Journal of Advances in Medicine and Medical Research

Aims: To present an atypical case of vernal keratoconjunctivitis associated with unusual inferior location of shield ulcer.

Presentation of Case: We are presenting an unusual case of vernal disease in a 7-year-old male associated with 2 corneal ulcers in the same eye, one of which was located inferiorly. The patient was prescribed topical steroids, antihistamine and lubricating eye drops. Three weeks later the symptoms got resolved and ulcers were healed, leaving mild subepithelial fibrosis. The patient was advised to continue antihistamine eye drops for the whole year with prophylactic dosage regimen.

Discussion: Vernal keratoconjunctivitis is a bilateral, seasonally recurring inflammation of conjunctiva and cornea. It affects mostly children with male preponderance. In several cases vernal disease can be complicated with development of a shield ulcer, which usually has superior location under upper eyelid. Despite the fact that literature review has revealed two atypical cases with inferior localization reported in India, it is a very rare finding. Our case also was unusual with two shield ulcers, one of which was located inferiorly.

Conclusion: This case demonstrates a very rare presentation of an atypical inferiorly located shield ulcer. Literature review revealed only two similar cases in India. Our case demonstrates the usage of topical steroids to be successful and advisable in the treatment of shield ulcer, as it controls the inflammation. Topical antihistamine medications should be added and given for a long period for preventing possible recurrences.

Current COVID-19 has become a major public health problem because of its pandemicity, with wide spectrum of disease manifestation. SARS-COV-2 can have a varied clinical manifestation ranging from asymptomatic, mild symptomatic to severe disease like acute respiratory distress syndrome, cytokine storm, and multiorgan dysfunction. It has been described in literature that cytokine storm/hyperinflammation arises as result of dysregulated immune response leading to excessive release of various cytokines which causes multiorgan dysfunction. But there is paucity of literature describing the immune response and hyperinflammation in mild disease which may cause unremitting symptoms. Here we describe a case series of three patients with mild disease, who had persistent symptoms beyond 1 week and managed with low dose steroid after confirming it to be hyperinflammation. So it is imperative to detect the hyperinflammatory phase to halt the disease progression. Also we have discussed the role of immune system and role of steroid in COVID-19.

Aims: To assess the effects of short acting octreotide on the Fibroblast Growth Factor-23 levels and the clinical outcome in a bedridden patient with Tumour Induced Osteomalacia.

Presentation of the Case: A 40-year old female, presented with a 16-year history of progressive weakness and bone pains. Severe hypophosphatemia had been documented throughout and she had been treated intermittently with oral phosphate and various preparation of vitamin D.  Hypercalcaemia due to parathyroid hyperplasia was diagnosed 4 years previously. In the last 2 years she had undergone bilateral hip prostheses and removal of 2 hyperplastic parathyroid glands. When seen by us she was bedbound with severe restriction of all joint movements, there was a palpable left buttock mass 4x4 cm. Tumour induced osteomalacia was suspected and confirmed by finding grossly elevated levels of Fibroblast growth factor (FGF-23) 3400 Ru/ml (44-140).The serum calcium 2.5 mmol/L (n 2.1-2.5), phosphate 0.3 mmol/L  (n 0.8-1.45).Alkaline phosphatase (ALP) 400 U/L ( n 35-104), Parathyroid hormone (PTH) 27 pmol/L (n 1.6-9.3) , and creatinine 70 umol/L (n 45-84). Octreotide scanning revealed focal uptake in the buttock corresponding to the MRI findings. Treatment with octreotide 100 mcg 8 hourly was given for 10 days before surgery. By day 3 the FGF-23 had fallen to 400 and on the day of surgery was 210 Ru/ml. A benign mesenchymal tumour was completely resected and 8 weeks following surgery the FGF-23 was normal, serum calcium 2.7 mmol/L, serum phosphorus 0.63 mmol/L, ALP 690 U/L, PTH 22 pmol/L . The patient was then able to walk in a Zimmer frame after 2 months. Since then she recovered completely, she is able to walk without assistance for the last 2 years.

Conclusion: This case provides an example of successful use of short acting octreotide in controlling the disease and demonstrated a rapid normalisation of elevated FGF-23 levels achieved during treatment with octreotide. It describes a rare association between tumour induced osteomalacia (TIO) and parathyroid hyperplasia, the value of octreotide scanning in tumour localisation and the potential for using LA octreotide therapy in patients with responsive tumours that cannot be localised or removed for any reason.

Aspergilloma describes the saprophytic colonization of an area of devitalized lung tissue. It usually develops in pre-existing pulmonary cavities caused by tuberculosis, sarcoidosis and other such conditions. It is found in almost 15% to 25% of patients with cavitatory lesions resulting from tuberculosis. In developing countries with high prevalence of tuberculosis, like India, aspergilloma is often misdiagnosed as tuberculosis. Hemoptysis is often equated with TB, and most patients are diagnosed clinically. Here we report one such case of a 56 year old male patient with past history of tuberculosis, who was initially diagnosed and being treated as a relapse of tuberculosis on the basis of hemoptysis and chest radiograph findings, till further detailed investigations revealed an aspergilloma in a post tubercular cavity as the cause of his symptoms.

Aims: To study whether there is any correlation between baseline blood basophil count and serum tryptase levels in newly diagnosed chronic phase chronic myeloid leukemia (CML-CP) patients.

Settings and Design: 40 newly diagnosed CML-CP patients were enrolled from Medical Oncology Hematology OPD based on their baseline BCR-ABL status (done in department of Biochemistry).

Methods and Materials: Serum tryptase level was measured using Sandwich ELISA and peripheral blood basophil count was estimated using automated cell counter & peripheral blood film examination. BCR-ABL quantification was done using real time PCR after conversion of RNA (extracted from whole blood) to cDNA.

Statistical Analysis Used: SPSS Version 23.

Results: Baseline peripheral blood basophil levels showed a significant correlation with baseline serum tryptase levels (p<0.01) and tryptase level also correlated with EUTOS score, which has basophil count as one of the parameters. This may signify that serum tryptase levels can be a surrogate marker of the basophil compartment in CML-CP.

Conclusions: Based on findings of the present study and other studies available in literature, serum tryptase can be utilised as a surrogate marker of the basophil compartment in CML-CP.

Aims: Over the period of time lot of advancement has been done in the field of dentistry. In spite of these newer materials and improvement in the properties of composite material post-operative sensitivity is still a major concern for a dentist after composite restoration placement. Dentine bonding agents; dentine adhesives are either a “total-etch technique” or “self-etch technique” which bond to the tooth structure. The purpose of this study was to evaluate the clinical efficacy of self -etch and total-etch with strict inclusion and exclusion criteria. Self-etching adhesives are used to prevent postoperative sensitivity when used before placing posterior resin-based composite restorations. The purpose of this study was to see whether self-etch adhesive would result in less postoperative sensitivity than a total-etch adhesive; Total Etch adhesive would result in a better enamel marginal integrity than Self Etch Adhesive.

Study Design: Clinical Trial.

Place and Duration of Study: Department of Operative Dentistry, Fatima Jinnah Dental College between October 2019 – February 2020.

Methodology: Sample size was calculated using a WHO sample size determination for health studies software using power 80% and the level of significance 5%. Sample size was calculated in accordance with the literature review. The sample size required was 32 in each group. Sample technique was Non-probability purposive sampling. Total 62 teeth were restored (molars and premolars) 32 in each group, age range 18 to 40 years. Cross tab made for the pain score between self-etch and total etch or pain comparison. Man Whitney test was applied. Both adhesives were handled and applied according to manufacturer’s instructions. The patients were carefully examined at recall appointments at 2 weeks, 4 weeks and 3 months.

Results: Total 62 teeth were restored (molars and premolars) 32 in each group. On the basis of frequency and percentage clinically significant difference was found but no significance was found. Patients were evaluated before treatment, 2 weeks after treatment and 3 months after treatment. When compared the sensitivity severity with self-etch technique 19.4% had moderate sensitivity before treatment which was reduced to 0% after 2 weeks and 3 months. While in total etch technique there was 16.1% sensitivity preoperatively which was reduced to 3.2% and 6.5% after 2 weeks and 3 months respectively.

Conclusion: There is lesser degree of sensitivity when total etch technique was used under composite in comparison to self-etch.

Background: Erectile dysfunction (ED) is a chronic complication of diabetes mellitus (DM) that is associated with a negative impact on emotional wellbeing and poor quality of life. There is dearth of current data on the lifestyle correlates of ED in subjects with type 2 diabetes both locally and globally.

Objective: To determine the association between ED, tobacco use (snuff use and cigarette smoking) and alcohol consumption in type 2 DM patients attending the diabetes outpatient clinic of Nnamdi Azikiwe University Teaching Hospital, Nnewi in South-Eastern Nigeria.

Materials and Methods: This was a cross sectional hospital-based study comprising 124 male type 2 diabetic subjects. Data collection was done with a researcher designed study proforma. The Hospital Anxiety and Depression Scale (HADS), International Index of Erectile Function (IIEF) and the abbreviated version of Alcohol Use Disorder Identification Test (AUDIT-C) questionnaires were used for the diagnosis of anxiety/depression, erectile dysfunction and obtaining the alcohol history respectively. History of tobacco use was obtained and cigarette smoking estimated in pack years. Subjects who had anxiety, depression or hypogonadism were excluded from the study. Statistical analysis was done using the Statistical Package for Social Sciences (SPSS) version 20. P value of ˂ 0.05 is considered significant.

Results: A total of 124 patients were studied. The prevalence rate of ED among the subjects was 48.4%. No significant associations were found between erectile dysfunction and tobacco use (Cigarette smoking and Snuff use) (P = 0.814, OR = 0.904, 95% C.I = 0.389 – 2.101) (P = 0.762, OR = 0.867, 95% C.I = 0.344 – 2.15) and alcohol consumption (P = 0.389, OR = 0.670, 95% C.I = 0.269 – 1.667) respectively.

Conclusions: There was no significant association between ED and tobacco use and alcohol consumption in subjects with type 2 diabetes mellitus. Similarly, no significant association was found between ED, pack years of cigarette smoking and the grades of alcohol consumption in the subjects. The subjects’ diet, medications and the social/religious stigma attached to the use of these substances in our setting could have influenced our findings.

Aims: The present study aimed to evaluate the quality of care provided to elderly victims of violence, comparing the basic health units (BHU) of the municipality of Gurupi-TO with and without the medical residency program in family and community health.

Study Design:  This is a descriptive, cross-sectional and retrospective study.

Place and Duration of Study: Study from December 2017 to March 2018. Performed in 12 basic health units (BHU) in the municipality of Gurupi-TO, with a total of 21 family health teams, 10 (ten) have the Family Medical Medical Residency Program (FMMRP) and are distributed in six BHU, totaling approximately 210 individuals, divided into 21 teams.    

Methodology: Study conducted in 12 BHU, in which health workers responded to the QualiAB assessment and monitoring instrument and the data were tested by the chi-square test to verify if there is a difference in care, considering p≤5% through the EPI INFO 3.2.2 program.

Results: We interviewed 107 health workers who found that of the 16 items analyzed, eight had better levels in BHU with MRPFCM.

Conclusion: The presence of MRPFCM programs contributes and improves the quality of service in basic health units, regarding the care of the elderly victims of violence and, as a public policy, should receive support for its expansion and effective incorporation in basic care to SUS users.

Our aim was to investigate the effect of different progesterone (P4) at day of triggering HCG on the outcomes of ICSI with fresh embryo transfer in cases who underwent controlled ovarian stimulation (COS). Pituitary desensitization done either with long agonist or antagonist pituitary desensitization protocols, then analyzing the effect of serum P4-hCG level on ICSI-fresh embryos transfer outcome including; number and quality of retrieved oocytes (OR), embryo number (ER) & quality and ongoing pregnancy outcomes. The cases are which continued their pregnancy till 12 weeks, aborted cases, ectopic pregnancy & cancelled cases (for different reasons).

Materials and Methods: This prospective cohort study was carried on 120 cases who underwent ICSI cycles for different causes and types of infertility. Controlled ovarian stimulation (COS) protocol and pituitary down-regulation either by; GnRH long agonist /antagonist protocols then, fertilization, embryo grading, embryo transfer and hormonal luteal support was done. Blood samples were taken on the day of hCG administration to measure P4 in all cases. All patients who got pregnant and continue till 12 weeks, they were categorized into 3 subgroups as regard serum P4 level: Group A: (P4< 0.5 ng/ml), Group B: (P4=O.5-I.5 ng/ml) & Group C: (P4 >I.5 ng/ml) and correlated with their ICSI outcome. The outcomes of ICSI-ET cycles in those cases were compared with 3 groups of P4 levels in the controlled ovarian stimulation with two protocols.

Results: P4 level had insignificant relation with number and quality of retrieved oocytes, fertilized embryo number and quality and endometrial thickness regardless the protocol of COS. The low and high levels of P4 both, had a detrimental effect on CPR, meanwhile, with no harmful impact on the ongoing pregnancy rate was noticed, regardless the protocol of ovarian stimulation. P4-hCG isn’t considered to be the only predictive measure of ICSI outcome. Highest CRP was noticed in cases with P4 level (0.5-I.5 ng/ mI) regardless the type of protocol used.

Aims: The objective was to analyze the clinical data in population from Mexican Guanajuato state as a suspected case of COVID-19 and with result positive of rRT-PCR, reported until October 2, 2020.

Study Design: It is a cross-sectional based in data from National Epidemiological Surveillance System from General Epidemiological Directorate, Secretary of Health in Mexico.

Place and Duration of Study: Sample: All registries from confirmed and discarded cases of COVID-19 in database until October 2, 2020.

Methodology: It was included 100,919 registries, and from them, 810 were excluded by missing the result of rRT-PCR test. A suspected case was one with a clinical finding considered greater (cough, fever, headache or dyspnea and accompanied by at least one of the following: myalgia, arthralgia, odynophagia, chills, chest pain, rhinorrhea, anosmia, dysgeusia or conjunctivitis); a confirmed case of COVID-19 is a person with a positive rRT-PCR test for SARS-CoV-2, regardless of the clinical data presented. We included age, sex, and clinical data registered and result of rRT-PCR for SARS-CoV-2. It was used logistic regression to analyze the effect of clinical data on positive rRT-PCR.

Results: It was analyzed 100,109 registries. From them, 41,734 were positive for SARS-CoV-2. Fever (OR 1.72, CI95% 1.68 to 1.77), cough (OR 1.70, CI95% 1.66 to 1.74), and odynophagia (OR 1.71, CI95% 1.66 to 1.75) shown a stronger effect on positive rRT-PCR test. Cyanosis did not have any effect on the result of the rRT-PCR test.

Conclusion: There are not pathognomonic clinical data for COVID-19. All clinical data in confirmed cases are similar to another respiratory viral infections.

Background and Purpose: Attention Deficit Hyperactivity Disorder (ADHD) is the most common neurodevelopmental disorder in children. The purpose of this study is to explore the rate of psychiatric comorbidities among children with ADHD and investigating the impact of comorbidities on function of children.

Subjects and Methods: Sixty-four children of both genders who fulfilled DSM-5 criteria for ADHD were included. All subjects were subjected to IQ assessment, Kiddie Schedule for Affective Disorders and Schizophrenia (K-SADS), Conners Rating Scale, and Child Behavior Check List (CBCL).

Results: Combined subtype was the commonest (50%) followed by hyperactive-impulsive (31.25%), then inattentive (18.75%). Psychiatric comorbid disorder among pediatric cases with ADHD was ODD (31.25%), followed by nocturnal enuresis (23.44%), conduct disorders (18.75%), motor tic disorders (15.63%), anxiety disorders (12.50%), depressive disorders (10.94%), substance abuse disorders (9.38%), autism spectrum disorders (7.81%), vocal tic disorders (1.56%).  There was a statistically significant difference between gender and conduct disorder and SUDs (P <0.05). There was no significant difference in the distribution of comorbidities among subtypes except for conduct disorder (P<0.05). There was a significant difference between comorbidities and severity of ADHD, according to the Conners scale (P<0.05). There was a significant difference between comorbidities number and different CBCL parameters (P<0.05). There was a significant negative correlation between the number of comorbidities and total competence and positive correlation with the total problem (P<0.05).

Conclusions: The presence of comorbid disorders among pediatric cases with ADHD is the rule rather than the exception. Oppositional defiant disorder, followed by nocturnal enuresis, are the most common comorbid diseases. Comorbidities number is negatively correlated with total competence and positively correlated with the total problem.

Background: This prospective study was carried out to look for the frequency of isolation of Extended spectrum b lactamase (ESBL) producing bacteria from urine samples and study their susceptibility pattern. The detection of ESBL genes responsible for their resistance was done by Polymerase chain reaction (PCR).

Methods: The study was carried out over a period of one year from January 2016 to        December 2016. Urine specimens from patients were processed as per standard protocol. Antimicrobial susceptibility testing was performed by disk diffusion method as per CLSI guidelines 2016.

Urine isolates obtained were screened for ESBL, by cefotaxime, ceftazidime disk and confirmation was made by Double disk diffusion test method. The detection of ESBL genes responsible for their resistance was done by Polymerase chain reaction (PCR) for blaCTX-M, blaTEM and blaSHV genes.

Results: Prevalence of ESBL producing uropathogens were found to be 20.47% with most common organism to be isolated was Escherichia coli (E. coli) followed by Klebsiella pneumoniae. Nitrofurantoin and Imipenem were the most effective antibiotic agents against urinary isolates. Most common gene responsible for ESBL production was blaCTX-M (71.42%).

Conclusion: A large number of ESBL producing strains are creating significant therapeutic problems. Therefore, monitoring of ESBL production, judicious use of antibiotics and infection control measures are necessary to avoid treatment failures in patients with Urinary Tract Infections (UTI).

Background: Malignant musculoskeletal tumours are comparatively rare tumours and delays in diagnosis and treatment are common. Understanding the factors that influence delay is important so as to improve the outcomes for cancer patients.

Aim: To describe factors associated with delay in presentation of patients with primary musculoskeletal tumours.

Study Design: Descriptive cross-sectional study.

Setting: The study was conducted in a tertiary referral hospital from July to December 2014.

Methodology: 56 patients with a confirmed histopathological diagnosis of a primary malignant musculoskeletal tumour and who had consented to the study were included.

Data was collected using a pre-tested questionnaire. The clinical findings, laboratory results and radiographs of the lesions and the chest, as well as histopathological results were used to stage the musculoskeletal tumour.

Data was analyzed using SPSS software version 20.0. Univariate and bivariate analysis was done for associations and results presented in the form of tables, pie charts and bar graphs.

Results: A total of 56 patients were studied, 34 (60.7%) males and 22 (39.3%) females with a male to female ratio of 1.5:1. 73.2% (41) of the patients were adults while children comprised 26.8% (15). The age range was 4yrs-78yrs, with a mean of 32.25yrs.

The mean patient delay was four months with 50% (28) of the patients seeking care for the first time after three months.

Males were twice as likely to present late compared to females (OR 2.5, P=0.10) while patients younger than 40 years were more likely to present late (OR 1.4, P=0.59). Low educational level (OR 3.7, P=0.15) and low family income (OR 2.3, P=0.38) were associated with delayed presentation.

Conclusion: Delayed presentation of patients with MS tumours is influenced by a multitude of factors ranging from the socio-demographics (age, sex, education level), socio-economic status and tumour knowledge, beliefs and perception.

Study Objective: The colostomy is not used systematically for the treatment of Fournier’s gangrene. Through our study, we compared two groups of patients who had faecal diversion and those how did not .we tried to get the advantages of this method and his impact on wound healing and duration of hospitalization

Patients and Methods: This is a 14-years retrospective study from 1st January 2005 to 31st December 2018. We collected 86 cases of Fournier's gangrenes, of which 30 patients benefited from a derivative colostomy, done by the same surgical team. We divided the two groups by aetiology and morbidly-mortality.

Results: In the group with colostomy, prevalent disease was perianal suppurations with the presence of risk factors in75% of cases such as diabetes, immunosuppressive therapy or patients age over 70 years old .While these factors are found only in 52% of the other group. The average days of hospital stay in the group with colostomy was 25 days and 32 in the other group, 67% of patients had a colostomy with hyperbaric oxygen therapy against 70% in the other group. Mortality was 30% in first group with colostomy, an 12.5% in the second one, the overall mortality was19% globally in the two groups.

Conclusions: In our series only 35% benefited from a colostomy: Patient with major deterioration and the presence of others diseases. But overall mortality in our series is comparable to that of teams practicing colostomy systematically.

Background: The complete lockdown in Nigeria earlier this year as a result of the COVID-19 pandemic severely disrupted surgical care and training in all ramifications as mostly, only emergency cases were seen besides COVID-19 patients. After the lockdown, and gradual introduction of out-patient and elective surgical care and other medical services, measures to prevent transmission of the virus in our daily surgical practice as well as the introduction of virtual meetings and training are some of the new normal that will remain even after the pandemic.

Aim: The aim of this paper is to assess the impact of the COVID-19 pandemic on residency training in surgical specialties in Northcentral Nigeria.

Methodology: The objective was achieved using an online questionnaire distributed to residency training tertiary centres in Northcentral Nigeria.

Results: We found that various aspects of training were affected differently by the pandemic, with novel strategies adopted to minimize the impact.

Conclusion: We conclude that although there was a reduction in core activities of surgical training, there were strategies in place to mitigate the negative impact of the pandemic by streamlining care to protect the surgical community, whilst adopting new methods to sustain learning. There is need to incorporate these new methods into mainstream surgical training in the sub-region even after this pandemic.

Background: Sexual dysfunction of which erectile dysfunction is one of the complications usually occurred in men with diabetes mellitus. Hence this study aimed to assess the prevalence and analyze risk factors for erectile dysfunction (ED) in patients with type 2 diabetes mellitus (DM).

Materials and Methods: This is a cross-sectional study of 147 men with type 2 DM recruited from the diabetes clinic of a tertiary health institution in Nigeria. ED was assessed using an abridged version of international index of erectile function (IIEF–5). Sociodemographic data that included age, education, occupation, marital status were assessed and medical history including diabetes duration, smoking, alcohol intake, frequency and style of sexual intercourse obtained.

Results: The mean age of the study sample was 68.22±12.15 years. The prevalence of ED was 69.5%, of which 14.3%, 14.3%, 10.5% and 29.9% had mild, mild-moderate, moderate and severe dysfunctions respectively. The prevalence of ED increased with age, duration of diabetes and obesity but not with glycaemic control, consumption of alcohol or smoking.

Conclusions: ED was highly prevalent among men with DM in South-West Nigeria. Hence, efforts must be made to reduce the high prevalence by managing the factors responsible for its development. Also, health care practitioners must regularly inquire about this specifically as patients may not readily volunteer this information.

Aims: The study was conducted to check the association of risk factors with asymptomatic peripheral artery disease (PAD) in patients with type 2 diabetes mellitus in local population.

Study Design: Cross sectional study.

Place and Duration of Study: Department of Medicine in public sector university from 14^th June 2013 to 13^th December 2014.

Methodology: Male & female patients with ≥ 35 years of age, having type II diabetes mellitus for ≥ 5 years duration were included in the study. Enrolled patients were evaluated for peripheral artery disease by doing color Doppler study and their Ankle-brachial index was calculated. Ankle-brachial index < 0.9 was criteria for Peripheral arterial disease. Data was analyzed using statistical software SPSS version 21.

Results: Of 385 consecutive patients, 212 (55%) were male and 173 (45%) were female. 134 (34.8%) patients had peripheral artery disease. Mean age of PAD patients was 46.52 ± 8.67 years. The Proportion of males was 64.2% for PAD and 50.2% for Non-PAD patients. Association was found between peripheral artery disease and gender (male); OR 1.77 (1.15- 2.73), Age; OR 0.96 (0.93 - 0.99), smoking; OR 6.96 (3.45- 14.03) Hba1C; OR 2.74 (1.83 - 4.13), with significant P-value of 0.01, 0.04, < 0.001 and < 0.001 respectively.

Conclusion: Asymptomatic peripheral artery disease is common in type 2 Diabetic patients particularly those who are aged male, have uncontrolled diabetes, has longer duration and are smokers as well.

Background: Pulmonary arterial hypertension (PAH) is a frequent complication of congenital heart disease (CHD) with left-to-right shunt. Increased pulmonary pressure leads to vascular remodeling and RV dysfunction.

Objectives: To analyze the role of  high-sensitive cardiac  troponin T (hs -cTnT) in the determination of myocardial injury caused by volume and pressure load due to pulmonary hypertension (PH) in children with left to right cardiac shunt.

Patients and Methods: Twenty  patients with congenital heart disease (CHD) with left to right shunt and PAH-CHD, 20 patients with CHD with left to right shunt but without PH, and 20 healthy children, in total 60 individuals, were included in the study. All cases aged between 3 and 36 months. Plain x-ray chest and heart, electrocardiography, Doppler and Two –dimensional, M- mode echocardiographic evaluation of CHD and pulmonary pressure were performed in all patients. Blood samples were obtained from all cases for measurement of serum high-sensitive cardiac troponin T (hs-cTnT) levels by highly sensitive third-generation quantitative test.

Results: The mean hs-cTnT levels were significantly higher in patients with PH than in patients without PH (p < 0.05) with a sensitivity 70% and specificity 95%. A statistically significant positive correlation was determined between pulmonary artery pressure and hs-cTnT levels, and significant negative correlation with EF% and FS %( by echocardiography).

Conclusions: Serum levels of high-sensitive cardiac troponin T (hs-cTnT) were significantly elevated in PAH-CHD children denoting myocardial injury caused by volume and pressure load due to PH in children with left to right cardiac shunts, so it could be used as a cardiac biomarker in PAH-CHD children with good diagnostic and prognostic value and high sensitivity and specificity, which may be useful in the management of PH in childhood.

Background: Hemorrhoidectomy is one of the most effective treatments for Grade III/IV hemorrhoids. This study was aimed to compare the outcomes and postoperative complications arising from the harmonic scalpel hemorrhoidectomy with conventional hemorrhoidectomy.

Methods: In this retrospective study, 1120 patients were operated on for symptomatic Grade III/IV hemorrhoids during April 2004-April 2020. In the conventional hemorrhoidectomy patient group, the operation was performed by Ferguson closed method using monopolar electrocautery, while the other patient group was operated using a harmonic scalpel. Patient demographic data and common patient complaints were recorded. Operation duration and blood loss during the procedure were noted. Regular follow up of the patients was done for 4 weeks, and postoperative pain relief was recorded using the Visual Analog Scale. Finally, patient satisfaction and complete wound healing were analyzed along with postoperative complications like incontinence, secondary hemorrhage, recurrence, and anal stenosis.

Results: The patient demographic characteristics and preoperative complaints were similar for both groups. Harmonic scalpel procedure resulted in shorter operation time and less blood loss. Postoperative pain relief was substantially better in the patient group who underwent harmonic scalpel hemorrhoidectomy. Harmonic hemorrhoidectomy procedure also resulted in higher patient satisfaction and wound healing. Minimal postoperative complications were observed for both groups.

Conclusion: Harmonic scalpel hemorrhoidectomy is a safe and effective procedure that achieves simultaneous tissue and vessel sealing. It reduces the duration of the operation, blood loss, postoperative pain, and complications compared to a conventional hemorrhoidectomy procedure.

Background: Diabetes is the leading cause of nontraumatic amputation. Foot screening which detects and stratification of diabetics which are at the risk of developing diabetic foot ulcer is the simple and useful part of this model of care.

Aims: Primary Aim: To stratify patients with type II diabetes into different risk categories of diabetic foot as per International Diabetic Federation guidelines.

Secondary Aim: To determine the relationship of various risk factors with risk categories of diabetic foot.

Study Design: Cross sectional study.

Place and Duration of Study: Department of Medicine, Liaquat University Hospital Jamshoro / Hyderabad from February 2019 to August 2020.

Methodology: This study included 117 consecutive patients with confirmed diagnosis of Type-II diabetes of either sex ≥ 18 years of age.

Patients fulfilling above criteria were included in study. Feet were thoroughly examined for neuropathy, peripheral vascular disease, infections, ulcers and osteoarthropathy. All the data was recorded on proforma. Patients having normal protective sensations were put in low risk (category 0), those having loss of protective sensations in moderate risk (category 1), those having loss of protective sensations with either high pressure or poor circulation or structural foot deformities or onychomycosis in high risk (category 2) and those having past history of ulceration, amputation or neuropathic fracture were put in very high risk (category 3). Data was analyzed by using SPSS version. 20.

Results: Total 117 patients of diabetic foot ulcer were studied, their mean age was 52.28±9.26 years, diabetic duration 10.21±8.10 years and mean HbA1c level was 10.07±1.96 mmol/l. Male were in majority 52.1%. Ulceration history was in 18.8% cases, amputation history was in 7.7% cases, 46 patients (39.3%) had risk category 1. A strong relationship was found between risk categories and age, sex, duration of diabetes, HBA1c.

Conclusion: This study revealed that 33 (28%) patients attending the diabetic clinic were at high risk of developing diabetic ulcer.

Aim: Patients perception of health care delivery system can be expressed as an opinion. The aim of the study is to assess patients’ opinion on availability and cost of drugs in the General Outpatient Department of a state teaching hospital in Nigeria.

Study Design: The study was of descriptive, cross-sectional design.

Place and Duration of Study: This study was conducted at the General Outpatient department, Enugu State University Teaching Hospital, Enugu state, Nigeria. It was conducted between August 1^st and October 31^st, 2017.

Methodology: Information was collected from 313 patients exiting the Pharmacy unit, using structured interviewer-administered questionnaire. Statistical Package for Social Sciences (SPSS) was used for analysis, and the results expressed as frequencies and percentages. Education, sex, and age patterns of the responses were looked at.

Results: A total of 313 patients responded, 131 (41.9%) males and 182 (58.1%) females. Out of these, 91 (29.0%) were of the opinion that drugs were reasonably or completely available, while 184(58.8%) reported that it was either few or completely unavailable; with 38(12.1%) having no opinion on availability. With respect to price; 198(63.3%) believed that price is affordable or very affordable, while 78(24.9%) thought it was exorbitant or very exorbitant; with 37(11.8%) being uncertain about the price of drugs.

Conclusions: In LMIC, inadequate stock of drugs in health facilities is a common occurrence. More than half of patients that presented in the study health facility were of the opinion that only few prescribed drugs, or completely none were available. However, most of them believed that the price of drugs was affordable or very affordable. It is crucial that governments and health care managers redouble their efforts towards provision of drugs, if meaningful progress will be made in the area of global Universal Health Coverage.

Background: In December 2019, a cluster of pneumonia cases caused by a novel corona virus (2019-nCov), later named as severe acute respiratory syndrome corona virus-2 (SARS-CoV-2) was detected in China. In India, 30^th January 2020 first positive case ofSARS-CoV-2was reported from Kerala. The reverse transcriptase polymerase chain reaction (RT-PCR) is the standard method of choice for diagnosis of SARS-CoV-2 infection. Certain biomarker molecules that are being evaluated for assessment of severity and prognosis are; D-dimer, C reactive protein (CRP), lactate dehydrogenase (LDH), complete blood counts (CBC) and serum ferritin. The elevated levels of these biomarkers were associated with extent of inflammation.

Objective: This prospective study was designed to assess the severity and prognosis of pneumonia cases caused by SARS-CoV-2 using different haematological and biochemical biomarkers.

Materials and Methods: This study was conducted among 242 participants attending covid-19 facility of BRD Medical College Gorakhpur, after confirmation by RT-PCR. Different haematological and biochemical biomarkers were analyzed using 5 ml fasting venous blood samples and these were analysed in auto analysers using standard protocol as per manufacturer’s instructions. Finally result was analyzed using standard statistical calculation by %positivity, confidence interval, p values and ≤ 0.05 is considered as statistically significant.

Results: Among a total of 242 COVID-19 cases based on different haematological and biomarkers assessment; 92 were critically ill and 150 non-critically ill. The mean ±SD of various haematological parameters among critically ill cases were; haemoglobin (13.0±1.8),TLC (13846.13±3903.76),PLT (92213.48±61415.07),NLR(36.5±30.4).The mean ±SD of the biochemical parameters of critically ill participant was; CRP 44.7±35.4 (95%CI 25.06,2.93),D. dimer 2.9±2.6 (95%CI 1.69,0.10), serum ferritin 1204.7±750.7 (95%CI 581.8,60.1),LDH 397.2±180.8 (95% CI 133.01,0.0163). The level of different haematological and biochemical parameters was raised also in non-critically ill cases but at lower side. Out of these 242 cases; 106 (43.8%) were died and 136 (56.2%) survived but the mortality was high in critically ill cases.

Conclusion: Our findings show that level of D-dimer, LDH, CRP, NLR and serum ferritin,can be used to assess the severity and prognosis of COVID-19 cases. Among these biomarkers; D-dimer levels correlate more precisely with severity and can be considered as a reliable prognostic marker.

Background: Hospital-acquired pneumonia is a major medical problem even in developed countries. It is the most common nosocomial infection reaching 25% of all infections in the intensive care unit (ICU).

Aim: Aim is to study the radiographic findings of hospital acquired pneumonia in collaboration with laboratory and clinical findings in pediatric intensive care unit.

Patients and Methods: A prospective study on 60 pediatric patients admitted to PICU. Cases were divided into two groups. Group A: 30 cases with clear chest x-ray on admission and developed Hospital Acquired Pneumonia (HAP) after 48 hours. Group B: 30 cases with Community Acquired Pneumonia (CAP) on admission. Both groups were subdivided into mechanically ventilated and non-Mechanically Ventilated (MV and non-MV).

Results: Regarding X-ray in 1^st day there was significant increase in CAP compared with HAP in the form of Bronchopneumonia and lobar pneumonia with effusion. X-ray in HAP had significant worsening in 3^rd day compared with 1^st day in both MV and non-MV groups. Otherwise no difference was found between groups.

Regarding CT Chest, there was statistically significant increase in Bronchopneumonia in non-MV CAP compared with other groups. Also, there was statistically significant increase in Rt. Upper lobar pneumonia in MV HAP compared with other groups. Similarly, there was statistically significant increase in Lt. pleural effusion with underling consolidation collapse of lower lobe in MV HAP compared with other groups. There was statistically significant increase in Rt. pleural effusion with underling consolidation collapse of rt. Lung in non-MV CAP compared with other groups. There was statistically significant increase in Bronchopneumonia with Rt. minimal pneumothorax in MV CAP compared with other groups. Otherwise, there was no significant difference between the studied groups.

Conclusion: Hospital acquired pneumonia was worse radiologically and bacteriologically. Hence, need more time to heal and more aggressive therapy was needed. Clinical pulmonary infection score was predictor for mortality. Predictors for length of stay (LOS) were found total leukocystic count (TLC), Absolute Neutrophilic Count (ANC), ESR and Culture & Sensitivity of bronchial secretions.

A cross sectional study was conducted among subjects from two health facilities in Port Harcourt to assess malaria status and its health determinants. Seven hundred subjects of different ages and both sexes were investigated after ethical approval was obtained from Rivers State Ministry of Health, Port Harcourt, Nigeria. Written consent of the subjects was obtained before questionnaire administration to obtain the demographic data. The uninfected subjects were used as control. Four (4) mls of blood was taken from each subject by vein-puncture into separate EDTA bottles for haematological profile tests and malaria parasite identification using standard haematological and parasitological techniques. The overall prevalence of malaria was 27%. The males had slightly higher prevalence (27.8%) than the females (26.5%), though the difference was not statistically significant (P> 0.05). The highest prevalence occurred among females (48.4%) of age group <1-10yrs and followed by males (40.7%) of same age group, and followed by males of 11-20 yrs with 36.4%. From risk groups related prevalence the School children (45%) were the most infected, followed by Blood donors (35.7%) and pregnant women (26.5%). Only the Packed Cell Volume was significantly affected adversely by malaria (P<0.0001), of all the haematological Parameters tested.

Introduction: The irrational and inappropriate use of beta-lactam antimicrobial drugs has led to the advent of resistant strains worldwide. Beta-lactam resistance is mainly attributed to acquiring beta-lactamase genes, the consequence has been preventable treatment failures (sometimes fatal) in patients.

Aims: To Identify the Incidence of Extended-spectrum Beta-lactamae Producing Bacteria In Urinary Tract Infection (U.T.I). Patients (outpatients and inpatients) of Specialist Hospital Jimeta-Yola Adamawa State, North-east Nigeria.

Methodology: It was a Cross-sectional study carried out in Microbiology Unit of the Department of Science Laboratory Technology, School of Life Sciences, Modibbo Adama University of Technology Yola, Adamawa State, Nigeria. Between April and June 2016, The Strains Were Isolated, Identified And Screened For E.S.B.L By Double Disc Diffusion Synergy Tests (DDDST) Using Augmentin and Third-Generation Cephalosporin Cefuroxime-CRX, Cefixime-CXM and Ceftazidime-CAZ Purchased from Rapid labs. U.K.

Results: Of the 150 isolates, 49%(74/150) were Gramm positive and 51%(76/150) were Gramm negative, S. aureus 29% (44/150) was found to be the most prevalent organism followed by E. coli  21%(31/150) while P. aeruginosa has the lowest 2%(4/150), of the 150 isolates,17.4%(26/150)  were E.S.B.L producers with female patients accounting for the 84.6%(22/26), out of 31 E. coli isolates 25%(8/31) were ESBL producers, out of the 21 K. pneumonia isolates 19%(4/21) is ESBL  producers, out of the 16 S. feacalis isolates 6%(1/16) is ESBL producers, out of the 14 P. mirabilis isolates 21%(3/14) is ESBL producers, out of the 4 isolates 50%(2/4) are ESBL producers and none of the isolates of S. epidermis and E. aeruginosa was ESBL producer.

Conclusion: Periodic Study Of E.S.B.L Should Be Employed To Monitor Local Resistance Pattern And Comparative Study Of Both The Phenotypic And Genotypic Detection Should Be Employed To Authenticate The Reliability Of The Phenotypic Detection Method(S).

Background: Convulsion, a common neurological disorder resulting from abnormal electrical activities in the brain with morbidity and mortality depending largely on the cause of the convulsion and interventional practices. Outcome is often worsened when agitated parents/caregivers ignorantly deploy harmful home practices.

Objective: This study evaluated different home care offered to a convulsing child and their impact on the child.

Methods: This was a prospective study involving all children who came in with convulsion to the Paediatric Department of the Federal Medical Center, Asaba over a study period of 14 months. A Researcher administered pre-tested questionnaire was used to assess the types of home care given. Physical examination was carried out on all the patients while using a Chest radiogram to confirm cases of suspected aspiration.

Results: One form or more of harmful traditional home care was administered to 84% of the study children, 48% percent had palm kernel oil applied to the skin and other parts of the body while 33.3% of the convulsing children had spoons forcefully inserted into their mouths. The most common complication was massive blood loss from scarification marks in 60% of the subjects while fear of death was a common cause for concern in 56% of the parents.

The relationship between the socio-economic status of the parents and the caregiver to a convulsing child was seen to be statistically significant (p < 0.005).

Conclusion: Homecare/treatment for childhood convulsion is a common practice among caregivers necessitating an urgent need for mass education and enlightenment on proper management of convulsion.

Background: Cystic knee lesions (synovial cysts, bursae, ganglia, and meniscal cysts) are frequently discovered and can be divided into real cysts and lesions that simulate cysts (hematomas, seromas, abscesses and vascular lesions).

Aim of the Work: The aim of this study was to assess the role of magnetic resonance imaging in evaluation of cysts and cyst like lesions in and around the knee.

Subjects and Methods: From January 2018 to August 2019, 30 patients were referred from outpatient clinics and orthopedic surgery department to MRI unit of radiodiagnosis and medical imaging department at Tanta University Hospitals, for MRI evaluation of suspected knee cystic lesions.

Results: MRI was able to detect all clinically suspected cystic lesions within the knee. It also helped to describe morphology and it’s relation to surrounding tissues. 16.7% and 3.3% of the studied cystic lesions had fine and thick septa respectively, and 67 % of the studied cystic lesions had communication with the joints. MRI could identify the associated pathology of most of the detected cystic lesions (80%). The most common pathology were meniscal degeneration (26.7%) followed by meniscal tear and osteoarthritis (23.3%) and (20%) respectively. Ligament tear / sprain formed 6.7% of the total cysts while bone contusion forms 3.3%.

Conclusion: The findings of this study confirm that In spite of its high cost, limited availability and the need for highly expert radiologists, MRI remains the method of choice for both diagnosis, characterization and uncovering the associated pathology and cause of cystic lesions around the knee. The high ability of MRI to image soft tissues plays a key role.

Background: Tibial plateau fracture is considered one of the most common intra-articular fractures, especially lateral condyle fractures. The purpose of this study is to evaluate clinical, radiological, and functional outcomes of using subchondral periarticular rafting screw above a lateral plate without bone grafting or substitute for Schatzker type II and type III fractures.

Methods: This prospective study was carried out on 43 patients above the age of 18, fit for surgery with closed tibial plateau fracture [lateral split depression (type II) and lateral depression (type III) according to Schatzker classification] time of trauma less than 14 days with no other skeletal injuries. All patients were followed up for at least six months. All patients were treated by open reduction and internal fixation (ORIF) and using subchondral periarticular screws as rafting construct to maintain articular surface and protect it from collapse. Analysis of clinical outcome was clinically based on Modified Rasmussen clinical scoring system and radiologically based on Rasmussen radiological knee scoring system.

Results: In our study, 28 females and 15 males with a mean age of 49.5 years, mechanisms of trauma were road traffic accidents in 26 cases, and fall from height in 17 cases, 24 cases with Schatzker type II fracture, and 19 with type III. According to functional Rasmussen score, acceptable results were 93.1%, (76.8% excellent & 11.6% good) while non-acceptable results were 6.9%, (4.6% fair & 2.3% poor). According to radiological Rasmussen score, acceptable results were 83.7%, (65% excellent & 18.7% good) while non-acceptable results were 16.3%, (9.3% & 7%). No significant difference was found between the studied groups regarding sex, side affected, type of fracture, and type of trauma. The final outcome was significantly affected by age, medical history.

Conclusions: Fixation using a subchondral periarticular rafting screws for lateral split-depression and lateral depression tibial plateau fractures without using bone graft or bone substitutes is a viable and good option during open reduction and internal fixation, helps surgeons achieve and preserve the anatomic joint line and normal mechanical axis, with superior functional results in the short term. Therefore, avoiding morbidity associated with bone grafting without compromising the fracture stability.

This study sought to perform a review of the literature on the use of electromyography to assess postural load in dental work. The literature used in this review was obtained from databases and only articles published published between 1991 and 2019 were considered. The main keywords were “electromyography,” "working posture”, “ergonomics” and “muscle activity”. Each abstract was read to determine whether the information in the article included discussions on the use of electromyography to assess postural load in dental work (n=27). It was found that electromyography is beneficial to assess the influence of different devices used in dental work, however, as it has limitations, researchers must be aware of them to seek alternatives to circumvent them.

The distal radioulnar joint is one of the inherently unstable joint in the body, its injury is commonly missed and the patient may present later with pain and restricted movement because of joint instability.  The distal radioulnar joint instability could be dorsal , volar , or bidirectional, and it could be caused by soft tissue injury or bony injury and malunion. It is fundamentall to recognize the type of injury and the cause of instability to be able to provide the proper form of treatment to get the best results.