Open Access Letter to the Editor

Work-flow Protocol for Preoperative COVID-19 Testing of the “Transplant Pair” in a Live Donor Liver Transplant Program

A. Rammohan, G. Narasimhan, V. Devarajan, S. Sundaramoorthy, I. Kaliamoorthy, M. Rela

Journal of Advances in Medicine and Medical Research, Page 76-78
DOI: 10.9734/jammr/2020/v32i2230708

The “Type of Article” of this paper is “Letter to the Editor”. This paper discuses about: “ Work-flow Protocol for Preoperative COVID-19 Testing of the “Transplant Pair” in a Live Donor Liver Transplant Program ”. No formal abstract is available. Readers are requested to read the full article.

Open Access Original Research Article

Accuracy of Combined Measure of Serum Uric Acid and Beta Human Chorionic Gonadotropin (β hCG) Versus Serum Beta Human Chorionic Gonadotropin Alone as Prognostic Indicators of Pregnancy Outcome of Preeclampsia

E. O. S. Aigere, D. O. Allagoa, E. L. Kotingo, L. Obagah, B. E. Kasia, P. C. Oriji

Journal of Advances in Medicine and Medical Research, Page 1-9
DOI: 10.9734/jammr/2020/v32i2230700

Background: Measurement of variety of biological, biochemical and biophysical markers in pregnancy implicated in the pathophysiology of preeclampsia have been proposed to predict its development.

Aim: To evaluate the accuracy of combined measure of maternal serum uric acid level and quantitative serum beta hCG versus serum beta hCG alone as prognostic indicators of pregnancy outcome among preeclamptic patients at the Federal Medical Centre, Yenagoa.

Methods: This is a hospital based prospective case control study by systematic sampling selection. The two groups comprised of 100 consecutive patients each, one with pre-eclampsia (study group) and the other without pre-eclampsia (control) admitted for management into the antenatal ward and labour ward over the seven-month period of the study. The values of their serum uric acid and beta hCG levels were evaluated on admission and followed up. Data entry and statistical analysis was done using statistical package for social science (windows version 22.0. SPSS Inc; Chicago, USA). Level of significance was set at P < 0.05.

Results: The mean quantitative serum β hCG level amongst the subjects (26776.6 ± 19590.5) was statistically significantly higher (p < 0.001) than the mean quantitative serum β hCG level amongst the control (7973.6 ± 4193.7). The prognostic accuracy in predicting pregnancy outcomes were: HELLP syndrome (0.33, 0.44), Eclampsia (0.50, 0.39), Acute Renal Failure (0.44, 0.33), IUGR (0.43, 0.39), IUFD (0.38, 0.27) and Birth Asphyxia (0.49, 0.38) respectively for combined measure of serum uric acid and serum β hCG, and serum β hCG alone.

Conclusion: Serum β hCG levels remains a useful prognostic indicator for feto-maternal outcome in preeclamptic women. However, combined measure of serum uric acid and serum β hCG level in prognosticating pregnancy outcome in preeclamptic women was shown to have a better accuracy than serum β hCG.  

Open Access Original Research Article

Evaluation of Dento-craniofacial Characteristics in Monozygotic Twins - Case Study

Gabriela Rocha- Gomes, Noádia Abreu Souza, Fernanda Rocha- Gomes, Bruna de Cássia Ávila, Rejane Pereira Otoni, Saulo Gabriel Moreira Falci, Thiago Fonseca- Silva

Journal of Advances in Medicine and Medical Research, Page 10-19
DOI: 10.9734/jammr/2020/v32i2230701

Introduction: Monozygotic twins are a valuable sample for the study of human craniofacial growth and development.

Aims: The aim of the present study was to analyze the dento-craniofacial characteristics in monozygotic twins and to discuss the genetic, epigenetic and environmental influences in the twin’s phenotypic features.

Material and Methods: Two 21-year-old female twins attended the Dental Service of Universidade Federal dos Vales do Jequitinhonha e Mucuri were analyzed. For validation of this study, a genetic test of zygosity was performed to confirm the individuals' monozygosity. Intraoral buccal examination revealed occlusal differences as well as disagreement in the eruption of the third molars.

Results: The analysis of models showed differences in the mesio-distal diameter of the teeth of both arches, as well as disagreement in the perimeter of the mandibular arches between the two individuals. The cephalometric analysis showed remarkable differences in the vertical and horizontal parameters of the craniofacial structure. The SNA, SNB and LAFH showed differences of 10º, 9º and 3mm respectively. Additionally, the components related to the dentition also showed discrepant results.

Conclusion: It can be suggested that the dento-craniofacial characteristics present a genetic component; however, the interaction of epigenetic and environmental factors can lead to different phenotypes in univiteline twins.

Open Access Original Research Article

Plasma Growth Differentiation Factor-15 as a Prognostic Biomarker in Children with Congestive Heart Failure

Abrar Mohamed Khayal, Shimaa Basyoni El- Nemr, Hesham Ahmed El- Serogy, Amr Mohamed Zoair

Journal of Advances in Medicine and Medical Research, Page 34-42
DOI: 10.9734/jammr/2020/v32i2230703

Aim and Objectives: This study aimed to evaluate the plasma levels of Growth Differentiation Factor-15 (GDF-15) in children with congestive heart failure, also to evaluate the diagnostic and prognostic value of this novel biomarker in pediatric congestive heart failure, by correlation of its levels with the clinical status and the echocardiographic data of these patients.

Subjects and Methods: This study was conducted on Thirty (30) children with congestive heart failure (CHF), Patients were selected from those admitted to Pediatric Cardiology Unit, Pediatric Department, Tanta University Hospital, from (August 2018-April 2020), and thirty (30) healthy children, matched for age and sex, were enrolled as a control group. All children in this study were subjected to Plain X-ray chest and heart: Cardiothoracic ratio (CTR) was measured, and Echocardiographic assessment: Doppler and Two-dimensional, M-mode Echocardiographic evaluation of these parameters and Plasma level of Growth Differentiation Factor-15 (GDF-15) was measured.  

Results: the results revealed that The best cutoff point of GDF-15 to differentiate between cases with CHF and control group was >446.5 ng/l with 93.33% sensitivity, 90% specificity, 90.3% PPV, 93.1% NPV and AUC was 0.992.

There was significant decrease of EF% and FS% (systolic dysfunction of LV) in patients with CHF as compared to control group.

There was statistically significant positive correlation between plasma level of GDF-15 and Ross clinical stage of CHF.

There was statistically significant negative correlation between GDF-15 and EF%, FS % by echocardiography.

Conclusion: Plasma levels of GDF-15 were elevated in children with CHF, and these levels were correlated to the Ross staging of CHF and echocardiographic assessment of LV function. Plasma levels of GDF-15 were elevated in patients with bad prognosis, denoting its prognostic value as a novel biomarker in pediatric CHF.

Open Access Original Research Article

Comparison between Cuff Leak Test and Ultra Sound Assessment of Laryngeal Edema in Predicting Successful Extubation in Mechanically Ventilated Patients

Manar Mohammed Ismail, Sohair Mostafa Soliman, Hoda Alsaid Ahmed Ezz, Amr Arafa Elbadry

Journal of Advances in Medicine and Medical Research, Page 43-51
DOI: 10.9734/jammr/2020/v32i2230704

Objects: Endotracheal intubation commonly leads to local complications, including mechanical lesions, such as friction and compressions between the tube and the anatomic structures of the larynx leading to laryngeal edemamanifested as ‘‘stridor’’ after extubation. There is no standard method to predict patients at risk of post-extubation stridor. This study was conducted to compare between cuff leak test and ultra sound in predicting successful extubation in mechanically ventilated patients.

Patients and Methods: We included a total of 83 mechanically ventilated patients with endotracheal intubation > 24 hours. They were divided according to the outcome after extubation into 72 patients who didn’t develop laryngeal edema and 11 patients who developed laryngeal edema. The patients were extubated when they fulfilled the criteria of extubation and become negative to cuff leak test. All patients underwent both cuff leak test (CLT) and ultra-sound to assess air column width difference (ACWD) after intubation and before extubation.

Results: All patients were matched as regard demographic data. There was a significant increase in the duration of mechanical ventilation in the LE group. No significant difference was detected between the two groups regarding CLT and ACWD after intubation. However, cases with laryngeal edema had significantly lower CLT and ACWD before extubation. Using a cut off value of 1.52 mm, ACWD had sensitivity and specificity of 90.9 and 91.7% respectively to predict laryngeal edema after extubation.

Conclusions: Laryngeal Ultrasonography could be a useful, reliable, non-invasive method in the evaluation of vocal cords, laryngeal morphology and airflow passing through the vocal cords or subglottic area in intubated patients in comparison with cuff leak test.

Open Access Original Research Article

Correlation between Central Corneal Thickness and Degree of Myopia among Malaysian Patients Undergoing Laser Keratorefractive Surgery

Sagili Chandrasekhara Reddy, Mohd Mansor Shariff, Aina Malindri Dasrilsyah

Journal of Advances in Medicine and Medical Research, Page 52-58
DOI: 10.9734/jammr/2020/v32i2230705

Purpose: To determine the central corneal thickness in myopic adult patients scheduled for laser corneal refractive surgery and to explore its correlation with degree of refractive error.

Materials and Methods: The case records of 130 myopic patients who underwent laser corneal refractive surgery in a military hospital over a period of two years were reviewed to determine the central corneal thickness. All patients had 6/6 vision with best correction, and did not have any other anterior segment or fundus diseases in both eyes. The central corneal thickness was measured with Visante Carl Zeiss anterior segment optical coherence tomography instrument.                                                                                                                       

Results: Out of 130 patients, males were more (73, 56.2%); mean age of patients was 33.8 years (range 18-60 years) and majority were Malays (110, 84.6%).  The spherical power of myopia ranged from – 0.5 to – 10.00 D, and the cylindrical power ranged from – 0.25 to – 3.25 D. The mean central corneal thickness of both eyes was 528.2 µm (range 331- 615 µm); in the mild degree of myopia (- 0.50 to - 2.00 D) 527.9 µm, moderate degree (- 2.25 to -5.00 D) 529.4 µm, and high degree (-5.25 to -11.00 D) 523.9 µm.

Conclusion: The anterior segment optical coherence tomography provides noncontact, rapid, pachymetry mapping of the corneal thickness. In Malaysian patients, the mean central corneal thickness of both eyes in myopia was 528.1 µm (range 331- 615 µm). There was no correlation between the mean central corneal thickness and degree of myopia, different genders, age groups, ethnic groups and two eyes.

Open Access Original Research Article

Development and Feasibility of a Very Low-cost, Home-made, Near Infrared lymphatic Imaging Device

P. T. Luis López Montoya, M. D. Luis Roberto García Valadez, P. T. Yucari López, P. T. Joceline Sandoval, P. T. Angel López Montoya, P. T. Itzel Alcaraz, P. T. Claudia Paz

Journal of Advances in Medicine and Medical Research, Page 59-65
DOI: 10.9734/jammr/2020/v32i2230706

Introduction: Near Infrared (NIR), lymphatic Imaging is an emergent imaging                    technique used to assess superficial lymphatic structures and its function. It uses a                      NIR light source and a special camera that detects the fluorescence of a non-radioactive             dye called indocyanine green (ICG), which is injected subdermally and its way through       lymphatic capillaries, making this device useful in the diagnosis and follow up of lymphatic diseases.

Objective: To show (NIR) step-by-step development of a feasible, user-friendly, and low-cost homemade Near Infrared (NIR) lymphatic imaging device.

Methods: Using worldwide available components such as a customized laser and a modified webcam, we assembled what is a functional plug and play NIR lymphatic imaging device and evaluated its function with a 25-year-old healthy woman.

Conclusion: It is feasible to build a functional, homemade, low-cost Near Infrared (NIR) lymphatic imaging device in a tenth of its value.

Open Access Original Research Article

Factors Associated with Psychiatric Morbidity in Female Medical Doctors in Kwara State, North- Central, Nigeria

Oluwabunmi Idera Nimata Buhari, Adebusola Jane Ogunmodede, James Ayodele Ogunmodede

Journal of Advances in Medicine and Medical Research, Page 66-75
DOI: 10.9734/jammr/2020/v32i2230707

Introduction: The female doctor apart from being affected by the same variables that impose stress on the general population is also prone to stress because of the peculiarities of medical practice and the socio-cultural demands on them by virtue of their gender.

Objectives: This study was aimed at assessing the personal, work-stress as well as family       related factors in female doctors associated with psychiatric morbidity in female doctors in Kwara state.

Methods: This was a cross-sectional study involving female medical doctors in Ilorin, Kwara State, North-Central, Nigeria. Questionnaires were administered to the Members of the state Chapter of the Medical Women’s Association of Nigeria (MWAN) who were present at the general and scientific meeting of the association held in Kwara state in June 2018. A self-administered semi-structured questionnaire designed to assess biodata, personal history, work related stress, family related history and self-care history of the participants as well as the 12 item general health questionnaire (GHQ-12) was distributed to 80 participants that consented.

Results: The prevalence of 23.8% psychiatric morbidity found. Age, relationship with co-workers, feelings of frustration and anger at work, reconsidering a change in work environment, views of negative effect of stress on work as well as access to a maternity leave were found to be associated with psychiatric mobility.

Conclusions: These findings underline the need to pay attention to the welfare of female doctors and a need for routine evaluation, early identification and prompt intervention as well as support.

Open Access Review Article

Potential Impact of Nutrition on Immune System: Prevent or Assist COVID-19 Recovery

Sudhanshu Mishra, Disha Sharma, Anshita Raghuvanshi, Aishwarya Rajput, Vikash Chaturvedi, Kumari Shanno

Journal of Advances in Medicine and Medical Research, Page 20-33
DOI: 10.9734/jammr/2020/v32i2230702

In human beings, infection risk and severity differ according to immune competence based on how the immune system grows, matures, and declines. Many factors affect the immune system and its competencies, including diet. A number of clinical trials are underway to determine treatment options for coronavirus disease 2019 (COVID-19), caused by extreme acute coronavirus syndrome. Considering Covid-19, enhanced nutrition including micronutrient supplementation to improve the immune system has been recognized as a viable solution to both preventing and alleviating infection severity. Micronutrient deficiencies, especially vitamins A, B complex, C, and D including trace minerals zinc, iron, and selenium, are prevalent among vulnerable populations in general, and among COVID-19 patients in particular, and may likely increase mortality risk. A systematic review of the literature was conducted to identify nutritional strategies that might prevent or assist COVID-19 recovery. There is still an unmet need for covering the treatment of geriatric and pediatric patients.

Open Access Review Article

Polyaxial Locking Plate in Fractures of the Distal Radius

Mostafa F. Mohamed, Ali M. Emran, Osama A. Selim, Mahmoud A. El Rosasy

Journal of Advances in Medicine and Medical Research, Page 79-88
DOI: 10.9734/jammr/2020/v32i2230709

Introduction: Volar locking plate represents the gold standard method of treatment of unstable distal end radius fractures.

Objectives: The Present study aimed to identify the functional and radiological outcomes of distal radius fractures treated by open reduction and internal fixation using polyaxial volar locking plate.

Patients and Methods: We reviewed 25 unstable distal end radius fractures that were operated in Orthopedic Department in Tanta University Hospital with polyaxial volar locking plates June 2018 to June 2019. The mean age of the patients was 40.8±14.34 years (range 24 to 65) and the mean duration of follow-up was 8.61 ± 3.19 months (range 6 to 17). All of the patients underwent open reduction and internal fixation with polyaxial locking plate through over flexor carpi radialis approach. After three months, pain, tendon functions, ROM, hand grip as well as radial median and ulnar nerves functions were well assessed. X-rays were done to assure full fracture consolidation. At the end of follow up, clinical results were evaluated according to Quick DASH Score. Castaign radiological assessment score was used for radiological evaluation.

Results: There was a significant improvement in the functional indices from twelve weeks to the final follow-up. According to Castaign radiological assessment score 10 patients (40%) had excellent results, 14 patients (56%) had good results and 1 patient (4%) had fair results, no patients had poor results at the final follow up. Compared the performance of the polyaxial locking plate to another monoaxial plate and reported an improved range of radial and ulnar deviation with the variable angle device but they use another plate system.

Conclusions: The use of polyaxial locking plates in treating unstable distal end radius fractures is associated with excellent to good functional results with minimal complications.