: The incidence of Osteomyelitis is disproportionately higher in low-income countries (43-200 per 100,000 children) compared to high-income countries (1.94-13 per 100,000 children).These infections remains a significant threat to proper growth and development of children in low-income countries, and this is partly due to late presentation to the hospital coupled with wanton unorthodox pre-hospital intervention by traditional healers.

Aim: To determine the clinical and microbiological profile of paediatric osteomyelitis at Federal Medical Centre Asaba.

Methods: This is a 4year single centre retrospective study of all paediatric osteomyelitis managed in this hospital from January 2014 to December 2018. Important data such as type (acute, subacute and chronic) of osteomyelitis, bone involved, bone sites (epiphyseal, metaphyseal or diaphyseal) affected, microbiological culture results (implicated microorganisms), and genotype, treatment and outcome of treatment were expressed as frequencies and mean ± standard deviations, and Pearson’s Chi square test was used to measure associations. P values ˂ .05 were considered statistically significant.

Results: Forty (40) out of 3657 children had osteomyelitis, 17 (42.5%), 4(10%) and 19 (47.5%) were diagnosed with acute, subacute and chronic osteomyelitis respectively. The prevalence of osteomyelitis in this study was 1%. The children were between the ages of 6 months to 17 years with a mean age of 8.1 ± 4.23 years and spent an average of 19 ± 14 days on admission. Low and middle socioeconomic status were significantly associated with the risk of infection (P = .04). Tibia (47.5%) and femur (25%) were the commonest bones involved. Staphylococcus aureus accounted for 52.5% of cases and the metaphysis was the commonest site involved. The sickle cell heamoglobin to normal heamoglobin genotype ratio is 1:3. Out-come was favourable 87.5% of the cases.

Conclusion: Low socioeconomic class is a risk factor for paediatric osteomyelitis in our locality. Early diagnosis and prompt treatment are vital in ensuring favourable outcome.

Open Access Original Research Article

The Effectiveness of the Heated Humidified High Flow Nasal Cannula as a Noninvasive Respiratory Support for Preterm Infants for Prevention of Extubation Failure

Sarah Mohamed Nofal, May Rabie El- Sheikh, Heba Saed El- Mahdy, Mostafa Mohamed Awny

Journal of Advances in Medicine and Medical Research, Page 44-56
DOI: 10.9734/jammr/2020/v32i2130695

Aims: To compare the efficacy and safety of the HHHFNC as a post extubation respiratory support of preterm infants who were initially required endotracheal intubation and conventional mechanical ventilator after birth at different flow rates (3 L/min and 6 L/min).

Study Design: A Randomized controlled trial.

Place and Duration of Study: Neonatal Intensive Care Unit, Pediatrics department, Tanta University Hospitals, over one-year period, from December 2018 to December 2019.

Methodology: 30 preterm, with gestational age (30-36) weeks and birth weight ≥ 1300 g, were randomized to receive HHHFNC at either flow rate 3 or 6 L\min to prevent postextubation failure. Primary outcomes: the incidence of treatment failure of the HHHFNC at flow 3 and 6 L/min, which will require n CPAP or NIMV, or will require reintubation after successful extubation within 72 h. Secondary outcomes: rate of deaths within 72 hours post extubation, the total duration of all types of oxygen support, total duration of hospitalization and incidence of neonatal morbidities such as nasal trauma, BPD, symptomatic PDA, IVH ≥ grade II, pneumothorax, pulmonary hemorrhage, ROP, apnea, sepsis and NEC ≥ stage II.

Results: The incidence of need for higher flow rate of HHHFNC (n =17, 56.6%) , the need for n CPAP or NIMV after failure of higher flow rate of HHHFNC (n =16, 53.3%), the need for intubation & MV (n =7, 23.3%), the incidence of nasal trauma (n =9, 30%), BPD (n =9, 30%) , IVH ≥ II (n =7, 23.3%) , NEC ≥ II (n =0), pneumothorax ( n =5, 16.6%) , pulmonary haemorrhage (n =3, 10%), death (n =3, 10%), median duration of hospitalization in days =22.5 (17-28), median duration of all oxygen support in days = 18 (15-21), so the failure rate was 17 out of 30 (56.6%).

Conclusion: HHHFNC use is noninferior to other forms of noninvasive respiratory support in preterm infants for prevention of extubation failure. There were better outcomes of HHHFNC with higher gestational age and birth weight in preterm infants at either flow rates 3 or 6 L/min.

Open Access Original Research Article

Psychosocial and Demographic Variables as Correlates of Patterns of Substance Abuse among in-Patients in Two Selected Neuro-Psychiatric Hospitals in South-West, Nigeria

Quamariyat Adekemi Akinlawon, Christiana Obiageli Emeghara, Christian C. C. Asonye, Olawale Rasheed Oladapo, Okechukwu Emeghara

Journal of Advances in Medicine and Medical Research, Page 65-76
DOI: 10.9734/jammr/2020/v32i2130696

Aims: The study main objective is to access psychosocial and demographic variables as correlates of patterns of psychoactive substance abuse among patients admitted to drug treatment centers in two federal mental health institutions in Nigeria.

Study Design: Descriptive correlational research design.

Place and Duration of Study: Neuropsychiatric Hospital (Aro & Lantoro Annex) Abeokuta and Federal Neuro Psychiatric Hospital, Yaba, Lagos in February 2018.

Methodology: The sample size for this study comprises 224 patients admitted for treatment due to psychoactive substance abuse at the Neuropsychiatric Hospital (Aro & Lantoro Annex) Abeokuta and Federal Neuro Psychiatric Hospital, Yaba, Lagos. A self-developed, pre-tested semi structured interviewer administered questionnaire was used to collect data on psychosocial and demographic variables that may explain the patterns of substance abuse among. Data were analysed using descriptive and inferential statistics at 0.05 level of significance.

Results: The study found that social, psychological and demographic factors have significant influence on psychoactive substance use (F (6, 213) =23.214, P=0.07), Adj R2 = .158 (F (3, 216) =33.193, P=0.000), Adj R2 = .104, (F (6, 213) =10.101, P=0.031), Adj R2 = .062 respectively. Social factors of accessibility, family usage, affordability and peer usage exerted positive impact on psychoactive substance use β = .81, P = 000, β =.127, P = .037, β = .118, P = 0.011 and β = .139, P = .009 respectively. The psychological factors of perception, impulsivity and self- gratification exerted positive and significant influence on psychoactive substance use β = .148, P = 047, β =.197, P = .000 and β = .107, P = 0.03 respectively. Demographic factors age (x2 = 21.347, P = .000); gender (x2 = 5.432, P = .013); marital status (x2 = 2.707, P = .034) and religion is (x2 = 4.119, P = .009) exerted significant effect on pattern of substance abuse.

Conclusion: The study concluded that social, psychological and demographic variables are the main correlates of psychoactive substance abuse among patients admitted and treated in sampled Neuropsychiatric Hospitals.

Open Access Original Research Article

Analysis of the Adverse Drug Reactions and Associated Cost Burden on the Patients in a South Indian Teaching Hospital

Meda Venkatasubbaiah, P. Dwarakanadha Reddy, Suggala V. Satyanarayana

Journal of Advances in Medicine and Medical Research, Page 88-98
DOI: 10.9734/jammr/2020/v32i2130697

Objectives: To analyse the adverse drug reactions (ADR) and related economic burden on the health care system and health seekers

Methods: A prospective observational study was conducted in a South Indian tertiary care teaching hospital from July 2016 – December 2018.ADRs were analyzed for their causality, severity, predictability, and preventability through standard scales and were reported to the Pharmacovigilance Program of India (PvPI) through a specified updated Indian Pharmacopoeia Commission (IPC) suspected ADR reporting form. The total cost burden including both direct and indirect were calculated by assessing the ADR management including the clinical investigations done. The indirect cost was calculated based on the per capita analysis by using the Gross Domestic Product (GDP) of our study area.

Results: Among 458 ADRs, 81.88% were reported in Adult population with an almost same incidence in both the genders, majority were probable (41.70%) and Antibiotics were most commonly involved (16.18%). Around 60% ADRs were treated with at least one drug, 27% ADRs required either hospitalization or increased length of Hospitalization. A total of 989164.5 Indian Rupee (INR) was spent by the hospital and the patients for the management of ADRs, of which 79% was direct cost and 21% was indirect cost.

Conclusion: In this hospital, 26.88% of patients were identified with ADRs that were associated with high direct costs, due to hospitalization/extended hospitalizations, which resulted in an extra economic burden to the healthcare sector and seekers for the management of ADRs.

Open Access Original Research Article

Positron Emission Tomography /Computed Tomography Follow-Up in Patients with Gastrointestinal Tract Malignancies

Abdellatief Mohammed Khairy Eltahan, Mohamad Abd El-Hamid Alm El- Din, Alsiagy Ali Abdel- Aziz, Emad Mohamad Mashaly

Journal of Advances in Medicine and Medical Research, Page 77-87
DOI: 10.9734/jammr/2020/v32i2130698

Background: PET/CT has an increasing role in the oncology field, including GIT. The role of PET/CT is more significant in the follow-up than initial staging and diagnosis as it helps in therapy assessment and detects recurrence and metastasis. In esophageal cancer, it helps by detecting the distant metastasis and discover synchronous neoplasm. Also, it is acclaimed to help in early detection of the response of the patient to chemo and radiotherapy. In the follow-up, it may be useful to detect recurrence. PET/CT has a minimal role in gastric cancer, as it shows no superiority over C.T. alone. For Colorectal Cancer, PET/CT has a good value in cases of suspected liver or lung metastasis and local recurrence after surgery. This study aimed to evaluate the impact of PET/CT on treatment decision & follow-up of patients with gastrointestinal tract malignancies.

Methods: This study is a cross-sectional study and was done retrospectively by collecting data and records of 47 GIT malignancy patients who underwent PET/CT during or after treatment. At PET/CT unit, Diagnostic Radiology Department in Educational hospitals - Tanta University between July 2015 and December 2017.

Results: The patients were mainly colorectal in the site and primarily adenocarcinoma in type. We found that 27.7% of cases treatment plans were influenced by the PET/CT results, the percentage is highest with colon cancer (40%) then rectal cancer (25%), and our few esophageal, gastric, intestinal malignancies cases have shown no influence which is due to a small number of cases. PET/CT seems to have the best add value in patients with colorectal cancer with metastasis with a 66.7% change in treatment plans. Six patients had inconclusive results of PET/CT due to scan limitations.

Conclusion: Relying on PET/CT in clinical decisions in esophageal or gastric cancer is not encouraged unless in case of clinical or imaging suspicion of recurrence. On the other hand, PET/CT is useful in detecting post-treatment metastasis and local recurrence in colorectal cancer.

Open Access Original Research Article

Stenting versus Pharmacological Therapy in Treatment of Single Vessel Intermediate Culprit Lesion Stenosis in Acute St-Segment Elevation Myocardial Infarction

Hazem K. Shalaby, Ayman Mohammed El Saied, Hanan Kasem, Mai Salama, Seham Fahmy Badr

Journal of Advances in Medicine and Medical Research, Page 99-106
DOI: 10.9734/jammr/2020/v32i2130699

Background: Primary percutaneous coronary intervention (PCI) with stent implantation has been the standard therapy in acute ST-segment elevation myocardial infarction (STEMI) patients. Compared with medical treatment alone, stent implanting can achieve larger lumen gain and helps to reduce the re-occlusion risk of the infarct-related artery.

Purpose: The aim of this study was to compare the effectiveness of stenting of single vessel intermediate culprit lesion stenosis to pharmacological treatment alone in acute STEMI patients.

Methods: This study was prospective comparative interventional case series. It included 60 patients admitted to coronary care unit of our University hospital with acute STEMI. All patients were subjected to detailed history taking, clinical examination, 12 leads ECG, echocardiography and cardiac catheterization and angiography (TIMI flow and corrected TIMI frame count (CTFC) was reported. Patients selected were those with intermediate culprit lesion (40-70%) single vessel stenosis.

Patients were divided into 2 groups:

Group A: 30 patients who underwent stenting of the culprit lesion in addition to standard pharmacological treatment.

Group B: 30 patients who received pharmacological treatment and no stenting (Glycoprotein II b/IIIa inhibitor in addition to the standard pharmacological treatment).

Patients were followed up for 12 months and major adverse cardiac events (MACE) were reported (death, myocardial infarction, coronary re-vascularization, stroke and hospitalization because of heart failure).

Results: 63.3% of group A patients reported complete ST segment resolution versus 30% of group B (P=0.034). TIMI Flow showed statistically significant difference in group A compared to group B regarding (P value=0.005) Group A reported slow fast blood flow (CTFC<60) in 1 patient (3.3%) while in group B it was reported in 5 patients (16%). There was a statistically significant difference between the 2 groups regarding CTFC (P value=0.029). At 12 months follow up, MACE were reported in one patient of group A versus 4 patients of group B (P value >0.05).

Conclusion: Stent implantation reported better immediate efficacy and safety results among acute STEMI patients with single vessel intermediate culprit lesion stenosis and favourable effects in reducing MACE.

Open Access Review Article

COVID-19 and Its Effect on Dentistry

Amil Sharma, Rupali Balpande, Arpit Shrivastava, Gayatri Deshmukh, Pritee Bargaje, Sharmishtha Sharma

Journal of Advances in Medicine and Medical Research, Page 14-24
DOI: 10.9734/jammr/2020/v32i2130691

COVID-19 or normally known as a coronavirus disease has already been in a pandemic situation which almost grabs many countries in the world. Its outbreak is still at large and even grasping medical professionals too.COVID-19 is a disease caused by SARS-CoV-2 that can trigger what doctors call a respiratory tract infection. It can affect the upper respiratory tract (sinuses, nose, and throat) or lower respiratory tract (windpipe and lungs). It spreads the same way other coronaviruses do, mainly through person-to-person contact. Infections range from mild to deadly. Although the mortality rate of this virus is low, it is especially potent against people with underlying systemic conditions. The practice of dentistry involves the use of rotary dental and surgical instruments, such as Handpieces or ultrasonic Scalars and air-water syringes. These instruments create a visible spray that can contain particle droplets of water, saliva, blood, microorganisms, and other debris. Dental health care professionals are at higher risk due to their close working field to the patient's oral cavity. The outbreak of COVID-19 has affected all businesses including general dental practices, which are suffering huge financial losses as they have been advised to give only emergency dental care because dentistry is a profession where the doctor as well as the dental staff works in close range of patients mouth. These recommendations should be appreciated as a positive step but they have caused serious financial implications for dental practices. It can be concluded that current dental practice globally is limited to the provision of emergency treatments only. So this article briefly discussed Covid-19 and a precautionary measurement needs to be taken by dental professionals