Open Access Case Report

Into the Unknown-exploring a Rare BRAF K601E Mutation in a Rectal Adenocarcinoma

Nupur Karnik, Mandar Ankolkar, Prachi Gogte, Mukta Ramadwar, Vikas Ostwal, Omshree Shetty

Journal of Advances in Medicine and Medical Research, Page 224-228
DOI: 10.9734/jammr/2020/v32i2430770

Aim: v-Raf murine sarcoma viral oncogene homolog B (BRAF) gene mutations are broadly divided as BRAF V600E and BRAF non-V600E. These groups exhibit differences in the clinical, histological, molecular and therapeutic mechanisms.

Case Presentation and Discussion: The case described is of a middle aged female with an aggressive rectal adenocarcinoma diagnosed on biopsy and immunohistochemistry. A rare BRAF non-V600E mutation at codon 601, K601E was detected. This mutation has been described in very few cases of colonic adenocarcinoma. The tumor showed extensive local and peritoneal disease with lung metastasis at presentation and progression on the primary line of chemotherapy. The aggressive predisposition of the tumor was contrary to reports suggesting non-V600E tumors to connote a better prognosis.

Conclusion: Active reporting of non-V600E BRAF variants in colorectal adenocarcinoma is essential in order to create a robust database which will help in assessing a biological behavior of these tumors and explore the role of targeted therapy.

Open Access Case Study

An Autosomal Recessive form of Cornelia de Lange Syndrome Due to Mutations in TRMT61A Gene: A Case Report

Fadel A. Sharif

Journal of Advances in Medicine and Medical Research, Page 327-331
DOI: 10.9734/jammr/2020/v32i2430785

Background: Cornelia de Lange syndrome is a rare genetic disorder presenting with craniofacial dysmorphia, developmental delay, intellectual disabilities, upper limb abnormalities and gastrointestinal problems. The disease is genetically heterogenous and the underlying genetic cause in unknown in around 30% of the cases.

Case Presentation: A Palestinian family visited our department for genetic counseling. The non-consanguineous parents have only two (4 and 2 years old) daughters, both presented with features consistent with Cornelia de Lange syndrome. Whole exome sequencing revealed two previously unknown coding variants in the autosomal TRMT61A, a gene that has not been linked to any human disease before. TRMT61A codes for the catalytic subunit of tRNA (adenine-N1-)-methyltransferase. The mother harbored an in-frame deletion variant c.478_483delCGCACC (p.R160_T161del), whereas the father carried a missense variant c.323G>T (p.C108F). Both variants are novel and were predicted as "damaging". So far, no autosomal recessive forms of the disease has been described in the literature. The carrier states of the parents and the existence of the two variants in compound heterozygous forms in both girls was further confirmed by allele-specific PCR. In their next pregnancy, prenatal diagnosis indicated that the fetus is a carrier of the mother's variant and the pregnancy culminated in the birth of a healthy baby girl.

Conclusion: It can be concluded that the TRMT61A mutations are the cause of the disease features observed in this family and supports the proposal that RNA modification defects are involved in the molecular pathogenesis of Cornelia de Lange syndrome.

Open Access Short Research Article

Clinico-pathological Outcomes of Men with Initial Likert 2 Multiparametric Magnetic Resonance Imaging of the Prostate: Findings from a Case Series in a Non-teaching Hospital in UK

Abigail Duckett, Stephen Hughes, Basharat Jameel, Mohamed Yehia, Christian Seipp, Sanjay Agarwal, Iqbal Shergill

Journal of Advances in Medicine and Medical Research, Page 63-70
DOI: 10.9734/jammr/2020/v32i2430752

Introduction: With the recent introduction of Multiparametric MRI (MP-MRI) for suspected prostate cancer, we investigated the clinic-pathological outcome of men who were suspected to have prostate cancer but in whom initial MP-MRI was negative (Likert 2).

Methods: Demographic and clinico-pathological outcomes data were analysed in men, with minimum 2 year follow up, who had undergone investigation for suspected prostate cancer with a negative (Likert 2) initial MP-MRI. The primary outcome was subsequent identification of prostate cancer in this cohort. Secondary outcome measures included correlation of prostate volume, presence of previous prostate biopsy, age, Prostate Specific Antigen (PSA) dynamics (pre and post MP-MRI scan), Digital Rectal Examination (DRE) findings and follow-up in months with the primary outcome.

Results: With respect to the primary outcome of this study, prostate cancer was identified in 8.7% of men only (n=4). Of these, two cases were low risk and two were high risk. With regards the secondary outcome measures, there was a positive correlation between PSA dynamics, age at MP-MRI and follow-up in months with subsequent diagnosis of prostate cancer, although this was not statistically significant. There was no prostate cancer specific mortality or morbidity in this cohort.

Conclusions: In this study, despite initial negative MP-MRI scan, prostate cancer was subsequently diagnosed in 4 men (8.7%). Reassuringly, this compares very favourably to the negative predictive value (89%) from the PROMIS trial and as such, adds an important body of work to the contemporary literature on modern diagnosis of suspected prostate cancer.

Open Access Minireview Article

“Mother-Microbe-Infant-Microbe” Synchrony– A Mini Review

Prameela Kannan Kutty

Journal of Advances in Medicine and Medical Research, Page 136-146
DOI: 10.9734/jammr/2020/v32i2430761

Is breast milk nutrition “alive”, dynamic and impossible to emulate? This question remains important in the context of the emergence of novel diseases and may be answered by comparing it to a few events that happen in nature, with parallels evident in the breast feeding dyad. Edified by nature, and its myriad coexisting species, including the microbes, there seems to be much interplay between species through symbiosis, perhaps, with a lofty purpose. This is compared to the breastfeeding infant’s gut that develops in symbiosis with the microbes that enter it through every feed. Breast milk not only nurtures the infant, but also nourishes the commensal microbes it provides. Milk microbes are influenced by maternal, infant and environmental variables, supporting them differently, parallel to the manner in which microbes and other elements in nature support ecosystems. Reviewing and synthesising information from two different but comparable ecosystems show parallels worthy of appraisal. The lactating mammary gland provides and supports beneficial microbes and microbial environments. Secretory immunoglobulin A (sIgA), the key molecule of mucosal gut immunity, is mutualistic with commensal microbes, capable of mucosal defences, yet preserving equilibrium between pathogen defences and commensal tolerance. Through microbial signals, the nursing mother shares her mucosal immune experiences, commenced in utero, transplacentally and then “translactionally”, to mature infant immunity, concluding an exceptional loop of nurture. Technology allows much appreciation that “immune cross- talk” between mother and infant does occur. In this review, commensal gut microbes in the infant are conceptualised as miniature ecosystems and, breastfeeding, as a vibrant compartment where being “alive” pivots in and around microbial existence and sustenance - a biological setting that, at best, may be emulated but not reproduced.

Open Access Minireview Article

Porcelain Veneers vs Composite Resin Veneers: A Review

Jenny Lalmalsawmi Sailo, Natasha Bathla, Prarthana Thakur, Archana Nagpal, Rajeev Gupta, Karan Duvedi

Journal of Advances in Medicine and Medical Research, Page 316-326
DOI: 10.9734/jammr/2020/v32i2430784

The main concern for clinical dentistry is the rehabilitation of lost dental aesthetics. These days' people are more conscious of how they feel about their smiles and their effect on other people. Contemporarily based upon the patient's fascination, they are various procedures and material options to select. It is quite challenging for the dentist to satisfy the needs and keep within the patient's budget. The effect of preparation design and material type on the success of dental veneers is controversial. Usually, the clinician's preference decides the preparation geometry. Nevertheless, veneers with incisal coverage seem to have better aesthetic and more predictable outcomes, while having a chamfer finish line palatable seems to be unnecessary, and limiting the preparation to a butt-join finish line is more sensible. Composite veneers provide good aesthetic outcome and patient satisfaction; however, due to its physical properties and bonding strength compared to porcelain veneers, composite veneers tend to fail significantly faster than porcelain veneers. Therefore, veneers have to compare, reviewed, and discussed in details. This review literature discusses the essential parameters.

Open Access Original Research Article

Serum Zinc Levels of Under Five Children with Diarrheal Disease

U. P. Ikejiaku, I. Anochie, E. C. Nwolisa, F. U. Iregbu, I. B. Amamilo

Journal of Advances in Medicine and Medical Research, Page 1-10
DOI: 10.9734/jammr/2020/v32i2430745

Background: Diarrhoea is a major cause of morbidity and mortality in children below five years of age especially in developing countries. One of the consequences of diarrhoea in children is zinc deficiency, which may worsen the diarrhoea itself, and thus increase morbidity and mortality.

Aim and Objectives: The study aimed to determine the serum zinc status of under five children with diarrhoea attending Federal Medical Centre Owerri. Also, to compare the serum zinc level between children with diarrhoea and their age and sex-matched controls, as well as determine the relationship, if any between types of diarrhoea, and frequency of diarrhoea episodes.

Methodology: The study was a comparative cross-sectional study carried out at the Emergency Paediatric Unit, The Children’s Outpatient Clinic and The Children’s Ward of the Federal Medical Centre, Owerri. A total of 402 study participants were analyzed. Structured questionnaires were used to collect data including participants’ socio demographic characteristics, the clinical presentation of the present diarrhoeal episode, as well as the frequency and duration of diarrhoeal episodes in the preceding year. Serum zinc was assessed using Varian AA240 Atomic Absorption Spectrophotometer.

Results: The prevalence of zinc deficiency in children with diarrhoea was 84.1% while that of children without diarrhoea was 56.2%. Mean serum zinc level was significantly lower in children with diarrhoea when compared to their age and sex matched controls (p=0.000). All children with persistent diarrhoea and dysentery had zinc deficiency. Children with persistent diarrhoea had significantly lower serum levels when compared to children with acute watery diarrhoea. There was a negative correlation between serum zinc level and frequency of stool, duration of the present episode of diarrhoea, frequency of diarrhoea episodes, and the duration of each episode of diarrhoea in the preceding year and the severity of dehydration.

Conclusion: The findings of this study support the present recommendation of the World Health Organization for zinc supplementation in children with diarrhoea, and recommends that children with persistent diarrhoea should have longer treatment with zinc tablets.

Open Access Original Research Article

Radiation Dose to the Closest Critical Organ during External Beam Radiotherapy of Head & Neck, Breast and Cervix at the University College Hospital, Ibadan, Nigeria

Akinlade Bidemi I., Adenuga Temitope M., Aborisade Caleb A., Farai Idowu P.

Journal of Advances in Medicine and Medical Research, Page 11-16
DOI: 10.9734/jammr/2020/v32i2430746

Introduction: Radiotherapy is the use of ionizing radiation for treatment of diseases, mostly malignant and non-malignant. Its goal is to deliver maximum radiation dose to tumour cells while minimizing dose to the surrounding normal cells. Studies have shown that patients who underwent radiotherapy usually receive highest scattered radiation dose to organs closest to the treatment sites due to inevitable exposure and making them susceptible to cancer induction. This study aims at quantify scattered radiation dose to closest critical organs during external beam radiotherapy of the head & neck, breast, and cervix at the University College Hospital, Ibadan, Nigeria.

Materials and Methods: Seventy-nine patients living with cancer in the region of head & neck, breast or cervix, who gave permission to participate were considered. The closest critical organs of interest are the eye lens, thyroid and femur head respectively. Thermoluminescence dosimeters (TLDs) were used to measure scattered radiation dose to these reference organs during radiation therapy of the target organs. After each treatment session, the exposed TLDs were taken to the designated Research Laboratory for processing with manual TLD reader system, HARSHAW, model 3500. 

Results: The mean scattered radiation doses to reference organs during the treatment of head & neck, breast and cervical cancer cases were 110 ±77 cGy (Eye lens), 211 ± 83 cGy (Thyroid), and 319 ±103 cGy (Femur head) respectively.

Conclusion: In all, Femur head received the highest (87% of prescribed dose to target organ) scattered radiation dose followed by thyroid (54%) and the eye lens (32%) from their respective target organ.

Open Access Original Research Article

The Efficacy of Autologous Nanofat Versus Enhanced Nanofat with Adipose-Derived Stem Cells Transfers in the Treatment of Atrophic Post Acne Scars

Marwa Elsamongy, Hashem Ayad, Manal Eid, Shereen Gheida, Amany Abdel- Latif

Journal of Advances in Medicine and Medical Research, Page 17-31
DOI: 10.9734/jammr/2020/v32i2430748

Background: Acne scarring is a visible reminder of acne vulgaris resulting from inappropriate healing of active lesions. Yet, no golden standard is present. Nanofat is an emulsified homogenous suspension of adipose tissue rich in adipose derived stem cells (ADSCs). Its application serves regenerative purposes.

Objective: To evaluate efficacy of nanofat versus enhanced nanofat with adipose-derived stem cells transfer in treating atrophic acne scars.

Methods and Materials: This study was carried on 40 patients with atrophic acne scars; grouped into two groups. Group A: 20 patients; treated with nanofat with platelet-rich plasma (PRP) and group B: 20 patients; treated with enhanced nanofat with ADSCs and PRP. Histopathological examination was done before and 6-months after treatment, specimens were stained by haematoxylin and eosin, Mallory trichrome and Verhoeff-Van Gieson.

Results: In both groups; 70% showed excellent and very good improvement and patients’ satisfaction was 60% for both groups. Histopathological examination revealed increase in epidermal thickness, formation of new collagen and elastic fibers without significant difference between both groups.

Conclusion: Nanofat transfer is easy, cost-effective, and safe for treating acne scars, compared to enhanced nanofat with ADSCs transfer which is costly and time consuming

Open Access Original Research Article

Ventriculo-Peritoneal Shunt Complications at Emergency Teaching Hospital in Duhok City

Nabeel Ali Hussein, Walid W. Al- Rawi, Arjan M. Rasheed

Journal of Advances in Medicine and Medical Research, Page 32-42
DOI: 10.9734/jammr/2020/v32i2430749

Background: Ventriculoperitoneal (VP) shunt surgery is the predominant mode of therapy for patients with hydrocephalus. However, it has potential complications that may require multiple surgical procedures during a patient’s lifetime. The aim of the article was to review the experience in a 2-year teaching hospital and to evaluate the risk factors for PV shunt failure after initial shunt surgery and after subsequent reviews.

Methods: The study was carried out at The Emergency Teaching Hospital in Duhok City in Iraq. All complications of VP shunted patients admitted to the hospital from January 2013 to January 2015, were included in the study. Forty six patients (out of 170 VP shunt operations), with all shunt related complications, qualified for this study. Identification of patients with complications of VP shunt is done by obtaining proper history, examination, and identification of ventricular enlargement with periventricular edema on imaging (brain computed tomography (CT) or magnetic resonance study (MRI); also, identification of any evidence of device migration by direct vision, chest and abdominal X-ray and evidence of infection on CSF analysis.

Results: The incidence of the complications was (27.1%). There were 24 (52.2%) males and 22 (47.8%) females. Males were affected more than females with a ratio 1.1:1. Their age ranged from 2 months to 67 years, with mean age 8.6 years. The most common cause for the initial VP shunt implantation was congenital hydrocephalus and was noticed in 34 (73.9%) patients. Mean duration to develop VP shunt complication was 26.6 months. The most common presenting symptom in pediatric patients was decreased oral intake in 37 (80.4%) patients; however, in adult patients, it was headache, 4 (80%) patients. The most common complication was obstruction, 25 (54.3%) patients, followed by infection in 9 (19.6%) patients. The most common treatment option given to the patients who suffered from VP shunt complications was whole system change for a new one, in 15 (32.6%) patients.

Conclusions: The findings of the study indicate that age of the patient at time of shunt placement, etiology of hydrocephalus, and previous treatments before shunt surgery were independently significantly associated with the shunt survival. Prospective controlled studies are required to address the observed associations between the risk factors and incidence of shunt revisions in these patients.

Open Access Original Research Article

Assessment of the Efficacy of Nebulized 3% Hypertonic Saline versus Nebulized Adrenaline in Infants with Acute Bronchiolitis

Nancy Elsayed Abdel Gawad Elkhateeb, Mohamed Bassiony Hamza, Rasha Mohamed Gamal El Shafiey, Ahmed Mohamed Abdel- Razik

Journal of Advances in Medicine and Medical Research, Page 43-54
DOI: 10.9734/jammr/2020/v32i2430750

Aims: The aim of the work was to assess the efficacy of nebulized 3% hypertonic saline versus nebulized adrenaline in treatment of acute bronchiolitis in infants as supportive therapy with conventional therapy.

Place and Duration of Study: Pediatric Pulmonology Unit (PPU), Tanta University Hospital (TUH), was applied during the period from April 2019 to April 2020.

Methodology: We included ninety infants with moderate to severe acute bronchiolitis were selected, enrolled in the study and randomized into 3 groups: Group A: thirty patients were received nebulized 3% hypertonic saline plus conventional therapy. Was started from first day of admission till RADI score became 4. Group B: thirty patients were received nebulized adrenaline plus conventional therapy. Was started from first day of admission till RADI score became 4. Group C: thirty patients were received conventional therapy. Was started from first day of admission till RADI score became 4. They were subjected to history taking, clinical assessment and investigations (CXR, ECHO, CBC and CRP). Follow up done in Chest Clinic four day after discharge.

Results: There was statistically significant difference between studied groups as mean duration of O2 supplementation was significantly shorter in group B than in  group  A than in group C (p-value<0.05). On admission, mean RR in group B was significantly higher than those in groups A and C (p-value=0.05), On 5th day, mean RR in group B was significantly lower than those in groups A and C (p-value= 0.05). On admission, mean HR in group B was significantly higher than those in groups A and c (p-value =0.05) On 5th days, mean HR in group B was significantly lower than those in groups A and C (p-value= 0.05), with no statistically significant difference between groups A and C. length of hospitalization in studied groups group B showed significantly shorter need for hospital stay than that in groups A and C, with no statistically significant difference between group A and C.

Conclusion: When comparing between inhalation of adrenaline and hypertonic saline 3% in acute bronchiolitis adrenaline improve RD, oxygenation and decrease length of hospitalization.

Open Access Original Research Article

Incidence of Early Pregnancy Loss in Poly Cystic Ovary Syndrome Patients With /Without Metformin Therapy: A Comparative Study

Basma S. Ibrahem, Amal A. El Syokar, Ahmed M. Ossman, Tarek M. El-Saba

Journal of Advances in Medicine and Medical Research, Page 55-62
DOI: 10.9734/jammr/2020/v32i2430751

Background: The most prominent source of anovulatory infertility in the world is polycystic ovary syndrome. Getting pregnant these days has a larger risk of early maternal death than in the general population. It induces symptoms in about five and ten percent of women of reproductive age (12-45 years old). Women that are insulin tolerant are more prone to have Elevated Insulin levels, Polycystic OVARIES and Hyperandrogens. They are at risk for suboptimal reproductive activity attributable to compromising ovarian function and hormonal equilibrium. The aim of this research was to determine the prevalence of late pregnancy failure in women with Polycystic Ovary Syndrome (PCOS) taking metformin as compared to women who don't take it.

Materials and Methods: This case control-controlled study included 100 females and divided in to two groups. Each group composed of 50 patients and the patients were distributed   in each group by simple Randomization method.

Results: There was no significant difference between control and study group regarding todescriptive data. Association between rate of pregnancy loss and metformin treatment early pregnancy loss was significantly frequent in control group than in study group with metformin treatment. Gestational age (weeks)at which pregnancy loss occurred is significantly higher in study group than in control group. The rate of early pregnancy loss among studied groups is significantly lower than in control group.

Conclusion: Metformin therapy in pregnant women with polycystic ovary syndrome was associated with a significant reduction in the rate of early pregnancy loss. It was well tolerated by patients with a minimum of side effects. However, extended studies are required to evaluate its effect on further pregnancy complications and fetal outcomes.

Open Access Original Research Article

Effect of Ingested Foods Preheated (With Microwave) in Plastic Containers on the Reproductive Profile of Male Albino Rats

Onengiyeofori Ibama, Ugochukwu Chioma, Joshua Lelesi Konne, Felix Konne

Journal of Advances in Medicine and Medical Research, Page 71-75
DOI: 10.9734/jammr/2020/v32i2430753

Recently, there has been a notably increased use of microwave energy for heating and processing foods particularly in catering services and in our homes owing to its speed, convenience and efficiency compared to the traditional heating method. Due to the availability and affordability of plastic containers, they are mostly used to contain foods for preheating in a microwave. However, these plastics pose great risk on humans’ health if they get scratched or heated, and leach out chemicals into the contained foods. Also, the microwave energy has been speculated to have posed risks to the health of humans considering the electromagnetic radiations it emits. This study was aimed at evaluating the effect of ingested foods preheated (with microwave) in plastic containers on the reproductive profile of male albino rats. A total of twenty-four (24) male albino rats weighing between 120 to 200 g were used for this study. The rats were divided into three (3) groups (group I, II and III) of eight (8) rats per group. The rats were fed ad libitum with porridge beans and jellof rice with meat and fish daily for 40 days. The foods ingested by group I rats were not preheated in a microwave; the foods ingested by group II rats were put in ceramics and preheated in a microwave for 2 minutes daily; while the foods ingested by group III rats were put in plastic containers (not labeled as ‘‘microwave safe’’) and preheated in a microwave daily for 2 minutes. After an overnight fast, the rats were anaesthetized using chloroform, and blood samples obtained (via cardiac puncture) were used to analyze serum luteinizing hormone (LH), follicle-stimulating hormone (FSH) and testosterone using the ELISA method. The epididymis was also excised and immediately macerated to obtain semen, which was used for semen analysis. The results obtained showed a significantly decreased (p<0.05) mean LH, FSH, testosterone and sperm count in group III (plastic-microwaved) compared to group I and II. Also noted, was a significantly decreased (p<0.05) sperm count in group II compared to group I. However, there was no significant difference in LH, FSH and testosterone between groups I and II. Conclusively, it was evident from this study that, ingestion of foods preheated (with microwave) in plastic containers overtime, may predispose male rats and thus male individuals to dysfunction in their reproductive system which may eventually lead to male infertility. It is therefore, highly recommended that preheating of foods (with microwave) in plastic containers should be highly prohibited, but should rather be done using ceramics.

Open Access Original Research Article

Evaluation of Atosiban Therapy in the Management of Preterm Labour in Indian Patients

Bhupesh Dewan, Sanjaykumar Navale, Siddheshwar Shinde

Journal of Advances in Medicine and Medical Research, Page 76-88
DOI: 10.9734/jammr/2020/v32i2430754

Aims: To assess the efficacy and fetomaternal safety of atosiban among Indian pregnant women presenting with preterm labor.

Study Design: Prospective, open-label, multicentric, non-comparative, phase-IV clinical study.

Place and Duration of Study: Department of Obstetrics and Gynaecology at nine hospitals across India from October 2016 to December 2019.

Methodology: A total of 212 pregnant women admitted with preterm labour between 24 and 36 weeks of gestation were administered intravenous atosiban up to 48 hours. Efficacy was defined as the successful delay of delivery without the need of an additional or alternative tocolytic agent for 72 hours. Safety was evaluated by recording the occurrence of adverse events in the mother, fetus and neonate.

Results: Tocolytic efficacy of Atosiban was 84.88% at 48 hours and 74.15% at day 7 without additional tocolytic agent or retreatment after 48 hours. The mean number of days gained after the start of atosiban tocolysis were 29.15 ± 1.82 days with mean gestational age at delivery of 35.1 ± 3.33 weeks. Atosiban reduced the frequency of contractions from 4.3 ± 1.47 to 0.67 ± 1.13 contractions/30 min at 72 hours. The proportion of neonates with birth weights more than 2,500 gm was 41.67%. A total of 205 neonates out of 216 (94.95%) had APGAR score more than 7 after 5 minute. Atosiban successfully delayed the labour in 92.31% (n=13) of “Twin pregnancy” patients for 48 hours and beyond 7 days in 9 patients (69.2%). There were no serious adverse events reported.

Conclusions: In patients with threatened preterm birth, 48 hour tocolysis with atosiban was found to be safe and effective in preventing imminent preterm birth even when it was a twin pregnancy or associated with co-morbidities. Atosiban showed favorable side effects profile and improved the perinatal outcomes.

Clinical Trial Registry of India Number: CTRI/2017/03/008065;

Open Access Original Research Article

Pre-Interventional and Post-Interventional Analysis of Knowledge, Attitude and Practice Regarding Hepatitis B & C among Prison Inmates of Malir Jail, Karachi, Pakistan

Agha M. Wali Mirza, Syed Ali Farhan, Junaid Nawab, Sahrish Mukhtar, Shagufta Naqvi, Syed Sanower Ali, Iqra Baig, Mohid Ahmad, Wassay Hussain

Journal of Advances in Medicine and Medical Research, Page 89-99
DOI: 10.9734/jammr/2020/v32i2430755

Background: Hepatitis B and Hepatitis C being the most prevalent and preventable infectious disease in Sindh with prison inmates being a major risk group.

Aims: To assess the knowledge, attitude and practice of this deadly debilitating disease.

Study Design: Interventional Study

Place and Duration of Study: It was performed in Malir Jail, Karachi, Pakistan in which 128 prison inmates participated. The research was done in three phases for the duration of 1 month.

Methodology: In first phase a pre-intervention questionnaire was filled which assessed the basic knowledge regarding hepatitis, its spread and prevention. In the second phase an elaborate audiovisual presentation was given with detailed explanation to all the participants about hepatitis B and hepatitis C. In the third phase a post-intervention questionnaire was filled.

Results: On assessment, the results showed that before intervention prisoners lacked basic knowledge about hepatitis and after the intervention their knowledge and awareness improved significantly with a p-value of <0.001.

Conclusion: It is concluded that prison inmates of Malir jail Karachi lacked basic knowledge of hepatitis B and hepatitis C and with substantial repeated interventions this preventable infectious disease could be prevented.

Open Access Original Research Article

Study of the Neonatal Resuscitation and Adaptation Score (NRAS) Compared to the Apgar Score in Neonatal Resuscitation

Aya Mohamed Abd Elglil, Ashraf Mohamed Ibrahim, Nihal Salah Shihab, Abd El Rahman Mohamed El Mashad

Journal of Advances in Medicine and Medical Research, Page 100-110
DOI: 10.9734/jammr/2020/v32i2430757

Introduction: The Neonatal Resuscitation and Adaptation Score (NRAS) was developed to address the concerns regarding how resuscitation impacts the Apgar score and how it can be accounted for in the scoring assessment.

Aims: The objective of this work was to compare between the Neonatal Resuscitation and Adaptation Score (NRAS) and the Apgar score, to determine the correlation between the two scoring systems, and their predictive ability for mortality and short-term morbidities.               

Methodology: This study was a prospective cohort study. It was carried out on 410 neonates in Tanta University Hospital. Both Apgar and NRAS scores were recorded for all cases at 1st and 5th minutes of life. The scores were divided into three categories: Low (0-3), Middle (4-6), High (7-10). All neonates were followed up for 48 hours. Correlation between both scores and neonatal outcome were recorded.

Results: There was a significant positive correlation between Apgar and NRAS scores at both 1st and 5th minutes. NRAS score was more précised in discriminating neonatal admissions, mortality, need for respiratory support and morbidities than Apgar score at both 1st and 5th minutes. The regression model revealed that Apgar 5th min and both of NRAS 1st and 5th minutes were significant predictors for neonatal mortality and morbidities. The most significant predictor was NRAS 1st min.

Conclusion: Both scores can be used in assessing the neonatal condition. The most significant predictor for neonatal mortality and morbidities was NRAS 1st min.

Open Access Original Research Article

Predictive Value of First Trimester Measurement of Adiponectin and 1,5 Anhydroglucitol in Diagnosis of Gestational Diabetes Mellitus

Merhan M. Salem, Amal A. El-Sokary, Sahar M. Hazzaa, Mohamed N. El-Gharib

Journal of Advances in Medicine and Medical Research, Page 111-118
DOI: 10.9734/jammr/2020/v32i2430758

Background: Gestational diabetes mellitus (GDM) defined as glucose intolerance, which is first detected during pregnancy. Adiponectin is a protein that secreted from both adipose tissue & placenta in pregnancy. 1,5 anhydroglucitol in a steady-state normally and almost completely reabsorbed in renal tubules. Serum levels decreased in periods of hyperglycemia due to increased urinary excretion. The objective of this study is to predict gestational diabetes by measuring serum adiponectin, and 1, 5 anhydroglucitol during the first trimester.

Materials and Methods: This case-control study was conducted on 50 patients who attended inpatient and outpatient clinics Obstetrics & Gynecology Department. The study population grouped in two groups, Group A and B. Each group was comprised of 25 cases. Group I (25 cases): with high risk for gestational diabetes. Group II (25 cases): with no risk locates for developing gestational diabetes. Serum glucose level and adiponectin 1,5 anhydroglucitol was measured by ELISA method in the first trimester.

Results: The mean levels of the Adiponectin (μg/ml) and the 1,5 AG were significantly lower in GDM women (5.2 ± 2.1μg/mL,) and (6.8 ± 5.7μg/mL,) respectively compared to women without GDM (7.8 ± 2.4μg/mL) and (9.8 ± 4.2μg/mL) respectively (p = 0.001). The correlation between Adiponectin and BMI >30KG/M2, Fasting plasma glucose in the study group I with a significant correlation between in the first trimester. ROC curve of 1,5 AG was conducted for developing gestational diabetes. Excellent AUC was found (AUC = 0.907, p<0.001). At the cut off value of 17.55, sensitivity was 100%, specificity was 80%, PPV was 88.3%, NPV was 87%, and accuracy was 90%. ROC curve of Adiponectin for developing gestational. Good AUC was found (AUC = 0.881, p<0.001). At the cut off value of 17.3, sensitivity was 100%, specificity was 66.7%, PPV was 83.2%, NPV was 80%, and accuracy was 94%.

Conclusion: 1,5 AG and Adiponectin levels are lower in pregnant women with GDM compared to individuals without GDM. 1,5 AG and adiponectin are a good tool for monitoring the glucose profile in pregnancies complicated by diabetes mellitus, especially for the hyperglycemic episodes.

Open Access Original Research Article

A Two-year Retrospective Review of Paediatric Mortality in a Tertiary Facility in North-western Nigeria

M. O. Ugege, B. I. Garba

Journal of Advances in Medicine and Medical Research, Page 119-128
DOI: 10.9734/jammr/2020/v32i2430759

Introduction: Mortality pattern is reflective of both the severity of illness and the quality of treatment given.

Objective: To identify the age, time and cause of death in the paediatric wards of Usmanu Danfodiyo University Teaching Hospital (UDUTH), Sokoto.

Methods: This was a retrospective review of mortalities in children 5weeks to 15 years at the paediatric wards of UDUTH from 1st January 2016 to 31st December 2017. The bio-data, duration of illness, diagnoses, complications and duration of hospital stay were extracted from the mortality case files and analysed.

Results: There were 121 mortalities, representing 2.3% of 5,355 total admissions during the study period. Sixty-seven (55.4%) were males (M: F ratio 1.2:1). Seventy-five (62.0%) were under-fives and mean age ± standard deviation was 54 months ± 46.3. Most deaths 76 (62.0%) occurred between July and December and majority 96 (79.3%) occurred ≥ 24 hours after admission. Severe acute malnutrition [SAM] 31 (41.3%), severe malaria 12(16.0%), and septicaemia 9 (12.0%), were the leading causes of death in the under-fives, whereas severe malaria 8 (17.4%), meningitis 7(15.2%) and malignancy 5 (10.9%) predominate in those > 5 years [P<0.001]. There was delayed presentation ≥ 7 days in 87 (71.9%) children and 90 (74.4%) had at least one or more complications.

Conclusion: Severe acute malnutrition and severe malaria were the leading causes of mortalities in our facility. It is needful to scale up preventive and curative services targeted at curbing these diseases in Sokoto and environs.

Open Access Original Research Article

Diagnostic Value of Serum Leptin Level in Critically Ill Septic Child

Asmaa A. Abo El Yazeed, Ahmed I. Harkan, Amira Y. Ahmed, Ahmed A. Abo Elezz

Journal of Advances in Medicine and Medical Research, Page 129-135
DOI: 10.9734/jammr/2020/v32i2430760

Introduction: Diagnosis of sepsis is important to reduce morbidity and mortality. Leptin is an important immunoregulatory hormone that enhances a number of immune responses in sepsis.

Objective: to assess serum leptin in diagnosing sepsis in critically ill pediatric patients.

Subjects and Methods: This study was carried out on 50 children divided into a case group included 40 critically ill patients initially sepsis free and fulfilling 2 of 4 criteria of SIRS admitted to the Pediatric Intensive Care Unit, children hospital, Tanta university and a control group included 10 apparently healthy children. According to the presence or absence of infection, our patients were classified into SIRS group and sepsis group. For all studied patients; serum leptin, CRP and others indicators of sepsis were measured at admission and 72h later, while were measured one time only for control group.

Results: patients who developed sepsis had significantly higher serum leptin levels than those of the control group and SIRS (33.9 ± 20.8 vs. 1.9 ± 0.4, 21.5+ 10.1 respectively, p>0.05).

Conclusion: Serum leptin may have a role in early diagnosis of sepsis.

Open Access Original Research Article

Obesity and Perceived Body Shape among Adults Attending Primary Health Care Centers in Jeddah

Rajaa Mohammad Al-Raddadi, Saad Abdullah Alholaibi, Ammar Abdulwadood Albakistani, Sultan Sameer Alrabghi, Reem Masoud Hafiz, Nasser Abdullah Al-humaidi, Samaher Ali Alowais, Fanar Fareed Hakim, Omaima Ibrahim Shabouni

Journal of Advances in Medicine and Medical Research, Page 147-155
DOI: 10.9734/jammr/2020/v32i2430762

Background: Body image can be defined as how an individual believes, realizes and gets along with their physical appearance. The relationship between obesity and body image is complex as studies argue that the image of the body might be influenced by obesity over psychological problems, which affects the quality of an adult's life.

Aim:  To identify the association between perceived body image and obesity.

Study Design: An analytical cross-sectional.

Place and Duration: the study was conducted in two primary health care centers in Jeddah City, Saudi Arabia during 2020.

Methodology: Target sample was 425 cases of Saudi adults of 20 years of age and above. Data was collected using questionnaire includes demographic characteristics, body image questionnaire. Anthropometric measurements include waist, Hip and neck circumference, and waist, height and weight were measured.

Results: men constitute 250 (58.8%) and 175 women (41.1%). Regarding marital status majority of participants were married (71.8%). The prevalence of obesity according to Body mass index was 37.6% among men and 42.9% among women, by high Waist circumference it was 68.8% among men and 84.6% women, using waist hip ratio, the prevalence among men was 64.8% and 53.7% among women. Neck circumference 57.2% among men and 53% for women. The prevalence of high Waist Hight Ratio was 89.2% among men and 86.9% for women.

Women showed higher Waist circumference underestimation compared to men. Using Body mass index men exhibited higher underestimation for obesity and women for overweight.

However, the significant associations between Perceived body image, waist height ratio and neck circumference were showed only among men. In general, obese participants are more likely to underestimate their actual body image by all obesity measurements.

Conclusion: A discrepancy was found in the PBI compared to different anthropometric measurements. Obese women are more likely to underestimate their obesity than men.

Open Access Original Research Article

Determination of Rifampicin Resistance Tuberculosis on Gene Xpert among Patients Attending Federal Medical Centre Yenagoa, Bayelsa State Niger Delta Region of Nigeria

Oluwayemisi A. Olorode, Ofonime M. Ogba, Joshua J. Tarilade

Journal of Advances in Medicine and Medical Research, Page 156-163
DOI: 10.9734/jammr/2020/v32i2430763

Aim: Department of Medical Laboratory Science (Medical Microbiology Section), Niger Delta University. Tuberculosis, being an oldest known human disease, is a major cause of mortality. Does gender determine Rifampicin Resistance Mycobacterium tuberculosis among the patients with tuberculosis in Bayelsa State? This work was carried out between February, 2019 and September 2019 to determine the prevalence of Mycobacterium tuberculosis and its resistance to Rifampicin anti-mycobacterium therapy among patients attending Federal Medical Centre, Yenogoa, Bayelsa State.

Methodology: A total of 250 sputum samples were collected from both HIV and non-HIV patients attending Federal Medical Centre, Mycobacteriology Laboratory (a referral laboratory in Bayelsa state); (age range 21-71 years) and immediately taken to the laboratory for analysis using GeneXpert machine, an automated cartridge based nucleic acid amplification diagnosis and traditional Ziehl-Neelsen test for the detection of Mycobacterium tuberculosis and Rifampicin resistance gene.

Results: Findings showed that 50(100%) sputum samples (of which 24(48%) were from males and 26(52%) from females) out of the 250 samples examined were positive to Mycobacterium tuberculosis. Based on the GeneXpert analysis, the total of 8(16%); {4(8%) females and 4(8%) males}, samples were resistant to Rifampicin. Out of 50(100%) positive samples, the highest percentage prevalence of Mycobacterium tuberculosis was recorded within the age range of 21 and 30 years (52%); followed by 31-40 years (44%) and the least was 71 years (04%). The percentage prevalence of Rifampicin resistance Mycobacterium tuberculosis (RMB) was 16.0% while non-resistance was 84.0%; resistance was higher among the study subjects within the age range of between 21 and 30 years (6%) followed by 31-40 years (4%); 51-60 years (4.0%) and the least was 10-20 years and 70 years above(2%). There is no significant difference between the tuberculosis infected male and female resistance to rifampicin at P value= .88, t=14, df=4. However, out of 50 (100%) positive samples, 24 (48%) patients had HIV co-infection with tuberculosis while 26(52%) had tuberculosis only. There was no statistical significant difference between these two groups at P=.29, t=1.2 and df=4.

Conclusion: There is a progressive increase in the frequency of Rifampicin resistant Mycobacterium tuberculosis (RrMTB) in this research compared to the percentage prevalence (4%) reported by World Health Organization (WHO) in 2018. There is therefore a need to establish more medical diagnostic laboratories for rapid detection of tuberculosis infection in all the eight (8) Local Government Areas of Bayelsa state.

Open Access Original Research Article

Platelet Indices in Uterine Leiomyoma Compared with other Major Gynecological Diseases

Roxana Covali, Demetra Socolov, Ioana Pavaleanu, Alexandru Carauleanu, Razvan Socolov

Journal of Advances in Medicine and Medical Research, Page 164-176
DOI: 10.9734/jammr/2020/v32i2430764

Aims: The aim of this study was to determine whether platelet indices are of value when diagnosing uterine leiomyomas.

Study Design: Prospective study.

Place and Duration of Study: Elena Doamna Obstetrics and Gynecology University Hospital, Iasi, Romania, between January 2017 and December 2017.

Methodology: In this study 98 patients were selected from 140 consecutive screened patients and operated upon; 53 of the operated-on patients had uterine leiomyoma (Group 1) and 45 had severe non-leiomyoma gynecological disease (Group 2). Complete blood count, just before the intervention was studied.

Results: The RDW-CV, PLT and PCT values were significantly higher (P = .017, P = .05, P = .001, respectively) in leiomyoma patients, whereas WBC, RBC, MPV, PDW, P-LCR, NLR, PLR were not significantly different between the 2 groups. The inflammatory indices WBC, NLR and PLR were not significantly higher in leiomyoma patients compared with non-leiomyoma patients, despite the fact that leiomyoma also has an inflammatory cause. Although leiomyomas were accompanied                  by acute or chronic blood loss, only RDW-CV was significantly higher (P = .017) in                        leiomyoma patients, whereas HCT and RBC values were not significantly different between the 2 groups.

Conclusion: The RDW-CV, PLT and PCT values were significantly higher in leiomyoma patients, whereas WBC, RBC, MPV, PDW, P-LCR, NLR, PLR were not significantly different. Still, the specificity of RDW-CV, PLT and PCT was not high enough to allow using them as diagnostic tools for leiomyoma.

Open Access Original Research Article

Health Workers and Coronavirus Disease Pandemic: Knowledge, Attitude and Effects in Port Harcourt, Nigeria

Joy O. Dayi, Bisola O. I. Onajin-Obembe, Rex F. O. A. Ijah

Journal of Advances in Medicine and Medical Research, Page 177-186
DOI: 10.9734/jammr/2020/v32i2430765

Background: There are reports of the spread of the novel COVID-19 to Africa, Nigeria, and some cases in Rivers State. The aim of this study was to investigate the knowledge, attitude and effects of the coronavirus disease pandemic on hospital staff in the month of May to June 2020.

Methodology: The convenience sampling method was used to recruit 297 hospital staff in a cross-sectional descriptive study carried out using semi-structured questionnaires in a tertiary healthcare facility. Data obtained was analysed using the Statistical Package for the Social Sciences (SPSS) version 20.0.

Results: Two hundred and sixty-two respondents (88.2%) had prior knowledge of coronavirus, and 228 (76.8%) got their information from Television/Radio/Newspapers. Two hundred and fifty-one (84.5%) respondents described COVID-19 pandemic as a disease caused by an imported germ. Regardless of the fear/panic of the COVID-19 pandemic, 230 (77.4%) of the respondents indicated that they would continue to visit their sick relative in the hospital. The COVID-19 pandemic moderately affected the family life of 110 (37.0%) respondents, while 68 (12.5%) were devastated by it. The means of livelihood was moderately affected in 76 (25.6%) respondents, and 43 (14.5%) devastated by it.

Conclusion: The negative impact of the coronavirus pandemic was experienced significantly in varied proportions – moderately, severely, and in devastating manner.  

Open Access Original Research Article

Echocardiographic Results of Myocardial Revascularization Depending on the Genetic Polymorphism of Inflammatory Cytokines

Dildora Karimovna Tulyaganova

Journal of Advances in Medicine and Medical Research, Page 187-197
DOI: 10.9734/jammr/2020/v32i2430766

Introduction: Heart failure – is a clinical syndrome that occurs in response to systolic and/or diastolic myocardial dysfunction, leading to insufficient supply of tissues and organs with oxygen and nutrients. Cardiac fibroblasts are activated under conditions of increased mechanical stress, which is reflected in the dilation of the heart chambers. Under stress, they not only produce an excessive amount of extracellular matrix, but also increase the production of cytokines and stimulate the typical pathogenesis of inflammation.

The study of genes that control the activity of cytokines is one of the important tasks in uncovering the pathogenetic links of the initiation and course of diseases, and identifying predisposition to diseases in the early stages. Knowledge of their role in the pathogenesis of many diseases allows, on the one hand, to predict the risk of developing pathology or the severity of its course, on the other — to individually select specific therapy for a particular patient. It is known that with an unfavorable genetic background, in combination with environmental factors, a pathological phenotype is formed. And interleukin genes have an extremely high degree of polymorphism. So in what combination of genes is the most favorable course of the disease possible and in what case is it fleeting?

Aims: To study the dynamics of the structural and functional state of the myocardium in patients with coronary heart disease during the first year after coronary revascularization, depending on the genetic polymorphism of proinflammatory cytokine genes

Study Design: Observational data.

Place and Duration of Study: Republican specialized scientific practical medical centre of therapy and medical rehabilitation, between January and December 2019.

Methodology: 127 patients with stable forms of coronary heart disease complicated by the development of chronic heart failure, who underwent coronary artery stenting, were examined. All patients were included in the study by echocardiography To assess the structural and functional state of the myocardium, and the genotype of the selected SNP genes IL-1, IL-6 and TNF-alpha with the allocation of minor alleles.

Results: The study showed a lower positive dynamics of the LV myocardial mass index in patients with the IL-6 minor allele and the right ventricular area reduction fraction and LV Tei in patients with the IL-1 minor allele. The TNF-alpha genotype had no significant effect on the processes of myocardial remodeling in CHD patients after revascularization. At the same time, for all three studied genes, a less favorable EchoCG characteristic was preserved during the entire follow-up period in patients carrying the minor allele.

Conclusion: Revascularization, which has an anti-ischemic effect, reduces the activity of the systemic inflammatory response, which explains the more pronounced positive dynamics of EchoCG indicators in patients with an initial high concentration of cytokines and a large number of minor alleles in the genotype of cytokine genes.

Open Access Original Research Article

Squamous Cell Carcinoma of Tongue: Analysis of Clinico Pathological Features

Sana Fatima, Mervyn Hosein, Saima Akram Butt, Faraz Ahmed Baig, Rehan Ahmed Siddiqui, Fizza Abidi

Journal of Advances in Medicine and Medical Research, Page 198-203
DOI: 10.9734/jammr/2020/v32i2430767

Aims: Squamous cell carcinoma of tongue (SCCOT) is the most common malignant neoplasm of oral cavity. It is a major health concern and causes significant morbidity and mortality. There is high prevalence of exposure to risk factors of SCCOT in our region, therefore the present study is designed to provide an insight of clinicopathological parameters of SCCOT that will help in identifying any specific trends.

Study Design: Cross sectional study.

Place and Duration of Study: Department of histopathology, Ziauddin Hospital, Karachi, from January 2020 to November 2020.

Methodology: 27 biopsy specimens of SSSOT were taken. Clinocopathological parameters of SCCOT were evaluated. Data was subjected to appropriate statistics using SPSS version 20.

Results: Out of the 27patients, 15(55.6%) were men and 12(44.4%) were women. The overall mean age at presentation was (46.77+/-14.05) years. Lateral borders of tongue were involved in 16(59.3%) of patients. Of the total, 22 (81.5%) patients had moderately differentiated carcinoma.  T3 size of tumor was present in 12 (44.4%) of patients.  Cervical lymph node metastasis was found in 15 (55.5%) of patients. At presentation, 20(74%) had advanced Stage (III-IV) disease.

Conclusion: It is an alarming situation that most patients presented with advance stages of SCCOT. Emphasis should be given on early diagnosis of SCCOT. There is also need on increasing oral cancer awareness among the public to reduce the burden of this disease.

Open Access Original Research Article

Effect of Heroin on Liver and Kidney Functions

Aalaa Desoky Ahmad Abohamar, Wesam Abd El Salam Ghareeb, Gihan Farouk Attia, El Sayed Abd El Hamied Gad

Journal of Advances in Medicine and Medical Research, Page 204-215
DOI: 10.9734/jammr/2020/v32i2430768

Background and Aim: Drug use disorders are serious health issues with a significant burden for individuals affected and their families. There are also significant costs to society including lost productivity, security challenges and crime. Heroin has the highest dependence, tolerance and withdrawal score. The aim of this study is to assess the effect of heroin on liver and renal functions.

Materials and Methods: This comparative case - control study was carried out on 60 males aged from 15 to 45 years old at the Department of Neuropsychiatry and the Center of Psychiatry, Neurology and Neurosurgery, Tanta University, Egypt from March 2019 through April 2020. Patients group: 30 patients with heroin use disorders diagnosed according to DSM-5 criteria with history of smoking. Control group: thirty smoker persons were taken as a control group matching with patients group. All participants were subjected to: History taking, physical examination and investigations including liver and renal function tests, urine drug screening and psychometry by the addiction severity index scale.

Results: Heroin addicts had significant elevation in liver enzyme (Aspartate and Alanine transaminase) and alkaline phosphatase (p<0.001). There was no significant difference between heroin group and control regarding Albumin/Globulin ratio, Prothrombin Time, International Normalized Ratio and bilirubin level. Heroin addicts had significant elevation in blood urea, serum creatinine and Albumin/Creatinine ratio (P <0.001). There was significant decrease in Estimated Glomerular Filtration Rate in heroin group in comparison to control group (p<0.001). Positive correlation with statistical significance between (dose of heroin in grams, duration of use of heroin and severity index of addiction) and (liver functions and renal functions) in patient group.

Conclusion: In heroin addicts, there was significant elevation in liver enzymes, ALP, Albumin/creatinine ratio, Urea and Creatinine and significant decrease in eGFR. The higher the dose of heroin use, the more the impairment of liver and renal functions. The longer the duration of heroin use,the more the deterioration of liver and renal functions. The more the severity index of addiction, the more the impairment of liver and renal functions.

Open Access Original Research Article

Licit and Illicit Drugs Consumption among Students of the Federal University of Rondonia, Porto Velho Campus: A Cross Sectional Analysis 2011-2017

Rosely Valéria Rodrigues, Cleitiane de Jesus Gomes Silva, Giovanna Lorena Nery Tavernard, Sérgio Valério Escobar Filho, Úrsula Melo de Souza Maia

Journal of Advances in Medicine and Medical Research, Page 216-223
DOI: 10.9734/jammr/2020/v32i2430769

Aim: To perform a comparative analysis of the pattern of illicit drug consumption among students at the Porto Velho campus of the Federal University of Rondônia in 2011 and 2017. Study design: This is a cross-sectional and longitudinal study. Place and Duration of Study: Federal University of Rondonia Foundation (UNIR) campus José Ribeiro Filho, Porto Velho – Rondonia (Brazil), 2017. Methodology: The sample in 2017 comprised 352 students divided by knowledge centers, to tabulate and consolidate statistical data the software Statistical Package for the Social Sciences and Microsoft Excel were used, it was considered a 95.0% CI and 0.5% standard deviation. Results: 54.1% of the students are female, the average age is 23 years old, drug intake in 2017 increased when compared to 2011, alcohol (from 72.3% to 75.9%), tobacco (from 23.0% to 32.2%), marijuana (from 10.7% to 24.7%), there was a similar effect on cocaine and/or crack, amphetamines and/or ecstasy, inhalants, hallucinogen use, opioids, antipsychotics and antidepressants.

Conclusion: In the comparison between the years 2011 and 2017, there was an increase in drug usage by college students, it is expected that the results found in this study may promote strategies of action to prevent and combat drug consumption among academics.

Open Access Original Research Article

Role of Hybrid Interventions in Management of Critical Lower Limb Ischemia

Samy R. Zekilah, Adel H. Kamhawy, Hassan A. Hassan, Mohamed A. El-heniedy, Ahmed M. Ismael

Journal of Advances in Medicine and Medical Research, Page 229-237
DOI: 10.9734/jammr/2020/v32i2430772

Aims: To evaluate safety and efficacy of the hybrid technique in revascularization of multilevel lower limb arterial occlusive disease in patients with critical lower limb ischemia.

Study Design: A prospective non comparative interventional study.

Place and Duration of Study: It was conducted between February 2017 and June 2019 in the Department of Vascular Surgery, Tanta University hospital.

Methodology: The study included 23 patients were treated with hybrid intervention techniques, and data were collected prospectively. Detailed history was taken and clinical examination was done for every patient along with routine laboratory investigations and radiological work up like duplex scanning with or without CT angiography. All patients were undergone hybrid interventions in an operating room with imaging facilities (mobile c-arm device) where both surgical and endovascular interventions were done simultaneously.

Results: Twenty three patients were treated for unilateral critical lower limb ischemia using single session elective hybrid intervention. The patients age ranged from 46 to 76 (mean 62.6) with 19 males. 8 patients (34.8%) presented with ischemic rest pain and the remainder (65.2%) presented with tissue loss (ischemic ulcer or gangrene). most common inflow procedure was femoro-popliteal supragenicular bypass, and the commonest outflow procedure was tibial angioplasty. Technical success was achieved in 22 patients. Mean ABI was improved from 0.49 preoperatively to 0.84 in early post-operative measurements. Out of 23 limbs treated there were 20 limbs saved from amputation (87% limb salvage rate). We had three mortalities from other co-morbidities and four minor complications treated conservatively and resolved.

Conclusion: Hybrid interventions were proved to be reasonable, effective and safe option for treatment of critical lower limb ischemia.

Open Access Original Research Article

Assessment of Health Related Quality of Life Using EORTC QLQ BR-23 among Breast Cancer Patients in Pakistan

Madeeha Malik, Naziha Inam, Azhar Hussain

Journal of Advances in Medicine and Medical Research, Page 238-245
DOI: 10.9734/jammr/2020/v32i2430773

Introduction: Pakistan has the highest rate of breast cancer among all other Asian countries.Late presentation of breast cancer negatively impact health related quality of life among patients.

Objective: The present study was designed to assess health related quality of life using EORTC QLQ-BR23 among patients of breast cancer in Pakistan.

Methodology: A descriptive cross sectional study design was used to assess health related quality of life among 382 breast cancer patients using EORTC QLQ-BR23. Data was collected and statistically analysed using SPSS version 21.

Results: The results highlighted that the lowest scores for HRQoL were observed in the domain of functional scale i.e. sexual enjoyment (7.18, ±16.84) while highest scores were observed in the domains of body image (55.82, ±29.07) followed by systemic therapy side effects (50.88, ±18.47).

Conclusion: The current study concluded poor HRQoL with a negative impact on its all domains among breast cancer patients in Pakistan. Lowest scores for HRQoL were observed in the domain of functional scale i.e. sexual enjoyment and sexual functioning while, highest scores were observed in the domains of body image followed by systemic therapy side effects.

Open Access Original Research Article

The Effect of Balance Training in Knee Osteoarthritis

Marwa Mohamed Alawady Elsheikh, Marwa Ahmed Abo El-Hawa, Hanan Mohamed El-saadany, Mervat Abd El Sattar Elsergany

Journal of Advances in Medicine and Medical Research, Page 246-255
DOI: 10.9734/jammr/2020/v32i2430775

Background: Osteoarthritis (OA) is the most common chronic disease that affects joints; especially knee joints. OA causes progressive irreversible joint damage and finally joint failure. Proprioceptive deficits are greater in people with knee OA.

Objective: The aim of this study is to assess and evaluate the effect of balance training as an additional modality in management of mild and moderate knee osteoarthritis and its effect on clinical and functional outcome.

Methods: The study included 60 patients with primary knee osteoarthritis, consecutively selected from outpatient clinic of Physical Medicine, Rheumatology and Rehabilitation Department, Faculty of Medicine, Tanta University Hospitals. They were divided into two groups: Group I:  (30) Patients was trained by strength exercises rehabilitation program in addition to training program of the BSS-SD. Three sessions per week for twelve weeks. Group II: (30) Patients were trained by strength exercises rehabilitation program only by three sessions per week for twelve weeks. Patients were assessed by clinical evaluation (visual analogue scale (VAS), Ritchie's tenderness scale, morning stiffness, range of motion) physical performance assessments by chair stand test, functional assessment by WOMAC, assessment of postural stability and balance disturbance (postural stability test- fall risk test- limits of stability test) were performed before, 6 and 12 weeks after rehabilitation programs

Results: Our study showed improvement in both groups of clinical assessment (VAS of pain, tenderness, morning stiffness) also there was significant improvement of (active range of movement and passive range of movement and CST). There was significant improvement of pain assessed by WOMAC. There was significant improvement of (postural stability test, fall risk testing, and limits of stability).  There were improvement in-group I more significant than group II.

Conclusion: Combined therapy of strength exercises rehabilitation program and training program of balance by BSS-SD have more potential effects in treatment of mild and moderate knee OA better than strength exercises rehabilitation program only.

Open Access Original Research Article

Epidemiological Study of Salmonella typhi and Its Month-Wise Effect on Different Age Groups in Dehradun

Sandhya Maurya, Chetna Kalra, Rupesh Kumar Mahto, Sandeep Singh, Narotam Sharma, Shilpa Semwal

Journal of Advances in Medicine and Medical Research, Page 256-260
DOI: 10.9734/jammr/2020/v32i2430776

Introduction: Salmonella typhi is a bacterial disease caused by contaminated food and water, also known as foodborne and waterborne infection, it transmitted via faeco-oral route.

Materials and Methods: A total of 204 clinical isolates were considered for its proposed study. IgM/IgG rapid card test (CTK Biotech) was used for the detection and Widal test (BEACON) was also performed for the same.

Duration: March 2020 to November 2020.

Results: A total of 204 blood samples were analyzed with clinically suspected cases of typhoid fever, out of which, some cases showed reactiveness and 50.98% showed negative for Salmonella typhi. Widal test showed reactive result for O Ag (Somatic Antigen) and H Ag (flagellar antigen) and 8.82% IgG and 42.64% (monthly) IgM antibody showed positive result.

Conclusion: Typhoid IgM/IgG antibody rapid card test and Widal Antigen test, a simple and rapid method for the detection of Salmonella typhi bacterium in patient’s serum by serological techniques. Maximum number of positive cases were in the month of August, 2020 and September, 2020. The age group between 21-40 years were most infected by Salmonella typhi.

Open Access Original Research Article

Role of Endoscopy in Round Window Identification during Cochlear Implant

Ayman Fouad, Fatthe Erfan, Mohamed Hisham Hamed, Yasser Aglan

Journal of Advances in Medicine and Medical Research, Page 261-264
DOI: 10.9734/jammr/2020/v32i2430777

Aim: To access the usage of the endoscopy in round window (RW) orientation during cochlear implant (CI).

Methodology: This was a retrospective case series study done in Otolaryngology Department, Tanta University, Egypt in 2018 and 2019. Inclusion criterion was all cases with CI surgery in which the endoscopy was used to locate the round window (RW) when this was difficult through the transmastoid approach.

Results: The total cohort consisted of 13 CI patients in which endoscopy was used. Age mean was 35.5 years. Situations necessitating the usage of endoscope were: 6/13 with cochlear rotation, 4/13 with very narrow mastoid cavity, and 3/13 with narrow facial recess. By using the endoscope, the RW was fully visualized in all patients and CI insertion done through it.

Conclusion: The endoscopy was of great value in some difficult CI cases.

Open Access Original Research Article

Deep Neck Space Infections in Northern Ghana

Theophilus Adjeso, Mawutor Dzogbefia, Edem Kojo Dzantor

Journal of Advances in Medicine and Medical Research, Page 265-270
DOI: 10.9734/jammr/2020/v32i2430778

Background: Deep neck space infections (DNSI) continue to pose a challenge due to its potentially lethal complications that can arise despite the reduced prevalence as a result of widespread antibiotic use and improved dental care. We conducted a review of our experience with DNSI at the Ear, Nose and Throat (ENT) Unit, Tamale Teaching Hospital (TTH).

Materials and Methods: We performed a retrospective analysis of patients hospitalized with a diagnosis DNSI at the ENT Unit, TTH from January 2013 to June 2020. Parameters analyzed included the age and sex distribution of patients, source of infection, sites involved, duration of admission and outcomes. Data analysis was done using SPSS version 20.0 (Chicago, IBM 2010).

Results: The study involved 135 cases of DNSIs with age range of 5 months to 76 years (35.7± 19.0 years). Majority of the DNSIs cases occurred within the third decade of life and slightly more common among males (50.4%). The duration of hospital stays ranged from a day to 41 days (10.1± 8.2 days). Multi-space abscesses were the most common diagnosed DNSIs with odontogenic infections (63%) being the most common source of DNSIs. Majority (83.7%) of the patients were successfully treated with a mortality rate of 12.6%.

Conclusion: DNSIs was most common among males with patients in their third decade most affected. Odontogenic infections were the most common source of DNSI with multi-space abscesses being the most common presentation. Majority of the patients were treated successfully.

Open Access Original Research Article

Complications of Prostate Biopsy: A Prospective, Single-institution Study

Colette M. Antoine, Belinda F. Morrison, Michael E. Brooks

Journal of Advances in Medicine and Medical Research, Page 271-279
DOI: 10.9734/jammr/2020/v32i2430779

Aims:  This study aimed to determine the prevalence rates of transrectal ultrasound-guided prostate biopsy-related complications among patients receiving treatment at the large tertiary-care urology clinic of Kingston Public Hospital (KPH), Jamaica.

Study Design: Prospective cohort study.

Place and Duration of Study: Kingston Public Hospital (KPH), Jamaica from July 2018 to April 2019.

Methodology: Our study population included men who underwent prostate biopsy at KPH. Data on demographics and clinical characteristics were collected using purpose-designed questionnaires from consenting patients who underwent prostate biopsy during the stated period. Patients were then followed up for complications 30 days post biopsy. Details regarding hospitalization due to biopsy-related complications were obtained from the medical records.

Results: Data from 185 men were included in the final analysis. Among the patients biopsied, 49% were diagnosed with prostate cancer, while 72% experienced at least one complication, mainly non-infectious complications such as hematuria (46%), lower urinary tract symptoms (24%), rectal bleeding (23%), hematospermia (9%), and urinary retention (16%). Overall, a 15% risk of developing infectious complications was observed, with 9% experiencing fever and 3% experiencing both urinary tract infection and epididymo-orchitis. Our data showed a 6% hospitalization rate within 30 days, with all available records suggesting infectious complications. One death from a prostatic abscess was noted. The present study showed that most prostate biopsy complications were minor. Moreover, although bleeding and infectious complications as well as hospitalization rates were consistent with those reported in larger series, our population experienced a slightly higher mortality and urinary retention rate.

Conclusion: Overall, our results showed that prostate biopsies performed within our institution are generally safe and well tolerated. Nonetheless, further studies are needed to determine whether morbidity of the procedure remains acceptable.

Open Access Original Research Article

Caregivers’ Perception and Practice of Infection Prevention and Control for COVID-19 at a Tertiary Centre, Southern Nigeria

G. K. Eke, L. E. Yaguo-Ide

Journal of Advances in Medicine and Medical Research, Page 280-288
DOI: 10.9734/jammr/2020/v32i2430780

Introduction: The World Health Organization had recommended a multi-prong approach for the prevention and control of COVID-19, which has risen into a major global public health challenge. Government of nations are to disseminate information on these protective measures to the general public to mitigate the spread of the disease. However, people’s adherence to these preventive strategies is essential to guarantee success.

Objective: To appraise the perception and practice of recommended measures for the prevention and control of COVID-19 by caregivers of children attending the University of Port Harcourt Teaching Hospital.

Methodology: This descriptive cross-sectional study was done among parents/caregivers of children attending the Children’s Out Patient clinics, wards and emergency room of the Department of Paediatrics at the University of Port Harcourt Teaching Hospital, between August and September 2020. Information obtained using a structured investigator-administered questionnaire included bio data and perception about COVID-19 while practice of its preventive measures was observed. Data were analysed using SPSS version 25. 

Results: All participants (161) have heard about COVID-19, mainly through the television and radio. The majority of them (n=141, 87.6%) knew that a combination of measures is needed for its prevention. More than half of participants (59%) washed their hands with water and soap provided, 89% of them had a facemask, a lesser proportion (58%) wore the mask and an even lesser proportion (28.6%) of them wore it properly. There was no significant difference between level of education or occupation of caregivers and proper wearing of the facemask.

Conclusion: Though the awareness of COVID-19 was high, there was a gap between perception and practice of its preventive measures. Health education and innovative local strategies are recommended, to help improve the people’s acceptance of, and compliance to the stipulated multi-prong preventive measures.

Open Access Original Research Article

Evaluation of Ascorbic Acid Adjuvant Therapy and Oxidative Stress Parameters in Burns Patients

A. D. G. Nwosu, E. N. Ossai, O. Onwuasoigwe, F. N. Ahaotu, J. K. Anieze, E. I. Umeji, B. Okonedo, O. Ogboji

Journal of Advances in Medicine and Medical Research, Page 296-306
DOI: 10.9734/jammr/2020/v32i2430782

Background: Burns trauma is associated with considerable morbidity and mortality. Resuscitation of burns patients with high-dose of Ascorbic acid has shown potential for mitigating the injury, but the optimal dose for this indication is unknown.

Aim: This study aimed to evaluate the impact of adjuvant therapy with intravenous Ascorbic acid (6g over 24 hours) on indicators of oxidative stress in patients with major burns.

Materials and Methods: We conducted a randomized placebo-controlled study on patients with major burns who presented at the National Orthopaedic Hospital, Enugu, Nigeria between August 2017 and July 2020. Each patient in the treatment group received intravenous Ascorbic acid, 6g over 24 hours, while those in the placebo group received Normal saline in the resuscitation fluid. Oxidative stress evaluation was based on measurement of total antioxidant capacity and malondialdehyde in the participants. The level of statistical significance was determined by a p value of <0.05.

Results: The study was conducted on 37 burns patients and 15 healthy subjects. At presentation, the burns patients had significantly lower total antioxidant capacity; P=0.006, and higher serum malondialdehyde; P=0.040, compared to the healthy volunteers. The decrease in serum malondialdehyde in the burns patients treated with high-dose Ascorbic acid; 0.9±0.8 nmol/mL, was greater than that in those treated with placebo; 0.3±1.4 nmol/mL. Similarly the increase in total antioxidant capacity in the burns patients treated with high-dose Ascorbic acid; 151.7±116.5 µmol/L was greater than that in those treated with placebo; 58.4±219.1 µmol/L. However these effects weren’t statistically significant.

Conclusion: Intravenous Ascorbic acid at a dose of 6g over 24 hours did not significantly alter the indicators of oxidative stress in the burns patients, under the prevailing conditions of the study.

Open Access Original Research Article

A Comparative Evaluation of Frictional Resistance of Conventional, Teflon and Epoxy Coated Stainless Steel Archwires in Metal, Ceramic Brackets – An In vitro Study

Praveen Katepogu, . Balagangadhar, Chetan Dilip Patil, Sanjeev V. Jakati

Journal of Advances in Medicine and Medical Research, Page 307-315
DOI: 10.9734/jammr/2020/v32i2430783

Aim and Objectives: To evaluate the frictional resistance of Conventional, Teflon, and Epoxy coated stainless steel archwires in Metal, Ceramic brackets.

Materials and Methods: 0.019” x 0.025” Stainless steel arch wire. (G & HTM) – 30n, 0.019” x 0.025” Teflon coated stainless steel archwire. (D-TechTM) – 30n, 0.019” x 0.025” Epoxy coated stainless steel archwire. (G & HTM) – 30n, 0.22 MBT Stainless steel (Gemini- 3M UnitekTM,) lower incisor brackets – 30n, 0.22 MBT Ceramic (Gemini- 3M UnitekTM), lower incisor brackets – 60n. The wires are cut into 5cm long and are ligated to bracket using 0.010- inch ligature wire. Acrylic block is placed in lower arm of Instron universal testing machine, free end of wire is pulled with upper arm of universal testing machine, at a rate of 10 mm/ min while the wire is placed parallel to long axis of bracket and tooth, and a load of 50 kg was used to measure frictional forces.

Results: Stainless steel bracket combined with Stainless Steel wire showed maximum Friction 2.640N (mean) and minimum was 0.307N (mean) with a SD of ±1.2275 (0.6618). Stainless-steel bracket combined with Epoxy coated SS wire showed maximum Friction of 10.3N and minimum was 5.62N with a SD of ± 7.3513 (1.8975). Stainless steel bracket combined with Teflon coated SS wire maximum Friction noted was 5.59N and minimum was 1.66N with a SD of ± 1.8652 (0.9545). Ceramic brackets combined with Stainless Steel wire showed maximum Friction 10.88N and minimum 4.29N with a SD of ± 6.55529 (1.6081). Ceramic brackets combined with Epoxy coated SS wire showed maximum Friction 14.88N and minimum 5.62 with a SD of ± 9.3305 (2.4077) Ceramic brackets combined with Teflon coated SS wire showed maximum Friction of 6.93N and minimum 4.31N with a SD of ±6.3483 (1.2302)

Conclusions: Stainless steel brackets combined with stainless steel archwires or Teflon coated archwires may be used effectively in sliding mechanics, rather than ceramic brackets and tooth-colored epoxy coated archwires.

Open Access Original Research Article

Metabolic Effects of Probiotic Supplementation in Diabetic Hemodialysis Patients

Ahmed G. Mosbah, Nashwa M. Elgharbawy, Amal S. El Bendary, Nelly D. El shall

Journal of Advances in Medicine and Medical Research, Page 332-341
DOI: 10.9734/jammr/2020/v32i2430786

Aims: To evaluate the effects of probiotic supplementation in diabetic hemodialysis patients on metabolic profile and level of inflammation.

Study Design: Single blind, placebo controlled clinical trial.

Place and Duration of Study: Dialysis unit of internal medicine department, Tanta University, Egypt in a period between 1 st of January 2019 to 31 th march 2019.

Methodology: 60 hemodialysis and diabetic patients were included. They were divided into two groups of equal numbers (Probiotics group and control group). Probiotic supplements were added to the Probiotics group, as regarding CBC parameters, lipid, iron profile, renal functions, HbA1c, serum albumin and CRP; we compared the base line values and values after the end of study in both groups.

Results: There was significant increase in hemoglobin in study and control group at the end of study P value <0.001 in study group and P value <0.001 in control group, also significant decrease in CRP in study group P value <0.001, significant decrease in HbA1c in study group P value 0.001 and significant increase in serum albumin in study group P value 0.039.

Conclusion: Although probiotics significantly improved the inflammation and glycemic control in diabetic hemodialysis patients, it had no significant effect in lipid and iron profile.

Open Access Original Research Article

Aerobic Bacteriology of Burn Wound Infections in Burn Patients and Their Antibiotic Susceptibility Pattern in a Tertiary Care Hospital in Kashmir Valley

Asifa Nazir, Humaira Bashir, Seema Aleem, Shoaib Mohmad Khan

Journal of Advances in Medicine and Medical Research, Page 342-351
DOI: 10.9734/jammr/2020/v32i2430792

Aims: The burn wound represents a susceptible site for opportunistic colonization by organisms of endogenous and exogenous origin. Burn wound infections are an important cause of mortality, morbidity and prolonged hospitalization in burn patients and the causative agent is generally a multidrug resistant organism. The pattern of microbial flora infecting burn wound varies according to geographical pattern as well as with duration of hospital stay. The main aim of the study was to determine the bacteriological profile and antimicrobial susceptibility patterns of burn wound isolates.

Study Design:  It was a prospective cross-sectional hospital-based study.

Place and Duration of Study: The present study was conducted in the Department of Microbiology, Government Medical College, Srinagar, from December 2019 to November 2020.

Methodology: Swabs were taken from burn wound of 351 patients and cultured aerobically. Samples were processed for identification and sensitivity. Bacteria isolated were identified using their morphological characteristics, Gram staining reaction and biochemical tests. The antimicrobial susceptibility testing was done using Kirby-Bauer disc diffusion method.

Results: A total of 351 samples were obtained for the study out of which, the most common isolate was Klebsiella pneumoniae  – 154 (38.3%), followed by  Pseudomonas aeruginosa  - 133 (33.08%), Proteus sp – 42( 10.44%) ,  Acinetobacter sp- 26 (6.46%), Staphylococcus aureus - 26 (6.46%),  Escherichia coli - 17 (4.22%),  Enterococcus - 2 (0.49%), and Providencia sp- 2 (0.49%). Colistin was the most effective drug against Gram negative organisms while as linezolid was most effective against Gram positives.

Conclusion: The finding of the study will be helpful for identifying the common bacteria causing burn wound infection and also to take proper precautions to prevent the emergence of antibiotic-resistant bacteria.

Open Access Original Research Article

Sleep Difference between Adolescents and Young Adults

Pragya Verma, Ramji Dubey, Sangeeta Rani, Shalie Malik

Journal of Advances in Medicine and Medical Research, Page 352-359
DOI: 10.9734/jammr/2020/v32i2430826

Background: Sleep is important for maintaining overall physical and mental health. Adolescents and young adults (AYAs) at growing age need more sleep because it acts as the fuel for rapidly growing brain and bodies. Many physicians encounter young people having health issue developed due to improper sleep. Understanding the connection between sleep and health in AYAs is important as the sleep problem is coming up as a global pandemic that can seriously harm the health, safety, productivity of our nation’s young generation, thus, is a major public health concern.

Aim: The current study investigates the sleep behavior (such as sleep onset, sleep offset, sleep latency, sleep inertia, actual sleep) of adolescents in comparison to young adults.

Methods: Present study is based on self-reported sleep-log entries made by subjects. The collection of data is done on a random basis from school and university set up. Sleep log sheet is an instrument that elicits sleep-related data (sleep onset/offset, latency/inertia, etc.) on a day-to-day basis. Statistical analysis was done using the Mann-Whitney U test at a significance level of p < 0.005.

Results: To conduct this study, individuals of two different age groups were selected; adolescent group (age = 14±01 year; n = 564) and young adult (age = 23±01 year; n = 43). The study shows a significant difference between adolescents and young adult’s timings for various sleep variables such as time to bed (p<0.0001), sleep onset (p<0.0001), sleep offset (p<0.0001), sleep inertia (p= 0.0156). Although, no significant difference was reported in actual sleep duration and sleep latency between the groups.

Conclusion: Outcomes of the study are indicative of sleep deprivation in adolescent students. This information can help us to further understand the sleep-related differences in the behavior of adolescent and young adults. This can aid in devise a better work schedule to optimize their performance.

Open Access Original Research Article

Evalution of Human Amniotic Membrane in Extraction Socket for Faster Wound Healing

S. P. Indra Kumar, Afrose Fathima, S. Deepika, R. J. Aravind, T. Kavin, Gayathri Priyadharshini, R. Narendar

Journal of Advances in Medicine and Medical Research, Page 360-363
DOI: 10.9734/jammr/2020/v32i2430842

Background: Preservation of extraction site with grafting shall always produce better healing results. Various materials have been used for this process and each material has its unique benefits and properties. Few such materials are Simvastatin, Bone ceramic, oxidized cellulose, bone allograft, etc. In this given study, 10 patients were placed Human amniotic membrane in their extracted socket and the results were reviewed after 7days, 14 days, 21 days, 1 month, 3 month and 6 month.

Materials and Methods: The samples are voluntary and those patients with no clinical abnormalities were included. Human amniotic membrane is received from Tata Memorial Hospital, Mumbai.

Ten patients who reported to Department of OMFS were selected for the augmentation procedure. After extraction, the Human amniotic membrane was placed in the extracted socket and secured with sutures. Post-operative visits scheduled after 7days, 14 days, 21 days, 1 month, 3 month and 6 month intervals for analyzing the he.0aling property of amnion in the augmented extraction sockets.

Results: The results of this study have shown that Amniotic membrane has proven its effect, as it initiates faster wound healing of the extraction socket.

Conclusion: This article shall reveal the effectiveness of the Human amniotic membrane in rapid wound healing of the augmented extraction socket.

Open Access Original Research Article

Viral Hepatitis Training for Laboratory Workers: Addressing the Unaddressed

Pranav Keshan, Sapna Chauhan, Sabin Syed, Aayushi Rastogi, Akanksha Bansal

Journal of Advances in Medicine and Medical Research, Page 364-372
DOI: 10.9734/jammr/2020/v32i2430852

Aims: The aim of the study was to assess the current Knowledge, Attitude and Practice (KAP) of laboratory technicians about viral hepatitis and to assess the effect of one day training on knowledge levels of the participants.

Study Design: Pre-post design.

Place and Duration of Study: Institute of Liver and Biliary Sciences New Delhi and October 2018 to September 2019.

Methodology: A one-day training program titled “Hepatitis Induction Program” on viral hepatitis for laboratory technicians was conducted. The participants were provided theoretical as well as demonstrative and hands-on training about diagnostic management and prevention of viral hepatitis among laboratory technicians. An online link for KAP and Pre-post knowledge assessment questionnaire consisting 49 (KAP) questions was shared with all registered participants. Same knowledge questionnaire consisting 25 questions was shared with the participants after training. One mark was allotted for each correct response. The data was analysed using IBM-SPSS version-21. Independent samples t-test was used to assess the mean knowledge score across various demographic factors and the paired t-test was used to assess the improvement in knowledge post training. Pearson correlation coefficient was used to establish relationship between KAP score. The statistical significance was considered at 0.05.

Results: A total of 151 laboratory technicians were trained in 5 one day trainings and data for KAP and pre-post assessment data was available for all 151 participants. Correlation coefficient between knowledge, attitude and practice score stated a positive correlation between knowledge and attitude (r=0.36 P<0.001), knowledge and practice (r=0.192, P<0.001), attitude and practice (r=0.425, P<0.001). Also, Mean difference between pre and post knowledge score was 3.12 which was statistically significant (P<0.001).There was no significant association observed between pre-post knowledge score and demographic characteristics.

Conclusion: The study was able to reflect the significant effect of one-day training regarding diagnostic management and prevention of viral hepatitis on knowledge level of the laboratory workers. The present training program can also be up scaled and help in educating the lab technicians on various health-related topics across the country as authors have found lack of studies or training programs of this kind for the laboratory workers.

Open Access Review Article

Post COVID-19 Syndrome: A Literature Review

Ankita Kabi, Aroop Mohanty, Ambika Prasad Mohanty, Subodh Kumar

Journal of Advances in Medicine and Medical Research, Page 289-295
DOI: 10.9734/jammr/2020/v32i2430781

The COVID-19 pandemic shook the entire world in January 2020 last year and is still posing a major threat to the entire humanity. A lot of studies have been conducted studying the diagnosis and management of the disease caused by this highly contagious virus, but less is known about the Post COVID-19 sequelae. There is very limited evidence about the management of COVID-19 after the first three weeks of illness. About 10% of the patients experience prolonged illness after COVID-19. Treatment is mainly focused on reassurance, self-care, and symptomatic control. There are currently no FDA-approved treatments specifically for this condition. Clinicians and researchers have focused on the acute phase of COVID-19, but continued monitoring after discharge for long-lasting effects is needed.