Open Access Case Report

Full Mouth Rehabilitation Using Alveolar Ridge Splitting Technique with Immediate Implant Placement in the Maxilla and Delayed Implant Placement in the Mandible: A Case Report with 4 Years Follow-Up

Houssam Abou Hamdan, Talal H. Salame, Georges Aoun

Journal of Advances in Medicine and Medical Research, Page 81-89
DOI: 10.9734/jammr/2021/v33i730877

The bone split technique is used to increase the width of a narrow ridge for implant placement with high success rates. This technique was performed on a 53-year-old patient with bilateral mandibular posterior edentulous and fully edentulous maxilla. Implants placement was performed afterward with two-step modus operandi on the mandible and immediate placement on maxilla. A successful prosthetic rehabilitation was done following the healing phase. This approach led to full restoration of function and esthetic with a predictable outcome.

Open Access Original Research Article

Insulin Resistance in Obese Children and Adolescents in Relation to Breastfeeding Duration

Mohammed Helmi Mahmoud Emara, Shaymaa Mohamed Elrifaey, Wessam Salah Mohamed, Ashraf Abd Elmonaem Elsharkawy, Adel Ali Erfan

Journal of Advances in Medicine and Medical Research, Page 12-19
DOI: 10.9734/jammr/2021/v33i730869

Background: Childhood obesity is unarguably a major public health challenge, which is associated with the incidence of many health problems like insulin resistance which is the main trigger of metabolic syndrome, that is characterized by many comorbidities like dyslipidemia, hypertension, diabetes, steatosis and many cardiovascular problems. Breast milk is an essential way for supplying the needed nutrients for infants’ growth and development. The aim of this work was to assess insulin resistance in obese children and adolescents and to detect its relation to duration of breastfeeding.

Methods: This case controlled study was started at June 2018 till July 2020 and carried out on 120 children who were divided into 2 equal groups: Group (1) obese children. Group (2) healthy controls -of matched age and sex- that weren’t obese.

Results: Weight, body mass index, waist circumference and blood pressure were significantly higher among obese children than healthy controls. There was no statistically significant difference between both groups regarding duration of breastfeeding. HOMA-IR was higher among obese children who received shorter duration of breastfeeding but without statistically significant difference. There was a significant positive correlation between HOMA-IR of obese children and both of fasting blood glucose and fasting serum insulin levels. While a significant                             negative correlation was observed between HOMA-IR and high density lipoproteins of obese children.

Conclusion: Obese children and adolescents had higher HOMA-IR indices than healthy controls which indicate their predisposition for having insulin resistance and metabolic syndrome. HOMA-IR can be used as a useful tool for evaluation of metabolic syndrome risk in obese children as evidenced by the strong correlation between it and other components of metabolic syndrome. No significant relation was found between insulin resistance and breastfeeding duration in obese children and adolescents.

Open Access Original Research Article

Diagnostic Performance of Hrp2 Based Diagnostic Test Kits and Frequency of Pfhrp2 Gene Deletion in Plasmodium falciparum Isolates of Osogbo, Southwestern Nigeria

A. S. Nassar, A. S. Bakarey, A. A. Abdulazeez, O. O. Fayemi

Journal of Advances in Medicine and Medical Research, Page 20-25
DOI: 10.9734/jammr/2021/v33i730870

Introduction: The introduction of P. falciparum encoded HRP-2 based malaria Rapid Diagnostic Test (RDT) kits is widely accepted in Nigeria and worldwide as a simplified form of diagnosis and a cheaper alternative to the microscopy technique (gold standard). However, deletion of Pfhrp2 gene contributes to false negative results and large number of such deletions has been reported in advanced countries thereby highlighting the importance of surveillance to detect such deletions in our local environment.

Methodology: Microscopy as well as RDT techniques (using Rapid malaria test kit: SD BIOLINE Malaria Ag P.f/Pv, South Korea) were carried out on the blood samples of three hundred and twenty-three (323) febrile subjects attending Ladoke Akintola University Teaching Hospital, Osogbo, Osun State Nigeria. PCR analysis was also conducted on 50 blood samples that were positive for microscopy but negative for RDT.

Results: The results from the study revealed that microscopy had a sensitivity of 99% and specificity of 99.2%. The RDT however had a sensitivity of 100% and a specificity of 60.1%. Fifty (50) samples that were positive for microscopy but negative for RDT were subjected to further PCR examination to detect the possible deletion of the Pfhrp-2 gene and the result revealed that the gene was present in 39 (78%) of the blood samples while remaining 11 (22%) samples lacked the gene which could possibly be the reason for the negative results obtained using the RDT kits.

Conclusion: This study provides evidence of low level of presence of Pfhrp-2 gene deletion of Plasmodium falciparum parasites in our healthcare facility setting in Osogbo, Nigeria.

Open Access Original Research Article

Etiological and Clinical Spectrum of Pancytopenia Based on Peripheral Blood Smear and Bone Marrow Examination: A Cross-sectional Study

Vipin Porwal, Rajesh Deshpande, Rohit Modi

Journal of Advances in Medicine and Medical Research, Page 26-32
DOI: 10.9734/jammr/2021/v33i730871

Aims: Pancytopenia is a common clinic-haematological problem suspected in patients with anaemia, prolonged fever, and a bleeding tendency.  This study was performed to find the prevalence of pancytopenia and to determine the common causes of pancytopenia.

Study Design:  Cross-sectional observational study.

Place and Duration of Study: department of general medicine at R. D. Gardi Medical College, Ujjain, India between November 2017 toAugust 2019.

Methodology: The study was conducted among patients with pancytopenia during a two-year period. The etiological pattern was assessed through routine blood tests to determine their clinical features, peripheral blood pictures, and bone marrow morphologies.

Results: Out of 100 patients with pancytopenia, the majority (64.0%) were men. A total of 34 patients were aged between the 21 and 30 years and 28 were aged between 31 and 40 years. Generalized weakness was the most common (88%) presentation and the most common clinical finding was pallor (94.0%), followed by splenomegaly (40.0%) and hepatomegaly (30.0%). Megaloblastic anaemia was the most common cause of pancytopenia that was observed in 58 patients, followed by aplastic anaemia (n=12), cirrhosis of the liver (n=8), leukaemia (n=6), dengue, myelodysplastic syndrome, and malaria (n=4 each), paroxysmal nocturnal haemoglobinuria and acquired immunodeficiency syndrome (n=2 each). A total of 28.0% patients had normocellular bone marrow and 72.0% had cellular marrow.

Conclusion: Megaloblastic anaemia was the most common aetiology of pancytopenia.

Open Access Original Research Article

Relationship of Non Alcoholic Fatty Liver Disease (NAFLD) and Serum Level of Thyroid Stimulating Hormone (TSH) in Normal Reference Range

Doaa Ameen Khalil, Yasser Mohammed Abdul Raouf, Amal Said Al-Bendary, Kamal Mohamed Okasha

Journal of Advances in Medicine and Medical Research, Page 33-39
DOI: 10.9734/jammr/2021/v33i730872

Background: Non-alcoholic fatty liver disease (NAFLD) can increase the incidence of cardiovascular disease and hepatocellular carcinoma. Thyroid hormones also play important roles in hepatic lipid metabolism and hepatic insulin resistance. Hypothyroidism is associated with reduced lipolysis and decreased liver uptake of free fatty acids derived from triglycerides. In recent years, the correlation between overt or subclinical hypothyroidism and NAFLD has been discussed. The relationship between NAFLD and thyroid function parameters remains unclear.

Aim: We aimed to evaluate the relationship between serum level of Thyroid Stimulating Hormone (TSH) within normal reference range and Non Alcoholic fatty liver Disease (NAFLD).

Subjects and Methods: This is a cross sectional case control study on 40 patients with NAFLD and a control group of 20 healthy individuals, who were attendants of Outpatient Clinic of Internal Medicine Department of Tanta University Hospitals and EL-Menshawy General Hospital from February 2018 to the end of January 2019.

Results: In the present study, univariate regression analysis showed that serum levels of AST, FT3, FT4 and Anti-TPO were independent risk factors of NAFLD, while in multivariate analysis the only independent risk factor of NAFLD was Anti-TPO serum level.

Conclusion: Serum levels of AST, FT3, FT4 and Anti-TPO were independent risk factors of NAFLD in univariate regression analysis, while in multivariate analysis the only independent risk factor of NAFLD was Anti-TPO serum level. Despite the positive correlation between serum TSH level and grade of NAFLD, the study didn’t show serum TSH level as independent risk factor of NAFLD.

Open Access Original Research Article

Reversible alteration of Nerve Conduction Velocity in Iron Deficient Anemic Patients in Response to Treatment

G. Sharma, S. Gupta, S. K. Atri, P. Sharma

Journal of Advances in Medicine and Medical Research, Page 40-44
DOI: 10.9734/jammr/2021/v33i730873

Aim: Evaluation of nerve conduction in adult patients of iron deficiency anemia and to study the response to treatment.

Study Design: Prospective randomized control study

Place and Duration of Study: Department of Medicine and Department of Physiology, PGIMS Rohtak

Introduction: Iron deficiency anemia is associated with central and peripheral nervous system disturbances. Iron is an essential component of brain growth, myelination, nerve impulse conduction, protein synthesis, hormone production, fundamental aspects of cellular energy metabolism and is involved in neurotransmitter synthesis including serotonin, norepinephrine and dopamine. Hence, its deficiency adversely affects motor performance, mental development as well as cognitive and behavioral functions. Since myelination is concerned with conduction in nerve fibers, iron deficiency potentially impairs neuronal transmission and leads to functional neurodeficit like dysfunction in the peripheral nervous system such as paresthetic complaints.

Method: Nerve conduction was recorded using RMS EMG EP MK2 machine in 30 newly diagnosed patients of iron deficiency anemia with haemoglobin less than 10.9-4 g/dl between 18-50 years of age who were followed up after 3 months of treatment and compared with 30 age and sex matched controls.

Results: An increase in distal latencies and a decrease in amplitude and nerve conduction velocities of motor and sensory component of all the nerves was seen in IDA patients as compared to the control groups which was reversible with iron replacement therapy.

Conclusion: Altered values of nerve conduction parameters indicates peripheral neuropathy in IDA individuals with or without polyneuropathy. Thus, nerve conduction study provides an objective method for monitoring the function of PNS, especially the clinically silent peripheral nerve compromise in patients of iron deficiency anemia before and after iron replacement therapy.  Thus NCS is a non-invasive test for early diagnosis and therefore early treatment to prevent complications.

Open Access Original Research Article

Pattern of Lower Limb Doppler Ultrasonography Requests and Findings in a Tertiary Institution in Makurdi; North-Central Nigeria

Chia Daniel Msuega, Annongu Isaac Terkimbi, Hameed Mohammed, Kator Paul Iorpagher, Abdullahi Aliyu

Journal of Advances in Medicine and Medical Research, Page 45-57
DOI: 10.9734/jammr/2021/v33i730874

Background: Doppler ultrasound scan (DUS) is a valuable, cost effective, and relatively rapid diagnostic technique that provides a non-invasive assessment of the vascular circulation in the lower limb.

Aims: To determine the pattern of lower limbs Doppler requests in our environment and to evaluate the Doppler findings.

Study Design: Retrospective study

Place and Duration of Study: Radiology department of Benue state university Teaching Hospital over a one-year period from January 2018 to December 2018.

Methods: We included 200 patients that had lower limb Doppler ultrasound for various indications. Data on age, gender, indications and findings was retrieved from departmental cards and case notes, then collated and analyzed using SPSS software version 23, with the P value taken as =.005.

Results: Two hundred patients were scanned;106 males and 94 females with age range of 10-109 years. Their mean age was 34.2 ±13.5 years. Most patients 48(24.0%), who presented for Doppler sonography of the lower limb had diabetic foot ulcer (DFU), followed by left leg swelling in 42(21.0%) patients. DVT alone was indicated in 33(16.5%) patients. Both DFU and DVT were more in the male patients with a M:F ratio of 26:22 and 21:12 respectively. The indications for lower limb doppler ultrasound scan are seen to generally increase with increasing age, with the least among those less than 40years 32(16.0%) and highest among the greater than 60years age groups 89(44.5%). At doppler ultrasound, there are more patients with Deep vein thrombosis (DVT) 104(52.0%). Normal study and peripheral vascular disease (PVD) have equal incidence respectively in 48(24%) of the patients. DVT and PVD were more in the male group with a M: F ratio of 55:49 and 27:21 respectively while normal studies were seen equally in both sexes (M: F=24:24).

Conclusion: Doppler ultrasound has been shown to be a cost-effective and valuable non-invasive tool for the diagnosis of lower limb vascular diseases.

Open Access Original Research Article

The Analgesic Efficacy of Ultrasound-Guided Quadratus Lumborum Block Versus Ultrasound-Guided Caudal Block for Hip Surgery in Pediatrics: A Prospective Randomized Study

Islam M. Salim, Shimaa M. EL. Rahwan, Mohamed M. Abu Elyazd, Lobna M. Abo Elnasr

Journal of Advances in Medicine and Medical Research, Page 58-68
DOI: 10.9734/jammr/2021/v33i730875

Background: Ultrasound-guided quadratus lumborum (QL) block, is local anesthetic technique providing perioperative somatic, perhaps even visceral, analgesia for patients of all ages. The aim of this study is to evaluate the analgesic efficacy of ultrasound-guided anterior QL block versus ultrasound-guided caudal block in pediatric patients undergoing hip surgery.

Patients and Methods: This prospective, randomized study was carried out on seventy patients aged 1-7 years, of both with ASA physical status I or II scheduled for elective surgical correction of developmental dysplasia of hip (DDH).

Anterior QL Block Group: Patients received ipsilateral ultrasound-guided anterior QL block after induction of general anesthesia using of bupivacaine 0.25% (0.5 mL/kg).

Caudal Block Group: Patients received ultrasound-guided caudal block after induction of general anesthesia using of bupivacaine 0.25% (0.75 mL/kg). Postoperative pain scores were assessed on admission to PACU and at 1, 2, 4, 6, 8, 12, 18 and 24 h postoperative. Total intraoperative fentanyl (µg) consumption, total postoperative rescue analgesic (morphine) consumption, time to the first rescue analgesic administration and Parent satisfaction were assessed. Heart rate and mean arterial blood pressure had been recorded pre–operative, every 15 min intra-operative , and postoperative on admission to PACU and at 1, 2, 4, 6, 8, 12, 18 and 24 h postoperative. Any undesirable side effects during the first 24 hours such as, bradycardia, hypotension, local hematoma at the side of injection, nausea and vomiting had been recorded.

Results: The median FLACC score was significantly lower in anterior QL block group than caudal block group at 4,6,8 and 12h postoperative (P<0.001). Total intraoperative fentanyl (µg) consumption was insignificant different between both groups (P=0.862). Post-operative morphine consumption was significantly lower in anterior QL group compared to caudal group (P<0.001). Time to first postoperative analgesic requirement was significantly prolonged in anterior QL block group compared to caudal block group (P < 0.001). The incidence of nausea and vomiting was insignificantly different between both groups (P > 0.999).

Conclusions: Ultrasound-guided anterior QL block provided effective and long lasting postoperative analgesia than ultrasound-guided caudal block with lesser postoperative analgesic consumption in pediatric patients undergoing surgical correction of DDH.

Open Access Original Research Article

The Role of Transferrin and Laminin Biomarkers in the Diagnosis of Diabetic Nephropathy in Type II Diabetic Patients

Mohy Eldin Abd EL-Fattah, Laila Ahmed Rashed, Suzan Magdy Mohammed Nasr

Journal of Advances in Medicine and Medical Research, Page 69-80
DOI: 10.9734/jammr/2021/v33i730876

Background/Aim: Diabetic nephropathy is one of the most important microvascular complications associated with type II diabetic patients. It occurs in 20-40% patients with diabetes mellitus, and microalbuminuria is still considered as the first sign of diabetic nephropathy. Low sensitivity and specificity of microalbuminuria leads to more sensitive biomarkers that may be used to detect diabetic nephropathy at an earlier stage with higher accuracy. This study was carried out to detect the validity of using serum Transferrin and Laminin as a diagnostic biomarkers for diabetic nephropathy in type ΙΙ diabetic patients.

Methods: Egyptian patients (n=96) included 72 type 2 diabetic patients who were classified into three groups: group 1 - normoalbuminuric patients (uACR up to 30 mg/g), group 2 - microalbuminuric patients (uACR from 30 – 300 mg/g), group 3 - macroalbuminuric patients (uACR from >300 mg/g) and 24 healthy control were surveyed in a cross-sectional study over a period of 6 months at biochemistry department, KASR ALAINY Hospital of Cairo University. Patients were subjected to measurement of Albumin creatinine ratio, eGFR, Serum creatinine, glycosylated hemoglobin (HbA1c) and lipid profile. The serum concentrations of transferrin and lamnin were measured using a highly sensitive one-step sandwich enzyme immunoassay kit.

Results: Serum laminin was significantly higher in macroalbuminuric patients than in the microalbuminuric and in microalbuminuric patients than in the normoalbuminuric and healthy control subject. By comparing these goups according to serum laminin concentration we found statistically significant positive correlation (p value <0.001, r= 0.670), serum transferrin was significantly lower in macroalbuminuric patients than in the microalbuminuric and in microalbuminuric patients than in the normoalbuminuric and healthy control subject. By comparing these goups according to serum transferrin concentration we found statistically significant inverse correlation (p value <0.001, r= -0.579). There was no correlation between level of serum transferrin /laminin and glycoregulation, and statistically significant positive correlation was found between serum laminin and duration of diabetes and statistically significant inverse correlation was found between serum transferrin and duration of diabetes.

Conclusions: The results from this study provide the evidence that serum laminin and transferrin could be used as a diagnostic markers of diabetic nephropathy.

Open Access Original Research Article

Hemodynamic Changes During Spinal Anesthesia with Different Bupivacaine Concentrations in Elderly Cardiac Patients Undergoing Transurethral Resection of Prostate

Omar Mohamed Fathy Elkady, Naglaa Khalil Mohamed, Ahmed Esam-Eldein Salim, Ahmed Ali Eldaba

Journal of Advances in Medicine and Medical Research, Page 99-108
DOI: 10.9734/jammr/2021/v33i730878

Background: Spinal anesthesia produces hypotension more often in elderly patients than in younger patients due to decrease systemic vascular resistance mainly. Limiting the dose (and thus, extent of anesthetic spread) to the necessary dermatomes reduces the likelihood of side effects. The aim of the study was to compare hemodynamic effects of spinal anesthesia by using different bupivacaine concentrations in elderly cardiac patients undergoing TURP.

Methods: This prospective randomized controlled double-blinded study was carried out on 60 male patients aged 65 years and above, American Society of Anesthesiologists (ASA) III, with IHD (history of MI, a history of a positive treadmill test result (ECG stress test), use of nitroglycerin, chronic stable angina for more than two months, or an ECG with abnormal Q waves), with ejection fraction (EF) 35%-50%, undergoing TURP with prostate from 100-150 gm by using bipolar resection technique and normal saline wash during surgical procedure. Patients were randomly allocated into two equal groups: Group I (Control group): received 2.5 ml bupivacaine 0.5% + 0.5 ml fentanyl (25 mcg). Group II: received 1.75ml bupivacaine 0.5% + 0.75 ml distilled water + 0.5 ml fentanyl (25 mcg).

Results: Mean arterial blood pressure was significantly decreased in group I than group II at 6, 9, 12, 15 and 30 minutes. Heart rate and peripheral oxygen saturation were insignificantly different between both groups. Ischemia occurred in 3 (10%) patients in group I and no patients in group II & the difference between both groups was insignificant. Hypotension was found significantly higher in group I than group II (P = 0.021) while PONV, bradycardia, headache, backache and shivering were insignificantly different between both groups. TURP syndrome didn’t occur in any case of our study.

Conclusions: Hyperbaric bupivacaine 8.75 mg injected at L4-L5 is sufficient to provide adequate sensory and motor block, while maintaining hemodynamic stability during TURP procedures.

Open Access Original Research Article

Serum Vitamine D3 Level in Women with Gestational Diabetes Mellitus

Riham M. Enab, Amal A. El Sokary, Heba A. Mourad, Amal E. Mahfouz

Journal of Advances in Medicine and Medical Research, Page 90-98
DOI: 10.9734/jammr/2021/v33i730880

Background: Vitamin D3 is synthesized in skin and sequentially metabolized in liver and kidney in humans. It is well known for its function in maintaining calcium and phosphorus homeostasis and promoting bone mineralization. The primary objective of this study was to evaluate vitamin D3 level in pregnant women who were suffering from gestational diabetes mellitus and comparing it with the control groups.

Materials and Methods: This case control study was conducted on 100 pregnant women who were attending the inpatient and outpatient clinics of Obstetrics department, Tanta University Hospital, who were divided into two equal groups.Group A (control group): Fifty apparently healthy pregnant women at 24th-28th weeks of gestation. Group B (study group): Fifty pregnant women had gestational diabetes.

Results: There is significant increase between the two studied groups according to HbA1c, also there is decrease between the two groups as regards VIT D. Mean HbA1c % was statistically significant higher in the study group versus control group. There was statistical significant difference noted between mean serum level of vitamin D among the two studied groups. A statistically significant negative correlation was observed between serum 25 OH vitamin D and HbA1c among our cases (r=- 0.745) (p ≤ 0.001). Mean serum vitamin D was significantly lower in cases with complications than those with normal outcome.

Conclusion: Vitamin D deficiency may have a positive relationship with gestational diabetes mellitus.

Open Access Review Article

Early Human Iron Equilibrium: A Review

Prameela Kannan Kutty

Journal of Advances in Medicine and Medical Research, Page 1-11
DOI: 10.9734/jammr/2021/v33i730868

The biological equilibrium of iron, a potent, multifunctional micronutrient is a decisive factor in the holistic health of the mother and child. Iron dysequilibrium impairs organ function, effects growth and development and predisposes to a spectrum of disease states. This article revisits the homeostasis of body iron in early life as a sequential continuum from prenatal to early post- natal life ,then reviews, compares and attempts to integrate intra and early extra uterine events related to iron metabolism. The “adaptive evolutionary” mechanisms involved in iron homeostasis in early life such as the transfer of iron from the mother to the feto-placenta unit and from the lactating mammary glands into breastmilk are revisited as both organs support life during dynamic developmental stages of growth and differentiation. The checks and balances of iron metabolism in pregnancy also endow some iron to the feto-placental unit, by actively transporting iron from the mother to the developing fetus. In early postnatal life the mechanisms involved in iron absorption are not yet fully mature, and other sources of iron such as transplacentally transferred iron and the iron stored from hemolysis of the rapidly decreasing red blood cell (RBC) mass contribute to early iron equilibrium. Additionally, although breastmilk is low in iron, the concept of active iron bioavailability in the breastfed infant provides utilizable iron. The lactating mammary glands may adopt unique features of iron metabolism adapted to the individual infant with the iron content in breastmilk largely, but not entirely, independent of maternal iron status. Early physiological iron equilibrium reflects essential homeostatic complexity, highlighting that exogenous iron, when required, must also be weighed for its benefits against its risks, as evident in the cautious homeostasis in our biological systems.