Open Access Case Study

Inflammatory Myopathy with Cardiac Involvement Associated with Anti-Mitochondrial Antibodies

Baya Wafa, Ben Hassine Imen, Ben Fredj Fatma, Anoun Jihed, Mzabi Anis, Karmani Monia, Rezgui Amel, Abdessayed Nihed, Sriha Badreddine, Laouani Kechrid Chedia

Journal of Advances in Medicine and Medical Research, Page 50-55
DOI: 10.9734/jammr/2021/v33i530845

Aim: Anti-mitochondrial antibodies (AMA) positive myositis is an atypical and rare form with various characteristics. We aim to highlight these specificities through this case report.

Presentation of the Case: We present the case of a young woman diagnosed with frequent polymorphic ventricular extrasystoles and left ventricular dysfunction. Two years after, she developed asthenia and muscle weakness. Clinical and biological tests confirmed the diagnosis of myositis complicated by focal myocarditis. The immunological screening revealed negative antinuclear antibodies and positive AMA type anti-AMA-M2 and anti-M2-3E. A good clinical evolution was noted under corticosteroids and methotrexate.

Discussion: Cases of primary biliary cholangitis (PBC) or positive AMA associated with other autoimmune diseases such as systemic scleroderma, Sjögren syndrome, rheumatoid arthritis and myositis have been reported. AMA’s pathogenic role on the musculoskeletal and cardiac systems remains to be clarified.

Conclusion: Inflammatory myopathy associated with AMA is a rare and serious entity, characterized by a delayed diagnosis and frequent cardiac involvement, often indicating a heavy treatment.

Open Access Short Research Article

Prevalence and Pattern of Modern Contraceptive Choices among Women of Reproductive Age 15-49 Years in a Community Health Facility: An Eight Year Retrospective Study

Akinwale Oladayo Damilola, Akinbade Musiliat Olufunke, Ogunsina Ibukunoluwa Deborah, Akinwale Akinwumi Adebowale

Journal of Advances in Medicine and Medical Research, Page 22-33
DOI: 10.9734/jammr/2021/v33i530843

Aims: Utilization of modern contraception to prevent pregnancies is a unique health intervention as unplanned pregnancies expose women to additional health risks and lifetime risk of maternal mortality by increasing the number of lifetime pregnancies and deliveries. This study therefore aims at evaluating the prevalence and pattern of modern contraceptive choices among women of reproductive age and to identify the most commonly used modern contraceptives.

Study Design: Retrospective study carried out at family planning clinic of Community Health Centre, Osun State University Teaching Hospital, Osogbo, Osun State, South-West Nigeria between January 2013 to December 2020.

Methodology: The clients who had attended family planning clinic for modern contraceptive services during the period of eight (8) years were identified from clinic register. Their case files were retrieved and relevant data extracted with the use of standardized pro forma. Two hundred and twenty-two (222) case notes were available and suitable for analysis. Data were analysed using descriptive statistics and inferential statistics of chi square and ANOVA.

Results: The result revealed highest prevalence of modern contraceptive utilization among young women with slight increase in rate of utilization as the age increases and decreases with older age. The most commonly utilized methods of contraception were Injectables: Noristerat and Depo-Provera; and IUCD. Result further showed significant relationship between age, number of children alive, breastfeeding status and desire to have more children and choice of modern contraceptive (P- value < 0.000).

Conclusion: Utilization of modern contraceptives can be improved through adequate public health education, thus, this study recommended that health education should be intensified at antenatal clinic, infant welfare clinic, religious places, market places and any place of public gathering.

Open Access Original Research Article

A New Approach to the Laparoscopic Double Stapling Technique: Exploration and Reinforcement of Weak Points

Masahiro Kimura, Yoshiyuki Kuwabara, Akira Mitsui, Takaya Nagasaki, Seiichi Nakaya

Journal of Advances in Medicine and Medical Research, Page 1-7
DOI: 10.9734/jammr/2021/v33i530840

Background: Anastomotic leakage is a serious complication in colorectal surgery, often associated with higher morbidity and mortality. Even with advances in medical technology and devices, the rates of anastomotic leakage is not on downward trend. We describe our experimental and clinical validation of our method to overcome the weakness of the double stapling technique, especially the intersecting staple lines.

Methods: Experimentally, we conducted double stapled anastomosis with pig small intestines. In order to verify pressure resistance, the anastomosis was tested and compared with that formed by a conventional stapler and a reinforced cartridge preattached to a Neoveil sheet. Additionally, during the anastomosis performed by the circular stapler, both ends of the Neoveil sheet were grasped by forceps, and the Neoveil sheet was pulled tight to fit the anastomotic surface. The burst pressure of the anastomosis was recorded. Clinically, we used a reinforced cartridge for rectal surgery performing a low anterior resection and verified its efficacy and safety.

Results: Unlike a conventional stapler, our methods with the use of a reinforced cartridge showed no leakage from the intersecting staple lines. Clinically, our method has been used for 20 patients without complications, including leakage and bleeding.

Conclusion: The addition of reinforcing material to the linear stapler should lead to increased strength of the anastomosis. We believe that a double stapling anastomosis that uses our method for the intersection lines provides increased safety and security and thereby should lead to a reduced rate of suture failure after rectal resection.

Open Access Original Research Article

Weight Management and Dietary Style Modifications among University Students

Mona Abdelgadir Ahmed

Journal of Advances in Medicine and Medical Research, Page 56-66
DOI: 10.9734/jammr/2021/v33i530846

Weight management is a long term approach to a healthy life style. It includes a balance of healthy eating and physical exercise to equate energy expenditure and energy intake. Weight management depends on your body need and according to the basal metabolic rate. A descriptive cross- sectional study was conducted based on the questionnaire that were distributed among under graduated students. In a case study group, a total of 200 females aged less than 25 years old were taken into consolidation.  All the female participants were from Saudi Arabia Healthy females without any complication who were the students of Albaha University enrolled in 2017, participated in the questionnaire.

The Study Aimed: Is to know the dietary style modification during weight management among female university students.

The Specific Objectives: Is to find out the  reasons for body weight management,  to evaluate the different  methods used in  weight  management ,  and also to assess  different  knowledge  of university female students   and  their  body management  interesting  and   also  to give them advice about the correct way for body weight management. The data analysis only covers (42). Students who were concerned in weight management (included criteria) and exclude all students who were not concerned in weight management (210) (excluded criteria). The questionnaire variables include demographic (question about age resident and the student knowledge about her weight (According to the body mass index) that represents how many of females are underweight, normal weight and obese. The questionnaire also covered other information about their normal physical activities and dietary modification.

Open Access Original Research Article

Effect of Thermal Stimulation on Gene Expression Related to Skeletal Muscle-derived Cell Density

Masayo Nagai, Hidesuke Kaji

Journal of Advances in Medicine and Medical Research, Page 73-81
DOI: 10.9734/jammr/2021/v33i530848

Aims: Our previous study demonstrated favorable changes in plasma protein levels such as adiponectin by fomentation in healthy people. We also reported that the thermal stimulation caused changes of mRNA levels to prevent atherosclerosis in human skeletal muscle-derived cell (SMDC). However, cell number decreased to 74.6% by heat stimulation. In order to clarify this mechanism, we investigated whether the heat stimulation affects the levels of mRNA related to cell density or number of SMDC.

Study Design: Experimental study comparing transcriptome between cells cultured at higher temperature and control cells.

Place and Duration of Study: From September 2015 to March 2017, Division of Physiology and Metabolism, University of Hyogo.

Methodology: SMDC was cultured at 42°C and 37°C and its gene expression was analyzed by using microarray technique.

Results: Thermal stimulation of SMDC significantly altered the expression of 10 genes related to apoptosis, 1 gene related to cell division and 1 gene related to cell adhesion. mRNA expression of apoptosis promoting gene, such as THAP2 (THAP domain containing, apoptosis associated protein 2), PDCD6 (programmed cell death 6), BCL2L13 (BCL2-like 13), LOC728613 (programmed cell death 6 pseudogene), CASP4 (caspase 4), and FAS (Fas cell surface death, receptor) was up-regulated. On the other hand, PAWR (PRKC, apoptosis, WT1, regulator) was downregulated, and mRNA expression of anti-apoptotic genes, such as NOL3 (nucleolar protein 3), CIAPIN1 (cytokine-induced apoptosis inhibitor 1) and NAIF1 (nuclear apoptosis inducing factor1), was up-regulated, Gene Ontology analysis showed alterations in the expression of genes that promote apoptosis and cell growth inhibition. Pathway analysis demonstrated the pathways that promote apoptosis, stimulate cell growth and negatively or positively regulate cell adhesion.

Conclusion: The present study suggested that thermal stimulation of SMDC might predominantly promote apoptosis from consistent changes in related gene expression by any analysis.

Open Access Original Research Article

Surgical Site Infection after Caesarean Section: Epidemiology, Microbiology, Management and Prevention in a Tertiary Health Facility in Niger Delta Region, Nigeria

Eugene M. Ikeanyi, Isaac J. Abasi, Ninabai N. Ofuruma

Journal of Advances in Medicine and Medical Research, Page 82-95
DOI: 10.9734/jammr/2021/v33i530849

Background: Surgical site infection despite marked advances in surgical techniques and preventive measures continues to contribute substantially to hospital morbidity, financial burden and mortality.

Aims: This study was designed to measure surgical site infection rate following caesarean section, investigate the risk factors and the pattern of the offending microbes. The paucity of SSI data from authors’ center influenced the desire to contribute data to cesarean section-related SSI.

Study Design: A case control study.

Place and Duration of Study: Niger Delta University Teaching Hospital Bayelsa State Nigeria between May 2018 and March 2020.

Methodology: Consenting cases of caesarean procedure-related surgical site infection were recruited as study group and the next non-infected caesarean patients as the control group. Descriptive statistics was done with EPI Info and Instat software.   Relative risk (RR) determined association of variables and SSI with p-value <.05.

Results: Twenty six (9.4%) of the 276 caesarean section cases had surgical site infection. Unbooked status (RR 2.4, p=0.003), BMI≥30mgm-2(RR 2.2, p=0.02), surgery duration > 60 minutes (RR 5.3, p=0.03), interrupted stitch (RR 3.0, P<0.001), prolonged rupture of fetal membranes (p=0.008), chorioamnionitis (RR2.68, p=0.002), estimated blood loss>1000ml (p=0.02) were significant risk factors for SSI. SSIs had longer postoperative hospital stay median (IQR) 14.5(10-21) vs.6.0 (5-7), P<.001. Obstructed labor (42.3%) was responsible for most of SSIs after C-section. Wound discharge (37%), fever (23%) and wound dehiscence 17% were the main clinical features of SSI. The most isolated microorganisms were staphylococcus aureus (22.7%), klebsiella species and Escherichia coli 18.2% each and they were predominantly susceptible to quinolones and gentamicin and resistant to beta-lactam antibiotics.

Conclusions: Surgical site infection after C-section is still common in Nigeria. The factors were multifactorial and largely modifiable. 

Open Access Original Research Article

Dialectical Behavior Therapy and Emotion Regulation Changes in Patients with Borderline Personality Disorder in Delta Region of Egypt

Noha F. M. Fnoon, Mai A. Eissa, Ehab E. Ramadan, Hossam E. El-Sawy, Ahmed M. A. Abd El-Karim

Journal of Advances in Medicine and Medical Research, Page 96-104
DOI: 10.9734/jammr/2021/v33i530850

Background: Researchers have proved the role of dialectical behavior therapy (DBT) in improving emotion regulation skills in patients with borderline personality disorder (BPD). Further researches for its effect in different cultures was needed. The current study aimed to examine the effectiveness of DBT relative to treatment as usual “TAU” in improving emotional regulation in BPD patients of the delta region of Egypt.

Subjects and Methods: We conducted a prospective, comparative, non-randomized study. Eligible patients were assigned at their convenience or according to the immediate availability of treatment slots to a comprehensive DBT program integrating DBT skills into skills training schedule or treatment as usual (TAU). Patients were assessed at baseline, and follow up assessment at 4, 8, 12, and 16 months was done using the Arabic version of, Difficulties in Emotion Regulation Scale (DERS),

Results: DBT patients showed better and lower scores of emotion regulation and distress tolerance scales in comparison to TAU. Overall, these positive outcomes were maintained in follow-up for four months post-treatment year.

Conclusions: We provide the superior efficacy of DBT in improving emotion regulation in delta region's patients with BPD in comparison to TAU.

Open Access Original Research Article

Predictors of Peripheral Artery Disease among Elderly Respondents in an Urban Hospital, Edo State Nigeria

Iboro Samuel Akpan, Ferguson Ayemere Ehimen, Babatunde Adedokun, Osaretin Oviasu

Journal of Advances in Medicine and Medical Research, Page 105-115
DOI: 10.9734/jammr/2021/v33i530853

Peripheral artery disease (PAD) potentially affects health-related Quality of Life, Disability Adjusted Life Years (DALYs) and is a strong prognostic marker for future cardiovascular events in elderly population. PAD commonly affects the elderly but may go undiagnosed in them, probably due to the presence of other morbidities like osteoarthritis and associated muscle spasm.

Aim. The aim of this study was to determine the predictors of PAD in elderly by evaluating the socio-demographic and clinical characteristics in elderly patients.

Methods. A cross sectional hospital based study was carried out among 370 patients aged 60 years and above attending a Tertiary Hospital from September to November 2017. A systematic random sampling technique was utilized. A structured questionnaire was administered to collect data on socio-demographic characteristics, lifestyle variables, and medical history. The Ankle Brachial Index (ABI) was used to assess for PAD. Analysis was done using Chi-square test and logistic regression. 

Results. The mean age was 69.3±7 years comprising of 76.5% females, 50% of the respondents were married while 47% were widowed. After adjusting for other variables, the result of the multi-logistic regression indicated that only patients with abnormal pedal pulse were more likely to present with PAD than those with normal pedal pulse (OR=10.634, 95% CI=2.4-47.121, p=0.002).

Conclusion. The study reveals that abnormal pedal pulses were significant predictors of PAD, therefore it is recommended that regular screening (clinical foot examination and ABI) should be done for elderly to achieve early detection of PAD and facilitate prompt treatment.

Open Access Original Research Article

Comparative Studies of the Effect of Different Types of Iron Tonics on Umbilical and Middle Cerebral Blood Flow in Cases of Moderate Iron Deficiency Anemia in Late Second Trimester of Pregnant Women

Basma M. Elbehiry, Raghda A. El-Dakhakhni, Mohamed F. Dawood, Mohamed M. Esmail

Journal of Advances in Medicine and Medical Research, Page 116-126
DOI: 10.9734/jammr/2021/v33i530854

Background: Maternal anemia is frequently associated with premature delivery, reduced neonatal weight, infant iron deficiency, neonatal death, and low Apgar scores at 1 min. It is also suspected to reduce the oxygen supply to the growing fetus, leading to the redistribution of fetal blood flow. This study aims to evaluate the effect of the different types of iron medications given to anemic patients on fetal Doppler indices namely umbilical artery and middle cerebral artery in the late second trimester of pregnancy.

Materials and Methods: This cohort prospective study. This study conducted at department of obstetrics and gynecology at Tanta university hospital. Participants consisted of 90 pregnant women during their gestational age (20-28 weeks) they were attended or admitted to obstetric unit.divided into 3 groups. Lactoferrin group included 30 cases received 250 mg lactoferrin capsules once daily for 4 weeks. Iron amino acid chelated group included 30 cases received ferrous bis – glycine chelate (FeBC) 15 mg/day for 4 weeks. Ferrous fumarate group included 30 cases received 350 mg dried ferrous fumarate capsules once daily for 4 weeks. Pre-and post-treatment Doppler measurement of umbilical artery and middle cerebral artery parameter compared 4 weeks after the start of treatment for patients whose anemia successfully treated.

Results: Post hoc analysis of maternal serum hemoglobin of the studied groups show insignificant different between the groups. Pre- and Post-treatment follow-up of resistance index (RI) of the studied groups, Pre- and Post-treatment follow-up of pulsatility index (PI) of the studied groups, Post hoc analysis of pulsatility index (PI) of the studied groups and Post hoc analysis of resistance index (RI) of the studied groups show insignificant different between groups.

Conclusion: Based on our results, it can be concluded that cerebral vasodilatation due to severe maternal anemia is a reversible condition that can be corrected through the prompt treatment of anemia. Additionally, the three therapeutics tested in the current study showed a comparable effect in treating maternal anemia, with subsequent improvement of doppler indices.

Open Access Review Article

Literature Review on Epidemiological Modelling, Spatial Modelling and Artificial Intelligence for COVID-19

Danial Saraee, Charith Silva

Journal of Advances in Medicine and Medical Research, Page 8-21
DOI: 10.9734/jammr/2021/v33i530841

Introduction: Following the outbreak of Coronavirus (COVID-19) in Wuhan, China in December 2019, the World Health Organisation (WHO) has declared this infectious disease as a pandemic. Unlike previous infectious outbreaks such as Severe Acute Respiratory Syndrome (SARS) and Middle Eastern Respiratory syndrome (MERS), the high transmission rate of COVID-19 has resulted in worldwide spread. The countries with the highest recorded incidence and mortality rates are the US and UK.

Rationale/Objective: This review will compare studies that have used epidemiological models for disease forecasting and other models that have identified sociodemographic factors associated with COVID-19. We will evaluate several models, from basic equation-based mathematical models to more advanced machine-learning ones. Our expectation is that by identifying high impact models used by policy makers and discussing their limitations, we can identify possible areas for future research.

Evidence Review: The bibliographic database google scholar was used to search keywords such as ‘COVID-19’, ‘epidemiological modelling’ and ‘machine learning’. We examined data review articles, research studies and government-released articles.

Results: We identified that the current SEIR model used by the UK government lacked the spatial modelling to enable an accurate prediction of disease spread. We discussed that machine-learning systems which can identify high-risk groups can be used to establish the disparities in COVID-19 death in BAME groups. We found that most of the data hungry AI models used were limited by the lack of datasets available.

Conclusion: In conclusion, advances in AI methods for infectious disease have overcome challenges presented in mathematical models. Whilst limitations do exist, when optimised, these highly advanced models have a great potential in public health surveillance, particularly infectious disease transmission.

Open Access Review Article

Serum YKL-40 Levels are Increased in Patients with Diabetes Mellitus and Coronary Artery Diseases: A Meta-analysis

Shireen Salome Papabathini, Nathan Obore, Joseph Kawuki, Upama Ghimire, Wang Lina

Journal of Advances in Medicine and Medical Research, Page 34-49
DOI: 10.9734/jammr/2021/v33i530844

Background: YKL-40 also named as chitinase-3-like protein 1 (CHI3L1) is a novel inflammatory biomarker found to be elevated in inflammatory and chronic diseases. This meta-analysis was done to estimate the pooled SMD of serum YKL-40 and evaluate its use as a diagnostic biomarker for Diabetes Mellitus (DM) and Coronary artery disease (CAD).

Methods: Through searching the following electronic databases: Google scholar, PubMed, Scopus among others, related articles were extracted in English language. Stata (Version 12.0) was used for statistical analysis. Newcastle–Ottawa Scale was used for quality assessment. Standard mean difference (SMD) and its corresponding 95% confidence interval (95% CI) were calculated. Heterogeneity was assessed by I2 statistic.

Results: Fourteen CAD studies with 1400 patients, 1685 controls and Thirteen DM studies with 1103 patients, 982 controls were selected for statistical analysis. The results showed that serum YKL-40 level in both CAD and DM patients was significantly higher than that in control subjects (SMD = 1.76 (95% CI 0.96-2.57) and (SMD=1.89 (95% CI 0.79-3.00) respectively. In both studies, stratified analysis showed that, studies which did not control for smoking had higher SMD compared to those controlled. Besides, CAD patients from developed countries had higher serum YKL-40 levels compared to those from developing countries.

Conclusion: This meta-analysis suggests that an elevated serum YKL-40 level may be used as a promising diagnostic tool for early identification of CAD and DM. However patients’ age, history of smoking, and comorbidities should be put into consideration.

Open Access Review Article

Adult Intussusception in a Referral Hospital in Sub-Saharan Africa: Case Report and Literature Review

Richard Wismayer

Journal of Advances in Medicine and Medical Research, Page 67-72
DOI: 10.9734/jammr/2021/v33i530847

Introduction: Adult intussusception is a rare form of bowel obstruction which constitutes less than 5% of all cases of intussusception. In Sub-Saharan Africa, adult intussusception is not a rare cause of bowel obstruction. It is usually caused by a lead point which may be malignant in up to 50% of cases unlike childhood intussusceptions which are usually idiopathic. The author reports on a case of intussusception followed by a literature review on the pathogenesis and treatment options for intussusception in Sub-Saharan Africa.

Presentation of Case: A 46 year old gentleman presented with nonspecific abdominal symptoms mainly with epigastric pain associated with vomiting. No palpable masses were felt in the abdomen. Laboratory investigations were unremarkable. At laparotomy an ileo-ileal-caecal intussusception was found and when reduced 30 cm of ileum resulted gangrenous. A limited resection of the small bowel with end-to-side anastomosis involving the viable ileum and ascending colon was carried out. A lobulated lipoma was the pathological lead point on inspection of the ileum in the resected specimen.

Discussion: The atypical clinical features and pathogenesis of adult intussusception are described in the case presented. In addition, this study reviews the literature regarding the pathogensis, clinical features, diagnostic imaging modalities and treatment options of adult intussusception.

Conclusions: Patients with long standing abdominal pain and vomiting should have an abdominal CT scan to achieve a clear diagnosis of intussusception. This will avoid any unnecessary delays in the operative management of this condition.