Open Access Case Study

COVID-19 Pneumonia, Diabetes and Alteration of the Biochemical Values of Blood: A Case Report and Review of the Literature

Petronela Vicoveanu, Roxana Covali, Laura Riscanu, Demetra Socolov, Ioana Pavaleanu, Alexandru Carauleanu, Razvan Socolov

Journal of Advances in Medicine and Medical Research, Page 92-96
DOI: 10.9734/jammr/2021/v33i630865

Aims: The variability in evolution of the novel coronavirus has perplexed the medical community. We herein report the case of a patient with specific characteristics, somewhat outside the reported average values.

Presentation of Case: A 60-year-old type I diabetic patient was admitted as an outpatient to a university hospital for the following symptoms: fever up to 38.1˚C, malaise, and shortness of breath. Upon admittance, the chest X-ray revealed a homogenous triangular opacity, of medium intensity, located in the lower lobe of the left lung, suggesting pneumonia. Altered biochemistry values in our hospital included ALT = 86U/L, AST = 118 U/L, serum urea = 43.4 mg/dL, serum creatinine = 1.43 mg/dL, fasting blood glucose = 167.9 mg/dL (she had type 1 diabetes and received insulin only in the evening), triglycerides = 214.9 mg/dL, serum magnesium = 1.48 mg/dL, serum iron = 14.1 mg/dL. Fever, malaise, and shortness of breath, together with the X-ray image of the chest suggested COVID-19. RT-PCR confirmed the diagnosis 12 hours later. Three days after admission, she felt dyspneic, and oxygen therapy was administered for 7 days, together with Lopinavir/Ritonavir, Dexamethasone, Heparin and Vitamin C. After 18 days in the hospital, she felt good, and was released from the hospital.

Conclusion: Despite the numerous aggravating factors for COVID-19 (age [60 years old], type 1 diabetes, increased values of ALT, AST, serum urea, serum creatinine, fasting blood glucose, low serum magnesium, one whole lobe pneumonia, and only one favorable factor–low serum iron), the patient survived and recovered.

Open Access Case Study

Burkholderia cepacia Infection, When to Treat and When Not To

Manjunath Totaganti, G. Jithesh, M. Pradeep Chakaravarthy, Divanshee Sharma, . Ravikant

Journal of Advances in Medicine and Medical Research, Page 110-113
DOI: 10.9734/jammr/2021/v33i630867

B. cepacia causes pneumonia in people with preexisting lung diseases and is intrinsically resistant to many antibiotics. Here we present a 55-year-old female with community acquired pneumonia developed colonization of B. cepecia. In our case we monitored her daily for the progression of illness and decided not to treat her. It posed a dilemma whether to treat or not to treat as there is not adequate data regarding management of B. cepacia infections.

Open Access Original Research Article

Ultrasound-guided Paravertebral Block Versus Intravenous Sedative Analgesic using Midazolam /Fentanyl in Patients Undergoing Extracorporeal Shock Wave Lithotripsy

Fatma M. Elaiashy, Mohamed M. Abu Elyazd, Ahmed A. Eldaba, Tarek A. Gameel

Journal of Advances in Medicine and Medical Research, Page 1-10
DOI: 10.9734/jammr/2021/v33i630855

Background: Thoracic paravertebral block (TPVB) produces ipsilateral somatic and sympathetic nerve blockade in multiple contiguous dermatomes both above and below the site of injection.

 The Aim of This Study: was to compare the effectiveness of ultrasound-guided TPVB versus intravenous (IV) sedative analgesic using midazolam / fentanyl in patients undergoing extracorporeal shock wave lithotripsy (ESWL) procedure.

Patients and Methods: This prospective, randomized study was carried out on sixty patients aged 20-60 years, with radio-opaque renal stone not more than1.5cm. TPVB group (30 patients) received ipsilateral ultrasound-guided TPVB at the level T9-T10 using bupivacaine 0.25% (20 mL) about 30 minutes before the ESWL. Midazolam/fentanyl group (30 patients) received sedatives analgesic drugs using IV midazolam (0.05 mg / kg) and fentanyl (1 µg/kg) about 5 min before the ESWL. The VAS score during and 30 min post procedure, total dose of rescue analgesic consumption during ESWL procedure, the success rate of ESWL, the time needed to stone clearance, patient and operator satisfaction scores were recorded.

Result: During and after ESWL procedure, the VAS scores were significantly higher in midazolam/fentanyl group than TPVB group (P < 0.05). The number of patients required rescue analgesic during ESWL was significantly higher in midazolam/fentanyl group compared to TPVB group (P < 0.05).The success rate of ESWL was insignificantly different between both groups (P > 0.05). The time needed to stone clearance was significantly shorter in TPVB group compared to midazolam/fentanyl group (P < 0.05).

Conclusions: Ultrasound-guided TPVB provided more effective analgesia with reduced number of ESWL sessions and shorter time to renal stone clearance than IV midazolam/fentanyl.

Open Access Original Research Article

Evaluation of Intralesional Injection of 5-fluorouracil in Treatment of Vitiligo

D. M. Abo Anber, D. A. Mohammed Ali, R. A. El-Tatawy, L. H. Elgarhy

Journal of Advances in Medicine and Medical Research, Page 11-16
DOI: 10.9734/jammr/2021/v33i630856

Background: Vitiligo is a chronic cutaneous disease characterized by depigmented patches that leave psychological impact on the patients. New treatment modalities have been developed to improve the results vitiligo with less side effects.

Objective: To evaluate intralesional injection of 5-fluorouracil in treatment of vitiligo.

Patients and Methods: The study included 20 localized stable vitiligo patients. Each patient was treated with intralesional injection of 5-fluorouracil every 2 weeks for 3 sessions followed by narrow band sessions twice weekly for 3 months.

Results: There was statistically significant repigmentation after treatment with intralesional 5-FU (mean of 50.30 ± 34.60, P value =0.001 Wilcoxon signed ranks test between before and after). 55% of patients showed >50% repigmentation. after 3 months therapy. Side effects were minimal and transient.

Conclusion: Intralesional injection of 5-FU is safe and effective in the treatment of vitiligo.

Open Access Original Research Article

Effect of Intrathecal Dexmedetomidine in Preventing Intra-operative Shivering after Spinal Anesthesia

Hossam Ibrahim Ibrahim, Hesham Elsayed Elashry, Reda Sobhy Abdel Rahman, Osama Mahmoud Shalaby

Journal of Advances in Medicine and Medical Research, Page 17-26
DOI: 10.9734/jammr/2021/v33i630858

Background: Dexmedetomidine (DEX) has sedative, analgesic, sympatholytic, anesthetic-sparing and hemodynamic-stabilizing properties. This study aims to evaluate the effects of intrathecal DEX as an adjuvant to hyperbaric bupivacaine in the prevention of shivering in patients who underwent surgeries under Intrathecal anesthesia.

Methods: A prospective double-blind, controlled, randomized study was conducted on 100 patients aged above 21 years old, ASA I & II undergoing lower limb orthopedic surgeries under intrathecal anesthesia. Patients were subdivided randomly into 2 equal group; Group Bupivacaine-Dexmedetomidine (BD): 5 µg dexmedetomidine diluted in 0.5 ml 0.9% normal saline was added to 12.5 mg heavy bupivacaine 0.5% and Group Bupivacaine (B): 0.5 ml 0.9% normal saline was added to 12.5mg heavy bupivacaine 0.5% (3ml volume).

Results: Shivering occurred in 9 patients (18%) in group BD and 23 patients (46%) in group B with a significant decrease in group BD compared to group B (P = 0.003). The relative risk of developing shivering was decreased 53% (95% Confidence Interval: 74 – 16%) with group BD compared to group B. Tsai and Chu score was significantly better in group BD (P = 0.013).

Conclusion: The use of intrathecal DEX (5μg) in conjugation with heavy bupivacaine help decrease the incidence and intensity of shivering when compared with heavy bupivacaine alone in surgeries under spinal anesthesia.

Open Access Original Research Article

Effect of the Brain Balance Program® on Cognitive Performance in Children and Adolescents with Developmental and Attentional Issues

Rebecca Jackson, Conor J. Wild

Journal of Advances in Medicine and Medical Research, Page 27-41
DOI: 10.9734/jammr/2021/v33i630857

We reviewed the cognitive task performance of children and adolescents with developmental and attentional issues, before and after participation in the Brain Balance® (BB) program. The program consisted of three 1-hour sessions/week (sensorimotor stimulation and academic activities) with other multimodal activities, for 3 months. Participants were compared to a control group that had the same underlying demographic and phenotypical features but did not yet complete the program (participated on average for 27 days). For all ages (4-6 and 7+ years), we found a significant main effect of group, such that BB groups improved overall more than controls (CTRLs). More specifically, BB groups improved on all cognitive tests (three tests for ages 4-6 years; 12 tests for ages 7+ years), whereas CTRLs only improved on one test. These data support the potential of multimodal training programs toward the overarching goal of improving cognitive performance in children with developmental and attentional difficulties.

Open Access Original Research Article

Immunohistochemical Expression of Nibrin in Epithelial Dysplasia and OSCC: A Cross-Sectional Study

Fizza Abidi, Mervyn Hosein, Saima Akram Butt, Faraz Baig, Rehan Ahmed, Abeeha Batool Zaidi

Journal of Advances in Medicine and Medical Research, Page 42-48
DOI: 10.9734/jammr/2021/v33i630859

Inherited defect in DNA repair capability is the fundamental problem causing mutations to be passed on to new generation of cells leading to cancer. The NBS1/Nibrin/p95 belongs to the family of the DNA double-strand break repair complex (hMre11 complex) which is a transcript of the mutated NBS gene, located on human chromosome 8q21 The protein complex containing nibrin binds to the edges of the DNA double-stranded break causing defective repair process. Nibrin also activates various signaling cascades such as; phosphatidylinositide 3-kinases PI3-kinase/Akt triggering the oncogenic process.

Aims: The purpose of this research was to aid in the diagnosis of oral cancer and dysplastic lesions in Karachi population.

Study Design: This cross-sectional study was conducted at a tertiary care hospital. All samples were recruited for the study after obtaining written informed consent from patients and seeking ethical approval from Ethic Review Committee Ziauddin University (Reference Code: 0330618FAOM), Karachi Pakistan.

Place and Duration of Study: Ziauddin hospital north Nazimabad Karachi, November 2018 to September 2019.

Methodology: Expression of Nibrin (NBS1) was evaluated by Immunohistochemistry on dysplasia and OSCC biopsies by H-Score method. The tumor was graded by broder system. Immunohistochemical analysis for nibrin was performed on the tumor block. Mean, frequency, percentages were calculated for quantitative variables, chi square was used for qualitative variables. A value <0.05 was considered as significant.

Results: 92% OSCC cases were positive for Nibrin while 80% of oral dysplasia revealed Nibrin expression. This accounts for significant statistical association of Nibrin with OSCC (0.012*) and dysplasia (0.001*). Unfortunately, apart from moderaterly histological differentiation (0.012) none of these clinicopathological parameters showed statistical significance.

Conclusion: We conclude that a Nibrin protein showed overexpression among 92% of OSCC patients out of total 100 cases and in 80% out of 30 cases of dysplasia so the association of histological grading with expression of Nibrin was significant and expression of Nibrin intensity with histological grading was significant as well. Our study suggests that this expression of Nibrin may be used as a diagnostic marker for potential OSCC patients.

Open Access Original Research Article

Magnetic Resonance Imaging with Diffusion and Perfusion in Assessment of Patients with Cerebral Infarction

Mervat Samy El-Mestekawy, Manal Fathy Hamisa, Ahmed Mohamed El-Shamy, Samah Ahmed Radwan

Journal of Advances in Medicine and Medical Research, Page 49-61
DOI: 10.9734/jammr/2021/v33i630860

Background: Diffusion-weighted MR imaging is most useful for detecting irreversibly infarcted tissue, perfusion-weighted imaging may be used to identify areas of reversible ischemia as well. This work highlights the role of MR imaging in acute ischemic infarction evaluation, with particular emphasis on the importance of diffusion and perfusion MR imaging for evaluating the penumbra.

Methods: This prospective study was conducted on 30 patients who were suspected to have a cerebral infarction. All patients underwent functional MRI.

Results: 25 patients (83.3%) were isointense in T1 and only 5 patients (16.6%) were low intense, in T2 there was 25 patients (83.3%) were high intense and only 5 patients (16.6%) were isointense .in FLAIR there was 24 patients (80%) were high intense and only 6 patients (20%) were isointense. In DW1 all the cases show high signal also in ADC all the cases show low signal. As regards to Ischemic area: the mean rCBV (relative cerebral blood volume) in the core was 0.33±0.30 cc while in the peripheral area was 1.24±1.35 cc. There was a highly significant difference between CT and MRI in diagnosis of acute stroke with P= 0.001.

Conclusion: Only depending on a single or a few parameters may not be sufficient, instead comprehensively combining the information from each MRI sequence (i.e., DWI, FLAIR and PWI) and using various mismatch parameters (DWI-FLAIR mismatch and/or PWI-DWI mismatch) may be more helpful in establishing an indication of MRI-based thrombolysis.

Open Access Original Research Article

The Underlying Causes of Recurrent Pneumonia in Children: A Two-Center Study

Amany Nagy Barakat, Mahitab Morsy Hussein, Eman Mahmoud Fouda, Amr Mohamed Zoair, Ahmed Mohamed Abd El-Razek

Journal of Advances in Medicine and Medical Research, Page 62-69
DOI: 10.9734/jammr/2021/v33i630861

Background: Recurrent pneumonia is a challenge for pediatric pulmonologists. There are limited data on the underlying causes of recurrent pneumonia in children in the developing countries.

Aim: To identify the underlying causes of recurrent pneumonia in children with undiagnosed etiology.

Patients and Methods: The study was conducted in Pulmonology Units, Pediatric Departments Tanta and Ain-Shams Universities Hospitals from 2017 to 2019. Fifty-six cases children with a diagnosis of recurrent pneumonia were included to identify the etiologies. The underlying causes were confirmed in each case according to the clinical features and the diagnostic tests.

Results: Uncontrolled bronchial asthma was the commonest cause of recurrent pneumonia (23.2%), followed by congenital heart diseases (12.5%) and aspiration syndromes (12.5%).

Conclusion: Uncontrolled bronchial asthma was the most common underlying cause of recurrent pneumonia in children, so early diagnosis and proper controller therapy may decrease the risk of occurrence of recurrent pneumonia.

Open Access Original Research Article

Study of Serum Uric Acid in Different Stages of Chronic Kidney Disease

Shahida Akhter, A. S. M. Rizwan

Journal of Advances in Medicine and Medical Research, Page 70-79
DOI: 10.9734/jammr/2021/v33i630862

Background: Hyperuricaemia is a metabolic marker of decreased renal function in chronic kidney disease (CKD). It increases cardiovascular, cerebrovascular and mortality risk in patients with CKD.

Objectives: To estimate serum uric acid level in different stages of CKD.

Methods: The present study was a cross sectional analytical study and was conducted in the Department of Physiology, Dhaka Medical College, Dhaka from July 2012 to June 2013 on 300 participants. They were divided into group A (150 control healthy participants) and group B (150 diagnosed cases of CKD). Serum creatinine and serum uric acid levels were measured by auto analyzer in Department of Pathology, Dhaka Medical College. Estimated glomerular filtration rate (eGFR) was calculated from serum creatinine level by Modification of Diet in Renal Disease (MDRD) equation. For statistical analysis unpaired Student “t” test, one way ANOVA test, Bonferroni test, Pearson’s correlation coefficient (r) test and Linear regression were performed using SPSS for windows version 20.

Result: In this study, serum uric acid level was significantly (p<0.05) higher and eGFR were significantly lower in study groups than that of control group. There was gradual rise of serum uric acid level in CKD subjects from stage I to V. A significant inverse correlation was observed between serum uric acid level and eGFR. Serum uric acid level increased 0.048 mg/dl for each ml/min/1.73m2 decrease of eGFR.

Conclusion: This study concludes that serum uric acid level increases gradually in accordance with the higher stages of CKD. There is a negative correlation of serum uric acid with eGFR in all stages of CKD which was statistically significant (p<0.05). Screening of serum uric acid level in different stages of CKD may be beneficial for assessing renal damage as well as prediction of co-morbidities associated with it.

Open Access Original Research Article

The Relationship between Procalcitonin with Morbidity, Mortality and Survival in Gastric Cancer

Mehmet Ali Çaparlar, Yasin Uçar, Şeref Dokcu, Ismail Hasirci, Mehmet Eşref Ulutaş, Ogün Erşen

Journal of Advances in Medicine and Medical Research, Page 80-91
DOI: 10.9734/jammr/2021/v33i630863

Introduction: In this study, it was aimed to examine the relationship between procalcitonin (PCT) values and complications, age, mortality, survival and to evaluate the correlation of procalcitonin, C-reactive protein (CRP), and white blood cell (WBC) values in patients operated for gastric cancer.

Methods: File records of 50 patients who were operated on for gastric cancer between 2015 and 2018 and whose procalcitonin levels were obtained were retrospectively reviewed.

Results: Eighteen (36%) of the study participants in the study were female, and 32 (64%) were male. Mortality rates were found to be significantly higher in those with PCT values of 2 and above on PO 1st and 3rd days. It was observed that the development of respiratory complications was significantly higher in patients with a PCT value of 2 and above on PO 5th and 7th days.

Conclusions: Post-operative high values in gastric cancer patients are significant in terms of mortality and survival in the follow-up. In gastric cancer and other malignant diseases, it is necessary to determine cut-off values, to conduct specificity and sensitivity studies by making detailed examinations for respiratory complications, mortality, and survival times during treatment.

Open Access Original Research Article

Magnetic Resonance Imaging Versus Serum Iron Status as Diagnostic Tools for Pituitary Iron Overload in Children with Beta Thalassemia

Lamia M. Morad, Mohamed R. EL-Shanshory, Nahed M. Hablas, Amal S. El-Bendary, Rasha A. El-Shafey, Adel A. Hagag

Journal of Advances in Medicine and Medical Research, Page 97-109
DOI: 10.9734/jammr/2021/v33i630866

Background: Thalassemia is a common genetic disorder associated with endocrine disorders. Iron deposition may start in the anterior pituitary gland, but clinical signs are usually not evident until puberty. Aim of the study was to evaluate pituitary iron overload in children with β thalassemia using MRI T2* and correlate MRI T2* and biochemical markers of iron overload with pituitary hormones.

Patients and Methods: This study was carried out on 30 children with β-thalassemia major (19 females and 11 males ) with their age ranging from 10 - 18 years and mean age value of 12.8 ± 2.4 and 30 healthy children of matched age and sex as controls in the period from September 2018 to September 2019. For all patients the following were done: complete clinical evaluation including anthropometric data and Tanner staging, laboratory investigations including serum iron status, thyroid function, basal and growth hormone provocation test by clonidine, Follicle stimulating hormone (FSH) , Luteinizing hormone (LH) , and pituitary MRI T2*.

Results: Weight, Z score of weight, height, Z score of height and Body mass index (BMI) were found significantly lower in patients compared with controls. Patients had delayed puberty compared with controls. Pituitary MRI T2* was found significantly lower in patients compared with controls (P=0.001). FSH, LH, and provocative growth hormone levels were found significantly lower in patients compared to controls (p <0.001). Serum ferritin & iron were found significantly higher in patients than controls (P<0.001). Significant negative correlations were found between serum ferritin and Weight, Height, Z score of Weight, Z score of Height, BMI and pituitary hormones. Significant negative correlations were found between Pituitary MRI T2* and serum ferritin. Significant positive correlations were found between Pituitary MRI T2* and Weight, Height, Z score of Weight, Z score of Height and pituitary hormons. The pituitary T2* carried the sensitivity of 80% ,100% and 100% and specificity of 70% ,83.3% and 100% for predicting GH hormone abnormality, LH and FSH respecetively.

Conclusions: There were a significant positive correlations between pituitary MRI T2*and anthropometric measurement and pituitary hormones of studied patients. There was a significant negative correlation between Pituitary T2* and serum ferritin. Pituitary iron overload can be detected by MRI T2* which is a diagnostic tool in detecting pituitary iron overload with subsequent effect on hormonal secretion especially growth hormone.

Recommendations: Children with thalassemia should undergo meticulous follow up regarding regular blood transfusion, regular iron chelators in a proper manner and doses and routine use of MRI T2* in the evaluation of pituitary iron overload before irreversible damage occur in the pituitary gland.