Open Access Case Study

A Three-part Broken Interlocking Femoral Nail: Novel Technique of Removal and Review of Literature

A. Raviraj, K. Abhishek Sugumar, Vidyasagar Maalepati, H. A. Shivareddy, Ashish Anand

Journal of Advances in Medicine and Medical Research, Page 39-43
DOI: 10.9734/jammr/2021/v33i1230940

A segmentally broken (three part) interlocking femoral nail with broken interlocking screw can be challenging to remove. We describe a novel technique for extraction of an unusual two level broken cannulated anterograde femoral nail to treat the delayed union with exchange nailing.  This is the first reported case of a three-part broken intramedullary interlocking nail with broken distal locking screws, where the broken hardware was removed without opening the facture site or the knee. This technique is simple and does not require specialized equipment. The surgical technique and review of literature is presented.

Open Access Short Communication

The Impact of Changing from Prednisolone to Dexamethasone for the Management of Wheeze in Children- A Service Evaluation

James Thyng, Lynn Cunningham, Susanne McKinley, Felix Hay, Catherine Nunn, Damian Roland

Journal of Advances in Medicine and Medical Research, Page 44-46
DOI: 10.9734/jammr/2021/v33i1230941

Dexamethasone has become a popular alternative to Prednisolone as an oral steroid used for wheeze in children in many Paediatric Emergency Departments. It has proved non-inferior to Prednisolone in several studies [1,2] and its main advantages are single dose requirement and greater tolerability in children [3,4]. However, to the best of our knowledge there are no studies looking into the differences in re-attendance rates. Using our local Electronic Health Records, we extracted data of all over 5-year olds presenting with asthma and wheeze for 21 months of Prednisolone data and 15 months of Dexamethasone and found no statistically significant increase in re-attendance rates.

Open Access Original Research Article

Neurophysiological Study of Alzheimer’s Disease and Diabetes Mellitus Type 2 Patients. Is there a Common Link?

Vasileios Papaliagkas, Mara Gkioka, Athanasios Mousiolis, Maria Chatzidimitriou, Petros Skepastianos, Magda Tsolaki, Kyriakos Kazakos

Journal of Advances in Medicine and Medical Research, Page 10-15
DOI: 10.9734/jammr/2021/v33i1230935

Introduction:  Recent studies have shown that insulin resistance and deficiency, a marker of Diabetes mellitus type 2 (DM), interact with beta amyloid and tau protein phosphorylation, which are the basic neuropathological hallmarks of Alzheimer’s Disease (AD). Based on these results, it was recently proposed that AD might be considered as ‘Diabetes type 3’. Aim of the current study is to assess the cognitive function of DM patients and Mild cognitive impairment (MCI) patients with neurophysiological and neuropsychological measures and seek possible correlations.

Methods: The study participants were divided into two groups: group 1 and group 2. Group 1 consisted of 24 DM patients (7 men, 17 women; age 70.6±6.5 (mean ± SD) years; age range 55-86 years. Group 2 consisted of 16 MCI patients  age 72.61±7.42 (mean ± SD)years; age range 58-89 years)   age-matched (t-value=1.06,  p=0.30) and gender matched (χ2=0.084,  p=0.772) with group 1 patients. All patients were assessed with auditory event-related potentials (AERPs) and neuropsychological tests, which include MMSE, MOCA, IADL, and HAMILTON depression scale. Latencies and amplitudes of the major AERP waves (N200, P300 and Slow Wave) were determined,

Results: No statistically significant difference was observed in the AERP characteristics and the performance of the patients in the neuropsychological tests between the two groups (p>0.05).

Conclusions: From the results of the current study, it appears that the higher cognitive functions of DM patients as assessed with ERPs and neuropsychological tests are affected in a similar way with that of MCI patients; a finding which supports the existence of common pathophysiological mechanisms between the two diseases.

Open Access Original Research Article

The Effect of Cardiometry Guided Fluid Management on Outcome of Patients Presented for Intracranial Surgeries: Randomized Controlled Study

Amgd Shaaban El-Sheikh, Sameh Abdelkhalik Ismael, Nagat Sayed El-Shmaa, Soheir Mostafa Soliman

Journal of Advances in Medicine and Medical Research, Page 16-25
DOI: 10.9734/jammr/2021/v33i1230936

Background: Fluid management in neurosurgical patients is critical and important during the perioperative period. Electrical cardiometry (EC) is a new noninvasive technique for measuring cardiac output (COP). EC works based on the application of a high frequency transthoracic current and the analysis of variations of voltage in each heartbeat. The aim of this work is to compare the fluid management of intracranial surgeries using EC routine parameters.

Methods: This is a prospective randomized, double-blinded controlled study was carried out on 70 patients of both genders aged > 21 years old, ASA physical status II or III, GCS 15 scheduled for elective craniotomy. Patients were divided into two equal groups at random; group A: standard management, group B: EC guided management. The primary outcome was the duration of intensive care unit (ICU) stay.

Results: The ICU and hospital stay duration were significantly decreased in group B compared to group A. The mean total amount of infused volume of crystalloid solutions was significantly decreased in group B compared to group A. Hemodynamics, and number of patients received colloid, blood, vasopressor, and inotropes were insignificantly different between both groups. There was a significant increase in optic nerve sheath diameter in group A compared to group B at PACU and 24 h. Adverse events were comparable between both groups except encephalodema, which was significantly higher in group A.

Conclusions: EC is an effective tool in COP measurement and a novel guide for fluid therapy as EC guided fluid therapy group was significantly decreased in ICU and hospital stay duration and the total amount of crystalloid with fewer adverse events.

Open Access Original Research Article

Comparative Evaluation of Cleaning Efficacy of Three Different Single File Systems: An In Vitro Study

Deebah Choudhary

Journal of Advances in Medicine and Medical Research, Page 26-31
DOI: 10.9734/jammr/2021/v33i1230937

Aim: The aim of this study was to evaluate the canal cleaning efficacy of these three file systems using scanning electron microscopy.

Place and Duration of Study: The study was conducted in the Department of Conservative dentistry and Endodontics, Institute of Dental Sciences Sehora, between October 2020 and December 2020.

Materials and Methods: Access cavity preparation was performed on sixty extracted human mandibular premolar teeth and working length was determined. The samples were randomly divided into three groups (n=20) depending upon the file system used i.e. Group 1 (Reciproc Blue), Group 2 (Waveone Gold) and Group 3 (F360). Samples were split into two halves by creating longitudinal grooves on the buccal and lingual surfaces. The samples were sputter-coated with gold and examined under scanning electron microscope at 5000X. The dentinal wall of root canal at coronal, middle and apical thirds of each sample were evaluated for the presence of determining the canal cleanliness and then analyzed using a five-score index.

Results: The results of this study revealed that Group 1 (Reciproc Blue) exhibited better cleaning efficacy than samples of Group 2 (WaveOne Gold) and Group 3 (F360) at different locations in the canal i.e. coronal, middle and apical. The mean debris present was highest in coronal area for both group 2 and group 3 i.e. 2.1 and least was seen in apical area of group 1 i.e. 0.3. (p<0.05)

Conclusion: Reciproc Blue single-file showed highest cleaning efficacy followed by Waveone Gold and F360. Reciproc file also showed effective cleaning in the apical third of the canal.

Open Access Original Research Article

Levels of Maternal Serum Alpha-fetoprotein and Beta Human Chorionic Gonadotropin in HIV Seropositive Pregnant Women Attending Antenatal Care at Nnamdi Azikiwe University Teaching Hospital Nnewi, Nigeria

C. H. Udeogu, M. C. Ugwu, J. Okwara, A. C. Ohale, O. C. Ike, N. C. Amadi, O. Ugwu, F. C. Eguogwu

Journal of Advances in Medicine and Medical Research, Page 32-38
DOI: 10.9734/jammr/2021/v33i1230939

HIV infection remains a worrisome pandemic especially in developing countries like Nigeria, with an increasing number of infected women becoming pregnant, with added risk of pregnancy complications such as intrauterine fetal death, neural tube defects, and vertical transmissions. Hence this study assessed the levels of maternal serum alpha-fetoprotein (MSAFP) and beta human chorionic gonadotropin (β-hCG) in HIV seropositive pregnant women, and their implication for maternal and fetal health. A total of 86 patients were recruited for the study from the Antenatal Clinic of Nnamdi Azikiwe University Teaching Hospital (NAUTH) Nnewi.  Forty three were HIV seropositive (Test group), and forty three were HIV seronegative (Control group). Maternal serum alpha-fetoprotein and beta human chorionic gonadotropin levels were assayed by Enzyme Linked Immunosorbent Assay. The results showed that MSAFP levels (3.14±2.80 ng/ml) were significantly lower (P < .05) in HIV infected pregnant women when compared to HIV uninfected pregnant women (4.75±3.68 ng/ml). There was no significant difference in the levels of β-hCG (217.88±63.85mIU/mL) in the test group (P = 0.629) as compared to controls (223.75±47.71 mIU/mL). In the test group, increased CD4 counts were significantly   associated   with   increased MSAFP and β-hCG levels in a positive fashion (P < .05). Increase in Gestational age was also significantly associated with increased β-hCG levels (P < .05).

The measurements of MSAFP and β-hCG levels may be used alongside CD4 count in the assessment of maternal and fetal wellbeing. Human Immunodeficiency Virus by reducing the levels of MSAFP in HIV infected pregnant women increases the likelihood of pregnancy complications such as intrauterine fetal death.

Open Access Original Research Article

Association between Risk Factors and New-Onse Seizures in Old Age Population

Samee Jatoi, Dayo Abdullah, M. Z. Jilani, Soomro Fatima

Journal of Advances in Medicine and Medical Research, Page 47-58
DOI: 10.9734/jammr/2021/v33i1230942

Objective: To determine the association between risk factors and new-onset seizures in old age population at a tertiary care hospital, Karachi.

Methods: A case control study on old age patients of > 60 years visited emergency department (ED) either with new onset seizure or without seizure were conducted at ED of Ziauddin University Hospital Karachi. 154 consecutive old age patients were distributed into two groups i.e., case group (77 old age patients of new onset seizure) and control group (77 old age patients without seizure). Risk factors including stroke, dementia, head trauma, metabolic causes, brain tumor, infection of central nervous system (CNS), depression and anxiety were evaluated.

Results: Out of 154 old age patients, male was 32 (41.6%) and 40 (51.9%) and female was 45 (58.4%) and 37 (48.1%) in case and control group respectively. Type of seizure in control group was generalized tonic–clonic seizure (GTCS) in 51 (66.2%) patients and focal seizure in 26 (33.8%) patients. Comorbidities were diabetes mellitus (DM) in 76 (98.7%) and 59 (76.6%) patients, hypertension (HTN) in 72 (93.5%) and 63 (81.8%) patients and ischemic heart disease (IHD) in 39 (50.6%) and 25 (32.5%) patients. Risk factors were stroke in 23 (29.9%) and 16 (20.8%) patients, dementia in 3 (3.9%) and 0 (0.0%) patients, head trauma in 0 (0.0%) and 33 (42.9%) patients, metabolic causes in 27 (35.1%) and 27 (35.1%) patients, brain tumor in 6 (7.8%) and 0 (0.0%) patients, CNS infection in 17 (22.1%) and 1 (1.3%) patients and depression in 2 (2.6%) and 0 (0.0%) patients.

Conclusion: New-onset seizures are significantly associated with age, diabetes mellitus, hypertension, ischemic heart disease, brain tumor and CNS infection.

Open Access Original Research Article

The effect of Dichlorvous (Sniper) Inhalation on the Histology of the Lungs of Adult Male Wistar Rats

A. E. Anyabolu, D. N. Ezejindu, B. N. Obinwa

Journal of Advances in Medicine and Medical Research, Page 59-68
DOI: 10.9734/jammr/2021/v33i1230943

The organophosphate, dichlorvous (Otapia-pia) formulated in varying concentrations as insecticides is utilized by several individuals in most remote places of Nigeria due to its affordable value and accessibility. However, this present study is conducted to investigate the adverse effect of the exposure of this substance on the respiratory system (lungs) of male albino wistar rats. Twenty (20) albino wistar rats comprising of all males weighing between 150-230g were divided into four groups (A-D) of five animals each. Group A received only water, feed, and served as the control. Group B was exposed to dichlorvous inhalation 3hrs daily for a period of two weeks; Group C was exposed to dichlorvous inhalation 6hrs daily for a period of two weeks; while Group D was exposed to dichlorvous inhalation 10hrs daily for a period of two weeks. Twenty four hours after the last exposure, the animals were sacrificed by cervical dislocation and dissected. The lungs were weighed and fixed in 10% formal saline for histological studies. The body weight of the experimental groups decreased insignificantly when compared with the control group. The lungs weight increased significantly when compared to the control groups. Histological observation revealed a moderate to severe effects on the lungs with severe consolidated inflammatory exudates (discharge of fluids from pores), a moderate intra-alveoli hemorrhage, and a severe dilation of alveolar septa which is evident as emphysematous changes. This result revealed that the exposure to dichlorvous causes distortion of the normal histological architecture of the lungs. Thus, showing that dichlorvous inhalation influences the normal physiologic mechanisms of the lungs.

Open Access Original Research Article

Self-efficacy of Patient Centeredness among the Physical Therapists of Sindh, Pakistan

Natasha Bhutto, Aadil Ameer Ali, Shobha Lekhraj, Naseebullah Sheikh, Vikash Chughani, Shazia Abdul Hamid khalfe

Journal of Advances in Medicine and Medical Research, Page 79-86
DOI: 10.9734/jammr/2021/v33i1230945

Aim: To assess the self-efficacy of patient centeredness and its implication rates among physical therapists of Sindh, Pakistan.

Study Design: A cross sectional study.

Place and Duration: The Study was conducted from August to December 2017. The data was collected from different hospitals of Sindh, Pakistan, Agha Khan Hospital, Liaquat National Hospital, Jinnah Postgraduate Medical Centre, Rabia moon Hospital, Liaquat University of Medical and Health Sciences, Dow University of Health Sciences, Jijal Mauu Hospital.

Methodology: The Self-Efficacy in Patient Centeredness Questionnaire (SEPCQ-27) consisting of (1-27) scoring key, with total score of 108 was distributed among 377 physical therapists while 305 were filled and returned. The Data was analyzed using statistical package for social sciences (SPSS) version 21.

Results: Most of the participants were from age group of 24-29 years (n=252, 82.6%) and were male (n=194, 63.6%). Most of the participants were having experience of 1-5 years (n=251, 82.3%), working in general hospital setting (n=133, 43.6). The working hours ranges between 4-8 hours (n=194, 63.6%). Most of the participants reported high degree (n=270, 88.5%) of patient centeredness. Minimum reported score on SEPCQ-27 was 41 while the maximum reported score was 108.

Conclusion: The study concludes that self-efficacy in patient centered care among physiotherapists of Sindh, Pakistan was high. The study also reported that physiotherapists implement patient centered care to higher degrees, It has positive influence on outcomes, patient satisfaction, patient-therapist relation, patients health related quality of life, adherence to treatment and physical and mental wellness.

Open Access Original Research Article

Multiple Intramedullary Nailing Versus Low Profile Mini-Plating in Unstable Metacarpal Neck Fractures

Amr A. Aboelnaga, Mohammed Osama Ramadan, Muhammad Abdel-Monem Quolquela, Mostafa Hussein Hegazy

Journal of Advances in Medicine and Medical Research, Page 102-114
DOI: 10.9734/jammr/2021/v33i1230947

Background: Neck fractures of the metacarpal bone can alter optimal hand function. Many surgical fixation techniques are described for this fracture with no robust evidence for the best treatment. Recently developed low profile plates may, however, challenge the preference for K-wires. Low profile plates were found to have lower complications than conventional plates in addition to early range of motion and early return to work. The aim of the present study was to determine the best outcome in patients with unstable fracture neck metacarpals using either multiple K wires or low profile mini-plating.

Methods: This prospective randomized controlled study included 37 patients suffering from metacarpal neck fractures. patients were designated as group 1 (AIN group; 18 patients), and the other consecutive patients were designated as group 2 (LPP group; 19 patients). Both groups were treated within the first 48 hours of their injury and followed up for a minimum period of 40 weeks; the maximum period of follow up was 48 weeks.

Results: No significant differences were found for PVAS, Q-DASH, TAM, time to radiological union or residual deformities at last follow-up. Grip strength, however, was significantly better in the K-wire group. Operative time and time off work were significantly shorter in the k-wire group. Plate group showed prevalent complications both peri and post-operative hitting 63.2 % of the plate group vs 16.7% in K-wire group.

Conclusions: Low profile plates with immediate mobilization paradoxically prolonged operative time, technical demand and disturbing the fracture’s biological environment along with the extra cost were thus not justified by results. Antegrade intramedullary K-wire nailing was superior for the management of unstable metacarpal neck fractures.

Open Access Original Research Article

Determining the Dynamic Contrast - Enhanced Magnetic Resonance Imaging (DCE- MRI) in Diagnosis of Pulmonary Nodules

Mona Adel El-Nenaey, Mohamed Mahmoud Alashwah, Basem Ibrahim Al-Shafey, Amr Mohamed El-Badry

Journal of Advances in Medicine and Medical Research, Page 115-129
DOI: 10.9734/jammr/2021/v33i1230948

Objective: The aim of this study is to evaluate the role of dynamic contrast _ enhanced magnetic resonance imaging (DCE-MRI) in diagnosis of pulmonary nodules.

Patients and methods: The study was a cross-sectional study that was conducted on 30 patients with lung nodules referred to Radio diagnosis and imaging department from chest and oncology departments. By performing repeated CT within 30 days, we identified malignant nodules. The CT was repeated at 3 and 6 months which showed that the malignant pulmonary nodules increased in size and number.

Results: The maximum enhancement curve was a significant discriminator. At cut-off value of ≥ 375, the maximum enhancement curve yielded a sensitivity of 92.6% and specificity of 96% (figure 3). In contrary, the ADC value had poor diagnostic accuracy in differentiating between malignant and benign cases.

Conclusion: Dynamic contrast-enhanced MRI is valuable for diagnosis of pulmonary nodules and discrimination of benign from malignant ones.

Open Access Review Article

Evaluation of the Gallbladder Wall Thickening as a Non-invasive Predictor of Esophageal Varices in Cirrhotic Patients

Nora M. Shehata, Alsiagy A. AbdelAziz, Medhat Abd El-Megid, Yasser M. Hafez

Journal of Advances in Medicine and Medical Research, Page 1-9
DOI: 10.9734/jammr/2021/v33i1230934

Background: Liver cirrhosis represent the end stage of fibrosis that destroy normal liver parenchyma and leads to serious complication as portal hypertension which result in esophageal varices (EV), EV bleeding leads to high mortality, so repeated upper endoscopy needed to control bleeding which is invasive procedure and of high risk of hazards as infection.

Our Study Aimed: to evaluate the Gallbladder Wall Thickening (GBWT) as a non-invasive predictor of Esophageal Varices (EV) in cirrhotic patients.

Methods: In this cross sectional study, we tested 120 cirrhotic patients at gastroenterology and hepatology unit, internal medicine department, Tanta university hospitals. They were divided into 60 cirrhotic patients with EV and 60 cirrhotic patients without EV. All patients were subjected to history taking,  physical examination, investigation (complete blood count, liver function tests, viral markers) ultrasound detecting (gall bladder wall thickness, portal vein diameter, portal vein flow velocity, portal cross sectional area and gall bladder fasting volume) upper gastrointestinal endoscopy to detect presence or absence of varices.

Results: Significant correlation was observed between gall bladder wall thickness (GBWT) and portal hypertension, GBWT ranged from 2.5 to 7 mm in group 2 (cirrhotic patients with EV) and from 1.5 to 5 in group 1( cirrhotic patients without EV).

There is significant difference between group 1 and group 2 as regard GBWT with (P value < 0.05), portal vein diameter (PVD) with (P value <0.05) and platelets counts with (P value <0.05).

Conclusions: We recommend thatgall bladder wall thickness can be used as a non-invasive predictor of esophageal varices in cirrhotic patients.

Open Access Review Article

Forensic Medicine: A Synopsis of the Past, Present and a Glimpse into the Future Scenarios

S. R. Hulathduwa

Journal of Advances in Medicine and Medical Research, Page 69-78
DOI: 10.9734/jammr/2021/v33i1230944

Forensic medicine is the science (as well as the art) of applying medical knowledge, skills (and perhaps even the attitudes) to assist in the process of execution of justice. Forensic medicine is broadly divided into clinical forensic medicine and forensic pathology though the boundaries between the two are merging. Forensic pathology is not a pure science as it is nurtured by many other sciences, sociological/criminological disciplines and law. The principle role of forensic pathology today is to deal with numerous medico-legal issues pertaining to all forms of deaths. To achieve this, the principle approach of forensic pathology today in most of the institutions globally is conducting a standard autopsy. In this review article, we expect to discuss the  historical development of forensic pathology up to what it is today, its present role and scope as well as the predictable future of forensic pathology with the recent developments of technology.

Open Access Review Article

Transfusion Strategy and Postoperative Complications in Adults Undergoing Cardiac and Vascular Surgery: Systematic Review and Meta-analysis

Letícia Gonçalves Libonati, Gabriella Cury Ribeiro Gatto, Marcos Pereira, Marinho Marques da Silva Neto

Journal of Advances in Medicine and Medical Research, Page 87-101
DOI: 10.9734/jammr/2021/v33i1230946

Background: Bleeding is frequent in cardiac and vascular surgery (CVS) having a greater need for transfusion. Studies have observed an increase in complications in transfused patients, and in this context the use of a liberal strategy (LS) was questioned, and a restrictive strategy (RS) gained space in the scientific environment. However, the effects of these strategies remain uncertain. This study aimed to verify if there is an association between the transfusion strategy and the occurrence of postoperative complications in adult patients undergoing CVS.

Methodology: Searches were performed in four databases and manually. The selection was made from studies with adult patients who underwent CVS that required transfusion, and the outcome variable was the complications arising from this procedure. The languages were restricted to Portuguese and English. The Stata software was used for meta-analysis.

Results: Six publications, involving 6,187 patients, were included. In four studies there was no evidence that the risk of mortality and adverse events differed among patients allocated to an RS transfusion versus an LS. On the other hand, two studies raised a possible RS inferiority, however, the meta-analysis demonstrated no statistically significant difference between the two strategies. Furthermore, another study also suggested that the number of red blood cell units transfused was an independent risk factor for the occurrence of complications.

Conclusions: RS is not inferior to LS in terms of postoperative complications in CVS, but other randomized clinical trials are necessary to better define the minimum allowed value for the RS.

Open Access Review Article

Innate Recognition and Signaling during Times of Pandemic and Beyond from Intensive Care Perspective

Sylvia Frisancho-Kiss

Journal of Advances in Medicine and Medical Research, Page 130-143
DOI: 10.9734/jammr/2021/v33i1230949

The systemic inflammatory response (SIRS) underlies the majority of intensive care-related conditions. Depending on the origin it may become a governing force of organ dysfunctions. The immune response therefore may be a contemptuous reaction. While necessary for viral, or bacterial elimination, clearance of debris, and regeneration, when dysregulated, overpowering, or chronically ongoing, it may lead to significant collateral damage, organ failure, and autoimmunity. Understanding the immune response in specific complex situations, monitoring, and targeted influencing may become a future step in intensive care management. Toll-like receptor four (TLR4) is a representative innate immune receptor with authoritative downstream signaling and regulatory functions. The following review aims to bridge the logics of innate immune recognition, signaling, and influence on intensive care-related acute conditions by TLR4. We demonstrate that overwhelming innate immune response can be blunted, skewed, and consequently, adaptive immunity positively influenced, but such an approach must be careful and targeted for specific situations optimally under comprehensive immune monitoring. The unanswered questions of the field, as well as possible caveats of such novel approaches, are mapped through discussing in vitro and animal models, human trials.