Open Access Case Report

Developmental Venous Anomaly with Adjacent Parenchymal Abnormality Masquerading as Glioma-A Unique Case Report

Amna Alvi, Rabail Raza, Fatima Mubarak, Asma Alvi

Journal of Advances in Medicine and Medical Research, Page 1-9
DOI: 10.9734/jammr/2021/v33i430828

Developmental venous anomaly (DVA)/ Cerebral Venous Angioma is the most common type of cerebral vascular malformations, mostly an incidental benign finding. But there are documented associated complications like parenchymal signal abnormalities, thrombosis, cavernous malformations and parenchymal atrophy.

In this report, we present a unique case of cerebral DVA with cortical changes mimicking the Glioma. Altered haemodynamics in DVA is the underlying pathophysiology for these changes. Correct MRI interpretation, by an expert neuroradiologist, can establish the diagnosis of DVA and its related changes. Therefore, it can reduce the morbidity and mortality by preventing the unnecessary invasive procedures like biopsy for diagnosis.

Open Access Short Communication

Military Medicine Module Training to Undergraduate Medical Students: A Unique Approach in National Defence University of Malaysia

L. Shahidah, S. C. Reddy, V. F. Knight

Journal of Advances in Medicine and Medical Research, Page 66-76
DOI: 10.9734/jammr/2021/v33i430835

Background: Faculty of Medicine and Defence Health in the National Defence University of Malaysia is the only university in the country that offers a unique combination of medical education and military training into an integrated academic programme.

Objective: To communicate to all the academic staff in the medical colleges about the military medicine module training to undergraduate medical students studying in National Defence University of Malaysia.

Teaching-learning Methods: The training is charted into 5 modules: Military Trauma Life Support, Army, Aviation and Naval Medicine, Advance Trauma Life Support and Battlefield Medicine.  These modules are delivered across the 5 years of the medical programme in the form of lectures, demonstrations and field training in the medical battalion, aviation medicine and underwater medicine facilities. Visits to relevant medical institutions and simulator trainings will broaden the students’ perspectives on occupational hazards, anticipate suitable patient-care management and mode of casualty evacuation. The combination of classroom learning and field exposure will definitely promote critical thinking, develop problem solving, decision making and analytical skills. 

Conclusion: The management of patient under stipulated harsh scenarios/environments have created opportunities for students to exercise critical thinking and decision making. All the positive feedback obtained from students after the completion of their posting in each year on the knowledge, skills and attributes suggest that the Military Medicine training programme enhanced their personal attributes and complemented their medical knowledge.

Open Access Original Research Article

Alpha and Beta Coronavirus Infections in a University Hospital

Harun Agca, Imran Saglik, Beyza Ener

Journal of Advances in Medicine and Medical Research, Page 10-16
DOI: 10.9734/jammr/2021/v33i430829

Background:  Human coronaviruses (CoV) are significant causes etiological factors of respiratory tract infections.  There are four major subgroups of CoVs, known as alpha, beta, gamma and delta. Four types of endemic human CoVs are 229E, OC43, NL63 and HKU1.

Aims and Objectives: In this retrospective study, we aimed to analyze the results of the respiratory samples of hospitalized patients by Real-Time(RT) PCR for CoVs 229E, NL63,OC43 and HKU1.

Methodology: Hospitalized patients with respiratory symptoms, including nasal congestion, rhinorrhea, nasal discharge, sneezing, sore throat and cough, were tested by RT PCR between April 2018 and March 2020. We retrospectively investigated the results of 1422 respiratory samples including 1245 nasopharyngeal swabs and 177 BAL samples. Detection rate and subtypes of CoV among upper and lower respiratory samples were retrospectively analyzed from patient records.

Results: Patients were between 0-93 years with a mean age of 26 years. We detected 142 (11,4%) CoVs in 1245 nasopharyngeal samples and 21 CoVs (11,9%) in 177 BAL samples. Most common CoV was OC43 (n=72, 44,2%) in overall samples.

Conclusion: Although CoV infections are predominant in the winter season, they are diagnosed throughout the year with lower incidence in summer and are identified in individuals of all ages. Understanding the epidemiological and virological features of CoV infections is important to effectively control their burden.

Open Access Original Research Article

Hysteroscopic Evaluation of Uterine Cavity after Conservative Management of Placenta Accreta

Mohammed A. Saker, Shereef L. Elshwaikh, Ayman A. Eldorf, Manal M. AbdAlla

Journal of Advances in Medicine and Medical Research, Page 17-25
DOI: 10.9734/jammr/2021/v33i430830

Background: Placenta accrete occurs when there is abnormal attachment of the placenta to the uterine wall either partially or totally. Placenta accreta had many complications mainly intraoperative and postpartum including injury to local organs (e.g. bowel, bladder, ureters) and neurovascular structures in the retroperitoneum. The aim of the present study was to evaluate the uterine cavity after conservative management of placenta accreta by using hysteroscope.

Materials and Methods: This is prospective study was carried on 40 pregnant at Tanta University Hospital with age >35 years, to detect Presence or absence of intra uterine changes after conservative management of placenta accrete by hysteroscopy, easiness of performing diagnostic hysteroscopy and Correlation between intrauterine changes and operative data.

Results: Hysteroscopic examination of the participants showed that 30.0% with incidences of Cervical stenosis, 15.0% with uterine cavity irregularity, 15.0% with intrauterine adhesions, 10.0% with endometrial fibrosis, 5.0% with scar dehiscence and 5.0% with Remnant. There was a statistically significant positive correlation between development of cervical stenosis and endometrial thickness by US (correlation coefficient r = 0.323 with p value 0.042) .There was a statistically significant negative correlation between Endometrial fibrosis and scar thickness (correlation coefficient r = -0.538 with p value <0.001). There was a statistically significant negative correlation between Intra uterine adhesions and scar thickness (correlation coefficient r = -0.470 with p value 0.002). There was a statistically significant negative correlation between uterine cavity irregularity and duration of CS  (correlation coefficient r = -0.320 with p value 0.044).

Conclusion: The frequency of abnormal hysteroscopic findings after conservative management of placenta accreta is high, for at least several months after the procedure. The most frequently found abnormalities, associated with conservative treatment, are cervical stenosis, uterine cavity irregularity and Intrauterine adhesions.

Open Access Original Research Article

Gastrointestinal Tract Endoscopic Evaluation of Iron Deficiency Anemia Patients without Gastrointestinal Manifestations Tanta University Hospitals Experience

Mahmoud A. Elmezayen, Hossam A. Hodeib, Mohamed E. Enaba, Amr M. Gawaly

Journal of Advances in Medicine and Medical Research, Page 26-34
DOI: 10.9734/jammr/2021/v33i430831

Aims: Endoscopic evaluation of symptomless IDA patients and related lesions.

Study Design: A Cross-sectional epidemiological study.

Place and Duration of Study: The hematology unit of the Internal medicine department in Tanta university hospital, the duration of the study was 6 months from 1 January to 31 June 2019.

Methodology: 100 consecutive patients with laboratory base diagnosis of IDA without GI symptoms were involved in the study and their clinical and biochemical variables were recorded. All patients underwent esophagogastroduodenoscopy (EGD) and colonoscopy. Endoscopic findings were documented as the presence/absence of bleeding-related lesions or other causes of IDA.

Results: Possible cause of anemia was found in 95% and bleeding related lesions were found in 70% of patients. Upper GIT lesions were found in 70% of patients with 42% bleeding related lesions. Lower GIT lesions were found in 33% of patients with 21% bleeding related lesions. On multivariable logistic regression: old age, low hemoglobin (HB), low serum ferritin, and positive fecal occult blood test (FOBT) were predictive factors for GIT lesions and cause of IDA.

Conclusion: Clinical and biochemical markers can predict GI lesions on endoscopy in IDA patients without GI symptoms. A high proportion of upper GI involvement makes EGD an initial endoscopic procedure however, a colonoscopy should be done in old age, and when upper GI lesions don't correlate with the severity of IDA.

Open Access Original Research Article

Impact of Cultural Competence Intervention on Satisfaction with Maternity Services among Women of Reproductive Age in Rural Kenya

Solomon Kemoi Cheboi, Kenneth Kibaara Rucha, Anastasiah Nyamilu Kimeu, Peter Kithuka

Journal of Advances in Medicine and Medical Research, Page 35-48
DOI: 10.9734/jammr/2021/v33i430832

Introduction: Quality of care is acknowledged as a critical facet of the unfinished maternal and newborn health agenda. Yet modalities of reorienting maternity services to respectful services are rare. This study investigated the effect of training health workers in cultural competence towards satisfaction with maternity service.

Materials and Methods: This was a Cluster Randomized Controlled Trial undertaken in public hospitals. The intervention was provision of culturally sensitive maternity services by health workers after cultural competence training. Three hundred and seventy nine women were interviewed per group using exit and mystery client surveys. The effect was measured using standard mean difference (Cohen’s d) and t-test.

Results: There was significant effect on satisfaction with provided information on delivery methods (F (1, 756) = 11.493, p < 0.001, ηp2 = .049). The mean of intervention group increased from 3.55 ±1.056 to 3.94, ±0.894 while the control changed from 3.57±1.187 to 3.62 ± 1.149. The mean changes tweaked the group variance from insignificant t (725) =0.290, p = 0.771 to significant t (713) =-4.336 p <0.001.

Conclusion: Cultural competence training is effective in creating room for desired maternal needs and improving perceived satisfaction with maternity services. Consequently, there is a need to integrate cultural knowledge and skills into existing maternal policies and training.

Open Access Original Research Article

Sexual Dysfunction and Related Factors during Pregnancy at a Tertiary Health Facility in Southwestern Nigeria

Adeyemi Sunday Adefisan, Jacob Olumuyiwa Awoleke, Babatunde Ajayi Olofinbiyi, Olusola Peter Aduloju, Temitope Omoladun Okunola, Oluwatoyin Olawumi Adefisan, Oluseyi Emmanuel Adelekan

Journal of Advances in Medicine and Medical Research, Page 49-58
DOI: 10.9734/jammr/2021/v33i430833

Aims: This study aimed at determining the prevalence of sexual dysfunction among the pregnant women studied. It compared the prevalence in each trimester of pregnancy, and identified               socio-demographic factors associated with sexual dysfunction in pregnancy.

Study Design: A descriptive cross-sectional study.

Place and Duration of Study: Department of Obstetrics and Gynaecology, Ekiti State University Teaching Hospital, Ado Ekiti, Nigeria between 1st and 30th of November 2020.

Methodology: We included a total of 124 pregnant women. Data were collected using an electronic questionnaire incorporating the Female Sexual Function Index (FSFI). An FSFI score ≤ 26.55 was classified as sexual dysfunction.

Results:  Some 60.5% of the respondents had sexual dysfunction. The total FSFI score of study participants was 20.62 ± 8.32. The FSFI mean score of women with sexual dysfunction was 15.25±6.34 while it was 28.57±2.42 for those without sexual dysfunction.

Conclusion: Sexual dysfunction is prevalent among the pregnant population studied. The prevalence increased with advancing gestation. Aside from routine antenatal care, healthcare providers should be aware and equipped to provide the necessary information and care for this sensitive issue.

Open Access Original Research Article

Antibiotic Resistance Pattern of Common Uropathogens among Adult Inpatients of a Tertiary Teaching Hospital

Shahida Akhter, A. S. M. Rizwan

Journal of Advances in Medicine and Medical Research, Page 59-65
DOI: 10.9734/jammr/2021/v33i430834

Introduction: Urinary tract infection is one of the common community and nosocomial problem that we encounter at a daily basis. The mounting problem of emergence of resistant strains of bacteria causing urinary tract infection (UTI) is a great concern. We had tried in this study to outline the local pattern of antibiotic resistance of the commonly found uropathogens.

Materials and Methods: This descriptive study was carried out in the Ad-din Sakina Women’s Medical College Hospital, Jashore, Bangladesh on patients attending inpatient Department from January to December 2020. Presence of more than or equal to 105 colony forming units/ml in urine culture was considered as significant for UTI. Isolated bacteria were tested by disk diffusion method.

Results: Out of 1170 urine sample tested, 372 (31.8%) were found to be culture positive cases. A clear female preponderance (77.15%) was noted in positive culture rate. E. coli was the commonest organism found among all isolates (82.25%) followed by enterococci (4.3%), klebsiella (3.76%), pseudomonas (2.95%), proteus (2.68%), enterobacter (2.15%) and Staphylococcus aureus (1.88%). High resistance was noted in E. coli isolates against nalidixic acid (77%), Cefuroxime (75%), azithromycine (61%), cefotaxime (58%) and ceftazidime (54%). The antibiotic which showed least resistance overall includes imipenem, meropenem, nitrofurantoin and gentamicin.

Conclusions: Antibiotic stewardship in accordance to local resistance and sensitivity pattern of uropathogens is mandatory to prevent the development of multidrug resistant strains. 

Open Access Original Research Article

Serum Hepcidin Level in Obese Children and Adolescents: It’s Association with Iron Deficiency Anemia

Mahmoud Ibrahim El Nashar, Rasha Mohamed Gamal EL-Shafiey, Mohammed Attia Saad, Mohammed Amr Hamam

Journal of Advances in Medicine and Medical Research, Page 77-88
DOI: 10.9734/jammr/2021/v33i430836

Background: Childhood obesity is a worldwide chronic public health problem. It was found that obesity is associated with iron deficiency and iron profile abnormalities, which appear to be caused by several factors such as decreased intake, insufficient bioavailability, and deficient intestinal iron uptake as well as iron release from stores because of an over expression of hepcidin.

Aim of the Work: Was to estimate serum hepcidin levels in obese children and adolescents and to evaluate its relation with iron deficiency anemia in these children.

Subjects and Methods: The current study included 50 patients recruited from the Nutrition Clinic of Pediatric Department at Tanta University Hospital, 25 of them were obese with iron deficiency anemia and the other 25 were obese without iron deficiency anemia and 25 healthy children and adolescents of matched age and sex enrolled as controls. All studied children were subjected to complete history taking, thorough clinical examination including anthropometric measures (Weight, height, Body mass index), assessment of pubertal status using Tanner criteria and laboratory investigations including: CBC, BUN, creatinine, ALT, AST, stool analysis, occult blood in stool, CRP, iron profile, Serum Hepcidin, abdominal ultrasound.

Results: There were significant differences between patients and control group as regard Weight, BMI and their z scores. Significantly lower levels of hemoglobin, serum ferritin, serum iron and transferrin saturation in obese children with IDA than obese children without IDA and controls and significantly higher levels of TIBC were found in obese children with IDA compared to obese children without IDA and controls. As regard CRP it was significantly higher in obese children than controls. Serum hepcidin was significantly higher in obese children than controls but there is no significant difference between obese children with IDA and obese children without IDA. Significant positive correlation between Serum hepcidin levels and BMI in obese children was found. Conclusion: Serum hepcidin level was significantly higher in obese children and adolescents in comparison with healthy lean control with no significant difference between obese children with IDA and obese children without IDA. So, estimation of serum hepcidin level is not diagnostic but it may be beneficial in screening of iron deficiency anemia in pediatric obese individuals. Further studies with larger sample size are needed to verify these findings.

Open Access Original Research Article

Study of Markers for Assessment of Insulin Resistance in Obese Children and Adolescents

Sarah Ibrahim El Shall, Ahmed Mohamed Hassan, Wesam Salah Mohamed, Mona Hasan Hafez, Adel Ali Erfan

Journal of Advances in Medicine and Medical Research, Page 89-95
DOI: 10.9734/jammr/2021/v33i430837

Background: Valid and reliable methods are essential to assess the presence and the extent of insulin resistance, the associated risk factors and the effect of pharmacological and lifestyle interventions. The aim of this work was to evaluate Homeostatic model assessment of insulin resistance (HOMA-IR) for assessment of insulin resistance among obese children and adolescents.

Methods: This case control study included 40 children and adolescent with ages of 6 to 16 years who were classified into: Group I: 20 obese children and adolescents (body mass index (BMI) > 95th percentile on Egyptian growth curves and Group II: 20 healthy children as a control group of matched age and sex to group 1 and who had normal BMI. All subjects underwent 1) Thorough history taking 2) Full clinical examination 3) Laboratory investigations: Fasting blood glucose, Fasting serum insulin level, HOMA-IR, HbA1c.and OGTT.

Results: There is no significant statistical difference as regard age, height, sex and puberty staging in both groups. The mean for weight, BMI, waist circumference, hip circumference, waist/hip ratio and acanthosis nigricans were found to be significantly higher in patient group. FBG, fasting serum insulin, HbA1c and HOMA-IR were significantly higher in patient group than in control group (p <0.001). HOMA-IR was significantly correlated with HbA1c and OGTT in obese patients (p<0.001*).

Conclusions: HOMA-IR can be used in assessment of insulin resistance among obese children and adolescents.

Open Access Original Research Article

Role of T2 Mapping Sequences using MR Imaging in Evaluation of Knee Joint Articular Cartilage

Eman Magdy Abokamer, Atef Hamad Taiema, Kamal Mohamed Hafez, Rasha Mahmoud Dawoud

Journal of Advances in Medicine and Medical Research, Page 96-104
DOI: 10.9734/jammr/2021/v33i430838

Background: Cartilage mapping using Magnetic Resonance Imaging T2 is a functional scanning procedure without invasion delivering cartography of the cartilage T2 relaxation time without using of any contrast. It is tissue anisotropy sensitive, and compositional data on the collagen network of cartilage, content of water and concentration of proteoglycans are provided by it. This study used MR scanning technique to assess the T2 mapping sequence role in diagnosis of articular cartilage lesions of knee joint.

Patients and Methods: This prospective trial was done to utilize sagittal T2 mapping sequence for assessment of articular cartilage of knee joint on 1.5 T MR. The material of this study included thirty (30) patients. The study included 24/30 cases presented by knee pain, 6/30 cases presented by knee pain following trauma, 10/30 cases presented by limitation of movement and 7/30 cases presented by knee swelling. As each patient had a single conventional MRI examination of the knee followed by a single sagittal T2 maps, 30 MRI examinations and 30 corresponding T2 maps were analyzed.

Results: The addition of sagittal T2 maps to standard views improved accuracy in diagnosing cartilage affection in early osteoarthritis. there are 69 (57.5%) lesions diagnosed as grade 0 by MRI only VS 24 (20%) lesions diagnosed as grade 0 by MRI with T2 mapping sequence and 34 (28.3%) lesions diagnosed as grade 1 by MRI only VS 77 (64.2%) lesions diagnosed as grade 1 by MRI with T2 mapping sequence. there is 46 (38.3%) lesions diagnosed as grade 1a by MRI with T2 mapping sequence which diagnosed grade 0 by MRI only.

Conclusions: This imaging plane seems to provide a useful addition to standard MR imaging when osteoarthritis is suspected specially among the young population.

Open Access Original Research Article

COVID-19 Knowledge among Healthcare Professionals in Gombe, Northeast, Nigeria: A Quick Online Cross-Sectional Survey

Rabiu Ibrahim, Abdulsalam Yakubu, Ahmed Iya Girei, Danladi Muhammed Umar

Journal of Advances in Medicine and Medical Research, Page 105-114
DOI: 10.9734/jammr/2021/v33i430839

Aims: Despite control measures adopted to check the rapid spread of the COVID-19 pandemic in Nigeria, healthcare workers still face a serious threat to infection due to SARS-CoV-2 virus. Adherence to control measures by healthcare workers depends on their knowledge. This study aimed to determine the knowledge of COVID-19 and related infection control practices among healthcare professionals in Gombe State.

Mythology: A cross sectional study was conducted among healthcare professionals in Gombe. Relying on our network with the healthcare professionals, 500 participants were recruited into the study using simple random sampling method.  The data were collected using online questionnaire consisting of socio-demographic questions and 17questions based on knowledge and infection control practices related to COVID-19 disease in the healthcare setting adapted from a study in India. The data were analyzed using SPSS version 23 at uni-variate and bivariate levels with p value at < 0.05.

Results: Close to three-fourth (72.1%) of the participants reported correct answer about knowledge of COVID-19, thus overall knowledge was found to be adequate for all subgroups. About four-fifth (78.9%) of doctors’ responses were correct. and the lowest (65.5%) was from CHOs, Laboratory assistants and health recorders. 43.7% of the participants could correctly define “close contact.” More than three-fourths of the participants knew the various infection control measures like rapid triage, respiratory hygiene, and cough etiquette and having a separate, well ventilated waiting area for suspected COVID-19 patients. However, less than half (47.8) of the participants were aware of the correct sequence for the application of a mask/respirator, and 62.2% of them knew the preferred hand hygiene method for visibly soiled hands.

Conclusion: Regular health educational programs aimed at improving COVID-19 knowledge and infection control are needed.