Open Access Case Study

Gastro-intestinal Stromal Tumor Complicated by an Acute Intestinal Occlusion: A Case Report

A. Elbakouri, A. Zouhair, F. Z. Bensardi, M. Bouali, K. Elhattabi, A. Fadil

Journal of Advances in Medicine and Medical Research, Page 12-17
DOI: 10.9734/jammr/2021/v33i1130919

Gastrointestinal stromal tumours (GISTs) are rares connective tumors, usually located in the stomach or small intestine. Derived from Cajal cells or one of their precursors.

Gastrointestinal stromal tumors (GISTs) represent 1% to 2% of all neoplasms of the digestive tract, The average age is between 50 and 60 years old, most often occurring in the stomach, Their clinical symptomatology is variable according to the region affected or the size of the lesion, they are responsibles for digestive bleeding, pain, or abdominal mass, as well as an alteration in the general state of health. More rarely, the diagnosis is made on the occasion of an intestinal occlusion. the  GIST complicated by occlusion due either to invagination of the tumour mass or to exophytic development of the tumour. In CT scans, they are manifested by a localised parietal tumour thickening of variable size with most often an exophytic development. Molecular biology plays an important role in this disease.

The main treatment is radical surgery .The Imatinib has radically changed the prognosis of patients with unresectable and/or metastatic GIST.

We report the case of a patient with a stromal tumour complicated by occlusion operated in emergency in the department of visceral surgical emergencies of Ibn Rochd UHC.

Open Access Case Study

An Aggressive Calcifying Epithelial Odontogenic Tumor: A Rare Case Report

Sheetal Singar, Ajay Pratap Singh Parihar, Prashanthi Reddy, Ashish Saxena, Arvind Jain

Journal of Advances in Medicine and Medical Research, Page 24-30
DOI: 10.9734/jammr/2021/v33i1130921

Calcifying epithelial odontogenic tumor is an epithelial origin locally aggressive benign odontogenic tumor. It is an extremely rare neoplasm comprise of <1 % of all odontogenic tumors. It manifests clinically as asymptomatic, slow-growing, and locally aggressive lesion which causes expansion of the affected bone. About 400 cases of CEOT (calcifying epithelial odontogenic tumor) are reported in the literature. This article reported a case 18 years old female with a locally aggressive calcifying epithelial odontogenic tumor involving the mandible, without much disfigurement of the face.

Aim: The aim of this article to put a drop of water in the ocean of literature. Report a case with aggressive nature.

Open Access Case Study

Evaluation of the Split-crest Technique with Simultaneous Implant Placement in Atrophic Edentulous Maxillary and Mandibular Bone: A 5-Year Follow-up Study

Houssam Abou Hamdan, Georges Aoun, Jean Nassar, Talal H. Salame

Journal of Advances in Medicine and Medical Research, Page 31-37
DOI: 10.9734/jammr/2021/v33i1130922

Aim: To evaluate the behavior of the alveolar ridge split technique in a series of surgical cases.

Materials and Methods:  One hundred and fifty implants were included in this study for a total of 60 patients. The surgeries consisted of a mid-crestal incision and subsequent bone management with a piezoelectric system. The implants were placed after the alveolar bone was expanded by about 3mm and present bony defects were filled by a mixture of 50% autogenous bone and a xenograft (Bio-Oss®). Bone fracture of the buccal alveolar plate occurred in 8 cases, and those were stabilized with osteosynthesis screws. Implants were simultaneously placed in 140 cases, out of them 4 failures occurred due to membrane exposition.

Results: The osseointegration success was estimated to be 97.5%.

Conclusion: This study concluded that the bone splitting/expansion seem to be a reliable, predictable, relatively noninvasive technique with limited intraoperative complications.

Clinical significance: The study revealed that the alveolar ridge split can be used as an effective technique for atrophic edentulous maxillary and mandibular bone

Open Access Original Research Article

Study of Serum Milk Fat Globule-epidermal Growth Factor 8 (MFG-E8) in Patients with Type 2 Diabetes Mellitus

Yasmen Sabry Madkour, Mona Mohamed Watany, Azza Abbas Ghali, Ekhlas Hussein ElSheikh

Journal of Advances in Medicine and Medical Research, Page 1-11
DOI: 10.9734/jammr/2021/v33i1130918

Background: Milk Fat Globule-Epidermal Growth Factor 8 (MFG-E8) has been shown to be involved in various biological functions including the phagocytic clearance of apoptotic cells, neovascularization and epithelial restitution. Recently, emerging studies have reported that MFG-E8 plays a role in inflammatory responses and inflammatory/autoimmune diseases. The aim of the present study was to investigate the role of serum MFG-E8 in early diagnosis of microvascular complications in type 2 diabetic (T2D) patients.

Methods: The study included 80 patients with T2D; they were divided in to 4 groups depending on the value of clinical and laboratory parameters. Group A: included 20 patients free of any vascular complications. Group B: included 20 patients with subclinical atherosclerosis. Group C: included 20 patients with early microvascular complications without subclinical atherosclerosis. Group D: included 20 patients with both subclinical atherosclerosis and early microvascular complications. Serum (MFG-E8) was measured by ELISA technique.

Results: There was a significant decrease in the mean value of serum MFG-E8 concentrations in groups C (T2D with early microvascular complications) and D (T2D with both early microvascular complications and subclinical atherosclerosis) when compared to those in groups A (T2D without any vascular complications) and B (T2D with subclinical atherosclerosis only). It negatively correlated with age, fasting and postprandial glucose level, HbA1C, urinary albumin excretion rate, hs-CRP and positively correlated with HDL-C while didn't correlate with body mass index, triglycerides, cholesterol, LDL-C or carotid intima media thickness.

Conclusions: Serum MFG-E8 may be used as an early diagnostic marker of microvascular complications in T2D. MFG-E8 seemed not to be a sensitive biomarker for early diagnosis of subclinical atherosclerosis in T2DM.

Open Access Original Research Article

Development and Validation of Class I Preparation and Restoration Quality Assessment Methods

Danielle Wajngarten, Júlia Margato Pazos, Tamíris da Costa Neves, Patricia Petromilli Nordi Sasso Garcia

Journal of Advances in Medicine and Medical Research, Page 18-23
DOI: 10.9734/jammr/2021/v33i1130920

This study sought to develop and validate two methods of quality assessment, one for Class I cavity preparation and another for composite resin restoration. This was an experimental laboratory study. The methods are named Class I Cavity Preparation Assessment – COCA and Class I Cavity Restoration Assessment – COCRA. During the development of the methods, 5 items were elaborated for COCA and 10 items for COCRA. Each item should be classified as appropriate, partially appropriate, or inappropriate. For each method, after evaluation, all item values should be added with a maximum possible score of ten points. The reliability of the COCA and COCRA was estimated through intra-observer reproducibility. For the methods application, 80 Class I cavity preparation and restoration in first molars were evaluated. A descriptive statistical analysis was performed, and the intra-observer concordance was estimated using the intraclass correlation coefficient (ρ). As a result, it was possible to observe that the reproducibility for COCA of evaluator 1 (ρ=0.76) and evaluator 2 (ρ=1.00) was classified as good and excellent, respectively. The reproducibility for COCRA of evaluator 1 (ρ=0.99) and evaluator 2 (ρ=0.77) was classified as excellent and good, respectively. It was concluded that COCA and COCRA were valid and reliable for the assessment of quality of Class I cavity preparation and restoration.

Open Access Original Research Article

Cranioplasty: Surgical Research

Moustafa Ahmed Aboushehata, Essam Ahmed Abd-Elhameed, Ehab Ezzat El-Gamal, Ali Ibrahem Saif Eldeen

Journal of Advances in Medicine and Medical Research, Page 38-52
DOI: 10.9734/jammr/2021/v33i1130923

Background: Cranioplasty involves the repair of a cranial defect or deformation for cosmetic reasons, as well as long-term protection of the brain from the external environment. This work aims to evaluate and compare the efficacy, advantages and limitations of different materials used in cranioplasty. 

Methods: Prospective study of twenty-five patients who underwent cranioplasty for a skull bone defect by using different materials from March 2018 to March 2020. 

Results: The study included 13 males and 12 females. The defect was post-traumatic in 11 patient neoplastic in 13 patients and 1 patient was after decompressive craniectomy for malignant ischemia .When the defect was less than 80 cm² bone cement was used in 54.5%. When the defect was ≥ 80 cm² titanium mesh was used in 71.4 % of those cases. 72.0% of the patients (18 of 25) reported excellent cosmetic results, 24% (6 of 25) good, 4.0% (1 of 25) poor results. 

Conclusion: When the original bone flap is not available for cranioplasty titanium mesh is suitable for the large calverial bone defects.  it is strong but hard to shape while bone cement is more suitable for small defects near the skull base as it is easy to shape but weak. Medpore and hydroxyapetite powder are better for pediatric defects as they don't hinder bone growth. Prefabricated bone flaps are effective but expensive and can't be used if cranioplasty is planned in the same operation.

Open Access Original Research Article

Assessment of Some Haemostatic Parameters in Sickle Cell Anaemia Subjects Resident in Rivers and Bayelsa States

Barinaaziga S. Mbeera, Susanna O. Akwuebu, A. C. U. Ezimah, Nancy C. Ibeh, Evelyn M. Eze

Journal of Advances in Medicine and Medical Research, Page 53-64
DOI: 10.9734/jammr/2021/v33i1130925

Aim: The aim of this study was to assess some haemostatic parameters in sickle cell anaemia subjects in Rivers and Bayelsa States.

Study Design: This study is a cross-sectional observational study.

Place and Duration of Study: This study was carried out at the University of Port Harcourt Teaching Hospital, Rivers State, and the Federal Medical Centre, Yenagoa, Bayelsa State, between the months of February and August, 2020. 

Methodology: A total of four hundred and fifty (450) subjects with age range of 1-50 years were randomly selected. There were about 200 registered patients (adults and children alike) at the sickle cell clinics of the University of Port Harcourt Teaching Hospital, and the Federal Medical Centre, Yenagoa, with an average of 4 new patients per month. The sample size was obtained using a prevalence of sickle cell anaemia of 2% and the sample size was calculated using Cochran sample size formula. Five milliliters (5ml) of venous blood sample was withdrawn from the peripheral vein in the upper limb of subjects using a standard venipuncture technique. The sample was rocked gently to mix and kept at room temperature and the haemostatic parameters (vWF, FVIII, D-dimer, L-arginine, fibrinogen, ADAMTS13) were assayed quantitatively with Bioassay Technozym kit using Microplate Reader (Labtech microplate auto ELISA plate reader, an IS0 13485:2003 CE and WHO compliance Co., Ltd. Shanghai International Holding Corp. GmbH; Europe) calibrated to a wavelength of 450 nm with strict adherence to the manufacturer's instructions, while PT and APTT were analysed with Fortress reagent and Uniscope SM801A Laboratory using water bath.Data management and statistical analyses were conducted using Statistical Analyses System SAS 9.4 (SAS Institute, Cary, North Carolina, USA) and p values less than .05were considered statistically significant.

Results: The results showed the mean comparison of haemostatic parameters in sickle cell anaemia and control subjects. The comparison of haemostatic parameters showed significant(p<.05) increasesand decreases inVaso-Occlusive Crisis (VOC) and steady state respectively compared with the control group. There was statistically significantreduction in the mean comparison of L-Arginine (p<.01) in VOC) condition than steady state in relation to the control group in our study population, while D-Dimer, ADAMTS13 were also significantly reduced statistically (p<.01) in VOC condition than steady state compared with the control group. However, the mean FVIII inhibitor, Fibrinogen, PT (INR) and APTT were significantly higher (p<.01) in VOC than steady state when compared to controls with normal haemoglobin (HbAA).Correlations of haemostaticparameters by sickle cell anaemia subjects’ condition showed more significant positive correlations in VOC than steady state.

Conclusion: This study showed a heightened hypercoagulability in Sickle Cell Snaemia(SCA)subjects, and further pave way for better understanding particularly the diagnostic variables underlying SCA, specific to each subject condition (steady state and VOC). Subjects with SCA, particularly during VOC, undergo significant haemostatic alterations that increase their risk of developing coagulation activation-related complications. Thus, though selected markers of coagulation were significantly different between the subject conditions, they were often significantly higher in the SCA.

Open Access Original Research Article

The State of the Structure of the Brain Cortex at Different Times of the Postmortal Period after Massive Blood Loss and Blood Loss Complicated by Hemorrhagic Shock

Jumanov Ziyadulla Eshmamatovich, Indiaminov Sayit Indiaminovich

Journal of Advances in Medicine and Medical Research, Page 65-71
DOI: 10.9734/jammr/2021/v33i1130926

Determine the time of death based on these characteristics.

Aims: The aim of the study was to identify the features of changes in the structure of the cerebral cortex in different periods of the post - mortem period after massive blood loss and blood loss complicated by hemorrhagic shock, and to determine the age of death based on these data.

Study Design: Cross-sectional study.

Place and Duration of Study: Department of Medicine and Department of Forensic Medicine 2020 between.

Methodology: The structures of the cortex from the Brodman sixth field of the large hemispheres of the brain were studied from 73 corpses of individuals who died from massive blood loss (MB) - 61 and blood loss complicated by hemorrhagic shock -12. The study of corpses with MB (group 1) was carried out in the period: 6-8 h (26), 8-10 h (6), 10-12 h (4), 12-14 h (6), 14-16 h ( 12), 16-24 h (5), 24-28 h (2) postmortem period. Research of corpses after hemorrhagic shock (group 2) were carried out after 6-8 hours (3), 12-14 (3), 18-20 (2), 24-28 (4). Histological preparations of the brain were first examined qualitatively, then quantitatively. Quantitative study of structures was carried out by the point method according To G. G. Avtandilov, the digital material was statistically processed by the Student – Fisher method.

Results: Thus, at death from massive blood loss, as the post-mortem period increases, there is an increase in structural changes in cortical neurons,as well as an expansion of  pericellular space. The vascular component of the cerebral cortex is also involved in destructive processes associated with an increase in the postmortem period, and an increase in perivascular spaces is observed.

Conclusion: Comparative analysis of the data obtained showed that in the postmortem period after hemorrhagic shock (group 2), destructive changes in the cerebral cortex appear earlier and are more pronounced than in the case of death from massive blood loss (group 1). Similar expansion of perineuronal and perivascular spaces in the cerebral cortex reflects the persistence of thanatogenesis manifestations in different periods of the post-mortal period after death from massive blood loss and hemorrhagic shock.

Open Access Original Research Article

Cytokine Profile in Juvenile Systemic Lupus Erythematosus

A. Elfar, Amal El-Bendary, M. A. Abdel-Hafez, N. Abo El Hana

Journal of Advances in Medicine and Medical Research, Page 72-78
DOI: 10.9734/jammr/2021/v33i1130927

Background: Cytokines have an important role in immune system dysregulation in SLE because they act on the differentiation, maturation, and activation of several effector cells, culminating in inflammation and subsequent tissue damage.The aim of the work was to evaluate cytokine profile (IL2, IL10 and IL13) in children with SLE and their possible role in the pathogenesis of lupus nephritis.

Methods: This is a cross sectional case-control study conducted on 60 children with SLE and 30 healthy children of matched age and sex served as a control group. The presence of lupus nephritis was confirmed by renal biopsy and histopathological examination. The SLE Disease Activity Index (SLEDAI) score for each patient was used to evaluate disease activity. Serum IL2, IL-10 & IL-13levels were measured using ELISA.

Results: There was a significant increase in serum IL-10 levels in SLE patients compared to healthy controls and in patients with lupus nephritis compared to patients without lupus nephritis. Also, there were significant positive correlation between IL-10 and SLEDAI Score and between IL-10 and 24-hour urinary protein collection. There was no statistically significant difference in IL-2 levels in SLE patients compared to healthy controls. However, IL2 levels were significantly lower in active patients without lupus nephritis compared to active patients with lupus nephritis. There was no correlation between IL-2 and 24-hour urinary protein collection. The levels of IL13 were significantly higher in SLE patients compared to healthy controls and in patients with lupus nephritis compared to patients without lupus nephritis. There were significant positive correlations between Il 13 and SLEDAI Score and between IL-13and 24-hour urinary protein collection.

Conclusions: Soluble IL10 and IL-13 could be used as a measure of disease activity. Further studies are needed to evaluate SLE pathophysiology including measurement of cytokine profile.

Open Access Original Research Article

Ultrasound Guided Erector Spinae Plane Block Versus Transverses Abdominis Plane Block for Post-Operative Analgesia in Pediatric Patients Undergoing Laparoscopic Inguinal Hernia Repair: A Randomized Controlled Trial

Nashwa Atef Badawy, Mona Blough El Mourad, Ahmed Said AL gebaly, Yasser Mohamed Amr

Journal of Advances in Medicine and Medical Research, Page 79-90
DOI: 10.9734/jammr/2021/v33i1130928

Background: Inguinal hernia repair is one of the most common surgical procedures in the pediatric age group and it is associated with significant post-operative discomfort. The aim of this study is to compare the safety, reliability, and efficacy of ultrasound-guided transverses abdominis plane (TAP) block versus erector spinae plane (ESP) block for postoperative pain control in pediatrics undergoing laparoscopic inguinal hernia repair.

Methods: This prospective randomized study was carried out on 90 pediatric patients of both sexes aged (2 -7) years with ASA physical status I/II scheduled for elective laparoscopic inguinal hernia repair. Patients were divided into 3 equal groups. Group C received general anesthesia alone. group T received bilateral ultrasound-guided TAP block after induction of general anesthesia with the injection of 0.4 ml/kg bupivacaine 0.25%. group E received bilateral ultrasound-guided ESP block after induction of general anesthesia with the injection of 0.4 ml/kg bupivacaine 0.25%.

Results: According to CHEOPS, we found no statistically significant difference between ESP and TAP groups but significant increase in the control group. also, There was a significant decrease in total rescue analgesia (intra-operative & postoperative ) in the T group and E as compared to group C. Also there was a significant delay in onset of first rescue analgesia post operatively between group T&E in comparison to group C. The mean value of heart rate between the 3 groups showed no statistically significant difference between TAP and ESP groups intra-operatively but significant increase in heart rate in the control group in all stages of the operation as compared to T& E groups. Mean arterial blood pressure changes were insignificant between three groups in all stages of operation.

Conclusions: TAP block and ESP block are effective and safe techniques for postoperative pain control in pediatric patients undergoing laparoscopic inguinal hernia repair with more hemodynamic stability, less intra and postoperative analgesia requirement.

Open Access Original Research Article

Diffusion Magnetic Resonance Imaging in Differentiation of Ovarian Cystic Lesions

Hala Abd El-Hamid Mohamed Moharam Shaban, Samah Ahmed Ibrahim Radwan, Moustafa Zein ElAabden Moustafa, Naglaa Mohamed Lotfy Dabees

Journal of Advances in Medicine and Medical Research, Page 91-101
DOI: 10.9734/jammr/2021/v33i1130929

Background: MRI can specifically diagnose some certain pathologic types by providing accurate information on fat, collagen and hemorrhage. Diffusion-weighted magnetic resonance imaging, an emerging non-invasive MRI technique, is of the capability to evaluate the extent of microscopic diffusion which might exist in biologic tissues. Evidence has shown that DWI-MRI and ADC were beneficial in differentiating malignant from benign ovarian lesions and may be helpful to predict suboptimal cytoreduction in ovarian cancer. The aim of this study to assess the role of magnetic resonance imaging with diffusion weighted images in the assessment and differentiation of ovarian cystic lesions.

Methods: This prospective study was conducted on 30 female patients who are proved by ultrasound to have ovarian cystic lesions.  Selected patients were given butylscopolamine bromide (20mg) administered IV or intramuscularly at the beginning of the examination. Imaging is performed with the patient in the supine position with an empty urinary bladder. A distended urinary bladder is not recommended because it increases phase ghost artifacts and can compress the uterus.

Results: As regards diagnosis according to Ultrasound examination, revealed that ovarian cancer and simple cyst were the most frequent (26.7% and 20% respectively), followed by Tubo-ovarian hydrosalpinx and Hemorrhagic cyst (10%) each. Ovarian serous cyst adenoma constituted (6.7%), while pyosalpinx, PCO, hydrosalpinx, and endometrial cyst constitutes (3.3%) each.

As regards diagnosis according to MRI examination, Simple cyst and ovarian cancer were the most frequent (13.3%) each, followed by Tubo-ovarian hydrosalpinx and Hemorrhagic cyst (10%) each. Krekenberg tumor, Ovarian dermoid, and Ovarian serous cyst adenoma constituted 6.7% each. As regards the ADC value was significantly lower in the malignant lesions (0.7*103) than benign ones (0.9*103). As regards histopathologic confirmation, 23 cases of the studied women, Ovarian cancer (17.4%), Tubo-ovarian hydrosalpinx (13.0%), and Hemorrhagic cyst (13.0%) were the most common diagnosis. Ovarian dermoid, Krekenberg tumor, and Ovarian serous cyst adenoma constituted 8.7% each. Other less frequent diagnosis included Endometeriotic cyst, Hydrosalpnix, Mucinous cystadenoma, Ovarian serous cyst adenocarcinoma, Ovarian dysgerminoma and Terato-dermoid (4.3%) each. The mean ADC value was significantly lower in the malignant lesions than benign ones. At a cut off ≤0.7, ADC showed a significant good diagnostic value of malignant lesions with sensitivity, Specificity, and an accuracy.

Conclusions: DWI to conventional MRI is an important tool. It improves the specificity of MRI and thus increasing radiologists confidence in image interpretation which will finally reflect on patientsoutcome and prognosis. Cost effective technique (no additional cost to MRI examination), was easily added to MR study protocols.

Open Access Original Research Article

Platelet to Lymphocyte Percentage Ratio as a Marker of Arterial Stiffness in Hemodialysis Patients‎

Hend H. Al Gazzar, Amr M. El-Badry, Tamer A. El-Bedewy, Gamal F. El-Naggar

Journal of Advances in Medicine and Medical Research, Page 102-112
DOI: 10.9734/jammr/2021/v33i1130930

Aim of the Work: To evaluate platelet to lymphocyte percentage ratio as a marker of arterial stiffness in hemodialysis

Study Design: Cross sectional.

Place and Duration of Study: Tanta University Hospitals; Hemodialysis Units, from June 2019 till October 2020.

Methodology: The study included 80 end stage renal disease patients (40 males and 40 females) on regular hemodialysis for at least 3months. Laboratory investigations included complete blood counts (CBC), lipid profile, serum albumin, calcium, phosphorus, parathormone hormone, uric acid and C-reactive protein (CRP). Ankle brachial index (ABI) was measured using a hand held Doppler. Data obtained was statistically analyzed.

Results: In our study, abnormal ankle-brachial index was found to be associated with high neutrophil %, high platelet count, high platelet lymphocyte percentage ratio (PL%R) and platelet lymphocyte ratio (PLR), elevated cholesterol and low density lipoprotein levels, and presence of cerebrovascular and coronary artery diseases. In multivariate analysis, PL%R and PLR were independently related to abnormal ABI in hemodialysis patients with P value 0.03 and 0.04 respectively. PL%R had sensitivity 92% and specificity 83% while PLR had sensitivity 81% and specificity 60%. There was a positive correlation between PL%R and CRP as a marker of inflammation.

Conclusion: Increased platelet-to-lymphocyte percentage ratio was independently associated with increased arterial stiffness in hemodialysis patients.

Open Access Original Research Article

Diabetic Ketoacidosis in Children with Type-1 Diabetes in a Tertiary Hospital in Sokoto, North-Western Nigeria: Clinical Profile and Outcome

M. O. Ugege, T. Yusuf

Journal of Advances in Medicine and Medical Research, Page 142-152
DOI: 10.9734/jammr/2021/v33i1130933

Introduction: Diabetic ketoacidosis (DKA) is a life-threatening complication of type 1 diabetes (T1D). Few reports are available on DKA among children in North-west Nigeria. 

Objective: To describe the clinical profile and outcome of children managed for DKA in the Paediatric Endocrinology Unit of Usmanu Danfodiyo University Teaching Hospital (UDUTH), Sokoto, North-western Nigeria over a ten-year period (January 2011- December 2020).

Methods: This was a retrospective review of the case records of all children managed for T1D between 2011 and 2020.  Socio-demographic and clinical data of those with DKA were extracted and analysed using SPSS version 23.

Results: Ten (62.5%) out of 16 children with T1D had DKA, comprising 8 males and 2 females; M: F ratio 4:1. Majority (90%) were adolescents aged 10-15years. The mean age ± standard deviation (SD) at diagnoses of T1D was 11.1 ± 3.14 years; DKA was the presenting manifestation of diabetes in 4 (40%) children, while 6(60%) were known diabetics with an average of 2-episodes per patient. The median duration of symptoms was 5 days (range 1-42 days). Abdominal pain (90%), polyuria (80%), fast breathing (70%), vomiting (70%), altered consciousness (70%), dehydration (100%) and Kussmaul respiration (70%) were the common presenting features. The mean blood glucose, bicarbonate and venous PH at admission were 23.28± 7.14 (range; 12.3-33.3) mmol/L, 14.1± 3.41 (10-21) mmol/L and 6.96± 0.06 (6.92-7.00) respectively. Co-morbid conditions included infections (80%), predominantly malaria (70%). There was no mortality.

Conclusion: DKA is common in male adolescents, with good management outcome in our facility.  Abdominal pain, dehydration, polyuria and Kussmaul respiration were the commonest presenting features. A high index of suspicion of DKA is recommended in any child, particularly, male adolescents with the aforementioned features. Effort should be made to confirm diagnosis and prompt treatment instituted.

Open Access Review Article

Sexual Behaviour, Needs and Concerns Regarding Sexual and Reproductive Health among Adults Living with HIV in Sub-Saharan Africa- A Systematic Review

Ifeoma Chinyere Ofurum

Journal of Advances in Medicine and Medical Research, Page 113-132
DOI: 10.9734/jammr/2021/v33i1130931

Background:  The sexual and reproductive health of people living with HIV in sub-Saharan Africa should be of paramount importance and, therefore, given the attention it deserves. The advent of antiretroviral therapy (ART) and subsequent access to it has aided millions of infected people to live a normal life. However, being on ART is not enough as most of these people despite being on the therapy are faced with needs and concerns that have shaped their sexual behaviour.

This review aims to bring to perspective the sexual behaviour, needs, and concerns regarding the sexual and reproductive health of adults living with HIV in sub-Saharan Africa (SSA) with a view to reducing the disease's ultimate burden in the region.

Method: An extensive search of articles was carried out using the reporting systematic review and meta-analysis (PRISMA). The database search was from JSTORE, Scopus, Google Scholar, Medline, Cochrane, Semantic scholar, and Pubmed.

Results: A total of 3,984 results were obtained from the search. The application of the inclusion and exclusion criteria finally gave ten studies which were reviewed. The review revealed, among other things, that a good number of adults living with HIV have multiple sex partners, and some still have sex without condoms. Besides, most of them indicated the need for their own biological children, especially after being on ART for a while. Some women living with HIV in SSA do not have a right to decide on their sexual and reproductive health.

Recommendation: It was recommended that there be intense re-orientation and health education for this group of people. Women need to be empowered and taught their rights.

Open Access Review Article

Day Case Surgery: The Way Forward for Elective Surgery in Developing Countries

Richard Wismayer

Journal of Advances in Medicine and Medical Research, Page 133-141
DOI: 10.9734/jammr/2021/v33i1130932

The established principle of ambulating surgical patients as early as possible lies behind the concept of day case surgery currently being practised worldwide. There is a lag in day surgery practise between the developed and the developing world. In the last decades, freestanding and autonomous day surgery units have been established in the developed world however the developing world still tends to practise hospital based day case surgery. This article reviews the evolution, organization and infrastructure for day case surgery and evaluates this practise in developing countries. There is increasing need to develop the potential and relevance of day case surgery in developing countries which may result in substantial economic benefits. The health sectors in developing countries are coping with scarce resources and therefore day case surgery is an economically better option providing more advantages to patients as well as stakeholders. Surgical societies in developing countries should work closely with the Associations of Surgery in developed countries to establish infrastructure and guidelines to promote day case surgery in developing countries in East Africa.