Open Access Case Study

Case Report of a Giant Adrenal Myelolipoma in a Patient with Sickle Cell Anaemia

Udochikwuka Patience Ikejiaku, Chidinma Adaobi Udah, Johnpatrick Uchenna Ugwoegbu, Emeka Nwolisa

Journal of Advances in Medicine and Medical Research, Page 88-93
DOI: 10.9734/jammr/2021/v33i1731032

Adrenal myelolipomas (AMLs) are rare benign adrenal tumours containing adipose and hematopoietic tissue as a result of reticuloendothelial cell metaplasia. In this case report, we describe the diagnostic evaluation and the operative management of a giant adrenal myelolipoma in a 14-year-old male who has sickle cell anaemia. He presented with a one-week history of bilateral leg swelling. A physical examination revealed a mass in the right lumbar region. Ultrasound of the abdomen revealed a well-defined rounded echo-complex encapsulated supra-renal mass impinging on the upper pole of the right kidney, displacing it downwards. There was also marked compression of the inferior vena cava. A computed tomography scan showed a large mass occupying the right adrenal gland. The patient had an exploratory laparotomy with excision of the right adrenal tumour. Histopathological (Immunohistochemistry) evaluation of the mass confirmed the diagnosis of adrenal myelolipoma. The diagnosis of an adrenal myelolipoma requires a good history, physical examination, a high index of suspicion, imaging techniques, and a thorough histopathological evaluation. Surgery is the main treatment modality and good post-operative management minimizes complications and guarantees rapid recovery.

Open Access Commentary

Comorbidity within Axis-II Disorders: The Unending Issues

Nonyenim Solomon Enyidah, Esther Ijeoma Nonye-Enyidah

Journal of Advances in Medicine and Medical Research, Page 10-12
DOI: 10.9734/jammr/2021/v33i1731022

Personality Disorders have since the 19th century been known and established as psychiatric diagnosis, yet till date, issues of definition still remain unresolved. With a prevalence of 10-15% of the general population, and it’s associated extreme disruption in the lives of the patients and the communities, it is still not a principle focus of treatment. It’s assessment and diagnosis have been restricted to clinical settings and drug treatment and rehabilitation centres. A study in a Nigerian prison community has revealed a comorbidity prevalence rate of 70% with substance use disorder, a 25% comorbidity prevalence within the personality disorders and a strong association between personality disorders and criminality.

Open Access Original Research Article

Inguinal Hernia Repairs in a Rural Setting in East Africa

Richard Wismayer

Journal of Advances in Medicine and Medical Research, Page 13-19
DOI: 10.9734/jammr/2021/v33i1731023

Background: Inguinal hernias are a major cause of morbidity and mortality in the developing world. In resource limited settings in rural Africa the clinical management of inguinal hernias may pose a therapeutic challenge to the surgeon due to the late presentation of this condition and lack of availability and affordability of mesh and laparoscopy. In our environment there is a lack of data and literature regarding the surgical management of inguinal hernias. The purpose of this study was to outline the clinical profile and outcomes among patients undergoing inguinal hernia repairs in our hospital.

Methods: A descriptive retrospective study was carried out between 1st April 2008 to the 31st July 2012 on all patients ≥15 years of age that underwent an inguinal hernia repair were eligible in this study. The patients were reviewed on the surgical ward postoperatively and in the surgical out-patients clinic 3 months post-operatively. Data was collected using a pretested questionnaire on the following variables: age, sex, recurrence of hernia, post-operative pain and post-operative complications. Physical examination was used to determine post-operative recurrence and evidence of haematomas, seromas or severe wound sepsis requiring operative intervention.

Results: One hundred and fifty eight patients following repair of inguinal hernia using the Modified Bassini technique were analyzed. Mean age was 44.84 years. The male:female ratio was 3.65:1 with male predominance. Emergency inguinal hernia repairs were carried out in 4(2.53%) and the majority of patients, 154(97.47%) were elective inguinal hernia repairs. One(0.63%) mortality and the morbidity included 1(0.63%) seroma, 1(0.63%) haematoma, 1(0.63%) necrotizing fasciitis and 1(0.63%) enterocutaneous fistula. The overall complication rate was 3.16%.

Conclusions: In rural Africa patients with inguinal hernias should be encouraged to present early with signs and symptoms of inguinal hernia. Elective hernia repair of inguinal hernias, irrespective of the type of repair, will reduce the morbidity and mortality from this common problem in East Africa.

Open Access Original Research Article

Periodontitis can lead to an Initial Process of Neuroinflammation in Experimental Models

Jossinelma Camargo Gomes, Bianca Caroline Custodio dos Santos, Iohana Fiorese Choptian, Maria Luiza Serradourada Wutzke, Leonardo Maso Nassar, Sara Cristina Sagae Schneider, Ivo Ilvan Kerppers, Guilherme Ribas Taques, Patricia Oehlmeyer Nassar, Carlos Augusto Nassar

Journal of Advances in Medicine and Medical Research, Page 28-42
DOI: 10.9734/jammr/2021/v33i1731025

Introduction: Recent evidence shows a possible causal relationship between periodontitis and neurodegenerative diseases. Changes in the hippocampus can result in reduced cognitive functions such as behaviors associated with memory and emotions.

Objectives: Evaluate the influence of ligature-induced experimental periodontitis on the inflammation of the hippocampus of rats.

Materials and Methods: Twenty male Wistar rats, divided into Control Group (GC) and Periodontal Disease Group (GDP). GDP was induced to experimental periodontitis by placing a ligature on the lower molars for 30 days. The study performed three behavioral tests during the experiment in two stages: before and after the induction of periodontitis; at the end, the rats underwent euthanasia and the collection of the hippocampus (histological and immunological analysis) and hemimandibles (histological and radiographic analysis), with subsequent performance of Student's T-tests and Two-Way ANOVA to analyze the results.

Results: GDP showed a higher level of anxiety, less habituation and reduced time to explore the new object compared to GC (p<0.05). Besides, GDP had a lower number of osteocytes and osteoblasts, and higher osteoclastic activity, as well as more significant alveolar bone loss compared to GC (p<0.05). Senile plaques were noted in the hippocampus in addition to positive beta-amyloid, tau, and CD68 markings on GDP.

Conclusions: Therefore, it can be concluded that periodontitis triggered the presence of senile plaques, beta-amyloid, tau, and CD68 markings, which, together, manifested an initial neuroinflammation process in these animals. Clinical Relevance: Periodontitis can be a risk factor in neuroinflammation process

Open Access Original Research Article

Knowledge of COVID-19 and Willingness to Participate in Medical Response to It among Clinical-Level Medical Students in a Nigerian University

Samuel Robsam Ohayi, Sunday Gabriel Mba, Ifeoma N. Asimadu

Journal of Advances in Medicine and Medical Research, Page 43-53
DOI: 10.9734/jammr/2021/v33i1731026

Aims: To determine medical students’ knowledge of COVID-19 pandemic and their willingness to participate in medical response to it and the associated factors.

Study Design: Cross-sectional study involving use of online self-administered questionnaire developed by the author was administered to clinical level medical students.

Place and duration of study: Enugu State University College of Medicine from 16th September 2020 to 27th November 2020.

Methodology: There were 177 participants in this study comprised of 79 males and 89 females with 21, 24, 110, and 22 at 300 level, 400 level, 500 level and 600 level of study respectively. The questionnaire was sent to the representative of each class after discussions with them about the research work. They then transmitted the questionnaire to their class WhatsApp platform with an accompanying request for the completion of the questionnaire.

Result: Most participants (145; 81.9%) have good knowledge level of the virus and pandemic. Age (p<.05) and year of study (p=<.05) significantly affect knowledge level. Most students, 113(63.8%) were willing to participate in the response to the pandemic; the most avowed reasons were to gain skill as future members of the health team, 100(88.5%) and as a sense of duty if called upon by government 69(61.1%). Main reason for unwillingness was fear of contracting the infection (20; 90.9%) coupled with lack of PPE (16; 72.7%). Knowledge level about the pandemic did not significantly affect willingness to participate in the response to it. Most respondents were more willing to participate in non-PPE-requiring tasks 103(91.2%) than in others.

Conclusion: Medical students in our center are knowledgeable regarding COVID-19 pandemic and are willing to participate in response to COVID-19 pandemic especially if suitable environment is provided.

Open Access Original Research Article

Peri-neural Invasion in Oral Squamous Cell Carcinoma (OSCC): A Clinico-pathological Marker of OSCC Prognosis and Risk Assessment

Priyankar Singh, Zeenat S. Imam, Sidhharth Singh, Setu Sinha, Varsha Singh, A. K. Sharma

Journal of Advances in Medicine and Medical Research, Page 1-9
DOI: 10.9734/jammr/2021/v33i1731021

Aims And Objectives: To assess the incidence of Peri-Neural invasion in oral squamous cell carcinoma (OSCC), and to notify its significance as potent risk factor in OSCC recurrence and metastasis.

Study Design and Place of Study: A retrospective in vitro study was conducted at Indira Gandhi Institute of Medical Sciences, Patna, after approval of ethical committee

Material and Methods: Clinical, histopathological and follow-up details of 86 cases of oral squamaous cell carcinoma were collected from medical records as secondary data from December 2019 till April 2021. Peri-Neural invasion was assessed in all patients and was associated with, lymph node involvement and with the different histologic grades of OSCC. Location, density and patterns of Peri-Neural invasion was checked along with extracapsular spread and survival. Chi-square test was used for analyzing statistical data. P value of < .05 was considered as significant

Results: On statistical analysis it was found that, out of total 86 cases of OSCC, 59 were primary and 27 were recurrent OSCC. Male to female ratio was 3:1 and primary cases were more in age group of 35-44 years where as recurrent OSCC were more in age group of 55-64 years. Out of 59 primary cases of OSCC, Peri-Neural invasion was seen in 27 cases and out of 27 recurrent OSCC 18 had Peri-Neural invasion with a total of 45 cases with Peri-Neural invasion out of 86. Intratumor location was assessed in 22 cases and density of 1-2 nerves per section was seen. “Crescent” pattern was commonly occurring pattern in our study.

Conclusion: Our study affirmed that the incidence of Peri-Neural invasion is high in OSCC. It is present in both primary and recurrent tumors, irrespective of tumor’s grading. PNI must be assessed in all cases of OSCC as it gives markable impression on recurrence, metastasis and prognosis, and modulates treatment protocols.

Open Access Original Research Article

The Relevance between Fecal Tumor M2 Pyruvate Kinase and Colonoscopy for the Detection of Cancer Colon

Muhammed Essam Genedy, Sherif El-Sayed Ezzat, Sahar Mohey Eldin Hazzaa, Mohamed Mohamed Elbedewy

Journal of Advances in Medicine and Medical Research, Page 54-63
DOI: 10.9734/jammr/2021/v33i1731027

Background: Colorectal cancer (CRC) determination is focused on clinical, serological and endoscopic observations These methods are considered as non-invasive, cost-effective and convenient clinical examination methods. A direct association between M2 Pyruvate Kinase (M2-PK) and separate oncoprotein is the product of dissociation of tetrameric form from dimeric structure in tumor cells. The aim of this analysis is to assess the sensitivity in high risk or symptomatic populations of fecal tumor M2-PK.

Methods: This study is a cross sectional study carried out on 50 patients who were categorized into two groups: 25 patients with colorectal neoplasms (group 1). 25 patients symptomatizing of: diarrhea, persistent abdominal discomfort or bleeding per rectum, without colorectal neoplasms (group 2).

Results: The median value of stool M2-PK showed statistically significance. At cut-off ≥ 70 of stool M2-PK to predict activity, sensitivity was 88%, specificity was 84%, PPV was 84.6% and NPV was 87.5%. AUC was 0.907 and P value was <0.001.

Conclusions: Fecal M2-PK can be used as a pre colonoscopy screening test for CRC patients and is superior to other tumor markers (CEA and CA19.9) as it is more sensitive and specific. As a result of its low cost and ease of use, it is a viable tool for pre-selecting individuals who undergo colonoscopy.

Open Access Original Research Article

Assessment of Sexual Functions among Male with Substance Use Disorders

Ahmed Osama Tolba, Mohammad Abd El Hakim Selem, Maged Mostafa Ragab, Ahmed Abd El Rahman Mubarak, Adel Abd El Kerem Badawy

Journal of Advances in Medicine and Medical Research, Page 64-74
DOI: 10.9734/jammr/2021/v33i1731028

Background: Recent epidemiological and clinical studies confirmed the presence of a strong association between substance use disorders and sexual dysfunctions. Studies have demonstrated that prevalence of sexual dysfunctions among addict was about 30 %the most common problem among male substance abuse patients were Erectile Dysfunction (ED) and delayed ejaculation

Methods: This cohort comparative study was conducted on of 376 males aged between 18 – 50 years who were substance abusers including tramadol, cannabis and poly substance related and addictive disorders. All participants were subjected to psychiatric interview which was done using SCID-5-CV structured clinical interview for DSM-5 disorders. Psychometric, biochemical, medical and drug history evaluations were also performed.

Results: Our results show comparison between four groups (opiates-cannabis-poly substance abuse and control group according to severity of drug abuse, psychiatric evaluation and according to sexual functions. There were statistically significant differences between groups in sociodemographic data mainly in occupational and educational history. There also were statistically significant differences between groups in terms of drug use, psychiatric assessment, assessment of sexual activity, hormonal assessment of the studied population and quality of life assessment.

Conclusions: Long term drug use has a statistically significant negative effect on all domains of male sexual functions. Also average daily dose and severity of addiction are significantly correlated to sexual dysfunctions in patients with tramadol abuse. This is done through an alteration in sex hormone and alters feedback regulations of the pituitary on the hypothalamus.

Open Access Original Research Article

Comparative Study between Stair-step Protocol of Clomiphene Citrate and Combined Clomiphene and Gonadotropins for Induction of Ovulation in Women with Polycystic Ovary Syndrome

Sabah E. Sallam, Shereef L. El-shwaikh, Hossam A. Hodeib, Dina G. El-kholy

Journal of Advances in Medicine and Medical Research, Page 75-87
DOI: 10.9734/jammr/2021/v33i1731029

Background: Polycystic ovary syndrome affects 7 to 8% of women and may be the most common cause of female infertility. Anovulation, early pregnancy loss has all been implicated in the low fecundity. The aim of this study was to compare between the use of clomiphene citrate by stair-step protocol and use of combined clomiphene citrate and gonadotropins in patients with polycystic ovary syndrome.

Methods: This randomized non blinded controlled clinical study was carried out on 60 Patients who was selected from outpatient clinic of Tanta university hospitals from September 2019 to September 2020. Selected patients were allocated into two groups with 1:1 ratio. Group (A): was subjected to clomiphene citrate stair-step stimulation protocol. Group (B): was subjected to combined clomiphene and gonadotropins stimulation protocol.

Results: Mann-Whitney U test was used to compare quantitative data because it is not normally distributed (Age, BMI and duration of infertility). Significance defined by p < 0.05. Chi-square analysis was used for the categorical variable (number of MGF). Mann-Whitney U test was used to compare quantitative data because it is not normally distributed (Size of larger follicle and Endometrial thickness), Chi-square analysis was used for the categorical variables (Ovulation rate and Pregnancy rate). Mann-Whitney U test was used to compare quantitative data which are not normally distributed (FSH and LH). Student t test was used for the quantitative data which are normally distributed (Prolactin and TSH).

Conclusions: In conclusion, the CC stair‐step protocol is a safe, simple option for the management of PCOS patients, having a larger number of mature Grafian follicle, lower endometrial thickness and higher ovulation rate compared to combined clomophine and gonadotrophin protocol.

Open Access Original Research Article

Assessment of the Role of Lung Ultrasonography for the Accuracy of Clinically Estimated Dry Weight in Chronic Hemodialysis Patients

Yasmin S. Hammad, Samy A. Khodier, Ghada M. Al-Ghazaly, Ibrahim A. Nassar

Journal of Advances in Medicine and Medical Research, Page 94-103
DOI: 10.9734/jammr/2021/v33i1731033

Objective: The aim of this study was to  evaluate  the utility  of lung  ultrasonography  to  determine   the accuracy of prescribed  dry  weight in chronic hemodialysis patients  and  to  ascertain   the  adequacy  of  fluid  removal .

Methods: In this cross sectional study LUS was performed immediately before and after (within 15 min) the dialysis session on 60 patients on regular hemodialysis, 4-hours per session, three times weekly at Tanta university hospitals, Internal Medicine Department, Nephrology units, Egypt. The ultrasonography B-lines was tabulated and compared to the intradialytic ultrafltration parameters and dry weight.

Results: Positive significant correlation (P 0.02) was achieved between the intradialytic percentage change in B-lines and the percent change in total body weight reduction and also Positive significant correlation (P 0.05) was achieved between the intradialytic percentage change in B-lines and the ultrafiltration rate.

Conclusion: LUS is a valuable diagnostic tool for recognizing the adequacy of fluid removal and to avoid inaccurate estimation of dry weight by usual clinical parameters or even radiologic studies including chest X-ray.

Open Access Original Research Article

Assessment of Right Ventricular Function by 2D Speckle Tracking Echocardiography Pre and Post the Trans Catheter Closure of Atrial Septal Defect

Saad Abd Elmaseh Saad, Mohamed Elsayed Elsetiha, Mohamed Naseem Hussein, Fatma Aboalsoud Taha

Journal of Advances in Medicine and Medical Research, Page 104-109
DOI: 10.9734/jammr/2021/v33i1731034

Background: dysfunction is associated with adverse outcomes in patients with congenital heart disease. RV adaptation to disease is complex and depends on many factors. 2D Speckle tracking echocardiography is an angle-independent technique that may allow an accurate assessment of segmental myocardial deformation.

Aims: The aim of the work is to assess right ventricular function in patients with congenital left to right shunt (ASD) pre and 3 month post device closure using.

Patients and Methods: 31 patients were enrolled in the study, comparison was held between the group and itself before and 3 month after device closure. ESPAP measurement via TR jet also Tricuspid annular. Global longitudinal Strain of RV free wall and septum were measured by 2D STE.

Results: Volume overload on RV and according to Frank Starling law leads to increased contractility provided that function is preserved, so volume load in ASD cases leads to increased deformation and deformation rate values as evidenced in significant reduction of strain and strain rate values after volume load elimination. Strain and strain rate values gained via 2D speckle tracking echocardiography are load dependent parameter of contractility as evidenced in this study testing RV performance under both pressure and volume load. The value of these parameters of contractility assessment comes from their ability to detect subtle changes in mechanics and deformation that are not easily detected by conventional measures.

Conclusion: Myocardial deformation imaging is a novel echocardiographic tool for evaluation of global and regional myocardial function that can be applied to the RV for assessment of its longitudinal deformation by 2DE. 2D-STE derived strain and strain rate is a good method to exclude the effect of tethering and translational motions. RV responds to volume load by increasing its deformation and deformation rate provided that contractile function is preserved.

Open Access Original Research Article

The Potential Diagnostic Utility of TROP-2 & C-Kit in Thyroid Neoplasms

Amal Abd El-Halim El-Dakrany, Yomna Abd El-Monem Zamzam, Rania Elsayed Wasfy, Assia Mahfouz Abd El-Raouf

Journal of Advances in Medicine and Medical Research, Page 110-123
DOI: 10.9734/jammr/2021/v33i1731035

Background: Thyroid nodules are common finding, only 5% of nodules are malignant and the vast majority is non-neoplastic lesions or benign neoplasms. Thyroid cancer incidence is increasing faster than any other cancer types, thus representing one of the most common and clinically worrying malignant tumors of the endocrine system. Trophoblast antigen 2 (TROP2) is a transmembrane receptor glycoprotein encoded by the tumor-associated calcium signal transducer 2(Tacstd2) gene, which is located on chromosome 1p32. Although the biological function of TROP2 is unclear, accumulating evidence has demonstrated that its expression is elevated in various malignant tissues, whereas in human normal tissues relatively low or no TROP2 expression is observed. C-Kit is a type III receptor tyrosine kinase. C-Kit expression and signaling have been well characterized in several tumors, including gastrointestinal stromal tumors (GISTs). However, few studies have investigated c-Kit in the thyroid gland or in thyroid malignancies. The aim of this study was to investigate the diagnostic utility of TROP-2 on a large set of neoplastic thyroid lesions & to investigate the utility of TROP-2 & c-Kit markers to distinguish between benign and malignant thyroid neoplasms on Paraffin blocks.

Methods: Immunohistochemistry for TROP2 and c-Kit was carried out on 85 different thyroid lesions (40 benign, 7 borderline and 38 malignant).

Results: Malignant thyroid lesions were found to have negative expression of c-Kit in contrast to 80% of benign thyroid neoplasms. TROP2 was strong positive in 87.5% of papillary thyroid carcinomas (PTC), but there was no TROP2 expression in benign thyroid neoplasms, non-invasive follicular thyroid neoplasm with papillary like nuclear features, follicular carcinoma, anaplastic and poorly differentiated thyroid carcinoma.

Conclusions: TROP2 is a good diagnostic tool for PTCs to differentiate between PTCs & other lesions with papillary like nuclear features as NIFTP, c-Kit is a good diagnostic tool for follicular adenoma & to differentiate between follicular adenoma & follicular carcinoma.

Open Access Original Research Article

Efficacy of Intralesional Injection of Botulinum Toxin in Treatment of Keloids

Toka Ahmed El Sayed, Yomna Mazid Neinaa, Dareen Abd El-Aziz Mohamed, Nashwa Naeem El Far

Journal of Advances in Medicine and Medical Research, Page 124-130
DOI: 10.9734/jammr/2021/v33i1731036

Background: Keloid is generally accepted to be the result of prolonged and aberrant wound healing. Botulinum toxin injections are considered an efficient therapy for keloids. The current study evaluated the efficacy and safety of intralesional injection of botulinum toxin in treatment of keloids.

Methods: This prospective interventional study was carried out on 20 patients presented with keloids. Patients were treated by intradermal injection at the periphery of lesions by botulinum toxin as 100 IU diluted by 2 ml normal saline (5 IU/ cm3). Vancouver Scar Scale (VSS) and Verbal Rating Scale (VRS) were used for the assessment of the therapeutic efficacy.

Results: There was a statistically significant improvement in all VSS and VRS parameters. Vast majority, 18 (90%) patients, were satisfied and 2 (10%) patient was not satisfied. There was non-significant correlation between the age of patients, duration of keloid nor size of keloid in relation to degree of improvement of VSS after treatment. There was positive significant correlation between VSS before treatment and degree of improvement of VSS after treatment.

Conclusions: Intralesional injection of botulinum toxin was effective and safe therapeutic techniques in inhibiting keloids regarding the statistically significant improvement on comparing between before treatment and after the end of follow up period.

Open Access Original Research Article

The Prevalence of Substance use among in-School and out-of-School Adolescents: A Comparative Analysis in Anambra State, Nigeria

C. R. Aniemena, F. N. Ilika, P. O. Nwosu, P. O. Adogu, E. C. Azuike, M. C. Ohamaeme

Journal of Advances in Medicine and Medical Research, Page 131-143
DOI: 10.9734/jammr/2021/v33i1731037

Aim: The use of various substances is very common among the populace. These agents are readily abused by adolescents and youths who are introduced to these substances at an early age in life. This thus leads to abuse and misuse that eventually has a catastrophic outcome to the society at large.

The aim of this study was to determine the prevalence of substance use among in-school and out-of-school adolescents; a comparative analysis in Anambra State, Nigeria.

Study Design: This was a cross-sectional comparative study.

Place and Duration of Study: The study was conducted in schools, parks and markets of Onitsha municipal area of Anambra State, Nigeria, from September 2019-April 2020.

Methodology: A total of 250 in-school and 250 out-of-school adolescents aged 10-19 years, within Onitsha municipal area was sampled through the use of a semi-structured interviewer administered questionnaire, that was adapted from a WHO designed instrument on drug use among non-student youths. Frequency distributions were developed, while associations between variables were tested using t-test, fisher’s test, and chi-square.

Results: The results showed that most participants were males with mean ages of both sexes being 16.7 among the in-school and 16.1 in the out-of-school. There was statistically significant difference in alcohol consumption between in-school compared to out-of-school, p=0.001; and cigarette smoking, p=0.001. However, inhalants use was more among in-school compared to out-of-school, though not statistically significant. The overall prevalence of substance use was 58.4%, with 80.4% among the out-of-school compared to 36.4% with the in-school participants.
Conclusion: Substance use is common among in-school and out-of-school adolescents. The prevalence of substance use was significantly higher among out-of-school compared to in-school adolescents. Parents should teach their children the dangers of substance abuse while Schools and governments should ensure inclusion of such in the curriculum.

Open Access Original Research Article

Assessment of Hepatic Steatosis and Fibrosis in Egyptian Patients with Type 2 Diabetes Mellitus

Eman Basiouny, Faiza lashin, Manal Hamisa, Amal Selim

Journal of Advances in Medicine and Medical Research, Page 144-151
DOI: 10.9734/jammr/2021/v33i1731038

Aims: To assess hepatic steatosis and fibrosis in patients of type 2 diabetes mellitus (T2DM), their possible risk factors and their association with metabolic syndrome and micro or macro-albuminuria.

Study Design: Cross sectional study.

Place and Duration of Study: Outpatient Clinic of Diabetes, Metabolism and Endocrinology Unit in internal medicine department, Tanta University, Egypt in a period between September 2019 to March 2020.

Methodology: We included 200 patients had a diagnosis of T2DM according to American Diabetes Association criteria. Then patients were assessed for presence of hepatic steatosis and fibrosis using fibroscan and we used liver stiffness measurements (LSMs, as a measure of fibrosis) and controlled attenuation parameter (CAP, as a measure of steatosis) and routine laboratory data were done to rule out possible risk factors.

Results: 98.5% of participants had hepatic steatosis and 53.5% of participants had hepatic fibrosis. Those patients had longer duration of DM, higher BMI, bad control of T2DM, higher lipid profile values, association with metabolic syndrome, micro and macro-albuminuria and non-significantly elevated liver enzymes.

Conclusion: Hepatic steatosis and fibrosis are highly prevalent in patients with T2DM, incidence of hepatic steatosis and fibrosis is positively correlated with longer duration of DM, higher BMI, bad control of DM, dyslipidemia, presence of metabolic syndrome, diabetic nephropathy, weakly correlated with liver enzymes. TE is an accurate and non-invasive tool to be used in screening for hepatic steatosis and fibrosis ,so we recommend screening for hepatic steatosis and fibrosis using fibroscan to help in early management and prevent its progression into liver cirrhosis.

Open Access Original Research Article

The Prevalence of Cesarean Scar Niche and Its Relation to Certain Gynecological and Obstetrical Issues

Mazen Mohammed AlRassad, Mohammed Mohsen ElNamoury, Mona Khaled Omar, Manal Mostafa Abdallah

Journal of Advances in Medicine and Medical Research, Page 152-158
DOI: 10.9734/jammr/2021/v33i1731039

Background: A cesarean section (CS) is a life-saving surgical procedure when certain complications arise during pregnancy and labor. However, it is a major surgery and is associated with immediate maternal and perinatal risks and may have implications for future pregnancies as well as long-term effects that are still being investigated. This study aims at determining the prevalence of isthmocele (niche) among those who gave birth through Cesarean section, and figure out how many of the women diagnosed with scar niche are symptomatic.

Methods: This observational cross-sectional study involved 300 women who gave birth by CS at the latest 6 months and they were recruited from the outpatient clinics of obstetrics and gynecology department, Tanta university hospital.

Results: The prevalence of the niche was 21.7%. And the most common shapes of niche documented were the semicircular defects followed by the triangular defects. The majority of cases were symptomatic while only 7.7% were asymptomatic and discovered accidentally by routine ultrasound examination. The most common symptoms documented were abnormal uterine bleeding (AUB), chronic pelvic pain, dysmenorrhea, and secondary infertility. There was a positive significant relationship between the number of CS, the size of the niche, and the severity or frequency of the presenting symptom (P value < 0.01).

Conclusion: Cesarean scar niche has a strong statistically significant association with symptoms such as AUB (especially inter-menstrual bleeding), chronic pelvic pain, and dysmenorrhea. In our study, the prevalence of cesarean niche was 21.7% and the common niche shapes documented were the semicircular and triangular niches.

Open Access Original Research Article

Maternal Lipid Profile in Preeclampsia: Case-Control Study

J. O. Agbara, K. A. Rabiu, A. Gbadegesin, N. W. Okoh

Journal of Advances in Medicine and Medical Research, Page 159-166
DOI: 10.9734/jammr/2021/v33i1731040

Background: Preeclampsia has continued to be a challenge especially in the areas of understanding the pathogenesis and prevention or treatment of the disease. Previous reports on the relationship between maternal lipids and preeclampsia have varied as its role in the aetiopathogenesis of pre-eclampsia is not clearly defined. This study aimed at comparing the lipid profile in preeclampsia with that in normotensive pregnancy. It also examined for any relationship between an abnormal profile and severe disease.

Methods: This was a prospective case-control study. It was conducted among pregnant women who presented for routine antenatal care and those seen in the emergency room of the obstetrics unit of a tertiary institution in Lagos, Nigeria.  The duration of the study was 6 months as it took place between May 2015 to October 2015. Pregnant women in their second half of pregnancy, diagnosed to have pre-eclampsia and, who gave consent were consecutively recruited as cases and pregnant women with similar age and gestational age, who had normal blood pressure were also selected as controls within the study period. The Maternal lipid profile was assayed using an enzyme-based assay kit and analysed according to the manufacturer’s instructions. All participants were followed up till delivery.

Results: One hundred and seventy pregnant women in the third trimester of pregnancy participated in this study. They were within 18 – 45 years of age. More of the participants were nulliparous. Eighty-five of them had pre-eclampsia and constituted the study group while 85 were normotensive in the control group. The mean age was similar in both groups (control=29.59 ± 4.50 years versus pre-eclampsia=29.73 ± 5.10 years). The gestational ages at blood sampling of the patients in this study ranged between 27 – 40 weeks.  The analysis of data revealed that the level of total cholesterol, triglycerides, low-density lipoprotein and very-low-density lipoprotein was higher in the cases compared with the control. This difference was statistically significant because the calculated P-value was <0.05. The level of high-density lipoprotein was lower in those with pre-eclampsia. Serum cholesterol and low-density lipoprotein were significantly higher (P-value= 0.04) in those with severe disease. A significant positive relationship was observed between mean arterial blood pressure and abnormal levels of lipids.

Conclusion: An abnormal pattern of lipid profile was observed in women with preeclampsia and this was more marked in those with severe disease. A larger multi-centre study will be required to substantiate this finding.

Open Access Original Research Article

Fetal Liver Size, Hepatic Artery Doppler Study in Late Intra Uterine Growth Restriction

Ali Farag Ali, Magdy Hassan Hussein Balaha, Ahmed El Sayed El Halwagy, Mohamed Mohsen El Namori

Journal of Advances in Medicine and Medical Research, Page 167-176
DOI: 10.9734/jammr/2021/v33i1731041

Background: Intrauterine growth restriction (IUGR) is a condition in which the fetus does not reach its growth potential. It is well known that a fetus affected with late IUGR has smaller abdominal size.  The aim of the study is to evaluate the fetal liver size, fetal hepatic artery blood flow and other fetal vascular Doppler indices in cases of late IUGR.

Methods: This observational analytical, cross-sectional study was carried out on 100 pregnant women at or above 32 weeks. Participants were divided into two groups: Group 1 (study group): 50 pregnant women as study group who were affected with IUGR. Group 2 (control group): 50 normally pregnant women as control group.

Results: There was no statistically significant correlation between fetal weight and liver length. There was a positive highly statistically significant correlation between symphysial fundal height and the estimated fetal weight by ultrasound in cases of IUGR. There was a statistically significant decrease in the liver size in IUGR compared to the normal group. There was a statistically significant reduced hepatic arterial Doppler indices.

Conclusions: Reduced liver size and hepatic arterial Doppler indices (PI, RI) can be valid diagnostic methods in IUGR. SFH, in fetuses suffering from IUGR when compared to normal cases, was correlated with EFW.

Open Access Original Research Article

Drug-Substance Abuse, Age at Onset and Contributing Factors to Stoppage of Drug Use among Students in Aluu Community

Chigozie Njoku, Vivian Oparah

Journal of Advances in Medicine and Medical Research, Page 177-183
DOI: 10.9734/jammr/2021/v33i1731042

Background: Most drug-substance abusers do have withdrawal symptoms considering the type of drug. Some of the symptoms include: changes in appetite, changes in mood, congestion, seizure, fatigue etc. These symptoms make it difficult for someone to effectively withdraw. It therefore means that for someone to effectively withdraw from drug abuse, there are other factors that must come into play to enhance success. Hence, this study was done to determine the contributing factors to stoppage of drug use among students in university of Port Harcourt’s host communities as an attempt to curb the menace and its effect on students and the entire society at large.

Materials and Methods: The study was a descriptive cross-sectional study carried out in ALUU Community in Ikwerre Local Government Area of Rivers State between August 2019 and December 2019. The study involved 150 volunteers recruited randomly through a multi-staged sampling technique which included secondary school students, undergraduates who are 13yrs and above residing in ALUU community while those who did not give consent were excluded. The data was collected using self-structured close-ended self-administered questionnaires and data analysis done using SPSS version 25. 

Results and Discussions: The results of the study showed that the proportion of students that have stopped drug/substance abuse was 7.34%, the most prevalent age group at onset of drug use was 16-18yrs, and 26.42% of students used drugs/substance daily. The most prevalent reason for stopping drug use was personal decision 54.55%, while the least proportion was other reason 9.09%; Family and religious leaders had equal influence (45.45%) in the stoppage of drug/substance use by students.

Conclusion: The results of the study showed that the most prevalent reason for stopping drug use was personal decision 54.55%, Family and religious leaders (45.45%) were the major contributing factors and had equal influence in the stoppage of drug/substance use by students.

Open Access Original Research Article

Effect of Balanites aegyptiaca (L.) Del.) Seed Oil on Liver and Kidney Biomakers of Albino Rat

Jude Nwaogu, Isah Musa Fakai, Ibrahim Abdullahi

Journal of Advances in Medicine and Medical Research, Page 184-191
DOI: 10.9734/jammr/2021/v33i1731043

Vegetable oil has been used for cocking and ethnomedicinal purpose in developing countries. The aim of this research was to determine the toxicological effect of Balanites aegytiaca seed oil in albino rats. Acute and sub chronic toxicological evaluations were carried out on albino rats. The albino rats were divided into six experimental groups (n = 6 albino rats/ group). Five different doses of Balanites aegytiaca seed oil; 1000mg/kg, 2000mg/kg, 3000mg/kg, 4000mg/kg and 5000mg/kg were administered orally (gavage) to groups 2 – 6 respectively, once per day for 28 consecutive days. While control group received saline with Tween® 80 2%. Standard laboratory methods were used to assess liver and kidney functions indices. The acute toxicity screening revealed that the Balanite aegyptiaca seed oil (BASO) was non-toxic with LD 50 above 5000mg/kg. The liver function test parameters revealed non-significant (p>0.05) difference in serum AST and ALT activities between control group and treated groups. However, there is significant (p<0.05) increased of serum ALP activity in treated groups when compared to normal control group. Serum albumin concentration significantly (p<0.05) decreased in treated groups when compared to normal control group.  No significant difference (P>0.05) in the concentration of total protein, total and direct bilirubin observed in treated groups when compared to normal control group. While kidney function test parameters showed alterations in serum creatinine and Potassium concentrations in treated groups compared to normal control group. Oral administration of B. aegyptiaca seed oil for 21 days did not displayed signs organs damage. The results suggest that prolonged consumption of Balanites aegytiaca seed oil could not cause adverse effects on the liver and kidney organs.

Open Access Original Research Article

Magnetic Resonance Imaging with Diffusion Tractography in Assessment of Cerebral Lesions Affecting the Optic Radiations

Nayera Mohamed El-Ganainy, Samah Ahmed Radwan, Ehab Mohamed El-Gamal, Mohamed Fouad Sherif

Journal of Advances in Medicine and Medical Research, Page 192-201
DOI: 10.9734/jammr/2021/v33i1731044

Background: The combination of Functional magnetic resonance imaging with Diffusion Tensor Imaging has proven scientific and clinical relevance. By measuring the directed provides complementary information on white matter architecture, i.e., on the course and integrity of functionally important white matter tracts. In the diffusion of protons along myelinated fibers, Diffusion Tensor neuroimaging research is mainly applied to study the human brain's structural connectivity, whereas diffusion tensor tractography is often also employed for clinical applications. Diffusion Tensor Imaging measurements can be obtained together with Functional magnetic resonance imaging in the same scanning session, which gives an even more complete picture of each patient's brain. This study aimed to assess cerebral lesions affecting optic radiations by magnetic resonance imaging with diffusion tensor imaging tractography.

Methods: Our prospective study was conducted on 30 cases ages ranged from 17-83 years, 10 of them were normal and considered as the control group and 20 patients were presented with clinical neurological symptoms and signs associated with visual abnormalities.

Results: There is a significant difference between the Fractional anisotropy difference and difference ratio between the two groups with a p-value of 0.016 and 0.017 respectively. There was a strong significant positive correlation between Fractional anisotropy difference ratio (%) and tractography; r = 0.716 (95% confidence interval: 0.470 - 0.858) and p-value <0.001. We correlated the pathological types with different patterns of tractography. optic radiations fiber tracts were displaced in 83.3% of benign tumors and infiltrated in 16.3%. while in malignant tumors optic radiations fiber tracts were displaced in 75%, infiltrated in 12.5%, and disrupted in 25%. There is no "gold standard" for in vivo tractography. Diffusion Tensor Imaging is the only method that permits the calculation and visualization of fiber tracts trajectories in vivo.

Conclusions: Diffusion Tensor Imaging tractography is clinically feasible and provides useful information regarding the site of optic radiations and their affection by different brain lesions also, surgical strategy for lesions located in eloquent visual areas. Also, there was a strong significant positive correlation between Fractional anisotropy difference ratio (%) and tractography distribution. Also, probabilistic multifiber tractography applied to diffusion Magnetic resonance imaging data acquired at 3T may be better as it can cope with crossing and kissing fibers than deterministic models because it allows many more possible local pathway orientations for each Diffusion Tensor Imaging sample point.

Open Access Original Research Article

Prevalence, Awareness and Risk Factors of Hypertension among Public Sector Workers Aged 40 Years and above in the Tamale Metropolis of Ghana

Mishio Bawa Elijah, Mensah-Onumah Deborah, Julius Tieroyaare Dongdem, Cletus Adiyaga Wezena

Journal of Advances in Medicine and Medical Research, Page 202-213
DOI: 10.9734/jammr/2021/v33i1731045

Aim: To determine the prevalence, awareness and risk factors associated with hypertension among adults.

Study Design: Cross-sectional study.

Place and Duration of Study: Tamale Metropolis from January to March 2020.

Methodology: 200 adults (101 men and 99 females) aged 40 years and above were recruited. Socio-demographic characteristics, anthropometric and blood pressure data of participants collected through face-to-face administered questionnaire and physical measurements were analyzed for prevalence, knowledge and awareness of hypertension. Binary and multivariate logistic regression was used to estimate the odds of association of risk factors with hypertension.

Results: Overall age-standardized prevalence of hypertension was 46.00% (49.50% in males, 42.42% in females). The prevalence of both systolic and diastolic hypertension was higher in males than in females. 49.10% of hypertensive participants were unaware of their status at the time of this study and 83.3% of the hypertensive participants who were aware of their status were diagnosed incidentally. Multivariate logistic regression analysis revealed a significant positive association of being male [AOR = 2.39, (95% CI: 1.08–5.30)], aged between 50 – 65 years [AOR = 2.03, (95% CI: 1.03–4.01)], and being obese [AOR = 3.64, (95% CI: 1.43–9.29)] with hypertension. Being widowed [AOR = 0.06, (95% CI: 0.01–0.66)] was negatively associated with hypertension. Only obesity [AOR = 2.81, (95% CI: 1.29–6.14)] was independently associated with hypertension.

Conclusion: Hypertension affects one in every two adults aged 40 years and above in the Tamale Metropolis of Ghana. Awareness of adult hypertension status in the Metropolis is very low with the most diagnoses of the disease occurring accidentally. Obesity, advancing age, being male and being widowed are risk factors associated with hypertension. The study suggests workplace BP screening and a scale-up of awareness campaigns in the Metropolis to curb the incidence of the disease and control associated risk factors.

Open Access Original Research Article

The Effect of Irrigation to the Amount of Bacterial Colony Formation in Open Fracture

Udi Heru Nefihancoro, Muhammad Fariza Audi Putra

Journal of Advances in Medicine and Medical Research, Page 214-220
DOI: 10.9734/jammr/2021/v33i1731046

Aims: To determine the effectiveness of 3, 6, and 9 liters of physiological saline for                   wound irrigation in grade II open fracture at lower extremity in reducing the number of bacterial colonies

Study Design:  This observational study determined the quantity of physiological saline for wound irrigation in grade II open fracture at lower extremity which is effective in reducing the number of bacterial colonies.

Place of Study: Moewardi Hospital Emergency Room and the Microbiology Laboratory of the Faculty of Medicine, Universitas Sebelas Maret.

Methodology: 16 patients with grade II open fracture at lower extremity who came and received treatment was included. Patients with grade II long bone open fracture less than six hours, patients with multiple open fractures of the long bones taken only in one place, patients who had not received medical treatment since the incident were included. Patients suffering from previous bone and/or soft tissue infections at the fracture site and suffering from multiple trauma who should receive immediate life-saving measures were included.

Results: There were 12 patients who met criteria inclusion. After 3 L irrigation, there was a decrease in the amount of bacterial colony, same as 6 L irrigation, while there was no increase in the number of bacterial colonies in 9 L irrigation. There were significant differences in 3L, 6L, 9L irrigations (p = 0.001), but the most effective irrigation fluid was in 9 liters compared with 6 liters (p <0.05).

Conclusion: Wound irrigation with 3, 6, and 9 liters of normal saline will significantly reduce the number of bacteria. However, irrigation with 9 liters of normal saline dilution in grade II open fracture at the lower extremity is the most effective.

Open Access Original Research Article

Serum Progesterone Level at the Day Prior to Frozen Thawed Embryo Transfer and Pregnancy Rate

Merihan Mohamed Elewa, Ayman Abdelaziz Eldorf, Shahinaz Hamdy Elshorbagy, Manal Mostafa Abdallah

Journal of Advances in Medicine and Medical Research, Page 221-231
DOI: 10.9734/jammr/2021/v33i1731047

Background: Cryopreservation's success rate varies depending on woman age, as low as 14.8% (if eggs were extracted from 40-year-old women), and as high as 31.5% with 25-year-old women. The goal of the research is to improve laboratory methods for freezing-thawing embryos, leading to elevated embryo survival rate. Yet, in hormonal replacement therapy frozen-thawed embryo transfer (HRT-FET) cycles, effective endometrial preparation before embryo transfer attracted less focus. The present research’s aim is to see whether there's a link between blood progesterone levels and pregnancy rates the day before frozen-thawed embryo transfer.

Methods: This prospective observational research has investigated 120 patients of frozen-thawed embryo transfer cycle treatment, only 100 individuals subdivided to 2 groups for serum level of progesterone one day before frozen-thawed embryo transfer. The subjects visited both the Obstetrical and Gynecological Department of Tanta University as well as private centers between May 2020 and January 2021.

Results: We discovered no correlation between maternal age with pregnancy test results. Yet, our study discovered highly significant variation among both groups regarding endometrial thickness one day preceding embryo transfer, and regarding pregnancy rate (p<0.05).

Conclusion: The serum progesterone hormone preceding frozen embryo transfer has significant and direct relation and impact upon pregnancy rates. The present research detected low serum progesterone less than 10 nanograms/ml in the day before frozen-thawed embryo transfer in HRT-FET cycles significantly decreased probability of ongoing pregnancy post frozen-thawed embryo transfer.

Open Access Review Article

Relationship between Sonographic Umbilical cord Diameter and Gestational Age in Third Trimester of Pregnancy

Sara Essam ALdabouly, Mohamed Mohsen El Namori, Mona Khaled Omar, Essmat Hamdy AboZeid

Journal of Advances in Medicine and Medical Research, Page 20-27
DOI: 10.9734/jammr/2021/v33i1731024

Background: Throughout the fourth week of embryonic development the umbilical cord (UC) is formed, which corresponds to the fifth to the twelfth weeks of gestation. Fetuses with intrauterine growth restriction (IUGR) have leaner UCs than fetuses of appropriate gestational age do, and the caliber of the umbilical vein decreases significantly, resulting in a worsening of the Doppler parameters of the umbilical artery in the mother. The goal of this study was to evaluate the significance of sonographic UC diameter in determining gestational age in third trimester in pregnant women.

Methods: We conducted a comparative cross-sectional research on 300 pregnant women aged range between (20-35) years, singleton gestation, gestational age (3rd) trimester estimated from antenatal mothers last menstrual period (LMP), viable fetus, presenting to obstetrics and gynecology department at Tanta university hospital.

Results: Highly statistically significant positive correlation between UC diameter and gestational age, BPD, FL, AC, AFI, and estimated fetal weight was found. The increase in UC diameter was positively and significantly correlated with the increase in gestational age and estimated fetal weight, indicating that those who have prolonged gestational age and estimated fetal weight are more likely to have wider UC diameter.

Conclusions: The UC diameter (UCD) has the potential to be a valuable indicator of fetal growth, well-being, and perinatal outcome.

Sonographic measurement of UC diameter could be an efficient method of measuring fetal growth and predicting gestational age (GA), particularly between 28-40 weeks GA. It is possible that abnormal UC diameter can be a strong indicator to identify antenatal mothers at risk for IUFD and poor fetal outcomes.